Search

ABSTRACT Objective: To understand the bioethical issues involved in the care management of nurses working in the Family Health Strategy. Method: A qualitative study was conducted through five focus groups with 36 nurses selected in the sample. Thematic content analysis was performed based on the bioethical framework, and the synthesis was presented in a conceptual map. Results: Bioethical issues were identified in the nursing care practice, related to both specific bioethical themes and the peculiarities of the work. Additionally, challenges and facilitators that interfere with addressing these issues were identified. Final considerations: Understanding the bioethical issues involved in the care management of nurses was possible with the theoretical support of different bioethical perspectives. The identified issues relate to persistent and current themes in the field of bioethics. However, some aspects intrinsic to daily practice are still imperceptible to professionals, contributing to the difficulty of discussing bioethics in this care model.

The United States Pharmacopeial Convention (USP) is a nonprofit, scientific, standard-setting organization, and world leader in establishing quality, purity, and testing standards for medicines, foods, and dietary supplements. USP quality standards are used in more than 140 countries and are legally recognized by more than 40 countries. Currently, there is renewed interest in herbal medicines globally, and health policies are being implemented worldwide for the use of complementary and traditional medicine. In response, USP has developed a robust body of monographs that can be used to guide industry and regulators in ensuring the quality and safety of botanical ingredients used in dietary supplements and herbal medicines. Throughout the Pan American regions, there is a strong tradition of using botanicals as herbal medicines and, as in other regions, a growing desire for botanical dietary supplements. This underscores the need for public quality standards to ensure quality, reduce the flow of substandard and adulterated products, and ensure public health and safety. In April 2022, USP launched the Pan America Botanical Dietary Supplements and Herbal Medicines Expert Panel, with experts representing 12 different countries. The Expert Panel’s work focuses on developing quality control standards for the most important botanical ingredients used in the respective countries, ingredients that are also of global importance. This article provides an overview of the state of botanical dietary supplements and herbal medicines in different Pan American regions with a focus on the regulatory status of herbal products, the development of national quality and research initiatives, and policies related to agriculture conservation and sustainability, among other topics.

Basiliximab (BAS) is an interleukin-2 monoclonal antibody initially used as induction therapy after liver and kidney transplantation. BAS use after lung transplantation (LTx) has supplanted antithymocyte globulin (ATG) as the main induction immunosuppression over the years, but few studies have compared them. In this study, we aimed to compare the efficacy and safety between BAS and ATG in LTx. We performed a retrospective analysis of all LTx done in Portugal between January 2016 and December 2019. Three groups were made according to the initial induction status: BAS, ATG or no induction (NI). The occurrences of cytomegalovirus (CMV) infection, pneumonia, side effects, primary graft dysfunction (PGD), acute rejection, chronic allograft disfunction (CLAD) and death episodes were assessed during two years after LTx. A total of 124 patients were divided in 3 groups: 61 (49.2%) BAS; 43 (34.7%) ATG; 20 (16.1%) NI. The incidences of pneumonia and CMV were similar between induction groups. Additionally, there was no difference between the induction groups in PGD, acute rejection, CLAD, deaths and two-year survival. Side effects were reported only in ATG group (n = 20; 46.5%). In our study, BAS had a better safety profile than ATG in LTx with a similar efficacy.

There is only a very short reaction time for people to find the best way out of a building in a fire outbreak. Software applications can be used to assist the rapid evacuation of people from the building; however, this is an arduous task, which requires an understanding of advanced technologies. Since well-known pathway algorithms (such as, Dijkstra, Bellman–Ford, and A*) can lead to serious performance problems, when it comes to multi-objective problems, we decided to make use of deep reinforcement learning techniques. A wide range of strategies including a random initialization of replay buffer and transfer learning were assessed in three projects involving schools of different sizes. The results showed the proposal was viable and that in most cases the performance of transfer learning was superior, enabling the learning agent to be trained in times shorter than 1 min, with 100% accuracy in the routes. In addition, the study raised challenges that had to be faced in the future.

