Factors Associated with the Oral Health-Related Quality of Life in Children with Intellectual Disabilities / Factores asociados con la calidad de vida relacionada con la salud bucal en niños con discapacidad intelectual

Abstract: Different factors can influence the perception of quality of life in individuals with intellectual disabilities. This study investigated the factors associated with quality of life related to oral health in children with intellectual disabilities from the perspective of their parents. A cross-sectional study was carried out with Brazilian children from specialized institutions and their respective guardians. Data were collected through medical records, application of instruments and oral clinical examination (n=92). Most children had poor oral hygiene (64.10%) and a high caries experience (59.8%). The mothers' perception of quality of life related to oral health was low, however there was an association of greater perception when they had low education, female child, less brushing frequency and history of breastfeeding (p≤0.05). Although the perception of quality of life was low, the oral condition found evidences the need to promote oral health education actions with children with intellectual disabilities and their respective guardians.

Resumen: Diferentes factores pueden influir en la calidad de vida de personas con discapacidad intelectual. Este estudio investigó los factores asociados con la calidad de vida relacionada con la salud oral en niños con discapacidades intelectuales desde la perspectiva de sus cuidadores. Se realizó un estudio transversal con niños brasileños institucionalizados, que fueron evaluados clínicamente y sus respectivos tutores, quienes respondieron cuestionarios. Los datos fueron recolectados a través de registros médicos, aplicación de instrumentos de evaluación y examen clínico oral (n=92). La mayoría de los niños presentaban una higiene oral deficiente (64,10%) y una experiencia de caries alta (59,8%). Si bien la percepción específicamente de las madres respecto del impacto de las condiciones de la salud oral en la calidad de vida fue baja, mostró una tendencia a aumentar en cuanto disminuía el nivel educacional, la frecuencia de cepillado y la historia de lactancia materna (p≤0.05). El hecho de que la percepción del impacto en la calidad de vida por parte de los tutores no se condiga con las precarias condiciones de salud oral exhibida por los niños con discapacidad intelectual, no sólo demuestra el desconocimiento respecto de la importancia de la salud oral en un contexto general, sino que también evidencia la necesidad de promover acciones que incentiven el cuidado y educación en relación con este aspecto, tanto en los tutores como en los niños afectados.

Effect of high-intensity interval training on aerobic capacity and heart rate control of heart transplant recipients: a systematic review with meta-analysis

Abstract Introduction: Heart transplantation (HTx) is the gold standard procedure for selected individuals with refractory heart failure. High-intensity interval training (HIIT) is safe and allows patients to exercise in high intensity for longer time when compared to moderate-intensity continuous training (MICT). The primary aim of this study was to perform a systematic review and meta-analysis about the effect of HIIT compared to MICT on exercise capacity, peak heart rate, and heart rate reserve in HTx recipients. Secondarily, we pooled data comparing MICT and no exercise training in these patients. Methods: This systematic review followed the standardization of the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement and the Cochrane Collaboration Handbook. We presented the treatment effects of HIIT on the outcomes of interest as mean difference (MD) and 95% confidence interval (CI). Meta-analysis was performed using the random-effects, generic inverse variance method. Results: HIIT improved peak oxygen consumption (peakVO2) (MD = 2.1; 95% CI 1.1, 3.1; P<0.0001), peak heart rate (MD = 3.4; 95% CI 0.8, 5.9; P=0.009), and heart rate reserve (MD = 4.8; 95% CI -0.05, 9.6; P=0.05) compared to MICT. Improvements on peakVO2 (MD = 3.5; 95% CI 2.3, 4.7; P<0.00001) and peak heart rate (MD = 5.6; 95% CI 1.6, 9.6; P=0.006) were found comparing HIIT and no exercise training. Conclusion: Current available evidence suggests that HIIT leads to improvements on peakVO2, peak heart rate, and heart rate reserve compared to MICT in HTx recipients. However, the superiority of HIIT should be tested in isocaloric protocols.

Effect of High-Intensity Interval Training on Aerobic Capacity and Heart Rate Control of Heart Transplant Recipients: a Systematic Review with Meta-Analysis.

