Novel Approach to Intradialytic Progressive Resistance Exercise Training.

Physical activity levels are typically undesirably low in chronic kidney disease patients, especially in those undergoing haemodialysis, and particularly on dialysis days. Intradialytic exercise programmes could be a solution to this issue and have been reported to be safe and relatively easily implemented in dialysis clinics. Nevertheless, such implementation has been failing in part due to barriers such as the lack of funding, qualified personnel, equipment, and patient motivation. Intradialytic aerobic exercise has been the most used type of intervention in dialysis clinics. However, resistance exercise may be superior in eliciting potential benefits on indicators of muscle strength and mass. Yet, few intradialytic exercise programmes have focused on this type of intervention, and the ones which have report inconsistent benefits, diverging on prescribed exercise intensity, absent or subjective load progression, equipment availability, or exercise supervision. Commonly, intradialytic resistance exercise interventions use free weights, ankle cuffs, or elastic bands which hinder load progression and exercise intensity monitoring. Here, we introduce a recently developed intradialytic resistance exercise device and propose an accompanying innovative resistance exercise training protocol which aims to improve the quality of resistance exercise interventions within dialysis treatment sessions.

Regular voluntary running has favorable histological effects on doxorubicin-induced kidney toxicity in Wistar rats.

Knowing the therapeutic effects of regular physical exercise on kidney toxicity induced by a single dose of doxorubicin (DOX) in animal models, the aim of this study is to verify the effectiveness of regular voluntary running on kidney histology after a prolonged DOX administration, mimicking a chemotherapy protocol. Thirty-four male Wistar rats were randomly divided into two clusters: DOX (n = 17) and SSS (sterile saline solution, n = 17), receiving a weekly intraperitoneal injection of DOX (2 mg/kg) or vehicle for 7 weeks, respectively. Two weeks after the last injection, five animals from each cluster (SSSG, n = 5; DOXG, n = 5) were euthanized, while the remaining ones were divided into sedentary (DOXsed, n = 6; SSSsed, n = 6) and active subgroups (DOXact, n = 6; SSSact, n = 6). Active animals were placed individually in cages with a running wheel for regular voluntary activity. After 2 months, the animals were euthanized and kidneys were histologically examined. Compared to SSSG, kidneys from DOXG revealed higher levels of damage, more collagen content and thickening of Bowman's capsule (p < .05). The levels of damage and thickness of Bowman's capsule increased in DOXsed as compared to DOXG (p < .05). Compared to DOXsed, the DOXact presented an overall improvement in kidney structure (p < .05), with a decrease in collagen content and of the thickness of Bowman's capsule. The results allow concluding that regular voluntary running attenuate the long-term harmful effects on kidney structure induced by a prolonged DOX treatment. These results, supporting the potential benefit of physical activity in patients under DOX treatment, need to be tested in humans.

[Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review]. / Eficácia da heparina e soro fisiológico para manter a permeabilidade dos cateteres venosos centrais: revisão sistemática.

OBJECTIVE: Determining which is the most effective solution (heparin flush compared to 0.9% saline flush) for reducing the risk of occlusions in central venous catheters (CVC) in adults. METHOD: The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS: Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0.68, 95% CI=0.41-1.10; p=0.12). Analysis by subgroups showed that there was no difference in fully deployed CVC (RR=1.09, CI 95%=0.53-2.22; p=0.82); Multi-Lumen CVC showed beneficial effects in the heparin group (RR=0.53, CI 95%=0.29-0.95; p=0.03); in Double-Lumen CVC for hemodialysis (RR=1.18, CI 95%=0.08-17.82; p=0.90) and Peripherally inserted CVC (RR=0.14, CI 95%=0.01-2.60; p=0.19) also showed no difference. CONCLUSION: Saline solution is sufficient for maintaining patency of the central venous catheter, preventing the risks associated with heparin administration.

The effect of cognitive stimulation on nursing home elders: a randomized controlled trial.

