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BACKGROUND: Alcohol abuse and dependence can cause a wide variety of cognitive, psychomotor, and visual-spatial deficits. It is questionable whether this condition is associated with impairments in the recognition of affective and/or emotional information. Such impairments may promote deficits in social cognition and, consequently, in the adaptation and interaction of alcohol abusers with their social environment. The aim of this systematic review was to systematize the literature on alcoholics' recognition of basic facial expressions in terms of the following outcome variables: accuracy, emotional intensity, and latency time. METHODS: A systematic literature search in the PsycINFO, PubMed, and SciELO electronic databases, with no restrictions regarding publication year, was employed as the study methodology. RESULTS: The findings of some studies indicate that alcoholics have greater impairment in facial expression recognition tasks, while others could not differentiate the clinical group from controls. However, there was a trend toward greater deficits in alcoholics. Alcoholics displayed less accuracy in recognition of sadness and disgust and required greater emotional intensity to judge facial expressions corresponding to fear and anger. CONCLUSION: The current study was only able to identify trends in the chosen outcome variables. Future studies that aim to provide more precise evidence for the potential influence of alcohol on social cognition are needed. Language: en

Considerando o prejuizo causado pela esquizofrenia e a tendencia mundial de inserir e tratar seus portadores na comunidade, torna-se imprescindivel rever a literatura cientifica referente aos fatores influentes associados a qualidade de vida dessa populacao. Metodo: Uma revisao bibliografica foi realizada com o objetivo de descrever quais papeis sociais influenciam na qualidade de vida e quais variaveis foram investigadas. Resultados: Foram selecionados 17 estudos, a maior parte de paises europeus. A maioria foi realizada apos o ano 2000. Quase todos os estudos eram seccionais e a maior parte avaliou amostras ambulatoriais. De um modo geral, a maioria dos estudos relatou uma melhor qualidade de vida associada com maior numero de papeis sociais. Os papeis sociais apareceram atrelados aos dominios da qualidade de vida e nenhum dos estudos utilizou um instrumento especifico para papeis sociais. Conclusoes: A necessidade de maior numero de estudos com aprofundamento sobre os aspectos centrais do tema se fez notar, devido a importância percebida sobre a influencia dos papeis sociais na qualidade de vida.

Vitamin A (VA) and iron deficiencies are important nutritional problems, affecting particularly preschool children, as well as pregnant and lactating women. A PubMed (National Library of Medicine, National Institutes of Health, Bethesda, MD, USA) literature review was carried out to search for clinical trials published from 1992 to 2013 that assessed the influence of vitamin A supplementation on iron status. Simultaneous use of iron and vitamin A supplements seemed to be more effective to prevent iron deficiency anemia than the use of these micronutrients alone. Some studies did not include a placebo group and only a few of them assessed vitamin A status of the individuals at baseline. Moreover, the studies did not consider any inflammatory marker and a reasonable number of iron parameters. Another important limitation was the lack of assessment of hemoglobin variants, especially in regions with a high prevalence of anemia. Assessment of hemoglobin variants, inflammatory markers and anemia of chronic inflammation would be important to the studies investigated. Studies involving different populations are necessary to elucidate the interaction between the two micronutrients, especially regarding iron absorption and modulation of erythropoiesis.

Background:Depression is the most common psychiatric manifestation in patients with Parkinson's disease (PD). In addition, depressive symptoms may be considered to be a prodromal manifestation of PD. In recent years, the association between PD and depression has been the focus of neuroimaging studies using functional and structural techniques.Methods:The aim of this study was to review the main neuroimaging studies assessing the comorbidity between depression and PD. Literature searches were conducted to find the major neuroimaging studies that consider primarily the comorbidity between depression and PD using the indices Web of Science and Lilacs.Results:In total, 296 papers were identified, and 18 of these studies were selected for the current review. The principal neuroimaging technique used was SPECT. The structural neuroimaging studies that have evaluated the impact of current or previous bouts of depression on the neurodegenerative process of PD are scarce and inclusive. The instruments that were used to evaluate depression differed among the studies. Several brain regions appear to be involved in depression, particularly the limbic system and the basal ganglia. In addition, the serotonergic, dopaminergic, and noradrenergic systems also appear to be associated with depressive symptoms in PD.Conclusion:Several brain regions and neurotransmitter systems are involved in depression in PD; however, the variety of criteria used to evaluate depressive symptoms precludes more specific conclusions.

OBJETIVO: Analisar as evidências científicas sobre a influência do grupo familiar na sintomatologia da anorexia nervosa (AN). MÉTODOS: Revisão sistemática da literatura no período de 2000 a 2012, utilizando as bases PubMed, CINAHL, PsycINFO, Lilacs e os descritores: "transtornos da alimentação", "relações familiares", "relação entre gerações" e "relação mãe-filho". RESULTADOS: Com base nos critérios de inclusão e exclusão, foram selecionadas e analisadas 20 publicações na íntegra. A maior parte dessas publicações focaliza mulheres diagnosticadas com transtornos alimentares (TA) ou com comportamento alimentar de risco, tem delineamento quantitativo e utiliza escalas padronizadas para coleta de dados. Predominou o Nível de Evidência 4, que corresponde a estudos de desenho não experimental, como pesquisa descritiva correlacional e qualitativa, ou estudos de caso. As evidências encontradas indicam que os relacionamentos familiares exercem impacto significativo tanto no desenvolvimento como na manutenção de sintomas de TA. Padrões relacionados à alimentação e ao alimento são transmitidos entre as gerações, bem como aspectos não elaborados do funcionamento psíquico materno. CONCLUSÕES: Os estudos sugerem a necessidade de ampliar o foco da atenção para incluir os familiares no tratamento, bem como incorporar os achados de transmissão psíquica intergeracional como subsídios norteadores do planejamento e qualificação do cuidado oferecido nos TA. OBJECTIVE: To analyze scientific evidence about the influence of the family group on anorexia nervosa (AN) symptoms. METHODS: Systematic review of the literature published between 2000 and 2012, using the databases PubMed, CINAHL, PsycINFO, Lilacs and the descriptors: "eating disorders", "family relations", "intergenerational relations" and "mother-child relations". RESULTS: Based on the inclusion and exclusion criteria, 20 publications were selected and their full version was analyzed. Most of the papers focus on women diagnosed with eating disorders (ED) or risky eating behavior, have a quantitative design and use standardized scales for data collection. Evidence Level 4 was predominant, which corresponds to studies with a non-experimental design, like correlational and qualitative descriptive studies, or case studies. The evidences found indicate that family relations significantly affect both the development and maintenance of ED symptoms. Eating and food patterns are transmitted between generations, as well as non-elaborated aspects of maternal psychic functioning. CONCLUSIONS: Studies suggest the need for a broader care focus, so as to include family members in treatment, as well as to incorporate the findings related to intergenerational psychic transmission to guide the planning and qualification of the care offered in case of ED.

