Instrumentos de avaliação multidimensional de fragilidade para uso no cuidado de idosos com doença cardiovascular / Multidimensional frailty assessment tools for use in the care of older adults with cardiovascular disease / Instrumentos de evaluación multidimensional de la fragilidad en la atención de adultos mayores con enfermedad cardiovascular

Objetivo: identificar quais os instrumentos disponíveis para avaliação multidimensional da fragilidade em idosos com doença cardiovascular, potencialmente aplicáveis durante a realização do Processo de Enfermagem. Método: revisão sistemática conduzida em oito bases de dados/portais, para identificação de estudos que apresentassem instrumentos multidimensionais de avaliação de fragilidade em idosos com doença cardiovascular e que fossem aplicáveis ao processo de enfermagem. Resultados: foram incluídos 19 instrumentos multidimensionais. O Brief Frailty Index for Coronary Artery Disease foi desenvolvido para uso no cuidado cardiovascular de idosos. O Frailty Index for Adults e o Maastricht Frailty Screening Tool for Hospitalized Patients foram desenvolvidos para uso no Processo de Enfermagem. Conclusão: apesar de apenas um instrumento ter sido desenvolvido para o idosos com doença cardiovascular e apenas dois serem aplicáveis ao processo de enfermagem, a maioria deles tem potencial de adaptação e validação para uso nesta população durante a avaliação de enfermagem.

Objective: to identify which tools are available for multidimensional frailty assessment of older adult with cardiovascular disease and which are potentially applicable during the Nursing Process. Method: a systematic review conducted in eight databases/portals to identify studies that presented multidimensional frailty assessment tools for older adult with cardiovascular disease and that were applicable to the nursing process. Results: a total of 19 multidimensional tools were included. The Brief Frailty Index for Coronary Artery Disease was developed for use in the cardiovascular care of older adult. The Frailty Index for Adults and the Maastricht Frailty Screening Tool for Hospitalized Patients were developed for use in the Nursing Process. Conclusion: although only one tool was developed for older adults with cardiovascular disease and only two are applicable to the nursing process, most of them have the potential to be adapted and validated for use in this population during nursing assessment.

Objetivo: identificar qué instrumentos están disponibles para la evaluación multidimensional de la fragilidad en personas mayores con enfermedad cardiovascular, que se puedan aplicar en el Proceso de Enfermería. Método: revisión sistemática realizada en ocho bases de datos/portales, para identificar estudios que presentaran instrumentos multidimensionales para la evaluación de la fragilidad en adultos mayores con enfermedad cardiovascular y que fueran aplicables al proceso de enfermería. Resultados: se incluyeron 19 instrumentos multidimensionales. El Brief Frailty Index for Coronary Artery Disease se desarrolló para usarlo en el cuidado cardiovascular de las personas mayores. El Frailty Index for Adults y la Maastricht Frailty Screening Tool for Hospitalized Patients se elaboraron para ser usados en el Proceso de Enfermería. Conclusión: aunque sólo se elaboró un instrumento para adultos mayores con enfermedad cardiovascular y sólo dos son aplicables al proceso de enfermería, la mayoría de ellos tienen el potencial para ser adaptados y validados para ser usados en esa población en la evaluación de enfermería.

Culturally adapted cognitive assessment tool for Indigenous communities in Brazil: Content, construct, and criterion validity.

