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de Magalhães Bandeira C, Cascaes AM, Camargo MBJ, Santos IS, de Castilhos ED, Corrêa MB, Matijasevich A, Silva AER. Parental stress and dental caries experience in adolescents: analysis of data from a birth cohort study in Pelotas, Southern Brazil. Eur Arch Paediatr Dent 2023:10.1007/s40368-023-00797-z. [PMID: 37052793 DOI: 10.1007/s40368-023-00797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Analyze the association between parental stress and dental caries experience in adolescents in southern Brazil using data from the Pelotas 2004 Birth Cohort. METHODS Interviews and oral health examinations for the determination of the main exposure and outcome of the study were performed in the homes of the adolescents. The outcome was dental caries experience in the permanent dentition analyzed using the Decayed, Missing and Filling Surfaces (DMFS) index. The main exposure was parental stress measured using the Parenting Stress Index-Short Form administered to the parents of the adolescents. Demographic/socioeconomic characteristics, oral health characteristics and oral health-related quality of life were considered potential confounding factors. Negative binomial regressions estimated mean ratios (MR) and 95% confidence intervals (CI). RESULTS Nine hundred ninety-six adolescents were evaluated at 12 and 13 years of age. The prevalence of dental caries experience in the adolescents was 36.9% (95% CI: 33.8-40.0) and 15.1% (95% CI: 12.8-17.3) of the parents had parental stress. After adjusting for confounding factors, parental stress was associated with a higher mean number of decayed, missing and filling surfaces in the adolescents (MR = 1.10; 95% CI: 1.01-1.26; p = 0.045). CONCLUSION Adolescents of parents with parental stress have more dental caries experience compared to those whose parents do not have parental stress.
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Affiliation(s)
- C de Magalhães Bandeira
- School of Dentistry, Universidade Federal de Pelotas, 457 Gonçalves Chaves Street, 5th Floor, Pelotas, RS, Brazil
| | - A M Cascaes
- Department of Public Health, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - M B J Camargo
- School of Dentistry, Universidade Federal de Pelotas, 457 Gonçalves Chaves Street, 5th Floor, Pelotas, RS, Brazil
| | - I S Santos
- Epidemiology, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - E D de Castilhos
- School of Dentistry, Universidade Federal de Pelotas, 457 Gonçalves Chaves Street, 5th Floor, Pelotas, RS, Brazil
| | - M B Corrêa
- School of Dentistry, Universidade Federal de Pelotas, 457 Gonçalves Chaves Street, 5th Floor, Pelotas, RS, Brazil
| | - A Matijasevich
- Department of Preventive Medicine, Faculty of Medicine, University de São Paulo, São Paulo, SP, Brazil
| | - A E R Silva
- School of Dentistry, Universidade Federal de Pelotas, 457 Gonçalves Chaves Street, 5th Floor, Pelotas, RS, Brazil.
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Mariano RMDS, Gonçalves AAM, de Oliveira DS, Ribeiro HS, Pereira DFS, Santos IS, Lair DF, da Silva AV, Galdino AS, Chávez-Fumagalli MA, da Silveira-Lemos D, Dutra WO, Giunchetti RC. A Review of Major Patents on Potential Malaria Vaccine Targets. Pathogens 2023; 12:pathogens12020247. [PMID: 36839519 PMCID: PMC9959516 DOI: 10.3390/pathogens12020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Malaria is a parasitic infection that is a great public health concern and is responsible for high mortality rates worldwide. Different strategies have been employed to improve disease control, demonstrating the ineffectiveness of controlling vectors, and parasite resistance to antimalarial drugs requires the development of an effective preventive vaccine. There are countless challenges to the development of such a vaccine directly related to the parasite's complex life cycle. After more than four decades of basic research and clinical trials, the World Health Organization (WHO) has recommended the pre-erythrocytic Plasmodium falciparum (RTS, S) malaria vaccine for widespread use among children living in malaria-endemic areas. However, there is a consensus that major improvements are needed to develop a vaccine with a greater epidemiological impact in endemic areas. This review discusses novel strategies for malaria vaccine design taking the target stages within the parasite cycle into account. The design of the multi-component vaccine shows considerable potential, especially as it involves transmission-blocking vaccines (TBVs) that eliminate the parasite's replication towards sporozoite stage parasites during a blood meal of female anopheline mosquitoes. Significant improvements have been made but additional efforts to achieve an efficient vaccine are required to improve control measures. Different strategies have been employed, thus demonstrating the ineffectiveness in controlling vectors, and parasite resistance to antimalarial drugs requires the development of a preventive vaccine. Despite having a vaccine in an advanced stage of development, such as the RTS, S malaria vaccine, the search for an effective vaccine against malaria is far from over. This review discusses novel strategies for malaria vaccine design taking into account the target stages within the parasite's life cycle.
