Práticas integrativas e complementares em saúde entre estudantes universitários: motivos de uso e de não uso / Integrative and complementary health practices among university students: reasons for use or non-use

Resumo O objetivo deste estudo é compreender os motivos de uso e não uso das práticas integrativas e complementares entres estudantes universitários da área da saúde. Trata-se de uma pesquisa quanti-qualitativa, com dados coletados por meio de questionários (667) e entrevistas (34) e submetidos à análise de conteúdo. Os efeitos terapêuticos, a influência familiar e a oferta de alternativa à biomedicina foram as principais razões elencadas para o uso das práticas integrativas e complementares, ao tempo que a ausência de demanda, o desinteresse e a falta de oportunidade foram as motivações mais frequentes para o não uso. Nesse sentido, as motivações de uso enfatizam as vantagens obtidas através da interlocução com essas práticas e alguns contextos que determinam sua adoção. Em relação às motivações de não uso, destaca-se um cenário de baixa oferta e dominância da biomedicina na cultura ocidental contemporânea. Portanto, esses resultados corroboram a demanda de enfrentamento da monocultura da biomedicina, bem como a abordagem das práticas integrativas na educação superior. Desse modo, a universidade pode se construir a partir da tessitura entre diferentes culturas em saúde, com a facilitação do emprego das práticas não hegemônicas e a ampliação das bases epistêmicas de cuidado na formação e vida da comunidade acadêmica.

Abstract The objective of this study is to understand the reasons for use or non-use of the integrative and complementary practices among university health students. It is a quantitative and qualitative research, with data collected with questionnaires (667) and interviews (34), and investigated by content analysis. Therapeutic effects, family influence, and offer of alternatives to biomedicine were the main reasons for use of integrative and complementary practices, while the absence of demand, disinterest, and lack of opportunity were the most frequent barriers for use. Therefore, the motivations for use emphasize advantages obtained with these practices and some contexts that determine their adoption. Regarding the barriers for use, a scenario of low availability and dominance of biomedicine in contemporary western culture stands out. Therefore, these results corroborate the demand to confront the monoculture of biomedicine, as well as the inclusion of integrative practices in higher health education. Thus, university can be built on dialogues between different cultures in health, facilitating the use of non-hegemonic practices and expanding the epistemic bases of care in the formation and the life of the academic community.

Conversational Agents for Health and Well-being Across the Life Course: Protocol for an Evidence Map.

BACKGROUND: Conversational agents, which we defined as computer programs that are designed to simulate two-way human conversation by using language and are potentially supplemented with nonlanguage modalities, offer promising avenues for health interventions for different populations across the life course. There is a lack of open-access and user-friendly resources for identifying research trends and gaps and pinpointing expertise across international centers. OBJECTIVE: Our aim is to provide an overview of all relevant evidence on conversational agents for health and well-being across the life course. Specifically, our objectives are to identify, categorize, and synthesize-through visual formats and a searchable database-primary studies and reviews in this research field. METHODS: An evidence map was selected as the type of literature review to be conducted, as it optimally corresponded to our aim. We systematically searched 8 databases (MEDLINE; CINAHL; Web of Science; Scopus; the Cochrane, ACM, IEEE, and Joanna Briggs Institute databases; and Google Scholar). We will perform backward citation searching on all included studies. The first stage of a double-stage screening procedure, which was based on abstracts and titles only, was conducted by using predetermined eligibility criteria for primary studies and reviews. An operational screening procedure was developed for streamlined and consistent screening across the team. Double data extraction will be performed with previously piloted data collection forms. We will appraise systematic reviews by using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2. Primary studies and reviews will be assessed separately in the analysis. Data will be synthesized through descriptive statistics, bivariate statistics, and subgroup analysis (if appropriate) and through high-level maps such as scatter and bubble charts. The development of the searchable database will be informed by the research questions and data extraction forms. RESULTS: As of April 2021, the literature search in the eight databases was concluded, yielding a total of 16,351 records. The first stage of screening, which was based on abstracts and titles only, resulted in the selection of 1282 records of primary studies and 151 records of reviews. These will be subjected to second-stage screening. A glossary with operational definitions for supporting the study selection and data extraction stages was drafted. The anticipated completion date is October 2021. CONCLUSIONS: Our wider definition of a conversational agent and the broad scope of our evidence map will explicate trends and gaps in this field of research. Additionally, our evidence map and searchable database of studies will help researchers to avoid fragmented research efforts and wasteful redundancies. Finally, as part of the Harnessing the Power of Conversational e-Coaches for Health and Well-being Through Swiss-Portuguese Collaboration project, our work will also inform the development of an international taxonomy on conversational agents for health and well-being, thereby contributing to terminology standardization and categorization. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26680.

