Perceived sources of stress amongst dental students: A multicountry study.

AIMS: The aim of this study was to explore the perceived sources of stress reported by dental students from fourteen different countries. METHODS: A total of 3568 dental students were recruited from 14 different dental schools. The dental environmental stress (DES) questionnaire was used including 7 domains. Responses to the DES were scored in 4-point Likert scale. Comparison between students was performed according to the study variables. The top 5 stress-provoking questions were identified amongst dental schools. Data were analysed using SPSS software program. Mann-Whitney and Kruskal-Wallis tests were used as appropriate. Logistic regression analysis was also conducted to determine the effect of the studied variables on the stress domains. The level of statistical significance was set at <.05. RESULTS: Internal consistency of the scale was excellent (0.927). Female students formed the majority of the total student population. The percentage of married students was 4.8%. Numbers of students in pre-clinical and clinical stages were close together. The most stress-provoking domain was "workload" with a score of 2.05 ± 0.56. Female students scored higher stress than male students did in most of the domains. Significant differences were found between participating countries in all stress-provoking domains. Dental students from Egypt scored the highest level of stress whilst dental students from Jordan scored the lowest level of stress. CONCLUSION: The self-reported stress in the dental environment is still high and the stressors seem to be comparable amongst the participating countries. Effective management programmes are needed to minimise dental environment stress.

Comparison between digestive endoscopy and 24-hour esophageal pH monitoring for the diagnosis of gastroesophageal reflux esophagitis: "presentation of 100 cases".

BACKGROUND/AIMS: We present the results obtained from 100 new cases of clinical esophagitis caused by gastroesophageal reflux at the Hospital of Caldas and at the Service of Gastroenterology of VIME (Endoscopical Video Medicine) in Manizales, Caldas, Colombia; between the months of June and November of 1996, evaluated by digestive endoscopy and classified based on the New Savary-Miller 5-Grade Classification. METHODOLOGY: The patients were selected based on the presence of symptomatology suggestive of esophagitis caused by gastroesophageal reflux; an endoscopy was performed followed by 24-hour esophageal pH monitoring. The patients were grouped according to their grade of esophagitis in the New Savary-Miller Classification. The central analysis was focused on determining the existing relationship between the observed esophagitis and the results obtained by the 24-hour esophageal pH monitoring. RESULTS: Findings show that 51% and 48% of patients with esophagitis grades 1 and 2 had a normal DeMeester's score (< 14.7) in channel 1. In channel 2 we found normal scores in 86% and 82% of esophagitis grades 1 and 2, respectively. CONCLUSIONS: We ask whether the average level of pathological reflux of 14.7 can be extrapolated to our population; also whether endoscopical overdiagnosis of esophagitis caused by gastroesophageal reflux exists, or if non-recognized causes of esophagitis exist. Another question is if it is justified to order 24-hour esophageal pH monitoring in patients with grades 1 and 2 esophagitis.

[Changes in brain serotonin biosynthesis in rats with diabetes mellitus induced by streptozocin: effect of insulin treatment]. / Cambios en la biosíntesis de serotonina cerebral en ratas con diabetes mellitus inducida por estreptozotocina: efecto del tratamiento con insulina.

OBJECTIVE: To investigate if the changes in the activity of the tryptophan-5-hydroxylase and in brain serotonin synthesis provoked by diabetes mellitus persist or return to normal in the diabetic rats submitted to treatment with insulin. METHODS: Diabetes induced by the administration of streptozotocin in rats and their treatment with insulin was the paradigm used. At days 7, 14 and 21 of evolution, the brain serotonergic biosynthetic activity was evaluated. RESULTS: The diabetic rats showed a significant decrease of body weight. Also, they showed a low concentration of I-tryptophan, as well as a diminution in the activity of the key enzyme tryptophan-5-hydroxylase and its product serotonin in the cerebral cortex and brainstem. Interestingly, the activity of the enzyme was higher in the brainstem from day 14, accompanied with an elevation of the neurotransmitter. The diabetic rats submitted to treatment with insulin showed a complete physical recovery and a return to normal of plasma and brain I-tryptophan. The activity of the enzyme not only normalized but was elevated and with an increase of serotonin in the brainstem and cerebral cortex. CONCLUSION: The present findings confirm that diabetes mellitus produced a chronic anabolic deficit and a decrease in some brain regions of serotonin synthesis. Also, demonstrate that the diabetic rats under specific treatment with insulin had a complete physical recovery and a return to normal of the serotonin precursor in the blood and brain. However, the activity of the limiting enzyme TrpOH case was elevated with an increase of the neurotransmitter in all regions studied. Since the diabetic animal, insulin treated, does recover metabolically, the mechanism of activation of the serotonin biosynthetic path in the brain may not be dependent on the decreased availability of its precursor the free plasma I-tryptophan. Instead, it might be due to a change in the kinetics of tryptophan-5-hydroxylase, since its activity remains significantly increased in spite of plasma and brain normalization of its substrate. Altogether these changes in the biosynthesis of an important brain neurotransmitter may be of relevance in the pathophysiology of the psychoneurological complications in diabetic patients.

[Changes in cerebra serotonin synthesis induced by insulin-dependent diabetes mellitus]. / Alteraciones en la síntesis de serotonina cerebral inducidas por diabetes mellitus insulino-dependiente.

OBJECTIVE: Evaluate if the rats with diabetes mellitus insulin-dependent have a minor activity of the serotonergic biosynthetic pathway through the decrease of the free fraction of L-tryptophan in plasma. METHODS: Diabetes mellitus was induced in rats, and the brain serotonergic biosynthetic activity was evaluated at 7, 14, and 21 days after streptozotocin administration. RESULTS: The diabetic animals showed a general decrease in body weight. In plasma they had a decrease in the free fraction of L-tryptophan. Also, in the brain they show low levels of the amino acid, as well as decrease of the activity of the limiting enzyme tryptophan-5-hydroxylase and its product serotonin. Interestingly, the activity of the enzyme was higher in the brainstem from day 14, accompanied with an elevation of the neurotransmitter. CONCLUSIONS: The results confirm that diabetes mellitus insulin-depend induce chronic undernourishment. The low levels of L-tryptophan in blood of the diabetic animals suggest a minor transport of the amino acid to the brain and a decrease in serotonin synthesis, in cerebral cortex and hypothalamus. Besides, during the evolution of the disease, the activity of tryptophan hydroxylase was elevated, independently of L-tryptophan concentration in the brainstem of diabetic animals, suggesting a different response according to the brain region and possibly a different functional change, accompanied by an increase in the synthesis of the neurotransmitter.

Legislación para la salud / Health legislation

Se realizó este trabajo de manera enunciativa y de estímulo como un aporte inicial en las tareas implícitas de la promoción de la legislación para la salud, orientada a solicitar efectos legales que aseguren la no intervención de los servicios destinados a la protección de la salud