Epigenetic programming for obesity and noncommunicable disease: From womb to tomb.

Several epidemiological, clinical and experimental studies in recent decades have shown the relationship between exposure to stressors during development and health outcomes later in life. The characterization of these susceptible phases, such as preconception, gestation, lactation and adolescence, and the understanding of factors that influence the risk of an adult individual for developing obesity, metabolic and cardiovascular diseases, is the focus of the DOHaD (Developmental Origins of Health and Disease) research line. In this sense, advancements in molecular biology techniques have contributed significantly to the understanding of the mechanisms underlying the observed phenotypes, their morphological and physiological alterations, having as a main driving factor the epigenetic modifications and their consequent modulation of gene expression. The present narrative review aimed to characterize the different susceptible phases of development and associated epigenetic modifications, and their implication in the development of non-communicable diseases. Additionally, we provide useful insights into interventions during development to counteract or prevent long-term programming for disease susceptibility.

Intersectional insights into racism and health: not just a question of identity.

Intersectionality is a useful tool to address health inequalities, by helping us understand and respond to the individual and group effects of converging systems of power. Intersectionality rejects the notion of inequalities being the result of single, distinct factors, and instead focuses on the relationships between overlapping processes that create inequities. In this Series paper, we use an intersectional approach to highlight the intersections of racism, xenophobia, and discrimination with other systems of oppression, how this affects health, and what can be done about it. We present five case studies from different global locations that outline different dimensions of discrimination based on caste, ethnicity and migration status, Indigeneity, religion, and skin colour. Although experiences are diverse, the case studies show commonalities in how discrimination operates to affect health and wellbeing: how historical factors and coloniality shape contemporary experiences of race and racism; how racism leads to separation and hierarchies across shifting lines of identity and privilege; how racism and discrimination are institutionalised at a systems level and are embedded in laws, regulations, practices, and health systems; how discrimination, minoritisation, and exclusion are racialised processes, influenced by visible factors and tacit knowledge; and how racism is a form of structural violence. These insights allow us to begin to articulate starting points for justice-based action that addresses root causes, engages beyond the health sector, and encourages transnational solidarity.

Relationship between polyvictimization and overweight among adolescents from São Paulo city, Brazil.

This study is to identify victimization patterns and analyze the association between the experience of polyvictimization and overweight or obesity among adolescent girls and boys. The sample consisted of 2680 Brazilian ninth-graders enrolled in public and private schools, taken from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Victimization was explored in two ways: (i) as per Finkelhor and (ii) by latent class analysis (LCA). The interest outcomes were overweight and obesity. Multinomial logistic regression models were used to study the relationship between victimization and overweight or obesity, controlling for confounders. LCA grouped boys and girls adolescents into three classes. These classes received the same labels, but the patterns differed between sexes. Class 1 was characterized by fewer types of victimization suffered and lower endorsement values in the analyzed items and was named bullying and indirect victimization (♀: 42.7%, n = 546; ♂: 21.6%, n = 293). Class 2 included more victimization types than Class 1 and less than Class 3. This class was labeled family violence and peer victimization (♀: 29.1%, n = 356; ♂: 47.9%, n = 652). Class 3 was named high polyvictimization (♀: 28.2%, n = 345; ♂: 30.5%, n = 418). According to Finkelhor, polyvictimization was not associated with overweight or obesity in both sexes. Only the class of high polyvictimization was associated with being overweight (ORadj: 1.60, 95%CI: 1.01-2.54) in girls. In this study, polyvictimization was associated with being overweight only among adolescent girls. Longitudinal studies in different contexts and populations are needed to understand this relationship.

Lean in one way, in obesity another: effects of moderate exercise in brown adipose tissue of early overfed male Wistar rats.

