Prognostic value of nutritional screening tools in hospitalized patients with decompensated heart failure: A systematic review and meta-analysis.

Nutritional risk screening is fundamental to prevent undesirable outcomes in heart failure (HF). Current reviews of nutritional screening tools encompass both hospitalized and outpatient settings, which may not be suitable because of different clinical manifestations. We hypothesize that multidimensional tools would better identify prognosis of decompensated patients because the tools assess more than isolated aspects. This systematic review aims to explore the association of multidimensional nutritional risk screening tools and prognosis in patients hospitalized with decompensated HF. Five databases were searched for studies that assessed nutritional risk through multidimensional screening tools and its association with prognosis in adults hospitalized with decompensated HF. The 95% confidence interval and relative risk were computed using a random-effects model. Inverse variance method was used. Thirty-eight studies were included. Most studies demonstrated higher nutritional risk was significantly associated with worse prognosis. Quantitative analysis identified higher nutritional risk by using the Mini Nutritional Assessment Short Form (MNA-SF), Controlling Nutritional Status, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index to be associated with all-cause mortality. The MNA-SF demonstrated greater magnitude of association with all-cause mortality in older subjects (relative risk, 4.85; 95% confidence interval, 2.0-11.75). Higher nutritional risk was associated with poor prognosis and higher mortality in patients hospitalized with decompensated HF, especially when screened by MNA-SF. Tools were not directly compared. That might reinforce the importance of evaluating multiple aspects when screening hospitalized HF patients once symptoms associated with decompensation frequently mask the underlying nutritional status and risk. PROSPERO registration number (CRD42021256271).

Effects of transcranial direct current stimulation associated with hypocaloric diet on glucose homeostasis in obesity.

OBJECTIVE: The aim of this study was to test the effects of repetitive active transcranial direct current stimulation (tDCS) over the right dorsolateral prefrontal cortex (rDLPFC) associated with a hypocaloric diet on glucose homeostasis in people with excessive weight. METHODS: Adults with overweight or obesity were selected in a randomized, double-blind pilot study to complete 4 weeks (20 sessions) of fixed-dose tDCS (2 mA, 20 minutes) delivered over the rDLPFC and associated with a standard hypocaloric diet. Participants were randomly assigned (1:1) and stratified by sex to the active tDCS group (active) or the sham tDCS group (sham). Changes in glucose homeostasis were assessed in a 4-hour liquid meal tolerance test, performed before and after the intervention. RESULTS: Twenty-eight participants were randomized (79% with obesity; mean [SD] age 37.6 [5.8] years). After the intervention, fasting plasma glucose (mean [95% CI], -7.8 mg/dL [-14.0 to -1.6]) and insulin levels (-7.7 µIU/mL [-13.9 to -1.6]) decreased in the active compared with the sham. Similarly, the Matsuda insulin sensitivity index increase in the active (4.7 pmol-1  × mmol-1 [1.6 to 7.8]) compared with the sham (0.6 pmol-1  × mmol-1 [-1.4 to 3.2]). CONCLUSIONS: Repetitive, active tDCS over the rDLPFC could be a promising noninvasive technique to improve glucose homeostasis in individuals with overweight or obesity on a low-calorie diet, highlighting the importance of investigating this intervention modality in individuals with type 2 diabetes mellitus.

Initial Development of a National Survey on Remote Learning in Early Childhood During COVID-19: Establishing Content Validity and Reporting Successes and Barriers.

This article describes the development and administration of a survey to identify early childhood educators' successes and barriers when delivering remote instruction (e.g., online whole or small group instruction) during the COVID-19 pandemic to children 2-5 years old. The survey was developed using procedures outlined by the commonly accepted stages of an instrument development process. Content validity was established using four approaches: (a) identification of the purpose of the survey, (b) creation of a blueprint of items, (c) cognitive interviews, and (d) expert panel review. A total of 1,053 early childhood educators began the survey, with 808 (77%) of the responses included because educators met the inclusion criteria of working in the United States and responding to at least one question related to remote instruction. The survey contained 37 closed-ended and six open-ended items covering eight domains: (a) demographic information; (b) preparation, guidelines, and materials for remote learning; (c) caregiver communication and engagement; (d) assessment; (e) instruction; (f) educators' levels of confidence before and after remote learning; (g) access to services (i.e., wraparound and/or special education); and (h) planning for the return to face-to-face instruction. Both quantitative (descriptive, t-test, regression, ANOVA, and Chi-square tests) and consensual qualitative research analyses were applied to summarize the survey results. Findings from this survey indicated that even with limited or no guidance from administrators, educators successfully adapted to remote instruction and their levels of confidence increased over time. Ongoing improvements need to be made to sustain regular communication with all families, to offer access to technology (i.e., devices and internet), to administer assessments or universal screeners, and to provide cohesive guidelines and expectations. Results from this study begin to shed light on early childhood educators' adaptation to remote instruction as a result of COVID-19. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10643-021-01216-y.