INTRODUCTION: Heart transplantation (HTx) is the gold standard procedure for selected individuals with refractory heart failure. Highintensity interval training (HIIT) is safe and allows patients to exercise in high intensity for longer time when compared to moderateintensity continuous training (MICT). The primary aim of this study was to perform a systematic review and meta-analysis about the effect of HIIT compared to MICT on exercise capacity, peak heart rate, and heart rate reserve in HTx recipients. Secondarily, we pooled data comparing MICT and no exercise training in these patients. METHODS: This systematic review followed the standardization of the Preferred Reporting Items for Systematic Reviews and Metaanalyses statement and the Cochrane Collaboration Handbook. We presented the treatment effects of HIIT on the outcomes of interest as mean difference (MD) and 95% confidence interval (CI). Metaanalysis was performed using the random-effects, generic inverse variance method. RESULTS: HIIT improved peak oxygen consumption (peakVO2) (MD = 2.1; 95% CI 1.1, 3.1; P<0.0001), peak heart rate (MD = 3.4; 95% CI 0.8, 5.9; P=0.009), and heart rate reserve (MD = 4.8; 95% CI -0.05, 9.6; P=0.05) compared to MICT. Improvements on peakVO2 (MD = 3.5; 95% CI 2.3, 4.7; P<0.00001) and peak heart rate (MD = 5.6; 95% CI 1.6, 9.6; P=0.006) were found comparing HIIT and no exercise training. CONCLUSION: Current available evidence suggests that HIIT leads to improvements on peakVO2, peak heart rate, and heart rate reserve compared to MICT in HTx recipients. However, the superiority of HIIT should be tested in isocaloric protocols.

Effects of Water-Circulating Cooling Mask on Postoperative Outcomes in Orthognathic Surgery and Facial Trauma.

The purpose of this study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the efficacy of hilotherapy on postoperative pain, swelling, neurosensory impairment and patient satisfaction. The authors analyzed RCTs comparing the use of hilotherapy versus conventional cryotherapy or no cold treatment for orthognathic surgery and repair of facial trauma. The authors assessed the risk of bias and strength of evidence according to the Cochrane guidelines and GRADE rating system, respectively. Treatment effects were defined as weighted or standardized mean difference using the inverse variance method. Five RCTs were included. Postoperative pain and swelling in patients using hilotherapy were lower comparing to the control group in the postoperative day 2 (Pain: MD -1.75, CI 95% -2.69 to -0.81; Swelling: MD -21.16 mL, CI 95% -38.91 to -3.41) and in the final evaluation (Pain: MD -0.31, CI 95% -0.44 to -0.18; MD -4.45 mL, CI 95% -7.87 to -1.03). Patients reported higher satisfaction with hilotherapy, but no differences were found for neurosensory impairment. Current evidence suggests that hilotherapy is effective in reducing postoperative pain and swelling in orthognathic surgery and repair of facial fractures and may lead to improvements in patient satisfaction in the recovery phase.

Oral and maxillofacial conditions, dietary aspects, and nutritional status of children with congenital Zika syndrome.

OBJECTIVE: The aim of this study was to investigate oral and maxillofacial outcomes in children with congenital Zika syndrome (CZS) and the presence of nonnutritive sucking habits, functional habits, and features related to breastfeeding and nutrition of these children. STUDY DESIGN: We conducted a cross-sectional study with 45 children with CZS and 50 healthy controls in Sergipe state, Brazil, from February 2018 to June 2018. Demographic and clinical data, including breastfeeding and feeding data, were obtained for each child. Additionally, oral and maxillofacial evaluation was performed. RESULTS: Low weight (prevalence rate [PR] 8.33; 95% confidence interval [CI] 2.02-34.45), nonexclusive breastfeeding up to 6 months (PR 1.56; 95% CI 1.18-2.08); mouth breathing (PR 3.46; 95% CI 1.83-6.52); difficulty in swallowing (PR 6.00; 95% CI 2.53-14.25); and excessive salivation (PR 4.81; 95% CI 2.18-10.62) were more frequent in children with CZS. Children with CZS were more likely to have abnormal insertion of the upper labial frenulum (PR 7.04; 95% CI 2.23-22.20); ogival palate (PR 3.70; 95% CI 1.63-8.40), dental enamel defects (PR 2.22; 95% CI 1.05-4.69); and delayed dental eruption (PR 8.89; 95% CI 1.16-68.32) compared with healthy children. CONCLUSIONS: Children with CZS had a higher frequency of problems related to breastfeeding, low weight, and oral and maxillofacial abnormalities compared with healthy children.

Association Between Mouth Breathing and Asthma: a Systematic Review and Meta-analysis.

PURPOSE OF REVIEW: This systematic review and meta-analysis evaluated the association between asthma and mouth breathing. We performed a systematic search in the PubMed, SCOPUS, Lilacs, Web of Science, Google Scholar and OpenThesis databases. RECENT FINDINGS: Asthma is defined as a heterogeneous disease characterized by variable symptoms of wheezing, shortness of breath, chest oppression and/or cough, and limitation of expiratory airflow. Although several studies have examined the association between asthma and mouth breathing, there are no systematic reviews or meta-analyses that synthesize the available bodies of evidence. We used the odds ratio as a measure of the association between asthma and mouth breathing. Summary estimates were calculated using random-effects models, and the risk of bias was estimated using the Newcastle-Ottawa Scale for case-control studies and the National Institutes of Health tool for cross-sectional studies. Nine studies were included in the present systematic review. Data from 12,147 subjects were analyzed, of which 2083 were children and adolescents and 10,064 were adults. We found an association between mouth breathing and asthma in children and adolescents (OR 2.46, 95% CI 1.78-3.39) and in adults (OR 4.60, 95% CI 1.49-14.20). However, limitations were found in the methodological description of the included studies, as well as high heterogeneity among studies evaluating adult populations. This meta-analysis showed an association between mouth breathing and asthma in children, adolescents and adults, but the results should be interpreted with caution. Further studies with standardized criteria for the investigation of mouth breathing are needed.

