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This review explores current guidelines for integrating psychosocial support, nutrition, and physical activity into cancer care and examines the resources available to deliver comprehensive care effectively and equitably, with a focus on telehealth solutions. A review of current guidelines related to psychosocial support, nutrition, and exercise in oncology published between the years 2020 and 2024 was conducted. Additionally, relevant articles from the authors' personal archives were included. Current guidelines emphasize routine psychosocial distress screening, nutritional assessment, and tailored physical activity interventions for patients with cancer. The National Comprehensive Cancer Network and ASCO highlight the need for regular psychosocial evaluations and the management of common psychiatric disorders. The American Cancer Society and the Academy of Nutrition and Dietetics recommend nutritional screening, personalized counseling, and exercise to improve treatment tolerance and overall quality of life. Despite these recommendations, challenges such as resource limitations, time constraints, and financial barriers hinder their implementation. Integrating psychosocial support, medical nutrition therapy, and physical activity into cancer care is essential to enhancing patients' quality of life. Telehealth offers a viable solution to overcome barriers by providing remote access to supportive services, facilitating comprehensive care, and promoting patient engagement. The effectiveness of telehealth in delivering psychosocial, nutritional, and physical activity support highlights its potential to improve patient outcomes and overcome barriers to care. Telehealth technologies hold high potential to optimize cancer care delivery, ensuring personalized support for patients throughout their cancer journey.

Este artigo examina como o Tribunal de Justiça do Distrito Federal e Territórios (TJDFT) aplica três importantes teses jurídicas relacionadas a infrações e crimes de trânsito, definidas pelos Tribunais Superiores (STJ e STF). O Tema 901 do STJ trata do crime de confiar a direção de veículo automotor a pessoa não habilitada ou sem condições de dirigir, classificado como crime de perigo abstrato. O Tema 1060 aborda a desobediência à ordem legal de parada emitida por agentes de segurança pública. Já o Tema 1079 do STF trata da recusa em realizar testes de alcoolemia e suas respectivas sanções administrativas. A análise mostra que o TJDFT segue de perto as orientações dos tribunais superiores, reforçando a uniformidade na aplicação da legislação de trânsito.

Nutrition in rabbit farming accounts for about 70% of all costs; in this sense, C. argentea is an excellent alternative as a feed, due to its bromatological composition. Our goal is to evaluate the nutritional value of diets formulated with the dried leaves of C. argentea to feed growing rabbits. Twenty-eight white rabbits of the New Zealand breed, 55 days old, of both sexes, were used. Two treatments (n = 14, 7 males, and 7 females) were evaluated in a randomized block experimental design in a 2 x 2 factorial scheme. The control diet (CTRL) was formulated to meet the nutritional requirements of growing rabbits, and the test diet (DRY) was obtained by replacing 20% of the CTRL diet with dried leaves of C. argentea. The experimental period was comprised of 11 days, with seven days of adaptation and four days of total feces collection. The average daily gain, dry matter intake, feed conversion, and final body weight were not affected by replacing the CTRL diet with the dried leaves of C. argentea. The coefficient of dry matter digestibility showed better results in CTRL rabbits (female: 72.19%, male: 72.48%). Rabbits fed with the CTRL diet exhibited a higher consumption of crude protein compared to those fed with the DRY diet, however, these rabbits showed higher elimination and lower retention of crude protein. It is concluded that C. argentea presents values of 1,400.67 kcal per kg of dry matter, digestible energy, and 3.34% digestible protein per kg of dry matter.

