Hand and ultrasonic instrumentation for orthograde root canal treatment of permanent teeth

Root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment. OBJECTIVES: The objectives of this systematic review of randomized controlled trials were to determine the relative clinical effectiveness of hand instrumentation versus ultrasonic instrumentation alone or in conjunction with hand instrumentation for orthograde root canal treatment of permanent teeth. MATERIAL AND METHODS: The search strategy retrieved 226 references from the Cochrane Oral Health Group Trials Register (7), the Cochrane Central Register of Controlled Trials (CENTRAL) (12), MEDLINE (192), EMBASE (8) and LILACS (7). No language restriction was applied. The last electronic search was conducted on December 13th, 2007. Screening of eligible studies was conducted in duplicate and independently. RESULTS: Results were to be expressed as fixed-effect or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confdence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible randomized controlled trials were identifed. CONCLUSIONS: This review illustrates the current lack of published or ongoing randomized controlled trials and the unavailability of high-level evidence based on clinically relevant outcomes referring to the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment. In the absence of reliable research-based evidence, clinicians should base their decisions on clinical experience, individual circumstances and in conjunction with patients' preferences where appropriate. Future randomized controlled trials might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis on not only clinically relevant, but also patient-centered outcomes.

Richards growth model and viability indicators for populations subject to interventions

In this work we study the problem of modeling identification of a population employing a discrete dynamic model based on the Richards growth model. The population is subjected to interventions due to consumption, such as hunting or farming animals. The model identification allows us to estimate the probability or the average time for a population number to reach a certain level. The parameter inference for these models are obtained with the use of the likelihood profile technique as developed in this paper. The identification method here developed can be applied to evaluate the productivity of animal husbandry or to evaluate the risk of extinction of autochthon populations. It is applied to data of the Brazilian beef cattle herd population, and the the population number to reach a certain goal level is investigated.

Gender and schooling inequalities in risk and protective factors for chronic diseases among Brazilian adults, through telephone survey

OBJECTIVES: To assess risk and protective factors for chronic noncommunicable diseases (CNCD) and to identify social inequalities in their distribution among Brazilian adults. METHODS: The data used were collected in 2007 through VIGITEL, an ongoing population-based telephone survey. This surveillance system was implemented in all of the Brazilian State capitals, over 54,000 interviews were analyzed. Age-adjusted prevalence ratios for trends at different schooling levels were calculated using Poisson regression with linear models. RESULTS: These analyses have shown differences in the prevalence of risk and protective factors for CNCD by gender and schooling. Among men, the prevalence ratios of overweight, consumption of meat with visible fat, and dyslipidemia were higher among men with more schooling, while tobacco use, sedentary lifestyle, and high-blood pressure were lower. Among women, tobacco use, overweight, obesity, high-blood pressure and diabetes were lower among men with more schooling, and consumption of meat with visible fat and sedentary lifestyles were higher. As for protective factors, fruit and vegetables intake and physical activity were higher in both men and women with more schooling. CONCLUSION: Gender and schooling influence on risk and protective factors for CNCD, being the values less favorable for men. vigitel is a useful tool for monitoring these factors amongst the Brazilian population.

Consumo alimentar e dislipidemia decorrente da terapia antirretroviral combinada para infecção pelo HIV: uma revisão sistemática

Revisar e sintetizar as evidências científicas disponíveis sobre a relação entre o consumo alimentar e dislipidemia em pacientes infectados pelo HIV em terapia antirretroviral combinada de alta atividade (TARV). Desenvolveu-se uma revisão sistemática de literatura. Foram pesquisados estudos originais e duas categorias de exposição dietética foram revisadas: consumo de energia e nutriente ou consumo de uma dieta teste. Foi feita síntese narrativa dos estudos selecionados. Os achados foram sintetizados segundo a categoria de desfecho metabólico (efeito sobre colesterol total e LDL-c, efeito sobre HDL-c e efeito sobre triglicérides). Vinte estudos originais foram incluídos na revisão, sendo 13 ensaios clínicos e 7 estudos epidemiológicos observacionais. A suplementação com ácido graxo ω-3 resultou em significativa redução nos níveis séricos de triglicérides. Observou-se evidência insuficiente acerca da efetividade de intervenções dietéticas na prevenção e controle das dislipidemias em pacientes infectados pelo HIV em uso de TARV.

