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Chronic respiratory diseases (CRDs), such as asthma and chronic obstructive pulmonary disease (COPD), are among the leading non-communicable diseases (NCDs) worldwide. However, diagnosing CRDs in low-income and middle-income countries (LMICs) remains challenging due to limited access to spirometry and trained professionals. Aggravating the burden, CRDs often coexist with other NCDs, increasing healthcare costs, reducing quality of life and elevating mortality. These challenges highlight the need for simple case-finding approaches for CRDs, such as the COPD in Low-Income and Middle-Income Countries Assessment (COLA-6) questionnaire, to support prompt identification and appropriate care within NCD services in LMICs.
To evaluate the discriminative accuracy, feasibility and implementation of the COLA-6 questionnaire in identifying and managing CRDs in Brazilian Primary Healthcare (PHC) services for NCDs.
The Multimorbidity Approach for REspiratory Solutions (MARES) study consists of three work packages to be conducted in PHC services in São Carlos/SP and São Paulo/SP, Brazil.
MARES-1: A cross-sectional observational study enrolling 859 individuals with at least one NCD receiving care in PHC. The COLA-6 questionnaire will be administered by the research team and compared with quality-assured spirometry. The Chronic Airways Assessment Test (CAAT), Asthma Control Questionnaire (ACQ-7) and fractional exhaled nitric oxide (FeNO) will also be assessed. The diagnostic performance of COLA-6 for identifying CRDs—including COPD, asthma, preserved ratio impaired spirometry, restriction and overlaps—will be assessed using area under receiver operating characteristic curves and 95% CIs.
MARES-2: A cross-sectional observational study enrolling 20 healthcare professionals (physicians, physiotherapists, community health agents and nurses) from five PHC services. These professionals will apply the COLA-6 during routine NCD care to a total sample of 1000 patients. Qualitative interviews will be conducted to explore barriers and facilitators to the implementation of COLA-6, using deductive thematic analysis.
MARES-3: A longitudinal, prospective observational study in which patients from MARES-1 and MARES-2 will be reassessed at 6-month follow-up. A total sample of 473 participants with abnormal spirometry, a diagnosis of CRD or high risk for CRDs is expected. Participants will undergo spirometry, and a subset will be interviewed to explore their healthcare experiences through qualitative thematic analysis. Access to diagnostic and treatment services in Brazil will be assessed. Changes in spirometry values, FeNO, CAAT and ACQ-7 scores from baseline to 6 months in patients from MARES-1 will be analysed.
This study has been approved by the Ethics Committees of Federal University of São Carlos and University of Santo Amaro (UNISA). Ethical approval was also granted by the University College London. Results will be disseminated through peer-reviewed medical journals and presentations at international conferences. Results will improve identification of CRDs, addressing a significant gap in current PHC settings.
Despite evidence of the cost-effectiveness of physical activity (PA) promotion interventions in healthcare settings, translating them into practice remains challenging. This study aimed to identify implementation barriers and facilitators of a Portuguese PA consultation programme implemented in primary healthcare of the Portuguese National Health Service. Additionally, it sought to inform future implementation strategies, using a theoretically based approach.
Qualitative interview study, using both deductive and inductive approaches.
Primary healthcare units across all health administration regions of mainland Portugal.
Twenty-eight participants (six medical doctors, five exercise professionals and 17 patients) from all health regions of the country, involved in the implementation of the Portuguese PA prescription consultation.
Fifty-three categories of determinants were identified, using the Tailored Implementation for Chronic Diseases framework. Key barriers included ineffective referral processes to the consultation, challenges in integrating the intervention with existing healthcare demands and insufficient local/regional prioritisation of PA promotion. Key facilitators included high intervention acceptability, diverse community PA resources and good interpersonal skills of implementers. Drawing on the Behaviour Change Wheel, theoretically based inputs to design strategies addressing each barrier were provided.
