Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity

BACKGROUND

Recent studies in patients with previously untreated T1 and T2 squamous cell carcinoma (SCC) of the tongue and floor of the mouth have shown a relationship between tumor thickness, neck metastasis, and survival. Our study was conducted to determine the indication of elective neck dissection in patients with early oral cavity SCC.

PATIENTS AND METHODS

Sixty-seven patients were stratified by stage (T1 and T2 NO), and those in each stage were randomized to receive one of two types of treatment; resection alone (RA) or resection plus elective supraomohyoid neck dissection (RSOND). Fifty-two patients (78%) were men and 15 (22%) were women. The median age was 57 years old (range 34 to 95).

RESULTS

Twenty-six (39%) patients had tumor in the floor of the mouth and 41 (61%), in the tongue. Using the criteria of the Union Internationale Contre le Cancer (UICC), 1987, we classified 31 tumors (46%) as T1 lesions and 36 (54%) as T2 lesions. Thirty patients had a tumor thickness < or = 4 mm and 37 had a tumor thickness > 4 mm. Thirty-three (49%) patients were treated with RA, and 34 patients (51%) were treated with RSOND. Seven (21%) patients of the RSOND group had occult cervical metastasis. There were recurrences in 14 (42%) patients of the RA group and 8 (24%) patients of the RSOND group. The disease-free survival rates at 3.5 years for RA and RSOND patients were 49%, and 72%, respectively. The impact of sex, age, site, cancer stage, and tumor thickness was assessed by the Mantel-Haenszel chi-square procedure. Later stage (P = 0.05) and increased tumor thickness (P = 0.005) were significantly associated with treatment failures.

CONCLUSION

Neck dissection remains mandatory in the early stage of oral SCC, because of better survival rates compared to RA and the poor salvage rate. In particular, patients with tumor thickness > 4 mm treated with RSOND had significant benefit on disease-free survival.

Elective neck dissection versus observation in stage I squamous cell carcinomas of the tongue and floor of the mouth

A retrospective study was undertaken of patients with T1N0M0 squamous cell carcinoma of the oral tongue and floor of the mouth who underwent surgical treatment between 1985 and 1995. Evaluation of two groups of patients (neck dissection versus observation) was made according to the management of the neck. Results were obtained regarding the presence of occult metastases, recurrence in the neck, treatment failure, results of salvage treatment, and disease-free survival. Forty-nine patients underwent surgical treatment: 25 resection of primary and 24 resection plus neck dissection. Overall incidence of regional metastases was 24.5%. Eight patients (16%) developed recurrence of the disease. Seven (14%) had regional recurrences (including 1 with distant metastases) and 1(2%) had local recurrence. Twenty-four percent of patients from the resection of primary group developed neck recurrences in comparison with 4% of the resection plus neck dissection group (P = 0.05). Overall salvage rate was 37.5%. Second primary tumors developed in 16% of patients. Patients who underwent elective neck dissection had a 23% higher disease-free survival rate compared with those who underwent resection of the tumor alone (P = 0.03). The findings of this study stress the importance of control of the neck in early oral cancer. Elective neck dissection significantly improved regional control of the disease.

Photodynamic antimicrobial chemotherapy and ultraconservative caries removal linked for management of deep caries lesions

BACKGROUND

Ultraconservative removal of carious tissue is becoming increasingly highlighted for management of deep caries lesions, and combined with an antimicrobial photochemistry-based treatment modality (PACT), this approach can be enhanced favoring dental tissue repair and preservation. The aim was to investigate the effectiveness of PACT using a light emitting diode (LED) associated with a photosensitizer toluidine blue ortho (TBO) on deep caries lesions.

METHODS

For that, a single blind, randomized, controlled, split-mouth clinical trial where 45 patients with at least two deep carious lesions on permanent posterior teeth was performed. The primary intervention was deep caries lesion management with disinfection of remaining dentin tissue using PACT. Bacterial counts were measured following treatments as the main outcome. The remaining dentinal samples of each lesion were treated with either non-PACT-control or PACT. The PACT procedure were characterized by 100 μg mL(-1) TBO followed by 94J cm(-2) LED irradiation. Samples of dentin were collected before and immediately after treatments for microbiological analysis of total viable bacteria, mutans streptococci and Lactobacillus spp. counts. Microbial reduction was data were submitted to unpaired t test (α=5%).

