Mapa de evidências sobre a efetividade clínica da acupuntura: informe executivo. / Evidence map on clinical effectiveness of acupuncture: executive report

Este informe executivo apresenta os principais achados do mapa de evidências sobre os efeitos da Acupuntura para desfechos em saúde, que representa a evidência de 163 estudos de revisão que analisaram o efeito da acupuntura como intervenção para pelo menos um dos 96 desfechos de saúde organizados em 14 grupos: Câncer e Neoplasias; Dor; Doenças Cardiovasculares; Doenças Respiratórias; Doenças Reumáticas e Musculoesqueléticas; Doenças Nutricionais, Metabólicas e Endócrinas; Doenças do Sistema Nervoso; Dermatopatias; Gastroenteropatias; Indicadores Metabólicos e Fisiológicos; Oftalmopatias e Otorrinolaringopatias; Sinais e Sintomas; Transtornos Mentais; e Outros desfechos. No todo foram 201 associações entre acupuntura e os desfechos de saúde. Para cada associação intervenção-desfecho foi incluído o efeito reportado pelo estudo de revisão.

This executive report presents the main findings of the evidence map on the effects of acupuncture for health outcomes, representing evidence from 163 review studies that analyzed the effect of acupuncture as an intervention for at least one of the 96 health outcomes organized into 14 groups: Cancer and Neoplasms; Pain; Cardiovascular Diseases; Respiratory Diseases; Rheumatic and Musculoskeletal Diseases; Nutritional, Metabolic, and Endocrine Diseases; Diseases of the Nervous System; Dermatopathies; Gastroenteropathies; Metabolic and Physiological Indicators; Ophthalmopathies and Otorhinolaryngopathies; Signs and Symptoms; Mental Disorders; and Other outcomes. In total, there were 201 associations between acupuncture and health outcomes. For each intervention-outcome association, the reported effect by the review study was included.

Este informe ejecutivo presenta los principales hallazgos del mapa de evidencia sobre los efectos de la acupuntura en los resultados de salud, representando la evidencia de 163 estudios de revisión que analizaron el efecto de la acupuntura como intervención para al menos uno de los 96 resultados de salud organizados en 14 grupos: Cáncer y Neoplasias; Dolor; Enfermedades Cardiovasculares; Enfermedades Respiratorias; Enfermedades Reumáticas y Musculoesqueléticas; Enfermedades Nutricionales, Metabólicas y Endocrinas; Enfermedades del Sistema Nervioso; Dermatopatías; Gastroenteropatías; Indicadores Metabólicos y Fisiológicos; Oftalmopatías y Otorrinolaringopatías; Signos y Síntomas; Trastornos Mentales; y Otros resultados. En total, hubo 201 asociaciones entre la acupuntura y los resultados de salud. Para cada asociación intervención-resultados se incluyó el efecto informado por el estudio de revisión.

Influence of acupuncture needle physical-chemical properties on needling quality.

OBJECTIVES: This study analyzed the physical-chemical properties of three different brands of acupuncture needle, classified by acupuncturists as high (A), medium (B) and low (C) quality. METHODS: Experienced acupuncturists, rated, in terms of perceived needling quality, three acupuncture needle brands as high (A), medium (B) and low (C) quality. Next, scanning electron microscopy (SEM) images of the tip and surface finish of the needles of each brand were analyzed. A mechanical test was developed and performed to evaluate the compressive force required to insert the needles through a smooth surface (silicon). In addition, X-ray fluorescence spectroscopy (XRF) and dispersive energy spectroscopy (DES) were conducted to analyze the material composition of the needles and presence of oxidation. RESULTS: SEM images revealed that needle brands A and B presented a sharper tip and a more regular surface finish in comparison to brand C. In the insertion test, needle brands A and B had similar performance characteristics, with A requiring less force to penetrate the silicon device when compared to B, while C failed to penetrate the silicon and complete the test. The XRF analysis did not reveal any differences in material composition between the three brands. However, brand C exhibited particles embedded on the needle surface and DES confirmed oxidation. CONCLUSION: This study demonstrates that perceived needling quality by acupuncturists can be correlated with physical-chemical properties of the needles, especially those related to finishing quality of the tip and the surface of the needles.

Stroke Communication Scale based on the International Classification of Functioning, Disability and Health (ICF - SCS).

