Prevalence and concentration of pesticides in European waters: A protocol for systematic review and meta-analysis.

There is currently a growing interest in the so-called emerging pollutants, such as pesticides, pharmaceuticals, personal hygiene care products, drugs, etc., whose presence in natural ecosystems is not necessarily recent, but the development in latest years of new and more sensitive methods of analysis has allowed their detection. They can be present in the natural environment, food, and many products of everyday origin, which suggests that human exposure to them is massive and universal. Therefore, the study of this type of substances is becoming one of the priority lines of research of the main agencies dedicated to the protection of public and environmental health, such as the World Health Organization (WHO), United States Environmental Protection Agency (USEPA) or European Union (EU). In this sense, it is of vital importance to know the nature and quantity of this type of contaminants, to establish preventive mechanisms that minimize its presence in aquatic systems, with special requirements for human consumption. This study aimed to describe a protocol for a systematic review and meta-analysis to assess the status of pesticides in European waters. We will search for original studies in the PubMed/Medline, Scopus, Web of Science, EMBASE, ScienceDirect databases. Prevalence studies of emerging contaminants (pesticides) in water resources (watersheds, aquifers, rivers, marine and springs), wastewaters (influent and effluent), and drinking water should be included. Two reviewers will independently screen and assess the included studies, with any disagreements being resolved by a third reviewer. We will summarize the findings using a narrative approach and, if possible, conduct a quantitative synthesis (meta-analysis). We will conduct the protocol following the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. The review will summarize the current evidence on the presence of pesticides in European waters such as glyphosate, chlorpyrifos, pyrethroid pesticides, neonicotinoid pesticides, and/or fungicides, in samples of different water resources like wastewaters and drinking water. We expect that this systematic review will establish preventive mechanisms that minimize the presence of pesticides in water in the environment.

Gamification as a health education strategy of adolescents at school: Protocol for a systematic review and meta-analysis.

The objective of the study is to present a systematic review and meta-analysis protocol for evaluating the effects of health education gamification-based interventions, on health parameters (food consumption, sleep quality and physical activity) of adolescent students. This protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022373833). The search will be performed in the following databases: MEDLINE, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, APA, and ADOLEC. Intervention studies (clinical trials - randomized or non-randomized) and quasi-experimental studies will be included. The risk of bias will be assessed using the Risk of Bias in Non-randomized Studies of Interventions tool for randomized controlled trials, non- randomized controlled trials and quasi-experimental trials. Two independent researchers will conduct all assessments, and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be analyzed using RevMan 5.4.1 software. We will conduct the study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guideline. The review will summarize the current evidence on gamification health education changes in parameters related to the health of adolescents. Gamification has been used to verify the increase in adherence to healthy habits or the development of health-related skills, but there are still few results for the adolescent population. We expect that the systematic review could indicate strategies with gamification interventions and also determine how these strategies can improve health parameters of adolescent students, and they will be available as a reference for these interventions.

Extended reality as a health education strategy of adolescents at school: protocol for systematic review and meta-analysis.

INTRODUCTION: Extended reality (XR) is the ensemble of interactive experiences based on a computer-simulated environment that encompasses virtual reality and augmented reality and has been proven to be potentially innovative in the field of health education with adolescents. The objective of this study is to present a systematic review and meta-analysis protocol that seeks to evaluate the main effects of interventions that use XR on health parameters (food intake, sound quality and physical activity) of adolescent students. METHODS AND ANALYSIS: The literature search will be performed in the following databases: MEDLINE, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, APA and ADOLEC. Intervention studies (clinical trials-randomised or non-randomised) and quasi-experimental studies will be included. The risk of bias will be assessed using the Risk of Bias in Non-randomized Studies of Interventions tool for randomised controlled trials (RCTs), non-RCTs and quasi-experimental trials. Two independent researchers will conduct all the assessments, and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be performed using RevMan V.5.4.1 software. The study will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guideline. ETHICS AND DISSEMINATION: Ethical approval and human consent were not required, as this is a protocol for a systematic review and only secondary data will be used. The findings will be published in a journal and presented at conferences. In case of any changes to this protocol, it will be updated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses website, and the modifications will be explained in the final report of this review. PROSPERO REGISTRATION NUMBER: CRD42022373876.

In silico structure-based design of peptides or proteins as therapeutic tools for obesity or diabetes mellitus: A protocol for systematic review and meta analysis.

BACKGROUND: In silico studies using dynamic simulation or molecular docking have boosted the screening and identification of molecules and/or targets in studies aimed at treating diseases such as obesity and diabetes mellitus, optimizing the development of new drugs. This study aims to describe a systematic review protocol on peptides and proteins evaluated in silico as potential therapeutic agents for obesity or diabetes mellitus. METHODS: This protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols and was registered in the International Prospective Register of Systematic Reviews database (number: CRD42022355540). The databases to be searched will be PubMed, ScienceDirect, Scopus, Web of Science, virtual health library, and EMBASE. It will be included in silico studies that evaluate the simulation by dynamics or molecular docking of proteins or peptides involved in treating obesity or diabetes mellitus. Two independent reviewers will select studies, extract data, and assess methodological quality using the adapted Strengthening the reporting of empirical simulation studies. A narrative synthesis of the included studies will be performed for the systematic reviews. RESULTS: This protocol contemplates the production of 2 systematic reviews to be developed focusing on obesity or diabetes mellitus. CONCLUSION: The reviews will enable knowledge of peptides and proteins involved in research treating these diseases and will emphasize the importance of in silico studies in this context and for the development of future studies.

Effect of School-Based Food and Nutrition Education Interventions on the Food Consumption of Adolescents: A Systematic Review and Meta-Analysis.

