Tratamento da sindrome da apnéia e hipopnéia obstrutiva do sono (sahos) com aparelhos intrabucais

The apnea and hypopnea sleep obstructive syndrome is a disorder that affects part of adult population. Some characteristics can come with this syndrome that cause social problems such as snoring and excessive daytime sleepiness, associated many times with pulmonary hypertension and cardiac insufficiency. The dentist who is inserted into a multidisciplinary team is a professional highly regarded for diagnosis and treatment of sleep disorders. Among treatments recommended, therapy with intraoral appliance shows an excellent non invasive alternative, achieving satisfactory results.

A psicopatologização da infância no contemporâneo: um estudo sobre a expansão do diagnóstico de transtorno de déficit de atenção e hiperatividade

The expansion of psychiatric labeling does not reach only the adult population, but also the problematic related to childhood have been captured by the speeches and practices of the medical-psychiatric knowledge and turned into psychopathologies which tend to be treated with the main resource made available by psychiatrics in the present times: the psychotropic drugs. This work presents a critical thinking on the expansion of the diagnoses of “attention deficit disorder and hyperactivity” (ADHD) both in children and teenagers and on the conduction of drug therapies. It follows that the processes of childhood psycho-pathologization and the trivializing of psychotropic drug prescription are related to the overvaluation of the biological conception of psychic suffering and to the economic interests of the great pharmaceutical laboratories which by means of several strategies influence the medical practices, factors that lead to exposure of these patients to possible side effects and the risks of stigmatization that must be considered.

Mental health of the elderly: perceptions related to aging

To understand the elderly's perception of their current condition. Methodology. Study undertaken in 2012 using the qualitative method of Minayo and the thematic analysis according to Bardin's suggestions. Data were collected through semi-structured interviews that took place in the homes of the elderly people. The guiding question was: At this point in your life, how do you feel? Tell me. Results. The elderly who were satisfied stated that this was due to the good relationship with their family, spouse, to the fact of having autonomy and respect from the society. Those who were shown to be dissatisfied reported lack of family support, physical limitations imposed by age and the presence of illnesses as the main causes. Conclusion. The adult population requires the use of care technologies that cover all the stages of life, including old age. Nursing professionals should be prepared for the increasing care demand of these people.

Impact of functional training on cardiac autonomic modulation, cardiopulmonary parameters and quality of life in healthy women

Coordenação de Aperfeiçoamentode Pessoal de Nível Superior (CAPES)

Risco da síndrome da apneia obstrutiva do sono em amostra populacional da cidade de Botucatu - SP

The most common sleep disorder is obstructive sleep apnea syndrome (OSAS), that is characterized by repeated pauses in breathing during sleep, resulting in partial or complete obstruction of the upper airway. It is associated with systemic arterial hypertension and obesity. Objective: To assess the frequency of OSAS in the adult population of Botucatu by the Berlin questionnaire. Method: Transveral study was performed in which the sample size was estimated at 385 individuals. The Berlin questionnaire was administered to adults randomly on the streets, supermarkets and local shops. Data were analyzed taking into account age, gender, "high risk for OSAS", hypertension, obesity and correlations for OSAS. Results: 468 people interviewed were aged between 18 and 95 years, average of 59 years. 166 (35.25%) individuals were identified as "high risk for OSAS", being more frequent in the population above 40 years. Obesity was present in 23.3%, more common in women (60.2%). 83.5% of the population obese also had a "high risk for OSAS". Hypertension was observed in 27.3%, of these 71.9% were at "high risk for OSAS". Conclusion: The study showed a high frequency of "high risk for OSAS" in the adult population. Despite the dissemination by the media about sleep apnea, patients are not investigated, even under medical care for hypertension.

