Sulfated Nutrition Modifies Nutrient Content and Photosynthetic Pigment Concentration in Cabbage under Salt Stress.

Negative effects of salt stress may be counteracted by adequate management of sulfated nutrition. Herein, we applied 3.50, 4.25, and 5.00 mM SO42- in a nutrient solution to counteract salt stress induced by 75 and 150 mM NaCl in cabbage cv. Royal. The increase in NaCl concentration from 75 to 150 mM reduced the contents of macronutrients and micronutrients in the shoot. When increasing from 3.50 to 4.25 mM SO42-, the contents of nitrogen (N), phosphorous (P), potassium (K), calcium (Ca), magnesium (Mg), and sulfur (S) in shoots were enhanced, at both concentrations of NaCl. Increasing from 3.50 to 4.25 mM SO42- enhanced iron (Fe), zinc (Zn), manganese (Mn), and sodium (Na) concentrations with 75 mM NaCl. With 150 mM NaCl, the increase from 3.50 to 4.25 mM SO42- enhanced the contents of Cu and Mn, but also those of Na. Chlorophylls a, b, and total decreased as the concentration of SO42- increased in plants treated with 150 mM NaCl. With 75 mM NaCl, carotenoid concentration had a positive relationship with SO42-. Hence, the 4.25 mM SO42- concentration increased the contents of macronutrients and micronutrients in the presence of 75 mM NaCl, while, with 150 mM NaCl, it improved the contents of macronutrients except K. The chlorophyll a/chlorophyll b ratio remained close to 3 when the plants were treated with 5.00 mM SO42-, regardless of NaCl. Similarly, this level of SO42- increased the concentration of carotenoids, which translated into reductions in the total chlorophyll/carotenoid ratios, indicating a protective effect of the photosynthetic apparatus. It is concluded that higher doses of sulfur favor the accumulation of nutrients and increase the concentration of carotenoids under salt stress.

What are the global patterns of microplastic ingestion by fish? A scientometric review.

The billions of tons of plastic released into the environment mostly fragment into smaller particles that reach rivers and oceans, posing toxicity risks to aquatic organisms. As fish serve as excellent environmental indicator organisms, this study aims to comprehensively review and quantify published data regarding the abundance of microplastics (MPs) ingested by fish through scientometric analysis. Systematic analysis reveals that global aquatic ecosystems are contaminated by MPs, with the characteristics of these contaminants stemming from inadequate disposal management practices. The abundance of MPs was recorded in several fish species, notably Cyprinus carpio in natural environments and Danio rerio in controlled environments. According to the surveyed studies, laboratory experiments do not accurately represent the conditions found in natural environments. The results suggest that, in natural environments, the predominant colors of MPs are blue, black, and red. Fibers emerged as the most prevalent type, with polyethylene (PE) and polypropylene (PP) being the most frequently identified chemical compositions. On the other hand, laboratory studies showed that the spheres and fragments ingested were predominantly polystyrene (PS) green, followed by the colors blue and red. This discrepancy complicates drawing accurate conclusions regarding the actual effects of plastic particles on aquatic biota. Given the enduring presence of plastic in the environment, it is imperative to consider and implement environmental monitoring for effective, long-term management.

Oscillometry of the respiratory system in Parkinson's disease: physiological changes and diagnostic use.

