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Background: This study addresses the rising burden of type 2 diabetes mellitus, and explores the potential of teleconsultation, as an alternative for diabetes management. The primary objective was to test the hypothesis that teleconsultation is non-inferior to face-to-face consultation in terms of glycaemic control measured as glycated haemoglobin (HbA1c) (non-inferiority margin for the upper confidence interval for the difference between groups of 0,5% in HbA1c) for type 2 diabetes mellitus patients referred from Primary Healthcare to Specialized Care within the SUS., Methods: TELECONSULTA, is a randomized, pragmatic, phase 2, single-centre, open-label, non-inferiority trial conducted in Joinville, Brazil. A total of 278 participants diagnosed with type 2 diabetes were randomized through mandatory teleconsulting services from primary care health units. The randomization was 1:1 to teleconsultation or face to face consultation. The study was registered at the Brazilian Clinical Trial Register-REBEC, under the code RBR-8gpgyd. Study status is "Completed"., Findings: This study included 278 participants in the intention-to-treat (ITT) analysis. The median age was 61 (54-68) years, 167 (60%) were women. The between-groups comparative average reduction in HbA1c was -0.6% (90% CI -1.0; -0.1) at 3-months and -0.5% (90% CI -0.9; 0.0) at 6-months in Modified Intention-to-Treat (mITT) population with imputed data, showing the non-inferiority of teleconsultation. Results with no missing data imputation and in the per protocol population were similar. The frequency of hypoglycaemia and other adverse events was well balanced between groups., Interpretation: The results underscore the transformative potential of telemedicine in addressing the complexities of diabetes management within the framework of a universal healthcare system, contributing with valuable insights for healthcare policymakers and practitioners seeking innovative solutions to tackle the growing diabetes epidemic., Funding: This study was funded by the Brazilian Ministry of Health, through the Unified Health System-Institutional Development Support Program (PROADI-SUS)., Competing Interests: The authors have none to declare., (© 2024 The Author(s).)

Departures from monogamy are socially discouraged and met with negative judgments, and being a target of stigmatization has consequences for the way individuals in consensual non-monogamous (CNM) relationships connect to others, including their partner(s). However, social support seems to be an important factor associated with increases in wellbeing and relationship quality. Aligned with this reasoning, results of a cross-sectional study showed that participants in CNM relationships who endorsed more internalized negativity reported less commitment to partner one (P1), less disclosure of their relationship agreement to others, as well as less acceptance and more secrecy toward P1 and partner two (P2). Results further showed that perceiving more social support was associated with more commitment to P1, less disclosure to people from the extended social circle, and more acceptance of the relationship with P1 and P2 among participants with higher internalized negativity. Perceiving more social support was also associated with more disclosure to people from the close social circle, as well as more acceptance and less secrecy toward the relationship with P1 and P2 among participants with lower internalized negativity. These results demonstrate that relationships embedded in social contexts of support can be a protective factor, even for individuals who report higher internalized negativity. Hence, for individuals in CNM relationships, fostering a positive and supportive social network seems to increase positive personal and relationship outcomes.

Reports worldwide have been showing increasing rates of sexually transmitted infections (STIs) and condomless sex in recent years. Research has identified several individual and situational variables that can determine the decision to use condoms or forgo their use. We argue that such a decision can also be shaped by motives related to pleasure and safety (i.e., regulatory focus in sexuality). Using open ended questions, we asked 742 Portuguese and Spanish adults to indicate situations and reasons that could inform the decision making process with casual partners and the functions/attributes related to condoms. Using thematic analyses, we coded the drivers of condomless sex and condom use into themes and subthemes, and computed their frequencies. Using quantitative measures, we also asked participants to indicate their condom use expectancies and perceived barriers. Comparing participants according to regulatory focus revealed some differences. Pleasure promotion participants were more likely to consider that condom use decision making is driven by unexpectedness, pleasure, and intimacy pursuit, attached more pleasure reduction functions to condoms, expected more negative outcomes in condom use, and endorsed more sensation and partner barriers in condom use. In contrast, disease prevention participants were more likely to consider that condom use decision making is driven by adequate sexual education, responsibility, and behavioral control, and attached more health protective functions to condoms. These differences can inform the development of tailored intervention and awareness campaigns aimed at helping people to use condoms more consistently with casual partners and to avoid behaviors that put them at risk of STI transmission.

People with prolonged grief disorder (PGD) are at risk of public stigma, but research has yet to examine whether stigma is shaped by different types of relationship losses. In an experimental study, we asked participants ( N  = 306) to read three scenarios in which targets lost their romantic partner, child, or companion animal. Targets with PGD ( vs. integrated grief) elicited more negative emotional reactions and attributions, and their experiences were perceived as less legitimate. Targets who lost their companion animal ( vs. other relationship losses) were perceived as the most sensitive and their grief as the least legitimate, but they also elicited the lowest prosocial and fear reactions and were perceived as the warmest. Lastly, targets with PGD who lost their companion animal ( vs. other relationship losses) elicited more negative emotional reactions and attributions, and their experiences were perceived as less legitimate. Implications and suggestions for future studies are discussed.

Monogamy is deeply rooted in most Western societies, shaping how people construe and behave in romantic relationships. These normative views facilitate the emergence of negative perceptions and evaluations when people choose not to adhere to mononormativity. Even though people in consensual non-monogamous (CNM) relationships are targets of stigmatization, research shows a dichotomy between these negative views and the relational experiences of CNM people. Indeed, people in CNM and monogamous relationships have comparable relationship functioning and quality and struggle with similar relationship problems. One of the differences is that CNM relationships afford people to explore their sexuality and fulfill their needs with multiple partners, without agreed-upon extradyadic behavior being perceived as infidelity or having deleterious consequences to relationship maintenance. These positive experiences notwithstanding, CNM people are continuously pressured by mononormativity and stigmatization, increasing the risk of internalized CNM negativity and worse personal and relational outcomes. One possible way to counteract CNM stigmatization and improve the lives of CNM people is by changing discourses surrounding non-monogamy and improving acceptance, not only in professional settings but also in the general population. Another strategy is to understand how the relationship beliefs and scripts of younger generations can help promote more inclusive and diverse societies., (© 2024. The Author(s).)

