Efficacy and specificity of melanopsin reporters for retinal ganglion cells.

Intrinsically photosensitive retinal ganglion cells (ipRGCs) are specialized retinal output neurons that mediate behavioral, neuroendocrine, and developmental responses to environmental light. There are diverse molecular strategies for marking ipRGCs, especially in mice, making them among the best characterized retinal ganglion cells (RGCs). With the development of more sensitive reporters, new subtypes of ipRGCs have emerged. We therefore tested high-sensitivity reporter systems to see whether we could reveal yet more. Substantial confusion remains about which of the available methods, if any, label all and only ipRGCs. Here, we compared many different methods for labeling of ipRGCs, including anti-melanopsin immunofluorescence, Opn4-GFP BAC transgenic mice, and Opn4cre mice crossed with three different Cre-specific reporters (Z/EG, Ai9, and Ai14) or injected with Cre-dependent (DIO) AAV2. We show that Opn4cre mice, when crossed with sensitive Cre-reporter mice, label numerous ganglion cell types that lack intrinsic photosensitivity. Though other methods label ipRGCs specifically, they do not label the entire population of ipRGCs. We conclude that no existing method labels all and only ipRGCs. We assess the appropriateness of each reporter for particular applications and integrate findings across reporters to estimate that the overall abundance of ipRGCs among mouse RGCs may approach 11%.

Barreiras à implementação da educação interprofissional: uma análise do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) / Implementation barriers to interprofessional education: an analysis of the Educação pelo Trabalho para a Saúde Program (PET-Saúde)

Resumo Este estudo analisa as barreiras para a implementação da educação interprofissional de cursos de graduação em saúde do estado do Rio de Janeiro participantes do Programa de Educação pelo Trabalho para a Saúde (PET-Saúde). Foi conduzido um estudo de caso exploratório e qualitativo, com 32 participantes do PET-Saúde, que busca promover mudanças curriculares nos cursos da saúde. Dados foram coletados em 2020 mediante entrevistas individuais e submetidos à análise temática. Foram identificadas barreiras sociopolíticas, institucionais e relacionais. As sociopolíticas incluem o sucateamento do sistema público de saúde e a violência nos territórios de atuação das equipes de atenção primária, enquanto as institucionais incluem a rigidez curricular, a rotatividade dos gestores universitários e a incipiência dos processos de avaliação das experiências inovadoras de ensino. Na dimensão relacional, o elemento central é a força dos silos profissionais e das relações de hierarquia e poder entre os diferentes profissionais de saúde. A superação dessas barreiras implica a mobilização de políticas públicas intersetoriais, maior integração entre os sistemas profissionais, de saúde e de educação, e o reconhecimento de que a educação interprofissional é uma rota potencial para melhorar a saúde da população, reduzir os custos da assistência e garantir satisfação e segurança aos profissionais.

Abstract This study analyzes the barriers undergraduate health courses participating in the Educação pelo Trabalho para a Saúde (PET-Saúde), in Rio de Janeiro, face to implement interprofessional education. An exploratory and qualitative case study was conducted with 32 participants from PET-Saúde, a program that promotes curricular changes in undergraduate health courses. Data were collected in 2020 by means of individual interviews. Thematic analysis of the data identified sociopolitical, institutional, and relational barriers. Degradation of the health system and the regional violence hindering healthcare activities were the main sociopolitical barriers. In turn, institutional barriers included curriculum rigidity, university administrator turnover, and lack of evaluation methods for innovative interprofessional education. As for relational barriers, professional silos hindering collaborative efforts, top-down power hierarchies resistant to feedback, and unsatisfactory communications among stakeholders were the main complaints. Overcoming these barriers requires intersectoral public policies, greater integration among professionals, healthcare, and education systems, and recognizing that interprofessional education can improve public health, reduce healthcare costs, and ensure professional satisfaction and work safety.

Early Introduction of Multi-Allergen Mixture for Prevention of Food Allergy: Pilot Study.

