Subgingival microbiome in periodontal health, gingivitis and different stages of periodontitis.

AIM: To characterize the subgingival microbiome in subjects with different periodontal health statuses. MATERIALS AND METHODS: In this cross-sectional observational study, subgingival samples were harvested from Spanish subjects with different periodontal health statuses, based on the 2018 Classification of Periodontal and Peri-Implant Diseases and Conditions. Samples were processed using high-throughput sequencing technologies (Illumina MiSeq). Taxa differentially abundant were identified using Analysis of Compositions of Microbiomes with Bias Correction (ANCOM-BC). α- and ß-diversity metrics were calculated using q2-diversity in QIIME2. The analyses were adjusted for age, gender and smoking status. RESULTS: The identified subgingival microbiome showed statistically significant differences among subjects, categorized into periodontal health, gingivitis and stages I-II and III-IV periodontitis (p < .05). In patients with severe (stages III-IV) periodontitis, the genera Filifactor and Fretibacterium were detected 24 times more frequently than in periodontally healthy subjects. Similarly, the genera Porphyromonas, Prevotella and Tannerella were detected four times more frequently (p < .05). The genera Granulicatella, Streptococcus, Paracoccus, Pseudomonas, Haemophilus, Actinobacteria, Bergeyella and Capnocytophaga were significantly associated with healthier periodontal status (p < .05). CONCLUSIONS: Significant differences were detected in the subgingival microbiome among periodontal health, gingivitis and stages I-II or III-IV periodontitis, suggesting overlapping, yet distinguishable microbial profiles.

Neuroinflammation related to the blood-brain barrier and sphingosine-1-phosphate in a pre-clinical model of periodontal diseases and depression in rats.

AIM: To explore the potential mechanisms of neuroinflammation (microglia, blood-brain barrier [BBB] permeability, and the sphingosine-1-phosphate [S1P] pathways) resulting from the association between periodontitis and depression in rats. MATERIALS AND METHODS: This pre-clinical in vivo experimental study used Wistar rats, in which experimental periodontitis (P) was induced by using oral gavages with Porphyromonas gingivalis and Fusobacterium nucleatum. Then, a chronic mild stress (CMS) model was implemented to induce a depressive-like behaviour, resulting in four groups: P with CMS (P+CMS+), P without CMS (P+CMS-), CMS without P (P-CMS+), and control (P-CMS-). After harvesting brain samples, protein/mRNA expression analyses and fluorescence immunohistochemistry were performed in the frontal cortex (FC). Results were analysed by ANOVA. RESULTS: CMS exposure increased the number of microglia (an indicator of neuroinflammation) in the FC. In the combined model (P+CMS+), there was a decrease in the expression of tight junction proteins (zonula occludens-1 [ZO-1], occludin) and an increase in intercellular and vascular cell adhesion molecules (ICAM-1, VCAM-1) and matrix metalloproteinase 9 (MMP9), suggesting a more severe disruption of the BBB. The enzymes and receptors of S1P were also differentially regulated. CONCLUSIONS: Microglia, BBB permeability, and S1P pathways could be relevant mechanisms explaining the association between periodontitis and depression.

The Cantabria Cohort, a protocol for a population-based cohort in northern Spain.

Cantabria Cohort stems from a research and action initiative lead by researchers from Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital and University of Cantabria, supported by the regional Goverment. Its aim is to identify and follow up a cohort that would provide information to improve the understanding of the etiology and prognosis of different acute and chronic diseases. The Cantabria Cohort will recruit between 40,000-50,000 residents aged 40-69 years at baseline, representing 10-20% of the target population. Currently, more than 30,000 volunteers have been enrolled. All participants will be invited for a re-assessment every three years, while the overall duration is planned for twenty years. The repeated collection of biomaterials combined with broad information from participant questionnaires, medical examinations, actual health system records and other secondary public data sources is a major strength of its design, which will make it possible to address biological pathways of disease development, identify new factors involved in health and disease, design new strategies for disease prevention, and advance precision medicine. It is conceived to allow access to a large number of researchers worldwide to boost collaboration and medical research.

Adjunctive efficacy of systemic metronidazole in the surgical treatment of periodontitis: a double-blind parallel randomized clinical trial.

