The usefulness of patient-reported outcome measures in decision making in Chagas cardiomyopathy: a scoping review.

Chagas cardiomyopathy (ChC) presents many biopsychosocial complexities, highlighting the need to have patient self-report questions. This study demonstrates the scope of the use of patient-reported outcome measures (PROMs) in patients with ChC and highlights the main research gaps. This is a scoping review and the search strategy was performed in the Online Medical Literature Analysis and Retrieval System (MEDLINE), Excerpta Medica database (EMBASE), Accumulated Index of Nursing and Allied Health Literature (CINAHL), Cochrane Central, Latin American Literature and Caribbean in Health Sciences (LILACS) and Diagnostic Test Accuracy (DITA). The search identified 4484 studies and 20 studies met the inclusion criteria. The Short-Form of 36 items (SF-36) had potential prognostic value and the ability to identify systolic dysfunction. The Human Activity Profile was able to screen for functional impairment, and the New York Heart Association showed potential prognostic value. The SF-36 and Minnesota Living with Heart Failure Questionnaire were responsive to interventions. The pharmaceutical care affected adherence to treatment as assessed by the Morisky score and also for SF-36. Despite the increased use of PROMs, there are still a large number of gaps in the literature, and further studies using PROMs are needed.

Functional Status in Peripheral Arterial Disease: Rehabilitated Versus Nonrehabilitated.

BACKGROUND: To analyze patient perception of functional status related to activity and participation of rehabilitated and nonrehabilitated individuals with peripheral arterial disease. METHODS: Cross-sectional study assessing the activity and participation domain using the Human Activity Profile (HAP) questionnaire and the Participation Scale, respectively. Groups were compared using Chi-squared test and unpaired t-test. RESULTS: A total of 87 individuals (36 rehabilitated) with 65.28 ± 8.29 years (66.7% male) were included. HAP classified 58.6% of individuals with weak or inactive physical activity level, and approximately half of the sample did not have participation restriction. HAP scores and Participation Scale (locomotion inside and outside home) were lower in nonrehabilitated than in rehabilitated individuals. CONCLUSIONS: Individuals with peripheral arterial disease presented little participation restriction and a great activity limitation, the last one being more evident among nonrehabilitated.

Physical and autonomic functionality in women with breast cancer pre and post chemotherapy: a case control study.

BACKGROUND: Breast cancer (BC) is one of the most incident types of cancer among women in the world. Although chemotherapy is an effective way to treat several types of cancer, it may also cause serious complications, including cardiotoxicity. This study aimed to identify the impact of chemotherapy on functional capacity, muscle strength and autonomic function. METHODS: Ten breast cancer patients in therapeutic follow-up (TG) and ten women without comorbidities (CG) participated in the study (46±8.87 years old). Both groups were evaluated at two time points, before and 20 weeks after the start of chemotherapy. Functional capacity and muscle strength were assessed by 6-minute walk test (6MWT) and handgrip test, respectively. Autonomic function was assessed by heart rate variability analysis. RESULTS: TG presented greater reductions in the handgrip test for the non-dominant hand (TG ↓15.2%; CG: ↑1.1%, p<0.05) compared to GC. However, no significant differences were found regarding VO2max (p>0.05) and 6MWT total distance (p>0.05). Regarding the heart rate variability variables before and after follow-up period, rMSSD (CG= 39.15±37.66; TG= 14.89±8.28, p= 0.01) and SDNN (CG= 55.77±40.03; TG= 26.30±10.37, p= 0.02) showed effect in the group and time interaction, whereas the LF/HF ratio presented significant difference only in the time analysis (CG= 2.24±2.30; TG= 2.84±1.82, p= 0.04). CONCLUSION: Chemotherapy used in the treatment of breast cancer patients resulted in decreased muscle strength and autonomic imbalance. The data suggests that chemotherapy may carry the risk of developing cardiovascular disease. TRIAL REGISTRATION: Registration not required.

Assessment of health-related quality of life in patients with Chagas cardiomyopathy using Minnesota living with heart failure questionnaire: A validation study.