Interest in consensually non-monogamous (CNM) relationships has been increasing in the general population in recent years. However, given the cultural dominance of monogamy and the normative expectations often imposed through socialization (i.e., mononormativity), people in CNM relationships may experience negativity, which can become internalized and harm their individual and relationship health. The present study investigated if mononormativity beliefs and CNM relationship stigma were associated with more dehumanization and if internalized CNM negativity was an underlying mechanism for these associations. Results showed that participants who endorsed more mononormative beliefs and CNM relationship stigma also reported more internalized CNM negativity. In turn, participants who experienced more internalized CNM negativity attributed more negative (vs. positive) emotions to themselves and treated their partners as more immature, unrefined, exploitable, and emotionless. These results show that mononormativity and internalized negativity can shape the attitudes, perceptions, and behaviors of CNM individuals toward themselves and their partners., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Past research showed that high trait anxiety and low self-compassion, along with lack of perceived social support, have been associated with experiencing stronger grief symptoms. However, research is yet to understand if and how these factors interact among grieving individuals. Results of a cross-sectional study ( N = 539) showed that perceived social support interacted differently with trait anxiety and self-compassion to shape grief experiences. Unexpectedly, perceived social support did not buffer the association between higher trait anxiety and stronger grief symptoms. Instead, participants with higher trait anxiety reported stronger symptoms only when they perceived to have less social support. In contrast, participants with higher self-compassion reported less symptoms when they perceived to have more social support. These findings show that social support can emphasize the detrimental role of anxiety and the protective role of self-compassion when people are coping with a loss. Implications and suggestions for future research are discussed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Certain criteria for ventilator-associated events (VAE) definition might influence the type of an event, its detection rate and consequently the resource expenditure in intensive care unit. The Impact of Infections by Antimicrobial-Resistant Microorganisms - Ventilator-Associated Pneumonia (IMPACTO MR-PAV) aims to evaluate the incidence and diagnostic accuracy of ventilator-associated pneumonia (VAP) using the current criteria for VAP surveillance in Brazil versus the VAE criteria defined by the US National Healthcare Safety Network-Center for Diseases Control and Prevention (CDC) criteria., Methods and Analysis: The study will be conducted in around 15 centres across Brazil from October 2022 to December 2023. Trained healthcare professionals will collect data and compare the incidence of VAP using both the current criteria for VAP surveillance in Brazil and the VAE criteria defined by the CDC. The accuracy of the two criteria for identifying VAP will also be analysed. It will also characterise other events associated with mechanical ventilation (ventilator-associated condition, infection-related ventilator-associated complication) and adjudicate VAP reported to the Brazilian Health Regulatory Agency (ANVISA) using current epidemiological diagnostic criteria., Ethics and Dissemination: This study was approved by the Institutional Review Board under the number 52354721.0.1001.0070. The study's primary outcome measure will be the incidence of VAP using the two different surveillance criteria, and the secondary outcome measures will be the accuracy of the two criteria for identifying VAP and the adjudication of VAP reported to ANVISA. The results will contribute to the improvement of VAP surveillance in Brazil and may have implications for other countries that use similar criteria., Trial Registration Number: NCT05589727; Clinicaltrials.gov., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The introgression of M. enterolobii resistance-related genes in guava breeding programs can be compromised by incompatibility among Psidium species. This study aimed to evaluate the female parent preference and genetic diversity of Psidium interspecific hybrids using morphoagronomic traits and resistance to M. enterolobii. There were evaluated cross successes and germination from crosses between accesses of P. cattleyanum, P. guineense and P. guajava and the genetic diversity by Ward-MLM method of hybrids according to descriptors developed for the genus. Crosses were more successful when P. cattleyanum was the female parent. Germination was more successful in crosses involving P. cattleyanum and P. guajava. Four groups were formed. The group IV clustered the most resistant genotypes, composed by genotypes of P. cattleyanum x P. guineense, while the group II was the most susceptible. The groups I and III grouped some genotypes of P. cattleyanum x P. guajava with low levels of susceptibility. There are preferences of female parent species among crosses. Some individuals of groups I and III can be used as source of resistance genes for the breeding program, due the presence of favorable alleles inherited from guava parent. The high susceptibility leads to reduction in root development.

Objective: Regulatory Focus Theory suggests that goal pursuit is driven by two separate and fundamental motives. Being more focused on prevention motivates people to enact safer behaviors and avoid negative outcomes (e.g., to prevent diseases), whereas being more focused on promotion motivates people to take risks and pursue pleasurable experiences (e.g., condomless sex)., Methods: A quasi-experimental study ( N  = 476) examined if differences in regulatory focus (i.e., prevention vs. promotion) determined condom use intentions with a prospective casual partner, depending on condom availability delay and STI risk cues., Results: Participants focused on prevention ( vs. promotion) were less likely to consider having condomless sex across condom availability delays conditions. However, STI risk cues changed condom use intentions. When STI risk was lower, condom use intentions decreased as condom availability delays increased (particularly for participants focused on promotion). When STI risk was higher, condom use intentions were stronger and consistent across condom availability delays (particularly for participants focused on prevention)., Conclusions: These findings highlight the importance of distinct sexual motives when examining sexual health practices., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper., (© 2023 Taylor & Francis Group, LLC.)

The way people perceive risks and make decisions about their health is regulated by two motivational systems-prevention of harm or promotion of pleasure. People more focused on prevention strive to avoid negative outcomes and enact more health-protective behaviors. In contrast, people more focused on promotion strive to attain positive outcomes and take more risks with their health. Building upon recent evidence extending this framework to sexual behaviors and health, we conducted a pre-registered online survey ( OSF ) with Portuguese and Spanish adults (N = 742; M age  = 31.42, SD = 9.16) to examine whether self-reported STI knowledge and sexual health practices differ based on predominant regulatory focus. This study was part of the Prevent2Protect project ( OSF ). Results showed that prevention-focused participants had heard about more STIs and retrieved more of their knowledge from scientific sources but had been tested for fewer STIs in the past. In contrast, promotion-focused participants indicated they had specific knowledge about more STIs, retrieved more of their knowledge from medical and peer sources, and had been tested for more STIs in the past. They also reported more frequent STI testing, using free testing facilities or asking their family practice doctor to get tested, more routine sexual health check-ups, and more use of other contraceptive methods, such as birth control pills. These results remained unchanged after controlling for demographic differences. Overall, our findings showed that different motives in sexuality shape sexual health knowledge and sexual health practices., (© 2023. The Author(s).)

