The Effectiveness of Psychological Interventions for the Treatment of Erectile Dysfunction: Systematic Review and Meta-Analysis, Including Comparisons to Sildenafil Treatment, Intracavernosal Injection, and Vacuum Devices

In contrast to the impressive advances in somatic research of erectile dysfunction (ED), scientific literature shows contradictory reports on the results of psychotherapy for the treatment of ED. Authors conducted a meta-analysis to evaluate the effectiveness of psychological interventions for the treatment of ED compared to oral drugs, local injection, vacuum devices, or other psychological intervention. Distinct sources of randomized controlled trials (RCTs) were searched: electronic databases (between 1966 and 2007), cross checking of references, and contact with scientific societies. For dichotomous outcomes the pooled relative risks were calculated and for continuous outcomes mean differences between interventions. Statistical heterogeneity was addressed. Eleven RCTs involving 398 men met the inclusion criteria. There is evidence that group therapy improves ED. Focused sex group therapy showed greater efficacy than control group. Men randomized to receive psychotherapy plus sildenafil showed significant improvement of ED and were less likely than those receiving only sildenafil to drop out. Regarding to the effectiveness of psychological interventions for the treatment of ED compared to local injection and vacuum devices no difference was found. Melnik T, Soares BGO, and Nasello AG. The effectiveness of psychological interventions for the treatment of erectile dysfunction: Systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med 2008;5:2562-2574.

Clinical Evaluation of the Effectiveness of Different Bleaching Therapies in Vital Teeth

The aims of this in vivo study were to compare the effectiveness and color stability of at-home and in-office bleaching techniques and to evaluate whether the use of light sources can alter bleaching results. According to preestablished criteria, 40 patients were selected and randomly divided into four groups according to bleaching treatment: (1) at-home bleaching with 10% carbamide peroxide, (2) in-office bleaching with 35% hydrogen peroxide (HP) without a light source, (3) in-office bleaching with 35% HP with quartz-tungsten-halogen light, and (4) in-office bleaching with 35% HP with a light-emitting diode/laser. Tooth shade was evaluated using the VITA Classical Shade Guide before bleaching as well as after the first and third weeks of bleaching. Tooth shade was evaluated again using the same guide 1 and 6 months after the completion of treatment. The shade guide was arranged to yield scores that were used for statistical comparison. Statistical analysis using the Kruskal-Wallis test showed no significant differences among the groups for any time point (P > .01). There was no color rebound in any of the groups. The bleaching techniques tested were equally effective. Light sources are unnecessary to bleach teeth. (Int J Periodontics Restorative Dent 2012;32:303-309.)

Comparative clinical study of the effectiveness of different dental bleaching methods - two year follow-up

This study evaluated color change, stability, and tooth sensitivity in patients submitted to different bleaching techniques. Material and methods: In this study, 48 patients were divided into five groups. A half-mouth design was conducted to compare two in-office bleaching bleaching techniques (with and without light activation): G1: 35% hydrogen peroxide (HP) (Lase Peroxide - DMC Equipments, Sao Carlos, SP, Brazil) + hybrid light (HL) (LED/Diode Laser, Whitening Lase II DMC Equipments, Sao Carlos, SP, Brazil); G2: 35% HP; G3: 38% HP (X-traBoost - Ultradent, South Jordan UT, USA) + HL; G4: 38% HP; and G5: 15% carbamide peroxide (CP) (Opalescence PF - Ultradent, South Jordan UT, USA). For G1 and G3, HP was applied on the enamel surface for 3 consecutive applications activated by HL. Each application included 3x3' HL activations with 1' between each interval; for G2 and G4, HP was applied 3x15' with 15' between intervals; and for G5, 15% CP was applied for 120'/10 days at home. A spectrophotometer was used to measure color change before the treatment and after 24 h, 1 week, 1, 6, 12, 18 and 24 months. A VAS questionnaire was used to evaluate tooth sensitivity before the treatment, immediately following treatment, 24 h after and finally 1 week after. Results: Statistical analysis did not reveal any significant differences between in-office bleaching with or without HL activation related to effectiveness; nevertheless the time required was less with HL. Statistical differences were observed between the result after 24 h, 1 week and 1, 6, 12, 18 and 24 months (integroup). Immediately, in-office bleaching increased tooth sensitivity. The groups activated with HL required less application time with gel. Conclusion: All techniques and bleaching agents used were effective and demonstrated similar behaviors.

