Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social function associated with aging. The aim of this study was to identify instruments for the detection of frailty in older adults, characterizing their components, application scenarios, ability to identify pre-frailty and clinimetric properties evaluated. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), under registration number CRD42017039318. A total of 14 electronic sources were searched to identify studies that investigated instruments for the detection of frailty or that presented the construction and/or clinimetric evaluation of the instrument, according to criteria established by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 96 studies were included in the qualitative synthesis: 51 instruments for the detection of frailty were identified, with predominantly physical domains; 40 were constructed and/or validated for use in the older adult community population, 28 only highlighted the distinction between frail and non-frail individuals and 23 presented three or more levels of frailty. The FRAGIRE, FRAIL Scale, Edmonton Frail Scale and IVCF-20 instruments were the most frequently analyzed in relation to clinimetric properties. It was concluded that: (I) there is a large number of instruments for measuring the same construct, which makes it difficult for researchers and clinicians to choose the most appropriate; (II) the FRAGIRE and CFAI stand out due to their multidimensional aspects, including an environmental assessment; however, (III) the need for standardization of the scales was identified, since the use of different instruments in clinical trials may prevent the comparability of the results in systematic reviews and; (IV) considering the different instruments identified in this review, the choice of researchers/clinicians should be guided by the issues related to the translation and validation for their location and the suitability for their context.

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The aim of this study was to evaluate the effectiveness of pre-exercise low-level phototherapy (Light-Emitting Diode therapy [LEDtherapy] or Light Amplification by Stimulate Emission of Radiation therapy [LASERtherapy]) in increasing exercise capacity and muscle performance of people undergoing exercise when compared to placebo treatment. Randomized controlled trials and crossover studies were sought on CENTRAL, MEDLINE, EMBASE, SciELO, PEDro and LILACS from its inception up to February 2015. References lists of included studies were sought for additional relevant research. Two authors independently extracted data on study design, treatment parameters, exercise capacity (number of repetitions, time to exhaustion, blood lactate concentration and lactate dehydrogenase activity) and muscle performance (torque, power and strength) using an structured table. Agreement should be reached by consensus or by a third reviewer. Sixteen studies involving 297 participants were included. Improvement of number of repetitions (mean difference [MD] [95 % confidence interval] = 3.51 repetitions [0.65-6.37]; P = 0.02), delay in time to exhaustion (MD = 4.01 s [2.10-5.91]; P < 0.0001), reduction in lactate levels (MD = 0.34 mmol/L [0.19-0.48]; P < 0.00001) and increased peak torque (MD = 21.51 Nm [10.01-33.01]; P < 0.00001) were observed when LASERtherapy was applied. LEDtherapy meta-analyses were performed with two studies and retrieved no between-group statistically significant difference in power, lactate levels or time to exhaustion. Although our results suggest that LASERtherapy is effective in improving skeletal muscle exercise capacity, the quality of the current evidence is limited.

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To determine the effectiveness of low-level phototherapy (i.e. light-emitting diode therapy [LEDtherapy] or light amplification by stimulated emission of radiation therapy [LASERtherapy]) on pain, skeletal muscle injury (creatine kinase [CK] levels and edema) and skeletal muscle function (range of movement and strength) in people undergoing an exercise protocol. (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PEDro, SciELO and LILACS up to May 2014), we included randomized controlled trials, quasi-randomized controlled trials and crossover studies in which study participants were allocated to receive either low-level phototherapy or placebo treatment. Phototherapy should have been applied in a single treatment session, either before or after an exercise protocol. We identified 15 studies involving 317 participants. Meta-analyses were limited by substantial heterogeneity. Compared to the placebo group, reduction in CK levels was only observed when LASERtherapy was applied before an exercise protocol (standardized mean difference = -0.66; 95 % CI = -1.30, -0.02). No between-group difference in edema, range of movement and strength were detected when phototherapy was applied before or after exercise. Evidence from this review suggests that low-level phototherapy may not have substantial effect in the treatment of skeletal muscle injury and pain caused by exercise. Definitive conclusions are limited due to the small number of included studies in each meta-analysis, disparities across the included studies and small sample sizes.