Research has shown mixed findings regarding the effect of the COVID-19 pandemic on relationship and sexual quality and activity. We argue that some of these findings might be understood considering people's predisposition to maintain safety (i.e., prevention focus) or take risks (i.e., promotion focus), and sharing concerns with one's partner about the pandemic. A longitudinal study ( N = 153) tested if regulatory focus before the pandemic (November 2019) was associated with relationship quality, sexual quality, and joint sexual activity later on (June 2020) and whether these effects were moderated by shared concerns over the pandemic. Results showed that participants more focused on prevention experienced higher relationship quality later on, but also less sexual quality and less frequent joint sexual activity, when they shared fewer (vs. more) concerns with their partner. In contrast, participants more focused on promotion experienced higher relationship quality later on when they shared more (vs. less) concerns with their partner. These results indicate how individuals' regulatory focus and shared concerns in times of crisis, such as the COVID-19 pandemic, can have downstream consequences on people's relational and sexual dynamics. We offer insights for mental health professionals to improve psychosocial health and well-being when people are faced with critical events.

Sociosexuality refers to an individual's disposition to have casual sex without establishing affective bonds and has been widely studied worldwide using the Revised Sociosexual Orientation Inventory (SOI-R; Penke & Asendorpf, 2008). Despite its many validations in different cultural contexts, no psychometric analyses of this instrument have been conducted in Spanish-speaking Latin American countries. To address this gap in the literature, we examined the psychometric properties of the SOI-R in Colombia. In a cross-sectional study with a large sample of participants (N = 812; 64% women), we conducted exploratory and confirmatory factor analyses to identify different factor structures and determine which had the best fit for our sample and examined the reliability of the scale. Results showed that a three-factor structure, with sociosexual behaviors, attitudes, and desire as first-order factors, and global sociosexuality as a second-order factor, had the best fit indexes. Each factor presented good reliability indexes. Replicating already established gender differences, we also found that men scored higher on each factor when compared to women. These findings show that the SOI-R is a reliable and valid instrument to assess sociosexuality in countries where sociosexuality research is underrepresented., (© 2022. The Author(s).)

Objective: Self-regulation can help individuals cope during stressful events, but little is known about why and when this might occur. We examined if being more focused on prevention was linked to negative affective experiences during the COVID-19 pandemic. We also examined possible underlying mechanisms for this association, and whether social support buffered it., Design: Pre-registered longitudinal study, with surveys every 2 weeks over one month ( N = 1269)., Main Outcome Measures: Regulatory focus and worry for health (T1), adherence to self-isolation and preventive health behaviours (T2), negative affective experiences, positive affect, frequency of online interactions, and perceived social support (T3)., Results: Prevention focus was associated with health worries at baseline and linked to greater adherence to preventive health behaviours (T2). Only adherence to self-isolation was linked to more negative affective experiences (T3). Exploratory analyses showed that prevention focus was linked to more negative affective experiences (T3), but only for participants with fewer online interactions with their family and less perceived social support from family and friends., Conclusions: Prevention motives in threatening times can be a double-edged sword, with benefits for health behaviours and consequences for negative affective experiences. Having a strong social network during these times can alleviate these consequences.

Studies have shown that romantic partners in consensual non-monogamous (CNM) relationships are targets of stigmatization. However, little is known about the underlying mechanisms and the conditions under which such stigmatization occurs. In two experimental studies (combined N = 772), we asked participants to read the description of two partners in a relationship (monogamous vs. open relationship vs. polyamorous) and make a series of judgments about those partners. Overall results showed that CNM (vs. monogamous) partners were perceived as less trustworthy and as having more sexual health concerns (Studies 1 and 2), and as being less committed and less sexually satisfied (Study 2). Results from a conditional mediation analysis (Study 2) further showed that participants with negative attitudes toward consensual non-monogamy perceived CNM (vs. monogamous) partners as having less conservation and more openness to change values, which was then associated with more stigmatization. In contrast, participants with positive attitudes toward consensual non-monogamy perceived CNM (vs. monogamous) partners as having more openness to change values, which was then associated with less stigmatization. Taken together, these results extended the literature focused on prejudice, discrimination, and stigmatization of minority groups and highlighted key elements that can be used to buffer stigmatization., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The COVID-19 pandemic has touched many aspects of people's lives around the world, including their romantic relationships. While media outlets have reported that the pandemic is difficult for couples, empirical evidence is needed to test these claims and understand why this may be. In two highly powered studies ( N = 3271) using repeated measure and longitudinal approaches, we found that people who experienced COVID-19 related challenges (i.e., lockdown, reduced face-to-face interactions, boredom, or worry) also reported greater self and partner phone use (Study 1) and time spent on social media (Study 2), and subsequently experienced more conflict and less satisfaction in their romantic relationship. The findings provide insight into the struggles people faced in their relationships during the pandemic and suggest that the increase in screen time - a rising phenomenon due to the migration of many parts of life online - may be a challenge for couples., (© The Author(s) 2022.)

Bovine tuberculosis (bTB) impacts considerably animal production and one health worldwide. To describe the prevalence, risk factors, and spatial pattern of the disease in the state of Paraná, Brazil, a cross-sectional study was conducted from September 2018 to February 2019. The area was divided into seven regions. Within each region, farms were randomly selected, and a predetermined number of cows was selected and tested by a comparative cervical tuberculin test. 17,210 animals were tested across 1757 farms. Herd prevalence of bTB-infected herds in Paraná was 2.5% [1.87-3.00%]. It has varied from 0.8 to 3.98% among seven regions, with clustering being detected in the west, central, and northeast areas. Animal prevalence was 0.35% [0.21-0.59%] and has varied from 0.08 to 0.6% among the pre-set regions. No major shifts in the prevalence of bTB were detected since 2007. Large-sized herds, dairy production, and feeding with whey were detected to be correlated with the presence of bTB. Exclusively among dairy herds, veterinary assistance from cooperatives, possession of self-owned equipment to cool milk, and feeding with whey were correlated with the disease. Considering these results, it is recommended that the state of Paraná seek to implement a surveillance system for the detection of bTB-infected herds transforming them into free ones, if possible, incorporating elements of risk-based surveillance. Health education is also recommended to inform farmers about the risks of introducing animals without testing and of feeding raw whey to calves., (© 2022. The Author(s).)

People focussed on prevention (vs. promotion) are motivated by safety and are less inclined to take risks. We tested if having a prevention (vs. promotion) focus before the COVID-19 pandemic outbreak predicted threat perceptions and health outcomes throughout the pandemic. Participants (N = 161) took part in a longitudinal study. Measures were assessed before the pandemic was declared (on November 2019, T1) and after a global pandemic was declared (on June 2020, T2). Participants who were more focussed on prevention prior to the onset of the pandemic (at T1) perceived greater risk and were more worried about contracting COVID-19, and engaged in more preventive behaviours during the pandemic (at T2). They also reported less anxiety and felt healthier later on (at T2). Exploratory analyses revealed that enacting preventive behaviours helped people cope with pandemic-related anxiety. Being motivated by security and enacting preventive behaviours seems to have helped people reduce anxiety over risk even during the pandemic., (© 2022 John Wiley & Sons Ltd.)