OBJECTIVES: The purpose of this study was to evaluate the clinical and microbiological impact of adjunctive metronidazole to periodontal surgery. MATERIALS AND METHODS: Systemically healthy patients, with stages III-IV, grades B-C periodontitis, were randomly assigned to receive metronidazole or placebo adjunctive to periodontal surgery, after subgingival instrumentation. Clinical variables were recorded at the initial visit, 6 weeks after subgingival instrumentation, and 3, 6, and 12 months after surgery. Microbiological samples were taken at initial and final visits and analyzed by quantitative polymerase chain reaction. RESULTS: Our results showed no statistically significant differences in the reduction of probing depth between the initial and final (1 year) visits in the two treatment groups. Additionally, no statistically significant differences were observed between study groups when comparing the post-subgingival instrumentation and final visits. However, 3 months after surgery, probing depth (mean difference, MD = 0.31 mm, 95% confidence interval, CI [0.13; 0.49]; p = 0.001) and clinical attachment level (MD = 0.64 mm, 95% CI [0.02; 1.27]; p = 0.044) were significantly lower in the test group. CONCLUSIONS: The adjunctive use of systemic metronidazole to periodontal surgery has a limited clinical and microbiological impact in the present study, and therefore, its use is not recommended. CLINICAL RELEVANCE: There are no studies that have evaluated the clinical and microbiological impact of the adjunctive use of systemic metronidazole to periodontal surgery (step 3 of periodontal therapy). The results of the present study do not support the adjunctive use of systemic metronidazole to periodontal surgery.

Periodontal diseases and depression: A pre-clinical in vivo study.

AIM: To analyse, through a pre-clinical in vivo model, the possible mechanisms linking depression and periodontitis at behavioural, microbiological and molecular levels. MATERIALS AND METHODS: Periodontitis (P) was induced in Wistar:Han rats (oral gavages with Porphyromonas gingivalis and Fusobacterium nucleatum) during 12 weeks, followed by a 3-week period of Chronic Mild Stress (CMS) induction. Four groups (n = 12 rats/group) were obtained: periodontitis and CMS (P+CMS+); periodontitis without CMS; CMS without periodontitis; and control. Periodontal clinical variables, alveolar bone levels (ABL), depressive-like behaviour, microbial counts and expression of inflammatory mediators in plasma and brain frontal cortex (FC), were measured. ANOVA tests were applied. RESULTS: The highest values for ABL occurred in the P+CMS+ group, which also presented the highest expression of pro-inflammatory mediators (TNF-α, IL-1ß and NF-kB) in frontal cortex, related to the lipoprotein APOA1-mediated transport of bacterial lipopolysaccharide to the brain and the detection of F. nucleatum in the brain parenchyma. A dysregulation of the hypothalamic-pituitary-adrenal stress axis, reflected by the increase in plasma corticosterone and glucocorticoid receptor levels in FC, was also found in this group. CONCLUSIONS: Neuroinflammation induced by F. nucleatum (through a leaky mouth) might act as the linking mechanism between periodontal diseases and depression.

[A dialectical view of curriculum changes in nursing training]. / Um olhar dialético para as mudanças curriculares na formação do enfermeiro.

OBJECTIVE: To understand the contradictions involved in the process of curriculum reconstruction in the training of nurses, on the professors' perception. METHOD: Qualitative interpretative study, in which professors of nursing courses from three public and three private institutions were interviewed. The analysis was based on dialectical hermeneutics. RESULTS: 21 professors participated in the study. The proposals of changes are associated with advances and resistances, since the extended view of the health-disease process is opposed to the biological view; the diversification of learning scenarios is confronted with the hegemony of the hospital scenario; the integration of teaching and service faces the inequality of participation of the parties; and integration between the basic and the clinical cycle finds resistance in the knowledge accumulated in each discipline. CONCLUSION: The contradictions found, although inherent to the change process, indicate that persistence and continuous movement towards curriculum reformulation are necessary.

Clinical and microbiological effects of the adjunctive use of probiotics in the treatment of gingivitis: A randomized controlled clinical trial.

