Resumo Fundamento: As ferramentas de telecardiologia são estratégias valiosas para melhorar a estratificação de risco. Objetivo: Objetivamos avaliar a acurácia da tele-eletrocardiografia (ECG) para predizer anormalidades no ecocardiograma de rastreamento na atenção primária. Métodos: Em 17 meses, 6 profissionais de saúde em 16 unidades de atenção primária foram treinados em protocolos simplificados de ecocardiografia portátil. Tele-ECGs foram registrados para diagnóstico final por um cardiologista. Pacientes consentidos com anormalidades maiores no ECG pelo código de Minnesota e uma amostra 1:5 de indivíduos normais foram submetidos a um questionário clínico e ecocardiograma de rastreamento interpretado remotamente. A doença cardíaca grave foi definida como doença valvular moderada/grave, disfunção/hipertrofia ventricular, derrame pericárdico ou anormalidade da motilidade. A associação entre alterações maiores do ECG e anormalidades ecocardiográficas foi avaliada por regressão logística da seguinte forma: 1) modelo não ajustado; 2) modelo 1 ajustado por idade/sexo; 3) modelo 2 mais fatores de risco (hipertensão/diabetes); 4) modelo 3 mais história de doença cardiovascular (Chagas/cardiopatia reumática/cardiopatia isquêmica/AVC/insuficiência cardíaca). Foram considerados significativos valores de p < 0,05. Resultados: No total, 1.411 pacientes realizaram ecocardiograma, sendo 1.149 (81%) com anormalidades maiores no ECG. A idade mediana foi de 67 anos (intervalo interquartil de 60 a 74) e 51,4% eram do sexo masculino. As anormalidades maiores no ECG se associaram a uma chance 2,4 vezes maior de doença cardíaca grave no ecocardiograma de rastreamento na análise bivariada (OR = 2,42 [IC 95% 1,76 a 3,39]) e permaneceram significativas (p < 0,001) após ajustes no modelo 2 (OR = 2,57 [IC 95% 1,84 a 3,65]), modelo 3 (OR = 2,52 [IC 95% 1,80 a 3,58]) e modelo 4 (OR = 2,23 [IC 95% 1,59 a 3,19]). Idade, sexo masculino, insuficiência cardíaca e doença cardíaca isquêmica também foram preditores independentes de doença cardíaca grave no ecocardiograma. Conclusões: As anormalidades do tele-ECG aumentaram a probabilidade de doença cardíaca grave no ecocardiograma de rastreamento, mesmo após ajustes para variáveis demográficas e clínicas. Fundamento Objetivo teleeletrocardiografia tele eletrocardiografia (ECG Métodos meses portátil TeleECGs Tele ECGs cardiologista 15 5 1: remotamente moderadagrave moderada moderada/grave disfunçãohipertrofia disfunção hipertrofia ventricular motilidade forma idade/sexo idadesexo hipertensão/diabetes hipertensãodiabetes hipertensão diabetes (hipertensão/diabetes) Chagas/cardiopatia Chagascardiopatia Chagas cardiopatia reumáticacardiopatia reumática isquêmicaAVCinsuficiência AVC cardíaca. . cardíaca) 005 0 05 0,05 Resultados total 1411 411 1.41 1149 149 1.14 81% 81 (81% intervalo 74 514 51 51,4 masculino 24 2, OR 242 42 IC 95 176 76 1,7 3,39 339 39 3,39] 0,001 0001 001 257 57 2,5 184 84 1,8 3,65, 365 3,65 , 65 3,65]) 252 52 180 80 3,58 358 58 3,58] 223 23 2,2 159 59 1,5 3,19. 319 3,19 19 3,19]) Idade Conclusões teleECG clínicas (hipertensão/diabetes 00 0,0 141 41 1.4 114 14 1.1 8 (81 7 51, 9 1, 3,3 33 0,00 000 25 18 36 3,6 3,65] 3,5 35 22 31 3,1 3,19] 0, 1. 11 (8 3, (

