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ABSTRACT Calcium (Ca) and available phosphorus (avP) requirements for egg production are different between the beginning and the end of the egg-production cycle. The objective of this study was to estimate the Ca and avP requirements of Japanese quails at end of the production phase. In total, 256 Japanese quails with 48 weeks of age were randomly distributed in 2 x 2 factorial arrangement consisting of two Ca levels (29 and 38 g/kg) and two avP levels (1.5 and 3.0 g/kg), totaling four treatments with eight replicates of eight hens each. The variables evaluated were feed intake (FI); egg production (EP); marketable egg production (MEP); egg weight (EW); egg mass (EM); feed conversion ratio per egg mass (FCRM); feed conversion ratio per dozen eggs (FCRD); livability (L); yolk weight (YW), albumen weight (AW), eggshell weight (SW); yolk percentage (YP), albumen percentage (AP), eggshell percentage (SP), specific egg weight (SEW); bone calcium percentage (BCa), bone phosphorus percentage (BP), bone ash weight (Bash) and bone ash percentage (PBash). There was no interaction between Ca and avP levels for any of the evaluated parameters, except for SEW. Quail performance was not influenced by the treatments, except for MEP. Bone characteristics were not influenced by the tested dietary Ca and avP levels. However, SW and SP increased and AP decreased as dietary Ca level increased. The dietary supplementation of 38 g Ca/kg and 3.0 g avP/kg may increase marketable egg production and the egg quality of Japanese quails at end of the production cycle.

Colorectal cancer remains a significant cause of mortality worldwide. A spiro-acridine derivative, ( E )-1'-((4-bromobenzylidene)amino)-5'-oxo-1',5'-dihydro-10 H -spiro[acridine-9,2'-pyrrole]-4'-carbonitrile (AMTAC-19), showed significant cytotoxicity in HCT-116 colorectal carcinoma cells (half maximal inhibitory concentration, IC50 = 10.35 ± 1.66 µM) and antioxidant effects after 48 h of treatment. In this study, Molegro Virtual Docker v.6.0.1 software was used to investigate the interactions between AMTAC-19 and the Extracellular Signal-Regulated Kinase 1 (ERK1), c-Jun N-terminal Kinase 1 (JNK1), and p38 Mitogen-Activated Protein Kinase α (p38α MAPK). In vitro assays were conducted in HCT-116 cells to evaluate the effect of AMTAC-19 on the modulation of these proteins' activities using flow cytometry. Furthermore, the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay in the presence or absence of ERK1/2, JNK, and p38 MAPK inhibitors was used to evaluate the involvement of these enzymes in AMTAC-19 cytotoxicity. ROS production was assessed using the 2,7-dichlorodihydrofluorescein diacetate (DCFH-DA) assay at various incubation times (30 min, 1 h, 6 h, 12 h, and 24 h), and the MTT assay using N-acetyl-L-cysteine (NAC) was performed. In silico results indicated that AMTAC-19 interacts with ERK1, JNK1, and p38α MAPK. Additionally, AMTAC-19 activated ERK1/2 and JNK1 in HCT-116 cells, and its cytotoxicity was significantly reduced in the presence of ERK1/2 and JNK inhibitors. AMTAC-19 also induced a significant increase in ROS production (30 min and 1 h), while NAC pretreatment reduced its cytotoxicity. These findings support AMTAC-19's in vitro antitumor effect through ROS-dependent activation of ERK and JNK pathways., Competing Interests: The authors declare no conflicts of interest.

Background: This study evaluated stakeholders' perceptions regarding the initial implementation process of the health promoting school model proposed by the affordable health initiative (AHI HPS model) in schools of Belo Horizonte/BRA., Methods: The model has been implemented since 2019, by an implementation committee (IC) with members from university, health, and education sectors. Data were collected from records of the IC meetings (n = 10) and interviews with 5 IC members to evaluate the model's acceptability, adoption, appropriateness, and feasibility. The material was decomposed by content analysis., Results: Two categories and 7 subcategories emerged, suggesting that stakeholders found the model straightforward and well-suited to schools. Facilitators (teamwork, motivation, commitment, teacher's central role, inclusive decision-making, intersectoral responsibility pact, model alignment with school context) and barriers (family involvement, time constraints for curriculum integration, financial resource, school infrastructure, records difficulties, university unawareness of the school context) to implementation were presented., Implications for School Health Policy, Practice, and Equity: The results highlight the need to involve civil society and decision-makers to make the program feasible., Conclusion: Participants showed they accept and intend to contribute to implementing the model. They believe in the program's feasibility as long as teacher involvement is prioritized, and identified barriers are overcome., (© 2024 American School Health Association.)

Objective: To investigate the relationship between childhood consumption of ultra-processed foods and symptoms of hyperactivity/inattention in adolescents from São Leopoldo, a city in southern Brazil., Methods: Data were collected at four distinct stages: when participants were 12-16 months old in 2001 and 2002 and later when they were 3-4, 7-8, and 12-13 years old. During the interview at 12-16 months, mothers were asked about the introduction of sugar in their child's diet. Two 24-hour recall surveys were conducted with children aged 3-4, 7-8, and 12-13 years to assess their consumption of ultra-processed foods. At the age of 12-13 years, the participants completed the Hyperactivity/Inattention subscale of the Strengths and Difficulties Questionnaire (SDQ), which screens for mental health problems., Results: Among the 173 adolescents, 22.5% exhibited hyperactivity symptoms. The consumption of ultra-processed foods in grams, kilocalories, and as a percentage of energy intake at 3-4 years old were found to be predictors of hyperactivity/inattention symptoms (RR: 0.81, 95%CI: 0.69-0.95; RR: 1.01, 95%CI: 1.00-1.02; RR: 1.02, 95%CI:1.01-1.02; RR: 1.25, 95%CI:1.04-1.51, respectively)., Conclusion: The consumption of ultra-processed foods at an early age was associated with hyperactivity and inattention symptoms in adolescence.

