Artigos - Saúde Pública - FMB

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Safety of beta-alanine supplementation in humans: a narrative review
(2023-01-01) de Oliveira, Erick P.; Artioli, Guilherme G.; Burini, Roberto Carlos [UNESP]; Universidade Federal de Uberlândia (UFU); Manchester Metropolitan University; Universidade Estadual Paulista (UNESP)
Carnosine levels play a significant role in intracellular pH buffering during exercise. The limiting factor for muscle carnosine synthesis is the availability of β-alanine. Results from meta-analysis showed a significant positive effect of β-alanine supplementation on high-intensity exercise performance. Nonetheless, much less has been described about the safety of β-alanine. The available literature indicates no adverse events related to β-alanine usage; side effects such as paresthesia may be observed if a large single high dose of β-alanine is taken, but the symptom can be attenuated either by using splitting doses (< 1.6 g) or a sustained-release formula. No adverse effects have been reported up to 24 weeks of β-alanine supplementation (3.2 g.day−1), but the adverse effects of longer supplementation periods are still unknown. Most of the existing clinical studies were not designed with safety evaluations as primary end points. β-Alanine is currently considered to be safe in healthy populations, at recommended doses, by the International Society of Sports Nutrition stands position, while the Australian Institute of Sports has established β-alanine as a safe performance-enhancing supplement with strong scientific evidence (grade A). Cohort studies are needed evaluating the safety of β-alanine among representative populations, and the effects of co-variables such as sex, age, and ethnicity.
Upper-Limb Kinematic Behavior and Performance Fatigability of Elderly Participants Performing an Isometric Task: A Quasi-Experimental Study
(2023-05-01) Silva-Migueis, Helena; Martínez-Jiménez, Eva María; Casado-Hernández, Israel; Dias, Adriano [UNESP]; Monteiro, Ana Júlia; Martins, Rodrigo B.; Bernardes, João Marcos [UNESP]; López-López, Daniel; Gómez-Salgado, Juan; Universidade da Coruña; Escola Superior de Saúde da Cruz Vermelha Portuguesa-Lisboa; Universidad Complutense de Madrid; Universidade Estadual Paulista (UNESP); Universidad de Huelva; Universidad Espíritu Santo
Upper-limb position-sustained tasks (ULPSIT) are involved in several activities of daily living and are associated with high metabolic and ventilatory demand and fatigue. In older people, this can be critical to the performance of daily living activities, even in the absence of a disability. Objectives: To understand the ULPSIT effects on upper-limb (UL) kinetics and performance fatigability in the elderly. Methods: Thirty-one (31) elderly participants (72.61 ± 5.23 years) performed an ULPSIT. The UL average acceleration (AA) and performance fatigability were measured using an inertial measurement unit (IMU) and time-to-task failure (TTF). Results: The findings showed significant changes in AA in the X- and Z-axes (p < 0.05). AA differences in women started earlier in the baseline cutoff in the X-axis, and in men, started earlier between cutoffs in the Z-axis. TTF was positively related to AA in men until 60% TTF. Conclusions: ULPSIT produced changes in AA behavior, indicative of movement of the UL in the sagittal plane. AA behavior is sex related and suggests higher performance fatigability in women. Performance fatigability was positively related to AA only in men, where movement adjustments occurred in an early phase, though with increased activity time.
Presentation – between the specialized and the common: a possible dialogue?
