Testing the reliability of CT scan-based dental wear magnitude scoring.

OBJECTIVES: Digital models are now frequently used in biological anthropology (bioanthropology) research. Despite several studies validating this type of research, none has examined if the assessment of dental wear magnitude based on Computerized Tomography (CT) scans is reliable. Thus, this study aims to fill this gap and assess if dental wear magnitude scoring based on CT scans provides results consistent with scoring based on direct observation of the physical specimens. MATERIALS AND METHODS: Dental wear magnitude from 412 teeth of 35 mandibles originating from the Portuguese Muge and Sado Mesolithic shell-middens was scored. The mandibles were also CT scanned and visualized using 3D Slicer. CT scan-based scoring of dental wear magnitude was then undertaken. Two scoring rounds were undertaken for each observation method (totaling four scoring rounds) and an intra-observer error test was performed. The averaged results of the two observation methods were compared via boxplots with paired cases. RESULTS: Intra-observer error was negligible and non-significant. Scoring results are comparable between the two observation methods. Notwithstanding, some differences were found, in which CT scan assessment generally overestimates dental wear when compared to direct observation. DISCUSSION: Our results generally validate the use of CT scans in studies of dental wear magnitude. Notwithstanding several caveats relating to CT scanning and visualization limitations should be considered to avoid over or under-estimation of dental wear.

Assessing the reliability of virtual reconstruction of mandibles.

OBJECTIVES: Mandibular morphological variation is often used to examine various aspects of human palaeobiology. However, fossil and archeological skeletal remains are often fragmented/distorted and so are frequently excluded from studies. This leads to decreased sample sizes and, potentially, to biased results. Thus, it is of interest to restore the original anatomy of incomplete/distorted specimens. Thin plate splines (TPS), commonly used in Geometric Morphometrics (GM), offer the prospect of reconstruction of missing parts and particularly of interest here, missing landmarks. MATERIALS AND METHODS: Here, the reliability of TPS based mandibular reconstruction is tested. To that end missing landmarks were simulated in originally complete hemimandibles. TPS was then used to restore the location of simulated missing data and the predicted landmarks were compared to the original ones. RESULTS: Results show that error varies according to the number and location of estimated landmarks. Notwithstanding, estimation error is usually considerably smaller than the morphological differences between individuals from the same species. DISCUSSION: TPS based reconstruction allows fragmentary mandibles to be used in studies of whole mandibular variation, provided the above mentioned caveats are considered.

Adapting the Portuguese dignity question framework for adolescents: ages 10-18.

OBJECTIVE: Dignity therapy (DT) is well established in adult populations, and it is likely that it could benefit younger people. This study aimed to adapt the adult Portuguese DT question framework for adolescents (DT-QF-Adol) (ages 10-18). METHOD: Five stages were followed: (1) the Portuguese DT-QF for adults was adapted for adolescents with the original author's collaboration, (2) an expert committee provided feedback on the adapted version, (3) an initial consensus version of the DT-QF-Adol was created, (4) expert committee consult affirmed final consensus, and (5) validation stage with a sample of 17 adolescents followed in ambulatory psychology clinic. RESULTS: DT's original author endorsed the final Portuguese DT-QF-Adol, reinforcing that it captures the fundamental dimensions of DT. There was 100% agreement on the final consensus version and defined age group (10-18 years old). Twenty adolescents were invited to participate, and 17 were included after informed consent was obtained; 53% were female. The average age was 12.7 years. The interviewed adolescents reported that the DT-QF-Adol was clear, and they did not identify any ambiguity or difficulty in answering any of the questions. They assumed that this information could positively affect the way parents and friends see and cared for them, permitting others to understand their concerns and preferences. Participants felt that the DT-QF-Adol could be a good starting point for a conversation with their loved ones. Although they did not consider vital for health professionals to access their answers, they strongly felt that the DT-QF-Adol might be essential to sick adolescents and they would recommend it to others. SIGNIFICANCE OF RESULTS: We developed a DT-QF of nine questions for Portuguese adolescents (DT-QF-Adol), coined Protocolo de Perguntas da Terapia da Dignidade para Adolescentes - 10-18 anos. This tool can potentially be considered a good addition for pediatric palliative care.

