Chronic disease in the elderly: spirituality and coping.

This is an exploratory study using a qualitative methodology which aimed to identify and understand the role of spirituality in the management of chronic disease in the elderly. The discourse analysis revealed the following central themes: multidimensional impact of chronic diseases, coping and expectations of the elderly. Regarding coping with chronic diseases, the individual coping, social support and religiosity/spirituality/faith were analyzed. The results showed the changes brought about the diagnosis of chronic disease and its implications for the adaptation to the new way of life. The management of these changes is complex and many factors influence positively and negatively in order to deal with the new condition. The results showed that spirituality/religiosity /faith interfere positively in addressing the barriers and difficulties of life, strengthening the resilience of the patient, thus improving their quality of life.

A fermented milk drink with Umbu (Spondias tuberosa) pulp and whey is effective for weight gain and re-nutrition in malnourished: An in vivo study in mice and children.

Malnutrition is considered one of the major public health problems worldwide and negatively affects the growth, development and learning of schoolchildren. This study developed and evaluated a fermented milk drink with added Umbu (Spondias tuberosa) pulp in the weight gain and renutrition of mice submitted to malnutrition by calorie restriction, and in malnourished children. The supplementation with this fermented milk drink contributed to an increase of 7.2 % in body weight, and 64.3 % in albumin, and a reduction of 35 % in cholesterol in malnourished mice. In humans, a group of nine malnourished children consumed a daily 200 mL serving of the milk drink (for 60 days). For humans, the fermented milk drink allowed an increase of 16.5 % in body weight, and 20.9 % in body mass index in malnourished children. In conclusion, fermented milk drink has a positive effect on the re-nutrition of malnourished mice and helps to improve the nutritional status of malnourished children.

Impact of COVID-19 pneumonia on pulmonary vascular volume.

Background: Pulmonary manifestations of COVID-19 pneumonia are well known. However, COVID-19 is also associated with a range of vascular manifestations such as embolism, congestion, and perfusion changes. Regarding congestion, research from different groups has suggested arteriovenous anastomosis dysregulation as a contributing factor. In this study, we aim to better describe the changes in vascular volume in affected lung zones and to relate them to pathophysiological hypotheses. Methods: We performed automatic vascular volume extraction in 10 chest CTs of patients, including 2 female and 8 male with a mean age of 63.5 ± 9.3 years, diagnosed with COVID-19 pneumonia. We compared the proportion of vascular volumes between manually segmented regions of lung parenchyma with and without signs of pneumonia. Results: The proportion of vascular volume was significantly higher in COVID (CVasc) compared to non-COVID (NCVasc) areas. We found a mean difference (DVasc) of 5% and a mean ratio (RVasc) of 3.7 between the two compartments (p < 0.01). Conclusion: Vascular volume in COVID-19 affected lung parenchyma is augmented relative to normal lung parenchyma, indicating venous congestion and supporting the hypothesis of pre-existing intra-pulmonary arteriovenous shunts.

EUS-guided choledochoduodenostomy for malignant biliary obstruction: A multicenter comparative study between plastic and metallic stents.

Background and Objectives: EUS-guided choledochoduodenostomy (EUS-CDS) is commonly employed to address malignant biliary obstruction (MBO) after a failed ERCP. In this context, both self-expandable metallic stents (SEMSs) and double-pigtail stents (DPSs) are suitable devices. However, few data comparing the outcomes of SEMS and DPS exist. Therefore, we aimed to compare the efficacy and safety of SEMS and DPS at performing EUS-CDS. Methods: We conducted a multicenter retrospective cohort study between March 2014 and March 2019. Patients diagnosed with MBO were considered eligible after at least one failed ERCP attempt. Clinical success was defined as a drop of direct bilirubin levels ≥ 50% at 7 and 30 postprocedural days. Adverse events (AEs) were categorized as early (≤7 days) or late (>7 days). The severity of AEs was graded as mild, moderate, or severe. Results: Forty patients were included, 24 in the SEMS group and 16 in the DPS group. Demographic data were similar between the groups. Technical success rates and clinical success rates at 7 and 30 days were similar between the groups. Similarly, we found no statistical difference in the incidence of early or late AEs. However, there were two severe AEs (intracavitary migration) in the DPS group and none in the SEMS cohort. Finally, there was no difference in median survival (DPS 117 days vs. SEMS 217 days; P = 0.99). Conclusion: EUS-guided CDS is an excellent alternative to achieve biliary drainage after a failed ERCP for MBO. There is no significant difference regarding the effectiveness and safety of SEMS and DPS in this context.

