Effect of transcranial direct current stimulation and transcranial magnetic stimulation on the cognitive function of individuals with Alzheimer's disease: a systematic review with meta-analysis and meta-regression.

OBJECTIVE: To analyze the effects of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) on the cognitive function of individuals with Alzheimer's disease (AD). METHODS: This systematic review with meta-analysis and meta-regression included randomized clinical trials published until 05/2022. We included studies conducted with individuals with AD of both sexes, aged between 55 and 85 years, treated with tDCS, TMS, or both. RESULTS: Twenty-one studies were included in the systematic review and sixteen in the meta-analysis. Meta-regression suggested a significant influence of anodic tDCS with current intensity of 1.5 mA on cognitive function. Significant results were found with treatment frequencies of three and five days a week for two weeks. Subgroup analysis found that anodic tDCS influences cognitive function, regardless of AD stage. Similar was observed for TMS using a frequency of 20 Hz and current intensity of 90% of the resting motor threshold. DISCUSSION: Anodal tDCS and 20 Hz TMS have demonstrated the ability to improve cognitive function in AD by modulating neural activity. These therapies are safe and well-tolerated, offering promise as adjuncts to available pharmacological treatments. Studies with greater methodological rigor and parameter standardization are warranted. Comprehensive investigations involving neuroimaging techniques may provide a better understanding of the interaction between induced electrical fields and the complex neural networks affected in AD, paving the way for more personalized and effective neurostimulation approaches.

A Novel Exploratory Graph-Based Analytical Tool for Functional Near-Infrared Spectroscopy in Naturalistic Experiments: An Illustrative Application in Typically Developing Children.

Naturalistic paradigms are being increasingly applied to investigate human brain function. Compared with resting-state and task-based paradigms in neuroimaging, naturalistic stimuli and situations can be potentially more readily translated to daily-life applications. Among neuroimaging modalities, functional near-infrared spectroscopy (fNIRS) is particularly suitable for naturalistic investigations and applications. However, specific and tailored statistical analysis to interrogate brain function using naturalistic fNIRS is warranted. Here, we describe an exploratory graph-centrality-based approach to investigating participants' spatiotemporal similarities from the fNIRS signal. We illustrate the usefulness of our approach in a sample of typically developing children (10 males and 9 females; mean age of 5.2 years old; sd = 0.78) while they watch the Inscapes movie designed for neuroimaging acquisition. A node in the left dorsal prefrontal cortex presented similar responses across children, and those fNIRS responses were in line with scene transitions in the movie stimulus. Our results suggest the feasibility of applying centrality graph-based measures to investigate brain function in naturalistic fNIRS during development.

Cobertura populacional de enfermeiros no Brasil: estimativas com base em diferentes fontes de dados / Population coverage of nurses in Brazil: estimates based on different data sources / Cobertura poblacional de enfermeros en Brasil: estimaciones basadas en diferentes fuentes de datos

Resumo Estima-se um déficit de seis milhões de enfermeiros em todo o mundo. Apesar da importância para os sistemas de saúde, estudos sociodemográficos são escassos devido à ausência de dados sistematizados específicos para enfermeiros. O objetivo deste estudo foi comparar a cobertura populacional de enfermeiros no Brasil com base em fontes oriundas do Instituto Brasileiro de Geografia e Estatística (IBGE), nos anos de 2010 e 2015, e do Conselho Federal de Enfermagem (Cofen), nos anos de 2013 e 2019. Em ambas as fontes, houve um aumento médio de 164 mil enfermeiros em todo o Brasil. A taxa de crescimento para o período das pesquisas do IBGE (15,7% ao ano) foi o triplo daquela registrada nos dados do Cofen (5,3% ao ano). A cobertura nos estados do Brasil permanece aquém da recomendação internacional (40 enfermeiros a cada 10 mil habitantes), com maiores déficits nos estados das regiões Norte e Nordeste. As comparações deste estudo reiteram a importância da disponibilidade de dados padronizados e sistematizados para a Enfermagem no Brasil. Indicadores de saúde acurados subsidiam políticas públicas para a redução de iniquidades em saúde, com destaque para a cobertura de enfermeiros, especialmente em regiões de elevadas vulnerabilidades socioeconômicas.

