Hemodiafiltration versus Hemodialysis in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis.

Rationale & Objective: The use of hemodiafiltration (HDF) as a kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD) has sparked a debate regarding its advantages over conventional hemodialysis (HD). The present study aims to shed light on this controversy by comparing mortality rates and cause-specific deaths between ESKD patients receiving HDF and those undergoing HD. Study Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted using PubMed, EMBASE, and Cochrane Central on July 1, 2023. Setting & Participants: Adult patients with ESKD on regular KRT. Exposure: Studies with participants undergoing HDF. Outcomes: Primary outcomes were all-cause mortality, cardiovascular (CV) mortality, deaths related to infections, and kidney transplant. We also evaluated the endpoints for deaths related to malignancy, myocardial infarction, stroke, arrhythmias, and sudden death. Analytical Approach: We included RCTs evaluating HDF versus HD. Crossover trials and studies with overlapping populations were excluded. Two authors independently extracted the data following predefined search criteria and quality assessment. The risk of bias was assessed with Cochrane's RoB2 tool. Results: We included 5 RCTs with 4,143 patients, of which 2,078 (50.1%) underwent HDF, whereas 2,065 (49.8%) were receiving HD. Overall, HDF was associated with a lower risk of all-cause mortality (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.73-0.91; P < 0.001; I2 = 7%) and a lower risk of CV-related deaths (RR, 0.75; 95% CI, 0.61-0.92; P = 0.007; I2 = 0%). The incidence of infection-related deaths was also significantly different between therapies (RR, 0.69; 95% CI, 0.50-0.95; P = 0.02; I2 = 26%). Limitations: In individual studies, the HDF groups achieved varying levels of convection volume. Conclusions: Compared with those undergoing HD, patients receiving HDF experienced a reduction in all-cause mortality, CV mortality, and infection-related mortality. These results provide compelling evidence supporting the use of HDF as a beneficial intervention in ESKD patients undergoing KRT. Registration: Registered at PROSPERO: CRD42023438362.

Recycling composted human feces as biofertilizer for crop production: Assessment of soil and lettuce plant tissue contamination by Escherichia coli and human adenovirus.

Using waste from sewage systems, particularly human excreta, could save resources and increase soil fertility, contributing to nutrient management. However, because of the pathogenic content in human feces, this resource can pose health risks to farmers and consumers. Therefore, this work analyzed the behavior of the microorganisms: Escherichia coli ATCC13706 and human adenovirus (HAdV-2) in the soil and the internal part of the plant tissue during the vegetative stage after applying spiked composted human feces as biofertilizer. In a greenhouse, we simulated the application of the biofertilizer in lettuce cultivation by spiking three concentrations of E. coli (6.58, 7.31, and 8.01 log10 CFU.g-1) and HAdV-2 (3.81, 3.97, and 5.92 log10 PFU.g-1). As a result, we achieved faster decay in soil at higher concentrations of E. coli. We estimated linear decay rates of -0.07279, -0.09092, and -0.115 days, corresponding to T90s of 13.7, 11.0, and 8.6 days from higher to smaller concentrations of E. coli, respectively. The estimated periods for the inactivation of 4 logarithmic units of E. coli bacteria in soil are longer than the cultivation period of lettuce for all concentrations studied. Concerning the bacterial contamination in plants, we found E. coli in the internal part of the leaves at the highest concentration tested during the first three weeks of the experiment. Furthermore, HAdV-2 was found in roots at a stable concentration of 2-2.3 log10 PFU.g-1 in five of the six samples analyzed. Therefore, bacterial infection could pose a risk, even if fresh greens are washed before consumption, especially for short-term cultures. Regarding viral infection, a positive result in the roots after disinfection may pose a risk to root and tubercule vegetables. These discoveries highlight the importance of conducting comprehensive evaluations of hygiene practices in incorporating organic amendments in crops, explicitly aiming to minimize the risk of post-contamination.

Age-related Morphofunctional Changes in Sickle Cell Mice Bone Marrow Mesenchymal Stromal Cells.

BACKGROUND AND OBJECTIVES: Bone marrow mesenchymal stromal cells (BM-MSCs) are key elements of the hematopoietic niche and participate in the regulatory mechanisms of hematopoietic stem cells (HSCs). Hematological diseases can affect MSCs and their functions. However, the dysregulations caused by sickle cell disease (SCD) are not fully elucidated. This work explored changes in BM-MSCs and their relationship with age using sickle cell mice (Townes-SS). MATERIALS AND METHODS: BM-MSCs were isolated from Townes-SS, and control groups 30- and 60-day-old Townes-AA and C57BL/6 J. RESULTS: The BM-MSCs showed no morphological differences in culture and demonstrated a murine MSC-like immunophenotypic profile (Sca-1+, CD29+, CD44+, CD90.2+, CD31-, CD45-, and CD117-). Subsequently, all BM-MSCs were able to differentiate into adipocytes and osteocytes in vitro. Finally, 30-day-old BM-MSCs of Townes-SS showed higher expression of genes related to the maintenance of HSCs (Cxcl12, Vegfa, and Angpt1) and lower expression of pro-inflammatory genes (Tnfa and Il-6). However, 60-day-old BM-MSCs of Townes-SS started to show expression of genes related to reduced HSC maintenance and increased expression of pro-inflammatory genes. CONCLUSION: These results indicates age as a modifying factor of gene expression of BM-MSCs in the context of SCD.

Occurrence of zoonotic enteric parasites in fecal samples from dogs in shelters, parks, squares and public roads, and the dog guardians' perception of zoonoses as for the risk to public health in the city of Guarapuava, Paraná, Brazil.

