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INTRODUCTION: Worldwide, the prevalence of degenerative diseases such as dementia and mild cognitive impairment (MCI) is increasing with population ageing and increasing life expectancy. Both conditions share modifiable risk factors. Physical inactivity is one of these modifiable risk factors, and research points to the protective effect of physical activity on the incidence of dementia and MCI. However, this association tends to change according to type, intensity, frequency, duration and volume of physical activity. Furthermore, it remains unclear which of these characteristics offers the greatest protective effect. Therefore, this study aims to evaluate the impacts of different types, intensities, frequencies, duration and volume of physical activity on dementia and cognitive decline in older adults. METHODS AND ANALYSIS: The search will be carried out from October 2023, using the following databases: PubMed, Embase, Scopus, CINAHL and Web of Science. Cohort studies with a follow-up time of 1 year or longer that have investigated the incidence of dementia and/or MCI in older adults exposed to physical activity will be included. There will be no limitations on the date of publication of the studies. Studies published in English, Spanish or Portuguese will be analysed. Two researchers will independently screen the articles and extract the data. Any discrepancies will be resolved by a third reviewer. Association measures will be quantified, including OR, HR, relative risk and incidence ratio, with a 95% CI. If the data allow, a meta-analysis will be performed. To assess the methodological quality of the selected studies, the Grading of Recommendations, Assessment, Development and Evaluations instrument, and the Downs and Black instrument to assess the risk of bias, will be used. ETHICS AND DISSEMINATION: Ethical approval is not required. The results will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42023400411.

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INTRODUCTION: Dementia and cognitive decline are highly prevalent in later life and are growing public health concerns worldwide due to the increasing aging population. Individuals diagnosed with dementia have reduced mental function, resulting in social and cognitive skill deficits, increased dependence, and reduced autonomy-all of which are conditions associated with higher mortality rates. This systematic review aims to assess the effectiveness of treating dementia and cognitive decline with methylfolate. The main outcomes analyzed will be dementia and changes in cognitive function measured by different instruments in older adults treated with methylfolate. Secondary outcomes, such as inflammatory markers, plasma folic-acid levels, and total homocysteine, will also be assessed. METHODS AND ANALYSIS: This study will be carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This protocol is registered in the International Prospective Registry of Systematic Reviews, under the code CRD42021275755. We will include clinical trials conducted with older adults diagnosed with dementia or cognitive decline and treated with folic acid. The searches will be conducted on the PubMed, Scopus, and Embase databases, and the articles will be selected by reading their titles and abstracts first, followed by the full text. The quality of the selected studies will be assessed using GRADE and the risk of bias will be assessed using the Downs-and-Black method. ETHICS AND DISSEMINATION: The results will be presented at scientific conferences and disseminated by publishing a scientific article in an international English-language journal. We hope to find robust and significant evidence regarding the effectiveness of methylfolate supplementation in improving dementia symptoms and cognitive decline among older adults. By systematizing this evidence and possibly performing a meta-analysis study, we expect to significantly contribute to the treatment of this health problem, reduce mortality, and improve the quality of life and health of this population, boosting the development of medical protocols capable of reducing the financial effects of public health.

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Introduction: the COVID-19 pandemic has impacted on mortality and several adverse health outcomes. It has also affected education as schools and universities had to adapt to remote learning due to social isolation strategies.Objective: to analyze the pandemic's impact on medical education including undergraduate and graduate students and lecturers, as follow: i) teaching methods adopted by education institutes during shutdown, ii) students and lecturers' perceptions and iii) impacts on students' mental health.Methods: this systematic review includes the following study designs: cross-sectional, surveys, case-control, cohort, and clinical trials. The literature search was performed in four databases: PubMed, Scopus, Embase, and SciELO . The risk of bias and the quality of the evidence were evaluated.Results: a total of 1,576 articles were identified through searching databases, and 40 articles were included. We found the use of several teaching methods such as virtual platforms and social media, pre-recorded videos, discussion forums and others. Student's challenges related to interference during online study such as family distractions, lack of a study room, challenges with internet connectivity, difficulties in communication between students and lecturers, gaps encountered during clinical skills learning. Lecturers' challenges were difficulty in grasping students' progress and learning outcomes and the lack of experience in online teaching. Only five studies explored mental health issues of medical students and found the occurrence of depression, anxiety, and stress. However, their prevalence was not comparable due to the use of different diagnostic instruments.Conclusion: there has been a wide range of teaching methods implemented for distance learning of medical students globally. The perceptions of medical students about these methods and their impact were also varied. Infrastructure, family, and curriculum problems represented the greatest difficulties in adherence and satisfaction with distance learning. However, the flexibility of digital learning was one of the factors that helped reduce these problems. Regarding mental health, the occurrence of anxiety, depression, and stress was reported.

