Non-pharmacological and non-surgical interventions to manage patients with knee osteoarthritis: An umbrella review 5-year update.

Objective: This umbrella review aimed to summarize (and update) the effectiveness of non-pharmacological and non-surgical interventions for patients with knee osteoarthritis. Methods: The study followed the PRISMA guidelines. Manual and electronic databases were searched, to identify systematic reviews, following the P (knee osteoarthritis) I (non-pharmacological and non-surgical treatments) C (pharmacological, surgical, placebo, no intervention, or other non-pharmacological/non-surgical conservative treatments) O (pain, function, quality of life, and other knee-specific measures) model. The quality of evidence was assessed using the R-AMSTAR checklist and GRADE principles. Results: The search yielded 4086 records, of which 61 met the eligibility criteria. After evaluation with R-AMSTAR, four systematic reviews were excluded, resulting in 57 included systematic reviews, with an overall score of 29.6. The systematic reviews were published between 2018 and 2022 (29.8% in 2022), conducted in 19 countries (52.6% in China), and explored 24 distinct interventions. The systematic reviews encompassed 714 trials (mean of 13 â€‹± â€‹7.7 studies per systematic review), and 59,343 participants (mean 1041 â€‹± â€‹1002 per systematic review, and 82 â€‹± â€‹59.2 per study). The majority of participants were older obese women (61.6 â€‹± â€‹4.2 years, 30.2 â€‹± â€‹3.6 â€‹kg/m2, 70%, respectively). Conclusions: Based on the systematic reviews findings, Diet Therapy, Patient Education, and Resistance Training are strongly supported as core interventions for managing patients with knee osteoarthritis. Aquatic Therapy, Balance Training, Balneology, Dietary Supplements, Extracorporeal Shockwave Therapy, and Tai Ji show moderate support. For other interventions, the evidence quality was low, results were mixed or inconclusive, or there was not sufficient efficacy to support their use.

Validation of the Revised Screening Scale for Pedophilic Interests (SSPI-2) in Portugal.

The accurate assessment of pedophilic sexual interests is crucial for the treatment and management of individuals who have sexually offended children. This study aimed to validate the Revised Screening Scale for Pedophilic Interests (SSPI-2) in a Portuguese sample of 170 men convicted of sexual offenses against children, 104 serving sentences in the community, and 66 in prison. The findings indicated that SSPI-2 demonstrated good convergent validity, as evidenced by its significant and positive associations with the "sexual deviance" item of SVR-20, the number of previous convictions for sexual crimes against children, and having 3 or more child victims, which is associated with high sensitivity and specificity in distinguishing men who show greater sexual arousal to children than to adults. Furthermore, the SSPI-2 exhibited good divergent validity, with no significant correlations observed with a self-report measure of psychopathy or with a nonsexual criminal history.

Non-vitamin K versus vitamin K antagonist oral anticoagulants in surgical mitral valve repair or bioprosthetic valve replacement in the first three months after surgery.

INTRODUCTION AND OBJECTIVES: Oral anticoagulation (OAC) with non-vitamin K antagonist oral anticoagulants (NOACs) after surgical mitral valve repair (MVR) or bioprosthetic valve replacement (BVR) in mitral position remains a controversial topic among the cardiovascular community, in particular in the early postoperative period. This study aimed to evaluate the efficacy and safety of NOACs in the first three months after MVR or mitral BVR compared to vitamin K antagonists (VKAs). METHODS: This was a single-center retrospective study with prospectively collected peri-intervention outcomes between 2020 and 2021. Records were retrieved and all participants were contacted by telephone. Patients were divided into groups according to OAC strategy. The primary outcome was a composite of death, rehospitalization, myocardial infarction, stroke or transient ischemic attack, systemic embolism, mitral thrombosis, or bleeding during the first three months after surgery. RESULTS: A total of 148 patients were enrolled, with a mean age of 65.5±12.2 years, 56.8% male. On discharge, 98 (66.2%) patients were on VKAs and 50 (33.8%) were on DOACs for at least three months. The primary outcome occurred in 22 (22.4%) patients in the VKA group and in three (6%) in the NOAC group (p=0.012), mainly driven by more bleeding events in the former. Independent predictors of the primary outcome were smoking (p=0.028) and OAC with VKAs at discharge, the latter predicting three times more events (p=0.046, OR 3.72, 95% CI 1.02-13.5). CONCLUSIONS: NOACs were associated with fewer events, supporting their efficacy and safety during the first three months after surgical MVR or mitral BVR.

