Factors Related to Recurrent Falls Among Older Adults Attending Primary Health Care: A Biopsychosocial Perspective.

The objective of this study was to investigate factors related to recurrent falls among older adults attending primary health care, considering the biopsychosocial perspective. A representative sample of 201 older adults were interviewed in three Primary Health Care units randomly selected in a city in southeastern Brazil. Outcome included self-report of two or more falls in the past 12 months. Exposures included personal and environmental aspects, according to domains of International Classification of Functioning of the World Health Organization (ICF-WHO). Recurrent falls were reported by 24.4% of the participants. Associations with depressive symptoms (p = .003), having osteoporosis (p = .031), chronic musculoskeletal pain (p = .020), frailty (p = .013), sleep satisfaction (p < .001), and functional status (p < .001) were found. In logistic regression models, cognitive status, musculoskeletal pain, and functional status were predictors of recurrent falls; however, only sleep satisfaction remained significant in the final model. Strategies aimed at preventing recurrent falls in primary health care should consider assessments and interventions targeting sleep aspects among older adults.

Energy Consumption Forecasting for Smart Meters Using Extreme Learning Machine Ensemble.

The employment of smart meters for energy consumption monitoring is essential for planning and management of power generation systems. In this context, forecasting energy consumption is a valuable asset for decision making, since it can improve the predictability of forthcoming demand to energy providers. In this work, we propose a data-driven ensemble that combines five single well-known models in the forecasting literature: a statistical linear autoregressive model and four artificial neural networks: (radial basis function, multilayer perceptron, extreme learning machines, and echo state networks). The proposed ensemble employs extreme learning machines as the combination model due to its simplicity, learning speed, and greater ability of generalization in comparison to other artificial neural networks. The experiments were conducted on real consumption data collected from a smart meter in a one-step-ahead forecasting scenario. The results using five different performance metrics demonstrate that our solution outperforms other statistical, machine learning, and ensembles models proposed in the literature.

Use of road underpasses by terrestrial tetrapods inside a protected area in the southeastern part of the State of São Paulo, Brazil / Uso de pontes e galerias rodoviárias por tetrápodes terrestres em uma área protegida na região sudeste do Estado de São Paulo

Abstract: Roads, despite playing a key role in economy, begin or aggravate processes of forest fragmentation and lead to several species losing their natural habitats, acting as filters and barriers that impose challenges to animal locomotion. Wildlife crossings seek to reestablish the connectivity of the landscape. In general, after being installed, these passages need to be evaluated regarding their functioning. In this study, we present the results of monitoring the underpasses on Serra da Macaca Park Road (SP-139), which crosses Carlos Botelho State Park. The underpasses, constituted by bridges and culverts, were constructed after a license obtained to restore this section of the road. Camera traps were installed inside all crossing structures, and systematic samples were obtained through four field expeditions, with sampling efforts of 10 days each, between March 2018 and February 2019. The footprints found around the intersection structures were also considered. A two-sided Student's t-test was applied to verify differences in richness between the underpasses that have distinct types of margins. Differences in abundance were analyzed through the non-parametric Mann-Whitney test. A Whittaker diagram was generated according to the order of the species, from the most common to the rarest, while their diversity was estimated through Simpson's Diversity Index (1 - D). The Pearson correlation coefficient was used to study the interaction between diversity and altitude variation. We observed a richness of 16 species of terrestrial tetrapods, without any statistically significant differences between underpasses with dry or flooded margins. Cuniculus paca was the most abundant species, and higher altitudes presented the most diversity. We concluded that the underpasses located inside Permanent Preservation Areas (PPAs) of watercourses are essential to maintain the flow of animals beneath the road.

Resumo: As rodovias, apesar de exercerem um papel fundamental na economia, instauram ou agravam processos de fragmentação florestal e levam à perda de habitat. Atuam como filtros e barreiras, dificultando a movimentação animal. As passagens de fauna buscam restabelecer a conectividade na paisagem. Geralmente, após serem implantadas procede-se à avaliação do seu funcionamento. Nesse artigo nós apresentamos os resultados de um monitoramento do uso das passagens inferiores de fauna da Estrada Parque Serra da Macaca (SP-139), que atravessa o Parque Estadual Carlos Botelho. As passagens inferiores, representadas por pontes e galerias hidráulicas, foram concebidas através do licenciamento das obras de revitalização do trecho rodoviário. Armadilhas fotográficas foram instaladas no interior de todas as estruturas, e as amostragens sistemáticas ocorreram por meio de quatro expedições a campo, com um esforço amostral de 10 dias cada, entre março de 2018 e fevereiro de 2019. Os rastros encontrados no perímetro das estruturas de transposição também foram considerados. Os dados foram submetidos ao teste T de Student bicaudal, para verificar a diferença de riqueza entre as passagens inferiores com tipos distintos de margens. As diferenças de abundância foram analisadas pelo teste não paramétrico de Mann-Whitney. O diagrama de Whittaker foi gerado pela ordenação das espécies, a partir das mais comuns para as mais raras, enquanto a diversidade de espécies foi estimada pelo índice de Simpson (1 - D). O coeficiente de correlação de Pearson foi empregado para estudar a interação entre a diversidadade e a variação de altitude. Detectamos uma riqueza de 16 espécies de tetrápodes terrestres e não houve diferença significativa entre as passagens com margens secas e alagadas. Cuniculus paca foi a espécie mais abundante. Altitudes mais elevadas concentraram as maiores diversidades. Concluímos que as passagens inferiores alocadas em APPs de curso d'água são essenciais para manter o fluxo da fauna sob a rodovia.

