Socioeconomic factors increase the risk of teenage pregnancy: spatial and temporal analysis in a Brazilian municipality.

OBJECTIVE: To evaluate the distribution of the proportion of teenage mothers (PTM) in time and space and its relationship with socioeconomic indicators and social vulnerability. METHODS: An ecological study was carried out with teenage mothers living in 322 census tracts in Foz do Iguaçu (state of Paraná, Brazil) between 2013 and 2019. Spatial clusters of teenage mothers were identified by spatial scanning and grouped into strata with different prevalence. The association between these strata and the individual social vulnerability of the mothers was evaluated using the Pearson's Chi-square test. Linear regression models were adjusted to evaluate the association between PTM and socioeconomic factors by census tract and temporal trend in PTM in different strata. RESULTS: We identified five high prevalence clusters in peripheral regions and six with low prevalence in the central region of the municipality. Proportionally, there were more teenage mothers with a worse vulnerability index in the high prevalence stratum than in the low prevalence stratum. Places with worse socioeconomic conditions present higher PTM, a profile that did not change over time. For the increase of one unit in the Brazilian Deprivation Index and proportion of women responsible for the household, the PTM increased, respectively, by 3.8 (95%CI 3.1-4.4) and 0.086% (95%CI 0.03-0.14). There was a reduction in the global PTM in part of the period, which occurred later in the higher prevalence strata, but the proportions were stable again in the last years of study. CONCLUSION: Teenage pregnancy is concentrated in regions with worse socioeconomic conditions and greater maternal vulnerability and its behavior over time occurred differently in these areas.

Socioeconomic factors increase the risk of teenage pregnancy: spatial and temporal analysis in a Brazilian municipality / Fatores socioeconômicos aumentam o risco de gravidez na adolescência: análise espacial e temporal em um município brasileiro

ABSTRACT Objective: To evaluate the distribution of the proportion of teenage mothers (PTM) in time and space and its relationship with socioeconomic indicators and social vulnerability. Methods: An ecological study was carried out with teenage mothers living in 322 census tracts in Foz do Iguaçu (state of Paraná, Brazil) between 2013 and 2019. Spatial clusters of teenage mothers were identified by spatial scanning and grouped into strata with different prevalence. The association between these strata and the individual social vulnerability of the mothers was evaluated using the Pearson's Chi-square test. Linear regression models were adjusted to evaluate the association between PTM and socioeconomic factors by census tract and temporal trend in PTM in different strata. Results: We identified five high prevalence clusters in peripheral regions and six with low prevalence in the central region of the municipality. Proportionally, there were more teenage mothers with a worse vulnerability index in the high prevalence stratum than in the low prevalence stratum. Places with worse socioeconomic conditions present higher PTM, a profile that did not change over time. For the increase of one unit in the Brazilian Deprivation Index and proportion of women responsible for the household, the PTM increased, respectively, by 3.8 (95%CI 3.1-4.4) and 0.086% (95%CI 0.03-0.14). There was a reduction in the global PTM in part of the period, which occurred later in the higher prevalence strata, but the proportions were stable again in the last years of study. Conclusion: Teenage pregnancy is concentrated in regions with worse socioeconomic conditions and greater maternal vulnerability and its behavior over time occurred differently in these areas.