INTRODUCTION: The International Classification of Functioning, Disability, and Health encompasses activities, participation, and contextual factors in health care, helping in the evaluation, planning, and management of patients. AIM: To develop an instrument to evaluate and classify speech-language needs, participation, and functioning in post-stroke based on the International Classification of Functioning, Disability, and Health. MATERIALS AND METHODS: This is a methodological research to develop an instrument. We adopted the following steps: a) selection of the International Classification of Functioning, Disability, and Health domains related to speech-language; b) development of guiding questions and qualification criteria; c) content validity; d) development of instructions; d) pilot test; e) inter-observer reliability. RESULTS: The Stroke Communication Scale is a clinical assessment in the Brazilian Portuguese language with 35 questions, integrating language, environmental, and personal aspects. This instrument showed good validity and reliability, demonstrating its applicability. Additionally, the possibility of using different sources of information (patient, caregiver, and health professional observations) and time of application of the protocol constitute positive factors for its use in different clinical settings. CONCLUSION: The Stroke Communication Scale allows a comprehensive clinical evaluation helping in the development of individualized treatment programs in post-stroke in a biopsychosocial approach centered on the patient.IMPLICATIONS FOR REHABILITATIONCommunication disorders post-stroke can be an important social barrier.An assessment based on the International Classification of Functioning, Disability, and Health offers an integral view of different perspectives of health.The Stroke Communication Scale is a holistic instrument to assess communication, participation, and functioning.The Stroke Communication Scale allows an evaluation of functional communication beyond the disorder.Interview-format encourages the participation of individuals with communication impairment, which is essential for their rehabilitation process and participation in social activities.

Profile of acupuncture use among primary care physicians working in the Brazilian public healthcare system.

BACKGROUND: An introductory acupuncture course has been offered to primary health care physicians and family medicine residents in southern Brazil since 2011. OBJECTIVE: To analyze the profile of acupuncture utilization of primary care physicians who completed an introductory course of acupuncture between 2011 and 2018. METHOD: A survey using an electronic questionnaire was sent to all 119 physicians who completed the course. RESULTS: Fifty-five physicians answered the questionnaire. The majority of them reported continuation of the practice of acupuncture in scheduled appointments and on spontaneous demand. The most commonly used principles of point selection were traditional acupuncture point function, myofascial trigger point needling and point protocols. As barriers to the practice of acupuncture, time limitation and inadequate physical space were predominant. The participants described the problem-solving potential of the procedure and good patient acceptance as facilitators. The most common problems treated with acupuncture were musculoskeletal pain, and mood and anxiety disorders. A reduction in referrals to specialists and reduced prescription of pain medications were also reported. Most physicians answered that they often combined acupuncture with other medications or associated acupuncture with other complementary practices. The main adverse events reported by the participants were vascular trauma and fainting. CONCLUSION: Most primary care physicians who completed the introductory course and answered the survey still used acupuncture in their routine, primarily for the management of musculoskeletal conditions and mental health conditions. These physicians reported reductions in specialist referrals and prescription of pain medication after integrating basic acupuncture skills into primary care practice.

Modulation of cortical and subcortical brain areas at low and high exercise intensities.

INTRODUCTION: The brain plays a key role in the perceptual regulation of exercise, yet neuroimaging techniques have only demonstrated superficial brain areas responses during exercise, and little is known about the modulation of the deeper brain areas at different intensities. OBJECTIVES/METHODS: Using a specially designed functional MRI (fMRI) cycling ergometer, we have determined the sequence in which the cortical and subcortical brain regions are modulated at low and high ratings perceived exertion (RPE) during an incremental exercise protocol. RESULTS: Additional to the activation of the classical motor control regions (motor, somatosensory, premotor and supplementary motor cortices and cerebellum), we found the activation of the regions associated with autonomic regulation (ie, insular cortex) (ie, positive blood-oxygen-level-dependent (BOLD) signal) during exercise. Also, we showed reduced activation (negative BOLD signal) of cognitive-related areas (prefrontal cortex), an effect that increased during exercise at a higher perceived intensity (RPE 13-17 on Borg Scale). The motor cortex remained active throughout the exercise protocol whereas the cerebellum was activated only at low intensity (RPE 6-12), not at high intensity (RPE 13-17). CONCLUSIONS: These findings describe the sequence in which different brain areas become activated or deactivated during exercise of increasing intensity, including subcortical areas measured with fMRI analysis.

