Telemedicine for Diabetes Mellitus Management in Older Adults: A Systematic Review.

BACKGROUND: Diabetes mellitus affects almost 20% of the world's population between 65 and 99 years old. The care for this disease urges a complex, multidisciplinary, and stepwise approach. Telemedicine has been evaluated, and clinical trials as well as systematic reviews have been performed, and most have shown the benefits of its use in DM management. However, as the prevalence of diabetes mellitus increases, as well as the population ages, considerations regarding access and compliance of older patients to such technologies arise. OBJECTIVE: The study aimed to determine the efficacy of telemedicine medical consultations in comparison to standard face-to-face consultations. METHODS: A systematic literature search to identify trials investigating the effect of telemedicine medical consultations in clinical-laboratory aspects of DM management was conducted. The search was carried out in electronic databases: Medline, EMBASE, LILACS, ClinicalTrials.gov, and the CENTRAL Cochrane. Two authors independently assessed the included studies using the proper bias assessment tool for each study design. RESULTS: In agreement with the eligibility criteria, three studies were included. In terms of the main outcome, HbA1c, only one out of three articles showed a significant difference between the groups, favoring patients in the telemedicine group. With respect to blood pressure, Sood A reported that the usual care group exhibited a greater improvement in systolic blood pressure with statistical differences. All other results displayed no significant statistical difference between the groups. Also, no statistical difference was found in most of the lipid profile results. CONCLUSION: Our review shows that teleconsultations do not provide a clear benefit to elderly people with diabetes, but they may be non-inferior.

Comparison of ultrasonography learning between distance teaching and traditional methodology. An educational systematic review

ABSTRACT BACKGROUND: Use of the web for radiological education is an obvious application. Many computer-based teaching materials have been developed over recent years, and e-learning is becoming increasingly popular in medical schools. OBJECTIVE: To assess whether the effectiveness of distance-learning and/or e-learning, m-learning and web-based methods are equivalent to traditional methods. DESIGN AND SETTING: Systematic review of comparative studies of teaching techniques guided by Best Evidence Medical Education. METHODS: A search was carried out in the MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS online databases in April 2020, for original publications in all languages. The following MeSH terms were used: Ultrasonography; Teleradiology; Telemedicine; Education, Medical; Teaching; and Simulation Training; along with the terms e-learning, m-learning and web-based. All eligible studies were assessed using the Kirkpatrick model and Buckley's quality indicators. RESULTS: The search in the databases and a manual search resulted in 4549 articles, of which 16 had sufficient methodological quality for their inclusion. From analysis of these data, it was observed that teaching of ultrasonography using telemedicine methods is similar to the traditional method, except for venous access procedures, for which the studies did not show agreement. CONCLUSION: We found that learning via telemedicine methodologies presents great acceptance among students, besides demonstrating quality similar to the traditional method. Thus, at least at the moment, this has the capacity to serve as an important adjunct in the teaching of ultrasonography. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/CGUPA at the OPENSCIENCE Framework.

Comparison of ultrasonography learning between distance teaching and traditional methodology. An educational systematic review.

BACKGROUND: Use of the web for radiological education is an obvious application. Many computer-based teaching materials have been developed over recent years, and e-learning is becoming increasingly popular in medical schools. OBJECTIVE: To assess whether the effectiveness of distance-learning and/or e-learning, m-learning and web-based methods are equivalent to traditional methods. DESIGN AND SETTING: Systematic review of comparative studies of teaching techniques guided by Best Evidence Medical Education. METHODS: A search was carried out in the MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS online databases in April 2020, for original publications in all languages. The following MeSH terms were used: Ultrasonography; Teleradiology; Telemedicine; Education, Medical; Teaching; and Simulation Training; along with the terms e-learning, m-learning and web-based. All eligible studies were assessed using the Kirkpatrick model and Buckley's quality indicators. RESULTS: The search in the databases and a manual search resulted in 4549 articles, of which 16 had sufficient methodological quality for their inclusion. From analysis of these data, it was observed that teaching of ultrasonography using telemedicine methods is similar to the traditional method, except for venous access procedures, for which the studies did not show agreement. CONCLUSION: We found that learning via telemedicine methodologies presents great acceptance among students, besides demonstrating quality similar to the traditional method. Thus, at least at the moment, this has the capacity to serve as an important adjunct in the teaching of ultrasonography. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/CGUPA at the OPENSCIENCE Framework.