BACKGROUND: Lung function analysis in Parkinson's disease (PD) is often difficult due to the demand for adequate forced expiratory maneuvers. Respiratory oscillometry exams require onlyquiet tidal breathing and provide a detailed analysis of respiratory mechanics. We hypothesized that oscillometry would simplify the diagnosis of respiratory abnormalitiesin PD and improve our knowledge about the pathophysiological changes in these patients. MATERIALS AND METHODS: This observational study includes 20 controls and 47 individuals with PD divided into three groups (Hoehn and Yahr Scale 1-1.5; H&Y scale 2-3 and PD smokers).The diagnostic accuracy was evaluated by investigating the area under the receiver operating characteristic curve (AUC). RESULTS: Initial stages are related to increased peripheral resistance (Rp; p = 0.001). In more advanced stages, a restrictive pattern is added, reflected by reductions in dynamic compliance (p < 0.05) and increase in resonance frequency (Fr; p < 0.001). Smoking PD patients presented increased Rp (p < 0.001) and Fr (p < 0.01). PD does not introduce changes in the central airways. Oscillometric changes were correlated with respiratory muscle weakness (R = 0.37, p = 0.02). Rp showed adequate accuracy in the detection of early respiratory abnormalities (AUC = 0.858), while in more advanced stages, Fr showed high diagnostic accuracy (AUC = 0.948). The best parameter to identify changes in smoking patients was Rp (AUC = 0.896). CONCLUSION: The initial stages of PD are related to a reduction in ventilation homogeneity associated with changes in peripheral airways. More advanced stages also include a restrictive ventilatory pattern. These changes were correlated with respiratory muscle weakness and were observed in mild and moderate stages of PD in smokers and non-smokers. Oscillometry may adequately identify respiratory changes in the early stages of PD and obtain high diagnostic accuracy in more advanced stages of the disease.

Callus Type, Growth Regulators, and Phytagel on Indirect Somatic Embryogenesis of Coffee (Coffea arabica L. var. Colombia).

Coffee is a crop of global relevance. Indirect somatic embryogenesis has allowed plants of different coffee genotypes to be massively regenerated. The culture medium composition can affect the calli characteristics that are generated and their ability to form somatic embryos. This research aimed to determine the influence of the type of callus, growth regulators, and phytagel concentration on the embryogenic capacity of the Colombia variety. Leaf explants were cultured on Murashige and Skoog medium with 2,4-dichlorophenoxyacetic acid (2,4-D) (0.5-1.0 mg L-1), benzylaminopurine (BAP, 1.0 mg L-1), and phytagel (2.3-5.0 g L-1). The explants generated two types of calli: friable (beige, soft, watery, easy disintegration, polyhedral parenchyma cells) and compact (white, hard, low water content, difficult disintegration, elongated parenchyma cells). About 68% of the total callus generated was compact; this type of callus produced a greater number of embryos (71.3) than the friable one (29.2). The number of differentiated embryos was significantly affected by the concentration of phytagel; higher concentrations (5.0 g L-1) resulted in larger quantities (73.7). The highest number of embryos (127.47) was obtained by combining 1.0 mg L-1 2,4-D, 1.0 mg L-1 BAP, 5.0 g L-1 phytagel, and compact callus.

Prevalence and local causes for retention of primary teeth and the associated delayed permanent tooth eruption.

BACKGROUND: This study aimed to evaluate the prevalence of retained primary teeth (RPT) associated with delayed permanent tooth eruption and the factors associated with this condition in German children. METHODS: This is a cross-sectional retrospective study that evaluated panoramic radiographs from orthodontic patients. The diagnosis of RPT was established according to Nolla developmental stage. The primary tooth was considered retained when its successor permanent tooth was in Nolla stage 8, 9, or 10. Statistical analysis was performed with an α of 5% (p < 0.05). RESULTS: A total of 102 children (48 girls and 54 boys), and 574 primary teeth and their respective permanent successor teeth were evaluated. We classified 192 teeth as RPT. Sixty-one (59.8%) children presented one or more RPT. Gender was not significantly different between RPT and control teeth (p = 0.838; odds ratio 0.95, confidence interval 95% 0.44-2.16). In the majority of the RPT cases (68.7%), no clear cause to explain the prolonged retention was identified. The pathological problems most commonly observed with RPT were dental fillings (19.3%), followed by dental caries (4.6%), and ectopic tooth eruption (2.1%). CONCLUSIONS: The incidence of RPT associated with delayed permanent tooth eruption in German children was high and the most common pathological condition associated with RPT was dental caries.

Predictors of persistent symptoms after mRNA SARS-CoV-2 vaccine-related myocarditis (myovacc registry).

