The use of ChatGPT in scientific publishing / O uso do ChatGPT na publicação científica

The use of Generative Pretrained Transformer (ChatGPT), an artificial intelligence tool, for writing scientific articles has been reason for discussion by the academic community ever since its launch in late 2022. This artificial intelligence technology is becoming capable of generating fluent language, and distinguishing between text produced by ChatGPT and that written by people is becoming increasingly difficult. Here, we will present some topics to be discussed: (1) ensuring human verification; (2) establishing accountability rules; (3) avoiding the automatization of scientific production; (4) favoring truly open-source large language models (LLMs); (5) embracing the benefits of artificial intelligence; and (6) broadening the debate. With the emergence of these technologies, it is crucial to regulate, with continuous updates, the development and responsible use of LLMs with integrity, transparency, and honesty in research, along with scientists from various areas of knowledge, technology companies, large research funding bodies, science academies and universities, editors, non-governmental organizations, and law experts

O uso do Generative Pretrained Transformer (ChatGPT), ferramenta de inteligência artificial, na redação de artigos científicos, tem sido motivo de discussão pela comunidade acadêmica desde seu lançamento, no fim de 2022. Essa tecnologia de inteligência artificial está ganhando a capacidade de gerar linguagem fluente, sendo cada vez mais difícil distingui-la dos textos escritos por pessoas. Serão apresentados alguns aspectos para serem debatidos: (1) assegurar a verificação humana; (2) desenvolver regras de responsabilidade; (3) evitar a automatização da produção científica; (4) dar preferência a grandes modelos de linguagem verdadeiramente (LLMs) abertos; (5) abraçar os benefícios da IA; e (6) ampliar o debate. Com o surgimento dessas tecnologias, faz-se necessário regulamentar, com atualização contínua, o desenvolvimento e o uso responsável dos LLMs com integridade, transparência e honestidade na pesquisa, com participação de cientistas de diversas disciplinas, empresas de tecnologia, grandes financiadores de pesquisas, academias de ciências e universidades, editores, organizações não governamentais (ONGs) e especialistas jurídicos

Impact of long-term care facilities' size on adherence to COVID-19' infection prevention guidance. / Impacto do tamanho das instituições de longa permanência na adesão às orientações de prevenção de infecções por COVID-19.

OBJECTIVE: to evaluate the adherence of Brazilian long-term care facilities to the World Health Organization Infection Prevention and Control guidance, and assess the association of their size with the adherence to these recommendations. METHOD: cross-sectional study conducted with facilities' managers. Authors developed a 20-item questionnaire based on this guidance, and a global score of adherence, based on the adoption of these recommendations. Adherence was classified as (1) excellent for those who attended ≥14 out of 20 recommendations; (2) good for 10 to 13 items; and (3) low for those with less than ten items. Facilities' sizes were established as small, intermediate, and large according to a two-step cluster analysis. Descriptive statistics and chi-square tests were used at a 5% significance level. RESULTS: among 362 included facilities, 308 (85.1%) adhered to 14 or more recommendations. Regarding its size, adherence to screening COVID-19 symptoms of visitors (p=0.037) and isolating patients until they have had two negative laboratory tests (p=0.032) were lower on larger ones compared to medium and small facilities. CONCLUSION: adherence to COVID-19 mitigation measures in Brazilian facilities was considered excellent for most of the recommendations, regardless of the size of the units.

Impacto do tamanho das instituições de longa permanência na adesão às orientações de prevenção de infecções por COVID-19 / Impact of long-term care facilities' size on adherence to COVID-19' infection prevention guidance / Impacto del tamaño de las instituciones de larga estancia en la adhesión a las orientaciones de prevención de infecciones por COVID-19

