Does participation in the European Trauma Course lead to new behaviours and organisational change? A Portuguese experience.

BACKGROUND: Medical educational courses can be successful from an immediate feedback perspective but not lead to new behaviour or organisational changes in the workplace. The aim of this study was to assess the self-perceived impact of the European Trauma Course (ETC) on Reanima trainees' behaviour and organisational change. METHODS: A 40-item questionnaire based on Holton's evaluation model was used to evaluate the candidate's perceptions. The results were analysed with descriptive and inferential statistical analysis using nonparametric tests with α = 0.05. RESULTS: Out of 295 participants, 126 responded to the survey. Of these, 94% affirmed that the ETC modified their approach to trauma patients, and 71.4% described a change in their behaviour. Postcourse responders changed their behaviour in their initial approach to trauma care in the nontechnical skills of communication, prioritisation and teamwork. Being an ETC instructor strongly influenced the acquisition of new material, and this group was able to implement changes in attitudes. Individuals with no previous trauma course experience identified lack of self-efficacy as a significant obstacle to introducing new work-based learning. In contrast, responders with ATLS training noted a lack of ETC colleagues as the main impediment for moving from conceptualisation to experimentation in the workplace. CONCLUSIONS: Participation in the ETC led to behavioural changes in the workplace. However, the ability to influence others and bring about wider organisational changes was more difficult to achieve. Major factors were the status of the person, their experience and self-efficacy. National organisational impact was obtained, which went far beyond our aspirations in acknowledging change in individual daily practice. Future research studies will include the effect of implementing the ETC methodology on the outcome of trauma patients.

Prevalence of dental floss use in deciduous dentition: A systematic review and meta-analysis.

OBJECTIVES: Adherence to the daily use of dental floss in childhood is recommended by various international health institutions/organizations. This systematic review (PROSPERO number CRD42020205232) aims to evaluate the prevalence of dental floss use in deciduous dentition. MATERIALS AND METHODS: A systematic review was conducted in six databases (B-on, Cochrane Library, PubMed, Scielo, Science Direct and Web of Science) up to December 2020. The CoCoPop mnemonic allowed for obtaining 2333 articles and resulted in the inclusion of 7 observational studies that evaluated the prevalence of dental floss use (primary outcome) in children up to 6 years old. The Joanna Briggs Institute critical appraisal checklist was used to evaluate the risk of bias, showing that most articles presented good quality. Meta-analyses were performed using the proportion of dental floss use (yes or once/day) and the random effects model. RESULTS: The meta-analysis showed a prevalence of dental floss use of only 12.60% (95% CI: 7.69%-18.52%) based on studies with high heterogeneity of results (I2  = 94.75%; 95% CI: 91.44%-96.78%). Six of the seven studies showed that more than 70% of children never used dental floss. CONCLUSIONS: A low prevalence of dental floss use was observed in children up to 6 years old. Given the diversity of evaluating the use of dental floss, different options should be the target of standardization in future studies.

Are oral overuse behaviours associated with painful temporomandibular disorders? A cross-sectional study in Portuguese university students.

BACKGROUND: Many different types of oral overuse behaviours occur frequently in adult populations with painful temporomandibular disorders (TMDs). Less is known regarding these behaviours and their associations with TMDs in university students. OBJECTIVES: Test the association between frequency of different oral overuse behaviours evaluated by the Oral Behaviour Checklist (OBC) and the severity of painful TMDs. METHODS: In this cross-sectional study, 1381 students from 19 universities in the Oporto District, Portugal, completed the Research Diagnostic Criteria for TMD (RDC/TMD) Personal History Questionnaire and the OBC, and they received an RDC/TMD clinical examination. The OBC sum score (ranging from 0 to 84 points) was classified as normal (0 ≤ 16 points), low overuse (17 ≤ 24) or high overuse (≥25). Painful TMD subtypes (myalgia, arthralgia or combined) were identified. Associations were tested using multivariable binary logistic regression models (α = .05), adjusted for age and sex, and referencing the normal parafunction group. RESULTS: University students with high overuse were more likely to have a painful TMD: myalgia (OR = 1.9, 95% CL: 1.3-3.0); arthralgia (OR = 2.2; 95% CL: 1.4-3.4), combined (OR = 5.0; 95% CL: 3.1-8.1). Students with low overuse were more likely to have only the combined painful TMD (OR = 2.4; 95% CL: 1.4-4.0) but not the individual painful disorders. Of the 21 different behaviours, 13 were reported at least 50% of the time. CONCLUSIONS: In this university student sample, oral overuse behaviours are widespread, and their overall extent exhibited a dose-response relationship with respect to severity of painful TMDs based on pain and chronicity. Only some behaviours were independently associated with painful TMDs, suggesting the value of further OBC instrument development.

