ABSTRACT: This study evaluated the effect of dietary supplementation with glutamine and glutamic acid (Gln+Glu) on performance, intestinal morphometry, and carcass characteristics of broiler quails. Eight hundred birds were used, distributed in an entirely randomized design with 20 birds per experimental unit, and given five treatments (0.0; 0.2; 0.4; 0.6; and 0.8% Gln+Glu supplementation) with eight replicates. At 1-21 days of age, lower (P < 0.05) feed intake at 0.6 and 0.8% Gln+Glu supplementation and lower weight gain at 0.8% Gln+Glu supplementation compared to the control treatment were observed. By regression analysis, excluding the control treatment, there was an increasing linear effect (P < 0.05) for feed intake at 22 to 42 days of age. For intestinal morphometry, Gln+Glu supplementation only favored the villus development of the ileum (P < 0.05), giving it greater height at 0.2, 0.6, and 0.8% supplementation. Carcass characteristics, cuts, and edible viscera of the birds at 42 days were not affected (P > 0.05) by Gln+Glu supplementation levels. Thus, the glutamine and glutamic acid supplementation affected the performance and intestinal morphology of 21-d-old quails, decreasing feed intake and weight gain associated with the improvement of ileum morphology; conversely, performance and carcass characteristics at 42 days were not affected by amino acid supplementation.

RESUMO: Objetivou-se avaliar o efeito da suplementação dietética de glutamina e ácido glutâmico (Gln+Glu) sobre o desempenho, a morfometria intestinal e as características de carcaça de codornas de corte. Foram utilizadas 800 aves, distribuídas em delineamento inteiramente casualizado, com cinco tratamentos (0,0; 0,2; 0,4; 0,6 e 0,8% de suplementação de Gln+Glu) e oito repetições com 20 aves por unidade experimental. Na fase de um a 21 dias, constatou-se menor (P < 0,05) consumo de ração aos níveis de 0,6 e 0,8% de Gln+Glu e menor ganho de peso ao nível 0,8% de Gln+Glu em comparação ao tratamento controle; e, pela análise de regressão, excluindo-se o tratamento controle, houve efeito linear crescente (P < 0,05) para consumo de ração na fase 22 a 42 dias de idade. Para morfometria intestinal, a suplementação de Gln+Glu apenas favoreceu o desenvolvimento vilos do íleo (P < 0,05), conferindo-lhe maior altura aos níveis de 0,2; 0,6 e 0,8% de suplementação. As características de carcaça, cortes e vísceras comestíveis das aves aos 42 dias não foram afetadas (P > 0,05) pelos níveis de suplementação de Gln+Glu. Assim, a suplementação de glutamina e ácido glutâmico influenciou o desempenho e a morfometria intestinal de codornas de corte aos 21 dias de idade, promovendo redução do consumo de ração e do ganho, associado ao aumento morfométrico do íleo; por outro lado, o desempenho das aves e as suas características de carcaça aos 42 dias não foram afetados pela suplementação dos aminoácidos.

Resumo Introdução: A vida das pessoas com Doença Renal Crônica (DRC) é alterada em diversos aspectos. Dentre eles, o trabalho destaca-se como um dos que sofrem profundas consequências e comprometimento na sua continuidade. Embora existam estudos sobre as limitações impostas pelo tratamento da DRC nas atividades profissionais, a percepção dos pacientes em relação a essas limitações ainda é pouco explorada na literatura. Objetivo: Conhecer as percepções dos pacientes renais crônicos, em hemodiálise e transplantados renais, sobre as limitações impostas pelo tratamento nas suas atividades profissionais. Métodos: Estudo qualitativo, realizado com 21 pacientes com DRC (13 em tratamento de hemodiálise e 8 transplantados renais). A coleta de dados se deu por meio de entrevistas, a partir de um roteiro semiestruturado, e submetidas à análise de conteúdo, na modalidade temática. Resultados: Foram identificados três temas de análise: 1. Diagnóstico e acesso ao tratamento; 2. Limitações nas atividades diárias e no trabalho e 3. Mudanças relacionadas ao trabalho e apoio familiar. Entre os pacientes com hemodiálise, a necessidade de realizar sessões frequentes foi citado como um dificultador para a retomada das atividades laborais. Mesmo entre os pacientes transplantados, as limitações físicas e os cuidados pós-cirúrgicos afetaram a produtividade e a capacidade de retorno ao trabalho da maneira habitual. Conclusões: As mudanças experimentadas pelos entrevistados após o início do tratamento da DRC afetaram sua capacidade de retornar ao trabalho, e o apoio familiar foi considerado essencial para facilitar esse processo. A pesquisa qualitativa se mostrou uma ferramenta importante no entendimento de como as mudanças na vida do paciente renal crônico após o início do tratamento afetam sua capacidade de retornar ao trabalho.