Aims: Epidemiological surveillance has raised safety concerns for mRNA SARS-CoV-2-vaccination-related myocarditis. We aimed to analyze epidemiological, clinical and imaging findings associated with clinical outcomes in these patients in an international multi-center registry (NCT05268458). Methods and results: Patients with clinical and CMR diagnosis of acute myocarditis within 30 days after mRNA SARS-CoV-2-vaccination were included from five centers in Canada and Germany between 05/21 and 01/22. Clinical follow-up on persistent symptoms was collected. We enrolled 59 patients (80% males, mean age 29 years) with CMR-derived mild myocarditis (hs-Troponin-T 552 [249-1,193] ng/L, CRP 28 [13-51] mg/L; LVEF 57 ± 7%, LGE 3 [2-5] segments). Most common symptoms at baseline were chest pain (92%) and dyspnea (37%). Follow-up data from 50 patients showed overall symptomatic burden improvement. However, 12/50 patients (24%, 75% females, mean age 37 years) reported persisting symptoms (median interval 228 days) of chest pain (n = 8/12, 67%), dyspnea (n = 7/12, 58%), with increasing occurrence of fatigue (n = 5/12, 42%) and palpitations (n = 2/12, 17%). These patients had initial lower CRP, lower cardiac involvement in CMR, and fewer ECG changes. Significant predictors of persisting symptoms were female sex and dyspnea at initial presentation. Initial severity of myocarditis was not associated with persisting complaints. Conclusion: A relevant proportion of patients with mRNA SARS-CoV-2-vaccination-related myocarditis report persisting complaints. While young males are usually affected, patients with persisting symptoms were predominantly females and older. The severity of the initial cardiac involvement not predicting these symptoms may suggest an extracardiac origin.

In Vitro Mass Propagation of Coffee Plants (Coffea arabica L. var. Colombia) through Indirect Somatic Embryogenesis.

Coffea arabica is one of the two most consumed coffee species in the world. Micropropagation through somatic embryogenesis has allowed the large-scale propagation of different coffee varieties. However, the regeneration of plants using this technique depends on the genotype. This study aimed to develop a protocol for the regeneration of C. arabica L. var. Colombia by somatic embryogenesis for its mass propagation. Foliar explants were cultured on Murashige and Skoog (MS) supplemented with different concentrations of 2,4-dichlorophenoxyacetic acid (2,4-D), 6-benzylaminopurine (BAP), and phytagel for inducing somatic embryogenesis. In total, 90% of the explants formed embryogenic calli with a culture medium containing 2 mg L-1 of 2,4-D, 0.2 mg L-1 BAP, and 2.3 g L-1 phytagel. The highest number of embryos per gram of callus (118.74) was obtained in a culture medium containing 0.5 mg L-1 2,4-D, 1.1 mg L-1 BAP, and 5.0 g L-1 phytagel. In total, 51% of the globular embryos reached the cotyledonary stage when they were cultured on the growth medium. This medium contained 0.25 mg L-1 BAP, 0.25 mg L-1 indoleacetic acid (IAA), and 5.0 g L-1 of phytagel. The mixture of vermiculite:perlite (3:1) allowed 21% of embryos to become plants.

Effect of the Case for Carpule as a Visual Passive Distraction Tool on Dental Fear and Anxiety: A Pilot Study.

The present cross-over study aimed to evaluate the effect of a visual passive distraction tool, a case for carpule, in the management of fear and anxiety during invasive dental treatment. Children between the ages of 4 and 8 years that need at least two treatments with inferior alveolar nerve block were selected. All the included children received two treatments at different moments: in one treatment, local anesthesia was performed with a visual passive distraction tool, the crocodile case, for carpule (experimental); in the other treatment, local anesthesia was performed without the device (control). An evaluation of the anxiety levels was performed by measuring the heart rate and salivary cortisol levels. Wilcoxon's nonparametric test was used for a data analysis (p < 0.05). The mean heart rate with the visual passive distraction device fell from 81.8 to 78.1, while the control rose from 91.4 to 100 (p < 0.05). The mean salivary cortisol levels with the visual passive distraction device fell from 2.0 to 1.6, while in the control, they rose from 2.1 to 2.4 (p < 0.05). In conclusion, the crocodile case for carpule as a visual passive distraction device contributed positively to the management of fear and anxiety during inferior alveolar nerve block in children.

