ABSTRACT Introduction: Brazil is one of the countries with the largest population of people with hemophilia (PwH) worldwide. In this scoping review, we aim to investigate the Brazilian context for hemophilia regarding three predefined concepts: (i) clinical-epidemiological profile, (ii) burden of disease and (iii) patient journey and unmet needs. Methods: Three questions in each concept guided the screening of references retrieved by systematic searches carried out in MEDLINE, LILACS and the Digital Library of Theses and Dissertations. Quantitative and qualitative studies conducted in Brazil from 2002 onwards were assessed for eligibility. Main results: Ninety-two studies were included. A total of 66 studies addressed the concept “Clinical-epidemiological profile”, 31 investigated the concept of “Burden of disease” and 26 addressed the concept “Patient journey and unmet needs”. Based on these studies, pain and arthropathy affect a substantial proportion of the PwH, with physical functioning, pain and school or work being the domains of quality of life with the greatest impact. About 43 % to 82.6 % of the PwH are unemployed. Rates of inhibitor development are highly variable across studies, especially in hemophilia A. Adherence to prophylactic treatment ranges from 25 % to 72 %. The annualized bleeding rate is estimated at 2.4 ± 4.1. The barriers to treatment identified include distance to reference centers, lack of coordination of specialized and emergency care and restricted access to rehabilitation. Conclusions: Hemophilia poses a considerable burden on the PwH. Despite the available modalities of treatment, there are remaining unmet needs that should be addressed by researchers and policy makers in the future. Introduction (PwH worldwide review concepts i (i clinicalepidemiological clinical epidemiological profile ii (ii iii (iii Methods MEDLINE Dissertations 200 eligibility results Ninetytwo Ninety two included 6 Clinicalepidemiological Clinical , profile” 3 Burden 2 Patient . needs” functioning impact 4 826 82 82. unemployed 7 24 2. 41 1 4.1 centers rehabilitation Conclusions future 20 8 4.

ABSTRACT OBJECTIVE To identify lifestyle-related, sociodemographic, and mental health characteristics of people with insomnia symptoms and people without insomnia during the pandemic. METHODS A case-control study was conducted with data collected by snowball sampling using an online questionnaire. From November 2020 to April 2021, 6,360 people with a mean age of 43.5 years (SD = 14.3) participated in the survey. For this study, we considered 158 cases of insomnia disorder and 476 controls (three controls per case) randomly selected from the participants without sleep problems. RESULTS The results of the comparative analysis between cases and controls showed that sleeping less than six hours daily (OR = 3.89; 95%CI 2.50–6.05), feeling sadness frequently (OR = 2.95; 95%CI 1.69–5.17), residing in metropolitan areas (OR = 1.71; 95%CI 1.04–2.84), being 40 years or older (OR = 1.93; 95%CI 1.22–3.06), and the interaction between occupation and poorer education (OR = 2.12; 95%CI 1.22–3.69) were predictors for symptoms of insomnia disorder during the pandemic. CONCLUSIONS In addition to confirming the hypothesis that mental health problems are associated with insomnia symptoms, the results point to insomnia as an important outcome for studies on the effects of unemployment, vulnerability and low education of the population, especially in large cities, highlighting that the effects of the crisis on health and the economy are extremely unequally distributed. lifestylerelated, lifestylerelated lifestyle related, related lifestyle-related sociodemographic pandemic casecontrol case control questionnaire 202 2021 6360 6 360 6,36 435 43 5 43. SD 14.3 143 14 3 survey 15 47 three OR 3.89 389 89 95CI CI 95 2.50–6.05, 250605 2.50–6.05 , 2 50 05 2.50–6.05) 2.95 295 1.69–5.17, 169517 1.69–5.17 1 69 17 1.69–5.17) 1.71 171 71 1.04–2.84, 104284 1.04–2.84 04 84 1.04–2.84) 4 1.93 193 93 1.22–3.06, 122306 1.22–3.06 22 06 1.22–3.06) 2.12 212 12 1.22–3.69 122369 unemployment population cities distributed 20 636 36 6,3 14. 3.8 38 8 9 25060 2.50–6.0 0 2.9 29 16951 1.69–5.1 1.7 7 10428 1.04–2.8 1.9 19 12230 1.22–3.0 2.1 21 1.22–3.6 12236 63 6, 3. 2506 2.50–6. 2. 1695 1.69–5. 1. 1042 1.04–2. 1223 1.22–3. 250 2.50–6 169 1.69–5 104 1.04–2 122 1.22–3 25 2.50– 16 1.69– 10 1.04– 1.22– 2.50 1.69 1.04 1.22 2.5 1.6 1.0 1.2

