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BACKGROUND: Effective stakeholder engagement in health research is increasingly being recognised and promoted as an important pathway to closing the gap between knowledge production and its use in health systems. However, little is known about its process and impacts, particularly in low-and middle-income countries. This opinion piece draws on the stakeholder engagement experiences from a global health research programme on Chronic Obstructive Pulmonary Disease (COPD) led by clinician researchers in Brazil, China, Georgia and North Macedonia, and presents the process, outcomes and lessons learned. MAIN BODY: Each country team was supported with an overarching engagement protocol and mentored to develop a tailored plan. Patient involvement in research was previously limited in all countries, requiring intensive efforts through personal communication, meetings, advisory groups and social media. Accredited training programmes were effective incentives for participation from healthcare providers; and aligning research findings with competing policy priorities enabled interest and dialogue with decision-makers. The COVID-19 pandemic severely limited possibilities for planned engagement, although remote methods were used where possible. Planned and persistent engagement contributed to shared knowledge and commitment to change, including raised patient and public awareness about COPD, improved skills and practice of healthcare providers, increased interest and support from clinical leaders, and dialogue for integrating COPD services into national policy and practice. CONCLUSION: Stakeholder engagement enabled relevant local actors to produce and utilise knowledge for small wins such as improving day-to-day practice and for long-term goals of equitable access to COPD care. For it to be successful and sustained, stakeholder engagement needs to be valued and integrated throughout the research and knowledge generation process, complete with dedicated resources, contextualised and flexible planning, and commitment.

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O objetivo do presente trabalho foi discutir sobre a diferença entre os termos bucal e oral na Odontologia, tendo como respaldo a Língua Portuguesa. A metodologia bibliográfica buscou se ancorar em teóricos da linguagem e da Odontologia para investigar a diferença entre tais palavras. Após leitura de textos que versaram sobre essas vertentes, observamos que a principal diferença residiu na origem das palavras bucca e os, originárias do latim clássico e vulgar, respectivamente, com significados distintos. Todavia, ao migrarem para o português, os falantes escolheram o termo bucca em detrimento de os, o qual ainda hoje é usado ao lado de oral, com sentidos semelhantes. Notamos, ainda, que para os profissionais da saúde seria importante padronizar a terminologia, pois facilitaria a compreensão desses termos para pacientes e profissionais de outras áreas, tais como os tradutores; por outro lado, ficou nítido que, em alguns momentos, a unificação terminológica seria mais difícil, pois os contextos de uso teriam que ser mudados. Por fim, destacamos que estudar estes vocábulos no contexto da Odontologia é importante para que tanto pacientes quanto os profissionais de saúde, ou de áreas similares conheçam a peculiar diferença(AU)

The objective of the present work was to discuss the difference between the terms oral and oral in Dentistry, based on the Portuguese language. The bibliographic methodology sought to anchor in language and dentistry theorists to investigate the difference between such words. After reading texts that dealt with these aspects, we observed that the main difference resided in the origin of the word bucca and os, originating from classical and vulgar Latin, respectively, with different meanings. However, when migrating to Portuguese, the speakers chose the term bucca over os, which is still used alongside oral, with similar meanings. We also noted that for health professionals it would be important to standardize the terminology, as it would facilitate the understanding of these terms for patients and professionals from other areas, such as translators; on the other hand, it was clear that at times, terminological unification would be more difficult, as the contexts of use would have to be changed. Finally, we emphasize that studying these words in the context of Dentistry is important so that both patients and health professionals, or from similar areas, know the peculiar difference(AU)

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AIM: To analyze the association of demographic, clinical, health and functional capacity variables as predictors of frailty in older adults after one year of hospital discharge. BACKGROUND: There is still insufficient research with older persons after hospital discharge that evaluated the predictive variables for an increase in the frailty score. Identifying the characteristics that result in greater risk helps to guide care and interventions. METHODS: Longitudinal study involving 129 older adults who completed the follow-up. The Frailty Phenotype was used according to Fried and sociodemographic, clinical, health and functional capacity variables. Analysis was performed using structural equation modeling. RESULTS: At admission, the highest percentage (53.4%) of older adults were pre-frail, followed by frail (23.3%) and non-frail (23.3%). After a year of discharge, there was a decrease in the frail condition (22.5%) and pre-frail (52.7%); and an increase in non-frail (24.8%). At baseline, 29.5% showed impairment in only one component, with an increase in the percentage at follow-up (37.2%). The highest number of morbidities and hospital readmissions and lower IADL scores were predictors of an increase in the frailty score during follow-up. CONCLUSION: The prevalence of frailty was high among hospitalized older adults and after follow-up. Identifying the risk factors allows early and individualized interventions with reduction of negative outcomes. During hospitalization, a multidimensional assessment of older adults should be performed, especially with regard to frailty. The recognition of frailty predictors directs the care of older persons considering their individual needs and allows the improvement and/or stability of the frailty condition.