Sindrome de burnout, atividade física e fatores ocupacionais que afetam os servidores púbicos de uma universidade federal do sul do Brasil / Burnout syndrome, physical activity and occupational factors that affect public servants at a federal university in southern Brazil / Síndrome de burnout, actividad física y factores ocupacionales que afectan a los servidores públicos de una universidad federal del sur de Brasil

O estudo buscou identificar a prevalência de Síndrome de Burnout (SB), bem como verificar se existe uma associação da SB com fatores ocupacionais e a prática de atividade física (AF) em servidores técnico-administrativos (STA) de uma universidade federal do sul do Brasil. A amostra foi composta por 203 STA. Foram coletados dados sociodemográficos, ocupacionais, nutricional, SB e prática de AF. A prevalência de SB entre os STA foi de 50%, sendo que a mesma esteve associada inversamente com a faixa etária (p=0,02) e com as atividades administrativas ou de escritório (p=0,008), ambas com proteção superior a 30%. Conclui-se que a prevalência de SB é elevada entre os STA e que políticas voltadas a redução dos fatores que levam a SB entre STA devem ser criadas e implementadas pela instituição, auxiliando na redução do adoecimento (AU).

The study sought to identify the prevalence of Burnout Syndrome (BS), as well as to verify if there is an association of BS with occupational factors and the practice of physical activity (PA) in technical-administrative servers (TAS) of a federal university in south of Brazil. The sample was composed by 203 STA. Sociodemographic, occupational, nutritional, SB and PA practice data were collected. The prevalence of BS among the TAS was 50%, being that it was inversely associated with age group (p=0.02) and with administrative or desk activities (p=0.008), both with protection greater than 30 %. It was concluded that the prevalence of BS is high among the TAS and policies aimed at reducing two factors that lead to BS among TAS should be created and implemented by the institution helping in the reduction of the treatment (AU).

El estudio buscó identificar la prevalencia del Síndrome de Burnout (SB), así como verificar si existe asociación del SB con actores ocupacionales y la práctica de actividad física (AF) en servidores técnico-administrativos (STA) de una universidad federal en el sur de Brasil. La muestra fue compuesta por 203 STA. Fueron colectados datos sociodemográficos, ocupacionales, nutricional, SB y práctica de AF. La prevalencia de SB entre os STA foi de 50%, siendo que la misma estuvo asociada inversamente com el grupo de edad (p=0,02) y com las actividades administrativas o- de oficina (p=0,008), ambas con protección superior a 30 % Se concluyo que la prevalencia de SB es elevada entre los STA y políticas específicas de disminución de los factores que llevam a SB entre STA deven ser creadas y aplicadas por la institución auxiliando en la disminución de dolencias (AU).

Engineering of ion permeable planar membranes and polymersomes based on ß-cyclodextrin-cored star copolymers.

For polymersome-based nanoreactor purposes, we herein present the synthesis and characterization of well-defined star amphiphilic copolymers composed of a beta-cyclodextrin (ßCD) core and seven poly(butylene oxide)-block-polyglycidol (PBO-PGL) arms per side (ßCD-(PBO-PGL)14). The self-assembly behavior of 14-armed ßCD-(PBO-PGL)14 and PGL-PBO-PGL (linear analogues without the ßCD segment) was investigated using scattering techniques for comparison. The morphologies, including vesicles and micelles, are governed by the hydrophobic-to-hydrophilic (weight) ratio, regardless of the polymer architecture (linear or star). Interestingly, despite notable differences in polymer conformation, the produced supramolecular structures were evidenced to be fairly similar on the structural point of view. We subsequently investigated the ion permeability of the membranes of the self-assemblies focusing on the impact of the presence of ßCD. The results demonstrated that the ßCD-containing vesicular membranes are less permeable to H+, compared with ßCD-free vesicular membranes. The presence of ßCD in planar membranes also influences the K+Cl- permeability to some extent. Thus, ßCD-containing membranes can be considered as potential candidates in designing nano-containers towards applications where precise changes in environmental pH are required.

Comparison of Apple Watch vs KardiaMobile: A Tale of Two Devices.

