Prevalence of cognitive impairment and associated factors in older people.

BACKGROUND: Older people are the fastest-growing age group, with the highest risk of cognitive impairment. This study assessed the prevalence and associated factors with cognitive impairment in community-dwelling older people. METHODS: Older people were interviewed and accomplished through sociodemographic and health questionnaires. The quantitative variables were described by mean and standard deviation or median and interquartile range. The significance level adopted was 5 % (p < 0.05). The association between the quantitative variables was evaluated using the Pearson or Spearman correlation coefficients. RESULTS: The research population comprised 165 long-lived adults aged ≥80. The youngest one was 80, and the oldest one was 94 years old. The participants were 84.8 ± 3.6 years old, female (63 %) with a mean of education of 2.9 ± 1.8 years. A poor performance in the Mini-Mental State Examination (MMSE) was found in 58 (35.2 %) individuals when adjusted for educational level. After adjustment for confounding factors, body mass index (BMI) (p = 0.09), total older adults' income (up to 1 minimum wage [mw], p = 0.023; over 1 to 2 mw, p = 0.023), functional disability (Moderate dependence 75 %, p = 0.038; Moderate dependence 50 %, p = 0.081; Moderate dependence 25 %, p = 0.054), and the anxiety scale (p = 0.032), remained associated with cognitive impairment. CONCLUSIONS: This study showed that BMI, total older adults' income, functional disability, and anxiety are related to cognitive impairment in long-lived adults. This study has some limitations, such as the fact that it is a cross-sectional study, the reduced number of individuals, and the fact that there were no comparisons among different ages and populations.

Abbreviated Suicidal Narrative Inventory: Factor Structure, Internal Consistency, and Validity in a Brazilian Sample.

AIM: To investigate the factor structure, reliability, and validity of the Brazilian version of the Abbreviated Suicidal Narrative Inventory (SNI-38). METHODS: We used an anonymous online questionnaire of the SNI-38 and self-report measures administered between November 2020 and October 2021 in the Brazilian community. Participants were recruited through social media advertisements. Confirmatory factor analysis was carried out to test the factor structure of the SNI-38. In addition, we examined internal consistency, and convergent validity against stressful life events, the suicide crisis syndrome, suicidal ideation, and suicide attempts. RESULTS: 2660 participants were included. The eight-factor model SNI-38 had a good model fit (χ2[637] = 7,473.98, p < .001, CFI = .99, TLI = .99, RMSEA = .07, SRMR = .06); all items were significantly and positively loaded onto their respective factors (factor loadings ≥ .45). Reliability was good to high in all subscales except goal disengagement. Additionally, all subscales - except goal disengagement - were correlated positively which the suicide crisis syndrome, stressful life events, lifetime/past-month suicidal ideation, and lifetime suicide attempts. CONCLUSIONS: These findings provide preliminary support for the validity of the Brazilian version of the SNI-38, being an appropriate and valid tool for measuring suicidal narrative among Brazilian samples.

Critical period of exposure to mercury and the diagnostic of autism spectrum disorder: A systematic review.

Autism spectrum disorder (ASD) is characterized by repetitive behaviors and deficits in social interaction. Its etiology is not completely clear, but both genetic and environmental factors contribute to and influence its development and course. The increased number of autism cases in recent years has been strongly associated with increased exposure to heavy metals. Mercury (Hg) has gained prominence in the scientific literature as a result of its presence as an urban pollutant and well-described neurotoxicity. This review assessed the relationship between Hg exposure in the pre- and post-natal period and ASD. The systematic review identified observational clinical studies and pre-clinical trials in journals indexed in the PubMed, Embase, ProQuest, and LILACS databases. The aim of this study was to investigate the association between exposure to Hg and ASD and to define the critical period of exposure. A total of 57 articles were selected for this review, with 35 articles (61.40%) identifying a positive association between ASD and Hg, while 22 articles (38.60%) did not find the same outcome. The biological samples most used to analyze Hg body burdens were hair (36.84%) and blood (36.84%). Most case-control studies found an increase in Hg levels in individuals with ASD who were exposed to a polluted environment in the post-natal period. Taken together, the studies suggest that these patients have a deficient detoxification system, and this could worsen the symptoms of the disorder. However, new studies addressing the influence of Hg on the post-natal nervous system and its relationship with ASD should be carried out.

The effects of academic unprofessional behaviour on disciplinary action by medical boards: Systematic review and meta-analysis.