Resumo Objetivo: avaliar a adesão das instituições de longa permanência brasileiras às orientações de Prevenção e Controle de Infecções da Organização Mundial da Saúde, observando a associação entre seu porte e a adesão a essas recomendações. Método: estudo transversal realizado com gestores de estabelecimentos. Os autores desenvolveram um questionário de 20 itens, com base nessas orientações, e um escore global de adesão, com base na adesão a essas recomendações. A adesão foi classificada como (1) excelente para aquelas que atenderam ≥14 de 20 recomendações, (2) bom para 10 a 13 itens e (3) baixo para aquelas com menos de dez itens. O tamanho das instalações foi classificado como pequeno, médio e grande, de acordo com uma análise de cluster em duas etapas. Estatística descritiva e teste de qui-quadrado foram utilizados com nível de significância de 5%. Resultados: das 362 instituições incluídas, 308 (85,1%) aderiram a 14 ou mais recomendações. Em relação ao seu tamanho, a adesão à triagem de sintomas de COVID-19 dos visitantes (p=0,037) e ao isolamento de pacientes até que tenham dois exames laboratoriais negativos (p=0,032) foi menor em estabelecimentos maiores, em comparação com estabelecimentos de médio e pequeno porte. Conclusão: a adesão às medidas de mitigação da COVID-19 nas unidades brasileiras foi considerada excelente para a maioria das recomendações, independentemente do porte das unidades.

Abstract Objective: to evaluate the adherence of Brazilian long-term care facilities to the World Health Organization Infection Prevention and Control guidance, and assess the association of their size with the adherence to these recommendations. Method: cross-sectional study conducted with facilities' managers. Authors developed a 20-item questionnaire based on this guidance, and a global score of adherence, based on the adoption of these recommendations. Adherence was classified as (1) excellent for those who attended ≥14 out of 20 recommendations; (2) good for 10 to 13 items; and (3) low for those with less than ten items. Facilities' sizes were established as small, intermediate, and large according to a two-step cluster analysis. Descriptive statistics and chi-square tests were used at a 5% significance level. Results: among 362 included facilities, 308 (85.1%) adhered to 14 or more recommendations. Regarding its size, adherence to screening COVID-19 symptoms of visitors (p=0.037) and isolating patients until they have had two negative laboratory tests (p=0.032) were lower on larger ones compared to medium and small facilities. Conclusion: adherence to COVID-19 mitigation measures in Brazilian facilities was considered excellent for most of the recommendations, regardless of the size of the units.

Resumen Objetivo: evaluar la adhesión de instituciones brasileñas de larga estancia a las orientaciones de Prevención y Control de Infecciones de la Organización Mundial de la Salud y evaluar la asociación entre su tamaño y la adhesión a esas recomendaciones. Método: estudio transversal realizado con gerentes de establecimientos. Los autores desarrollaron un cuestionario de 20 ítems basado en estas directrices y un puntaje general de cumplimiento acorde a la observancia de estas recomendaciones. La adhesión se calificó (1) excelente para aquellas que cumplieron con ≥14 de 20 recomendaciones; (2) buena para 10 a 13 artículos; y (3) baja para aquellas con menos de diez elementos. El tamaño de las instalaciones se clasificó como pequeños, medianos y grandes de acuerdo con un análisis de clúster de dos pasos. Se utilizó estadística descriptiva y la prueba de chi-cuadrado con un nivel de significancia del 5%. Resultados: de las 362 instituciones incluidas, 308 (85,1%) se adhirieron a 14 o más recomendaciones. En cuanto a su tamaño, la adhesión al cribado de síntomas de COVID-19 de los visitantes (p=0,037) y al aislamiento de los pacientes hasta que tengan dos pruebas de laboratorio negativas (p=0,032) fue menor en los establecimientos más grandes en comparación con los establecimientos medianos y pequeños. Conclusión: la adhesión a las medidas de mitigación de la COVID-19 en las unidades brasileñas fue considerada excelente para la mayoría de las recomendaciones, independientemente del tamaño de las unidades.

Knowledge and attitudes in dementia held by general practitioners in the primary care setting of Botucatu, São Paulo, Brazil.

BACKGROUND: Alzheimer's disease (AD) is the leading cause of dementia worldwide. Despite alarming evidence on dementia prevalence, the condition is still underdiagnosed by general practitioners (GPs) in primary care. Early detection of the disease is beneficial for patients and relatives, who should be provided comprehensive guidance on dealing with dementia complications, covering medical, family and social aspects, thereby providing an opportunity to plan for the future. OBJECTIVE: The objective of this study was to assess the knowledge of and attitudes toward dementia held by GPs from a city in the interior of São Paulo State, Brazil. METHODS: A non-randomized intervention study was conducted involving six lectures about dementia. Before and after the intervention, the participating physicians completed two quizzes about knowledge of and attitudes towards dementia. The study was carried out in the primary care services of the town and a total of 34 GPs participated in the study. RESULTS: The mean age of the sample was 33.9 (±10.2) years and the majority (76.5%) of the sample had not undertaken medical residency training. The mean number of correct answers on the Knowledge Quiz about dementia before and after the training intervention was 59.6 and 71.2% (p<0.001), respectively. The comparison of the mean responses on the Attitude Quiz revealed no statistically significant difference between the two applications of the instrument, before and after intervention (p=0.059). CONCLUSIONS: More training for GPs on dementia should be provided.

