Mapa de evidências - Efetividade de estratégias de promoção da saúde em escolas / Effectiveness of health promotion strategies in schools

DESTAQUES ● Este mapa de evidências apresenta resultados de efetividade de intervenções realizadas em escolas, recuperadas da literatura científica global. ● Foram incluídos 217 revisões sistemáticas (RS) e 3 estudos primários que avaliaram os efeitos de treze ações relativas à Promoção da Saúde em Escolas. ● Quanto à qualidade metodológica, as RS foram assim classificadas: 9 de confiança alta, 14 moderada, 16 baixa e 178 criticamente baixas. ● As intervenções foram categorizadas segundo as ações previstas no Programa Saúde na Escola (PSE): 1) Combate ao Aedes aegypti; 2) Promoção da atividade física; 3) Promoção da cidadania ; 4) Prevenção da Covid-19; 5) Promoção de direitos sexuais e reprodutivos; 6) Controle de doenças negligenciadas; 7) Ações de saúde auditiva; 8) Ações de saúde bucal; 9) Ações de saúde ocular; 10) Promoção da alimentação saudável; 11) Monitoramento da situação vacinal; 12) Prevenção e uso de substâncias e 13) Prevenção de violências e acidentes.

HIGHLIGHTS ● This evidence map presents results on the effectiveness of interventions carried out in schools, retrieved from the global scientific literature. ● A total of 217 systematic reviews (SRs) and 3 primary studies that evaluated the effects of thirteen actions related to Health Promotion in Schools were included. ● Regarding methodological quality, the SRs were classified as follows: 9 with high confidence, 14 moderate, 16 low and 178 critically low. ● The interventions were categorized according to the actions provided for in the Brazilian School Health Program (PSE): 1) Combating Aedes aegypti; 2) Promoting physical activity; 3) Promoting citizenship; 4) Preventing Covid-19; 5) Promoting sexual and reproductive rights; 6) Controlling neglected diseases; 7) Hearing health actions; 8) Oral health actions; 9) Eye health actions; 10) Promoting healthy eating; 11) Monitoring vaccination status; 12) Prevention and use of substances and 13) Prevention of violence and accidents.

[Evidence for Health Promotion in Brazil: report on a rapid response serviceEvidencia para la promoción de la salud en Brasil: informe sobre un servicio de respuesta rápida]. / Evidências para a Promoção da Saúde no Brasil: relato de um serviço de resposta rápida.

Objective: Present the experience of a rapid response service to support decision-making in health systems. Methodology: Description of the processes and results of a service that produces rapid reviews and evidence maps to support decision-making under the National Health Promotion Policy, as well as the authors' perception of the work process. Results: The rapid response service started in 2020. By December 2023, 54 rapid reviews and five evidence maps had been produced, covering nine health promotion topics. These products were developed in 14 stages by a team made up of a coordinator, supervisors, proofreaders, and a librarian. The development of rapid responses involved a knowledge translation process, with continuous interactions between the requesting teams and production teams. Establishing effective communication was a critical factor in delivering products on time and in line with the needs of decision-makers and their supporters. Conclusion: Rapid response services can help improve the use of evidence for decision-making in health policies and health systems.

Objetivo: Presentación de la experiencia de un servicio de respuesta rápida para brindar apoyo a la toma de decisiones en materia de salud. Método: Se describen los procesos y resultados de un servicio de elaboración de revisiones rápidas y mapas de evidencia para brindar apoyo a la toma de decisiones en el marco de la Política Nacional de Promoción de la Salud, así como la percepción de los autores sobre el proceso de trabajo. Resultados: El servicio de respuesta rápida se inició en el 2020. Hasta diciembre del 2023, se habían elaborado 54 revisiones rápidas y cinco mapas de evidencia, que abarcaban nueve temas de promoción de la salud. Estos productos fueron elaborados en 14 etapas por un equipo formado por un coordinador, varios supervisores y revisores y un bibliotecario. La elaboración de respuestas rápidas fue un proceso de traducción del conocimiento e implicó una interacción continua entre los equipos solicitantes y el equipo de elaboración. El establecimiento de una comunicación eficaz fue un factor decisivo para entregar los productos a tiempo y en consonancia con las necesidades de los responsables de la toma de decisiones y su personal de apoyo. Conclusión: Los servicios de respuesta rápida pueden ayudar a mejorar el uso de evidencia en la toma de decisiones relacionadas con las políticas y los sistemas de salud.

Evidências para a Promoção da Saúde no Brasil: relato de um serviço de resposta rápida / Evidence for Health Promotion in Brazil: report on a rapid response service / Evidencia para la promoción de la salud en Brasil: informe sobre un servicio de respuesta rápida

[RESUMO]. Objetivo. Apresentar a experiência de um serviço de resposta rápida para apoiar a tomada de decisão em saúde. Método. São descritos os processos e resultados de um serviço de produção de revisões rápidas e mapas de evidências para apoiar a tomada de decisão no âmbito da Política Nacional de Promoção da Saúde, bem como a percepção dos autores sobre o processo de trabalho. Resultados. O serviço de resposta rápida teve início em 2020. Até dezembro de 2023, foram produzidas 54 revisões rápidas e cinco mapas de evidências, abrangendo nove temáticas de Promoção da Saúde. Estes produtos foram desenvolvidos em quatorze etapas por uma equipe composta por coordenador, supervisoras, revisores e bibliotecária. O desenvolvimento das respostas rápidas se configurou um processo de tradução do conhecimento e envolveu a interação contínua entre as equipes demandantes e de produção. O estabelecimento de comunicação efetiva foi um fator crítico para que os produtos fossem entregues em tempo oportuno e alinhados às necessidades dos tomadores de decisão e seus apoiadores. Conclusão. Os serviços de resposta rápida podem contribuir para melhorar o uso de evidências na tomada de decisão nas políticas e sistemas de saúde.