Value Flow Map: application and results in the disinfection center.

OBJECTIVE: To identify and eliminate steps that do not add value for customers in the disinfection center. METHOD: We applied the Lean tool: Value Flow Map, using the concepts of gemba and kaizen in the work process of the disinfection unit for ventilatory care materials, aiming at improving such process. After performing a training with the team on the Lean concepts described above, applying the Value Flow Map in the gemba, analyzing the opportunities for improvement, and approving the changes, the Value Flow Map of the future state was devised and changes were implemented. RESULT: The time of the disinfection process was reduced in 2h37 and the financial resources required also decreased, in R$ 809.08/month. CONCLUSION: The application of Lean concepts presented positive results for the elimination of wastages in the disinfection center.

Value Flow Map: application and results in the disinfection center / Mapa de la Cadena de Valor: aplicación y resultados en el centro de desinfección / Mapa de Fluxo de Valor: aplicação e resultados na central de desinfecção

ABSTRACT Objective: To identify and eliminate steps that do not add value for customers in the disinfection center. Method: We applied the Lean tool: Value Flow Map, using the concepts of gemba and kaizen in the work process of the disinfection unit for ventilatory care materials, aiming at improving such process. After performing a training with the team on the Lean concepts described above, applying the Value Flow Map in the gemba, analyzing the opportunities for improvement, and approving the changes, the Value Flow Map of the future state was devised and changes were implemented. Result: The time of the disinfection process was reduced in 2h37 and the financial resources required also decreased, in R$ 809.08/month. Conclusion: The application of Lean concepts presented positive results for the elimination of wastages in the disinfection center.

RESUMEN Objetivo: identificar y eliminar los pasos que no agregan valor para los clientes en el centro de desinfección. Método: aplicamos la herramienta Lean: mapa de la cadena de valor, conceptos de gemba y kaizen, en el proceso de trabajo de la unidad de desinfección para materiales de asistencia ventilatoria con el objetivo de mejorar el proceso. Después de realizar una capacitación con el equipo sobre los conceptos Lean descritos anteriormente, aplicamos el Mapa de la cadena de valor en el gemba, analizamos las oportunidades de mejora y aprobamos los cambios; se diseñó el Mapa de la cadena de valor del estado futuro y se implementaron los cambios. Resultado: el tiempo del proceso de desinfección se redujo en dos horas y treinta y siete minutos, y los recursos financieros requeridos también disminuyeron en R$ 809,08/mes. Conclusión: la aplicación de los conceptos Lean presentó resultados positivos para la eliminación de desperdicios en el centro de desinfección.

RESUMO Objetivo: identificar e eliminar as etapas que não agregam valor ao cliente na central de desinfecção. Método: foi aplicada a ferramenta Lean: Mapa de Fluxo de Valor, utilizando os conceitos Gemba e Kaizen no processo de trabalho da unidade de desinfecção de materiais para uso na assistência ventilatória com o intuito de melhorar o processo de trabalho. Foi realizada a capacitação da equipe em relação aos conceitos Lean descritos acima, foi aplicado o Mapa de Fluxo de Valor no Gemba, foram analisadas as oportunidades de melhoria e, após, aprovação das alterações, foi desenhado o Mapa de Fluxo de Valor do estado futuro e implementadas as mudanças. Resultado: obteve-se redução de tempo em 2h37 no processo de desinfecção e redução de recursos financeiros em R$ 809,08 reais/mês. Conclusão: a aplicação de conceitos Lean apresentou resultados positivos na eliminação de desperdícios na central de desinfecção.

Using Lean tools to reduce patient waiting time.

