Evaluation of the experience with the use of telemedicine in a home dialysis program-a qualitative and quantitative study.

Introduction: Assisted home hemodialysis is a therapeutic modality for patients diagnosed with end-stage renal disease who require dialysis replacement therapy and have concomitant health limitations that prevent them from attending a satellite dialysis unit or performing their own treatment.

Objective: The main objective of this study was to evaluate whether telemedicine provided through telemonitoring can improve the ongoing relationship between the doctor, the nurse and the patient.

Method: This prospective longitudinal, qualitative and quantitative study analyzes the impact of telemedicine through an evaluation of the experiences of patients and nurses.

Value-based medicine and palliative care: how do they converge?

: Sick persons need doctors who understand their pathology, know how to treat their problem, and accompany them through their illness. This study aimed to synthesize the state of knowledge regarding the concept of value-based medicine (VBM) through an integrative literature review, and establish how VBM can be applied in palliative care. : An integrative review was conducted with the keywords 'value-based medicine,' 'patient-centered care,' and 'medicina baseada em valor' (Portuguese for VBM) in PubMed and Virtual Health Library, identifying 17,189 articles in total.

Multi-part quality evaluation of a customized mobile application for monitoring elderly patients with functional loss and helping caregivers.

Background: The challenges faced by caregivers of the elderly with chronic diseases are always complex. In this context, mobile technologies have been used with promising results, but often have restricted functionality, or are either difficult to use or do not provide the necessary support to the caregiver - which leads to declining usage over time. Therefore, we developed the Mobile System for Elderly Monitoring, SMAI.

Maternal and developmental toxicity of the hallucinogenic plant-based beverage ayahuasca in rats.

Rats were treated orally with ayahuasca (AYA) on gestation days (GD) 6-20 at doses corresponding to one-(1X) to eight-fold (8X) the average dose taken by a human adult in a religious ritual, and the pregnancy outcome evaluated on GD21. Rats treated with 4X and 8X doses died during the treatment period (44 and 52%), and those that survived showed kidney injury. Rats surviving the 8X dose showed neuronal loss in hippocampal regions and in the raphe nuclei, and those from the 2X dose neuronal loss in CA1.

Identifying the loss of functional independence of older people residing in the community: Validation of the PRISMA-7 instrument in Brazil.

The identification of the older people who are functionally dependant is essential for planning interventions with emphasis on secondary and tertiary prevention. Therefore, a simplified tool, able to identify these individuals for a more comprehensive evaluation, is required. However, the use of a measuring tool in a different socio-cultural context requires prior adaptation.

rs3851179 Polymorphism at 5' to the PICALM Gene is Associated with Alzheimer and Parkinson Diseases in Brazilian Population.

Alzheimer's (AD) and Parkinson's diseases (PD) share clinical and pathological features, suggesting that they could have common pathogenic mechanisms, as well as overlapping genetic modifiers. Here, we performed a case-control study in a Brazilian population to clarify whether the risk of AD and PD might be influenced by shared polymorphisms at PICALM (rs3851179), CR1 (rs6656401) and CLU (rs11136000) genes, which were previously identified as AD risk factors by genome-wide association studies. For this purpose, 174 late-onset AD patients, 166 PD patients and 176 matched controls were genotyped using TaqMan assays.

Influence of low frequency PSEN1 variants on familial Alzheimer's disease risk in Brazil.

About 30-70% of familial Alzheimer's disease (AD) cases are related to mutations in presenilin-1 gene (PSEN1). Although the role of mutations and common variants in AD had been extensively investigated, the contribution of rare or low frequency PSEN1 variants on AD risk remains unclear. In the current study, we performed a mutational screening of PSEN1 coding exons and flanking intronic sequences among 53 index cases with familial history of AD from Rio de Janeiro (Brazil).

[Cross-cultural adaptation of the PRISMA-7 instrument for use in Brazil: evaluation of conceptual, item, and semantic equivalences].

Screening with a simplified instrument is effective for identifying elderly at risk of functional decline, for more comprehensive subsequent evaluation. However, use of a measurement tool in a different sociocultural context from the original requires prior adaptation. The current article aims to describe the initial stages of a cross-cultural adaptation of PRISMA-7, a questionnaire developed to identify community-dwelling elderly at risk of functional decline.

