Potential of Cricket (Acheta domesticus) Flour as a Lean Meat Replacer in the Development of Beef Patties.

This study examined the incorporation of cricket (Acheta domesticus) flour (CF) (0, control; 5.0%, CF5.0; 7.5%, CF7.5; and 10.0%, CF10.0) as a lean meat replacer in beef patties and its impact on composition, microbiological, sensory, and technological properties, as well as its influence on the cooking process. The inclusion of CF led to beef patties with significantly higher protein levels than the control group. Additionally, an elevation in total viable (TVC) and lactic acid bacteria (LAB) counts was observed. However, Enterobacteriaceae counts remained at safe levels. CF5.0 demonstrated similar sensory scores and purchase intention to the control treatment. CF7.5 and CF10.0 showed comparable sensory scores to the control except for texture attributes. The inclusion of CF significantly reduced cooking loss and diameter reduction values. Beef patties with CF were notably firmer and had a browner color than the control. In general, the cooking process impacted the technological properties similarly in both the control and beef patties with CF. In all cooked samples, no significant differences in pH, redness (a*), or texture were observed. This study demonstrated that incorporating up to 5.0% CF into beef patties is optimal in terms of composition, technological, sensorial, and cooking properties.

Dbp1 is a low performance paralog of RNA helicase Ded1 that drives impaired translation and heat stress response.

Ded1 and Dbp1 are paralogous conserved RNA helicases that enable translation initiation in yeast. Ded1 has been heavily studied but the role of Dbp1 is poorly understood. We find that the expression of these two helicases is controlled in an inverse and condition-specific manner. In meiosis and other long-term starvation states, Dbp1 expression is upregulated and Ded1 is downregulated, whereas in mitotic cells, Dbp1 expression is extremely low. Inserting the DBP1 ORF in place of the DED1 ORF cannot replace the function of Ded1 in supporting translation, partly due to inefficient mitotic translation of the DBP1 mRNA, dependent on features of its ORF sequence but independent of codon optimality. Global measurements of translation rates and 5' leader translation, activity of mRNA-tethered helicases, ribosome association, and low temperature growth assays show that-even at matched protein levels-Ded1 is more effective than Dbp1 at activating translation, especially for mRNAs with structured 5' leaders. Ded1 supports halting of translation and cell growth in response to heat stress, but Dbp1 lacks this function, as well. These functional differences in the ability to efficiently mediate translation activation and braking can be ascribed to the divergent, disordered N- and C-terminal regions of these two helicases. Altogether, our data show that Dbp1 is a "low performance" version of Ded1 that cells employ in place of Ded1 under long-term conditions of nutrient deficiency.

Método Canguru: percepção da equipe de enfermagem em uma maternidade de alto risco / Kangaroo Method: perception of the nursing team in a high-risk maternity hospital / Método Canguro: percepción del equipo de enfermería en una maternidad de alto riesgo

Objetivo: analisar a percepção da equipe de enfermagem sobre o método canguru em uma maternidade de alto risco. Método: estudo exploratório, descritivo, de abordagem qualitativa, realizado por meio de entrevista semiestruturada com enfermeiros de uma maternidade de alto risco de Recife (PE), desenvolvida entre janeiro e fevereiro de 2020. As entrevistas foram transcritas e submetida a análise através da técnica de conteúdo de Bardin. Resultados: ocorreu a formulação de duas categorias, assistência de enfermagem no método canguru e benefícios e desafios encontrados no Método Canguru. As participantes relataram que os cuidados de enfermagem se baseiam principalmente em orientações as mães, a escassez de profissionais e baixa adesão foram evidenciados como principais desafios. Conclusão: constatou-se que a atuação de enfermagem no método canguru é um complexo processo, necessitando de uma equipe de enfermagem motivada e especializada

Objective: analyze the nursing team's perception of the kangaroo method in a high-risk maternity hospital. Method: exploratory, descriptive study, with a qualitative approach, carried out through semi-structured interviews with nurses from a high-risk maternity hospital in Recife (PE), carried out between January and February 2020. The interviews were transcribed and subjected to analysis using the content technique by Bardin. Results: two categories were formulated, nursing care in the kangaroo method and benefits and challenges found in the Kangaroo Method. Participants reported that nursing care is mainly based on guidance from mothers, the shortage of professionals and low adherence were highlighted as main challenges. Conclusion: it was found that nursing practice in the kangaroo method is a complex process, requiring a motivated and specialized nursing team

Objetivos: analizar la percepción del equipo de enfermería sobre el método canguro en una maternidad de alto riesgo. Método: Estudio exploratorio, descriptivo, con enfoque cualitativo, realizado a través de entrevistas semiestructuradas a enfermeros de una maternidad de alto riesgo de Recife (PE), realizado entre enero y febrero de 2020. Las entrevistas fueron transcritas y sometidas a análisis mediante el Técnica de contenidos de Bardin. Resultados: Se formularon dos categorías, los cuidados de enfermería en el método canguro y los beneficios y desafíos encontrados en el Método Canguro. Los participantes informaron que la atención de enfermería se basa principalmente en la orientación de las madres, la escasez de profesionales y la baja adherencia fueron destacados como principales desafíos. Conclusión: se encontró que la práctica de enfermería en el método canguro es un proceso complejo, que requiere de un equipo de enfermería motivado y especializado

Occupational stressors and mental illness in healthcare work: An intersection between gender, race, and class.