PURPOSE: This paper describes the effectiveness of cognitive stimulation therapy (CST) on cognition and depressive symptoms in older adults in nursing homes (NHs). DESIGN: A randomized controlled trial, carried out from 2012 to 2013, included 56 residents from four NHs, 36 women and 20 men (randomized into experimental and control groups). Eight participants dropped out. METHODS: Participants of the experimental group underwent 14 CST sessions (7 weeks) in groups of six to eight older adults, and participants of the control group received usual care. The Montreal Cognitive Assessment, the Geriatric Depression Scale-15, and the Barthel Index of activities of daily living (ADLs) were administered at baseline and postintervention. FINDINGS: Repeated measures revealed that CST increased cognition (F = 8.581; p = .005; partial η squared = 0.157; power = 0.82). There were no statistically significant differences in depressive symptoms (F = 1.090; p = .302). Baseline level of ADLs did not affect the outcomes. CONCLUSIONS: CST had significantly improved cognition, explaining the 15.7% variability, but there was no statistical evidence of its effectiveness on depressive symptoms. This improvement was not affected by the baseline level of dependence-independence in ADLs. CLINICAL RELEVANCE: CST offers a range of activities, providing general stimulation for thinking, concentration, and memory, usually in a social setting. These results will support implementation of CST in NHs. In addition to the impact on elderly independence and autonomy, CST may also have an economic impact by reducing the direct costs of the impact of elders' cognitive frailty.

Administration of chemotherapy in patients admitted to a haematology service: a best practice implementation project.

OBJECTIVES: To promote evidence-based practices related to the prevention of adverse events associated with medication administration (only chemotherapy) in a hospital service. INTRODUCTION: The medication management process in a hospital setting is highly complex, going through multiple stages from drug selection, procurement and storage, to prescription, validation, dispensing, preparation, administration and monitoring. METHODS: An evidence implementation project based on an audit and feedback approach was conducted from December 2019 to April 2021 using the JBI Practical Application of Clinical Evidence System and Getting Research into Practice. RESULTS: The results of the baseline audit showed that the 10 audit criteria were mostly met; however, two of the criteria (criterion 6: the expiry date of medication is checked before use and criterion 7: the nurse who prepares the medication administers the medication to the patient) had low compliance (respectively, 0 and 67.9%). After identifying the barriers and implementing strategies to deal with the identified barriers, we verified a significant improvement in compliance with best practices (criterion 6 improved to 64.3% and criterion 7 to 78.6%). CONCLUSION: This implementation project was a success, achieving a great improvement of the implementation of evidence-based guidelines concerning the prevention of adverse events associated with medication administration in a hospital in central Portugal. More such projects should be planned to sustain the implementation of evidence-based methods to improve health outcomes, patient safety, costs and health systems.

Citizen involvement in scientific activities and extension of knowledge to society.

High-quality health research must involve the citizen, bringing merit, relevance, and value to research and ensuring the transfer of new knowledge or outputs to the community. This theoretical study aimed to conceptualize and discuss the role of Citizen Involvement and Extension to Society in research processes and outcomes, revealing that both concepts have different purposes. Research units and research funding agencies are promoting Citizen Involvement in all steps of the research process because it adds quality to it. Moreover, universities, research units, and researchers should extend their knowledge to society, the citizens, or the end-users as part of their social responsibility. Citizen Involvement and Extension to Society should be considered strategic areas for the development of research in general and nursing research in particular. More studies are needed to generate new knowledge and useful products to better serve the real needs of society.

Promoting evidence-based practice: training health professionals for the evidence synthesis.

OBJECTIVE: To report the experience of the Portugal Centre For Evidence Based Practice (PCEBP): a JBI Centre of Excellence in the training of health professionals, researchers, and professors in the Comprehensive Systematic Review Training Program, a course on Evidence Synthesis, specifically on Systematic Literature Reviews. METHOD: This article aims to report the experience of the Portugal Centre For Evidence Based Practice: a JBI Centre of Excellence in the implementation of the Comprehensive Systematic Review Training Program that trains health professionals, researchers, and teachers to develop Systematic Reviews, according to the JBI approach. RESULTS: By the end of 2020, 11 editions of the course had been developed with 136 participants from different educational and health institutions, from different countries. As a result of the training of these participants, 13 systematic reviews were published in JBI Evidence Synthesis and 10 reviews were published in other journals. CONCLUSION: The reported results and the students' satisfaction evaluation allow us to emphasize the relevance of the course for health professionals training on evidence synthesis.

