Nature-Based Interventions Targeting Elderly People's Health and Well-Being: An Evidence Map.

BACKGROUND: Healthy aging encompasses more than the absence of disease, emphasizing the preservation of functional abilities for enhanced well-being and quality of life. Nature-based interventions are scientifically proven contributors to healthy aging. OBJECTIVE: To develop an evidence map showcasing nature-based interventions targeting older individuals' health and well-being. METHODS: The evidence map was developed through critical analysis of systematic reviews and clinical trials utilizing the tools AMSTAR2 and CONSORT. A systematic search spanning the past decade was conducted across databases: Cochrane, SCOPUS, PubMed, Web of Science, Embase, and LILACS. RESULTS: Twelve articles met the eligibility criteria. Nature-based interventions such as forest bathing, hiking, therapeutic gardens, virtual reality, and forest sounds were identified. Outcomes were categorized into physical aspects (cardiovascular and pulmonary; neuro-immuno-endocrinological) and mental/behavioral aspects. The final map integrated interventions, outcomes, and quality assessments. CONCLUSIONS: The survey highlights the positive impact of nature-based interventions on the health of the elderly. This study provides insights across various domains, fostering the development of programs and policies in management to promote healthy aging. Regarding healthcare, it encourages discourse among professionals regarding the integration of nature-based practices for equitable care in both individual and group settings. Furthermore, it underscores the need for research in the Southern Hemisphere, particularly in Brazil, where the study was conducted.

A time with e-Natureza (e-Nature): a model of nature-based health interventions as a complex adaptive system.

Discussions surrounding the positive impacts of nature on human health and strategies to enhance our connection with the natural world have been ongoing. However, a limited number of theoretical models are available to guide research and practice in this area. Therefore, there is a pressing need for a systematic framework that outlines clear steps for conducting research implementing nature-based interventions. In this study, we investigate the relationship between health and nature through the lens of Complex Adaptive Systems. This approach involves examining the dynamic interactions between multiple interconnected elements to understand the complex emergent behaviors that arise from such relationships. Our model is designed to support nature-based interventions, considering the essential interdependence between humans and nature. This perspective aims to improve both human health and biodiversity conservation in a mutually beneficial manner. The underlying interactions that drive nature-based health interventions are thoroughly explored, leading us to propose a novel intervention model named "A time with e-Natureza" (e-Nature). This model encompasses four types of experiences, drawing from scientific literature and insights from authors engaged in an interdisciplinary research group: (1) Aesthetic and emotional experience; (2) Multisensory integration experience; (3) Knowledge experience; and (4) Engagement experience. Each experience within the model targets affective, cognitive, and behavioral aspects, with a specific focus on fostering a deeper connection with nature. Distinct activities are incorporated within each experience to promote successful outcomes. The model is grounded in existing theories that address the human-nature relationship and is informed by Nursing theories that support health promotion interventions. By presenting this new model, our aim is to contribute to the effective implementation of nature-based interventions that not only enhance human well-being but also support the conservation of nature. This integrated approach recognizes the mutual benefits of human-nature interaction and offers valuable insights for future research and practical applications in the fields of nature and health.

Nature Photographs as Complementary Care in Chemotherapy: A Randomized Clinical Trial.

The incidence of cancer cases is increasing worldwide, and chemotherapy is often necessary as part of the treatment for many of these cases. Nature-based interventions have been shown to offer potential benefits for human well-being. OBJECTIVE: This study aims to investigate the outcome of nature images on clinical symptom management related to chemotherapy. METHODS: A randomized clinical trial was conducted in an outpatient cancer unit of a private hospital in Brazil, with 173 participants over the age of 18 who were undergoing chemotherapy and had signed an informed consent form. The intervention consisted of the presentation of a 12-min video featuring nature images categorized under the themes of Tranquility, Beauty, Emotions Up, or Miscellany. Images were sourced from the e-Nature Positive Emotions Photography Database (e-NatPOEM), a publicly available collection of affectively rated images. Sociodemographic and clinical data, as well as the participants' connection to nature, were investigated. The Positive Affect/Negative Affect Scale (PANAS) and the Edmonton Symptom Assessment System (ESAS) were applied pre- and post-intervention. RESULTS: Data showed very strong evidence of a reduction in negative affect for the intervention group (p < 0.001) and moderate evidence for the control group (p = 0.034). There was also a significant reduction in the intervention group for pain (p < 0.001), tiredness (p = 0.002), sadness (p < 0.001), anxiety (p < 0.001), and appetite (p = 0.001). The Beauty video had the best performance, while the Tranquility video showed no significant improvement in any of the symptoms evaluated. These findings suggest that images of nature may be a valuable tool to help control clinical and psychological symptoms in cancer patients undergoing chemotherapy.

