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Given the need to measure parents' perceptions of their children's exposure to tobacco smoke, the Parental Perceptions of Children's Exposure to Tobacco Smoke (PPE) instrument was developed and validated in Hebrew and later translated into English and Portuguese. The PPE has already been translated and adapted to the Brazilian context but a more robust sample is necessary to investigate the measurement properties. Thus, this study evaluated the measurement properties of the Brazilian version of the PPE instrument. Reliability and validity study were conducted with 161 parents with children up to 18 years of age. Perception of parental smoking status was investigated using analysis of variance. The instrument showed excellent reliability (Cronbach α = 0.92 and intraclass correlation coefficient = 0.91). The exploratory factor analysis identified 4 factors with a total accumulated variance of 71.6%. Confirmatory factor analysis validated this structure with 4 factors. It was necessary to exclude a question that presented low commonality. Analysis of variance demonstrated that nonsmoking and former smoking parents have similar scores, although they are higher than those of current smokers. Our findings provide evidence that the PPE version translated and adapted for the Brazilian context is a reliable and valid instrument. Thus, it can help us understand how parents cope with exposure to tobacco smoke., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: to identify the repercussions of financial toxicity on the lives of adult cancer patients during the COVID-19 pandemic., Methods: an integrative review was conducted using the PubMed, Web of Science, Scopus, and Embase databases, as well as the Virtual Health Library portal, in March 2023., Results: out of 62 studies found, 13 were included for analysis. The primary repercussions of financial toxicity included difficulties in covering basic expenses such as food, housing, medication, transportation, and internet access; increased anxiety and concerns related to health and financial situations; reduction or absence of income; challenges in obtaining treatment or accessing healthcare services; rising expenses; and telemedicine as a less burdensome alternative., Conclusions: the pandemic has exacerbated financial toxicity; therefore, healthcare teams must recognize it as an adverse event of oncological treatment and understand its potential to affect various aspects of patients' lives.

Objective: This study aimed to assess anxiety levels among women with metastatic breast cancer undergoing palliative chemotherapy., Methods: A descriptive, prospective study was conducted at an oncology hospital in southern Brazil from September 2021 to October 2022. A total of 123 adult women receiving outpatient palliative chemotherapy were included in the study. Anxiety levels were evaluated using the State-Trait Anxiety Inventory at baseline, the fifth week, and the eleventh week of treatment. Data were analyzed using Kruskal-Wallis, Mann-Whitney, and Multiple General Regression Models., Results: Women with advanced breast cancer had an average trait-anxiety score of 48.24±5.92. A progressive improvement in anxiety scores was observed throughout the treatment evaluation stages (44.90±5.89; 43.37±5.34; 42.58±5.75), with a significant difference between the evaluations (p=0.008). Significant correlations were found between trait-anxiety and work situation (p=0.010) and ovarian metastasis (p=0.022). The adjusted general regression model also showed statistical significance for baseline evaluation with offspring (p=0.045) and education level (p=0.041)., Conclusion: Women with breast cancer undergoing palliative chemotherapy exhibited high trait-anxiety scores, which decreased significantly over the course of treatment.

Background: Sinonasal cancers (SNC) are rare cancers with a high proportion attributable to occupational carcinogens. This study aims to describe the sociodemographic, clinical, and occupational characteristics of subjects with SNC in Brazil., Methods: Observational study conducted with secondary data from a network of Hospital Cancer Registries. We selected epithelial/unspecified SNC records with a year of diagnosis from 2007 to 2021. We performed descriptive statistics of SNC cases and calculated crude and age-standardized rates (ASR, standard: world population) by gender and Region of residence., Results: We identified 2,384 cases, 1,553 (65.1%) in men and 831 (34.9%) in women. The mean age at diagnosis was 59 years for both. Most SNC (50.7% in men and 53.2% in women) originated from the maxillary sinus. Most (65.5% in men and 54.5% in women) were squamous cell carcinomas. Information on occupation was missing in the years 2019-2021. Most male SNC patients (44.8%) were employed in group 6 (Agricultural, forestry, and fishing workers), while women had been mainly (34.6%) working in groups 8 (Workers in the production of industrial goods and services, machine operators) and in group 6 (27.6%). Crude SNC incidence rates were 1.0 per million person-years in men and 0.5 in women, while ASR were 1.0 and 0.4, respectively. In both genders, the highest ASR was in Minas Gerais (men: 1.9; women: 0.7)., Conclusions: Establishing the profile of Brazilians with sinonasal cancer can stimulate epidemiologic research for monitoring this group of cancers with a high association with occupational exposures.

The waste management sector is undergoing profound transformations that challenge its structures and institutions. The function and position of waste management and recycling companies have been changing, and this process accelerates as the circular economy consolidates as part of the strategy to implement green shifts. This article argues that scholars, practitioners and policymakers interested in waste management could benefit from building bridges with the field of industrial dynamics. Industrial dynamics is concerned with the driving forces of economic transformation, with focus on not just outcomes but processes and structures. This type of research is crucial in face of transformations going on in the sector. Three crucial themes for cross-disciplinary investigation are: (i) industry evolution and institutions, (ii) business organization and management, and (iii) technological change, innovation and entrepreneurship. Waste management is a lively, complex and diverse sector, whose process of reinvention present the opportunity to research profound industrial transformations in real time. By systematically investigating the industrial dynamics of waste management, it becomes possible to uncover the structural changes underpinning the transformation of waste into resources, their driving forces and the directions to which they point, while mindful of the evolving discourses and the wider technological and institutional landscape., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: to evaluate and correlate the quality of life and financial toxicity of adult patients undergoing hematopoietic stem cell transplantation during the COVID-19 pandemic., Method: observational, analytical study, carried out with 35 patients in a reference hospital for transplantation in Latin America. For data collection, the Functional Assessment Cancer Therapy Bone Marrow Transplantation and COmprehensive Score for Financial Toxicity questionnaires were used. Spearman and Mann-Whitney correlation tests were used for data analysis., Results: general quality of life during COVID-19 had a low score (67.09/108) with greater impairment in functional well-being (14.47/28), social well-being (16.76/28) and additional concerns (23.41/40). The means of the allogeneic group were lower than those of the autologous group in all domains, showing a significant difference in relation to additional concerns (p=0.01) and in the treatment evaluation index (p=0.04). Financial toxicity was considered to have a slight impact (22.11/44). There was a relationship, albeit not significant, between quality of life and financial toxicity (p=0.051)., Conclusion: the quality of life of the sample was low; there is a correlation between quality of life and financial toxicity, although not significant. The higher the financial toxicity, the lower the quality of life.