RESULTS

PACT led to statistically significant reductions in mutans streptococci (1.08 ± 1.20 log), Lactobacillus spp. (1.69 ± 1.37 log), and total viable bacteria (1.07 ± 1.01 log) compared to the control, which showed log reductions respectively of 0.05 ± 0.49, 0.52 ± 0.89, and 0.47 ± 0.77 for the same microorganisms.

CONCLUSION

Dentin from deep carious lesions treated with PACT showed a decrease in cariogenic microbial load.

Elective neck dissection in the treatment of T3/T4 N0 squamous cell carcinoma of the larynx

BACKGROUND

This study analyzed pathologic findings of clinically occult cervical lymph nodes of T3/T4 N0 squamous cell laryngeal carcinoma and their impact on locoregional failures and overall survival.

PATIENTS AND METHODS

A retrospective analysis of 76 patients with T3/T4 N0 laryngeal carcinoma was carried out between 1981 and 1989. Sixty-seven patients had transglottic tumor, 31 patients had extralaryngeal spread, 56 patients were T3 N0, and 20 patients were T4 N0. Seventy-five patients had total laryngectomy and 1 had near total laryngectomy. All patients had bilateral elective neck dissection. The chi-square test was applied to factors related to neck metastasis and locoregional failure. Survival was analyzed using the Kaplan-Meier actuarial method; differences were tested using the Wilcoxon signed-rank test.

RESULTS

Eighteen patients had positive surgical margins. Occult neck metastasis was observed in 30%. Univariate analysis showed that cancer stage and cartilage status were not significant to predict neck metastasis. Locoregional recurrence was observed in 28% of patients. Surgical margins, cervical metastasis, lesion extension, and cartilage invasion had significant impact on disease-free survival. The 5-year overall survival was 52%; disease-free survival was 57%.

CONCLUSION

The elective bilateral neck dissection performed in T3/T4 N0 patients yielded a 30% incidence of occult neck metastasis. Classification of transglottic carcinomas into endolaryngeal and exolaryngeal provides a better parameter for predicting neck metastasis than does T status. Disease-free and overall survival were significantly affected by neck metastasis, T stage, exolaryngeal tumor, cartilage infiltration, and surgical margins.

Anterior Vocal Commissure Invasion in Laryngeal Carcinoma Diagnosis

BACKGROUND

Laryngeal carcinoma involving anterior vocal commissure (AVC) represents a great challenge for staging and treatment.

OBJECTIVES

To compare laryngoscopy and computed tomography (CT) scan efficiency in staging tumors extending to the AVC. We also analyzed the helicoidal axial CT scan accuracy in recognizing this larynx subregion invasion.

MATERIAL AND METHODS

Fifty-two glottic and supraglottic laryngeal squamous cell carcinoma patients with tumoral extension to the AVC were prospectively studied from August 2001 to August 2003 at the National Cancer Institute (Rio de Janeiro, Brazil). All patients underwent videolaryngoscopic examination and direct laryngoscopy for lesion extension analysis and biopsy. After AVC helicoidal axial CT scan with sagittal and coronal 1.0 mm thick reconstruction, patients were submitted to surgical treatment. The same pathologist analyzed all surgical specimens.

RESULTS

When compared with pathologic stage, clinical endoscopic classification was correct in 40.38% of cases (40% for T1, 29.41% for T2, 46.43% for T3, and 50% in T4). Helicoidal axial CT scan accuracy for AVC tumors was 75% (P = .0001), being more important for T2 (62.50%), T3 (73.91%), and T4 (88.24%) lesions. Identification of radiologic signs described as gross radiologic anterior commissure involvement (GRACI) increased radiologic image staging accuracy to over 96%.

CONCLUSIONS

Endoscopic evaluation understaged tumors in all clinical stages but really T1. Helicoidal axial CT scan reformatted to 1.0 mm thick played an important role in correctly staging more advanced AVC laryngeal tumors. Radiologic signs, here identified as GRACI, may be very helpful for tomographic staging and patient treatment.

