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.

Scientists of Tomorrow/ Cientistas do Amanhã : a project to inspire, stimulate scientific thinking, and introduce scientific methodology for young students.

The Scientists of Tomorrow/ Cientistas do Amanhã project is an immersive science training program developed by the Program of Post-Graduation in Health Sciences at Hospital Israelita Albert Einstein. This program was conducted in partnership with Volunteering and Escola Municipal de Ensino Fundamental Professor Paulo Freire in Paraisópolis, São Paulo, Brazil. The Scientists of Tomorrow Program comprised a short training period conducted in May 2022 involving 37 students, and a long training period from August to December 2022, which included 15 students. It aimed to popularize science through practical activities; transfer knowledge to young students; sensitize and guide them to pursue academic-scientific careers; reduce stereotypes about scientific work and scientists; and help students understand the social, political, and ethical roles of science within society. All activities were led by postgraduate students and professors from our postgraduate program, physicians, nurses, physiotherapists, biomedicals, and veterinarians from Hospital Israelita Albert Einstein, as well as medical students from Faculdade Israelita de Ciências da Saúde Albert Einstein . Activities in the short training included lectures on cinema and science, strategies to combat fake news, non-violent communication, innovation, design-thinking framework, and developing a scientific project. During the long training period, discussions were focused on nanotechnology, animal research, big data, bioinformatics, meditation, blood and bone marrow donation, telemedicine, sex and sexually-transmitted infections, rehabilitation, career opportunities, and scientific integrity. In addition, practical activities were further expanded using optical and confocal microscopy, cytometry, and basic concepts regarding the structure and function of living cells. The program also included the launching of the open-air outreach Education E-natureza activity, which turned students into ambassadors of nature. In conclusion, the Scientists of Tomorrow Program was innovative and enabled young students to learn that science is a collective activity that can enhance public health. In Brief Rangel et al. enumerated the Scientists of Tomorrow/Cientistas do Amanhã program, an immersive science initiative conducted in collaboration with a public school. The program, which involved 15 students, aimed to promote science, share knowledge, inspire academic paths, and underscore societal impacts. Led by postgraduates, professors, and healthcare experts, the program included diverse lectures and practical laboratory activities. Highlights Every research endeavor commences with a fundamental question. Sharing of findings by researchers and students contributes toward the expansion of knowledge. Teaching scientific methodology is a pivotal step in nurturing critical thinking skills. Science permeates our daily lives and plays a crucial role in addressing societal issues.

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 volunteer-led activities on the quality of life of volunteers, residents, and employees of a long-term care institution: a cohort study.

BACKGROUND: The COVID-19 pandemic primarily impacted long-term care facilities by restricting visiting and circulation of visitors, affecting the quality of life (QoL) of older adults living in these institutions. Volunteer activities, essential for older adults' daily life, were also interrupted and potentially negatively impacted the QoL of older adults, volunteers themselves, and also employees in these institutions. In this context, this study aims to evaluate the impact of the return of volunteer-led activities in a long-term care institution on the QoL of older adult residents, employees, and volunteers. METHODS: This study used a pre-test and post-test design within the same group. The first round of data collection was conducted before volunteer-led activities returned and the second round after 1 month of return. The instrument used to assess QoL was the EUROHIS-QoL-8 scale. This study was conducted within a nursing home in São Paulo, Brazil, created in 1937 by members of the Israeli community living in Brazil. Volunteer-led activities were part of residents' daily life before the COVID-19 pandemic, when these activities were interrupted for about 20 months. A total of 79 individuals participated in both rounds (pre and post), of which: 29 residents, 27 volunteers, and 23 employees of the long-term care institution. RESULTS: Using a Wilcoxon signed-rank test, the analyses indicated improvements after the 1 month return in different QoL aspects for the three groups. Volunteers improved their personal relationships (Z - 2.332, p < .05), residents their overall health (Z - 2.409, p < .05) and employees in their overall QoL perception (Z - 2.714, p < .05). Influencing factors for residents were the number of activities (3 or more), gender (male), and education (undergraduate/graduate). For employees, those who assumed additional activities due to the volunteer-led activities interruption had a significant impact on their overall QoL. CONCLUSIONS: Evidence from this study suggests that volunteers' return positively impacted different QoL aspects for volunteers, residents, and employees.