Lifestyle changes caused by the COVID-19 pandemic had mostly negative consequences for individual, relationship, and sexual functioning. However, some individuals have reported increases in sexual desire and made new additions to their sex lives. Given that stress-provoking situations can sometimes make mortality more salient and heighten sexual desire, it is possible that lifestyle changes and fear of COVID-19 infection may have benefited some relationships. We conducted a cross-sectional study with 303 romantically involved adults (58.1% men) and found that lifestyle changes were associated with negative changes in one's sex life, unrelated to wanting to spend time with one's partner, and positively associated with relationship quality. Lifestyle changes were also positively associated with sexual desire, but only for participants with high (vs. low) fear of COVID-19 infection. For these participants, sexual desire was associated with positive changes in one's sex life and wanting to spend time with one's partner, but not with overall relationship quality. Results were consistent after controlling for pandemic-related anxiety and demographic variables. This study advances literature focused on the importance of romantic relationships in stress-provoking situations such as the COVID-19 pandemic by shedding light on the association between sexual desire and personal and relational well-being.

Asexuality is a complex construct with a considerable lack of research until recently. Building upon available findings, we examined the extent to which romantic orientation shapes individual and relationship experiences, and expectations of asexual individuals. Specifically, our research focused on the distinction between romantic asexual individuals, who experience romantic attraction, and aromantic asexual individuals, who do not experience romantic attraction. A cross-sectional study with members of different asexual online communities (N = 447, 55.02% women; M age  = 24.77 years, SD = 7.21) aimed at examining how both groups differ in their identification with the asexuality construct as measured by the Asexuality Identification Scale (Yule et al., 2017), individual perspectives on sexuality, sexual behavior and relationships, concerns about commitment and sexual performance in a relationship, and attachment style. Results showed that aromantic asexual individuals identified more with asexuality, reported a more avoidant attachment style, and were more concerned with relationship commitment. In contrast, romantic asexual individuals reported less sex aversion, more sexual experiences (both past and current), and more sexual partners in the past. These individuals also engaged in romantic relationships more frequently in the past, had a stronger desire to engage in a romantic relationship in future (either with or without sexual intimacy), and were more concerned with sexual performance. Overall, our findings contribute to the literature by highlighting the need to consider romantic orientation when examining asexuality and its interpersonal outcomes., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

We examined if motives for security (i.e., prevention focus) or pleasure (i.e., promotion focus) were uniquely associated with intentions to get tested for STIs and behavioral control over condom use, over and above variables already identified in theoretical models. We conducted an online survey with Portuguese adults ( N = 836; M age  = 22.27, SD  = 5.14). Overall, 99.4% of the participants knew at least one of eight STIs, but only 25.2% got tested in the last six months. Participants more focused on prevention had condomless sex less frequently, whereas participants more focused on promotion knew more STIs and got tested for more STIs. Furthermore, participants had stronger intentions to get tested for STIs if they got tested for more STIs in the past, were more concerned about STIs, perceived greater susceptibility to STI acquisition, and were more focused on promotion (but not prevention). Participants had greater behavioral control over condom use if they had condomless sex less often and were more focused on prevention (but not promotion). These findings suggest that promotion-focused people are more likely to consider the consequences of having condomless sex. In contrast, prevention-focused people are more likely to take control of their sexual health.

Computer-mediated communication allows people to communicate across several contexts (e.g., friends, professional settings) by using video-based or text-based channels. In the latter case, communication lacks nonverbal cues (e.g., tone of voice) that are critical to message interpretation. Including emoji can help express emotion and reinforce or clarify the meaning of a message. However, the benefits of using emoji are likely to depend on the context (e.g., the relationship between interlocutors) and the messages' features (e.g., the valence of the message). To date, studies have not systematically and empirically examined how the use of emoji is perceived across different communication scenarios. In the current study, we asked 175 participants (49.5 percent women; M age  = 36.32, SD  = 12.22) to imagine receiving either a negative or a positive message from 22 senders (e.g., friend; bank manager) and to indicate, for each case, how much they would like to receive an emoji and how useful and appropriate they considered the use of emoji. These ratings were combined into a single index of emoji use adequacy. Based on factor analysis, the 22 scenarios were aggregated in distant and close scenarios. Overall, results showed that participants considered emoji use more inadequate in distant (vs. close) scenarios and for negative (vs. positive) messages. These findings suggest that the perceived benefits of emoji use for text-based communication may not be generalized to all text-based communication contexts, such that relationship proximity and message valence should not be overlooked. Implications for the fields of consumer psychology and communication are discussed.

Excessive sugar intake represents an increased risk of developing non-communicable diseases (e.g., obesity, cardiometabolic diseases, and dental diseases). Still, it is unclear whether people are aware of these adverse health outcomes. The current study systematically examined the extent to which people associate health conditions with excessive sugar intake. Participants ( N = 1010 Portuguese volunteers) freely reported all health conditions they associated with excessive sugar consumption and rated the strength of these associations for eight specific health conditions. All participants reported health conditions associated with excessive sugar intake, with the most frequent being risk factors for cardiometabolic diseases (e.g., diabetes), cardiovascular diseases, oral problems, oncological and mental health conditions. Moreover, participants considered diabetes, overweight/obesity, and oral problems as being the conditions most related to excessive sugar intake. Women, participants with children in the household, and experts in health/nutrition rated excessive sugar intake as being more strongly linked to some of the health conditions. The identification of the health conditions that people associate with excessive sugar consumption may inform policymakers, educators, and health professionals and support interventions targeting the general public or specific groups (e.g., overweight people) in raising awareness of potential adverse health outcomes and, ultimately, contribute to reducing sugar intake.

