The prevalence of caries in patients referred for orthodontic assessment in Northern Ireland – A retrospective study

Objectives: To determine the prevalence of untreated carious lesions in permanent teeth in patients (under the age of 18) referred for an orthodontic assessment in specialist practice. In addition, the figures shall be compared with national data for Northern Ireland (as outlined in the recent Child Dental Health Survey 2013)
The Gold standard would be that 100% of patients would be caries free upon presentation.

Methods: The clinical records and radiographs (OPT of quality grading 1 or 2) of 337 patients were reviewed. This encompassed patients who had an orthodontic assessment carried out in specialist practice over a 6 month period (following referral from their general dental practitioner)

Results: A total of 337 patient records were examined. Of these, 149 were male (44.2%) and 188 were female (55.8%), with an age range of 7-17 years at the time of new patient assessment. It was found that 36 patients (10.7%) had evidence (clinical and/or radiographic) of active and untreated dental caries. Of those affected, 14 were male and 22 were female.
Breaking the data down in terms of age, we can also get some indication as to how this cohort compares with national data for Northern Ireland :⃰

7-10 years (Mean = 9.3) = 14.3% caries (versus NI average of 6% for 8 year olds)
11-13 years (Mean = 12.1) = 10.1% caries, (versus NI average of 16% for 12 year olds)
14-17 years (Mean = 15.2) = 9.1% caries (versus NI average of 15% for 15 year olds)

⃰using the diagnostic threshold “Decay into dentine (visual dentine caries excluded)”


Conclusion: In this sample group, a total of 10.7% of patients (9.4% of males, 11.7% of females) presented with evidence of undiagnosed caries upon being assessed as a new patient in specialist orthodontic practice. Hence, the gold standard was not met.

Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study)

AIMS: Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment.

METHODS AND RESULTS: This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12-51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries.

CONCLUSION: Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.

Increasing fruit and vegetable intake has no effect on retinal vessel caliber in adults at high risk of developing cardiovascular disease

BACKGROUND AND AIM: Retinal vessel abnormalities are associated with cardiovascular disease (CVD) risk. To date, there are no trials investigating the effect of dietary factors on the retinal microvasculature. This study examined the dose response effect of fruit and vegetable (FV) intake on retinal vessel caliber in overweight adults at high CVD risk.

METHODS AND RESULTS: Following a 4 week washout period, participants were randomized to consume either 2 or 4 or 7 portions of FV daily for 12 weeks. Retinal vessel caliber was measured at baseline and post-intervention. A total of 62 participants completed the study. Self-reported FV intake indicated good compliance with the intervention, with serum concentrations of zeaxanthin and lutein increasing significantly across the groups in a dose-dependent manner (P for trend < 0.05). There were no significant changes in body composition, 24-h ambulatory blood pressure or fasting blood lipid profiles in response to the FV intervention. Increasing age was a significant determinant of wider retinal venules (P = 0.004) whereas baseline systolic blood pressure was a significant determinant of narrower retinal arterioles (P = 0.03). Overall, there was no evidence of any short-term dose-response effect of FV intake on retinal vessel caliber (CRAE (P = 0.92) or CRVE (P = 0.42)).

CONCLUSIONS: This study demonstrated no effect of increasing FV intake on retinal vessel caliber in overweight adults at high risk of developing primary CVD.

A Role for Behavior in the Relationships Between Depression and Hostility and Cardiovascular Disease Incidence, Mortality, and All-Cause Mortality: the Prime Study

BACKGROUND: Behavioral factors are important in disease incidence and mortality and may explain associations between mortality and various psychological traits.

PURPOSE: These analyses investigated the impact of behavioral factors on the associations between depression, hostility and cardiovascular disease(CVD) incidence, CVD mortality, and all-cause mortality.

METHODS: Data from the PRIME Study (N = 6953 men) were analyzed using Cox proportional hazards models, following adjustment for demographic and biological CVD risk factors, and other psychological traits, including social support.

