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In mammalian cells, primary miRNAs are cleaved at their hairpin structures by the Microprocessor complex, whose core is composed of DROSHA and DGCR8. Here, we show that 5' flanking regions, resulting from Microprocessor cleavage, are targeted by the RNA exosome in mouse embryonic stem cells (mESCs). This is facilitated by a physical link between DGCR8 and the nuclear exosome targeting (NEXT) component ZCCHC8. Surprisingly, however, both biochemical and mutagenesis studies demonstrate that a variant NEXT complex, containing the RNA helicase MTR4 but devoid of the RNA-binding protein RBM7, is the active entity. This Microprocessor-NEXT variant also targets stem-loop-containing RNAs expressed from other genomic regions, such as enhancers. By contrast, Microprocessor does not contribute to the turnover of less structured NEXT substrates. Our results therefore demonstrate that MTR4-ZCCHC8 can link to either RBM7 or DGCR8/DROSHA to target different RNA substrates depending on their structural context., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To synthesise and evaluate the quality of the recommendations for exercise therapy and physical activity from guidelines for the prevention and/or management of low back pain., Design: Systematic review., Methods: Included clinical practice guidelines for the management of low back pain published between 2014 and 2022 and searched in 9 databases until September 2022. The quality of evidence was evaluated with the Appraisal of Guidelines, Research and Evaluation tool (AGREE-II instrument)., Results: After screening 3448 studies, 18 clinical practice guidelines were included in this review. Only five (27 %) guidelines were judged as having a satisfactory quality of evidence (i.e., rigour of development and applicability), and 13 (72 %) of guidelines are discussed and rated as critical. Regarding physical activity, no guidelines provided recommendations for the primary prevention of low back pain or incorporated adequate physical activity aspects considering type, dosage, frequency, and intensity. For exercises, all (100 %) guidelines recommended at least one type of supervised exercise in the management of low back pain, and 16 (88 %) provided an overall recommendation for people to stay active., Conclusions: Guidelines offer minimal or, sometimes, no detail regarding physical activity or specific exercise regimens for the management and prevention of low back pain. When some guidance is provided, the recommendations typically lack specificity concerning the type, intensity, duration, and frequency of exercise and, in many cases, they represent a combination of scarce available evidence and stakeholder perspectives., Competing Interests: Declaration of interest statement The authors declare that they have no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: The purpose of this study was to evaluate the feasibility of a randomized controlled trial investigating the effectiveness of a multimodal program (PAT-Back) compared to best practice advice on pain and disability in older adults with chronic low back pain (LBP) in primary care., Methods: This feasibility study took place in Fortaleza, Northeast Brazil. The PAT-Back intervention consisted of a program including exercises, pain education, and motivational text messages for the in-home component. The control group received an evidence-based educational booklet. Feasibility outcomes were recruitment, adherence and retention rates, level of difficulty of the education and intervention content, perception of utility of mobile technology, and adverse events. The feasibility criteria were previously defined., Results: A total of 248 people were screened, of which 46 older adults were eligible. The retention rate was high (100% in the PAT-Back group and 95% in the control group). The adherence rate to intervention was partially met (60%), whereas the adherence rate to unsupervised exercises was adequate (75%), and perception about safety to perform home exercise was partially acceptable (70%) in the PAT-Back group. In addition, 100% of older adults reported which text messages motivated them to perform the exercises in the PAT-Back group. Difficulty reported by participants in understanding and performing the intervention was small in both groups. Six participants reported transient adverse events in both groups., Conclusion: Older adults accepted both interventions. Results demonstrated that the program is feasible, although minor changes targeting adherence and safety in home exercise are needed., Impact: This feasibility study supports progression to a full trial investigating the effectiveness of a multimodal program (PAT-Back) on pain and disability in older adults with chronic LBP within a primary health care setting in low to middle income countries where such data from the older population are scarce and the burden of LBP is increasing., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Although placebo-controlled trials are considered the gold standard for evaluating the efficacy of healthcare interventions, they can be perceived to be controversial and challenging to conduct for surgical treatments. The SUcceSS trial is the first placebo-controlled trial of lumbar decompression surgery for symptomatic lumbar canal stenosis. The SUcceSS trial has experienced common issues affecting the implementation of randomised placebo-controlled surgery trials, accentuated by the COVID-19 pandemic. Using the SUcceSS trial as an example, we discuss key challenges and mitigation strategies specific to the conduct of a randomised placebo-controlled surgical trial. Overall, the key lessons learned were (i) involving key stakeholders early and throughout the trial design phase may increase clinician and patient willingness to participate in a placebo-controlled trial of surgical interventions, (ii) additional resources (e.g. budget, staff time) are likely required to successfully operationalise trials of this nature, (iii) the level of placebo fidelity, timing of randomisation relative to intervention delivery, and nuances of the surgical procedure under investigation should be considered carefully. Findings are based on one example of a placebo-controlled surgical trial; however, researchers may benefit from employing or building from the strategies described and lessons learned when designing or implementing future trials of this nature., (© 2023. The Author(s).)

