Factors associated with Brazilian adolescents' satisfaction with oral health.

OBJECTIVE: To identify the sociodemographic, clinical and self-reported indicators of oral health associated with Brazilian adolescents' satisfaction with oral health. METHODS: Secondary data were used following the examination of 4,231 adolescents, aged 15 to 19 years, participating in a national oral health survey (SBBrasil 2010). The independent variables were grouped into demographics, predisposition/facilitation, oral health conditions and perceived dental treatment need. Satisfaction with oral health was considered the dependent variable. Ordinal logistic (multiple) regression models tested the variables in sequence (hierarchical), as per the conceptual model, assuming p≤0.05 as the criterion for remaining in the model (Wald test). Adjustment of the model was evaluated with the Akaike information criterion (AIC) and -2 Log L. RESULTS: Participants with perceived treatment need (OR=2.36, 95% CI = 2.14-2.61), toothache (OR=1.18, 1.10-1.28), presence of oral impacts on daily performance (OIDP) (OR= 1.55, 1.44-1.68), severe and very severe dental aesthetic index (DAI) (OR=1.17, 1.08-1.27), were female (OR=1.16, 1.10-1.23), were of black/brown ethnicity (OR=1.10, 1.04-1.17), and had caries in anterior (OR=1.20, 1.08-1.32) and posterior teeth (OR=1.22, 1.13-1.32) presented lower satisfaction with oral health. CONCLUSION: Satisfaction with oral health in Brazilian adolescents is linked to a multidimensional structure of factors that include demographic aspects, such as gender and ethnic group, self-perception aspects, such as perceived treatment need and oral health impact on daily activities, and clinical aspects, such as the presence of toothache, severe malocclusion and caries in anterior and posterior teeth.

Evaluation of an educational activity in the oral health of students.

OBJECTIVE: To investigate the influence of educational activity in the school environment based on prescriptive and subjective oral health indicators. METHODS: Cross-sectional, comparative study involving students between 9 and 12 years of age, from schools that have educational activities and those that do not, designated schools A and B. The oral health indicators used were the Simplified Oral Hygiene Index (OHI-S) and the Community Periodontal Index (CPITN). Knowledge and attitudes with regard to oral health were evaluated using a structured questionnaire. RESULTS: A total of 289 schoolchildren took part, 50.5% from school A and 49.5% from school B, in the town of Montes Claros, in the Brazilian state of Minas Gerais. In school A, the schoolchildren's OHI-S was satisfactory for 9.6%, normal for 78.8% and deficient for 11.6%, while in school B, the respective percentages were 3.5%, 17.5% and 79% (chi-squared, P < 0.001). The students in school A showed better CPITN results, namely lack of bleeding for 61.6%, the presence of bleeding for 29.5% and presence of tartar for 8.9%, while in school B, the respective results were 25.2%, 45.5% and 29.4% (chi-squared, P < 0.001). Students in school A achieved more correct answers in questions that evaluated knowledge of oral health. The account of daily use of dental floss in school A was 21.7% and in B, 3.6% (chi-squared, P < 0.001). CONCLUSION: It is believed that educational activity in the school environment had a positive effect on oral health conditions, the consolidation of knowledge and incorporation of oral hygiene habits.

The accuracy of the modified Evan's blue dye test in detecting aspiration in tracheostomised patients.

OBJECTIVES: To evaluate the sensitivity and specificity of the modified Evans blue dye test compared to the fibre-optic endoscopic evaluation of swallowing to detect aspiration in tracheostomised patients. METHODS: This observational accuracy study included 17 patients hospitalised for respiratory complications, subjected to prolonged intubation, and for this reason, tracheostomised. RESULTS: Mean patient age was 60.2 ± 21.0 years. Aspiration was identified in 10 patients when assessed by fibre-optic endoscopic evaluation of swallowing; of these, 1 had aspiration when evaluated by modified Evans blue dye test. The dye test had a sensitivity of 10.0 per cent and specificity of 100.0 per cent for detecting aspiration. Fibre-optic endoscopic evaluation of swallowing revealed no statistically significant associations between aspiration presence and: speech and language therapy duration, intubation time, or tracheostomy plus mechanical ventilation duration. CONCLUSION: The modified Evans blue dye test is simple and inexpensive, and does not require prior knowledge in endoscopy; it may be used as an initial screening test in all tracheostomised patients for evaluating aspiration. However, fibre-optic endoscopic evaluation of swallowing should be used for a more comprehensive diagnosis of tracheostomy patients, especially for those at high risk for aspiration.

