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ABSTRACT BACKGROUND: Selenium is essential to human health. There are few reports on the analysis of selenium intake in the Brazilian population; however, data have shown that Brazilian are in the deficient range of consumption. OBJECTIVES: This study aimed to identify the major foods that contribute to dietary selenium and determine the socioeconomic and lifestyle factors associated with selenium intake. DESIGN AND SETTING: This cross-sectional study used baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS: Selenium consumption was evaluated using a food frequency questionnaire (FFQ) developed and validated for the ELSA-Brasil. To determine the contribution of selenium consumption, each food item was divided by the total selenium intake of the population. Associations between selenium intake (mg/day, dependent variable) and sociodemographic and lifestyle factors (predictors) were tested using multiple linear regression analyses. RESULTS: The sample comprised 14,780 participants, most of whom were adults (78.5%). Individuals with income ≥ 3 minimum wages were mostly concentrated in the 5th quintile of selenium consumption; positive and significant correlations were found between selenium intake and female sex, age ≥ 60 years, income ≥ 3 minimum wages, higher or postgraduate education, alcohol consumption, and moderate physical activity level. Nuts and fish contributed the most to dietary selenium. CONCLUSION: Nuts, meat, and fish contributed the most to the dietary intake of selenium, and selenium intake was associated with sociodemographic and lifestyle factors among the evaluated individuals.

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ABSTRACT BACKGROUND: The incidence of skin cancer is increasing globally. However, it is largely preventable through early detection. Therefore, raising public awareness through education is essential. OBJECTIVE: This study aimed to evaluate the effect of a planned visual education program—based on the Health Belief Model—on university students’ attitudes and beliefs regarding skin cancer. DESIGN AND SETTING: This cluster-randomized controlled trial was conducted in two departments at a university in Manisa, Türkiye. METHODS: The study was conducted with 116 university students, divided equally into an intervention group (n = 58) and a control group (n = 58). Data were collected using the Student Information Form and the Health Belief Model Scale in Skin Cancer. RESULTS: Following the visual education program based on the Health Belief Model, significant differences were observed between the intervention and control groups in perceived severity, perceived susceptibility, perceived barriers, perceived benefits, and self-efficacy scores. While the intervention group showed significant improvements across these domains, no significant difference was found in perceived severity scores. CONCLUSION: The findings indicate that planned visual education based on the Health Belief Model positively influenced students’ attitudes and beliefs regarding skin cancer. CLINICAL TRIAL REGISTRATION: The research was recorded at https://clinicaltrials.gov/study/NCT05788939.

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ABSTRACT BACKGROUND: Peripheral nerves may be affected in subclinical hypothyroidism (SH). OBJECTIVES: This study aimed to investigate the presence of common entrapment mononeuropathies in patients with SH. DESIGN AND SETTING: A prospective case-control study conducted between September 2022 and November 2023 at Adana City Training and Research Hospital, Adana, Türkiye. METHODS: SH patients without neurological complaints and healthy individuals over the age of 18 were included. Serum levels of free T3, free T4, thyroid-stimulating hormone (TSH), thyroid peroxidase (TPO) antibody, and creatine kinase (CK) were measured. All participants underwent nerve conduction studies of the upper and lower extremities. RESULTS: Thirty patients with SH and 40 healthy individuals were included in the study. The percentage reduction in compound muscle action potential (CMAP) amplitude across the knee segment was 2.8 ± 3.5% in healthy individuals and 6.7 ± 6.6% in SH patients (P = 0.017). Apart from this significant difference, other nerve conduction study findings did not differ between the two groups. A positive correlation was observed between CK levels and the percentage reduction in peroneal nerve CMAP amplitude across the knee segment (P = 0.021, r = 0.421). Additionally, there was a positive correlation between TPO antibody levels and F-wave latency in both the median and ulnar nerves (P = 0.028 r = 0.400/P = 0.005 r = 0.501). Electrodiagnostic evaluations revealed carpal tunnel syndrome (CTS) in four patients, peroneal neuropathy at the fibular head (PNFH) in four patients, and ulnar neuropathy at the elbow (UNE) in one patient. CONCLUSION: This study suggests that patients with SH may develop subclinical CTS and PNFH, but not UNE. Accordingly, it highlights the importance of avoiding risk factors that may contribute to the development of CTS and PNFH. Serum CK and TPO antibody levels may be useful in monitoring subclinical neuropathy in SH.

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ABSTRACT BACKGROUND: Severe heart disease has high prevalence, morbidity, and mortality rates.Heart stimulation is important in the final stages of heart disease. The concentration of procedures in a service allows for the epidemiological analysis of our population. OBJECTIVE: To analyze the epidemiological profile of severe heart disease in Rio Grande do Norte by registering all patients undergoing artificial cardiac stimulation (ACS) in a Unified Health System reference service in Rio Grande do Norte. DESIGN AND SETTING: This cross-sectional study included all patients who underwent ACS procedures at the Hospital Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), from 2006 to 2021. Sociodemographic characteristics, procedures, and health conditions were examined. Additionally, a spatial analysis of casuistry was performed according to the municipality of origin. METHODS: This cross-sectional study analyzed data derived from patients treated at Hospital Onofre Lopes, UFRN, from 2006 to 2021, including sociodemographic characteristics, procedures, and health conditions. RESULTS: A total of 894 patients (male, 59.8%; mean age: 65.5 years) were included. Third-degree atrioven tricular block was indicated in 191 patients, an ischemic etiology was found in 269 patients, whereas dyspnea was reported by 398 patients. Furthermore, 69.5%, 24.4%, and 31.7% of patients had hypertension, diabetes, and dyslipidemia, respectively. Spatial analysis showed no significant differences in the formation of clusters. CONCLUSIONS: The characteristics of the service contributed to possible differences in the literature. The spatial distribution of severe heart disease was random in the state, indicating an adequate distribution of reference services even in the absence of a defined flowchart for such services.

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ABSTRACT BACKGROUND: Investigating the frequency and characteristics of iron overload cases with HFE gene mutation is crucial, given the population-level risks associated with excessive iron. OBJECTIVE: To determine the frequency of HFE mutations in patients with iron overload in Santa Catarina, Brazil. DESIGN AND SETTING: A cross-sectional study of patients with iron overload at the Ambulatory Department of the Centro de Hematologia e Hemoterapia de Santa Catarina (Hemorrede-HEMOSC) in Santa Catarina. METHODS: HFE genotype frequencies were determined, and a division were made between carriers of HFE-C282Y/C282Y mutations and carriers of other HFE-non-C282Y/C282Y mutations, according to each region of Santa Catarina. Binary logistic regression was used for association between sex and age with genetic mutation trait. RESULTS: Among the 1,022 patients, 10.4% had secondary hemochromatosis, and 89.6% were evaluated for iron overload due to hereditary hemochromatosis (HH). Of these, 367 underwent genetic testing, which revealed HFE mutations in 77.3%. Most patients with HFE mutations had non-C282Y/C282Y-hemochromatosis, especially H63D/WT (> 39%), regardless of the Santa Catarina region. The frequency of C282Y/C282Y was higher in the West (20.9%) and North (28.3%) regions. Adjusted association analysis showed that men have an increased chance of hemochromatosis when involving 'non-C282Y/C282Y' mutations (OR: 2.77; 95% CI: 1.60–6.608). CONCLUSIONS: The data show the magnitude and characteristics of iron overload cases with HFE mutations in Santa Catarina. As most patients referred for treatment have H63D mutation, we suggest further studies to assess whether other factors, including dietary habits and mandatory iron fortification policies, contribute to iron overload or HH manifestation.

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ABSTRACT BACKGROUND: Chronic kidney disease (CKD) presents challenges to human health and quality of life, with care primarily focusing on renal function and comorbidity management. Several studies confirm the relationship between oral and systemic conditions of patients. Therefore, CKD and periodontal disease can be related because they are both inflammatory conditions that further increase the risk of other pathologies. The impact of CKD on oral health and overall quality of life is an area of interest. OBJECTIVES: To evaluate patients with CKD undergoing renal replacement therapy regarding the levels of self-perception of oral health and quality of life. DESIGN SETTING: This case-control study was conducted jointly at the Universidade de Passo Fundo and Hospital São Vicente de Paulo, Brazil. METHODS: This study included two patient groups: 1) Case group with CKD (CGA) comprising 116 patients; 2) Control group without CKD (CGO) composed of 124 patients. We used a structured questionnaire and the Oral Health Impact Profile (OHIP-14). We used the Chi-square and Wilcoxon-Mann-Whitney tests as well as an analysis of variance measure (P < 0.05). RESULTS: The systemic diseases most prevalent among our patient cohort included hypertension (16.9% CGO and 75.9% CGA) and diabetes mellitus (8.9% CGO and 38.8% CGA). The systemic health perception was good in 66.9% of the CGO group and average in 42.2% of CGA group members. Oral health perception was good in 46% of CGO and 50% of CGA group members. Results of the self-assessment for quality of life showed a statistically significant difference between the groups for physical domain, physical disability, and social disadvantage. A comparison between the control and case (CKD) groups, based on the OHIP-14 score, showed statistically significant differences in the functionality (P < 0.006), physical disability (P < 0.042), and social disadvantage (P < 0.031) domains for the CKD group. CONCLUSION: Patients with CKD have lower rates of self-perception of oral health and quality of life than individuals without CKD.