Objective: To determine the comparative effectiveness and safety of psychological interventions for chronic low back pain., Design: Systematic review with network meta-analysis., Data Sources: Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, and CINAHL from database inception to 31 January 2021., Eligibility Criteria for Study Selection: Randomised controlled trials comparing psychological interventions with any comparison intervention in adults with chronic, non-specific low back pain. Two reviewers independently screened studies, extracted data, and assessed risk of bias and confidence in the evidence. Primary outcomes were physical function and pain intensity. A random effects network meta-analysis using a frequentist approach was performed at post-intervention (from the end of treatment to <2 months post-intervention); and at short term (≥2 to <6 months post-intervention), mid-term (≥6 to <12 months post-intervention), and long term follow-up (≥12 months post-intervention). Physiotherapy care was the reference comparison intervention. The design-by-treatment interaction model was used to assess global inconsistency and the Bucher method was used to assess local inconsistency., Results: 97 randomised controlled trials involving 13 136 participants and 17 treatment nodes were included. Inconsistency was detected at short term and mid-term follow-up for physical function, and short term follow-up for pain intensity, and were resolved through sensitivity analyses. For physical function, cognitive behavioural therapy (standardised mean difference 1.01, 95% confidence interval 0.58 to 1.44), and pain education (0.62, 0.08 to 1.17), delivered with physiotherapy care, resulted in clinically important improvements at post-intervention (moderate quality evidence). The most sustainable effects of treatment for improving physical function were reported with pain education delivered with physiotherapy care, at least until mid-term follow-up (0.63, 0.25 to 1.00; low quality evidence). No studies investigated the long term effectiveness of pain education delivered with physiotherapy care. For pain intensity, behavioural therapy (1.08, 0.22 to 1.94), cognitive behavioural therapy (0.92, 0.43 to 1.42), and pain education (0.91, 0.37 to 1.45), delivered with physiotherapy care, resulted in clinically important effects at post-intervention (low to moderate quality evidence). Only behavioural therapy delivered with physiotherapy care maintained clinically important effects on reducing pain intensity until mid-term follow-up (1.01, 0.41 to 1.60; high quality evidence)., Conclusions: For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise). Pain education programmes (low to moderate quality evidence) and behavioural therapy (low to high quality evidence) result in the most sustainable effects of treatment; however, uncertainty remains as to their long term effectiveness. Although inconsistency was detected, potential sources were identified and resolved., Systematic Review Registration: PROSPERO CRD42019138074., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Although the literature describes a favorable course of low back pain (LBP) in adults, little information is available for older adults. LBP is prevalent and complex in older adults, and the analysis of its trajectories may contribute to the improvement of therapeutic approaches., Objective: To describe pain and disability trajectories in older adults with a new episode of LBP., Methods: Older adults (n = 542), aged >55 years with a new episode of nonspecific LBP, were followed for 12 months in a prospective cohort. Pain intensity (Numeric Rating Scale) and disability (Roland-Morris Disability Questionnaire) were assessed at baseline and 3, 6, 9, and 12 months. Latent class growth analysis (LCGA) was used to model pain and disability scores over time. Baseline biopsychosocial characteristics were compared using one-way analysis of variance or Chi-square test (α=0.05)., Results: The LCGA identified three and four trajectories in the pain and disability courses, respectively. Trajectories with low, intermediate, or high scores over time were defined. Worse biopsychosocial status at baseline was associated with worst prognosis over 12 months. Low educational level, physical inactivity, poor mobility, recent falls, worse fall self-efficacy, presence of depressive symptoms, more kinesiophobia, greater number of comorbidities, and the presence of other LBP-associated complaints were found in older adults with severe and persistent symptoms., Conclusion: The trajectories allow the identification of clusters with similar clinical prognoses in older adults with a new episode of LPB. In practice, excessive treatments and unnecessary tests can be avoided, while more accurate and targeted interventions can be implemented., Competing Interests: Conflicts of Interest The authors declare no conflict of interest., (Copyright © 2022 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Climate change and the COVID-19 pandemic share many similarities. However, in the past months, concerns have increased about the fact the health emergency has put on hold during the pandemic many climate adaptation and mitigation policies. We focus our attention on understanding the role of the recent health emergency on the transmission of information related to climate change, jointly with other socio-economic variables, social norms, and cultural dimensions. In doing so, we create a unique dataset containing the number of tweets written with specific climate related keywords per country worldwide, as well as country specific socio-economic characteristics, relevant social norms, and cultural variables. We find that socio-economic variables, such as income, education, and other risk-related variables matter in the transmission of information about climate change and Twitter activity. We also find that the COVID-19 pandemic has significantly decreased the overall number of messages written about climate change, postponing the climate debate worldwide; but particularly in some vulnerable countries. This shows that in spite of the existing climate emergency, the current pandemic has had a detrimental effect over the short-term planning of climate policies in countries where climate action is urgent., Competing Interests: The authors report no declarations of interest., (© 2021 The Authors. Published by Elsevier Ltd.)

