Analysis of maxillary arch expansion in growing patients treated with early Class III protocol versus RME.

Aim: To evaluate and compare the maxillary arch expansion obtained in growing patients treated with Class III early treatment protocol (the modified SEC III protocol), or rapid maxillary expansion (RME). Methods: This retrospective observational study included patients in the mixed dentition with maxillary constriction and/ or dental crowding. The first group consisted of 30 patients (11 males and 19 females, mean age 9.4 ±1.7 years) with dentoskeletal Class III malocclusion treated with the modified SEC III protocol. The second group of 30 patients (14 males and 16 females, mean age 9.3 ±1.5 years) with Class I or II malocclusion was treated with a Hyrax-type expander applied to bands on the first upper molars. For each subject, initial (T0) and post expansion (T1) digital dental casts were collected. The intermolar and intercanine widths, the arch lengths at both cusp and gingival levels, the anteroposterior length and the palatal depth were measured at T0 and T1. Results: At T1 there were statistically significant differences for 3-3 occlusal (OC) (P < 0.009), arch-length OC (P <0.030), anteroposterior arch-length (AP) (P <0.003), Depth (P <0.030) and Ap (P <0.000). No statistically significant T0-T1 changes were found between the modified SEC III and Hyrax groups except for Depth (P <0.011) with a mean difference of 2.3 mm between the two groups. Conclusions: Both bonded and banded expanders, used in the modified SEC III protocol and RME treatment respectively, produced similar changes in the upper arch. The different initial dentoskeletal malocclusions of the two sample groups were not relevant to the post-expansion arch changes.

Factors associated with non-adoption of healthy behavior among individuals with diabetes: a population-based study in Brazil.

BACKGROUND: The non-adoption of behavioral changes to control diabetes mellitus contributes to a low adherence to self-care. This study aimed to investigate the factors associated with non-adoption of healthy behaviors among diabetic individuals. METHODS: Cross-sectional study using data from the National Health Survey (Pesquisa Nacional de Saúde) carried out in 2013 in Brazil, with adults (≥18 years) (n = 3098). The outcome variable was the non-adoption-two or fewer-of healthy behaviors. Logistic regression model was used to identify the factors associated with non-adoption of healthy behaviors. RESULTS: Approximately, 50% of the participants adopted two or fewer healthy habits and the most frequently mentioned were not drinking excessively (94.1%) and not smoking (89.1%). Not using diabetic medication (odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.02-1.85), not making regular doctor visits (OR = 1.42, 95% CI = 1.08-1.87), no limitation of usual activities (OR = 1.39, 95% CI = 1.01-1.94) and good self-rated health (OR = 1.47, 95% CI = 1.09-1.98) increased the chance of individuals non-adoption of healthy behaviors independently of gender, age, schooling and economic status. CONCLUSIONS: Health professionals need to be aware of issues, such as diabetic medication use, frequency of doctor visits, limitation of usual activities and good self-rated health, which are factors that can interfere with the adoption of healthy behaviors of diabetic patients.

Excess mortality associated with COVID-19 in Brazil: 2020-2021.

OBJECTIVE: To evaluate excess mortality in Brazil from January 2020 to April 2021, according to the primary causes of death registered in the Brazilian Mortality Information System (MIS). METHODS: Cross-sectional study with data extracted from the MIS. Excess deaths were examined by the primary cause of death according to 11 grouped causes. Autoregressive models used mortality data from 2015 to 2019 to predict expected deaths from January 2020 to April 2021. Excess deaths were calculated as the difference between the observed and the expected number of deaths. RESULTS: Total excess deaths of 370 055 were observed in the studied period, corresponding to a ratio of observed to expected of 1.14 in 2020 and 1.40 in 2021. Excess deaths were seen in three groups: symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified; other diseases of the respiratory system and coronavirus infection, unspecified site. CONCLUSIONS: The excess mortality in Brazil in these 16 months was 1.20 times greater than the previous year. The increase in not elsewhere classified causes and causes of death associated to COVID-19 indicate caution about the negative balance for some causes. Furthermore, the inequalities of mortality reporting systems in low- and middle-income countries in relation to underestimation of mortality still need to be addressed.