The effectiveness of percutaneous injections of ozonotherapy in low back pain.

INTRODUCTION: Lumbar pain is one of the main reasons for medical consultation, causing the disruption of daily routines due to its disabling nature, thus resulting in social and personal damage. Among the complementary treatments, ozonotherapy offers analgesia to most patients, with reports of complications. However, great questions about its clinical effectiveness have not been answered yet, and there have been reports of serious complications. OBJECTIVE: To describe the use of ozonotherapy in the treatment of lumbar pain, focusing on its favorable and unfavorable effects, and its analog profile. METHODS: A cross-sectional bibliographic research was performed with scientific articles obtained from the Pubmed, LILACS and Scopus database, using the following descriptors: "Ozone", "Therapy", "Lumbar pain", "complication", "Disk herniation", "Guideline", "Protocol", "Standards", "Criteria". RESULTS: The researched literature corroborates that, in clinical practice, there is safety in the use of oxygen-ozone therapy through percutaneous injections for the treatment of lumbar pain, especially when compared to surgeries and use of medicines, provided that strict criteria are followed. CONCLUSION: The procedure is effective and has a favorable analgesic profile. However, it is necessary to produce a medical guideline that will help in its strict and systematic control.

The effectiveness of percutaneous injections of ozonotherapy in low back pain

SUMMARY INTRODUCTION Lumbar pain is one of the main reasons for medical consultation, causing the disruption of daily routines due to its disabling nature, thus resulting in social and personal damage. Among the complementary treatments, ozonotherapy offers analgesia to most patients, with reports of complications. However, great questions about its clinical effectiveness have not been answered yet, and there have been reports of serious complications. OBJECTIVE To describe the use of ozonotherapy in the treatment of lumbar pain, focusing on its favorable and unfavorable effects, and its analog profile. METHODS A cross-sectional bibliographic research was performed with scientific articles obtained from the Pubmed, LILACS and Scopus database, using the following descriptors: "Ozone", "Therapy", "Lumbar pain", "complication", "Disk herniation", "Guideline", "Protocol", "Standards", "Criteria". RESULTS The researched literature corroborates that, in clinical practice, there is safety in the use of oxygen-ozone therapy through percutaneous injections for the treatment of lumbar pain, especially when compared to surgeries and use of medicines, provided that strict criteria are followed. CONCLUSION The procedure is effective and has a favorable analgesic profile. However, it is necessary to produce a medical guideline that will help in its strict and systematic control.

RESUMO INTRODUÇÃO Dor lombar é um dos principais motivos de consultas médicas, provocando afastamento das rotinas diárias, por ser incapacitante, resultando em danos sociais e pessoais. Dentre os tratamentos complementares, a ozonioterapia oferece analgesia para a maioria dos pacientes e com mínimos relatos de complicações. Entretanto, grandes questionamentos sobre sua efetividade clínica ainda não foram respondidos, além de haver relatos de complicações graves. OBJETIVO Descrever o uso da ozonioterapia no tratamento da dor lombar, enfocando seus efeitos favoráveis e desfavoráveis, e seu perfil analgésico. MÉTODOS Foi realizada uma pesquisa bibliográfica transversal com artigos científicos obtidos das bases de dados PubMed, Lilacs e Scopus, utilizando os descritores: "Ozônio", "Terapia", "Dor lombar", "Complicação", "Hérnia de Disco","Diretriz", "Protocolo", "Padrões", "Critérios". RESULTADOS A literatura pesquisada corrobora que, na prática clínica, há segurança na utilização da terapia com a mistura oxigênio-ozônio por meio de injeções percutâneas para o tratamento de dor lombar, principalmente quando comparada às cirurgias e ao uso de medicamentos, desde que sejam seguidos critérios rígidos. CONCLUSÃO O procedimento é efetivo e tem perfil analgésico favorável. No entanto, é necessária a confecção de uma diretriz médica que auxiliará no controle rígido e sistemático do mesmo.

[Effectiveness of magnesium sulfate compared to rocuronium for rapid sequence tracheal intubation in adults: clinical randomized trial]. / Efetividade do sulfato de magnésio comparado ao rocurônio para intubação em sequência rápida em adultos: ensaio clínico randomizado.

INTRODUCTION AND OBJECTIVES: Magnesium sulfate has been used in anesthesia because it has relevant clinical features such as: analgesia, autonomic response control and muscle relaxation. Using the agent to establish adequate conditions for tracheal intubation remains controversial. The aim of the study was to compare the effectiveness of magnesium sulfate and rocuronium for rapid sequence tracheal intubation in adults. METHODS: Double blind, randomized, unicentric, prospective study assessed 68 patients, ASA 1 or 2, over 18 years, scheduled for appendectomy under general anesthesia. Patients were divided into two groups. GM patients received 50 mg.kg-1magnesium sulfate and GR patients, 1 mg.kg-1 rocuronium immediately before anesthesia induction. Arterial Blood Pressure (BP) and Heart Rate (HR) were measured in both groups at five times related to the administration of the drugs studied. The primary variable was the clinical status of tracheal intubation. TRIAL REGISTRY: RBR-4xr92k. RESULTS: GM was associated with no significant hemodynamic parameter change after injection. GM showed 85% (29/34) poor intubation clinical status, 15% (5/34) good, and 0% excellent (< 0.0001). CONCLUSION: Magnesium sulfate did not provide adequate clinical status when compared to rocuronium at a dose of 50 mg.kg-1 for rapid sequence intubation in adult patients.

