High rate of undetected infections in failed osteosynthesis of pertrochanteric fractures.

OBJECTIVE: The objective of this study was to assess the incidence of infection in patients with cut-out after PFF osteosynthesis. METHODS: Design: Retrospective cohort study. SETTING: Third-level trauma center. PATIENT SELECTION CRITERIA: Patients presenting with a cut-out following proximal femur fracture (PFF) (OTA/AO 31A) osteosynthesis, between January 2007 to December 2020. OUTCOME MEASUREMENTS: The primary outcome was infection according to EBJIS criteria. RESULTS: Sixty-seven patients presenting with a cut-out were included, with mean age of 83.3 years (range 63-96) and 51 (76.1%) were women. Of all cases, 16 (24.7%) presented a concomitant infection. The presence of concomitant infection was suspected preoperatively in only 3 of the cases. A subgroup analysis was performed between the cases with infection and those without infection, the groups being comparable in terms of demographic data and postoperative radiological criteria. Patients with underlying infection had a higher rate of surgical wound complication (56.3% vs 22%, p = 0.014) and higher rates of leukocytosis (11.560 vs 7.890, p = 0.023). CONCLUSION: Faced with a cut-out after osteosynthesis of a proximal femur fracture, underlying infection should be considered as a possible etiological factor. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Anaemia and iron deficiency associate with polymorphism TMPRSS6 rs855791 in Brazilian children attending day care centres.

Fe-deficiency anaemia is a major public health concern in children under 5 years of age. TMPRSS6 gene, encoding matriptase-2 protein, is implicated in Fe homoeostasis and has been associated with anaemia and Fe status in various populations. The aim of this cross-sectional study was to investigate the associations between the single nucleotide polymorphism (SNP) TMPRSS6 rs855791 and biomarkers of anaemia and Fe deficiency in Brazilian children attending day care centres. A total of 163 children aged 6-42 months were evaluated. Socio-economic, demographic, biochemical, haematological, immunological and genotype data were collected. Multiple logistic and linear regressions with hierarchical selection were used to assess the effects of independent variables on categorised outcomes and blood marker concentrations. Minor allele (T) frequency of rs855791 was 0·399. Each copy of the T allele was associated with a 4·49-fold increased risk of developing anaemia (P = 0·005) and a 4·23-fold increased risk of Fe deficiency assessed by serum soluble transferrin receptor (sTfR) (P < 0·001). The dose of the T allele was associated with an increase of 0·18 mg/l in sTfR concentrations and reductions of 1·41 fl and 0·52 pg in mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH), respectively. In conclusion, the T allele of SNP TMPRSS6 rs855791 was significantly associated with anaemia and Fe deficiency assessed by sTfR in Brazilian children attending day care centres. The effect was dose dependent, with each copy of the T allele being associated with lower MCV and MCH and higher concentrations of sTfR.

Associations between Normal-Weight Obesity and Disturbances in the Lipid Profile of Young Adults. / Associações entre Obesidade Eutrófica e Alterações no Perfil Lipídico de Adultos Jovens.

BACKGROUND: Normal-weight obesity (NWO) is characterized by normal body mass index (BMI) but high body fat percentage (%BF) that increases the risks of cardiometabolic comorbidities. Accurate assessment and interpretation of body composition data are necessary to reduce these risks. OBJECTIVES: To compare the cardiometabolic profile of individuals with NWO and normal %BF and evaluate the associated risk factors. METHODS: A cross-sectional study was conducted with 222 Brazilian adults from a university community, of whom 157 had NWO and 65 had normal BMI and %BF (non-NWO). All participants reported being asymptomatic and without underlying health conditions. Socioeconomic, lifestyle, food intake, anthropometry, body composition measures (using dual-energy radiological absorptiometry), and lipid and glycemic profiles were evaluated. A p < 0.05 was established as significant. RESULTS: The median age of the participants was 23 years (interquartile range: 21 to 25), and most were female (67.1%). No significant differences were found in blood pressure, age, or physical activity levels between the NWO and non-NWO groups. However, the frequency of lipid profile disturbances was higher in the NWO group (54%) compared to the non-NWO group (34%) (p < 0.006). Neck circumference, %BF, and lipid profile disturbances were positively associated with NWO. CONCLUSION: Individuals with NWO have a worse cardiometabolic profile than those without NWO, and this condition is associated with important biomarkers. Addressing these outcomes is important for preventing long-term cardiometabolic complications. Accurate assessment and interpretation of body composition data, regardless of BMI, are crucial in this scenario.