Purpose This paper aims to address problems in patient flow and identify the reasons behind extensive wait time at a public liver transplant outpatient clinic in an education and research hospital through the use of Lean health-care theories. Design/methodology/approach This paper opted for the application of Lean thinking and action research strategy. Data were collected through personal observations, interviews with users and team brainstorming. A value stream map was developed, improvement possibilities were identified and non-value-added activities were attempted to be eliminated. Findings Significant problems were identified and improvements were implemented and measured. The major remedial measures were: change the scheduling pattern, create a flow chart and a Kanban visual guide for medical students. In addition, an institutional change in the medical appointment scheduling software collaborated in the reduction of time and in the patient's displacement. The waiting time was reduced by 4.5 h, and the per cent complete and accurate increased by 50 per cent. Practical implications The flow was redesigned, and a culture of continuous improvement was introduced. Visiting the place where work was being done, leaders identified and created more value to the process without significant costs. The Gemba Walk was a powerful tool, interacting with people and processes in a Kaizen spirit. Originality/value Public health services in developing countries are one of the most deprived social needs of good practice. It will be useful for those who need examples about how to apply Lean tools in health care.

Concurrent Training with Blood Flow Restriction does not Decrease Inflammatory Markers.

The aging process is associated with several changes in the elderly such as the decrease in cardiorespiratory fitness, strength and muscle mass, in addition to chronic low-grade inflammation. Concurrent training with blood flow restriction can be an interesting alternative to improve functional capacity with low mechanical stress in the elderly. The purpose of this study was to compare the inflammatory effects in older individuals submitted to two different protocols of concurrent training. Twenty-two healthy older adults (63.7±3.8 years; 69.8±8.9 kg; 1.6±0.1 m) performed 12 weeks of concurrent training (CT) or concurrent training with blood flow restriction (CTBFR) and the effects on inflammatory markers were analyzed. We found inflammatory behavior for the CTBFR group with a significant difference in serum concentration of C-reactive protein between pre- and post-moment (0.96±0.37 to 1.71±1.45, p=0.049), with no difference between groups, and a time effect in interleukin-6 (pre=0.86±0.43; post=1.02±0.46, p=0.016). We conclude that the CTBFR showed a pro-inflammatory profile after the period of intervention whereas the CT showed the opposite.

Electroencephalography Patterns and Prognosis in Acute Ischemic Stroke.

BACKGROUND AND PURPOSE: The prognostic significance of interictal epileptiform discharges (IED) and periodic patterns (PP) after ischemic stroke has not been assessed. We sought to test whether IED and PP, detected on standard Electroencephalography (EEG) performed during the acute phase of ischemic stroke are associated with a worse functional outcome. METHODS: One-hundred-fifty-seven patients 18 years or older with a diagnosis of acute ischemic stroke presenting within 72 h from stroke onset were prospectively enrolled and followed. Patients with a pre-stroke history of seizures or epilepsy, previous debilitating neurological disease or conditions that precluded the performance of EEG were excluded. Interpretation was performed by a blinded board certified neurophysiologist. IED and PP (grouped as epileptiform activity [EA]) were defined according to proposed guidelines. Univariable and multivariable analyses were used to identify predictors of outcome (modified Rankin Scale dichotomized ≤2 vs. ≥3) at 3 months. RESULTS: In the univariable analysis, admission NIHSS (OR 1.20, 95% CI 1.12-1.28, p = 0.001), age (OR 1.03, 95% CI 1.01-1.05, p = 0.02), and presence of EA (OR 2.94, 95% CI 1.51-5.88, p = 0.001) were significantly associated with the outcome at 3 months. In the multivariable analysis, only admission NIHSS (OR 1.19, 95% CI 1.11-1.28, p < 0.001) and the presence of EA (OR 2.27, 95% CI 1.04-5.00, p = 0.04) were independently associated with the prognosis. SIGNIFICANCE: The importance of EEG in the prognosis of acute ischemic stroke warrants additional research, examining the role of medication therapy on the outcome and the occurrence of seizures for those patients with specific EEG patterns.

Brain Connectivity and Functional Recovery in Patients With Ischemic Stroke.

BACKGROUND: Brain mapping studies have demonstrated that functional poststroke brain reorganization is associated with recovery of motor function. Nonetheless, the specific mechanisms associated with functional reorganization leading to motor recovery are still partly unknown. In this study, we performed a cross-sectional evaluation of poststroke subjects with the following goals: (1) To assess intra- and interhemispheric functional brain activation patterns associated with motor function in poststroke patients with variable degrees of recovery; (2) to investigate the involvement of other nonmotor functional networks in relationship with recovery. METHODS: We studied 59 individuals: 13 patients with function Rankin > 1 and Barthel < 100; 19 patients with preserved function with Rankin 0-1 and Barthel = 100; and 27 healthy controls. All subjects underwent structural and functional magnetic resonance imaging (3T Philips Achieva, Holland) using the same protocol (TR = 2 seconds, TE = 30 ms, FOV = 240 × 240 × 117, slice = 39). Resting state functional connectivity was used by in-house software, based on SPM12. Among patients with and without preserved function, the functional connectivity between the primary motor region (M1) and the contralateral hemisphere was increased compared with controls. Nonetheless, only patients with decreased function exhibited decreased functional connectivity between executive control, sensorimotor and visuospatial networks. CONCLUSION: Functional recovery after stroke is associated with preserved functional connectivity of motor to nonmotor networks.