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Poor oral health is associated with worse clinical outcomes in Chronic Obstructive Pulmonary Disease (COPD). This qualitative study aimed to investigate the knowledge, attitudes and practices of COPD patients and primary health care professionals (HCPs) in Brazil - where there are high rates of COPD and periodontal disease. Semi-structured interviews with COPD patients (n = 9) and three semi-structured focus groups with HCPs (n = 25) were conducted in São Paulo. Interviews were thematically analysed using The Framework Method. Despite a high prevalence of edentulism, patients viewed tooth loss and decay as a norm and neglected preventative oral health practices. HCPs blamed patients for avoiding preventative opportunities, whilst patients discussed significant barriers to oral healthcare. Knowledge of the relationship between oral health and COPD was lacking among HCPs and patients, but all participants were receptive to oral health education. Practitioners identified the need for a COPD primary care pathway that integrates oral health protocols. This study indicates that Brazil must incorporate preventative oral health into COPD management and expand public dental services to increase uptake.

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Asthma and chronic obstructive pulmonary disease (COPD) are leading causes of hospitalisation and death in the city of Sao Bernardo do Campo. The municipality had difficulties in sustaining a pulmonology specialist team. Local policy has strengthened the knowledge of the primary care teams to improve the management of these diseases. Our aim is to pilot the implementation of an educational intervention based on collaborative care focused on reducing respiratory-related referrals. We implemented 'matrix support': a Brazilian collaborative educational intervention promoting specialist training and support for primary care physicians in three health territories with the highest number of referrals. Clinicians and nurses from primary care attended an 8-h workshop. The backlog of respiratory referrals was prioritised, where Asthma and COPD represented 70% of referral reasons. Initially, pulmonologists held joint consultations with physicians and nurses; as confidence grew, these were replaced by round-table note-based case discussions. The primary outcome was the number of asthma and COPD referrals. Almost all primary healthcare professionals in the three areas (132 of 157-87%) were trained; 360 patients were discussed, including 220 joint consultations. The number of respiratory referrals dropped from 290 (the year before matrix support) to 134 (the year after) (P<0.05). Referrals for asthma/COPD decreased from 13.4 to 5.4 cases per month (P=0.09) and for other lung diseases from 10.8 to 5.3 cases per month (P<0.05). Knowledge scores showed a significant improvement (P<0.001). Matrix-support collaborative care was well-accepted by primary care professionals associated with improved knowledge and reduced respiratory referrals. The initiative attracted specialists to the region overcoming historical recruitment problems.

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A new method is presented to determine the retinal spectral sensitivity function S(λ) using the electroretinogram (ERG). S(λ)s were assessed in three different species of myomorph rodents, Gerbils (Meriones unguiculatus), Wistar rats (Ratus norvegicus), and mice (Mus musculus). The method, called AC Constant Method, is based on a computerized automatic feedback system that adjusts light intensity to maintain a constant-response amplitude to a flickering stimulus throughout the spectrum, as it is scanned from 300 to 700 nm, and back. The results are presented as the reciprocal of the intensity at each wavelength required to maintain a constant peak to peak response amplitude. The resulting S(λ) had two peaks in all three rodent species, corresponding to ultraviolet and M cones, respectively: 359 nm and 511 nm for mice, 362 nm and 493 nm for gerbils, and 362 nm and 502 nm for rats. Results for mouse and gerbil were similar to literature reports of S(λ) functions obtained with other methods, confirming that the ERG associated to the AC Constant-Response Method was effective to obtain reliable S(λ) functions. In addition, due to its fast data collection time, the AC Constant Response Method has the advantage of keeping the eye in a constant light adapted state.