Ischemic heart disease and correlates in adults from Ribeirao Preto, Brazil

OBJECTIVE: To identify the prevalence of ischemic heart disease (IHD) and correlates in an adult population. METHODS: Cross-sectional population-based epidemiological study including a weighted sample of 2,471 adults of both sexes and with age 30 years or older residing in Ribeirao Preto, Southeastern Brazil, in 2007. The Rose Questionnaire was administered, and IHD prevalence was calculated with point estimates and 95% confidence intervals. To identify correlates (sociodemographic, cardiovascular risk factors, and those related to access to health services and to physical activity level), crude and adjusted prevalence ratios were estimated using Poisson regression. RESULTS: IHD prevalence was higher in females than males at all age strata. In the final model, the following variables were independently associated with IHD: work status (PR = 0.54 [0.37; 0.78]); family history of IHD (PR = 1.55 [1.12;2.13]); hypertension (PR = 1.70 [1.18;2.46]); self-reported health status (PR=2.15 [1.40;3.31]); smoking duration (third tertile) (PR=1.73 [1.08;2.76]); adjusted waist circumference (PR=1.79 [1.21;2.65]) and hypertriglyceridemia (PR=1.48 [1.05;2.10]). Linear trend test of PR across self-reported health status categories was statistically significant (p<0.05). CONCLUSIONS: A high prevalence of IHD was found, and the factors associated with the outcome are almost all modifiable and potentially influenced by public policy interventions.

Prevalence of excessive daytime sleepiness and associated factors in women aged 35-49 years from the "Pindamonhangaba Health Project" (PROSAPIN)

OBJETIVO: Estimar a prevalência da sonolência diurna excessiva (SDE) e identificar os fatores associados em mulheres de 35 a 49 anos de idade do "Projeto de Saúde de Pindamonhangaba" (PROSAPIN). MÉTODOS: O estudo foi observacional transversal com 372 mulheres com idade entre 35 e 49 anos selecionadas aleatoriamente da Estratégia Saúde da Família (ESF) do município de Pindamonhangaba, São Paulo, onde é desenvolvido o "Projeto de Saúde de Pindamonhangaba" (PROSAPIN). A SDE foi avaliada por entrevista utilizando a Escala de Sonolência de Epworth e os fatores associados por meio de questões que investigaram as características sócio-demográficas, a história ginecológica, a presença de comorbidades, o estilo de vida, a rotina de sono e o uso de medicamentos capazes de alterar o estado de alerta, além de mensuradas as variáveis antropométricas. Estimou-se a prevalência da SDE com intervalo de confiança de 95% (IC 95%) e foram identificados os fatores associados por meio de um modelo de regressão logística múltipla realizado no Programa Stata, versão 10.0. RESULTADOS: A prevalência da SDE foi de 18,5% (IC 95%: 14,7- 22,9) e os fatores associados foram: profissão relacionada a serviços domésticos (OR = 2,2; IC 95%: 1,1-4,3), nível de atividade física acima da média da população estudada (OR = 1,9; IC 95%: 1,1-3,4); e a presença de características sugestivas de ansiedade (OR = 1,9; IC 95%: 1,1-3,4). CONCLUSÃO: A prevalência da SDE em mulheres de 35 a 49 anos do PROSAPIN foi elevada e associada à característica sociodemográfica, à presença de comorbidades e ao estilo de vida.

Factors associated with smoking in the elderly: a health survey in Sao Paulo (ISA-SP)

This article reports on smoking prevalence and associated factors in the elderly, based on a population-based cross-sectional study with multistage sampling including 1,954 individuals 60 years or older living in four areas of Sao Paulo State, Brazil. Overall smoking prevalence was 12.2%, and higher rates were associated with male gender, age 60-69 years, not belonging to an Evangelical church, lower income, low body weight, lack of leisure-time physical activity, depression/anxiety, and hypertension. There was a high prevalence of smokers among individuals with a history of stroke, cancer, and chronic obstructive pulmonary disease. The results point to the need for effective interventions in healthcare services to promote smoking cessation among the elderly, since many are unable to stop on their own, even when they have tobacco-related illnesses. Special attention should be paid to individuals that depend on the National Health System, since smoking prevalence is higher in underprivileged socioeconomic groups.