RESUMO Objetivo: Avaliar a distribuição da proporção de mães adolescentes (PMA) no tempo e espaço e sua relação com indicadores socioeconômicos e vulnerabilidade social. Métodos: Realizou-se estudo ecológico com mães adolescentes residentes em 322 setores censitários de Foz do Iguaçu (PR) entre 2013 e 2019. Aglomerados espaciais de mães adolescentes foram identificados por varredura espacial e agrupados em estratos com diferentes prevalências. Avaliou-se a associação entre esses estratos e a vulnerabilidade social individual das mães pelo teste qui-quadrado de Pearson. Ajustaram-se modelos de regressão linear para avaliar associação entre a PMA e fatores socioeconômicos por setor censitário e tendência temporal da PMA nos diferentes estratos. Resultados: Identificaram-se cinco aglomerados de alta prevalência nas regiões periféricas e seis de baixa na região central do município. Proporcionalmente houve mais mães adolescentes com pior índice de vulnerabilidade no estrato de alta prevalência do que no de baixa. Locais com piores condições socioeconômicas apresentaram maior PMA, perfil que não mudou ao longo do tempo. Para o aumento de uma unidade do Índice Brasileiro de Privação e da proporção de mulheres responsáveis por domicílio, a PMA aumentou respectivamente 3,8 (IC95% 3,1-4,4) e 0,086% (IC95% 0,03-0,14). Houve uma redução na PMA global em parte do período, que ocorreu mais tardiamente nos estratos de maior prevalência, mas as proporções voltaram a ficar estáveis nos últimos anos de estudo. Conclusão: A gravidez na adolescência se concentra em regiões de pior condição socioeconômica e com maior vulnerabilidade materna e seu comportamento no tempo ocorreu, nessas áreas, de modo distinto.

Photobiomodulation does not improve anaerobic performance in well-trained cyclists.

To determine if photobiomodulation (PBM) has ergogenic effects on the anaerobic performance of well-trained cyclists. Fifteen healthy male road or mountain bike cyclists participated in this randomized, double-blinded, placebo-controlled, crossover study. Athletes were randomly assigned to receive photobiomodulation (630 nm, 4.6 J/cm2, 6 J per point, 16 points, PBM session) or placebo intervention (PLA session) in the first session. The athletes then performed a 30-s Wingate test to determine mean and peak average power, relative power, mean and peak velocity, mean and peak RPM, fatigue index, total distance, time to peak power, explosive strength, and power drop. After 48 h, athletes returned to the laboratory for the crossover intervention. The repeated-measures ANOVA test followed by Bonferroni post hoc test or Friedman test with Dunn's post hoc test (p < 0.05), and Cohen's d statistic were used for comparisons. Performance in the Wingate test was not significantly different (p > 0.05) between PBM and PLA sessions for any variable. Only a small effect size was detected for time to peak power (-0.40; 1.11 to 0.31) and explosive strength (0.38; -0.34 to 1.09). We conclude that irradiation with red light, under a low energy density, does not promote ergogenic effects on the anaerobic performance of cycling athletes.

Presentation approaches for enhancing interpretability of patient-reported outcomes in meta-analyses: a systematic survey of Cochrane reviews.

OBJECTIVES: To systematically survey Cochrane reviews' approaches to calculating, presenting, and interpreting pooled estimates of patient-reported outcome measures (PROMs). STUDY DESIGN AND SETTING: We retrospectively selected 200 Cochrane reviews that met the eligibility criteria. Two researchers independently extracted the pooled effect measures and approaches for pooling and interpreting the effect measures, reaching consensus through discussions. RESULTS: When primary studies used the same PROM, Cochrane review authors most often used mean differences (MDs) (81.9%) for calculating the pooled effect measures; when primary studies used different PROMs, the review authors often applied standardized mean differences (SMDs) (54.3%). Although in most cases (80.1%) the review authors interpreted the importance of effect, they failed, in 48.5% of the pooled effect measures, to report criteria for categorizing the magnitude of effect. When authors interpreted the importance of the effect, for those with primary studies using the same PROM, they most often referred to the minimally important differences (MIDs) (75.0%); for those with primary studies using different PROMs, the approaches used varied. CONCLUSION: Cochrane review authors most often used MDs or SMDs for calculating and presenting the pooled effect measures of PROs but often failed to make explicit their criteria for categorizing the magnitude of effect.

Prognosis of older patients with newly diagnosed AML undergoing antileukemic therapy: A systematic review.