ABSTRACT Background: Inflammatory bowel diseases (IBD) have rising incidence and prevalence rates globally. In IBD, there are scarce studies comparing differences between patients according to socioeconomic status. Our aim was to comparatively evaluate hospitalizations, use of biologics and rates of surgery in patients with IBD between public and private healthcare systems. Methods: Single-center retrospective cohort study in patients with IBD from a tertiary referral unit from Latin America, between 2015 and 2021. CD and UC patients were classified into two subgroups: public and private systems. Demographic characteristics, hospitalizations, need for surgery and biologics were compared. Results: A total of 500 patients were included, 322 with CD and 178 with UC. CD-related hospitalizations were frequently observed in both healthcare systems (76.28% in private and 67.46% in public). More than half of the patients had been submitted to one or more CD-related abdominal surgery, with no significant difference between the subgroups. Although there was no difference in the rates of use of biological therapy in CD subgroups, infliximab was more used in the public setting (57.69% vs 43.97%). There was no difference in UC-related hospitalizations between the subgroups (public 30.69% and private 37.66%) as well as the rates of colectomy (public: 16.83%, private: 19.48%). Biologics were prescribed almost twice as often in private as compared to public (45.45 vs 22.77%). Conclusion: There were no differences in the rates of hospitalization and abdominal surgery between the systems. In patients with UC, there was greater use of biological therapy in the private healthcare setting.

ABSTRACT Background: Inflammatory bowel diseases (IBD) are associated with important changes in nutritional status. Objective: The aim of the study was to compare body fat composition between two anthropometric methods: skinfolds and ultrasonography, in patients with IBD. Methods: Single-center cross-sectional study with IBD patients in remission or active disease. For the agreement analysis between the body fat assessment methods, the Bland Altman method was used. Results: A total of 101 patients with IBD were included, 75 with Crohn’s disease and 26 with ulcerative colitis. Approximately 56% of the patients with Crohn’s disease and 65.4% of those with ulcerative colitis had a body fat composition above normal levels, with no significant difference between the diseases (P=0.63). The Bland-Altman concordance analysis showed that the methods for assessing the percentage of fat by the adipometer and ultrasound were not in full agreement (P=0.001), despite both presented good correlation (CC 0.961; P=0.000). Conclusion: The analysis of body fat percentage in patients with IBD was different between the skinfolds and ultrasound. Both methods can be used to assess the of body fat percentage of patients with IBD. However, monitoring of body fat sequentially and longitudinally should always be performed using the same method throughout the disease course. Prospective longitudinal studies are warranted to precisely define the role of these two methods of measuring body composition in patients with IBD.

ABSTRACT Background: Microscopic colitis (MC) is a chronic inflammatory bowel disease causing non-bloody diarrhea, and several cases are undiagnosed as a hidden cause of chronic diarrhea. Objective: We aimed to report the symptoms, delay diagnosis and the treatment of MC in a case series. Methods: All patients were treated at a Gastroenterology reference office from May 2022 to June 2023. Personal history including preexisting disorders, use of medications and smoking habits were collected. The delay between the onset of symptoms and the correct diagnosis was informed. All patients consented to use budesonide MMX (Corament®) off label. Results: During the study period, six Caucasoid patients were diagnosed with MC, five females and one male, between the ages of 65 and 74. All patients had comorbities and were taking multiple prescription drugs. Laboratory findings showed negative serology for celiac disease for all patients, normal levels of albumin and vitamin B12. The delay between the symptoms and the MC diagnosis varied from 2 months to 6 years. All patients had a previous diagnosis of irritable bowel syndrome. All patients were in complete clinical remission during the treatment and referred no side effects of the drug. Conclusion: Older females using high-risk medications are suggestive of MC. Preventing delay in the diagnosis of MC is crucial to improvement in patients´ quality of life. Budesonide MMX appears to be effective, safe and well-tolerated.

ABSTRACT Microscopic colitis is a chronic inflammatory bowel disease characterized by non-bloody diarrhea that can range from mild to severe. It is difficult to attribute up to 10-20% of chronic diarrhea to microscopic colitis. The three determinants factors of the diagnosis are characteristic clinical symptoms, normal endoscopic picture of the colon, and pathognomonic histological picture. This manuscript aimed to update considerations and recommendations for professionals involved (gastroenterologist, endoscopists and pathologist) in the diagnosis of MC. In addition, a short recommendation about treatment.

