Randomized clinical trial of tissue equivalent bolus prescription in postmastectomy radiotherapy stratified by skin involvement status.

Purpose: To assess the impact and optimize the prescription of tissue-equivalent bolus in postmastectomy radiotherapy (PMRT), we compared the use of different bolus regimens tailored by skin involvement status. Methods: Patients with breast cancer who required PMRT were recruited (NCT01925651) and classified into two groups: standard-risk (SR, without skin involvement) and high-risk (HR, with skin involvement). SR was randomized between no bolus or 5 mm-bolus on alternate days and HR between 5 mm-bolus on alternate days or daily. Conventional fractionation (50.4 Gy; 1.8 Gy/daily) was used. Acute skin toxicity was evaluated blindly and the radiodermatitis-specific toxicity index [rads-TI] calculated. Subsequently, patients were followed up to assess oncologic outcomes, focusing on chest wall (CW) local control. Results: Fifty-eight patients were enrolled (34 SR and 24 HR). Baseline characteristics were similar between arms within the same risk group. Overall, maximal radiodermatitis rates were 29.4 % (G2) and 15.7 % (G3). In the SR group, no difference existed in G2 radiodermatitis incidence between the subgroups (p = 0.70) and no G3 events occurred. In the HR group, incidences of G2 (100 % vs 44.5 %, p = 0.01) and G3 radiodermatitis (70 % vs 11.1 %, p = 0.02) were higher with daily bolus. After adjusting for confounders, the daily bolus had a higher incidence of G2 (p = 0.03), G3 radiodermatitis (p = 0.04), and worse rads-TI (p < 0.01). After a median follow-up of 6.2 years, the 5-year local control was 95.8 % (95 %CI: 88.2 %-100 %) in the SR and 91.7 % (95 %CI: 77.3 %-100 %) in the HR groups. Per risk group, there was no difference in local control between the SR (p = 0.90) or the HR bolus regimens (p = 0.70). Conclusion: Daily 5 mm bolus prescription significantly increased the overall toxicity burden. In this preliminary study, within the same risk group, no detriment in CW local control was detected with less intense bolus regimens (SR: no bolus; HR: alternate-days bolus). Additionally, the rads-TI was able to distinguish overall radiodermatitis burden.

Satisfação laboral, bem estar e a prática de Mindfulness em profissionais de saúde / Job satisfaction, wellbeing and the practice of Mindfulness in health professionals

Resumo A importância atribuída à prática de mindfulness no contexto do trabalho tem vindo a destacar-se, existindo evidências que revelam os benefícios do mindfulness, relacionados com o bem-estar psicológico, repercutindo-se no aumento dos níveis de satisfação e de performance das organizações. Suportamos este estudo no modelo de dois componentes para o mindfulness: a auto regulação da atenção ao momento presente; e, a adoção de uma postura de curiosidade, abertura e aceitação para com esses eventos mentais. Avaliar a satisfação laboral, as atitudes de mindfulness e o bem-estar dos trabalhadores e a eventual relação entre estas dimensões. Estudo transversal, descritivo e correlacional, numa amostra de 272 adultos em idade ativa, dos quais 71 (26.1%) praticam atividades de meditação ou mindfulness na sua vida diária. Como instrumento de recolha de dados utilizou-se um questionário online, constituído por: i. questões socioprofissionais; ii. Mindfulness Attention Awareness Scale; iii. Satisfaction With Life Scale; e, iv. The Generic Job Satisfaction Scale. Encontraram-se níveis de satisfação laboral, bem-estar e atitudes de mindfulness ligeiramente acima das suas médias teóricas, com diferenças estatisticamente significativas entre o bem-estar e o estado civil, e para o bem-estar e a satisfação no trabalho e a prática de mindfulness, com os praticantes a evidenciarem bem-estar e satisfação com o trabalho superiores. Níveis mais elevados de mindfulness promovem maior satisfação no trabalho e por sua vez saúde mental positiva e bem-estar geral. Apontamos como intervenção o programa mindfulness-based stress reduction e mindfulness-based cognitive therapy na redução do stress e aumento do bem-estar emocional.

Abstract The importance attached to the practice of mindfulness in the context of work has been highlighted, with evidence that reveals the benefits of mindfulness, related to psychological well-being, with repercussions on the increase in the levels of satisfaction and performance of organizations. We support this study in the two-component model for mindfulness: self-regulation of attention to the present moment; and, the adoption of a posture of curiosity, openness and acceptance of these mental events. Evaluate job satisfaction, attitudes of mindfulness and well-being of workers and the possible relationship between these dimensions. Cross-sectional, descriptive and correlational study, in a sample of 272 adults of working age, of whom 71 respondents (26.1%) practice meditation or mindfulness activities in their daily life. As an instrument of data collection, an online questionnaire was used, consisting of: i. socio-professional issues; ii. Mindfulness Attention Awareness Scale; iii. Satisfaction With Life Scale; and, iv. The Generic Job Satisfaction Scale. Levels of job satisfaction, well-being and mindfulness attitudes were found slightly above their theoretical averages, with statistically significant differences between well-being and marital status, and for well-being and job satisfaction and the practice of mindfulness, with practitioners showing superior well-being and job satisfaction. Higher levels of mindfulness promote greater job satisfaction and in turn positive mental health and general well-being. We point out as an intervention the mindfulness-based stress reduction program and mindfulness-based cognitive therapy in reducing stress and increasing emotional well-being.

Growth Performance, Carcass and Meat Traits of Autochthonous Arouquesa Weaners Raised on Traditional and Improved Feeding Systems.