Unilateral Versus Bilateral Resistance Exercise in Postoperative Rehabilitation After ACL Reconstruction With Bone-Patellar Tendon-Bone Graft: A Randomized Controlled Trial.

Background: Lower limb muscle strength symmetry has been suggested as an essential criterion for the safe return to sports after anterior cruciate ligament (ACL) reconstruction. Limited evidence is available regarding the most effective intervention to achieve symmetry after reconstruction with contralateral bone-patellar tendon-bone (BPTB) graft. Purpose: To verify whether unilateral isotonic resistance exercise is more effective than bilateral exercise for obtaining postoperative functional and muscular strength symmetry between the donor limb and reconstructed limb for patients who received BPTB graft. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 88 patients were randomly divided into a control group (n = 44) and an intervention group (n = 44). All participants performed an 8-week exercise program starting at the beginning of the fourth postoperative month and were evaluated before and after the program. The control group performed bilateral exercises, and the intervention group performed unilateral exercises for the donor limb only (the limb with the greatest disability). The primary outcome was muscle strength (peak torque and hamstrings to quadriceps [H:Q] ratio), and the secondary outcomes were range of motion (ROM; goniometry), KT-1000 arthrometer side-to-side difference in anteroposterior knee laxity, and objective (single-leg hop test) and subjective (Lysholm score) functionality. Results: Both groups improved significantly from before to after the exercise program. The improvements were significantly greater in the intervention group regarding peak torque, H:Q ratio, flexion ROM, single-leg hop test, and Lysholm score in the donor limb (P < .001 for all), and the improvements were significantly greater in the control group regarding peak torque and single-leg hop test in the reconstructed limb (P < .001 for both). Comparison between the groups showed significantly increased symmetry regarding peak torque, H:Q ratio, and single-leg hop test in the intervention group compared with the control group (P < .001), with large effect sizes (>0.80) except for the H:Q ratio. Conclusion: Although postoperative, bilateral, isotonic resistance exercise provided better strength gains to the reconstructed limb, unilateral exercise was more effective in obtaining functional and muscle strength between-limb symmetry in patients who underwent ACL reconstruction with contralateral BPTB graft. Registration: Brazilian Registry of Clinical Trials (number RBR-22rnjh).

Telementored ultrasonography: a narrative review.

BACKGROUND: Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. OBJECTIVE: To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. DESIGN AND SETTING: Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. RESULTS: We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. CONCLUSIONS: Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

Telementored ultrasonography: a narrative review

ABSTRACT BACKGROUND: Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. OBJECTIVE: To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. DESIGN AND SETTING: Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. RESULTS: We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. CONCLUSIONS: Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

Indications for accurate and appropriate use of personal protective equipment for healthcare professionals. A systematic review

ABSTRACT BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous pressure on hospitals and other healthcare facilities. This, together with blockages in several countries, has hindered the availability and accessibility of the necessary personal protective equipment (PPE). OBJECTIVE: To identify, systematically evaluate and summarize the available scientific evidence on the efficacy, safety, safe use and reuse of PPE for healthcare professionals, for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN AND SETTING: Systematic review of studies analyzing products for disinfecting and enabling reuse of PPE for coronavirus within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science and LILACS databases, for articles published up to November 30, 2020. RESULTS: Ten studies were selected. These analyzed the use of N95, surgical and cotton masks, face shields, flexible enclosures with plastic covers or polycarbonate intubation boxes and plastic curtains; and also PPE disinfection using several substances. CONCLUSION: Combined use of a face shield with a N95 mask proved to be superior to other associations for protecting healthcare workers. Some products are useful for disinfecting PPE, such as 70% ethanol, 0.1% sodium hypochlorite and a mixture of quaternary ammonium and H2O2, and hydrogen peroxide. Ultraviolet light and dry heat at 70 °C can be used to decontaminate N95 masks. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/4V5FD at the OPENSCIENCE Framework.

The management of lower back pain using pilates method: assessment of content exercise reporting in RCTs.

