From pathophysiology to practice: addressing oxidative stress and sperm DNA frag-mentation in Varicocele-affected subfertile men.

Varicocele can reduce male fertility potential through various oxidative stress mechanisms. Excessive production of reactive oxygen species may overwhelm the sperm's defenses against oxidative stress, damaging the sperm chromatin. Sperm DNA fragmentation, in the form of DNA strand breaks, is recognized as a consequence of the oxidative stress cascade and is commonly found in the ejaculates of men with varicocele and fertility issues. This paper reviews the current knowledge regarding the association between varicocele, oxidative stress, sperm DNA fragmentation, and male infertility, and examines the role of varicocele repair in alleviating oxidative-sperm DNA fragmentation in these patients. Additionally, we highlight areas for further research to address knowledge gaps relevant to clinical practice.

Vas deferens to rete testis anastomosis for obstructive azoospermia.

PURPOSE: This video aims to present an in-depth, step-by-step tutorial on microsurgical reconstruction for obstructive azoospermia, featuring a distinctive case involving anastomosis from vas deferens to rete testis. The primary aim of this endeavor is to offer thorough and practical insights for healthcare professionals and researchers within the realm of reproductive medicine. The video endeavors to disseminate expertise, methodologies, and perspectives that can be advantageous to individuals grappling with obstructive azoospermia, providing a significant contribution to the progress of reproductive medicine and the augmentation of existing treatment alternatives. MATERIALS AND METHODS: Surgical footage was recorded using the ORBEYE 4K 3D Orbital Camera System by Olympus America, with patient consent acquired for research purposes. Additionally, a retrospective examination of patient records was undertaken to compile relevant medical histories. RESULTS: This video furnishes an exhaustive guide to microsurgical reconstruction for obstructive azoospermia, encompassing a distinctive instance of anastomosis from vas deferens to rete testis. State-of-the-art technology, such as the ORBEYE 4K 3D Orbital Camera, heightens procedural transparency, accentuating the significance of advanced instrumentation. The ethical underpinning is emphasized by obtaining patient consent for footage utilization, and a retrospective chart review augments the repository of valuable patient data. This comprehensive approach serves as an invaluable reservoir of knowledge for medical professionals and underscores excellence in clinical and ethical healthcare research. CONCLUSIONS: Anastomosis from vas deferens to rete testis emerges as a viable surgical reconstruction alternative for obstructive azoospermia, particularly when confronted with non-dilated tubules within the epididymis.

Low-dose prednisone is an effective rescue for deteriorating semen parameters following vasovasostomy.

OBJECTIVE: This retrospective study aimed to evaluate the effectiveness of low-dose prednisone as a rescue therapy for patients with deteriorating semen parameters following vasovasostomy. MATERIALS AND METHODS: Electronic medical records were queried at the University of Miami with documented CPT code 55400 (Bilateral Vasovasostomy) between January 2016 and April 2023. Records were then reviewed to identify patients who demonstrated ≥50% decrease in semen parameters, specifically sperm concentration, motility and total motile sperm count. Patients who were treated with 6 weeks of low-dose prednisone were identified, and baseline semen parameters and subsequent changes after prednisone therapy were assessed. A Mann-Whitney U Test was used to compare semen parameter changes before and after prednisone. Adverse effects associated with prednisone were monitored. RESULTS: A total of 8 patients were identified with deteriorating semen parameters who were treated with 6 weeks of low-dose prednisone. Following prednisone therapy, all patients demonstrated improvements in total motile sperm count (TMSC), with a median improvement of 6 million. The median relative improvement in TMSC was 433%. Sperm concentration and motility also improved compared to post-operative baseline. No adverse effects were reported during the treatment period. CONCLUSIONS: Low-dose prednisone therapy appears to be a safe and effective intervention for managing deteriorating semen parameters following VV. The observed improvements in TMSC suggest the potential of prednisone to rescue patients with delayed failure after VV. Further research with larger sample sizes is warranted to confirm the safety and efficacy of low-dose prednisone as a rescue therapy in this specific patient population. Optimizing VV outcomes is crucial in male infertility, and further exploration of steroid therapy and innovative biotechnologies is warranted.

