Resumen Objetivo: describir los efectos de la neuromodulación en el desempeño de funciones ejecutivas en pacientes con sobrepeso y/o obesidad. Métodos: se seleccionaron artículos publicados en las bases de datos PubMed, ScienceDirect, BIREME y Web of Science utilizando la siguiente combinación de descriptores: (“resolución de problemas” O “función ejecutiva” O memoria) Y (tDCS O TMS) Y obesidad. Después de aplicar los criterios de selección, 08 artículos fueron incluidos para el análisis. Resultados: los artículos incluidos tuvieron un promedio de 30,1 participantes por estudio, con un mínimo de 12 y un máximo de 76. El estado nutricional general osciló entre bajo peso y obesidad grado 3, y el índice de masa corporal promedio general fue de 28,1 kg/m2. En cuanto a los instrumentos utilizados para evaluar las funciones ejecutivas, los más frecuentes fueron: paradigma del flanqueador; rivalidad binocular para la supresión continua de flash (bCFS/NoCFS); tarea de Stroop; Tarea Go/No-Go; y tarea N-back. Los resultados primarios dependieron del sitio objetivo de la neuromodulación. Se observó una reducción del antojo de alimentos y un mejor rendimiento en el grupo activo debido a la disminución del tiempo de respuesta y al aumento de la precisión en las tareas cognitivas. Conclusión: la neuromodulación puede generar cambios en las funciones ejecutivas, reduciendo el antojo de alimentos en personas con sobrepeso y obesidad.

Abstract Objective: to describe the effects of neuromodulation on the performance of executive functions in overweight and/or individuals with obesity. Methods: articles published in PubMed, ScienceDirect, BIREME, and Web of Science databases were selected using the following combination of descriptors: (“problem solving” OR “executive function” OR memory) AND (tDCS OR TMS) AND obesity. After applying the selection criteria, 08 articles were included for analysis. Results: the articles included had an average of 30.1 participants per study, with a minimum of 12 and a maximum of 76. The overall nutritional status ranged from underweight to grade 3 obesity, and the general mean body mass index was 28,1 kg/m2. Regarding the instruments used to assess executive functions, the most frequent were: the flanker paradigm; binocular rivalry for Continuous Flash Suppression (bCFS/NoCFS); Stroop task; Go/No-Go task; and N-back task. The primary outcomes were dependent on the neuromodulation target site. Reduced food craving and improved performance in the active group were observed from decreased response time and increased precision in cognitive tasks. Conclusion: neuromodulation can generate changes in executive functions, reducing food cravings in overweight and individuals with obesity.

Abstract Introduction Non-invasive brain stimulation (NIBS) as monotherapy has been increasingly used to enhance the activity of brain networks. However, it is unclear whether a combination of distinct NIBS approaches could enhance prefrontal cortical (PFC) activity. Objective We propose to investigate the combined and standalone effects of two NIBS modalities on the PFC through a working memory task, single photon emission computed tomography (SPECT), and salivary cortisol. We hypothesize that the combined protocol will provoke greater changes in the collected measures compared to the remining protocols. Methods A randomized, double-blind, sham-controlled, full-factorial design will be conducted. The effects of transcranial direct current stimulation (tDCS) and intermittent theta-burst stimulation (iTBS) will be investigated over four different sessions (sham tDCS + sham iTBS, anodal tDCS + sham iTBS, anodal tDCS + active iTBS and sham tDCS + active iTBS) in 30 healthy adult volunteers. A 99mTc-ethylene cysteine dimer (99mTC-ECD) will be administered during the NIBS session and neuroimaging will be acquired within one hour. Salivary cortisol will be collected before and after each session and an n-back working memory task will be applied after the end of each NIBS session. The outcomes will be cerebral perfusion alterations (99mTC-ECD SPECT), accuracy and reaction time in the n-back task, and changes in salivary cortisol level. Conclusion The results from this trial can guide future therapeutic protocols for NIBS treatments stimulating the PFC by demonstrating that the combination of NIBS techniques is feasible, tolerable, and can lead to greater enhancement of PFC activity.

Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles.