OBJECTIVE: The objective of this study is to evaluate the association of disciplinary actions by regulatory councils and unprofessional behaviour during medical graduation. METHODS: A search strategy was developed using the terms: 'physicians', 'disciplinary action', 'education', 'medical', 'undergraduate' and their synonyms, subsequently applied to the electronic databases MEDLINE, Embase, Cochrane Library, LILACs and grey literature, with searches up to November 2023. The risk of bias was assessed using the Newcastle-Ottawa scale and statistical analysis was performed using the RevMan software. RESULTS: A total of 400 studies were found in the databases, and 15 studies were selected for full-texting reading. Four studies met the inclusion criteria and were included, bringing together a total of 3341 evaluated physicians. Three studies were included in the meta-analysis, showing a greater chance of disciplinary actions among physicians who exhibited unprofessional behaviour during medical graduation (OR: 2.54; 95%CI: 1.87-3.44; I2 : 0%; P < 0.0001; 3077 participants; physicians with disciplinary action: 107/323; control physicians: 222/2754). CONCLUSIONS: There is a statistically significant association between unprofessional behaviour during medical undergraduate study and subsequent disciplinary actions by Medical Councils. The tools for periodic assessments of student behaviour during undergraduate studies can be a perspective for future studies aimed at reducing disciplinary actions among physicians.

The Revised Suicide Crisis Inventory (SCI-2): Factor Structure, Internal Consistency, and Validity in a Brazilian Sample.

OBJECTIVE: To examine the factor structure, reliability, and validity of the Brazilian version of the Suicide Crisis Inventory (SCI-2) among Brazilian adults. METHODS: The SCI-2 was cross-culturally adapted into Portuguese and administered to 2,265 individuals in the Brazilian community. Confirmatory factor analyses, internal consistency, and convergent and criterion validity against the suicidal narrative, stressful life events, suicidal ideation, and suicide attempts were examined. RESULTS: The revised one-factor model of the SCI-2 resulted in adequate, but not optimal, model fit (χ2[1539] = 31,442.79, p < .001, CFI = .99, TLI = .99, RMSEA = .09, SRMR = .05). The revised five-factor model, on the other hand, demonstrated good fit (χ2[1529] = 14,174.86, p < .001, CFI = 1.00, TLI = 1.00, RMSEA = .06, SRMR = .04). Comparison of these two models indicated that the five-factor exhibited a superior model fit to the one-factor model. The SCI-2 total and subscales showed strong internal consistency, good convergent, and criterion validity in relation to stressful life events, suicidal narrative (except goal disengagement subscale), suicidal ideation, and suicide attempts. CONCLUSIONS: These findings indicate that the Brazilian version of the SCI-2 is a valid tool for measuring symptoms of the Suicide Crisis Syndrome.

Suicide Risk Moderates the Relationship Between Stressful Life Events, the Suicidal Narrative, and the Suicide Crisis Syndrome: A Brazilian Cross-Sectional Study.

BACKGROUND: Stressful life events are associated with higher odds of suicidal thoughts and behaviors. Furthermore, stressful life events can trigger specific symptoms, including the suicidal narrative and suicide crisis syndrome, resulting in an increased risk of suicidal thoughts and behaviors. This study examined the moderating role of suicide risk in the relationship between stressful life events, the suicidal narrative, and the suicide crisis syndrome. METHODS: 2,260 adults completed an online survey recruited through advertisements on social media. The level of emotional distress was assessed through the Suicide Narrative Inventory, Suicide Crisis Inventory-2, Stressful Life Events Questionnaire, and Mini International Neuropsychiatric Interview. The PROCESS macro (Hayes) was used to analyze the moderation models. RESULTS: Stressful life events were positively correlated with the suicidal narrative and suicide crisis syndrome. The effects of stressful life events on suicidal narrative and suicide crisis syndrome were strongest when suicide risk was low and weakest when suicide risk was high. CONCLUSIONS: These findings suggest that including stressful life events as part of suicide risk assessment in general and clinical settings is critical to managing treatment for suicidal thoughts and developing adaptive coping.

University indigenous students' perspectives on climate change and survival of indigenous peoples in Brazil: a concept mapping study.

Introduction: This study aimed to identify what indigenous university students in Brazil perceived to be important and feasible actions to protect the survival of indigenous peoples from climate change-related impacts. Methods: Concept mapping, which is a participatory mixed methodology, was conducted virtually with 20 indigenous students at two universities in Brazil. A focus prompt was developed from consultations with indigenous stakeholders and read "To protect the survival of the Indigenous Peoples from climate change, it is necessary to…". Students brainstormed 46 statements, which they then sorted into clusters based on conceptual similarity. They rated each statement for importance and feasibility. Quantitative multivariate analyses of clusters and ratings were conducted to produce multiple visual maps of perceived actionable priorities. These analyses used the Group Wisdom TM software. Results: Students agreed on 8 clusters that reflect the factors that influence the survival of indigenous peoples-preservation of lands 0.16 (SD 0.13), protection of demarcated lands 0.31 (SD 0.10), indigenous health and wellbeing 0.35 (SD 0.14), ancestral customs 0.46 (SD 0.04), global and national actions 0.61 (SD 0.13), indigenous rights 0.64 (SD 0.23), collective living 0.71 (SD 0.21), and respect 0.75 (SD 0.14). Discussion: The most actionable priorities are related to the respect for their lands and customs, educational initiatives in schools about the importance of indigenous peoples to society, guarantees for basic health rights, and culturally appropriate provision of care, with specific mention of mental healthcare. The findings aligned closely with the concept of indigenous self-determination, which is rooted in autonomy and respect for cultural diversity, and the right to make decisions that impact their lives, land, and resources.

