INTRODUCTION: Immunization is a highly cost-effective public health intervention that prevents millions of deaths, but inequalities in vaccination coverage persist. Refugee, asylum-seeking, and displaced children face barriers to access, resulting in lower coverage and a higher risk of vaccine-preventable diseases. OBJECTIVE: To map and describe the available scientific evidence on access to immunization and vaccination coverage among refugee, asylum-seeking, and internally displaced children in host countries, including the identification of barriers, facilitators, and strategies related to immunization in these contexts. METHODS AND MATERIALS: Scoping review protocol following the Joanna Briggs Institute approach and the PRISMA-ScR checklist. The research question was structured using the PCC framework: Population, Concept, and Context. Articles and gray literature on immunization in refugee, asylum-seeking, and internally displaced children in host countries will be included. Searching will be conducted in PubMed, ScienceDirect, BVS, SciELO, and Cochrane Library. Study selection will be performed by two independent reviewers using the Rayyan platform. Data will be analyzed using the PAGER framework. RESULTS: Variations in vaccination coverage, associated factors, methodological heterogeneity, and research gaps are expected to be identified. CONCLUSION: The review aims to organize knowledge on immunization among forcibly displaced children, contributing to practice, research, and global health policies.
CONTEXT: Meta-analysis is widely positioned at the apex of the evidence hierarchy in evidence-based medicine (EBM), often serving as the foundation for clinical guidelines, policy decisions, and therapeutic recommendations. Their quantitative nature conveys an appearance of precision and objectivity that reinforces their authority in clinical reasoning. However, this perceived robustness may obscure important methodological and epistemological limitations. CONCEPTUALIZATION: This article critically examines the conditions under which meta-analysis may produce misleading inferences. We argue that the aggregation of evidence does not inherently generate validity, particularly in the presence of heterogeneity, publication bias, and variable study quality. By exploring structural limitations, including analytical flexibility, amplification of bias, and the misinterpretation of statistical significance, we demonstrate how meta-analysis can create an illusion of certainty. Rather than resolving uncertainty, they may repack it into quantitatively precise but conceptually fragile estimates. We propose that meta-analysis should be interpreted as conditional and context-dependent constructs, whose validity depends on rigorous methodological scrutiny and epistemological awareness. Reframing their role within EBM is essential to prevent overreliance and to promote more critical, responsible clinical decision-making.
INTRODUCTION: Intimate partner violence (IPV) represents a serious violation of human rights and a significant public health issue, especially in contexts marked by structural inequalities, such as countries in the Global South. OBJECTIVES: This protocol describes the methodological procedures for conducting a scoping review that aims to map the scientific evidence on IPV in this context, focusing on prevalence, risk factors, consequences, and response strategies. METHODS: The review will be conducted in accordance with the JBI guidelines, reported following the PRISMA-ScR extension, and registered on the Open Science Framework platform. The research question was structured using the PCC mnemonic. The search strategy will be conducted in the PubMed, VHL, SciELO, ScienceDirect, and ERIC databases, utilizing descriptors and free terms. EXPECTED RESULTS: The review aims to identify patterns, gaps, and relevant recommendations to support future research, professional practices, and public policies aimed at mitigating IPV in socially vulnerable contexts.
In the arc of every scientific life, there comes a moment when the focus naturally shifts. The attention that once centered on one’s own findings, papers, and recognitions begins to expand—sometimes imperceptibly—toward people. The students, colleagues, and early-career scientists whose curiosity, ambition, and questions begin to mirror those of our younger selves. In that moment, leadership becomes less about how we navigate the system and more about how we prepare others to move through it with clarity, confidence, and direction. The next generation of scientists will shape what we will live to see—and what we will never witness. Some of them will eventually lead our institutions, our disciplines, and in many cases, ourselves. Training them is no longer a personal gesture; it is a generational imperative.
This article aims to describe and reflect on a possible performance bias found in the randomized clinical trial by Baron et al, on the effectiveness of neuromuscular electrical stimulation for the prevention of pressure ulcers in critically ill patients.
Scientific progress hinges on collaboration, trust, and the exchange of ideas. This essay explores the roles of "Givers" and "Takers" within the scientific community, emphasizing how behaviors focused on collective advancement drive innovation and enduring success. Givers foster environments of mutual respect and sustainable partnerships, while Takers, prioritizing short-term gains, risk undermining the collaborative fabric of science. Through a conceptual analysis, the manuscript highlights the importance of strategic generosity in overcoming challenges posed by Takers and underscores the necessity of institutional support for a culture of giving. The discussion concludes with a call to embrace collaborative values as a pathway to meaningful and lasting contributions in science.