INTRODUCTION: Initial dementia prevalence estimates have revealed a significant burden of the disease in Indigenous communities in Amazonas, Brazil. However, the need for culturally adapted cognitive tools poses a critical challenge when assessing cognitive performance in these communities. This study addressed this issue by culturally adapting and providing validity indicators for the Brazilian Indigenous Cognitive Assessment (BRICA) tool in Manaus, Brazil's urban multiethnic Indigenous community. METHODS: Using a three-stage process and a stakeholder-engaged approach, the BRICA tool was culturally adapted in an urban multiethnic Indigenous community from Manaus, Brazil. The content validity index (CVI) examined inter-rater concordance between experts, while criterion and concurrent validity were performed using diagnostic consensus criteria in 141 Indigenous participants aged ≥ 50 years. RESULTS: Findings showed evidence of content validity in terms of equivalence aspects (scale CVI [S-CVI] 0.93) and relevance ratings (S-CVI 0.85) between expert panels. The identified cut-off score of ≤ 33/39 on the BRICA demonstrated a sensitivity of 94.4%, specificity of 99.2%, positive predictive value of 94.4%, and negative predictive value of 99.2% for dementia diagnosis. DISCUSSION: Using a stakeholder-engaged approach, we culturally adapted the BRICA tool for a Brazilian urban multiethnic Indigenous community. This comprehensive adaptation process resulted in favorable indicators of content, construct, and criteria validity for the BRICA tool. By addressing the existing bias in cognitive assessment within Indigenous communities, the BRICA tool represents a noteworthy breakthrough. Its implementation exhibits potential for improving the early detection and management of dementia among Indigenous groups. Highlights: Culturally sensitive tools are essential to assess cognition in Indigenous populations.An expert panel and stakeholders' perspectives were incorporated to design the Brazilian Indigenous Cognitive Assessment (BRICA) tool.A cognitive screening tool was adapted and validated using a stakeholder approach.BRICA is the first culturally sensitive cognitive tool for urban Brazilian Indigenous individuals.

Vulnerabilities, care, and exposure to illness risks among people with intellectual disabilities in Brazil during the COVID-19 pandemic (2020-2021).

People with intellectual disabilities, especially those who require care, are among the most affected by severe forms of COVID-19 and COVID-19- related deaths. In this study we investigated how care needs and other vulnerabilities influence the possibility COVID-19 infection among people with intellectual disabilities in Brazil. Method: Descriptive quantitative study using an online questionnaire answered by 2,800 respondents with intellectual disabilities over the age of sixteen. Results: Individuals with a greater need for care had higher frequencies of positive COVID-19 diagnoses (6.5%-8%) and were approximately six times more likely to be infected by family members than those who did not have COVID-19 in the family. Conclusions: There is a need for specific government measures to protect people with intellectual disabilities and their caregivers, because those with greater care needs are the most exposed to risks of contagion and sickness and have potential vectors of infection among family members and caregivers.

Family dysfunction and cognitive decline in aging: the "Health, Wellbeing, and Aging" (SABE) longitudinal population-based study.

Stress during aging is not uncommon and dysfunctional family relationships are important sources of stress in the elderly. Considering the potential stressor that family dysfunction represents, it is questioned whether prolonged exposure to dysfunctional family arrangements can contribute to cognitive decline in aging. Objective: To verify whether family dysfunction is a predictive factor of cognitive decline in aging. Methods: Secondary study with analysis of existing data from the longitudinal, population-based study "Health, Wellbeing and Aging" (SABE). Data from 791 elderly people from two cohorts of the SABE study between 2006 and 2015 were analyzed. Family dysfunction was assessed using the Apgar family instrument, while cognitive performance was assessed using the Mini-Mental State Examination (MMSE), verbal fluency (animals) and digit length in reverse order. Cognitive decline was measured by the difference in scores in the period between 2006 and 2015. Results: Approximately 10% of the sample had family dysfunction. The familial Apgar score was not associated with decline on MMSE (p=0.732), verbal fluency (p=0.852) and digit span scores (p=0.718). Scores related to cognition and family functionality, such as age, education, living alone, depression and family Apgar, do not explain cognitive decline. Conclusion: The findings indicate that family functioning is not associated with cognitive decline in community-dwelling elderly. New studies will be needed to analyze the qualitative characteristics of family relationships in the cognitive performance of the elderly.

