Systematic review of international clinical guidelines for the promotion of physical activity for the primary prevention of cardiovascular diseases.

BACKGROUND: Cardiovascular diseases are the world's leading cause of morbidity and mortality. An active lifestyle is one of the cornerstones in the primary prevention of cardiovascular disease. An initial step in guiding primary prevention programs is to refer to clinical guidelines. We aimed to systematically review clinical practice guidelines on primary prevention of cardiovascular disease and their recommendations regarding physical activity. METHODS: We systematically searched Trip Medical Database, PubMed and Guidelines International Network from January 2012 up to December 2020 using the following search strings: 'cardiovascular disease', 'prevention', combined with specific cardiovascular disease risk factors. The identified records were screened for relevance and content. We methodologically assessed the selected guidelines using the AGREE II tool. Recommendations were summarized using a consensus-developed extraction form. RESULTS: After screening, 27 clinical practice guidelines were included, all of which were developed in Western countries and showed consistent rigor of development. Guidelines were consistent about the benefit of regular, moderate-intensity, aerobic physical activity. However, recommendations on strategies to achieve and sustain behavior change varied. Multicomponent interventions, comprising education, counseling and self-management support, are recommended to be delivered by various providers in primary health care or community settings. Guidelines advise to embed patient-centered care and behavioral change techniques in prevention programs. CONCLUSIONS: Current clinical practice guidelines recommend similar PA lifestyle advice and propose various delivery models to be considered in the design of such interventions. Guidelines identify a gap in evidence on the implementation of these recommendations into practice.

Tropane alkaloids from the stem bark of Erythroxylum bezerrae.

Six previously undescribed tropane alkaloids, designated as erythrobezerrines A-F, were isolated from the EtOH extract from the stem bark of Erythroxylum bezerrae Plowman. Their structures were elucidated based on the interpretation of the NMR and MS data and in some instances, confirmed by X-ray diffraction analysis. The cytotoxicity of the isolated compounds was evaluated against the cancer cell lines L929, PC-3, HCT-116, SNB-19 and NCI-H460, but only erythrobezerrine C showed moderate activity with IC50 values of 3.38 and 5.43 µM for HCT-116 and NCI-H460, respectively.

Mobile applications for elderly healthcare: A systematic mapping.

CONTEXT: The increase in the population aging has brought more significant concern about how proper care will be provided to the elderly in the future. Thus, the development of technological solutions for the health domain has gained more prominence. Joining this scenario to the growing use of mobile devices for daily activities, several mobile applications focused on the elderly healthcare have been developed with healthcare and software engineer professionals involved. However, there is no survey to help both professionals to take decisions on the target of application, elderly profile, empirical validation techniques, among others. Thus, the following question arises: how have mobile applications for elderly healthcare been addressed in the literature in the past years? OBJECTIVE: To identify the state of the art in the literature concerned with the development of mobile applications for elderly healthcare, considering healthcare and software Engineering viewpoints. METHOD: We performed a systematic mapping conducted by health and software engineering researchers to provide an interdisciplinary investigation of the papers that address mobile applications for elderly healthcare, summarizing the data collected under the following classification: target of application, older adult profile, spatial-temporal distribution, techniques for empirical validation and type of software engineering research. RESULTS: We found a total of 2533 papers and, after applying our eligibility criteria, we got 149. We observed aspects related to the digital health initiative type, using the classification proposed by the World Health Organization (WHO), the elderly profile prioritized by the application, the spatial-temporal distribution of the studies, the empirical validation type, and the research contribution of each analyzed paper to the software engineering area. CONCLUSIONS: Regarding the WHO classification, we noticed that two categories were more frequently found, Clients and Data Services, and that none of the mobile apps were classified in the Health System Manager category. The data extraction result also reveals that most of the applications found in the literature focused on the independent elderly. Moreover, we observed that most of the studies were proposals of solutions for elderly health and the validation process of these solutions generally consisted of controlled experiments and usability evaluations. At last, the research focused on mobile applications for elderly healthcare has been performed mostly by developed countries.

What research agenda could be generated from the European General Practice Research Network concept of Multimorbidity in Family Practice?

BACKGROUND: Multimorbidity is an intuitively appealing, yet challenging, concept for Family Medicine (FM). An EGPRN working group has published a comprehensive definition of the concept based on a systematic review of the literature which is closely linked to patient complexity and to the biopsychosocial model. This concept was identified by European Family Physicians (FPs) throughout Europe using 13 qualitative surveys. To further our understanding of the issues around multimorbidity, we needed to do innovative research to clarify this concept. The research question for this survey was: what research agenda could be generated for Family Medicine from the EGPRN concept of Multimorbidity? METHODS: Nominal group design with a purposive panel of experts in the field of multimorbidity. The nominal group worked through four phases: ideas generation phase, ideas recording phase, evaluation and analysis phase and a prioritization phase. RESULTS: Fifteen international experts participated. A research agenda was established, featuring 6 topics and 11 themes with their corresponding study designs. The highest priorities were given to the following topics: measuring multimorbidity and the impact of multimorbidity. In addition the experts stressed that the concept should be simplified. This would be best achieved by working in reverse: starting with the outcomes and working back to find the useful variables within the concept. CONCLUSION: The highest priority for future research on multimorbidity should be given to measuring multimorbidity and to simplifying the EGPRN model, using a pragmatic approach to determine the useful variables within the concept from its outcomes.