Physical activity and myopia in Danish children-The CHAMPS Eye Study

PURPOSE

To determine associations between physical activity (PA) and myopia in Danish school children and investigate the prevalence of myopia.

METHODS

This is a prospective study with longitudinal data on PA in a Danish child cohort. Physical activity (PA) was measured objectively by repeated ActiGraph accelerometer measurement four times with different intervals (1-2.5 years) at the mean ages 9.7, 11.0, 12.9 and 15.4 years. Mean intensity of PA was estimated as counts/minutes, and time spent in sedentary, light, moderate and vigorous PA was summed using defined cut-off points. The ophthalmologic examination was conducted at the mean age of 15.4 ± 0.7 years and included cycloplegic autorefraction and biometry.

RESULTS

A total of 307 children participated in the Childhood Health, Activity, and Motor Performance School (CHAMPS) Eye Study. The cycloplegic spherical equivalent (SE) was 0.30 ± 1.46 dioptres. The prevalence of myopia was 17.9% (SE ≤-0.5 dioptres). Mean axial length (AL) was 23.5 ± 0.9 mm. For all participants, the overall mean daily distribution of PA was 67.2% in sedentary, 25.6% in light, 4.4% in moderate and 2.9% in vigorous PA. Age- and sex-adjusted linear regression showed no association between PA and SE or AL. In a prospective slope analysis, there was no association between accumulated PA during the 7 years and AL or SE.

CONCLUSION

The prevalence of myopia among Danish children was 17.9%. By logistic regression and slope analysis, we found no association between PA and myopia, in this first of its kind study based on objective and repeated PA data.

The longitudinal relationship between motor competence and measures of fatness and fitness from childhood into adolescence

OBJECTIVES

To examine longitudinal (seven years) relationships among cardiorespiratory fitness (VO_2peak), body fatness, and motor competence.

METHOD

Data were collected as part of the Copenhagen School Child Intervention Study (CoSCIS). Body fatness was assessed by the sum of four skinfolds. VO_2peak was measured directly in a continuous running protocol. Motor competence was assessed using the Körperkoordinationtest für Kinder. This study used multilevel linear mixed models to evaluate the reciprocal longitudinal association between body fatness, VO_2peak, and motor competence. All regressions were stratified by sex and adjusted by intervention and pubertal status. All variable coefficients were standardized.

RESULTS

A reciprocal relationship was observed between children's motor competence with body fatness and VO_2peak at the seven-year follow-up (6-13 years of age). Children with higher motor competence at baseline had a lower risk of having higher body fatness (β_boys=-0.45, 95% CI: -0.52 to -0.38; β_girls=-0.35, 95% CI: -0.42 to -0.28) and higher VO_2peak (β_boys=0.34, 95% CI: 0.27-0.40; β_girls=0.27, 95% CI: 0.20-0.33) during childhood. Alternatively, higher body fatness or lower levels of VO_2peak at baseline were associated with lower motor competence during childhood.

CONCLUSIONS

These data suggest motor competence, body fatness, and VO_2peak demonstrate reciprocal relationships across childhood (6-13 years of age). Interventions addressing motor competence, cardiorespiratory fitness, and body fatness in early childhood are recommended, as intervention effects are likely to be enhanced because of the mutual reciprocal associations between these three variables.

Motor competence and cardiorespiratory fitness have greater influence on body fatness than physical activity across time

