Prevalence and severity of dental fluorosis among students from João Pessoa, PB, Brazil

The aim of this study was to determine the prevalence and severity of dental fluorosis among 12-15-year-old students from João Pessoa, PB, Brazil before starting a program of artificial fluoridation of drinking water. The use of fluoridated dentifrice was also surveyed. A sample of 1,402 students was randomly selected. However, 31 students refused to participate and 257 were not permanent residents in João Pessoa, thus leaving a final sample of 1,114 students. Clinical exams were carried out by two calibrated dentists (Kappa = 0.78) under natural indirect light. Upper and lower front teeth were cleaned with gauze and dried, and then examined using the TF index for fluorosis. A questionnaire on dentifrice ingestion and oral hygiene habits was applied to the students. The results revealed that fluorosis prevalence in this age group was higher than expected (29.2%). Most fluorosis cases were TF = 1 (66.8%), and the most severe cases were TF = 4 (2.2%). The majority of the students reported that they had been using fluoridated dentifrices since childhood; 95% of the participants preferred brands with a 1,500 ppm F concentration, and 40% remembered that they usually ingested or still ingest dentifrice during brushing. It was concluded that dental fluorosis prevalence among students in João Pessoa is higher than expected for an area with non-fluoridated water. However, although most students use fluoridated dentifrices, and almost half ingest slurry while brushing, the majority of cases had little aesthetic relevance from the professionals' point of view, thus suggesting that fluorosis is not a public health problem in the locality.

Information and communication technology demands at work : the association with job strain, effort-reward imbalance and self-rated health in different socio-economic strata

PURPOSE: The use of information and communication technology (ICT) is common in modern working life. ICT demands may give rise to experience of work-related stress. Knowledge about ICT demands in relation to other types of work-related stress and to self-rated health is limited. Consequently, the aim of this study was to examine the association between ICT demands and two types of work-related stress [job strain and effort-reward imbalance (ERI)] and to evaluate the association between these work-related stress measures and self-rated health, in general and in different SES strata. METHODS: This study is based on cross-sectional data from the Swedish Longitudinal Occupational Survey of Health collected in 2014, from 14,873 gainfully employed people. ICT demands, job strain, ERI and self-rated health were analysed as the main measures. Sex, age, SES, lifestyle factors and BMI were used as covariates. RESULTS: ICT demands correlated significantly with the dimensions of the job strain and ERI models, especially with the demands (r = 0.42; p < 0.01) and effort (r = 0.51; p < 0.01) dimensions. ICT demands were associated with suboptimal self-rated health, also after adjustment for age, sex, SES, lifestyle and BMI (OR 1.49 [95 % CI 1.36-1.63]), but job strain (OR 1.93 [95 % CI 1.74-2.14) and ERI (OR 2.15 [95 % CI 1.95-2.35]) showed somewhat stronger associations with suboptimal self-rated health. CONCLUSION: ICT demands are common among people with intermediate and high SES and associated with job strain, ERI and suboptimal self-rated health. ICT demands should thus be acknowledged as a potential stressor of work-related stress in modern working life.

Severity in biliary peritonitis

Objective. To analyze clinical and laboratory findings in order to find variables predictive of severity of Biliary Peritonitis (BP). Patients and methods. Physical findings, course of illness, imaging and laboratory data were evaluated in 42 patients with BP, and statistically analysed to assess their prognostic significance. Results. Serious illness and worse outcome were associated with: age ≥ 60 years (P=0.034), long time between onset of symptoms and treatment (P=0.025), fever > 38°C (P=0.009), WBC count > 17,000 cell/mm³ (P=0.043), diffuse abdominal pain (P=0.034), and infected bile (P=0.048). Conclusions. Most patients become severely ill due to supervening infection, while early bile drainage avoids serious complications. In addition, abdominal pain, fever and WBC count are also predictive of severity of BP.