Abstract Background: Tele-cardiology tools are valuable strategies to improve risk stratification. Objective: We aimed to evaluate the accuracy of tele-electrocardiography (ECG) to predict abnormalities in screening echocardiography (echo) in primary care (PC). Methods: In 17 months, 6 health providers at 16 PC units were trained on simplified handheld echo protocols. Tele-ECGs were recorded for final diagnosis by a cardiologist. Consented patients with major ECG abnormalities by the Minnesota code, and a 1:5 sample of normal individuals underwent clinical questionnaire and screening echo interpreted remotely. Major heart disease was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, or wall-motion abnormalities. Association between major ECG and echo abnormalities was assessed by logistic regression as follows: 1) unadjusted model; 2) model 1 adjusted for age/sex; 3) model 2 plus risk factors (hypertension/diabetes); 4) model 3 plus history of cardiovascular disease (Chagas/rheumatic heart disease/ischemic heart disease/stroke/heart failure). P-values < 0.05 were considered significant. Results: A total 1,411 patients underwent echo; 1,149 (81%) had major ECG abnormalities. Median age was 67 (IQR 60 to 74) years, and 51.4% were male. Major ECG abnormalities were associated with a 2.4-fold chance of major heart disease on echo in bivariate analysis (OR = 2.42 [95% CI 1.76 to 3.39]), and remained significant after adjustments in models (p < 0.001) 2 (OR = 2.57 [95% CI 1.84 to 3.65]), model 3 (OR = 2.52 [95% CI 1.80 to3.58]), and model 4 (OR = 2.23 [95%CI 1.59 to 3.19]). Age, male sex, heart failure, and ischemic heart disease were also independent predictors of major heart disease on echo. Conclusions: Tele-ECG abnormalities increased the likelihood of major heart disease on screening echo, even after adjustments for demographic and clinical variables. Background Telecardiology Tele cardiology stratification Objective teleelectrocardiography tele electrocardiography (ECG (echo PC. . (PC) Methods months protocols TeleECGs ECGs cardiologist code 15 5 1: remotely moderatesevere moderate severe dysfunctionhypertrophy dysfunction hypertrophy dysfunction/hypertrophy effusion wallmotion wall motion follows age/sex agesex sex hypertension/diabetes hypertensiondiabetes hypertension diabetes (hypertension/diabetes) Chagas/rheumatic Chagasrheumatic Chagas rheumatic diseaseischemic diseasestrokeheart stroke failure. failure failure) Pvalues P values 005 0 05 0.0 Results 1411 411 1,41 1149 149 1,14 81% 81 (81% IQR 74 years 514 51 51.4 2.4fold 24fold fold 2.4 OR 242 42 95% 95 [95 176 76 1.7 3.39, 339 3.39 , 39 3.39]) p 0.001 0001 001 257 57 2.5 184 84 1.8 3.65, 365 3.65 65 3.65]) 252 52 180 80 to3.58, to358 to3.58 to3 58 to3.58]) 223 23 2.2 95%CI 95CI 159 59 1.5 3.19. 319 3.19 19 3.19]) Age Conclusions TeleECG variables (PC (hypertension/diabetes 00 0. 141 41 1,4 114 14 1,1 8 (81 7 51. 4fold 24 2. 9 [9 1. 33 3.3 3.39] 0.00 000 25 18 36 3.6 3.65] to35 to3.5 to3.58] 22 31 3.1 3.19] 1, 11 (8 [ 3. to3. (

Abstract Studies evaluating the roughness, wettability and microbial adhesion of 3D-printed resins for complete denture bases and teeth are scarce. Objective This study evaluated the surface roughness, wettability and adhesion of multispecies biofilms (Candida albicans, Staphylococcus aureus and Streptococcus mutans) on 3D-printed resins for complete denture bases and teeth compared to conventional resins (heat-polymerized acrylic resin; artificial pre-fabricated teeth). Methodology Circular specimens (n=39; 6.0 mm Ø × 2.0 mm) of each group were subjected to roughness (n=30), wettability (n=30) and biofilm adhesion (n=9) tests. Three roughness measurements were taken by laser confocal microscopy and a mean value was calculated. Wettability was evaluated by the contact angle of sessile drop method, considering the mean of the three evaluations per specimen. In parallel, microorganism adhesion to resin surfaces was evaluated using a multispecies biofilm model. Microbial load was evaluated by determining the number of Colony Forming Units (CFU/mL) and by scanning electron microscopy (SEM). Data were subjected to the Wald test in a generalized linear model with multiple comparisons and Bonferroni adjustment, as well as two-way ANOVA (α=5%). Results The roughness of the conventional base resin (0.01±0.04) was lower than that of the conventional tooth (0.14±0.04) (p=0.023) and 3D-printed base (0.18±0.08) (p<0.001). For wettability, conventional resin (84.20±5.57) showed a higher contact angle than the 3D-printed resin (60.58±6.18) (p<0.001). Higher microbial loads of S. mutans (p=0.023) and S. aureus (p=0.010) were observed on the surface of the conventional resin (S. mutans: 5.48±1.55; S. aureus: 7.01±0.57) compared to the 3D-printed resin (S. mutans: 4.11±1.96; S. aureus: 6.42±0.78). The adhesion of C. albicans was not affected by surface characteristics. The conventional base resin showed less roughness than the conventional dental resin and the printed base resin. Conclusion The 3D-printed resins for base and tooth showed less hydrophobicity and less adhesion of S. mutans and S. aureus than conventional resins. 3Dprinted Dprinted 3D D scarce Candida heatpolymerized heat polymerized prefabricated pre fabricated teeth. . teeth) n=39 n39 n 39 (n=39 60 6 0 6. 20 2 2. n=30, n30 n=30 , 30 (n=30 n=9 n9 9 (n=9 tests calculated method specimen parallel CFU/mL CFUmL CFU mL (CFU/mL SEM. SEM (SEM) adjustment twoway two way α=5%. α5 α α=5% 5 (α=5%) 0.01±0.04 001004 01 04 (0.01±0.04 0.14±0.04 014004 14 (0.14±0.04 p=0.023 p0023 p 023 (p=0.023 0.18±0.08 018008 18 08 (0.18±0.08 p<0.001. p0001 p<0.001 001 (p<0.001) 84.20±5.57 8420557 84 57 (84.20±5.57 60.58±6.18 6058618 58 (60.58±6.18 S p=0.010 p0010 010 (p=0.010 (S 5.48±1.55 548155 48 1 55 7.01±0.57 701057 7 4.11±1.96 411196 4 11 96 6.42±0.78. 642078 6.42±0.78 42 78 6.42±0.78) C characteristics n=3 n3 3 (n=3 n= (n= (SEM α=5 (α=5% 0.01±0.0 00100 (0.01±0.0 0.14±0.0 01400 (0.14±0.0 p=0.02 p002 02 (p=0.02 0.18±0.0 01800 (0.18±0.0 p000 p<0.00 00 (p<0.001 84.20±5.5 842055 8 (84.20±5.5 60.58±6.1 605861 (60.58±6.1 p=0.01 p001 (p=0.01 5.48±1.5 54815 7.01±0.5 70105 4.11±1.9 41119 64207 6.42±0.7 (n α= (α=5 0.01±0. 0010 (0.01±0. 0.14±0. 0140 (0.14±0. p=0.0 p00 (p=0.0 0.18±0. 0180 (0.18±0. p<0.0 (p<0.00 84.20±5. 84205 (84.20±5. 60.58±6. 60586 (60.58±6. 5.48±1. 5481 7.01±0. 7010 4.11±1. 4111 6420 6.42±0. (α= 0.01±0 (0.01±0 0.14±0 014 (0.14±0 p=0. p0 (p=0. 0.18±0 018 (0.18±0 p<0. (p<0.0 84.20±5 8420 (84.20±5 60.58±6 6058 (60.58±6 5.48±1 548 7.01±0 701 4.11±1 411 642 6.42±0 (α 0.01± (0.01± 0.14± (0.14± p=0 (p=0 0.18± (0.18± p<0 (p<0. 84.20± 842 (84.20± 60.58± 605 (60.58± 5.48± 54 7.01± 70 4.11± 41 64 6.42± 0.01 (0.01 0.14 (0.14 p= (p= 0.18 (0.18 p< (p<0 84.20 (84.20 60.58 (60.58 5.48 7.01 4.11 6.42 0.0 (0.0 0.1 (0.1 (p (p< 84.2 (84.2 60.5 (60.5 5.4 7.0 4.1 6.4 0. (0. 84. (84. 60. (60. 5. 7. 4. (0 (84 (60 ( (8 (6