Objective: The authors sought to describe the protocol of a randomized controlled trial that will investigate the effects of the TEXT4myBACK self-management text message intervention compared with control in people with low back pain (LBP)., Methods: A single-blind (assessor and statistician), randomized controlled trial with economic analysis and process evaluation will be conducted. A total of 304 people with non-specific LBP of less than 12 weeks will be enrolled and randomly allocated either to TEXT4myBACK intervention or control groups. The TEXT4myBACK intervention group will receive 4 semi-personalized text messages per week providing advice, motivation, and information about LBP, physical activity, sleep, mood, use of care, and medication during 12 weeks. The control group will receive 1 text message with a link to a LBP and diet online information package. Outcomes will be assessed at baseline and 3, 6, and 12 months. The primary outcome will be function assessed with the Patient-Specific Functional Scale. Secondary outcomes will include pain intensity, physical activity participation, sedentary behavior, global impression of change, health-related quality of life, and eHealth literacy. Data on demographic characteristics, smallest worthwhile change (ie, smallest function scored needed to be achieved at the end of the intervention to consider it to be worthwhile), health care utilization, and adverse events (ie, any new health issue that occurs during participation in the study) will be collected. An economic and process evaluation will also be conducted., Impact: This study will assess if a self-management text message intervention is effective and cost-effective in improving function of people with LBP. This study can inform clinical practice of a simple, scalable, and affordable intervention for managing LBP., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: The presence of comorbidities is quite common in older adults. However, the effects of comorbidities on the course of acute low back pain (LBP) are not fully understood., Objective: To investigate the effects of the number and severity of comorbidities on the severity of pain and disability 3 months from baseline in people with an acute episode of non-specific LBP., Methods: Data from the Back Complaints in the Elders study, a cohort that enrolled 602 community-dwelling older adults with acute LBP at baseline, were used in these analyses. Comorbidities, pain intensity and disability were assessed using the Self-Administered Comorbidities Questionnaire (SCQ), the Numeric Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. Age, sex, marital status, education, income and body mass index were covariates., Results: The mean age of participants was 67.6 ± 7.0 years. Both pain and disability scores decreased from 7.2 (95% confidence interval [95% CI] 7.0-7.4) to 5.8 (95% CI 5.5-6.1) in NRS and from 13.5 (95% CI 13.0-14.1) to 12.0 (95% CI 11.4-12.7) in RMDQ 3 months from baseline. The linear regression analysis showed a significant association between SCQ scores at baseline and pain (coefficient = 0.16, 95% CI 0.08-0.24; P < 0.001) or disability (coefficient = 0.29, 95% CI 0.16-0.41; P < 0.001) scores at the 3-month follow-up, after adjusting for confounders. Participants with highest SCQ scores were less likely to report improvement of at least 30% in pain (OR: 0.41, 95% CI 0.22-0.79; P = 0.008) and disability (OR: 0.42, 95% CI 0.28-0.85; P = 0.015)., Conclusion: The presence and severity of comorbidities were independently associated with the prognosis of acute non-specific LBP in older adults., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

This cross-sectional study evaluated the association of biopsychosocial factors with disability in older adults with a new episode of acute low back pain. Older patients with a new episode of acute low back pain were included and those with cognitive alterations and severe motor impairment were excluded. Disability was assessed using the Roland Morris Disability Questionnaire. The biopsychosocial factors (clinical, functional, health status, psychological and social variables) were evaluated by a structured multidimensional questionnaire and physical examination. A multivariate linear regression was used to analyze data with a statistical significance of 0.05. A total of 386 older individuals with a mean age of 71.6 (± 4.2) years and disability of 13.7 (± 5.7) points were enrolled. Our regression analyses identified that worse physical and mental health (assessed through SF-36), low falls self-efficacy, trouble sleeping due to pain, worse kinesiophobia levels, higher body mass indexes, lumbar morning stiffness, increased pain intensity, female gender and worse functional mobility were significantly associated with baseline disability (p < 0.05). Low back pain-related disability is significantly associated with worse biopsychosocial health conditions in older adults.

Background/objectives: The burden of low back pain (LBP) is high, especially for older adults who experience a higher number of years living with a disability. However, this population is not being well represented in clinical trials (CTs). This study analyzed the International Clinical Trial Registry Platform (ICTRP) database from the World Health Organization to verify the future trend in the participation of older adults in registered CTs on LBP., Design: We performed a cross-sectional review of the ICTRP searching for prospective protocols planning interventions for LBP with registration dates from January 2015 through November 2018. From the protocols of the eligible studies, we extracted those planning to include older adults., Results: A total of 167 protocols for CTs for LBP were planning to recruit participants older than 65 years. However, only five registries (2.99%; pooled sample = 169 participants) were designed to target participants specifically older than 65 years. The exclusion of older participants was not justified and imposed through an arbitrary upper-age limit in 93.6% of the protocols. Most of the protocols are from single-center studies, and a greater number are planned to be carried out in developed regions. Higher interest was in pharmacologic interventions, devices/technology, and physical rehabilitation., Conclusion: Older adults with LBP will continue to be underinvestigated in CTs for LBP in the near future. In general, ongoing trials are small, planned in developed regions, and proposing pharmacologic interventions to deal with LBP. J Am Geriatr Soc 67:603-608, 2019., (© 2018 The American Geriatrics Society.)