Mapping Research Conducted on Long-Term Care Facilities for Older People in Brazil: A Scoping Review.

This scoping review aimed to explore the characteristics, strengths, and gaps in research conducted in Brazilian long-term care facilities (LTCFs) for older adults. Electronic searches investigating the residents (≥60 years old), their families, and the LTCF workforce in Brazil were conducted in Medline, EMBASE, LILACS, and Google Scholar, within the timescale of 1999 to 2018, limited to English, Portuguese, or Spanish. The reference lists were hand searched for additional papers. The Mixed Methods Appraisal Tool (MMAT) was used for critical appraisal of evidence. Data were reported descriptively considering the study design, using content analysis: 327 studies were included (n = 159 quantitative non-randomized, n = 82 quantitative descriptive, n = 67 qualitative, n = 11 mixed methods, n = 6 randomized controlled trials, and n = 2 translation of assessment tools). Regardless of the study design, most were conducted in a single LTCF (45.8%), in urban locations (84.3%), and in non-profit settings (38.7%). The randomized trials and descriptive studies presented the lowest methodological quality based on the MMAT. This is the first review to provide an overview of research on LTCFs for older people in Brazil. It illustrates an excess of small-scale, predominantly qualitative papers, many of which are reported in ways that do not allow the quality of the work to be assured.

Da prática baseada em evidências para a saúde coletiva informada por evidências: revisão narrativa / De la práctica basada en evidencias para la salud colectiva informada por evidencias: revisión narrativa / From evidence-based practice to evidence-informed public health: a narrative review

Objetivo: Revisar na literatura a descrição dos conceitos e o emprego das evidências científicas no âmbito da Saúde Coletiva (SC). Métodos: Realizou-se uma revisão narrativa utilizando e combinando as palavras-chave "Saúde Pública" OR "Saúde Coletiva"; "Medicina baseada em evidências" e "Política informada por evidências" por meio da consulta as bases de dados Lilacs, SciELO e MedLine. As buscas foram limitadas ao período entre janeiro de 1990 a dezembro de 2016, no idioma português e/ou inglês. A seleção dos estudos foi realizada por dois autores, de modo independente, por meio da leitura do título, resumo e texto completo. Para o processo de síntese, as temáticas encontradas foram agrupadas em três grandes eixos norteadores: as evidências e a prática em saúde, as evidências em SC, e os avanços e desafios da Saúde Coletiva Informada pelas Evidências (SCIE). Resultados: Os achados desta revisão apontam que as tomadas de decisão na SC são mais complexas do que as decisões clínicas individuais, pois envolvem avaliações de impactos orçamentários e políticos, reforçando a relevância da adoção de práticas informadas pelas evidências neste campo. Conclusão: Os meios de apropriação e emprego das evidências no campo da SC são complexos, pois envolvem pressupostos de plausibilidade e adequação nem sempre observados em intervenções individuais. Ainda assim, o campo beneficia-se da aproximação observada na SCIE e, em particular, na tomada de decisões em saúde. (AU)

Objective: To review the literature about the description of concepts and the use of scientific evidence in Public Health (PH). Methods: A narrative review was carried out using and combining the keywords "Public Health" OR "Collective Health"; "Evidence-based medicine" and "Evidence-informed policy" to consult the Lilacs, SciELO and MedLine databases. The searches were limited to articles published between January 1990 and December 2016 in Portuguese and/or English. The studies were selected by two independent authors who read the title, abstract and full text. For the synthesis process, the themes found were grouped into three main guiding axes: health evidence and practice, PH evidence, and the advances and challenges of Evidence-Informed Public Health (EIPH). Results: The findings of this review point out that decision making in PH is more complex than individual clinical decisions as it involves assessment of budgetary and political impacts, thus reinforcing the relevance of adopting evidence-informed practice in this field. Conclusion: The means of appropriation and use of evidence in the PH field are complex because they involve assumptions of plausibility and adequacy that are not always observed in individual interventions. Yet, the field benefits from the approach observed in EIPH and, particularly, in health decision making. (AU)

