Rauer Ferreira Franco

Background: Hypertensive emergencies are severe clinical conditions characterized by sudden elevation of blood pressure accompanied by acute target organ damage, including cardiovascular, cerebrovascular, renal, and retinal complications. Although blood pressure elevation is the defining feature, accumulating evidence indicates that activation of the renin–angiotensin–aldosterone system (RAAS) may play a central role in the molecular and cellular mechanisms underlying vascular injury. This review critically examines the current evidence regarding the involvement of the RAAS in the pathophysiology of hypertensive emergencies, highlighting its contribution to endothelial dysfunction, oxidative stress, inflammation, microvascular damage, and target organ injury, as well as its therapeutic implications and future research perspectives. Methods: A comprehensive narrative review of the literature was conducted using narrative reviews, systematic reviews, meta-analyses, experimental, translational, and clinical studies published in major biomedical databases, with particular emphasis on recent evidence addressing RAAS signaling, hypertensive emergencies, target organ damage, and emerging therapeutic approaches. Current international guidelines and landmark studies were also considered to provide an updated overview of the diseases. Results: Available evidence indicates that excessive activation of the classical ACE/angiotensin II/AT1 receptor axis contributes to acute vasoconstriction, endothelial dysfunction, reactive oxygen species generation, inflammatory activation, impaired vascular autoregulation, and microvascular injury, thereby promoting acute damage to the brain, heart, kidneys, retina, and large arteries. Conversely, the counter-regulatory ACE2/angiotensin-(1–7)/Mas receptor axis exerts protective vascular effects, although its role in hypertensive emergencies is unclear. Current therapies primarily focus on controlled blood pressure reduction, whereas the potential benefits of targeted RAAS modulation during the acute phase remain uncertain. Conclusions: The RAAS may play an important role in the pathophysiological processes underlying hypertensive emergencies, extending beyond its classical function of blood pressure regulation. However, direct human evidence remains limited and heterogeneous, warranting caution in interpreting these findings. A deeper understanding of the interactions between RAAS activation, vascular dysfunction, and target organ injury could help identify potential biomarkers and therapeutic targets, ultimately contributing to improved management and prognosis in patients with hypertensive emergencies.

Background: Wounds are common and clinically consequential, and consistent assessment is essential for communication, monitoring, and decision-making. Although multiple wound assessment instruments exist, there is no agreement among specialists on which criteria to prioritize during validation processes and evidence synthesis remains insufficient within the Brazilian context. Objective: This scoping review aims to map which aspects of wound assessment instruments are considered important by expert health professionals when validating these instruments in the Brazilian context across clinical care settings. Methods: The review will be conducted in accordance with JBI guidance for scoping reviews. A 3-step search strategy will be used on the MEDLINE (PubMed), Embase, Scopus, Web of Science, and Cochrane Library databases, as well as in the LILACS, SciELO, and BDENF (Base de Dados em Enfermagem) databases, supplemented by gray literature sources (Brazilian Digital Library of Theses and Dissertations, CAPES Theses Catalog, and Google Scholar) and reference list screening. Records will be deduplicated and screened by 2 independent reviewers, with reporting aligned to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Data will be extracted using a piloted extraction tool and synthesized descriptively in tables and with narrative mapping. Critical appraisal will not be performed. Results: This protocol was registered with the Open Science Framework on February 6, 2026. Database searches are scheduled to commence following protocol publication. Data collection is projected to begin in July 2026, with screening and data extraction expected to be completed by December 2026, and the final review report planned to be submitted for publication in the first quarter of 2027. Results will map the extent, nature, and distribution of evidence on expert-led validation of Brazilian wound assessment instruments across clinical settings. Conclusions: This scoping review will provide a systematic and transparent synthesis of which aspects health professionals consider when validating Brazilian national wound assessment instruments. We expect the findings to identify methodological gaps, inform future validation studies, and support the development and refinement of nationally applicable instruments across diverse Brazilian health care contexts.