RESULTS: Following initial adjustment, both depression and hostility were significantly associated with both mortality outcomes (smallest SHR = 1.24, p < 0.001). Following adjustment for behavioral factors, all relationships were attenuated both when accounting for and not accounting for other psychological variables. Associations with all-cause mortality remained significant (smallest SHR = 1.14, p = 0.04). Of the behaviors included, the most significant contribution to outcomes was found for smoking, but a role was also found for fruit and vegetable intakes and high alcohol consumption.

CONCLUSIONS: These findings demonstrate well-known associations between depression, hostility, and mortality and suggest the potential importance of behaviors in explaining these relationships.

Serum 25-hydroxyvitamin D and insulin resistance in people at high risk of cardiovascular disease: a euglycaemic hyperinsulinaemic clamp study

CONTEXT: In observational studies low serum 25-hydroxyvitamin D (25-OHD) concentration is associated with an increased risk of type 2 diabetes mellitus (DM). Increasing serum 25-OHD may have beneficial effects on insulin resistance or beta-cell function. Cross-sectional studies utilising sub-optimal methods for assessment of insulin sensitivity and serum 25-OHD concentration provide conflicting results.

OBJECTIVE: This study examined the relationship between serum 25-OHD concentration and insulin resistance in healthy overweight individuals at increased risk of cardiovascular disease, using optimal assessment techniques.

METHODS: 92 subjects (mean age 56.0, SD 6.0 years), who were healthy but overweight (mean BMI 30.9, SD 2.3 kg/m(2) ) underwent assessments of insulin sensitivity (two-step euglycaemic hyperinsulinaemic clamp, HOMA2-IR), beta-cell function (HOMA2%B), serum 25-OHD concentration and body composition (DEXA).

RESULTS: Mean total 25-OHD concentration was 32.2, range 21.8 - 46.6 nmol/L. No association was demonstrated between serum 25-OHD concentration and insulin resistance.

CONCLUSIONS: In this study using optimal assessment techniques to measure 25-OHD concentration, insulin sensitivity and body composition, there was no association between serum 25-OHD concentration and insulin resistance in healthy, overweight individuals at high risk of developing cardiovascular disease. This study suggests the documented inverse association between serum 25-OHD concentration and risk of type 2 DM is not mediated by a relationship between serum 25-OHD concentration and insulin resistance. 

Beneficial effect of a polyphenol-rich diet on cardiovascular risk: a randomised control trial

OBJECTIVES: There is previous epidemiological evidence that intake of polyphenol-rich foods has been associated with reduced cardiovascular disease risk. We aimed to investigate the effect of increasing dietary polyphenol intake on microvascular function in hypertensive participants.

METHODS: All participants completed a 4-week run-in phase, consuming <2 portions of fruit and vegetables (F&V) daily and avoiding berries and dark chocolate. Subjects were then randomised to continue with the low-polyphenol diet for 8 weeks or to consume a high-polyphenol diet of six portions F&V (including one portion of berries/day and 50 g of dark chocolate). Endothelium-dependent (acetylcholine, ACh) and endothelium-independent (sodium nitroprusside) vasodilator responses were assessed by venous occlusion plethysmography. Compliance with the intervention was measured using food diaries and biochemical markers.

RESULTS: Final analysis of the primary endpoint was conducted on 92 participants. Between-group comparison of change in maximum % response to ACh revealed a significant improvement in the high-polyphenol group (p=0.02). There was a significantly larger increase in vitamin C, carotenoids and epicatechin in the high-polyphenol group (between-group difference p<0.001; p<0.001; p=0.008, respectively).

CONCLUSIONS: This study has shown that increasing the polyphenol content of the diet via consumption of F&V, berries and dark chocolate results in a significant improvement in an established marker of cardiovascular risk in hypertensive participants.