RESUMO OBJETIVO Identificar características relacionadas ao estilo de vida, sociodemográficas e saúde mental de pessoas com sintomas de insônia e pessoas sem insônia durante a pandemia. MÉTODOS A partir de dados coletados por amostragem em bola de neve, por meio de um questionário online foi realizado um estudo caso-controle. Durante o período de novembro de 2020 a abril de 2021, 6.360 pessoas com idade média de 43,5 anos (DP = 14,3) participaram da pesquisa. No presente estudo, foram considerados 158 casos de transtorno de insônia e 476 controles (três controles por caso) selecionados aleatoriamente dentre os participantes sem problemas de sono. RESULTADOS Os resultados da análise comparativa entre casos e controles mostraram que dormir menos de seis horas diárias (OR = 3,89; IC95% 2,50–6,05), sentir tristeza frequentemente (OR = 2,95; IC95% 1,69–5,17), residir em metrópoles (OR = 1,71; IC95% 1,04–2,84), estar com 40 anos ou mais (OR = 1,93; IC95% 1,22–3,06) e a interação entre ocupação e escolaridade mais precária (OR = 2,12; IC95% 1,22–3,69) foram fatores preditores para sintomas de transtorno de insônia durante a pandemia. CONCLUSÕES Além da confirmação da hipótese de que problemas de saúde mental estão associados a sintomas de insônia, os resultados apontam para a insônia como um desfecho importante para estudos sobre efeitos do desemprego, vulnerabilidade e baixa escolaridade da população, sobretudo nas grandes metrópoles, ressaltando que os efeitos da crise sobre a saúde e a economia são distribuídos de forma extremamente desiguais. vida pandemia neve casocontrole. casocontrole caso controle. controle caso-controle 202 2021 6360 6 360 6.36 435 43 5 43, DP 14,3 143 14 3 pesquisa 15 47 três sono OR 3,89 389 89 IC95 IC 2,50–6,05, 250605 2,50–6,05 , 2 50 05 2,50–6,05) 2,95 295 95 1,69–5,17, 169517 1,69–5,17 1 69 17 1,69–5,17) 1,71 171 71 1,04–2,84, 104284 1,04–2,84 04 84 1,04–2,84) 4 1,93 193 93 1,22–3,06 122306 22 06 2,12 212 12 1,22–3,69 122369 desemprego população desiguais 20 636 36 6.3 14, 3,8 38 8 IC9 25060 2,50–6,0 0 2,9 29 9 16951 1,69–5,1 1,7 7 10428 1,04–2,8 1,9 19 1,22–3,0 12230 2,1 21 1,22–3,6 12236 63 6. 3, 2506 2,50–6, 2, 1695 1,69–5, 1, 1042 1,04–2, 1,22–3, 1223 250 2,50–6 169 1,69–5 104 1,04–2 1,22–3 122 25 2,50– 16 1,69– 10 1,04– 1,22– 2,50 1,69 1,04 1,22 2,5 1,6 1,0 1,2