Objective: to assess the financial toxicity of people with chronic kidney disease undergoing hemodialysis treatment., Method: a descriptive analytical cross-sectional study, carried out with 214 people, between February and May 2022. For data collection, a sociodemographic and clinical instrument and the COmprehensive Score for financial Toxicity were used. For analysis, the Odds Ratio, ANOVA and Cronbach's alpha tests were used., Results: the mean financial toxicity score was 20.30. Women with a monthly family income of at most two minimum wages are more likely to have some degree of financial toxicity (Odds Ratio: 0.85; 0.76)., Conclusion: financial toxicity was identified to different degrees and varied according to sociodemographic and clinical characteristics. Measuring financial toxicity can help nurses plan care and develop strategies to avoid interrupting treatment.

Objectives: to identify in the literature and summarize nursing care in a hospital environment directed to patients who suffered burns., Methods: a scoping review, according to the JBI Reviewers' Manual recommendations, with a search in the MEDLINE, CINAHL, Web of Science, Scopus databases and in the Virtual Health Library portal, through articles published between 2016 and December 2021., Results: of the total 419 articles found, nine were selected for analysis. The main care measures identified were changing dressings and types of coverage, vital sign control, non-pharmacological techniques for pain relief and opioid reduction., Conclusions: the complexity of burn care requires constant updating by the nursing team. Keeping it prepared to carry out the best nursing care practices for burn patients will promote adequate care, patient recovery and reduction of possible harm.

Grumixama ( Eugenia brasiliensis Lam.) is a native fruit of the Brazilian Atlantic Forest, belonging to the Myrtaceae family, which designatesthe most significant number of species with food potential. It stands out due to its phytochemical characteristics because of the presence of polyphenols and volatile organic compounds. Volatile compounds are substances released by foods that give off an aroma and influence flavor. Solid-phase microextraction is a technique that allows for low-cost, fast, and solvent-free extraction, has an affinity for numerous analytes, and is easily coupled to gas chromatography. The objectives of this work were to evaluate the efficiency of different fibers of SPME (solid-phase microextraction) in the extraction of volatile organic compounds from grumixama pulp; optimize a method for extraction time, temperature, and sample weight; and to determine the characteristic volatile profile of this fruit. For the extraction of volatile compounds, three fibers of different polarities were used: polar polyacrylate (PA) fibers, divinylbenzene/carboxyne/polydimethylsiloxane (DVB/CAR/PDMS) semipolar fibers, and polydimethylsiloxane/divinylbenzene (PDMS/DVB). Fourteen volatile organic compounds (VOCs) were identified by DVB/CAR/PDMS, six by PA, and seven by PDMS/DVB through solid-phase microextraction in the headspace mode (SPME-HS). Considering the total number of compounds identified, regardless of the fiber used, and the optimization of the method, Eugenia brasiliensis presented sesquiterpene fractions (85.7%, 83.3%, and 85.7% of total VOCs) higher than the monoterpene fractions (14.3%, 16.7%, and 14.3%) for DVB/CAR/PDMS, PA, and PDMS/DVB, respectively in its composition. In addition, it was possible to verify that the fiber DVB/CAR/PDMS presented a better efficiency due to the larger chromatographic area observed when the grumixama pulp was subjected to conditions of 75 °C, 2.0 g, and an adsorption time of 20 min.

Objective: Fatigue is among the most common symptoms of the long-term effects of coronavirus (long COVID). This study aims to compare the effectiveness of osteopathic manipulative treatment (OMT) combined with physiotherapy treatment (PT) compared to PT alone on fatigue and functional limitations after two months post randomization in adults with long COVID., Methods: This is a study protocol for a two-arm, assessor-blinded, pragmatic randomized controlled superiority trial. Seventy-six participants will be randomly allocated to OMT + PT or PT. The PT includes usual care interventions including motor and respiratory exercises targeting cardiorespiratory and skeletal muscle functions. The OMT entails direct and indirect musculoskeletal, viceral and cranial techniques. Patients will be evaluated before and after a 2-month intervention program, and at 3-month follow-up session. Primary objectives comprise fatigue and functional limitations at 2-month post randomization as assessed by the fatigue severity scale and the Post-COVID Functional State scale. Secondary objectives comprise fatigue and functional limitations at 3 months, and the perceived change post-treatment as assessed by the Perceived Change Scale (PCS-patient)., Registration: This protocol was registered (NCT05012826) and received ethical approval (38342520.7.0000.5235). Participant recruitment began in August 2021 and is expected to conclude in July 2023. Publication of the results is anticipated in 2023., Competing Interests: The funder had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication., (© 2022 Elsevier Ltd. All rights reserved.)

Advice to stay active is the primary management strategy for sciatica. Other conservative treatments such as neural management techniques may also contribute to sciatica recovery, but currently, the effects have not been robustly assessed. Thus, the aim of this study is to compare the effects of adding neural management to advice to stay active versus advice to stay active alone in improving pain intensity and functional limitation. Secondarily, to compare the effects of the experimental intervention in the sciatic neurodynamic, pain modulation, and psychosocial factors. A parallel-group, controlled, examiner-blinded superiority clinical trial randomised at a 1:1 allocation will be conducted in 210 participants with chronic sciatica. Patients will be recruited from outpatient physiotherapy clinics and community advertisements. The experimental group will receive neural mobilisation techniques and soft tissue mobilisation techniques for 30 minutes per session, 10 weekly sessions, plus advice to stay active on their activities of daily living, information on physical activity, imaging tests, and sciatica for 5 biweekly sessions lasting 25-30 minutes. The control group will receive advice to stay active only. The re-evaluation will be performed out after 5 weeks, 10 weeks, and 26 weeks after randomisation and primary endpoints will be pain intensity and functional limitation at 10 weeks. Secondary outcomes will include neuropathic symptoms, sciatic neurodynamic, pain modulation, and psychosocial factors. Adverse events and patient satisfaction will be assessed. Ethical approval has been granted from an Institutional Human Research Ethics Committee. Trial registration: Trial was prospectively registered in the Brazilian Registry of Clinical Trials (number: RBR-3db643c)., Competing Interests: The authors have declared that no competing interests exist.

