Mapa de evidências: estratégias efetivas em programas e políticas de alimentação e nutrição / Evidence map: effective strategies in food and nutrition programs and policies

O mapa de evidências foi desenvolvido tendo como referência as nove diretrizes da Política Nacional de Alimentação e Nutrição (PNAN). O objetivo foi identificar intervenções efetivas para melhorar as condições de saúde, alimentação e nutrição da população. Foram analisadas 101 revisões sistemáticas. As intervenções foram classificadas em 5 categorias e 80 subcategorias. Os desfechos foram classificados em 8 categorias e 119 subcategorias. Foram relatados efeitos positivos de 71 subcategorias de intervenção para 94 subcategorias de desfecho. Lacunas: poucas revisões sistemáticas abordaram "Atenção Nutricional" e "Força de Trabalho". Não foram identificadas revisões sistemáticas sobre "Vigilância Alimentar e Nutricional", "Gestão das Ações de Alimentação e Nutrição", "Participação e Controle Social", "Pesquisa, Inovação e Conhecimento em Alimentação e Nutrição".

The evidence map was developed with reference to the nine guidelines of the National Food and Nutrition Policy (PNAN). The objective was to identify effective interventions to improve the health, food and nutrition conditions of the population. 101 systematic reviews were analyzed. Interventions were classified into 5 categories and 80 subcategories. Outcomes were classified into 8 categories and 119 subcategories. Positive effects of 71 intervention subcategories were reported for 94 outcome subcategories. Gaps: few systematic reviews addressed "Nutritional Care" and "Workforce". No systematic reviews were identified on "Food and Nutrition Surveillance", "Management of Food and Nutrition Actions", "Participation and Social Control", "Research, Innovation and Knowledge in Food and Nutrition".

Estratégias para prevenção e manejo da desnutrição crônica em crianças menores de cinco anos / Strategies for the prevention and management of chronic malnutrition in children under five years of age

O problema: A desnutrição se refere a deficiências, excessos ou desequilíbrios na ingestão de energia e/ou nutrientes. O déficit de altura resulta em baixa estatura para a idade, e geralmente está associada a condições socioeconômicas adversas, saúde e nutrição materna precárias, doenças frequentes e/ou alimentação e cuidados inadequados das crianças no início da vida. No Brasil, estima-se que a prevalência de baixa estatura para a idade é de 7% em crianças menores de cinco anos. Esta revisão teve como objetivo identificar opções para políticas de prevenção e manejo de déficit de altura em crianças menores de cinco anos. Opções para enfrentar o problema: As buscas nas bases de dados recuperaram 558 revisões sistemáticas (RS), sendo complementadas por sete RS identificadas em busca manual. Após processo de seleção, 28 RS atenderam aos critérios de elegibilidade e foram incluídas nesta revisão narrativa. As estratégias de prevenção e manejo de déficit de altura em crianças menores de 5 anos analisadas nas RS foram categorizadas conforme similaridade em oito opções, apresentadas a seguir. Efeitos positivos foram relatados nas RS para uma variedade de estratégias, no entanto, algumas incertezas também foram apontadas. Com relação à qualidade metodológica, sete RS foram classificadas como de confiança alta, uma confiança moderada, oito confiança baixa e doze confiança criticamente baixa.

The problem: Malnutrition refers to deficiencies, excesses or imbalances in energy and/or nutrient intake. Height deficit results in low height for age, and is usually associated with adverse socioeconomic conditions, poor maternal health and nutrition, frequent illnesses and/or inadequate feeding and care of children in early life. In Brazil, it is estimated that the prevalence of low height for age is 7% in children under five years of age. This review aimed to identify policy options for the prevention and management of stunting in children under five years of age. Options to deal with the problem: Searches in the databases retrieved 558 systematic reviews (SR), complemented by seven SRs identified in a manual search. After the selection process, 28 SR met the eligibility criteria and were included in this narrative review. The height deficit prevention and management strategies in children under 5 years of age analyzed in the SR were categorized according to similarity in eight options, presented below. Positive effects were reported on the SR for a variety of strategies, however, some uncertainties were also pointed out. Regarding methodological quality, seven SR were classified as having high confidence, one moderate confidence, eight low confidence and twelve critically low confidence.

Riscos do consumo de edulcorantes para a saúde humana / Riscos do consumo de edulcorantes para a saúde humana

Pergunta: Quais são os riscos do consumo de edulcorantes para a saúde humana? Métodos: Após realização de protocolo de pesquisa, quatro bases da literatura eletrônica foram buscadas em maio de 2022, para identificar estudos que abordassem possíveis riscos do consumo de edulcorantes para a saúde humana. Utilizando atalhos de revisão rápida, foram realizadas seleção de revisões sistemáticas (RS), extração de dados e avaliação da qualidade metodológica com a ferramenta AMSTAR 2. Resultados: De 707 registros identificados nas bases de dados, 29 RS foram incluídas após processo de triagem e elegibilidade. As RS foram consideradas de confiança criticamente baixa (93,1%) e baixa (6,9%). Os desfechos analisados nos estudos se referem a eventos cardiovasculares (11 RS), peso corporal e outras medidas antropométricas (7 RS), neoplasias (7 RS), diabetes mellitus tipo 2 (5 RS), período gestacional (3 RS), doença renal (3 RS), mortalidade (2 RS), depressão ou alterações cognitivas (1 RS), doença hepática (1 RS), eventos gastrointestinais (1 RS), infertilidade masculina (1 RS). Uma RS também apresentou informações sobre eventos adversos. A maioria dos resultados indica que o consumo de edulcorantes e bebidas adoçadas artificialmente aumentou o risco de hipertensão arterial, diabetes, eventos cardiovasculares, como acidente vascular cerebral; mostrou-se associado a ganho de peso, aumento de outras medidas antropométricas e obesidade. O consumo de bebidas adoçadas artificialmente durante a gestação apresentou associação com parto prematuro, ganho de peso da gestante e do recém-nascido, além de possível risco para desenvolvimento de asma em crianças. A maioria dos resultados relacionados aos adoçantes artificiais e bebidas adoçadas artificialmente e bebidas dietéticas contendo adoçantes artificiais mostraram não haver uma associação com risco de cânceres. Observou-se associação com alguns tipos de câncer, porém se referem a poucos estudos de coorte ou caso-controle. Poucos estudos também apontam possível risco do consumo de bebidas adoçadas artificialmente para doença renal crônica e mortalidade por todas as causas, depressão e alterações hormonais e da microbiota intestinal com adoçantes artificiais. Não se constatou associação com infertilidade masculina e o consumo de ciclamato. Considerações finais: Em síntese, os resultados mais consistentes quanto ao risco do consumo de edulcorantes referem-se a eventos cardiovasculares, diabetes e parto prematuro, condições para as quais os estudos apontam inclusive uma relação dose-resposta. Além das lacunas do conhecimento, é importante considerar as falhas metodológicas da maioria das RS.