[ABSTRACT]. Objective. Present the experience of a rapid response service to support decision-making in health systems. Methodology. Description of the processes and results of a service that produces rapid reviews and evidence maps to support decision-making under the National Health Promotion Policy, as well as the authors' perception of the work process. Results. The rapid response service started in 2020. By December 2023, 54 rapid reviews and five evidence maps had been produced, covering nine health promotion topics. These products were developed in 14 stages by a team made up of a coordinator, supervisors, proofreaders, and a librarian. The development of rapid responses involved a knowledge translation process, with continuous interactions between the requesting teams and production teams. Establishing effective communication was a critical factor in delivering products on time and in line with the needs of decision-makers and their supporters. Conclusion. Rapid response services can help improve the use of evidence for decision-making in health policies and health systems.

[RESUMEN]. Objetivo. Presentación de la experiencia de un servicio de respuesta rápida para brindar apoyo a la toma de decisiones en materia de salud. Método. Se describen los procesos y resultados de un servicio de elaboración de revisiones rápidas y mapas de evidencia para brindar apoyo a la toma de decisiones en el marco de la Política Nacional de Promoción de la Salud, así como la percepción de los autores sobre el proceso de trabajo. Resultados. El servicio de respuesta rápida se inició en el 2020. Hasta diciembre del 2023, se habían elaborado 54 revisiones rápidas y cinco mapas de evidencia, que abarcaban nueve temas de promoción de la salud. Estos productos fueron elaborados en 14 etapas por un equipo formado por un coordinador, varios supervisores y revisores y un bibliotecario. La elaboración de respuestas rápidas fue un proceso de traducción del conocimiento e implicó una interacción continua entre los equipos solicitantes y el equipo de elaboración. El establecimiento de una comunicación eficaz fue un factor decisivo para entregar los productos a tiempo y en consonancia con las necesidades de los responsables de la toma de decisiones y su personal de apoyo. Conclusión. Los servicios de respuesta rápida pueden ayudar a mejorar el uso de evidencia en la toma de decisiones relacionadas con las políticas y los sistemas de salud.

Research evidence communication for policy-makers: a rapid scoping review on frameworks, guidance and tools, and barriers and facilitators.

BACKGROUND: Communication is a multifaceted process, ranging from linear, one-way approaches, such as transmitting a simple message, to continuous exchanges and feedback loops among stakeholders. In particular the COVID-19 pandemic underscored the critical need for timely, effective and credible evidence communication to increase awareness, levels of trust, and evidence uptake in policy and practice. However, whether to improve policy responses in crises or address more commonplace societal challenges, comprehensive guidance on evidence communication to decision-makers in health policies and systems remains limited. Our objective was to identify and systematize the global evidence on frameworks, guidance and tools supporting effective communication of research evidence to facilitate knowledge translation and evidence-informed policy-making processes, while also addressing barriers and facilitators. METHODS: We conducted a rapid scoping review following the Joanna Briggs Manual. Literature searches were performed across eight indexed databases and two sources of grey literature, without language or time restrictions. The methodological quality of included studies was assessed, and a narrative-interpretative synthesis was applied to present the findings. RESULTS: We identified 16 documents presenting either complete frameworks or framework components, including guidance and tools, aimed at supporting evidence communication for policy development. These frameworks outlined strategies, theoretical models, barriers and facilitators, as well as insights into policy-makers' perspectives, communication needs, and preferences. Three primary evidence communication strategies, comprising eleven sub-strategies, emerged: "Health information packaging", "Targeting and tailoring messages to the audience", and "Combined communication strategies". Based on the documented barriers and facilitators at micro, meso and macro levels, critical factors for successful communication of evidence to policy-makers were identified. CONCLUSIONS: Effective communication is indispensable for facilitating knowledge translation and evidence-informed policy-making. Nonetheless gaps persist in frameworks designed to enhance research communication to policy-makers, particularly regarding the effectiveness of multiple communication strategies. To advance in this field, the development of comprehensive frameworks incorporating implementation strategies is warranted. Additionally, barriers and facilitators to implementing effective communication must be recognized and addressed taking diverse contexts into consideration. Registration https://zenodo.org/record/5578550.

