bluuebunny/crossref_metadata_2025 huggingface dataset:
Coexistência de transtornos respiratórios do sono e síndrome fibromiálgica
Authors: Germanowicz Dienaro , Lumertz Magali Santos , Martinez Denis , Margarites Ane Freitas
Published: September 2007

OBJETIVO: Identificar síndrome fibromiálgica em pacientes com transtornos respiratórios do sono. MÉTODOS: Foram estudados 50 pacientes que compareceram à Clínica do Sono com queixas de roncar no sono, apnéias e sonolência diurna. Confirmou-se o diagnóstico de transtornos respiratórios do sono através de polissonografia. Para se estabelecer o diagnóstico de síndrome fibromiálgica, submeteram-se os pacientes a avaliação de acordo com os critérios estabelecidos pelo American College of Rheumatology. RESULTADOS: Estudaram-se 50 pacientes, 32 do sexo masculino. A média (± desvio-padrão) de idade do grupo foi de 50 ± 12 anos. A média do índice de massa corporal do grupo foi de 29,7 ± 5,6 kg/m². A média do índice de apnéias e hipopnéias do grupo foi de 36 ± 29 apnéias e hipopnéias /hora. Nove das 18 mulheres e 2 homens preencheram os critérios estabelecidos pelo American College of Rheumatology para o diagnóstico de síndrome fibromiálgica. CONCLUSÃO: Considerando-se que a prevalência de síndrome fibromiálgica na população geral é de 0,5% para homens e de 3,4% para mulheres, a fração de casos de fibromialgia mais de dez vezes maior nesta amostra reforça a hipótese de associação entre transtornos respiratórios do sono e síndrome fibromiálgica.
Microepidemia de histoplasmose em Blumenau, Santa Catarina
Authors: Oliveira Flávio de Mattos , Unis Gisela , Severo Luiz Carlos
Published: September 2007

A histoplasmose pulmonar aguda é pouco diagnosticada e muitas vezes confundida com tuberculose. A maior parte do conhecimento sobre a doença veio de relatos de epidemias resultantes da exposição de certo número de indivíduos a uma mesma fonte de infecção. O isolamento do H. capsulatum var. capsulatum a partir de amostras de solo comprova o foco epidêmico. Pela primeira vez é descrita uma microepidemia, com o relato de dois casos e o isolamento do fungo do foco de infecção, em Santa Catarina. Recomendam-se novos estudos epidemiológicos para se determinar a prevalência da infecção nesse estado.
Aspergilose broncopulmonar alérgica com imagem radiológica em "dedo de luva"
Authors: Kalil Marta Elizabeth , Fernandes Ana Luiza Godoy , Curzel Aline Cristiane da Silva , Cortez Márcio Zamuner , Lima Gláucia Cristina Godinho Alves
Published: September 2007

A aspergilose broncopulmonar alérgica é uma doença pulmonar que ocorre em pacientes com asma ou fibrose cística, desencadeada pela reação de hipersensibilidade à presença do fungo Aspergilus fumigatus nas vias aéreas. Relatamos aqui um caso em que uma paciente com quadro clínico sugestivo de asma apresentou critérios clínicos, laboratoriais e radiológicos compatíveis com o diagnóstico de aspergilose broncopulmonar alérgica. A importância de tais achados deve-se ao fato de que quanto mais precocemente for feito o diagnóstico, menores serão os riscos de agravamento do quadro respiratório e de aparecimento de fibrose.
Criptococose pulmonar isolada em paciente imunocompetente
Authors: Barbosa Ana Teresa Fernandes , Colares Fernando Antônio , Gusmão Edson da Silva , Barros Amanda Araújo , Cordeiro Cristiane Gonçalves , Andrade Maria Cecília Tolentino
Published: September 2007

O presente trabalho relata um caso de criptococose pulmonar isolada em paciente com sintomas respiratórios, sem imunossupressão e sorologia negativa para o vírus da imunodeficiência humana, com massa pulmonar no radiograma de tórax. O diagnóstico foi confirmado pela biópsia transbrônquica e lavado broncoalveolar. A paciente recebeu tratamento ambulatorial com fluconazol, na dose de 300 mg/dia por seis meses, evoluindo com melhora clínica e regressão parcial da imagem radiológica. O presente caso ilustra uma apresentação não freqüente da criptococose pulmonar e faz considerações sobre a abordagem terapêutica com base na literatura.
Comparação entre o tratamento farmacológico aplicado em crianças de zero a cinco anos atendidas em uma unidade de emergência e as diretrizes do III Consenso Brasileiro no Manejo da Asma
Authors: Santos Ana Paula Ochoa , Lima Luciane Soares de , Wanderley Almir Gonçalves
Published: September 2007

OBJETIVO: Avaliar o manejo da crise asmática em crianças de zero a cinco anos atendidas em uma unidade de emergência pediátrica da região metropolitana do Recife (PE) e verificar se a condução da crise asmática pode interferir no tempo de permanência da criança no serviço de emergência. MÉTODOS: Estudo de natureza descritiva exploratória, abordagem quantitativa e corte transversal. Envolveu 246 crianças em crise asmática de uma unidade de emergência, tendo sido avaliada a conduta utilizada, a conduta preconizada pelo III Consenso Brasileiro no Manejo da Asma e o tempo de permanência da criança na emergência. RESULTADOS: Os fármacos foram utilizados de acordo com o preconizado em 69 atendimentos (28,1%). As doses dos fármacos foram concordantes com as preconizadas em 34 atendimentos (13,8%) e os procedimentos de nebulização em 33 (13,4%). Não houve associação entre as condutas utilizadas e o tempo de permanência no serviço. Após aplicação do modelo de regressão, observou-se que crianças com asma de classificação persistente leve e intermitente tiveram um risco ajustado, respectivamente, de quatro e quinze vezes maior de permanecerem no serviço de emergência por tempo insuficiente para avaliação da resposta ao tratamento da crise, conforme o preconizado pelo consenso. CONCLUSÃO: Apesar de o manejo preconizado pelo consenso encontrar barreiras de aplicação como pouca familiaridade da equipe multidisciplinar com as diretrizes e ausência de recursos materiais e terapêuticos preconizados, a repercussão no tempo de permanência esteve relacionada a fatores classificatórios da doença.
Telangiectasia hemorrágica hereditária: uma causa rara de anemia grave
Authors: Santos José Wellington Alves dos , Dalcin Tiago Chagas , Neves Kelly Ribeiro , Mann Keli Cristina , Pretto Gustavo Luis Nunes , Bertolazi Alessandra Naimaier
Published: September 2007

