The Challenge of Evaluating the Oral Health Status of Older Persons in Latin America.

Knowledge Transfer Statement: This article provides an overview of the oral health status of older people from Latin American countries and the emergence of recent gerodontology research initiatives within the region.

A novel fibrinogen mutation: FGA g. 3057 C > T (p. Arg104 > Cys) impairs fibrinogen secretion.

BACKGROUND: Abnormal fibrinogens can be caused by clinically silent hereditary mutations. A new case was detected accidentally in an 11-year-old girl when routine pre-operative coagulation tests were performed for nasal turbinate surgery. METHODS: The fibrinogen genes FGA, FGG and FGB were sequenced using standard protocols. The kinetics of fibrin formation were followed by turbidity at 350 nm. Purified fibrinogen was incubated with plasmin, and the degradation products analyzed by SDS/PAGE. The formation of fibrinogen-albumin complexes was analyzed by immunobloting. Fibrin structure was examined in a Nikon Eclipse TE 2000-U laser microscope. Secretion of the variant protein was analyzed directly by reverse phase-electrospray time of flight-mass spectrometry (TOF-MS). RESULTS: DNA sequencing revealed a novel heterozygous g. 3057 C > T mutation in the FGA that predicts a p. Arg104 > Cys substitution, in the proband and her father. Both patients were asymptomatic with low functional and antigen fibrinogen concentrations. The proband's plasma fibrinogen polymerization was almost normal, with a 12% decrease in the final turbidity, while, the father's fibrin formation had a diminished slope and final turbidity (2.5× and 40%, respectively). Aα Arg104 is located at a plasmin cleavage site in the coiled-coil region of fibrinogen. However, the father's fibrinogen plasmin degradation was normal. Although the exchanged Cys introduces an unpaired -SH, immunoblotting showed no fibrinogen-albumin complexes. Furthermore, the plasma clot structure observed by confocal microscopy appeared almost normal. TOF-MS showed that the variant Aα chain was underrepresented in plasma and made up only about 25% of the total. CONCLUSIONS: The low expression of the Aα Arg104 > Cys chain in circulation could account for the observed hypodysfibrinogenemia.

Childhood hearing surveillance activity in Italy: preliminary recommendations.

Following the positive outcomes of the newborn hearing screening programmes already underway in several Italian regions, it is now necessary to address the identification of childhood hearing impairments that missed the neonatal screening programme or have delayed onset. Within the framework of the Ministry of Health project CCM 2013 "Preventing Communication Disorders: a Regional Program for early Identification, Intervention and Care of Hearing Impaired Children", a group of professionals identified three main recommendations that can be useful to improve hearing surveillance activity within the regional and state Italian Health System. The family paediatrician is recognised as having a key role in ongoing monitoring of hearing capacity and development of the growing child.

Achieving early functional auditory access in paediatric cochlear implantation.

Cochlear implantation (CI) is a viable option for providing access to auditory stimulation in severe-to-profound hearing loss/impairment of cochlear origin. It has been demonstrated that CI is safe and effective for deaf children. Younger age at activation after CI is linked with better outcomes. It is important to study variables and issues that can interfere with an early fitting and access to sound after CI. They range from patient characteristics, family compliance and support, to technical, medical or organisational problems. A SWOT analysis and a subsequent TOWS matrix was conducted to discuss issues and propose recommendations to be considered when operating an early switch on of the CI.

Empowering the family during the first months after identification of permanent hearing impairment in children.

The latest international guidelines highlight the importance of involving the family in the diagnostic and rehabilitation process of children affected by permanent hearing impairment. This emphasises how meaningful this approach is for the development of the deaf child. So far, there is very little evidence about this approach in Italy, and there are still some barriers to its practical management. The aim of this paper is to report the results of a strategic analysis, which identifies the strengths, weaknesses, opportunities and threats of the family empowerment process during early auditory diagnosis and rehabilitation. The audiology programme should have the goal to offer information and support to families in order to achieve a conscious decision about the use and type of auditory prosthesis and rehabilitation choice within three months after audiologic diagnosis. Within the framework of the Ministry of Health project CCM 2013 "Preventing Communication Disorders: a Regional Program for Early Identification, Intervention and Care of Hearing Impaired Children", a group of professionals identified three main recommendations that can be useful to foster the natural communicative development of the child by strengthening the therapeutic alliance and empowerment of the family. The recommendations obtained with this analysis can help to develop new Italian guidelines with the aim to foster natural communicative development of the child by strengthening the therapeutic alliance and empowerment of the family.

Endothelial fibrinolytic response onto an evolving matrix of fibrin.