(2023-01-01) Cyrino, Antonio Pithon [UNESP]; Schraiber, Lilia Blima; Campos, Rosana Teresa Onocko; Universidade Estadual Paulista (UNESP); Universidade de São Paulo (USP); Universidade Estadual de Campinas (UNICAMP)
Intakes of Unprocessed and Minimally Processed and Ultraprocessed Food Are Associated with Diet Quality in Female and Male Health Professionals in the United States: A Prospective Analysis
(2023-01-01) Rossato, Sinara Laurini; Khandpur, Neha; Lo, Chun-Han; Jezus Castro, Stela Maris; Drouin-Chartier, Jean Philippe; Sampson, Laura; Yuan, Changzheng; Murta-Nascimento, Cristiane [UNESP]; Carvalhaes, Maria Antonieta [UNESP]; Monteiro, Carlos Augusto; Sun, Qi; Fung, Teresa T.; Willett, Walter C.; Universidade Federal de Uberlândia (UFU); Harvard T.H. Chan School of Public Health; Universidade de São Paulo (USP); Massachusetts General Hospital and Harvard Medical School; Universidade Federal do Rio Grande do Sul; Québec; Ferdinand Vandry Pavillon; Brigham and Women's Hospital and Harvard Medical School; Zhejiang University School of Medicine; Universidade Estadual Paulista (UNESP); Simmons College
Background: High unprocessed and minimally processed food (UMP) intake has been associated with high-quality diets, whereas the opposite has been shown for ultraprocessed food (UPF). Nevertheless, the association between UMP and UPF consumption and diet quality over the long-term warrants further examination. Objective: This study aimed to assess whether UMP and UPF intake are associated with three diet-quality metrics in female and male health professionals from two US cohorts over 3 decades of follow-up. Design: This was a cohort study, including data from the Nurses’ Health Study (NHS), from 1986 to 2010 (N = 51,956) and the Health Professionals Follow-up Study (HPFS) from 1986 to 2006 (n = 31,307). Participants and setting: Participants were invited in 1976 (NHS) and 1986 (HPFS) to respond to mailed questionnaires every 2 to 4 years and diet was assessed with a semi-quantitative food frequency questionnaire every 4 years. Main exposure measures: UMP and UPF intake were calculated using the NOVA classification. Statistical analyses: Generalized estimating equations for marginal means and repeated cross-sectional associations between diet-quality metrics and quintiles of UMP and UPF. Diets were assessed every 4 years from 1986 to 2010. Results: With increasing quintiles of UMP intakes, the Alternate Healthy Eating Index-2010 increased 7.1% (3.80 points, 95% CI 3.66 to 3.93) in the NHS and 10.1% (5.75 points, 95% CI 5.52 to 5.98) in the HPFS; the Mediterranean diet index increased 11.7% (0.50 points, 95% CI 0.47 to 0.52) in the NHS and 14.0% (0.64 points, 95% CI 0.60 to 0.68) in the HPFS; and the Dietary Approaches To Stop Hypertension diet score increased 7.5% (1.81 points, 95% CI 1.76 to 1.87) in the NHS and 10.6% (2.66 points, 95% CI 2.57 to 2.76) in the HPFS. In the fifth quintile of UPF intake compared with the first, the Alternate Healthy Eating Index-2010 was –9.3% (–4.60 points, 95% CI –4.73 to –4.47) lower in the NHS and –13.7% (–6.89 points, 95% CI –7.12 to –6.66) lower in the HPFS; the Mediterranean diet index was –14.7% (–0.55 points, 95% CI –0.57 to –0.53) lower in the NHS, and –19.0% (–0.74 points, 95% CI –0.78 to –0.70) lower in the HPFS; and the Dietary Approaches To Stop Hypertension diet score was –8.1% (–1.81 points, 95% CI –1.86 to –1.76) lower in the NHS and –12.8% (–2.84 points, 95% CI –2.93 to –2.74) lower in the HPFS. Conclusions: Consumption of UMP was associated with better dietary quality, whereas consumption of UPF was associated with poorer dietary quality.
The Impact of Low Back Pain on the Quality of Life of Children between 6 and 12 Years of Age
(2023-04-01) Santos, Elisiane de Souza [UNESP]; Bernardes, João Marcos [UNESP]; Vianna, Luana Schneider; Ruiz-Frutos, Carlos; Gómez-Salgado, Juan; Alonso, Melissa Spröesser [UNESP]; Noll, Matias; Dias, Adriano [UNESP]; Universidade Estadual Paulista (UNESP); (UNIFAJ); University of Huelva; Universidad Espíritu Santo; Instituto Federal Goiano; Universidade Federal de Goiás (UFG)
This study aimed to evaluate the impact of low back pain on the perceived health-related quality of life of children between 6 and 12 years of age. This is a cross-sectional study of three hundred seventy-seven students from three schools (two private and one public) located in the city of Botucatu, São Paulo. Data were collected using the Pediatric Quality of Life Inventory (PedsQL, version 4.0), a questionnaire comprising questions on personal background, sociodemographic and socioeconomic information, and a questionnaire about quality of life. Comparisons were made between groups with and without low back pain. The chi-squared test was used for analyzing categorical variables, and the non-parametric Mann–Whitney test was used for continuous variables. According to the findings obtained in this study, it was observed that low back pain in the last month was reported by 27.3% of the total participants. The perceived health-related quality of life was lower among individuals who had low back pain, and the scores of physical and emotional functioning domains were also lower in the presence of low back pain. The prevalence of low back pain among children and adolescents is relatively high. Furthermore, the repercussions of low back pain may lead to a lower overall perception of the health-related quality of life in this population and affect aspects of physical and emotional functioning.