Introduction/aims: Amyotrophic lateral sclerosis (ALS) may be familial or sporadic, and twin studies have revealed that even sporadic forms have a significant genetic component. Variants in 55 nuclear genes have been associated with ALS and although mitochondrial dysfunction is observed in ALS, variants in mitochondrial genomes (mitogenomes) have not yet been tested for association with ALS. The aim of this study was to determine whether mitogenome variants are associated with ALS., Methods: We conducted a genome-wide association study (GWAS) in mitogenomes of 1965 ALS patients and 2547 controls., Results: We identified 51 mitogenome variants with p values <10 -7 , of which 13 had odds ratios (ORs) >1, in genes RNR1, ND1, CO1, CO3, ND5, ND6, and CYB, while 38 variants had OR <1 in genes RNR1, RNA2, ND1, ND2, CO2, ATP8, ATP6, CO3, ND3, ND4, ND5, ND6, and CYB. The frequencies of haplogroups H, U, and L, the most frequent in our ALS data set, were the same in different onset sites (bulbar, limb, spinal, and axial). Also, intra-haplogroup GWAS revealed unique ALS-associated variants in haplogroups L and U., Discussion: Our study shows that mitogenome single nucleotide variants (SNVs) are associated with ALS and suggests that these SNVs could be included in routine genetic testing for ALS and that mitochondrial replacement therapy has the potential to serve as a basis for ALS treatment., (© 2024 Wiley Periodicals LLC.)

Objective: This study aimed to survey the practice of palliative sedation in Portugal, where data on this subject were lacking. Methods: This was a prospective multicentric study that included all patients admitted to each team that agreed to participate. Patients were followed until death, discharge, or after 3 months of follow-up. Results: The study included 8 teams: 4 as palliative care units (PCU), 1 as a hospital palliative care team (HPCT), 2 as home care (HC), and 1 as HPCT and HC. Of the 361 patients enrolled, 52% were male, the median age was 76 years, and 285 (79%) had cancer. Continuous sedation was undergone by 49 (14%) patients: 26 (53%) were male, and the median age was 76. Most patients, 46 (94%), had an oncological diagnosis. Only in a minority of cases, the family, 16 (33%), or the patient, 5 (10%), participated in the decision to sedate. Delirium was the most frequent symptom leading to sedation. The medication most used was midazolam (65%). In the multivariable analysis, only age and the combined score were independently associated with sedation; patients <76 years and those with higher levels of suffering had a higher probability of being sedated. Conclusions: The practice of continuous palliative sedation in Portugal is within the range reported in other studies. One particularly relevant point was the low participation of patients and their families in the decision-making process. Each team must have a deep discussion on this aspect., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Atrial wall thickness (AWT) is a significant factor in understanding the pathological physiological substrate of atrial fibrillation, with a potentially substantial impact on the outcomes of catheter ablation procedures. Precise measurements of the AWT may provide valuable insights for categorising patients with AF and planning targeted interventions. Objectives: The purpose of this study was to evaluate the characteristics of the left atrium (LA) using non-invasive multidetector computed tomography (MDCT) scans and subsequent three-dimensional (3D) image post-processing using novel software designed to calculate atrial thickness dimensions and mass. Methods: We retrospectively analysed 128 consecutive patients (33.6% females; mean age 55.6 ± 11.2 years) referred for AF ablation (37 with persistent AF and 91 with paroxysmal AF) who underwent preprocedural MDCT. The images were post-processed and analysed using the ADAS software (Galgo Medical), automatically calculating the LA volume and regional wall thickness. In addition, the software employed a regional semi-automatic LA parcellation feature that divided the atrial wall into 12 segments, generating atrial wall thickness (AWT) maps per segment for each patient. Results: This study demonstrated considerable variability in the average thickness of LA walls, with the anterior segments being the thickest across the cohort. Distinct sex-specific differences were observed, with males exhibiting greater anterior and septal wall thickness than females. No significant associations were identified between the average AWT and body mass index, LA volume, or sphericity. Survival analysis conducted over 24 months revealed a meaningful relationship between mean anterior wall thickness and recurrence-free survival, with increased thickness associated with a lower likelihood of AF-free survival. No such relationship was observed for the indexed LA volume. Conclusions: The variability in AWT and its association with recurrence-free survival following AF ablation suggest that AWT should be considered when stratifying patients for AF management and ablation strategies. These findings underscore the need for personalised treatment approaches and further research on the interplay of the structural properties of the left atrium as factors that can serve as important prognostic markers in AF treatment.