BACKGROUND: Fibrin provides a temporary matrix at the site of vascular injury. The aims of the present work were (1) to follow fibrin formation and lysis onto the surface of human dermal microvascular endothelial cells (HMEC-1), and (2) to quantify the secretion of fibrinolytic components in the presence of fibrin. METHODS: Fibrin clots at different fibrinogen concentrations were formed on top of (model 1) or beneath (model 2) the endothelial cells. Fibrin formation or lysis onto the surface of HMEC-1 cells, was followed by turbidity. Clot structure was visualized by laser scanning confocal microscopy (LSCM). The secretion of uPA and PAI-1 by HMEC-1 cells was quantified by ELISA. RESULTS: The rate of fibrin formation increased approximately 1.5-fold at low fibrinogen content (0.5 and 1 mg/mL; p < 0.05) compared to the condition without cells; however, it was decreased at 2 mg/mL fibrinogen (p < 0.05) and no differences were found at higher fibrinogen concentrations (3 and 5 mg/mL). HMEC-1 retarded dissolution of clots formed onto their surface at 0.5 to 3 mg/mL fibrinogen (p < 0.05). Secretion of uPA was 13 × 10(-6) ng/mL per cell in the absence of RGD and 8 × 10(-6) ng/mL per cell in the presence of RGD, when clots were formed on the top of HMEC-1. However, the opposite was found when cells were grown over fibrin: 6 × 10(-6) ng/mL per cell without RGD vs. 17 × 10(-6) ng/mL per cell with RGD. The secretion of PAI-1 by HMEC-1 cells was unrelated to the presence of fibrin or RGD, 7 × 10(-6) µg/mL per cell and 5 × 10(-6) µg/mL per cell, for the apical (model 1) and basal clots (model 2), respectively. CONCLUSIONS: HMEC-1 cells influence fibrin formation and dissolution as a function of the fibrin content of clots. Clot degradation was accentuated at high fibrin concentrations. The secretion of fibrinolytic components by HMEC-1 cells seemed to be modulated by integrins that bind RGD ligands.

Comparison by sex between thrombin generation and fibrin network characteristics in a healthy population.

BACKGROUND: The aim of the present work was to compare sex differences in thrombin generation and fibrin network characteristics in a young healthy population, and correlate thrombin generation parameters with fibrin network characteristics. METHODS: Sixty individuals aged 21 y (18-26), 50% men and 50% women were selected. Thrombin generation was performed with the Technothrombin TGA kit. Plasma fibrin formation kinetic was followed by turbidity at 350 nm, and the fibrin elastic modulus was measured with the Hemodyne. In addition, the prothrombin polymorphism G20210A was assessed. RESULTS: Thrombin generation in men was: lag time (LT): 12.5 ± 3.0 min, peak thrombin: 257 ± 135 nmol/l, and endogenous thrombin potential (ETP): 3459 ± 449 nmol/l·min, while in women the LT was shortened (9.7 ± 2.8 min, p<0.05) and thrombin formation increased (peak thrombin: 345 ± 178 nmol/l and ETP: 4017 ± 429 nmol/l·min, p<0.05). Prothrombin and fibrinogen plasma levels were similar between sexes, and the GG genotype of prothrombin G20210A polymorphism (rs1799963) had a frequency of 1. In women, fibrin formation was slightly faster and the elastic modulus was higher than men. CONCLUSIONS: The differences in thrombin generation between women and men were not related to prothrombin concentration, prothrombin polymorphism G20210A or fibrinogen concentration.

Necesidad de tratamiento ortodóncico en escolares residentes en una comunidad rural: estudio preliminar / Orthodontic treatment need in a shoolchildren population from a rural community: a preliminary study

Los problemas de maloclusión se asocian con discriminación por apariencia, problemas oclusales, trastornos témporomandibulares, problemas de deglución, fonación, dificultad para la higiene bucal

Number of teeth and its association with central obesity in older Southern Brazilians.

UNLABELLED: Evidence suggests that older adults with extensive tooth loss may present dietetic restrictions and frequently choose softer and more processed foods, which consequently may lead to obesity. OBJECTIVE: To evaluate whether there was an association between dental status and central obesity in community-dwelling elderly. BASIC RESEARCH DESIGN: A simple random sample of 471 community-dwelling Brazilian elderly ranging from 60 to 89 years old was evaluated in 2006. A questionnaire on socio-demographic, behaviour, general and oral health variables was applied. The number of natural teeth and the use of dental prostheses, following the World Health Organization (WHO) criteria, were assessed. MAIN OUTCOME MEASURES: The circumferences of the waist and the hip were measured in order to provide the waist circumference (WC) and the waist-hip ratio (WHR) measures. For both measures, participants were categorised as non-obese or obese according to the WHO-established cut-off points. RESULTS: Participants with more than 8 teeth were less likely to have central obesity, as measured by WHR [OR = 0.49 (0.32 to 0.87)], while participants with only 1-8 natural teeth were more likely to have central obesity when evaluated by WC [OR = 3.28 (CI 1.43 to 7.52)]. CONCLUSIONS: Tooth loss was associated with central obesity, even when controlled for confounders, suggesting a relationship between oral health status and nutritional status in this sample of community-dwelling Brazilian elderly. Preserving natural teeth may have a positive impact on the nutritional status of older adults and on obesity-related morbidity.

