Religiosidade/espiritualidade no processo de formação do profissional de saúde: relato de experiência / Religiosity/spirituality in the health professional training process: experience report / Religiosidad/espiritualidad en el proceso educativo de profesionales de la salud: relato de experiencia

INTRODUÇÃO: Por muito tempo os profissionais de saúde seguiram um modelo com uma visão fragmentada do cuidado, focado apenas na doença. Atualmente, esse modelo tem mudado e os profissionais têm adotado uma visão integral do sujeito, ampliando o entendimento de saúde para aspectos biopsicossociais e espiritual no conceito multidimensional de saúde. OBJETIVOS: analisar o processo de formação do profissional de saúde durante a pós-graduação sobre a inclusão da religiosidade e espiritualidade como prática de cuidado em saúde, e identificar as etapas vivenciadas. MÉTODO: Trata-se de uma pesquisa qualitativa, que tem como base metodológica um relato de experiência de março de 2021 a novembro de 2022, a partir da prática de uma residente fisioterapeuta do Programa Multiprofissional em Clínica da Pessoa e da Família. RESULTADOS E DISCUSSÃO: Foram definidos a divisão e o compartilhamento de algumas fases de aprendizado durante a residência: (1) Desconhecimento sobre o tema na graduação, (2) Introdução teórica ao tema da Espiritualidade e (3) Abordagem com os pacientes e os impactos na minha formação. A análise das etapas foi realizada com base nas leituras de artigos científicos realizadas para embasamento do presente estudo. CONSIDERAÇÕES FINAIS: É importante que mais estudos sobre o tema sejam desenvolvidos, com objetivo de incentivar discussões sobre o assunto nas universidades, para que futuros profissionais de saúde tenham uma formação humanizada, ademais, desenvolver métodos eficazes para integração da espiritualidade na prática clínica e construir/validar escalas no Brasil.

INTRODUCTION: For a long time, health professionals followed a model with a fragmented view of care, focused only on the disease. Currently, this model has changed and professionals have adopted an integral view of the subject, expanding the understanding of health to biopsychosocial and spiritual aspects in the multidimensional concept of health. OBJECTIVES: analyze the training process of health professionals during postgraduate studies on the inclusion of religion and spirituality as a health care practice, identifying the stages experienced. METHOD: This is qualitative research and its methodological basis is an experience report from March 2021 to November 2022, based on the practice of a physiotherapist resident of the Multiprofessional Program in Clínica da Pessoa e da Família. RESULTS AND DISCUSSION: It was defined the division and sharing of some learning phases during the residency: (1) Lack of knowledge about the subject in graduation, (2) Theoretical introduction to the theme of Spirituality and (3) Approach with patients and the impacts on my training. The analysis of the stages was carried out based on the readings of scientific articles carried out for the basis of the present study. FINAL CONSIDERATIONS: It is important that more studies on the subject be developed with the aim of encouraging discussions on the subject in universities so that future health professionals have a humanized training, in addition, to develop effective methods for integrating spirituality into clinical practice and to build/validate scales in Brazil.

INTRODUCCIÓN: Durante mucho tiempo, los profesionales de la salud siguieron un modelo con una visión fragmentada del cuidado, centrado únicamente en la enfermedad. Actualmente, ese modelo ha cambiado y los profesionales han adoptado una visión integral del tema, ampliando la comprensión de la salud a aspectos biopsicosociales y espirituales en el concepto multidimensional de la salud. OBJETIVOS: analizar el proceso de formación de los profesionales de la salud durante los estudios de posgrado sobre la inclusión de la religión y la espiritualidad como práctica de atención a la salud, identificando las etapas vividas. MÉTODO: Esta es una investigación cualitativa y su base metodológica es un relato de experiencia de marzo de 2021 a noviembre de 2022, basado en la práctica de un fisioterapeuta residente del Programa Multiprofesional en la Clínica da Pessoa e da Família. RESULTADOS Y DISCUSIÓN: Se definió la división y puesta en común de algunas fases de aprendizaje durante la residencia: (1) Falta de conocimiento sobre el tema en la graduación, (2) Introducción teórica al tema de la Espiritualidad y (3) Acercamiento con los pacientes y los impactos en mi entrenamiento. El análisis de las etapas se realizó a partir de las lecturas de artículos científicos realizadas para la base del presente estudio. CONSIDERACIONES FINALES: Es importante que se desarrollen más estudios sobre el tema con el objetivo de incentivar discusiones sobre el tema en las universidades para que los futuros profesionales de la salud tengan una formación humanizada, además de desarrollar métodos efectivos para integrar la espiritualidad en la práctica clínica y para construir/validar escalas en Brasil.

A native strain of Bacillus subtilis increases lipid accumulation and modulates expression of genes related to digestion and amino acid metabolism in Litopenaeus vannamei.

In the field of shrimp aquaculture, the utilization of probiotics represents a promising avenue, due to the well-documented benefits conferred by these microorganisms. In the current study, a Bacillus subtilis strain, referred to as strain E, was isolated from the gastrointestinal tract of the shrimp Litopenaeus vannamei and subsequently identified via molecular methods and phylogeny. The probiotic potential of strain E was characterized, and its application as a feed shrimp additive was evaluated in a 45-day experiment. Several parameters were assessed, including zootechnical performance, muscle tissue proximate composition, hepatopancreas lipid concentration, and the expression of genes associated with digestion, amino acid metabolism, and antioxidant defense mechanisms in various shrimp tissues. Although no significant impact on zootechnical performance was observed, supplementation with strain E led to an increase in lipid concentration within both muscle and hepatopancreas tissues. Furthermore, a marked decrease in the expression of genes linked to digestion and amino acid metabolism was noted. These findings suggest that the addition of the B. subtilis strain E to shrimp feed may enhance nutrient absorption and modulate the expression of genes related to digestion and amino acid metabolism.

Efeitos anti-inflamatórios do extrato alcoólico de folhas de garcinia gardneriana na peritonite induzida por lipopolissacarídeo / Anti-inflammatory effects of garcinia gardneriana leaf extract on lipopolysaccharideinduced peritonitis

Introdução: A Garcinia gardneriana é utilizada na medicina tradicional brasileira para o tratamento de tumores, inflamações e alívio de dores, mas as informações científicas são ainda limitadas. Objetivos: Diante do uso popular e o anseio por efeitos colaterais mínimos, o objetivo geral deste estudo foi avaliar as propriedades anti-inflamatórias da G. gardneriana em modelo de peritonite induzido por lipopolissacarideo (LPS). Métodos: Ratos Wistar foram divididos aleatoriamente em 3 grupos (n= 5/ grupo): controle, induzido à peritonite e não tratado e induzido à peritonite e tratado com extrato de folhas alcoólico de G. gardneriana a 4%. A peritonite foi induzida por única injeção intraperitoneal de LPS (1 mg/kg). O tratamento com o extrato foi realizado por gavagem (1 ml), administrado antes e 12h após a injeção do LPS. Os ratos foram eutanasiados após 24h da indução de peritonite. Amostras de sangue foram coletadas para análise plasmática de histamina, o lavado intraperitoneal para quantificação de neutrófilos e o intestino delgado para processamento histológico, quantificação de mastócitos e imuno-histoquímica da expressão da proteína Anexina A1 (AnxA1). Resultados: As análises quantitativas indicaram os efeitos anti-inflamatórios do extrato, pela redução do recrutamento de neutrófilos para a cavidade peritoneal e a diminuição da quantidade de mastócitos na lâmina própria do intestino delgado, comparadas aos animais não tratados. Não houve diferença estatística dos níveis de histamina. A imuno-histoquímica indicou diminuição acentuada da expressão da AnxA1 na mucosa intestinal dos animais tratados. Conclusão: Nossos dados demonstraram que o extrato alcoólico de G. gardneriana tem forte ação anti-inflamatória e potencial terapêutico para o desenvolvimento de fitoterápicos com propriedades anti-inflamatórias

