Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement.

BACKGROUND: Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR. METHODS: Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014). RESULTS: Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all). CONCLUSIONS: Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.

Inflammatory markers in saliva as indicators of gingival inflammation in cerebral palsy children with and without cervical motor control.

AIM: To evaluate the relation among gingival inflammation, salivary osmolality, levels of IL-1ß, IL-6, IL-8, TNF-α, and s-IgA concentrations in children with spastic CP with or without cervical motor control in a cross-sectional study. DESIGN: Unstimulated whole saliva and the gingival index were collected in 37 and 34 CP children with and without cervical motor control, respectively. The data were dichotomized as follows: (=0) absence of gingival inflammation and (≥0.1) presence of gingival inflammation. RESULTS: The group without cervical control presented statistically higher mean values of salivary osmolality, s-IgA, and cytokines. In addition, statistically positive correlation between the gingival index and salivary cytokines was observed in the group with cervical control. Salivary osmolality, salivary cytokines, and s-IgA from both groups presented a significant positive correlation. Significant differences (P = 0.00336) in the values of salivary osmolality were observed between the CP individuals with (93.9 ± 32.7) and without gingival inflammation (74.4 ± 16.6). ROC analysis was performed, and values of salivary osmolality >80 indicated a sensitivity of 0.54 and a specificity of 0.79. CONCLUSIONS: Children without cervical motor control presented a more pronounced oral inflammatory status that was characterized by higher levels of cytokines.

Alcohol use and health behavior among nursing professionals. / Uso de álcool e comportamento de saúde entre profissionais da enfermagem.

OBJECTIVE: To evaluate the problematic use of alcohol and health behavior among the nursing staff of a general hospital. METHOD: Cross-sectional study conducted at a general hospital. A questionnaire with socio-demographic information, the alcohol and substance use screening test, and a questionnaire on health behavior were applied. RESULTS: A total of 416 professionals participated in the study. In the final model of logistical regression, male professionals (OR 4.3), singles (OR 3.7), those that professed to having other religions (OR 3.8), worked as nursing technician (OR 2.3), did not consume low doses of alcoholic beverages per day (OR 2.0), used tobacco (OR 8.9), avoided consuming beverages with caffeine (OR 1.9) and avoided noisy environments (OR 2.0) showed higher chances of consuming alcohol at a problematic level. CONCLUSION: Among nursing professionals, the use of alcohol and not engaging in health behavior are strongly associated. These findings have implications for the implementation of strategies for the promotion of health and the prevention of alcohol use in work relationships.

Infective endocarditis after transcatheter aortic valve implantation: results from a large multicenter registry.

BACKGROUND: We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: This multicenter registry included 53 patients (mean age, 79±8 years; men, 57%) who suffered IE after TAVI of 7944 patients after a mean follow-up of 1.1±1.2 years (incidence, 0.67%, 0.50% within the first year after TAVI). Mean time from TAVI was 6 months (interquartile range, 1-14 months). Orotracheal intubation (hazard ratio, 3.87; 95% confidence interval, 1.55-9.64; P=0.004) and the self-expandable CoreValve system (hazard ratio, 3.12; 95% confidence interval, 1.37-7.14; P=0.007) were associated with IE (multivariate analysis including 3067 patients with individual data). The most frequent causal microorganisms were coagulase-negative staphylococci (24%), followed by Staphylococcus aureus (21%) and enterococci (21%). Vegetations were present in 77% of patients (transcatheter valve leaflets, 39%; stent frame, 17%; mitral valve, 21%). At least 1 complication of IE occurred in 87% of patients (heart failure in 68%). However, only 11% of patients underwent valve intervention (valve explantation and valve-in-valve procedure in 4 and 2 patients, respectively). The mortality rate in hospital was 47.2% and increased to 66% at the 1-year follow-up. IE complications such as heart failure (P=0.037) and septic shock (P=0.002) were associated with increased in-hospital mortality. CONCLUSIONS: The incidence of IE at 1 year after TAVI was 0.50%, and the risk increased with the use of orotracheal intubation and a self-expandable valve system. Staphylococci and enterococci were the most common agents. Although most patients presented at least 1 complication of IE, valve intervention was performed in a minority of patients, and nearly half of the patients died during the hospitalization period.

