Evaluation Period Research Articles

Alkasite restorative material for endodontically treated teeth: a randomized controlled pilot study.

This study aimed to evaluate the clinical performance of an alkasite restorative material in molars that had undergone root canal treatment. The research was registered in Brazilian Registry of Clinical Trials. The randomized clinical trial involved 33 patients, each with at least 1 mandibular molar requiring restoration after receiving endodontic treatment. Patients were randomly assigned to receive either bulk-fill resin composite (Tetric N Ceram Bulk Fill, Ivoclar Vivadent) or the alkasite restorative material (Cention N, Ivoclar Vivadent). Upon completion of the restorations, 3 calibrated professionals utilized the United States Public Health Service criteria to assess various factors, including retention, secondary caries, marginal adaptation, restoration color, marginal pigmentation, and anatomical form. Evaluations were conducted at intervals of 7 days, 6 months, and 17 months. Additionally, the assessment encompassed the presence of radiolucent lines adjacent to the restoration, material deficiencies or excess, contact points, and caries recurrence. The data underwent analysis using the Friedman and Mann-Whitney tests (α = 0.05). After 17 months, the results revealed that the alkasite restorative material exhibited greater wear of anatomical shape compared to the bulk-fill resin composite (p = 0.0189). Furthermore, the alkasite restorative material significantly differed from the natural tooth color in most cases (p = 0.0000). However, no other criteria displayed significant differences between the materials or over time (p > 0.05). The alkasite restorative material (Cention N) emerges as a viable option for restoring endodontically treated teeth, displaying clinically acceptable alterations after a 17-month evaluation period. Brazilian Registry of Clinical Trials (ReBEC) Identifier: RBR-97kx5jv.

Isopentyl caffeate as a promising drug for the treatment of leishmaniasis: An in silico and in vivo study

Leishmaniasis is recognised as the second largest parasitic disease worldwide and yet a neglected disease. The current pharmacological treatments are associated with significant challenges, including high toxicity, high cost and parasitic resistance. Considering the potential of isopentyl caffeate (ICaf) as an anti-leishmanial agent, the present work evaluated the in vivo toxicity of ICaf and the absorption, distribution, metabolism, and excretion (ADME) properties in silico, aiming at the treatment of Leishmania amazonensis. For the in vivo toxicity testing, Swiss mice (Mus musculus) were treated with a single dose of ICaf. During the 14-day evaluation period, the animals underwent assessments including hippocratic screening, weight measurement, as well as histological and hematological evaluations. Analysis of ADME properties of ICaf was conducted to evaluate its pharmacokinetic characteristics and bioavailability. Characteristics, such as molar refractivity through Lipinski's Rule of Five, were identified. The in silico results showed that ICaf is considered to have good oral bioavailability and has potential to be considered as a new drug. From the in vivo toxicity testing, none of the evaluated parameters revealed toxicity of ICaf to the animals when treated intraperitoneally. The in vivo treatment reduced the lesion and the parasite load at the tested doses, corroborating the assumption that ICaf may be a potential pharmacological alternative against L. amazonensis.

고령자의 시지각 기능 향상을 위한 애플리케이션 개발 및 사용성 평가

Objective : This study aimed to develop the 'Find My Half' application, hereinafter referred to as the visual perception app, for improving the visual perception of the elderly. The research verified its usability and application satisfaction among the elderly and occupational therapists. Methods : The visual perception app was developed to enable visual perception training by identifying the whole form from viewing half of an image. The developed application underwent a two-month period of usability and satisfaction evaluation from July to September 2023. A total of 22 participants (including 12 occupational therapists and 10 elderly individuals) were involved in the assessment after using the visual perception app, evaluating its validity, convenience, usability, functionality, and ease of learning, as well as assessing improvement points and overall satisfaction. Results : The usability assessment employed a Likert 5-point scale. According to the usability evaluation, the elderly participants scored an average of 4.57±0.29 points, whereas the therapists scored an average of 3.53±0.20 points. Improvement suggestions were derived from the use of the application, and the satisfaction rating among the elderly averaged 4.30±1.25 points. Furthermore, the therapists' satisfaction scores averaged 3.17±0.72 points. Conclusion : The visual perceptual application developed in this study for improving the visual perception of the elderly showed positive results in terms of usability and satisfaction among both the elderly
 users and occupational therapists. It is anticipated that further advancements, particularly in terms of enhancing audio guidance and usage instructions, will lead to more active application among the elderly, aiding in preventing difficulties in performing daily activities due to visual perceptual impairments.

