Effect of an exercise-based cardiac rehabilitation program on quality of life of patients with chronic Chagas cardiomyopathy: results from the PEACH randomized clinical trial.

To investigate the effect of an exercise-based cardiac rehabilitation program on the quality of life (QoL) of patients with chronic Chagas cardiomyopathy (CCC). PEACH study was a single-center, superiority randomized clinical trial of exercise training versus no exercise (control). The sample comprised Chagas disease patients with CCC, left ventricular ejection fraction < 45%, without or with HF symptoms (CCC stages B2 or C, respectively). QoL was assessed at baseline, after three months, and at the end of six months of follow-up using the SF-36 questionnaire. Patients randomized for the exercise group (n = 15) performed exercise training (aerobic, strength and stretching exercises) for 60 min, three times a week, during six months. Patients in the control group (n = 15) were not provided with a formal exercise prescription. Both groups received identical nutritional and pharmaceutical counseling during the study. Longitudinal analysis of the effects of exercise training on QoL, considering the interaction term (group × time) to estimate the rate of changes between groups in the outcomes (represented as beta coefficient), was performed using linear mixed models. Models were fitted adjusting for each respective baseline QoL value. There were significant improvements in physical functioning (ß = + 10.7; p = 0.02), role limitations due to physical problems (ß = + 25.0; p = 0.01), and social functioning (ß = + 19.2; p < 0.01) scales during the first three months in the exercise compared to the control group. No significant differences were observed between groups after six months. Exercise-based cardiac rehabilitation provided short-term improvements in the physical and mental aspects of QoL of patients with CCC.Trial registration: ClinicalTrials.gov Identifier: NCT02517632; August 7, 2015.

Chagas heart disease is associated with decreased physical activity levels: A cross-sectional analysis.

Background: Studies evaluating physical activity (PA) levels in individuals with Chagas disease (CD) are still scarce. The present study aimed to evaluate PA levels in CD individuals and examine their association with Chagas heart disease (ChHD). Methods: We included patients with CD regularly followed in a reference center for treatment of infectious diseases. PA levels were assessed using the short version of the International Physical Activity Questionnaire (IPAQ). ChHD was determined following the Brazilian Consensus on Chagas Disease. The association between ChHD and levels of PA (total, walking, moderate, and vigorous) as a continuous variable was fitted using generalized linear models. Logistic regression models were fitted to evaluate the association between ChHD and meeting WHO's PA recommendations. Results: Among the 361 participants included in the analysis (60.7 ± 10.7 years; 56.2 % women), 58.1 % (n = 210) complied with the WHO's PA recommendations. After adjustments for potential confounders, regression analyses revealed that ChHD without heart failure was significantly associated with reduced vigorous PA (Exp ß 0.32 95 % CI 0.10 to 0.98). ChHD with heart failure had significantly lower levels of total (Exp ß 0.61 95 % CI 0.44 to 0.84) and moderate (Exp ß 0.59 95 % CI 0.39 to 0.89) PA. ChHD with heart failure had a lower odd of meeting the PA recommendation in comparison to those with no cardiac involvement (OR 0.48 95 % CI 0.24 to 0.97). Conclusions: We found low levels of PA among individuals with CD. Presence of ChHD (mainly with HF) was associated with decreased levels of PA.

Inspiratory muscle endurance is similarly reduced in the early and late stages of chronic Chagas heart disease.

OBJECTIVE: Inspiratory muscle strength (IMS) appears to be reduced in subjects with chronic Chagas heart disease (CHD), especially in the presence of heart failure (HF). However, only one study about IMS and inspiratory muscle endurance (IME) in those with CHD without heart failure is available. This study aimed to compare IMS and IME in subjects with CHD in the presence and absence of HF. METHODS: This is a cross-sectional study in which 30 CHD adult patients were divided into CHD-CC group (initial phase of CHD, without HF; n = 15) and CHD-HF group (advanced phase of CHD, with HF; n = 15). We assessed IMS by maximum inspiratory pressure (MIP) and IME by incremental (Pthmax) and constant load (TLim) tests. Reduced IMS and IME were considered by predicted MIP values <70% and Pthmax/MIP <75%, respectively. RESULTS: Inspiratory muscle weakness (IMW) was more frequent in CHD-HF than in CHD-CC (46.7% vs. 13.3%; p = 0.05), and both groups had high frequencies of reduced IME (93.3% CHD-CC vs. 100.0% CHD-HF; p = 0.95). Age-adjusted logistic regression analysis using HF as a dependent variable showed that HF was associated with an increased chance of IMW compared with the CHD-CC group (OR = 7.47; p = 0.03; 95% CI 1.20-46.19). CONCLUSION: This study suggests that, in patients with CHD, HF is associated with IMW, and that reduction of IME is already present in the initial phase, similar to the advanced phase with HF.

