Association between sense of coherence and oral clinical conditions in adults and the elderly: systematic review and meta-analysis

OBJECTIVE

This study systematically reviews the evidence on the relationship between sense of coherence (SOC) and oral clinical conditions in adults and elderly people.

METHODS

PubMed, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences - Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Brazilian Dentistry Bibliography - Bibliografia Brasileira de Odontologia (BBO), Cochrane Library and grey literature were searched. Observational studies involving adults and elderly people that evaluated SOC with a valid instrument and investigated oral clinical measurements as outcomes were included. Two review authors independently assessed the studies for inclusion and extracted data. The quality of studies was assessed using the Downs and Black checklist. Meta-analysis used the random-effect inverse-variance method to obtain pooled odds ratios (OR) and 95% Confidence Intervals (CI) for each oral clinical condition.

RESULTS

From a total of 872 identified studies, ten observational cross-sectional and one longitudinal study were included. Nine studies were judged of medium or high risk of bias. Meta-analyses showed that adults and elderly people with higher SOC were less likely to present dental caries (OR 0.84; 95%CI = 0.73-0.96), periodontal disease (OR 0.58; 95%CI = 0.30-0.85), gingivitis (OR 0.54; 95%CI = 0.18-0.90) or dental biofilm (OR 0.65; 95%CI = 0.43-0.86).

CONCLUSIONS

Current evidence suggests that better SOC is positively related to better oral clinical status in adults and elderly people. Longitudinal and intervention studies are needed to confirm these findings.

Ultrafast sonochemistry-based approach to coat TiO2 commercial particles for sunscreen formulation

TiO₂ is a common inorganic filter used in sunscreens due to its photoprotective effect on the skin against UV radiation. However, the use of this kind of material in cosmetics is limited by its inherent photocatalytic activity. It is known that coating on TiO₂ surface can improve some features. Although, many of the methodologies used for this purpose are still laborious and time-consuming. Thus, this work reports a novel, easy, cheap and fast strategy to coat TiO₂ particles by using a sonochemistry approach, aiming to decrease photocatalytic activity and to enhance colloidal stability. For this proposal, SiO₂, Al₂O₃, ZrO₂ and sodium polyacrylate (PAANa) were used to tune the surface of commercial TiO₂ particles and they were applied in a sunscreen formulation. The samples were characterized by XRPD, FT-IR, DLS, EDS, SEM and TEM. The photocatalytic activity and UV-shielding ability were also evaluated. The sunscreen formulations were prepared and characterized by zeta potential, DLS, and Sun Protection Factor (SPF). FT-IR, EDS, and charge surface of the particles confirmed the success of the sonochemistry coating. Additionally, TiO₂@Al₂O₃, TiO₂@SiO₂ and TiO₂@PAANa show a lower photocatalytic activity than original TiO₂ with similar UV-shielding ability. The sunscreens produced with the coated TiO₂ have similar SPF to the one with commercial TiO₂. Specifically, the sunscreen with TiO₂@PAANa shows an increase in colloidal stability. Herein, the incorporation of the sonochemical-coated TiO₂ particles in sunscreen formulations may produce sunscreens with better aesthetic appearance and a greater health security due to its lower free radicals production.

Short-term caloric restriction does not modify the in vivo insulin signaling pathway leading to Akt activation in skeletal muscle of Ames dwarf (Prop1(df)/Prop1(df)) mice

The purpose of this study was to analyze the interaction between caloric restriction (CR) and the dwarf mutation at the level of insulin sensitivity and signal transduction. To this end, we analyzed the in vivo status of the insulin signaling system in skeletal muscle from Ames dwarf (df/df) and normal mice fed ad libitum or subjected to short-term (20-day) CR. We measured insulin-stimulated phosphorylation of the IR and IRS-1, IRS-1-p85 association and Akt activation, and the abundance of the IR, IRS-1, p85, GLUT-4 and IGF-1 receptor in skeletal muscle. In terms of glucose homeostasis, the response to CR was different in both groups of animals. In normal animals, CR induced a significant reduction in both circulating insulin and glucose levels, while CR did not modify these parameters in df/df mice. We did not find any significant alteration in either activation or abundance of signaling molecules analyzed after short-term CR in either normal or Ames dwarf mice. We conclude that the initial adaptation to CR in normal mice is an increase in insulin sensitivity without changes in insulin signal transduction, and that this adaptation is not evidenced in df/df mice, probably since they are already hypersensitive to insulin.

Incidência de cesáreas segundo fonte de financiamento da assistência ao parto

OBJETIVO: Estudar os tipos de partos de acordo com a categoria de internação da paciente, bem como as indicações de cesarianas mais freqüentemente referidas. MÉTODOS: A partir dos dados de um sistema de informações hospitalares, foi feita uma análise retrospectiva dos partos ocorridos no município de Ribeirão Preto, São Paulo, Brasil, no período de 1986-1995. Foram estudados: tipo de parto, categoria de admissão e diagnósticos referidos. RESULTADOS: Ocorreram 86.120 partos no período estudado, sendo 5,4% na categoria privada, 28,7% na categoria de pré-pagamento e 65,9% no sistema público (Sistema Único de Saúde -- SUS), observando-se uma diminuição nas categorias privada e SUS e aumento na categoria de pré-pagamento. A percentagem de cesáreas aumentou de 68,3% para 81,8% na categoria privada e de 69,1% para 77,9% na categoria pré-pagamento e diminuiu de 38,7% para 32,1% na categoria SUS. As principais indicações cesarianas referidas foram o sofrimento fetal, cujas incidências foram 9,5%, 10,9% e 9,0%, respectivamente, nas categorias particular, pré-pagamento e SUS; e distócia céfalo-pélvica cujas taxas foram 5,8%, 6,5% e 3,9%, respectivamente, nas mesmas categorias mencionadas. CONCLUSÃO: A incidência de cesariana variou segundo a categoria de internação, observando-se um gradiente crescente à medida que se elevou o padrão social das gestantes, não havendo correspondência com o risco obstétrico.