Integrating acupuncture into primary health care: the experience of an educational model implemented within the Brazilian Unified Health System in Florianópolis.

OBJECTIVE: Primary health care (PHC) is the main entry point and the first level of contact for individuals, families and communities within the Brazilian public health system. Considering that few studies have investigated the use of acupuncture in PHC, this article presents our experience in the city of Florianópolis when integrating acupuncture into PHC using an educational programme developed to teach acupuncture to primary care physicians (PCPs). METHODS: The course programme was designed using the WHO standards for acupuncture training and discussed at three consensus meetings. Between 2011 and 2014 three iterations of an introductory acupuncture course for PCPs were offered. During this period 53 physicians finished the programme. RESULTS: The number of acupuncture sessions in PHC rose from 1349 in 2011 to 6488 in 2015. It was observed in 2015 that 81% of the course participants working in PHC were regularly using acupuncture in their daily practice, with a mean number of sessions of 11.35 sessions per month. Moreover, collaborative work, which started during the course between the PCPs and the acupuncture specialists in secondary and tertiary public health care, helped to increase the quality of acupuncture referrals and facilitate clinical case discussions. CONCLUSIONS: Our experience in the city of Florianópolis shows that teaching acupuncture to PCPs is a sustainable model that can help introduce acupuncture into PHC. Furthermore it can expand access to acupuncture treatment for the population and increase the communication between PCPs and acupuncture specialists.

Status and Impact of Acupuncture Research: A Bibliometric Analysis of Global and Brazilian Scientific Output from 2000 to 2014.

OBJECTIVE: This bibliometric study was designed to evaluate the scientific output of Brazilian acupuncture publications and compare that output to the global trends in the same area. METHODS: The analyzed data were retrieved from the online version of Science Citation Index Expanded (SCI-E) database and covered the period from 2000 to 2014. The documents were searched by using the topic filter to find acupuncture-related documents (ARDs) and the title filter for acupuncture-specific documents (ASDs). The analyzed categories included number of publications, type of documents, number of citations, universities/institutions, research areas, and journals. RESULTS: A total of 9301 ARDs and 5974 ASDs were published in the past 15 years worldwide. The global average number of citations per document was 10.61 for ARDs and 9.24 for ASDs. Brazil has published 252 ARDs and 169 ASDs, which corresponds to the tenth and ninth positions on the global correspondent rankings. The United States is the most productive country, with 2503 ARD publications, followed by China with 2143 and South Korea with 925. Norway is in the first position for the ARD citation rank, with 25.77 citations per document; Switzerland is in the first position for the ASD citation rank, with 26.66. Brazil has 4.19 citations per document, which corresponds to the 20th position in the ASD citation rankings. Evidence-Based Complementary Medicine, Acupuncture in Medicine, and The Journal of Alternative and Complementary Medicine are the leading journals in terms of numbers of ARDs and ASDs in Brazil and globally. CONCLUSION: The bibliometric analysis of the SCI-E database shows that global numbers of ARDs and ASDs and citations have constantly increased from 2000 to 2014. Brazil is among the top 10 most productive countries in the world in terms of number of acupuncture publications. However, the number of citations of Brazilian documents is below the global average.

Asymptomatic carotid stenosis is associated with gray and white matter damage.