FUNDAMENTO: A obesidade eutrófica (OE) é caracterizada por índice de massa corporal (IMC) normal, mas com alto percentual de gordura corporal (%GC), o que aumenta os riscos de comorbidades cardiometabólicas. A avaliação e interpretação precisas dos dados de composição corporal são necessárias para reduzir esses riscos. OBJETIVOS: Comparar o perfil cardiometabólico de indivíduos com OE e %GC normal e avaliar os fatores de risco associados. MÉTODOS: Foi realizado estudo transversal com 222 adultos brasileiros de uma comunidade universitária, dos quais 157 tinham OE e 65 tinham IMC e %GC normais (grupo sem OE). Todos os participantes relataram ser assintomáticos e sem problemas de saúde subjacentes. Foram avaliadas características socioeconômicas, estilo de vida, consumo alimentar, antropometria, medidas de composição corporal (por meio de absorciometria radiológica de dupla energia) e perfis lipídico e glicêmico. Valor de p < 0,05 foi estabelecido como significativo. RESULTADOS: A mediana de idade dos participantes foi de 23 anos (intervalo interquartil: 21 a 25), sendo a maioria do sexo feminino (67,1%). Não foram encontradas diferenças significativas na pressão arterial, idade ou nível de atividade física entre os grupos com e sem OE. No entanto, a frequência de distúrbios do perfil lipídico foi maior no grupo com OE (54%) em comparação com o grupo sem OE (34%) (p < 0,006). Circunferência do pescoço, %GC e distúrbios do perfil lipídico foram positivamente associados com a OE. CONCLUSÃO: Indivíduos com OE apresentam pior perfil cardiometabólico do que aqueles sem OE, e essa condição está associada a importantes biomarcadores. Torna-se importante abordar esses resultados para prevenir complicações cardiometabólicas de longo prazo. A avaliação e a interpretação precisas dos dados da composição corporal, independentemente do IMC, são cruciais nesse cenário.

Arthroscopically Assisted Suprapatellar Tibial Nail Removal.

Intramedullary nailing remains the most popular and preferred method of fixation for tibial shaft fractures. The infrapatellar approach through the patellar tendon has long been considered the gold standard. However, the suprapatellar approach has gained popularity because of the advantages of being easier to perform when treating proximal shaft and metaphyseal fractures and there being less postoperative anterior knee pain. Despite increased use of this approach, the removal of the implant from the same suprapatellar approach is tricky, and in most cases, the removal is performed through a new transpatellar tendon approach. This article describes arthroscopically assisted suprapatellar tibial nail removal using the same approach and instrumentation of the nail insertion. The technique has the advantage of preserving the patellar tendon without causing secondary damage to it. Through arthroscopy, direct visualization of the patellofemoral joint aids in preventing possible cartilage injury. Moreover, any associated intra-articular lesions can be diagnosed and addressed.

Whole-genome resequencing of common bean elite breeding lines.

The expansion of bean genome technologies has prompted new perspectives on generating resources and knowledge essential to research and implementing biotechnological tools for the practical operations of plant breeding programs. This study aimed to resequence the entire genome (whole genome sequencing-WGS) of 40 bean genotypes selected based on their significance in breeding programs worldwide, with the objective of generating an extensive database for the identification of single nucleotide polymorphisms (SNPs). Over 6 million SNPs were identified, distributed across the 11 bean chromosomes. After quality variant filtering, 420,509 high-quality SNPs were established, with an average of 38,228 SNPs per chromosome. These variants were categorized based on their predicted effects, revealing that the majority exerted a modifier impact on non-coding genome regions (94.68%). Notably, a significant proportion of SNPs occurred in intergenic regions (62.89%) and at least one SNP was identified in 58.63% of the genes annotated in the bean genome. Of particular interest, 7841 SNPs were identified in 85% of the putative plant disease defense-related genes, presenting a valuable resource for crop breeding efforts. These findings provide a foundation for the development of innovative and broadly applicable technologies for the routine selection of superior genotypes in global bean improvement and germplasm characterization programs.

Consumption of ultra- and non-ultra-processed foods of individuals with normal-weight obesity.