Introdução: a pandemia de COVID-19 teve impacto na mortalidade e em vários resultados adversos para a saúde. Também afetou a educação, pois escolas e universidades tiveram que se adaptar ao ensino remoto devido às estratégias de isolamento social.Objetivo: analisar o impacto da pandemia na educação médica, incluindo alunos de graduação e pós-graduação e professores, a saber: i) métodos de ensino adotados pelas instituições de ensino durante a paralisação, ii) percepções de alunos e professores e iii) impactos na saúde mental dos alunos.Método: esta revisão sistemática inclui os seguintes desenhos de estudo: transversal, surveys, caso-controle, coorte e ensaios clínicos. A pesquisa bibliográfica foi realizada em quatro bases de dados: PubMed, Scopus, Embase e SciELO. O risco de viés e a qualidade da evidência foram avaliados.Resultados: um total de 1.576 artigos foram identificados por meio de busca em bancos de dados, e 40 artigos foram incluídos. Constatamos a utilização de diversos métodos de ensino como plataformas virtuais e redes sociais, vídeos pré-gravados, fóruns de discussão e outros. Desafios dos alunos relacionados à interferência durante o estudo online, como distrações familiares, falta de uma sala de estudo, desafios com conectividade à Internet, dificuldades de comunicação entre alunos e professores, lacunas encontradas durante o aprendizado de habilidades clínicas. Os desafios dos professores foram a dificuldade em compreender o progresso dos alunos e os resultados de aprendizagem e a falta de experiência no ensino online. Apenas cinco estudos exploraram questões de saúde mental de estudantes de medicina e encontraram a ocorrência de depressão, ansiedade e estresse. No entanto, sua prevalência não foi comparável devido ao uso de diferentes instrumentos de diagnóstico.Conclusão: existe uma ampla gama de métodos de ensino implementados para o ensino a distância de estudantes de medicina em todo o mundo. As percepções dos estudantes de medicina sobre esses métodos e seu impacto também foram variadas. Problemas de infraestrutura, família e currículo representaram as maiores dificuldades de adesão e satisfação com o ensino a distância. No entanto, a flexibilidade do aprendizado digital foi um dos fatores que ajudou a reduzir esses problemas. Em relação à saúde mental, foi relatada a ocorrência de ansiedade, depressão e estresse.

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INTRODUCTION: Chronic pain is highly prevalent in older adults and can cause functional limitations, negatively affecting health and quality of life. Physical activity is a non-pharmacological approach used to prevent chronic pain as it promotes the release of endogenous opioids that block pain sensitivity. Therefore, we developed a systematic review protocol to analyse the relationship between physical activity and the occurrence and intensity of chronic pain in older adults. METHODS AND ANALYSES: The systematic review will search PubMed, Scopus and Embase databases. The inclusion criteria will be observational studies that had primary chronic pain as an outcome, including persistent and intermittent pain. The population will include older adults from the community, living in a long-stay institution, or in outpatient follow-up. There will be no restriction regarding the year of publication and articles published in Portuguese, English and Spanish will be analysed. Effect or impact measures will be quantified, including OR, HR, prevalence ratio, incidence ratio and relative risk with their 95% CIs. If the data allow, a meta-analysis will be performed. The results may help understand the impact of physical activity as a potential protection factor against the occurrence of pain later in life as well as promote strategic prevention plans and public policies that encourage this practice in older adults. ETHICS AND DISSEMINATION: Ethical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete. PROSPERO REGISTRATION NUMBER: CRD42021282898.

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