Seroprevalence and risk factors of bovine brucellosis (Brucella abortus) in herds and cattle were estimated by a cross-sectional study in the state of Paraná, Brazil. The state was divided into seven regions and a random, two-stage sampling was performed on properties and cattle from each region between 2018 and 2019. Serum samples were collected from 11,592 cows over 24 months from 1,757 properties and a questionnaire was applied to identify potential risk factors. As recommended by the National Program for the Control and Eradication of Animal Brucellosis and Tuberculosis (PNCEBT), serological testing for the detection of anti-Brucella antibodies included the buffered plate agglutination test (screening test) and the fluorescence polarization assay (confirmatory test). The seroprevalence of bovine brucellosis on properties and in cattle was 4.87% (95% confidence interval [CI]: 3.98-5.93%) and 2.24% (95% CI: 1.47-3.41%), respectively. Multiple logistic regression analysis identified larger herd size and failure to test for brucellosis as risk factors for the presence of anti-B. abortus antibodies. These results demonstrate no change in the prevalence when comparing initial studies conducted in 2002. Given our findings, it is recommended that policies for brucellosis control include a widespread vaccination program for higher prevalence areas and eradication approach to lower prevalence areas. All steps related to correct immunization of the herds should be verified and improved by training and education. Health education action must be carried out informing farmers about the risks of introducing animals not tested for brucellosis into their herds and the benefits of testing their herds regularly., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

The Amazon biome is under severe threat due to increasing deforestation rates and loss of biodiversity and ecosystem services while sustaining a high burden of neglected tropical diseases. Approximately two thirds of this biome are located within Brazilian territory. There, socio-economic and environmental landscape transformations are linked to the regional agrarian economy dynamics, which has developed into six techno-productive trajectories (TTs). These TTs are the product of the historical interaction between Peasant and Farmer and Rancher practices, technologies and rationalities. This article investigates the distribution of the dominant Brazilian Amazon TTs and their association with environmental degradation and vulnerability to neglected tropical diseases. The goal is to provide a framework for the joint debate of the local economic, environmental and health dimensions. We calculated the dominant TT for each municipality in 2017. Peasant trajectories (TT1, TT2, and TT3) are dominant in ca. fifty percent of the Amazon territory, mostly concentrated in areas covered by continuous forest where malaria is an important morbidity and mortality cause. Cattle raising trajectories are associated with higher deforestation rates. Meanwhile, Farmer and Rancher economies are becoming dominant trajectories, comprising large scale cattle and grain production. These trajectories are associated with rapid biodiversity loss and a high prevalence of neglected tropical diseases, such as leishmaniasis, Aedes -borne diseases and Chagas disease. Overall, these results defy simplistic views that the dominant development trajectory for the Amazon will optimize economic, health and environmental indicators. This approach lays the groundwork for a more integrated narrative consistent with the economic history of the Brazilian Amazon., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Codeço, Dal'Asta, Rorato, Lana, Neves, Andreazzi, Barbosa, Escada, Fernandes, Rodrigues, Reis, Silva-Nunes, Gontijo, Coelho and Monteiro.)

We built upon a recent study by Rodrigues, Fasoli, Huic, and Lopes (2018) by investigating potential mechanisms driving the dehumanization of consensual non-monogamous (CNM) partners. Using a between-subjects experimental design, we asked 202 Portuguese individuals (158 women; M age  = 29.17, SD = 9.97) to read the description of two partners in a monogamous, open, or polyamorous relationship, and to make a series of judgments about both partners. Results showed the expected dehumanization effect, such that both groups of CNM partners (open and polyamorous) were attributed more primary (vs. secondary) emotions, whereas the reverse was true for monogamous partners. Moreover, results showed that the dehumanization effect was driven by the perception of CNM partners as less moral and less committed to their relationship. However, these findings were observed only for individuals with unfavorable (vs. favorable) attitudes toward CNM relationship. Overall, this study replicated the original findings and extended our understanding of why people in CNM relationships are stigmatized.

More frequent internet pornography use is often associated with decreased sexual satisfaction. However, individuals who use internet pornography more often can experience better relationship outcomes, depending on how they use it in the context of their relationship. Indeed, internet pornography use with the partner seems to be positively associated with sexual satisfaction. We explored whether the type of agreement partners have about monogamy is related to this association. We conducted a cross-sectional study (N = 866; 66.3% women, M age  = 27.40, SD = 8.58) with individuals in monogamous (n = 552), non-consensual non-monogamous (NCNM; n = 210) and consensually non-monogamous (CNM; n = 104) relationships. Results showed that CNM individuals used internet pornography substantially more than the other two groups, but they were as sexually satisfied with themselves and with their primary partner as monogamous individuals. NCNM individuals were the least sexually satisfied and reported more sexual arousal difficulties than the other groups. Results further showed that CNM individuals included their primary partner in their internet pornography use more frequently than the other groups, and this inclusion was positively associated with sexual satisfaction with the primary partner. The frequency of internet pornography use with the partner was negatively associated with sexual arousal difficulties for monogamous individuals and positively associated with personal and relational sexual satisfaction in both monogamous and NCNM individuals. These results complement past findings by shedding light on the role of internet pornography use for different relationship agreements, and its association with personal and relational experiences.

Excessive sugar intake has been associated with multiple health conditions (e.g., higher risk for non-communicable diseases). Hence, health organizations have issued guidelines defining the maximum daily intake of free or added sugars. However, data from several countries suggests that these guidelines are rarely met, particularly by young adults. For example, almost half of Portuguese adolescents and young adults exceed the recommended sugar intake. In this work, we aim to further explore college students' attitudes, knowledge, and perceptions about sugar intake, as well as about sugar intake guidelines. A thematic analysis on data from five focus groups (N = 40) indicated that participants reported difficulty in the comprehension of added/free sugars definition and sugar intake recommendations. Overall, attitudes toward sugar were ambivalent. Sugar was simultaneously perceived as pleasurable and needed, but also as addictive and harmful. Although aware of the potential negative health outcomes associated with excessive sugar intake, most participants did not perceive being at risk due to their youth, exercise habits, or type of diet. The few concerns expressed were mostly associated with the negative impact of high sugar intake on body image (e.g., weight gain). The main barriers to reducing sugar intake identified were environmental (e.g., time restrictions, food available at the university). Still, participants could identify several individual strategies to effectively regulate sugar intake. By identifying knowledge gaps and sources of bias related to sugar consumption, our findings are useful to inform future interventions aiming to address the problem of high sugar intake among university students., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

In this work, we examined knowledge about sugars and guidelines for its consumption and explored the relationship between knowledge and measures related to nutritional information processing as well as sugar consumption. Specifically, we asked participants ( n = 1010 Portuguese) to categorize a set of ingredients (e.g., glucose, aspartame) regarding their composition (i.e., intrinsic vs. added/free sugars) and origin (e.g., natural vs. artificial) and if they were aware of the WHO guidelines for sugar intake. Overall, despite using information about sugar frequently and considering attending to such information as very important to stay healthy, most participants were unaware of the WHO guidelines and revealed difficulties in the categorization task. Women, participants with a higher level of education, and those with children in the household reported higher use of sugar content information present in nutritional labels, higher perceived knowledge of nutritional guidelines, and higher hit rates in categorizing sugar sources. Almost one-fourth of the population exceeds the daily limit recommended by the WHO. Therefore, characterizing the knowledge of a Portuguese sample regarding sugar sources and sugar intake guidelines is particularly relevant, and our results emphasize the need to implement effective strategies to reduce sugar intake.