Question: What are the risks of consuming sweeteners to human health? Methods: After carrying out a research protocol, four databases from the electronic literature were searched in May 2022, to identify studies that addressed possible risks of the consumption of sweeteners to human health. Using rapid review shortcuts, selection of systematic reviews (SR), data extraction and methodological quality assessment were performed with the AMSTAR 2 tool. Results: Of 707 records identified in the databases, 29 RS were included after the screening and eligibility process. The SRs were considered critically low (93.1%) and low (6.9%) confidence. The outcomes analyzed in the studies refer to cardiovascular events (11 RS), body weight and other anthropometric measures (7 RS), neoplasms (7 RS), type 2 diabetes mellitus (5 RS), gestational period (3 RS), kidney disease (3 RS), mortality (2 RS), depression or cognitive impairment (1 RS), liver disease (1 RS), gastrointestinal events (1 RS), male infertility (1 RS). An SR also presented information on adverse events. Most of the results indicate that consumption of sweeteners and artificially sweetened beverages increased the risk of high blood pressure, diabetes, cardiovascular events such as stroke; was associated with weight gain, increase in other anthropometric measurements and obesity. The consumption of artificially sweetened beverages during pregnancy was associated with preterm birth, weight gain of the pregnant woman and the newborn, in addition to a possible risk for the development of asthma in children. Most of the results related to artificial sweeteners and artificially sweetened beverages and diet drinks containing artificial sweeteners showed no association with cancer risk. There was an association with some types of cancer, but they refer to few cohort or case-control studies. Few studies also point to a possible risk of consumption of artificially sweetened beverages for chronic kidney disease and all-cause mortality, depression and hormonal and intestinal microbiota changes with artificial sweeteners. There was no association with male infertility and consumption of cyclamate. Final considerations: In summary, the most consistent results regarding the risk of sweetener consumption refer to cardiovascular events, diabetes and premature birth, conditions for which studies even point to a dose-response relationship. In addition to knowledge gaps, it is important to consider the methodological flaws of most SRs.

Uso de tecnologias na promoção de atividade física em usuários de serviços de saúde com morbidades diversas / Use of technologies to promote physical activity in health service users with different morbidities

Contexto: A atividade física é um comportamento que traz benefícios para o desenvolvimento humano em todas as fases da vida e pode ser praticada de diversas maneiras e em diferentes momentos, como ao se deslocar de um lugar para outro, durante o trabalho ou estudo, ao realizar tarefas domésticas ou durante o tempo livre. Atualmente, uma das formas de abordagem da atividade física utilizada pelos serviços de saúde inclui as tecnologias que viabilizam o cuidado à distância, fornecendo intervenção e educação em saúde. Pergunta: A abordagem da atividade física por meio de tecnologias em saúde é efetiva para os usuários dos serviços de saúde? Método: Realizou-se uma revisão rápida com base em protocolo de pesquisa previamente definido. Três bases da literatura eletrônica foram buscadas em junho de 2022, para identificar revisões sistemáticas (RS) que apresentassem abordagens de atividade física por meio de tecnologias em saúde. A qualidade metodológica das RS foi avaliada com a ferramenta AMSTAR 2. Resultados: De 563 registros recuperados nas bases, 13 RS foram incluídas. Três RS foram classificadas como de confiança baixa e dez de confiança criticamente baixa. As intervenções para promoção da atividade física, apresentadas nessas revisões, utilizaram seis tipos de tecnologias: aplicativos; ligação telefônica, mensagem de texto e/ou e-mail; internet (site, plataforma, e-mails, redes sociais); tecnologias vestíveis; telessaúde ou teleconsulta; tecnologias combinadas. Duas RS também apresentaram resultados de eventos adversos. A maioria dos resultados apresentados se refere a estudos primários únicos (ensaio clínico randomizado, ensaio quase experimental, estudo piloto), mostrando efeito positivo sobre a prática de atividade física para pacientes com diversas condições de saúde - cânceres, esclerose múltipla, insuficiência cardíaca, artrite reumatoide, doença pulmonar obstrutiva crônica, diabetes tipo 2. Considerações finais: Constata-se uma escassez de estudos sobre efeitos do uso de tecnologias na promoção da atividade física. Além da heterogeneidade das intervenções e das populações estudadas, é preciso considerar as falhas metodológicas das RS incluídas, bem como o fato de a maioria dos estudos ter sido conduzida em países de alta renda.

Context: Physical activity is a behavior that brings benefits to human development at all stages of life and can be practiced in different ways and at different times, such as when moving from one place to another, during work or study, when do household chores or during free time. Currently, one of the ways of approaching physical activity used by health services includes technologies that enable remote care, providing intervention and health education. Question: Is the approach to physical activity through health technologies effective for users of health services? Method: A rapid review was performed based on a previously defined research protocol. Three electronic literature bases were searched in June 2022 to identify systematic reviews (SR) that presented physical activity approaches through health technologies. The methodological quality of the SRs was evaluated using the AMSTAR 2 tool. Results: Of 563 records retrieved from the databases, 13 RS were included. Three RS were classified as low confidence and ten as critically low confidence. Interventions to promote physical activity, presented in these reviews, used six types of technologies: applications; phone call, text message and/or email; internet (website, platform, emails, social networks); wearable technologies; telehealth or teleconsultation; combined technologies. Two SRs also had adverse event results. Most of the results presented refer to single primary studies (randomized clinical trial, quasi-experimental trial, pilot study) showing a positive effect on physical activity for patients with various health conditions - cancers, multiple sclerosis, heart failure, arthritis rheumatoid, chronic obstructive pulmonary disease, type 2 diabetes. Final considerations: There is a scarcity of studies on the effects of the use of technologies in the promotion of physical activity. In addition to the heterogeneity of the interventions and populations studied, it is necessary to consider the methodological flaws of the SRs included, as well as the fact that most studies were conducted in high-income countries.