The school is a favorable environment for the development of interventions to prevent obesity. The objective of this systematic review is to evaluate the effects of school-based food and nutrition education interventions on adolescent food consumption. The literature search was conducted on databases: MEDLINE/PubMed, Embase, Scopus, ERIC, Science Direct, Web of Science, Cochrane, LILACS, and ADOLEC. The following research strategies were focused on: population (adolescents), intervention (food and nutrition education), outcome (food consumption), and study design (clinical trial). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement guidelines were followed and all stages of this review were performed by two researchers and, when necessary, a third researcher resolved discrepancies. Included studies are randomized clinical trials (RCT). A total of 24 articles were included for review and 11 articles in meta-analysis. In the evaluation of the general effects, there was a significant effect (mean difference (MD) for fruit consumption (MD = 0.09, CI 0.05, 0.14) in serving/day; and for vegetables (MD = 0.59, IC 0.15, 1.03) at times/week. In the consumption of FV (fruits and vegetables), there was no significant effect (standardized mean difference (SMD) of interventions in their consumption (SMD = 0.00, 95% C1 -0.11, 0.11). The evidence available in this review and meta-analysis concludes that food and nutrition education interventions in schools presented favorable results in the food consumption of adolescents. Registered on the PROSPERO database (CRD42019116520).

Mechanisms of action of anti-inflammatory proteins and peptides with anti-TNF-alpha activity and their effects on the intestinal barrier: A systematic review.

Several studies in animal models of intestinal inflammation have been performed with the aim of understanding the mechanisms of action of anti-inflammatory proteins and peptides that reduce TNF-α. In order to present the best targets, effects and strategies for the treatment of intestinal inflammation in experimental models, this systematic review (SR) aimed to answer the following question: what are the mechanisms of action of molecules with anti-TNF-α activity on the intestinal barrier? The SR protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, number CRD42019131862) and guided by the methodological procedures used for the elaboration of the SR. Articles that were part of the SR were selected considering the eligibility criteria according to the PICO (Population, Intervention, Comparison/Control and Outcomes) and were searched in the PubMed, Scopus, Web of Science, Excerpta Medica Database (EMBASE) and ScienceDirect databases. Twenty-five articles reporting studies in rats and mice were selected and the risk of bias was assessed using the tool from the SYstematic Review Center for Laboratory Animal Experimentation (SYRCLE). A descriptive synthesis of the results obtained was carried out. Based on the results, the anti-inflammatory molecules that reduced TNF-α acted mainly on the TNF-TNFR1/TNFR2 and TLR4/MD2 complex signaling pathways, and consequently on the NF-κB pathway. This improved the aspects of the inflammatory diseases studied. In addition, these mechanisms also improved the macroscopic, histological and permeability aspects in the intestine of the animals. These findings point to the potential of protein and peptide molecules that act on inflammatory pathways for medical applications with specific and promising strategic targets, aiming to improve inflammatory diseases that affect the intestine. This systematic review also highlights the need for more details during the methodological description of preclinical studies, since this was a limitation found.

Encapsulation techniques perfect the antioxidant action of carotenoids: A systematic review of how this effect is promoted.

Considering that antioxidant activities are directly related to carotenoid functionalities, it is necessary to use techniques that promote the stability of these natural pigments. This systematic review aimed to gather evidence on the effect of encapsulation techniques on the maintenance and/or enhancement of the antioxidant activity of carotenoids. The study was registered in PROSPERO (CRD42020142065). Searches were performed in PubMed, Embase, Virtual Health Library, Scopus, ScienceDirect, and Web of Science databases. Assessment of methodological quality was performed using OHAT. A total of 1577 articles were selected, resulting in 20 eligible studies. Overall, results showed that the mechanisms involved are related to the emergence of new chemical interactions, increased surface area, and the controlled release of carotenoids. Thus, evidence proved that encapsulation could preserve and/or enhance bioactivities of carotenoids, allowing the use in foods to promote benefits on population health.

Desafios do profissional de educação física nos Núcleos Ampliados de Saúde da Família e Atenção Básica: uma revisão sistemática da literatura brasileira / Challenges of the physical education professional in the Extended Centers for Family Health and Primary Care: a systematic review of Brazilian literature

Resumo Introdução A inserção dos profissionais de educação física na atenção básica tem relevância devido aos trabalhos relacionados à promoção da saúde, porém alguns desafios são apresentados na literatura como barreiras para a atuação profissional. Objetivo Revisar na literatura os desafios encontrados por profissionais de educação física que atuam nos Núcleos Ampliados de Saúde da Família e Atenção Básica (NASF-AB). Método Uma busca utilizando os termos "educação física" e "Núcleo de Apoio à Saúde da Família" foi realizada na base de dados LILACS e no portal SciELO. Os critérios de inclusão foram: ser artigo original, estar publicado no idioma português, ter sido publicado a partir do ano de 2008 e ter avaliado a atuação de profissionais de educação física no NASF-AB. Resultados Dos 45 estudos encontrados na busca inicial, seis atenderam os critérios de inclusão. Além desses, outros dois artigos foram identificados nas referências, resultando em oito artigos incluídos na revisão. Entre os vários desafios relatados, os mais frequentes encontrados nos estudos foram a falta de infraestrutura física e material, a distância entre a formação acadêmica e a área de saúde coletiva e a instabilidade profissional. Conclusão Embora alguns desafios relatados não dependam apenas do profissional de educação física para serem resolvidos, os achados dessa revisão fornecem importantes informações para que futuros profissionais que desejam atuar no NASF-AB possam se preparar de forma mais objetiva e consigam realizar um trabalho com eficiência e qualidade.