Os tratamentos tópicos ganharam popularidade para uso geral como um adjuvante de medicamentos sistêmicos na dor neuropática, mas seu uso produz resultados clínicos variáveis e eventos adversos locais. Objetivo Avaliar o efeito de segurança e analgesia de uma formulação de capsaicina lipossomal (LC) (0,025%) em pacientes com neuralgia pós-herpética. Método Os pacientes que permaneceram sintomáticos após tratamento de primeira e de segunda linha foram randomizados para receber LC durante seis semanas em um estudo cruzado controlado por placebo. A avaliação clínica foi realizada no início do estudo, na segunda, quarta e sexta semana de tratamento. Resultados Treze pacientes completaram dois períodos de tratamento. Escala Visual Analógica diminuiu significativamente após o final do estudo (p = 0,008), no entanto, o efeito do tratamento não era significativo (p = 0,076). Não houve diferença na impressão global de mudança e de outras características da dor. LC foi segura e bem tolerada. No entanto, para a concentração utilizada, os seus efeitos analgésicos foram marginais e não significativos.

Topical treatments have gained popularity for general use as an adjunct to systemic drugs in neuropathic pain, but their use produces variable clinical results and local adverse events. Objective To evaluate the safety and analgesic effect of a formulation of liposomal capsaicin (LC) (0.025%) in patients with post herpetic neuralgia (PHN). Method Patients who remained symptomatic after first-and second-line treatment were randomized to receive LC for six weeks in a placebo-controlled, crossover design study. Clinical assessment was performed at baseline, in the second, fourth and sixth week of treatment. Results Thirteen patients completed both treatment periods. Visual Analog Scale (VAS) was significantly decreased after the end of the study (p = 0.008), however the effect of treatment was not significant (p = 0.076). There was no difference on global impression of change and other pain characteristics. LC was safe and well tolerated. However, at the concentration used, its analgesic effects were marginal and not significant.

OBJECTIVE: This research was designed as a pilot proof-of-concept study to evaluate the use of low-dose methadone in post-herpetic neuralgia patients who remained refractory after first and second line post-herpetic neuralgia treatments and had indications for adding an opioid agent to their current drug regimens. METHODS: This cross-over study was double blind and placebo controlled. Ten opioid naïve post-herpetic neuralgia patients received either methadone (5 mg bid) or placebo for three weeks, followed by a 15-day washout period and a second three-week treatment with either methadone or placebo, accordingly. Clinical evaluations were performed four times (before and after each three-week treatment period). The evaluations included the visual analogue scale, verbal category scale, daily activities scale, McGill pain questionnaire, adverse events profile, and evoked pain assessment. All patients provided written informed consent before being included in the study. ClinicalTrials.gov: NCT01752699 RESULTS: Methadone, when compared to placebo, did not significantly affect the intensity of spontaneous pain, as measured by the visual analogue scale. The intensity of spontaneous pain was significantly decreased after the methadone treatment compared to placebo on the category verbal scale (50% improved after the methadone treatment, none after the placebo, p = 0.031). Evoked pain was reduced under methadone compared to placebo (50% improved after the methadone treatment, none after the placebo, p = 0.031). Allodynia reduction correlated with sleep improvement (r = 0.67, p = 0.030) during the methadone treatment. The side effects profile was similar between both treatments. Conclusions: Methadone seems to be safe and efficacious in post-herpetic neuralgia. It should be tried as an adjunctive treatment for post-herpetic neuralgia in larger prospective studies.

Tomando como referência a natureza multidimensional e dinâmica do conceito de vulnerabilidade em saúde, o objetivo deste artigo foi promover uma discussão sobre o que vem a ser envelhecer de forma bem-sucedida mesmo na presença de vulnerabilidades. Foram selecionados estudos que discutiram dimensões da vulnerabilidade no contexto da velhice, problematizando os recursos pessoais, sociais, programáticos e comunitários que poderiam tornar as pessoas idosas menos vulneráveis em face das situações de dependência e capacidade funcional reduzida. Embora pouco aplicada no campo da Gerontologia, a articulação entre o conceito de vulnerabilidade em saúde e o envelhecimento saudável e bem-sucedido parece ser produtiva e precisa ser melhor explorada.

Considering the multidimensional and dynamic nature of the concept of health vulnerability, this article aimed to promote a discussion about the meaning of aging successfully even in the presence of vulnerabilities. We have selected studies which discussed dimensions of vulnerability in the context of old age, exploring personal, social, programmatic and community resources that could make older adults be less vulnerable in situations of dependence and reduced functional capacity. The articulation of the concept of health vulnerability and successful and healthy aging seems to be productive and should be further explored.