RESUMO OBJETIVO Identificar características relacionadas ao estilo de vida, sociodemográficas e saúde mental de pessoas com sintomas de insônia e pessoas sem insônia durante a pandemia. MÉTODOS A partir de dados coletados por amostragem em bola de neve, por meio de um questionário online foi realizado um estudo caso-controle. Durante o período de novembro de 2020 a abril de 2021, 6.360 pessoas com idade média de 43,5 anos (DP = 14,3) participaram da pesquisa. No presente estudo, foram considerados 158 casos de transtorno de insônia e 476 controles (três controles por caso) selecionados aleatoriamente dentre os participantes sem problemas de sono. RESULTADOS Os resultados da análise comparativa entre casos e controles mostraram que dormir menos de seis horas diárias (OR = 3,89; IC95% 2,50–6,05), sentir tristeza frequentemente (OR = 2,95; IC95% 1,69–5,17), residir em metrópoles (OR = 1,71; IC95% 1,04–2,84), estar com 40 anos ou mais (OR = 1,93; IC95% 1,22–3,06) e a interação entre ocupação e escolaridade mais precária (OR = 2,12; IC95% 1,22–3,69) foram fatores preditores para sintomas de transtorno de insônia durante a pandemia. CONCLUSÕES Além da confirmação da hipótese de que problemas de saúde mental estão associados a sintomas de insônia, os resultados apontam para a insônia como um desfecho importante para estudos sobre efeitos do desemprego, vulnerabilidade e baixa escolaridade da população, sobretudo nas grandes metrópoles, ressaltando que os efeitos da crise sobre a saúde e a economia são distribuídos de forma extremamente desiguais.

ABSTRACT OBJECTIVE To identify lifestyle-related, sociodemographic, and mental health characteristics of people with insomnia symptoms and people without insomnia during the pandemic. METHODS A case-control study was conducted with data collected by snowball sampling using an online questionnaire. From November 2020 to April 2021, 6,360 people with a mean age of 43.5 years (SD = 14.3) participated in the survey. For this study, we considered 158 cases of insomnia disorder and 476 controls (three controls per case) randomly selected from the participants without sleep problems. RESULTS The results of the comparative analysis between cases and controls showed that sleeping less than six hours daily (OR = 3.89; 95%CI 2.50–6.05), feeling sadness frequently (OR = 2.95; 95%CI 1.69–5.17), residing in metropolitan areas (OR = 1.71; 95%CI 1.04–2.84), being 40 years or older (OR = 1.93; 95%CI 1.22–3.06), and the interaction between occupation and poorer education (OR = 2.12; 95%CI 1.22–3.69) were predictors for symptoms of insomnia disorder during the pandemic. CONCLUSIONS In addition to confirming the hypothesis that mental health problems are associated with insomnia symptoms, the results point to insomnia as an important outcome for studies on the effects of unemployment, vulnerability and low education of the population, especially in large cities, highlighting that the effects of the crisis on health and the economy are extremely unequally distributed.

SUMMARY OBJECTIVE: This study aimed to characterize teleconsultations in neurology executed by Regula+Brasil project in Recife, a capital city in northeastern Brazil. METHODS: A descriptive study carried out by four private hospitals, in a partnership with the Ministry of Health in Brazil. Teleconsultation was performed preferably in the video modality. Conditions eligible for teleconsultation were headache, epilepsy, and cerebrovascular disorders. Period of analysis was May to September 2020. RESULTS: A total of 243 teleconsultations were analyzed, of which 76.95% was a first appointment. In 48.97% of cases, the teleconsultation represented the first opportunity for the patient to be consulted with the specialist. Among cases of first appointment, 20.16% were further referred to a face-to-face consultation and 21.81% could be redirected to primary health care. Headache disorders were the most predominant clinical conditions. CONCLUSIONS: The implementation and development of telemedicine by Regula+Brasil during the COVID-19 pandemic represented an opportunity to assess the value of having teleconsultations added along the line of care from primary care to a medical specialty, promoting the coordination of care across different levels of complexity of care in the health system and improving access to specialized care.

Resumo O encaminhamento de casos da atenção primária para a secundária no Sistema Único Brasileiro é uma das questões mais importantes a ser enfrentada. As estratégias de telessaúde têm se mostrado eficazes para evitar encaminhamentos desnecessários. O objetivo deste estudo foi estimar o custo por caso encaminhado por meio de um sistema de gerenciamento de referenciamentos operado remotamente para subsidiar a tomada de decisão sobre o tema. Análise de custo por meio da aplicação de custeio baseado em atividades orientado pelo tempo (time-driven activity-based costing ou TDABC). As análises de custo incluíram comparações entre especialidades médicas, localidades para as quais os encaminhamentos estavam sendo conduzidos e períodos de tempo. O custo por referenciamento em todas as localidades variou entre R$ 5,70 a R$ 8,29. O custo por referenciamento nas especialidades médicas variou entre R$ 1,85 a R$ 8,56. Estratégias para otimizar a gestão dos referenciamentos para a atenção especializada nos sistemas públicos de saúde ainda são necessárias. As estratégias de telessaúde podem ser vantajosas, com estimativas de custo entre as localidades variando entre R$ 5,70 a R$ 8,29, com variabilidade adicional observada relacionada ao tipo de especialidade médica.