The oral health impact profile and well-being on mothers and preschool children.

OBJECTIVES: to verify the contribution of mothers' oral health impact profile to their children's oral health profile and the contribution of mothers' well-being and the caries index (dmft) to children's well-being. METHODS: This is a cross-sectional observational study. Mothers and pre-school children enrolled in public schools in the municipality of Araraquara-SP took part. The Oral Health Impact Profile Questionnaire (OHIP-14), Satisfaction with Life Scale (SWLS), Early Childhood Oral Health Impact Scale (ECOHIS) and the Autoquestionnaire Qualité de Vie Enfant Imagé (AUQEI) were used. To diagnose caries, a clinical examination was carried out to calculate the dmft index. Path analysis was carried out and the path coefficients were estimated (ß) and evaluated using the z-test (α = 5%). RESULTS: 443 children took part (5.19 ± 0.64 years; 52.4% boys) with an mean dmft of 1.31 ± 2.19. The mean age of the mothers was 33.4 ± 7.01 years. There was a significant impact of dmft and maternal well-being on the child's subjective well-being (s2explained = 43%). The mothers' oral health impact profile and the child's caries experience had a significant influence on both the child (OHIP: ß = 0.22; p < 0.001; dmft: ß = 0.48; p < 0.001) and the family (OHIP: ß = 0.29; p < 0.001; dmft: ß = 0.32; p < 0.001). The child's dmft (ß=-0.10; p = 0.005) and the mothers' subjective well-being (ß=-0.61; p < 0.001) had a significant impact on the child's subjective well-being. CONCLUSION: The mothers' oral health impact profile and the child's caries experience had an impact on both the child and the family. Mothers' subjective well-being and caries experience should be considered when assessing the subjective well-being of Brazilian preschool children.

Assessment of Medical and Social Risk Factors Before Arthroplasty in Argentina: A Poll of Argentinian Hip and Knee Association (ACARO) Members.

BACKGROUND: Assessment of risk factors is crucial for lowering complication rates and costs of hip and knee arthroplasty. The objective of this study was to assess if members of the Argentinian Hip and Knee Association (ACARO) are influenced by such risk factors when planning surgery. METHODS: In 2022, a survey was distributed as an electronically based questionnaire to 370 members of the ACARO. A descriptive analysis was performed on 166 proper answers (44.9%). RESULTS: There were 68% of the respondents who were specialists in joint arthroplasty and 32% practiced general orthopedics. A large number had large volumes at private hospitals without service/residents and 48.2% had been in practice for more than 15 years. Of the responding surgeons, 99% routinely performed a preoperative reversible risk factors evaluation that considered diabetes, malnutrition, weight, and smoking, and 95% canceled/postponed the surgery for abnormalities. Malnutrition was important for 79% of the polled with blood albumin being used by 69.3%. Fall risk assessment was performed by 60.2% of the surgeons. Only 44% of the surgeons felt free to choose the implant for the arthroplasty, possibly because 69.9% work for a capitated system. Important delays for surgery were reported by 63.9 and 84.3% had waiting lists. 74.7% of the polled noted physical or psychological deterioration during such delays. CONCLUSION: Socioeconomic factors firmly impact on the accessibility to arthroplasty in Argentina. Despite these barriers, the qualitative analysis of this poll let us demonstrate greater awareness of preoperative risk factors, especially diabetes as the most reported comorbidity.

Handgrip force and bite force in dentulous and edentulous individuals.

