How different attributes are weighted in professionals' decision-making in Pediatric Dentistry-a protocol for guiding discrete choice experiment focused on shortening the evidence-based practice implementation for dental care.

BACKGROUND: Important evidence has been constantly produced and needs to be converted into practice. Professional consumption of such evidence may be a barrier to its implementation. Then, effective implementation of evidence-based interventions in clinical practice leans on the understanding of how professionals value attributes when choosing between options for dental care, permitting to guide this implementation process by maximizing strengthens and minimizing barriers related to that. METHODS: This is part of a broader project investigating the potential of incorporating scientific evidence into clinical practice and public policy recommendations and guidelines, identifying strengths and barriers in such an implementation process. The present research protocol comprises a Discrete Choice Experiment (DCE) from the Brazilian oral health professionals' perspective, aiming to assess how different factors are associated with professional decision-making in dental care, including the role of scientific evidence. Different choice sets will be developed, either focusing on understanding the role of scientific evidence in the professional decision-making process or on understanding specific attributes associated with different interventions recently tested in randomized clinical trials and available as newly produced scientific evidence to be used in clinical practice. DISCUSSION: Translating research into practice usually requires time and effort. Shortening this process may be useful for faster incorporation into clinical practice and beneficial to the population. Understanding the context and professionals' decision-making preferences is crucial to designing more effective implementation and/or educational initiatives. Ultimately, we expect to design an efficient implementation strategy that overcomes threats and potential opportunities identified during the DCEs, creating a customized structure for dental professionals. TRIAL REGISTRATION: https://osf.io/bhncv .

Self-reported attention and hyperactivity symptoms among adults with epilepsy.

BACKGROUND: Patients with epilepsy (PWE) frequently have comorbid psychiatric disorders, the most common of which are depression and anxiety. Attention deficit disorder with hyperactivity (ADHD) is also more frequent among PWE, though that condition has been scarcely studied among the adult PWE population. OBJECTIVE: This study aimed to compare the presence of ADHD symptoms between adult PWE and the general population. METHODS: This was an observational case-control study. Ninety-five adult PWE from a tertiary center in southern Brazil were compared with 100 healthy controls. All subjects were submitted to three structured scales: 1) the World Health Organization Adult ADHD Self-Report Scale version 1.1 (ASRS); 2) the Hospital Anxiety and Depression Scale (HADS); and 3) the Adverse Events Profile (AEP). Dichotomic variables were analyzed through chi-square test and Fisher's exact test, as appropriate, and non-parametric variables were analyzed through the Mann-Whitney U test. RESULTS: Medians and interquartile ranges (IR) were: 1) ASRS: 26.00 (IR: 18 to 38) among PWE versus 17.00 (IR: 11 to 24) among controls, p < 0.001; 2) HADS: 14.00 (IR: 8 to 21) among PWE versus 11.00 (IR: 8 to 16) among controls, p = 0.007; 3) AEP: 3800 (IR: 31 to 49) among PWE versus 33.00 (IR: 23 to 43) among controls, p = 0.001. CONCLUSION: PWE showed a higher burden of symptoms of ADHD, depression, and anxiety when compared with controls, which replicates in the Brazilian population the findings of current literature that point toward a higher prevalence of such disorders among PWE.

ANTECEDENTES: Pacientes com epilepsia (PCE) frequentemente apresentam comorbidades psiquiátricas, principalmente depressão e ansiedade. O transtorno do déficit de atenção e hiperatividade (TDAH) também é mais frequente nos PCE, porém foi pouco estudado na população adulta de PCE. OBJETIVO: Comparar a presença de sintomas de TDAH entre PCE adultos e a população geral. MéTODOS: Noventa e cinco PCE adultos de um centro terciário no Sul do Brasil foram comparados a 100 controles saudáveis. Todos os sujeitos foram submetidos a três escalas estruturadas: 1) a Escala Autorrelatada de TDAH em Adultos da Organização Mundial da Saúde, versão 1.1 (ASRS); 2) a Escala Hospitalar de Ansiedade e Depressão (HADS); e 3) o Perfil de Eventos Adversos (AEP). Variáveis dicotômicas foram analisadas através dos testes chi-quadrado e exato de Fisher, conforme apropriado, e as variáveis não paramétricas foram analisadas através do teste U de Mann-Whitney. RESULTADOS: As medianas e os intervalos interquartis (IIQ) foram: 1) ASRS: 26.00 (IIQ: 18 a 38) em PCE versus 17.00 (IIQ: 11 a 24) nos controles, p < 0,001; 2) HADS: 14.00 (IIQ: 8 a 21) em PCE versus 11.00 (IIQ: 8 a 16) nos controles, p = 0,007; 3) AEP: 38.00 (IIQ: 31 a 49) em PCE versus 33.00 (IIQ: 23 a 43) nos controles, p = 0,001. CONCLUSãO: PCE apresentaram uma maior carga de sintomas de TDAH, depressão e ansiedade quando comparados aos controles, o que replica na população brasileira os achados da literatura atual, que apontam para uma maior prevalência de tais transtornos entre PCE.