Telangiectasia hemorrágica hereditária é uma doença autossômica dominante na qual comunicações arteriovenosas afetam comumente pele, superfícies mucosas, pulmões, cérebro e trato gastrointestinal. As manifestações comuns desta doença são epistaxe, sangramento gastrointestinal, e malformações arteriovenosas cerebrais e pulmonares. Apesar de a epistaxe e o sangramento gastrointestinal poderem causar anemia, a telangiectasia hemorrágica hereditária raramente é diagnosticada com anemia grave. Neste artigo é relatado o caso de um homem de 49 anos de idade com telangiectasia hemorrágica hereditária não diagnosticada e anemia grave.
Avaliação da resposta de pacientes asmáticos com refluxo gastroesofágico após terapia com pantoprazol: estudo prospectivo, randomizado, duplo cego e placebo-controlado
Authors: Santos Leandro Heusi dos , Ribeiro Iana Oliveira e Silva , Sánchez Pablo Gerardo , Hetzel Jorge Lima , Felicetti José Carlos , Cardoso Paulo Francisco Guerreiro
Published: September 2007

OBJETIVOS: Determinar o efeito do tratamento da DRGE no controle clinico e funcional respiratório em indivíduos asmáticos e avaliar as características clinicas deste grupo de pacientes. MÉTODOS: Pacientes com asma portadores de DRGE patológico documentado por pHmetria de 24 h foram avaliados por meio de questionários sobre sintomas respiratórios, digestivos, de qualidade de vida além de manometria esofágica, espirometria e pico de fluxo expiratório antes e após o estudo. Quarenta e nove indivíduos que apresentavam DRGE patológico na pHmetria esofágica de 24 h foram selecionados e participaram de ensaio clínico terapêutico com pantoprazol (40 mg/dia) controlado com placebo, randomizado, duplo-cego, paralelo por 12 semanas consecutivas. RESULTADOS: Quarenta e quatro indivíduos completaram o estudo (n = 22 cada grupo). Houve melhora significativa no escore de sintomas respiratórios e na qualidade de vida somente no grupo que utilizou pantoprazol (p = 0,01 e p = 0,001, respectivamente). Os parâmetros funcionais respiratórios não se modificaram com os diferentes tratamentos. CONCLUSÕES: Neste estudo, o tratamento efetivo do RGE melhorou a qualidade de vida, determinou diminuição dos sintomas em asma de maneira significativa no grupo que utilizou medicamento, contudo sem alterar os parâmetros funcionais.
Acurácia do teste de escada utilizando o consumo máximo de oxigênio como padrão-ouro
Authors: Cataneo Daniele Cristina , Cataneo Antonio José Maria
Published: September 2007

OBJETIVO: Determinar a acurácia dos atributos do teste de escada (TE) de altura definida utilizando como padrão-ouro o consumo máximo de oxigênio (VO2 máx). MÉTODOS: O TE foi realizado com incentivo, em escada (6 lances; 72 degraus; 12,16 m de altura total), em 51 pacientes. O 'tempo' de subida foi cronometrado e o 'trabalho' e a 'potência' calculados. O VO2 máx foi obtido por ergoespirometria, utilizando-se o protocolo de Balke. Foram calculados a correlação linear de Pearson (r) e os valores de p entre as variáveis do TE e o VO2 máx. Para o cálculo da acurácia, o ponto de corte do VO2 máx foi estabelecido em 25 mL/kg/min, estratificando os indivíduos em normais ou alterados. Os pontos de corte para os atributos do TE foram obtidos através da curva receiver operating characteristic. A estatística Kappa (k) foi utilizada para estudo da concordância. RESULTADOS: Obtiveram-se os seguintes valores para a variável 'tempo': ponto de corte = 40 s; x= 41 ± 15,5 s; r = -0,707; p < 0,005; especificidade = 89%; sensibilidade = 83%; acurácia = 86% e k = 0,724. Para a variável 'potência', obteve-se ponto de corte = 200 w; x= 222,3 ± 95,2 w; r = 0,515; p < 0,005; especificidade = 67%; sensibilidade = 75%; acurácia = 71% e k = 0,414. A correlação de 'trabalho' com o VO2 máx não foi significativa, sendo esse atributo descartado. CONCLUSÃO: Dos atributos testados do TE, tendo como padrão-ouro o VO2 máx, a variável 'tempo' foi a que apresentou a melhor acurácia.
Influência do sistema de fornecimento de oxigênio na qualidade de vida de pacientes com hipoxemia crônica
Authors: Tanni Suzana Erico , Vale Simone Alves , Lopes Paula S , Guiotoko Marcelo M , Godoy Ilda , Godoy Irma
Published: September 2007

