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.

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.

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.

[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.

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 and depressive-like deficits, 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, rescueing neurogenesis and, importantly, promoting recovery of emotional deficits characteristic of disorders such as MDD.

[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.

Adesão, barreiras e facilitadores no tratamento de hipertensão arterial: revisão rápida de evidências

[RESUMO]. Objetivo. Identificar estratégias para aumentar a adesão ao tratamento de hipertensão arterial sistêmica (HAS) e descrever as barreiras e os facilitadores para implementação dessas estratégias na atenção primária à saúde (APS). Métodos. Foi realizada uma revisão rápida de evidências. Foram incluídas revisões sistemáticas, com ou sem metanálises, publicadas em inglês, espanhol ou português, que avaliaram adultos (18 a ≤ 60 anos) com HAS acompanhados na APS. As buscas foram realizadas em nove bases de dados em dezembro de 2020 e atuali- zadas em abril de 2022. As revisões sistemáticas incluídas foram avaliadas quanto à qualidade metodológica por meio da ferramenta AMSTAR 2. Resultados. Foram incluídas 14 revisões sistemáticas sobre estratégias de adesão ao tratamento e três sobre barreiras e facilitadores para implementação. A qualidade metodológica foi moderada em uma revisão sistemática, baixa em quatro e criticamente baixa nas demais. Quatro estratégias foram identificadas como opções para políticas de saúde: ações realizadas por farmacêuticos; ações realizadas por profissionais não farmacêuticos; automonitoramento, uso de aplicativos de celular e mensagens de texto; e oferta de subsídios para aquisição de medicamentos. O baixo letramento digital, o acesso limitado à internet, processos de tra- balho e formação incipiente foram barreiras para os profissionais. Foram facilitadores o nível educacional e de letramento em saúde dos usuários, a acessibilidade aos serviços de saúde e o bom relacionamento com os profissionais. Conclusões. Identificaram-se efeitos positivos de estratégias relacionadas à atenção farmacêutica, automo- nitoramento e uso de aplicativos de celular e mensagem de texto para aumentar a adesão ao tratamento da HAS no âmbito da APS. Porém, para fins de implementação, é preciso considerar barreiras e facilitadores, além das limitações metodológicas das revisões sistemáticas analisadas.

[ABSTRACT]. 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-analy- ses, 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 professio- nals. 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.

[RESUMEN]. 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 estra- tegias 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.

Integration of evidence into Theory of Change frameworks in the healthcare sector: A rapid systematic review.

BACKGROUND: Theory of Change (ToC) has become an established approach to design and evaluate interventions. While ToC should-in line with the growing international focus on evidence-informed health decision-making-consider explicit approaches to incorporate evidence, there is limited guidance on how this should be done. This rapid review aims to identify and synthesize the available literature on how to systematically use research evidence when developing or adapting ToCs in the health sector. METHODS: A rapid review methodology using a systematic approach, was designed. Eight electronic databases were consulted to search for peer-reviewed and gray publications detailing tools, methods, and recommendations promoting the systematic integration of research evidence in ToCs. The included studies were compared, and the findings summarized qualitatively into themes to identify key principles, stages, and procedures, guiding the systematic integration of research evidence when developing or revising a ToC. RESULTS: This review included 18 studies. The main sources from which evidence was retrieved in the ToC development process were institutional data, literature searches, and stakeholder consultation. There was a variety of ways of finding and using evidence in ToC. Firstly, the review provided an overview of existing definitions of ToC, methods applied in ToC development and the related ToC stages. Secondly, a typology of 7 stages relevant for evidence integration into ToCs was developed, outlining the types of evidence and research methods the included studies applied for each of the proposed stages. CONCLUSION: This rapid review adds to the existing literature in two ways. First, it provides an up-to-date and comprehensive review of the existing methods for incorporating evidence into ToC development in the health sector. Second, it offers a new typology guiding any future endeavors of incorporating evidence into ToCs.

