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Objective: To compare the color change, the risk and intensity of tooth sensitivity (TS), and gingival irritation (GI) of at‐home bleaching applied on the buccal surface only or the buccal and lingual surfaces. Materials and Methods: Sixty patients with canines A2 or darker were selected and their superior arches were randomized in two groups: at‐home bleaching on the buccal‐only or on the buccal and lingual surfaces, with 7.5% hydrogen peroxide, for 1 h daily/2 weeks. The color change was evaluated at baseline, 7, 14 days, and 1 month after bleaching using shade guides scales (ΔSGU) and a spectrophotometer (ΔEAB, ΔE00, and ΔWID). Risk and intensity of TS and GI were recorded daily using visual analogic scale (0–10). Patient satisfaction was evaluated with the orofacial esthetics. Paired t‐test, McNemar's, and Wilcoxon signed‐rank test were used for data analysis (α = 5%). Results: Neither the color change nor the risk/intensity of TS was statistically different between groups (p > 0.05). Patient satisfaction increased after bleaching for both groups (p < 0.05). Conclusion: The addition of one contact surface does not result in an increased whitening degree compared to bleaching applied solely on the buccal surface. Clinical Significance: Understanding the influence of surfaces interacting with the bleaching agent is crucial for comprehending the bleaching mechanism and avoiding unnecessary material expenses. Notably, employing the buccal‐only technique is sufficient to achieve the desired efficacy. [ABSTRACT FROM AUTHOR]

Objective: This case–control study evaluated the association of sociodemographic profile, mental health disorders and oral health‐related quality of life (OHRQoL) with periodontitis. Methods: Patients with periodontitis (PP, n = 50) and control patients (CP, n = 50) were allocated into 2 groups after a complete periodontal examination. Data collection included age, sex, marital status, education and application of 2 questionnaires: Hospital Anxiety and Depression Scale for the diagnosis of anxiety/depression and Impact Profile on Oral Health (OHIP‐14) for classification of well‐being. An adjusted multiple binary logistic regression analysis was performed to assess the effect of all studied covariates on periodontitis. Results: The results show that mean clinical attachment loss and periodontal probing depth were 5.92 (SD = 0.42) and 5.46 (SD = 0.78) in PP and 0.00 (SD = 0.00) and 2.85 (SD = 0.23) in CP, respectively (p < 0.001). The regression analysis demonstrated a significant effect on periodontitis for age (OR = 1.13; p < 0.0001; 95% CI: 1.07–1.20), with the PP having more people aged 50 years or older than CP, anxiety (OR = 1.25; p = 0.020; 95% CI: 1.04–1.50) and OHIP‐14 (OR = 1.17; p < 0.0001; 95% CI: 1.08–1.226). Conclusions: The findings showed a positive association between anxiety, OHRQoL and age with periodontitis. [ABSTRACT FROM AUTHOR]

Objective: To validate the level of agreement between self‐report and clinical examination for oral conditions and evaluate the effect of sociodemographic conditions on the validity of self‐report among women aged 60 and older. Methods: A cross‐sectional study was conducted in a social community center for seniors in Southern Brazil. Sociodemographic data (age, level of education, and income) were measured. Participants were interviewed and clinically examined for the number of teeth (DMF‐T index) and the use of dental prostheses. The self‐reported number of teeth in each arch and the use of dental prostheses were gathered through interviews. The level of agreement was estimated using the observed agreement, Kappa statistics, sensitivity/specificity (edentulism/prostheses) and Lin's concordance correlation coefficient, and related tests (number of teeth). The validity of the oral conditions was estimated according to sociodemographic information. Results: Ninety‐nine women participated in the study. High levels of agreement were observed for edentulism (97.8%; 95%CI 92.8;99.7; Kappa 0.947) and the use of dental prostheses (97.0%; 95%CI 91.3;99.4; Kappa 0.922). In both conditions, despite achieving similar concordance correlation coefficients (ranging from weak to moderate), the mean number of upper teeth was lower in clinical examination (7.1 ± 5.2) compared with self‐reported (8.6 ± 3.6), while the opposite was observed for lower teeth (clinical examination: 9.1 ± 3.4; self‐reported: 6.6 ± 5.3). Larger differences were found among women of low income and educational levels. Conclusions: Our findings suggest that the participants' socio‐economic position might influence their self‐reported number of teeth. [ABSTRACT FROM AUTHOR]

Purpose: Determine if different technology‐based health education interventions can reduce oral health inequalities between the sexes in a sample of adolescents. Methods: A cluster randomized clinical trial was conducted in three phases with an initial sample of 291 male and female adolescents 14–19 years of age. Phase I (n = 288) comprised a clinical examination performed by a calibrated examiner using the simplified oral hygiene index (OHI‐S) and gingival bleeding index (GBI). Phase II involved two educational interventions: video (VD; n = 147) or oral counselling (OR; n = 141) with standardized content. In phase III, an App was made available to half of the clusters (OR + App; n = 66/OR without App; n = 71/VD + App; n = 63/VD without App; n = 63), and the clinical examination was performed a second time. Data were evaluated using descriptive analysis and nonparametric tests. Results: In phase I, boys had a lower standard of oral hygiene compared with girls, with higher mean OHI‐S (p = 0.039) and GBI (p = 0.015). After VD and OR interventions, no significant difference between sexes was found regarding the mean OHI‐S. However, males had a higher mean GBI compared with females in the OR group (p = 0.006). When the App was added to OR and VD groups, males in the 'OR without App' group had a higher mean GBI compared with females (p = 0.007). Conclusion: This clinical trial demonstrated that educational interventions involving information technologies were effective at reducing oral health inequalities between the sexes among adolescents. However, oral counselling alone was not efficient in reducing GBI in male adolescents. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the reduction of patients' bed rest time after percutaneous renal biopsy (PRB) from 24 to 8 h using the Nursing Outcomes Classification (NOC). Methods: This was a randomized clinical trial registered with Clinical Trials number NCT04629235. The sample comprised 16 patients in the intervention group and 18 in the control group. In the intervention group, the rest time was modified to 8 h, and afterward, the patients were released to ambulate, whereas the control patients remained at absolute rest for 24 h after PRB according to institutional protocol. All patients were observed for 24 h and evaluated at five time points with the outcomes and indicators of the NOC: before the biopsy, immediately after, at the 8th hour, at the 12th hour, and at the 24th hour after the procedure. Results: In the 170 evaluations performed, statistically significant differences were identified in the outcome Comfort status: physical and the indicators "physical well‐being and comfortable position." None of the complications were related to reduced bed rest time. Conclusions: Reducing patients' bed rest time from 24 to 8 h did not increase complications from PRB, and using the NOC provided a standardized and reliable assessment. Implications for nursing practice: Important evidence was identified for patient care after PRB, demonstrating the positive impact on patient comfort and the possibility of reducing costs to the institution and the workload of the multidisciplinary team. In addition, these findings may contribute to strengthening the use of NOC in clinical practice, teaching, and research. [ABSTRACT FROM AUTHOR]

Objective: To understand the factors associated with the practice of chemsex among MSM in Brazil, especially during the Mpox health crisis, and to design effective prevention and intervention strategies specifically for this population. Design: A cross‐sectional and analytical study using an electronic survey, conducted from September to December 2022, during the peak of the Mpox outbreak in Brazil. Sample: A total of 1452 MSM aged 18 and older. Measurements: Data were collected via the REDCap platform through a survey with 46 questions. These addressed demographic data, sexual affiliations, practices, experiences with Mpox, healthcare service usage, and stigma or fear related to Mpox. Results: The prevalence of chemsex was 19.42% (n = 282). Multivariate Poisson modeling indicated a high incidence of chemsex among those diagnosed with Mpox and those involved in high‐risk behaviors. The practice of chemsex was six times higher among those diagnosed with Mpox (95% CI: 4.73–9.10). MSM who engage in bugchasing had a prevalence twice that of the main outcome (95% CI: 1.31–3.16). Conclusion: There is a significant need for targeted interventions for MSM in Brazil, especially given the Mpox outbreak. This study highlights the strong relationships between chemsex, experiences with Mpox, and various sexual behaviors, underscoring the importance of effective public health initiatives. [ABSTRACT FROM AUTHOR]