SPATIAL DISTRIBUTION OF NEWBORNS WITH SICKLE CELL TRAIT IN SERGIPE, BRAZIL.

OBJECTIVE: To use the spatial distribution of the sickle cell trait (SCT) to analyze the frequency of hemoglobin S (HbS) carriers in Sergipe. METHODS: The sample consisted of all individuals born in Sergipe from October 2011 to October 2012 who underwent neonatal screening in the public health system. Tests were carried out in basic health units and forwarded to the University Hospital laboratory, where they were analyzed. We used spatial autocorrelation (Moran's index) to assess the spatial distribution of heterozygous individuals with hemoglobinopathies. RESULTS: Among 32,906 newborns, 1,202 showed other types of hemoglobin besides Hemoglobin A. We found a positive correlation between the percentage of black and multiracial people and the incidence of SCT. Most SCT cases occurred in the cities of Aracaju (n=273; 22.7%), Nossa Senhora do Socorro (n=102; 8.4%), São Cristóvão (n=58; 4.8%), Itabaiana (n=39; 4.2%), Lagarto (n=37; 4.01%), and Estância (n=46; 4.9%). CONCLUSIONS: The spatial distribution analysis identified regions in the state with a high frequency of HbS carriers. This information is important health care planning. This method can be applied to detect other places that need health units to guide and care for sickle cell disease patients and their families.

Changes in Occupational Roles and Common Mental Disorders in Mothers of Children With Congenital Zika Syndrome.

IMPORTANCE: The functional limitations and long-term dependence of children with congenital Zika syndrome (CZS) may lead to changes in maternal occupational roles, which can have a negative impact on mothers' well-being and mental health. OBJECTIVE: To investigate changes in occupational roles and their effects on the mental health of mothers who have a child with CZS. DESIGN: Cross-sectional study. SETTING: Rehabilitation centers of the Brazilian Unified Health System in Alagoas, Northeast Brazil. PARTICIPANTS: Forty mothers of children with CZS. OUTCOMES AND MEASURES: The Role Checklist and the Self-Reporting Questionnaire-20 were used to assess the mothers' involvement in occupational roles and common mental disorders (CMDs), respectively. The relationship between changes in occupational roles and CMDs was analyzed using a logistic regression model. RESULTS: Our study showed that loss of paid work (p = .026) is associated with poor mental health of mothers of children with CZS. CONCLUSIONS AND RELEVANCE: Strengthening public policies to reduce the economic impact of CZS on families, offering multidisciplinary counseling, and implementing psychoeducational strategies for promoting maternal psychological adjustment are needed. WHAT THIS ARTICLE ADDS: The time and money spent by mothers in daily care activities for children with CZS contribute to a reduction in family income and social well-being and have a negative impact on mothers' mental health.

Are Clinical Outcomes Associated With Medication Regimen Complexity? A Systematic Review and Meta-analysis.

Background: Current evidence of the influence of the medication regimen complexity (MRC) on the patients' clinical outcomes are not conclusive. Objective: To systematically and analytically assess the association between MRC measured by the Medication Regimen Complexity Index (MRCI) and clinical outcomes. Methods: A search was carried out in the databases Cochrane Library, LILACS, PubMed, Scopus, EMBASE, Open Thesis, and Web of Science to identify studies evaluating the association between MRC and clinical outcomes that were published from January 1, 2004, to April 2, 2018. The search terms included outcome assessment, drug therapy, and medication regimen complexity index and their synonyms in different combinations for case-control and cohort studies that used the MRCI to measure MRC and related the MRCI with clinical outcomes. Odds ratios (ORs), hazard ratios (HRs), and mean differences (WMDs) were calculated, and heterogeneity was assessed using the I2 test. Results: A total of 12 studies met the eligibility criteria. The meta-analysis showed that MRC is associated with the following clinical outcomes: hospitalization (HR = 1.20; 95% CI = 1.14 to 1.27;I2 = 0%) in cohort studies, hospital readmissions (WMD = 7.72; 95% CI = 1.19 to 14.25; I2 = 84%) in case-control studies, and medication nonadherence (adjusted OR = 1.05; 95% CI = 1.02 to 1.07; I2 = 0%) in cohort studies. Conclusion and Relevance: This systematic review and meta-analysis gathered relevant scientific evidence and quantified the combined estimates to show the association of MRC with clinical outcomes: hospitalization, hospital readmission, and medication adherence.

