RESUMO
AIM: To investigate the relationship of radiographic evidence of root filled teeth to cardiovascular outcomes. METHODOLOGY: Baseline data for 506 subjects including 256 angiographically verified heart disease patients and 250 matched cardiologically healthy controls participating in the Kuopio Oral Health and Heart study were collected in 1995-1996. Cardiovascular disease (CVD) mortalities were accrued until 31 May 2015 and appended to the baseline data. Mortality status data were obtained from the Finnish National Death Register where all mortality cases and the causes of death are compiled for all Finnish citizens. Of the 506 participants, 473 subjects who had no missing values in the predictor, outcome or confounding factors were included in the analyses to assess the relationship of radiographic evidence of root filled teeth with prevalent coronary artery disease (CAD) cross sectionally and also with CVD mortality longitudinally. Multivariable logistic regression was used for the cross-sectional part and proportional hazard regression analyses for the longitudinal part of the study were used adjusting for age, sex, smoking, edentulism, diabetes, hypertension, total/HDL cholesterol ratio and income. Additionally, whether this association was independent of periodontitis, and a systemic marker of inflammation, serum C-reactive protein (CRP) was examined. RESULTS: Having ≥1 root filled teeth was associated with 84% lower odds of prevalent CAD with Odds Ratio (OR) = 0.16, 95% confidence interval (CI) 0.09-0.28, P < 0.0001. The OR for edentulism was 1.32 (CI: 0.73-2.38), P = 0.36, suggesting a nonsignificant increase in risk. Prospectively, having at least one root filled teeth was associated with a 49% lower risk of CVD mortality (hazard ratio [HR] = 0.51, CI = 0.27-0.97, P = 0.04) whilst edentulism was associated with nonsignificantly increased risk for CVD mortality: HR = 1.25 (CI: 0.65-2.42), P = 0.36. Adjustment for periodontitis or serum CRP levels changed the OR or HR slightly but the associations remained significant. CONCLUSIONS: Having ≥1 root filled teeth was associated with significantly lower odds for prevalent CAD cross sectionally and lower risk of cardiovascular mortality prospectively. These reduced associations with CVD were independent of periodontitis or serum CRP levels.
Assuntos
Doenças Cardiovasculares/mortalidade , Restauração Dentária Permanente , Idoso , Proteína C-Reativa/análise , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Feminino , Finlândia/epidemiologia , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Radiografia Dentária , Fatores de Risco , Obturação do Canal Radicular , Raiz Dentária/diagnóstico por imagemRESUMO
OBJECTIVES: The school environment has been the focus of many health initiatives over the years as a means to address the childhood obesity crisis. The availability of low-nutrient, high-calorie foods and beverages to students via vending machines further exacerbates the issue of childhood obesity. However, a healthy overhaul of vending machines may also affect revenue on which schools have come to depend. This article describes the experience of one school district in changing the school environment, and the resulting impact on food and beverage vending machines. STUDY DESIGN: Observational study in Ann Arbor public schools. METHODS: The contents and locations of vending machines were identified in 2003 and surveyed repeatedly in 2007. Overall revenues were also documented during this time period. RESULTS: Changes were observed in the contents of both food and beverage vending machines. Revenue in the form of commissions to the contracted companies and the school district decreased. CONCLUSIONS: Local and national wellness policy changes may have financial ramifications for school districts. In order to facilitate and sustain school environment change, all stakeholders, including teachers, administrators, students and healthcare providers, should collaborate and communicate on policy implementation, recognizing that change can have negative financial consequences as well as positive, healthier outcomes.
Assuntos
Bebidas/classificação , Distribuidores Automáticos de Alimentos/normas , Alimentos/classificação , Política Pública , Instituições Acadêmicas , Comércio , Distribuidores Automáticos de Alimentos/economia , Promoção da Saúde , Humanos , Michigan , Obesidade/prevenção & controle , Setor Público , EstudantesRESUMO
Recombinase-activating gene-2-deficient (Rag2(-/-)) mice lacking functional lymphocytes provide a useful model of chronic inflammatory bowel disease-emulating events in human colon cancer. Infection of Rag2(-/-) mice with Helicobacter hepaticus led to accumulation of macrophages and neutrophils in the colon, a process temporally related to up-regulation of tissue inducible nitric oxide synthase (iNOS) expression at the site of infection and increased nitric oxide (NO) production, as evidenced by urinary excretion of nitrate. Progressive development of increasingly severe inflammation, hyperplasia, dysplasia, and cancer accompanied these changes. Concurrent administration of an iNOS inhibitor prevented NO production and abrogated epithelial pathology and inhibited the onset of cancer. The presence of Gr-1(+) neutrophils and elevated tumor necrosis factor-alpha (TNF-alpha) expression in colon were required for increased iNOS expression and cancer, whereas interleukin-10 (IL-10) down-regulated TNF-alpha and iNOS expression and suppressed cancer. Anti-inflammatory CD4(+) regulatory lymphocytes also down-regulated iNOS and reduced cancer formation. Collectively, these results confirm essential roles for inflammation, increased TNF-alpha expression, and elevated NO production in colon carcinogenesis.
Assuntos
Colo/patologia , Neoplasias do Colo/patologia , Proteínas de Ligação a DNA/deficiência , Infecções por Helicobacter/microbiologia , Helicobacter hepaticus/imunologia , Óxido Nítrico/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Animais , Arginina/farmacologia , Colo/enzimologia , Colo/imunologia , Colo/microbiologia , Neoplasias do Colo/complicações , Neoplasias do Colo/imunologia , Neoplasias do Colo/microbiologia , Proteínas de Ligação a DNA/metabolismo , Inibidores Enzimáticos/farmacologia , Infecções por Helicobacter/enzimologia , Infecções por Helicobacter/imunologia , Infecções por Helicobacter/urina , Inflamação/imunologia , Inflamação/microbiologia , Mediadores da Inflamação/metabolismo , Camundongos , Nitratos/urina , Óxido Nítrico Sintase Tipo II/antagonistas & inibidores , Óxido Nítrico Sintase Tipo II/metabolismoRESUMO
OBJECTIVE: To assess whether sex differences exist in the angiographic severity, management and outcomes of acute coronary syndromes (ACS). METHODS: The study comprised 7638 women and 19 117 men with ACS who underwent coronary angiography and were included in GRACE (Global Registry of Acute Coronary Events) from 1999-2006. Normal vessels/mild disease was defined as <50% stenosis in all epicardial vessels; advanced disease was defined as >or=one vessel with >or=50% stenosis. RESULTS: Women were older than men and had higher rates of cardiovascular risk factors. Men and women presented equally with chest pain; however, jaw pain and nausea were more frequent among women. Women were more likely to have normal/mild disease (12% vs 6%, p<0.001) and less likely to have left-main and three-vessel disease (27% vs 32%, p<0.001) or undergo percutaneous coronary intervention (65% vs 68%, p<0.001). Women and men with normal and mild disease were treated less aggressively than those with advanced disease. Women with advanced disease had a higher risk of death (4% vs 3%, p<0.01). After adjustment for age and extent of disease, women were more likely to have adverse outcomes (death, myocardial infarction, stroke and rehospitalisation) at six months compared to men (odds ratio 1.24, 95% confidence interval 1.14 to 1.34); however, sex differences in mortality were no longer statistically significant. CONCLUSIONS: Women with ACS were more likely to have cardiovascular disease risk factors and atypical symptoms such as nausea compared with men, but were more likely to have normal/mild angiographic coronary artery disease. Further study regarding sex differences related to disease severity is warranted.
Assuntos
Síndrome Coronariana Aguda/terapia , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/mortalidade , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Angiografia Coronária , Feminino , Mortalidade Hospitalar , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores Sexuais , Resultado do Tratamento , Adulto JovemAssuntos
Depressores do Apetite/administração & dosagem , Ciclobutanos/administração & dosagem , Obesidade/tratamento farmacológico , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Medicina Baseada em Evidências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Redução de PesoRESUMO
Fingertip amputations are injuries commonly seen by family physicians. The classification of fingertip injuries corresponds with the normal anatomy of the tip of the digit. There are three zones of injury; the V-Y plasty technique is used to repair zone II injuries. The plane of the injury can be described as dorsal, transverse or volar. The dorsal and transverse planes lend themselves to the use of the V-Y plasty technique. In carefully selected injuries, the family physician can use this technique to repair the injured digit. The use of a single V-Y plasty has replaced the original technique that repaired the digit and restored the contour of the fingertip. Good cosmetic and functional results can be obtained. Complications may include flap sloughing, infection and sensory changes.