Introduction: Studies evaluating smoking and periodontal status show controversial results regarding the impact on oral health‐related quality of life (OHRQol). The aim was to evaluate the association between OHRQol and periodontal status in patients according to their smoking habit. Methods: Cross‐sectional study with a total of 100 patients (31.44 ± 8.50 years, 55% females) answered the short version of Oral Health Impact Profile (OHIP‐14) and underwent a periodontal examination. Associations between periodontal status and total mean OHIP‐14 scores related with smoking habit were analysed with Kruskal–Wallis test. Results: Mean percentage of sites with Bleeding on Probing (BOP), Clinical Attachment Loss (CAL) and Number of Teeth were significantly different between current smokers (n = 53) and never (n = 40) or former smokers (n = 7; p < 0.05). There was no significant difference for Periodontal Probing Depth (PPD) in relation to smoking status. A total mean OHIP‐14 score of 13.07 was observed for the entire sample. The corresponding total mean OHIP‐14 scores, for current smokers, never smokers and former smokers, were 15, 10 and 13 (p = 0.280), respectively. The domains social disability and handicap of the OHIP‐14 were worse in current smokers (p = 0.028 and p = 0.026, respectively). Conclusion: Current smoking was associated with a negative influence on OHRQoL in the domain of social disability and handicap. In addition, smokers have worse periodontal status, related to less BOP, greater CAL and fewer teeth than never and former smokers. [ABSTRACT FROM AUTHOR]

Background and Objectives: Cardiopulmonary and skeletal muscle impairment and poor physical activity are potential contributors to reduced functional capacity in cystic fibrosis (CF). The Glittre‐ADL test (TGlittre) has great potential for clinical use in adult CF adults, as it meets the need for a comprehensive assessment of physical function using tasks similar to activities of daily living. This study aimed to evaluate the performance of TGlittre in CF adults compared to the 6‐min walk test (6MWT) and, secondarily, to quantify the associations of their results with pulmonary function, muscle strength, and health‐related quality of life (HRQoL). Methods: This cross‐sectional study evaluated 34 CF adults and compared them with 34 subjects from a control group. The participants underwent the following assessments: functional capacity using TGlittre and 6MWT; spirometry; respiratory muscle strength; handgrip strength (HGS); and HRQoL using the Cystic Fibrosis Questionnaire‐Revised (CFQ‐R). Results: While CF patients showed a longer time to perform TGlittre compared to controls (134 (119–150) versus 107 (95–126) % of the predicted time p = 0.0002), no difference between these groups was observed in the 6MWT. When the second TGlittre was compared to the first TGlittre, there was a significant decrease in total time for both CF patients (p < 0.0001) and controls (p = 0.0001). TGlittre time correlated with 6MWT distance (6MWD) (rs = −0.641, p < 0.0001), HGS (rs = −0.364, p = 0.034), peripheral oxygen saturation at the end of the test (rs = −0.463, p = 0.006) and the "digestive symptoms" domain of CFQ‐R (rs = 0.376, p = 0.028). TGlittre time was shorter in patients who engaged in regular physical activity (3.10 (2.49–3.39) min versus 3.28 (2.95–3.53) min, p = 0.016). Conclusions: TGlittre is more effective than the 6MWT in detecting limitations during exercise. There is an important learning effect of TGlittre in adult CF patients. TGlittre time was correlated with 6MWD, HGS, oxygen saturation level, and the patient's level of physical activity. [ABSTRACT FROM AUTHOR]

Background and Purpose: Fibromyalgia (FM) is associated with altered descending pain modulatory pathways, which can be assessed through Conditioned Pain Modulation (CPM). In this study, we aimed to explore the relationship between CPM and self‐reported baseline characteristics in patients with fibromyalgia. We also performed a longitudinal analysis exploring CPM as a potential predictor of clinical improvement over time in individuals with FM. Methods: We performed cross‐sectional univariable and multivariable analyses of the relationship between CPM and other variables in 41 FM patients. We then performed longitudinal analyses, building linear mixed‐effects models with pain in the Visual Analogue Scale (VAS) as the dependent variable, and testing for the interaction between time and CPM. We also tested the interaction between CPM and time in models using other outcomes, such as the revised Fibromyalgia Impact Questionnaire and Quality of Life Scale (QOLs). Results: We found no association between CPM and other demographic and clinical variables in the univariable analysis. We found a statistically significant association in the multivariable linear regression model between CPM and the QOLs at the baseline after controlling for age, sex, and duration of symptoms. In the longitudinal analyses, we found that CPM is an effect modifier for clinical improvement over time for the pain VAS, QOLs, and FIQR: individuals with low‐efficient CPM at the baseline have a different (improved) pattern of response over time when compared to those with high‐efficient CPM. Conclusions: Our findings suggest that CPM is not a reliable biomarker of clinical manifestations in chronic pain patients during cross‐sectional assessments. However, our results are consistent with previous findings that CPM can be used to predict the evolution of clinical pain over time. We expect that our findings will help in the selection of patients with the best profile to respond to specific interventions and assist clinicians in tailoring pain treatments. [ABSTRACT FROM AUTHOR]

Introduction: Transvenous temporary pacemaker (TvTP) implantation is a critical procedure often performed under time limitations, playing a crucial role in patient survival. However, the amount of training provided for resident cardiologists is variable, due to the availability of patients. Thus, the use of simulators for this cardiologic procedure could be used as training tools. Objective: The present study aimed to develop a simulator system for TvTP implantation based on electrograms, called ETTIS (Electrogram‐guided Transvenous Temporary‐pacemaker Implantation Simulator), and to evaluate its educational potential and cardiology residents' perceived learning efficacy as a training tool. Methodology: The development of the ETTIS involved three stages: (1) Adaptation of an anatomical mannequin; (2) Design and manufacture of electronic circuits and software capable of identifying the catheter contact site within the heart chambers and reproducing electrograms in both surfaces (mode‐on) and intracavitary (mode‐off); (3) To evaluate its educational potential, a modified Likert questionnaire was administered to nine cardiology experts. Additionally, to evaluate the perceived learning efficacy, another modified Likert questionnaire was given to six cardiology residents both before and after training with the ETTIS. Descriptive statistics with measures of position and dispersion were employed, and the weighted Kappa test was used for agreement analysis. Results: A high rate of acceptance (over 90%) was found among experts who evaluated the ETTIS. The cardiology residents showed significant self‐perceived learning gains, as evidenced by a lack of agreement between their responses to a questionnaire before and after training. Conclusion: The ETTIS is a promising tool for medical training, displaying both educational potential and efficacy. It has been shown to be effective in learning a variety of skills, including cardiac catheterization and electrophysiology. Additionally, the ETTIS is highly engaging and allows cardiology residents to practice in a safe and controlled environment. [ABSTRACT FROM AUTHOR]

Background: The study aims to assess agreement between data obtained from interviews with postpartum women and their health records about labor and birth characteristics, newborn care, and reasons for cesarean birth. Methods: The present study analyzes the Birth in Brazil study dataset, a nationwide hospital‐based survey that included 23,894 postpartum women. Reliability was assessed using kappa coefficients and 95% confidence intervals. We also calculated the proportion of specific agreement: the observed proportion of positive agreement (Ppos) and the observed proportion of negative agreement (Pneg). Results: In terms of labor and birth characteristics, more significant discrepancies in prevalence were observed for fundal pressure (1.4%–42.6%), followed by amniotomy, and augmentation. All of these variables were reported more frequently by women. Reliability was nearly perfect only for mode of delivery (kappa 0.99–1.00, Ppos and Pneg >99.0%). Higher discrepancies in reasons for cesarean prevalence were observed for previous cesarean birth (CB) (3.9%–10.4%) and diabetes mellitus (0.5%–8.5%). Most kappa coefficients for CB reasons were moderate to substantial. Lower coefficients were seen for diabetes mellitus, induction failure, and prelabor rupture of membranes and Pneg was consistently higher than Ppos. Discussion: Our findings raise relevant questions about the quality of information shared with women during and after the process of care for labor and birth, as well as the information recorded in medical charts. Not having access to full information about their own health status at birth may impair women's health promotion behaviors or clear disclosure of risk factors in future interactions with the healthcare system. [ABSTRACT FROM AUTHOR]

Background and Purpose: The World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed to assess health and disability based on the biopsychosocial model. The WHODAS 2.0 has not been validated for Brazilians with chronic non‐specific low back pain (LBP). We aimed to evaluate the reliability, internal consistency, and construct validity of the Brazilian version of the WHODAS 2.0 in patients with chronic LBP. Methods: Methodological study. The Brazilian version of the WHODAS 2.0 was applied to 100 volunteers with chronic nonspecific LBP. Test‐retest reliability, internal consistency, and construct validity were assessed using the Spearman correlation test, Cronbach's alpha (α) coefficient, and Spearman's correlation test between WHODAS 2.0, the Oswestry Disability Index (ODI), Roland‐Morris Disability Questionnaire (RMDQ), and Fear Avoidance Beliefs Questionnaire (FABQ), respectively. Results: WHODAS 2.0 showed satisfactory test‐retest reliability with a moderate correlation for total WHODAS 2.0 (r = 0.75, p < 0.05). Internal consistency was adequate for all domains and total score (α = 0.82–0.96). Regarding construct validity, WHODAS 2.0, ODI (r = 0.70, p < 0.05), and WHODAS 2.0 and RMDQ (r = 0.71, p < 0.05) had significant correlations. Total WHODAS 2.0 and FABQ‐Phys subscale scores correlated moderately (r = 0.66, p < 0.05). Discussion: The Brazilian WHODAS 2.0 was proved to be a valid and reliable tool for patients with chronic LBP. The item referring to sexual intercourse had 27% and 30% of the missing values during the test and retest stage, respectively and had a high percentage of missing data for work‐related questions (41% missing data) in the life activities domain; therefore, the data must be interpreted with caution. Implications for Physiotherapy Practice: WHODAS 2.0 can be used as a disability assessment strategy from a biopsychosocial perspective in this population. [ABSTRACT FROM AUTHOR]

