Effectiveness of gallium and aluminum Arsenide laser in bone repair/Efetividade do laser de Arseneto de gálio e alumínio no reparo ósseo

Introdução - O conhecimento de métodos que estimulem a consolidação óssea vem adquirindo considerável importância atualmente. Dentre eles, estudos experimentais com laserterapia mostraram-se promissores. Objetivo -  avaliar o efeito de diferentes doses de Laser de baixa potência (LBP) sobre o processo de consolidação óssea em Rattus norvegicus. Métodos - Utilizaram-se 45 ratos da espécie rattus norvegicus, divididos em quatro grupos, um controle e três terapêuticos (4J, 6J, 10J) com aplicação de LBP em lesões nas tíbias esquerdas. Após o sacrifício, analisaram-se as dosagens bioquímicas de cálcio, fósforo, fosfatase alcalina e a densidade mineral óssea média. Quanto aos níveis séricos de fósforo, observou-se maior concentração nos grupos terapêuticos. Resultados - Verificaram-se resultados distintos entre os grupos de animais irradiados, sendo encontrada maior concentração de fosfatase alcalina no de 6J, e conforme a medição da densidade mineral óssea, o de 4J apresentou maior valor, e o de 10J, o menor. Conclusão - o laser favorece a remodelação óssea, porém conforme a análise radiográfica, os melhores resultados foram obtidos com dosagem de 4J, apesar da análise bioquímica, evidenciar altos níveis de fosfatase alcalina sérica no grupo de 6J

Effectiveness of therapeutic ultrasound in the treatment of pain and return to function in knee osteoarthritis - an integrative review / Efetividade do ultrassom terapêutico no tratamento da dor e retorno da função na osteoartrite de joelho - uma revisão integrativa

Introdução: A osteoartrite (OA) é um distúrbio articular bastante comum em nossa sociedade e sua incidência aumenta com o avançar da idade.  Embora possa afetar várias articulações do nosso corpo, as alterações mais evidentes são observadas em grandes articulações de carga. A abordagem terapêutica da OA visa reduzir a sintomatologia dolorosa, diminuir os níveis de rigidez, melhorar a mobilidade e a qualidade de vida. Dentre as opções terapêuticas não farmacológicas temos a terapia com ultrassom (US) que promove um aquecimento profundo nos tecidos e cujo tópico carece de mais evidências científicas que comprovem sua eficácia no alívio da dor em pacientes com OA de joelho.  Objetivo: Este trabalho visa descrever os efeitos e a eficácia do ultrassom terapeêutico (UST) no tratamento da dor e função na osteoartrose primária de joelhos.  Métodos: Foi realizado uma busca sistemática nas bases de dados PubMed, LILACS, CENTRAL, SCIELO e PEDro por ensaios clínicos randomizados e quasi-randomizados, publicados nos últimos 10 anos. As palavras-chave utilizadas foram Ultrassom, Terapia por Ultrassom, Dor, Joelho, Articulação do Joelho, Osteoartrite do Joelho.  Resultados: Seis estudos, que avaliaram ao todo 561 paciente foram selecionados. Alguns estudos demonstraram que não houve diferença significativa entre os grupos US contínuo e US pulsado no alívio da dor e melhora da função. O US quando usado como coadjuvante terapêutico resultou em melhora da dor. Conclusão: Os trabalhos selecionados sugerem que aplicações de US combinado principalmente com exercícios são eficazes no alivio de dor e melhora da funcionalidade de pacientes com osteoartrite de joelho

Influência da velocidade da movimentação do transdutor na administração da terapia ultrassônica pulsada na cicatrização de feridas cutâneas em ratos / Influence of transducer drive speed on ultrasonic pulsed therapy management in the healing of skin wounds in rats

Introdução: O ultrassom terapêutico tem sido usado extensivamente para promover a cicatrização de tecidos. Objetivo: Avaliar a influência da velocidade da movimentação do transdutor na administração da terapia ultrassônica pulsada na cicatrização de feridas cutâneas em ratos. Métodos: 21 ratos da linhagem Wistar, foram distribuídos em 03 grupos experimentais de 07 animais: Grupo 01: constituído de animais submetidos apenas à produção da ferida e tratados com aparelho desligado; Grupo 02: constituído de animais submetidos à produção da ferida e tratados com ultrassom pulsado com transdutor estacionário; E grupo 03: constituído de animais submetidos à produção da ferida e tratados com ultrassom pulsado com transdutor em movimento. O tratamento teve duração de treze dias com (ERA: 3 cm²; BNR: = 8; Frequência: 1 MHz; Ciclo de trabalho: 20%; Intensidade de 0,4 W/cm²; Frequência de repetição de pulso: 48 Hz; Potência: 1,6 W; Tempo de aplicação: 5 min.) de irradiação. Analisou-se a morfometria por meio do software ImageJ®. Para resultados quantitativos, utilizou-se como análise estatística ANOVA Tow way e o post test Bonferroni. Resultados: No 7º e 13º dias foi observado redução estatisticamente significativa entre as áreas das lesões não havendo presença de processo inflamatório com contaminação e infecção a nível macroscópico, apresentaram cicatrização mais avançada com uma significativa presença de tecido fibrinoso e de granulação quando comparado os grupos G2 e G3 ao grupo G1. Conclusão: O tratamento com ultrassom terapêutico pulsado, favoreceu a cicatrização de feridas cutâneas em ratos, independente da velocidade e movimentação do transdutor ultrassônico

Perfil baropodométrico em crianças atendidas em uma clínica de fisioterapia / Baropodometric profile in children attended in a physiotherapy clinic

A baropodometria é um equipamento utilizado para avaliar pressões plantares, centro de gravidade e tipologia podal. Há escassez na literatura de artigos que falem sobre a utilização deste exame na avaliação da pisada de crianças. O objetivo deste estudo foi avaliar o perfil de pisada de crianças atendidas em uma clínica particular de Teresina – PI. Para isso foi realizado um estudo transversal com abordagem quali-quantitativa de caráter documental de exames baropodométricos cadastrados no banco de dados realizados no período de 2013 a 2018. Observou-se que não houve correlação entre as variáveis, altura, peso, IMC, idade e o pico de pressão plantar máximo. 94% dos exames avaliados apresentaram pé cavo. O estudo evidenciou que não houve uma correlação significativa do pico de pressão plantar com os dados antropométricos (idade, peso, altura, IMC), e maior incidência de pé cavo e centro de gravidade posteriorizado à direita.

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost