Prevalence of disabling musculoskeletal pain in children and adolescents in Brazil: A cross-sectional study.

BACKGROUND: Estimates of prevalence of musculoskeletal pain in children and adolescents vary considerably and the impact of pain on children's life is often not considered. OBJECTIVE: To determine the one-month prevalence of disabling musculoskeletal pain in children and adolescents. The secondary aims are to: 1) determine the body region with the highest prevalence; 2) understand the characteristics of the children with disabling musculoskeletal pain; and 3) describe the parents' perception of the prevalence. METHODS: This cross-sectional study was conducted in public and private schools in the states of São Paulo and Ceará, Brazil. Children self-reported presence and impact of pain, pain intensity, psychosomatic symptoms, and quality of life. Parents completed parent-proxy versions and perception of the child's sleep quality. Descriptive statistics were used to summarise the data. RESULTS: A total of 2,688 children and adolescents were included in this study. The prevalence of disabling musculoskeletal pain in the previous month was 27.1%. The back was the region most often affected (51.8%). Children with disabling musculoskeletal pain were older, heavier, had worse relationships with their family, perceived their backpacks as heavy, carried their backpacks more with one shoulder, had more negative psychosomatic symptoms, had poorer quality of life, and had higher pain intensity. Parents tended to underestimate the presence of pain in their children. CONCLUSION: The one-month prevalence of activity limiting musculoskeletal pain in children and adolescents was 27.1% with the back being the most often affected body region. Parents tended to underestimate the presence of pain in their children.

Trunk muscles influence lower limb performance in crossfit athletes: A cross-sectional study.

INTRODUCTION: Crossfit is a sport that combines cardio-respiratory and muscle endurance, strength, flexibility, muscle power, speed, coordination, agility and balance. However, there is no information in the literature regarding functional performance of the lower limbs and the endurance of core muscles in this population. The objective of this study was to evaluate the correlation between trunk strength/endurance and lower limb function through lower limb symmetry and balance tests. METHODS: Forty-one young adults aged 19-41 years (26.3 ± 5.4) participated, 15 sedentary and 26 cross fit practitioners for at least one year. The tests were as follows: Biering-Sørensen Test of trunk extensor endurance, Trunk Flexors Endurance Test at 60°, Side Plank Endurance Test, Lumbar Dynamometry, Single-Leg Hop Test and Star Excursion Balance Test. RESULTS AND DISCUSSION: Although there were higher values, there was no significant difference (p > 0.05) between the groups for lower limb symmetry and strength of trunk flexor muscles. For balance, strength and resistance variables of trunk extensor muscles, the values found were higher in crossfit practitioners than in sedentary subjects. CONCLUSION: There is a relationship between trunk muscle strength and endurance and lower limb balance. Moreover, cross fit athletes showed higher values of trunk muscle strength/endurance and lower limb balance compared to sedentary adults.

Sociodemographic and undergraduate-related variables as predictors of dental students' empathy: an e-survey in a south brazilian dental school / Variáveis sociodemográficas e relacionadas à graduação como preditoras da empatia de estudantes de odontologia: um e-survey em uma faculdade de odontologia do Sul do Brasil

Aim: To assess the associations between sociodemographic and undergraduate-related characteristics and empathy scores among dental students in a school in Southern Brazil. Materials and methods: Cross-sectional study developed from self-administered online questionnaires to undergraduate dental students at the Federal University of Pelotas. Outcomes were the total score of empathy obtained through the Interpersonal Reactivity Index (IRI) and the scores obtained in four domains: perspective-taking (PT), fantasy (FA), empathic concern (EC), and personal distress (PD). In RStudio version 4.1.3 simple and adjusted linear regression models with robust residual standard errors were performed. Results: Eighty-seven students were included (response rate 24.4%). Considering the total IRI score, there was a mean score of 3.62 (SD=0.64) by item, and dental students had a mean score of 94.07 (SD=16.62). In adjusted analysis, being a woman increased the IRI (0.505;95%CI 0.187;0.823), EC (0.494;95%CI 0.168;0.819), and PT (0.822; 95%CI 0.329;1.315) scores compared to men. Adjusted associations were found between the EC domain and skin color and between the PT domain and family income. FA scores increased with age and family income and, decreased with dissatisfaction with undergraduate studies, only in the bivariate analysis. Discussion: Dental professionals' empathy is essential in daily practice, improving the patient-professional relationship in a patient-centered care approach. Thus, it is relevant to recognize predictors of empathy among dental students to promote strategies to increase empathy in dental practice. Conclusion: Gender, skin color, family income, age, and satisfaction with undergraduate studies were associated with empathy scores among dental students.