Ionizing radiation exposure in complex percutaneous coronary intervention: Defining local diagnostic reference levels in the catheterization laboratory.

INTRODUCTION AND OBJECTIVES: Concerns regarding the consequences of ionizing radiation (IR) have been increasing in the field of interventional cardiology (IC). There is little information on reported national and local radiation diagnostic reference levels (DRLs) in catheterization laboratories in Portugal. This study was designed to assess the IR dose exposure during complex percutaneous coronary intervention (PCI), and to set the respective DRLs and future achievable doses (ADs). METHODS: This was a retrospective cohort study which took place between 2019 and 2020, including patients who underwent complex PCI. Complex PCI was defined as all procedures that encompass treatment of chronic total occlusions (CTO) or left main coronary artery. DRLs were defined as the 75th percentile of the distribution of the median values of air kerma area product (PKA) and cumulative air kerma (Ka,r). ADs were set at the 50th percentile of the study dose distribution. Multivariate analysis was performed using linear regression to identify predictors significantly associated with radiation dose (Ka,r). RESULTS: A total of 242 patients were included in the analysis. Most patients underwent a CTO procedure (146, 60.3%). Patients were aged 67.9±11.2 years and mostly male (81.4%). DRLs were set in Ka,r (3012 mGy) and PKA (162 Gy cm2) for complex PCI. ADs were also set in Ka,r (1917 mGy) and PKA (101 Gy cm2). Independent predictors of Ka,r with a positive correlation were PKA (0.893, p<0.001), fluoroscopy time (0.520, p<0.001) and PCI time (0.521, p<0.001). CONCLUSIONS: This study reports the results of IR in complex PCI. DRLs were set for IR dose exposure measured in Ka,r (3012 mGy) and PKA (162 Gy cm2). ADs, values to be achieved in future assessment, were set to Ka,r (1917 mGy) and PKA (101 Gy cm2).

Evidence-based Interventions Targeting Remand Prisoners: A Systematic Review and Meta-analysis / Intervenciones basadas en la evidencia dirigidas a reclusos en prisión preventiva: revisión sistemática y meta-análisis

Background/Aim: Official data show that nearly three million people are awaiting trial in prison. Despite this group representativeness, few interventions have been developed and assessed for these prisoners, even though literature has been showing that they present specific vulnerabilities. Nevertheless, no previous literature review had covered this topic. Considering this, the present review aims to gather evidence on the programs focused on this population, analyzing their intervention targets and their effectiveness. Method: The search identified a total of 7,143 studies. After removing the duplicates, 2,199 were screened using the title and abstract, according to the inclusion criteria. The full-text screening comprehended 45 articles, of which 37 were excluded. This resulted in 8 studies for inclusion in the final analysis, of which four were pharmacological studies. Results: Overall, meta-analysis results exhibited that treatment of remand prisoners (RPs) has an extraordinarily large positive effects, exceeding 92%. Our study confirmed that RPs would benefit from treatment, and therefore intervention programs should be established. Conclusions: Besides, our findings underlined the scarce resources to address the difficulties of the remand population, reinforcing the importance of assessing these individuals’ needs to develop effective responses to them. (AU)

Introducción/Objetivo: Los datos oficiales muestran que casi tres millones de personas se encuentran en prisión a la espera de juicio. A pesar de la representatividad de este grupo, se han desarrollado y evaluado pocas intervenciones para estos presos, a pesar de que las publicaciones científicas han venido demostrando que presentan vulnerabilidad específica. Sin embargo, ninguna revisión anterior de la literatura había abordado este tema. Teniendo esto en cuenta, la presente revisión pretende reunir evidencias sobre los programas dirigidos a esta población, analizando sus objetivos de intervención y su efectividad. Método: La búsqueda identificó un total de 7,143 estudios. Tras eliminar los duplicados, se seleccionaron 2,199 mediante el título y el resumen, de acuerdo con los criterios de inclusión. El cribado del texto completo comprendió 45 artículos, de los cuales 37 fueron excluidos. Esto dio lugar a 8 estudios para su inclusión en el análisis final, de los cuales 4 eran estudios farmacológicos. Resultados: En general, los resultados del meta-análisis mostraron que el tratamiento de los presos preventivos tiene enormes efectos positivos, superiores al 92%. Nuestro estudio confirmó que los presos preventivos se beneficiarían del tratamiento, por lo que deberían establecerse programas de intervención. Conclusiones: Los resultados subrayan los escasos recursos que hay para abordar las dificultades de la población en prisión preventiva, reforzando la importancia de evaluar las necesidades de estos individuos para desarrollar respuestas efectivas a las mismas. (AU)