Abstract There is an estimated deficit of six million nurses worldwide. Despite its importance for health systems, sociodemographic studies are scarce due to the absence of systematized data specific to nurses. The objective of this study was to compare the population coverage of nurses in Brazil based on sources from the Brazilian Institute of Geography and Statistics (IBGE), in the years 2010 and 2015, and the Federal Nursing Council (Cofen), in the years 2013 and 2019. In both sources, there was an average increase of 164 thousand nurses throughout Brazil. The growth rate for the period of the IBGE surveys (15.7% per year) was triple that recorded in the Cofen data (5.3% per year). Coverage in the states of Brazil remains below the international recommendation (40 nurses per 10 thousand inhabitants), with greater deficits in the states of the North and Northeast regions. The comparisons in this study reiterate the importance of the availability of standardized and systematized data for Nursing in Brazil. Accurate health indicators subsidize public policies to reduce health inequities, with emphasis on the coverage of nurses, especially in regions with high socioeconomic vulnerabilities.

Resumen Hay un déficit estimado de seis millones de enfermeros en todo el mundo. A pesar de la importancia para los sistemas de salud, estudios sociodemográficos son escasos debido a la ausencia de datos sistematizados específicos para enfermeros. El objetivo de este estudio fue comparar la cobertura poblacional de enfermeros en Brasil a partir de fuentes del Instituto Brasileño de Geografía y Estadística (IBGE), en los años 2010 y 2015, y del Consejo Federal de Enfermería (Cofen), en los años 2013 y 2019. En ambas fuentes, hubo un aumento promedio de 164.000 enfermeros en todo Brasil. La tasa de crecimiento para el período de las encuestas del IBGE (15,7% anual) resultó el triple de la registrada en los datos del Cofen (5,3% anual). La cobertura en los estados de Brasil permanece por debajo de la recomendación internacional (40 enfermeros por 10.000 habitantes), con mayores déficits en los estados de las regiones Norte y Nordeste. Las comparaciones de este estudio reiteran la importancia de la disponibilidad de datos estandarizados y sistematizados para la Enfermería en Brasil. Indicadores precisos de salud apoyan las políticas públicas para reducir las desigualdades en salud, con énfasis en la cobertura de enfermeros, especialmente en regiones de alta vulnerabilidad socioeconómica.

Effects of multisite anodal transcranial direct current stimulation combined with cognitive stimulation in patients with Alzheimer's disease and its neurophysiological correlates: A double-blind randomized clinical trial.

OBJECTIVES: We aimed to examine the effects of multisite anodal transcranial direct current stimulation (tDCS) combined with cognitive stimulation (CS) over 2 months on cognitive performance and brain activity, and the relationship between them, in patients with Alzheimer's disease (AD). METHODS: Patients with AD were randomly assigned to an active tDCS+CS (n=18) or a sham tDCS+CS (n=18) group. Cognitive performance was assessed using the Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-cog) and brain activity using EEG (spectral power and coherence analysis) before and after the intervention. Multisite anodal tDCS (2 mA, 30 min) was applied over six brain regions [left and right dorsolateral prefrontal cortex (F3 and F4), Broca's area (F5), Wernicke's area (CP5), left and right somatosensory association cortex (P3 and P4)] for 24 sessions (three times a week). Both groups performed CS during tDCS. RESULTS: Anodal tDCS+CS delays cognitive decline (ADAS-cog change) to a greater extent than sham tDCS+CS (-3.4±1.1 vs. -1.7±0.4; p=.03). Bilateral EEG coherence at high and low frequencies was greater for the active tDCS+CS than sham+CS group for most electrode pairs assessed (p < .05). The post-intervention ADAS-cog change score was predictive for EEG coherence at different sites (R²=.59 to .68; p < .05) in the active but not in the sham tDCS+CS group. CONCLUSION: Anodal tDCS+CS improved overall cognitive function and changed EEG brain activity compared to sham tDCS+CS. Changes in cognitive performance were associated with changes in EEG measures of brain activity. Anodal tDCS+CS appears to be a promising therapeutic strategy to modulate cortical activity and improve cognitive function in patients with AD.