The normal-weight obesity (NWO) is highly associated with an increased risk for chronic non-communicable diseases and intricately linked to diet quality. Therefore, we assessed the consumption of ultra-processed and non-ultraprocessed foods of 224 Brazilian adults with NWO (n 159) and without NWO (n 65, non-NWO) in a cross-sectional study. For that, three dietary recalls were applied and categorised according to the NOVA classification. Individuals with NWO showed lower energy intake from the 'fresh or minimally processed food' group, specifically for rice (P = 0⋅037), beans (P = 0⋅002) and fruits (P = 0⋅026), as well as lower consumption of dietary fibre (P < 0⋅05) compared with non-NWO subjects. Total consumption of ultra-processed foods did not differ between groups; however, individuals with NWO had a higher energy intake from processed meats compared with the non-NWO group (54⋅1 ± 73⋅5 × 32⋅5 ± 50⋅8 kcal; P = 0⋅023). Energy and added sugar from ultra-processed foods (OR 1⋅02, CI 95 % 1⋅00-1⋅04, P = 0⋅0100) and total fat from non-ultra-processed foods (OR 1⋅09, CI 95 % 1⋅01-1⋅18; P = 0⋅0100) were associated with the presence of NWO. In conclusion, non-NWO individuals consumed more non-ultra-processed foods compared with the NWO group. Overall, there were no differences in the consumption of ultra-processed foods between the two groups. Important associations between food compounds and the presence of NWO were observed, emphasising the importance of fresh and minimally processed foods as the basis of the diet.

Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis.

AIM: To evaluate the simulation design characteristics that may influence the stress, anxiety and self-confidence of undergraduate nursing students during learning. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Searchers were conducted in October 2020 and updated in August 2022 in the databases CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, Scopus and Web of Science, PQDT Open (ProQuest), BDTD, Google Scholar and specific journals on simulation. REVIEW METHODS: This review was conducted according to the recommendations of Cochrane Handbook for Systematic Reviews and reported according to the PRISMA Statement. Experimental and quasi-experimental studies that compared the effect of simulation on stress, anxiety and self-confidence of nursing students were included. The selection of studies and data extraction was performed independently by two reviewers. Simulation information was collected as prebriefing, scenario, debriefing, duration, modality, fidelity and simulator. Data summarization was performed by qualitative synthesis and meta-analytical methods. RESULTS: Eighty studies were included in the review, and most reported in detail the structure of the simulation, contemplating prebriefing, scenario, debriefing and the duration of each step. In subgroup meta-analysis, the presence of prebriefing, duration of more than 60 min and high-fidelity simulations helped reduce anxiety, while the presence of prebriefing and debriefing, duration, immersive clinical simulation modalities and procedure simulation, high-fidelity simulations and use of mannequins, standardised patients and virtual simulators, contributed to greater students' self-confidence. CONCLUSIONS: Different modulations of simulation design components imply reduction of anxiety and increased self-confidence in nursing students, especially highlighting the quality of the methodological report of simulation interventions. RELEVANCE TO CLINICAL PRACTICE: These findings help to support the need of more rigorous methodology in simulation designs and research methods. Consequently, impact on the education of qualified professionals prepared to work in clinical practice. No Patient or Public Contribution.

Prevalence of vitamin D deficiency in South America: a systematic review and meta-analysis.

CONTEXT: Vitamin D deficiency is considered a global public health issue, even in low-latitude countries where there is abundant sunlight radiation. Nevertheless, the prevalence of vitamin D insufficiency and deficiency in the South American continent has not been well characterized. OBJECTIVE: The aim of this review was to estimate the prevalence of vitamin D deficiency (25-hydroxy-calciferol < 20 ng/mL) in South American populations. DATA SOURCES: Seven electronic databases (MEDLINE, Web of Science, Embase, Biblioteca Virtual de Saúde, SciELO, Scopus, and Google Scholar) were searched systematically for observational studies published before July 1, 2021, and reporting vitamin D status of healthy adults in South America. DATA EXTRACTION: Data were extracted using a standardized form. Risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence. All steps were conducted independently by two authors. Data were pooled using a random-effects model. Stratified meta-analysis and meta-regression were conducted (R software). DATA ANALYSIS: Of 9460 articles identified, 96 studies with a total of 227 758 participants were included. The overall prevalence of vitamin D deficiency was 34.76% (79 studies; 95%CI, 29.68-40.21; I2 = 99%). There were significant differences in prevalence rates related to age, sex, country, latitude, season, and year of publication. CONCLUSION: The prevalence of vitamin D deficiency is unexpectedly elevated in South American populations. Public health strategies should include efforts to prevent, detect, and treat vitamin D deficiency. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42020169439.

Chemical composition and prebiotic activity of baru (Dipteryx alata Vog.) pulp on probiotic strains and human colonic microbiota.