OBJECTIVE: Chagas cardiomyopathy (ChC) is the most severe clinical form of Chagas disease and, in association with psychosocial factors, can compromise the health-related quality of life (HRQoL) of affected patients. To date, there is no specific instrument to assess the HRQoL of these patients, and the Minnesota Living with Heart Failure Questionnaire (MLwHFQ), specific for heart failure, is being used both in research and current clinical practice. Therefore, we aimed to verify the validity of the MLwHFQ in the assessment of HRQoL of patients with ChC. METHODS: Fifty patients with ChC (50.6 ± 10.1 years, NYHA I-III) were evaluated. The MLwHFQ, Short-Form of Health Survey (SF-36), Beck Depression Inventory (BDI), and Human Activity Profile (HAP) were applied. All patients underwent echocardiography and Cardiopulmonary Exercise Testing (CPET). RESULTS: The MLwHFQ score correlated with almost all SF-36 domains (with r-value ranging from -0.38 to -0.69), except pain (p = 0.118). The MLwHFQ score also correlated with the BDI score (r = 0.748; p < 0.001), HAP score (r = -0.558; p = 0.001), peak oxygen uptake (r = -0.352; p = 0.01), and left ventricular ejection fraction (r = -0.329; p = 0.021). There was no significant difference in the score found on the MLwHFQ among NYHA classes (p = 0.101), as well as between patients with systolic dysfunction (n = 30) and preserved cardiac function (n = 20) (p = 0.058). Similarly, there was no significant difference in the score found on the physical (p = 0.423) and mental (p = 0.858) components of SF-36 between patients with systolic dysfunction and preserved cardiac function (p = 0.271 and p = 0.609, respectively). There was also no difference in the mental component of SF-36 among NYHA classes (p = 0.673). However, the HRQoL using the physical component of SF-36 was worse in advanced NYHA classes (p = 0.014). CONCLUSION: MLwHF correlated with most SF-36 HRQoL domains, depressive symptoms, physical activity, and systolic function and seems to be valid in assessing the HRQoL of ChC patients.

Resistance of Common Bean Genotypes to Chrysodeixis includens (Walker, 1858) (Lepidoptera: Noctuidae).

The common bean (Phaseolus vulgaris L.) is an important leguminous crop providing low-cost protein in developing countries worldwide. Insect pests are the main threats to common bean production, and this article focuses on the soybean looper (SL) Chrysodeixis includens (Walker, 1858) (Lepidoptera: Noctuidae), which feeds on leaves and pods. The recurrent use of synthetic chemicals may lead to pest resistance. Genetically resistant plants may diminish their use. Thus, the objective was to study common bean genotypes' resistance toward SL. The plants were grown in greenhouse conditions. The biology, fertility life table, oviposition preference and free-choice feeding preference were analyzed. Phenol and flavonoid content were assessed in leaves using a biology assay. Uirapuru genotype negatively affected C. includens biology and reproduction. Tangará genotype favored these parameters. Genotypes Quero-Quero, Nhambu, Corujinha, Andorinha, ANFC 9, Siriri, BRS Radiante and Verdão were more attractive for third-instar larvae. Negative correlations between phenolic and flavonoid compounds with survival rate (from egg to adult) rate were found. Common bean genotypes with dark leaves are less preferred for oviposition.

Comparison between the effects of virtual supervision and minimal supervision in a 12-week home-based physical exercise program on mental health and quality of life of older adults: Secondary analysis from a randomized clinical trial.

AIM: The objective of this study was to compare the effects of virtual supervision and minimal supervision in a 12-week home-based physical exercise program on the mental health and quality of life of community-dwelling older adults. METHODS: This study presents a secondary analysis of a randomized clinical trial conducted during the COVID-19 pandemic. The sample comprised 38 elderly men and women (81.6% women, mean age 68 ± 6.4 years; mean weight 69.8 ± 12.1 km) without physical and/or cognitive impairments. The volunteers were divided into two groups: one group received virtual supervision (monitored via videoconference), while the other group received minimal supervision (monitored through weekly text messages). Both groups followed the same home-based physical exercise program, consisting of three sessions per week, differing only in the supervision strategy. Mental health was assessed using the Depression, Anxiety, and Stress Scale (DASS-21) in conjunction with the POMS questionnaire, which evaluates mood, and quality of life was assessed using the WHOQOL-OLD questionnaire. RESULTS: Our findings demonstrated statistically significant superiority of virtual supervision compared with minimal supervision in relation to depression (-2.92, 95% confidence interval = -5.22 to -0.63). Conversely, minimal supervision exhibited superiority over virtual supervision regarding quality of life (-6.70, 95% confidence interval = -11.66 to -1.73). CONCLUSIONS: Virtual supervision yielded better outcomes for the depression indicator, while minimal supervision favored the quality of life of older adults at the conclusion of the 12-week home-based physical exercise program. Geriatr Gerontol Int 2023; 23: 864-870.