This cross-sectional study assessed the magnitude of inequalities in self-rated oral health (SROH) among different socioeconomic groups in Brazil. Secondary data from interviews with a sample of adults (≥18 years) from the national health survey 2013 ( n = 64,308) and 2019 ( n = 88,531) were analyzed. Positive SROH was considered when participants selected the good or very good options. Socioeconomic indicators were monthly household income and years of education. The magnitude of inequalities among socioeconomic groups was estimated using the Slope (SII) and Relative Index of Inequality (RII). Interaction term assessed changes in SII/RII over time. Estimates were adjusted for sex and age. The prevalence of SROH was 67.50% in 2013 and 69.68% in 2019. Individuals with lower socioeconomic indicators had a lower prevalence of positive SROH. Significant reductions in the magnitude of the education-based RII between 2013 (1.58) and 2019 (1.48) in Brazil, as well as in north (1.70; 1.45) and northeast (1.50; 1.41) regions and reduction in the income-based RII in the north (1.71; 1.51) were observed. Socioeconomic inequalities in SROH persist across different Brazilian regions, although there was a reduction in disparities among education groups in 2019 compared with 2013. The findings of this study suggest that equitable Brazilian oral health policies may have contributed to reducing SROH inequality over time.

A 65-year-old male with chronic liver disease and refractory ascites was being evaluated for liver transplant, when constrictive pericarditis (CP) was suspected. Initial diagnostics were inconclusive due to overdiuresis. After suspension of diuretics, cardiac magnetic resonance confirmed CP, leading to successful pericardiectomy and normalization of liver function, emphasizing volume status and multimodality imaging role in CP diagnosis., (© 2024. The Author(s).)

Introduction: The postpartum period is considered a phase of many physiological and hormonal changes that affect the individual. Fatigue is something present and can influence the postpartum woman in a negative way. In this way, the nurse has an essential role, and the nursing process can be used to establish an efficient care plan., Objective: To present the main nursing interventions and activities of the nursing diagnosis (ND) fatigue (00093) in individuals/people in the immediate postpartum period obtained through an integrative literature review and correlate with the proposed ND puerperal fatigue/excessive burden of fatigue in the postpartum period., Methods: Integrative literature review, carried out in the databases Cochrane, Scopus and Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science (WoS), Virtual Health Library (VHL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL), following rigorous methodological standards., Results: Six articles were included that identified the main nursing interventions related to the proposed ND puerperal fatigue., Conclusions: The integrative review highlighted the main nursing interventions and activities, and this study will be the basis for the next stages of the validation process for the ND puerperal fatigue/excessive fatigue in the postpartum period., Implications for Nursing Practice: This work can help nurses in clinical practice establish an efficient care plan through the most accurate nursing interventions and thus improve the quality of nursing services., (© 2024 NANDA International, Inc.)

Background: Infections are complications in the wound healing process, and their treatment can lead to antibiotic overuse and bacterial resistance. Antimicrobial photodynamic therapy (aPDT) is used to treat infectious diseases caused by fungi, viruses, or bacteria. Methylene blue (MB) and its derivatives are commonly used dyes in antimicrobial photodynamic therapy (aPDT-MB)., Methods: This study is a PRISMA systematic review of animal models used to discuss the usefulness and therapeutic parameters of aPDT-MB or its derivatives for treating infected skin wounds., Results: After an extensive literature review, 13 controlled trials totaling 261 animals were selected to evaluate skin infection by leishmaniasis and cutaneous bacterial and fungal infections. All studies found results favoring the use of aPDT-MB. Great variability in parameters was found for radiant exposure from 12 to 360 J/cm 2 , MB diluted in saline solution or distilled water, irradiation time from 40 to 3600 s, irradiance most commonly at a maximum of 100 mW/cm 2 , and wavelength used mainly in the 630-670 nm range., Conclusion: MB is a safe and promising agent used as a photosensitizer in aPDT for skin-infected lesions. There is great variability in the parameters found. Comparisons concerning concentration, irradiation time, and light intensity need to be performed., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This cross-sectional study investigated the association between experiences of discrimination and oral health self-perception among a probabilistic cluster sample of Brazilian adults who participated in the 2013 National Health Survey. Oral health self-perception was categorized into three groups (very good + good; fair; poor + very poor). Reported experiences of discrimination included attributions based on the respondent's race/skin color, social class, income, occupation, illness, sexual orientation, religion, sex, and age. Covariates included sociodemographic data, oral health conditions, access to healthcare services, health habits, mental health, and participation in social and/or religious activities. Data were analyzed using ordinal logistic regression for non-proportional odds, considering sample weights and complex samples. Among 60,202 adults, 5.84% perceived their oral health as poor + very poor, with a significantly higher proportion among those experiencing discrimination (9.98%). Adults who experienced discrimination were 1.39 times more likely to report a "poor/very poor/fair" oral health self-perception compared to those who did not experience discrimination. Those who suffered discrimination were 1.28 times more likely to have a "very poor/poor" oral health self-perception than their counterparts who were not affected by discrimination. These findings underscore the importance of considering discrimination experiences as part of the social determinants influencing oral health.