Sebaceous Carcinoma of the Vulva: An Unexpected Diagnosis and Literature Review.

Sebaceous carcinoma of the vulva is a rare malignancy of the sebaceous glands, with potentially aggressive behaviour, that is usually found in the peri-ocular area. Nonetheless, there are sebaceous glands in the vulva and this diagnosis is especially rare, with only ten cases described in the literature. We report a case of 78-year-old female patient who presented with vulvar pruritus, previously treated with topical steroid and antifungal treatments, without improvement. The vulvar examination showed a visible yellow papule, 12 x 10 mm on the right major labia, which was biopsied and the microscopic examination revealed an invasive sebaceous carcinoma of the vulva, with an in situ component. We performed an uneventful excisional biopsy, followed by a subsequent margin widening. Three months after the diagnosis, she presented with the first recurrence. Two and half years after the diagnosis, she recurred with a larger lesion (13 mm) in the upper half of small right lip, more than 10 mm away from the midline. In a multidisciplinary meeting it was decided that the patient should undergo partial right vulvectomy with homolateral inguino-femoral sentinel node biopsy (one negative node). There was no evidence of recurrence one-year post-surgery.

O carcinoma sebáceo da vulva é uma neoplasia maligna rara das glândulas sebáceas com comportamento potencialmente agressivo, mais comummente encontrada na área periocular. Este diagnóstico é particularmente raro nas glândulas sebáceas da vulva, com apenas dez casos previamente descritos na literatura. Relatamos o caso de uma paciente de 78 anos que se apresentou com prurido vulvar, anteriormente tratado com corticóides tópicos e antifúngicos, sem melhoria evidente. Ao exame objetivo apresentava uma pápula amarela visível, com cerca de 12 x 10 mm no grande lábio direito, que foi biopsada. O exame microscópico revelou um carcinoma sebáceo invasivo da vulva, com componente in situ. Posteriormente, foi realizada uma biópsia excisional, com alargamento de margens, sem intercorrências. Três meses após o diagnóstico, surgiu a primeira recidiva, pelo que foi realizada uma nova biópsia excisional. Dois anos e meio após o diagnóstico, a doente apresentava uma lesão com 13 mm, na metade superior do pequeno lábio direito, mais de 10 mm afastada da linha mediana. Em reunião multidisciplinar decidiu-se que deveria ser submetida a uma vulvectomia parcial direita, com pesquisa de gânglio sentinela inguino-femoral homolateral (um gânglio negativo). Um ano após a cirurgia, a doente encontra-se sem evidência de recorrência.

In vitro anti-trypanosomal potential of kaurane and pimarane semi-synthetic derivatives.

As part of the search for anti-trypanosomal agents, this work presents the production of sixteen derivatives. All of them were obtained from two natural diterpenes, one with kaurane skeleton (ent-kaurenoic acid) and other with a pimarane skeleton (ent-pimaradienoic acid). Then, the eighteen compounds were assayed against epimastigote form of Trypanosoma cruzi, with the derivatives showing increase of activity in relation to their precursors. Moreover, the most active derivative presented an IC50 <12.5 µM (estimated 0.8 µM), lower than Benznidazole (IC50 = 9.8 µM), used as control. The esterification of acid diterpenes showed to be an interesting way in the search for anti-trypanosomal agents.

Senescence and senility: the new paradigm in primary health care. / Senescência e senilidade: novo paradigma na atenção básica de saúde.