Schizophrenia and Progressive Muscle Relaxation - A systematic review of effectiveness.

OBJECTIVE: We perform a systematically search, appraise and synthesize of the best available evidence on the effectiveness of Progressive Muscle Relaxation (PMR) in the adults with schizophrenia, in any setting, regarding anxiety, personal and social functioning, cognition, and well-being. METHOD: Major databases were searched to find both published and unpublished studies from inception until April 2017, using Schizophren* AND Relax* as keywords, and studies published in Portuguese, English, Spanish, Italian, French were considered for inclusion in this review. Methodological quality was assessed by two independent reviewers using the Critical Appraisal Checklist for Randomized Controlled Trials from the Joanna Briggs Institute. RESULTS: From a total of 1172 studies, five studies, involving 216 adults with schizophrenia, met the inclusion criteria for this systematic review after assessment of their methodological quality. These studies reported benefits in experimental group participants after PMR intervention on anxiety (assessed with State anxiety inventory, Beck Anxiety Inventory and Spielberger Trait Anxiety Inventory), well-being (assessed with Subjective Exercise Experiences Scale) and personal and social functioning (assessed with Sheehan Disability Scale and Therapist Rating Scale). CONCLUSIONS: Evidence suggests that PMR was effective in adults diagnosed with schizophrenia, except in one study where was only effective when combined with education. Thus, PMR may be useful to decrease state anxiety, improve well-being and social functioning in adults diagnosed with schizophrenia. However, due to the diversity of clinical intervention designs of PMR (different number and length of sessions) and outcome assessment scales, no strong evidence was found in this systematic review.

[Effect of cognitive stimulation in elderly community]. / Efectos de la estimulación cognitiva sobre las personas mayores en el ámbito comunitario.

OBJECTIVE: To demonstrate that the implementation of the Cognitive Stimulation (CS) program 'Making a Difference' (MD) improves cognition and depressive symptoms in retired community elders. METHOD: This was a multicenter quasi-experimental study of 45 community dwelling elders (38 women and 7 men), with a mean age of 75.29, from 3 day-care centers in rural, semi-rural and urban environments in the central region of Portugal. Participants attended 14 sessions twice a week over seven weeks. The Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale (GDS-15) were administered at the following three time points: baseline, post-test, and follow-up. RESULTS: From baseline to post-test, there is a statistically significant difference in depressive symptoms (F=7.494; P=.010) explaining 21% of the variance (partial eta squared [ηp(2)]=.21), power=.75, but there is no statistically significant difference in cognition. From post-test to follow-up, there is no difference in both cognition and depression outcomes. CONCLUSIONS: Our results showed improvement in elders' depressive symptoms after a seven weeks intervention program but it did not have a protective effect after the three months follow-up. No evidence was found for its efficacy in improving cognition. Cognitive stimulation may be a useful in preventing elder's depressive symptoms when included in their health promotion care plan.

Citizen involvement in scientific activities and extension of knowledge to society / Envolvimento do cidadão nas atividades científicas e extensão do conhecimento à sociedade / Intervención del ciudadano en actividades científicas y extensión del conocimiento a la sociedad

ABSTRACT High-quality health research must involve the citizen, bringing merit, relevance, and value to research and ensuring the transfer of new knowledge or outputs to the community. This theoretical study aimed to conceptualize and discuss the role of Citizen Involvement and Extension to Society in research processes and outcomes, revealing that both concepts have different purposes. Research units and research funding agencies are promoting Citizen Involvement in all steps of the research process because it adds quality to it. Moreover, universities, research units, and researchers should extend their knowledge to society, the citizens, or the end-users as part of their social responsibility. Citizen Involvement and Extension to Society should be considered strategic areas for the development of research in general and nursing research in particular. More studies are needed to generate new knowledge and useful products to better serve the real needs of society.