BACKGROUND: Early postnatal overfeeding (PO) induces long-term overweight and reduces brown adipose tissue (BAT) thermogenesis. Exercise has been suggested as a possible intervention to increase BAT function. In this study, we investigated chronical effects of moderate-intensity exercise in BAT function in postnatal overfed male Wistar rats METHODS: Litters' delivery was on postnatal-day 0 - PN0. At PN2, litters were adjusted to nine (normal litter - NL) or three pups (small litter - SL) per dam. Animals were weaned on PN21 and in PN30 randomly divided into sedentary (NL-Sed and SL-Sed) or exercised (NL-Exe and SL-Exe), N of 14 litters per group. Exercise protocol started (PN30) with an effort test; training sessions were performed three times weekly at 60% of the VO2max achieved in effort test, until PN80. On PN81, a temperature transponder was implanted beneath the interscapular BAT, whose temperature was assessed in periods of lights-on and -off from PN87 to PN90. Sympathetic nerve activation of BAT was registered at PN90. Animals were euthanized at PN91 and tissues collected RESULTS: PO impaired BAT thermogenesis in lights-on (pPO < 0.0001) and -off (pPO < 0.01). Exercise increased BAT temperature in lights-on (pExe < 0.0001). In NL-Exe, increased BAT activity was associated with higher sympathetic activity (pExe < 0.05), ß3-AR (pExe < 0.001), and UCP1 (pExe < 0.001) content. In SL-Exe, increasing BAT thermogenesis is driven by a combination of tissue morphology remodeling (pExe < 0.0001) with greater effect in increasing UCP1 (pExe < 0.001) and increased ß3-AR (pExe < 0.001) content. CONCLUSION: Moderate exercise chronically increased BAT thermogenesis in both, NL and SL groups. In NL-Exe by increasing Sympathetic activity, and in SL-Exe by a combination of increased ß3-AR and UCP1 content with morphologic remodeling of BAT. Chronically increasing BAT thermogenesis in obese subjects may lead to higher overall energy expenditure, favoring the reduction of obesity and related comorbidities.

Primary dental care treatment in primary Sjögren's syndrome: a possible role in improving salivary flow rate.

OBJECTIVES: Primary Sjögren's syndrome (pSS) is an inflammatory chronic disorder that mainly affects exocrine glands. Additionally, oral infections can aggravate the glandular dysfunction. However, data on primary dental care (PDC) treatment in pSS are scarce. This study aimed to appraise the impact of PDC on the Xerostomia Inventory (XI), unstimulated/stimulated salivary flow rates and salivary cytokine profile in pSS. METHODS: Fifty-two pSS patients and 52 sex- and age-matched control participants without systemic autoimmune diseases were included in a prospective study. At inclusion, all participants were assessed through a standardised protocol, measurement of salivary pro-inflammatory cytokines, and underwent PDC. Dental procedures included: oral hygiene guidance, restorative treatment of caries, surgical removal of residual roots and impacted or partially erupted teeth, cysts, supra and subgingival periodontal scaling and treatment of soft tissue disorders (removal of lesions and treatment of opportunistic infections). After 3 months, the clinical/laboratorial assessments were repeated. RESULTS: At inclusion, the Decayed, Missing and Filled Teeth (DMFT) index was higher in the pSS patients than in the control group (13.3±8.2 vs. 8.6±6.2, p=0.002), whereas periodontal parameters were comparable in both groups (p>0.05). After PDC, 26.9% of pSS patients showed a reduction of at least 6 points (clinical improvement) in XI, but mean XI remained unchanged (p=0.285). PDC resulted in an increase in mean unstimulated (p<0.001) and stimulated (p=0.001) salivary flow rates in pSS, with no change in salivary cytokine profile (p≥0.05). CONCLUSIONS: PDC promoted improvement in unstimulated and stimulated salivary flow rates in pSS. This novel finding reinforces the recommendation of this strategy for pSS patients. CLINICALTRIALS: gov (Identifier: NCT03711214).

Local understandings of PTSD and complex PTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city, Brazil.

