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Efeito do exercício em casa versus presencial na aptidão física e funcionalidade de idosos com doença de Alzheimer: um ensaio clínico randomizado controlado

2026-09-16T06:20:05Z

Title: Efeito do exercício em casa versus presencial na aptidão física e funcionalidade de idosos com doença de Alzheimer: um ensaio clínico randomizado controlado Abstract: Introduction: Alzheimer’s disease (AD) progressively impairs cognition and functionality in older adults. Non-pharmacological strategies, such as supervised physical exercise, have proven effective in maintaining functional independence. Telerehabilitation has emerged as a promising alternative, especially in contexts with logistical and access barriers. Objective: To evaluate the effects of a supervised multicomponent exercise program delivered via telerehabilitation on the functionality and balance of older adults with AD, in comparison to face-to-face supervision and a control group. Methods: A randomized clinical trial was conducted with 35 older adults diagnosed with mild to moderate AD, allocated into three groups: telerehabilitation (TG, n=10), face-to-face supervision (FFSG, n=12), and control (CG, n=13). The intervention lasted 12 weeks, with two weekly sessions of multicomponent exercises. The following outcomes were assessed: postural balance (force platform), functional mobility (TUG), lower limb strength (sit-to-stand test), and functionality (DAD Scale). Statistical analysis was performed using generalized estimating equations (p<0.05). Results: The TG showed a significant improvement in lower limb strength (FFSG: 10±4reps pre and 10±4reps post; TG: 7±3reps pre and 9±3reps post; CG: 8±3reps pre and 9±3reps post; group: p=0.083; time: p=0.012; interaction: p=0.039). The FFSG group showed an increase in postural sway with eyes open (FFSG: 60±16.9cm pre and 75.3±6.9cm post; TG: 65.9±19.6cm pre and 77±8.3cm post; CG: 72.8±22.6cm pre and 62.5±20.3cm post; group: p=0.728; time: p=0.098; interaction: p=0.003) and with eyes closed (FFSG: 71.7±23.5cm pre and 95.3±19.8cm post; TG: 83.6±34.2cm pre and 77.3±15.4 cm post; CG: 89±33.4cm pre and 75.5±19.1cm post; group: p=0.965; time: p=0.794; interaction: p<0.001), indicating a decline in balance. All other tests showed maintenance of the variables assessed. Conclusion: Telerehabilitation proved effective in improving muscle strength and maintaining balance, agility, handgrip strength, and functionality, representing a viable and accessible alternative for older adults with AD.

Diagnóstico translacional da hanseníase - aplicações de metabolômica e espectroscopia em diferentes matrizes biológicas

2026-09-15T06:26:16Z

Title: Diagnóstico translacional da hanseníase - aplicações de metabolômica e espectroscopia em diferentes matrizes biológicas Abstract: Introduction: Leprosy remains a major public health problem, marked by clinical heterogeneity and the lack of routine laboratory methods that allow early diagnosis and adequate patient stratification. The identification of Mycobacterium leprae-specific metabolic and spectral biomarkers represents an opportunity to develop innovative diagnostic strategies. Objectives: This thesis, composed of two complementary studies, aimed to integrate metabolomic and spectroscopic (ATR-FTIR) analyses applied to biological samples from patients with different clinical forms of leprosy, aiming at the development of artificial intelligence-assisted diagnostic models. Materials and Methods: In the first study, formalin-fixed, paraffin-embedded (FFPE) tissue samples from skin biopsies were analyzed by liquid chromatography-mass spectrometry (HPLC/MS) for untargeted identification of differentially expressed metabolites according to the clinical Ridley-Jopling spectrum. In the second study, serum and dermal scraping samples from patients and controls were evaluated by attenuated total reflection infrared (ATR-FTIR) spectroscopy, and the spectra were processed using multivariate techniques (PCA, decision trees, and neural networks) to build predictive models. Results: Metabolomic analysis revealed distinct chemical signatures among the clinical forms, particularly oxidized lipids and tryptophan derivatives, associated with bacillary load and inflammatory response. Spectroscopic analysis allowed the discrimination of samples positive and negative for IgM anti-PGL-I and M. leprae DNA by qPCR, with variance explained above 98% in the first two principal components. Machine learning-based models showed accuracy above 90% for differentiating positive and negative samples. Conclusion: The integration of metabolomics and ATR-FTIR spectroscopy demonstrated potential for rapid, noninvasive, and standardizable recognition of biochemical and structural patterns characteristic of leprosy. The results demonstrate the viability of omics tools and artificial intelligence as diagnostic support and contribution to disease surveillance and control.