Telessaúde no consumo e comportamento alimentar em adultos: uma revisão rápida de revisões sistemáticas

[RESUMO]. Objetivo. Sintetizar as evidências sobre os efeitos de intervenções de telessaúde oferecidas por meio de apli- cativos de celular e de mensagens de texto no comportamento de adultos com vistas à alimentação saudável. Métodos. Foi realizada uma revisão rápida por meio de buscas em nove bases eletrônicas da literatura para identificar revisões sistemáticas publicadas em inglês, português e espanhol que avaliassem estratégias de telessaúde comparadas a atendimento presencial para melhoria da alimentação na população adulta (18 a 59 anos). As buscas foram realizadas em novembro de 2020 e atualizadas em abril de 2022. As revisões sistemáticas incluídas foram avaliadas quanto à qualidade metodológica com a ferramenta AMSTAR 2. Resultados. Cinco revisões sistemáticas foram incluídas, sendo uma com avaliação de confiança moderada e as demais com confiança criticamente baixa. Verificou-se uma escassez de estudos comparando o uso de estratégias de telessaúde com o atendimento presencial para a promoção da alimentação saudável em adultos. Os resultados mais consistentes referem-se ao aumento no consumo de frutas e vegetais com o uso de aplicativo ou mensagens de texto, além de melhoria do padrão alimentar de pessoas com diabetes ou intolerância à glicose com o uso de mensagens de texto. Conclusão. A maioria das análises de intervenções utilizando aplicativos de celular ou mensagens de texto mostrou efeitos positivos nos desfechos de alimentação saudável. No entanto, esses achados se referem aos poucos ensaios clínicos com amostras pequenas de participantes incluídos nas revisões sistemáticas da presente revisão rápida, a maioria de baixa qualidade metodológica. Conclui-se que há uma lacuna no conhecimento, sendo importante a realização de estudos metodologicamente mais robustos.

[ABSTRACT]. 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 data- bases 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 cri- tically 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.

[RESUMEN]. 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 estrate- gias 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 compara- ran 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 tele- fonía 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 estu- dios con una metodología más sólida.

Atenção à saúde do estomizado na rede de atenção à saúde na perspectiva de enfermeiros / Health care of the stomized in the health care network from the perspective of nurses / Atención sanitaria de estomizados en la red de salud desde la perspectiva de enfermeras

Objetivo: Identificar como é o cuidado oferecido às pessoas que vivem com estomias na rede de atenção à saúde na ótica dos enfermeiros. Métodos: Estudo qualitativo, descritivo, desenvolvido com 29 enfermeiros que atuavam na Rede de Atenção à Saúde que dispensam cuidados ao paciente com estomia. O referencial teórico metodológico utilizado foi a pesquisa social de Minayo, a qual apoia-se no materialismo histórico e dialético. Coleta de dados realizada nos meses de março e abril de 2018, por meio de uma entrevista semiestruturada. Realizada análise temática dos dados. Resultados: Foram identificadas fragilidades na comunicação na rede de atenção à saúde, bem como nas ações de cuidado efetivadas pelos enfermeiros às pessoas que vivem com estomas, demonstrou-se um cuidado centralizado e falha na atenção devido a falta de educação continuada. Conclusão: O cuidado aos estomizados possui pontos a serem melhorados como à definição de itinerário para este paciente, centralização do cuidado, garantia da continuidade do cuidado e integralidade, referência e contrarreferência, necessidade de uma comunicação efetiva entre as equipes de saúde que assistem estes pacientes bem como falta de educação continuada. (AU)

Objective: To identify how care is provided to people living with ostomy in the health care network from the perspective of nurses. Methods: Qualitative, descriptive study, developed with 29 nurses who worked in the Health Care Network who provide care to patients with ostomy. The methodological theoretical framework used was Minayo's social research, which is based on historical and dialectical materialism.Data collection carried out in March and April 2018, through a semi-structured interview. Thematic analysis of the data was carried out. Results: Weaknesses were identified in communication in the health care network, as well as in the care actions carried out by nurses to people living with stomas, demonstrating a centralized care and failure in care due to the lack of continuing education. Conclusion: The care of ostomy patients has points to be improved, such as defining an itinerary for this patient, centralization of care, ensuring continuity of care and completeness, referral and counter-referral, need for effective communication between the health teams that care for these patients as well as lack of continuing education. (AU)