Cell-based therapies for the surgical treatment of periodontal intrabony defects: a systematic review.

OBJECTIVE: The aim of the study is to investigate the efficacy of cell-based therapy in the surgical treatment of periodontal intrabony defects. MATERIALS AND METHODS: PRISMA guidelines were followed, and the study protocol was regis-tered in PROSPERO. Electronic and hand searches were carried out on electronic databases and major international journals of periodontology. All randomized clinical trials (RCTs) comparing cell-based therapies com-bined with surgery to surgery alone for the treatment of periodontal intrabony defects were considered. Quality assessment was performed using the Cochrane Risk of Bias Tool for randomized clinical trials (RoB 2). Quantitative evaluation of data was performed by meta-analysis. RESULTS: Five hundred twenty-eight records were initially screened and 5 RCTs fulfilling the eligibility criteria were included. Periodontal ligament stem cells, dental pulp stem cells, periosteum-derived stem cells, gingival fibroblasts and their associated stem cells were used in combination with different surgical techniques to treat intrabony periodontal defects. Meta-analysis showed a statistically signif-icant effect in favor of cell-based groups for clinical attachment level gain (p=0.004), with a difference in means of 1.7 mm (95% CI 0.5; 2.9). This was replicated for intrabony defect depth reduction (p=0.006), with a difference in means of 1.3 (95% CI 0.4; 2.3). CONCLUSIONS: Cell-based therapies have been positively applied for the surgical treatment of intrabony periodontal defects with promising results. However, the results obtained should be interpreted with caution due to the low number of available RCTs, the study design heterogeneity, and the limited extension of the follow-up.

Prevalence of retained/transmigrated permanent and persistence of primary teeth associated with odontomas in young children.

AIM: Odontomas are odontogenic tumours of the jaws; they are generally asymptomatic with an unknown aetiology. This study was conducted on non-syndromic children aged 9 to 14 years to explore the side effects deriving from the presence of these benign tumours, as retention, transmigration, ectopic eruption of permanent teeth and the permanence of primary teeth in the affected area. METHODS: Two hundred panoramic (OPT) and 92 Cone Beam Computed Tomography radiographs (CBCT) of patients (130 males and 70 females) were analysed from February 2018 to December 2019. Two hundred odontomas (145 compound and 55 complex type) and 800 teeth (160 primary and 640 permanent) were included. RESULTS: The prevalence of these tumours in both male and female subjects was 65% and 35%, respectively; the prevalence of compound odontomas in maxillary and mandibular bones was respectively 27.58% and 72.41%. The prevalence of complex odontomas in maxillary bones in female and male subjects was 37.5% and 62.5% respectively. It was observed the presence of a primary tooth in 81% of cases, the presence of retained teeth in 16.5% and a dental transmigration in the remaining 2.5% of cases in the compound type. Gender (p?=0.158) has no significant correlation. CONCLUSIONS: An early diagnosis and removal of odontomas in primary dentition is crucial in order to prevent later dental complications. Since the detection of odontomas is mainly an accidental radiological finding, the need for routine radiographic analysis should be highlighted.

Perioral muscle activity changes after Lip Bumper treatment.

AIM: This prospective non-randomised case-control study analysed lip muscle activity after Lip Bumper (LB) treatment thought surface electromyography. METHODS: The study group was composed of 40 young patients with a mean age of 10 years and 1 month, treated with LB in the lower arch, while 40 children who did not undergo any treatment, matched for sex and age with the previous sample, constituted the control group. Measurements were performed at the beginning and after 1 year for both groups. Electromyographic recordings were obtained in rest position and during the swallowing of 50 ml of water. RESULTS: In the study group, after 1 year of LB treatment, a statistically significant decrease in values was found; specifically, in upper lip muscle activities at rest position with the appliance in situ (p <0.002) and both with (p <0.001) and without (p <0.001) the appliance for the lower lip. CONCLUSION: One year of LB treatment significantly reduced lip muscle activities at both rest position and during swallowing compared with the untreated sample. These results indicated a potential short-term of upper and lower lip muscle adaptation to the new balance induced by LB treatment.