BACKGROUND: Cognitive deficits in patients with asymptomatic carotid stenosis have been reported. The ultimate mechanism of cognitive deficits remains unclear and might be related to subtle structural brain damage. AIMS: The aim of the present study was to evaluate the presence of subtle white and grey matter abnormalities associated with asymptomatic carotid stenosis. METHODS: Twenty-five patients with asymptomatic ≥70%/occlusion carotid stenosis and 25 healthy controls, matched for gender and age, underwent 3 Tesla brain magnetic resonance imaging. Gray and white matter macrostructural abnormalities were evaluated with voxel-based morphometry using spm8 software. White matter microstructural abnormalities were evaluated with diffusion tensor images with the Diffusion Toolbox package and tract-based spatial statistics from FMRIB Software Library. RESULTS: We observed significant macro- and microstructural white matter abnormalities, and these findings were diffuse and symmetrical in both hemispheres. In contrast, gray matter atrophy was observed in the areas corresponding to the anterior circulation of the hemisphere ipsilateral to the carotid stenosis. CONCLUSIONS: Patients with asymptomatic carotid stenosis have different patterns of gray and white matter abnormalities. While the white matter damage is diffuse, the gray matter atrophy is localized in the territory of anterior circulation ipsilateral to the stenosis. The role of asymptomatic carotid stenosis in the gray matter damage must be further investigated with longitudinal studies and comparison with neuropsychological evaluation.

Atitude de Estudantes de Medicina frente a Terapias Alternativas e Complementares / Medical Students’ Attitudes toward Alternative and Complementary Therapies

O uso das Terapias Alternativas e Complementares (TAC) vem aumentando ao longo dos anos no Brasil e no mundo com o advento de políticas de saúde favoráveis ao emprego dessas práticas. No entanto, as escolas médicas ainda não oferecem disciplinas curriculares sobre este tema. Com o intuito de descrever as atitudes dos estudantes de Medicina de uma universidade do Sul do Brasil com relação às terapias complementares, foi realizado um estudo observacional transversal descritivo, por meio da aplicação de um questionário. Houve 65,22% de taxa de resposta, e a terapia mais conhecida pelos estudantes foi a Fitoterapia (90,3%). A maioria deles demonstrou atitudes favoráveis com relação às terapias, e 75,26% gostariam de aprender sobre o tema em aulas curriculares.

The use of Complementary and Alternative Therapies (CAT) has been increasing over the years in Brazil and worldwide, with the advent of health policies that favor the use of these practices. However, medical schools still do not offer curricular disciplines on these topics. In order to describe the attitudes of Brazilian medical students toward complementary therapies a cross-sectional observational study was conducted by means of a questionnaire. There was a 65.22% response rate and the best-known therapy among students was Phytotherapy (90.3%). Most students showed positive attitudes toward these therapies, and 75.26% would like to learn about the topic in curricular classes. Our results have shown a favorable attitude on the part of medical students in relation to complementary therapies, as well as some knowledge about them. Students demonsatrated willingness to learn about these topics during curricular lectures.

XIII Encontro Nacional da Federação Brasileira de Epilepsia em Porto Velho/RO: luta pelos direitos e questões trabalhistas das pessoas com epilepsia / XIII National Meeting of the Brazilian Federation of Epilepsy in Porto Velho/RO: campaign for rights and labor issues of people with epilepsy / XIII Encuentro Nacional de la Federación Brasileña de Epilepsia en Porto Velho/RO: lucha por los derechos y cuestiones laborales de las personas con epilepsia

Introdução: Desde 2004, ano de fundação da Federação Brasileira de Epilepsia (Epibrasil), são realizadas reuniões anuais objetivando consolidar o apoio às associações de epilepsia, fortalecer o movimento e estabelecer metas de trabalho para o próximo ano. Neste ano, o Encontro Nacional foi realizado na Sede do Ministério Público de Rondônia, em Porto Velho, RO. Objetivo: Relatar os principais destaques do XIII Encontro e da XI Assembleia, ocorridos de 27 a 28 de março de 2015. Métodos: Registro descritivo dos eventos e análise qualitativa para compor o presente relato. Resultados: Estiveram presentes no evento representantes de 10 associações. As palestras abordaram temas em discussão na mídia, como o uso de canabidiol para o tratamento de epilepsia e a questão trabalhista, tendo sido ressaltada a dificuldade de inserção das pessoas com epilepsia no mercado de trabalho. Em consonância com as discussões do Encontro de 2014, manteve-se a ênfase na questão trabalhista, com o intuito de garantir às pessoas com epilepsia o acesso ao trabalho e a manutenção do emprego. Conclusão: A partir das discussões, delinearam-se as propostas com foco no próximo ano, especialmente no tema "Epilepsia e Trabalho", articulando diferentes setores da sociedade para promover a inclusão da pessoa com epilepsia...