Objective: First and second violinists in orchestras use identical instruments, but the motor patterns used to execute the different notes may vary between the two groups and the biomechanical gestures may influence musculoskeletal complaints. The primary objective of this study was to compare the pain intensity and interference in musical performance of first and second violinists of professional youth chamber orchestras. Second, to investigate the correlation between pain and the musical practice profile in this population., Methods: This cross-sectional study enrolled 74 violinists, aged 12 to 17 years, from three professional youth chamber orchestras in Brazil. Participants completed a validated self-administered questionnaire, the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians-Brazilian version (MPIIQM-Br). Variables related to musical practice profiles were also recorded. Data analysis applied t-tests for independent samples and Pearson's correlation coefficient., Results: The sample of first violinists (n=39) presented 23 males and 16 females, and the second violinists (n=35) included 23 females and 12 males. The mean age was 13.9 yrs (SD 1.1) and 14.1 yrs (1.0) for the first and second violinist groups, respectively. Most participants (n=66, 89%) reported pain in at least one moment of their career, and 54 (76%) reported pain at the time of data collection. A higher pain prevalence was identified in the right shoulder (37.7%), in 28.2% of the second violinists and 9.4% of the first. The second violinists presented higher scores for most variables related to pain intensity and pain interference in performance (p < 0.05). A correlation was observed between time working at a professional level and the number of affected areas on the body pain map (r=0.30; 95% CI 0.23-0.42) and between the hours of daily practice and the number of affected areas on the body pain map (r=0.39; 95% CI 0.29-0.45)., Conclusion: Second violinists had more complaints of pain and difficulty in playing their instrument compared to the first violinists. The study also found a correlation between the number of body areas with pain complaints and variables linked to the violinists' practice profile.

Plastic litter is accumulating on pristine northern European beaches, including the European Arctic, and questions remain about the exact origins and sources. Here we investigate plausible fishery and consumer-related sources of beach littering, using a combination of information from expert stakeholder discussions, litter observations and a quantitative tool - a drift model - for forecasting and backtracking likely pathways of pollution. The numerical experiments were co-designed together with practice experts. The drift model itself was forced by operational ocean current, wave and weather forecasts. The model results were compared to a database of marine litter on beaches, collected every year according to the standardized monitoring program of the Oslo/Paris Convention for the Protection of the Marine Environment of the North-East Atlantic (OSPAR). By comparing the heterogeneous beach observations to the model simulations, we are able to highlight probable sources. Two types of plastic are considered in the simulations: floating plastic litter and submerged, buoyant microplastics. We find that the model simulations are plausible in terms of the potential sources and the observed plastic litter. Our analysis results in identifiable sources of plastic waste found on each beach, providing a basis for stakeholder actions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: Low back pain is highly prevalent worldwide and in Brazil. Postural control is a functional limitation in patients with low back pain. Postural control can be investigated through the centre of pressure (CoP) displacement, using a baropodometry. However, there is a lack of validation data about posturography variables obtained from the baropodometer. This study aimed to investigate the concurrent validity of the displacement of CoP measured through baropodometer T-Plate® in patients with chronic non-specific low back pain during three tasks., Method: A validation study was conducted in 37 participants with chronic non-specific low back pain during three different tasks, including bipedal support, bipedal support holding bags, and bipedal squatting holding bags. The tasks were performed on a baropodometer (index method) placed on a force plate (criterion measure). Measurements included velocity, amplitude of displacement, and sway area., Results: Weak to strong correlations were found in the three tasks between the baropodometer and the force plate for most variables. The Bland-Altman analyses revealed no substantive differences between the two methods for the standard deviation of amplitude mediolateral and sway area for the three tasks. There was a systematic bias for the mean velocity and the standard deviation of amplitude anteroposterior displacement in the three tasks., Conclusion: The baropodometer could be used to measure the displacement of the CoP in patients with chronic non-specific low back pain. Sway area showed an appropriate validity to measure postural stability of the participants using the baropodometer., Competing Interests: Declaration of competing interest None of the authors have any financial or other interests relating to the manuscript to be submitted for publication in the Journal of Bodywork Movement and Therapies., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: to assess/correlate health-related quality of life with the social dimension of hematopoietic, autologous and allogeneic stem cell transplant patients in the three years post-transplant., Methods: longitudinal, observational study with 55 patients, in a reference hospital in Latin America, from September 2013 to February 2019, using the Quality of Life Questionnaire-Core and Functional Assessment Cancer Therapy Bone Marrow Transplantation., Results: A total of 71% underwent allogeneic transplantation. The social dimension had low averages since the baseline stage (55, 21) and low scores (56) for quality of life in pancytopenia. There was a significant positive correlation between social dimension, quality of life in pancytopenia (p<0.01) and follow-up after hospital discharge (p<0.00). There is a significant difference (p<0.00) throughout the stages, however, not in terms of the type of transplant (p>0.36/0.86)., Conclusions: patients with better assessments in the social dimension have a better quality of life. Interventions focusing on the multidimensionality of the quality of life construct are necessary.

Objective: To reflect on the understanding of financial toxicity, as an adverse event of cancer diagnosis and treatment, and its implications on the quality of life of these patients., Method: Reflexive study, based on the international literature about the concept of financial toxicity and its relationship with quality of life., Results: Financial toxicity is related to the financial difficulties associated with cancer and its treatment, which occur in the lives of patients and family members. Its consequences include: possible worsening of the clinical symptoms, indebtedness, loss of professional opportunities, changes in family habits and decline in quality of life., Final Considerations: Measures to minimize financial toxicity should also be a concern of the state and be part of the therapeutic itinerary of cancer patients. Dialogue can become an essential tool for the health team to clarify the therapeutic options and their costs. This attitude shows respect and preserves the patient's autonomy, which can minimize the feeling of helplessness in the face of the disease.