Objetivo: Avaliar associações entre as características sociodemográficas e relacionadas à graduação e os escores de empatia entre estudantes de odontologia de uma escola do Sul do Brasil. Materiais e métodos: Estudo transversal desenvolvido com questionários on-line autoadministrados para estudantes de graduação em odontologia da Universidade Federal de Pelotas. Foram considerados desfechos o escore total de empatia medido pelo Índice de Reatividade Interpessoal (IRI) e os escores obtidos em quatro domínios: tomada de perspectiva (TP), fantasia (FA), consideração empática (CE) e angústia pessoal (AP). No RStudio versão 4.1.3 foram realizadas regressões lineares simples e múltiplas com erros residuais robustos. Resultados: Foram incluídos 87 alunos (taxa de resposta=24,4%). Considerando a pontuação total do IRI, houve média de 3,62 (DP=0,64) por item, e de 94,07 (DP=16,62) por estudante. Na análise multivariável, mulheres tiveram maiores pontuações no IRI (0,505; IC95%0,187;0,823), CE (0,494; IC95%0,168;0,819) e AP (0,822; IC95%0,329;1,315) em comparação aos homens. Foram encontradas associações ajustadas entre o domínio CE e cor da pele e entre o domínio PT e renda familiar. Os escores do domínio FA aumentaram com idade e renda familiar e diminuíram com insatisfação com a graduação, somente em análise bivariada. Discussão: A empatia do profissional de odontologia é essencial na prática diária, melhorando a relação paciente-profissional. Assim, é relevante reconhecer os preditores da empatia entre os estudantes de odontologia, visando estratégias para aumentar a empatia na prática odontológica. Conclusão: Gênero, cor da pele, renda familiar, idade e satisfação com a graduação foram associados aos escores de empatia entre estudantes de odontologia.

Uncovering the Relationship Between Statins and Muscle Problems in the ELSA-Brasil MSK Cohort.

PURPOSE: To investigate the association between statins and muscle problems in a highly diverse sample of Brazilian civil servants. METHODS: We conducted a cross-sectional data analysis at baseline of the ELSA-Brasil MSK cohort. Pain was identified through self-reported symptoms in large muscle groups (lower back and/or hips/thighs). Muscle strength was assessed using the five-times-sit-to-stand (FTSTS) and handgrip tests, with weakness defined as the lowest and highest quintiles of age- and sex-stratified handgrip strength and FTSTS performance time, respectively. Multivariable logistic regression analyses were conducted to investigate the association between statin use and muscle pain and weakness. Secondary analyses explored the impact of different types of statins and their duration of use on the response variables. RESULTS: A total of 2156 participants (mean age 55.6 ± SD 8.9, 52.8% women) were included, of whom 21.1% were taking statins and 25.1% reported muscle pain. We found no significant association between statin use and muscle problems. Secondary analysis on different types of statins revealed an association between atorvastatin and muscle weakness, as measured by the five-times-sit-to-stand test (OR 1.94, 95% CI 1.12-3.37), but not by the handgrip test (OR 0.75, 95% CI 0.29-1.42). No evidence was found to support a link between the duration of statin treatment and muscle problems. CONCLUSIONS: This study challenges previous claims of an efficacy-effectiveness gap between experimental and observational literature on statins. The findings indicate that statin use does not contribute to muscular problems.

What can Mendelian randomization contribute to biological anthropology?

Uncovering causal relationships between exposures and outcomes can be difficult in observational studies because of the potential for confounding and reverse causation to produce biased estimates. Conversely, randomized controlled trials (RCTs) provide the strongest evidence for causality but they are not always feasible. Mendelian randomization (MR) is a method that aims to strengthen causal inference using genetic variants as proxies or instrumental variables (IVs) for exposures, to overcome the above-mentioned biases. Since allele segregation occurs at random from parents to offspring, and alleles for a trait assort independently from those for other traits, MR studies have frequently been compared to "natural" RCTs. In biological anthropology (BA) relationships between variables of interest are usually evaluated using observational data, often remaining descriptive, and other approaches to causal inference have seldom been implemented. Here, we propose the use of MR to investigate cause and effect relationships in BA studies and provide examples to show how that can be done across areas of BA relevance, such as adaptation to the environment, nutrition and life history theory. While we consider MR a useful addition to the biological anthropologist's toolbox, we advocate the adoption of a wide range of methods, affected by different types of biases, in order to better answer the important causal questions for the discipline.

Estudios de corte transversal: un diseño de investigación a considerar en ciencias morfológicas / Cross section studies: a research design to consider in morphological sciences

Los estudios de corte transversal (ECT) inician en la década de los 40 en países Europeos. Los ECT corresponden a investigaciones de tipo observacional que permiten estudiar prevalencia de enfermedad, determinar asociación entre variables y el desarrollo de un efecto de interés, conocer propiedades de una prueba diagnóstica, y censar poblaciones; describiendo las características de una población en un momento y lugar determinado. Esto implica, que no se requieren periodos de seguimiento, que no son prospectivos ni retrospectivos; características que permiten que sean más baratos y fáciles de realizar en relación a los estudios longitudinales. Por otro lado, al ser de carácter descriptivo sirven como insumo y evidencia preliminar para estudios de mayor complejidad metodológica, como estudios de cohortes. Sin embargo, tienen limitantes y sesgos que deben ser considerados por los investigadores. El objetivo de este manuscrito fue generar un documento de estudio para revisar características esenciales, fortalezas y debilidades; discutir cuestiones metodológicas de los ECT en ciencias de la salud; y proporcionar algunos ejemplos obtenidos de la literatura, para mejor comprensión del diseño.