Objective: Pharmacological treatment is considered indispensable to major depressive disorder. In spite of this, a significant number of patients do not respond adequately to treatment based only on medication, presenting high relapse and recurrence rates. Therefore, psychosocial interventions, such as psychoeducation, have been increasingly recognized as an essential component in the treatment of depression, associated with pharmacological strategies. Thus, the aim of the present systematic review was to evaluate the effectiveness of psychoeducation for patients with unipolar depression, analyzing the evidence from the literature. Method: Searches were undertaken from April to October 2012 in LILACS, PsycINFO, PubMed, SCOPUS and ISI Web of Knowledge with keywords including ‘psychoeducation’, ‘psychoeducational intervention’ and ‘depression’, with no restriction regarding publishing dates. Results: Fifteen studies were included in the review, 13 of which evaluated the effectiveness of psychoeducation for patients with depression: 10 papers evaluated in-person psychoeducation approaches and three papers evaluated long-distance approaches. In addition to these 13 papers, one evaluated psychoeducational interventions for patients’ families and patients’ responses and another evaluated psychoeducational interventions for patients’ families and families’ responses. Findings suggest that increased knowledge about depression and its treatment is associated with better prognosis in depression, as well as with the reduction of the psychosocial burden for the family. Conclusions: Psychoeducation is a psychosocial treatment that has been well documented as an adjunct to pharmacological therapy. However, there are only a few studies regarding its effectiveness on adult patients with major depressive disorder. Although the publications in this area are still very limited, the articles selected in this review suggest that psychoeducation is effective in improving the clinical course, treatment adherence, and psychosocial functioning of depressive patients.

Aims and objectives To analyse available research on the effectiveness of prewarming to prevent perioperative hypothermia and identify knowledge gaps for future research. Background Perioperative hypothermia is common and causes complications, such as coagulation and platelet function abnormalities; increased cardiac morbidity, surgical site infection, and pressure ulcer incidence levels. In this context, several methods have been investigated to prevent perioperative hypothermia, including prewarming. Prewarming is defined as the warming of peripheral tissues or the skin surface before anaesthetic induction and may consist of an active cutaneous warming system or the preoperative administration of vasodilation drugs. Design Systematic review. Methods We searched CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline (January 1990–November 2011) for randomised controlled trials on the effectiveness of prewarming for prevention of perioperative hypothermia, published in English, Spanish and Portuguese, and involving elective surgery patients aged 18 years or older. Results Of 730 identified studies, only 13 met the inclusion criteria. After hand-searching the reference lists of included studies, an additional study was identified for a total sample of 14 studies. The results suggest that forced-air warming system is effective to reduce hypothermia when applied for the prewarming of surgical patients. Conclusion Prewarming patients with the forced-air warming system might be effective to reduce perioperative hypothermia, and new studies are needed to examine the use of carbon fibre technology. Relevance to clinical practice Nurses can use this review to inform decision-making on a prewarming programme in the perioperative period. They can also develop research on strategies to put in practice prewarming in the surgical context.

Considerando la importancia del proceso enfermero en la práctica basada en evidencias, buscamos identificar instrumentos validados y confiables para la recolección de datos en pacientes. Realizamos una revisión integrativa utilizando las bases CINAHL, BVS, PUBMED. Fueron incluidos artículos disponibles a texto completo en inglés, español y portugués, se excluyeron las revisiones que no contenían descritos los pasos metodológicos y los que no abordaban el tema. En los 40 estudios analizados fueron identificados instrumentos aplicables a diferentes áreas como geriatría y gerontología, terapia intensiva, oncología, psiquiatría, nutrición, infectología, salud del trabajador, cuidados paliativos, cardiología, entre otros. La mayoría de los instrumentos 47.5% aplicaba para población anciana. Enfermería al utilizar instrumentos validados en su práctica pasa a ejercer una asistencia con mayor calidad. Sin embargo, es evidente que diversos comportamientos y manifestaciones clínicas todavía no disponen de instrumentos validados para su evaluación. In view of the importance of the nursing process in evidence-based practice, we attempt to identify validated and reliable instruments to collect data from patients. An integrative review was carried out in the databases CINAHL, BVS and PUBMED, using the words “nursing” and “validated clinical assessment tools”, as well as “validation studies”, “reproducibility of results” and “nursing assessment”. Full articles available in English, Spanish or Portuguese were included, excluding reviews that did not follow the methodological steps described and did not address the theme. In the 40 analyzed studies, instruments were identified that are applicable to different areas, such as geriatrics and gerontology, intensive care, oncology, psychiatry, nutrition, infectology, occupational health, palliative care, cardiology, among others. Instruments were found to evaluate the following areas: risk of falls, patient satisfaction, quality of life, sleep, depression, mental confusion, dementia, pain, behavior, nutritional status, violence, personality, psychosis, breastfeeding, nausea and vomit, fatigue, end of life needs, sedation and agitation, abstinence from opioid use, pressure ulcers, capacity of workers with musculoskeletal problems to restart activities, immunological status of patients with HIV/AIDS, and patients’ degree of knowledge about their disease. There was an increase in the number of publications from 1990 to 2006. Most of the instruments, 47.5%, were applicable to elderly populations. Nursing, when using validated instruments in its practice, provides more qualified care. Several behaviors and clinical manifestations exist, however, without validated instruments for their assessment.