Clinical results of percutaneous coronary intervention in chronic total occlusions of the right coronary artery.

INTRODUCTION AND OBJECTIVES: Coronary chronic total occlusions (CTOs) of the right coronary artery (RCA) are a relatively common finding in the context of coronary angiography. However, the benefit of revascularization remains controversial. METHODS: A single-center retrospective cohort analysis prospectively collected outcomes of CTO patients undergoing percutaneous coronary intervention (PCI) in 2019 and 2020. Patients were divided into two groups according to the CTO vessel treated (left coronary artery [LCA]-CTO or RCA-CTO). The primary outcome was defined as the recurrence of angina and/or heart failure (HF) symptoms and secondary outcomes were myocardial infarction (MI) and all-cause mortality. RESULTS: A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65±11 years. The primary outcome occurred in 28 (16.6%) patients and was significantly more frequent in RCA-CTO patients (19, 24.7%, p=0.010) in a mean follow-up of 18 months. This was mainly driven by recurrence of HF symptoms (12, 15.6%, p=0.013). Treated RCA-CTO was an independent predictor of the primary outcome (p=0.019, HR 2.66, 95% CI 1.17-6.05). MI and mortality rates were no different between groups (RCA-CTO with 1.3%, p=0.361 and 2.6%, p=0.673, respectively, on survival analysis). Left ventricular ejection fraction was an independent predictor of mortality (p=0.041, HR 0.93, 95% CI 0.87-0.99). CONCLUSIONS: Revascularization of CTO lesions by PCI was associated with low rates of symptom recurrence, and clinical outcomes showed no differences regardless of which artery was treated. Recanalization of RCA-CTO was less beneficial in reducing the recurrence of HF symptoms.

A report on a survey among Portuguese Association of Interventional Cardiology associates regarding ionizing radiation protection practices in national interventional cath-labs.

INTRODUCTION AND OBJECTIVES: Concerns surrounding the consequences of ionizing radiation (IR) have increased in interventional cardiology (IC). Despite this, the ever-growing complexity of diseases as well as procedures can lead to greater exposure to radiation. The aim of this survey, led by Portuguese Association of Interventional Cardiology (APIC), was to evaluate the level of awareness and current practices on IR protection among its members. METHODS: An online survey was emailed to all APIC members, between August and November 2021. The questionnaire consisted of 50 questions focusing on knowledge and measures of IR protection in the catheterization laboratory. Results were analyzed using descriptive statistics. RESULTS: From a response rate of 46.9%, the study obtained a total sample of 159 responses (156 selected for analysis). Most survey respondents (66.0%) were unaware of the radiation exposure category, and only 60.4% reported systematically using a dosimeter. A large majority (90.4%) employed techniques to minimize exposure to radiation. All participants used personal protective equipment, despite eyewear protection only being used frequently by 49.2% of main operators. Ceiling suspended shields and table protectors were often used. Only two-thirds were familiar with the legally established limit on radiation doses for workers or the dose that should trigger patient follow-up. Most of the survey respondents had a non-certified training in IR procedures and only 32.0% had attended their yearly occupational health consultation. CONCLUSIONS: Safety methods and protective equipment are largely adopted among interventional cardiologists, who have shown some IR awareness. Despite this, there is room for improvement, especially concerning the use of eyewear protection, monitoring, and certification.

Clinical outcomes of percutaneous coronary intervention in chronic total occlusion in patients with type 2 diabetes mellitus.