Statistical Innovations Improve Prevalence Estimates of Nutrient Risk Populations: Applications in Sao Paulo, Brazil

The objective of this study was to estimate the prevalence of inadequate micronutrient intake and excess sodium intake among adults age 19 years and older in the city of Sao Paulo, Brazil. Twenty-four hour dietary recall and sociodemographic data were collected from each participant (n=1,663) in a cross-sectional study, Inquiry of Health of Sao Paulo, of a representative sample of the adult population of the city of Sao Paulo in 2003 (ISA-2003). The variability in intake was measured through two replications of the 24-hour recall in a subsample of this population in 2007 (ISA-2007). Usual intake was estimated by the PC-SIDE program (version 1.0, 2003, Department of Statistics, Iowa State University), which uses an approach developed by Iowa State University. The prevalence of nutrient inadequacy was calculated using the Estimated Average Requirement cut-point method for vitamins A and C, thiamin, riboflavin, niacin, copper, phosphorus, and selenium. For vitamin D, pantothenic acid, manganese, and sodium, the proportion of individuals with usual intake equal to or more than the Adequate Intake value was calculated. The percentage of individuals with intake equal to more than the Tolerable Upper Intake Level was calculated for sodium. The highest prevalence of inadequacy for males and females, respectively, occurred for vitamin A (67% and 58%), vitamin C (52% and 62%), thiamin (41% and 50%), and riboflavin (29% and 19%). The adjustment for the within-person variation presented lower prevalence of inadequacy due to removal of within-person variability. All adult residents of Sao Paulo had excess sodium intake, and the rates of nutrient inadequacy were high for certain key micronutrients. J Acad Nutr Diet. 2012;112:1614-1618.

Lifetime Prevalence, Age and Gender Distribution and Age-of-Onset of Psychiatric Disorders in the Sao Paulo Metropolitan Area, Brazil: Results from the Sao Paulo Megacity Mental Health Survey

Objectives: To estimate prevalence, age-of-onset, gender distribution and identify correlates of lifetime psychiatric disorders in the Sao Paulo Metropolitan Area (SPMA). Methods: The Sao Paulo Megacity Mental Health Survey assessed psychiatric disorders on a probabilistic sample of 5,037 adult residents in the SPMA, using the World Mental Health Survey Version of the Composite International Diagnostic Interview. Response rate was 81.3%. Results: Lifetime prevalence for any disorder was 44.8%; estimated risk at age 75 was 57.7%; comorbidity was frequent. Major depression, specific phobias and alcohol abuse were the most prevalent across disorders; anxiety disorders were the most frequent class. Early age-of-onset for phobic and impulse-control disorders and later age-of-onset for mood disorders were observed. Women were more likely to have anxiety and mood disorders, whereas men, substance use disorders. Apart from conduct disorders, more frequent in men, there were no gender differences in impulse-control disorders. There was a consistent trend of higher prevalence in the youngest cohorts. Low education level was associated to substance use disorders. Conclusions: Psychiatric disorders are highly prevalent among the general adult population in the SPMA, with frequent comorbidity, early age-of-onset for most disorders, and younger cohorts presenting higher rates of morbidity. Such scenario calls for vigorous public health action.