COVID-19, Anxiety, and Body Mass Index Increase Leptin Levels: a Cross-sectional Multicentric Study.

Although many efforts have been made to understand the pathophysiological mechanisms of COVID-19, critical gaps remain to be explored. This study aimed to investigate potential alterations in adipokine levels (specifically adiponectin, leptin, and resistin) among individuals with COVID-19. Within this population, we further assessed the association between these markers with both, body mass index (BMI) and psychiatric symptoms. This cross-sectional study included an age- and sex-matched sample of adults with COVID-19 (cases) and without COVID-19 (controls). We evaluated the severity of psychiatric symptoms, BMI, and adipokines. Individuals with COVID-19 presented greater BMI, stress levels, and leptin levels when compared to controls. Leptin levels were greater in individuals with moderate/severe COVID-19 as compared to individuals with COVID-19 who were asymptomatic or having mild symptoms. Leptin levels were positively correlated with BMI, severity of depressive and anxiety symptoms, and stress levels in the total sample. Leptin levels were also positively correlated with BMI, severity of anxiety symptoms, and stress levels in controls. In cases, there was a positive correlation between adiponectin and the severity of depressive symptoms and stress levels and leptin/resistin with BMI. A linear regression model revealed that BMI, severity of anxiety symptoms, and the diagnosis of COVID-19 are independently associated with increased leptin levels. Thus, leptin levels seem to be impacted by the COVID-19 infection, anxiety, and BMI.

Climate change and mental health of Indigenous peoples living in their territory: a concept mapping study.

Background: The alarming increase in annual deforestation rates has had devastating consequences in climate change, and it is affecting Indigenous people, who depend entirely on the land for survival and has also weakened the rainforest's crucial role in stabilizing the global climate. Recognizing and respecting Indigenous people's needs and social, economic, and historical conditions influence health and healthcare. This study aimed to conduct online concept mapping workshops with university students to identify perceived important and feasible actions for improving the mental health of Indigenous people living in their territory in association with climate change. Methods: Concept mapping, a participatory mixed methodology, was conducted virtually with 20 Indigenous students at two universities in Brazil. A focus prompt was developed from consultations with Indigenous stakeholders and read-"To improve the mental health of Indigenous peoples in their territory during climate change crises, it is necessary to…." Results: University students organized 42 unique statements in 6 clusters that cover a wide range of topics: family support, 0.68 (SD 0.19); respect and understanding, 0.37 (SD 0.08); improvement actions, 0.52 (SD 0.07); public policies in favor of Indigenous people's mental health, 0.24 (0.09); health actions, 0.15 (SD 0.08); Indigenous training in health and its importance in improving mental health 0.32 (SD 0.07). Conclusion: These clusters range from community initiatives, public policies, health actions, and strengthening professional services in Indigenous communities. These all provide numerous concrete ideas for developing interventions designed to address mental health challenges associated with climate change.