O estresse ao longo do envelhecimento não é incomum, e as relações familiares disfuncionais constituem fontes importantes de estresse nos idosos. Considerando-se o potencial estressor que a disfunção familiar representa, questiona-se se a exposição prolongada a arranjos familiares disfuncionais pode contribuir para o declínio cognitivo no envelhecimento. Objetivo: Verificar se a disfunção familiar é um fator preditivo de declínio cognitivo no envelhecimento. Métodos: Estudo secundário com análise de dados provenientes do estudo longitudinal de base populacional "Saúde, Bem-estar e Envelhecimento" (SABE). Foram analisados dados de 791 idosos de duas coortes do estudo SABE no período entre 2006 e 2015. A disfunção familiar foi avaliada pelo instrumento Apgar familiar, enquanto o desempenho cognitivo foi avaliado pelo Miniexame do Estado Mental (MEEM), fluência verbal (animais) e extensão de dígitos na ordem inversa. O declínio cognitivo foi medido pela diferença dos escores entre 2006 e 2015. Resultados: Aproximadamente 10% da amostra apresentou disfunção familiar. O escore Apgar familiar não foi associado ao declínio cognitivo pelo MEEM (p=0,732), fluência verbal (p=0,852) e extensão de dígitos ao longo do tempo (p=0,718). Escores relacionados à cognição e funcionalidade familiar, como idade, escolaridade, morar sozinho, depressão e Apgar de família, não explicam o declínio cognitivo. Conclusão: Os achados mostram que a funcionalidade familiar não está associada ao declínio cognitivo de idosos da comunidade. Novos estudos serão necessários para analisar as características qualitativas das relações familiares no desempenho cognitivo de idosos.

Relationship between nocturnal enuresis and sleep in children and adolescents.

BACKGROUND: Nocturnal enuresis (NE) is a multifactorial and complex condition. One less understood factor in its pathophysiology is the enuretic inability to wake up when the bladder is full (impaired arousal). OBJECTIVE: We aimed to investigate the relationship between sleep and NE in children and adolescents. METHODS: A systematic review was performed following the PRISMA guidelines, and the electronic databases MEDLINE (via PubMed) and SCOPUS were searched until March 2022. Eligibility criteria were studies that recruited patients aged five-17 years with a diagnosis of NE according to the International Child Continence Society (ICCS), Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), or International Classification Criteria of Sleep Disorders-Third edition (ICSD-3) who had their sleep assessed using validated questionnaires and/or polysomnography. The tool used to analyze the risk of bias in the included studies was the risk of bias in non-randomized studies of exposure. RESULTS: Of 1582 citations screened, nine were included, giving 1685 participants, 581 with NE. All studies were observational and half had a low risk of bias. Four studies evaluated sleep by questionnaires only; two used questionnaires and polysomnography; two used only polysomnography, and one used sleep logs and actigraphy. Sleep questionnaires showed that children with enuresis had more sleep problems than controls, especially parasomnias, breathing disorders, and daytime sleepiness. Among the polysomnography parameters, the sleep stage architecture and periodic limb movements during sleep had conflicting data between the two studies. LIMITATIONS: The studies evaluated sleep through heterogeneous tools. They used different questionnaires; even those considered by polysomnography did not record the same channels. CONCLUSION: It seems that enuretic children and adolescents sleep differently from those who are non-enuretic. More studies are needed to clarify the best way to assess sleep and better understand this relationship. The review protocol was registered with PROSPERO, CRD42021266338. There was no funding.

Porcine circovirus 3: a new challenge to explore.

The intensification of production processes, resulting from the rise in pork production, contributes to environmental changes and increased interaction between humans, animals, and wildlife. This favorable scenario promotes the spread of potent viral species, such as PCV3, increasing the potential for the emergence of new pathogenic agents and variants. These changes in the epidemiology and manifestation of PCV3 highlight the need for enhanced understanding and control. The current literature presents challenges in the classification of PCV3, with different groups proposing diverse criteria. Establishing common terminology is crucial to facilitate comparisons between studies. While consensus among experts is valuable, new approaches must be transparent and comparable to existing literature, ensuring reproducible results and proper interpretation, and positively impacting public health. This study aims to review the literature on PCV3 infection, exploring its key aspects and highlighting unanswered questions.