We investigated the longitudinal associations among physical activity (PA), motor competence (MC), cardiorespiratory fitness (VO_2peak ), and body fatness across 7 years, and also analyzed the possible mediation effects of PA, MC, and VO_2peak on the relationships with body fatness. This was a seven-year longitudinal study with three measuring points (mean ages [in years] and respective sample size: 6.75±0.37, n=696; 9.59±1.07, n=617; 13.35±0.34, n=513). PA (moderate-to-vigorous PA-MVPA and vigorous PA-VPA) was monitored using accelerometers. MC was assessed by the "Körperkoordinationstest für Kinder-KTK" test battery. VO_2peak was evaluated using a continuous running protocol until exhaustion. Body fatness was determined by the sum of four skinfolds. Structural equation modeling was performed to evaluate the longitudinal associations among PA, MC, VO_2peak, and body fatness and the potential mediation effects of PA, MC, and VO_2peak . All coefficients presented were standardized (z-scores). MC and VO_2peak directly influenced the development of body fatness, and VO_2peak mediated the associations between MVPA, VPA, MC, and body fatness. MC also mediated the associations between MVPA, VPA, and body fatness. In addition, VO_2peak had the largest total association with body fatness (β=-0.431; P<.05), followed by MC (β=-0.369; P<.05) and VPA (β=-0.112; P<.05). As PA, MC, and VO_2peak exhibited longitudinal association with body fatness, it seems logical that interventions should strive to promote the development of fitness and MC through developmentally appropriate physical activities, as the synergistic interactions of all three variables impacted body fatness.

The synergic relationship between social anxiety, depressive symptoms, poor sleep quality and body fatness in adolescents

BACKGROUND

The aim of the current study was to evaluate the cross-sectional synergic relationship among social anxiety, poor sleep quality, depressive symptoms and body fatness.

METHODS

A cross-sectional study was performed with 1,242 adolescents from a north-eastern district in Brazil. It was used the Social Anxiety Scale for Adolescents for symptoms of social anxiety, the Pittsburgh Sleep Quality Index for sleep quality and the Depression Scale of the Center for Epidemiologic Studies for depressive symptoms. Body fatness was the sum of triceps and subscapular skinfolds. Structural equation modelling was used to evaluate associations among these comorbidities.

RESULTS

Social anxiety was directly and positively associated with depressive symptoms, poor sleep quality and body fatness (β = 0.316 standard deviations [SD]; β = 0.299 SD; β = 0.072 SD, respectively). Moreover, social anxiety was indirectly associated with depressive symptoms via poor sleep quality (β = 0.113 SD). Poor sleep quality was directly associated with depressive symptoms (β = 0.377 SD). We did not observe a significant relationship of poor sleep quality and depressive symptoms with body fatness.

LIMITATIONS

This is a cross-sectional study; therefore, we cannot infer causality in the interpretation of the findings.

CONCLUSIONS

Social anxiety seemed to play pivotal role in adolescents' health, since it was associated with poor sleep quality, depressive symptoms and body fatness. Interventions targeting sleep quality, depressive symptoms and body fatness in adolescents should designate relevant effort addressing social anxiety.

Prognostic factors and outcome in craniofacial surgery for malignant cutaneous tumors involving the anterior skull base

BACKGROUND

We retrospectively reviewed the medical charts of 57 patients with advanced malignant cutaneous tumors involving the anterior skull base who underwent combined craniofacial resection in our department from January 1, 1981, to December 31, 1994.

METHODS

The data regarding histological results, demographic aspects, clinical presentation, previous treatment, extent of the disease, extent of surgical procedure, type of reconstruction, complications, and follow-up were analyzed using the chi 2 method. Survival analysis was performed using the Kaplan-Meier method.

RESULTS

We found prevalence of the male sex (60%) and white race (86%), with a mean age of 62 years. Thirty-five patients (61%) showed extensive lesions directly invading the anterior skull base (type II); 46 patients (81%) had been treated previously; 10 patients (18%) had dural invasion; 29 patients (51%) could not have the eyeball preserved; 32 patients (56%) underwent microsurgical reconstruction; and 45 patients (79%) underwent pericranial or galeal-pericranial flap reconstruction for the anterior skull base defect. Postoperative complications occurred in 29 patients (51%). The most common complication was postoperative infection (17 patients [59%]). Thirty-two patients (56%) were free of disease, and 4 (7%) were alive with disease at the time of our study.

CONCLUSIONS

The extent of facial disease (P = .005) and the type of facial reconstruction (P = .01) were the most important risk factors in the development of infectious complications. Invasion of the dura and the type of reconstruction of the anterior skull base were the most important factors related to cerebrospinal fluid leakage (P = .003) and meningoencephalitis (P = .06). Invasion of the dura mater significantly affected survival (P = .005).

