Brazilian version of the Pasero Opioid-Induced Sedation Scale: cross-cultural adaptation study.

OBJECTIVE: Perform a cross-cultural adaptation of the Pasero Opioid-induced Sedation Scale to the Brazilian setting. METHOD: This is a methodological study using Beaton's framework, which consists in six stages: translation, synthesis of translations, re-translation, expert committee, pre-test, and sending the adapted version of the instrument to the author of the original. The study was carried out from April to December 2021. The research was conducted in a private hospitalin the city of São Paulo, in the adult hospitalization and critical care units. It was approved by the research ethics committee. RESULTS: After translation, translation synthesis and back-translation steps, the version was evaluated by the expert committee, requiring two rounds to obtain acceptable CVI values above 0.80. In the pre-test phase, the scale was well understood, with a CVI of 0.98. CONCLUSION: The scale was adapted for the Brazilian context; however, further studies will be needed to analyze validity and reliability evidence.

The association between malocclusion and health-related quality of life in adolescents: A mediation analysis.

This study investigated the role of oral health-related functional limitations and social well-being, self-perceived health, psychosocial factors, and social support in mediating the impact of malocclusion on health-related quality of life (HRQoL). A school-based 6-month cohort study was conducted with 376 12-year-old deprived adolescents. Measures at baseline included malocclusion (DAI score), dental caries, sociodemographic characteristics, psychosocial traits (self-esteem, sense of coherence, oral health beliefs), and social support. The oral health-related functional limitations and symptoms (social well-being) domains of the CPQ11-14 , self-perceived health, and HRQoL (Kiddo-KINDL) were evaluated at the 6-month follow-up. Associations between observed and latent variables (social support, psychosocial factors, and HRQoL) were evaluated using structural equation modelling, according to the Wilson and Cleary theoretical model. Malocclusion was indirectly associated with worse HRQoL, mediated by functional limitations, social well-being, and self-perceived health. Better psychosocial status was directly associated with better HRQoL, and higher social support was indirectly associated with better HRQoL via psychosocial factors. Dental caries experience, female sex, and lower family income were indirectly associated with worse HRQoL. The impact of malocclusion on HRQoL was mediated by oral health-related functional limitations, social well-being, and self-perceived health. Sociodemographic and psychosocial factors, and social support also impacted HRQoL.

Brazilian version of the Pasero Opioid-Induced Sedation Scale: cross-cultural adaptation study / Versión brasileña de la escala Pasero Opioid-Induced Sedation Scale: estudio de adaptación transcultural / Versão brasileira da Pasero Opioid-Induced Sedation Scale: estudo de adaptação transcultural

ABSTRACT Objective: Perform a cross-cultural adaptation of the Pasero Opioid-induced Sedation Scale to the Brazilian setting. Method: This is a methodological study using Beaton's framework, which consists in six stages: translation, synthesis of translations, re-translation, expert committee, pre-test, and sending the adapted version of the instrument to the author of the original. The study was carried out from April to December 2021. The research was conducted in a private hospitalin the city of São Paulo, in the adult hospitalization and critical care units. It was approved by the research ethics committee. Results: After translation, translation synthesis and back-translation steps, the version was evaluated by the expert committee, requiring two rounds to obtain acceptable CVI values above 0.80. In the pre-test phase, the scale was well understood, with a CVI of 0.98. Conclusion: The scale was adapted for the Brazilian context; however, further studies will be needed to analyze validity and reliability evidence.

RESUMEN Objetivo: Realizar la adaptación transcultural de la escala de Pasero Opioid-induced Sedation Scale para el contexto brasileño. Método: Estudio metodológico, utilizando el marco de referencia de Beaton, que consta de seis fases: traducción, síntesis de traducciones, traducción inversa, comité de expertos, prueba previa, y envío del instrumento adaptado ala autora del instrumento original. El estudio se realizó de abril a diciembre de 2021, y a la investigación se condujo en un hospital privado, ubicado en la ciudad de São Paulo, en las unidades de hospitalización de adultos y cuidados críticos. Recibió la aprobación del comité de ética. Resultados: Después de las etapas de traducción, síntesis de traducción y traducción inversa, la versión fue evaluada por un comité de expertos, con dos rondas para obtener valores aceptables de índice de validez de contenido superiores a 0,80. En la fase previa a la prueba, la escala mostró una buena comprensión, con una puntuación de 0,98. Conclusión: La escala fue adaptada para el contexto brasileño, sin embargo, serán necesarios más estudios para analizar las evidencias de validez y confiabilidad.

