ABSTRACT BACKGROUND: Insulin resistance often occurs in patients with chronic kidney disease (CKD) owing to mineral and bone metabolism disorders. Fibroblast growth factor (FGF)-23 and soluble klotho (s-KL) play crucial roles in linking CKD with mineral and bone metabolism. OBJECTIVE: This study aimed to examine the relationship between insulin resistance and FGF-23 and s-KL in patients with non-diabetic pre-dialysis patients with CKD. DESIGN AND SETTING: This research was conducted in the Ankara Bilkent City Hospital Nephrology Clinic. Ankara,Turkey. METHODS: This study included 133 male and 150 female patients with pre-dialysis CKD. The patients were compared with 80 healthy individuals. FGF-23 and s-KL levels were determined using enzyme-linked immunosorbent assay kits. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to determine insulin resistance. RESULTS: Creatinine, urine protein/creatinine ratio (UPCR), log10 FGF-23, log 10 s-KL, and HOMA-IR were notably higher, while glomerular filtration rate was notably lower, in patients than in healthy individuals. Stage 5 CKD, log10 FGF-23, creatinine, and UPCR were significantly higher in patients with HOMA-IR > 3.06 compared to those with HOMA-IR ≤ 3.06. No difference was observed in s-KL levels between the two groups. Univariate and multivariate logistic regression analyses revealed an increase in HOMA-IR and log10 FGF-23 values. CONCLUSIONS: Insulin resistance, serum FGF-23, and s-KL levels increased in patients compared with healthy individuals. Higher creatinine, proteinuria, and FGF-23 levels were associated with greater insulin resistance. The study highlighted a significant relationship between insulin resistance and FGF-23.

ABSTRACT BACKGROUND: Although multiple strategies have been suggested for evidence-based practice educational interventions, few studies have focused on the development of abilities for evidence-based practice implementation. OBJECTIVE: To explore the effectiveness of evidence-based practice in higher education and understand its teaching methods. DESIGN AND SETTING: Narrative review was conducted at the Universidade Municipal de São Caetano do Sul, Brazil. METHODS: Narrative review included research studies that measured any type of evidence-based practice teaching method and its effectiveness. Searches included publications from inception to June 2022, conducted on MEDLINE, EMBASE, CINAHL, CENTRAL, ERIC, and the Cochrane Library. Two independent authors descriptively extracted and analyzed the data. The methodological quality of the studies was also analyzed. RESULTS: The results determined that 79.2% of the studies proved their effectiveness. Teaching methods varied according to the time period, format, and types of questionnaire. CONCLUSIONS: Most studies demonstrated the effectiveness of the chosen teaching methods. This study shows the importance of health professionals using evidence-based practice to ensure effective patient treatment.

ABSTRACT BACKGROUND: Temporomandibular disorders (TMD) are a major cause of non-dental pain in the oral and facial regions. OBJECTIVE: This study aimed to determine the prevalence and severity of TMD and anxiety among academics and to investigate the relationship between TMD and its associated factors. DESIGN AND SETTING: This cross-sectional study included a sample of 295 academics undertaking health courses at a university in Brazil. METHODS: The Simplified Anamnesis Index and Beck Anxiety Inventory were used to evaluate TMD and assess anxiety, respectively. Data were statistically analyzed using relative and absolute frequencies of variables. In the bivariate analysis, Pearson’s chi-square test was used, and in the multivariate analysis, raw and adjusted binary logistic regressions were used to obtain the odds ratio (OR) and respective 95% confidence intervals. Statistical significance was set at P < 0.05. RESULTS: The average age of academics was 22.95 (standard deviation ± 6.14) years, predominantly comprising women (82.7%), whites (90.8%), and singles (86.6%). The findings revealed that 81.2% of academics had TMD and 50.5% exhibited symptoms of anxiety. Academics with anxiety were three times more likely to have TMD (OR = 3.6) than those without anxiety. CONCLUSION: A significant association between anxiety and TMD was observed in academics. The prevalence of TMD was high, with academics with anxiety having a high likely to develop TMD. These findings highlight the importance of addressing mental health concerns in addition to physical health, as they are often related.