Spatial distribution of newborns with sickle cell trait in sergipe, brazil / Distribuição espacial de recém-nascidos com traço falciforme em sergipe

ABSTRACT Objective: To use the spatial distribution of the sickle cell trait (SCT) to analyze the frequency of hemoglobin S (HbS) carriers in Sergipe. Methods: The sample consisted of all individuals born in Sergipe from October 2011 to October 2012 who underwent neonatal screening in the public health system. Tests were carried out in basic health units and forwarded to the University Hospital laboratory, where they were analyzed. We used spatial autocorrelation (Moran's index) to assess the spatial distribution of heterozygous individuals with hemoglobinopathies. Results: Among 32,906 newborns, 1,202 showed other types of hemoglobin besides Hemoglobin A. We found a positive correlation between the percentage of black and multiracial people and the incidence of SCT. Most SCT cases occurred in the cities of Aracaju (n=273; 22.7%), Nossa Senhora do Socorro (n=102; 8.4%), São Cristóvão (n=58; 4.8%), Itabaiana (n=39; 4.2%), Lagarto (n=37; 4.01%), and Estância (n=46; 4.9%). Conclusions: The spatial distribution analysis identified regions in the state with a high frequency of HbS carriers. This information is important health care planning. This method can be applied to detect other places that need health units to guide and care for sickle cell disease patients and their families.

RESUMO Objetivo: Basear-se na distribuição espacial do traço falciforme (TF) para analisar a frequência dos portadores da hemoglobina S (HbS) em Sergipe. Métodos: A amostra foi constituída por todos os indivíduos nascidos em Sergipe, no período de outubro de 2011 a outubro de 2012, submetidos à triagem neonatal pelo Sistema Único de Saúde, ano de início da triagem universal no Estado. Os testes foram realizados em unidades básicas de saúde e encaminhados para o laboratório do Hospital Universitário, onde foram analisados. A análise da distribuição espacial dos indivíduos heterozigotos para hemoglobinopatias foi realizada por autocorrelação espacial (índice de Moran). Resultados: Dentre os 32.906 recém-nascidos estudados, 1.202 apresentaram outras hemoglobinas além da Hemoglobina A. Houve correlação positiva entre a porcentagem de negros e mestiços e a incidência de TF. A maioria dos casos foi encontrada nos municípios de Aracaju (n=273; 22,7%), Nossa Senhora do Socorro (n=102; 8,4%), São Cristóvão (n=58; 4,8%), Itabaiana (n=39; 4,2%), Lagarto (n=37; 4,01%) e Estância (n=46; 4,9%). Conclusões: Na análise de distribuição espacial por autocorrelação, identificaram-se regiões no Estado com maior frequência de HbS, o que é de extrema importância para o planejamento do sistema de saúde, podendo a mesma metodologia ser aplicada para identificação de outros locais com maior necessidade de centros para cuidados e orientações a portadores de doença falciforme e seus familiares.

Vitamin D Food Fortification and Nutritional Status in Children: A Systematic Review of Randomized Controlled Trials.

Children are in the risk group for developing hypovitaminosis D. Several strategies are used to reduce this risk. Among these, fortification of foods with vitamin D (25(OH)D) has contributed to the achievement of nutritional needs. This systematic review aims to discuss food fortification as a strategy for maintenance or recovery of nutritional status related to vitamin D in children. The work was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in the International prospective register of systematic reviews (PROSPERO) database (CRD42018052974). Randomized clinical trials with children up to 11 years old, who were offered vitamin D-fortified foods, and who presented 25(OH)D concentrations were used as eligibility criteria. After the selection stages, five studies were included, totaling 792 children of both sexes and aged between two and 11 years. Interventions offered 300-880 IU of vitamin D per day, for a period of 1.6-9 months, using fortified dairy products. In four of the five studies, there was an increase in the serum concentrations of 25(OH)D with the consumption of these foods; additionally, most children reached or maintained sufficiency status. Moreover, the consumption of vitamin D-fortified foods proved to be safe, with no concentrations of 25(OH)D > 250 nmol/L. Based on the above, the fortification of foods with vitamin D can help maintain or recover the nutritional status of this vitamin in children aged 2-11 years. However, it is necessary to perform additional randomized clinical trials in order to establish optimal doses of fortification, according to the peculiarities of each region.

Evidence of orofacial myofunctional therapy patients with asthma and rhinitis: a systematic review.