Background: Musculoskeletal pain frequently occurs in more than one body region, with up to 80% of adults reporting more than one joint pain site in the last 12 months. Older people and females are known to be more susceptible to multiple joint pain sites, however the association of multisite joint pain with physical and psychosocial functions in this population are unknown., Methods: Cross-sectional data from 579 women were analyzed. Women were asked "Which of your joints have been troublesome on most days of the past month?" Pain qualities were measured using the McGill Pain Questionnaire (Short Form) and PainDETECT, and health was assessed using the SF-36 and sociodemographic variables. Statistical analysis using generalized ordinal logistic regression included comparison of three joint pain groups: no joint pain, 1-4 sites of joint pain and ≥ 5 sites of joint pain., Results: Two thirds of respondents had multisite pain (>1 site), and one third had ≥5 joint pain sites. Compared to women with fewer joint pain sites, women with >5 joint pain sites (multisite joint pain) had significantly poorer physical and emotional health-related quality of life, more severe pain, a higher probability of neuropathic pain, and a longer duration of pain. More than half of women in the multisite joint pain group were still employed, statistically significantly more than women with no joint pain. In the final model, pain duration, the number of medications, pain intensity (discomforting and distressing) and the physical component of health-related quality of life were significantly associated with increased number of joint pain sites., Conclusions: Over one-third of older women in our sample had >5 painful joints in the last month. These women demonstrated significantly poorer psychosocial health, and increased medication use, than women with no or fewer sites of joint pain. Many women with multisite joint pain were still in the workforce, even when nearing retirement age. This study has important implications for future research into musculoskeletal pain, particularly in regards to womens health and wellbeing, and for clinical practice where there should be increased awareness of the implications of concurrent, multisite joint pain., Competing Interests: Ethical approval was received by the Human Research Ethics Committee of the University of Newcastle; Approval number: H-2012-0144.Written informed consent was obtained from the participants for publication of their individual details in this manuscript. The consent form is held by the corresponding authors institution at the time of data collection (the University of Newcastle) and is available for review by the Editor-in-Chief.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Sugarcane vinasse has been widely used as a soil fertilizer in the Brazilian sucro-alcohol industry for recycling potassium and water. However, the potential negative effects from long-term soil fertirrigation represent a major drawback regarding this practice, whereas the application of biodigestion represents an efficient method for reducing the polluting organic load and recovering bioenergy from vinasse. Regardless of the predicted use for vinasse, an understanding of the potential of each option is imperative, as the seasonal alterations in the inorganic/organic fractions of vinasse directly affect its management. In this context, this study presents a detailed compositional characterization of sugarcane vinasse from a large-scale Brazilian biorefinery throughout the 2014/2015 harvest to assess the environmental effects (due to fertirrigation) and to estimate the biogas energetic potential. Calculated inputs of organic matter into soils due to vinasse land application were equivalent to the polluting load of populations (117-257inhabha -1 ) at least 2-fold greater than the largest Brazilian capital cities (78-70inhabha -1 ). Two-phase biodigestion could efficiently reduce the polluting load of vinasse (23-52inhabha -1 ) and eliminate the negative effects from direct sulfide emissions in the environment. However, a high risk of soil sodification could result from using high doses of Na-based alkalizing compounds in biodigestion plants. Finally, the optimized recovery of bioenergy through biogas (13.3-26.7MW as electricity) could supply populations as large as 305 thousand inhabitants, so that over 30% of the surplus electricity produced by the studied biorefinery could be obtained from biogas. Overall, applying biodigestion in the treatment of vinasse provides important environmental and energetic gains. However, the benefits of reducing the polluting organic load of vinasse through bioenergy recovery may lose their effect depending on the alkalizing strategy, indicating that the proper use of chemicals in full-scale biodigestion plants is imperative to attain process sustainability., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Hybrid electric vehicles (HEVs) could be a good short term option to help achieve global targets regarding road transport greenhouse gas emissions. Several common and country-specific public policies based on price or tax rebates are established in order to encourage the adoption of HEVs. The present research empirically assesses market preferences for HEVs in Spain, looking at the role of subsidies. An interactive internet-based survey was conducted in a representative sample (N = 1,200) of Spanish drivers. Drivers are willing to pay an extra amount of €1,645 for a HEV model compared to a conventional vehicle, premium which is well below the price markup for these cars. Therefore, current levels of economic subsidies applied in isolation to promote these types of vehicles may have a quite limited effect in extending their use. Overall, it is found that drivers have clear misconceptions about HEVs, which affect their purchasing choices and perceptions. Therefore, a policy mix of various incentives (including informational campaigns) may be required in order to stimulate the demand for HEVs.