Is there an improvement on acoustic voice parameters in patients with bilateral vocal fold nodules after voice therapy? a meta-analysis.

BACKGROUND/OBJECTIVE: The aim of this study is to estimate the effect of voice therapy intervention in adults with vocal fold nodules, on three acoustic voice parameters (fundamental frequency, jitter and shimmer). The purpose of this meta-analysis is to present evidence based on literature regarding objective acoustic voice parameters changes, after voice therapy, in patients with bilateral VFNs. A pooled statistical analysis comparing pre- and post-therapy measurements of three acoustic voice parameters (average F0, % jitter and % shimmer) were performed. METHODS: A literature review was performed by searching studies in adults, with bilateral vocal fold nodules who received voice therapy, and where voice quality was evaluated quantitatively using acoustic analysis, before and after treatment. Meta-analysis was performed using random-effects model. PubMed, CINAHL, CENTRAL and Web of Science were searched for retrospective and prospective cohort, cross-sectional and case-control with comparative studies in adults published between January/1995 and March/2019 and English written. Search terms used were: intervention, therapy, vocal, voice, nodules, bilateral, multidimensional assessment, acoustic and analysis. RESULTS: Overall 1950 articles were identified. After removing repeated articles and conducting screening stages using inclusion and exclusion criteria, a total of four studies were selected with 147 participants for the meta-analysis. The pooled results analysis showed a statistically significant effect in two acoustic parameters after voice therapy: (1) F0 [increased mean difference post-therapy was 33.00 Hz (95% CI 20.26-45.74, p < 0.001)] and (2) jitter (%) [decreased mean difference post-therapy was 0.59% (95% CI 0.23-0.94%, p = 0.001)]. In addition, a non-statistically significant effect in shimmer (%) [decreased mean difference post-therapy was 2.98% (95% CI - 0.03-6.00, p = 0.052)]. CONCLUSION: Acoustic analysis has a clinical role in patients with vocal fold nodules, by objectively assessing and providing data on the effect of voice therapy in voice acoustic parameters. This meta-analysis has shown that patients with vocal fold nodules improved their acoustic voice parameters after receiving voice therapy.

Effectiveness of voice therapy in patients with vocal fold nodules: a systematic search and narrative review.

BACKGROUND/OBJECTIVE: An adult with vocal fold nodules can suffer from hoarseness, breathiness and vocal fatigue, which, in turn, significantly affects their vocal participation as well as activities. A well-designed voice therapy program improves the quality of life and vocal functionality. This is a narrative review with a systematic search of the current literature about the effectiveness of voice therapy interventions in adults with vocal fold nodules. METHODS: Several key terms were used for the database electronic search of articles. Strict inclusion criteria were used and a broad evaluation of the studies was performed. This included the level of evidence based on the National Health and Medical Research Council levels of evidence, assessment, and critical appraisal. RESULTS: Nine out of 30 reviewed articles met the criteria of inclusion and reported positive effects of voice therapy intervention on adult patients with vocal fold nodules. The vast majority of the reviewed studies reported multidimensional voice measures outcome data, most of them containing visual-perceptual, auditory-perceptual, acoustic and self-assessment results. Regardless of receiving direct or indirect or a combination of both voice therapy contents, nearly all voice quality parameters were found to improve after treatment. Short-term treatment (< 3 weeks) may be as beneficial as longer traditional voice therapy programs, and using telepractice voice therapy may be an achievable and practical way of delivering treatment and enhance adherence to therapy. The study design and the evidence levels of the included studies were low (≤ III-2) and the risk of bias of the comparative studies was moderate. CONCLUSION: This narrative review cannot conclude the general effectiveness of voice therapy programs. Further research and understanding of what specific parameters (exercise and techniques) of a therapy's content will improve voice outcome measures. More studies are required to investigate whether or not voice therapy benefits are sustainable 6 months after ending the therapy. However, improved evidence is required to suggest that short period treatments are as beneficial as traditional therapy programs. Telepractice voice therapy may be an achievable and practical way of delivering treatment and enhance adherence to therapy.