PURPOSE: to evaluate the efficacy of orofacial myofunctional therapy in improving orofacial function and nasal breathing in patients with asthma and rhinitis and, consequently, achieve clinical control of these conditions. RESEARCH STRATEGIES: We used the elements of the PICOT method (study population, intervention, comparison, outcomes and type of studies) to define the eligibility criteria: (1) Population: patients with asthma and rhinitis; (2) Intervention: orofacial myofunctional therapy to improve chewing, swallowing, and breathing; (3) Comparison: control group without orofacial myofunctional therapy; (4) Predefined outcomes: clinical control of asthma and improvement of orofacial functions and nasal breathing; (5) Study type: clinical trials. The data were collected from PubMed, SCOPUS, Web of Science, Science Direct, LILACS, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), OATD, and Open Thesis, in November 2018. SELECTION CRITERIA: Randomized controlled trials published in full-text versions without language restriction, no filter was used. DATA ANALYSIS: Demographic characteristics of study participants, specific diagnosis of asthma and control medication, type, duration, intensity and follow-up of orofacial myofunctional therapy, and outcome data. The risk of bias was assessed according to the Cochrane guidelines for clinical trials. RESULTS: One study met the eligibility criteria: although the study has shown an improvement of functional control and clinical scores of asthma, the evidence is very low. CONCLUSION: There is no scientific evidence on the efficacy of orofacial myofunctional therapy in improving clinical control, orofacial function, and nasal breathing in patients with asthma and rhinitis.

Multiplicando saberes: ampliando os cuidados em saúde bucal. Relato de experiência de um projeto de extensão universitária / Multiplying knowledge: extending oral health care. Experience report of a university extension project / Multiplicar el conocimiento: extender la atención de la salud bucal. Informe de experiencia de un proyecto de extensión universitaria

A extensão universitária é uma atividade que engrandece a vivência acadêmica, implementando melhorias na qualidade de saúde bucal da comunidade. Esse escopo teve como objetivo mostrar o desenvolvimento de práticas educativas e promoção de saúde no projeto de Extensão Multiplicando Saberes o qual é vinculado ao Programa de Pós-Graduação em Odontologia (PRODONTO) da UFS. A ação de extensão envolveu atividades educativas voltadas à cidadania e promoção de saúde bucal, com orientação e avaliação odontológica a crianças e adolescentes com deficiência e seus cuidadores, professores e orientadores educacionais. Participaram 162 crianças e adolescentes com deficiência das quais 22 com paralisia cerebral, 36 com transtorno do espectro autista, 13 com síndrome de Down e 91 com retardo mental. Dos 44 cuidadores participantes, 92% eram mulheres. A faixa etária da maioria foi de 30 a 40 anos (54.5%), casados (38.6%),tendo 2 a 3 filhos (63.6%),e ensino médio completo (72.7%) e são cuidadores integrais 79.5%. Cerca de 68.2% não possuem renda formal. Dos 4 educadores participantes, 3 são do gênero feminino e apresentam ensino médio completo. Foi possível observar a materialização de noções básicas de saúde, o autocuidado e a capacitação de cuidadores, elevados à condição de agentes ativos e multiplicadores das ações de promoção de saúde em nível individual e coletivo. (AU)

Introduction: University extension is an activity that enhances the academic experience, implementing improvements in the oral health quality of the community. Objective: This scope aimed to show the development of educational practices and health promotion in the Extension Multiplicando Saberes project, which is linked to the Postgraduate Program in Dentistry (PRODONTO) of UFS. Material and Method: The extension action involved educational activities focused on citizenship and oral health promotion, with orientation and dental assessment to children and adolescents with disabilities and their caregivers, teachers and educational counselors. RESULTS: A total of 162 children and adolescents with a disability participated, 22 of them with cerebral palsy, 36 with autism spectrum disorder, 13 with Down syndrome and 91 with mental retardation. Of the 44 participating caregivers, 92% were women. The majority age group was between 30 and 40 years old (54.5%), married (38.6%), having 2 to 3 children (63.6%), and complete secondary education (72.7%). About 68.2% have no formal income. Of the 4 participating educators, 3 are female and have completed high school. Conclusion: It was possible to observe the materialization of basic concepts of health, self-care and the training of caregivers, elevated to the condition of active agents and multipliers of actions of health promotion at individual and collective level. (AU)

La extensión universitaria es una actividad que mejora la experiencia académica, implementando mejoras en la calidad de la salud oral de la comunidad. Este alcance tuvo como objetivo mostrar el desarrollo de las prácticas educativas y la promoción de la salud en el proyecto de Extensión del Conocimiento Multiplicador que está vinculado al Programa de Postgrado en Odontología de UFS (PRODONTO). La acción de extensión incluyó actividades educativas dirigidas a la ciudadanía y la promoción de la salud bucal, con orientación y evaluación dental para niños y adolescentes con discapacidades y sus cuidadores, maestros y consejeros educativos. Participaron 162 niños y adolescentes con discapacidad, 22 con parálisis cerebral, 36 con trastorno del espectro autista, 13 con síndrome de Down y 91 con retraso mental. De los 44 cuidadores participantes, el 92% eran mujeres. El grupo de edad mayoritario fue de 30 a 40 años (54.5%), casados (38.6%), con 2 a 3 hijos (63.6%) y completar la escuela secundaria (72.7%) y cuidadores completos 79.5%. Alrededor del 68.2% no tiene ingresos formales. De los 4 educadores participantes, 3 son mujeres y han completado la escuela secundaria. Fue posible observar la materialización de los conceptos básicos de salud, autocuidado y capacitación de cuidadores, elevada a la condición de agentes activos y multiplicadores de acciones de promoción de la salud a nivel individual y colectivo. (AU)

Telomere length and frailty in older adults-A systematic review and meta-analysis.