Objetivo: Identificar cómo se atiende a las personas que viven con ostomía en la red asistencial desde la perspectiva del enfermero. Métodos: Estudio cualitativo, descriptivo, desarrollado con 29 enfermeras que laboraban en la Red de Atención de Salud que brinda atención a pacientes con ostomía. El marco teórico metodológico utilizado fue la investigación social de Minayo, que se basa en el materialismo histórico y dialéctico. Recolección de datos realizada en marzo y abril de 2018, mediante entrevista semiestructurada. Se realizó un análisis temático de los datos. Resultados: Se identificaron debilidades en la comunicación en la red de atención de salud, así como en las acciones de atención que realizan las enfermeras a las personas que viven con estoma, ubicando la atención centralizada y falla en la atención por falta de educación continua. Conclusión: La atención al paciente con ostomía tiene puntos a mejorar, como la definición de un itinerario para este paciente, la centralización de la atención, asegurar la continuidad y la integralidad de la atención, la derivación y contrarreferencia, la necesidad de una comunicación efectiva entre los equipos de salud que atienden. estos pacientes, así como la falta de educación continua. (AU)

Foley catheter plus misoprostol versus misoprostol alone for labor induction.

OBJECTIVE: This study aimed to analyze the effects of Foley catheter combined with misoprostol in the labor induction process. METHODS: This is a nonblinded, block randomized, controlled trial that compared the association between transcervical Foley catheter/vaginal misoprostol 25 µg combination and vaginal misoprostol 25 µg alone in normal-risk and healthy pregnant women undergoing labor induction in the south of Brazil. RESULTS: A total of 230 patients with indications for labor induction were evaluated and classified into the "combined" group (Foley catheter plus misoprostol), consisting of 107 patients, and the "misoprostol" group (misoprostol only), consisting of 123 patients. The "combined" group was observed to have a shorter labor induction time (p=0.008). In addition, there was a lower need for misoprostol use for overall cervical ripening (p<0.001) and a lower relative risk of needing a second, third, or fourth misoprostol tablet in the "combined" group (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.71-0.91; RR 0.41; 95%CI 0.31-0.56; and RR 0.29, 95%CI 0.17-0.52, respectively) (p<0.001). No statistically significant difference was found in induction failure rate, cesarean section rate, or perinatal outcomes. CONCLUSION: A combination of methods leads to shorter labor induction, lower need for misoprostol doses, and lower risk of cesarean section, with no increase in the rate of perinatal complications. REBEC number is RBR-7xcjz3z.

Foley catheter plus misoprostol versus misoprostol alone for labor induction

SUMMARY OBJECTIVE: This study aimed to analyze the effects of Foley catheter combined with misoprostol in the labor induction process. METHODS: This is a nonblinded, block randomized, controlled trial that compared the association between transcervical Foley catheter/vaginal misoprostol 25 μg combination and vaginal misoprostol 25 μg alone in normal-risk and healthy pregnant women undergoing labor induction in the south of Brazil. RESULTS: A total of 230 patients with indications for labor induction were evaluated and classified into the "combined" group (Foley catheter plus misoprostol), consisting of 107 patients, and the "misoprostol" group (misoprostol only), consisting of 123 patients. The "combined" group was observed to have a shorter labor induction time (p=0.008). In addition, there was a lower need for misoprostol use for overall cervical ripening (p<0.001) and a lower relative risk of needing a second, third, or fourth misoprostol tablet in the "combined" group (risk ratio [RR] 0.80, 95% confidence interval [CI] 0.71-0.91; RR 0.41; 95%CI 0.31-0.56; and RR 0.29, 95%CI 0.17-0.52, respectively) (p<0.001). No statistically significant difference was found in induction failure rate, cesarean section rate, or perinatal outcomes. CONCLUSION: A combination of methods leads to shorter labor induction, lower need for misoprostol doses, and lower risk of cesarean section, with no increase in the rate of perinatal complications. REBEC number is RBR-7xcjz3z.

Effects of continuous aerobic training associated with resistance training on maximal and submaximal exercise tolerance, fatigue, and quality of life of patients post-COVID-19.