Quadros de referência (frameworks) sobre colaboração intersetorial em promoção da saúde / Frameworks on intersectoral collaboration in health promotion

Contexto: De acordo com a Política Nacional de Promoção da Saúde, ações intersetoriais envolvendo o intercâmbio entre diferentes setores podem produzir soluções que melhorem a qualidade de vida. Em saúde, essa articulação pressupõe uma agenda que considera múltiplos aspectos envolvidos no processo saúde-doença e a participação de outros setores na avaliação de parâmetros sanitários importantes para a construção de políticas públicas. Pergunta: Quais são as principais estruturas ou quadros de referência (frameworks) sobre colaboração intersetorial em promoção da saúde? Método: Com base no protocolo de pesquisa, esta revisão rápida teve como objetivo identificar estruturas sobre colaboração intersetorial na promoção da saúde. A busca de evidências foi realizada em julho de 2022, por meio do Web App da plataforma Dimensions. A seleção dos estudos foi feita por dois revisores, de forma independente. Não foi realizada avaliação da qualidade metodológica dos estudos. Resultados: De 1.412 registros identificados na base de dados, doze foram incluídos nesta revisão rápida. Uma síntese narrativa apresenta as estruturas citadas nos estudos para a implementação ou análise de experiências de colaboração intersetorial na promoção da saúde. As estruturas foram agrupadas em três categorias. (1) Estrutura Saúde em Todas as Políticas (Health in all policies - HiAP): Quatro estudos sobre a estrutura HiAP abordaram os princípios que sustentam seus mecanismos, analisaram processos de implementação de colaboração intersetorial nos EUA, e os mecanismos sociais para a implementação sustentável. (2) Estruturas para promoção da saúde no contexto escolar: Quatro estudos analisaram a estrutura formatada para ação escolar, componentes e mecanismos para implementação de escolas promotoras de saúde, elementos e mecanismos na implementação de ações intersetoriais, e uma ferramenta para monitoramento de processos colaborativos. (3) Estruturas para implementação de processos de colaboração intersetorial: Quatro estudos discutiram as funções essenciais de saúde pública para as Américas, processos que facilitam a colaboração intersetorial, colaboração intersetorial para mudança social, e abordagens de planejamento para a prática de promoção da saúde. Considerações finais: Os estudos mostram que processos colaborativos intersetoriais para a promoção da saúde são complexos e exigem a utilização de diversas estratégias desde a fase de planejamento de um programa ou política. As estruturas ou quadros de referência, como ilustrado nesses estudos a partir de exemplos de implementação, podem auxiliar no planejamento e compreensão das ações necessárias para o aprimoramento da colaboração intersetorial.

Context: According to the National Health Promotion Policy, intersectoral actions involving exchanges between different sectors can produce solutions that improve quality of life. In health, this articulation presupposes an agenda that considers multiple aspects involved in the health-disease process and the participation of other sectors in the evaluation of important health parameters for the construction of public policies. Question: What are the main frameworks for intersectoral collaboration in health promotion? Method: Based on the research protocol, this rapid review aimed to identify frameworks on intersectoral collaboration in health promotion. The search for evidence was carried out in July 2022, through the Dimensions platform's Web App. The selection of studies was carried out by two reviewers, independently. Assessment of the methodological quality of the studies was not performed. Results: Of the 1,412 records identified in the database, twelve were included in this rapid review. A narrative synthesis presents the structures cited in the studies for the implementation or analysis of experiences of intersectoral collaboration in health promotion. Frameworks were grouped into three categories. (1) Health in All Policies (HiAP) Framework: Four studies on the HiAP framework addressed the principles that underpin its mechanisms, analyzed processes for implementing intersectoral collaboration in the US, and the social mechanisms for sustainable implementation . (2) Frameworks for health promotion in the school context: Four studies analyzed the formatted structure for school action, components and mechanisms for implementing health promoting schools, elements and mechanisms in the implementation of intersectoral actions, and a tool for monitoring collaborative processes . (3) Frameworks for Implementing Intersectoral Collaboration Processes: Four studies discussed essential public health functions for the Americas, processes that facilitate intersectoral collaboration, intersectoral collaboration for social change, and planning approaches to health promotion practice. Final considerations: Studies show that intersectoral collaborative processes for health promotion are complex and require the use of different strategies from the planning stage of a program or policy. Frameworks, as illustrated in these studies from implementation examples, can assist in planning and understanding the actions needed to improve intersectoral collaboration.

Estratégias para prevenção e manejo de desnutrição aguda em crianças menores de cinco anos / Strategies for the prevention and management of acute malnutrition in children under five years of age

O problema: A Organização Mundial da Saúde (OMS) ressalta que cerca de 45% das mortes de crianças menores de cinco anos estão relacionadas à desnutrição, e que elas ocorrem principalmente em países de baixa e média renda. No Brasil, estudo recente estimou uma prevalência de 2,9% de crianças brasileiras com baixo peso para a idade. A Política Nacional de Alimentação e Nutrição propõe a implementação de ações específicas para o combate ao binômio infecção-desnutrição que afeta principalmente crianças provenientes de classes econômicas com reduzido poder aquisitivo, em regiões com baixos índices de desenvolvimento econômico e social. Esta síntese rápida de evidências teve como objetivo identificar opções para políticas de enfrentamento da desnutrição aguda em crianças abaixo de cinco anos de idade. Opções para enfrentar o problema: De 1.261 registros recuperados das bases de dados, após processo de seleção e elegibilidade, vinte e quatro revisões sistemáticas (RS) foram incluídas nesta síntese narrativa. Os resultados foram organizados em doze opções para prevenir ou tratar o déficit de peso em crianças menores de cinco anos. Efeitos positivos foram relatados nas RS para uma variedade de estratégias, no entanto, algumas incertezas também foram apontadas. Com relação à qualidade metodológica, cinco RS foram classificadas como de confiança alta, sete de confiança baixa e doze de confiança criticamente baixa.

The problem: The World Health Organization (WHO) points out that around 45% of deaths among children under five are related to malnutrition, and that these occur mainly in low- and middle-income countries. In Brazil, a recent study estimated a prevalence of 2.9% of Brazilian children with low weight for age. The National Food and Nutrition Policy proposes the implementation of specific actions to combat the infection-malnutrition binomial that mainly affects children from economic classes with low purchasing power, in regions with low levels of economic and social development. This rapid synthesis of evidence aimed to identify options for policies to address acute malnutrition in children under five years of age. Options for tackling the problem: From 1,261 records retrieved from the databases, after the selection and eligibility process, twenty-four systematic reviews (SR) were included in this narrative synthesis. The results were organized into twelve options for preventing or treating underweight in children under five years of age. Positive effects were reported on the SR for a variety of strategies, however, some uncertainties were also pointed out. With regard to methodological quality, five SR were classified as having high confidence, seven as low confidence and twelve as critically low confidence.