RESUMO Investigação de alta qualidade em saúde deve envolver o cidadão, pois promove mérito, relevância e valor às atividades de investigação e assegura a transferência de novos conhecimentos ou resultados para a comunidade. Este estudo teórico teve como objetivo conceituar e discutir o Envolvimento do Cidadão nos processos de investigação e Extensão à Sociedade dos seus resultados, revelando que ambos os conceitos têm finalidades distintas. Unidades de investigação e agências de financiamento incentivam o Envolvimento do Cidadão em todas as etapas do processo de pesquisa, acreditando-se que o mesmo adiciona qualidade aos processos de pesquisa. Por outro lado, universidades, unidades de investigação e pesquisadores têm a responsabilidade social de estenderem seus conhecimentos à sociedade, aos cidadãos ou aos usuários finais. O Envolvimento do Cidadão e a Extensão à Sociedade devem ser considerados áreas estratégicas para o desenvolvimento da pesquisa em geral e da enfermagem em particular. Estudos que envolvam o cidadão são necessários para gerar novos conhecimentos e produtos úteis para melhor atender às reais necessidades da sociedade.

RESUMEN La investigación en salud de alta calidad debe involucrar el ciudadano, aportar mérito, relevancia y valor a la investigación y garantizar la transferencia de nuevos conocimientos o resultados para la comunidad. Este estudio teórico tuvo como objetivo conceptuar y debatir el rol de la Intervención Ciudadana y de la Extensión a la Sociedad en los procesos y conclusiones de investigación, revelando que ambos los conceptos tienen finalidades distintas. Unidades de investigación y agencias de fomento a la investigación han promovido la Intervención del Ciudadano en todas las etapas del proceso de investigación una vez que ella aporta calidad a los mismos. Por otro lado, universidades, unidades de investigación e investigadores deben "extender" sus conocimientos a la sociedad, a los ciudadanos o a los usuarios finales como parte de su responsabilidad social. La Intervención del Ciudadano y la Extensión a la Sociedad deben ser consideradas áreas estratégicas para el desarrollo de la investigación en enfermería, específicamente. Más estudios son necesarios para generar nuevos conocimientos y productos útiles con la finalidad de atender mejor a las necesidades de la sociedad.

Promoting evidence-based practice: training health professionals for the evidence synthesis / Promoción de la práctica basada en la evidencia: formación de profesionales de salud para la síntesis de la evidencia / Promoção da prática baseada em evidências: formação de profissionais de saúde para a síntese da evidência

ABSTRACT Objective: To report the experience of the Portugal Centre For Evidence Based Practice (PCEBP): a JBI Centre of Excellence in the training of health professionals, researchers, and professors in the Comprehensive Systematic Review Training Program, a course on Evidence Synthesis, specifically on Systematic Literature Reviews. Method: This article aims to report the experience of the Portugal Centre For Evidence Based Practice: a JBI Centre of Excellence in the implementation of the Comprehensive Systematic Review Training Program that trains health professionals, researchers, and teachers to develop Systematic Reviews, according to the JBI approach. Results: By the end of 2020, 11 editions of the course had been developed with 136 participants from different educational and health institutions, from different countries. As a result of the training of these participants, 13 systematic reviews were published in JBI Evidence Synthesis and 10 reviews were published in other journals. Conclusion: The reported results and the students' satisfaction evaluation allow us to emphasize the relevance of the course for health professionals training on evidence synthesis.

RESUMEN Objetivo: Relatar la experiencia del Portugal Centre For Evidence Based Practice (PCEBP): a JBI Centre of Excellence en la formación de profesionales de salud, investigadores y docentes en el Comprehensive Systematic Review Training Program, un curso en Síntesis de la Evidencia, específicamente sobre Revisiones Sistemáticas de la Literatura. Método: Este artículo tiene como objetivo relatar la experiencia del Portugal Centre For Evidence Based Practice: a JBI Centre of Excellence en la implementación del Comprehensive Systematic Review Training Program que capacita profesionales de salud, investigadores y docentes para el desarrollo de Revisiones Sistemáticas, según la metodología del JBI. Resultados: Hasta el final del año 2020, fueron desarrolladas 11 ediciones del curso sumando en total 136 participantes provenientes de diferentes instituciones de enseñanza y de salud, de distintos países. Resultó tras la formación de estos participantes que, 13 revisiones sistemáticas fueron publicadas en la JBI Evidence Synthesis y 10 revisiones fueron publicadas en otras revistas. Conclusión: Los referidos resultados y la evaluación de satisfacción de los egresos nos permiten resaltar la pertinencia del curso para la formación en síntesis de evidencia de profesionales de salud.

