Exergames in Older Adult Community Centers and Nursing Homes to Improve Balance and Minimize the Risk of Falls in Older Adults: A Systematic Review and Meta-Analysis.

There is a substantial gap in our knowledge regarding the efficacy of exergames on the reduction of fall risk in older adults. This systematic review analyzes the findings of clinical trials describing the efficacy of exergames to improve balance or reduce the risk of falls in individuals above 60 years of age who are residents in community centers or nursing homes. We searched Google Scholar, PubMed, and Embase up to January 2023. Initially, 52,294 records were screened. After applying the inclusion and exclusion criteria, 20 studies were included in this systematic review. Meta-analyses revealed statistically significant reductions in the risk of falls and improvements in balance. Exergaming tended to produce positive benefits according to the results obtained using different instruments (TUG, PPA, BBS, and others), control groups, and times of intervention. Nevertheless, a substantial proportion of studies exhibited a high risk of bias and only one had a long follow-up period. Although a large body of evidence supports the view that exergaming is suitable for reducing fall risk and improving balance in older adults, some gaps remain in our knowledge about such benefits.

The association between non-permanence of dogs in households and non-compliance with the principles of responsible animal guardianship: A survey in a medium-sized city in Brazil.

The permanence of a dog in a household is relevant in terms of public health and animal welfare because it implies that the animal is receiving better care and is unlikely to be abandoned. We have performed a survey in a medium-sized city in southeastern Brazil in order to identify predictors associated with the non-permanence of dogs in households as determined one year after the first visit. During the first of two visits to randomly selected domiciles, guardians were asked to complete a structured questionnaire regarding the traits and history of each dog in the household, features of the domicile, characteristics of the guardian and adherence to the principles of responsible companion animal guardianship (RCAG). A second visit to each domicile was performed one year later in order to establish in loco whether the dog still resided in the domicile and, where appropriate, to apply a further questionnaire concerning the fate of the missing animal. The total sample population comprised 513 dogs, of which 98 (19.1%) were verified as no longer resident in the domicile on the occasion of the second visit. Of the absent dogs, 59 had died as a result of fights with stray animals, traffic accidents, diseases or old age, 13 had been sent to alternative addresses, 8 had been donated to third parties and 7 had escaped from the domicile. The fates of the remaining 11 animals were not divulged by the guardians. Multiple regression analysis revealed that the risk of non-permanence was significantly higher (p < 0.05) among male dogs, those that were infested with ticks, had free access to the streets or resided in domiciles near a wooded area, but was significantly lower among wormed and neutered dogs. The adoption of RCAG principles is associated with the permanence of dogs in households and, consequently, in reduction of the stray population, animal well-being and prevention of zoonoses. On this basis, it is important to raise awareness about the concepts of RCAG and to strengthen accountability of guardians that do not take proper care of their animals.

Responsible companion animal guardianship is associated with canine visceral leishmaniasis: an analytical cross-sectional survey in an urban area of southeastern Brazil.

BACKGROUND: Responsible companion animal guardianship (RCAG) comprises a set of concepts involving activities, behavior and care that guardians must provide to ensure the welfare of their animals. When such principles are disregarded, the risk of animals developing zoonotic diseases, such as canine visceral leishmaniasis (CVL), increases. This disease is a public health problem in many urban settings in Brazil because dogs are the main reservoirs of Leishmania and are involved in the transmission of the parasites to humans. Our analytical cross-sectional epidemiological survey aimed to investigate the prevalence of CVL in a city in southeastern Brazil and to establish the association between the disease and a number of predictor variables including dog traits, socioeconomic status of guardians, ecological features of the domicile and RCAG. RESULTS: Our study showed that the global prevalence of CVL in the sample canine population was 6.7% (47/704). All variables related to better dog care were associated with lower chances of infection. Multiple regression analysis revealed that the chances of animals being seropositive for CVL were significantly (p < 0.05) higher when guardians had no formal education or possessed a university degree (vs. those with complete primary or secondary schooling) and when dogs were sheltered outside the house and had free access to the streets. An additional novel finding was that dogs that were acquired as puppies presented half of the chance of developing the disease in comparison with those acquired at the adult stage. Geographically weighted logistic regression coefficients showed that the strengths of the predictor/CVL associations varied depending on the studied geographical space. Both models demonstrated that the associations were always in the same directions. CONCLUSIONS: Our findings indicate that regardless of age and mode of acquisition, adult dogs should be submitted to clinical evaluation and tests for CVL. RCAG can exert positive effects on the control of CVL.

Cirurgia ortopédica e Covid: quais os riscos e perspectivas? / Orthopedic surgery and Covid: risks and perspectives

A pandemia revolucionou a assistência médica global de uma maneira sem precedentes e com repercussões inimagináveis. A prática diária ortopédica foi significativamente afetada. O trauma e a ortopedia estão na linha de frente do coronavírus, uma vez que as operações ortopédicas de emergência ainda estão entre os procedimentos cirúrgicos de emergência mais comuns. No entanto, as indicações cirúrgicas foram reformuladas, com casos eletivos sendo adiados. De acordo com as diretrizes propostas pela Academia Americana de Cirurgiões Ortopédicos (AAOS) e Colégio Americano de Cirurgiões (ACS) as cirurgias eletivas devem ser criteriosamente adiadas, dependendo do local, prevalência de COVID-19 e disponibilidade de recursos. Estudos demonstraram que a chance do paciente que será operado ser portador assintomático do SARS-Cov-2 é de 0,07%, cerca de 1 em 1.400. A partir dessa informação, calcula-se que a chance de um paciente assintomático evoluir a óbito devido a COVID-19 após cirurgia ortopédica é de 1 em 7.000 casos. O risco de morte em cirurgia eletiva em um contexto de pandemia por COVID-19 serão cumulativos; no entanto, o risco do COVID-19 será menor do que o risco de morte por todas as causas em um determinado ano.