PURPOSE: To evaluate the quality of the reporting of exercise interventions with Pilates method for the treatment of lower back pain (LBP) in adults. MATERIALS AND METHODS: Two independent evaluators selected randomized controlled trials (RCTs) of moderate and high methodological quality included in a Cochrane Systematic Review (SR) and from an additional updated search in the following databases: CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro and SPORTDiscus. Three assessment tools (Consensus on Therapeutic Exercise Training (CONTENT) scale, Template for Intervention Description and Replication (TIDieR) checklist and Consensus on Exercise Reporting Template (CERT) checklist) were utilized by three pairs of two independent researchers trained. The scales' concordance was measured using the Kappa coefficient. RESULTS: Ten RCTs were included. The CONTENT scale score was 5.3 (± 1.33) out of 9 points; the TIDieR checklist was 8.5 (± 1.71) out of 12 points and the CERT checklist was 9.5 (± 3.62) out of 19 points. The CONTENT and CERT had moderate concordance, while there was fair concordance between the other tools. CONCLUSIONS: The overall reporting quality for the Pilates exercises in ten moderate-to-high quality RTCs for the management of LBP was low according to CONTENT scale and CERT checklist and high according to TIDieR checklist.Implications for RehabilitationReporting of Pilates exercise program in moderate-to-high quality RCTs for the management of lower back pain remains incomplete.Pilates exercise program should be personalized and contextualized to individual participants.There may be a need to consider adding to or combining the information available from various trials.

Indications for accurate and appropriate use of personal protective equipment for healthcare professionals. A systematic review.

BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous pressure on hospitals and other healthcare facilities. This, together with blockages in several countries, has hindered the availability and accessibility of the necessary personal protective equipment (PPE). OBJECTIVE: To identify, systematically evaluate and summarize the available scientific evidence on the efficacy, safety, safe use and reuse of PPE for healthcare professionals, for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN AND SETTING: Systematic review of studies analyzing products for disinfecting and enabling reuse of PPE for coronavirus within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science and LILACS databases, for articles published up to November 30, 2020. RESULTS: Ten studies were selected. These analyzed the use of N95, surgical and cotton masks, face shields, flexible enclosures with plastic covers or polycarbonate intubation boxes and plastic curtains; and also PPE disinfection using several substances. CONCLUSION: Combined use of a face shield with a N95 mask proved to be superior to other associations for protecting healthcare workers. Some products are useful for disinfecting PPE, such as 70% ethanol, 0.1% sodium hypochlorite and a mixture of quaternary ammonium and H2O2, and hydrogen peroxide. Ultraviolet light and dry heat at 70 °C can be used to decontaminate N95 masks. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/4V5FD at the OPENSCIENCE Framework.

The impact of a low-calorie, low-glycemic diet on systemic lupus erythematosus: a systematic review.

BACKGROUND: Diet plays a critical role in Systemic Lupus Erythematosus (SLE) patients, impacting on the microbiota composition and, consequently, on the immune response. The objective was to analyze and verify the diet effect on SLE patients. METHODS: This is a systematic review performed at the Evidences-based Health Lab, Escola Superior em Ciências da Saúde, Brasília (DF), Brazil. In March, 2021, five databases, and grey literature, through JSTOR, Open Grey, and Google Scholar were searched. Randomized Clinical Trials in which SLE patients with calorie restricted, low glycemic index or other diet involving the joint adequacy of these aspects, compared with placebo or different types of diet, were included. RESULTS: It was identified in the databases 758 articles; 132 were duplicated; 616 references were screened, and 604 were excluded. After reading the title and abstract, 12 articles were included for full-text reading. After the full-text reading, three studies were included for quantitative analysis. The diet improved the quality of life at 6 (MD 16.30; 5.91;26.69) and 12 weeks (MD 14.60; 0.88;28.32). The GRADE was used to evaluate the quality of evidence. CONCLUSION: There is low evidence that the diet has a positive impact on the quality of life of SLE patients. Trial registration PROSPERO-CRD4202012208.

Methodological Quality Analysis of Systematic Review for the Treatment of Rotator Cuff Disease.

Objective To evaluate the methodological quality of systematic reviews for the surgical and nonsurgical treatment of individuals with rotator cuff syndrome; to compare, through the Assessing the methodological quality of systematic reviews (AMSTAR) instrument, the quality of studies found in the Cochrane Library, PubMed (Publisher Medline ), EMBASE andQinsightdatabases. Methods This is a descriptive and comparative cross-sectional study, in which two independent authors analyzed, through the AMSTAR instrument, the methodological quality of Cochrane and non-Cochrane systematic reviews on the treatment of individuals diagnosed with rotator cuff syndrome. Results A total of 76 systematic reviews were evaluated by the AMSTAR instrument. The overall mean score was 6.1 (±2.1) and the mean per database was 9.1 (±0.9) for the Cochrane reviews and 5.7 (±1.8) for the non-Cochrane reviews. The lowest-scoring item of AMSTAR was 11, related to the display of the conflict of interests of the publication. In a comparative analysis of the final variable score, there was a statistical difference between the Cochrane and non-Cochrane studies. Conclusion According to the present study, systematic reviews using the Cochrane methodology have a better methodological quality compared to non-Cochrane studies on the treatment of rotator cuff dysfunctions.

Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis.

BACKGROUND: Computed tomography (CT) accounts for 13% of all radiological examinations in the United States and 40-70% of the radiation that patients receive. Even with the advent of magnetic resonance imaging (MRI), CT continues to be the gold standard for diagnosing bone fractures. There is uncertainty as to whether CT with a low radiation dose has a fracture detection rate similar to that of standard-dose CT. OBJECTIVE: To determine the detection rate of low-dose radiation CT and standard-dose radiation CT for fractures, in patients with suspected fractures. DESIGN AND SETTING: Systematic review of comparative studies on diagnostic accuracy within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: We searched the electronic databases Cochrane Library, MEDLINE, EMBASE and LILACS up to June 29, 2020, for studies evaluating the detection rates of low-dose CT and standard-dose CT for diagnosing bone fractures. The Research Triangle Institute (RTI) item bank tool was used for methodological quality evaluation. RESULTS: The fracture detection rate according to the number of bones evaluated, using CT with low-dose radiation was 20.3%, while with standard-dose radiation it was 19.2%, and the difference between the methods was not significant. The fracture detection rate according to the number of patients, using CT with low-dose radiation was 56.0%, while with standard-dose radiation it was 58.7%, and this difference between the methods was not significant, either. CONCLUSION: CT with low-dose radiation presented detection rates similar to those of CT with standard-dose radiation, regardless of the bones evaluated. REGISTRATION NUMBER: CRD42019148491 at the PROSPERO database.

Computed tomography with low-dose radiation versus standard-dose radiation for diagnosing fractures: systematic review and meta-analysis

BACKGROUND: Computed tomography (CT) accounts for 13% of all radiological examinations in the United States and 40-70% of the radiation that patients receive. Even with the advent of magnetic resonance imaging (MRI), CT continues to be the gold standard for diagnosing bone fractures. There is uncertainty as to whether CT with a low radiation dose has a fracture detection rate similar to that of standard-dose CT. OBJECTIVE: To determine the detection rate of low-dose radiation CT and standard-dose radiation CT for fractures, in patients with suspected fractures. DESIGN AND SETTING: Systematic review of comparative studies on diagnostic accuracy within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: We searched the electronic databases Cochrane Library, MEDLINE, EMBASE and LILACS up to June 29, 2020, for studies evaluating the detection rates of low-dose CT and standard-dose CT for diagnosing bone fractures. The Research Triangle Institute (RTI) item bank tool was used for methodological quality evaluation. RESULTS: The fracture detection rate according to the number of bones evaluated, using CT with low-dose radiation was 20.3%, while with standard-dose radiation it was 19.2%, and the difference between the methods was not significant. The fracture detection rate according to the number of patients, using CT with low-dose radiation was 56.0%, while with standard-dose radiation it was 58.7%, and this difference between the methods was not significant, either. CONCLUSION: CT with low-dose radiation presented detection rates similar to those of CT with standard-dose radiation, regardless of the bones evaluated. REGISTRATION NUMBER: CRD42019148491 at the PROSPERO database.

Methodological Quality Analysis of Systematic Review for the Treatment of Rotator Cuff Disease / Análise da qualidade metodológica de revisões sistemáticas para tratamento de disfunções do manguito rotador

Abstract Objective To evaluate the methodological quality of systematic reviews for the surgical and nonsurgical treatment of individuals with rotator cuff syndrome; to compare, through the Assessing the methodological quality of systematic reviews (AMSTAR) instrument, the quality of studies found in the Cochrane Library, PubMed (Publisher Medline), EMBASE andQinsightdatabases. Methods This is a descriptive and comparative cross-sectional study, in which two independent authors analyzed, through the AMSTAR instrument, the methodological quality of Cochrane and non-Cochrane systematic reviews on the treatment of individuals diagnosed with rotator cuff syndrome. Results A total of 76 systematic reviews were evaluated by the AMSTAR instrument. The overall mean score was 6.1 (±2.1) and the mean per database was 9.1 (±0.9) for the Cochrane reviews and 5.7 (±1.8) for the non-Cochrane reviews. The lowest-scoring item of AMSTAR was 11, related to the display of the conflict of interests of the publication. In a comparative analysis of the final variable score, there was a statistical difference between the Cochrane and non-Cochrane studies. Conclusion According to the present study, systematic reviews using the Cochrane methodology have a better methodological quality compared to non-Cochrane studies on the treatment of rotator cuff dysfunctions.