The association between alcohol consumption and self-reported current depression among adults residing in Brazil.

BACKGROUND: The purpose of the current study was to investigate the association between binge and heavy drinking and self-reported current depression (SRCD) in a representative population-based sample of adults residing in Brazil. METHODS: The sample for this study was based on the 2013 Brazilian National Health Survey. SRCD was accessed using the Patient Health Questionnaire (PHQ-8), a valid eight-item depression measure for population-based studies instrument. The association between binge/heavy drinking and SRCD was investigated using weighted and adjusted multivariable logistic regression models. RESULTS: Out of the final study sample of 59 399 Brazilians, 47.2% were young adults, 34.6% were middle age adults and 52.4% were females. The prevalence of binge drinking was 13.8%, of heavy drinking was 3.2% and SRCD was 7.6%. There was a significant weighted and adjusted association between binge drinking and SRCD among young and middle age females (OR = 1.5, 95% CI:1.1-2.0 and OR = 0.6, 95% CI:0.4-0.8, respectively) and between heavy drinking and SRCD among young and middle age males (OR = 1.8, 95% CI:1.2-2.8 and OR = 2.5, 95% CI:1.5-4.1, respectively). CONCLUSIONS: The possible protective factor of binge drinking for SRCD among middle-aged Brazilian females needs to be further investigated and understood. Longitudinal research is needed to provide further evidence of associations found in this study.

Temporomandibular disc displacement with reduction treated with anterior repositioning splint: a 2-year clinical and magnetic resonance imaging (MRI) follow-up.

Clicking may appear in the initial, middle, or final phase of mandibular opening. Magnetic Resonance Imaging (MRI) is the most appropriate diagnostic imaging for diagnosing disc position. With anterior repositioning splint (ARS), disc recapture is achieved through a change in the position of the condyle to encourage adaptation of the retrodiscal tissues. Three patients reported pain and sounds during movement and clicking in the final phases; also, the MRI confirmed anteriorized disc position and the treatments consisted of an ARS. The post-treatment examination confirmed a normal opening without deviations and deflections. After 2 years, the conditions were stable, and the MRI showed thickening of the retrodiscal tissues, including extra fibrous tissue, resulting in a pseudodisc. Treatment using ARS can stimulate tissue fibrosis and the formation of a pseudodisc. MRI is the gold standard for diagnosis and treatment planning of disc displacement cases.

Decision-making process as guide to the management of non-carious cervical lesions with and without painful symptomatology.

The aim of this study is to develop a decision-making path for the management of non-carious cervical lesions (NCCLs) associated with or without dentin hypersensitivity (DH) This will allow to limit or delay invasive approaches identifying the causes that produced them. The need for this review is because there are no clear guidelines in the current literature for the treatment of NCCLs. Usually, the selection of the best therapy option is postponed to clinical judgment which can be influenced by a patient's demands (aesthetic, symptomatologic reasons or worsening of pre-existing NCCL). To establish a therapeutic plan the young dentist should be able to distinguish the NCCLs that need to be monitored over time from those in need of early treatment. Indeed, the experience of the dentist and the compliance of the patient play a decisive role for the success of the therapy.

Investigation of the immediate pre-operative physical capacity of patients scheduled for elective abdominal surgery using the 6-minute walk test.