Objetivo: Revisar en la literatura la descripción de los conceptos y el empleo de las evidencias científicas en el ámbito de la Salud Colectiva (SC). Métodos: Se realizó una revisión narrativa utilizando y mesclando las palabras-clave "Salud Pública" OR "Salud Colectiva"; "Medicina basada en la evidencia" AND "Política informada por evidencias" a través de la consulta en las bases de datos LILACS, SciELO y MEDLINE. Las búsquedas se han limitado al período entre enero de 1990 y diciembre de 2016 en los idiomas portugués y/o inglés. La selección de los estudios se dio por dos autores de modo independiente a través de la lectura del título, resumen y texto completo. Para el proceso de síntesis se han unido las temáticas encontradas en tres grandes ejes norteadores: las evidencias y la práctica en salud, las evidencias en SC y los avances y desafíos de la Salud Colectiva Informada por las Evidencias (SCIE). Resultados: Los hallazgos de esta revisión apuntan que las tomas de decisiones de la SC son más complejas que las decisiones clínicas individuales pues implican evaluaciones de impactos políticos y de presupuesto con refuerzo para la importancia de prácticas informadas por las evidencias en este campo. Conclusión: Los medios de apropiación y empleo de las evidencias para el campo de la SC son complejos pues implican presupuestos de plausibilidad y adecuación no observados en intervenciones individuales. Aun así, el campo se beneficia de la aproximación observada en la SCIE y, en particular, de las tomas de decisiones en salud. (AU)

Effectiveness of probiotics on the occurrence of infections in older people: systematic review and meta-analysis.

BACKGROUND: infectious diseases in older people are associated with higher mortality rates and probiotics have been hypothesised to reduce the occurrence of infection. OBJECTIVES: to assess the effectiveness and safety of probiotics in the occurrence of infections in older adults in comparison to placebo. METHODS: a systematic review and meta-analysis of randomised placebo-controlled trials were conducted on 30 December 2016 using Medline, Embase, CENTRAL, Web of Science and LILACS databases. Efficacy outcomes were: occurrence of infection, quality of life, mortality and mean duration of infection per episode. Safety outcomes were adverse events. Data were analysed using relative risk ratios with 95% confidence intervals. Relative risk ratios were pooled where more than three estimates were available. RESULTS: fifteen articles were included, with a total of 5,916 participants with a mean age of 75.21 years. The effect of probiotics was not significantly different from that reported for placebo on the occurrence of infection, adverse events, mortality or mean duration of infection episodes (relative risk (RR) 0.90, 95% confidence interval (CI) 0.76 to 1.08; RR 1.01, 95% CI 0.91 to 1.12; RR 1.09, 95% CI 0.70 to 1.72; MD -0.35, 95% CI -1.57 to 0.87, respectively). CONCLUSION: the current low-quality evidence does not support the use of probiotics for the reduction in the occurrence of infection in older adults, however, the safety outcomes were similar between probiotics and placebo. Further research is required to confirm these findings.PROSPERO: CRD42014013707.

Knowledge and attitudes towards dementia in a sample of medical residents from a university-hospital in São Paulo, Brazil.

An estimated 61% of the 24.3 million people diagnosed with dementia worldwide live in underdeveloped countries, including Brazil, where a public healthcare system covers the majority of the population. This care is usually provided by General Practitioners (GP) and in Brazil many doctors recently graduated from medical school and residents of different medical specialties practice as GPs. OBJECTIVE: The aim of this study was to describe the knowledge and attitudes about dementia in a sample of Brazilian medical residents from a university-hospital in São Paulo, Brazil. METHODS: A total of 152 Brazilian medical residents participated in the study. Participants answered a "Knowledge Quiz" (KQ) and "Attitude Quiz" (AQ) about dementia issues, transculturally adapted for use in Brazilian physicians. A descriptive analysis of the correct answers on knowledge and of the attitude aspects was performed. RESULTS: The medical residents showed poor knowledge (<50%) about dementia prevalence and incidence and a good knowledge on disease management and diagnosis. Participants tended to be optimistic about caring for demented patients. CONCLUSION: In this study, it is likely that the physicians' good knowledge about dementia issues is the reason for their optimism dealing with demented patients.