OBJETIVO: Avaliar a qualidade de vida relacionada à saúde de pacientes com doença obstrutiva crônica das vias aéreas recebendo oxigenoterapia domiciliar prolongada (ODP) por meio de cilindros de oxigênio e comparar estes resultados com os obtidos após seis meses de modificação do sistema de fornecimento para concentradores de oxigênio. MÉTODOS: Um total de 45 pacientes, 24 com hipoxemia crônica e 21 sem evidências de hipoxemia, foram avaliados. Os pacientes com hipoxemia crônica estavam recebendo ODP regularmente durante pelo menos os últimos seis meses e foram avaliados no momento basal, em uso de cilindro, e após seis meses de transição para concentradores. Os pacientes não hipoxêmicos foram avaliados no mesmo intervalo de tempo que os pacientes hipoxêmicos. Para avaliar a qualidade de vida foi utilizada a versão validada para língua portuguesa (Brasil) do Questionário Respiratório Saint George (Saint George's Respiratory Questionnaire - SGRQ). RESULTADOS: No momento inicial, os pacientes hipoxêmicos apresentaram maior comprometimento da qualidade de vida, avaliada pelo escore total e pelos escores dos domínios sintomas e impacto do SGRQ, que os pacientes não hipoxêmicos. Após seis meses, houve melhora significativa da qualidade de vida dos pacientes hipoxêmicos e, neste momento, não foi encontrada diferença entre os pacientes com e sem hipoxemia. CONCLUSÃO: Nossos achados mostraram que os pacientes com doença obstrutiva crônica das vias aéreas e hipoxemia crônica apresentam prejuízo da qualidade de vida, que essa qualidade de vida pode ser melhorada com o uso regular de ODP e que o sistema de fornecimento de oxigênio tem influência nessa melhora.
Análise comparativa e reprodutibilidade do teste de caminhada com carga progressiva (modificado) em crianças normais e em portadoras de fibrose cística
Authors: Coelho Cristiane Cenachi , Aquino Evanirso da Silva , Almeida Dorcas Costa de , Oliveira Gisele Caroline , Pinto Roberta de Castro , Rezende Ivana Mara Oliveira , Passos Cíntia
Published: September 2007

OBJETIVO: Realizar uma análise comparativa do teste de caminhada com carga progressiva e respectivo re-teste em crianças com fibrose cística (FC), em relação a crianças normais. MÉTODOS: As crianças foram divididas em dois grupos: grupo FC, com diagnóstico confirmado pelo teste de suor, e grupo controle, de crianças normais, sem relatos de doenças pulmonares e com prova de função pulmonar sem alterações. As crianças foram submetidas a pelo menos dois testes consecutivos, com intervalo de 30 min entre eles. Os parâmetros avaliados foram: distância caminhada, sobrecarga cardíaca, saturação periférica de oxigênio (SpO2) e percepção subjetiva do esforço (escala de dispnéia em repouso, e de Borg). RESULTADOS: Foram avaliadas 28 crianças entre 7 e 15 anos de idade (11,57 ± 2,50 e 11,28 ± 1,85 anos para os grupos FC e controle, respectivamente). Os escores da escala de Borg foram significativamente maiores nos controles (p = 0,007). Não foram encontradas diferenças quanto à sobrecarga cardíaca e SpO2. Em relação ao re-teste intergrupos, no segundo teste o grupo controle apresentou aumento significativo tanto da distância caminhada quanto da dispnéia em repouso (p = 0,014 e p = 0,036, respectivamente). O grupo FC apresentou aumento significativo apenas da escala de dispnéia em repouso (p = 0,168 e p = 0,042, respectivamente). CONCLUSÃO: A sobrecarga cardíaca imposta pelo teste não diferiu entre os grupos. O maior cansaço inicial no segundo teste sugere que o intervalo de 30 min entre os testes não foi suficiente para o descanso das crianças.
Avaliação dos valores sérico e pleural dos marcadores tumorais CEA, CYFRA21-1 e CA 15-3 em portadores de derrame pleural
Authors: Wagner Isabella Coimbra , Guimarães Murilo José de Barros , Silva Lilian Karine Neves da , Melo Francisco Montenegro de , Muniz Maria Tereza Cartaxo
Published: September 2007

OBJETIVO: Dosar os marcadores tumorais antígeno carcinoembrionário (CEA), fragmento da citoqueratina 19 (CYFRA21-1) e antígeno glicosídico associado a tumor 15-3 (CA 15-3) em sangue e líquido pleural de portadores de derrames pleurais benignos e malignos, avaliando a sensibilidade de cada um deles nesses fluidos. MÉTODOS: Avaliamos prospectivamente 85 pacientes com derrame pleural. O estudo do líquido pleural obedeceu a critérios determinados pela literatura. A dosagem dos marcadores foi realizada por eletroquimioluminescência. A sensibilidade foi determinada sob a condição de que a especificidade fosse > 90%. RESULTADOS: Foram diagnosticados 36 casos malignos (42,4%), 30 benignos (35,3%); em 19 pacientes (22,3%), o diagnóstico foi inconclusivo. Nos casos malignos, os valores de CEA e CYFRA21-1 foram maiores no líquido pleural do que no sangue, fato não observado para o CA 15-3. Nos casos benignos, os valores do CYFRA21-1 foram maiores no líquido pleural do que no soro, enquanto que para o CEA e o CA 15-3, ocorreu o oposto. Todos os marcadores apresentaram diferença significativa entre os casos malignos e benignos, em líquido pleural e soro. Foi encontrada sensibilidade para CEA, CYFRA21-1 e CA 15-3 no líquido pleural de 69,4%, 69,4% e 66,7%, respectivamente e quando associados, foi 80,6%. No soro, a sensibilidade foi 57,1, 71,4 e 48,6% para CEA, CYFRA21-1 e CA 15-3, respectivamente, e quando associados, foi 77%. CONCLUSÃO: Os resultados sugerem que a utilização desses marcadores pode ser útil na diferenciação entre derrames pleurais malignos e benignos.
Perfil dos pacientes com tuberculose e avaliação do programa nacional de controle da tuberculose em Bagé (RS)
Authors: Silveira Marysabel Pinto Telis , Adorno Raquel Fabiane Roscoff de , Fontana Tiago
Published: September 2007