OBJECTIVES: To evaluate the effects of repetition of the 6-minute walk test in patients scheduled to undergo abdominal surgery within the next 48 hours, and to verify the physical capacity of these subjects before surgery. DESIGN: Cross-sectional study. SETTING: University teaching hospital. PARTICIPANTS: Forty-two patients scheduled for elective abdominal surgery within the next 48 hours. OUTCOME MEASURES: Distance walked in the 6-minute walk test, heart rate, peripheral oxygen saturation, dyspnoea and leg fatigue. RESULTS: Thirty-one patients (74%) were able to walk for a longer distance when the test was repeated. In these subjects, the mean increase in distance walked was 35.4 [standard deviation (SD) 19.9]m. Heart rate, dyspnoea and leg fatigue increased significantly over time on both tests (P<0.05). The mean heart rate at the end of the sixth minute was significantly higher on the second test (P=0.022). Peripheral oxygen saturation remained above 90% in both tests. The furthest distance walked was, on average, 461.3 (SD 89.7)m. This value was significantly lower than that predicted for the sample (P<0.001). CONCLUSION: Patients scheduled to undergo abdominal surgery were able to walk further when they performed a second 6-minute walk test. Moreover, they showed reduced physical ability before surgery. These findings suggest that repetition of the 6-minute walk test may increase the accuracy of the distance walked, which is useful for studies assessing the physical capacity of patients undergoing abdominal surgery.

Hypertensive disorders in pregnancy: frequency and associated factors in a cohort of Brazilian women.

OBJECTIVE: To evaluate the frequency of and risk factors associated with hypertensive disorders in general antenatal care in five distinct areas of Brazil. METHODS: We performed a cohort study of 4892 women enrolled in midpregnancy from 1991 to 1995. Patients were queried at enrollment about hypertension prior to pregnancy. Medical diagnoses of hypertensive disorders in pregnancy were abstracted from patient records. Hypertensive disorders in pregnancy were classified according to recommendations of the American College of Obstetrics and Gynecology (ACOG). RESULTS: Of 4892 women studied, 367 (7.5%) presented hypertensive disorders, 113 (2.3%) being preeclampsia/eclampsia and 198 (4.0%) chronic hypertension. Frequencies of superimposed preeclampsia/eclampsia and transitory hypertension were 0.5% and 0.7%, respectively. Greater brachial arm circumference was strongly associated both with preeclampsia/eclampsia and with chronic hypertension (threefold difference across extreme quartiles, p < or =0.001). In adjusted analyses, being older, black, and obese were important and statistically significant risk factors for chronic hypertension. Similarly, nulliparity was a statistically significant risk factor for preeclampsia/eclampsia, and tendencies toward increased risk were seen for older, black, and obese women in adjusted analyses. Preeclampsia/eclampsia and chronic hypertension were notably less frequent in Manaus, although regional differences were statistically significant only for chronic hypertension. CONCLUSIONS: Hypertensive disorders commonly complicate pregnancy in Brazilian women. Risk factors for these disorders appear similar to those reported in other countries. Use of an inappropriately sized cuff to measure blood pressure may result in many false-positive diagnoses in more obese women. The considerably lower frequency of hypertensive disorders found in Manaus, in the Amazon region, warrants further study.

Nutritional status of pregnant women: prevalence and associated pregnancy outcomes.

INTRODUCTION: Although obesity is well recognized as a current public health problem, its prevalence and impact among pregnant women have been less investigated in Brazil. The objective of the study was to evaluate the impact of pre-obesity and obesity among pregnant women, describing its prevalence and risk factors, and their association with adverse pregnancy outcomes. METHODS: A cohort of 5,564 pregnant women, aged 20 years or more, enrolled at approximately 20 to 28 weeks of pregnancy, seen in prenatal public clinics of six state capitals in Brazil were followed up, between 1991 and 1995. Prepregnancy weight, age, educational level and parity were obtained from a standard questionnaire. Height was measured in duplicate and the interviewer assigned the skin color. Nutritional status was defined using body mass index (BMI), according to World Health Organization (WHO) criteria. Odds ratios and 95% confidence interval were calculated using logistic regression. RESULTS: Age-adjusted prevalences (and 95% CI) based on prepregnancy weight were: underweight 5.7% (5.1%-6.3%), overweight 19.2% (18.1%-20.3%), and obesity 5.5% (4.9%-6.2%). Obesity was more frequently observed in older black women, with a lower educational level and multiparous. Obese women had higher frequencies of gestational diabetes, macrosomia, hypertensive disorders, and lower risk of microsomia. CONCLUSIONS: Overweight nutritional status (obesity and pre-obesity) was seen in 25% of adult pregnant women and it was associated with increased risk for several adverse pregnancy outcomes, such as gestational diabetes and pre-eclampsia.