This study aimed to test the effects of an IVM SPOM adaptation (SPOM-adapted IVM) on the production, total number of cells (TNC), apoptosis, and cryotolerance (post-warming survival and cytoskeleton actin integrity) of bovine IVP embryos. Two experiments were conducted with two experimental groups based on IVM treatment: A control group (TCM 199 without FCS) and an SPOM-adapted group (TCM 199 with forskolin and IBMX in pre-IVM and IVM with cilostamide). The first experiment evaluated embryo in vitro production, TNC, and apoptosis rate on D9 of development. In the second experiment, embryos were vitrified/warmed at D7 (control fresh and vitrified; SPOM-adapted fresh and vitrified) and assessed regarding post-warming survival rates and cytoskeleton actin integrity. Statistical analysis was performed using GraphPad INSTAT software at a significance level of 5%. An increase (p < 0.05) in blastocyst production was observed in the SPOM-adapted group comparing to the control group. There was no difference (p > 0.05) in the TNC or apoptosis rate between the groups. Regarding cryopreservation, no differences were found (p > 0.05) in actin integrity or post-warming survival rates between the vitrified groups. In both vitrified groups, we observed a significantly lower uninjured pattern of actin integrity compared to the fresh groups (p < 0.05). We conclude that the SPOM-adapted IVM system is beneficial for blastocyst production and does not affect the quality and cryotolerance of the produced embryos., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2020. Published by Elsevier Inc.)

Objective: to identify evidence in the literature about financial toxicity in cancer patients during chemotherapy treatment., Methods: this is a mini review with search in the following databases: Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, National Library of Medicine and Scopus. Articles were surveyed from July 2018 to February 2019 using the following descriptors and Boolean operators: "financial toxicity" OR "financial difficulties" AND "cancer" AND "chemotherapy"., Results: the search totaled 64 articles. After exclusion of duplicates that did not meet the inclusion criteria, the final sample was composed of five articles published in 2013, 2015, 2017 and 2018. Financial difficulty caused by cancer treatment and its impact on quality of life was a frequent expression used in the studies., Conclusion: studies show that financial toxicity damages the quality of life of patients. A scarcity of studies on the subject was also observed, possibly because this is a new concept.

Cyclic adenosine monophosphate (cAMP) is an important molecule in signal transduction within the cell, functioning as a second cell messenger of gonadotrophin stimulation. The concentration of cAMP in cumulus-oocyte complexes (COCs) is known to be controlled through modulation of its synthesis by adenylyl cyclase (AC) and by degradation through the cyclic nucleotide phosphodiesterase (PDE) enzymes. One of the main obstacles for in vitro embryo production is the optimization of reproduction processes that occur in oocyte maturation. The function of cAMP is important in maintaining meiotic arrest in mammalian oocytes. When the oocyte is physically removed from the antral follicle for in vitro maturation (IVM), intra-oocyte cAMP concentrations decrease and spontaneous meiotic resumption begins, due to the depletion of inhibitory factors from the follicle. In many studies, relatively greater cAMP concentrations before IVM has been reported to improve oocyte competence, leading to subsequent benefits in embryonic development in different species. There, therefore, has been an increase in oocyte cAMP concentrations with several treatments and different approaches, such as invasive AC, stimulators of AC activity, PDE inhibitors, and cAMP analogs. The aim of this review is to comprehensively evaluate and provide data related to (i) the use of cAMP modulators during IVM and the effects on completion of meiosis and cytoplasmic reorganization, which are required for development of oocytes with the capacity to contribute to fertilization and subsequent embryonic development; and (ii) the main cAMP modulators and the effects when used in oocyte IVM., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To identify the prevalence and risk factors for musculoskeletal pain in keyboard musicians., Design: Systematic review METHODS: A systematic review was conducted according to the MOOSE recommendations and it was registered with the PROSPERO database under registration number CRD42016042913. We included observational studies through the electronic databases PubMed, Scopus, ScienceDirect, Web of Science, Répertoire International de Littérature Musicale (RILM), Retrospective Index to Music Periodicals (RIPM), Scielo, and Google Scholar, with combinations of the keywords pianists, keyboard players, musculoskeletal pain, muscular disease, tendinitis, tendinopathy, observational, case-control, prevalence, and risk factors. Data from population, information about pain, and risk factors were extracted from studies that fulfilled the eligibility criteria. The methodological quality of the studies was classified through the Newcastle-Ottawa Scale. The risk of bias and quality of evidence was assessed using the GRADE system., Results: Twelve articles (case-controls) were included for the qualitative synthesis. The quality of the studies was classified as fair (n = 6) and good (n = 6). Prevalence was observed between 25.8% and 77.0% of musculoskeletal pain among keyboard musicians, with a higher prevalence in wrists and hands (13.8%-65.8%), neck (9.8%-64.2%), and shoulders (9.8%-59.8%). The only consistent risk factor found in the 4 studies was being female, with OR ranging from 1.05-1.90. Age greater than 18 years; weekly training more than 20 hours; training for more than 60 minutes without a rest break; not having a habit of practicing sports; and playing despite the pain were also described as risks factors for musculoskeletal pain. It was not possible to perform the meta-analysis due to the heterogeneity of the studies., Conclusion: Keyboard musicians presented a high prevalence of musculoskeletal pain, especially in the upper extremity regions of the body. Female, ageing, playing behaviors, and sedentary lifestyle showed an increased likelihood to report musculoskeletal pain., Level of Evidence: II., (Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

The objective of this study is to investigate the factors associated with serum phosphate concentrations in severely burned children and whether hypophosphatemia is associated with outcome. Seventy-eight children with a total body surface area of 24% (6.0-68.5) were retrospectively analyzed for serum phosphate concentrations during the first 10 days of stay in the intensive care unit (ICU). The method of generalized estimating equations was used to evaluate the effect of the exposure variables for serum phosphate concentrations during the study period. Outcome variables were the probability of ICU discharge at 30 days and time on mechanical ventilation. Potential explanatory variables for clinical outcome were hypophosphatemia (serum phosphate <3.8 mg/dL for children <2 years and <3.5 mg/dL for older children), age, sex, percent total body surface area burn, inhalation injury, and severe sepsis and/or septic shock. Competing-risk analysis was applied to calculate the probability of ICU discharge at 30 days, and death was assumed as the competing event. The rate of hypophosphatemia was 79.5%. Serum phosphate concentrations were associated with C-reactive protein (coefficient: -0.63; 95% confidence interval [CI]: -0.96 to -0.30; P = .001). Hypophosphatemia was independently associated with a 68% decrease in the probability of ICU discharge at 30 days (subhazard ratio: -0.32; 95% CI: 0.20, 0.53; P = .001) and an increase of 2.9 days in mechanical ventilation (coefficient: 2.91; 95% CI: 1.16, 4.66; P = .001). Serum phosphate concentrations in pediatric burn patients are associated with the magnitude of inflammatory response. Hypophosphatemia is associated with decreased probability of ICU discharge and increased time on mechanical ventilation.