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OBJECTIVE: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. METHODS: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. RESULTS: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. CONCLUSIONS: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.

OBJETIVO: Relatar os resultados de uma oficina de trabalho sobre programas e centros de atenção a asmáticos (PCAAs) no Brasil para que possam servir como instrumento para melhoria e avanço dos PCAAs existentes e criação de novos. MÉTODOS: A oficina de trabalho constituiu-se de cinco apresentações e discussões em grupos. Os grupos de trabalho discutiram os seguintes temas: implementação de uma linha de cuidado em asma; recursos humanos necessários para os PCAA; recursos necessários para financiar os PCAA; e manutenção do funcionamento dos PCAAs. RESULTADOS: A oficina envolveu 39 participantes de todas as regiões do país, representando associações de asmáticos (n = 3), centros universitários (n = 7) e PCAAs (n = 29). Evidenciou-se uma relação direta entre a ausência de planejamento e o insucesso dos PCAAs. Com base nas experiências brasileiras elencadas durante a oficina, as premissas comuns foram a importância da sensibilização do gestor, maior participação da comunidade, interdependência entre a atenção primária e a especializada, observação da regionalização e utilização dos medicamentos disponíveis no sistema público de saúde. CONCLUSÕES: O Brasil já tem um núcleo de experiências na área programática da asma. A implementação de uma linha de cuidado em doenças respiratórias crônicas e sua inclusão nas redes de saúde parecem ser o caminho natural. Porém, a experiência nessa área ainda é pequena. Agregar pessoas com experiência nos PCAAs na elaboração da linha de cuidado em asma encurtaria tempo na criação de redes de atenção com possível efeito multiplicador, evitando que se partisse do zero em cada local isolado.

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Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero. .

Objetivo: Relatar os resultados de uma oficina de trabalho sobre programas e centros de atenção a asmáticos (PCAAs) no Brasil para que possam servir como instrumento para melhoria e avanço dos PCAAs existentes e criação de novos. Métodos: A oficina de trabalho constituiu-se de cinco apresentações e discussões em grupos. Os grupos de trabalho discutiram os seguintes temas: implementação de uma linha de cuidado em asma; recursos humanos necessários para os PCAA; recursos necessários para financiar os PCAA; e manutenção do funcionamento dos PCAAs. Resultados: A oficina envolveu 39 participantes de todas as regiões do país, representando associações de asmáticos (n = 3), centros universitários (n = 7) e PCAAs (n = 29). Evidenciou-se uma relação direta entre a ausência de planejamento e o insucesso dos PCAAs. Com base nas experiências brasileiras elencadas durante a oficina, as premissas comuns foram a importância da sensibilização do gestor, maior participação da comunidade, interdependência entre a atenção primária e a especializada, observação da regionalização e utilização dos medicamentos disponíveis no sistema público de saúde. Conclusões: O Brasil já tem um núcleo de experiências na área programática da asma. A implementação de uma linha de cuidado em doenças respiratórias crônicas e sua inclusão nas redes de saúde parecem ser o caminho natural. Porém, a experiência nessa área ainda é pequena. Agregar pessoas com experiência nos PCAAs na elaboração da linha de cuidado em asma encurtaria tempo na criação de redes de atenção com possível efeito multiplicador, evitando que se partisse do zero em cada local isolado. .

