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Understanding the impact that climate had in shaping cranial variation is critical for inferring the evolutionary mechanisms that played a role in human diversification. Here, we provide a comprehensive study aiming to analyze the association between climate and cranial variation of high latitude populations living in temperate to cold environments of Asia, North America, and South America. For this, we compiled a large morphometric dataset (N = 2633), which was combined with climatic and genomic data. We tested the influence of climate on the facial skeleton, nasal protrusion, and cranial vault and through multiple statistical tests at two geographical scales: intracontinental and intercontinental. We show that populations living in cold areas share a morphological pattern characterized by an increase in nasal height, facial and orbital heights and widths, a decrease in facial protrusion, and larger, longer, and lower cranial vaults. There are also distinctive features; populations from north Asia present the tallest noses, largest faces, and cranial vaults of the whole sample. Nasal breadth dimensions show small values in Asians, large values in South Americans, and non-significant changes in arctic North America. The morphological pattern in populations living at high latitude may be the result of parallel adaptation, as supported by physiological, morphometric, ecological, and genetic explanations, while the differences in magnitude and phenotypic expression could be due to the diverse population histories, severity of climate, and cultural strategies. Overall, our study shows that climate is a relevant factor shaping modern human morphology and it should be considered when studying modern human evolution and diversification.
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Background and Aim: Although reverse zoonotic transmission events from humans to domestic cats have been described, there is currently little evidence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) circulation in stray cats. Due to the evidence of natural and experimental infections in cats and the capacity to disseminate the virus among them, this study aimed to identify the SARS-CoV-2 antigen in stray cats from the Federal University of Sergipe in Brazil. Materials and Methods: One hundred twenty six stray cats from the university were screened for SARS-CoV-2 antigens by random sampling. Throat swab samples were tested for the virus using rapid antigen detection tests. Results: Of the 126 animals tested, 30 (23.60%) were positive for SARS-CoV-2 antigens. To our knowledge, for the first time, this study detected the SARS-CoV-2 antigen in stray cats and confirmed the presence of SARS-CoV-2 infections in Brazil's stray cat population. Conclusion: The detection of SARS-CoV-2 in stray cats poses a risk for infected and healthy animals and possibly for humans who attend the university daily. As a limitation of the study, the small sample size necessitates caution when interpreting the results. This underscores the need for further research in this area to help control diseases in stray animals during potential pandemics. This highlights the need for monitoring and controlling the spread of the virus in stray animal populations.
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This work demonstrates the effectiveness of using alternative solvents to obtain jambolan extracts with a high content of bioactive compounds compared to conventional organic solvents, being the first study to evaluate the best ecological solvent alternative for Syzygium cumini (L.) Skeels. Five alternative solvents were used for extraction: water at 25 °C (W25), water at 50 °C (W50), water at 75 °C (W75), water with citric acid at 2.4% (CA2), and water with citric acid at 9.6% (CA9) in comparison with three conventional solvents: ethanol (EtOH), water with ethanol at 50% (WE), and water with methanol at 50% (WM). A protocol was then established for the extraction and concentration of samples obtained with these solvents. The highest content of total phenolic compounds (TPCs) in the extracts was obtained with the solvent W75 (1347.27 mg GAE/100 g), while in the concentrates it was the solvents EtOH (3823.03 mg GAE/100 g) and WM (4019.39 mg GAE/100 g). Total monomeric anthocyanins (TMAs) increased by 209.31% and 179.95% in extractions with CA2 and CA9, respectively, compared to pulp (35.57 mg eq c-3-g/100 g), demonstrating that they are the most efficient alternative solvents in this extraction. The levels of bioactive compounds and antioxidant activity varied according to the solvents used. Delphinidin 3,5-diglucoside, cyanidin 3,5-diglucoside, delphinidin 3-glucoside, petunidin 3,5-diglucoside, cyanidin 3-glucoside, peonidin 3,5-diglucoside, malvidin 3,5-diglucoside, petunidin 3-glucoside, and malvidin 3-glucoside were identified in most of the samples by UPLC-MS/MS. This study suggests that a simple procedure using alternative solvents can be used as an environmentally friendly strategy to achieve efficient extraction of bioactive compounds in jambolan.