Atividade física para usuários de serviços de saúde com doenças respiratórias / Physical activity for health service users with respiratory diseases

Contexto: A respiração é regulada por um complexo processo fisiológico que pode ser afetado em algumas patologias. No Brasil, a mortalidade por doenças respiratórias em relação ao total de mortes foi de 6%, no ano de 2016. Dados do período de 1995 a 2005 indicam que as doenças do aparelho respiratório estiveram entre as principais causas de internação do Sistema Único de Saúde (SUS) em todas as regiões brasileiras. A atividade física (AF) pode beneficiar a saúde de indivíduos com diagnóstico de problemas respiratórios, já que a prática regular permite a manutenção dos volumes e das capacidades respiratórias, diminuindo a restrição do movimento pela rigidez da caixa torácica e da coluna vertebral, além de manter a capacidade funcional e promover o bem-estar geral. Pergunta de pesquisa: A prática de atividade física é efetiva para a melhoria da capacidade respiratória e do desempenho das atividades de vida diária de usuários de serviços de saúde com diagnóstico de patologias respiratórias? Método: As buscas foram realizadas em quatro bases de literatura científica para identificar revisões sistemáticas (RS) sobre os efeitos da prática de AF na saúde de pessoas com doenças respiratórias. A qualidade metodológica das RS foi avaliada com a ferramenta AMSTAR 2. Resultados: De 1.045 registros recuperados nas bases, 21 revisões sistemáticas foram selecionadas para esta revisão rápida. Com relação à qualidade metodológica, três RS foram classificadas como de confiança alta, uma de confiança moderada, cinco de confiança baixa e doze de confiança criticamente baixa. Os dados extraídos das RS são apresentados conforme a condição da doença respiratória avaliada. Efeito de AF em pessoas com doença pulmonar obstrutiva crônica (DPOC): Onze RS analisaram AF em pessoas com DPOC ou obstrução crônica das vias aéreas. Oito indicaram que a maioria dos desfechos avaliados não apresentaram diferenças significativas ou foram incertos entre os grupos com AF combinando exercícios aeróbicos e anaeróbicos e o comparador. Três RS analisando apenas exercícios aeróbicos apontaram maioria de efeitos positivos dessa modalidade de AF em alguns desfechos de saúde dessas pessoas. Efeito de AF em pessoas com hipertensão pulmonar: Três RS utilizando exercícios combinados indicaram efeitos benéficos. Uma RS apresentou resultados incertos em relação à qualidade de vida. Efeito de AF em pessoas com fibrose pulmonar: Duas RS combinaram exercícios aeróbicos e anaeróbicos indicaram efeito positivo ou incerto para qualidade de vida. Houve efeitos positivos nos desfechos de distância de caminhada (DTC6), capacidade de exercício e dispneia, e efeitos incertos no pico de volume de oxigênio (pico de VO2) e no volume expiratório forçado no primeiro segundo e nenhuma diferença na participação em AF. Efeito de AF em pessoas com bronquiectasia: Uma RS apontou efeitos positivos de exercícios combinados para DTC6, qualidade de vida, distância incremental da caminhada, exacerbação de bronquiectasia, dispneia e fadiga. Indicou que não houve diferença de efeito entre os grupos para tosse. Efeito de AF em pessoas com câncer de pulmão de células não pequenas: Três RS apontaram que os efeitos foram em sua maioria positivos para pico de VO2 e DTC6. Houve efeitos inconclusivos para a melhora na qualidade de vida. Efeito de AF em pessoas com sarcoidose pulmonar: Uma RS indicou efeitos positivos para fadiga, força muscular e DTC6 de programas de tratamentos de reabilitação para pessoas com sarcoidose pulmonar. Segurança de AF para pessoas com doenças respiratórias: Cinco RS apresentaram resultados de eventos adversos. De modo geral, elas indicaram que as intervenções de AF foram seguras para pessoas com patologias respiratórias. Considerações finais: A atividade física mostrou relação com a melhoria da capacidade respiratória e física de pessoas com doenças respiratórias. Deve-se considerar, no entanto, as limitações metodológicas da maioria das RS incluídas, a heterogeneidade de intervenções e comparadores, além da escassez de estudos para algumas das condições de saúde.

Context: Breathing is regulated by a complex physiological process that can be affected in some pathologies. In Brazil, mortality from respiratory diseases in relation to total deaths was 6% in 2016. Data from 1995 to 2005 indicate that respiratory diseases were among the main causes of hospitalization in the Unified Health System (SUS) in all Brazilian regions. Physical activity (PA) can benefit the health of individuals diagnosed with respiratory problems, since regular practice allows for the maintenance of respiratory volumes and capacities, reducing movement restriction due to the rigidity of the rib cage and spine, in addition to maintain functional capacity and promote general well-being. Research question: Is the practice of physical activity effective for improving respiratory capacity and the performance of activities of daily living of users of health services diagnosed with respiratory pathologies? Method: Searches were carried out in four scientific literature databases to identify systematic reviews (SR) on the effects of PA practice on the health of people with respiratory diseases. The methodological quality of the SRs was evaluated using the AMSTAR 2 tool. Results: Of 1045 records retrieved from the databases, 21 systematic reviews were selected for this rapid review. Regarding methodological quality, three RS were classified as high confidence, one as moderate confidence, five as low confidence and twelve as critically low confidence. The data extracted from the RS are presented according to the condition of the respiratory disease evaluated. Effect of PA in people with chronic obstructive pulmonary disease (COPD): Eleven RS analyzed PA in people with COPD or chronic airway obstruction. Eight indicated that most of the outcomes evaluated did not show significant differences or were uncertain between the groups with PA combining aerobic and anaerobic exercises and the comparator. Three SRs analyzing only aerobic exercises showed the majority of positive effects of this PA modality on some health outcomes of these people. Effect of PA in people with pulmonary hypertension: Three RS using combined exercises indicated beneficial effects. One SR presented uncertain results in relation to quality of life. Effect of PA in people with pulmonary fibrosis: Two RS combined aerobic and anaerobic exercise indicated a positive or uncertain effect for quality of life. There were positive effects on outcomes of walking distance (6MWD), exercise capacity and dyspnea, and uncertain effects on peak oxygen volume (peak VO2) and forced expiratory volume in one second and no difference in PA participation. Effect of PA in people with bronchiectasis: An RS showed positive effects of combined exercise for 6MWD, quality of life, incremental walking distance, exacerbation of bronchiectasis, dyspnea and fatigue. It indicated that there was no difference in effect between the cough groups. Effect of AF in people with non-small cell lung cancer: Three RS showed that the effects were mostly positive for peak VO2 and 6MWD. There were inconclusive effects for improvement in quality of life. Effect of AF in people with pulmonary sarcoidosis: An RS indicated positive effects for fatigue, muscle strength and 6MWD of rehabilitation treatment programs for people with pulmonary sarcoidosis. Safety of PA for people with respiratory diseases: Five RS showed adverse event results. Overall, they indicated that PA interventions were safe for people with respiratory conditions. Final considerations: Physical activity showed a relationship with the improvement of respiratory and physical capacity of people with respiratory diseases. However, one should consider the methodological limitations of most of the SRs included, the heterogeneity of interventions and comparators, in addition to the scarcity of studies for some of the health conditions.