Family dysfunction and cognitive decline in aging: the "Health, Wellbeing, and Aging" (SABE) longitudinal population-based study / Disfunção familiar e declínio cognitivo no envelhecimento: estudo longitudinal populacional "Saúde, Bem-Estar e Envelhecimento" (SABE)

ABSTRACT. Stress during aging is not uncommon and dysfunctional family relationships are important sources of stress in the elderly. Considering the potential stressor that family dysfunction represents, it is questioned whether prolonged exposure to dysfunctional family arrangements can contribute to cognitive decline in aging. Objective: To verify whether family dysfunction is a predictive factor of cognitive decline in aging. Methods: Secondary study with analysis of existing data from the longitudinal, population-based study "Health, Wellbeing and Aging" (SABE). Data from 791 elderly people from two cohorts of the SABE study between 2006 and 2015 were analyzed. Family dysfunction was assessed using the Apgar family instrument, while cognitive performance was assessed using the Mini-Mental State Examination (MMSE), verbal fluency (animals) and digit length in reverse order. Cognitive decline was measured by the difference in scores in the period between 2006 and 2015. Results: Approximately 10% of the sample had family dysfunction. The familial Apgar score was not associated with decline on MMSE (p=0.732), verbal fluency (p=0.852) and digit span scores (p=0.718). Scores related to cognition and family functionality, such as age, education, living alone, depression and family Apgar, do not explain cognitive decline. Conclusion: The findings indicate that family functioning is not associated with cognitive decline in community-dwelling elderly. New studies will be needed to analyze the qualitative characteristics of family relationships in the cognitive performance of the elderly.

RESUMO. O estresse ao longo do envelhecimento não é incomum, e as relações familiares disfuncionais constituem fontes importantes de estresse nos idosos. Considerando-se o potencial estressor que a disfunção familiar representa, questiona-se se a exposição prolongada a arranjos familiares disfuncionais pode contribuir para o declínio cognitivo no envelhecimento. Objetivo: Verificar se a disfunção familiar é um fator preditivo de declínio cognitivo no envelhecimento. Métodos: Estudo secundário com análise de dados provenientes do estudo longitudinal de base populacional "Saúde, Bem-estar e Envelhecimento" (SABE). Foram analisados dados de 791 idosos de duas coortes do estudo SABE no período entre 2006 e 2015. A disfunção familiar foi avaliada pelo instrumento Apgar familiar, enquanto o desempenho cognitivo foi avaliado pelo Miniexame do Estado Mental (MEEM), fluência verbal (animais) e extensão de dígitos na ordem inversa. O declínio cognitivo foi medido pela diferença dos escores entre 2006 e 2015. Resultados: Aproximadamente 10% da amostra apresentou disfunção familiar. O escore Apgar familiar não foi associado ao declínio cognitivo pelo MEEM (p=0,732), fluência verbal (p=0,852) e extensão de dígitos ao longo do tempo (p=0,718). Escores relacionados à cognição e funcionalidade familiar, como idade, escolaridade, morar sozinho, depressão e Apgar de família, não explicam o declínio cognitivo. Conclusão: Os achados mostram que a funcionalidade familiar não está associada ao declínio cognitivo de idosos da comunidade. Novos estudos serão necessários para analisar as características qualitativas das relações familiares no desempenho cognitivo de idosos.

Benefícios terapêuticos dos canabinoides no tratamento da dor crônica em pacientes com câncer / Therapeutic benefits of cannabinoids in the treatment of chronic pain in cancer patients / Beneficios terapéuticos del cannabinoides en el tratamiento del dolor crónico en pacientes con cáncer

Objetivo: apresentar o estado da arte das publicações expressas na literatura cientifica mundial sobre a temática, bem como identificar os benefícios terapêuticos da Cannabis medicinal no tratamento da dor. Método: trata-se de uma revisão integrativa da literatura, cuja busca de dados foi realizada nas bibliotecas virtuais. Web of Science, Scopus, Medline, IBECS, Lilacs, Cochrane Library, Emerald Insight e Scielo no período de agosto a outubro de 2021. Resultados: foram encontrados 367 artigos. Quarenta e três artigos foram selecionados para serem lidos na íntegra e 15 atenderam aos critérios desta revisão. Conclusão: as evidências mostram que embora cada vez mais prescritos ou autorizados, a cannabis medicinal ou os Canabinóides para a dor crónica continuam a ser controversos para muitos médicos.