Análise da associação entre as políticas e programas pró-AM e três principais indicadores de AM em países de alta, média e baixa renda

2026-08-26T06:18:40Z

Title: Análise da associação entre as políticas e programas pró-AM e três principais indicadores de AM em países de alta, média e baixa renda Abstract: Introduction: The World Breastfeeding Trends Initiative (WBTi) was developed as a standardized tool to assist countries in identifying strengths and limitations in breastfeeding promotion policies and programs. The use of the WBTi across different countries, focusing on the impact of breastfeeding policies and programs on indicators over time, reinforces the importance of relating these policies to breastfeeding outcomes, since evidence regarding this association remains limited. Therefore, the objectives of this thesis were: to verify the association between gross domestic product based on purchasing power parity (GDP PPP) and WBTi scores; to assess the association between WBTi scores and the indicators exclusive breastfeeding (EBF), breastfeeding within the first hour of life (BF1h), and continued breastfeeding (continued BF) in high-, middle-, and low-income countries; and to investigate the association between WBTi scores and the outcomes EBF and mixed breastfeeding (mixed BF) during the 2000s and 2020s in low- and middle-income countries. Methods: All data regarding breastfeeding policies and programs were obtained from the WBTi tool, whereas GDP PPP and countries’ economic classifications were obtained from the World Bank. The first and second objectives were operationalized through ecological studies. Initially, WBTi scores and GDP PPP data from 98 countries were obtained. Means and standard deviations (SD) were estimated for total scores and for each WBTi indicator. ANOVA and Tukey’s tests were used to compare mean WBTi scores according to countries’ GDP PPP. The association between GDP PPP and total and individual WBTi scores was analyzed using linear regression. Subsequently, data on EBF, BF1h, and continued BF from 63 countries were obtained from household surveys and other national nutrition surveys involving children under two years of age. Data on breastfeeding policies and programs were obtained from the WBTi and countries’ economic classifications from the World Bank. Associations between WBTi scores and breastfeeding indicators were analyzed using beta regression. Finally, the third objective was operationalized through a cross-sectional study using EBF and mixed BF data from DHS (Demographic and Health Surveys) and MICS (Multiple Indicator Cluster Surveys) surveys involving children under six months of age. Data on breastfeeding policies and programs were obtained from the WBTi. Time 1 (T1) corresponded to the 2000s and Time 2 (T2) to the 2020s. Multilevel logistic regression evaluated associations between WBTi scores and the outcomes EBF and mixed BF. Results: Analysis of 98 high-, middle-, and low-income countries identified the highest mean WBTi scores for health care systems and nutrition support (indicator 5) (6.4±2.0) and information support (indicator 7) (6.4±2.5). Mean total scores and scores for indicators 3 (Code implementation), 7 (information support), 9 (infant feeding during emergencies), and 10 (monitoring and evaluation) were higher in low- and middle-income countries, whereas indicator 4 (maternity protection) presented higher mean scores in high-income countries (p<0.05). A negative association was observed between GDP PPP and the total WBTi score (β=-2.67; 95%CI:-5.06;-0.29), indicator 3 (Code implementation) (β=-0.50; 95%CI:-0.91;-0.08), indicator 7 (information support) (β=-0.67; 95%CI:-1.07;-0.27), indicator 8 (infant feeding and HIV) (β=-0.59; 95%CI:-1.07;-0.11), and indicator 9 (infant feeding during emergencies) (β=-0.91; 95%CI:-1.34;-0.48). A positive association was observed between GDP PPP and indicator 4 (maternity protection) (β=0.63; 95%CI:0.24;1.02). In the second article, upper-middle-income countries presented lower mean EBF prevalence (37.9±2.9). Upper-middle-income (40.9±3.9) and high-income countries (26.3±9.9) showed lower mean continued BF prevalence. Countries with higher scores for indicator 8 (infant feeding and HIV) presented higher EBF prevalence (β=7.7; 95%CI=1.6;13.7). Countries with higher scores for indicator 2 (BFHI) (β=4.2; 95%CI=3.2;11.6) and indicator 3 (Code implementation) presented higher prevalence of continued BF. In the third article, at T1, maternal age (OR=0.68; 95%CI:0.58–0.79), total WBTi score (OR=0.99; 95%CI:0.98–0.99), indicator 1 (policy and funding) (OR=0.87; 95%CI:0.85–0.89), and indicator 5 (health care systems and nutrition support) (OR=0.81; 95%CI:0.78–0.84) were negatively associated with EBF, whereas BF1h (OR=1.24; 95%CI:1.14–1.34), indicator 2 (BFHI) (OR=1.12; 95%CI:1.09–1.16), and indicator 4 (maternity protection) (OR=1.06; 95%CI:1.02–1.10) were positively associated with EBF. At T2, female sex (OR=1.08; 95%CI:1.01–1.16), BF1h (OR=1.16; 95%CI:1.08–1.24), and indicator 1 (policy and funding) (OR=1.04; 95%CI:1.02–1.07) were positively associated with EBF, whereas maternal age (OR=0.80; 95%CI:0.70–0.92), indicator 2 (BFHI) (OR=0.91; 95%CI:0.89–0.94), and indicator 4 (maternity protection) (OR=0.89; 95%CI:0.86–0.91) were negatively associated. For mixed BF, at T1, maternal age (OR=1.68; 95%CI:1.37–2.06), indicator 1 (policy and funding) (OR=1.21; 95%CI:1.18–1.25), and indicator 5 (health care systems and nutrition support) (OR=1.32; 95%CI:1.26–1.39) were positively associated, whereas BF1h (OR=0.73; 95%CI:0.66–0.81), indicator 2 (BFHI) (OR=0.86; 95%CI:0.83–0.87), indicator 4 (maternity protection) (OR=0.86; 95%CI:0.82–0.91), and the total WBTi score (OR=1.02; 95%CI:1.02–1.03) were negatively associated with mixed BF. At T2, maternal age (OR=1.32; 95%CI:1.10–1.58), cesarean section (OR=1.38; 95%CI:1.22–1.57), and indicator 9 (infant feeding during emergencies) (OR=1.05; 95%CI:1.03–1.08) were positively associated with mixed BF, whereas BF1h (OR=0.71; 95%CI:0.64–0.78), indicator 3 (Code implementation) (OR=0.87; 95%CI:0.83–0.92), and indicator 5 (health care systems and nutrition support) (OR=0.95; 95%CI:0.92–0.99) were negatively associated. Conclusion: Countries with lower GDP PPP presented higher WBTi scores, except for the maternity protection indicator, which showed higher scores in countries with higher GDP PPP. Countries with higher WBTi scores presented higher breastfeeding prevalence. Wealthier countries showed lower EBF and continued BF rates compared to poorer countries. Countries with higher scores for BFHI implementation (indicator 2), implementation of the International Code of Marketing of Breastmilk Substitutes (indicator 3), and development of infant feeding and HIV policies (indicator 8) presented higher prevalence of EBF and continued BF. BF1h was identified as a protective factor for EBF and as a reducing factor for mixed BF, regardless of the analyzed period. Older maternal age and cesarean section appeared to act as barriers to EBF. Infant feeding during emergencies may favor the adoption of mixed BF, whereas strengthening regulatory measures related to Code implementation may contribute to reducing mixed BF. The positive association between total WBTi score and mixed BF suggests that advances in breastfeeding promotion and support may contribute to maintaining breastfeeding, even if not exclusively.