Critérios globais para caracterizar cidades saudáveis / Global criteria to characterize healthy cities

Contexto: Na década de 1970, o Relatório Lalonde apresentou-se como uma nova perspectiva de saúde e um ponto de partida para o conceito de Cidades Saudáveis. Ele expôs um conceito ampliado de saúde ao afirmar que as melhorias das condições de saúde da população podem ser resultado de mudanças no ambiente físico-social e no estilo de vida. Pergunta: Quais são os critérios adotados em diferentes partes do mundo para caracterizar cidades/municípios saudáveis? Método: As buscas foram realizadas em PubMed, Biblioteca Virtual em Saúde e Social Systems Evidence, em 8 e 10 de março de 2022, com o propósito de identificar estudos primários e secundários que abordassem critérios para caracterização de Cidades Saudáveis. Utilizando atalhos de revisão rápida para simplificar o processo, apenas o processo de seleção por títulos e resumos foi realizado em duplicidade e de forma independente. Foram incluídos estudos publicados em inglês, espanhol e português, e não houve limitação para inclusão quanto ao delineamento ou data de publicação. Os estudos incluídos foram avaliados quanto à qualidade metodológica com instrumentos específicos para cada delineamento. Resultados: As publicações recuperadas nas fontes de dados foram 2.723, das quais 24 foram incluídas após o processo de seleção. Os domínios das Cidades Saudáveis propostos pela OMS foram utilizados para agregar os estudos incluídos, conforme apresentado a seguir. Domínio 1: Melhorar a governança da cidade para a saúde e bem-estar. Seis artigos foram indicados neste domínio, que trata sobre parcerias locais para promover a saúde; responsabilização e prestação de contas; utilização de um perfil de saúde na cidade em conjunto com um plano de desenvolvimento de saúde; promoção da saúde nas políticas públicas; e diplomacia na cidade. Domínio 2: Reduzir/minimizar as desigualdades em saúde. Cinco artigos foram incluídos neste domínio, que aborda o significado e as formas de medir os problemas de desigualdade social e impacto sobre a sociedade; e desenvolver um plano de ação para resolver os conflitos. Domínio 3: Promover a abordagem de saúde em todas as políticas. Sete artigos são apresentados neste domínio, que se refere a mecanismos de formulação de políticas locais com coerência para benefício da saúde e para aumentar a capacidade de avaliação dos impactos na saúde. Domínio 4: Promover o desenvolvimento e o empoderamento da comunidade e criar ambientes sociais que apoiem a saúde. Cinco artigos foram associados a este domínio, que abarca temas de promoção do letramento e resiliência da comunidade; promoção da inclusão social e projetos comunitários; garantia de acesso à assistência social; incentivo à prática de atividade física em todas as idades; criação de ambientes físicos e sociais livres de fumo; incentivo à alimentação saudável e limitação do acesso a alimentos ricos em açúcares; e abordagem de problemas de saúde mental e bem-estar social. Domínio 5: Criar ambientes físicos e construídos que apoiem a saúde e as escolhas saudáveis. Onze estudos foram arrolados neste domínio, que aborda temas como criar bairros seguros e limpos; promover e investir em deslocamento saudável (a pé ou de bicicleta); enfrentar os problemas de saneamento básico, poluição sonora e do ar, mudanças climáticas, diminuição da emissão de carbono, higiene e habitação; incentivar a receptividade de crianças e idosos; garantir acesso a áreas verdes para convívio social e investir em planejamento urbano saudável. Domínio 6: Melhorar a qualidade e o acesso aos serviços locais de saúde e sociais. Um estudo foi associado a este domínio, que é caracterizado por assegurar a cobertura universal na saúde e remover barreiras; melhorar a qualidade de serviços para a comunidade e a articulação entre os serviços de atenção primária à saúde e outros serviços públicos de saúde. Domínio 7: Considerar todas as pessoas no planejamento da cidade e priorizar os mais vulneráveis. Quatro artigos foram relacionados neste domínio, que se refere à prática saudável para crianças no início da vida, garantir acesso à educação para todos, garantir o envelhecimento saudável e identificar nas cidades as necessidades das pessoas mais vulneráveis. Domínio 8: Fortalecer os serviços locais de saúde pública e a capacidade de lidar com emergências relacionadas à saúde. Um artigo foi citado neste domínio, que trata de temáticas de investimento em programas de promoção da saúde e prevenção de doenças com base na população e comunidade; cuidar do problema de obesidade em jovens e adultos; e lidar com emergências relacionadas às mudanças climáticas e fenômenos como epidemias e desastres naturais. Domínio 9: Manter um plano de preparação, prontidão e resposta urbana em emergências de saúde pública. Nenhum estudo foi associado a este domínio, que é caracterizado pelo desenvolvimento de práticas de vigilância inclusivas; promoção de informações e práticas com base em evidências; entendimento e ação sobre as vulnerabilidades; trabalho em fortalecimento e respostas comunitárias; e planejamento de medidas de emergências. Outras propostas: Dois estudos abordam proposições que não foram associadas diretamente aos domínios recomendados pela OMS, mas que podem contribuir para aprimorar os critérios de Cidades Saudáveis. Um deles discute o conceito de cidades inteligentes, que utilizam tecnologias de informação e comunicação para melhorar a produtividade e organizar uma governança mais aberta. O outro estudo tem como foco o ecofeminismo, trabalho reprodutivo e de cuidado, planejamento urbano feminista e o incentivo para integração da saúde humana e ambiental. Considerações finais: Os estudos incluídos apresentam informações relevantes sobre a caracterização de Cidades Saudáveis, principalmente os diferentes conceitos abordados acerca do que considerar na avaliação e implementação de cidades e comunidades saudáveis. Os resultados mostram que ainda são escassos os relatos sobre experiências de implementação da proposta de Cidades Saudáveis. As ações de promoção da saúde, como a criação de ambientes físicos e construídos que apoiem a saúde e as escolhas saudáveis, o planejamento urbano voltado à abordagem de uma grande diversidade de problemas e soluções, a promoção da abordagem de saúde em políticas de outros setores e a melhora da governança na cidade para saúde e bem-estar, fazem parte do rol de critérios de Cidades Saudáveis, e têm sido postas em prática em muitos municípios, inclusive no Brasil. No entanto, as estratégias de busca desta revisão rápida não conseguiram recuperar tais experiências nacionais. O fato de não terem sido recuperadas nas buscas pode ser um indicativo de que o termo "cidade saudável" não tem sido considerado por muitos pesquisadores em suas publicações.

