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Background: Physical activity (PA) has been associated with decreased symptoms of depression and anxiety in the general population, but more consistent evidence is needed in the university population. Purpose: Investigate the association between physical activity and depressive and anxiety symptoms in undergraduates. Methods: 100 university students (23 ± 4 years, 47% female) were included in this cross-sectional study. We performed multiple linear regression analyses to investigate the association between the main variables. Results: The physical activity (MET/min/week) had a significant association with depressive (F(2, 97) = 15.104, p <.001; adjusted R2 =.222) and anxiety symptoms (F(2, 97) = 11.853 p <.001; adjusted R2 =.180), explaining these outcomes in approximately 22% and 18%, respectively. Moderate or vigorous physical activity did not have an association with depressive (B = −0.10, t = −0.700, p =.486) or anxiety symptoms (B = −0.11, t = 0.725, p =.470). Discussion: Individuals with high levels of physical activity have lower depressive and anxiety symptoms than individuals with lower levels of PA. Translation to Health Education Practice: Increasing the level of physical activity may be a viable strategy to reduce symptoms of anxiety and depression in university students. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) [ABSTRACT FROM AUTHOR]

To investigate the validity of six age-predicted maximum heart rate (HRmax) equations after stroke. Sixty individuals (54 (12) years; 64 (69) months after stroke) were included. A Cardiopulmonary Exercise Test (CPET) performed on a treadmill obtained the HRmax. The most used age-predicted equations were investigated: (1) 220-age, proposed by Fox; (2) 206.9– (0.67 × age), proposed by Gellish; (3) 208– (0.7 × age), proposed by Tanaka; (4) 216.6– (0.84 × age), proposed by Astrand; (5) 164– (0.72 × age) and (6) 200– (0.92 × age) proposed by Brawner. No statistically significant agreement was found between the HRmax obtained by the CPET and the one predicted by the equations 1–5 (–0.18 ≤ 95% confidence interval ≤0.79). A significant and moderate agreement was found between the HRmax obtained by the CPET and the one predicted by equation (6) (95% CI= 0.05–0.75; Intraclass Correlation Coefficient= 0.51). Bland-Altman plots showed that equations (1–4) and (6) overestimated the HRmax. Equation (6) presented the lower mean difference. The equations developed for non-disabled individuals (1–4) are not adequate to be used in individuals after a stroke. Equation (6) (Brawner) showed the best results to be used in individuals after stroke; however, it should be used cautiously. Prediction equations for maximum heart rate (HRmax) are commonly used to prescribe aerobic exercise for individuals following a stroke. The equations developed for non-disabled individuals are not valid for use with individuals after stroke, leading to an overestimation of the HRmax. An age-predicted HRmax equation developed for individuals with coronary heart disease may provide outcomes that are more accurate for stroke survivors, but care should still be taken when using it. [ABSTRACT FROM AUTHOR]

Victims of traumatic events that involve repeated interpersonal aggression and low or no chance of escape frequently report intense Self-Conscious Emotions (SCEs), such as Shame, Guilt, and Humiliation. Humiliation is the reaction to a forced loss of status and is hypothesized to have unique contributions to the development and maintenance of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD). However, previous studies did not include humiliation or did not simultaneously probe the relative contribution of each SCE to posttraumatic symptoms. This study aimed to investigate the dynamics between specific SCEs and trauma-related symptomatology in the general population who suffered a form of complex trauma. Four hundred forty-nine people (77.11% women) exposed to domestic violence and sexual abuse answered an online survey. We investigated whether each emotion would accurately predict probable PTSD and CPTSD levels above the proposed cutoff. We estimated a network model to understand the dynamics of their interactions and whether the traumatic event type would moderate relationships between SCEs and posttraumatic stress symptoms, comparing networks of two types of complex trauma. No SCE predicted PTSD, but humiliation was a predictor of CPTSD while controlling for Shame and Guilt. Humiliation was also the most central SCE domain in the networks of both traumatic events. Our results stress the relevance of Humiliation to understanding posttraumatic stress symptoms and the necessity to consider humiliation when studying the emotional processing in complex trauma. [ABSTRACT FROM AUTHOR]

The drug use prevention program #Tamojunto2.0, a Brazilian version of the European Unplugged, showed effectiveness in preventing the alcohol use onset at short term. However, we aimed to evaluate the program effects on its secondary outcomes, such as drug knowledge, behavioral beliefs, attitudes, decision-making skills, and refusal skills. A cluster-randomized controlled trial (registration: RBR-8cnkwq) was conducted in 73 public middle schools in three Brazilian cities (N = 5,208 students; 49.4% girls; Mage= 13.2 years). The intervention group attended twelve #Tamojunto2.0 lessons conducted by their own teachers previously trained. The control group received no intervention. Data were collected pre-intervention (February/March 2019) and at nine-month follow-up (November/December 2019). We used multiple imputation to handle missing data and performed multilevel mixed-effect regression models, adjusted for sex, age, socioeconomic status, and city. The #Tamojunto2.0 program seems to have increased drug knowledge (Coef.= 0.26, 95%CI = 0.17–0.36), and negative and non-positive alcohol beliefs (Coef.= 0.24, 95%CI= 0.05–0.42), according to its logical framework. Nevertheless, it was found no evidence regarding the program's effect on marijuana beliefs, attitudes, decision-making skills, and refusal skills. These findings could explain the effectiveness of the program in preventing the onset of alcohol consumption in adolescent participants. More research is needed to observe the long-term effects of the program on primary and secondary outcomes. [ABSTRACT FROM AUTHOR]

Dengue, a disease with multifactorial determinants, is linked to population susceptibility to circulating viruses and the extent of vector infestation. This study aimed to analyze the temporal trends of dengue cases and deaths in Belo Horizonte, Minas Gerais, Brazil, from 2007 to 2020. Data from the Notifiable Diseases Information System (Sinan) were utilized for the investigation. To assess the disease's progression over the study period and predict its future incidence, time series analyses were conducted using a generalized additive model (GAM) and a seasonal autoregressive integrated moving average (SARIMA) model. Over the study period, a total of 463,566 dengue cases and 125 deaths were reported. Notably, there was an increase in severe cases and deaths, marking hyperendemics characterized by simultaneous virus circulation (79.17% in 2016–50% in 2019). The generalized additive model revealed a non-linear pattern with epidemic peaks in 2010, 2013, 2016, and 2019, indicating an explosive pattern of dengue incidence. The SARIMA (3,1,1) (0,0,0)12 model was validated for each year (2015 to 2019). Comparing the actual and predicted numbers of dengue cases, the model demonstrated its effectiveness for predicting cases in the municipality. The rising number of dengue cases emphasizes the importance of vector surveillance and control. Enhanced models and predictions by local health services will aid in anticipating necessary control measures to combat future epidemics. [ABSTRACT FROM AUTHOR]

Air pollution is a critical public health concern. The present study assessed the risk to human health of airborne Potentially Toxic Elements (PTE) arsenic, nickel and lead exposure in particulate matter (PM10–2.5) in Sao Paulo, Brazil. Statistical analysis was performed using R Software and the risk assessment for human health was carried out according to the methods of the United States Environmental Protection Agency. The results for mean annual concentration of PTE (ng m−3) were within the limits stipulated for air-quality by international agencies (arsenic <6, nickel <20 and lead <150). Airborne arsenic and lead showed higher mean concentrations during the winter than the other seasons (p < 0.05). However, the results showed a greater health risk for the adult population and during the winter season. These findings highlight the importance of air pollution as a risk factor for population health. [ABSTRACT FROM AUTHOR]

Blood cell biomarkers, such as the neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR), have been recently used as prognostic markers in tumors. In this study, we investigated the association between NLR and PLR with sociodemographic, clinical, anthropometric, and quality of life factors of hospitalized women with non-metastatic breast cancer. A cross-sectional observational study was conducted at a reference center for oncological treatment in Southeast Brazil. Female participants aged over 18 years, with a histopathological diagnosis of stage I, II or III breast cancer, in any phase of antineoplastic treatment, were included. Our study revealed a high risk for participants, with high mean values of NLR and PLR, indicating low antitumor activity and worse prognosis. The binary logistic regression model showed that there was a significant association of the NLR marker and marital status (OR = 3.1; 95%CI = 1.06-8.57; p = 0.03) and, in relation to PLR, a trend was shown for a higher chance in women of black ethnicity to have increased PLR compared to white women (OR = 4.13; 95%CI = 0.96-17.70; p = 0.05). However, the inflammatory markers (NLR and PLR) did not show any significant association with nutritional factors. NLR and PLR are inflammatory biomarkers that can be easily obtained and measured in clinical practice. [ABSTRACT FROM AUTHOR]

