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Background and objective: Most trans women are requesting a gender affirming genital surgery by vulvovaginoplasty. However, long-term complications such as genital prolapse are unknown. Through this systematic review, our objective was to provide an overview of the published outcomes related to genital prolapse after vaginoplasty in male-to-female transgender individuals, including prevalence, identified risk factors, and treatment. Methods: We included all studies reporting genital prolapse rates following vulvovaginoplasty from 1995 to the present. Only studies that focused on the transgender population were included. The primary outcome was the genital prolapse rate. The secondary outcomes included risk factors and treatment of genital prolapse after vulvovaginoplasty. Article selection was performed by two independent reviewers. Key findings and limitations: Twenty-four studies, involving 3166 patients, that presented sufficient data were analyzed. The mean age at the time of vulvovaginoplasty was 37.7 yr. The mean follow-up time was 22.5 mo. Most of the studies were retrospective case series of low to intermediate quality. The penile skin inversion technique was the most frequently employed method (in 85% of the 3166 patients). The prevalence of prolapse ranged from 0% to 7% with the penile skin inversion technique and from 1.6% to 22.7% with intestinal vaginoplasty. Upon consolidating the results, an overall rate of 2.7% was observed. Specifically, the prolapse rate within the penile inversion technique subgroup was 2.5%, while the rate for the intestinal-derived neovagina subgroup was 3.5%. The only significant risk factor identified was a high body mass index at the time of surgery. The most employed intraoperative technique to prevent neovaginal prolapse involves fixation to the sacrospinous ligament, coupled with systematic vaginal packing. Few case reports addressed the surgical treatment of neovaginal prolapse, predominantly using open abdominal or laparoscopic approaches. None of these considered transvaginal or perineal approaches. No recommendation exists about the use of vaginal prosthesis. Conclusions and clinical implications: Neovaginal prolapse in male-to-female transgender patients remains a rare complication, but its significance is growing as the transgender population ages. Scarce information is available regarding preventative techniques and treatments, necessitating further exploration, hampered by its infrequent occurrence. Patient summary: Neovaginal prolapse in male-to-female transgender patients is a rare complication, with the only recognized risk factor being a high body mass index. However, its importance is growing with the aging of the transgender population. Long-term complications, preventive techniques, and management of these prolapses need to be explored through further research.

BackgroundEarly weight loss is an established predictor for treatment outcomes in weight management interventions for people with obesity. However, there is a paucity of additional, reliable, and clinically actionable early predictors in weight management interventions. Novel blended-care weight management interventions combine coach and app support and afford new means of structured, continuous data collection, informing research on treatment adherence and outcome prediction. ObjectiveAgainst this backdrop, this study analyzes app engagement as a predictor for weight loss in large-scale, real-world, blended-care interventions. We hypothesize that patients who engage more frequently in app usage in blended-care treatment (eg, higher logging activity) lose more weight than patients who engage comparably less frequently at 3 and 6 months of intervention. MethodsReal-world data from 19,211 patients in obesity treatment were analyzed retrospectively. Patients were treated with 3 different blended-care weight management interventions, offered in Switzerland, the United Kingdom, and Germany by a digital behavior change provider. The principal component analysis identified an overarching metric for app engagement based on app usage. A median split informed a distinction in higher and lower engagers among the patients. Both groups were matched through optimal propensity score matching for relevant characteristics (eg, gender, age, and start weight). A linear regression model, combining patient characteristics and app-derived data, was applied to identify predictors for weight loss outcomes. ResultsFor the entire sample (N=19,211), mean weight loss was –3.24% (SD 4.58%) at 3 months and –5.22% (SD 6.29%) at 6 months. Across countries, higher app engagement yielded more weight loss than lower engagement after 3 but not after 6 months of intervention (P3 months.05). ConclusionsEarly app engagement is a predictor of weight loss, with higher engagement yielding more weight loss than lower engagement in this analysis. This new predictor lends itself to automated monitoring and as a digital indicator for needed or adapted clinical action. Further research needs to establish the reliability of early app engagement as a predictor for treatment adherence and outcomes. In general, the obtained results testify to the potential of app-derived data to inform clinical monitoring practices and intervention design.

Introdução: O aumento da carga de trabalho dos profissionais de saúde e o grau de complexidade dos pacientes, atribuem maior risco para o estresse psicossocial. Objetivo: Avaliar as associações entre o estresse ocupacional, a qualidade de vida no trabalho e as estratégias de enfrentamento pela equipe de enfermagem hospitalar na pandemia de COVID-19. Métodos: Estudo transversal, quantitativo com amostragem por conveniência, coleta de dados de agosto a dezembro de 2020; em duas unidades da rede hospitalar privada, com questionário sociodemográfico, ocupacional e de saúde; escala visual analógica de avaliação da qualidade de vida no trabalho; Escala de Demanda-Controle-Apoio Social (DCS); Escala de Coping ocupacional. Resultados: A amostra total foi de 196 profissionais de Enfermagem. Houve correlação significativa negativa, porém fraca, entre a dimensão “Demanda” da DCS e QVT (p