Estima-se que 61% dos 24,3 milhões de pessoas diagnosticadas com demência no mundo vivem em países subdesenvolvidos, incluindo o Brasil, onde o sistema público de saúde (SUS) abrange a maioria da população. Os atendimentos médicos no SUS são realizados, habitualmente, por médicos generalistas. No Brasil, muitos médicos, logo após a graduação e residentes de diferentes especialidades médicas trabalham como médicos generalistas. OBJETIVO: O objetivo deste estudo foi descrever o conhecimento e as atitudes sobre demência em uma amostra de médicos residentes brasileiros de um hospital universitário em São Paulo, Brasil. MÉTODOS: 152 médicos residentes participaram do estudo respondendo a um instrumento sobre conhecimentos e atitudes sobre demências que havia sido adaptado transculturalmente para ser usado no Brasil. Uma análise descritiva das respostas corretas sobre conhecimentos e atitudes foi realizada. RESULTADOS: Os médicos residentes mostraram pouco conhecimento (<50%) sobre a prevalência e incidência de demência e maior conhecimento em gerenciamento e diagnóstico. Os profissionais tenderam a ser otimistas sobre como cuidar de pacientes com demência. CONCLUSÃO: Neste estudo, provavelmente, o bom conhecimento sobre algumas questões de demência é a razão para esses médicos sentirem-se mais otimistas com o cuidado aos pacientes com demência.

Dietary patterns are associated with general and central obesity in elderly living in a Brazilian city / Padrões alimentares associados com obesidade geral e central em idosos residentes em uma cidade brasileira

Objective: dietary pattern evaluation is often used in order to determine wheter a diet is healthy, as well as to predict the onset of diseases. This study aimed to identify dietary patterns, and to examine their associations with general (body mass index) and central (waist circumference and waist-to-hip ratio) obesity in community-living elderly in a Brazilian city. Methods: this cross-sectional study included 126 elderly subjects aged 60 or older (57.1% females and mean age 74.2 ± 6.46 years). Anthropometric variables, weight, height, waist (WC) and hip (HC) circumferences, were measured. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Answers to a Food Frequency Questionnaire were interpreted by Principal Component Analysis in order to identify dietary patterns. Results: five dietary patterns were identified and named as prudent (fruit, vegetables and meat), sweets and fats (pastries, sugary foods, fatty foods, whole milk), typical Brazilian (fried eggs, cooked beans, beef, candy, string beans, fried cassava), Mediterranean (fruit, vegetables, olive oil and nuts) and traditional meal (rice and beans). Moderate and high adherences to the Mediterranean pattern were protective factors to general and central obesity (WHR). High adherence to prudent was also protective to central obesity (WC). Conclusion: adherences to the dietary patterns prudent and Mediterranean were protective factors to general and central obesity in elderly. .

Objetivo: a avaliação do padrão alimentar é muitas vezes usada para determinar se uma dieta é saudável, bem como para predizer o aparecimento de doenças. Este estudo teve como objetivo identificar padrões alimentares e analisar as suas associações com obesidade geral (índice de massa corporal) e central (circunferência da cintura e relação cintura-quadril) em idosos residentes em comunidade em uma cidade brasileira. Métodos: este estudo transversal incluiu 126 idosos com 60 anos ou mais de idade (57,1% do sexo feminino e média de idade 74,2 ± 6,46 anos). As variáveis antropométricas [peso, altura, circunferências da cintura (CC) e do quadril (CQ)] foram mensuradas. Foram calculados o índice de massa corporal (IMC) e relação cintura-quadril (RCQ). As respostas a um questionário de frequência alimentar foram interpretadas por Análise de Componentes Principais, a fim de identificar os padrões alimentares. Resultados: cinco padrões alimentares foram identificados e nomeados como prudente (frutas, legumes e car-ne), doces e gorduras (alimentos de pastelaria, doces, alimentos gordurosos, leite integral), padrão tipicamente brasileiro (ovos fritos, feijão cozido, carne, caramelo, vagens, mandioca frita), Mediterrâneo (frutas, legumes, azeite de oliva e nozes) e tradicional (arroz e feijão). Adesões moderada e alta ao padrão Mediterrâneo foram fatores de proteção para obesidade geral e central (RCQ). Alta adesão ao padrão prudente também foi protetor contra a obesidade central (CC). Conclusão: adesões aos padrões alimentares prudente e Mediterrâneo foram fatores de proteção para obesidade geral e central em idosos. .

