Potentially inappropriate medications used by the elderly: Prevalence and risk factors in Brazilian care homes

Abstract. Background: The use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study's objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings. Methods. We performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression. Results: Among the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404). Conclusions: The results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency. © 2013 Lima et al.; licensee BioMed Central Ltd.

Influence of risk behavior aggregation in different categories of physical activity on the occurrence of cardiovascular risk factors

Background: We aimed to verify the association of risk behavior aggregation in different categories of physical activity (PA) with the presence of cardiovascular risk factors (RF) employees at a public university. Method. We analyzed data of 376 employees, which were visited in their workplace for measurement of weight, height and questionnaires to identify the risk behaviors and risk factors. Chi-square test was used to analyze the association between the dependent and independent variables and binary logistic regression was used to construct a multivariate model for the observed associations. Results: Associations were found between the aggregation of following risk behaviors: smoking, alcohol consumption and physical inactivity, considered in different categories of PA, and the increase in RF, except for the presence of hypertriglyceridemia. Individuals with two or more risk behaviors in occupational PA category are more likely to be hypertensive (3.04 times) and diabetes (3.44 times). For the free time PA category, these individuals were 3.18 times more likely to have hypercholesterolemia and for locomotion PA, more likely to be hypertensive (2.42 times) and obese (2.51 times). Conclusion: There are association between the aggregation of two or more risk behaviors and the presence of cardiovascular RF. © 2013 Bernardo et al.; licensee BioMed Central Ltd.

Effect of Zingiber officinale and propolis on microorganisms and endotoxins in root canals

The purpose of this study was to evaluate the effectiveness of glycolic propolis (PRO) and ginger (GIN) extracts, calcium hydroxide (CH), chlorhexidine (CLX) gel and their combinations as ICMs (ICMs) against Candida albicans, Enterococcus faecalis, Escherichia coli and endotoxins in root canals. Material and Methods: After 28 days of contamination with microorganisms, the canals were instrumented and then divided according to the ICM: CH+saline; CLX, CH+CLX, PRO, PRO+CH; GIN; GIN+CH; saline. The antimicrobial activity and quantification of endotoxins by the chromogenic test of Limulus amebocyte lysate were evaluated after contamination and instrumentation at 14 days of ICM application and 7 days after ICM removal. Results and Conclusion: After analysis of results and application ofthe Kruskal-Wallis and Dunn statistical tests at 5% significance level, it was concluded that all ICMs were able to eliminate the microorganisms in the root canals and reduce their amount of endotoxins; however, CH was more effective in neutralizing endotoxins and less effective against C. albicans and E. faecalis, requiring the use of medication combinations to obtain higher success.

Antibiofilm activity, pH and solubility of endodontic sealers

Aim: To evaluate antibiofilm activity against Enterococcus faecalis, pH and solubility of AH Plus, Sealer 26, Epiphany SE, Sealapex, Activ GP, MTA Fillapex (MTA-F) and an experimental MTA-based Sealer (MTA-S). Methodology: Sealer samples were manipulated and stored for 2 or 7 days. Prepared sealers were evaluated by a modified direct contact test (DCT) for 5 h, 10 h or 15 h with biofilm previously induced on bovine dentine for 14 days. In the control group, the biofilm was not exposed to the sealers. The number of colony-forming units (CFU mL-1) in the remaining biofilm was determined. Sealer solubility was assessed by the percentage of mass loss after 15 h of immersion in distilled water. Sealer pH was measured at 5 h, 10 h and 15 h. Statistical analysis was performed using Kruskal-Wallis and Dunn or anova and Tamhane's T2 tests, at 5% significance. Results: At 2 days post-manipulation, the DCT showed that Sealapex and MTA-F were associated with a reduction in the number of bacteria in all 3 contact periods evaluated, compared with the control group (P < 0.05). At 7 days, Sealapex had the greatest antibiofilm action at 10 h and 15 h. Sealapex had the highest pH values 2 and 7 days post-manipulation. Regarding the solubility, at 2 days the highest values were observed for MTA-F, MTA-S, Sealapex and Activ GP (P < 0.05). At 7 days, MTA-S and MTA-F had greater solubility than the other materials (P < 0.05). AH Plus had the lowest solubility for both post-manipulation periods (P < 0.05). Conclusion: Sealapex and MTA-F were associated with a reduction in the number of bacteria in biofilms and had greater solubility. The high solubility and pH may be related to the antibacterial activity of these materials. © 2012 International Endodontic Journal.