Inspiratory Muscle Strength in Chagas Cardiomyopathy: A Systematic Scoping Review.

The increase in inflammatory markers associated with persistent chronic fibrosing myocarditis, a characteristic of chronic Chagas disease, can result in a reduction in inspiratory muscle strength (IMS) in Chagas cardiomyopathy (CC). However, literature in this field is still scarce. This review aimed to map and summarize the evidence regarding IMS in patients with CC. The inclusion criteria included reports with adult participants with a CC diagnosis, with or without heart failure (HF). The core concept examined was the maximum inspiratory pressure evaluated in the untrained and trained groups in the pre-training period. The context was open, including but not limited to hospitals and health centers. Two authors independently identified eligible studies and extracted the data. Descriptive synthesis was used as the primary strategy for analyzing the results. Nine studies (five clinical trials, three cross-sectional, and one cohort) were included. The CC classification differed among the studies, with no mention of HF in five and no CC staging specification in six. IMS was assessed using a manovacuometer, and only six studies analyzed and interpreted the data concerning the predicted values. The CC population with HF appeared to have impaired IMS. All studies involved only Brazilian volunteers. In conclusion, randomized clinical trials evaluating IMS and the effects of inspiratory muscle training need to be conducted to better understand the prevalence and risk of inspiratory muscle weakness in the CC population, as well as the effects of training. Such studies should be conducted at different stages of CC in different populations and countries.

Corrigendum: Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): a study protocol for a randomized clinical trial.

[This corrects the article DOI: 10.3389/fmed.2022.1087188.].

Comparative effects of a cardiovascular rehabilitation program on functional capacity in patients with chronic chagasic cardiomyopathy with or without heart failure.

PURPOSE: The aim of the present study was to evaluate the effects of cardiovascular rehabilitation (CR) on functional capacity of patients with chronic chagasic cardiomyopathy (CCC) and to compare the responses between CCC patients without and with heart failure (HF). MATERIALS AND METHODS: A longitudinal observational retrospective study was carried out including 36 patients with CCC without HF (stage B2 [n = 7]) and with HF (stage C [n = 29]), who participated in a CR program. Functional capacity was assessed by a maximal progressive cardiopulmonary exercise test performed on a treadmill. The longitudinal effects of the CR on functional capacity were determined by linear mixed models that included an interaction term to evaluate the differential responses between patients without and with HF. RESULTS: Significant improvements in peak oxygen consumption, resting heart rate and blood pressure, and maximum pulmonary ventilation were observed for the overall study sample, with no apparent differential effects according to the presence of HF. CONCLUSIONS: CR significantly improved functional capacity of patients with CCC. The responses to CR appear to be similar among patients without and with HF, reinforcing the need for its inclusion as a standard treatment strategy of CCC.Implications for rehabilitationExercise-based cardiovascular rehabilitation (CR) is a safe strategy that improves functional capacity, cardiac function, and quality of life in patients with several cardiovascular diseases, and recent studies also suggested a potential beneficial effect of CR in chronic chagasic cardiomyopathy (CCC).In this observational study, CR seems to equally improve exercise capacity, resting heart rate, resting blood pressure, and maximum pulmonary ventilation in patients with CCC without (stage B2) and with heart failure (stage C).Cardiovascular rehabilitation should be included as a standard treatment strategy for patients with CCC, regardless the severity of cardiomyopathy.

Analysis of the Degree of Information of Dental Surgeons about Antiresorptive Drugs According to the Time Since Graduation in Dentistry

ABSTRACT Objective: To determine the level of scientific information of dental surgeons who carry out their professional activities in Brazil about antiresorptive drugs and indicated pharmacological procedures aiming at the prevention of osteonecrosis of the jaws and the therapy of drug sequelae that may occur, considering the time since graduation in Dentistry. Material and Methods: This is a quantitative cross-sectional study in which 339 dentists were consulted using the virtual questionnaire containing topics of personal nature, elements contained in the anamnesis carried out and knowledge about antiresorptive drugs, including indications, adverse effects and treatments applied. Chi-square and Fisher's exact tests were performed to analyze associations of data described by absolute and relative frequencies with professionals' time since graduation. All analyses were performed using the R software, with a 5% significance level. Results: Those who revealed to have graduated for more than five years with the highest academic degree were those who demonstrated maximum knowledge of antiresorptive drugs or revealed that, somehow, they had information about them (p<0.05). Conclusion: Dental surgeons in Brazil who have more than five years since graduation have more scientific information about antiresorptive drugs and pharmacological procedures, which can positively contribute to the prevention of osteonecrosis of the jaws and treatment of drug sequelae that may occur.