RESUMO Objetivo: Realizar adaptação transcultural da escala Pasero Opioid-Induced Sedation para o cenário brasileiro. Método: Estudo metodológico, utilizado referencial de Beaton, composto por seis fases: tradução, síntese das traduções, retradução, comitê de especialistas, pré-teste e envio dos instrumentos adaptados ao autor do instrumento original. Estudo foi realizado de abril a dezembro de 2021. A pesquisa desenvolveu-se em um hospital privado, localizado no município de São Paulo, nas unidades de internação e críticas adultos. Recebeu aprovação do comitê de ética. Resultados: Após as etapas de tradução, síntese de tradução e retrotradução a versão foi avaliada pelo comitê de especialistas, com duas rodadas para obtenção de valores aceitáveis de índice de validade de conteúdo acima de 0,80. Na fase de pré-teste a escala apresentou boa compreensão com score de 0,98. Conclusão: A escala foi adaptada para o contexto brasileiro, no entanto, novos estudos serão necessários para análises de evidências de validade e confiabilidade.

Barriers to and facilitators of populational adherence to prevention and control measures of COVID-19 and other respiratory infectious diseases: a qualitative evidence synthesis.

AIMS: To summarise the evidence on barriers to and facilitators of population adherence to prevention and control measures for coronavirus disease 2019 (COVID-19) and other respiratory infectious diseases. METHODS: A qualitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Cochrane Effective Practice and Organization of Care: Qualitative Evidence Synthesis. We performed an electronic search on MEDLINE, Embase and PsycINFO from their inception to March 2023. RESULTS: We included 71 studies regarding COVID-19, pneumonia, tuberculosis, influenza, pertussis and H1N1, representing 5966 participants. The measures reported were vaccinations, physical distancing, stay-at-home policy, quarantine, self-isolation, facemasks, hand hygiene, contact investigation, lockdown, infection prevention and control guidelines, and treatment. Tuberculosis-related measures were access to care, diagnosis and treatment completion. Analysis of the included studies yielded 37 barriers and 23 facilitators. CONCLUSIONS: This review suggests that financial and social support, assertive communication, trust in political authorities and greater regulation of social media enhance adherence to prevention and control measures for COVID-19 and infectious respiratory diseases. Designing and implementing effective educational public health interventions targeting the findings of barriers and facilitators highlighted in this review are key to reducing the impact of infectious respiratory diseases at the population level.

Effects of home healthcare for adults with chronic respiratory diseases and post-COVID-19 syndrome on hospital bed turnover rate: a protocol of systematic review with meta-analysis.

INTRODUCTION: Chronic respiratory diseases (CRDs) have a high prevalence, morbidity and mortality worldwide. After the COVID-19 pandemic, the number of patients readmitted after hospital discharge increased. For some populations, early hospital discharge and home healthcare may reduce health costs in patients treated at home when compared with those hospitalised. This study aims to systematically review the effectiveness of home healthcare for patients with CRDs and post-COVID-19 syndrome. METHODS AND ANALYSIS: We will search on MEDLINE, CENTRAL, Embase and PsycINFO. We will include randomised controlled trials (RCTs) and non-RCT studies reported in full text and abstracts. No language restriction will be applied. We will include studies related to adults with a diagnosis of CRDs or post-COVID-19 syndrome that compared in-patient hospital care with any home healthcare. We will exclude studies with participants with neurological, mental diseases, cancer or pregnant women. Two review authors will screen abstracts and select the eligible studies. To investigate the risk of bias, we will use the Cochrane 'Risk of Bias' tool for RCT, and the Risk of Bias In Non-randomised Studies-of Interventions for non-RCT. We will use the five Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) considerations to assess the quality of the evidence. Patients and the public will be involved in the preparation, execution and implementation phases of the review. ETHICS AND DISSEMINATION: No ethical approval is required because only published data will be analysed. The publication of the results in peer-reviewed journals and at relevant conferences will guide the direction of future research in the field and healthcare practice. The results will also be disseminated in plain language on social media to disseminate the knowledge to society and the public interested in the topic.

Fluoride Concentration in Public Water Supply in a City in the Amazon Region

Abstract Objective: To analyze the fluoride concentration in the public water supply in Manaus, Brazil. Material and Methods: Water samples were collected in 50 mL polyethylene bottles, identified, and labeled. The collection was performed from September 2016 to August 2018. For the selection of collection points, all neighborhoods of the city of Manaus, divided into four health districts (North, South, East, and West), were mapped. From each district, 30 samples were collected, totaling 120 monthly samples. Water samples were analyzed using an ion analyzer, ORION 720-A, and a specific electrode, ORION 96-09. The ion analyzer and electrode were calibrated in standard solutions. The levels were classified in intervals based on technical consensus to guide the health surveillance agencies. Results: Of the 2,874 water samples, 50.3% were within the recommended range, and 49.7% were inadequate, with 31.6% considered above the parameters and 18.1% below. Among the districts, the North had the highest percentages of unsatisfactory samples, resulting in limited action to prevent tooth decay. During the 24 months of analysis, there were large oscillations in the values in all four districts of Manaus. Conclusion: Results reinforce the importance of heterocontrol for the city to guarantee the effectiveness of this public health measure.

