Socioeconomic inequalities and temporomandibular joint disorders in adolescents: contributions from a Maranhão cohort.

AIM: To assess the prevalence of temporomandibular disorder (TMD) in adolescents and estimate possible associations with poverty. BASIC RESEARCH DESIGN: A cross-sectional study nested within a prospective birth cohort study conducted in São Luís, Maranhão, Brazil. PARTICIPANTS: 2,412 adolescents aged 18-19 years. MATERIAL AND METHODS: The presence of TMD, classified according to the Fonseca Anamnestic Index, was used as the outcome. The following explanatory variables were assessed: gender, household head, paved/asphalted street, piped water, and socioeconomic background, based on the Brazilian Association of Market Research criteria and the poverty income ratio (PIR). Logistic regression analysis was performed with the estimation of odds ratios (OR) and 95% confidence intervals. RESULTS: TMD was common (51.4%) and was associated with poverty, as it was more frequent among adolescents from social classes D-E (OR=2.60; 95% CI: 1.48-4.55) and C (OR=1.82; 95% CI: 1.12-2.99) compared to A/B, and among poor adolescents using the PIR (OR=1.50; 95% CI: 1.02-2.33). CONCLUSIONS: The prevalence of TMD in socioeconomically disadvantaged adolescents in São Luís is high, and these data allow the early identification of at-risk groups. We recommend carrying out other population-based studies, using diagnostic strategies with greater accuracy.

Birth by cesarean section and mood disorders among adolescents of a birth cohort study in northern Brazil.

The increasing number of cesarean sections worldwide has encouraged research on the long-term effects of this birth type on the offspring's mental health. The objective of this study was to investigate whether there is an association between birth by cesarean section and the development of mood disorders (depression and bipolar disorders) in adolescents. A cohort study was carried out with 1603 adolescents from 18 to 19 years old who participated in the third phase of a birth cohort study in São Luís, MA, in 2016. Information on birth type and weight, prematurity, mother's age and schooling, parity, marital status, and smoking behavior during pregnancy, were collected at birth. The study outcomes were depression, bipolar disorder, and "mood disorder" construct. A Directed Acyclic Graph (DAG) was developed to select the variables for minimal adjustment for confounding and collision bias. Associations were estimated through propensity score weighting using a two-step estimation model, and confounders for cesarean birth were used in the predictive model. There was no significant association in the relationship between birth type and depression (95%CI: -0.037 to 0.017; P=0.47), bipolar disorder (95%CI: -0.019 to 0.045; P=0.43), and mood disorder (95%CI: -0.033 to 0.042; P=0.80) in adolescents of both sexes. Birth by cesarean section was not associated with the development of mood disorders in adolescents.

Socio-environmental determinants of the delay in the first dental visit: results of two population-based cohort studies in Brazil

The objective of this study was to describe the timing of the first dental visit and investigate the association of socioeconomic and behavioral factors with dental visit delay among 10/11-year-old children from two live-birth population cohorts with extremely contrasting socioeconomic profiles. Follow-up data (2004-2005) from cohorts of Ribeirão Preto (RP) (n=790) and São Luís (SL) (n=673) were evaluated. Delay in dental visit was defined as not visiting a dentist before the age of 7. Covariates included family socioeconomic characteristics, mother-related health behavior, and child-related characteristics. Prevalence ratios with robust standard errors were estimated. In both cohorts, less than 5% of children had visited a dentist before the age of two and about 35% of them had not visited a dentist before the age of seven. Lower mother's schooling and lack of private health insurance were associated with the delay in first dental visit for both cohorts. A small number of mother's prenatal care visits and being from a single-father family or a family without parents were only associated in the RP cohort, while having ≥4 siblings and lifetime dental pain were associated in the SL cohort. The association with dental pain probably reveals a preventive care-seeking behavior. Therefore, the percentage of delayed first dental visit of children was very high even among those with the most educated mothers. Further studies are necessary to analyze recent changes and underlying factors related to access to first dental visit after the implementation of the National Oral Health Policy in 2006.

Birth by cesarean section and mood disorders among adolescents of a birth cohort study in northern Brazil

The increasing number of cesarean sections worldwide has encouraged research on the long-term effects of this birth type on the offspring's mental health. The objective of this study was to investigate whether there is an association between birth by cesarean section and the development of mood disorders (depression and bipolar disorders) in adolescents. A cohort study was carried out with 1603 adolescents from 18 to 19 years old who participated in the third phase of a birth cohort study in São Luís, MA, in 2016. Information on birth type and weight, prematurity, mother's age and schooling, parity, marital status, and smoking behavior during pregnancy, were collected at birth. The study outcomes were depression, bipolar disorder, and "mood disorder" construct. A Directed Acyclic Graph (DAG) was developed to select the variables for minimal adjustment for confounding and collision bias. Associations were estimated through propensity score weighting using a two-step estimation model, and confounders for cesarean birth were used in the predictive model. There was no significant association in the relationship between birth type and depression (95%CI: -0.037 to 0.017; P=0.47), bipolar disorder (95%CI: -0.019 to 0.045; P=0.43), and mood disorder (95%CI: -0.033 to 0.042; P=0.80) in adolescents of both sexes. Birth by cesarean section was not associated with the development of mood disorders in adolescents.

