Search

Patients experiencing a cerebrovascular event are vulnerable to declining nutritional status, hindering rehabilitation. This study aims to analyze the association between malnutrition risk and hospital rehabilitation indicators in ischemic stroke survivors (ISS). This analytical study examined medical records of 160 adult patients (69.3 ± 13 years). Undernutrition risk (UR; independent variable) and rehabilitation indicators (dependent variables) like hospital stay, clinical outcome, functionality, stroke severity, food intake, mobility (bedridden), mechanical ventilation, and enteral nutrition were assessed. Data were dichotomized, and the chi-square test identified associations (p ≤ 0.05), followed by Poisson regression for prevalence ratios. Patients at UR had 2-fold higher risk of death (95% confidence interval [CI], 0.99-4.79), 1.8-fold higher risk of high stroke severity (95% CI, 1.06-3.11), 76% higher chance of being bedridden (95% CI, 1.28-2.44), and 3-fold higher risk of mechanical ventilation (95% CI, 1.20-9.52). UR in hospitalized ISS is associated with deteriorating rehabilitation indicators, including mobility, decreased food intake, mechanical ventilation use, and neurological deficit, indicating an increased mortality risk post-stroke., Competing Interests: Conflict of Interest: The authors have no potential conflicts of interest to disclose., (Copyright © 2024. Korean Society for Neurorehabilitation.)

Color stability is among the most frequent causes of restoration failures, and influences surface properties., Aim: The aim of this study was to investigate the influence of pigment solutions on low-shrinkage and conventional composites regarding changes in the physical properties of composite surfaces., Materials and Method: Specimens of four composites (Filtek Z350 XT, Point 4, N'Durance and Venus Diamond) were randomly distributed into three groups to be submitted to each of three pigment solutions (red wine, tomato sauce and coffee) in fifteen-minute daily cycles, for twenty-eight days. There were 12 groups altogether (n = 10). Color, surface roughness and hardness tests were performed. Statistical analysis includedAnalysis of variance (ANOVA) and Tukey's significance test (a = 0.05)., Results: Color changes caused by the solutions did not differ significantly among Filtek Z350 XT, Venus Diamond and N'Durance. Hardness decreased significantly in Filtek Z350 XT and Venus Diamond after chemical challenge with each solution. For the composite independent factor, roughness was highest in Venus Diamond, followed by Filtek Z350 XT, Point 4 and N'Durance., Conclusions: Treatment with different pigment solutions (red wine, tomato sauce or coffee) increased stainability and decreased hardness of both low-shrinkage and conventional composites, while roughness was unaffected., Competing Interests: The authors declare no potential conflicts of interest regarding the research, authorship, and/or publication of this article.

Objectives: The aim of the study was to describe the cost and factors associated with the hospitalization of patients undergoing heart transplantation., Methods: A cross-sectional, descriptive study with a quantitative approach developed at an important heart transplant center in southern Brazil. Twenty patients who had undergone transplantation during the period 2007 to 2016 were included in the study. Central tendency measures and values presented as mean ± SD or median and quartiles were calculated. Multiple linear regression was performed to verify the variables that interfered with the cost., Results: The cost of hospitalization of patients undergoing heart transplantation was $522,997.26 in Brazilian reals ($220,002.58 in US dollars). The Brazilian public health system was responsible for paying the hospital bill of all patients. Female sex, patients up to 40 years of age, and length of stay in the hospital units were variables that were related to the highest values for the hospital service. Clinical complications of the patients during the hospitalization period were also factors that were related to the greater length of stay in the hospitalization units, reflecting higher expenses for the health institution., Conclusions: There is a need for health managers to implement strategies that will minimize complications, such as health care-related infections, that can be prevented during hospitalization and to stimulate the allocation of resources in order to improve care and reduce hospital expenses., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Several lines of evidence from the last decade support the connection between nutrition and epigenetic mechanisms. In the present study we evaluated the impact of the daily dietary intake of calories and the micronutrients vitamin A, D, B1, B2, B5, C, E, copper, calcium, phosphorus, iron, iodine, selenium, manganese, potassium and sodium on the global DNA methylation profile of blood cells from older individuals., Research Methods and Procedures: The study enrolled 126 physically independent elderly of both sexes (60 men and 66 women). For the molecular analysis, DNA samples were extracted from leukocytes and global DNA methylation was evaluated using a high throughput Elisa-based method. Correlations between global DNA methylation and the daily intake of calorie or micronutrients were evaluated using Prism5 GraphPad Software., Results: A statistically significant correlation was observed between global DNA methylation and the daily caloric value (p=0.019, r=-0.21), and the intake of vitamin A (p=0.03, r=-0.18), Vitamin E (p=0.027, r=-0.20) and copper (p=0.04, r=-0.18). No correlation was observed between global DNA methylation and the daily intake of vitamin D, B1, B2, B5, C, calcium, phosphorus, iron, iodine, selenium, manganese and potassium (p>0.05)., Conclusion: Our data demonstrate that the daily intake of calories or the micronutrients vitamin A, vitamin E and copper can potentially modulate the global DNA methylation profile of leukocytes in older adults and corroborate the notion of nutritional influences on epigenetic mechanisms., Competing Interests: The authors declare that they have no conflict of interest