Supracricoid laryngectomy with CHEP: functional results and outcome

OBJECTIVES

To assess whether supracricoid laryngectomy with cricohiodoepiglottopexy could successfully reach the cure and preserve the voice in glottic laryngeal cancer, we studied 27 patients with T2/T3 squamous cell carcinoma of the larynx treated in our institution with cricohiodoepiglottopexy.

STUDY DESIGN

A retrospective analysis has been carried out between 1995 through 1997. We classified 11 patients as T2N0M0 and 16 patients as T3N0M0. Nineteen patients had bilateral selective lateral neck dissection, 3 patients had unilateral lateral neck dissection, and 5 patients had undissected neck. Survival was analyzed under the Kaplan-Meyer method.

RESULTS

Five patients had postoperative complications, 2 were treated with a total laryngectomy. The remaining 25 patients kept the normal airway, swallowing, and speech. None of the patients in the neck dissection group had neck metastasis. Two patients had recurrences, 1 with local recurrence was treated with a total laryngectomy and is alive without disease; the other patient had neck recurrence, was treated with radical neck dissection plus radiotherapy, and is dead of the disease. One patient had a second tumor in oropharynx treated with palliative radiotherapy and is dead of the disease. Three years disease-free survival was 75% for T2 and 79% for T3.

CONCLUSIONS

This technique is useful in the treatment of selected cases of T3/T2 glottic cancer regarding the extent of disease. The incidence of complications in need of a complete laryngectomy does not compromise the functionality of this technique. The survival is comparable to patients who submitted to total laryngectomy and near-total laryngectomy, regarding the extent of the lesion.

Tracking of Gross Motor Coordination From Childhood Into Adolescence

PURPOSE

The purpose of this study was to analyze tracking and stability of motor coordination in children from age 6 years to ages 9 and 13 years.

METHOD

Data were from the Copenhagen School Child Intervention Study. Motor coordination (MC) was measured using the körperkoordinationstest für Kinder (KTK) test. The crude performance score on every item was converted into a standardized "score" based on the original German reference study, which was used to generate a total standardized motor coordination (MQ) score. The MQ scores, which represented children's level of gross MC, were classified as low (MQ score < 85), normal (MQ score = 85-115), or high (MQ score>115). Pearson correlation was used to calculate the tracking coefficients of each KTK element and MQ score, and weighted kappa was used to analyze maintenance in MC classification groups. Mixed-effects logistic regression analyses were performed to examine the odds of remaining in the low MC group over time based on body mass index (BMI), weight, and height tertiles.

RESULTS

Tracking coefficients among the MQ score and each KTK element at different ages were moderate (r>.35). Children in the highest BMI and weight tertiles had a 5.44 and 5.15 times greater chance to be in the lower MC classification group during the 7-year follow-up, respectively, in comparison with children in their lowest tertiles.

CONCLUSION

MC tracked moderately through childhood to early adolescence. Because heavier children had a greater chance to be in the lower MC group at older ages, intervention may be useful at earlier ages for those with lower MC and disadvantageous weight status.

Predictors of dental anxiety in Brazilian 5-7years old children

OBJECTIVES

The aim of this study was to analyze the predictors of dental anxiety in 5 to 7-year-old children in a two years follow-up.

MATERIALS AND METHODS

This is a longitudinal study conducted with 784 children with 5 to 7years old. A face-to-face interview was conducted with the parents. The Dental Anxiety Question (DAQ) answers were categorized as presence or absence of dental anxiety. The possible predictor factors analyzed were: related to the children (age, sex, parentage, childbirth, physical activity, body satisfaction, psychological well-being, physical well-being, dentist visit); and related to the parents or guardians (excessive alcohol consumption, smoke, family income, number of children). Forward stepwise logistic binary regression was performed for the multivariate analysis. The analysis was controlled by gender.