Individual satisfaction is associated with increased retention in HIV/AIDS care services and adherence to treatment. This study assessed factors associated with individual satisfaction at the initiation of antiretroviral therapy and compared the proportions of satisfaction at the initiation of antiretroviral therapy and after three months of follow-up. Face-to-face interviews were carried out among 398 individuals of three HIV/ AIDS healthcare services in Belo Horizonte, Brazil. Variables included sociodemographic and clinical characteristics, perception about healthcare services, and domains of quality of life. Individuals that rated the quality of healthcare services as good or very good were classified as satisfied. A logistic regression analysis of the association between independent variables and individual satisfaction was performed. The proportion of individual satisfaction with healthcare services was 95.5% at the initiation of antiretroviral therapy and 96.7% after three months and these changes were not statistically significant (p = 0.472). The physical domain of quality of life was found to be associated with satisfaction at the initiation of antiretroviral therapy (OR = 1.38; CI = 1.11–1.71; p = 0.003). Training and supervision of health professionals for addressing the needs of individuals with lower levels of physical domain of quality of life may improve satisfaction with HIV/ AIDS care. [ABSTRACT FROM AUTHOR]

The unique characteristics of rural areas and agricultural work can contribute to the genesis of diseases, including mental disorders such as depression. To estimate the prevalence of and factors associated with depression symptoms in Brazilian farmers. A cross-sectional epidemiological study involving 784 farmers of the state of Espírito Santo/Brazil was carried out. Depression was identified using the Mini-International Neuropsychiatric Interview. Hierarchical logistic regression was used to assess the associated factors. The prevalence of depression symptoms among farmers was 16.8% (n = 132). Of those experiencing symptoms, 6.1% (n = 48) we're currently experiencing a depressive episode, and 10.7% (n = 84) a recurrent depressive episodes. The associated factors were: female gender (OR 1.63; 95% CI 1.04–2.54), not owning the land (OR 1.79; 95% CI 1.11–2.89), professional dissatisfaction (OR 1.99; 95% CI 1.18–3.35), previous pesticide poisoning (OR 2.87; 95% CI 1.45–5.67), complex multimorbidity (OR 1.95; 95% CI 1.15–3.31) and occurrence of previous depressive episodes (OR 9.83; 95% CI 4.39–21.99). A high prevalence of depression symptoms was identified among rural workers. Sociodemographic, occupational, clinical, and professional dissatisfaction factors were associated with a higher risk of depression symptoms in this population. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify the occurrence of AKI, and factors associated with in-hospital mortality and unfavorable outcomes in patients with severe traumatic brain injury (TBI) and acute kidney injury (AKI) severity. A retrospective cohort study which analyzed data with severe TBI between 2013 and 2017. We examined demographic and clinical information, and outcome by in-hospital mortality, and the Glasgow Outcome Scale six months after TBI. We associated factors to in-hospital mortality and unfavorable outcome in severe TBI and AKI with an association test. A total of 219 patients were selected, 39.3% had an AKI, and several factors associated with AKI occurrence after severe TBI. Stage 2 or 3 of AKI (OR 12.489; 95% CI = 4.45–37.94) were independent risk for both outcomes in multivariable models, severity injury by the New Trauma Injury Severity Score (OR 0.97; 95% CI = 0.96–0.99) for mortality, and the New Injury Severity Score (OR1.07; 95% CI = 1.04–1.10) and Trauma and Injury Severity Score (OR = 0.98; 95% CI = 0.965–0.997) for unfavorable outcome. The findings of our study confirmed that AKI severity and severity of injury was also related to increased mortality and unfavorable outcome after severe TBI. [ABSTRACT FROM AUTHOR]

To investigate the effects of aquatic exercise programs (AEP) in body structure and function, activity, and participation outcomes in individuals with Parkinson's disease (PD) with mild to moderate disability levels. Six databases were searched from inception until November 2022. Randomized clinical trials that used AEP alone, AEP combined and/or compared two types of AEP were included. The quality of evidence was assessed by the GRADE approach and the standardized mean differences (SMD) were calculated the meta-analysis. Twelve studies (n = 380) were included. AEP alone was superior to active control in improving body structure and function outcome: postural balance (low evidence, SMD = 0.47, p = 0.02). No statistically significant differences were found for the other body structure and function outcomes: lower limb muscle strength (p = 0.14) and depressive symptoms (p = 0.79), activity outcomes: mobility (p = 0.32) and participation outcomes: quality of life (p = 0.05). AEP combined showed no statistically significant difference for the outcomes of body structure and function: postural balance (p = 0.11) and activity: mobility (p = 0.21) when compared to active control. AEP showed positive effects on body structure and function outcome (postural balance) in individuals with PD with mild to moderate disability levels while, no significant improvements were noticed for activity and participation outcomes. Our findings indicate that aquatic exercise programs (AEP) lead to significant improvements on body structure and function (i.e., postural balance) in individuals with Parkinson's disease (PD). The AEP evaluated in this study implemented postural balance, gait, single and double training, as well as aerobic exercises, trunk mobility exercises, and Ai Chi. The average duration, frequency, and total time implemented were 50 minutes, three times a week, for seven weeks, respectively. Considering the potential benefits identified in this study, AEP can be recommended as an adjunct treatment strategy for individuals with PD. Additionally, the use of the International Classification of Functionality, Disability and Health on the development of rehabilitation treatment plans is advised. [ABSTRACT FROM AUTHOR]

The aim of the present study is to identify sociodemographic and behavioral factors associated with alcohol and tobacco use among adolescents. Students (n = 712) from the 7º to the 9º grade of six public schools were analyzed. The frequency of tobacco smoking and alcohol consumption during the 30 days before the survey was reported. Physical activity, sleep duration, eating habits, screen time, and sociodemographic variables were retrieved. Mixed-effects logistic regressions were performed. The prevalence of alcohol consumption was 25.6% and cigarette smoking was 2.9%. In adjusted models, age and sweets intake were associated with both cigarette smoking and alcohol consumption. Age (OR = 2.32, 95%CI 1.5–3.7) and sweets intake (OR = 1.32, 95%CI 1.1–1.6) were positively related to odds of cigarette smoking while time watching TV were negatively associated with cigarette smoking (OR = 0.65, 95%CI 0.5–0.9). Age (OR = 1.9, 95%CI 1.6–2.3), sweets intake (OR = 1.2, 95%CI 1.0–1.3), and physical activity were positively associated with alcohol consumption (OR = 2.13, 95%CI 1.5–3.1). While the prevalence of cigarette smoking was low, it was high for alcohol consumption. Behavioural, but not sociodemographic factors were associated with early smoking and alcohol use among adolescents. Interventions and policies may be more successful considering these factors. [ABSTRACT FROM AUTHOR]

There is limited evidence regarding the impact of race/racism and its intersection with socioeconomic status (SES) on breast and cervical cancer, the two most common female cancers globally. We investigated racial inequalities in breast and cervical cancer mortality and whether SES (education and household conditions) interacted with race/ethnicity. The 100 Million Brazilian Cohort data were linked to the Brazilian Mortality Database, 2004–2015 (n = 20,665,005 adult women). We analysed the association between self-reported race/ethnicity (White/'Parda'(Brown)/Black/Asian/Indigenous) and cancer mortality using Poisson regression, adjusting for age, calendar year, education, household conditions and area of residence. Additive and multiplicative interactions were assessed. Cervical cancer mortality rates were higher among Indigenous (adjusted Mortality rate ratio = 1.80, 95%CI 1.39–2.33), Asian (1.63, 1.20–2.22), 'Parda'(Brown) (1.27, 1.21–1.33) and Black (1.18, 1.09–1.28) women vs White women. Breast cancer mortality rates were higher among Black (1.10, 1.04–1.17) vs White women. Racial inequalities in cervical cancer mortality were larger among women of poor household conditions, and low education (P for multiplicative interaction <0.001, and 0.02, respectively). Compared to White women living in completely adequate (3–4) household conditions, the risk of cervical cancer mortality in Black women with 3–4, 1–2, and none adequate conditions was 1.10 (1.01–1.21), 1.48 (1.28–1.71), and 2.03 (1.56–2.63), respectively (Relative excess risk due to interaction-RERI = 0.78, 0.18–1.38). Among 'Parda'(Brown) women the risk was 1.18 (1.11–1.25), 1.68 (1.56–1.81), and 1.84 (1.63–2.08), respectively (RERI = 0.52, 0.16–0.87). Compared to high-educated White women, the risk in high-, middle- and low-educated Black women was 1.14 (0.83–1.55), 1.93 (1.57–2.38) and 2.75 (2.33–3.25), respectively (RERI = 0.36, −0.05–0.77). Among 'Parda'(Brown) women the risk was 1.09 (0.91–1.31), 1.99 (1.70–2.33) and 3.03 (2.61–3.52), respectively (RERI = 0.68, 0.48–0.88). No interactions were found for breast cancer. Low SES magnified racial inequalities in cervical cancer mortality. The intersection between race/ethnicity, SES and gender needs to be addressed to reduce racial health inequalities. [ABSTRACT FROM AUTHOR]