Background: The terms sedentary behavior and physical inactivity have been confusingly mixed. Although the association between physical inactivity and mortality has been shown previously in subjects with COPD, this association had not yet been investigated with regard to sedentarism. The aim of this work was to investigate the impact of sedentary behavior on mortality of subjects with COPD and to propose a cutoff point of sedentarism with prognostic value., Methods: In this retrospective cohort study, sedentary behavior was assessed with 2 activity monitors (DynaPort and Sensewear armband) in 101 subjects with COPD from 2006 to 2011. Vital status was then ascertained in 2015. The following 6 variables of sedentary behavior were analyzed: average of metabolic equivalent of task (MET)/d (reflecting intensity); time spent/d lying, sitting, and lying + sitting (reflecting duration of sedentary postures); and time spent/d in activities requiring <1.5 MET and <2 MET (reflecting intensity and duration of sedentary time). Cutoff points for sedentarism and their respective prognostic values were investigated for each variable., Results: Forty-one subjects (41%) died over a median (interquartile range) follow-up period of 62 (43-88) months. After adjusting for potential confounders in the Cox regression model, cutoff points from variables that combine duration of sedentary time and intensity <1.5 MET or <2 MET were associated with the increased risk of mortality. The strongest independent cutoff for predicting mortality was ≥8.5 h/d spent in sedentary activities <1.5 MET (area under the curve 0.76; hazard ratio 4.09, 95% CI 1.90-8.78; P < .001)., Conclusions: Sedentary behavior was an independent predictor of mortality in subjects with COPD, even adjusting for moderate-to-vigorous physical activity and a number of other variables. Mortality was higher in subjects with COPD who spend ≥8.5 h/d in activities requiring <1.5 MET. These findings may open room for future studies aiming at decreasing sedentary time as a promising strategy to reduce mortality risk in subjects with COPD., (Copyright © 2017 by Daedalus Enterprises.)

Purpose: To investigate the influence of the presence of Temporomandibular Disorders (TMD) on postural balance in elderly individuals., Methods: The study sample consisted of 150 elderly: 103 women (67.7±5.0 years) and 47 men (69.3±5.5 years). Evaluation of the presence and severity of TMD included an anamnesis questionnaire, an evaluation of the temporomandibular joint (TMJ), and a muscular examination, which allowed the division of the elderly into 2 groups: G1 (experimental, n=95), with TMD; G2 (control, n=55), without TMD. Postural balance was assessed by means of the one-leg stance test (OLST) on a force platform (BIOMEC400), thus permitting the following measurements: center of foot pressure (COP); mean sway velocity (MV) and frequency (MF) of COP in both the anteroposterior (VAP and FAP) and medial/lateral (VML and FML) directions. The statistical analysis of data was performed using independent t-test, Variance Analysis, and Chi Square test (α=5%)., Results: Presence of TMD was observed in 63.3% of the individuals (Group 2), with different degrees of severity (mild: 42.7%, moderate: 14.7%, severe: 6%). Significantly higher TMD was observed for women (73.8%) compared with men (40.4%) (p=0.0002). No significant difference was found in between the groups for all balance parameters, e.g., presence and severity of TMD, presence of pain to palpation of TMJ and of masticatory and cervical muscles., Conclusion: The presence and severity of TMD, in addition to the presence of pain to palpation of TMJ and masticatory and cervical muscles did not alter the variables related to postural balance in this population.

Background: Studies have shown that individuals with COPD have impaired body balance, probably caused by the disease's multisystemic manifestations plus age-related decline in balance, potentially increasing the risk of falling and its consequences. However, little is known about the profile of individuals with COPD who present balance impairments, especially related to sex and disease severity stages. The aim of this work was to compare static and functional balance between subjects with COPD and healthy controls and to check possible differences according to sex and degrees of disease severity., Methods: Forty-seven subjects with COPD and 25 healthy controls were included in this study. Their static balance was assessed in one-legged stance using a force platform and functional balance with the Timed Up and Go test. Additionally, participants performed spirometry, the 6-min walk test and isometric quadriceps maximal voluntary contraction assessment. Disease severity was classified according to the Global Initiative for Obstructive Lung Disease stages and BODE (body mass index, air-flow obstruction, dyspnea, and exercise capacity) scores., Results: In comparison with healthy controls, subjects with COPD had worse static (center of pressure displacement area: 9.3 ± 1.9 cm 2 vs 11.6 ± 4.0 cm 2 , respectively, P = .01) and functional balance (Timed Up and Go test: 8.5 ± 1.3 s vs 10.3 ± 1.8 s, respectively, P < .001). In the COPD group, men performed better in the Timed Up and Go test than women (9.8 ± 1.2 s vs 10.9 ± 2.2 s, respectively, P = .03), whereas women presented a better static balance in comparison with men for all parameters related to center of pressure (P < .005 for all). Disease severity did not affect any balance results., Conclusions: Individuals with COPD had worse static and functional balance in comparison with healthy controls. Sex can mediate these results, depending on the type of balance evaluation (force platform or functional test). Balance performance was similar among the groups classified according to disease severity., (Copyright © 2016 by Daedalus Enterprises.)

[Purpose] This study aimed to assess the exercise capacity and muscle strength in elderly people using drugs for angiotensin-II blockage. [Subjects and Methods] Four hundred and seven older adults were recruited for this study. Data about comorbidities and medication use were recorded and the individuals were divided into three groups: control group- elderly people with normal exercise capacity (n=235); angiotensin-converting enzyme inhibitor group - individuals using angiotensin-converting enzyme inhibitors (n=140); and angiotensin-II receptor blocker group- patients using angiotensin-II receptor blockers (n= 32). Exercise capacity was evaluated by a 6-minute walking test and muscle strength was measured using a handgrip dynamometer. [Results] Patients from the angiotensin-converting enzyme inhibitor group (mean: 99 ± 12%) and the angiotensin-II receptor blocker group (mean: 101 ± 14%) showed higher predicted values in the 6-minute walking test than the control group patients (mean: 96 ± 10%). Patients from the angiotensin-converting enzyme inhibitor group (mean: 105 ± 19%) and the angiotensin-II receptor blocker group (mean: 105.1 ± 18.73%) showed higher predicted values of muscle strength than control group patients (mean: 98.15 ± 18.77%). [Conclusion] Older adults using angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers have better functional exercise capacity and muscle strength.