Behavioural and neurotoxic effects of ayahuasca infusion (Banisteriopsis caapi and Psychotria viridis) in female Wistar rat.

Ayahuasca, a psychoactive beverage used by indigenous and religious groups, is generally prepared by the coction of Psychotria viridis and Banisteriopsis caapi plants containing N,N-dimethyltryptamine (DMT) and β-carboline alkaloids, respectively. To investigate the acute toxicity of ayahuasca, the infusion was administered by gavage to female Wistar rats at doses of 30X and 50X the dose taken during a religious ritual, and the animals observed for 14 days. Behavioural functions were investigated one hour after dosing at 15X and 30X using the open field, elevated plus maze, and forced swimming tests.

Integrating medical and health multiprofessional residency programs: the experience in building an interprofessional curriculum for health professionals in Brazil.

Background: The aging of the population demands a development of the skills of different health professionals working in teams due to the complexity of the problems arising from this population. This article discusses the integration of two residency programs: medical and multiprofessional. The challenge was to construct a curriculum with practical and theoretical activities that develop competencies within the scope of interprofessional education, ensuring the necessary depth and detail of study in all the professional areas involved in the development of specific skills.

Integration and continuity of Care in health care network models for frail older adults.

A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion.

[Screening the risk for functional loss: a basic strategy for organizing the elderly health care network].

From a critical analysis of experiments in the use of screening tools for functional loss in the elderly, it was observed that the main motivation to develop and implement a screening instrument is to improve health care for the frail elderly or those at risk of functional loss and repeated hospital admissions. The instruments are preferably short questionnaires with no more than 16 self-reported questions. The main intervention performed after screening was monitoring the elderly by a specialized nursing service that, when necessary, referring them to the medical service.

[The Family Health Strategy and healthcare for the elderly: experiences in three Brazilian cities].

This study focuses on healthcare for the elderly under the Family Health Strategy in three municipalities (counties) in the State of Rio de Janeiro, Brazil, specifically analyzing the organization of the healthcare network and the knowledge of six health teams, using interviews and focus groups. The study emphasized the central role of work by community health agents, the prioritization of program activities as compared to management of problems in the community covered by the strategy, a work overload in the health teams, disorganization of the healthcare networks, and lack of systemic approaches based on the basic contents of Geriatrics and Gerontology. The article concludes that there is a need for a healthcare network for the elderly consisting of hierarchically organized services and levels of care that provide support for the healthcare teams' work.

LRRK2 p.G2019S mutation is not common among Alzheimer's disease patients in Brazil.

Mutations in the leucine-rich repeat kinase 2 (LRRK2) gene have emerged as a potential common cause for both sporadic and familial Parkinson's Disease (PD) in different populations. The pleomorphic features exhibited by LRRK2 mutation carriers and the central role of Lrrk2 protein in the proper functioning of central nervous system suggest that mutations in this protein might be involved in multiple cellular processes leading to other neurodegenerative disorders than PD. The location of LRRK2 gene on chromosome 12, close to a linkage peak for familial late-onset Alzheimer's Disease (AD), highlights that LRRK2 mutations might be involved in AD pathogenesis.

[Training professionals for delivering ingreated health care to the aged: the interdisciplinary experience of NAI - UNATI/UERJ].

The training of professionals in the field of healthcare for the aged is one of the priorities of the national policy for the aged in Brazil due to the accelerated aging of the population. The Núcleo de Atenção ao Idoso (NAI), a unit of the Open University of the Third Age/UERJ (UNATI/UERJ) develops an educational program in this field, based on practical care delivery with emphasis to inter-disciplinarity and teamwork. The program includes different training levels and modalities: Residency, Specialization, Professional Practice and Graduation.

[New professional competences in the field of health and the aging Brazilian population: integrality, interdisciplinarity, intersectoriality].

This paper discusses the challenges faced by medical education with regard to the aging Brazilian population as well as the specificities of senior health care services, aiming at systematizing the contents and practices needed to prepare health professionals. The assumption is based on a clear gap between appropriate contents for quality geriatric practices and health policy guidelines on the one hand, and current undergraduate and graduate level medical programs on the other. This epidemiological and demographic transition positions Geriatrics and Gerontology as fields of expertise in an expanding market, both in the public and private sectors, which raises the discussion on medical training standardization and health HR distribution.