Little knowledge is available in literature regarding the chemical composition and health-promoting effects of baru (Dipteryx alata Vog.) pulp, a by-product usually discarded by the agro-industry during the processing of baru fruit. This study evaluated the chemical composition of baru pulp and investigated its prebiotic activity on distinct probiotic strains and human colonic microbiota with in vitro assays. Baru pulp had high contents of insoluble dietary fibers and phenolic compounds (mainly hesperidin). Baru pulp stimulated the growth and metabolism of the probiotics Bifidobacterium animalis subsp. lactis BB-12, Lactobacillus acidophilus LA-05, and Lacticaseibacillus casei L-26. In addition, digested baru pulp induced significant benefits on the human colonic microbiota, increasing the relative abundance of Lactobacillus-Enterococcus, Bifidobacterium, and Bacteroides-Prevotella, as well as the production of lactate, acetate, propionate, and butyrate. The results show that baru pulp has potential prebiotic properties to be explored in the formulation of new health-promoting foods.

Associações entre Obesidade Eutrófica e Alterações no Perfil Lipídico de Adultos Jovens / Associations between Normal-Weight Obesity and Disturbances in the Lipid Profile of Young Adults

Resumo Fundamento A obesidade eutrófica (OE) é caracterizada por índice de massa corporal (IMC) normal, mas com alto percentual de gordura corporal (%GC), o que aumenta os riscos de comorbidades cardiometabólicas. A avaliação e interpretação precisas dos dados de composição corporal são necessárias para reduzir esses riscos. Objetivos Comparar o perfil cardiometabólico de indivíduos com OE e %GC normal e avaliar os fatores de risco associados. Métodos Foi realizado estudo transversal com 222 adultos brasileiros de uma comunidade universitária, dos quais 157 tinham OE e 65 tinham IMC e %GC normais (grupo sem OE). Todos os participantes relataram ser assintomáticos e sem problemas de saúde subjacentes. Foram avaliadas características socioeconômicas, estilo de vida, consumo alimentar, antropometria, medidas de composição corporal (por meio de absorciometria radiológica de dupla energia) e perfis lipídico e glicêmico. Valor de p < 0,05 foi estabelecido como significativo. Resultados A mediana de idade dos participantes foi de 23 anos (intervalo interquartil: 21 a 25), sendo a maioria do sexo feminino (67,1%). Não foram encontradas diferenças significativas na pressão arterial, idade ou nível de atividade física entre os grupos com e sem OE. No entanto, a frequência de distúrbios do perfil lipídico foi maior no grupo com OE (54%) em comparação com o grupo sem OE (34%) (p < 0,006). Circunferência do pescoço, %GC e distúrbios do perfil lipídico foram positivamente associados com a OE. Conclusão Indivíduos com OE apresentam pior perfil cardiometabólico do que aqueles sem OE, e essa condição está associada a importantes biomarcadores. Torna-se importante abordar esses resultados para prevenir complicações cardiometabólicas de longo prazo. A avaliação e a interpretação precisas dos dados da composição corporal, independentemente do IMC, são cruciais nesse cenário.

Abstract Background Normal-weight obesity (NWO) is characterized by normal body mass index (BMI) but high body fat percentage (%BF) that increases the risks of cardiometabolic comorbidities. Accurate assessment and interpretation of body composition data are necessary to reduce these risks. Objectives To compare the cardiometabolic profile of individuals with NWO and normal %BF and evaluate the associated risk factors. Methods A cross-sectional study was conducted with 222 Brazilian adults from a university community, of whom 157 had NWO and 65 had normal BMI and %BF (non-NWO). All participants reported being asymptomatic and without underlying health conditions. Socioeconomic, lifestyle, food intake, anthropometry, body composition measures (using dual-energy radiological absorptiometry), and lipid and glycemic profiles were evaluated. A p < 0.05 was established as significant. Results The median age of the participants was 23 years (interquartile range: 21 to 25), and most were female (67.1%). No significant differences were found in blood pressure, age, or physical activity levels between the NWO and non-NWO groups. However, the frequency of lipid profile disturbances was higher in the NWO group (54%) compared to the non-NWO group (34%) (p < 0.006). Neck circumference, %BF, and lipid profile disturbances were positively associated with NWO. Conclusion Individuals with NWO have a worse cardiometabolic profile than those without NWO, and this condition is associated with important biomarkers. Addressing these outcomes is important for preventing long-term cardiometabolic complications. Accurate assessment and interpretation of body composition data, regardless of BMI, are crucial in this scenario.

Genetic mapping of the Andean anthracnose resistance gene present in the common bean cultivar BRSMG Realce.