BACKGROUND: Adolescents in low-resource urban settings in Brazil are often exposed to high levels of trauma that can result in post-traumatic stress disorder (PTSD). However, preliminary evidence indicates that PTSD tends to be under-reported in Brazilian health services, despite the high prevalence of trauma. Additionally, little is known about the perceived applicability among clinicians of the new ICD-11 diagnosis of complex PTSD (CPTSD), despite its potential relevance for contexts of chronic trauma. The current study investigated local understandings of PTSD and CPTSD among health professionals working with adolescents in violent neighbourhoods of São Paulo city. METHODS: Semi-structured interviews were conducted with 58 health professionals working at both the primary care and specialized mental health levels in two areas of São Paulo city with high levels of community violence. RESULTS: Most participants knew about PTSD, but most did not know about CPTSD. There were mixed views concerning the commonality of PTSD among adolescents exposed to community violence. Many participants reported having no experience working with patients with the PTSD diagnosis. According to some, community violence was normalized by adolescents and health professionals, and did not result in PTSD. Others highlighted how they did not use psychiatric diagnoses in their practice, had critical perspectives towards psychiatric diagnoses and/or PTSD, or simply knew little about PTSD. Furthermore, many highlighted how the chronic nature of multiple traumas experienced by adolescents often resulted in complex clinical presentations characterised by many symptoms beyond PTSD. The diagnosis of CPTSD was considered appropriate to the context by many participants as it captured the complex traumatic histories and symptom presentations of adolescents exposed to community violence in Brazil. CONCLUSIONS: These findings have important implications for the assessment and treatment of mental health among adolescents exposed to community violence in Brazil.

The relationship between ultra-processed food consumption and internalising symptoms among adolescents from São Paulo city, Southeast Brazil.

OBJECTIVE: To investigate the association between ultra-processed food (UPF) consumption and internalising symptoms (IS) among adolescents. DESIGN: It is a cross-sectional study. Paper-pencil survey was completed in classroom with information on UPF consumption, IS and selected covariates. IS were assessed with the Internalizing Symptoms sub-scale from the Social Behaviour Questionnaire (IS-SBQ). UPF was evaluated with a FFQ extracted from the Brazilian National School Health Survey. Crude and adjusted association between UPF and IS was investigated with structural equation models. SETTING: São Paulo, SP, Brazil. PARTICIPANTS: A total of 2680 students, Mage = 14·85; (95 % CI 14·81, 14·88). RESULTS: UPF consumption was associated with higher scores in IS in the crude (ß = 0·14; P < 0·001) and adjusted (ß = 0·12; P < 0·001) models. The higher the consumption of UPF, the higher is the IS score. The following variables were associated with a lower risk of UPF consumption: male sex, public school and having more meals with parents. The change in the magnitude of the standardised score was almost negligible, but the model was significantly improved with the inclusion of covariates. CONCLUSIONS: Our results provide evidence about the positive association between UPF consumption and IS among adolescents. The association, despite its low magnitude, remained significant after adjusting for potential confounders. These results are relevant considering the increase in UPF consumption worldwide and in low- and middle-income countries. Also, our study emphasises the importance of a healthy diet with a reduction in UPF consumption among adolescents.

Feeding restriction in the pre and postpartum period of hair ewes raised in the semi-arid region: implications on performance and carcass traits of the progeny.

Feed restriction (FR) occurs commonly in sheep production systems in the Brazilian semi-arid region and can cause physiological changes in the progeny. We assessed the effects of the FR pre and postnatal on the performance and carcass traits of Morada Nova lambs. Twenty-four lambs born from a group of 68 ewes were distributed in three treatments of 8 replicates as follows: ewes fed ad libitum pre and postnatal (AL-AL); postnatal restriction (POSTN-R): included lambs born from ewes fed ad libitum in the last third of pregnancy with FR postnatal; and prenatal feeding restriction (PREN-AL): comprised lambs born from ewes subjected to FR in the last third of pregnancy but ad libitum postnatal. Slaughter body weight (20.96 kg); total weight gain (11.34 kg); average daily weight (0.096 kg); fasting carcass weight (19.45); hot carcass weight (9.33 kg); and cold carcass weight (9.11 kg) were smaller (P < 0.05) in POSTN-R but similar between AL-AL and PREN-AL. Rib (0.47 kg), shoulder (0.85 kg), loin (0.50 kg), and chest-flank (0.97 kg) had lower weight in lambs under POSTN-R (P < 0.05). The treatments did not affect the tissue composition of the 12th rib. The non-carcass components and carcass traits are the variables that best discriminate animals under FR plans. The postpartum FR in native lambs has an impact on the performance and carcass weight of the progeny, unlike lambs submitted to prepartum FR, which demonstrates the adaptation to intrauterine nutritional deficiency in Morada Nova ewes to produce lambs with heavy carcasses in regions semi-arid.