Abstract Referral of cases from primary to secondary care in the Brazilian public healthcare system is one of the most important issues to be tackled. Telehealth strategies have been shown effective in avoiding unnecessary referrals. The objective of this study was to estimate cost per referred case by a remotely operated referral management system to further inform the decision making on the topic. Analysis of cost by applying time-driven activity-based costing. Cost analyses included comparisons between medical specialties, localities for which referrals were being conducted, and periods of time. Cost per referred case across localities ranged from R$ 5.70 to R$ 8.29. Cost per referred case across medical specialties ranged from R$ 1.85 to R$ 8.56. Strategies to optimize the management of referral cases to specialized care in public healthcare systems are still needed. Telehealth strategies may be advantageous, with cost estimates across localities ranging from R$ 5.70 to R$ 8.29, with additional observed variability related to the type of medical specialty.

Resumo O encaminhamento de casos da atenção primária para a secundária no Sistema Único Brasileiro é uma das questões mais importantes a ser enfrentada. As estratégias de telessaúde têm se mostrado eficazes para evitar encaminhamentos desnecessários. O objetivo deste estudo foi estimar o custo por caso encaminhado por meio de um sistema de gerenciamento de referenciamentos operado remotamente para subsidiar a tomada de decisão sobre o tema. Análise de custo por meio da aplicação de custeio baseado em atividades orientado pelo tempo (time-driven activity-based costing ou TDABC). As análises de custo incluíram comparações entre especialidades médicas, localidades para as quais os encaminhamentos estavam sendo conduzidos e períodos de tempo. O custo por referenciamento em todas as localidades variou entre R$ 5,70 a R$ 8,29. O custo por referenciamento nas especialidades médicas variou entre R$ 1,85 a R$ 8,56. Estratégias para otimizar a gestão dos referenciamentos para a atenção especializada nos sistemas públicos de saúde ainda são necessárias. As estratégias de telessaúde podem ser vantajosas, com estimativas de custo entre as localidades variando entre R$ 5,70 a R$ 8,29, com variabilidade adicional observada relacionada ao tipo de especialidade médica.

Abstract Referral of cases from primary to secondary care in the Brazilian public healthcare system is one of the most important issues to be tackled. Telehealth strategies have been shown effective in avoiding unnecessary referrals. The objective of this study was to estimate cost per referred case by a remotely operated referral management system to further inform the decision making on the topic. Analysis of cost by applying time-driven activity-based costing. Cost analyses included comparisons between medical specialties, localities for which referrals were being conducted, and periods of time. Cost per referred case across localities ranged from R$ 5.70 to R$ 8.29. Cost per referred case across medical specialties ranged from R$ 1.85 to R$ 8.56. Strategies to optimize the management of referral cases to specialized care in public healthcare systems are still needed. Telehealth strategies may be advantageous, with cost estimates across localities ranging from R$ 5.70 to R$ 8.29, with additional observed variability related to the type of medical specialty.