Anterior knee pain is a common complaint and can cause difficulty with its inability to bear weight. The aim of the study was to analyse the effect of adding myofascial techniques to an exercise programme for patients with anterior knee pain. A clinical trial with 18 patients with a clinical diagnosis of anterior knee pain was conducted. One group (E) with nine individuals was treated with hip muscle strengthening exercises; another group (EM), with nine individuals, had myofascial techniques added. To quantify the results, the Numeric Pain Rating Scale (NPRS) and the Lower Extremity Functional Scale (LEFS) were used. The E group showed an improvement in pain (p = 0.02), but not in the mean degree of disability. The EM group showed an improvement in pain (p = 0.01), as well as the degree of disability (p = 0.008). The effect size analysis showed that participants of the EM group had a greater impact on clinical pain and disability (Cohen's d = .35 and .30, respectively). The addition of myofascial techniques should be considered to improve the functionality of the lower limbs and reduce pain in patients with anterior knee pain., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

This case report presents the effect of Cognitive Functional Therapy (CFT) in a patient with chronic non-specific low back pain associated with unilateral loading impairment of the left lower limb. The patient believed surgery was the only possible way to treat the cause of the problem. The management of this idea was to change such belief. Manual therapy and active exercises were combined in order to encourage the patient to trust his back and lower limb again. One month and a half after the first appointment, the treatment resulted in complete absence of pain and disability. The patient returned to work and he was able to climb stairs and load his left limb normally., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study was to analyze the intra- and inter-rater reliability of the Low Back Clinical Postural Grouping (LBCPG)., Methods: Fifty-eight school adolescents were evaluated by lateral photography. The examiners classified the posture of the participants as: hyperlordotic, sway back, flat back or neutral. The intra- and inter-rater reliability were quantified by the percentage agreement between clinicians and the kappa coefficient with 95% confidence intervals (95% CI)., Results: The intra-rater percentage agreement was 91.4%, k = 0.87 (95% IC 0.77-0.98, p < 0.001) for the more experienced rater, and 86.2% k = 0.79 (IC 95% 0.62-0.96, p < 0.001) for the less experienced rater. The percentage agreement between clinicians was 55.17% k = 0.39 (95% CI: 0.23-0.55, p < 0.001). The agreement rose to 70.69%, k = 0.58 (95% CI 0.41-0.74, p < 0.001) when an optional second opinion of the raters was also considered., Conclusion: The LBCPG was reliable when used by the same clinician. The strategy of a second opinion could be used to improve the inter-rater reliability in epidemiological studies with large samples., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Context: The assessment of the range of motion (ROM) of the cervical spine is common in physical therapy practice. An ROM assessment is used as an integral part of a physical examination, both in symptomatic and asymptomatic populations. Spine manipulation has shown several benefits, including an increased range of passive rotation of the upper cervical spine., Objectives: The study intended to analyze the immediate effects of manipulation of the occipitoatlantoaxial (OAA) joint on the ROM of the cervical rotation and its relationship to an individual's most limited side on Mitchell's test., Design: The study used a single-subject experimental design., Setting: The study took place at Hospital Universitário Gaffrée e Guinle in Rio de Janeiro, Brazil., Participants: A convenience sample of 40 healthy participants with a limited ROM in respect to the rotation of the cervical spine, who were selected in the outpatient physical therapy team (professionals and students)., Intervention: The OAA joint manipulation was performed by an independent therapist on all participants, on the side with the greater ROM restriction only., Outcome Measures: Cervical rotation using a ROM fleximeter and the Mitchell's test was performed., Results: At baseline, 25 of the participants (62.5%) had a reduction in movement for the right-side rotation, whereas 15 of the participants (37.5%) had restricted movement for left-side rotation. After the OAA manipulation, the ROM was increased on both sides independent of the side that had the most restriction to movement. The right-side rotation increased by 9.75°, whereas the left-side rotation increased by 8.26°. Despite a bilateral ROM increase, a difference was observed in the magnitude of the changes between the more-restricted sides and the other sides when the Mitchell's tests were considered, with large clinical effects., Conclusions: The OAA manipulation increased the ROM for bilateral cervical rotation, irrespective of the side of the restriction, and the increase was more pronounced when considering the results of the Mitchell's test.

Among the world's continents, Africa has the highest incidence of food insecurity and poverty and the highest rates of population growth. Yet Africa also has the most arable land, the lowest crop yields, and by far the most plentiful land resources relative to energy demand. It is thus of interest to examine the potential of expanded modern bioenergy production in Africa. Here we consider bioenergy as an enabler for development, and provide an overview of modern bioenergy technologies with a comment on application in an Africa context. Experience with bioenergy in Africa offers evidence of social benefits and also some important lessons. In Brazil, social development, agricultural development and food security, and bioenergy development have been synergistic rather than antagonistic. Realizing similar success in African countries will require clear vision, good governance, and adaptation of technologies, knowledge, and business models to myriad local circumstances. Strategies for integrated production of food crops, livestock, and bioenergy are potentially attractive and offer an alternative to an agricultural model featuring specialized land use. If done thoughtfully, there is considerable evidence that food security and economic development in Africa can be addressed more effectively with modern bioenergy than without it. Modern bioenergy can be an agent of African transformation, with potential social benefits accruing to multiple sectors and extending well beyond energy supply per se. Potential negative impacts also cut across sectors. Thus, institutionally inclusive multi-sector legislative structures will be more effective at maximizing the social benefits of bioenergy compared to institutionally exclusive, single-sector structures.

Stress Urinary Incontinence (SUI) is a common condition and can cause social isolation and decreased quality of life. The literature demonstrates that perineal exercises are effective in promoting urinary continence and lumbar stability. This uncontrolled (group) pilot study, using a pre-test-post-test design, investigated whether a weekly session of Holistic Gymnastics(®) conducted during a one-year period, could change outcomes in a group of twenty women diagnosed with SUI. In the first and last evaluation, the subjects underwent a clinical examination and were asked to complete two questionnaires, one regarding quality of life and the other about lumbar disability. Improvement in the quality of life was observed in nine out of ten domains. There was also an improvement in lumbar disability. These results suggest that a program with therapeutic exercises can be effective in controlling urinary incontinence and improve the quality of life and lumbar disability in woman with SUI., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: to assess the prevalence of common mental disorder (CMD) and to identify potential associated factors among medical, dental and nursing students., Methods: a cross-sectional study conducted in a public university in Northeast Brazil with 172 undergraduate students of the last three semesters of the medicine, dentistry and nursing courses, in February 2010, using the Self Reporting Questionnaire (SRQ-20) and a structured questionnaire developed by the authors. Logistic regression was performed for data analysis., Results: the prevalence of CMD was 33.7%. The courses presented no differences in CMD prevalence. The logistic regression analysis showed a strong association of the following variables with CMD: female (OR=4.34), lack of good expectations regarding the future (OR=5.83), course as not a source of pleasure (OR=7.52) and feeling emotionally tense (OR=11.23)., Conclusion: the high prevalence suggests that immediate preventive measures should be implemented, such as the setting up of psycho-pedagogic support services for students, and teacher development programs.