ABSTRACT BACKGROUND: The diagnosis and treatment of latent tuberculosis infection (LTBI) are crucial for tuberculosis (TB) control. Household contacts (HHC) of patients with pulmonary TB are at a high risk of LTBI due to their close proximity to source cases. OBJECTIVE: To describe the diagnosis and treatment of LTBI among HHC. DESIGN AND SETTING: This cross-sectional follow-up study was conducted in the municipality of Paulo Afonso, northeastern Brazil, between 2013 and 2022. METHODS: We retrieved secondary data from the medical records of HHC who were followed up at a specialized referral center for TB. LTBI prevalence estimates were calculated and are presented with 95% confidence intervals (CIs). RESULTS: In total, 622 HHC were screened for LTBI, with 620 evaluated using the tuberculin skin test (TST). Of these, 40 (6.5%) did not return for TST reading. The overall prevalence of LTBI was 53.1% (95% CI: 49–57.1%), with a high prevalence among females and individuals aged 25–34 years. The overall LTBI treatment initiation rate was 26.1% (95%CI: 21.5–31.3%), and 64.2% (95%CI: 53.3–73.8%) of HHC who initiated treatment completed their course. CONCLUSION: This study revealed a high prevalence of LTBI among HHC, particularly among women and individuals aged 25–34 years, underscoring the ongoing TB transmission within the community. Only 26.1% of the diagnosed HHC initiated treatment, with approximately 64% completing their course. This highlights the challenges in managing LTBI and emphasizes the need for targeted screening and interventions for high-risk groups.

ABSTRACT BACKGROUND: Universal healthcare is a cornerstone of Brazil’s public health system. However, delayed diagnosis and treatment of chronic kidney disease (CKD) remain substantial issues. The scarcity of outpatient dialysis facilities contributes to extended hospital stays. This study aimed to examine how the time to dialysis initiation (TID) impacts mortality in patients with renal disease. OBJECTIVES: This study aimed to evaluate the correlation between variables affecting TID and mortality in hospitalized patients with renal disease. DESIGN AND SETTING: A cross-sectional study was conducted at Santa Marcelina Hospital in São Paulo. METHODS: This cross-sectional study was conducted in a tertiary hospital, involving adults with kidney disease who were referred to the emergency department between 2014 and 2017. Primary outcomes included TID and mortality rates. RESULTS: Among the 402 patients studied, the average age was 58.6 years, and 59.4% were men. The median hospital stay was 44.5 d. Notably, 28.1% of the patients began dialysis under emergency conditions. Diabetes and hypertension were the most prevalent causes of renal disease. A positive correlation was found between age and TID (P = 0.007). CONCLUSIONS: Primary care in Brazil often fails to effectively detect and manage CKD, leading to a higher incidence of emergency dialysis, particularly among older adults. This delay correlates with increased mortality rates. Older age is associated with delayed TID, prolonged hospital stays, and consequently higher mortality. These findings highlight the need for better primary care to effectively manage CKD and reduce hospitalization and mortality.

ABSTRACT BACKGROUND: The Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score is commonly used to assess the functional status of athletes with conditions affecting the shoulder and elbow. However, a Brazilian Portuguese version of the KJOC questionnaire is currently unavailable. OBJECTIVES: This study aimed to develop a Brazilian Portuguese version of the KJOC questionnaire. DESIGN AND SETTING: This translation and cultural adaptation study was conducted at the Federal University of Paraíba, Brazil. METHODS: The procedures adopted in this study followed guidelines recommending translation by two independent translators, synthesis of the translations, back-translation performed by two native English-speaking translators, analysis by an expert committee, and pre-testing. The Portuguese version was tested with 32 athletes to assess their understanding of the assessment tool. Items were deemed adequate if they were understood by at least 90% of the athletes. RESULTS: The terms and expressions of some original items were modified to achieve better comprehensibility in the Brazilian context. No further modifications were necessary after the pre-test; all terms were comprehensible to over 90% of athletes. CONCLUSION: The translation and cultural adaptation of the KJOC questionnaire into Portuguese were completed, resulting in a Brazilian version of the scale. Further studies are needed to evaluate the reliability and validity of this scale.