Changes in dental wear magnitude in the last ∼8000 years in southwestern Iberia.

OBJECTIVE: This study examines changes in dental wear magnitude in the past ∼8000 years, i.e., since Mesolithic until the 19th century, in southwestern Iberia. Thus, it encompasses the transition from hunting-gathering to agro-pastoralism, and then to the industrialization of food production and pre-processing. DESIGN: Dental wear magnitude was scored in a total of 191 individuals and 1557 teeth from Mesolithic (individuals=56; teeth=643), Neolithic (individuals=35; teeth=169), Chalcolithic (individuals =35; teeth=221), Modern Age (individuals=17; teeth=209), and Late Modern Age (individuals=48; teeth=315) samples originating in southwestern Iberia (i.e., present central and southern Portugal) and according to the 8 levels ordinal scale of Smith (1984). RESULTS: Results show a general trend for decreased wear magnitude in these two major transitions and during this timespan (although the hunting-gathering - agro-pastoralism transition had larger impact). The only meaningful differences in wear rate were found between the Late Modern Age and all remaining samples. CONCLUSION: Dental wear generally decreased during this timespan (although wear magnitude was less impacted by the industrialization of food production and pre-processing). Our results are consistent with studies documenting skull morphological gracilization associated with reduced masticatory demands due to the adoption of softer diets.

Mandibular morphology and the Mesolithic-Neolithic transition in Westernmost Iberia.

Neolithic farming and animal husbandry were first developed in the Near East ~ 10,000 BCE and expanded westwards, reaching westernmost Iberia no later than 5500 BCE. It resulted in major social, cultural, economic and dietary changes. Yet, the impact of this change on human mandibular morphology in Iberia is yet to be assessed, which is regrettable because mandible form is impacted by population history and diet. In this study we used Mesolithic to Chalcolithic Iberian samples to examine the impact of this transition on mandibular morphology. We also compared these samples with a Southern Levantine Chalcolithic population to assess their relationship. Lastly, we assessed dental wear to determine if the morphological differences identified were related to the material properties of the diet. We found differences between samples in mandibular shape but not size, which we attribute to contrasting population histories between Mesolithic and later populations. Some differences in the severity of dental wear were also found between Mesolithic and later Iberian samples, and smaller between the Mesolithic Iberians and southern Levantines. Little relationship was found between wear magnitude and mandibular shape. Altogether, our results show that the Mesolithic-Neolithic Iberian transition resulted in a meaningful change in mandibular morphology, which was likely driven more by population history than by dietary change.

Repeated filling of elastomeric infuser pumps for home-based subcutaneous medications: a case series.

BACKGROUND: Several medical devices have been developed for continuous subcutaneous drug infusion for home palliative care (HPC), such as elastomeric infuser pumps (EIP). There is no evidence on the repeated filling of EIP for continuous subcutaneous delivery for HPC. AIM: A clinical case series report of terminally-ill patients cared for in HPC, with repeated filling of EIPs for home-based subcutaneous medications. METHODS: A retrospective analysis of each patient's EIP-related entries in an anonymised database regarding: 1) EIP general functioning aspects; 2) clinical aspects: symptom control and local skin complications. Overall and per-patient cost-saving was also calculated. FINDINGS: A total of 10 cases were analysed (four 50-hour EIP and six 30-hour EIP). All EIPs had a mean number of refillings (standard deviation (SD), mode) of 1.6 ((0.5), 2); with 3.2 drugs on average used in each EIP ((1.4), 4). Approximate total mean (SD) usage time for both types of EIP was 87 (29) hours; and all EIP were used, on average (SD), 49 (23) hours more than its labelled duration. All EIPs showed a complete reservoir deflation between refilling. Only one patient had a minor skin complication and no symptom aggravation was observed, except for two cases with mild anxiety and agitation. Cost-saving analysis for the complete case series showed that EIP refillings saved, on average, €24 per-patient and a total of nearly €240, for both types of infuser pumps. CONCLUSION: This preliminary study suggests that refilling is safe and reduces cost. Future research on EIP refilling using controlled and systematic methodologies are warranted.

Phenotypical and genotypical characterization of Bordetella pertussis strains isolated in São Paulo, Brazil, 1988-2002.