RESUMO Introdução: Há diversas terapias sendo utilizadas, consideradas ou propostas para o tratamento da COVID-19, muitas carecendo de apropriada avaliação de efetividade e segurança. O propósito deste documento é fornecer recomendações baseadas nas evidências científicas disponíveis e em sua interpretação transparente, para subsidiar decisões sobre o tratamento farmacológico da COVID-19 no Brasil. Métodos: Um grupo de 27 especialistas e metodologistas integraram a força-tarefa formada pela Associação de Medicina Intensiva Brasileira (AMIB), pela Sociedade Brasileira de Infectologia (SBI) e pela Sociedade Brasileira de Pneumologia e Tisiologia (SBPT). Foram realizadas revisões sistemáticas rápidas, atualizadas até 28 de abril de 2020. A qualidade das evidências e a elaboração das recomendações seguiram o sistema GRADE. As recomendações foram elaboradas nos dias 5, 8 e 13 de maio de 2020. Resultados: Foram geradas 11 recomendações, embasadas em evidência de nível baixo ou muito baixo. Não há indicação para uso de rotina de hidroxicloroquina, cloroquina, azitromicina, lopinavir/ritonavir, corticosteroides ou tocilizumabe no tratamento da COVID-19. Heparina deve ser utilizada em doses profiláticas no paciente hospitalizado, mas não deve ser realizada anticoagulação na ausência de indicação clínica específica. Antibacterianos e oseltamivir devem ser considerados somente nos pacientes em suspeita de coinfecção bacteriana ou por influenza, respectivamente. Conclusão: Até o momento, não há intervenções farmacológicas com efetividade e segurança comprovada que justifiquem seu uso de rotina no tratamento da COVID-19, devendo os pacientes serem tratados preferencialmente no contexto de pesquisa clínica. As recomendações serão revisadas continuamente, de forma a capturar a geração de novas evidências.

ABSTRACT Introduction: Different therapies are currently used, considered, or proposed for the treatment of COVID-19; for many of those therapies, no appropriate assessment of effectiveness and safety was performed. This document aims to provide scientifically available evidence-based information in a transparent interpretation, to subsidize decisions related to the pharmacological therapy of COVID-19 in Brazil. Methods: A group of 27 experts and methodologists integrated a task-force formed by professionals from the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB), the Brazilian Society of Infectious Diseases (Sociedad Brasileira de Infectologia - SBI) and the Brazilian Society of Pulmonology and Tisiology (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT). Rapid systematic reviews, updated on April 28, 2020, were conducted. The assessment of the quality of evidence and the development of recommendations followed the GRADE system. The recommendations were written on May 5, 8, and 13, 2020. Results: Eleven recommendations were issued based on low or very-low level evidence. We do not recommend the routine use of hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir, corticosteroids, or tocilizumab for the treatment of COVID-19. Prophylactic heparin should be used in hospitalized patients, however, no anticoagulation should be provided for patients without a specific clinical indication. Antibiotics and oseltamivir should only be considered for patients with suspected bacterial or influenza coinfection, respectively. Conclusion: So far no pharmacological intervention was proven effective and safe to warrant its use in the routine treatment of COVID-19 patients; therefore such patients should ideally be treated in the context of clinical trials. The recommendations herein provided will be revised continuously aiming to capture newly generated evidence.

ABSTRACT CONTEXT AND OBJECTIVE: Insomnia is a frequent complaint that generates more than five million visits to doctors per year in the United States. This study summarizes all Cochrane systematic reviews (SRs) that evaluated interventions to treat insomnia. DESIGN AND SETTING: Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: A sensitive search was carried out in the Cochrane Database of Systematic Reviews to identify Cochrane SRs that assessed the effects of any type of intervention for people with insomnia. The results, main characteristics of the SRs and the certainty of the evidence obtained from them were synthesized and discussed. RESULTS: Seven SRs were included. They addressed the benefits and harm of acupuncture (n = 1), behavioral interventions (n = 1), music (n = 1), pharmacotherapy (n = 2), phototherapy (n = 1) and physical exercise (n = 1). The certainty of the evidence ranged from moderate to very low. CONCLUSION: Acupuncture, music, physical exercise, paroxetine, doxepin, trimipramine and trazodone seem to present some benefit for patients with insomnia. However, the uncertainty around these results means that no robust and definitive recommendations for clinical practice can be made until the benefits and harms from each intervention for patients with insomnia have been confirmed through further studies.