Self-reported attention and hyperactivity symptoms among adults with epilepsy / Sintomas de desatenção e hiperatividade autorrelatados entre adultos com epilepsia

Abstract Background Patients with epilepsy (PWE) frequently have comorbid psychiatric disorders, the most common of which are depression and anxiety. Attention deficit disorder with hyperactivity (ADHD) is also more frequent among PWE, though that condition has been scarcely studied among the adult PWE population. Objective This study aimed to compare the presence of ADHD symptoms between adult PWE and the general population. Methods This was an observational case-control study. Ninety-five adult PWE from a tertiary center in southern Brazil were compared with 100 healthy controls. All subjects were submitted to three structured scales: 1) the World Health Organization Adult ADHD Self-Report Scale version 1.1 (ASRS); 2) the Hospital Anxiety and Depression Scale (HADS); and 3) the Adverse Events Profile (AEP). Dichotomic variables were analyzed through chi-square test and Fisher's exact test, as appropriate, and non-parametric variables were analyzed through the Mann-Whitney U test. Results Medians and interquartile ranges (IR) were: 1) ASRS: 26.00 (IR: 18 to 38) among PWE versus 17.00 (IR: 11 to 24) among controls, p< 0.001; 2) HADS: 14.00 (IR: 8 to 21) among PWE versus 11.00 (IR: 8 to 16) among controls, p= 0.007; 3) AEP: 3800 (IR: 31 to 49) among PWE versus 33.00 (IR: 23 to 43) among controls, p= 0.001. Conclusion PWE showed a higher burden of symptoms of ADHD, depression, and anxiety when compared with controls, which replicates in the Brazilian population the findings of current literature that point toward a higher prevalence of such disorders among PWE.

Resumo Antecedentes Pacientes com epilepsia (PCE) frequentemente apresentam comorbidades psiquiátricas, principalmente depressão e ansiedade. O transtorno do déficit de atenção e hiperatividade (TDAH) também é mais frequente nos PCE, porém foi pouco estudado na população adulta de PCE. Objetivo Comparar a presença de sintomas de TDAH entre PCE adultos e a população geral. Métodos Noventa e cinco PCE adultos de um centro terciário no Sul do Brasil foram comparados a 100 controles saudáveis. Todos os sujeitos foram submetidos a três escalas estruturadas: 1) a Escala Autorrelatada de TDAH em Adultos da Organização Mundial da Saúde, versão 1.1 (ASRS); 2) a Escala Hospitalar de Ansiedade e Depressão (HADS); e 3) o Perfil de Eventos Adversos (AEP). Variáveis dicotômicas foram analisadas através dos testes chi-quadrado e exato de Fisher, conforme apropriado, e as variáveis não paramétricas foram analisadas através do teste U de Mann-Whitney. Resultados As medianas e os intervalos interquartis (IIQ) foram: 1) ASRS: 26.00 (IIQ: 18 a 38) em PCE versus 17.00 (IIQ: 11 a 24) nos controles, p< 0,001; 2) HADS: 14.00 (IIQ: 8 a 21) em PCE versus 11.00 (IIQ: 8 a 16) nos controles, p= 0,007; 3) AEP: 38.00 (IIQ: 31 a 49) em PCE versus 33.00 (IIQ: 23 a 43) nos controles, p= 0,001. Conclusão PCE apresentaram uma maior carga de sintomas de TDAH, depressão e ansiedade quando comparados aos controles, o que replica na população brasileira os achados da literatura atual, que apontam para uma maior prevalência de tais transtornos entre PCE.

Arterial hypertension in rotating shift workers: The role of hypertriglyceridemic waist and hypertriglyceridemic waist-to-height ratio phenotypes.

OBJECTIVE: To examine the association of arterial hypertension and the hypertriglyceridemic waist phenotype (HWP) and hypertriglyceridemic waist-to-height phenotype (HWHP). METHODOLOGY: This cross-sectional study was conducted with 1422 male rotating shift workers in Brazil. The HWP was defined as having a waist circumference ≥94 cm and serum triglycerides ≥150 mg/dL, whereas the HWHP was determined by having a waist-to-height ratio ≥0.5 and serum triglycerides ≥150 mg/dL. To provide a characterization of the sample, data were presented in both absolute and relative values, and Pearson's chi-square test was employed. To investigate the potential association between arterial hypertension and the presence of HWP or HWHP, multivariate logistic regression was conducted, accounting for sociodemographic, behavioral, and clinical variables. Furthermore, we conducted a stratified multivariate logistic regression analysis, considering the duration of shift work, to assess whether the results remained consistent depending on the length of work experience in shifts. RESULTS: A noteworthy association was observed between arterial hypertension and both HWP and HWHP, with HWHP exhibiting a stronger association with the disease. Furthermore, a positive association between arterial hypertension and these phenotypes was identified in workers with five or more years of shift work. CONCLUSION: We recommend the utilization of HWHP as a screening tool, as it indicates a stronger association with arterial hypertension compared to HWP. Additionally, the duration of time spent working in shifts emerged as a significant factor influencing the presence of these phenotypes.

Assessment of the Sensitivity of the Vocal Tract in Parkinson Disease by Nasal Video Endoscopy.