Arouquesa is an autochthonous bovine breed known for its Arouquesa PDO beef labeling. There are several production systems under the definition of PDO labeling. This study aimed to compare the effect of different production systems on carcass and meat traits for the Arouquesa breed. Two trials differing in diet and weaning age were conducted. The first trial included a TF group fed the traditional way and weaned at 9 months; a TF + S1 group, equal to TF, but with a starter supplement; and finally, a S1 + S2 group that was fed with a starter and a growth supplement and weaned at 5 months. The second trial was composed of a TF + S3 group fed like the TF + S1 group but reared until 12 months with a finishing supplement, and finally, the S3 group fed like the S1 + S2 group but reared until 12 months. In the first trial, the TF + S1 and S1 + S2 groups showed higher final live weight and average daily gain. In the second trial, we observed differences in the subcutaneous fat that was higher in the S3 group. Regarding meat traits, we observed differences in exudative and cooking losses in the first trial. In general, supplementation improved meat production without affecting meat quality parameters.

The Effect of Weaning and Slaughter Age on the Physicochemical and Sensory Characteristics of Arouquesa Beef-A PDO Portuguese Meat.

(1) Background: Autochthonous breeds meat is well accepted due to its sensory characteristics, perceived low environmental impact, and animal welfare. We aimed to evaluate the effect of weaning and slaughter age on the physicochemical and sensory characteristics of Arouquesa, a Portuguese Protected Designation of Origin (PDO) meat and to evaluate the psychological effect of knowing the weaning age on the consumer's hedonic evaluation. (2) Methods: Meat from 26 animals was assigned to 4 groups, with combinations of weaning (W) at 9 or 5 months and slaughter (S) at 9 or 12 months: W9-S9, W9-S12, W5-S9, and W5-S12. The meat was analysed for pH24h, colour (L*a*b*), cooking losses and shear force. A Check All that Apply test was made with 70 consumers; they were also asked to punctuate the hedonic appreciation of anonymous and weaning age-identified meat. (3) Results: W9-S9 were more tender, had lower shear force, and was juicier than W5-S9. When animals were slaughtered at 12 months, there were no differences in the physicochemical and sensory characteristics between the weaning ages. The effect of information about the weaning age influences the consumer's hedonic evaluation, as revealed by the comparison between the anonymous and identified samples. (4) Later weaning resulted in more tender meat when the slaughter was at 9 months and positively impacted consumer perception.

Efficacy and Incontinence Rates After Urethroplasty for Radiation-induced Urethral Stenosis: A Systematic Review and Meta-analysis.

OBJECTIVE: To estimate the efficacy of urethroplasty and rates of de novo stress urinary incontinence (SUI) in the specific setting of radiation-induced urethral stenosis. METHODS: A systematic search of databases (PubMed and EMBASE) was performed between 1980-2019 (CRD42020144845). Inclusion criteria were: (1) prior pelvic radiotherapy; (2) surgical urethroplasty; (3) rates of successful treatment and/or SUI development and (4) total case number provided. The pooled summary of stenosis resolution rate and SUI were calculated using the random-effects model weighted by the inverse variance. Accessory analyses were performed by reconstructive technique and type of RT. RESULTS: Ninety-six studies were identified, of which 8 retrospective studies met inclusion criteria, comprising 256 patients. The proportion of cases treated with external beam RT (EBRT), brachytherapy (BT), or combination (EBRT+BT) were 52%, 33%, and 15%, respectively, of studies that specified modality. Most strictures involved the bulbomembranous region (n = 212; 83%). Sixty-one percent of cases (n = 157) entailed primary anastomosis, while the remainder underwent augmentation reconstruction (graft or flap). The mean follow-up time after urethroplasty varied from 10 to 50.5 months. The pooled stenosis resolution rate was 80% (95% CI: 74%-86%). There were no significant associations between stenosis resolution rate and reconstructive technique (rho=0.20, P = .74) or RT modality (rho=-0.31, P = .53). Fifty-three cases developed subsequent SUI, with a pooled complication rate of 19% (95% CI: 10%-31%). CONCLUSIONS: Urethroplasty after radiation-induced urethral stenosis is effective for 80% of cases, independent of prior RT modality or urethroplasty technique; however, 1 out of every 5 patients develops SUI post-procedure.

A felicidade como catalisadora dos níveis de ansiedade, depressão e stress no ensino superior / Happiness as a catalyst for anxiety, depression and stress levels in higher education / La felicidad como catalizador de los niveles de ansiedad, depresión y estrés en la enseñanza superior

CONTEXTO: A felicidade como medida do bem-estar, tem vindo a ganhar importância na última década. Contudo, o mundo moderno, impõe cada vez mais exigências aos indivíduos, promovendo altos níveis de ansiedade, depressão e stress, que por sua vez podem influenciar negativamente a felicidade. OBJETIVO(S):Identificar os níveis de felicidade, ansiedade, depressão e stress dos docentes, pessoal não docente e estudantes do ensino superior; identificar relações entre a felicidade e a ansiedade, depressão e stress. MÉTODOS:Estudo transversal, descritivo, correlacional e inferencial. Amostra de 732 indivíduos de institutos politécnicos: 189 docentes; 121 pessoal não docente; e 422 estudantes. Utilizou-se um questionário online, com questões socioprofissionais, uma parte com o Oxford Happiness Questionnaire, e a terceira parte com a Escala de Ansiedade, Depressão e Stress. RESULTADOS:Verificou-se que o cluster dos alunos é o que apresenta menores níveis de felicidade e níveis superiores de Ansiedade, Depressão e Stress. O grupo com níveis mais elevados de felicidade é dos docentes (M=4.26; DP=.663), bem como em termos de Ansiedade (M=2.56; DP=3.022), Depressão (M=3.32; DP=3.667) e Stress (M=5.94; DP=4.109). Verificaram-se diferenças estatisticamente significativas para a felicidade entre os grupos e correlações negativas baixas a moderadas entre o nível de felicidade e as dimensões de saúde mental sob estudo. CONCLUSÕES: Verificou-se uma relação entre os níveis de ansiedade, depressão e stress e o nível de felicidade. Propomos que este estudo deverá ser aprofundado para identificar as possíveis causas que provocam o baixo nível de felicidade e os altos níveis de ansiedade, depressão e stress dos estudantes.