Assuntos
Traumatismos dos Dedos/cirurgia , Retalhos Cirúrgicos , Amputação Traumática/cirurgia , Humanos , SuturasAssuntos
Náusea/tratamento farmacológico , Fitoterapia , Plantas Medicinais , Complicações na Gravidez/tratamento farmacológico , Vômito/tratamento farmacológico , Zingiber officinale/uso terapêutico , Adulto , Medicina Baseada em Evidências , Feminino , Humanos , Guias de Prática Clínica como Assunto , Gravidez , Primeiro Trimestre da Gravidez , Projetos de Pesquisa/normas , Índice de Gravidade de Doença , Resultado do TratamentoAssuntos
Fatores Biológicos/normas , Suplementos Nutricionais/normas , Contaminação de Medicamentos/legislação & jurisprudência , Contaminação de Alimentos/legislação & jurisprudência , Melatonina/química , Plantas Medicinais/química , Terminologia como Assunto , Estados Unidos , United States Food and Drug AdministrationAssuntos
Resfriado Comum/prevenção & controle , Medicamentos para o Sistema Respiratório/uso terapêutico , Acetato de Zinco/uso terapêutico , Adulto , Resfriado Comum/fisiopatologia , Intervalos de Confiança , Constipação Intestinal/induzido quimicamente , Citocinas/sangue , Método Duplo-Cego , Seguimentos , Humanos , Incidência , Placebos , Estudos Prospectivos , Medicamentos para o Sistema Respiratório/administração & dosagem , Medicamentos para o Sistema Respiratório/efeitos adversos , Índice de Gravidade de Doença , Comprimidos , Fatores de Tempo , Resultado do Tratamento , Xerostomia/induzido quimicamente , Zinco/sangue , Acetato de Zinco/administração & dosagem , Acetato de Zinco/efeitos adversosAssuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Captopril/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Losartan/uso terapêutico , Idoso , Método Duplo-Cego , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosAssuntos
Anti-Inflamatórios/administração & dosagem , Asma/tratamento farmacológico , Asma/fisiopatologia , Budesonida/administração & dosagem , Administração por Inalação , Agonistas Adrenérgicos beta/uso terapêutico , Adulto , Anti-Inflamatórios/farmacologia , Budesonida/farmacologia , Doença Crônica , Método Duplo-Cego , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Reprodutibilidade dos Testes , Testes de Função Respiratória , Resultado do TratamentoRESUMO
BACKGROUND: Documentation guidelines have been developed by the Health Care Financing Administration (HCFA) to promote consistent selection of physician evaluation and management (E & M) codes. Our goals were to determine whether medical providers and auditors agree in their assignment of office codes using 1995 and 1998 guidelines and to ascertain if the code levels assigned are affected by auditor experience and training. METHODS: A total of 1,069 established patient charts from private family physician offices were reviewed by a family practice faculty physician, a family practice resident physician, and a professional coder. The main outcome measures were the agreement between the auditors and the medical care provider on code selection and the degree to which documentation supported the code selected. RESULTS: All auditors agreed with the medical provider code selection in only 15.2% (1995 guidelines) and 29.2% (1998 guidelines) of visits. Professional coders were more likely than faculty physicians or resident physicians to agree with the code assigned by the medical provider (51.7% vs 40.7% and 39.6%, P <.001). Documentation adequately supported the most common office code selection, 99213, in 92.7% (1995) and 91.0% (1998) of the charts reviewed. Concurrence among all auditors was only 31.0% (1995) and 44.3% (1998). CONCLUSIONS: Interobserver differences exist in the assignment of E & M codes by auditors using both 1995 and 1998 HCFA guidelines. The 1998 documentation guidelines produce greater agreement among auditors. The documentation supported the level of code billed in the majority of established patient office visits.