ABSTRACT BACKGROUND: The therapeutic effects of cannabinoid compounds have been the center of many investigations. This study provides a synthesis on all Cochrane systematic reviews (SRs) that assessed the use of cannabinoids as a therapeutic approach. DESIGN AND SETTING: Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: A broad search was conducted in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed the efficacy and safety of cannabinoids as a therapeutic approach. The results and key characteristics of all reviews included were summarized and discussed. RESULTS: Eight SRs were included. They assessed the use of cannabinoids for the following types of conditions: neurological (two SRs), psychiatric (two SRs), rheumatological (one SR), infectious (one SR) and oncological (two SRs). There was moderate-quality evidence showing that the use of cannabinoids reduced nausea and vomiting among adults, compared with placebo. Additionally, there was moderate-quality evidence showing that there was no difference between cannabinoids and prochlorperazine regarding the number of participants who reported vomiting, in this same population. CONCLUSIONS: This review identified eight Cochrane systematic reviews that provided evidence of unknown to moderate quality regarding the use of cannabinoids as a therapeutic intervention. Further studies are still imperative for solid conclusions to be reached regarding practical recommendations.

ABSTRACT CONTEXT AND OBJECTIVE: Psoriasis is a common chronic inflammatory skin disease characterized by abnormal and increased growth of the cells that produce keratin and abnormal functioning of the immune system. We aimed to summarize the evidence available regarding interventions for patients with psoriasis. DESIGN AND SETTING: Review of systematic reviews, developed in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: A systematic search was conducted to identify Cochrane systematic reviews that fulfilled the eligibility criteria. Two authors screened titles and abstracts that had been retrieved through the search strategy. The results from all the Cochrane systematic reviews that were included were summarized and presented in a narrative synthesis. RESULTS: We included six Cochrane systematic reviews assessing interventions for treating psoriasis. The findings from high-quality evidence were that (a) etanercept reduced the psoriasis severity index, compared with placebo and (b) steroids plus vitamin D, compared with vitamin D alone, improved the skin clearance rate, as assessed by investigators, but was associated with a higher proportion of participants who dropped out due to adverse events. For all other comparisons, the quality of the evidence ranged from moderate to very low. CONCLUSION: This review included six Cochrane systematic reviews that provided evidence ranging in quality from unknown to high, regarding management of psoriasis. Further randomized controlled trials are imperative to reduce the uncertainties relating to several treatments that are already used in clinical practice.

ABSTRACT BACKGROUND: Varicose veins affect nearly 30% of the world’s population. This condition is a social problem and needs interventions to improve quality of life and reduce risks. Recently, new and less invasive methods for varicose vein treatment have emerged. There is a need to define the best treatment options and to reduce the risks and costs. Since there are cosmetic implications, treatments for which effectiveness remains unproven present risks to consumers and higher costs for stakeholders. These risks and costs justify conducting an overview of systematic reviews to summarize the evidence. DESIGN AND SETTING: Overview of systematic reviews within the Discipline of Evidence-Based Health, at Universidade Federal de São Paulo (UNIFESP). METHODS: Systematic reviews on clinical or surgical treatments for varicose veins were included, with no restrictions on language or publication date. RESULTS: 51 reviews fulfilled the inclusion criteria. Outcomes and comparators were described, and a narrative review was conducted. Overall, there was no evidence that compression stockings should be recommended for patients as the initial treatment or after surgical interventions. There was low to moderate evidence that minimally invasive therapies (endovenous laser therapy, radiofrequency ablation or foam sclerotherapy) are as safe and effective as conventional surgery (ligation and stripping). Among these systematic reviews, only 18 were judged to present high quality. CONCLUSIONS: There was evidence of low to moderate quality that minimally invasive treatments, including foam sclerotherapy, laser and radiofrequency therapy are comparable to conventional surgery, regarding effectiveness and safety for treatment of varicose veins.

ABSTRACT BACKGROUND: This study identified and summarized all Cochrane systematic reviews (SRs) on the effects of ten integrative practices that were recently added to the Brazilian public healthcare system (SUS). DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp). METHODS: Review of Cochrane SRs on the following interventions were identified, summarized and critically assessed: apitherapy, aromatherapy, bioenergetics, family constellation, flower therapy, chromotherapy, geotherapy, hypnotherapy, hand imposition or ozone therapy. RESULTS: We included a total of 16 SRs: 4 on apitherapy, 4 on aromatherapy, 6 on hypnotherapy and 2 on ozone therapy. No Cochrane SR was found regarding bioenergetics, family constellation, chromotherapy, clay therapy, flower therapy or hand imposition. The only high-quality evidence was in relation to the potential benefit of apitherapy, specifically regarding some benefits from honey dressings for partial healing of burn wounds, for reduction of coughing among children with acute coughs and for preventing allergic reactions to insect stings. CONCLUSION: Except for some specific uses of apitherapy (honey for burn wounds and for acute coughs and bee venom for allergic reactions to insect stings), the use of ten integrative practices that have recently been incorporated into SUS does not seem to be supported by evidence from Cochrane SRs.