Context: In the 1970s, the Lalonde Report presented itself as a new perspective on health and a starting point for the concept of Healthy Cities. He exposed an expanded concept of health by stating that improvements in the population's health conditions can be the result of changes in the physical-social environment and in lifestyle. Question: What are the criteria adopted in different parts of the world to characterize healthy cities/municipalities? Method: The searches were carried out in PubMed, Virtual Health Library and Social Systems Evidence, on March 8 and 10, 2022, with the purpose of identifying primary and secondary studies that addressed criteria for the characterization of Healthy Cities. Using rapid review shortcuts to simplify the process, only the title and abstract selection process was performed in duplicate and independently. Studies published in English, Spanish and Portuguese were included, and there was no limitation for inclusion in terms of design or publication date. The included studies were evaluated for methodological quality with specific instruments for each design. Results: The publications retrieved from the data sources were 2,723, of which 24 were included after the selection process. The Healthy Cities domains proposed by WHO were used to aggregate the included studies, as shown below. Domain 1: Improve city governance for health and well-being. Six articles were indicated in this domain, which deals with local partnerships to promote health; accountability and accountability; use of a health profile in the city in conjunction with a health development plan; health promotion in public policies; and diplomacy in the city. Domain 2: Reduce/minimize health inequalities. Five articles were included in this domain, which addresses the meaning and ways of measuring problems of social inequality and impact on society; and develop an action plan to resolve conflicts. Domain 3: Promoting the health approach in all policies. Seven articles are presented in this domain, which refers to mechanisms for formulating local policies with coherence for the benefit of health and to increase the capacity to assess health impacts. Domain 4: Promote community development and empowerment and create social environments that support health. Five articles were associated with this domain, which covers topics of literacy promotion and community resilience; promoting social inclusion and community projects; guarantee of access to social assistance; encouraging the practice of physical activity at all ages; creating smoke-free physical and social environments; encouraging healthy eating and limiting access to foods rich in sugars; and addressing mental health and social well-being issues. Domain 5: Create physical and built environments that support health and healthy choices. Eleven studies were enrolled in this domain, which addresses topics such as creating safe and clean neighborhoods; promote and invest in healthy commuting (on foot or by bicycle); face the problems of basic sanitation, noise and air pollution, climate change, reduction of carbon emissions, hygiene and housing; encourage the receptivity of children and the elderly; ensure access to green areas for social interaction and invest in healthy urban planning. Domain 6: Improve the quality of and access to local health and social services. One study was associated with this domain, which is characterized by ensuring universal health coverage and removing barriers; improve the quality of services for the community and the articulation between primary health care services and other public health services. Domain 7: Consider all people in city planning and prioritize the most vulnerable. Four articles were listed in this domain, which refers to healthy practice for children early in life, ensuring access to education for all, ensuring healthy aging and identifying the needs of the most vulnerable people in cities. Domain 8: Strengthen local public health services and capacity to deal with health-related emergencies. An article was cited in this domain, which deals with investment themes in population and community-based health promotion and disease prevention programs; to take care of the problem of obesity in young people and adults; and dealing with emergencies related to climate change and phenomena such as epidemics and natural disasters. Domain 9: Maintain an urban preparedness, preparedness, and response plan for public health emergencies. No studies were associated with this domain, which is characterized by the development of inclusive surveillance practices; promotion of evidence-based information and practices; understanding and acting on vulnerabilities; work in community strengthening and responses; and planning of emergency measures. Other proposals: Two studies address propositions that were not directly associated with the domains recommended by the WHO, but that may contribute to improving the Healthy Cities criteria. One of them discusses the concept of smart cities, which use information and communication technologies to improve productivity and organize more open governance. The other study focuses on ecofeminism, reproductive and care work, feminist urban planning, and encouraging the integration of human and environmental health. Final considerations: The studies included present relevant information about the characterization of Healthy Cities, mainly the different concepts approached about what to consider in the evaluation and implementation of healthy cities and communities. The results show that there are still few reports on experiences of implementing the Healthy Cities proposal. Health promotion actions, such as creating physical and built environments that support health and healthy choices, urban planning aimed at addressing a wide range of problems and solutions, promoting a health approach in policies in other sectors and the improvement of governance in the city for health and well-being, are part of the list of Healthy Cities criteria, and have been put into practice in many municipalities, including Brazil. However, the search strategies of this rapid review failed to retrieve such national experiences. The fact that they were not retrieved in searches may be an indication that the term "healthy city" has not been considered by many researchers in their publications.

Scrutiny of COVID-19 response strategies among severely affected European nations

Although the health care systems in Europe are considered the global benchmark, European nations were severely affected by the coronavirus disease 2019 (COVID-19) pandemic. This manuscript aimed to examine the strategies implemented to combat the COVID-19 pandemic by France, the United Kingdom, Spain, Italy, Germany, and Russia and their outcomes in terms of the number of cases, testing, and deaths. This is the first review of its kind that extensively analyzes the preparedness, mitigation, and response strategies against the COVID-19 pandemic adopted by these nations. This paper further suggests a strategic preparedness model for future pandemics. From the analysis, we found that a decentralized approach, prompt decision-making and timely execution, coordination between local health authorities, and public participation in the implementation of strategies could substantially reduce the case fatality rate. Nations with a high percentage of gross domestic product invested in the health sector, as well as more nurses, physicians, hospital beds, intensive care unit beds, and ventilators, better managed the pandemic. Instead, nations that postponed their pandemic response by delaying tracking, tracing, testing, quarantine, and lockdown were badly affected. The lessons learned from the present pandemic could be used as a guide to prepare for further pandemics.

Scrutiny of COVID-19 response strategies among severely affected European nations

Although the health care systems in Europe are considered the global benchmark, European nations were severely affected by the coronavirus disease 2019 (COVID-19) pandemic. This manuscript aimed to examine the strategies implemented to combat the COVID-19 pandemic by France, the United Kingdom, Spain, Italy, Germany, and Russia and their outcomes in terms of the number of cases, testing, and deaths. This is the first review of its kind that extensively analyzes the preparedness, mitigation, and response strategies against the COVID-19 pandemic adopted by these nations. This paper further suggests a strategic preparedness model for future pandemics. From the analysis, we found that a decentralized approach, prompt decision-making and timely execution, coordination between local health authorities, and public participation in the implementation of strategies could substantially reduce the case fatality rate. Nations with a high percentage of gross domestic product invested in the health sector, as well as more nurses, physicians, hospital beds, intensive care unit beds, and ventilators, better managed the pandemic. Instead, nations that postponed their pandemic response by delaying tracking, tracing, testing, quarantine, and lockdown were badly affected. The lessons learned from the present pandemic could be used as a guide to prepare for further pandemics.

Improving Diagnosis of Hepatitis C Virus Infection Using Hepatitis C Core Antigen Testing in a Resource-Poor Setting

Abstract INTRODUCTION: We compared the hepatitis C virus (HCV) core antigen test with the HCV RNA assay to confirm anti-HCV results to determine whether the HCV core antigen test could be used as an alternative confirmatory test to the HCV RNA test. METHODS: Sera from 156 patients were analyzed for anti-HCV and HCV core antigen using a chemiluminescent microparticle immunoassay (Architect i2000SR) and for HCV RNA using the artus HCV RG RT-PCR Kit (QIAGEN) in a Rotor-Gene Q instrument. RESULTS: The diagnostic sensitivity, specificity, and positive and negative predictive values of the HCV core antigen assay compared to the HCV RNA test were 77.35%, 100%, 100%, and 89.38%, respectively. HCV core antigen levels showed a good correlation with those from HCV RNA quantification (r =0.872). However, 13 samples with a viral load of less than 4000 IU/mL were negative in the HCV core antigen assay. All gray-zone reactive samples were also RNA positive and were positive on repeat testing. CONCLUSIONS: The Architect HCV core antigen assay is highly specific and has an excellent positive predictive value. At the present level of sensitivity (77%), the study is still relevant in a low-income setting in which most of the HCV-positive patients would go undiagnosed, since HCV RNA testing is not available and/or not affordable. HCV core antigen testing can also help determine the true burden of infection in a population, considering the fact that almost 50% of the anti-HCV positive cases are negative for HCV RNA.