Conhecimento sobre influenza entre profissionais de saúde de um hospital geral / Knowledge about the influenza among health professionals of a general hospital

Em 2009 ocorreu uma pandemia do vírus Influenza A H1N1. Por conta da capacidade de disseminação do vírus, o mesmo foi alvo de preocupação por toda a sociedade. Com isso, observou-se a importância de profissionais de saúde capacitados para realização de diagnóstico e tratamento oportunos bem como medidas de prevenção e controle da epidemia. O objetivo é avaliar o conhecimento de profissionais da saúde sobre a Influenza H1N1. A pesquisa teve como público-alvo profissionais da saúde de um hospital geral do município do Rio de Janeiro, referência durante a epidemia de 2009. Aplicou-se um questionário durante a campanha de vacinação destinada a este grupo, realizada pelo Núcleo de Epidemiologia do hospital. De 1710 vacinados, 462 participaram da pesquisa. A média de idade foi de 38,9 anos (DP ± 11,96), sendo 61,5% do sexo feminino e 33,3% do sexo masculino. Em relação à categoria funcional, 25,5% eram médicos, 39,6% enfermeiros e 34,6% da categoria "outros". Na autoavaliação do conhecimento sobre a doença, 45% classificaram seus conhecimentos sobre a doença como Muito Bom ou Bom. As pontuações médias obtidas dos conhecimentos sobre fatores de risco mostram um bom desempenho dos médicos, com média de 6,17 (± 2,9) acertos, quando o máximo seriam 10. Os resultados apontam que o conhecimento demonstrado pelos profissionais de saúde é insuficiente. Este grupo tem papel fundamental de enfrentar provável segunda onda causada por este vírus. Assim, são importantes ações contínuas de educação e informação direcionadas a este público, bem como subsídio ao seu planejamento e organização.

In 2009 there was a pandemic of the virus Influenza A H1N1. Because of its spreading capacity, it has been causing concern throughout society. Along the same, there was the importance of health professionals trained to perform diagnosis and timely treatment as well as prevention and control of the epidemic. The study was made with health professionals, who work in a general hospital, located in Rio de Janeiro, reference during the 2009 epidemic. During the vaccination campaign, we applied a questionnaire aimed at this group, conducted by the Hospital's Epidemiology Center. Of 1710 vaccinated, 462 participated in the study. The mean age was 38.9 years (SD ± 11.96), and 61.5% female and 33.3% male. Regarding the functional category, 25.5% were doctors, 39.6% nurses and 34.6% category "other". In the self-assessment of knowledge about the disease, 45% rated their knowledge as Very Good or Good. The average score of knowledge about risk factors show a good performance of physicians, averaging 6.17 (± 2.9) correct answers, when the maximum is 10. The results show that knowledge demonstrated by health professionals is insufficient. This group has a fundamental role to face a prossible second wave caused by this virus. Thus, it's necessary to reinforce the importance of continuous education actions and information targeted to that audience, as well as the supporting of its planning and organization.

Perfil das queimaduras em adolescentes / Profile of burns in adolescents

Introdução: Durante a adolescência, ocorrem mudanças de ordem emocional e na indecisão de como se conduzir, e o adolescente se expõe, com grandes chances de insucessos. O objetivo deste estudo é analisar as queimaduras em adolescentes e fornecer dados para programas de prevenção. Método: Estudo retrospectivo, avaliando idade, sexo, agente causal, local do acidente e mortalidade, em adolescentes queimados. Resultados: Foram avaliados 51 adolescentes entre 12 e 18 anos de idade (média 14,8 anos), sendo 50,98% do sexo feminino. O álcool foi o agente causal mais prevalente (33,33%) e 25,49% dos pacientes possuíam de 20-29% da superfície corporal queimada. Todos os óbitos ocorreram em indivíduos com superfície corporal queimada superior a 40%. Conclusão: São necessários novos estudos que analisem as características envolvendo a queimadura nessa faixa etária, para o desenvolvimento de ações preventivas para tal evento.

Introduction: During adolescence, emotional changes and indecision on how to conduct himself take place, and the adolescent is exposed, with a high chance of failure. The purpose of this study is to analyze the burns in adolescents and provide data for prevention programs. Methods: A retrospective study evaluating age, sex, causal agent, burned site and mortality was performed, in adolescents. Results: This study assessed 51 adolescents between 12 and 18 years old (mean 14.8 years), 50.98% female. Alcohol was the most prevalent causal agent (33.33%), and 25.49% patients had 20-29% of body surface area burned. All deaths occurred in individuals with more than 40% of the body surface area burned. Conclusion: Further studies are needed to examine the characteristics involving the burn in this age group for the development of preventive measures for this event.