Performance assessment of primary health care facilities in Brazil: Concordance between web-based questionnaire and in-person interviews with health personnel
(2023-02-01) Nunes, Luceime Olivia; Castanheira, Elen Rose Lodeiro [UNESP]; Sanine, Patricia Rodrigues [UNESP]; Akerman, Marco; Nemes, Maria Ines Baptistella; Universidade de São Paulo (USP); Universidade Estadual Paulista (UNESP)
This study is a concordance analysis comparing answers to two external assessment tools for Primary Health Care (PHC) facilities that use two different data collection methodologies: (a) external assessment through structured interviews and direct observation of facilities conducted by the National Program for Improvement of Access and Quality of Primary Care (AE-PMAQ-AB), and (b) a computerized web-based self-administered questionnaire for Assessment of the Quality of Primary Health Care Services (QualiAB). The two surveys were answered by 1,898 facilities located in 437 municipalities in the state of São Paulo, Brazil, between 2017 and 2018. Both surveys aimed to assess the management and organization of PHC facilities. A total of 158 equivalent questions were identified. The answers were grouped by thematic similarity into nine domains: Territory characteristics; Local management and external support; Structure; Health promotion, disease prevention, and therapeutic procedures; Attention to unscheduled patients; Women’s health; Children’s health; Attention to chronic conditions; and Oral health. The results show a high level of concordance between the answers, with 81% of the 158 compared questions showing concordance higher than 0.700. We showed that the information obtained by the web-based survey QualiAB was comparable to that of the structured interview-based AE-PMAQ-AB, which is considered the gold standard. This is important because web-based surveys are more practical and convenient, and do not require trained interviewers. Online assessment surveys can allow immediate access to answers, reports and guidelines for each evaluated facility, as provided by the QualiAB system. In this way, the answers to this type of survey can be directly employed by users, allowing the assessment to fulfill all phases of an assessment process.
Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil
(2023-01-01) da Silva, T. R. [UNESP]; Luvizutto, G. J.; Martins, L. G. [UNESP]; da Costa, R. D.M. [UNESP]; de Souza, J. T. [UNESP]; Winckler, F. C. [UNESP]; Sartor, L. C.A. [UNESP]; Modolo, G. P. [UNESP]; Ferreira, N. C. [UNESP]; Rodrigues, J. C.S. [UNESP]; Kanda, R. G. [UNESP]; Fogaroli, M. O. [UNESP]; Borges, G. F. [UNESP]; Rizzatti, G. R.S. [UNESP]; Ribeiro, P. W. [UNESP]; Pires, D. S.; Favoretto, D. B.; Aguiar, L. R.; Bazan, S. G.Z. [UNESP]; Betting, L. E.G. [UNESP]; Antunes, L. C.O. [UNESP]; Nunes, H. R.C. [UNESP]; Pereira, V. M.; Edwards, T. G.S.; Pontes-Neto, O.; Conforto, A. B.; Bazan, R. [UNESP]; Universidade Estadual Paulista (UNESP); Universidade Federal do Triângulo Mineiro; Universidade de São Paulo (USP); University of Toronto
There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.