Introduction Sensory deficits of the upper airways are common in people with Parkinson disease. Compounded by considerable deterioration of the swallowing function, these deficits may contribute to the elevated rates of morbidity and mortality among this population. Objective To examine the sensitivity of the vocal tracts of people with Parkinson disease using nasal videoendoscopy and to compare the results with paired controls. Methods The present was a prospective, observational, case-control study. Sensitivity assessments were conducted in a sample of 24 people divided into 2 groups: one group of 12 patients with Parkinson's disease, and a control group with 12 healthy subjects. The study group also underwent a fiberoptic endoscopic evaluation of swallowing and answered the Swallowing Disturbance Questionnaire (SQD) to detect dysphagia. Results There was a significant difference ( p < 0.05) in the region of the arytenoid cartilages, showing that sensitivity was better preserved among the control group, and that sensitivity deficits were present in the study group. The qualitative results showed sensorial impairment in the study group than in the control group regarding the base of the tongue, the vestibular folds, and the vocal folds. The study group showed self-awareness regarding the deficits in the swallowing function, but there was no statistically significant association between swallowing function deficits and deterioration of sensorial function among them. Conclusions Sensorial deficits were present in the study group when compared to the healthy subjects, mainly in the qualitative evaluation.

Uso de óxido nitroso como sedação consciente por profissionais de odontologia no Rio Grande do Sul: um estudo transversal / Prevalence of nitrous oxide use as conscious sedation by dentistry professionals in Rio Grande do Sul: a cross-sectional study

Objetivo: Avaliar fatores associados, percepção e prevalência do uso de óxido nitroso por cirurgiões-dentistas do Rio Grande do Sul, Brasil. Metodologia: Realizou-se um estudo transversal, de base eletrônica, com profissionais registrados no Rio Grande do Sul. A coleta de dados baseou-se no envio, por e-mails e campanhas no Instagram, de um questionário via plataforma Google Forms contendo 27 questões acerca do uso de óxido nitroso em atendimentos odontológicos, bem como o perfil e as percepções dos profissionais sobre a técnica. Resultados: Dos 220 participantes, apenas 12,3% utilizava o óxido nitroso em sua prática clínica, sendo as especialidades que mais utilizavam, cirurgia e odontopediatria. Dentre os que reportaram utilizar a técnica, 81,5% tinham mais de 29 anos (p<0,001) e possuíam curso de pós-graduação, sendo que destes, 55,6% realizou o curso de habilitação (p<0,01) e mais da metade (55,6%) relatou utilizar em pacientes adultos (p<0,001). O alto custo do equipamento, bem como a falta de interesse dos profissionais, foram as principais razões para o não uso da técnica. Conclusão: A técnica de sedação consciente com óxido nitroso é pouco usada pelos cirurgiões-dentistas no Estado do Rio Grande do Sul. É possível que a ampliação do conhecimento acerca da indicação e aplicação do óxido nitroso, ainda durante a graduação, possa expandir o uso e contribuir para uma melhor qualidade no atendimento de pacientes com medo e ansiedade odontológicos. (AU)

Objective: The aim of this study is to evaluate associated factors, perception and prevalence of nitrous oxide use by dental surgeons in Rio Grande do Sul, Brazil. Methodology: A cross-sectional, electronic-based study was carried out with professionals registered in Rio Grande do Sul. Data collection was based on sending, via emails and Instagram campaigns, a questionnaire via the Google Forms platform containing 27 questions about the use of nitrous oxide in dental care, as well as the profile and perceptions of professionals about the technique. Results: Of the 220 participants, only 12.3% used nitrous oxide in their clinical practice, the specialties they used most being surgery and pediatric dentistry. Among those who reported using the technique, 81.5% were over 29 years old (p<0.001) and had a postgraduate course, of which 55.6% completed the qualification course (p<0.01) and more than half (55.6%) reported using it in adult patients (p<0.001). The high cost of the equipment, as well as the lack of interest from professionals, were the main reasons for not using the technique. Conclusion: The conscious sedation technique with nitrous oxide is little used by dental surgeons in the State of Rio Grande do Sul. It is possible that expanding knowledge about the indication and application of nitrous oxide, even during graduation, can expand its use and contribute to a better quality of care for patients with dental fear and anxiety. (AU)

Enhancing antimicrobial photodynamic therapy with phenothiazinium dyes and sodium dodecyl sulfate against Candida albicans at various growth stages.

BACKGROUND: The eradication of C. albicans is difficult due to the organization of the yeast in biofilms. Photodynamic therapy (PDT) has been proposed as an alternative to antifungals. Phenothiazinium dyes, e.g. methylene blue (MB), have been proposed as photosensitizing agents (PS), and their association with sodium dodecyl sulfate (SDS) has recently been shown to improve the effectiveness of PDT in planktonic culture. In this sense, the objective of this work was to evaluate the effect of PDT with phenothiazinium dyes associated to SDS in biofilms at the different stages of growth. METHODS: Experiments were carried out to evaluate the effects of PDT on biofilm formation and on established biofilms of C. albicans ATCC 10231. Samples were exposed to PS 50 mg/L (MB, Azure A - AA, Azure B - AB and dimethyl methylene blue - DMMB) dissolved in water or 0.25% SDS, for 5 min in the dark. After irradiation at 660 nm, 37.3mW/cm2 for 27 min, 60.4J/cm2 colony forming units count assay (CFU/mL) was performed. One or two irradiations were applied. Statistical methods were used to assess effectiveness. RESULTS: PSs showed low toxicity in the dark. An application of PDT irradiation was not able to reduce the CFU/mL both in mature biofilms (24h) and in biofilms in the dispersion phase (48h), only in the adherence phase did PDT prevent the formation of biofilms. With two successive applications of PDT irradiation in the dispersion phase, PDT with MB, AA, and DMMB completely inactivated C. albicans. The similar was not observed with mature biofilms. CONCLUSIONS: Different stages of biofilm growth respond differently to PDT, with the greatest inhibitory effect found in the adhesion stage. Mature and dispersed biofilms are less susceptible to PDT. The use of two successive applications of PDT with PSs associated with SDS may be a useful approach to inactivate C. albicans biofilms.