Scientists of Tomorrow/ Cientistas do Amanhã : a project to inspire, stimulate scientific thinking, and introduce scientific methodology for young students

ABSTRACT The Scientists of Tomorrow/ Cientistas do Amanhã project is an immersive science training program developed by the Program of Post-Graduation in Health Sciences at Hospital Israelita Albert Einstein. This program was conducted in partnership with Volunteering and Escola Municipal de Ensino Fundamental Professor Paulo Freire in Paraisópolis, São Paulo, Brazil. The Scientists of Tomorrow Program comprised a short training period conducted in May 2022 involving 37 students, and a long training period from August to December 2022, which included 15 students. It aimed to popularize science through practical activities; transfer knowledge to young students; sensitize and guide them to pursue academic-scientific careers; reduce stereotypes about scientific work and scientists; and help students understand the social, political, and ethical roles of science within society. All activities were led by postgraduate students and professors from our postgraduate program, physicians, nurses, physiotherapists, biomedicals, and veterinarians from Hospital Israelita Albert Einstein, as well as medical students from Faculdade Israelita de Ciências da Saúde Albert Einstein . Activities in the short training included lectures on cinema and science, strategies to combat fake news, non-violent communication, innovation, design-thinking framework, and developing a scientific project. During the long training period, discussions were focused on nanotechnology, animal research, big data, bioinformatics, meditation, blood and bone marrow donation, telemedicine, sex and sexually-transmitted infections, rehabilitation, career opportunities, and scientific integrity. In addition, practical activities were further expanded using optical and confocal microscopy, cytometry, and basic concepts regarding the structure and function of living cells. The program also included the launching of the open-air outreach Education E-natureza activity, which turned students into ambassadors of nature. In conclusion, the Scientists of Tomorrow Program was innovative and enabled young students to learn that science is a collective activity that can enhance public health.

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.

Nurses' perception of solutions proposed by nurse leaders in face of COVID-19 pandemic: A cross-sectional study.

AIM: To evaluate the perception of bedside nurses regarding the implementation of solutions proposed by nurse leaders for patient and employee care during the COVID-19 pandemic. BACKGROUND: Nurse leaders have proposed solutions to better manage the challenges of the pandemic. However, multiple factors influence the transposal of actions from the tactical to the operational levels. METHOD: This cross-sectional study was carried out in a 620-bed non-profit institution. Participants were bedside nurses who completed an online survey. RESULTS: One hundred sixty-eight nurses participated in the study. Most of the proposed solutions were very effective and easily identified by the nurses. These solutions included adaptations of the physical structure, availability of medical supplies and adequacy of institutional protocols. The actions that stood out with low perception were adequate integration of new employees and the availability of remote work, hotel accommodations for frontline health care workers and day care for children whose parents worked at the hospital. CONCLUSION: Bedside nurses were able to recognize most of the solutions proposed by their nurse leaders during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Tactical-level nurse leaders need constant proximity to bedside nurses and continuous elucidation of the objectives to be achieved by the strategies adopted.

When One Health Meets the United Nations Ocean Decade: Global Agendas as a Pathway to Promote Collaborative Interdisciplinary Research on Human-Nature Relationships.

Strong evidence shows that exposure and engagement with the natural world not only improve human wellbeing but can also help promote environmentally friendly behaviors. Human-nature relationships are at the heart of global agendas promoted by international organizations including the World Health Organization's (WHO) "One Health" and the United Nations (UN) "Ocean Decade." These agendas demand collaborative multisector interdisciplinary efforts at local, national, and global levels. However, while global agendas highlight global goals for a sustainable world, developing science that directly addresses these agendas from design through to delivery and outputs does not come without its challenges. In this article, we present the outcomes of international meetings between researchers, stakeholders, and policymakers from the United Kingdom and Brazil. We propose a model for interdisciplinary work under such global agendas, particularly the interface between One Health and the UN Ocean Decade and identify three priority research areas closely linked to each other: human-nature connection, conservation-human behavior, and implementation strategies (bringing stakeholders together). We also discuss a number of recommendations for moving forward.

