Mapping the learning styles of medical students in Brazil.

BACKGROUND: Medical education has evolved based on the application of pedagogical actions that place the student as the protagonist of the learning process through the use of active teaching methodologies. Within this context, higher education teachers should use strategies that focus on the student and his/her context and avoid traditional teaching methods. Specifically in medical schools, there is an even greater challenge since the teaching methods of medical curricula differ from those used in previous schooling. Consequently, students acquire their own style of processing information that is often incompatible with the profile of medical schools. This may be one of the factors responsible for the lack of motivation among undergraduates. OBJECTIVE: The aim of this study was to characterize the learning styles of students enrolled in a Brazilian medical school using the Felder-Soloman Index of Learning Styles (ILS). METHODS: This was a cross-sectional, descriptive, quantitative study that included students from the 1st to the 6th year of a Brazilian medical school. The students participating in this study voluntarily answered 44 questions about learning styles of the Felder-Silverman instrument validated in Brazil. The instrument was divided so that each domain consisted of 11 questions with two response options in which only one could be selected. For each domain, a score (1 point) was assigned to the selected option (a, b) of the question and the learning style category was determined as the difference between these values. For data collection and tabulation, we used the Learning Syle Platform (EdA Platform) developed based on Felder's studies since this system processes information about the dimension analyzed, the preferred style, and the most striking characteristics of each style. RESULTS: The results showed that sensing was the preferred learning style of the students, followed by the sequential and visual styles. It was not possible to determine whether gender or age influences the choice of learning methods because of the homogeneity of the results. CONCLUSIONS: The present data will enable teachers of the institution involved in this study to plan pedagogical actions that improve the students' self-awareness, as well as their teaching-learning skills, by choosing the most adequate active methodologies for the medical education programs considering the individuality of each student and class.

Genetic alterations landscape in paediatric thyroid tumours and/or differentiated thyroid cancer: Systematic review.

Differentiated thyroid cancer (DTC) is a rare disease in the paediatric population (≤ 18 years old. at diagnosis). Increasing incidence is reflected by increases in incidence for papillary thyroid carcinoma (PTC) subtypes. Compared to those of adults, despite aggressive presentation, paediatric DTC has an excellent prognosis. As for adult DTC, European and American guidelines recommend individualised management, based on the differences in clinical presentation and genetic findings. Therefore, we conducted a systematic review to identify the epidemiological landscape of all genetic alterations so far investigated in paediatric populations at diagnosis affected by thyroid tumours and/or DTC that have improved and/or informed preventive and/or curative diagnostic and prognostic clinical conduct globally. Fusions involving the gene RET followed by NTRK, ALK and BRAF, were the most prevalent rearrangements found in paediatric PTC. BRAF V600E was found at lower prevalence in paediatric (especially ≤ 10 years old) than in adults PTC. We identified TERT and RAS mutations at very low prevalence in most countries. DICER1 SNVs, while found at higher prevalence in few countries, they were found in both benign and DTC. Although the precise role of DICER1 is not fully understood, it has been hypothesised that additional genetic alterations, similar to that observed for RAS gene, might be required for the malignant transformation of these nodules. Regarding aggressiveness, fusion oncogenes may have a higher growth impact compared with BRAF V600E. We reported the shortcomings of the systematized research and outlined three key recommendations for global authors to improve and inform precision health approaches, glocally.

Intensity-Dependent Influence of Interoceptive Accuracy on Psychophysiological Responses During Aerobic Exercise in Physically Inactive Men.

We aimed to investigate the influence of interoceptive accuracy on affective valence, arousal, and ratings of perceived exertion (RPE) during 20 minutes of aerobic exercise at both moderate and heavy intensity among physically inactive men. We divided our participant sample into men with poor heartbeat perception (PHP, n = 13) and good heartbeat perception (GHP, n = 15), based on their cardioceptive accuracy. We measured their heart rate reserve (%HRreserve), perceived affective valence (Feeling Scale; +5/-5), perceived arousal (Felt Arousal Scale, 0-6), and ratings of perceived effort (RPE; Borg scale 6-20) every five minutes during an exercise session on a bicycle ergometer. During moderate-intensity aerobic exercise, the GHP group presented a greater decline in affective valence (p = 0.010; d = 1.06) and a greater increase in RPE (p = 0.004; d = 1.20) compared to the PHP group, with no group differences in %HRreserve (p = 0.590) and arousal (p = 0.629). Psychophysiological and physiological responses to the heavy-intensity aerobic exercise were not different between groups. We concluded that the influence of interoceptive accuracy on psychophysiological responses during submaximal fixed-intensity aerobic exercise was intensity-dependent in these physically inactive men.

Associations between physical activity and cardiorespiratory fitness with vascular health phenotypes in older adults: a cross-sectional study.

Objective: We investigated the associations between physical activity (PA) and cardiorespiratory fitness (CRF) with vascular health phenotypes in community-dwelling older adults. Methods: This cross-sectional study included 82 participants (66.8 ± 5.2 years; 81% females). Moderate-to-vigorous physical activity (MVPA) was assessed using accelerometers, and CRF was measured using the distance covered in the 6-min walk test (6MWT). The vascular health markers were as follows: i) arterial function measured as aortic pulse wave velocity (aPWV) estimated using an automatic blood pressure device; and ii) arterial structure measured as the common carotid intima-media thickness (cIMT). Using a combination of normal cIMT and aPWV values, four groups of vascular health phenotypes were created: normal aPWV and cIMT, abnormal aPWV only, abnormal cIMT only, and abnormal aPWV and cIMT. Multiple linear regression was used to estimate the beta coefficients (ß) and their respective 95% confidence intervals (95% CI) adjusting for BMI, and medication for diabetes, lipid, and hypertension, sex, age, and blood pressure. Results: Participants with abnormal aPWV and normal cIMT (ß = -53.76; 95% CI = -97.73--9.78 m; p = 0.017), and participants with both abnormal aPWV and cIMT (ß = -71.89; 95% CI = -125.46--18.31 m; p = 0.009) covered less distance in the 6MWT, although adjusting for age, sex and blood pressure decreased the strength of the association with only groups of abnormal aPWV and cIMT covering a lower 6MWT distance compared to participants with both normal aPWV and cIMT (ß = -55.68 95% CI = -111.95-0.59; p = 0.052). No associations were observed between MVPA and the vascular health phenotypes. Conslusion: In summary, poor CRF, but not MVPA, is associated with the unhealthiest vascular health phenotype (abnormal aPWV/cIMT) in older adults.

Fasting and prolonged food restriction differentially affect GH secretion independently of GH receptor signaling in AgRP neurons.

Growth hormone (GH) receptor (GHR) is abundantly expressed in neurons that co-release the agouti-related protein (AgRP) and neuropeptide Y (NPY) in the arcuate nucleus of the hypothalamus (ARH). Since ARHAgRP/NPY neurons regulate several hypothalamic-pituitary-endocrine axes, this neuronal population possibly modulates GH secretion via a negative feedback loop, particularly during food restriction, when ARHAgRP/NPY neurons are highly active. The present study aims to determine the importance of GHR signaling in ARHAgRP/NPY neurons on the pattern of GH secretion in fed and food-deprived male mice. Additionally, we compared the effect of two distinct situations of food deprivation: 16 h of fasting or four days of food restriction (40% of usual food intake). Overnight fasting strongly suppressed both basal and pulsatile GH secretion. Animals lacking GHR in ARHAgRP/NPY neurons (AgRP∆GHR mice) did not exhibit differences in GH secretion either in the fed or fasted state, compared to control mice. In contrast, four days of food restriction increased GH pulse frequency, basal GH secretion, and pulse irregularity/complexity (measured by sample entropy), whereas pulsatile GH secretion was not affected in both control and AgRP∆GHR mice. Hypothalamic Ghrh mRNA levels were unaffected by fasting or food restriction, but Sst expression increased in acutely fasted mice, but decreased after prolonged food restriction in both control and AgRP∆GHR mice. Our findings indicate that short-term fasting and prolonged food restriction differentially affect the pattern of GH secretion, independently of GHR signaling in ARHAgRP/NPY neurons.

Implicit motor imagery performance and cortical activity throughout the menstrual cycle.

Studies show that female motor and visuospatial skills are modulated by the menstrual cycle. Implicit motor imagery, meaning the involuntary imagination of movements during a task, involves kinesthetic, visual, and spatial aspects of the corresponding action and can be investigated by using the hand laterality judgment task (HLJT). In this study we aimed to investigate whether implicit motor imagery performance and cortical activity are altered throughout the menstrual cycle, as demonstrated by motor skills in females. Thus, 31 healthy women underwent HLJT during the menstrual, follicular and luteal phases of their menstrual cycles. Right-handed participants had to recognize the laterality (right or left) of hands presented in different views (palm or back) and orientations on a computer screen. Test performance and EEG event-related potentials were analyzed. Participants performed better in the test in the follicular and luteal phases when compared to the menstrual phase, and the accuracy of the test was positively correlated with estradiol levels in the follicular phase. The difference between medial and lateral hand orientations for rotation-related negativity was significant in the medial and left parieto-occipital regions only in the follicular phase. These findings suggest positive modulating action of estradiol in performing implicit motor imagery.

Aplicativos móveis direcionados aos idosos para autogerenciamento do cuidado: revisão de escopo / Mobile apps aimed at the elderly for self-management of care: scoping review / Aplicaciones móviles dirigidas a personas mayores para la autogestión del cuidado: revisión del alcances

Introdução: o uso de aplicativos móveis pode facilitar o autogerenciamento em saúde e oportunizar a autonomia dos idosos no seu autocuidado. Objetivo: mapear a produção científica sobre aplicativos móveis para autogerenciamento do cuidado direcionados aos idosos. Materiais e Métodos: revisão de escopo realizada no período de setembro de 2020 a janeiro de 2021, a partir das bases de dados: MEDLINE, SciELO, Scopus, Web of Science e Science Direct, mediante a estratégia de busca: ("Self-management" OR "Self-care") AND (Elderly OR "Old man") AND ("Mobile Applications" OR Smartphone OR "Cell phone"), com a inclusão de artigos que tratassem do uso de aplicativos móveis por idosos para o autogerenciamento do cuidado, sem delimitação de tempo e idioma. Resultados: a amostra final compôs-se de 14 artigos, categorizados em três vertentes de gerenciamento, a saber: medicamentos, comorbidades e práticas saudáveis. Na maioria dos estudos, os aplicativos foram direcionados ao autogerenciamento dos medicamentos, seguidos dos cuidados de condições crônicas e por último a autoavaliação do risco de quedas e tratamentos não-farmacológicos da dor. Discussão: esta revisão contribui para a prática clínica e pesquisa em enfermagem, uma vez que seus resultados apontam o que há publicado sobre o desenvolvimento e uso de aplicativos móveis por idosos para o autogerenciamento do cuidado. Conclusões: o uso de aplicativos móveis facilita o autocuidado da população idosa, principalmente, na gestão de medicamentos para condições crônicas.

Introduction: the use of mobile applications can facilitate self-management in health and provide opportunities for the autonomy of the elderly in their self-care. Objective: to map the scientific production on mobile applications for self-management of care aimed at the elderly. Materials and Methods: scope review carried out from September 2020 to January 2021, based on the following databases: MEDLINE, SciELO, Scopus, Web of Science and Science Direct, using the search strategy: ("Self-management" OR "Self-care") AND (Elderly OR "Old man") AND ("Mobile Applications" OR Smartphone OR "Cell phone"), with the inclusion of articles dealing with the use of mobile applications by the elderly for self-management of care, without time and language limitations. Results: the final sample consisted of 14 articles, categorized into three aspects of management, namely: medications, comorbidities and healthy practices. In most studies, applications were aimed at self-management of medications, followed by care for chronic conditions and finally self-assessment of the risk of falls and non-pharmacological pain treatments. Discussion: this review contributes to clinical practice and nursing research, as its results point to what has been published about the development and use of mobile applications by the elderly for self-management of care. Conclusions: the use of mobile applications facilitates self-care for the elderly population, especially in the management of medication for chronic conditions.

Introducción: el uso de aplicaciones móviles puede facilitar la autogestión en salud y brindar oportunidades para la autonomía de las personas mayores en su autocuidado. Objetivo: mapear la producción científica en aplicaciones móviles para la autogestión del cuidado dirigido a las personas mayores. Materiales y Métodos: revisión de alcance realizada desde septiembre de 2020 a enero de 2021, con base en las siguientes bases de datos: MEDLINE, SciELO, Scopus, Web of Science y Science Direct, utilizando la estrategia de búsqueda: ("Self-management" OR "Self-care") AND (Elderly OR "Old man") AND ("Mobile Applications" OR Smartphone OR "Cell phone"), con la inclusión de artículos que tratan sobre el uso de aplicaciones móviles por parte de los ancianos para la autogestión de cuidado, sin limitaciones de tiempo e idioma. Resultados: la muestra final constó de 14 artículos, categorizados en tres aspectos del manejo, a saber: medicamentos, comorbilidades y prácticas saludables. En la mayoría de los estudios, las aplicaciones estuvieron dirigidas al autocontrol de los medicamentos, seguido de la atención de las condiciones crónicas y finalmente la autoevaluación del riesgo de caídas y los tratamientos no farmacológicos del dolor. Discusión: esta revisión contribuye a la práctica clínica y la investigación en enfermería, ya que sus resultados apuntan a lo publicado sobre el desarrollo y uso de aplicaciones móviles por parte de los ancianos para la autogestión del cuidado. Conclusiones: el uso de aplicaciones móviles facilita el autocuidado de la población anciana, especialmente en el manejo de la medicación para enfermedades crónicas.

Prophylactic action of ayahuasca in a non-human primate model of depressive-like behavior.

Observational studies of long-term users of ayahuasca, an Amazonian psychedelic brew, suggest an increase in resilience via improvements in emotion and cognition. Ayahuasca has also demonstrated clinical antidepressant effects in human and animal studies; however, its potential prophylactic action in depression has not been previously studied. Therefore, this experimental study sought to evaluate the potential prophylactic effects of repeated and long-term ayahuasca use, via the modulation of resilience, in a non-human primate animal model, Callithrix jacchus, subjected to a protocol for induction of depressive-like behavior. For the formation of the study groups, some juvenile marmosets were kept in their family groups (GF = 7), while for the two experimental groups, the animals were removed from the family and kept socially isolated. Then, part of the isolated animals made up the group in which ayahuasca was administered (AG, n = 6), while for others, no intervention was made (IG, n = 5). AG animals took ayahuasca (1.67 mL/300g body weight) at weeks 4 (before isolation), 8, and 12 (during isolation) of the study. More adaptive stress response was observed for the AG when compared to the IG. The AG showed higher cortisol reactivity and fecal cortisol levels than IG, while both measures were similar to FG. Moreover, AG animals showed no signs of anhedonia and no increase in chronic stress-related behaviors, which were expressed by the IG. Thus, ayahuasca seems to promote the expression of resilient responses, indicating a prophylactic action, buffering the emergence of depressive-like behaviors and cortisol alterations associated with major depression. These results are encouraging for further research on the prophylactic use of psychedelics to prevent psychopathologies associated with chronic stress.

The bank robbery analogy as a first approach for understanding basic concepts of synthesis, transport, and mechanism of action of hormones.

Learning endocrine physiology can be challenging. Some physiological concepts are abstract, making the process of learning more difficult for students. The comprehension of basic concepts, such as chemical hormone classification, is essential to understand the differences in synthesis, secretion, transport, and mechanism of action of hormones. To assist the students on this subject, we developed an analogy between the basic concepts of hormone synthesis, transport, and mechanism of action and a bank robbery as a first approach to engage and stimulate their learning process. In the analogy, the students are asked to help identify and characterize two bank robbery crews based on a set of evidence collected by the police. The goal is to identify the general profile of lipid- and water-soluble hormones synthesis, transport, and mechanism of action on target cells. When applying the activity, the students showed a great deal of interest in solving the crime and they seemed to understand the similarities between the analogy and the subject.NEW & NOTEWORTHY Two endocrine bank robbery crews are being searched by the police. As an endocrine system student, you have been summoned to help the police solve the robberies.

Criterion validity of 14-item Health Literacy Scale (HLS-14) questionnaire in Brazilian adults and older people.

