Search Results (190)

Background: Type 2 diabetes (T2D) is a growing public health concern, particularly in low- and middle-income countries. Although prediabetes is a major risk factor for T2D, it remains largely underdiagnosed and untreated. Structured lifestyle interventions have proven effective in preventing diabetes, but their feasibility within the Brazilian public health system remains unclear. Methods: This multicenter pilot randomized controlled trial assessed the feasibility of a culturally adapted lifestyle intervention (PROVEN-DIA) across the five regions of Brazil. A total of 220 adults at high risk for T2D were randomized to an intervention group or a control group (usual care) and followed for three months. Both groups received similar educational content on healthy eating and physical activity, but the intervention group participated in a structured and personalized lifestyle program with regular follow-up sessions. The primary outcome was adherence to dietary recommendations, assessed using the BALANCE Index—a validated dietary score (range: 0–40) based on the Brazilian Cardioprotective Diet that classifies foods into color-coded groups according to nutritional quality—along with engagement in moderate-to-vigorous physical activity (MVPA). Secondary outcomes included diet quality (DQIR), anthropometric and metabolic parameters. Results: Feasibility was demonstrated by a 93.2% retention rate (n = 205). There was no significant difference in the primary outcome (simultaneous improvement in diet and MVPA). However, the PROVEN-DIA group exhibited significantly greater improvements in diet quality, with a 2.8-point increase in the BALANCE Index (vs. 0.5 in the control, p = 0.03), and a significant improvement in the DQIR (p < 0.001). No significant differences between groups were observed in MVPA, HbA1C, glycaemia, or body weight. Conclusions: The PROVEN-DIA intervention proved feasible within the Brazilian public health context, resulting in significant improvements in dietary quality among individuals at high risk for T2D. A larger trial with longer follow-up is warranted to evaluate its effectiveness in preventing the progression to diabetes. However, to enhance physical activity outcomes, specific adaptations and targeted strategies may be required to better support participant engagement in exercise. Full article

Carbapenem resistance is considered one of the greatest current threats to public health, particularly in the management of infections in clinical settings. Carbapenem resistance in bacteria is mainly due to mechanisms such as the production of carbapenemases (such as the imipenemase IMP, or other enzymes like VIM, NDM, and KPC), that can be detected by several laboratory tests, including immunochromatography and automated real-time PCR (qPCR). Methods: As part of local studies to monitor carbapenem-resistant bacteria in Costa Rica, two cases were initially identified with inconsistent IMP detection results. A possible gene drop-out in the automated qPCR test was suggested based on the negative result, contrasting with the positive result by immunochromatography and whole-genome sequencing. We hypothesized that molecular testing could be optimized through the development of tailored assays to improve the detection of IMP genes. Thus, using IMP gene sequences from the local isolates and regional sequences in databases, primers were redesigned to extend the detection of IMP alleles of regional relevance. Results: The tailored qPCR was applied to a local collection of 119 carbapenem-resistant isolates. The genomes of all 14 positive cases were sequenced, verifying the results of the custom qPCR, despite the negative results of the automated testing. Conclusions: Guided by whole-genome sequencing, it was possible to extend the molecular detection of IMP alleles circulating in Latin America using a tailored qPCR to overcome IMP gene drop-out and false-negative results in an automated qPCR. Full article

Balantioides coli is the only ciliate currently described as an intestinal parasite of humans, although it can also infect other animals, particularly pigs. Its in vitro cultivation remains challenging, and no axenic culture system is currently available. Cultures are initiated by adding small amounts of feces containing cysts or trophozoites to the culture medium. Implantation success is lower when starting from cysts, and the mechanisms and early events of excystation remain poorly understood. In this study, we describe the sequence of events involved in excystation and identify factors potentially important for culture establishment. Cysts were obtained from orangutan feces and genetically confirmed as B. coli. Only viable cysts, determined by trypan blue or methylene blue exclusion, were used. After artificial digestion with pepsin and trypsin, cysts were incubated at 28 °C for up to 72 h in DMEM supplemented with L-glutamine, yeast extract, fetal bovine serum, and starch granules. Excystation began with a fissure in the cyst wall, allowing for bacterial entry. This appeared to stimulate the trophozoites, the increased motility of which progressively weakened and ruptured the wall, allowing for their emergence. Wall rupture and bacterial entry were critical for activation., whereas starch type had no apparent influence. Excystation occurred within the first hours; otherwise, cysts degenerated. Full article