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Objetivos : Constatando que a depressão é comum em idosos institucionalizados, associando-se à solidão, à ansiedade e à afetividade, pretendemos descrever a evolução da depressão durante dois anos e verificar que fatores se associam a essa evolução. Métodos : Em um estudo de coorte prospectivo em dois momentos (2011 e 2013), avaliamos 83 idosos institucionalizados, com idade no primeiro momento entre os 60 e os 100 anos, sendo 79,5% mulheres, 86,7% sem companheiro(a), e 72,3% com algum grau de escolaridade. Usamos a Escala Geriátrica da Depressão (GDS), a Escala de Solidão (UCLA-L), o Inventário Geriátrico de Ansiedade (GAI) e a Lista de Afetos Positivos e Negativos (PANAS). Resultados: Verificamos que 59,0% mantiveram a depressão e 10,8% desenvolveram depressão. Os idosos com depressão tiveram significativamente piores resultados na UCLA, GAI e PANAS, e os não depressivos tiveram afetos positivos mais altos. Quanto à evolução da depressão, os idosos que mantiveram depressão tiveram inicialmente pontuações elevadas no GDS, GAI, UCLA e na subescala PANAS negativo e pontuações baixas na subescala PANAS positivo. Esses idosos apresentaram associadamente um agravamento dos sentimentos de solidão, dos sintomas ansiosos e do afeto negativo ao longo dos dois anos. Os que desenvolveram depressão tiveram, no primeiro momento, pontuações elevadas na UCLA. Conclusões: Os sintomas de depressão com ou sem solidão no momento inicial, o agravamento da solidão, a ansiedade, o afeto negativo e o baixo afeto positivo poderão ser fatores de risco para a manutenção da depressão. A solidão poderá ainda ser um fator de risco para o desenvolvimento de depressão. .

Objectives : Knowing that depression is common in institutionalized elderly and associated with loneliness, anxiety, and affectivity, we want to describe the evolution of depression over two years and identify which factors are associated with the development of depression. Methods: In this prospective cohort study, that encompassed two evaluation moments (2011 and 2013), 83 institutionalized elders were inquired, with age at baseline between 60 and 100 years, 79.5% women, 86.7% single and 72.3% with some type of education. The instruments included the Geriatric Depression Scale (GDS), Loneliness Scale (UCLA-L), Geriatric Anxiety Inventory (GAI) and List of Positive and Negative Affects (PANAS). Results: Fifty-nine percent of the subjects maintained depression, and 10.8% developed depression. Elderly patients with depression had significantly worse outcomes in the UCLA, GAI and PANAS, and those who were not depressed had a higher positive affect. Regarding the evolution of depression, elders that maintained depression had high scores on the GDS, GAI, UCLA, and negative PANAS subscale, and low scores on the PANAS positive subscale at baseline. These elders showed an increase in the feelings of loneliness, anxiety symptoms, and negative affect over the two years. Those who developed depression had higher scores on the UCLA-L at baseline. Conclusions: We conclude that depression symptoms with or without loneliness at baseline, the worsening of loneliness, anxiety, and of the positive and negative affects may all be risk factors for the maintenance of depression. Loneliness may also be a risk factor for the development of depression. .

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The diurnal Dipsadidae snakes Philodryas olfersii and P. patagoniensis are closely related in their phylogeny but inhabit different ecological niches. P. olfersii is arboreal, whereas P. patagoniensis is preferentially terrestrial. The goal of the present study was to compare the density and topography of neurons, photoreceptors, and cells in the ganglion cell layer in the retinas of these two species using immunohistochemistry and Nissl staining procedures and estimate the spatial resolving power of their eyes based on the ganglion cell peak density. Four morphologically distinct types of cones were observed by scanning electron microscopy, 3 of which were labeled with anti-opsin antibodies: large single cones and double cones labeled by the antibody JH492 and small single cones labeled by the antibody JH455. The average densities of photoreceptors and neurons in the ganglion cell layer were similar in both species (∼10,000 and 7,000 cells·mm(-2), respectively). The estimated spatial resolving power was also similar, ranging from 2.4 to 2.7 cycles·degree(-1). However, the distribution of neurons had different specializations. In the arboreal P. olfersii, the isodensity maps had a horizontal visual streak, with a peak density in the central region and a lower density in the dorsal retina. This organization might be relevant for locomotion and hunting behavior in the arboreal layer. In the terrestrial P. patagoniensis, a concentric pattern of decreasing cell density emanated from an area centralis located in the naso-ventral retina. Lower densities were observed in the dorsal region. The ventrally high density improves the resolution in the superior visual field and may be an important adaptation for terrestrial snakes to perceive the approach of predators from above.