Abstract Background The inclusion of physical education professionals in primary care is relevant due to work related to health promotion, but some challenges are presented in the literature as barriers to professional performance. Objective This study aimed to review in the literature the challenges faced by physical education professionals who work in the extended centers for family health and primary care (NASF-AB). Method A search using the terms "physical education" and "family health support centers" was performed in the LILACS and SciELO databases. The inclusion criteria were: be an original article, be published in the Portuguese language, be published from 2008 onwards, and have assessed the role of physical education professionals in the NASF-AB. Results From 45 studies identified in the initial search, six met the inclusion criteria. In addition to these, two other articles were identified in the references, resulting in eight articles included in the review. Among the several challenges reported, the most frequent ones in the different studies were the lack of physical and material infrastructure, the distance between academic formation and the collective health area, and also professional instability. Conclusion Although some of the challenges reported do not depend solely on the physical education professional to be solved, the findings of this review already provide important information for future professionals who wish to work in NASF-AB to prepare themselves more objectively and perform an efficient and quality work.

Is rituximab effective for systemic sclerosis? A systematic review and meta-analysis

Abstract Background: Systemic sclerosis (SSc) Is a clinically complex and challenging disease, that leads to skin fibrosis. Its most frequent complication is interstitial lung disease (ILD), which leads to a worse prognosis. In this situation, cyclophosphamide is considered the gold standard for its treatment, despite the controversies regarding its efficacy and toxicity. However, studies using rituximab (RTX) have shown that this drug may be a promising therapeutic option. Objectives: This paper objective was to analyze the scientific evidence on the RTX effects on SSc. Methods: A systematic review (SR) was performed including clinical trials (CTs) on the use of RTX in SSc, published up to May 2020. The studies were identified through systematic searches in bibliographic databases using a predefined search strategy. The following databases were used: PUBMED, SCOPUS, SCIELO, LILACS, SCIENCE DIRECT, WEB OF SCIENCE, COCHRANE, WHOLIS, PAHO and EMBASE. Also, a manual search was performed. The methodological quality of the studies was determined using Jadad scale, Risk of Bias Tool (RoB 2.0) and Risk of Bias in Non-Randomized Studies - of Interventions tool (ROBINS-I). A meta-analysis of the randomized CTs was performed, using Review Manager. Results: Ten CTs were included in this SR. Of these, three were randomized and seven were non-randomized. Five showed a statistically significant improvement in forced vital capacity (FVC) at some time during follow-up. Regarding the skin, eight studies showed statistically significant improvements according toa the modified Rodnan skin score. The meta-analysis found positive effects of RTX in SSc, with a statistical significance for lung disease. Conclusion: Rituximab is a promising strategy for the SSc-associated ILD and cutaneous fibrosis treatment. PROSPERO registration number: CRD42019132018.(AU)

Effect of carotenoid encapsulation on antioxidant activities: A protocol for systematic review.

BACKGROUND: Carotenoids play essential roles in human health, such as antioxidant activity, and therefore can decrease free radicals oxidation action, preventing numerous diseases. However, these compounds have an unstable nature, turning them susceptible to adverse conditions in food processing and storage. Thereby the search for alternatives that maintain and enhance carotenoid antioxidant function, such as encapsulation, has grown. The objective of this study was to establish a systematic review protocol to evaluate the effect of different encapsulation techniques on the antioxidant action of carotenoids, evaluating which one is the best and safest, and their role in enhancing the antioxidant activity. METHODS: This protocol was guided by the preferred reporting items for protocols for systematic reviews and meta-analyzes. The databases to be searched are PubMed, EMBASE, Scopus, ScienceDirect, and Web of Science. Experimental studies conducted in rats and mice (in vivo) of both sexes and ages, evaluating the use of encapsulated and crude carotenoids will be included in the systematic review. The characteristics of the studies, the experimental model, and the main results will be described, and the risk of bias assessment will be evaluated. Three independent reviewers will proceed with the selection of studies, data extraction, and methodological quality assessment. A narrative synthesis will be made for the included studies. Besides, if sufficient qualitative data is available, a meta-analysis will be conducted. I2 statistics will be used to assess heterogeneity. RESULTS: This protocol will guide the production of a systematic review that can determine the effect of different encapsulation techniques and encapsulating agents on the antioxidant action of carotenoids. Thus, it will enable the determination of the best encapsulation techniques to promote the preservation and increase of the antioxidant activity, contributing to future research that may reproduce the best carotenoid encapsulation technique in an animal model. CONCLUSION: The systematic review to be produced from this protocol will provide support for the construction of research that evaluates the effect of encapsulation on the antioxidant function of carotenoids and its possible application as a nutraceutical, considering that this functionality is directly associated with health promotion. RECORD OF SYSTEMATIC REVIEW: This review was recorded in the International Register of Prospective Systematic Reviews on January 22, 2020 (registration: CRD42020142065). Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020142065.

Isolamento de pacientes por coorte na pandemia de Coronavírus / Aislamiento de pacientes por cohorte en la pandemia Coronavirus / Isolation of patients by cohort in the Coronavirus pandemic

Objetivo: descrever a experiência de elaboração de Guia sobre isolamento em coorte de pacientes no contexto da pandemia de Coronavírus em uma rede de hospitais públicos de ensino brasileiros. Método: relato de experiência, baseado na observação da construção de Guia sobre isolamento em coorte nos hospitais, desenvolvido durante os meses de julho e agosto de 2020 pelas equipes das Unidades de Vigilância em Saúde, Segurança do Paciente e Gestão da Qualidade dos hospitais, durante a pandemia. Resultados: descreveu-se o processo de elaboração do Guia, apresentado segundo espaços de inovação e as 14 seções relacionadas à coorte de pacientes, baseadas nas recomendações vigentes. Conclusões: este relato de experiência poderá subsidiar outras instituições na adequação dos fluxos dos pacientes isolados por coorte de Coronavírus de forma segura e efetiva.(AU)