Auditory brainstem implant outcomes and MAP parameters: Report of experiences in adults and children

The auditory brainstem implant (ABI) was first developed to help neurofibromatosis type 2 patients. Recently, its use has been recently extended to adults with non-tumor etiologies and children with profound hearing loss who were not candidates for a cochlear implant (Cl). Although the results has been extensively reported, the stimulation parameters involved behind the outcomes have received less attention. Objective: The aim of this study is to describe the audiologic outcomes and the MAP parameters in ABI adults and children at our center. Methods: Retrospective chart review. Five adults and four children were implanted with the ABI24M from September 2005 to June 2009. In the adult patients, four had Neurofibromatosis type 2, and one had postmeningitic deafness with complete ossification of both cochleae. Three of the children had cochlear malformation or dysplasia, and one had complete ossified cochlea due to meningitis. Map parameters as well as the intraoperative electrical auditory brainstem responses were collected. Evaluation was performed with at least six months of device use and included free-field hearing thresholds, speech perception tests in the adult patients and for the children, the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) and (ESP) were used to evaluate the development of auditory skills, besides the MUSS to evaluate. Results: The number of active electrodes that did not cause any non-auditory sensation varied from three to nineteen. All of them were programmed with SPEAK strategy, and the pulse widths varied from 100 to 300 mu s. Free-field thresholds with warble tones varied from very soft auditory sensation of 70 dBHL at 250 Hz to a pure tone average of 45 dBHL. Speech perception varied from none to 60% open-set recognition of sentences in silence in the adult population and from no auditory sensation at all to a slight improvement in the IT-MAIS/MAIS scores. Conclusion: We observed that ABI may be a good option for offering some hearing attention to both adults and children. In children, the results might not be enough to ensure oral language development. Programming the speech processor in children demands higher care to the audiologist. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Lifetime Prevalence, age and gender distribution and age-of-onset of psychiatric disorders in the São Paulo Metropolitan Area, Brazil: results from the São Paulo Megacity Mental Health Survey

OBJECTIVES: To estimate prevalence, age-of-onset, gender distribution and identify correlates of lifetime psychiatric disorders in the São Paulo Metropolitan Area (SPMA). METHODS: The São Paulo Megacity Mental Health Survey assessed psychiatric disorders on a probabilistic sample of 5,037 adult residents in the SPMA, using the World Mental Health Survey Version of the Composite International Diagnostic Interview. Response rate was 81.3%. RESULTS: Lifetime prevalence for any disorder was 44.8%; estimated risk at age 75 was 57.7%; comorbidity was frequent. Major depression, specific phobias and alcohol abuse were the most prevalent across disorders; anxiety disorders were the most frequent class. Early age-of-onset for phobic and impulse-control disorders and later age-of-onset for mood disorders were observed. Women were more likely to have anxiety and mood disorders, whereas men, substance use disorders. Apart from conduct disorders, more frequent in men, there were no gender differences in impulse-control disorders. There was a consistent trend of higher prevalence in the youngest cohorts. Low education level was associated to substance use disorders. CONCLUSIONS: Psychiatric disorders are highly prevalent among the general adult population in the SPMA, with frequent comorbidity, early age-of-onset for most disorders, and younger cohorts presenting higher rates of morbidity. Such scenario calls for vigorous public health action.