Potentialities and difficulties of technological mediation in the work of nurse managers in hospitals / Potencialidades y dificultades de la mediación tecnológica en el trabajo de los gerentes de enfermería en los hospitales / Potencialidades e dificuldades da mediação tecnológica no trabalho de enfermeiros gestores em hospitais

ABSTRACT Objective to describe the potentialities and difficulties mentioned by nurse managers in the use of technologies in hospitals. Method qualitative, descriptive-exploratory study, conducted in the period of one year, 2019 to 2020, in Brazil and Portugal, in four hospitals. Data were collected through interviews, following a semi-structured script, involving 71 nurse managers. For data analysis, resources of the ATLAS.ti software were used, following the precepts of thematic content analysis and work process theory. Results nurse managers consider that technologies contribute to the improvement of institutional processes, information recording, time management, data storage and patient safety. Among the difficulties, problems related to the work instruments themselves are highlighted, such as lack of equipment/computers, slowness and lack of systems integration; and related to the workforce, such as time management, cultural adaptation, lack of knowledge and training to use technology. Conclusion innovative technologies contribute to management work, but their effectiveness depends on training, adequate number of professionals, in addition to efficient and integrated equipment and information systems.

RESUMEN Objetivo describir las potencialidades y dificultades mencionadas por los enfermeros gestores en el uso de las tecnologías en los hospitales. Método estudio cualitativo, descriptivo-exploratorio, realizado durante un año, 2019 a 2020, en Brasil y Portugal, en cuatro hospitales. Los datos fueron recolectados a través de entrevistas, siguiendo un guión semiestructurado, involucrando a 71 enfermeros gestores. Para el análisis de datos se utilizaron los recursos del software ATLAS.ti, siguiendo los preceptos del análisis de contenido temático y la teoría de proceso de trabajo. Resultados los gestores de enfermería consideran que las tecnologías contribuyen para la mejora de los procesos institucionales, el registro de informaciones, la gestión del tiempo, el almacenamiento de datos y la seguridad del paciente. Entre las dificultades, destacaron problemas relacionados con los propios instrumentos de trabajo, como: la falta de equipos/computadoras, lentitud y falta de integración de sistemas; y relacionados con la fuerza de trabajo, tales como: gestión del tiempo, adaptación cultural, desconocimiento y capacitación en el uso de la tecnología. Conclusión las tecnologías innovadoras contribuyen al trabajo de gestión, pero su eficacia depende de la formación, número adecuado de profesionales, además de equipos y sistemas de información eficientes e integrados.

RESUMO Objetivo descrever potencialidades e dificuldades mencionadas por enfermeiros gestores no uso de tecnologias em hospitais. Método estudo qualitativo, descritivo-exploratório, realizado no período de um ano, 2019 a 2020, no Brasil e Portugal, em quatro hospitais. Os dados foram coletados através de entrevistas, seguindo roteiro semiestruturado, envolvendo 71 enfermeiros gestores. Para análise dos dados utilizou-se recursos do software ATLAS.ti, seguindo preceitos da análise de conteúdo temática e da teoria do processo de trabalho. Resultados enfermeiros gestores consideram que tecnologias contribuem para melhoria dos processos institucionais, registro de informações, gestão do tempo, armazenamento dos dados e segurança do paciente. Dentre as dificuldades destacaram problemas relacionados aos próprios instrumentos de trabalho, como: a falta de equipamentos/computadores, lentidão e falta de integração de sistemas; e relacionados à força de trabalho, como: gestão do tempo, adaptação cultural, falta de conhecimento e capacitação para utilizar a tecnologia. Conclusão tecnologias inovadoras contribuem para o trabalho de gestão, mas sua efetividade depende de capacitação, quantitativo adequado de profissionais, além de equipamentos e sistemas de informação eficientes e integrados.

Pain Management of Amazon Indigenous Peoples: A Community-Based Study.