Micronutrientes em pó: efetividade das estratégias de fortificação da alimentação de crianças menores de cinco anos / Powdered micronutrients: effectiveness of food fortification strategies for children under five years of age

Contexto - A alimentação inadequada nos primeiros anos de vida está associada à morbimortalidade de crianças, representada por doenças infecciosas, afecções respiratórias, cárie dental, desnutrição, excesso de peso e carências específicas de micronutrientes como de ferro, zinco e vitamina A. O Estudo Nacional de Alimentação e Nutrição Infantil (ENANI), realizado em 2019 com crianças brasileiras de até 5 anos, mostrou uma redução na prevalência de anemia de 20,9%, em 2006, para 10,1%, em 2019, com diferenças entre as regiões brasileiras. Evidências indicam que o fornecimento de alimentos complementares fortificados a crianças dos 6 aos 23 meses podem reduzir a anemia em 43% e aumentar as concentrações de hemoglobina de forma significativa. Pergunta - Qual é a efetividade das estratégias de fortificação de micronutrientes em pó (MNP) implementadas na alimentação de crianças de 6 meses até 59 meses? Métodos - As buscas por revisões sistemáticas (RS) foram realizadas em abril de 2024 nas bases de dados Lilacs - Literatura Latino-Americana e do Caribe em Ciências da Saúde, Pubmed, Embase e Epistemonikos. Nesta revisão rápida, apenas a seleção de estudos foi realizada em duplicidade e de modo independente. Resultados - As buscas resultaram em 109 registros recuperados. Após seleção por leitura de títulos e resumos, 17 RS elegíveis foram lidas na íntegra, das quais quatro foram incluídas. Os achados foram organizados de acordo com grupos de desfechos avaliados nos estudos: anemia e seus indicadores, estado nutricional, níveis séricos de micronutrientes, eventos adversos.

Context - Inadequate nutrition in the first years of life is associated with morbidity and mortality in children, represented by infectious diseases, respiratory conditions, dental caries, malnutrition, overweight and specific deficiencies of micronutrients such as iron, zinc and vitamin A. The National Study of Child Feeding and Nutrition (ENANI), carried out in 2019 with Brazilian children up to 5 years old, showed a reduction in the prevalence of anemia from 20.9%, in 2006, to 10.1%, in 2019, with differences between Brazilian regions. Evidence indicates that providing fortified complementary foods to children aged 6 to 23 months can reduce anemia by 43% and significantly increase hemoglobin concentrations. Question - How effective are the strategies for fortifying powdered micronutrients (MNP) implemented in the diets of children aged 6 months to 59 months? Methods - Searches for systematic reviews (SRs) were conducted in April 2024 in the databases Lilacs - Latin American and Caribbean Literature in Health Sciences, Pubmed, Embase and Epistemonikos. In this rapid review, only the selection of studies was performed in duplicate and independently. Results - The searches resulted in 109 retrieved records. After selection by reading titles and abstracts, 17 eligible SRs were read in full, of which four were included. The findings were organized according to groups of outcomes evaluated in the studies: anemia and its indicators, nutritional status, serum micronutrient levels, adverse events.

Caffeine Consumption and Interaction with ADORA2A, CYP1A2 and NOS1 Variants Do Not Influence Age at Onset of Machado-Joseph Disease.

BACKGROUND: The age at onset (AO) of Machado-Joseph disease (SCA3/MJD), a disorder due to an expanded CAG repeat (CAGexp) in ATXN3, is quite variable and the role of environmental factors is still unknown. Caffeine was associated with protective effects against other neurodegenerative diseases, and against SCA3/MJD in transgenic mouse models. We aimed to evaluate whether caffeine consumption and its interaction with variants of caffeine signaling/metabolization genes impact the AO of this disease. METHODS: a questionnaire on caffeine consumption was applied to adult patients and unrelated controls living in Rio Grande do Sul, Brazil. AO and CAGexp were previously determined. SNPs rs5751876 (ADORA2A), rs2298383 (ADORA2A), rs762551 (CYP1A2) and rs478597 (NOS1) were genotyped. AO of subgroups were compared, adjusting the CAGexp to 75 repeats (p < 0.05). RESULTS: 171/179 cases and 98/100 controls consumed caffeine. Cases with high and low caffeine consumption (more or less than 314.5 mg of caffeine/day) had mean (SD) AO of 35.05 (11.44) and 35.43 (10.08) years (p = 0.40). The mean (SD) AO of the subgroups produced by the presence or absence of caffeine-enhancing alleles in ADORA2A (T allele at rs5751876 and rs2298383), CYP1A2 (C allele) and NOS1 (C allele) were all similar (p between 0.069 and 0.516). DISCUSSION: Caffeine consumption was not related to changes in the AO of SCA3/MJD, either alone or in interaction with protective genotypes at ADORA2A, CYP1A2 and NOS1.

From the Gut to the Brain: Is Microbiota a New Paradigm in Parkinson's Disease Treatment?

Parkinson's disease (PD) is recognized as the second most prevalent primary chronic neurodegenerative disorder of the central nervous system. Clinically, PD is characterized as a movement disorder, exhibiting an incidence and mortality rate that is increasing faster than any other neurological condition. In recent years, there has been a growing interest concerning the role of the gut microbiota in the etiology and pathophysiology of PD. The establishment of a brain-gut microbiota axis is now real, with evidence denoting a bidirectional communication between the brain and the gut microbiota through metabolic, immune, neuronal, and endocrine mechanisms and pathways. Among these, the vagus nerve represents the most direct form of communication between the brain and the gut. Given the potential interactions between bacteria and drugs, it has been observed that the therapies for PD can have an impact on the composition of the microbiota. Therefore, in the scope of the present review, we will discuss the current understanding of gut microbiota on PD and whether this may be a new paradigm for treating this devastating disease.