Palavras e olhares de uma pandemia / Words and looks of a pandemic

Em primeiro lugar registramos nosso agradecimento aos organizadores e às editoras que se associaram para produzir a coletânea "Palavras e olhares de uma pandemia", com uma diversidade de manuscritos que experimentam formatos e estéticas para um conhecimento que não pretende substituir a disseminação científica, mas que adentra na seara de uma comunicação científica mais horizontal, capaz de mobilizar imaginários e afecções de quem está no cotidiano e pretende modificá-lo. A pandemia nos ensinou que aprender significa aumentar a potência de transformar a si e ao mundo, para configurações mais solidárias, justas e inclusivas, assim como nos ensinamentos do educador brasileiro Paulo Freire reconhecido internacionalmente. Ou se faz isso, ou se assume uma identidade observadora que coloca em risco a si e ao território que nos constitui. A coleção de textos cuidadosamente selecionados e organizados no livro demonstra que há um grande coletivo que não pretende observar o mundo, mas tomar o presente e o futuro em suas mãos. No momento da escrita, estávamos aqui em Bolonha, na Itália, num processo de trabalho colaborativo entre a Rede Unida e os sistemas socio sanitários da Região da Emília Romagna, e ouvíamos juntos a manifestação de Cíntia Guajajara, indígena da etnia Tenethara-Guajajara, que mora na terra indígena Arariboia, na aldeia Água Quieta, no Maranhão, falando aos colegas italianos sobre a produção do bem viver nos territórios tradicionais. Com alguma frequência, ela precisava alternar a língua para falar sobre essa temática, usando expressões em português e na sua língua, que é do tronco linguístico tupi-guarani. Na alternância das línguas, frequentemente utilizava o canto e a música para estabelecer as complexas conexões com o território (na cultura indígena, a separação homem e natureza não faz sentido e a proteção da vida é exatamente sincrônica com a proteção do ambiente onde vivem), que uma parte do que pretendia dizer não era dizível apenas com as palavras, requerendo a vibração do corpo (tampouco as separações entre razão e emoção e entre ambiente e cultura fazem sentido para nossas culturas tradicionais). Nos relatos, Cintia com frequência sentia necessidade de reverenciar a ancestralidade, que a quebra com o pensamento do seu povo e com a história do seu povo tornaria a informação falsa. Pelo que deduzimos da cuidadosa precisão com que utilizava as palavras, não pretendia correr o risco de fazer circular informações falsas, seja por negação do que é verdadeiro (e o que é verdadeiro inclui sempre o que vem sendo transmitido ao longo do tempo pelos seus ancestrais, que teve uma validação ao longo dos séculos), seja por informações não sustentadas em histórias que fizessem sentido no universo simbólico da sua vivência e seus conhecimentos. A sua fala era precisa, complexa e densa. Difícil de traduzir, por vezes, que a gramática italiana, sustentada como o português na língua latina, não percorreu iguais processos de desenvolvimento do que o português amazônico. Difícil de ouvir, com uma recente história de uso abusivo de medicamentos ineficazes, de circulação de notícias falsas com finalidade política de vulnerabilizar vidas e valorizar medicamentos, de governantes exercendo visíveis ações necropolíticas ... mas também de trabalhadores da saúde e da educação esquivando-se de combater enunciados que fragilizam as vidas. Bem, algumas expressões que Cíntia utilizou representam expressamente a densidade dessas conexões, quando afirmava que ela e as populações indígenas defendem que as árvores amazônicas "permaneçam em pé", como as gentes, que os vivos de sua gente que foram abatidos nos combates com os grileiros e colonizadores "encantaram-se" e permanecem na floresta (diferentemente de "ascenderem ao mundo dos mortos"). As bandeiras de quem as- sumiu outra forma de vida e permanece encantado no território não mobiliza apenas a memória, mas todas as formas de existência. Enquanto ouvíamos atônitos cada palavra, cada frase, cada gesto, nos perguntávamos sobre como atualiza tantas pontes de pensamento em curto espaço de tempo e, muitas vezes, em resposta a perguntas que visivelmente ocupam outros lugares de fala, frequentemente de uma obviedade branca e eurocêntrica de ruborescer nossas faces. Como é falsa a construção epistêmica que associa natureza e condição "selvagem" e cultura com civilidade! Mas também como é limitado nosso vocabulário "ilustrado" para falar do complexo, do que precisa perceber o múltiplo e o diverso e dialogar com eles. O diálogo com o qual Cíntia entabula sua fala inclui construções de pensamento, produzem imagens ao pensamento. E o pensamento não é abstração em estado puro, é história em processo dialógico. Falar sobre a pandemia, nesse período que nos afasta do início ou do estágio agudo desse evento mundial recente, nos provoca a um repertório linguístico e simbólico que não se esgota no conhecimento disciplinar que nos tornou profissionais de saúde. Tampouco o repertório da saúde pública, que nos fez prescrever "isolamento social" a todas as pessoas, sem refletir sobre os efeitos em quem, por exemplo, não pode dispensar deslocamentos para viabilizar o alimento cotidiano para si ou para seus familiares, ou sobre os profissionais de saúde e das áreas essenciais, que, para circular com mais segurança para seus afazeres de relevância à vida dos coletivos, precisavam da redução da circulação de pessoas em geral. Afora o fato de que, para o cuidado em saúde, o distanciamento geográfico não pode ser sinônimo de isolamento. Aliás, quebrar o isolamento físico e social é uma necessidade premente do cuidado. Vejam a tensão que as palavras jogadas precipitadamente produzem no cotidiano quando a condição de complexidade pede passagem. Algumas vezes reificam o cotidiano, como bloco sólido e monolítico, intransponível. Alguém, por acaso, esqueceu que operamos comum conceito de saúde que afirmava tratar-se de um "estado de completo bem-estar físico, mental e social"? Ora, no nosso cotidiano, qualquer pessoa que afirmar estar em tal condição merece cuidados de saúde mental com urgência! Há uma evidente desconexão com as tensões, dores e delícias do cotidiano da vida. Mas também há uma construção que idealiza a saúde como uma condição que não cabe no bem viver cotidiano, quiçá reivindicando apoio do complexo industrial da saúde. A saúde para avançar na direção da integralidade precisa de uma virada epistêmica. Precisamos novas ideias, novos olhares, novos pensamentos e novas palavras! Assim, chegamos na chamada pública de manuscritos sobre "Palavras e olhares de uma pandemia". Palavras e olhares que se originam nos territórios, com a intensidade dos fazeres e das relações que se realizaram na pandemia, no cuidado e na formação. Há um flerte entre a ciência e a literatura nas produções que a chamada fez produzir, que é para fecundar o pensamento que se chamou novas palavras e olhares. Há uma aposta em produções criativas e inventivas, que é para aproximar o pensamento da saúde do bem viver. Se permite brincar com as palavras, que é para colocar em cada uma a tensão sobre a precisão necessária para comunicar o que se quer. As palavras sempre requerem precisão e aqui nos lembramos de Ítalo Calvino, que define o desafio do escritor no justo emprego da linguagem no texto como "aquele que permite o aproximar-se das coisas (presentes ou ausentes) com discrição, atenção e cautela, respeitando o que as coisas (presentes ou ausentes) comunicam sem o recurso das palavras" (CALVINO, 1990, p. 90-91). Precisão não é estado, é processo e contexto! Em tempos de pandemia (o pós-pandemia é impreciso, dado que precisamos adjetivar os efeitos tardios, atualizar a memória e os afetos, falsear as notícias falsas, relembrar os crimes éticos e políticos do que deveria ter sido um enfrentamento, mas que se apresentou, muitas vezes, como fomento ... e que ainda atuam em nosso meio), buscar a justa medida das palavras requer, muitas vezes, a coragem de reinventá-las. Essa é uma tarefa estética impostergável. Assim, cumprimentamos também os organizadores e pesquisadores de duas importantes universidades (Universidade do Extremo Sul Catarinense ­ UNESC, e Universidade Federal do Rio Grande do Sul - UFRGS) e as duas relevantes editoras (Editora da UNESC - EDIUNESC e a Editora Rede Unida), que tiveram a ousadia de abrir a caixa de pandora das palavras e olhares da pandemia, para que se tornassem visíveis as desgraças, mas também a esperança. Cumprimentamos também às pessoas que assumiram a ousadia de produzir textos autorais com base na experiência ou na sensibilidade que a pandemia despertou, para falar de aspectos que não frequentam regularmente a literatura científica, mas que povoam e produzem encontros e cuidado. De produzir textos com imagens, que são as linguagens das coisas como elas são. O efeito da leitura dos textos foi de esperançamento, como sonho e motivação para fazer o que nos pede cuidado e aprendizagem desde a pandemia. Desde antes da pandemia, que colocar alma no cuidado e na formação das profissões da saúde é desafio antigo e impostergável. Boa leitura, e que os textos aqui reunidos atualizem a capacidade de produzir palavras, compor textos, viver as intensidades da vida e os encontros que fazem sempre novas palavras necessárias para descrever a produção da saúde como bem viver!