Objective: to present the state of the art of publications expressed in the world scientific literature on the subject, as well as to identify the therapeutic benefits of medicinal cannabis in the treatment of pain. Method: this is an integrative literature review, whose data search was performed in virtual libraries. Web of Science, Scopus, Medline, IBECS, Lilacs, Cochrane Library, Emerald Insight and Scielo from August to October 2021. Results: 367 articles were found. Forty-three articles were selected to be read in full and 15 met the criteria of this review. Conclusion: evidence shows that although increasingly prescribed or authorized, medical cannabis or Cannabinoids for chronic pain remain controversial for many physicians.

Objetivo: presentar el estado del arte de las publicaciones expresadas en la literatura científica mundial sobre el tema, así como identificar los beneficios terapéuticos del cannabis medicinal en el tratamiento del dolor. Método: se trata de una revisión integradora de la literatura, cuya búsqueda de datos se realizó en bibliotecas virtuales. Web of Science, Scopus, Medline, IBECS, Lilacs, Cochrane Library, Emerald Insight y Scielo de agosto a octubre de 2021. Resultados: se encontraron 367 artículos. Se seleccionaron 43 artículos para ser leídos en su totalidad y 15 cumplieron con los criterios de esta revisión. Conclusión: la evidencia muestra que, aunque cada vez más se prescribe o autoriza, el cannabis medicinal o los cannabinoides para el dolor crónico siguen siendo controvertidos para muchos médicos.

Family and Community Support, Brain-Derived Neurotrophic Factor, and Cognitive Performance in Older Adults: Findings From the Health, Wellbeing and Aging Study Population-Based Cohort.

Background: Social networks can modulate physiological responses, protects against the detrimental consequences of prolonged stress, and enhance health outcomes. Family ties represent an essential source of social networks among older adults. However, the impact of family support on cognitive performance and the biological factors influencing that relationship is still unclear. We aimed to determine the relationship between family support, cognitive performance and BDNF levels. Methods: Cross-sectional data from three-hundred, eight-six individuals aged on average 60 years enrolled in the Health, Wellbeing and Aging Study (SABE), a population-cohort study, were assessed for family support, community support and cognitive performance. Structural and functional family support was evaluated based on family size and interactions allied to scores in the Family APGAR questionnaire. Community assistance (received or provided) assessed the community support. Cognitive performance was determined using the Mini-Mental State Examination (MMSE), verbal fluency (animals per minute) and backward digital span. Blood samples were obtained to determine BDNF levels. Results: Multivariate analysis showed that functional family support, but not structural, was associated with higher MMSE, verbal fluency and digit span scores, even controlling for potential cofounders (p < 0.001). Providing support to the community, rather than receiving support from others, was associated with better cognitive performance (p < 0.001). BDNF concentration was not associated with community support, family function, or cognitive performance. Conclusion: These findings suggest that emotional components of functional family and community support (e.g., loving and empathic relationship) may be more significant to cognitive health than size and frequency of social interactions.

Renovascular hypertension in pediatric patients: update on diagnosis and management.