RESUMO Os objetivos do estudo foram mapear e analisar a oferta das Práticas Integrativas e Complementares (Pics) na atenção primária pela enfermagem no município de São Paulo e a interferência da pandemia da Covid-19 na oferta dessas práticas. Estudo descritivo de série temporal, realizado com dados secundá- rios a partir do banco de dados oficiais do Departamento de Informática do Sistema Único de Saúde no período entre 2018 e 2020. Os resultados demonstram que as Pics ofertadas pela enfermagem totalizaram 10.933 procedimentos em 2018, 24.684 em 2019 e 12.651 em 2020. Entre os anos de 2018 e 2019, houve um aumento de 120% na oferta, tendência interrompida em 2020 em decorrência da pandemia da Covid-19. A oferta dessas práticas pela enfermagem é uma forma de atendimento com vistas ao cuidado integral e apreensão ampliada do processo saúde-doença. Contudo, apesar do grande potencial para adoção dessa abordagem no cuidado, a categoria tem demonstrado percentuais pouco representativos do total ofertado no município analisado.

Maize is a crop of significant economic importance. In the northeast region of Brazil, it serves as the foundation of family support for the majority of farmers. However, achieving high levels of productivity requires an adequate water supply throughout its growth cycle. The northeast semi-arid region experiences low rainfall and high potential evapotranspiration, directly affecting maize development and leading to severe declines in productivity. In this study, genetic selection and proteomic analysis are proposed as a strategy to identify the tolerance of maize cultivars against water stress. The experiments were conducted under two water regimes using randomized block designs with three replicates. Development and productivity traits were evaluated, and genetic parameters were estimated using mixed linear models. Selection for water stress tolerance was based on the harmonic mean of the relative performance of genotypic values. Total protein extraction from maize leaves followed the protocol established by the phenol method, and peptides were analyzed through mass spectrometry. The AG8677P cultivar demonstrated remarkable productivity under drought stress conditions, and proteins related to various fundamentally important biological processes for the tolerance mechanism were identified. The combination of genetic selection with proteomic analysis proves to be an efficient strategy, even in the face of limited resources and a small number of treatments.

Introdução: A pandemia da COVID-19 tem feito inúmeras vítimas fatais em todo o mundo. Ela não apenas ameaça a esfera física do indivíduo, como também pode gerar importante adoecimento psicológico na população, principalmente por conta do medo de contrair a doença. Objetivo: Avaliar a relação do medo da COVID-19 com sintomas ansiosos e depressivos dos residentes de Medicina de Família e Comunidade da região metropolitana de Fortaleza. Métodos: Realizou-se um estudo quantitativo analítico, correlacional e transversal, no qual os participantes responderam a um formulário eletrônico que continha um questionário elaborado pelos autores e os instrumentos Escala Hospitalar de Ansiedade e Depressão (HADS) e Escala de Medo do COVID-19 (EMC-19). Resultados: A pesquisa contou com 50 participantes. Verificou-se que 52% dos residentes apresentavam sintomas de ansiedade, 36% sintomas depressivos e 22% possuíam medo da doença de moderado a intenso. As maiores médias de medo foram dos residentes que já tratavam ansiedade ou depressão e dos residentes que iniciaram tratamento durante a pandemia. Conclusões: O estudo demonstrou que uma porcentagem relevante dos pesquisados apresentou sintomas de ansiedade e depressão, além de mostrar associação direta entre esses sintomas e o medo da COVID-19. Conclui-se enfatizando que o contexto pandêmico exige maior atenção às circunstâncias da saúde mental dos residentes de Medicina de Família para propor medidas de enfrentamento mais resolutivas à problemática.

Abstract The purpose of this reflection is to include ethical principles in the discussion on resource allocation in times of covid-19. This study presents recent news and documents on the use of resources in the pandemic and principles such as justice, autonomy and beneficence. The comprehension that all human beings are worthy of respect, solidarity and protection can help pave the way for accelerating pandemic control for all.