Socio-environmental determinants of the delay in the first dental visit: results of two population-based cohort studies in Brazil.

The objective of this study was to describe the timing of the first dental visit and investigate the association of socioeconomic and behavioral factors with dental visit delay among 10/11-year-old children from two live-birth population cohorts with extremely contrasting socioeconomic profiles. Follow-up data (2004-2005) from cohorts of Ribeirão Preto (RP) (n=790) and São Luís (SL) (n=673) were evaluated. Delay in dental visit was defined as not visiting a dentist before the age of 7. Covariates included family socioeconomic characteristics, mother-related health behavior, and child-related characteristics. Prevalence ratios with robust standard errors were estimated. In both cohorts, less than 5% of children had visited a dentist before the age of two and about 35% of them had not visited a dentist before the age of seven. Lower mother's schooling and lack of private health insurance were associated with the delay in first dental visit for both cohorts. A small number of mother's prenatal care visits and being from a single-father family or a family without parents were only associated in the RP cohort, while having ≥4 siblings and lifetime dental pain were associated in the SL cohort. The association with dental pain probably reveals a preventive care-seeking behavior. Therefore, the percentage of delayed first dental visit of children was very high even among those with the most educated mothers. Further studies are necessary to analyze recent changes and underlying factors related to access to first dental visit after the implementation of the National Oral Health Policy in 2006.

Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

OBJECTIVES: Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). STUDY DESIGN: Cross-sectional ecological study. METHODS: Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. RESULTS: More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. CONCLUSION: Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances.

Fear and/or anxiety of children and parents associated with the dental environment.

AIM: To assess levels of anxiety in children concerning different dental instruments and equipment and to relate them with parents' anxiety levels moments before the appointment. MATERIALS AND METHODS: Fifty children from 4 to 12 years of age (average of 10±3.07) and their respective parents were evaluated. A facial scale was used to assess children's anxiety levels, while the Dental Anxiety Scale (DAS) was used to assess parents. Friedman test was applied to check any differences in children's anxiety levels relative to the equipment/instruments, and this was complemented by the use of the Wilcoxon test for two-by-two comparison. In order to assess correlation between parents' and their children's anxiety levels, the study used Spearman correlation coefficient. RESULTS: With regard to parents' anxiety levels, 4% resulted as null, 18% were low, 56% were moderate, and 22% were exacerbated; children's anxiety level results were: 52% light, 44% intermediate, and 4% intense. Anxiety levels related to instruments/equipment were, in descending order: carpule syringe > paediatric forceps > dental explorer > x-ray machine > rubber dam punch > high speed handpiece > rubber dam forceps > mouth mirror > clinical tweezers > dental chair. No correlation was found between parents' anxiety levels and those of their children (p=0.546). CONCLUSION: The instruments/equipment used in the assessment generated different anxiety levels in the children. No correlation was found between parents' anxiety levels and those of their children.

Paraventricular nucleus administration of DuP753 or PD123319 inhibits the effects of angiotensin on water and sodium intake.

We determined the effects of DuP753 and PD123319 (both nonpeptides and selective antagonists of the AT1 and AT2 angiotensin receptors, respectively), and [Sar1, Ala8]ANG II(a non-selective peptide antagonist of angiotensin receptors) on water and 3% NaCl intake induced by administration of angiotensin II (ANG II) into the paraventricular nucleus (PVN) of sodium-depleted Holtzman rats weighing 250-300 g. Twenty hours before the experiments, the rats were depleted of sodium using furosemide (10 ng/rat, sc). The volume of drug solution injected was 0.5 microliters over a period of 10-15 sec. Water and sodium intake were measured at 0.25, 0.5, 1.0 and 2.0 h. Pre-treatment with DuP753 (14 rats) at a dose of 60 ng completely abolished the water intake induced by injection of 12 ng of ANG II (15 rats) (6.4 +/- 0.6 vs 1.4 +/- 0.3 ml/2 h), whereas [Sar1, Ala8] ANG II (12 rats) and PD123319 (10 rats) at the doses of 60 ng partially blocked water intake (6.4 +/- 0.6 vs 2.9 +/- 0.5 and 2.7 +/- 0.2 ml/h, respectively). In the same animals, [Sar1, Ala8]ANG II, DuP753, and PD123319 blocked the sodium intake induced by ANG II (9.2 +/- 1.6 vs 3.3 +/- 0.6, 1.8 +/- 0.3, and 1.4 +/- 0.2 ml/2 h respectively). These results indicate that both DuP753 and PD123329, administered into the PVN, blocked the water and sodium intake induced by administration of ANG II into the same site.