The incidence and prevalence of food allergy (FA) is increasing. While several studies have established the safety and efficacy of early introduction of single allergens in infants for the prevention of FA, the exact dose, frequency, and number of allergens that can be safely introduced to infants, particularly in those at high or low risk of atopy, are still unclear. This 1-year pilot study evaluated the safety of the early introduction of single foods (milk, egg, or peanut) vs. two foods (milk/egg, egg/peanut, milk/peanut) vs. multiple foods (milk/egg/peanut/cashew/almond/shrimp/walnut/wheat/salmon/hazelnut at low, medium, or high doses) vs. no early introduction in 180 infants between 4-6 months of age. At the end of the study, they were evaluated for plasma biomarkers associated with food reactivity via standardized blood tests. Two to four years after the start of the study, participants were evaluated by standardized food challenges. The serving sizes for the single, double, and low dose mixtures were 300 mg total protein per day. The serving sizes for the medium and high dose mixtures were 900 mg and 3000 mg total protein, respectively. Equal parts of each protein were used for double or mixture foods. All infants were breastfed until at least six months of age. The results demonstrate that infants at either high or low risk for atopy were able to tolerate the early introduction of multiple allergenic foods with no increases in any safety issues, including eczema, FA, or food protein induced enterocolitis. The mixtures of foods at either low, medium, or high doses demonstrated trends for improvement in food challenge reactivity and plasma biomarkers compared to single and double food introductions. The results of this study suggest that the early introduction of foods, particularly simultaneous mixtures of many allergenic foods, may be safe and efficacious for preventing FA and can occur safely. These results need to be confirmed by larger randomized controlled studies.

Correction: Quake et al. Early Introduction of Multi-Allergen Mixture for Prevention of Food Allergy: Pilot Study. Nutrients 2022, 14, 737

In the original publication [...].

Normative values and reference equation for the six-minute step test to evaluate functional exercise capacity: a multicenter study / Valores normativos e equação de referência para o teste do degrau de seis minutos para avaliar a capacidade funcional de exercício: um estudo multicêntrico

ABSTRACT Objective: To establish normative values and a reference equation for the number of steps climbed during the six-minute step test (6MST) in healthy adults, and to assess the reliability of the test and of the equation. Methods: This was a multicenter cross-sectional study involving 468 healthy volunteers (age range: 18-79 years) recruited from the general community in six research laboratories across different regions of Brazil, which is a country with continental dimensions. The 6MST was performed twice (30-min interval), and clinical, demographic, and functional variables were evaluated. An independent sample of 24 volunteers was evaluated to test the reference equation a posteriori. Results: The number of steps had excellent test-retest reliability (intraclass correlation coefficient = 0.96 [95%CI: 0.95-0.97]), and the mean number of steps was 175 ± 45, the number being 14% greater in males than in females. The best performance on the test was correlated with age (r = −0.60), sex (r = 0.28), weight (r = 0.13), height (r = 0.41), BMI (r = −0.22), waist circumference (r = −0.22), thigh circumference (r = 0.15), FVC (r = 0.54), and physical activity level (r = 0.17; p < 0.05 for all). In the regression analysis, age, sex, height, and weight explained 42% of the variability of the 6MST. Normative values were established for the 6MST according to age and sex. There was no difference between the 6MST values from the independent sample and its predicted values (157 ± 29 steps vs. 161 ± 25 steps; p = 0.47; 97% of predicted values). Conclusions: The normative values and the reference equation for the 6MST in this study seem adequate to accurately predict the physical functional performance in adults in Brazil.