Inspiratory Muscle Strength in Chagas Cardiomyopathy: A Systematic Scoping Review

ABSTRACT The increase in inflammatory markers associated with persistent chronic fibrosing myocarditis, a characteristic of chronic Chagas disease, can result in a reduction in inspiratory muscle strength (IMS) in Chagas cardiomyopathy (CC). However, literature in this field is still scarce. This review aimed to map and summarize the evidence regarding IMS in patients with CC. The inclusion criteria included reports with adult participants with a CC diagnosis, with or without heart failure (HF). The core concept examined was the maximum inspiratory pressure evaluated in the untrained and trained groups in the pre-training period. The context was open, including but not limited to hospitals and health centers. Two authors independently identified eligible studies and extracted the data. Descriptive synthesis was used as the primary strategy for analyzing the results. Nine studies (five clinical trials, three cross-sectional, and one cohort) were included. The CC classification differed among the studies, with no mention of HF in five and no CC staging specification in six. IMS was assessed using a manovacuometer, and only six studies analyzed and interpreted the data concerning the predicted values. The CC population with HF appeared to have impaired IMS. All studies involved only Brazilian volunteers. In conclusion, randomized clinical trials evaluating IMS and the effects of inspiratory muscle training need to be conducted to better understand the prevalence and risk of inspiratory muscle weakness in the CC population, as well as the effects of training. Such studies should be conducted at different stages of CC in different populations and countries.

Metacognición, autopercepción y autoconsciencia en niños de 9 a 12 años / Metacognição, autopercepção e autoconsciência em crianças de 9 a 12 anos / Metacognition, self-perception, and self-awareness in children from 9 to 12 years old

A metacognição é um processo cognitivo fundamental para a aprendizagem e está relacionada à autorreflexão. O objetivo deste estudo, exploratório e de enfoque qualitativo, foi descrever a percepção de crianças sobre suas estratégias metacognitivas a partir de uma escala de metacognição. Participaram 106 crianças de 9 a 12 anos de idade, que responderam a um questionário estruturado. A análise dos dados seguiu os critérios da fenomenologia semiótica. Os resultados revelaram cinco temáticas: (1) Alegria e motivação; (2) Indecisão e curiosidade; (3) Saber mais sobre mim; (4) Ansiedade; (5) Diferente do que faço na escola. A diversidade temática da percepção das crianças sobre seu processo autorreflexivo sugere a amplitude do monitoramento dos próprios pensamentos, sentimentos e comportamentos e da experiência e julgamento de conteúdos internalizados. Sugere-se que tarefas autorreflexivas sejam incluídas nos programas escolares, pois propiciam às crianças a ressignificação do papel de sujeitos de seu próprio processo de conhecimento.

La metacognición es un proceso cognitivo fundamental hacia el aprendizaje y está relacionada a la autorreflexión. El objetivo de este estudio, exploratorio y de enfoque cualitativo, fue describir la percepción de niños sobre sus estrategias metacognitivas a partir de una escala de metacognición. Participaron 106 niños de 9 a 12 años, que respondieron a un cuestionario estructurado. El análisis de los datos siguió los criterios de la fenomenología semiótica. Los resultados apuntaron cinco temáticas: (1) Alegría y motivación; (2) Indecisión y curiosidad; (3) Saber más sobre mí; (4) Ansiedad; (5) Diferente de lo que hago en la escuela. La diversidad temática de la percepción de los niños sobre su proceso autorreflexivo sugiere la amplitud de la supervisión de los propios pensamientos, sentimientos y comportamientos y de la experiencia y juzgamiento de contenidos internalizados. Se sugiere que tareas autorreflexivas sean incluidas en los programas escolares, pues propician a los niños la resignificación del papel de sujetos de su propio proceso de conocimiento.

Metacognition is a fundamental cognitive process for learning and it is related to self-reflection. The objective of this exploratory and qualitative study was to describe children's perception of their metacognitive strategies based on a metacognition scale. In this way,106 children aged 9 to 12 years old participated, who answered a structured questionnaire. Data analysis followed the semiotic phenomenology criteria. The results revealed five themes: (1) Joy and motivation; (2) Indecision and curiosity; (3) Know more about me; (4) Anxiety; (5) Different from what I do at school. The diversity thematic of children's perception of their self-reflective process suggests the extent of monitoring their own thoughts, feelings and behaviors and the experience and judgment of internalized contents. It is suggested that self-reflective tasks may be included in school programs, as they allow children to re-signify their role as subjects of their own knowledge process.