Mapa de evidências - Estratégias para o cuidado de pessoas com diabetes mellitus tipo 2, hipertensão arterial sistêmica ou obesidade / Evidence map - Strategies for the care of people with type 2 diabetes mellitus, systemic arterial hypertension or obesity

DESTAQUES ● Este mapa de evidências tem como objetivo apresentar estratégias que podem ser efetivas para o cuidado de pessoas com diabetes, hipertensão ou obesidade. ● Foram incluídas 93 revisões sistemáticas, cujos estudos primários foram realizados em sua maioria (65,1%) na América do Norte, Ásia e Europa. ● As intervenções foram classificadas em 5 categorias e 26 subcategorias. Observouse maior frequência da categoria "Teleconsulta/eHealth" e da subcategoria "cuidado assistencial". ● Os desfechos analisados foram classificados em clínicos e não clínicos. Desfechos clínicos foram relatados em 53 revisões sistemáticas, com destaque para a pressão arterial. Desfechos não clínicos foram relatados em 51 revisões sistemáticas, com destaque para a adesão ao tratamento farmacológico. ● As cinco categorias de intervenções - Teleconsulta/eHealth, Educação, Automonitoramento/autogerenciamento, Tratamento farmacológico, Serviço de saúde - apresentaram efeito positivo ou potencialmente positivo acima de 50% para os desfechos avaliados.

HIGHLIGHTS ● This evidence map aims to present strategies that may be effective for the care of people with diabetes, hypertension or obesity. ● 93 systematic reviews were included, the majority of whose primary studies were carried out (65.1%) in North America, Asia and Europe. ● Interventions were classified into 5 categories and 26 subcategories. There was a greater frequency of the "Teleconsultation/eHealth" category and the "assistance care" subcategory. ● The analyzed outcomes were classified as clinical and non-clinical. Clinical outcomes were reported in 53 systematic reviews, with emphasis on blood pressure. Non-clinical outcomes were reported in 51 systematic reviews, with emphasis on adherence to pharmacological treatment. ● The five categories of interventions - Teleconsultation/eHealth, Education, Self-monitoring/self-management, Pharmacological treatment, Health service - showed a positive or potentially positive effect above 50% for the evaluated outcomes.

Glial-restricted precursors stimulate endogenous cytogenesis and effectively recover emotional deficits in a model of cytogenesis ablation.

Adult cytogenesis, the continuous generation of newly-born neurons (neurogenesis) and glial cells (gliogenesis) throughout life, is highly impaired in several neuropsychiatric disorders, such as Major Depressive Disorder (MDD), impacting negatively on cognitive and emotional domains. Despite playing a critical role in brain homeostasis, the importance of gliogenesis has been overlooked, both in healthy and diseased states. To examine the role of newly formed glia, we transplanted Glial Restricted Precursors (GRPs) into the adult hippocampal dentate gyrus (DG), or injected their secreted factors (secretome), into a previously validated transgenic GFAP-tk rat line, in which cytogenesis is transiently compromised. We explored the long-term effects of both treatments on physiological and behavioral outcomes. Grafted GRPs reversed anxiety-like deficits and demonstrated an antidepressant-like effect, while the secretome promoted recovery of only anxiety-like behavior. Furthermore, GRPs elicited a recovery of neurogenic and gliogenic levels in the ventral DG, highlighting the unique involvement of these cells in the regulation of brain cytogenesis. Both GRPs and their secretome induced significant alterations in the DG proteome, directly influencing proteins and pathways related to cytogenesis, regulation of neural plasticity and neuronal development. With this work, we demonstrate a valuable and specific contribution of glial progenitors to normalizing gliogenic levels, rescuing neurogenesis and, importantly, promoting recovery of emotional deficits characteristic of disorders such as MDD.

Effects of sodium dodecylbenzene sulfonate (SDBS) on zebrafish (Danio rerio) gills and blood.

Sodium dodecylbenzene sulfonate (SDBS) is an important surfactant used as a cleaning agent and industrial additive to remove unwanted chemicals which have been detected in the aquatic environment. The aim of this study was to examine the toxicological potential of SDBS on the gills of adult male zebrafish (Danio rerio) exposed to this chemical. For the 96 hr acute exposure, fish were divided into three groups: control, 0.25 mg/L, and 0.5 mg/L of SDBS. After the experiment, morphophysiological analyses (gill histopathology and histochemistry), oxidative stress (determination of gill activities of superoxide dismutase (SOD) and catalase (CAT)), and hematological analyses (leukocyte differentiation) were conducted. Data demonstrated that SDBS at both tested concentrations altered the histopathological index and initiated circulatory disturbances, as well as adverse, progressive, and immunological changes in the gills. In the 0.5 mg/L group, SOD activity decreased significantly, but CAT activity was not altered. Prominent blood changes observed in this group were neutrophilia and lymphocytosis. The number of mucous and chloride cells increased significantly in both groups. Taken together, our findings demonstrated that exposure of D. rerio to SDBS, even for 96 hr, produced adverse morphological and hematological effects associated with a reduction in SOD activity. Our findings indicate that exposure of aquatic species to the anionic surfactant SDBS may lead to adverse consequences associated with oxidative stress. Therefore, this study highlights the risks that this substance may pose to aquatic ecosystems and emphasizes the need for further investigations and strict regulations on its disposal.