IsomiR_Window: a system for analyzing small-RNA-seq data in an integrative and user-friendly manner.

BACKGROUND: IsomiRs are miRNA variants that vary in length and/or sequence when compared to their canonical forms. These variants display differences in length and/or sequence, including additions or deletions of one or more nucleotides (nts) at the 5' and/or 3' end, internal editings or untemplated 3' end additions. Most available tools for small RNA-seq data analysis do not allow the identification of isomiRs and often require advanced knowledge of bioinformatics. To overcome this, we have developed IsomiR Window, a platform that supports the systematic identification, quantification and functional exploration of isomiR expression in small RNA-seq datasets, accessible to users with no computational skills. METHODS: IsomiR Window enables the discovery of isomiRs and identification of all annotated non-coding RNAs in RNA-seq datasets from animals and plants. It comprises two main components: the IsomiR Window pipeline for data processing; and the IsomiR Window Browser interface. It integrates over ten third-party softwares for the analysis of small-RNA-seq data and holds a new algorithm that allows the detection of all possible types of isomiRs. These include 3' and 5'end isomiRs, 3' end tailings, isomiRs with single nucleotide polymorphisms (SNPs) or potential RNA editings, as well as all possible fuzzy combinations. IsomiR Window includes all required databases for analysis and annotation, and is freely distributed as a Linux virtual machine, including all required software. RESULTS: IsomiR Window processes several datasets in an automated manner, without restrictions of input file size. It generates high quality interactive figures and tables which can be exported into different formats. The performance of isomiR detection and quantification was assessed using simulated small-RNA-seq data. For correctly mapped reads, it identified different types of isomiRs with high confidence and 100% accuracy. The analysis of a small RNA-seq data from Basal Cell Carcinomas (BCCs) using isomiR Window confirmed that miR-183-5p is up-regulated in Nodular BCCs, but revealed that this effect was predominantly due to a novel 5'end variant. This variant displays a different seed region motif and 1756 isoform-exclusive mRNA targets that are significantly associated with disease pathways, underscoring the biological relevance of isomiR-focused analysis. IsomiR Window is available at https://isomir.fc.ul.pt/ .

Usability of an Intelligent Virtual Assistant for Promoting Behavior Change and Self-Care in Older People with Type 2 Diabetes.

In the context of the VASelfCare project, we developed an application prototype of an intelligent anthropomorphic virtual assistant. Designed as a relational agent, the virtual assistant has the role of supporting older people with Type 2 Diabetes Mellitus (T2D) in medication adherence and lifestyle changes. Our paper has two goals: describing the essentials of this prototype, and reporting on usability evaluation. We describe the general architecture of the prototype, including the graphical component, and focus on its main feature: the incorporation, in the way the dialogue flows, of Behavior Change Techniques, identified through a theoretical framework, the Behaviour Change Wheel. Usability was experimentally evaluated in field tests in a purposive sample of 20 participants (11 older adults with T2D and 9 experts). The Portuguese version of the System Usability Scale was employed, supplemented with qualitative data from open questions, diaries, digital notes and telephone follow-ups. The aggregated mean SUS score was 73,75 (SD 13,31), which corresponds to a borderline rating of excellent. Textual data were content analyzed and will be prioritized to further improve usability.

Development of a Complex Intervention to Improve Adherence to Antidiabetic Medication in Older People Using an Anthropomorphic Virtual Assistant Software.