BACKGROUND: Happiness as a measure of well-being has been gaining importance in the last decade. However, the modern world imposes more and more demands on individuals, promoting high levels of anxiety, depression and stress, which in turn can negatively influence happiness. AIM: To identify the levels of happiness, anxiety, depression and stress of teachers, non-teaching staff and students of higher education; to identify relationships between happiness and anxiety, depression and stress. METHODS: Cross-sectional, descriptive, correlational and inferential study. Sample of 732 individuals from polytechnic institutes: 189 teachers; 121 non-teaching staff; and 422 students. An online questionnaire was used, with socio-professional questions, one part with the Oxford Happiness Questionnaire, and the third with the Anxiety, Depression and Stress Scale. RESULTS: It was verified that the students are those with lower levels of happiness and higher levels of Anxiety, Depression and Stress. The group with the highest levels of happiness is the group of teachers (M = 4.26, SD = .663), as well as in terms of Anxiety (M = 2.56, SD = 3.022), Depression (M = 3.32, SD = Stress (M = 5.94, SD = 4.109). There were statistically significant differences for happiness among several of the groups and low to moderate negative correlations between the level of happiness and the dimensions of mental health under study. CONCLUSIONS: There was a relationship between levels of anxiety, depression and stress and the level of happiness. We propose that this study should be deepened to identify the possible causes that cause the low level of happiness and the high levels of anxiety, depression and stress of the students.

CONTEXTO: La felicidad como medida del bienestar, ha venido a ganar importancia en la última década. Sin embargo, el mundo moderno, impone cada vez más exigencias a los individuos, promoviendo altos niveles de ansiedad, depresión y estrés, que a su vez pueden influenciar negativamente la felicidad. OBJETIVO(S): Identificar los niveles de felicidad, ansiedad, depresión y estrés de los docentes, personal no docente y estudiantes de la enseñanza politécnica; identificar relaciones entre la felicidad y la ansiedad, la depresión y el estrés. METODOLOGÍA: Estudio transversal, descriptivo, correlacional e inferencial. Muestra de 732 individuos de enseñanza superior: 189 docentes; 121 personal no docente; y 422 estudiantes. Se utilizó un cuestionario online, con cuestiones socioprofesionales, una parte con el Oxford Happiness Questionnaire, y la tercera parte con la Escala de Ansiedad, Depresión y Stress. RESULTADOS: Se verificó que los alumnos son los que presentan menores niveles de felicidad y niveles superiores de Ansiedad, Depresión y Stress. El grupo con mejores niveles de felicidad es el grupo de los docentes (M = 4.26, DP = .663), así como en términos de Ansiedad (M = 2.56, DP = 3.022), Depresión (M = 3.32, DP = 3.667) Stress (M = 5.94, DP = 4.109). Se verificaron diferencias estadísticamente significativas para la felicidad entre varios grupos y correlaciones negativas bajas a moderadas entre el nivel de felicidad y las dimensiones de salud mental bajo estudio. CONCLUSIONES: Se verificó una relación entre los niveles de ansiedad, depresión y estrés y el nivel de felicidad. Proponemos que este estudio debe profundizarse para identificar las posibles causas que provocan el bajo nivel de felicidad y los altos niveles de ansiedad, depresión y estrés de los estudiantes.

Felicidade, ansiedade, depressão e stress em bombeiros portugueses / Happiness, anxiety, depression and stress among Portuguese firefighters / Felicidad, ansiedad, depresión y estrés entre los bomberos portugueses

CONTEXTO: Sabe-se que, devido à natureza do seu trabalho, os bombeiros, estão expostos a situações adversas, assim como a eventos potencialmente traumáticos, sendo considerados um grupo de risco. OBJETIVO(S): Objetivou-se estudar o nível de ansiedade, depressão e stress, bem como da felicidade; a relação entre a ansiedade, depressão e stress na felicidade; e a relação entre a autopercepção de felicidade e o nível de felicidade avaliada. MÉTODOS: Estudo transversal, descritivo, correlacional e inferencial, numa amostra de 312 bombeiros de 18 corporações de Trás-os-Montes. Como instrumento de recolha de dados utilizou-se um questionário com questões socioprofissionais, a Escala Sobre a Felicidade (ESAF) e, a Escala de Ansiedade, Depressão e Stress (EADS-21). RESULTADOS: Da análise de resultados, verificaram-se: níveis baixos de ansiedade, depressão e stress e, níveis de felicidade elevados; correlações positivas entre as dimensões ansiedade, depressão e stress e uma correlação negativa entre estas três dimensões e o nível de felicidade. A relação entre a autopercepção de felicidade e o nível de felicidade medida, mostra que os indivíduos que responderam considerarem-se felizes, apresentam um nível de felicidade superior comparativamente àqueles que responderam não se considerarem felizes. CONCLUSÕES: Os bombeiros da amostra apresentam níveis de ansiedade, depressão e stress normais, de acordo com a classificação dos autores da escala EADS e níveis de felicidade elevados.