Osteoarthritis (OA) is the most prevalent disease of the musculoskeletal system and it has an important genetic component. Despite several reports have shown the involvement of pro-inflammatory cytokine such as interleukin-1β and TNF-α, the role of interleukin-6 (IL-6) in osteoarthritis is still unclear. Thus, this study aimed to analyze the relationship between the single nucleotide polymorphism in the portion -572 of the promoter region of the IL6 gene (SNP -572G/C) with hip and knee OA in the elderly. In this case-control study, 257 physically independent elderly were recruited (case group: 92 individuals with osteoarthritis and control group: 165 individuals with no osteoarthritis). Blood samples were collected from patients for the DNA fragments extraction and amplification by real-time polymerase chain reaction (PCR) by TaqMan system for subsequent genotyping of IL6 gene. The degree of joint damage was assessed by radiographic classification based on the criteria of Kellgren and Lawrence. The functional status was evaluated by Lequesne and WOMAC questionnaires. It was observed that individuals carrying the C allele have lower susceptibility to osteoarthritis (OR=0.51, 95% CI: 0.32-0.80, p=0.004) and less radiological impairment for both hip (Fisher-Freeman-Halton test=4.2 and p=0.04) and knee joints (Fisher-Freeman-Halton test=4.7 and p=0.03). Regarding functional status, individuals carrying the C allele has a lower degree of functional impairment assessed by WOMAC (Mann-Whitney test, p=0.04), although no difference was observed in the Lequesne questionnaire (p>0.05). Additionally, it was observed a marked reduction in IL-6 serum levels in individuals with GC and CC genotypes when compared to individuals harboring GG genotype. In conclusion, the polymorphism -572G/C IL6 is a protective factor for the presence and severity of hip and knee osteoarthritis in the elderly. Further prospective studies with large sample size and methods (e.g. effect of this polymorphism on gene expression, haplotype analysis for IL-6 promoter polymorphism) are needed to validate this study findings., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction Dizziness can be characterized as a balance disorder that causes discomfort, leading to several functional limitations. Currently, vestibular rehabilitation has been highlighted as a possible treatment. Objective Analyze the effects of completing a vestibular rehabilitation treatment protocol on quality of life and postural balance in patients with vestibular complaints, as well as to compare these effects between the patients taking or not taking antivertigo drugs. Methods A nonrandomized controlled trial was performed with 20 patients previously diagnosed with vestibular diseases. Information regarding vertigo symptoms, quality of life as assessed through the Dizziness Handicap Inventory, visual analog scale of dizziness, and stabilometry using force platform was collected. Patients were treated for 12 weeks by a custom protocol. The sample was divided into two groups according to the use (medicated group, n = 9) or not (control group, n = 11) of antivertigo drugs. Results There was improvement in quality of life (p < 0.001) and intensity of dizziness (p = 0.003) with the intervention. An improvement of postural balance was observed through functional tests. However, no statistically significant difference was noted in stabilometry. When both groups were compared, no statistically significant differences between the variations of the variables analyzed were found in the re-evaluation session. Conclusion Quality of life and postural balance are improved with intervention. However, this improvement is not associated with pharmacologic treatment.

Objective: To evaluate if the Incremental Shuttle Walking Test (ISWT) requires maximal effort in healthy subjects of different ages., Design: Cross-sectional., Setting: University-based research laboratory., Participants: 331 healthy subjects separated into six groups according to age: G1, 18 to 28 years; G2, 29 to 39 years; G3, 40 to 50 years; G4, 51 to 61 years; G5, 62 to 72 years and; G6, 73 to 83 years., Main Outcome Measures: Two ISWTs were performed and participants were permitted to run and to exceed 12 levels during the test, if necessary. Heart rate (HR) and symptoms of dyspnoea and fatigue were recorded before and after the test, and the percentage of age-predicted maximal HR (HRmax) was calculated. Maximal effort was defined as HRmax >90% of age-predicted HRmax., Results: Almost 31% of the subjects exceeded 12 levels in the ISWT. At the end of the test, all groups presented a median [interquartile range] HR greater than 90% of HRmax (G1: 100 [95 to 104]; G2: 100 [96 to 105]; G3: 103 [97 to 108]; G4: 99 [91 to 106]; G5: 96 [87 to 106] and G6: 96 [91 to 109]% HRmax). Regarding symptoms, all groups showed higher values after the test (P<0.05). A multiple logistic regression analysis identified female gender, older age and a lower HR before the test as determinants of not achieving 90% of HRmax at the end of the test., Conclusions: The ISWT requires maximal effort in healthy individuals, but for that it is necessary to extend the test beyond twelve levels. Female gender, older age and lower heart rate before the test are the determinants of not reaching maximal effort., (Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

[Purpose] This study aimed to evaluate the anti-inflammatory and analgesic effects of intraoral application of low-level laser therapy (660 nm) to control pain, swelling and interincisal opening following the extraction of mandibular third molars. [Subjects and Methods] Ten patients underwent removal of lower third molars using the same surgical protocol and pharmacological approach. In the postoperative period, all patients received four consecutive daily sessions of low-level laser therapy, beginning 24 hours after the surgery. Intraoral applications using the diode laser with 660 nm wavelength in the continuous scan mode were performed covering the entire surgical area, which was divided into four quadrants, each of 1 cm(2) area at a distance of 1 cm. The energy applied at each point was 5 J/cm(2) during 8 seconds. [Results] The swelling and interincisal opening returned to normal 24 hours after the first low-level laser therapy application (Friedman test). Moreover, the pain intensity was reduced on the third postoperative day, according to the Friedman test. [Conclusion] Low-level laser therapy (660 nm), at the dosimetry used in this study, was effective in reducing postoperative pain and swelling following oral surgery.