The role of intestinal microbiota on pre-eclampsia: Systematic review and meta-analysis.

AIM: To investigate differences between gut microbiota diversity and composition of healthy pregnant women and women with pre-eclampsia (PE). METHODS AND RESULTS: This is a systematic review and meta-analysis of the literature, in which the terms "pre-eclampsia", "gastrointestinal microbiome" and "pregnant women" were used to search MEDLINE (PubMed), BVS (LILACS and others), Embase (Elsevier) and Cochrane Library, including observational studies and case-control that investigated changes in the gut microbiota during pregnancy. Six studies were included, with 479 pregnant women. A significantly lower gut microbiota alpha diversity measured as the Shannon index was found in pregnant women with PE in comparison with healthy controls (SMD: -0.47; 95 %IC: -0.77 to -0.18; P = 0.02; I2 = 0 %; three studies, 179 participants), while no significant differences were found in the relative abundance of Bacteroidetes, Firmicutes, Actinobacteria, and Proteobacteria, despite significant differences reported in the individual studies. CONCLUSION: Pregnant women with PE have lower gut microbiome diversity, however, there is insufficient evidence to determine whether there are changes in gut microbiota composition. SIGNIFICANCE AND IMPACT OF THE STUDY: The gut microbiota can be a new treatment target to try to prevent changes in maternal bacterial proportions, aiming to reduce complications during pregnancy.

ABO Blood Type and Metabolic Markers in COVID-19 Susceptibility and Severity: A Cross-Sectional Study.