The impact of disease changes and mental health illness on readapted return to work after repeated sick leaves among Brazilian public university employees
(2023-01-09) Dias, Adriano [UNESP]; Nunes, Hélio Rubens de Carvalho [UNESP]; Ruiz-Frutos, Carlos; Gómez-Salgado, Juan; Spröesser Alonso, Melissa [UNESP]; Bernardes, João Marcos [UNESP]; García-Iglesias, Juan Jesús; Lacalle-Remigio, Juan Ramón; Universidade Estadual Paulista (UNESP); University of Huelva; Universidad Espíritu Santo; University of Sevilla
Introduction: Health affects work absenteeism and productivity of workers, making it a relevant marker of an individual's professional development. Objectives: The aims of this article were to investigate whether changes in the main cause of the sick leaves and the presence of mental health illnesses are associated with return to work with readaptation. Materials and methods: A historical cohort study was carried out with non-work-related illnesses suffered by statutory workers of university campuses in a medium-sized city in the state of São Paulo, Brazil. Two exposures were measured: (a) changes, throughout medical examinations, in the International Classification of Diseases (ICD-10) chapter regarding the main condition for the sick leave; and (b) having at least one episode of sick leave due to mental illness, with or without change in the ICD-10 chapter over the follow-up period. The outcome was defined as return to work with adapted conditions. The causal model was established a priori and tested using a multiple logistic regression (MLR) model considering the effects of several confounding factors, and then compared with the same estimators obtained using Targeted Machine Learning. Results: Among workers in adapted conditions, 64% were health professionals, 34% had had changes in the ICD-10 chapter throughout the series of sick leaves, and 62% had diagnoses of mental health issues. In addition, they worked for less time at the university and were absent for longer periods. Having had a change in the illness condition reduced the chance of returning to work in another function by more than 30%, whereas having had at least one absence because of a cause related to mental and behavioral disorders more than doubled the chance of not returning to work in the same activity as before. Conclusion: These results were independent of the analysis technique used, which allows concluding that there were no advantages in the use of targeted maximum likelihood estimation (TMLE), given its difficulties in access, use, and assumptions.
Genetic and Antimicrobial Resistance Profiles of Mammary Pathogenic E. coli (MPEC) Isolates from Bovine Clinical Mastitis
(2022-12-01) Campos, Fernanda C. [UNESP]; Castilho, Ivana G. [UNESP]; Rossi, Bruna F. [UNESP]; Bonsaglia, Érika C. R. [UNESP]; Dantas, Stéfani T. A. [UNESP]; Dias, Regiane C. B. [UNESP]; Fernandes Júnior, Ary [UNESP]; Hernandes, Rodrigo T. [UNESP]; Camargo, Carlos H.; Ribeiro, Márcio G. [UNESP]; Pantoja, José C. F. [UNESP]; Langoni, Hélio [UNESP]; Rall, Vera L. M. [UNESP]; Universidade Estadual Paulista (UNESP); Adolfo Lutz Institute
Mammary pathogenic E. coli (MPEC) is one of the main pathogens of environmental origin responsible for causing clinical mastitis worldwide. Even though E. coli are strongly associated with transient or persistent mastitis and the economic impacts of this disease, the virulence factors involved in the pathogenesis of MPEC remain unknown. Our aim was to characterize 110 MPEC isolates obtained from the milk of cows with clinical mastitis, regarding the virulence factor-encoding genes present, adherence patterns on HeLa cells, and antimicrobial resistance profile. The MPEC isolates were classified mainly in phylogroups A (50.9%) and B1 (38.2%). None of the isolates harbored genes used for diarrheagenic E. coli classification, but 26 (23.6%) and 4 (3.6%) isolates produced the aggregative or diffuse adherence pattern, respectively. Among the 22 genes investigated, encoding virulence factors associated with extraintestinal pathogenic E. coli pathogenesis, fimH (93.6%) was the most frequent, followed by traT (77.3%) and ompT (68.2%). Pulsed-field gel electrophoresis analysis revealed six pulse-types with isolates obtained over time, thus indicating persistent intramammary infections. The genes encoding beta-lactamases detected were as follows: blaTEM (35/31.8%); blaCTX-M-2/blaCTX-M-8 (2/1.8%); blaCTX-M-15 and blaCMY-2 (1/0.9%); five isolates were classified as extended spectrum beta-lactamase (ESBL) producers. As far as we know, papA, shf, ireA, sat and blaCTX-M-8 were detected for the first time in MPEC. In summary, the genetic profile of the MPEC studied was highly heterogeneous, making it impossible to establish a common genetic profile useful for molecular MPEC classification. Moreover, the detection of ESBL-producing isolates is a serious public health concern.