Association Between Transcatheter Aortic Valve Replacement and Subsequent Infective Endocarditis and In-Hospital Death.

IMPORTANCE: Limited data exist on clinical characteristics and outcomes of patients who had infective endocarditis after undergoing transcatheter aortic valve replacement (TAVR). OBJECTIVE: To determine the associated factors, clinical characteristics, and outcomes of patients who had infective endocarditis after TAVR. DESIGN, SETTING, AND PARTICIPANTS: The Infectious Endocarditis after TAVR International Registry included patients with definite infective endocarditis after TAVR from 47 centers from Europe, North America, and South America between June 2005 and October 2015. EXPOSURE: Transcatheter aortic valve replacement for incidence of infective endocarditis and infective endocarditis for in-hospital mortality. MAIN OUTCOMES AND MEASURES: Infective endocarditis and in-hospital mortality after infective endocarditis. RESULTS: A total of 250 cases of infective endocarditis occurred in 20 006 patients after TAVR (incidence, 1.1% per person-year; 95% CI, 1.1%-1.4%; median age, 80 years; 64% men). Median time from TAVR to infective endocarditis was 5.3 months (interquartile range [IQR], 1.5-13.4 months). The characteristics associated with higher risk of progressing to infective endocarditis after TAVR was younger age (78.9 years vs 81.8 years; hazard ratio [HR], 0.97 per year; 95% CI, 0.94-0.99), male sex (62.0% vs 49.7%; HR, 1.69; 95% CI, 1.13-2.52), diabetes mellitus (41.7% vs 30.0%; HR, 1.52; 95% CI, 1.02-2.29), and moderate to severe aortic regurgitation (22.4% vs 14.7%; HR, 2.05; 95% CI, 1.28-3.28). Health care-associated infective endocarditis was present in 52.8% (95% CI, 46.6%-59.0%) of patients. Enterococci species and Staphylococcus aureus were the most frequently isolated microorganisms (24.6%; 95% CI, 19.1%-30.1% and 23.3%; 95% CI, 17.9%-28.7%, respectively). The in-hospital mortality rate was 36% (95% CI, 30.0%-41.9%; 90 deaths; 160 survivors), and surgery was performed in 14.8% (95% CI, 10.4%-19.2%) of patients during the infective endocarditis episode. In-hospital mortality was associated with a higher logistic EuroSCORE (23.1% vs 18.6%; odds ratio [OR], 1.03 per 1% increase; 95% CI, 1.00-1.05), heart failure (59.3% vs 23.7%; OR, 3.36; 95% CI, 1.74-6.45), and acute kidney injury (67.4% vs 31.6%; OR, 2.70; 95% CI, 1.42-5.11). The 2-year mortality rate was 66.7% (95% CI, 59.0%-74.2%; 132 deaths; 115 survivors). CONCLUSIONS AND RELEVANCE: Among patients undergoing TAVR, younger age, male sex, history of diabetes mellitus, and moderate to severe residual aortic regurgitation were significantly associated with an increased risk of infective endocarditis. Patients who developed endocarditis had high rates of in-hospital mortality and 2-year mortality.

Gingivitis and salivary osmolality in children with cerebral palsy.

AIM: To investigate the influence of salivary osmolality on the occurrence of gingivitis in children with cerebral palsy (CP). DESIGN: A total of 82 children with spastic CP were included in this cross-sectional study. Oral motor performance and gingival conditions were evaluated. Unstimulated saliva was collected using cotton swabs, and salivary osmolality was measured using a freezing point depression osmometer. Spearman's coefficient, receiver operating characteristic (ROC), and multiple logistic regression analyses were performed. RESULTS: Strong correlation (r > 0.7) was determined among salivary osmolality, salivary flow rate, visible plaque, dental calculus, and the occurrence of gingivitis. The area under the ROC to predict the influence of salivary osmolality on the occurrence of gingivitis was 0.88 (95% CI 0.81-0.96; P < 0.001). The cutoff value of 84.5 for salivary osmolality presented good sensitivity and specificity, both higher than 77%. The proportion of children presenting salivary osmolality ≤84.5 mOsm/kgH2 O and gingivitis was 22.5%, whereas for the group presenting osmolality >84.5 mOsm/kgH2 O, the proportion of children with gingivitis was 77.5%. Salivary osmolality above 84.5 increased the likelihood of gingivitis fivefold, whereas each additional 0.1 mL of salivary flow reduced the likelihood of gingivitis by 97%. CONCLUSION: Gingivitis occurs more frequently in children with CP showing increased values of salivary osmolality.