The Effect of Gender-Affirming Hormone Therapy on the Risk of Subclinical Atherosclerosis in the Transgender Population: A Systematic Review.

OBJECTIVE: The impact of gender-affirming hormone therapy (GAHT) on cardiovascular (CV) health is still not entirely established. A systematic review was conducted to summarize the evidence on the risk of subclinical atherosclerosis in transgender people receiving GAHT. METHODS: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and data were searched in PubMed, LILACS, EMBASE, and Scopus databases for cohort, case-control, and cross-sectional studies or randomized clinical trials, including transgender people receiving GAHT. Transgender men and women before and during/after GAHT for at least 2 months, compared with cisgender men and women or hormonally untreated transgender persons. Studies reporting changes in variables related to endothelial function, arterial stiffness, autonomic function, and blood markers of inflammation/coagulation associated with CV risk were included. RESULTS: From 159 potentially eligible studies initially identified, 12 were included in the systematic review (8 cross-sectional and 4 cohort studies). Studies of trans men receiving GAHT reported increased carotid thickness, brachial-ankle pulse wave velocity, and decreased vasodilation. Studies of trans women receiving GAHT reported decreased interleukin 6, plasminogen activator inhibitor-1, and tissue plasminogen activator levels and brachial-ankle pulse wave velocity, with variations in flow-mediated dilation and arterial stiffness depending on the type of treatment and route of administration. CONCLUSIONS: The results suggest that GAHT is associated with an increased risk of subclinical atherosclerosis in transgender men but may have either neutral or beneficial effects in transgender women. The evidence produced is not entirely conclusive, suggesting that additional studies are warranted in the context of primary prevention of CV disease in the transgender population receiving GAHT. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, identifier CRD42022323757.

A time with e-Natureza (e-Nature): a model of nature-based health interventions as a complex adaptive system

Discussions surrounding the positive impacts of nature on human health and strategies to enhance our connection with the natural world have been ongoing. However, a limited number of theoretical models are available to guide research and practice in this area. Therefore, there is a pressing need for a systematic framework that outlines clear steps for conducting research implementing nature-based interventions. In this study, we investigate the relationship between health and nature through the lens of Complex Adaptive Systems. This approach involves examining the dynamic interactions between multiple interconnected elements to understand the complex emergent behaviors that arise from such relationships. Our model is designed to support nature-based interventions, considering the essential interdependence between humans and nature. This perspective aims to improve both human health and biodiversity conservation in a mutually beneficial manner. The underlying interactions that drive nature-based health interventions are thoroughly explored, leading us to propose a novel intervention model named “A time with e-Natureza” (e-Nature). This model encompasses four types of experiences, drawing from scientific literature and insights from authors engaged in an interdisciplinary research group: (1) Aesthetic and emotional experience; (2) Multisensory integration experience; (3) Knowledge experience; and (4) Engagement experience. Each experience within the model targets affective, cognitive, and behavioral aspects, with a specific focus on fostering a deeper connection with nature. Distinct activities are incorporated within each experience to promote successful outcomes. The model is grounded in existing theories that address the human-nature relationship and is informed by Nursing theories that support health promotion interventions. By presenting this new model, our aim is to contribute to the effective implementation of nature-based interventions that not only enhance human well-being but also support the conservation of nature. This integrated approach recognizes the mutual benefits of human-nature interaction and offers valuable insights for future research and practical applications in the fields of nature and health.