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Affiliation(s)
- Reysla Maria da Silveira Mariano
- Laboratory of Biology of Cell Interactions, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte CEP 31270-901, MG, Brazil
| | - Ana Alice Maia Gonçalves
- Laboratory of Biology of Cell Interactions, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte CEP 31270-901, MG, Brazil
| | - Diana Souza de Oliveira
- Laboratory of Biology of Cell Interactions, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte CEP 31270-901, MG, Brazil
| | - Helen Silva Ribeiro
- Laboratory of Biology of Cell Interactions, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte CEP 31270-901, MG, Brazil
| | - Diogo Fonseca Soares Pereira
- Laboratory of Biology of Cell Interactions, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte CEP 31270-901, MG, Brazil
| | - Ingrid Soares Santos
- Laboratory of Biology of Cell Interactions, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte CEP 31270-901, MG, Brazil
| | - Daniel Ferreira Lair
- Laboratory of Biology of Cell Interactions, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte CEP 31270-901, MG, Brazil
| | - Augusto Ventura da Silva
- Laboratory of Biology of Cell Interactions, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte CEP 31270-901, MG, Brazil
| | - Alexsandro Sobreira Galdino
- Laboratory of Biotechnology of Microorganisms, Federal University of São João Del-Rei, Divinópolis CEP 35501-296, MG, Brazil
| | - Miguel Angel Chávez-Fumagalli
- Computational Biology and Chemistry Research Group, Vicerrectorado de Investigación, Universidad Católica de Santa María, Urb. San José S/N, Arequipa 04000, Peru
| | - Denise da Silveira-Lemos
- Campus Jaraguá, University José of Rosário Vellano, UNIFENAS, Belo Horizonte CEP 31270-901, MG, Brazil
| | - Walderez Ornelas Dutra
- Laboratory of Biology of Cell Interactions, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte CEP 31270-901, MG, Brazil
| | - Rodolfo Cordeiro Giunchetti
- Laboratory of Biology of Cell Interactions, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte CEP 31270-901, MG, Brazil
- Correspondence: or ; Tel.: +55-31-3409-3003
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3
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Suemoto CK, Szlejf C, Santos IS, Brunoni AR, Goulart AC, Bertola L, Bittencourt MS, Viana MC, Barreto SM, Lotufo PA, Bensenor IM. Ideal vascular health and cognitive performance in the Brazilian Longitudinal Study of Adult Health. Eur J Neurol 2020; 28:71-80. [PMID: 32920963 DOI: 10.1111/ene.14532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Most evidence for the association between ideal vascular health (IVH) and cognitive performance comes from high income countries. The aim was to investigate this association in the Brazilian Longitudinal Study of Adult Health. METHODS Cognition was assessed using the word list, verbal fluency and trail making tests. The IVH score included ideal metrics for body mass index, smoking, physical activity, diet, blood pressure, fasting glucose and total cholesterol. Poor, intermediate and optimal health were characterized in those presenting 0-2, 3-4, 5-7 ideal metrics, respectively. To determine the association between IVH score and cognitive performance, linear regression models adjusted for age, sex, education, race, alcohol use, depression and thyroid function were used. RESULTS In 12 271 participants, the mean age was 51.3 ± 8.9 years, 54% were women, 57% White and 53% had poor vascular health. Participants with intermediate (β = 0.064, 95% confidence interval 0.033; 0.096) and optimal health (β = 0.108, 95% confidence interval 0.052; 0.164) had better global cognitive Z-scores. In addition, interactions of IVH score with age, education and race were found, suggesting a better cognitive performance with higher IVH in older adults, Black/Brown participants and those with lower levels of education. CONCLUSION Ideal vascular health was associated with better cognitive performance. Older, Black/Brown and low-educated participants had better cognition in the presence of higher IVH scores.