The implementation of PA consultation was influenced by a broad range of determinants. The most frequently reported barriers are primarily structural and opportunity-related, suggesting system-level implementation strategies are most appropriate. Future strategies should consider implementing clinical standards/orientations for PA promotion, providing institutional incentives based on the attainment of PA indicators, expanding consultation coverage and diversifying referral strategies, reinforcing health system-community partnerships and strengthening training opportunities for implementers. These findings offer relevant insights for enhancing the future implementation of PA consultations, for scaling them up and, ultimately, to increase their effectiveness.
by Ariene Silva do Carmo, Paulo César Pereira de Castro Júnior, Thais Cristina Marquezine Caldeira, Daniela Silva Canella, Rafael Moreira Claro, Luiza Delazari Borges, Larissa Loures Mendes
The present study analyzed the prices of food sold in canteens of Brazilian private schools and described price-based marketing strategies, according to the NOVA food classification system. This is a mixed methods study combining a cross-sectional component and time series analysis, with data from 2,241 canteens in private elementary and secondary schools in the 26 capitals of Brazil and the Federal District, collected between June 2022 and June 2024. Price data collected for unprocessed, minimally processed, or processed foods and culinary preparations based on these foods (UMPCP), and ultra-processed foods and culinary preparations based on these foods (UpCP) sold in school canteens and from the National System of Consumer Price Indices (SNIPC), were used to create a data set containing deflated monthly prices for food and beverages sold between August 2022 and July 2024. Calculations were made for adjusted prices (R$/100 g or ml) and absolute prices (R$ per portion), and frequency of use of strategies such as combos and promotions. UMPCP showed lower adjusted price, but higher absolute price than UpCP, especially for solid foods. About 27% of the study canteens implemented pricing strategies for both food groups. Most of these strategies did not exclusively favor healthy foods, indicating that promotions and combos were used without distinction. The affordability of healthy foods is disadvantaged in school canteens when considering the price per portion, which may negatively influence students’ food choices. The findings show that current prices for food sold in most canteens discourage the purchase of healthy items, but favor the purchase of unhealthy ones. These results reinforce the importance of interventions for promoting healthy foods and making them more affordable.Patients living with chronic obstructive pulmonary disease (COPD) experience periods of disease stability and exacerbations (ECOPD). COPD imposes a negative and impactful extrapulmonary impairment and commonly overlaps with multimorbidity, particularly cardiovascular disease. Pulmonary rehabilitation (PR) aims to improve physical activity (PA) and quality of life, while behavioural change interventions (BCIs) aim to promote lifestyle changes and autonomy. However, after ECOPD, a variety of barriers often delay patient referral to PR. This study aims to assess the effects of a BCI for patients after ECOPD, focusing on cardiovascular health, PA and functionality. Additionally, the study will assess 6-month sustainability of PA and conduct a cost-utility analysis comparing a non-intervention group in the Unified Health System.
This randomised clinical trial will assess patients with ECOPD over 12 weeks using a BCI based on self-determination theory to increase daily steps. First, the cardiovascular and functional profile will be evaluated. Afterwards, the patients will receive an accelerometer to monitor the PA level. After 7 days, questionnaires will be applied on quality of life, symptoms and motivational levels for PA. Patients will be randomised into control group or intervention groups, both will receive educational booklets and IG will also receive an educational interview. PA will be tracked using activPAL accelerometer at weeks 1, 4 and 12, and follow-up at 6 months. Data analysis will include unpaired Student’s t-test or Mann-Whitney test for group comparison, and a linear mixed model to assess intervention effects over time. Economic evaluation, using STATA (V.14), will involve correlation analysis, and p
This study has been approved by the Federal University of São Carlos’ Ethics Committee, Irmandade Santa Casa de Misericórdia de São Carlos and Base Hospital of São José do Rio Preto. All procedures will be conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines and applicable regulatory requirements. All results will be presented in peer-reviewed medical journals and international conferences.
Brazilian Registry of Clinical Trials under the registration number RBR-6m9pwb7.
Analyse data collected through the WHO Regional Office for Europe to describe the proportion of European Union (EU) member states that have relevant policies related to physical activity (PA) counselling and exercise referral schemes in healthcare settings and the education of health professionals in health-enhancing PA (HEPA).
Cross-sectional survey.