Every day there is criticism about lack of evidence on traditional, complementary, and integrative medicine (TCIM). But is this narrative evidence-based? Are we really missing research about TCIM? Or are we just not looking correctly at the evidence? Evidence maps are a useful method with the dual function of synthesizing available evidence on a specific topic and identifying knowledge gaps. This article presents a six-step evidence map methodology along with recently published TCIM evidence maps, including one related to COVID-19. TCIM evidence maps are useful instruments to inform decision-making for policymakers, health practitioners, and patients.

ABSTRACT OBJECTIVE: To identify the possible repercussions of the COVID-19 pandemic on the workers’ health, the care strategies used, and the provision of Integrative and Complementary Practices in health services in the context of COVID-19. METHOD: Descriptive study, with a qualitative approach, which used a focus group for data collection and content analysis according to Bardin. RESULTS: Eleven health professionals from the city of Registro (SP) participated and, based on the information analysis, four categories emerged: (1) Changes in work routine caused by the pandemic and the feelings they generate in health professionals; (2) Integrative and Complementary Practices as a self-care strategy in the pandemic; (3) Provision of Integrative and Complementary Practices during the pandemic; and (4) Occupational health as the focus and strategy motivator to resume the provision of Integrative and Complementary Practices in the municipality. CONCLUSION: This study allowed the identification of the impact of the pandemic, especially on workers’ mental health, which influenced the search for care strategies that included the Integrative and Complementary Practices. Professionals with this training began to offer the Integrative and Complementary Practices in the service to other workers, given the interruption of their provision to the population due to the COVID-19 pandemic.

Abstract Caffeine is a highly-consumed substance around the world and can be found in various food sources and certain medications. The present systematic review aimed to evaluate the effect of caffeine on bone metabolism in rats. A systematic review was conducted in the PubMed, Medline, Scopus, Cocharane, Embase, and Clinical Trials.gov databases, and the Guidelines for Preferential Reporting for Systematic Reviews and Meta-Analyzes (PRISMA) were followed. In vivo experimental studies that presented caffeine as the study object were included, and studies which did not evaluate the bone metabolism and/or evaluated the caffeine in association with other substances were excluded. The quality evaluation of the selected studies was carried out following the guidelines of the Systematic Review Center for Laboratory Animal Experimentation (SYRCLE) and the Animal Research Reporting In Vivo Experiment (ARRIVE). Nine of the 472 initially identified articles met the inclusion criteria and were selected for qualitative evaluation. There was a variation between the included studies regarding the administered caffeine doses in each experimental group, as well as their frequency and duration of ingestion. Most studies show that caffeine can interfere with bone metabolism, be it in a negative way by accelerating bone loss and delaying bone repair, or in a beneficial way by activating osteogenesis and bone neoformation. There is a need for further studies to better understand the real effect of caffeine on bone metabolism.

Os anti-inflamatório são usados para amenizar ou impedir reação de inflamação, além disso possuem duas classes, sendo elas os esteroides e os não esteroides (AINEs). Os AINEs agem inibindo a ciclo-oxigenase (COX) e são um dos fármacos mais prescritos no mundo para controle da dor. Entretanto, o uso prolongado ou em altas doses pode ter efeitos deletérios, impedindo funções não relacionado à inflamação, como a citoproteção da isoenzima, que previne gastropatias. Ademais, é usado frequentemente em associação com outros fármacos, caracterizando polifarmácia, principalmente em idosos, que se apresentam efeitos adversos potencializados. Logo o presente estudo tem como objetivo analisar e descrever os efeitos do uso indiscriminado dos anti-inflamatórios não esteroidais, sua associação com a polifarmácia e as consequências gastropáticas relacionadas a isso. O trabalho é uma revisão integrativa, realizada de forma descritiva de informações compiladas de bases de dados, para a seleção dos artigos foram usados os descritores “gastrointestinal diseases” AND “drug effects” e as palavras chaves “anti-inflamatório” e “polifarmácia”, entre os anos de 2010 a 2019. Tais fármacos são percursores ao causar deficiência de prostaglandinas pela inibição da COX, não deixando ocorrer a cicatrização, o que pode causar hemorragia gastrointestinal oculta ou evidente nas fezes, desconforto gástrico, dispepsia, diarreia e doenças inflamatórias, dentre outros sintomas. Além disso os AINEs estão intimamente ligados ao risco de desenvolver doença de Crohn, aumentando, também, em 2x, a chance para desenvolver colite. Os estudos demostraram que existe relação desses medicamentos com complicações gastrointestinais, principalmente em polifarmácia, presente em especial na população idosa. Assim, definiu-se que indivíduos do sexo masculino, maiores de 75 anos e usuários de AINEs são pacientes com características para a alta suscetibilidade do desenvolvimento de patologias gástricas. Desse modo, o estudo fomenta uma maior atenção dos profissionais de saúde a fim de evitar a potencialização do risco dessas complicações gastrointestinais.