Buteyko method for people with asthma: a protocol for a systematic review and meta-analysis.

INTRODUCTION: Buteyko method is recommended as a non-pharmacological treatment for people with asthma. Although the worldwide interest in the Buteyko method, there is a paucity of studies gathering evidence to support its use. Therefore, we aim to conduct a systematic review and meta-analysis to assess the effects of the Buteyko method in children and adults with asthma. METHODS AND ANALYSIS: We will search on Cochrane Central Register of Controlled Trials, MEDLINE, Embase, US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov and WHO International Clinical Trials Registry Platform for studies focusing on the Buteyko method for children and adults with asthma. The searches will be carried out in September 2021 from database's inception to the present. We will include randomised controlled trials comparing Buteyko method alone with asthma education or inactive control intervention. There will be no restriction on language. Primary outcomes include quality of life, asthma symptoms and adverse events/side effects. Two review authors will independently screen the studies for inclusion and extract data. We will assess the quality of the included studies using the 'Risk of Bias' tool. The certainty of the evidence will be assessed using the GRADE approach. Data synthesis will be conducted using Review Manager software. Reporting of the review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and the Cochrane Handbook for Systematic Reviews of Interventions. ETHICS AND DISSEMINATION: This study will assess and provide evidence for the use of the Buteyko method in people with asthma. We will analyse secondary data and this does not require ethics approval. The findings will be published in peer-reviewed journals, at relevant conferences and will be shared in plain language in social media. Moreover, the findings of this review could guide the direction of healthcare practice and research. PROSPERO REGISTRATION NUMBER: CRD42020193132.

Access to Health Services and Assistance Offered to the Afro-Descendant Communities in Northern Brazil: A Qualitative Study.

The remnants of quilombos, individuals of African descent, have faced several barriers throughout its history, either due to prejudice imposed by society, or the non-fulfillment of their rights guaranteed in the 1988 Constitution, such as access to health services. Thus, this study aims to evaluate the health care offered to quilombo communities in the northern region of Tocantins. This is an exploratory, descriptive study with a qualitative approach, including field research and focus group, carried out with 58 quilombo remnants people from communities in the northern region of Tocantins. Data collection was carried out between from October 2017 to July 2018, through semi-structured interviews. We found that these communities have limited access to health services, in addition to a negative perception of the assistance offered to the health of their population and the commitment of managers. Therefore, access to health and assistance received by the studied communities required to be prioritized since the care provided is not unique and has not met the health demands and needs of the remaining quilombos in northern Tocantins, Brazil.

Barriers and facilitators to populational adherence to prevention and control measures of COVID-19 and other respiratory infectious diseases: a rapid qualitative evidence synthesis protocol.

INTRODUCTION: The current COVID-19 pandemic has increased the need for populational adherence to measures for the prevention and control of respiratory infectious diseases. However, their effectiveness depends on the population's preventive behaviour, which may be divergent from public policies. Therefore, this study aims to summarise and evaluate the evidence on barriers and facilitators to populational adherence to prevention and control measures in COVID-19 and other respiratory infectious diseases. METHODS AND ANALYSIS: We will search on MEDLINE, Embase and PsycINFO for studies focusing on adults receiving protective behaviour recommendations to combat COVID-19 and other respiratory infectious diseases. The searches will be carried out from database's inception to the present. We will include studies that use qualitative methods in their data collection and analysis and studies that use mixed methods if they include any qualitative methods of analysis. Studies published in English, Portuguese and Spanish will be included. Two review authors will independently screen the studies for inclusion and extract data. We will assess the quality of the included studies using the Critical Skills Appraisal Programme tool. For the assessment of the confidence in the synthesised findings, we will use the GRADE-Confidence in the Evidence from Reviews of Qualitative research. Data analysis will be conducted using the best-fit framework approach based on adapted dimensions from the Health Belief Model and the Behaviour Change Wheel. ETHICS AND DISSEMINATION: This study will be conducted on published evidence, and thus, no ethical approval is required. The findings of this rapid qualitative evidence synthesis will be disseminated to academic audiences, health policy-makers and the general population. We will publish the results in peer-reviewed journals, present our findings in conferences, and disseminate results via social media. We also aim to present the research findings in plain language and disseminate the knowledge to the general population to increase public interest. PROSPERO REGISTRATION NUMBER: CRD42020205750.