Association between oxidative stress and nutritional status in the elderly.

Ageing is a dynamic and progressive process that is characterized by the occurrence of morphological, biochemical, functional and psychological changes in the organism. The aim of the present article is to provide updated concepts on oxidative stress, covering its importance in aging, as well as nutritional status and supplementation with antioxidants (substances that prevent or attenuate oxidation of oxidizable substrates, such as lipids, proteins, carbohydrates and deoxyribonucleic acid) in the geriatric population. Evidence suggests that there is an inverse relationship between oxidative stress and nutritional status in elderly individuals. Although an increase in oxidative stress in chronic diseases associated with aging has been proven, such as Parkinson's disease and Alzheimer's disease, up to now there has been no consistent clinical evidence proving the efficiency of supplementation with antioxidants against oxidative stress. In this context, supplementation is not recommended. On the other hand, the elderly should be encouraged to eat antioxidant foods, such as fruits and vegetables. Maintaining a normal weight (body mass index between 23 and 28 Kg/m(2)) should also be stimulated.

Association between oxidative stress and nutritional status in the elderly / Associação entre estresse oxidativo e estado nutricional de idosos.

Ageing is a dynamic and progressive process that is characterized by the occurrence of morphological, biochemical, functional and psychological changes in the organism. The aim of the present article is to provide updated concepts on oxidative stress, covering its importance in aging, as well as nutritional status and supplementation with antioxidants (substances that prevent or attenuate oxidation of oxidizable substrates, such as lipids, proteins, carbohydrates and deoxyribonucleic acid) in the geriatric population. Evidence suggests that there is an inverse relationship between oxidative stress and nutritional status in elderly individuals. Although an increase in oxidative stress in chronic diseases associated with aging has been proven, such as Parkinson’s disease and Alzheimer’s disease, up to now there has been no consistent clinical evidence proving the efficiency of supplementation with antioxidants against oxidative stress. In this context, supplementation is not recommended. On the other hand, the elderly should be encouraged to eat antioxidant foods, such as fruits and vegetables. Maintaining a normal weight (body mass index between 23 and 28 Kg/m2) should also be stimulated.

O envelhecimento é um processo dinâmico e progressivo que se caracteriza pela ocorrência de modificações morfológicas, bioquímicas, funcionais e psicológicas do organismo. O objetivo do presente artigo é fornecer conceitos atualizados sobre estresse oxidativo, abordando sua importância no envelhecimento, assim como o estado nutricional e suplementação com antioxidantes (substâncias que evitam ou atenuam a oxidação de substratos oxidáveis, como lipídeos, proteínas, carboidratos e o ácido desoxirribonucleico) na população geriátrica. Evidências sugerem que existe uma relação inversa entre estresse oxidativo e estado nutricional em indivíduos idosos. Embora seja comprovado o aumento do estresse oxidativo nas doenças crônicas associadas ao envelhecimento, como doença de Parkinson e doença de Alzheimer, não há, até o momento, evidências clínicas consistentes que comprovem a eficiência da suplementação com antioxidantes contra o estresse oxidativo. Nesse contexto, a suplementação não é recomendada. Por outro lado, idosos devem ser encorajados a ingerir alimentos antioxidantes, como, por exemplo, frutas e vegetais. A manutenção do peso dentro da faixa de normalidade (índice de massa corpórea entre 23 e 28 kg/m2) também deve ser estimulada.

B-type natriuretic peptide in the evaluation of cardiac function / Peptídeo natriurético tipo B na avaliação da função cardíaca

B type natriuretic peptide (BNP) and its precursor, the inactive form of NT-pro-BNP, are currently the most studied laboratory parameters in the heart disease spectrum. The assessment of their blood concentrations provides invaluable information on the likelihood, severity and prognosis of the disease. The present review aims to describe the biological determinants, the factors that influence these peptide concentrations, the suggested cutoff values for the diagnosis of heart failure and the use of this biomarker in the assessment of cardiac function.