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ABSTRACT BACKGROUND: The prevalence of obesity has increased considerably worldwide, and it has become an important risk factor for chronic non-communicable diseases. BJECTIVE: To translate, cross-culturally adapt, and validate the Weight Management Questionnaire (WMQ) to evaluate weight control practices for health monitoring and intervention in Brazil. DESIGN AND SETTING: This was a quantitative cross-sectional study. METHODS: Obese and physically active lean individuals aged 18−59 years were included in this study. The tool used as an adaptation was the WMQ. The cross-cultural adaptation was conducted in five phases. For structural validity, confirmatory factor analysis (CFA) was used to verify the internal structure considering two domains: diet and physical activity. To determine construct validity, a comparison was performed between different groups (lean versus obese). Reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS: The short version of the WMQ after CFA presented eight items. Thus, the structure with two domains presented adequate fit indices: chi-square/degree of freedom = 1.66, comparative fit index = 0.996, Tucker-Lewis index = 0.994, root mean square error of approximation = 0.057, and standardized root mean square residual = 0.047. For construct validity, a significant difference was observed between the groups (P < 0.05) in both domains. We observed adequate reliability for both domains (ICC ≥ 0.854). CONCLUSIONS: The WMQ can be used for the Brazilian population, as it is reliable and has adequate internal structure, supporting its use in future research.

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ABSTRACT BACKGROUND: The High-Activity Arthroplasty Score (HAAS) is a reliable and valid self-administered questionnaire that was developed in British English and was designed to determine the level of physical activity in patients after lower limb arthroplasty (hip and/or knee). The Brazilian version (HAAS-Brazil) was developed after a cross-cultural adaptation in 2023. OBJECTIVE: To evaluate the psychometric properties of HAAS-Brazil in patients after hip arthroplasty. DESIGN AND SETTING: A cross-sectional quantitative and qualitative study was conducted in an orthopedic outpatient setting. METHODS: Evidence for the validity of HAAS-Brazil was assessed via psychometric testing, which followed the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). RESULTS: A total of 112 patients with a mean age of 56 years were included as participants; of these patients, 50.9% were female, with 44.6% being overweight and 85.7% being engaged in physical activity. HAAS-Brazil provided satisfactory evidence of content validity (CVC > 0.9), structural validity (AISP = 1; Hi > 0.3; VIMon = 0; VIIIO = 0), construct validity (ρ HOS-SP = 0.696; ρ SF-12 PSC = 0.554; ρ SF-1 MSC = 0.338), no ceiling or floor effect, acceptable internal consistency (Mokken ρ = 0.707; Cronbach α = 0.663), and good reliability (ICC(3,K) = 0.840 ; P < 0.001). CONCLUSION: The HAAS-Brazil provided satisfactory validation evidence in patients who underwent hip arthroplasty.

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ABSTRACT BACKGROUND: Lipid profiles are largely determined by genetic variants, and lipid metabolism plays a crucial role in Alzheimer’s disease. OBJECTIVE: To investigate whether lipid profile variability in response to diverse statins could be affected by cholesterol metabolism-related genetic variants in Alzheimer’s disease.. DESIGN AND SETTING: This prospective observational pharmacogenetic study was conducted at the Universidade Federal de São Paulo (Unifesp), Brazil. METHODS: Consecutive outpatients were prospectively followed for lipid profile variations over one year, estimated by the associations between statin therapy and the following variants: rs2695121 (NR1H2), rs3846662 (HMGCR), rs11669576 (LDLR8), rs5930 (LDLR10), rs5882 and rs708272 (CETP), rs7412 and rs429358 (APOE), and ACE insertion/deletion polymorphism. RESULTS: All polymorphisms in the 189 patients were in Hardy-Weinberg equilibrium. Statins resulted in lower total cholesterol and LDL cholesterol levels, whereas the effects on HDL cholesterol varied according to the statin used. Atorvastatin resulted in lower triglyceride level variations than simvastatin. APOE-ε4 carriers showed a better response to atorvastatin in elevating HDL-cholesterol than APOE-ε4 non-carriers. Carriers of the ACE insertion allele had cumulatively lower total cholesterol and LDL-cholesterol levels, regardless of statin therapy, but lower triglyceride levels when using atorvastatin. Carriers of rs11669576-G had lower total cholesterol and LDL-cholesterol levels when using simvastatin, and lower total cholesterol and triglycerides when using atorvastatin. Concerning CETP haplotypes, carriers of rs5882-A and rs708272-A benefitted the most from statins, which lowered total cholesterol and increased HDL-cholesterol levels, and from atorvastatin lowering triglycerides; however, the effects of atorvastatin lowering total cholesterol and LDL-cholesterol were more pronounced for carriers of rs5882-GG/rs708272-GG. CONCLUSION: Lipid profile variations may be pharmacogenetically mediated in Alzheimer’s disease, thus, confirming their high heritability.