Background: Binge drinking has been linked to traumatic dental injury (TDI). Once drunk, adolescents are more prone to accidents, which may result in orofacial injury., Aim: This study evaluated the possible association of binge drinking with a number of traumatised teeth in a population of 12-year-old Brazilian adolescents in 2013 and 2015., Design: This study was longitudinal, carried out with 588 adolescents at two moments, 2013 and 2015. TDI, overjet and lip protection were assessed by calibrated examiners. Binge drinking data were collected through the Alcohol Use Disorders Identification Test. Sociodemographic indicators were obtained through a questionnaire answered by the parents/guardians. The Poisson regression model with a random effects intercept was estimated., Results: A higher prevalence of traumatised teeth was observed among adolescents who binge drink (IRR = 1.37; 95% CI: 1.05-1.80; p < .05). The prevalence was also significantly higher among adolescents in this age range with a ≥ 3-mm overjet and those with inadequate lip protection (IRR = 1.99; 95% CI: 1.44-2.76; p < .001 and IRR = 3.41; 95% CI: 2.57-4.53; p < .001, respectively)., Conclusion: A greater number of traumatised teeth were found among adolescents who reported binge drinking and had severe overjet and inadequate lip coverage., (© 2024 BSPD, IAPD and John Wiley & Sons Ltd.)

Introduction: In patients with atrial fibrillation (AF), up to one third have recurrence after a first catheter ablation (CA). Epicardial adipose tissue (EAT) has been considered to be closely related to AF, with a potential role in its recurrence. We aimed to evaluate the association between the volume of EAT measured by cardiac computed tomography (CT) and AF recurrence after CA., Methods: Consecutive AF patients underwent a standardized cardiac CT protocol for quantification of EAT, thoracic adipose volume (TAV) and left atrium (LA) volume before CA. An appropriate cut-off of EAT was determined and risk recurrence was estimated., Results: 305 patients (63.6 % male, mean age 57.5 years, 28.2 % persistent AF) were followed for 24 months; 23 % had AF recurrence at 2-year mark, which was associated with higher EAT (p = 0.037) and LAV (p < 0.001). Persistent AF was associated with higher EAT volumes (p = 0.010), TAV (p = 0.003) and LA volumes (p < 0.001). EAT was predictive of AF recurrence (p = 0.044). After determining a cut-off of 92 cm 3 , survival analysis revealed that EAT volumes > 92 cm 3 showed higher recurrence rates at earlier time points after the index ablation procedure (p = 0.006), with a HR of 1.95 (p = 0.008) of AF recurrence at 2-year. After multivariate adjustment, EAT > 92 cm 3 remained predictive of AF recurrence (p = 0.028)., Conclusion: The volume of EAT measured by cardiac CT can predict recurrence of AF after ablation, with a volume above 92 cm 3 yielding almost twice the risk of arrhythmia recurrence in the first two years following CA. Higher EAT and TAV are also associated with persistent AF., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Geopropolis resins are produced by stingless bees (Meliponinae), developed from the collection of resinous materials, waxes and exudates, from the flora of the region where stingless bees are present, in addition to the addition of clay or earth in its composition. Several biological activities are attributed to Ethanol Extracts of Geopropolis (EEGP). The bioactive properties are associated with the complex chemical composition that the samples have. This work aims to evaluate the biological activities of the EEGP, in order to contribute with a natural therapeutic alternative, to face infections, mainly those caused by resistant strains of Staphylococcus aureus. The EEGP MIC tests showed antibacterial activity against two strains of S. aureus, both at concentrations of 550 μg/mL. The MBC performed with the inhibition values showed that the EEGP has bacteriostatic activity in both strains. Biofilm inhibition rates exhibited an average value greater than 65 % at the highest concentration. The EEGP antioxidant potential test showed good antioxidant activity (IC50) of 11.05±1.55 μg/mL. In the cytotoxicity test against HaCat cells, after 24 hours, EEGP induced cell viability at the three tested concentrations (550 μg/mL: 81.68±3.79 %; 1100 μg/mL: 67.10±3.76 %; 2200 μg/mL: 67.40±1.86 %). In view of the above, the safe use of EEGP from the brazilian northeast could be proven by the cytotoxicity test, and its use as an antioxidant and antibacterial agent has proven to be effective, as an alternative in combating oxidative stress and microorganisms such as S. aureus, which, through the spread and ongoing evolution of drug resistance, generates an active search for effective solutions., (© 2024 Wiley-VHCA AG, Zurich, Switzerland.)

Objective: This study aimed to carry out a systematic review of observational studies searching the association between salivary factors (amount and quality of saliva) and noncarious cervical lesions (NCCL) in individuals with permanent dentition., Design: Cross-sectional, case-control, and cohort studies performed in humans with permanent dentition (population) and considering noncarious cervical lesions (outcome) in association with salivary characteristics (exposure) were included. PubMed, Web of Science, Cochrane, LILACS/BBO, Scopus, Embase, IBCT, NICE, OpenGrey, and Google Scholar were searched, with no language or date restrictions. Of 6561 potentially eligible studies, 142 were selected for full-text analysis. Three reviewers independently selected the studies, performed data extraction, and quality analysis through the Newcastle-Ottawa Scale., Results: Finally, ten references were included in the review, four case-control and six cross-sectional studies. Several salivary parameters were evaluated. Some parameters were considered associated with the presence of noncarious cervical lesions: salivary buffering capacity, salivary pH, citric acid, and calcium and potassium levels. The methodological quality varied across studies, with high heterogeneity among them., Conclusions: Some associations between saliva and NCCL suggesting protective factors and others risk factors were found. However, the evidence is sparse and comes from a few studies with great heterogeneity. New scientific evidence, with standardized methods, should be encouraged. Understanding salivary parameters that influence the occurrence of NCCL is important to guide dentists in relation to etiological factors that could potentially be neglected. The results may help in the development of new and early diagnostic methods and treatments for noncarious cervical lesions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