BACKGROUND: The literature is unclear about bite force (BF) and handgrip force (HF) in a specific group of different ages and dentate conditions, or even a predictive model for each specific group, using BF and HF as factors. OBJECTIVE: To establish the correlation between HF and BF in female participants with distinct ages and dentate conditions; also create a predictive model of BF as a function of HF. METHODS: Participants were divided into three groups (GI: young natural dentate women, n = 65; GII: adult natural dentate women, n = 67; and GIII: edentulous women users of bimaxillary complete dentures, n = 67) and subjected to an HF measurement test using a digital dynamometer. Subsequently, BF was measured using a digital gnathodynamometer in the molar region. Pearson correlation coefficient (r) and multivariate analysis of variance (α = 0.05) were performed, and simple linear regression was used to obtain a model to predict BF from HF for each group separately (α = 0.05). RESULTS: All groups presented moderate and strong correlations among the variables (GI: r = 0.838; GII: r = 0.714; GIII: r = 0.646). A significant difference in BF was observed (GI > GII > GIII; p < .05). GIII presented a significantly lower HF than the other groups (p < .05). Besides, three equations predicting BF, using HF, were obtained for use in young/adult dentate and edentulous women. CONCLUSION: All groups found a positive and significant correlation between BF, HF and groups. HF can be a simple and efficient method for predicting BF using the predictive models developed for women with good health.

Self-perception of orofacial appearance: Brazil-Finland cross-national study.

OBJECTIVE: (i) To study the measurement invariance of Orofacial Esthetic Scale (OES) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), (ii) to compare the perception of orofacial appearance (OA) and (iii) to study the frequency of individuals who have sought or received aesthetic dental treatment between Brazil and Finland. METHODS: This was a cross-sectional observational study with snowball non-probability sample selection. Students and staff from universities in Finland and Brazil were invited to participate. Data were collected online using a demographic questionnaire, OES and PIDAQ. The samples consisted of 3636 Finns (75.0% female; age: 32.0 years) and 1468 Brazilians (72.6% female; age: 33.2 years). The frequency of receiving aesthetic dental treatment was estimated. If configurational invariance was observed, cross-national measurement invariance was verified by multigroup analysis. When measurement invariance was attested, factor scores were compared using Welch's t-test. RESULTS: OES showed configurational and measurement invariance and no significant difference between the countries. Despite similarity in satisfaction with OA, 71.9% of Brazilians had received aesthetic dental treatment, while 59.4% of Finns had never sought such treatments. PIDAQ did not present configurational invariance between the countries. CONCLUSION: Although there is no difference in satisfaction with OA, seeking and receiving aesthetic dental treatment is significantly greater for Brazilians. Psychosocial impact of OA is perceived differently in the studied countries.

The role of thickness inhomogeneities in hierarchical cortical folding.

The mammalian brain cortex is highly folded, with several developmental disorders affecting folding. On the extremes, lissencephaly, a lack of folds in humans, and polymicrogyria, an overly folded brain, can lead to severe mental retardation, short life expectancy, epileptic seizures, and tetraplegia. Not only a specific degree of folding, but also stereotyped patterns, are required for normal brain function. A quantitative model on how and why these folds appear during the development of the brain is the first step in understanding the cause of these conditions. In recent years, there have been various attempts to understand and model the mechanisms of brain folding. Previous works have shown that mechanical instabilities play a crucial role in the formation of brain folds, and that the geometry of the fetal brain is one of the main factors in dictating its folding characteristics. However, modeling higher-order folding, one of the main characteristics of the highly gyrencephalic brain, has not been fully tackled. The simulations presented in this work are used to study the effects of thickness inhomogeneity in the gyrogenesis of the mammalian brain in silico. Finite-element simulations of rectangular slabs are performed. These slabs are divided into two distinct regions, where the outer region mimicks the gray matter, and the inner region the underlying white matter. Differential growth is introduced by growing the top region tangentially, while keeping the underlying region untouched. The brain tissue is modeled as a neo-Hookean hyperelastic material. Simulations are performed with both homogeneous and inhomogeneous cortical thicknesses. Our results show that the homogeneous cortex folds into a single wavelength, as is common for bilayered materials, while the inhomogeneous cortex folds into more complex conformations. In the early stages of development of the inhomogeneous cortex, structures reminiscent of the deep sulci in the brain are obtained. As the cortex continues to develop, secondary undulations, which are shallower and more variable than the structures obtained in earlier gyrification stage emerge, reproducing well-known characteristics of higher-order folding in the mammalian, and particularly the human, brain.

Symptoms related to mental disorder in healthcare workers during the COVID-19 pandemic in Brazil.