Introduction: Garcinia gardneriana is used in traditional Brazilian medicine for the treatment of tumors, inflammation and relief of pain, but scientific information is still limited. Objective: In the face of popular use and the desire for minimal side effects, the general objective of this study was to evaluate the anti-inflammatory properties of G. gardneriana in a model of lipopolysaccharide-induced peritonitis (LPS). Methods: Wistar rats were randomly divided into 3 groups (n = 5 / group): control, induced to peritonitis and untreated and induced to peritonitis and treated with 4% alcoholic extract of G. gardneriana leaves. Peritonitis was induced by single intraperitoneal injection of LPS (1 mg/kg). Treatment with the extract was performed by gavage (1 ml), given before and 12h after LPS injection. The rats were euthanized 24h after the peritonitis induction. Blood samples were collected for plasma analysis of histamine, intraperitoneal lavage for quantification of neutrophils and the small intestine for histological processing for quantification of mast cells, and immunohistochemical analysis of the expression of Annexin A1 (AnxA1) protein. Results: Quantification analyses indicated the anti-inflammatory effects of the extract by reducing the recruitment of neutrophils into the peritoneal cavity and reducing the amount of mast cells in the lamina propria of the small intestine compared to the untreated animals. There was no statistical difference in the levels of histamine. Immunohistochemical studies indicated a marked decrease of the AnxA1 expression in the intestinal mucosa of the treated animals. Conclusion: Our data demonstrated that the alcoholic extract of G. gardneriana has a strong anti-inflammatory action and therapeutic potential for the development of herbal products with anti-inflammatory properties

Introducción: Garcinia gardneriana se utiliza en la medicina tradicional brasileña para el tratamiento de tumores, inflamaciones y alivio del dolor, pero la información científica aún es limitada. Objetivo: Frente al uso popular y la búsqueda de efectos secundarios mínimos, lo objetivo general de este estudio fue evaluar las propiedades antiinflamatorias de G. gardneriana en un modelo de peritonitis inducido por lipopolisacárido (LPS). Métodos: Se dividieron aleatoriamente ratas Wistar en 3 grupos (n= 5/grupo): control, inducido a peritonitis y no tratado, e inducido a peritonitis y tratado con extracto alcohólico de hojas de G. gardneriana al 4%. La peritonitis fue inducida por una única inyección intraperitoneal de LPS (1 mg/kg). El tratamiento con el extracto se realizó por gavaje (1 ml), administrado antes y 12 horas después de la inyección de LPS. Las ratas fueron sacrificadas después de 24 horas de la inducción de peritonitis. Se recopilaron muestras de sangre para el análisis plasmático de histamina, el lavado intraperitoneal para la cuantificación de neutrófilos y el intestino delgado para el procesamiento histológico, la cuantificación de mastocitos y la inmunohistoquímica de la expresión de la proteína Anexina A1 (AnxA1). Resultados: Los análisis cuantitativos indicaron los efectos antiinflamatorios del extracto, mediante la reducción del reclutamiento de neutrófilos en la cavidad peritoneal y la disminución de la cantidad de mastocitos en la lámina propia del intestino delgado, en comparación con los animales no tratados. No hubo diferencia estadística en los niveles de histamina. La inmunohistoquímica indicó una disminución pronunciada de la expresión de AnxA1 en la mucosa intestinal de los animales tratados. Conclusión: Nuestros datos demostraron que el extracto alcohólico de G. gardneriana tiene una fuerte acción antiinflamatoria y potencial terapéutico para el desarrollo de fitoterapéuticos con propiedades antiinflamatorias.

Mapa de evidências - Benefícios da atividade física para saúde da população / Map of evidence - Benefits of physical activity for the health of the population

Este mapa de evidências tem como objetivo apresentar os potenciais benefícios da atividade física para a saúde da população. ● Foram incluídas 131 revisões sistemáticas, sendo os estudos primários realizados principalmente nos Estados Unidos (46,5%). ● As intervenções foram classificadas em 4 categorias e 30 subcategorias. Observou-se maior frequência da categoria "exercícios físicos aeróbicos", e da subcategoria "práticas integrativas e complementares de saúde". ● Os desfechos foram classificados em clínicos, não clínicos e eventos adversos. Desfechos clínicos foram relatados em 100 revisões sistemáticas, com destaque para sintomas e transtornos depressivos, índice de massa corporal, e sintomas e transtornos de ansiedade. Desfechos não clínicos foram relatados em 70 revisões sistemáticas, com destaque para qualidade de vida. Eventos adversos foram relatados em 14 revisões sistemáticas. ● Três categorias de intervenções apresentaram efeito positivo acima de 50% para os desfechos avaliados: Exercícios aeróbicos; Exercícios físicos não especificados; Intervenções combinadas.

This evidence map aims to present the potential benefits of physical activity for the health of the population. ● 131 systematic reviews were included, with the primary studies conducted mainly in the United States (46.5%). ● Interventions were classified into 4 categories and 30 subcategories. There was a higher frequency of the category "aerobic physical exercises", and of the subcategory "integrative and complementary health practices". ● Outcomes were classified into clinical, non-clinical and adverse events. Clinical outcomes were reported in 100 systematic reviews, with emphasis on depressive symptoms and disorders, body mass index, and anxiety symptoms and disorders. Non-clinical outcomes were reported in 70 reviews systematic, with emphasis on quality of life. Adverse events were reported in 14 systematic reviews. ● Three categories of interventions showed a positive effect above 50% for the evaluated outcomes: Aerobic exercises; Unspecified physical exercises; Combined interventions.

Eicosapentaenoic acid-rich oil supplementation activates PPAR-γ and delays skin wound healing in type 1 diabetic mice.

Delayed wound healing is a devastating complication of diabetes and supplementation with fish oil, a source of anti-inflammatory omega-3 (ω-3) fatty acids including eicosapentaenoic acid (EPA), seems an appealing treatment strategy. However, some studies have shown that ω-3 fatty acids may have a deleterious effect on skin repair and the effects of oral administration of EPA on wound healing in diabetes are unclear. We used streptozotocin-induced diabetes as a mouse model to investigate the effects of oral administration of an EPA-rich oil on wound closure and quality of new tissue formed. Gas chromatography analysis of serum and skin showed that EPA-rich oil increased the incorporation of ω-3 and decreased ω-6 fatty acids, resulting in reduction of the ω-6/ω-3 ratio. On the tenth day after wounding, EPA increased production of IL-10 by neutrophils in the wound, reduced collagen deposition, and ultimately delayed wound closure and impaired quality of the healed tissue. This effect was PPAR-γ-dependent. EPA and IL-10 reduced collagen production by fibroblasts in vitro. In vivo, topical PPAR-γ-blockade reversed the deleterious effects of EPA on wound closure and on collagen organization in diabetic mice. We also observed a reduction in IL-10 production by neutrophils in diabetic mice treated topically with the PPAR-γ blocker. These results show that oral supplementation with EPA-rich oil impairs skin wound healing in diabetes, acting on inflammatory and non-inflammatory cells.