RESUMO Objetivo: Relatar a experiência do Portugal Centre For Evidence Based Practice (PCEBP): a JBI Centre of Excellence na formação de profissionais de saúde, pesquisadores e docentes no Comprehensive Systematic Review Training Program, um curso em Síntese da Evidência, especificamente sobre Revisões Sistemáticas da Literatura. Método: Este artigo tem como objetivo relatar a experiência do Portugal Centre For Evidence Based Practice: a JBI Centre of Excellence na implementação do Comprehensive Systematic Review Training Program que capacita profissionais de saúde, pesquisadores e docentes para o desenvolvimento de Revisões Sistemáticas, segundo a abordagem do JBI. Resultados: Até o final do ano 2020, foram desenvolvidas 11 edições do curso com um total de 136 participantes provenientes de diferentes instituições de ensino e de saúde, de diferentes países. Resultante da formação destes participantes, 13 revisões sistemáticas foram publicadas na JBI Evidence Synthesis e 10 revisões foram publicadas noutras revistas. Conclusão: Os referidos resultados e a avaliação de satisfação dos formados nos permitem realçar a pertinência do curso para a formação em síntese de evidência de profissionais de saúde.

Translation, cross-cultural adaptation and preliminary validation of instruments for Portuguese nursing educators regarding evidence based practice / Traducción, adaptación cultural y validación preliminar de instrumentos para educadores de enfermería portugueses sobre práctica basada en la evidencia / Tradução, adaptação transcultural e validação preliminar de instrumentos para docentes de enfermagem portugueses sobre prática baseada na evidência

Abstract The objective of this study is to translate and culturally adapt to European Portuguese "EBP Beliefs Scale for Educators" (EBPB-E), "EBP Implementation Scale for Educators" (EBPI-E) and "Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey" for Educators (OCRSIEP-E); and to provide preliminary validation data. The study was carried out in two phases: translation and transcultural adaptation; and preliminary validation in nursing educators of nine nursing schools in Portugal. Pre-final versions of the instruments were considered easy to understand. But, the participants suggested including the possibility of "I don't know" response and increasing the recall period in the EBPI-E. 68 educators participated in phase II. The α for EBPB-E, EBPI-E and OCRSIEP-E was 0.88, 0.95 and 0.94 and the corrected element-total correlations between the items and the total score ranged from 0.20 to 0.75, 0.59 to 0.84 and -0.06 to 0.78, respectively. Preliminary findings showed a strong internal consistency. It is concluded that other validation studies with more robust samples are needed to prove the reliability and validity of the instruments.

Resumen El objetivo de este estudio es traducir y adaptar culturalmente al portugués europeo "EBP Beliefs Scale for Educators" (EBPB-E), "EBP Implementation Scale for Educators" (EBPI-E) y "Organizational Culture & Readiness for School-wide Integration of Evidence-based Practice Survey" para docentes (OCRSIEP-E); y presentar datos preliminares de validación. El estudio se realizó en dos fases: traducción y adaptación transcultural; y validación preliminar en docentes de enfermería de nueve escuelas de enfermería de Portugal. Las versiones prefínales de los instrumentos se consideraron de fácil comprensión. Pero, los participantes sugirieron incluir la posibilidad de respuesta "no sé" y aumentar el período de recuerdo en el EBPI-E. 68 educadores participaron en la fase II. El α para EBPB-E, EBPI-E y OCRSIEP-E fue 0,88, 0,95 y 0,94 y las correlaciones elemento-total corregidas entre los ítems y la puntuación total variaron de 0,20 a 0,75, 0,59 a 0,84 y -0,06 a 0,78, respectivamente. Los hallazgos preliminares mostraron una fuerte consistencia interna. Se concluye que se necesitan otros estudios de validación con muestras más robustas para probar la confiabilidad y la validez de los instrumentos.