The combination of methylene blue and sodium dodecyl sulfate enhances the antimicrobial photodynamic therapy of Candida albicans at lower light parameters.

BACKGROUND: The growth of resistant microorganisms has been a challenge for health systems. Antimicrobial Photodynamic Therapy (aPDT) has gained attention due to its effects on resistant strains. Recently, it was shown that the association of methylene blue (MB) and sodium dodecyl sulfate (SDS) are an effective strategy to increase the effect of aPDT; however, it is unknown which are the best light parameters (such as irradiance and radiant exposure, RE), to reach the most effective protocols. This work aimed to evaluate the light parameters, irradiance, and radiant exposure, in aPDT with MB when conveyed in water compared to MB associated with SDS. METHODS: Tests were carried out to quantify the colony-forming units (CFU) of ATCC 10,231 strain of Candida albicans when using MB in different media and with different light parameters: Control (water), SDS (0.25%), MB (20 mg/mL), and the MB/SDS at irradiances of 3.7; 11.2; 18.6, and 26.1 mW/cm2 and varied irradiation times to reach radiant exposures of 4.4; 17.8; 26.7, and 44 J/cm². RESULTS: The results showed that aPDT with MB/SDS had a higher antimicrobial effect than MB when conveyed in water. Furthermore, for the highest irradiance studied (26.1 mW/cm2), CFU decreases exponentially with increasing RE from 4.4 up to 44 J/cm2. Similarly, at a fixed RE, the higher the irradiance used, the higher the antimicrobial effect was observed, except for the lowest RE studied (4.4 J/cm2). CONCLUSIONS: aPDT with MB/SDS had a greater antimicrobial action at the lower light parameters when compared to MB conveyed in water. The authors suggest the use of RE above 18 J/cm2 and irradiance above 26 mW/cm2 since at the mentioned parameters the increase in its value caused a greater antimicrobial effect.

In vitro evaluation of nanocomposites of linseed mucilage and k-carrageenan loaded with Achyrocline satureioides nanoemulsion: a gradual-release candidate of antimicrobials for the treatment of bovine mastitis.

This research paper presents the development and evaluation of pioneering nanocomposites (NCs) based on the combination of k-carrageenan and linseed mucilage. When loaded with macela extract nanoemulsion they present an innovative approach for the sustained release of antimicrobial herbal constituents, specifically tailored for bovine mastitis treatment. The NCs, encompassing various ratios of k-carrageenan and linseed mucilage polymers (8:2, 7:3, and 5:5 w/w) with 1.25 mg of macela extract/g of gel, underwent in vitro assessment, emphasizing viscosity, degradation speed, release of herbal actives from macela nanoemulsion and antimicrobial activity. The NCs exhibited thermoreversible characteristics, transitioning from liquid at 60°C to a gel at 25°C. NCs allowed a gradual release of phenolic compounds, reaching approximately 80% of total phenolics release (w/v) within 72 h. NCs inhibited the growth of MRSA (ATCC 33592) until 8 h of incubation. No toxic effect in vitro of NCs was found on MAC-T cells. Thus, the developed materials are relevant for the treatment of bovine mastitis, especially in the dry period, and the data support future evaluations in vivo.

Assessment of the Sensitivity of the Vocal Tract in Parkinson Disease by Nasal Video Endoscopy

Abstract Introduction Sensory deficits of the upper airways are common in people with Parkinson disease. Compounded by considerable deterioration of the swallowing function, these deficits may contribute to the elevated rates of morbidity and mortality among this population. Objective To examine the sensitivity of the vocal tracts of people with Parkinson disease using nasal videoendoscopy and to compare the results with paired controls. Methods The present was a prospective, observational, case-control study. Sensitivity assessments were conducted in a sample of 24 people divided into 2 groups: one group of 12 patients with Parkinson's disease, and a control group with 12 healthy subjects. The study group also underwent a fiberoptic endoscopic evaluation of swallowing and answered the Swallowing Disturbance Questionnaire (SQD) to detect dysphagia. Results There was a significant difference (p < 0.05) in the region of the arytenoid cartilages, showing that sensitivity was better preserved among the control group, and that sensitivity deficits were present in the study group. The qualitative results showed sensorial impairment in the study group than in the control group regarding the base of the tongue, the vestibular folds, and the vocal folds. The study group showed self-awareness regarding the deficits in the swallowing function, but there was no statistically significant association between swallowing function deficits and deterioration of sensorial function among them. Conclusions Sensorial deficits were present in the study group when compared to the healthy subjects, mainly in the qualitative evaluation.