상속세 및 증여세법상부동산 시가적용에 관한 최근 과세 쟁점

The basic structure of the assessment of property under the current inheritance and gift tax law is a simple one in which it is based on the market price, but in cases where it is impracticable to calculate the current market price, complementary valuation methods are used as an exception. However, the abstractness of the concept of the market price and what specific extent to which it should be recognized as the market price are complex and difficult issues. Because of this, many controversies arise between taxpayers and tax authorities.
 With the purpose of the improvement of fair taxation, Korea's inheritance and gift tax law has continuously expanded the scope of what can be recognized as the market price based on the principle of the market price. This reflects the reality that there is an inevitable conflict of interest between taxpayers who prefer complementary valuation methods due to the property valuation method of the inheritance and gift law, which allows complementary valuation methods to be exceptionally applied only in cases where it is impracticable to calculate the current market price and the realistic price rate of the officially assessed real estate price that is far below the market price, and tax authorities.
 The value recognized as the market price under the current inheritance and gift tax law can be divided into four categories, which are the relevant property and the case value for similar property within the principle of assessment period, and the relevant property and the case value for similar property within the extended evaluation period.
 This study deals with ‘the application of similar case values to apartments, etc.’ which is controversial regarding the scope of market recognition and ‘whether the appraised value requested by the tax office after the reporting date for non-residential real estate, etc. is recognized as market price or not’ targeting real estate, which accounts for a high proportion of inherited and gifted properties. In relation to this, there are many criticisms that it is not only against the principle of fair taxation, but it can also infringe on the taxpayer's predictability in terms of that excessive taxation is imposed on some taxpayers for properties with the same burden due to the existence of a sale price of similar property traded by another person by chance or an appraisal request based on the arbitrary judgment of the tax authorities, etc.
 It is not easy in reality to establish clear and consistent standards that all taxpayers can agree on when calculating the market price of inherited or gifted property whose ownership is transferred gratuitously. However, it is essential that the tax authorities continue to make efforts to accept criticism of existing taxation practices as article 15 of the enforcement rules of the inheritance and gift tax law legislate the scope of similar property in apartments in detail.
 This study analyzed major issues in taxation practice by analyzing the provisions of the inheritance and gift tax law and recent precedents regarding the scope of provisional recognition of the market price and sought ways to improve them. The main tax issues in applying the case value for similar property to apartments, etc. are; first, exclusion of application of the case value for similar property if there is a case value for the relevant property, second, the period of market recognition for the case value for similar property, third, criteria for judging similarity, and fourth, whether there are special circumstances for price fluctuations.

Effect of the Bio Optimize® prebiotic on animal welfare and production variables of broiler chickens

The objective was to evaluate the use of the BIO OPTIMIZE® prebiotic on indicator variables of well-being and production of Ross 308 hybrid broiler chickens. Three treatments were evaluated: 1.- Control without the inclusion of the prebiotic; 2.-Prebiotic applied in the litter from day 9 and from day 21 in the drinking water and 3.-Prebiotic only applied in the litter from day 9 of the birds' productive cycle. 144 chickens were used in a completely randomized design, with three treatments, six repetitions and the experimental unit consisting of eight chickens. The environmental temperature and relative humidity of the breeding units were monitored, in addition to the temperature of the bedding and drinking water. Body temperature, hyperventilation levels, ammonia levels in the litter, feed consumption and conversion, and weight gain of the chickens were quantified. The temperature and relative humidity were outside the comfort range; there was a direct relationship between the environmental temperature and the temperature of the drinking water, while the temperature of the bed increased during the evaluation period. The application of BioOptimize® to the litter from 28 days onwards reduced ammonia levels in the breeding units, reduced body temperature and increased hyperventilation levels in the chickens. The best feed conversion index was obtained in the treatment without prebiotic derived from an inverse behavior in feed consumption.