Nature photographs as complementary care in chemotherapy: a randomized clinical trial

The incidence of cancer cases is increasing worldwide, and chemotherapy is often necessary as part of the treatment for many of these cases. Nature-based interventions have been shown to offer potential benefits for human well-being. Objective: This study aims to investigate the outcome of nature images on clinical symptom management related to chemotherapy. Methods: A randomized clinical trial was conducted in an outpatient cancer unit of a private hospital in Brazil, with 173 participants over the age of 18 who were undergoing chemotherapy and had signed an informed consent form. The intervention consisted of the presentation of a 12-min video featuring nature images categorized under the themes of Tranquility, Beauty, Emotions Up, or Miscellany. Images were sourced from the e-Nature Positive Emotions Photography Database (e-NatPOEM), a publicly available collection of affectively rated images. Sociodemographic and clinical data, as well as the participants’ connection to nature, were investigated. The Positive Affect/Negative Affect Scale (PANAS) and the Edmonton Symptom Assessment System (ESAS) were applied pre- and post-intervention. Results: Data showed very strong evidence of a reduction in negative affect for the intervention group (p < 0.001) and moderate evidence for the control group (p = 0.034). There was also a significant reduction in the intervention group for pain (p < 0.001), tiredness (p = 0.002), sadness (p < 0.001), anxiety (p < 0.001), and appetite (p = 0.001). The Beauty video had the best performance, while the Tranquility video showed no significant improvement in any of the symptoms evaluated. These findings suggest that images of nature may be a valuable tool to help control clinical and psychological symptoms in cancer patients undergoing chemotherapy.

e-Nature Positive Emotions Photography Database (e-NatPOEM): affectively rated nature images promoting positive emotions.

Affectively rated image databases have their main application in studies that require inducing distinct stimuli on subjects. Widespread databases are designed to cover a broad range of stimuli, from negative to positive (valence), and relaxed to excited (arousal). The availability of narrow domain databases, designed to cover and thoroughly analyze a few categories of images that induce a particular stimulus, is limited. We present a narrow domain affective database with positive images, named e-Nature Positive Emotions Photography Database (e-NatPOEM), consisting of 433 high-quality images produced by professional and amateur photographers. A total of 739 participants evaluated them using a web-based tool to input valence-arousal values and a single word describing the evoked feeling. Ratings per image ranged from 36 to 108, median: 57; first/third quartiles: 56/59. 84% of the images presented valence > middle of the scale and arousal < middle of the scale. Words describing the images were classified into semantical groups, being predominant: Peace/tranquility (39% of all words), Beauty (23%), and Positive states (15%). e-NatPOEM is free and publicly available, it is a valid resource for affective research, and presents the potential for clinical use to assist positive emotions promotion.

e-Nature positive emotions photography database e-NatPOEM: affectively rated nature images promoting positive emotions

Affectively rated image databases have their main application in studies that require inducing distinct stimuli on subjects. Widespread databases are designed to cover a broad range of stimuli, from negative to positive valence, and relaxed to excited arousal. The availability of narrow domain databases, designed to cover and thoroughly analyze a few categories of images that induce a particular stimulus, is limited. We present a narrow domain affective database with positive images, named e-Nature Positive Emotions Photography Database e-NatPOEM, consisting of 433 high-quality images produced by professional and amateur photographers. A total of 739 participants evaluated them using a web-based tool to input valence-arousal values and a single word describing the evoked feeling. Ratings per image ranged from 36 to 108, median: 57; first/third quartiles: 56/59. 84% of the images presented valence > middle of the scale and arousal < middle of the scale. Words describing the images were classified into semantical groups, being predominant: Peace/tranquility 39% of all words, Beauty 23%, and Positive states 15%. e-NatPOEM is free and publicly available, it is a valid resource for affective research, and presents the potential for clinical use to assist positive emotions promotion.