This study aimed to identify and analyze nurses' competences to work at Intensive Care Units-ICU. An integrative review method was used, and data were collected in LILACS, SciELO and BDENF, from August to October 2010. Ten articles were identified, published in the last 12 years. Data grouping permitted the construction of thematic units related to nurses' competences: nursing care management, high-complexity nursing care delivery, decision making, leadership, communication, continuing/permanent education, human resource management, material resource management. The professional competences identified can support the outline of guidelines to constitute the profile of nursing working in intensive care units and drive/mobilize the improvement of nursing care practices. Este estudio tuvo como objetivo identificar y analizar las competencias de las enfermeras para actuar en Unidades de Cuidados Intensivos-UCI. Se utilizó el método de revisión integradora, y la recolección de datos se realizó a través de la base de datos LILACS, SciELO BDENF, entre agosto y octubre de 2010. Se identificaron 10 artículos, y el cotejo de los datos permitió la construcción de las siguientes unidades temáticas relacionadas con las habilidades de las enfermeras: gestionar los cuidados de enfermería, realizar los cuidados de enfermería más complejos, la toma de decisiones, el liderazgo, la comunicación, la educación continua y permanente y la gestión de recursos humanos y materiales. Las habilidades identificadas en este estudio sirven como una guía para formar el perfil de la enfermera que trabaja en unidades de cuidados intensivos-UCI y por lo tanto representan la línea de orientación que puede aumentar/movilizar la mejoría de las prácticas de atención recibidas por este profesional. Este estudo teve como objetivo analisar as competências profissionais dos enfermeiros em Unidades de Terapia Intensiva (UTI). Utilizou-se o método de revisão integrativa, e a coleta de dados foi realizada nas bases de dados LILACS, SciELO, BDENF, nos meses de agosto a outubro de 2011. Foram identificados 10 artigos, publicados nos últimos 12 anos, e o agrupamento dos dados possibilitou a construção de unidades temáticas relacionadas às competências dos enfermeiros: gerenciar o cuidado de enfermagem, executar o cuidado de enfermagem de maior complexidade, tomada de decisão, liderança, comunicação, educação continuada/permanente, gerenciamento de recursos humanos e de recursos materiais. As competências profissionais identificadas podem oferecer subsídios para traçar diretrizes para a construção do perfil do enfermeiro que atua em unidades de terapia intensiva e impulsionar/mobilizar as práticas de cuidado por esse profissional.

Nas culturas Ocidentais, a Morte não se apresenta como tema preferido. Contudo, como os profissionais que convivem e enfrentam a Morte cotidianamente devem proceder? Qual o significado que esta assume? Este estudo se constitui de um levantamento da literatura científica sobre o tema na formação acadêmica de Enfermagem. A metodologia é qualitativa, através de um estudo exploratório documental, caracterizado pela pesquisa bibliográfica, num recorte temporal de cinco anos. As palavras-chave são: Docente e Discente de Enfermagem, Morte e Morrer. Foram localizados 12 artigos em periódicos, que compuseram três categorias: Os discentes de enfermagem e o convívio com a morte; O docente em enfermagem convivendo com a morte e as habilidades para ensinar; A formação acadêmica dando suporte para visão crítico-reflexiva sobre a temática morte-morrer. Concluiu-se que não há preparo dos discentes de enfermagem sobre o tema. Somente maiores investimentos e estudos trarão mudanças para a realidade atual. In Western cultures, Death is not among the favorite topics. Nevertheless, how should professionals who deal with Death on a daily basis behave? What meaning does Death have to them? This study consists of a survey on scientific literature about the referred subject in nursing education. Using a qualitative method, a documentary exploratory study was performed, characterized by a survey over a five-year period. The following keywords were used: Nursing Professor and Student, Death and Dying. Twelve articles were located and comprised three categories: Nursing students and dealing with death every day; The nursing professor dealing with death every day and the teaching skills; Academic education providing support for a critical-reflexive view about death-dying. In conclusion, there is o preparation for nursing students on the referred theme. Changing the current situation is only possible with greater investments and if further studies are performed. La muerte, en las culturas occidentales no se presenta como tema de preferencia. Así y todo, ¿cómo deben proceder los profesionales que conviven y se enfrentan con la muerte cotidianamente? ¿Cuál es el significado que ella asume? Este estudio parte de una investigación de la literatura científica sobre este tema en la formación académica de Enfermería. La metodología fue cuantitativa, a través de un estudio exploratorio documental, caracterizado por la pesquisa bibliográfica en un lapso temporal de cinco años. Las palabras llave fueron: Docente y alumno de enfermería, Muerte y Agonía. Fueron localizados 12 artículos en periódicos, los cuales compusieron tres categorías: Los alumnos de enfermería y la convivencia con la muerte; El docente en enfermería conviviendo con la muerte y las habilidades para enseñar; La formación académica brindando soporte para una visión crítico-reflexiva sobre la temática muerte-agonía. Se concluyó en que no hay preparación de los alumnos de enfermería sobre el tema. Solamente mayores inversiones y estudios provocarán cambios en la actual realidad.

Malnutrition continues to be recognized as the most common and serious form of children’s dietary disease in the developing countries and is one of the principal factors affecting brain development. The purpose of this paper is to review human and animal studies relating malnutrition to cognitive development, focusing in correlational and interventional data, and to provide a discussion of possible mechanisms by which malnutrition affects cognition.