Telomere shortening has been proposed as a potentially useful biomarker of human ageing and age-related morbidity and mortality. We performed a systematic review and meta-analysis to summarize results from individual studies on the telomere length according to the frailty status and frailty index in older adults. We searched the PubMed, SCOPUS and Web of Science databases to identify studies that evaluated the telomere length in frail and non-frail older adults and the relationship between telomere length and frailty index score. We used the base pairs (bp) as a measure of the telomere length. Summary estimates were calculated using random-effects models. Nine studies were included in the present systematic review and a total of 10,079 older adults were analyzed. We found that the frail older adults (n = 355) had shorter telomeres than the non-frail (n = 1894) (Standardized Mean Difference [SMD] -0.41; 95% CI -0.73 to -0.09; P = 0.01; I2 = 82%). Significant differences in telomere length between frail and non-frail older adults were identified in Hispanic (SMD -1.31; 95% CI -1.71 to -0.92; P < 0.0001; I2 = 0%) but not in Non-Hispanic countries (SMD -0.13; 95% CI -0.26 to 0.00; P = 0.06; I2 = 0%). Similar results were found in the adjusted meta-analysis (SMD -0.56; 95% -1.12 to 0.00; P = 0.05; I2 = 85%). A significant but weak relationship was found between telomere length and frailty index analyzing 8244 individuals (SMD -0.06; 95% IC -0.10 to 0.01; P = 0.01; I2 = 0%). The current available evidence suggests that telomere length may be not a meaningful biomarker for frailty. Because the potential influence of ethnicity in shortening of telomeres and decline in physiologic reserves associated with aging, additional multiethnic studies are needed.

Alterações da mastigação e deglutição secundárias à rinite alérgica e à asma em crianças e adolescentes ­ revisão integrativa / Changes in chewing and swallowing secondary to allergic rhinitis and asthma in children and adolescents - integrative review / Alteraciones de la masticación y deglución secundaria a la rinitis alérgica y el asma en niños y adolescentes - revisión integrativa

Introdução: A asma e a rinite alérgica têm sido consideradas manifestações de uma mesma síndrome, uma vez que apresentam bases epidemiológicas, genéticas e fisiopatológicas comuns. A interação entre a dificuldade na função de respiração, a asma e a rinite alérgica podem promover alterações no sistema estomatognático, como as funções de mastigação e a deglutição, além de modificações anatômicas e funcionais, no crescimento facial e somático. Objetivo: Realizar uma revisão integrativa da avaliação da mastigação e deglutição em crianças e adolescentes com rinite e asma. Materiais e Métodos: Foi realizada uma pesquisa nas bases de dados Lilacs, MedLine, PubMed e Scielo, sobre artigos que abordavam a deglutição e mastigação em crianças e adolescentes com asma e rinite no período de janeiro e fevereiro de 2017, e a pesquisa foi atualizada em junho de 2018. Resultados: Foram encontrados 2.537 artigos, mas apenas cinco apresentaram os critérios de elegibilidade. Discussão: Poucos estudos referentes ao tema foram encontrados. Dos cinco artigos selecionados, três inferiram não encontrar alterações e dois encontraram padrões alterados, relacionando com o fator de obstrução nasal. É necessário que mais pesquisas sejam realizadas sobre o tema. Conclusão: Não há evidências científicas que afirmem a presença de alterações de mastigação e deglutição decorrentes da asma e da rinite em crianças e adolescentes.

Introduction: Asthma and allergic rhinitis have been considered as manifestations of the same syndrome, since they have common epidemiological, genetic and pathophysiological bases. The interaction between difficulty in breathing function, asthma and allergic rhinitis may promote changes in the stomatognathic system, such as chewing and swallowing functions, as well as anatomical and functional changes in facial and somatic growth. Objective: To perform an integrative review of chewing and swallowing assessment in children and teenagers with rhinitis and asthma. Materials and Methods: We searched the Lilacs, MedLine, PubMed and Scielo databases for articles on swallowing and chewing in children and teenagers with asthma and rhinitis in January and February 2017, and this research was updated in June 2018. Results: A total of 2,537 articles were found, but only five presented the eligibility criteria. Discussion: Few studies regarding the topic were found. Of the five articles selected, three inferred to find no alterations and two found altered patterns, relating to the nasal obstruction factor. More research is needed on the subject. Conclusion: There is no scientific evidence to support the presence of chewing and swallowing disorders due to asthma and rhinitis in children and teenagers.