Spondias sp: Shedding Light on Its Vast Pharmaceutical Potential.

Many plants are used by the population through popular knowledge passed from generation to generation for the treatment of various diseases. However, there is not always any scientific content supporting these uses, which is very important for safety. One of these plants is the fruit of the Spondias genus, which during its processing generates various residues that are discarded, but which also have pharmacological properties. The focus of this review is to survey the pharmacological activities that Spondias genus shows, as well as which part of the plant is used, since there is a lot of richness in its by-products, such as leaf, bark, resin, seed, and peel, which are discarded and could be reused. The main activities of this genus are antioxidant, anti-inflammatory, antidiabetic, antifungal, and antiviral, among others. These properties indicate that this genus could be used in the treatment of several diseases, but there are still not many products available on the market that use this genus as an active ingredient.

Design and Optimization of a Natural Medicine from Copaifera reticulata Ducke for Skin Wound Care.

In this study, we developed a bioadhesive emulsion-filled gel containing a high amount of Copaifera reticulata Ducke oil-resin as a veterinary or human clinical proposal. The phytotherapeutic system had easy preparation, low cost, satisfactory healing ability, and fly repellency, making it a cost-effective clinical strategy for wound care and myiasis prevention. Mechanical, rheological, morphological, and physical stability assessments were performed. The results highlight the crosslinked nature of the gelling agent, with three-dimensional channel networks stabilizing the Copaifera reticulata Ducke oil-resin (CrD-Ore). The emulgel presented antimicrobial activity, satisfactory adhesion, hardness, cohesiveness, and viscosity profiles, ensuring the easy spreading of the formulation. Considering dermatological application, the oscillatory responses showed a viscoelastic performance that ensures emulgel retention at the action site, reducing the dosage frequencies. In Vivo evaluations were performed using a case report to treat ulcerative skin wounds aggravated by myiasis in calves and heifers, which demonstrated healing, anti-inflammatory, and repellent performance for the emulsion-filled gel. The emulgel preparation, which is low in cost, shows promise as a drug for wound therapy.

Alternativas fitoterápicas no controle da obesidade / Phytotherapy alternatives in obesity control / Alternativas herbales en el control de la obesidad

Nos últimos anos, a obesidade vem aumentando consideravelmente entre adultos e crianças e, segundo a OMS, estima-se que em 2025 o número de obesos ultrapasse a 2,3 milhões em todo o mundo. O indivíduo obeso apresenta maiores riscos de desenvolver doenças crônicas não transmissíveis, como diabetes, doenças cardiovasculares, dislipidemias e ainda alguns tipos de cânceres. O tratamento para a obesidade é variado e inclui mudanças no estilo de vida como: hábitos alimentares e prática de atividade física, tratamento medicamentoso, cirurgia bariátrica e fitoterápicos com o potencial de auxiliar no tratamento. O objetivo deste trabalho foi realizar uma revisão bibliográfica a fim de avaliar os benefícios da utilização de medicamentos fitoterápicos como auxiliar no tratamento da obesidade, seus principais ativos, mecanismos de ação e sua utilização popular. Dentre as plantas pesquisadas e que demonstraram potencial para atuar no tratamento da obesidade encontram-se Camelia sinensis, Citrus aurantium, Hibiscus sabdariffa, Coffea arabica, Ephedra sinica, Zingiber oficinale e Senna alexandrina. Os principais mecanismos de ação envolvidos no potencial anti-obesidade das plantas medicinais são a capacidade de controle do apetite e ingestão de energia, estímulo da termogênese, inibição da lipase pancreática e redução da absorção de gordura, diminuição da lipogênese e aumento da lipólise. Desta forma, conclui-se que as plantas selecionadas neste estudo apresentaram efeitos positivos nos parâmetros bioquímicos e físicos, podendo ser incluídas nos protocolos como coadjuvantes nos tratamentos de emagrecimento.

In recent years, obesity has increased considerably among adults and children and according to the WHO, it is estimated that in 2025 the number of obese people will exceed 2.3 million worldwide. The obese individual is at greater risk of developing non-communicable chronic diseases, such as diabetes, cardiovascular disease, dyslipidemia and even some types of cancer. The treatment for obesity is varied, including changes in lifestyle such as eating habits and physical activity, drug treatment, bariatric surgery and phytotherapy with the potential to aid in the treatment. The objective of this work was to carry out a literature review, evaluating the benefits of using herbal medicines as an aid in the treatment of obesity, their main assets, mechanisms of action and their popular use. Among the plants researched and that have shown potential to act in the treatment of obesity are Camelia sinensis, Citrus aurantium, Hibiscus sabdariffa, Coffea arabica, Ephedra sinica, Zingiber officiale and Senna alexandrina. The main mechanisms of action involved in the antiobesity potential of medicinal plants are the ability to control appetite and energy intake, thermogenesis stimulation, pancreatic lipase inhibition and reduction of fat absorption, lipogenesis decrease and lipolysis increase. Thus, it is concluded that the plants selected in this study showed positive effects on biochemical and physical parameters, and can be included in the protocols as adjuvants in weight loss treatments.

En los últimos años, la obesidad ha aumentado considerablemente entre adultos y niños y, según la OMS, se estima que en 2025 el número de obesos superará los 2,3 millones en todo el mundo. Los individuos obesos tienen un mayor riesgo de desarrollar enfermedades crónicas no transmisibles, como la diabetes, las enfermedades cardiovasculares, las dislipidemias e incluso algunos tipos de cáncer. El tratamiento de la obesidad es variado e incluye cambios en el estilo de vida como: hábitos alimenticios y práctica de actividad física, tratamiento farmacológico, cirugía bariátrica y medicamentos a base de hierbas con potencial para ayudar en el tratamiento. El objetivo de este trabajo fue realizar una revisión bibliográfica para evaluar los beneficios del uso de las hierbas medicinales como ayuda en el tratamiento de la obesidad, sus principales activos, mecanismos de acción y su uso popular. Entre las plantas investigadas y que mostraron potencial para actuar en el tratamiento de la obesidad están Camelia sinensis, Citrus aurantium, Hibiscus sabdariffa, Coffea arabica, Ephedra sinica, Zingiber oficinale y Senna alexandrina. Los principales mecanismos de acción implicados en el potencial antiobesidad de las plantas medicinales son la capacidad de controlar el apetito y la ingesta de energía, estimular la termogénesis, inhibir la lipasa pancreática y reducir la absorción de grasas, disminuir la lipogénesis y aumentar la lipólisis. Por lo tanto, se concluye que las plantas seleccionadas en este estudio mostraron efectos positivos sobre los parámetros bioquímicos y físicos, y pueden ser incluidas en los protocolos como coadyuvantes en los tratamientos de pérdida de peso.

Thermosensitive gel based on cellulose derivative for topical delivery of propolis in acne treatment.