Objective: Low back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care., Methods: We sourced baseline information on socio-demographic, pain-related and clinical characteristics from 602 older adults from the Brazilian Back Complaints in the Elders (Brazilian BACE) study. We analyzed differences in pain, disability, functional capacity and psychosocial factors between sub-groups based on age (i.e. participants aged 55-74 or ≥75 years), education (i.e. those with four years or less of schooling or those with more than four years of schooling) and income (i.e. participants who reported earning two or less minimal wages or three and more)., Results: Participants presented severe LBP (7.18/10, SD: 2.59). Younger participants were slightly more disabled (mean difference 1.29 points, 95% confidence interval [CI]: 0.03/5.56), reporting poorer physical health, and less fall-related self-efficacy (mean difference of 2.41, 95% CI 0.35/4.46). Those less educated, and those with income equal or less than two minimum wages had more disability, pain catastrophizing and worse functional capacity., Conclusions: This was the first study showing that Brazilian older adults with LBP present high levels of functional disability and psychological distress, especially those with low socioeconomic status., (Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Objective: Assess the demographic and clinical characteristics of surgical patients seen in the Pre-anesthetic Assessment Clinic of the Hospital Universitário Gaffrée e Guinle (APA/HUGG), in order to assist in the pursuit for quality, effectiveness, and resource rationalization of hospital management., Method: Cross-sectional descriptive study with 491 patients undergoing elective surgery, treated at APA/HUGG Clinic from March to December 2014. The following variables were assessed: sex, age, BMI, smoking status, associated diseases, classification of MET's and ASA, presence of decompensated disease, medical associated appointments interconsultation, specialty and surgical risk, history of prior anesthetic-surgical procedure, and complications., Results: There was a predominance of female (64.8%) and overweight patients (55.9%), aged 18-59 years. The prevalence of associated diseases was high (71.3%), with hypertension pressure prevailing (50.1%). Most patients had clinically compensated morbidity (96.3%) and long-term use of medication (77.4%). Regarding the surgical characteristics, the most frequent specialty was general and medium risk surgeries. The analysis of the characteristics by age showed that the elderly have more associated diseases and long-term use of medication, in addition to predominance of ASA II-III., Conclusion: The epidemiological profile of surgical patients seen at the APA/HUGG was female, age 18-59 years, overweight, with associated diseases, long-term use of medication, without clinical decompensation, ASA II and MET's ≥4. Knowledge of the clinical characteristics of surgical patients is critical to schedule the perioperative care, allowing the improvement of quality and safety in anesthesia and surgery., (Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: Telehealth has emerged as a potential alternative to deliver interventions for low back pain (LBP); however, its effectiveness has not been investigated., Purpose: The aim of this review was to evaluate whether interventions delivered by telehealth improve pain, disability, function, and quality of life in non-specific LBP., Study Design: This is a systematic review with meta-analysis., Methods: Seven databases were searched from the earliest records to August 2015. Eligible studies were randomized controlled trials that investigated the effectiveness of telehealth-based interventions, solo or in combination with other interventions, for non-specific LBP compared with a control group. Trials deemed clinically homogeneous were grouped in meta-analyses., Results: Eleven studies were included (n=2,280). In chronic LBP, telehealth interventions had no significant effect on pain at short-term follow-up (four trials: 1,089 participants, weighted mean difference [WMD]: -2.61 points, 95% confidence interval [CI]: -5.23 to 0.01) or medium-term follow-up (two trials: 441 participants, WMD: -0.94 points, 95% CI: -6.71 to 4.84) compared with a control group. Similarly, there was no significant effect for disability. Results from three individual trials showed that telehealth was superior to a control intervention for improving quality of life. Interventions combining telehealth and usual care were more beneficial than usual care alone in people with recent onset of LBP symptoms., Conclusion: There is moderate-quality evidence that current telehealth interventions, alone, are not more effective than minimal interventions for reducing pain and disability in chronic LBP. To date, modern telehealth media (eg, apps) and telehealth as an adjunct to usual care remain understudied., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: to evaluate the impact of the use of a local protocol of preoperative test requests in reducing the number of exams requested and in the occurrence of changes in surgical anesthetic management and perioperative complications., Methods: we conducted a randomized, blinded clinical trial at the Gaffrée and Guinle University Hospital with 405 patients candidates for elective surgery randomly divided into two groups, according to the practice of requesting preoperative exams: a group with non-selectively requested exams and a protocol group with exams requested according to the study protocol. Studied exams: complete blood count, coagulogram, glycemia, electrolytes, urea and creatinine, ECG and chest X-ray. Primary outcomes: changes in surgical anesthetic management caused by abnormal exams, reduction of the number of exams requested after the use of the protocol and perioperative complications., Results: there was a significant difference (p<0.001) in the number of exams with altered results between the two groups (14.9% vs. 29.1%) and a reduction of 57.3% in the number of exams requested between the two groups (p<0.001), which was more pronounced in patients of lower age groups, ASA I, without associated diseases and submitted to smaller procedures. There was no significant difference in the frequency of conduct changes motivated by the results of exams or complications between the two groups. In the multivariate analysis, complete blood count and coagulogram were the only exams capable of modifying the anesthetic-surgical management., Conclusion: the proposed protocol was effective in eliminating a significant number of complementary exams without clinical indication, without an increase in perioperative morbidity and mortality.

In order to test the effect of calorie information on fast food choices, we conducted a questionnaire employing two types of stated preferences methods (the best-worst-scaling and intentional questions) and a follow-up randomized field experiment in a sample of 119 participants. This combined approach allowed us to test the internal validity of preferences for fast food meals across elicitation scenarios. The results showed that calorie information reduces the probability of selecting high calorie meals only in the questionnaire, while it did not have any significant impact on actual purchasing behavior in the field experiment. Thus, the findings show that there is a clear difference between the role of calorie information on immediate stated preference choices, and the relatively low level of responsiveness in real choices in a restaurant. We believe that the current results are quite suggestive, indicating the limits of predicting actual fast food behavior, and may open the way to using data sources that combine stated methods with field experiments., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Introduction: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created., Objective: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors., Materials and Methods: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors., Results: Of the respondents, 91.8% reported they had committed administration errors, adding the total error of 274 and mean of 4.7 (6.9) errors per respondent. The most common error was replacement (68.4%), followed by dose error (49.1%), and omission (35%). Only 7% of respondents reported neuraxial administration error. Regarding circumstances of errors, they mainly occurred in the morning (32.7%), in anesthesia maintenance (49%), with 47.8% without harm to the patient and 1.75% with the highest morbidity and irreversible damage, and 87.3% of cases with immediate identification. As for possible contributing factors, the most frequent were: distraction and fatigue (64.9%) and misreading of labels, ampoules, or syringes (54.4%)., Conclusion: Most respondents committed more than one error in anesthesia administration, mainly justified as a distraction or fatigue, and of low gravity., (Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