Construção de vídeo sobre uso dos preservativos para surdos e ouvintes / Construction of a video about condom use for deaf and hearing people

RESUMO Objetivo: construir tecnologia assistiva, no formato de vídeo, para surdos e ouvintes sobre saúde sexual e o uso do preservativo. Métodos: estudo metodológico constituído das etapas de pré-produção, produção e pós-produção. Na pré-produção construiu-se roteiro, storybord e cenas, seguindo os princípios da Teoria da Aprendizagem de Lev Semenovich Vygotsky. Na produção houve o desenvolvimento da animação e gravação das cenas pelo intérprete de Libras. Na pós-produção ocorreu a edição final do vídeo. Resultados: o vídeo "Preservativo: aprenda a usar corretamente", com duração de nove minutos e 25 segundos discorre sobre o sistema sexual e reprodutivo do homem e da mulher; modo de ação, benefícios e cuidados com o uso do preservativo. Diante da escassez de materiais educativos sobre o tema, empregaram-se recursos de acessibilidade para construir um vídeo para surdos e ouvintes. Conclusão: a construção do vídeo como tecnologia assistiva dirigida aos surdos foi realizada com êxito.

ABSTRACT Objective: to build assistive technology, in video format, for deaf and hearing people about sexual health and condom use. Methods: methodological study consisting of the stages of pre-production, production and post-production. In pre-production we built the script, storyboard and scenes, following the principles of Lev Semenovich Vygotsky's Theory of Learning. In production there was the development of the animation and recording of the scenes by the Libras interpreter. In post-production the final editing of the video took place. Results: the video "Condom: learn to use correctly", lasting nine minutes and 25 seconds discusses the sexual and reproductive system of man and woman; mode of action, benefits and care with the use of condoms. Given the scarcity of educational materials on the subject, accessibility resources were used to build a video for deaf and hearing people. Conclusion: the construction of the video as an assistive technology directed to the deaf was successfully accomplished.

The Role of the Non-neuronal Cholinergic System in Inflammation and Degradation Processes in Osteoarthritis.

OBJECTIVE: The non-neuronal cholinergic system represents non-neuronal cells that have the biochemical machinery to synthetize de novo and/or respond to acetylcholine (ACh). We undertook this study to investigate this biochemical machinery in chondrocytes and its involvement in osteoarthritis (OA). METHODS: Expression of the biochemical machinery for ACh metabolism and nicotinic ACh receptors (nAChR), particularly α7-nAChR, in human OA and murine chondrocytes was determined by polymerase chain reaction and ligand-binding. We investigated the messenger RNA expression of the human duplicate α7-nACh subunit, called CHRFAM7A, which is responsible for truncated α7-nAChR. We assessed the effect of nAChR on chondrocytes activated by interleukin-1ß (IL-1ß) and the involvement of α7-nAChR using chondrocytes from wild-type (WT) and α7-deficient Chrna7-/- mice. The role of α7-nAChR in OA was explored after medial meniscectomy in WT and Chrna7-/- mice. RESULTS: Human and murine chondrocytes express the biochemical partners of the non-neuronal cholinergic system and a functional α7-nAChR at their cell surface (n = 5 experiments with 5 samples each). The expression of CHRFAM7A in human OA chondrocytes (n = 23 samples) correlated positively with matrix metalloproteinase 3 (MMP-3) (r = 0.38, P < 0.05) and MMP-13 (r = 0.48, P < 0.05) expression. Nicotine decreased the IL-1ß-induced IL-6 and MMP expression, in a dose-dependent manner, in WT chondrocytes but not in Chrna7-/- chondrocytes. Chrna7-/- mice that underwent meniscectomy (n = 7) displayed more severe OA cartilage damage (mean ± SD Osteoarthritis Research Society International [OARSI] score 4.46 ± 1.09) compared to WT mice that underwent meniscectomy (n = 9) (mean ± SD OARSI score 3.05 ± 0.9; P < 0.05). CONCLUSION: The non-neuronal cholinergic system is functionally expressed in chondrocytes. Stimulation of nAChR induces antiinflammatory and anticatabolic activity through α7-nAChR, but the anticatabolic activity may be mitigated by truncated α7-nAChR in human chondrocytes. In vivo experiments strongly suggest that α7-nAChR has a protective role in OA.

Aprendizado de surdos e ouvintes portugueses sobre preservativo masculino após utilização de vídeo educativo / Learning of deaf people and Portuguese listeners about male condoms after using educational video