ABSTRACT | CONTEXT: Belief and skepticism, often seen as opposing forces, both play crucial roles in shaping scientific inquiry and addressing global health challenges. Belief provides ethical frameworks, fosters cooperation, and inspires compassion, while skepticism nurtures intellectual humility, critical thinking, and empirical rigor. CONCEPTUALIZATION: This article explores how these philosophical and spiritual frameworks, despite their apparent differences, mutually enrich the scientific endeavor. By integrating principles of faith, agnosticism, and organized skepticism, I examine their influence on ethics, motivation, societal development, and practical applications in medicine and global health. Through this synthesis, I highlight how these perspectives converge to support a science driven by evidence, empathy, and a commitment to the greater good.
CONTEXT: Physician-scientists occupy a unique and critical position at the intersection of clinical practice and scientific research, yet they are becoming increasingly rare due to systemic challenges, including time constraints, financial disincentives, and insufficient institutional support. This article explores the conceptual and historical differences between physicians, researchers, scientists, and physician-scientists, highlighting their distinct contributions to global health, policy-making, and medical innovation. Historical examples, such as Robert Koch and Virchow Rudolf, exemplify the transformative impact of physician-scientists in advancing medicine. The rise of artificial intelligence (AI) presents new opportunities and challenges for these professionals, as AI can enhance their dual roles in research and patient care. CONCEPTUALIZATION: However, to sustain and grow the physician-scientist workforce, significant changes are needed, including better financial incentives, protected research time, and stronger mentorship programs. Without such support, the future of medical innovation and global health may be jeopardized. This article advocates for a renewed focus on cultivating physician-scientists, emphasizing their indispensable role in bridging the gap between bench and bedside, and ensuring that scientific discoveries translate into tangible improvements in human health and well-being.
INTRODUCTION: Many mistakes in clinical practice arise from confusing the probability of a positive test in those with the disease and the probability of having the disease in those who test positive. This misunderstanding leads to overestimating disease probability, diagnosing diseases in healthy individuals, ordering invasive diagnostic tests, and prescribing unnecessary treatments, resulting in unjustified adverse effect, psychological stress, and increased cost. Probabilistic reasoning is an essential skill to mitigate this confusion, and Bayes theorem is an important tool to accomplish this goal. OBJECTIVE: To present a step-by-step demonstration of Bayes' formula for positive and negative predictive values, fostering understanding and enabling its adoption in evidence-based medicine education and clinical practice as a supporting tool in the decision-making process. METHODS: In this article, we explain the difference between deductive and inductive thinking and how diagnostic reasoning is predominantly inductive, where evidence (the test result) is used to predict the cause (the presence of disease), a path that involves reverse probability, for which our reasoning is hazier. Through a clinical example involving the diagnosis of systemic lupus erythematosus, we use the Bayesian framework as a tool to help understand the difference between sensitivity/specificity (forward probability; deductive) and positive/negative predictive values (reverse probability: inductive). CONCLUSIONS: Excellent doctors are masters at applying Bayesian reasoning without using any formulas: they understand that the most important component of the diagnostic process is the reasoning that originates it and the resulting clinical decision depends on interpreting results considering their interaction with the context, not in isolation. Bad clinical reasoning results in bad clinical decisions, despite how accurate the diagnostic test: garbage in, garbage out. We hope our step-by-step approach to Bayes' rule can help demystify this powerful statistical tool and strengthen the idea that the value of a diagnostic test is directly proportional to the quality of clinical reasoning that led to its request.
In the heart of Brazil, a renowned MD, PhD scientist and his son, a newly accepted medical student, embark on a unique collaboration.This essay serves as a bridge between generations, capturing the essence of entering the medical profession from two distinct vantage points.Through it, they aim to share their fears, hopes, and advice, illuminating the path for others who dare to follow in their footsteps.
BACKGROUND: Public and Patient Involvement [PPI] is a relatively new concept within the field of research. However, it involves a process whereby service users/patients are involved in every step of the research process. Recently, The Lancet Psychiatry and the Journal of Mental Health released a mandate for all future submissions to have PPI representation clearly documented in the manuscripts. This, although welcome, raises the fear of tokenistic practices in research production and dissemination. This has resulted in a space of contentious fluidity developing as researchers and indeed PPI representatives struggle to ascertain what exactly PPI is all about. Only when these questions are answered, will we, as scholars, determine whether to actively use the approach or let it die off like a burnt out candle
Irritable bowel syndrome (IBS) is a multifactorial condition for which there is no known aetiology. The lack of evidence base surrounding the aetiology of IBS coupled with the variety of management tools employed by affected patients has meant that the condition has been an increased topic of interest amongst “patient influencers”. While there is a notable value to such influencers on social media in terms of peer-to-peer support and fostering discussions of lived experiences with an affected community, concerns remain over the quality and accuracy of information being shared. Medical misinformation poses a new global health threat; medical professionals remain powerless to filter through what has been dubbed by some as “misinformation mayhem”. The COVID-19 pandemic exposed significant gaps in health literacy and a lack of trust in the medical and political systems that were responsible for communicating health information. This literature review outlines the missed opportunities for counteracting medical misinformation during the COVID-19 pandemic and identifies the ways in which these lessons could be applied to future communication and interaction with IBS (mis)information within the social media sphere.