RESUMO Objetivo: Estabelecer valores normativos e uma equação de referência para o número de degraus subidos no teste do degrau de seis minutos (TD6) em adultos saudáveis, bem como avaliar a confiabilidade do teste e da equação. Métodos: Estudo transversal multicêntrico com 468 voluntários saudáveis (faixa etária: 18-79 anos) recrutados na comunidade geral em seis laboratórios de pesquisa em diferentes regiões do Brasil, um país de dimensões continentais. O TD6 foi realizado duas vezes (com 30 min de intervalo entre uma e outra), e foram avaliadas variáveis clínicas, demográficas e funcionais. Uma amostra independente composta por 24 voluntários foi avaliada para testar a equação de referência a posteriori. Resultados: O número de degraus subidos apresentou excelente confiabilidade teste-reteste [coeficiente de correlação intraclasse = 0,96 (IC95%: 0,95-0,97)], e a média de degraus subidos foi de 175 ± 45, sendo 14% maior no sexo masculino. O melhor desempenho no teste correlacionou-se com as seguintes variáveis: idade (r = −0,60), sexo (r = 0,28), peso (r = 0,13), estatura (r = 0,41), IMC (r = −0,22), circunferência da cintura (r = −0,22), circunferência da coxa (r = 0,15), CVF (r = 0,54) e nível de atividade física (r = 0,17; p < 0,05 para todos). Na análise de regressão, idade, sexo, estatura e peso explicaram 42% da variabilidade do TD6. Foram estabelecidos valores normativos para o TD6 de acordo com a idade e o sexo. Não houve diferença entre os valores do TD6 na amostra independente e os valores previstos (157 ± 29 vs. 161 ± 25 degraus subidos; p = 0,47; 97% dos valores previstos). Conclusões: Os valores normativos e a equação de referência para o TD6 neste estudo parecem adequados para predizer com precisão o desempenho físico funcional em adultos no Brasil.

Effect of Pain Education, Cryotherapy, and Transcutaneous Electrical Nerve Stimulation on the Pain, Functional Capacity, and Quality of Life in Patients With Nonspecific Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to analyze the effects of pain education and the combined use of cryotherapy and transcutaneous electrical nerve stimulation on the pain sensation, functional capacity, and quality of life of patients with nonspecific chronic low back pain. DESIGN: This is a randomized controlled and blind clinical trial including patients with nonspecific chronic low back pain in the following 4 groups: control group, cryotherapy group, burst transcutaneous electrical nerve stimulation group, and cryotherapy combined with burst transcutaneous electrical nerve stimulation group. They were evaluated at baseline and after the protocol was concluded using the following: Roland-Morris questionnaire and sit-to-stand test; quality-of-life questionnaire; and pain. The protocol consisted of 10 sessions with pain education associated the combination of the electrophysical agents. RESULTS: There were no statistical differences between groups after the intervention protocol. In the within analysis, all groups presented an improvement in visual analog scale scores, Roland-Morris questionnaire, sit-to-stand test, and pain domain of quality-of-life questionnaire. CONCLUSIONS: This study showed that with pain education, there was no difference between cryotherapy and transcutaneous electrical nerve stimulation alone, combined, or placebo mode in improving pain, functional capacity, and quality of life in patients with nonspecific chronic low back pain.

A Combined Alcohol and Smoking Cue-Reactivity Paradigm in People Who Drink Heavily and Smoke Cigarettes: Preliminary Findings.

AIMS: Previous studies have shown that there may be an underlying mechanism that is common for co-use of alcohol and tobacco and it has been shown that treatment for alcohol use disorder can increase rates of smoking cessation. The primary aim of this study was to assess a novel methodological approach to test a simultaneous behavioral alcohol-smoking cue reactivity (CR) paradigm in people who drink alcohol and smoke cigarettes. METHODS: This was a human laboratory study that utilized a novel laboratory procedure with individuals who drink heavily (≥15 drinks/week for men; ≥8 drinks/week for women) and smoke (>5 cigarettes/day). Participants completed a CR in a bar laboratory and an eye-tracking (ET) session using their preferred alcohol beverage, cigarettes brand and water. RESULTS: In both the CR and ET session, there was a difference in time spent interacting with alcohol and cigarettes as compared to water (P's < 0.001), but no difference in time spent interacting between alcohol and cigarettes (P > 0.05). In the CR sessions, craving for cigarettes was significantly greater than craving for alcohol (P < 0.001), however, only time spent with alcohol, but not with cigarettes, was correlated with craving for both alcohol and cigarettes (P < 0.05). CONCLUSION: This study showed that it is feasible to use simultaneous cues during a CR procedure in a bar laboratory paradigm. The attention bias measured in the integrated alcohol-cigarettes ET procedure predicted participants' decision making in the CR. This novel methodological approach revealed that in people who drink heavily and smoke, alcohol cues may affect craving for both alcohol and cigarettes.