The vulnerability of epigenetic marks of brain cells to environmental stimuli and its implication for health have been recently debated. Thus, we used the rat model of acute restraint stress (ARS) to evaluate the impact of stress on the global DNA methylation and on the expression of the Dnmt1 and Bdnf genes of hippocampus, cortex, hypothalamus and periaqueductal gray (PAG). Furthermore, we verified the potential of physical exercise to modulate epigenetic responses evoked by ARS. Sedentary male Wistar rats were submitted to ARS at the 75th postnatal day (PND), whereas animals from a physically active group were previously submitted to swimming sessions (35-74th PND) and to ARS at the 75th PND. Global DNA methylation profile was quantified using an ELISA-based method and the quantitative expression of the Dnmt1 and Bdnf genes was evaluated by real-time PCR. ARS induced a decrease in global DNA methylation in hippocampus, cortex and PAG of sedentary animals and an increased expression of Bdnf in PAG. No change in DNA methylation was associated with ARS in the exercised animals, although it was associated with abnormal expression of Dnmt1 and Bdnf in cortex, hypothalamus and PAG. Our data reveal that ARS evokes adaptive changes in global DNA methylation of rat brain that are independent of the expression of the Dnmt1 gene but might be linked to abnormal expression of the Bdnf gene in the PAG. Furthermore, our evidence indicates that physical exercise has the potential to modulate changes in DNA methylation and gene expression consequent to ARS., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Aims: This study aimed to assess the influence of pharmacotherapy on health-related quality of life of elderly with ostheoartritis., Methods: Longitudinal study involving 91 older adults from both genders (Age: 70.36±5.57 years) from EELO project with self-reported knee or hip ostheoartritis, confirmed by radiographic analysis. Data regarding pharmacotherapy was assessed by a structured questionnaire and the quality of life was analyzed by SF-36 questionnaire at the initial moment and two years thereafter. All domains from quality of life were grouped in physical and mental components for further data analysis., Results: A statistically significant decline in health-related quality of life was observed (Wilcoxon test, p<0.05). However, it was observed a slighted decline in physical components in group treated with chondroitin/glucosamine when compared to other groups, according to Kruskal-Wallis test (p=0.007). On the other hand, it was not observed any influence of pharmacological treatment on mental components of health-related quality of life (p>0.05)., Conclusions: Treatment with condroitin/glucosamin contributes to a lower decline in physical component while it had no influence on mental component of health-related quality of life in older adults with ostheoartritis., (Copyright © 2014 Elsevier Editora Ltda. All rights reserved.)

Objective: To assess the upper airway (UAW) total volume (TV), the nasopharyngeal narrowest area (NNA), and the oropharyngeal narrowest area (ONA) in patients with bronchial asthma., Materials and Methods: The sample consisted of 52 patients divided into two groups: the control group (n  =  26; mean age  =  14.85 years), which consisted of patients not suffering from bronchial asthma; and the asthmatic group (n  =  26; mean age  =  16.65 years), which consisted of patients with bronchial asthma. To assess UAW-related variables (TV, NNA, and ONA), cone-beam computed tomography scans of the patients were evaluated by means of the Dolphin Imaging software 11.5. All measurements were repeated after 30 days, and the results were submitted to reliability tests by means of the intraclass correlation coefficient and the Bland-Altman agreement test. The values obtained for TV, NNA, and ONA for each group were compared by using Student's t-test for independent samples (5% level of significance)., Results: The results showed that the groups were matched concerning gender, cephalometric characteristics, and type of malocclusion. The asthmatic group had significantly lower TV (P  =  .01) and ONA (P  =  .007) than the control group. However, no significant difference was observed for NNA between the groups (P  =  .54)., Conclusions: Bronchial asthma may be a determining factor for the reduction of UAW dimensions, as patients with asthma showed significant reductions in TV and ONA dimensions.

Purpose: This study investigated the prevalence of Temporomandibular Disorders (TMD) in the elderly and its association with palpation of the temporomandibular joint (TMJ), masticatory and cervical muscles as well as the presence of headache and joint noises., Methods: The sample consisted of 200 elderly of both genders (mean age: 69.2±5.7 years). The clinical evaluation of TMD signs and symptoms was divided into three stages: an anamnestic questionnaire, a TMJ evaluation, and a muscular examination. The results were analyzed through descriptive statistics as well as using χ2 and the tendency tests., Results: The presence of TMD was observed in 61% of the sample (mild: 43.5%, moderate: 13%, severe: 4.5%). A significantly greater prevalence of TMD was found for females (72.4%) compared with that for men (41.1%) (p<0.0001). Additionally, a significant association among TMD severity and palpation of the TMJ (p=0.0168), of masticatory muscles (p<0.0001), and of cervical muscles (p<0.0001) was verified. Also, there was a significant association between the frequency of headaches and the presence of TMD (p=0.0001). The association between the presence of joint noises and sensitivity to TMJ palpation was not significant., Conclusion: The elderly presented high TMD prevalence, mostly in females, with mild severity and related to TMJ and masticatory/cervical muscles palpation. Thus, the accomplishment of a detailed clinical examination to investigate the presence of such disorders is essential and it must not be neglected during the treatment of elderly patients.