The effect of transcranial direct current stimulation along with a hypocaloric diet on weight loss in excessive weight people: A pilot randomized clinical trial.

BACKGROUND & AIMS: The dorsolateral prefrontal cortex plays an important role in the desire to eat and food intake regulation and may be a target for transcranial direct current stimulation (tDCS) to promote weight loss. Our aim was to test the effect of repeated, active tDCS along with a hypocaloric diet (HD) on weight loss in overweight adults. METHODS: This was a randomized, placebo-controlled, double-blind pilot study conducted in Porto Alegre, Brazil. Twenty-eight overweight adults were selected to receive 4-week (20 sessions, t0 to t20; 5 weekdays) fixed-dose tDCS along with an HD. Subjects were randomly assigned to active (AG) or sham (SG) tDCS groups. The primary outcome was weight loss as determined via body weight measurements at baseline (t0), weekly (t5, t10, t15, and t20), and after the intervention (tF). A visual analogue scale was used to assess desire to eat at t0 and at tF. Registered under ClinicalTrials.gov Identifier no. NCT02683902. RESULTS: Although there was a greater weight loss in the AG (mean -4.5 kg [95%CI: -9.4, 0.5]) than in the SG (-2.3 kg [-5.0, 0.3]), this difference was not statistically significant. However, the AG showed a significant reduction in the desire for sweet foods (P = 0.005). CONCLUSIONS: Although this pilot study did not show that repeated tDCS is able to optimize weight loss, it was able to reduce the desire to eat sweet foods. These findings suggest that a protocol with a larger sample size could determine whether tDCS may be an adjunctive treatment of obesity.

Antimicrobial and fluoride release capacity of orthodontic bonding materials.

OBJECTIVE: The aim of this study was to evaluate the antimicrobial and fluoride releasing capacity of 3 bonding materials. MATERIAL AND METHODS: Thirty nine specimens with standardized surface smoothness and dimensions were prepared. The antimicrobial capacity of the materials against S. mutans, L. casei and C. albicans was evaluated by determining the percentage of growth inhibition of these microorganisms in an inoculated medium, obtained by optical density readouts on a spectrophotometer. The potential to interfere in microbial growth on the surface of the studied materials was observed by means of scanning electron microscopy (SEM). The fluoride release capacity in ultrapure water for 14 days was analyzed by means of ion chromatography. RESULTS: The PLUS group presented the highest percentage of microbial inhibition and the most contamination-free surface. The FUJI group presented the best fluoride release capacity. CONCLUSIONS: The TransbondTM Plus Color Change was the one that presented the best general behavior considering the evaluated aspects.

Antimicrobial and fluoride release capacity of orthodontic bonding materials

OBJECTIVE: The aim of this study was to evaluate the antimicrobial and fluoride releasing capacity of 3 bonding materials. MATERIAL AND METHODS: Thirty nine specimens with standardized surface smoothness and dimensions were prepared. The antimicrobial capacity of the materials against S. mutans, L. casei and C. albicans was evaluated by determining the percentage of growth inhibition of these microorganisms in an inoculated medium, obtained by optical density readouts on a spectrophotometer. The potential to interfere in microbial growth on the surface of the studied materials was observed by means of scanning electron microscopy (SEM). The fluoride release capacity in ultrapure water for 14 days was analyzed by means of ion chromatography. RESULTS: The PLUS group presented the highest percentage of microbial inhibition and the most contamination-free surface. The FUJI group presented the best fluoride release capacity. CONCLUSIONS: The TransbondTM Plus Color Change was the one that presented the best general behavior considering the evaluated aspects. .

Does bone mineral density influence the primary stability of dental implants? A systematic review.

OBJECTIVE: The aim of this systematic review was to investigate the influence of bone mineral density on the primary stability of dental implants. MATERIAL AND METHODS: A search of health science databases (Cochrane Library, MEDLINE-PubMed, ISI Web of Knowledge, EMBASE, LILACS) and grey literature was performed, including papers published until January 2011. The main key words used were "bone density" (MeSH/DeCS), "dental implant" (MeSH/DeCS), "implant stability", "implant stability quotient", "ISQ", "resonance frequency analysis", "RFA", "Osstell", "Periotest value", "PTV", "Periostest", "insertion torque", "placement torque", "cutting torque". The inclusion criteria comprised observational clinical studies performed in patients who received dental implants for rehabilitation; studies that evaluated the association between bone mineral density and implant primary stability; bone density assessment performed by measurement of Hounsfield units using cone beam computed tomography; and dental implant primary stability evaluated by ISQ value, PTV value or insertion torque measurement. The articles selected were carefully read and classified as low, moderate and high methodological quality, and data of interest were tabulated. RESULTS: Ten articles met the inclusion criteria, but only seven were included because of overlapping patients. They were classified as low or moderate methodological quality and control of bias, and presented positive association between primary stability and bone density. CONCLUSIONS: There is a positive association between implant primary stability and bone mineral density of the receptor site. However, the methodological quality and control of bias of the studies should be improved to produce stronger evidences.