Association between self-control and health risk behaviors: a cross-sectional study with 9th grade adolescents in São Paulo.

BACKGROUND: Self-control (SC) has been consistently found associated with diverse health risk behaviors (HRBs), but little research refers to low- and middle-income countries. Furthermore, there is evidence that some HRBs tend to aggregate, however studies with the specific purpose of addressing the relation between SC and multiple health risk behaviors (MHRBs) are rare. The objective of this study is to analyze these associations and provide evidence to help filling these gaps. METHODS: A sample of 2106 9th grade students from the city of São Paulo responded a self-administered questionnaire in 2017. We tested the association of SC measured as an ordinal variable with four levels (higher, high, medium and low) with six HRBs (binge drinking, marijuana use, smoking, high consumption of ultra-processed food, sedentary behavior and bullying perpetration), in both separated and aggregated forms (MHRBs), controlling for potential confounders. Binary logistic regression was used to test the association between exposure (SC) and single outcomes. In order to analyze the association of SC with MHRBs, multinomial logistic regression was employed. RESULTS: SC was associated with five of six HRBs investigated and with MHRBs. The effect size of the association of SC and MHRBs increased in a steep pattern with accumulation of more HRBs. CONCLUSION: Low self-control is associated with most HRBs investigated and the magnitude of the association increases when more than two or three HRBs are accumulated. There seems to be a group of adolescents in a position of pronounced vulnerability for MHRBs. This should be considered when designing public policy and prevention programs. In contexts of limited or scarce resources and public funds, interventions focusing the most vulnerable groups, instead of universal interventions, should be considered.

Assessing the measurement invariance and antecedents of legal cynicism in São Paulo, Zurich, and Montevideo.

INTRODUCTION: This paper accomplishes two goals. First, we assesses the measurement invariance of legal cynicism among adolescents in São Paulo, Brazil, Montevideo, Uruguay, and Zurich, Switzerland. Second, we evaluate a series of social and individual antecedents that are expected to influence legal cynicism across contexts. METHODS: This paper first evaluates the measurement invariance of legal cynicism using Multigroup Confirmatory Factor Analysis with three randomized clustered samples of adolescents in Zurich (n = 1447), São Paulo (n = 2680) and Montevideo (n = 2204). Second, we assessed the correlates for legal cynicism in each city using structural equation modelling techniques. RESULTS: The results demonstrated metric invariance, but not scalar invariance among adolescents in São Paulo, Zurich, and Montevideo. We were able to establish partial measurement invariance for legal cynicism in São Paulo and Zurich, and therefore proceeded with the comparison of latent means and antecedents. The results show that on average legal cynicism is higher in Zurich, but that the size and strength of antecedents were similar across cities. Low self-control was by far the strongest correlate of legal cynicism. CONCLUSIONS: Overall, our results suggest that current operationalizations of legal cynicism may not be rooted in social structural context and experiences with legal authorities, but rather reflect how individuals interpret legal boundaries and dispositions towards rule-breaking. Researchers must reconsider how legal cynicism fits into models of legal socialization, and whether developmental models of self-control may help us understand the origins and nature of legal cynicism, as it is currently measured.

Food environments in schools and in the immediate vicinity are associated with unhealthy food consumption among Brazilian adolescents.

BACKGROUND: Evidence of the influence of the school food environment on adolescent diet is still little explored in low- and middle-income countries. We aimed to evaluate the association between food environment in schools and the immediate vicinity and the regular consumption of unhealthy food among adolescents. METHODS: We used cross-sectional data collected by the Brazilian National Survey of School Health (PeNSE) from a representative sample of adolescents attending 9th grade public and private schools in Brazil, in 2012. We estimated students' regular consumption (>5days/week) of unhealthy food (soft drinks, bagged salty snacks, deep fried salty snacks and sweets) and school availability, in the cafeteria or an alternative outlet, of the same food plus some healthy options (fruit and natural fruit juice). We performed multilevel logistic regression models. RESULTS: Having a cafeteria inside school selling soft drinks (private schools OR=1.23; 95% CI=1.14-1.33; public schools OR=1.13; 95% CI=1.06-1.20) and deep fried salty snacks (private schools OR=1.41 95% CI=1.26-1.57; public schools OR=1.16 95% CI=1.08-1.24) was associated with a higher consumption of these unhealthy foods of among students. In private schools, cafeteria selling fruit and natural fruit juice was associated with lower student consumption of bagged salty snacks (OR=0.86; 95% CI 0.77-0.96) and soft drinks (OR=0.85; 95% CI=0.76-0.94). In addition, eating meals from the Brazilian School Food Program in public schools was associated with a lower consumption of unhealthy foods. CONCLUSIONS: Foods available in the school food environment are associated with the consumption of unhealthy food among adolescents in Brazil.