Physiotherapy In Primary Care: Piloting of A New Integrated Service 

Introduction: In recent years, the prevalence of osteoarticular pain in our society has been following an unstoppable upward curve, with a medium-term forecast that points to it as one of the major causes of disability. The approach to the treatment of these ailments from an exclusively biomedical model, far from resolving them, saturates the health services themselves and fails to add value to the health/disease experience of those who suffer from them.
 Objectives: To evaluate the implementation of a Physiotherapy service in Osakidetza Primary Care centers for the management of people suffering from osteoarticular pain.
 Material And Methods: As part of the corporative strategy delineated by Osakidetza for Pirmary Care, the aim was to introduce a new approach to osteoarticular pain based in an integral model using exercise as the instrument to maintain health and prevent relapses, empowering the person in the management of their process, in connection with the municipal sports services. Specifically, it is intended to refer patients from primary care family medicine professionals to physiotherapy, under an agreed treatment protocol and in coordination with the Rehabilitation Service. This process is based on a fundamentally educational approach, consisting in 10 sessions of 1 hour of duration, in groups of 8-10 people, carried out over 2 weeks each group, with specific exercises adapted to their pathology. The piloted evaluation of the program was conducted in 2 gyms located in 2 health centers serving the entire regional population of 312,000 inhabitants, between November 2018 to December 2021. 
 Results: The number of people assessed by 4 physiotherapists during the evaluation period was 4,175. Of these, 3,294 (79%)performed the treatment, 4% were referred to the hospital rehabilitation service after the assessment, 3% of the patients were returned to their Family Doctor due to inadequate referral and 17% refused treatment, in all cases due to the impossibility of reconciling work-family life. In accordance with the available evidence, the most frequent reason for consultation was back pain, in 72% of the cases. In 76% of the cases, the waiting time from the physical therapist's evaluation to access to the treatment was less than 1 month, being in all cases less than 2 months. After participation in the program, 81% of the users treated showed improvement in pain and/or functionality. Regarding satisfaction, 95% found the treatment useful and 100% would recommend the treatment to others, with an average satisfaction of 9.3 out of 10.
 Conclusions: The approach to non-specific back and shoulder pain in the context of primary care offers a service to the affectd citizens closer in time and space, with an effective resolution of the symptomatology and a highly valued patient experience. The physiotherapist, in addition to leading the whole process, is a key figure of integration between the two levels of care of Primary and Specialized Care. By resolving non-complex pathology in the primary care setting, more space is given to address more complex pathology in the hospital setting.

Predicting marine and aeolian contributions to the Sand Engine’s evolution using coupled modelling

Quantitative predictions of marine and aeolian sediment transport in the nearshore–beach–dune system are important for designing Nature-Based Solutions (NBS) in coastal environments. To quantify the impact of the marine-aeolian interactions on shaping NBS, we present a framework coupling three existing process-based models: Delft3D Flexible Mesh, SWAN and AeoLiS. This framework facilitates the continuous exchange of bed levels, water levels and wave properties between numerical models focussing on the aeolian and marine domain. The coupled model is used to simulate the morphodynamic evolution of the Sand Engine mega-nourishment. Results display good agreement with the observed aeolian and marine volumetric developments, showing similar marine-driven erosion from the main peninsula and aeolian-driven infilling of the dune lake. To estimate the magnitude of the interactions between aeolian and marine processes, a comparison between the simulated morphological development by the coupled and stand-alone models was made. This comparison shows that aeolian sediment transport to the foredune, i.e. 214,000 m3 over 5 years, extracts sediment from the marine domain. As a result, the alongshore redistribution of sediment from the main peninsula by marine-driven processes decreased by 70,000 m3, representing 1.7% of the total marine-driven dispersion. From the aeolian perspective, marine-driven deposition and erosion reshape the cross-shore profile, controlling the supply-limited aeolian sediment transport and the magnitude of sediment deposition in the foredunes. In the region with persistent accretion along the Sand Engine’s southern flank, a higher than average foredune deposition was predicted due to morphological development of the region where sediment is picked up by aeolian transport. Including these marine processes in the coupled model resulted in an increase of 1.3% in foredune growth in year 1 and up to 6.7% in year 5 along this accretive section. At the northern flank, where the developing lagoon and tidal channel provided increased shelter to the supratidal beach, predicted foredune deposition reduced up to −11.5% over the evaluation period. Our findings show that both aeolian and marine transports impact reshaping the nourished sand, where developments in one domain affect the other. The study findings echo that the interplay between aeolian- and marine-driven morphodynamics could play a relevant role when predicting sandy NBS.