Abstract Introduction: The lives of people with Chronic Kidney Disease (CKD) are changed in several ways, among them, work stands out as one of those that suffers profound consequences and compromises its continuity. Although there are studies on the limitations imposed by the treatment of CKD in professional activities, the perception of patients in relation to these limitations is still little explored in the literature. Objective: To know the perceptions of chronic kidney patients, on hemodialysis and kidney transplant patients, about the limitations imposed by the treatment in their professional activities. Methods: Qualitative study, carried out with 21 patients with CKD (13 on hemodialysis and 8 with kidney transplant). Data collection took place through interviews, based on a semi-structured script, and submitted to content analysis, in the thematic modality. Results: Three analysis themes were identified: 1. Diagnosis and access to treatment; 2. Limitations in daily activities and work and 3. Work-related changes and family support. Among hemodialysis patients, the need for frequent sessions was cited as a barrier to resuming work activities. Even among transplant patients, physical limitations and post-surgical care affected productivity and the ability to return to work as usual. Conclusions. The changes experienced by respondents after starting CKD treatment affected their ability to return to work, and family support was considered essential to facilitate this process. Qualitative research proved to be an important tool in understanding how changes in the life of chronic renal patients after starting treatment affect their ability to return to work.

Hypertension is one of the primary modifiable risk factors for morbidity and mortality worldwide, being a major risk factor for coronary artery disease, stroke, and kidney failure. Furthermore, it is highly prevalent, affecting more than one-third of the global population. Blood pressure measurement is a MANDATORY procedure in any medical care setting and is carried out by various healthcare professionals. However, it is still commonly performed without the necessary technical care. Since the diagnosis relies on blood pressure measurement, it is clear how important it is to handle the techniques, methods, and equipment used in its execution with care. It should be emphasized that once the diagnosis is made, all short-term, medium-term, and long-term investigations and treatments are based on the results of blood pressure measurement. Therefore, improper techniques and/or equipment can lead to incorrect diagnoses, either underestimating or overestimating values, resulting in inappropriate actions and significant health and economic losses for individuals and nations. Once the correct diagnosis is made, as knowledge of the importance of proper treatment advances, with the adoption of more detailed normal values and careful treatment objectives towards achieving stricter blood pressure goals, the importance of precision in blood pressure measurement is also reinforced. Blood pressure measurement (described below) is usually performed using the traditional method, the so-called casual or office measurement. Over time, alternatives have been added to it, through the use of semi-automatic or automatic devices by the patients themselves, in waiting rooms or outside the office, in their own homes, or in public spaces. A step further was taken with the use of semi-automatic devices equipped with memory that allow sequential measurements outside the office (ABPM; or HBPM) and other automatic devices that allow programmed measurements over longer periods (HBPM). Some aspects of blood pressure measurement can interfere with obtaining reliable results and, consequently, cause harm in decision-making. These include the importance of using average values, the variation in blood pressure during the day, and short-term variability. These aspects have encouraged the performance of a greater number of measurements in various situations, and different guidelines have advocated the use of equipment that promotes these actions. Devices that perform HBPM or ABPM, which, in addition to allowing greater precision, when used together, detect white coat hypertension (WCH), masked hypertension (MH), sleep blood pressure alterations, and resistant hypertension (RHT) (defined in Chapter 2 of this guideline), are gaining more and more importance. Taking these details into account, we must emphasize that information related to diagnosis, classification, and goal setting is still based on office blood pressure measurement, and for this reason, all attention must be given to the proper execution of this procedure.