OBJETIVO: Realizar um levantamento epidemiológico dos pacientes com diagnóstico de tuberculose, e fatores associados, além de verificar a eficácia do Programa Nacional de Controle da Tuberculose na cidade de Bagé, Rio Grande do Sul. MÉTODOS: Realizou-se um estudo retrospectivo dos casos notificados de tuberculose do Posto Paulo Barcellos, através da revisão de prontuários médicos e dos dados do Sistema Nacional de Agravos de Notificação, entre janeiro de 2001 e dezembro de 2004. RESULTADOS: Neste período, foram realizadas 4.468 baciloscopias, sendo a de escarro a amostra mais numerosa. Resultaram positivas 131 amostras, com prevalência maior do sexo masculino e idade entre 26 e 35 anos, e prevalência menor daqueles com idade acima de 65 anos. Mais de 50% dos pacientes eram da raça branca, tinham apenas 1 a 3 anos de estudo, e exerciam alguma função que lhes garantia algum sustento, com renda mensal baixa (média de 265 reais/mês). Houve equivalência entre os fumantes e não fumantes, e somente um dos 131 casos de tuberculose era HIV positivo. CONCLUSÃO: O número de baciloscopias realizadas em Bagé foi crescente nos últimos quatro anos. Em 2003 e 2004, esse número superou as metas do Programa Nacional de Controle da Tuberculose, o que demonstra a eficácia da busca ativa de casos de tuberculose na cidade, no entanto, houve diminuição de casos novos.
Estudo comparativo entre pacientes idosos internados com diagnóstico clínico de pneumonia comunitária, com ou sem confirmação radiológica
Authors: Augusto Daniel Knupp , Miranda Luís Felipe José Ravic de , Cruz Carlos Eduardo Gazinelli , Pedroso Ênio Roberto Pietra
Published: September 2007

OBJETIVOS: Comparar aspectos clínicos, radiológicos e evolutivos de idosos internados com diagnóstico clínico de pneumonia comunitária, com ou sem confirmação radiológica. MÉTODOS: Foram estudados, retrospectivamente, 141 pacientes com idade acima de 60 anos. RESULTADOS: Em 45 pacientes, os achados radiológicos corroboraram o diagnóstico clínico e, em 96 pacientes, a radiologia não foi compatível com a suspeita clínica. Os sinais, os sintomas, a terapêutica e os desfechos destes dois grupos foram comparados. Os achados do estudo sugerem que não houve diferença significativa entre os grupos segundo os critérios analisados. A prevalência de radiografias de tórax compatíveis com pneumonia entre pacientes com suspeita clínica da doença foi de pouco mais de 30%. CONCLUSÃO: O diagnóstico clínico de pneumonia comunitária tem baixa especificidade em idosos e deve ser usado com cautela. Devido ao pequeno número de pacientes estudados, mais estudos sobre o tema são necessários para confirmar os achados.
Aplicação do índice antropométrico para avaliação do Pectus excavatum em pacientes submetidos à técnica de Nuss: relato de 2 casos
Authors: Brigato Rodrigo Ribeiro , Campos José Ribas Milanez de , Jatene Fabio Biscegli
Published: September 2007

O Pectus excavatum (PEX) é a deformidade congênita mais freqüente da parede torácica anterior e é definido como o afundamento da porção média ou inferior da região esternal no sentido da coluna vertebral. Há muitos modos de medir a deformidade. Neste trabalho, damos ênfase a um método objetivo de avaliação ou mensuração do PEX, o índice antropométrico para PEX (IA-PEX). O IA-PEX foi desenvolvido pelo Serviço de Cirurgia Torácica do Instituto do Coração - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Este índice afere a deformidade por medidas antropométricas realizadas durante o exame físico. Relatamos, neste trabalho, dois casos de pacientes com PEX tratados pela técnica minimamente invasiva de Nuss e avaliados pelo IA-PEX. As medidas foram realizadas sempre no local de maior deformidade. Os pacientes foram medidos no dia da operação e também após o período de 60 dias da cirurgia. O IA-PEX permitiu mensurar adequadamente o defeito. Os resultados de pós-operatório de ambos os pacientes foram satisfatórios.
Microscopic qualitative evaluation of fixation time and decalcification media in rat maxillary periodontium
Authors: Fernandes Marilene Issa , Gaio Eduardo José , Rosing Cassiano Kuchenbecker , Oppermann Rui Vicente , Rado Pantelis Varvaki
Published: September 2007

The rat model is widely used in periodontal research and the quality of histological sections is essential. The purpose of this study was to evaluate the histological characteristics of periodontal tissues in Wistar rat maxillae, with different times of fixation and decalcified by nitric acid or formic acid (Anna Morse Solution). Fifteen rats were used. Fixation was performed for 24, 48 and 72 hours. The maxillae were hemi-sectioned and each part was decalcified either in nitric acid for 7 days or in Anna Morse solution for 35 days. Two trained and blinded examiners performed the evaluation. Fourty eight hours of fixation and decalcification with Anna Morse solution showed more clear characteristics of the epithelium-connective tissue interface and of the periodontal structures. Mean measurements between the cementum-enamel junction and the bone crest varied in the different experimental times from 176.5 (± 60.45) to 210.94 (± 39.33) pixels on the buccal aspect, and from 199.69 (± 38.33) to 298.55 (± 70.81) pixels on the palatal aspect, with no statistically significant differences (ANOVA, p > 0.05). In the same fixation period, decalcification with nitric acid or Anna Morse solution did not display any statistically significant differences. It may be concluded that for a qualitative histological analysis, fixation should preferably be for 48 hours and the demineralization should be made by Anna Morse solution. For a histomorphometric analysis, the decalcification solution does not interfere in the results.
Masticatory performance and bite force in children with primary dentition
Authors: Gavião Maria Beatriz Duarte , Raymundo Vaneska Graciele , Rentes Alessandra Matias
Published: September 2007