Objective: Governments worldwide have been implementing interventions aimed at improving citizens' dietary habits. Examining how individuals perceive these interventions is relevant for promoting future policies in this area, as well as informing the way they are designed and implemented. In the current study, we focused on interventions aimed at reducing sugar intake in Portugal, given the current high sugar consumption patterns in the population., Design: Online survey to assess which interventions are the most salient and receive greater public support., Setting: Portugal., Participants: 1010 (76·7 % female, MAge 36·33, sd 13·22)., Results: Data from a free-recall task showed that only about one-third of participants reported knowing about these interventions, namely those related to taxation, weight restrictions in individual sugar packets and limited availability of products with high sugar content. We also found evidence of high support for the eight interventions presented (except for replacing sugar by artificial sweeteners), positive attitudes towards the need of reducing sugar intake in the Portuguese population and high agreement with the importance of reducing sugar intake across all age groups, particularly among children. Participants also indicated paying attention to the amount of sugar in their diets and a low self-reported frequency of consumption of high sugary foods and beverages. A hierarchical regression analysis suggested that these variables were significantly associated with the overall acceptance of interventions, independently of social-demographic variables (i.e., age, education and sex)., Conclusion: By examining how people perceive and accept different interventions targeting the reduction of sugar intake, the current work aims to support policymaking in this domain.

There are no guava cultivars resistant to the Meloidogyne enterolobii; for this reason, genetic breeding has been performed by introgressing genes into the current cultivars through interspecific hybridization. We used 33 microsatellite markers for the genetic-molecular characterization of segregating populations of Psidium resistant to M. enterolobii, aiming at selection within and between populations for generation advancement in the guava breeding program. The average number of alleles per locus ranged from 1.60 to 2.09. Populations 1 (P. guineense × P. cattleyanum) and 5 (P. guajava × P. cattleyanum) obtained the greatest genetic diversity, which can be confirmed by the higher observed-heterozygosity values (0.422 and 0.312, respectively). Bayesian analysis showed that the populations were subdivided into three groups, agreeing with the number of groups observed by Nei's genetic distance. The population obtained from the P. guineense × P. cattleyanum cross differed from the others with a clear structuring, whereas the P. guajava × P. cattleyanum and P. cattleyanum × P. guineense populations were the most similar between each other. The SSR markers were efficient in discriminating the populations, and individual 80 may be employed in future crosses with guava, allowing generation advancement in the guava breeding program aimed at resistance to M. enterolobii.

Introduction: Several theoretical models and intervention programs overlook the importance of individual motivations for the decision to have condomless sex. For instance, people focused on promotion (ie, eager to pursue pleasure) report less intentions to use condoms, because they perceive a lower risk of acquiring sexually transmitted infections., Aim: We aimed at understanding to what extent individual motivations are predictive of condomless sex behavior among single individuals., Methods: A sample of 415 Portuguese individuals (254 women) with ages ranging from 18-46 years (M = 23.30; SD = 5.28) were recruited to a cross-sectional study. All participants were neither dating nor in a romantic relationship at the time of the study. The link to an anonymous web survey was shared in social networking platforms., Main Outcome Measure: The survey included self-reported demographic variables (eg, age and sex), recent condomless sex behavior, and previously validated measures assessing regulatory focus in sexuality, ability in sexual restraint, perceived control over condom use, perceived safety with sex partners, and salience of the condom use norm., Results: More than two-thirds of the sample had recently engaged in condomless sex. A logistic regression showed that condomless sex was more likely for participants predominantly focused on promotion in sexuality. It was also more likely among less educated participants, those with a lower ability to restrain their sexual behavior, those who perceive to have less control over condom use, those for whom the condom use norm was less salient, and those who perceived to be safer with their sex partners. No other results were significant., Clinical Implications: Our results can be informative to sexual health care professionals when planning strategies to increase condom use awareness, by considering the role of specific individual motivations., Strengths & Limitations: This is the first study showing that individual motivations uniquely contribute to the decision to have condomless sex. This study has 2 main limitations that constraint the generalizability of the findings: (a) cross-sectional data prevents us from establishing causality, and (b) individual data does not account for dyadic processes in sexuality (eg, condom use negotiation)., Conclusion: Our findings showed that condomless sex results from an individual focus on seeking pleasure, a lack of control in sexual behavior, and a perception of sex partners as more trustworthy. Overall, these findings are likely to help researchers and health care professionals improving theoretical models predicting condom use and preventing the spread of sexually transmitted infections. Rodrigues DL, Lopes D, Pereira M, et al. Predictors of Condomless Sex and Sexual Health Behaviors in a Sample of Portuguese Single Adults. J Sex Med 2020;17:26-36., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Understanding pet relinquishment is essential to inform interventions and assess their impact. In a cross-sectional study, we explored how attitudes of lack of obligation and pragmatism toward pet relinquishment correlated with, and differed according to, sociodemographic characteristics (age, gender, education, political orientation, religion, income, and household), previous animal experience, and owner perceptions of animals (perceiving pet as a burden, motives for pet relinquishment, regret having a pet, and general trust in pets). We adapted and developed three scales to measure attitudes toward pet relinquishment (ATPR), motives for pet relinquishment (MPR), and general trust in pets (GTP), revealing good psychometric qualities. Hierarchical linear regressions showed that attitudes of lack of obligation toward pet relinquishment were stronger in older people, those perceiving their pet as a burden, and those with lower general trust in pets. Attitudes of pragmatism toward pet relinquishment were stronger in men, those who were main pet caretakers, those perceiving their pet as a burden, those with higher motives for pet relinquishment, and those with lower general trust in pets. Furthermore, results showed that past pet relinquishment behavior was predicted by attitudes of pragmatism, but not attitudes of lack of obligation., Competing Interests: The authors declare no conflict of interest.