Is there a link between aspirin therapy and stroke severity

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Association between obstructive sleep apnea severity and glucose control in patients with untreated versus treated diabetes

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Stroke severity, early recovery and outcome are each related with clinical classification of stroke: data from the 'Tinzaparin in Acute Ischaemic Stroke Trial (TAIST)

Introduction: Baseline severity and clinical stroke syndrome (Oxford Community Stroke Project, OCSP) classification are predictors of outcome in stroke. We used data from the ‘Tinzaparin in Acute Ischaemic Stroke Trial’ (TAIST) to assess the relationship between stroke severity, early recovery, outcome and OCSP syndrome. Methods: TAIST was a randomised controlled trial assessing the safety and efficacy of tinzaparin versus aspirin in 1,484 patients with acute ischaemic stroke. Severity was measured as the Scandinavian Neurological Stroke Scale (SNSS) at baseline and days 4, 7 and 10, and baseline OCSP clinical classification recorded: total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) and posterior circulation infarction (POCI). Recovery was calculated as change in SNSS from baseline at day 4 and 10. The relationship between stroke syndrome and SNSS at days 4 and 10, and outcome (modified Rankin scale at 90 days) were assessed. Results: Stroke severity was significantly different between TACI (most severe) and LACI (mildest) at all four time points (p<0.001), with no difference between PACI and POCI. The largest change in SNSS score occurred between baseline and day 4; improvement was least in TACI (median 2 units), compared to other groups (median 3 units) (p<0.001). If SNSS did not improve by day 4, then early recovery and late functional outcome tended to be limited irrespective of clinical syndrome (SNSS, baseline: 31, day 10: 32; mRS, day 90: 4); patients who recovered early tended to continue to improve and had better functional outcome irrespective of syndrome (SNSS, baseline: 35, day 10: 50; mRS, day 90: 2). Conclusions: Although functional outcome is related to baseline clinical syndrome (best with LACI, worst with TACI), patients who improve early have a more favourable functional outcome, irrespective of their OCSP syndrome. Hence, patients with a TACI syndrome may still achieve a reasonable outcome if early recovery occurs.

Prevalence, severity and risk factors of allergic disorders among people in south India.

Background: Allergic disorders are not usually life-threatening conditions but they impair the person’s ability to function. It thus adversely affects the psychological wellbeing and quality of life. These implications of allergic disorders can be minimized if strategies are planned for its early identification followed by appropriate interventions. Objectives: To find out the prevalence and risk factors of allergic disorders. Methods: Data was collected by house to house survey among participants aged 18 years and above using a standardized allergy assessment questionnaire. Results: Mean age of the 400 participants was 42.8±14.7 years. Majority 105(26.2%) were in the age group 36 to 45 years. Majority were females 287(71.7%) and were house wives 217(54.2%). Majority of participants were of upper socio economic class 98(44.7%) out of 219 and majority were from urban areas 326(81.5%). The prevalence of allergy among participants was found to be 115(28.7%). Out of these 115, 37(32.2%) had possibility of allergy, 60(52.2%) had probability of allergy and the rest 18(15.6%) had very high likelihood for allergy. People residing in semi urban areas had increased risk of allergy (p=0.024) than those from urban areas. The prevalence of asthma was 30(7.5%) and skin allergy was 23(5.8%). Most common precipitating factors for allergy were dust exposure 103(25.8%) followed by seasonal changes 71(17.8%). Family history of allergy was associated with allergy among participants (p<0.001). Usage of firewood was associated with symptoms of respiratory allergy among participants (p=0.01). Conclusion: The study revealed some important determinants of allergic disorders which have important implications to frame appropriate prevention and health educational strategies.