An online survey (LimeSurvey) was sent to nominated government representatives of the 27 EU member states (via the EU PA Focal Point Network) in March 2021. The survey was open for 2 months, with support offered to all national representatives by the WHO Regional Office for Europe throughout. The survey had been developed by a panel of experts and was previously disseminated (and analysed) in 2015 and 2018.
National recommendations regarding (1) PA counselling in healthcare settings and (2) the inclusion of HEPA within teaching curricula.
All 27 countries responded. Of the 18 countries that reported national policies to provide PA counselling by healthcare professionals (HCPs), all reported that counselling on PA was provided through primary care, with an additional half also reporting PA counselling provision as part of secondary care. Twenty-one countries reported that HEPA is taught in the curricula of HCPs, but large variations exist regarding which cadres of HCPs have HEPA integrated within their curricula and whether the HEPA teaching is a mandatory or optional component of training.
Despite PA counselling being a key recommendation for promoting PA at the population level, only two-thirds of EU member states have national policies in place. Although three-quarters of EU member states report healthcare education curricula, including HEPA, more research is required to understand the methods and content of delivery and the subsequent effectiveness on knowledge and clinical outcomes.
Traditional peoples and communities (TPCs), such as indigenous peoples and quilombolas (communities descended from escaped African slaves), face challenges related to food security and the impact of the food environment on their health. Changes in food systems, urbanisation and loss of territorial rights have contributed to less healthy eating patterns, with increased consumption of ultra-processed foods and a higher prevalence of chronic non-communicable diseases. Despite this, there are gaps in knowledge about how the food environments of these communities are investigated, especially in relation to the physical, economic, political and sociocultural dimensions.
This scoping review will be conducted following the methodological framework developed by the Joanna Briggs Institute for scoping reviews, and its reporting will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews checklist. A systematic search will be carried out in the following databases: PubMed, SciELO, Web of Science, Embase and EBSCO, using terms related to traditional populations and food environments. The studies to be included will be selected according to the inclusion and exclusion criteria defined based on the population, concept and context technique. The study population will include TPCs, such as indigenous peoples and quilombolas; the concept will address the food environment in its physical, economic, political and sociocultural dimensions; and the context will encompass studies conducted at a global level, without any restrictions on geographic location. The study type will include original articles and grey literature. The screening of studies will involve independent reviewers and predefined inclusion and exclusion criteria. Data synthesis will be presented in tables, including information on focus, geographic scope and methodology of the selected studies. The risk of bias will be assessed using the Risk of Bias in Non-randomised Studies of Exposure tool.
As the study does not involve the collection of primary data or human participants, it does not require ethical approval. The results will be submitted to peer-reviewed journals and presented at public health and nutrition conferences, contributing to the advancement of knowledge on food environments of TPCs.
Dermoscopy has a proved validity in the diagnosis of cutaneous melanoma, which is one of the most aggressive forms of skin cancer. Although some studies have demonstrated a relationship between specific dermoscopic and pathologic melanoma features, there is no solid evidence allowing reliable conclusions. This study will evaluate the evidence regarding this association.
Observational studies eligible for our systematic review will enrol adults with histological cutaneous non-volar melanoma diagnosis and with dermoscopy image analysis. We will search the following databases: PubMed, Embase, Web of Science, MEDLINE and Cochrane Library. We will not impose any language or date restrictions. Outcomes of interest include the association of at least one of the melanoma dermoscopy features (irregular pigmentation, blue-white veil, atypical network, multicomponent pattern, atypical dots and/or globules, regression, peripheral tan structureless area, negative network, shiny white structures, atypical vessels and streaks/pseudopods), with melanoma Breslow index or other histopathology characteristics (melanoma subtype, mitotic index and presence of ulceration). Two reviewers will independently screen and search results, extract data from eligible studies and assess risk of bias. The evidence derived by this study will elucidate the possible link between melanoma dermoscopy and histopathology. If we could predict melanoma thickness based on dermoscopy, we would be able to anticipate melanoma treatment with impact on survival.