Thermosensitive bioadhesive formulations can display increased retention time, skin permeation, and improve the topical therapy of many drugs. Acne is an inflammatory process triggered by several factors like the proliferation of the bacteria Propionibacterium acnes. Aiming for a new alternative treatment with a natural source, propolis displays great potential due to its antibiotic, anti-inflammatory, and healing properties. This study describes the development of bioadhesive thermoresponsive platform with cellulose derivatives and poloxamer 407 for propolis skin delivery. Propolis ethanolic extract (PES) was added to the formulations with sodium carboxymethylcellulose (CMC) or hydroxypropyl methylcellulose (HPMC) and poloxamer 407 (Polox). The formulations were characterized as rheology, bioadhesion, and mechanical analysis. The selected formulations were investigated as in vitro propolis release, cytotoxicity, ex vivo skin permeation by Fourier Transform Infrared Photoacoustic Spectroscopy, and the activity against P. acnes. Formulations showed suitable sol-gel transition temperature, shear-thinning behavior, and texture profile. CMC presence decreased the cohesiveness and adhesiveness of formulations. Polox/HPMC/PES system displayed less cytotoxicity, modified propolis release governed by anomalous transport, skin permeation, and activity against P. acnes. These results indicate important advantages in the topical treatment of acne and suggest a potential formulation for clinical evaluation.

Evaluation of the healing properties of Garcinia brasiliensis extracts in a cutaneous wound model.

ETHNOPHARMACOLOGICAL RELEVANCE: Wound healing is a complex process that can leave pathological scars, especially in case of infections from opportunistic microorganisms. In this context, herbal medicines open up great possibilities for investigation. One of the species of interest native to Brazil is Garcinia brasiliensis ("bacupari"). Traditionally known for treating wounds and ulcers, G. brasiliensis presents anti-inflammatory, antioxidant and antimicrobials properties. But, its wound healing profile in experimental models, in order to validate its efficacy, is still litle studied. AIM OF THE STUDY: Thus, the objective of this work was to evaluate, in an infected cutanous wound model, the potential of formulations incorporated with G. brasiliensis leaves extracts. MATERIALS AND METHODS: Crude extract (CE), Ethyl Acetate Fraction (EAF) and Hexanic Fraction (HF) were submitted to phytochemical assays, high performance thin layer chromatography (HTPLC) and cytotoxicity studies. CE and EAF were also tested for microbicidal properties and incorporated in cream and gel formulations at 10% concentration. After stability testing, the gel formulations with CE or EAF at 10% were selected and applied to skin wounds infected or not with Staphylococcus aureus in Wistar rats. The healing potenttial of the extracts was verified by the expression of the protein Annexin A1 (AnxA1), related to the processes of inflammation and antifibrotic function, the cells immunostaining for Gasdermin-D (GSDM-D), a marker of pyroptotic cell death, and the dosage of interleukin-10 (IL-10) and monocyte chemotactic protein (MCP)-1 inflammatory mediators. RESULTS: Phytochemical studies indicated the presence of compounds of pharmacological interest, including Catechin, Quercetin and Berberine in addition to low cytotoxicity of CE and EAF at 10%. After the 6-day topical treatments, CE and EAF gel formulations demonstrated to control the pruritus formation process. The treatments decreased AnxA1 expression and the amount of cells immunostained for GSDM-D, and increased the expression of MCP-1 in infected wounds. CONCLUSIONS: Together, the results show important anti-inflammatory profile and skin healing potential of CE and EAF from G. brasiliensis leaves, even in infected lesions, with therapeutic perspectives.

In vitro leishmanicidal effect of Yangambin and Epi-yangambin lignans isolated from Ocotea fasciculata (Nees) Mez.

Introduction: Yangambin and epi-yangambin are the main lignans found in Louro-de-Cheiro [Ocotea fasciculata (Nees) Mez], a tree native to the Atlantic forests of northeastern Brazil whose leaves and bark are widely used in folk medicine. The present study investigated the leishmanicidal and immunomodulatory effects of both lignans in in vitro models of infection by Leishmania amazonensis or Leishmania braziliensis, both etiological agents of Cutaneous Leishmaniasis in Brazil. Methods: Bone marrow-derived mouse macrophages were infected with L. amazonensis or L. braziliensis and then treated for 48 h at varying concentrations of yangambin or epi-yangambin. Results: Yangambin and epi-yangambin were found to reduce the intracellular viability of either Leishmania species in a concentration-dependent manner, with respective IC50 values of: 43.9 ± 5 and 22.6 ± 4.9 µM for L. amazonensis, compared to IC50 values of 76 ± 17 and 74.4 ± 9.8 µM for L. braziliensis. In this context, epi-yangambin proved more selective and effective against in vitro infection by L. amazonensis. However, both lignans were found to distinctly modulate the production of inflammatory mediators and other cytokines by macrophages infected by either of the Leishmania species evaluated. While yangambin increased the production of IL-10 by L. braziliensis-infected macrophages, both compounds were observed to lower the production of NO, PGE2, IL-6 and TNF-α in both Leishmania species. Discussion: The present results serve to encourage the development of novel studies aimed at screening natural bioactive compounds with the hope of discovering new therapeutic options for the treatment of Cutaneous Leishmaniasis.

Design and Optimization of Stimuli-responsive Emulsion-filled Gel for Topical Delivery of Copaiba Oil-resin.

This study presents a phytotherapeutic emulsion-filled gel design composed of Pluronic® F127, Carbopol® C934P, and high level of copaiba oil-resin (PHY-ECO). Mathematical modeling and response surface methodology (RSM) were employed to access the optimal ratio between the oil and the polymer gel-matrix constituents. The chemometric approach showed robust mechanical and thermoresponsive properties for emulsion gel. The model predicts viscosity parameters at 35.0°C (skin temperature) from PHY-ECOs. Optimized PHY-ECOs were described by 18-20% (w/w) F127, 0.25% (w/w) C934P, and 15% (w/w) copaiba oil-resin, and showed interfacial layers properties that led to high physicochemical stability. Besides, it had thermal stimuli-responsive that led large viscosity range before and after skin administration, observed by oscillatory rheology. These behaviors give the optimized smart PHY-ECO high design potential to be used as a pharmaceutical platform for CO delivery, focusing on the anti-inflammatory therapy and skin wound care.

Effect of Photo Biomodulation on Muscle Repair: a Literature Review / Efeito da Fotobiomodulação Sobre o Reparo Muscular: uma Revisão de Literatura

Abstract Muscle injuries are frequent, both in the practice of exercises and in the work environment, and after the injury, healing begins. The inflammatory phase of muscle healing is accompanied by an increase in the production of reactive oxygen species (ROS), and a reduction in the antioxidant activity of defense enzymes. This imbalance between both can generate oxidative stress, which can cause oxidative damage by directly affecting vital cellular constituents, such as lipids, proteins and DNA, in addition to interfering negatively in the muscle cells differentiation . Therefore, substances or therapies that stimulate antioxidant repair and defense are crucial to keep the levels of free radical production low, and to minimize factors that delay or prevent tissue recovery, among these therapies photo biomodulation has stood out. The objective of this literature review is to clarify the FBM effect on oxidative stress and muscle repair. Therefore, a search was carried out in the databases of Pubmed, Scielo, Lilacs and PEDro, using the keywords "Photo biomodulation", "low power laser", "muscle repair", "oxidative stress", and in English were "Photo biomodulation", "low level laser therapy", "muscle repair" and "oxidative stress". The texts that addressed the research topic, published between 2000 and 2020, were chosen. After analyzing the articles, it was possible to observe that photo biomodulation, despite presenting a great variety of parameters, moment of application and irradiation protocol found in the literature, shows beneficial results in the repair muscle and in the reduction of oxidative stress and fatigue markers. (AU)