INTRODUCTION: Medical thinking lacks economic thinking although temporality plays a crucial role in shared clinical decision-making. Present benefits, such as symptom relief, at times, should not be underestimated in the economic evaluation of medical interventions; and immediate effects in present benefit scenarios allow for valuable feedback, aiding in the assessment of the appropriateness of the chosen intervention. Ultimately, we underscore the need for a nuanced understanding of the interplay between time, costs, and benefits in clinical decision-making.
BACKGROUND: Diabetes Mellitus (DM) is currently considered a global epidemic, with alarming estimates for the coming years on all continents, with Chronic Kidney Disease (CKD) as one of its main consequences when a timely diagnosis is not made. OBJECTIVE: The objective of this study is to estimate the prevalence of DM among individuals diagnosed with CKD by means of a systematic review and meta-analysis. METHODS: A systematic review was carried out in the main free-access databases such as Pubmed (Medlaine), Lilacs, Scopus and Scielo. Two researchers selected the articles, extracted the data and evaluated the quality. The collected data were evaluated using a random effects model. RESULTS: Of 994 articles, 17 studies were included that looked at three continents. The group prevalence of DM among individuals with CKD (95% CI) was 29% (23-35%), with heterogeneity I2 = 99,86% and p = 0.00, which was not explained by meta-regression and subgroups. CONCLUSIONS: The present study confirmed the high prevalence of DM among individuals with CKD, especially among those with end-stage renal disease, demonstrating the need for early diagnosis and timely treatment of DM and new studies in this area, considering the social and economic impact of these diseases worldwide.
INTRODUCTION: The debate on scientific research and reporting integrity issues in Brazil is incipient. Literature suggests that a journalology training course could help to improve the competencies of the participants. OBJECTIVE: To evaluate the immediate impact of a journalology training course on perceived academic competencies, comprised of knowledge, attitudes, and skills. METHODS: The course was taught in 5 consecutive days to an online audience of individuals from the health sciences. A self-applied questionnaire was employed before and immediately after the course, which included initial and acquired perceived knowledge, attitudes, skills. The Wilcoxon non-parametric test for paired samples was used for analysis. RESULTS: A total of 45 individuals participated in the course, with a 53% response rate before and after. The number of participants in each course session ranged between 32 and 45. There was an improvement in perceived knowledge of: (1) writing review articles; (2) ethical aspects of research; (3) scientific authorship; (4) predatory practices; (5) publication bias and spin, and (6) researcher evaluation. There was no improvement in self-reported attitudes towards any item. There was an improvement in the perception of skills relating to: (1) writing a response letter and (2) writing an opinion as a reviewer. CONCLUSIONS: Overall, attendees who participated in the survey reported perceived improved knowledge and skills in some items but not in their attitudes. Therefore, the course appears to have been unable to modify perceived scientific reporting competencies.
INTRODUCTION: Whenever there has been a technological revolution, there have been advantages and disadvantages associated with it. Artificial intelligence is now going through this phase of uncertainty. There are groups that agree and embrace this new technology, and others that simply refuse to let it into our daily lives. OBJECTIVE: The purpose of this reflection will be to understand the advantages and disadvantages of the use of artificial intelligence in health and science.
BACKGROUND: The quality of reporting in the abstract section of scientific articles is one of the important aspects of good communication of trials. OBJECTIVES: We investigated abstracts of randomized clinical trials (RCTs) in the physical activity field according to adherence to the Consolidated Standards of Reporting Trials (CONSORT) for Abstracts (primary outcome) and checked the recommendations of the selected journals regarding the contents and structure of the abstract. METHODS: This study is a descriptive, cross-sectional study of the Strengthening the Evidence in Exercise Sciences (SEES) Initiative. RCTs published in 9 exercise science journals and 2 general medicine journals during 2019 were eligible. Two researchers conducted study selection and, thereafter, assessment of the abstracts using a form comprising 16 items based on CONSORT for Abstracts. Also, extracted, in duplicate and independently, the journals’ recommendations for authors. RESULTS: 131 abstracts were eligible for evaluation. From items evaluated, those with the highest adherence were objectives or hypothesis (99%), conclusion (98%), and intervention (94%). The lowest reporting was observed in the number of participants analyzed (6%), allocation and randomization (1%), and funding (1%). Ten journals recommended the abstract structure, but only two mentioned the CONSORT for Abstracts. CONCLUSIONS: There is variable and suboptimal adherence to the CONSORT for Abstracts in trials in the physical activity field and poor recommendation of this instrument in journals selected. Therefore, we suggest editors, reviewers, and authors a greater adherence to guidelines, and to journal recommendations to improve the quality of reporting of abstracts in the physical activity field.