AIM: To evaluate the efficacy of a probiotic combination in the treatment of gingivitis and to assess its impact on the subgingival microbiota. MATERIALS AND METHODS: A placebo-controlled clinical trial was conducted in gingivitis subjects during 6 weeks. Test treatment consisted of the administration of two oral tablets per day containing the probiotic strains Lactobacillus plantarum, Lactobacillus brevis and Pediococcus acidilactici; the control group received the same tablets but without live bacteria. The main outcome variable was the changes in gingival index (GI). Subgingival samples were collected and analysed by quantitative polymerase chain reaction (qPCR) for five putative periodontal pathogens. Outcome variables were compared between and within groups, and multiple regression analysis was performed. RESULTS: A total of 59 patients (29 tests, 30 placebos) were included in the analysis. Both treatment groups experienced a statistically significant improvement in mean GI (p < .0001), but no differences between treatment groups were found for any clinical index. A significantly higher reduction in the number of sites with higher GI scores (GI = 3 at baseline) was observed in the test group. In subgingival samples, a significant reduction in T. forsythia was significant only in the test group (p < .008). CONCLUSIONS: The use of probiotic tablets containing L. plantarum, L. brevis and P. acidilactici did not lead to significant changes in mean GI; although a significant reduction occurred in the number of sites with severe inflammation. Furthermore, the adjunctive use of this probiotic promoted a significant microbiological impact.

Experience of hypertensive patients with self-management of health care.

AIMS: The aim of this study was to interpret how hypertensive patients experience health care self-management. BACKGROUND: Hypertension is one of the most prevalent chronic diseases worldwide. The involvement of individuals in the management of their health care to treat this disease is fundamental, with aid and advice from healthcare professionals, especially nurses, so that hypertensive patients can effectively self-manage their health care. DESIGN: Qualitative study. METHODS: Hypertensive patients were recruited using theoretical sampling. The study sample consisted of 28 hypertensive patients aged 18-59 years who were registered in the e-Health programme of the Ministry of Health. Data were collected and analyzed between September 2012-October 2014 using a semi-structured interview based on the methodological framework of the constructivist grounded theory. FINDINGS: The participants' statements depicted an outline of their experience with the disease: the beginning of the illness; understanding the disease process; incorporating behaviour for self-management of the disease; experiencing attitudes and actions in the control and treatment of the disease; and being treated in the public healthcare system. A central phenomenon emerged, namely hypertensive patients' experience of self-management of health care. CONCLUSION: This phenomenon has paths, actions and interactions. When patients discover that they have the disease and become aware of the disease process, they assume the identity of being hypertensive and become proactive in their health care and in living with their families and in communities.

[Living and health conditions of elderly people over 80]. / Condições de vida e de saúde de idosos acima de 80 anos.

OBJECTIVE: This article proposes to describe demographic data and health conditions of elderly people at age 80 or more. METHOD: Quantitative-descriptive study of 95 elderlies from five units of the Family Health Strategy in the period from September to December 2013, using script with general data of the living conditions and health, including validated scales in geriatrics and gerontology. RESULTS: The average age was 85.4 years. There was a predominance of women. Most were widowers with family income, more frequently between 2 or 3 minimum wages and economic participation is for means of sharing responsibility. They present dependency for many of Daily Living Instrumental Activities and, on average, reported 2.2 diseases. Fear of falling, decreased vision and hearing as well as pain in different body regions are reported. CONCLUSION: It appears that they have more intense needs than the elderly in general, requiring new ways of organizing their health care.

Medical student in the family health strategy on the first years of college: perception of graduates.

There is a lack of knowledge about the effective value of the experience gained by medical students who participate in the Family Health Strategy (Estratégia Saúde da Família (ESF)) during the early stages of their medical training. This teaching strategy is based on learning by experiencing the problems that exist in real life. This study proposed to understand the value of this teaching strategy from the viewpoint of the students who had participated, after their graduation. The method adopted was a qualitative study conducted through interviews with students who graduated in the years 2009, 2010 and 2011. The data analysis used the hermeneutic dialectic technique as its model. The graduates considered that this experience enabled them to understand the organization and functioning of the health service and the context of the daily life of the users. This experience facilitated the doctor patient relationship, the development of clinical reasoning and the bond with the user. However the students emphasized that a lack of maturity prevented them gaining a higher level of benefit from the experience. Therefore, although the structure of the course is permeated by advances and challenges, it was concluded that this experience contributed to the student's learning of certain essential elements of medical training.