The challenges associated with the availability of fossil fuels in the past decades intensified the search for alternative energy sources, based on an ever-increasing demand for energy. In this context, the application of anaerobic digestion (AD) as a core treatment technology in industrial plants should be highlighted, since this process combines the pollution control of wastewaters and the generation of bioenergy, based on the conversion of the organic fraction to biogas, a methane-rich gaseous mixture that may supply the energetic demands in industrial plants. In this context, this work aimed at assessing the energetic potential of AD applied to the treatment of stillage, the main wastewater from ethanol production, in an attempt to highlight the improvements in the energy balance ratio of ethanol by inserting the heating value of methane as a bioenergy source. At least 5-15% of the global energy consumption in the ethanol industry could be supplied by the energetic potential of stillage, regardless the feedstock (i.e. sugarcane, corn or cassava). The association between bagasse combustion and stillage anaerobic digestion in sugarcane-based distilleries could provide a bioenergy surplus of at least 130% of the total fossil fuel input into the ethanol plant, considering only the energy from methane. In terms of financial aspects, the economic gains could reach US$ 0.1901 and US$ 0.0512 per liter of produced ethanol, respectively for molasses- (Brazil) and corn-based (EUA) production chains. For large-scale (∼1000 m(3)EtOH per day) Brazilian molasses-based plants, an annual economic gain of up to US$ 70 million could be observed. Considering the association between anaerobic and aerobic digestion, for the scenarios analyzed, at least 25% of the energetic potential of stillage would be required to supply the energy consumption with aeration, however, more suitable effluents for agricultural application could be produced. The main conclusion from this work indicates that anaerobic processes should be considered the core technology to treat stillage, based mainly on the attractive relation energy generation-financial return and on the possibility to keep the advantages inherent to the common fertigation when using the treated effluent in agriculture., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Jellyfish outbreaks and their consequences appear to be on the increase around the world, and are becoming particularly relevant in the Mediterranean. No previous studies have quantified tourism losses caused by jellyfish outbreaks. We used a stated-choice questionnaire and a Random Utility Model to estimate the amount of time respondents would be willing to add to their journey, in terms of reported extra travel time, in order to reduce the risk of encountering jellyfish blooms in the Catalan coast. The estimation results indicated that the respondents were willing to spend on average an additional 23.8% of their travel time to enjoy beach recreation in areas with a lower risk of jellyfish blooms. Using as a reference the opportunity cost of time, we found that the subsample of individuals who made a trade-off between the disutility generated by travelling longer in order to lower the risk of jellyfish blooms, and the utility gained from reducing this risk, are willing to pay on average €3.20 per beach visit. This estimate, combined with the respondents' mean income, yielded annual economic gains associated with reduction of jellyfish blooms on the Catalan coast around €422.57 million, or about 11.95% of the tourism expenditures in 2012. From a policy-making perspective, this study confirms the importance of the economic impacts of jellyfish blooms and the need for mitigation strategies. In particular, providing daily information using social media applications or other technical devices may reduce these social costs. The current lack of knowledge about jellyfish suggests that providing this information to beach recreationists may be a substantially effective policy instrument for minimising the impact of jellyfish blooms.

Stillage is the main wastewater from ethanol production, generated specifically in the step of distillation. Regardless the feedstock, stillage contains high concentrations of organic matter, potassium and sulfates, as well as acidic and corrosive characteristics. Currently almost the entire volume of stillage generated in Brazilian distilleries is directed to the fertigation of sugarcane fields, due to its fertilizer character. However, the polluting potential of stillage characterizes its land disposal as problematic, considering probable negative impacts on the soil structure and water resources in case of excessive dosages. Since the literature lacks critical content describing clearly the cons related to the reuse of stillage in agriculture in the long-term, this review aimed to assess the real polluting potential of stillage, and the implications of its land disposal and/or discharge into water bodies. Evidence from the literature indicate that the main obstacles to reuse stillage in natura include risks of soil salinization; clogging of pores, reduction in the microbial activity and the significant depletion of dissolved oxygen concentrations in water bodies; contamination per nitrates and eutrophication; soil structure destabilization due to high concentrations of potassium and sodium; and, possible acidification of soil and water resources, considering the low pH of stillage (∼4,5). Toxic metals, such as cadmium, lead, copper, chromium and nickel, were also identified in concentrations above the recommended limits in stillage samples, increasing risks to human health (e.g. carcinogenic potential) and to crops (e.g. productivity loss). In short, although some studies report benefits from the land application of stillage, its treatment prior to disposal is essential to make fertigation an environmentally suitable practice., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Stillage is the main wastewater from ethanol production, containing a high chemical oxygen demand in addition to acidic and corrosive characteristics. Though stillage may be used as a soil fertilizer, its land application may be considered problematic due its high polluting potential. Anaerobic digestion represents an effective alternative treatment to reduce the pollution load of stillage. In addition, the methane gas produced within the process may be converted to energy, which can be directly applied to the treatment plant. The objective of this paper was to investigate the energetic potential of anaerobic digestion applied to stillage in the sugarcane ethanol industry. An overall analysis of the results indicates energy recovery capacity (ERC) values for methane ranging from 3.5% to 10%, respectively, for sugarcane juice and molasses. The processes employed to obtain the fermentable broth, as well as the distillation step, represent the main limiting factors to the energetic potential feasibility. Considering financial aspects the annual savings could reach up to US$ 30 million due to anaerobic digestion of stillage in relatively large-scale distilleries (365,000 m3 of ethanol per year). The best scenarios were verified for the association between anaerobic digestion of stillage and combustion of bagasse. In this case, the fossil fuels consumption in distilleries could be fully ceased, such the ERC of methane could reach values ranging from 140% to 890%.