Study Basis: This evidence map presents a summary of studies that addressed the effects of meditation on various clinical and health conditions. Meditation is a contemplative practice that has been used for the promotion of health, and the treatment of different conditions.Method: The study is based on the search of four electronic databases for the period 1994-November 2019 and includes systematic reviews, meta-analyses, meta-syntheses, and integrative reviews. 3iE evidence gap map was the methodology of choice, and AMSTAR 2 was used for the analyses. Tableau was used to graphically display the confidence level, number of reviews, health outcomes, and intervention effects.Results: This map encompasses 191 studies, with Mindfulness being the key word that retrieved the highest number of results. Several meditation techniques were evaluated in different contexts, and the confidence levels of 22 studies were high, 84 were moderate, and 82 were low. Two 2 meta-syntheses and 1 integrative review were also included. Most of the studies reported positive effects and a beneficial potential of the practice of meditation. Health outcomes were divided into five groups out of which mental health and vitality, and well-being and quality of life stood out with the largest number of studies.Conclusions: Meditation has been applied in different areas. This Evidence Map intends to be an easy visual tool to access valuable evidence-based information on this complementary therapy for patients, health professionals, and managers.

Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes.Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects.Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia.Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.

Background: This evidence map describes Pediatrics Massage intervention research reporting health outcomes. Massage is a complementary therapy and can be defined as any form of systematic tactile stimulation by human hands, the type of massage typically used in pediatrics care is a gentle, slow stroking of each part of the body in turn. Methods: The evidence map is based on the 3iE evidence gap map methodology. We searched four electronic databases from inception to November 2019 and included systematic reviews and non-systematic reviews. Systematic reviews were analyzed based on AMSTAR 2. We used tableau to graphically display confidence level, number of reviews, outcomes and a broad estimate of effectiveness. Results: The map is based on 38 reviews. Most of the reviews were published in the last ten years. The Pediatrics Massage was the most researched intervention. Massage was evaluated as an intervention in several health outcomes, resulting in the following confidence levels: 11 high, 13 moderate and 14 low. Every outcome effect was classified: 6 as no effect; 1 mixed and 28 as positive. The outcomes were divided into four major groups: physical and metabolic effects; vitality, well-being and quality of life, mental health; and management. High quality studies presented no effect and positive effects, highlighting outcomes related to neuro-motor development (Badr et al., 2015; Bennett et al., 2013; Vickers et al., 2015), growth (Badr et al., 2015; Bennett et al., 2013; Vickers et al., 2015) and stress disorders (Bennett et al., 2013; Vickers et al., 2015). Conclusions: Pediatrics massage has been applied in different areas and these Evidence Gap Map provides an easy visualization of valuable information for patients, health practitioners and managers, in order to promote evidence-based complementary therapies.

