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Background: To address the rehabilitative barriers to frequency and precision of care, we conducted a pilot study of a biofeedback electropalatography (EPG) device paired with telemedicine for patients who underwent primary surgery +/- adjuvant radiation for oral cavity carcinoma. We hypothesized that lingual optimization followed by telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER) would further improve speech and swallowing outcomes after "standard-of-care" SOC rehabilitation., Method: Pilot prospective 8-week (TEBER) program following 8 weeks of (SOC) rehabilitation., Results: Twenty-seven patients were included and 11 completed the protocol. When examining the benefit of TEBER independent of standard of care, "range-of-liquids" improved by +0.36 [95% CI, 0.02-0.70, p = 0.05] and "range-of-solids" improved by +0.73 [95% CI, 0.12-1.34, p = 0.03]. There was a positive trend toward better oral cavity obliteration; residual volume decreased by -1.2 [95% CI, -2.45 to 0.053, p = 0.06], and "nutritional-mode" increased by +0.55 [95% CI, -0.15 to 1.24, p = 0.08]., Conclusion: This pilot suggests that TEBER bolsters oral rehabilitation after 8 weeks of SOC lingual range of motion., (© 2024 Wiley Periodicals LLC.)

Purpose: Complications related to parotidectomy can cause significant morbidity, and thus, the decision to pursue this surgery needs to be well-informed. Given that information available online plays a critical role in patient education, this study aimed to evaluate the readability and quality of online patient education materials (PEMs) regarding parotidectomy., Methods: A Google search was performed using the term "parotidectomy" and the first 10 pages of the search were analyzed. Quality and reliability of the online information was assessed using the DISCERN instrument. Flesch-Kincaid Grade Level (FKGL) and Flesch-Reading Ease Score (FRE) were used to evaluate readability., Results: Thirty-five PEMs met the inclusion criteria. The average FRE score was 59.3 and 16 (46%) of the online PEMs had FRE scores below 60 indicating that they were fairly difficult to very difficult to read. The average grade level of the PEMs was above the eighth grade when evaluated with the FKGL. The average DISCERN score was 41.7, which is indicative of fair quality. There were no significant differences between PEMs originating from medical institutions and PEMs originating from other sources in terms of quality or readability., Conclusion: Online PEMs on parotidectomy may not be comprehensible to the average individual. This study highlights the need for the development of more appropriate PEMs to inform patients about parotidectomy.

Objective: Patients are increasingly turning to the Internet as a source of healthcare information. Given that neck dissection is a common procedure within the field of Otolaryngology - Head and Neck Surgery, the aim of this study was to evaluate the quality and readability of online patient education materials on neck dissection., Methods: A Google search was performed using the term "neck dissection." The first 10 pages of a Google search using the term "neck dissection" were analyzed. The DISCERN instrument was used to assess quality of information. Readability was calculated using the Flesch-Reading Ease, Flesch-Kincaid Grade Level, Gunning-Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook Index., Results: Thirty-one online patient education materials were included. Fifty-five percent ( n  = 17) of results originated from academic institutions or hospitals. The mean Flesch-Reading Ease score was 61.2 ± 11.9. Fifty-two percent ( n  = 16) of patient education materials had Flesch-Reading Ease scores above the recommended score of 65. The average reading grade level was 10.5 ± 2.1. The average total DISCERN score was 43.6 ± 10.1. Only 26% of patient education materials (PEMs) had DISCERN scores corresponding to a "good quality" rating. There was a significant positive correlation between DISCERN scores and both Flesch-Reading Ease scores and average reading grade level., Conclusions: The majority of patient education materials were written above the recommended sixth-grade reading level and the quality of online information pertaining to neck dissections was found to be suboptimal. This research highlights the need for patient education materials regarding neck dissection that are high quality and easily understandable by patients., Competing Interests: The authors declare that they have no competing interests., (© 2022 The Authors. World Journal of Otorhinolaryngology ‐ Head and Neck Surgery published by John Wiley & Sons Ltd on behalf of Chinese Medical Association.)