Depression during pregnancy and gestational weight gain: A study of Brazilian pregnant women
(2023-02-01) Gomes, Caroline de Barros [UNESP]; Mendonça, Lettícia Silva [UNESP]; Roberto, Ana Paula Costa [UNESP]; Carvalhaes, Maria Antonieta de Barros Leite [UNESP]; Universidade Estadual Paulista (UNESP)
Objectives: The relationship between psychosocial factors/mental health/depressive symptoms and inadequate gestational weight (GW) change remains poorly understood. Thus, the aim of this study was to evaluate the association between depressive symptoms and inadequate GW change according to the criteria established by the Institute of Medicine in 2009. Methods: This cross-sectional study was part of a prospective cohort, and conducted in Botucatu, São Paulo, Brazil. Pregnant women who received prenatal care at basic health care units in the city participated in the study (n = 297). The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms during pregnancy, and the cutoff point used for the positive screening of depressive symptoms was ≥13. The association between depressive symptoms and two outcomes (insufficient and excessive weight change during second and third trimesters) was investigated using logistic regression models with adjustment for potential confounders. Crude and adjusted effect measures (odds ratios) and their relevant 95% confidence intervals were estimated. Results: There was an association between a positive score for depression during pregnancy and insufficient GW gain. No association was observed between depressive symptoms and excessive GW gain. Conclusions: The presence of depressive symptoms significantly increased the chance of insufficient GW change. This finding enhances the need for screening for depression in prenatal care.
The Effectiveness Of Lifestyle Changing With Supervised Physical Exercises On Overweight Patients With Obstructive Sleep-apnea
(Lippincott Williams & Wilkins, 2022-09-01) Burini, Roberto C. [UNESP]; Escorce, Ana Carolina M. [UNESP]; Weber, Silke A. T. [UNESP]; Universidade Estadual Paulista (UNESP)
Knowledge of women who have sex with women about Sexually Transmitted Infections and AIDS
(Abrasco - Brazilian Association Of Collective Health, 2023-01-01) Parenti, Ana Beatriz Henrique [UNESP]; Ignacio, Mariana Alice de Oliveira [UNESP]; Buesso, Thayna Santos [UNESP]; Almeida, Margareth Aparecida Santini de [UNESP]; Parada, Cristina Maria Garcia de Lima [UNESP]; Duarte, Marli Teresinha Cassamassimo [UNESP]; Universidade Estadual Paulista (UNESP)
This article aims to study the knowledge of women who have sex with women about Sexually Transmitted Infections and AIDS. Cross-sectional study of 260 women, 81 women who either have sex with women or with men and women (WSW) and 179 women who have sex exclusively with men (WSM). Data were collected in 2019/2020 by means of a form and validated instruments. To study the association between sexual partnership and level of knowledge about Sexually Transmitted Infections and AIDS, multiple Cox regression models were adjusted, producing significant associations of p<0,05. The median percentage of correct answers was lower among WSW when compared to WSM [68% (1896) vs 75% (14-96); p=0.023]. Having sex with woman [PR=2.36 (1.07-5.21); p=0.033] and less than 11 years of schooling [PR=2.64 (1.12-6.21); p=0.026] were independently associated with low knowledge. WSW had a lower level of knowledge about Sexually Transmitted Infections and AIDS than WSM, and lower education was independently associated with this finding.
Educação interprofessional na formação em saúde no Brasil: scoping review
(Associação Brasileira de Educação Médica, 2022-09-19) Prevedello, Alexandra Secreti; Góes, Fernanda Dos Santos Nogueira De; Cyrino, Eliana Goldfarb [UNESP]; Escola de Enfermagem de Ribeirão Preto; Universidade Estadual Paulista (UNESP)
The incorrect disposal of solid residues inside an operation room: an environmental, economic, and social problem
(2022-01-01) Patricio, Karina Pavão [UNESP]; Amorim, Alefe Rebouças [UNESP]; Borges, Beatriz Zanelato Rueda [UNESP]; Universidade Estadual Paulista (UNESP)
The overproduction of waste in our population is a serious social problem. In the health system, this is even more worrisome as the risks are aggravated by dangerous residues which need complex management. The lack of information and training of health professionals and managers, cleaning staff and patients regarding these residues may even result in occupational health, impact the environment, and result in considerable economical costs. In this work, the generation process of health care waste in an Operation Room (OR) of a large hospital was investigated, analyzing weights and costs, through in-loco observation of the operation row to investigate how the disposal is done and unveil the weak points in the process. During 4 months, 55 surgical procedures were observed and the residues generated in 1,498 procedures were weighted, of which 92% were disposed of as infectious waste. Among the factors that favored incorrect disposal, the following stand out: room size and disposal of trash cans for common and infectious waste. Here we highlight the need for ongoing training and environmental education, and the need to incorporate social-environmental values into the healthcare waste management routine, as well as the promotion of sustainable actions in the hospital leading to environmental, social, and economic sustainability.