Brewers’ spent grain (BSG) is an important waste produced by beer companies and has a high potential to be transformed into commercial by-products. The present paper reports a forecasting technology study with the aid of bibliographic review and patent analysis tools aiming to investigate the maturity of certain technologies, considering the use of BSG on a closed-loop biorefinery and circular bioeconomy concept integrated into a brewery. To evaluate the possibilities of production of high-added-value products in Brazil, we present an overview of BSG’s scientific, technological, and marketing products and applications. The comparison between the numbers of articles versus patents shows that the solutions proposed by research articles are not being transformed into maturated viable technologies. The results suggest that there is a gap between the scientific research in the institutions and their applications in the industry, which lead to the destination of BSG for more economically attractive investments when compared with research in Brazil. Ultimately, from the carried-out analysis, it is possible to propose a brewing process connected to the biorefinery system, showing its possibility in the newly arising brewery industries.

Nosso objetivo foi caracterizar a cinética de degradação de resíduos agroindustriais fibrosos e amiláceos que podem ser utilizados na alimentação de ruminantes. Foram avaliados feno de palha de braquiária não processado (UBH), feno de palha de braquiária processado (briquetagem) (PBH), um subproduto amiláceo do processamento de batata (SBP) e fécula de mandioca (CST). Duas dietas foram formuladas: uma incluindo UBH e CST (UBH-CSTd); e o outro PBH e SBP (PBH-SBPd). Para o estudo da cinética de degradação, foi utilizada a técnica de fermentação de produção cumulativa de gás in vitro, na qual o modelo Monomolecular-G3G1 de dois compartimentos forneceu um ajuste mais provável. Os volumes cumulativos de gás produzidos foram 23,2 (UBH), 29,6 (PBH), 39,1 (SBP), 36,6 (CST), 27,9 (UBH-CSTd) e 28,5 (PBH-SBPd) mL por 0,1 g de matéria seca. Os alimentos amiláceos apresentaram fermentação mais intensa nas primeiras horas. Essa fermentação ágil ocorre porque se trata de um alimento solúvel e/ou rapidamente degradável que contém uma quantidade muito pequena de matéria fibrosa. Já para os alimentos fibrosos, UBH e PBH, a fermentação ocorreu mais lentamente nas primeiras horas, liberando menos gases. Como a fibra tem uma parte lentamente degradável e insolúvel, a fase assintótica demora mais para ser alcançada. Já as dietas apresentaram fermentação intermediária às dos alimentos amiláceos e fibrosos, o que acompanhou fielmente o perfil de produção de gases de seus ingredientes. Ambas as dietas apresentaram menores valores de k1 e maiores valores de k2 quando comparadas à silagem de milho. Este resultado confirma a real possibilidade de utilização dos dejetos estudados na alimentação de ruminantes. Ou seja, além de serem ingredientes com potencial de utilização na produção de ruminantes, a utilização de subprodutos na alimentação animal pode eliminar um problema substancial de poluição para a indústria.

In many species, the shape, size, and location of home ranges depend on the spatial positioning of resources. Therefore, evaluating the resources and conditions related to the space use of individuals can provide crucial information on the species' ecology and sociobiology In this study, we evaluated factors shaping the use of space by the lizard Tropidurus montanus M.T. Rodrigues, 1987 and assessed how the distribution of resources can affect the size of the home range and how the quality of the male's home range can influence the number of associated females. We hypothesized that (i) males with a larger body size would have a higher-quality home range, and (ii) there would be a positive relationship between the home-range size and home-range quality of males and the number of associated females. Our results suggest that males, females, and juveniles adopt different strategies. While females and juveniles have relatively small home ranges located in more suitable locations, males invest in larger home ranges, including in lower-quality habitat patches. Our results suggest that males increase their home ranges to incorporate resources females prefer, enlarging the number of females in their harems. Key words: habitat preference, multicriteria analysis, use of space, montane lizard, Tropidurus montanus, 1. Introduction Space use by individuals is a key aspect of understanding species sociobiology, which can be even more relevant for species where direct observations of their interactions are difficult [...]