Healthy eating index in southern Brazilian older adults and its association with socioeconomic, behavioral and health characteristics.

OBJECTIVE: The objective of this study was to assess factors associated with the diet quality of brazilian older adults. DESIGN: Cross-sectional study. SETTING: City of Carlos Barbosa, Brazil. PARTICIPANTS: 228 participants aged 60 and older. MEASUREMENTS: A questionnaire with questions on socioeconomic and behavioral variables and health characteristics was used. The body mass index was calculated and the waist circumference was measured to provide information in respect to abdominal fat accumulation. Dietary data were collected via 24-hour recall and the diet quality was assessed using the Healthy Eating Index, an instrument that attributes scores to the diet according to the adequacy of intake of the main food and nutrient groups. Participants were divided into three categories, according to the Healthy Eating Index scores: under 51--poor diet; between 51 and 80--diet that needs improvement; over 80--good diet. The evaluation employed the analysis of variance, t test and non-conditional logistic regression to assess the association between the Healthy Eating Index and the other variables. RESULTS: Most participants (80.9%) presented diet that needs improvement and the marital status showed an independent association with the Healthy Eating Index--married individuals showed higher odds of presenting good diet. CONCLUSION: The results of this study suggest that, in general, the diet quality of this group needs improvement and that the marital status is a factor that can be considered for the development of activities to promote health and healthy food intake habits.

Edentulism, use of dentures and consumption of fruit and vegetables in south Brazilian community-dwelling elderly.

There is evidence suggesting that edentulous older persons modify their diet, avoiding foods that are difficult to chew, such as fruit and vegetables; meanwhile, the consumption of these foods is associated with prevention of chronic diseases. However, few studies evaluated whether a poor oral status without prosthetic rehabilitation is associated with a reduction in the consumption of fruit and vegetables in community-dwelling older persons. We evaluated the association of oral status with emphasis on complete dentures use with the daily consumption of at least 400 g of fruit and vegetables, following the recommendations of the WHO. A random sample of 282 south Brazilians ≥60 years of age was evaluated. Measurements included a questionnaire to assess sociodemographic, behaviour, and health data; consume of fruit and vegetables by means of a 24-h diet recall, and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prosthesis. Multivariate Poisson regression showed that the only variable significantly associated with inadequate consumption of fruit and vegetables was edentulism with the use of only one denture [PR=1·75 (1·11-2·74)]. Edentulous participants wearing only one denture were less likely to consume at least 400 g day(-1) of fruit and vegetables. These results indicate that, in edentulous community-dwelling elderly, oral health rehabilitation might play an important role in the maintenance of consumption of adequate amounts of fruit and vegetables, which is an important component of a healthy diet and also in the prevention of chronic diseases.

The effects of additional carbohydrate in the coiled-coil region of fibrinogen on polymerization and clot structure and properties: characterization of the homozygous and heterozygous forms of fibrinogen Lima (Aalpha Arg141-->Ser with extra glycosylation).

Fibrinogen Lima is an abnormal fibrinogen with an Aalpha Arg141-->Ser substitution resulting in an extra N-glycosylation at Aalpha Asn139, which seems to be responsible for the impairment of fibrin polymerization. We have studied the polymerization and properties of clots made from both plasma and purified fibrinogen of both the homozygous and heterozygous forms. The clot permeation studies with both plasma and purified protein revealed a normal flux through the network for the heterozygous form but very decreased permeation in the homozygous form. Consistent with turbidity results, the clot network of the homozygous form, seen by scanning electron microscopy, was tight and composed of thin fibers, with many branch points, while the appearance of clots from the heterozygous form was similar to that of control clots, but in both cases the fibers were more curved than those of control clots. The rheological properties of clots from the homozygous form were also altered, with rigidity being increased in plasma clots, but decreased in the purified system, a consequence of the balance between numbers of branch points and fiber curvature. From these results it seems that the extra carbohydrate moiety, located in the alpha coiled-coil region close to the betaC domains, impairs the protofibril lateral association process, giving rise to thinner, more curved fibers, with the structural anomalies being most pronounced in the clots from the homozygous plasma. These studies support a model for fibrin polymerization in which the betaC-betaC interactions are involved in lateral aggregation.

Avian infectious bronchitis: characterization of new isolates from Italy.