Background: Pain is a disagreeable and distressing feeling that affects human beings in multi-dimensional ways. A number of non-pharmacological interventions have had varying degrees of success in treating cancer-related pain, such as breathing and relaxation techniques, and music therapy, which have been identified as beneficial therapies for alleviating pain and anxiety. Objective: Identify the therapeutic effects of music interventions in psychological and physiological terms and on the quality of life of children undergoing cancer treatment. Method: Systematic review of effectiveness based on the methodology of the Joanna Briggs Institute. Results: Eleven articles were included with a total of 429 children, whose ages ranged from 0 to 18 years. The mean duration of the music intervention was 30.6 (±SD 9.8) min. In a combined estimate of five studies for pain and anxiety outcomes, there were benefits to using music when compared with the control group (SMD −1.05; CI 95 % −1.70 – 0.40 N = 453 I2 = 90 %). A combined analysis of five studies to assess quality of life showed that the use of music was favorable when compared with the control (SMD -0.80; CI 95 % −1.17−0.43 N = 457= I2 = 71 %). Conclusion: After completing this review, it was determined that there is evidence to support the use of music to reduce pain and anxiety and improve the quality of life of children undergoing cancer treatment.

Resumo Objetivo Conhecer os benefícios das práticas de enfermagem aos pacientes com dor acompanhados na clinica de dor. Métodos Revisão integrativa de literatura, sendo utilizado o portal eletrônico SCIELO, e base de dados CINAHL e PubMed Central, com recorte temporal de 2008 a 2018 e período de coleta de dados entre junho e julho de 2018. Como descritores em saúde (DeCs): Pacientes, Dor crônica, Cuidados de Enfermagem, Clínicas de dor; e, o Medical Subject Heading (MeSH): Patients, Chronic pain, Nurse Care, Pain clinic. Resultados Evidenciou-se que a produção analisada é, majoritariamente, sobre práticas de enfermagem não farmacológica a pacientes com dor crônica, com publicações reduzidas no Brasil e tendem a se concentrar nos últimos cinco anos. O paciente com este tipo de agravo, vivencia condições multifatoriais que influenciam diretamente na condição de saúde, e necessitando de acompanhamento integral por equipe interprofissional, com inclusão da rede cuidadora, através intervenções qualificadas e resolutivas, visando adaptação e ou melhora da sua condição de saúde. Conclusão Os estudos indicam benefícios gerados pelas práticas sistematizadas implementadas por enfermeiros, por meio de instrumentos e ferramentas para detecção, intervenção e avaliação, além de apoio clínico.

Abstract: Introduction: The presence of chronic stress, caused by the activities and demands of the medical course, can lead to what is called ‘burnout’, a syndrome characterized by three dimensions: emotional exhaustion, dehumanization (or depersonalization) and reduced professional achievement. Considering the increased incidence of burnout syndrome, anxiety and depression symptoms, suicide attempts and suicide rates among medical students, as a consequence of increasing demands for professional and financial success at the expense of physical and mental health, one understands the importance of studying the subject and proposing measures of prevention and control. The aim of this study was to evaluate and describe the levels of burnout and well-being of medical students at a Brazilian public university. Method: The stress and well-being levels of students from the first to the sixth year for the Medical Course at Universidade Federal de São Paulo were evaluated using MBI-SS and WHOQOL-BREF questionnaires, applied online on the REDCAP platform. Results: A total of 302 students completed the questionnaires. Regarding the MBI-SS, students showed a low value in the emotional exhaustion factor and high levels of professional disbelief and effectiveness, indicating a burnout that ranged from low to moderate. It was also observed that female students showed a greater tendency toward emotional exhaustion when compared to male ones, as well as the fact that students from the 1st and 2nd years showed higher values of professional effectiveness when compared with 3rd and 4th years, with no difference between genders. Based on the answers from WHOQUOL-BREF questionnaire, the students thought they had a good quality of life. Discussion: These results reinforce possible factors that might interfere with the students’ quality of life: excessive workload, teaching model based on extensive lectures, lack of stimulation, recognition for their efforts. Conclusion: The medical students evaluated in this study have a good quality of life and show low or moderate burnout levels.