Maximal respiratory pressures: Measurements at functional residual capacity in individuals with different health conditions using a digital manometer.

BACKGROUND: Measuring maximal respiratory pressure is a widely used method of investigating the strength of inspiratory and expiratory muscles. OBJECTIVES: To compare inspiratory pressures obtained at functional residual capacity (FRC) with measures at residual volume (RV), and expiratory pressures obtained at FRC with measures at total lung capacity (TLC) in individuals with different health conditions: post-COVID-19, COPD, idiopathic pulmonary fibrosis (IPF), heart failure (CHF), and stroke; and to compare the mean differences between measurements at FRC and RV/TLC among the groups. METHODS: Inspiratory and expiratory pressures were obtained randomly at different lung volumes. Mixed factorial analysis of covariance with repeated measures was used to compare measurements at different lung volumes within and among groups. RESULTS: Seventy-five individuals were included in the final analyses (15 individuals with each health condition). Maximal inspiratory pressures at FRC were lower than RV [mean difference (95% CI): 11.3 (5.8, 16.8); 8.4 (2.3, 14.5); 11.1 (5.5, 16.7); 12.8 (7.1, 18.4); 8.0 (2.6, 13.4) for COVID-19, COPD, IPF, CHF, and stroke, respectively] and maximal expiratory pressures at FRC were lower than TLC [mean difference (95% CI): 51.9 (37.4, 55.5); 60.9 (44.2, 77.7); 62.9 (48.1, 77.8); 58.0 (43.9, 73.8); 57.2 (42.9, 71.6) for COVID-19, COPD, IPF, CHF, and stroke, respectively]. All mean differences were similar among groups. CONCLUSION: Although inspiratory and expiratory pressures at FRC were lower than measures obtained at RV/TLC for the five groups of health conditions, the mean differences between measurements at different lung volumes were similar among groups, which raises the discussion about the influence of the viscoelastic properties of the lungs on maximal respiratory pressure.

Team sports as a protective factor against mental health problems and suicidal ideation in adolescents / El deporte colectivo como factor protector ante problemas de salud mental e ideación suicida en adolescentes

Abstract Introduction Adolescents who practice sports have better mental health indicators. Objective To analyze the association between different types of physical activity (systematized exercise, individual, and collective sports), mental health, and suicidal ideation in adolescents. Method We conducted a cross-sectional study with 666 Brazilian adolescents (14-19 y.o.) attending high schools and selected using random cluster sampling. The mental health indicators analyzed were evaluated through the Self Reporting Questionnaire and the Strengths and Difficulties Questionnaire, including suicidal ideation. We also obtained physical activity information through questionnaires. Results There was a higher prevalence related to mental disorders (54.2% vs. 32.5%), difficulties related to mental health (79.6% vs. 48.4%), and suicidal thoughts (22.9% vs. 11.4%) in girls than in boys (p < .001 for all). The boys engaged in more team sports (41.0 vs. 23.8), whereas girls performed more exercise (45.1 vs. 26.5; p < .001). Discussion and conclusion The practice of team sports helps develop the collective spirit, stimulates social interaction, and develops reasoning and emotional intelligence. Boys who play team sports have fewer symptoms of common mental disorders, lower mental health problems, and less suicidal ideation than physically inactive boys.