Validation of ATP bioluminescence as a tool to assess antimicrobial effects of mouthrinses in an in vitro subgingival-biofilm model.

OBJECTIVES: The aim of this investigation was to evaluate whether the adenosine triphosphate (ATP) bioluminescence method is an appropriate tool to assess the efficacy of antiseptic mouthrinses in terms of quantitative reductions of total viable microbial counts in mixed biofilm populations in vitro. STUDY DESIGN: Three mouthrinses, containing respectively, chlorhexidine and cetylpyridinium chloride (CHX/CPC), essential oils (EO) and amine fluoride/stannous fluoride (AFSF), as well as Phosphate Buffered Saline (PBS) used as control, were tested in an in vitro static biofilm model by ATP bioluminescence and compared to culture method. Biofilms were grown on saliva-coated hydroxyapatite disks for 72 hours and then exposed for 1 minute to the mouthrinse or control by immersion. The antibacterial effect of the rinses was tested by analysis of variance. The reliability of the ATP bioluminescence method was assessed by calculating the Pearson correlation coefficients when compared to the viable cell counts obtained by culture. RESULTS: Using ATP bioluminescence, the antimicrobial activity of the tested mouthrinses was demonstrated when compared to the PBS control. The ATP bioluminescence values were significantly correlated (0.769, p<0.001) to the viable cell counts. CHX/CPC and AFSF showed similar antimicrobial activity, although AFSF had a less homogeneous effect, being both more effective than the EO rinse. CONCLUSION: ATP bioluminescence viability testing may be considered a useful tool to assess the in vitro efficacy of antibacterial compounds. In the proposed model, CHX/CPC and AFSF containing mouthrinses demonstrated superior antimicrobial activity, as compared to EO rinses, in a multispecies biofilm model.

[Projections and expectations of students enrolled in a teaching qualification in a technical health professional education course]. / Projeções e expectativas de ingressantes no curso de formação docente em educação profissional técnica na saúde.

This research aims at analyzing the projections and expectations of students enrolled in a teaching qualification in technical health professional education course, aiming at overcoming disciplinary fragmentation and further approaching the working world. This was a qualitative study that included interviews with 33 students enrolled in the course, and the data analysis was performed using a content analysis technique. The following categories were identified among the results: the possibility of teaching-learning; the need for pedagogical qualification and the constant search for learning; and the possibility of changing reality. We conclude that students enrolled in this course foresee the transformation of their social reality, taking into account the need to acquire new skills and professional competences to effectively perform their job and compete within the working world.

Perception of graduates about the education of Nursing Technicians.

OBJECTIVES: to interpret the perception of graduates from the nursing technician program on the learning process developed during their education. METHODS: a qualitative study was conducted from March to September 2021, based on interviews with 20 graduates from a nursing technician program at a school in the Midwest of São Paulo, using thematic analysis and the NVivo tool. RESULTS: the following themes were identified: traditional teaching methods, active learning strategies, valuing proactivity and experiences in professional practice. FINAL CONSIDERATIONS: according to the graduates, the teaching process is essentially based on traditional methods, although there are initiatives to implement active strategies and recognition of the importance of advancing student proactivity and practical experience.

Distinct docking mechanisms mediate interactions between the Msg5 phosphatase and mating or cell integrity mitogen-activated protein kinases (MAPKs) in Saccharomyces cerevisiae.