Este artigo apresenta uma revisão crítica da literatura a respeito das redes sociais de apoio no contexto do desenvolvimento de crianças nascidas pré-termo, centrada na abordagem do Modelo Bioecológico do Desenvolvimento Humano, a qual aborda a influência de ambientes externos como contexto para o desenvolvimento. Realizou-se o levantamento bibliográfico nas bases de dados Portal da Capes, MedLine, Lilacs e SciELO, por meio de descritores pré-estabelecidos. Dentre 137 trabalhos, apenas 39 referiam-se à temática proposta, e apenas um relacionou prematuridade e modelo bioecológico. Os resultados apontam a importância do apoio de pessoas significativas e dos programas de acompanhamento de crianças que nascem pré-termo e de suas famílias, o que remete, respectivamente, à rede social pessoal e institucional. Ressalta-se a implementação das políticas de saúde que planejam as ações na saúde perinatal e na área da infância a partir da perspectiva das redes sociais de apoio como estratégia de cuidado. This article presents a critical review of the literature related to social support networks in the context of the development of children born pre-term. The focus is on the approach of the Bioecological Model of Human Development, which highlights the influence of external environments as a context for development. The bibliographical survey was carried out in the following databases, Portal da Capes, MedLine, Lilacs and SciELO, using pre-established descriptors. Among the 137 studies, only 39 referred to the proposed theme and only one related prematurity with the Bioecological Model. The results highlight the importance of support from significant people and of the monitoring programs for children born preterm and their families, referring to the personal and institutional social network, respectively. The importance of the implementation of health policies in which actions are planned in the perinatal and childhood health area is noteworthy from the perspective of social support networks as a care strategy.

Background Social Anxiety Disorder (SAD) and Williams-Beuren Syndrome (WS) are two conditions which seem to be at opposite ends in the continuum of social fear but show compromised abilities in some overlapping areas, including some social interactions, gaze contact and processing of facial emotional cues. The increase in the number of neuroimaging studies has greatly expanded our knowledge of the neural bases of facial emotion processing in both conditions. However, to date, SAD and WS have not been compared. Methods We conducted a systematic review of functional magnetic resonance imaging (fMRI) studies comparing SAD and WS cases to healthy control participants (HC) using facial emotion processing paradigms. Two researchers conducted comprehensive PubMed/Medline searches to identify all fMRI studies of facial emotion processing in SAD and WS. The following search key-words were used: "emotion processing"; "facial emotion"; "social anxiety"; "social phobia"; "Williams syndrome"; "neuroimaging"; "functional magnetic resonance"; "fMRI" and their combinations, as well as terms specifying individual facial emotions. We extracted spatial coordinates from each study and conducted two separate voxel-wise activation likelihood estimation meta-analyses, one for SAD and one for WS. Results Twenty-two studies met the inclusion criteria: 17 studies of SAD and five of WS. We found evidence for both common and distinct patterns of neural activation. Limbic engagement was common to SAD and WS during facial emotion processing, although we observed opposite patterns of activation for each disorder. Compared to HC, SAD cases showed hyperactivation of the amygdala, the parahippocampal gyrus and the globus pallidus. Compared to controls, participants with WS showed hypoactivation of these regions. Differential activation in a number of regions specific to either condition was also identified: SAD cases exhibited greater activation of the insula, putamen, the superior temporal gyrus, medial frontal regions and the cuneus, while WS subjects showed decreased activation in the inferior region of the parietal lobule. Conclusions The identification of limbic structures as a shared correlate and the patterns of activation observed for each condition may reflect the aberrant patterns of facial emotion processing that the two conditions share, and may contribute to explaining part of the underlying neural substrate of exaggerated/diminished fear responses to social cues that characterize SAD and WS respectively. We believe that insights from WS and the inclusion of this syndrome as a control group in future experimental studies may improve our understanding of the neural correlates of social fear in general, and of SAD in particular.

To identify the demographic, psychological, and social maternal risk factors associated with the development of Fetal Alcohol Spectrum Disorders (FASD). A bibliographic search was conducted in PubMed, SciELO, Lilacs, Web of Knowledge, and PsycINFO. The Newcastle–Ottawa Quality Assessment Scale (NOS) was used to evaluate the quality of the studies with case–control design. Articles were selected based on their relevance and presentation of data related to statistical comparisons of at least one or more demographic, psychological, or social maternal risk factors for FASD. 738 references were identified, of which 15 met the criteria to be included in the present review. Mothers of FASD children tend to: be older at the time of birth of the affected child, present lower educational level, have other family relatives with alcohol abuse, have other children with FASD, present a pattern of little prenatal care and a distinguishing pattern of alcohol consumption (alcohol use before and during pregnancy, failure to reduce alcohol use during pregnancy, and frequent episodes of binge drinking). Application of the NOS scale of methodological quality indicated that 8 studies (53 %) met the criterion for selection, 4 (27 %) were suitable for the criterion for comparability and only 4 studies were suitable for the exposition criterion. Mothers of FASD children have a distinctive pattern of drinking and accumulate several social risk factors. Maternal age at birth of the child seems to accentuate the risk. There are, however, few controlled studies that are adequate according to the NOS requirements for methodological quality. Fewer are based on the verification of a theoretical model. Clinicians should be aware of the relevance of preventive assessment of FASD risk mothers.

Aims To analyze and synthesize knowledge concerning sexuality in adult burn victims through an integrative literature review. Method Two researchers independently searched six electronic databases (PUBMED, LILACS, ISI Web of Science, PSYCINFO, CINAHL and EMBASE) and also performed a hand search using the following descriptors, in different combinations: burn, sexuality, gender identity, sexual behavior and sexual factors, in order to identify the articles published in English, Portuguese or Spanish, in the last 20 years. A total of 1781 articles were found and 22 were selected based on the inclusion and exclusion criteria. Results The findings were organized into two categories that influence sexuality: (1) studies where the main purpose was to assess sexuality in burn victims; (2) studies that indirectly assess sexuality. Conclusion The synthesis of the knowledge concerning sexuality in burn victims showed that sexual dysfunction can be related to the younger ages, TBSA > 20%, burns on the genitalia and on exposed areas, prolonged length of hospital stay, avoidance coping, and mental disorders. The multidisciplinary team should be prepared to integrate sexuality as an important variable in the continuing treatment of burn patients.