La hipertensión arterial (HTA) es uno de los principales factores de riesgo modificables para la morbilidad y mortalidad en todo el mundo, siendo uno de los mayores factores de riesgo para la enfermedad de las arterias coronarias, el accidente cerebrovascular (ACV) y la insuficiencia renal. Además, es altamente prevalente y afecta a más de un tercio de la población mundial. La medición de la presión arterial (PA) es un procedimiento OBLIGATORIO en cualquier atención médica o realizado por diferentes profesionales de la salud. Sin embargo, todavía se realiza comúnmente sin los cuidados técnicos necesarios. Dado que el diagnóstico se basa en la medición de la PA, es claro el cuidado que debe haber con las técnicas, los métodos y los equipos utilizados en su realización. Debemos enfatizar que una vez realizado el diagnóstico, todas las investigaciones y tratamientos a corto, mediano y largo plazo se basan en los resultados de la medición de la PA. Por lo tanto, las técnicas y/o equipos inadecuados pueden llevar a diagnósticos incorrectos, subestimando o sobreestimando valores y resultando en conductas inadecuadas y pérdidas significativas para la salud y la economía de las personas y las naciones. Una vez realizado el diagnóstico correcto, a medida que avanza el conocimiento sobre la importancia del tratamiento adecuado, con la adopción de valores de normalidad más detallados y objetivos de tratamiento más cuidadosos hacia metas de PA más estrictas, también se refuerza la importancia de la precisión en la medición de la PA. La medición de la PA (descrita a continuación) generalmente se realiza mediante el método tradicional, la llamada medición casual o de consultorio. Con el tiempo, se han agregado alternativas a través del uso de dispositivos semiautomáticos o automáticos por parte del propio paciente, en salas de espera o fuera del consultorio, en su propia residencia o en espacios públicos. Se dio un paso más con el uso de dispositivos semiautomáticos equipados con memoria que permiten mediciones secuenciales fuera del consultorio (AMPA; o MRPA) y otros automáticos que permiten mediciones programadas durante períodos más largos (MAPA). Algunos aspectos en la medición de la PA pueden interferir en la obtención de resultados confiables y, en consecuencia, causar daños en las decisiones a tomar. Estos incluyen la importancia de usar valores promedio, la variación de la PA durante el día y la variabilidad a corto plazo. Estos aspectos han alentado la realización de un mayor número de mediciones en diversas situaciones, y diferentes pautas han abogado por el uso de equipos que promuevan estas acciones. Los dispositivos que realizan MRPA o MAPA, que además de permitir una mayor precisión, cuando se usan juntos, detectan la hipertensión de bata blanca (HBB), la hipertensión enmascarada (HM), las alteraciones de la PA durante el sueño y la hipertensión resistente (HR) (definida en el Capítulo 2 de esta guía), están ganando cada vez más importancia. Teniendo en cuenta estos detalles, debemos enfatizar que la información relacionada con el diagnóstico, la clasificación y el establecimiento de objetivos todavía se basa en la medición de la presión arterial en el consultorio, y por esta razón, se debe prestar toda la atención a la ejecución adecuada de este procedimiento.

A hipertensão arterial (HA) é um dos principais fatores de risco modificáveis para morbidade e mortalidade em todo o mundo, sendo um dos maiores fatores de risco para doença arterial coronária, acidente vascular cerebral (AVC) e insuficiência renal. Além disso, é altamente prevalente e atinge mais de um terço da população mundial. A medida da PA é procedimento OBRIGATÓRIO em qualquer atendimento médico ou realizado por diferentes profissionais de saúde. Contudo, ainda é comumente realizada sem os cuidados técnicos necessários. Como o diagnóstico se baseia na medida da PA, fica claro o cuidado que deve haver com as técnicas, os métodos e os equipamentos utilizados na sua realização. Deve-se reforçar que, feito o diagnóstico, toda a investigação e os tratamentos de curto, médio e longo prazos são feitos com base nos resultados da medida da PA. Assim, técnicas e/ou equipamentos inadequados podem levar a diagnósticos incorretos, tanto subestimando quanto superestimando valores e levando a condutas inadequadas e grandes prejuízos à saúde e à economia das pessoas e das nações. Uma vez feito o diagnóstico correto, na medida em que avança o conhecimento da importância do tratamento adequado, com a adoção de valores de normalidade mais detalhados e com objetivos de tratamento mais cuidadosos no sentido do alcance de metas de PA mais rigorosas, fica também reforçada a importância da precisão na medida da PA. A medida da PA (descrita a seguir) é habitualmente feita pelo método tradicional, a assim chamada medida casual ou de consultório. Ao longo do tempo, foram agregadas alternativas a ela, mediante o uso de equipamentos semiautomáticos ou automáticos pelo próprio paciente, nas salas de espera ou fora do consultório, em sua própria residência ou em espaços públicos. Um passo adiante foi dado com o uso de equipamentos semiautomáticos providos de memória que permitem medidas sequenciais fora do consultório (AMPA; ou MRPA) e outros automáticos que permitem medidas programadas por períodos mais prolongados (MAPA). Alguns aspectos na medida da PA podem interferir na obtenção de resultados fidedignos e, consequentemente, causar prejuízo nas condutas a serem tomadas. Entre eles, estão: a importância de serem utilizados valores médios, a variação da PA durante o dia e a variabilidade a curto prazo. Esses aspectos têm estimulado a realização de maior número de medidas em diversas situações, e as diferentes diretrizes têm preconizado o uso de equipamentos que favoreçam essas ações. Ganham cada vez mais espaço os equipamentos que realizam MRPA ou MAPA, que, além de permitirem maior precisão, se empregados em conjunto, detectam a HA do avental branco (HAB), HA mascarada (HM), alterações da PA no sono e HA resistente (HAR) (definidos no Capítulo 2 desta diretriz). Resguardados esses detalhes, devemos ressaltar que as informações relacionadas a diagnóstico, classificação e estabelecimento de metas ainda são baseadas na medida da PA de consultório e, por esse motivo, toda a atenção deve ser dada à realização desse procedimento.