ABSTRACT The objective of this study was to evaluate levels of inclusion of an enzyme complex (EC) in corn- and soybean meal-based diets for laying hens on the digestibility of nutrients and energy. A metabolism trial was conducted using 75 Dekalb Brown laying hens at 26 weeks of age, which were distributed into five treatments with five replicates in a completely randomized design. The ingredients used in the diets received an additional (enriched) 3% methionine, lysine, cysteine, threonine, tryptophan, and metabolizable energy and 33.3% phosphorus. Treatments consisted of diets including 0, 150, 200, 250, or 300 mg.kg‒1 EC. We determined apparent metabolizable energy (AME); nitrogen-corrected AME (AMEn); apparent metabolizability coefficients of dry matter (DMAM), crude protein (CPAM), gross energy (GEAM), and phosphorus (PAM); digestible crude protein (CPD); and intake, retention, and excretion of phosphorus. No effects of EC levels were detected on the metabolizable energy values or digestibility coefficients, except for CPAM, which showed a quadratic response (maximum coefficient at 89.0 mg.kg‒1EC). A quadratic effect was also observed for CPD (minimum at 115 mg.kg‒1 EC), P excretion (maximum at 173.2 mg.kg‒1 EC), and P retention (maximum at 122.4 mg.kg‒1 EC) when EC was used. The use of the EC in corn- and soybean meal-based diets for laying hens improves their ileal digestibility of protein and apparent digestibility of phosphorus. However, EC addition to the diets does not affect AME, AMEn, or their metabolizability coefficients.

OBJETIVO: Avaliar os resultados da aplicação de programa de treinamento da Organização Mundial de Saúde, voltado para diagnóstico e tratamento da depressão, dirigido a médicos clínicos gerais. MÉTODOS: Dezessete clínicos e 1.224 pacientes da cidade de Campinas, SP, participaram do estudo. Um mês antes e um após o treinamento, foram avaliados o conhecimento dos médicos, suas atitudes e o atendimento prestado aos pacientes; esses, por sua vez, completaram escalas de auto-avaliação de sintomas depressivos: Zung e um "checklist" para depressão maior do manual para diagnóstico e estatística em saúde mental (DSM-IV/CID-10). A mudança de conhecimento e atitude dos clínicos entre as fases 1 e 2 foi avaliada pelos testes t de Student. Mudanças com relação ao conhecimento de cada indivíduo foram mensuradas pelo teste de qui-quadrado de McNemar. As diferenças entre o modo de atender os pacientes entre as duas fases foram determinadas pelo teste de qui-quadrado de Pearson. A concordância diagnóstica foi analisada utilizando o Kappa, com o intuito de corrigir a concordância ao acaso. RESULTADOS: O programa mostrou benefícios limitados nessa amostra de clínicos gerais. Não foi capaz de mostrar aumento do conhecimento sobre a depressão e nem quanto à atitude dos médicos com relação a esse transtorno. Não houve modificação no número de casos diagnosticados antes ou após o programa. Existiram algumas evidências com relação à melhora no manejo psicofarmacológico. Aparentemente, o programa tornou os clínicos mais confiantes para o tratamento da depressão, diminuindo o número de encaminhamentos feitos aos profissionais da área de saúde mental. Porém, um baixo poder estatístico não permitiu que os dois últimos achados atingissem significância. CONCLUSÕES: A inclusão de clínicos gerais é um componente central de qualquer iniciativa para melhorar a detecção e o tratamento da depressão, porém faz-se necessário testar melhores métodos de treinamento dos clínicos brasileiros no manejo desta.