DNA viruses that produce persistent infections have been proposed as potential causes for the extinction of Neanderthals, and, therefore, the identification of viral genome remnants in Neanderthal sequence reads is an initial step to address this hypothesis. Here, as proof of concept, we searched for viral remnants in sequence reads of Neanderthal genome data by mapping to adenovirus, herpesvirus and papillomavirus, which are double-stranded DNA viruses that may establish lifelong latency and can produce persistent infections. The reconstructed ancient viral genomes of adenovirus, herpesvirus and papillomavirus revealed conserved segments, with nucleotide identity to extant viral genomes and variable regions in coding regions with substantial divergence to extant close relatives. Sequence reads mapped to extant viral genomes showed deamination patterns of ancient DNA, and these ancient viral genomes showed divergence consistent with the age of these samples (≈50,000 years) and viral evolutionary rates (10 -5 to 10 -8 substitutions/site/year). Analysis of random effects showed that the Neanderthal mapping to genomes of extant persistent viruses is above what is expected by random similarities of short reads. Also, negative control with a nonpersistent DNA virus does not yield statistically significant assemblies. This work demonstrates the feasibility of identifying viral genome remnants in archaeological samples with signal-to-noise assessment.

This study evaluates the performance of large intelligent surface (LIS) technology in the context of a multi-user MIMO mobile communication system (Mu-MIMO) proposed for the sixth generation (6G). LIS employs digitally controlled reflectors to enhance Signal-to-Interference plus Noise Ratio (SINR) and establish line of sight (LoS) connectivity in non-LoS environments, improving transmission security. Analytical expressions are derived to assess LIS performance metrics, including distribution parameters, bit error probability, and secrecy outage probability, considering the presence of eavesdroppers and environmental fading. The study highlights the potential of LIS technology to enhance the confidentiality and reliability of digital communication systems in next-generation networks.

Objective: Evaluate and compare the protagonism of Oral Health teams (OHt) in the teamwork process in Primary Healthcare (PHC) over five years and estimate the magnitude of disparities between Brazilian macro-regions., Methods: Ecological study that used secondary data extracted from the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Healthcare) from 2018 to 2022. Indicators were selected from a previously validated evaluative matrix, calculated from records in the Collective Activity Form on the degree of OHt's protagonism in team meetings and its degree of organization concerning the meeting agendas. A descriptive and amplitude analysis of the indicators' variation over time was carried out, and the disparity index was also calculated to estimate and compare the magnitude of differences between macro-regions in 2022., Results: In Brazil, between 3.06% and 4.04% of team meetings were led by OHt professionals. The Northeast and South regions had the highest (3.71% to 4.88%) and lowest proportions (1.21% to 2.48%), respectively. From 2018 to 2022, there was a reduction in the indicator of the "degree of protagonism of the OHt" in Brazil and macro-regions. The most frequent topics in meetings under OHt's responsibility were the work process (54.71% to 70.64%) and diagnosis and monitoring of the territory (33.49% to 54.48%). The most significant disparities between regions were observed for the indicator "degree of organization of the OHt concerning case discussion and singular therapeutic projects"., Conclusions: The protagonism of the OHt in the teamwork process in PHC is incipient and presents regional disparities, which challenges managers and OHt to break isolation and lack of integration, aiming to offer comprehensive and quality healthcare to the user of the Unified Health System (SUS).

Background: The challenges to conducting oral health studies involving older people in long-term care facilities (LTCFs) must be debated., Objective: This study aimed to investigate researchers' perceptions and experiences while conducting an epidemiological survey on oral health among older individuals residing in LTCFs., Methods: A qualitative study was conducted involving six researchers who utilized field diaries to record their impressions during data collection through interviews (older individuals (or their proxies), caregivers, and LTCF coordinators) and oral examinations of the older people participants. Additionally, researchers responded to open-ended questions about their experiences. The collected material was subjected to content analysis by two researchers., Results: The themes that emerged from the analysis were institutional context, aspects affecting the operationalization of the study, and data collection oriented by the clinical-functional profile of the older people. According to the researchers' perceptions, LTCF coordinators demonstrated concern for the study's benefits for older adults and the preservation of institutional routines during the research process. Caregivers emerged as vital sources of information, guiding researchers in navigating the challenges posed by the physical and mental complexities of the older people participants, necessitating empathy, sensitivity, and attentive listening from the researchers. The organization of materials and a streamlined data collection process proved essential for optimizing time efficiency and reducing stress for participants and researchers., Conclusion: The researchers recognized the important role played by LTCF coordinators and formal caregivers, underscoring the significance of empathetic methodologies and streamlined data collection processes in mitigating the challenges inherent to research conducted within LTCFs., (© 2024. The Author(s).)