Estudo epidemiológico sobre a saúde de estudantes universitários

Os factores de risco nos adultos jovens são fortes preditores da incidência de doença cardiovascular e mortalidade na idade mais avançada. Em Portugal, desconhecem-se estudos que avaliem os factores de risco para as doenças crónicas, em jovens adultos, na transição do ensino secundário para o universitário. Este estudo pretendeu contribuir para a promoção do conhecimento dos determinantes sócioculturais e ambientais no diagnóstico e detecção de factores de risco para as doenças crónicas, nomeadamente as doenças cardiovasculares, em estudantes universitários. Teve como objectivo principal a investigação do efeito da vida académica nos factores de risco modificáveis, estilos de vida e determinantes da saúde. Teve como objectivos específicos identificar a(s) prevalência(s) dos factores de risco cardiovascular numa população universitária, a identificação dos intervalos de referência para a homocisteína total no soro de adultos jovens portugueses, a determinação do perfil lípidico, comportamentos de saúde e dieta alimentar de tipo mediterrânico entre os estudantes universitários de acordo com o género e a área científica de frequência e a avaliação longitudinal do impacto da exposição à vida académica no estado de saúde dos estudantes universitários Participaram no estudo 781 estudantes sendo a média de idades de 20,6. Os factores de risco estudados para as doenças crónicas, foram o hábito tabágico, a pressão arterial, o índice de massa corporal, a composição do sangue (lípidos, homocisteina e glicose), a alimentação e a actividade física. O estudo mostra que a prevalência de: sedentarismo é significativamente mais elevada nos rapazes (p<0,001); dislipidemia e a hipertrigliceridemia é significativamente mais elevada nas raparigas. Mais de um quarto dos estudantes tem colesterol elevado sendo a hipercolesterolemia significativamente mais elevada nas raparigas (p<0,001); a hipertensão verificou-se em ambos os sexos (6,0%) mas foi significativamente mais elevada nos rapazes (p=0,001). O estudo identificou o intervalo de referência para a homocisteína em adultos jovens portugueses independentemente do sexo (6,2 a 11,6 μmol/) sendo que, acima de 11,6 μmol/l é condição para vigilância médica em populações jovens adultas. Quando se estudou a exposição à vida académica comparada com aqueles que acabaram de entrar na universidade, verificou-se uma associação significativa no que respeita às concentrações de lípidos no sangue, à pressão arterial sistólica e à actividade física, tendo sido as raparigas aquelas que mais se afastavam dos padrões saudáveis (p<0,001). No que respeita à adesão à dieta mediterranica, não foram encontradas associações entre este tipo de alimentação e os vários factores de risco independentemente do género. Os resultados forneceram, evidências empíricas acerca da importância da detecção dos principais factores de risco na idade adulta (jovem) na prevenção das doenças cardiovasculares e vieram corroborar as orientações do Plano de Desenvolvimento Estratégico do Instituto Nacional de Saúde Português para as doenças crónicas, nomeadamente o estabelecimento de valores de referência nacionais para análises biológicas e as orientações do Plano de Acção Estratégica Global para a Prevenção e Controle das Doenças Não-Transmissíveis-2008/2013 da Organização Mundial de Saúde.