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Affiliation(s)
| | - C Szlejf
- University of São Paulo, São Paulo, Brazil
| | - I S Santos
- University of São Paulo, São Paulo, Brazil
| | | | | | - L Bertola
- University of São Paulo, São Paulo, Brazil
| | | | - M C Viana
- Federal University of Espirito Santo, Espirito Santo, Brazil
| | - S M Barreto
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - P A Lotufo
- University of São Paulo, São Paulo, Brazil
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Moura BAB, Santos IS, Goulart AC, Schmidt MI, Lotufo PA, Bensenor IM, Baena CP. Neck and waist circumference values according to sex, age, and body-mass index: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ACTA ACUST UNITED AC 2020; 53:e9815. [PMID: 32813851 PMCID: PMC7433850 DOI: 10.1590/1414-431x20209815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/10/2020] [Indexed: 11/22/2022]
Abstract
Body fat distribution predicts cardiovascular events better than body-mass index (BMI). Waist circumference (WC) and neck circumference (NC) are inexpensive anthropometric measurements. We aimed to present the conditional distribution of WC and NC values according to BMI, stratified by age and sex, from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline data. We analyzed 15,085 ELSA-Brasil participants with complete data. We used spline quantile regression models, stratified by sex and age, to estimate the NC and WC quantiles according to BMI. To test a putative association between age and median NC or WC values, we built sex-specific median regression models using both BMI and age as explanatory variables. We present estimated 25th, 50th, 75th, and 90th percentiles for NC and WC values, according to BMI, age, and sex. Predicted interquartile intervals for NC values varied from 1.6 to 3.8 cm and, for WC values, from 5.1 to 10.3 cm. Median NC was not associated with age in men (P=0.11) nor in women (P=0.79). However, median WC increased with advancing age in both sexes (P<0.001 for both). There was significant dispersion in WC and NC values for a given BMI and age strata for both men and women. WC, but not NC values, were associated with increasing age. The smaller influence of advancing age on the relationship between BMI and NC (compared to WC) values may be useful in longitudinal studies.
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Affiliation(s)
- B A B Moura
- Escola de Medicina, Programa de Pós Graduação em Ciências da Saúde, Pontifícia Universidade Católica Paraná, Curitiba, PR, Brasil
| | - I S Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M I Schmidt
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - P A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I M Bensenor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C P Baena
- Escola de Medicina, Programa de Pós Graduação em Ciências da Saúde, Pontifícia Universidade Católica Paraná, Curitiba, PR, Brasil
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5
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Brunoni AR, Szlejf C, Suemoto CK, Santos IS, Goulart AC, Viana MC, Koyanagi A, Barreto SM, Moreno AB, Carvalho AF, Lange S, Griep RH, Lotufo PA, Benseñor IM. Association between ideal cardiovascular health and depression incidence: a longitudinal analysis of ELSA-Brasil. Acta Psychiatr Scand 2019; 140:552-562. [PMID: 31587258 DOI: 10.1111/acps.13109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We investigated whether ideal cardiovascular health (ICH), a metric proposed by the American Heart Association, predicts depression development. METHODS Cohort analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Adults with no current depression and other common mental disorders, cardiovascular diseases, and antidepressant drug use at baseline had their ICH (composite score of smoking, dietary habits, body mass index, blood pressure, fasting glucose, cholesterol, and physical activity) assessed and classified into poor, intermediate, and optimal. Depression was assessed using the Clinical Interview Schedule-Revised (CIS-R). Poisson regression models, adjusted for sociodemographic factors and alcohol consumption, were employed. Stratified analyses were performed for age and sex. RESULTS We included 9214 participants (mean age 52 ± 9 years, 48.6% women). Overall depression incidence at 3.8-year follow-up was 1.5%. Intermediate and poor ICH significantly increased the risk rate (RR) of developing depression (2.48 [95%CI 1.06-5.78] and 3 [1.28-7.03], respectively) at a 3.8-year follow-up. Higher ICH scores decreased the rate of depression development (RR = 0.84 [0.73-0.96] per metric). Stratified analyses were significant for women and adults < 55 years old. CONCLUSIONS Poor cardiovascular health tripled depression risk at follow-up in otherwise healthy adults. Ameliorating cardiovascular health might decrease depression risk development.