Autoavaliação negativa do estado de saúde entre adultos no Brasil / Negative self-assessment of health status among adults in Brazil / Autoevaluación negativa del estado de salud entre adultos en Brasil

Objetivo: Descrever a autoavaliação negativa do estado de saúde entre adultos no Brasil no período de 2011 a 2020. Método: Estudo ecológico descritivo de série temporal realizado com dados secundários oriundos da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL). As variáveis consideradas foram: ano, região de residência, capitais, sexo, idade e escolaridade. Resultados: No período ocorreu uma redução das taxas de adultos brasileiros com autoavaliação negativa do estado de saúde. A região Norte apresentou o maior percentual de autoavaliação negativa de saúde (3,9%). A frequência de autoavaliação negativa do estado de saúde foi maior nas mulheres (4,9%), entre as pessoas na faixa etária de 65 anos ou mais e em adultos com menor escolaridade (7,5%). Conclusão: As mulheres, adultos com mais idade e com menor grau de escolaridade tem uma maior autoavaliação negativa de saúde.

Objective: To describe the negative self-assessment of health status among adults in Brazil from 2011 to 2020. Method: Descriptive ecological study of time series conducted with secondary data from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL). The variables considered were: year, region of residence, capital, sex, age, and education. Results: In the period there was a reduction in the rates of Brazilian adults with negative self-assessment of health status. The North region presented the highest percentage of negative self-rated health (3.9%). The frequency of negative self-assessment of health status was higher in women (4.9%), among people aged 65 years or more and in adults with lower education (7.5%). Conclusion: Women, adults with older age and lower level of education have a higher negative self-rated health.

Objetivo: Describir la autoevaluación negativa del estado de salud entre adultos en Brasil de 2011 a 2020. Método: Estudio descriptivo de serie temporal ecológica realizado con datos secundarios de la Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Encuesta Telefónica (VIGITEL). Las variables consideradas fueron: año, región de residencia, capitales, sexo, edad y escolaridad. Resultados: Durante el período, hubo una reducción en las tasas de adultos brasileños con estado de salud autopercibido negativo. La región Norte presentó el mayor porcentaje de salud autoevaluada negativa (3,9%). La frecuencia de autoevaluación negativa del estado de salud fue mayor entre las mujeres (4,9%), entre las personas de 65 años o más y entre los adultos con menor escolaridad (7,5%). Conclusión: Las mujeres, los adultos mayores y los adultos con menor nivel educativo tienen una mayor autopercepción negativa de salud.

The association between variables of cardiopulmonary exercise test and quality of life in patients with chronic Chagas cardiomyopathy (Insights from the PEACH STUDY).

Studies investigating the association between functional capacity and quality of life (QoL) in individuals with chronic Chagas cardiomyopathy (CCC) usually do not include a gold-standard evaluation of functional capacity, limiting the validity and the interpretation of the results. The present study is a cross-section analysis aiming to evaluate the association between functional capacity (quantified by cardiopulmonary exercise test [CPET]) and QoL in individuals with CCC. QoL was assessed using the SF-36 questionnaire. Sociodemographic, anthropometric, clinical, cardiac function and maximal progressive CPET variables were obtained from PEACH study. Generalized linear models adjusted for age, sex, and left ventricular ejection fraction were performed to evaluate the association between CPET variables and QoL. After adjustments, VO2 peak and VO2 AT were both associated with physical functioning (ß = +0.05 and ß = +0.05, respectively) and physical component summary (ß = +0.03 and ß = +0.03, respectively). Double product was associated with physical functioning (ß = +0.003), general health perceptions (ß = +0.003), physical component summary (ß = +0.002), and vitality (ß = +0.004). HRR≤12bpm was associated with physical functioning (ß = -0.32), role limitations due to physical problems (ß = -0.87), bodily pain (ß = -0.26), physical component summary (ß = -0.21), vitality (ß = -0.38), and mental health (ß = -0.19). VE/VCO2 slope presented association with all mental scales of SF-36: vitality (ß = -0.028), social functioning (ß = -0.024), role limitations due to emotional problems (ß = -0.06), mental health (ß = -0.04), and mental component summary (ß = -0.02). The associations between CPET variables and QoL demonstrate the importance of CPET inclusion for a more comprehensive evaluation of individuals with CCC. In this setting, intervention strategies aiming to improve functional capacity may also promote additional benefits on QoL and should be incorporated as a treatment strategy for patients with CCC.

How COVID-19 elucidated challenges in the pedagogy of physiotherapy entry-level education in Brazil and directions for their remediation with special attention to digital teaching and learning.

INTRODUCTION: As experienced physiotherapy educators in Brazil, we observed that COVID-19 elucidated challenges in the pedagogy of entry-level education overall, and directions for their remediation. In this commentary, we describe our observations with particular attention to the opportunity for digital and distance teaching and learning in Brazil's exemplary middle-income country. BODY: First, the legislation in Brazil around health professional education, specifically entry-level physiotherapy education, is described concerning distanced learning. Then, we contrast such education before and during the COVID-19 pandemic, and in the aftermath of its peak. Our observations reinforce the need to preserve teaching and learning excellence in physiotherapy education with various approaches including distanced and digital learning; be aware of both advantages and disadvantages; and identify means of balancing these for optimal delivery and learner outcomes. Our collective experience and insights strongly support the need for change in the legislative document governing physiotherapy education in Brazil. CONCLUSION: We hope our experiences will enable other educators to evaluate their contexts, reflect on how best to deliver entry-level physiotherapy education in general and during a pandemic, and reinforce the essentiality of practical face-to-face classes in achieving physiotherapy competencies. Only in this way will global standards of practice be ensured, through quality professional education and the factors that inform and govern these.

The association of exercise test variables with long-term mortality in patients with chronic Chagas disease.

Background: The identification of variables obtained in the exercise test (ET) associated with increased risk of death is clinically relevant and would provide additional information for the management of Chagas disease (CD). The objective of the present study was to evaluate the association of ET variables with mortality in patients with chronic CD. Methods: This retrospective longitudinal observational study included 232 patients (median age 46.0 years; 50% women) with CD that were followed at the Evandro Chagas National Institute of Infectious Diseases (Rio de Janeiro, Brazil) and performed an ET between 1989 and 2000. The outcome of interest was all-cause mortality. Results: There were 103 deaths (44.4%) during a median follow-up of 21.5 years (IQR 25-75% 8.0-27.8), resulting in 24.5 per 1,000 patients/year incidence rate. The ET variables associated with mortality after adjustments for potential confounders were increased maximal (HR 1.02; 95% CI 1.00-1.03 per mmHg) and change (HR 1.03; 95% CI 1.01-1.06 per mmHg) of diastolic blood pressure (DBP) during ET, ventricular tachycardia at rest (HR 3.95; 95% CI 1.14-13.74), during exercise (HR 2.73; 95% CI 1.44-5.20), and recovery (HR 2.60; 95% CI 1.14-5.91), and premature ventricular complexes during recovery (HR 2.06; 1.33-3.21). Conclusion: Our findings suggest that ET provides important prognostic value for mortality risk assessment in patients with CD, with hemodynamic (increased DBP during exercise) and electrocardiographic (presence of ventricular arrhythmias) variables independently associated with an increased mortality risk in patients with CD. The identification of individuals at higher mortality risk can facilitate the development of intervention strategies (e.g., close follow-up) that may potentially have an impact on the longevity of patients with CD.

Cost-effectiveness of an exercise-based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study.

OBJECTIVES: The present study aimed to perform a cost-effectiveness analysis of an exercise-based cardiovascular rehabilitation (CR) program in patients with chronic Chagas cardiomyopathy (CCC). METHODS: Cost-effectiveness analysis alongside a randomised clinical trial evaluating the effects of a 6-month exercise-based CR program. The intervention group underwent 3 weekly exercise sessions. The variation of peak oxygen consumption (VO2peak ) was used as a measurement of clinical outcome. Cost information from all healthcare expenses (examinations, healthcare visits, medication and hospitalisation) were obtained from the medical records in Brazilian reais (R$) and transformed into dollars using the purchasing power parity ($PPP). The longitudinal costs variation was evaluated through linear mixed models, represented by ß coefficient, adjusted for the baseline values of the dependent variable. The cost-effectiveness evaluation was determined through an incremental cost-effectiveness ratio using the HEABS package (Stata 15.0). RESULTS: The intervention group presented higher costs with healthcare visits (ß = +3317.3; p < 0.001), hospitalisation (ß = +2810.4; p = 0.02) and total cost (ß = +6407.9; p < 0.001) after 3 months of follow-up. Costs related to healthcare visits (ß = +2455.8; p < 0.001) and total cost (ß = +4711.4; p < 0.001) remained higher in the intervention group after 6 months. The CR program showed an incremental cost-effectiveness ratio (ICER) of $PPP 1874.3 for each increase of 1.0 ml kg-1  min-1 of VO2peak . CONCLUSIONS: The CR program can be considered a cost-effective alternative and should be included as an intervention strategy in the care of patients with CCC.

Acute and subacute hemodynamic responses and perception of effort in subjects with chronic Chagas cardiomyopathy submitted to different protocols of inspiratory muscle training: a cross-over trial.

PURPOSE: This study aimed to evaluate acute and subacute hemodynamic responses and perception of effort in individuals with CCC submitted to different IMT protocols. MATERIALS AND METHODS: This was a randomized cross-over trial conducted on CCC subjects with systolic left ventricular dysfunction (<45% left ventricular ejection fraction) without or with heart failure (stages B2 and C, respectively). Twenty-one participants performed two IMT protocols, one targeting 60% maximal inspiratory pressure with 3 × 10 repetitions (MIP60) and the other targeting 30% maximal inspiratory pressure (MIP30) with 3 × 20 repetitions with a 2 min recovery between sets for both. MIP60 and MIP30 were performed on the same day with a 2 h washout period. Measurements were taken at baseline, during and 60 min after IMT. RESULTS: No differences in hemodynamic variables were observed across protocols. The perception of effort increased in both protocols, with higher scores for the MIP30 protocol (ß = +1.6, p = 0.01; ß = +1.1, p = 0.02; ß = +0.9, p = 0.08 for the 1st, 2nd and 3rd sets, respectively). CONCLUSIONS: There were no differences in hemodynamic responses comparing MIP60 and MIP30 protocols in subjects with CCC. Despite the higher perception of effort during endurance protocol, both protocols can be considered a safe therapeutic strategy.IMPLICATIONS FOR REHABILITATIONDespite inspiratory muscle training may result in functional capacity improvements, no previous study evaluated the hemodynamic acute and subacute responses to inspiratory muscle training in chronic Chagas cardiomyopathy.The two inspiratory muscle training protocols (30% and 60% of maximal inspiratory pressure) did not cause significant hemodynamic repercussions in subjects with chronic Chagas cardiomyopathy.Inspiratory muscle training seems to be an effective strategy to improve functional capacity and can be implemented in the rehabilitation programs for patients with Chagas cardiomyopathy.Since no significant adverse responses were observed in any of the hemodynamic parameters during the inspiratory muscle training sessions, these two protocols of inspiratory muscle training (30% and 60% of maximal inspiratory pressure) seems to be safe in subjects with Chagas cardiomyopathy.

Home-based exercise program in the indeterminate form of Chagas disease (PEDI-CHAGAS study): A study protocol for a randomized clinical trial.

Background: Chagas disease (CD) is a neglected endemic disease with worldwide impact due to migration. Approximately 50-70% of individuals in the chronic phase of CD present the indeterminate form, characterized by parasitological and/or serological evidence of Trypanosoma cruzi infection, but without clinical signs and symptoms. Subclinical abnormalities have been reported in indeterminate form of CD, including pro-inflammatory states and alterations in cardiac function, biomarkers and autonomic modulation. Moreover, individuals with CD are usually impacted on their personal and professional life, making social insertion difficult and impacting their mental health and quality of life (QoL). Physical exercise has been acknowledged as an important strategy to prevent and control numerous chronic-degenerative diseases, but unexplored in individuals with the indeterminate form of CD. The PEDI-CHAGAS study (which stands for "Home-Based Exercise Program in the Indeterminate Form of Chagas Disease" in Portuguese) aims to evaluate the effects of a home-based exercise program on physical and mental health outcomes in individuals with indeterminate form of CD. Methods and design: The PEDI-CHAGAS is a two-arm (exercise and control) phase 3 superiority randomized clinical trial including patients with indeterminate form of CD. The exclusion criteria are <18 years old, evidence of non-Chagasic cardiomyopathy, musculoskeletal or cognitive limitations that preclude the realization of exercise protocol, clinical contraindication for regular exercise, and regular physical exercise (≥1 × per week). Participants will be assessed at baseline, and after three and 6 months of follow-up. The primary outcome will be QoL. Secondary outcomes will include blood pressure, physical fitness components, nutritional status, fatigability, autonomic modulation, cardiac morphology and function, low back pain, depression and anxiety, stress, sleep quality, medication use and adherence, and biochemical, inflammatory and cardiac biomarkers. Participants in the intervention group will undergo a home-based exercise program whilst those in the control group will receive only general information regarding the benefits of physical activity. Both groups will receive the same general nutritional counseling consisting of general orientations about healthy diets. Conclusion: The findings from the present study may support public health intervention strategies to improve physical and mental health parameters to be implemented more effectively in this population. Clinical trial registration: [https://ensaiosclinicos.gov.br/rg/RBR-10yxgcr9/], identifier [U1111-1263-0153].