ABSTRACT BACKGROUND: Prenatal depression threatens maternal and child well-being and interferes with issues prioritized by the 2030 agenda for the Sustainable Development Goals. OBJECTIVES: This study aimed to estimate the prevalence of depressive disorders during pregnancy using the Patient Health Questionnaire-9 (PHQ-9). DESIGN AND SETTING: A cross-sectional study using a sample of pregnant Brazilian women, representative of Brazil as a whole. METHODS: Data were obtained from the National Health Survey 2019 (PNS-2019), as coordinated by the Instituto Brasileiro de Geografia e Estatística (IBGE). Women aged 18-49 years who were pregnant during PNS-2019 data collection were included. The prevalence of depressive disorders and 95% confidence intervals (95%CI) were calculated. RESULTS: The prevalence of depression before the current pregnancy was 6.03% (95%CI: 3.80%; 8.25%). Using the PHQ-9, the prevalence of Major Depressive Disorder (MDD) in the current pregnancy was estimated to be 17.39% (95%CI: 12.70%–22.06%) among pregnant women who were targeted by the PNS-2019. Moreover, MDD was 15.26% (95%CI: 10.54%; 19.97%) among those who were free from depression history and in half of the pregnant woman population with depression history. Suicidal ideation has been reported in almost 23% of pregnant women with a history of depression. The two items from Patient Health Questionnaire-2 (PHQ-2) (anhedonia and depressed mood) with a cutoff of ≥ 3 presented similar results. CONCLUSIONS: Depression during pregnancy affects a non-negligible proportion of pregnant women, thus constituting an important public health problem. Therefore, it is crucial to discuss the implementation of regular screening for depression during prenatal care programs in Brazil.

ABSTRACT BACKGROUND: Radiation therapy (RT) is a standard treatment for non-metastatic breast cancer and is associated with acute and late toxicities. Intensity-modulated RT (IMRT) may decrease toxicity and is convenient for patients. OBJECTIVES: To assess the efficacy and safety of IMRT in women with early stage breast cancer. DESIGN AND SETTING: Systematic review study; Multi-institutional centers. METHODS: Seven databases were searched. Randomized controlled trials (RCT) comparing IMRT with any “non-IMRT” strategies were included. Primary outcomes were local control and acute toxicity. Cochrane Handbook was use to plan and conduct the review, and PRISMA 2020 was used to report results. RESULTS: Five RCT involving 2,556 women (n = 1,283 IMRT; n = 1,274 control arm) were included. Baseline characteristics were similar between trials and arms. Local relapse-free survival rates were not different (hazard-ratio [HR] 0.62; 95%confidence interval [CI] -0.38 to 1.62; P > 0.05); however, IMRT reduced the overall acute toxicity (RR 0.69, 95%CI 0.58 to 0.82; P < 0.00001) and acute moist desquamation (risk-ratio [RR] 0.71, 95%CI 0.60 to 0.82; P < 0.00001). Lymphedema and pneumonitis rates, and survival outcomes were not affected by IMRT. The 2-year telangiectasia rate was decreased with IMRT (RR 0.66, 95%CI 0.47 to 0.93; P = 0.02); however, edema, pain, pigmentation, or fibrosis remained unaffected. IMRT did not improve cosmesis. CONCLUSIONS: IMRT improved acute toxicity and lowered telangiectasia rates, without affecting oncological and aesthetic outcomes. SYSTEMATIC REVIEW REGISTRATION: This review was registered at Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD010420. https://doi.org/10.1002/14651858.CD010420.