Background: The Apple Watch Series 4 (AW4) and the KardiaMobile single bipolar lead model (KM) are 2 of the most popular US Food & Drug Administration (FDA)-approved commercial heart trackers. However, a lack of knowledge remains regarding their rhythm-detection accuracy in real-life clinical situations. This paper aims to determine the practicality of using an AW4 or a KM in modern medical practice, by assessing the accuracy of each in identifying heart rhythms and heart rate. Methods: Participants from the Toronto Heart Centre clinic were enrolled from January 2019 to December 2019. They had a 12-lead electrocardiogram (ECG), followed by wearing the AW4 watch (OS 5.3), and pressing on the KM electrode plates, within the span of 5 minutes of one another. Each session involved a 12-lead ECG, an ECG from each device, and AW4's photoplethysmography function (APPG). Results: Of 200 participants, 162 (81%) were in sinus rhythm, and 38 (19%) had atrial fibrillation. The rhythm-detection accuracy for sinus rhythm was 100% for the AW4, and 99.03% for the KM. For atrial fibrillation, accuracy was 90.48% for the AW4, and 100% for the KM. The heart rate accuracy for sinus rhythm was 94.39% for the KM, 90.65% for the APPG, and 96.26% for the Apple ECG function. The heart rate accuracy for atrial fibrillation was 91.30% for the KM, 82.61% for the APPG, and 86.96% for the Apple ECG function. Conclusions: Both the AW4 and the KM could reliably detect rhythm and heart rate in real-life clinical situations. However, a nonsignificant trend occurred toward better rhythm detection and accuracy with KM, compared with AW4. The difference is mainly due to artifacts (eg, tremors) and the fit of the strap for AW4. The findings have important implications for how these consumer devices can be used in real-life clinical settings.

Contexte: La Apple Watch Series 4 (AW4) et le dispositif KardiaMobile à trois électrodes (KM) sont deux des capteurs cardiaques commerciaux les plus populaires approuvés par la Food & Drug Administration (FDA) des États-Unis. Cependant, les connaissances sont encore insuffisantes en ce qui concerne leur précision à détecter le rythme cardiaque dans des situations cliniques réelles. Cet article vise à déterminer l'utilité de l'AW4 ou du KM dans la pratique médicale moderne, en évaluant la précision de chaque appareil dans la perception des rythmes cardiaques et de la fréquence cardiaque. Méthodologie: Des patients du Toronto Heart Centre ont participé à l'étude de janvier à décembre 2019. Ils ont subi un électrocardiogramme (ECG) à 12 dérivations, puis ont porté la montre AW4 (OS 5.3) et utilisé les électrodes du KM, à intervalles de 5 minutes. Chaque séance comprenait un ECG à 12 dérivations, un ECG réalisé avec chacun des dispositifs et l'utilisation de la fonction de photopléthysmographie de l'AW4. Résultats: Sur les 200 participants, 162 (81 %) étaient en rythme sinusal et 38 (19 %) présentaient une fibrillation auriculaire. Pour ce qui est du rythme cardiaque, la précision de détection chez les patients en rythme sinusal était de 100 % pour l'AW4 et de 99,03 % pour le KM. Pour ceux présentant une fibrillation auriculaire, la précision était de 90,48 % pour l'AW4 et de 100 % pour le KM. En ce qui concerne la fréquence cardiaque, la précision de détection pour le rythme sinusal était de 94,39 % pour le KM, de 90,65 % pour la fonction de photopléthysmographie de l'AW4 et de 96,26 % pour la fonction ECG d'Apple. Chez les patients atteints de fibrillation auriculaire, la précision à détecter la fréquence cardiaque était de 91,30 % pour le KM, de 82,61 % pour la fonction de photopléthysmographie de l'AW4 et de 86,96 % pour la fonction ECG d'Apple. Conclusions: L'AW4 et le KM ont tous deux permis de détecter de manière fiable le rythme cardiaque et la fréquence cardiaque dans des situations cliniques réelles. Soulignons toutefois qu'une tendance non significative s'est dégagée en faveur du KM pour ce qui est de la détection du rythme et de la précision par rapport à l'AW4. La différence s'explique principalement par des interférences (secousses) et par l'ajustement du bracelet avec l'AW4. Ces résultats ont une incidence importante quant à l'utilisation de ces appareils destinés aux consommateurs dans un contexte clinique réel.