Background: Due to the pandemic, there is a significant interest in the therapeutic resources linked to TCIM to support potentially therapeutic research and intervention in the management of Coronavirus - 19 (COVID-19). At the date of this evidence map´s publication, there is no evidence of specific treatments for COVID-19. This map organizes information about symptoms management (especially on dimensions related to mental health and mild viral respiratory infections, as well as immune system strengthening and antiviral activity). Method: This evidence map applies methodology developed by Latin American and Caribbean Center on Health Sciences Information based on the 3iE evidence gap map. A search was performed in the Traditional, Complementary and Integrative Medicine Virtual Health Library and PubMed, using the MeSH and DeCS terms for respiratory viral diseases associated with epidemics, COVID-19 symptoms, relevant mental health topics, pharmacological and non-pharmacological interventions related to TCIM. Results: For the map, 126 systematic reviews and controlled clinical studies were characterized, distributed in a matrix with 62 interventions (18 phytotherapy, 9 mind-body therapies, 11 traditional Chinese medicine, 7 homeopathic and anthroposophic dynamized medicines and 17 supplements), and 67 outcomes (14 immunological response, 23 mental health, 25 complementary clinical management of the infection and 5 other). Conclusion: The map presents an overview of possible TCIM contributions to various dimensions of the COVID-19 pandemic, especially in the field of mental health, and it is directed to researchers and health professionals specialized in TCIM. Most of the antiviral activity outcomes described in this map refers to respiratory viruses in general, and not specifically to SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2). This information may be useful to guide new research, but not necessarily to support a therapeutic recommendation. Finally, any suspicion of COVID-19 infection should follow the protocols recommended by the health authorities of each country/region.

Objetivo: Descrever os aspectos epidemiológicos, as complicações e as hospitalizações relacionadas à estomia. Métodos: Trata-se de um estudo transversal, descritivo e quantitativo das variáveis: sexo, idade, faixa etária, raça/cor, tempo de estomia, tipo de estomia, etiologia, complicações e internações hospitalares associadas à colostomia de 123 pacientes atendidos no ambulatório de enfermagem para pacientes estomizados de um hospital escola em Goiânia, Goiás, Brasil. Após a disposição dos dados em tabelas, utilizou-se o software Epi Info 7 para a descrição dos resultados, a análise de prevalências e a associação de variáveis. Resultados: 51,2% (n=63) dos pacientes eram do sexo masculino e houve predominância do tipo de colostomia terminal (n=68;57,6%), enquanto 24,5% (n=29) era do tipo em alça e 17% (n=20) do tipo dupla boca. Quanto à etiologia da estomia, 40,5% (n=49) ocorreu por neoplasia, 17,3% (n=21) por doença inflamatória intestinal e 9% (n=11) por trauma. O desenvolvimento de complicações esteve presente em 38 (30,89%) pacientes, sendo a dermatite periestomal a principal delas, e 9 (7%) pacientes necessitaram de internação hospitalar relacionada à estomia. Conclusão: Observa-se que os pacientes investigados apresentam predominância do sexo masculino, média de idade de 61,5 anos, raça/cor parda, de colostomia terminal e etiologia neoplásica, sendo a maioria dos pacientes portadores de colostomia há cerca de 5 anos.

Abstract Background Mindfulness has been applied in the United States and Europe to improve physical and psychological health; however, little is known about its feasibility and efficacy in a Brazilian population. Mindfulness may also be relevant in tackling obesity and eating disorders by decreasing binge eating episodes—partly responsible for weight regain for a large number of people—and increasing awareness of emotional and other triggers for overeating. The aim of the present study protocol is to evaluate and compare the feasibility and efficacy of two mindfulness-based interventions (MBIs) addressing overweight and obesity in primary care patients: a general programme called Mindfulness-Based Health Promotion and a targeted mindful eating protocol called Mindfulness-Based Eating Awareness Training. Methods/design A randomised controlled trial will be conducted to compare treatment as usual separately in primary care with both programmes (health promotion and mindful eating) added to treatment as usual. Two hundred forty adult women with overweight and obesity will be enrolled. The primary outcome will be an assessment of improvement in eating behaviour. Secondary outcomes will be (1) biochemical control; (2) anthropometric parameters, body composition, dietary intake and basal metabolism; and (3) levels of mindfulness, stress, depression, self-compassion and anxiety. At the end of each intervention, a focus group will be held to assess the programme’s impact on the participants’ lives, diet and health. A feasibility study on access to benefits from and importance of MBIs at primary care facilities will be conducted among primary care health care professionals and participants. Monthly maintenance sessions lasting at least 1 hour will be offered, according to each protocol, during the 3-month follow-up periods. Discussion This clinical trial will result in more effective mindfulness-based interventions as a complementary treatment in primary care for people with overweight and obesity. If the findings of this study confirm the effectiveness of mindfulness programmes in this population, it will be possible to improve quality of life and health while optimising public resources and reaching a greater number of people. In addition, on the basis of the evaluation of the feasibility of implementing this intervention in primary care facilities, we expect to be able to suggest the intervention for incorporation into public policy. Trial registration ClinicalTrials.gov, NCT02893150. Registered retrospectively on 30 March 2017.