Gene expression, localization, and characterization of endothelin A and B receptors in the human adrenal cortex.

Compelling evidence indicates that the endothelium-derived potent vasoconstrictor endothelin-1 (ET-1) stimulates aldosterone secretion by interacting with specific receptors. Although two different ET-1 receptors have been identified and cloned, the receptor subtype involved in mediating aldosterone secretion is still unknown. Accordingly, we wished to investigate whether the genes of ET-1 and of its receptors A and B are expressed in the normal human adrenal cortex. We designed specific primers for ET-1 and the ETA and ETB receptors genes and developed a reverse transcription polymerase chain reaction (RT-PCR) with chemiluminescent quantitation of the cDNA. In addition, we carried out 125I ET-1 displacement studies with cold ET-1, ET-3 and the specific ETA and ETB ligands BQ123 and sarafotoxin 6C. Localization of each receptor subtype was also investigated by autoradiography. Binding experiments were first individually analyzed by Scatchard and Hofstee plot and then coanalyzed by the nonlinear iterative curve fitting program Ligand. Histologically normal adrenal cortex tissue, obtained from kidney cancer patients (n = 7), and an aldosterone-producing adenoma (APA), which is histogenetically derived from the zona glomerulosa (ZG) cells, were studied. Results showed that the ET-1, ETA and ETB mRNA can be detected by RT-PCR in all adrenal cortices as well as in the APA. The best fitting of the 125I ET-1 displacement binding data was consistently provided by a two-site model both in the normal adrenal cortex (F = 22.1, P < 0.0001) and in the APA (F = 18.4, P < 0.0001). In the former the density (Bmax) of the ETA and ETB subtype was 2.6 +/- 0.5 pmol/mg protein (m +/- SEM) and 1.19 +/- 0.6, respectively. The dissociation constant (Kd) of ET-1, ET-3, S6C, and BQ-123 for each receptor subtype resulted to be within the range reported for human tissue for the ETA and ETB receptors. In the APA tissue the Bmax tended to be lower (1.33 and 0.8 pmol/mg protein, for the ETA and ETB, respectively) but the Kd were similar. Autoradiographic studies confirmed the presence of both receptor subtypes on the ZG as well as on APA cells. Thus, the genes of ET-1 and both its receptor subtypes ETA and ETB are actively transcribed in the human adrenal cortex. Furthermore, both receptor subtypes are translated into proteins in ZG and APA cells.

Endothelin-1 and its receptors A and B in human aldosterone-producing adenomas.

Endothelin-1 stimulates aldosterone secretion by interacting with specific receptors. Accordingly, we wished to investigate endothelin-1, endothelin-A (ETA) receptor, and endothelin-B (ETB) receptor gene expression, localization, and properties in aldosterone-producing adenomas and in the normal human adrenal cortex. We carried out 125I-endothelin-1 displacement studies with cold endothelin-1, endothelin-3, the specific ETA antagonist BQ-123, and the specific ETB weak agonist sarafotoxin 6 C and coanalyzed data with the nonlinear iterative curve-fitting program LIGAND. We also studied gene expression with reverse transcription-polymerase chain reaction with specific primers for endothelin-1, ETA, and ETB complementary DNA. Normal adrenal cortices from consenting kidney cancer patients (n = 2) and aldosterone-producing adenomas (n = 4) were studied; for the latter, surrounding normal cortex and kidney biopsy tissue served as controls. To further localize the receptor subtypes, tissue sections were studied by autoradiography in the presence and absence of 500 nmol/L BQ-123, 100 nmol/L sarafotoxin 6 C, and 1 mumol/L cold endothelin-1. In all tissues examined, endothelin-1, ETA, and ETB messenger RNAs were easily detected. However, in aldosterone-producing adenomas, both receptors' genes were expressed at a higher level than in the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of extracranial carotid artery lesions at duplex in primary aldosteronism.