Is Weiner's attribution-help model stable across cultures? A test in Brazilian subcultures.

The effect of attribution of responsibility on the intention to help is a well-studied effect. The Weiner model of attribution-emotion-help is the main theoretical development to describe the structural relation between these variables. Some research results have suggested that culture influences the relation between model variables. Collectivists tend to show more compassionate emotions independent of attribution of responsibility whereby emotion is no longer a mediator. The present research aims to test the Weiner model in Brazil, a country with established subcultures and clear distinctions in the collectivism-individualism dimension across its regions. An experiment with 1,569 participants from all five Brazilian regions was conducted. Path analysis revealed that more socially oriented participants tended to feel more compassion for the experimental scenario's protagonist, independent of controllability manipulation, decreasing the effect of emotions in the model. These results depict the effect of culture on the model, questioning the stability of the model across cultures.

Assessing salivary osmolality as a caries risk indicator in cerebral palsy children.

BACKGROUND: Salivary osmolality reflects the hydration status of individuals with cerebral palsy (CP) necessary for an adequate unstimulated salivary flow rate. AIM: To investigate whether salivary osmolality could serve as a potential indicator of caries risk in children with spastic CP by displaying a stronger association with caries occurrence than salivary flow rate. DESIGN: The convenience sample consisted of 65 children with CP aged 6-13 years old. Unstimulated whole saliva was collected using cotton roll, and salivary osmolality was measured using a freezing point depression osmometer. The children's oral motor performance was evaluated during the feeding process using the Oral Motor Assessment Scale. Caries occurrence was also evaluated according the World Health Organization criteria. RESULTS: Motor skills were significantly associated with caries experience. Regarding the salivary parameters, osmolality presented a stronger association with caries experience than did the salivary flow rate. Children with worse oral motor performance presented a higher rate of caries occurrence. CONCLUSION: Osmolality exhibited a stronger association with caries occurrence than did salivary flow rate. This parameter, therefore, could be a potential caries risk indicator for spastic cerebral palsy children.

In-Hospital Outcomes in the Brazilian Registry of Transcatheter Aortic Valve Implantation - 14-Year Analysis. / Desfechos Intra-Hospitalares no Registro Brasileiro de Implante de Bioprótese Aórtica por Cateter ­ 14 Anos em Análise.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has had an exponential increase of its indication, being incorporated into the Brazilian Unified Public Health System in 2022, thus requiring assessment of its use in Brazil. OBJETICVE: To assess the factors associated with in-hospital mortality and non-fatal complications in both genders in the Brazilian Registry of Transcatheter Aortic Valve Implantation and New Technologies (RIBAC-NT) population. METHOD: Analysis of the RIBAC-NT database from 2008 to 2022 was performed. Logistic models and machine learning were used for statistical assessment of the association between variables and outcomes. The software R was used and a 5% significance level, adopted. RESULTS: Analysis of 2588 patients (women, 51.2%; in-hospital death, 8.2%). Mortality was associated with procedural complications, of which major vascular complication (VC) and acute kidney injury (AKI) stood out (p<0.001). Major VC occurred in 6% of the patients, with 34% mortality; AKI occurred in 8.8%, with 13% mortality, which increased up to 8 times when AKI coexisted with other complications. Non-fatal complications occurred in 50.5% of all patients, affecting 63% of those with 1st generation (1G) bioprosthesis and 39% of those with 2nd generation (2G) bioprosthesis (p<0,001). Non-femoral access and heart rhythm influenced non-fatal complications in patients with 1G prostheses, while complications in patients with 2G prosthesis associated with the female gender (39.6% vs. 30.4%, p=0.003). CONCLUSION: In-hospital mortality in the RIBAC-NT population was directly associated with procedural complications, mainly major VC and AKI. The occurrence of non-fatal complications differed according to gender and bioprosthesis type.