Abstract Objective: To assess the upper airway (UAW) total volume (TV), the nasopharyngeal narrowest area (NNA), and the oropharyngeal narrowest area (ONA) in patients with bronchial asthma. Materials and Methods: The sample consisted of 52 patients divided into two groups: the control group (n  =  26; mean age  =  14.85 years), which consisted of patients not suffering from bronchial asthma; and the asthmatic group (n  =  26; mean age  =  16.65 years), which consisted of patients with bronchial asthma. To assess UAW-related variables (TV, NNA, and ONA), cone-beam computed tomography scans of the patients were evaluated by means of the Dolphin Imaging software 11.5. All measurements were repeated after 30 days, and the results were submitted to reliability tests by means of the intraclass correlation coefficient and the Bland-Altman agreement test. The values obtained for TV, NNA, and ONA for each group were compared by using Student's t-test for independent samples (5% level of significance). Results: The results showed that the groups were matched concerning gender, cephalometric characteristics, and type of malocclusion. The asthmatic group had significantly lower TV (P  =  .01) and ONA (P  =  .007) than the control group. However, no significant difference was observed for NNA between the groups (P  =  .54). Conclusions: Bronchial asthma may be a determining factor for the reduction of UAW dimensions, as patients with asthma showed significant reductions in TV and ONA dimensions.

Actinic cheilitis (AC) is a potentially malignant disorder of the lips. Because of its heterogeneous clinical aspect, it is difficult to indicate representative biopsy area. The purpose of this study was to evaluate the usefulness of tissue autofluorescence in AC diagnosis. The system was composed of a 405-nm light-emitting diode, sent to the sample by a dichroic, that allows the fluorescence signal to reach a camera directly plugged in the system. Fifty-seven patients with clinical diagnosis of AC and 45 normal volunteers were selected. According to clinical and fluorescence features, one or more areas were selected for biopsies in the AC group and epithelial dysplasia (ED) grades were established. The autofluorescence images were processed by a clustering algorithm for AC automated diagnosis. The tissue autofluorescence image revealed a heterogeneous pattern of loss and increase of fluorescence in patients with AC. ED was found in 93% of the cases, and most of the areas graded as moderate or severe ED were chosen with the aid of autofluorescence. The processed autofluorescence images from AC patients showed a higher number of spots in an irregular pattern. Tissue autofluorescence image system is a useful technique in association with clinical examination for AC diagnosis.

The aim of this cross-sectional study was to assess the factors associated with the impact of oral health on the quality of life in a sample of 504 Brazilian independent elderly. Data collection included oral examinations and structured interviews. The simplified form of the Oral Health Impact Profile (OHIP-14) was used to measure OHRQoL. Information on sociodemographic characteristics, use of dental services, and subjective measures of health was collected. Poisson regression within a hierarchical model was used to data analyses. The following variables were associated with a negative impact on OHRQoL: female gender (PR = 1.40; CI 95%: 1.11-1.77); lower class (PR = 1.58; CI 95%: 1.13-2.20); up to 3 occluding pairs of posterior teeth (PR = 1.88; CI 95%: 1.13-3.14); at least one untreated caries (PR = 1.28; CI 95%: 1.06-1.54); curative reasons for the last dental appointment (PR = 1.52; CI 95%: 1.15-2.00); poor self-perception of oral health (PR = 2.49; CI 95%: 1.92-3.24); and poor perception of dental care provided (PR = 1.34; CI 95%: 1.12-1.59). The younger elderly also noticed this negative impact. These findings showed that the clinical, sociodemographic, and subjective factors evaluated exerted a negative impact on OHRQoL in elderly people. Health authorities must address all these factors when planning interventions on oral health for this population.

Balance impairs with aging and may cause mobility limitations and functional decline. We aimed to evaluate postural balance and PADL in physically independent older adults with different levels of exercise capacity. One hundred fifty seven physically independent individuals, aged 60 years or older were evaluated. Postural balance assessment was performed during one-legged stance test using a force-platform and maximum exercise capacity with the incremental shuttle walking test (ISWT). PADL was assessed subjectively by the modified Baecke questionnaire and objectively using a pedometer. Based on the performance achieved in the ISWT, according to the percentage of the predicted value, the older adults were separated into 3 groups: low performance group (LP group, ISWT < 80% predicted, n = 32, 19 women), normal performance group (NP group, 80 ≤ ISWT ≤ 100% predicted, n = 30, 22 women) and high performance group (HP group, ISWT > 100% predicted, n = 95, 67 women). The HP group showed better postural balance when compared to LP groups (p < 0.001) and also higher levels of PADL measured with pedometer (p < 0.001). There was a modest correlation (r = 0.45) between exercise capacity and PADL in the LP group and a weak correlation between exercise capacity and balance (r = -28) in the HP group. Physically independent older adults with more preserved exercise capacity have better postural balance and higher levels of PADL in comparison to those older adults who show a poorer condition in terms of exercise capacity., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Aims: This study aimed to investigate the dental caries status and salivary properties in 3- to 15-year-old children/adolescents., Methods: The sample was split in two groups: asthma group (AG), composed of 65 patients who attended Public Health Service; asthma-free group (AFG), composed of 65 nonasthmatic children/adolescents recruited in two public schools. Stimulated salivary samples were collected for 3 min. Buffering capacity and pH were ascertained in each salivary sample. A single trained and calibrated examiner (kappa = 0.98) performed the dental caries examination according to WHO criteria., Results: The AFG showed salivary flow rate (1.10 ± 0.63 mL/min) higher (P = 0.002) than AG (0.80 ± 0.50 mL/min). An inverse relationship was observed between asthma severity and salivary flow rate (Phi coefficient, rφ: 0.79, P = 0.0001). Children with moderate or severe asthma showed an increased risk for reduced salivary flow rate (OR: 17.15, P < 0.001). No association was observed between drug use frequency (P > 0.05) and drug type (P > 0.05) with salivary flow rate. Buffering capacity was similar in both groups. No significant differences were encountered in dental caries experience between AFG and AG groups., Conclusions: Although asthma can cause reduction in flow rate, the illness did not seem to influence dental caries experience in children with access to proper dental care., (© 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.)