Background: The principal barrier to an HIV cure is the presence of the latent viral reservoir (LVR), which has been understudied in African populations. From 2018 to 2019, Uganda instituted a nationwide rollout of ART consisting of Dolutegravir (DTG) with two NRTI, which replaced the previous regimen of one NNRTI and the same two NRTI., Methods: Changes in the inducible replication-competent LVR (RC-LVR) of ART-suppressed Ugandans with HIV (n = 88) from 2015 to 2020 were examined using the quantitative viral outgrowth assay. Outgrowth viruses were examined for viral evolution. Changes in the RC-LVR were analyzed using three versions of a Bayesian model that estimated the decay rate over time as a single, linear rate (model A), or allowing for a change at time of DTG initiation (model B&C)., Findings: Model A estimated the slope of RC-LVR change as a non-significant positive increase, which was due to a temporary spike in the RC-LVR that occurred 0-12 months post-DTG initiation (p < 0.005). This was confirmed with models B and C; for instance, model B estimated a significant decay pre-DTG initiation with a half-life of 6.9 years, and an ∼1.7-fold increase in the size of the RC-LVR post-DTG initiation. There was no evidence of viral failure or consistent evolution in the cohort., Interpretation: These data suggest that the change from NNRTI- to DTG-based ART is associated with a significant temporary increase in the circulating RC-LVR., Funding: Supported by the NIH (grant 1-UM1AI164565); Gilead HIV Cure Grants Program (90072171); Canadian Institutes of Health Research (PJT-155990); and Ontario Genomics-Canadian Statistical Sciences Institute., Competing Interests: Declaration of interests RR and SLL are employed by BioInfoExperts, LLC. No other authors have any conflicts to report., (Published by Elsevier B.V.)

This study aimed to evaluate the clinical evolution of patients with diabetic foot ulcer treated with antimicrobial photodynamic therapy (aPDT) using the Bates-Jensen (BJ) scale. A total of 21 patients were monitored, with an average age of 58 years. Patients underwent the standard treatment protocol of the institution, supplemented with aPDT utilizing 0.01% methylene blue (MB) and laser irradiation (660 nm, 100 mW, 6 J per point). Following aPDT, the lesions were protected with hydrofiber dressings containing silver. The Bates-Jensen Scale was employed at pre-treatment and post-aPDT sessions to assess lesion progression. The results demonstrated a significant difference between pre- and post-treatment values in the overall BJ score. The use of MB in aPDT proved to be an effective, safe, well-tolerated treatment with high patient adherence and the potential for implementation in the care of diabetic foot conditions., (© 2024 Wiley‐VCH GmbH.)

Background: Impaired left atrial (LA) strain predicts atrial fibrillation (AF) recurrence after catheter ablation (CA), but currently there is no cut-off to guide patient selection for CA. Integrated backscatter (IBS) is a promising tool for noninvasive quantification of myocardial fibrosis. The aim of this study was to compare LA strain and IBS between paroxysmal, persistent, and long-standing persistent AF and evaluate their association with AF recurrence after CA., Methods: Analysis of consecutive patients with symptomatic paroxysmal and persistent AF who underwent CA. LA phasic strain, strain rate and IBS were assessed by two-dimensional speckle-tracking at baseline., Results: We analyzed 78 patients, 31% with persistent AF (46% long-standing AF), 65% male, mean age 59 ± 14 years, who underwent CA and were followed-up for 12 months. AF recurrence occurred in 22 (28%) patients. LA phasic strain parameters were significantly impaired in patients with AF recurrence and were independent predictors of AF recurrence in a multivariable analysis. LA reservoir strain (LASr) < 18% predicted AF recurrence with 86% sensitivity and 71% specificity, with a higher predictive power compared to LA volume index (LAVI). LASr < 22% in paroxysmal AF and LASr < 12% in persistent AF correlated with AF recurrence. Increased IBS was a predictor of AF recurrence in patients with paroxysmal AF., Conclusion: LA phasic strain parameters were predictors of AF recurrence after CA, independently of LAVI and AF subtype. LASr < 18% showed a higher predictive power compared to LAVI. Further studies are needed to investigate the role of IBS as a predictor of AF recurrence., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The genetic contributions of Neanderthals to the modern human genome have been evidenced by the comparison of present-day human genomes with paleogenomes. Neanderthal signatures in extant human genomes are attributed to intercrosses between Neanderthals and archaic anatomically modern humans (AMHs). Although Neanderthal signatures are well documented in the nuclear genome, it has been proposed that there is no contribution of Neanderthal mitochondrial DNA to contemporary human genomes. Here we show that modern human mitochondrial genomes contain 66 potential Neanderthal signatures, or Neanderthal single nucleotide variants (N-SNVs), of which 36 lie in coding regions and 7 result in nonsynonymous changes. Seven N-SNVs are associated with traits such as cycling vomiting syndrome, Alzheimer's disease and Parkinson's disease, and two N-SNVs are associated with intelligence quotient. Based on recombination tests, principal component analysis (PCA) and the complete absence of these N-SNVs in 41 archaic AMH mitogenomes, we conclude that convergent evolution, and not recombination, explains the presence of N-SNVs in present-day human mitogenomes.