School-based interventions are needed due to the low levels of physical activity (PA) in adolescents. The aim is to examine the mediation effects of psychosocial factors (attitude, self-efficacy, social support from parents, friends, general teachers, and PE teachers, and environment school perception) and moderation by sex, school grade, and socioeconomic level of a school-based PA intervention on the PA practice among adolescents. The Movimente Programme is a randomised controlled trial at schools in southern Brazil (n = 921 adolescents). Strategies included teacher training, educational actions, and environmental changes. Adolescents self-reported their weekly PA. Potential psychosocial mediators and moderators were investigated through validated questionnaires in a Brazilian sample. The product of the coefficients with percentile bootstrapping 95% confidence interval was performed. The Movimente Programme was related to positive changes in adolescents' perception of the school environment and social support from general and physical education teachers. Most psychosocial variables (attitude, self-efficacy, social support from friends, and social support from teachers) were associated with PA, but none mediated the impact of the Movimente Programme on PA. Results varied according to sex and school grade. The Movimente Programme increased the adolescents' perception of the school environment and social support from teachers, but no mediators were confirmed. [ABSTRACT FROM AUTHOR]

We estimate the effectiveness of antiretroviral therapy (ART) among individuals receiving HIV care in Rio de Janeiro, Brazil. Adults (18y+) initiating ART between Jan/2008 and Dec/2018 (follow-up through Dec/2020) were included. First-line ART (two nucleoside reverse transcriptase inhibitors plus one antiretroviral from another class) was categorized into four categories: non-nucleoside reverse transcriptase inhibitor/NNRTI-based, protease inhibitor/PI-based, integrase strand transfer inhibitor/INSTI-based, and single-tablet regimen (STR, Tenofovir 300mg + Lamivudine 300mg + Efavirenz 600mg). Effectiveness (viral load ≤50 copies/µL) was evaluated at 6(3–9) and 12(9–15) months from ART initiation. Bayesian logistic regression models were used to quantify the association between exposure and outcomes while accounting for missing data. Overall, 1863(57%), 652(19.9%), 412(12.6%), and 342(10.5%) individuals used, respectively, NNRTI-based, PI-based, INSTI-based regimens, and STR. Compared to NNRTIs, the odds of viral suppression with INSTI-based regimens was 76% higher (adjusted OR:1.76, 95%CI:1.23–2.51) at six months but no higher at 12 months. Older age, higher education, CD4 count ≥500 cells/mm3 and viral load <100,000 copies/µL at ART initiation increased the odds of viral suppression. Viral suppression at six months was the strongest predictor of viral suppression at 12 months. These results highlight population groups that could benefit from close monitoring during the first year of ART. [ABSTRACT FROM AUTHOR]

To investigate the influence of climate on hospitalizations of sickle cell anemia (SCA) adults and children, we analyzed the health and meteorological parameters from a metropolis (1999-2018). 1462 hospitalizations were coded for SCA patients in crisis (M:F = 715:747) and 1354 hospitalizations for SCA patients without crisis (M:F = 698:656) [age = 22.9 vs 15.2 years and duration of hospitalization (DoH) = 5.7 vs 4.4 days, respectively,]. More hospitalizations were for adults than children in crisis, and for children than adults without crisis. More children and adults were hospitalized in winter andspring than in summer and autumn Hospitalizations correlated positively with humidity (lag −5), maximum pressure (lag −2), mean pressure (lag −2), and thermal amplitude (lag −2), and negatively with maximum temperature (lag −3). DoH positively correlated with minimum temperature (lag −4). Understanding these complex associations would induce attitudinal/behavioral modifications among patients and their caregivers. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to examine the relationship between postpartum depression symptoms, anxiety, and stress during the postpartum period. A total of 101 women were assessed using the Depression, Anxiety and Stress Scale (DASS-21) and the Edinburgh Postnatal Depression Scale (EPDS) within 14 days after delivery. Multivariate regression analysis revealed that paid work, tobacco use, and stress symptoms were significantly associated with a higher incidence of postpartum depression symptoms. These results underscore the importance of comprehensive prenatal care and effective postpartum follow-up to address maternal mental health and prevent adverse outcomes for both mothers and children. [ABSTRACT FROM AUTHOR]

The study aims to evaluate the association between substance use and social isolation with food consumption in adolescents. A crosssectional study was conducted with 2,040 adolescents from a medium-sized city in Brazil. The exposures assessed were the use of alcohol, tobacco, and other substances, and social isolation. The outcomes were the regular consumption (=5 times/week) of beans, fruit/fruit salad, candies, and soft drinks, and an unhealthy eating score. The association between health risk behaviors and food consumption was assessed through logistic and linear regressions. Regular users of alcohol were more likely to have regular consumption of candies and soft drinks, and those who used tobacco regularly were less likely to have regular bean consumption and more likely to have regular candies consumption. The use of at least one substance was negatively associated with regular bean consumption and positively associated with regular consumption of sweets and soft drinks. Socially isolated adolescents were less likely to have regular bean consumption. Substance use was positively associated with the unhealthy eating score. In conclusion, substance use and social isolation were associated with less regular consumption of healthy food markers and greater regular consumption of unhealthy food markers. [ABSTRACT FROM AUTHOR]

The Stroke Upper Limb Capacity Scale (SULCS) is a clinically useful measure of upper-limb (UL) capacity, which assesses both basic and advanced capacities. To examine the reliability, construct validity, and interpretability of the SULCS-Brazil with community-dwelling individuals with stroke. The SULCS-Brazil and measures of impairment (handgrip strength and motor function of the paretic UL), capacity (manual and digital dexterities), and performance were applied during the first session, to establish construct validity (80 patients). The SULCS-Brazil was applied again during a second session (a sub-set of 30 patients), to investigate test–retest reliability. Test–retest reliability was evaluated using kappa statistics (k) for the individual items, intraclass correlation coefficient (ICC) for the total scores, standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plot. For the evaluation of construct validity, pre-defined hypotheses were created to estimate the strength of the correlations between the SULCS-Brazil scores and established measures of UL function, using Spearman correlation coefficients. Interpretability was investigated by evaluating both ceiling/ floor effects. High level of agreement was found between the SUCLS-Brazil total scores obtained on both applications (ICC = 0.98; 95%CI:0.96–0.99) and 80% of the individual items had almost perfect agreement (k= 0.81–1.0). The SEM (0.46) and the MDC (1.27) showed clinically acceptable values. All pre-defined hypotheses were confirmed, indicating adequate construct validity of the SULCS-Brazil. No significant ceiling/floor effects were observed. The SULCS-Brazil showed to be reliable and valid for the evaluation of upper-limb capacity of individuals with stroke. [ABSTRACT FROM AUTHOR]

The present study aimed to analyze the effect of the COVID-19 pandemic on the rates of periodontal procedures, and provide a comparison with general dental care and primary medical care procedures carried out in the Brazilian Public Health System. The study had an ecological, retrospective design with data from 5,564 Brazilian municipalities (99.9%). A multilevel mixed-effects linear regression was used to analyze the longitudinal associations between the COVID-19 pandemic and the rate of procedures. There was a significant reduction in the number of periodontal procedures (Coef. −428.6 [95%CI −774.3/-82.9]) during the COVID-19 pandemic, although this reduction was no greater than that of medical and general dental procedures. Medical procedures witnessed the sharpest drop in procedures (Coef. −2831.5 [95%CI −3964.1/-1699.0]). A lower rate of general dental procedures was also identified during the pandemic (Coef. −2,110.6 [95%CI −3,400.8/-820.4]). The COVID-19 pandemic has had a negative effect on the rate of periodontal procedures carried out in the Brazilian Public Health System. The highest recutions were observed in general dental and medical procedures. [ABSTRACT FROM AUTHOR]