Introduction: Since 2004, when the Brazilian Federation of Epilepsy (Epibrasil) was founded, annual meetings are held in order to consolidate support for epilepsy associations, aiming to strengthen the movement and establish working goals for the forthcoming year. This year, the National Meeting was held at the headquarters of the Public Ministry of Rondônia, in Porto Velho, RO. Objective: To report the main highlights of the XII National Meeting of Epibrasil, held on March 27th and 28th, 2014. Methods: Descriptive record of the events and qualitative analysis. Results and Discussion: In this meeting, there were representatives of 10 associations. Lectures covered topics discussed in the media, such as the use of cannabidiol for epilepsy treatment as well as labor issues with emphasis on difficulties faced by people with epilepsy to find and maintain jobs. Aligned with discussions during the last meeting, there was a special emphasis on labor issues, in order to ensure people with epilepsy access to work and job retention. Conclusion: Based in these discussions, proposals were drafted for the next year focusing especially on the topic "Epilepsy and Work", linking different sectors of society to promote the inclusion of people with epilepsy...

Introducción: Desde 2004, año de la fundación de la Federación Brasileña de Epilepsia (Epibrasil), son realizadas reuniones anuales con el objetivo de consolidar el apoyo a las asociaciones de epilepsia, fortalecer el movimiento y establecer metas de trabajo para el próximo año. Este año, el Encuentro Nacional se realizó en la Sede del Ministerio Público de Rondônia, en la ciudad de Porto Velho. Relatar los principales destaques del XIII Encuentro y de la XI Asamblea, ocurridos los días 27 y 28 de marzo de 2015. Métodos: Registro descriptivo de los eventos y análisis cualitativo para componer el presente relato. Resultados: Han estado presentes representantes de 10 asociaciones. Las conferencias abordaron temas en discusión en los medios, como el uso de cannabidiol para el tratamiento de epilepsia y la cuestión laboral, habiendo sido resaltada la dificultad de inserción de las personas con epilepsia en el mercado de trabajo. En consonancia con las discusiones en el Encuentro de 2014, se mantuvo el énfasis en la cuestión laboral, con el objetivo de asegurar a las personas con epilepsia el acceso al trabajo y el mantenimiento del empleo. Conclusión: A partir de las discusiones, fueron delineadas las propuestas en foco en el próximo año, en especial en el tema "Epilepsia y Trabajo", articulando diferentes sectores de la sociedad para promover la inclusión de la persona con epilepsia...

Lateral pterygoid muscle volume and migraine in patients with temporomandibular disorders.

PURPOSE: Lateral pterygoid muscle (LPM) plays an important role in jaw movement and has been implicated in Temporomandibular disorders (TMDs). Migraine has been described as a common symptom in patients with TMDs and may be related to muscle hyperactivity. This study aimed to compare LPM volume in individuals with and without migraine, using segmentation of the LPM in magnetic resonance (MR) imaging of the TMJ. MATERIALS AND METHODS: Twenty patients with migraine and 20 volunteers without migraine underwent a clinical examination of the TMJ, according to the Research Diagnostic Criteria for TMDs. MR imaging was performed and the LPM was segmented using the ITK-SNAP 1.4.1 software, which calculates the volume of each segmented structure in voxels per cubic millimeter. The chi-squared test and the Fisher's exact test were used to relate the TMD variables obtained from the MR images and clinical examinations to the presence of migraine. Logistic binary regression was used to determine the importance of each factor for predicting the presence of a migraine headache. RESULTS: Patients with TMDs and migraine tended to have hypertrophy of the LPM (58.7%). In addition, abnormal mandibular movements (61.2%) and disc displacement (70.0%) were found to be the most common signs in patients with TMDs and migraine. CONCLUSION: In patients with TMDs and simultaneous migraine, the LPM tends to be hypertrophic. LPM segmentation on MR imaging may be an alternative method to study this muscle in such patients because the hypertrophic LPM is not always palpable.

Brain activity and perceived exertion during cycling exercise: an fMRI study.