Resumo O objetivo deste estudo é traduzir e adaptar culturalmente o português europeu "Escala de Crenças EBP para Educadores" (EBPB-E), "Escala de Implementação EBP para Educadores" (EBPI-E) e "Cultura Organizacional e Prontidão para Integração em toda a Escola de Pesquisa Prática Baseada em Evidências" para profesores (OCRSIEP-E); e fornecer dados preliminares de validação. O estudo foi realizado em duas fases: tradução e adaptação transcultural; e validação preliminar em professores de enfermagem de nove escolas de enfermagem em Portugal. As versões prefinais dos instrumentos foram consideradas fáceis de entender. Porém, os participantes sugeriram incluir a possibilidade de resposta "não sei" e aumentar o período de recall no EBPI-E. 68 educadores participaram da fase II. O α para EBPB-E, EBPI-E e OCRSIEP-E foi de 0,88, 0,95 e 0,94 e as correlações elementototal corrigidas entre os itens e a pontuação total variaram de 0,20 a 0,75, 0,59 a 0,84 e -0,06 a 0,78, respetivamente. Os resultados preliminares mostraram uma forte consistência interna. Conclui-se que outros estudos de validação com amostras mais robustas são necessários para comprovar a confiabilidade e validade dos instrumentos.

Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review / Efectividad de la heparina y el suero fisiológico para mantener la permeabilidad de los catéteres venosos centrales: revisión sistemática / Eficácia da heparina e soro fisiológico para manter a permeabilidade dos cateteres venosos centrais: revisão sistemática

Abstract OBJECTIVE Determining which is the most effective solution (heparin flush compared to 0.9% saline flush) for reducing the risk of occlusions in central venous catheters (CVC) in adults. METHOD The systematic review followed the principles proposed by the Cochrane Handbook; critical analysis, extraction and synthesis of data were performed by two independent researchers; statistical analysis was performed using the RevMan program 5.2.8. RESULTS Eight randomized controlled trials and one cohort study were included and the results of the meta-analysis showed no difference (RR=0.68, 95% CI=0.41-1.10; p=0.12). Analysis by subgroups showed that there was no difference in fully deployed CVC (RR=1.09, CI 95%=0.53-2.22;p=0.82); Multi-Lumen CVC showed beneficial effects in the heparin group (RR=0.53, CI 95%=0.29-0.95; p=0.03); in Double-Lumen CVC for hemodialysis (RR=1.18, CI 95%=0.08-17.82;p=0.90) and Peripherally inserted CVC (RR=0.14, CI 95%=0.01-2.60; p=0.19) also showed no difference. CONCLUSION Saline solution is sufficient for maintaining patency of the central venous catheter, preventing the risks associated with heparin administration.

Resumen OBJETIVO Determinar cuál es la solución (flush con heparina comparado con el de suero fisiológico al 0,9%) más eficaz en la reducción del riesgo de oclusiones de catéteres venosos centrales (CVC) en adultos. MÉTODO La revisión sistemática siguió los principios propuestos por elCochrane Handbook; el análisis crítico, la extracción y la síntesis de los datos fueron realizados por dos investigadores, aisladamente; y el análisis estadístico fue llevado a cabo con recurso al programa RevMan 5.2.8. RESULTADOS Se incluyeron ocho estudios randomizados controlados y un estudio de cohorte, y los resultados del metaanálisis muestran no existir diferencias (RR=0.68, IC 95%=0.41-1.10; p=0.12). El análisis por subgrupos muestra que en los CVC totalmente implantados no se verificaron diferencias (RR=1.09, IC 95%=0.53-2.22; p=0.82); en los CVC con varios lúmenes existió un efecto benéfico en el grupo de la heparina (RR=0.53, IC 95%=0.29-0.95; p=0.03); en los CVC de doble lumen para hemodiálisis (RR=1.18, IC 95%=0.08-17.82; p=0.90) y en los CVC de inserción periférica (RR=0.14, IC 95%=0.01-2.60;p=0.19) tampoco se verificaron diferencias. CONCLUSIÓN El suero fisiológico es suficiente para mantener la permeabilidad de los catéteres venosos centrales, previniendo los riesgos asociados con la administración de la heparina.