Práticas corporais e atividade física para mulheres gestantes e puérperas: efeitos na saúde / Body practices and physical activity for pregnant and postpartum women: health effects

Contexto - As práticas corporais e atividade física (PCAF) contribuem para reduzir os riscos à saúde e melhorar a qualidade de vida das pessoas. Entre gestantes e puérperas a AF pode trazer benefícios para a saúde da mulher e do bebê, além de reduzir riscos e complicações relacionados à gravidez. Pergunta - Quais são os efeitos das práticas corporais e/ou atividade física para a promoção da saúde de gestantes e puérperas na Atenção Primária à Saúde (APS)? Métodos - As buscas de revisões sistemáticas (RS) foram realizadas em dezembro de 2023 nas bases de dados da Biblioteca Virtual em Saúde, Pubmed, Embase e Health Systems Evidence. Apenas os processos de seleção de estudos recuperados e de avaliação da qualidade metodológica das RS (AMSTAR 2) foram realizados em duplicidade e de modo independente. Resultados - De 193 registros recuperados nas buscas, 36 RS foram incluídas. Os resultados são apresentados de acordo com os períodos de realização da AF: gravidez, perinatal e pós-parto. De modo geral, observaram-se benefícios para os seguintes desfechos: ➔ Dor, dor pélvica e dor lombar (9 RS) ➔ Qualidade de vida (5 RS); ➔ Sintomas depressivos e de ansiedade (4 RS) ➔ Complicações na gravidez, parto e pós-parto (4 RS) ➔ Medidas antropométricas (3 RS) ➔ Capacidade funcional e fadiga (2 RS) Considerações finais - A maioria dos resultados indica efeitos positivos relacionados à prática de PCAF para a promoção da saúde de gestantes e puérperas no contexto da APS. No entanto, deve-se observar que as RS foram classificadas em qualidade criticamente baixa (13 RS), baixa (2 RS) e alta (1 RS). Além disso, há grande variedade quanto às modalidades, à frequência e à duração das intervenções.

Context - Body practices and physical activity (PCAF) contribute to reducing health risks and improving people's quality of life. Among pregnant and postpartum women, PA can bring benefits to the health of women and babies, in addition to reducing risks and complications related to pregnancy. Question - What are the effects of body practices and/or physical activity for promoting the health of pregnant and postpartum women in Primary Health Care (PHC)? Methods - Searches for systematic reviews (SRs) were carried out in December 2023 in the databases of the Virtual Health Library, Pubmed, Embase, and Health Systems Evidence. Only the processes of selection of retrieved studies and assessment of the methodological quality of the SRs (AMSTAR 2) were performed in duplicate and independently. Results - Of 193 records retrieved in the searches, 36 SRs were included. The results are presented according to the periods of PA performance: pregnancy, perinatal, and postpartum. In general, benefits were observed for the following outcomes: ➔ Pain, pelvic pain and low back pain (9 SR) ➔ Quality of life (5 SR); ➔ Depressive and anxiety symptoms (4 SR) ➔ Complications during pregnancy, childbirth and postpartum (4 SR) ➔ Anthropometric measurements (3 SR) ➔ Functional capacity and fatigue (2 SR) Final considerations - Most results indicate positive effects related to the practice of PCAF for promoting the health of pregnant and postpartum women in the context of PHC. However, it should be noted that the SR were classified as critically low (13 SR), low (2 SR) and high (1 SR) quality. In addition, there is great variety in terms of the modalities, frequency and duration of the interventions.

Correlation between peripheral endothelial function, oxygen consumption and ventilatory efficiency in heart transplantation recipients.

BACKGROUND: Endothelial dysfunction and peak oxygen uptake (VO2peak) are also predictors of increased risk of cardiovascular events in heart transplantation (HTx) recipients. The preservation of endothelial function may contribute to exercise tolerance. OBJECTIVE: To investigate the correlation between peripheral endothelial function and exercise tolerance through VO2peak and ventilation to carbon dioxide production slope (VE / VCO2 slope) in HTx recipients. METHODS: A pilot cross-sectional study was conducted with adult individuals aged 18-65 years, HTx ≥ six months after surgery, who had a stable medical condition and no changes over the last three months of immunosuppressive treatment. The patients underwent an assessment of endothelial function through PAT (EndoPAT-2000®) and performed a cardiopulmonary exercise test (CPET). RESULTS: A total of 41% of the studied population presented endothelial dysfunction. The individuals were divided into two groups: the endothelial dysfunction (GED; n=9) group and the normal endothelial function (GNEF; n=13) group according to the logarithm of the reactive hyperemia index (LnRHI). There was a positive and moderate correlation between the LnRHI and VO2 peak (r=0.659, p=0.013) and a negative and moderate correlation between the LnRHI and VE/VCO2 slope (r= -0.686, p= 0.009) in the GNEF. However, no significant correlations were found in the GED. CONCLUSION: The results showed that the preservation of peripheral endothelial function is significantly correlated with an increase in exercise tolerance in individuals after HTx. These findings bring important considerations for cardiovascular risk prevention and emphasize that therapeutic strategies with physical training programs must be implemented early.