The aim of this study was to evaluate the relationship between masticatory performance and maximum bite force in the primary dentition. The sample comprised 15 children of both genders, aged 3 to 5.5 years, with good systemic and oral health, presence of all primary teeth without large caries, no structural anomalies, without severe malocclusion, and no history of orthodontic treatment. They chewed one standardized silicone tablet for 20 strokes and the median areas of the chewed particles were measured by an optical digital system. Enhanced performance was measured by a decrease in the chewed particle areas and an increase in the amount of chewed particles. The bite force was determined using a transmitter pressurized tube connected to an analog/digital electronic circuit. Weight, height and body mass index (kg/m²) were determined. The data were analyzed by descriptive statistics and Pearson or Spearman's correlations, after assessment of the normality of the distribution by Shapiro-Wilks' W-test. There was no correlation between bite force and particle area and amount (p > 0.05), neither were the body variables correlated with the masticatory variables (p > 0.05). It was concluded that the bite force was not a primary determinant of masticatory performance, and both variables were not dependent on body variables in the studied sample.
Tensile bond strength of glass fiber posts luted with different cements
Authors: Bonfante Gerson , Kaizer Osvaldo Bazzan , Pegoraro Luiz Fernando , Valle Accácio Lins do
Published: September 2007

Proper selection of the luting agent is fundamental to avoid failure due to lack of retention in post-retained crowns. The objective of this study was to investigate the tensile bond strength and failure mode of glass fiber posts luted with different cements. Glass fiber posts were luted in 40 mandibular premolars, divided into 4 groups (n = 10): Group 1 - resin-modified glass ionomer RelyX Luting; Group 2 - resin-modified glass ionomer Fuji Plus; Group 3 - resin cement RelyX ARC; Group 4 - resin cement Enforce. Specimens were assessed by tensile strength testing and light microscopy analysis for observation of failure mode. The tensile bond strength values of each group were compared by ANOVA and Tukey test. The significance level was set at 5%. The failure modes were described as percentages. The following tensile strength values were obtained: Group 1 - 247.6 N; Group 2 - 256.7 N; Group 3 - 502.1 N; Group 4 - 477.3 N. There was no statistically significant difference between Groups 1 and 2 or between Groups 3 and 4, yet the resin cements presented significantly higher tensile bond strength values than those presented by the glass ionomer cements. Group 1 displayed 70% of cohesive failures, whereas Groups 2, 3 and 4 exhibited 70% to 80% of adhesive failures at the dentin-cement interface. We concluded that resin cements and glass ionomer cements are able to provide clinically sufficient retention of glass fiber posts, and that glass ionomer cements may be especially indicated when the application of adhesive techniques is difficult.
Maximal bite force in young adults with temporomandibular disorders and bruxism
Authors: Pizolato Raquel Aparecida , Gavião Maria Beatriz Duarte , Berretin-Felix Giédre , Sampaio Ana Claudia Martins , Trindade Junior Alceu Sergio
Published: September 2007

Parafunctional habits, such as bruxism, are contributory factors for temporomandibular disorders (TMD). The aim of this study was to evaluate the maximal bite force (MBF) in the presence of TMD and bruxism (TMDB) in young adults. Twelve women (mean age 21.5 years) and 7 men (mean age 22.4 years), composed the TMDB group. Ten healthy women and 9 men (mean age 21.4 and 22.4 years, respectively) formed the control group. TMD symptoms were evaluated by a structured questionnaire and clinical signs/symptoms were evaluated during clinical examination. A visual analogical scale (VAS) was applied for stress assessment. MBF was measured with a gnatodynamometer. The subjects were asked to bite 2 times with maximal effort, during 5 seconds, with a rest interval of about one minute. The highest values were considered. The data were analyzed with Shapiro-Wilks W-test, descriptive statistics, paired or unpaired t tests or Mann-Whitney tests when indicated, and Fisher's exact test (p < 0.05). TMDB women presented lower values of MBF as compared to those presented by TMDB men and by the control group. MBF for TMDB men was similar to that of the control group. The proportion of TMDB women with muscle pain and facial/teeth/head pain upon waking up was significantly higher than that of men. Control women presented significantly lower stress scores than the others. It was concluded that MBF was reduced in TMDB women, as they presented more signs and symptoms. Men presented higher MBF values than women, but TMD and bruxism did not significantly decrease MBF. Stress was not an influencing factor for TMD and bruxism in men.
c-Myb Is Required for Neural Progenitor Cell Proliferation and Maintenance of the Neural Stem Cell Niche in Adult Brain
Authors: Malaterre Jordane , Mantamadiotis Theo , Dworkin Sebastian , Lightowler Sally , Yang Qing , Ransome Mark I. , Turnley Ann M. , Nichols Nancy R. , Emambokus Nikla R. , Frampton Jon , Ramsay Robert G.
Published: September 2007

Ongoing production of neurons in adult brain is restricted to specialized neurogenic niches. Deregulated expression of genes controlling homeostasis of neural progenitor cell division and/or their microenvironment underpins a spectrum of brain pathologies. Using conditional gene deletion, we show that the proto-oncogene c-myb regulates neural progenitor cell proliferation and maintains ependymal cell integrity in mice. These two cellular compartments constitute the neurogenic niche in the adult brain. Brains devoid of c-Myb showed enlarged ventricular spaces, ependymal cell abnormalities, and reduced neurogenesis. Neural progenitor cells lacking c-Myb showed a reduced intrinsic proliferative capacity and reduction of Sox-2 and Pax-6 expression. These data point to an important role for c-Myb in the neurogenic niche of the adult brain.