The rajado seeded Andean bean (Phaseolus vulgaris L.) cultivar BRSMG Realce (striped seed coat) developed by Embrapa expressed a high level of anthracnose resistance, caused by Colletotrichum lindemuthianum, in field and greenhouse screenings. The main goal of this study was to evaluate the inheritance of anthracnose resistance in BRSMG Realce, map the resistance locus or major gene cluster previously named as Co-Realce, identify resistance-related positional genes, and analyze potential markers linked to the resistance allele. F2 plants derived from the cross BRSMG Realce × BRS FC104 (Mesoamerican) and from the cross BRSMG Realce × BRS Notável (Mesoamerican) were inoculated with the C. lindemuthianum races 475 and 81, respectively. The BRSMG Realce × BRS FC104 F2 population was also genotyped using the DArTseq technology. Crosses between BRSMG Realce and BAT 93 (Mesoamerican) were also conducted and resulting F2 plants were inoculated with the C. lindemuthianum races 65 and 1609, individually. The results shown that anthracnose resistance in BRSMG Realce is controlled by a single locus with complete dominance. A genetic map including 1,118 SNP markers was built and shown 78% of the markers mapped at a distances less than 5.0 cM, with a total genetic length of 4,473.4 cM. A major locus (Co-Realce) explaining 54.6% of the phenotypic variation of symptoms caused by the race 475 was identified in Pv04, flanked by the markers snp1327 and snp12782 and 4.48 cM apart each other. These SNPs are useful for marker-assisted selection, due to an estimated selection efficiency of 99.2%. The identified resistance allele segregates independently of the resistance allele Co-33 (Pv04) present in BAT 93. The mapped genomic region with 704,867 bp comprising 63 putative genes, 44 of which were related to the pathogen-host interaction. Based on all these results and evidence, anthracnose resistance in BRSMG Realce should be considered as monogenic, useful for breeding purpose. It is proposed that locus Co-Realce is unique and be provisionally designated as CoPv04R until be officially nominated in accordance with the rules established by the Bean Improvement Cooperative Genetics Committee.

Effects of Oral Nutritional Supplementation on Patients with Venous Ulcers: A Clinical Trial.

Background: The dosage and safety of nutritional supplements for patients with venous ulcers are still not well established. Aim: To evaluate the effects of a high calorie, high protein, arginine-, zinc-, and vitamins A, C, and E-enriched nutritional supplement on the biochemical profile, dietary intake, anthropometry, muscle strength, and characteristics of lesions of patients with venous ulcers. Methods: A controlled before−after clinical trial with a four-week follow-up involved 27 patients with venous ulcers under outpatient treatment in Brazil. It was administered in two to three doses per day (200 mL each) of a high-calorie and high-protein supplement enriched with arginine, zinc, and vitamins A, C, and E. Patients were assessed for anthropometric parameters, dietary intake, biochemical tests, and healing conditions according to the Pressure Ulcer Scale for Healing (PUSH). Results: It was observed that an increase in energy and protein supply led to an adequate intake of immunonutrients (zinc and vitamins A, C, and E), increased body weight, increased body mass index, and stronger handgrip strength. The injury area and the score on the PUSH notably decreased after the intervention (p < 0.001). Conclusions: The administered supplement, at the tested dosage, improved the nutritional status and characteristics of lesions in patients with venous ulcers.

Lack of sufficient evidence to support a positive role of selenium status in depression: a systematic review.

CONTEXT: Globally, depression affects more than 322 million people. Studies exploring the relationship between diet and depression have revealed the benefits of certain dietary patterns and micronutrients in attenuating the symptoms of this disorder. Among these micronutrients, selenium stands out because of its multifaceted role in the brain. OBJECTIVE: To assess the impact of selenium intake and status on symptoms of depression. DATA SOURCES: A systematic search was performed in databases, including PubMed, Web of Science, EMBASE, PsycINFO, Scopus, and gray literature (on April 6, 2021, updated on January 28, 2022), without restrictions of date, language, or study type. DATA EXTRACTION: Studies of adults (18-60 y of age) with depression or depressive symptoms were included. Data on selenium biomarkers and/or intake were included. The risk of bias was assessed using the Joanna Briggs Institute checklists. DATA ANALYSIS: Of the 10 studies included, 2 were cohorts (n = 13 983 and 3735), 3 were cross-sectional (n = 736, 7725, and 200), 1 was case-control (n = 495), and 4 were randomized controlled trials (n = 30, 11, 38, and 63). Several studies have indicated that low selenium intake or concentration may be associated with symptoms of depression. However, this association was inconsistent across the studies included in this systematic review; due to the high heterogeneity, it was not possible to perform meta-analyses. The main contributing factors to the high heterogeneity include the different methodological designs, methods for diagnosing depression, selenium assessment, and clinical conditions. CONCLUSION: Overall, there is insufficient evidence to support a positive role of selenium status in depression. Studies with more accurate methods and adequate assessment of selenium status are needed to better understand the role of this nutrient in depression. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42021220683.