Preservativo masculino é um método anticoncepcional utilizado para o duplo propósito de prevenir gravidez não planejada e Infecções Sexualmente Transmissíveis. Pessoas surdas possuem lingua visuoespacial como primeira comunicação, no entanto poucos enfermeiros dominam a língua de sinais, dessa forma, havendo dificuldade em produzir materiais educativos inclusivos e, consequentemente, dificultando o acesso desse grupo a informações sobre saúde sexual e reprodutiva. Nesse contexto, fez-se necessário elaborar tecnologia educacional que atendesse aos preceitos de desenho universal (para surdos e ouvintes), desempenhando papel importante na aceitação do preservativo. Objetivou-se avaliar aprendizado de surdos e ouvintes portugueses após utilização de vídeo educativo sobre preservativo masculino. Estudo multi-métodos, realizado entre janeiro de 2018 a fevereiro de 2019, sendo composto por seis etapas, a saber: Construção e Validação do Conteúdo e Banco de Questões sobre Saúde Sexual e Reprodutiva, e Uso do Preservativo Masculino; Elaboração do Roteiro e Stoyrboard do Vídeo; Adaptação Transcultural do Roteiro e Banco de Questões; Gravação e Edição do Video; e Avaliação de Conhecimento de Surdos e Ouvintes Antes e Após Utilização do Vídeo. Instituições de referência para ensino e diálogo de surdos das cidades de Porto e Coimbra serviram como locais para captação e aplicação da pesquisa, com amostra de 23 surdos para teste piloto no processo de adaptação transcultural e 29 surdos para avaliação de conhecimento. Duas instituições de Ensino Superior da cidade do Porto compuseram locais para compor amostra de 91 ouvintes para avaliação de conhecimento. Para análise dos dados utilizou-se testes: Índice de Validade de Conteúdo, Alfa de Cronbach, Teste de McNewmar, Qui-Quadrado e t de Student, considerando nível de significância de 5%. Foram respeitados preceitos éticos e legais segundo diretrizes nacionais e internacionais de pesquisa envolvendo seres humanos. Construção do conteúdo e banco de questões seguiu diretrizes nacionais e internacionais acerca da temática; e processo de validação ocorreu em dois ciclos, havendo concordância final superior a 80%. Elaboração do roteiro respeitou eixos norteadores da Teoria de aprendizagem de Vygotsky, e retratou situação fictía acerca da saúde sexual e reprodutiva de um casal heterossexual com enfoque no sexo seguro. Storyboard buscou explorar a dimensão estética e houve cuidado para que as imagens não reforçassem estereótipos. Roteiro e Banco de questões sofreram modificações para aprimoramento do processo cultural, sendo mais substanciais mudanças referidas na avaliação por comitê de especialistas. Ademais, análise da consistência interna pelo coeficiente de alfa de Cronbach revelou alta confiabilidade, para cultura portuguesa, das cenas do roteiro (α= 0,909) e das perguntas do banco de questões (α = 0,874). Vídeo foi gravado em 19 cenas, e possuiu versão final contendo 10 minutos e 47 segundos, sendo composto por narração, áudio, legenda, animação e língua gestual portuguesa sincronizados. Número de acertos do pré-teste e pós-teste imediato foi de 8,64 para 9,64 nos ouvintes, e de 6,17 para 8,17 para surdos (p<0,0001). Conclui-se que vídeo educativo elevou conhecimento sobre uso do preservativo masculino para surdos e ouvintes, tornando-se relevante sua divulgação em ampla escala, pois proporcionará um referencial para avaliação sobre o assunto em regiões geográficas distintas. Desse modo, contribuindo para autonomia sobre utilização deste método contraceptivo entre ambos os grupos estudados. (AU)

High-content screen in human pluripotent cells identifies miRNA-regulated pathways controlling pluripotency and differentiation.

BACKGROUND: By post-transcriptionally regulating multiple target transcripts, microRNAs (miRNAs or miR) play important biological functions. H1 embryonic stem cells (hESCs) and NTera-2 embryonal carcinoma cells (ECCs) are two of the most widely used human pluripotent model cell lines, sharing several characteristics, including the expression of miRNAs associated to the pluripotent state or with differentiation. However, how each of these miRNAs functionally impacts the biological properties of these cells has not been systematically evaluated. METHODS: We investigated the effects of 31 miRNAs on NTera-2 and H1 hESCs, by transfecting miRNA mimics. Following 3-4 days of culture, cells were stained for the pluripotency marker OCT4 and the G2 cell-cycle marker Cyclin B1, and nuclei and cytoplasm were co-stained with Hoechst and Cell Mask Blue, respectively. By using automated quantitative fluorescence microscopy (i.e., high-content screening (HCS)), we obtained several morphological and marker intensity measurements, in both cell compartments, allowing the generation of a multiparametric miR-induced phenotypic profile describing changes related to proliferation, cell cycle, pluripotency, and differentiation. RESULTS: Despite the overall similarities between both cell types, some miRNAs elicited cell-specific effects, while some related miRNAs induced contrasting effects in the same cell. By identifying transcripts predicted to be commonly targeted by miRNAs inducing similar effects (profiles grouped by hierarchical clustering), we were able to uncover potentially modulated signaling pathways and biological processes, likely mediating the effects of the microRNAs on the distinct groups identified. Specifically, we show that miR-363 contributes to pluripotency maintenance, at least in part, by targeting NOTCH1 and PSEN1 and inhibiting Notch-induced differentiation, a mechanism that could be implicated in naïve and primed pluripotent states. CONCLUSIONS: We present the first multiparametric high-content microRNA functional screening in human pluripotent cells. Integration of this type of data with similar data obtained from siRNA screenings (using the same HCS assay) could provide a large-scale functional approach to identify and validate microRNA-mediated regulatory mechanisms controlling pluripotency and differentiation.