Renovascular hypertension and high renin hypertension were found to be associated with an excess prevalence of carotid artery atherosclerotic lesions and to a higher risk of stroke, respectively, as compared to low-to-normal renin hypertension. Primary aldosteronism, being characterized by hypertension and a chronically suppressed plasma renin activity, should be accompanied by a low prevalence of carotid artery lesions. To verify this hypothesis we investigated prospectively, by a high resolution duplex ultrasound technique, the prevalence of extracranial carotid artery lesions in a case-controlled study of 34 (22 women and 12 men, aged 22 to 76 years) patients with no history or symptoms of cerebrovascular disease. Primary aldosteronism was diagnosed in 17 patients; 12 had a surgically confirmed unilateral aldosterone-secreting adenoma; and 5 had idiopathic hyperaldosteronism. Each primary aldosteronism patient was individually matched with a control with primary hypertension for sex, race, age, body mass index, casual blood pressure levels, duration of hypertension, smoking, diabetes mellitus, total serum cholesterol, and triglycerides. After the matching, the two groups were similar in terms of demographic features and overall cardiovascular risk profile (all P = NS). However, plasma renin activity and aldosterone levels were significantly lower and higher, respectively, in primary aldosteronism than in primary hypertensive patients. In primary aldosteronism the overall prevalence of carotid artery lesions at duplex was 59%, not significantly different from that (53%) found in primary hypertensives. Thus, at variance with renovascular hypertension, primary aldosteronism is not associated with an excess prevalence of carotid artery lesions.

Excess prevalence of extracranial carotid artery lesions in renovascular hypertension.

High renin hypertension has been associated with a higher risk of stroke than low-to-normal renin hypertension. Accordingly, we investigated prospectively the prevalence of the extracranial carotid artery lesions in a case-control study of 70 patients (38 women and 32 men, aged 16 to 77 years) without history or symptoms of cerebrovascular disease. Renovascular hypertension was diagnosed in 35 patients on the basis of the angiographic demonstration of renal artery stenosis and of the favorable outcome after revascularization. It was caused by atherosclerosis in 20 patients and by fibrodysplasia in 15. Each renovascular hypertensive patient was individually matched with a control with primary hypertension for sex, race, age, blood pressure levels, duration of hypertension, smoking, diabetes mellitus, total serum cholesterol, and triglycerides. Carotid arteries were evaluated by a High Resolution Duplex system (Biosound 2000, probe 4 cm, 8 mHz). Our results show that after the matching the two groups were similar in terms of demographic features and overall cardiovascular risk profile (all P = NS). In renovascular hypertensives the prevalence of carotid artery lesions (82.6%) was significantly (P less than .01) higher than in primary hypertensives (42.9%). The higher prevalence of lesions in renovascular hypertension was observed not only in patients with atherosclerosis (100% v 55%, P less than .001), but also in those with fibrodysplasia (57% v 27%, P less than .01). Thus, for the same demographic features and overall cardiovascular risk profile, renovascular hypertension carries a more detrimental effect on the carotid artery than primary hypertension.

Imaging of aldosterone-secreting adenomas: a prospective comparison of computed tomography and magnetic resonance imaging in 27 patients with suspected primary aldosteronism.

We have compared prospectively the sensitivity, specificity and accuracy of CT and MRI in a series of 27 consecutive patients (age 23-76 yrs, 17 females, 10 males) with clinically suspected primary aldosteronism. We found 13 patients with a unilateral aldosterone-producing adenoma (11 on the left and 2 on the right side), 6 with idiopathic hyper-aldosteronism and 8 with primary hypertension, which in two cases was associated with a nonfunctioning adrenal adenoma. The diagnosis of aldosterone-producing adenoma was confirmed at surgery and pathology in all cases. Idiopathic hyper-aldosteronism was diagnosed on the basis of the results of dexamethasone-suppressed adrenal scintigraphy and/or selective adrenal vein sampling. MRI correctly identified all cases of aldosterone-producing adenoma, but gave false positive results in five cases: one had idiopathic hyper-aldosteronism with bilateral nodular hyperplasia and four primary hypertension, which in two patients was associated with a nonfunctioning adrenal adenoma. Therefore, the sensitivity of MRI was 100%, its specificity 64% and overall diagnostic accuracy 81%. In comparison, CT correctly recognized only eight of the 13 patients with aldosterone-producing adenoma and gave false positive results in three primary hypertensives, including the two patients with a nonfunctioning adrenal adenoma. Therefore, its sensitivity, specificity and accuracy were 62, 77 and 69%, respectively. Based on these results, it could be anticipated that about four of every ten patients with aldosterone-producing adenoma would not be correctly diagnosed by CT.(ABSTRACT TRUNCATED AT 250 WORDS)