In higher education, reasonable accommodations are increasingly made for students with a wide range of disabilities. However, rigorous assessment is paramount to ensure these students are supported while preventing ineligible students from gaining unfair advantages. In this context, we sought to identify under which circumstances a university student should be allowed academic accommodation for attention-deficit/hyperactivity disorder (ADHD) and to outline an evidence-based policy for use in Brazil based on the global experience. We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodations for ADHD are provided (including detection of malingering) and scrutinized the eligibility criteria of leading universities worldwide. Finally, renowned experts in the field and national stakeholders were consulted. Despite an exhaustive search, we found no international standard for the assessment of students with ADHD who request academic accommodation; even renowned institutions worldwide differ in their approaches to granting accommodations on the grounds of ADHD. Therefore, we propose a unified set of nationwide criteria for Brazilian universities, which could be generalized internationally. Higher education institutions in Brazil and beyond may benefit from adoption of such criteria. disabilities However advantages context attentiondeficit/hyperactivity attentiondeficithyperactivity attention deficit/hyperactivity deficit hyperactivity (ADHD evidencebased evidence experience including malingering Finally consulted search Therefore internationally attentiondeficit deficithyperactivity

ABSTRACT Introduction: Supplementation with probiotics for patients with chronic kidney disease (CKD) may be associated with decreased systemic inflammation. Objective: To assess the impact of oral supplementation with probiotics for patients with CKD on hemodialysis. Method: This double-blind randomized clinical trial included 70 patients on hemodialysis; 32 were given oral supplementation with probiotics and 38 were in the placebo group. Blood samples were collected at the start of the study and patients were given oral supplementation with probiotics or placebo for three months. The probiotic supplement comprised four strains of encapsulated Gram-positive bacteria: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 and Bifidobacterium longum A101. Patients were given one capsule per day for 3 months. Blood samples were taken throughout the study to check for inflammatory biomarkers. Non-traditional biomarkers Syndecan-1, IFN-y, NGAL, and cystatin C were measured using an ELISA kit, along with biochemical parameters CRP, calcium, phosphorus, potassium, PTH, GPT, hematocrit, hemoglobin, glucose, and urea. Results: Patients given supplementation with probiotics had significant decreases in serum levels of syndecan-1 (239 ± 113 to 184 ± 106 ng/mL, p = 0.005); blood glucose levels also decreased significantly (162 ± 112 to 146 ± 74 mg/dL, p = 0.02). Conclusion: Administration of probiotics to patients with advanced CKD was associated with decreases in syndecan-1 and blood glucose levels, indicating potential improvements in metabolism and decreased systemic inflammation.

Resumo Introdução: A suplementação com probióticos na doença renal crônica (DRC) pode estar associada à redução do processo inflamatório sistêmico. Objetivo: Avaliar a suplementação oral com probióticos em pacientes com DRC em hemodiálise. Método: Ensaio clínico, duplo cego, randomizado com 70 pacientes em hemodiálise, sendo 32 do grupo que recebeu o suplemento de probióticos e 38 do grupo placebo. Inicialmente ocorreu a coleta de sangue e suplementação oral com probióticos ou placebo durante três meses. O suplemento probiótico foi composto pela combinação de 4 cepas de bactérias Gram-positivas encapsuladas: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 e Bifidobacterium longum A101, sendo 1 cápsula do suplemento ao dia, durante 3 meses. Após esse período foram feitas novas coletas de sangue para dosagem dos biomarcadores inflamatórios. Foram analisados os biomarcadores não tradicionais: Syndecan-1, IFN-y, NGAL e cistatina C pelo método ELISA, e os seguintes parâmetros bioquímicos: PCR, cálcio, fósforo, potássio, PTH, TGP, hematócrito, hemoglobina, glicose e ureia. Resultados: Os pacientes que receberam suplemento tiveram diminuição significativa dos níveis séricos de syndecan-1 (de 239 ± 113 para 184 ± 106 ng/mL, p = 0,005). Outro parâmetro que diminuiu significativamente nos pacientes que receberam suplemento foi a glicemia (de 162 ± 112 para 146 ± 74 mg/dL, p = 0,02). Conclusão: O uso de probióticos na DRC avançada esteve associado à redução dos níveis de syndecan-1 e glicemia, sinalizando possível melhora no metabolismo e redução do processo inflamatório sistêmico.