SUMMARY: Cross-sectional studies (CSS) began European countries in the 1940s in. The CSSs correspond to observational-type investigations that allow studying the prevalence of disease, determining the association between variables and the development of an effect of interest, discovering the properties of a diagnostic test, and censusing populations, describing the characteristics of a population at a given time and place. This implies that follow-up periods are not required, and that they are neither prospective nor retrospective. These characteristics allow them to be cheaper and easier to perform in relation to longitudinal studies. On the other hand, being descriptive in nature, they serve as input and preliminary evidence for studies of greater methodological complexity, such as cohort studies. However, they have limitations and biases that must be considered by researchers. The aim of this manuscript was to generate a study document to review essential characteristics, strengths and weaknesses; discuss methodological issues of ECT in health sciences; and provide some examples obtained from the literature, for a better understanding of the design.

Vitamin D and depression in older adults: lessons learned from observational and clinical studies.

Depression is a mental disorder triggered by the interaction of social, psychological and biological factors that have an important impact on an individual's life. Despite being a well-studied disease with several established forms of treatment, its prevalence is increasing, especially among older adults. New forms of treatment and prevention are encouraged, and some researchers have been discussing the effects of vitamin D (VitD) on depression; however, the exact mechanism by which VitD exerts its effects is not yet conclusive. In this study, we aimed to discuss the possible mechanisms underlying the association between VitD and depression in older adults. Therefore, we conducted a systematic search of databases for indexed articles published until 30 April 2021. The primary focus was on both observational studies documenting the association between VitD and depression/depressive symptoms, and clinical trials documenting the effects of VitD supplementation on depression/depressive symptoms, especially in older adults. Based on pre-clinical, clinical and observational studies, it is suggested that the maintenance of adequate VitD concentrations is an important issue, especially in older adults, which are a risk population for both VitD deficiency and depression. Nevertheless, it is necessary to carry out more studies using longitudinal approaches in low- and middle-income countries to develop a strong source of evidence to formulate guidelines and interventions.

Análisis mediante variables instrumentales para establecer causalidad en investigaciones observacionales / Analysis through instrumental variables to establish causality in observational research

La identificación de relaciones causales es uno de los problemas fundamentales de la investigación científica en medicina y es necesaria para poder ejercerla en forma efectiva. Sin embargo, desde el punto de vista práctico es difícil establecer la existencia de relaciones causales en estudios de carácter observacional, en gran parte por la presencia de factores de confusión. El análisis a través de variables instrumentales es una de las estrategias que permite controlar el efecto confundidor y documentar la presencia de relaciones causa-efecto en estas situaciones. En este artículo, el autor resume los principales supuestos del análisis a través de variables instrumentales, haciendo foco en la aleatorización mendeliana. (AU)

The identification of causal relationships is one of the fundamental challenges in scientific research in medicine and is necessary for its effective practice. However, from a practical standpoint, establishing the existence of causal relationships in observational studies is difficult, largely due to the presence of confounding factors. Analysis through instrumental variables is one of the strategies that allows to control the confounding effect and documenting the presence of cause-and-effect relationships in these situations. In this article, the author summarizes the main assumptions of analysis through instrumental variables, with a focus on Mendelian randomization. (AU)

Association of Polyphenols Consumption with Risk for Gestational Diabetes Mellitus and Preeclampsia: A Systematic Review and Meta-Analysis.

Gestational Diabetes Mellitus (GDM) and preeclampsia (PE) affects 6-25% of pregnancies and are characterized by an imbalance in natural prooxidant/antioxidant mechanisms. Due to their antioxidant and anti-inflammatory properties, polyphenols consumption during the pregnancy might exert positive effects by preventing GDM and PE development. However, this association remains inconclusive. This systematic review and metanalysis is aimed to analyze the association between polyphenol-rich food consumption during pregnancy and the risk of GDM and PE. A systematic search in MEDLINE, EMBASE, and Web of Science (Clarivate Analytics, London, United Kingdom) for articles dated between 1 January 1980 and July 2022 was undertaken to identify randomized controlled trials and observational studies evaluating polyphenol-rich food consumption and the risk of GDM and PE. The Newcastle-Ottawa Scale was used to evaluate the quality of these included studies. Twelve studies were included, of which eight articles evaluated GDM and four studied PE. A total of 3785 women presented with GDM (2.33%). No association between polyphenol consumption and GDM was found (ES = 0.85, 95% CI 0.71-1.01). When total polyphenol intake was considered, a lower likelihood to develop GDM was noted (ES = 0.78, 95% CI 0.69-0.89). Furthermore, polyphenol consumption was not associated with PE development (ES = 0.90, 95% CI 0.57-1.41). In conclusion, for both outcomes, pooled analyses showed no association with polyphenol-rich food consumption during pregnancy. Therefore, association of polyphenol intake with a decreased risk of GDM and PE remains inconclusive.

Associação entre características sociodemográficas e adesão à detecção precoce do câncer de mama / Association between sociodemographic characteristics and adherence to early detection of breast cancer

RESUMO Objetivo verificar a associação entre as características sociodemográficas e a realização das ações de detecção precoce do câncer de mama. Métodos estudo transversal, realizado em seis unidades de atenção primária à saúde, com 400 mulheres consideradas população-alvo para ações de detecção precoce do câncer de mama. Para análise inferencial foi utilizado o Teste de Qui-quadrado de Independência (2x2). Resultados a maioria das mulheres estava entre 60 e 64 anos, eram casadas, com baixa escolaridade, sem ocupação ou plano de saúde. Foi encontrada associação significativa entre o estado civil e o intervalo entre a solicitação e a realização da mamografia (X 2 (1)= 208,185, p<0,001, Phi-coefficient = 0,902; Intervalo de Confiança: 0,0308-0,0928). Mulheres sem companheiro apresentaram prevalência 0,95 vezes maior de realizar mamografia. Conclusão houve associação da variável sociodemográfica estado civil com a realização da mamografia, em um intervalo menor de tempo, tendo como fator de proteção não possuir companheiro. Contribuições para a prática a elucidação de fatores que podem estar relacionados com a realização das ações para rastreio do câncer de mama pode sinalizar para os profissionais de saúde as pacientes que necessitam de uma maior vigilância no que concerne à presença de sinais e sintomas sugestivos do câncer de mama.

ABSTRACT Objective to verify the association between sociodemographic characteristics and the performance of actions for early detection of breast cancer. Methods a cross-sectional study was carried out in six primary health care units, with 400 women considered a target population for actions for early detection of breast cancer. The Chi-square test of independence (2x2) was used for inferential analysis. Results most women were between 60 and 64 years old, married, had low education and lacked an occupation or health insurance. A significant association was found between marital status and the interval between requesting and performing a mammogram (X 2 (1) = 208.185, p<0.001, Phi-coefficient= 0.902; Confidence Interval: 0.0308-0.0928). Women without a partner had a 0.95 times higher prevalence of having a mammogram. Conclusion there was an association between the sociodemographic variable marital status and the performance of mammography in a shorter period, and not having a partner was a protective factor. Contributions to practice the elucidation of factors related to the performance of actions for breast cancer screening can signal patients who need greater vigilance regarding the presence of signs and symptoms suggestive of breast cancer.

The importance of full text screening when judging eligibility criteria in a systematic review: a systematic survey / A importância da avaliação do texto completo ao julgar os critérios de elegibilidade em uma revisão sistemática: uma revisão de métodos

Aim: To evaluate if statistically significant results are more likely to be reported in title/abstracts compared to non-significant outcomes. Methods: In this methodological survey, we reanalyzed 59 observational studies from a previous systematic review. The PECO question was: Patient (P): children with primary teeth; Exposure (E): low birth weight and/or preterm; Comparison (C): normal birth weight and/or full-term; Outcome (O): dental caries. We analyzed the presence of key terms in the titles and abstracts, such as gestational age, preterm, full-term, birth weight, low/normal birth weight. Full texts were analyzed for "positive outcomes" (statistically significant association, p < 0.05 or 95% CI not crossing the null effect line) related to the association between the outcome and the exposure; and "negative outcomes" (when the outcome had statistically similar occurrence between the exposure and the comparison group). The odds ratio (OR) was calculated between the presence of key terms in titles/abstracts and the type of outcome (positive or negative). Results: Of 59 studies, 66% cited the key terms in titles/abstracts, and 75% reported negative outcomes. Studies with positive outcomes were more likely to report key terms in the titles/abstracts compared to studies with negative outcomes (OR: 4.5; 95% CI: 0.9-22.4; Chi-square test: p = 0.06). Studies with statistically significant outcomes, favoring the exposure or the comparison, were more likely to report these data in the titles/abstracts. Conclusion: When conducting a systematic review, the final decision related to the inclusion of a study must be based on a full-text level.

Objetivo: Avaliar se os resultados estatisticamente significativos são mais prováveis de serem relatados nos títulos/resumos dos artigos do que os resultados não significativos. Métodos: Neste levantamento metodológico, foram reanalisados 59 estudos observacionais de uma revisão sistemática anterior. A questão PECO foi: Paciente (P): crianças com dentes decíduos; Exposição (E): baixo peso ao nascer e/ou pré-termo; Comparação (C): peso normal ao nascer e/ou a termo; Resultado (O): cárie dentária. Foi analisada a presença de termos-chave nos títulos/resumos, como idade gestacional, pré-termo, a termo, peso ao nascer, baixo/peso normal ao nascer. Textos completos foram analisados para "desfechos positivos" (associação estatisticamente significativa, p < 0,05 ou IC 95% não cruzando a linha de efeito nulo) relacionados à associação entre o desfecho e a exposição; e "desfechos negativos" (quando o desfecho teve ocorrência estatisticamente semelhante entre a exposição e o grupo de comparação). Foi calculada a odds ratio (OR) entre a presença de termos-chave nos títulos/resumos e o tipo de resultado (positivo ou negativo). Resultados: Dos 59 estudos, 66% citaram os termos-chave nos títulos/resumos e 75% relataram resultados negativos. Estudos com resultados positivos foram mais propensos a relatar os termos-chave nos títulos/resumos em comparação com estudos com resultados negativos (OR: 4,5; IC 95%: 0,9-22,4; teste do qui-quadrado: p = 0,06). Estudos com significância estatística os desfechos, favorecendo a exposição ou a comparação, foram mais propensos a relatar esses dados nos títulos/resumos. Conclusão: Ao realizar uma revisão sistemática, a decisão final quanto à inclusão de um estudo deve ser baseada por meio da análise do texto completo.

The mortality burden of hematological malignancies in Ecuador.