Violence at work and depressive symptoms in primary health care teams: a cross-sectional study in Brazil.

PURPOSE: Implementation of primary care has long been a priority in low- and middle-income countries. Violence at work may hamper progress in this field. Hence, we examined the associations between violence at work and depressive symptoms/major depression in primary care teams (physicians, nurses, nursing assistants, and community health workers). METHODS: A cross-sectional study was undertaken in the city of Sao Paulo, Brazil. We assessed a random sample of Family Health Program teams. We investigated depressive symptoms and major depression using the nine-item Patient Health Questionnaire (PHQ-9), and exposure to violence at work in the previous 12 months using a standardized questionnaire. Associations between exposure to violence and depressive symptoms/major depression were analyzed using multinomial logistic regression. RESULTS: Of 3141 eligible workers, 2940 (93 %) completed the interview. Of these, 36.3 % (95 % CI 34.6-38.1) presented intermediate depressive symptoms, and 16 % (95 % CI 14.6-17.2), probable major depression. The frequencies of exposure to the different types of violence at work were: insults (44.9 %), threats (24.8 %), physical aggression (2.3 %), and witnessing violence (29.5 %). These exposures were strongly and progressively associated with depressive symptoms (adjusted odds ratio 1.67 for exposure to one type of violence; and 5.10 for all four types), and probable major depression (adjusted odds ratio 1.84 for one type; and 14.34 for all four types). CONCLUSION: Primary care workers presenting depressive symptoms and those who have experienced violence at work should be assisted. Policy makers should prioritize strategies to prevent these problems, since they can threaten primary care sustainability.

Emergency Dental Treatment of a Patient With Sturge-Weber Syndrome.

The Sturge-Weber (SWS) syndrome is a rare condition with congenital capillary malformations. Hemorrhages may occur on dental treatment, which can have a dramatic effect on a patient's vital sign. The aim of the present brief clinical study was to briefly report a case of a female patient with SWS who underwent an endodontic treatment. A 25-year-old patient (C.O.B.S.) with SWS and vascular malformation in cervicofacial right region was admitted to the dental clinic with pulsatile pain in tooth 16. An emergency dental treatment with cavity preparation and access to root canals was performed with intraligamentary and intrapulpal anesthesia with 3% prilocain 3% with felypressin 0.03 UI/mL because the tooth was located in the region of the vascular malformation, and any surgical treatment could lead to hemorrhages. After 7 days, the patient was recalled with the absence of painful symptoms. The endodontic treatment in patients with SWS is feasible, and safety should be an alternative to surgical treatments.

Psychiatric Nursing in Integrated Wards Accommodating Both Female and Male Patients: A Historic Pioneering Reform Initiative Implemented by the Institute of Psychiatry, a Unit of the Federal University of Rio De Janeiro, Brazil.

The purpose of this research is to analyze aspects of the sexuality of people with mental disorders, an issue that influenced nursing care in the mixed nursing wards of the Institute of Psychiatry at the Federal University of Rio de Janeiro between 1996-2002. A qualitative Historical Social Study methodology used written and oral texts that were analyzed drawing on Michel Foucault's ideas about sexuality. Results of the study indicate that a rupture occurred in the distribution model according to gender at the Psychiatric Hospitalization Unit. This, in turn, influenced nursing care. From this study, we conclude that accommodating patients in mixed wards better facilitates the psychosocial rehabilitation process and changes nursing teams' conceptions about the sexuality of people with mental disorders.

[Discourses on the nursing and psychiatric nurse models, published in the Annals of Nursing (1933-1951)]. / Discursos sobre os modelos de enfermagem e de enfermeira psiquiátrica nos Annaes de Enfermagem (1933-1951).