INTRODUCTION AND OBJECTIVES: Coronary chronic total occlusions (CTOs) are relatively common findings in patients with type 2 diabetes mellitus (T2DM). However, the indication for percutaneous coronary intervention (PCI) and its clinical benefit in these patients remain controversial. METHODS: A single-center retrospective cohort study with prospectively collected outcomes was carried out with CTO patients undergoing PCI in 2019 and 2020. Patients were divided into two groups according to previous T2DM diagnosis (T2DM and non-T2DM). The primary outcome was recurrence of angina and/or heart failure symptoms and secondary outcomes were myocardial infarction and all-cause mortality. RESULTS: A total of 177 patients (82.5% male) were included in the analysis, with a mean age of 65±11 years. The primary outcome (total symptom recurrence) occurred in 16.6% of the sample, with no difference between groups (non-T2DM 13.6% vs. T2DM 21.2%, p=0.194) in a two-year follow-up. Angina recurrence was significantly more frequent in T2DM patients (15.2%, p=0.043). The presence of T2DM was not an independent predictor of symptom recurrence (p=0.429, HR 1.37, 95% CI 0.62-2.98). Myocardial infarction and all-cause mortality were also not different between groups (T2DM 1.5%, p=0.786 and 4.5%, p=0.352, respectively, on survival analysis). Independent predictors of all-cause mortality were left ventricular function and creatine clearance (p=0.039, HR 0.92, 95% CI 0.85-0.99 and p=0.013, HR 0.96, 95% CI 0.93-0.99, respectively). CONCLUSIONS: T2DM did not influence outcomes in CTO patients undergoing PCI, and its presence should not be a limiting factor in deciding on CTO revascularization.

Pretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes in contemporaneous clinical practice.

BACKGROUND: Pretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes (NSTE-ACS) during hospitalization is still a matter of contention within the cardiology community. Our aim was to analyze in-hospital and one-year follow-up outcomes of patients with NSTE-ACS pretreated with dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT). METHODS: A retrospective study was carried out with NSTE-ACS patients planned to undergo an invasive strategy and were included in the Portuguese Registry of ACS between 2018-2021. A composite primary outcome (in-hospital re-infarction, stroke, heart failure, hemorrhage, death) was compared regarding antiplatelet strategy (DAPT versus SAPT). Secondary outcomes were defined as one-year all-cause mortality and one-year cardiovascular rehospitalization. RESULTS: A total of 1469 patients were included, with a mean age of 66±12 years and 73.9% were male. DAPT regime was used in 38.2% and SAPT in 61.8% of patients. NSTE myocardial infarction was the most frequent presentation (88.5%). Revascularization after 24h occurred in 44.8% patients (63% of these after 48h). Enoxaparin was the anticoagulant more frequently used (45.1%). The primary outcome was more frequently observed in the SAPT group (10.4%, p=0.033), mainly driven by more ischemic events. Time until revascularization > 48h and SAPT regime were independent predictors of the primary outcome (OR 1.66, p=0.036 and OR 2.03, p=0.008, respectively). CONCLUSION: NSTE-ACS patients pretreated with SAPT had worse in-hospital outcomes. This difference can be probably explained by a delay in time until revascularization. Pretreatment DAPT strategy and crossover between heparins is still frequently used in clinical practice.

Physical Therapists' Choices, Views and Agreements Regarding Non-Pharmacological and Non-Surgical Interventions for Knee Osteoarthritis Patients: A Mixed-Methods Study.

Objective/Aims: The aims of this study are to collect the most common non-pharmacological and non-surgical interventions used by the Portuguese physical therapists in their knee osteoarthritis patients, and to deeper understand the factors associated to their intervention choices. Methods: This study incorporated a mixed-methods design. For the quantitative data it was choose an e-survey (with 25 close-end questions, plus general information of the study and a clinical vignette), retrieving sociodemographic and self-reported practice on knee osteoarthritis information. It was analysed response frequencies and associations between variables with logistic regression analyses. For the qualitative data, it was chosen to perform semi-structured interviews in purposefully selected physical therapists to include different sociodemographic factors and survey responses regarding the physical therapists' interventions chosen. After the interviews, the audios were collected, anonymised, transcribed verbatim, and the texts explored by the thematic approach. Results: From the 277 PTs that shown interest in participating in the study, 120 fully completed the questionnaire and, from those, 10 participated in the interviews. The most chosen interventions included Resistance Exercise, Manual Therapy, Nutrition/Weight Loss, Self-care/Education, Stretching and Aquatic Exercise. Furthermore, it seems that PTs' individual characteristics (age, experience, and clinical reasoning), patient's characteristics (clinical findings and preferences), and work-related factors (facility type, work environment and available resources) are the main actors responsible for an intervention chosen. Conclusions: In the Portuguese PTs context the most important interventions are Exercise, Manual Therapy, Nutrition/Weight Loss, and Self-care/Education; these interventions chosen may be influenced by PT, patient and work-related factors.