FUNDAMENTO: O implante valvar aórtico transcateter (TAVI) apresenta crescimento exponencial de suas indicações e foi incorporado ao Sistema Único de Saúde em 2022, sendo necessário avaliar seu uso no Brasil. OBJETIVO: Conhecer os fatores associados a mortalidade e complicações não fatais intra-hospitalares, em ambos os gêneros, na população do Registro Brasileiro de Implante de Bioprótese Aórtica por Cateter e Novas Tecnologias (RIBAC-NT). MÉTODO: Análise do banco de dados RIBAC-NT de 2008 a 2022. Aplicados modelos logísticos e machine learning na avaliação estatística da associação das variáveis com os desfechos, empregando o software R e nível de significância de 5%. RESULTADOS: Analisados 2.588 pacientes (mulheres, 51,2%; óbito intra-hospitalar, 8,2%). Mortalidade associou-se a complicações do procedimento, dentre elas destacam-se complicações vasculares (CV) maiores e insuficiência renal aguda (IRA) (p< 0,001). A CV maior ocorreu em 6%, com 34% de mortalidade; IRA ocorreu em 8,8%, com 13% de mortalidade, que aumentou até 8 vezes quando IRA coexistiu com outras complicações. Complicações não fatais ocorreram em 50,5% do total de pacientes, acometendo 63% daqueles com bioprótese de 1a geração (1G) e 39% daqueles com bioprótese de 2a geração (2G) p<0,001. O acesso não femoral e o ritmo cardíaco influenciaram as complicações não fatais nas próteses 1G, enquanto complicações das próteses 2G associaram-se ao gênero feminino (39,6% vs. 30,4%, p= 0,003). CONCLUSÃO: A mortalidade intra-hospitalar na população do RIBAC-NT associou-se diretamente a complicações do procedimento, principalmente CV maior e IRA. A ocorrência de complicações não fatais diferiu conforme o gênero e o tipo da bioprótese.

Increased salivary immunoglobulin A and reduced α-amylase activity in whole saliva from spastic cerebral palsy individuals.

BACKGROUND: Salivary immunoglobulin A (SIgA) together with innate defenses such as α-amylase, provides the 'first line of defense' against pathogens present at mucosal surfaces. This study aimed to evaluate salivary α-amylase and immunoglobulin A (IgA) in whole saliva of spastic cerebral palsy (CP) individuals. METHODS: Whole saliva was collected from 22 CP and 24 sibling volunteers with no neurological damage control groups (CG) (aged 7-14 years). The salivary flow rate, total protein and SIgA concentrations, and α-amylase activity were determined. RESULTS: The CP group presented higher salivary flow rate (35%) and lower total protein concentration (18%) compared with the CG (P ≤ 0.05). CPG had higher absolute (68%, µg SIgA/ml) and relative (55%, µg SIgA/mg prot and 108%, µg SIgA/min) concentrations of IgA compared with the CG (P ≤ 0.05). CPG had lower relative α-amylase activity (15% mg malt/mg prot and 33%, mg malt/min) compared with the CG (P ≤ 0.05). CONCLUSION: This study concluded that CP individuals presented alterations in the profile of salivary proteins involved in the defense system of the oral cavity.

Salivary osmolality and hydration status in children with cerebral palsy.