Resumen Introducción Los adolescentes que practican deportes tienen mejores indicadores de salud mental. Objetivo Analizar la asociación entre los diferentes tipos de actividad física (ejercicio sistematizado, deportes individuales y colectivos), la salud mental y la ideación suicida en adolescentes. Método Se realizó un estudio transversal realizado con 666 adolescentes brasileños (14-19 años) que asisten a escuelas secundarias y fueron seleccionados mediante muestreo aleatorio por conglomerados. Los indicadores de salud mental analizados fueron evaluados a través del Cuestionario de Autoinforme y el Cuestionario de Fortalezas y Dificultades, incluyendo la ideación suicida. También obtuvimos información de la actividad física a través de cuestionarios. Resultados Hubo una mayor prevalencia relacionada con trastornos mentales (54.2% contra 32.5%), dificultades relacionadas con la salud mental (79.6% contra 48.4%) y pensamientos suicidas (22.9% contra 11.4%) en niñas que en niños (p < .001 para todos). Los chicos practicaban más deportes de equipo (41.0 contra 23.8), mientras que las chicas hacían más ejercicio (45.1 contra 26.5; p < .001). Discusión y conclusión La práctica de deportes de equipo ayuda en el desarrollo del espíritu colectivo, estimula la interacción social, desarrolla el razonamiento y la inteligencia emocional. Los niños que practican deportes de equipo tienen menos síntomas de trastornos mentales comunes, menos problemas de salud mental y menos ideación suicida en comparación con los niños físicamente inactivos.

Biomarkers and Echocardiographic Predictors of Cardiovascular Outcome in Patients With Chronic Chagas Disease.

Background Chagas disease (CD) presents an ominous prognosis. The predictive value of biomarkers and new echocardiogram parameters in adjusted models have not been well studied. Methods and Results There were 361 patients with chronic CD (57.6% men, 61±11 years of age, clinical forms: indeterminate 27.1%, cardiac 56.6%, digestive 3.6%, cardiodigestive 12.7%) included in this single-center, observational, prospective longitudinal study. Echocardiographic evaluation included strain analyses of left atrial, left ventricular (LV), and right ventricular and 3-dimensional analyses of left atrial and LV volumes. Biomarkers included cardiac troponin I, brain natriuretic peptide, transforming growth factor ß1, tumor necrosis factor, matrix metalloproteinases, and Trypanosoma cruzi polymerase chain reaction. The studied end point was a composite of CD-related mortality, heart transplant, hospital admission due to worsening heart failure, or new cardiac device insertion. Event-free survival was analyzed by multivariable regression analyses adjusted for competing risks. P values <0.05 were considered significant. The composite event occurred in 79 patients after 4.9±2.0 years follow-up. LV end-diastolic volume (hazard ratio [HR], 1.01 [95% CI, 1.00-1.02]; P=0.02), peak negative global atrial strain (HR, 1.08 [95% CI, 1.00-1.17]; P=0.04), LV global circumferential strain (HR, 1.12 [95% CI, 1.04-1.21]; P=0.003), LV torsion (HR, 0.55 [95% CI, 0.35-0.81]; P=0.003), brain natriuretic peptide (HR, 2.03 [95% CI, 1.23-3.34]; P=0.005), and positive T cruzi polymerase chain reaction (HR, 1.80 [95% CI, 1.12-2.91]; P=0.01) were end point predictors independent from age, sex, 2-dimensional echocardiographic indexes, hypertension, previous cardiac device, and CD cardiac form. Conclusions Two-dimensional strain- and 3-dimensional-derived parameters, brain natriuretic peptide, and positive T cruzi polymerase chain reaction can be useful for prediction of CD cardiovascular events.

Pentoxifylline reduces inflammation and prevents myocardial perfusion derangements in experimental chronic Chagas' cardiomyopathy.

BACKGROUND: Myocardial perfusion defect (MPD) is common in chronic Chagas cardiomyopathy (CCC) and is associated with inflammation and development of left ventricular systolic dysfunction. We tested the hypothesis that pentoxifylline (PTX) could reduce inflammation and prevent the development of MPD in a model of CCC in hamsters. METHODS AND RESULTS: We investigated with echocardiogram and rest myocardial perfusion scintigraphy at baseline (6-months after T. cruzi infection/saline) and post-treatment (after additional 2-months of PTX/saline administration), female Syrian hamsters assigned to 3 groups: T. cruzi-infected animals treated with PTX (CH + PTX) or saline (CH + SLN); and uninfected control animals (CO). At the baseline, all groups showed similar left ventricular ejection fraction (LVEF) and MPD areas. At post-treatment evaluation, there was a significant increase of MPD in CH + SLN group (0.8 ± 1.6 to 9.4 ± 9.7%), but not in CH + PTX (1.9 ± 3.0% to 2.7 ± 2.7%) that exhibited MPD area similar to CO (0.0 ± 0.0% to 0.0 ± 0.0%). The LVEF decreased in both infected groups. Histological analysis showed a reduced inflammatory infiltrate in CH + PTX group (395.7 ± 88.3 cell/mm2), as compared to CH + SLN (515.1 ± 133.0 cell/mm2), but larger than CO (193.0 ± 25.7 cell/mm2). The fibrosis and TNF-α expression was higher in both infected groups. CONCLUSIONS: The prolonged use of PTX is associated with positive effects, including prevention of MPD development and reduction of inflammation in the chronic hamster model of CCC.