BACKGROUND AND OBJECTIVE: The prognostic value of age and other non-hematological factors in predicting outcomes in older patients with newly diagnosed acute myeloid leukemia (AML) undergoing antileukemic therapy is not well understood. We performed a systematic review to determine the association between these factors and mortality and health-related quality of life or fatigue among these patients. METHODS: We searched Medline and Embase through October 2021 for studies in which researchers quantified the relationship between age, comorbidities, frailty, performance status, or functional status; and mortality and health-related quality of life or fatigue in older patients with AML receiving antileukemic therapy. We assessed the risk of bias of the included studies using the Quality in Prognostic Studies tool, conducted random-effects meta-analyses, and assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: We included 90 studies. Meta-analysis showed that age (per 5-year increase, HR 1.16 95% CI 1.11-1.21, high-quality evidence), comorbidities (Hematopoietic Cell Transplantation-specific Comorbidity Index: 3+ VS less than 3, HR 1.60 95% CI 1.31-1.95, high-quality evidence), and performance status (Eastern Cooperative Oncology Group/ World Health Organization (ECOG/WHO): 2+ VS less than 2, HR 1.63 95% CI 1.43-1.86, high-quality evidence; ECOG/WHO: 3+ VS less than 3, HR 2.00 95% CI 1.52-2.63, moderate-quality evidence) were associated with long-term mortality. These studies provided inconsistent and non-informative results on short-term mortality (within 90 days) and quality of life. CONCLUSION: High-quality or moderate-quality evidence support that age, comorbidities, performance status predicts the long-term prognosis of older patients with AML undergoing antileukemic treatment.

Development and design validation of a novel network meta-analysis presentation tool for multiple outcomes: a qualitative descriptive study.

OBJECTIVE: The Grades of Recommendations, Assessment, Development and Evaluation working group recently developed an innovative approach to interpreting results from network meta-analyses (NMA) through minimally and partially contextualised methods; however, the optimal method for presenting results for multiple outcomes using this approach remains uncertain. We; therefore, developed and iteratively modified a presentation method that effectively summarises NMA results of multiple outcomes for clinicians using this new interpretation approach. DESIGN: Qualitative descriptive study. SETTING: A steering group of seven individuals with experience in NMA and design validation studies developed two colour-coded presentation formats for evaluation. Through an iterative process, we assessed the validity of both formats to maximise their clarity and ease of interpretation. PARTICIPANTS: 26 participants including 20 clinicians who routinely provide patient care, 3 research staff/research methodologists and 3 residents. MAIN OUTCOME MEASURES: Two team members used qualitative content analysis to independently analyse transcripts of all interviews. The steering group reviewed the analyses and responded with serial modifications of the presentation format. RESULTS: To ensure that readers could easily discern the benefits and safety of each included treatment across all assessed outcomes, participants primarily focused on simple information presentations, with intuitive organisational decisions and colour coding. Feedback ultimately resulted in two presentation versions, each preferred by a substantial group of participants, and development of a legend to facilitate interpretation. CONCLUSION: Iterative design validation facilitated the development of two novel formats for presenting minimally or partially contextualised NMA results for multiple outcomes. These presentation approaches appeal to audiences that include clinicians with limited familiarity with NMAs.

Less intensive antileukemic therapies (monotherapy and/or combination) for older adults with acute myeloid leukemia who are not candidates for intensive antileukemic therapy: A systematic review and meta-analysis.

INTRODUCTION: Elderly patients with acute myeloid leukemia not eligible for intensive antileukemic therapy are treated with less intensive therapies, uncertainty remains regarding their relative merits. OBJECTIVES: To compare the effectiveness and safety of less intensive antileukemic therapies for older adults with newly diagnosed AML not candidates for intensive therapies. METHODS: We included randomized controlled trials (RCTs) and non-randomized studies (NRS) comparing less intensive therapies in adults over 55 years with newly diagnosed AML. We searched MEDLINE and EMBASE from inception to August 2021. We assessed risk of bias of RCTs with a modified Cochrane Risk of Bias tool, and NRS with the Non-Randomized Studies of Interventions tool (ROBINS-I). We calculated pooled hazard ratios (HRs), risk ratios (RRs), mean differences (MD) and their 95% confidence intervals (CIs) using a random-effects pairwise meta-analyses and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: We included 27 studies (17 RCTs, 10 NRS; n = 5,698), which reported 9 comparisons. Patients were treated with azacitidine, decitabine, and low-dose cytarabine (LDAC), as monotherapies or in combination with other agents. Moderate certainty of evidence suggests no convincing difference in overall survival of patients who receive azacitidine monotherapy compared to LDAC monotherapy (HR 0.69; 95% CI, 0.31-1.53), fewer febrile neutropenia events occurred between azacitidine monotherapy to azacitidine combination (RR 0.45; 95% CI, 0.31-0.65), and, fewer neutropenia events occurred between LDAC monotherapy to decitabine monotherapy (RR 0.62; 95% CI 0.44-0.86). All other comparisons and outcomes had low or very low certainty of evidence. CONCLUSION: There is no convincing superiority in OS when comparing less intensive therapies. Azacitidine monotherapy is likely to have fewer adverse events than azacitidine combination (febrile neutropenia), and LDAC monotherapy is likely to have fewer adverse events than decitabine monotherapy (neutropenia).

Ergogenic Effects of Photobiomodulation on Performance in the 30-Second Wingate Test: A Randomized, Double-Blind, Placebo-Controlled, Crossover Study.

ABSTRACT: Molina Correa, JC, Padoin, S, Varoni, PR, Demarchi, MC, Flores, LJ, Nampo, FK, and de Paula Ramos, S. Ergogenic effects of photobiomodulation on performance in the 30-second Wingate test: A randomized, double-blind, placebo-controlled, crossover study. J Strength Cond Res 36(7): 1901-1908, 2022-The purpose of this study was to evaluate the ergogenic effects of red light (630 nm) photobiomodulation on anaerobic capacity in the Wingate test. Sixteen healthy and physically active male volunteers (21.71 ± 2.49 years of age, body mass index between 18.5 and 24.9 kg/m2) participated in this randomized, double-blind, placebo-controlled, crossover study. The subjects performed 3 Wingate test sessions, with a 48-hour interval between tests. In the first session (baseline session, BS), a Wingate test was performed to evaluate the initial performance. Subjects were paired by performance in the BS and allocated through a draw to receive either the phototherapy (630 nm, 4.6 J/cm2, 6 J per point, 16 points, light-emitting diode [LED] session) or placebo intervention (PLA session) in the second test session. In the third test session, a crossover intervention was performed. The repeated-measures analysis of variance test, followed by Bonferroni post hoc test or Friedman test with Dunn's post hoc test (p < 0.05) and Cohen's d statistic were used for comparisons. The LED session with phototherapy promoted an increase in performance in peak power (p < 0.05), relative power (p < 0.05), RPMpeak (p < 0.05), and peak velocity (p < 0.05), as well as total displacement (p < 0.01) compared with PLA. The mean power (p < 0.05), relative power (p < 0.05), RPMmean (p < 0.01), and mean velocity (p < 0.01) were higher in the LED session than those of BS. We concluded that phototherapy improves performance in Wingate anaerobic exercise, possibly due to large effects on the anaerobic alactic metabolism.

Health Related Values and Preferences Regarding Meat Intake: A Cross-Sectional Mixed-Methods Study.

BACKGROUND: In addition to social and environmental determinants, people's values and preferences determine daily food choices. This study evaluated adults' values and preferences regarding unprocessed red meat (URM) and processed meat (PM) and their willingness to change their consumption in the face of possible undesirable health consequences. METHODS: A cross-sectional mixed-methods study including a quantitative assessment through an online survey, a qualitative inquiry through semi-structured interviews, and a follow-up assessment through a telephone survey. We performed descriptive statistics, logistic regressions, and thematic analysis. RESULTS: Of 304 participants, over 75% were unwilling to stop their consumption of either URM or PM, and of those unwilling to stop, over 80% were also unwilling to reduce. Men were less likely to stop meat intake than women (odds ratios < 0.4). From the semi-structured interviews, we identified three main themes: the social and/or family context of meat consumption, health- and non-health-related concerns about meat, and uncertainty of the evidence. At three months, 63% of participants reported no changes in meat intake. CONCLUSIONS: When informed about the cancer incidence and mortality risks of meat consumption, most respondents would not reduce their intake. Public health and clinical nutrition guidelines should ensure that their recommendations are consistent with population values and preferences.

Applying evidence-based methods to the development and use of adverse outcome pathways

The workshop "Application of evidence-based methods to construct mechanistic frameworks for the development and use of non-animal toxicity tests" was organized by the Evidence-based Toxicology Collaboration and hosted by the Grading of Recommendations Assessment, Development and Evaluation Working Group on June 12, 2019. The purpose of the workshop was to bring together international regulatory bodies, risk assessors, academic scientists, and industry to explore how systematic review methods and the adverse outcome pathway framework could be combined to develop and use mechanistic test methods for predicting the toxicity of chemical substances in an evidence-based manner. The meeting covered the history of biological frameworks, the way adverse outcome pathways are currently developed, the basic principles of systematic methodology, including systematic reviews and evidence maps, and assessment of cer­tainty in models, and adverse outcome pathways in particular. Specific topics were discussed via case studies in small break-out groups. The group concluded that adverse outcome pathways provide an important framework to support mechanism-based assessment in environmental health. The process of their development has a few challenges that could be addressed with systematic methods and automation tools. Addressing these challenges will increase the transparency of the evidence behind adverse outcome pathways and the consistency with which they are defined; this in turn will increase their value for supporting public health decisions. It was suggested to explore the details of applying systematic methods to adverse outcome pathway development in a series of case studies and workshops.

How do cancer screening guidelines trade off benefits versus harms and burdens of screening? A systematic survey.

OBJECTIVES: Cancer screening guidelines differ in their recommendations for or against screening. To be able to provide explicit recommendations, guidelines need to specify thresholds for the magnitude of benefits of screening, given its harms and burdens. We evaluated how current cancer screening guidelines address the relative importance of benefits versus harms and burdens of screening. DATA SOURCE: We searched the Guidelines International Network, International Guideline Library, ECRI Institute and Medline. Two pairs of reviewers independently performed guideline selection and data abstraction. ELIGIBILITY CRITERIA: We included all cancer screening guidelines published in English between January 2014 and April 2019. RESULTS: Of 68 eligible guidelines, 25 included a statement regarding the trade-off between screening benefits versus harms and burdens (14 guidelines), or a statement of direction of the net effect (defined as benefits minus harms or burdens) (13 guidelines). None of these 25 guidelines defined how large a screening benefit should be to recommend screening, given its harms and burdens. 11 guidelines performed an economic evaluation of screening. Of these, six identified a key benefit outcome; two specified a cost-effectiveness threshold for recommending a screening option. Eight guidelines commented on people's values and preferences regarding the trade-off between benefits versus harms and burdens. CONCLUSIONS: Current cancer screening guidelines fail to specify the values and preferences underlying their recommendations. No guidelines provide a threshold at which they believe the benefits of screening outweigh its harms and burdens. PROSPERO REGISTRATION NUMBER: CRD42019138590.

Major birth defects in the Brazilian side of the triple border: a population-based cross-sectional study.

BACKGROUND: Major birth defects increase the risk of fetal death and pediatric hospitalization, which also impact on healthcare costs. Sociodemographic factors can drastically affect reproductive health and be used to discriminate the exposure to hidden risk factors. Foz do Iguassu is a Brazilian city located in the triple-border region of Brazil / Paraguay / Argentina with high rates of birth defects. However no study aimed to verify factors associated with this incidence or preventive care is reported. The current work investigated the prevalence of major birth defects and its association with maternal sociodemographic factors in Foz do Iguassu. METHODS: In this population-based cross-sectional study we used data of all live births occurred in Foz do Iguassu from 2012 to 2017. The associated sociodemographic variables such as maternal age, maternal education, maternal race, country of residence, maternal parity and onset of prenatal care were analyzed. Each major birth defect was described according to absolute and relative frequencies, Kruskal-Wallis and logistic regression models were used to evaluate variables associated with selected birth defects. RESULTS: The most prevalent major birth defects were Cleft Lip and/or Palate (9.5/10,000), gastroschisis (6.93/10,000), spina bifida (5.53/10,000), hydrocephalus (5.53/10,000), hypospadias (4.55/10,000), Down syndrome (4.23/10,000), anencephaly (2.93/10,000), anorectal atresia / stenosis (1.95/10,000), undetermined sex (1.95/10,000), esophageal atresia / stenosis with or without fistula (1.63/10,000) and limb reduction defects (1.30/10,000). Maternal age was associated with gastroschisis and Down syndrome. Only maternal education up to 7 years was statistically associated with major birth defects considering all other sociodemographic variables. CONCLUSION: Cleft Lip and/or Palate and Gastroschisis prevalence were higher than those found in the literature. This findings may suggest a distinct epidemiological behavior regarding major birth defects in the region. The work opens new perspectives for birth defects risk factors in the triple-border.