BACKGROUND: Unstimulated whole salivary parameters have been identified as potential markers of hydration status. Reduced salivary flow rate and increased salivary osmolality have been shown to be useful to identify dehydration, even when minimal loss of body water occurs. This study aimed to evaluate whether unstimulated salivary flow rate and salivary osmolality from individuals with cerebral palsy correlate with plasma and urine osmolality. METHODS: Thirty-five male and female children, aged 9-13 years old, diagnosed with cerebral palsy were compared to 27 nondisabled children (10-12 years old). Unstimulated whole saliva was collected under slight suction and salivary flow rate (ml/min) was calculated. Plasma without venostasis and urine were also collected. Salivary, plasma and urine osmolality were measured using a freezing point depression osmometer. RESULTS: Cerebral palsy children presented a reduction in salivary flow rate (50%) compared to the control group (P < 0.01). Moreover, an increase in salivary (50%), plasma (3%), and urine osmolality (20%) was also observed in the cerebral palsy children compared to the control group (P < 0.01). Salivary flow rate was negatively correlated with the salivary, plasma and urine osmolality (P < 0.01). Salivary osmolality correlated positively with plasma and urine osmolality (P < 0.01). CONCLUSION: Cerebral palsy children seem to present impaired adequate hydration status. Since the possible hypohydration condition may be reflected in saliva fluid, which could compromise the protective function exerted by saliva, the earlier this condition is identified the greater the chances of administering preventive measures. Moreover, salivary osmolality is a reliable parameter that reflects changes in plasma and urine.

Characterization of the electrocardiographic pattern of individuals with cerebral palsy.

BACKGROUND: Dentists of Lar São Francisco observed during dental treatment that children with cerebral palsy (CP) had increased heart rate (HR) and lower production of saliva. Despite the high prevalence of CP found in the literature (2.08-3.6/1000 individuals), little is known about the electrocardiographic (ECG) characteristics, especially HR, of individuals with CP. OBJECTIVE: This study aimed to investigate the hypothesis that individuals with CP have a higher HR and to define other ECG characteristics of this population. METHODS: Ninety children with CP underwent clinical examination and 12-lead rest ECG. Electrocardiographic data on rhythm, HR, PR interval, QRS duration, P/QRS/T axis, and QT, QTc and T(peak-end) intervals (minimum, mean, maximum, and dispersion) were measured and analyzed then compared with data from a control group with 35 normal children. Fisher and Mann-Whitney U tests were used, respectively, to compare categorical and continuous data. RESULTS: Groups cerebral palsy and control did not significantly differ in age (9 ± 3 × 9 ± 4 years) and male gender (65% × 49%). Children with CP had a higher HR (104.0 ± 20.6 × 84.2 ± 13.3 beats per minute; P < .0001), shorter PR interval (128.8 ± 15.0 × 138.1 ± 15.1 milliseconds; P = .0018), shorter QRS duration (77.4 ± 8.6 × 82.0 ± 8.7 milliseconds; P = .0180), QRS axis (46.0° ± 26.3° × 59.7° ± 24.8°; P = .0024) and T-wave axis (34.3° ± 28.9° × 42.9° ± 17.1°; P = .034) more horizontally positioned, and greater mean QTc (418.1 ± 18.4 × 408.5 ± 19.4 milliseconds; P = .0110). All the electrocardiogram variables were within the reference range for the age group including those with significant differences. CONCLUSION: Children with CP showed increased HR and other abnormal ECG findings in the setting of this investigation. Further studies are needed to explain our findings and to correlate the increased HR with situations such as dehydration, stress, and autonomic nervous disorders.

Prevalence of dental trauma in individuals with special needs.

BACKGROUND: Individuals with special needs exist throughout the world. The last demographic census (IBGE, 2002) in Brazil indicated that 14.5% of the total population (24.5 million) present some type of impairment. This study aimed to evaluate the prevalence of dental trauma (DT) in individuals with special needs and the first attendance by a dental surgeon of patients admitted to the special care clinic of the School of Dentistry of Universidade Paulista (UNIP), Brazil, between 2001 and 2005. MATERIAL AND METHODS: The sample included 544 individuals with special needs aged 1-20 years old (mean 10.7 ± SD 5.3). Patient medical records were reviewed for demographic and clinical data, including medical diagnosis, gender, age, presence of DT and whether the attendance provided was the first time the patient had sought dental treatment. RESULTS: The individuals were distributed into 11 subgroups according to medical diagnosis. The DT prevalence determined was 9.2% (n = 50), with no difference in relation to gender. The majority (78.3%) of the individuals were seeking dental treatment for the first time at an advanced age. CONCLUSIONS: The present data suggest that DT prevalence in individuals presenting special needs is more common in permanent dentition and that the first attendance by a dental surgeon is delayed.

