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BACKGROUND AND OBJECTIVE: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach is a systematic method for assessing the certainty of evidence (CoE) and strength of recommendations in health care. We aimed to verify the effects of an online-based GRADE course on multirater consistency in the evaluation of the CoE in systematic reviews (SRs) analysis. STUDY DESIGN AND SETTINGS: Sixty-five Brazilian methodologists and researchers participated in an online course over 8 weeks. Asynchronous lessons and weekly synchronous meetings addressed the GRADE system in the context of CoE assessment. We asked participants to evaluate the CoE of random SRs (two before and another two after the course). Analyzes focused on the multirater agreement with a standard response, in the interrater agreement, and before-after changes in the proportion of participants that rated down the domains. RESULTS: 48 individuals completed the course. Participants presented improvements in the raters' assessment of the CoE using the GRADE approach after the course. The multirater consistency of indirectness, imprecision, and the overall CoE increased after the course, as well as the agreement between raters and the standard response. Furthermore, interrater reliability increased for risk of bias, inconsistency, indirectness, publication bias, and overall CoE, indicating progress in between-raters consistency. After the course, approximately 78% of individuals rated down the overall CoE to a low/very low degree, and participants presented more explanations for the judgment of each domain. CONCLUSION: An online GRADE course improved the consistency and agreement of the CoE assessment by Brazilian researchers. Online training courses have the potential to improve skills in guideline methodology development.

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INTRODUCTION: Shorter courses of antimicrobials have been shown to be non-inferior to longer, "traditional" duration of therapies, including for some severe healthcare-associated infections, with a few exceptions. However, evidence is lacking regarding shorter regimes against severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB), which are often caused by distinct strains and commonly treated with second-line antimicrobials. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we aim to assess the non-inferiority of 7-day versus 14-day antimicrobial therapy in critically ill patients with severe infections caused by MDR-GNB. METHODS: This is a randomized, multicenter, open-label, parallel controlled trial to assess the non-inferiority of 7-day versus 14-day of adequate antimicrobial therapy for intensive care unit (ICU)-acquired severe infections by MDR-GNB. Adult patients with severe infections by MDR-GNB initiated after 48 h of ICU admission are screened for eligibility. Patients are eligible if they proved to be hemodynamically stable and without fever for at least 48 h on the 7th day of adequate antimicrobial therapy. After consenting, patients are 1:1 randomized to discontinue antimicrobial therapy on the 7th (± 1) day or to continue for a total of 14th (± 1) days. PLANNED OUTCOMES: The primary outcome is treatment failure, defined as death or relapse of infection within 28 days after randomization. Non-inferiority will be achieved if the upper edge of the two-tailed 95% confidence interval of the difference between the clinical failure rate in the 7-day and the 14-day group is not higher than 10%. CONCLUSION: The OPTIMISE trial is the first randomized controlled trial specifically designed to assess the duration of antimicrobial therapy in patients with severe infections by MDR-GNB. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05210387. Registered on 27 January 2022. Seven Versus 14 Days of Antibiotic Therapy for Multidrug-resistant Gram-negative Bacilli Infections (OPTIMISE).

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Objective: The purpose of this literature review was to identify knee alignment assessment methods using radiography in the sagittal and frontal planes and to identify normality values for classifying knee alignment using these methods. Methods: A systematic review with a meta-analysis was conducted. The eligibility criterion was studies that performed radiographic examinations to assess the knee alignment of adults without a history of hip or knee prosthesis surgery. The methodological qualities of the included studies were assessed using the QUADAS-2 tool. A meta-analysis was performed to measure the normality values of knee alignment in the frontal plane. Results: The hip-knee-ankle (HKA) angle was the measure most frequently used to assess knee alignment. Only a meta-analysis of HKA normality values was possible. Thereby, we found normality values of the HKA angle for the overall population, men, and women. The normality values of knee alignment for healthy adults that were found in this study were as follows: overall sample (male and female patients) HKA angle = -0.2° (-2.8° to 2.41°), male patient HKA angle = 0.77° (-2.91° to 7.94°), and female patient HKA angle = -0.67° (-5.32° to 3.98°). Conclusion: This review identified the most common methods and expected values for knee alignment assessment methods using radiography in the sagittal and frontal planes. We suggest HKA angles ranging from -3° to 3° as the cutoff for classifying knee alignment in the frontal plane, in accordance with the normality limits found in the meta-analysis.