The objective of this study was to evaluate the criterion validity of the 14-item Health Literacy Scale (HLS-14) in Brazilian adults and older adults. The cross-sectional study performed in an oral health (OH) prospective cohort was conducted in 2017 in Piracicaba, Brazil. The HLS-14 questionnaire was applied to evaluate Health Literacy (HL) by dimensions: Functional literacy (FunL), Communicative literacy (ComL) and Critical literacy (CriL). An evaluation protocol (EP) was proposed to evaluate the criterion validity of HLS-14 considering HL dimensions (FunL: reading of the drug information leaflets; ComL: reading of the medical prescription and CriL: identification of OH conditions). HL (total) was dichotomized by the median in high (≥35 point) or low (<35 point) HL. Kendall's rank correlation coefficient (p < 0.05) and chi-squared test (p < 0.05) were applied. There was agreement between EP and HLS-14 for FunL (p < 0.01). There was association between high HL, measured through the HLS-14 questionnaire, assessing the reading of the drug information leaflets (p < 0.01) and the need for help to read them (p < 0.01). EP showed association between high HL and being able to read the drug information leaflet (p < 0.01), not needing help to read (p < 0.01), having found in the prescription all the information to take the medicine (p < 0.01) and knowing two or more health and OH information in the educational material (p < 0.01). The HSL-14 questionnaire showed criterion validity to measure FunL, and for some items of ComL and CriL evaluation. HL evaluation in a practical and multidimensional way could have an effect on the communication between health professional and patient, motivation and health outcomes.

Increased GH Secretion and Body Growth in Mice Carrying Ablation of IGF-1 Receptor in GH-releasing Hormone Cells.

Growth hormone (GH) secretion is controlled by short and long negative feedback loops. In this regard, both GH (short-loop feedback) and insulin-like growth factor 1 (IGF-1; long-loop feedback) can target somatotropic cells of the pituitary gland and neuroendocrine hypothalamic neurons to regulate the GH/IGF-1 axis. GH-releasing hormone (GHRH)-expressing neurons play a fundamental role in stimulating pituitary GH secretion. However, it is currently unknown whether IGF-1 action on GHRH-expressing cells is required for the control of the GH/IGF-1/growth axis. In the present study, we investigated the phenotype of male and female mice carrying ablation of IGF-1 receptor (IGF1R) exclusively in GHRH cells. After weaning, both male and female GHRHΔIGF1R mice exhibited increases in body weight, lean body mass, linear growth, and length of long bones (tibia, femur, humerus, and radius). In contrast, the percentage of body fat was similar between control and GHRHΔIGF1R mice. The higher body growth of GHRHΔIGF1R mice can be explained by increases in mean GH levels, GH pulse amplitude, and pulse frequency, calculated from 36 blood samples collected from each animal at 10-minute intervals. GHRHΔIGF1R mice also showed increased hypothalamic Ghrh mRNA levels, pituitary Gh mRNA expression, hepatic Igf1 expression, and serum IGF-1 levels compared with control animals. Furthermore, GHRHΔIGF1R mice displayed significant alterations in the sexually dimorphic hepatic gene expression profile, with a prevailing feminization in most genes analyzed. In conclusion, our findings indicate that GHRH neurons represent a key and necessary site for the long-loop negative feedback that controls the GH/IGF-1 axis and body growth.

Effect of the Menstrual Cycle on Electroencephalogram Alpha and Beta Bands During Motor Imagery and Action Observation.