Crisis hotlines are direct communication systems, usually telephone-based, set up to prevent suicide. However, few studies have evaluated their effectiveness. The present study aims to perform a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, of the effectiveness of interventions through direct communication systems to reduce the number of suicides or suicide attempts. We searched the MEDLINE, Cochrane, SciELO, and ClinicaTrials.gov databases, and used the 2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence classification. The literature search yielded 267 studies, of which 35 fulfilled the selection criteria. Although significant heterogeneity was found among studies, there is evidence that direct telephone interventions are effective when included in broader preventive protocols and provided by trained staff. Despite the limitations, which included heterogeneity of samples, designs, and outcome measures, we were able to design a protocol for the use of remote services to prevent suicide and suicide attempts. A hotline or similar system could be an effective intervention for broader suicide prevention programs. However, further research is necessary to specify which protocol components are key to enhance effectiveness. Systematic review registry number: PROSPERO CRD42020206517

Abstract Introduction Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale’s psychometric properties. Method An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital’s psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. Results In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). Conclusion The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.

ABSTRACT The mixed-model methodology is an alternative to select genotypes for traits highly influenced by the environment. In addition, this method allows FOR estimating the repeatability coefficient and predicting the number of assessments needed for a selection process to increase reliability. This study aimed to determine the minimum number of evaluations necessary for a reliable selection process and to estimate the variance components used for predicting genetic gains between and within half-sib families of elephant grass ( Cenchrus purpureus (Schumach.) Morrone ) using the mixed-model methodology. Half-sib families were generated using genotypes from the Active Germplasm Bank of Elephant Grass. The experiment was performed in a randomized block design with nine half-sib families, three replicates, and eight plants per plot. We evaluated 216 genotypes (individual plants) of elephant grass. The deviance analysis was carried out, genetic parameters were estimated, gains between and within families were predicted, and repeatability coefficients were obtained using Selegen software. There was genetic variability for selection within the families evaluated. The reliability values found above 60 % for plant height and number of tillers and above 80 % for dry matter yield suggest that only two evaluations are required to select superior genotypes with outstanding reliability. Sixteen genotypes were identified and selected for their productive potential, which can be used as parents in elephant grass breeding programs for bioenergy production.

Abstract Objective The Child and Adolescent Behavior Inventory (CABI) is a cost-free 75 question-questionnaire developed by an Italian group to collect information from parents on the behavior of children and adolescents aged 6 to 18 years. It assesses different areas of children's behavior and psychopathology, including internalizing and externalizing symptoms, and can be used to identify children at risk of mental disorders both in clinical and epidemiological settings. In this study, the authors present a Brazilian-Portuguese adaptation of the CABI and its psychometric properties. Methods First, the authors conducted a rigorous transcultural adaptation of CABI's questions and instructions for the Brazilian context. In an online sample of 598 parents, the authors found high reliability (internal consistency) for the CABI's main subscales. Results Validity was supported by exploratory factor analysis (the authors found 6 factors representing several aspects of psychopathology both according to the DSM and HiTop models) and significant differences in most CABI's subscales between children with parent-reported psychopathology and typically developing ones. The present study suggests that the adapted version of CABI is a valid and reliable measure that can be used in Brazil. Conclusions The CABI can be useful to the pediatrician to get fast but wide information from parents on the behavioral condition of their children or adolescents, and also to decide whether it is appropriate to consult a mental health professional.

Abstract Chicken broilers digestibility and performance fed with different ME levels, with and without adjustments of digestible lysine, calcium, and available phosphorus, were evaluated. For digestibility, 210 male Cobb 500 chicken broilers were used and distributed into a 3x2+1 factorial arrangement, with three ME levels (3050; 3125 and 3200 kcal/kg) with and without nutrient adjustment, plus one control treatment (2975 kcal ME/kg), totaling seven treatments including six repetitions with five birds into each repetition. For initial performance, 1120 birds were distributed randomly with eight replications within treatments and 20 birds for each replication. For final performance, 1008 chickens were distributed with eight replications and 18 birds for each replication. The DCDM and DCCP were improved (P<0.05) according to the increase of ME and the adjustment in dietary nutrients, as well as GE digestibility. The final performance showed no interaction (P>0.05) between energy and nutrient adjustment, but the increase in energy levels improved the feed conversion ratio (FCR=1.370). Increasing energy density with nutrient adjustment improves both nutrient utilization and bird performance.