Users' passivity in accessing digested scientific evidence through social media: cross-sectional insights.

OBJECTIVES: This manuscript provides novel insights about the potential use of social media (a Facebook page, the first strategic attempt by EviDent initiative) to share evidence-based dentistry content and empowerment strategies for professionals, using quantifiable usage metrics, besides exposing the strengths and weaknesses of this knowledge translation strategy. One year-long gathered metrics were analyzed to understand information about usage patterns. RESULTS: Publications were potentially exposed to 4784 users, and subsequent interaction with the page occurred in 18% of cases. Users' involvement with page content was associated with the number of page visitors (P = .005). However, users' interaction with the page was not associated with the potential number of users that could have seen the page (P = .25). Even considering the users that approved the posts, only 7%, on average, interacted with the post's links. Although social media has effectively disseminated scientific content, our experience revealed the user's passivity in interacting with the content. We expect to overcome these barriers by developing a mobile app to offer a more interactive and dynamic interface associated with a more attractive format for posting, including images and infographics.

Gestação e Desenvolvimento Inicial de Gêmeos: Um Estudo a partir de Relatos Maternos / Pregnancy and Early Development of Twins: A Study based on Maternal Reports / Embarazo y Desarrollo inicial de Gemelos: Un Estudio basado en Informes Maternos

As interações sociais iniciais são fundamentais para o desenvolvimento infantil, sendo essencial o papel dos adultos na promoção de práticas que o favoreçam. Tais práticas podem ser influenciadas por aspectos contextuais e pelas emoções, concepções e expectativas parentais sobre seus filhos. No presente estudo, foi considerada a configuração familiar caracterizada pela presença de bebês gêmeos. O objetivo foi conhecer as emoções das mães acerca da gravidez gemelar e analisar as suas concepções e expectativas sobre o desenvolvimento dos gêmeos nos primeiros 24 meses de vida. Participaram deste estudo nove mães de bebês gemelares, que responderam a um questionário sociodemográfico e a uma entrevista semiestruturada. Os resultados revelaram sentimentos maternos ambivalentes relativos à experiência com a gemelaridade desde a gestação; concepções sobre desenvolvimento infantil, fatores que podem influenciá-lo e diferenças entre os gêmeos; e expectativas sobre o desenvolvimento dos bebês. Conclui-se que uma maior compreensão sobre aspectos relacionados à maternidade de gemelares pode auxiliar na criação de redes de apoio socioemocional aos cuidadores e de contextos que favoreçam as interações estabelecidas entre a tríade mãe-bebês.

Initial social interactions are fundamental to child development, and the role of adults in promoting practices that favor them is essential. Such practices can be influenced by contextual aspects and by parental emotions, conceptions and expectations about their children. In the present study, the family configuration characterized by the presence of twin babies was considered. The objective was to get to know the mothers' emotions about twin pregnancies and to analyze their conceptions and expectations about the development of twins in the first 24 months of life. Nine mothers of twin babies participated in this study, who answered a sociodemographic questionnaire and a semi-structured interview. The results revealed ambivalent maternal feelings regarding the experience with twinning since pregnancy; conceptions about child development, factors that can influence it and differences between twins; and expectations about the development of babies. We conclude that a greater understanding of aspects related to twin maternity can help in the creation of social and emotional support networks for caregivers and contexts that favor the interactions established between the mother-babies triad.

Las interacciones sociales iniciales son fundamentales para el desarrollo infantil, siendo fundamental el rol de los adultos en la promoción de prácticas que los favorezcan. Dichas prácticas pueden estar influenciadas por aspectos contextuales y por emociones, concepciones y expectativas de los padres sobre sus hijos. En el presente estudio se consideró la configuración familiar caracterizada por la presencia de bebés gemelos. El objetivo fue conocer las emociones de las madres sobre los embarazos gemelares y analizar sus concepciones y expectativas sobre el desarrollo de los gemelos en los primeros 24 meses de vida. En este estudio participaron nueve madres de gemelos, quienes respondieron un cuestionario sociodemográfico y una entrevista semiestructurada. Los resultados revelaron sentimientos maternos ambivalentes con respecto a la experiencia del hermanamiento desde el embarazo; concepciones sobre el desarrollo infantil, factores que pueden influir en él y diferencias entre gemelos; y expectativas sobre el desarrollo de los bebés. Concluimos que una mayor comprensión de los aspectos relacionados con la maternidad gemelar puede ayudar en la creación de redes de apoyo social y emocional a los cuidadores y contextos que favorezcan las interacciones que se establecen entre la tríada madre-bebé.

Using information and communication technologies (ICTs) to solve the repressed demand for primary dental care in the Brazilian Unified Health System due to the COVID-19 pandemic: a randomized controlled study protocol nested with a before-and-after study including economic analysis.