Female sex steroids (FSS) can affect the motor system, modulating motor cortex excitability as well as performance in dexterity and coordination tasks. However, it has not yet been explored whether FSS affects the cognitive components of motor behavior. Mu is a sensorimotor rhythm observed by electroencephalography (EEG) in alpha (8-12 Hz) and beta (15-30 Hz) frequency bands in practices such as motor imagery (MI) and action observation (AO). This rhythm represents a window for studying the activity of neural circuits involved in motor cognition. Herein we investigated whether the alpha-mu and beta-mu power in the sensorimotor region (C3 and C4, hypothesis-driven approach) and the alpha and beta power over frontal, parietal, and occipital regions (data-driven approach) are modulated differently in the menstrual, follicular, and luteal phases of menstrual cycles in right-handed dominant women. To do so, these women underwent MI and AO in the three menstrual cycle phases. The spectral activity of the cortical regions for the alpha and beta bands were compared between phases of the menstrual cycle and a correlation analysis was also performed in relation to estrogen and progesterone levels. For the hypothesis-based approach, beta-mu event-related desynchronization (ERD) was significantly stronger in the C3 channel in the follicular phase than in the menstrual and luteal phases. For the data-driven approach, beta ERD during MI was higher in the follicular phase than in the menstrual and luteal phases in the frontal region. These findings suggest the effect of FSS on executive movement control. No effect of menstrual cycle phases was observed in cortical areas investigated during OA, but alpha and beta bands correlated positively with the follicular phase plasma estradiol level. Thus, the attenuation of alpha and beta bands referring to mirror neuron activities appears to be associated with inhibition of cortical activity when estradiol levels are lower, improving cognitive processing of motor action.

Welfare Improvement by Enrichment Programs in Common Marmoset Females Under Social Isolation.

Animal welfare is critical to buffer stress in captive animals and to ensure the reliability of data from studies. The most usual environmental enrichment technique (EE) for social non-human primates is the social enrichment. However, some experimental protocols require keeping individuals isolated, thus demanding other types of EE. We tested in six adult Callithrix jacchus females, single housed for experimental purpose, the stress buffering efficacy of a structural enrichment protocol (SEP) and SEP in combination with a foraging enrichment (FSEP) using  fecal cortisol and behaviors to infer stress levels. Both types of EE improved welfare in different ways, while cortisol levels decreased with both EE as compared to the baseline, autogrooming, and piloerection increased after FSEP probably due to the new foods. Therefore, these findings support alternative practices of EE when social animals are living in isolation and reinforce the positive role of structural and food enrichment for decreasing stress markers. It also encourages studies on welfare with females, since its use as an animal model has increased.

Perception and knowledge of pharmacogenetics among Brazilian psychiatrists.

Pharmacogenetics (PGx) can optimize drug therapy in psychiatry and is particularly important in admixed populations. Here we developed and successfully validated a questionnaire for assessing the perception and knowledge of PGx among Brazilian psychiatrists. Overall, the participants showed some familiarity with PGx. Most psychiatrists reported to have knowledge of PGx and recognized its usefulness in psychiatry; however, they declared concerns regarding PGx education, the request of tests and their interpretation, cost-effectiveness, and ethical issues. PGx testing is relatively prevalent in their clinical practice, but education on the topic is lacking. Bivariate analysis revealed significant associations. Psychiatrists > 40 years of age more frequently had a positive perception of other clinicians' familiarity with PGx. Psychiatrists in private health services showed less self-reported competency in the use of PGx testing. Furthermore, women had better perception of PGx education. The present study adds knowledge about PGx in psychiatry and encourages the development of educational and training resources for PGx to improve its clinical implementation.

Consequences of Using Artificial Nipples in Exclusive Breastfeeding: An Integrative Review / Consequências do uso de bicos artificiais para a amamentação exclusiva: uma revisão integrativa / Consecuencias del uso de pezones artificiales para la lactancia exclusiva: una revisión integradora

Objetivo: describir las consecuencias del uso de picos artificiales para la lactancia exclusiva. Materiales y método: revisión integradora realizada en las bases de datos Medline®, Cinahl, Lilacs, Web of Science e Scopus para contestar a la siguiente cuestión: ¿cuál es la influencia que ejerce en la lactancia la oferta de picos artificiales a los recién nacidos? Resultados: se analizaron 38 artículos; el análisis originó dos categorías: factores neonatales y factores maternos de influencia en la lactancia exclusiva. La interrupción de la lactancia materna fue el factor neonatal más asociado al uso de picos artificiales, mientras el nivel de escolaridad materno se destacó como factor interviniente en la lactancia exclusiva. El chupo fue el pico artificial más encontrado citado, seguido del biberón y del protector mamilar. Conclusiones: las consecuencias de la oferta de picos artificiales a los bebés em la lactancia son, en su mayoría, negativas y relacionadas con el neonato, como el desmame temprano y el rechazo al seno, la succión perjudicada, el agarre inadecuado, la interferencia en el desarrollo orofacial y la interrupción de la lactancia materna exclusiva. Las madres que ofrecieron picos artificiales a sus hijos están más propensas a sentir dolor, tener fisura mamilar, frustración y reducción de la interacción con su hijo.