Background: Alcohol intake has been widely reported as a risk factor for low back pain (LBP), however, the literature is inconclusive about this association., Objectives: To determine, in a systematic review, the relationship between alcohol intake and LBP., Methods: A search was conducted in CINAHL, LILACS, Medline, National Research Register and Web of Science to identify studies that investigated the association between alcohol intake and LBP. Quantitative results and its estimators were extracted. When possible, meta-analyses were performed using a random effects model., Results: Twenty-six studies were included in this review. Twenty-three studies were retrospective cohorts, two were case-controls, and one employed a longitudinal design. Pooled results from nine studies (two case-controls and seven retrospective cohorts) showed that alcohol consumption is slightly associated with LBP (OR: 1.3; 95% CI: 1.1-1.5). This association appears to be present in studies investigating alcohol as an abuse dependence substance in chronic LBP. Remaining individual studies tended to report no statistical significant association. No dose-response relationship was identified. Only one longitudinal study was identified and even though alcohol consumption was found to be negatively associated with a future episode of LBP (OR: 0.7; 95% CI: 0.5-0.9) this association lost significance for future incidence of LBP in people with no LBP at baseline., Conclusions: Alcohol consumption appears to be associated with complex and chronic LBP only and in people with alcohol consumption dependence. Clinicians in the musculoskeletal field could use this information to design educational strategies for this population., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study was to assess examiners' intrarater and interrater reliability to use a pressure biofeedback unit (PBU) during 6 lower limb movement tests based on Movement System Impairment classification model for low back pain (LBP) in people with nonspecific LBP., Methods: Thirty subjects (13 men and 17 women) with chronic nonspecific LPB were assessed during 6 lower limb movement tests based on Movement System Impairment classification using a PBU. Each test was performed twice by 2 assessors with a 48-hour interval between test sessions. Reliability indices of PBU measures (intraclass correlation coefficient [ICC]) were calculated., Results: Intrarater reliability for hip and knee movement tests was good to excellent (ICC(3,3), 0-.60-0.95). Interrater reliability for hip and knee movement tests was fair to excellent (ICC(2,3), 0.40-0.86). Standard error of the measurement and smallest detectable change for the movement tests ranged from 1.4 to 11.3 mm Hg and from 3.9 to 31.3 mm Hg, respectively., Conclusions: The results of this study indicate that trained examiners can reliably perform PBU measures for patients with chronic LBP., (Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

This study investigated the effect of lumbar posture on function of transversus abdominis (TrA) and obliquus internus (OI) in people with and without non-specific low back pain (LBP) during a lower limb task. Rehabilitative ultrasound was used to measure thickness change of TrA and OI during a lower limb task that challenged the stability of the spine. Measures were taken in supine in neutral and flexed lumbar postures in 30 patients and 30 healthy subjects. Data were analysed using a two-way (groups, postures) ANOVA. Our results showed that lumbar posture influenced percent thickness change of the TRA muscle but not for OI. An interaction between group and posture was found for TrA thickness change (F(1,56) = 6.818, p = 0.012). For this muscle, only healthy participants showed greater thickness change with neutral posture compared to flexed (mean difference = 6.2%; 95% CI: 3.1-9.3%; p < 0.001). Comparisons between groups for both muscles were not significant. Neutral lumbar posture can facilitate an increase in thickness of the TrA muscle while performing a leg task, however this effect was not observed for this muscle in patients with LBP. No significant difference in TrA and OI thickness change between people with and without non-specific LBP was found., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Many manual therapists assess and treat spinal stiffness of people with low back pain. The objectives of this study were to investigate: (i) whether spinal stiffness changes after treatment; (ii) the relationship between pre-treatment spinal stiffness and change in stiffness with treatment; (iii) the relationship between spinal stiffness, pain, disability and global perceived effect of treatment; (iv) whether spinal stiffness predicts outcome of treatment or response to treatment in chronic low back pain patients. One hundred and ninety-one subjects with chronic low back pain were randomly allocated to groups that received either spinal manipulative therapy, motor control exercise, or a general exercise program. Spinal stiffness was assessed before and after intervention. All three groups showed a significant decrease in stiffness following treatment (p<0.001). No difference between groups was observed. There was a significant negative correlation between pre-treatment stiffness and change in stiffness (r=-0.61; p<0.001). There was a significant but weak correlation (r=0.18; p=0.02) between change in stiffness and change in global perceived effect of treatment, and a significant but weak correlation between change in stiffness and change in function for subjects in the spinal manipulative therapy group (r=-0.28; p=0.02). No significant association was observed between initial stiffness score and any of the final outcome measures following treatment. Initial stiffness did not predict response to any treatment. In conclusion, spinal stiffness decreases over the course of an episode of treatment, more so in those with the stiffest spines, but the decrease is not dependent on treatment and is not generally related to outcome.

Study Design: Translation, cross-cultural adaptation, and clinimetric testing of self-report outcome measures., Objective: The aims of this investigation were to perform the translation and cross-cultural adaptation of the Patient-Specific Functional Scale (PSFS) into Brazilian-Portuguese and to perform a head-to-head comparison of the clinimetric properties of the Brazilian-Portuguese versions of the PSFS, the Roland-Morris Disability Questionnaire (RMDQ) and the Functional Rating Index (FRI)., Summary of Background Data: To date, there is no Brazilian-Portuguese version of the PSFS available and no head-to-head comparison of the Brazilian-Portuguese versions of the PSFS, RMDQ, and FRI has been undertaken., Methods: The PSFS was translated and adapted into Brazilian-Portuguese. The PSFS, the RMDQ, and the FRI were administered to 99 patients with low back pain to evaluate internal consistency, reproducibility, ceiling and floor effects, construct validity, internal and external responsiveness. To fully test the construct validity and external responsiveness of these measures, it was necessary to cross-culturally adapt the Pain Numerical Rating Scale and the Global Perceived Effect Scale., Results: All measures demonstrated high levels of internal consistency (Cronbach's alpha range = 0.88-0.90) and reproducibility (Intraclass Correlation Coefficient 2,1 range = 0.85-0.94). High correlations among the disability-related measures were observed (Pearson's r ranging from 0.51 to 0.71). No ceiling or floor effects were detected. The PSFS was consistently more responsive than the other measures in both the internal responsiveness and external responsiveness analyses., Conclusion: The results from this study demonstrate that the Brazilian-Portuguese versions of the RMDQ, the FRI and the PSFS have similar clinimetric properties to each other and to the original English versions. Of allthe measures tested in this study the PSFS seems the most responsive. These measures will enable international comparisons to be performed, and encourage researchers to include Portuguese speakers in their clinical trials.