Objective:to describe the experience of preparing a Guide on isolation in a cohort of patients in the context of the Coronavirus pandemic in a network of Brazilian public teaching hospitals. Method:experience report based on the observation of the construction of a Guide on isolation in cohort in hospitals, developed during the months of July and August 2020 by the teams of the Health Surveillance, Patient Safety and Quality Management Units in hospitalsduring the pandemic. Results:theGuide elaboration process was described, presented according to innovation spaces and the 14 sections related to the patient cohort, based on the current recommendations. Conclusions: this experience report can help other institutions to adequately adjust safely and effectivelythe flows of patients isolated by a Coronavirus cohort.(AU)

Objetivo:describir la experiencia de elaboración de una Guía sobre aislamiento en una cohorte depacientes en el contexto de la pandemia de Coronavirus en una red de hospitales públicos docentes brasileños. Método:relato de experiencia basado en la observación de la construcción de una Guía sobre aislamiento en cohorte en hospitales, desarrollada durante los meses de julio y agosto de 2020 por los equipos de las Unidades de Vigilancia Sanitaria, Seguridad del Paciente y Gestión de la Calidad en hospitalesdurante la pandemia. Resultados:sedescribió el proceso de elaboración de la Guía, presentado según los espacios de innovación y los 14 apartados relacionados con la cohorte de pacientes, en base a las recomendaciones vigentes. Conclusiones: este informe de experiencia puede ayudar a otrasinstituciones a ajustar de manera adecuada los flujos de pacientes aislados por una cohorte de Coronavirusde forma segura y eficaz.(AU)

Melhoria da qualidade do cuidado à hipertensão gestacional em terapia intensiva / Improvement of the quality of care for gestational hypertension in intensive care

Resumo Objetivo: Avaliar o efeito de um ciclo de melhoria da qualidade na implementação de práticas baseadas em evidências no tratamento de mulheres com doenças hipertensivas gestacionais admitidas em Unidade de Terapia Intensiva Materna (UTIM). Método: Estudo quase-experimental, sem grupo de controle, realizado numa UTIM de um hospital universitário que seguiu as etapas de um ciclo de melhoria da qualidade. Avaliaram-se nove critérios de processo em todas as mulheres admitidas com diagnóstico de doenças hipertensivas gestacionais nos períodos anterior (n = 50) e posterior à intervenção (n = 50) em 2015. Estimou-se a conformidade com intervalo de confiança de 95 %, as não conformidades com gráficos de Pareto e a significância da melhoria com teste do valor Z unilateral (α = 5 %). Resultados: O nível de qualidade inicial foi alto em seis dos nove critérios (amplitude: 94-100 %), as práticas com menor adesão foram a "manutenção de sulfato de magnésio" (54 %), "solicitação de ultrassom fetal" (72 %) e "restrição hídrica intravenosa" (78 %). Houve melhoria absoluta em cinco dos nove critérios (amplitude: 2-16 %), que foi significativa para a solicitação de ultrassom fetal (melhoria absoluta: 16 %; p = 0,023) e para o total de critérios (4 %; p = 0,01). Conclusão: A intervenção de melhoria da qualidade proposta aumentou a adesão às recomendações baseadas em evidência para o tratamento de pacientes com doenças.

Resumen Objetivo: Evaluar el efecto de un ciclo de mejora de la calidad en la implementación de prácticas basadas en la evidencia en el tratamiento de mujeres con enfermedades gestacionales hipertensivas admitidas en la Unidad de Cuidados Intensivos Maternos (UCIM). Método: Estudio cuasiexperimen-tal, sin grupo de control, realizado en una UCIM de un hospital universitario que ha seguido los pasos de un ciclo de mejoramiento de la calidad. Se evaluaron nueve criterios de proceso en todas las mujeres admitidas con un diagnóstico de enfermedades gestacionales hipertensivas en los periodos anterior (n = 50) y posterior a la intervención (n = 50) en 2015. Se estimó el cumplimiento con el intervalo de confianza al 95 %, el porcentaje de no conformidad en los gráficos de Pareto y la significancia del mejoramiento con la prueba de valor Z unilateral (α = 5 %). Resultados: El nivel de calidad inicial fue alto en seis de los nueve criterios (amplitud: 94-100 %), las prácticas con menor adherencia fueron "mantenimiento de sulfato de magnesio" (54 %), "solicitud de ultrasonido fetal" (72 %) y "restricción de agua intravenosa" (78 %). Hubo una mejoría absoluta en cinco de los nueve criterios (amplitud: 2-16 %), que ha sido significativa para la solicitud de ultrasonido fetal (mejoría absoluta: 16 %; p = 0,023) y para el criterio total (4 %; p = 0,01). Conclusión: La intervención de mejoramiento de la calidad propuesta incrementó el cumplimiento de las recomendaciones basadas en la evidencia para el tratamiento de pacientes con hipertensión gestacional ingresados en una UCIM.

Abstract Objective: To assess the effect of a cycle of quality improvement on the implementation of evidence-based practices in the treatment of women with gestational hypertensive diseases admitted to the Maternal Intensive Care Unit (MICU). Method: Quasi-experimental study, without a control group, performed in a MICU of a university hospital which followed the steps of a cycle of quality improvement. Nine process criteria were assessed in all women admitted with a diagnosis of gestational hypertensive diseases in the periods before (n = 50) and after the intervention (n = 50) in 2015. The compliance was estimated with the confidence interval of 95 %, the non-conformities with Pareto charts and the significance of improvement with one-tailed Z-test (α = 5 %). Results: The initial quality level was high in six out of nine criteria (amplitude: 94-100 %), the practices with the lowest adherence were "magnesium sulfate maintenance" (54 %), "fetal ultrasound request" (72 %) and "intravenous fluid restriction" (78 %). There was absolute improvement in five out of nine criteria (amplitude: 2-16 %), which was significant for fetal ultrasound request (absolute improvement: 16 %; p = 0.023) and for the total criteria (4%; p = 0.01). Conclusion: The proposed intervention of quality improvement increased the adherence to evidence-based recommendations for the treatment of patients with gestation-al hypertension admitted to a MICU.