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Affiliation(s)
- A R Brunoni
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - C Szlejf
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - C K Suemoto
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - I S Santos
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - A C Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - M C Viana
- Center of Psychiatric Epidemiology (CEPEP), Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil
| | - A Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,ICREA, Barcelona, Spain
| | - S M Barreto
- School of Medicine & Clinical Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - A B Moreno
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - A F Carvalho
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| | - S Lange
- Institute for Mental Health Policy Research, Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| | - R H Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - P A Lotufo
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - I M Benseñor
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
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6
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Santos-Neto PJ, Sena-Santos EH, Meireles DP, Santos IS, Bensenor IM, Lotufo PA. Reproducibility of carotid ultrasound measurements in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) at baseline. ACTA ACUST UNITED AC 2019; 52:e8711. [PMID: 31389494 PMCID: PMC6686272 DOI: 10.1590/1414-431x20198711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/04/2019] [Indexed: 11/22/2022]
Abstract
Carotid artery assessment by ultrasound is a non-invasive evaluation of subclinical atherosclerosis and a predictor of cardiovascular events. However, ultrasound examinations are operator-dependent. In the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), ultrasound images have been acquired from more than 10,000 participants. In this article, we describe the reproducibility of carotid intima-media thickness (CIMT), carotid plaque detection, and carotid plaque score (defined as the number of arterial sites with plaques) using ELSA-Brasil protocol, in a subset of 118 participants. Two board-certified radiologists and a trained technician read carotid images. We calculated intra- and inter-observer intraclass correlation (ICC) for CIMT values. We also present kappa coefficients for plaque detection and weighted kappa coefficients for carotid plaque score. Participants were aged 58.2±6.6 years, and 60 (50.8%) were men. For common carotid artery CIMT measurements, intra- and inter-observer ICC values were very good to excellent, ranging from 0.90 (95% confidence interval [95%CI]: 0.72–0.95) to 0.98 (95%CI: 0.97–0.99). For carotid plaque, intra- (0.96 [95%CI: 0.96–0.96]) and inter- (0.99 [95%CI: 0.99–0.99]) observer weighted kappa coefficients were very good. Intra- and inter-observer Kappa coefficients for the presence of plaques by site were good to very good, ranging from 0.69 to 1.00. In conclusion, we found very good reproducibility for carotid plaque score and CIMT measurements in the ELSA-Brasil at baseline. These results are comparable to the best findings from similar large cohorts that analyzed carotid ultrasound data.