Are there any solutions for improving the cleft area hygiene in patients with cleft lip and palate? A systematic review.

OBJECTIVE: Children with cleft lip and palate (CLP) present high incidence of oral health problems, namely those associated with the accumulation of dental plaque. The objective of this systematic review was to verify if there is any solution to improve the hygiene of the cleft area. MATERIALS AND METHODS: A structured systematic review was performed based on articles published in several electronic databases: PubMed, Web of Science, Cochrane Library and Scopus in the last 20 years. The MeSH terms used were cleft lip, palate, harelip, oral hygiene and toothbrush. RESULTS: From 270 potentially relevant articles, 39 articles were selected, corresponding to a total of 3226 CLP patients and 914 matched controls. The selected studies exhibited great heterogeneity regarding the type of the study, study population (average range 0 -49 years old; sampling sizes 15-400 CLP patients), evaluation periods, reported variables and oral hygiene routines. Consensual outcomes were the presence of high plaque indexes, high prevalence of dental caries and worse oral hygiene patterns in CLP patients. Additionally, poor education in oral health and low motivation to integrate regular hygiene routines in the daily family life were also evident. CONCLUSION: There is a clear need to improve the oral hygiene care of CLP children, but few studies were focused on specific preventive approaches. Development of devices especially designed to the hygiene of the cleft area and implementation of standardized prevention and control programmes targeting education, motivation and compliance would contribute to improve oral health in CLP children.

Cultural equivalence, reliability and utility of the Portuguese version of the Oral Behaviours Checklist.

BACKGROUND: Oral behaviors (OBs) must be assessed as part of a biobehavioural evaluation for patients with temporomandibular disorders (TMD). OBJECTIVES: The aims of this study were: to translate and culturally adapt the Oral Behaviors Checklist (OBC) into Portuguese; to evaluate its basic psychometric properties; and to assess the utility of the Portuguese OBC. METHODS: The Portuguese translation, cross-cultural equivalence, and two studies (Pre-field test, N = 8, and field test, N = 45) of the OBC adhered to official guidelines of the International RDC/TMD Research Consortium (now, INfORM). In the formal test (N = 120) the Portuguese RDC/TMD was used for TMD diagnosis. RESULTS: Translation and cultural equivalence of the OBC into Portuguese was reviewed and approved by an expert panel. In the field test, item agreement between English and Portuguese OBC versions was very good (weighted Kappa ≥ 0.934). Test-retest reliability of the OBCS umScore was excellent intra-class correlation coefficient ((ICC) = 0.998, P < 0.001). As an initial probe into validity using parallel forms, comparison of the sleep bruxism and awake clenching questions included in the RDC/TMD with the corresponding OBC questions yielded excellent (Kappa = 0.932) and very good (k = 0.850), respectively, convergent validity as well as excellent (that is, poor agreement, kappa = 0.013) discriminant validity for these specific OBs. The mean OBCS umScore was significantly lower for the healthy group, compared to the painful TMD group (ANOVA, P = 0.037). CONCLUSIONS: The Portuguese translation of the OBC exhibits cross-cultural equivalence for use in Portugal, and the instrument performs with acceptable psychometric properties. The validity of the parafunction construct requires additional research in both Portuguese and other languages.

Oral hygiene of children with cleft lip and palate: Efficacy of the cleft toothbrush - A designed add-on to regular toothbrushes.