Effort-reward imbalance and sedentary lifestyle: an observational study in a large occupational cohort

Objectives: To investigate the association between effort-reward imbalance (ERI) at work and sedentary lifestyle. Methods: Cross-sectional data from the ongoing Finnish Public Sector Study related to 30 433 women and 7718 men aged 17-64 were used (n = 35 918 after exclusion of participants with missing values in covariates). From the responses to a questionnaire, an aggregated mean score for ERI in a work unit was assigned to each participant. The outcome was sedentary lifestyle defined as <2.00 metabolic equivalent task (MET) hours/day. Logistic regression with generalized estimating equations was used as an analysis method to include both individual and work unit level predictors in the models. Adjustments were made for age, marital status, occupational status, job contract, smoking, and heavy drinking. Results: Twenty five percent of women and 27% of men had a sedentary lifestyle. High individual level ERI was associated with a higher likelihood of sedentary lifestyle both among women (odds ratio (OR) = 1.08, 95% CI 1.01 to 1.16) and men (OR = 1.17, 95% CI 1.02 to 1.33). These associations were not explained by relevant confounders and they were also independent of work unit level job strain measured as a ratio of job demands and control. Conclusions: A mismatch between high occupational effort spent and low reward received in turn seems to be associated with an elevated risk of sedentary lifestyle, although this association is relatively weak.

Effort-reward imbalance at work and the co-occurrence of lifestyle risk factors: cross-sectional survey in a sample of 36,127 public sector employees

Background In occupational life, a mismatch between high expenditure of effort and receiving few rewards may promote the co-occurrence of lifestyle risk factors, however, there is insufficient evidence to support or refute this hypothesis. The aim of this study is to examine the extent to which the dimensions of the Effort-Reward Imbalance (ERI) model – effort, rewards and ERI – are associated with the co-occurrence of lifestyle risk factors. Methods Based on data from the Finnish Public Sector Study, cross-sectional analyses were performed for 28,894 women and 7233 men. ERI was conceptualized as a ratio of effort and rewards. To control for individual differences in response styles, such as a personal disposition to answer negatively to questionnaires, occupational and organizational -level ecological ERI scores were constructed in addition to individual-level ERI scores. Risk factors included current smoking, heavy drinking, body mass index ≥25 kg/m2, and physical inactivity. Multinomial logistic regression models were used to estimate the likelihood of having one risk factor, two risk factors, and three or four risk factors. The associations between ERI and single risk factors were explored using binary logistic regression models. Results After adjustment for age, socioeconomic position, marital status, and type of job contract, women and men with high ecological ERI were 40% more likely to have simultaneously ≥3 lifestyle risk factors (vs. 0 risk factors) compared with their counterparts with low ERI. When examined separately, both low ecological effort and low ecological rewards were also associated with an elevated prevalence of risk factor co-occurrence. The results obtained with the individual-level scores were in the same direction. The associations of ecological ERI with single risk factors were generally less marked than the associations with the co-occurrence of risk factors. Conclusion This study suggests that a high ratio of occupational efforts relative to rewards may be associated with an elevated risk of having multiple lifestyle risk factors. However, an unexpected association between low effort and a higher likelihood of risk factor co-occurrence as well as the absence of data on overcommitment (and thereby a lack of full test of the ERI model) warrant caution in regard to the extent to which the entire ERI model is supported by our evidence.

CURB-65 and other markers of illness severity in community-acquired pneumonia among HIV-positive patients