Background: Changes in nutritional status are recognised as predictors of unfavourable outcomes in children and adolescents with cancer, particularly in developing countries. There have been no studies on children and adolescents with cancer from every region of Brazil or on the impact of nutritional status on clinical outcomes. The aim of this study is to assess the association between the nutritional status of children and adolescents with cancer and the prediction of clinical outcomes. Methods: This was a longitudinal, multicentre, hospital‐based study. An anthropometric nutritional assessment was performed, and the Subjective Global Nutritional Assessment (SGNA) was administered within 48 h of admission. Seven hundred and twenty‐three patients (aged 2–18 years) were included in the sample, undergoing cancer treatment. They were recruited in 13 reference centres in the five macro‐regions of Brazil between March 2018 and August 2019. The outcomes evaluated were readmission within 30 days and death within 60 days of admission. To identify predictors of 60‐day survival, Cox regression and log‐rank statistics were used to compare Kaplan–Meier curves between the strata. Results: About 36.2% (n = 262) of the samples were malnourished according to the SGNA. Severe malnutrition by the SGNA (relative risk [RR] = 8.44, 95% confidence interval [CI]: 3.35–21.3, P = 0.001) and living in the North region (RR = 11.9, 95% CI: 3.34–42.7, P = 0.001) were associated with the poorest survival. The North (RR = 5.77, 95% CI: 1.29–25.8, P = 0.021), Northeast (RR = 1.46, 95% CI: 1.01–2.11, P = 0.041), Midwest (RR = 0.43, 95% CI: 0.20–0.095, P = 0.036), age group 10–18 years (RR = 0.65, 95% CI: 0.45– 0.94, P = 0.022) and haematologic malignancy (RR = 1.52, 95% CI: 1.10–2.10, P = 0.011) were predictors of readmission within 30 days. Conclusions: The prevalence of malnutrition was high and related to death. These results highlight the need to use the SGNA in clinical practice alongside classic anthropometric methods for the diagnosis of malnutrition, and the need to standardise care across all Brazilian regions, which should include nutritional care for children and adolescents with cancer. Key points: Malnutrition, according to Subjective Global Nutritional Assessment (SGNA), was high and related to death in Brazilian children and adolescent with cancer.Patients from more economically disadvantaged regions of Brazil, aged 10–18 years and in haematological treatment, had higher readmission rates. [ABSTRACT FROM AUTHOR]

Background: Patient and family‐centred care (PFCC) is a healthcare model has been acknowledged as the central pillar in the paediatric health care that recognizes the family's role and experience in the health care delivery. Aims: This study investigated and compared the perception of PFCC from the perspective of staff and parents of hospitalized children and adolescents. Methods: A quantitative and comparative cross‐sectional survey was used in a convenience sample of 105 staff and 116 parents, who completed the Brazilian versions of the Perceptions of Family Centred Care—Parent and Staff questionnaires, with additional questions on their characteristics. Descriptive and analytical statistics were used, as well as the Kruskal–Wallis and Mann–Whitney tests and Spearman's correlation coefficient. Results: Both parents and staff responses were positive and parents had significantly higher scores for 19 of the 20 items (p < 0.001). The item related to parental participation did not show any significant difference between the groups. Conclusion: The positive perception of PFCC for both groups is consistent with recommendations for expanded care that includes patient and family in healthcare settings. Parents' perception was more positive than staff perceptions of their delivery of family‐centred care in hospital. The lowest score for the parent support subscale in both groups requires investigation. [ABSTRACT FROM AUTHOR]

Understanding of the association between nutritional risk and clinical outcomes in hospitalised patients with overweight is still at an early stage. Given the lack of specific tools for the patient with overweight, the objective of this study was to compare two of the main general screening instruments for assessing nutritional risk in predicting clinical outcomes in a population of hospitalised patients with overweight. A retrospective study was carried out in a medium‐sized hospital in Brazil, with patients ≥20 years old admitted between July 2017 and December 2019. Patients who were overweight and had records of Nutritional Risk Screening‐2002 (NRS‐2002) and Mini‐Nutritional Assessment‐Short Form (MNA‐SF) in their medical files were included in the study. Clinical outcomes data (longer length of stay, readmission during the study period and mortality before the end of study or during hospitalisation) were obtained. The Kappa coefficient assessed agreement between both tools, and their performance for predicting outcomes was analysed using characteristic receiver operating curves (ROC). Data were collected from 643 patients. The prevalence of nutritional risk was 17.7% and 36.1% according to the NRS‐2002 and MNA‐SF (k = 0.390; p < 0.001), respectively. According to both tools, all clinical outcomes were significantly more common among individuals at nutritional risk (p < 0.05). Only the MNA‐SF showed a significant percentage of predictions for readmission (57.2%) and death during hospitalisation (65.7%). For mortality until the end of the study, the area under the ROC curve was similar for MNA‐SF (60.5%) and NRS‐2002 (60.7%; p = 0.057). The MNA‐SF detected a greater proportion of nutritional risk among hospitalised patients with overweight and better predicted all clinical outcomes compared to the NRS‐2002 and should be used to screen patients with overweight for nutritional risk. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence and associated factors of self‐reported halitosis in institutionalized adolescents in a city in southern Brazil. Methods: This cross‐sectional study involved male institutionalized adolescents, aged 15–19 years old, at the Socio‐Educational Assistance Center in the city of Passo Fundo, Brazil. Data collection was performed by a research team composed of two interviewers, two clinical examiners of oral health and two examiners of salivary flow. A structured questionnaire was applied, which included demographical, socioeconomical, general health behaviour, presence of health problems and oral health self‐perception variables. Decayed, Missing, Filled Index was used for the clinical examination. The salivary flow collection was performed using the mechanically stimulated total saliva method, in which only the liquid component was measured. Results: The prevalence of self‐reported halitosis in this sample was 51.5% (n = 35). In the final multivariate analysis, halitosis was significantly associated with the non‐white racial group (prevalence ratio [RP]:1.703; 95% confidence interval [95%CI]:1.101–2.634), use of crack (RP:1.857; 95%CI:1.270–2.714) and number of decayed teeth (PR: 1.123; 95%CI:1.008–1.252). The use of alcohol and access to dental care in the last 12 months were not significantly associated with self‐reported halitosis. Conclusion: It was concluded that non‐white and crack‐user youngsters had a high occurrence of self‐reported halitosis. Higher rates of dental caries are also associated with halitosis. [ABSTRACT FROM AUTHOR]

Objective: To evaluated the relationship between serum vitamin D levels and periodontal healing outcomes in patients with mild or moderate periodontitis. Methods: Serum vitamin D levels and periodontal pockets and gingival bleeding were evaluated in 51 patients before and 6 months after non‐surgical periodontal treatment. A t‐test and chi‐square test were used to analyse the data (p ≤ 0.05). Results: The mean reduction of periodontal pocket depth was statistically significant higher in patients with vitamin D ≥30 ng/ml than those with <30 ng/ml (CI = −0.23–0.42, p = 0.05), but not clinically significant. Vitamin D level was not associated with the percentage of sites of gingival bleeding on probing at the final evaluation (OR = 0.58, 95% CI = 0.17–1.99, p = 0.39). Conclusion: Lower serum vitamin D level was associated with a slightly reduced periodontal healing after non‐surgical periodontal therapy, which should be further investigated in a larger population. [ABSTRACT FROM AUTHOR]

Introduction: Paediatric HIV follow‐up is challenging, and treatment indicators are markedly far from Joint United Nations Programme on HIV/AIDS (UNAIDS) goals. In this study, we describe the 2019 Brazilian HIV cascade according to age categories and sociodemographic variables and address temporal trends between 2009 and 2019. Methods: We obtained data from the Brazilian Ministry of Health monitoring database. Cascade outcomes included retention in care, antiretroviral use, and viral suppression. We assessed the effect of age on timely initiation of antiretroviral treatment (ART; initiation with CD4+ T‐cell count ≥350 cells/mm3 or a first ART dispensation ≤30 days after the first CD4+ T‐cell measurement) and detectable HIV viral load (>50 copies/mL) in univariable and multivariable analysis adjusted for sex, race, and social vulnerability index (SVI). Temporal trends in timely ART initiation and viral suppression were evaluated graphically. Results: Among 771 774 people living with HIV, those in the youngest age categories had poorer indicators in the care cascade. Those in younger age groups, those with higher SVI, and those declaring Black and native Brazilian race/ethnicity had higher odds of having detectable viral load and delayed ART initiation. Although children living with HIV tend to start ART with higher CD4+ T‐cell counts, time–series analysis suggests that improvements in treatment indicators seen in the adult population are not observed in the paediatric population. Conclusion: Our results highlight the challenges faced by children and adolescents living with HIV in achieving UNAIDS goals. Lower access to ART among children is a central barrier to improved paediatric care. [ABSTRACT FROM AUTHOR]