Background: Stereolithography is a rapid prototyping and 3D printing technique that creates solid three-dimensional models. An accurate and functional 3D model using stereolithography is invaluable in scientific research, particularly in studies involving edentulous patients. Additive manufacture and CAD systems help achieve accurate measurements and procedures and be easily replicated by lowering human error mistakes. The main objective of this study was to develop an in vitro simulation model with a reduced alveolar ridge with the same characteristics as mandibular edentulous patients using stereolithography. Methods: A mandibular model with a resorbed mandibular crest was scanned, and the STL model was aligned to the XYZ reference system. A reduction in the alveolar ridge corresponding to the mandibular mucosa of an edentulous patient was achieved. A negative model also derived from the original model was made to ensure the space for oral simulation material. A dimensional stability test was performed to validate the model. Results: The maximal mean displacement of the model was 0.015 mm, and the minimal mean displacement was 0.004 mm. The oral mucosa had a displacement of approximately 1.6 mm. Conclusions: An in vitro 3D simulation model of a complete edentulous patient mucosa was achieved. Full article

Deficits in social interaction and communication characterize Autism Spectrum Disorder (ASD). Although widely recognized by its symptoms, diagnosing ASD remains challenging due to its wide range of clinical presentations. Methods: In this study, we propose a method to assist in the early diagnosis of autism, which is currently primarily based on clinical assessments. Our approach aims to develop an early differential diagnosis based on electroencephalogram (EEG) signals, seeking to identify patterns associated with ASD. In this study, we used EEG data from 56 participants obtained from the Sheffield dataset, including 28 individuals diagnosed with Autism Spectrum Conditions (ASC) and 28 neurotypical controls, applying numerical techniques to handle missing data. Subsequently, after a detailed analysis of the signals, we applied three different starting approaches: one with the original database and the other two with selection of the most significant attributes using the PSO and evolutionary search methods. In each of these approaches, we applied a series of machine learning models, where relatively high performances for classification were observed. Results: We achieved accuracies of 99.13% ± 0.44 for the dataset with original signals, 99.23% ± 0.38 for the dataset after applying PSO, and 93.91% ± 1.10 for the dataset after the evolutionary search methodology. These results were obtained using classical classifiers, with SVM being the most effective among the first two approaches, while Random Forest with 500 trees proved more efficient in the third approach. Conclusions: Even with all the limitations of the base, the results of the experiments demonstrated promising findings in identifying patterns associated with Autism Spectrum Disorder through the analysis of EEG signals. Finally, we emphasize that this work is the starting point for a larger project with the objective of supporting and democratizing the diagnosis of ASD both in children early and later in adults. Full article

Background/Objectives: The COVID-19 pandemic affected frontline workers’ mental health, including healthcare workers, firefighters, and police officers, increasing the need for effective interventions. This study focuses on the pandemic’s psychological impact, perceived stress, depression/anxiety symptoms, and resilience, examining if a brief virtual reality (VR)–based relaxation session could reduce psychological symptoms. Methods: In this preliminary study with data collected in 2025 from frontline workers who had served during the acute phase of the COVID-19 pandemic, 54 frontline workers completed a baseline assessment of the perceived psychological impact of COVID-19 pandemic, general perceived well-being, perceived stress (PSS-4), anxiety/depression (PHQ-4) and resilience (RS-25). Each participant then engaged in a 10-min immersive VR relaxation session featuring a calming 360° nature environment with audio guidance, after which questionnaires were re-administered. Paired samples t-tests and repeated-measures ANOVA evaluated pre-/post-session differences, and a hierarchical multiple linear regression model tested predictors of the change in stress. Results: Pre-session results showed moderate perceived stress and resilience and low depression/anxiety. Occupation groups varied in baseline stress, mostly reporting negative pandemic psychological effects. After VR, significantly perceived well-being increased, and stress decreased, whereas depression/anxiety changes were nonsignificant. Repeated-measures ANOVA revealed a main effect of time on stress (p = 0.003) without occupation-by-time interaction (p = 0.246), indicating all occupational groups benefited similarly from the VR session. Hierarchical regression indicated baseline depression and higher perceived pandemic-related harm independently predicted greater stress reduction, whereas resilience and baseline anxiety showed no statistically significant results. Conclusions: A single VR relaxation session lowered perceived stress among frontline workers, particularly those reporting higher baseline depression or pandemic-related burden. Limitations include the absence of a control group. Results support VR-based interventions as feasible, rapidly deployable tools for high-stress settings. Future research should assess longer-term outcomes, compare VR to alternative interventions, and consider multi-session protocols. Full article