AMMI-Bayesian perspective in the selection of pre-cultivars of carioca beans in Agreste-Sertão of Pernambuco, Brazil.

The productivity of beans is greatly influenced by the different edaphoclimatic conditions in the Agreste-Sertão region, requiring the identification of adapted and stable genotypes to minimize the effects of the interaction between genotypes per environments (GxE). The objective of this work was to analyze the adaptability and stability of carioca bean pre-cultivars in three municipalities in the Agreste-Sertão of Pernambuco using the AMMI model in its Bayesian version BAMMI and compare the results with the frequentist approach. According to the results, the BAMMI analysis showed better predictive capacity, as well as better performance in the study of adaptability and stability. The cultivar BRS Notável stood out in terms of main effect and stability. Adaptability of genotypes to specific locations was also observed, enabling the use of the positive effect of the GxE interaction, which was more evident with the BAMMI model. From this work, the flexibility of BAMMI model to deal with data resulting from multi-environmental experiments can be seen, overcoming limitations of the standard analysis of the AMMI model.

Automatic dental biofilm detection based on deep learning.

AIM: To estimate the automated biofilm detection capacity of the U-Net neural network on tooth images. MATERIALS AND METHODS: Two datasets of intra-oral photographs taken in the frontal and lateral views of permanent and deciduous dentitions were employed. The first dataset consisted of 96 photographs taken before and after applying a disclosing agent and was used to validate the domain's expert biofilm annotation (intra-class correlation coefficient = .93). The second dataset comprised 480 photos, with or without orthodontic appliances, and without disclosing agents, and was used to train the neural network to segment the biofilm. Dental biofilm labelled by the dentist (without disclosing agents) was considered the ground truth. Segmentation performance was measured using accuracy, F1 score, sensitivity, and specificity. RESULTS: The U-Net model achieved an accuracy of 91.8%, F1 score of 60.6%, specificity of 94.4%, and sensitivity of 67.2%. The accuracy was higher in the presence of orthodontic appliances (92.6%). CONCLUSIONS: Visually segmenting dental biofilm employing a U-Net is feasible and can assist professionals and patients in identifying dental biofilm, thus improving oral hygiene and health.

Use of the reversible jump Markov chain Monte Carlo algorithm to select multiplicative terms in the AMMI-Bayesian model.

The model selection stage has become a central theme in applying the additive main effects and multiplicative interaction (AMMI) model to determine the optimal number of bilinear components to be retained to describe the genotype-by-environment interaction (GEI). In the Bayesian context, this problem has been addressed by using information criteria and the Bayes factor. However, these procedures are computationally intensive, making their application unfeasible when the model's parametric space is large. A Bayesian analysis of the AMMI model was conducted using the Reversible Jump algorithm (RJMCMC) to determine the number of multiplicative terms needed to explain the GEI pattern. Three a priori distributions were assigned for the singular value scale parameter under different justifications, namely: i) the insufficient reason principle (uniform); ii) the invariance principle (Jeffreys' prior) and iii) the maximum entropy principle. Simulated and real data were used to exemplify the method. An evaluation of the predictive ability of models for simulated data was conducted and indicated that the AMMI analysis, in general, was robust, and models adjusted by the Reversible Jump method were superior to those in which sampling was performed only by the Gibbs sampler. In addition, the RJMCMC showed greater feasibility since the selection and estimation of parameters are carried out concurrently in the same sampling algorithm, being more attractive in terms of computational time. The use of the maximum entropy principle makes the analysis more flexible, avoiding the use of procedures for correcting prior degrees of freedom and obtaining improper posterior marginal distributions.

Association between Sleep Quality and Cardiac Autonomic Modulation in Adolescents: A Cross Sectional Study.