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Sulfur-containing biomolecules such as [FeS] clusters, thiamin, biotin, molybdenum cofactor, and sulfur-containing tRNA nucleosides are essential for various biochemical reactions. The amino acid l-cysteine serves as the major sulfur source for the biosynthetic pathways of these sulfur-containing cofactors in prokaryotic and eukaryotic systems. The first reaction in the sulfur mobilization involves a class of pyridoxal-5'-phosphate (PLP) dependent enzymes catalyzing a Cys:sulfur acceptor sulfurtransferase reaction. The first half of the catalytic reaction involves a PLP-dependent CS bond cleavage, resulting in a persulfide enzyme intermediate. The second half of the reaction involves the subsequent transfer of the thiol group to a specific acceptor molecule, which is responsible for the physiological role of the enzyme. Structural and biochemical analysis of these Cys sulfurtransferase enzymes shows that specific protein-protein interactions with sulfur acceptors modulate their catalytic reactivity and restrict their biochemical functions.
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Cisteína , Fosfato de Piridoxal , Enxofre , Sulfurtransferases , Enxofre/metabolismo , Enxofre/química , Cisteína/metabolismo , Cisteína/química , Sulfurtransferases/metabolismo , Sulfurtransferases/química , Fosfato de Piridoxal/metabolismo , Humanos , Cofatores de Molibdênio , Liases de Carbono-Enxofre/metabolismo , Liases de Carbono-Enxofre/químicaRESUMO
This study assesses career satisfaction, discrepancies between ideal and expected careers, and likelihood of leaving current positions among former K awardees.
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Mobilidade Ocupacional , Satisfação no Emprego , Feminino , Humanos , Masculino , Distinções e Prêmios , Estados Unidos , National Institutes of Health (U.S.) , Inquéritos e Questionários/estatística & dados numéricosRESUMO
BACKGROUND: Common etiological factors have been reported in the development of molar-incisor hypomineralisation (MIH) and dental anomalies (DA). AIM: To assess the association between MIH and DAs. DESIGN: A cross-sectional study was performed to evaluate the presence of MIH and other six DAs in a sample of 415 pretreatment records from patients aged 9-18 years. Statistical analyses were performed using the chi-squared and Fisher's exact tests, and logistic regressions. RESULTS: There was statistically significant association between the prevalence of DAs and MIH (CI: 1.43-2.43, φ-coefficient: 0.204, PR: 1.87). Higher percentage of tooth agenesis (CI: 1.37-1.68, φ-coefficient: 0.271, PR: 1.50), maxillary premolar agenesis (CI: 1.70-3.65, φ-coefficient: 0.125, PR: 2.49), mandibular second premolar agenesis (CI: 1.68-3.16, φ-coefficient: 0.172, PR: 2.30) and distoangulation of the mandibular second premolars (CI: 1.31-3.47, φ-coefficient: 0.103, PR: 2.13) was observed among children who had MIH-affected teeth. Individuals with MIH had a 2.95 times greater chance of having DAs (R2 = .153). The number of patients with DAs was higher when the first molar showed severe defects (OR = 4.47; R2 = .149). CONCLUSION: There is a weak association between MIH and DAs. Patients with severe MIH lesions have a slightly higher risk of presenting DAs.
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AIM: The purpose of this study was to evaluate the mandibular growth and/or projection following maxillary incisor proclination, overbite correction, and maxillary dentoalveolar expansion without the use of any class II mechanics, in growing class II division 2 patients treated with clear aligners. MATERIALS AND METHODS: Before and after treatment cone-beam computed tomographic (CBCT) generated lateral and posteroanterior cephalograms of thirty-two patients with skeletal class II division 2, 16 in the treatment group and 16 in the untreated group, were reviewed to evaluate treatment-related changes. Upper incisors were proclined and protruded, as well as upper arch expansion and overbite correction were performed as part of their regular treatment. Cephalometric analysis was performed to evaluate skeletal and dental changes. Unpaired statistical t-tests were performed to determine if significant skeletal class II correction was achieved in the treatment group. RESULTS: In the treatment group, after treatment, the upper incisors became more proclined and protruded, and the inter-molar width increased while the overbite was reduced compared to the control group. An increase in skeletal mandibular growth and forward projection was also observed, thus contributing to an improvement of the sagittal skeletal relationship as evidenced by ANB and Wits values compared to the control group. CONCLUSION: A combination of upper incisor proclination, correction of deep overbite, and maxillary dentoalveolar expansion using clear aligners appears to contribute to an improvement of the skeletal class II relationship in growing patients with class II division 2. CLINICAL SIGNIFICANCE: This study shows that unlocking the mandible by correcting a deep overbite, proclining upper incisors, and expanding the upper arch in growing class II division 2 patients can improve skeletal class II using clear aligners. How to cite this article: Mirzasoleiman P, El-Bialy T, Wiltshire WA, et al. Evaluation of Mandibular Projection in Class II Division 2 Subjects Following Orthodontic Treatment Using Clear Aligners. J Contemp Dent Pract 2024;25(4):295-302.
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Cefalometria , Tomografia Computadorizada de Feixe Cônico , Má Oclusão Classe II de Angle , Mandíbula , Humanos , Má Oclusão Classe II de Angle/terapia , Má Oclusão Classe II de Angle/diagnóstico por imagem , Mandíbula/crescimento & desenvolvimento , Mandíbula/diagnóstico por imagem , Feminino , Masculino , Adolescente , Criança , Incisivo/diagnóstico por imagem , Sobremordida/terapia , Ortodontia Corretiva/métodos , Ortodontia Corretiva/instrumentaçãoRESUMO
PURPOSE: Characterize heart rate and cardiac autonomic response to painful stimulus on neck pain. METHODS: Twenty-five individuals with neck pain and 25 healthy subjects were included. Heart rate variability and heart rate were assessed in the conditioned pain modulation test at pretest rest, during testing and in recovery. Heart rate variability indices were obtained using linear and nonlinear methods. RESULTS: No significant differences were observed between groups regarding heart rate and the linear methods (p > 0.05). However, significant difference was observed between groups regarding nonlinear methods (standard deviation of the instantaneous variability of beat-to-beat interval variability, p = 0.005) CONCLUSIONS: Individuals with chronic neck pain showed autonomic responses similar to those of their healthy counterparts during the conditioning stimulus.
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INTRODUCTION: Sporotrichosis is a subcutaneous mycosis caused by different species of thermodimorphic fungi belonging to the genus Sporothrix. These fungi may affect a wide range of warm-blooded animals, including humans, dogs and, mainly, cats. METHODS: In this article, we conducted a narrative literature review about the status of feline and cat-transmitted sporotrichosis in Latin American countries, with emphasis on Brazil. RESULTS: From a global perspective, Latin America is one of the main foci of human and feline sporotrichosis. In humans, the disease has been reported in several countries, with endemic transmission occurring in Brazil, Colombia, Costa Rica, Guatemala, Mexico and Uruguay. Sporothrix brasiliensis is the most common species identified in human cases in Brazil, whereas Sporothrix schenckii predominates in other countries. CONCLUSION: Domestic cats are the main source of infection in the zoonotic transmission cycle of sporotrichosis in Latin America. Cases of feline sporotrichosis have been reported in several countries, including Argentina, Brazil, Chile, Colombia, Mexico, Panama, Paraguay and Peru.
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Rheumatic diseases (RDs) are characterized by autoimmunity and autoinflammation and are recognized as complex due to the interplay of multiple genetic, environmental, and lifestyle factors in their pathogenesis. The rapid advancement of genome-wide association studies (GWASs) has enabled the identification of numerous single nucleotide polymorphisms (SNPs) associated with RD susceptibility. Based on these SNPs, polygenic risk scores (PRSs) have emerged as promising tools for quantifying genetic risk in this disease group. This chapter reviews the current status of PRSs in assessing the risk of RDs and discusses their potential to improve the accuracy of the diagnosis of these complex diseases through their ability to discriminate among different RDs. PRSs demonstrate a high discriminatory capacity for various RDs and show potential clinical utility. As GWASs continue to evolve, PRSs are expected to enable more precise risk stratification by integrating genetic, environmental, and lifestyle factors, thereby refining individual risk predictions and advancing disease management strategies.
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BACKGROUND: Neck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain (CNNP) involves diverse symptoms impacting mobility and quality of life. While therapeutic exercises demonstrate efficacy, the role of photobiomodulation therapy (PBMT) remains uncertain. This study aims to assess the additional effects of PBMT within a multimodal therapeutic intervention for CNNP. METHODS: A randomized, two-arm, controlled, blind clinical trial follows CONSORT and SPIRIT guidelines. Participants diagnosed with CNNP will receive a stand-alone multimodal therapeutic intervention or the same program with additional PBMT. The primary outcomes will be assessed by the functional disability identified through applying the NDI (Neck Disability Index). Secondary outcomes will be pain intensity during rest and active neck movement, catastrophizing and kinesiophobia, functionality, and disability assessed at baseline, after 8 weeks, and at a 4-week follow-up. Both groups receive pain education before personalized interventions, including resistance exercises, neuromuscular activities, mobility, and body balance. The PBMT group undergoes low-level light therapy. Intention-to-treat analysis, using linear mixed models, employs data presented as mean, standard deviation, and differences with a 95% confidence interval. Non-normally distributed variables transform. Statistical significance is set at 5%. DISCUSSION: This study addresses a critical gap in understanding the combined effects of PBMT and therapeutic exercises for CNNP. The findings aim to guide clinicians, researchers, and CNNP sufferers through rigorous methodology and diverse outcome assessments, offering valuable insights into evidence-based practices for CNNP management. Data confidentiality is maintained throughout, ensuring participant privacy during statistical analysis. TRIAL REGISTRATION: Effects of adding photobiomodulation to a specific therapeutic exercise program for the treatment of individuals with chronic nonspecific neck pain, registration number: NCT05400473, on 2022-05-27.
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Dor Crônica , Terapia com Luz de Baixa Intensidade , Cervicalgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Cervicalgia/terapia , Cervicalgia/fisiopatologia , Cervicalgia/diagnóstico , Terapia com Luz de Baixa Intensidade/métodos , Dor Crônica/terapia , Dor Crônica/fisiopatologia , Dor Crônica/diagnóstico , Terapia Combinada , Resultado do Tratamento , Medição da Dor , Avaliação da Deficiência , Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Terapia por Exercício/métodos , Fatores de Tempo , Qualidade de VidaRESUMO
Gamification involves using game design elements in non-game contexts. It is an emerging strategy that, being able to motivate consumer engagement with brands, has been increasingly used by companies in marketing activities. Recently, the application of gamification to marketing has become increasingly popular, with an increasing amount of research outputs. However, a clear overview of the field, a theoretical orientation or an agenda for research are still missing, which justifies the analysis of the existing literature joining these two fields of research. The motivation for conducting this review was twofold: Firstly, it is helpful to attain a broad overview of this developing field, synthesizing the existing knowledge in a structured way, understanding how gamification research in marketing has progressed and what type of knowledge has been acquired; secondly, it allows us to provide valuable information that will guide future research. Thus, this study provides a hybrid review, which integrates a bibliometric and TCCM analysis, of gamification in marketing by analyzing 114 articles. The data was retrieved from the Scopus scientific database. The bibliometric analysis showed the existence of 8 clusters, mostly representing current areas of research. It was found that the focus of the literature, so far, has been on studying which game elements should be implemented in a gamification system, as well as examining the impact of gamification experiences on engagement and consumer's behaviors. The TCCM analysis revealed the major theories and methodological approaches explored in published articles. The use of self-determination theory and quantitative methodology, based on primary data using online surveys, stands out. These complementary analyzes allowed to provide future research directions to scholars and practitioners working in this domain, promoting the advancement of scientific knowledge, contextual relevance and methodological rigor. Moreover, this review also helps marketers make more informed strategic decisions and supports successful gamification design.