Orthodontic treatment need, self-esteem, and oral health-related quality of life among 12-yr-old schoolchildren.

The aim of this study was to investigate the association between orthodontic treatment need and oral health-related quality of life (OHRQoL) among 12-yr-old children. The study also assessed whether self-esteem modifies and/or moderates this relationship. Cross-sectional data on 406 schoolchildren aged 12 yr were analyzed. Data on socio-economic and demographic characteristics, dental pain, self-esteem, and OHRQoL were collected using validated questionnaires. Orthodontic treatment need was assessed, through dental examinations, using the dental aesthetic index (DAI). Multiple negative binomial regression and path analysis were used to estimate the association of orthodontic treatment need and self-esteem with OHRQoL. A modifying effect of self-esteem on the relationship between DAI and OHRQoL was observed. Self-esteem did not mediate the abovementioned relationship. Children with lower scores of self-esteem had worse OHRQoL among those with lower orthodontic treatment need (a DAI score of < 31). However, self-esteem did not influence the association between DAI and OHRQoL in children with greater orthodontic treatment need (a DAI score of ≥ 31). Self-esteem attenuated the impact of malocclusion on OHRQoL in children with minor or definite malocclusion, but not among those with severe or very severe malocclusion. Self-esteem appears to buffer the impact of malocclusion on OHRQoL in children with minor orthodontic treatment need.

Variation in DNA methylation in the KvDMR1 (ICR2) region in first-trimester human pregnancies.

OBJECTIVE: To investigate the levels of DNA methylation in the KvDMR1 (KvLQT1 differentially methylated region 1) in embryonic and extra-embryonic tissues. DESIGN: Cross-sectional study. SETTING: University medical center and clinical hospital. PATIENT(S): Embryonic and/or extraembryonic tissues (umbilical cord, chorionic villus, chorion, decidua, and/or amnion) collected from 27 first-trimester pregnancies (up to 12 weeks of gestation, single embryos) from elective abortions, extravillous trophoblasts (EVTs) from the top of individual chorionic villi, and chorionic villi from 10 normal full-term placentas collected after birth. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): DNA methylation of the KvDMR1 region evaluated using quantitative analysis of DNA methylation followed by real-time polymerase chain reaction (qAMP) and bisulfite sequencing (bis-seq) analysis. RESULT(S): The results showed variability in KvDMR1 DNA methylation in different tissues from the same pregnancy. The average of DNA methylation was not different between the embryo, umbilical cord, amnion, and chorionic villi, despite the relatively low level of methylation observed in the amnion (33.50% ± 14.48%). Chorionic villi from term placentas showed a normal methylation pattern at KvDMR1 (42.60% ± 6.08%). The normal methylation pattern at KvDMR1 in chorionic villi (as well as in EVTs) from first-trimester placentas was confirmed by bis-seq. CONCLUSION(S): Our results highlight an existing heterogeneity in DNA methylation of the KvDMR1 region during first trimester and a consistent hypomethylation in the amnion in this period of gestation.

Technologies for health education for the deaf: integrative review / Tecnologías para una educación en salud de sordos: revisión integradora / Tecnologias para educação em saúde de surdos: revisão integrativa

ABSTRACT Objective: investigate the scientific evidence on the technologies that are used for health education for deaf people. Method: integrative review carried out in October 2017, with the publications of the last 15 years, in the databases MEDLINE/PubMed, CINAHL, LILACS via Biblioteca Virtual em Saúde (BVS), Web of Science and Scopus. Results: we found 3367 articles, of which 19 were included in the study. The predominant type of technology was video, present in ten studies and computerized technologies, such as web sites and online courses, in four studies. The topic most approached by the technologies was cancer, in ten studies and oral health in three. Two articles were methodological, in 17 the application of the technology with deaf occurred and in 16 of these the efficacy and/or viability for health education was proven. Conclusion: educational technologies are mostly videos that are comprehensible to deaf people and effective for use in health education.

RESUMEN Objetivo: investigar las evidencias científicas sobre las tecnologías que se utilizan para una educación en salud de personas sordas. Método: revisión integradora realizada en octubre de 2017, a partir de las publicaciones de los últimos 15 años en las bases de datos MEDLINE/PubMed, CINAHL, LILACS a través de la Biblioteca Virtual en Salud, Web of Science y Scopus. Resultados: se encontraron 3367 artículos, de los cuales 19 han sido incluidos en el estudio. El tipo de tecnologías predominantes han sido el video, que estuvo presente en diez estudios, y las tecnologías computadorizadas, como sitios web y cursos on-line, en cuatro estudios. Las temáticas más abordadas por las tecnologías fueron el cáncer, en diez estudios, y la salud bucal, en tres estudios. Dos artículos eran metodológicos, en 17 se implementó la tecnología con sordos, y en 16 de estos se pudo comprobar la eficacia y/o viabilidad para la educación en salud. Conclusión: Las tecnologías educativas son, en su mayoría, videos que las personas sordas pueden comprender y eficaces para utilizarse en la educación en salud.