Resumo Objetivo Avaliar a qualidade metodológica das revisões sistemáticas para tratamento cirúrgico e não cirúrgico de indivíduos com síndrome do manguito rotador; comparar, através do instrumento Assessingthemethodologicalqualityofsystematic reviews(AMSTAR, na sigla em inglês), a qualidade dos estudos encontrados nas bases de dados Cochrane Library, PubMed (Publisher Medline), EMBASE e Qinsight. Métodos Trata-se de um estudo transversal descritivo e comparativo, em que dois autores independentes analisaram, por meio do instrumento AMSTAR, a qualidade metodológica das revisões sistemáticas Cochrane e nãoCochrane sobre tratamento de indivíduos com diagnóstico de síndrome do manguito rotador. Resultados 76 revisões sistemáticas foram avaliadas pelo instrumento AMSTAR. O escore médio geral foi de 6,1(±2,1) e a média por base de dados foi 9,1(±0,9) para as revisões Cochrane e 5,7(±1,8) para as não Cochrane. O item de menor pontuação do AMSTAR foi 11, relacionada à exibição dos conflitos de interesse da publicação. Em uma análise comparativa do escore da variável final, houve uma diferença estatística entre os estudos Cochrane e nãoCochrane. Conclusão De acordo com o presenteestudo, revisões sistemáticas utilizando a metodologia Cochrane têm uma melhor qualidade metodológica em comparação com estudos nãoCochrane sobre o tratamento de disfunções do manguito rotador.

Evidence for the efficacy of Tai Chi for treating rheumatoid arthritis: an overview of systematic reviews

ABSTRACT BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease with higher prevalence among women aged between 30 and 50 years and general prevalence of 1% worldwide. Interventions promoting improvement of quality of life for individuals with RA are required. Tai Chi appears to be a low-cost alternative, with studies showing positive results from this technique. However, regarding aspects of RA such as pain and sensitivity, studies remain inconclusive. OBJECTIVES: To compare the effectiveness of the Tai Chi method for treating patients diagnosed with rheumatoid arthritis, among systematic reviews. DESIGN AND SETTING: Overview of systematic reviews with Cochrane and non-Cochrane methodology. METHODS: Systematic reviews involving quasi-randomized and randomized clinical trials (RCTs) on use of Tai Chi, with no restrictions regarding the date and language of publication, were included. RESULTS: Three systematic reviews were included. The effects of Tai Chi associated with education and stretching exercises versus education and stretching were evaluated in these reviews. They showed that improvements in the variables of mood, depression and functional index were associated with use of Tai Chi. CONCLUSIONS: The findings suggest that clinical improvement was achieved, although not statistically significant with regard to pain and disease pattern, as assessed using the ACR20 measurement. Improvements relating to disability and quality of life were also seen. There was a low level of evidence and therefore caution in data analysis is recommended. The three studies included showed poor reliability for providing an accurate and complete summary of use of Tai Chi among people diagnosed with rheumatoid arthritis. PROSPERO: CRD42019125501.

Evidence for the efficacy of Tai Chi for treating rheumatoid arthritis: an overview of systematic reviews.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease with higher prevalence among women aged between 30 and 50 years and general prevalence of 1% worldwide. Interventions promoting improvement of quality of life for individuals with RA are required. Tai Chi appears to be a low-cost alternative, with studies showing positive results from this technique. However, regarding aspects of RA such as pain and sensitivity, studies remain inconclusive. OBJECTIVES: To compare the effectiveness of the Tai Chi method for treating patients diagnosed with rheumatoid arthritis, among systematic reviews. DESIGN AND SETTING: Overview of systematic reviews with Cochrane and non-Cochrane methodology. METHODS: Systematic reviews involving quasi-randomized and randomized clinical trials (RCTs) on use of Tai Chi, with no restrictions regarding the date and language of publication, were included. RESULTS: Three systematic reviews were included. The effects of Tai Chi associated with education and stretching exercises versus education and stretching were evaluated in these reviews. They showed that improvements in the variables of mood, depression and functional index were associated with use of Tai Chi. CONCLUSIONS: The findings suggest that clinical improvement was achieved, although not statistically significant with regard to pain and disease pattern, as assessed using the ACR20 measurement. Improvements relating to disability and quality of life were also seen. There was a low level of evidence and therefore caution in data analysis is recommended. The three studies included showed poor reliability for providing an accurate and complete summary of use of Tai Chi among people diagnosed with rheumatoid arthritis. PROSPERO: CRD42019125501.