The effect of natural products in animal models of temporomandibular disorders.

Treatment of temporomandibular disorders (TMD) is a challenge for health care professionals. Therefore, new approaches have been investigated, such as the use of natural products. Objective This systematic review aims to summarize the natural products used in treatment of experimental models of TMD. Methodology A systematic search was performed in the databases Medline, Web of Science, Scopus, Embase, SciELO, LILACS, and Scholar Google databases in January 2020, dating from their inception. Pre-clinical studies with natural products for intervention in experimental TMD were included. Two reviewers independently selected the studies, extracted the data, and evaluated the risk of bias. Results 17 records were selected, and 17 different natural products were found, including three lectins, three plants or algae extracts, three sulfated polysaccharides, three cocoa preparations, and five isolated compounds. Concerning the risk of bias, most studies lacked on randomization and blinding. Nociception induced by phlogistic agents was evaluated in most articles, and in five studies it was associated with analysis of inflammatory parameters. In order to investigate the mechanism of action of the natural products used, eight studies evaluated expression of neural or glial molecular markers. Conclusions 16 of 17 natural products found in this review presented positive results, showing their potential for treatment of TMD. However, the lack of methodological clarity can influence these results.

Natural products for orofacial nociception in pre-clinical studies: A systematic review.

OBJECTIVE: The aim of this systematic review was to summarize the use of natural products (NP) in the treatment of orofacial nociception in animal models. METHODS: Pre-clinical studies that have evaluated the efficacy of NPs in experimental orofacial nociception were sought in the Medline, Web of Science, Scopus, Embase, SciELO, LILACS and Scholar databases in January 2020, covering the period since the inception of each one. Two reviewers independently selected the studies, extracted the data and evaluated the risk of bias of the included studies. RESULTS: We included 41 records in qualitative synthesis. Fifty different NPs were investigated. All studies presented positive results for at least one orofacial nociception test. Regarding the risk of bias, most studies presented poor experimental design, mainly lack of randomization and blinding. The main class of isolated compounds tested was terpenes, of which monoterpenes were investigated in the majority of the studies. CONCLUSION: These results indicate that NPs are effective in treating experimental orofacial nociception and highlight some of these NPs, mainly terpenes, suggesting their potential for translational research.

Chemical cleaning methods for prostheses colonized by Candida spp.: A systematic review.

STATEMENT OF PROBLEM: Different chemical agents have been used to clean and decontaminate dentures. However, consensus on their effectiveness and protocol for use is lacking. PURPOSE: The purpose of this systematic review was to evaluate chemical cleaning methods used to promote a reduction in or elimination of Candida spp. from dental prostheses. MATERIAL AND METHODS: Searches were performed in the electronic databases MEDLINE, Cochrane Library, Elsevier, Embase, SciELO, Scopus, Web of Science, Bvsalud, and Google Scholar. Manual searches were also performed. There were no restrictions on date of publication or language. Randomized clinical trials on the reduction of prosthesis surface colonization by Candida spp. by using chemical agents compared with distilled water were included. RESULTS: After the first screening, 52 studies were included, of which 5 were included for quality assessment. The studies evaluated the efficacy of alkaline peroxides, chlorhexidine, and chlorine dioxide. Among the studied solutions, alkaline peroxides demonstrated no effect on the decrease of Candida spp. on prostheses. Chlorhexidine and chlorine dioxide significantly reduced colony-forming unit (CFU) rates of these microorganisms. CONCLUSIONS: The evaluated studies presented a high risk of bias and weak evidence of the effects of chemical agents to reduce CFU counts of Candida spp. Only chlorhexidine and chlorine dioxide demonstrated some evidence of a reduction in Candida spp. colonization. Clinical trials with better methodological designs should be performed to clarify the effectiveness of these solutions in prosthesis decontamination.