Effect of simulation on stress, anxiety, and self-confidence in nursing students: Systematic review with meta-analysis and meta-regression.

INTRODUCTION: Simulation is a promising strategy in health education, with evidence of importance for learning, but the available systematic reviews are still inconclusive about the effect of the strategy on stress, anxiety, and self-confidence of nursing students, which impact the adherence to and sustainment of this strategy. Thus, better evidence is needed of the impact of simulation on these competences, essential for health professional education. OBJECTIVE: To evaluate the effect of simulation-based experiences on stress, anxiety, self-confidence and learning of undergraduate nursing students compared to conventional teaching strategies or no intervention. DESIGN: Systematic review with meta-analysis and meta-regression. DATA SOURCES: The databases used included: CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, SCOPUS and Web of Science. Additional searches occurred in PQDT Open (ProQuest), BDTD, Google Scholar and journals with a specific scope in clinical simulation. REVIEW METHODS: This study was conducted by the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Experimental and quasi-experimental studies that compared the effects of simulation on stress, anxiety, and self-confidence of nursing students were included. Study selection and data extraction steps were performed independently by two reviewers. Critical appraisal of the studies was managed by means of the risk of bias tools RoB 2 and ROBINS-I, and quality of evidence by means of the GRADE tool. Data summarization was performed by qualitative synthesis with descriptive analysis and quantitative synthesis by meta-analytic methods and meta-regression. RESULTS: Sixty-two studies were included covering an overall sample of 4570 undergraduate nursing students. When comparing simulation with other teaching strategies, simulation showed small effect size for anxiety (d = -0.33; 95% CI: -0.66-0.002; p = 0.051) and medium effect size for self-confidence (d = 0.71; 95% CI: 0.46-0.95; p < 0.001); there was no difference in the effect-size for stress (d = 0.04; 95% CI:-0.91-0.99; p = 0.90). Subgroup analyses showed an effect of methodological characteristics of the studies on students' anxiety and self-confidence. A positive relationship between self-confidence and learning was identified by meta-regression (p = 0.018; R2 = 20.96%). CONCLUSION: Simulation is an effective strategy for reducing anxiety and increasing self-confidence compared to conventional teaching strategies. Results are still inconclusive for stress. The use of simulation-based experiences in nursing education obtains positive results on anxiety and self-confidence in students, providing support for its implementation in undergraduate curricula to improve the education of qualified nurses. REGISTRATION NUMBER: CRD42020206077. TWEETABLE ABSTRACT: Simulation is an effective teaching strategy for reducing anxiety and increasing self-confidence in learning.

Patients lose weight after a total knee arthroplasty: myth or reality?

BACKGROUND: Obesity is one of most discussed factors when assessing prosthetic knee surgery outcomes. Prior to the procedure, most patients perceive that their excessive weight is secondary to the low level of activity due to limiting knee pain. OBJECTIVES: The main objective of this study was to assess whether patients undergoing total knee arthroplasty (TKA) lose weight after the procedure. The secondary objective was to correlate weight loss with post-operative knee function. METHODS: A prospective observational study was designed including 247 patients who undergone TKA from January 2018 to January 2019. A significant change in weight was considered anything above or below 5% of the pre-operative weight. Three groups were established based on a change in weight: loss of more than 5%, those who did not pass above or below 5% of their initial weight and increase of more than 5%. Follow-up was carried out at 12 months after the intervention assessing patient's BMI (kg/m2), functional level (KSS), weight loss expectations, and range of motion. RESULTS: Among the total population, 17 (6.9%) lost weight, 168 (68%) did not have a change, and 62 (25.1%) increased weight at one year follow-up. The mean pre-operative BMI was 31.5 kg/m2, and mean postoperative BMI was 31.98 kg/m2. Furthermore, obese patients were more likely to present weight reduction than non-obese (p = 0.01). When comparing functional results between groups, no differences were observed in terms of KSS-K and KSS-F. CONCLUSION: Patients who undergo TKA do not lose weight one year after surgery. When correlating weight loss with post-operative outcomes, no differences were observed between groups.

Dietary Intake is Associated with miR-31 and miR-375 Expression in Patients with Head and Neck Squamous Cell Carcinoma.