BACKGROUND AND PURPOSE: Dyspnea, fatigue, and reduced exercise tolerance are common in post-COVID-19 patients. In these patients, rehabilitation can improve functional capacity, reduce deconditioning after a prolonged stay in the intensive care unit, and facilitate the return to work. Thus, the present study verified the effects of cardiopulmonary rehabilitation consisting of continuous aerobic and resistance training of moderate-intensity on pulmonary function, respiratory muscle strength, maximum and submaximal tolerance to exercise, fatigue, and quality of life in post-COVID-19 patients. METHODS: Quasi-experimental study with a protocol of 12 sessions of an outpatient intervention. Adults over 18 years of age (N = 26) with a diagnosis of COVID-19 and hospital discharge at least 15 days before the first evaluation were included. Participants performed moderate-intensity continuous aerobic and resistance training twice a week. Maximal and submaximal exercise tolerance, lung function, respiratory muscle strength, fatigue and quality of life were evaluated before and after the intervention protocol. RESULTS: Cardiopulmonary rehabilitation improved maximal exercise tolerance, with 18.62% increase in peak oxygen consumption (VO2peak) and 29.05% in time to reach VO2 peak. VE/VCO2 slope reduced 5.21% after intervention. We also observed increased submaximal exercise tolerance (increase of 70.57 m in the 6-min walk test, p = 0.001), improved quality of life, and reduced perceived fatigue after intervention. DISCUSSION: Patients recovered from COVID-19 can develop persistent dysfunctions in almost all organ systems and present different signs and symptoms. The complexity and variability of the damage caused by this disease can make it difficult to target rehabilitation programs, making it necessary to establish specific protocols. In this work, cardiopulmonary rehabilitation improved lung function, respiratory muscle strength, maximal and submaximal exercise tolerance, fatigue and quality of life. Continuous aerobic and resistance training of moderate intensity proved to be effective in the recovery of post-COVID-19 patients.

Agendamentos de consultas na Atenção Primária: síntese de evidências para apoio à decisão da gestão / Appointment Scheduling in Primary Care: synthesis of evidence to support management decision

Introdução: O acesso na Atenção Primária está relacionado à qualidade do cuidado prestado e deve suprir as demandas. Existem três modelos descritos de organização da agenda (tradicional, carve-out e acesso avançado). Este estudo tem por objetivo levantar estratégias efetivas de agendamento de consultas na Atenção Primária com desfechos positivos de acesso. Metodologia: Elaborou-se uma Síntese de Evidências para Políticas e, em seguida, foi realizado um diálogo deliberativo, buscando discutir aspectos relacionados à implementação das estratégias. Resultados: Foram identificadas diversas estratégias efetivas, agrupadas por similaridade de temas em seis opções: 1) Ampliação da oferta de consultas do dia; 2) Monitoramento por equipes multidisciplinares; 3) Aumento da capacidade; 4) Pacotes de intervenção; 5) Intervenções prévias ao agendamento da consulta; 6) Regulação entre os níveis de atenção. Discussão: Essas opções podem ser implementadas de forma parcial ou completa, associadas ou não. Faz-se necessário observar barreiras e facilitadores para a implementação de cada uma delas em relação à quatro níveis: usuários do serviço, profissionais, organização dos serviços e sistemas de saúde. Conclusão: A síntese oferece o embasamento teórico, mas apresenta limitações, e os resultados precisam ser considerados com cautela para a realidade brasileira.

Estratégias dos serviços de Atenção Primária durante a pandemia da COVID-19 no Brasil: uma revisão de escopo / Brazilian Primary Health Care strategies during the COVID-19 pandemic: A scoping review

A Atenção Primária à Saúde é a porta de entrada dos usuários ao sistema de saúde brasileiro e foi, especialmente, impactada pelas demandas com a COVID-19. Essa revisão identificou e mapeou sistematicamente evidências sobre as estratégias novas ou adaptadas desenvolvidas na Atenção Primária à Saúde durante a pandemia de COVID-19 no Brasil. Foi realizada uma revisão de escopo, conforme metodologia proposta pelo JBI. Os resultados apresentados em uma síntese narrativa, foram analisados e discutidos à luz da Teoria do Processo de Trabalho em Saúde que agrupou as publicações em dois grandes domínios de estratégias, gerenciais e assistenciais, sendo elas novas, adaptadas ou mantidas. A partir de 49 estudos, mapeou-se 226 intervenções (130 gerenciais; 96 assistenciais). Em ambos os domínios, as novas estratégias apareceram em maior número e as mantidas, em menor. A diversidade de intervenções explicitou distintos modelos de atenção, que ora se aproximaram de um enfoque biologicista, ora da integralidade e da longitudinalidade baseada no cuidado centrado na pessoa, na família e na comunidade. Evidenciou-se, assim, que perduram os mesmos desafios anteriores ao período pandêmico.