Regular Use of Ivermectin as Prophylaxis for COVID-19 Led Up to a 92% Reduction in COVID-19 Mortality Rate in a Dose-Response Manner: Results of a Prospective Observational Study of a Strictly Controlled Population of 88,012 Subjects.

Background We have previously demonstrated that ivermectin used as prophylaxis for coronavirus disease 2019 (COVID-19), irrespective of the regularity, in a strictly controlled citywide program in Southern Brazil (Itajaí, Brazil), was associated with reductions in COVID-19 infection, hospitalization, and mortality rates. In this study, our objective was to determine if the regular use of ivermectin impacted the level of protection from COVID-19 and related outcomes, reinforcing the efficacy of ivermectin through the demonstration of a dose-response effect. Methods This exploratory analysis of a prospective observational study involved a program that used ivermectin at a dose of 0.2 mg/kg/day for two consecutive days, every 15 days, for 150 days. Regularity definitions were as follows: regular users had 180 mg or more of ivermectin and irregular users had up to 60 mg, in total, throughout the program. Comparisons were made between non-users (subjects who did not use ivermectin), and regular and irregular users after multivariate adjustments. The full city database was used to calculate and compare COVID-19 infection and the risk of dying from COVID-19. The COVID-19 database was used and propensity score matching (PSM) was employed for hospitalization and mortality rates. Results Among 223,128 subjects from the city of Itajaí, 159,560 were 18 years old or up and were not infected by COVID-19 until July 7, 2020, from which 45,716 (28.7%) did not use and 113,844 (71.3%) used ivermectin. Among ivermectin users, 33,971 (29.8%) used irregularly (up to 60 mg) and 8,325 (7.3%) used regularly (more than 180 mg). The remaining 71,548 participants were not included in the analysis. COVID-19 infection rate was 49% lower for regular users (3.40%) than non-users (6.64%) (risk rate (RR): 0.51; 95% CI: 0.45-0.58; p < 0.0001), and 25% lower than irregular users (4.54%) (RR: 0.75; 95% CI: 0.66-0.85; p < 0.0001). The infection rate was 32% lower for irregular users than non-users (RR: 0.68; 95% CI: 0.64-0.73; p < 0.0001). Among COVID-19 participants, regularusers were older and had a higher prevalence of type 2 diabetes and hypertension than irregular and non-users. After PSM, the matched analysis contained 283 subjects in each group of non-users and regular users, between regular users and irregular users, and 1,542 subjects between non-users and irregular users. The hospitalization rate was reduced by 100% in regular users compared to both irregular users and non-users (p < 0.0001), and by 29% among irregular users compared to non-users (RR: 0.781; 95% CI: 0.49-1.05; p = 0.099). Mortality rate was 92% lower in regular users than non-users (RR: 0.08; 95% CI: 0.02-0.35; p = 0.0008) and 84% lower than irregular users (RR: 0.16; 95% CI: 0.04-0.71; p = 0.016), while irregular users had a 37% lower mortality rate reduction than non-users (RR: 0.67; 95% CI: 0.40-0.99; p = 0.049). Risk of dying from COVID-19 was 86% lower among regular users than non-users (RR: 0.14; 95% CI: 0.03-0.57; p = 0.006), and 72% lower than irregular users (RR: 0.28; 95% CI: 0.07-1.18; p = 0.083), while irregular users had a 51% reduction compared to non-users (RR: 0.49; 95% CI: 0.32-0.76; p = 0.001). Conclusion Non-use of ivermectin was associated with a 12.5-fold increase in mortality rate and a seven-fold increased risk of dying from COVID-19 compared to the regular use of ivermectin. This dose-response efficacy reinforces the prophylactic effects of ivermectin against COVID-19.

Polyethylene terephthalate clamps: Optimization in endodontic and restorative practices.