Intra-abdominal fat is related to metabolic syndrome and non-alcoholic fat liver disease in obese youth

Background: Previous studies have shown an association between adiposity, especially intra-abdominal adipose tissue, and hemodynamic/metabolic comorbidities in adults, however it is not clear in pediatric population. The aim of the study was to analyze the relationship between non-alcoholic fatty liver disease (NAFLD) and components of metabolic syndrome (MS) with values of intra-abdominal (IAAT) and subcutaneous (SCAT) adipose tissue in obese children and adolescents.Methods: Cross-sectional study. Subjects: 182 obese sedentary children and adolescents (aged 6 to 16 y), identified by the body mass index (BMI). Measurements: Body composition and trunk fat by dual-energy X-ray absorptiometry- DXA; lipid profile, blood pressure and pubertal stage were also assessed. NAFLD was classified as absent (0), mild (1), moderate (2) and severe (3), and intra-abdominal and subcutaneous abdominal fat thickness were identified by ultrasound. The MS was identified according to the cut offs proposed by World Health Organization adapted for children and adolescents. The chi-square test was used to compare categorical variables, and the binary logistic regression indicated the magnitude of the associations adjusted by potential cofounders (sex, age, maturation, NAFLD and HOMA-IR).Results: Higher quartile of SCAT was associated with elevated blood pressure (p = 0.015), but not associated with NAFLD (p = 0.665). Higher IAAT was positively associated with increased dyslipidemia (p = 0.001), MS (p = 0.013) and NAFLD (p = 0.005). Intermediate (p = 0.007) and highest (p = 0.001) quartile of IAAT were also associated with dyslipidemia, independently of age, sex, maturation, NAFLD and HOMA-IR (homeostatic model assessment-insulin resistance).Conclusion: Obese children and adolescents, with higher IAAT are more prone to develop MS and NAFLD than those with higher values of SCAT, independent of possible confounding variables. © 2013 Silveira et al.; licensee BioMed Central Ltd.

Energy and fat intake are not associated with abdominal adiposity

Background and objective: Central or abdominal obesity (AA) is a highly prevalent determinant of the metabolic syndrome and its control requires intervention strategies. This study investigated the risk factors associated with the presence of AA in hospitalized individuals. Patients and methods: A total of 1626patients were studied. The investigated risk factors possibly associated with AA were gender, age, body mass index (BMI), habitual energy intake (HEI) and fat intake (FI). AA was determined by waist circumference (WC) and waist-to-hip ratio (WHR). The chi2, Mann-Whitney and Kruskal-Wallis tests were used to compare the data and univariate and multiple logistic regressions were used to identify the predictive factors of AA. Results: Women were at higher risk of developing AA than men (P. <. 0.0001). The HEI and FI of individuals with and without AA and of women and men were not significantly different. According to multivariate analysis, HEI was not a predictive factor of AA, contrary to gender and age. The risk factors for AA, determined by WC, were gender (OR. = 6.8; CI. = 5.3-8.7) and age (OR. = 1.0; CI. = 1.0-1.0). Women were six times more likely to develop AA than men. Conclusions: Evidence of an association between AA and HEI or FI was not found, but gender and age were associated with AA. © 2013 Elsevier Masson SAS.