Acesso e implicações da automedicação em idosos na atenção primária à saúde / Access and implications of self-medication in the elderly in primary health care / Acceso e implicaciones de la automedicación en ancianos en la atención primaria de salud

Objetivo: avaliar o acesso e sua interferência no processo da automedicação em idosos. Método: estudo de avaliação de serviços com corte seccional, com idosos de ambos os sexos, que utilizam os serviços da atenção primária à saúde, pertencente ao município de Natal, Rio Grande do Norte. Foram realizadas 121 entrevistas, em nove unidades básicas de saúde no ano de 2016. Os dados foram analisados a partir do teste T de Student e o teste Qui-Quadrado, para determinar a significância estatística entre as variáveis independentes e os desfechos. Resultados: a prevalência de automedicação foi de 66,7%, associada negativamente ao acesso, atributo desfavoravelmente avaliado pelos idosos (média de 3,4). A febre (19,8%) foi a principal queixa motivadora de automedicação, sendo os analgésicos, os fármacos mais utilizados na automedicação. A automedicação apresentou associação significativa entre idade e medicamento sem prescrição médica para febre e cefaleia. Conclusão: apesar de não ter encontrado associação entre acesso e automedicação, foi identificada a alta prevalência dessa prática. Assim, é necessário que haja o fortalecimento da atenção primária, por meio de políticas voltadas às necessidades dos idosos com abordagem integral e com maior acesso ao atendimento multidisciplinar e multiprofissional, e não apenas a oferta de medicamentos.

Objective: to evaluate the access and its interference in the process of selfmedication in the elderly. Method: evaluation study of cross-sectional services with elderly men and women who use primary health care services in the city of Natal, Rio Grande do Norte. A total of 121 interviews were conducted in 09 basic health units of the municipality in 2016. Data were analyzed using the Student's ttest and chi-square test to determine the statistical significance between the two independent variables and outcomes. Results: the prevalence of self-medication was 66.7%, being negatively associated with access, a negatively assessed attribute in the perception of the elderly, showing an unsatisfactory degree (mean of 3.4). Fever (19.8%) was the main motivating complaint of self-medication, with analgesics being the most used self-medication. Self-medication showed a significant association between age and nonprescription medication for fever and headache. Conclusion: despite not finding an association between access and selfmedication, the high prevalence of this practice was identified. Thus, it is necessary to strengthen primary care through policies focused on the needs of the elderly with a comprehensive approach and greater access to multidisciplinary and multiprofessional care, not just the supply of medicines.

Objetivos: evaluar el acceso y su interferencia en el proceso de la automedicación en ancianos. Metodo: Estudio de evaluación de servicios transversales con ancianos que utilizan los servicios de Atención Primaria a la Salud en la cidad de Natal, Rio Grande do Norte. Se realizaron 121 entrevistas, en nueve unidades de atención primaria de salud en 2016. Los datos se analizaron mediante la prueba t de Student y la prueba de chi-cuadrado para determinar la significacíon estadística entre las variables independentes y resultados. Resultados: La prevalencia de la automedicación fue del 66,7%, asociada negativamente al acceso, un atributo desfavorablemente evaluado por los ancianos(media de 3,4). La fiebre (19,8%) fue la principal queja motivadora de la automedicación, siendo los analgésicos la automedicacíon más utilizados. La automedicación msotró asociación significativa entre edad y la medicacíon sin receta para la fiebre e el dolor de cabeza. Conclusión: aunque no se encontró asociación entre el acceso y la automedicación, se identificó la alta prevalencia de esta práctica. Por lo tanto, es necesario fortalecer la atención primaria a través de políticas centradas en las necesidades de las personas mayores con un enfoque integral y un mayor acceso a la atención multidisciplinaria y multiprofesional, no solo el suministro de medicamentos.

Mechanisms of action of molecules with anti-TNF-alpha activity on intestinal barrier inflammation: A systematic review protocol.

BACKGROUND: Tumor necrosis factor-alpha (TNF-alpha), among cytokines that mediate the inflammatory process, plays an important role in diseases involving the loss of intestinal barrier integrity. Several molecules with anti-TNF-alpha activity have been studied aiming to develop new therapies. The purpose of this paper is to describe the systematic review protocol of experimental studies that determine mechanisms of action of molecules with anti-TNF-alpha activity on intestinal barrier inflammation. METHODS: This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes Protocols (PRISMA-P). The databases to be searched are PubMed, EMBASE, Scopus, ScienceDirect, and Web of Science. Experimental studies in rats or mice that assessed the activity of anti-TNF-alpha molecules in models of intestinal barrier inflammation will be included in the systematic review. Studies characteristics, experimental model, and main results will be described and the bias risk assessment will be performed. Two independent reviewers will perform study selection, data extraction, and methodological quality assessment. A narrative synthesis will be made for the included studies. Also, if sufficient data is available, a meta-analysis will be conducted. I statistics will be used to assess heterogeneity. RESULTS: The present protocol will assist in producing a systematic review that identifies the mechanisms underlying the reduction of TNF-alpha in intestinal barrier inflammation models. CONCLUSION: The systematic review may contribute to the theoretical basis of research on new molecules with anti-TNF-alpha potential and, consequently, in the development of new therapies employed in humans. PROSPERO REGISTRATION NUMBER: CRD42019131862.

Protocol for systematic reviews of school-based food and nutrition education intervention for adolescent health promotion: Evidence mapping and syntheses.