Soluble plasma thrombomodulin levels in patients with chronic myeloproliferative disorder.

The plasma levels of soluble thrombomodulin (TM) were measured in 44 patients with chronic myeloproliferative disorder, 15 with polycythemia vera (PV), 29 with essential thrombocythemia (ET), and a group of 62 matched healthy controls. The younger patients had significantly lower TM levels (mean: 15.6 +/- 4.8 ng/mL) than the older patients (mean: 28.6 +/- 8.2 ng/mL, p < .001). Moreover, a significant negative correlation between platelet counts and plasma TM levels in healthy persons was noted (r = 0.317, p < .05). The only significant difference we found in plasma TM levels between patients and controls or among patients was between the young patients with ET (mean: 29.0 +/- 19.2 ng/mL) and young healthy controls (mean: 15.6 +/- 4.8 ng/mL). It is possible that younger ET patients with more active platelets are more susceptible to earlier vascular damage. The lack of any significant difference compared with the older patient population supports this hypothesis.

[Services for prevention, cure and rehabilitation of drug addiction in the Vercelli and Novara provinces]. / Servizi per la prevenzione, cura e riabilitazione delle tossicodipendenze nelle province di Vercelli e Novara.

The drug addiction prevention and treatment services in the provinces of Vercelli and Novara are examined. The aim of the present work was to study an area in a transitional stage, where agricultural and industrial work and society is changing as are cultural values but where there is sufficient prosperity both to encourage the spread of drug addiction to permit the establishment of appropriate care. The local services for the prevention and cure of drug addiction and the rehabilitation of addicts were set up in 1978. The present work aims to assess the current situation and function of those services.

[An examination of the correlations between the general population and the users of the Biella Mental Health Service]. / Esame di alcune correlazioni tra la popolazione generale e l'utenza afferente al Servizio di Salute Mentale di Biella.

This paper correlates certain general population variables with that of the users of the Biella Mental Health Service. Age, sex, civic status and schooling are considered. Analysis of the data points to certain risk zones. The significance of these correlations is considered.

[An epidemiological study of psychiatric emergencies at the Biella Department of Emergencies and Admissions in the 5 years of 1983-1987]. / Indagine epidemiologica sull'urgenza psichiatrica presso il DEA di Biella nel quinquennio 1983-87.

The psychiatric intervention procedure at the Emergency and Registration Department (ERD) of Biella Hospital is examined. After a short introduction in which some general data are provided regarding Health Unit no. 47 of Biella and Unit no. 48 of Cossato, the data collected by the ERD psychiatric register are analysed. Data on ERD arrival modalities are reviewed and the type of diagnosis attributed by the psychiatrist to patients examined at the ERD is examined. The various types of responses given by the psychiatrist after consultancy are then presented. The time bands in which the request for psychiatric intervention mainly fall are then noted. The paper closes with remarks on the effectiveness over time of psychiatric intervention at the ERD.

[Hospital emergencies in drug addiction. Analysis and interpretation of data recorded at 3 DEAs of the Turin area]. / L'emergenza ospedaliera nelle tossicodipendenze. Analisi ed interpretazione dei dati condotta in tre DEA dell'area torinese.

The present research forms part of a wider research organised as part of an NRC sub-project on the psychotherapy of drug addiction. It aims to examine drug addiction services in order to assess the interrelations between these services, their ways of operating and the use drug addicts make of them. An attempt is also made to identify the response models offered by these structures and their relation to the specific demand by the drug addicted users, the aim being to show that the initial response has in itself a largely unexploited capacity to direct the requirements of the drug addicted patients.