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INTRODUCTION: Patellofemoral pain (PFP) patients often show an altered lower limb alignment during the single-leg squat (SLS). There is evidence that proximal and distal-to-the-knee muscle alterations can modify the lower limb alignment in PFP patients. However, we observed a lack of studies investigating the possible association between the thickness and strength of proximal and distal-to-the-knee muscles and lower limb alignment during SLS in women with PFP. Therefore, this study aimed to investigate the association between the thickness and strength of lower limb muscles and dynamic knee valgus (DKV) during SLS in women with PFP. METHODS: Cross-sectional study, where fifty-five women with PFP were submitted to the following evaluations: (1) muscle thickness (MT) of Gluteus Medius (GMed), Gluteus Maximus (GMax), Vastus Lateralis (VL), and Tibialis Anterior (TA); (2) isometric peak torque of hip abductors, hip external rotators, knee extensors, and foot inversors; and (3) DKV during SLS. RESULTS: There was a significant negative association between GMax's MT and DKV (r = -0.32; p = 0.01), and between TA's MT and DKV (r = -0.28; p = 0.03). No significant correlations were observed between isometric torques and DKV. Regression analysis found that GMax's MT explained 10% of the DKV's variance during SLS. DISCUSSION: Poor lower limb alignment during SLS is weakly associated with proximal and distal-to-the-knee muscle thicknesses, with no association with isometric torque in PFP women. CONCLUSION: Our results suggest that other factors besides strength and muscle thicknesses may explain and improve lower limb alignment in women with PFP.
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Extremidade Inferior , Força Muscular , Músculo Esquelético , Síndrome da Dor Patelofemoral , Humanos , Feminino , Estudos Transversais , Adulto , Síndrome da Dor Patelofemoral/fisiopatologia , Músculo Esquelético/fisiopatologia , Músculo Esquelético/fisiologia , Força Muscular/fisiologia , Adulto Jovem , Extremidade Inferior/fisiopatologia , Extremidade Inferior/fisiologia , Torque , Articulação do Joelho/fisiopatologia , Articulação do Joelho/fisiologiaRESUMO
OBJECTIVE: The aim of the present study was to analyze the profile and trends of HIV mother-to-child transmission (MTCT) in the Brazilian land border strip (LBS). METHODS: This was a quantitative, ecological, and cross-sectional study using secondary data available in the information systems of the Brazilian Ministry of Health. All cases reported in the Notifiable Diseases Information System between 2010 and 2021 were studied. RESULTS: Between 2010 and 2021, 275 children were born infected through MTCT, and 6076 pregnant women were living with HIV in the Brazilian LBS. HIV detection rates in pregnant women increased in all border arcs. The northern arc experienced the highest increase (19.6%), followed by the central arc (11.4%), and the southern arc (6.1%). Despite historically high detection rates, the southern arc exhibited the smallest increase. While MTCT rate decreased by 37.7% in the border area, the central arc showed no statistically significant reduction. In 2021, the average age of pregnant women was 26.2 years, 25.7% had up to 8 years of schooling, and 55.8% identified as non-white. The majority (92.8%) received antenatal care, and 59.7% were diagnosed with HIV before prenatal care. The use of prophylactic antiretroviral therapy during prenatal care occurred in 69.6% of pregnant women, and infant prophylaxis was provided within first 24 h to 43.6% of live births. CONCLUSION: The results indicate progress in reducing MTCT cases in Brazilian LBS. Disparities in HIV detection rates may be influenced by differences in testing uptake, despite mandatory testing for all babies. It is crucial to continue implementing strategies to reach these women and ensure equitable access to healthcare services for MTCT prevention.