BACKGROUND: Nutrition is an important modifiable factor in combating overweight and obesity among adolescents. School has been indicated as an effective environment for influencing eating behavior; however, recent reviews assessing school-based interventions specifically for adolescents are scarce. Therefore, we propose the present systematic review with the aim to comprehensively review the quantitative and qualitative literature on the effects of school-based food and nutrition education interventions on adolescent health promotion through healthy eating habits. METHODS: We will search MEDLINE/PubMed, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, and ADOLEC. We will include randomized controlled trials (RCT), non-RCT, and controlled before-after studies. Risk of bias will be assessed using the EPOC Risk of Bias Tool for RCT, Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for non-RCT or controlled before-after, as well as the Critical Appraisal Skills Program (CASP) checklist for qualitative studies. We will analyze the overall strength of the evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Two independent researchers will conduct all evaluations and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be analyzed by the RevMan 5.3 software. We will conduct the study in accordance with the guideline of the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols. RESULT: This review will evaluate the effects of school-based food and nutrition education interventions on adolescent health promotion through healthy eating habits. The primary outcome will be changes in adolescent food consumption. Secondary outcomes will be biological parameters (e.g., body mass index (BMI), waist circumference (WC), body composition, etc); biochemical parameters (e.g., glycemia, triglycerides, total cholesterol, etc); qualitative evidences that support or explain the effect of school-based food and nutrition education interventions on adolescent food consumption. CONCLUSION: The findings of this systematic review will summarize the latest evidence of the effects of school-based food and nutrition education interventions on adolescent health promotion. The findings will be an available reference for school-based interventions and other further research. REGISTRATION: PROSPERO CRD42019116520.

Distribuição da morbimortalidade por violência em idosos no Rio Grande do Norte / Distribution of morbidity and mortality by violence against elderly people in Rio Grande do Norte

Resumo Objetivo: analisar a morbimortali-dade decorrente da violência e maus tratos contra idosos no Rio Grande do Norte (RN) (Brasil), no período de 2000 a 2010, e analisar sua distribuição espacial. Metodologia: estudo ecológico, utilizando o índice de Moran Local-LiSA, com valor de p < 0,05, considerado para significância estatística. No estudo da morbimortalidade em idosos por agressões no RN, separada por sexo, os dados foram coletados a partir do DATASOS. A população estudada foi o grupo dos idosos residentes no estado do RN que faleceram ou foram internados em função de violência ou maus tratos no período analisado. Resultados: a mortalidade e morbidade por agressões no RN da população idosa entre 2000 e 2010 apontam maior incidência no sexo masculino (90 %) do que no feminino (85 %). Na análise geoespacial da mortalidade, destacou-se que no sexo feminino há maior concentração de casos nas áreas leste e central do estado e masculino nas regiões oeste e Agreste. Os dados sobre morbidade apontam concentração nas regiões leste e Agreste para as mulheres e para os homens nas regiões leste, oeste e central. Não houve significância estatística, provavelmente em função de número reduzido de ocorrências e isso pode indicar subnotificações. Conclusão: a identificação das áreas desfavoráveis aponta à necessidade de averiguar a existência de casos não notificados de violência contra idosos, a fim de levantar dados que possam embasar a construção de estratégias conjuntas de enfrentamen-to a essas violações envolvendo saúde, assistência social e sociedade civil.

Resumen Objetivo: analizar la morbimortalidad derivada de la violencia y malos tratos contra adultos mayores en Rio Grande do Norte (RN) (Brasil), en el periodo 2000-2010 y analizar su distribución espacial. Metodología: estudio ecológico que utiliza el índice de Moran Local-LiSA, con valor de p < 0,05 considerado para significancia estadística. En el estudio de morbimortalidad de adultos mayores por agresiones en RN, separada por sexo, los datos se recolectaron mediante DATAsus. La población en estudio fue el grupo de los ancianos residentes en el estado de RN que fallecieron o fueron internados en función de violencia o malos tratos en el periodo analizado. Resultados: la mortalidad y morbilidad por agresiones en RN en la población anciana entre 2000 y 2010 presentan mayor incidencia en el sexo masculino (90 %) que en el femenino (85 %). En el análisis geoespacial de la mortalidad se destacó que en el sexo femenino hay mayor concentración de casos en las áreas Este y Central del estado y masculino en las regiones Oeste y Agreste. Los datos sobre morbilidad apuntan concentración en las regiones Este y Agreste para las mujeres y para los hombres en las regiones Este, Oeste y Central. No hubo significancia estadística probablemente en función de un número reducido de ocurrencias, lo que puede indicar subnotificaciones. Conclusión: la identificación de áreas desfavorables señala la necesidad de indagar por la existencia de casos no notificados de violencia contra ancianos, a fin de levantar datos que puedan sustentar la construcción de estrategias conjuntas de enfrentamiento a esas violaciones, involucrando salud, asistencia social y sociedad civil.

Abstract Objective: to analyze morbidity and mortality resulting from violence and abuse against elderly in Rio Grande do Norte (RN) (Brazil), in the period 2000-2010, and study its spatial distribution. Methodology: eco-friendly study that uses Moran Local-LiSA index, with value of p < 0.05, considered for statistical significance. In morbidity and mortality, separated by sex, in elderly by attacks in RN, the data were collected by DATASUS. The population under study was the group of elderly residents in the State of RN who died or were interned because of violence or abuse in the analyzed period. Results: mortality and morbidity by assaults on RN in the elderly population between 2000 and 2010 are higher in males (90 %) than in females (85 %). In mortality geospa-tial analysis it was highlighted that there is higher concentration of cases of females in the East and Central areas of the State, and males in the West and Agreste areas. Data on morbidity indicate concentration in the East and Agreste regions for women and in the East, West and Central regions for men. There was no statistical significance based on a small number of occurrences, which may indicate sub-notifications. Conclusion: the identification of unfavorable areas indicates the need to investigate the existence of non-notified cases of violence against elderly people, in order to get data that may support the creation of joint strategies of confrontation to those violations, involving health, social assistance, and civil society.