Objective: The aim of this study was to investigate the behavior of the force applied during the Maitland grade III anteroposterior joint mobilization of the talus and its effect on dorsiflexion range of motion (ROM)., Methods: Two examiners performed measurements of dorsiflexion ROM on both ankles of healthy volunteers using a universal goniometer. The anteroposterior talus mobilization was first applied by examiner A for 30 seconds. Examiner B then repeated the same procedure. A platform was placed under the volunteer's leg to register the forces obtained during mobilization. After the procedure, examiner A assessed the ankle dorsiflexion., Results: The results showed consistency regarding maximal forces applied throughout the 30 seconds of mobilization as well as low consistency upon the minimal forces. A significant increase in dorsiflexion ROM of the ankle was found immediately after joint mobilization., Conclusions: The results of the present study have shown consistent maximal forces applied by one examiner and inconsistent minimal forces during an ankle mobilization in healthy volunteers when the same examiner was compared. Moreover, the applied force was able to increase dorsiflexion ROM after the Maitland grade III anteroposterior mobilization of the talus.

The purpose of this paper is to present the experience of nurses since the introduction of information technology in hospital work processes. It analyzes the meaning of information technology within the subjectivity and perception of healthcare in nursing work in a general hospital. As a theoretical background, it takes studies of work psychodynamics/psychopathology, referred to healthcare work processes and their repercussions on worker health. This qualitative inquiry strives to understand the significance of this subject in nursing routines. The field research was based on semi-structured interviews and non-systematic observation of some nursing activities, noting some resistance to change among the nurses, with difficulties in organizing the work and introducing them to new ways of handling their tasks. Faced by a machine, they feel trapped and isolated. This leads to the conclusion that the implementation of information technology interferes significantly in the work processes of the nurses participating in this study, and may adversely affect their health in the future.

Despite the increasing prevalence and economic costs of obesity in the USA, many physicians and other health care professionals do not advise their overweight and obese patients about weight loss. Using the 2001-2003 Behavioral Risk Factor Surveillance System data the purpose of our research is to investigate the relationship between individuals' receipt of physician's advice on weight loss and their tendency to eat fewer calories and fat or to use physical activity to lose weight. We find that physician's advice to lose weight has positive effects on both the probability of eating fewer calories and fat to lose weight and on the probability of using exercise to lose weight.

Study Design and Objectives: Meta-analysis of randomized controlled trials to evaluate the effectiveness of the McKenzie method for low back pain (LBP)., Summary of Background Data: The McKenzie method is a popular classification-based treatment for LBP. The faulty equation of McKenzie to extension exercises (generic McKenzie) is common in randomized trials., Methods: MEDLINE, EMBASE, PEDro, and LILACS were searched up to August 2003. Two independent reviewers extracted the data and assessed methodologic quality. Pooled effects were calculated among homogeneous trials using the random effects model. A sensitivity analysis excluded trials reporting on generic McKenzie., Results: Eleven trials of mostly high quality were included. McKenzie reduced pain (weighted mean difference [WMD] on a 0- to 100-point scale, -4.16 points; 95% confidence interval, -7.12 to -1.20) and disability (WMD on a 0- to 100-point scale, -5.22 points; 95% confidence interval, -8.28 to -2.16) at 1 week follow-up when compared with passive therapy for acute LBP. When McKenzie was compared with advice to stay active, a reduction in disability favored advice (WMD on a 0- to 100-point scale, 3.85 points; 95% confidence interval, 0.30 to 7.39) at 12 weeks of follow-up. Heterogeneity prevented pooling of studies on chronic LBP as well as pooling of studies included in the sensitivity analysis., Conclusions: There is some evidence that the McKenzie method is more effective than passive therapy for acute LBP; however, the magnitude of the difference suggests the absence of clinically worthwhile effects. There is limited evidence for the use of McKenzie method in chronic LBP. The effectiveness of classification-based McKenzie is yet to be established.

Four years after the first visit seventeen public health units were visited again and evaluated as to standards of storage recommended by the Brazilian Immunization Programme. In 100% of the units, refrigerators and proper inside location of vaccines in the refrigerator were adequately or regularly maintained and checked, respectively. However, when control of temperature was checked, only 64.7% presented adequate storage conditions. In 94.1% of the units, health workers complained of lack of immediate technical support in emergency situations. In 55.2% the titers vaccine samples of were under the minimal recommended potency. It is necessary that the factors concerning the cold chain be continually evaluated so that the quality of the vaccines that will be used is not affected.

In order to study the measles antibody behavior of three vaccination schedules, 684 children were divided into 4 Groups: Group A (341 vaccinated children under the age of one); Group B (101 children at the age of one); Group C (74 children under the age of one and one at the age of one); Group D (163 unvaccinated children with a history of measles in the past-Group control). Children of Group A presented lower rates and 25.9% of the age group under two did not show any measles antibodies. In Group B, all the children presented antibodies. In Group C only 4.0% did not. In all age groups, the geometric mean HI antibody titers of Group A were lower than the values found in the other groups. The age at vaccination was the factor of greater influence on the results of this study.

Twenty two "Public Health Units" were visited and evaluated as to standards of storage recommended by the Brazilian Immunization Programme. In 86.4% of the units, refrigerators were adequately or regularly maintained. However, when items such as proper inside location of the vaccines in the refrigerator or the control of temperature were checked, only 60% and 54.5% respectively presented adequate storage conditions. In 90% of the Units health workers complained of lack of immediate technical support in emergency situations. In 100% of the vaccine samples titers were well under the minimal recommended potency. Inadequacy and lack of uniformity, at regional and local levels, concerning conditions of vaccine storage as well as insufficient training of health personnel must have contributed to the above results.