BACKGROUND: Previous studies have supported the relevance of using broad and complex approaches, including multiple explanatory categories, to analyze mental disorders in the working population. This study aimed to assess the direct and indirect effects of gender, race, social class, and occupational stressors on mental health. METHODS: A cross-sectional study used a random sample of 3343 health workers. The effort-reward imbalance (ERI) scale measured occupational stressors. The World Health Organization Self-Reporting Questionnaire (SRQ-20) evaluated common mental disorders (CMDs) as outcomes. The role of gender, race/color, and class determinants (level of schooling and income) in the relationship between occupational stressors and CMD was assessed. Structural equation modeling was used to determine associations and effects. RESULTS: Occupational stressors were directly associated with CMD and mediated the relationship between income and CMD. Gender was directly associated with occupational stressors, income, and domestic overload. Race was associated with education and with CMD through indirect paths mediated by class indicators. Class indicators contributed to increasing exposure to occupational stressors and the occurrence of CMD. CONCLUSION: The results highlight the relevance of gender, race/color, and class in understanding the unequal distribution of work stressors and mental illness in health workers.

Efeitos combinados de gênero, raça e estressores ocupacionais na saúde mental / Combined effects of gender, race, and occupational stressors on mental health

Resumo Objetivo: analisar os efeitos isolados e combinados do gênero, da raça e dos estressores ocupacionais sobre a saúde mental de trabalhadores e trabalhadoras da saúde. Métodos: estudo transversal com amostra aleatória de trabalhadores(as) da saúde da Bahia, Brasil. As variáveis de exposição principais foram: gênero, raça e estressores ocupacionais, avaliados por meio da escala de Desequilíbrio Esforço-Recompensa (DER). O Self-Reporting Questionnaire (SRQ-20) mensurou os transtornos mentais comuns (TMC), variável desfecho. As medidas de interação foram verificadas com base no critério da aditividade, pelo cálculo do excesso de prevalência, excesso de razão de prevalência e diferença relativa. Resultados: participaram 3.343 trabalhadores, 77,9% do sexo feminino. A prevalência de TMC foi 21,7% maior entre mulheres, negros e pessoas em situações de exposição aos estressores laborais. Entre as mulheres negras em situação de DER, a prevalência de TMC foi três vezes maior em relação aos homens brancos em situação de equilíbrio (grupo de referência). Discussão: trabalhadoras negras acumulam desvantagens sociais e estão mais suscetíveis a ocupações de maior esforço e menor recompensa. A prevalência de TMC foi superior na intersecção das exposições. O efeito combinado dos fatores excedeu a soma dos efeitos isolados, demonstrando interação entre gênero, raça e estressores ocupacionais.

Abstract Objective: analyze the isolated and combined effects of gender, race, and occupational stressors on the mental health of healthcare workers. Methods: cross-sectional study with a random sample of health workers in Bahia, Brazil. The primary exposure variables were gender, race, and occupational stressors, assessed using the Effort-Reward Imbalance (ERI) scale. The Self-Reporting Questionnaire (SRQ-20) measured common mental disorders (CMD), the outcome variable. The interaction measures were verified based on the additivity criterion by calculating the excess prevalence, excess prevalence ratio, and relative difference. Results: 3,343 workers participated, 77.9% were female. CMD prevalence was 21.7% higher among women, Black people, and those exposed to work stressors. Among Black women in a situation of ERI, the prevalence of CMD was three times higher compared with white men in a situation of balance (reference group). Discussion: black women workers accumulate social disadvantages and are more susceptible to occupations that require more significant effort and less reward. CMD prevalence was higher at the intersection of exposures. Combined effect of the factors exceeded the sum of the isolated effects, demonstrating an interaction between gender, race, and occupational stressors.

Blood Loss Control in Patients with Idiopathic Scoliosis Undergoing Spinal Fusion: Prospective Evaluation of a Cohort.

Objective This study aimed to identify risk factors for increased perioperative bleeding in scoliosis surgery. Methods This is a prospective cohort study including 30 patients with idiopathic scoliosis undergoing posterior instrumentation using the pedicle screw system at a university hospital. Results Intraoperative blood losses totaled 798.6 ± 340 mL (24.8% of blood volume). Nine subjects presented massive blood loss. On average, hemoglobin dropped by 3.7 g/dL, and each patient received 1.4 blood bags. Postoperative blood loss was 693.4 ± 331.1 mL, and the total number of days using a drain was 2.7 ± 0.7. Intraoperatively, the following variables showed significant correlations ( p < 0.05) with increased bleeding: age, time from diagnosis to treatment, preoperative Cobb angle, amount of curve correction, number of instrumented and fixated levels, total number of screws, and the number of transfused bags. Postoperatively, the following variables had significant correlations ( p < 0.05): age, preoperative Cobb angle, length of hospital stay, number of blood bags transfused, and number of levels fixated with screws. Conclusion The variables most contributing to blood loss were age, preoperative Cobb angle, number of blood bags transfused, and number of levels fixated with a screw. Therefore, patients may benefit from surgical treatment while younger and presenting a lower Cobb angle, consequently requiring a lower degree of curve correction and lower-density implants.

A hitchhikers' guide to the terminology of accreditation processes for health professionals and institutions.