BACKGROUND: The anatomical and morphological alterations associated with cleft lip and palate (CLP) favour the buildup of dental plaque. AIM: To assess the efficacy of a new add-on to regular toothbrush-the Cleft Toothbrush, in removing the dental plaque of CLP patients, compared to a regular toothbrush. DESIGN: Forty-five children with CLP were randomly organized into two groups: A (n = 26, 2-6 years old) and B (n = 19, 7-12 years old). They were evaluated at days 0, 15, 30, and 60. After brushing their teeth with a regular toothbrush or with the Cleft Toothbrush, the dental plaque was recorded using an adapted Plaque Index (aPI). Data analyses were performed in IBM SPSS(c) , and all statistic inference comparisons were made using non-parametric tests. RESULTS: In the first 15 days, children used a new regular toothbrush and aPI-C (teeth adjacent to the cleft) was recorded. The Cleft Toothbrush, used by all children from day 15 to day 30, showed high efficacy in removing dental plaque in the cleft area, evidenced by significantly lower aPI-C values, compared to those observed with the regular toothbrush (P < 0.001). When given free option of brushing technique, from day 30 to day 60, most of the children (38 out of 45) chose the Cleft Toothbrush. CONCLUSIONS: The Cleft Toothbrush showed high efficacy in removing dental plaque in the cleft area, and presented high level of acceptance by parents and children, compared to a regular toothbrush. This is expected to improve the health status of the local adjacent tissues, a requirement for their rehabilitation.

Oral Health-Related Quality of Life Among a Portuguese Sample of Institutionalised Alcoholic Patients under Rehabilitation Therapy.

PURPOSE: To assess the self-reported Oral Health Related Quality of Life (OHRQoL) among institutionalised patients in an alcoholic detoxification programme in northern Portugal. MATERIALS AND METHODS: This analytical cross-sectional study using the Oral Health Impact Profile-49 (OHIP-49) was carried out in 300 individuals institutionalised for alcohol detoxification in withdrawal units. The seven OHIP-49 domain scores and three summary indicators were examined: 'Prevalence' (percentage of people reporting one or more of 49 items at least 'fairly often'), 'Extent' (number of impacts [items] reported at least 'fairly often') and 'Severity' (mean sum of the participants' OHIP score). RESULTS: The sample comprised 83.3% males with a mean age of 44 ± 8.6 years and an abusive alcoholic consumption history of 21.2 ± 11.5 years. The results show a 'prevalence' of 62.4% (95% CI: 56.7%-67.7%), the mean 'extent' was 3.8 (95% CI: 3.2-4.5) impacts and the mean 'severity' level was 54.8 (95% CI: 49.9-59.7). 'Prevalence' was significantly and positively associated with patients with gastroesophageal reflux disease (GERD), those with a higher estimated daily alcohol intake, who previously used hashish and who brushed their teeth after drinking alcohol. 'Extent' was higher among females, those with higher levels of education, patients with GERD, smokers, and those with a higher estimated daily alcohol consumption; it was negatively associated with not brushing teeth. 'Severity' was significantly and positively associated with female gender and smoking, and negatively associated with not brushing teeth. CONCLUSION: This population of alcohol-dependent patients undergoing an addiction rehabilitation programme presented a high prevalence of negative oral health impacts, but not a high extent or severity.

Erosive tooth wear status of institutionalized alcoholic patients under rehabilitation therapy in the north of Portugal.

OBJECTIVES: The objective of the study was to determine the erosive tooth wear (ETW) status of institutionalized patients for alcohol misuse rehabilitation therapy in the north of Portugal. MATERIAL AND METHODS: Descriptive, analytical, and cross-sectional study, conducted on 277 individuals (83.4 % men) with an average age of 43.6 ± 8.4 years, institutionalized at Instituto da Droga e Toxicodependência-Delegação Regional Norte (IDT-Norte). ETW prevalence and severity were assessed by Eccles and Jenkins index. Multivariate logistic regression was used to identify ETW risk factors. Subjects with ETW risk identification according to biological and behavioral exposure were determined in the study. RESULTS: ETW prevalence was 98.6 %. In the cohort, 51.3 % showed localized ETW lesions, 40.1 % generalized ETW lesions, and 7.2 % enamel ETW lesions, more frequently localized in maxilla. From the examined dental surfaces (n = 15,598), 11,493 had erosive wear lesions: 92.4 % (95 % CI 91.7-93.1 %) of all occlusal surfaces, 71.9 % (95 % CI 70.7-73.1 %) of all palatal/lingual, and 56.7 % (95 % CI 55.4-58.1 %) of all buccal surfaces. Buccal and lingual surfaces showed 43.2 and 41.8 % enamel erosive wear lesions; occlusal surfaces had 43.4 % localized erosive wear lesions in dentin. The main ETW risk factors were as follows: age, gastroesophageal reflux disease over 1 year, daily intake of alcohol ≥240 g (grams), and intra-oral location in anterior region; 46.2 % of the participants had erosive risk by exposure to biological and behavioral factors. CONCLUSIONS: The ETW status showed high values for disease prevalence and severity, mainly located in the maxilla, and high frequency of erosive wear lesions at occlusal, buccal, and lingual surfaces, resulting from simultaneous exposure to several risk factors. CLINICAL IMPLICATIONS: For ETW differential diagnosis, the association of both clinical and biological/nutritional/behavioral risk factors should be done for each studied population.