RESULTS

The prevalence of dental anxiety was 17.4%. Children in lower family income had 2.3 (95% CI: 1.3-4.0) greater chance to report high dental anxiety in comparison to children in higher family income. Similarly, children's parents who reported lower psychological well-being had 1.5 (95% CI: 1.0-3.0) greater chance to report high dental anxiety in comparison to children's parents with higher psychological well-being.

CONCLUSIONS

The prevalence of dental anxiety was high, and the family income and psychological well-being were inversely associated to dental anxiety in children.

CLINICAL RELEVANCE

Knowing the dental anxiety predictors could help the pediatric dentist to analyze and understand who is more susceptible to develop dental anxiety. An adequate approach, a trust relationship could be built, improving the oral health conditions and reducing the need of treatment in children.

Condutas de risco à saúde e indicadores de estresse psicossocial em adolescentes estudantes do Ensino Médio

O objetivo deste artigo foi analisar a associação entre condutas de risco à saúde (tabagismo, consumo de bebidas alcoólicas e uso de drogas) e indicadores de estresse psicossocial em adolescentes estudantes do ensino médio. A pesquisa foi realizada com amostra constituída por 4.210 adolescentes estudantes de escolas públicas do Estado de Pernambuco, Brasil. O Global School-based Student Health Survey foi usado para coletar dados pessoais (demográficos e socioeconômicos) e comportamentais, e para obter medidas dos indicadores de estresse psicossocial (variáveis desfecho). Foram observadas prevalências de tristeza, sentimento de solidão, pensamento de suicídio, dificuldade para dormir devido à preocupação e planos de suicídio. Tabagismo, consumo de bebidas alcoólicas e uso de drogas foi relatado, respectivamente, por 7,7%, 30,3% e 6,9%. As prevalências de indicadores de estresse psicossocial foram maiores entre as moças, e as prevalências de exposição a condutas de risco à saúde foram maiores entre os rapazes. Concluiu-se com o estudo que o uso de drogas está diretamente associado ao pensamento e plano de suicídio e, entre as moças, o consumo de bebidas alcoólicas foi um fator associado ao estresse psicossocial.

Near-total laryngectomy for treatment of advanced laryngeal cancer

BACKGROUND

In order to assess whether near-total laryngectomy (NTL) could successfully reach the cure and preserve the voice in advanced laryngeal cancer, we studied 28 patients with T3/T4 squamous cell carcinoma of the larynx treated with NTL in our institution.

METHODS

A retrospective analysis has been carried out from 1990 through 1994. We classified 24 patients as Stage III and 4 patients as Stage IV. All patients had lateral neck dissection. Survival was analyzed under the Kaplan-Meier method.

RESULTS

Twenty-six patients achieved voice preservation. Two patients in the bilateral neck dissection group had a metastatic lymph node on the opposite side. No patient had local recurrence. Three patients died of the disease, and 1 patient was salvaged with neck dissection. Three-year disease-free survival was 85%.

CONCLUSION

This technique is useful in the treatment of selected cases of advanced laryngeal cancer and achieves local control of the lesion in all cases. The survival is comparable with that of patients submitted to total laryngectomy, regarding the extent of lesion. Voice preservation can be achieved in most cases.

[Medullary paracoccidioidomycosis: report of a case]

Paracoccidioidomycosis of the central nervous system presents either as meningeal or pseudotumoral lesions. Although occurring more frequently in the brain and meninges, they can occasionally involve the spinal cord. A case of paracoccidioidomycosis in the cervical spinal cord is reported in this paper. Difficulties in establishing the etiologic diagnosis, the importance of radiologic examination of the thorax, and the treatment of the patient are commented. In an extensive review of the literature on the subject, only three other cases have been found, which are also discussed.

[Playing in hospital: addition to nursing care]

Playing is one of the essential activities for the physical, emotional and social development to the child. Although the recognized importance of this activity, during the hospitalization process it is little value, so it is not find out between the foreseen therapeutic actions that are preview. The goal of this paper is discuss the theory and practice principles to subsidize the utilization of play in the aid to the hospitalization children. The empiric data collection was realized through the participant observation of 11 children who were intern in a pediatric unit of a teaching hospital of State of São Paulo up country. We identify that the act to play has repercussions in the child, nurse and hospital. To the child it is not obstruct the development; help it in the understanding about what is occurring with itself and discharge fear, tension, anxiety and frustration; promote satisfaction, funny and spontaneity and allows it transforms experiences that should support inactive in active discharge. To the nurse it is a tool of intervention and a way of communication, that allows detect the uniqueness of each child. Related to the hospital, change the current view that is only a pain and suffering place.