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A Epistemologia Genética defende que o indivíduo passa por várias etapas de desenvolvimento ao longo da sua vida. O desenvolvimento é observado pela sobreposição do equilíbrio entre a assimilação e a acomodação, resultando em adaptação. Assim, nesta formulação, o ser humano assimila os dados que obtém do exterior, mas uma vez que já tem uma estrutura mental que não está "vazia", precisa adaptar esses dados à estrutura mental já existente. O processo de modificação de si próprio é chamado de acomodação. Este esquema revela que nenhum conhecimento chega do exterior sem que sofra alguma alteração pelo indivíduo, sendo que tudo o que se aprende é influenciado por aquilo que já havia sido aprendido. A assimilação ocorre quando a informação é incorporada às estruturas já pré-existentes nessa dinâmica estrutura cognitiva, enquanto que a adaptação ocorre quando o organismo se modifica de alguma maneira de modo a incorporar dinamicamente a nova informação. Por fim, de um pensamento moderno que, buscando a síntese inusitada entre o biológico e o lógico-matemático, parece encontrar seus limites na desconstrução ainda mais inusitada a que tende sistematicamente todo o pensamento na atualidade: a de si mesmo se construindo de modo essencialmente esclarecido

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A Epistemologia Genética defende que o indivíduo passa por várias etapas de desenvolvimento ao longo da sua vida. O desenvolvimento é observado pela sobreposição do equilíbrio entre a assimilação e a acomodação, resultando em adaptação. Assim, nesta formulação, o ser humano assimila os dados que obtém do exterior, mas uma vez que já tem uma estrutura mental que não está "vazia", precisa adaptar esses dados à estrutura mental já existente. O processo de modificação de si próprio é chamado de acomodação. Este esquema revela que nenhum conhecimento chega do exterior sem que sofra alguma alteração pelo indivíduo, sendo que tudo o que se aprende é influenciado por aquilo que já havia sido aprendido. A assimilação ocorre quando a informação é incorporada às estruturas já pré-existentes nessa dinâmica estrutura cognitiva, enquanto que a adaptação ocorre quando o organismo se modifica de alguma maneira de modo a incorporar dinamicamente a nova informação. Por fim, de um pensamento moderno que, buscando a síntese inusitada entre o biológico e o lógico-matemático, parece encontrar seus limites na desconstrução ainda mais inusitada a que tende sistematicamente todo o pensamento na atualidade: a de si mesmo se construindo de modo essencialmente esclarecido.(AU)

The Genetic Epistemology argues that the individual goes through various stages of development throughout his life. The development is seen by the overlap of the balance between assimilation and accommodation, resulting in adaptation. Thus, in this formulation humans assimilate the data they obtain from the outside, but once they already have a mental structure that is not "empty", they must adapt these data to the existing mental structure. The process of change itself is called accommodation. This scheme reveals that no knowledge comes from outside without suffering any change by the individual, and everything that is learned is influenced by what was learned. Assimilation occurs when information is incorporated into pre-existing structures in this dynamic cognitive structure, while the conversion occurs when the organism is changed in some way to incorporate the new information dynamically. Finally, a modern thought that seeking the unusual synthesis between the biological and logical-mathematical seems to find its limits in the deconstruction even more unusual that tends systematically all thought at present: the self developing in a essentially clarified way.(AU)

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Com o objetivo de verificar se as medidas incluídas nos índices de Pont, Korkhaus e Schwarz, elaboradas para jovens europeus, poderiam ser usadas em brasileiros, foram feitas mensuraçöes em 66 modelos de estudo e 66 telerradiografias em norma lateral, obtidos de uma amostra de jovens brasileiros, leucodermas, de ambos sexos, com dentaduras permanentes, näo tratados ortodonticamente, com idade variando entre 12 e 18 anos, portadores de oclusäo considerada normal, moradores na regäo do ABC, no estado de Säo Paulo. Com base nos resultados obtidos e segundo a metodologia empregada, julgamos correto concluir que näo houve correlaçäo considerada estatisticamente significante entre as medidas comparadas. A partir desse resultado, foi sugerida a mudança de proporçäo constante, usada para as predeterminaçöes das larguras do arco-dentário superior na regäo inter-primeiros pré-molares de 80 para 85.8, e na área inter-primeiros molares de 64 para 67, para a aplicaçäo da tabela em pacientes brasileiros. Entretanto, pela ampla variaçäo étnica e racial própria da regiäo onde foi coletada a amostra, foi salientado que essa proporçáo constante corrigida näo deveria ser empregada indiscriminadamente, porque näo poderia ser considerada representativa de jovens brasileiros

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