Evaluating adults' health-related values and preferences about unprocessed red meat and processed meat consumption: protocol for a cross-sectional mixed-methods study.

Background: People need to choose from a wide range of foods, and in addition to availability and accessibility, people's values and preferences largely determine their daily food choices. Given the potential adverse health consequences of red and processed meat and the limited knowledge on individuals' health-related values and preferences on the topic, such data would be useful in the development of recommendations regarding meat consumption. Methods and analysis: We will perform an international cross-sectional mixed methods study in four countries across two continents. The study population will consist of adult omnivores currently consuming a minimum of three weekly servings of either unprocessed red meat or processed meat. We will explore participants' willingness to stop or reduce their unprocessed red meat, or their processed meat consumption through a direct-choice exercise. This exercise will consist of presenting a scenario tailored to each individual's average weekly consumption. That is, based on a systematic review and meta-analysis of the best estimate of the risk reduction in overall cancer mortality and cancer incidence, we will ask participants if they would stop their consumption, and/or reduce their average consumption. We will also present the corresponding certainty of the evidence for the potential risk reductions. Finally, for all included participants, we will measure their meat consumption three months after the interview and determine if they have made any changes to their average consumption. Ethics and dissemination: The research protocol was approved by the ethics committees in Canada (Research Ethics Board, Dalhousie University), Spain (Comitè Ètic d'Investigació Clínica de l'IDIAP Jordi Gol), Poland (The Bioethics Committee of the Jagiellonian University), and Brazil (National Research Ethics Commission). The study is based on voluntary participation and informed written consent. Results from this project will be disseminated through publications and presentations.

The effect of natural products in animal models of temporomandibular disorders

Abstract Treatment of temporomandibular disorders (TMD) is a challenge for health care professionals. Therefore, new approaches have been investigated, such as the use of natural products. Objective This systematic review aims to summarize the natural products used in treatment of experimental models of TMD. Methodology A systematic search was performed in the databases Medline, Web of Science, Scopus, Embase, SciELO, LILACS, and Scholar Google databases in January 2020, dating from their inception. Pre-clinical studies with natural products for intervention in experimental TMD were included. Two reviewers independently selected the studies, extracted the data, and evaluated the risk of bias. Results 17 records were selected, and 17 different natural products were found, including three lectins, three plants or algae extracts, three sulfated polysaccharides, three cocoa preparations, and five isolated compounds. Concerning the risk of bias, most studies lacked on randomization and blinding. Nociception induced by phlogistic agents was evaluated in most articles, and in five studies it was associated with analysis of inflammatory parameters. In order to investigate the mechanism of action of the natural products used, eight studies evaluated expression of neural or glial molecular markers. Conclusions 16 of 17 natural products found in this review presented positive results, showing their potential for treatment of TMD. However, the lack of methodological clarity can influence these results.

Determinants of neonatal mortality in the largest international border of Brazil: a case-control study.