Riscos à saúde em áreas contaminadas: contribuições da teoria social

Este artigo versa sobre contribuições da teoria social a um estudo sobre o risco à saúde humana e ao ambiente, desenvolvido entre 2003 e 2005 em área urbana contaminada, localizada no bairro Vila Carioca, no sudeste do município de São Paulo, Brasil. Resíduos perigosos provenientes de processo produtivo do setor químico, dispostos inadequadamente na localidade ao longo do tempo, resultaram em contaminação ambiental, cujos efeitos representam riscos à saúde da população local. A investigação foi realizada com o objetivo de identificar interpretações sociais sobre o conceito de situação de risco, condizentes com concepções incorporadoras da dimensão social do risco e voltadas à melhoria das condições de saúde ambiental. Utilizou-se metodologia qualitativa de pesquisa, alicerçada na teoria social, e instrumentos variados de coleta de dados. Os resultados apontaram interpretações sociais diferenciadas sobre o conceito de situação de risco, sugerindo diversidade de concepções entre a população pesquisada a respeito dos problemas ambientais e de saúde que os atingiam. Neste artigo, apresentam-se fundamentos do enfoque do risco, na teoria social e na obra de Ulrick Beck sobre sociedade de risco, a fim de conferir suporte teórico à interpretação dos dados coletados em campo. Tais contribuições da teoria social, em contraponto com abordagens multidisciplinares e ecossistêmicas em saúde e ambiente, são discutidas como forma de incorporar a diversidade de interpretações sociais expressadas pela população, no sentido de favorecer a inter-relação entre portadores de risco e decisões políticas locais sobre a questão do risco, ampliar o escopo dos fenômenos observados e propiciar a busca de melhores condições de saúde dos indivíduos e da qualidade do seu ambiente

Internal and external time conflicts in adolescents: sleep characteristics and interventions

Daytime fatigue and lack of sleep seem to increase throughout adolescent years. Several environmental, psychological, and biological factors have been associated with the development of sleep across adolescence. The aim of the present article is to summarize these factors and to give examples of various outcomes in sleep patterns among adolescents studied in different cultural settings. It is obvious from earlier work that many adolescents have displaced circadian rhythms and lack of adaptation to school hours due to an early school start or additional burdens for work. Several interventions have aimed to help the adaptation process by supporting sleep processes and changing scheduling, in this way promoting classroom alertness. In summary, adolescents worldwide shorten their sleep due to schoolwork hours and additional work, especially by disturbing their sleep due to circadian misalignment

LED Phototherapy to Prevent Mucositis: A Case Report

Objective: The purpose of this case report was to evaluate the efficacy of phototherapy using light-emitting diodes (LEDs) to prevent oral mucositis in a Hodgkin's disease patient treated with the ABVD ( doxorubicin [Adriamycin], bleomycin, vinblastine, and dacarbazine) chemotherapy regimen. Background Data: Mucositis is a common dose-limiting complication of cancer treatment, and if severe it can lead to alterations in treatment planning or suspension of cancer therapy, with serious consequences for tumor response and survival. Therefore, low-power lasers and more recently LEDs, have been used for oral mucositis prevention and management, with good results. Materials and Methods: In this study, a 34-year-old man received intraoral irradiation with an infrared LED array (880 nm, 3.6 J/cm(2), 74 mW) for five consecutive days, starting on chemotherapy day 1. In each chemotherapy cycle, he received the ABVD protocol on days 1 and 15, and received LED treatment for 5 d during each cycle. To analyze the results, the World Health Organization (WHO) scale was used to grade his mucositis, and a visual analogue scale (VAS) was used for pain evaluation, on days 1, 3, 7, 10, and 13 post-chemotherapy. Results: The results showed that the patient did not develop oral mucositis during the five chemotherapy cycles, and he had no pain symptoms. Conclusion: LED therapy was a safe and effective method for preventing oral mucositis in this case report. However, further randomized studies with more patients are needed to prove the efficacy of this method.

Comparison Between Single-Diode Low-Level Laser Therapy (LLLT) and LED Multi-Diode (Cluster) Therapy (LEDT) Applications Before High-Intensity Exercise

Background Data and Objective: There is anecdotal evidence that low-level laser therapy (LLLT) may affect the development of muscular fatigue, minor muscle damage, and recovery after heavy exercises. Although manufacturers claim that cluster probes (LEDT) maybe more effective than single-diode lasers in clinical settings, there is a lack of head-to-head comparisons in controlled trials. This study was designed to compare the effect of single-diode LLLT and cluster LEDT before heavy exercise. Materials and Methods: This was a randomized, placebo-controlled, double-blind cross-over study. Young male volleyball players (n = 8) were enrolled and asked to perform three Wingate cycle tests after 4 x 30 sec LLLT or LEDT pretreatment of the rectus femoris muscle with either (1) an active LEDT cluster-probe (660/850 nm, 10/30mW), (2) a placebo cluster-probe with no output, and (3) a single-diode 810-nm 200-mW laser. Results: The active LEDT group had significantly decreased post-exercise creatine kinase (CK) levels (-18.88 +/- 41.48U/L), compared to the placebo cluster group (26.88 +/- 15.18U/L) (p < 0.05) and the active single-diode laser group (43.38 +/- 32.90U/L) (p<0.01). None of the pre-exercise LLLT or LEDT protocols enhanced performance on the Wingate tests or reduced post-exercise blood lactate levels. However, a non-significant tendency toward lower post-exercise blood lactate levels in the treated groups should be explored further. Conclusion: In this experimental set-up, only the active LEDT probe decreased post-exercise CK levels after the Wingate cycle test. Neither performance nor blood lactate levels were significantly affected by this protocol of pre-exercise LEDT or LLLT.