BACKGROUND: The Hematological neoplasms (HN) are a heterogeneous group of cancers that originated in the hematopoietic or lymphoid tissues. There is reduced information published regarding HN mortality in Ecuador. This study aims to present the crude and age-specific mortality rates for HN in the Ecuadorian population. METHODS: We performed a cross-sectional study through the national database of defunctions published by the Ecuadorian National Institute of Statistics and Census, 2019. We used the ICD-10 codes to classify the HN. RESULTS: During 2019, 1462 deaths were reported, 53.83% were males, 87.96% of mestizo ethnicity, and 78.32% residents in urban areas. The median age was 62 years, with an interquartile range of 34.The crude mortality rate obtained was 8.49 per 100000 inhabitants, and the higher age-specific mortality rates was 43.29 per 100000 inhabitants aged ≥ 60 years, contrasting with the 2.63 per 100000 inhabitants in people aged < 20 years. Considering each ICD-10 group, we found the following rates by 100000 inhabitants; C85 2.04, C91 1.92, C92 1.46, C90 1.11, C83 0.70, C95 0.48, C81 0.38, C84 0.16, C82 0.10, C96 0.05, C93 0.04, C86 and C94 0.02, and C88 0.01. CONCLUSION: In Ecuador, during 2019, approximately eight people died due to HN by 100000 inhabitants, affecting mainly people aged ≥ 60 years. The most frequent neoplasms were Non-Hodgkin lymphomas, similar to other reports globally. These results should be analyzed considering some deficiencies in the Ecuadorian health system and the national registry. Therefore, we suggest conducting more studies regarding HN.

Estudo de métodos mistos do conforto de estudantes de enfermagem para atender a pedidos de oração / Mixed methods study of nursing students comfort to answer prayer requests

INTRODUÇÃO: A oração é uma prática espiritual ancestral e amplamente difundida no Brasil e no mundo. Ainda que o ato de orar seja uma prática religiosa, quando solicitada pelo paciente pode se mostrar como um caminho para o cuidado espiritual e o atendimento às necessidades espirituais. No entanto, pode haver desconforto relacionado a essa prática quando esta é considerada pelo profissional de saúde como uma atividade além do cuidado. Esse desconforto pode interferir na prática do cuidado espiritual e o uso da oração como estratégia de acolhimento, de modo a provocar uma não aceitação desse pedido. A oração no cuidado em saúde pode ser influenciada por experiências individuais dos envolvidos, formação e crenças religiosas ou espirituais e pelo fato de o profissional sentir-se confortável ou não em relação a esta prática, como parte da sua função de cuidador. OBJETIVO: Explorar o conforto de acadêmicos de enfermagem com a solicitação de oração iniciada pelo paciente em diferentes cenários simulados. METODOLOGIA: Trata-se de um estudo de métodos mistos realizado com 90 estudantes matriculados no curso de graduação de Enfermagem da Universidade Federal de Minas Gerais no segundo semestre de 2020. Os estudantes responderam ao questionário sociodemográfico, ao Questionário de Conforto do Estudante de Enfermagem face a um Pedido de Oração pelo paciente (Prayer and the Registered Nurse-PRN) e ao instrumento de Qualidade de Vida/espiritualidade, religião e crenças pessoais (WHOQOL-SRPB). RESULTADOS: Verificou-se predominância de estudantes do gênero feminino, de cor branca e parda, com média de idade de 25 anos e que se reconhecem majoritariamente como católicos e evangélicos-protestantes. A maior parte dos participantes referiu conforto e disponibilidade em atender ao pedido de oração. Não se observou associação entre gênero, período do curso e identificação com as religiões católica e evangélicos-protestantes e o conforto dos estudantes para orar com pacientes e seus familiares. Já a experiência anterior em orar com um paciente ou familiar, idade maior que 23 anos, a identificação com alguma religião e maiores níveis de espiritualidade se mostraram associadas ao conforto em realizar a oração. A partir dos dados qualitativos, identifica-se que, o atendimento ao pedido de oração esteve relacionado a compatibilidade de crenças entre o estudante e o paciente, a ambientes que garantem privacidade para o atendimento ao pedido, ao conhecimento acerca do cuidado espiritual, à empatia e à capacidade de se conectar e atender às necessidades do indivíduo. CONCLUSÃO: O conforto para o cuidado espiritual e atendimento ao pedido de oração se relaciona com a aceitação ou não aceitação do pedido de oração realizado pelos pacientes. Identificar os fatores predisponentes para a tomada de decisão acerca desse pedido fornece subsídio para que a formação profissional, a pesquisa, a política e a prática possam fortalecer o que favorece o atendimento ao pedido e enfraquecer aquilo que conduz ao não atendimento. Por sua vez, para que essa realidade seja transformada, faz-se necessário a implementação de políticas de saúde pública e educacionais, além de um suporte das organizações e serviços de saúde voltados para o cuidado espiritual.