BACKGROUND: It is known that, due to the nature of their work, firefighters are exposed to adverse situations, as well as potentially traumatic events, and are considered a risk group. AIM: The objective was to study the level of anxiety, depression and stress, as well as happiness; the relationship between anxiety, depression and stress in happiness; and the relationship between self-perception of happiness and the level of happiness assessed. METHODS: A cross-sectional, descriptive, correlational and inferential study was carried out on a sample of 312 firefighters from 18 Trás-os-Montes corporations. As data collection instrument, a questionnaire with socio-professional questions, the Scale about Happiness (ESAF) and the Depression, Anxiety and Stress Scale (DASS-21) were used. RESULTS: From the analysis of results, there were: low levels of anxiety, depression and stress and, high levels of happiness; positive correlations between the dimensions anxiety, depression and stress and a negative correlation between these three dimensions and the level of happiness. The relationship between the self-perception of happiness and the level of happiness measured shows that the individuals who responded that they felt happy, present a level of happiness superior to those who considered themselves not to feel happy. CONCLUSIONS: Firefighters in the sample have normal levels of anxiety, depression and stress, according to the authors' EADS rating and high levels of happiness.

CONTEXTO: Se sabe que, debido a la naturaleza de su trabajo, los bomberos, están expuestos a situaciones adversas, así como a eventos potencialmente traumáticos, siendo que se consideran un grupo de riesgo. OBJETIVO(S): Se objetivó estudiar el nivel de ansiedad, depresión y estrés, así como de la felicidad; la relación entre la ansiedad, la depresión y el estrés en la felicidad; y la relación entre la autopercepción de felicidad y el nivel de felicidad evaluada. METODOLOGÍA: Estudio transversal, descriptivo, correlacional e inferencial, en una muestra de 312 bomberos de 18 corporaciones de Trás-os-Montes. Como instrumento de recogida de datos se utilizó un cuestionario con cuestiones socioprofesionales, la Escala sobre la Felicidad (ESAF) y la Escala de Ansiedad, Depresión y Stress (EADS-21). RESULTADOS: Del análisis de resultados, se verificó: niveles bajos de ansiedad, depresión y estrés y niveles de felicidad altos; las correlaciones positivas entre las dimensiones ansiedad, depresión y estrés y una correlación negativa entre estas tres dimensiones y el nivel de felicidad. La relación entre la autopercepción de felicidad y el nivel de felicidad medida, muestra que los individuos que respondieron sentirse felices, presentan un nivel de felicidad superior en comparación a aquellos que respondieron no sentirse felices. CONCLUSIONES: Los bomberos de la muestra presentan niveles de ansiedad, depresión y estrés normales, de acuerdo con la clasificación de los autores de la escala EADS y niveles de felicidad altos.

Outcomes and toxicity after salvage radiotherapy for vaginal relapse of endometrial cancer.

OBJECTIVES: Studies of salvage radiotherapy in locally recurrent endometrial cancer remain limited. The aim of this study was to evaluate the efficacy of salvage radiotherapy for vaginal relapse of endometrial cancer and to explore prognostic factors associated with outcomes. METHODS: We evaluated 30 patients treated with salvage external-beam radiotherapy and/or vaginal brachytherapy for vaginal relapses of endometrial cancer between 2009 and 2018. The inclusion criteria were: pathologically-confirmed recurrence; loco-regional relapse (in absence of distant metastases); and salvage treatment including external-beam radiotherapy and/or vaginal brachytherapy. Outcomes were evaluated via Kaplan-Meier, with the log-rank test employed to compare differences among various groups and identify prognostic factors. RESULTS: 30 patients developed vaginal recurrence at a median time of 20.6 months (range 2-219) post-hysterectomy. The most common site of recurrence was the vaginal apex (60%), followed by the distal vagina (10%). Salvage radiotherapy entailed combination external-beam radiotherapy and vaginal brachytherapy (n=24) or single modality treatment (n=6), along with concurrent chemotherapy in 20 cases. At a median follow-up of 4.4 years (range 0.1-130) post-radiotherapy, the 5 year rates of local control, regional control, metastasis-free interval, disease-free interval, and overall survival were 89%, 91.5%, 75.5%, 69%, and 83%, respectively. Factors associated with improved disease-free interval included: endometrioid histology (p=0.03), isolated vaginal relapse (p=0.003), late recurrence (>9 months) (p=0.007), and combined modality radiotherapy (p=0.001). The only factor associated with overall survival was isolated vaginal relapse (in the absence of other recurrent disease) (p=0.02). Regarding toxicity, 18% of patients experienced acute grade ≥3 events (most commonly gastrointestinal). The 5 year rates of rectal bleeding, small bowel obstruction, and pelvic fracture were 31%, 18%, and 13%, respectively. CONCLUSIONS: Salvage radiotherapy imparts excellent loco-regional control for vaginal relapses of endometrial cancer and should entail combination external-beam radiotherapy and vaginal brachytherapy. Patients should be closely monitored for late gastrointestinal toxicity following salvage radiotherapy.

Pelvic Insufficiency Fractures After External Beam Radiation Therapy for Gynecologic Cancers: A Meta-analysis and Meta-regression of 3929 Patients.

PURPOSE: To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiation therapy for gynecologic cancers based on posttreatment computed tomography, magnetic resonance imaging, positron emission tomography, or bone scintigraphy. METHODS AND MATERIALS: A systematic search of databases (PubMed and EMBASE) was performed (CRD42019125679). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures. RESULTS: Twenty-one studies met the inclusion criteria (total 3929 patients). Five hundred four patients developed PIF, translating to an overall rate of 14% (95% confidence interval, 10%-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95% confidence interval, 52%-69%, based on 14 studies). The total number of PIFs was 704 (mean, 1.72 PIFs per each patient to develop PIF, based on 14 studies). More recent series (P = .0074) and the use of intensity modulated radiation therapy (P = .0299) were associated with lower fracture rates. The most common fracture sites were sacroiliac joint (39.7%), body of the sacrum (33.9%), pubis (13%), lumbar vertebra (7%), iliac bone (2.8%), acetabulum (2.1%), and femoral head/neck (1.5%). The median time to fracture was 7.1 to 19 months after radiation therapy. CONCLUSIONS: The incidence of PIF after radiation therapy for gynecologic cancers is high (14%), with the majority affecting the sacral bone or joint (73.6%), although this risk appears to be lower with intensity modulated radiation therapy. Posttreatment bone surveillance is warranted in this population because nearly 40% of patients were asymptomatic at the time of PIF diagnosis.