The aim of this study was to determine the occurrence of zoonotic enteroparasites in the feces of dogs from public shelters, squares, parks, and public roads in the city of Guarapuava, Paraná, Brazil, and to evaluate the perception of dog guardians regarding zoonoses and their risk to public health. Fecal samples were collected, coproparasitological examinations were performed to detect zoonotic enteroparasites, and polymerase chain reaction (PCR) was used to identify Giardia spp. and Cryptosporidium spp. Questionnaires were given to guardians who walked their dogs in parks, squares, and public roads, as to assess their perception of zoonoses. A total of 333 samples were collected, of these 75, 123, and 135 of them were from public shelters, squares and parks, and public roads, respectively. One or more parasites were identified in 166 (50 %) samples, of which 58/75 (77 %) were from public shelters, 50/123 (41 %) from squares and parks, and 58/135 (43 %) from public roads. The parasites detected included Ancylostoma spp., Giardia spp., Trichuris spp., Toxocara spp., and Cystoisospora spp., with Ancylostoma spp. having the highest occurrence. PCR was performed on 161 samples for convenience due to financial limitations, because only a portion of the study was funded by the municipal government, of which 15.6 % were positive for Giardia spp., and all were negative for Cryptosporidium spp. In total, 246 guardians were interviewed, of which 36 % said they did not collect their animals' feces during walks, 20 % did not use anti-helminthics on their dogs, and 23 % did not know which diseases could be transmitted by feces. Therefore, we conclude that there is a high infection rate of parasites with zoonotic potential in public places, showing the need to raise awareness among guardians about the diseases transmitted by dog feces, correct vermifugation and the importance of collecting feces in public places.

A espiritualidade e o luto na morte perinatal: uma revisão narrativa / Spirituality and bereavement in perinatal death: a narrative review

A morte perinatal, compreendida como a morte de um feto entre 28 semanas ou mais de gestação e nascido vivo com menos de 28 dias de idade, envolve aspectos multidimensionais do sofrimento familiar. Entre as estratégias existentes de como lidar com esse sofrimento, a espiritualidade, entendida como busca pessoal de compreensão das questões existenciais humanas e suas relações com o sagrado e transcendente, pode ser uma forma de ressignificar esse processo de luto. Investigar a influência da espiritualidade no luto familiar decorrente de mortes perinatais. Foi realizada uma pesquisa no PUBMED utilizando os descritores DeCs/Mesh "Bereavement", "Perinatal death" e "Spirituality" no mês de junho de 2023. Foram incluídos 14 artigos nesta revisão narrativa. Realizar rituais que honrem a memória do bebê, identificando-o como membro da família favorecem o processo de elaboração e aceitação do luto. A autorreflexão acerca do processo da perda torna-se inerente para ressignificar o luto perinatal como uma "experiência humana natural". Além disso, a espiritualidade representa um meio de fortalecimento e ressignificação tanto para a mãe quanto para os familiares diante do sofrimento experienciado. Por fim, há uma carência de profissionais de saúde e religiosos qualificados que consigam abordar de uma maneira sistemática a oferecer melhora no processo e na qualidade assistencial da perda materna. A experiência do luto perinatal pode assumir novos valores e significados ao ser reconhecida, respeitada e auxiliada por profissionais qualificados em abordar sobre o tema, sendo a espiritualidade um aspecto importante para a elaboração do luto materno.

Perinatal death, understood as the death of a fetus between 28 weeks or more of gestation and a live birth less than 28 days old, involves multidimensional aspects of family suffering. Among the existing strategies for dealing with this suffering, spirituality, understood as a personal search for understanding human existential issues and their relationships with the sacred and transcendent, can be a way of giving new meaning to this grieving process. Investigate the influence of spirituality on family bereavement resulting from perinatal deaths. A search was carried out on PUBMED using the DeCs/Mesh descriptors "Bereavement", "Perinatal death" and "Spirituality" in June 2023. 14 articles were included in this narrative review. Performing rituals that honor the baby's memory, identifying them as a member of the family, favors the process of elaboration and acceptance of bereavement. Self-reflection about the process of loss becomes inherent to re-signify perinatal bereavement as a "natural human experience". Furthermore, spirituality represents a means of strengthening and giving new meaning for both the mother and family members in the face of the suffering experienced. Finally, there is a lack of qualified health and religious professionals who can systematically approach and improve the process and quality of care for maternal loss. The experience of perinatal bereavement can take on new values and meanings when recognized, respected and assisted by professionals qualified to address the topic, with spirituality being an important aspect in the elaboration of maternal bereavement.

Validation of the Brazilian 10-item Cervantes Scale for the assessment of menopausal symptoms

Abstract Objective: To validate the 10-item Cervantes Scale (CS-10) among Brazilian women. Methods: This is a cross-sectional observational study involving women in the community aged 40-55 years in the Southern region of Brazil. They completed a general health, habits and socio-demographic questionnaire, the CS-10 and the Women's Health Questionnaire (WHQ). Women unable to understand the survey, not consenting to participate, or having incapacity imposing difficulties during the completion of the questionnaire were excluded. A Confirmatory Factor Analysis (CFA) was conducted with the AMOS 16.0 software. Chi-square of degrees of freedom (χ2/df), the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI) and the Root-Mean-Square Error of Approximation (RMSEA) were used as indices of goodness of fit. Cronbach's alpha coefficient was used for internal consistency. Results: A total of 422 women were included (premenopausal n=35, perimenopausal n=172, postmenopausal n=215). The CFA for the CS-10 showed a good fit (χ²/df=1.454, CFI=0.989; TLI=0.985; RMSEA=0.033; CI 90%=0.002-0.052; PCLOSE=0.921; Model p=0.049). Good reliability was established in CS-10 and WHQ (Cronbach's alpha=0.724). Postmenopausal women had higher total CS-10 scores (p≤0.0001), reflecting worse quality of life (QoL) related to menopause symptoms and confirming the greater symptomatology evaluated by high total scores for WHQ found in this population when compared to those in the premenopausal period (p=0.041). Conclusion: The CS-10 is a consistent tool for health-related QoL in Brazilian mid-aged women.