BACKGROUND: Studies of previous pandemics indicate that healthcare workers have a high risk of developing symptoms related to mental health, especially depression, anxiety, and stress. OBJECTIVE: To identify mental disorder symptoms among Brazilian healthcare workers during the Sars-Cov-2 pandemic and compare findings in different work categories. METHODS: This was an online cross-sectional study. Information related to the pandemic and mental disorder symptoms was collected. The Depression, Anxiety, and Stress Scale and the Impact of Event Scale-revised were used. Associations were estimated by the chi-square test. The mean scores were compared among work categories with ANOVA (α = 5%) and the prevalence of symptoms was estimated. RESULTS: 1,609 healthcare workers participated in the survey [mean age: 36.9 (SD = 11.6) years, women = 83.6%]. There was no association between work category and changes in mental health during the pandemic (p = 0.288) or prevalence of unsafe feeling (p = 0.218). A significant relationship was observed between maintaining work activities during the pandemic and work category (p < 0.001). Physicians had the lowest out-of-work prevalence (9.5%) while dentists had the highest (32.3%). Physicians and nurses showed the highest prevalence of in-person work routine. Psychologists presented the highest prevalence of remote work (64.0%) while dentists had the lowest (20.2%). A high prevalence of depression (D), anxiety (A), and stress (S) symptoms was observed in all professional categories (D: 57.2, 95% CI 48.3-66.1%; A: 46.20%, 95% CI = 37.2-55.2%; S: 55.80%, 95% CI = 46.8-64.8%), with physicians (D = 38.4%, A = 25.80%, S = 37.90%), psychologists (D = 50.2%, A = 39.0%, S = 43.1%), and nurses (D = 50.0%, A = 40.9%, S = 49.0%) having significantly lower scores. Psychologists had the lowest pandemic-related psychological impact (42.70%, 95% CI 36.8-48.6%). CONCLUSION: Extreme changes in the work routine of dentists and psychologists and an overall high prevalence of mental symptoms due to the pandemic were found. Researchers should focus on gathering information that can identify workers at increased risk of mental illness to guide discussions and develop actions to minimize the harm of the pandemic. In addition, we suggest that healthcare and support systems urgently adopt mental health care measures with specialized professionals to protect the psychological well-being of the healthcare community.

Orofacial Esthetic Scale and Psychosocial Impact of Dental Aesthetics Questionnaire: development and psychometric properties of the Finnish version.

OBJECTIVE: To develop the Finnish version of the Orofacial Esthetic Scale (OES-Fi) and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ-Fi) and estimate the psychometric properties of these instruments applied to adult Finns. METHODS: The English versions of the instruments were translated into Finnish and back-translated. Thereafter, OES-Fi and PIDAQ-Fi were established in a pilot study. The factorial validity was estimated using Confirmatory Factor Analysis (CFI, TLI, SRMR) in independent samples (Test and Validation samples). The measurement invariance of the factorial models was tested using multigroup analysis (ΔCFI). Convergent validity [Average Variance Extracted (AVE)] and reliability [Composite Reliability (CR) and α] were estimated. RESULTS: A total of 3636 individuals [mean age = 32.0 (SD = 11.6) years, 75% women] participated in the study. After refinements, the factorial model of the instruments showed an adequate fit to the data (CFI ≥0.94, TLI ≥0.90, SRMR ≤0.07) and showed measurement invariance in two independent samples (|ΔCFI| <0.01). Convergent validity (AVE = 0.54-0.82) and reliability (α = 0.86-0.94) were adequate. CONCLUSION: The data obtained using OES-Fi and PIDAQ-Fi were valid and reliable. Thus, these instruments could be useful for evaluating individual satisfaction with orofacial appearance and the psychosocial impact of dental aesthetics in a clinical or research setting.

A tutorial and tool for exploring feature similarity gradients with MRI data.