Factor Va alternative conformation reconstruction using atomic force microscopy.

Protein conformational variability (or dynamics) for large macromolecules and its implication for their biological function attracts more and more attention. Collective motions of domains increase the ability of a protein to bind to partner molecules. Using atomic force microscopy (AFM) topographic images, it is possible to take snapshots of large multi-component macromolecules at the single molecule level and to reconstruct complete molecular conformations. Here, we report the application of a reconstruction protocol, named AFM-assembly, to characterise the conformational variability of the two C domains of human coagulation factor Va (FVa). Using AFM topographic surfaces obtained in liquid environment, it is shown that the angle between C1 and C2 domains of FVa can vary between 40° and 166°. Such dynamical variation in C1 and C2 domain arrangement may have important implications regarding the binding of FVa to phospholipid membranes.

Assessment of potential drug-drug interactions at hospital discharge.

OBJECTIVE: The evaluation of the prevalence of potential drug-drug interactions and assessment of their clinical relevance in patients' discharge medication in the medical ward of a community teaching hospital. The relevant clinical information was reported to the treating physicians. METHODS: 200 patients at discharge from a medical ward were included. Prescribed drugs were analysed for interactions using commercially available software (Pharmavista). Clinical pharmacists and a physician assessed the clinical relevance of detected interactions, eliminated those which were not considered clinically relevant and formulated recommendations for those considered clinically relevant. A written recommendation was given to the physician to provide rapid feedback before discharge. RESULTS: The median age of the 200 patients studied was 69 years. At discharge, patients took an average of 7 different drugs. 62.5% of patients had at least one potential drug-drug interaction. In total, 373 potential drug-drug interactions were identified: 223 (60%) of minor severity, 143 (38%) of moderate severity and 7 (2%) of major severity. CONCLUSIONS: A computerised drug-drug interaction program (detection) together with clinical pharmacological experience (interpretation/evaluation) can be useful for decreasing the number of potentially harmful drug combinations. This approach may lead to an improvement in the quality of prescription, reducing possible risks and thus contributing to patient safety.

An integrated methodology for data processing in dynamic force spectroscopy of ligand-receptor binding.

Dynamic force spectroscopy (DFS), using atomic force microscopy (AFM), is a powerful tool to study ligand-receptor binding. The interaction mode of two binding partners is investigated by exploring stochastic behaviors of bond rupture events. However, to define a rupture event from force-distance measurements is not conclusive or unique in literature. To reveal the influence of event identification methods, we have developed an efficient protocol to manage tremendous amount of data by implementing different choices of peak selection from the force-distance curve. This data processing software simplifies routinely experimental procedures such as cantilever spring constant and force-distance curve calibrations, statistical treatments of data, and analysis distributions of rupture events. In the present work, we took available experimental data from a complex between a chelate metal compound and a monoclonal antibody as a study system.

Residência em Saúde da Família: desafios na qualificação dos profissionais na atenção primária

O Programa Saúde da Família - PSF tem como objetivo contribuir, para a reorientação do modelo assistencial a partir da atenção básica, em conformidade com os princípios do Sistema Único de Saúde. Para implementação deste novo modelo é imprescindível a qualificação de profissionais neste nível. A formação dos profissionais da área da saúde sempre esteve pautada na área curativa, principalmente dos cursos de nível superior de medicina e enfermagem. É necessário instrumentalizar esses profissionais, reparando as deficiências de conhecimentos, habilidades e prática referentes à atenção primária de saúde. O município de Sobral, com gestão plena, implantou 31 equipes do PSF em 22 áreas descentralizadas de saúde. Cada equipe é composta de um médico e de um a três enfermeiros, dependendo da necessidade da área, totalizando 77 profissionais de nível superior. O objetivo da residência é capacitar os profissionais de saúde (médicos e enfermeiros) para atuarem na estratégia de Saúde da Família. Trata-se de um curso de pós-graduação latu sensu, com duração de dois anos, carga horária mínima de 2400 horas anuais e forte componente de treinamento em serviço com preceptoria. Uma parceria entre a Universidade Estadual Vale do Acaraú e a Secretaria de Saúde e Assistência Social está viabilizando o curso, que já teve seu primeiro módulo oferecido no mês de setembro. Entendemos que só com projetos deste porte poderemos consolidar o modelo, que elege a família e seu espaço social como núcleo básico de abordagem no atendimento à saúde. (AU)

Caderneta de saúde da mãe e da criança de Sobral: utilização e opinião das gestantes usuárias

A Caderneta de Saúde da Mãe e da Criança de Sobral é um documento de 78 páginas que é entregue a todas as gestantes de Sobral na sua primeira consulta de pré-natal. Uma das maiores preocupações na sua elaboração foi dar acesso às mães a informações que venham diminuir a ansiedade comum no período gestacional, seja em aspectos ligados diretamente a este período, como também relacionados com o crescimento e desenvolvimento da criança. Para isto foram utilizadas linguagem simples e muitas ilustrações. Neste estudo 79 por cento das gestantes leram a Caderneta só, em grupo ou com ajuda de outra pessoa e 75 por cento gostaram da leitura. Estes resultados deixam claro a importância da manutenção da Caderneta. Quanto ao preenchimento verificou-se um percentual importante de informações incompletas ou ausentes, o que orienta no sentido de itensificar o estímulo para que os profissionais de saúde realmente valorizem e preencham a Caderneta. (AU)