Antitumor efficacy and safety of unedited autologous CD5.CAR T cells in relapsed/refractory mature T-cell lymphomas

AbstractDespite newer targeted therapies, patients with primary refractory or relapsed (r/r) T-cell lymphoma have a poor prognosis. The development of chimeric antigen receptor (CAR) T-cell platforms to treat T-cell malignancies often requires additional gene modifications to overcome fratricide because of shared T-cell antigens on normal and malignant T cells. We developed a CD5-directed CAR that produces minimal fratricide by downmodulating CD5 protein levels in transduced T cells while retaining strong cytotoxicity against CD5+ malignant cells. In our first-in-human phase 1 study (NCT0308190), second-generation autologous CD5.CAR T cells were manufactured from patients with r/r T-cell malignancies. Here, we report safety and efficacy data from a cohort of patients with mature T-cell lymphoma (TCL). Among the 17 patients with TCL enrolled, CD5 CAR T cells were successfully manufactured for 13 out of 14 attempted lines (93%) and administered to 9 (69%) patients. The overall response rate (complete remission or partial response) was 44%, with complete responses observed in 2 patients. The most common grade 3 or higher adverse events were cytopenias. No grade 3 or higher cytokine release syndrome or neurologic events occurred. Two patients died during the immediate toxicity evaluation period due to rapidly progressive disease. These results demonstrated that CD5.CAR T cells are safe and can induce clinical responses in patients with r/r CD5-expressing TCLs without eliminating endogenous T cells or increasing infectious complications. More patients and longer follow-up are needed for validation. This trial was registered at www.clinicaltrials.gov as #NCT0308190.

How Does Bank Syariah Indonesia's Financial Performance Measure Up Using The RGEC Method's Bank Health Assessment?

Banks are required to conduct periodic self-assessment of their health level and take effective corrective measures using an assessment of factors including risk profile, good corporate governance (GCG), earnings, and capital, abbreviated as RGEC. The RGEC method is what banks currently use to assess the health level of banks because it is a refinement of previous methods. The degree of bank health as determined by the RGEC technique is the subject of this quantitative descriptive study, which analyzes Bank Syariah Indonesia's health for the years 2019 to 2022. The study's secondary data sources are the yearly financial reports of Islamic Commercial Banks covering the years 2019 to 2022. The following findings are derived from the debate of Bank Syariah Indonesia's Islamic banking sharia for the 2019–2022 evaluation period, The non-performing financing ratio (NPF Nett in composite position 1 may be considered to be in very good health. Conversely, Bank Syariah Indonesia's FDR ratio values in composite positions 1 and 2 might be considered highly healthy. Bank Syariah Indonesia's GCG ratio in composite position 2 may be considered healthy. The Bank Syariah Indonesia's earnings evaluation, or its capacity to turn a profit, received a composite score of 3 to 1, indicating that it is both fairly healthy and extremely healthy from 2019 to 2022. Bank Syariah Indonesia's bank capital was evaluated from 2019 to 2022, and it received a composite evaluation of 1, meaning it is in excellent condition.

Smartphone application assisted optoelectronic nose for monitoring milk freshness

This study introduces an innovative method for detecting the freshness of milk through the use of smart packaging and a smartphone application. The proposed technique employs a colorimetric sensor array and a decision tree classifier, with a curvature test for feature selection. The freshness of milk samples was assessed using six colorimetric sensors, of which three, namely (Methyl violet, Chlorophenol red, and Nile blue) were chosen based on their classification error rates of 4%, 35.67%, and 8.33%, respectively. Sensor 1 was ultimately selected due to its superior performance, and its color information, along with the decision tree classification rules, was incorporated into a smartphone application. The application underwent an evaluation process, during which it was tested on twenty milk samples until total bacterial counts (TBC) reach 7 log CFU.g−1. The results showed that the application achieved a zero-error rate in identifying each sample, with the exception of 4–4.5 log CFU.g−1, where an error rate of 35% was observed. Overall, the total error rate for the entire evaluation period was 3%. Given these results, it can be concluded that this application has the potential to transform milk quality control and improve food safety.