Self-Perceived Quality of Life (WHOQOL-Bref), and Self-Reported Health, Social and Environmental Factors Related to Its Improvement among Residents of Anil, Rio de Janeiro-Cross-Sectional Study.

This study aims to assess the self-perception of the QoL (WHOQOL-bref) in the Canal of Anil zone and its neighbor zone of the center of the District of Anil in Rio de Janeiro and to identify which factors are associated with the population self-perception of the need to "improve" their quality of life (QoL). A cross-sectional observational analytical study was carried out after approval by the competent ethics committee (CEP/CONEP) approval. A non-probabilistic sampling of residents of the Canal of Anil (n = 494) and the central district of Anil (n = 250) was used. A questionnaire was administered in person to collect data on self-reported sociodemographic characteristics, general health, sanitation, lifestyle in the residential area, and the WHOQOL-Bref. Although with a worse self-perceived water/sanitation participants in the Anil Canal community report fewer allergies, less medication, fewer skin diseases, less Zika virus, and less Chikungunya, among others. The self-perception of the need to improve the QoL in the Anil Canal community and the zone at the central District of Anil has proved to be influenced by several social and economic factors as well as residential practices and conditions. The multivariate analysis allowed us to identify both modifiable and non-modifiable risk factors for the need to improve physical QoL: taking medication, respiratory problems, skin disease diagnosed by a doctor, having a water tank at home or having filtered water at home, unpleasant odor of the water of the Anil Canal and the level of education, and age. Regarding the need to improve the environmental QoL, both areas are largely modifiable (e.g., having had ascariasis/roundworm; having a water tank in the house; not drinking bottled water; not having pavements in the street). Sociodemographic and environmental factors, in addition to health conditions, play a pivotal role in influencing individuals' perceptions of the necessity for enhanced physical and environmental well-being.

Determinants of Neonatal and Postneonatal Mortality in Northeastern Brazil: A Cohort Study of Newborns Admitted to the Neonatal Intensive Care Unit.

Despite advances in neonatology, neonatal mortality from preventable causes remains high in the North and Northeast regions of Brazil. This study aimed to analyze the determinants associated with neonatal and postneonatal mortality in newborns admitted to a neonatal intensive care unit. A cohort study was carried out in a capital in the Brazilian Northeast from 2013 to 2018. The outcome studied was death. Poisson regression was performed in the multivariate analysis of variables. Four hundred and eighty newborns were eligible, and 8.1% (39 newborns) died. Among them, 34 died in the neonatal period. The determinants that remained significantly associated with neonatal and postneonatal mortality in the final adjustment model (p < 0.05) were history of abortion, perinatal asphyxia, early neonatal sepsis and umbilical venous catheterization. All causes of this outcome were preventable. The neonatal mortality rate, although it did not include twins, neonates with malformations incompatible with life and other conditions, was 3.47 deaths per thousand live births (95% CI:1.10-8.03‱), well below the national average. In this study, pregnant women from different social classes had in common a private plan for direct access to health services, which provided them with excellent care throughout pregnancy and postnatal care. These results indicate that reducing neonatal mortality is possible through public policies with strategies that promote improvements in access to health services.

Frequency and Risk Factors Associated with Prematurity: A Cohort Study in a Neonatal Intensive Care Unit.