Identificação de metabólitos séricos e salivares por meio de análise metabolômica e técnicas de aprendizado de máquina para o diagnóstico do câncer colorretal

2026-08-18T06:21:19Z

Title: Identificação de metabólitos séricos e salivares por meio de análise metabolômica e técnicas de aprendizado de máquina para o diagnóstico do câncer colorretal Abstract: Introduction: Colorectal cancer (CRC) is the third most prevalent neoplasm worldwide, as well as the second leading cause of cancer death, and is frequently associated with late diagnosis due to low adherence to gold-standard screening and diagnostic methods such as colonoscopy, which is considered invasive. Therefore, the search for serum and salivary metabolites that can aid in the development of screening tools and contribute to a diagnosis better accepted by patients is necessary. Objective: To analyze the abundance of serum and salivary metabolites using Liquid Chromatography coupled to Mass Spectrometry (LC-MS) and machine learning (ML) techniques for CRC diagnosis. Materials and methods: In the first manuscript, a cross-sectional study was conducted with 52 CRC patients and 47 healthy control individuals matched for sex and age, in which serum samples were analyzed. In the second manuscript, a cross-sectional study was conducted with 55 CRC patients and 46 individuals in the control group, matched for sex and age, in which saliva samples were analyzed. In both studies, samples were analyzed using LC-MS. A heat map analysis with hierarchical clustering and a volcano plot were used to show the differentially abundant metabolites between the groups. Significance criteria (p ≤ 0.05; expression variation ≥ 2.0) were applied. Subsequently, ML algorithm approaches were applied. Diagnostic accuracy was evaluated through sensitivity, specificity, and respective ROC curves. Results: In the first manuscript, differentially abundant metabolites were identified between serum samples from the groups, with increased levels of sn-glycero-3-phosphocholine, 18:1(13Z)(17Me), glyceryl 5-hydroxydecanoate, and piperidine in CRC patients, while D-tryptophan showed greater abundance in the control group. Among the ML models evaluated, Random Forest showed the best diagnostic performance, with a sensitivity of 92.31%, specificity of 91.49%, and an area under the ROC curve of 0.973. In the second manuscript, an increase in metabolites related to vitamin E, polyamines, glycerides, phospholipids, and sphingolipids was observed in cancer patients, while glycerophospholipids, eicosanoids, and 17-Hydroxy-5alpha,17alpha-pregn-1-en-3-one showed greater abundance in the control group. The Naïve Bayes model demonstrated excellent discriminatory power, with a sensitivity of 97.83%, specificity of 96.36%, and an area under the curve of 0.996. Conclusion: The results indicate that metabolomics, combined with ML, represents a promising technique for non-invasive CRC screening, with the potential to optimize diagnosis, improve patient acceptance and, consequently, clinical prognosis, provided it is validated in future studies.