INTRODUCTION: Prayer is an ancient and widespread spiritual practice in Brazil and around the world. Although the act of praying is a religious practice, when requested by the patient, it can be shown as a path to spiritual care and meeting spiritual needs. However, there may be discomfort related to this practice when it is considered by the health professional as an activity beyond care. This discomfort can interfere with the practice of spiritual care and the use of prayer as a welcoming strategy, in order to provoke non-acceptance of this request. Prayer in health care can be influenced by the individual experiences of those involved, training and religious or spiritual beliefs and by the fact that the professional feels comfortable or not in relation to this practice, as part of their role as a caregiver. OBJECTIVE: To explore the comfort of nursing students with patient-initiated prayer request in different simulated scenarios. METHODOLOGY: This is a mixed methods study carried out with 90 students enrolled in the undergraduate Nursing course at the Federal University of Minas Gerais in the second half of 2020. The students answered the sociodemographic questionnaire, the Nursing Student Comfort Questionnaire face to a Prayer Request by the patient (Prayer and the Registered Nurse-PRN) and to the instrument of Quality of Life/spirituality, religion and personal beliefs (WHOQOL-SRPB). RESULTS: There was a predominance of female students, white and brown, with a mean age of 25 years and who mostly recognize themselves as Catholics and Evangelical-Protestants. Most participants reported comfort and willingness to respond to the prayer request. There was no association between gender, period of the course and identification with the Catholic and Evangelical-Protestant religions and the students' comfort to pray with patients and their families. Previous experience in praying with a patient or family member, over 23 years of age, identification with a religion and higher levels of spirituality were associated with comfort in praying. From the qualitative data, it is identified that the fulfillment of the prayer request was related to the compatibility of beliefs between the student and the patient, to environments that guarantee privacy for the service of the request, to knowledge about spiritual care, to empathy and the ability to connect and meet the individual's needs. CONCLUSION: Comfort for spiritual care and answering the prayer request is related to the acceptance or non-acceptance of the prayer request made by the patients. Identifying the predisposing factors for decision-making about this request provides support so that professional training, research, policy and practice can strengthen what favors the fulfillment of the request and weaken what leads to non-compliance. In turn, for this reality to be transformed, it is necessary to implement public health and educational policies, in addition to support from health organizations and services focused on spiritual care.

On the use of the E-value for sensitivity analysis in epidemiologic studies / O uso do valor de E para análise de sensibilidade em estudos epidemiológicos / Sobre el uso del E-value para el análisis de sensibilidad en los estudios epidemiológicos

Abstract: This study illustrates the use of a recently developed sensitivity index, the E-value, helpful in strengthening causal inferences in observational epidemiological studies. The E-value aims to determine the minimum required strength of association between an unmeasured confounder and an exposure/outcome to explain the observed association as non-causal. Such parameter is defined as E - v a l u e = R R + R R R R - 1, where RR is the risk ratio between the exposure and the outcome. Our work illustrates the E-value using observational data from a recently published study on the relationship between indicators of prenatal care adequacy and the outcome low birthweight. The E-value ranged between 1.45 and 5.63 according to the category and prenatal care index evaluated, showing the highest value for the "no prenatal care" category of the GINDEX index and the minimum value for "intermediate prenatal care" of the APNCU index. For "inappropriate prenatal care" (all indexes), the E-value ranged between 2.76 (GINDEX) and 4.99 (APNCU). These findings indicate that only strong confounder/low birthweight associations (more than 400% increased risk) would be able to fully explain the prenatal care vs. low birthweight association observed. The E-value is a useful, intuitive sensitivity analysis tool that may help strengthening causal inferences in epidemiological observational studies.

Resumo: O estudo ilustra o uso de um índice recém-desenvolvido para análise de sensibilidade, o valor de E, útil para embasar inferências causais em estudos epidemiológicos observacionais. O valor de E busca identificar a força mínima da associação entre um fator de confusão não medido e uma exposição/desfecho que seria necessária para explicar a associação observada enquanto não causal, definido como valor de E - v a l u e = R R + R R R R - 1, onde RR é a razão de riscos entre a exposição e o desfecho. Aqui, o valor de E é exemplificado através de dados observacionais de um estudo recém-publicado sobre a relação entre indicadores de adequação da assistência pré-natal e o baixo peso ao nascer enquanto desfecho. O valor de E variou entre 1,45 e 5,63, a depender da categoria e do índice de assistência pré-natal avaliado, com o valor máximo para a categoria "sem assistência pré-natal" do índice GINDEX e o mínimo para "assistência pré-natal intermediária" do índice APNCU. Na categoria "assistência pré-natal inadequada" (todos os índices), o valor de E variou entre 2,76 e 4,99 (índices GINDEX e APNCU, respectivamente). Isso indica que apenas associações fortes entre um fator de confusão e baixo peso ao nascer (aumento de risco maior que 400%) seria capaz de explicar plenamente a associação entre assistência pré-natal e baixo peso ao nascer. O valor de E é uma ferramenta útil e intuitiva para análise de sensibilidade, que pode ajudar a fortalecer as inferências causais em estudos epidemiológicos observacionais.

Resumen: El presente estudio ilustra el uso de un índice desarrollado recientemente para el análisis de la sensibilidad, el E-value, útil para el fortalecimiento de las inferencias causales en los estudios epidemiológicos observacionales. El E-value tiene por objetivo identificar la fortaleza de asociación mínima necesaria entre un factor de confusión no calculable y una exposición/resultado que sería necesario para explicar la asociación observada como no-causal, y está definida como E - v a l u e = R R + R R R R - 1, donde RR es la ratio de riesgo entre la exposición y el resultado. Aquí, el E-value es ilustratado con datos observacionales de un estudio recientemente publicado para mostrar la relación entre indicadores de adecuación de cuidado prenatal y el resultado de bajo peso al nacer. El E-value varió entre 1,45 and 5,63, dependiendo de la categoría y el índice cuidado prenatal evaluado, con su valor más alto para la categoría "no cuidado prenatal" del índice GINDEX y el mínimo para el "cuidado prenatal intermedio" del índice APNCU. En la categoría "inapropiado cuidado prenatal" (todos los índices) el E-value varió entre 2,76 y 4,99 (los índices GINDEX y APNCU, respectivamente). Esto indica que solamente un factor de confusión fuerte/asociaciones bajo peso al nacer (incrementaron el riesgo más de un 400%) habría hecho posible explicar completamente la asociación observada cuidado prenatal vs bajo peso al nacer. El E-value es una herramienta de análisis de sensibilidad útil, intuitiva, que puede ayudar a fortalecer las inferencias causales en los estudios epidemiológicos observacionales.