Influence of an Upper Limb Isometric Task in Perceived and Performance Fatigability of Elderly Subjects: A Quasi-Experimental Study
(2022-08-01) Silva-Migueis, Helena; Martínez-Jiménez, Eva María; Casado-Hernández, Israel; Dias, Adriano [UNESP]; Monteiro, Ana Júlia; Martins, Rodrigo B.; Romero-Morales, Carlos; López-López, Daniel; Gómez-Salgado, Juan; Universidade da Coruña; Escola Superior de Saúde da Cruz Vermelha Portuguesa—Lisboa; Universidad Complutense de Madrid; Universidade Estadual Paulista (UNESP); Universidad Europea de Madrid; University of Huelva; Universidad Espíritu Santo
Isometric activity can be used as a strategy to improve health, fitness, and functional performance in the elderly population, but differences in fatigability may occur. This study aimed to understand fatigability behavior during an upper limb isometric task (ULIT) and the role of health status and physical activity in the fatigability of elderly participants. Thirty-two (32) elderly participants (72.5 ± 5.18 years) were instructed to perform ULIT. The Borg CR10 scale and task failure point (TTF) were used to measure perceived and performance fatigability. Self-reported measures were used to assess the quality of life and physical activity level. A significant relationship between perceived and performance fatigability was found only in the final phase of activity (p < 0.01). Significant correlations were found between perceived fatigability and the social functioning dimension (p < 0.05), and between performance fatigability (TTF) and BMI (p < 0.01), physical functioning (p < 0.01), and role functioning/physical (p < 0.05) dimensions. In conclusion, ULIT produces changes in fatigability of elderly people, which are positively related in the final stage of the activity. Changes in fatigability are negatively related to BMI. It is also negatively related to health, social functioning, physical functioning and role functioning/physical quality of life dimensions.
Effect of Robot-Assisted Training on Unilateral Spatial Neglect After Stroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials
(2022-08-01) Bazan, Rodrigo [UNESP]; Fonseca, Bruno Henrique de Souza; Miranda, Jessica Mariana de Aquino; Nunes, Hélio Rubens de Carvalho [UNESP]; Bazan, Silméia Garcia Zanati [UNESP]; Luvizutto, Gustavo José; Universidade Estadual Paulista (UNESP)
Background: Several studies have shown that robotic devices can effectively improve motor function in stroke patients through limb activation. However, the effects of robot-assisted therapy on perceptual deficits after stroke is unclear. Objective: This review aimed to evaluate the effectiveness of robotic limb activation in patients with unilateral spatial neglect (USN) after stroke. Methods: In this systematic review, a literature search was performed using MEDLINE, EMBASE, CENTRAL, CINAHL, and LILACS databases without language restrictions. Randomized controlled trials (RCTs) and quasi-RCTs of robot-assisted therapy for USN after stroke were selected. Two reviewers independently assessed the risk of bias and certainty of the evidence of the included studies. Results: A total of 630 studies were identified, including five studies for qualitative synthesis and four meta-analyses. The results of RCTs comparing robotic limb activation with a control group suggested an improvement in the degree of USN measured by the line bisection test (standardized mean difference [SMD], −0.64; 95% confidence interval [CI], −1.13 to −0.15; P =.01). There were no differences between the groups in the motor-free visual perception test 3rd edition (SMD, 0.27; 95% CI, −0.25–0.79; P =.31), star cancellation test (SMD, 0.26; 95% CI, −0.42−0.94; P =.54), Albert’s test (SMD, −0.67; 95% CI, −2.01−0.66; P =.32), and Catherine Bergego Scale (SMD, −0.81; 95% CI, −2.07−0.45; P =.21). Conclusion: The study demonstrated that limb activation through robotic therapy can improve midline perception. However, there was no impact on tasks assessing visual scanning, functionality, or activities of daily living.