Assessment of weight gain during pregnancy in general prenatal care services in Brazil.

Obesity is an emerging major health risk for women around the world. In this regard, little attention has been given to pregnancy, a moment of risk not only for major weight gain in these women, but also for macrosomia in their offspring. The objective of this study is to evaluate weight gain during pregnancy. Data pertains to a cohort of pregnant women attending general prenatal care clinics in six state capitals in Brazil, from 1991 to 1995. We studied women aged 20 years and over with singleton pregnancies and no diagnosis of diabetes outside pregnancy, enrolled at approximately 20 - 28 weeks of gestation. According to the Institute of Medicine criteria, 38% (95%CI: 36-40%) of the women studied gained less and 29% (95%CI: 28-31%) had more than the recommended total weight gain. These proportions vary according to pre-pregnancy nutritional status. Given the increasing epidemic of obesity, the high prevalence of overweight and obesity in Brazilian women prior to pregnancy, and the lack of achievement of recommended weight gain during pregnancy, more effective means of managing weight gain during pregnancy are necessary.

Fasting plasma glucose is a useful test for the detection of gestational diabetes. Brazilian Study of Gestational Diabetes (EBDG) Working Group.

OBJECTIVE: To evaluate fasting plasma glucose as a screening test for states of gestational diabetes. RESEARCH DESIGN AND METHODS: Baseline data of a cohort conducted in general prenatal care units in Brazil, enrolling 5,579 women aged > or = 20 years with gestational ages of 24-28 weeks at the time of testing and no previous diagnosis of diabetes. A standardized 2-h 75-g oral glucose tolerance test was performed in 5,010 women. Gestational diabetes and its subcategories--diabetes and impaired glucose tolerance--were defined according to the 1994 World Health Organization panel recommendations. We evaluated screening properties of calculated sensitivity and specificity for fasting plasma glucose with receiver operator characteristic curves. RESULTS: For detection of the subcategory diabetes, a fasting plasma glucose of 89 mg/dl jointly maximizes sensitivity (88%) and specificity (78%), identifying 22% of the women as test-positive. For detection of impaired glucose tolerance, a value of 85 mg/dl jointly maximizes sensitivity and specificity (68%), identifying as test-positive 35% of the women. Lowering the cut point to 81 mg/dl increases sensitivity to 81%, but decreases specificity to 54%, labeling as test-positive 49% of the women. CONCLUSIONS: Fasting plasma glucose is a useful test for the screening of both subcategories of gestational diabetes, a threshold of 85 mg/dl being an acceptable option. Effective screening for the subcategory diabetes can be achieved using a cut point of 89 mg/dl. If greater emphasis is placed on the detection of impaired glucose tolerance, a lower value, 81 mg/dl, may be needed.

Culture, universals, and the personal.