Disclosure of potential conflicts of interest is found at the end of this article.
Sonic Hedgehog Stimulates Mouse Embryonic Stem Cell Proliferation by Cooperation of Ca2+/Protein Kinase C and Epidermal Growth Factor Receptor As Well as Gli1 Activation
Authors: Heo Jung Sun , Lee Min Young , Han Ho Jae
Published: September 2007

Hedgehog signaling has an essential role in the control of stem cell growth in embryonic tissues. Therefore, this study examined the effect of sonic hedgehog (Shh) on the self-renewal of mouse embryonic stem (ES) cells and its related mechanisms. Shh increased DNA synthesis blocked by the inhibition of the smoothened receptor. Shh required Gli1 activation to induce the increases in Notch/Hes-1 and Wnt/β-catenin. Shh increased the intracellular calcium concentration ([Ca2+]i) and protein kinase C (PKC) activity. We show that the Shh-induced increase in the Gli1 mRNA level requires [Ca2+]i and PKC. Shh increased the phosphorylation of epidermal growth factor receptor (EGFR), which is blocked by the matrix metalloproteinase inhibitor. Subsequently, Shh increased the nuclear factor (NF)-κB p65 phosphorylation, which was inhibited by blocking PKC and EGFR tyrosine kinase. Shh also increased the level of the cell cycle regulatory proteins in a dose-dependent manner. However, Shh decreased the levels of the cyclin-dependent kinase inhibitory proteins. The effect of Shh on these proteins was inhibited by blocking PKC, EGFR, and NF-κB as well as transfection of Gli1 small interfering RNA (siRNA). Finally, Shh-induced progression of the G1/S-phase was blocked by the inhibition of PKC and EGFR tyrosine kinase. In conclusion, Shh stimulates mouse ES cell proliferation through Gli1 activation as well as Ca2+/PKC and EGFR.

Disclosure of potential conflicts of interest is found at the end of this article.
Supporting the Long-Term Residential Care Needs of Older Homeless People With Severe Alcohol-Related Brain Injury in Australia: The Wicking Project
Authors: Rota-Bartelink Alice , Lipmann Bryan
Published: September 2007

For years, community service providers have been frustrated with the lack in availability of long-term, specialized supported accommodation for older people, particularly older homeless people, with severe acquired brain injury (ABI) and challenging behaviors. Although the incidence of ABI (particularly alcohol-related brain injury) is far wider than being confined to the homeless population, it is frequently misdiagnosed and very often misunderstood. Wintringham is an independent welfare company in Melbourne, Australia, that provides secure, affordable, long-term accommodation and high quality services to older homeless people. The high incidence of alcohol abuse among the resident population has led us to adapt our model of care to accommodate a complexity of need. However, there are some individuals with severely affected behaviors that continue to challenge Wintringham’s capacity to provide adequate support. The deficiency in highly specialized, long-term supported accommodation for older people with severe alcohol-related brain injury (ARBI) is the driving force behind this project. We aim to further develop and improve the current Wintringham model of residential care to better support people with these complex care needs. We will report on the synthesis of this project, which aims to test a specialized model that can be reproduced or adapted by other service providers to improve the life circumstances of these frequently forgotten people.
Availability of Litigation as a Public Health Tool for Firearm Injury Prevention: Comparison of Guns, Vaccines, and Motor Vehicles
Authors: Vernick Jon S. , Rutkow Lainie , Salmon Daniel A.
Published: September 2007

The Protection of Lawful Commerce in Arms Act (PLCAA), enacted in 2005, grants the firearm industry broad immunity from liability. The PLCAA not only prevents most people from receiving compensation for their firearm-related injuries, it erodes litigation’s ability to serve its public health role of providing manufacturers with a financial incentive to make their products safer.

When the viability of the vaccine industry was threatened in the 1980s, Congress provided limited protection from liability and also established the Vaccine Injury Compensation Program. The liability of nearly all other products, for example motor vehicles, is governed by traditional common law principles.

The absence of both litigation and product safety rules for firearms is a potentially dangerous combination for the public’s health.
Costa Rica: Achievements of a Heterodox Health Policy
Authors: Unger Jean-Pierre , De Paepe Pierre , Buitrón René , Soors Werner
Published: September 2007

Costa Rica is a middle-income country with a strong governmental emphasis on human development. For more than half a century, its health policies have applied the principles of equity and solidarity to strengthen access to care through public services and universal social health insurance.

Costa Rica’s population measures of health service coverage, health service use, and health status are excellent, and in the Americas, life expectancy in Costa Rica is second only to that in Canada. Many of these outcomes can be linked to the performance of the public health care system.

However, the current emphasis of international aid organizations on privatization of health services threatens the accomplishments and universality of the Costa Rican health care system.
Current Smoking and Type 2 Diabetes Among Patients in Selected Indian Health Service Clinics, 1998–2003
Authors: Morton Deborah J. , Garrett Mario , Reid Jennifer , Wingard Deborah L.
Published: September 2007

Objectives. In non-American Indian/Alaska Native groups, current smoking prevalence is similar for those with or without diabetes (26%) We analyzed current smoking prevalence in American Indian/Alaska Natives by diabetes status.

Methods. Data were extracted from Indian Health Service clinic visit information from 1998 to 2003. After consolidation into unique patient records, the sample comprised 71221 patients aged 14 years or older with both diabetes and current smoking information.

Results. Cross-sectional results indicated that diabetic American Indian/Alaska Natives were significantly more likely than those without diabetes to be current smokers (29.8% vs 18.8%; P<.01). Smoking rates were 2 to 3 times higher among diabetic American Indians and Alaska Natives for each age category (P<.001), and current smokers with diabetes were more likely than nonsmokers to have glycosylated hemoglobin A1c levels at 8.0% or higher (P <.05).

Conclusions. American Indian/Alaska Natives with diabetes at all sites and age categories were found to smoke at significantly higher rates than those without diabetes. Smoking cessation programs should target diabetic patients to more effectively prevent complications and promote successful management of diabetes in American Indians/Alaska Natives.
Major Depressive Episodes and Work Stress: Results From a National Population Survey
Authors: Blackmore Emma Robertson , Stansfeld Stephen A. , Weller Iris , Munce Sarah , Zagorski Brandon M. , Stewart Donna E.
Published: September 2007

Objectives. We determined the proportion of workers meeting criteria for major depressive episodes in the past year and examined the association between psychosocial work-stress variables and these episodes.

Methods. Data were derived from the Canadian Community Health Survey 1.2, a population-based survey of 24324 employed, community-dwelling individuals conducted in 2002. We assessed depressive episodes using the Composite International Diagnostic Interview.