Comunicação de evidências de pesquisa para formuladores de políticas: uma rápida revisão de escopo sobre estruturas, orientações e ferramentas, e barreiras e facilitadores / Research evidence communication for policy-makers: a rapid scoping review on frameworks, guidance and tools, and barriers and facilitators

Background Communication is a multifaceted process, ranging from linear, one-way approaches, such as transmitting a simple message, to continuous exchanges and feedback loops among stakeholders. In particular the COVID19 pandemic underscored the critical need for timely, efective and credible evidence communication to increase awareness, levels of trust, and evidence uptake in policy and practice. However, whether to improve policy responses in crises or address more commonplace societal challenges, comprehensive guidance on evidence communication to decision-makers in health policies and systems remains limited. Our objective was to identify and systematize the global evidence on frameworks, guidance and tools supporting efective communication of research evidence to facilitate knowledge translation and evidence-informed policy-making processes, while also addressing barriers and facilitators. Methods We conducted a rapid scoping review following the Joanna Briggs Manual. Literature searches were performed across eight indexed databases and two sources of grey literature, without language or time restrictions. The methodological quality of included studies was assessed, and a narrative-interpretative synthesis was applied to present the fndings. Results We identifed 16 documents presenting either complete frameworks or framework components, including guidance and tools, aimed at supporting evidence communication for policy development. These frameworks outlined strategies, theoretical models, barriers and facilitators, as well as insights into policy-makers' perspectives, communication needs, and preferences. Three primary evidence communication strategies, comprising eleven substrategies, emerged: "Health information packaging", "Targeting and tailoring messages to the audience", and"Combined communication strategies". Based on the documented barriers and facilitators at micro, meso and macro levels, critical factors for successful communication of evidence to policy-makers were identifed. Conclusions Efective communication is indispensable for facilitating knowledge translation and evidenceinformed policy-making. Nonetheless gaps persist in frameworks designed to enhance research communication

Keeping reptiles as pets in Brazil: keepers' motivations and husbandry practices.

BACKGROUND: Reptiles are considered one of the most popular pets in the world and are often associated with an incorrect belief that they are simple, highly adaptable, and easy to keep animals when compared with other pets, such as dogs and cats. However, keeping reptiles as pets can pose several challenges in meeting their needs in a domestic setting, requiring specific conditions and effort to maintain their health, well-being, and survival. METHODS: During 2015, using online semi-structured questionnaires applied to 719 Brazilian pet reptile keepers who participated in online groups of reptile breeders on the social network Facebook, this study aimed to identify Brazilian keepers' motivations for maintaining reptiles as pets, investigate their monthly expenses, and the husbandry practices for the maintenance, such as housing and feeding conditions, handling of the animal, health issues, and treatment provided. RESULTS: We found multiple motivations for keeping reptiles as pets (mostly snakes, lizards, and chelonians), the main motivation being emotional reasons, followed by entertainment and convenience reasons. The great majority of keepers (69%) declared to spend less than or up to US$30 per month in maintaining their reptiles. Most reptiles were kept alone in terrarium/aquarium enclosures, with basic environmental complexity in terms of physical elements. Lizards and chelonians were fed with a few insect species, cultivated fruits and vegetables, while snakes were fed mainly with domestic rodents, rabbits, or birds. Keepers declared frequent cleaning of the enclosure, but inappropriately handled their animals directly with their hands, which might result in potential threats to human and reptile health and safety. Several diseases or injuries were mentioned and 55.6% of the keepers declared taking the reptile to the vet for treatment. CONCLUSIONS: Overall, our findings revealed several challenges that reptiles face when kept in domestic environments, including issues related to housing, nutrition, and healthcare. Even though keepers demonstrated positive feelings toward their pets, suggesting a positive relationship and a willingness to provide them with proper care, it seems that without the proper knowledge and awareness, reptiles may unintentionally be kept with poor husbandry. Addressing these challenges on husbandry practices is essential for improving reptiles' welfare and promoting a responsible pet ownership.

The first Portuguese Open Dialogue pilot project intervention.

Introduction: In 2020, the Directorate General of Health (DGS), a central service of the Ministry of Health in Portugal, approved and co-financed the first Open Dialogue program in the country. The present report aims to demonstrate the preliminary results of the first year of the project, implemented in the northern interior region of Alentejo. Methods: Seven people at the Center of Concern (PCC) and 21 family members/social networks received care through Open Dialogue; four external social workers and psychologists were also involved in the project as members of the support network. A total of 160 network meetings were undertaken, reaching as many as 27 per month in the busiest periods. Based on a previous Italian Research Protocol, developed by Pocobello et al. (non-published manuscript), quantitative and qualitative data were collected in and after the clinical meetings involving PCC and their family/social network, through a multi-method approach: clinical history interview (e.g., generic research on sociodemographic data, duration of untreated symptoms, reasons for requesting help, possible hospitalizations, and/or treatments/therapies) and the following scales applied every five sessions (e.g., CORE-OM, BSI, GAF, and LSNS-6). Results: The preliminary results indicate an improvement in global functioning and the enlargement of social network size/support, a decrease in symptoms, and a negative correlation between the number of sessions and the LSNS6. Medication use remained largely unchanged at the end of the project. Discussion: In general, even with a small sample, the results are considered satisfactory and seem to be aligned with the vast majority of Open Dialogue studies, which for several decades have consistently pointed toward better recovery rates than treatment as usual as well as increased client satisfaction. We expect that the results presented can boost further research and help strengthen the OD approach.