Effects of Infrared-LED Illumination Applied During High-Intensity Treadmill Training in Postmenopausal Women

Background data: Technology and physical exercise can enhance physical performance during aging. Objective: The purpose of this study was to investigate the effects of infrared-light-emitting diode (LED) illumination (850 nm) applied during treadmill training. Materials and methods: Twenty postmenopausal women participated in this study. They were randomly divided into two groups. The LED group performed treadmill training associated with infrared-LED illumination (n = 10) and the control group performed only treadmill training (n = 10). The training was performed during 3 months, twice a week during 30 min at intensities between 85 and 90% of maximal heart rate. The irradiation parameters were 31 mW/cm(2), treatment time 30 min, 14,400 J of total energy and 55.8 J/cm(2) of fluence. Physiological, biomechanical, and body composition parameters were measured at the baseline and after 3 months. Results: Both groups improved the time of tolerance limit (Tlim) (p < 0.05) during submaximal constant-speed testing. The peak torque did not differ between groups. However, the results showed significantly higher values of power [from 56 +/- 10 to 73 +/- 8W (p = 0.002)] and total work [from 1,537 +/- 295 to 1,760 +/- 262 J (p = 0.006)] for the LED group when compared to the control group [power: from 58 +/- 14 to 60 +/- 15W (p >= 0.05) and total work: from 1,504 +/- 404 to 1,622 +/- 418 J (p >= 0.05)]. The fatigue significantly increased for the control group [from 51 +/- 6 to 58 +/- 5 % (p = 0.04)], but not for the LED group [from 60 +/- 10 to 60 +/- 4 % (p >= 0.05)]. No significant differences in body composition were observed for either group. Conclusions: Infrared-LED illumination associated with treadmill training can improve muscle power and delay leg fatigue in postmenopausal women.

Green Chemistry-Sensitive Analytical Procedure for Photometric Determination of Orthophosphate in River and Tap Water by Use of a Simple LED-Based Photometer

In the current work a Green Analytical Chemistry (GAC) procedure for photometric determination of orthophosphate in river water at mu g L-1 concentration level is described. The flow system module and the LED-based photometer were assembled together to constitute a compact unit in order to allow that a flow cell with optical path-length of 100mm was coupled to them. The photometric procedure based on the molybdenum blue method was implemented employing the multicommuted flow injection analysis approach, which provided facilities to allow reduction of reagent consumption and as well as waste generation. Aiming to prove the usefulness of the system, orthophosphate in river and tap waters was determined. Accuracy was ascertained by spiking samples with orthophosphate solution yielding recoveries ranging from 96% up to 107%. Other profitable features such as a wide linear response range between 10 to 800 mu g L-1 [image omitted]; a detection limit (3 sigma criterion) of 2.4 mu g L-1 [image omitted]; a relative standard deviation (n=7) of 2% using a typical water sample with concentration of 120 mu g L-1 [image omitted]; reagent consumption of 3.0mg ammonium molybdate, 0.3mg hydrazine sulfate, and 0.03mg stannous chloride per determination; a waste generation of 2.4mL per determination; and a sampling throughput of 20 determination per hours were also achieved.

Contuse lesion of the rat spinal cord of moderate intensity leads to a higher time-dependent secondary neurodegeneration than severe one - An open-window for experimental neuroprotective interventions

Secondary neurodegeneration takes place in the surrounding tissue of spinal cord trauma and modifies substantially the prognosis, considering the small diameter of its transversal axis. We analyzed neuronal and glial responses in rat spinal cord after different degree of contusion promoted by the NYU Impactor. Rats were submitted to vertebrae laminectomy and received moderate or severe contusions. Control animals were sham operated. After 7 and 30 days post surgery, stereological analysis of Nissl staining cellular profiles showed a time progression of the lesion volume after moderate injury, but not after severe injury. The number of neurons was not altered cranial to injury. However, same degree of diminution was seen in the caudal cord 30 days after both severe and moderate injuries. Microdensitometric image analysis demonstrated a microglial reaction in the white matter 30 days after a moderate contusion and showed a widespread astroglial reaction in the white and gray matters 7 days after both severities. Astroglial activation lasted close to lesion and in areas related to Wallerian degeneration. Data showed a more protracted secondary degeneration in rat spinal cord after mild contusion, which offered an opportunity for neuroprotective approaches. Temporal and regional glial responses corroborated to diverse glial cell function in lesioned spinal cord. (C) 2007 Elsevier Ltd. All rights reserved.