RESUMO Objetivo Compartilhar a experiência da dupla titulação em enfermagem promovida entre a Escola de Enfermagem da Universidade de São Paulo e o Instituto de Ciências da Saúde da Universidade Católica Portuguesa, fazendo uma reflexão sobre as potencialidades e os desafios dessa oportunidade para o estudante de pós-graduação. Método Trata-se de um relato de experiência apresentado em ordem cronológica e de natureza descritiva. A dupla titulação em enfermagem foi realizada no período de 6 meses, em instituição diferente da de origem. Resultados Dentre as atividades desenvolvidas durante a dupla titulação destacam-se: participação em bancas de defesa, congressos, seminário, cursos, encontros, palestras, colóquios, aulas, grupos de pesquisa e visita técnica aos serviços de saúde. Um quadro apresenta e descreve os principais benefícios da experiência vivenciada pelas autoras. Conclusão A dupla titulação, quando bem planejada e desenvolvida, pode promover o desenvolvimento pessoal, cultural e profissional do estudante, favorecendo a internacionalização e contribuindo para a qualificação dos programas de pós-graduação.

Atualmente, os destinos turísticos exigem uma oferta adaptada às exigências dos novos e diferentes mercados, tendo em vista a competitividade dos territórios. O turismo criativo, impulsionado pela co-criação de experiências, surge como uma forma de conferir um caráter único a estes espaços, proporcionando contextos de aprendizagem e envolvimento entre turistas e comunidades locais. No entanto, esta interação tem sido vedada à população com incapacidade, sendo crucial eliminar determinados constrangimentos (internos, interativos e externos). É neste contexto que o presente artigo visa realçar a pertinência em se apostar na educação e sensibilização dos stakeholders dos destinos para a promoção da interatividade, dinamismo e total envolvimento dos intervenientes na experiência turística. O Modelo Educacional de Turismo Criativo para Todos sugerido evidencia a importância da educação na co-criação de produtos turísticos inovadores e inclusivos, tendo em vista a plena participação de qualquer interveniente, bem como a competitividade e desenvolvimento dos destinos turísticos.

O estudo objetivou compreender a deliberação ética de enfermeiros e médicos diante de pacientes difíceis na Atenção Primária à Saúde (APS). Utilizou-se uma abordagem compreensiva, ancorada no referencial teórico metodológico da bioética deliberativa. Analisaram-se as entrevistas semiestruturadas, tomando a prudência como categoria analítica. Entre 2002-2010, entrevistaram-se setenta profissionais da APS do município de São Paulo. Os resultados evidenciam que os cursos de ação intermediários dos profissionais tendem à conciliação dos valores cuidado e ordenamento. Nos cursos de ação extremos, as enfermeiras tendem para o cuidado, e os médicos, para o ordenamento. Conclui-se que os pacientes difíceis são comuns na APS e os profissionais tendem a apresentar cursos de ação para atendê-los, sem perturbar a rotina da unidade, os demais profissionais e usuários.