RESUMO Objetivo: investigar as evidências científicas acerca das tecnologias que são utilizadas para educação em saúde de pessoas surdas. Método: revisão integrativa realizada em outubro de 2017, com as publicações dos últimos 15 anos, nas bases de dados MEDLINE/PubMed, CINAHL, LILACS via Biblioteca Virtual em Saúde, Web of Science e Scopus. Resultados: foram encontrados 3367 artigos, dos quais 19 foram incluídos no estudo. O tipo de tecnologia predominante foi o vídeo, presente em dez estudos e as tecnologias computadorizadas, como sites e cursos online, em quatro estudos. O tema mais abordado pelas tecnologias foi o câncer, em dez estudos e a saúde bucal em três. Dois artigos eram metodológicos, em 17 ocorreu a aplicação da tecnologia com surdos e, em 16 desses foi comprovada a eficácia e/ou viabilidade para educação em saúde. Conclusão: as tecnologias educativas são, em sua maioria, vídeos que se mostram compreensíveis pelas pessoas surdas e eficazes para serem utilizados na educação em saúde.

Design instrucional na enfermagem: tecnologias assistivas para cegos e surdos / Diseño instruccional en enfermería: tecnologías para la atención de ciegos y sordos / Instructional design in nursing: assistive technologies for the blind and deaf

RESUMO Este estudo apresenta análise reflexiva sobre desenvolvimento de tecnologias assistivas online, que subsidiam o cuidado de enfermagem à pessoa com deficiência, com base em modelo de design instrucional de Falkembach. Estudo reflexivo, realizado em abril de 2018, através do repositório institucional online do Programa de Pós-Graduação em Enfermagem da Universidade Federal do Ceará. Selecionaram-se pesquisas sobre tecnologias dos últimos cinco anos envolvendo pessoas com deficiência sensorial. Foram analisadas quatro pesquisas de construção de tecnologias assistivas online, sendo três cursos e uma cartilha, sobre prevenção e promoção da saúde na saúde mamária, hipertensão arterial, saúde sexual e reprodutiva e prevenção da violência sexual com linguagem acessível e inclusiva. Concluiu-se que o enfermeiro deve utilizar métodos rigorosos e eficazes na construção de tecnologias assistivas, obedecer às etapas do modelo, evitando erros e otimizando resultados.

RESUMEN Estudio que presenta un análisis reflexivo sobre el desarrollo de tecnologías de atención online que respaldan la atención de enfermería a las personas con discapacidades, en base al modelo de diseño instruccional de Falkembach. Estudio reflexivo, realizado en abril de 2018 utilizando el repositorio online institucional del programa de posgrado en enfermería de la Universidade Federal do Ceará. Fueron seleccionadas investigaciones sobre tecnologías de los últimos cinco años en referencia a personas con carencias sensoriales. Se analizaron cuatro estudios de construcción de tecnologías de atención online: tres cursos y una libreta sobre prevención y promoción de salud en salud mamaria, hipertensión arterial, salud sexual y reproductiva y prevención de la violencia sexual con lenguaje sencillo e inclusivo. Se concluyó en que el enfermero debe utilizar métodos rigurosos y eficaces en la construcción de tecnologías de atención y respetar las etapas del modelo, evitando errores y optimizando resultados.

ABSTRACT The present study provides a reflective analysis on the development of online assistive technologies that support nursing care for people with disabilities, based on Falkembach's instructional design model. Reflective study conducted in April 2018 through the online institutional repository of the Graduate Program in Nursing of Universidade Federal do Ceará. Studies on technologies from the last five years involving people with sensory disabilities were selected. Four studies on the construction of online assistive technologies were analyzed, and three courses and one educational leaflet addressed prevention and health promotion in breast health, high blood pressure, sexual and reproductive health and prevention of sexual violence with accessible and inclusive language. It was concluded that nurses should use rigorous and effective methods in the construction of assistive technologies, observe all the steps the model, avoiding errors and optimizing results.

Construction and validation of an Educational Content Validation Instrument in Health.

OBJECTIVE: to construct and validate the Educational Content Validation Instrument in Health. METHOD: methodological study that includes the establishment of the conceptual structure; definition of objectives and population; construction of items and response scale; selection and arrangement of items; instrument structuring; opinion of experts; pre-test and content validation. RESULTS: an instrument with 15 items was constructed and, after expert evaluation, eighteen items were obtained, divided into three domains: objectives (four), structure/presentation (nine), and relevance (two). Six items were modified since they presented a percentage of agreement below 0.8. Items of the total instrument presented good internal consistency (0.877) regarding domains. CONCLUSION: an Educational Content Validation Instrument in Health was elaborated and validated, presenting good reliability, and may contribute to the practice of researchers and health professionals in the development of educational content.