Results. Of the original sample, 4.6% (weighted n=745948) met criteria for major depressive episodes. High job strain was significantly associated with depression among men (odds ratio [OR]=2.38; 95% confidence interval [CI]=1.29, 4.37), and lack of social support at work was significantly associated with depression in both genders (men, OR=2.70; 95% CI=1.55, 4.71; women, OR=2.37; 95% CI=1.71, 3.29). Women with low levels of decision authority were more likely to have depression (OR=1.59; 95% CI=1.06, 2.39) than were women with high levels of authority.

Conclusions. A significant proportion of the workforce experienced major depressive episodes in the year preceding our study. Gender differences appear to affect work-stress factors that increase risk for depression. Prevention strategies need to be developed with employers and employee organizations to address work organization and to increase social support.
Health and Economic Benefits of Reducing the Number of Students per Classroom in US Primary Schools
Authors: Muennig Peter , Woolf Steven H.
Published: September 2007

Objectives. We estimated the costs associated with reducing class sizes in kindergarten through grade 3 as well as the effects of small class sizes on selected outcomes such as quality-adjusted life-years and future earnings.

Methods. We used multiple data sets to predict changes in the outcomes assessed according to level of educational attainment. We then used a Markov model to estimate future costs and benefits incurred and quality-adjusted life-years gained per additional high school graduate produced over time.

Results. From a societal perspective (incorporating earnings and health outcomes), class-size reductions would generate a net cost savings of approximately $168 000 and a net gain of 1.7 quality-adjusted life-years for each high school graduate produced by small classes. When targeted to low-income students, the estimated savings would increase to $196 000 per additional graduate. From a governmental perspective (incorporating public expenditures and revenues), the results of reducing class sizes ranged from savings in costs to an additional cost of $15000 per quality-adjusted life-year gained.

Conclusions. Reducing class sizes may be more cost-effective than most public health and medical interventions.
Political Will: A Bridge Between Public Health Knowledge and Action
Authors: Lezine DeQuincy A. , Reed Gerald A.
Published: September 2007

We propose a new model of the public health policy cycle: the Bridges From Knowledge to Action model. Many prevention initiatives require policy change to achieve broad implementation. Political will, society’s commitment to support or alter prevention initiatives, is essential for securing the resources for policy change. We focus on the role of political will in developing and implementing public health policy that integrates scientific evidence and community participation.
Feeding value of low quality grass silage supplemented with maize silage for sheep
Authors: VRANIC M. , KNEZEVIC M. , BOSNJAK K.
Published: September 2007

The objective of this experiment was to study the effects of interactions between low quality grass silage (GS) dominated by orchardgrass and maize silage (MS) on ad libitum intake, digestibility and nitrogen retention in wether sheep. The study consisted of four feeding treatments involving GS and MS alone and GS and MS mixtures in a ratio of 67:33 or 33:67 (dry matter (DM) basis) fed twice daily. The GS was high in DM (463 g kg1), neutral detergent fibre (715 g kg1DM) and acid detergent fibre (429 g kg1DM) while low in crude protein (90.1 g kg1DM). The DM content (g kg1) and starch concentration (g kg1DM) of MS were 264 and 211, respectively. The inclusion of MS into diet had positive linear effects on fresh matter ad libitum intake (kg d1 and g kg1M0.75d1) (P < 0.01 and P < 0.001 respectively), digestibility of DM (P < 0.01), organic matter (P < 0.01), acid detergent fibre (P < 0.05), starch (P < 0.001), digestibility of organic matter in DM (D-value) (P < 0.001), nitrogen intake (P < 0.01) and nitrogen output in faeces (P < 0.01). A positive associative effect of low quality GS and MS was observed for ad libitum intake (kg d1 and g kg1M0.75d1) of fresh matter (quadratic, P < 0.01), DM (quadratic, P < 0.001 and P < 0.01 respectively) and organic matter (P < 0.001), for digestibility of DM, neutral detergent fibre, acid detergent fibre, crude protein, starch and D-value (quadratic, P < 0.01), digestibility of organic matter (quadratic, P < 0.05), nitrogen intake (quadratic, P < 0.001) and nitrogen balance (quadratic, P < 0.05). It was concluded that differences between low quality GS and MS resulted in positive associative responses of GS and MS for all parameters measured (intake, digestibility and nitrogen retention).;
Aerobic Membrane Bioreactor for Ammonium‐Rich Wastewater Treatment
Authors: Chandrasekeran Prabhu , Urgun‐Demirtas Meltem , Pagilla Krishna R.
Published: September 2007

The major research objective involving ammonia‐rich synthetic wastewater (centrate) treatment using a membrane bioreactor (MBR) was to determine the suitable hydraulic retention time (HRT), solids retention time (SRT), and ammonium loading rate for complete nitrification of centrate. The experiments were performed using a laboratory‐scale 2‐L MBR, which was supplied with synthetic wastewater (1000 mg nitrogen/L and 350 mg chemical oxygen demand [COD]/L). The entire study period was divided into five different experimental runs based on various HRTs and SRTs. Batch nitrification rate tests and microbial studies using fluorescent in situ hybridization were also conducted. The MBR was able to achieve more than 95% ammonium removal efficiency and 90% carbonaceous soluble COD removal efficiency. The experimental results showed that complete nitrification of centrate during treatment can be achieved at a 1‐day HRT and 50‐day SRT. The suitable ammonium loading rate was found to be 0.3 mg nitrogen/mg volatile suspended solids/d.
Phosphorus Fate and Transport in Soil Columns Loaded Intermittently with Influent of High Phosphorus Concentrations
Authors: Zhang Tian C. , Dahab Mohamed F. , Nunes Germana S. , Hu Cong , Surampalli Rao
Published: September 2007