MAPK phosphatases (MKPs) are negative regulators of signaling pathways with distinct MAPK substrate specificities. For example, the yeast dual specificity phosphatase Msg5 dephosphorylates the Fus3 and Slt2 MAPKs operating in the mating and cell wall integrity pathways, respectively. Like other MAPK-interacting proteins, most MKPs bind MAPKs through specific docking domains. These include D-motifs, which contain basic residues that interact with acidic residues in the common docking (CD) domain of MAPKs. Here we show that Msg5 interacts not only with Fus3, Kss1, and Slt2 but also with the pseudokinase Slt2 paralog Mlp1. Using yeast two-hybrid and in vitro interaction assays, we have identified distinct regions within the N-terminal domain of Msg5 that differentially bind either the MAPKs Fus3 and Kss1 or Slt2 and Mlp1. Whereas a canonical D-site within Msg5 mediates interaction with the CD domains of Fus3 and Kss1, a novel motif ((102)IYT(104)) within Msg5 is involved in binding to Slt2 and Mlp1. Furthermore, mutation of this site prevents the phosphorylation of Msg5 by Slt2. This motif is conserved in Sdp1, another MKP that dephosphorylates Slt2, as well as in Msg5 orthologs from other yeast species. A region spanning amino acids 274-373 within Slt2 and Mlp1 mediates binding to this Msg5 motif in a CD domain-independent manner. In contrast, Slt2 uses its CD domain to bind to its upstream activator Mkk1. This binding flexibility may allow MAPK pathways to exploit additional regulatory controls in order to provide fine modulation of both pathway activity and specificity.

Prosodic awareness skills and literacy acquisition in Spanish.

There has been very little research in Spanish on the potential role of prosodic skills in reading and spelling acquisition, which is the subject of the present study. A total of 85 children in 5th year of Primary Education (mean age 10 years and 9 months) performed tests assessing memory, stress awareness, phonological awareness, reading and spelling. In written language tests, errors were classified as phonological (grapheme-to-phoneme conversion rules) or stress-related (placement of the stress mark). Regression analyses showed that, once memory and phonological awareness were controlled, stress awareness partially explained reading and spelling performance as well as error type; however, differences were found between reading and spelling errors. These results show a relationship between prosodic skills--namely stress sensitivity--and the acquisition of reading and spelling skills that seems to be independent of phonological awareness skills.

[The perception of hypertensive elderly patients regarding their health needs]. / Percepção de idosos hipertensos sobre suas necessidades de saúde.

Considering the prevalence of arterial hypertension among the elderly, the present study analyzes their perception of health needs, in a qualitative way, from focal groups with elderly users of Family Health Units. Data analysis was performed according to the hermeneutic-dialectical perspective and resulted in three nuclei of meaning: recognizing the possibility of having access to basic health care together with the desire to consume services of greater complexity and understanding the shortcomings of the State; attachment and welcoming as fundamental elements in the feelings of support and security and autonomy permeated by the tranquility to deal with the disease and the difficulties imposed by conditions inherent to the subjects' life style. Therefore, it is understood that the Family Health Strategy has been complying with its role in terms of the access to the healthcare system and regarding the professional-user attachment. However, health care continues to be centered on the disease rather than the individual.

Mental health promotion and protection actions aimed at the elderly in the context of primary health care: an integrative review. / Ações de promoção e proteção à saúde mental do idoso na atenção primária à saúde: uma revisão integrativa.

The increase in the elderly population requires rethinking the organization of society, especially health services. The aim was to analyze actions aimed at promoting and protecting the mental health of the elderly in the context of primary health care, through an integrative review. The databases used were: Lilacs, Scopus, IBECS, Medline, CINAHL, BDENF and Index Psicologia. The descriptors used were "elderly", "health promotion", "mental health" and "primary health care". The final sample included 15 articles. The results indicate that group actions contribute to the reduction of depressive symptoms; health education in the perspective of active learning, aiming at health literacy and memory workshop strengthening spaces for socialization. Matrix support is highlighted as an indispensable tool for new mental health practices. We conclude that the moment is right for expanding the scope of actions offered to the elderly in psychological distress. Efforts have been detected in the production of care aiming at integrality, which is still incipient.