Introducción: El asma y la rinitis alérgica se han considerado manifestaciones de un mismo síndrome, ya que presentan bases epidemiológicas, genéticas y fisiopatológicas comunes. La interacción entre la dificultad en la función de respiración, el asma y la rinitis alérgica pueden promover alteraciones en el sistema estomatognático, como las funciones de masticación y deglución, además de modificaciones anatómicas y funcionales, en el crecimiento facial y somático. Objetivo: Realizar una revisión integrativa de la evaluación de la masticación y deglución en niños y adolescentes con rinitis y asma. Materiales y Métodos: Se realizó una investigación en las bases de datos Lilacs, MedLine, PubMed y Scielo, sobre artículos que abordaban la deglución y masticación en niños y adolescentes con asma y rinitis en el período de enero y febrero de 2017, la investigación fue actualizada en junio de 2018. Resultados: Se encontraron 2.537 artículos, pero sólo cinco presentaron los criterios de elegibilidad. Discusión: Pocos estudios referentes al tema fueron encontrados. De los cinco artículos seleccionados, tres dedujeron no encontrar alteraciones y dos encontraron patrones alterados, relacionando con el factor de obstrucción nasal. Es necesario que más investigaciones se realicen sobre el tema. Conclusión: No hay evidencias científicas que afirmen la presencia de alteraciones de masticación y deglución derivadas del asma y de la rinitis en niños y adolescentes.

Cryotherapy in reducing pain, trismus, and facial swelling after third-molar surgery: Systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: The aim of this systematic review and meta-analysis was to evaluate the efficacy of cryotherapy in reducing pain, trismus, and facial swelling in patients undergoing third-molar surgery. TYPES OF STUDIES REVIEWED: The authors searched for randomized clinical trials in PubMed, Web of Science, SCOPUS, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Google Scholar, and OpenThesis. Eligibility criteria were population: patients submitted to removal of impacted third molars; intervention and comparison: postoperative cryotherapy versus no cold therapy; and outcomes: primary outcome was postoperative pain, and secondary outcomes were facial swelling and trismus. Eligible studies must have reported at least 1 of the outcomes of interest. After extracting data and assessing quality, the authors performed the meta-analyses. RESULTS: The authors included 6 studies in the quantitative synthesis analysis. Differences in pain intensity were found on postoperative day 2 (weighted mean difference, -0.72; 95% confidence interval, -1.45 to 0.01; P = .05) and postoperative day 3 (weighted mean difference, -0.36; 95% confidence interval, -0.59 to -0.13; P = .002). No evidence was found that cryotherapy was effective in reducing trismus and facial swelling. The quality of evidence was graded as low. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Evidence suggests that cryotherapy may have a small benefit in reducing pain after third-molar surgery, but it is not effective on facial swelling and trismus. Owing to the lack of standardization of cold application, effective evidence-based treatment protocols for cryotherapy after third-molar surgery still need to be established.

Evidence of orofacial myofunctional therapy patients with asthma and rhinitis: a systematic review / Evidência da terapia miofuncional orofacial em pacientes com asma e rinite: Uma revisão sistemática

ABSTRACT Purpose to evaluate the efficacy of orofacial myofunctional therapy in improving orofacial function and nasal breathing in patients with asthma and rhinitis and, consequently, achieve clinical control of these conditions. Research strategies We used the elements of the PICOT method (study population, intervention, comparison, outcomes and type of studies) to define the eligibility criteria: (1) Population: patients with asthma and rhinitis; (2) Intervention: orofacial myofunctional therapy to improve chewing, swallowing, and breathing; (3) Comparison: control group without orofacial myofunctional therapy; (4) Predefined outcomes: clinical control of asthma and improvement of orofacial functions and nasal breathing; (5) Study type: clinical trials. The data were collected from PubMed, SCOPUS, Web of Science, Science Direct, LILACS, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), OATD, and Open Thesis, in November 2018. Selection criteria Randomized controlled trials published in full-text versions without language restriction, no filter was used. Data analysis Demographic characteristics of study participants, specific diagnosis of asthma and control medication, type, duration, intensity and follow-up of orofacial myofunctional therapy, and outcome data. The risk of bias was assessed according to the Cochrane guidelines for clinical trials. Results One study met the eligibility criteria: although the study has shown an improvement of functional control and clinical scores of asthma, the evidence is very low. Conclusion There is no scientific evidence on the efficacy of orofacial myofunctional therapy in improving clinical control, orofacial function, and nasal breathing in patients with asthma and rhinitis.