Communication, information, and knowledge in the pandemic by COVID-19 in Brazil
(2022-07-15) Campolino, Luana Moura [UNESP]; Bernardes, João Marcos [UNESP]; Alonso, Melissa Spröesser [UNESP]; Gómez-Salgado, Juan; Ruiz-Frutos, Carlos; Domínguez-Salas, Sara; Días, Adriano [UNESP]; Universidade Estadual Paulista (UNESP); University of Huelva; Universidad Espíritu Santo; Universidad Loyola Andalucía
As coronavirus disease 2019 (COVID-19) is asserting itself as a health crisis, it is necessary to assess the knowledge and perceptions of people about the disease. The aim of this study is to assess the knowledge of the general population about COVID-19 and how the media influence this knowledge. This is a cross-sectional study with 5066 participants who answered an online questionnaire between April and May 2020. Data analysis was performed using descriptive statistics and logistic regression models. Over 75% have obtained a high degree of knowledge regarding signs, symptoms, and transmission, 95% stated to check the veracity of the information received, and also showed that the total knowledge about COVID-19 was associated with the level of instruction, with the perception of the quality of information disseminated by the media, and with the risk perception. Despite the high level of knowledge of participants, the results pointed to the need to reinforce information for individuals with less education and the importance of avoiding denialism that reduces the risk perception about COVID-19.
Two-year risedronate treatment for osteoporosis in patients with esophageal varices: a non-randomized clinical trial
(2022-01-01) Santos, Lívia Alves Amaral [UNESP]; Lima, Talles Bazeia [UNESP]; de Carvalho Nunes, Hélio Rubens [UNESP]; Qi, Xingshun; Romeiro, Fernando Gomes [UNESP]; Universidade Estadual Paulista (UNESP); General Hospital of Shenyang Military Command
Background: Bisphosphonates are the mainstay of osteoporosis treatment, but their use for patients with esophageal varices has been avoided due to the risk of esophagitis, which may cause variceal bleeding. Since most clinical trials assessing osteoporosis treatment last 2–3 years, this study aimed to evaluate a 2-year risedronate treatment for patients with esophageal varices and liver cirrhosis. Methods: The study received Institutional Review Board approval, and the sample was divided into two groups according to bone mineral density (BMD). Cirrhosis severity and endoscopic findings at baseline were similar between the groups. The intervention group had 51 patients with osteoporosis, who received oral risedronate 35 mg weekly plus calcium and vitamin D supplements. The control group had 51 patients with osteopenia, receiving only the supplements. Scheduled esophagogastroduodenoscopies and BMD measurements were carried out. Results: The adjusted esophagitis risk was higher in the intervention group; however, none of the subjects had digestive bleeding. Lumbar spine BMD increased in the intervention group (− 3.06 ± 0.71 to − 2.33 ± 0.90; p < 0.001) and in the control group (− 1.38 ± 0.77 to − 1.10 ± 1.05; p = 0.012). Femoral neck BMD did not change in the intervention group (− 1.64 ± 0.91 to − 1.71 ± 0.95; p = 0.220), but tended to decrease in the control group (− 1.00 ± 0.74 to − 1.09 ± 0.82; p = 0.053). Conclusion: Oral risedronate was effective and did not cause gastrointestinal bleeding in cirrhotic patients with esophageal varices under endoscopic surveillance. Graphic abstract: [Figure not available: see fulltext.]