Plano de pós-parto para gestantes e puérperas: produção de material educativo / Plan de posparto para mujeres embarazadas y puérperas: producción de material educativo / Postpartum plan for pregnant and postpartum women: production of educational material

Resumo Objetivo Desenvolver e validar material educativo para a construção de um plano de pós-parto pela mulher no ciclo gravídico-puerperal, com ou não profissionais da saúde. Métodos Estudo metodológico, organizado em três etapas. 1) Análise e seleção de conteúdo, elaboração teórica do projeto e adaptação na linguagem; 2) Produção do material, com elaboração do design gráfico e projeto ilustrativo; 3) Validação com sete juízes nas áreas de saúde da mulher e educação em saúde. A coleta de dados foi executada com a aplicação de um questionário de caracterização e o Suitability Assessment of Materials for evaluation of health-related information for adults (SAM). A análise se deu por estatística descritiva e Índice de Validade de Conteúdo, sendo considerados aprovados os itens que apresentassem valor igual ou superior a 0,80. Resultados O plano de cuidado intitulado "Meu plano de pós-parto" apresentou ótima aceitação e confiabilidade, evidenciado por um Índice de Validade de Conteúdo global de 0,98. As principais sugestões apresentadas foram a respeito da adaptação da escrita para uma linguagem mais simples e acessível, sendo estas aceitas pelas autoras. Os especialistas apontaram a importância e relevância do plano de pós-parto para o público-alvo. Conclusão O material demonstrou ser um instrumento válido e confiável para a utilização das mulheres durante o ciclo gravídico puerperal, favorecendo uma reflexão sobre os cuidados e preparo precoce para enfrentamento deste período.

Resumen Objetivo Elaborar y validar material educativo para la creación de un plan de posparto por la mujer durante el embarazo y el puerperio, con o sin profesionales de la salud. Métodos Estudio metodológico, organizado en tres etapas: 1) análisis y selección de contenido, elaboración teórica del proyecto y adaptación del lenguaje; 2) producción del material, con elaboración del diseño gráfico y proyecto ilustrativo, y 3) validación por siete jueces de áreas de la salud de la mujer y educación para la salud. La recopilación de datos se llevó a cabo mediante la aplicación de un cuestionario de caracterización y el Suitability Assessment of Materials for evaluation of health-related information for adults (SAM). El análisis se realizó con estadística descriptiva y con el Índice de Validez de Contenido, donde se consideraron aprobados los ítems que presentaron un valor igual o superior a 0,80. Resultados El plan de cuidado llamado "Mi plan de posparto" presentó una excelente aceptación y fiabilidad, demostradas con un Índice de Validez de Contenido global de 0,98. Las principales sugerencias propuestas fueron sobre adaptar la escritura a un lenguaje más simple y accesible, y las autoras las aceptaron. Los especialistas señalaron la importancia y la relevancia del plan de posparto para el público destinatario. Conclusión El material demostró ser un instrumento válido y confiable para que lo utilicen mujeres durante el embarazo y el puerperio, y así favorecer una reflexión sobre los cuidados y la preparación temprana para enfrentar este período.

Abstract Objective To develop and validate an educational material for the construction of a postpartum plan by women in the pregnancy-puerperal cycle, with or without health professionals. Methods Methodological study, organized in three stages. 1) Content analysis and selection, theoretical elaboration of the project and language adaptation; 2) Production of material, with preparation of graphic design and illustrative project; 3) Validation with seven judges in the areas of women's health and health education. Data collection was carried out using a characterization questionnaire and the Suitability Assessment of Materials for evaluation of health-related information for adults (SAM). The analysis was carried out using descriptive statistics and Content Validity Index, with items that presented a value equal to or greater than 0.80 being considered approved. Results The care plan entitled "My postpartum plan" showed excellent acceptance and reliability, evidenced by an overall Content Validity Index of 0.98. The main suggestions presented were about adapting the writing to a simpler and more accessible language, which were accepted by the authors. Experts highlighted the importance and relevance of the postpartum plan for the target audience. Conclusion The material proved to be a valid and reliable instrument for use by women during the pregnancy and puerperal cycle, encouraging reflection on care and early preparation to face this period.

Seroprevalence and risk factors for Neospora caninum and Toxoplasma gondii in dairy cattle from São Paulo State, Brazil / Soroprevalência e fatores de risco para Neospora caninum e Toxoplasma gondii em bovinos leiteiros do Estado de São Paulo

Abstract Neospora caninum is a major cause of reproductive loss in cattle worldwide as it leads to abortion and animal repositioning. Although Toxoplasma gondii does not cause a reproductive problem in cattle, consuming raw or uncooked beef poses the risk of transmission. This study aimed to evaluate the occurrence of anti-N. caninum and anti-T. gondii antibodies in dairy cattle in the West and Northwest regions of São Paulo State, Brazil. A total of 653 serum samples from dairy cows were analyzed using an indirect immunofluorescence assay (IFA). Epidemiological data from the farms were associated with the serological results of the animals by logistic regression based on the presence of antibodies. The frequencies of the antibodies against N. caninum and T. gondii were 41.6% (272/653) and 11.5% (75/653), respectively. A statistically significant association was observed between: the serum anti-N. caninum antibodies and breed, history of food supplementation for calves, introduction of outside animals that later presented reproductive problems, and history of reproductive problems by the trimester of gestation. The present study highlights the importance of neosporosis in dairy cattle in the study regions and that the inclusion of this parasite in the investigation of animals with reproductive disorders is important.