Background Oral treatment in women with breast cancer has been increasingly used. However, a potentially negative side of oral medication is poor patient adherence and/or discontinuation, which reduces the treatment effectiveness, accelerating progression of the disease and reducing the patient survival rate. Aim of the review To compare the rates of adherence and/or discontinuation and the methodologies used to assess these outcomes. It was conducted an integrative review of original articles published from 2000 to 2012, in which their primary outcome was to quantify medication adherence and/or discontinuation of oral hormonal therapy in patients with hormone receptor positive breast cancer. Methods Original studies were searched in the PubMed/MEDLINE, Scopus, Embase and SciELO databases. The Medical Subject Heading was used to define descriptors. The descriptor “breast neoplasms” was used in all combinations. Each of the descriptors “medication adherence” and “patient compliance” were combined with each of the following descriptors “tamoxifen”, “aromatase inhibitors”, “selective estrogen receptor modulators”, or the terms “letrozole”, “anastrozole”, and “exemestane”. Results Twenty-four original articles were included. Our study showed a wide range of adherence and discontinuation rates, ranging from 45–95.7 and 12–73 %, respectively. Regarding the methodological development of the selected articles, a high prevalence (87.5 %) of prospective and/or retrospective longitudinal studies was found. In addition, there was a high prevalence of studies using a database (70.8 %). Among some of the studies, it was shown that patient adherence to hormonal therapy gradually reduces, while discontinuation increases during the treatment. Conclusions It was observed a great diversity among rates of adherence and/or discontinuation of hormonal therapy for breast cancer, which may be due to a lack of methodology standardization. Therefore, adequate and validated methods to ensure reliability of the results and allow comparison in the literature are needed. Furthermore, adherence decreases and discontinuation increases over time, suggesting the need for patient continuous education and a pharmacotherapeutic follow up by health professionals to improve these clinical outcomes.

Objective: To present the most relevant findings regarding the Brazilian Medical Associationguidelines for the diagnosis and differential diagnosis of panic disorder.Methods: We used the methodology proposed by the Brazilian Medical Association for the DiretrizesProject. The MEDLINE (PubMed), Scopus, Web of Science, and LILACS online databases werequeried for articles published from 1980 to 2012. Searchable questions were structured using thePICO format (acronym for ‘‘patient’’ [or population], ‘‘intervention’’ [or exposure], ‘‘comparison’’ [orcontrol], and ‘‘outcome’’).Results: We present data on clinical manifestations and implications of panic disorder and itsassociation with depression, drug abuse, dependence and anxiety disorders. In addition, discussionswere held on the main psychiatric and clinical differential diagnoses.Conclusions: The guidelines are proposed to serve as a reference for the general practitioner andspecialist to assist in and facilitate the diagnosis of panic disorder.Keywords: Panic disorder; anxiety; guidelines; diagnosis; differential diagnosis

The perimenopausal and postmenopausal periods are associated with many symptoms, including sexual complaints. In this review1, we aim to assess the effect of hormone therapy on sexual function in p...

Worldwide aging of the human population has promoted an increase in the incidence of neoplasia, including hematological cancers, which render patients particularly vulnerable to invasive fungal infections. For this reason, air filtration in hemato-oncology units has been recommended. However, scarce literature has assessed the impact of microbiological air quality on the occurrence of fungal infections in this population. We performed an integrative review of studies in the MEDLINE database that were published between January 1980 and October 2012, using the following combinations of keywords: air × quality × HEPA, air × quality × hematology, and airborne fungal infections. The search yielded only 13 articles, suggesting that high-efficiency filtering of the ambient air in hemato-oncology units can prevent the incidence of invasive fungal infections. However, no randomized clinical trial was found to confirm this suggestion. Currently, there is no consensus about the maximum allowable count of fungi in the air, which complicates filtration monitoring, including filter maintenance and replacement, and needs to be addressed in future studies.

Introduction:Cisplatin is an effective chemotherapeutic agent commonly used in the treatment of malignant tumours, but ototoxicity is a significant side effect.Objectives:To discuss the mechanisms of cisplatin ototoxicity and subsequent cell death, and to present the results of experimental studies.Material and methods:We conducted a systematic search for data published in national and international journals and books, using the Medline, SciELO, Bireme, LILACS and PubMed databases.Results:The nicotinamide adenine dinucleotide phosphate oxidase 3 isoform (also termed NOX3) seems to be the main source of reactive oxygen species in the cochlea. These reactive oxygen species react with other molecules and trigger processes such as lipid peroxidation of the plasma membrane and increases in expression of the transient vanilloid receptor potential 1 ion channel.Conclusion:Cisplatin ototoxicity proceeds via the formation of reactive oxygen species in cochlear tissue, with apoptotic cell death as a consequence.

Background: The growing concern about cannabis use, the most commonly used illicit drug worldwide, has led to a significant increase in the number of human studies using neuroimaging techniques to determine the effect of cannabis on brain structure and function. We conducted a systematic review to assess the evidence of the impact of chronic cannabis use on brain structure and function in adults and adolescents. Methods: Papers published until August 2012 were included from EMBASE, Medline, PubMed and LILACS databases following a comprehensive search strategy and pre-determined set of criteria for article selection. Only neuroimaging studies involving chronic cannabis users with a matched control group were considered. Results: One hundred and forty-two studies were identified, of which 43 met the established criteria. Eight studies were in adolescent population. Neuroimaging studies provide evidence of morphological brain alterations in both population groups, particularly in the medial temporal and frontal cortices, as well as the cerebellum. These effects may be related to the amount of cannabis exposure. Functional neuroimaging studies suggest different patterns of resting global and brain activity during the performance of several cognitive tasks both in adolescents and adults, which may indicate compensatory effects in response to chronic cannabis exposure. Limitations: However, the results pointed out methodological limitations of the work conducted to date and considerable heterogeneity in the findings. Conclusion: Chronic cannabis use may alter brain structure and function in adult and adolescent population. Further studies should consider the use of convergent methodology, prospective large samples involving adolescent to adulthood subjects, and data-sharing initiatives.