Detection of air gaps around the cylinder by postinsertion computed tomography in vaginal cuff brachytherapy: A prospective series, systematic review, and meta-analysis.

PURPOSE: Postinsertion computed tomography (CT) can identify air gaps (AGs) around the cylinder in vaginal cuff brachytherapy (VCB). This study investigates the incidence and location of AGs. METHODS AND MATERIALS: Planning CTs of 22 prospectively recruited patients (NCT02091050) treated with 2.6 cm (n = 8) and 3.0 cm (n = 14) cylinders were evaluated. In addition, a systematic literature review and meta-analysis was performed (PubMed and EMBASE). The pooled incidence of AGs was calculated by using the random-effects model weighted by inverse variance. RESULTS: In 18 cases (82%), a total of 45 AGs were found: 26 within the 2 cm cranial length and 19 between 2 and 4 cm of the cylinder. The mean AG diameter was 3.7 mm (range: 1.3-11.8). Cylinder diameter, primary tumor site, and use of external beam radiotherapy were not associated with AG incidence. Systematic literature review revealed nine additional relevant studies, totaling 657 patients. The pooled incidence of patients with ≥1 AG was 67% (95% confidence interval: 50-83). AGs were located at the apex in 43.4%-94.4% of cases. In patients with ≥1 AG (n = 244), the pooled mean number of AGs was 2.18 per patient. The mean dose reduction varied from 9.6% to 29.3%. CONCLUSION: More than two-thirds of VCB cases present with AGs, which are most commonly at the apex and can potentially reduce mucosal dose. By identifying AGs, postinsertion CT can facilitate selection of optimal cylinder size in VCB.

Altered-fractionation radiotherapy improves local control in early-stage glottic carcinoma: A systematic review and meta-analysis of 1762 patients.

OBJECTIVES: To perform a systematic review of 1762 patients to comprehensively assess the benefit of altered-fractionation radiotherapy (ART) in early stage glottic carcinoma (ESGC). MATERIALS AND METHODS: Studies were identified in PubMed and EMBASE. Inclusion criteria were: (1) diagnosis of squamous cell ESGC (Tis, T1, T2); (2) ART versus conventionally-fractionationated radiotherapy (CRT); and (3) provision of number of local recurrence events and total numbers per fractionation arm. The random-effects model was fitted to estimate the pooled hazard ratio (HR). Subgroup sensitivity analyses were performed based on ART strategy (hypo- versus hyperfractionation), treatment-day reductions, machine type, tumor stage, and anterior commissure involvement. RESULTS: Eleven studies met inclusion criteria: 4 randomized controlled trials (RCTs) and 7 two-arm retrospective studies. ART was associated with 38% fewer (HR 0.62; 95% CI: 0.46-0.82, p = 0.0009) and 60% fewer (HR 0.40; 95% CI: 0.24-0.66, p = 0.0003) local failure events in pooled analyses of the RCTs and retrospective studies, respectively. Both hyperfractionation (HR 0.65; 95% CI: 0.43-0.97, p = 0.03) and hypofractionation (HR 0.55; 95% CI: 0.33-0.91, p = 0.02) strategies were superior to CRT. The benefit persisted for all treatment- and tumor-related parameters, including anterior commissure involvement, with the exception of a pooled analysis of studies with predominantly T2 (<50% T1) cases (HR 0.60, 95% CI: 0.30-1.20, p = 0.15). CONCLUSION: Both hypofractionation and hyperfractionation improve local control in ESGC, including T1 tumors and for anterior commissure involvement. However, this benefit may not persist for T2 tumors, for which alternative strategies should be considered.

Motivations and attitudes towards the act of blood donation among undergraduate health science students.

BACKGROUND: Undergraduate students are a target for blood donation, as they constitute a young healthy and well-informed group. AIM: To understand motivations and attitudes underpinning the act of blood donation among undergraduate health science students. MATERIALS AND METHODS: Cross-sectional study enrolling undergraduate students of a College of Health Sciences in the Northeast of Portugal (January/February, 2017). Data collection tool was a self-administered questionnaire covering questions about motivations (n = 8) and attitudes (n = 5) towards the act of blood donation. Participants were classified by donation status into donors (one previous donation) and non-donors (never donated). Multiple logistic regression models were used to assess the association between each attitude and motivation on donation status. Odds-ratio (OR) and respective 95% confidence intervals (95%CI) adjusted for potential confounders, were obtained. RESULTS: Out of 362 participants, 12.7% (n = 46) had ever donated blood and 56.5% (n = 26) of them were regular donors. Out of 316 non-donors, 88.0% (n = 278) will donate blood under request. There were no differences between donors and non-donors regarding the attitudes towards blood donation. From all motivations only "be a civic duty" had a significant impact on donor status, such that participants reporting this motivation are more likely to be blood donors (OR = 2.58; IC95%:1.34-4.99) than their counterparts. CONCLUSION: This study revealed that 80.0% of undergraduate health science students are non-donors, but they are available to donate blood under request. Campaigns and advertising methods focused on the emergent needs for blood donation could play an important role in the recruitment of new donors among undergraduate students.