Whooping cough or pertussis was a major cause of childhood morbidity and mortality in the world until the introduction of a whole-cell vaccine in the 1940's. However, since the early 1980's whooping cough cases have increased in many countries, becoming an important problem of public health. This increase may be due to accuracy of laboratory diagnosis and reporting of the disease, a decline in immunity over time, demographic changes, and adaptation of the bacterial population to vaccine-induced immunity. The purpose of this study was to analyze phenotypically and genotypically a collection of 67 Bordetella pertussis isolates recovered during the period 1988-2002 in São Paulo State, Brazil to determine their characteristics and relatedness. All isolates were submitted to susceptibility testing to erythromycin, serotyping, and 56 isolates were analyzed by Pulsed Field Gel Electrophoresis (PFGE). All isolates were susceptible to erythromycin and the majority of them belonged to serotype 1,3. The 56 isolates were classified into 11 PFGE profiles according to the differences in banding patterns. Although more than 60% of the isolates were recovered from patients aged less than three months, almost 15% of them were isolated from adolescents/adults evidencing the increase in the incidence of pertussis among this age group.

Early Upper Paleolithic colonization across Europe: Time and mode of the Gravettian diffusion.

This study presents new models on the origin, speed and mode of the wave-of-advance leading to the definitive occupation of Europe's outskirts by Anatomically Modern Humans, during the Gravettian, between c. 37 and 30 ka ago. These models provide the estimation for possible demic dispersal routes for AMH at a stable spread rate of c. 0.7 km/year, with the likely origin in Central Europe at the site of Geissenklosterle in Germany and reaching all areas of the European landscape. The results imply that: 1. The arrival of the Gravettian populations into the far eastern European plains and to southern Iberia found regions with very low human occupation or even devoid of hominins; 2. Human demography was likely lower than previous estimates for the Upper Paleolithic; 3. The likely early AMH paths across Europe followed the European central plains and the Mediterranean coast to reach to the ends of the Italian and Iberian peninsulas.

Towards an integrative attachment-based model of relationship functioning.

Based on attachment theory, this study developed a theory-based model of heterosexual relationship functioning that examined both proximal and distal factors and both actor and partner effects. A particular focus was on the underexplored issue of double-mediated effects between attachment orientation and relationship satisfaction. Data were collected from a community sample of 95 cohabiting and married couples with a mean age of 39.30 years. Participants completed measures of attachment, commitment, provision of partner support, trust, intimacy, destructive conflict management, and relationship satisfaction. The hypothesized model was largely supported. The association between attachment orientation and relationship satisfaction was mediated through a series of actor and partner variables. No gender differences were found across actor paths; however, differences were found in partner effects for men and women. The model has important implications for relationship researchers and practitioners.

Phenotypical and genotypical characterization of Bordetella pertussis strains isolated in São Paulo, Brazil, 1988-2002

Whooping cough or pertussis was a major cause of childhood morbidity and mortality in the world until the introduction of a whole-cell vaccine in the 1940's. However, since the early 1980's whooping cough cases have increased in many countries, becoming an important problem of public health. This increase may be due to accuracy of laboratory diagnosis and reporting of the disease, a decline in immunity over time, demographic changes, and adaptation of the bacterial population to vaccine-induced immunity. The purpose of this study was to analyze phenotypically and genotypically a collection of 67 Bordetella pertussis isolates recovered during the period 1988-2002 in São Paulo State, Brazil to determine their characteristics and relatedness. All isolates were submitted to susceptibility testing to erythromycin, serotyping, and 56 isolates were analyzed by Pulsed Field Gel Electrophoresis (PFGE). All isolates were susceptible to erythromycin and the majority of them belonged to serotype 1,3. The 56 isolates were classified into 11 PFGE profiles according to the differences in banding patterns. Although more than 60 percent of the isolates were recovered from patients aged less than three months, almost 15 percent of them were isolated from adolescents/adults evidencing the increase in the incidence of pertussis among this group of age.