Effectiveness of magnesium sulfate compared to rocuronium for rapid sequence tracheal intubation in adults: clinical randomized trial / Efetividade do sulfato de magnésio comparado ao rocurônio para intubação em sequência rápida em adultos: ensaio clínico randomizado

Abstract Introduction and objectives: Magnesium sulphate has been used in anesthesia because it has relevant clinical features such as: analgesia, autonomic response control and muscle relaxation. Using the agent to establish adequate conditions for tracheal intubation remains controversial. The aim of the study was to compare the effectiveness of magnesium sulfate and rocuronium for rapid sequence tracheal intubation in adults. Methods: Double blind, randomized, unicentric, prospective study assessed 68 patients, ASA 1 or 2, over 18 years, scheduled for appendectomy under general anesthesia. Patients were divided into two groups. GM patients received 50 mg.kg-1magnesium sulfate and GR patients, 1 mg.kg-1 rocuronium immediately before anesthesia induction. Arterial Blood Pressure (BP) and Heart Rate (HR) were measured in both groups at five times related to the administration of the drugs studied. The primary variable was the clinical status of tracheal intubation. Trial Registry: RBR-4xr92k. Results: GM was associated with no significant hemodynamic parameter change after injection. GM showed 85% (29/34) poor intubation clinical status, 15% (5/34) good, and 0% excellent (< 0.0001). Conclusion: Magnesium sulfate did not provide adequate clinical status when compared to rocuronium at a dose of 50 mg.kg-1 for rapid sequence intubation in adult patients.

Resumo Justificativa e objetivos: O sulfato de magnésio vem sendo utilizado em anestesia por apresentar características relevantes à prática clínica como: analgesia, controle dos reflexos autonômicos e relaxamento muscular. A utilização deste agente para garantir condições adequadas para a intubação traqueal permanece controverso. O objetivo deste trabalho é determinar a efetividade do sulfato de magnésio comparado ao rocurônio para intubação orotraqueal em sequência rápida em pacientes adultos. Métodos: Este estudo duplamente encoberto, aleatorizado, unicêntrico e prospectivo avaliou 68 pacientes, ASA 1 ou 2, maiores de 18 anos, escalados para cirurgias de apendicectomia sob anestesia geral. Foram alocados em dois grupos, o GM recebeu 50 mg.kg-1 de sulfato de magnésio e o GR, 1 mg.kg-1 de rocurônio imediatamente antes da indução anestésica. Os valores de Pressão Arterial (PA) e Frequência Cardíaca (FC) foram aferidos nos dois grupos em cinco momentos relacionados com a administração dos fármacos do estudo. A variável primária foi condição clínica da intubação. Registro: RBR-4xr92k. Resultados: O GM não apresentou alteração significativa dos parâmetros hemodinâmicos após infusão. O GM apresentou 85% (29/34) de condição pobre, 15% (5/34) condição clínica boa e 0% condição clínica excelente (< 0,0001). Conclusão: O sulfato de magnésio não propiciou condições clínicas aceitáveis quando comparado ao rocurônio para intubação orotraqueal em sequência rápida em pacientes adultos quando utilizada a dose de 50 mg.kg-1.

Acute-phase protein profile in horses subjected to different exercise protocols.

High-intensity exercise can be associated with the occurrence of muscle injury, as well as the induction of an acute-phase response (APR). The present study aims to investigate the synthesis and profile of serum proteins in horses before and after participating in 2 different exercise protocols and to relate this profile to the presence or absence of muscular injury caused by exercise. Ten purebred Arabian (n = 5) and Criollo (n = 5) horses were subjected to 2 different tests on a treadmill, one consisting of short-duration and rapid-acceleration training (TRA) that was mostly anerobic and the other of long-duration and slow-acceleration training (TLD) that was predominantly aerobic. Blood samples were obtained before the beginning of exercise (T0) and at 6 post-exercise time points: immediately after (T1) and 30 min (T2), 3 h (T3), 12 h (T4), 24 h (T5), and 48 h (T6) after exercise. Hematocrit was determined by the microhematocrit method. Plasma and serum samples were prepared by centrifugation (1500 × g for 5 min) for plasma concentrations of fibrinogen, total serum proteins (TP), sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), and creatine-kinase (CK) serum activity. Total protein concentration and CK serum activity were determined in an automated biochemistry analyzer. Fibrinogen was determined by the heat precipitation method in microhematocrit capillary tubes. Estimated concentrations of haptoglobin (Hp) significantly decreased after TRA and estimated concentrations of alpha-1 acid glycoprotein (AGP) significantly increased after both protocols at T2. Albumin increased after the TLD exercise protocol. Changes in hematocrit, haptoglobin, and albumin concentrations in horses subjected to different treadmill exercise protocols are related to a physiological response to hemoconcentration and hemolysis. Increases of AGP in the TLD protocol suggest the release of catecholamines as a response to avoid oxidative damage to tissue.