Dipeptidyl Peptidase IV Inhibitors for Nonalcoholic Fatty Liver Disease - Systematic Review and Metanalysis.

INTRODUCTION: Hepatic steatosis is a frequent condition that afflicts, especially, obese and insulin-resistant patients. Diagnosis is usually made through imaging tests. Despite the high prevalence and risk of complications, there is no specific treatment approved, though a vast number of medications have been tested. OBJECTIVE: This study aimed to determine the efficacy of dipeptidyl peptidase IV inhibitors (i DPP- IV) in the treatment of NAFLD. METHODS: We searched the electronic databases of the Cochrane Library, MEDLINE, EMBASE, and LILACS, as well as reference lists of the included studies and grey literature; 9 studies were selected for inclusion. RESULTS: 7 studies were used for metanalysis for 3 outcomes. i DPP-IV showed an ALT-reducing power of MD -10.83 (95% CI 35.23 to 13.57) at 3 months and MD -9.27 (95% CI 10.92 to -7.62) at 6 months of intervention, as well as a reduction of hepatic steatosis via MRI of SMD 0.10 (95% CI 0.31 to 0.50); the overall incidence of adverse events was very low. The studies were considered of low and very low quality by the GRADE evaluation. CONCLUSION: Because of the overall poor quality of the studies and heterogeneity of the population analyzed, i DPP-IV did not show efficacy on inflammatory markers or fibrosis in patients with NAFLD.

Trajetória esportiva e habilidades psicológicas de jogadores de futebol da seleção brasileira / Trayectoria deportiva y habilidades psicológicas de jugadores de fútbol de la selección brasileña / Sports trajectory and psychological skills of brazilian national team soccer players

Resumo O objetivo deste estudo foi compreender a construção da trajetória de jogadores de futebol profissional da seleção brasileira. Foram entrevistados seis jogadores de futebol, do gênero masculino, que faziam parte da equipe principal de clubes que disputam a primeira divisão do Campeonato Brasileiro. Critério de inclusão: mínimo de dois anos como jogador profissional e pelo menos uma convocação pela seleção brasileira de futebol. Os atletas foram entrevistados individualmente. A partir da análise das entrevistas, constatou-se que o futebol se apresenta como tema central em suas vidas e que a família tem um papel importante no contexto do esporte. A importância das habilidades psicológicas é confirmada para aqueles que atingiram a elite do futebol profissional e a seleção brasileira. A compreensão da trajetória esportiva de atletas da elite constitui um tema de grande relevância para o avanço da ciência do esporte.

Resumen El objetivo de este estudio es comprender la construcción de la trayectoria de futbolistas profesionales de la selección brasileña. Entrevistamos a seis futbolistas, de género masculino, que formaban parte del equipo principal de clubes que compiten en la primera división del Campeonato Brasileño. Criterios de inclusión: mínimo de dos años como jugador profesional y al menos una convocatoria para la Selección Brasileña de Fútbol. Los atletas fueron entrevistados individualmente. A partir del análisis de las entrevistas, se constató que el fútbol es un tema central en sus vidas y que la familia juega un papel importante en el contexto del deporte. La importancia de las habilidades psicológicas se confirma para aquellos que alcanzaron la élite del fútbol profesional y la selección brasileña. Comprender la trayectoria deportiva de los deportistas de élite es un tema de gran relevancia para el avance de la ciencia del deporte.

Abstract This study looked into the construction of the professional trajectories of players from Brazil's national soccer team. Interviews were conducted with six male players who were part of the first team of clubs that play in the first division of the Brazilian Championship. Inclusion criteria: minimum of two years as a professional player and at least one call-up to the Brazilian national team. Athletes were interviewed individually. According to the analysis of the interviews, soccer is a central theme in their lives, and their families play important roles in the sports context. The importance of psychological skills for those who reach the elite of professional soccer and the Brazilian team is confirmed. Understanding the trajectories of elite athletes in sports is important for the advancement of sports science.