Comparison of the accuracy for three dental impression techniques and index: An in vitro study

Objectives: This in vitro study compared the dimensional accuracy of stone index (I) and three impression techniques: tapered impression copings (T), squared impression copings (S) and modified squared impression copings (MS) for implant-supported prostheses. Methods: A master cast, with four parallel implant abutment analogs and a passive framework, were fabricated. Vinyl polysiloxane impression material was used for all impressions with two metal stock trays (open and closed tray). Four groups (I, T, S and MS) were tested (n = 5). A metallic framework was seated on each of the casts, one abutment screw was tightened, and the gap between the analog of implant and the framework was measured with a stereomicroscope. The groups' measurements (80 gap values) were analyzed using software (LeicaQWin - Leica Imaging Systems Ltd.) that received the images of a video camera coupled to a Leica stereomicroscope at 100× magnification. The results were statistically analyzed with Kruskal-Wallis One Way ANOVA on Ranks test followed by Dunn's Method, 0.05. Results: The mean values of abutment/framework interface gaps were: Master Cast = 32 μm (SD 2); Group I = 45 μm (SD 3); Group T = 78 μm (SD 25); Group S = 134 μm (SD 30); Group MS = 143 μm (SD 27). No significant difference was detected among Index and Master Cast (P = .05). Conclusion: Under the limitations of this study, it could be suggested that a more accurate working cast is possible using tapered impression copings techniques and stone index. © 2013 Japan Prosthodontic Society.

Disinfection protocols to prevent cross-contamination between dental offices and prosthetic laboratories

Control of cross-contamination between dental offices and prosthetic laboratories is of utmost importance to maintain the health of patients and dental office staff. The purpose of this study was to evaluate disinfection protocols, considering antimicrobial effectiveness and damage to the structures of prostheses. Solutions of 1% sodium hypochlorite, 2% chlorhexidine digluconate, 50% vinegar and sodium perborate were evaluated. Specimens were contaminated in vitro with standardized suspensions of Candida albicans, Streptococcus mutans, Escherichia coli, Staphylococcus aureus and Bacillus subtilis spores. Disinfection by immersion for 10. min was performed. Final counts of microorganisms were obtained using the plating method. Results were statistically compared by Kruskal-Wallis ANOVA and Dunn's test. The surface roughness of 40 specimens was analyzed before and after 10 disinfection cycles, and results were compared statistically using Student's t test. The solution of 50% vinegar was as effective as 1% sodium hypochlorite and 2% chlorhexidine against C. albicans, E. coli and S. mutans. The sodium perborate solution showed the lowest antimicrobial effectiveness. Superficial roughness increased after cycles in 1% sodium hypochlorite (p=0.02). Solutions of 1% sodium hypochlorite, 2% chlorhexidine and 50% vinegar were effective for the disinfection of heat-polymerized acrylic specimens. Sodium hypochlorite increased the superficial roughness. © 2013 King Saud Bin Abdulaziz University for Health Sciences.

Uso da lidocaína isolada ou associada à quetamina ou ao butorfanol, em anestesia epidural em cães: avaliação cardiorrespiratória e analgésica

Pós-graduação em Anestesiologia - FMB

Ropivacaína isolada ou associada à morfina, butorfanol ou tramadol pela via peridural em cadelas para realização de ovariosalpingohisterectomia

Pós-graduação em Ciência Animal - FMVA

Histomorfometria das fibras colágenas e das fibras do sistema elástico da queilite actínica e sua relação com os níveis de atipia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação quantitativa de micronúcleos na citologia esfoliativa da mucosa bucal de pacientes dependentes químicos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comportamento das pressões respiratórias e do pico de fluxo expiratório de pacientes submetidos à cirurgia de revascularização miocárdica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Consumo de álcool entre estudantes do ensino médio do município de Passos-MG

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influência de três hemostáticos tópicos no processo de reparo em feridas de extração dental: análise histológica e histométrica em ratos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)