L'exercice est associé à l'induction d'une réponse inflammatoire en phase aiguë (APR). La présente étude vise à étudier la synthèse et le profil des protéines sériques avant et après la mise en pratique de deux protocoles d'exercices différents, et à et à établir un lien entre ce profil à la présence ou à l'absence de lésions musculaires causées par l'exercice. Dix chevaux, de race pure arabe (n = 5) et criollo (n = 5), ont été soumis à des tests sur un tapis roulant d'accélération rapide et de courte durée, principalement anaérobique (TRA), et des exercices de faible intensité et de longue durée (TLD), principalement aérobique. Des échantillons de sang veineux ont été prélevés avant le début de l'exercice (T0) et à six moments post-exercice : immédiatement après (T1), 30 minutes (T2), 3 h (T3), 12 h (T4), 24 h (T5) et 48 h (T6). L'hématocrite a été déterminé par la méthode du microhématocrite. Des échantillons de plasma et de sérum ont été préparés par centrifugation (1500 × g pendant 5 min) pour les concentrations plasmatiques de fibrinogène, les protéines sériques totales (TP), l'électrophorèse sur gel de polyacrylamide de sodium dodécylsulfate (SDS-PAGE) et l'activité sérique de créatine kinase (CK). La concentration en TP et l'activité sérique en CK ont été déterminées dans un analyseur automatique de biochimie. Le fibrinogène a été établi par la méthode de précipitation thermique dans des tubes capillaires à microhématocrite. Les niveaux estimés d'haptoglobine ont diminué de manière significative en TRA et les concentrations estimées d'AGP ont été significativement augmentées pour les deux protocoles à T2. L'albumine a augmenté considérablement dans le protocole TLD. Les variations des concentrations d'hématocrite, d'haptoglobine et d'albumine chez les chevaux soumis à différents protocoles d'exercice sur tapis roulant sont liées à la réponse physiologique à l'hémoconcentration et à l'hémolyse. L'augmentation de l'AGP dans le protocole TLD suggère la libération de catécholamines et une réponse permettant d'éviter les dommages oxydatifs aux tissus.(Traduit par les auteurs).

Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials / Efetividade da ozonioterapia comparada a outras terapias para dor lombar: revisão sistemática com metanálise de ensaios clínicos randomizados

Abstract Background and objectives: Low back pain is a prevalent disease in the adult population, whose quality of life is considerably affected. In order to solve this problem, several therapies have been developed, of which ozone therapy is an example. Our objective in this study was to determine the effectiveness of ozone therapy for lumbar pain relief in adult patients compared to other therapies (steroid and placebo). Method: We used randomized clinical trials to compare the effectiveness of ozone and other therapies for lumbar pain relief in adults (Prospero: CRD42018090807). Two independent reviewers searched the Medline (1966-April/2018), Scopus (2011-May/2018), Lilacs (1982-May/2018), and EMBASE (1974-March/2018) databases. We use the terms ozone and pain as descriptors. The primary variable was pain relief and the secondary ones were complication, degree of satisfaction, quality of life and recurrence of pain. Results: Of the 779 identified articles, six selected clinical trials show that ozone therapy is more effective for lumbar pain relief; however, they were mostly classified as having a high or uncertain risk of bias (Cochrane Handbook). The meta-analysis regarding the effectiveness of pain relief did not show a significant difference between groups in the three-month period (RR = 1.98, 95% CI: 0.46-8.42, p= 0.36; 366 participants). It also showed greater effectiveness of the ozone therapy at six months compared to other therapies (steroid and placebo) (RR = 2.2, 95% CI: 1.87-2.60, p< 0.00001; 717 participants). Conclusions: The systematic review has shown that ozone therapy used for six months for lumbar pain relief is more effective than other therapies; however, this result is not definitive as data from studies with moderate to high risk of bias were used.

Resumo Justificativa e objetivos: A lombalgia é uma enfermidade prevalente na população adulta, que tem sua qualidade de vida afetada consideravelmente. Com intuito de resolver este problema, desenvolveram-se várias terapias. Um exemplo é a ozonioterapia. Objetivamos neste estudo determinar a efetividade da ozonioterapia para alívio da dor lombar em pacientes adultos, quando comparada a outras terapias (esteroide e placebo). Método: Usamos de ensaios clínicos randomizados para comparar a efetividade do ozônio e de outras terapias para o alívio da dor lombar em adultos (Prospero: CRD42018090807). Dois revisores independentes analisaram as bases Medline (1966-Abril/2018), Scopus (2011-Maio/2018), Lilacs (1982-Maio/2018) e Embase (1974-Março/2018). Como descritores, usamos termos ozone e pain. Temos como variável primária o alívio da dor e como variáveis secundárias: complicação, grau de satisfação, qualidade de vida e recorrência da dor. Resultados: Os seis ensaios clínicos selecionados, de 779 artigos identificados, mostram que o grupo do ozônio é mais efetivo para o alívio da dor lombar, porém, foram classificados em sua maioria com alto ou incerto risco de viés (Handbook Cochrane). A metanálise referente à efetividade no alívio da dor não apresentou diferença significante entre os grupos no período de três meses (RR = 1,98; 95% IC: 0,46-8,42; p= 0,36; 366 participantes). Também denotou maior efetividade em seis meses do grupo ozônio em relação a outras terapias (esteroide e placebo) (RR = 2,2; 95% IC: 1,87-2,60; p< 0,00001; 717 participantes). Conclusões: A revisão sistemática demonstrou que ozonioterapia usada por seis meses para alívio da dor lombar é mais efetiva do que outras terapias. Entretanto, esse resultado não é definitivo, visto que foram usados dados de estudos com moderado a alto risco de viés.

[Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials]. / Efetividade da ozonioterapia comparada a outras terapias para dor lombar: revisão sistemática com metanálise de ensaios clínicos randomizados.

BACKGROUND AND OBJECTIVES: Low back pain is a prevalent disease in the adult population, whose quality of life is considerably affected. In order to solve this problem, several therapies have been developed, of which ozone therapy is an example. Our objective in this study was to determine the effectiveness of ozone therapy for lumbar pain relief in adult patients compared to other therapies (steroid and placebo). METHOD: We used randomized clinical trials to compare the effectiveness of ozone and other therapies for lumbar pain relief in adults (Prospero: CRD42018090807). Two independent reviewers searched the Medline (1966-April/2018), Scopus (2011-May/2018), Lilacs (1982-May/2018), and Embase (1974-March/2018) databases. We use the terms ozone and pain as descriptors. The primary variable was pain relief and the secondary ones were complication, degree of satisfaction, quality of life, and recurrence of pain. RESULTS: Of the 779 identified articles, six selected clinical trials show that ozone therapy is more effective for lumbar pain relief; however, they were mostly classified as having a high or uncertain risk of bias (Cochrane Handbook). The meta-analysis regarding the effectiveness of pain relief did not show a significant difference between groups in the three-month period (RR = 1.98, 95% CI: 0.46-8.42, p = 0.36; 366 participants). It also showed greater effectiveness of the ozone therapy at six months compared to other therapies (steroid and placebo) (RR = 2.2, 95% CI: 1.87-2.60, p < 0.00001; 717 participants). CONCLUSIONS: The systematic review has shown that ozone therapy used for six months for lumbar pain relief is more effective than other therapies; however, this result is not definitive as data from studies with moderate to high risk of bias were used.

Tutorial for performing systematic review and meta-analysis with interventional anesthesia studies / Tutorial para execução de revisões sistemáticas e metanálises com estudos de intervenção em anestesia

Abstract Background and objective: The systematic review of randomized clinical trials is crucial to assess the safety and effectiveness of intermediate procedures. The objective of this article is to present a tutorial for the planning and execution of systematic review and meta-analysis of randomized clinical trial studies. Method: The systematic literature review is the type of research that organizes, criticizes, and integrates available evidence published in the health field. Systematization leads to less bias, however, the quality of systematic reviews may not always be perceived due to the way it is described in the articles. The information disclosed in the articles is not always free of bias. The steps for carrying out a systematic review include design, protocol registration, implementation, mathematical analysis of results, and dissemination. PRISMA statement has improved the quality of systematic review reports by providing a list of items to be described, and this article emphasizes the key steps for performing a systematic review of interventions. Conclusion: The evidence generated through a systematic review can provide the clinician with greater confidence in decision making at the moment of clinical practice and optimize the benefits to his patients, serving as a tool to assist managers in making decisions regarding the implementation of new strategies for the health of the population.

Resumo Justificativa e objetivo: A revisão sistemática de ensaios clínicos randomizados é crucial para avaliar a segurança e a efetividade das intervenções médicas. O objetivo deste artigo é apresentar um tutorial para o planejamento e execução de revisões sistemáticas e metanálises de estudos de ensaios clínicos randomizados. Método: A revisão sistemática da literatura é o tipo de pesquisa que organiza, critica e integra as evidências disponíveis publicadas na áera da saúde. A sistematização leva a menos vieses, entretanto a qualidade das revisões sistemáticas nem sempre pode ser percebida devido à forma como têm sido descritas nos artigos. A informação divulgada nos artigos nem sempre está livre de vieses. Os passos para a revisão sistemática incluem o delineamento, o registro do protocolo, a execução, a análise matemática dos resultados e a divulgação. O PRISMA statement melhorou a qualidade dos relatos das revisões sistemáticas, pois fornece uma lista de itens a serem descritos, e este artigo enfatiza os principais passos para a execução de uma revisão sistemática de intervenção. Conclusão: A evidência gerada por meio de uma revisão sistemática pode propiciar ao médico maior confiança na tomada de decisões no momento da prática clínica, aprimorar os benefícios aos seus pacientes e servir como ferramenta para auxiliar os gestores na tomada de decisões quanto à implantação de novas estratégias em prol da saúde da população.

Effectiveness of Insulin Analogs Compared with Human Insulins in Pregnant Women with Diabetes Mellitus: Systematic Review and Meta-analysis.

Diabetes during pregnancy has been linked to unfavorable maternal-fetal outcomes. Human insulins are the first drug of choice because of the proven safety in their use. However, there are still questions about the use of insulin analogs during pregnancy. The objective of the present study was to determine the effectiveness of insulin analogs compared with human insulin in the treatment of pregnant women with diabetes through a systematic review with meta-analysis. The search comprised the period since the inception of each database until July 2017, and the following databases were used: MEDLINE, CINAHL, EMBASE, ISI Web of Science, LILACS, Scopus, SIGLE and Google Scholar. We have selected 29 original articles: 11 were randomized clinical trials and 18 were observational studies. We have explored data from 6,382 participants. All of the articles were classified as having an intermediate to high risk of bias. The variable that showed favorable results for the use of insulin analogs was gestational age, with a mean difference of - 0.26 (95 % confidence interval [CI]: 0.03-0.49; p = 0.02), but with significant heterogeneity (Higgins test [I2] = 38%; chi-squared test [χ2] = 16.24; degree of freedom [DF] = 10; p = 0.09). This result, in the clinical practice, does not compromise the fetal well-being, since all babies were born at term. There was publication bias in the gestational age and neonatal weight variables. To date, the evidence analyzed has a moderate-to-high risk of bias and does not allow the conclusion that insulin analogs are more effective when compared with human insulin to treat diabetic pregnant women.

Diabetes durante a gestação tem sido relacionado a desfechos materno-fetais desfavoráveis. As insulinas humanas são a primeira escolha medicamentosa, devido à comprovada segurança no seu uso. Entretanto, ainda há questionamentos sobre o uso dos análogos da insulina na gestação. O objetivo do presente estudo foi determinar a efetividade dos análogos da insulina comparados às insulinas humanas no tratamento de gestantes com diabetes por meio de uma revisão sistemática com metanálise. A busca compreendeu desde o início de cada base de dados até julho de 2017, e foi realizada nos seguintes bancos de dados: MEDLINE, CINAHL, EMBASE, ISI Web of Science, LILACS, Scopus, SIGLE e Google Scholar. Selecionamos 29 artigos originais, sendo 11 ensaios clínicos randomizados e 18 estudos observacionais. Exploramos dados de 6.382 participantes. Todos os artigos foram classificados como sendo de intermediário a alto risco de viés. A variável que demonstrou resultado favorável ao uso dos análogos da insulina foi idade gestacional, com uma diferença média de - 0.26 (95% índice de confiança [IC]: 0.03­0.49; p = 0.02), porém com heterogeneidade significativa (teste de Higgins [I2] = 38%; teste do qui quadrado [χ2] =16.24; graus de liberdade [GL] =10; p = 0.09). Esse resultado, na prática clínica, não compromete o bem-estar fetal, uma vez que todos os bebês nasceram a termo. Houve viés de publicação nas variáveis idade gestacional e peso neonatal. Até o momento, as evidências analisadas possuem um risco de viés moderado a elevado e não permitem concluir que os análogos da insulina sejam mais efetivos em comparação às insulinas humanas para tratar gestantes diabéticas.

[Tutorial for performing systematic review and meta-analysis with interventional anesthesia studies]. / Tutorial para execução de revisões sistemáticas e metanálises com estudos de intervenção em anestesia.

BACKGROUND AND OBJECTIVE: The systematic review of randomized clinical trials is crucial to assess the safety and effectiveness of intermediate procedures. The objective of this article is to present a tutorial for the planning and execution of systematic review and meta-analysis of randomized clinical trial studies. CONTENT: The systematic literature review is the type of research that organizes, criticizes, and integrates available evidence published in the health field. Systematization leads to less bias, however, the quality of systematic reviews may not always be perceived due to the way it is described in the articles. The information disclosed in the articles is not always free of bias. The steps for carrying out a systematic review include design, protocol registration, implementation, mathematical analysis of results, and dissemination. PRISMA statement has improved the quality of systematic review reports by providing a list of items to be described, and this article emphasizes the key steps for performing a systematic review of interventions. CONCLUSION: The evidence generated through a systematic review can provide the clinician with greater confidence in decision making at the moment of clinical practice and optimize the benefits to his patients, serving as a tool to assist managers in making decisions regarding the implementation of new strategies in favor of the public health.

Effectiveness of insulin analogs compared with human insulins in pregnant women with diabetes mellitus: systematic review and meta-analysis / Efetividade dos análogos da insulina comparados às insulinas humanas em gestantes com diabetes mellitus: Revisão sistemática com metanálise

Abstract Diabetes during pregnancy has been linked to unfavorable maternal-fetal outcomes. Human insulins are the first drug of choice because of the proven safety in their use. However, there are still questions about the use of insulin analogs during pregnancy. The objective of the present study was to determine the effectiveness of insulin analogs compared withhuman insulin in the treatment of pregnant women with diabetes througha systematic review withmeta-analysis. The search comprised the period since the inception of each database until July 2017, and the following databases were used:MEDLINE, CINAHL, EMBASE, ISIWeb of Science, LILACS, Scopus, SIGLE andGoogle Scholar.We have selected 29 original articles: 11 were randomized clinical trials and 18 were observational studies.We have explored data from 6,382 participants. All of the articles were classified as having an intermediate to high risk of bias. The variable that showed favorable results for the use of insulin analogs was gestational age, with a mean difference of - 0.26 (95 % confidence interval [CI]: 0.03-0.49; p = 0.02), but with significant heterogeneity (Higgins test [I2] = 38%; chi-squared test [χ2] = 16.24; degree of freedom [DF] = 10; p = 0.09). This result, in the clinical practice, does not compromise the fetal well-being, since all babies were born at term. There was publication bias in the gestational age and neonatal weight variables. To date, the evidence analyzed has a moderate-to-high risk of bias and does not allow the conclusion that insulin analogs are more effective when compared with human insulin to treat diabetic pregnant women.