Background and Aims: To evaluate the effect of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus on the function and metabolic changes, as well as the relationship of the virus with blood groups. Methods and Results: This cross-sectional study included a matched sample of adult individuals with coronavirus disease 2019 (COVID-19) (n = 114) or without (controls; n = 236). Blood samples were collected and processed for triglycerides (TGs), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and blood typing analysis. The results showed that subjects with COVID-19 had higher TG and lower HDL-C levels compared with the control group. As for blood typing, the risk of COVID-19 was higher in subjects with blood group A than in those with blood group B and in those with other blood groups. In addition, an association of COVID-19 with blood type and Rh A- was observed. When related to the severity of COVID-19 symptoms, blood type A was more protective against moderate/severe symptoms compared with blood type O. In addition, individuals with blood type O were 2.90 times more likely to have symptoms moderate/severe symptoms of COVID-19 than those with other blood groups and individuals with type A blood were less likely to have severe/moderate symptoms of COVID-19 compared with individuals without type A blood. Conclusion: The results suggest that blood type may play a role in susceptibility to SARS-CoV-2 infection and add evidence that infection with the novel coronavirus may be associated with changes in lipid metabolism.

Anti-Müllerian Hormone levels after metformin treatment in polycystic ovary syndrome: A systematic review and meta-analysis.

This systematic review and meta-analysis aim to evaluate whether treatment with metformin would reduce Anti-Müllerian Hormone levels in patients with polycystic ovary syndrome. A search was performed in Medline, Embase, Web of Science, and Cochrane Library databases and grey literature (Google Scholar). The following keywords were used in the search strategy: "Polycystic Ovary Syndrome", "Anti-Mullerian Hormone", "Metformin". The search was limited to human studies, with no language restriction. 328 studies were found, 45 studies were selected for full-text reading and 16 of those studies, six randomized controlled trial and 10 non-randomized studies were included. The synthesis of randomized controlled trials, metformin showed a reduction in serum levels of Anti-Müllerian Hormone compared to control groups (SMD - 0.53, 95 %CI - 0.84 to - 0.22, p < 0.001, I2 = 0 %, four studies, 171 participants, high quality of evidence). Six non-randomized studies evaluated data before and after the metformin intervention. The synthesis showed that using metformin reduced serum Anti-Müllerian Hormone values (SMD - 0.79, 95 %CI - 1.03 to - 0.56, p < 0.001, I2 = 0 %, six studies, 299 participants, low quality of evidence). Metformin administration in women with polycystic ovary syndrome is associated significantly with reduced Anti-Müllerian Hormone serum levels.

Stress levels, psychological symptoms, and C-reactive protein levels in COVID-19: A cross-sectional study.

BACKGROUND: Although many studies have pointed out a possible relationship between COVID-19 and the presence of psychiatric disorders, the majority of the studies have significant limitations. This study investigates the influence of COVID-19 infection on mental health. METHODS: This cross-sectional study included an age- and sex-matched sample of adult individuals positive (cases) or negative (controls) for COVID-19. We evaluated the presence of psychiatric conditions and C-reactive protein (CRP). RESULTS: Findings showed greater severity of depressive symptoms, higher levels of stress, and greater CRP in cases. The severity of depressive and insomnia symptoms, as well as the CRP were more remarkable in individuals with moderate/severe COVID-19. We found a positive correlation between stress and severity of anxiety, depression, and insomnia in individuals with or without COVID-19. There was a positive correlation between CRP levels and severity of depressive symptoms in cases and controls, and a positive correlation between CRP levels and the severity of anxiety symptoms and stress levels only in individuals with COVID-19. Individuals with COVID-19 and depression had greater CRP than those with COVID-19 without current major depressive disorder. LIMITATIONS: We cannot infer causality because this is a cross-sectional study, and the majority of COVID-19 sample was asymptomatic or had mild symptoms, which may limit the generalizability of our findings for moderate/severe cases. CONCLUSIONS: Individuals with COVID-19 showed greater severity of psychological symptoms, which may impact on the development of psychiatric disorders in the future. CPR seem to be a promising biomarker for earlier detection of post-COVID depression.

Gut and Vaginal Microbiota in the Endometriosis: Systematic Review and Meta-Analysis.

Background: Endometriosis is a clinical condition associated with genetic, endocrine, and immunological factors, present in 6 to 10% of women of reproductive age. Currently, the human microbiota has been studied and associated with the evolution of diseases due to its influence on pathogenesis, indicating that changes in the colonization of microorganisms in the genitourinary and gastrointestinal systems can promote physiological changes that can trigger inflammatory and immunological processes and hormonal dysregulation, which can be linked to endometriosis. Thus, this systematic review and meta-analysis evaluated microbiota changes in women with endometriosis. Methods: The following electronic databases were searched up to April 2022: Medline, Embase, Web of Science, Cochrane Library, and gray literature (Google Scholar), using the keywords "dysbiosis", "microbiome" and "endometriosis", combined with their synonyms. The observational studies conducted with women diagnosed with endometriosis and women without endometriosis as controls were included. For the analyses, a standard mean difference with a 95% confidence interval was used using RevMan software (version 5.4), and for methodological quality assessment, the Newcastle-Ottawa scale was used. Results: A total of 16 studies were found in the literature assessing the composition of the microbiota in women with endometriosis, and no significant difference were found for changes in alpha diversity analysis in gut microbiota (SMD = -0.28; 95% CI = -0.70 to 0.14; P = 0.19; I2 = 52%; four studies, 357 participants) or vaginal microbiota (SMD = -0.68; 95% CI = -1.72 to 0.35; P = 0.19; I2 = 66%; two studies, 49 participants). Conclusion: In intestinal and vaginal samples from women with endometriosis, alpha-diversity did not present a significant difference when compared to the control population. However, each study individually showed a possible relationship between the female microbiota and endometriosis. This trial is registered with CRD42021260972.