Bioassay guided fractionation of Cyclea peltata using in vitro RAW 264.7 cell culture, antioxidant assays and isolation of bioactive compound tetrandrine

Background: Cyclea peltata is one of the herbs mentioned in ancient scriptures of Ayurveda and is used indifferent types of Ayurvedic gritham preparations. Moreover, in traditional/tribal medicine C. peltata isused as digestive, anti-inflammatory, diuretic and to treat jaundice, digestive disorders, etc.Objective: Activity guided fractionation of C. peltata and in correlation with the levels of bioactivecompound tetrandrine.Materials and methods: Preliminary phytochemical screening, estimation of total alkaloid content,preparation of different extracts of C. peltata (crude extract CP, hexane extract HCP, chloroform extractCCP, methanol extract MCP, alkaloid fraction ACP). In vitro anti-inflammatory studies using RAW264.7 cells and in vitro antioxidant assays of the different extracts of C. peltata. HPTLC estimation oftetrandrine (TET) was carried out using solvent system toluene: ethyl acetate: diethylamine (7.2: 2: 0.8)and isolation of TET from ACP.Results: Preliminary phytochemical studies of C. peltata showed the presence of alkaloid content in allextracts. Whereas, saponins, steroids and terpenoids were detected in CP and CCP. ACP and TET showedsignificant in vitro anti-inflammatory and antioxidant activity when compared to other extracts. ACP andTET (100 mg/ml) treatment significantly inhibited the mRNA expression of iNOS, COX-2, TNF-a in LPStreated RAW 264.7 cells. HPTLC estimation of bioactive compound tetrandrine was highest in ACP228.4 mg/mg followed by CP-29.62 mg/mg, CCP-23.46 mg/mg, MCP-18.82 mg/mg and HCP-1.25 mg/mg. TEThas been isolated from ACP.Conclusion: The results of the present in vitro assays revealed that the alkaloid fraction (ACP) is the mostactive fraction when compared to other extracts and has a positive correlation with the levels of bioactivecompound tetrandrine.

COVID-19: Weighing the Endeavors of Nations, with Time to Event Analysis

The cataclysmic COVID-19 pandemic erupted silently causing colossal impact worldwide, the repercussions of which indicated a lackadaisical vigilance in preparation for such a pandemic. This review assessed the measures taken by nations to contain this pandemic. A literature review was conducted using Medline, Google Scholar, Science Direct, Scopus, and WHO website. There were 8 nations (selected from the GHS index list) appraised for containment strategies. This was achieved by using mortality rate (per million) as the primary endpoint. The nations which were proactive, initiated scientific strategies earlier with rigor, appeared to have succeeded in containing the pandemic, although it is still too early to arbitrate a verdict. The so called “pandemic war” mandates international, interdisciplinary, and interdepartmental collaboration. Furthermore, building trust and confidence between the government and the public, having transparent communication, information sharing, use of advanced research-technology, and plentiful resources are required in the fight against COVID-19.

The Pandemic League of COVID-19: Korea Versus the United States, With Lessons for the Entire World / 예방의학회지

Coronavirus disease 2019 (COVID-19) is inflicting a brutal blow on humankind, and no corner of the world has been exempted from its wrath. This study analyzes the chief control measures and the distinctive features of the responses implemented by Korea and the United States to contain COVID-19 with the goal of extracting lessons that can be applied globally. Even though both nations reported their index cases on the same day, Korea succeeded in flattening the curve, with 10 752 cases as of April 28, 2020, whereas the outbreak skyrocketed in the United States, which had more than 1 million cases at the same time. The prudent and timely execution of control strategies enabled Korea to tame the spread of the virus, whereas the United States paid a major price for its delay, although it is too early to render a conclusive verdict. Information pertaining to the number of people infected with the virus and measures instituted by the government to control the spread of COVID-19 was retrieved from the United States Centers for Disease Control and Prevention and the Korea Centers for Disease Control and Prevention websites and press releases. Drawing lessons from both nations, it is evident that the resolution to the COVID-19 pandemic lies in the prudent usage of available resources, proactive strategic planning, public participation, transparency in information sharing, abiding by the regulations that are put into place, and how well the plan of action is implemented.

Validation Study of Korean Translated Systemic Clinical Outcome Routine Evaluation-15 as Self-Report Family Assessment Measure: Focusing on Adolescent in Daegu and North Gyeongsang Province / 가정의학회지

Background@#Systemic Clinic Outcome and Routine Evaluation (SCORE-15) is a compact scale that contains the most critical family function assessment tools including assessments of the strengths, adaptability, and communication among family members. It has been translated into other languages in the United States and Europe. This study aimed to verify the reliability and validity of SCORE-15 with a small research population and justify its applicability in Korea. @*Methods@#SCORE-15 is a self-reporting family function measurement tool for each family member over the age of 11 years. This study used the Family Communication Scale (FCS) included in the Family Adaptability and Cohesion Evaluation Scales (FACES) IV package and FACES in FACES-III to verify the validity of the Korean-translated SCORE-15. Cronbach’s α value was calculated to check the reliability of SCORE-15. Data were analyzed using STATA ver. 15.0 (Stata Corp., College Station, TX, USA). @*Results@#The study analyzed the correlation between FACES-III and SCORE-15 and FCS and SCORE-15 so that there was a significant static correlation in both comparisons (r=0.72 and r=0.81, respectively). Also, the research compared each subscale to analyze the correlation and the range was 0.47 to 0.95. The total SCORE-15 Cronbach’s α value was 0.92 and those values of the subscales for family strengths, family communication, and family difficulty were 0.89, 0.73, and 0.87, respectively (P<0.001). @*Conclusion@#Our study was the first to validate the Korean SCORE-15, which can be used as an appropriate shortform indicator for evaluating family function and changes in detecting therapeutic improvements in Korea.