Resumo Diabetes durante a gestação tem sido relacionado a desfechos materno-fetais desfavoráveis. As insulinas humanas são a primeira escolha medicamentosa, devido à comprovada segurança no seu uso. Entretanto, ainda há questionamentos sobre o uso dos análogos da insulina na gestação. O objetivo do presente estudo foi determinar a efetividade dos análogos da insulina comparados às insulinas humanas no tratamento de gestantes com diabetes por meio de uma revisão sistemática com metanálise. A busca compreendeu desde o início de cada base de dados até julho de 2017, e foi realizada nos seguintes bancos de dados: MEDLINE, CINAHL, EMBASE, ISI Web of Science, LILACS, Scopus, SIGLE e Google Scholar. Selecionamos 29 artigos originais, sendo 11 ensaios clínicos randomizados e 18 estudos observacionais. Exploramos dados de 6.382 participantes. Todos os artigos foram classificados como sendo de intermediário a alto risco de viés. A variável que demonstrou resultado favorável ao uso dos análogos da insulina foi idade gestacional, com uma diferençamédia de - 0.26 (95% índice de confiança [IC]: 0.03-0.49; p = 0.02), porém com heterogeneidade significativa (teste de Higgins [I2] = 38%; teste do qui quadrado [χ2] =16.24; graus de liberdade [GL] =10; p = 0.09). Esse resultado, na prática clínica, não compromete o bem-estar fetal, uma vez que todos os bebês nasceram a termo. Houve viés de publicação nas variáveis idade gestacional e peso neonatal. Até o momento, as evidências analisadas possuem um risco de viés moderado a elevado e não permitem concluir que os análogos da insulina sejam mais efetivos em comparação às insulinas humanas para tratar gestantes diabéticas.

Prevalência do consumo de substâncias psicotrópicas por motoristas de ônibus urbano: uma revisão sistemática* / Prevalence of psychotropic substance use by urban bus drivers: a systematic review / Prevalencia del uso de estupefacientes entre conductores de autobuses urbanos: una revisión sistemática

OBJETIVO: investigar a prevalência do consumo de substâncias psicotrópicas por motoristas de ônibus urbano através da revisão de estudos publicados sobre o consumo de drogas por essa população e identificar a associação entre esse consumo e as variáveis sociodemográficas e ocupacionais inerentes à profissão. MÉTODO: revisão sistemática de literatura utilizando as bases MEDLINE, LILACS, SciELO, EMBASE, PsycINFO e CAPES, utilizando-se os descritores: motoristas de ônibus, motoristas de ônibus urbano, uso de drogas e consumo de drogas, de julho a dezembro de 2015. RESULTADOS: esses profissionais estão cotidianamente expostos a importantes fatores estressores ocupacionais e o consumo de drogas pode estar relacionado a uma estratégia negativa de enfrentamento do estresse. O uso de drogas entre esses profissionais é preocupante, bem como a evidente relação entre esse uso e a ocorrência de acidentes de trânsito. CONCLUSÃO: estressores inerentes à profissão e respostas pouco eficazes ao estresse podem levar tais profissionais ao uso de substâncias psicotrópicas. Faz-se necessária a realização de estudos sobre a prevalência do consumo de drogas em uma amostra significativa de motoristas de ônibus urbano.

OBJECTIVE: to investigate the prevalence of psychotropic substance use by urban bus drivers by reviewing studies addressing drug use among this population and identify potential associations between drug use and sociodemographic and occupational variables inherent to the profession. METHOD: systematic literature review searching the MEDLINE, LILACS, SciELO, EMBASE, PsycINFO and CAPES databases using the Portuguese equivalents of the following: bus drivers, urban bus drivers, and drug use from July to December 2015. RESULTS: these professionals are exposed to important occupational stressors daily and the consumption of drugs may be related to negative coping strategies. Drug use among these workers is of concern, as well as the apparent relationship between drug use and traffic accidents. CONCLUSION: stressors inherent to the profession and inefficacious responses to stress may lead these professionals to use psychotropic substances. Thus, studies addressing the prevalence of drug use in a significant sample of urban bus drivers are necessary.

OBJETIVO: investigar la prevalencia del uso de sustancias psicotrópicas entre los conductores de autobuses urbanos mediante la revisión de los estudios publicados sobre el uso de drogas en esta población e identificar una asociación entre el consumo de dichas sustancias y las variables sociodemográficas y laborales inherentes a la profesión. MÉTODO: revisión sistemática de la literatura utilizando las bases de datos MEDLINE, LILACS, SciELO, EMBASE, PsycINFO y CAPES, utilizando los descriptores: conductores de autobuses, conductores de autobús urbano, uso de drogas y consumo de drogas, de julio a diciembre de 2015. RESULTADOS: estos profesionales están expuestos diariamente a factores estresantes importantes en el ámbito laboral y el uso de drogas puede constituir una estrategia negativa para hacer frente al estrés. El uso de drogas entre estos profesionales es preocupante, así como el vínculo claro entre el uso de dichas sustancias y la incidencia de accidentes de tránsito. CONCLUSIÓN: los estresores inherentes a la profesión y las respuestas ineficaces al estrés pueden llevar a estos profesionales a usar sustancias psicotrópicas. Por lo que se hace necesaria la realización de estudios sobre la prevalencia del consumo de drogas en una muestra significativa de conductores de autobuses urbanos.

Fungal peritonitis in patients undergoing peritoneal dialysis (PD) in Brazil: molecular identification, biofilm production and antifungal susceptibility of the agents.