Background: Left ventricular global longitudinal strain (GLS) has incremental prognostic value over ejection fraction (EF) in patients with ST-segment-elevation myocardial infarction (STEMI), but it is also load dependent. It has been recently demonstrated that Myocardial work (MW), integrating blood pressure with GLS, predicts long-term all-cause mortality. We aimed to further explore the prognostic value of MW for cardiovascular endpoints in patients with STEMI., Methods and Results: Retrospective study of 200 consecutive patients admitted with a STEMI, mean age of 62 (SD 12) years, 79.5% males, that survived to discharge. Transthoracic echocardiography was performed before discharge (5 ± 3 days after admission). Mean follow-up was 790 days. The primary outcome was a composite of cardiovascular death, non-fatal myocardial infarction, and unplanned cardiovascular admission (ACE). During follow-up, 26 patients had a ACE. In univariable Cox regression analysis, male gender, body mass index, GRACE risk score and Global Work Index (GWI) were selected to the multivariable analysis, in which, only GWI (per 100 mmHg% decrease: hazard ratio estimate 1.19, 95% confidence interval 1.07-1.34, p-value = 0.002) remained independently associated with ACE, with effective reclassification of non-events. The best GWI cut-off to predict ACE was ≤1165 mmHg% (Log-rank, p = 0.034)., Conclusions: LV GWI is independently associated with medium-term ACE. Nevertheless, prospective studies in a larger sample of patients are warranted to confirm this finding., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2024 The Author. Published by Elsevier B.V. All rights reserved.)

Aim: The aim of the study was to evaluate several mechanical and chemical decontamination methods associated with a newly introduced biofilm matrix disruption strategy for biofilm cleaning and preservation of implant surface features., Materials and Methods: Titanium (Ti) discs were obtained by additive manufacturing. Polymicrobial biofilm-covered Ti disc surfaces were decontaminated with mechanical [Ti curette, Teflon curette, Ti brush, water-air jet device, and Er:YAG laser] or chemical [iodopovidone (PVPI) 0.2% to disrupt the extracellular matrix, along with amoxicillin; minocycline; tetracycline; H 2 O 2 3%; chlorhexidine 0.2%; NaOCl 0.95%; hydrocarbon-oxo-borate-based antiseptic] protocols. The optimal in vitro mechanical/chemical protocol was then tested in combination using an in vivo biofilm model with intra-oral devices., Results: Er:YAG laser treatment displayed optimum surface cleaning by biofilm removal with minimal deleterious damage to the surface, smaller Ti release, good corrosion stability, and improved fibroblast readhesion. NaOCl 0.95% was the most promising agent to reduce in vitro and in vivo biofilms and was even more effective when associated with PVPI 0.2% as a pre-treatment to disrupt the biofilm matrix. The combination of Er:YAG laser followed by PVPI 0.2% plus NaOCl 0.95% promoted efficient decontamination of rough Ti surfaces by disrupting the biofilm matrix and killing remnants of in vivo biofilms formed in the mouth (the only protocol to lead to ~99% biofilm eradication)., Conclusion: Er:YAG laser + PVPI 0.2% + NaOCl 0.95% can be a reliable decontamination protocol for Ti surfaces, eliminating microbial biofilms without damaging the implant surface., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Although strong scientific evidence of the efficacy and effectiveness of treatment-as-prevention (TasP) is available, full endorsement of the "Undetectable = Untransmittable" (U = U) and "zero-risk" messages could be improved. Increasing knowledge about HIV transmission, prevention and treatment is a critical component of care efforts. The study assessed knowledge of HIV transmission and prevention strategies, and the perceived accuracy of the slogan U = U among sexual and gender minorities (SGM) in Brazil., Methods: Cross-sectional web-based survey targeting adult SGM living in Brazil (2021-2022) recruited on social media and dating apps. We used the 12-item HIV Knowledge Assessment (HIV-KA) questionnaire to assess HIV knowledge, three items of which address pre-exposure prophylaxis (PrEP), post-exposure prophylaxis and TasP. Perceived accuracy of the U = U slogan was assessed with the question: "With regards to HIV-positive individuals transmitting HIV through sexual contact, how accurate do you believe the slogan U = U is?". We a priori grouped the study population into three mutually exclusive groups: people living with HIV (PLHIV), HIV negative and HIV unknown. We used logistic regression models to assess factors associated with high HIV knowledge and perception of the U = U as completely accurate., Results: Of 50,222 individuals accessing the questionnaire, 23,981 were included: 5071 (21.0%) PLHIV, 17,257 (71.5%) HIV negative and 1653 (6.9%) HIV unknown. The proportion of participants with high knowledge was significantly higher for PLHIV and HIV negative (48.1% and 45.5%, respectively) compared to 26.1% of HIV unknown. More PLHIV perceived U = U as completely accurate (80.4%), compared to 60.0% of HIV negative and 42.9% of HIV unknown. HIV knowledge correlates with perceived accuracy of the U = U slogan across all groups. Higher HIV knowledge was associated with higher income and education regardless of HIV status. Among HIV-negative participants, PrEP awareness and use were associated with higher knowledge and accurate perception of the U = U slogan., Conclusions: Our findings show that HIV knowledge and perceived accuracy of U = U are strongly correlated, that knowledge differs according to HIV status, and that poor socio-economic is linked to poor knowledge among SGM from Brazil. Educational strategies regarding TasP, U = U and zero risk targeting socio-economically vulnerable populations are urgent in Brazil., (© 2024 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)