Accreditation processes for health care professions are designed to ensure that individuals and programs in these fields meet established standards of quality and effectiveness. The accelerating pace of globalization in the health care professions has increased the need for a shared understanding of the vocabulary of evaluation, assessment, and accreditation. The psychometric principles of valid and reliable assessment are commonly accepted, but the terminology is confusing. We believe that all stakeholders - evaluators, faculty, students but also the community - will benefit from a shared language and common set of definitions. We recognize that not all readers will agree with the definitions we propose, but we hope that this guide will help to ensure clarity, consistency, transparency, and fairness, and that it will promote through the stimulation of a debate greater collaboration across national and international boundaries.

Overexpression of mTOR in Leukocytes from ALS8 Patients.

BACKGROUND: The mutated VAPBP56S (vesicle B associated membrane protein - P56S) protein has been described in a Brazilian family and classified as Amyotrophic Lateral Sclerosis type 8 (ALS8). OBJECTIVE: We aimed to study altered biochemical and immunological parameters in cells from ALS8 patients to identify possible biomarkers or therapeutic targets. METHODS: Wild-type VAPB, VAPBP56S, mTOR, proinflammatory cytokines, and oxidant/reducing levels in serum, leucocytes, and cellular lysate from ALS8 patients and health Controls were performed by ELISA, fluorimetry, and spectrophotometry. RESULTS: Our results showed similar levels of mutant and wild-type VAPB in serum and intracellular lysate (p > 0.05) when ALS8 patients and Controls were compared. IL-1ß, IL-6, and IL-18 levels in patients and Controls showed no difference, suggesting an absence of peripheral inflammation (p > 0.05). Oxidative metabolic response, assessed by mitochondrial ROS production, and reductive response by MTT reduction, were higher in the ALS8 group compared to Controls (p < 0.05), although not characterizing typical oxidative stress in ALS8 patients. Total mTOR levels (phosphorylated or non-phosphorylated) of ALS8 patients were significantly lower in serum and higher in intracellular lysate than the mean equivalents in Controls (p < 0.05). A similar result was observed when we quantified the phosphorylated protein (p < 0.05). CONCLUSION: We demonstrate the possibility of using these biochemical and immunological parameters as potential therapeutic targets or biomarkers. Furthermore, by hypothesis, we suggest a hormetic response in which both VAPB forms could coexist in different proportions throughout life. The mutated VAPBP56S production would increase with aging and predominate over the wild-type VAPB levels, determining the onset of symptoms and aggravating the disease.

Sintomas de transtornos alimentares em acadêmicos de medicina / Symptoms of eating disorders in medical students

Objetivo: avaliar os sintomas de transtornos alimentares em estudantes do Curso de Medicina do Centro Universitário Christus. Métodos: o estudo foi realizado com acadêmicos do quarto semestre do curso de Medicina. Utilizou-se um questionário sociodemográfico e antropométrico e os instrumentos Eating Atitudes Test (EAT-26); Binge Eating Scale (BES); e Sick Control One Stone Fat Food Questionnaire (SCOFF). Resultados: participaram do estudo 78 alunos, sendo 54 pessoas do sexo feminino (69,23%). A média de idade dos participantes foi de 22 (±4,7) anos, e o IMC médio foi de 24,33 (±4,11) kg/m2. Quanto ao SCOFF, 38,46% dos participantes apresentaram elevada probabilidade de transtorno alimentar, 14,10% apresentaram alto risco para desenvolverem transtornos alimentares segundo o EAT-26, e 12,82% apresentaram escores sugestivos de presença de compulsão alimentar moderada mediante o uso da BES. Conclusão: os transtornos alimentares e os comportamentos alimentares alterados foram identificados entre os acadêmicos de medicina. Assim, são necessárias intervenções de educação em saúde e de apoio psicológico para esta população, objetivando reduzir o risco de desenvolvimento de transtornos alimentares.

Objective: this study aimed to evaluate the symptoms of eating disorders in medical students at Centro Universitário Christus. Methods: the study was carried out with fourth-semester medical students. A sociodemographic and anthropometric questionnaire was used, the Eating Attitudes Test (EAT-26) instruments; Binge Eating Scale (BES); and Sick Control One Stone Fat Food Questionnaire (SCOFF). Results: 78 students participated in the study, 54 of whom were female (69.23%). The mean age of the participants was 22 (±4.7) years and the mean BMI was 24.33 (±4.11) kg/m2. As for the SCOFF, 38.46% of the participants had a high probability of having an eating disorder, 14.10% had a high risk of developing eating disorders according to the EAT-26, and 12.82% had scores suggestive of the presence of moderate binge eating using BES. Conclusion: eating disorders and altered eating behaviors were identified among medical students. Thus, health education and psychological support interventions are needed for this population, aiming to reduce the risk of developing eating disorders.

DNMT1 inhibition by pUG-fold quadruplex RNA.

Aberrant DNA methylation is one of the earliest hallmarks of cancer. DNMT1 is responsible for methylating newly replicated DNA, but the precise regulation of DNMT1 to ensure faithful DNA methylation remains poorly understood. A link between RNA and chromatin-associated proteins has recently emerged, and several studies have shown that DNMT1 can be regulated by a variety of RNAs. In this study, we have confirmed that human DNMT1 indeed interacts with multiple RNAs, including its own nuclear mRNA. Unexpectedly, we found that DNMT1 exhibits a strong and specific affinity for GU-rich RNAs that form a pUG-fold, a noncanonical G-quadruplex. We find that pUG-fold-capable RNAs inhibit DNMT1 activity by inhibiting binding of hemimethylated DNA, and we additionally provide evidence for multiple RNA binding modes with DNMT1. Together, our data indicate that a human chromatin-associated protein binds to and is regulated by pUG-fold RNA.