PET-Saúde/Interprofissionalidade: uma análise sobre o estado do Rio de Janeiro / PET-Saúde/Interprofessionality: an anlisys of the state of Rio de Janeiro

O Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) visa reorientar a formação profissional em saúde a partir da inserção de estudantes nos serviços de saúde. Pensar no trabalho em equipe, no protagonismo dos integrantes na construção das atividades do programa e na ampliação do olhar crítico sobre a realidade social e o trabalho em saúde é instigante tanto do ponto de vista da formação quanto da qualificação do sistema de saúde. Este estudo objetivou analisar o desenvolvimento da edição PET-Saúde/Interprofissionalidade na perspectiva dos elementos teóricos-metodológicos da educação interprofissional (EIP) e das práticas colaborativas. Trata-se de estudo de caso qualitativo, descritivo e exploratório, desenvolvido no estado do Rio de Janeiro, cujos dados foram coletados em 2020, mediante entrevistas abertas com 32 integrantes do programa. As entrevistas foram gravadas, transcritas e tratadas por análise de conteúdo. Constatou-se que a edição deflagrou experiências assertivas a partir da aplicação dos pressupostos da EIP e das práticas colaborativas, resultando na indução de reformas curriculares e de criação de disciplinas interprofissionais; porém, ainda não representa uma política incorporada pelas instituições de ensino, cujos impasses para sua solidificação perduram. Dificultaram o desenvolvimento dos projetos sob o alicerce da EIP as barreiras profissionais, cujo elemento central é o modelo de formação fragmentado, baseado em silos profissionais; barreiras culturais, que se expressam pela resistência a mudanças e pela dicotomia ensino versus serviço; barreiras políticas, que se relacionam com a carência de processos de apoio institucional que fortaleçam o sentido da corresponsabilização do ensino e do serviço com as mudanças; e barreiras estruturais, refletidas na incompatibilidade de horários dos diferentes cursos e rotatividade de gestores e profissionais do serviço. Em função da pandemia, os atores precisaram replanajar as ações previstas e se adaptar para o uso das tecnologias digitais. Conseguiram intensificar as atividades intragrupos por meio de encontros virtuais, apoiar às secretarias de saúde a partir de atividades de telemonitoramento, e desenvolver educação em saúde por meio das mídias sociais. O PET-Saúde/Interprofissionalidade corresponde a uma prática educacional inovadora que atende ao objetivo central da EIP e que se configurou num salto qualitativo ao promover a incorporação de habilidades e competências colaborativas ao ensino na saúde. As barreiras evidenciadas refletem explicitamente o contexto histórico-político que fundou as relações de poder entre o ensino e o serviço e entre a educação e o trabalho; e que as transformações almejadas requerem apoio institucional e político e um sentido de corresponsabilidade de todos os atores do quadrilátero estruturante do SUS. O PET-Saúde é, seguramente, uma estratégia potente para incitar novos movimentos dialógicos e de integração entre instituições, entre disciplinas e profissões, entre teoria e prática e, o mais importante, entre diferentes atores, que cotidianamente produzem cuidado e sem os quais não há mudança possível.