There has been an increasing interest in examining organisational principles of the cerebral cortex (and subcortical regions) using different MRI features such as structural or functional connectivity. Despite the widespread interest, introductory tutorials on the underlying technique targeted for the novice neuroimager are sparse in the literature. Articles that investigate various "neural gradients" (for example based on region studied "cortical gradients," "cerebellar gradients," "hippocampal gradients" etc … or feature of interest "functional gradients," "cytoarchitectural gradients," "myeloarchitectural gradients" etc …) have increased in popularity. Thus, we believe that it is opportune to discuss what is generally meant by "gradient analysis". We introduce basics concepts in graph theory, such as graphs themselves, the degree matrix, and the adjacency matrix. We discuss how one can think about gradients of feature similarity (the similarity between timeseries in fMRI, or streamline in tractography) using graph theory and we extend this to explore such gradients across the whole MRI scale; from the voxel level to the whole brain level. We proceed to introduce a measure for quantifying the level of similarity in regions of interest. We propose the term "the Vogt-Bailey index" for such quantification to pay homage to our history as a brain mapping community. We run through the techniques on sample datasets including a brain MRI as an example of the application of the techniques on real data and we provide several appendices that expand upon details. To maximise intuition, the appendices contain a didactic example describing how one could use these techniques to solve a particularly pernicious problem that one may encounter at a wedding. Accompanying the article is a tool, available in both MATLAB and Python, that enables readers to perform the analysis described in this article on their own data. We refer readers to the graphical abstract as an overview of the analysis pipeline presented in this work.

Pain perception in orthodontic patients: A model considering psychosocial and behavioural aspects.

OBJECTIVES: To estimate the agreement between orthodontic pain perception, evaluated with the visual analog scale (VAS), and psychosocial and behavioural aspects of pain and to estimate the impact of clinical and demographic characteristics on these aspects. DESIGN: Cross-sectional design using non-probabilistic sampling. SETTING AND SAMPLE POPULATION: Orthodontic patients undergoing treatment at orthodontic clinics (n = 507 [63.3% women], mean age: 26.32 [SD = 11.70] years). MATERIALS AND METHODS: Psychosocial and behavioural aspects of pain were evaluated using the Multidimensional Pain Inventory (MPI-Orthodontic). Agreement between the pain impact level assessed according to different methods was estimated using the linear-weighted Kappa (κp ) statistic. Structural models were elaborated to estimate the impact of clinical and demographic characteristics on the psychosocial and behavioural aspects of pain. The fit of the model was evaluated, and the z test (α = 5%) was used to estimate the significance of the impact (ß). RESULTS: The agreement between VAS and MPI-Orthodontic factors was inadequate (κp  = 0.028-0.584). The fit of the structural models was adequate. Women, younger individuals, and those who reported difficulty/pain with feeding exhibited greater perception of both the psychosocial and behavioural aspects. Individuals in lower socioeconomic strata who were not satisfied with treatment and did not seek treatment voluntarily exhibited greater perception of the psychosocial aspect of pain. CONCLUSIONS: The impact of orthodontic pain on psychosocial and behavioural aspects of patients' lives is a relevant issue. Clinical and demographic characteristics contributed to these aspects; however, pain intensity as a sole measure may be insufficient for an adequate understanding of pain perception.

Fluoroscopic C-Arm and CT-Guided Selective Radiofrequency Ablation for Trigeminal and Glossopharyngeal Facial Pain Syndromes.

Objectives: Percutaneous radiofrequency ablation (RFA) of the gasserian ganglion through the foramen ovale and the glossopharyngeal nerve at the jugular foramen is a classical approach to treating trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GPN), respectively. However, it can be technically challenging with serious complications. We have thus developed a novel technique utilizing C-arm and computerized tomography (CT) guidance to block TN and GPN. Our goals were to describe a three-dimensional image-based technique to improve patient comfort and to decrease procedural time associated with needle guidance. Study design: Consecutive procedures were reviewed. Setting: Academic hospital. Methods: Three patients with classical TN and GPN and 15 patients with atypical facial pain (AFP) were treated. Numeric rating scale (NRS) scores for pain at pretreatment and at one, three, and 12 months post-treatment were recorded. The primary clinical outcome (50% or more reduction in NRS) and secondary adverse clinical outcome (hematoma, facial numbness, etc.) were monitored. Results: We had a 100% technical success with respect to appropriate needle positioning. All three classical TN/GPN patients had both immediate and sustained pain relief. Complications were minimal. The 15 AFP patients, however, showed more variable results, with only five (33%) having sustained pain relief, while in the other 10 (67%) patients, we observed suboptimal response. Conclusions: We present a novel method and single-center experience with C-arm and CT-guided RFA of facial pain. Quick and accurate needle placement will help future advancements in the RFA algorithm so that more durable and consistent effects can be attained, reducing uncertainty with respect to needle placement as a confounder. The RFA procedure in our study had a satisfying effect for classical TN/GPN patients but was less successful for AFP patients, though it did mirror the results from previous studies. Limitations: This study is limited by its small sample size and nonrandomized design.

