Socio-behavioral factors influence prevalence and severity of dental caries in children with primary dentition

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

Occlusal caries prevention in high and low risk schoolchildren. A clinical trial

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

Differential nutritional, endocrine, and cardiovascular effects in obesity-prone and obesity-resistant rats fed standard and hypercaloric diets

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

N-acetylcysteine in high-sucrose diet-induced obesity: Energy expenditure and metabolic shifting for cardiac health

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

Prevention or repression? The false dilemma of citizen security

Includes bibliography

Influência da prática de atividades físicas sobre os gastos com o tratamento ambulatorial de pacientes da rede pública de Bauru, São Paulo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Efeitos de instruções, treino de relato verbal e treino de automonitoração sobre o seguimento de regras nutricionais em crianças com obesidade ou sobrepeso

A obesidade é uma doença crônica definida como o acúmulo de gordura anormal ou excessiva que pode prejudicar a saúde. Torna-se necessário intervir no seu combate e prevenção, especialmente entre as crianças. A literatura da área indica que, em geral, intervenções apenas com crianças ou com cuidadores, ou com ambos, apresentam resultados favoráveis. Neste estudo foram avaliados os efeitos de instruções, do treino de relato verbal (TRV) e do treino de automonitoração (TA), aplicados com e sem a participação do cuidador principal, sobre o seguimento de regras nutricionais em crianças com obesidade ou sobrepeso. Participaram duas crianças (9 e 11 anos) e suas cuidadoras primárias. O ambiente foi um consultório do ambulatório de psicologia de um hospital universitário. Foram utilizados: Prontuário dos pacientes, Roteiro de entrevista inicial, Inventário de estilos parentais (IEP), Roteiro de entrevista 2, Recordatório 24 horas, Manual informativo sobre obesidade e alimentação saudável, Teste de conhecimentos, Protocolo de orientação nutricional para crianças, Protocolo de automonitoração, Roteiro para análise do protocolo de automonitoração, jogos e brinquedos e Roteiro de entrevista final. O procedimento de coleta ocorreu em 10 sessões distribuídas em aproximadamente 15 semanas e consistiu de análise dos prontuários; entrevista no ambulatório com o cuidador e com a criança para assinatura do Termo de Consentimento Livre e Esclarecido, aplicação do roteiro de entrevista inicial e do IEP; inserção dos participantes em uma de duas condições (Condição 1, apenas a criança [P1] presente; Condição 2, tanto a criança [P2] quanto seu cuidador primário [C2] estavam presentes); aplicação do Roteiro de entrevista 2 seguido da aplicação do Recordatório 24 horas (Linha de Base 1 [LB1]); aplicação do Manual informativo sobre obesidade e alimentação saudável e do Teste de conhecimentos; TRV (Linha de Base 2 [LB2]); TA; entrevista de acompanhamento e entrevista de encerramento. Quanto aos efeitos das instruções, os resultados indicam que P1 manteve a mesma classificação em todos os itens, enquanto P2 melhorou seu desempenho nos itens conhecimento e seguimento das orientações nutricionais e C2 apresentou melhora no conhecimento sobre obesidade ao final do estudo. Os Índices de adesão à dieta obtidos por P2 foram mais elevados do que os obtidos por P1 em todas as fases da pesquisa. Comparando-se a média obtida pelos dois participantes em LB1 e LB2, observou-se aumento de 39,77% indicando mudança com significância clínica após intervenção. A combinação de variáveis nesta pesquisa mostrou-se favorável a ampliação do repertório dos participantes em relação ao comportamento alimentar, tendo como referência o próprio sujeito ao longo do estudo. Os resultados sugerem que há maior eficácia quando crianças e cuidadores são alvo de intervenção.