Reciprocal longitudinal relationship between dental fear and oral health in schoolchildren

BACKGROUND

No longitudinal study has evaluated the mutual relationship between dental fear and oral health in the same investigation.

AIM

To evaluate the reciprocal longitudinal relationship between dental fear and oral health in schoolchildren.

DESIGN

This longitudinal study monitored 416 Brazilian children aged 5-7 years of age at baseline for 2 years. The decayed, filled and missing teeth were clinically assessed for each child. Dental fear was evaluated by Dental Anxiety Question. Multilevel mixed-effects linear and logistic regressions analysed the reciprocal relationship between dental fear and oral health.

RESULTS

Children with caries experience had 1.8 times higher odds of dental fear compared to children who were caries free. The presence of a carious tooth increased the odds of dental fear by 1.2 times. Children with dental fear had 0.46 additional carious tooth; an additional 0.22 tooth indicated for extraction; and a 0.67 higher caries experience score compared to children without dental fear.

CONCLUSIONS

We observed a reciprocal relationship between dental fear and poor oral health. Both parents and dentists should provide realistic information for the children, discouraging biased negative expectations regarding dental treatment. Ultimately, the child would acquire positive perceptions of the dental environment, reducing their phobia and consequently improving oral health.

[Human gastroenteritis associated with Vibrio parahaemolyticus in Recife, Brazil]

A study was carried out on the occurrence of Vibrio parahaemolyticus in 1,100 diarrheal feces, routinely sent to a private clinical laboratory for microbiologic diagnosis, in Recife. V. parahaemolyticus was isolated from 14 (1.3%) fecal samples. However, if we considered only the specimens from adult patients, the isolation rate of V. parahaemolyticus rose to 7.1%. In most cases (92.86%), V. parahaemolyticus was the only enteropathogen recognized. Among the isolates, seven K antigen serovars were demonstrated, and three were untypable. Only two human isolates, both ureolytic, did not produce the thermostable direct hemolysin. We concluded that V. parahaemolyticus is an important cause of sea food linked diarrhea among adults in Recife.

[The problem of suffering: perception by adolescents with cancer]

Adolescents with cancer undergo suffering resulting from diagnosis, therapy and changes in their routine and family life. The objective of this study was to identify the chief causes of their suffering, identified in interviews with those patients themselves. The study population were 12 adolescents admitted to the Paediatric Clinic of the Ribeirão Preto Medical School Clinical Hospital, University of São Paulo, from the 13th. November, 1997 to 16th. December, 1997. Data were analysed by means of qualitative approach. The chief causes of suffering reported by the studied adolescents were: hospitalization, restrictions in routine activities, aggressive therapy, modification of self-image and fear of dying. The adolescents not only talked about their suffering but also offered some suggestions to lessen it, as for instance, use of central venous catheter, liberation of visiting time, reducing number of hospitalization events, efficient communication and good rapport with the attending team.

Prevalência e fatores associados a indicadores negativos de saúde mental em adolescentes estudantes do ensino médio em Pernambuco, Brasil

OBJETIVOS: identificar a prevalência e fatores associados a indicadores negativos de saúde mental em adolescentes. MÉTODOS: utilizou-se um questionário previamente validado para coletar dados de 4.207 adolescentes (14-19 anos) estudantes do ensino médio, selecionados através de amostragem por conglomerados em dois estágios. RESULTADOS: as prevalências de tristeza, sentimento de solidão, pensamento de suicídio, dificuldade para dormir devido à preocupação e planos de suicídio foram, respectivamente, 29,7%, 15,8%, 11,2%, 10,0% e 7,8%. A prevalência de todos os indicadores foi superior entre as moças, sendo a tristeza o indicador mais prevalente. Identificou-se que a cor da pele não foi um fator associado à ocorrência dos indicadores negativos de saúde mental, enquanto não morar com os pais apresentou associação significativa com sentimento de solidão e pensamento em suicídio. CONCLUSÕES: a prevalência de sentimento de solidão e de tristeza é alta e as moças representam um subgrupo de maior risco em relação a todos os indicadores negativos de saúde mental.