Nuevas pautas de actuación en la hiperplasia benigna de próstata en la Comunidad Valenciana: un estudio de vida real

Introduction and objectivesA training program was developed to increase general practitioners’ engagement in the optimal management of benign prostatic hyperplasia (BPH). The goal of this study was to evaluate changes in BPH management after the implementation of a training program. Material and methodsThis observational retrospective cohort study was conducted between 2019 and 2020. Aggregated data were analyzed in 3 evaluation periods (2010, 2012 and 2015), addressing quality indicators for diagnosis, treatment, and treatment outcomes. ResultsOverall, 118,795 patients who presented any data points were included. All quality indicators (number of IPSS and PSA determinations) increased between the first period and the last. Combination (alpha-blocker+5-ARI) therapy was increasingly prescribed during the study periods whereas the proportion of prescriptions for single-agent alpha-blocker showed no significant differences among the periods analyzed. However, the total number of patients eligible for combination therapy who actually received this treatment was low in all periods (7.5, 17.9, and 20.1%, in 2010, 2012, and 2015, respectively). The outcome indicators revealed a decrease in referrals to the Urology unit mostly among newly diagnosed patients. Even though the proportion of patients who underwent BPH-related surgeries increased significantly from the first to the second period, the number of surgeries remained stable between the second and third periods. ConclusionsThe training program had a generally positive impact on the management of BPH patients in primary care, but the overall study period may be insufficient to show an effect on some outcome indicators such as the number of surgeries.

Clinical benefits with 300 IR HDM SLIT tablet in Europeans with house dust mite allergic rhinitis: Post hoc analysis of a large phase 3 trial

BackgroundHouse dust mite (HDM)-induced allergic rhinitis (AR) is a major cause of allergic respiratory disease. The efficacy and safety of the 300 IR HDM sublingual immunotherapy (SLIT) tablet in patients with moderate-to-severe HDM-AR was confirmed in a large, international, phase 3 randomized controlled trials (RCTs). Here, we analyzed the results in the European population. MethodsData from 91 European centers that participated in the international, double-blind, RCT (EudraCT 2014-004223-46, NCT02443805) with the 300 IR HDM SLIT tablet versus placebo over 12 months were analyzed post hoc. The treatment effect in European adults and adolescents was notably assessed through the European Academy of Allergy and Clinical Immunology (EAACI)-recommended combined symptom and medication score (CSMS0-6, pre-defined endpoint) and the total combined rhinitis score (TCRS0-24, post hoc endpoint, also balanced) during the primary evaluation period (4 weeks at the end of treatment period) using analysis of covariance (ANCOVA). ResultsThere were 818 patients who comprised the modified full analysis set in Europe. Over the primary period, the differences in CSMS0-6 and TCRS0-24 between the 300 IR and placebo groups were statistically significant (p < 0.0001): −0.32 (95%CI [-0.46; −0.17]) and −1.28 (95%CI [-1.63; −0.94]), respectively, with relative differences of −20.9% and −21.2%. All post hoc and the rhinoconjunctivitis quality of life endpoints were significantly improved with 300 IR versus placebo. The 300 IR HDM tablet was generally well tolerated. ConclusionThis RCT sub-analysis confirmed the 300 IR HDM SLIT tablet is an effective and safe treatment for European adults and adolescents with HDM-AR with clinically meaningful benefits from the patients' perspective. Trial registrationNCT02443805. Registered on April 29, 2015./EudraCT 2014-004223-46. Registered on September 16, 2015.

Adequate calorie and protein administration via enteral nutrition may contribute to improved 30-day survival in patients with solid tumors at nutritional risk