PURPOSE: Indigenous peoples are vulnerable populations that live in remote areas of the Amazon forest with limited access to health-care services. Underreporting and undertreatment of pain is a common event in the general population but little is known about these issues in indigenous peoples. The aim of this study was to investigate the characteristics and cultural aspects of pain management in five ethnicities of the Brazilian Amazon. MATERIALS AND METHODS: Cross-sectional study carried out with adult indigenous individuals from five ethnicities of the Brazilian Amazon over two scientific expeditions (June-July/2017 and February-March/2019). Pain assessment included etiology, intensity, duration, aggravating and alleviating factors, body location, impact of pain on activities of daily living, and treatment. RESULTS: Ninety indigenous individuals with a mean age of 41.42 ± 19.59 years (range 19‒98 years) and median age of 37 years participated in the study. Sixty-four individuals (71.1%) reported experiencing pain at the time of interview with intermittent musculoskeletal pain of strong intensity being the more prevalent (back pain: 45.3%, joint pain: 43.7%) followed by headache (26.5%). The main alleviating factors reported were traditional indigenous medicine (21.0%) and rest (30.0%), and physical exertion was the main aggravating factor (69.0%). Most study participants reported that pain affected their mood, activities of daily living, and sleep and that they used both traditional indigenous medicine (78.0%) and conventional medicine (81.0%) for pain relief. CONCLUSION: Musculoskeletal pain is prevalent among indigenous individuals, affects their quality of life, and is partly attributed to their lifestyle. Cultural aspects mediating the pain experience were observed. Traditional indigenous medicine for pain relief remains partially preserved among the ethnic groups investigated. The findings of this study can help improve the delivery care to these vulnerable populations.

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.

Pain in the bipolar disorder: prevalence, characteristics and relationship with suicide risk.

OBJECTIVE: to know the prevalence and characteristics of pain, to verify how pain management has been carried out by the health services, and to correlate suicide risk with pain intensity in patients with bipolar disorder. METHOD: an observational study with a quantitative approach. The study included people with bipolar disorder assessed by the McGill-Reduced Pain Questionnaire, Body Diagram, Visual Numerical Scale, and the Suicidal Ideation Scale (Beck). RESULTS: the sample of 60 participants was mainly composed of women with a mean age of 40 years old and a mean psychiatric treatment time of approximately 13 years. Of these, 83% reported feeling pain at the time of the interview. Half of the participants indicated that pain interferes with routine and 80% did not receive care in health institutions. The main descriptors that qualify the painful experience were as follows: painful, heavy and sensitive for the sensory descriptors, tiring and punishing in the affective category. Suicide attempt was reported by 57% of the participants. There was a correlation between suicide risk and pain intensity. CONCLUSION: pain presented a high prevalence. Suicide risk was identified in more than half of the participants. Pain intensity showed a significant correlation with suicide risk.

Music as an intervention in health projects.

OBJECTIVE: To identify and characterize music projects in the health area, their therapeutic goals, theoretical frameworks, evaluation/monitoring, and dissemination of their results for a possible structure model for this process. METHOD: Descriptive study with multiple cases and documental analysis. RESULTS: Nine projects have participated in this study; these were predominantly in São Paulo and conducted with the adult population in public institutions. The coordinators were mostly women, specialists, with a qualification in health, music, or both. The interventions were performed live, with a mean of 60 minutes per week and repertoires selected by patients. Less than half indicated basing their activities in some theoretical framework or any type of project monitoring. Therapeutic goals related to social insertion and restoring self-esteem, citizenship, protagonism, and communication were pointed out. CONCLUSION: The theoretical indication of the music projects was scarce. Around half the analyzed projects indicated some type of evaluation and dissemination of the performed activities. Two projects only had some risk surveillance and scientific production out of their results, which has not enabled proposing a monitoring model for these initiatives.

Fall prevention education for people with multiple sclerosis: a randomized clinical trial.

BACKGROUND: Online spaced education (OSE) is a method recognized for promoting long-term knowledge retention, changing behaviors and improving outcomes for students and healthcare professionals. However, there is little evidence about its impacts on patient education. OBJECTIVES: The aim of this research was to compare knowledge retention using educational brochure and OSE on individuals with multiple sclerosis (MS) and to verify the impact of educational methods on fall outcome. METHODS: Individuals with MS (n = 230) were randomly assigned to two types of patient education-educational brochure (control) and OSE (intervention). During 12 weeks, the intervention group received multiple-choice tests on fall prevention. Knowledge retention, behavior change and fall incidence were assessed before intervention and after 3 and 6 months. The participants' satisfaction with the education method was also evaluated. RESULTS: Knowledge retention was similar between groups, and behavior change was observed in both groups. There was a significant reduction in fall rate in the intervention group, from 0.60 to 0.27 at 6 months (P < 0.001). Participants' satisfaction achieved an average of 8.75, with no differences between groups. CONCLUSION: Individuals demonstrated significant improvement in fall rate outcome in both groups with no significant difference. In regard to test scores and satisfaction, results were similar between groups.