Objective: This study investigated the mechanical properties of glass ionomer cements (GICs) combined with propolis as a natural antimicrobial substance., Material and Methods: Typified green propolis, as an ethanolic extract (EEP) or in the lyophilized form (powder), was incorporated to specimens of Ketac Fil Plus, ChemFlex and Ketac Molar Easymix GICs. For each test, 8 specimens of each material were prepared. For water sorption and solubility tests, specimens were subjected to dehydration, hydration and redehydration cycles until a constant mass was obtained for each step. Measurements were recorded using a digital balance of 10-4 g precision. For the diametral tensile strength test, specimens were tested in a universal test machine at 0.5 mm/min crosshead speed after 24 h storage in deionized water. Data were evaluated by one-way ANOVA and Tukey's tests (p<0.05)., Results: The addition of propolis to GIC clearly increased water sorption compared to pure material. Solubility was material-dependent and was not clearly evident. For the diametral tensile strength test, association with propolis altered negatively only Chemflex., Conclusion: It may be concluded that incorporation of propolis to GICs alters some properties in a material-dependent condition.

Objectives: The aim of this study was to investigate the superficial texture of composite restorations after different bleaching protocols., Methods: Filtek Supreme (S), Filtek Z350 (F), and Grandio (G) were compared to Opallis (O) and Filtek Z250 (Z) (control microhybrid composites) and to bovine enamel using three different bleaching agents: 35% hydrogen peroxide Whiteness HP (WHP), 35% Whiteness HP MAXX (WMAXX) and 16% carbamide peroxide Whiteness Standard (WS). Six specimens from each composite were treated using each bleaching agent, according to the manufacturers' instructions. Three random sites were measured for superficial roughness (Hommel Tester T 1000) weekly for each sample. Data were analyzed for each bleaching system using two-way ANOVA and Bonferroni tests at 5% significance level., Results: WHP treatment significantly altered the Filtek Supreme composite over time. When WMAXX was used, Grandio displayed the most significant alterations in surface roughness throughout the evaluation period, which was not observed for the other nanocomposites. Using WS, Filtek Z250 presented significant surface alterations over time, which was not seen in the nanofilled materials., Conclusions: Surface roughness alteration was material and time-dependent. The bleaching gels affected nanofilled and microhybrid composite resins. Enamel was the surface less affected by bleaching.

This study evaluated the caries risk of asthmatic patients on the basis of mutans streptococci (MS) and lactobacilli levels in saliva samples as well as the index of oral hygiene and dental caries (DMFT index). The study population was composed of 80 asthmatic children, aged 3-15 years, who use specific medication, and 80 matched, healthy control children. The parents were interviewed about oral health-related factors. The World Health Organization criteria were used for dental examinations. The Köhler and Bratthal methodology was used to detect salivary MS levels and dilutions of saliva were done for lactobacilli counting. No differences between asthma and control groups were observed for caries prevalence in children aged 3-6 and 7-10 years, except in severe cases in the younger group. However, higher caries prevalence for permanent dentition was observed in 11- to 15-year-old asthmatic children. An increased dental biofilm was observed in the asthma group, as well as salivary levels of MS. No differences were observed in levels of lactobacilli. No statistical correlations were found between medication, frequency of treatment, method of consumption and caries experience, dental biofilm and salivary levels of MS or lactobacilli. However, there was a correlation between MS levels and treatment duration. The logistic regression revealed that MS level is an important risk factor for increased caries experience. Asthma should be evaluated as a risk factor for caries experience because it can increase the levels of MS and the dental biofilm., (Copyright © 2011 S. Karger AG, Basel.)

Objectives: Solvents are ingredients in dentin-bonding agents (DBAs) that are essential to obtain efficient adhesion to dentin under wet-technique bonding protocol. However, an excess of solvents can compromise bonding durability. This study aimed to assess the retention of solvents present in different DBAs after their application to a demineralized dentin matrix., Methods: Thirty-six specimens of bovine dentin were demineralized for 7 days in 0.5M EDTA and divided into six groups n=6 (Scotchbond primer, Adper Single Bond 2, Excite, AdheSE primer, Prime & Bond NT and Xeno III). These specimens were individually saturated by the systems for 5 min and then kept in vials protected against light exposure. Each specimen was measured using a digital balance and then measured at the following intervals 10, 20, 30 sec, 1, 2 and 5 min thereafter. Data were analyzed by two-way ANOVA and Tukey tests (alfa=.05)., Results: There were significant differences evident in Excite, Prime & Bond NT at 2 and 5 min, respectively. There was no significant interaction between materials and time in all experimented time evaluated. The amount of solvent spontaneously evaporated was limited even in acetone-based specimens., Conclusions: After DBAs are applied, professionals may facilitate their evaporation, since spontaneous evaporation is limited.