Objectives: To identify the physiological changes in older adults' vision during the aging process., Methods: An exploratory, descriptive study with a qualitative approach was conducted with 20 older adults and six healthcare providers who worked with older adults in João Pessoa, Paraíba (Brazil). The Focus Group Technique was used for data collection, with the collected information subsequently being submitted to Inductive Thematic Analysis using textual analysis software., Results: The physiological changes related to vision were described by both the older adults and healthcare providers using the following words: vision, difficulty; see; cataract; glasses; surgery; more; age; eye; and no. These terms represent declines in vision resulting from advancing age which significantly modify the daily lives of older adults and their families., Conclusions: The perception of the older adults and the healthcare providers who care for them regarding the physiological changes in vision throughout the aging process shows that the loss of visual acuity significantly affects the daily life of older adults and their families., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright� by the Universidad de Antioquia.)

This study analyses the multiple abuse against older adults reported to the elder abuse police units of three Brazilian cities from 2009 to 2013. This is a longitudinal and retrospective study carried out through the analysis of police reports (PRs) in the elder abuse police units of three Brazilian cities: Ribeirão Preto (SP), Teresina (PI), and João Pessoa (PB). Descriptive statistical analysis consisted of absolute and percentage frequencies. The chi-square test, Fisher's Exact test, and Relative Risk (RR) were used to analyze the data, with a 95% Confidence Interval (CI) and a significance of 5%. A total of 2,313 reports of older adult abuse were analyzed, of which 245 (10.6%) were related to reports of multiple abuse, 49.4% in Ribeirão Preto, São Paulo, 22.9% in João Pessoa, Paraíba, and 27.8% in Teresina, Piauí. Most of the victims of recurrent older adult abuse are female and younger elderly. Psychological abuse was the most recurrent, followed by financial abuse, occurring in the victim's own home. In João Pessoa, older women and elderly living with their abusers were at a higher risk of report of multiple abuse acts. In Ribeirão Preto, living with the aggressor was a risk factor for multiple violent acts. In the total population of the study, living without companion and not living with the aggressor were identified as protective factors against recurrent violence. The need to implement social and legal actions to improve safety for the more vulnerable groups is emphasized., Competing Interests: The authors have declared that no competing interests exist.

Sclerosing epithelioid fibrosarcoma (SEF) is an uncommon variant of fibrosarcoma that is characterized by a distinct morphology. It most frequently presents in the deep soft tissues of the lower extremities, often in intimate association with fascia and periosteum, although reports of the head and neck involvement have been reported. A minority of cases show morphological, immunohistochemical and molecular overlap with low grade fibromyxoid sarcoma (LG-FMS). Herein, we describe a case of a bland spindle cell neoplasm presenting in the jaw that was initially incompletely excised. Over the course of 20 years the tumor subsequently recurred with a SEF morphology. Molecular testing performed on both specimens subsequently confirmed the presence of an EWSR1-CREB3L1 gene fusion. This report highlights the diagnostic difficulty with LG-FMS, particularly in unusual anatomic locations; reiterates the potential for the uncommon EWSR1-CREB3L1 fusion product in LG-FMS; and, reaffirms the potential for progression and/or overlap between LG-FMS to SEF over time.

Objective: To analyze the police reports filed by older adults who suffered abuse in order to identify the socio-demographic characteristics of victims and aggressors, type of violence, location, as well as to compare rates in three Brazilian cities in the period from 2009 to 2013., Method: Ecological study, in which 2,612 police reports registered in Police Stations were analyzed. An instrument was used to obtain data from the victim, the aggressor and the type of violence., Results: Psychological abuse predominated and most cases occurred in the older adults own home. In the cities of Ribeirão Preto and João Pessoa, the older adults presented similar rates for both gender. Regarding the standardized rates, in João Pessoa, there was a rise of this type of abuse in the two first years, and later there was a certain stability. In the city of Teresina, there was an increase, also observed in the city of Ribeirão Preto in the three first years, followed by a decrease., Conclusion: Older adults abuse is a cultural phenomenon difficult to be reported by them, since it occurs in the family context.

Objectives: to analyze the dimensionality, convergent construct validity and internal consistency of the Informal Caregiver Burden Assessment Questionnaire (QASCI) after its semantic adaptation to Brazil., Method: this methodological study was developed with 132 informal caregivers of elders who are dependent of help for basic or instrumental activities of daily living, in a capital city in Northeast Brazil. Quality of life measures related to health, anxiety and depression were used in the analysis of the convergent construct validity of the QASCI., Results: the results of the instrument construct validation evidenced statistically significant correlations with the three measures. The confirmatory factor analysis evidenced good adjustment of the theoretical model of seven factors (domains) of the version used in the group studied. Cronbach's alpha for the scale total was 0.92., Conclusion: the Brazilian version of the QASCI was considered to be valid and reliable for assessing the burden of informal elder caregivers.