Senescence and senility are themes of growing interest, considering the inxrease of the elderly population in the wrold, particularly in Brazil. Health care for the edlery should value to maintain quality of life, considering the loss process particular of aging and the possiblities to prevent, maintenain and rehabilitate their health condition. Knowing the everyday lives of the elderly has been a challenge for health care professsionals regardint the implementation of programs and actions that aim to maintain the balance of the health-disease process, and it is in this search that we have made efforts to constibute, effectively, with the strategies to strengthen the edlerly and their relatives so it becomes possible to trigger health promotion actions, especially considering that the challenge for the millenium is to build collective awareness to achieve a society for all ages, with justice and the guarantee of full rights.

Case Report: Intrapulmonary Arteriovenous Anastomoses in COVID-19-Related Pulmonary Vascular Changes: A New Player in the Arena?

Up to now, COVID-19-related vascular changes were mainly described as thrombo-embolic events. A handful of researchers reported another type of vascular abnormality referred to as "vascular thickening" or "vascular enlargement," without specifying whether the dilated vessels are arteries or veins nor providing a physiopathological hypothesis. Our observations indicate that the vascular dilatation occurs in the venous compartment, and underlying mechanisms might include increased blood flow due to inflammation and the activation of arteriovenous anastomoses.

Parasitic sirtuin 2 as an opportunity in drug discovery.

Infections caused by protozoans remain a public health issue, especially in tropical countries. Serious adverse events, lack of efficacy at the different stages of the infection and routes of administration that have a negative impact on treatment adherence are some of the problems with currently available therapy against these diseases. Here we describe an epigenetic target, sirtuin 2 and its related proteins, that is promising given the results in phenotypic assays and in vivo models against Sir2 of Plasmodium falciparum, Leishmania donovani, Leishmania infantum, Schistosoma mansoni, Trypanosoma brucei and Trypanosoma cruzi parasites. The results we present highlight how this target can be extensively explored and how its inhibitors might be employed in the clinic.

Diagnostic Properties of Three SARS-CoV-2 Antibody Tests.

Serological assays emerged as complementary tools to RT-PCR in the diagnosis of SARS-CoV-2 as well as being needed for epidemiological studies. This study aimed to assess the performance of a rapid test (RT) compared to that of serological tests using finger prick blood samples. A total of 183 samples were evaluated, 88 of which were collected from individuals with negative RT-PCR and 95 from positive RT-PCR individuals. The diagnostic performance of RT (WONDFO®) and LUMIT (PROMEGA®) were compared to that of ELISA (EUROIMMUN®) for detecting antibodies against SARS-CoV-2 according to time from symptoms onset. The IgG antibody tests were detected in 77.4% (LUMIT), 77.9% (RT), and 80.0% (ELISA) of individuals. The detection of antibodies against SARS-CoV-2 increases in accordance with increasing time from symptoms onset. Considering only time from symptoms onset >21 days, the positivity rate ranged from 81.8 to 97.0% between the three tests. The RT and LUMIT showed high agreement with ELISA (agreement = 91.5%, k = 0.83, and agreement = 96.3%, k = 0.9, respectively) in individuals who had symptoms 15 to 21 days before sample collection. Compared to that of the ELISA assay, our results show sensitivity ranged from 95% to 100% for IgG antibody detection in individuals with symptoms onset between 15 and 21 days before sample collection. The specificity was 100% in individuals with symptoms onset >15 days before serological tests. This study shows good performance and high level of agreement of three immunoassays for the detection of SARS-CoV-2 antibodies.

ADOLESCENT GLUTEN INTAKE: POPULATION-BASED STUDY IN A BRAZILIAN CITY.

OBJECTIVE: To estimate the prevalence of gluten intake according to demographic, socioeconomic, and health-related behavioral variables in adolescents. METHODS: This is a population-based cross-sectional study with a two-stage cluster sampling, conducted in Campinas, São Paulo, in 2008-2009. Foods containing gluten were identified using a 24-hour Recall. We calculated the prevalence and adjusted prevalence ratios with multiple Poisson regression. RESULTS: The study had a sample of 924 adolescents aged 10 to 19 years. Among the foods assessed, 26.9% (confidence interval of 95% - 95%CI 25.3-28.6) contained gluten. We found a higher prevalence of gluten intake in younger individuals (10 to 14 years), as well as in subgroups of adolescents who had a higher number of household appliances, attended school, consumed fewer beans and vegetables during the week (<4 times), and whose head of the family had better education level (≥12 years of schooling). The main food sources of gluten in their diet were: bread, cakes, and cereals (30.2%), chocolate milk (14%), chicken nuggets (12.3%), and cookies (11%). CONCLUSIONS: The results of the study show the epidemiological profile associated with gluten intake in adolescents and could support actions aimed at promoting healthy eating habits and preventing gluten-related diseases.