O peptídeo natriurético tipo B (BNP) ou o seu precursor, a forma inativa do fragmento N terminal do pró-BNP (NT-pró-BNP), são os parâmetros laboratoriais mais estudados atualmente no espectro da insuficiência cardíaca (IC). Por meio da mensuração de seus níveis no sangue, informações valiosas quanto a probabilidade, gravidade e prognóstico da doença podem ser reunidas. Esta revisão tem como objetivo descrever os determinantes biológicos, os fatores interferentes nas concentrações desses peptídeos, os valores de corte sugeridos para diagnóstico da IC e o uso deste biomarcador na avaliação da função cardíaca.

Systematic reviews showed insufficient evidence for clinical practice in 2004: what about in 2011? The next appeal for the evidence-based medicine age.

RATIONALE AND AIM: The aims of the Cochrane systematic reviews are to make readily available and up-to-date information for clinical practice, offering consistent evidence and straightforward recommendations. In 2004, we evaluated the conclusions from Cochrane systematic reviews of randomized controlled trials in terms of their recommendations for clinical practice and found that 47.83% of them had insufficient evidence for use in clinical practice. We proposed to reanalyze the reviews to evaluate whether this percentage had significantly decreased. METHODS: A cross-sectional study of systematic reviews published in the Cochrane Library (Issue 7, 2011) was conducted. We randomly selected reviews across all 52 Cochrane Collaborative Review Groups. RESULTS: We analyzed 1128 completed systematic reviews. Of these, 45.30% concluded that the interventions studied were likely to be beneficial, of which only 2.04% recommended no further research. In total, 45.04% of the reviews reported that the evidence did not support either benefit or harm, of which 0.8% did not recommend further studies and 44.24% recommended additional studies; the latter has decreased from our previous study with a difference of 3.59%. CONCLUSION: Only a small number of the Cochrane collaboration's systematic reviews support clinical interventions with no need for additional research. A larger number of high-quality randomized clinical trials are necessary to change the 'insufficient evidence' scenario for clinical practice illustrated by the Cochrane database. It is recommended that we should produce higher-quality primary studies in active collaboration and consultation with global scholars and societies so that this can represent a major component of methodological advance in this context.

Normatização da abertura de ligas acadêmicas: a experiência da Faculdade de Medicina de Botucatu / Regulation of student leagues: the experience at the Botucatu School of Medicine

A criação de ligas acadêmicas por estudantes de Medicina tem ocorrido em todo o Brasil. Aceitas como atividades extracurriculares de extensão universitária, as ligas trazem tanto benefícios como riscos à formação médica. Assim, a abertura de ligas deveria ser racionalizada, visando ao aperfeiçoamento de suas atividades. Neste relato, descrevemos a normatização adotada na Faculdade de Medicina de Botucatu - Universidade Estadual Paulista (FMB/Unesp), contextualizando- a numa discussão sobre a importância das ligas como atividades extracurriculares e os prejuízos que podem trazer à formação médica. A normatização contém orientações processuais e um conjunto de critérios para avaliação dos projetos de abertura de novas ligas. Os critérios avaliam a relevância da proposta, os objetivos, o modelo de gestão planejado e a ideologia da formação. A utilização destas diretrizes tem capacitado o desenvolvimento de projetos de novas ligas e desencadeado na escola o aprofundamento de reflexões sobre a função de ligas acadêmicas.

Student leagues have been created by medical students all across Brazil. Accepted as extracur ricular university extension activities, the leagues have produced both benefits and risks for medical training. Student leagues thus need to be rationalized, with the aim of improving their activities. This report describes the regulation adopted by the Botucatu School of Medicine (Universidade Estadual Paulista, FMB/UNESP), framed within a discussion of the importance of such leagues as extracurricular activities and the potential harm they can cause to medical training. The regulation contains procedural guidelines and a set of criteria for the evaluation of proposals to create new leagues. The criteria assess the proposal's relevance, objectives, planned management model, and training ideology. The use of these guidelines has allowed the development of projects for new leagues and triggered more in-depth reflection in the school on the role of student leagues.

[Infection in elderly interned in long-term care facilities]. / Infecção em idosos internados em instituição de longa permanência.