BACKGROUND: With the COVID-19 pandemic, thousands of children had their dental care interrupted or postponed, generating a pent-up demand for primary care. To minimize the impact of this outage, information and communication technologies (ICT) could be an alternative. The aim of this study is to elucidate the impact of implementing the ICTs in primary dental care for children on resolving the pent-up demand for primary dental care to children in the national health system service (SUS) due to the COVID-19 pandemic. METHODS: Different research strategies are being proposed to demonstrate such effect and extrapolating findings to a real-world context to guide further research, practice and policies: two clinical trials (one randomized controlled by the waiting list trial (RCT) and a before-and-after study), one simulation study to prospect trial results to a broader population and three economic evaluations using different effects. Children enrolled in a reference dental unit will be invited to participate in the before-and-after study for trials. The first 368 families will be randomized for the RCT to the intervention vs waiting list. All participants will receive the intervention, but the waiting list group will be assessed before the intervention is available for them. The intervention comprises standardized non-face-to-face primary dental care using the V4H platform. The problem-solving and the family's perception will be the primary outcomes set for the before-and-after study and RCT, respectively. They will be measured 2 weeks after randomization. Based on trial findings, we will develop theoretical models to estimate how the intervention could benefit the population included in the national health system.  Three economic evaluations will be carried out considering different trial effects (cost-effectiveness analyses). A societal perspective and the pandemic time horizon will be considered. Possible social impact (inequalities) will also be explored. DISCUSSION: This ongoing trial may be an essential contribution to clarify positive and negative aspects related to the use of technologies for non-face-to-face dental care for children. Trial products may bring relevant contributions to the pandemic context and the post-pandemic period. Potential benefits may be feasible to implement and preserve in the health system even in the post-pandemic period. Trial registration Clinicaltrials.gov registration NCT04798599 (registered March 2021).

Protection of bovine mammary epithelial cells by a nanoemulsion of the medicinal herb Achyrocline satureioides (Lam.) DC and its capacity of permeation through mammary epithelium.

The low levels of toxicity and cytoprotective effect attributed to Achyrocline satureioides (Lam.) DC, a medicinal plant native to South America, are of interest for bovine mastitis therapy. This research paper reports the hypothesis that a nanoemulsion of macela extract (Achyrocline satureioides) exerts protective effects on bovine mammary alveolar cells -T (MAC-T) and increases the permeation of flavonoid compounds through mammary epithelium. Extract-loaded nanoemulsions (2.5 mg/ml) (NE-ML) (n = 4) were prepared using high-pressure homogenization with varying concentrations of flaxseed oil and Tween 80. Permeation and retention of free and nanoencapsulated quercetin, 3-O-methylquercetin and luteolin were performed on mammary glandular epithelium using Franz diffusion cells. The cell viability was evaluated on mammary epithelial cells (MAC-T lineage) using the MTT method (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) after exposure to loaded and blank nanoemulsions (NE-ML and NE-BL). Necrotic or apoptotic cell death was evaluated by flow cytometry after exposure to nanoemulsions (NE-ML and NE-BL). Subsequently, the cell death was assessed by previously treating MAC-T cells with NE-ML for 23 h, followed by exposure to H2O2 (2 mM) for 1 h. Higher permeation of quercetin and 3-O-methylquercetin in NE-ML was found compared to that of free extract with a final permeated amount of 50.7 ± 3.2 and 111.2 ± 0.6 µg/cm2 compared to 35.0 ± 0.6 and 48.9 ± 1.2, respectively. For NE-BL, the IC50 was at least 1.3% (v/v), while for the NE-ML, it was at least 2.6% (v/v). After exposure to NE-ML (5 and 1.2%, v/v), the percentage of apoptotic cells was reduced (±30%). For the H2O2 assay, the percentage of cells in necrosis was reduced by 40% after exposure to NE-ML1% (v/v) + H2O2 2 mM. The protective effects and increased permeation of macela nanoemulsion make this a promising new candidate for bovine mastitis therapy.

Rationale and design of the Brazilian diabetes study: a prospective cohort of type 2 diabetes.

BACKGROUND: Optimal control of traditional risk factors only partially attenuates the exceeding cardiovascular mortality of individuals with diabetes. Employment of machine learning (ML) techniques aimed at the identification of novel features of risk prediction is a compelling target to tackle residual cardiovascular risk. The objective of this study is to identify clinical phenotypes of T2D which are more prone to developing cardiovascular disease. METHODS: The Brazilian Diabetes Study is a single-center, ongoing, prospective registry of T2D individuals. Eligible patients are 30 years old or older, with a confirmed T2D diagnosis. After an initial visit for the signature of the informed consent form and medical history registration, all volunteers undergo biochemical analysis, echocardiography, carotid ultrasound, ophthalmologist visit, dual x-ray absorptiometry, coronary artery calcium score, polyneuropathy assessment, advanced glycation end-products reader, and ambulatory blood pressure monitoring. A 5-year follow-up will be conducted by yearly phone interviews for endpoints disclosure. The primary endpoint is the difference between ML-based clinical phenotypes in the incidence of a composite of death, myocardial infarction, revascularization, and stroke. Since June/2016, 1030 patients (mean age: 57 years, diabetes duration of 9.7 years, 58% male) were enrolled in our study. The mean follow-up time was 3.7 years in October/2021. CONCLUSION: The BDS will be the first large population-based cohort dedicated to the identification of clinical phenotypes of T2D at higher risk of cardiovascular events. Data derived from this study will provide valuable information on risk estimation and prevention of cardiovascular and other diabetes-related events. CLINICALTRIALS.GOV IDENTIFIER: NCT04949152.

The importance of combining methods to assess Candida albicans biofilms following photodynamic inactivation.