Paraventricular nucleus administration of DuP753 or PD123319 inhibits the effects of angiotensin on water and sodium intake

We determined the effects of DuP753 and PD123319 (both nonpeptides and selective antagonists of the AT1 and AT2 angiotensin receptors, respectively), and [Sar(l), Ala(8)]ANG II (a non-selective peptide antagonist of angiotensin receptors)on water and 3 per cent NaCl intake induced by administration of angiotensin II (ANG II) into the paraventricular nucleus (PVN) of sodium-depleted Holtzman rats weighing 250-300 g. Twenty hours before the experiments, the rats were depleted of sodium using furosemide (10 ng/rat, sc). The volume of drug solution injected was 0.5 mul over a period of 10-15 sec. Water and sodium intake were measured at 0.25, 0.5, 1.0 and 2.0 h. Pre-treatment with DuP753 (l4 rats) at a dose of 60 ng completely abolished the water intake induced by injection of 12 ng of ANG II (15 rats) (6.4 ñ 0.6 vs 1.4 ñ 0.3 ml/2 h), whereas [Sar(l), Ala(8)]ANG II (l2 rats) and PDl23319 (10 rats) at the doses of 60 ng partially blocked water intake (6.4 ñ 0.6 vs 2.9 ñ 0.5 and 2.7 ñ 0.2 ml/2 h, respectively). In the same animals, [Sar(l), Ala(8)]ANG II, DuP753, and PDl23319 blocked the sodium intake induced by ANG II (9.2 ñ 1.6 vs 3.3 ñ 0.6, 1.8 ñ 0.3, and 1.4 ñ 0.2 ml/2 h, respectively). These results indicate that both DuP753 and PD123319, administered into the PVN, blocked the water and sodium intake induced by administration of ANG II into the same site.

Progesterone administration to ovariectomized rats reduces water and salt intake induced by central administration of angiotensin II.

We tested the effects of estradiol, progesterone and testosterone on water and salt intake induced by angiotensin II (ANG II) injected into the third ventricle of female Holtzman rats weighing 250-300 g. The water and salt ingestion observed after 120 min in the control experiments (injection of 0.5 microliter of 0.15 M NaCl into the third ventricle) was 1.6 +/- 0.3 ml (N = 10) and 0.3 +/- 0.1 ml (N = 8) in intact rats, respectively, and 1.4 +/- 0.3 ml (N = 10) and 0.2 +/- 0.1 (N = 8) in ovariectomized rats, respectively. ANG II injected in intact rats (4, 6, 12, 25, and 50 ng, icv, in 0.5 microliter saline) induced an increase in water intake (4.3 +/- 0.6, 5.4 +/- 0.7, 7.8 +/- 0.8, 10.4 +/- 1.2, 11.2 +/- 1.4 ml/120 min, respectively) (N = 43). The same doses of icv ANG II in intact rats increased the 3% NaCl intake (0.9 +/- 0.2, 1.4 +/- 0.3, 2.3 +/- 0.4, 2.2 +/- 0.3, and 2.5 +/- 0.4 ml/120 min, respectively) (N = 42). When administered to ovariectomized rats ANG II induced comparable amounts of water intake (4.0 +/- 0.5, 4.8 +/- 0.6, 6.9 +/- 0.7, 9.6 +/- 0.8, and 10.9 +/- 1.2 ml/120 min, respectively) (N = 43) but there was a significant decrease of 3% NaCl solution ingestion (0.3 +/- 0.1, 0.4 +/- 0.1, 0.8 +/- 0.2, 0.7 +/- 0.2, and 0.6 +/- 0.2 ml/120 min, respectively) (N = 44). Estrogen (50 micrograms), progesterone (25 ng), and testosterone (300 micrograms) were injected daily into ovariectomized rats for 21 days. Treatment with estrogen decreased the water intake and abolished the saline ingestion induced by icv injection of ANG II (12 ng) (2.8 +/- 1.2 and 0.3 +/- 0.1 ml/120 min, respectively) (N = 8). Treatment with progesterone also reduced the water intake (3.3 +/- 0.6 ml/120 min) (N = 8) and abolished the ANG II-induced saline ingestion (0.4 +/- 0.1 ml/120 min) (N = 8), but these effects were not observed with testosterone (6.4 +/- 0.8 and 2.2 +/- 0.3 ml/120 min, respectively) (N = 8). These results indicate that ANG II induces a greater increase in sodium intake in intact female rats than in ovariectomized rats and that estrogen and progesterone impair water and sodium intake in ovariectomized rats.