The impact of environmental stressors and types of work contract on occupational stress.

This study aimed to investigate the impact of seven environmental stressors (role conflict, work overload, interpersonal difficulties, work-family conflict, work instability, lack of autonomy and pressure of responsibility) and the nature of the employment contract (permanent or atypical) on three psychological reactions to occupational stress (job satisfaction, positive emotions, and negative emotions at work). 305 Brazilian workers from both sexes participated in this research, distributed between permanent and atypical workers. The results showed that the role conflict and the work overload had a negative impact on job satisfaction. The role conflict had a negative impact on the positive emotions at work, while the pressure of responsibility interfered positively in it. The work overload interfered positively in the negative emotions at work, while the pressure of responsibility interfered negatively in it. The type of contract did not affect significantly any one of the dependent variables. The implications of the results for future research are discussed.

Testing the Two Directions of the Work-Family Interface: A Diary Study.

The work-family interface can be viewed as a process in which daily fluctuations in work demands and resources influence family functioning and behavior, and vice versa. This study aimed to test the daily processes of both directions of the work-family interface through two studies. The first study consisted of 103 male and female workers from 17 Brazilian states. The participants' ages ranged from 20 to 61 years (M = 33.68; SD = 9.13). Each participant answered a daily questionnaire over the course of 10 days, totaling 1,030 answers. The second study's sample consisted of 101 male and female workers from 15 states in Brazil. Participants' ages ranged from 20 to 62 years (M = 33.77; SD = 8.46). Each participant answered the daily questionnaire over the course of ten days, with the number of answers totaling 1,010. The first study showed that at the daily level, perceived work-related demands and social support at work were significantly related to family satisfaction. The second study indicated that at the daily level, perceived family demands and family social support showed significant associations with job satisfaction. Positive affect had a mediating role in these relationships, whereas the use of problem-solving coping strategies had a moderating role. Both studies also showed that the relationships identified remain significant when the variables were tested at different times: independent variables, mediating variable and moderator variable on one day, and the dependent variable on the following day. Day-to-day implications for organizations are discussed, and suggestions for a future research agenda on the work-family interface are presented.

Does the neuromotor abnormality type affect the salivary parameters in individuals with cerebral palsy?

BACKGROUND: Previous studies reported alterations in salivary flow rate and biochemical parameters of saliva in cerebral palsy (CP) individuals; however, none of these considered the type of neuromotor abnormality among CP individuals, thus it remains unclear whether the different anatomical and extended regions of the brain lesions responsible for the neurological damage in CP might include disruption of the regulatory mechanism of saliva secretion as part of the encephalopathy. The aim of this study was to evaluate salivary flow rate, pH and buffer capacity in saliva of individuals with CP, aged 3-16 years, with spastic neuromotor abnormality type and clinical patterns of involvement. METHODS: Sixty-seven individuals with CP spasticity movement disorder, were divided in two groups according to age (3-8- and 9-16-years-old) and compared with 35 sibling volunteers with no neurological damage, divided in two groups according to age (3-8- and 9-16-years-old). Whole saliva was collected under slight suction and pH and buffer capacity were determined using a digital pH meter. Buffer capacity was measured by titration using 0.01N HCL, and flow rate was calculated in ml/min. RESULTS: In both age groups studied, whole saliva flow rate, pH and buffer capacity were significantly lower in the spastic CP group (P<0.05). The clinical patterns of involvement did not influence the studied parameters. CONCLUSION: These findings show that individuals with spastic cerebral palsy present lower salivary flow rate, pH and buffer capacity that can increase the risk of oral disease in this population.

Evaluation of Myocardial Ischemia with iFR (Instantaneous Wave-Free Ratio in the Catheterization Laboratory: A Pilot Study.