Expected and perceived burdens in patients receiving mandibular overdentures retained by one or two implants.

PURPOSE: This study aimed to assess patients' expected burdens before treatment and their perceived burdens after the surgical and prosthodontic procedures of mandibular overdenture treatment and to evaluate factors influencing patients' perceptions. METHODS: Data were collected from 47 participants enrolled in a randomized clinical trial comparing mandibular overdentures retained by one or two implants. A 20-item questionnaire measured on a four-point Likert scale covering the surgical and prosthetic treatment procedures was used to assess the patients' perception of the procedural burdens before (expected burdens) and immediately after (experienced burdens) each procedure. Operators' perceptions of intercurrences associated with the procedures were also assessed as an independent variable. RESULTS: Low levels of perceived burdens were observed both before and after treatment. The mean overall scores of 1.65 ± 0.46 and 1.53 ± 0.33 for expected and experienced burdens, respectively, indicated that most items ranged between "not burdensome at all" and "somewhat burdensome." Significant differences between expected and experienced burdens were found for eight items (P < 0.001). Considering the treatment stages, expected burdens scored higher in the pre-surgical, surgical, and prosthetic stages and lower in the post-surgical phase than experienced burdens. Overall, the experienced burdens were significantly affected by the expected burdens (P < 0.001) and operator's perceived burdens(P = 0.045). CONCLUSIONS: Treatments were associated with low levels of perceived burdens related to surgical and prosthodontic procedures and were highly correlated with the expected burdens before treatment. However, patients tend to overestimate the expected burdens before treatment, especially for surgical procedures.

Blood Loss Control in Patients with Idiopathic Scoliosis Undergoing Spinal Fusion: Prospective Evaluation of a Cohort / Controle de sangramento em pacientes com escoliose idiopática submetidos a artrodese da coluna: Avaliação prospectiva de uma coorte de pacientes

Abstract Objective This study aimed to identify risk factors for increased perioperative bleeding in scoliosis surgery. Methods This is a prospective cohort study including 30 patients with idiopathic scoliosis undergoing posterior instrumentation using the pedicle screw system at a university hospital. Results Intraoperative blood losses totaled 798.6 ± 340 mL (24.8% of blood volume). Nine subjects presented massive blood loss. On average, hemoglobin dropped by 3.7g/dL, and each patient received 1.4 blood bags. Postoperative blood loss was 693.4±331.1 mL, and the total number of days using a drain was 2.7±0.7. Intraoperatively, the following variables showed significant correlations (p<0.05) with increased bleeding: age, time from diagnosis to treatment, preoperative Cobb angle, amount of curve correction, number of instrumented and fixated levels, total number of screws, and the number of transfused bags. Postoperatively, the following variables had significant correlations (p < 0.05): age, preoperative Cobb angle, length of hospital stay, number of blood bags transfused, and number of levels fixated with screws. Conclusion The variables most contributing to blood loss were age, preoperative Cobb angle, number of blood bags transfused, and number of levels fixated with a screw. Therefore, patients may benefit from surgical treatment while younger and

Resumo Objetivo O objetivo deste estudo é identificar os fatores de risco para o aumento de sangramento perioperatório em cirurgias para tratamento de escoliose. Métodos Estudo de coorte prospectivo incluindo 30 pacientes com escoliose idiopática submetidos à instrumentação posterior com o uso do sistema de parafusos pediculares em um hospital universitário. Resultados As perdas sanguíneas intraoperatórias totalizaram 798,6 ml ±340 ml (24,8% do volume sanguíneo). Houve perda maciça de sangue em 9 pacientes. Em média, a hemoglobina caiu 3,7 g/dl e foram transfundidas 1,4 bolsas de sangue por paciente. A perda sanguínea pós-operatória foi de 693,4 ml ± 331,1ml, e o total de dias utilizando dreno foi 2,7 ± 0,7. No intraoperatório, as seguintes variáveis apresentaram correlações significativas (p < 0,05) com o aumento do sangramento: idade, intervalo entre diagnóstico e tratamento, Cobb pré-operatório, quantidade de correção da curva, número de níveis instrumentados e fixados, número total de parafusos e o número de bolsas transfundidas. No pós-operatório, as seguintes variáveis apresentaram relação (p<0,05): idade, Cobb pré-operatório, tempo de internação, quantidade de bolsas de sangue transfundidas e o número de níveis fixados com parafuso. Conclusão As variáveis que mais contribuíram para a perda sanguínea foram idade, Cobb pré-operatório, quantidade de bolsas de sangue transfundidas e número de níveis fixados com parafuso. Portanto, os pacientes podem se beneficiar do tratamento cirúrgico

Use of a mobile platform in rheumatology by undergraduate medical students during the COVID-19 pandemic / Uso de uma plataforma móvel em reumatologia por acadêmicos de Medicina durante a pandemia por Covid-19