Abstract Background There is a rapid increase in the incidence of inflammatory bowel diseases (IBD) in newly industrialized countries, yet epidemiological data is incomplete. We herein report the methodology adopted to study the incidence of IBD in newly industrialized countries and to evaluate the effect of environmental factors including diet on IBD development. Methods Global IBD Visualization of Epidemiology Studies in the 21st Century (GIVES-21) is a population-based cohort of newly diagnosed persons with Crohn’s disease and ulcerative colitis in Asia, Africa, and Latin America to be followed prospectively for 12 months. New cases were ascertained from multiple sources and were entered into a secured online system. Cases were confirmed using standard diagnostic criteria. In addition, endoscopy, pathology and pharmacy records from each local site were searched to ensure completeness of case capture. Validated environmental and dietary questionnaires were used to determine exposure in incident cases prior to diagnosis. Results Through November 2022, 106 hospitals from 24 regions (16 Asia; 6 Latin America; 2 Africa) have joined the GIVES-21 Consortium. To date, over 290 incident cases have been reported. All patients have demographic data, clinical disease characteristics, and disease course data including healthcare utilization, medication history and environmental and dietary exposures data collected. We have established a comprehensive platform and infrastructure required to examine disease incidence, risk factors and disease course of IBD in the real-world setting. Conclusions The GIVES-21 consortium offers a unique opportunity to investigate the epidemiology of IBD and explores new clinical research questions on the association between environmental and dietary factors and IBD development in newly industrialized countries.

Esse estudo objetiva analisar o conceito de território como um conhecimento indispensável para a resistência dos povos do campo, de comunidades e povos tradicionais. Tem como base epistêmica o pensamento de fronteira e a pesquisa bibliográfica, documental e entrevistas como bases metodológicas. Analisa como a desvalorização dos vínculos territoriais dos outros povos para ocultação de sua importância, fundadas nas diferenças étnicas e raciais, num sentido de interferência na produção de conhecimento. Destaca a importância da implantação da territorialidade dominante do colonizador, ancorada na subjetividade da terra como mercadoria, para a colonialidade da natureza. Busca elucidar a correlação da gestão fundiária com a colonialidade e sua interrelação com as categorias míticas que revitalizam a complexa colonização do imaginário dos povos inferiorizados para o seu controle. Analisa conceitos e exemplos que têm ancorado a resistência no sentido oposto da colonialidade, rumo à decolonialidade ou à contra colonização. Destaca a importância do território como lócus epistêmico e aponta para importância conceitual de território como uma base para a resistência de diversos povos e populações do campo na América Latina.

Objetivo: analisar os elementos gerais da regulação e o papel do Estado Regulador brasileiro com foco na salvaguarda dos direitos fundamentais, em especial do direito à saúde. Metodologia: a pesquisa apoiou-se no método dedutivo de René Descartes, utilizando, como premissas, os princípios gerais do direito, o ordenamento jurídico em torno do direito da saúde e do papel do Estado Regulador e a jurisprudência do Supremo Tribunal Federal relativa à vigilância sanitária. Resultados: a efetiva proteção da saúde, que envolve a garantia de que os cidadãos terão acesso a produtos e serviços de saúde seguros e eficazes, demanda uma estrutura regulatória sólida e devidamente reconhecida pelas instituições democráticas do país. O agente regulador deve interferir nas atividades econômicas que destoam do que se considera contrário ao interesse público e, sobretudo, no que concerne ao direito fundamental à saúde. Conclusão: a atuação independente e bem fundamentada das agências reguladoras é essencial para garantir a segurança e o bem-estar dos cidadãos em matéria de saúde.

BackgroundLeprosy is caused by multiple interactions between Mycobacterium leprae (M. leprae) and the host's peripheral nerve cells. M. leprae primarily invades Schwann cells, causing nerve damage and consequent development of disabilities. Despite its long history, the pathophysiological mechanisms of nerve damage in the lepromatous pole of leprosy remain poorly understood. This study used the findings of 18F-FDG PET/CT on the peripheral nerves of eight lepromatous patients to evaluate the degree of glucose uptake by peripheral nerves and compared them with clinical, electrophysiological, and histopathological evaluations.MethodsEight patients with lepromatous leprosy were included in this study. Six patients were evaluated up to three months after leprosy diagnosis using neurological examination, nerve conduction study, 18F-FDG PET/CT, and nerve biopsy. Two others were evaluated during an episode of acute neuritis, with clinical, neurophysiological, and PET-CT examinations to compare the images with the first six.ResultsInitially, six patients already had signs of peripheral nerve injury, regardless of symptoms; however, they did not present with signs of neuritis, and there was little or no uptake of 18F-FDG in the clinically and electrophysiologically affected nerves. Two patients with signs of acute neuritis had 18F-FDG uptake in the affected nerves.Conclusions18F-FDG uptake correlates with clinical neuritis in lepromatous leprosy patients but not in silent neuritis patients. 18F-FDG PET-CT could be a useful tool to confirm neuritis, especially in cases that are difficult to diagnose, such as for the differential diagnosis between a new episode of neuritis and chronic neuropathy.