The Education through Work for Health Program (PET-Saúde) aims to reorient professional training in health based on the inclusion of students in health services. Thinking about teamwork, the role of members in the construction of the program's activities and the expansion of a critical view of the social reality and health work is exciting both from the point of view of training and qualification of the health system. This study aimed to analyze the development of the PET-Saúde/Interprofessionality edition from the perspective of theoretical-methodological elements of interprofessional education (IPE) and collaborative practices. This is a qualitative, descriptive and exploratory case study, developed in the state of Rio de Janeiro, whose data were collected in 2020, through open interviews with 32 members of the program. The interviews were recorded, transcribed and treated by content analysis. It was found that the edition triggered assertive experiences from the application of IPE assumptions and collaborative practices, resulting in the induction of curricular reforms and the creation of interprofessional subjects; however, it still does not represent a policy incorporated by educational institutions, whose impasses for its solidification persist. For those interviewed, different barriers hindered the development of projects under the foundation of the IPE: professional barriers, whose central element is the fragmented training model, based on professional silos; cultural barriers, expressed by resistance to change and by the teaching versus service dichotomy; political barriers, which are related to the lack of institutional support processes that strengthen the sense of co-responsibility of education and service with changes; and structural barriers, reflected in the incompatibility of timetables for different courses and turnover of managers and professionals in the service. Besides, due to the pandemic, the actors needed to replan the planned actions and adapt to the use of digital technologies. They were able to intensify intragroup activities through virtual meetings, support the health departments through telemonitoring activities, and develop health education through social media. The PET-Saúde/Interprofessionality corresponds to an innovative educational practice that meets the main objective of the EIP and which took the form of a qualitative leap by promoting the incorporation of collaborative skills and competences in health education. The barriers highlighted explicitly reflect the historical-political context that founded the power relations between teaching and service and between education and work; and that the desired transformations require institutional and political support and a sense of co-responsibility from all actors in the SUS structuring quadrilateral. PET-Saúde is certainly a powerful strategy to incite new dialogic and integration movements between institutions, between disciplines and professions, between theory and practice and, most importantly, between different actors, who daily produce care and without which they do not no change possible.

Método Pilates na pressão arterial de idosos: uma revisão narrativa / Pilates Method on arterial pressure of elderly: a narrative review / Método de Pilates en la presión arterial antigua: una revisión narrative

O objetivo do estudo foi buscar na literatura a influência do Método Pilates na pressão arterial de idosos. Trata-se de uma revisão de literatura científica do tipo narrativa. Foram analisados cinco artigos (três ensaios clínicos randomizados, uma revisão sistemática com metanálise e um texto on-line). Observa-se que o Método Pilates é eficaz na manutenção da pressão arterial de idosos como um coadjuvante a alguma terapia associada.

The aimed of the study was to search the literature for the influence of the Pilates Method on the blood pressure of the elderly. It is a review of scientific literature of the type of narrative. Five articles were analysed (three randomized clinical trials, one systematic review with a meta-analysis and one text online). The Pilates Method is effective in maintaining the blood pressure of the elderly as a coadjuvant to some associated therapy.

El objetivo del estudio fue buscar en la literatura la influencia del Método Pilates en la presión arterial de los ancianos. Se trata de una revisión de la literatura científica del tipo narrativa. Se analizaron cinco artículos (tres ensayos clínicos aleatorizados, una revisión sistemática con metanálisis y un texto en línea). Se observa que el Método Pilates es eficaz en el mantenimiento de la presión arterial de los ancianos como un coadyuvante a alguna terapia asociada.

Determinants of long-acting reversible contraceptive (LARC) use by adolescent girls and young women.

OBJECTIVES: To identify factors relevant for adolescents and young women in their selection of a contraceptive method and reasons for acceptance or rejection of long-acting reversible contraceptives (LARCs). METHOD: Questionnaire survey among 194 women attending an integrated young people service. RESULTS: Compared to the number of those who had heard about all LARCs (71%), the number of respondents who had used a LARC was low (28%). Awareness of intrauterine methods was the lowest, compared to other LARCs. High efficacy, protection against sexually transmitted infections and non interference with sex were the three most important factors when choosing a contraceptive method, whereas the possibility of altering the menstrual pattern and reversibility were not considered important. Qualities of LARCs such as reliability and long duration of action would encourage young women to accept LARCs. Knowledge of peers' good experience with a LARC fosters, but fear of pain and needle (most obvious for intrauterine methods) restrains use of these methods. CONCLUSIONS: Despite reliability and long-term use being important advantages, fear of pain and needles make LARCs less appealing to young people. Current LARCs meet some, but not all expectations of adolescents and young women.