The COVID-19 pandemic has revolutionized global health care in an unprecedented way and with unimaginable repercussions. Daily orthopedic practice was significantly affected. Trauma and orthopedics surgeries are at the forefront of coronavirus, since emergency orthopedic operations are still among the most common emergency surgical procedures. However, surgical indications have been reformulated, with elective cases being postponed. According to the guidelines proposed by the American Academy of Orthopedic Surgeons (AAOS) and American College of Surgeons (ACS), elective surgeries should be carefully postponed, depending on the location, prevalence of COVID-19 and availability of resources. Studies have shown that the chance that the patient to be operated on will be asymptomatic with SARS-Cov-2 is 0.07%, about 1 in 1,400. From this information, it is estimated that the chance of an asymptomatic patient evolving to death due to COVID-19 after orthopedic surgery is 1 in 7,000 cases. The risk of death from elective surgery in a context of a COVID-19 pandemic will be cumulative; however, the risk of COVID-19 will be less than the risk of death from all causes in a given year.

Accuracy of diagnostic tests for American tegumentary leishmaniasis: a systematic literature review with meta-analyses.

OBJECTIVES: To analyse the accuracy of American tegumentary leishmaniasis (ATL) diagnostic methods and evaluate the quality of the existing publications by means of a systematic review. METHODS: Diagnostic tests evaluated in at least two studies with common reference standards were included in the sensitivity and/or specificity meta-analyses. Quality and susceptibility to bias were analysed using the QUADAS-2 and STARD tools. RESULTS: The title and abstract of 3387 publications were evaluated after deduplication resulting from database searches. Thirty-eight studies were included in the review, and 26 of them had results inserted in meta-analyses. The diagnostic methods with the highest pooled sensitivity values were ELISA, polymerase chain reaction (PCR), indirect immunofluorescence reaction and Montenegro's intradermal reaction. Cytometry was assessed in only two studies and presented 100% sensitivity in both. Smear slide microscopy and histopathology showed low pooled values of sensitivity. For specificity, the highest pooled values were identified for PCR. High values were also identified for ELISA, except for studies in which the reference standard for defining negative participants included individuals with Chagas' disease or paracoccidioidomycosis, which also occurred for cytometry. IFR had lower specificities than ELISA. There was a predominance of case-control designs of phase 1 or 2 and only four studies were strongly recommended as evidence generators. Several reference standards were adopted, and different methods were assessed in a small number of studies. CONCLUSION: PCR showed the highest accuracy for the diagnosis of ATL, and its use should be encouraged in clinical practice. ELISA is recommended for the screening of suspected individuals, but the possibility of cross-reactions should be considered. New validation studies for the tests evaluated in few publications and studies of phase 3 with appropriate methods are needed.

OBJECTIFS: Analyser l'exactitude des méthodes de diagnostic de la leishmaniose tégumentaire américaine (LTA) et évaluer la qualité des publications existantes au moyen d'une analyse systématique. MÉTHODES: Les tests diagnostiques évalués dans au moins deux études avec des étalons de référence communs ont été inclus dans les méta-analyses de sensibilité et/ou de spécificité. La qualité et la sensibilité au biais ont été analysées à l'aide des outils QUADAS-2 et STARD. RÉSULTATS: Le titre et le résumé de 3387 publications ont été évalués après déduplication résultant de recherches dans la base de données. 38 études ont été incluses dans la revue et 26 d'entre elles ont eu des résultats inclus dans des méta-analyses. Les méthodes de diagnostic avec les valeurs de sensibilité poolées les plus élevées étaient ELISA, la réaction en chaîne par polymérase (PCR), la réaction d'immunofluorescence indirecte et la réaction intradermique du Monténégro. La cytométrie a été évaluée dans seulement deux études et présentait une sensibilité de 100% dans les deux. La microscopie et l'histopathologie sur lame de frottis ont montré de faibles valeurs poolées de sensibilité. Pour la spécificité, les valeurs poolées les plus élevées ont été identifiées pour la PCR. Des valeurs élevées ont également été identifiées pour l'ELISA, à l'exception des études dans lesquelles la norme de référence pour définir les participants négatifs incluait des individus atteints de la maladie de Chagas ou de paracoccidioïdomycose, qui s'est également produite pour la cytométrie. L'IFR avait des spécificités plus faibles que l'ELISA. Il y avait une prédominance des essais cas-témoins de phases 1 ou 2 et seules quatre études étaient fortement recommandées comme génératrices de preuves. Plusieurs normes de référence ont été adoptées et différentes méthodes ont été évaluées dans un petit nombre d'études. CONCLUSION: la PCR a montré la plus grande exactitude pour le diagnostic de l'ATL et son utilisation doit être encouragée dans la pratique clinique. L'ELISA est recommandé pour le dépistage des personnes suspectées, mais la possibilité de réactions croisées doit être considérée. De nouvelles études de validation des tests évalués dans quelques publications et des études de phase 3 avec des méthodes appropriées sont nécessaires.