Background: Caries and periodontal disease may cause tooth losses and chewing difficulty, especially in the elderly. Ingesting poorly chewed food may delay gastric emptying and favour the development of gastroesophageal reflux disease (GERD). Objective: This study investigated the association between masticatory dysfunction and GERD in the elderly from a rural area in southern Brazil. Methods: This census invited all 489 elderly from a city to participate. The study used a GERD symptoms questionnaire, followed by an oral examination. Masticatory dysfunction was analysed based on the chewing difficulty for some food groups. Tooth loss and chewing self‐perception were also considered as exposure variables. Poisson regression determined the association among variables by calculating the prevalence ratio [PR (95% confidence interval)]. Results: The response rate was 93.1% (n = 455, average age of 70.9 years, 50.5% men). The prevalence of GERD in this population was 36.9%. GERD was associated with chewing difficulty for vegetables (PR = 1.54), meats (PR = 1.34) and cereals (PR = 1.43) but not with poor chewing self‐perception (PR = 0.80) and tooth loss (PR = 1.22). GERD was also associated with xerostomia (PR = 1.63) and the female gender (PR = 1.35). Conclusion: Elderly people from a rural area with a reduced number of teeth present chewing difficulty and a high prevalence of GERD, indicating an association between GERD and masticatory dysfunction. [ABSTRACT FROM AUTHOR]

In recent years, immense amounts of data have been generated, from sensors to purchase transaction records, mobile GPS signals, digital satellite images, and social media. The raise of data collection has brought the need for quantitative minded professionals able to transform that data into information and decision making. In this opinion piece, we will share some of our views and experiences about the general role that data science plays nowadays, with a special interest in the field of environmetrics. We will include a limited number of examples that highlight the usefulness of data science in environmetrics, and a specific illustration of the behavior of the wildfires in Brazil between January and December of 2021. [ABSTRACT FROM AUTHOR]

Associations between breastfeeding intention, duration and post‐natal depression (PND) have been shown in pre‐COVID‐19 studies. However, studies during COVID‐19 have not examined the associations between breastfeeding intention, breastfeeding practices, and PND in an international sample of post‐natal women, taking into consideration COVID‐19 related factors. This is the first study to address this gap as both PND and breastfeeding may be affected by COVID‐19, and have important long‐term effects on women's and infant's health. A cross‐sectional internet‐based survey was conducted with 3253 post‐natal women from five countries: Brazil, South Korea, Taiwan, Thailand, and the United Kingdom from July to November 2021. The results showed that women who intended to breastfeed during pregnancy had lower odds of having PND than women who did not intend to. Women who had no breastfeeding intention but actually breastfed had greater odds (AOR 1.75) of having PND than women who intended to breastfeed and actually breastfed. While there was no statistical significance in expressed breast milk feeding in multivariable logistic regression models, women who had shorter duration of breastfeeding directly on breast than they planned had greater odds (AOR 1.58) of having PND than those who breastfed longer than they planned even after adjusting for covariates including COVID‐19‐related variables. These findings suggested the importance of working with women on their breastfeeding intention. Tailored support is required to ensure women's breastfeeding needs are met and at the same time care for maternal mental health during and beyond the pandemic. Key messages: This study identified independent associations of breastfeeding intention and actual breastfeeding practices with PND after adjustment for COVID‐19‐related covariates.Although women who intended to breastfeed during pregnancy were less likely to have PND, those who did not intend to breastfeed but did breastfeed were more likely to have PND than those who intended to breastfeed and breastfed.Women with shorter (vs. longer) than planned duration of breastfeeding on breast were more likely to have PND.Health care providers and policymakers should ensure tailored support is available for women's infant feeding plans and mental health. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the accuracy of the clinical indicators of the nursing diagnosis Ineffective Health Management in people with hypertension. Methods: This is a cross‐sectional diagnostic accuracy study. The ineffective health management was investigated in 120 people with hypertension in a referral public outpatient clinic in Brazil between August and November 2020. The accuracy measures were analyzed using Rasch analysis, considering the difficulty of clinical indicator and person's ability. Results: Ineffective health management is probably present in 37.5% of people with hypertension. 'Failure to include treatment regimen in daily living' was the clinical indicator with the highest sensitivity value, and 'failure to take action to reduce risk factor' had the highest specificity value. Conclusions: Rasch analysis demonstrated that all clinical indicators contribute significantly to estimating the presence of ineffective health management in people with hypertension in the outpatient scenario. Implications for Nursing Practice: This research contributes by providing accurate clinical indicators of ineffective health management, helping nurses prescribe and deliver the appropriate nursing interventions for people with hypertension by telenursing. [ABSTRACT FROM AUTHOR]

Aims: To translate and culturally validate the Estabrooks' Kinds of Research Utilization (RU) and the Conceptual Research Utilization Scale (CRU) into Brazilian Portuguese; and to describe the research use by health professionals working on Long Term Care Institutions (LTCI) for older people. Background: Research utilisation ensures greater quality and effectiveness in the care provided by health professionals. However, there are no instruments to evaluate research utilisation in Latin America countries, like Brazil. Materials & Methods: A methodological cross‐sectional questionnaire validity and descriptive study. The translation and adaptation of the instruments was performed in seven steps following psychometric guidelines. The instruments evaluate research utilisation by health professionals in clinical practice. The RU is composed of single‐items of instrumental, persuasive, conceptual and overall forms; and the CRU the conceptual form through a 5‐item scale. Professionals of technical level and graduated working in nine LTCI were evaluated from August to December 2018. Descriptive and inferential (reliability, correlation, internal consistency and structure of CRU) analyses were conducted. Results: Sample composed of 117 professionals, 67.5% of healthcare aides and 32.5% of graduated health professionals. All forms of research utilisation showed high implementation in practice (about 75% of the time, or frequently). CRU internal consistency (α = 0.885) and structure were adequate. There were significant correlations between RU and CRU (from very low r = 0.187 to high r = 0.712). Intra‐rater, inter‐rater and alternate forms reliability ranged from moderate to substantial. Conclusions: The Brazilian versions of the RU and the CRU are valid, reliable and acceptable for evaluating research utilisation by professionals working on LTCI. It is of great relevance to introduce these instruments in low‐ and middle‐income countries to have future data on how much older people care is influenced by the best evidence available. These instruments can be adapted to different healthcare settings and populations. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study aimed to investigate the associations of oral health literacy (OHL), sense of coherence (SOC) and other covariates with self‐reported school performance (SRSP) in adolescents enrolled in public schools in Brazil. METHODS: This was a cross‐sectional study conducted with adolescents aged from 14 to 18 years enrolled in 6 public schools in Piracicaba, São Paulo, Brazil. Researchers carried out data collection at schools using a self‐administered structured questionnaire. The dependent variable was SRSP. The explanatory factors included were sociodemographic characteristics, OHL, SOC, self‐rated oral health, health behaviors, and experience of bullying. Analyses included simple and multiple logistic regression models. RESULTS: The final sample consisted of 385 adolescents with a mean age of 16 years. Poor school performance was associated (95%CI) with being male, with more than 1 sibling, individual whose last visit to the dentist was due to dental pain, with a lower level of OHL and SOC. CONCLUSIONS: OHL and SOC were important factors associated with SRSP performance together with other sociodemographic and oral health‐related variables in high school students. Our findings reinforce the importance of intersectoral actions between the health and education sectors to promote better school performance among adolescents, including actions to improve OHL and SOC. [ABSTRACT FROM AUTHOR]