This paper presents data on fungal peritonitis (FP) in patients undergoing peritoneal dialysis (PD) at the University Hospital of Botucatu Medical School, São Paulo, Brazil. In a total of 422 patients, 30 developed FP, from which the medical records and the fungal isolates of 23 patient cases were studied. All patients presented abdominal pain, cloudy peritoneal effluent, needed hospitalization, had the catheter removed and were treated with fluconazole or fluconazole plus 5-flucitosine; six of them died due to FP. Concerning the agents, it was observed that Candida parapsilosis was the leading species (9/23), followed by Candida albicans (5/23), Candida orthopsilosis (4/23), Candida tropicalis (3/23), Candida guilliermondii (1/23), and Kodamaea ohmeri (1/23). All the isolates were susceptible to amphotericin B, voriconazole and caspofungin whereas C. albicans isolates were susceptible to all antifungals tested. Resistance to fluconazole was observed in three isolates of C. orthopsilosis, and dose-dependent susceptibility to this antifungal was observed in two isolates of C. parapsilosis and in the K. ohmeri isolate. Biofilm production estimates were high or moderate in most isolates, especially in C. albicans species, and low in C. parapsilosis species, with a marked variation among the isolates. This Brazilian study reinforces that FP in PD is caused by a diverse group of yeasts, most prevalently C. parapsilosis sensu stricto species. In addition, they present significant variation in susceptibility to antifungals and biofilm production, thus contributing to the complexity and severity of the clinical features.

Cuidados domiciliares a pessoas com lesões de pele e o papel do técnico em enfermagem

A dermatite ocre está associada ao edema de insuficiência venosa crônica LIVC), que é uma síndrome clínica composta por edema, hiperpigmentação e lesões ulcerosas nas partes inferiores das pernas, tornando, muitas vezes uma doença incapacitante e de difícil tratamento. O objetivo desse relatório é descrever a minha experiência de estágio em que realizei cuidados técnicos em uma pessoa com esta patologia e que me proporcionou fazer uma revisão bibliográfica sobre o tema e ainda relatar os cuidados de enfermagem a lesões de pele, como melhorar a qualidade de vida do paciente (conforto) com comprometimento da família e equipe de saúde da Unidade Básica de Saúde. Conclui que a equipe de saúde da Unidade Básica de Saúde deve fazer um plano de ação para prestar assistência adequada, reunindo a equipe multiprofissional juntamente com o comprometimento da família, pois o tratamento é a longo prazo. Ainda, constatei que o cuidado do técnico em enfermagem é importante nas visitas domiciliares para avaliação das feridas, para verificar a evolução das mesmas e também a troca do curativo.

CA²JU: an Assistive Tool for Children with Cerebral Palsy.

This paper presents CA2JU, a hardware/software tool that aims to help individuals with severe speech or language problems in their communication in order to promote their social and digital inclusion. CA2JU is composed of two applications: CA2JU Accelerated, which makes typing faster by suggesting potential words to the user; and CA2JU Illustrated, which automatically converts a sentence of words into a sequence of pictographic symbols, allowing a user familiar with the symbols to verify whether the written sentence is correct. We have implemented, evaluated in a controlled scenario, and deployed CA2JU in a real environment with children with cerebral palsy. In the controlled settings, the results confirm CA2JU Accelerated speed up typing by reducing the number of clicks made by users, and CA2JU Illustrated obtained high accuracy by suggesting the correct pictograms from sentences. In the real scenario, the two use cases show that the children improved their communication and linguistic abilities.

Structured Open Urban Data: Understanding the Landscape.

A growing number of cities are now making urban data freely available to the public. Besides promoting transparency, these data can have a transformative effect in social science research as well as in how citizens participate in governance. These initiatives, however, are fairly recent and the landscape of open urban data is not well known. In this study, we try to shed some light on this through a detailed study of over 9,000 open data sets from 20 cities in North America. We start by presenting general statistics about the content, size, nature, and popularity of the different data sets, and then examine in more detail structured data sets that contain tabular data. Since a key benefit of having a large number of data sets available is the ability to fuse information, we investigate opportunities for data integration. We also study data quality issues and time-related aspects, namely, recency and change frequency. Our findings are encouraging in that most of the data are structured and published in standard formats that are easy to parse; there is ample opportunity to integrate different data sets; and the volume of data is increasing steadily. But they also uncovered a number of challenges that need to be addressed to enable these data to be fully leveraged. We discuss both our findings and issues involved in using open urban data.

Inhibition of mouse urinary bladder carcinogenesis by açai fruit (Euterpe oleraceae Martius) intake.

Açai, fruit from Euterpe oleraceae Martius, is consumed in natura and in a variety of beverages and food preparations and possesses several potential antioxidant compounds. In a first study for anticarcinogenicity screening, male Swiss mice (n = 20/per group) were chemically-induced to urothelial bladder carcinogenesis for 10 weeks and received a standard diet or a standard diet containing 2.5 and 5 % spray-dried açai pulp (AP) for 10 weeks. At week 20, the incidence of simple and nodular hyperplasia and the incidence and multiplicity of transitional cell carcinoma (TCC) were evaluated. In a second study for antigenotoxicity screening, male Swiss mice (n = 6/per group) were fed standard diet or standard diet containing 5 % AP for three weeks. Urothelial cell suspensions were obtained and challenged with H(2)O(2) for induction of DNA damage and analyzed by comet assay. Overall, dietary 5 % AP reduced TCC incidence and multiplicity (p = 0.019 and p = 0.015, respectively) and tumor cell proliferation and p63 expression (p = 0.02 and p = 0.007, respectively), Furthermore, the group fed the 5 % AP presented a significant reduction (p < 0.01) in DNA damage induced by H(2)O(2), a notable oxidant agent. The results suggest that the spray-dried açai pulp used here inhibits the TCC development in male Swiss mice, probably due to its potential antioxidant action.