Abstract: Introduction: Mobile applications are considered relevant in the health area. As rheumatology is a complex and prevalent specialty in clinical practice, the development of tools that favor learning becomes necessary. Objective: To evaluate the impact of a mobile platform on learning, obtaining the degree of satisfaction with the teaching tool and the effects on different scenarios of educational practice, including performance evaluation regarding questions about the theoretical contents of the platform. Methods: Quantitative, descriptive study, carried out in Christus University Center, located in Fortaleza, Brazil. Questionnaires prepared by the authors were used to assess the impact on the different active methodologies used in the institution and the degree of student satisfaction regarding their use. The estimate of the students' cognitive gain was measured through pre-test and post-test, using the multiple-choice format. Results: The questionnaires were applied to 71 students to assess the effects and satisfaction. A total of 90 students participated in the pre-test and 32 in the post-test phase. The platform showed a positive perception of learning for 83.1% of the students, with greater impact on lectures, although there was a greater impact on the simulation scenarios in the eighth semester. A good degree of satisfaction was observed in 94.4% of the answers, with improved performance in the tests, increasing from 43.7% to 63.3% (P < 0.001). Conclusions: The development and application of the mobile platform in rheumatology showed excellent results, with favorable effects on the teaching of the specialty, disclosing a good degree of satisfaction regarding its use and better performance on the questioning about the theoretical contents of the platform.

Resumo: Introdução: Aplicativos móveis são considerados relevantes na área da saúde. Sendo a reumatologia uma especialidade complexa e prevalente na prática clínica, torna-se necessário o desenvolvimento de ferramentas que favoreçam a aprendizagem. Objetivo: Este estudo teve como objetivo avaliar o impacto no aprendizado que uma plataforma móvel proporcionou, obtendo o grau de satisfação com a ferramenta de ensino e a repercussão nos diferentes cenários de prática educacional, incluindo avaliação de performance quanto a questionamentos do conteúdo teórico da plataforma. Método: Trata-se de estudo transversal com delineamento descritivo e abordagem quantitativa do tipo analítico, realizado no Centro Universitário Christus, localizado em Fortaleza, Brasil. Pesquisaram-se, por meio de questionários elaborados pelos autores, a repercussão nas diferentes metodologias ativas presentes na instituição e o grau de satisfação dos alunos quanto ao uso. A estimativa do ganho cognitivo dos alunos foi mensurada por meio de pré-teste e pós-teste, no formato de múltiplas escolhas. Resultado: Participaram 71 alunos durante do questionário sobre a repercussão e a satisfação. Nas questões de múltiplas escolhas, 90 alunos participaram do pré-teste e 32 do pós-teste. A plataforma apresentou percepção positiva na aprendizagem para 83,1% dos alunos, havendo maior impacto nas aulas expositivas, embora no oitavo semestre tenha havido maior repercussão nos cenários de simulação. Houve boa satisfação em 94,4% das respostas, com melhora no aproveitamento quanto às questões de múltiplas escolhas, evoluindo de 43,7% para 63,3% (p < 0,001). Conclusão: A elaboração e a aplicação da plataforma móvel em reumatologia obtiveram excelentes resultados, com repercussão favorável no ensino da especialidade e boa satisfação quanto ao uso e melhor performance no que concerne ao questionamento sobre os conteúdos teóricos da plataforma.

Occupational stress and common mental disorders: how do coping strategies work?

Introduction: Coping strategies are described as devices capable of minimizing the effects of occupational stress on workers' mental health. Objectives: To evaluate the association between occupational stressors and occurrence of common mental disorders and how coping strategies work in this relationship. Methods: This is a cross-sectional study with 3,343 healthcare workers from six municipalities in the state of Bahia, Brazil. Common mental disorders were measured by the Self-Reporting Questionnaire, and occupational stressors by the Job Content Questionnaire. Coping strategies included physical activity, leisure activities, social support at work, alcohol consumption, and smoking. Bivariate and multivariate analyses were performed, stratified by sex. Results: Occupational stressors were associated with common mental disorders, more strongly among women. The practice of physical activity contributed to reduce the prevalence of common mental disorders, regardless of occupational stressors. Leisure activities were associated with lower prevalence of common mental disorders, but without statistical significance, losing relevance in the presence of occupational stressors. Social support and smoking or drinking habits were not associated with common mental disorders and did not influence the relationship with occupational stressors. Conclusions: Occupational stressors are associated with common mental disorders, with emphasis on high demand, even after adjusted for coping strategies. The relationship between occupational stressors and mental is corroborated, with greater female vulnerability, as well as the role of positive coping strategies in protecting mental health. The pertinence of adopting measures that reduce stress at work, promote the adoption of positive coping strategies, and consider gender inequalities in these relationships.

Stressful work in primary health care and mental health: The role of gender inequities in Brazil.

BACKGROUND: This study aims to analyze the association between occupational stressors, evaluated by the Effort-Reward Imbalance Model (ERI), and the occurrence of common mental disorders (CMD) among healthcare workers (HCW), additionally considering mediation by over-commitment from work (OW) and mediation of gender effects by work stressors. METHODS: Cross-sectional study, including a random sample of 3343 HCWs, from six municipalities of Bahia, Brazil. The ERI scale measured the occupational stressors (main exposure), and the Self-Reporting Questionnaire (SRQ-20) was used to screen for CMD. Data analysis used Structural Equation Modeling techniques to understand the relationships between gender, occupational stressors, and the occurrence of CMD. RESULTS: ERI and OW were associated with CMD. OW mediated the negative effect of ERI on the mental health of HCW. Female workers had higher levels of ERI, OW, and CMD prevalence; the total gender effect on CMD prevalence was mediated by ERI and OW. CONCLUSIONS: The findings highlight the association of work psychosocial stressors and CMD among HCW, including partial mediation by OW. Gender inequalities persisted among HCW, with women most exposed to occupational stressors and CMD. ERI and OW partially mediated the effect of gender on CMD.