Short-course palliative radiation therapy leads to excellent bleeding control: A single centre retrospective study.

PURPOSE: To compare and evaluate the utility of varying hemostatic radiotherapy prescriptions for emergent palliation of bleeding tumors. MATERIALS AND METHODS: This retrospective study analyzed 112 consecutive patients treated with radiotherapy for emergent palliation of bleeding tumors at an academic institution. Study endpoints included: primary bleeding control; re-bleeding rate after initial control; treatment interruption rate; overall survival; and death within 30 days of treatment. RESULTS: The most commonly prescribed fractionations were: 20 Gy in 5 fractions, 30 Gy in 10 fractions, and 8 Gy in a single fraction. The overall primary bleeding control rate was 89%. By location, primary bleeding control rates were 89% (31/35), 80% (16/20), 88% (14/16), 93% (13/14), 100% (9/9), and 100% (6/6) for gastrointestinal, genitourinary, head and neck, thoracic, extremity, and gynecologic sites, respectively. The overall re-bleeding rate following initial bleeding control was 25%. Female patients had a significantly reduced risk of bleeding recurrence (HR 0.18 [0.04-0.79], p = 0.02). Longer fractionation regimens (>5 fractions) were not associated with a reduced incidence of re-bleeding (p = 0.65), but were associated with more treatment interruptions (p = 0.02). The 1-year overall survival rate in this population was 24%, with mortality greater in patients with poor performance status (HR 2.99 [1.36-6.58], p = 0.007). CONCLUSIONS: Regardless of prescription, palliative radiotherapy is highly effective for primary bleeding control, with both long and short regimens demonstrating equal hemostatic effect and durability in the emergent setting. Longer radiotherapy regimens (>5 fractions), however, are accompanied by increased treatment interruptions and hospital days. Therefore, shorter hemostatic regimens (<5 fractions) are preferable in this palliative setting, with respect to minimizing treatment burden for patients while achieving symptomatic relief.

Stress e engagement na profissão de enfermagem: Análise de dois contextos internacionais / Stress and engagement in the nursing profession: Analysis of two international contexts / Estrés y engagement en la profesión de enfermería: Análisis de dos contextos internacionales

CONTEXTO: As mudanças constantes nas condições de trabalho, têm conduzido ao aparecimento de riscos psicossociais que conjugados com alterações organizacionais, de gestão de recursos humanos e das cargas horárias, podem levar ao aumento dos níveis de stress e ao comprometimento da saúde física e mental dos trabalhadores. OBJETIVO(S): Objetivou-se caraterizar duas amostras de enfermeiros (espanhóis e portugueses) e analisar as dimensões do stress e engagement. METODOLOGIA: Estudo comparativo e correlacional. Amostra não probabilística por conveniência, 504 enfermeiros portugueses (65.8%) e 363 espanhóis (34.2%) inscritos nas respetivas Ordens. Utilizou-se um questionário online, composto pela escala de stress, a “Nursing Stress Scale”, medindo sete dimensões de stress, e a escala de motivação, a “Utrecht Work Engagement Scale” (UWES), medindo três dimensões de motivação. RESULTADOS: Os enfermeiros portugueses apresentam pontuações médias superiores no Stress Total (2.2962±.43731) do que os espanhóis (2.2518±.46651) e nas dimensões “Morte e Morrer” e “Falta de Apoio”, essas diferenças são estatisticamente significativas (p=.015 e p<.001 respetivamente), sendo que no engagement os espanhóis apresentam resultados consistentemente superiores e estatisticamente significativos (p<.001) nas três dimensões. A variável profissional que mais dimensões do stress e do engagement influencia, é o tipo de horário, sendo o horário rotativo mais indutor de stress e menos motivador do que o horário fixo, sendo essas diferenças estatisticamente significativas (p≤.001) para o Stress Total e as três dimensões da UWES. CONCLUSÕES: Existem diferenças a nível do stress e motivação entre os enfermeiros portugueses e espanhóis.

BACKGROUND: Constant changes in working conditions have led to the emergence of psychosocial risks that, combined with organizational changes, human resources management and working hours, can lead to an increase in stress levels and compromise the physical and mental health of workers. AIM: To characterize two samples of nurses (Spanish and Portuguese) and analyse the dimensions of stress and engagement. METHODS: Comparative and correlational study. Non-probabilistic sample for convenience, 504 Portuguese nurses (65.8%) and 363 Spaniards (34.2%) enrolled in the respective Nurses Associations. An online questionnaire was used, consisting of the stress scale, the Nursing Stress Scale, measuring seven dimensions of stress, and the Utrecht Work Engagement Scale (UWES), measuring three dimensions of motivation. RESULTS: Portuguese nurses have higher mean scores in Total Stress (2.2962 ± .43731) than the Spanish (2.2518 ± .46651) and in the "Death and Dying" and "Lack of Support" dimensions, those differences are statistically significant (p =. 015 and p <.001 respectively), and in engagement, the Spaniards presented consistently higher and statistically significant scores (p <.001) in the three dimensions. The professional variable that more dimensions of stress and engagement influences, is the type of schedule, with rotating hours inducing more stress and less motivating than fixed hours, these differences being statistically significant (p≤.001) for Total Stress and the three dimensions of UWES. CONCLUSIONS: There are differences in stress and motivation among Portuguese and Spanish nurses.

