Evaluation of methodological and reporting quality of systematic reviews on conservative non-pharmacological musculoskeletal pain management in children and adolescents: A methodological analysis.

BACKGROUND: There are no studies investigating the methodological and report quality of systematic reviews of non-pharmacological interventions for musculoskeletal pain management among children and adolescents. OBJECTIVE: To evaluate the methodological and reporting quality of systematic reviews on conservative non-pharmacological pain management in children and adolescents with musculoskeletal pain. METHODS: Searches were conducted on the Cochrane Database of Systematic Reviews, Medline, Embase, and three other databases. Two pairs of reviewers independently assessed each article according to the predetermined selection criteria. We assessed the methodological quality of systematic reviews, using the AMSTAR 2 checklist and the quality of reporting, using PRISMA checklist. Descriptive analysis was used to summarise the characteristics of all included systematic reviews. The percentage of systematic reviews achieving each item from the AMSTAR 2, PRISMA checklist and the overall confidence in the results were described. RESULTS: We included 17 systematic reviews of conservative non-pharmacological pain management for musculoskeletal pain in children and adolescents. Of the 17 systematic reviews included, nine (53%) were rated as "critically low", seven (41%) were rated as "low", and one (6%) was rated as "high" methodological quality by AMSTAR-2. The reporting quality by items from PRISMA range from 17.6% (95% CI 6.2 to 41) to 100% (95% CI 81.6 to 100). CONCLUSION: This systematic review of physical interventions in children and adolescents showed overall 'very low' to 'high' methodological quality and usually poor reporting quality.

Plantão psicológico no referencial do psicodrama: encontro com subjetividades desviantes / Psychological emergency attendance in the psychodrama framework: encounter with deviant subjectivities / La guardia psicológica en el marco del psicodrama: encuentro con subjetividades desviadas

RESUMO O presente trabalho relata uma investigação a partir de encontros clínicos com usuários de uma instituição de apoio que apresentam discursos delirantes. O plantão psicológico fundamentado na teoria do Psicodrama foi o referencial adotado. As interações entre plantonistas e usuários foram registradas em diários de campo, buscando-se analisar as experiências e os sofrimentos narrados, além dos impactos no terapeuta. Foi utilizada a metodologia da Teoria Fundamentada nos Dados, de caráter qualitativo. As produções delirantes foram percebidas como modos de existência que deveriam ser acolhidos. Os sofrimentos diante de experiências desestabilizadoras demonstraram conexões entre vivências de fortes intensidades e as subjetividades fragmentadas. Os plantonistas se sentiram convocados a sustentar as tensões presentes no encontro com formas subjetivas desorganizadas e acolher as produções delirantes.

ABSTRACT This work reports an investigation based on clinical encounters with users of a support institution who present delusional discourses. The Psychological counseling based on Psychodrama theory was the reference adopted. The interactions between therapists and patients were registered in research diaries, seeking to analyze the experiences and the suffering narrated, as well as the impact on the therapist. The methodology of the Grounded Theory was used, with a qualitative character. The delusions were perceived as modes of existence that should be accepted. The suffering in the face of destabilizing experiences demonstrated connections between intense experiences and fragmented subjectivities. The therapists were compelled to sustain the tensions present in the encounter with disorganized subjective forms and to welcome the delirious productions.

RESUMEN El presente trabajo relata una investigación basada en encuentros clínicos con usuarios de una institución de apoyo que presentan discursos delirantes. La guardia psicológica basada en la teoría del Psicodrama fue el marco adoptado. Las interacciones entre los profesionales de turno y los usuarios fueron registradas en diarios de campo, buscando analizar los sufrimientos y experiencias narradas y los impactos producidos en el terapeuta. Se utilizó la Grounded Theory, una metodología cualitativa. Las producciones delirantes fueron percibidas como modos de existencia y manejadas como aspectos del sujeto que debían ser abrazados. El sufrimiento frente a experiencias desestabilizadoras han demostrado conexiones entre experiencias de fuertes intensidades y subjetividades fragmentadas. Los enfermeros de turno se sintieron llamados a sostener las tensiones presentes en el encuentro con formas subjetivas desorganizadas y para acoger las producciones delirantes.

Are periodontal diseases associated with sleep duration or sleep quality? A systematic review.