MicroRNAs (miRNAs) are important epigenetic regulators in head and neck squamous cell carcinoma (HNSCC), with miR-31 being considered an oncomir and miR-375, a tumor suppressor miR, which are up- and down-regulated in HNSCC, respectively. Nutrients are known to influence miRNA expression; however, this association is poorly explored in HNSCC. This work aimed to identify associations between dietary intake and the expression of miR-31 and miR-375 in patients newly diagnosed with HNSCC. The expression of miR-31 was positively associated with the consumption of iron (ß = 16.65) and vitamin C (ß = 0.37), and inversely associated with total sugar (ß = -0.88), cholesterol (ß= -0.23), vitamin B9 (ß= -0.37) and zinc (ß = -5.66) intake. The expression of miR-375 was positively associated with the consumption of selenium (ß = 1.52), vitamin C (ß = 0.17) and vitamin D (ß = 13.01), and inversely associated with the consumption of added sugar (ß = -0.49), phosphorus (ß= -0.27) and vitamin B12 (ß = -10.80). Our findings showed important associations between dietary intake and miR-31 and miR-375 expression in HNSCC, offering possible directions for further studies investigating how nutrients interfere with carcinogenesis.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.1990972 .

[Factors that influence children`s anthropometric indices: a focus on female single-parent families]. / Fatores que afetam os índices antropométricos infantis: um enfoque nas famílias monoparentais femininas.

In the last decades several alterations have occurred in the dynamics of the organization of families, including changes in size, structure, and composition. Among new family arrangements, the increase in female single-parent families stands out. This structure tends to be in a situation of greater social vulnerability in relation to other arrangements. With this in mind, the scope of this study sought to analyze the relationship between the female single-parent family arrangement and anthropometric measurements of under five-year-old offspring, with data from the 2008-2009 Brazilian household budget survey (POF/IBGE). Two equations for the analysis of anthropometric measurements, with the z-score of "height-for-age" and the z-score of "weight-for-height" as dependent variables, were estimated. The results revealed that, taking other important variables into consideration, such as income, education and domestic characteristics pertaining to the "female single-parent" arrangement, had a positive effect on anthropometric measurements when compared with the "couple with children" arrangement, indicating that in households in which the mother does not have a spouse in residence, children had better long-term health indicators than in households in which the spouse was present.

Nas últimas décadas aconteceram várias alterações no padrão de organização das famílias, como mudanças no tamanho, estrutura e composição. Dentre os novos arranjos familiares, destaca-se o crescimento de famílias monoparentais femininas. Este arranjo tende a se encontrar em situação de maior vulnerabilidade social em relação a outros arranjos. Diante disso, este estudo buscou analisar a relação entre o arranjo monoparental feminino e o estado nutricional de crianças menores de cinco anos, com dados da Pesquisa de Orçamentos Familiares (POF/IBGE) de 2008-2009. Para isso, estimaram-se duas equações para análise de índices antropométricos, tendo como variáveis dependentes o escore z da "altura para idade" e o escore z do "peso para altura". Os resultados mostraram que, controlando para outras variáveis importantes como renda, escolaridade e características domiciliares, pertencer ao arranjo "monoparental feminino" teve efeito positivo sobre o escore z da "altura para idade" quando comparado ao arranjo "casal com filhos", indicando que a presença da mãe, sem o cônjuge, contribui para melhorar esse indicador de saúde de longo prazo.

Fatores que afetam os índices antropométricos infantis: um enfoque nas famílias monoparentais femininas / Factors that influence children`s anthropometric indices: a focus on female single-parent families

Resumo Nas últimas décadas aconteceram várias alterações no padrão de organização das famílias, como mudanças no tamanho, estrutura e composição. Dentre os novos arranjos familiares, destaca-se o crescimento de famílias monoparentais femininas. Este arranjo tende a se encontrar em situação de maior vulnerabilidade social em relação a outros arranjos. Diante disso, este estudo buscou analisar a relação entre o arranjo monoparental feminino e o estado nutricional de crianças menores de cinco anos, com dados da Pesquisa de Orçamentos Familiares (POF/IBGE) de 2008-2009. Para isso, estimaram-se duas equações para análise de índices antropométricos, tendo como variáveis dependentes o escore z da "altura para idade" e o escore z do "peso para altura". Os resultados mostraram que, controlando para outras variáveis importantes como renda, escolaridade e características domiciliares, pertencer ao arranjo "monoparental feminino" teve efeito positivo sobre o escore z da "altura para idade" quando comparado ao arranjo "casal com filhos", indicando que a presença da mãe, sem o cônjuge, contribui para melhorar esse indicador de saúde de longo prazo.