Use of Hyaluronidase to Prevent Perineal Trauma During Spontaneous Births: A Randomized, Placebo-Controlled, Double-blind, Clinical Trial

Introduction: The purpose of this study was to compare the frequency and severity of perineal trauma during spontaneous birth with or without perineal injections of hyaluronidase (HAase). Methods: A randomized, placebo-controlled, double-blind clinical trial was conducted in a midwife-led, in-hospital birth center in Sao Paulo, Brazil. Primiparous women (N = 160) were randomly assigned to an experimental (n = 80) or control (n = 80) group. During the second stage of labor, women in the experimental group received an injection of 20.000 turbidity-reducing units of HAase in the posterior region of the perineum, and those in the control group received a placebo injection. The assessment of perineal outcome was performed by 2 independent nurse-midwives. A 1-tailed Fisher exact test was performed, and a P value < .025 was considered statistically significant. Results: Perineal integrity occurred in 34.2% of the experimental group and in 32.5% of the control group, which was not a statistically significant difference (P = .477). First-degree laceration was the most common trauma in the posterior region of the perineum in women in both groups (experimental = 56%, control = 42.6%). Severe perineal trauma occurred in 28.9% of the experimental group and 38.8% of the control group, which also was not a statistically significant difference (P =. 131). The depth of second-degree perineal lacerations in the experimental and control groups, measured by the Peri-Rule, was 1.9 cm and 2.3 cm, respectively. An episiotomy was performed in 11 women (experimental group = 3, control group = 8), and 4 (all in control group) had third-degree lacerations. Discussion: The use of injectable HAase did not increase the proportion of intact perineum and did not reduce the proportion of severe perineal trauma in our sample. J Midwifery Womens Health 2011; 56: 436-445 (C) 2011 by the American College of Nurse-Midwives.

Images of a `good nurse` presented by teaching staff

Nursing is at the same time a vocation, a profession and a job. By nature, nursing is a moral endeavor, and being a `good nurse` is an issue and an aspiration for professionals. The aim of our qualitative research project carried out with 18 nurse teachers at a university nursing school in Brazil was to identify the ethical image of nursing. In semistructured interviews the participants were asked to choose one of several pictures, to justify their choice and explain what they meant by an ethical nurse. Five different perspectives were revealed: good nurses fulfill their duties correctly; they are proactive patient advocates; they are prepared and available to welcome others as persons; they are talented, competent, and carry out professional duties excellently; and they combine authority with power sharing in patient care. The results point to a transition phase from a historical introjection of religious values of obedience and service to a new sense of a secular, proactive, scientific and professional identity.

Neural network model for designing automotive devices using SMD LED

The advantages offered by the electronic component LED (Light Emitting Diode) have resulted in a quick and extensive application of this device in the replacement of incandescent lights. In this combined application, however, the relationship between the design variables and the desired effect or result is very complex and renders it difficult to model using conventional techniques. This paper consists of the development of a technique using artificial neural networks that makes it possible to obtain the luminous intensity values of brake lights using SMD (Surface Mounted Device) LEDs from design data. This technique can be utilized to design any automotive device that uses groups of SMD LEDs. The results of industrial applications using SMD LED are presented to validate the proposed technique.

Urban upgrading interventions and engaging residents in fuzzy management: Case studies from Novos Alagados, Salvador, Brazil

International theory and practice have promoted state-assisted upgrading of `informal` urban areas worldwide since the late 1970s, with various forms of monitoring and assessment of impact. Two independent studies of how residents perceive and evaluate such interventions have recently been undertaken for neighbouring parts of the upgraded area of Novos Alagados on the Itapagipe peninsula in the northwestern part of Salvador, Brazil`s third largest city. These studies start from different premises and have been implemented in very different ways, but both have the objective of permitting the `voice` of the residents to be heard concerning the upgrading process. Comparing them helps highlight the essential `fuzzy` nature of values concerning urban interventions of this nature and leaves us with thought-provoking questions concerning the role of local society in relation to the state in urban development, and the potential this has for on-going forms of urban management in cities which are emerging globally. Crown Copyright (C) 2009 Published by Elsevier Ltd. All rights reserved.