Infant feeding practices impact children's nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian site of the MAL‐ED study were evaluated at 9 (n = 193), 15 (n = 182) and 24 months (n = 164) using 24‐h dietary recalls. IYCF indicators were evaluated, and the extent of food processing was evaluated, using the NOVA classification. Breastfeeding declined significantly over time, from 77.6% at 9 months to 45.1% at 24 months. Although dietary diversity did not significantly change during the study period (80.5% at 24 months), the minimum acceptable diet significantly increased from 67.9% to 76.1% at 24 months (p < 0.0005). All the studied children consumed sweetened beverages from 9 months. Unhealthy food consumption and zero vegetable or fruit consumption significantly increased over time (p < 0.0005). Unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005), while ultra‐processed food consumption increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, breastfed children presented a lower risk for ultra‐processed food consumption (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.13–0.77); and children reaching the minimum acceptable diet presented more risk for ultra‐processed food consumption (OR = 2.31; 95% CI = 1.01–5.27). In conclusion, data showed a reduction in the quality of infant feeding practices over the first 2 years of life, with a decrease in breastfeeding and an increase in the consumption of unhealthy and ultra‐processed foods. Key messages: Data showed a reduction in the quality of infant feeding practices over the first 2 years of life.Breastfeeding decreased over the studied period. There was an increase in the consumption of ultra‐processed and unhealthy foods, which occurred concomitantly to the increase of no consumption of fruits/vegetables.Breastfeeding was an important protective factor against a greater consumption of ultra‐processed food.National nutrition policy should consider promoting breastfeeding and increasing fresh and minimally processed food consumption in children under 2 years. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence of oral mucosal lesions (OML) and oral self‐examination and their associated factors among pregnant women from the 2015 Pelotas Birth Cohort Study, Brazil. Methods: Pregnant women who would deliver babies in 2015 were included in the antenatal study. Data related to demographic, socio‐economic and behavioural conditions were collected using questionnaires. Participants were also clinically assessed for oral health outcomes. The outcomes were the presence of OMLs and oral self‐examination. Size, location, time of onset and symptomatology of the lesions were collected. Descriptive and bivariate analysis, and Poisson regression were performed. p‐Value <0.05 was set to indicate statistical significance. Results: Data from 2481 pregnant women were analysed. Four hundred and nine (16.5%) had at least one OML. The most prevalent lesions were exostosis (80/16.6%), coated tongue (70/14.5%) and benign oral brownish pigmentation (68/14.1%). Non‐white skin colour was associated with a higher prevalence of OMLs (PR 1.3; 95% CI 1.1–1.6), while daily use of dental floss was positively associated with the prevalence of oral self‐examination (PR 1.4; 95% CI 1.2; 1.5). Conclusions: Almost 20% of pregnant women presented OML, which were more prevalent in non‐white individuals. Women with better oral care were more likely to perform oral self‐examination. [ABSTRACT FROM AUTHOR]

Purpose: To clinically validate nursing outcomes and interventions associated with the nursing diagnoses of Risk for Frail elderly syndrome or Frail elderly syndrome. Methods: This cross‐sectional study utilized an instrument containing assessment cues, nursing diagnoses, outcomes, and interventions in a sample of 28 older adults. The Generalized Estimation Equation model, complemented by the Bonferroni test, was used for statistical analysis. Results: Twenty‐three (82%) older adults were diagnosed with Risk for Syndrome and five (18%) with Frail elderly syndrome. Ten outcomes and three interventions were validated with significant differences statistically. Conclusions: The clinical validation made it possible to demonstrate the clinical evolution of these patients under follow‐up. Implications for Nursing Practice: Those outcomes and interventions are a linkages proposal between them and the nursing diagnoses. Objetivo: Validar clinicamente os resultados e intervenções de enfermagem associados ao diagnóstico de enfermagem Risco para Síndrome do Idoso Frágil ou Síndrome do Idoso Frágil. Métodos: Estudo transversal que utilizou um instrumento contendo possibilidades de avaliação, diagnóstico de enfermagem, resultados e intervenções em uma amostra de 28 idosos. A análise estatística utilizou o modelo de Equações de Estimativas Generalizadas, complementado pelo teste de Bonferroni. Resultados: Vinte e três (82%) idosos foram diagnosticados com Risco de Síndrome e cinco (18%) idosos com Síndrome. Dez resultados e três intervenções foram validados com diferença estatisticamente significativa. Conclusões: A validação clínica permitiu demonstrar a evolução clínica desses pacientes em acompanhamento. Implicações para a prática de enfermagem. Esses resultados e intervenções são uma proposta de vínculo entre eles e os diagnósticos de enfermagem. [ABSTRACT FROM AUTHOR]

BACKGROUND: The aim of the present study was to analyze the association between course type and health among high school students. METHODS: A cross‐sectional study with 675 Brazilian high school students. The independent variable was course type (general or vocational) and dependent variables were health characteristics. All information was obtained by a self‐report questionnaire and the following health characteristics were analyzed: mental health, physical activity, sedentary behavior, food consumption, daytime sleepiness, tobacco use, alcohol consumption, aggression, and musculoskeletal symptoms. The prevalence ratio (PR) was estimated by Poisson regression. RESULTS: Vocational students presented a higher prevalence in 7 of the 20 mental health symptoms analyzed (PR = 1.21‐1.64), daytime sleepiness (PR = 1.39‐1.71), and musculoskeletal symptoms in neck, shoulders, low back, and knees (PR = 1.31‐1.41), and a lower likelihood of being physically active (PR = 0.59‐0.70). Conversely, vocational students showed lower sedentary behavior on TV and videogames during the week (PR = 0.35‐0.46), consumption of snacks, cookies, and crackers (PR = 0.56‐0.72), and experiences of aggression (PR = 0.13‐0.17), all P <.05. CONCLUSIONS: High school can affect students' health distinctly, indicating that intervention programs and health monitoring should be specific to course type. [ABSTRACT FROM AUTHOR]

Introduction: Adverse childhood experiences (ACEs) can negatively affect children's current and future health. Objectives: This study aims to analyse the impact of ACE on the health of 12‐month‐old infants assessed by a Physical Health and Maternal Care Indicator (ISCM). Methods: We conducted a retrospective cohort including 170 infants born in two public services for high‐risk births in Brazil. ISCM gathers information that reflects maternal care and the child's health throughout the first year of life, such as vaccination, nutrition, growth, illnesses and accidents. The ACE impact on ISCM was analysed by multiple linear regression, and the d‐Cohen test estimated its effect size. Spearman's correlation was used to analyse the cumulative ACE effect, measured by a score reflecting events such as family dysfunction, maternal mental health, poverty and exposure to violence. Results: Most infants were born prematurely (71.7%), had low birthweight (64.7%) and were exposed to three ACEs on average. The ISCM was lower in children exposed to maternal depression (P < 0.001, d‐Cohen = 0.08), substance abuse by family members (P = 0.02, d‐Cohen = 0.6) and marital conflicts (P = 0.03, d‐Cohen = 0.7). The Spearman's correlation showed that the greater the exposure to ACEs, the lower the ISCM (r = −0.40, P < 0.0001). Conclusion: Exposure to ACE, especially in the family environment, had negative effect on maternal care and child health. The impact could be detected in the first year of life and had cumulative effect. Our findings indicate the need for a broader approach to child health to minimize ACE's impacts. [ABSTRACT FROM AUTHOR]

Background: Aims: To describe typical phonological development of Brazilian Portuguese (BP)‐speaking children, considering the following parameters: age of customary production, acquisition and mastery. Methods & Procedures: Data were collected from 857 children aged between 3 years and 8 years 11 months with typical language and speech development. The sample was grouped into 6‐month age bands. The data were analysed using one‐way analysis of variance (ANOVA) followed by Games–Howell post‐hoc tests. Outcomes & Results: Stops (/p, b, t, d, k, g/), nasals (/m, n, ɲ/) and some fricatives (/f, v, s, z/) were mastered before the age of 3 years (age of mastery). The age of acquisition for phonemes /ʃ, ʒ/ was 3;6, though both were only mastered at 4;0 years. The liquid /l/ was acquired at 3;0 and mastered at age 3;6, while /x/ was acquired and mastered at age 3;6. The phoneme /ʎ/ was acquired at 7;0 and mastered at age 8;6. The tap /ɾ/ was acquired between the ages of 4;0 and 4;6, and mastered at 4;6. In coda position, /n, l/ were acquired at 3;0, while /s/ was mastered at 4;6 and /ɾ/ between 4;6 and 5;0 years. Clusters involving /ɾ/ were acquired at 6;0, while those with /l/ were acquired between the ages of 6;6 and 7;0. Conclusions & Implications: This study presented acquisition for consonants in BP and can be used as a reference for the assessment of developmental speech disorders. In this study, stops and nasals were acquired first, followed by fricatives and, lastly, liquids. This finding is corroborated by previous studies in BP and other languages. What this paper adds: What is already known on the subject: What this paper adds to existing knowledge: What are the potential or actual clinical implications of this work?: [ABSTRACT FROM AUTHOR]