This chapter summarizes a part of the case that can be made that the individual construction of a personal domain of choice and privacy generalizes across cultures and is not restricted to persons who live within Western or so-called modern societies. The research findings reported here are consistent with the view that persons seek to establish such areas of control in order to maintain a differentiated personal identity and a sense of personal agency. Children, adolescents, and adults from the United States and traditional cultures have been found to identify a class of behaviors and issues as being outside the legitimate sphere of social or moral regulation. Mothers from Western and traditional cultural settings recognize and foster their children's claims to areas of personal choice and privacy. Across cultures, as children mature and move toward adulthood, they lay claim to a broader range of issues and actions as personal matters. Research on adolescent-parent conflict with U.S. and Chinese samples has indicated that these shifts associated with adolescent claims to freedom are the source of most family conflicts. Anthropological accounts of adolescent-parent conflicts in 160 cultures have provided evidence that such conflicts are widespread (Schlegel and Barry, 1991). Finally, we are beginning to obtain evidence that parental overcontrol of personal issues is associated with symptoms of psychological problems in their adolescent children. These research findings are consistent with the proposal (Nucci, 1996) that establishment of a personal domain is an intrinsic feature of normal human development, resulting from the inevitable attempt by individuals to account for and differentiate between their own motives, values, and experiences and those of others. The evidence also points to the fact that such personal issues are coexistent with concerns for interpersonal harmony and social integration. Thus, it is not surprising that the work summarized here also suggests considerable social-class and cultural variation in how the personal is expressed. Such variation is consistent with the assumption that the personal is constructed out of social interactions (Nucci, 1996) that entail reciprocal interchange between individual and societal structures (Turiel, 1996). In Spiro's analysis (1984), the results of such reciprocal structural interaction cannot be accounted for by reducing the analysis of psychological structures in terms of cultural structures and vice versa. Thus, any accurate interpretation of the impact of culture on psychological development must be constrained by features that are peculiar to psychological systems. Extending this to the cross-cultural study of the personal domain, a case can be made for the need to explore such issues at the level of the individual, rather than at the level of the cultural shared-symbol system. On the other hand, this nonreductionist approach and the available evidence rule out the reification of the personal as a culturally empty set of psychological issues. As illustrated in studies of the distribution of rights in relation to gender and social hierarchy among Druze Arabs (Wainryb and Turiel, 1994), the interplay between the personal and the cultural system of roles and obligations provides a rich and contradictory portrait that can be understood only by shifting perspective from the social to the individual and back again without favor.

Mothers' concepts of young children's areas of personal freedom.

White suburban working- to upper-middle-class mothers (N = 40) of children ages 5 and 7 were interviewed regarding their concepts of children's areas of personal discretion, autonomy, and individuality. Mothers treated standardized moral, conventional, and prudential items as issues that mothers should control, while standardized personal items were treated as up to the child. In open-ended interviews, mothers reported setting limits around issues of safety, family conventions, and daily routines but permitted children to make decisions about food, recreational activities, clothes, and playmates. Mothers viewed mother-child conflict as occurring over these same issues and viewed children's choices as helping them to develop autonomy and competence. Mothers viewed their roles as educators and nurturers and valued the development of individuality in their children, which was thought to emerge in infancy or toddlerhood. Few age differences were observed, but gender differences were found in the ways mothers characterized boys' and girls' resistances to parental authority and in the content of mother-child disputes. Results were interpreted in terms of the emergence of the personal domain in children.

Social class effects on northeastern Brazilian children's conceptions of areas of personal choice and social regulation.

2 studies examined middle- and lower-class Brazilian children's concepts of personal choice and social regulation. In Study 1, interviews of 40 middle- and lower-class children (9 and 15 years old) revealed that children across classes distinguished moral from conventional issues on the bases of rule contingency and act generalizability criteria. Lower-class children, however, were less likely to view conventions as rule contingent and more likely to generalize conventional acts. In Study 2, interviews of 240 middle- and lower-class children (ages 8, 12, 16 years) found that across classes, children distinguished prudential issues from matters they treated as personal. Prudential issues were seen as subject to parental authority. Middle-class children were more likely to treat personal issues as matters of choice. With age, lower-class children increasingly tended to treat personal items as matters of choice, and by adolescence there were no class differences. Findings show that Brazilian children maintain a heterogeneous orientation to rules and authority which includes a domain of personal choice. Class differences indicate that hierarchical social structures affect children's sense of autonomy. However, developmental effects indicate that a domain of personal choice emerges among children across social classes.

Social interactions in the home and the development of young children's conceptions of the personal.

Observations and interviews of 20 middle-class 3- and 4-year-olds and their mothers were conducted to examine the emergence of the personal domain. Interviews with children showed that 3- and 4-year-olds make a conceptual distinction between personal, and moral or conventional issues. Interviews with mothers indicated that they viewed it as important for young children to have freedom of choice over personal issues to develop a sense of autonomy and individuality. Observations in the home revealed that mothers tended to give direct social messages to children about moral, conventional, and prudential events, and were more likely to give indirect social messages in the form of offered choices to children in response to personal issues. Mothers were more likely to negotiate with children over personal than other social events. These data revealed a pattern of social interactions concordant with event domain, which included a reciprocal system along the border between the personal and the conventional.