Síndrome de Leopard: rara fenocópia da miocardiopatia hipertrófica / Leopard syndrome: rare phenocopy of hypertrophic cardiomyopathy

INTRODUÇÃO: A Síndrome de Leopard, considerada uma fenocópia da cardiomiopatia hipertrófica (CMH) é uma rasopatia, caracterizada por alterações de crescimento, lentiginose, alterações oculares, genitais e cardíacas. Devido à sua raridade, há poucasinformações na literatura sobre a história natural da doença. Este caso descreve a evolução de 18 anos de um paciente com esta síndrome. RELATO DO CASO: masculino, 19 anos, iniciou acompanhamento com 1 ano e 3 meses de idade. Assintomático, possuíamanchas hipercrômicas na pele,sobretudo face, dorso emembrossuperiores. O ecocardiograma evidenciava já no segundo ano de vida, hipertrofia biventricular, com espessura septal e de parede posterior de 10/9 mm, gradiente de via de saída do ventrículo esquerdo (VSVE) de 107mmHg e de 50mmHg na via de saída do ventrículo direito (VSVD). Havia também movimento sistólico anterior do folheto mitral e função contrátil preservada. Do ponto de vista neurológico, foi identificado atraso no desenvolvimento neuropsicomotor. Aos 4 anos, a massa ventricular esquerda era de 149g, septo de 15mm e parede posterior de 11mm, com gradiente de 101mmHg em VSVE, fração de ejeção de ventrículo esquerdo (FEVE) de 74%. O painel genético identificou mutação no gene PTPN11, compatível com síndrome de Leopard. Hoje, aos 19 anos, apesar de manter-se oligossintomático, apresenta sinais de disfunção ventricular, com FEVE 47%, strain longitudinal de 6, fractional area change (FAC) 30%, septo de 30mm, parede posterior 19mm, massa ventricular de 487g. O gradiente na VSVE é de 82mmHg e na VSVD de 103mmHg. A ressonância magnética cardíaca atual evidencia realce tardio subendo/mesocárdico, com massa de fibrose estimada em 10g (3% do total). Há dilatação biventricular, com FEVE estimado pela ressonância de 37%. DISCUSSÃO: Em comparação com o fenótipo habitual da CMH, pacientes portadores de síndrome de Leopard apresentam sintomas mais precocemente na infância e podem manter progressão da hipertrofia ao longo de vários anos, diferentemente da CMH, que habitualmente atinge um platô em sua evolução. Não é bem estabelecido qual o risco de morte súbita associado à esta síndrome, nem quais critérios utilizar na indicação de CDI. Há relatos de melhora dos sintomas após realização de miectomia, porém ainda não temos registro se há resposta com uso de inibidores de miosina ATPase. CONCLUSÃO: A síndrome de Leopard, diferente da CMH, tem evolução desfavorável, com aumento progresso da hipertrofia ventricular esquerda ao longo dos anos e disfunção ventricular precoce.