Molecular Detection of Toxoplasma Gondii in Haemaphysalis Ticks in Korea

Toxoplasma gondii are intracellular protozoa that can cause neurological disease or death in fetuses and even in immunocompromised human adults. Ticks are recognized as vectors of many microorganisms including viruses, bacteria, and protozoa. Recent studies detected T. gondii in various tick species in many countries. In this study, we performed PCR detection of the T. gondii B1 gene from Haemaphysalis ticks collected from vegetation in 4 localities, Wonju, Gunsan, Miryang, and Yangsan, in Korea. We analyzed DNA from 314 ticks (268 Haemaphysalis longicornis and 46 Haemaphysalis flava) and the B1 gene of T. gondii was detected in 13 of these. The detection of T. gondii in ticks differed significantly by region (P=0.021). T. gondii was detected in the following percentages of collected ticks: 3.7% (7 of 189) in Gunsan, 10% (5 of 50) in Wonju, 16.7% (1 of 6) in Yangsan, and 0% (0 of 69) in Miryang. The detection of T. gondii in ticks was not associated with tick species or development stage. This is the first report of T. gondii detection in ticks in Korea. Our results provide important information necessary to understand toxoplasmosis transmission.

Imaging Features of Various Benign and Malignant Tumors and Tumorlike Conditions of the Pleura: A Pictorial Review

Pleural masses may be caused by various conditions, including benign and malignant neoplasms and non-neoplastic tumorlike conditions. Primary pleural neoplasms include solitary fibrous tumor, malignant mesothelioma, and primary pleural non-Hodgkin's lymphoma. Metastatic disease is the most common neoplasm of the pleura and may uncommonly occur in patients with hematologic malignancy, including lymphoma, leukemia, and multiple myeloma. Pleural effusion is usually associated with pleural malignancy. Rarely, pleural malignancy may arise from chronic empyema, and the most common cell type is non-Hodgkin's lymphoma (pyothorax-associated lymphoma). Non-neoplastic pleural masses may be observed in several benign conditions, including tuberculosis, pleural plaques caused by asbestos exposure, and pleural loose body. Herein, we present a review of benign and malignant pleural neoplasms and tumorlike conditions with illustrations of their computed tomographic images.

Study on structure and functions of organs involved in the formation of khuumii sound / Монголын Анагаах Ухаан

Introduction@#Khuumii (throat singing) is a unique form of art derived from the nomadic population of Central Asia, producing two or more “simultaneous” sounds and melodies through the organ of speech. @*Material and Methods@#The aim of the study is to identify the anatomical structures involved in the formation of khuumii and the features and patterns of their functions and compare each type of khuumii as performed by Mongolian people. A total of 60 participants aged 18-60 years (54 men and 6 women) were selected by non-random sampling method using cross-sectional study. Statistical analysis was performed using SPSS 23 software using questionnaires, X-ray, endoscopy, sound research method, and general blood tests. @*Results@#90.7% of the khuumii singers were male and 9.3% were female. The average height of the participants was 172.91±0.93 cm (arithmetic mean and mean error), average body weight was 77.53±2.46 kg, and body mass index was 25.93±5.31 respectively. Heart rate was 92.19±20.71 per minute prior to khuumii while 133.19±19.09 after performing khuumii and 85.81-98.56 at 95% confidence interval. In terms of ethnicity (ethnographically), the Khalkh were the largest ethnic group (72.1%), followed by Bayad, Buryatia, Darkhad, Torguud, and Oirat (2.3%), respectively. 60.5% of the participants were professional khuumii singers who graduated from relevant universities and colleges. The process of Khuumii was recorded by X-ray examination, and laryngeal endoscopy evaluated the movement of true and false vocal chords, interstitial volume, movements of epiglottis and arytenoid cartilage, and mucosa. Khuumii increases the workload of the cardiovascular system by 70-80%. Furthermore, the sound frequency is 2-4 times higher than that of normal speech, and sound volume is 0.5-1 times higher. 95.3% of throat singers did not have a sore throat, 88.4% did not experience heavy breathing, and 74.1% had no hoarseness. During the formation of khuumii sound, thoracic cavity, diaphragm, and lungs regulate the intensity of the air reaching the vocal folds, exert pressure on the airways and vibrate the sound waves through air flows passing through the larynx and vocal folds. Mouth-nose cavity as well as pharynx are responsible for echoing the sound.@*Conclusion@#It is appropriate to divide khuumii into two main types according to structural and functional changes in the organs involved; shakhaa and kharkhiraa. Khuumii, the “Human music” originating from the people of Altai Khangai basin by imitating the sounds of nature with their own voice in ancient times, spread all over the world from Mongolia and it is proposed to classify khuumii into two main types of shakhaa and kharkhiraa in terms of structural involvement and functionality.

Analysis of Women's Health Online News Articles Using Topic Modeling

OBJECTIVES: This research aimed to understand the popularity of topics in the field of women's health through analysis of online news articles which were chronologically classified and examined to determine how women's health and diseases had changed over time. METHODS: Women's health and disease news articles were collated from a popular news website between 1993 to 2015 and preprocessed using gynecological medical terminology, Korean words and nouns (excluding general nouns not related to women's healthcare topics). The resultant articles (N = 7,710) were analyzed using the Latent Dirichlet Allocation algorithm and major topics were extracted. Topic trends were analyzed by year and period for women's health. RESULTS: It was observed that most of the women's health articles were focused on “Healthcare”, and 9 other topics were identified that represented a relatively small proportion in 1993–2000. In 2001–2005, most of the articles were focused on “Medical Services” and “Dietary Supplements” with some specific topics that peaked people's interest, as compared to those focused on “Healthcare” in the 1990s. It was also observed that differences in the proportion of each topic was small after 2011. CONCLUSION: Changes in topics related to women's disease were not clearly distinguished in the 1990s but this changed from 2001where articles related to “women disease” appeared as articles on the topics of various diseases.

Pneumatosis Intestinalis Associated with Pulmonary Disorders

PURPOSE@#To determine the clinical features, imaging findings and possible causes of pneumatosis intestinalis (PI) in thoracic disorder patients.@*MATERIALS AND METHODS@#From 2005 to 2017, Among 62 PI patients, four of PI related with thoracic disease (6%) were identified. Medical records were reviewed to determine the clinical presentation, laboratory findings and treatment at the time of presentation of PI. Two experienced chest radiologists reviewed all imaging studies and recorded specific findings for each patient.@*RESULTS@#The causative thoracic diseases for each four patient were severe asthma, emphysema and airway obstruction. The imaging appearance of PI, including the involved bowel segment and pattern of the air, were divided into two mesenteric vascular territories; three of our cases showed linear pattern of PI located in the ascending & proximal transverse colon and the fourth case (lung cancer) had bubbly and cystic PI in the distal transverse and descending colon. All of the remaining 3 patients, except one patient who had not been followed up, improved within 1 month by conservative treatment.@*CONCLUSION@#Thoracic disorder with obstructive lung disease may result in the development of benign PI. Such PI in thoracic disease patients has a similar linear and cystic appearance with ischemic bowel disease, but can nevertheless be managed by conservative treatment.