Music as an intervention in health projects / La música como intervención en proyectos de salud / A música como intervenção em projetos de saúde

ABSTRACT Objective: To identify and characterize music projects in the health area, their therapeutic goals, theoretical frameworks, evaluation/monitoring, and dissemination of their results for a possible structure model for this process. Method: Descriptive study with multiple cases and documental analysis. Results: Nine projects have participated in this study; these were predominantly in São Paulo and conducted with the adult population in public institutions. The coordinators were mostly women, specialists, with a qualification in health, music, or both. The interventions were performed live, with a mean of 60 minutes per week and repertoires selected by patients. Less than half indicated basing their activities in some theoretical framework or any type of project monitoring. Therapeutic goals related to social insertion and restoring self-esteem, citizenship, protagonism, and communication were pointed out. Conclusion: The theoretical indication of the music projects was scarce. Around half the analyzed projects indicated some type of evaluation and dissemination of the performed activities. Two projects only had some risk surveillance and scientific production out of their results, which has not enabled proposing a monitoring model for these initiatives.

RESUMEN Objetivo: Identificar y caracterizar proyectos de música en el área de la salud, sus objetivos terapéuticos, referencias teóricas, evaluación/seguimiento y difusión de resultados para un posible modelo de estructura para este proceso. Método: Estudio descriptivo, de casos múltiples y análisis documental. Resultados: Participaron en el estudio nueve proyectos, concentrados mayoritariamente en São Paulo y realizados con población adulta en instituciones públicas. Los coordinadores eran en su mayoría mujeres, especialistas y con formación en salud, música o ambas. Las intervenciones se realizaron en vivo, con una media de 60 minutos por semana y repertorio elegido por los pacientes. Menos de la mitad indicó que sus actividades se basaban en alguna referencia teórica o tener algún tipo de seguimiento del proyecto. Se propusieron objetivos terapéuticos relacionados con la inserción social, la recuperación de la autoestima, la ciudadanía, el protagonismo y la comunicación. Conclusión: La indicación teórica de los proyectos musicales fue escasa. Cerca de la mitad de los proyectos analizados indicaban algún tipo de evaluación y divulgación de las actividades realizadas. Dos proyectos presentaban solamente algún tipo de seguimiento de los riesgos y la publicación científica de sus resultados, lo que no ha permitido proponer un modelo de acompañamiento para estas iniciativas.

RESUMO Objetivo: Identificar e caracterizar projetos musicais na área de saúde, seus objetivos terapêuticos, referenciais teóricos, avaliação/monitoramento e disseminação dos resultados para um possível modelo de estrutura para esse processo. Método: Estudo descritivo com casos múltiplos e análise documental. Resultados: Participaram do estudo nove projetos, predominantemente concentrados em São Paulo e realizados com população adulta em instituições públicas. Os coordenadores eram majoritariamente mulheres, especialistas e com formação em saúde, em música ou ambas. As intervenções foram realizadas ao vivo, com média/semana de 60 minutos e repertório selecionado pelos pacientes. Menos da metade indicou pautar suas atividades em algum referencial teórico, ou algum tipo de monitoramento do projeto. Objetivos terapêuticos relacionados à inserção social, resgate de autoestima, cidadania, protagonismo e comunicação foram apontados. Conclusão: A indicação teórica dos projetos musicais foi escassa. Cerca de metade dos projetos analisados indicou algum tipo de avaliação e divulgação das atividades realizadas. Dois projetos apenas possuíam algum monitoramento de riscos e produção científica de seus resultados, o que não permitiu propor um modelo de acompanhamento para essas iniciativas.

Pain in the bipolar disorder: prevalence, characteristics and relationship with suicide risk / Dor no transtorno bipolar: prevalência, características e relação com risco de suicídio / Dolor en el trastorno bipolar: prevalencia, características y relación con el riesgo de suicidio

Objective: to know the prevalence and characteristics of pain, to verify how pain management has been carried out by the health services, and to correlate suicide risk with pain intensity in patients with bipolar disorder. Method: an observational study with a quantitative approach. The study included people with bipolar disorder assessed by the McGill-Reduced Pain Questionnaire, Body Diagram, Visual Numerical Scale, and the Suicidal Ideation Scale (Beck). Results: the sample of 60 participants was mainly composed of women with a mean age of 40 years old and a mean psychiatric treatment time of approximately 13 years. Of these, 83% reported feeling pain at the time of the interview. Half of the participants indicated that pain interferes with routine and 80% did not receive care in health institutions. The main descriptors that qualify the painful experience were as follows: painful, heavy and sensitive for the sensory descriptors, tiring and punishing in the affective category. Suicide attempt was reported by 57% of the participants. There was a correlation between suicide risk and pain intensity. Conclusion: pain presented a high prevalence. Suicide risk was identified in more than half of the participants. Pain intensity showed a significant correlation with suicide risk.