OBJECTIVE: The American Regional Office of the WHO has launched a major initiative to reduce the prevalence of affective disorders region-wide that includes focusing on the primary health care system. This study evaluated the results of an educational training program for Brazilian primary care physicians that measured changes in knowledge, attitudes, and practice. METHODS: A total of 17 primary care physicians and 1,224 patients participated in the study. Physician's knowledge, attitudes, and clinical practice were assessed one-month prior and one-month following the training program. In addition, the patients that visited the clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major depression checklist at both times. RESULTS: The training program showed limited benefits in this small sample of physicians. The program was unable to demonstrate benefit in improving knowledge about depression and in changing disorder-related attitudes. There were no changes in the diagnostic rates of major depression. There was some evidence to support improvement in psychopharmacological management. The physicians seemed more confident in treating patients, as there was a reduction of referrals to the specialists. Lack of statistical power prevented the latter two findings from reaching statistical significance. CONCLUSIONS: The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of depression. However, more effective methods of training Brazilian primary care physicians in the management of major depression need to be tested.

OBJETIVO: Avaliar os resultados da aplicação de programa de treinamento da Organização Mundial de Saúde, voltado para diagnóstico e tratamento da depressão, dirigido a médicos clínicos gerais. MÉTODOS: Dezessete clínicos e 1.224 pacientes da cidade de Campinas, SP, participaram do estudo. Um mês antes e um após o treinamento, foram avaliados o conhecimento dos médicos, suas atitudes e o atendimento prestado aos pacientes; esses, por sua vez, completaram escalas de auto-avaliação de sintomas depressivos: Zung e um "checklist" para depressão maior do manual para diagnóstico e estatística em saúde mental (DSM-IV/CID-10). A mudança de conhecimento e atitude dos clínicos entre as fases 1 e 2 foi avaliada pelos testes t de Student. Mudanças com relação ao conhecimento de cada indivíduo foram mensuradas pelo teste de qui-quadrado de McNemar. As diferenças entre o modo de atender os pacientes entre as duas fases foram determinadas pelo teste de qui-quadrado de Pearson. A concordância diagnóstica foi analisada utilizando o Kappa, com o intuito de corrigir a concordância ao acaso. RESULTADOS: O programa mostrou benefícios limitados nessa amostra de clínicos gerais. Não foi capaz de mostrar aumento do conhecimento sobre a depressão e nem quanto à atitude dos médicos com relação a esse transtorno. Não houve modificação no número de casos diagnosticados antes ou após o programa. Existiram algumas evidências com relação à melhora no manejo psicofarmacológico. Aparentemente, o programa tornou os clínicos mais confiantes para o tratamento da depressão, diminuindo o número de encaminhamentos feitos aos profissionais da área de saúde mental. Porém, um baixo poder estatístico não permitiu que os dois últimos achados atingissem significância. CONCLUSÕES: A inclusão de clínicos gerais é um componente central de qualquer iniciativa para melhorar a detecção e o tratamento da depressão, porém faz-se necessário testar melhores métodos de treinamento dos clínicos brasileiros no manejo desta.

OBJECTIVE: The American Regional Office of the WHO has launched a major initiative to reduce the prevalence of affective disorders region-wide that includes focusing on the primary health care system. This study evaluated the results of an educational training program for Brazilian primary care physicians that measured changes in knowledge, attitudes, and practice. METHODS: A total of 17 primary care physicians and 1,224 patients participated in the study. Physician's knowledge, attitudes, and clinical practice were assessed one-month prior and one-month following the training program. In addition, the patients that visited the clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major depression checklist at both times. RESULTS: The training program showed limited benefits in this small sample of physicians. The program was unable to demonstrate benefit in improving knowledge about depression and in changing disorder-related attitudes. There were no changes in the diagnostic rates of major depression. There was some evidence to support improvement in psychopharmacological management. The physicians seemed more confident in treating patients, as there was a reduction of referrals to the specialists. Lack of statistical power prevented the latter two findings from reaching statistical significance. CONCLUSIONS: The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of depression. However, more effective methods of training Brazilian primary care physicians in the management of major depression need to be tested.