Objetivo: descrever as consequências do uso de bicos artificiais para a amamentação exclusiva. Materiais e método: revisão integrativa realizada nas bases de dados Medline®, Cinahl, Lilacs, Web of Science e Scopus para responder à seguinte questão: qual a influência que a oferta de bicos artificiais aos recém-nascidos exerce na amamentação? Resultados: foram analisados 38 artigos; a análise deu origem a duas categorias: fatores neonatais e fatores maternos de influência na amamentação exclusiva. A interrupção do aleitamento materno foi o fator neonatal mais relacionado ao uso de bicos artificiais, enquanto o nível de escolaridade materno destacou-se como fator interveniente na amamentação exclusiva. A chupeta foi o bico artificial mais encontrado citado, seguido da mamadeira e do protetor mamilar. Conclusões: as consequências da oferta de bicos artificiais às crianças em amamentação são, em sua maioria, negativas e relacionadas ao neonato, como o desmame precoce, a recusa do peito, a sucção prejudicada, a pega incorreta, a interferência no desenvolvimento orofacial e a interrupção do aleitamento materno exclusivo. As mães que ofereceram bicos artificiais aos seus filhos estão mais propensas a ter dor, fissura mamilar, frustração e redução da interação com seu filho.

Objective: To describe the consequences of using artificial nipples to exclusive breastfeeding. Materials and method: An integrative review carried out in the Medline®, Cinahl, Lilacs, Web of Science, and Scopus databases to answer the following question: What are the consequences of using artificial nipples to exclusive breastfeeding? Results: 38 articles were analyzed; the analysis gave rise to two categories: neonatal factors and maternal factors influencing exclusive breastfeeding. Breastfeeding interruption was the neonatal factor most associated with the use of artificial nipples, while the level of maternal education stood out as an intervening factor in exclusive breastfeeding. Pacifiers were the dummy type more commonly mentioned, followed by feeding bottles and nipple shields. Conclusions: The consequences of offering artificial nipples to breastfed infants are mostly negative and associated with the newborn, such as early weaning, refusal to breastfeed, impaired suction technique, incorrect latch-on, interference with orofacial development, and interruption of exclusive breastfeeding. Mothers who offered artificial nipples to their infants are more likely to experience pain, nipple fissures, frustration, and reduced interaction with their infants.

Spondias mombin as a reservoir of fruit fly parasitoid populations in the Eastern Amazon: an undervalued ecosystem service.

Fruit flies are economically important pests that infest a wide variety of host trees. The environmental damage caused by traditional pesticide-based control methods has prompted scientists to seek less damaging alternatives such as biological control by native species. Parasitoids, especially Braconidae species, have excellent potential as biological control agents for fruit flies, being both generalists and well distributed geographically. Native fruit trees that support medium or high levels of these parasitoids could therefore play an important role in biological control strategies. A good potential example is Spondias mombin L. in the Brazilian Amazon, which hosts several species of fruit flies and associated parasitoids. Here, we provide a unique synthesis of over nearly two decades of data from the east Amazon, clearly demonstrating the potential of S. mombin to act as a source and reservoir of fruit fly parasitoids. This important ecosystem service (biological control) provided by the parasitoids and supported by S. mombin could be further enhanced through conservation of this plant species in its natural environment.

Natural and Experimental Evidence Drives Marmosets for Research on Psychiatric Disorders Related to Stress.