ABSTRACT BACKGROUND: Emotional distress increases, also affected by the setting. OBJECTIVE: To estimate changes in prevalence of severe anxiety and depressive symptoms and associated factors. DESIGN AND SETTING: This cross-sectional study included adults living in Manaus selected through a three-stage probability sampling in 2015 and 2019. METHODS: This is an analysis of two surveys conducted. The outcomes were assessed by Generalized Anxiety Disorder 7-item (≥ 15 points) and Patient Health Questionnaire 9-item (≥ 20), and changes were tested by chi-square goodness-of-fit. Prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated by Poisson regression. RESULTS: Severe anxiety symptoms increased from 3.3% (95%CI = 2.7–3.9) in 2015 (n = 3,479) to 8.7% (95%CI = 7.5–9.8) in 2019 (n = 2,321); severe depressive symptoms changed from 2.5% (95%CI = 2.0–3.0) to 8.5% (95%CI = 7.3–9.6). Variations were more pronounced in social vulnerability (P < 0.05). Outcomes were higher in women (anxiety: PR = 1.27; 95%CI = 1.20–1.34, depression: PR = 1.35; 95%CI = 1.27–1.44), low-income individuals (anxiety: PR = 1.90; 95%CI = 1.20–3.00, depression: PR = 1.98; 95%CI = 1.22–3.19), less educated individuals (anxiety: PR = 2.20; 95%CI = 1.16–4.18, depression: PR = 2.37; 95%CI = 1.23–4.60), and individuals with poor health status (anxiety: PR = 9.06; 95%CI = 6.72–12.21, depression: PR = 8.99; 95%CI = 6.67–12.12). CONCLUSION: Severe anxiety and depression tripled in Manaus, potentially reflecting Brazilian socioeconomic crises.

ABSTRACT BACKGROUND: Detraining can partially or completely reduce training-induced metabolic adaptations. However, the duration for which the rehabilitation effects persist after detraining, especially in patients with heart disease, remains unclear. OBJECTIVES: To evaluate the principle of reversibility/detraining in patients with heart disease via the 6-minute walk test (6MWT) after a period of rest. DESIGN AND SETTING: A retrospective cohort study developed at the Rehabilitation Center of the Universidade Federal do Triângulo Mineiro in Uberaba/MG, Brazil. METHODS: This clinical, retrospective longitudinal study involved 20 patients with heart disease who underwent 5 months of supervised cardiac rehabilitation (CR). The mean age of participants was 64.05 ± 9.25 years. The initial rehabilitation was followed by an interruption period and rehabilitation for another 5 months. Functional capacity was assessed using the 6MWT. RESULTS: In the specific analysis of the distance covered, values of P = 0.03 and P = 0.01 were obtained on comparing post-training (669.64 ± 58.80 meters) with post-detraining (640.82 ± 101.23 meters) and post-detraining with post-retraining (650.82 ± 96.28 meters), respectively. No significant difference was observed for the comparison between training and retraining (P = 0.83). CONCLUSION: Cardiovascular rehabilitation positively stimulates functional capacity, whereas detraining significantly reduces it. The 6MWT is effective in measuring changes in physical capacity.

ABSTRACT BACKGROUND: Genitourinary health significantly affects the quality of life of men, particularly those in middle age. Recent studies have shown that more than half of the men aged over 40 years experience some degree of low urinary tract symptoms (LUTS) or erectile dysfunction (ED). OBJECTIVE: To assess the prevalence of ED and LUTS in middle-aged men and correlate this with quality of life data. DESIGN AND SETTING: A cross-sectional study was conducted in a municipality in the countryside of São Paulo. METHODS: A trained team collected data between July 2021 and August 2022 through face-to-face interviews using a characterization instrument, International Prostate Symptom Score (IPSS), International Index of Erectile Function-6 (IIEF-6), and World Health Organization Quality-of-Life Scale. RESULTS: The study included 375 male participants with a median age of 53 years (interquartile range [IQR] 38.5-66). The IIEF-6 showed the presence of some degree of ED in 51.1% (n = 188) of patients, with a median score of 25 (IQR 21-29). The IPSS revealed that 35.2% (n = 132) of the patients had some degree of LUTS, with a median score of 5 (IQR 2-11). The urological questionnaires had a direct proportional correlation with age (P < 0.001) and significant differences between the medians of different marital statuses (P < 0.001). The presence or severity of these disorders was inversely correlated with the individuals’ quality of life (P < 0.001). CONCLUSIONS: ED and LUTS significantly correlated with the quality of life, marital status, and age in men.