Artificial diet for laboratory rearing of Condylorrhiza vestigialis (Guenée, 1854) (Lep.: Crambidae).

The Brazilian Poplar Moth, Condylorrhiza vestigialis (Guenée), compromises the wood productivity of poplar trees (Populus sp.), mainly affecting the matchstick industry in southern Brazil. Considering the lack of information on rearing techniques for this insect, the objective of this study was to develop an artificial diet to rear C. vestigialis with biological characteristics similar to the wild insects. A properly diet will enable bio-ecological studies and biological control programs using the baculovirus Condylorrhiza vestigialis multiple nucleopolyhedrovirus (CvMNPV). To attain this objective, first, three artificial diets were tested. Only the diet based on corn, wheat germ and yeast as a protein source (Diet 3) was able to supply the nutritional requirements of the moth and support completion of its life cycle. In the second experiment, Diet 3 was compared to the natural diet of C. vestigialis. The artificial diet supported a viability of 81% of the eggs, while only 40% developed on the natural diet. Life-table data showed the same pattern: the net reproductive rate (Ro) of C. vestigialis reared on the artificial diet was 401.70, and on the natural diet was 151.22. The artificial diet is adequate for mass rearing of C. vestigialis, to support biological control programs using the baculovirus.

Multicenter Retrospective Study of Neurostimulation With Exit of Therapy by Explant.

INTRODUCTION: Spinal cord stimulation (SCS) devices are cost effective and improve function as well as quality of life. Despite the demonstrated benefits of SCS, some patients have the device explanted. We are interested in exploring the patient characteristics of those explanted. METHODS: This is a retrospective chart review of neurostimulation patients who underwent explantation at 18 centers across the United States within the previous five years. RESULTS: Data from 352 patients were collected and compiled. Failed Back Surgery syndrome was the most common diagnosis (38.9%; n = 136/350) and over half of the patients reported numerical rating scale (NRS) scores ≥8 prior to implant (64.3%; n = 207/322). All patients reported changes in NRS scores across time, with an initial decrease after implant followed by a pre-explant increase (F (2, 961) = 121.7, p < 0.001). The most common reason for device explant was lack or loss of efficacy (43.9%; 152/346) followed by complications (20.2%; 70/346). Eighteen percent (18%; 62/343) of patients were explanted by a different physician than the implanting one. Rechargeable devices were explanted at a median of 15 months, whereas primary cell device explants occurred at a median of 36 months (CI 01.434, 2.373; median endpoint time ratio = 2.40). DISCUSSION: Loss or lack of efficacy and complications with therapy represent the most frequent reasons for neurostimulation explantation. Of the devices that were explanted, therapy was terminated earlier when devices were rechargeable, when complications occurred, or when pain relief was not achieved or maintained. Furthermore, in nearly 20% of the cases, a different provider than the implanting physician performed device removal. CONCLUSIONS: SCS is largely a safe and efficacious strategy for treating select chronic refractory pain syndromes. Further prospective data and innovation are needed to improve patient selection, maintain SCS therapeutic efficacy and reduce the reasons that lead to device explant.

Prediction of cognitive performance differences in older age from multimodal neuroimaging data.