Background: Health inequities represent a persistent and multifaceted challenge, particularly pronounced for individuals with intellectual and developmental disabilities (IDDs), including Down syndrome (DS). This population frequently faces systemic barriers to care and is at higher risk of adverse health outcomes . Despite advances, gaps persist in health care professionals’ training for caring for this population. Undergraduate medical education constitutes a crucial component in addressing these disparities and promoting inclusive care, especially through practical experiences for future physicians. Objective: This study aims to map and synthesize evidence regarding undergraduate medical education for the care of individuals with DS and other IDDs in medical schools, identifying gaps and opportunities for enhancement in curricula and educational programs, including pedagogical strategies and experiential learning opportunities. Methods: A scoping review following the methodological frameworks by Arksey and O’Malley, Levac et al, and the Joanna Briggs Institute will be conducted. The search will be performed in electronic databases and gray literature sources using descriptors in English, Portuguese, and Spanish. Study selection will involve undergraduate medical students as the target population. Two independent reviewers will perform study selection following predefined inclusion and exclusion criteria. Data will be extracted using a standardized form and synthesized narratively, with qualitative (thematic) and descriptive quantitative analyses where appropriate. This protocol has been registered with the Open Science Framework and will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: A comprehensive overview of current undergraduate medical education regarding the care of individuals with DS and other IDDs will be provided, informing the development of more effective and inclusive interventions and yielding insights into existing pedagogical strategies, practical learning opportunities, and medical students’ knowledge and attitudes toward this population, providing a foundation for evidence-based recommendations. Conclusions: This review will address an important gap in the literature, providing insights for the improvement of undergraduate medical education and clinical practice in caring for individuals with DS and other IDDs, contributing to the development of more capable and empathetic professionals. By systematically mapping the current landscape and identifying specific needs, this protocol lays the groundwork for transformative changes in medical curricula worldwide, ultimately enhancing health outcomes for this vulnerable population.

A Atenção Primária à Saúde (APS) ocupa posição estratégica na organização dos sistemas de saúde orientados pela universalidade, integralidade, equidade e continuidade do cuidado. No campo da saúde da mulher, sua importância transcende a assistência reprodutiva, abrangendo promoção da saúde, prevenção de agravos, detecção precoce de doenças, cuidado longitudinal das condições crônicas, atenção à saúde mental, enfrentamento da violência e articulação intersetorial para resposta às vulnerabilidades sociais. Este estudo teve como objetivo analisar criticamente o papel da APS como eixo estruturante do cuidado integral à saúde da mulher no contexto do Sistema Único de Saúde (SUS). Trata-se de uma revisão narrativa de literatura, de natureza qualitativa, ancorada em publicações científicas indexadas e documentos institucionais recentes. Os achados demonstram que a APS, quando organizada com base em seus atributos essenciais e derivados, favorece maior coordenação do cuidado, ampliação do acesso, vínculo, longitudinalidade e respostas mais resolutivas às necessidades femininas ao longo do curso de vida. Por outro lado, persistem desafios relacionados à fragmentação assistencial, baixa incorporação de ações de promoção da saúde, insuficiências no cuidado às mulheres em situação de violência e desigualdades territoriais na oferta e qualidade dos serviços. Conclui-se que o fortalecimento da APS, aliado à qualificação das equipes, ao uso de dados epidemiológicos, à atuação dos agentes comunitários de saúde e à consolidação de redes intersetoriais, constitui condição indispensável para efetivar a atenção integral à saúde da mulher.