Percepção dos enfermeiros sobre a transição do cuidado na alta hospitalar / Nurses' perception about the transition of care at hospital discharge

Existe uma clara lacuna na transição entre Atenção Hospitalar (AH) e Atenção Primária à Saúde (APS). A efetividade da Transição do Cuidado (TC) depende de uma excelente capacidade de comunicação entre profissionais e serviços, sendo a alta hospitalar um momento crítico. O objetivo deste estudo foi investigar as percepções dos enfermeiros da Atenção Hospitalar (AH) e Atenção Primária em Saúde (APS) sobre aspectos da alta hospitalar Trata-se de um estudo transversal e quantitativo realizado com dados de enfermeiros atuantes na AH e na APS no estado de Santa Catarina. Os dados foram coletados entre dezembro de 2020 e janeiro de 2021, por meio de formulário eletrônico. Foi realizada análise descritiva e inferencial. Para comparação entre grupos utilizou-se teste de qui-quadrado de Pearson. Há algumas sobre posições nas percepções dos enfermeiros da AH e APS sobre a temática, sendo que consideram importante o acompanhamento do paciente após a alta hospitalar (54; 91,5%), entende que existe pouca e fraca comunicação entre serviços de saúde (52; 88%). Ainda, são realizadas orientações verbalmente para pacientes e familiares no momento da alta (32; 54,2%), pouca informação é compreendida pelos pacientes (47; 79,7%) e o plano de alta não é individualizado (30; 50,8%), na maioria dos casos. A comunicação é uma grande fragilidade na alta hospitalar, que se expressa nesse estudo, pela percepção dos enfermeiros de uma comunicação fraca entre AH e APS, pela fragilidade do plano de alta e orientações realizadas verbalmente. A melhoria do processo de transição do cuidado, especialmente a alta hospitalar, permite uma assistência à saúde mais integrada, segura e centrada no paciente. O investimento em estratégias que aprimorem esse processo é essencial para a qualidade do cuidado.

There is a clear gap in the transition between Hospital Care (HC) and Primary Health Care (PHC). The effectiveness of the Care Transition (TC) depends on an excellent communication ability between professionals and services, with hospital discharge being a critical moment. The objective of this study was to investigate the perceptions of HC and PHC nurses on aspects of hospital discharge. This is a cross-sectional and quantitative study carried out with data from nurses working in HC and PHC in the state of Santa Catarina. Data was collected between December 2020 and January 2021, using an electronic form. Descriptive and inferential analysis were performed. Pearson's chi-square test was used for comparison between groups. There are some overlapping positions in the perceptions of HC and PHC nurses on the subject, considering that patient follow-up after hospital discharge is important (54; 91.5%), they understand that there is little and weak communication between health services (52; 88%). Also, verbal guidelines are given to patients and family members at discharge (32; 54.2%), little information is understood by patients (47; 79.7%) and the discharge plan is not individualized (30; 50.8%), in most cases. Communication is a major weakness in hospital discharge, which is expressed in this study, by the nurses' perception of poor communication between HC and PHC, by the fragility of the discharge plan and verbally given guidelines. Improving the care transition process, especially hospital discharge, allows for more integrated, safe and patient-centered healthcare. Investment in strategies that improve this process is essential for the quality of care.

Centrais de Regulação e Consórcios Intermunicipais de Saúde: a Percepção de Gestores Catarinenses

Objetivo: Analisar a percepção dos gestores dos consórcios intermunicipais de saúde e das comissões intergestores regionais do sul de Santa Catarina sobre a incorporação das centrais de regulação nos procedimentos eletivos de média e alta complexidade, inseridos nos consórcios intermunicipais de saúde do estado. Métodos: Trata-se de um estudo descritivo como abordagem mista, realizado com representantes legais de consórcios intermunicipais de saúde e gestores municipais representantes da Comissão Intergestores Regional do sul de Santa Catarina, totalizando 6 participantes. A coleta de dados se deu através de entrevista semiestruturada. A análise ocorreu por método de condensação de significados com auxílio do programa SPSS versão 23.0. Resultados: Foi possível obter a percepção dos representantes legais e gestores acerca dos mecanismos de regulação, legislação vigente, sua eficácia e seu conhecimento prévio a respeito dos mesmos. Além disso, conseguiu-se traçar as características do perfil profissional dos respectivos indivíduos. Conclusões: Os resultados obtidos apontam uma percepção positiva dos gestores acercada regulação e o auxílio que a mesma trouxe aos municípios em relação à continuidade na linha de cuidado e a garantia do acesso aos pacientes com critérios clínicos mais graves. Evidenciou-se também a necessidade de melhorias na eficiência e fiscalização das legislações vigentes, além da necessidade dos gestores receberem capacitações acerca de características pontuais dos mecanismos legais.