ABSTRACT BACKGROUND: Studies have shown an association between the clinical severity of coronavirus disease (COVID-19) and sociodemographic and clinical variables in older adults. However, few studies have described the explanatory factors of the relationship between these variables and the clinical severity of COVID-19 using structural equation modeling. OBJECTIVE: To analyze the factors directly and indirectly associated with the clinical severity of coronavirus disease (COVID-19) among older adults in Minas Gerais, Brazil. DESIGN AND SETTING: Retrospective epidemiological study. METHODS: This study included 51,141 elderly adults with COVID-19 living in Minas Gerais, Brazil. Data were collected through the Individual Registration Form – Hospitalized Cases of Severe Acute Respiratory Syndrome from January 28, 2020, to January 27, 2022. RESULTS: Older age (P < 0.001), male sex (P < 0.001), dyspnea (P < 0.001), change in chest X-ray examination findings (P < 0.001), greater number of risk factors/comorbidities (P < 0.001), and longer hospitalization time (P < 0.001) were directly associated with the clinical severity of COVID-19. Female sex, mediated by the greater number of risk/comorbidity factors (β = -0.02, P < 0.001), and younger age, mediated by longer hospitalization time (β = -0.01; P < 0.001), were indirectly associated with the clinical severity of COVID-19. CONCLUSION: Demographic and clinical variables were directly associated with increased disease severity. In addition to the direct effect, a greater number of risk/comorbidity factors and longer hospitalization time mediated the association between demographic variables and outcomes.

ABSTRACT BACKGROUND: Medical students demonstrate higher rates of substance use than other university students and the general population. The challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic raised significant concerns about mental health and substance use. OBJECTIVES: Assess the current prevalence of substance use among medical students at the University of São Paulo and evaluate the impact of the COVID-19 pandemic on drug consumption. DESIGN AND SETTING: A cross-sectional study was conducted on 275 medical students from the University of São Paulo Medical School (São Paulo, Brazil) in August 2020. METHODS: Substance use (lifetime, previous 12 months, and frequency of use before and during the COVID-19 pandemic) and socioeconomic data were assessed using an online self-administered questionnaire. Symptoms of depression were assessed using the Patient Health Questionnaire-9. RESULTS: Alcohol was the most consumed substance in their lifetime (95.6%), followed by illicit drugs (61.1%), marijuana (60%), and tobacco (57.5%). The most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%). Students in the first two academic years consumed fewer substances than those from higher years. There was a decreasing trend in the prevalence of most substances used after the COVID-19 pandemic among sporadic users. However, frequent users maintained their drug use patterns. CONCLUSION: The prevalence of substance use was high in this population and increased from the basic to the clinical cycle. The COVID-19 pandemic may have affected the frequency of drug use and prevalence estimates.

ABSTRACT BACKGROUND: Down syndrome (DS) is a non-rare genetic condition that affects approximately 1 in every 800 live births worldwide. Further, it is associated with comorbidities, anatomical alterations of the respiratory tract, and immunological dysfunctions that make individuals more susceptible to respiratory infections. OBJECTIVE: To systematize the current scientific knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among individuals with DS. DESIGN AND SETTING: This integrative review was conducted at the Universidade Federal de São Carlos, São Paulo, Brazil. METHODS: This review was conducted in the following databases: the Virtual Health Library (Biblioteca Virtual em Saúde, BVS), PubMed, and Web of Science, using MeSH descriptors. The search included English or Portuguese studies published between January 1, 2020, and October 14, 2022. RESULTS: A total of 55 articles from 24 countries were selected, comprising 21 case-control or cohort studies, 23 case reports or series, and 11 narrative reviews or opinion studies. The articles were grouped into five categories: previous comorbidities, coronavirus disease 2019 (COVID-19) clinical features and evolution, cytokine storm and interleukins, living in institutions as a risk factor, and behavioral actions as a protective factor against SARS-CoV-2 infection. CONCLUSION: Individuals with DS are more susceptible to COVID-19 infection due to variables such as previous comorbidities, immunological factors, and their habitable environments. These aspects confer a higher risk of infection and an unfavorable clinical course. The precise pathways involved in the pathophysiology of COVID-19 in individuals with DS are not clear, thus requiring further studies. SYSTEMATIC REVIEW REGISTRATION: The Open Science Framework registered the research protocol (https://osf.io/jyb97/).