Patients with cancer receiving adequate enteral nutrition (EN) have improved clinical outcomes. Unfortunately, discrepancies may exist between the amounts prescribed and received. This study aimed to investigate: (1) the receiving exclusive EN, (2) the relationship between inadequacy and unfavorable outcomes, and (3) the impact of inadequate EN administration on the survival of patients with cancer. This study included hospitalized patients with solid tumors who exclusively received EN and were evaluated using data extracted from electronic medical records. Nutritional risk was evaluated using Nutritional Risk Screening (NRS - 2002). EN adequacy was assessed from days 3-7 of hospitalization. Calorie and protein delivery by EN was classified as adequate (≥80% of EN administration) or inadequate (<80% of EN administration). Data were analyzed using dispersion and Bland-Altman plots, Pearson's chi-square and Fisher's exact tests, and Kaplan-Meier survival curves. A total of 114 patients were evaluated (63.9±13.1 years of age, 67.5% male, 32.5% with head and neck cancer, and 86.8% at nutritional risk). During the 5-day evaluation period, only 14% of the patients received the mean volume, proteins, and calories according to the EN prescription. A relationship was observed between inadequate EN (<80%) and 30-day in-hospital mortality. This result was confirmed by Kaplan-Meier survival analysis (p=0.020), which showed a survival benefit in patients at nutritional risk who received adequate calories and protein. This study demonstrated significant caloric and protein deficits related with EN. Furthermore, adequate calorie and protein administration could contribute to improved survival in patients with cancer who are at a risk of malnutrition, however, randomized controlled trials are required to confirm whether adequate calorie administration could contribute to improved survival.

Environmental macroscopic analysis of shallow wells containing water for human consumption in rural properties in Brazil

Water is an essential natural resource for maintaining life and its quality is influenced by the land use and occupation within a watershed. Furthermore, water quality has a direct impact on the health and well-being of a population. The present study aimed to carry out a macroscopic environmental analysis in shallow wells found in rural properties distributed in the states of Rio Grande do Sul and Santa Catarina, including the Uruguay River Basin. The evaluation period of the macroscopic parameters took place in April 2021. The physical characteristics of the water and the state of preservation of the shallow wells and their surroundings were visually evaluated in rural properties with predominant land use and occupation through dairy production, swine farming activity and seasonal crops (agricultural crops). As results obtained for the environmental macroscopic analysis, through the weighting of the characteristics observed in each parameter about the state of preservation of the shallow wells, it was verified that they presented different classifications, ranging from the Very Good class to the Poor, being possible to identify the main sources that cause negative impacts on the evaluated locations (state of vegetation, use by animals, protection of the area and proximity to residences). Therefore, rural producers were advised to carry out protection and care measures around these wells that presented lower classifications, Fair (38,10%) and Poor (19,09%) to improve the conditions and aspects that directly influence the quality of water for human consumption.

La longue marche du remboursement des psychothérapies par l’assurance maladie en France

ObjectivesTo outline the procedure for obtaining reimbursement by the French National Health system for psychotherapy provided by private practitioners. MethodBy conducting a review of scientific literature, reports, plans, and governmental decisions. ResultsSome twenty years have passed since a recommendation was included in the “plan of action for the development of psychiatry and the promotion of mental health”, which was drafted in 2003. The contribution of epidemiology applied to psychotherapeutic practices in France, and comparisons with neighboring countries, highlighted the quantitative importance of the role of psychiatrists (they provide more than half of all psychotherapeutic interventions) in the implementation of the plan of action, including in the least endowed areas of the country. The 2010 decree on the use of the title of psychotherapist was an essential preliminary step, since, previously, no requisite training was required for that title, which involved substantial risk. Henceforth, fundamental and clinical knowledge have been imposed with mandatory limits of duration. Subsequently, the publication of high expenditures on mental health by the French National Health Program coupled with the establishment of the reimbursement for psychotherapy in the United Kingdom, resulted in a promising French medico-economic study as well asan experiment in four departments involving patients between the ages of 18 and 60 who were suffering from mild and moderate anxious and depressive disorders. The diagnoses were based on PHQ9 and GAD7 being applied by the general practitioner, excluding the most severe cases, which allowed them to provide their patients with an evaluation session by an office-based psychologist followed by 10 sessions of “supportive therapy”. In the case of no improvement, an evaluation by a psychiatrist was required before providing 10 additional “structured therapy” sessions. After a two-year evaluation period, the process was determined to be beneficial for patients, general practitioners, and the psychologists who were involved. This led to the establishment, in 2022, of an on-line platform labeled “Mon Parcours Psy” (My Psychiatric Path) which facilitates the payment for 8 sessions per year of psychotherapy treatment for minor disorders for patients as young as 3 years of age., Parental authorization is required for minors. DiscussionThe prescription of psychotherapy by general practitioners for mild or moderate disorders and the price of services provided by psychologists have been the object of criticism by the members of this profession: both the quantity of prescriptions and the tariffs for such services were deemed to be too low. ConclusionsMaking psychotherapy provided by psychologists available to the public at large, thanks to the introduction of a system to cover the costs involved by the the French National Health Insurance, is an important step forward for several reasons: it improves the relationship between psychologists and general practitioners; it decreases the use of psychotropic drugs, often the only solution for such patients; it will potentially relieve the pressure on the public psychiatric system, allowing it to refocus on the most severe patients. However, its implementation and results remain to be evaluated.