Objective To analyze the impact of sleep quality/duration on cardiac autonomic modulation on physically active adolescents with obesity. Materials and Methods The present cross-sectional study included 1,150 boys with a mean age of 16.6 ± 1.2 years. The assessment of cardiac functions included the frequency domain of heart rate variability (HRV; low frequency - LF; high frequency - HF; and the ratio between these bands -LF/HF -, defined as the sympathovagal balance), and each parameter was categorized as low / high . Physical activity levels and sleep quality/duration were obtained by questionnaires. Abdominal obesity was assessed and defined as waist circumference > 80 th percentile. Results Poor sleep quality resulted in lower HF (odds ratio [OR]: 1.8; 95% confidence interval [95%CI]: 1.01-3.21]) regardless of physical activity and abdominal obesity. Moreover, the study found no association between sleep duration and HRV parameters in adolescents. Conclusion Sleep quality, not sleep duration, reduces parasympathetic cardiac modulation apart from other factors such as physical activity and abdominal obesity in adolescents.

Reference values for triceps surae tissue oxygen saturation by near-infrared spectroscopy.

Objective.To establish the reference values for peripheral tissue perfusion of the triceps surae muscle assessed by Near-infrared spectroscopy (NIRS) at rest and in progressive effort.Approach.A total of 288 apparently healthy individuals of both sexes were included; between 30 and 79 years of age; nonsmokers; without diagnosis of diabetes mellitus, systemic arterial hypertension, kidney disease, symptoms of angina and intermittent claudication, or any musculoskeletal alteration that would prevent physical exertion; and without diagnosis of Peripheral arterial disease (PAD) or other associated symptoms. All individuals performed anthropometric measurements, physical activity levels, and tissue oxygen saturation (StO2) assessments by NIRS during and after arterial occlusion maneuver and incremental shuttle walking test. The variables obtained by NIRS were presented in percentiles (P) for general comparison between sexes and for comparison between sexes according to age group. The relationship between the NIRS data and other variables was tested.Main results.Considering P50 and p<0.05, men had lower StO2 values, higher deoxygenation and reoxygenation (Tx-reox) rates at rest, and higher Tx-reox during progressive effort. There were correlations (p<0.0001) of body composition with the lowest StO2 and Tx-reox values and of functional capacity with Tx-reox in occlusion and Tx-reox.Significance.The percentiles presented can clinically assist in the diagnosis and monitoring of different health conditions; however, it is important to consider the individual's sex, body composition, and functional capacity.

Boundary-aware glomerulus segmentation: Toward one-to-many stain generalization.

The growing availability of scanned whole-slide images (WSIs) has allowed nephropathology to open new possibilities for medical decision-making over high-resolution images. Diagnosis of renal WSIs includes locating and identifying specific structures in the tissue. Considering the glomerulus as one of the first structures analyzed by pathologists, we propose here a novel convolutional neural network for glomerulus segmentation. Our end-to-end network, named DS-FNet, combines the strengths of semantic segmentation and semantic boundary detection networks via an attention-aware mechanism. Although we trained the proposed network on periodic acid-Schiff (PAS)-stained WSIs, we found that our network was capable to segment glomeruli on WSIs stained with different techniques, such as periodic acid-methenamine silver (PAMS), hematoxylin-eosin (HE), and Masson trichrome (TRI). To assess the performance of the proposed method, we used three public data sets: HuBMAP (available in a Kaggle competition), a subset of the NEPTUNE data set, and a novel challenging data set, called WSI_Fiocruz. We compared the DS-FNet with six other deep learning networks: original U-Net, our attention version of U-Net called AU-Net, U-Net++, U-Net3Plus, ResU-Net, and DeepLabV3+. Results showed that DS-FNet achieved equivalent or superior results on all data sets: On the HuBMAP data set, it reached a dice score (DSC) of 95.05%, very close to the first place (95.15%); on the NEPTUNE and WSI_Fiocruz data sets, DS-FNet obtained the highest average DSC, whether on PAS-stained images or images stained with other techniques. To the best we know, this is the first work to show consistently high performance in a one-to-many-stain glomerulus segmentation following a thorough protocol on data sets from different medical labs.

Assessing the concept of control points for dissolved reactive phosphorus losses in subsurface drainage.