Integração ensino-serviço: possibilidades de uma Universidade Comunitária em meio à pandemia da covid-19

O cenário da pandemia da COVID-19 convoca à rápidas mudanças no modo de trabalho, as Instituições de Ensino Superior (IES), além de potencializar as ações no campo da pesquisa reafirmam seu papel para a comunidade, especialmente quando se trata de Universidades comunitárias. Este artigo caracteriza-se como relato de experiência sobre as ações utilizadas para o enfrentamento da COVID-19 pela Universidade do Extremo Sul Catarinense (UNESC), do município de Criciúma ­ SC, uma Universidade comunitária. As ações da UNESC foram intensificadas durante o cenário pandêmico, trazendo ações inovadoras como implantação de Sala de Situação Covid-19, teleatendimentos como SOS UNESC Covid-19 e Acolher UNESC Covid-19, Programa de Rastreamento do Coronavírus, Comitê e Análise de Gestão da Covid-19 e várias ações realizadas para além dos espaços da IES. Este artigo marca o importante papel das Universidades comunitárias e seu compromisso com o desenvolvimento regional, ações, intervenções e parcerias com impacto direto na saúde da população local. A UNESC, enquanto Universidade comunitária, desenvolve ações pautadas nas melhores evidências científicas e valoriza o cuidado com a vida das pessoas. Palavra-chave: Coronavírus, Epidemiologia, Gestão de Riscos, Vigilância em Saúde Pública, Instituições de Ensino Superior.

Green tea promotes weight loss in women with polycystic ovary syndrome: Systematic review and meta-analysis.

Among the main consequences of polycystic ovary syndrome (PCOS) are menstrual dysfunction, infertility, hyperandrogenism, insulin resistance, and weight gain; in aggravated cases, it can become a risk factor for the development of metabolic syndrome and cardiovascular disease. We hypothesized that green tea can be an option to complement the treatment of PCOS. Thus, this systematic review aims to evaluate the effects of green tea supplementation in women with PCOS. We searched for randomized controlled trials (RCTs) that evaluated women with PCOS who received green tea compared with placebo in electronic databases: MEDLINE via PubMed, EMBASE via Elsevier, Cochrane Library, LILACS via BVS, and Web of Science using the terms: "polycystic ovary syndrome," "green tea," "Camellia sinensis," "epigallocatechin gallate." The outcomes listed in the study protocol were body weight, fasting insulin, body mass index, body fat percentage, daily caloric intake, waist circumference, hip circumference, and waist/hip ratio. Four double-blind RCTs were included, with a total of 169 women: 85 in the green tea group and 84 in the placebo group. We found a significantly lower body weight (kg) for green tea group (mean difference, -2.80; 95% confidence interval, -5.25 to -0.35; P = .03; I² = 0%; 4 studies, 169 participants, very low-quality evidence). Green tea has potential positive effects for the reduction of weight, and future studies will be needed to confirm the estimated effect size; we reasonably expect this to be an option of adjuvant treatment in PCOS clinical management. Registration number: CRD42021226296.

Colostrum Use and the Immune System of Premature Newborns: A Systematic Review and Meta-Analysis.

BACKGROUND: Human colostrum has been used in a number of investigations when preterm human infants cannot, for any reason, breastfeed directly from their mothers. One of the growing fields in these investigations is colostrum therapy, which consists of exposing the oropharyngeal mucosa of these preterm newborns to small amounts of raw colostrum. RESEARCH AIM: To critically review the scientific evidence about colostrum therapy in premature infants and to explore its influences on the immune system. METHODS: This systematic review was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). The following databases were searched for potentially eligible studies up to March 10, 2021: Medline, Scopus, Web of Science, Cochrane Library, Embase. Two reviewers independently screened all titles, abstracts, and full texts for eligibility. RESULTS: A total of 12 studies with 996 participants were included. A significant difference in lactoferrin levels in the urine was found (SMD 0.70; 95% CI [0.03,1.36]; p = .04; I² = 65% two studies, 112 participants, very low-quality evidence). CONCLUSION: Colostrum seems to result in increasing lactoferrin levels in the urine of premature newborns after 1 week of intervention. CLINICAL TRIAL REGISTRATION: The study was registered at PROSPERO with the number CRD42017073624, submitted on August 9, 2017.