Liver and spleen of hosts of Rhipicephalus linnaei exposed to synthetic (afoxolaner) and natural acaricides (esters from castor oil). A comparative clinical-morphological study.

In dogs, Rhipicephalus linnaei transmits pathogens such as Ehrlichia canis, Babesia vogeli, and Hepatozoon canis. The veterinary market has synthetic acaricides to ticks control. Esters derived from castor oil are efficient. However, there is little information about their effects on non-target organisms. This work consisted of a clinical (AST, ALT, and ALP) and histological and histochemical analysis (liver and spleen) of female rabbits exposed to these esters and afoxolaner. The rabbits were divided into three groups: control group (CG) received Bandeirante® rabbit feed; the afoxolaner treatment (TG1) received rabbit feed and two doses of afoxolaner; castor oil esters treatment (TG2) received rabbit feed enriched with esters (1.75 g esters/kg). No alterations were observed in the AST, ALT, and ALP enzymes in exposure to esters TG2. Rabbits from TG1 showed changes in AST. The liver of rabbits exposed to afoxolaner underwent histological and histochemical changes, such as steatosis and vacuolation, as well as poor protein labeling. Polysaccharides were intensely observed in the group exposed to esters. The spleen showed no changes in any of the exposure. Esters from castor oil caused fewer liver changes when incorporated into the feed and fed to rabbits than exposure to afoxolaner.

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.

N-Acetylcysteine Treatment May Compensate Motor Impairments through Dopaminergic Transmission Modulation in a Striatal 6-Hydroxydopamine Parkinson's Disease Rat Model.

Preventing degeneration and the loss of dopaminergic neurons (DAn) in the brain while mitigating motor symptoms remains a challenge in Parkinson's Disease (PD) treatment development. In light of this, developing or repositioning potential disease-modifying approaches is imperative to achieve meaningful translational gains in PD research. Under this concept, N-acetylcysteine (NAC) has revealed promising perspectives in preserving the dopaminergic system capability and modulating PD mechanisms. Although NAC has been shown to act as an antioxidant and (neuro)protector of the brain, it has yet to be acknowledged how this repurposed drug can improve motor symptomatology and provide disease-modifying properties in PD. Therefore, in the present work, we assessed the impact of NAC on motor and histological deficits in a striatal 6-hydroxydopamine (6-OHDA) rat model of PD. The results revealed that NAC enhanced DAn viability, as we found that it could restore dopamine transporter (DAT) levels compared to the untreated 6-OHDA group. Such findings were positively correlated with a significant amelioration in the motor outcomes of the 6-OHDA-treated animals, demonstrating that NAC may, somehow, be a modulator of PD degenerative mechanisms. Overall, we postulated a proof-of-concept milestone concerning the therapeutic application of NAC. Nevertheless, it is extremely important to understand the complexity of this drug and how its therapeutical properties interact with the cellular and molecular PD mechanisms.

[Adherence, barriers, and facilitators for the treatment of systemic arterial hypertension: rapid review of evidenceAdhesión, obstáculos y elementos facilitadores en relación con el tratamiento de la hipertensión: revisión rápida de la evidencia]. / Adesão, barreiras e facilitadores no tratamento de hipertensão arterial: revisão rápida de evidências.

Objective: To identify strategies to increase adherence to systemic arterial hypertension (SAH) treatment and describe the barriers and facilitators for implementing these strategies in primary health care (PHC). Method: A rapid evidence review was performed. We included systematic reviews with or without meta-analyses, published in English, Spanish or Portuguese, covering adults (age 18 to ≤ 60 years) with SAH followed in the PHC. Searches were performed in nine databases in December 2020 and updated in April 2022. The systematic reviews were assessed for methodological quality using the AMSTAR 2 tool. Results: Fourteen systematic reviews on treatment adherence strategies and three on barriers and facilitators for implementation were included. Regarding methodological quality, one systematic review was classified as moderate, four as low, and the others as critically low. Four strategies were identified as options for health policies: actions performed by pharmacists; actions performed by non-pharmaceutical health professionals; self-monitoring, use of mobile apps, and text messages; and subsidies for the purchase of medicines. Low digital literacy, limited access to the internet, work process and incipient training were barriers for professionals. The users' educational and health literacy levels, accessibility to health services and good relationships with professionals were facilitators. Conclusions: Positive effects of strategies related to pharmaceutical care, self-monitoring, and the use of cell phone applications and text messages were identified to increase adherence to the treatment of SAH in the context of PHC. However, for implementation purposes, it is necessary to consider barriers and facilitators, in addition to the methodological limitations of the analyzed systematic reviews.