Agricultural phosphorus (P) loss, which is highly variable in space and time, has been studied using the hot spot/hot moment concept, but increasing the rigor of these assessments through a relatively newer "ecosystem control point" framework may help better target management practices that provide a disproportionate water quality benefit. Sixteen relatively large (0.85 ha) subsurface drainage plots in Illinois were used as individual observational units to assess dissolved reactive P (DRP) concentrations and losses within a given field over four study years. Three plot-months were identified as DRP control points (one export and two transport control points), where each plot-month contributed >10% of the annual DRP load from the field. These control points occurred on separate plots and in both the growing and nongrowing seasons but were likely related to agronomic P applications. Elevated soil test P, especially near a historic farmstead, and soil clay content were spatial drivers of P loss across the field. The nongrowing season was hypothesized to be the most significant period of P loss, but this was only documented in two of the four study years. A cereal rye (Secale cereale L.) cover crop did not significantly reduce DRP loss in any year, but there was also no evidence of increased drainage P losses due to freezing and thawing of the cover crop biomass. This work confirmed annual subsurface drainage DRP losses were agronomically small (<3% of P application rate), although the range of DRP concentrations relative to eutrophication criteria still demonstrated a potential for negative environmental impact. The control point concept may provide a new lens to view drainage DRP losses, but this framework should be refined through additional within-field studies because mechanisms of P export at this field were more nuanced than just the presence of tile drainage (i.e., a transport control point).

Association between screen time exposure, anxiety, and sleep quality in adolescents / Asociación entre el tiempo de exposición a la pantalla, la ansiedad y la calidad del sueño en adolescentes

Abstract Introduction The increase in sedentary screen time can negatively affect the quality of sleep, impacting the performance of daily activities. Objective To analyze the association between sedentary screen time and sleep quality, regardless of the symptoms of anxiety in adolescents of both genders. Method Cross-sectional study integrating school-based epidemiological research with a representative sample (n = 666) of high school students (14 to 19 years old) in public schools in the municipality of Caruaru-PE. The translated versions into Portuguese of the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HAD) were applied to analyze sleep quality and anxiety, respectively. Binary logistic regression was used to analyze the association, considering sleep quality as an outcome. Results There was a positive, statistically significant (p< .001) correlation between sleep quality and symptoms of anxiety (r = .393). A significant association regarding the association between screen time and sleep quality was noted only in those adolescents classified as being possible or probable anxiety cases and only in exposure to the computer (OR = 2.337; 95% CI [1.01, 5.43]) and video games (OR = 8.083; 95% CI [2.0, 32.8]) after adjusting for gender, age, and school shift. Discussion and conclusion Increased interaction with the screen and higher levels of anxiety can be more harmful to sleep in adolescents. Exposure to screen time, specifically those which have a greater interaction such as video games and computers, can have a negative impact on sleep quality, but only in adolescents with a higher risk of anxiety.

Resumen Introducción Un elevado tiempo de exposición de pantalla puede afectar tanto la calidad del sueño como las actividades diarias. Objetivo Analizar la asociación entre el tiempo de pantalla sedentario y la calidad del sueño, independientemente de los síntomas de ansiedad en adolescentes de ambos sexos. Método Estudio transversal que integra la investigación epidemiológica escolar con una muestra representativa (n = 666) de estudiantes (14 a 19 años) de escuelas públicas de Caruaru-PE. Las versiones traducidas al portugués del Índice de Calidad del Sueño de Pittsburgh (PSQI) y la Escala de Ansiedad y Depresión Hospitalaria (HAD) se aplicaron para analizar la calidad del sueño y la ansiedad. Se utilizó regresión logística binaria para analizar la asociación, considerando como resultado la calidad del sueño. Resultados Hubo una correlación positiva y estadísticamente significativa (p< .001) entre la calidad del sueño y los síntomas de ansiedad (r = .393). Una asociación significativa en cuanto a la asociación entre el tiempo de pantalla y la calidad del sueño se observó sólo en adolescentes clasificados como casos posibles o probables de ansiedad y sólo en la exposición al ordenador (OR = 2.337; IC 95% [1.01, 5.43]) y videojuegos (OR = 8.083; 95% IC [2.0, 32.8]) después de los ajustes. Discusión y conclusión Una mayor interacción con la pantalla y altos niveles de ansiedad pueden ser perjudiciales para el sueño. La exposición al tiempo de pantalla, específicamente aquellos con mayor interacción, como los videojuegos y las computadoras, puede afectar negativamente la calidad del sueño, pero sólo en adolescentes con mayor riesgo de ansiedad.