Effectiveness of an exercise program on postural control in frail older adults

Background: Exercise programs have proved to be helpful for frail older adults. This study aimed to investigate the effects of an exercise program with a focus on postural control exercises in frail older adults. Method: Twenty-six older adults (76.7 +/- 4.9 years) deemed clinically stable, chosen from the Falls Unit, University Hospital Mutua Terrassa, Barcelona, Spain, participated in this single-group study. Volunteers' postural control was evaluated using the Timed Up and Go test (TUG) and the Guralnik test battery, and their static and dynamic posturography were evaluated using the Synapsys Posturography System (R). These evaluations were performed before and after the intervention program, which included an educational session and two weekly 1-hour sessions over an 8-week period of stretching exercises, proprioception, balance, and motor coordination. Data were analyzed using the Student's t-test or the Wilcoxon test, with a significance level of 5%. Results: The TUG and Guralnik tests did not show significant differences. Concerning static posturography, there was improvement in the base of support (P = 0.006), anteroposterior displacement with eyes open (P = 0.02) and closed (P = 0.03), and the total amplitude of the center of pressure with eyes closed (P = 0.02). Regarding dynamic posturography, a decrease of the oscillation speed in the anteroposterior direction (P = 0.01) was observed in individuals with their eyes open. Conclusion: The program used in this study was safe and was able to promote some improvement in postural control, especially in the anteroposterior direction and in the base of support. However, it is noteworthy that further improvements could be obtained from a program of longer duration and greater frequency.

Effectiveness of immediate bonding of etch-and-rinse adhesives to simplified ethanol-saturated dentin

This study examined the immediate bond strength of etch-and-rinse adhesives to demineralized dentin saturated with either water or absolute ethanol. The research hypothesis was that there would be no difference in bond strength to dentin between water or ethanol wet-bonding techniques. The medium dentin of 20 third molars was exposed (n = 5). The dentin surface was then acid-etched, left moist and randomly assigned to be saturated via either water wet-bonding (WBT) or absolute ethanol wet-bonding (EBT). The specimens were then treated with one of the following etch-and-rinse adhesive systems: a 3-step, water-based system (Adper Scotchbond Multipurpose, or SBMP) or a 2-step, ethanol/water-based system (Adper Single Bond 2, or SB). Resin composite build-ups were then incrementally constructed. After water storage for 24 h at 37 degrees C, the tensile strength of the specimens was tested in a universal testing machine (0.5 mm/min). Data were analyzed by two-way ANOVA and Tukey's test (alpha = 5%). The failure modes were verified using a stereomicroscope (40x). For both adhesives, no significant difference in bond strength was observed between WBT and EBT (p > 0.05). The highest bond strength was observed for SB, regardless of the bonding technique (p < 0.05). No significant interaction between adhesives and bonding techniques was noticed (p = 0.597). There was a predominance of adhesive failures for all tested groups. The EBT and WBT displayed similar immediate bond strength means for both adhesives. The SB adhesive exhibited higher means for all conditions tested. Further investigations are needed to evaluate long-term bonding to dentin mediated by commercial etch-and-rinse adhesives using the EBT approach.

A study of effectiveness of midazolam sedation for prevention of myocardial arrhythmias in endosseous implant placement

Purpose: The study aimed to assess electrocardiographic alterations during oral implant placement surgeries under local anesthesia (lidocaine chlorhydrate with epinephrine), using 15 mg of midazolam as an anxiolytic premedication. Material and methods: The study randomly selected 20 patients, aged 21-50 years old, requiring bilateral mandibular dental implants. Each patient was assessed using placebo on one side and midazolam on the contralateral side, with random, double-blinded distribution. The electrocardiogram recorded 12 static leads every 2 min, while D2 derivations were recorded continuously. Results: No statistically significant differences were observed between the placebo and midazolam when analyzing the morphological behavior of the electrocardiographic wave and the presence of arrhythmias during the experiment. However, under sedation, assessment of the behavior of electrocardiographic parameters during different stages of the procedure revealed statistically significant differences (P<0.05) for heart rate, P-wave amplitude and duration of the RR and QTc intervals. The arrhythmias detected were considered low risk for patients without systemic alterations and were observed in 53.3% of patients. The most frequently occurring alterations were tachycardia, bradycardia, supraventricular and ventricular extrasystoles and blocked atrial extrasystole, which were similar for both placebo and midazolam, with the greatest incidence during the initial, incision and bone drilling stages. Conclusion: The use of 15 mg of midazolam made no difference compared with the placebo. The use of 15 mg of midazolam did not show an advantage in the incidence of arrhythmias The anxiolytic premedication does not prevent myocardial arrhythmias in endosseous implant placement. The clinical significance of the arrhythmias may not represent serious risks.