Resumo Neospora caninum é uma das principais causas de perda reprodutiva em bovinos em todo o mundo, pois leva ao aborto e ao reposicionamento animal. Embora o Toxoplasma gondii não cause problemas reprodutivos em bovinos, o consumo de carne bovina crua ou não cozida apresenta risco de transmissão. Este estudo teve como objetivo avaliar a ocorrência de anticorpos anti-N. caninum e anti-T. gondii em bovinos leiteiros nas regiões Oeste e Noroeste do Estado de São Paulo, Brasil. Um total de 653 amostras de soro de bovinos leiteiros, foi analisado utilizando-se o ensaio de imunofluorescência indireta (IFI). Os dados epidemiológicos das propriedades foram associados aos resultados sorológicos dos animais por meio de regressão logística. As frequências dos anticorpos contra N. caninum e T. gondii foram 41,6% (272/653) e 11,5% (75/653), respectivamente. Foi observada associação estatisticamente significativa entre: soropositividade para N. caninum e raça, histórico de suplementação alimentar para bezerros, introdução de animais externos que, posteriormente, apresentaram problemas reprodutivos e histórico de problemas reprodutivos no segundo trimestre de gestação. O presente estudo destaca a importância da neosporose em bovinos leiteiros, nas regiões de estudo, e a inclusão deste parasita na investigação de animais com distúrbios reprodutivos é fundamental.

Consumo de medicamentos não padronizados na saúde indígena: uso racional? / Consumption of non-standard medication in indigenous health: rational usage?

Resumo O estudo analisou o consumo de medicamentos não padronizados na saúde indígena, enfatizando a racionalidade da farmacoterapia, por meio de um estudo transversal dos dados secundários, de 2018 e 2019, no Distrito Especial Sanitário de Saúde Indígena Minas Gerais/Espírito Santo. Esses medicamentos foram classificados pela Anatomical Therapeutic Chemical Classification. Para a comparação da origem de prescrição e da forma de aquisição, empregaram-se testes não paramétricos, avaliando o acesso a medicamentos. Verificou-se a racionalidade por meio do perfil de consumo e da opção terapêutica na lista de medicamentos padronizados. Foram consumidas 104.928 apresentações farmacêuticas, 66.967 (66%) eram para o trato alimentar e o metabolismo; 17.705 (17%) para o sistema nervoso; 12.961 (12%) para o sistema cardiovascular. Quanto aos medicamentos mais consumidos por regiões, 171 (90%) dos 190 apresentavam opção terapêutica. As prescrições foram mais provenientes do SUS. Encontraram-se diferenças na forma de aquisição dos medicamentos. O estudo apontou importante consumo de medicamentos não padronizados, podendo existir falhas na racionalidade terapêutica. Na saúde indígena, questões etnoculturais e sociais constituem desafios para o acesso aos medicamentos com uso racional.

Abstract The study analyzed the consumption of non-standard medication in the health of indigenous peoples, emphasizing the rationality of pharmacotherapy, by conducting a cross-sectional study of secondary data from 2018 and 2019 in the Minas Gerais/Espírito Santo Special Sanitary Indigenous Health Districts. These medicines were classified by Anatomical Therapeutic Chemical Classification. Non-parametric tests were applied to compare the origin of prescription and the form of acquisition, assessing access to medication. Rationality was verified through the consumption profile and the therapeutic option in the list of standardized medicines. A total of 104,928 pharmaceutical presentations were consumed, 66,967 (66%) for the alimentary tract and metabolism, 17,705 (17%) for the nervous system, and 12,961 (12%) for the cardiovascular system. With respect to medicines consumed per region, 171 (90%) out of 190 had a therapeutic option. Prescriptions were more from the SUS. Differences were found in the way the medicines were acquired. The study pointed to significant consumption of non-standard medicines, and there may be failings in therapeutic rationality. In indigenous health, ethnocultural and social issues are challenges to access to medicines with rational use.

Seeking treatment for traumatic dental injuries in schoolchildren: A multilevel analysis

ABSTRACT To investigate individual and contextual factors associated with seeking treatment for traumatic dental injuries. A cross-sectional study was conducted with 739 pairs of guardians and children. Guardians answered a questionnaire addressing sociodemographic characteristics, seeking treatment for a tooth injury in the child, and the Oral Health Literacy-Adult Questionnaire. Descriptive analysis and unadjusted and adjusted multilevel Poisson regression analysis (p<0.05). The prevalence of seeking treatment for traumatic dental injury was 44.7%. Sociodemographic variables associated were white skin of the child (PR = 1.30; 95% CI: 1.08-1.76), mother's age older than 35 years (PR = 1.70; 95% CI: 1.50-1.90), married parents (PR = 1.93; 95% CI: 1.70-2.23), guardians with more than eight years of schooling (PR = 2.00; 95% CI: 1.76-2.23), with adequate oral health literacy (PR = 3.33; 95% CI: 3.01-3.62) and the daily use of electronic devices by the child (PR = 1.26; 95% CI: 1.02-1.50). On the contextual level, attending a private school (PR = 1.77; 95% CI: 1.02-3.05) and the number of primary care units with oral health teams in the school district (PR = 1.78; 95% CI: 1.12-2.38) remained associated. Among the children who suffered TDI, adequate oral health literacy on the part of the parents stood out among the factors associated with seeking treatment.

Resumo Investigar fatores individuais e contextuais associados à busca de tratamento para lesões dentárias traumáticas. Foi realizado um estudo transversal com 739 pares de responsáveis e crianças. Os responsáveis responderam a um questionário abordando características sociodemográficas, busca por tratamento para traumatismo dentário na criança e o Questionário de alfabetização em saúde bucal para adulto. Análise descritiva e análise de regressão de Poisson multinível não ajustada e ajustada (p<0,05) foram realizadas. A prevalência de busca de tratamento para lesão dentária traumática foi de 44,7%. As variáveis sociodemográficas associadas foram a pele branca da criança (RP = 1,30; IC 95%: 1,08-1,76), idade da mãe maior que 35 anos (RP = 1,70; IC 95%: 1,50-1,90), os responsáveis casados (RP = 1,93; IC 95%: 1,70-2,23), com mais de oito anos de estudo (RP = 2,00; IC 95%: 1,76-2,23), com alfabetização adequada em saúde bucal (RP = 2,00; IC 95%: 1,76-2,23) e uso diário de dispositivos eletrônicos pela criança (RP = 1,26; IC 95%: 1,02-1,50). No nível contextual, frequentar uma escola particular (PR = 1,77; IC 95%: 1,02-3,05) e a quantidade de unidades básicas de saúde com equipes de saúde bucal no distrito sanitário da escola (PR = 1,78; IC 95%: 1,12-2,38) permaneceram associados. Entre as crianças que sofreram TDI, a alfabetização em saúde bucal adequada dos pais foi um fator que se destacou na busca por tratamento.

Cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for use on Brazilian adolescents

Abstract The present study aimed to perform the cross-cultural adaptation of the Digital Health Literacy Instrument (DHLI) for native Brazilian Portuguese-speaking adolescents (DHLI-BrA). Cross-cultural adaptation consisted of the following steps: translation, assessment, and adjustments by the expert committee to ensure cultural equivalence; back-translation, and synthesis of back-translations. Cognitive testing was then performed in a pretest with adolescents using cognitive interviews with probing questions on the item's understanding interpretation and response options. Cronbach's alpha coefficient and McDonald's omega were used to estimate the instrument's reliability. Forty-two Brazilian adolescents participated in the study (mean age: 16.0 ± 2.0 years; range: 13 to 19 years). Items that were difficult to understand were adapted to the context of Brazilian adolescents. Cronbach's alpha coefficient and McDonald's omega for the 21 items of the DHLI-BrA were, respectively, 0.79 and 0.80. Cronbach's alpha coefficient for the subscales of the self-report instrument was 0.53-0.79 (range), demonstrating good reliability in the total instrument and moderate reliability in the subscales. This study provides the cross-cultural adapted version of the Digital Health Literacy Instrument (DHLI), which is an instrument for measuring digital Health literacy, for use in Brazilian adolescents (DHLI-BrA).

Resumo O estudo teve o objetivo de adaptar transculturalmente o Digital Health Literacy Instrument (DHLI) para adolescentes nativos do idioma português do Brasil (DHLI-BrA). O estudo de adaptação transcultural consistiu nas seguintes etapas: tradução, avaliação e adequação de equivalência cultural da tradução por comitê de especialistas; retrotradução e síntese das retrotraduções. Foi realizada a testagem cognitiva em pré-teste com adolescentes, utilizando-se entrevistas cognitivas com perguntas de sondagem sobre a compreensão e interpretação dos itens e opções de resposta. O alfa de Cronbach e ômega de McDonald's foram utilizados para estimar a confiabilidade do instrumento. Participaram do pré-teste 42 adolescentes brasileiros com média de idade de 16,0 ± 2,0 (variação de 13-19) anos. Os itens com dificuldade de compreensão foram adaptados ao contexto dos adolescentes brasileiros. O coeficiente alfa de Cronbach e o ômega de McDonald's, para os 21 itens do DHLI-BrA foi respectivamente, 0,79 e 0,80. O coeficiente alfa de Cronbach para as subescalas do instrumento de autorrelato foi de 0,53-0,79 (variação), demonstrando boa confiabilidade no instrumento total e confiabilidade moderada nas subescalas. Este estudo fornece a versão adaptada transculturalmente do Digital Health Literacy Instrument (DHLI), um instrumento de mensuração do letramento digital em saúde, para utilização em adolescentes brasileiros (DHLI-BrA).

Homocysteine May Decrease Glucose Uptake and Alter the Akt/GSK3ß/GLUT1 Signaling Pathway in Hippocampal Slices: Neuroprotective Effects of Rivastigmine and Ibuprofen.

Homocysteine (Hcy) is a risk factor for neurodegenerative diseases, such as Alzheimer's Disease, and is related to cellular and tissue damage. In the present study, we verified the effect of Hcy on neurochemical parameters (redox homeostasis, neuronal excitability, glucose, and lactate levels) and the Serine/Threonine kinase B (Akt), Glucose synthase kinase-3ß (GSK3ß) and Glucose transporter 1 (GLUT1) signaling pathway in hippocampal slices, as well as the neuroprotective effects of ibuprofen and rivastigmine alone or in combination in such effects. Male Wistar rats (90 days old) were euthanized and the brains were dissected. The hippocampus slices were pre-treated for 30 min [saline medium or Hcy (30 µM)], then the other treatments were added to the medium for another 30 min [ibuprofen, rivastigmine, or ibuprofen + rivastigmine]. The dichlorofluorescein formed, nitrite and Na+, K+-ATPase activity was increased by Hcy at 30 µM. Ibuprofen reduced dichlorofluorescein formation and attenuated the effect of Hcy. The reduced glutathione content was reduced by Hcy. Treatments with ibuprofen and Hcy + ibuprofen increased reduced glutathione. Hcy at 30 µM caused a decrease in hippocampal glucose uptake and GLUT1 expression, and an increase in Glial Fibrillary Acidic Protein-protein expression. Phosphorylated GSK3ß and Akt levels were reduced by Hcy (30 µM) and co-treatment with Hcy + rivastigmine + ibuprofen reversed these effects. Hcy toxicity on glucose metabolism can promote neurological damage. The combination of treatment with rivastigmine + ibuprofen attenuated such effects, probably by regulating the Akt/GSK3ß/GLUT1 signaling pathway. Reversal of Hcy cellular damage by these compounds may be a potential neuroprotective strategy for brain damage.

Immunomodulatory effect of imidacloprid on macrophage RAW 264.7 cells.