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Background: When performed in unfavorable conditions, work can lead to the development of musculoskeletal disorders and decrease in work ability. Objectives: To identify the differences between three groups of workers (professors, technicians and outsourced workers) as for the sociodemographic profile, work ability, prevalence of musculoskeletal disorders, activity restrictions, and the correlation between the presence of musculoskeletal disorders and activity restrictions with each domain of the Work Ability Index. Methods: The sample consisted of 67 university workers assessed by a Sociodemographic Data Questionnaire, the Nordic Musculoskeletal Symptoms Questionnaire and the Work Ability Index. Descriptive statistics and Kendall's Tau correlation coefficient were used. Results: Professors presented more favorable sociodemographic and lifestyle aspects and higher work ability, while outsourced workers had less favorable sociodemographic and lifestyle aspects and lower work ability. The correlation between activity restrictions and work ability was found in only one domain of Work Ability Index among professors. Among outsourced workers were found correlations on presence of musculoskeletal disorders and activity restrictions with six domains of Work Ability Index. Technicians did not show significant correlation. Conclusions: Outsourced workers presented worse work ability and less favorable sociodemographic and lifestyle aspects among the workers in the study, requiring the maintenance and improvement of work ability in this population.

Introdução: O trabalho, quando realizado em condições desfavoráveis, pode levar ao desenvolvimento de distúrbios musculoesqueléticos e à diminuição da capacidade para o trabalho. Objetivos: Identificar diferenças entre três grupos de trabalhadores (professores, técnicos e terceirizados) em relação a perfil sociodemográfico, capacidade para o trabalho, presença de distúrbios musculoesqueléticos e restrição para atividades e correlacionar a presença de distúrbios musculoesqueléticos e a restrição para atividades com cada domínio do índice de Capacidade para o Trabalho. Métodos: A amostra foi composta por 67 trabalhadores de uma universidade, os quais preencheram um questionário de dados sociodemográficos, o Questionário Nórdico de Sintomas Osteomusculares e o índice de Capacidade para o Trabalho. Foram utilizados estatística descritiva e o teste tau de Kendall para identificar possíveis correlações. Resultados: Os professores apresentaram aspectos sociodemográficos e de estilo de vida mais favoráveis e maior capacidade para o trabalho, enquanto os terceirizados apresentaram aspectos sociodemográficos e de estilo de vida menos favoráveis, além de menor capacidade para o trabalho. Foi encontrada correlação entre restrição para atividades em apenas um dos domínios do Índice de Capacidade para o Trabalho entre professores. Entre os terceirizados, foram encontradas correlações entre a presença de distúrbios musculoesqueléticos e a restrição para atividades em seis domínios do índice de Capacidade para o Trabalho. Os técnicos administrativos não apresentaram correlações significativas. Conclusões: Os trabalhadores terceirizados apresentaram pior capacidade para trabalho e aspectos sociodemográficos e de estilo de vida menos favoráveis entre os trabalhadores do estudo, sendo necessárias a manutenção e a melhora da capacidade para o trabalho desta população.

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The Back Pain and Body Posture Evaluation Instrument (BackPEI) was created in 2013 to assess back pain and its risk factors in school children. However, it does not assess neck pain or the habits of mobile device usage, which are aspects that are often part of school children's lives. Therefore, we aimed to update the BackPEI questionnaire to include new questions assessing aspects related to neck pain and the use of mobile devices and to test the content validity and reliability of the new questions. The updated questionnaire was named Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA). The content was validated by eight experts using the content validity index (CVI). To assess reliability, the BackPEI-CA questionnaire was applied at two different times in 105 school children, and Cohen's kappa (k) and intraclass correlation coefficient (ICC) were calculated. All aspects assessed regarding content validity had a CVI higher than 0.8. The new questions presented moderate and good kappa values and excellent ICC values. The updated version of BackPEI-CA can be used as a clinic tool for assessing the presence, frequency, and intensity of back and neck pain and their risk factors.