Objective: This study aimed to evaluate the prevalence of developmental defects of enamel (DDEs) in relation to asthma severity, symptom onset and pharmacological treatment in pediatric asthma patients., Methods: Children and adolescents (68 asthma patients and 68 controls), 5-15 years of age and residents of the city of Londrina, Brazil, were enrolled in the study. Medical and dental histories were collected through the use of a structured questionnaire. Each participant underwent a dental examination in which the examiner employed the DDE index., Results: Of the 68 asthma group subjects, 61 (89.7%) presented dental enamel defects, compared with only 26 (38.2%) of those in the control group. Using multivariate logistic regression analysis, we estimated the risk of DDEs in permanent dentition to be 11 times higher in pediatric subjects with asthma than in those without (OR = 11.88, p = 0.0001). The occurrence of dental enamel defects correlated with greater asthma severity (p = 0.0001) and earlier symptom onset (p = 0.0001). However, dental enamel defects did not correlate with the initiation of treatment (p = 0.08) or the frequency of medication use (p = 0.93)., Conclusions: Pediatric patients with severe, early-onset asthma are at increased risk of dental enamel defects and therefore require priority dental care.

Solvents should be properly evaporated after application to dental substrates. The aim of this study was to assess the evaporation of commercial, experimental and neat solvents. The tested null hypotheses were that there are no differences in solvent evaporation regardless of its formulation and over time. Evaporation from commercial adhesive systems (Scotchbond Multipurpose Primer, Scotchbond Multipurpose Adhesive, Prime & Bond NT, Multi Bond, Excite, Single Bond 2, Adhese Primer, Adhese Bond, Xeno III A and Xeno III B) and experimental primers (35% HEMA plus 65% acetone or ethanol or water v/v) were compared to neat solvents (acetone, ethanol and water). Samples (10 microL) of these products were dripped into glass containers placed on a digital precision balance. Evaporation was assessed at 0, 5, 10, 15, 30, 60, 120, 300 and 600 s times to calculate mass loss. Data were analyzed statistically by ANOVA and Bonferroni's correction (a=0.05). Acetone-based products exhibited a remarkable capacity to evaporate spontaneously over time. Neat acetone evaporated significantly more than the HEMA-mixtures and the commercial formulations (p<0.05). The incorporation of monomers and other ingredients in the commercial formulations seem to reduce the evaporation capacity. Solvent evaporation was time and material-dependent.

The purpose of this study was to assess the current knowledge and recommendations of obstetricians and dentists as to the dental care to pregnant patients in the cities of Londrina/PR and Bauru/SP, Brazil. Questionnaires were distributed to professionals of both cities, arguing on the following issues: oral health during pregnancy; contact between prenatal care and dental care providers; prenatal fluoride supplementation; selection of therapeutic agents for local anesthesia, pain control and treatment of infection; and dental procedures that can be performed during each trimester. Data were analyzed by frequency of responses and statistical analyses were carried out using X(2) (type of workplace/service) and t test (time since graduation), significant if p<0.05. Seventy-nine obstetricians and 37 dentists responded the questionnaires. Most physicians referred the patient to dental care only when a source of dental problem was mentioned, limiting the adoption of a preventive approach. Forty-three percent of dentists and 34% of obstetricians did not know the potential contribution of periodontal infection as a risk factor for preterm low birth-weight babies. There was divergence from scientific literature as to the recommendation of local anesthetics (dentists and obstetricians), prenatal fluoride supplementation (obstetricians) and dental radiographs (dentists). The findings of this survey with dentists and obstetricians showed that dental management during pregnancy still presents some deviations from scientific literature recommendations, indicating the need to update these health care professionals in order to establish guidelines for prenatal dental care.

The medial prefrontal cortex (MPFC) is a structure that is also involved in cardiovascular modulation. The injection of norepinephrine (NE) into the prelimbic (PL) area of the MPFC of unanesthetized rats evokes a pressor response which is mediated by acute vasopressin release. Vasopressin is synthesized by magnocellular cells of the paraventricular (PVN) and supraoptic nucleus (SON) of the hypothalamus. In the present study, we endeavored to determine which vasopressin-synthesizing hypothalamic nucleus is involved in the pressor pathway activated after NE injection into the PL area of the MPFC. We report here that lidocaine microinjection into the SON did not change the pressor response evoked by NE injection into the PL. However, the response to NE was blocked by prior injection of lidocaine or CoCl(2) into the PVN, indicating that this area is responsible for the mediation of this pressor response. A neuroanatomic experiment in which the neuronal tracer biotinylated dextran amine (BDA) was microinjected into the MPFC showed a lack of axons or neuronal cell bodies in the PVN, indicating that there are no direct connections between the PL area of the MPFC and the PVN. The results suggest that the PVN is involved in the mediation of the pressor response to NE in the PL area and that this pathway must relay in other brain structures before reaching the PVN.

The cingulate cortex (CC) is involved in cardiovascular regulation. Microinjection of norepinephrine (NE) into the Cg3 area of the CC caused vasopressin release and pressor responses in unanesthetized rats. Microinjection of acetylcholine (ACh) into the lateral septal area (LSA) of unanesthetized rats caused similar vasopressin-related pressor responses. The LSA is anatomically connected to the CC and the paraventricular nucleus (PVN) of the hypothalamus, an important nucleus involved in vasopressin synthesis. Therefore, we attempted to verify if the cholinergic neurotransmission within the LSA is involved in the mediation of the pressor response to the microinjection of NE into the Cg3. Local pretreatment with lidocaine, muscimol, atropine or hemicholinium-3 microinjected into the LSA blocked the pressor response to the microinjection of NE injection into the Cg3. Conversely, pretreatment with physostigmine microinjected into the LSA potentiated the pressor response to NE injection into the Cg3. The present results indicate that the synapses in the LSA are part of the pressor pathway originating at the CC and that cholinergic neurotransmission within the LSA is involved in the mediation of the cardiovascular responses to the microinjection of NE into the Cg3.