CONTEXTO: Los cambios constantes en las condiciones de trabajo, han conducido a la aparición de riesgos psicosociales que, conjugados con alteraciones organizacionales, de gestión de recursos humanos y de las cargas horarias, pueden conducir al aumento de los niveles de estrés y al comprometimiento de la salud física y mental trabajadores. OBJETIVO(S): El objetivo fue caracterizar dos muestras de enfermeras (España y Portugal) y el análisis de las dimensiones de estrés y de compromiso. METODOLOGÍA: Estudio comparativo y correlacional. La muestra no probabilística de conveniencia, portugués 504 enfermeras (65,8%) y 363 españoles (34,2%) inscritos en los respectivos Órdenes. Se utilizó un cuestionario online, compuesto por la escala de estrés, la "Nursing Stress Scale", midiendo siete dimensiones de estrés, y la escala de motivación, la "Utrecht Work Engagement Scale" (UWES), midiendo tres dimensiones de motivación. RESULTADOS: Las enfermeras portuguesas tienen mayores puntuaciones medias en estrés total (2,2962 ± 0,43731) que la española (2,2518 ± 0,46651) y dimensiones "muerte y el morir" y "falta de apoyo", estas diferencias son estadísticamente significativas (p=.015 e p<.001 respetivamente) y en el compromiso los españoles presentan resultados consistentemente superiores y estadísticamente significativos (p <.001) en las tres dimensiones. La variable profesional que más dimensiones del estrés y del compromiso influye, es el tipo de horario, siendo el horario rotativo más inductor de estrés y menos motivador que el horario fijo, siendo esas diferencias estadísticamente significativas (p≤.001) para el Estrés Total y las tres dimensiones de la UWES. CONCLUSIONES: Existen diferencias en el estrés y la motivación entre los enfermeros de Portugal y España.

Decrease in uterine perforations with ultrasound image-guided applicator insertion in intracavitary brachytherapy for cervical cancer: A systematic review and meta-analysis.

PURPOSE: To estimate uterine perforations rates during intracavitary brachytherapy for cervical cancer with and without ultrasound (US) image guidance. MATERIALS AND METHODS: A systematic search of databases (PubMed and EMBASE) was performed. The pooled summary uterine perforation rate (detected by postinsertion CT or MRI) for the un-guided insertion group and the guided insertion group was calculated by using the random-effects model weighted by the inverse variance. RESULTS: A total of 690 articles were initially found, resulting in 12 studies that met the inclusion criteria. A total of 1757 insertions and 766 patients were included in the meta-analysis. The overall uterine perforation rate per insertion was 4.56% (95%CI: 2.35-8.67) and per patient was 7.39% (95%CI: 3.92-13.50). The pooled perforation rate per insertion without image guidance was 10.54% (95%CI: 6.12-17.57) versus 1.06% (95%CI: 0.41-2.67) with image guidance (p < 0.01). The pooled perforation rate per patient without guidance was 16.67% (95%CI: 10.01-26.45) versus 2.54% (95%CI: 1.21-5.24) with image guidance (p < 0.01). The ratio of perforations in the un-guided/guided groups was 9.94 and 6.56, per insertion and per patient, respectively. The most common sites of perforation were the posterior wall (>47 events) and the uterine fundus (24 events). None of the studies reported significant acute clinical consequences. Prophylactic antibiotic after perforation was used in 3 of the 4 studies that described the management. CONCLUSION: Using postinsertion CT or MRI to detect the perforation, the rate of uterine perforation per insertion in patients who received US-guided intracavitary brachytherapy insertion is 90% lower than with un-guided insertion.

Does para-aortic irradiation reduce the risk of distant metastasis in advanced cervical cancer? A systematic review and meta-analysis of randomized clinical trials.

PURPOSE: To evaluate the impact of the extension of the radiotherapy field cranially toward para-aortic lymph nodes (EF-RT) in advanced cervical cancer. MATERIALS AND METHODS: A systematic search of databases (PubMed, CENTRAL, Clinical Trials) was performed and included studies that were published between 1960 and November 2015 without language restrictions. All randomized clinical trials (RCTs) were analyzed further. All patients must have undergone pelvic radiotherapy and the same systemic therapy in both arms. The primary endpoints were locoregional failure, incidence of distant metastasis, para-aortic failure, and cancer related death. The Mantel-Haenszel method was used in the meta-analysis. The risk of bias analysis was determined using the 7-domain method per the Cochrane Handbook for Systematic Reviews of Interventions V5.1.0. A review of the treatment technique and toxicity was also performed. RESULTS: A total of 1309 studies were evaluated, 4 RCTs of which met the inclusion criteria; 506 patients were allocated to standard pelvic irradiation, and 494 underwent EF-RT. The risk of bias was considered to be low in nearly 80% of the domains. EF-RT significantly reduced the rate of para-aortic failure (HR 0.35, 95% CI 0.19-0.64; p<0.01) and the incidence of other distant metastases (HR 0.69, 95% CI 0.50-0.96; p=0.03). Locoregional failure and cancer-related death were not significantly altered (OR 1.06 [0.80-1.42]; p=0.67, and 0.68 [0.45-1.01]; p=0.06, respectively). The radiotherapy technique was conventional in 3 studies and conformational in 1 study. In total, 10 treatment-related deaths occurred-4 in pelvic radiation and 6 in EF-RT (OR 2.12 [0.71-6.27]; p=0.18). CONCLUSIONS: EF-RT that targets the para-aortic lymphatic chain reduces distant metastatic events, but its impact on survival is unknown. Future studies should examine the value of EF-RT using modern radiation techniques.

OC28 - Effect of mode of delivery on early oral colonization and childhood dental caries: a systematic review.