ABSTRACT CONTEXT AND OBJECTIVE: Despite the high prevalence of vitamin D supplementation, its use remains controversial. The objective of this review was to identify and summarize the evidence from Cochrane systematic reviews regarding vitamin D supplementation for preventing ortreating any clinical condition. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: A search was conducted to identify all Cochrane systematic reviews that fulfilled the inclusion criteria. Titles and abstracts were screened by two authors. RESULTS: We included 27 Cochrane systematic reviews: 10 assessing use of vitamin D for prevention and 17 for treatment. The reviews found moderate to high quality of evidence regarding the benefit of vitamin D for pregnant women (prevention of adverse events: preterm birth risk [rate ratio, RR 0.36; 95% confidence interval, CI 0.14 to 0.93] and low birthweight risk [RR 0.40; 95% CI 0.24 to 0.67]) and for asthma patients (reduction of severe exacerbations [RR 0.63; 95% CI 0.45 to 0.88]). No benefit was found regarding vitamin D supplementation alone (without calcium) for preventing hip or any new fracture. For all other outcomes assessed under various conditions, the current quality of evidence is low or unknown, and therefore insufficient for any recommendation. CONCLUSION: Based on moderate to high quality of evidence, the Cochrane systematic reviews included here showed that there were some benefits from vitamin D supplementation for pregnant women and asthma patients and no benefits for preventing fractures.

RESUMO CONTEXTO E OBJETIVO: O objetivo do teste de rastreamento para o câncer é detectá-lo em um estágio inicial, a fim de aumentar as chances de cura. Contudo, seu uso descomedido pode levar a exames desnecessários, sobrediagnóstico e aumento de custos. Portanto, é necessário que se avalie a repercussão clínica do rastreamento em termos de benefícios e riscos. TIPO DE ESTUDO E LOCAL: Revisão de revisões sistemáticas Cochrane realizada na Disciplina de Medicina Baseada em Evidências da Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). MÉTODOS: Foram incluídas revisões sobre efetividade clínica de testes de rastreamento para câncer. Os títulos e resumos foram avaliados independentemente por dois autores e divergências foram resolvidas por outros dois. Os achados foram resumidos e discutidos. RESULTADOS: 17 revisões sistemáticas foram incluídas: 15 sobre rastreamento para cânceres específicos (vesical, mamário, colorretal, hepático, pulmonar, nasofaríngeo, esofágico, oral, prostático, testicular, uterino) e duas para câncer em geral. A qualidade das evidências encontradas pelas revisões variou muito. Duas revisões encontraram evidências de alta qualidade: o rastreamento com tomografia em dose baixa em pacientes de alto risco parece reduzir a mortalidade por câncer pulmonar; e rastreamento com sigmoidoscopia flexível e pesquisa de sangue oculto nas fezes parece reduzir a mortalidade por câncer colorretal. CONCLUSÃO: As evidências de revisões sistemáticas Cochrane não indicam a realização dos testes mais usados para rastreamento de câncer. Recomenda-se que os pacientes sejam informados sobre as possibilidades de falsos positivos e de falsos negativos antes de serem submetidos aos testes. Estudos adicionais para avaliar melhor a eficácia de testes de rastreamento para o câncer e os eventos adversos são necessários.