Background/Objectives: Prematurity rates remain high and represent a challenge for the public health systems of any country, with a high impact on neonatal mortality. This study aimed to evaluate the frequency and environmental and maternal-fetal risk factors for premature birth in a cohort of parturient women, with their newborns monitored in a neonatal intensive care unit at a private reference hospital. Methods: A cohort was carried out between 2013 and 2018 among parturient women living in a capital city in the Northeast of Brazil whose newborns were admitted to the neonatal intensive care unit. This study was approved by the Research Ethics Committee of the University of Fortaleza. The information collected comprised data from both medical records and hydrosanitary data from maternal homes. Results: The prevalence of prematurity among live births (n = 9778) between 2013 and 2018 at this hospital was 23%. The frequency of prematurity among those eligible (n = 480) was 76.9%, and the frequency of eligible premature babies (n = 369) in relation to the total number of births in this period was 3.8%. In the multivariate analysis, the significant risk factors for prematurity were primigravida (RR = 1.104, 95%CI: 1.004-1.213) and hypertensive syndromes during pregnancy (RR = 1.262, 95%CI: 1.161-1.371), and the significant protective factor was the highest number of prenatal consultations (RR = 0.924, 95%CI: 0.901-0.947). Conclusions: This study contributes to providing greater visibility to prenatal care and the understanding of complications during pregnancy and childbirth care. These results indicate the need to implement public policies that promote improvements in the population's living conditions and care for pregnant women to reduce premature births and, consequently, neonatal and infant mortality.

Correlation between Periodontitis and Gastritis Induced by Helicobacter pylori: A Comprehensive Review.

The goal of this comprehensive review was to verify if the prevalence of Helicobacter pylori (Hp) bacteria in patients with dyspepsia is higher in the oral cavity of periodontal or non-periodontal patients. The bibliographic search was conducted on scientific studies published in PubMed, Cochrane Library, SciELO, and BVS. The focus question was: "In patients with dyspepsia and periodontitis, is the prevalence of Hp bacteria in the oral cavity higher than in patients with only dyspepsia or without any disease?" The inclusion criteria were human studies in English, Portuguese, or Spanish languages, published between 2000 and 2022, that included patients over the age of 18 and aimed to evaluate the presence of Hp bacteria in the oral cavity and in the protective mucosal layer of the gastric lining of patients with the diseases (periodontitis and dyspepsia) or without disease; clinical trials, randomized controlled clinical trials, comparative studies, case-control studies, cross-sectional studies, and cohort studies. The methodological quality evaluation of the included articles was performed using the Joanna Briggs Institute tools. The final scores could be of "Low" quality (at least two "no" [red] or ≥ five "unclear" found), "Moderate" quality (one "no" [red] was found or up to four "unclear" criteria were met), or "High" quality (all green [yes] or at maximum two "unclear"). Of 155 potentially eligible articles, 10 were included in this comprehensive review after the application of the eligibility criteria. The selected studies were scrutinized regarding the relationship between Hp colonization in the oral cavity and stomach, its impact on severity and complications of gastric infection, as well as the effect of the presence of oral and gastric Hp on dental and systemic parameters. Hp can colonize periodontal pockets regardless of its presence in the stomach. There was a higher prevalence of oral biofilm in dyspeptic patients with periodontal disease, and worse control of bleeding and low oral hygiene was observed in periodontal compared to non-periodontal patients. For que quality assessment, the scientific studies included presented low to moderate methodological quality. Conclusions: It is possible to conclude that Hp is a bacterium that can colonize dental plaque independently of the stomach and vice versa; however, when both diseases are found, its presence may be more significant. Supra and subgingival dental plaque may be a reservoir of Hp, suggesting that patients with gastric infections are more likely to have Hp in the oral cavity. The results must be carefully analyzed due to the limitations present in this review.

Association between Environmental Cadmium Exposure and Osteoporosis Risk in Postmenopausal Women: A Systematic Review and Meta-Analysis.