Physical accessibility in primary healthcare: a step towards the embracement. / Acessibilidade física na atenção primária à saúde: um passo para o acolhimento.

OBJECTIVE: To assess the physical accessibility from the front desk of primary healthcare units. METHOD: Descriptive and quantitative research to map the accessibility of the physical space in 157 health units, between August 2014 and May 2015, in the region of Baturité, Ceará, Brazil. The data were collected using a checklist instrument type, and absolute and relative frequencies, binomial and verisimilitude tests for statistical analysis, with statistical significance of p <0.05 were used. RESULTS: Of the analyzed items, stairs (24.8%), ramps (47.1%) and floors (75.8%) were inaccessible in most health units. Comparing urban and rural areas, circulation area (0.7x, p=0.293), counter (0.4x, p=0.010), seat (0.7x, p=0.758) and drinking fountain (0.7x, p=0.736) were more inaccessible in the urban area. CONCLUSION: The access of persons with physical disabilities to primary care should be seen as a priority. There are physical, architectural and furniture barriers that compromise the full embracement of the user.

Acessibilidade física na atenção primária à saúde: um passo para o acolhimento / Accesibilidad física en la atención primaria de salud: un paso más para la acogida / Physical accessibility in primary healthcare: a step towards the embracement

Resumo OBJETIVO: Avaliar acessibilidade física da recepção de unidades de atenção primária à saúde. MÉTODO: Pesquisa descritiva, quantitativa, para mapear acessibilidade do espaço físico da área de recepção em 157 unidades de saúde, entre agosto de 2014 a maio de 2015, na região do maciço de Baturité, Ceará, Brasil. Os dados foram coletados com instrumento tipo check-list e para análise utilizou-se frequências absolutas, relativas, teste binomial e teste de verossimilhança, com significância estatística de p<0,05. RESULTADOS: Dos itens analisados, escadas (24,8%), rampas (47,1%) e piso (75,8%) foram inacessíveis na maioria das unidades de saúde. Comparando zona urbana e rural, área de circulação (0,7x; p=0,293), balcão (0,4x; p=0,010), assento (0,7x; p=0,758) e bebedouros (0,7x; p=0,736) tiveram maior inacessibilidade na zona urbana. CONCLUSÃO: O acesso das pessoas com deficiência física na atenção primária deve ser visto como prioridade; existem barreiras físicas, arquitetônicas e mobiliárias que comprometem o acolher integralmente do usuário.

Resumen OBJETIVO Evaluar la accesibilidad física de la recepción de las unidades de atención primaria de la salud. MÉTODO Investigación descriptiva y cuantitativa para mapear la accesibilidad del espacio físico de la zona de recepción en 157 unidades de salud, entre agosto 2014 y mayo 2015, en la región del cerrado de Baturité, Ceará, Brasil. Se recolectaron los datos a través del instrumento tipo check-listy, y los mismos se analizaron mediante frecuencias absolutas, relativas, prueba binomial y la prueba de probabilidad, con significación estadística de p <0,05. RESULTADOS De los elementos analizados, escaleras (24,8%), rampas (47,1%) y piso (75,8%) la mayoría de las unidades de salud era inaccesible. Comparando las áreas urbanas con las rurales, las áreas de circulación (0,7x; p = 0,293), las barras (0,4 x; p = 0,010), los asientos (0,7x; p = 0,758) y los bebederos (0,7x; p = 0,736 ) presentaron mayor inaccesibilidad en el área urbana. CONCLUSIÓN El acceso de las personas con discapacidad física en la atención primaria debe ser percibido como una prioridad. Existen barreras físicas, arquitectónicas y mobiliarias que comprometen la acogida integral del usuario.

Abstract OBJECTIVE To assess the physical accessibility from the front desk of primary healthcare units. METHOD: Descriptive and quantitative research to map the accessibility of the physical space in 157 health units, between August 2014 and May 2015, in the region of Baturité, Ceará, Brazil. The data were collected using a checklist instrument type, and absolute and relative frequencies, binomial and verisimilitude tests for statistical analysis, with statistical significance of p <0.05 were used. RESULTS Of the analyzed items, stairs (24.8%), ramps (47.1%) and floors (75.8%) were inaccessible in most health units. Comparing urban and rural areas, circulation area (0.7x, p=0.293), counter (0.4x, p=0.010), seat (0.7x, p=0.758) and drinking fountain (0.7x, p=0.736) were more inaccessible in the urban area. CONCLUSION The access of persons with physical disabilities to primary care should be seen as a priority. There are physical, architectural and furniture barriers that compromise the full embracement of the user.