ABSTRACT CONTEXT AND OBJECTIVE: The purpose of screening tests for cancer is to detect it at an early stage in order to increase the chances of treatment. However, their unrestrained use may lead to unnecessary examinations, overdiagnosis and higher costs. It is thus necessary to evaluate their clinical effects in terms of benefits and harm. DESIGN AND SETTING: Review of Cochrane systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: Cochrane reviews on the clinical effectiveness of cancer screening procedures were included. Study titles and abstracts were independently assessed by two authors. Conflicts were resolved by another two authors. Findings were summarized and discussed. RESULTS: Seventeen reviews were selected: fifteen on screening for specific cancers (bladder, breast, colorectal, hepatic, lung, nasopharyngeal, esophageal, oral, prostate, testicular and uterine) and two others on cancer in general. The quality of evidence of the findings varied among the reviews. Only two reviews resulted in high-quality evidence: screening using low-dose computed tomography scans for high-risk individuals seems to reduce lung cancer mortality; and screening using flexible sigmoidoscopy and fecal occult blood tests seems to reduce colorectal cancer mortality. CONCLUSION: The evidence found through Cochrane reviews did not support most of the commonly used screening tests for cancer. It is recommended that patients should be informed of the possibilities of false positives and false negatives before they undergo the tests. Further studies to fully assess the effectiveness of cancer screening tests and adverse outcomes are required.

RESUMO INTRODUÇÃO: Demência é uma condição com alta prevalência e incidência global. Sua característica crônica e progressiva tem impacto em aspectos físicos, psicossociais e na saúde pública. Nosso objetivo foi resumir evidências de revisões Cochrane sobre intervenções não farmacológicas para distúrbios cognitivos e demências. TIPO DE ESTUDO E LOCAL: Revisão de revisões sistemáticas conduzida na Disciplina de Medicina Baseada em Evidências da Escola Paulista de Medicina, Universidade Federal de São Paulo. MÉTODOS: Foram incluídas revisões Cochrane sobre intervenções não farmacológicas para disfunções cognitivas e/ou qualquer tipo de demência, após a avaliação realizada de forma independente por dois autores. RESULTADOS: Vinte e quatro revisões foram incluídas. As revisões mostraram que ingestão de carboidratos e a terapia de validação podem ser benéficas para distúrbios cognitivos. Para demência, existe benefício potencial de programas de atividade física, treino cognitivo, tratamentos psicológicos, aromaterapia, terapia com luz, reabilitação cognitiva, estimulação cognitiva, oxigenoterapia hiperbárica associada a donepezila, análise funcional, terapia de reminiscência, estimulação elétrica transcutânea, decisão estruturada em opções de alimentação, abordagem de gestão de casos e intervenções aplicadas por trabalhadores na área de saúde não especialistas e por unidades de cuidado especializado. Não foram encontrados benefícios para alimentação por sonda entérica, acupuntura, estimulação de Snoezelen, cuidados de repouso, equipe de cuidados paliativos e intervenções para prevenir comportamento de perambulação. CONCLUSÃO: Várias intervenções não farmacológicas para pacientes com comprometimento cognitivo e demência têm sido estudadas, mostrando benefícios potenciais. Entretanto, a força de evidência derivada desses estudos é em geral considerada baixa, devido às limitações metodológicas dos estudos primários.

ABSTRACT BACKGROUND: Dementia is a highly prevalent condition worldwide. Its chronic and progressive presentation has an impact on physical and psychosocial characteristics and on public healthcare. Our aim was to summarize evidence from Cochrane reviews on non-pharmacological treatments for cognitive disorders and dementia. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: Cochrane reviews on non-pharmacological interventions for cognitive dysfunctions and/or type of dementia were included. For this, independent assessments were made by two authors. RESULTS: Twenty-four reviews were included. These showed that carbohydrate intake and validation therapy may be beneficial for cognitive disorders. For dementia, there is a potential benefit from physical activity programs, cognitive training, psychological treatments, aromatherapy, light therapy, cognitive rehabilitation, cognitive stimulation, hyperbaric oxygen therapy in association with donepezil, functional analysis, reminiscence therapy, transcutaneous electrical stimulation, structured decision-making on feeding options, case management approaches, interventions by non-specialist healthcare workers and specialized care units. No benefits were found in relation to enteral tube feeding, acupuncture, Snoezelen stimulation, respite care, palliative care team and interventions to prevent wandering behavior. CONCLUSION: Many non-pharmacological interventions for patients with cognitive impairment and dementia have been studied and potential benefits have been shown. However, the strength of evidence derived from these studies was considered low overall, due to the methodological limitations of the primary studies.