Resumo Lesões musculares são frequentes, tanto na prática de exercícios como no ambiente de trabalho, sendo que após a lesão, inicia a cicatrização. A fase inflamatória da cicatrização muscular é acompanhada do aumento da produção de espécies reativas de oxigênio (ERO) e uma redução da atividade antioxidante das enzimas de defesa. Este desequilíbrio entre ambos pode gerar o estresse oxidativo, que leva a danos e atingi diretamente constituintes celulares vitais, como lipídios, proteínas e DNA, além de interferir negativamente na diferenciação das células musculares. Portanto, substâncias ou terapias que estimulem a reparação e a defesa antioxidante são cruciais para manter os níveis de produção de radicais livres baixos, e minimizar os fatores que atrasam ou impedem a recuperação do tecido, dentre estas terapias a fotobiomodulação tem se destacado. O objetivo da presente revisão de literatura é esclarecer o efeito da FBM sobre o estresse oxidativo e o reparo muscular. Sendo assim, realizou-se uma pesquisa nas bases de dados da Pubmed, Scielo, Lilacs e PEDro, utilizando as palavras-chave "Fotobiomodulação", "laser de baixa potência", "reparo muscular", "estresse oxidativo", e em inglês foram "photobiomodulation", "low level laser therapy", "muscle repair" e "oxidative stress". Foram escolhidos os textos que abordavam o tema da pesquisa, publicados entre 2000 e 2020. Analisando os artigos foi possível observar que a fotobiomodulação apesar de apresentar grande variedade de parâmetros, momento de aplicação e protocolo de irradiação encontrados na literatura, mostra resultados benéficos no reparo muscular e na diminuição de marcadores do estresse oxidativo e fadiga. (AU)

Robust Immune Response Induced by Schistosoma mansoni TSP-2 Antigen Coupled to Bacterial Outer Membrane Vesicles.

PURPOSE: The use of adjuvants can significantly strengthen a vaccine's efficacy. We sought to explore the immunization efficacy of bacterial outer membrane vesicles (OMVs) displaying the Schistosoma mansoni antigen, SmTSP-2, through a biotin-rhizavidin coupling approach. The rationale is to exploit the nanoparticulate structure and the adjuvant properties of OMVs to induce a robust antigen-specific immune response, in light of developing new vaccines against S. mansoni. MATERIALS AND METHODS: OMVs were obtained from Neisseria lactamica and conjugated with biotin. The recombinant SmTSP-2 in fusion with the biotin-binding protein rhizavidin (rRzvSmTSP-2) was produced in E. coli and coupled to biotinylated OMVs to generate an OMV complex displaying SmTSP-2 on the membrane surface (OMV:rSmTSP-2). Transmission electron microscopy (TEM) and dynamic light scattering analysis were used to determine particle charge and size. The immunogenicity of the vaccine complex was evaluated in C57BL/6 mice. RESULTS: The rRzvSmTSP-2 protein was successfully coupled to biotinylated OMVs and purified by size-exclusion chromatography. The OMV:rSmTSP-2 nanoparticles showed an average size of 200 nm, with zeta potential around - 28 mV. Mouse Bone Marrow Dendritic Cells were activated by the nanoparticles as determined by increased expression of the co-stimulatory molecules CD40 and CD86, and the proinflammatory cytokines (TNF-α, IL-6 and IL-12) or IL-10. Splenocytes of mice immunized with OMV:rSmTSP-2 nanoparticles reacted to an in vitro challenge with SmTSP-2 with an increased production of IL-6, IL-10 and IL-17 and displayed a higher number of CD4+ and CD8+ T lymphocytes expressing IFN-γ, IL-4 and IL-2, compared to mice immunized with the antigen alone. Immunization of mice with OMV:rSmTSP-2 induced a 100-fold increase in specific anti-SmTSP-2 IgG antibody titers, as compared to the group receiving the recombinant rSmTSP-2 protein alone or even co-administered with unconjugated OMV. CONCLUSION: Our results demonstrate that the SmTSP-2 antigen coupled with OMVs is highly immunogenic in mice, supporting the potential effectiveness of this platform for improved antigen delivery in novel vaccine strategies.

Chemical composition and anti-Mayaro virus activity of Schinus terebinthifolius fruits.

Brazilian traditional medicine has explored the antiviral properties of many plant extracts, including those from the Brazilian pepper tree, Schinus terebinthifolius. In the present study, we investigated the chemical composition and anti-mayaro virus (MAYV) activity of S. terebinthifolius fruit. Extensive virucidal activity (more than 95%) was detected for the ethyl acetate extract and the isolated biflavonoids. From the ethyl acetate extract of Schinus terebinthifolius fruits, two bioflavonoids were isolated ((2S, 2″S)-2,3,2″,3″-tetrahydroamentoflavone and agathisflavone), which showed strong virucidal activity against Mayaro virus. Furthermore, several other compounds like terpenes and phenolics were identified by hyphenated techniques (GC-MS, LC-MS and HPLC-UV), as well as by mass spectrometry. Immunofluorescence assay confirmed antiviral activity and transmission electron microscopy revealed damage in viral particles treated with biflavonoids. The data suggest the direct action of the extract and the biflavonoids on the virus particles. The biflavonoids tetrahydroamentoflavone and agathisflavone had strong virucidal activity and reduced MAYV infection. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13337-021-00698-z.

Segurança do uso de ácido fólico em dosagem elevada durante a gestação / Safety of high-dose folic acid use during pregnancy