The medial prefrontal cortex (MPFC) is involved in cardiovascular control and baroreflex modulation. Recent studies indicated that stimulation of MPFC muscarinic receptors causes hypotensive responses whereas stimulation of alpha1- but not of alpha2-adrenoceptors causes pressor responses in unanesthetized rats. It has also been shown that the MPFC is involved in the modulation of the parasympathetic component of the baroreflex in rats. We report that bilateral injections of CoCl2 in the ventral portion of the MPFC (vMPFC) reduced the parasympathetic component of the baroreflex, thus confirming the involvement of local synapses. We further evaluated the effect of the pharmacologic block of vMPFC alpha1- or alpha2-adrenoceptors and muscarinic receptors on the vMPFC-related modulation of the parasympathetic component of the baroreflex in unanesthetized rats. Bilateral microinjections of 10 nmol of the selective alpha1-adrenoceptor antagonist WB4101 or 10 nmol of the selective alpha2-adrenoceptors antagonist RX821002 into the MPFC did not affect the baroreflex. Bilateral microinjections of 9 nmol of the muscarinic antagonist atropine also did not affect baroreflex activity. The present results indicate that although vMPFC alpha-adrenergic and muscarinic receptors are involved in cardiovascular regulation, they do not mediate the vMPFC-related modulation of the parasympathetic component of the baroreflex.

1. The diagonal band (DB) and the lateral septal area (LSA) are two prosencephalic structures, which were implicated in vasopressin release. 2. The present experiment was designed to investigate neural connections between the DB and the LSA and from these nuclei to the paraventricular (PVN) and supraoptic (SON) nuclei, which could be related to vasopressin release. 3. For the above purpose the bidirectional neuronal tracer biotinylated dextran amine (BDA) was injected into the DB or the LSA of male Wistar rats. Five days later the animals were sacrificed and brain slices were processed and analyzed to determine neuronal projections efferent from as well as afferent to these structures. 4. Neuronal staining was more prominent in regions ipsilateral to the BDA injection site. 5. After BDA injections into the DB, efferent projections from the DB were observed at the LSA, the PVN, the prefrontal cortex, the mediodorsal thalamic nucleus, and throughout the anterior hypothalamus, but not at the SON. At the PVN, labeled varicose fibers were observed at the magnocellular portion. The DB was found to receive a massive input from the LSA. More discrete projections to the DB were originated at the prefrontal cortex and from hypothalamic neurons outside the PVN and the SON. 6. After BDA injections into the ventral portion of the LSA, efferent projections from the LSA were intense at the DB and throughout the hypothalamus. Labeled fibers were observed at the structures surrounding the SON or the PVN but not within those nuclei. 7. The results indicate a massive neural output from the LSA to the DB and the existence of a direct neural connection from the DB to the PVN. No direct connections were observed between the LSA and the magnocellular nuclei (PVN and SON) or between the DB and the SON.

The ventral portion of the medial prefrontal cortex (vMPFC) that comprises the prelimbic and infralimbic cortex is involved in arterial blood pressure and heart rate control. In the present study, we attempted to verify the effect of an acute and reversible blockade of vMPFC activity by local bilateral microinjections of either lidocaine (a local anesthetic) or CoCl2 (a nonselective synapse blocker) on the baroreflex response of unanesthetized rats. Bilateral microinjection of lidocaine into the vMPFC did not affect the tachycardiac response to mean arterial pressure (MAP) decreases caused by i.v. infusion of sodium nitroprusside or the baroreflex gain in unanesthetized rats. However, lidocaine caused a reversible shift of the reflex threshold pressure toward higher (MAP) increases in response to i.v. infusion of phenylephrine, thus indicating an action on the parasympathetic component of the baroreflex. The effects of the blockade of local synapses in the vMPFC by CoCl2 were similar to those observed after the acute ablation of that area caused by lidocaine. Bilateral microinjection of CoCl2 into the vMPFC also caused a shift of the reflex threshold pressure bradycardiac responses to MAP increases toward higher MAP values, without affecting the baroreflex gain. In conclusion, our data indicate that the vMPFC is involved in baroreflex control, and more specifically in the modulation of the parasympathetic baroreflex component. The temporary ablation of this area by local microinjections of lidocaine caused a shift of the reflex threshold pressure toward higher MAP values, which is compatible with the idea that the vMPFC has a modulatory action on the baroreflex. The observation that CoCl2 and lidocaine microinjections had similar effects on the baroreflex also suggests that this modulation involves local synaptic neurotransmission within the vMPFC.

The cingulate cortex (CC) is involved in cardiovascular modulation. CC electrical or chemical stimulation may evoke either pressor or depressor responses, depending on the stimulated site and experimental conditions such as anesthesia. Noradrenaline (NA) is involved in cardiovascular regulation and it is present throughout the cortex. However, there is no report on the cardiovascular effects of intracortical injections of NA. We attempted to verify the effect of NA injection into the CC and to identify possible receptor and peripheral mechanisms involved. NA injection caused pressor responses accompanied by bradycardia, in unanesthetized rats. These responses were markedly reduced under urethane anesthesia. The pressor response was blocked by intracortical pretreatment with phenoxybenzamine or the selective alpha(1)-antagonist WB4101, and it was not affected by pretreatment with the selective alpha(2)-antagonist RX821002, suggesting that alpha(1)-adrenoceptors mediate the response. The pressor response was potentiated by pretreatment with the ganglion blocker mecamylamine and it was abolished by pretreatment with the vasopressin antagonist, dTyr(CH(2)) (5)(Me)AVP or by hypophysectomy. Circulating vasopressin levels were increased after NA injection into the CC. The present results indicate that the pressor response to local injection of NA within the CC is independent of sympathetic nerve activation and is mediated by vasopressin release.