Introduction: As the relative burden of community-acquired bacterial pneumonia among HIV-positive patients increases, adequate prediction of case severity on presentation is crucial. We sought to determine what characteristics measurable on presentation are predictive of worse outcomes. Methods: We studied all admissions for community-acquired bacterial pneumonia over 1 year at a tertiary centre. Patient demographics, comorbidities, HIV-specific markers and CURB-65 scores on Emergency Department presentation were reviewed. Outcomes of interest included mortality, bacteraemia, intensive care unit admission and orotracheal intubation. Results: A total of 396 patients were included, 49 HIV positive and 347 HIV negative. Mean CURB-65 score was 1.3 for HIV-positive and 2.2 for HIV-negative patients (p<0.0001), its predictive value for mortality being maintained in both groups (p¼0.03 and p<0.001, respectively). Adjusting for CURB-65 scores, HIV infection by itself was only associated with bacteraemia (adjusted odds ratio 7.1 CI 95% [2.6–19.5]). Patients with<200 CD4 cells/mL presented similar CURB- 65 adjusted mortality (adjusted odds ratio 1.7 CI 95% [0.2–15.2]), but higher risk of intensive care unit admission (adjusted odds ratio 5.7 CI 95% [1.5–22.0]) and orotracheal intubation (adjusted odds ratio 9.1 CI 95% [2.2–37.1]), compared to HIV-negative patients. These two associations were not observed in the>200 CD4 cells/mL subgroup (adjusted odds ratio 2.2 CI 95% [0.7–7.6] and adjusted odds ratio 0.8 CI 95% [0.1–6.5] respectively). Antiretroviral therapy and viral load suppression were not associated with different outcomes (p>0.05). Conclusions: High CURB-65 scores and CD4 counts<200 cells/mL were both associated with worse outcomes. Severity assessment scales and CD4 counts may both be helpful in predicting severity in HIV-positive patients presenting with community-acquired bacterial pneumonia.

The specific shapes of gender imbalance in scientific authorships : a network approach

Gender differences in collaborative research have received little at- tention when compared with the growing importance that women hold in academia and research. Unsurprisingly, most of bibliomet- ric databases have a strong lack of directly available information by gender. Although empirical-based network approaches are often used in the study of research collaboration, the studies about the influence of gender dissimilarities on the resulting topological outcomes are still scarce. Here, networks of scientific subjects are used to characterize patterns that might be associated to five categories of authorships which were built based on gender. We find enough evidence that gen- der imbalance in scientific authorships brings a peculiar trait to the networks induced from papers published in Web of Science (WoS) in- dexed journals of Economics over the period 2010-2015 and having at least one author affiliated to a Portuguese institution. Our re- sults show the emergence of a specific pattern when the network of co-occurring subjects is induced from a set of papers exclusively au- thored by men. Such a male-exclusive authorship condition is found to be the solely responsible for the emergence that particular shape in the network structure. This peculiar trait might facilitate future network analyses of research collaboration and interdisciplinarity.

Correlacion entre hemoglobina glicosilada con hallazgos sintax score ii en pacientes con sospecha clínica de enfermedad coronaria, hospitalizados en la unidad coronaria del hospital San José centro en enero a septiembre del año 2015

Se realiza un estudio de corte transversal en el periodo de enero a septiembre del año 2016 en la unidad coronaria del Hospital San José Centro de la Ciudad de Bogotá; en pacientes con sospecha de enfermedad coronaria (Síndrome coronario agudo y angina estable) y antecedente de Diabetes Mellitus Tipo 2, se recolectaron 42 pacientes con los criterios de inclusión a quienes se realizó angiografía coronaria como parte del protocolo de estudio y manejo de la unidad, el objetivo primario fue demostrar la posible correlación entre niveles de hemoglobina glicosilada y la escala de severidad SYNTAX Score I y II de enfermedad coronaria, como objetivos secundarios; caracterizar las variables sociodemográficas, comorbilidades y posible relación con el tipo de presentación de enfermedad coronaria. Como hallazgos relevantes no se encontró correlación importante ni significativa entre niveles de hemoglobina glicosilada y la escala Syntax score II ni Syntax score I, a pesar de que la mayoría de pacientes mostraban mal control crónico de su diabetes mellitus tipo 2, con niveles mayores > 7%, como hallazgo positivo se encontro asociación estadísticamente significativa con niveles de LDL y las diferentes formas de presentación de enfermedad coronaria, a mayor niveles de LDL mayor probabilidad de IAM e IAM con elevación del segmento ST. Se considera que con estudios multicentricos en diferentes ciudades y unidades de cuidado cardiovascular con diferentes niveles de riesgo, se podría demostrar la posible correlación entre niveles de hemoglobina glicosilada y los grados de severidad de enfermedad coronaria representados por las escalas Syntax score I y II.