Contexto: A suplementação de ácido fólico durante toda a gestação é recomendada pelo Ministério da Saúde para prevenção da ocorrência de defeitos do tubo neural. A dose recomendada é de 400 mcg/dia nas gestações de baixo risco para esses defeitos e doses elevadas de 4000 a 5000 mcg/dia em situações de alto risco. Devido à indisponibilidade do ácido fólico na dose de 400 mcg no SUS, têm sido prescritas doses elevadas para todas as gestantes. Sem desconsiderar os benefícios do ácido fólico, é necessário investigar a segurança de seu uso em doses elevadas para a saúde de mulheres e crianças. Pergunta: Qual é a segurança da suplementação de ácido fólico em dosagem elevada durante a gestação? Métodos: Após realização de protocolo prévio, sete bases da literatura eletrônica foram buscadas em duas ocasiões, junho e julho de 2021, para identificar estudos que abordassem possíveis riscos da suplementação com doses elevadas de ácido fólico para gestantes e crianças. Utilizando atalhos de revisão rápida para simplificar o processo, foram realizadas seleção e extração dos dados com posterior avaliação da qualidade dos estudos. Resultados: A primeira busca recuperou 1.641 registros, dos quais cinco foram selecionados e informaram possíveis riscos do uso de ácido fólico em doses elevadas na gestação para as crianças, com relação a alergias, transtornos do desenvolvimento infantil e do espectro autista. Em face desses resultados, realizou-se uma busca de revisões sistemáticas que analisaram a associação entre uso de ácido fólico por gestantes e esses três agravos para suas crianças. Nesta segunda busca foram identificadas 88 RS, das quais nove foram incluídas nesta revisão rápida, todas de confiança criticamente baixa. Com relação ao transtorno do espectro autista, quatro RS relataram que o uso de ácido fólico em doses elevadas reduziu o risco, uma RS relatou não haver associação e duas RS apresentaram resultados contraditórios. Das RS que analisaram associação entre uso de ácido fólico e desenvolvimento infantil, duas relataram efeito protetor e duas mostraram que não houve associação estatisticamente significativa. Quanto ao desenvolvimento de alergias na infância, uma RS mostrou aumento no risco principalmente com o uso de dose de ácido fólico abaixo de 400 mcg. E uma RS relatou não haver associação entre uso de ácido fólico e asma em crianças em uma metanálise, e risco aumentado de asma em outra metanálise. Considerações finais: Esta revisão rápida incluiu nove RS que analisaram uma possível associação entre o uso de ácido fólico em doses elevadas durante a gestação e o risco para a saúde das crianças. Com relação aos transtornos do desenvolvimento e do espectro autista, os estudos mostraram que não houve associação ou o uso de doses elevadas de ácido fólico por gestantes teve um efeito protetor para esses agravos. Para as alergias na infância, os resultados dos estudos foram conflitantes, ora mostrando que não houve associação, ora mostrando aumento do risco. Conclui-se, portanto, que não há evidências suficientes para afirmar que o uso de ácido fólico em doses elevadas durante a gestação tenha associação com riscos para a saúde de mulheres e crianças. É importante ressaltar que há uma escassez de estudos sobre a segurança da suplementação com ácido fólico em doses elevadas, e que a avaliação metodológica das revisões sistemáticas incluídas mostrou que são de confiança criticamente baixa. Considerando essa particularidade do Brasil, onde gestantes de baixo risco para gerar crianças com defeito do tubo neural estão recebendo a dose de ácido fólico recomendada apenas para gestantes de alto risco, há necessidade de acompanhamento dessas gestantes para afastar possíveis riscos para a saúde de suas crianças.

Background: Folic acid supplementation throughout pregnancy is recommended by the Ministry of Health to prevent the occurrence of neural tube defects. The recommended dose is 400 mcg/day in low-risk pregnancies for these defects and high doses of 4000 to 5000 mcg/day in high-risk situations. Due to the unavailability of folic acid at a dose of 400 mcg in the SUS, high doses have been prescribed for all pregnant women. Without disregarding the benefits of folic acid, it is necessary to investigate the safety of its use in high doses for the health of women and children. Question: How safe is high-dose folic acid supplementation during pregnancy? Methods: After carrying out a previous protocol, seven databases from the electronic literature were searched on two occasions, June and July 2021, to identify studies that addressed possible risks of supplementation with high doses of folic acid for pregnant women and children. Using rapid review shortcuts to simplify the process, data selection and extraction were performed with subsequent evaluation of the quality of the studies. Results: The first search retrieved 1,641 records, of which five were selected and reported possible risks of the use of folic acid in high doses during pregnancy for children, in relation to allergies, child development disorders and autism spectrum disorders. In view of these results, a search for systematic reviews was carried out that analyzed the association between the use of folic acid by pregnant women and these three conditions for their children. In this second search, 88 SRs were identified, of which nine were included in this rapid review, all of which were critically low confidence. With regard to autism spectrum disorder, four SRs reported that the use of high-dose folic acid reduced risk, one SR reported no association, and two SRs had contradictory results. Of the SRs that analyzed the association between folic acid use and child development, two reported a protective effect and two showed no statistically significant association. Regarding the development of allergies in childhood, an RS showed an increased risk, especially with the use of folic acid doses below 400 mcg. And one SR reported no association between folic acid use and asthma in children in one meta-analysis, and increased risk of asthma in another meta-analysis. Final considerations: This rapid review included nine SRs that analyzed a possible association between the use of high doses of folic acid during pregnancy and the risk to children's health. With regard to developmental and autism spectrum disorders, studies have shown that there was no association or the use of high doses of folic acid by pregnant women had a protective effect against these conditions. For childhood allergies, the results of the studies were conflicting, either showing that there was no association, or showing an increased risk. It is concluded, therefore, that there is not enough evidence to affirm that the use of folic acid in high doses during pregnancy is associated with risks to the health of women and children. Importantly, there is a paucity of studies on the safety of high-dose folic acid supplementation, and that methodological evaluation of the included systematic reviews has shown them to be of critically low reliability. Considering this particularity of Brazil, where pregnant women at low risk of having children with neural tube defect are receiving the dose of folic acid recommended only for high-risk pregnant women, there is a need for monitoring these pregnant women to rule out possible risks to the health of their children. .

Preclinical study of methotrexate-based hydrogels versus surfactant based liquid crystal systems on psoriasis treatment.

Psoriasis is an autoimmune, inflammatory and chronic skin disease in which cell growth and proliferation are increased, causing erythema, lesions and skin's peeling. Oral methotrexate (MTX) is the first-choice drug when phototherapy or retinoid treatment are not effective. Topical administration can be advantageous to better orientate the drug's delivery; however, the stratum corneum performs as a barrier for hydrofilic drugs penetration. This study sought to evaluate two different types of vehicles for MTX on the psoriasis treatment - hydrogel and liquid crystal systems (LCs). Lamellar and hexagonal liquid crystalline phases were selected from a ternary phase diagram based on polysorbate 80, isopropyl miristate and water. The hydrogel was based on alkylated carbomer (ACH). Rheological analysis showed ACH was more elastic than lamellar and hexagonal phases. ACH interacted better with pig skin than LCs in bioadhesion assay. Preclinical study revealed the ACH decreased inflammation in mice with induced psoriasis, being as effective as dexamethasone to regulate epidermis thickness, COX-2 and myeloperoxidase activity and TNF-α level, while LCs demonstrated inflammatory effect. Therefore, MTX-loaded hydrogel based platforms are indicated for local treatment of psoriasis and present great potential for further studies.

Metodologias de monitoramento e avaliação de ações de Promoção da Saúde na Atenção Primária à Saúde / Monitoring and evaluation methodologies of Health Promotion actions in Primary Health Care