Introduction: The priority of Pilates is to obtain physical and mental health, including flexibility, in a secure and balanced way., Aim: To verify the change in the quality of life of practitioners of the Pilates method., Methodology: Descriptive observational study of 74 Pilates practitioners divided into 3 groups: practitioner for up to three months; practitioner for more than 1 year; and ex-practitioners. The quality of life analysis was performed using the self-administered questionnaire, SF-36. The comparison between groups was made by ANOVA one-way, then an analysis by post-hoc Scheffé, with a significance level of p < 0.05., Result: The group of experienced practitioners showed better results in the dimensions of physical function (mean 86.37 points; p < 0.01), general health (mean 29.48 points; p < 0.001) and mental health (mean 43.59 points; p < 0.02) of quality of life., Conclusion: Pilates was associated with the improvement of quality of life., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Purpose: We analysed the cognitive influence on walking in multiple sclerosis (MS) patients, in the absence of clinical disability., Method: A case-control study was conducted with 12 MS patients with no disability and 12 matched healthy controls. Subjects were referred for completion a timed walk test of 10 m and a 3D-kinematic analysis. Participants were instructed to walk at a comfortable speed in a dual-task (arithmetic task) condition, and motor planning was measured by mental chronometry., Results: Scores of walking speed and cadence showed no statistically significant differences between the groups in the three conditions. The dual-task condition showed an increase in the double support duration in both groups. Motor imagery analysis showed statistically significant differences between real and imagined walking in patients., Conclusion: MS patients with no disability did not show any influence of divided attention on walking execution. However, motor planning was overestimated as compared with real walking.

Purpose: Motor deficits in lower extremities and gait abnormalities are a major feature of the multiple sclerosis (MS) patients. Patients with minimal clinical disability have subtle gait changes. The aim of this study was to analyze the gait characteristics of MS patients in the absence of clinical disability., Method: A case-control study was carried out with 12 MS patients and 12 matched healthy controls. The subjects underwent a clinical neurological evaluation to determine their disability level (EDSS ≤ 1.5). Then, the subjects were referred for completion self-report questionnaires (gait, perceived balance confidence, physical activity and fatigue), gait clinical trials, and 3D kinematic analysis., Results: MS patients showed more impairment of perceived fatigue, perceived of walking impact and perceived balance confidence, despite having no disability. Gait characteristics showed no differences when they were determined by clinical observation. The 3D kinematic analysis of gait showed slight but significant changes in ankle movement., Conclusion: MS patients with no clinical disability have discrete changes in gait that can be evidenced by perceived impact on walking and kinematic evaluation, mainly of ankle movement. Moreover, there is a decrease in perceived balance confidence and an increase in perceived fatigue, which are correlated despite having different origins.

Background: The concepts of quality management have increasingly been introduced into the health sector. Methods to measure satisfaction and quality are examples of this trend., Objective: This study aimed to identify the level of customer satisfaction in a physical therapy department involved in the public area and to analyze the key variables that impact the usersâ€(tm) perceived quality., Method: A cross-sectional observational study was conducted, and 95 patients from the physical therapy department of the Hospital Universitário Gaffrée e Guinle - Universidade Federal do Estado do Rio de Janeiro (HUGG/UNIRIO) - Rio de Janeiro, Brazil, were evaluated by the SERVQUAL questionnaire. A brief questionnaire to identify the sociocultural profile of the patients was also performed., Results: Patients from this health service presented a satisfied status with the treatment, and the population final average value in the questionnaire was 0.057 (a positive value indicates satisfaction). There was an influence of the educational level on the satisfaction status (χ²=17,149; p=0.002). A correlation was found between satisfaction and the dimensions of tangibility (rho=0.56, p=0.05) and empathy (rho=0.46, p=0.01) for the Unsatisfied group. Among the Satisfied group, the dimension that was correlated with the final value of the SERVQUAL was responsiveness (rho=0.44, p=0.01)., Conclusions: The final values of the GGUH physical therapy department showed that patients can be satisfied even in a public health service. Satisfaction measures must have a multidimensional approach, and we found that people with more years of study showed lower values of satisfaction.

Purpose: The aim of this study was to validate the Chronic Liver Disease Questionnaire (CLDQ) for use in Brazilian population., Method: A total of 200 patients with chronic liver disease and varying disease severity answered a socio-demographic questionnaire, t CLDQ, and the Medical Outcome Study Short Form 36 (SF-36). Patients returned in 1-15 days to answer CLDQ again. The Cronbach's alpha of the total CLDQ score was 0.95 and fluctuated between 0.69 and 0.83 in its six domains., Results: The intra-class correlation between total CLDQ scores in two evaluations was 0.97 and in all domains was >0.93. CLDQ was moderately correlated with the SF-36, 0.63 (total CLDQ vs. vitality, SF-36), 0.62 (CLDQ and mental health, SF-36), 0.62 (preoccupation, CLDQ, vs. General Health, SF-36), 0.59 (fatigue, CLDQ, vs. vitality, SF-36), 0.59 (activity, CLDQ, vs. vitality, SF-36), and 0.59 (fatigue, CLDQ, vs. mental health, SF-36). The highest scores were found in non-cirrhotic group. Child A patients had higher average scores than Child B and C groups in all domains, while patients with MELD <15 scored higher than patients with MELD ≥15., Conclusion: CLDQ-BR was validated in Brazilian population and was appropriate for use in patients with liver disease of different etiologies and degrees of severity.