Mixoma atrial direito: causa rara de hipoxemia persistente / Right atrial myxoma: rare cause of persistent hypoxemia

INTRODUÇÃO: Os tumores cardíacos podem ser divididos em primários ou secundários. Tumores primários são raros, com incidência estimada em 0.02% da população. Dentre os tumores primários benignos, o tipo mais comum é o mixoma atrial, sendo que cerca de 75% destes ocorrem no átrio esquerdo. DESCRIÇÃO: Feminino, 57 anos, sem antecedentes prévios, iniciou quadro de dispneia, dessaturação e síncope, há cerca de 4 meses da admissão. Evoluiu com necessidade de oxigenoterapia suplementar durante a internação. Angiotomografia de tórax excluiu tromboembolismo pulmonar, porém evidenciou presença de massa em átrio direito. O ecocardiograma transtorácico confirmou presença de massa arredondada e heterogênea, aderida ao teto do átrio direito, medindo 51 x 42 mm. A ressonância magnética cardíaca evidenciou massa arredondada de contornos irregulares no interior do átrio direito de 4,9x4,4 cm, móvel, que se insinua até o plano da valva tricúspide na sístole atrial. Apresentava sinal heterogêneo em sequências ponderadas em T1 e hipersinal em sequências ponderadas em T2, com perfusão na primeira passagem do contraste e captação heterogênea de contraste em fases de realce tardio. Durante a observação, a paciente apresentou novo episódio de síncope e insuficiência respiratória, com saturação de oxigênio de 84% e pressão parcial de oxigênio de 44mmHg em gasometria arterial. Decidido por urgenciar a cirurgia de ressecção da massa atrial. No intraoperatório foi visualizado grande tumor aderido à parede lateral do átrio direito, de aparência gelatinosa, com anatomopatológico compatível com mixoma. Paciente apresentou boa evolução no pós-operatório com melhora completa de todos os sintomas, incluindo a hipoxemia. Recebeu alta sem uso de oxigênio suplementar. COMENTÁRIOS E CONCLUSÕES: O mixoma atrial é um tumor benigno, cujo quadro clínico é usualmente composto por sintomas constitucionais, sintomas obstrutivos mecânicos e fenômenos tromboembólicos. Neste caso, a apresentação foi atípica, observando-se hipoxemia progressiva e refratária, provavelmente relacionada à diminuição de fluxo de sangue aos pulmões, causada pela obstrução mecânica nas cavidades direitas. A resolução da hipoxemia com a ressecção cirúrgica do tumor sugere a relação causal entre as duas condições. Concluímos que a hipoxemia crônica persistente pode ser listada entre as manifestações clínicas de tumoração grande em átrio direito.

Cotyledonoid Dissecting Leiomyoma of the Uterus: An Unexpected Diagnosis After Delivery.

Cotyledonoid dissecting leiomyoma, also known as Sternberg tumor, is a rare benign uterine tumor with a gross and radiological appearance that may suggest the possibility of a malignancy. We report a case of a thirty-eight-year-old female patient who presented with menorrhagia and abdominal pain one month after delivery by cesarean section. An ultrasound scan showed a heterogeneous pelvic mass, near the isthmic region, with 25 x 24 x 23 mm without vascularization so the possibility of placenta accreta could not be excluded. During hysterectomy, we also removed a small grey mass in the right ovary. Microscopic examination revealed a proliferation of a sparsely cellular tissue with extensive hyalinization and coagulative necrosis, composed of spindle shaped muscle cells without cellular atypia or mitoses. The patient is without evidence of recurrence one year and six months post-surgery.

O leiomioma cotiledonóide dissecante, também conhecido como tumor de Sternberg, é uma forma rara de tumor uterino benigno com uma aparência macroscópica e radiológica sugestiva de malignidade. Reportamos o caso de uma doente de trinta e oito anos que se apresentou com menorragia e dor abdominal, um mês após um parto por cesariana. Na ecografia visualizava-se uma massa heterogénea, próxima da região ístmica, com 25 x 24 x 23 mm e sem vascularização, pelo que não foi excluída a possibilidade de placenta acreta. Aquando da histerectomia, foi também excisada uma pequena massa cinzenta do ovário direito. A análise microscópica das peças cirúrgicas, revelou uma proliferação de tecido celular esparso, com extensas áreas de hialinização e necrose coagulativa, compostas por células fusiformes musculares sem atipia ou mitoses. A doente apresenta-se sem evidência de recorrência um ano e meio após a cirurgia.