INTRODUÇÃO: A Análise do Discurso tem demonstrado que a neutralidade é algo inexistente na língua. Cada escolha lexical não é aleatória e, dentro de cada escolha, há uma diversidade de possibilidades de intenções, colocações e interpretações. Cultura, hábitos, crenças e todo o conjunto de características que compõe uma sociedade influenciam a construção da língua. Em uma sociedade na qual a ciência e o método científico estejam sendo subestimados ou ignorados, enquanto práticas pseudocientíficas são valorizadas, é esperado que haja um reflexo disso na linguagem. OBJETIVO: Discutir o impacto da linguagem e das escolhas lexicais na aparência de legitimidade científica de práticas pseudocientíficas. METODOLOGIA: Neste estudo, utilizamos ferramentas da linguística associadas ao pensamento científico para identificar de que forma as pseudociências podem se beneficiar da linguagem para aumentar sua credibilidade, com foco no uso de afixos. RESULTADOS: Falantes de uma língua possuem intuições sobre as regras formativas e significados relacionados aos afixos, mesmo sem estudarem formalmente as construções linguísticas ou epistemologia. Nesse sentido, práticas pseudocientíficas podem se beneficiar da aparência de legitimidade científica conferida pela percepção etimológica popular de sufixos e prefixos comumente empregados para designar áreas ou subáreas de estudos acadêmico-científicos. CONCLUSÃO: As palavras e afixos utilizados na linguagem científica não possuem definições precisas e inequívocas, mas sim, estão sujeitos a interpretações variadas e conflitantes. Diante dessa vulnerabilidade, a linguagem, como reflexo da sociedade em que estamos inseridos, pode limitar nossa capacidade de tomada de decisões racionais em relação à saúde.
INTRODUCTION: The use of biomodulatory therapies in order to help tissue repair has been increasingly common in different areas of health. OBJECTIVE: This study aims to comparatively evaluate the effects of 660 nm laser photobiomodulation, ozone therapy, and ozonated oil on repair through histomorphometric analysis in skin wounds in rats. Forty Wistar rats will be divided into 4 groups of 10 animals each, Control Group (GC), Laser Group (LG), Ozone Gas Group (OGG), and Ozonated Oil Group (OOG). MATERIALS AND METHODS: Standard skin wounds will be made on the back of the animals, and the different experimental groups will be treated with the biomodulatory therapies described for three consecutive days. Five and ten days after surgery, five rats from each group will be euthanized. Skin fragments, including the wound area, will be removed for histological processing and subsequent staining of histological sections with Hematoxylin-eosin and Sirius red. Micrographs of the histological sections will be obtained and ten standard images will be captured for quantitative evaluation of the variables collagen area, number of blood vessels, and epithelium thickness. The variables infiltrate of polymorphonuclear and monomorphonuclear inflammatory cells, as well as edema, will be analyzed semiquantitatively. Statistical analysis of the study variables will be performed, with a significance level of p<0.05. CONCLUSION: It is expected to verify which of the biomodulatory therapies used can favor the resolution of tissue repair, in particular, by promoting collagen biosynthesis.
INTRODUCTION: In a pandemic, stakeholders such as policy makers, clinicians, patients, and the public need access to high-quality, timely, relevant research evidence in a format that is understandable and applicable. OBJECTIVES: An online survey was used to determine where a global audience finds research evidence about COVID-19 and how they prefer to keep up to date. METHODS AND MATERIALS: We conducted an online survey of people interested in research in English and Spanish. We used a convenience sample of people visiting websites and social media accounts of Cochrane, an international organisation that collates systematic reviews of research. RESULTS: 831 people with various roles and locations responded over a short period with little active promotion. Healthcare professionals, members of the public, and policy influencers wanted research evidence to inform decisions about COVID-19. More than half found research evidence from government websites (52%), international organisations (57%), journals (56%), and evidence collation organisations (60%) useful. People wanted research evidence about COVID-19 formats such as lay summaries (60%), online systematic reviews (60%), short summaries with commentaries (51%), and visual summaries (48%). People preferred to be kept up to date about COVID-19 research via email updates and newsletters, tailored to people’s interests (34%), traditional media (13%) and social media (12%). CONCLUSIONS: It was feasible to collect feedback rapidly using a simple online survey. Websites from official organisations were key sources of COVID-19 research evidence. More research is needed on how best to provide evidence that is easy to access and understand.