O aumento da população de idosos exige repensar a organização da sociedade, especialmente os serviços de saúde. Por meio de revisão integrativa, o objetivo foi analisar ações de promoção e proteção à saúde mental do idoso no contexto da atenção primária à saúde. As bases de dados foram: LILACS, Scopus, IBECS, Medline, CINAHL, BDENF e Index Psicologia. Os descritores foram "idoso", "promoção da saúde", "saúde mental" e "atenção primária à saúde". A amostra final foi constituída por 15 artigos. Os resultados apontam ações em grupo contribuindo para a redução de sintomas depressivos, educação em saúde na perspectiva da aprendizagem ativa, visando à alfabetização em saúde, e oficina de memória, fortalecendo espaços de socialização. Ressalta-se o apoio matricial como ferramenta indispensável a novas práticas em saúde mental. Conclui-se que o momento é de ampliação do escopo de ações oferecidas aos idosos em sofrimento psíquico. Detectam-se esforços para a produção do cuidado na direção da integralidade, mas ainda incipientes.

Elderly victims of violence: family assessment through the Calgary model.

OBJECTIVE: To understand the structure, development, and functionality of the family of the elderly victim of violence. METHOD: Descriptive research with a qualitative approach, based on the Calgary Family Assessment Model. Four elderly people who suffered violence and their family members were assessed at home, from October to November 2019. Data analysis was based on the genogram and ecomap, as proposed in the model. RESULTS: It was found that the members of the four families had low schooling and financial difficulties. As for the social support network, the neighbors, the health unit and the Church stood out. The members of each family nucleus expressed feelings of fear, insecurity, anger, nervousness, sadness and impotence, resulting from the conflict between the couple. FINAL CONSIDERATIONS: In the assessed families, weaknesses and potentialities in the structure, development and functioning are highlighted, which must be considered in the elaboration of the care plan.

Experiences of alcohol-dependent elderly: grounded theory.

OBJECTIVE: To interpret the experiences of alcohol-dependent elderly people. METHOD: Qualitative research developed through the theoretical and methodological assumptions of the Grounded Theory in the Straussian version. It was carried out in a small town in the mid-western region of the state of São Paulo. The selection was by theoretical sampling, totaling 25 participants from three sample groups. Semistructured interviews were conducted from March 2019 to January 2020. RESULTS: The phenomenon "Experiencing alcohol dependence in old age", is conditioned by the category "Initiating Alcohol Consumption", are actions/interactions "Justifying alcohol consumption" and "Coping with alcohol treatment and abstinence" whose consequences are "Experiencing the harms of alcohol dependence" and "Expressing feelings". CONCLUSION: It was evidenced that the elderly participants consider alcohol dependence as a way to deal with negative emotions, and, in this trajectory, they experience physical, mental, and social consequences. The elderly in abstinence express feelings of loneliness, regret, and desire for a life with quality, and indicate that behavioral change occurs through treatment and awareness of its harmful effects.

Neurodevelopment Outcome in Children with Fetal Growth Restriction at Six Years of Age: A Retrospective Cohort Study.

OBJECTIVE: This study aimed to describe neurodevelopment in fetal growth restriction children at the age of six. Secondly, we tried to demonstrate influencing factors that can improve or exacerbate this development, as well as predictive factors that might select a population at risk to assist with early childhood support. METHOD: It was a study of 70 children affected with FGR. FGR was based on these definitions: birth weight below the 3rd percentile or birth weight below the 10th percentile with an abnormal hemodynamic Doppler study. Neurodevelopment was assessed at 6 years old by means of Batelle Development Inventory. A global development quotient under a 100 score was considered a neurodevelopment delay. All variables regarding pregnancy care, delivery episode, postpartum, neonatal care, sociodemographic issues, and the need for support in the first years were studied. RESULTS: The mean gestational age at diagnosis was 33.14 weeks (standard deviation (SD = 4.31), with 32.9% of early-onset diagnoses. The mean gestational age at delivery was 35.61 (SD = 3.21), and the cesarean rate was 64.3%. The average age of the children at the moment of the evaluation was 76.20-month-old (SD = 3.70). The mean global development quotient was 97.28 (SD = 13.97). We were able to record a 57.1% of global development delay. In the cases of cognition, only 17.1% of the children registered a delay. Motor and communication skills were the most frequently affected. We discovered that socioeconomic status was positively related to the global development quotient, as well as both gestational age at delivery and middle cerebral artery pulsatility index was positively related to the global development quotient. CONCLUSIONS: We found a higher neurodevelopment delay rate (57.1%). We could relate a higher gestational age at delivery and a higher MCA percentile with better global neurodevelopment quotients.