Social-historical study aimed at discussing the nursing and psychiatric nurse models, from the discourses published in the Annals of Nursing.The historical sources were articles published in the Annals of Nursing journal, from 1933 to 1951. An analysis of the discourse was subsidized by the genealogy of power by Michel Foucault.The analysis showed that the discourse on nursing and the psychiatric nurse, in the first half of the 20th century, is set, on one side, by the propositions used by psychiatrists, who sought to reiterate stereotypes and vocations to practice nursing, and, on the other side, by the active participation of nurses seeking to legitimize expertise for psychiatric nursing. It was concluded that the discourses analyzed defined a psychiatric care focused on the nurse and not the rest of the nursing staff, at that time.

Respiratory viral infections before the COVID-19 in Portugal: A single center study.

Objectives: We aimed to describe the respiratory viruses (RV) found in respiratory samples from patients admitted to Hospital de São Bernardo, Setúbal, Portugal, between October 2019 and March 2020, and to correlate these with clinical features. Design: This retrospective study explored 948 fresh frozen naso/oropharyngeal swabs, tested by reverse transcription-polymerase chain reaction. Results: Rhinovirus/enterovirus, influenza, and respiratory syncytial virus (hRSV) were the most prevalent RV. Half of the patients fulfilled the acute respiratory infection (ARI) and/or influenza-like illness (ILI) criteria, with increasing age significantly reducing the risk of ARI and/or ILI. Hospital admission was more frequently observed in symptomatic patients, but the length of stay and mortality were significantly lower. Most (96.5 %) patients had a main respiratory diagnosis. In adults, the most prevalent was pneumonia, which particularly affected older patients, while in children, the most common was bronchiolitis. The number of hospital admissions was high. Sudden onset, shortness of breath, older age, and hRSV detection significantly increased the risk of hospital admission overall. In bronchiolitis, female gender significantly increased the risk of hospital admission, while older age significantly reduced this risk. Twenty patients died within the first month of sampling, and all were older adults. Older age and male gender significantly increased the risk of death. Conclusions: Respiratory viral infections can have a significant clinical impact, particularly in young infants with bronchiolitis and older adults with pneumonia. This study provides the first snapshot of the respiratory viral infections just before the outbreak of SARS-CoV-2 in Portugal, providing relevant clinical insights.

Bone pattern changes in post liver transplant patients using bisphosphonates.

OBJECTIVE: To identify radiographic findings suggestive of drug-induced osteonecrosis and evaluate radiomorphometric patterns indicative of changes in bone mineral density in individuals transplanted for liver disorders using bisphosphonates. STUDY DESIGN: The study group included panoramic x-rays of liver transplant patients who are being monitored and who present a clinical status of osteoporosis and use bisphosphonates. The control group was made up of liver transplant patients who did not have osteoporosis. On panoramic radiographs, mental index (MI) and mandibular cortical index (MCI) and the presence of radiographic anomalies suggestive of osteonecrosis were evaluated. RESULTS: There were significant statistical results when comparing the groups in relation to the decrease in bone mineral density (BMD) with MCI-C3 (p = 0.036), however, there were none in relation to MI (p = 0.14). There were no valid statistical results when relating MCI (p = 0.94) and MI (p = 0.66) with reduced BMD and use of bisphosphonates. CONCLUSION: Liver transplant individuals using bisphosphonates present greater radiographic signs of bone sclerosis suggestive of a greater propensity to develop osteonecrosis of the jaw and an increased risk of presenting changes suggestive of reduced bone mineral density on panoramic radiographs when compared to liver transplant individuals not using bisphosphonates.

Medication Non-adherence in Depression: A Systematic Review and Metanalysis.