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ABSTRACT BACKGROUND: Inadequate diet is considered a major risk factor for chronic noncommunicable diseases and mortality. Among the ultra-processed foods, sweetened soft drinks are significant contributors to high-calorie diets and are associated with adverse health outcomes. OBJECTIVE: To estimate the association between soft drink consumption and the risk of cardiovascular events. DESIGN AND SETTING: A cross-sectional study was conducted using data of adults aged ≥ 18 years from the 2013 National Health Survey. METHODS: The explanatory variable was the daily consumption of sugar-sweetened soft drinks. Cardiovascular risk (CVR) was calculated using the Framingham score. Multinomial logistic regression was used for the analyses. Two models were used: one adjusted for age and body mass index and the other for age and waist circumference. Both models were applied to the general population and stratified by race and educational attainment. RESULTS: The study sample consisted of 8,391 participants. Individuals with sugary soda consumption ≥ 0.4 cups/day were associated with a higher CVR, which escalated with increasing consumption of soft drinks. CONCLUSIONS: CVR was observed across all consumption categories and difference in risk was based on the intake quantity.

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ABSTRACT BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on healthcare systems, particularly on critically ill patients requiring prolonged mechanical ventilation (MV). Percutaneous tracheostomy (PT) has emerged as a potential strategy to facilitate weaning, reduce intensive care unit (ICU) stay, and optimize resource use. However, the timing, safety, and outcomes of PT in COVID-19 patients remain debatable. OBJECTIVES: This study aimed to describe the technical aspects of the procedure and evaluate the early safety of our technique to healthcare professionals, as well as the short-term factors affecting survival in 103 consecutive patients after tracheostomy. METHODS: We retrospectively analyzed patients with COVID-19 who underwent PT between March 2020 and June 2020 at Hospital Alemão Oswaldo Cruz, São Paulo. The factors considered for analysis included age, sex, timing of tracheostomy, proportion of affected lungs, comorbidities, fraction of inspired oxygen on MV, and availability of professional private equipment. Univariate analysis was performed for screening, and variables with P < 0.20 were included in the multivariate Cox proportional hazards regression model. RESULTS: Most patients were male, with a median age of 68 years. The most common comorbidities were hypertension (n = 55/52%), diabetes (n = 37/36%), and heart disease (n = 24/21%). Patients over 60 years old had reduced survival (hazard ratio [HR] = 3.35; P = 0.003), and those who underwent high nasal flow catheter (HR = 0.49; P = 0.02) and PT earlier (< 10 days) had better survival (HR = 0.37; P = 0.04). CONCLUSION: Early PT in selected patients may reduce the duration of MV and lead to shorter ICU stays. The health system is overloaded by the scarcity of ventilators and beds for critically ill patients.

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ABSTRACT BACKGROUND: Surgical treatment of hemorrhoidal disease has undergone numerous modifications in recent decades. Among the technical options, stapled hemorrhoidopexy is currently considered an optimal alternative because it provides a less painful recovery. However, many reports have associated this technique with higher recurrence rates than excisional techniques. OBJECTIVES: This manuscript presents a technical modification that aims to provide more extensive mucosectomy with mechanical hemorrhoidopexy. DESIGN AND SETTING: The present technical modification was developed and has been recently used in two hospitals in São Paulo (SP), Brazil. METHODS: To achieve this, we placed a circumferential submucosal suture at the 3 o’clock position in the clockwise direction. When the left lateral position (9 o’clock) was reached, a loop of 2-0 non-absorbable suture thread was passed around the continuous suture and retracted to the left. Subsequently, the original suture progressed towards the point on the right lateral side, where it was started. RESULTS: Specifically, the modification consists of establishing two traction points from the pursestring suture; thus, the rectal mucosa entering the stapler head will be more uniform, and the retrieved mucosal strip will present a greater height. These features may play a role in effectively reducing mucosal prolapse and alleviating the symptoms. CONCLUSIONS: The proposed modification of the original operative technique is simple and aims to improve postoperative results by increasing the height of the mucosal specimen to be resected, thereby reducing long-term recurrence. In the future, this hypothesis will be tested in a randomized study comparing the mucosectomy height and postoperative outcomes of both technical options (classical and present).