BACKGROUND: The Instantaneous Wave-Free Ratio (iFR) is an invasive functional evaluation method that does not require vasoactive drugs to induce maximum hyperemia. OBJECTIVE: To evaluate the contribution of the iFR to the therapeutic decision-making of coronary lesions in the absence of non-invasive diagnostic methods for ischemia, or in case of discordance between these methods and coronary angiography. METHOD: We studied patients older than 18 years, of both sexes, consecutively referred for percutaneous treatment between May 2014 and March 2018. Coronary stenotic lesions were classified by visual estimation of the stenosis diameter into moderate (41-70% stenosis) or severe (71%-90%). An iFR ≤ 0.89 was considered positive for ischemia. Logistic regression was performed using the elastic net, with placement of stents as outcome variable, and age, sex, arterial hypertension, diabetes, dyslipidemia, smoking, family history, obesity and acute myocardial infarction (AMI) as independent variables. Classification trees, ROC curves, and Box Plot graphs were constructed using the R software. A p-value < 0.05 was considered statistically significant. RESULTS: Fifty-two patients with 96 stenotic lesions (56 moderate, 40 severe) were evaluated. The iFR cut-off point of 0.87 showed a sensitivity of 0.57 and 1-specificity of 0.88, demonstrating high accuracy in reclassifying the lesions. Diabetes mellitus, dyslipidemia, and presence of moderate lesions with an iFR < 0.87 were predictors of stent implantation. Stents were used in 32% of lesions in patients with stable coronary artery disease and AMI with or without ST elevation (non-culprit lesions). CONCLUSION: The iFR has an additional value to the therapeutic decision making in moderate and severe coronary stenotic lesions, by contributing to the reclassification of lesions and decreasing the need for stenting.

Feedback received and role performance: The mediating role of engagement and the moderating role of authentic living

This research aims to identify the moderating role of authentic living in the relationship between feedback received and role performance, mediated by work engagement. The data were based on a convenience sample of Brazilian workers from public and private organizations (N = 1,244). The significant interaction between the feedback and authentic living allowed us to understand that the main effects of feedback on performance take place in individuals with high authentic living. When individuals are more authentic, the information they receive about their performance more strongly affects the motivational process at work itself. This study highlights the positive relationship between work and personal resources, as well as the work engagement and performance on the other, thus contributing to increase the feedback the organizations receive about performance, as well as to create environments that facilitate authenticity.

O objetivo desta pesquisa foi identificar o papel moderador da vivência autêntica na relação do feedback recebido com o desempenho de papéis, mediado pelo engajamento no trabalho. Os dados foram obtidos a partir de uma amostra por conveniência de trabalhadores brasileiros provenientes de organizações públicas e privadas (N = 1.244). A interação significativa entre o feedback e a vivência autêntica permitiu compreender que os maiores efeitos do feedback sobre o desempenho acontecem em indivíduos com elevada vivência autêntica. Quando os indivíduos são mais autênticos, as informações que os mesmos recebem sobre o desempenho afetará mais fortemente o próprio processo motivacional no trabalho. Este estudo fornece evidências da relação positiva entre os recursos do trabalho e pessoais com o engajamento e o desempenho no trabalho, contribuindo, assim, para um aumento, por parte das organizações, do feedback recebido sobre o desempenho, bem como a criação de ambientes facilitadores de autenticidade.

El objetivo de esta investigación fue identificar el papel moderador de la experiencia auténtica en la relación entre la retroalimentación recibida y el desempeño de roles, mediada por el compromiso laboral. Los datos se obtuvieron de una muestra por conveniencia de trabajadores brasileños de organizaciones públicas y privadas (N = 1244). La interacción significativa entre la retroalimentación y la experiencia auténtica permitió comprender que los mayores efectos de la retroalimentación sobre el desempeño ocurren en individuos con alta experiencia auténtica. Cuando los individuos son más auténticos, la información que reciben sobre el desempeño afectará más fuertemente su propio proceso motivacional en el trabajo. Este estudio proporciona evidencia de la relación positiva entre el trabajo y los recursos personales con el compromiso y el desempeño en el trabajo, de esta forma contribuyen al aumento, por parte de las organizaciones, de la retroalimentación recibida sobre el desempeño, así como a la creación de entornos propicios de autenticidad.