Este estudo teve por objetivo compreender de que modo a parentalidade homossexual masculina vem sendo investigada na literatura científica nacional e internacional. Por meio de uma revisão sistemática nas bases MedLine, SciELO, PsycINFO e CINAHL, de 2000 a 2011, foram recuperados 12 artigos. No contexto internacional, os estudos se concentram em delineamentos empíricos focalizando casais homossexuais e seus filhos. No Brasil, predominam estudos teóricos sobre a família homoparental. A Psicanálise emerge como principal referencial teórico. São necessárias pesquisas empíricas no contexto brasileiro, haja vista a aprovação da união estável entre pessoas do mesmo sexo e abertura de jurisprudência para adoção por esses casais. Outras abordagens teóricas são requeridas para que se possa compreender o contexto desenvolvimental das famílias e casais de mesmo sexo com crianças em um cenário social em permanente transformação. This study aimed to understand how homoparenthood has been investigated in national and international scientific literature. We carried out a systematic literature review in MedLine, SciELO, PsycINFO and CINAHL from 2000 to 2011 and 12 articles were retrieved. Most of the international production consists of empirical studies with gay couples and their children. In Brazil theoretical studies about homoparental family are dominant. Psychoanalysis emerges as the main theoretical reference used. It is highlighted that empirical studies are required in the Brazilian context given the recent recognition of stable unions between same-sex people and the legal context that makes adoption possible by same-sex couples. Other theoretical approaches seem to be required for understanding the developmental context of same-sex families or same-sex couples with children in a constantly changing social setting.

Background: Standard precautions (SP) play an important role in hospital infection control, as well as in issues related to biosafety and security of patients, professionals and students active in direct or indirect health care delivery. Objective: This research aimed to identify in the literature which instruments nurse researchers have used to evaluate knowledge, attitudes and compliance with SP for infection control. Methods: A literature review was undertaken in the databases Web of Science, Bireme (Medline and Lilacs) and Scopus. Results: 91.66% of the studies were ranked as evidence level IV; 66.66% of the instruments were structured questionnaires, 58.33% of which had been validated and half of these instruments presented reliability and validity scores for the instrument used. Publications were concentrated in 2009 (41.66%), mostly in English (75%), in nursing journals with impact factor above 1.60 (83.33%). Conclusions: The instruments nurse researchers most employed were structured questionnaires associated with Likert-type rating scales.

Neste estudo realizou-se uma revisão sistemática da literatura sobre o tema "Desenvolvimento de bebês em situação de acolhimento institucional", tendo-se em vista as dificuldades em implementar ações neste sentido e as implicações sociais e teóricas referentes a esse tema. A revisão foi conduzida em duas bases de dados - a nacional (BVS-Psi) e a internacional (PsicInfo) -, com cruzamento das palavras-chave bebês e abrigos. Os resultados revelaram baixa produção de estudos sobre medidas de acolhimento com foco em bebês, e nos estudos não há destaque diferenciado para a experiência com bebês nesse contexto, nem para aspectos do seu desenvolvimento; o eixo temático colocou em destaque formação dos vínculos iniciais - principalmente em termos de rompimento do vínculo materno -, tratando menos sobre a relação com cuidadores. Observou-se ainda que, no decorrer das últimas três décadas, pesquisas internacionais apresentaram maior diversidade na oferta de serviços de proteção e maior variabilidade de temas discutidos. Entre as conclusões, destaca-se a necessidade de ampliar os estudos sobre acolhimento de bebês. Due to the difficulties of its implementation, as well as social implications and theoretical ones about babies' development in a situation of institutional care, it was carried on a systematic literature review on this issue. The review was conducted in two databases, national (BVS-Psi) and international (PsicInfo), with the intersection of the keywords infants and foster home. Results revealed that the academic production of researches concerning foster care for infants is not extensive; neither the babies' experience in the context of foster home care nor their developmental aspects are specially highlighted in the studies ; the thematic axis regarding the construction of bonds is highlighted, focusing especially in terms of the breaking up of infant's relationship with the mother, and less concerning the babies' relationship construction with the caregivers and it was observed that during the last three decades, international researches presented a higher diversity of protection services and greater variability of issues under discussion. Among the findings, we highlight the need to expand studies on babies' institutional care. Debido a las dificultades de su aplicación, así como las implicaciones sociales y el desarrollo de los bebés en una situación de la atención institucional, se produjo una revisión sistemática de la literatura sobre este tema. La revisión se realizó en dos bases de datos, nacional (BVS-Psi) e internacionales (PsicInfo), con la intersección de las palabras clave lactante y abrigos. Los resultados rebelaron la baja producción de investigaciones sobre abrigos teniendo como foco lactantes; no había un destaque diferenciado para la experiencia de los bebes en ese contexto y ni para aspectos de su desarrollo. El eje temático en destaque fue la formación de los vínculos iniciales - principalmente en términos de rompimiento con el vinculo materno, y menos sobre la relación con los cuidadores; durante las ultimas tres décadas las investigaciones internacionales presentaron mayor diversidad en la oferta de servicios de protección y mayor variabilidad de temas en discusión. Se concluye que existe necesidad de realizar estudios más amplios sobre institucionalización de los bebés.