Abstract In the last decades several alterations have occurred in the dynamics of the organization of families, including changes in size, structure, and composition. Among new family arrangements, the increase in female single-parent families stands out. This structure tends to be in a situation of greater social vulnerability in relation to other arrangements. With this in mind, the scope of this study sought to analyze the relationship between the female single-parent family arrangement and anthropometric measurements of under five-year-old offspring, with data from the 2008-2009 Brazilian household budget survey (POF/IBGE). Two equations for the analysis of anthropometric measurements, with the z-score of "height-for-age" and the z-score of "weight-for-height" as dependent variables, were estimated. The results revealed that, taking other important variables into consideration, such as income, education and domestic characteristics pertaining to the "female single-parent" arrangement, had a positive effect on anthropometric measurements when compared with the "couple with children" arrangement, indicating that in households in which the mother does not have a spouse in residence, children had better long-term health indicators than in households in which the spouse was present.

Determination of genetic scores to estimate disturbances in circulating lipid profile biomarkers of adolescents: A preliminary report.

OBJECTIVE: The aim of this study was to develop genetic scores based on single-nucleotide polymorphisms (SNPs) related to lipid metabolism and evaluate whether they used to estimate disturbances in the circulating lipid profile biomarkers of adolescents. METHODS: In a preliminary cross-sectional approach, 113 Brazilian adolescents (10-19 y of age) with cardiovascular disease risk factors were evaluated. Genetic scores from 20 SNPs related to lipid metabolism were calculated by codifying each of them as the rescaled sum of risk allele frequencies. All scores were distributed in classes between 0 (absence of risk alleles) and 10 (presence of all risk alleles) to evaluate the additive effect of risk alleles on the lipid profile outcomes in the same interval. Multiple linear regression analyses were performed to evaluate the association between each score and blood lipid profile biomarkers. RESULTS: Significant associations between genetic scores and unfavorable outcomes in all evaluated lipid profile biomarkers were found. The mean ± SD of the genetic scores for the circulating lipid profile biomarkers in the 0 to 10 scale were 4.4 ± 2 for triacylglycerol, 5.3 ± 1.5 for total cholesterol, 5.6 ± 1.2 for high-density lipoprotein cholesterol, 4.9 ± 1.6 for low-density lipoprotein cholesterol, and 3.6 ± 1.9 for minimally modified low-density lipoprotein cholesterol. For each point obtained in each genetic score, a mean increase ± SE of 15.8 ± 4.2 mg/dL in triacylglycerol (P = 0.0001), 5.3 ± 1.7 mg/dL in total cholesterol (P = 0.0032), 4.8 ± 1.3 mg/dL in low-density lipoprotein cholesterol (P = 0.0003), and 1.1 ± 0.3 U/L in minimally modified low-density lipoprotein cholesterol (P = 0.0020) and a mean decrease of 3.7 ± 0.7 mg/dL in high-density lipoprotein cholesterol (P < 0.0001) concentrations were obtained. CONCLUSION: The calculated genetic scores could be used to estimate disturbances in circulating lipid profile biomarkers of adolescents and be applied in clinical practice to better target interventions to reduce cardiovascular disease risk throughout life.

Electric Scooter-Related Injuries: A New Epidemic in Orthopedics.

BACKGROUND: The use of electric scooters has increased considerably as they are an accessible means of transportation. The number of injuries from falls and collisions has risen significantly. Therefore, the aim of the study was to describe demographics injury patterns of electric scooter accidents produced over one year. METHODS: A prospective observational study of electric scooter- related injuries presented in the emergency room from May 2019 until May 2020. The inclusion criteria was based on the direct cause of injury produced while an electric scooter was in use. Demographic data, the use of a helmet or the lack thereof, accident mechanism, injury time, type of injury produced, and the treatment applied were collected. RESULTS: Over the study period, 397 patients were identified with a total of 422 injuries. The mean age was 30.8 years, with 12.6% of patients being minors. The patients mainly presented in evening hours and in summertime at the emergency department. Of the total injuries seen, 46.9% were fractures. Some 25% of the total cases required surgery. Only 19% of the riders wore a helmet at the time of the accident. Most of the fractures were to the upper limbs (62.6%). There was a greater incidence of radius fractures. CONCLUSION: Injuries incurred while using electric scooters are an emerging phenomenon, despite existing regulations. In this study, most injuries occurred in young men and were due to falls from the vehicle. Nearly half of those injuries were fractures to the upper limbs. Surprisingly, 50% of the fractures required surgery.