OBJECTIVE: Medication non-adherence is frequently reported in patients with major depressive disorder (MDD). The objective of this review is to consolidate data on the prevalence of non-adherence to antidepressant in MDD. METHODS: A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and the protocol was registered in PROSPERO under the number CRD42021199987. Studies assessing medication adherence in MDD were searched in PubMed/Medline, Embase, CINAHL (The Cumulative Index to Nursing and Allied Health Literature) and PsycINFO. The data extraction was performed by two independents authors. Meta-analysis used random effects model and performed a subgroup analysis. RESULTS: From the articles retrieved, eleven studies were considered eligible for the final analysis. Most of them assessed non-adherence by self-report scales, followed by Pharmacy Dispensation Records, Monitoring Events Medication System (MEMS) and blood tests. The pooled proportion of non-adherence was 42% (95% IC 30%-54%), but heterogeneity was very large (I2=99%). CONCLUSION: Data from the selected studies suggests that a high number of individuals with MDD do not adequately take their medication as prescribed. The high heterogenicity of measures used for the assessment of adherence may have impacted the great variability of the results. The results suggest it is necessary that health care professionals should address this issue in order to achieve a better treatment outcome in major depression.

Association between ultra-processed dietary pattern and bullying: the role of deviant behaviors.

Background: Ultra-processed foods have been associated with several negative outcomes, but it is not clear whether they are related to bullying perpetration. Moreover, no previous study has investigated the potential role of deviant behaviors as a mediator of this association. Our objective was to evaluate the association between ultra-processed dietary pattern and bullying, and the mediating effect of deviant behaviors in this association, among school adolescents. Methods: We used data from a representative sample of 9th grade Brazilian adolescents (N = 2,212) from the São Paulo Project for the social development of children and adolescents (SP-PROSO). Exploratory factor analysis was used to obtain the dietary patterns, through questions of frequency of consumption in the last week of several foods. The ultra-processed dietary pattern was considered as exposure. The outcomes were the types of bullying (any type, social exclusion, psychological/verbal aggression, physical aggression, property destruction, and sexual harassment). Deviant behaviors (mediator) were assessed through a score. Mediation analyses were carried out using logistic regression based on the KHB method. Results: After adjusting for covariates, the mediating effect of deviant behaviors was found in the association between ultra-processed dietary pattern and all the types of bullying perpetration, especially for psychological/verbal aggression (39.4%). A small mediating effect of deviant behaviors in the association of ultra-processed dietary pattern with physical aggression (17.7%) and property destruction (18.5%) was observed, but this effect explained only a small portion of the total effect of such association (significant direct effect). Conclusion: The ultra-processed dietary pattern was associated with bullying, and the association was mediated through deviant behaviors. Policies and actions for improving the adolescent's diet and managing the adoption of deviant and bullying behaviors by this public are required.

Is there a superiority between arthrocentesis and stabilizing occlusal splint for the treatment of anterior disc displacement with reduction and intermittent block and anterior disc displacement without reduction in TMJ? Randomized clinical trial.

INTRODUCTION: Anterior displacement of the temporomandibular joint (TMJ) disc is a disorder in which the articular disc is dislocated from its correct position relative to the mandibular condyle and mandibular fossa. Traditionally, the initial treatment of disc displacements involves various conservative measures, including the use of a stabilizing interocclusal splint. However, in cases where there is associated limited mouth opening, as in the case of anterior disc displacement with reduction and intermittent block (ADDwRIB), and anterior disc displacement without reduction (ADDw/oR), arthrocentesis has been suggested as another modality of initial treatment due to its faster effect in preventing disease progression to a more advanced stage, as well as reducing the chances of pain chronification and central sensitization. OBJECTIVES: This study aimed to analyze whether there is a preponderance in efficacy between treatments with a stabilizing interocclusal splint or arthrocentesis in these patients. METHODS: A randomized, prospective, longitudinal clinical trial was conducted. The sample was obtained by convenience, between June 2021 and January 2023. Twenty-four patients with diagnoses of ADDwRIB and ADDw/oR were included. The diagnosis and clinical evaluations followed the DC/TMD criteria, and TMJ MRI was performed. Patients were randomly allocated to 2 treatment groups. Group 1 (n = 13): stabilizing interocclusal splint. Group 2 (n = 11): arthrocentesis. Patients were evaluated after 1, 2, 3, and 6 months for clinical parameters of pain, functionality, and psychosocial status. RESULTS: Both treatments were effective in reducing pain levels, with no statistically significant differences. Group 1 showed significantly greater mouth-opening levels compared to Group 2 (P = .041). CONCLUSION: Both groups showed significant improvements in various parameters evaluated throughout the study, indicating they are equally effective in pain control and most functional and quality of life parameters. However, the stabilizing interocclusal splint treatment was superior in restoring mouth opening.