RESUMO Objetivo avaliar a eficácia da terapia miofuncional orofacial na melhora das funções orofaciais, na respiração nasal em pacientes com asma e rinite e, consequentemente, alcançar o controle clínico das doenças. Estratégia de pesquisa Utilizamos a estratégia PICOT (população, intervenção, comparação, resultado e tipo de estudo) para definir os critérios de elegibilidade: (1) População: pacientes com asma e rinite; (2) Intervenção: terapia miofuncional orofacial, para melhora da mastigação, deglutição e respiração; (3) Comparação: grupo controle sem terapia miofuncional orofacial; (4) Desfechos pré-definidos: controle clínico da asma e melhora das funções orofaciais e respiração nasal; (5) Tipo de estudo: ensaios clínicos. Os dados foram coletados no PubMed, SCOPUS, Web of Science, Science Direct, LILACS, Google Scholar, Cochrane Central Register de Ensaios Controlados (CENTRAL), OATD, Open thesis, Novembro de 2018. Critérios de seleção Ensaios controlados randomizados publicados em versões de texto completo, sem restrição de idioma, nenhum filtro foi utilizado. Análise dos dados Foram avaliadas as características demográficas dos participantes do estudo, diagnóstico específico de asma e medicação de controle, tipo, duração, intensidade, acompanhamento da terapia miofuncional orofacial e dados do desfecho. O risco de viés foi avaliado de acordo com as diretrizes da Cochrane para ensaios clínicos. Resultados Um estudo atendeu aos critérios de elegibilidade. Embora o estudo tenha mostrado melhora do controle funcional e escores clínicos da asma, as evidências são baixas. Conclusão Não há evidências científicas sobre a eficácia da terapia miofuncional orofacial na melhora do controle clínico, funções orofaciais e respiração nasal em pacientes com asma e rinite.

Association between human herpes virus seropositivity and frailty in the elderly: A systematic review and meta-analysis.

Frailty is an emerging geriatric syndrome characterized by decreased physiologic reserve and increased vulnerability to environmental factors. Several studies have examined the association between persistent cytomegalovirus (CMV) infection and poor clinical outcomes in the elderly, but the results are often contradictory. Here, we performed a systematic review and meta-analysis to analyze the association between human herpesvirus seropositivity [CMV, Epstein-Barr virus (EBV), Varicella zoster virus (VZV), and Herpes simplex virus (HSV)] and frailty in elderly people. Searches were performed in PubMed, SCOPUS, Lilacs, IBECS, and Web of Science databases. We used the odds ratio (OR) as a measure of the association between herpesvirus infections and frailty. Summary estimates were calculated using random-effects models. Six studies were included in the present systematic review. The data from 2559 elderly subjects were analyzed; 1571 of the subjects had ages between 60 and 79 years, and 988 of the subjects were older than 80. We found an association between CMV seropositivity and frailty in the elderly aged 60-79 years (OR 2.33, CI 95% 1.48-3.67) but not in the oldest-old subjects (OR 0.67, CI 95% 0.42-1.05). Moreover, no association was found between EBV, VZV, and HSV infections and frailty. Current evidence suggests an association between CMV seropositivity and frailty in individuals aged 60-79 years old.

High-concentration carbamide peroxide can reduce the sensitivity caused by in-office tooth bleaching: a single-blinded randomized controlled trial.

Objectives A single-blinded, randomized, parallel clinical trial evaluated the use of 37% carbamide peroxide (CP) on bleaching effectiveness and tooth sensitivity reported by patients undergoing in-office tooth bleaching, in comparison with the results of using 35% hydrogen peroxide. Material and Methods Forty patients were allocated to receive two sessions of in-office tooth bleaching using either 35% hydrogen peroxide (HP) or 37% CP. Each patient's sensitivity level was evaluated during and up to 24 h after bleaching. The effectiveness of the bleaching procedures was evaluated with a spectrophotometer one week after each session and 30 days after the last session. The impact of tooth bleaching on the patients' perceptions regarding smile changes, in addition to the bleaching procedures and their results, were also recorded. Absolute and relative sensitivity risks were calculated. Data on sensitivity level were analyzed using the Mann-Whitney or T-test, and data from the color evaluation were subjected to 2-way repeated measures ANOVA. Results The use of CP reduced the risk and level of tooth sensitivity to values close to zero, whereas the difference between the bleaching agents disappeared after 24 h. An increased bleaching effect was observed for HP, mainly due to an improved reduction of redness and yellowness. Participants perceived improved tooth bleaching for HP and reduced sensitivity for CP, but no differences regarding the comfort of the techniques were noted. Conclusions In our study, 37% CP resulted in reduced tooth sensitivity but decreased the tooth bleaching effectiveness. However, both bleaching agents resulted in high levels of patient satisfaction.