Gas Exchange in Tomato under Different Water Management in Cultivation

The water management in the tomato crop has a direct effect on the development and yield, however the gas exchange rates of the plant can be influenced by the management and evaluation period. The study aimed to analyze gas exchange in tomato, in full production, in plants cultivated under different water management. The experiment was conducted in a completely randomized design with two water conditions during cultivation (with deficit and without deficit). The management of the water deficit adopted using different depths of water replacement, under water deficit the replacement of 60% of the crop evapotranspiration (ETc) was carried out while in the condition without deficit there was replacement of 100% of the ETc. The determination of gas exchanges, in a period with full production, was performed at 70 and 71 days after transplanting, determining photosynthesis (A), stomatal conductance (Gs), internal CO2 (Ci) and transpiration (E). From the A/E ratio, the intrinsic water use efficiency (iWUE) was calculated. The data were submitted to analysis of variances and the means compared by the Tukey test with 5% of significance. There is significant variation in gas exchange rates depending on the water management adopted and evaluation period. Water deficit has a cumulative effect on plants. Tomato plants cultivated with water deficit (60% of ETc) have lower rates of gas exchange, with no full recovery of rates even after irrigation. Tomato plants grown without water deficit (100% of ETc) show adaptation and compensation in gas exchange due to soil drying.

A Comparative Multicenter Cohort Study Evaluating the Long-Term Influence of the Strict Lockdown during the First COVID-19 Wave on Lung Cancer Patients (ARTEMISIA Trial).

The consequences of the strict health restrictions during the first wave of COVID-19 on lung cancer (LC) patients are not known. This cohort study evaluated the impact of the initial lockdown on management of and long-term outcome in LC patients. This exposed-unexposed-type study included two evaluation periods of 6 months each in non-selected patients; one began on the first day of lockdown in 2020, and the other in 2019 during the same calendar period. Various indicators were compared: clinical profiles, management delays and overall survival beyond 2 years. A total of 816 patients from 7 public or private centers were enrolled. The clinical characteristics of the patients in 2020 did not differ from those in 2019, except that the population was older (p = 0.002) with more non-smokers (p = 0.006). Delays for pre-therapeutic medical management were generally reduced after the first imaging in 2020 (1.28 [1.1-1.49]). In the multivariate analysis, being part of the 2020 cohort was correlated with better prognosis (HR = 0.71 [0.5-0.84], p < 0.001). The gain observed in 2020 mainly benefited non-smoking patients, along with ECOG PS 0-2 (p = 0.01), stage 4 (p = 0.003), squamous cell carcinoma (p = 0.03) and receiving systemic therapy (p = 0.03). In conclusion, the first lockdown did not exert any deleterious impact on LC patients.

Co-development and evaluation of the Musculoskeletal Telehealth Toolkit for physiotherapists.