Learning effect on an isokinetic knee strength test protocol among male adolescent athletes.

Learning effect occurs when the best performance is not achieved at the earliest trial of a repeated protocol of evaluation. The present study examined, within testing session, the intra-individual variation in an isokinetic strength protocol composed of five reciprocal concentric and eccentric contractions of knee extensors (KE) and knee flexors (KF) among male adolescent swimmers. Additionally, test-retest reliability was determined as intra-individual mean differences between two consecutive testing sessions. The sample included 38 swimmers aged 10.1-13.3 years. A subsample (n = 17) completed a second visit. Isokinetic dynamometry was used to assess concentric and eccentric contractions of KE and KF at an angular velocity of 60°.s-1. The protocol included three preliminary repetitions that were not retained for analysis, a 60-second interval, and five reciprocal maximal concentric contractions (cc). The preceding sequence was repeated for eccentric contractions (ecc) of KE and KF. Multilevel regression confirmed intra-individual and inter-individual levels as significant sources of variance in peak torque (PT) values. Intra-class correlation (ICC) fluctuated between 0.582 and 0.834 and, in general, a substantial percentage of participants need more than three repetitions to attain their best PT: KEcc (36.8%), KEecc (23.7%), KFcc (39.5%), KFecc (18.4%). For the subsample of 17 swimmers who completed a second testing session, intra-individual mean differences of the best PT were trivial or small. In summary, the validity of shorter protocols may be compromised if swimmers do not attain their best peak torque in the first few attempts, and the reliability of a 5-repetition protocol seemed acceptable.

High-Performance Semi-Transparent Perovskite Solar Cells with over 22% Visible Transparency: Pushing the Limit through MXene Interface Engineering.

Semi-transparent perovskite solar cells (ST-PSCs) have attracted enormous attention recently due to their potential in building-integrated photovoltaic. To obtain adequate average visible transmittance (AVT), a thin perovskite is commonly employed in ST-PSCs. While the thinner perovskite layer has higher transparency, its light absorption efficiency is reduced, and the device shows lower power conversion efficiency (PCE). In this work, a combination of high-quality transparent conducting layers and surface engineering using 2D-MXene results in a superior PCE. In situ high-temperature X-ray diffraction provides direct evidence that the MXene interlayer retards the perovskite crystallization process and leads to larger perovskite grains with fewer grain boundaries, which are favorable for carrier transport. The interfacial carrier recombination is decreased due to fewer defects in the perovskite. Consequently, the current density of the devices with MXene increased significantly. Also, optimized indium tin oxide provides appreciable transparency and conductivity as the top electrode. The semi-transparent device with a PCE of 14.78% and AVT of over 26.7% (400-800 nm) was successfully obtained, outperforming most reported ST-PSCs. The unencapsulated device maintained 85.58% of its original efficiency after over 1000 h under ambient conditions. This work provides a new strategy to prepare high-efficiency ST-PSCs with remarkable AVT and extended stability.

Changes in Clinical Training for Nursing Students during the COVID-19 Pandemic: A Scoping Review.

(1) Background: The COVID-19 pandemic has cost social, economic, cultural, and educational life, distressing nursing training and practice. This study aimed to map the literature on changes in clinical training for nursing students during the COVID-19 pandemic. (2) Methods: A scoping review was conducted according to JBI methodology's latest guidance. A set of relevant electronic databases and grey literature was searched to report results published in English, Spanish, and Portuguese. (3) Results: A total of 12 studies were included in the study, addressing changes in clinical training in undergraduate nursing students due to COVID-19 pandemic activity, published between 2020 and 2022. (4) Conclusions: Nursing schools made an effort to replace traditional clinical training with several activities, primarily based on simulation or virtual activities. However, contact with others is essential, and simulation programs or scenarios cannot provide it.