Implementação de um painel de indicadores on-line para segurança do paciente / Implementation of an online indicator panel for patient safety / Implementación de un panel de indicadores on-line para la seguridad del paciente

Objetivo: Apresentar o processo de implementação de um painel de indicadores de segurança do paciente (PISP) para benchmarking em uma rede de hospitais universitários federais (HUF) brasileiros administrados por uma empresa pública. Síntese dos dados: Descrição de experiência de criação de ferramenta eletrônica, responsável pela temática segurança do paciente, ocorrida entre janeiro de 2016 e dezembro de 2018. A construção do PISP seguiu as seguintes etapas: definição de 62 indicadores de saúde; apresentação, qualificação e uniformização dos dados a serem coletados; cadastro dos responsáveis dos HUF na plataforma web; e alimentação do sistema, com a inserção dos dados pelos 39 HUF. A implantação do PISP priorizou 23 indicadores utilizados por instituições acreditadoras e recomendados por documentos nacionais, distribuídos entre indicadores de processo (13%) e de resultado (87%). Os resultados foram o envolvimento dos 39 HUF, a troca de experiências, o compartilhamento de informações e a institucionalização do Programa Gestão à Vista, que oportuniza o monitoramento contínuo desses indicadores na instituição para o aprimoramento da qualidade dos serviços de saúde. A experiência trouxe imenso aprendizado, proporcionando aos envolvidos desenvolver habilidades durante o processo. Destacam-se como dificuldade o processo de implantação de uma cultura de avaliação contínua e como facilidade a disponibilidade dos atores envolvidos na adesão dessa proposta. Conclusão: O painel de indicadores de segurança do paciente apresenta-se como recurso inovador no monitoramento de processos e resultados da implantação dos Núcleos de Segurança do Paciente, trazendo uma característica importante de sistemas de gestão da qualidade: transparência na gestão e divulgação de resultados.

Objective: To present the process of implementing a patient safety indicators panel (PISP) for benchmarking in a network of Brazilian federal university hospitals (HUF) managed by a public company. Synthesis of data: Description of the experience of creating an electronic tool, responsible for thematic patient safety, which took place between January 2016 and December 2018. The construction of the PISP followed the following steps: definition of 62 health indicators; presentation, qualification, and standardization of the data to be collected; registration of HUF managers on the web platform; and feeding the system, with data input by the 39 HUF. The implementation of the PISP prioritized 23 indicators used by accrediting institutions and recommended by national documents, distributed among process (13%) and result (87%) indicators. The results were the involvement of the 39 HUFs, the exchange of experiences, the sharing of information, and the institutionalization of the Management in Sight Program, which provides opportunities for the continuous monitoring of these indicators in the institution to improve the quality of health services. The experience brought immense learning, allowing those involved to develop skills during the process. The process of implementing a culture of continuous evaluation stands out as difficulty and the availability of the actors involved in adhering to this proposal as ease. Conclusion: The panel of patient safety indicators presents itself as an innovative resource in monitoring the processes and results of the implementation of the Patient Safety Centers, bringing an important characteristic of quality management systems: transparency in the management and dissemination of results.

Objetivo: Presentar el proceso de implementación de un panel de indicadores de seguridad del enfermo (PISE) para benchmarking en una red de hospitales universitarios federales (HUF) brasileños administrados por una empresa pública. Síntesis de los datos: Descripción de la experiencia de creación de la herramienta electrónica responsable por la temática seguridad del enfermo que se dio entre enero de 2016 y diciembre de 2018. La construcción del PISE siguió las etapas a continuación: definición de 62 indicadores de salud; presentación, cualificación y uniformización de los datos a recoger; registro de los responsables de los HUF en la plataforma web; y alimentación del sistema con la inserción de los datos de los 39 HUF. La implantación del PISE ha priorizado 23 indicadores utilizados por las instituciones acreditadoras y recomendadas por documentos nacionales distribuidos entre los indicadores de proceso (13%) y de resultado (87%). Los resultados fueron el envolvimiento de los 39 HUF, el cambio de experiencias, el compartir de informaciones y la institucionalización del Programa Gestión a la Vista que ofrece la oportunidad del monitoreo continuo de los indicadores en la institución para el enriquecimiento de la calidad de los servicios de salud. La experiencia trajo mucho aprendizaje promocionando a los involucrados el desarrollo de habilidades durante el proceso. Se destaca como dificultad el proceso de implantación de una cultura de evaluación continua y como facilidad la disponibilidad de los actores involucrados en la adhesión a esa propuesta. Conclusión: El panel de indicadores de seguridad se presenta como recurso innovador para el monitoreo de procesos y resultados de la implantación de los Núcleos de Seguridad del Enfermo con una característica importante de los sistemas de gestión de la calidad: la transparencia de la gestión y la divulgación de los resultados.

Prevalence and factors associated with alterations of the temporomandibular joint in institutionalized elderly / Prevalência e fatores associados a alterações na articulação temporomandibular em idosos institucionalizados

Abstract This article aims to analyze the prevalence and associated factors of TMJ alterations in elderly institutionalized. An cross-sectional study of 1192 elderly institutionalized in Brazil was undertaken. Intra and extra-oral exams were performed and the TMJ was evaluated based on the Oral Health Assessment Form of the WHO (1997). Demographic data and elderly dependence were also collected. The self-perception of the elderly regarding oral health was measured using the Geriatric Oral Health Assessment Index - GOHAI. Data analysis was performed using the Chi-squared test and robust Poisson regression (level of significance of 5%). The prevalence of TMJ alteration was low compared to adults and was only associated with the state of dependence of the elderly individual (independent had 45.4% more alterations than dependent individuals), gender (women had 47.4% more alterations), self-perception of oral health (who evaluated negatively had 65.6% more alterations) and the need of upper dentures (who needed some kind of upper dentures had 45.8% more alterations than those who did not). Despite being low, the presence of alterations in the TMJ was more frequent in elderly independent, women, who evaluated negatively oral health and need some kind of upper dentures.