Ethical approval is not required because this is a literature-based study. It will be published in scientific Pubmed indexed open access journals to ensure its accessibility.
CRD42024564919.
We examined studies that analysed the spatial association of cancers with demographic, environmental, behavioural and/or socioeconomic factors and the statistical methods applied.
Systematic mapping review.
Web of Science (SSCI) (search on 28 July 2022), MEDLINE, SocINDEX and CINAHL (search on 4 August 2022), additional searches included grey literature.
(1) Focused on the constituent countries of the UK (England, Wales, Scotland and Northern Ireland) and its major regions (eg, the North West); (2) compared cancer(s) outcomes with demographic, environmental, behavioural and socioeconomic characteristics by applying methods to identify their spatial association; (3) reported cancer prevalence, incidence rates, relative risk or ORs for a risk factor or to an average level of cancer.
A standardised data extraction form was developed and for all studies, core data were extracted including bibliographic information, study design, geographical factors analysed, data aggregation level, methods applied and main findings. We described and synthesised the characteristics of the studies using summary tables, charts and graphs.
52 studies were included covering a variety of objectives and geographical scales. These studies considered different types of cancer, with the most common cancer types analysed being blood and lymphoid cell cancers. The most common methods used to assess the association between cancers and geographical level factors were regression analyses, with the majority being Poisson regression, then logistic and linear regression. Studies were usually conducted at ward and local authority level, or by exact point location when distances from putative risk sources were considered. The results were usually presented in plots or as tables, instead of maps.
Our results highlight the lack of consideration of spatially explicit models in the analysed studies, with the risk of having failed the assumption of independence in the data.
CRD42022349165.
The way communication is conducted directly influences the professional–patient relationship, how patients cope with their diagnosis, and their sense of hope throughout treatment. This study aims to map the literature on strategies that healthcare professionals can use to promote hope in communication with pediatric patients and their families in the context of chronic illness. Based on this objective, the study highlights an algorithm to assist healthcare professionals in instilling hope in this population through communication.
Scoping review.
This systematized review was conducted using the databases PubMed, LILACS, PsycInfo, Embase, CINAHL, and Scopus, employing the PCC framework and the Boolean operators AND and OR. The time frame was limited to the last 20 years (2004–2024). A total of 734 studies were identified across the databases, with an additional four retrieved through manual citation searches, resulting in 19 articles included in the final sample.
The findings highlight three key pillars for promoting hope in communication: (1) careful preparation for information delivery, which involves identifying the diverse needs of families and creating a physically comfortable and emotionally supportive environment; (2) providing information and emphasizing how it is presented—considering content, clarity, honesty, empathy, and adaptation to the recipient's specific needs; and (3) follow-up after information delivery, ensuring emotional support and active, skilled listening.
Interpersonal communication between the healthcare professional, the patient, and the family was mainly focused on the transmission of information about the disease and treatment in a clear and empathetic manner, considering who is receiving the information and how the information is interpreted.
This review provides guidance for healthcare professionals in implementing communication strategies that foster hope in the context of pediatric chronic illness. Additionally, this guide may serve as a model for training students and healthcare professionals. Further research is needed to implement and explore additional effective communication strategies for this population across diverse cultural settings.