For the last 40 years, schizophrenia has been considered to be the result primarily of a dysfunction in brain dopaminergic pathways. In this review, it is described and discussed findings concerning nitric oxide-mediated neurotransmission in schizophrenia. Studies were searched in PubMed, SciELO, and LILACS using the terms schizophrenia and nitric oxide plasma levels or nitric oxide serum levels, with no time limit. The reference lists of selected articles were also hand-searched for additional articles. From 15 potential reports, 10 were eligible to be included in the review and meta-analysis. These studies included a total of 505 patients with schizophrenia and 339 healthy volunteers. No significant difference was found between patients and healthy controls regarding total nitrite plasma/serum levels (effect size g = 0.285, 95%CI = -0.205 to 0.774, p = 0.254). However, when studies with patients under antipsychotic treatment were examined separately, there was a significant difference between patients and healthy volunteers (effect size g = 0.663, 95%CI = 0.365 to 0.961, p < 0.001), showing that patients under treatment have higher levels of plasma/serum nitric oxide than controls. These results suggest that antipsychotics increase nitric oxide plasma/serum levels and that the nitrergic pathway would be a fertile target for the development of new treatments for patients with schizophrenia. Durante os últimos 40 anos, a esquizofrenia foi considerada, principalmente, como o resultado de disfunções dopaminérgicas no cérebro. Esta revisão descreve e discute algumas descobertas sobre a neurotransmissão mediada pelo óxido nítrico na esquizofrenia. A busca foi feita nas bases PubMed, SciELO e LILACS usando-se os termos schizophrenia e nitric oxide plasma levels ou nitric oxide serum levels, sem limites de tempo. As listas de referências dos artigos selecionados foram examinadas em busca de outras publicações pertinentes. Dentre 15 artigos passíveis de serem incluídos, 10 preenchiam os critérios estabelecidos para a revisão e metanálise. Esses estudos incluíram 505 pacientes com esquizofrenia e 339 voluntários saudáveis. Não foram encontradas diferenças significativas entre pacientes e voluntários saudáveis quanto aos níveis plasmáticos de nitrito total (effect size g = 0,285, IC 95% = -0,205 a 0,774, p = 0,254). No entanto, o exame separado dos estudos envolvendo pacientes em tratamento antipsicótico apresentou diferenças significativas entre pacientes e voluntários saudáveis (effect size g = 0,663, IC 95% = 0,365 to 0,961, p < 0,001), demonstrando que pacientes em tratamento possuem níveis plasmáticos mais altos de óxido nítrico. Esses resultados sugerem que os antipsicóticos podem aumentar os níveis plasmáticos de óxido nítrico e que a via nitrérgica (e sua estimulação) constituiria um alvo propício para o desenvolvimento de novos tratamentos para pacientes com esquizofrenia.

ResumoA obesidade vem aumentando significativamente em todo o mundo, e os fatores ambientais, como o consumo excessivo de alimentos e o sedentarismo, são os principais fatores relacionados com a gênese dessa doença. Em animais de laboratório, a gênese da obesidade está relacionada, em sua maioria, com mutações genéticas, porém esse modelo é muito distante do encontrado nos humanos. A adoção de dietas hipercalóricas ou hiperlipídicas vem sendo utilizada como modelo de indução da obesidade em animais, devido à sua semelhança com a gênese e às respostas metabólicas decorrentes da obesidade em humanos. Assim, o objetivo dessa revisão de literatura é apresentar os diferentes tipos de dietas utilizadas para a indução da obesidade em roedores, as modificações metabólicas induzidas e identificar alguns cuidados que devem ser tomados para que esse modelo seja eficaz para o estudo das complicações relacionadas com a obesidade. Realizou-se busca na base de dados PubMed utilizando as expressões: 1-“hipercaloric diet” AND “rodent”, 2- “hiperlipidic diet” AND “rodent”, sendo selecionadas aquelas consideradas mais relevantes a partir dos critérios: data de publicação (1995-2011), a utilização de animais wild type, a descrição detalhada sobre a dieta utilizada e a análise de parâmetros bioquímicos e vasculares de interesse. Foram inseridas referências para introduzir assuntos como o aumento da prevalência da obesidade e questões relacionadas com a gênese da obesidade em humanos. Podemos considerar eficiente o modelo de obesidade induzida por dieta em roedores quando o objetivo é o estudo da fisiopatologia das complicações metabólicas e vasculares associadas à obesidade.SummaryObesity has been significantly increasing worldwide, and environmental factors such as excessive food intake and sedentary lifestyle are the main factors related to the genesis of this disease. In laboratory animals, the genesis of obesity is related mostly to genetic mutations, but this model is far from that found in humans. The use of hypercaloric or hyperlipidemic diets has been used as a model of obesity induction in animals, because of its similarity to the genesis and metabolic responses caused by obesity in humans. The objective of this review is to show the different types of diets used to induce obesity in rodents, the induced metabolic alterations, and to identify some points that should be taken into account so that the model can be effective for the study of obesity- related complications. A search was performed in the PubMed database using the following keywords: 1- “hypercaloric diet” AND “rodent”, 2- “hyperlipidic diet” AND “rodent”, selecting those considered the most relevant according to the following criteria: date of publication (1995-2011); the use of wild-type animals; detailed description of the diet used and analysis of biochemical and vascular parameters of interest. References were included to introduce subjects such as the increased prevalence of obesity and questions related to the genesis of obesity in humans. The model of diet-induced obesity in rodents can be considered effective when the objective is the study of the physiopathology of metabolic and vascular complications associated with obesity.

This study analyzed the evidence available in the literature concerning the effectiveness of different active cutaneous warming systems to prevent intraoperative hypothermia. This is a systematic review with primary studies found in the following databases: CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline. The sample comprised 23 randomized controlled trials. There is evidence in the literature indicating that the circulating water garment system is the most effective in maintaining patient body temperature. These results can support nurses in the decision-making process concerning the implementation of effective measures to maintain normothermia, though the decision of health services concerning which system to choose should also take into account its cost-benefit status given the cost related to the acquisition of such systems. La finalidad del estudio fue analizar las evidencias disponibles en la literatura acerca de la efectividad de los diferentes métodos activos de calentamiento cutáneo para la prevención de hipotermia en el período intraoperatorio. Para esto, la revisión sistemática fue usada como método de revisión. La búsqueda de los estudios primarios fue efectuada en las bases de datos CINAHL, EMBASE, Cochrane Register of Controlled Trials y Medline. La muestra de la revisión abarcó 23 ensayos clínicos aleatorios controlados. La literatura ofrece evidencias que indican que el sistema de circulación de agua calentada es el método más efectivo en la manutención de la temperatura corporal. Los resultados evidenciados pueden subsidiar la toma de decisión del enfermero en la implementación de medidas efectivas para la manutención de la temperatura corporal. Sin embargo, considerando los costos de adquisición de los sistemas investigados, la elección del sistema en cada servicio de salud debería ser basada en el análisis de costo-beneficio. O estudo teve como objetivo analisar as evidências disponíveis na literatura sobre a efetividade dos diferentes métodos ativos de aquecimento cutâneo, para a prevenção de hipotermia no período intraoperatório. Para tal, a revisão sistemática foi empregada como método de revisão. A busca por estudos primários foi realizada nas bases de dados CINAHL, EMBASE, Cochrane Register of Controlled Trials e MEDLINE. A amostra da revisão foi composta por 23 ensaios clínicos randomizados controlados. Na literatura, há evidências que indicam que o sistema de circulação de água aquecida é o método mais efetivo à manutenção da temperatura corporal. Os resultados evidenciados podem subsidiar a tomada de decisão do enfermeiro na implementação de medidas efetivas para a manutenção da temperatura corporal. Recomenda-se, entretanto, que a escolha do sistema em cada serviço de saúde seja também baseada na análise custo/benefício, devido aos custos relativos à aquisição dos sistemas investigados.