Does (mis)use of industrial liquid silicone implants interfere with bone mineral density in transgender women?

The effects of gluteal implants on bone mass remain unclear. Transgender women with ILS presented higher BMD in the hip compared with transgender women without implants, while no difference was observed in other sites. These results may be artifactual and suggest using spine/forearm sites for DXA in individuals with ILS. PURPOSE: The inappropriate use of industrial liquid silicone (ILS) injections for cosmetic purposes is practiced by some transgender women. The aim of this study was to evaluate the impact of gluteal ILS on femur BMD in transgender women. METHODS: A total of 46 trans women with and without ILS injection in the gluteal region were selected. All patients underwent clinical and hormonal evaluation, and bone mass was assessed by DXA. RESULTS: Bone mineral density (BMD) values were significantly higher in trans women with ILS (n = 23) in femoral neck and total femur when compared with trans women without implants (n = 23). Similar BMD was observed in other sites, such as lumbar spine and forearm. Good agreement was found in the evaluation of low BMD using spine/forearm or spine/femur in patients without implants (k = 0.744 and 1.000 for male and female reference database, respectively), but poor to fair index was found in patients with ILS implants (k = 0.330 and 0.646 for male and female reference database, respectively). CONCLUSIONS: In transgender women with ILS implants, poor to moderate agreement was found on BMD when comparing lumbar spine/femur DXA with an alternative site to the femur, depending on using male or female database. These results may be artifactual and suggest using spine/forearm sites for more accurate DXA assessments in trans women with ILS gluteal implants.

A method for generating 3D thermal models with decoupled acquisition.

BACKGROUND AND OBJECTIVE: Both thermal imaging and 3D scanning offer convenient advantages for medical applications, namely, being contactless, non-invasive and fast. Consequently, many approaches have been proposed to combine both sensing modalities in order to acquire 3D thermal models. The predominant approach is to affix a 3D scanner and a thermal camera in the same support and calibrate them together. While this approach allows straightforward projection of thermal images over the 3D mesh, it requires their simultaneous acquisition. In this work, a method for generation of 3D thermal models that allows combination of separately acquired 3D mesh and thermal images is presented. Among the advantages of this decoupled acquisition are increased modularity of acquisition procedures and reuse of legacy equipment and data. METHODS: The proposed method is based on the projection of thermal images over a 3D mesh. Unlike previous methods, it is considered that the 3D mesh and the thermal images are acquired separately, so camera pose estimation is required to determine the correct spatial positioning from which to project the images. This is done using Structure from Motion, which requires a series of interest points correspondences between the images, for which the SIFT method was used. As thermal images of human skin are predominantly homogeneous, an intensity transformation is proposed to increase the efficacy of interest point detection and make the approach feasible. Before projection, the adequate alignment of the 3D mesh in space is determined using Particle Swarm Optimization. For validation of the method, the design and implementation of a test object is presented. It can be used to validate other methods and can be reproduced with common printed circuit board manufacturing processes. RESULTS: The proposed approach is accurate, with an average displacement error of 1.41  mm (s = 0.74  mm) with the validation test object and 4.58 mm (s = 2.12  mm) with human subjects. CONCLUSIONS: The proposed method is able to combine separately a acquired 3D mesh and thermal images into an accurate 3D thermal model. The results with human subjects suggest that the method can be successfully employed in medical applications.

An exergame system based on force platforms and body key-point detection for balance training.

Postural instability affects a large number of people and can compromise even simple activities of the daily routine. Therapies for balance training can strongly benefit from auxiliary devices specially designed for this purpose. In this paper, we present a system for balance training that uses the metaphor of a game, what contributes to the motivation and engagement of the patients during a treatment. Such approach is usually named exergame, in which input devices for posturographic assessment and a visual output perform the interaction with the subject. The proposed system uses two force platforms, one positioned under the feet and the other under the hip of the subject. The force platforms employ regular load cells and a microcontroller-based signal acquisition module to capture and transmit the samples to a computer. Moreover, a computer vision module performs body key-point detection, based on real time segmentation of markers attached to the subject. For the validation of the system, we conducted experiments with 20 neurologically intact volunteers during two tests: comparison of the stabilometric parameters obtained from the system with those obtained from a commercial baropodometer and the practice of several exergames. Results show that the proposed system is completely functional and can be used as a versatile tool for balance training.