Resumo Fundamento: A adesão à uma alimentação adequada em macronutrientes é fundamental para a prevenção secundária de doenças cardiovasculares. Objetivo: Avaliar a prevalência de adesão às recomendações de consumo de ácidos graxos para prevenção e tratamento de doenças cardiovasculares, e estimar se a presença de determinados fatores de risco cardiovascular estaria associada à adesão. Métodos: Estudo transversal com os dados de linha de base de 2358 participantes do estudo "Brazilian Cardioprotective Nutritional Program Trial". Dados de consumo alimentar, e fatores de risco cardiovascular foram avaliados. Foi considerada, de acordo com a Sociedade Brasileira de Cardiologia, uma ingestão adequada de ácidos graxos poli-insaturados (AGPI) ≥10% do consumo total de energia diária, para ácidos graxos monoinsaturados (AGM), 20% e para ácidos graxos saturados (AGS),

The role of artificial intelligence (AI) in the medical domain is increasing on an annual basis. AI allows instant access to the latest scientific data in urological surgery, facilitating a level of theoretical knowledge that previously required several years of practice and training. To evaluate the capability of AI to provide robust data in a specialized domain, we submitted the in-service assessment of the European Board of Urology to three different AI tools: ChatGPT 3.5, ChatGPT 4.0, and Bard. The assessment consists of 100 single-answer questions with four multiple-choice options. We compared the responses of 736 participants to the AI responses. The average score for the 736 participants was 67.20. ChatGPT 3.5 scored 59 points, ranking in 570th place. ChatGPT 4.0 scored 80 points, ranking 80th, just on the border of the top 10%. Google Bard scored 68 points, ranking 340th. Our study demonstrates that AI systems have the capability to participate in a urological examination and achieve satisfactory results. However, a critical perspective must be maintained, as current AI systems are not infallible. Finally, the role of AI in the acquisition of knowledge and the dissemination of information remains to be delineated. Patient summary: We submitted questions from the European Diploma in Urological Surgery to three artificial intelligence (AI) systems. Our findings reveal that AI tools show remarkable performance in assessments of urological surgical knowledge. However, certain limitations were also observed.

Pastures are of central importance in food production and provide multiple ecosystem services. The objective of this paper was to determine whether the intensification of pasture-based animal production systems, through practices such as fertilization and improved pasture species, has a higher capacity in the short-term (five years) to sequester carbon in the soil compared to (1) natural grassland without anthropogenic interactions, (2) natural grassland fertilized and overseeded with exotic species, and (3) annual pastures with frequent soil disturbance. The study assessed the organic carbon stock (OCS), total organic carbon (TOC), particle size, porosity, and density at different soil strata, as well as the root system and forage production. Forage dry matter (DM) production varied significantly with means ranging from 6615 to 13,000 kg ha–1 year–1 for natural grassland (NG) and permanent pasture (PP), respectively. Improved natural grassland (ING) and NG presented a higher density and root diameter than PP and annual pasture (AP). Forage systems significantly influenced soil porosity and density, with NG and ING showing lower soil densities and higher soil porosities. The OCS (0–100 cm) was similar between NG (270 Mg ha–1), ING (255 Mg ha–1), PP (274 Mg ha–1), and AP systems (256 Mg ha–1). Over a period of five years, the intensification of pasture-based animal production systems did not have a significant impact on OCS in the soils of a Brazilian subtropical highland.

Native grassland supports extensive livestock production in the Pampas of South America, but the impact of cattle excreta on nitrous oxide ([N.sub.2]O) emissions remains unknown in this biome. The objective of this study was to determine the [N.sub.2]O emission factor (EF-[N.sub.2]O, % of N applied that is emitted as [N.sub.2]O) for urine and dung from beef cattle grazing on native grasslands. A field trial was conducted under low and moderate forage allowances (FA4 and FA12; i.e. 4 and 12 kg dry matter/100 kg live weight respectively) during the 30th year of a long-term grassland experiment on a Typic Paleudult in South Brazil. Urine and dung were applied onto separate patches, at rates equivalent to one average urination or defecation; and [N.sub.2]O fluxes were monitored with closed static chambers over 338 days. In adjacent microplots receiving the same excreta treatment, water-filled pore space, nitrate, ammonium and extractable dissolved organic carbon were monitored in the top 0.1 m of soil. Averaged across the forage allowances, daily soil [N.sub.2]O fluxes were low in the control without excreta (1.3 g N [ha.sup.-1]), but increased upon application of dung (3.8 g N [ha.sup.-1]) and urine (66 g N [ha.sup.-1]). The annual [N.sub.2]O emission and the EF-[N.sub.2]O for urine were greater under FA12 than FA4, but no difference was observed for dung. The positive relationships between [N.sub.2]0-N emissions and ammonium intensity and nitrate intensity suggest that [N.sub.2]O may have been produced concurrently by nitrification, nitrifier/denitrification and denitrification. On average, the EF-[N.sub.2]O was almost 10 times higher for urine than for dung (0.74% vs 0.08%), both much lower than the IPCC's Tier 1 default value of 2%. Our findings reinforce the need for disaggregating the EF-[N.sub.2]O for urine and dung and of revising the IPCC's Tier 1 EF-[N.sub.2]O. Additional keywords: cattle excreta, forage allowance, livestock, [N.sub.2]O, subtropical. Received 27 April 2019, accepted 29 October 2019, published online 9 December 2019, Introduction The Pampa biome extends over 750000 [km.sup.2] in Uruguay, northern Argentina and southern Brazil. In Brazil, the Pampa's native grasslands support a grazing herd of 13 million cattle (Carvalho [...]