Objetivo: conhecer a prevalência e características da dor, verificar como o manejo da dor tem sido realizado pelos serviços de saúde e correlacionar o risco de suicídio com a intensidade da dor dos pacientes com transtorno bipolar. Método: estudo observacional com abordagem quantitativa. Participaram do estudo pessoas com transtorno bipolar avaliadas pelo Questionário de Dor McGill-reduzido, Diagrama Corporal, Escala Visual Numérica e a Escala de Ideação Suicida (Beck). Resultados: A amostra de 60 participantes foi composta principalmente por mulheres com idade média de 40 anos e tempo médio de tratamento psiquiátrico aproximado de 13 anos. Desses, 83% relataram sentir dor no momento da entrevista. Metade dos participantes indicou que a dor atrapalha a rotina e 80% não receberam cuidado nos equipamentos de saúde. Os principais descritores que qualificam a experiência dolorosa foram: dolorida, em peso e sensível para os descritores sensoriais, cansativo e castigante na categoria afetiva. A tentativa de suicídio foi relatada por 57% dos participantes. Foi observada correlação entre o risco de suicídio e a intensidade da dor. Conclusão: a dor apresentou prevalência elevada. O risco de suicídio foi identificado em mais da metade dos participantes. A intensidade da dor apresentou correlação significativa com o risco de suicídio.

Objetivo: conocer la prevalencia y las características del dolor, verificar cómo se ha realizado el manejo del dolor por parte de los servicios de salud y correlacionar el riesgo de suicidio con la intensidad del dolor en pacientes con trastorno bipolar. Método: se trata de un estudio observacional con abordaje cuantitativo. El estudio incluyó a personas con trastorno bipolar evaluadas mediante el Cuestionario de dolor de McGill - versión abreviada, el Diagrama Corporal, la Escala Visual Numérica y la Escala de Ideación Suicida (Beck). Resultados: la muestra de 60 participantes estuvo compuesta principalmente por mujeres con una edad promedio de 40 años y un tiempo promedio de tratamiento psiquiátrico de aproximadamente 13 años. El 83% de ellos manifestó sentir dolor en el momento de la entrevista. La mitad de los participantes indicó que el dolor interfiere en la rutina y el 80% no recibió atención en equipos de salud. Los principales descriptores que califican la experiencia dolorosa fueron: doloroso, pesadez y sensibilidad para los descriptores sensoriales, agotador y castigador en la categoría afectiva. El 57% de los participantes informó intento de suicidio. Se observó una correlación entre el riesgo de suicidio y la intensidad del dolor. Conclusión: el dolor tuvo una alta prevalencia. El riesgo de suicidio se identificó en más de la mitad de los participantes. La intensidad del dolor se correlacionó significativamente con el riesgo de suicidio.

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.

An Intervention to Increase Situational Awareness and the Culture of Mutual Care (Foco) and Its Effects During COVID-19 Pandemic: A Randomized Controlled Trial and Qualitative Analysis.

Situational awareness is especially important to decision-making in health care. Comprehending the situation is crucial for anticipating any change in the environment and delivering optimal care. The objective of this study was to evaluate the effects of a training to increase situational awareness and mutual care designed for health care workers (FoCo) in a randomized controlled trial with additional qualitative analysis. We also investigated the perception of the training for the COVID-19 pandemic moment, in May 2020, almost 6 months after we finished the data collection at the Emergency Care Unit, which became a COVID-19 treatment reference for the care of a population depending on the public health system, in Sao Paulo, Brazil. We conclude that FoCo training can be an important instrument for health care professionals both in times of pandemic and "normal times," to increase situational awareness, the culture of mutual care and decrease the possibility of occupational injuries and illnesses.