Objective: Consistent condom use is still not ideal. Research showed that perceived sexual self-control is associated with greater likelihood of using condoms. However, this association seems to vary according to age and relationship agreement (i.e. non-consensual non-monogamy, NCNM vs. consensual non-monogamy, CNM)., Design: Cross-sectional study with 307 heterosexual users of a dating web site for romantically involved individuals (81.8% men; M age = 42.24, SD  = 9.65, range: 23-76 years). All individuals were in a romantic relationship ( M length = 13.47 years, SD  = 9.39)., Measures: Demographic information, perceived sexual self-control, condom use frequency (casual sex partners; primary partner in the last 3 months) and relationship agreement., Results: Independently of relationship agreement, perceived sexual self-control was positively associated with condom use frequency with casual sex partners among younger and middle age participants, but not older ones (>49 years). Regarding the primary partner, a similar pattern emerged for CNM participants. In contrast, no significant association between perceived sexual self-control and condom use frequency with the primary partner emerged for NCNM individuals, regardless of age., Conclusion: Our findings can inform evidence-based strategies to promote consistent condom use as an effective behaviour to prevent sexually transmitted infections, especially among older and NCNM individuals.

: In addition to positional vertigo, it is quite common for patients with benign paroxysmal positional vertigo (BPPV) to present complaints associated with balance problems and a feeling of dizziness even after repositioning maneuvers., Objective: It was to evaluate the additional effects of vestibular rehabilitation exercises as a therapeutic resource in the treatment of BPPV, to improve symptoms and reduce recurrence., Study Design: This was an experimental, prospective, randomized, controlled study., Setting: Instituto Brasiliense de Otorrinolaringologia (IBORL) from August 2016 to September 2017., Patients: Thirty-two individuals, both men and women, over 18 years of age with BPPV., Intervention: They were randomly assigned to two groups: the control group (n = 15) performing only the maneuver technique as treatment and the experimental group (n = 17) performing the maneuvers and vestibular rehabilitation exercises. Patients underwent treatment and responded to the dizziness handicap inventory (DHI) and visual analog scale (VAS) questionnaires for comparison between groups. Participants were followed up for 6 months to observe recurrence of symptoms., Main Outcome Measures: To investigate the additional effects of vestibular exercises in the treatment of BPPV., Results: The experimental group had a lower level of dizziness in the posttreatment period (p < 0.05) and a lower incidence of recurrences (p = 0.038) than the control group., Conclusions: Vestibular exercises performed after repositioning treatments for BPPV increased the overall efficacy of treatment by improving symptoms with a lower rate of recurrence.

Research has typically shown that unrestricted sociosexuality is negatively associated with relationship quality and that relationship quality is positively associated with quality of life (QoL). However, these findings may be restricted to individuals in monogamous relationships, especially those with prior extradyadic interactions (i.e., non-consensual non-monogamous; NCNM). Indeed, individuals in consensual non-monogamous (CNM) relationships have more unrestricted sociosexuality and are also more satisfied with and committed to their relationships. Still, little research has examined whether both relationship agreements are associated differently with attraction forces (wanting to be) and constraining forces (having to be) in the relationship and how they are related to QoL. We conducted a cross-sectional study with 373 heterosexuals (73.2% men, M age  = 41.15, SD = 10.18) registered on Second Love, a dating Web site for romantically involved individuals. Results showed differences in the hypothesized model, according to relationship agreement. For individuals in CNM relationships, unrestricted sociosexuality was associated with stronger attraction forces, which were then associated with greater QoL. The opposite pattern was found for those in NCNM relationships. Furthermore, and regardless of relationship agreement, unrestricted sociosexuality was associated with weaker constraining forces, which were associated with greater QoL. These results make a novel contribution to the literature on relationship agreements and how they relate to QoL.

Despite recurrent efforts to prevent sexually transmitted diseases through the use of condoms, HIV infections are still prevalent across Europe. Recent research framed by the regulatory focus theory has shown that prevention (vs. promotion)-focused individuals are more likely to adopt strategies to protect their health. Therefore, these individuals should also be more motivated to use condoms, because they are more likely to perceive greater health threats. In two cross-sectional preregistered studies (combined N = 520 Portuguese participants; databases available at https://doi.org/10.17605/osf.io/zzkc2 ), we developed the new Regulatory Focus in Sexuality scale (Study 1), and tested if the association between prevention focus and intentions to use condoms was mediated by the perception of health threat (Study 2). Results from Study 1 suggested that the scale is reliable and valid. Results from Study 2 showed, as expected, that a predominant focus on prevention was associated with more condom use intentions with casual and regular sexual partners, because individuals perceived greater threat to their health. Additional exploratory analyses further showed that this mediation occurred only for individuals without a romantic relationship and was independent of how salient the condom use norm was. In contrast, for romantically involved individuals, there was no evidence for the mediation by perceived health threat. Instead, a predominant focus on prevention was positively associated with condom use intentions with the regular partner, but only when the condom use norm was more salient. Taken together, these results emphasize the importance of examining individual motivations for safe sex practices.

High specific surface area activated carbon prepared from endocarp of Jerivá (Syagrus romanzoffiana) (ACJ) was used for ciprofloxacin (CIP) antibiotic removal from aqueous effluents. The activated carbon (AC) was characterized via scanning electron microscope, Fourier transform infrared spectroscopy, N 2 adsorption/desorption, and pH value at the zero-charge point. Avrami kinetic model was the one that best fit the experimental results in comparison to the pseudo-first-order and pseudo-second-order kinetic models. The equilibrium data obeyed the Liu isotherm equation, showing a maximum adsorption capacity of 335.8 mg g -1 at 40 °C. The calculated thermodynamic parameters indicate that the adsorption of CIP was spontaneous and endothermic at all studied temperatures. Also, the free enthalpy changes (∆H° = 3.34 kJ mol -1 ) suggested physical adsorption between CIP and ACJ. Simulated effluents were utilized to check the potential of the ACJ for wastewater purification. The highly efficient features enable the activated carbon prepared from endocarp of Jerivá, an attractive carbon adsorbent, to remove ciprofloxacin from wastewaters.