Objective: This study analysed the association between caesarean section and early childhood caries (ECC), estimating the effects using regression and causal inference models. Methods: This was a historical cohort study of 697 mother‐child dyads, conducted in São Luís, Brazil. The caesarean section was the exposure, and the severity of ECC (dmft) was the outcome. Covariates household income, maternal schooling, maternal hypertension, maternal obesity and birth weight were adjusted for in the models. The effects were estimated by Poisson regression (Means Ratio‐MR) and causal inference using a marginal structural model (MSM) (MR and Average Treatment Effect‐ATE coefficients), weighted by the inverse probability (IPW) of exposure. Results: Caesarean section was protective against caries in the bivariate (MR 0.81; CI 0.70‐0.94; P = 0.005) and multivariate (MR 0.78; CI 0.67‐0.91; P = 0.002) models. In MSM analyses, the caesarean section had no effect on ECC (ATE = −0.35; P = 0.107), controlling for IPW of exposure. Conclusion: The apparent association between caesarean section and ECC severity seems spurious, as it did not persist after employing a superior approach to estimating causality. [ABSTRACT FROM AUTHOR]

Objective: To identify reasons among Brazilian women for never having a Pap test. Design: We designed a cross‐sectional study that used data from the National Health Survey. Sample: Two thousand four hundred and two women 25–64 years old who never had a pap test. Measures: Variables were age, race, education, marital status, housing condition, primary health care access, health insurance, self‐perceived health, and social support network. We calculated the prevalence of different reasons and odds ratios for each. Results: The most frequent reason for never having a test were linked to women thinking the test was unnecessary (42.3%) which had a significant association with marital status (OR = 1.52; 95% CI = 1.07–1.91), age (OR = 1.56; 95% CI = 1.21–1.99), area of residence (OR = 1.15; 95% CI = 1.02–1.39), having a health insurance (OR = 1.18; 95% CI = 1.01–1.36), and self‐perceived health (OR = 1.42; 95% CI = 1.28–1.56). The second most frequent reason was not knowing they needed a test (22.9%) which was associated with age (OR = 1.95; 95% CI = 1.74–2.16) and self‐perceived health (OR = 1.56; 95% CI = 1.33–1.80). Conclusions: The findings suggest lack of knowledge about cervical cancer and its prevention among Brazilian women. We consider it essential that the health service can provide the test, as well as the necessary guidelines for raising the awareness of the target audience. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether religiosity and spiritual well‐being are associated with appearance concerns among people with visible sequelae due to cancer surgery in the head and neck region. Methods: A cross‐sectional study was carried in 202 adult patients in a referral hospital for cancer treatment in Midwest Brazil. Data on sociodemographic, psychosocial and clinical aspects and cancer‐related behaviours were collected through interviews, clinical examination and medical records. The outcome was the patients' appearance concerns (Derriford Appearance Scale—DAS24). The independent explanatory variables were religiosity (Duke University Religiousness Index—DUREL) and spiritual well‐being (Functional Assessment of Chronic Illness Therapy‐Spiritual Well‐Being Scale—FACIT‐Sp12). Data were analysed using Pearson's chi‐square and Poisson regression. Results: Most of the participants were male (76.2%), and mean age was 58.6 years (SD = 11.6). The scores of appearance concerns (DAS24) ranged from 21 to 75 (median = 33.0). In the bivariate analysis, appearance concerns were associated with spiritual well‐being (FACIT‐Sp12), degree of disfigurement and treatment with radiotherapy/chemotherapy. Religiosity (DUREL) was not associated with the outcome. In the adjusted regression model, a lower prevalence of appearance concerns was found among patients with higher levels of spiritual well‐being (PR = 0.86; CI = 0.79‐0.94), males (PR = 0.87; CI = 0.79‐0.95), those with lower degrees of disfigurement (PR = 0.89; CI = 0.82‐0.98) and those who had no treatment with radiotherapy/chemotherapy (PR = 0.83; CI = 0.72‐0.94). Conclusion: High spiritual well‐being was independently associated with lower levels of appearance concerns in people with visible sequelae due to cancer surgery in the head and neck region. Understanding the role of this psychosocial determinant may help in the coping process. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the translucency parameter (TP) and contrast ratio (CR) of different conventional restorative glass‐ionomer cements (GICs). Materials and methods: Eighteen brands of GICs were evaluated. Five disks of each material were made following ISO 9917‐1. The luminous reflectance and Central Bureau of the International Commission on Illumination parameters of disks were evaluated using a colorimeter, against backings of white and black, to obtain the translucent parameter and contrast ratio of different brands of glass‐ionomer cements. The correlation between translucency parameter and contrast ratio was assessed with the Pearson correlation test. The translucent and contrast ratio parameters values were submitted to the one‐way ANOVA and Tukey test for multiple comparisons (p < 0.05). Results: There was a strong inverse relationship between CR and TP (r2 = 0.94, p < 0.001). The contrast ratio decreased as translucency increased. There were significant differences in TP and CR among brands (p < 0.001). Conlusions: GICs exhibit different translucency and contrast ratio behavior. Some brands of GICs presented very low TP and this condition would be unacceptable for areas with esthetic demands. In addition, TP and CR showed a strong linear relationship. Clinical significance: The results found in this study demonstrated that the knowledge of the translucency and CR of different conventional restorative GICs is important in order to guide clinicians in the selection of restorative GICs for anterior teeth. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the factors associated with length of stay (LOS) and death in nasogastric/nasoenteric tube (NG/NET)‐fed patients. Design: A cross‐sectional multicentre study. Method: Data collection took place from October 2017–April 2019, and the sample consisted of 365 participants from seven Brazilian hospitals. Demographic, clinical and therapeutic data were collected from the patients' medical records. Data analysis was performed using bivariate and multivariate tests, considering a significance level of p<.05. Results: Most patients were male, older adults, with high risk of death and highly dependent on nursing care. The LOS was associated with age, patient care complexity and length of NG/NET use. Death was associated with patient age. In the multivariate analysis, patients highly dependent on nursing care, and intensive and semi‐intensive care had a greater chance of dying when compared with patients receiving minimal care. Screening for factors affecting LOS and death is important to plan effective nursing care. [ABSTRACT FROM AUTHOR]

Background: The social isolation enforced as a result of the new coronavirus (COVID‐19) pandemic may impact families' lifestyle and eating habits. The present study aimed to assess the behaviour and dietary patterns of Brazilian children and adolescents during the social isolation imposed by the COVID‐19 pandemic. Methods: The present study was conducted using an online, anonymous cross‐sectional survey with 589 children and 720 adolescents from Brazil during a nationwide social isolation policy. The Mann–Whitney U‐test or the Kruskal–Wallis with the Dunn post‐hoc method and a radar chart were used to compare the weekly consumption of each food by age group and isolation status. p < 0.05 was considered statistically significant. Analyses were conducted using R statistical software, version 4.0.2 (R Foundation for Statisitical Computing). Results: We found that isolated families showed breakfast eating habits and the consumption of raw salad, vegetables, beans and soft drinks. Lower‐class isolated families and those from the Northeast region consumed fruits, juices, vegetables and beans less frequently. Compared to children, adolescents were less isolated (p = 0.016), less active (p < 0.001), exposed to longer screen time (p < 0.001), showed an inadequate sleeping pattern (p = 0.002) and were from lower‐class families (p < 0.001). Conclusions: Social isolation affected the eating habits of children and adolescents. Non‐isolated families presented a lower consumption of healthy food, especially those among the lower class, from Northeast Brazil, as well as adolescents. [ABSTRACT FROM AUTHOR]

Background: Children with intellectual development disorder (IDD) have high rates of comorbid neuropsychological and behavioural problems. However, there are not many studies on this population in middle‐income and low‐income countries. Therefore, we aimed to investigate the prevalence of neuropsychological and behavioural problems in students with and without IDD and to assess the correlation between the responses from informants (parents and teachers) and the clinical diagnoses in Brazil. Methods: After clinical diagnosis, 78 male and female students (7–15 years old) were divided into two groups: children with IDD (n = 39) and children without IDD (n = 39). The Child Behaviour Checklist (CBCL) and Teacher's Report Form (TRF) scales were used to track neuropsychological and behavioural problems. Calculations of prevalence ratios were performed using Poisson regression with Wald tests. The CBCL and TRF results were compared between groups with Mann–Whitney U‐tests and receiver operating characteristic (ROC) analyses. The agreement between scales was assessed using the Spearman correlation test. Results: Neuropsychological and behavioural problems were significantly more prevalent in students with IDD. The average amount of CBCL problems was significantly higher than that of TRF in the dimensions of thought, attention, somatic, attention deficit/hyperactivity, opposition defiant and total problems. Low‐to‐moderate correlations between CBCL and TRF dimensions in the IDD group were observed. ROC analyses revealed that the dimensions of internalising problems and total scores reflecting CBCL and TRF problems were the most important factors for identifying neuropsychological and behavioural problems in the IDD group. Conclusions: Students with IDD require early identification of behavioural and emotional symptoms to avoid the underdiagnoses of various mental health problems, especially those with internalising characteristics. The CBCL and TRF may assist in the early screening of these comorbidities. [ABSTRACT FROM AUTHOR]