Resident angiogenic mesenchymal stem cells from multiorgan donor thoracic aortas

Stem cells are one of the most fascinating areas of biology today, and since the discover of an adult population, i.e., adult Stem Cells (aSCs), they have generated much interest especially for their application potential as a source for cell based regenerative medicine and tissue engineering. aSCs have been found in different tissues including bone marrow, skin, intestine, central nervous system, where they reside in a special microenviroment termed “niche” which regulate the homeostasis and repair of adult tissues. The arterial wall of the blood vessels is much more plastic than ever before believed. Several animal studies have demonstrated the presence of cells with stem cell characteristics within the adult vessels. Recently, it has been also hypothesized the presence of a “vasculogenic zone” in human adult arteries in which a complete hierarchy of resident stem cells and progenitors could be niched during lifetime. Accordingly, it can be speculated that in that location resident mesenchymal stem cells (MSCs) with the ability to differentiate in smooth muscle cells, surrounding pericytes and fibroblasts are present. The present research was aimed at identifying in situ and isolating MSCs from thoracic aortas of young and healthy heart-beating multiorgan donors. Immunohistochemistry performed on fresh and frozen human thoracic aortas demonstrated the presence of the vasculogenic zone between the media and the adventitial layers in which a well preserved plexus of CD34 positive cells was found. These cells expressed intensely HLA-I antigens both before and after cryopreservation and after 4 days of organ cultures remained viable. Following these preliminary results, we succeeded to isolate mesenchymal cells from multi-organ thoracic aortas using a mechanical and enzymatic combined procedure. Cells had phenotypic characteristics of MSC i.e., CD44+, CD90+, CD105+, CD166+, CD34low, CD45- and revealed a transcript expression of stem cell markers, e.g., OCT4, c-kit, BCRP-1, IL6 and BMI-1. As previously documented using bone marrow derived MSCs, resident vascular wall MSCs were able to differentiate in vitro into endothelial cells in the presence of low-serum supplemented with VEGF-A (50 ng/ml) for 7 days. Under the condition described above, cultured cells showed an increased expression of KDR and eNOS, down-regulation of the CD133 transcript, vWF expression as documented by flow cytometry, immunofluorescence, qPCR and TEM. Moreover, matrigel assay revealed that VEGF induced cells were able to form capillary-like structures within 6 hours of seeding. In summary, these findings indicate that thoracic aortas from heart-beating, multi-organ donors are highly suitable for obtaining MSCs with the ability to differentiate in vitro into endothelial cells. Even though their differentiating potential remains to be fully established, it is believed that their angiogenic ability could be a useful property for allogenic use. These cells can be expanded rapidly, providing numbers which are adequate for therapeutic neovascularization; furthermore they can be cryostored in appropriate cell banking facilities for later use.

Studio di popolazione sull'associazione tra sindrome delle gambe senza riposo ed emicrania

Introduzione: La sindrome delle gambe senza riposo (RLS) è un disturbo caratterizzato da sensazione spiacevole disestesica generalmente agli arti inferiori, che si presenta o peggiora nelle ore serali-notturne e che migliora con il movimento. Studi clinici hanno mostrato una maggiore prevalenza di RLS negli emicranici, mentre mancano studi condotti su popolazione generale non selezionata. Lo scopo di questo studio era quello di valutare la associazione tra emicrania e RLS in una popolazione italiana adulta. Inoltre è stata valutata l’associazione tra RLS e cefalea fenotipizzata attraverso metodica di principal components analysis (PCA). Materiali e metodi: la presenza di RLS e di emicrania è stata determinata attraverso questionari basati sui criteri diagnostici correnti in un campione di 1567 partecipanti di un fase preliminare di uno studio in corso sulla popolazione adulta della Val Venosta (BZ). Risultati: gli emicranici hanno presentato un significativo maggior rischio di soffrire di RLS rispetto ai non emicranici, anche dopo aggiustamento per fattori confondenti come età, sesso, depressione, ansia e qualità del sonno (p = 0.049). Questa associazione non era modificata dalla presenza di aura emicranica, di cause possibili di RLS secondaria e dalla frequenza di attacchi emicranici. Inoltre la RLS non era risultata significativamente associata alla cefalea di tipo tensivo (TTH). Dall’analisi di associazione tra RLS e cefalea fenotipizzata attraverso PCA era emerso che la componente 1, caratterizzata da sintomi di sensitivizzazione del sistema nervoso centrale (SNC), correlava significativamente con la presenza di RLS (p = 0.021). Conclusioni: RLS ed emicrania sono risultate associate nel nostro campione di popolazione adulta; inoltre la RLS ha mostrato una correlazione significativa con i sintomi di sensitivizzazione del SNC legati agli attacchi di cefalea. Questa associazione potrebbe risiedere in una possibile base patogenetica comune.