Race and gender inequities in the incidence of hypertension (HTN) are well documented; however, few empirical investigations looked into these associations, considering the synergies and heterogeneous experiences of intersectional gender and race/skin colour groups. This study investigated the association of intersectional identities defined by gender and race/skin colour with HTN incidence, and verified whether they are affected by educational level in adulthood. We used the Longitudinal Study of Adult Health (ELSA-Brasil) data to estimate the incidence of HTN between visits 1 (2008–2010) and 2 (2012–2014), in 8528 participants without hypertension at visit 1. HTN was defined as systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or use of antihypertensive drugs. Generalized linear models with Poisson distribution and log link function were used to assess the associations. The incidence of HTN was 43.4/1000 person-years, ranging from 30.5/1000 in White women to 59.4/1000 in Black men. After adjusting by age and family history of HTN, the incidence rate ratio (IRR) was higher in Black men (2.25; 95%CI: 1.65–3.08), Brown (Pardo) men (1.89; 95%CI: 1.59–2.25), Black women (1.85; 95%CI: 1.50–2.30), Brown (Parda) women (1.47; 95%CI: 1.31–1.67) and White men (1.76; 95%CI: 1.49–2.08), compared to White women. These associations were maintained even after considering socioeconomic, behavioural and health mediators in the model. No interaction was found between education level and intersectional identities in the IRRs observed. By using an intersectional approach, we showed the complex relations between race/skin colour and gender inequities in the incidence of HTN, pointing not only that Black men have the highest risk of developing HTN, but also that the risk of HTN is greater in Black women than in White men, when compared to White women. [ABSTRACT FROM AUTHOR]

Substantial research has shown that the population distribution of major depressive disorder (MDD) is strongly influenced by race, gender, and socioeconomic position. However, a deeper understanding of inequities in access to care for MDD according to these social markers is yet to be reached. We use data from the 2019 Brazilian National Health Survey, which includes 87,187 respondents aged 18 years and over, to test two hypotheses derived from the inverse care law: women, Black, and low-education respondents have higher frequencies of MDD, but lower access to each step of the depression care cascade, including diagnosis by a health professional, regular healthcare visits, and access to specialised treatment (H1); low-education Black women show the highest MDD frequency and the lowest access to care across the entire cascade (H2). Partially supporting H1 and H2, our results reveal a bottleneck in the first step of the depression care cascade. While no racial inequities were observed in the MDD prevalence, Black individuals were less likely than whites to be diagnosed by a health professional (OR 0.74). Women (OR 2.64) and low-education (OR 1.18) were more likely to have probable MDD in relation to men and high-education respondents, respectively, but only women (OR 1.58) were more likely to be diagnosed. Low-education Black women were equally more likely to have probable MDD (OR 3.11) than high-education white men. Conversely, high-education white women emerged as the most likely to be diagnosed with MDD (OR 1.63). Our findings suggest the inverse care law applies to the depression care cascade in Brazil through indication that its healthcare system perpetuates a multilayered system of oppression that overlooks multiply marginalised individuals. We also show that adequate screening by health care professionals should mitigate the complex patterns of inequity revealed by our study. [ABSTRACT FROM AUTHOR]

Establish the validity of a triaxial accelerometer (Dynaport®) for evaluating the energy expenditure of patients with stroke sequelae at a rehabilitation hospital This is a cross-sectional study with 24 stroke inpatients of a rehabilitation hospital. The participants were assessed on energy expenditure by an ergospirometer system and the triaxial accelerometer simultaneously during a walk test. The data collected by both devices were compared by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement An almost perfect agreement (ICC = 0,94) in the energy expenditure measured by the accelerometer compared to the results of the ergospirometer system was found during the exercise test. The Bland-Altman analysis has shown suitable limits of agreement. Post hoc analyses with the maximum volume of oxygen and the total energy expenditure measured by the ergospirometer system evidenced significant correlation with the energy expenditure measurements by the accelerometer Our results evidence that the triaxial accelerometer Dynaport® and its built-in software are valid for estimating the energy expenditure of stroke sequelae during a walk exercise. [ABSTRACT FROM AUTHOR]

This study examined the within- and between-day variability of time-segmented sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) in adolescents. The sample comprised 154 adolescents (11–16 years old) from two public schools in Florianópolis, Brazil. The proportion of time spent in SB, LPA, and MVPA was measured using Actigraph GT3X+ accelerometers for the following weekday time segments: before school (07:00–07:59), school time (08:00–11:59), after school (12:00–12:59), afternoons (13:00–17:59), and evenings (18:00–23:00). Participants were more active during commuting-related time segments. Females showed lower MVPA than males during school time, afternoons, and evenings, but not before school and after school. Higher age was associated with higher SB and lower LPA during school time, afternoons, and evenings, and slightly lower MVPA during afternoons. The variability of SB, LPA, and MVPA for all time segments was mainly explained by within-participant day-to-day variations rather than between-participant differences of daily-averaged estimates. [ABSTRACT FROM AUTHOR]

Oxygen uptake efficiency slope during submaximal tests has been proposed as a more appropriate measure of aerobic capacity after suffering a stroke, since some individuals cannot tolerate maximal exercise testing. However, it has not yet been investigated whether the oxygen uptake efficiency slope is able to differentiate between healthy individuals and those who have suffered a stroke. To compare the oxygen uptake efficiency slope during walking and stair climbing between stroke survivors and age- and sex-matched healthy controls. This is a cross-sectional study in which 18 individuals who had suffered a stroke (stroke survivors) and 18 healthy controls matched for sex and age were included. Oxygen consumption and minute ventilation were collected breath-by-breath during walking (6-min Walk Test) and stair climbing. The oxygen uptake efficiency slope was estimated by the slope of the line obtained through linear regression. The stroke survivors had a lower oxygen uptake efficiency slope during the 6-min Walk Test than the healthy controls (MD 498, 95% CI 122 to 873, p =.01). The between-group difference for the Stair Test was smaller and not statistically significant (MD 349, 95%CI −73 to 772, p =.10). Stroke survivors had lower oxygen uptake efficiency slope during the performance of the 6-min Walk Test when compared to sex- and age-matched healthy controls. This suggests that stroke survivors have worse cardiopulmonary capacity. [ABSTRACT FROM AUTHOR]

To estimate the prevalence of at-risk drinking and smoking and associated factors among older adults in primary care in Brazil. A cross-sectional study carried out in seven primary care units with 503 older adults (60+), in a city in the state of Sao Paulo, Brazil. At-risk drinking was defined by AUDIT-C and by consumption of units per week. Poisson regression was used to assess the association between the sociodemographic and health characteristics and smoking and at-risk drinking. The median age of the 503 participants was 69.6 (SD ± 6.7; range:60-93). One third of participants (33.6%) were current drinkers, 16% were at-risk drinkers (AUDIT-C), 4% at-risk drinkers (units per week), and 13% of the sample were regular smokers. The prevalence of at-risk drinking (AUDIT-C) was higher for males (RP: 4.89; 95% CI: 2.52–9.49) and for those with higher levels of education (RP: 1,861.85 95% CI: 1.08–3.14), and lower for those over the age of 70 (RP: 0.50; 95% CI: 0.30-0.84). The prevalence of smoking was higher for those with depressive symptoms (RP: 1.95; 95% CI: 1.03-3.66), and lower for those over age 70 (RP: 0.52; 95% CI: 0.29-0.94). The results point to a set of factors associated with at-risk drinking (being male, younger and having a higher education), and with smoking (being younger and having depressive symptoms). Our findings could help health professionals to identify at-risk drinkers and smokers, as well as support strategies for future interventions by the identification of the groups most vulnerable to these behaviors. [ABSTRACT FROM AUTHOR]