Background: There is a growing search for innovations in dental materials and instruments and, therefore, an increase need to optimize the instruments used in the absolute isolation. The gold standard procedure contributes significantly to the quality of restorative and endodontic procedures. Thus, the aim of the present study was to evaluate the radiopacity of polyethylene terephthalate polymer clamps and compare them to conventional metal clamps. Material and Methods: The polyethylene terephthalate clamp was developed at the University of Uberaba (Patent application #PI0901719-4, Uberaba, MG, Brazil). Five polyethylene terephthalate clamps and five conventional metal clamps were used. The clamps were positioned, next to an aluminum scale, under the same phosphor plate to perform 3 radiographs. The locator cylinder was set perpendicular to the radiographic films at a focal length of 20 cm and set to 60 kVp and 0.06 seconds. After image processing, optical density values were read using DBWin 5.0.4 software. The mean of the 3 readings taken on each clamp was adopted as the radiodensity of the specimen. The differences between the groups were compared using Student's t-test (p<0.05). Results: Polyethylene terephthalate clamps demonstrated significantly lower radiopacity than conventional metal clamps (p<0.05). Conclusions: Polyethylene terephthalate clamps have lower radiopacity when compared to conventional metal clamps. Key words:Rubber Dams, Dentistry, Operative, Endodontics.

Counseling to change the lifestyle of sedentary workers on musculoskeletal pain: systematic review / Aconselhamento para mudança do estilo de vida de trabalhadores sedentários sobre a dor musculoesquelética: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Musculoskeletal pain (MSP) in sedentary workers is a cause of absenteeism, high health costs and is relate to their lifestyle and work. Systematic reviews of interventions on the condition of MSP in this population are based on work equipment and do not present consensus on the type of intervention and its effectiveness. Terefore, the objective was to analyze the evidence of intervention studies that included education strategies to change the lifestyle of sedentary workers on the reduction of MSP. CONTENTS: This systematic review follows the recommendations of PRISMA 2020. Searches were conducted until April 2021 in the PubMed, BIREME and Scielo databases, in order to identify randomized or non-randomized clinical trials published between January 1999 and April 2021. Indexed search descriptors were used and eligibility criteria were defined according to the PICOS strategy. The risk of bias was assessed using the PEDro scale. Eight randomized clinical trials published between 2004 and 2020, conducted in Europe, Asia, the United States and Australia involving 1,871 people (35 to 52 years old) were included. Interventions ranged from two weeks to 12 months. Five studies showed a higher number of women. In addition to lifestyle counseling, three studies addressed work characteristics (time in sitting posture, body posture) and three others investigated issues related to pain (symptoms, neck/shoulder anatomy and self-management). Six interventions were effective to reduce the intensity and frequency of MSP in the cervical and lumbar regions of the spine, shoulders and thoracic spine, which used counseling to increase the practice of physical activity, stress control, healthy eating, decreased alcohol consumption and smoking. Six studies presented medium/low bias risk in the following items: occult allocation, baseline comparability, blinding (individuals, therapists and evaluators), adequate follow-up and intention to treat analysis; and two studies presented medium/high risk in the same items, except in baseline comparability. CONCLUSION: Workplace interventions that include education strategies and counseling for lifestyle changes are effective for reducing the intensity and frequency of MSP in sedentary workers. PROSPERO registration: CRD42022342636. HIGHLIGHTS Lifestyle education can reduce musculoskeletal pain in workers. Physical activity and stress control contribute to reducing pain intensity. The workplace is a potent environment for decreasing musculoskeletal pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor musculoesquelética (DME) em trabalhadores sedentários é causa de absenteísmo, custos elevados em saúde e está relacionada ao seu estilo de vida e de trabalho. Revisões sistemáticas de intervenções sobre a condição de DME nesta população baseiam-se nos equipamentos de trabalho e não apresentam consenso quanto ao tipo de intervenção e sua efetividade. Portanto, o objetivo foi analisar as evidências dos estudos de intervenção que incluíram estratégias de educação para mudança do estilo de vida de trabalhadores sedentários para a redução da DME. CONTEÚDO: Esta revisão sistemática segue as recomendações do PRISMA 2020. Foram realizadas buscas até abril de 2021 nas bases de dados Pubmed, BIREME e Scielo, visando identificar estudos clínicos randomizados ou não randomizados publicados entre janeiro de 1999 e abril de 2021. Foram utilizados descritores de busca indexados e definidos critérios de elegibilidade segundo a estratégia PICOS. O risco de viés foi avaliado por meio da escala PEDro. Foram incluídos oito estudos clínicos randomizados publicados entre 2004 e 2020, realizados na Europa, Ásia, Estados Unidos e Austrália, que envolveram 1.871 pessoas (35 a 52 anos). As intervenções variaram de duas semanas a 12 meses. Cinco estudos apresentaram maior número de mulheres. Além dos aconselhamentos para estilo de vida, três estudos abordaram características do trabalho (tempo na postura sentada, postura corporal) e outros três investigaram questões relacionadas à dor (sintomas, anatomia pescoço/ombro e autogerenciamento). Seis intervenções foram efetivas para a redução da intensidade e da frequência de DME nas regiões cervical e lombar da coluna, nos ombros e coluna torácica, as quais utilizaram aconselhamentos para aumento da prática de atividade física, controle do estresse, alimentação saudável, diminuição do consumo de álcool e do tabagismo. Seis estudos apresentaram risco de viés médio/baixo nos itens alocação oculta, comparabilidade da linha de base, cegamento (indivíduos, terapeutas e avaliadores), acompanhamento adequado e análise de intenção de tratar; e dois estudos apresentaram risco médio/alto nos mesmos itens, exceto na comparabilidade da linha de base. CONCLUSÃO: Intervenções realizadas no local de trabalho e que incluam estratégias de educação e aconselhamentos para mudanças no estilo de vida podem ser efetivas para redução da intensidade e da frequência de DME em trabalhadores sedentários. Registro PROSPERO: CRD42022342636. DESTAQUES Educação a respeito de estilo de vida pode reduzir a dor musculoesquelética de trabalhadores. Atividade física e controle do estresse contribuem para redução da intensidade de dor. O local de trabalho é um ambiente potente para melhora na dor musculoesquelética.