A coqueluche ou pertussis foi a maior causa de morbidade e mortalidade infantil em todo o mundo até a introdução de uma vacina na década de 1940. Entretanto, desde a década de 1980, a coqueluche tornou-se, em muitos países , um importante problema de saúde pública. Este acontecimento pode ser atribuído à melhoria do diagnóstico laboratorial e da notificação da doença, declínio da imunidade no decorrer do tempo, mudanças demográficas ou adaptação da população bacteriana à imunidade induzida pela vacina. O objetivo deste estudo foi analisar as características fenotípicas e genotípicas de uma coleção de 67 cepas de Bordetella pertussis isoladas no período 1988-2002 em São Paulo, Brasil. Todas as cepas foram submetidas à determinação do perfil de resistência à eritromicina, à sorotipagem e 56 cepas à eletroforese em campo pulsado (PFGE). Todas as cepas foram sensíveis à eritromicina e a maioria delas pertencia ao sorotipo 1,3. As 56 cepas foram classificadas em 11 perfis de PFGE com base nas diferenças no padrão de bandas. Embora mais de 60 por cento das cepas tenham sido isoladas de crianças com menos de três meses de idade, cerca de 15 por cento delas era de adolescentes/adultos evidenciando um aumento da incidência da coqueluche nesse grupo etário.

Presença de leveduras do gênero Candida na saliva de pacientes com diferentes fatores predisponentes e de indivíduos controle / Presence of Candida genus yeasts in the saliva of patients with different predisposing factors and of control individuals

Os microrganismos do gênero Candida säo, em geral, comensais da cavidade bucal, mas, em determinados indivíduos e em situaçöes específicas, podem transformar-se na forma parasitária, produzindo candidoses bucais. O objetivo deste trabalho foi analisar a presença das espécies do gênero Candida na saliva de indivíduos controle, comparando com pacientes que apresentavam diferentes fatores predisponentes. Foram avaliados 493 pacientes, divididos em 7 grupos: prótese total, prótese parcial removível, periodontite crônica de adulto, respiraçäo bucal, aparelho ortodôntico fixo, aparelho ortodôntico removível e aparelho extrabucal. O grupo controle consistiu de 570 indivíduos que näo apresentavam nenhum desses fatores, divididos em 2 grupos: infantil e adulto. Foram realizados o isolamento e a identificaçäo das espécies do gênero Candida. Os resultados mostraram maior porcentagem de pacientes positivos para Candida nos grupos com fatores predisponentes em relaçäo aos controles. Houve predominância de isolamento de C. albicans em todos os grupos, porém, os pacientes com fatores predisponentes apresentaram diversidade maior de espécies

Surto de bacteriemia por Pseudomonas aeruginosa na unidade de hemodiálise de um hospital de Campinas, Säo Paulo, Brasil / Outbreak of Pseudmonas aeruginosa bacteremia in a Hemodialysis Center in Campinas, Säo Paulo, Brazil

Foram analisadas amostras de água e de dializados coletados de diferentes pontos do sistema de hemodiálise de um Centro de Hemodiálise de um Hospital de Campinas, Säo Paulo, Brasil, após um surto de bacteriemia ocorrido em setembro de 1996. As amostras foram submetidas à contagem de bactérias heterotróficas e pesquisa de coliformes totais, assim como foram realizadas as hemoculturas dos pacientes com bacteriemia. As cepas isoladas e identificadas com Pseudomonas aeruginosa foram submetidas à sorotipagem e à piocinotipagem e, naquelas pertecentes ao mesmo sorotipo e piocinotipo, procurou-se determinar o perfil de sensibilidade aos agentes antimicrobianos e o ribotipo. Quanto à pesquisa de Pseudomonas, 80(por cento) das amostras correspondentes à segunda coleta foram positivas e em todas as amostras referentes à terceira coleta foram isoladas Pseudomonas aeruginosa ou Bulkholderia cepacia. Apenas uma cepa de P.aeruginosa de água pertencia aos mesmos sorotipos (O15) e piocinotipo (P10) daqueles obtidos dos pacientes. A compatibilidade genética das amostras das duas origens, verificada pela ribotipagem, sugere um veículo comum na propagaçäo da infecçäo. (AU)