[Study of public and private hospital care on a population basis, 1986-1996]

INTRODUCTION

The last decade saw the creation and implementation of the Brazilian National Health System (NHS)--public, universal and equalitarian--with the objective of offering wide coverage to meet the population's health needs. The objective of the study was the assessment of the evolution of public and private hospital care on a populational basis during the period of the implementation of the NHS.

METHODS

The 984,142 inpatients of the general hospitals of Ribeirão Preto, Brazil, during the period 1986 to 1996 were studied and those of them living in their own municipal district were selected. The inpatients are classified according to the financing system as private, pre-payment and NHS; the social situation of the patients and the profile of hospital morbidity are analysed.

RESULTS

In the period studied a continuous growth in the number of hospitalizations is observed, both in absolute numbers and in coefficient per thousand inhabitants, increasing from 43,773 to 55,844 inpatients per year. Though when the categories of the hospitalizations are studied, it is seen that private inpatients present a reduction both in absolute numbers and as a coefficient from 3,181 (7.3%) to 2,215 (3.9%); the NHS inpatients decrease in absolute numbers and in a percentage by a third at the end of the period--falling from 33,254 (76.0%) to 29,373 (51.7%). On the other hand the pre-payment inpatient system triplicates in absolute numbers and duplicates by rate for inhabitant--from 7,338 (16.8%) to 25,256 (44.4%). The NHS hospital care attends mainly unskilled and semi-skilled manual workers; the professionals, technicians, non manual and skilled manual workers being assisted by the private services. The hospital morbidity of NHS inpatients is different from that of the private inpatient systems. The health policy in that period, limiting NHS financing, repressing demand and discouraging the private providers to work with NHS inpatients led to negative selectivity. The result was an increase in difference between standards of care as between the public and private services.

[Hospital assistance as an indicator of social inequality]

OBJECTIVE

To test a model for the study of inequalities in hospitalizations in the city of Ribeirâo Preto (SP), understanding them to be due both to the social position of inpatients and also to health care policies in Brazil.

MATERIAL AND METHOD

Using a hospital information system in existence for more than 25 years in the city of Ribeirâo Preto-SP, 56.293 hospitalizations of municipal inhabitants occurring in some of the 12 general hospitals in 1993, were studied. Using the Brazilian occupancy classification for mortality, these inpatients were grouped on 6 occupational levels, as in the British classification: professional, intermediate, qualified non manual, qualified manual, partially qualified and unqualified.

RESULTS AND CONCLUSIONS

Two-thirds of the inpatients had no place in the i.e. did not belong to the economically active population--and consisted of housewives, pensioners, children and students--and one third had some economic activity and thus belonged to the economically the active population. A close association was found between social strata and the classification of the hospital financing system into private, private group clinic and public health system patients. There were differences in hospital parameters as well as in morbidity patterns between these groups. The inequalities relating to average age, average age of hospital deaths, mean lengths of stay, hospital mortality, re-internment and frequency of diseases are discussed. This model allows the social position of the inpatient to be estimated using the hospital financing system, including also those patients with no economic activity, which covers the majority of the population. Social mechanisms created to compensate for inequalities in the welfare state do not cancel out the social differences.

[Inequalities among hospitalized patients due to cardiac and cerebrovascular diseases in localities of the State of São Paulo (Brazil), 1986]

The clinical and epidemiological characteristics of hospitalizations due to cardiac and cerebral-vascular diseases (CCVD-ICD 390-438), which occurred in 1986, were studied on the basis of data from an information system relating to medical care in the City of Ribeirão Preto, State of S. Paulo, Brazil. These causes accounted for 4,673 of the annual total of 43,449 hospital admissions. Using the sources of payment of the hospitalization as an indicator of the patients' social strata, the following four study groups were defined: private, social insurance, non-paying and "others". These groups showed significant differences in relation to the following variables: hospitalization rates due to CCVD, mean and median age at admission and time of death, occupation, average length of stay in the hospital, mortality rates and relative frequencies of specific sub-group diagnosis. These differences are attributed to inequalities in the standard of living and in the working conditions of the groups, which determine diverse patterns of disease, medical care and mortality.

[Congenital malformations in hospitalizations of the hospitals of Ribeirão Preto, SP, Brazil]

São apresentados os dados sobre internações por malformações congênitas registradas pelo Centro de Processamento de Dados Hospitalares do Departamento de Medicina Social da Faculdade de Medicina de Ribeirão Preto, USP, desde 19 de janeiro de 1970 a 30 de julho de 1974 em sete estabelecimentos hospitalares. Tais internações participam com 1,48% no total de internações, excluindo-se as causas acidentais. Encontrou-se que as distribuições de diagnósticos principais e secundários classificados por tipo de malformação são significantemente diferentes; descreveu-se a participação de cada estabelecimento nestas internações. Do mesmo modo, encontrou-se um incremento significativo na percentagem de internações por malformações congênitas com o transcurso de tempo, o que é atribuído ao Hospital das Clínicas exclusivamente. Apresentou-se a percentagem de mortalidade por diagnóstico, as razões de sexo e a duração média das internações, encontrando-se nesta última que é maior que a média do total de internações. Descreveu-se também a realização de procedimentos cirúrgicos, a distribuição por idades e a procedência dos pacientes com malformações congênitas, sugerindo que os hospitais de Ribeirão Preto funcionem como centros de referência para o tratamento e a correção dessas anomalias.