Modulation of Mechanical Properties of Short Bioinspired Peptide Materials by Single Amino-Acid Mutations.

The occurrence of modular peptide repeats in load-bearing (structural) proteins is common in nature, with distinctive peptide sequences that often remain conserved across different phylogenetic lineages. These highly conserved peptide sequences endow specific mechanical properties to the material, such as toughness or elasticity. Here, using bioinformatic tools and phylogenetic analysis, we have identified the GX8 peptide with the sequence GLYGGYGX (where X can be any residue) in a wide range of organisms. By simple mutation of the X residue, we demonstrate that GX8 can be self-assembled into various supramolecular structures, exhibiting vastly different physicochemical and viscoelastic properties, from liquid-like coacervate microdroplets to hydrogels to stiff solid materials. A combination of spectroscopic, electron microscopy, mechanical, and molecular dynamics studies is employed to obtain insights into molecular scale interactions driving self-assembly of GX8 peptides, underscoring that π-π stacking and hydrophobic interactions are the drivers of peptide self-assembly, whereas the X residue determines the extent of hydrogen bonding that regulates the macroscopic mechanical response. This study highlights the ability of single amino-acid polymorphism to tune the supramolecular assembly and bulk material properties of GX8 peptides, enabling us to cover a broad range of potential biomedical applications such as hydrogels for tissue engineering or coacervates for drug delivery.

The Effectiveness of Psychological Treatment in Adult Male Convicted for Sexual Offenses Against Children: A Systematic Review.

Child sexual abuse is a public health problem of global magnitude with profound and negative consequences for the victims and society. Thus, psychological intervention with individuals who sexually offended against children is crucial for reducing recidivism. Numerous reviews and meta-analyses have shown the effectiveness of psychological interventions in individuals who sexually offended, but few reviews have been done on this subtype of offenders. This article reviews evaluation studies of intervention programs designed to treat individuals who sexually offended against children, providing a more detailed account of treatment procedures. Articles were identified from peer-reviewed databases, bibliographies, and experts. Following full-text review, 12 studies were selected for inclusion by meeting the following criteria: quantitative or qualitative research studies published in English from 2000 to 2020 with titles or abstracts that indicated a focus on treatment effectiveness, detailing the psychological treatment procedures on adult, male individuals convicted for child sexual abuse. Cognitive-behavioral therapy with a relapse prevention approach was the most frequent modality found in child sexual offending treatment. Besides, different criminogenic and non-criminogenic factors emerge as targets for intervention. Study design, study quality, and intervention procedures shortened the accumulation of evidence in treatment effectiveness.

Examination of the Weinberger Adjustment Inventory-Short Form Among Portuguese Young Adults: Psychometrics and Measurement Invariance.

The Weinberger Adjustment Inventory-Short Form (WAI-SF) is a multidimensional measure of behavioral adjustment frequently used with forensic, clinical, and community populations. However, no previous studies have examined the WAI-SF from a more modern psychometric perspective including second-order models, measurement invariance and a better estimation of reliability. The current sample is composed of female and male young adults (N = 610, M = 21.33 years, SD = 3.09, range = 18-37) from a university context in Portugal. Results indicated that both the four-factor intercorrelated and the four-factor second order models of the WAI-SF Distress and Restraint scales showed good fits. The WAI-SF Distress and Restraint scales were negatively and significantly correlated, and the intercorrelations between the subscales of each scale ranged from moderate to high. The WAI-SF scales and subscales mostly showed adequate to good reliability in terms of McDonald's Omega and the more traditional Cronbach's Alpha. Strong cross-gender measurement invariance was demonstrated, with females scoring significantly higher than males on the Anxiety subscale of the Distress scale, and on the Suppression of Aggression, Impulse Control, Consideration of Others, Responsibility subscales, and Restraint scale. The WAI-SF scales and subscales showed distinctive correlates with other measures (e.g., low self-control, psychopathy) and variables (e.g., delinquency seriousness, substance use). Considering our findings, the use of the WAI-SF is recommended among the Portuguese young adult population and its use in criminological research is encouraged.