Objectives: This study evaluated Quality of Life (QoL) and mental health among nursing technicians in Brazilian Unified Health System (SUS) emergency units, specifically exploring occupational safety and well-being in the post-COVID-19 era. Design: A quantitative, descriptive, exploratory, cross-sectional design was employed. Methods: Data from 146 nursing professionals in Brazilian SUS emergency units were collected remotely during the post-acute pandemic phase (July–Nov 2024). QoL (WHOQOL-BREF) and mental health (HADS) were assessed, followed by descriptive and correlational statistics. Results: The predominantly female, experienced sample showed heterogeneous general QoL but pervasive anxiety, reflecting a sustained psychological burden. Sociodemographic/professional factors had a negligible impact; the emergency environment’s overwhelming influence, intensified by post-pandemic challenges, was key. Psychological distress was strongly negatively correlated with overall QoL and depression in the social domain. Conclusions: The intrinsic nature of emergency work, amplified by persistent psychosocial effects of the global health crisis, drives anxiety and impairs QoL/social relationships. Interventions strengthening QoL, enhancing coping, and adapting work environments to new realities (e.g., loneliness, prolonged mental health impacts) are vital for professional well-being and patient care in this post-pandemic era.

Nursing students frequently experience considerable stress, impacting their mental well-being and preparedness for professional practice. Psychological resilience is paramount in navigating these demands. This scoping review synthesized studies on resilience levels in nursing students, particularly those in their entry year, utilizing the Wagnild and Young Resilience Scale within the Latin American academic context. Following JBI methodology and PRISMA guidelines, a systematic search identified six relevant studies. Findings indicate that newly enrolled nursing students often exhibit low to moderate resilience, which may decline during the first academic year. Importantly, resilience acts as a protective factor against psychoemotional stress, depressive symptoms, and poor sleep quality. Family support, engagement in leisure activities, and course satisfaction positively correlate with higher resilience. These findings underscore the imperative for educational institutions to actively integrate resilience-building strategies, such as curricular adjustments and psychoeducational programs, to bolster student well-being and cultivate competent future professionals. Further longitudinal research is essential to deepen understanding and evaluate intervention efficacy.

Introduction: The mental health of nursing professionals is an escalating global concern, particularly due to the inherently challenging work conditions they frequently encounter. This study aimed to investigate the prevalence of Minor Mental Disorders (MMD) and resilience levels among nursing professionals, analyzing the relationship between these constructs and identifying resilience’s potential protective role. Methods: This was a quantitative, descriptive, correlational, and cross-sectional study. The sample consisted of 203 nursing professionals (including nursing assistants, technicians, and nurses) from two healthcare institutions in the interior of São Paulo, Brazil. Data were collected between August and October 2019. Instruments utilized included a sociodemographic and professional questionnaire, the Self-Report Questionnaire (SRQ-20) for MMD screening, and the Wagnild & Young Resilience Scale. Results: The overall prevalence of MMD in the studied sample was 31.0%. Mean scores for the SRQ-20 domains were observed as follows: Depressive/Anxious Mood (1.33), Somatic Symptoms (1.63), Reduced Vital Energy (1.77), and Depressive Thoughts (0.39). A key finding indicated that resilience did not demonstrate a significant direct predictive role on MMDs when the effect of quality of life was controlled. However, resilience showed a significant positive correlation with Quality of Life (QoL) (coef. = 0.515; p < 0.001). Furthermore, QoL emerged as a robust and statistically significant negative association with all dimensions of MMD. Discussion: These findings suggest that resilience may function as an indirect moderator or precursor to QoL, with QoL, in turn, exerting a more direct and substantial influence on the reduction of MMDs. This integrated perspective aligns with the understanding that resilience contributes to a more adaptive assessment of stressors and, consequently, to better QoL, thereby minimizing the detrimental effects of stress on mental health. Conclusion: This study reaffirms the high prevalence of Minor Mental Disorders among nursing professionals, highlighting Quality of Life as a primary target for interventions aimed at promoting mental well-being. It also emphasizes resilience as a valuable individual resource that indirectly supports mental health by enhancing QoL. A holistic understanding of occupational stressors, psychosocial, and biological mechanisms is crucial for developing effective and targeted support strategies for these essential professionals.