Tomando como referencia la naturaleza multi-dimensional y dinámica del concepto de vulnerabilidad en salud, el objetivo de este artículo es el promover una discusión sobre lo que viene a ser envejecer con éxito incluso en presencia de vulnerabilidades. Se han seleccionado estudios que discuten dimensiones de vulnerabilidad en el contexto de la vejez, encarando la problemática de los recursos personales, sociales, programáticos y comunitarios que podrían tornar a las personas ancianas menos vulnerables ante situaciones de dependencia y capacidad funcional reducida. Aunque poco aplicada en el campo de la Gerontología, la articulación del concepto de vulnerabilidad en salud y el envejecimiento saludable y feliz parece ser productiva y ha de ser mejor utilizada.

Tomando como referência a natureza multidimensional e dinâmica do conceito de vulnerabilidade em saúde, o objetivo deste artigo foi promover uma discussão sobre o que vem a ser envelhecer de forma bem-sucedida mesmo na presença de vulnerabilidades. Foram selecionados estudos que discutiram dimensões da vulnerabilidade no contexto da velhice, problematizando os recursos pessoais, sociais, programáticos e comunitários que poderiam tornar as pessoas idosas menos vulneráveis em face das situações de dependência e capacidade funcional reduzida. Embora pouco aplicada no campo da Gerontologia, a articulação entre o conceito de vulnerabilidade em saúde e o envelhecimento saudável e bem-sucedido parece ser produtiva e precisa ser melhor explorada.

Considering the multidimensional and dynamic nature of the concept of health vulnerability, this article aimed to promote a discussion about the meaning of aging successfully even in the presence of vulnerabilities. We have selected studies which discussed dimensions of vulnerability in the context of old age, exploring personal, social, programmatic and community resources that could make older adults be less vulnerable in situations of dependence and reduced functional capacity. The articulation of the concept of health vulnerability and successful and healthy aging seems to be productive and should be further explored.

Tomando como referencia la naturaleza multi-dimensional y dinámica del concepto de vulnerabilidad en salud, el objetivo de este artículo es el promover una discusión sobre lo que viene a ser envejecer con éxito incluso en presencia de vulnerabilidades. Se han seleccionado estudios que discuten dimensiones de vulnerabilidad en el contexto de la vejez, encarando la problemática de los recursos personales, sociales, programáticos y comunitarios que podrían tornar a las personas ancianas menos vulnerables ante situaciones de dependencia y capacidad funcional reducida. Aunque poco aplicada en el campo de la Gerontología, la articulación del concepto de vulnerabilidad en salud y el envejecimiento saludable y feliz parece ser productiva y ha de ser mejor utilizada.

Este artigo enfoca diferentes concepções de envelhecimento bem-sucedido, enfatizando o processo de envelhecimento como uma experiência heterogênea, que implica diferentes estratégias para a obtenção de bem-estar e qualidade de vida. Foram selecionados estudos que valorizam o processo de envelhecimento como parte do curso de vida humano, o papel da subjetividade e a auto-avaliação em saúde, como conceitos-chave para compreender o bem-estar e saúde na velhice. Os dados da literatura sugerem que a experiência do envelhecimento bem-sucedido valoriza a percepção dos próprios idosos, protagonistas de intervenções e dotados de julgamentos sobre bem-estar e qualidade de vida. Mesmo na presença de co-morbidades e diminuição da funcionalidade é possível identificar idosos que referem altos níveis de satisfação e boa qualidade de vida. Propomos questões que buscam aprimorar investigações e a elaboração deste constructo em gerontologia, tendo em vista a amplitude e complexidade do tema.

This article focuses on different conceptions of successful aging, emphasizing the process of aging as a heterogeneous experience that implies different strategies for achieving wellbeing and quality of life. Studies valuing the aging process as part of the course of human life and the role of subjectivity and health self-perception, as key concepts for understanding wellbeing and health in old age, were selected. Data in the literature suggest that the experience of successful aging values elderly people's own perceptions: they are the protagonists of interventions and possess judgment about wellbeing and quality of life. Even in the presence of comorbidities and diminished functional ability, it is possible to identify elderly people who report high levels of satisfaction and good quality of life. We propose questions that seek to improve investigations and elaborate this construct within gerontology, bearing in mind the size and complexity of this topic.

Este artículo aborda diferentes concepciones de envejecimiento bien llevado, enfatizando el proceso como una experiencia heterogénea que implica diferentes estrategias para la obtención del bienestar y calidad de vida; seleccionando estudios que evalúan el proceso de envejecimiento como parte del curso de vida humana, el papel de la subjetividad y la auto-evaluación en salud como conceptos clave para abarcar el bienestar y la salud en la vejez. Los datos obtenidos sugieren que este proceso resalta la percepción de los ancianos protagonistas de intervenciones. Proponemos cuestiones que tratan de perfeccionar investigaciones y la elaboración de este constructo en Gerontología.