This study mapped definitions of shortened dental configurations and health outcomes employed in association studies. A scoping review was conducted using the PubMed/Medline, Scopus, Web of Science, SciELO and Cochrane databases. Two trained researchers selected studies and extracted data. Studies that investigated the association between shortened dental configurations (exposure) and person-centered outcomes (general and oral health) related to health behavior (dietary patterns). Clinical outcomes were classified according to the International Classification of Functioning, Disability and Health and the International Classification of Diseases of the World Health Organization (WHO). Shortened dental configurations were defined as at least 20/21 teeth or the position of the teeth, including esthetics, dental occlusion and periodontal status (Eichner Index, Shortened Dental Arches, Functional Dentition Classification System, Posterior Occluding Pairs, Functional Tooth Units). The initial search resulted in 12,525 records in English, Portuguese and Spanish, 432 of which addressed the association of interest. General health (n = 203) and oral health (n = 201) were addressed in a similar number of studies. Most outcomes were related to general health (n = 184), the most frequent of which were endocrine, nutritional or metabolic diseases (n = 57) and mental functions (n = 26). Person-centered measures were addressed in 153 studies, most of which were about oral health and oral health-related quality of life (n = 62). Oral health outcomes were predominantly related to intake functions (n = 44) and diseases or disorders of the orofacial complex (n = 24). Dietary patterns (n = 43) and mortality (n = 38) were also studied. The cross-sectional design (n = 257) and non-probabilistic sampling (n = 218) were more frequent. The shortened dental configurations defined by the WHO were the most frequent in the studies (n = 206). The effects of shortened dental configurations have been investigated mainly in relation to endocrine, nutritional or metabolic diseases and measures of oral health-related quality of life. The findings point to a diversity of health outcomes assessed and substantial methodological variability., (© 2024. The Author(s).)

Patients with hypertrophic cardiomyopathy may exhibit impaired functional capacity, associated with increased morbidity and mortality. Systolic function is one of the determinants of functional capacity. Early identification of systolic disfunction may identify patients at risk for adverse outcomes. Myocardial deformation parameters, derived from three-dimensional (3D) speckle-tracking echocardiography (3DSTE) are useful tools to assess left ventricular systolic function, and are often abnormal before a decline in ejection fraction is seen. The aim of this study was to evaluate the correlation between myocardial deformation parameters obtained by 3DSTE and functional capacity in patients with hypertrophic cardiomyopathy. Seventy-four hypertrophic cardiomyopathy adult patients were prospectively evaluated. All patients underwent a dedicated 2D and 3D echocardiographic examination and cardiopulmonary exercise testing (CPET). Values of 3D global radial (GRS), longitudinal (3DGLS) and circumferential strain (GCS) were overall reduced in our population: 99% (n = 73) of the patients had reduced GLS, 82% (n = 61) had reduced GRS and all patients had reduced GCS obtain by 3DSTE. Average peak VO 2 was 21.01 (6.08) ml/Kg/min; 58% (n = 39) of the patients showed reduced exercise tolerance (predicted peak VO 2  < 80%). The average VE/VCO 2 slope was 29.0 (5.3) and 16% (n = 11) of the patients had impaired ventilatory efficiency (VE/VCO 2  > 34). In multivariable analysis, 3D GLS (β 1  = 0.10, 95%CI: 0.03;0.23, p = 0.014), age (β 1  = -0.15, 95%CI: -0.23; -0.05, p = 0.002) and female gender (β 1  = -5.10, 95%CI: -7.7; -2.6, p < 0.01) were independently associated with peak VO 2 . No association was found between left ventricle ejection fraction obtain and peak VO 2 (r = 0.161, p = 0.5). Impaired myocardial deformation parameters evaluated by 3DSTE were associated with worse functional capacity assessed by peak VO 2 ., (© 2023. The Author(s).)

Purpose: Non-VKA oral anticoagulants (NOACs) prescription is increasing in adults with congenital heart disease (ACHD). However, data on efficacy and safety in ACHD is unclear, particularly in severe CHD. The study aimed to review the safety and efficacy of NOACs in ACHD., Methods: Retrospective evaluation of ACHD patients started on NOACs from 2014 to 2020, with the primary endpoints of bleeding or thromboembolic events (TE). CHA 2 DS 2 -VASc and HAS-BLED scores were calculated, mortality was assessed, and risk factors for bleeding were identified., Results: A total of 93 patients were included, the mean age was 52 ± 15 years, 58% were female, 55.9% had moderate CHD, and 23.7% had severe CHD (3.2% Fontan). Most (66%) had a CHA 2 DS 2 -VASc score ≥ 2 and 82% HAS-BLED ≤ 2. In a median follow-up of 41 (IQR 21) months (400.4 patient-years), there were TE in two patients. The annual risk for TE was 0.49%/patient/year. The cardiovascular mortality was 2% and all-cause mortality 5%; there were no fatal TE or bleeding events. Minor (n = 6, 6.5%) and major (n = 3, 3.2%) bleeding events were observed, a median of 12 (IQR 15) months after starting NOAC therapy. The annual risk for bleeding was 2.2%/patient/year. Renal disease (HR 14.6 [95% CI 1.23-73.6], p = 0.033) and the HAS-BLED score were predictors of major (adjusted HR 6.97 [95% CI 1.69-28.78], p = 0.007) and minor (adjusted HR 3.80 [95% CI 1.48-9.78], p = 0.006) bleeding complications., Conclusion: In this real-life cohort of selected ACHD, the use of NOACs was safe and effective, with a low incidence of bleeding events., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)