BACKGROUND/AIM: Currently, the equipment and techniques available to assess brain function during dynamic exercise are limited, which has restricted our knowledge of how the brain regulates exercise. This study assessed the brain areas activated during cycling by making use of a novel cycle ergometer, constructed to measure functional MRI (fMRI) brain images during dynamic exercise. Furthermore, we compared brain activation at different levels of ratings of perceived exertion (RPE) generated during the exercise. METHODS: Seven healthy adults performed cycling exercise in a novel MRI compatible cycle ergometer while undergoing brain  fMRI. Participants completed a cycling block protocol comprising six trials of 2 min cycling with 16-s intervals between trials. Participants reported their RPE every minute through an audio link. The MRI cycling ergometer transferred the torque generated on the ergometer through a cardan system to a cycling ergometer positioned outside the MRI room. For data analysis, the effects of cycling as opposed to rest periods were examined after motion correction. RESULTS: The multiparticipant analysis revealed in particular the activation of the cerebellar vermis and precentral and postcentral gyrus when periods of cycling versus rest were compared. Single participant analysis in four participants revealed that activation of the posterior cingulate gyrus and precuneus occurred in cycling blocks perceived as 'hard' compared with exercise blocks that were less demanding. CONCLUSIONS: The present study offers a new approach to assess brain activation during dynamic cycling exercise, and suggests that specific brain areas could be involved in the sensations generating the rating of perceived exertion.

A Brazilian original pedagogical approach to the teaching of neurology.

UNLABELLED: The two-arm Clinical Decisions/Diagnostic Workshop (CD/DW) approach to undergraduate medical education has been successfully used in Brazil. OBJECTIVE: Present the CD/DW approach to the teaching of stroke, with the results of its pre-experimental application and of a comparative study with the traditional lecture-case discussion approach. METHOD: Application of two questionnaires (opinion and Knowledge-Attitudes-Perceptions-KAP) to investigate the non-inferiority of the CD/DW approach. RESULTS: The method was well accepted by teachers and students alike, the main drawback being the necessarily long time for its completion by the students, a feature that may better cater for different educational needs. The comparative test showed the CD/DW approach to lead to slightly higher cognitive acquisition as opposed to the traditional method, clearly showing its non-inferiority status. CONCLUSION: The CD/DW approach seems to be another option for teaching neurology in undergraduate medical education, with the bonus of respecting each learner`s time.

A Brazilian original pedagogical approach to the teaching of neurology / Uma abordagem pedagógica original brasileira para o ensino da neurologia

The two-arm Clinical Decisions/Diagnostic Workshop (CD/DW) approach to undergraduate medical education has been successfully used in Brazil. Objective Present the CD/DW approach to the teaching of stroke, with the results of its pre-experimental application and of a comparative study with the traditional lecture-case discussion approach. Method Application of two questionnaires (opinion and Knowledge-Attitudes-Perceptions-KAP) to investigate the non-inferiority of the CD/DW approach. Results The method was well accepted by teachers and students alike, the main drawback being the necessarily long time for its completion by the students, a feature that may better cater for different educational needs. The comparative test showed the CD/DW approach to lead to slightly higher cognitive acquisition as opposed to the traditional method, clearly showing its non-inferiority status. Conclusion The CD/DW approach seems to be another option for teaching neurology in undergraduate medical education, with the bonus of respecting each learner`s time. .

O método Decisões Clínicas/Oficinas Diagnósticas (DC/OD) é usado com sucesso na graduação médica no Brasil. Objetivo Apresentar o método DC/OD usando o exemplo do Acidente Vascular Encefálico, assim como os resultados de sua aplicação pré-experimental e de um estudo comparativo com o método tradicional (aula mais discussão de casos). Método Aplicação de questionários de opiniões e de questionários de conhecimentos, atitudes e percepções para investigar a não inferioridade do método DC/OD. Resultados DC/OD foi bem aceito por professores e estudantes. A principal crítica foi o tempo necessariamente longo para os estudantes completá-lo, característica que pode atender às diferentes necessidades educacionais. O estudo comparativo demonstrou que o método DC/OD levou a uma aquisição cognitiva maior que o tradicional, demonstrando sua não inferioridade. Conclusão O método DC/OD parece ser uma alternativa para o ensino da neurologia na graduação médica, com a vantagem de respeitar o diferente tempo de aprendizado dos estudantes. .