Objective: Characterize the social profile and the need of information from patients with refractory epilepsy., Method: A semi-structured questionnaire was applied to 103 patients to investigate sociodemographic aspects, pharmacotherapy and any doubts about epilepsy., Results: Patients were highly dependent on having a free and accessible supply of antiepileptic drugs. Sixty-eight percent of the population was unemployed, and 26% confirmed receiving social security benefits due to epilepsy. Twenty-nine percent of the population reached high school. Eighty-five percent of the patients had at least one doubt about epilepsy; treatment and epilepsy aspects in general were the main topics., Conclusion: As observed in developed countries, patients with refractory epilepsy from a developing country also have high rates of unemployment and low educational levels. The results raise a concern about the need of information about epilepsy by patients and their families, urging the necessity to invest in strategies to solve this deficiency in knowledge.

Background: Patients with refractory epilepsy often have impaired quality of life (QOL) as a consequence of seizures and adverse effects of antiepileptic drugs. We assessed the impact of adverse effects on QOL and the utility of a structured instrument to help the physician manage adverse effects in patients with refractory epilepsy., Methods: Clinical characteristics, drug treatment and adverse effects were evaluated in 102 patients with refractory epilepsy at a single tertiary referral centre. The Adverse Events Profile (AEP) and Quality of Life in Epilepsy-31 (QOLIE-31) questionnaires were completed at baseline and after six months. At baseline, patients with a high burden of adverse effects (AEP scores ≥45) were randomized to an intervention or control group. AEP scores in the intervention group were available to the physician as an instrument to help to reduce adverse effects., Results: Ninety-five patients (93.1%) were on polytherapy. Sixty-six completed the questionnaires and, of these, 43 (65.1%) had a high AE burden and were randomized to the intervention and control group. QOLIE-31 scores were inversely correlated with AEP scores at both visits. Among randomized patients, AEP scores tended to decrease between the baseline and the final visit without significant differences between groups (intervention group: 54.1 ± 6.1 vs 51.1 ± 9.1; control group: 55.8 ± 5.8 vs 50.5 ± 12.2). QOLI-31 scores did not change substantially between visits (intervention group: 45.9 ± 17.4 vs 48.4 ± 14; control group: 47.5 ± 15.7 vs 45.2 ± 18.9)., Conclusion: A significant proportion of patients had a high toxicity burden which had an impact on their QOL. Reduction of overtreatment is a difficult challenge which cannot be addressed solely by providing a structured assessment of adverse effects, but requires a more comprehensive approach aimed at optimizing the many components of the management strategy.

Hematological and physiological changes in the blood of juveniles of the freshwater fish, Prochilodus scrofa were determined after acute exposure to 20, 25, and 29 microgramsCu L-1 in water (pH 7.5; hardness 24.5 mg L-1 as CaCO3) for 96 h. Copper exposure to 25 and 29 microgramsCu L-1 caused significant increase in the hematocrit and red blood cell values. The increase in red blood cells was associated with increase in whole blood hemoglobin only in fish exposed to 29 microgramsCu L-1. Leukocytes increased following copper exposure and were significantly higher in fish exposed to 29 microgramsCu L-1. Differential leukocyte percentage displayed significant reduction in lymphocytes and an increase in neutrophils in fish exposed to 25 and 29 microgramsCu L-1. The percentage of monocytes remained unchanged after copper exposure. The thrombocytes did not change. There was a significant decrease in plasma [Na+] and [Cl-] and a significant drop in blood pH in fish exposed to 25 and 29 microgramsCu L-1 while [K+] showed significant increase in fish exposed to 29 microgramsCu L-1. Copper exposure led to ionoregulatory impairment, although chloride cell hypertrophy was induced. The changes in red blood cells suggest a compensatory response to respiratory surface reduction of gills (tissue damage and cell proliferation) in order to maintain oxygen transference from water to the tissues, allowing the fish to survive during the so-called shock phase of LC50 exposure, at least while at rest.