Prenatal immune challenge (PIC) in pregnant rodents produces offspring with abnormalities in behavior, histology, and gene expression that are reminiscent of schizophrenia and autism. Based on this, the goal of this article was to review the main contributions of PIC models, especially the one using the viral-mimetic particle polyriboinosinic-polyribocytidylic acid (poly-I:C), to the understanding of the etiology, biological basis and treatment of schizophrenia. This systematic review consisted of a search of available web databases (PubMed, SciELO, LILACS, PsycINFO, and ISI Web of Knowledge) for original studies published in the last 10 years (May 2001 to October 2011) concerning animal models of PIC, focusing on those using poly-I:C. The results showed that the PIC model with poly-I:C is able to mimic the prodrome and both the positive and negative/cognitive dimensions of schizophrenia, depending on the specific gestation time window of the immune challenge. The model resembles the neurobiology and etiology of schizophrenia and has good predictive value. In conclusion, this model is a robust tool for the identification of novel molecular targets during prenatal life, adolescence and adulthood that might contribute to the development of preventive and/or treatment strategies (targeting specific symptoms, i.e., positive or negative/cognitive) for this devastating mental disorder, also presenting biosafety as compared to viral infection models. One limitation of this model is the incapacity to model the full spectrum of immune responses normally induced by viral exposure.

Background Facilitating the provision of appropriate health care for immigrant and Aboriginal populations in Canada is critical for maximizing health potential and well-being. Numerous reports describe heightened risks of poor maternal and birth outcomes for immigrant and Aboriginal women. Many of these outcomes may relate to food consumption/practices and thus may be obviated through provision of resources which suit the women's ethnocultural preferences. This project aims to understand ethnocultural food and health practices of Aboriginal and immigrant women, and how these intersect with respect to the legacy of Aboriginal colonialism and to the social contexts of cultural adaptation and adjustment of immigrants. The findings will inform the development of visual tools for health promotion by practitioners. Methods/Design This four-phase study employs a case study design allowing for multiple means of data collection and different units of analysis. Phase 1 consists of a scoping review of the literature. Phases 2 and 3 incorporate pictorial representations of food choices (photovoice in Phase 2) with semi-structured photo-elicited interviews (in Phase 3). The findings from Phases 1-3 and consultations with key stakeholders will generate key understandings for Phase 4, the production of culturally appropriate visual tools. For the scoping review, an emerging methodological framework will be utilized in addition to systematic review guidelines. A research librarian will assist with the search strategy and retrieval of literature. For Phases 2 and 3, recruitment of 20-24 women will be facilitated by team member affiliations at perinatal clinics in one of the city's most diverse neighbourhoods. The interviews will reveal culturally normative practices surrounding maternal food choices and consumption, including how women negotiate these practices within their own worldview and experiences. A structured and comprehensive integrated knowledge translation plan has been formulated. Discussion The findings of this study will provide practitioners with an understanding of the cultural differences that affect women's dietary choices during maternity. We expect that the developed resources will be of immediate use within the women's units and will enhance counseling efforts. Wide dissemination of outputs may have a greater long term impact in the primary and secondary prevention of these high risk conditions.

The objective of this study was to clarify the role of bisphosphonates in the treatment of osteoporosis in patients with prostate adenocarcinoma under androgen deprivation therapy (ADT). The Medline, EMBASE, Cancerlit and the American Society of Clinical Oncology abstract databases were searched for published randomized, placebo-controlled trials evaluating the usage of bisphosphonates in patients with prostate cancer (PC) under ADT. The outcomes assessed were fracture, osteoporosis, incidence of adverse events and changes in bone mineral density (BMD) during treatment. A total of 15 articles (2634 participants) were included in the meta-analysis. Treatment with bisphosphonates showed a substantial effect in preventing fractures (risk ratio (RR), 0.80; P = 0.005) and osteoporosis (RR, 0.39; P

To evaluate the scientific contribution of Brazilian Spine Surgeons not only in number of publications but also in their quality between January 2000 to December 2011.A literature search of publications by Brazilian spinal surgeons on topics concerning the spine or spinal cord was performed using an online database; Pubmed.gov. The results were limited to articles published from January 2000 to December 2011. A total of 1,778 articles were identified after a Medline search. After exclusion criteria, the study comprised 206 articles. The quality of the Journals was assessed with IF and the article quality using the Oxford classification.An increasing number of publications by Brazilian spine surgeons was observed in recent years: 45.1 % of those papers were published during the last 4 years (2008-2011). Clinical studies and case reports were the most frequent types of article published (37.5 vs 31.1 %). An increasing number of Brazilian publications in non-Brazilian journals has been observed in recent years (linear-by-linear association: 5.449, P = 0.020). The Arquivos de Neuro-Psiquiatria was the most frequent journal in which the papers were published (N = 67, 32 %). The IF of the publications varied from 0.021 to 8.017. The analysis of quality of the articles using the Oxford classification demonstrated that most of them provided LOE 4 (N = 113, 54.9 %) or 5 (N = 45, 21.8 %).There have been an increasing number of publications by Brazilian spine surgeons in recent years and the quality of the articles published has improved. Also the number of publications by Brazilians in non-Brazilian journals has increased in recent years.