How Can Galectin-3 as a Biomarker of Fibrosis Improve Atrial Fibrillation Diagnosis and Prognosis?

Galectin-3 (Gal-3) is a biomarker of fibrosis that has been associated with atrial remodeling. Acknowledging the presence of a biomarker in patients with atrial fibrillation (AF) can allow for a better clinical treatment. The aim of this study was to assess the association of Gal-3 with atrial fibrosis in patients with AF. This is a systematic review study. From the total number of studies analyzed, 12 demonstrated a relation between atrial fibrosis and Gal-3 in patients with AF and presented statistically significant association values. We conclude that Gal-3 is associated with atrial fibrosis in patients with AF in all types, as well as after the arrhythmia treatment by ablation.

Homologies and heterogeneity between Rheumatology Congresses: Mexican, American College of Rheumatology and European League Against Rheumatism. / Análisis de homologías y heterogeneidad entre congresos de Reumatología: mexicanos, ACR y EULAR.

BACKGROUND: Medical meetings are a tool to help physicians advance and update their medical knowledge. Their quality is the responsibility of colleges and institutions. OBJECTIVE: To assess and compare the academic level of four different annual rheumatology meetings. MATERIAL AND METHODS: As a source of information, we used the abstracts published in the supplements of the journal Reumatología Clínica, SE1 Vol. 12, issued in February 2016, SE 1 Vol. 13 issued in February 2017, the electronic application of the 2016 ACR/ARHP of the 2016 American Congress of Rheumatology, devoted to the works presented at the 44th Mexican Congress of Rheumatology (CMR 44), the 45th Mexican Congress of Rheumatology (CMR 45), and the 2016 ACR/ARHP Annual Meeting (ACR 2016), as well as the Web page on the files and abstracts of EULAR 2017, respectively; from each work we compiled information on the major disease being referred to, the type of information provided and the type of report. We should point out that some were combined conditions or designs, from which we selected that which we considered to be the most important. RESULTS: In all, 275, 340, 3275 and 4129 studies were submitted to the XLIV Mexican Congress of Rheumatology, XLV Mexican Congress of Rheumatology, the 2016 ACR/ARHP Annual Meeting and EULAR 2017, respectively. Rheumatoid arthritis was the most common disorder, dealt with in 23%, 26%, 21% and 27% in CMR 44, CMR 45, 2016 ACR and EULAR 2017, respectively, followed by systemic lupus erythematosus; in third place, Mexican congresses reported trials related to systemic vasculitis, whereas spondylitis was the main subject of international congresses. In the case of rheumatoid arthritis, clinical topics accounted for 30% in the Mexican congresses and ACR, and nearly 20% in EULAR. Observational studies accounted for 40% in the Mexican congresses vs. 33% in 2016 ACR and 55% in EULAR 2017. Studies on basic science were minimal in the Mexican congress, whereas in 2016 ACR, they represented 21% and 12% in EULAR 2017. CONCLUSION: Rheumatology meetings constitute a tool to obtain adequate evidence-based medical knowledge in this important branch of medicine. For our Mexican Congress, we should encourage collaborative efforts between institutions, which will result in a greater number of controlled studies, clinical trials and basic studies that support the quality of the congress. We wish to emphasize that a greater diffusion of other musculoskeletal diseases is needed, not only autoimmune diseases, since the former represent an important percentage of the daily practice.

Direct costs of glaucoma: Relationship between cost and severity of the disease.

OBJECTIVES: To estimate the direct medical costs associated with the management of patients with primary open-angle glaucoma and to compare the costs of patients according to the degree of severity. METHODS: A longitudinal retrospective study was carried out using all patients with primary open-angle glaucoma that recorded follow-up from May 2010 to June 2013 at the Hospital Privado de Córdoba. We estimated the cost of the disease from the perspectives of the institution, with a bottom-up approach. RESULTS: The three-year follow-up after treatment of 104 patients revealed that the average cost of care for a patient with primary open-angle glaucoma was US$2746 ± 1560. The first year of treatment was significantly more expensive than subsequent ones (US$1100-$810-$827). Cost was related to the degree of severity of glaucoma; patients in "Stage 0" had significantly lower costs than those in other groups (Kruskal-Wallis test, p < 0.01). This was a consequence of lower costs associated with medication and a lower percentage of patients undergoing surgery. DISCUSSION: The direct medical costs of a patient with primary open-angle glaucoma vary according to the severity of their disease and the year of treatment. We found that costs increased with disease severity, but decreased over time.

Is the transmission of Mycobacterium avium subspecies paratuberculosis (MAP) infection through milk intended to feed calves an overlooked item in paratuberculosis control programs?