Esta revisão rápida foi comissionada e subsidiada pelo Ministério da Saúde, no âmbito do projeto GEREB-010-FIO-20 e faz parte da Coleção "Rapid response for health promotion". Contexto: A Política Nacional de Promoção da Saúde reconhece a necessidade de implementação das ações de maneira integrada, transversal e intersetorial. A promoção da saúde é caracterizada como um conjunto de formas e estratégias, individuais e coletivas, de produzir saúde, em articulação intersetorial com forte participação social. Assim, seu processo de implementação contempla um novo paradigma da saúde e os processos que levam ao adoecimento, deslocando o foco da doença e acolhendo os modos e contextos de vida. Muitos avanços ocorreram nas políticas e programas de promoção à saúde, no entanto há uma necessidade de metodologias para monitorar e avaliar as ações nesse campo. Uma metodologia estruturada serve como um modelo que possibilita um passo a passo a fim de construir e avaliar um programa de intervenção e sua implementação. Pergunta: Quais são as metodologias que têm sido utilizadas para monitorar e avaliar o resultado e o impacto das ações de Promoção da Saúde na APS? Métodos: Três frameworks para avaliação e monitoramento de ações de promoção da saúde foram identificados: RE-AIM, PRECEDE-PROCEED, PROCTOR e colaboradores. Buscas manuais foram realizadas nas fontes de informação Pubmed e Google Acadêmico para identificar artigos que abordassem os conceitos e o modo de operação desses frameworks, bem como exemplos de estudos que os tenham aplicado. As buscas foram realizadas por uma revisora e as extrações de dados por três revisores. Não foi realizada a avaliação da qualidade metodológica dos estudos. Os resultados são apresentados em síntese narrativa. Resultados: As buscas manuais recuperaram treze publicações, das quais dez compuseram a síntese narrativa desta revisão rápida. Cinco artigos abordando o framework RE-AIM são apresentados, um que discorre sobre o modelo e quatro que ilustram suas possibilidades de aplicação (exemplos de estudos de desenhos diversos sobre intervenções em atividade física, obesidade infantil e mudanças no estilo de vida). Para o framework PRECEDE-PROCEED foram incluídos um artigo sobre o modelo e dois artigos que exemplificam sua aplicação na avaliação de programa de saúde comunitária para adultos hipertensos e aconselhamento de atividade física. O modelo de ciência de implementação proposto por Proctor e colaboradores é abordado em um artigo e exemplificado em outro sobre avaliação qualitativa de um programa de promoção de saúde para usuários com risco de desenvolver doenças. Considerações finais: São apresentados três frameworks para avaliação de ações de promoção da saúde em ambientes de APS. Os modelos são distintos entre si e, de maneira geral, os estudos que os utilizaram indicam que eles podem ser boas ferramentas para planejar, implementar, monitorar e avaliar programas e ações de promoção de saúde.

This rapid review was commissioned and subsidized by the Ministry of Health, within the scope of the GEREB-010-FIO-20 project and is part of the "Rapid response for health promotion" Collection. Context: The Brazilian National Health Promotion Policy recognizes the need to implement actions in an integrated, transversal and intersectoral manner. Health promotion is characterized as a set of individual and collective ways and strategies to produce health, in intersectoral articulation with strong social participation. Thus, its implementation process contemplates a new health paradigm and the processes that lead to illness, shifting the focus of the disease and welcoming the ways and contexts of life. Many advances have been made in health promotion policies and programs, however there is a need for methodologies to monitor and evaluate actions in this field. A structured methodology serves as a model that provides a step-by-step approach to building and evaluating an intervention program and its implementation. Question: What methodologies have been used to monitor and evaluate the result and impact of Health Promotion actions in PHC? Methods: Three frameworks for evaluating and monitoring health promotion actions were identified: RE-AIM, PRECEDE-PROCEED, PROCTOR and collaborators. Manual searches were carried out in Pubmed and Google Scholar information sources to identify articles that addressed the concepts and operation of these frameworks, as well as examples of studies that have applied them. Searches were performed by one reviewer and data extractions by three reviewers. The evaluation of the methodological quality of the studies was not performed. The results are presented in narrative synthesis. Results: Manual searches retrieved thirteen publications, ten of which composed the narrative synthesis of this quick review. Five articles addressing the RE-AIM framework are presented, one that discusses the model and four that illustrate its application possibilities (examples of studies of different designs on interventions in physical activity, childhood obesity and changes in lifestyle). For the PRECEDE-PROCEED framework, an article about the model and two articles that exemplify its application in the evaluation of a community health program for hypertensive adults and physical activity counseling were included. The implementation science model proposed by Proctor and collaborators is addressed in an article and exemplified in another on qualitative evaluation of a health promotion program for users at risk of developing diseases. Final considerations: Three frameworks for evaluating health promotion actions in PHC environments are presented. The models are distinct from each other and, in general, the studies that used them indicate that they can be good tools for planning, implementing, monitoring and evaluating health promotion programs and actions.

Aconselhamento sobre alimentação saudável para idosos / Advice on healthy eating for the elderly

Contexto: O aconselhamento é uma abordagem para auxiliar o indivíduo a selecionar e programar comportamentos desejáveis de nutrição e estilo de vida. Ele é indicado na implementação de políticas públicas e pressupõe que os profissionais de saúde tenham habilidades de escuta, compreensão e apoio para adesão de práticas mais benéficas à saúde. Nesse sentido, cabe aos profissionais de saúde orientar a população idosa em relação à alimentação de acordo com as singularidades dessa fase do ciclo de vida e, em casos específicos, encaminhar ao nutricionista para planejamento da ação conjunta. Pergunta: Qual é a eficácia do aconselhamento sobre alimentação saudável ou da suplementação com vitaminas e minerais para a saúde de pessoas idosas? Métodos: Seguindo protocolo prévio, buscas por revisões sistemáticas (RS) foram realizadas em sete bases eletrônicas da literatura, em julho de 2021. Utilizando atalhos de rapid review para simplificar o processo, foram realizadas seleção e extração dos dados com posterior avaliação da qualidade das RS. Em seguida, os resultados foram reunidos em síntese narrativa conforme similaridade de desfechos avaliados. Resultados: De 2.428 registros recuperados das bases de dados, após processo de seleção e elegibilidade, sete RS foram incluídas. Quatro RS foram consideradas de confiança baixa e três de confiança criticamente baixa. As intervenções, em sua maioria, combinaram aconselhamento a outras estratégias, sendo realizadas sobretudo por nutricionistas. Os participantes dos estudos foram idosos acometidos por hipertensão, declínio cognitivo ou algum tipo de fragilidade. Os desfechos analisados nos estudos foram: alimentação; capacidade física/funcional; função cognitiva e psicológica; medidas antropométricas; eventos cardiovasculares; e qualidade de vida. Os resultados, em geral, mostraram não haver diferenças entre as intervenções envolvendo aconselhamento comparadas às outras intervenções. Considerações finais: Poucos estudos foram identificados sobre efeitos do aconselhamento para alimentação saudável ou uso de suplementos de vitaminas e minerais entre pessoas idosas. Desse modo, as evidências são insuficientes para tecer comentários sobre a efetividade do aconselhamento para esta população. É importante ressaltar as falhas metodológicas das revisões sistemáticas incluídas, que comprometem a confiança nos achados. Além disso, os estudos mostraram grande heterogeneidade, particularmente com relação aos desfechos analisados.

Context: Counseling is an approach to assisting the individual in selecting and programming desirable nutrition and lifestyle behaviors. It is indicated in the implementation of public policies and assumes that health professionals have listening skills, understanding and support for adherence to practices that are more beneficial to health. In this sense, it is up to health professionals to guide the elderly population in relation to food according to the singularities of this phase of the life cycle and, in specific cases, refer them to the nutritionist for joint action planning. Question: How effective is healthy eating counseling or vitamin and mineral supplementation for the health of older people? Methods: Following a previous protocol, searches for systematic reviews (SR) were carried out in seven electronic databases of the literature, in July 2021. Using rapid review shortcuts to simplify the process, data selection and extraction were performed with subsequent evaluation of the quality of the LOL. Then, the results were gathered in narrative synthesis according to the similarity of the evaluated outcomes. Results: Of the 2,428 records retrieved from the databases, after the selection and eligibility process, seven RS were included. Four SRs were considered low confidence and three critically low confidence. The interventions, for the most part, combined counseling with other strategies, being carried out mainly by nutritionists. Study participants were elderly people affected by hypertension, cognitive decline or some type of frailty. The outcomes analyzed in the studies were: diet; physical/functional capacity; cognitive and psychological function; anthropometric measurements; cardiovascular events; and quality of life. The results, in general, showed no differences between interventions involving counseling compared to other interventions. Final considerations: Few studies were identified on the effects of healthy eating counseling or use of vitamin and mineral supplements among older people. Thus, the evidence is insufficient to comment on the effectiveness of counseling for this population. It is important to highlight the methodological flaws of the systematic reviews included, which compromise confidence in the findings. In addition, the studies showed great heterogeneity, particularly with regard to the outcomes analyzed.