Non-contraceptive benefits and risks of contraception.

Contraception is primarily used to prevent pregnancy. However, a user should be aware of both the possible non-contraceptive benefits she/he may experience and any potential risks to her/his health. These issues should be discussed as fully as possible, using current, evidence-based information prior to commencing a method. Some methods may be prescribed solely for their non-contraceptive benefits for a woman who does not require it for contraception. Potential risks to a woman's health may make certain methods unacceptable if concurrent medical problems or lifestyle issues exist. This chapter discusses the main non-contraceptive benefits and risks for each contraceptive method in turn.

Randomised controlled trial assessing the acceptability of GyneFix versus Gyne-T380S for emergency contraception.

OBJECTIVE: To assess insertion-linked pain and the short-term user-acceptability and safety of the GyneFix as compared with T-framed intrauterine devices (IUDs). DESIGN: A randomised controlled trial in an outpatient clinic setting. METHOD: Women requesting an IUD for emergency contraception (EC) were allocated to either the short-term arm (GyneFix versus Nova-T200, or the long-term arm (GyneFix versus Gyne-T380S, and then randomised within each group. Visual analogue scores were used to assess the women's perception of the pain associated with insertion, which was patient-blinded. Follow-up was double-blinded, at 6 weeks, with bleeding and pain recorded over this time. RESULTS: A total of 175 women received an IUD in the long-term arm. The short-term arm was discontinued due to low recruitment (17 women at 20 months) and therefore the results relate to the long-term arm only. Outcome was known in 98% of subjects. The actual insertion procedure was scored as more painful for the GyneFix, both by the women (p = 0.013) and the doctors making their assessment of the women's pain (p = 0.04). The women with GyneFix described less pain in the subsequent 30 days after insertion (p = 0.005). Only 13% of women with GyneFix requested removal as compared with 20% with Gyne-T380S, with the difference being attributed to removal due to pain. The bleeding pattern was similar for those using GyneFix and Gyne-T380S. CONCLUSIONS: Our study suggests that although the actual fitting may be more painful, pain is less during the 6 weeks after insertion of GyneFix and fewer women discontinue its use because of pain, as compared with Gyne-T380S. The high overall continuation rate of all emergency IUDs at 6 weeks and low morbidity seen in this study favours more frequent IUD insertion where unprotected intercourse has occurred, given also its higher efficacy over oral hormonal EC.

Comparative trial of the force required for, and pain of, removing GyneFix versus Gyne-T380S following randomised insertion.

OBJECTIVE: To assess the force required for, and pain of, removal of the GyneFix as compared with T-framed intrauterine devices (IUDs). DESIGN: A comparative trial following patient-blinded randomisation in an outpatient clinic setting. METHOD: Women requesting an IUD for emergency contraception were fitted with either a GyneFix or a Gyne-T380S. For those requesting removal of the IUD, visual analogue scores were used to assess their perception of the associated pain, and a Newton dynamometer was used to measure the force required to remove the device. RESULTS: Removal required significantly more force for GyneFix as compared with Gyne-T380S (p = 0.004), but there was no significant difference in pain perceived by women during removal. Interestingly, anticipated pain was worse than actual pain experienced. CONCLUSION: Although more force is needed to remove the GyneFix as compared with the Gyne-T380S, this does not translate into more pain.

Risks and benefits of oral contraceptive pills.

In the more than 40 years since the combined oral contraceptive pill was first marketed, much information has been obtained as to its risks. Considerably less publicity has been given to the balancing benefits that have also emerged. There has been an increasing realization that the risks are focused in those women with recognised risk factors, meaning that the remainder can use the product with increasing reassurance. The doses of both hormones have also been lowered considerably since the early years. Thus, it can be a rational decision by a fully informed woman to use this form of contraception.