Access to validated stimuli depicting children's facial expressions is useful for different research domains (e.g., developmental, cognitive or social psychology). Yet, such databases are scarce in comparison to others portraying adult models, and validation procedures are typically restricted to emotional recognition accuracy. This work presents subjective ratings for a sub-set of 283 photographs selected from the Child Affective Facial Expression set (CAFE [1]). Extending beyond the original emotion recognition accuracy norms [2], our main goal was to validate this database across eight subjective dimensions related to the model (e.g., attractiveness, familiarity) or the specific facial expression (e.g., intensity, genuineness), using a sample from a different nationality (N = 450 Portuguese participants). We also assessed emotion recognition (forced-choice task with seven options: anger, disgust, fear, happiness, sadness, surprise and neutral). Overall results show that most photographs were rated as highly clear, genuine and intense facial expressions. The models were rated as both moderately familiar and likely to belong to the in-group, obtaining high attractiveness and arousal ratings. Results also showed that, similarly to the original study, the facial expressions were accurately recognized. Normative and raw data are available as supplementary material at https://osf.io/mjqfx/., Competing Interests: The authors have declared that no competing interests exist.

Introduction  Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, and it is characterized by episodes of vertigo roundabout when the head is moved. A systematic review was performed using the most important scientific databases. This review included studies published in English in the last ten years, performed in adults, with emphasis on the diagnosis and treatment of BPPV. Objective  To investigate the long-term effectiveness of vestibular rehabilitation (VR) in patients with BPPV and the rate of recurrence of symptoms. Data Synthesis  A total of 38 studies were identified, of which only 12 met the inclusion criteria. The majority of the studies stated that VR is effective in decreasing the symptoms, with a short-term efficacy of 84.7%, and 89.2% in the long term in the reviewed studies. Conclusion  Valuable studies show the beneficial effects of the maneuvers for the treatment of BPPV and their long-term effectiveness. This strengthens the conclusion that this treatment is effective in resolving symptoms and decreasing recurrences.

Methods:: Transcranial doppler was performed in accordance with the Stroke Prevention Trial in Sickle Cell Anemia Protocol., Results:: Of the 396 patients, 69.5% had homozygous SS hemoglobin. The TCD result was abnormal in 4.8%, conditional in 12.6%, inadequate in 4.3% and abnormally low in 1% of patients. The highest mean flow velocities were 121±23.83cm/s and 124±27.21cm/s in the left and right middle cerebral artery respectively. A total of 28.8% patients (mean age 9.19±5.92 years) were evaluated with TCD for the first time., Conclusions:: The SCD patients were evaluated with TCD at an older age, representing an important missed opportunity for stroke prevention. Since TCD screening in patients with SCD is important to detect those at high risk for stroke, it is recommended that this screening should be made more readily available.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by impairments in social functioning, language, communication, and behavior. Recent genome-wide association studies show some microdeletions on the 7q31-32 region, including the CADPS2 locus in autistic patients. This paper reports the case of a patient with ASD and recurrent psychotic syndrome, in which a deletion on the 7q31-32 band at the CADPS2 gene locus was evidenced, as well as a brief review of the literature on the CADPS2 gene and its association with ASD.

Morphological characterization is the most accessible and used method to quantify the genetic diversity of the available germplasm. The multivariate statistical method is highly important for this purpose. This study aimed to characterize parents and hybrids of Passiflora according to morphoagronomic descriptors and estimate the genetic divergence between them based on the joint analysis of qualitative and quantitative variables using the Ward-modified location model (MLM) procedure. One hundred and thirty-eight individuals were assessed (10 P. edulis, 10 P. setacea, and 118 interspecific hybrids) using 23 quantitative and 12 qualitative descriptors. The values for the quantitative descriptors were measured and subjected to multivariate statistics using the Ward-MLM strategy. Large genetic variability was detected by the morphoagronomic data in the 138 genotypes that were evaluated, and the hybrids presented higher variability than the parents. Pseudo-F and pseudo-t2 criteria showed that the optimal number of groups was three. Group I was composed of 118 hybrid genotypes; group II was composed of the 10 P. setacea genotypes, and group III was composed of the 10 P. edulis genotypes. The longest distance was found between groups II and III (474.96). The shortest distance was detected between groups I and II (198.78), which indicates that the segregating population is genetically closer to P. setacea than to P. edulis. The Ward-MLM procedure is a useful tool to detect genetic diversity and group accessions using both qualitative and quantitative variables.

This systematic review is aimed at analyzing the evidences about the use of papain in wound healing. A manual and electronic bibliographic research was performed in the following databases: LILACS, Cochrane, IBECS, MEDLINE via Pubmed and CINAHL, using the following terms as descriptors and as word: Carica, Papain and Wound Healing, from 1987 to 2010. The types of studies that predominated were descriptive, exploratory, case studies, case reports and only one randomized controlled clinical trial. The articles showed that papain can be used in wounds of many etiologies and in various healing stages without any specific contraindications, proving to be effective and safe; although there were reports of burning and pain. We conclude that this review contributes to the demonstration of how papain has been used in this period becoming a learning source, besides pointing to the need of further studies conducted with greater methodological rigor.

Neurosonological studies, specifically transcranial Doppler (TCD) and transcranial color-coded duplex (TCCD), have high level of specificity and sensitivity and they are used as complementary tests for the diagnosis of brain death (BD). A group of experts, from the Neurosonology Department of the Brazilian Academy of Neurology, created a task force to determine the criteria for the following aspects of diagnosing BD in Brazil: the reliability of TCD methodology; the reliability of TCCD methodology; neurosonology training and skills; the diagnosis of encephalic circulatory arrest; and exam documentation for BD. The results of this meeting are presented in the current paper.

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease that affects fertile-age women and of which treatment includes immunosuppressive agents that can affect the gonads., Objective: To evaluate the frequency of menstrual alterations in lupus patient treated with immunosuppressive agents (ISA)., Patients and Methods: A total of 87 patients, aged < 40 years, were studied. The patients were followed by outpatient management and the treatment used was verified. Only organic causes of menstrual alterations were excluded from the study. The menstrual alterations were correlated with the type and time of use of different ISA., Results: Age varied from 14 to 38 years, with a mean age of 28.01 ± 5.81 years; the mean age at menarche was 13.12 ± 1.77 years and the diagnosis of SLE was at 21.40 ± 5.75 years. Corticoids were used as single therapy by 63.2% of them, for a mean time of 6.11 ± 5.14 years and the use of other immunosuppressive agents occurred with a mean time of 5.60 ± 3.59 years. Menstrual alterations occurred in 37.9% and amenorrhea in 11.5%. There was an association between menstrual alterations with the use of ISA (P = 0.034)., Conclusion: The frequency of menstrual alterations was higher than that found in the general population, similar to what was observed in other publications on lupus treatment. The higher frequency of menstrual alterations in these patients was significantly associated with the use of ISA. The results justify caution when prescribing these medications,research indication and the use of techniques for ovarian preservation means.