Generation of 3D thermal models for dentistry applications.

There are a variety of medical imaging modalities available, although each modality focus into different aspects, for example: anatomical, physiological or geometrical information. This paper presents a new imaging modality (3D THERMO-SCAN) that combines anatomical computer tomography (CT) imaging slices, together with 2D infrared thermography images and 3D scanned shaped models of the area under study. Therefore, it is presented the 3D reconstructions involving a case study of a volunteer with bruxism. Some characteristics of bruxism are the hyperactivity of the chewing muscles, which changes the dynamics of microcirculation, also changing the correspondent skin's temperature. The emphasis is to show the corresponding structures, such as jaw/mandibular region that will produce either decrease or increase in temperature, which are related to bruxism and the associated use of an occlusal splint, respectively.

Combining 3D models with 2D infrared images for medical applications.

Infrared images are very useful for providing physiological information, although the representation is two-dimensional. On the other hand, a 3D scanning system is able to generate precise 3D spatial models of the area under study. This paper presents a methodology for combining both imaging modalities into a single representation. The Structure from Motion (SfM) technique is used in order to find the correct infrared camera's positioning and rotations in the space. Then, those 2D infrared images generate a 3D SfM model. Following this stage, the SfM model is replaced by an accurate 3D model from a scanning system, which is wrapped around by the infrared images. The experiments performed with a volunteer's face have shown that the proposed methodology successfully reconstruct a unique 3D surface model, which is able to deliver potential clinical applications.

In vivo assessment of the impedance ratio method used in electronic foramen locators.

BACKGROUND: The results of an in vivo study on the "ratio method" used in electronic foramen locators (EFL) are presented. EFLs are becoming widely used in the determination of the working length (WL) during the root canal treatment. The WL is the distance from a coronal reference point to the point at which canal preparation and filling should terminate. The "ratio method" was assessed by many clinicians with the aim of determining its ability to locate the apical foramen (AF). Nevertheless, in vivo studies to assess the method itself and to explain why the "ratio method" is able to locate the apical foramen and is unable to determine intermediate distances were not published so far. METHODS: A developed apparatus applies an electrical current signal with constant amplitude of 10 µARMS through the endodontic file within the root canal. The applied current signal is composed by summing six sine waves, from 250 Hz to 8 kHz. Data were acquired with the endodontic file tip at 7 different positions within root canals. In the frequency domain the quotients between the amplitude of a reference frequency and the amplitudes of the other frequencies components were calculated. Twenty one root canals were analyzed in vivo, during the endodontic treatment of twelve teeth of different patients, with age between 20 to 55 years. RESULTS: For the range of frequencies used in the commercial EFLs and for distances ranging from -3 mm to -1 mm of the AF, the impedance of the root canal is mainly resistive. However, when the file tip gets closer to AF, the root canal electrical impedance starts to change from a mainly resistive to a complex impedance. This change in the measured root canal impedance starts when the file tip is near -1.0 mm from the AF, getting stronger as the file tip gets closer to the AF. This change in the impedance behavior affects the ratio (quotient) of the impedance measured at different frequencies. Through graphic analysis it is demonstrated why EFLs based on the ratio method are unable to accurately measure any distances between - 3.0 and -0.5 mm from the apical foramen. The only reliable measurement is the 0 mm distance, which is when the file tip is at the AF. CONCLUSIONS: The electrical impedance values of 21 root canals were in vivo studied. The results confirm the ability of EFLs that are based on the ratio method to accurately locate the AF position and explain why they are unable to determine the file tip position along the root canal.