Osteoporosis is a common and serious health issue among postmenopausal women. We conducted a systematic review and meta-analysis study to determine whether environmental exposure to cadmium (Cd) is a risk factor for postmenopausal osteoporosis. A PROSPERO-registered review of the literature was performed on studies evaluating the relationship between urinary Cd (UCd) concentration, an indicator of long-term Cd exposure, and bone mineral density or osteoporosis in women aged 50 years and older. PubMed, Embase, Science Direct, Web of Science, and B-on databases were searched for articles published between 2008 and 2021. The association between UCd levels and osteoporosis risk was assessed by pooled odds ratio (OR) and 95% confidence interval (CI) using random-effect models. Ten cross-sectional studies were included in the qualitative analysis, of which five were used for meta-analysis. We separately assessed the risk of osteoporosis in women exposed to Cd at low environmental levels (n = 5895; UCd ≥ 0.5 µg/g creatinine versus UCd < 0.5 µg/g creatinine) and high environmental levels (n = 1864; UCd ≥ 5 µg/g creatinine versus UCd < 5 µg/g creatinine). The pooled OR for postmenopausal osteoporosis was 1.95 (95% CI: 1.39−2.73, p < 0.001) in the low exposure level group and 1.99 (95% CI: 1.04−3.82, p = 0.040) in the high exposure level group. This study indicates that environmental Cd exposure, even at low levels, may be a risk factor for osteoporosis in postmenopausal women. Further research based on prospective studies is needed to validate these findings.

Barthel's Index: A Better Predictor for COVID-19 Mortality Than Comorbidities.

BACKGROUND: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous conditions. The main goal of this study was to determine if activities of daily living (ADL) dependence measured by Barthel's index could be a predictor for COVID-19 mortality. METHODS: A prospective cohort study was performed with a consecutive sample of 340 COVID-19 patients representing patients from all over the northern region of Portugal from October 2020 to March 2021. Mortality risk factors were determined after controlling for demographics, ADL dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis, we used t test, chi-square test, or Fisher exact test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. IBM SPSS version 27 statistical software was used for data analysis. RESULTS: The cohort included 340 patients (55.3% females) with a mean age of 80.6±11.0 years. The mortality rate was 19.7%. Univariate analysis revealed that aging, ADL dependence, pneumonia, and dementia were associated with mortality and that dyslipidemia and obesity were associated with survival. In multivariable analysis, dyslipidemia (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.17-0.71) was independently associated with survival. Age ≥86 years (pooled OR, 2.239; 95% CI, 1.100-4.559), pneumonia (pooled OR, 3.00; 95% CI, 1.362-6.606), and ADL dependence (pooled OR, 6.296; 95% CI, 1.795-22.088) were significantly related to mortality (receiver operating characteristic area under the curve, 82.1%; p<0.001). CONCLUSION: ADL dependence, aging, and pneumonia are three main predictors for COVID-19 mortality in an elderly population.

Efficacy of speech language therapy intervention in unilateral vocal fold paralysis - a systematic review and a meta-analysis of visual-perceptual outcome measures.

OBJECTIVE: Unilateral vocal folds paralysis is a disorder that affects a patient's quality-of-life by disturbing their phonation, breathing, and swallowing activities. This systematic review aimed to estimate the efficacy of voice treatment on the vocal fold motility in adult patients with unilateral vocal folds paralysis. METHODS: PubMed, CINAHL, CENTRAL, and Web of Science were searched for retrospective and prospective cohort, case-control, and cross-sectional with comparative studies with adults that were published between 1 January 2008 to 31 December 2018. After applying the inclusion and exclusion criteria a total of 10 studies containing morpho-functional evaluation results were included in the analysis. Pooled data analysis of the motility of the vocal folds before and after voice therapy allowed inferring about the efficacy of voice therapy intervention in patients with unilateral vocal folds paralysis. A random-effect model was used to estimate the effect size. Publication bias was considered. RESULTS: The pooled data analysis of the visual-perceptual measures revealed that vocal fold motility improved in 72% (95% CI: 64.0-80.0) of all patients after the therapeutic interventions. The inconsistency index (I2 = 18.35%) of the studies included in this meta-analysis revealed an extremely low heterogeneity. Funnel plot and Cochran's Q test showed no publication bias. The systematic review was limited to only English language articles. CONCLUSION: This meta-analysis supports the evidence that voice therapy intervention can have a positive effect on the vocal fold motility, that is, they can improve the glottal gap closure, irrespective of the exercises and techniques used.

Universal Adhesives and Adhesion Modes in Non-Carious Cervical Restorations: 2-Year Randomised Clinical Trial.