Resumo O objetivo deste artigo é avaliar a prevalência e os fatores associados a alterações na ATM em idosos institucionalizados. Estudo observacional e transversal, conduzido em 1.192 idosos brasileiros. Foram realizados exames intra e extraoral, baseados na Ficha de Avaliação da OMS (1997). Dados demográficos e nível de dependência também foram coletados. A autopercepção do idoso quanto à saúde bucal foi obtida através do GOHAI (Geriatric Oral Health Assessment Index). Na análise dos dados foram usados o teste do Qui-quadrado e a Regressão robusta de Poisson (nível de significância de 5%). A presença de alguma alteração na ATM foi pouco prevalente quando comparada a dos adultos, e esteve associada à condição de dependência do idoso (os independentes tiveram 45,4% mais alterações do que os dependentes), ao sexo (mulheres tiveram 47,4% mais alterações), à autopercepção de saúde bucal (quem avaliou negativamente teve 65,6% mais alterações) e à necessidade de prótese (PT) superior (quem necessita de algum tipo de PT superior teve 45,8%). Apesar de ter sido baixa, a presença de alterações na ATM esteve mais frequente em idosos independentes, do sexo feminino, que avaliaram negativamente a saúde bucal e que necessitam de algum tipo de PT superior.

Ações desenvolvidas por cuidadores de idosos institucionalizados no Brasil / Actions developed by institutionalized caregivers of the elderly in Brazil

Resumo Objetivo: analisar as ações desenvolvidas por cuidadores de idosos direcionadas a residentes de Instituições de Longa Permanência para Idosos no Brasil (ILPI). Método: estudo de natureza qualitativa com análise de dados quantitativa, sendo classificado como observacional e analítico, desenvolvido em 36 ILPI selecionadas em 11 municípios brasileiros de médio e grande porte, distribuídas nas 5 regiões geográficas brasileiras. Foram realizadas entrevistas com os cuidadores no período de 2008 a 2011. A análise do material discursivo (corpus) foi mediada pelo software de análise quantitativa dos dados textuais, o Analyse Lexicale par Contexte d'un Ensemble de Segments de Texte (ALCESTE), versão 4.9 para Windows. Resultados: participaram da pesquisa 117 cuidadores de idosos das ilpi estudadas. A maioria dos cuidadores pertence ao sexo feminino e trabalha em ilpi sem fins lucrativos (filantrópica). O material textual originou 5 classes semânticas, as quais foram distribuídas em dois eixos principais. O primeiro eixo denominado foi Assistência à saúde do idoso institucionalizado e o segundo eixo Atividades habituais dos cuidadores nas ILPI. Conclusões: os discursos puderam trazer à tona que as principais ações realizadas estão relacionadas ao cuidado direto ao idoso, como a alimentação, higiene pessoal -bucal e geral- e administração de medicamentos. Além disso, a saúde bucal ocupa um lugar de relevância para os cuidadores, apesar de relatarem dificuldades para realização desta prática.

Resumen Objetivo: analizar las acciones realizadas por cuidadores de ancianos dirigidas a residentes de instituciones de larga estancia para ancianos (ILEA) en Brasil. Metodología: estudio de naturaleza cualitativa con análisis de datos cuantitativo, clasificado como observacional y analítico, desarrollado en 36 ilea seleccionadas en 11 municipios brasileños de medio y gran porte, distribuidas en las 5 regiones geográficas. Se realizaron entrevistas a los cuidadores en el periodo 2008-2011. El análisis del material discursivo (corpus) fue mediado por el software de análisis cuantitativo de datos textuales Analyse Lexicale par Contexte d'un Ensemble de Segments de Texte (ALCESTE), la versión 4.9 para Windows. Resultados: los participantes fueron 117 cuidadores de ancianos de las ilea estudiadas. La mayoría de los cuidadores son mujeres y trabajan en ilea sin ánimo de lucro (filantrópicas). El material textual originó 5 clases semánticas que se dividieron en dos ejes principales. El primer eje se denominó Asistencia a la salud de ancianos institucionalizados y el segundo eje Actividades habituales de cuidadores en ILEA. Conclusiones: los discursos evidenciaron que las principales acciones realizadas están relacionadas con el cuidado directo al anciano, como la alimentación, higiene personal -bucal y general- y administración de medicamentos. Además, la salud bucal ocupa un lugar de relevancia para los cuidadores, a pesar de que relaten dificultades para realizar esta práctica.

Abstract Objective: to analyze the actions taken by caregivers of the elderly aimed at long-stay institutions for elderly residents (LSIE) in Brazil. Methodology: qualitative study with quantitative data analysis, classified as observational and analytical, developed in 36 (LSIE) selected in 11 Brazilian municipalities of medium and large size, distributed in the 5 Brazilian geographic regions. Interviews were carried out with the care-givers from 2008 to 2011. The analysis of the discursive material (corpus) was mediated by quantitative analysis software of textual data, Analyse lexicale par Contexte d'un Ensemble de Segments de Texte (ALCESTE), version 4.9 for Windows. Results: the participants were 117 elderly institutionalized caregivers of LSIE. Most caregivers are female and work in philanthropic institutions. The textual material originated 5 semantic classes, which were divided into two fundamental areas. The first area was called Assistance to the health of institutionalized elderly and the second area Usual activities of caregivers in LSIE. Conclusions: the speeches showed that the main actions carried out are related to direct care to the elderly, such as food, personal hygiene -oral and general- and medication administration. In addition, oral health occupies a place of relevance for caregivers, despite the fact that they report difficulties to perform this practice.