Gestão Hospitalar: identificação das práticas de aprendizagem existentes em hospitais / Hospital Management: identifying learning practices in hospitals

A profissionalização da gestão em hospitais, a partir de diferentes práticas da administração, tem sido amplamente discutida, à luz de conceitos como gestão baseada em evidência, gestão do conhecimento e aprendizagem organizacional. Entretanto, são poucos os artigos identificando e discutindo essas práticas nas organizações de saúde. Este é o objetivo do presente artigo. Buscou-se realizar uma análise histórica da gestão em saúde no Brasil, considerando uma mudança a partir do processo de descentralização. Foi realizado o mapeamento das práticas de gestão enfatizando-se as metodologias de aprendizagem existentes no setor, a partir de pesquisas documentais. Pôde-se perceber uma mudança de modelo mental na área, passando de um enfoque linear para um enfoque sistêmico. Da mesma forma, identificou-se o processo de construção do conhecimento nessas organizações, especialmente a partir da prática médica. Constatou-se ainda que o processo de aprendizagem enfatiza a aprendizagem individual e não a aprendizagem organizacional.

The continuous improvement in management process of hospitals, has been widely related to concepts as evidence-based management, knowledge management and organizational learning. However, there are few articles identifying and presenting these practices in the health organizations. This is the objective of the present article. First, a historical analysis of health management in Brazil was conducted, considering the decentralization process. In this context, we perform a research to identify learning methodologies in the sector, from documentary research. A change of mental model in the area, looking for a systemic approach can be perceived. In the same way, the process of knowledge construction in these organizations generally started from the medical practice. One evidenced despite the learning process emphasizes the individual learning and not it organizational learning.

A negociação de sentidos sobre participação: um estudo dos processos dialógicos do orçamento participativo de Ipatinga-MG, pelo viés da cidadania / The negociation of senses about participation: a study of the dialogical processes of participatori budgeting of Ipatinga-MG through cidadany

O trabalho buscou compreender como se dá a negociação de sentidos sobre participação na experiência do orçamento participativo implantado na cidade de Ipatinga-MG já há 16 anos. Com a instituição de novos enquadres de gestão pública a partir da redemocratização, essas experiências de democracia direta têm se propagado no Brasil e no mundo. Enquanto os cientistas sociais estão interessados nos aspectos políticos do processo, meu interesse como psicólogo social diz respeito a como esses novos processos têm significado mudanças na maneira das pessoas compreenderem o seu mundo. Utilizando o referencial de Hacking (2001) para trabalhar com a análise de matrizes que dão sustentabilidade a idéias e construtos humanos, os elementos materiais que compõem a experiência do OP foram buscados e considerados enquanto elementos que permeiam as relações sociais. Hacking parte da proposta construcionista em psicologia social para possibilitar um enfoque sobre sentidos, redes de socialidades e materialidades. Os sentidos também podem ser encontrados em documentos de domínio público (SPINK, 2000), que são materialidades circulantes no meio público, o que permite considerar os posicionamentos dos diversos agentes no campo. Os resultados da pesquisa permitiram encontrar que as negociações ocorrem com uma diferença entre a população e a prefeitura quanto à visão do processo do OP. A população tem uma visão mais ligada à possibilidade de verdadeira deliberação, depositando no OP a expectativa da resolução dos problemas da comunidade através do diálogo. A prefeitura vê o OP como um processo que aproxima o cidadão da prefeitura, de forma que ele possa ter mais conhecimentos sobre a gestão e as dificuldades administrativas. Além disso, a prefeitura parece ver no OP um processo que leva à melhoria da qualidade de vida da população. Os aspectos mais importantes para a negociação de sentidos foram: da parte da prefeitura, o uso de recursos de comunicação de massa, principalmente jornais e revistas, e o uso da estrutura da prefeitura para acolher os representantes da população insatisfeitos ou, ao contrário, para premiar os aliados. Da parte da população, a tradicional presença das associações de moradores se mostraram como um aspecto que se mantém baseado nas relações pessoais informais, mais do que sobre relações com caráter formal. Um exemplo disso é a pouca relevância dos conselheiros do OP junto à população, sendo mais importantes os próprios representantes de associações...(AU)