The neonicotinoid imidacloprid was promoted in the market because of widespread resistance to other insecticides, plus its low mammalian impact and higher specific toxicity towards insects. This study aimed to evaluate the immunomodulatory effect of imidacloprid on macrophages. RAW 264.7 cells were incubated to 0-4000 mg/L of imidacloprid for 24 and 96 h. Imidacloprid presented a concentration-dependent cytotoxicity after 24 h and 96 h incubation for MTT reduction (3-(4,5-dimethyl-thiazol-2-yl)- 2,5-diphenyltetrazolium bromide) (EC50 519.6 and 324.6 mg/L, respectively) and Neutral Red (3-amino-7-dimethylamino-2-methylphenazine hydrochloride) assays (EC50 1139.0 and 324.2 mg/L, respectively). Moreover, imidacloprid decreased the cells' inflammatory response and promoted a mitochondrial depolarization. The complex II and succinate dehydrogenase (SDH) activities in RAW 264.7 cells incubated with imidacloprid increased more at 24 h. These results suggest that imidacloprid exerts an immunomodulatory effect and mitochondria can act as regulator of innate immune responses in the cytotoxicity mediated by the insecticide in RAW 264.7 cells.

P2X7 receptor contributes to long-term neuroinflammation and cognitive impairment in sepsis-surviving mice.

Introduction: Sepsis is defined as a multifactorial debilitating condition with high risks of death. The intense inflammatory response causes deleterious effects on the brain, a condition called sepsis-associated encephalopathy. Neuroinflammation or pathogen recognition are able to stress cells, resulting in ATP (Adenosine Triphosphate) release and P2X7 receptor activation, which is abundantly expressed in the brain. The P2X7 receptor contributes to chronic neurodegenerative and neuroinflammatory diseases; however, its function in long-term neurological impairment caused by sepsis remains unclear. Therefore, we sought to evaluate the effects of P2X7 receptor activation in neuroinflammatory and behavioral changes in sepsis-surviving mice. Methods: Sepsis was induced in wild-type (WT), P2X7-/-, and BBG (Brilliant Blue G)-treated mice by cecal ligation and perforation (CLP). On the thirteenth day after the surgery, the cognitive function of mice was assessed using the novel recognition object and Water T-maze tests. Acetylcholinesterase (AChE) activity, microglial and astrocytic activation markers, and cytokine production were also evaluated. Results: Initially, we observed that both WT and P2X7-/- sepsis-surviving mice showed memory impairment 13 days after surgery, once they did not differentiate between novel and familiar objects. Both groups of animals presented increased AChE activity in the hippocampus and cerebral cortex. However, the absence of P2X7 prevented partly this increase in the cerebral cortex. Likewise, P2X7 absence decreased ionized calcium-binding protein 1 (Iba-1) and glial fibrillary acidic protein (GFAP) upregulation in the cerebral cortex of sepsis-surviving animals. There was an increase in GFAP protein levels in the cerebral cortex but not in the hippocampus of both WT and P2X7-/- sepsis-surviving animals. Pharmacological inhibition or genetic deletion of P2X7 receptor attenuated the production of Interleukin-1ß (IL-1ß), Tumor necrosis factor-α (TNF-α), and Interleukin-10 (IL-10). Conclusion: The modulation of the P2X7 receptor in sepsis-surviving animals may reduce neuroinflammation and prevent cognitive impairment due to sepsis-associated encephalopathy, being considered an important therapeutic target.

Impact of oral health literacy and psychoactive substances on tooth loss in adolescents.

The aim of the present study was to investigate associations between tooth loss, and oral health literacy, the use of multiple psychoactive substances, and the reason for the last dental appointment in adolescents. A cross-sectional study was conducted with a representative sample of 746 adolescents aged 15-19 years in Campina Grande, Brazil. Parents/guardians answered a sociodemographic questionnaire. The adolescents answered the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30), the alcohol, smoking, and substance involvement screening test, and an oral health questionnaire from the National Oral Health Survey. The adolescents were then examined by two examiners who had undergone training and calibration exercises for the diagnosis of tooth loss due to caries (K > 0.80). Associations between variables were investigated using robust logistic regression analysis for complex samples (α = 5%). The prevalence of tooth loss was 17.4%. Oral health literacy (OR = 0.93; 95% CI: 0.89-0.97) was inversely associated with tooth loss, while multiple psychoactive substance use (OR = 2.01; 95% CI: 1.09-3.69) and last dental visit for treatment/symptoms (OR = 3.05; 95% CI: 1.73-5.36) were directly associated with tooth loss. Oral health literacy, multiple psychoactive substance use, and reason for last dental appointment exerted an influence on tooth loss among adolescents.

Nível de conhecimento ético-legal dos graduandos em Medicina: estudo transversal no ano de 2020 / Level of ethical-legal knowledge of medicine graduants: cross-sectional study in the year of 2020

Resumo: Introdução: A literatura refere como frequentes denúncias sobre má prática médica. Logo, a investigação de como é feita a formação do acadêmico de Medicina, no contexto ético-legal, pode contribuir para sua melhoria. Objetivo: Este estudo teve como objetivos avaliar e comparar o conhecimento de acadêmicos de uma faculdade de Medicina sobre aspectos ético-legais da profissão, a partir de sua formação nas disciplinas do eixo relacionado ("Ética Médica e Bioética", "Medicina Legal" e "Deontologia/Perícia Médica e Boas Práticas"). Método: Trata-se de um estudo transversal com aplicação de questionário (agosto-novembro/2020) estruturado no Código de Ética Médica e Código de Ética do Estudante de Medicina - dez questões sociodemográficas e 12 objetivas (temas: "sigilo profissional", "relações interpessoais do estudante de Medicina", "publicidade médica", "relação com pacientes e familiares", "direitos humanos", "princípios fundamentais", "atividade médica" e "telemedicina"). Avaliaram-se 116 alunos: início, meio (durante curso do eixo ético-legal) e final da graduação. Para comparação, utilizaram-se os testes de Kruskal-Wallis e de Dunn. Para associação entre variáveis categóricas, adotaram-se o qui-quadrado e o teste exato de Fisher. Resultado: Identificou-se desempenho crescente com o avançar dos períodos, com diferença estatística entre as médias de acertos do primeiro, sexto e décimo/12°: 5,1; 6,7; e 7,8, (valor-p < 0,001). Já a análise por blocos temáticos não apontou associação estatística dos acertos com avançar na graduação (valor-p > 0,05) para temas de amplo alcance e desenvolvimento das competências desde o ciclo básico, como "publicidade médica", "relação com pacientes e familiares", "telemedicina" e "relações interpessoais do estudante de Medicina" - com ênfase em limitações do acadêmico no atendimento. Já para temas que exigiam competências inerentes às disciplinas do eixo ético-legal, encontrou-se tal associação (valor-p < 0,05), sendo: "sigilo profissional", "direitos humanos", "princípios fundamentais", "atividade médica" e "relações interpessoais do estudante de medicina" - especificamente sobre uso de eletrônicos. Por fim, o maior percentual de acertos (95,7%) associa-se às "relações interpessoais do estudante de Medicina", com ênfase nas limitações do acadêmico. Já as menores taxas apresentaram-se em "sigilo profissional" (18,1%), "atividade médica" (33,6%) e "direitos humanos" (25%)". Conclusão: Existe associação entre a formação proposta pelo eixo ético-legal e aumento efetivo do nível de conhecimento no acadêmico de Medicina sobre os aspectos ético-legais da profissão.

