Nitric oxide plasma/serum levels in patients with schizophrenia: a systematic review and meta-analysis

For the last 40 years, schizophrenia has been considered to be the result primarily of a dysfunction in brain dopaminergic pathways. In this review, it is described and discussed findings concerning nitric oxide-mediated neurotransmission in schizophrenia. Studies were searched in PubMed, SciELO, and LILACS using the terms schizophrenia and nitric oxide plasma levels or nitric oxide serum levels, with no time limit. The reference lists of selected articles were also hand-searched for additional articles. From 15 potential reports, 10 were eligible to be included in the review and meta-analysis. These studies included a total of 505 patients with schizophrenia and 339 healthy volunteers. No significant difference was found between patients and healthy controls regarding total nitrite plasma/serum levels (effect size g = 0.285, 95%CI = -0.205 to 0.774, p = 0.254). However, when studies with patients under antipsychotic treatment were examined separately, there was a significant difference between patients and healthy volunteers (effect size g = 0.663, 95%CI = 0.365 to 0.961, p < 0.001), showing that patients under treatment have higher levels of plasma/serum nitric oxide than controls. These results suggest that antipsychotics increase nitric oxide plasma/serum levels and that the nitrergic pathway would be a fertile target for the development of new treatments for patients with schizophrenia.

Educação ao ar livre pela aventura: o aprendizado de valores morais em expedições à natureza

A educação ao ar livre, por meio de cursos no formato expedição, ainda acontece de forma tímida no Brasil. Entende-se por expedição uma experiência educacional contínua, de múltiplos dias, em que alunos e instrutores aventuram-se em um trajeto em área remota da natureza de forma autossuficiente. O presente estudo analisa os cursos desse tipo. Por meio de entrevistas e questionários semiestruturados, investigou-se a aprendizagem dos alunos segundo suas próprias percepções e as dos educadores da instituição, com ênfase no desenvolvimento moral do indivíduo. Como parte do estudo de caso sobre um aluno adolescente participante de um dos cursos, entrevistou-se também uma psicóloga que coordena um abrigo para menores. Os resultados encontrados indicam que os cursos de educação ao ar livre caracterizam-se por experiências que estimulam trabalhos em grupo, debates sobre justiça e solidariedade, e reflexões sobre valores e princípios como coragem, esforço pessoal, disciplina, respeito e superação de limites. Os resultados também indicam que tal proposta educacional aufere experiências sensíveis e de conexão do ser humano com a natureza. Muito embora haja potencial educacional para a educação ao ar livre, a atuação do educador perante seus alunos é fundamental para que as experiências sejam física e psicologicamente seguras, alcancem seus potenciais pedagógicos de desenvolvimento da moralidade e ajudem as pessoas a desenvolverem uma consciência ambiental, manifestada por meio de ações concretas ao retornarem dos cursos para suas comunidades.

Evidence on the best chlorhexidine concentration to perform oral hygiene: meta-analysis

Although scientific literature has demonstrated the relevance of oral hygiene with chlorhexidine in preventing ventilation-associated pneumonia, there is a wide variation of concentrations, frequency and techniques when using the antiseptic. The aim of this research was to assessthe best chlorhexidine concentration used to perform oral hygiene to prevent ventilation-associated pneumonia. A systematic review followed by four meta-analysis using chlorhexidine concentration as criterion was carried out. Articles in English, Spanish or Portuguese indexed in the Cochrane, Embase, Lilacs, PubMed/Medline and Ovid electronic databases were selected. The research was carried out from May to June 2011. The primary outcome measure of interest was ventilation-associated pneumonia. Ten primary studies were divided in four groups (Gl-4), based on chlorhexidine concentration criterion. Gl (5 primary studies, chlorhexidine 0.12%) showed homogeneity among studies and the use of chlorhexidine represented a protective factor. G2 (3 primary studies, chlorhexidine 0.20%) showed heterogeneity among studies and chlorhexidine did not represent a protective factor. G3 (2 primary studies, chlorhexidine 2,00%) showed homogeneity among studies and the use of chlorhexidine was significant. G4 (10 primary studies with different chlorhexidine concentrations) showed homogeneity among studies and the common Relative Risk was significant. Statistic analyses showed a protective effect of oral hygiene with chlorhexidine in preventing ventilation-associated pneumonia. However, it was not possible to identity a standard to establish optimal chlorhexidine concentration.