Objetivo: Buscar estrategias para aumentar la adhesión al tratamiento de la hipertensión arterial sistémica y describir las barreras y los elementos facilitadores para la implementación de esas estrategias en el ámbito de la atención primaria de salud. Métodos: Se realizó una revisión rápida de la evidencia. Se incluyeron revisiones sistemáticas, con o sin metaanálisis, publicadas en español, inglés o portugués, en las cuales se evaluaban a personas adultas (de 18 a ≤ 60 años) con hipertensión arterial sistémica observadas en el ámbito de la atención primaria de salud. Las búsquedas se realizaron en nueve bases de datos en diciembre del 2020 y se actualizaron en abril del 2022. Se evaluó la calidad metodológica de las revisiones sistemáticas incluidas con la herramienta AMSTAR 2. Resultados: Se incluyeron 14 revisiones sistemáticas sobre estrategias de adhesión al tratamiento y tres sobre obstáculos y elementos facilitadores para la implementación. La calidad metodológica fue moderada en una revisión sistemática, baja en cuatro y críticamente baja en las demás. Se identificaron cuatro estrategias como opciones para las políticas de salud: medidas tomadas por farmacéuticos; medidas tomadas por profesionales no farmacéuticos; autocontrol, uso de aplicaciones para teléfonos celulares y mensajes de texto; y oferta de subvenciones para la compra de medicamentos. La escasa alfabetización digital, el acceso limitado a internet y los procesos de trabajo y formación incipiente fueron obstáculos para los profesionales. Los elementos facilitadores fueron el nivel de educación y de conocimientos de los usuarios en materia de salud, la accesibilidad a los servicios de salud y las buenas relaciones con los profesionales. Conclusiones: Se observaron efectos positivos de las estrategias relacionadas con la atención farmacéutica, el autocontrol y el uso de aplicaciones de telefonía celular y mensajería de texto para aumentar la adhesión al tratamiento de la hipertensión arterial sistémica en el ámbito de la atención primaria de salud. Sin embargo, para fines de implementación, es necesario considerar los obstáculos y los elementos facilitadores, además de las limitaciones metodológicas de las revisiones sistemáticas analizadas.

[Telehealth, food consumption, and eating behavior in adults: a rapid review of systematic reviewsTelesalud, consumo de alimentos y comportamiento alimentario de la población adulta: examen rápido de revisiones sistemáticas]. / Telessaúde no consumo e comportamento alimentar em adultos: uma revisão rápida de revisões sistemáticas.

Objective: To synthesize the evidence about the effects of telehealth interventions provided through smart-phone apps and text messages on the behavior of adults regarding healthy food consumption. Method: A rapid systematic review of the literature was performed through searches in nine electronic databases to identify systematic reviews published in English, Portuguese, and Spanish that evaluated telehealth strategies compared to face-to-face interventions to improve dietary intake in the adult population (18 to 59 years old). Searches were performed in November 2020 and updated in April 2022. The included systematic reviews were assessed for methodological quality using the AMSTAR 2 tool. Results: Five systematic reviews were included. Methodological quality was moderate in one review and critically low in four. There was a dearth of studies comparing the use of telehealth strategies with face-to-face interventions for the promotion of healthy eating in adults. The most consistent results refer to an increase in the consumption of fruits and vegetables with the use of an app or text messages, in addition to improvement in the dietary habits of people with diabetes or glucose intolerance with the use of text messages. Conclusion: Positive effects were observed on healthy eating outcomes for most interventions using mobile apps or text messages; however, the findings refer to a few clinical trials with small samples that were analyzed in the systematic reviews covered in the present rapid review, most of which had low methodological quality. Thus, the current knowledge gap warrants the performance of further methodologically robust studies.

Objetivo: Sintetizar la evidencia sobre los efectos de las intervenciones de telesalud ofrecidas por medio de aplicaciones de telefonía móvil y mensajes de texto en el comportamiento de la población adulta relacionado con una alimentación saludable. Métodos: Se realizó un examen rápido mediante búsquedas en nueve bases bibliográficas electrónicas para localizar revisiones sistemáticas publicadas en español, inglés y portugués en las que se evaluaran estrategias de telesalud en comparación con atención presencial para mejorar la alimentación de la población adulta (de 18 a 59 años). Las búsquedas se realizaron en noviembre del 2020 y se actualizaron en abril del 2022. La calidad metodológica de las revisiones sistemáticas incluidas se evaluó con la herramienta AMSTAR 2. Resultados: Se incluyeron cinco revisiones sistemáticas, una con un grado de confianza moderado y las otras con un grado de confianza sumamente bajo. Se comprobó una falta de estudios en los que se compararan el uso de estrategias de telesalud con la atención presencial para promover la alimentación saludable de la población adulta. Los resultados más coherentes se refieren al aumento del consumo de frutas y verduras con el uso de aplicaciones móviles o de mensajes de texto, así como a la mejora del patrón alimentario de las personas con diabetes o con intolerancia a la glucosa con el uso de mensajes de texto. Conclusión: La mayoría de los análisis de las intervenciones en las que se emplearon aplicaciones de telefonía móvil o mensajes de texto mostraron efectos positivos en los resultados relativos a una alimentación saludable. Sin embargo, estos hallazgos se refieren a unos pocos ensayos clínicos con pequeñas muestras de participantes incluidos en las revisiones sistemáticas del presente examen rápido, en su mayoría de baja calidad metodológica. En conclusión, existe una laguna en los conocimientos y es importante realizar estudios con una metodología más sólida.