OBJECTIVES: This study aimed to systematically review the associations between periodontal diseases/tooth loss and sleep duration/quality. MATERIAL AND METHODS: PubMed, Scopus, and Embase databases were searched (up to May 2021) to identify studies that assessed the association between periodontal diseases or number of teeth with sleep quality and sleep duration. Two researchers independently selected the studies and extracted the data. Considering the high heterogeneity among the included studies, meta-analysis was deemed unviable. Results are presented descriptively for sleep quality (studies that have used PSQI), self-reported sleep hours, and other tools that assessed sleep patterns. RESULTS: Twenty studies (16 cross-sectional, two case-control, and two cohort) were included. Eight studies used the Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep. Six of these studies demonstrated that individuals with worse periodontal conditions demonstrated poorer sleep quality. However, most of the included studies that performed adjusted analysis showed no statistically significant association between self-reported hours of sleep and periodontitis. The mean number of present teeth was assessed in four studies; three of them demonstrated lower numbers of present teeth in individuals with inadequate sleep. CONCLUSION: The literature shows conflicting results for the association between sleep hours and periodontitis. However, inadequate sleep may be associated with lower number of present teeth and periodontal diseases. Further studies are necessary in order to confirm these results.

Association between clinical measures of gingival inflammation and obesity in adults: systematic review and meta-analyses.

OBJECTIVE: This study aimed to systematically review the literature about the association between clinical measures of gingival inflammation and obesity in adults. MATERIAL AND METHODS: Searches for studies were performed in five databases (Medline-PubMed, Scopus, Web of Science, Cochrane Library, and Embase) to compile studies of any design that evaluated the association between clinical measures of gingival inflammation and obesity in adults. Selection of studies, data extraction and risk of bias analysis were performed independently by two reviewers, and a third researcher was involved to resolve disagreements. Meta-analyses were performed for measures of gingival inflammation as compared to body mass index (BMI). Independent analyses were performed for studies involving periodontitis, gingivitis, and population-based/studies that did not provide a periodontal diagnosis. Standard mean deviation (SMD) and its 95% confidence interval (95%CI) were estimated. RESULTS: Ninety studies were included (cross-sectional/clinical trials [n=82], case-control [n=3], cohorts [n=5]). Most of the studies demonstrated no significant difference in the measures of gingival inflammation regardless of the comparison performed. However, meta-analysis showed that among individuals with periodontitis, significantly higher levels of gingival inflammation are observed in those with obesity (n of individuals=240) when compared to those who were not obese (n of individuals=574) (SMD:0.26; 95%CI:0.07-0.44). When considering population-based/those studies that did not provide periodontal diagnosis, significantly higher measures of gingival inflammation were observed in the groups with higher BMI. CONCLUSIONS: Within the limitations of the present study, it was concluded that higher measures of gingival inflammation may be expected for those with higher BMI. CLINICAL RELEVANCE: Clinicians must be aware that higher measures of gingival inflammation may be expected for individuals with higher BMI. However, there is a necessity for further longitudinal studies regarding the association between obesity and gingival inflammation.

What triggers an episode of acute low back pain? A protocol of a replication case-crossover study.

OBJECTIVE: To describe all the procedures of a study that will replicate a previous case-crossover study investigating physical and psychosocial transient exposure risk factors for triggering an episode of acute non-specific low back pain (LBP) at emergency departments in an emerging country. METHODS: This case-crossover study will recruit 350 patients, aged between 18 and 80 years, with a new episode of acute non-specific LBP seeking care at emergency departments from public hospitals in Brazil. We will collect information about exposure to a range of physical (eg, awkward postures, lifting children or animals, vigorous physical activity) and psychosocial triggers (eg, distraction, tiredness, alcohol consumption) that were examined in the previous study. The exposure to each trigger during the 2 hours preceding the onset of LBP (case window) will be compared with exposure in the 2-hour periods ending 24 (24-26 hours) and 48 (48-50 hours) hours before the onset of back pain (control window). Conditional logistic regression models will be built to estimate ORs expressing the magnitude of increased risk of developing LBP associated with each factor. DISCUSSION: This study will enable the confirmation of previous findings regarding transient exposure to factors that increase risk for an episode of acute LBP in a different setting (at emergency departments of an emerging country). To minimise the potential for recall bias, the maximum time between episode onset and interview will be 7 days; we will encourage participants to use their smartphones and diaries to remember the investigated period. Also, our interview script asked participants to nominate the key aspects of each day. Despite these efforts, the retrospective study design means it is not possible to completely exclude potential for recall bias. Furthermore, participants will be blinded to the case and control periods. ETHICS AND DISSEMINATION: Ethics were granted by the Research Ethics Committee (#20310219.8.0000.0064). Study findings will be disseminated through publications and conference presentations.

Predicting pain recovery in patients with acute low back pain: a study protocol for a broad validation of a prognosis prediction model.