The implementation of front‐of‐pack labelling to assist consumers in making healthier food choices requires an appropriate Nutritional Profile Model (NPM) to be defined. However, four different models have been proposed in Brazil: the Pan American Health Organization (PAHO), the Brazilian Association of Food Industries (ABIA) and National Health Surveillance Agency (ANVISA) less (1) and more restrictive (2) models. The present study aimed to use the information provided on the labels of eight ultra‐processed food categories selected from the most popular group of foods targeted at Brazilian children, to score critical nutrient levels according to the four different NPMs and compare the proportion of products categorised as 'high', 'medium' or 'low' according to each one. Labels (n = 409) were collected in supermarkets in Belo Horizonte‐MG, Brazil. Data were tabulated, and a comparison of the 'high' content of the four nutrients, total sugars, total and saturated fats and sodium, according to the four NPMs, was performed. Agreement between 'high', 'medium' and 'low' scores according to the different NPMs, in comparison with the PAHO model, was performed using the Kappa test. Of all 'fruit' drinks, 95% were considered as 'high' in total sugars by the PAHO model, while only 5% were categorised as 'high' by the ABIA and ANVISA 1 models. For total sugars, no product in the cakes, breakfast cereals and yogurts categories and only 5.7% of the sandwich cookies were categorised as 'high' by the ABIA model, while 100% of sandwich cookies were categorised as having a 'high' total sugars content by the PAHO and ANVISA models. Similar findings were observed for breakfast cereals, yogurts and corn snacks for the proportion of products scoring 'high' for saturated fats and sodium. Kappa's concordance analysis showed moderate to excellent agreement between the PAHO and ANVISA 2 models. It was observed that the PAHO model indicated more foods with a 'high' content of critical nutrients. We conclude that the ABIA model is more permissive when compared to the other models and the PAHO model more restrictive. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate women's satisfaction with vaginal birth in a public hospital in São Paulo, Brazil. Methods: A total of 372 low‐risk postpartum women were interviewed. Maternal satisfaction was measured by the Mackey Childbirth Satisfaction Rating Scale (MCSRS), validated to Brazilian Portuguese. The scale is divided into six subscales: self‐evaluation, partner, baby, nursing, physicians, and overall satisfaction. Childbirth care data were related to maternal mobility, shower bath, birth ball exercises, manual massage, and the health care providers assisting delivery. Results: The MCSRS total score was significantly higher in women living with their partners than those not living with a partner (median 145.5 vs 133.0; P = 0.019), in women with a companion during childbirth than those with no labor support (146.0 vs 136.5; P = 0.047), and in women who early breastfed within the first hour compared with those who did not (146.0 vs 137.0; P = 0.001). Multiple regression identified 'living with partner' (coefficient 6.205; P = 0.043) and 'breastfeeding within the first hour' (coefficient 7.856; P = 0.005) as independent variables that determine the total score of MCSRS. Conclusions: Our findings indicate that living with one's partner and early initiation of breastfeeding are key factors enhancing satisfaction with vaginal birth in women who received care at a public Brazilian hospital. [ABSTRACT FROM AUTHOR]

Aim: To examine the relationship between contextual and individual determinants with the need for endodontic treatment in Brazilian adults. Methods: Individual‐level data from 6897 adults aged 35‐44 years living in the Brazilian state capitals who participated in the Brazilian Oral Health Survey (SBBrasil 2010 Project) were combined with city‐level data. Individual‐ and city‐level variables were selected to represent the structural and intermediate determinants of health according to the WHO model of social determinants of health. The association of independent variables with one or more teeth in need of endodontic treatment was evaluated using multilevel logistic regression to estimate the odds ratio (OR) and 95% confidence intervals (CI). Results: The prevalence of the need for endodontic treatment was 7.7%. Adults living in cities with better contextual socioeconomic conditions (OR 0.82; 95% CI = 0.72‐0.93) and better specialized dental services (OR 0.85; 95% CI = 0.77‐0.95) were less likely to need endodontic treatment. Younger age, greater schooling and use of private dental services reduced the odds of need for endodontic treatment. Number of people per room, type of dental service and reason for the last dental visit were also associated with need of endodontic treatment. Conclusion: Contextual and individual factors were relevant determinants of endodontic treatment needs in adults. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the incidence and the prediction of unstable blood glucose level among critically ill patients hospitalized in an intensive care unit. METHODS: A cohort study was conducted with 62 adult patients hospitalized at an intensive care unit of a hospital located in Minas Gerais, Brazil, between March and July of 2017. Patient's demographic information, along with scores for Simplified Acute Physiology Score III, primary medical diagnosis, discharge status, diagnosis of diabetes and/or sepsis, length of stay, glycemic variability, type of nutrition, types of medications and treatments, and oxygen therapy were collected daily. A daily venous blood sample was collected to measure blood glucose levels during the patient's hospitalization period. Bivariate analysis was used to explore the association among the potential diagnostic indicators and the outcome of unstable blood glucose levels. Multivariate Cox regression was used to identify the potential predictors for the outcome. FINDINGS: Of the total of 62 participants, 45.1% (n=28) had unstable blood glucose level. Among the 28 patients with unstable blood glucose levels, half of them (n=14, 50%) had hypoglycemia and the other half had hyperglycemia (n=14, 50%). Decreased number of days hospitalized and the use of intensive glucose control with regular insulin were associated with decreased odds of developing hyperglycemia. The presence of mechanical ventilation was associated with a higher risk for the development of hypoglycemia. CONCLUSIONS: This study provides knowledge and evidence of diagnostic indicators for unstable blood glucose levels that are not currently included in the NANDA‐International terminology for the nursing diagnosis Risk for unstable blood glucose level (00179). IMPLICATIONS FOR NURSING PRACTICE: This study identified important diagnostic indicators that nurses can observe during the assessment to identify patients that are at risk for developing unstable blood glucose level and provide the appropriate care. [ABSTRACT FROM AUTHOR]

This study aims at fitting polynomial models based on latitude, longitude and altitude coordinates to estimate the monthly and annual mean rainfall in Mato Grosso do Sul state, Midwest region of Brazil. Furthermore, its target is to verify whether hydrologically similar regions provide statistical improvement in the regression fit for rainfall estimation. To create the monthly and annual rainfall for 32 rain gauge stations, there were used at least 15 years long data records for analysis with a percentage of gaps at most 10%. Generally, the monthly and annual rainfall models present suitable statistical validation coefficients. The number of predictor variables enhances the performance of the regression method when estimating monthly and annual rainfall. Fitting regressions in hydrologically similar groups through cluster analysis tends to increase regression performance; however, the limited number of rain gauge stations in Brazil makes this technique difficult to apply because the number of parameters of the regression models may be greater than the number of rain gauge stations in the cluster. The first degree polynomial regression proved to be the most adequate to represent the mean monthly and annual rainfall because of the equivalence between observed and predicted values of rainfall and because of the statistical analysis. Fitting polynomial models presents suitable method for practical applications, forming an important tool for environmental management in the Mato Grasso do Sul State. [ABSTRACT FROM AUTHOR]

The article discusses the role of human saliva as a COVID-19 virus diagnostic tool in paediatric patients, and it mentions saliva analysis in the detection of the SARS-CoV-2 virus in the Brazilian city of Araraquara, São Paulo. Total RNA extraction is assessed, along with symptoms such as sore throat, cough, and fever in children. According to the article, saliva collection is a less invasive strategy for COVID-19 virus surveillance.

Aim: To compare presenteeism levels among three samples of nurses and to identify the relationship between presenteeism and sociodemographic and professional characteristics. Background: Presenteeism (going to work ill) is a phenomenon studied from different perspectives, and it has become especially important during the current COVID‐19 outbreak; its connection to high healthcare costs, patient safety breaches and negative nurse well‐being has been proved. Introduction: The nursing profession is particularly associated with caring for the culture of teamwork, loyalty to colleagues and professional identity. This condition enhances the 'super nurse phenomenon', even though nurses do not feel physically and psychologically able to work. Methods: A multicentre, cross‐sectional study was conducted in three different country contexts: Oviedo (Spain), Porto (Portugal) and São Paulo (Brazil). Nurses performing functions in hospitals and primary health care were enrolled. Informed consent and data collection questionnaires were hand delivered. The Stanford Presenteeism Scale‐6 was applied. Results: A total of 659 nurses participated. Portuguese nurses showed greater prevalence of presenteeism, followed by Brazilian and Spanish nurses. Younger nurses with less professional experience presented lower levels of presenteeism but greater psychological commitment. Male participants showed lower capacity to complete work when ill than female participants. Conclusions: Age and length of professional experience proved to be significant predictors of total presenteeism, although only professional experience revealed statistical significance in the adjusted model. Implications for Nursing and Health Policy: The knowledge of this phenomenon among nurses highlights the need for the development of strategies in the curriculum of nursing students and organizations. Resilience and ergonomic training should be applied in the training programmes of the students and reinforced by the health centre managers. It is essential that healthcare systems design worksite wellness programmes that pursue greater physical and mental well‐being for healthcare professionals. [ABSTRACT FROM AUTHOR]