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Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez , Humanos , Feminino , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Gravidez , Brasil/epidemiologia , Infecções por HIV/transmissão , Infecções por HIV/epidemiologia , Estudos Transversais , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Recém-Nascido , Adulto Jovem , Cuidado Pré-Natal/estatística & dados numéricos , AdolescenteRESUMO
INTRODUCTION: This study evaluated the probability of developing malocclusions in mixed dentition. METHODS: A longitudinal study was conducted with 598 children (aged 5 years) in deciduous dentition. The children were followed for 3 years until mixed dentition (aged 8 years). Overjet, overbite, and transversal relations were evaluated. Bayesian models were used to analyze the data and estimate the parameters. RESULTS: The parameter θ was used for the distributions, indicating the probability of presenting a given condition with a credibility index (ICr) of 95%. After 3 years of follow-up, 121 children were reevaluated. The results showed that children have a high probability of malocclusion in mixed dentition. There was a higher probability of developing an increased overjet in the mixed dentition of 20.5% (ICr 95%, 13.6-28.4) to 48.3% (ICr 95%, 39.1-57.7) and a higher probability of having a normal overbite in the deciduous dentition and a lower probability in the mixed dentition (ICr 95%, 9.2-21.3). CONCLUSIONS: Considering the probabilistic model of Bayesian analysis, children with normal overjet in the deciduous dentition may show an increased overjet in the mixed dentition. Concerning overbite, children may present an anterior open bite during the transition between deciduous and mixed dentition, as well as self-correction of deep overbite in mixed dentition. Furthermore, they may present a posterior crossbite during the mixed dentition when there is a normal transverse relationship in the deciduous dentition.
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Human leukocyte antigen (HLA) molecules and their relationships with natural killer (NK) cells, specifically through their interaction with killer-cell immunoglobulin-like receptors (KIRs), exhibit robust associations with the outcomes of diverse diseases. Moreover, genetic variations in HLA and KIR immune system genes offer limitless depths of complexity. In recent years, a surge of high-powered genome-wide association studies (GWASs) utilizing single nucleotide polymorphism (SNP) arrays has occurred, significantly advancing our understanding of disease pathogenesis. Additionally, advances in HLA reference panels have enabled higher resolution and more reliable imputation, allowing for finer-grained evaluation of the association between sequence variations and disease risk. However, it is essential to note that the majority of these GWASs have focused primarily on populations of Caucasian and Asian origins, neglecting underrepresented populations in Latin America and Africa. This omission not only leads to disparities in health care access but also restricts our knowledge of novel genetic variants involved in disease pathogenesis within these overlooked populations. Since the KIR and HLA haplotypes prevalent in each population are clearly modelled by the specific environment, the aim of this review is to encourage studies investigating HLA/KIR involvement in infection and autoimmune diseases, reproduction, and transplantation in underrepresented populations.
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Determining the origin and pathways of contaminants in the natural environment is key to informing any mitigation process. The mass magnetic susceptibility of soils allows a rapid method to measure the concentration of magnetic minerals, derived from anthropogenic activities such as mining or industrial processes, i.e., smelting metals (technogenic origin), or from the local bedrock (of geogenic origin). This is especially effective when combined with rapid geochemical analyses of soils. The use of multivariate analysis (MVA) elucidates complex multiple-component relationships between soil geochemistry and magnetic susceptibility. In the case of soil mining sites, X-ray fluorescence (XRF) spectroscopic data of soils contaminated by mine waste shows statistically significant relationships between magnetic susceptibility and some base metal species (e.g., Fe, Pb, Zn, etc.). Here, we show how qualitative and quantitative MVA methodologies can be used to assess soil contamination pathways using mass magnetic susceptibility and XRF spectra of soils near abandoned coal and W/Sn mines (NW Portugal). Principal component analysis (PCA) showed how the first two primary components (PC-1 + PC-2) explained 94% of the sample variability, grouped them according to their geochemistry and magnetic susceptibility in to geogenic and technogenic groups. Regression analyses showed a strong positive correlation (R2 > 0.95) between soil geochemistry and magnetic properties at the local scale. These parameters provided an insight into the multi-element variables that control magnetic susceptibility and indicated the possibility of efficient assessment of potentially contaminated sites through mass-specific soil magnetism.