Abstract: Introduction: Complaints about medical malpractice are frequent. Therefore, investigating how the medical student formation is made concerning the ethical and legal aspects, can contribute to its improvement. Objective: To evaluate and compare the level of knowledge of medical students from a university about ethical and legal aspects of the profession, based on their formation in the disciplines of the related axis (Medical Ethics and Bioethics; Legal Medicine and Deontology/Medical Forensics and Good Practice). Method: Cross-sectional study carried out through the application of an online questionnaire (August-November/2020) based on the Code of Medical Ethics (CME) and the Code of Ethics for Medical Student- 10 sociodemographic and 12 objective questions (Topics: "Professional Confidentiality", "Medical student's Interpersonal Relations", "Medical Publicity", "Relations with Patients and Families", "Human Rights", "Fundamental Principles", "Medical Activity" and "Telemedicine"). A total of 116 students were evaluated at the start, middle and end of the medical course. The Kruskal-Wallis and Dunn tests were used for comparisons. The Chi-Square and Fisher's exact tests were used for the association of categorical variables. Results: The performance increased throughout the course, with statistical significance between the average number of correct answers in the 1st, 6th and 10th/12th periods: 5.1; 6.7 and 7.8, (p-value <0.001). The analysis by thematic blocks, on the other hand, did not show a statistical association of correct answers with progress in the medical course (p-value >0.05) for broad-reaching topics and development of competences from the basic cycle, such as "Medical Publicity", "Relations with Patients and Families", "Telemedicine" and "Medical Student's Interpersonal Relations" - with emphasis on the student's limitations in providing care. As for topics that required competences inherent to the disciplines of the ethical-legal axis, this association was identified (p-value <0.05), as follows: "Professional Confidentiality", "Human Rights", "Fundamental Principles", "Medical Activity" and "Medical Student's Interpersonal Relations" - specifically on the use of electronics. Finally, the highest percentage of correct answers (95.7%) is associated with "Medical Student's Interpersonal Relations", with an emphasis on the student's limitations. While the lowest rates were found in "Professional Confidentiality" (18.1%), "Medical Activity" (33.6%) and "Human Rights" (25%)". Conclusion: There is an association between the medical formation proposed by the ethical-legal axis, and the effective increase of the medical student's level of knowledge concerning the ethical-legal aspects of the profession.

Effects of different toothpaste formulations on erosive tooth wear prevention: systematic review / Efeitos de diferentes dentifrícios na prevenção do desgaste dentário erosivo: revisão sistemática de literatura

Objective: erosive tooth wear is a multifactorial condition that results in loss of dental hard tissue, caused by a chemical and mechanical process. This paper aims to carry out a systematic review presenting the effects of different toothpaste formulations on the loss of dental enamel surface in vitro. Material and Methods: the searches were performed in the databases PubMed, Web of Science, LILACS and Scielo. Articles published from 2010 to 2020 were filtered, without language restriction. Articles that included abrasion and erosion protocols were searched, as they were more similar to clinical reality, since toothpaste is applied through tooth brushing. The searches with descriptors and free terms on the topic resulted in 992 articles, however only 12 were within the search criteria. Results: the selected studies appointed that association of conventional fluorides (NaF) with metallic fluorides can be a promising strategy for the reduction of surface loss by erosive tooth wear. Toothpastes containing sodium fluoride, as well as tin without chitosan, showed a reduction in surface loss, considered sufficient for individuals with medium exposure to acids. In children's toothpastes, the one containing sodium fluoride showed a reduction in surface loss when compared to non-fluoride dentifrices. Conclusion: different protocols may result in less or greater loss of enamel surface, and methodological differences should be considered. To clarify the effects of dentifrices on erosive tooth wear, other properties of dentifrices should be investigated. (AU)

Objetivo: o desgaste erosivo é uma condição multifatorial que resulta em perda de tecido duro dentário, causado por um processo químico e mecânico. Este trabalho tem como objetivo realizar uma revisão sistemática de literatura apresentando os efeitos de diferentes formulações de dentifrícios na perda de superfície de esmalte dentário in vitro. Material e Métodos: a busca foi realizada nas bases de dados PubMed, Web of Science, LILACS e Scielo. Foram filtrados artigos publicados no intervalo de 2010 a 2020, sem restrição de idioma. Buscou-se artigos que incluíssem protocolos de abrasão e erosão, por mais se assemelhar a realidade clínica, uma vez que o dentifrício é aplicado através da escovação dentária. A busca com descritores e termos livres sobre o tema encontrou 992 artigos, entretanto somente 12 estavam dentro dos critérios da pesquisa. Resultados: os estudos selecionados apontaram que associação dos fluoretos convencionais (NaF) com os metálicos pode ser uma estratégia promissora para a redução de perda de superfície pelo desgaste dentário erosivo. Dentifrícios contendo fluoreto de sódio, assim como estanho sem quitosana, apresentaram redução na perda de superfície, sendo considerada suficiente para indivíduos com exposição média aos ácidos. Em dentifrícios infantis, aquele que continha fluoreto de sódio apresentou uma redução de perda de superfície quando comparado com dentifrícios sem fluoreto. Conclusão:diferentes protocolos podem resultar em menor ou maior perda de superfície de esmalte e as diferenças (AU)