Resumo OBJETIVO Determinar qual é a solução (flush heparina comparado com oflushde soro fisiológico 0.9%) mais eficaz na redução do risco de oclusões de cateteres venosos centrais (CVC) em adultos. MÉTODO A revisão sistemática seguiu os princípios propostos pelo Cochrane Handbook; a análise crítica, a extração e a síntese dos dados foram realizadas por dois investigadores, isoladamente; e a análise estatística efetuada com recurso ao programa RevMan 5.2.8. RESULTADOS Foram incluídos oito estudos randomizados controlados e um estudo de coorte e os resultados da meta-análise mostram não existir diferenças (RR=0.68, IC 95%=0.41-1.10; p=0.12). A análise por subgrupos mostra que nos CVC totalmente implantados não se verificaram diferenças (RR=1.09, IC 95%=0.53-2.22; p=0.82); nos CVC com vários lúmens existiu um efeito benéfico no grupo da heparina (RR=0.53, IC 95%=0.29-0.95;p=0.03); nos CVC de duplo lúmen para hemodiálise (RR=1.18, IC 95%=0.08-17.82; p=0.90) e nos CVC de inserção periférica (RR=0.14, IC 95%=0.01-2.60; p=0.19) também não se verificaram diferenças. CONCLUSÃO O soro fisiológico é suficiente para manter a permeabilidade dos cateteres venosos centrais, prevenindo os riscos associados à administração da heparina.

Violência em ambientes recreativos noturnos de jovens portugueses: relação com consumo de álcool e drogas / Violence at night time recreational environment among young portuguese people - the relation with alcohol consumption and drug use / La violencia entre los jóvenes portugueses en ambientes recreativos nocturnos. Relación con el consumo de alcohol y drogas

CONTEXTO: Os ambientes recreativos noturnos têm conquistado, na atualidade, um protagonismo crescente na vida juvenil, determinando estilos de vida, normalizando o consumo recreativo de álcool/drogas e a adoção de outros comportamentos de risco. OBJETIVO: Delinear o perfil dos jovens portugueses que frequentam ambientes recreativos noturnos e determinar a prevalência de comportamentos violentos relacionados com variáveis sociodemográficas, consumo de álcool e drogas e envolvimento nas atividades recreativas noturnas. METODOLOGIA: Entrevista de 1346 jovens (idade média = 22,49 anos) frequentadores de ambientes recreativos noturnos, de ambos os sexos, em 10 cidades portuguesas, utilizando uma variação da Respondent-driven sampling, entre 2007 e 2010. RESULTADOS: Verificou-se que existe uma relação positiva entre comportamentos violentos, consumo de álcool e drogas e a participação dos jovens na vida recreativa noturna. Conclusões: Sugere-se que a implementação de medidas preventivas neste contexto atenda às características dos jovens apresentadas neste estudo como preditoras de comportamentos violentos.

BACKGROUND: The night time recreational environments have currently gained an important role in the juvenile life, determining life styles, standardizing the recreational consumption of alcohol and drugs, as well as the adoption of associated risk behaviours. OBJECTIVES: To characterize the profile of Portuguese young people attending nightlife recreational environments and determine the prevalence of violent behaviors based on sociodemographic variables, alcohol consumption and drug use, and engagement in recreational nightlife activities. METHODOLOGY: Interview applied to 1346 young people who used to go to nighttime recreational environments, both sexes, into 10 Portuguese cities, between 2007 and 2010, using the respondent-driven sampling. RESULTS: It was notified the existence of a positive relation among violent behaviours, alcohol consumption and drug use, and young people's engagement in recreational nightlife.Conclusions: It is suggested that preventive actions should be implemented in recreational environments, to meet the characteristics of young people presented in this study as predictors of violent behaviors.