Investigate the association between pelvic floor muscle function and stress urinary incontinence (SUI) in women in the third trimester of pregnancy. Cross-sectional observational study. Urinary symptoms were collected through a questionnaire. The physical examination of the pelvic floor muscle was performed by vaginal palpation and manometry. Multivariate logistic regression analyses were performed to investigate the factors associated with SUI. Analysis of the data collected from nulliparous and multiparous women identified an association between decreased pelvic floor muscle function (i.e. Power, Repetition, and Maximal Voluntary Contraction (MVC)) and the presence of SUI. There were also associations noted between power and SUI [AOR (95% CI) = 1.41 (1.01–1.97)], repetition and SUI [AOR (95% CI) = 1.31 (1.06–1.63)], and MVC and SUI [AOR (95% CI) = 1.02 (1.00–1.03)]. In the analysis of nulliparous women, there was also an association between low resting vaginal pressure (manometry) and SUI [AOR (95% CI) = 1.03 (1.01–1.06)]. Low pelvic floor muscle strength, low MVC, and decreased ability to repeat sustained pelvic floor muscle contractions were associated with SUI in the third gestational trimester. In nulliparous women, there was an association between low resting vaginal pressure and SUI; however, none these associations were identified in multiparous women. [ABSTRACT FROM AUTHOR]

The suspension of social activities combined with health insecurity, uncertainty and fear of COVID-19 may influence physical activity practice. We aimed to investigate the relationship between the fear of COVID-19 and anxiety on physical activity patterns during the pandemic period. This cross-sectional study was performed in a sample of 520 Brazilian participants recruited by online sampling and snowball method. We assessed demographic variables, health perceptions, anxiety, fear of COVID-19 and physical activity characteristics. Both fear scores and anxiety were higher in woman (p < 0.0001). We observed a remarkable reduction in the frequency and intensity of physical activity and a modification in the exercise practice environment (from gym or sports centers to home-based physical activity) (p < 0.05). Sedentary (sitting) behavior increased during pandemic both in the weekdays and in the weekend (p < 0.0001). Participants who have never been infected were more prone of being classified in higher levels for physical activity (OR: 1.916, CI = 1.043–3.521) versus those who were previously infected (p = 0.05). Participants with a low or moderate level of physical activity before the pandemic presented lower chances of being classified as high physical activity level during the pandemic in comparison to those with high level before pandemic (p < 0.001). The Fear of Covid-19 score was negatively associated with the physical activity level (the higher the fear, the lower the level of physical activity); that is, for every increase in scale score, the odds of vigorous physical activity decreased 3%. In conclusion, fear of COVID-19 and previous contact with the virus negatively influenced physical activity practice. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of sleep problems and associated factors among Brazilian physiotherapists during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: Cross-sectional online survey of physiotherapists in Brazil. Sociodemographic data, sleep quality (Pittsburgh Sleep Quality Index – PSQI) and symptoms of anxiety, depression and stress (21-item Depression, Anxiety and Stress Scale – DASS-21) were assessed. Results: 342 physiotherapists responded the survey (18% male, median age 31 [27–38] years, 78% frontline workers). The three biggest fears reported by frontline physiotherapists were fear of being infected (48%), shortage of personal protective equipment (24%) and the severity of the disease (16%). The overall prevalence of poor sleep quality was 86%. Frontline physiotherapists showed worse scores on all PSQI components but sleep latency, disturbances and daytime dysfunction (p ≤ 0.037). Symptoms of anxiety and stress were highest in frontline workers (p ≤ 0.032). Being a frontline worker was independently associated with a poor sleep quality (odds ratio [95% CI] 1.99 [1.01 to 3.93]). Conclusion: Poor sleep quality was highly prevalent among Brazilian physiotherapists during the COVID-19 outbreak. Frontline physiotherapists showed worse sleep quality and more symptoms of anxiety and stress than non-frontline physiotherapists. Being at the frontline was associated with a higher chance of poor sleep quality. [ABSTRACT FROM AUTHOR]

To investigate the test–retest reliability and measurement error of the Brazilian version of the modified Gait Efficacy scale (mGES-Brazil) in individuals who have had stroke. The mGES-Brazil was applied on two occasions, five to seven days apart, in a research laboratory setting. Test–retest reliability and measurement error, which included the standard error of measurement (SEM), smallest detectable change (SDC), and analysis of the limits of agreement by the Bland–Altman plots, were examined. Fifty individuals who have had stroke (18 men), with a mean age of 64 ± 11 years, were evaluated. All individual items showed good reliability (Intra-class Correlation Coefficient – ICC2,1 > 0.90). The ICC was 0.98 (95% CI 0.97 to 0.99) and the Bland and Altman plots revealed no systematic changes in the mean test–retest scores. The SEM (SEM%) was 3 (5%), within the recommended values, while the SDC was 8 points. The mGES-Brazil demonstrated to be reliable to be applied within clinical and research contexts for the assessment of changes in walking confidence of individuals who have had stroke. Changes in mGES scores ≥8 points reflect real changes. [ABSTRACT FROM AUTHOR]

To compare the prevalence and characteristics of hypertension in women experiencing incarceration (WEI) to the general population in Brazil: (1) a prison survey conducted from January 2014 to December 2015 in 15 states, with 1,327 WEI; and (2) a household survey in the 26 states and the Federal District of Brazil administered to women in the general population (WGP). Data analysis used SPSS® version 20.0. The point estimates and the prevalence ratio with their respective confidence intervals were calculated using Poisson regression. Ages in the two populations differed, 27.9% of WGP were over 50, while 7.3% of WEI were. The overall prevalence of arterial hypertension was 31.3% (95% CI: 28.6–34.0) in the WEI and 38.9% (95% CI: 37.8–39.9) for WGP. For individuals under 30, hypertension was found in 22.4% of WEI and 13.4% of WGP. WEI have a higher prevalence of hypertension at an earlier age than the GP. Less education, obesity, using illegal drugs, previous pregnancy, and not using contraceptives were more frequent in this group, revealing the need to implement policies aimed at treating both their hypertension and other health issues in prison. [ABSTRACT FROM AUTHOR]

To verify the factors associated with the need of tube feeding (TF) during patients post-ischemic stroke hospitalization. This is a retrospective study with 70 adult post-ischemic hemispheric stroke adult patients hospitalized in the Neurology department at a tertiary public hospital in Santa Catarina, Brazil. We investigated associations between the need of a feeding tube during hospitalization and the variables age, gender, admission and discharge NIHSS and FOIS, length of hospital stay in days, presence of thrombolytic therapy, extensive stroke, hemisphere affected, prior stroke, pneumonia during hospitalization, presence of signs of laryngeal penetration and laryngotracheal aspiration and dysphagia in the first and last swallowing clinical evaluation. A total of 33 participants used tube feeding. There was a significant relationship among tube feeding and the following parameters: NIHSS (p value.001), FOIS (p value.001), extensive stroke (p value.034), left hemisphere involvement (p value.035), pneumonia during hospitalization (p value.001), length of hospital stay in days (p value.001), signs of laryngotracheal penetration/aspiration (p value.001) and dysphagia in speech-language assessment (p value.001). Tube feeding during patients hospitalization after ischemic hemispheric stroke was predicted by the severity of stroke and signs of airway permeation. Swallowing difficulty is one of the most common post-stroke consequences. There are few studies on the characterization of post-stroke patients with tube feeding. Tube feeding after ischemic stroke predictors were severity of stroke and signs of airway permeation. [ABSTRACT FROM AUTHOR]

This study aims to estimate a population-based cancer incidence among indigenous populations in the State of Acre, Brazilian Western Amazon, to provide knowledge about cancer epidemiological profiles contributing to healthcare policies and service planning. Although cancer epidemiology in Brazil is well described through incidence and mortality estimate in the general population, cancer estimates among indigenous peoples are still unknown. This is a descriptive study of cancer incidence among the indigenous population (2000–2012) in the State of Acre, Brazil. The sources used were population-based cancer registries of Goiânia, hospital-based cancer registry of Acre, São Paulo, and Porto Velho; Special Indigenous Health Districts databases of Acre, Goiânia, and São Paulo; Mortality Information System, and Rio Branco's public and private laboratories' reports. Standardized Incidence Ratio (SIR) was calculated using cancer incidence rates of Goiânia as reference. From 137 cancer cases, 51.8% occurred in women and 32.1% in people aged 70 +. Among men, the most frequent cancer sites were stomach (25.8%), liver (15.1%), colorectal (7.6%), leukemia (7.6%), and prostate (6.1%). Among women, the most frequent were cervical (50.7%), stomach (8.5%), leukemia (5.6%), liver (4.3%), and breast (4.3%). Among men, there was an excess of cancer cases for stomach (SIR=1.75; 95%CI:1.67–1.83), liver (SIR=1.77; 95%CI:1.66–1.88), and leukemia (SIR=1.64; 95%CI:1.49–1.78). In women, an excess of cancer cases was observed for cervical (SIR=4.49; 95%CI:4.34–4.64) and liver (SIR=2.11; 95%CI:1.88–2.34). A lower cancer incidence for prostate (SIR=0.06; 95%CI:0.05–0.07) and female breast (SIR=0.12; 95%CI:0.11–0.14) was observed. Cervical, stomach, and liver cancers corresponded to 52% of the cases and were highly incident among the Brazilian indigenous population of Western Amazon compared to non-indigenous counterparts. Despite the low frequency of breast and prostate cancer, the fact they were present among indigenous peoples suggests a complex epidemiological transition framework in these populations. [ABSTRACT FROM AUTHOR]