Sex differences in coronary artery disease severity and mortality: the impact of conventional cardiovascular risk factors

It is still unknown whether traditional risk factors may have a sex specific impact on the severity of coronary artery disease (CAD) and subsequent mortality in acute coronary syndromes (ACS). We identified 14 793 patients who underwent coronary angiography for acute coronary syndromes in the ISACS-TC (NCT01218776) registry from 2010 to 2019. The main outcome measure was the association between conventional risk factors and severity of CAD and its relationship with 30-day mortality. Risk ratios (RRs) and 95% CIs were calculated from the ratio of the absolute risks of women versus men using inverse probability of weighting. Severity of disease was categorized as obstructive (≥50% stenosis) versus nonobstructive CAD, specifically Ischemia and No Obstructive Coronary Artery disease (INOCA) and Myocardial Infarction with Non obstructive Coronary Arteries (MINOCA). The RR ratio for obstructive CAD in women versus men among people without diabetes mellitus was 0.49(95%CI,0.41–0.60) and among those with diabetes mellitus was 0.89(95% CI,0.62–1.29), with an interaction by diabetes mellitus status of P =0.002. Exposure to smoking shifted the RR ratios from 0.50 (95% CI, 0.41–0.61) in nonsmokers to 0.75 (95%CI, 0.54–1.03) in current smokers, with an interaction by smoking status of P=0.018. There were no significant sex-related interactions with hypercholesterolemia and hypertension. Women with obstructive CAD had higher 30-day mortality rates than men (RR, 1.75; 95% CI, 1.48–2.07). No sex differences in mortality were observed in patients with INOCA/MINOCA. In conclusion, obstructive CAD in women signifies a higher risk for mortality compared with men. Current smoking and diabetes mellitus disproportionally increase the risk of obstructive CAD in women. Achieving the goal of improving cardiovascular health in women still requires intensive efforts toward further implementation of lifestyle and treatment interventions.

The predictive role of the human gut microbiota in covid-19: implications for disease severity and post-covid syndrome

The COVID-19 pandemic, sparked by the SARS-CoV-2 virus, stirred global comparisons to historical pandemics. Initially presenting a high mortality rate, it later stabilized globally at around 0.5-3%. Patients manifest a spectrum of symptoms, necessitating efficient triaging for appropriate treatment strategies, ranging from symptomatic relief to antivirals or monoclonal antibodies. Beyond traditional approaches, emerging research suggests a potential link between COVID-19 severity and alterations in gut microbiota composition, impacting inflammatory responses. However, most studies focus on severe hospitalized cases without standardized criteria for severity. Addressing this gap, the first study in this thesis spans diverse COVID-19 severity levels, utilizing 16S rRNA amplicon sequencing on fecal samples from 315 subjects. The findings highlight significant microbiota differences correlated with severity. Machine learning classifiers, including a multi-layer convoluted neural network, demonstrated the potential of microbiota compositional data to predict patient severity, achieving an 84.2% mean balanced accuracy starting one week post-symptom onset. These preliminary results underscore the gut microbiota's potential as a biomarker in clinical decision-making for COVID-19. The second study delves into mild COVID-19 cases, exploring their implications for ‘long COVID’ or Post-Acute COVID-19 Syndrome (PACS). Employing longitudinal analysis, the study unveils dynamic shifts in microbial composition during the acute phase, akin to severe cases. Innovative techniques, including network approaches and spline-based longitudinal analysis, were deployed to assess microbiota dynamics and potential associations with PACS. The research suggests that even in mild cases, similar mechanisms to hospitalized patients are established regarding changes in intestinal microbiota during the acute phase of the infection. These findings lay the foundation for potential microbiota-targeted therapies to mitigate inflammation, potentially preventing long COVID symptoms in the broader population. In essence, these studies offer valuable insights into the intricate relationships between COVID-19 severity, gut microbiota, and the potential for innovative clinical applications.