Progesterone administration to ovariectomized rats reduces water and salt intake induced by central administration of angiotensin II

We tested the effects of estradiol, progesterone and testosterone on water and salt intake induced by angiotensin II (ANG II) injected into the third ventricle of female Holtzman rats weighing 250-300 g. The water and salt ingestion observed after 120 min in the control experiments (injection of 0.5µl of 0.15 M NaCl into the third ventricle) was 1.6 ñ 0.3 ml (N = 10) and 0,3 ñ 0.1 ml (N = 8) in intact rats, respectively, and 1.4 ñ 0.3 ml (N = 10) and 0.2 ñ 0.1 (N = 8) in ovariectomized rats, respectively. ANG II injected in intact rats (4, 6, 12, 25, and 50 ng, icv, in 0,5 µl saline) induced an increase in water intake (4.3 ñ 0.6, 5.4 ñ 0.7, 7.8 ñ 0.8, 10.4 ñ 1.2, 11.2 ñ 1.4 ml/120 min, respectively) ( N = 43). The same doses of icv ANG II in intact increased the 3 per cent NaCl intake (0.9 ñ 0,2, 1.4 ñ 0,3, 2,3 ñ 0.4, 2,2 ñ 0,3, and 2.5 ñ 0.4 ml/120 min, respectively) (N = 42). When administered to ovariectomized rats ANG II induced comparable amounts of water intake (4.0 ñ 0.5, 4.8 ñ 0.6 ñ 0.7, 9.6 ñ 0.8, and 10.9 ñ 1.2 ml/120 min, respectively (

Cytochemical localization of enzyme markers in Tritrichomonas foetus.

Cytochemical techniques associated with transmission electron microscopy were used for the localization in Tritrichomonas foetus of enzymes used as markers of different cell structures. Reaction product indicating the presence of Mg(2+)-adenosine triphosphatase (Mg(2+)-ATPase) and 5'-nucleotidase was observed in the plasma membrane. Glucose-6-phosphatase was seen in association with the endoplasmic reticulum, revealing its organization as parallel cisternae. Thiamino-pyrophosphatase was located in the cis-most region of the Golgi complex. Acid phosphatase was found within lysosomes as well as in several cisternae of the Golgi complex, in contrast to previous observations in mammalian cells. These observations provide support for the use of enzyme markers in future studies on cell fractionation of T. foetus.

Interaction between cholinergic and opiate receptors of the lateral hypothalamus in the control of renal excretion in rats.

The present study was carried out to investigate the participation and interaction between cholinergic and opiate receptors of the lateral hypothalamus (LH) in the regulation of Na+, K+ and water excretion. Male Holtzman rats were implanted with chronic cerebral cannulas into the LH. Urine was collected over a period of 2 h after injection of carbachol, FK-p33824 + carbachol or naloxone + carbachol into the LH. Carbachol (8 nmol) reduced urinary volume and increased Na+ excretion. Previous injection of FK-33824 (100 ng) into the LH increased the antidiuretic effect of carbachol, but blocked the increase in Na+ excretion and decreased K+ excretion. Naloxone (10 micrograms) produced no changes in the effect of carbachol on renal excretion. These data show an inhibitory effect of opiate receptors on the changes in urinary Na+ and K+ excretion that are induced by cholinergic stimulation of the LH in rats, and a potentiating effect on antidiuresis.

Interaction between cholinergic and opiate receptors of the lateral hypothalamus in the control of renal excretion in rats

The present study was carried out to investigate the participation and interaction between cholinergic and opiate receptors of the lateral hypothalamus (LH) in the regulation of Na+, K+ and water excretion. Malew Holtzman rats were implanted with chronic cerebral cannulas into the LH. Urine was collected over a period of 2h after injection of carbachol, FK-33824 + carbachol or naloxone + carbachol into the LH. Carbachol (8nmol) reduced urinary volume and increased Na + excretion. Previous injection of FK-333824(100ng) into the LH increased the antidiuretic effect of carbachol, but blocked the increase in Na+ excretion and decreased K+ excretion. Naloxone. Naloxone (10microng) produced no changes in the effect of carbacho9l on renal excretion. These data show an inhibitory effect of opiate receptors on the changes in urinary Na+ and K+ excretion that are induced by chronergic stimulation of the LH in rats, and a potentiating effect on antidiuresis