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Owing to the lack of longitudinal studies in Latin American countries, we aimed to evaluate back pain and its risk factors in a 3-year longitudinal study of Brazilian adolescents. We analysed data of 525 adolescents (aged 11-16 years) attending primary school (fifth to eighth grade) in Brazil. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire in 2011 and at a follow-up evaluation that was conducted 3 years later (2014). Back pain was the outcome variable; the exposure variables included exercise, behavioural, hereditary and postural factors. Generalized estimating equations were used to perform a Poisson regression model with robust variance to evaluate the risk factors for back pain. The prevalence of back pain at baseline was 56% (n = 294); this increased significantly at the 3-year follow-up evaluation to 65.9% (n = 346). The frequency of experiencing back pain also significantly increased after 3 years in both boys (p = 0.002) and girls (p = 0.001). The prevalence of back pain increased significantly in adolescents up to the age of 13 years, stabilized in those aged 14 years and older and was higher among girls. A family history of back pain (in the parents), watching television for lengthy periods and carrying a backpack asymmetrically were predictors for back pain.

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There is a paucity of information regarding the development of body posture during adolescence. This three-year prospective study aimed to evaluate sitting and sleeping postures among adolescents, and to determine whether these postures are associated with age and sex. We assessed 525 adolescents aged 11-16 years from the fifth to eighth grades. These adolescents were reassessed three years later. The Back Pain and Body Posture Evaluation Instrument was used to evaluate the sleeping posture and three sitting positions: sitting to write, to use a computer, and during leisure activities. Our findings indicated a low prevalence of adequate sleeping and sitting postures at baseline, with a decrease in prevalence observed after three years for all postures. These changes were similar for both sexes. Moreover, we found a strong reduction of adequate posture prevalence for younger adolescents, but the oldest adolescents demonstrated no significant differences after three years. Early, rather than late, adolescence is a critical period for establishing inadequate sitting and sleeping postures. This has implications for posture throughout adulthood; hence, interventions targeted at this age group are needed.

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PURPOSE: To determine the psychometric properties of the layout for assessing dynamic posture (LADy). METHODS: The study was divided into 2 phases: (1) development of the instrument and (2) determination of validity and reproducibility. The LADy was designed to evaluate the position adopted in 9 dynamic postures. RESULTS: The results confirmed the validity and reproducibility of the instrument. From a total of 51 criteria assessing 9 postures, 1 was rejected. The reproducibility for each of the criteria was classified as moderate to excellent. CONCLUSIONS: The LADy constitutes a valid and reproducible instrument for the evaluation of dynamic postures in children 11 to 17 years old. It is low cost and applicable in the school environment.

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[Purpose] The aim of this study was to identify whether postural changes are prevalent with advancing age using a photogrammetric method performing one-year follow-up study. [Subjects and Methods] Thirty-eight schoolchildren were evaluated in 2011 and 2012 in this cohort study. The subjects underwent a postural evaluation, which involved palpation of reference anatomic points, placement of reflexive markers over the anatomic points, image acquisition, and point digitalization using the Digital Image-based Postural Assessment evaluation software. For data analysis, descriptive statistics and inferential statistics were analyzed by McNemar's test. [Results] The results showed a significant increase in postural change prevalence for the lumbar spine in the sagittal plane (from 42.2% to 81.6%) and the knees in the frontal plane (from 39.5% to 63.2%) and a significant decrease in the prevalence of scoliosis (from 68.5% to 42.2%). [Conclusion] The findings indicate an increase in the prevalence of postural changes in schoolchildren from Teutônia, RS, Brazil, in 2012 compared with 2011. The development of longitudinal investigations for long-term monitoring of the evolution of posture and of schoolchildren habits's representing a viable alternative to subsidize health actions.

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Objetivou-se delinear a (in)dependência na realização de atividades básicas de vida diária de pessoas idosas domiciliadas; aplicar gerontotecnologias educativas direcionadas à minimização de perdas funcionais específicas; identificar alterações da funcionalidade dessas pessoas, após utilização das gerontotecnologias educativas. Pesquisa descritiva/quantitativa, em Rio Grande/Rio Grande do Sul, Brasil, com 109 idosos, em três etapas, de fevereiro de 2011 a abril de 2012, utilizando-se entrevista estruturada/Índice de Katz. Os dados foram agrupados para tratamento estatístico/descritivo. Primeira etapa: sexo feminino (69,7%), idade entre 60-69 anos (43,1%), casados (42,2%). Segunda etapa: aplicação de gerontotecnologias. Terceira etapa: semelhança no perfil das pessoas idosas em relação a primeira etapa. Na realização das atividades básicas de vida diária, 21% dos idosos apresentaram alguma dependência nas duas coletas, com destaque para a função continência (urinária). Os enfermeiros precisam perceber a avaliação funcional da pessoa idosa como ferramenta direcionadora ao planejamento/implementação dos cuidados.

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