Repercussões da infodemia associada ao COVID-19 na saúde mental do idoso no Brasil / Repercusiones de la infodemia asociada al COVID-19 en la salud mental de los ancianos en Brasil / Repercussions of infodemia associated with COVID-19 on the mental health of the elderly in Brazil

O fenômeno denominado infodemia refere-se ao aumento do volume informacional sobre um tema em específico, que se multiplica rapidamente em um curto período de tempo, e tem-se destacado frente ao contexto da crise sanitária desencadeada pela pandemia de COVID-19. O excesso de informações pode suscitar sentimentos de medo, ansiedade, estresse e outras condições de sofrimento mental. O estudo tem como objetivo descrever o perfil de exposição a informações sobre COVID-19 e suas repercussões na saúde mental de idosos brasileiros. Trata-se de um estudo transversal realizado com 1924 idosos brasileiros. Coletaram-se dados por meio de web-based survey enviada aos idosos por redes sociais e e-mail, no período de julho a outubro de 2020. Os resultados da análise descritiva dos dados demonstram que a maioria dos idosos apresentou idade entre 60 e 69 anos (69,02por cento), é do sexo feminino (71,26por cento), casados (53,79 por cento) e de cor branca (75,57por cento). Cerca de 21,67por cento (n = 417) concluíram a graduação, 19,75por cento (380) concluíram especialização e 16,63por cento (320) concluíram mestrado ou doutorado. Foram reportados como fontes frequentes de exposição às notícias ou informações sobre a COVID-19, a televisão 862 (44,80por cento) e as redes sociais 651 (33,84por cento). Os participantes assinalaram que a televisão (46,47por cento; n = 872), as redes sociais (30,81por cento; n = 575) e o rádio (14,48por cento; 251) os afetavam psicológica e/ou fisicamente. Receber notícias falsas sobre a COVID-19 pela televisão (n = 482; 19,8por cento) e pelas redes sociais (n = 415; 21,5por cento) repercutiu, principalmente, estresse e medo. As informações disseminadas contribuem para conscientização, mas, também, afetam física e/ou psicologicamente muitos idosos, principalmente gerando medo e estresse(AU)

El fenómeno denominado infodemia hace referencia al aumento del volumen de información sobre un tema específico, que se multiplica rápidamente en un corto período, y ha destacado en el contexto de la crisis sanitaria desencadenada por la pandemia de la COVID-19. Demasiada información puede desencadenar sentimientos de miedo, ansiedad, estrés y otras condiciones de angustia mental. El estudio tiene como objetivo describir el perfil de exposición a la información sobre la COVID-19 y sus repercusiones en la salud mental de los ancianos brasileños. Se trata de un estudio transversal realizado con 1924 ancianos brasileños. Los datos fueron recolectados a través de una encuesta web enviada a los ancianos a través de redes sociales y correo electrónico, de julio a octubre de 2020. Los resultados del análisis descriptivo de los datos muestran que la mayoría de los ancianos tenían entre 60 y 69 años (69,02 por ciento), mujer (71,26 por ciento), casada (53,79 por ciento) y blanca (75,57 por ciento). El 21,67 por ciento (n = 417) concluyó su graduación, el 19,75 por ciento (380) concluyó especialización y el 16,63 por ciento (320) concluyó maestría o doctorado. La televisión 862 (44,80 por ciento) y las redes sociales 651 (33,84 por ciento) se reportaron como fuentes frecuentes de exposición a noticias o información sobre el COVID-19. Los participantes indicaron que la televisión (46,47 por ciento; n = 872), las redes sociales (30,81 por ciento; n = 575) y la radio (14,48 por ciento; 251) les afectaban psicológica y/o físicamente. Recibir noticias falsas sobre el COVID-19 en la televisión (n = 482; 19,8 por ciento) y en las redes sociales (n = 415; 21,5 por ciento) resultó principalmente en estrés y miedo. La información difundida contribuye a la sensibilización, pero también afecta física y/o psicológicamente a muchas personas mayores, generando principalmente miedo y estrés(AU)