Between September 11 and 20, 1996, an outbreak of bacteremia occurred in patients undergoing hemodialysis at one dialysis center in Campinas, São Paulo, Brazil. Water and dialysate samples as well asblood samples from patients with bacteremia were collected for bacteriological analysis. All Pseudomonasaeruginosa strains were serotyped and pyocin-typed. P. aeruginosa strains belonging to the same serotype(O15) and pyocin type (P10) were submitted to antimicrobial susceptibility testing and to ribotyping using two restriction enzymes, EcoRI and BamHI. The high concentrations of bacteria detected in all hemodialyzers and their heavy rate of contamination (86.7%) by Pseudomonas aeruginosa or Burkholderia cepacia showed that this dialysis center was operating in inadequate conditions. One strain of P. aeruginosa isolated from hemodialyzer and the strains recovered from blood cultures of patients showed similar phenotypical and genetic traits which suggest a common source of infection in this oubreak. We report the potential risk forpatients undergoing hemodialysis to acquire infections due to the inadequate practice of reusing disposabledialyzers during the reprocessing procedures. (AU)

Molecular epidemiology of a nosocomial outbreak due to Enterobacter cloacae and Enterobacter agglomerans in Campinas, São Paulo, Brazil

A total of 73 isolates (57 Enterobacter cloacae and 16 Enterobacter agglomerans), recovered during an outbreak of bacteremia in the Campinas area, São Paulo, Brazil, were studied. Of these isolates, 61 were from parenteral nutrition solutions, 9 from blood cultures, 2 from a sealed bottle of parenteral nutrition solution, and one was of unknown origin. Of the 57 E. cloacae isolates, 54 were biotype 26, two were biotype 66 and one was non-typable. Of 39 E. cloacae isolates submitted to ribotyping, 87.2 percent showed the same banding pattern after cleavage with EcoRI and BamHI. No important differences were observed in the antimicrobial susceptibility patterns among E. cloacae isolates exhibiting the same biotype, serotype and ribotype. All E. agglomerans isolates, irrespective of their origin, showed same patterns when cleaved with EcoRI and BamHI. The results of this investigation suggest an intrinsic contamination of parenteral nutrition solutions and incriminate these products as a vehicle of infection in this outbreak

Caracterizaçäo sorológica de flavobacterium meningosepticum / Serological characterization of Flavobacterium meningosepticum

22 cepas de Flavobacterium meningosepticum, sendo 19 isoladas de líquido cefalorraquidiano, 2 de sangue e 1 de secreçäo traqueal, de diferentes procedências, foram sorotipadas por aglutinaçäo em lâmina, utilizando soros somáticos específicos, preparados segundo o método descrito por RICHARD et alii. As cepas, isoladas na sua grande maioria de crianças recém-nascidas, foram classificadas em 6 sorotipos, sendo o sorotipo C o mais frequênte, seguido de F, B, D, H e . A meningite neonatal, embora de ocorrência rara, é uma doença de alta letalidade que deixa graves sequelas. A caracterizaçäo das cepas responsáveis pelos surtos epidêmicos ocorridos nos diversos países tem sido realizada pela identificaçäo dos sorotipos, que säo principais marcadores epidemiológicos de F. meningosepticum

Influência dos antígenos do sistema ABO(H) na saliva sobre a presença do gênero cândida na cavidade bucal / The influence of ABO(H) system antigens on the presence of the candida genus in the oral cavity

A secreçäo dos antígenos dos grupos sanguíneos ABO na saliva está associada ao estado de portador de Cândida na cavidade bucal e às candidoses. O objetivo deste estudo foi correlacionar a secreçäo ou näo dos antígenos do sistema ABO(H) na saliva com a presença do gênero Cândida na cavidade bucal. Apesar do pequeno número de pacientes näo secretores (5,44 por cento) encontrados na populaçäo estudada, o percentual de isolamento de leveduras foi maior nesses pacientes (72,22 por cento). A espécie mais encontrada nos dois grupos foi C. Albicans, seguida por C. Tropicalis e C. Glabrata. Nossos resultados sugerem, portanto, que os antígenos ABH secretados na saliva interferem na presença de leveduras do gênero Cândida na cavidade bucal, podendo atuar como fator de predisposiçäo às candidoses

Acinetobacter species in clinical specimens: biotypes and serotypes of acinetobacter baumannii strains isolated in Säo Paulo, Brazil