Assuntos
Assistência Ambulatorial/classificação , Documentação/normas , Medicina de Família e Comunidade/normas , Guias como Assunto , Formulário de Reclamação de Seguro/classificação , Visita a Consultório Médico , Assistência Ambulatorial/economia , Centers for Medicare and Medicaid Services, U.S. , Docentes de Medicina/normas , Medicina de Família e Comunidade/economia , Controle de Formulários e Registros/normas , Humanos , Formulário de Reclamação de Seguro/normas , Internato e Residência/normas , Auditoria Médica , Variações Dependentes do Observador , Crédito e Cobrança de Pacientes/normas , Terminologia como Assunto , Estados UnidosRESUMO
Individuals increasingly are taking a more active role in their health care, and herbal products have emerged as a common choice among self-care therapies. Pharmacists are active participants in the care of patients who are taking herbal products. Currently, most pharmacists are not educated adequately about herbal products and other types of alternative medicine. Furthermore, good information about many of these products is not available. These combined factors present a challenge for pharmacists as they seek to provide optimal care and counseling to patients who use herbs or supplements. We recommend the following actions to place pharmacists in better positions as effective agents protecting public safety: Regulations should be implemented at a federal level to require basic levels of standardization and quality control in the manufacture of herbal products. Indexing terms in medical bibliographic systems should be expanded to target herbal products. Funding should be increased for scientific research evaluating herbal products. Pharmacy schools should include a competency statement in their curricula regarding herbal medicines. Continuing education in herbal products should be available and encouraged for all pharmacists. Pharmacists should approach the use of all therapeutic interventions with scientific rigor, whether they are traditional or complementary in nature. Patients will benefit as more information is known and widely disseminated. By actively embracing the responsibility for counseling individuals on the appropriate use of herbal products, pharmacists will become a recognized source of expert information in this rapidly growing area, yielding important improvements in the quality of care.
Assuntos
Fitoterapia , Humanos , Educação de Pacientes como Assunto , Farmacêuticos , Estados UnidosRESUMO
Disorders of the hair are commonplace in the primary care practice. Among these disorders are male pattern baldness, Telogen effluvium, alopecia areata, Trichotillomania, and fungal infections involving the hair shaft. A review of the normal anatomy and life cycle of hair also is presented.
Assuntos
Doenças do Cabelo/diagnóstico , Tinha do Couro Cabeludo/diagnóstico , Tricotilomania/diagnóstico , Alopecia/diagnóstico , Alopecia/etiologia , Alopecia/terapia , Diagnóstico Diferencial , Feminino , Cabelo/crescimento & desenvolvimento , Cabelo/fisiologia , Doenças do Cabelo/etiologia , Doenças do Cabelo/terapia , Humanos , Masculino , Tinha do Couro Cabeludo/tratamento farmacológico , Tricotilomania/terapiaAssuntos
Espasmo Brônquico/tratamento farmacológico , Broncodilatadores/uso terapêutico , Ipratrópio/uso terapêutico , Doença Aguda , Administração por Inalação , Adulto , Albuterol/administração & dosagem , Espasmo Brônquico/fisiopatologia , Método Duplo-Cego , Quimioterapia Combinada , Serviço Hospitalar de Emergência , Humanos , Nebulizadores e Vaporizadores , Admissão do Paciente/estatística & dados numéricos , Pico do Fluxo Expiratório , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos TestesAssuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Crupe/tratamento farmacológico , Budesonida/uso terapêutico , Criança , Pré-Escolar , Dexametasona/uso terapêutico , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Metanálise como Assunto , Reprodutibilidade dos Testes , Resultado do TratamentoAssuntos
Antidepressivos de Segunda Geração/administração & dosagem , Bupropiona/administração & dosagem , Abandono do Hábito de Fumar/métodos , Tabagismo/tratamento farmacológico , Adulto , Preparações de Ação Retardada , Método Duplo-Cego , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes , Resultado do TratamentoRESUMO
Sevoflurane has a lower blood-gas solubility and a less pungent odour than halothane; this may allow more rapid induction of anaesthesia. In a randomized, blinded study, we compared the induction characteristics of maximum initial inspired concentration of 8% sevoflurane and 5% halothane using conventional vaporizers in children aged 3 months to 3 years. There was no statistically significant difference in induction times between the two groups: mean times to loss of consciousness were 1 min 12 s (SD 18 s, range 40 s-1 min 44 s) for sevoflurane and 1 min 16 s (SD 17 s, range 50 s-1 min 52 s) for halothane, although these times were shorter than in previous studies using a gradual increase in vapour concentration. A small number of complications were noted in both groups, although none interfered with induction of anaesthesia. Struggling scores were lower in the sevoflurane group than in the halothane group (chi-square for trends = 6.34, P < 0.02). A significant number (11 of 15) of parents of children in the sevoflurane group who had previous experience of halothane induction preferred sevoflurane (chi-square for trends = 4.03, P < 0.05). We conclude that with this technique, induction was rapid with both sevoflurane and halothane. Our assessment of patient struggling and parents' perceptions suggests that induction with sevoflurane was more pleasant than with halothane.