Non-invasive Brain Stimulation Can Reduce Unilateral Spatial Neglect after Stroke: ELETRON Trial
(2022-09-01) da Silva, Taís Regina [UNESP]; de Carvalho Nunes, Hélio Rubens [UNESP]; Martins, Laís Geronutti [UNESP]; da Costa, Rafael Dalle Molle [UNESP]; de Souza, Juli Thomaz [UNESP]; Winckler, Fernanda Cristina [UNESP]; Sartor, Lorena Cristina Alvarez [UNESP]; Modolo, Gabriel Pinheiro [UNESP]; Ferreira, Natalia Cristina [UNESP]; da Silva Rodrigues, Josiela Cristina [UNESP]; Kanda, Rafael [UNESP]; Fogarolli, Marcelo Ortolani [UNESP]; Borges, Guilherme Ferreira [UNESP]; Rizzatti, Gabriela Rizzo Soares [UNESP]; Ribeiro, Priscila Watson [UNESP]; Favoretto, Diandra B.; dos Santos, Luan R. Aguiar; Bazan, Silméia Garcia Zanati [UNESP]; Betting, Luiz Eduardo [UNESP]; de Oliveira Antunes, Leticia Cláudia [UNESP]; Pereira, Vitor Mendes; Edwards, Taiza G. S.; Pontes-Neto, Octávio Marques; Conforto, Adriana Bastos; Bazan, Rodrigo [UNESP]; Luvizutto, Gustavo José; Universidade Estadual Paulista (UNESP); Universidade de São Paulo (USP); University of Toronto; Federal University of Triângulo Mineiro (UFTM)
Objective: Rehabilitation top-down techniques based on brain stimulation present variable outcomes in unilateral spatial neglect (USN) after stroke. This study aimed to examine the effects of physical therapy after anodal and cathodal transcranial direct current stimulation (A-tDCS and C-tDCS, respectively) to improve visuospatial and functional impairments in individuals with USN after stroke. Methods: This double-blinded, pilot randomized clinical trial enrolled patients with USN after ischemic stroke. Randomization was stratified according to the Behavior Inattention Test–Conventional (BIT-C) and Catherine Bergego Scale (CBS). Outpatient physical therapy was conducted for 7.5 weeks after 20 minutes of tDCS. The primary outcome was the USN degree evaluated by the BIT-C. Secondary outcomes were the difference in CBS score, stroke severity (National Institutes of Health Stroke Scale [NIHSS]), disability (modified Rankin Scale), autonomy (Barthel Index, Functional Independence Measure), and quality of life (EuroQol Group 5-Dimension Self-Report Questionnaire). Outcomes were analyzed using an analysis of covariance model corrected by age, baseline NIHSS, and baseline BIT-C. Pairwise post hoc comparisons were performed using Bonferroni correction. Results: In the primary outcomes, A-tDCS led to greater improvement in BIT-C after intervention (mean difference [MD] = 18.4, 95% confidence interval [CI] = 3.9–32.8, p = 0.008) compared to sham. However, no significant differences were observed between A-tDCS and C-tDCS (MD = 13.9, 95% CI = −0.3 to 28.1, p = 0.057), or C-tDCS and sham (MD = 4.5, 95% CI = −9.7 to 18.8, p = 0.99). There were no significant differences between groups in terms of secondary outcomes. Interpretation: A-tDCS associated with physical therapy can decrease the severity of USN after stroke. However, these preliminary findings must be confirmed by collecting additional evidence in a larger phase 3 trial. ANN NEUROL 2022;92:400–410.
Knowledge of COVID-19 among Brazilian health care professionals and associated factors
(2022-06-17) Bernardes, João Marcos [UNESP]; Magalhães, Daniela Mendes Dos Santos; Alonso, Melissa Spröesser [UNESP]; Gómez-Salgado, Juan; Ruiz-Frutos, Carlos; Romero, Adolfo; Días, Adriano [UNESP]; Universidade Estadual Paulista (UNESP); University Of Brasília; University Of Huelva; Universidad Espíritu Santo; Ibima
Health care professional's knowledge is essential to contain epidemics. This research aimed to evaluate the knowledge of Brazilian health care professionals regarding COVID-19 to analyze whether there is a difference in knowledge between professionals in Primary Health Care and those in other levels of care or not; and to identify factors associated with knowledge. This is a cross-sectional study, including 716 participants who answered an online questionnaire between April and May 2020. Descriptive statistics, difference tests between groups, and logistic regression models were used to analyze the data. The average knowledge score was 12.42 points (out of a possible total of 15). There was no significant difference between professionals in Primary Health Care and those in other levels of care. Knowledge was associated with age, profession, perception regarding media's information quality, and hours exposed to information on COVID-19. Participants showed adequate knowledge, despite some specific gaps. Continuing education actions should prioritize younger nonmedical professionals.

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