Background: Iron deficiency (ID) is a commonly seen comorbidity in heart failure (HF) patients. It is often associated with a poor prognosis and impaired physical capacity. The functional limitations linked to ID may lead to cardiac function abnormalities. The functional limitations linked to ID may lead to cardiac function abnormalities, that can be reversible after iron repletion. Some echocardiographic parameters, such as global longitudinal strain (GLS), myocardial work (MW) and its derivatives constructive work (CW), wasted work (WW) and work efficiency (WE), may be of added value in advanced cardiac performance assessment. Methods: IRON-PATH II was a multicenter, prospective and observational study designed to describe the pathophysiological pathways associated with ID. The echo-substudy included 100 HF patients that had undergone a specific pilot echocardiographic evaluation. Patients had a left ventricular ejection fraction (LVEF) ≤50%, were in stable clinical condition and on standard HF medication with hemoglobin ≥11 g/dL. The final cohort included 98 patients. Results: The ID group showed worse cardiac function, with lower GLS (−8.5 ± 9% vs. −10 ± 10%), WE (74 ± 10% vs. 80 ± 10%) and MW (665 [453–1013] vs. 947 [542–1199] mmHg%), as well as higher WW (290 [228–384] vs. 212 [138–305] mmHg%) and lower RV free wall strain (−13 [−20–(−11)]% vs. −17 [−23–(−14)]%). Following iron repletion, ID patients demonstrated improved LV (GLS, MW, WE and WW) and RV performance (RV free wall strain), aligning with non-ID patients (all p-values >0.05 compared to the non-ID group). Conclusions: Among HF patients with reduced LVEF, ID was associated with worse myocardial performance in both the LV and RV. All the alterations seen were reversible after intravenous iron repletion. Full article

Background: Blood transfusion is a therapeutic procedure characterized by the use of blood components for the treatment of certain pathologies. When applied properly, it is highly successful; however, it also has risks, such as transfusion reactions. Objective: This study aimed to evaluate the effects of the clinical simulation of transfusion reactions on the knowledge gain of nursing students. Methods: Two groups were compared: the intervention group, which used the educational intervention: “clinical simulation of transfusion reactions in adults”, and the control group, which did not use the strategy. The study was conducted at a Higher Education Institution from August 2022 to June 2023, with nursing students in the fifth semester. An instrument on the knowledge of transfusion reactions was applied before and seven days after the intervention. Data were analyzed descriptively and inferentially using the Mann–Whitney U and Wilcoxon tests. For both, p < 0.05 was accepted. Results: The Wilcoxon test revealed a statistically significant difference in pre- and post-test scores within the intervention group (p-value: 0.003), with a large effect size (Cohen’s d = 1.14). The average score in the pre-test was 16.47 and increased to 18.93 in the post-test (p = 0.002), while in the control group there was a drop from 14.53 to 12.07 (p = 0.053). In terms of overall scores, the intervention group went from an average of 8.10 to 9.67 (p = 0.001), while the control group went from 8.13 to 8.66 (p = 0.053). The reduction in errors was significant in topics such as hand hygiene (from 56.7% to 23.3%) and the maximum exposure time of the blood component at room temperature (from 66.7% to 20%). The data showed that the clinical simulation intervention had a significant positive effect on the acquisition of theoretical knowledge about transfusion reactions. Conclusions: Through the use of simulation as a teaching strategy, students gained greater knowledge. Full article

This article explores the process of developing policy briefs (PB) as strategic tools to translate knowledge stemming from the analysis of local educational practices into inclusive European policy recommendations. This paper highlights how educational practices from eleven partner institutions across Denmark, Norway, Poland, Portugal, and Spain informed recommendations to prevent early leaving from education and training (ELET) and to enhance youth’s school engagement. Educational practices involved a collaborative dialogue among multi-stakeholders to establish a shared vision about educational inclusion, and the co-creation of educational practices supported by monitoring, evidence collection, and the identification of promising examples. These elements reflect the aim to embed educational inclusion in policy development, while underscoring the role of PBs as mechanisms of participatory knowledge transfer between countries and sectors, bringing together diverse voices from policymakers, educators, researchers, and young people. In doing so, the methodological approach to produce PB recognised local produced knowledge as a catalyst for informed decisions promoting quality education. The analysis of PB highlights elements of the identified educational practices addressing ELET challenges, such as (i) implementing co-creation methodologies in both educational contexts and political formulation; (ii) addressing student citizenship as central to meaningful learning; (iii) valuing cross-sector partnerships to address systemic challenges, and (iv) reinforce relational pedagogies that enhance student–teacher and student–student relationships. Full article