Renovascular hypertension (RVH) is defined as an elevated blood pressure caused by kidney hypoperfusion, generally as a result of anatomic stenosis of the renal artery with consequent activation of the Renin Angiotensin-Aldosterone System. The main causes include genetic and inflammatory disorders, extrinsic compression, and idiopathic alterations. RVH is often asymptomatic and should be suspected in any child with refractory hypertension, especially if other suggestive findings are present, including those with severe hypertension, abdominal bruit, and abrupt fall of glomerular filtration rate after administration of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. There is a consensus that digital subtraction angiography is the gold standard method for the diagnosis of RVH. Nevertheless, the role of non-invasive imaging studies such as Doppler ultrasound, magnetic resonance angiography, or computed tomographic angiography remains controversial, especially due to limited pediatric evidence. The therapeutic approach should be individualized, and management options include non-surgical pharmacological therapy and revascularization with percutaneous transluminal renal angioplasty (PTRA) or surgery. The prognosis is related to the procedure performed, and PTRA has a higher restenosis rate compared to surgery, although a decreased risk of complications. This review summarizes the causes, physiopathology, diagnosis, treatment, and prognosis of RVH in pediatric patients. Further studies are required to define the best approach for RVH in children.

Caudal oviduct coiling in a viperid snake, Crotalus durissus

Sperm storage is common in the oviducts of female snakes and results in the decoupling of mating from ovulation and fertilization. In the majority of female snakes examined, sperm storage occurs in receptacles of the infundibular regions of the oviducts. In pitvipers (Viperida, Crotalinae), the storage of sperm was described in the caudal regions of the oviducts (utero‐vaginal junction) through a mechanism termed uterine muscular twisting (UMT). Uterine muscular twisting was described as a twisting of the oviducts after copulation because of uterine contractions. The twisting remains until ovulation at which time the oviducts straighten and sperm migrate cranially to fertilize ovulated ova. Here, we demonstrate that the UMT is not formed by twisting (rotation around axis) of the oviducts of Crotalus durissus but rather coils formed by the inner layers of the oviducts at the utero‐vaginal junction. Contrary to previous findings, coiling of the oviducts is present in females throughout the year, not only in the postcopulatory period; however, the degree of coiling is variable and may be linked to the seasonal reproductive cycle of C. durissus. We categorize the degree of coiling as pronounced coil, discreet coil or absent coil.

A participação da sociedade civil na democratização do setor de saúde no Brasil / Civil society's contribution to the democratization of the health sector in Brazil

Este ensaio apresenta a trajetória da participação da sociedade civil brasileira nas conquistas do setor de saúde no período da redemocratização política no País. Autores como Carvalho², Fleury³ Paim7 e Gerschman6 auxiliam a compreensão desse caminho. Pretende-se demonstrar a importância dos movimentos sociais da saúde e suas diferentes relações com o Estado brasileiro com vista à institucionalização dos Conselhos de Saúde. Como alternativa fundamental para a concretização da democracia participativa, os avanços práticos dos mecanismos de controle social desses colegiados ainda são bastante limitados. Os autores concluem que há um verdadeiro esvaziamento político na maioria dos Conselhos de Saúde, com práticas ainda marcadas pelo passado de legitimação do poder dominante. O papel exercido outrora pelos movimentos sociais e populares de formação de conselheiros encontra-se cada vez mais distante da população, institucionalizado na representação de um controle social ainda aparentemente "figurativo". Diante da realidade vivenciada neste e em outros estudos, questiona-se a atuação dos Conselhos de Saúde como espaço público democrático.

This study shows the trajectory of the contribution of Brazilian civil society to the milestones achieved by the Brazilian health sector during the country's re-democratization. Authors such as Carvalho², Fleury³, Paim7 and Gerschman6 facilitate an understanding of the transition. The study aims to demonstrate the importance of social movements in the health field and their various relations with the Brazilian state with the view of institutionalizing Health Councils. As a fundamental alternative in the realization of a participatory democracy, the practical advances made by the social control mechanisms in these councils remain very limited. The authors conclude that most Health Boards experience a real drain of policies with practices still marked by the past's legitimizing of the dominant power. The role once played by social and popular movements for the training of counselors has become increasingly distant from the population, and institutionalized in the representation of a Social Control which is still apparently "figurative". In light of this reality uncovered in this study and in others, these Health Councils' role as a democratic public space must be questioned.