Introduction: Improving adherence to antidiabetic medication is crucial, resulting in improved health outcomes, cost reduction, and minimization of waste. A lack of underlying theory in existing interventions may explain the limited success in sustaining behavior change. This paper describes the development of a theory and evidence-based complex intervention to improve adherence to oral antidiabetics in older people via a software prototype with an anthropomorphic virtual assistant. Methods: The Behavior Change Wheel (BCW) was used to develop a theoretical understanding of the change process, corresponding to the first phase of the Medical Research Council Framework for developing and evaluating complex interventions. At the BCW core is a model of human behavior (COM-B), which posits that human behavior (B) results from the interaction between capabilities (C), opportunities (O), and motivation (M). Literature-derived medication adherence determinants were mapped onto COM-B components. Then, intervention functions (IFs) were selected employing the APEASE criteria. Finally, standardized behavior change techniques (BCTs) were chosen based on their suitability and their effectiveness on medication adherence trials. The prototype was developed for android devices; its core was implemented in Unity3D, using a female 3D virtual assistant, named Vitória. Results: Two COM-B components were identified as main targets for behavior change-psychological capability and reflective motivation; these were linked with four IFs-education, persuasion, enablement, and environmental restructuring. Eleven BCTs were, in turn, linked with the IFs. An example of a BCT is "problem solving"; it requires users to pinpoint factors influencing non-adherence and subsequently offers strategies to achieve the desired behavior. BCTs were operationalized into the dialogues with Vitória and into supplementary software features. Vitória communicates with users verbally and non-verbally, expressing emotions. Input options consist of buttons or recording values, such as medication taken. Conclusion: The present approach enabled us to derive the most appropriate BCTs for our intervention. The use of an explicit bundle of BCTs, often overlooked in interventions promoting medication adherence, is expected to maximize effectiveness and facilitates replication. The first prototype is being refined with users and health professionals' contributions. Future work includes subjecting the prototype to usability tests and a feasibility trial.

The effects of prenatal "psychological" stressor exposure on lung inflammation and hyperresponsiveness in adult rat offspring.

The aim of this study was to establish whether exposure of pregnant rats to uncontrollable (psychological) stressors might change the likelihood of their offspring to exhibit functional and histopathological abnormalities suggestive of asthma in adulthood. Pregnant rats (n = 16) underwent one of three treatments: electric shocks of a maximum duration of 10 s that could be escaped (controllable group; C) those that could not be escaped (uncontrollable group; U) or no shocks (control group; N). The offspring (n = 54) were kept in animal house under standard conditions until 3 months of age, when lung hyperresponsiveness, histopathology, immunohistochemical measurements of the cytokines interleukin (IL) 2, IL-4, IL-5, and IL-13 and actin as well as oxidative stress based on iNOS-positive cell counts and isoprostane PGF2α contents were assessed. The results showed that prenatal exposure to physical stressors (shocks) caused lung hyperresponsiveness and increased cytokine expression; exposure to uncontrollable shock (group U) had a differential effect on the expression of IL-2, IL-5, and IL-13 in inflammatory cells compared to exposure to controllable shock (group C), which characterizes the "psychological" aspect of stress. The results show that not only stress but also its uncontrollability during gestation might increase the likelihood that the offspring will exhibit functional and histopathological abnormalities suggestive of asthma. These findings strengthen the importance of psychological control with regard to environmental stimuli for the occurrence of several illnesses, suggesting the desirability of integration among various fields of science.

Visualizing the brain on a mixed reality smartphone application.

Augmented and Virtual Reality approaches are getting more and more advanced and consequently their use in various real world areas is increasing. Medicine is one of the fields in which more practical applications are surfacing, mainly approaches that enable new forms of visualization of data obtained from real patients. Our work focuses on providing a new simple, practical and efficient way to visualize the brain of a patient, both in an Augmented Reality and in a Virtual Reality approach, through a smartphone application.