The Human Immunodeficiency Virus (HIV) is considered one of the greatest public health challenges given its impact on morbidity and mortality, and there is currently no vaccine available. The costs for any vaccine have to be weighed against current preventative measures as well as its impact in reducing future infections. This was the rationale behind conducting a willingness to pay (WTP) study to guide future funding decisions. A cross-sectional study was conducted involving residents of Northern Brazil regarding their WTP for a hypothetical vaccine against HIV with 70% effectiveness. 634 individuals were interviewed and 94% accepted to use this hypothetical vaccine. The WTP was US$47.54 (200.00BRL). We believe these findings can contribute to decision-making about pricing once a HIV vaccine becomes available in Brazil and in discussions with its acceptability. [ABSTRACT FROM AUTHOR]

Introduction: Psychological processes can play an important role in the expression and clinical impact of fibromyalgia. Objective: To investigate the association between the severity of pain and disability and psychological factors in patients with fibromyalgia. Methods: The following outcomes were assessed in 104 patients with fibromyalgia: pain intensity, using the Pain Numerical Rating Scale; disability, using the Patient-Specific Functional Scale; depression, using the Beck Depression Scale; anxiety, using the State-Trait Anxiety Inventory; kinesiophobia, using the Tampa Scale for Kinesiophobia; pain catastrophizing, using the Pain Catastrophizing Scale; beliefs and attitudes toward pain, using the Survey of Pain Attitudes; and the occurrence of abuse during some stage of life. Statistical analysis was performed using SPSS version 15. Initially, a simple regression analysis was performed between the dependent variables (pain and disability) and the other variables with a significance level of p ≤ 0.20, and then a multiple regression analysis was performed with a significance level of p ≤ 0.05. Results: Depression was found to be associated with pain severity (β = 0.07 [95% CI: 0.02 to 0.11], p =.00), and kinesiophobia was found to be associated with disability severity (β = −0.06 [95% CI: −0.09 to −0.02], p =.00). Depression can explain 10% of the variability of pain intensity, while kinesiophobia can explain 9% of the variability of disability. Conclusion: There are weak associations that are not clinically relevant between depression and pain severity, and between kinesiophobia and disability severity. However, other psychological factors are not associated with the severity of pain or disability. [ABSTRACT FROM AUTHOR]

Brazil is among the top ten countries in preterm delivery worldwide. This study assesses the factors associated with preterm birth in the Western Brazilian Amazon. A population-based cross-sectional study was held between July 2015 to June 2016 in Cruzeiro do Sul, Brazilian Amazon. A total of 1525 births were included in this analysis. Preterm birth was defined as births at gestational age < 37 weeks. A stepwise multiple logistic regression was used to identify factors associated with preterm delivery. The prevalence rate of preterm birth was 7.9% (n = 120; 95% CI: 6.5–9.3). After adjusting for confounding factors, a positive association with preterm birth was observed for pregnant women who completed less than six antenatal care visits (OR: 2.93; 95% CI: 1.89–4.56), who had a birth interval of < 18 months (OR: 2.65; 95% CI: 1.04–6.75), and who experienced bleeding (OR: 2.17; 95% CI: 1.39–3.38) and hypertension during pregnancy (OR: 1.74; 95% CI: 1.07–2.82). Factors associated with preterm birth in the Western Brazilian Amazon were mostly related to the aspects of health care provided to women, and thus could be prevented. Proper, timely, and regular antenatal care visits can help reduce adverse outcomes, such as hypertension and bleeding. [ABSTRACT FROM AUTHOR]

the aim of this study is two-fold: 1) to explore the pain characteristics among breast cancer survivors that return to work and do not return to work; 2) to identify the factors associated with pain on the upper quadrant of the affected side. Sixty-two breast cancer survivors were included. Quality of life was assessed using EORTC QLQ-C30 and QLQ-BR23. Pain characteristics were assessed with a body diagram and a numeric rating scale. Thirty-five breast cancer survivors did not return to work. Ninety-one percent of women that did not return to work reported pain. The most frequent pain sites were the cervical spine and the axilla of the affected side. There were no significant differences in pain intensity between groups. The factors associated with pain on the upper quadrant of the affected side were perception of shoulder stiffness OR = 5.93 (1.38–44.87, 95%CI) and time since surgery of more than four years OR = 5.54 (1.36–20.97, 95% CI). Pain was highly prevalent among breast cancer survivors. Breast cancer survivors that returned to work presented better quality of life. Longer time since surgery and perception of shoulder stiffness were associated with pain on the upper quadrant of the affected side. Pain is a major factor following breast cancer surgery preventing returning to work. This group reported more pain on the cervical spine and axilla of the affected side. Rehabilitation needs to focus specifically on pain management in order to improve quality of life. A multidisciplinary approach involving pain specialists and vocational support is recommended. [ABSTRACT FROM AUTHOR]

This study aims to describe and compare the phonological characteristics of European Portuguese and Brazilian Portuguese preschool and school age children with Speech Sound Disorders (SSD). Speech samples for the European Portuguese Group (EPG) (n = 13) were collected using Subteste Fonético e Fonológico of Teste Fonético e Fonológico Avaliação da Linguagem Pré-Escolar. For the Brazilian Portuguese Group (BPG) (n = 13) Prova de Nomeação de Fonologia of Teste de Linguagem Infantil ABFW was applied. Different phonological measures were considered. Groups were matched according to sex, age, and percentage of correct consonants (revised). EPG presented more weak syllable deletion (p =.00); absolute index and relative index had a higher number of omissions (p =.003). BPG had more substitutions (p =.004). Intragroup analysis showed differences between groups in the occurrence of phonological processes (p ≤ 0.00). The most occurring was gliding of liquids, cluster reduction and devoicing in both groups; for the absolute index and relative index, the EPG presented differences in omission (p =.003), and the BPG in substitution (p =.002). Results suggested differences between groups in phonological processes occurrence and a relation with the most frequent type of error. These findings may occur due to the variation of phonetic and phonological characteristics between European Portuguese and Brazilian Portuguese in the two phonological tests. Linguistic variations had not directly influenced the measures studied, which characterized SSD. European Portuguese and Brazilian Portuguese children with SSD demonstrated similar characteristics as to the type of errors and phonological processes. [ABSTRACT FROM AUTHOR]

To examine the psychological well-being of primary caregivers of infants and toddlers with Congenital Zika Syndrome (CZS), and the roles of family resources, parenting stress, and coping strategies in caregivers' adaptation. Family caregivers (N = 50) of children with CZS who were receiving treatment at a rehabilitation hospital in Recife, Brazil participated a cross-sectional survey study. Caregivers completed measures of anxiety and depression, coping strategies, family resources, and parenting stress. Mild to severe symptoms of depression were identified in 40% of caregivers and were a more prominent concern than symptoms of anxiety. Fewer family resources and high levels of parenting stress were significantly associated with both anxiety and depression. The association between parenting stress and depression was moderated by coping, such that parenting stress was associated with higher caregiver depression at low but not high levels of coping strategy use. Practitioners in Brazil should consider the role of family coping and resources as important resilience promoting factors in the development of new programs designed to promote psychological adaptation in caregivers to children with CZS. It is recommended that caregiver mental health support services be integrated into existing early intervention programs targeting children with CZS. Parents and other primary caregivers are encouraged to take an active role in the care and developmental monitoring of children born with CZS, but their ability to provide care may be compromised by difficulties in psychological adaptation. Moderate and severe symptoms of depression were more prominent in caregivers than moderate and severe symptoms of anxiety (20% versus 6%, respectively). Practitioners should include assessment of coping strategies, parenting stress and family resources conjointly with evaluation of symptoms of depression and anxiety as part of routine CZS family evaluations. A useful approach for caregivers in Brazil may be to more fully integrate caregiver mental health support services into existing early intervention programs for children with CZS. [ABSTRACT FROM AUTHOR]