cangas are iron-rich outcrops where rupestrian fields develop in the Carajás Mountain Range (CMR). canga formations are ancient ecosystems characterized by high levels of endemic and threatened plant species that thrive on iron-rich substrates in the southeastern Amazon uplands. The recent taxonomic validation of these species enables more accurate distribution modeling across past, present, and future time scales. This work presents a comprehensive palynological database for the Amazon canga vegetation, resulting from extensive field and herbarium surveys, as well as the compilation and taxonomic validation of species in the Carajás Mountain Range (CMR). This atlas includes 204 plant species: 10 ferns and lycophytes, 62 monocots, and 132 eudicots and magnoliids (mainly herbs, lianas, and trees). Most flowering plants are pollinated by bees, with secondary pollination by other insects and wind. The taxa co-occur in two geoenvironments: (1) forested slopes and caves over plinthosols and ferralsols and (2) slopes with canga vegetation over plinthosols. Seventeen species are potential domesticates used by Indigenous peoples. This highlights canga vegetation as a unique and diverse ecosystem with various survival strategies, emphasizing the need for precise habitat definitions in paleoenvironmental and paleoclimate reconstructions. This atlas provides a valuable reference for palynological studies, enhancing the vegetation reconstruction, climate history analysis, pre-Columbian influences on vegetation patterns, and ecological monitoring. Full article

Leptospirosis is a well-known disease that frequently occurs after floods. At the beginning of May 2024, a catastrophic flood occurred in the state of Rio Grande do Sul, Brazil, affecting two million people and leading to a state of calamity. Given the State’s high pre-flood leptospirosis rates, the disease became a major concern for decision-makers. This study aimed to estimate the rise in leptospirosis cases after the flood, assess the changes in case patterns before and after the disaster, and document the response of the state health surveillance center to the outbreak. We estimated the increase during the flood period (May to July 2024) by comparing it with the same period in the previous year as baseline. During the first three months of the catastrophic event, 6273 suspected cases of leptospirosis were reported to the surveillance system, and 958 cases were confirmed. The number of confirmed cases during the flood was 10.3-fold higher than the baseline. Spearman’s rank-order correlation coefficient was 0.77 (p-value < 0.0001) for the association of Health Regions regarding the rank in incidence rates of confirmed cases in the flood period and the proportion of the population with households flooded. Thirty deaths (three females) were confirmed, a 6.0-fold rise compared with 2023. The state responders carried out many activities, including epidemiological surveillance and the dissemination of information. Among the challenges faced was the lack of evidence in the literature supporting recommendations for antibiotic chemoprophylaxis for rescue personnel. Another difficulty concerned performing gold-standard laboratory diagnostic tests to confirm the enormous number of suspected cases reported during this catastrophe. Despite implementing many actions to mitigate its impact, leptospirosis remained a major challenge during the event. These findings may provide valuable insights for decision-makers facing similar situations in massive climate disasters. Full article

Background: Breast cancer is one of the main causes of mortality among women, and mastectomy has a significant effect on the body image, sexuality and psychology of women. The aim of postmastectomy rehabilitation is to improve functionality, minimize complications and promote well-being and quality of life. Objectives: This study aimed to understand the role of nurses specializing in rehabilitation nursing in the rehabilitation of women who have had a mastectomy. Methods: This was a qualitative, exploratory and descriptive study. The participants included seven nurses specializing in rehabilitation nursing who provided structured narratives about their experiences and care strategies in the rehabilitation of women who have had a mastectomy. The interviews were analyzed by thematic categorization via content analysis. Results: Three main categories emerged: the meaning of care, professional intervention strategies and health gains. Care is seen as a developmental and person-centered experience, with a focus on preventing complications. The interventions prioritize personalized projects, emotional support and self-care training. Conclusions: The rehabilitation of women postmastectomy depends on a holistic and individualized approach centered on the person through emotional and functional support. Rehabilitation interventions improve the functionality, quality of life and autonomy of women and are essential for preventing complications and promoting the acceptance of new health conditions. Full article