Universal school-based intervention targeting depressive symptoms in adolescents: A cluster randomized trial

We investigated the effects of three different interventions on depressive symptoms in adolescents. As a secondary aim, we explored the mediating role of social isolation, anxiety, sleep quality, and cognitive function of the intervention effect on depressive symptoms. We conducted a cluster randomized controlled trial, in which schools were randomly assigned to 1. Doubling physical education (PE) classes (3:20 h of PE/week); 2. Workshop with the PE teachers; 3. Workshop with the PE teachers + Doubling PE classes; and 4. Control group (1:40 h of PE/week). In total, 1279 adolescents were included, 56.4% females. Doubling PE classes and the workshop with the PE teachers + Doubling PE classes groups did not affect depressive symptoms (-0.947, 95% CI -3.176 to 1.281; and, 0.726, 95% CI -1.558 to 3.009, respectively). The workshop with the PE teachers decreased adolescents' depressive symptoms (-2.495, 95% CI -4.668 to -0.323), social isolation (-4.759, 95% CI -9.025 to -0.493), and poor sleep quality (-0.560, 95% CI -1.108 to -0.012) compared with the control group. Social isolation mediated 32% of the workshop effect on depressive symptoms. The workshop with the PE teachers and the workshop with the PE teachers + Doubling PE classes groups lowered in 93% and in 54% the risk of the adolescents in developing high depressive symptomatology compared with the control group, respectively. A workshop updating PE teachers on pedagogical and health-related topics decreased depressive symptoms in adolescents. Moreover, improvements in the adolescents' social isolation mediated the effect of PE teachers' workshop intervention on the depressive symptoms in adolescents.

Three times as much physical education reduced the risk of children being overweight or obese after 5 years

AIM

We evaluated the effect that increasing physical education lessons from 1.5 to 4.5 hours per week for 5 years had on the body mass index (BMI) and waist circumferences of children aged 5-11 years at inclusion.

METHODS

From 2008 to 2013, six intervention schools in Svendborg, Denmark, delivered 4.5 hours of physical education lessons per week to 750 children. Meanwhile, four matched control schools gave 549 children the standard 1.5 hours of physical education lessons per week. Measurements were taken at baseline and yearly for 5 years. Of the 1299 children, 81 joined the schools after 2008.

RESULTS

At baseline, the percentage of overweight children was 12% in the intervention schools and 13% in the control schools, whereas 15% and 19% were abdominal obese, respectively. After 5 years, the respective risks of remaining abdominal obese or overweight were 43% and 51% in the intervention schools and 78% and 84% in the control schools. Mean BMI increased 0.450 kg/m² more in the control group over the five-year period. The intervention was not effective in decreasing the average waist circumference.

CONCLUSION

Three times as much physical education lessons per week, for 5 years, effectively decreased BMI and the likelihood of remaining overweight or obese.

Reliability of the Baltimore Activity Scale Questionnaire for Intermittent Claudication

We assessed the reliability of the Baltimore Activity Scale for Intermittent Claudication (BASIC) for the evaluation of physical activity levels in individuals with intermittent claudication. We also identify the characteristics of the patients that influence the reliability of this questionnaire. A total of 38 men and women with peripheral artery disease and symptoms of intermittent claudication participated in the study. BASIC was administered to patients by the same evaluator at 2 different visits, separated by 7 days. The concordance coefficient ranged from .43 (How often do you walk at a fast pace?) to .85 (What happens when you feel pain while you walk?). The concordance coefficient of BASIC total score was .60. Higher concordance coefficients were observed in women (.66 vs .55), in younger patients (.63 vs .56), and in patients with lower ankle-brachial index (.64 vs .55). The reliability of BASIC questionnaire ranged from moderate to good in patients with claudication.