Disfunção sexual percebida e fatores atribuídos por mulheres com hanseníase / Perceived sexual dysfunction and factors attributed by women with leprosy

A hanseníase é uma doença infectocontagiosa de evolução lenta, alta infectividade e baixa patogenicidade, que apresenta sinais e sintomas dermatoneurológicos. A alteração no padrão sexual ocasionada pela disfunção sexual feminina é uma complicação que pode ser vivenciada por mulheres com hanseníase, causando um impacto negativo na qualidade de vida. O objetivo desta pesquisa foi identificar a função sexual percebida e fatores atribuídos por mulheres com hanseníase. Estudo descritivo, transversal desenvolvido em dois ambulatórios de referência em dermatologia do município de Fortaleza, Ceará, com 76 mulheres com hanseníase. Foi utilizado formulário de entrevista com variáveis socioeconômicas e clínicas, e aplicação do Female Sexual Function Index. Prevaleceu a idade adulta jovem, com condições socioeconômicas desfavoráveis, e formas multibacilares. A percepção da disfunção sexual foi predominante entre as entrevistadas (60,5%), que citaram como fatores relacionados a autoimagem (26,0%) e alteração no desejo sexual (26,0%). Os domínios com maior alteração foram: satisfação (R=3,06), excitação (R=3,78), desejo (R=3,79) e orgasmo (R=3,79). A abordagem sobre a função sexual de mulheres com hanseníase deve ser realizada por profissionais de saúde, de forma a promover uma maior satisfação sexual e pessoal para a paciente.

Leprosy is an infectious disease of slow evolution, high infectivity and low pathogenicity, which presents dermato-neurological signs and symptoms. The change in the sexual pattern caused by female sexual dysfunction is a complication that can be experienced by women with leprosy, causing a negative impact on quality of life. The objective of this study was to identify the perceived sexual function and factors attributed by women with leprosy. This descriptive, cross-sectional study was carried out in two dermatology outpatient clinics in the city of Fortaleza, Ceará, with 76 women with leprosy. An interview form was used with socioeconomic and clinical variables, and application of the Female Sexual Function Index. Young adulthood prevailed, with unfavorable socioeconomic conditions, and multibacillary forms. The perception of sexual dysfunction was predominant among the interviewees (60.5%), who cited as factors related to self-image (26.0%) and changes in sexual desire (26.0%). The domains with the greatest change were: satisfaction (R=3.06), arousal (R=3.78), desire (R=3.79), and orgasm (R=3.79). The approach to the sexual function of women with leprosy should be carried out by health professionals, in order to promote greater sexual and personal satisfaction for the patient.

Prevalence of kinesiophobia and catastrophizing in patients with temporomandibular disorders / Prevalência de cinesiofobia e catastrofização em pacientes com disfunção temporomandibular

ABSTRACT Purpose: to identify the frequency and levels of kinesiophobia and catastrophizing in patients with temporomandibular disorders who had been submitted to speech-language-hearing therapy. Methods: the sample comprised patients with myogenous (predominantly) and mixed temporomandibular disorders in the study group and healthy individuals in the control group. The instruments used were the Diagnostic Criteria for Temporomandibular Disorders, Tampa Scale for Kinesiophobia, and Pain Catastrophizing Scale. Statistical analyses were performed with the Mann-Whitney test (to compare the means on each scale between the groups) and the Spearman's correlation coefficient test (to analyze the correlation between the scales in each group and its significance). Results: the study group had a higher pain catastrophizing index than the control group. Likewise, the study group had greater kinesiophobia positive indices, whereas the control group had lower ones. A moderate positive correlation was also identified between kinesiophobia and catastrophizing in the study group. Conclusion: patients presented with temporomandibular disorders have higher levels of kinesiophobia and catastrophizing than subjects not diagnosed with the disorder.