BACKGROUND: Foz do Iguassu is a Brazilian municipality located in the most populous international border of the country and provides medical care to foreigners. Neonatal mortality in the city is higher than Brazil's average and corresponds to 61% of all deaths in children under five. The current study aimed to identify the determinants of neonatal mortality in Foz do Iguassu. METHODS: In this case-control study, we analyzed all neonatal deaths occurred in Foz do Iguassu from 2012 to 2016. Birth and mortality data were extracted from two national governmental databases (SINASC and SIM). We extracted data on (i) maternal sociodemographic characteristics, (ii) pregnancy care, and (iii) newborn characteristics. Multiple logistic regression with the conceptual framework was applied to examine the factors associated with neonatal mortality. RESULTS: Most of the deaths occurred in the early neonatal period (65.9%). The factors associated with neonatal death were fetal congenital anomaly (OR 22.49; CI 95% 7.44-67.95; p = < 0.001); low birth weight (OR 17.15; CI 95% 8.56-34.37; p = < 0.001), first minute Apgar score under 7 (OR 15.60; CI 95% 8.23-29.67; p = < 0.001); zero to 3 prenatal appointments (OR 3.34; CI 95% 1.28-8.73; p = 0.014) and prematurity (OR 3.60; CI 95% 1.87-7.11; p = < 0.001). CONCLUSION: The high rate of neonatal death in Foz do Iguassu is strongly associated with newborn characteristics and not associated with maternal sociodemographic characteristics. Thus, the health services in the Brazilian side of this international borders should be aware of the quality of the prenatal care and childbirth attention provided.

Safety, efficacy and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade cervical intraepithelial neoplasia associated with human papillomavirus: a systematic review protocol.

INTRODUCTION: Eighty per cent of the sexually active population will get human papillomavirus (HPV) infection, which is the most prevalent sexually transmitted disease worldwide. Persistence of high-grade HPV infection may evolve to a cervical intraepithelial neoplasia (CIN), and these lesions may be precursors of cervical cancer. However, this progression can be prevented by the administration of therapeutic vaccines which use the main oncoproteins responsible for cancer development in an attempt to trigger a more specific and effective immunological response against this disorder. We aim to evaluate the safety, efficacy and immunogenicity of therapeutic vaccines in the treatment of patients with high-grade CIN 2/3 associated with HPV. METHODS AND ANALYSIS: A systematic review of clinical trials will be undertaken. Medline, Excerpta Medica Database, Cochrane Central Register of Controlled Trials, Web of Science, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online and Scopus will be searched, with no restriction regarding publication date. Primary outcomes will include measures related to safety, efficacy and the immunogenicity of the therapeutic vaccines used in these patients. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for randomised controlled trials, and the quality evidence of the risk of bias in single studies will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. A narrative synthesis will be done for all included studies. Outcomes will be analysed according to the subgroups of HPV type, CIN grade, route of vaccine administration and vaccine type. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges' g score for both fixed and random effect models. I 2 statistics will be used to assess heterogeneity and identify their potential sources. ETHICS AND DISSEMINATION: Ethical approval is not required as primary data will not be collected. Findings will be disseminated widely via peer-reviewed publication and in different media, for example, conferences, congresses or symposia. PROSPERO REGISTRATION NUMBER: CRD42017077428.

Instruments for the detection of frailty syndrome in older adults: A systematic review.

Frailty is a dynamic process in which there is a reduction in the physical, psychological and/or social function associated with aging. The aim of this study was to identify instruments for the detection of frailty in older adults, characterizing their components, application scenarios, ability to identify pre-frailty and clinimetric properties evaluated. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), under registration number CRD42017039318. A total of 14 electronic sources were searched to identify studies that investigated instruments for the detection of frailty or that presented the construction and/or clinimetric evaluation of the instrument, according to criteria established by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). 96 studies were included in the qualitative synthesis: 51 instruments for the detection of frailty were identified, with predominantly physical domains; 40 were constructed and/or validated for use in the older adult community population, 28 only highlighted the distinction between frail and non-frail individuals and 23 presented three or more levels of frailty. The FRAGIRE, FRAIL Scale, Edmonton Frail Scale and IVCF-20 instruments were the most frequently analyzed in relation to clinimetric properties. It was concluded that: (I) there is a large number of instruments for measuring the same construct, which makes it difficult for researchers and clinicians to choose the most appropriate; (II) the FRAGIRE and CFAI stand out due to their multidimensional aspects, including an environmental assessment; however, (III) the need for standardization of the scales was identified, since the use of different instruments in clinical trials may prevent the comparability of the results in systematic reviews and; (IV) considering the different instruments identified in this review, the choice of researchers/clinicians should be guided by the issues related to the translation and validation for their location and the suitability for their context.