BACKGROUND: Methylene blue (MB)-mediated photodynamic inactivation (PDI) has shown good results in killing Candida spp. Although MB solutions are commonly used, new formulations have been designed to improve PDI. However, chemical substances in the formulation may interfere with the PDI outcome. In this sense, different methodologies should be used to evaluate PDI in vitro. Herein, we report different methodologies to evaluate the effects of PDI with an oral formulation (OF) containing 0.005% MB on Candida albicans biofilm. METHODS: Biofilms were treated using the MB-OF, with 5 min pre-irradiation time and exposure to a 640 nm LED device (4.7 J/cm2). PDI was evaluated by the XTT reduction test, counting the colony forming units (CFU), a filamentation assay, crystal violet (CV) staining, and scanning electronic microscopy (SEM). RESULTS: PDI was able to reduce around 1.5 log10 CFU/mL, even though no significant differences were noted in metabolic activity in comparison to the control immediately after PDI. A significant decrease in yeast to hyphae transition was observed after PDI, while the biofilm exhibited flattened cells and a reduced number of yeasts in SEM. The CV assay showed increased biomass. CONCLUSION: MB-OF-mediated PDI was effective in C. albicans biofilms, as it significantly reduced the CFU/mL and the virulence of surviving cells. The CV data were inconclusive, since the OF components interacted with the CV, making the data useless. Taken together, our data suggest that the association of different methods allows complementary responses to assess how PDI mediated by a formulation impacts biofilms.

Confiabilidade da baropodometria na avaliação do equilíbrio de indivíduos com deficiência visual / Reliability of baropodometry in assessing the balance of individuals with visual impairment

Indivíduos com deficiência visual podem apresentar déficits de equilíbrio e existem diversos métodos capazes de avalia-lo, sendo a baropodometria um método em expansão, porém com escassez de estudos que abordem suas medidas psicométricas e avaliações padronizados. Objetivo: Avaliar a confiabilidade relativa e absoluta da baropodometria em um protocolo de avaliação de equilíbrio para pessoas com deficiência visual. Método: Estudo observacional, de corte transversal, com 38 indivíduos, de ambos os sexos, com e sem diagnóstico de deficiência visual, sendo alocados: grupo controle (GCO) (n= 13) composto por indivíduos sem deficiência visual, grupo baixa visão (GBV) (n= 15), grupo cegueira (GCE) (n= 10) e posteriormente realizada a junção do GBV e GCE, compondo o grupo deficiência visual (GDV) (n= 25). Para avaliar a confiabilidade da baropodometria, utilizou-se o método teste e reteste, com um intervalo de sete dias. Os indivíduos foram avaliados em três condições, apoio bipodal, apoio unipodal direito e apoio unipodal esquerdo considerando as variáveis área, amplitude e velocidade média anteroposterior e laterolateral. Para confiabilidade relativa foi utilizado o Coeficiente de Correlação Intraclasse (CCI) e para a confiabilidade absoluta o erro padrão da medida (EPM). Resultados: Em relação a confiabilidade relativa, os CCIs das variáveis da baropodometria variaram de baixo a muito alto em todos os grupos, com melhor confiabilidade nas condições de apoios unipodais e maior índice no GCE. Na confiabilidade absoluta, 14 variáveis apresentaram boa confiabilidade. Conclusão: A baropodometria apresenta-se como um método confiável, porém deve-se ter cautela na escolha do posicionamento e da variável a ser analisada.

Individuals with visual impairment may have balance deficits and there are several methods capable of evaluating it, and baropodometry is an expanding method, but with a lack of studies that address its psychometric measures and standardized assessments. Objective: To assess the relative and absolute reliability of baropodometry in a balance assessment protocol for visually impaired people. Methods: Observational, cross-sectional study, with 38, of both sexes, with and without a diagnosis of visual impairment, were included in three groups: control group (CG) (n= 13) composed of individuals without visual impairment, low vision group (LVG) (n= 15), blindness group (BG) (n= 10) and subsequently the LVG and BG were joined, making up the group visual impairment (VIG) (n= 25). To evaluate the reliability of baropodometry, the test and retest method was used, with an interval of seven days. The individuals were evaluated in three conditions, support bipedal, right unipodal support and left unipodal support considering the variables area, amplitude and mean anteroposterior and laterolateral speed. For relative reliability, the Intraclass Correlation Coefficient (ICC) was used and for absolute reliability the standard error of measurement (SEM). Results: Regarding the relative reliability, the ICCs of the baropodometry variables varied from low to very high in all groups, with better reliability in the conditions of unipodal supports and a higher index in the BG. In absolute reliability, 14 variables showed good reliability. Conclusion: Baropodometry is a reliable method, however, care must be taken when choosing the position and the variable to be analyzed.