The phenomenon called infodemia refers to the increase in the volume of information on a specific topic, which multiplies rapidly in a short period of time, and has stood out in the context of the health crisis triggered by the COVID-19 pandemic. Too much information can trigger feelings of fear, anxiety, stress, and other conditions of mental distress. The study aims to describe the profile of exposure to information about COVID-19 and its repercussions on the mental health of elderly Brazilians. This is a cross-sectional study carried out with 1924 elderly Brazilians. Data were collected through a web-based survey sent to the elderly via social networks and email, from July to October 2020. The results of the descriptive analysis of the data show that most of the elderly were aged between 60 and 69 years (69.02percent), female (71.26percent), married (53.79percent) and white (75.57percent). About 21.67percent (n = 417) concluded their graduation, 19.75percent (380) concluded their specialization and 16.63percent (320) concluded their master's or doctoral degrees. Television 862 (44.80percent) and social networks 651 (33.84percent) were reported as frequent sources of exposure to news or information about COVID-19. Participants indicated that television (46.47percent; n = 872), social networks (30.81percent; n = 575) and radio (14.48percent; 251) affected them psychologically and/or physically. Receiving fake news about COVID-19 on television (n = 482; 19.8percent) and on social media (n = 415; 21.5percent) mainly resulted in stress and fear. The disseminated information contributes to awareness, but also affects physically and/or psychologically many elderly people, mainly generating fear and stress(AU)

Optimization and Clinical Validation of Colorimetric Reverse Transcription Loop-Mediated Isothermal Amplification, a Fast, Highly Sensitive and Specific COVID-19 Molecular Diagnostic Tool That Is Robust to Detect SARS-CoV-2 Variants of Concern.

The coronavirus disease 2019 (COVID-19) pandemic unfolded due to the widespread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission reinforced the urgent need for affordable molecular diagnostic alternative methods for massive testing screening. We present the clinical validation of a pH-dependent colorimetric reverse transcription loop-mediated isothermal amplification (RT-LAMP) for SARS-CoV-2 detection. The method revealed a limit of detection of 19.3 ± 2.7 viral genomic copies/µL when using RNA extracted samples obtained from nasopharyngeal swabs collected in guanidine-containing viral transport medium. Typical RT-LAMP reactions were performed at 65°C for 30 min. When compared to reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR), up to cycle-threshold (Ct) value 32, RT-LAMP presented 98% [95% confidence interval (CI) = 95.3-99.5%] sensitivity and 100% (95% CI = 94.5-100%) specificity for SARS-CoV-2 RNA detection targeting E and N genes. No cross-reactivity was detected when testing other non-SARS-CoV virus, confirming high specificity. The test is compatible with primary RNA extraction-free samples. We also demonstrated that colorimetric RT-LAMP can detect SARS-CoV-2 variants of concern and variants of interest, such as variants occurring in Brazil named gamma (P.1), zeta (P.2), delta (B.1.617.2), B.1.1.374, and B.1.1.371. The method meets point-of-care requirements and can be deployed in the field for high-throughput COVID-19 testing campaigns, especially in countries where COVID-19 testing efforts are far from ideal to tackle the pandemics. Although RT-qPCR is considered the gold standard for SARS-CoV-2 RNA detection, it requires expensive equipment, infrastructure, and highly trained personnel. In contrast, RT-LAMP emerges as an affordable, inexpensive, and simple alternative for SARS-CoV-2 molecular detection that can be applied to massive COVID-19 testing campaigns and save lives.

Temporal changes in the clinical-epidemiological profile of patients with Chagas disease at a referral center in Brazil.

INTRODUCTION: We aimed to describe the sociodemographic, epidemiological, and clinical characteristics of patients with chronic Chagas disease (CD) at an infectious disease referral center. Changes in patient profiles over time were also evaluated. METHODS: This retrospective study included patients with CD from November 1986-December 2019. All patients underwent an evaluation protocol that included sociodemographic profile; epidemiological history; anamnesis; and physical, cardiologic, and digestive examinations. Trend differences for each 5-year period from 1986 to 2019 were tested using a nonparametric trend test for continuous and generalized linear models with binomial distribution for categorical variables. RESULTS: A total of 2,168 patients (52.2% women) were included, with a mean age of 47.8 years old. White patients with low levels of education predominated. The reported transmission mode was vectorial in 90.2% of cases. The majority came from areas with a high prevalence (52.2%) and morbidity (67.8%) of CD. The most common clinical presentation was the indeterminate form (44.9%). The number of patients referred gradually decreased and the age at admission increased during the study period, as did the patients' levels of education. CONCLUSIONS: The clinical profile of CD is characterized by a predominance of the indeterminate form of the disease. Regarding the patients who were followed up at the referral center, there was a progressive increase in the mean age and a concomitant decrease in the number of new patients. This reflects the successful control of vector and transfusion transmission in Brazil as well as the aging population of patients with CD.