Valor prognóstico cardiovascular da MAPA numa população hipertensa portuguesa

Efectuou-se um estudo prospectivo e observacional em 1200 doentes, maiores de 18 anos, com hipertensão essencial e sem eventos cardiovasculares (CV) prévbs que foram referenciados entre 1991 e 1998 para realização de MAPA no Serviço de Cardiologia do Hospital Infante D. Pedro, Aveiro (HIP), na Unidade de Hipertensão e Risco CV do Hospital Pedro Hispano (HPH), Matosinhos e na Clínica Cross/Moss do Porto. O objectivo principal deste estudo foi avaliar, nesta população, seguida durante 8- 12 anos, o valor preditivo de morbi-mortalidade CV da pressurometria ambulatória de 24 horas (MAPA), nomeadamente de diversos índices e valores dela extraída, tais como: (i) valores médios da pressão arterial (PA) de 24-h, diurna e nocturna; (ii) queda tensional noctuma, (iii) diferentes padrões de queda tensional nocturna em particular do padrão Non Dipper; (iv) PA diferencial de 24h, diurna e nodurna; (v) frequência cardíaca de 24 horas (vi) Ambulatory Arterial Stifness. Foram incluídos registos de MAPA de 1200 doentes, de um total de 2644, dos quais 53,8% eram mulheres e 10,2% eram diabéticos. Ao longo de um follow up médio de 8,2+3,0 anos, verificaram-se 62 óbitos e 152 eventos CV fatais e não fatais compreendendo 79 AVC, 51 eventos coronários e 22 classificados de outros eventos cardiovasculares. O estudo permitiu concluir que: 1- A MAPA foi superior a PA casual como preditor de eventos CV globais e de acidentes cerebrovasculares (AVC). 2 - De entre os valores da MAPA, o valor preditivo dos valores sistólicos (de 24 h, diurnos e nocturnos) foi superior ao dos respectivos valores diastólicos e o dos valores nocturnos foi superior ao dos valores diurnos. 3 - 0s eventos CV totais e os eventos coronários foram mais frequentes nos homens do que nas mulheres, sem diferença relativamente ao AVC. O valor preditivo independente da MAPA (sobretudo da PAS e da PP24h) foi superior nas mulheres vs homens relativamente aos eventos globais e AVC. 4- 0s padrões non-dipper e reverted-dipper de queda tensional nocturna associaram-se a pior prognóstico cardiovascular, relativamente ao padrão dipper. Contudo, dentro do padrão non-dipper, somente os doentes com queda tensional nocturna entre 0-4,9% -non-dippers 1 (mas não os doentes com queda tensional nocturna entre 5,O-9,9% -non-dippers 2) apresentaram risco CV superior ao do padrão dipper e semelhante ao do padrão reverted-dipper. Este achado poderá implicar a reclassificação do padrão non-dipper e do risco CV a ele associado. 5- O índice de rigidez arterial derivado da MAPA (AASI) correlaciona-se com outros índices (ex. a velocidade da onda de pulso) e contribui para estratificar o risco CV (eventos CV e AVC). O valor preditivo CV do AASI não é globalmente superior ao da PP 24h, embora em alguns casos o AASI possa acrescentar informação prognostica adicional a PP.

Nanosensor for assessing the risk of a cardiovascular disease

The incidence of cardiovascular diseases (CVD) has been increasing according to the European and global statistics. Thus, the development of new analytical devices, such as biosensors for assessing the risk of CVD could become a valuable approach for the improvement of healthcare service. In latest years, the nanotechnology has provided new materials with improved electronic properties which have an important contribution in the transduction mechanism of biosensors. Thus, in this thesis, biosensors based on field effect transistors with single-walled carbon nanotubes (NTFET) were developed for the detection of C-reactive protein (CRP) in clinical samples, that is, blood serum and saliva from a group of control patients and a group of CVD risk patients. CRP is an acute-phase protein, which is commonly known as the best validated biomarker for the assessment of CVD, the single-walled carbon nanotubes (SWCNT) were applied as transduction components, and the immunoreaction (interaction between the CRP antigen and the antibodies specific to CRP) was used as the mechanism of molecular recognition for the label-free detection of CRP. After the microfabrication of field effect transistors (FET), the screening of the most important variables for the dispersion of SWCNT, the assemblage of NTFET, and their application on standard solutions of CRP, it was found that NTFET respond accurately to CRP both in saliva and in serum samples, since similar CRP levels were found with the NTFET and the traditional methodology (ELISA technique). On the other hand, a strong correlation between salivary and serum CRP was found with NTFET, which means that saliva could be used, based on non-invasive sampling, as an alternative fluid to blood serum. It was also shown that NTFET could discriminate control patients from CVD risk patients, allowing the determination of a cut-off value for salivary CRP of 1900 ng L-1, which corresponds to the well established cut-off of 3 mg L-1 for CRP in serum, constituting an important finding for the possible establishment of a new range of CRP levels based on saliva. According to the data provided from the volunteer patients regarding their lipoprotein profile and lifestyle factors, it was concluded that the control and the CVD risk patients could be separated taking into account the various risk factors established in literature as strong contributors for developing a CVD, such as triglycerides, serum CRP, total cholesterol, LDL cholesterol, body mass index, Framingham risk score, hypertension, dyslipidemia, and diabetes mellitus. Thus, this work could provide an additional contribution to the understanding of the association of biomarkers levels in serum and saliva samples, and above all, cost-effective, rapid, label-free, and disposable NTFET were developed, based on a noninvasive sampling, for the assessment of CVD risk, thus constituting a potential point-of-care technology.