Racial Differences in Blood Pressure Control from Users of Antihypertensive Monotherapy: Results from the ELSA-Brasil Study. / Diferenças Raciais no Controle da Pressão Arterial em Usuários de Anti-Hipertensivos em Monoterapia: Resultados do Estudo ELSA-Brasil.

BACKGROUND: It seems that the worst response to some classes of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, on the part of the Black population, would at least partially explain the worse control of hypertension among these individuals. However, most of the evidence comes from American studies. OBJECTIVES: This study aims to investigate the association between self-reported race/skin color and BP control in participants of the Longitudinal Study of Adult Health (ELSA-Brasil), using different classes of antihypertensive drugs in monotherapy. METHODS: The study involved a cross-sectional analysis, carried out with participants from the baseline of ELSA-Brasil. Blood pressure control was the response variable, participants with BP values ≥140/90 mmHg were considered out of control in relation to blood pressure levels. Race/skin color was self-reported (White, Brown, Black). All participants were asked about the continuous use of medication. Association between BP control and race/skin color was estimated through logistic regression. The level of significance adopted in this study was of 5%. RESULTS: Of the total of 1,795 users of antihypertensive drugs in monotherapy at baseline, 55.5% declared themselves White, 27.9% Brown, and 16.7% Black. Even after adjusting for confounding variables, Blacks using angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB), thiazide diuretics (thiazide DIU), and beta-blockers (BB) in monotherapy had worse blood pressure control compared to Whites. CONCLUSIONS: Our results suggest that in this sample of Brazilian adults using antihypertensive drugs in monotherapy, the differences in blood pressure control between different racial groups are not explained by the possible lower effectiveness of ACEIs and ARBs in Black individuals.

FUNDAMENTO: Aparentemente, a pior resposta a algumas classes de anti-hipertensivos, especialmente inibidores da enzima conversora da angiotensina e bloqueadores de receptor de angiotensina, pela população negra, explicaria, pelo menos parcialmente, o pior controle da hipertensão entre esses indivíduos. Entretanto, a maioria das evidências vêm de estudos norte-americanos. OBJETIVOS: Este estudo tem o objetivo de investigar a associação entre raça/cor da pele autorrelatadas e controle de PA em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) utilizando várias classes de anti-hipertensivos em monoterapia. MÉTODOS: O estudo envolveu uma análise transversal, realizada com participantes da linha de base do ELSA-Brasil. O controle de pressão arterial foi a variável de resposta, participantes com valores de PA ≥140/90 mmHg foram considerados descontrolados em relação aos níveis de pressão arterial. A raça/cor da pele foi autorrelatada (branco, pardo, negro). Todos os participantes tiveram que responder perguntas sobre uso contínuo de medicamentos. A associação entre o controle de PA e raça/cor da pele foi estimada por regressão logística. O nível de significância adotado nesse estudo foi de 5%. RESULTADOS: Do total de 1.795 usuários de anti-hipertensivos em monoterapia na linha de base, 55,5% se declararam brancos, 27,9%, pardos e 16,7%, negros. Mesmo depois de padronizar em relação a variáveis de confusão, negros em uso de inibidores da enzima conversora de angiotensina (IECA), bloqueadores de receptor de angiotensina (BRA), diuréticos tiazídicos (DIU tiazídicos) e betabloqueadores (BB) in monoterapia tinham controle de pressão arterial pior em comparação a brancos. CONCLUSÕES: Os resultados deste estudo sugerem que, nesta amostra de brasileiros adultos utilizando anti-hipertensivos em monoterapia, as diferenças de controle de pressão arterial entre os vários grupos raciais não são explicadas pela possível eficácia mais baixa dos IECA e BRA em indivíduos negros.

Diferenças Raciais no Controle da Pressão Arterial em Usuários de Anti-Hipertensivos em Monoterapia: Resultados do Estudo ELSA-Brasil / Racial Differences in Blood Pressure Control from Users of Antihypertensive Monotherapy: Results from the ELSA-Brasil Study

Resumo Fundamento Aparentemente, a pior resposta a algumas classes de anti-hipertensivos, especialmente inibidores da enzima conversora da angiotensina e bloqueadores de receptor de angiotensina, pela população negra, explicaria, pelo menos parcialmente, o pior controle da hipertensão entre esses indivíduos. Entretanto, a maioria das evidências vêm de estudos norte-americanos. Objetivos Este estudo tem o objetivo de investigar a associação entre raça/cor da pele autorrelatadas e controle de PA em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) utilizando várias classes de anti-hipertensivos em monoterapia. Métodos O estudo envolveu uma análise transversal, realizada com participantes da linha de base do ELSA-Brasil. O controle de pressão arterial foi a variável de resposta, participantes com valores de PA ≥140/90 mmHg foram considerados descontrolados em relação aos níveis de pressão arterial. A raça/cor da pele foi autorrelatada (branco, pardo, negro). Todos os participantes tiveram que responder perguntas sobre uso contínuo de medicamentos. A associação entre o controle de PA e raça/cor da pele foi estimada por regressão logística. O nível de significância adotado nesse estudo foi de 5%. Resultados Do total de 1.795 usuários de anti-hipertensivos em monoterapia na linha de base, 55,5% se declararam brancos, 27,9%, pardos e 16,7%, negros. Mesmo depois de padronizar em relação a variáveis de confusão, negros em uso de inibidores da enzima conversora de angiotensina (IECA), bloqueadores de receptor de angiotensina (BRA), diuréticos tiazídicos (DIU tiazídicos) e betabloqueadores (BB) in monoterapia tinham controle de pressão arterial pior em comparação a brancos. Conclusões Os resultados deste estudo sugerem que, nesta amostra de brasileiros adultos utilizando anti-hipertensivos em monoterapia, as diferenças de controle de pressão arterial entre os vários grupos raciais não são explicadas pela possível eficácia mais baixa dos IECA e BRA em indivíduos negros.

Abstract Background It seems that the worst response to some classes of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, on the part of the Black population, would at least partially explain the worse control of hypertension among these individuals. However, most of the evidence comes from American studies. Objectives This study aims to investigate the association between self-reported race/skin color and BP control in participants of the Longitudinal Study of Adult Health (ELSA-Brasil), using different classes of antihypertensive drugs in monotherapy. Methods The study involved a cross-sectional analysis, carried out with participants from the baseline of ELSA-Brasil. Blood pressure control was the response variable, participants with BP values ≥140/90 mmHg were considered out of control in relation to blood pressure levels. Race/skin color was self-reported (White, Brown, Black). All participants were asked about the continuous use of medication. Association between BP control and race/skin color was estimated through logistic regression. The level of significance adopted in this study was of 5%. Results Of the total of 1,795 users of antihypertensive drugs in monotherapy at baseline, 55.5% declared themselves White, 27.9% Brown, and 16.7% Black. Even after adjusting for confounding variables, Blacks using angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB), thiazide diuretics (thiazide DIU), and beta-blockers (BB) in monotherapy had worse blood pressure control compared to Whites. Conclusions Our results suggest that in this sample of Brazilian adults using antihypertensive drugs in monotherapy, the differences in blood pressure control between different racial groups are not explained by the possible lower effectiveness of ACEIs and ARBs in Black individuals.

Proprioceptive neuromuscular facilitation training reduces pain and disability in individuals with chronic low back pain: A systematic review and meta-analysis.

BACKGROUND: and purpose: Although proprioceptive neuromuscular facilitation (PNF) exercises are used in rehabilitation practice, their effects in patients with low back pain (LBP) remain unclear. This study aimed to investigate the efficacy of PNF training for pain and disability in patients with LBP. METHODS: In this systematic review, we searched five databases from the earliest date available to October 2020. Three comparisons were performed: PNF versus control, PNF versus core strengthening, and PNF versus conventional physical therapy. RESULTS: Sixteen studies met the eligibility criteria (722 patients). PNF training improved pain (standardized mean difference [SMD]: -2.6; 95% confidence interval [CI]: -4.2 to -0.9, n = 174) and disability (SMD: -3.29; 95% CI: -5.3 to -1.3, n = 144) compared to the control. PNF training also yielded a greater benefit for pain reduction (mean difference [MD]: -1.8, 95% CI: -2.2 to -0.3, n = 177) and disability improvement (MD: -6.6, 95% CI: -9.3 to -3.8, n = 113) than did core strengthening. CONCLUSION: PNF training seems to be a useful strategy for decreasing pain and improving disability in patients with LBP. However, the quality of evidence for the outcomes of both pain and disability was low to moderate.

Occupational stressors and work accidents among health workers.

OBJECTIVE: To test the association between occupational stressors and work accidents due to exposure to biological material (ATbio) in health workers, considering the isolated and combined analysis of the dimensions of two models, the demand-control model (DCM) and the effort-reward imbalance model (ERI). METHODS: Cross-sectional study in a representative sample of workers with higher, technical and secondary education, including health agents from primary and medium-complexity care units in five cities in Bahia. Random sampling was selected, stratified by geographic area, level of service complexity and occupation. The outcome variable was ATbio; The main exposure was occupational stressors, assessed by the DCM and ERI. Incidences and relative risks were estimated as a function of the acute, short-term nature of the outcome of interest. Associations between ATbio and isolated and combined DCM and ERI dimensions were tested. RESULTS: A total of 3,084 workers participated in the study. The global incidence of ATbio was 3.4% and was associated with high psychological demand, high effort and high commitment to work, adjusted for sex, age, education and work shift. High-strain work and a situation of imbalance between efforts and rewards were associated with ATbio. With the combination of the models, an increase in the measure of association with the outcome was observed. Significant associations of greater magnitude were observed in the complete combined models. ATbio's risk was 5.23 times higher among those exposed in both complete models compared to the absence of exposure in both models. CONCLUSIONS: Occupational stressors were associated with ATbio. Advantages in using the combined models were observed. The approach of different psychosocial dimensions has expanded the ability to identify exposed groups, offering a solid basis for interventions for ATbio's prevention in health.