Retinoids for prevention and treatment of actinic keratosis

Actinic keratosis is a common cause of dermatological consultations and it presents a strong association with squamous cell carcinoma. Many substances are used for treatment and prevention, such as retinoids. Nevertheless, many studies on retinoids emphasize their application in treating and preventing non melanoma skin cancers. In this article, we reviewed studies about systemic and topical retinoids used with immunocompetent patients and organ transplant recipients with actinic keratosis, as primary or secondary outcomes. The majority of these papers pointed to a reduction in actinic keratosis count after treatment with retinoids. However, studies need to be better-defined in order to address the lack of a standardized dose, the absence of control groups, the low number of patients and short follow-up periods. Blind, randomized and controlled clinical trials with adequate sample sizes, specifically focused on actinic keratosis, are needed to clarify the real benefit of topical and/or oral retinoids. Comparison of efficacy and safety between oral and topical retinoids in the prevention and treatment of non-melanoma skin cancers and actinic keratosis is an essential pre requisite to establish new strategies to control these conditions.

Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

BackgroundThis is an update of a Cochrane Review first published in The Cochrane Library 2008, Issue 3.Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry compared to no therapy or physiotherapy, including coughing and deep breathing, on all-cause postoperative pulmonary complications andmortality in adult patients admitted to hospital for upper abdominal surgery.ObjectivesOur primary objective was to assess the effect of incentive spirometry (IS), compared to no such therapy or other therapy, on postoperative pulmonary complications and mortality in adults undergoing upper abdominal surgery.Our secondary objectives were to evaluate the effects of IS, compared to no therapy or other therapy, on other postoperative complications, adverse events, and spirometric parameters.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE, EMBASE, and LILACS (from inception to August 2013). There were no language restrictions. The date of the most recent search was 12 August 2013. The original search was performed in June 2006.Selection criteriaWe included randomized controlled trials (RCTs) of IS in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.Data collection and analysisTwo authors independently assessed trial quality and extracted data.Main resultsWe included 12 studies with a total of 1834 participants in this updated review. The methodological quality of the included studies was difficult to assess as it was poorly reported, so the predominant classification of bias was 'unclear'; the studies did not report on compliance with the prescribed therapy. We were able to include data from only 1160 patients in the meta-analysis. Four trials (152 patients) compared the effects of IS with no respiratory treatment. We found no statistically significant difference between the participants receiving IS and those who had no respiratory treatment for clinical complications (relative risk (RR) 0.59, 95% confidence interval (CI) 0.30 to 1.18). Two trials (194 patients) IS compared incentive spirometry with deep breathing exercises (DBE). We found no statistically significant differences between the participants receiving IS and those receiving DBE in the meta-analysis for respiratory failure (RR 0.67, 95% CI 0.04 to 10.50). Two trials (946 patients) compared IS with other chest physiotherapy. We found no statistically significant differences between the participants receiving IS compared to those receiving physiotherapy in the risk of developing a pulmonary condition or the type of complication. There was no evidence that IS is effective in the prevention of pulmonary complications.Authors' conclusionsThere is low quality evidence regarding the lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large RCTs with high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.

Knowledge and practice of women regarding cervical cancer in a primary health care unit

Objectives: evaluating the level of information about the examination of uterine cervical cancer and its association with sociodemographic variables in women of a health care unit in the city of Bauru, São Paulo, Brazil. Methods: we conducted a cross-sectional descriptive study with 370 women aged 25 to 59, through structured interviews in their own homes; we used descriptive statistics and the χ2 test. Results: 40.5% of the women had not undergone the Papanicolaou test at the recommended frequency; 58.2% incorrectly defined the test, and 69.5% did not know about the risk factors for the development of cervical cancer; the knowledge about the test showed statistically significant association with schooling and family income of the studied population. Conclusions: women present deficiencies on the proper practice of the Papanicolaou test, on knowledge about the test, risk factors and prevention methods. Therefore, it is necessary to develop primary health actions for the most vulnerable population.