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Monitoramento Ambiental , Poluentes do Solo , Espectrometria por Raios X , Poluentes do Solo/análise , Espectrometria por Raios X/métodos , Análise Multivariada , Monitoramento Ambiental/métodos , Mineração , Portugal , Análise de Componente Principal , Solo/química , Estanho/análise , Fenômenos Magnéticos , Minas de Carvão , Carvão MineralRESUMO
Importance: For patients with nonspine bone metastases, short-course radiotherapy (RT) can reduce patient burden without sacrificing clinical benefit. However, there is great variation in uptake of short-course RT across practice settings. Objective: To evaluate whether a set of 3 implementation strategies facilitates increased adoption of a consensus recommendation to treat nonspine bone metastases with short-course RT (ie, ≤5 fractions). Design, Setting, and Participants: This prospective, stepped-wedge, cluster randomized quality improvement study was conducted at 3 community-based cancer centers within an existing academic-community partnership. Rollout was initiated in 3-month increments between October 2021 and May 2022. Participants included treating physicians and patients receiving RT for nonspine bone metastases. Data analysis was performed from October 2022 to May 2023. Exposures: Three implementation strategies-(1) dissemination of published consensus guidelines, (2) personalized audit-and-feedback reports, and (3) an email-based electronic consultation platform (eConsult)-were rolled out to physicians. Main Outcomes and Measures: The primary outcome was adherence to the consensus recommendation of short-course RT for nonspine bone metastases. Mixed-effects logistic regression at the bone metastasis level was used to model associations between the exposure of physicians to the set of strategies (preimplementation vs postimplementation) and short-course RT, while accounting for patient and physician characteristics and calendar time, with a random effect for physician. Physician surveys were administered before implementation and after implementation to assess feasibility, acceptability, and appropriateness of each strategy. Results: Forty-five physicians treated 714 patients (median [IQR] age at treatment start, 67 [59-75] years; 343 women [48%]) with 838 unique nonspine bone metastases during the study period. Implementing the set of strategies was not associated with use of short-course RT (odds ratio, 0.78; 95% CI, 0.45-1.34; P = .40), with unadjusted adherence rates of 53% (444 lesions) preimplementation vs 56% (469 lesions) postimplementation; however, the adjusted odds of adherence increased with calendar time (odds ratio, 1.68; 95% CI, 1.20-2.36; P = .003). All 3 implementation strategies were perceived as being feasible, acceptable, and appropriate; only the perception of audit-and-feedback appropriateness changed before vs after implementation (19 of 29 physicians [66%] vs 27 of 30 physicians [90%]; P = .03, Fisher exact test), with 20 physicians (67%) preferring reports quarterly. Conclusions and Relevance: In this quality improvement study, a multicomponent set of implementation strategies was not associated with increased use of short-course RT within an academic-community partnership. However, practice improved with time, perhaps owing to secular trends or physician awareness of the study. Audit-and-feedback was more appropriate than anticipated. Findings support the need to investigate optimal approaches for promoting evidence-based radiation practice across settings.
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Neoplasias Ósseas , Melhoria de Qualidade , Humanos , Neoplasias Ósseas/secundário , Neoplasias Ósseas/radioterapia , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Idoso , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricosRESUMO
BACKGROUND: Head and neck cancer encompasses neoplasms affecting the oral cavity, pharynx, larynx, and thyroid. Identifying factors that modulate the carcinogenesis process can aid in identifying subgroups at higher risk of developing the disease, enabling implementation of prevention programs. Vitamin D receptor polymorphisms can affect the carcinogenesis of various tumors by altering vitamin D metabolism and cellular response. METHODS: To elucidate the role of vitamin D receptor polymorphisms in head and neck cancer, a systematic review was performed, searching the Embase, PubMed, Scopus, and Lilacs databases. A total of 19 articles met the inclusion criteria. The frequency of vitamin D receptors polymorphism alleles (FokI, ApaI, BsmI, TaqI, Cdx2, rs2107301, rs2238135) was recorded and pooled to calculate the odds ratio in a meta-analysis using the Review Manager software. RESULTS: Subgroup analysis demonstrated significant associations in the anatomical site of cancer (oral cancer in ApaI and BsmI, and unspecified subsites of head and neck cancer in TaqI), genotyping method (FokI and BsmI), and continent of the study (ApaI, FokI, and BsmI). CONCLUSION: Our findings were heterogeneous, as with other evidence available in the literature. Therefore, more clinical studies with larger sample sizes are needed to obtain more accurate results on the relationship between vitamin D receptor polymorphism and head and neck cancer.