Efeitos da exposição a estímulos aversivos e apetitivos incontroláveis sobre o comportamento verbal em contingências de reforço positivo / Effects of exposure to uncontrollable, aversive and appetitive stimuli on verbal behavior under positive reinforcement contingencies

Foram analisados efeitos de diferentes histórias de incontrolabilidade por perda ou ganho de pontos sobre o desempenho posterior de participantes humanos na construção de frases. Inicialmente, os participantes podiam ganhar ou perder pontos independentemente de qualquer característica da frase construída. Posteriormente, recebiam pontos por construir frases iniciadas apenas pelo pronome "ele". Os resultados mostram que a exposição à incontrolabilidade pode dificultar condições posteriores de novas aprendizagens sob reforçamento positivo. Interessantemente, essas dificuldades foram menos acentuadas e, em certos casos, até mesmo superadas, no caso de uma história de exposição a ganhos incontroláveis de pontos. Em contrapartida, no caso de uma história de perdas incontroláveis de pontos, aprendizagens subsequentes sob reforço positivo tenderam a ser prejudicadas. Esses resultados contribuem para os estudos de incontrolabilidade e desamparo aprendido, em particular por apresentar alternativas metodológicas passíveis de aplicação a respostas verbais em humanos.

Human participants were exposed to a task in which, by constructing sentences, the effects of different stories of uncontrollability were assessed through the loss or acquisition of points in a subsequent exposure to a new learning condition. Initially, subjects could lose or win points regardless of any specific response. Subsequently, they would receive points for constructing any sentence beginning with the pronoun "he". Results show that exposure to uncontrollability can make it difficult to acquire a subsequent learning task. In particular, the effects of the history of exposure to uncontrollable points gains were relatively short-lived, concentrated at the beginning of the learning process and tending to recover throughout the exposure to the new task. On the other hand, the effects of uncontrollability through the loss of points had a detrimental effect on the acquisition of the new task. These results contribute to the study of uncontrollability and learned helplessness, particularly by proposing alternative methods using human verbal responses.

Minor psychiatric disorders in mothers and asthma in children.

OBJECTIVE: Recent studies have shown that asthma represents a major health issue not only in children of developed countries but also in urban centers in some middle-income countries. Brazil has one of the highest prevalences of asthma worldwide. Recently, interest has grown in the relationship between psychosocial factors and asthma. This article examines the relationship between maternal mental disorders and the prevalence of asthma in low-income children from an inner city area of Salvador in the state of Bahia, Brazil, and is part of the SCAALA program (Social Change, Allergy and Asthma in Latin America). PATIENTS AND METHODS: A total of 1,087 children between the ages of 5 and 12 were investigated, together with their mothers. The mothers' mental health was evaluated using the SRQ-20, an instrument for the psychiatric screening of minor psychiatric disorders (depression, anxiety and somatic complaints). The prevalence of asthma was investigated using the ISAAC survey, a standardized, validated questionnaire for asthma and other allergic diseases. Cases were defined as asthma if the patient reported having had wheezing in the previous 12 months in addition to at least one of the following: having asthma, wheezing while exercising, waking during the night because of wheezing, or having had at least four episodes of wheezing in the previous 12 months. Atopy was defined as a positive skin prick test to allergens. RESULTS AND CONCLUSION: The presence of minor psychiatric disorders in the mothers was significantly associated with the presence of asthma in the children, and this association was consistent with all forms of asthma, irrespective of whether it was atopic or nonatopic. Future studies should be carried out to further investigate this association and the potential biological mechanisms involved. Programs for asthma control should include strategies for stress reduction and psychological support for the families of asthmatic children.

Estimating adjusted prevalence ratio in clustered cross-sectional epidemiological data.

BACKGROUND: Many epidemiologic studies report the odds ratio as a measure of association for cross-sectional studies with common outcomes. In such cases, the prevalence ratios may not be inferred from the estimated odds ratios. This paper overviews the most commonly used procedures to obtain adjusted prevalence ratios and extends the discussion to the analysis of clustered cross-sectional studies. METHODS: Prevalence ratios(PR) were estimated using logistic models with random effects. Their 95% confidence intervals were obtained using delta method and clustered bootstrap. The performance of these approaches was evaluated through simulation studies. Using data from two studies with health-related outcomes in children, we discuss the interpretation of the measures of association and their implications. RESULTS: The results from data analysis highlighted major differences between estimated OR and PR. Results from simulation studies indicate an improved performance of delta method compared to bootstrap when there are small number of clusters. CONCLUSION: We recommend the use of logistic model with random effects for analysis of clustered data. The choice of method to estimate confidence intervals for PR (delta or bootstrap method) should be based on study design.