This prospective, double-blind, six-arm parallel randomised controlled trial aimed to compare the performance of two universal adhesives (UAs) in non-carious cervical lesions (NCCLs), using the FDI criteria, and analysed if participants/NCCLs' characteristics influenced the outcome. Thirty-eight 18- to 65-year-old participants were seeking routine dental care at a university clinic. At baseline, 210 NCCLs were randomly allocated to six groups (35 restorations' each). The UAs tested were FuturabondU (FBU) and AdheseUniversal (ADU) applied in either etch-and-rinse (ER) and self-etch (SE) modes. FuturabondDC (FBDC) in SE and in SE with selective enamel etching (SE-EE) modes were controls. NCCLs were restored with AdmiraFusion. The analysis included nonparametric tests, Kaplan-Meier and log-rank tests (α = 0.05). At 2-years, of 191 restorations, ten were missed due to retention loss (all groups, p > 0.05). FBDC (p = 0.037) and FBU (p = 0.041) performed worse than ADU in SE mode. FBDC and FBU also showed worse functional success rate (p = 0.012, p = 0.007, respectively) and cumulative retention rates (p = 0.022, p = 0.012, respectively) than ADU. Some participants/NCCLs' characteristics influenced (p < 0.05) the outcomes. FBU did not perform as well as ADU, especially in SE mode and due to functional properties. Participants' age and NCCLs' degree of dentin sclerosis and internal shape angle influenced FBU performance.

Dietary Patterns and Oral Health Behaviours Associated with Caries Development from 4 to 7 Years of Age.

The association between modifiable risk factors and caries in children has been documented; however, most studies have been cross-sectional and have not considered the complexity of dietary factors and oral health habits. This study aimed to investigate the prospective association between dietary patterns and oral health behaviours at 4 years of age and the development of new decayed, missing, and filled teeth (d3-6mft/D3-6MFT) over a period of three years. Participants were children from the Generation XXI population-based birth cohort. At 4 years of age, diet patterns were assessed using a food frequency questionnaire, with three dietary patterns being identified. For the purpose of capturing the new development of caries between 4 and 7 years of age, two dental outcomes were defined in the mixed dentition: "dental caries development" and "severe dental caries development" in the mixed dentition. Bivariate analysis and multivariate logistic regression were used. From 4 to 7 years of age, 51.2% of the children had at least one new d3-6mft/D3-6MFT and 27.4% had more than two new d3-6mft/D3-6MFT. Children belonging to the "energy-dense foods" (OR = 2.19; 95% CI: 1.20-4.00) and "snacking" (OR = 2.19; 95% CI: 1.41-3.41) dietary patterns at 4 years old were associated with severe dental caries development three years later. Preventive strategies should be implemented in an attempt to reduce snacking and the consumption of energy-dense, micronutrient-poor foods to promote children's oral health.

DNA-based detection of Mycobacterium avium subsp. paratuberculosis in domestic and municipal water from Porto (Portugal), an area of high IBD prevalence.

Mycobacterium avium subsp. paratuberculosis (MAP) may play a role in the pathology of human inflammatory bowel disease (IBD). Previously, we found a high frequency (98% in patients with active disease) of MAP DNA detection in the blood of Portuguese Crohn's Disease patients, suggesting this cohort has high exposure to MAP organisms. Water is an important route for MAP dissemination, in this study we therefore aimed to assess MAP contamination within water sources in Porto area (the residential area of our IBD study cohort). Water and biofilms were collected in a wide variety of locations within the Porto area, including taps connected to domestic water sources and from municipal water distribution systems. Baseline samples were collected in early autumn plus further domestic water samples in early winter, to assess the effect of winter rainfall. DNA was extracted from all 131 samples and IS900-based nested PCR used to assess the frequency of MAP presence. Our results show high MAP positivity in municipal water sources (20.7% of water samples and 41.4% of biofilm samples) and even higher amongst domestic sources (30.8% of water samples and 50% of biofilm samples). MAP positivity in biofilms correlated with positivity in water samples from the same sources. A significantly higher frequency of MAP-positivity was observed during winter rains as compared with samples collected in autumn prior to the winter rainfall period (61.9% versus 30.8%). We conclude that domestic and municipal water sources of Porto region have a high burden of MAP contamination and this prevalence increases with rainfall. We hypothesize that human exposure to MAP from local water supplies is commonplace and represents a major route for MAP transmission and challenge which, if positively linked to disease pathology, may contribute to the observed high prevalence of IBD in Porto district.