Prática de atividade física para controle de diabetes, hipertensão e obesidade da população adulta na Atenção Primária à Saúde / Practice of physical activity to control diabetes, hypertension and obesity in the adult population in Primary Health Care

Esta revisão rápida foi comissionada e subsidiada pelo Ministério da Saúde, no âmbito do projeto GEREB-010-FIO-20 e faz parte da Coleção "Rapid response for health promotion". Contexto: As Doenças Crônicas Não Transmissíveis (DCNT) estão entre as principais causas de mortalidade no mundo. Diabetes mellitus tipo 2 (DM2), hipertensão arterial sistêmica (HAS) e obesidade são considerados problemas de saúde pública com alta prevalência em países pobres. A atividade física pode ser um fator protetivo para DCNT, auxiliando na prevenção e tratamento das doenças e da incapacidade funcional, por meio da redução da adiposidade corporal e da pressão arterial, melhora do perfil lipídico e da sensibilidade à insulina, entre outros benefícios. Pergunta: Quais intervenções de atividade física são efetivas para controle de diabetes, hipertensão e de sobrepeso/obesidade na Atenção Primária à Saúde (APS)? Métodos: Oito bases da literatura eletrônica foram buscadas em maio de 2021 para identificar revisões sistemáticas (RS) sobre intervenções de atividade física para controle ou melhoria dos quadros de diabetes, hipertensão e sobrepeso/obesidade. Utilizando atalhos de revisão rápida para simplificar o processo, foram realizadas seleção e extração dos dados com posterior avaliação da qualidade das RS. Em seguida, os resultados foram reunidos em síntese narrativa conforme similaridade. Resultados: A busca retornou 633 referências únicas, que após seleção resultaram na inclusão de 6 revisões sistemáticas, todas de confiança criticamente baixa na avaliação da qualidade metodológica. A maioria dos estudos foi realizada na Ásia e América do Norte, com destaque para China e Estados Unidos. Uma revisão sistemática incluiu estudos realizados no Brasil. O protocolo desta revisão previa a inclusão de estudos realizados em serviços de atenção primária à saúde, porém durante o processo de seleção foi necessário ampliar os critérios de elegibilidade, pois não foram identificados estudos restritos a contextos de APS. Algumas RS também incluíram o grupo de comparadores envolvendo atividade física e voluntários saudáveis. Os resultados foram apresentados em três categorias conforme a condição analisada: hipertensão, diabetes mellitus 2 e as três condições combinadas (HAS, DM2 e obesidade). Os estudos envolveram as seguintes intervenções: prática de tai chi chuan; treino de resistência e/ou aeróbico; aeróbico, musculação e educação sobre estilo de vida; yoga; treino de hidroginástica, fortalecimento, alongamento e Baduanjin; uso de monitores de atividade (acelerômetros ou pedômetros) e exercício de resistência progressiva; pedômetro com atividade física. A maioria dos resultados mostrou efeitos positivos (pressão arterial média; controle efetivo da pressão arterial - PA; redução das pressões arteriais sistólica (PAS) e diastólica (PAD); melhora na medida da hemoglobina glicada; diminuição significativa do índice de massa corporal - IMC), indicando também incertezas quanto a alguns desfechos. Conclusão: As RS que avaliaram pacientes hipertensos indicam redução na PA com a prática de atividade física, porém a certeza da evidência foi baixa em uma delas. O uso de monitores de atividade não resultou em melhora nos indicadores de pacientes com DM2. Uma das RS indicou que exercícios de resistência melhoraram a medida da hemoglobina glicada, mas não apresentaram efeito na composição corporal de pacientes com DM2 e sobrepeso. Já o uso de pedômetros, em uma RS, foi associado à diminuição no IMC e na PAS em pacientes com comorbidades. Os estudos incluídos devem ser avaliados com cautela, pois apresentaram falhas metodológicas que comprometem a confiança em seus resultados.

This rapid review was commissioned and subsidized by the Ministry of Health, within the scope of the GEREB-010-FIO-20 project and is part of the "Rapid response for health promotion" Collection. Context: Chronic Noncommunicable Diseases (NCDs) are among the leading causes of mortality in the world. Type 2 diabetes mellitus (DM2), systemic arterial hypertension (SAH) and obesity are considered public health problems with high prevalence in poor countries. Physical activity can be a protective factor for NCDs, helping to prevent and treat diseases and functional disability, by reducing body adiposity and blood pressure, improving lipid profile and insulin sensitivity, among other benefits. Question: Which physical activity interventions are effective for controlling diabetes, hypertension and overweight/obesity in Primary Health Care (PHC)? Methods: Eight electronic literature databases were searched in May 2021 to identify systematic reviews (SR) on physical activity interventions to control or improve diabetes, hypertension and overweight/obesity. Using quick review shortcuts to simplify the process, data selection and extraction were performed with subsequent evaluation of the SR quality. Then, the results were gathered in narrative synthesis according to similarity. Results: The search returned 633 unique references, which after selection resulted in the inclusion of 6 systematic reviews, all with critically low confidence in the assessment of methodological quality. Most studies were carried out in Asia and North America, with emphasis on China and the United States. A systematic review included studies carried out in Brazil. The protocol of this review provided for the inclusion of studies carried out in primary health care services, but during the selection process it was necessary to expand the eligibility criteria, as no studies restricted to PHC contexts were identified. Some SRs also included the group of comparators involving physical activity and healthy volunteers. The results were presented in three categories according to the condition analyzed: hypertension, diabetes mellitus 2 and the three conditions combined (SAH, DM2 and obesity). The studies involved the following interventions: practice of tai chi chuan; resistance and/or aerobic training; aerobics, strength training and lifestyle education; yoga; water aerobics, strengthening, stretching and Baduanjin training; use of activity monitors (accelerometers or pedometers) and progressive resistance exercise; pedometer with physical activity. Most of the results showed positive effects (mean blood pressure; effective control of blood pressure - BP; reduction of systolic (SBP) and diastolic (DBP) blood pressures; improvement in the measurement of glycated hemoglobin; significant decrease in body mass index - BMI ), also indicating uncertainties regarding some outcomes. Conclusion: The SRs that evaluated hypertensive patients indicated a reduction in BP with the practice of physical activity, but the certainty of the evidence was low in one of them. The use of activity monitors did not result in an improvement in the indicators of patients with DM2. One of the RS indicated that resistance exercises improved the measurement of glycated hemoglobin, but had no effect on the body composition of patients with DM2 and overweight. The use of pedometers in an SR was associated with a decrease in BMI and SBP in patients with comorbidities. The included studies should be evaluated with caution, as they had methodological flaws that compromise confidence in their results.