Predictors associated with malocclusion in children with and without sleep disorders: a cross-sectional study

Abstract The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43-2.86), mouth breathing (OR = 1.04; 95%CI: 1.02-1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37-4.85), and obesity (OR = 1.54; 95%CI: 1.02-2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age.

"o animista é sempre o outro": o encantamento dos objetos e a experiência analítica / "the animist is always the other": the enchantment of objects and the analytical experience

RESUMO: O objetivo do artigo é revisitar a noção de animismo em psicanálise a partir das provocações do perspectivismo ameríndio. Trata-se de abrir espaço para conceber formas de alteridade não apenas ancoradas no totemismo e na divisão moderna entre natureza e cultura. As considerações de Winnicott sobre o self e os objetos servirão de ponto de apoio para reverberar na teoria e na clínica psicanalíticas as torções em nossas próprias bases sustentadas no animismo e no totemismo. Espera-se interpolar a ancoragem psicanalítica no pensamento moderno colonialista e, pelo encantamento dos objetos, entrever algo que escapa ao nosso próprio espelho - afinal, o animista nem sempre é o outro.

ABSTRACT: This article aimed to revisit the concept of animism in psychoanalysis through the provocations of Amerindian perspectivism. This involves creating space to conceive forms of alterity not solely anchored in totemism and the modern division between nature and culture. Winnicott's considerations on the self and objects serve as a fulcrum to resonate within psychoanalytic theory and practice the twists in our own foundations rooted in animism and totemism. The intention is to interpose the psychoanalytic anchoring in modern colonialist thought and, through the enchantment of objects, glimpse something that eludes our own reflection. After all, the animist is not always the other.

Vedolizumabe comparado a agentes anti-TNF-α para indução e manutenção da remissão na doença de Crohn refratária a medicamentos biológicos: revisão rápida / Vedolizumab compared to anti-tnf-α agents for induction and maintenance of remission in biologic-refractory crohn's disease: a rapid review of systematic reviews

Vedolizumabe e anticorpos anti-TNF-α (infliximabe, adalimumabe, certolizumabe pegol). Indicação: Tratamento pessoas com doença de Crohn com falha a um agente biológico anti-TNF-α em tratamento prévio. Pergunta: Para adultos com doença de Crohn moderada a grave com falha terapêutica para anticorpos monoclonais anti-TNF-α, em tratamento de segunda linha, Vedolizumabe tem efeitos superiores aos anti-TNF-α para induzir e manter a remissão da doença? Objetivo: Investigar a eficácia e segurança do vedolizumabe, comparado aos agentes anti-TNF-α (infliximabe, adalimumabe, certolizumabe pegol), na indução e manutenção da remissão em pacientes refratários aos anti-TNF-α com doença de Crohn moderada a grave. Métodos: Revisão rápida de revisões sistemáticas. Levantamento bibliográfico foi realizado nas bases de dados PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library e em registros de revisões sistemáticas e ensaios clínicos. Seguiu estratégias de buscas predefinidas. Foi feita avaliação da qualidade metodológica dos estudos incluídos através da ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version) Resultados: Foi selecionada uma revisão sistemática, que atendida aos critérios de elegibilidade, mas nenhum ensaio clínico foi escolhido, pois não atendiam aos critérios de inclusão. Conclusão: Adalimumabe, disponível no Sistema Único de Saúde, é mais eficaz que vedolizumabe para induzir remissão clínica em pacientes tratados previamente com biológicos. Vedolizumabe não é mais eficaz que placebo para induzir remissão clínica. Vedolizumabe e adalimumabe são similares entre si e são mais eficazes que placebo para manter a remissão clínica. Não foram encontradas evidências comparando vedolizumabe a infliximabe ou certolizumabe pegol

Vedolizumab and anti-TNF-α antibodies (infliximab, adalimumab, certolizumab pegol). Indication: Treatment of people with Crohn disease who have failed an anti-TNF-α biological agent in previous treatment. Question: For adults with moderate to severe Crohn disease with treatment failure for anti-TNF-α monoclonal antibodies, in second-line treatment, does vedolizumab have superior effects to anti-TNF-α in inducing and maintaining disease remission? Objective: To investigate the efficacy and safety of vedolizumab, compared to anti-TNF-α agents (infliximab, adalimumab, certolizumab pegol), in the induction and maintenance of remission in moderate to severe Crohn disease refractory to anti-TNF-α previous treatment. Methods: Rapid review of systematic reviews. A bibliographic search was done in the PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library databases and in registries of systematic reviews and clinical trials. The search has followed predefined strategies. The methodological quality of the included studies was evaluated using the AMSTAR-2 tool (Assessing the Methodological Quality of Systematic Reviews Version 2). Results: A systematic review was selected, which met the eligibility criteria, but no clinical trials were chosen as they did not meet the inclusion criteria. Conclusion: Adalimumab, available in the Brazilian Public Health System, is more effective than vedolizumab to induce clinical remission in patients previously treated with biologics. Vedolizumab is no more effective than placebo in inducing clinical remission. Vedolizumab and adalimumab are similar to each other and are more effective than placebo in maintaining clinical remission. No evidence was found comparing vedolizumab to infliximab or certolizumab pegol