Este artigo enfoca diferentes concepções de envelhecimento bem-sucedido, enfatizando o processo de envelhecimento como uma experiência heterogênea, que implica diferentes estratégias para a obtenção de bem-estar e qualidade de vida. Foram selecionados estudos que valorizam o processo de envelhecimento como parte do curso de vida humano, o papel da subjetividade e a auto-avaliação em saúde, como conceitos-chave para compreender o bem-estar e saúde na velhice. Os dados da literatura sugerem que a experiência do envelhecimento bem-sucedido valoriza a percepção dos próprios idosos, protagonistas de intervenções e dotados de julgamentos sobre bem-estar e qualidade de vida. Mesmo na presença de co-morbidades e diminuição da funcionalidade é possível identificar idosos que referem altos níveis de satisfação e boa qualidade de vida. Propomos questões que buscam aprimorar investigações e a elaboração deste constructo em gerontologia, tendo em vista a amplitude e complexidade do tema.

This article focuses on different conceptions of successful aging, emphasizing the process of aging as a heterogeneous experience that implies different strategies for achieving wellbeing and quality of life. Studies valuing the aging process as part of the course of human life and the role of subjectivity and health self-perception, as key concepts for understanding wellbeing and health in old age, were selected. Data in the literature suggest that the experience of successful aging values elderly people's own perceptions: they are the protagonists of interventions and possess judgment about wellbeing and quality of life. Even in the presence of comorbidities and diminished functional ability, it is possible to identify elderly people who report high levels of satisfaction and good quality of life. We propose questions that seek to improve investigations and elaborate this construct within gerontology, bearing in mind the size and complexity of this topic.

Este artículo aborda diferentes concepciones de envejecimiento bien llevado, enfatizando el proceso como una experiencia heterogénea que implica diferentes estrategias para la obtención del bienestar y calidad de vida; seleccionando estudios que evalúan el proceso de envejecimiento como parte del curso de vida humana, el papel de la subjetividad y la auto-evaluación en salud como conceptos clave para abarcar el bienestar y la salud en la vejez. Los datos obtenidos sugieren que este proceso resalta la percepción de los ancianos protagonistas de intervenciones. Proponemos cuestiones que tratan de perfeccionar investigaciones y la elaboración de este constructo en Gerontología.

Este artigo enfoca diferentes concepções de envelhecimento bem-sucedido, enfatizando o processo de envelhecimento como uma experiência heterogênea, que implica diferentes estratégias para a obtenção de bem-estar e qualidade de vida. Foram selecionados estudos que valorizam o processo de envelhecimento como parte do curso de vida humano, o papel da subjetividade e a auto-avaliação em saúde, como conceitos-chave para compreender o bem-estar e saúde na velhice. Os dados da literatura sugerem que a experiência do envelhecimento bem-sucedido valoriza a percepção dos próprios idosos, protagonistas de intervenções e dotados de julgamentos sobre bem-estar e qualidade de vida. Mesmo na presença de co-morbidades e diminuição da funcionalidade é possível identificar idosos que referem altos níveis de satisfação e boa qualidade de vida. Propomos questões que buscam aprimorar investigações e a elaboração deste constructo em gerontologia, tendo em vista a amplitude e complexidade do tema.

This article focuses on different conceptions of successful aging, emphasizing the process of aging as a heterogeneous experience that implies different strategies for achieving wellbeing and quality of life. Studies valuing the aging process as part of the course of human life and the role of subjectivity and health self-perception, as key concepts for understanding wellbeing and health in old age, were selected. Data in the literature suggest that the experience of successful aging values elderly people's own perceptions: they are the protagonists of interventions and possess judgment about wellbeing and quality of life. Even in the presence of comorbidities and diminished functional ability, it is possible to identify elderly people who report high levels of satisfaction and good quality of life. We propose questions that seek to improve investigations and elaborate this construct within gerontology, bearing in mind the size and complexity of this topic.

Este artículo aborda diferentes concepciones de envejecimiento bien llevado, enfatizando el proceso como una experiencia heterogénea que implica diferentes estrategias para la obtención del bienestar y calidad de vida; seleccionando estudios que evalúan el proceso de envejecimiento como parte del curso de vida humana, el papel de la subjetividad y la auto-evaluación en salud como conceptos clave para abarcar el bienestar y la salud en la vejez. Los datos obtenidos sugieren que este proceso resalta la percepción de los ancianos protagonistas de intervenciones. Proponemos cuestiones que tratan de perfeccionar investigaciones y la elaboración de este constructo en Gerontología.