[Activity of psychiatric consultation in the D.E.A. of the hospital of Biella in the 4-year period 1-15-83/1-15-87]. / Attività di consulenza psichiatrica presso il D.E.A. dell'ospedale di Biella nel quadriennio 15-1-83/15-1-87.

The paper analyses the work of the psychiatrist in Biella Hospital D.E.A. between 15-1-83 and 15-1-87. The general outlines of the study are described under Material and Method. This is followed by a description of the way patients arrive at the D.E.A. during which it is pointed out that both the general practitioner and the local psychiatric service are generally excluded from the emergency circuit. The reasons for the emergency, the diagnosis arrived at and the types of treatment proposed by the psychiatrist are then reviewed. One section is dedicated to recurrences with particular emphasis on the so-called major users of the psychiatric emergency service.

[Immunofluorescence and immunoperoxidase: a comparison for sensitivity in cutaneous immunopathology (author's transl)]. / Immunofluorescence et immunoperoxydase: comparaison de la sensibilité en immunopathologie cutanée.

A comparative study of the sensitivities of the immunofluorescence (IF) and immunoperoxydase (IPo) techniques was undertaken. The material used was biopsies of various skin lesions and especially pemphigus, bullous pemphigoid, lupus erythematosus and dermatitis herpetiformis. Direct and indirect methods were performed for the detection of fixed immunoglobulins and complement deposits. With large deposits, immunoperoxydase and immunofluorescence show an equal sensibility and the labeling obtained with IPo is never more intensive than the labeling obtained with IF. In contrast, with small deposits, IPo was less sensitive than IF and appears negative in the majority of the cases and especially in dermatitis herpetiformis. These results are confirmed in using increasing dilutions of conjugates and can be explained by the difficulty in doing the observation of small positive deposits with IPo.

[Quantitative ultrastructural study of the epidermis basal layer in the vitiligo patches and in the marginal hyperchromic and normal skin (author's transl)]. / Etude quantitative ultrastructurale de la couche basale de l'épiderme dans les taches de vitiligo, dans la mélanodermie périlésionnelle et la peau normale marginale.

To avoid any bias, the ultramicroscopic examination was performed by the morphologist without knowing whether the material examined was from the vitiligo patch or from the marginal hyperpigmented and normal skin. Only at the end of the investigation, he was informed about the code of the material. He had also been informed about the possibility of receiving skin biopsies from a patient without vitiligo, what in fact was done with the inclusion of one case of albinism. Six cases of vitiligo have been studied. The melanocytes usually have not been observed in the vitiligo patches, where a variable number of Langerhans cells were seen. In the melanocytes reached about 17 p. 100 of the cellular population; Langerhans cells were absents. In the marginal normal skin the average proportion of melanocytes was near 10 p. 100 of the cellular population and the Langerhans have been observed only in one case (1.8 p. 100 of the population). Regarding the keratinocytes of the marginal hyperpigmented and normal skin, respectively 75 p. 100 and 59 p. 100 contained melanin; in the vitiligo patches only in one case keratinocytes contained melanin (2.8 p. 100 of the keratinocytes population as an average).

In primary aldosteronism the circadian blood pressure rhythm is similar to that in primary hypertension.

To investigate whether the 24-hour blood pressure (BP) profile of primary aldosteronism differs from that of primary hypertension, ambulatory BP monitoring was performed in 11 patients with primary aldosteronism (9 with an adrenal adenoma and 2 with idiopathic hyperaldosteronism) and in 11 primary hypertensives, matched for sex (5M,6F), age (mean: 52 vs 49 yrs) and casual BP. We found no difference in 24-hour BP, nocturnal BP fall, BP variability (standard deviation and peaks of pressure) response to postural changes (lying-standing BP) between the two groups (all p values n.s.). Within the patients with primary aldosteronism no correlation was observed between BP, plasma renin activity, blood and urine aldosterone levels, blood and urine K+, and size of the tumour. Thus, at variance with previous reports, these results show that diurnal rhythm of BP and BP variability are similar in primary aldosteronism and primary hypertensives with similar demographic features and causal BP levels. They also show that an orthostatic fall of BP is not a common feature in this disease.