Objective. The purpose of this study was to analyze factors related to lower walking speed in persons with multiple sclerosis (PwMS). Methods. A cross-sectional survey was conducted. The study participants were 120 consecutive PwMS, who were able to walk, even with device assistance. Demographic and clinical data were collected. Walking speed was measured in 10 m walk test. Possible factors were assessed: disability, fatigue, visual functioning, balance confidence, physical activity level, walking impact, cognitive interference, and motor planning. A forward linear multiple regression analysis examined the correlation with lower speed. Results. Lower walking speed was observed in 85% of the patients. Fatigue (41%), recurrent falls (30%), and balance problems were also present, even with mild disability (average EDSS = 2.68). A good level of physical activity was noted in most of the subjects. Dual-task procedure revealed 11.58% of walking speed reduction. Many participants (69.57%) imagined greater walking speed than motor execution (mean ≥ 28.42%). Physical activity level was the only characteristic that demonstrated no significant difference between the groups (lower versus normal walking speed). Many mobility measures were correlated with walking speed; however, disability, balance confidence, and motor planning were the most significant. Conclusions. Disability, balance confidence, and motor planning were correlated with lower walking speed.

Inhibition of cyclooxygenase-2 (COX-2) is known to impair cancer cell metastatic behaviour, but the mechanisms involved largely remain elusive. We aimed to analyse whether the antimetastatic effect of COX-2 inhibition in breast cancer cells could be explained by variations in the expression levels of chemokine receptor CXCR4, vascular endothelium growth factor (VEGF) and UPA/UPAR components of the urokinase plasminogen activator system (uPAR). Breast cancer cell line MDA-MB-231 was exposed to COX-2-specific inhibitor NS398. Experimental data were assessed using Matrigel invasion tests, qRT-PCR, ELISA, flow cytometry and MTT test. Exposure to NS398 had no major effect on cell viability, apoptosis or VEGF production. Cell invasion was significantly decreased with reductions ranging from of 3.6% with 10 μM NS398 to 81.04% with 100 μM NS398. CXCR4 membrane expression was significantly reduced by 18% (P < 0.05) when cells were treated with 100 μM of NS398 for 72 h. UPA mRNA levels were significantly reduced to 78 and 63% after treatment with 10 μM NS398 for 48 and 72 h, respectively (P < 0.05). UPAR mRNA levels also decreased with mild NS398 concentrations, reaching the lowest level of 56% with 50 μM of NS398 for 48 h (P < 0.05). With NS398 higher concentrations, UPAR and UPA expression levels increased. According to our results, impairment of expression of CXCR4, UPA and UPAR differentially contribute to the antimetastatic effect of COX-2 inhibitors depending on drug concentration.

Poor walking performance is predictive of heart disease and osteoporosis and increases the risk of death in the elderly. Gait and vision have been identified as the most valuable physical functions according to multiple sclerosis patients' perceptions. The objective of this study was to perform a translation and cross-cultural adaptation of the Multiple Sclerosis Walking Scale (MSWS-12) into Brazilian Portuguese. A study of cross-cultural adaptation was conducted in ten steps. Participation in the study included four translators, two back-translators, twelve medical experts, twelve patients, twelve healthy subjects, and a Portuguese language expert. Only the question "Did standing make it more difficult to do things?" posed difficulty in the translation process. Maximum time for completion was less than three minutes (171 seconds). Internal consistency analyses showed high reliability (Cronbach's alpha = 0.94). The content validation and internal consistency stages were completed satisfactorily.

Objective: To estimate, among Medical School intern students, the prevalence of depressive symptoms and their severity, as well as associated factors., Methods: Cross-sectional study in May 2008, with a representative sample of medical intern students (n = 84) from Universidade Federal de Sergipe (UFS). Beck Depression Inventory (BDI) and a structured questionnaire containing information on sociodemographic variables, teaching-learning process, and personal aspects were used. The exploratory data analysis was performed by descriptive and inferential statistics. Finally, the analysis of multiple variables by logistic regression and the calculation of simple and adjusted ORs with their respective 95% confidence intervals were performed., Results: The general prevalence was 40.5%, with 1.2% (95% CI: 0.0-6.5) of severe depressive symptoms; 4.8% (95% CI: 1.3-11.7) of moderate depressive symptoms; and 34.5% (95% CI: 24.5-45.7) of mild depressive symptoms. The logistic regression revealed the variables with a major impact associated with the emergence of depressive symptoms: thoughts of dropping out (OR 6.24; p = 0.002); emotional stress (OR 7.43;p = 0.0004); and average academic performance (OR 4.74; p = 0.0001)., Conclusion: The high prevalence of depressive symptoms in the study population was associated with variables related to the teaching-learning process and personal aspects, suggesting immediate preemptive measures regarding Medical School graduation and student care are required.

The aim of this study was to evaluate the effect of culture media and stage of development in the osmotic ability of in vitro-fertilized bovine embryos and the expression of aquaporin 3 (Aqp3) and Na/K ATPase isoform 1 (ATPAse1) genes in embryos (i) with different ability to undergo rehydration and (ii) following vitrification. In experiment 1, in vitro fertilized presumptive zygotes were co-cultured in SOFaac or modified CR2aa medium and embryos at blastocyst and expanded blastocyst stages at day 7 post-insemination were exposed to NaCl hypertonic medium (900 mOsm) for 5 min following 120 min of culture in isotonic medium in order to evaluate dehydration and rehydration, respectively. No difference (P>0.05) on blastocyst rate was found between CR2aa and SOFaac medium but embryos co-cultured in SOFaac medium underwent greater (P<0.05) dehydration. Embryos at expanded blastocyst stage underwent greater dehydration but slower rehydration than embryos at blastocysts stage (P<0.05). In the experiment 2, the amount of Aqp3 and ATPase1 transcripts were quantified in blastocysts with high or low rehydration after exposure to hypertonic medium. No difference (P>0.05) on relative amount of transcripts was found in either genes. In the experiment 3, expanded blastocysts produced in a co-culture system were vitrified, warmed and then cultured for 72 h for analysis of embryo survival and amount of Aqp3 and ATPase1 transcripts. Lower (P<0.05) embryo survival rate was found for vitrified-warmed embryos (57.9%) than for their fresh counterparts (84.6%). There was no difference on expression of ATPase1 gene but lower (P<0.01) amount of Aqp3 transcripts was found in the vitrified-warmed embryos. In conclusion, embryo ability to undergo shrinkage and swelling is influenced by medium used in a co-culture system and by embryo stage. Rehydrating ability of embryos after exposure to NaCl hypertonic medium is not associated with variations on expression of Aqp3 and ATPase1 genes, but the vitrification can alter gene expression of in vitro-fertilized bovine embryos produced in a co-culture system., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: Doubts, competitiveness and preparation for the residency examination increase stress and insecurity at the end of medical course. Well-being is very important at this point, but it is known that medical students are reluctant to seek help, particularly for emotional problems. This study investigated the relationship among well-being, perceived needs and help-seeking in final-year students., Methods: Well-being was assessed using Beck's Inventories of Anxiety (BAI) and Depression (BDI) and the WHOQOL-brief (quality of life). A questionnaire was used to assess perceived needs and medical school support resources., Results: The students reported good quality of life (68%) but presented anxiety (27%), depression (20%) and impaired social functioning. Fifty-one percent of the students acknowledged academic needs and 25% psychological needs. Only a portion of the students with anxiety and depression or bad quality of life used the institutional support. Female gender, perceived psychological needs and anxiety symptoms were associated to the use of the Mental Health Service. Satisfaction with mentoring relationships and positive changes were associated to Mentoring attendance., Conclusion: There are different factors involved in help-seeking and identifying specificities in the use of institutional support resources can help to develop strategies to sensitize students about help-seeking during the medical course.