This study investigated the association between preserved lower-limb muscle strength, dynamic and static postural stability, risk of falling, and fear of falling in polio survivors. We also investigated whether these clinical features differ between polio survivors and healthy controls. Methods: This quasi-experimental study enrolled 16 polio survivors (13 underwent a complete-case analysis) and 12 age- and sex-matched healthy controls. Participants were assessed by the manual muscle test, Berg Balance Scale, force platform posturography, and Falls Efficacy Scale. Between-group mean differences with confidence intervals (MD, CI 95%) and Spearman's ρ are reported. Results: Compared to healthy controls, polio survivors presented reduced muscle strength (MD = –13, CI 95% −16 to −9 points), lower dynamic postural stability (MD = –14, CI 95% −19 to −8 points), and increased fear of falling (MD = 14, CI 95% 10–18 points) (all P < 0.001). In polio survivors, lower-limb muscle strength was correlated with dynamic (ρ = 0.760) and static postural stability (ρ = 0.738–0.351), risk of falling (ρ = −0.746), and fear of falling (ρ = −0.432). Dynamic postural stability was correlated with risk of falling (ρ = −0.841), fear of falling (ρ = −0.277), and static postural stability (ρ = −0.869 to −0.435; ρ = −0.361 to −0.200, respectively). Risk and fear of falling were also correlated (ρ = 0.464). Discussion: Polio survivors exhibited impaired dynamic postural stability but preserved static stability and increased risk of falling and fear of falling. Preserved lower-limb muscle strength, postural stability, fear of falling, and risk of falling are associated clinical features in this population. [ABSTRACT FROM AUTHOR]

Background: Studies that establish the indicators of clinical status deterioration of Ineffective airway clearance remain scarce. Prognostic studies provide data for nurses identify clinical indicators that suggest a higher chance of early development of a nursing diagnosis. Objective: To identify the prognostic indicators of short-term survival of ineffective airway clearance (IAC) in children with acute respiratory infection (ARI). Design: A prospective open cohort study. Methods: This study was with a group of 136 children with acute respiratory infection who were followed for a minimum of six and a maximum of ten consecutive days. Children who had not completed six days of monitoring or who were carriers of diseases that would alter the specific symptoms of respiratory infection were excluded. The survival rate of ineffective airway clearance was calculated using Nelson-Aalen's method. A Cox regression model was used to analyze the influence of clinical indicators on survival time of this diagnosis. Results: The diagnosis survival rate was extremely low (only 0.4% on the 5th day of follow-up). The greatest reduction in survival rate was observed in the first 48 h (survival rate = 2.5%). Four defining characteristics associated with a worse prognosis of IAC among children with ARI: ineffective cough (RR = 5.86; 95% CI: 3.53–9.72), absence of cough (RR = 2.92; 95% CI: 1.68–5.08), adventitious breath sounds (RR = 2.47; 95% CI: 2.01–3.03), and diminished breath sounds (RR = 1.23; 95% CI: 1.05–1.45). Conclusion: Four clinical indicators showed a strong relationship with an increased risk of worsening clinical status associated with this nursing diagnosis. Impact statement: Clinical deterioration related to ineffective airway clearance among children with acute respiratory infection is fast and requires particular attention from nurses. [ABSTRACT FROM AUTHOR]

The purpose of this study was two-step: (1) classify ball possession (BP) according to the duration and number of passes and (2) identify which tactical variables most discriminate the different BP. We obtained 527 BPs from four official matches of the Brazilian Soccer Championship 2016. Forty-one "notational", "space occupation", and "displacement synchronization" predictor variables were used. The BPs were classified into three groups: short (11.07 ± 4.49 s, 1.93 ± 0.99 passes), medium (26.83 ± 7.33 s, 5.41 ± 1.84 passes), long (55.50 ± 14.97 s, 12.11 ± 4.61 passes). Discriminant analysis identified the five most relevant variables to describe each group: coefficient of variation (CV) of the defensive team's synchronization-Y, CV defensive team´s synchronization-X, successful pass last third, CV distance between offensive team's centroid and target, mean of the offensive team's width. The approach highlights important variables and could benefit the description of offensive and defensive game sequences to provide precise knowledge on the process. [ABSTRACT FROM AUTHOR]

Prior studies on substance use in Brazil have not focused on opioid misuse, previously thought to be nearly non-existent. This paper presents new findings on heroin and non-medical use of opioid analgesics. Data come from the 2015 Brazilian Household Survey on Substance Use (BHSU-3), a nationally representative survey estimating epidemiological parameters related to substance use by residents across Brazil. BHSU-3 used stratified multi-stage probability sampling across multiple geographic domains of interest, resulting in 16,273 interviews with household residents. Lifetime heroin use among Brazilians was 0.3 (95% C.I:0.2–0.4). Lifetime, past-year, and past-month non-medical use of opioid analgesics were respectively 2.9 (95%C.I.:2.3–3.4), 1.4 (95%C.I.:1.1–1.7) and 0.6 (95%C.I.:0.4–0.8). Past-year prevalence of non-medical opioid analgesics use was lower among males [Prevalence Ratio (PR): 0.54 (95% C.I.:0.36–0.78)], those aged 12–24 [0.56 (95% C.I.:0.34–0.92)], persons with monthly family incomes between R$1,501–3,000 [0.59 (95% C.I.:0.38–0.92)] or greater than R$3,000 [0.64 (95% C.I.:0.42–0.98)], and persons who were unemployed [0.65 (95% C.I.:0.46–0.92)]. Non-medical use of opioids in Brazil may be more prevalent than previously recognised. Proper measurement and evaluation of opioid misuse across Brazil and other Latin American countries is critical to understand and prevent opioid-related harms. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of use of psychoactive agents among medical students attending Federal Higher Education Institutes in Brazil and to identify the licit and illicit drugs most often employed. Methods: The cross-sectional study involved ten medical schools located in a Brazilian state. Students were asked to complete a online questionnaire. Differences between the proportions of users and non-users of licit and illicit agents were compared using χ2 test and multivariate logistic regression analysis. Results: 647 students completed the survey satisfactorily. 70% (n = 452) of respondents consumed at least one psychoactive substance. Alcohol was the substance most frequently consumed followed by tobacco and cannabis. Most respondents who had used antidepressants and benzodiazepines reported that the drugs were informally indicated by health professionals. The use of licit substances was associated with no practising religion, high income and living with friends. The use of illicit substances was related to age (23–27 years), gender (male) and no practising religion. Conclusion: Our study draws attention to the importance of promoting responsibility and self-criticism during medical education in order to avoid students developing a feeling of dominance regarding alcohol or drug consumption that may deteriorate into addiction or even recklessness regarding their future prescribing practice. [ABSTRACT FROM AUTHOR]

Purpose: To validate the Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases from the perspective of adults with asthma. Methods: This was a qualitative, cross-sectional study. Individual interviews with questions related to the disease and its impact on the patient's life were performed. The meaning condensation procedure was used for analysis. Results: Thirty-five participants (26 females, 41 ± 13 years old) were interviewed. A total of 405 concepts were identified, and 348 were associated to the components Body Functions (n = 168), Body Structures (n = 22), Activities and Participation (n = 33), Environmental Factors (n = 125). These concepts were linked to 61 categories: second level (n = 25), third level (n = 33), fourth level (n = 3), which confirmed 41% and 77% of those included in the Comprehensive and Brief Core Sets, respectively. Twenty-four additional categories were identified, and 57 concepts could not be linked to the classification. Conclusions: The International Classification of Functioning, Disability and Health Core Sets for obstructive pulmonary diseases were supported by the perspective of adults with asthma. The Brief version seemed the best reference for rehabilitation, reflecting the typical disabilities and impairments of these patients. Unconfirmed and added categories have been reported, and their analysis may assist future document updates. The use of the International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases is relevant to guide patient assessment, treatment and monitoring. The concepts related to the Body functions and Environmental factors were the most relevant according to the perspective of adults with asthma. The Comprehensive and Brief International Classification of Functioning, Disability and Health Core Sets for Obstructive Pulmonary Diseases were supported by adults with asthma. [ABSTRACT FROM AUTHOR]