Differences in brain structure and functional and structural network architecture have been found to partly explain cognitive performance differences in older ages. Thus, they may serve as potential markers for these differences. Initial unimodal studies, however, have reported mixed prediction results of selective cognitive variables based on these brain features using machine learning (ML). Thus, the aim of the current study was to investigate the general validity of cognitive performance prediction from imaging data in healthy older adults. In particular, the focus was with examining whether (1) multimodal information, i.e., region-wise grey matter volume (GMV), resting-state functional connectivity (RSFC), and structural connectivity (SC) estimates, may improve predictability of cognitive targets, (2) predictability differences arise for global cognition and distinct cognitive profiles, and (3) results generalize across different ML approaches in 594 healthy older adults (age range: 55-85 years) from the 1000BRAINS study. Prediction potential was examined for each modality and all multimodal combinations, with and without confound (i.e., age, education, and sex) regression across different analytic options, i.e., variations in algorithms, feature sets, and multimodal approaches (i.e., concatenation vs. stacking). Results showed that prediction performance differed considerably between deconfounding strategies. In the absence of demographic confounder control, successful prediction of cognitive performance could be observed across analytic choices. Combination of different modalities tended to marginally improve predictability of cognitive performance compared to single modalities. Importantly, all previously described effects vanished in the strict confounder control condition. Despite a small trend for a multimodal benefit, developing a biomarker for cognitive aging remains challenging.

Indicators to evaluate quality of care in head and neck cancer in Spain.

PURPOSE: This study aimed to develop a set of criteria and indicators to evaluate the quality of care of patients with head and neck cancer (HNC). METHODS: A systematic literature review was conducted to identify valuable criteria/indicators for the assessment of the quality of care in HNC. With the aid of a technical group, a scientific committee of oncologists specialised in HNC used selected criteria to propose indicators that were evaluated with a two-round Delphi method. Indicators on which consensus was achieved were then prioritised by the scientific committee to develop a final set of indicators. RESULTS: We proposed a list of 50 indicators used in the literature or developed by us to be evaluated with a Delphi method. There was consensus on the appropriateness of 47 indicators in the first round; the remaining 3 achieved consensus in the second round. The 50 indicators were scored to prioritise them, leading to a final selection of 29 indicators related to structure (3), process (22), or outcome (4) and covering diagnosis, treatment, follow-up, and health outcomes in patients with HNC. Easy-to-use index cards were developed for each indicator, with their criterion, definition, formula for use in real-world clinical practice, rationale, and acceptable level of attainment. CONCLUSIONS: We have developed a set of 29 evidence-based and expert-supported indicators for evaluating the quality of care in HNC, covering diagnosis, treatment, follow-up, and health outcomes.

Emotional Appetite Questionnaire: psychometric properties in Brazilian adult samples before and after the COVID-19 pandemic onset.

Background: Appetite represents a desire of a person to eat specific food in order to reach satisfaction and pleasure states. This desire may be associated with the experience of negative or positive emotions (emotional appetite). Emotional appetite can influence eating behavior, and its investigation is relevant to avoid possible damage to health resulting from a disordered eating. Objectives: To adapt the Emotional Appetite Questionnaire (EMAQ) to the Portuguese language; to assess the validity and reliability of the data; and to assess emotional appetite in three samples of adults collected before and after the outbreak of the COVID-19 pandemic. Methods: This is a cross-sectional study with non-probabilistic convenience sampling. The Portuguese version of the EMAQ was presented after translation, back-translation, and content analysis. Two studies were conducted, the first before and the second after the pandemic onset. Three samples were formed (2019: Sample 1 (age = 19.7 ± 1.5 years) n = 323; 2020: Sample 2 (age = 21.3 ± 1.8 years) n = 1,011; and Sample 3 (age = 28.9 ± 3.1 years) n = 909). An exploratory strategy with parallel analysis was performed. The analyses were conducted in FACTOR and R (lavaan and semTools packages) software. After determining the best-fit model for the data, emotional appetite was examined considering decrease, non-alteration, and increase in appetite in the face of positive and negative emotions/situations. The profile of emotional appetite was determined using a circumplex model. Results: The two-factor model described by the valence of emotions/situations fitted the samples (Comparative Fit Indexminimum-maximum = 0.95-0.98; Tucker-Lewis Index = 0.94-0.98; Root Mean Square Error of Approximation = 0.03-0.08; αord = 0.78-0.88). Increases in appetite were more frequent for positive emotions/situations (52.0-57.5%), and both decreases (35.4-44.5%) and increases (50.0-56.2%) in appetite were observed for negative emotions/situations. Emotions with negative valence and activation were more relevant to appetite reduction, while a significant increase in appetite was observed with anxiety (negative valence and positive activation). Conclusion: Different emotions and situations may influence appetite in people, and such an investigation may be useful in preparing eating protocols.