RESUMO Objetivo: identificar a frequência e os níveis de cinesiofobia e catastrofização em pacientes com Disfunção Temporomandibular que realizaram terapia fonoaudiológica. Métodos: a amostra compreendeu pacientes com Disfunção Temporomandibular muscular e mista com predominância muscular, grupo de estudo e adultos saudáveis, o grupo controle. Os instrumentos utilizados foram: Diagnostic Criteria for Temporomandibular Disorders, Escala Tampa para Cinesiofobia e Escala de Catastrofização da Dor. A análise estatística foi composta do Teste de Mann-Whitney para comparar as médias entre os grupos de cada escala e o teste de Coeficiente de Correlação de Spearman para analisar a correlação entre as escalas em cada grupo e sua significância. Resultados: foi identificado um alto índice de catastrofização da dor no grupo de estudo em comparação ao grupo controle. Quanto à cinesiofobia, houve maior índice positivo para essa variável no grupo de estudo e menor para o grupo controle. Além disso, identificou-se correlação moderada e positiva entre a cinesiofobia e catastrofização no grupo de estudo. Conclusão: Pacientes com Disfunção Temporomandibular possuem níveis de cinesiofobia e catastrofização mais altos que pacientes que não foram diagnosticados com o distúrbio.

Nocebo effect in health communication: how to minimize it? / Efeito nocebo na comunicação em saúde: como minimizá-lo?

ABSTRACT Purpose: to describe the strategies used to minimize the nocebo effect in health communication. Methods: an integrative review of the literature. The keywords "nocebo effect" and "health communication" and their combinations were used in English, Portuguese, and Spanish to search publications from 2011 to 2021 in MEDLINE, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Library, EMBASE, and Web of Science/ISI. The following research question was used: "Which strategies have been used to minimize the nocebo effect in health communication?". Literature Review: altogether, 77 articles were found, although only six met the inclusion criteria and comprised the review sample. Their year of publication ranged from 2015 to 2021. Positive framing, assertive communication, and contextual factors were the strategies used to minimize the nocebo effect. Conclusion: the strategies used to minimize the nocebo effect were contextual factors, motivational talk, positive framing, assertive communication, and empathetic communication. These communication techniques are seemingly effective, though still little known by health professionals. This knowledge is important as it helps develop communicative skills aiming at humanized patient care.

RESUMO Objetivo: descrever as estratégias para minimizar o efeito nocebo na comunicação em saúde. Métodos: trata-se de uma revisão integrativa da literatura. Os descritores utilizados foram: "Efeito nocebo" e "comunicação em saúde", em inglês, português e espanhol e suas combinações, no período de 2011 a 2021, nas bases de dados da Medline, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cochrane Library, Embase e Web of Science/ISI. A pergunta de investigação para esse estudo foi: Quais as estratégias utilizadas para minimizar o efeito nocebo na comunicação em saúde? Revisão da Literatura: foram encontrados 77 artigos. Apenas seis preencheram os critérios de inclusão e compuseram a amostra da revisão. Os anos de publicação dos artigos variaram entre 2015 e 2021. As estratégias definidas para minimizar o efeito nocebo foram: enquadramento positivo, comunicação assertiva e utilização de fatores contextuais. Conclusão: as estratégias encontradas para minimizar o efeito nocebo foram fatores contextuais, conversa motivacional, enquadramento positivo, comunicação assertiva e comunicação empática. Essas técnicas de comunicação parecem ser efetivas, mas ainda são pouco conhecidas pelos profissionais em saúde. Esse conhecimento se faz importante, pois auxilia no desenvolvimento de habilidades comunicativas que visam à humanização do cuidado ao paciente.

[Micronutrient deficiencies in Brazilian children attending daycare centers: a review of the literature]. / Deficiências de micronutrientes em crianças brasileiras assistidas em creches: revisão da literatura.

The scope of the study was to review the scientific publications on the nutritional status of iron, vitamin A and zinc among Brazilian children attending daycare centers, focusing on diagnostic methods, the prevalence of respective deficiencies and associated factors. A review of the literature was conducted in the PubMed, LILACS and SciELO databases. Observational studies with random representative samples using biochemical indicators to evaluate the nutritional status of iron, vitamin A and zinc of children attending public daycare centers were included. The average weighted prevalence for anemia and vitamin A deficiency was estimated. The variables associated with anemia were computed. Twenty-one observational studies were included, in which the nutritional status of iron, vitamin A and zinc were analyzed in 17, 4 and 3, respectively. The average weighted prevalence of anemia and vitamin A deficiency were 42.7% and 12.5%, respectively. Young children and children living in less favorable socioeconomic situations represented the main explanatory conditions predominantly associated with the occurrence of anemia. The results suggest a high prevalence of anemia, as well as vitamin A deficiency in Brazilian children attending daycare centers, with etiological prospects focused on infectious diseases.