Knowledge of the behavioral ecology of marmosets carried out in their natural habitat associated with the advent of a non-invasive technique for measuring steroid hormones in feces has made a significant contribution to understanding their social relationships and sexual strategies. These studies showed that they are mainly monogamous, live in relatively stable social groups according to a social hierarchy in which females compete and males cooperate, and form social bonds similar to humans, which makes this species a potential animal model to study disorders related to social stress. In addition, laboratory studies observed the expression of behaviors similar to those in nature and deepened the descriptions of their social and reproductive strategies. They also characterized their responses to the challenge using behavioral, cognitive, physiological, and genetic approaches that were sexually dimorphic and influenced by age and social context. These findings, added to some advantages which indicate good adaptation to captivity and the benefits of the birth of twins, small size, and life cycle in comparison to primates of the Old World, led to their use as animal models for validating psychiatric diseases such as major depression. Juvenile marmosets have recently been used to develop a depression model and to test a psychedelic brew called Ayahuasca from the Amazon rainforest as an alternative treatment for major depression, for which positive results have been found which encourage further studies in adolescents. Therefore, we will review the experimental evidence obtained so far and discuss the extension of the marmoset as an animal model for depression.

Effectiveness of integrative medicine practices on workers' health within private companies.

INTRODUCTION: The attention to workers' health is fundamental not only considering economical aspects (reducing absenteeism) but also for guaranteeing their quality of life. OBJECTIVES: To verify whether integrative medicine practices are effective for workers in private companies. METHODS: Data were obtained from medical records of the acupuncture service of Irmandade da Santa Casa de Misericórdia de Piracicaba, in the state of São Paulo, Brazil. This is a descriptive study that evaluated the effectiveness of invasive and non-invasive integrative medicine practices in workers' health through the use of the visual numeric scale for measuring pain, as well as independent variables (sex, age, types of physical and emotional complaints). Our sample consisted of 259 workers in 14 companies. Results were statistically evaluated using a Student's t-test and a significance level of p = 0.05. RESULTS: Most of the patients that sought integrative medicine services were women (73%), with a mean age of 38 years. The mean visual numeric scale value for workers that had physical pain complaints at the first session was 4.96, while that at the final session was 1.38; this reduction was significant (p < 0.0001). Emotional symptoms showed a visual numeric scale reduction of 5.18 to 1.90 (p < 0.0001). Regardless of the practice type (invasive or non-invasive), we observed a reduction in visual numeric scale values over integrative medicine sessions, although invasive therapies resulted in a stronger reduction than non-invasive ones (p < 0.0001). CONCLUSIONS: Overall, integrative medicine practices had a positive impact on workers' health, reducing physical and emotional pain.

To Combine or Not to Combine Physical Therapy With tDCS for Stroke With Shoulder Pain? Analysis From a Combination Randomized Clinical Trial for Rehabilitation of Painful Shoulder in Stroke.

Purpose: Transcranial Direct Current Stimulation (tDCS) is an intervention that seems to be an ideal tool to enhance the effects of rehabilitation therapies given it facilitates generation of plasticity in the stimulated brain area. In stroke this strategy has been highly utilized; however, the results have been mixed. In this trial we have evaluated the analgesic and functional effects of Transcranial Direct Current Stimulation (tDCS) combined with physiotherapy in stroke survivors with shoulder pain. Methods: Twenty-six stroke surviving adults with shoulder pain received 10 sessions of passive mobilization and performed upper limb exercises using a cycle ergometer, combined with active or sham tDCS. The intensity of pain in the hemiplegic shoulder was measured using the Visual Analog Scale (VAS); secondary outcomes were the level of motor impairment, handgrip strength, range of motion, motor function of the upper limbs, and quality of life (QOL) assessed before and after 10 sessions and 1 month after the end of the treatment. Results: A clinically important pain reduction (3 points) was found in both groups and was maintained at follow-up; there was no significant difference between groups (p = 0.3). Similarly, the shoulder range of motion improved, motor function and quality of life improved showed no significant differences between groups. One result that needs to be underscored is that both groups had a significant effect size toward improvement in all of these outcomes. Conclusions: We discuss in this study that tDCS is not a useful combination strategy when the physical therapy has a large effect by itself and we also review other negative trials of combined therapy under this framework of ceiling effect of the main physical therapy. Trial registry: Trial registration: Brazilian Registry of Clinical Trials, RBR-8F5MNY (http://www.ensaiosclinicos.gov.br/rg/RBR-8f5mny/). Registered on June 2, 2017. Beginning of the recruitment of the volunteers: august, 2017.