Background: Knee pain during stair managing is a common complaint among individuals with PFP and can negatively affect their activities of daily living. Gait modification programs can be used to decrease patellofemoral pain. Immediate effects of a stair descent distal gait modification session that intended to emphasize forefoot landing during stair descent are described in this study. Objectives: To analyze the immediate effects of a distal gait modification session on lower extremity movements and intensity of pain in women with patellofemoral pain during stair descent. Method: Nonrandomized controlled trial. Sixteen women with patellofemoral pain were allocated into two groups: (1) Gait Modification Group (n = 8); and 2) Control Group (n = 8). The intensity of pain (visual analog scale) and kinematics of knee, ankle, and forefoot (multi-segmental foot model) during stair descent were assessed before and after the intervention. Results: After the gait modification session, there was an increase of forefoot eversion and ankle plantarflexion as well as a decrease of knee flexion. An immediate decrease in patellofemoral pain intensity during stair descent was also observed. Conclusion: The distal gait modification session changed the lower extremity kinetic chain strategy of movement, increasing foot and ankle movement contribution and decreasing knee contribution to the task. An immediate decrease in patellofemoral pain intensity during stair descent was also observed. To emphasize forefoot landing may be a useful intervention to immediately relieve pain in patients with patellofemoral pain during stair descent. Clinical studies are needed to verify the gait modification session effects in medium and long terms. [ABSTRACT FROM AUTHOR]

Background: Anklebot therapy has proven to be effective in improving hemiparetic gait. However, neither ankle torque steadiness nor the relationship between changes in force control and functional tasks after therapy with Anklebot were described. Objective: To assess whether a single session of robotic therapy promotes short-term ankle adaptations that influence ankle torque steadiness and walking speed in individuals with chronic hemiparesis. Methods: A sample of participants who had residual hemiparesis deficits (hemiparesis group; n = 13) and age- and sex-matched healthy control participants (control group; n = 13). For sample characterization, balance, mobility, sensorimotor impairment, and daily living activities performance were measured. Results: Differences in functional tests were identified only when the control and hemiparesis groups (F = 29.1; p =.001) were compared during the 10-metre Walking Test. Regarding the pre- and post-robotic assistance session, no significant difference was observed for any comparison (p >.05), except for the steadiness test, as demonstrated by the standard deviation (F = 7.10; p =.01) and coefficient of variation (F = 6.20; p =.02). The hemiparesis group showed better torque steadiness during dorsiflexion post-robotic assistance therapy (p ≥ 0.02) when compared with pre-robotic assessment. Correlations were identified between steadiness and walking speed variables. Conclusion: People with chronic hemiparesis presented short-term performance gains in torque steadiness, especially during dorsiflexion, after a single robotic therapy session. The robotic therapy did not influence the walking speed, although low to moderate correlations between torque steadiness variables and walking speed were observed. [ABSTRACT FROM AUTHOR]

Objective: The aims of the present research were to determine the prevalence of the use of dietary supplements and anabolic-androgenic steroids (AAS) without professional guidance in the countryside of Northeastern Brazil, and to compare blood pressure (BP) between nonusers of dietary supplements, thermogenic supplement users and AAS users. Methods: The sample consisted of 346 resistance training (RT) practitioners and bodybuilders. The participants answered a questionnaire on the use of dietary supplements and/or AAS. In addition, the participants underwent BP assessment. Results: 76.9% of the sample consumed dietary supplements and AAS at some point in their lives. 66.8% (95%CI: 61.5–71.7) of our sample used only food supplements without any guidance from a qualified professional. AAS and cosmetic doping was reported by 8.1% (95%CI: 5.6–11.2%) and 2.0% (95%CI: 1.0–4.2%) of the sample, respectively. Regarding BP, a significant difference was observed for systolic BP when nonusers of dietary supplements were compared to users of thermogenic supplements (126.5 ± 15.1 mmHg s. 134.7 ± 14.5 mmHg; p=.034) and when compared to AAS users (126.5 ± 15.1 mmHg vs. 136.6 ± 12.2 mmHg; p=.010). Conclusions: Our findings point to excessive consumption of dietary supplements and AAS (without professional guidance) by RT practitioners and bodybuilders. In addition, we observed high systolic blood pressure in users of thermogenic supplements and AAS users. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the relationship between pharyngeal response time (PRT) and lateralization of brain lesions. Methods: A Cross-sectional study. 73 videofluoroscopic swallow studies (VFSS)were conducted on patients after stroke The study subjects were divided into : group 1 (G1) consisting of 39 individuals with left cortical lesion and group 2 (G2) consisting of 34 individuals with right cortical lesions. The VFSS of G1 and G2 subjects were analyzed using puree (A) and liquid (B) consistencies, and were also subdivided into young adults and older persons.. The mean PRT was divided into times shorter and longer than 250 ms. Results: No statistically significant difference was observed between G1 and G2 for the A and B consistencies, being obtained : G1 (A mean: 56.6 ms; B mean: 99.5 ms; A mean: 3627 ms; B mean: 1712 ms) and G2 (A mean: 79.6 ms; B mean: 110.7 ms; A mean: 2040 ms, B mean: 1529 ms), for PRT shorter (A:p =.673; B: p = 1.000) and longer (A: p =.435; B: p =.847) than 250 ms, respectively. No statistically significant difference was found regarding the variable age in the comparison between young and old adults for mean PRT according to the A and B consistencies in G1 (A: p =.260; B: p =.732) and G2 (A: p =.586; B: p =.104). Conclusion: No relationship between PRT and lateralization of brain lesion was observed with respect to subject age and to the swallowing of different food consistencies. [ABSTRACT FROM AUTHOR]

Objective: Evaluate, code and qualify the participation of Brazilian stroke survivors based on the international classification of functioning, disability and health (ICF) and identify predictors of post-stroke participation. Methods: An exploratory, observational, cross-sectional study was conducted involving 78 individuals with hemiparesis stemming from a stroke. The stroke specific quality of life (SS-QOL) was used to evaluate the participation component of the ICF. The geriatric depression scale was used to screen depressive symptoms; the functional independence measure (FIM) was used to measure the degree of dependence; grip strength was determined using a dynamometer; and cognitive status was evaluated using the mini mental state examination. The one-way analysis of variance followed by the Bonferroni test was used for the comparison the participation scores of different groups (age and marital status). The independent t-test was used for the comparisons of the other groups (sex, time since the occurrence of stroke (<12 months or >12 months) and degree of functional independence). Multiple linear regression was employed to identify measures capable of predicting participation. Results: Based on the classification and qualifiers of the ICF, the individuals analyzed exhibited a moderate level of participation. Participation was significantly associated with time since the occurrence of stroke (F = 2.46; 95% confidence interval (CI) = −23.67–0.34; p = 0.05), degree of functional independence (F = 2.40; 95% CI = −33.0 to −18.93; p < 0.001) and marital status (married or widowed) (F = 2.6; p = 0.05). No statistically significant associations were found with regard to age, sex or affected side of the body. Functional independence was the main predictor of participation (F = 99.2; r2 = 0.57; p <0.001) and the occurrence of depressive symptoms was a moderate predictor (F =12.78; r2 = 0.40; p = 0.001). Conclusions: Twenty-four ICF categories were coded and qualified with the use of the SS-QOL, enabling the participation component of the ICF biopsychosocial model to be easily evaluated in clinical practice. Overall, the sample in the present study demonstrated a moderate decline in participation following a stroke and only the "social roles" domain was severely affected. The FIM was the main predictor of participation and the depression was a moderate predictor. Therefore, health professionals involved in the rehabilitation of these patients should focus on the promotion of functional independence and improvements in emotional health to optimize social participation following a stroke. The Brazilian stroke individuals analyzed exhibited a moderate level of participation. Functional independence was the main predictor of participation and the occurrence of depressive symptoms was a moderate predictor. Age, sex and affected side of the body were not predictors of participation. Our findings support that twenty-four International classification of functioning, disability and health categories were coded and qualified with the use of the stroke specific quality of life. Rehabilitation of social functioning post stroke patients should be focused on the promotion of functional independence and improvement in emotional health. This study offers a participation assessment model that can facilitate the incorporation of the ICF in the clinical practice. [ABSTRACT FROM AUTHOR]