Background: Awake prone positioning has been widely used in patients with COVID‐19 respiratory failure to avoid intubation despite limited evidence. Our objective was to evaluate if prone positioning is associated with a reduced intubation rate when compared to usual care. Methods: This was a retrospective cohort study in the emergency department of a large quaternary hospital in Sao Paulo. We retrieved data from all admitted patients in need of oxygen supplementation (>3 L/min) and tachypnea (>24 ipm) from March 1 to April 30, 2020, excluding those who had any contraindication to the prone position or who had an immediate need for intubation. The primary endpoint was endotracheal intubation up to 15 days. Secondary outcomes included a 6‐point clinical outcome ordinal scale, mechanical ventilation–free days, admission to the intensive care unit, and need of hemodialysis and of vasoactive drugs, all assessed at or up to 15 days. We analyzed unadjusted and adjusted effect estimates with Cox proportional hazards models, logistic regression, quantile regression, and sensitivity analyses using propensity score models. Results: Of 925 suspected COVID‐19 patients admitted off mechanical ventilation, 166 patients fulfilled inclusion and exclusion criteria: 57 were exposed to prone positioning and 109 to usual care. In the intervention group, 33 (58%) were intubated versus 53 (49%) in the control group. We observed no difference in intubation rates in the univariate analysis (hazard ratio = 1.21, 95% confidence interval [CI] = 0.78 to 1.88, p = 0.39) nor in the adjusted analysis (hazard ratio = 0.90, 95% CI = 0.55 to 1.49, p = 0.69). Results were robust to the sensitivity analyses. Secondary outcomes did not differ between groups. Conclusions: Awake prone positioning was not associated with lower intubation rates. Caution is necessary before widespread adoption of this technique, pending results of clinical trials. [ABSTRACT FROM AUTHOR]

Calcium is an essential micronutrient that plays a role in growing and pregnancy, and its necessity is increased during pregnancy in adolescence. Thus, the aim of the study is to describe the daily calcium intake and its associations with dietetic habits, sociodemographic data and perinatal outcomes among pregnant adolescents. A prospective cohort study was conducted among primiparous adolescents who started prenatal care before 20 weeks of gestation. Sociodemographic data, weight and height, 24‐h dietary recall (24hRec) and perinatal outcomes were collected over four meetings (three during pregnancy and one in puerperium). All 24hRecs were analysed by the Nutrition Data System for Research (NDSR)® programme, and descriptive analysis and univariate and multivariate logistic regression were done. A total of 150 pregnant adolescents were included, with a mean of daily calcium intake of 659.9 mg (50% of recommended intake). Adolescents who ate more than three meals per day (89.3%), and ate breakfast every day (69.3%), were shown to have higher daily calcium intake, odds ratio (OR CI 95%) of 3.4 (1.0, 11.0) and 16.8 (1.0, 302.1), respectively. No correlation was observed between calcium daily intake and sociodemographic data or perinatal outcomes. Dairy products were the foods that mostly contributed to achieving recommended daily calcium intake. In our cohort, pregnant adolescents had a low daily calcium intake. They should be advised to eat more than three meals per day, eat breakfast in particular, increase the consumption of calcium rich‐foods, such as dairy products and green leafy vegetables, and consider calcium supplementation. [ABSTRACT FROM AUTHOR]

We examined the association between household food insecurity and early child development and whether or not maternal depression and anxiety modifies this association. The cross‐sectional study included 468 mother–infant pairs recruited at primary health centers of the Federal District, Brazil. Mothers answered a questionnaire that evaluated early child development (outcome), household food insecurity (independent variable), maternal depression and trait anxiety (effect modifiers). Variables were collected with validated questionnaires for the Brazilian population. Pearson's χ2 test and logistic regression analyses were conducted. Infants who lived in a moderate or severe food insecure household had 2.52 times (95% confidence interval [CI] [1.13, 5.65]) the odds of having early child development delays compared with infants in secure households. Maternal depression and anxiety modified the strength of association between household food insecurity and early child development, which is an innovative finding. Among infants with depressed mothers, those experiencing mild (adjusted odds ratio [aOR] 3.33, 95% CI [1.17, 9.46]) and moderate/severe household food insecurity (aOR 10.13, 95% CI [2.18, 47.10]) had higher odds of having early child development delays, compared with infants in food secure households. Among infants with both anxious and depressed mothers, these associations were even stronger for mild (aOR 4.69, 95% CI [1.41, 15.59]) and moderate/severe household food insecurity (aOR 16.07, 95% CI [2.70, 95.66]). In conclusion, household food insecurity is a risk factor for early child development delays, and this association is modified by maternal depression and anxiety. Future studies should evaluate the impact of intervention packages that address maternal depression and anxiety and household food insecurity on preventing early child development delays. [ABSTRACT FROM AUTHOR]

Aim: There is strong interest in sleep disorders in the elderly, but there are gaps in identifying how multiple factors affect sleep quality in this population. We aimed to assess sleep quality and its relationship to mood, general cognition, and sociodemographic factors in a sample of cognitively active older adults. Methods: We assessed 105 non‐clinical older adults (mean age ± SD: 69.64 ± 0.66 years) based on a sociodemographic profile questionnaire, the Beck Anxiety Inventory, the Beck Depression Inventory II, the Montreal Cognitive Assessment, the Pittsburgh Sleep Quality Index, and the Epworth Sleepiness Scale. Separate analyses were conducted, controlled by sleep quality and daytime sleepiness, to understand how variables were associated. Results: About 46.7% of individuals had significantly poor sleep quality. Univariate analysis showed that non‐workers had a lower risk of impaired sleep quality (prevalence ratio (PR) = 0.67; P = 0.044). However, there was an increased risk of poor sleep quality in those experiencing depressive symptoms (PR = 1.78; P < 0.001) and anxiety symptoms (PR = 1.98; P < 0.001). In multivariate analysis, the language component of the Montreal Cognitive Assessment (PR = 0.80; P = 0.011) was associated with a lower risk of poor sleep quality, and anxiety symptoms (PR = 1.99; P < 0.001) remained significantly associated with a higher risk of poor sleep quality. No significant difference was observed in variables related to daytime sleepiness. Conclusion: We found that overall quality of sleep potentially relates to mood, cognition, and sociodemographic factors. Further studies using multifactorial approaches to sleep investigation are required. [ABSTRACT FROM AUTHOR]

This study analyzed the association of body size dissatisfaction with body mass index, dietary pattern, and physical activity in adolescents. A sample of 1074 participants between 10 and 17 years of age was recruited. Body size dissatisfaction was assessed with the silhouettes' scale. Dietary pattern, physical activity, and socioeconomic status were assessed with questionnaires. Body mass index was measured objectively. The prevalence of body size dissatisfaction was 77.0%, where 29.8% desired to increase body size and 47.2% desired to decrease body size. Adolescents who desired to increase body size were more likely to consume vegetables and sweets and less likely to be in the highest quartile of physical activity than satisfied adolescents. Adolescents who desired to reduce body size were more likely to report lower fruit and vegetable consumption than satisfied adolescents. Health actions aiming to reduce body dissatisfaction in adolescents should address improvement in dietary pattern and physical activity engagement, considering that desires to increase or decrease body size were differently associated in this study. [ABSTRACT FROM AUTHOR]

Background: Pain is a major consequence of caries, which negatively impacts the quality of life of children and their families. Aim: To analyse the parental report of dental pain and discomfort in preschool children, and to identify clinical and sociodemographic factors associated. Design: This cross‐sectional study involved 375 four‐ and five‐year‐old preschoolers enrolled in the city of Campo Magro public school system, along with their parents and caregivers. Parents/caregivers answered the Brazilian version of the Dental Discomfort Questionnaire (DDQ‐B) and a sociodemographic questionnaire. Two examiners (kappa > 0.79) performed clinical examinations using dmf‐t and pufa index. The associations were statistically analysed by univariate and multiple Poisson regression with robust variance (α = 0.05). Results: The prevalence of dental pain and discomfort was 70.3% (66%‐75% 95% CI). Children from non‐nuclear families (PRa 1.33; 95% CI: 1.01‐1.76) and whose parents presented a lower level of education (PRa 2.43; 95% CI 1.66‐3.55) presented a higher prevalence of dental pain or discomfort. Considering the clinical determinants, after adjusting, only the presence of clinical consequences of untreated dental caries (pufa ≥ 1) (PRa 1.37; 95% CI 1.02‐1.84) was significantly associated with higher dental pain or discomfort. Conclusions: Dental pain and discomfort were associated with socioeconomic factors and with the presence of clinical consequences of untreated dental caries. [ABSTRACT FROM AUTHOR]