Effectiveness of Piezoelectric Surgery in Preparing the Lateral Window for Maxillary Sinus Augmentation in Patients with Sinus Anatomical Variations: A Case Series

Purpose: The present article sought to evaluate the effectiveness of a piezoelectric surgical unit for maxillary sinus augmentation surgeries in avoiding perforation of the sinus membrane and other possible procedural complications in patients with anatomical variations of the sinus. Materials and Methods: Twenty-five patients presenting sinus anatomical variations, who were indicated for a total of 40 sinus grafting procedures performed by the lateral window approach with a piezoelectric device, were analyzed. After 6 months of healing, implants were placed. Information collected included clinical and computed tomographic information on anatomical variations in the sinus bone walls, in the size of the sinus, and in the thickness of the sinus membrane. Occurrence of sinus membrane perforation and computed tomographic measurements of the amount of bone height gained with the grafting procedures were also recorded. Results: Only two patients presented a small perforation (less than 5 mm in diameter) of the sinus membrane, which occurred only after osteotomies of the lateral windows and did not compromise the surgical outcome. No implants were lost during a mean follow-up period of 19 months. Conclusion: The use of piezoelectric surgery allowed for the accomplishment of all rehabilitation treatments within the follow-up period of this study. INT J ORAL MAXILLOFAC IMPLANTS 2012;27:1211-1215

Effectiveness of the association of dexamethasone with antibiotic therapy in pediatric patients with bacterial meningitis

Effectiveness of the association of dexamethasone with antibiotic therapy in pediatric patients with bacterial meningitis Objective: To evaluate the efficacy of the association of corticosteroids and the standard treatment of bacterial meningitis in pediatric patients. Methods: A systematic review of the literature was conducted through the MEDLINE database. Only randomized controlled trials comparing dexamethasone with placebo in the treatment of pediatric patients with bacterial meningitis were included. Results: Eight articles met the inclusion criteria and were selected for analysis. There were no difference in mortality (p = 0.86), and incidence of neurological (p = 0.41) and auditory (p = 0.48) sequelae between the groups. Conclusion: There are no benefits in associating corticosteroids with the standard treatment of bacterial meningitis in pediatric patients.

Effectiveness of Tooth Wipes in Removing Babies' Dental Biofilm

Purpose: To assess the effectiveness of tooth wipes in removing dental biofilm from babies' anterior teeth, as well as to evaluate the babies' behaviour and the guardians' preference concerning hygiene methods. Materials and Methods: In this random blind cross-over study, 50 high caries risk babies, from 8 to 15 months old, were divided into two groups: babies with oral hygiene performed by caregivers (n = 25) or by their mothers (n = 25). The caregivers and mothers removed biofilm using three methods of oral hygiene (tooth wipes, toothbrushes and gauze), one in each experimental phase. Professional cleaning was done before each phase, which had 2 days of biofilm accumulation and 1 experimental day, when caregivers and mothers used one method to remove biofilnn. Examiners blinded to the study design assessed the biofilm index at baseline, prior to and following biofilm removal using each method. The babies' behaviour and the mothers'/caregivers' preference were assessed. Results: The tooth wipes, toothbrushes and gauze significantly reduced the amount of biofilm (P < 0.001). The mothers' group removed more biofilm than the caregivers' group, using toothbrushes or tooth wipes (P < 0.05). Babies in the mothers' group had better behaviour using tooth wipes than toothbrushes (P < 0.05). Mothers and caregivers preferred to use tooth wipes. Conclusions: Tooth wipes are effective in removing biofilrn from babies' anterior teeth and are the method best accepted by mothers, caregivers and babies.

Cost-effectiveness of conventional and modified supervised toothbrushing in preventing caries in permanent molars among 5-year-old children

The cost-effectiveness of a modified supervised toothbrushing program was compared to a conventional program. A total of 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In the control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice was carried outfour times per year. With the test group, children also underwent professional cross-brushing on surfaces of first permanent molar rendered by a dental assistant five times per year. Enamel/dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars for a period of 18 months. The incidence density (ID) ratio was estimated using Poisson's regression model. The ID was 50% lower among boys in the test group (p = 0.016). The cost of the modified program was US$ 1.79 per capita. The marginal cost-effectiveness ratio among boys was US$ 6.30 per avoided carie. The modified supervised toothbrushing program was shown to be cost-effective in the case of boys.

Cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the universal immunisation of infants in Brazil

Background Cost-effectiveness studies have been increasingly part of decision processes for incorporating new vaccines into the Brazilian National Immunisation Program. This study aimed to evaluate the cost-effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) in the universal childhood immunisation programme in Brazil. Methods A decision-tree analytical model based on the ProVac Initiative pneumococcus model was used, following 25 successive cohorts from birth until 5 years of age. Two strategies were compared: (1) status quo and (2) universal childhood immunisation programme with PCV10. Epidemiological and cost estimates for pneumococcal disease were based on National Health Information Systems and literature. A 'top-down' costing approach was employed. Costs are reported in 2004 Brazilian reals. Costs and benefits were discounted at 3%. Results 25 years after implementing the PCV10 immunisation programme, 10 226 deaths, 360 657 disability-adjusted life years (DALYs), 433 808 hospitalisations and 5 117 109 outpatient visits would be avoided. The cost of the immunisation programme would be R$10 674 478 765, and the expected savings on direct medical costs and family costs would be R$1 036 958 639 and R$209 919 404, respectively. This resulted in an incremental cost-effectiveness ratio of R$778 145/death avoided and R$22 066/DALY avoided from the society perspective. Conclusion The PCV10 universal infant immunisation programme is a cost-effective intervention (1-3 GDP per capita/DALY avoided). Owing to the uncertain burden of disease data, as well as unclear long-term vaccine effects, surveillance systems to monitor the long-term effects of this programme will be essential.

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

Background: Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome. Methods/Design: Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments (TM) threshold sensibility test, Pinch Gauge T, Boston Carpal Tunnel Questionnaire and two point discrimination test. Discussion: This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome. Trial registration: Brazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184

Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial

Background: Recent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA) after short- term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA. Methods/Design: Fifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes-Moleca (R)-for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca (R) is a women's double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention). All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days) of paracetamol (500 mg) intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention to treat analysis, as well as general linear models of analysis of variance for repeated measure to detect treatment-time interactions (alpha = 5%). Discussion: This is the first randomized, clinical trial protocol to assess the chronic effect of minimalist footwear on the clinical and functional aspects and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca (R) shoes for six months will provide pain relief, reduction of the knee adduction moment when walking, and improve joint function in elderly women with knee OA, and that the treatment, thus, can be considered another inexpensive and easy-to-use option for conservative OA treatment.

The Effectiveness of a Voice Training Program for Telemarketers

Purpose. To use a randomized design to evaluate the effectiveness of voice training programs for telemarketers via multidimensional analysis. Methods. Forty-eight telemarketers were randomly assigned to two groups: voice training group (n = 14) who underwent training over an 8-week period and a nontraining control group (n = 34). Before and after training, recordings of the sustained vowel /epsilon/ and connected were collected for acoustic and perceptual analyses. Results. Based on pre- and posttraining comparisons, the voice training group presented with a significant reduction in percent jitter (P = 0.044). No other significant differences were observed, and inter-rater reliability varied from poor to fair. Conclusions. These findings suggest that voice training improved a single acoustic dimension, but do not change perceptual dimension of telemarketers' voices.

Effectiveness of the polysaccharide pneumococcal vaccine among HIV-infected persons in Brazil: a case control study

Abstract Background Polysaccharide pneumococcal vaccine is recommended for use in HIV-infected adults in Brazil but there is uncertainty about its effectiveness in this patient population. The main objective of this study was to assess the effectiveness of the 23-valent polysaccharide pneumococcal vaccine against invasive pneumococcal infection among HIV-infected adult patients in São Paulo, Brazil. Methods A case-control study of 79 cases and 242 controls matched on CD4+ cell count and health care setting was conducted. Among HIV-infected adults in São Paulo, Brazil, with and without S. pneumoniae recovered from a normally sterile site; prior receipt of 23 valent polysaccharide pneumococcal vaccine was determined by review of medical records and patient interview. Results After adjustment for confounding factors, the point estimate for the effectiveness of 23 valent polysaccharide vaccine among HIV-infected adults against all invasive pneumococcal infection was 18% (95% CI: <0 to 62%). Conclusion We were unable to demonstrate a statistically significant protective effect of 23 valent polysaccharide against invasive pneumococcal infection vaccine among HIV-infected adults in Brazil. While the vaccine is relatively inexpensive and safe, its effectiveness among HIV-infected adults in Brazil is uncertain.