This study aimed to describe the process of construction, validation, and usability of the chatbot ESTOMABOT to assist in the self-care of patients with intestinal ostomies. Methodological research was conducted in three phases: construction, validation, and usability. The first stage corresponded to the elaboration of a script through a literature review, and the second stage corresponded to face and content validation through a panel of enterostomal therapy nurses. In the third phase, the usability of ESTOMABOT was assessed with the participation of surgical clinic nurses, patients with intestinal elimination ostomies, and information technology professionals, using the System Usability Scale. The ESTOMABOT content reached excellent criteria of adequacy, with percentages of agreement equal to or greater than 90%, which were considered adequate, relevant, and representative. The evaluation of the content validity of the script using the scale content validity index/average proportion method reached a result above 0.90, and the Fleiss κ was excellent (P Objetivo: Analizar las repercusiones de la pandemia por el nuevo coronavirus en la salud de los profesionales de enfermería. Método: Investigación cuantitativa, descriptiva, realizada en un hospital universitario de Salvador, Bahía, Brasil, entre septiembre y octubre de 2020. La recolección de datos se realizó a través de un cuestionario electrónico estructurado, que fue respondido por 209 profesionales de enfermería de la institución. El proyecto fue aprobado por un Comité de Ética en Investigación (nº CAAE 36841720.0.0000.0049). Resultados: La mayoría de los profesionales relató insomnio o dormir menos de lo necesario (62,67%); mostró aumento del deseo de comer (46,89%) o pérdida del apetito (16,75%); tuvo pérdidas en actividades de ocio (97,6%); relataron una disminución en la práctica de actividad física (91,87%); mostró alteraciones en el estado de ánimo (83,75%); reportó algún grado de ansiedad (89,95%); y tenía diagnóstico de covid-19 (28,23%). Conclusión: Los resultados indican las repercusiones que trajo la pandemia para la salud física y mental de los profesionales de enfermería.
Objetivo principal: Aprehender las experiencias de los profesionales de enfermería en el cuidado de pacientes con covid-19. Metodología: Investigación cualitativa realizada con 17 profesionales de enfermería en un hospital universitario de Salvador, Bahía, Brasil. La información fue recolectada a través de entrevistas semiestructuradas y analizada con el apoyo del software IRAMUTEQ. Resultados principales: La experiencia de las prácticas fue descrita como difícil, aterradora, complicada, causando miedo, aprensión y estrés. Surgió el énfasis en las medidas de autoprotección y como medio para superar el aislamiento, los profesionales utilizaron estrategias para favorecer la aproximación y la comunicación entre los pacientes y el equipo, evidenciando así un cuidado sensible a las necesidades del otro. Conclusión principal: Las reacciones indican que los profesionales desarrollaron estados emocionales negativos; adaptaron el servicio; y el fortalecimiento del autocuidado mediante la exposición al riesgo de contaminación y utilizaron estrategias de atención permeadas por la sensibilidad.
Objetivo: describir las facilidades y dificultades de los técnicos de enfermería para realización del electrocardiograma (ECG) después del entrenamiento en servicio. Métodos: investigación cualitativa, realizada en una unidad cardiovascular de un Hospital Universitario de Salvador - Bahía, Brasil, con 10 técnicos de enfermería. Resultados: el análisis permitió identificar tres categorías: formación como facilitador de la práctica asistencial; uso adecuado de ECG en la rutina de servicio después del entrenamiento; escasez de recursos materiales necesarios para realizar el ECG. Los resultados mostraron que además de los beneficios para los usuarios del servicio, el curso de ECG también puede ofrecer al profesional algunas ventajas, como un mayor conocimiento y un aprendizaje favorecido. Conclusión: las facilidades fueron descritas como ampliación del conocimiento y favoreciendo el aprendizaje de las técnicas correctas para la realización del procedimento, conduciendo a una disminución de errores y el uso adecuado del dispositivo. Las dificultades estaban relacionadas con la escasez de materiales y las precarias condiciones de algunos dispositivos.
Objetivo: Analizar las notificaciones de lesiones de piel en un hospital universitario. Método: Estudio descriptivo, realizado en un hospital universitario, localizado en Salvador, Bahia, Brasil, con datos secundarios de notificaciones de incidentes. Fueron investigadas características sociodemográficas de los pacientes con lesiones de piel y características de las lesiones notificas en los años 2016 y 2017. Los datos fueron recolectados entre los meses de septiembre 2018 y mayo 2019 y el estudio respetó los principios éticos de investigación. Resultados: Fueron notificados 96 casos de lesión de piel. La mayoría fue adquirida en la hospitalización (89,58%), siendo frecuente la lesión por presión (77,08%), en la región sacra o glútea (61,46%), con pérdida de piel (54,17%), en grado leve (89,58%) y que prolongaron la hospitalización (7,29%). Conclusión: A pesar de ser realizada evaluación del riesgo para lesión, en más de la mitad de las notificaciones se observa que el tipo más prevalente fue la lesión por presión.
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