BACKGROUND: The clinical course of acute low back pain (LBP) is generally favourable; however, there is significant variability in the prognosis of these patients. A clinical prediction model to predict the likelihood of pain recovery at three time points for patients with acute LBP has recently been developed. The aim of this study is to conduct a broad validation test of this clinical prediction model, by testing its performance in a new sample of patients and a different setting. METHODS: The validation study with a prospective cohort design will recruit 420 patients with recent onset non-specific acute LBP, with moderate pain intensity, seeking care in the emergency departments of hospitals in São Paulo, Brazil. The primary outcome measure will be days to recovery from pain. The predicted probability of pain recovery for each individual will be computed based on predictions of the development model and this will be used to test the performance (calibration and discrimination) in the validation dataset. DISCUSSION: The findings of this study will better inform about the performance of the clinical prediction model, helping both clinicians and patients. If the model's performance is acceptable, then future research should evaluate the impact of the prediction model, assessing whether it produces a change in clinicians' behaviour and/or an improvement in patient outcomes. ETHICS AND DISSEMINATION: Ethics were granted by the Research Ethics Committee of the Universidade Cidade de São Paulo, #20310419.4.0000.0064. Study findings will be disseminated widely through peer-reviewed publications and conference presentations.

Critical evaluation of physical activity questionnaires translated to Brazilian-Portuguese: a systematic review on cross-cultural adaptation and measurements properties.

BACKGROUND: The number of questionnaires that measures physical activity levels has increased considerably. For Brazilian population it becomes a challenge, due to the need of a rigorous translation, adaptation and testing of measurement properties. OBJECTIVE: Evaluate the methodological quality and criteria of physical activity questionnaires translated to Brazilian-Portuguese. METHODS: Methodological quality and quality criteria was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. RESULTS: Sixty-nine studies were included, the most frequent questionnaires investigated were the International Physical Activity Questionnaire (n=16) and the Baecke Physical Activity Questionnaire (n=12). Translation (n=13), reliability (n=37) and construct validity (n=44) were the measurement properties commonly investigated. For reliability, most studies were rated as 'adequate' for methodological quality. The Intraclass Correlation Coefficient of the questionnaires ranged from 0.20 to 1.0. For construct validity, 31 analyses showed 'inadequate' methodological quality, due to poor description of the comparator instrument. High level of evidence on reliability were found for Baecke Physical Activity Questionnaire, Self-administered Physical Activity Checklist and Physical Activity Questionnaire of the Surveillance System of Risk Factors and Protection for Chronic Diseases; on construct validity for Self-administered Physical Activity Checklist, Physical activity Questionnaire for Adolescents, Physical activity Questionnaire for Older Children and Saúde naBoa Questionnaire. CONCLUSION: Most questionnaires showed poor methodological quality and measurement properties. The Baecke Physical Activity Questionnaire and Self-administred Physical Activity Checklist showed better scorings for methodological quality and quality criteria. Further high methodological quality studies are still warranted.

Cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese.

INTRODUCTION: The internet has proven to be a valuable resource for self-care, allowing access to information and promoting interaction between professionals, caregivers, users of health care services and people interested in health information. However, recurring searches are often related to excessive health anxiety and a phenomenon known as cyberchondria can have impacts on physical and mental health. Within this background, a Cyberchondria Severity Scale has been developed to differentiate healthy and unhealthy behavior in internet searches for health information, based on the following criteria: compulsion, distress, excesses, and trust and distrust of health professionals. OBJECTIVE: To conduct cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese, because of the lack of an appropriate instrument for Brazil. METHODS: This study was authorized by the original author of the scale. The process was divided into the following four steps: 1) initial translation, 2) back-translation, 3) development of a synthesized version, and 4) experimental application. RESULTS: Translation into Brazilian Portuguese required some idiomatic expressions to be adapted. In some cases, words were not literally translated from English into Portuguese. Only items 7, 8, 12, 23 and 27 were altered, as a means of both conforming to proper grammar conventions and achieving easy comprehension. The items were rewritten without loss of the original content. CONCLUSION: This paper presents a translated version of the Cyberchondria Severity Scale that has been semantically adapted for the Brazilian population, providing a basis for future studies in this area, which should in turn contribute to improved understanding of the cyberchondria phenomenon in this population.

Cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese / Tradução e adaptação transcultural da Cyberchondria Severity Scale para o português brasileiro

Abstract Introduction: The internet has proven to be a valuable resource for self-care, allowing access to information and promoting interaction between professionals, caregivers, users of health care services and people interested in health information. However, recurring searches are often related to excessive health anxiety and a phenomenon known as cyberchondria can have impacts on physical and mental health. Within this background, a Cyberchondria Severity Scale has been developed to differentiate healthy and unhealthy behavior in internet searches for health information, based on the following criteria: compulsion, distress, excesses, and trust and distrust of health professionals. Objective: To conduct cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese, because of the lack of an appropriate instrument for Brazil. Methods: This study was authorized by the original author of the scale. The process was divided into the following four steps: 1) initial translation, 2) back-translation, 3) development of a synthesized version, and 4) experimental application. Results: Translation into Brazilian Portuguese required some idiomatic expressions to be adapted. In some cases, words were not literally translated from English into Portuguese. Only items 7, 8, 12, 23 and 27 were altered, as a means of both conforming to proper grammar conventions and achieving easy comprehension. The items were rewritten without loss of the original content. Conclusion: This paper presents a translated version of the Cyberchondria Severity Scale that has been semantically adapted for the Brazilian population, providing a basis for future studies in this area, which should in turn contribute to improved understanding of the cyberchondria phenomenon in this population.

Resumo Introdução: A internet tem se revelado um recurso valioso para o autocuidado, permitindo o acesso a informações e promovendo a interação entre profissionais, cuidadores, usuários de serviços de saúde e pessoas interessadas em informações sobre saúde. No entanto, pesquisas recorrentes na internet estão frequentemente relacionadas a ansiedade excessiva com saúde, e um fenômeno conhecido como cybercondria pode ocasionar danos à saúde física e mental do indivíduo. Nesse contexto, a Cyberchondria Severity Scale foi desenvolvida para diferenciar o comportamento saudável do não saudável no que diz respeito a pesquisas na internet sobre informações de saúde, com base nos seguintes critérios: compulsão, aflição, excessos e confiança/desconfiança nos profissionais de saúde. Objetivo: Realizar a adaptação transcultural da Cyberchondria Severity Scale para o português brasileiro, em razão da falta de um instrumento adequado para uso no Brasil. Métodos: Este estudo foi autorizado pelo autor original da escala. O processo foi dividido em quatro etapas: 1) tradução inicial, 2) retrotradução, 3) desenvolvimento de uma versão sintética, e 4) aplicação experimental. Resultados: A adaptação para o português do Brasil exigiu algumas correções em expressões idiomáticas. Em alguns casos, as palavras não foram literalmente traduzidas do inglês para o português. Apenas os itens 7, 8, 12, 23 e 27 foram alterados, com o objetivo de seguir as normas gramaticais e favorecer a compreensão. Os itens foram reescritos sem que houvesse perda do conteúdo original. Conclusões: Este trabalho apresenta uma versão traduzida da Cyberchondria Severity Scale que foi adaptada semanticamente para a população brasileira, proporcionando uma base para futuros estudos na área, o que deverá, por sua vez, contribuir para uma melhor compreensão do fenômeno cybercondria nessa população.

O PROCESSO DE DESINSTITUCIONALIZAÇÃO NO BRASIL / THE PROCESS OF DEINSTITUCIONALIZATION IN BRAZIL

A reforma psiquiátrica desde a década de 70 luta pelos direitos das pessoas em sofrimento psíquico. A partir da lei 10.216/2001 deu-se início ao movimento de retirada dos indivíduos das instituições a longo tempo internados para ocupar novamente o território da cidade. O presente artigo propõe um recorte da análise histórica, mostrando como a pessoa em sofrimento psíquico era tratada desde os primórdios até os dias atuais, com ênfase no processo de desinstitucionalização. Objetivando a investigação de como se desenvolveu o processo de inserção das leis da reforma psiquiátrica e suas consequências, instituindo uma análise do cenário brasileiro atual que a saúde mental tem vivenciado. A desinstitucionalização no Brasil teve influência do modelo italiano de Basaglia, buscando não apenas a reforma do modelo assistencial, como também uma reforma subjetiva e cultural da visão da loucura e de como as pessoas em sofrimento psíquico grave são tratadas pela sociedade.(AU)

Psychiatric reform since the 70's fight for the rights of people in psychological distress. As a result of Law 10,216 / 2001 was initiated the pullout movement of individuals who were hospitalized for a long time to re-occupy the territory of cities. This article proposes a cut of historical analysis, showing how it was treated the person in psychic suffering from the beginnings to the present day, with emphasis on deinstitutionalization process. Aiming the investigation of how it develops the process of inserting the laws of psychiatric reform and its consequences, instituting an analysis of the current Brazilian context that mental health has experienced. The deinstitutionalization in Brazil was influenced by the Italian model of Basaglia, seeking not only to reform the health care model, as well as a subjective and cultural reform vision of madness and how people in severe psychological distress are treated by society.(AU)