Sedentary Behavior Counseling Received from Healthcare Professionals: An Exploratory Analysis in Adults at Primary Health Care in Brazil.

Counseling by health professionals has promising results in behavior change and is recommended as part of integrated community interventions. However, the knowledge about sedentary behavior (SB) counseling is incipient. The study aimed to identify the prevalence and explore the associated factors with SB counseling received from healthcare professionals by adults in primary health care (PHC) in Brazil. A cross-sectional study was conducted in 2019 that included a representative sample of 779 users in all 15 basic health units (BHU) in São José dos Pinhais, Paraná. We identified those who reported having received SB counseling during a consultation. The association between the sociodemographic factors, chronic diseases, access to health services, physical activity, SB, and counseling were analyzed using Poisson regression in a hierarchical model. The prevalence of counseling was 12.2% (95% CI: 10.1-14.7%); it was higher in women (PR: 1.77; 95% CI: 1.10-2.83), those aged ≥60 yrs (PR: 1.84; 95% CI: 1.14-2.98), BMI ≥ 30 kg/m2 (PR: 2.60; 95% CI: 1.31-5.17), who consume ≥3 medications (PR: 2.21; 95% CI: 1.06-4.59), and those who spend a prolonged period of the day engaged in SB (4th quartile PR: 3.44; 95% CI: 1.88-6.31). The results highlight that SB counseling is underutilized and incipient in PHC. Understanding these results can help managers and healthcare professionals in BHU teams to implement and direct specific actions to reduce SB in adults through counseling.

Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study.

OBJECTIVES: To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. DESIGN: Individual patient level data meta-analysis and modelling study. SETTING: Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. PARTICIPANTS: Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. MAIN OUTCOME MEASURE: Adjudicated diagnosis of acute heart failure. RESULTS: Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged <50 years, 50-75 years, and >75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups, with 40.3% (2502/6208) identified at low probability (negative predictive value of 98.6%, 97.8% to 99.1%) and 28.0% (1737/6208) at high probability (positive predictive value of 75.0%, 65.7% to 82.5%) of having acute heart failure. CONCLUSIONS: In an international, collaborative evaluation of the diagnostic performance of NT-proBNP, guideline recommended thresholds to diagnose acute heart failure varied substantially in important patient subgroups. The CoDE-HF decision support tool incorporating NT-proBNP as a continuous measure and other clinical variables provides a more consistent, accurate, and individualised approach. STUDY REGISTRATION: PROSPERO CRD42019159407.