To assess the effects of medicinal plants (MPs) or related natural products (RNPs) on fibromyalgia (FM) patients, we evaluate the possible benefits and advantages of MP or RNP for the treatment of FM based on eight randomized placebo-controlled trials (RCTs) involving 475 patients. The methodological quality of all studies included was determined according to JADAD and “Risk of Bias” with the criteria in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Evidence suggests significant benefits of MP or RNP in sleep disruption, pain, depression, joint stiffness, anxiety, physical function, and quality of life. Our results demonstrated that MP or RNP had significant effects on improving the symptoms of FM compared to conventional drug or placebo; longer tests are required to determine the duration of the treatment and characterize the long-term safety of using MP, thus suggesting effective alternative therapies in the treatment of pain with minimized side effects.

IntroductionEighty per cent of the sexually active population will get human papillomavirus (HPV) infection, which is the most prevalent sexually transmitted disease worldwide. Persistence of high-grade HPV infection may evolve to a cervical intraepithelial neoplasia (CIN), and these lesions may be precursors of cervical cancer. However, this progression can be prevented by the administration of therapeutic vaccines which use the main oncoproteins responsible for cancer development in an attempt to trigger a more specific and effective immunological response against this disorder. We aim to evaluate the safety, efficacy and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade CIN 2/3 associated with HPV.Methods and analysisA systematic review of clinical trials will be undertaken. Medline, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, Web of Science, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online and Scopus will be searched, with no restriction regarding publication date. Primary outcomes will include measures related to safety, efficacy and the immunogenicity of the therapeutic vaccines used in these patients. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for randomised controlled trials, and the quality evidence of the risk of bias in single studies will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. A narrative synthesis will be done for all included studies. Outcomes will be analysed according to the subgroups of HPV type, CIN grade, route of vaccine administration and vaccine type. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges’ g score for both fixed and random effect models. I2statistics will be used to assess heterogeneity and identify their potential sources.Ethics and disseminationEthical approval is not required as primary data will not be collected. Findings will be disseminated widely via peer-reviewed publication and in different media, for example, conferences, congresses or symposia.PROSPERO registration numberCRD42017077428.

Background Foz do Iguassu is a Brazilian municipality located in the most populous international border of the country and provides medical care to foreigners. Neonatal mortality in the city is higher than Brazil’s average and corresponds to 61% of all deaths in children under five. The current study aimed to identify the determinants of neonatal mortality in Foz do Iguassu. Methods In this case-control study, we analyzed all neonatal deaths occurred in Foz do Iguassu from 2012 to 2016. Birth and mortality data were extracted from two national governmental databases (SINASC and SIM). We extracted data on (i) maternal sociodemographic characteristics, (ii) pregnancy care, and (iii) newborn characteristics. Multiple logistic regression with the conceptual framework was applied to examine the factors associated with neonatal mortality. Results Most of the deaths occurred in the early neonatal period (65.9%). The factors associated with neonatal death were fetal congenital anomaly (OR 22.49; CI 95% 7.44–67.95; p = < 0.001); low birth weight (OR 17.15; CI 95% 8.56–34.37; p = < 0.001), first minute Apgar score under 7 (OR 15.60; CI 95% 8.23–29.67; p = < 0.001); zero to 3 prenatal appointments (OR 3.34; CI 95% 1.28–8.73; p = 0.014) and prematurity (OR 3.60; CI 95% 1.87–7.11; p = < 0.001). Conclusion The high rate of neonatal death in Foz do Iguassu is strongly associated with newborn characteristics and not associated with maternal sociodemographic characteristics. Thus, the health services in the Brazilian side of this international borders should be aware of the quality of the prenatal care and childbirth attention provided.