Background/Objectives: Leadership in nursing plays a pivotal role in the provision of high-quality healthcare. It is, therefore, of paramount importance to understand the challenges encountered by newly qualified nurses when assuming leadership responsibilities. This scoping review protocol aims to identify and map these challenges, thereby facilitating the development of more effective interventions and support programmes. The data collection and analysis were conducted from January 2024 to March 2024. Methods: The review was conducted in accordance with the Joanna Briggs Institute (JBI) guidelines for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) recommendations. A comprehensive search was undertaken across MEDLINE, CINAHL, Web of Science, Scopus, LILACS, and SciELO databases, in addition to a search for the grey literature. Study selection was performed by two independent reviewers, applying pre-defined inclusion and exclusion criteria. The data were extracted using a standardised form and analysed descriptively. Results: The review identified several key challenges faced by newly qualified nurses in leadership roles, including conflict management, decision-making under pressure, and effective communication. These findings highlight the complexity of transitioning from academic training to professional practice. The results provide a comprehensive overview of these challenges, enabling the identification of gaps in the existing knowledge base and informing the direction of future research and interventions. Conclusions: The findings of this review will contribute to the enhancement of healthcare quality and the promotion of the professional development of newly qualified nurses. This research underscores the importance of developing targeted interventions and support systems to address the specific challenges identified, thereby influencing nursing practice and policy.

O presente estudo teve como objetivo analisar a integração entre tecnologias digitais, metodologias ativas e currículos educacionais, buscando compreender como essa confluência contribui para a promoção de uma aprendizagem engajadora no contexto da educação 4.0. Para tanto, adotou-se uma revisão integrativa da literatura, com levantamento sistemático de artigos científicos em bases como SciELO, Web of Science e Google Acadêmico, aplicando critérios de seleção que contemplaram publicações brasileiras, em língua portuguesa, disponibilizadas integralmente e datadas entre 2023 e 2024. A análise qualitativa dos dados evidenciou que a incorporação intencional e articulada de tecnologias digitais, quando aliada a metodologias pedagógicas inovadoras - em especial as metodologias ativas - e sustentada por currículos flexíveis, promove o desenvolvimento de competências críticas, autonomia discente e engajamento colaborativo. Ademais, verificou-se que a efetividade dessas inovações depende de políticas institucionais robustas, investimento contínuo em formação docente e infraestrutura adequada, bem como da superação de resistências culturais e técnicas. Em suma, os resultados indicam que a integração desses elementos, mediada por uma abordagem sistêmica e planejada, representa um componente fundamental para a transformação do processo educativo, alinhando-o às exigências da sociedade contemporânea marcada pela digitalização e constante evolução.

Mental health challenges are increasingly prevalent among young individuals, particularly within high-stress academic environments such as nursing education. Resilience is critical for maintaining well-being and adapting to university demands. Objective: To assess resilience levels in first-year nursing students at FAMERP (Faculty of Medicine of São José do Rio Preto) upon entry in 2021 and their longitudinal evolution in 2022 and 2023, using the Wagnild and Young Resilience Scale. The study also aims to explore the implications for mental health promotion in young healthcare professionals. Methods: A descriptive, longitudinal, prospective, and quantitative study was conducted with 40 students. Data collection was performed via electronic forms and analyzed using descriptive statistics and specific tests within the R programming language. Results: The predominantly female sample, with a mean age of 19.5 years, exhibited moderate to high resilience levels: mean scores of 132.5 (2021), 135.8 (2022), and 139.2 (2023). A significant reduction in the Perseverance factor (p = 0.0131) was noted. There was a positive correlation between age and resilience scores (r = 0.42; p < 0.01). Discussion: Despite a slight overall increase in resilience, the decline in Perseverance is concerning, indicating potential growing mental health challenges as students progress. Small age differences significantly influence mental health outcomes. This decline may be related to increased academic stress, exposure to emotionally challenging clinical situations, and the cumulative effects of the “costs of caring”. Conclusions: Nursing students exhibit promising resilience levels, yet there is a critical need for interventions targeting Perseverance to enhance academic performance and patient care quality. Social Impact: This study contributes to the development of educational strategies designed to promote resilience, thereby potentially improving the mental health and academic performance of nursing students. By focusing on mental well-being, a more resilient healthcare workforce can be cultivated and better prepared to meet systemic challenges.