ANTECEDENTES: Los entornos recreativos nocturnos han conquistado, en la actualidad, una importancia creciente en la vida juvenil, determinando los estilos de vida, normalizando el consumo recreativo de alcohol/drogas y la practica de otros comportamientos de riesgo. OBJETIVO: Delinear el perfil de los jóvenes portugueses que frequentan ambientes recreativos nocturnos y determinar la prevalencia de conductas violentas en relación con variables sociodemográficas, consumo de alcohol y drogas y envolvimiento en las actividades recreacionales nocturnas. METODOLOGÍA: Entrevista con 1346 jóvenes (edad media = 22,49 años) frecuentadores de ambientes recreativos nocturnos, de ambos sexos, en 10 ciudades portuguesas, mediante el uso de una variación de la Respondent-Driven Sampling entre 2007 y 2010.Resultados: Se constató una relación positiva entre comportamiento violento, consumo de alcohol y drogas y la participación de los jóvenes en la vida recreativa nocturna. CONCLUSIÓN: Se sugiere que la implementación de medidas preventivas en este contexto atienda a las características de los jóvenes presentados en este estudio, como predictoras de la conducta violenta.

Efectos de la estimulación cognitiva sobre las personas mayores en el ámbito comunitario / Effect of cognitive stimulation in elderly community

OBJETIVO: Demostrar que la implementación del programa de estimulación cognitiva (EC) «Making a Difference» (MD) mejora la cognición y la sintomatología depresiva en personas mayores y jubiladas que residen en el ámbito comunitario. MÉTODO: Estudio multicéntrico y cuasiexperimental efectuado sobre 45 personas mayores (38 mujeres y 7 hombres) residentes en el ámbito comunitario, con una edad media de 75,29 años, seleccionados en 3 centros de día localizados en contextos rural, semirrural y urbano, en la región central de Portugal. Los participantes asistieron a 14 sesiones bisemanales a lo largo de 7 semanas. La escala de Valoración cognitiva de Montreal (Montreal Cognitive Assessment [MoCA]) y la escala de depresión geriátrica de 15 ítems (15-item Geriatric Depression Scale [GDS-15]) se aplicaron en 3 momentos de la evolución: al inicio del estudio, al final del estudio y en el seguimiento. RESULTADOS: Entre el inicio del estudio y el final del estudio hubo una diferencia estadísticamente significativa en la sintomatología depresiva (F = 7,494; p = 0,010) explicando el 21% de la varianza (valor eta cuadrado parcial [ηp2] = 0,21), potencia = 0,75; sin embargo, no hubo una diferencia estadísticamente significativa respecto a la cognición. Entre el final del estudio y el seguimiento no hubo diferencias en los resultados correspondientes a la cognición ni a la depresión. CONCLUSIONES: Nuestros resultados demuestran una mejoría de la sintomatología depresiva de las personas mayores tras un programa de intervención de 7 semanas de duración, pero sin persistencia del efecto terapéutico a los 3 meses de seguimiento. No se ha demostrado el efecto beneficioso del programa de intervención respecto a la mejora de la cognición. La EC puede tener utilidad para prevenir la sintomatología depresiva de las personas mayores cuando se incluye en el plan de cuidados para la promoción de la salud

OBJECTIVE: To demonstrate that the implementation of the Cognitive Stimulation (CS) program 'Making a Difference' (MD) improves cognition and depressive symptoms in retired community elders. Method: This was a multicenter quasi-experimental study of 45 community dwelling elders (38 women and 7 men), with a mean age of 75.29, from 3 day-care centers in rural, semi-rural and urban environments in the central region of Portugal. Participants attended 14 sessions twice a week over seven weeks. The Montreal Cognitive Assessment (MoCA) and the Geriatric Depression Scale (GDS-15) were administered at the following three time points: baseline, post-test, and follow-up. RESULTS: From baseline to post-test, there is a statistically significant difference in depressive symptoms (F = 7.494; P = .010) explaining 21% of the variance (partial eta squared [ηp2] = .21), power = .75, but there is no statistically significant difference in cognition. From post-test to follow-up, there is no difference in both cognition and depression outcomes. CONCLUSIONS: Our results showed improvement in elders' depressive symptoms after a seven weeks intervention program but it did not have a protective effect after the three months follow-up. No evidence was found for its efficacy in improving cognition. Cognitive stimulation may be a useful in preventing elder's depressive symptoms when included in their health promotion care plan