Turismo acessível : recurso de coping para gerir o stress na incapacidade

As sociedades contemporâneas testemunham os efeitos negativos do stress sobre a saúde, existindo evidências empíricas do relacionamento recíproco entre stress e doença (infeciosas, crónicas, cardiovasculares, cancro) (Iwasaki & Mannell, 2000). Por outro lado, Walden (2007) sublinha que o stress varia de acordo com as circunstâncias de vida e Rode et al. (2012) acrescentam que as pessoas com incapacidade apresentam taxas mais elevadas de problemas de saúde relacionados com o stress do que a população em geral. Neste contexto, surge o lazer como mecanismo de coping, como instrumento restaurador e benéfico para a saúde (Caldwell, 2005; Wijndaele et al., 2007). Assim, considerando o turismo como uma marcante atividade recreacional em tempo de lazer na vida das pessoas, e uma oportunidade de relaxamento e interação social (Richards, et al., 2010), pensou-se na possibilidade do turismo acessível ser um recurso de coping para gerir o stress na incapacidade. É com base na atualidade e pertinência destas reflexões que se estabeleceram duas metas para este trabalho: compreender o relacionamento entre turismo, stress e coping para os indivíduos com incapacidade, e desenvolver bases empíricas para fins terapêuticos e para o desenvolvimento de novos produtos turísticos, numa lógica biopsicossocial (biológica ou física, psicológica e social). Especificamente, pretende-se identificar fontes de stress para as pessoas com incapacidade e as suas respostas de coping, e explicar como o turismo atua nas dimensões biopsicossociais do stress-coping. Para atingir estes objetivos utilizou-se uma metodologia mista, suportada por uma revisão de literatura aprofundada, que consistiu na realização de um estudo qualitativo e outro quantitativo. No primeiro, recorreu-se à técnica de focus groups para cada tipo de incapacidade em análise, motora (N=6), auditiva (N=7) e visual (N=6), e no segundo, procedeu-se à aplicação de inquéritos por questionário a pessoas com incapacidade motora e sensorial (N=306), cujo questionário consistiu na adaptação e ajuste das ECL (Escalas de Coping através do Lazer) ao contexto do Turismo Acessível. Os resultados indicam que a principal fonte de stress dos indivíduos com incapacidade é a própria incapacidade em conjugação com a sociedade, demonstrando-se a prevalência de estratégias baseadas na interação social para a resolução de problemas, em detrimento de outras. Por sua vez, apuram-se os benefícios do turismo, cujas mais-valias no âmbito das dimensões biopsicossociais destes indivíduos em particular, são também discutidas. Conclui-se, portanto, que o turismo acessível é um novo formato de stress-coping para a população com incapacidade, suportando o reequilíbrio e harmonização dos seus recursos pessoais e sociais, contribuindo positivamente para a sua saúde e bem-estar global, servindo de base ao desenvolvimento de novos produtos turísticos adequados e direcionados para as necessidades específicas desta população e ao planeamento de intervenções terapêuticas alternativas no contexto da sua reabilitação.