The Effect of a Community-Based, Primary Health Care Exercise Program on Inflammatory Biomarkers and Hormone Levels

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Zinc supplementation for the prevention of type 2 diabetes mellitus in adults with insulin resistance

BackgroundDiabetes is associated with long-term damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. The risk of developing type 2 diabetes increases with age, obesity and lack of physical activity. Insulin resistance is a fundamental aspect of the aetiology of type 2 diabetes. Insulin resistance has been shown to be associated with atherosclerosis, dyslipidaemia, glucose intolerance, hyperuricaemia, hypertension and polycystic ovary syndrome. The mineral zinc plays a key role in the synthesis and action of insulin, both physiologically and in diabetes mellitus. Zinc seems to stimulate insulin action and insulin receptor tyrosine kinase activity.ObjectivesTo assess the effects of zinc supplementation for the prevention of type 2 diabetes mellitus in adults with insulin resistance.Search methodsThis review is an update of a previous Cochrane systematic review published in 2007. We searched the Cochrane Library (2015, Issue 3), MEDLINE, EMBASE, LILACS and the ICTRP trial register (frominception toMarch 2015). There were no language restrictions. We conducted citation searches and screened reference lists of included studies.Selection criteriaWe included studies if they had a randomised or quasi-randomised design and if they investigated zinc supplementation compared with placebo or no intervention in adults with insulin resistance living in the community.Data collection and analysisTwo review authors selected relevant trials, assessed risk of bias and extracted data.Main resultsWe included three trials with a total of 128 participants in this review. The duration of zinc supplementation ranged between four and 12 weeks. Risk of bias was unclear for most studies regarding selection bias (random sequence generation, allocation concealment) and detection bias (blinding of outcome assessment). No study reported on our key outcome measures (incidence of type 2 diabetes mellitus, adverse events, health-related quality of life, all-cause mortality, diabetic complications, socioeconomic effects). Evaluation of insulin resistance as measured by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) showed neutral effects when comparing zinc supplementation with control (two trials; 114 participants). There were neutral effects for trials comparing zinc supplementation with placebo for total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides (2 studies, 70 participants). The one trial comparing zinc supplementation with exercise also showed neutral effects for total cholesterol, HDL and LDL cholesterol, and a mean difference in triglycerides of -30 mg/dL (95% confidence interval (CI) -49 to -10) in favour of zinc supplementation (53 participants). Various surrogate laboratory parameters were also analysed in the included trials.Authors'conclusionsThere is currently no evidence on which to base the use of zinc supplementation for the prevention of type 2 diabetes mellitus. Future trials should investigate patient-important outcome measures such as incidence of type 2 diabetes mellitus, health-related quality of life, diabetic complications, all-cause mortality and socioeconomic effects.

Obesity does not lead to imbalance between myocardial phospholamban phosphorylation and dephosphorylation

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

The role of oxidative stress in renal injury related to obesity

The mechanisms linking obesity to kidney damage are unknown. AGEs are responsible for renal damage in obese individuals. The receptor AGEs (RAGE) contributes to nuclear transcription factors that result in the production of proinflammatory cytokines and this seems to contribute to the development of renal disease. Thus, intervention with antioxidant can have an important effect in the prevention and treatment of pro-oxidant and pro-inflammatory state in the kidneys resulting from obesity.

Acetylcysteine for Prevention of Renal Outcomes in Patients Undergoing Coronary and Peripheral Vascular Angiography Main Results From the Randomized Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT)

Background-It remains uncertain whether acetylcysteine prevents contrast-induced acute kidney injury. Methods and Results-We randomly assigned 2308 patients undergoing an intravascular angiographic procedure with at least 1 risk factor for contrast-induced acute kidney injury (age >70 years, renal failure, diabetes mellitus, heart failure, or hypotension) to acetylcysteine 1200 mg or placebo. The study drugs were administered orally twice daily for 2 doses before and 2 doses after the procedure. The allocation was concealed (central Web-based randomization). All analysis followed the intention-to-treat principle. The incidence of contrast-induced acute kidney injury (primary end point) was 12.7% in the acetylcysteine group and 12.7% in the control group (relative risk, 1.00; 95% confidence interval, 0.81 to 1.25; P = 0.97). A combined end point of mortality or need for dialysis at 30 days was also similar in both groups (2.2% and 2.3%, respectively; hazard ratio, 0.97; 95% confidence interval, 0.56 to 1.69; P = 0.92). Consistent effects were observed in all subgroups analyzed, including those with renal impairment. Conclusions-In this large randomized trial, we found that acetylcysteine does not reduce the risk of contrast-induced acute kidney injury or other clinically relevant outcomes in at-risk patients undergoing coronary and peripheral vascular angiography.