Bacillus cereus is a spore-forming, Gram-positive bacterium that causes foodborne illness and dairy spoilage. This study analyzed B. cereus s.s. isolates from milking environments, raw milk, and dairy products to assess their genotypic and phenotypic traits. From 466 samples, 61 isolates were obtained: 27 from milking environments, 9 from dairy environments, 8 from raw milk, and 17 from dairy products. Genomic sequencing identified genes encoding proteolytic (BC5350, BC0666, BC2984, BC0598, BC5351, BC3383, BC2735), lipolytic (BC4862, BC2141, BC1027, BC4123, BC4345, BC5402, BC5401), and esterase (BC1954, BC4515, BC3413, BC3606) enzymes. Plate assays confirmed enzymatic activities. Proteolytic genes were more prevalent in environmental samples, followed by raw milk and dairy products. Lipolytic genes were most frequent in raw milk, followed by environmental samples and dairy products. Esterase genes were most common in dairy environments. These findings suggest that dairy processing influences the enzymatic profile of B. cereus s.s., potentially impacting food safety and quality in the dairy industry. Understanding the distribution of these genes may help develop strategies to mitigate spoilage and contamination risks in dairy products. Full article

This study evaluated if the material, the substrate, and the cement have no influence on the color of pre-shaded monolithic zirconia crowns. The specific effect of the cement over each substrate/brand group was also studied. Two commercial brands of zirconia, Amann Girrbach (AG) and Zirkonzahn (ZZ), were used to produce crowns that were placed over three substrates (natural tooth, zirconia, metal) using two different resin cements (Ivoclar AG (Shaan, Liechtenstein) Neutral and Light) or glycerol (as the control) (n = 10). Lightness (L*), chroma (C*), hue (h*), and color difference (ΔE) of each crown were measured using a VITA Easyshade V^® spectrophotometer (VITA Zahnfabrik, Bad Säckingen, Germany), following the standardized reference. Since normality was not verified by the Shapiro–Wilk test, data were statistically analyzed using the Kruskal–Wallis test for group comparisons and Tukey’s post-hoc test for multifactorial variance analysis (α = 0.05). ΔE medians ranged between 1.3 in the AG/zirconia substrate/glycerol group and 8.0 in the ZZ/metal substrate/light cement group. In general, lower values of ΔE were recorded in AG restorations compared to ZZ (p < 0.05), zirconia, and natural tooth substrates compared to metal (p < 0.001) and neutral compared to light cements (p < 0.05). Specifically, over the metal substrate, AG crowns with neutral cement and ZZ crowns with neutral cement and glycerol showed lower ΔE values (p < 0.05). Over the zirconia substrate, light cement presented higher ΔE values than glycerol in both brands but similar to neutral cement. Over the natural tooth, no significant differences were observed between cements (p > 0.05) in the AG brand, while in the ZZ group, light cement showed higher ΔE values (p < 0.05). The final color of the restorations was significantly influenced by the zirconia brand, substrate type, and resin cement. Light cement led to greater color variations, particularly in ZZ restorations. These findings highlight the importance of material selection in achieving esthetically pleasing zirconia restorations. Full article

The study of substances of botanical origin is fundamental for the development of new effective alternatives for the control of Aedes (Stegomyia) aegypti (Culicidae), a vector of arboviruses in humans. In this study, the potential of two new dillapiole derivatives, propyl ether dillapiole and piperidyl dillapiole, was tested to determine their ability to deter oviposition and their larvicidal and residual effects against Ae. aegypti under simulated field conditions, as alternatives for the control of this mosquito. The ability of these substances to deter oviposition by pregnant Ae. aegypti females was assessed in the laboratory, and then the larvicide and residual effects of different concentrations were tested under simulated field conditions. The determination of the enzymatic activity in exposed larvae was carried out using sublethal concentrations. The LC₅₀ values of propyl ether dillapiole after 24 and 48 h were 24.60 µg/mL and 14.76 µg/mL, and those of piperidyl dillapiole were 31.58 µg/mL and 24.85 µg/mL, respectively. After 48 h of exposure to aged, treated water, the mortality of propyl ether dillapiole (100 µg/mL) and piperidyl dillapiole (200 µg/mL) fell to 81.7% and 75% on the second day, and to 73.3% and 66.7% on the fourth day, respectively. The concentrations of 100 µg/mL of propyl ether dillapiole and 200 µg/mL of piperidyl dillapiole caused oviposition rates of only 3.80% and 4.63% of the eggs of the females, respectively, compared to 22.01% in the negative control (water and DMSO at 2%). In the larvae exposed to propyl ether, piperidyl dillapiole, dillapiole, or the chemical insecticide temephos (positive control), inhibition of acetylcholinesterase (AChE) occurred. Propyl ether dillapiole and piperidyl dillapiole have potential for use as alternative forms of control of Ae. aegypti, with propyl ether dillapiole being the most promising molecule. Further studies are needed to understand the effects of these substances on this mosquito and on non-target organisms. Full article