The purpose of this study was to determine the effect of functional limitations and fatigue on the quality of life (QoL) in people with multiple sclerosis (MS). A descriptive case series study at Lagoa Hospital - Rio de Janeiro, Brazil was carried. The main outcome measurements were demographic variables, QoL (SF-36 v.1), disability (EDSS), motor function of the upper limb (Box & Blocks test), Tone (Modified Ashworth Scale), gait (Hauser ambulatory index) and fatigue (Fatigue Severity Scale). Sixty one patients fulfilled the study criteria. The mean age of patients was 39 years and 74% of patients were female. The most of cases presented mild disability (EDSS<3.5). A decrease was found in all domains of QoL. It was found association between physical functioning and the variables of EDSS, fatigue, lower limb tone and gait. Gait, disability, hypertonia of the lower limbs and fatigue negatively affected QoL in people with MS.

Objective: To investigate the relationship between work and quality of life of doctors and nurses in pediatric intensive care units and neonatal., Methods: Cross-sectional study with 37 doctors and 20 nurses. The Job Content Questionnarie (JCQ) e Effort-Reward Imbalance (ERI), and World Health Organization Quality of Life (WHOQOL-100) were used. The correlation was estimated by Spearman correlation coefficient., Results: The effort is inversely correlated with the areas physical, psychological, level of independence, environment (p<0.01) and social relationship (p<0.05). The reward is inversely correlated with the areas and psychological (p<0.05) level of independence (p<0.01). Control over the work is directly correlated with the physical domain (p<0.05). The psychological demands are inversely correlated with the areas physical (p<0.05), psychological (p<0.01) and level of independence (p<0.01). The physical demand is inversely correlated with physical areas, level of independence, environmental (p<0.01) and psychological (p<0.05). Job insecurity is inversely correlated with the psychological fields, level of independence (p<0.05) and the environment (p<0.01). Support the supervisor is directly correlated with degree of independence (p <0.05)., Conclusion: Doctors and nurses showed high efforts, demands psychological, physical and job insecurity that impact on quality of life.

Objective: To estimate the seroprevalence of HIV, hepatitis B and C and syphilis and to describe risk behaviors associated to their transmission among recyclable waste collectors., Methods: A seroepidemiological survey was carried out in the city of Santos, Southeastern Brazil, in 2005. A total of 315 individuals were enrolled in the survey, of which 253 subjects underwent serological testing HIV, hepatitis B and C and syphilis. Statistical analysis consisted of univariate and bivariate analyses (cross-tabulation and odds ratio) and multivariate analysis (by logistic regression), relating HIV infection with established risk behaviors and seropositivity., Results: Overall seroprevalences were: HIV, 8.9%; hepatitis B, 34.4%; hepatitis C, 12.4%; and syphilis, 18.4%. Subjects were characterized by a predominance of males with low educational and economic levels, subjected to parenteral and sexual exposures to HIV and other sexually transmitted infections. Multivariate analysis results indicated that risk factors for both sexually and parenterally related exposure were significantly associated with HIV in this community., Conclusions: Seroprevalences found in the study were approximately 10 to 12 times higher than the national average. These communities are socially marginalized and generally not recognized by national programs as potentially endangered populations.

Objective: To compare the emotional aspects of children with and without constipation., Methodology: Some emotional aspects were studied in children with and without constipation. A nonstructured interview was performed with the mothers regarding the emotional aspects of their children. The children were asked to tell a story based on the observation of a board from the thematic children apperception test. This is a qualitative study using the technique of constant comparison., Results: In the interview with the mothers of constipated children., Conclusion: In the children with constipation a higher prevalence of some emotional aspects was observed.

Background: Gingival fibromatosis (GF) is characterized by fibrotic enlargement of the gingiva that can be inherited as an isolated trait (named hereditary gingival fibromatosis) or as a component of a syndrome. This article reports one kindred affected by a syndrome characterized by GF associated with dental abnormalities (DA) including generalized thin hypoplastic amelogenesis imperfecta (AI)., Methods: To characterize the pattern of inheritance and the clinical features, 70 family members were examined. Hematoxylin and eosin staining, immunohistochemistry, and scanning electronic microscopy (SEM) were performed to identify the alterations on gingiva, teeth, and dental follicles., Results: Examination of the family pedigree demonstrated multiple consanguineous first-cousin marriages and an autosomal recessive trait of inheritance. Four members demonstrated mild GF in association with DA, including generalized thin hypoplastic AI, intrapulpal calcifications, delay of tooth eruption, and pericoronal radiolucencies involving unerupted teeth. One of those four patients also had mental retardation (MR). MR as an isolated feature was observed in six members, whereas isolated GF was found in one individual. A combination of gingivectomy and gingivoplasty followed by regular dental procedures were performed in these patients. Histologic examination of the gingival enlargement revealed a dense connective tissue containing myofibroblasts, islands of odontogenic epithelium, and calcified psammomatous deposits, which resembled cementicle-like structures by SEM. Pericoronal lesions also showed calcified psammomatous deposits in association with islands of odontogenic epithelium. Enamel ultrastructure analysis revealed normal surface alternating with irregular and porous areas., Conclusion: To the best of our knowledge, these cases represent a new syndrome within the spectrum of those including GF.