Foram estudadas 190 cepas de Acinetobcter (76 isoladas de líquido cefalorraquidiano, 30 de sangue e 84 de outros materiais clínicos), isoladas no período 1986-92, em Säo Paulo, Brasil. As espécies foram identificadas segundo Bouvet and Grimont e Vouvet and Jeanjean. Os sorotipos e biotipos foram determinados para A. baumannii seguindo os métodos descritos por Traub e Bouvet and Grimont, respectivamente. Entre as 10 espécies identificadas, o A.baumannii (60 por cento) e A.genospecies 3 (11.6 por cento) foram as mais frequentes. Verificou-se que os biotipos 2,6, e 9 e os sorotipos 04, 015 e 029 foram predominantes entre as cepas de A.baumannii

Caracterização fenotípica e gonotípica de Bordetella pertussis

Na era pré-vacinação, a coqueluche representou uma das principais causas da morbidade e mortalidade infantil. Significativa diminuição na sua incidência é verificada com a introdução da vacinação na década de 40. No entanto, a partir da década de 80, a coqueluche passou novamente a representar um importante problema de saúde pública em vários países, sendo comum a ocorrência de epidemias cíclicas a cada de 3 - 5 anos. Atualmente, a coqueluche é classificada pelo Centro de Controle de Doenças nos Estados Unidos (CDC) como uma doença re-emergente. As causas deste aumento não são conhecidas; no entanto podem estar associadas à imunidade induzida pela vacina. A coqueluche, causada pela Bordetella pertussi, é uma doença respiratória aguda, altamente contagiosa, e especialmente severa em crianças menores. Embora seja uma doença predominantemente da infância, nos últimos anos, tem sido reportado um aumento significativo nos adolescentes e adultos. O objetivo deste estudo foi caracterizar 72 cepas de B. pertussis isoladas da secreção nasofaríngea de casos suspeitos de coqueluche. Para o isolamento foi utilizado...

Caracterização fenotípica e gonotípica de Bordetella pertussis / Phenotypic and genotypic characterization of Bordetella pertussis

Na era pré-vacinação, a coqueluche representou uma das principais causas da morbidade e mortalidade infantil. Significativa diminuição na sua incidência é verificada com a introdução da vacinação na década de 40. No entanto, a partir da década de 80, a coqueluche passou novamente a representar um importante problema de saúde pública em vários países, sendo comum a ocorrência de epidemias cíclicas a cada de 3 - 5 anos. Atualmente, a coqueluche é classificada pelo Centro de Controle de Doenças nos Estados Unidos (CDC) como uma doença re-emergente. As causas deste aumento não são conhecidas; no entanto podem estar associadas à imunidade induzida pela vacina. A coqueluche, causada pela Bordetella pertussi, é uma doença respiratória aguda, altamente contagiosa, e especialmente severa em crianças menores. Embora seja uma doença predominantemente da infância, nos últimos anos, tem sido reportado um aumento significativo nos adolescentes e adultos. O objetivo deste estudo foi caracterizar 72 cepas de B. pertussis isoladas da secreção nasofaríngea de casos suspeitos de coqueluche. Para o isolamento foi utilizado...

Manual de vigilância epidemiológica; coqueluche: normas e instruções 2000

A coqueluche, também conhecida pela designação expressiva de "tosse comprida" é uma doença infecciosa aguda e transmissível que compromete predominantemente o aparelho respiratório, caracterizando-se por típicos acessos paroxísticos de tosse. Sendo um agravo de notificação nacional, a principal dificuldade na vigilância dessa doença com todos os seus pressupostos, está na confirmação etiológica. Outras doenças respiratórias agudas, virais ou bacterianas, podem provocar a "síndrome pertussis" ou "doenças coqueluchóides" (ítem 7). Aparecem, com maior frequência, nos mesmos grupos populacionais onde ocorre a coqueluche, e também apresentam maior gravidade nos lactentes e crianças menores de dois anos. Esses agravos podem, então, serem confundidos e classificados como coqueluche, clinicamente. Dessa forma, um sistema de notificação passivo para a coqueluche tem baixo valor preditivo positivo, ou seja, confirma casos (clinicamente e/ou por métodos laboratoriais não específicos) que não o são, podendo induzir à investigação e adoção de medidas de controle de epidemias que de fato não tenham ocorrido, provocando custos desnecessários ao sistema de vigilância. O que se propõe no presente documento é a implantação de um sistema sentinela de vigilância para a coqueluche no Estado de São Paulo