In this study, several columns of different lengths were filled with composite soils sampled from the field at corresponding depths and then loaded intermittently with influent of a high phosphorus concentration to evaluate phosphorus fate and transport in soil. The results indicate that the height of the mass transfer zone, solvent pore velocity, and soil's life expectancy for phosphorus removal increased with depth, while the retained phosphorus per kilogram of soil and the linear adsorption equilibrium coefficient, R, decreased with depth. An equation was developed to link liquid‐phase phosphorus with solvent traveling time and soil depth. The results of X‐ray diffraction and washout tests indicate that calcium‐phosphorus precipitation and/or crystal growth occurred in the columns. The new protocol is useful for evaluation of phosphorus fate and transport in other subsurface systems, because it allows flexible adjustments in hydraulic loadings, feed solution, and sampling schemes.
Calcium‐Enhanced Ferric Hydroxide Co‐Precipitation of Arsenic in the Presence of Silicate
Authors: Ruiping Liu , Xing Li , Shengji Xia , Yanling Yang , Rongcheng Wu , Guibai Li
Published: September 2007

This study focuses on the effectiveness of calcium (Ca 2+) improving ferric (hydro)oxides precipitation and its subsequent effects on arsenic co‐precipitation with ferric (hydro)oxides. The effects of Ca 2+ on surface charge characteristics and precipitating behavior, which are respectively represented as zeta (ζ) potential and R PDA, are investigated for ferric (hydro)oxides precipitates. The presence of Ca 2+ increases the ζ potential of ferric (hydro)oxides, and a more significant effect is observed at higher pH conditions. Calcium apparently facilitates ferric (hydro)oxide floc aggregation, increasing the maximum R PDA from 3.19 to 5.27% (in the presence of 3.5 mg/L silicate as silicon). These positive effects contribute to reduce the adverse effects resulting from the presence of silicate and enhance arsenic removal via ferric (hydro)oxides co‐precipitation under different conditions. Furthermore, the effect of Ca 2+ facilitating ferric precipitation (and therefore providing more precipitated solids for arsenic) is predominant in favoring arsenic removal compared with that of increasing surface charge. Calcium plays an important role in arsenic co‐precipitation with ferric (hydro)oxides in the presence of silicate.
Genotype by Diabetes Interaction Effects on the Detection of Linkage of Glomerular Filtration Rate to a Region on Chromosome 2q in Mexican Americans
Authors: Puppala Sobha , Arya Rector , Thameem Farook , Arar Nedal H. , Bhandari Kusum , Lehman Donna M. , Schneider Jennifer , Fowler Sharon , Farook Vidya S. , Diego Vincent P. , Almasy Laura , Blangero John , Stern Michael P. , Duggirala Ravindranath , Abboud Hanna E.
Published: September 2007

OBJECTIVE—Glomerular filtration rate (GFR) is used to assess the progression of renal disease. We performed linkage analysis to localize genes that influence GFR using estimated GFR data from the San Antonio Family Diabetes/Gallbladder Study. We also examined the effect of genotype by diabetes interaction (G × DM) on the detection of linkage to address whether genetic effects on GFR differ in diabetic and nondiabetic subjects.

RESEARCH DESIGN AND METHODS—GFR (N = 453) was estimated using the recently recalculated Cockcroft-Gault (GFR-CGc) and the simplified Modification of Diet in Renal Disease (GFR-4VMDRD) formulae. Both estimates of GFR exhibited significant heritabilities, but only GFR-CGc showed significant G × DM interaction. We therefore performed multipoint linkage analyses on both GFR measures using models that did not include G × DM interaction effects (Model 1) and that included G × DM interaction effects (Model 2, in the case of GFR-CGc).

RESULTS—The strongest evidence for linkage (Model 1) of both GFR-CGc (logarithm of odds [LOD] 2.9) and GFR-4VMDRD (LOD 2.6) occurred between markers D9S922 and D9S1120 on chromosome 9q. However, using Model 2, the strongest evidence for linkage of GFR-CGc on chromosome 2q was found near marker D2S427 (corrected LOD score [LODC] 3.3) compared with the LOD score of 2.7 based on Model 1. Potential linkages (LOD or LODC ≥1.2) were found only for GFR-CGc on chromosomes 3p, 3q, 4p, 8q, 11q, and 14q.

CONCLUSIONS—We found a major locus on chromosome 2q that differentially influences GFR in diabetic and nondiabetic environments in the Mexican-American population.
Contribution of Metabolic Syndrome Components to Cognition in Older Individuals
Authors: Dik Miranda G. , Jonker Cees , Comijs Hannie C. , Deeg Dorly J.H. , Kok Astrid , Yaffe Kristine , Penninx Brenda W.
Published: September 2007

OBJECTIVE— Recent evidence suggests that the metabolic syndrome and inflammation affect cognitive decline in old age and that they reinforce each other. However, it is not known what the roles of the individual components of the metabolic syndrome on cognition are.

RESEARCH DESIGN AND METHODS— The sample consisted of 1,183 participants in the Longitudinal Aging Study Amsterdam who were aged 65–88 years. Metabolic syndrome (U.S. National Cholesterol Education Program definition) and its individual components and the inflammatory markers C-reactive protein (CRP) and α1-antichymotrypsin (ACT) were assessed. Cognitive assessments included general cognition (Mini-Mental State Examination), memory (verbal learning test), fluid intelligence (Raven's Matrices), and information processing speed (coding task).

RESULTS— Of the sample, 36.3% had metabolic syndrome. Metabolic syndrome was significantly associated with all cognitive measures (P < 0.05). Of the individual components, hyperglycemia was most strongly and significantly associated with cognitive function (multivariate adjusted models; B values, indicating differences in scores between both groups, ranging from −0.38 to −1.21). There was a significant interaction between metabolic syndrome and inflammation on cognition (P < 0.01–0.09). Metabolic syndrome was negatively associated with cognition in subjects with high inflammation (highest tertile for both CRP and ACT; B values ranging from −0.86 to −1.94, P < 0.05), whereas an association was absent in subjects with low inflammation (B values ranging from −0.10 to −0.70).

CONCLUSIONS— Subjects with metabolic syndrome showed poorer cognitive performance than subjects without metabolic syndrome, especially those with high levels of inflammation. Hyperglycemia was the main contributor of the association of metabolic syndrome with cognition.