In-person physiotherapy services are not readily available to all individuals with musculoskeletal conditions, especially those in rural regions or with time-intensive responsibilities. The COVID-19 pandemic highlighted that telehealth may facilitate access to, and continuity of care, yet many physiotherapists lack telehealth confidence and training. This project co-developed and evaluated a web-based professional development toolkit supporting physiotherapists to provide telehealth services for musculoskeletal conditions. A mixed-methods exploratory sequential design applied modified experience-based co-design methods (physiotherapists [n=13], clinic administrators [n=2], and people with musculoskeletal conditions [n=7]) to develop an evidence-informed toolkit. Semi-structured workshops were conducted, recorded, transcribed, and thematically analysed, refining the toolkit prototype. Subsequently, the toolkit was promoted via webinars and social media. The usability of the toolkit was examined with pre-post surveys examining changes in confidence, knowledge, and perceived telehealth competence (19 statements modelled from the theoretical domains framework) between toolkit users (>30min) and non-users (0min) using chi-squared tests for independence. Website analytics were summarised. Twenty-two participants engaged in co-design workshops. Feedback led to the inclusion of more patient-facing resources, increased assessment-related visual content, streamlined toolkit organisation, and simplified, downloadable infographics. Three hundred and twenty-nine physiotherapists from 21 countries completed the baseline survey, with 172 (52%) completing the 3-month survey. Toolkit users had greater improvement in knowledge, confidence, and competence than non-users in 42% of statements. Seventy-two percentage of toolkit users said it changed their practice, and 95% would recommend the toolkit to colleagues. During the evaluation period, the toolkit received 5486 total views. The co-designed web-based Musculoskeletal Telehealth Toolkit is a professional development resource that may increase physiotherapist's confidence, knowledge, and competence in telehealth.

OP167 An Analysis Of Medication Exclusion Reports In The Health Technology Assessment Process For The Brazilian Unified Health System

IntroductionThe National Committee for Health Technology Incorporation of the Brazilian Public Health System (Conitec), which was created in 2011 by federal law, defines the criteria for incorporating and excluding health technologies in the Brazilian health system. For technology evaluation proposals a recommendation report is carried out, which finds the best scientific evidence about the efficacy, accuracy, effectiveness, and safety of the technology being analyzed. The report also provides a comparative economic evaluation of the technologies already in the health system to promote and protect public health, achieve the best allocation of resources, and reduce regional inequalities.MethodsThis exploratory, descriptive, and retrospective study aimed to identify the criteria considered for the exclusion of medicines within the Brazilian health system from 2012 to November 2022. Data were extracted from Conitec’s website into a specific extraction form and analyzed using descriptive statistics.ResultsDuring the evaluation period, 763 technology recommendations by Conitec were identified, of which 75 (10%) related to the exclusion of medicines. Several criteria were identified among the exclusion recommendations, including protocol updates, expiry or lack of registration in the National Health Surveillance Agency, and drugs whose clinical indication was not included in the list of drugs registered for treatments in the health system.ConclusionsAlthough there is no standardization of criteria in Conitec for recommendations on the exclusion of health technologies, this study contributes to a better understanding of these technologies. Disinvestment of technologies positively impacted the population because it resulted in better allocation of resources in the health system, and some of the excluded technologies presented a greater risk of interactions and undesirable adverse reactions.

Clinical relevance of pre- and coseasonal sublingual immunotherapy with a 300 index of reactivity 5-grass SLIT tablet in allergic rhinoconjunctivitis.

There is considerable interest in improving the scoring methods for evaluating the efficacy of allergen immunotherapy (AIT) and to show if this is associated with clinically meaningful results from the patient's perspective. We aimed to assess the efficacy and clinical relevance of a 300 index of reactivity (IR) 5-grass pollen sublingual immunotherapy (SLIT) tablet in children, adolescents and adults with moderate to severe grass-induced allergic rhinoconjunctivitis (ARC) with or without controlled asthma using the combined symptom and medication score CSMS0-36 . The data of the European population that participated in 3 Phase III, international, randomized double-blind placebo-controlled clinical trials were analyzed post hoc. A total of 864 patients randomized to 300 IR 5-grass tablet or placebo were analyzed. Over the primary evaluation period, the difference in CSMS0-36 between the 300 IR and placebo groups was statistically significant (point estimates: -2.51, CI95% [-3.88; -1.14], p<0.0001 in clinical trial1; -2.31, CI95% [-3.39; -1.23], p<0.0001 in CT2; and -2.31, CI95% [-3.58; -1.03], p=0.0004 in CT3). The relative differences between the 300 IR 5-grass tablet and placebo were -29.7%, -33.8%, and -26.3%, respectively. The results based on CSMS0-36 were consistent with those obtained with the primary endpoints of the trials and support the consideration of the 2-point threshold of the CSMS0-36 for clinical relevance of AIT. Post hoc analysis of 3 CTs with the 300 IR 5-grass SLIT tablet confirmed its significant and clinically relevant effect in the European population with grass pollen-induced ARC with or without controlled asthma.