Die Rolle der Topoisomerase 2 beta in der normalen Herzfunktion sowie in der Entstehung der Herzinsuffizienz

Die Herzinsuffizienz (HI) ist eine der häufigsten und teuersten medizinischen Indikationen in der heutigen Zeit. rnIn der vorliegenden Arbeit konnte zum ersten Mal die Topoisomerase 2b (Top2b) in Zusammenhang mit der Entstehung einer dilatativen Kardiomyopathie gebracht werden. rnIn einem speziellen Mausmodell war es möglich, die Top2b gewebsspezifisch und zeitspezifisch nur in Kardiomyozyten zu deletieren. Dies geschah mittels eines Tamoxifen-induzierten Cre-Rekombinase-Gendeletionsmodells. Phänotypisch zeigten die Top2b-deletierten Mäuse 8 Wochen nach der Tamoxifen-Gabe signifikant reduzierte kardiale Ejektionsfraktionen sowie erhöhte linksventrikuläre enddiastolische und endsystolische Volumina. Weder Schlagvolumen noch Körpergewicht waren verändert. Die natriuretischen Peptide ANP und BNP waren in den Top2b-deletierten Tieren ebenfalls signifikant erhöht. Zusätzlich zeigten sowohl elektronenmikroskopische Untersuchungen als auch klassische histologische Verfahren fibrotische Veränderungen und erhöhte Kollagenablagerungen in Top2b-deletierten Tieren. Begleitend dazu stiegen die mRNA-Expressionslevel von Col1a1, Col3a1, Tgfβ1 und Tgfβ2 in den deletierten Tieren 8 Wochen nach der Implementierung der Deletion signifikant an. rnIn einer genomweiten Hochdurchsatz-Sequenzierung waren bereits 2 Wochen nach Tamoxifen-Gabe 128 Gene mindestens 2-fach gegenüber der Kontrollgruppe differentiell exprimiert. Eine genauere Analyse der veränderten Genexpression ließ bereits 14 Tage nach Implementierung der Deletion kardiale Verschlechterungen vermuten. So waren neben dem atrialen natriuretischen Peptid ANP die beiden häufigsten Kollagenarten im Herzen, Col3a1 und Col1a1, hochreguliert. rnInteressanterweise beinhalteten die 37 herunterregulierten Gene 11 Transkriptionsfaktoren. Da der Top2b in den letzten Jahren eine immer stärker werdende Bedeutung in der Transkription zugesprochen wird, sollte mittels Chromatin-Immunpräzipitation ein direkter Zusammenhang zwischen der Top2b-Deletion und der Herunterregulierung der 11 Transkriptionsfaktoren sowie die Bindung der Top2b an Promotoren ausgewählter, differentiell-exprimierter Gene untersucht werden. Generell konnte keine vermehrte Bindung von Top2b an Promotorbereiche gezeigt werden, was aber nicht dem generellen Fehlen einer Bindung gleichkommen muss. Vielmehr gab es methodische Schwierigkeiten, weshalb die Bedeutung der Top2b in der Transkription im Rahmen der vorliegenden Arbeit nicht ausreichend geklärt werden konnte.rnEine Kardiomyozyten-spezifische Top2b-Deletion mündete 8 Wochen nach Tamoxifen-Gabe in eine dilatative Kardiomyopathie. Zum gegenwärtigen Zeitpunkt sind keine klaren Aussagen zum zugrundeliegenden Mechanismus der entstehenden Herzschädigung in Folge einer Top2b-Deletion zu treffen. Es gibt jedoch Hinweise darauf, dass der Tumorsuppressormarker p53 eine wichtige Rolle in der Entstehung der dilatativen Kardiomyopathie spielen könnte. So konnte 8 Wochen nach der Top2b-Deletion mittels Chromatin-Immunpräzipitation eine erhöhte Bindung von p53 an Promotorregionen von Col1a1, Tgfβ2 und Mmp2 detektiert werden. Die Bedeutung dieser Bindung, und ob aufgrund dessen die Entstehung der Fibrose erklärt werden könnte, ist zum jetzigen Zeitpunkt unklar.rn