Aesthetic dental treatment, orofacial appearance, and life satisfaction of Finnish and Brazilian adults.

AIMS: To study the probability of seeking/undergoing aesthetic dental treatment (ADT) and compare self-perception of orofacial appearance (OA) based on sex, age, and monthly income; and to estimate the impact of OA on life satisfaction (LS) among Finnish and Brazilian adults, considering the indirect effect of receiving ADT and the moderating effects of those sociodemographic variables. METHODS: This was an online cross-sectional study. Orofacial Esthetic Scale (OES), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and Satisfaction with Life Scale (SWLS) were used. Probability of seeking/receiving ADT was calculated using logistic regression and odds ratio (OR). OA scores were compared according to sociodemographic characteristics (ANOVA, α = 5%). Structural equations models estimated the impact of OA on LS. RESULTS: 3,614 Finns [75.1% female, 32.0 (SD = 11.6) years] and 3,979 Brazilians [69.9% female, 33.0 (SD = 11.3) years] participated in the study. Women were more likely to receive ADT than men in both countries (OR>1.3). However, no statistically or practical significant differences were observed in OA between sexes (p>0.05 or p<0.05, ηp2 = 0.00-0.02). In Finland, demand for ADT (OR = 0.9-1.0) and OA scores (p>0.05) were the same among different ages and monthly income. In Brazil, younger individuals (OR>1.6) and those with higher monthly income (OR>2.7) were more likely to receive ADT, while those with lower income had a greater psychosocial impact of OA (p<0.05; ηp2>0.07). Individuals who were more satisfied with their own OA and had less psychosocial impact from OA had higher levels of LS (ß = 0.31-0.34; p<0.01; explained variance: 9.8-13.1%). CONCLUSION: Demand for ADT is influenced by sociodemographic and cultural factors. Greater societal pressure on physical appearance is observed among women in Western countries. In countries with high socioeconomic inequalities, consumerism and social prestige are involved in this demand. Self-perception of orofacial appearance plays a significant role in individuals' subjective well-being. Therefore, the planning of aesthetic treatments in the orofacial region should consider the patient's perceptions and social context.

The Early Childhood Oral Health Impact Scale (ECOHIS): psychometric properties and application on preschoolers.

Background: The concept of oral health related to quality of life involves the impact that oral health has on an individual's well-being. The Early Childhood Oral Health Impact Scale (ECOHIS) was developed to measure the impact of oral health problems on the lives of children and their families. Objective: To evaluate the psychometric properties of ECOHIS applied to mothers of preschool children and estimate the influence of demographic characteristics, caries experience, and plaque index on the ECOHIS score. Methods: The fit of ECOHIS to the data was assessed by confirmatory analysis. Chi-square for degrees of freedom ratio (χ2/df), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA) were used. Reliability was estimated by the ordinal coefficients alpha (α) and omega (ω). The factorial invariance was estimated by the difference in CFI (ΔCFI). Comparisons of the ECOHIS mean scores according to the demographic characteristics, caries experience, and plaque index was performed using analysis of variance (ANOVA). Results: A total of 371 children participated in the study. Mothers' mean age was 33.0 (SD = 7.04) years. The ECOHIS presented a good fit to the data (χ2/df = 4.31; CFI = 0.95; TLI = 0.94; RMSEA = 0.09) and a strict model invariance. Children without caries and from higher income class had lower oral health impact. Conclusion: The data obtained with the ECOHIS were valid, reliable, and invariant. Children with caries experience and from lower income families had a greater impact of oral problems.