[Job dissatisfaction, psychosocial aspects, personal satisfaction, and mental health of male and female health workers]. / Insatisfação com o trabalho, aspectos psicossociais, satisfação pessoal e saúde mental de trabalhadores e trabalhadoras da saúde.

The objective was to evaluate the relationship between job dissatisfaction and the occurrence of common mental disorders (CMD), considering the psychosocial aspects of work and personal satisfaction. Cross-sectional study, with a sample of 3,084 health workers from five municipalities in Bahia. Structural equation modeling analysis, stratified by gender, was used. Dissatisfaction with work was the main exposure variable. The CMD, the outcome variable, was assessed by the Self-Reporting Questionnaire (SRQ-20). Personal satisfaction (SAP), assessed by World Health Organization Quality of Life (WHOQOL) questions, and stressful (AE) and protective (AP) psychosocial aspects, measured by the Job Content Questionnaire (JCQ) and the Effort-Reward Imbalance scale (ERI), were treated as latent variables. Dissatisfaction with work was associated with higher CMD prevalence, among men (0.160; CI95%: 0.024; 0.295) and women (0.198; CI95%: 0.135; 0.260). AEs were associated with greater dissatisfaction and higher CMD prevalence, while APs were associated with lower dissatisfaction and lower CMD prevalence, among men and women. Dissatisfaction with work mediated the effect of psychosocial aspects and personal satisfaction on the occurrence of CMD. The final model showed good adjustment. High job dissatisfaction, stressful psychosocial aspects, lack of protective aspects, and personal dissatisfaction were associated directly or indirectly with CMD. The results reinforce the need for actions to protect mental health at work by redesigning the harmful aspects identified and strengthening the aspects associated with the lower occurrence of CMD.

O objetivo foi avaliar a relação da insatisfação no trabalho e ocorrência de transtornos mentais comuns (TMC), considerando os aspectos psicossociais do trabalho e a satisfação pessoal (SAP). Estudo transversal, em amostra de 3.084 trabalhadores/as de saúde de cinco municípios baianos. Empregou-se análise de modelagem de equações estruturais, estratificada por gênero. A insatisfação com o trabalho foi a variável de exposição principal. Os TMC, variável desfecho, foram avaliados pelo Self-Reporting Questionaire (SRQ-20). Satisfação pessoal, avaliada por questões do World Health Organization Quality of Life (WHOQOL), e os aspectos psicossociais estressores (AE) e protetores (AP), mensurados pelo Job Content Questionnaire (JCQ) e pela escala Effort-Reward Imbalance (ERI), foram tratadas como variáveis latentes. A insatisfação com o trabalho associou-se positivamente aos TMC, entre homens (0,160; IC95%: 0,024; 0,295) e mulheres (0,198; IC95%: 0,135; 0,260). Os AE associaram-se positivamente à insatisfação com o trabalho e aos TMC, enquanto os AP associaram-se negativamente a esses dois eventos, entre homens e mulheres. A insatisfação com o trabalho mediou o efeito dos aspectos psicossociais e da SAP na ocorrência de TMC. O modelo final apresentou bom ajuste nos grupos analisados. Elevada insatisfação, presença de aspectos psicossociais estressores, carência de aspectos protetores e insatisfação pessoal associaram-se aos TMC direta ou indiretamente. Os resultados reforçam a necessidade de ações voltadas à proteção da saúde mental no trabalho em saúde com o redesenho dos aspectos nocivos identificados e fortalecimento dos aspectos associados à menor ocorrência de TMC.

El objetivo fue evaluar la relación de la insatisfacción en el trabajo y la ocurrencia de trastornos mentales comunes (TMC), considerando aspectos psicosociales del trabajo, así como la satisfacción personal. Se trata de un estudio transversal, en una muestra de 3084 trabajadores/as de salud de cinco municipios bahianos. Se utilizó un análisis de modelado de ecuaciones estructurales, estratificado por género. La insatisfacción con el trabajo fue la variable de exposición principal. Los TMC, variable de desenlace, se evaluaron mediante el Self-Reporting Questionaire (SRQ-20). Satisfacción personal (SAP), evaluada por cuestiones del World Health Organization Quality of Life (WHOQOL), y los aspectos psicosociales estresores (AE) y protectores (AP), medidos por el Job Content Questionnaire (JCQ) y por la escala Effort-Reward Imbalance (ERI), fueron tratadas como variables latentes. La insatisfacción con el trabajo se asoció positivamente a los TMC, entre hombres (0,160; IC95%: 0,024; 0,295) y mujeres (0,198; IC95%: 0,135; 0,260). Los AE se asociaron positivamente a la insatisfacción con el trabajo y a los TMC, mientras que los AP se asociaron negativamente a esos dos eventos, entre hombres y mujeres. La insatisfacción con el trabajo medió el efecto de los aspectos psicosociales y de la satisfacción personal en la ocurrencia de TMC. El modelo final presentó un buen ajuste en los grupos analizados. Elevada insatisfacción, presencia de aspectos psicosociales estresores, carencia de aspectos protectores e insatisfacción personal se asociaron a los TMC directa o indirectamente. Los resultados refuerzan la necesidad de acciones dirigidas a la protección de la salud mental en el trabajo en salud, con el rediseño de los aspectos nocivos identificados, así como el fortalecimiento de los aspectos asociados a una menor ocurrencia de TMC.