As in many parts of the world, Chile shows a high Mycobacterium avium subsp. paratuberculosis (MAP) infection rate. Evidently, the control recommendations have been inefficient. In the author's opinion, the potential risk of MAP transmission to susceptible calves through milk consumption is largely overlooked. Two observational studies were performed, one to confirm MAP shedding in young stock in a high MAP-infected dairy herd and MAP load in milk intended to feed these calves was estimated. In parallel, in a second study, we estimated the relationship between MAP herd seroprevalence and the cow MAP shedding level as well as the presence of this pathogen in milk used to feed dairy calves. In the first study, 53.7% of cows and 22.5% of calves showed positive culture results. Among all cows tested, 9 (2.19%) animals had a positive serum ELISA, and MAP load in milk reached 106 bacteria/mL. In the second study, three seroprevalence categories were established as follows: high (≥ 9%), medium (> 5% and ≤ 9%), and low (≤ 5%). Statistical significant differences among these categories were observed. Animals from the high seroprevalence category shed significantly more MAP than the others. However, in the low category, heavy shedder animals were also observed. Finally, in all study herds, MAP presence in milk intended to feed calves was reported, even from herds without ELISA-positive animals.

Caracterización de los pacientes con defectos bucomaxilofaciales atendidos en el Policlínico Universitario Julio Antonio Mella / Characterization of the patients with oral-maxillofacial defects attended in the University Polyclinic Julio Antonio Mella

RESUMEN Fundamento: las lesiones del macizo cráneofacial existen desde la evolución misma del hombre, lo que ha traído por consiguiente la necesidad de crear medios para enmascarar los defectos o restaurar el órgano perdido. Objetivo: caracterizar los pacientes con defectos bocomaxilofacial. Métodos: se realizó un estudio observacional, descriptivo y transversal desde enero del 2015 hasta mayo de 2018 en pacientes con defectos bucomaxilofaciales atendidos en el departamento de prótesis estomatológica del Policlínico Universitario Julio Antonio Mella de la Provincia Camagüey. El universo lo constituyeron 13 pacientes mayores de 20 años de edad de ambos sexos remitidos del Hospital Universitario Manuel Ascunce Domenech y Hospital Provincial Docente Oncológico María Curie. Resultados: respecto a los pacientes con defectos maxilofaciales rehabilitados según edad y sexo, fue más frecuente el sexo masculino y el grupo de 60 a 79 años. Según tipo y causa del defecto, fue superior el nasal y la oncológica con siete pacientes. Según tipo de defecto bucomaxilofacial y experiencia protésica, primó el defecto nasal, así como la experiencia protésica favorable en ocho pacientes. Conclusiones: los pacientes masculinos predominaron, junto con los mayores de 60 años. Los defectos bucomaxilofaciales más rehabilitados fueron los nasales y de origen oncológicos. Hubo un alto índice de experiencia favorable con el uso de las prótesis.

ABSTRACT Background: the injuries of the solid craniofacial exist from evolution of the man, which has brought therefore the need to create means to mask defects or to restore the lost organ. Objective: to characterize the patients with oral-maxillofacial defects. Methods: an observational, descriptive and transverse study was carried out from January, 2015 to May, 2018, in patients with oral-maxillofacial defects attended in the department dentistry prosthesis of the University Polyclinic Julio Antonio Mella of the city of Camagüey. The universe was constituted by 13 patients older than 20 years of age of both sexes cross-referred of the University Hospital Manuel Ascunce Domenech and Provincial University Oncological Hospital María Curie. Results: in relation to the patients with maxillofacial defects rehabilitated according to age and sex, prevailed the group 60 to 79 years, as well as the masculine sex. According to type and etiology of the defect, the nasal and the oncological was a superior with 7 patients respectively. According to type of defect oral-maxillofacial and prosthetic experience, the type of nasal defect had priority as well as the prosthetic favorable experience in 8 patients. Conclusions: the masculine patients predominated along with the older than 60 years old. The oral-maxillofacial defects most rehabilitated were the nasal and those of oncological causes. There was a tall index of favorable experience with the use of the prostheses.

I. THE ROLE OF RESEARCH ETHICS COMMITTEES IN OBSERVATIONAL STUDIES: EPIDEMIOLOGICAL REGISTRIES, CASE REPORTS, INTERVIEWS, AND RETROSPECTIVE STUDIES.

It is often unclear to the clinical investigator whether observational studies should be submitted to a research ethics committee (REC), mostly because, in general, no active or additional interventions are performed. Moreover, obtaining an informed consent under these circumstances may be challenging, either because these are very large epidemiological registries, or the subject may no longer be alive, is too ill to consent, or is impossible to contact after being discharged. Although observational studies do not involve interventions, they entail ethical concerns, including threats such as breaches in confidentiality and autonomy, and respect for basic rights of the research subjects according to the good clinical practices. In this context, in addition to their main function as evaluators from an ethical, methodological, and regulatory point of view, the RECs serve as mediators between the research subjects, looking after their basic rights, and the investigator or institution, safeguarding them from both legal and unethical perils that the investigation could engage, by ensuring that all procedures are performed following the international standards of care for research. The aim of this manuscript is to provide information on each type of study and its risks, along with actions to prevent such risks, and the function of RECs in each type of study.