Objectives to identify nursing challenges for universal health coverage, based on the findings of a systematic review focused on the health workforce' understanding of the role of humanization practices in Primary Health Care. Method systematic review and meta-synthesis, from the following information sources: PubMed, CINAHL, Scielo, Web of Science, PsycInfo, SCOPUS, DEDALUS and Proquest, using the keyword Primary Health Care associated, separately, with the following keywords: humanization of assistance, holistic care/health, patient centred care, user embracement, personal autonomy, holism, attitude of health personnel. Results thirty studies between 1999-2011. Primary Health Care work processes are complex and present difficulties for conducting integrative care, especially for nursing, but humanizing practices have showed an important role towards the development of positive work environments, quality of care and people-centered care by promoting access and universal health coverage. Conclusions nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care. It is necessary to overcome difficulties such as fragmented concepts of health and care and invest in multidisciplinary teamwork, community empowerment, professional-patient bond, user embracement, soft technologies, to promote quality of life, holistic care and universal health coverage.

Specimens attributed to the genus Lithophyllum were collected during multiple surveys conducted along the Brazilian coast. These specimens were studied using DNA sequences from three molecular markers (COI5P, psbA, rbcL) and comparative morphoanatomical analyses. This approach revealed eight distinct, well-supported lineages: two currently known species, Lithophyllum atlanticum and L. kaiseri; four new species, L. brasiliense sp. nov., L. pseudomargaritae sp. nov., L. solis sp. nov. and L. tomitae sp. nov.; and two additional lineages that remain unresolved as the available data were incongruent or insufficient. Lithophyllum pseudomargaritae was morpho-anatomically similar but distantly related to sequences from the type locality of specimens morphologically identified as L. margaritae. This study confirms the occurrence of cryptic/pseudocryptic coralline diversity in the Brazilian flora. [ABSTRACT FROM AUTHOR]

Molecular data related to morphology from the multicellular vesiculated genus Dictyosphaeria are scarce. We provide the first molecular data on Dictyosphaeria species from the southwestern Atlantic Ocean, sampled from the Brazilian northeastern coast, and two oceanic islands (Trindade, southeastern Brazil, and Fernando de Noronha, northeastern Brazil). The samples from Brazil were morphologically identified as Dictyosphaeria versluysii and D. ocellata. Our newly generated sequences of D. versluysii formed a monophyletic clade, while their relationship with D. versluysii from the Indo-Pacific Ocean, where the type locality of the species is located, was unresolved. Additionally, the newly generated sequences of D. ocellata confirm its status as a distinct species but reinforce the difficulties in morphologically separating this species. These results might be indicative of cryptic diversity in D. versluysii and highlight the need for molecular data from other geographic locations to understand the diversity and distribution of Dictyosphaeria species. [ABSTRACT FROM AUTHOR]

Context • The World Health Organization (WHO) seeks to support member states in providing Traditional, Complementary, and Integrative Medicine (TCIM) services within Primary Health Care (PHC). Health professionals’ offer of and referral to complementary therapies and humanizing practices can encounter some difficulties due to both conventional medical knowledge and institutional organizations. An integrative care model of complementary therapies and humanizing practices may be a strategy to overcome such difficulties. Objective • The study aimed to identify an integrative care model of complementary therapies and humanizing practices and to determine their influence on PHC. Design • The research team performed: (1) a qualitative meta-synthesis based on data from two systematic reviews that included more than 15000 professionals from 18 countries, and (2) qualitative research conducted with 24 participants, professionals from the South and Southeast regions of São Paulo, SP, Brazil. Setting • The study occurred at the Paulista School of Medicine at the Federal University of Sao Paulo (UNIFESP) in Sao Paulo, Brazil. Results • The analysis of the integrative care model resulted in two syntheses: (1) that PHC is offering complementary therapies and humanizing practices that have had a positive and subjective influence on PHC and (2) complementary therapies and humanizing practices improve PHC’s service quality and resolvability and reduce medicalization. Conclusions • The work process in PHC may pose difficulties for the provision of integrative and holistic care yet promoting a model to integrate complementary therapies and humanizing practices with conventional medicine in health services may improve PHC and the perceptions of health professionals, managers, and patients about the positive and subjective effects of these practices. [ABSTRACT FROM AUTHOR]