Gastos públicos em serviços ambulatoriais de Fonoaudiologia no Brasil entre 2009 e 2018: bases de dados do DATASUS / Public spending on outpatient speech therapy services in Brazil between 2009 and 2018: DATASUS databases

RESUMO Objetivo Analisar os gastos públicos em saúde destinados aos serviços ambulatoriais em Fonoaudiologia nas cinco Regiões Federativas do Brasil. Métodos Trata-se de um estudo ecológico realizado por meio da busca de dados secundários disponíveis em uma plataforma virtual de domínio público, DATASUS (Departamento de Informática do Sistema Único de Saúde). Os dados coletados referiram-se aos valores aprovados para os procedimentos da Fonoaudiologia no período de 2009 a 2018 nas cinco Regiões Federativas. Adotou-se análise descritiva dos dados e exposição dos resultados em valores absolutos, relativos e taxas de crescimento. Resultados Verificou-se que o investimento médio em reais (R$), por ano, nos serviços de Fonoaudiologia no Brasil foi de, aproximadamente, R$ 223.952.639.232,00; sendo 47,2% dos recursos destinados à Região Sudeste. Dentre as grandes áreas de especialização, a Audiologia foi responsável por 95,4% do investimento, seguida pelas áreas da Linguagem (4,0%), Motricidade Orofacial (0,5%) e Voz (0,1%). Conclusão Os serviços fonoaudiológicos demandam considerável parcela dos recursos públicos, sendo a área da Audiologia responsável por quase metade desses gastos, seguida pelas grandes áreas da Linguagem, Motricidade Orofacial e Voz.

ABSTRACT Purpose To analyze public spending on health services to outpatient services in Speech Therapy in the five federative regions of Brazil. Methods This is an ecological study carried out through the search for secondary data available on a public domain virtual platform, DATASUS. The collected data refer to the values ​​approved for the Speech Therapy procedures in the period from 2009 to 2018 in the five federative regions. Descriptive analysis of data and exposure of results in absolute and relative values ​​and growth rates were adopted. Results It was found that the average investment in reais, per year, in speech therapy services in Brazil was approximately R$ 223,952,639,232.00, with 47.2% of the resources destined for the Southeast region. Among the major areas of specialization, Audiology accounted for 95.4% of the investment, followed by Language (4.0%), Orofacial Motricity (0.5%) and Voice (0.1%). Conclusion The findings indicate that speech therapy services demand a considerable portion of public resources, with the area of ​​Audiology being responsible for almost half of these expenses, followed by the large area of ​​Language, Orofacial Motricity and Voice.

Utilização da ozonioterapia em odontologia / Use of ozoniotherapy in dentistry

O objetivo do presente estudo foi realizar uma revisão acerca do uso do ozônio como terapia em diversas áreas da Odontologia. Foi utilizado o portal PubMed, utilizando os termos (("ozone"[MeSH Terms] OR "ozone"[All Fields]) AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields])) AND ("dentistry"[MeSH Terms] OR "dentistry"[All Fields]), sem delimitação de data ou de idioma. Foi realizada leitura por título, por resumo e, por fim, a leitura na íntegra dos resumos selecionados. Os critérios de inclusão foram: ensaios clínicos randomizados e não randomizados, que utilizaram o ozônio em tratamentos odontológicos sozinhos ou associados a outros agentes. Com base nos resultados dos artigos abordados, constatou-se extrema heterogeneidade entre eles, bem como resultados bastante divergentes entre si. Quando o Ozônio é utilizado como adjuvante percebeu-se efeito benéfico em relação a redução da dor e a cicatrização, bem como efeito analgésico e anti-inflamatório. Por tudo isso, acredita-se que a terapia com ozônio, ainda que muito recente, tem se mostrado uma boa opção de tratamento. No entanto, são necessárias mais pesquisas com embasamento científico e estudos randomizados que visam comprovar a veracidade da sua eficácia e para que se tornem uma opção segura de aplicação.

The objective of the present study was to conduct a review on the use of ozone as a therapy in several areas of dentistry. The PubMed portal was used, using the terms ("ozone"[MeSH Terms] OR "ozone"[All Fields]) AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND ("dentistry"[MeSH Terms] OR "dentistry"[All Fields]), without delimitation of date or language. It was performed reading by title, by abstract and, finally, the full reading of the selected abstracts. The inclusion criteria were: randomized and non-randomized clinical trials, which used ozone in dental treatments alone or associated with other agents. Based on the results of the articles approached, extreme heterogeneity among them was observed, as well as quite divergent results. When ozone is used as an adjuvant, a beneficial effect in relation to pain reduction and healing, as well as analgesic and antiinflammatory effects, was observed. For all these reasons, it is believed that ozone therapy, although very recent, has proven to be a good treatment option. However, more research with scientific basis and randomized studies are necessary to prove the veracity of its effectiveness and to become a safe option of application.

How can we associate an economic evaluation with a clinical trial?

Economic evaluations in Dentistry have been increasing in recent years. They are a relevant contribution if an economic issue exists. Knowing if a new intervention is an efficient way of allocating available (and scarce) resources (the concept of opportunity costs), a well-designed economic evaluation may be helpful. One option is to conduct a trial-based economic analysis, which extracts a considerable board of information from a trial. This approach produces a more controlled result since many sources of variations might be reduced. On the other hand, some aspects could not be predicted directly from the trial or even extrapolated. Thus, combining model-based analysis may be an idea. In this paper, we intended to discuss important aspects to be considered by researchers in further economic evaluations. This paper will be systematically divided into sessions related to the study design as time horizon and perspective, health effects, costs, and data analysis. In the end, we expect the reader could be able to plan a trial-based economic evaluation, which should be a careful, meticulous, quite laborious and especially transparent process.