OBJECTIVE: To evaluate the occurrence of infection in elderly interned in long-term care facilities (LTCF) during 13 consecutive months. METHODS: Fifty five elderly were evaluated according to infection and, reporting was standardized. RESULTS: The median age was 75 (66 81) years. The data set consisted of 20,896 patients-day (PD) of care during the period, with a total of 76 infections for a pooled mean rate of infections 3.20 per 1,000 PD of care. Patient infection rate was 63.6%. Prevalent topographies of infection were respiratory (50%), urinary tract (32%), skin and soft tissue (12%) and gastroenteritis (7%), with an infection rate for specific categories/1000 PD of 1.60, 1.01, 0.38, 0.21, respectively. Mortality infection rate was 5%. Microbiological agents were isolated in 30.5% of the infection episodes. Escherichia coli and Staphylococcus aureus were prevalent. CONCLUSION: Infection presented an elevated incidence in the elderly interned, but no unusual problem with infections was disclosed.

Infecção em idosos internados em instituição de longa permanência / Infection in elderly interned in long-term care facilities

OBJETIVO: Avaliar ocorrência de infecção em idosos de instituição de longa permanência (ILP) durante 13 meses consecutivos. MÉTODOS: Cinqüenta e cinco idosos foram avaliados segundo critérios de infecção e de comunicação padronizada. RESULTADOS: A idade mediana foi de 75 (66-81) anos. O conjunto de dados constituiu-se de 20.896 pacientes-dia (PD) durante o período, com um total de 76 infecções para uma taxa média de infecção de 3,2 por 1000 PD. A taxa de pacientes com infecção foi de 63,6 por cento. As topografias prevalentes foram respiratória (50 por cento), trato urinário (32 por cento), pele e partes moles (12 por cento) e gastrintestinal (7 por cento), com taxa de infecção/1000 PD de 1,60; 1,01; 0,38; e 0,2, respectivamente. A taxa de mortalidade por infecção foi de 5 por cento. Agentes microbiológicos foram isolados em 30,5 por cento dos episódios infecciosos e Escherichia coli e Staphylococcus aureus foram os mais freqüentes. CONCLUSÃO: Infecção apresentou elevada incidência nos idosos institucionalizados, porém nenhum evento extraordinário foi observado.

OBJECTIVE: To evaluate the occurrence of infection in elderly interned in long-term care facilities (LTCF) during 13 consecutive months. METHODS: Fifty five elderly were evaluated according to infection and, reporting was standardized. RESULTS: The median age was 75 (66 81) years. The data set consisted of 20,896 patients-day (PD) of care during the period, with a total of 76 infections for a pooled mean rate of infections 3.20 per 1,000 PD of care. Patient infection rate was 63.6 percent. Prevalent topographies of infection were respiratory (50 percent), urinary tract (32 percent), skin and soft tissue (12 percent) and gastroenteritis (7 percent), with an infection rate for specific categories/1000 PD of 1.60, 1.01, 0.38, 0.21, respectively. Mortality infection rate was 5 percent. Microbiological agents were isolated in 30.5 percent of the infection episodes. Escherichia coli and Staphylococcus aureus were prevalent. CONCLUSION: Infection presented an elevated incidence in the elderly interned, but no unusual problem with infections was disclosed.

Avaliação nutricional, do estresse oxidativo e ocorrência de infecção em indivíduos institucionalizados do Asilo Padre Euclides de Botucatu-SP / Nutritional evaluation, of the oxidative stress and occurrence of infection in institutionalized persons of the Asylum Padre Euclides of Botucatu-SP

Objetivo: Determinar o estado nutricional e do estresse oxidativo em idosos institucionalizados. Métodos: Sujeitos foram submetidos à avaliação clínica, nutricional e do estresse oxidativo. Participantes: cinqüenta e cinco idosos (20 homens e 35 mulheres) que residiam em instituição de longa permanência (ILP). Resultados: A idade mediana foi de 75 (66 - 81) anos. Quarenta por cento apresentaram IMC < 22 kg/m2, 27,3 por cento entre 22 - 27 kg/m2 e 32,7 por cento > 27 kg/m2. O grupo feminino apresentou índice de massa corporal maior que o masculino. Os níveis de -caroteno foram maiores no grupo feminino e a relação MDA/beta caroteno foi maior no grupo masculino. Os níveis de albumina, proteína total e alfa tocoferol foram maiores no grupo com IMC > 22 kg/m2 que < 22 kg/m2. MDA/alfa tocoferol foi maior no grupo IMC < 22 kg/m2. Conclusão: Os idosos da ILP estudada apresentaram alta prevalência de baixo peso (IMC < 22 kg/m2). Esta variável foi associada com albumina < 3,5 g/dL, menores concentrações de beta tocoferol e a altas relações de MDA/beta caroteno