The isolation of four new variants or serotypes of avian infectious bronchitis virus in Italy is reported. The antigenic characteristics of these strains were investigated by cross-neutralization tests with the new isolates, Fa 6881/97, AZ 27/98, AZ 20/97, and BS 216/01; two of the most common European serotypes, AZ 23/74 and CR 88121 (793B); and the classic Massachusetts M41 serotype in association with a panel of 17 specific antisera. On the basis of the results obtained, the new isolates show relevant serologic differences. In fact, the four isolates were not neutralized by antisera against the most common European and American serotypes; the AZ 20/97 isolate was partially neutralized by FA 6881/97 antiserum but not reciprocally. The closely related Fa 6881/97 and AZ 27/98 isolates can be considered rather diffused in our country because they have been isolated over 20 times in the last 3 yr in different parts of Italy. On the contrary, the AZ 20/97 and BS 216/01 isolates were reported only once so far. The reverse transcription-polymerase chain reaction showed that Fa 6881/97 isolate is related to 793B isolate, whereas AZ 27/98 and BS 216/01 isolates appeared not to be related to the most common European and Massachusetts serotypes.

[Shift-work and cardiovascular diseases among chemical industry workers]. / Lavoro a turni e patologia cardiovascolare in operai di un'industria chimica.

In order to assess the prevalence of cardiovascular abnormalities among shift workers, who were free from such abnormalities at the time of hiring, compared to day workers and ex-shift workers, we studied the QTc interval and several cardiovascular risk factors in 61 chemical workers, including 40 shift workers, 11 day workers, and 10 ex-shift workers. We found a high prevalence rate of ischemic heart disease and conduction abnormalities among ex-shift workers (5/10, 50%). We did not observe variations in the QTc interval among the three groups. The occurrence of cardiovascular disease is a reason for moving workers to day work. Therefore, the shift workers group in our study might have been selected among subjects with a healthier lifestyle preventing side effects on their cardiovascular system.

Structure and properties of clots from fibrinogen Bicêtre II (gamma 308 Asn-->Lys). Increased permeability due to larger pores, thicker fibers, and decreased rigidity.

Fibrinogen Bicêtre II is a dysfibrinogenemia in which there is a substitution of Lys for Asn at gamma 308. We have studied the polymerization of this abnormal fibrinogen by measurement of turbidity and have characterized clot structure by scanning electron microscopy, permeation, and viscoelastic measurements. The results of these studies demonstrate that this amino acid substitution has substantial effects on the structure and properties of the clot, resulting in clots made up of thick fibers and large pores with greatly reduced stiffness and increased slippage of protofibrils.

Fibrinogen Caracas V, an abnormal fibrinogen with an Aalpha 532 Ser-->Cys substitution associated with thrombosis.

A new dysfibrinogenemia associated with thrombophilia has been identified in a Venezuelan kindred. Thrombin and Reptilase times were prolonged and the accelerating capacity of the patient's fibrin on the t-PA-induced plasminogen activation was decreased. In addition the affinity of fibrinogen for plasminogen was diminished. Permeability and electron microscopy studies revealed that the abnormal clot was made up of thin and densely packed fibres giving rise to a reduced fibrin gel porosity. This was confirmed by turbidity studies showing a decreased fibre mass/length ratio. Affected members were heterozygous for an Aalpha 532 Ser-->Cys mutation as demonstrated by genetic analyses. This abnormal fibrinogen has been designated as Fibrinogen Caracas V. The family study showed a convincing association between the mutation and thrombotic manifestations. The thrombotic tendency may be ascribed to lack of accelerating capacity of fibrin to induce fibrinolysis caused by an abnormal clot structure with thin fibres and reduced porosity.

Thrombotic dysfibrinogenemia. Fibrinogen "Caracas V" relation between very tight fibrin network and defective clot degradability.

Fibrinogen Caracas V is a thrombotic dysfibrinogenemia with an Aalpha 532 Ser-->Cys mutation characterized by a tight fibrin network formed of thin fibers responsible for a less porous clot than a normal one. In the present work, fibrinogen Caracas V is further characterized in order to understand the relationship between the structural defect and thrombophilia. This thrombotic disorder has been attributed to a tight fibrin network responsible for a decreased permeation of flow through the clot, leading to defective thrombus lysis due to a diminished availability of fibrinolytic enzymes to the inner fibrin surface. Correction of clot structure anomaly, by addition of dextran 40 to fibrinogen before clotting, induces an improvement in fibrin degradation that was attributed to an increase in porosity. The pulmonary embolism observed in this family has been related to an hyper rigidity of the clot, an anomaly that is also corrected by dextran. Furthermore, this abnormal fibrinogen binds more albumin than does normal fibrinogen, a phenomenon attributed to the mutation of serine in Aalpha-532 by cysteine. Therefore, this fibrinogen shows a striking similarity to the fibrinogen Dusart, allowing us to confirm that the alphaC-terminal part of fibrinogen plays an important role in fibrin structure, and to conclude that the anomaly of fibrin network observed in fibrinogen Caracas V is responsible for a deficient thrombus lysis.