UNLABELLED: Theme: Multidisciplinary team working. BACKGROUND: Oral colonization starts at birth by vertical transmission. OBJECTIVE: To determine whether mode of delivery influences the oral colonization of infants and contributes to the risk of childhood dental caries. METHODS: A systematic review was conducted in the electronic database Web of Science for articles published from January 1995 to December 2015 by using a set of keywords. RESULTS: From 2,644 citations identified through electronic search, ten studies met the inclusion criteria. According to the studies mode of delivery influences oral microbial density, oral microbial profile and the timing of oral colonization by cariogenic microbiota. However, there are no consistent results concerning either the prevalence of children harboring cariogenic microbiota or the prevalence of early childhood caries by mode of delivery. CONCLUSION: Mode of delivery influences early oral colonization. However, it seems that other determinants rather than mode of delivery could be major contributors to the development of early childhood caries.

Plantas medicinais: construindo a troca de saberes entre ACS e equipe multidisciplinar na UBS Jardim Iporã / Medicinal plants: building the exchange of knowledge between Community Health Agents and multidisciplinary team in the Basic Health Unit Garden Iporã

Esse trabalho foi desenvolvido a partir da sensibilização do farmacêutico que participou da 7ª edição do curso de Plantas Medicinais da PMSP (Prefeitura Municipal de São Paulo) e identificou na unidade, juntamente com a APA (Agente de Promoção Ambiental), a necessidade de trabalhar o tema junto aos ACS (Agentes Comunitários de Saúde), para se tornarem multiplicadores. A UBS (Unidade Básica de Saúde) está localizada em área mista (urbano e rural), onde a prática de uso de plantas medicinas é feita de forma tradicional pela população, passada por gerações. Sabendo da PNPIC SUS (Política Nacional de Práticas Integrativas e Complementares no SUS (Sistema Único de Saúde), os profissionais sentiram necessidade de sensibilizar os ACS da importância das PIC, e a inserção de outros profissionais, tais como gestor local do PAVS (Programa Ambientes Verdes e Saudáveis) e nutricionista do NASF (Núcleo de Apoio à Saúde da Família). Ocorreram 10 grupos, no período de 2013 a 2014, com a média de 19 participantes em cada encontro. Houve uma participação efetiva, demonstrando interesse e comprometimento dos ACS. Os encontros proporcionaram uma sensibilização ao tema e um olhar qualificado na visita domiciliar, principalmente com os pacientes hipertensos, diabéticos e gestantes, incentivando que os mesmos comuniquem nas consultas o uso das plantas

Avaliação do conhecimento prévio e adquirido sobre cárie dentária em graduandos de Odontologia da Universidade Federal do Espírito Santo ­ UFES / Evaluation of previous and acquired knowledge about dental caries from undergraduate dentistry students from the Federal University of Espirito Santo ­ UFES

Objetivo: Avaliar conhecimento prévio e adquirido sobre cárie dentária de graduandos em Odontologia da Universidade Federal do Espírito Santo ­ UFES. Material e Métodos: Este estudo exploratório teve como grupo amostral (N = 121) acadêmicos de Odontologia do 1o ao 8o períodos. Um questionário sobre os conhecimentos prévios e adquiridos sobre cárie dentária foi aplicado aos estudantes. A análise dos dados foi realizada de forma descritiva (frequências absolutas e relativas) e analítica (testes qui-quadrado e McNemar; p < 0,05). Resultados: Foi observado que quanto ao conceito da cárie dentária, 52,9% adquiriram de 1ª a 4ª séries, e 31,4% de 5ª a 8ª séries. Maior parte do conhecimento obteve-se da graduação em Odontologia (38,8%), da casa/família (28,1%) e dentista particular (13,2%). Os alunos afirmaram que o conhecimento foi aplicado na prática diária (90,1%) e melhorou a própria saúde bucal (95,0%). Foi observada diferença significativa nas respostas quanto à consequência da cárie dentária e necessidade de restauração entre alunos do início do curso (1º período) e do meio e final do curso (4º e 8º períodos) (qui-quadrado; p < 0,05). No entanto, não houve diferença estatística entre os alunos do 4º e 8º períodos. Quanto ao conhecimento sobre cárie dentária dos acadêmicos do 4º período "antes" e "após'' a inserção no curso de Odontologia, observou-se melhora estatisticamente significante após o ingresso na faculdade (McNemar; p < 0,05). Conclusão: Estudantes passaram adquirir conhecimento efetivo sobre cárie dentária somente após ingressarem na faculdade, tornando-se evidente após o 4º período do curso. Houve relevância das informações coletadas com prática de saúde bucal.(AU)

Aim: To evaluate the knowledge about dental caries that had been acquired both previously and during the undergraduate Dentistry course at the Federal University of Espírito Santo (UFES). Methods: This exploratory study was conducted with a sample group (n = 121) of undergraduate Dentistry students from the first to eighth semesters. A questionnaire about the knowledge of dental caries acquired before and during the Dentistry course was applied to the students. Data was analyzed by descriptive (absolute and relative frequencies) and analytical (chi-square test and McNemar test; p < 0.05) statistics. Results: It was observed that 52.9% of the students had learned about the concept of caries in elementary school, while 31.4% reported having learned about the concept during middle school. A large percentage of the students (38.8%) responded that they had acquired most of their knowledge about dental caries during Dental School, while 28.1% and 13.2% stated that it was from their home/family and private dentist, respectively. For 90.1% of the students, their knowledge about dental caries is used on a daily basis, and 95% reported that this knowledge improved their oral health. A significant difference was observed in the responses from first-year students (first period) when compared to the students from the middle (fourth period) and final (eighth period) years of the course as regards the consequences of dental caries and the need for restoration (chi-square, p < 0.05). However, no statistical difference was observed between fourth and eighth periods. Comparing the overall knowledge about dental caries before and during dental school, a significant improvement was observed only after the fourth period (McNemar test, p < 0.05). Conclusion: Relevant knowledge about dental caries was mostly acquired by the students during dental school, especially after the fourth period. Relevance from the collected data and improvement of oral self-care were also observed.(AU)