Latin America (LATAM) is a large region comprising 47 countries and territories. Each one carries a different cultural and historical background, diverse political systems, and a particular approach to healthcare management. There is a lack of high-quality data on the epidemiology of inflammatory bowel diseases (IBD) in this region, including broad and detailed information about the penetration of biological and advanced therapies as treatment strategies. From an IBD perspective, patients experience, in general, fragmentations and inequities in the healthcare systems, with different and usually delayed access to qualified health services. This review explores the barriers to accessing IBD care throughout LATAM. The authors compiled data from multiple sources, such as studies focusing on epidemiology, biological penetration, and surgical rates. In addition, overall access to IBD treatments was assessed through a questionnaire distributed to physicians in LATAM via email and direct messaging to capture local perspectives.

Abstract Background Anti-TNF therapy represented a landmark in medical treatment of ulcerative colitis (UC). There is lack of data on the efficacy and safety of these agents in Brazilian patients. The present study aimed to analyze rates of clinical and endoscopic remission comparatively, between adalimumab (ADA) and infliximab (IFX), in Brazilian patients with UC, and evaluate factors associated with clinical and endoscopic remission after 1 year of treatment. Methods A national retrospective multicenter study (24 centers) was performed including patients with UC treated with anti-TNF therapy. Outcomes as clinical response and remission, endoscopic remission and secondary loss of response were measured in different time points of the follow-up. Baseline predictive factors of clinical and endoscopic remission at week 52 were evaluated using logistic regression model. Indirect comparisons among groups (ADA and IFX) were performed using Student's t, Pearson χ2 or Fisher's exact test when appropriated, and Kaplan Meier analysis. Results Overall, 393 patients were included (ADA, n = 111; IFX, n = 282). The mean age was 41.86 ± 13.60 years, 61.58% were female, most patients had extensive colitis (62.40%) and 19.39% had previous exposure to a biological agent. Overall, clinical remission rate was 66.78%, 71.62% and 82.82% at weeks 8, 26 and 52, respectively. Remission rates were higher in the IFX group at weeks 26 (75.12% vs. 62.65%, p

This article is the second in a series of two publications on the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn's disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn's disease and an update of prior ECCO Guidelines. [ABSTRACT FROM AUTHOR]

Objective: Biopsychosocial distress is a common yet often underestimated complication in cancer care. We sought to translate and evaluate the psychometric properties of SupportScreen distress assessment tool in Brazil. Methods: A cancer cohort study was conducted at a public hospital in Brazil. The SupportScreen tool underwent transcultural translation into Portuguese. Eligible patients completed the SupportScreen, Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy‐General version (FACT‐G). Statistical analyses included confirmatory and exploratory factor analyses (CFA and EFA), comparisons with established distress tools, and assessments of associations with patients' characteristics. Results: A total of 302 patients were assessed (M:F 35.4%:64.6%; median age: 55). Most patients were diagnosed with breast (29.1%) and gastrointestinal cancer (20.5%), at advanced disease stage (78.8%). CFA identified optimal models for emotional and physical distress; EFA revealed two factors for the logistics of medical care: practical and medical system distress. The concurrent validity of subscales demonstrated significant correlations between distress domains. Sensitivity analyses indicated good performance of emotional and physical domains in identifying distress compared to gold standard criteria. Female patients were more likely to report high emotional distress, while younger age and late disease stage were associated with higher physical distress. Additionally, late disease stage was linked to higher practical distress. Conclusion: Emotional and physical domains demonstrated validity and reliability, aligning with validated measures. Logistics of medical care distress revealed practical and medical system dimensions, expanding understanding of patient challenges. The SupportScreen tool exhibited concurrent validity and sensitivity in identifying distress. [ABSTRACT FROM AUTHOR]