[Anthropometric indices of children treated in daycare centers and the relationship with socioeconomic, maternal and child factors]. / Índices antropométricos de crianças assistidas em creches e sua relação com fatores socioeconômicos, maternos e infantis.

Weight/height and weight/age anthropometric statistics are important, respectively, for identifying incipient changes in weight and alterations in nutritional status at an early stage. The scope of this study was to analyze weight/height- and weight/age-associated factors in preschool children. This is a cross-sectional study with a probabilistic sample scrutinizing 299 children enrolled in municipal daycare centers. Information was obtained through interviews with mothers together with a questionnaire analyzing socioeconomic, maternal and child information. Weight and height/stature of children were measured according to recommendations of the World Health Organization. The results showed that none of the maternal variables was associated with the nutritional status of children and that only birth weight among child variables revealed any association with weight/height (p = 0.0030) and weight/age scores (p = 0.0018). The block of socioeconomic variables, in turn, proved to be the most representative variation factor of results, especially in the weight/age index. The importance of birth weight in the weight/height and weight/age of children, as well as the socioeconomic conditions notably in weight/age indices, was clearly revealed.

Potencialidades e limitações da visita domiciliar realizada por estudantes de medicina na disciplina de Saúde da Família e Comunidade / Potentialities and limitations of the home visit performed by students of medicine in the course of Family and Community Health

Foram analisadas experiências vivenciadas nas visitas domiciliares realizadas pelos estudantes de Medicina, com objetivo de identificar e discutir as potencialidades e as limitações dessas. A partir disso, são descritas e avaliadas crítica e qualitativamente tais experiências, a fim de demonstrar a sua contribuição na área de atuação. O estudo teve como base a análise temática dos portfólios realizados por estudantes que cursavam a disciplina Saúde da Família e Comunidade, entre agosto de 2015 e outubro de 2016, e que, no presente, são membros da Liga Acadêmica de Atenção Básica à Saúde (LAABS). Diante de tais análises, destacam-se como potencialidades a importância do trabalho em equipe, aproximação entre profissional de saúde e a realidade do paciente, avaliação da situação de saúde e das condições de vida da população, além do desenvolvimento de vínculos com a população, o que facilita a continuidade do cuidado. Por outro lado, o pouco tempo disponível para a visita, o horário inadequado escolhido em algumas situações e a frustração quando o estudante não percebia adesão instantânea à mudança do estilo de vida pelo paciente foram algumas das limitações encontradas. Por fim, diante do exposto, embora a visita domiciliar apresente limitações, as potencialidades superam, visto que por auxiliar concretamente na melhoria da relação médico paciente, ela torna possível a realização de um trabalho contínuo e que propicia um melhor seguimento com a população.

Medical students' practices experienced in home visits were analyzed, aiming to identify and to discuss their potentialities and limitations. From this, these experiences are described and evaluated critically and qualitatively, in order to demonstrate their contribution in the area of performance. The study was based on the thematic analysis of the portfolios carried out by students who attended the Family and Community Health course, between August 2015 and October 2016, and who are currently members of the Academic League for Basic Health Care (ALBHC). Faced with such analyzes, the potentialities and the importance of teamwork are highlighted. as well as the approximation between health professional and patient reality; the evaluation of the health situation and the living conditions of the population and the development of ties with the population, which facilitates the continuity of care. On the other hand, some of the limitations were found like short time available for the visit; the inappropriate time chosen in some situations; the frustration when the student did not notice instant adherence to the lifestyle change by the patient. Finally, as described above, although the home visit presents limitations, the potentialities outweigh them, since they help concretely in the improvement of the patient-doctor relationship, which makes possible the accomplishment of a continuous work and allows a better follow-up with the population.