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Affiliation(s)
- P J Santos-Neto
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E H Sena-Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - D P Meireles
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I S Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I M Bensenor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Departamento de Clínica Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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7
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de Miranda ÉJFP, Hoshi RA, Bittencourt MS, Goulart AC, Santos IS, Brunoni AR, Diniz MFHS, Ribeiro ALP, Dantas EM, Mill JG, Lotufo PA, Benseñor IM. Relationship between heart rate variability and subclinical thyroid disorders of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ACTA ACUST UNITED AC 2018; 51:e7704. [PMID: 30156596 PMCID: PMC6118047 DOI: 10.1590/1414-431x20187704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/05/2018] [Indexed: 01/07/2023]
Abstract
The association between subclinical thyroid dysfunctions and autonomic modulation changes has been described by many studies with conflicting results. We aimed to analyze the association between subclinical hyperthyroidism (SCHyper), subclinical hypothyroidism (SCHypo), and heart rate variability (HRV) using the baseline from ELSA-Brasil. SCHyper and SCHypo were classified by use of medication to treat thyroid disorders, thyrotropin levels respectively above and under the reference range, and normal free thyroxine levels. For HRV, the participants underwent 10 min in supine position and the R-R intervals of the final 5 min were selected for analysis. We first used linear regression models to report crude data and then, multivariate adjustment for sociodemographic (age, sex, and race) and cardiovascular risk factors (hypertension, dyslipidemia, diabetes, smoking, body mass index, use of alcohol, and leisure physical activity) using the euthyroid group as reference. From 9270 subjects (median age, 50; interquartile range: 44–56), 8623 (93.0%) were classified as euthyroid, 136 (1.5%) as SCHyper, and 511 (5.5%) as SCHypo. Compared to euthyroid subjects, SCHyper participants presented significantly higher heart rate (68.8 vs 66.5 for euthyroidism, P=0.007) and shorter R-R intervals (871.4 vs 901.6, P=0.007). Although SCHyper was associated with lower standard deviation of NN interval (SDNN) (β: –0.070; 95% confidence interval (95%CI): –0.014 to –0.009) and low-frequency (LF) (β: –0.242, 95%CI: –0.426 to –0.058) compared to the euthyroid group, these differences lost significance after multivariate adjustment for confounders. No significant differences were found for HRV in SCHypo. No association was found between HRV and SCHyper or SCHypo compared to euthyroid subjects in this sample of apparently healthy subjects.
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Affiliation(s)
- É J F Peixoto de Miranda
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R A Hoshi
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S Bittencourt
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A C Goulart
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I S Santos
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A R Brunoni
- Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - M F H S Diniz
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - A L P Ribeiro
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - E M Dantas
- Colegiado de Ciências Biológicas, Universidade Federal do Vale do São Francisco, Petrolina, PE, Brasil
| | - J G Mill
- Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, Vitória, ES, Brasil
| | - P A Lotufo
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I M Benseñor
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
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8
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de Miranda EJFP, Bittencourt MS, Staniak HL, Sharovsky R, Pereira AC, Foppa M, Santos IS, Lotufo PA, Benseñor IM. Thyrotropin and free thyroxine levels and coronary artery disease: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). ACTA ACUST UNITED AC 2018; 51:e7196. [PMID: 29561960 PMCID: PMC5875905 DOI: 10.1590/1414-431x20177196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/19/2017] [Indexed: 01/07/2023]
Abstract
Data on the association between subclinical thyroid dysfunction and coronary artery disease (CAD) is scarce. We aimed to analyze the association between thyroid function and CAD using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We included subjects with normal thyroid function (0.4-4.0 mIU/L, and normal free thyroxine, FT4, or 0.8 to 1.9 ng/dL), subclinical hypothyroidism (SCHypo; TSH>4.0 mIU/L and normal FT4), and subclinical hyperthyroidism (SCHyper; TSH<0.4 mIU/L and normal FT4) evaluated by coronary computed tomography angiography. We excluded individuals using medications that interfere in thyroid function or with past medical history of cardiovascular disease. Logistic regression models evaluated the presence of CAD, segment involvement score (SIS) >4, and segment severity score (SSS) >4 of coronary arteries as the dependent variables, and quintiles of TSH and FT4 as the independent variables, adjusted for demographical data and cardiovascular risk factors. We included 767 subjects, median age 58 years (IQR=55-63), 378 (49.3%) women, 697 euthyroid (90.9%), 57 (7.4%) with SCHypo, and 13 (1.7%) with SCHyper. No association between TSH and FT4 quintiles and CAD prevalence was noted. Similarly, no association between TSH levels and the extent or severity of CAD, represented by SIS>4 and SSS>4 were seen. Restricting analysis to euthyroid subjects did not alter the results. TSH levels were not significantly associated with the presence, extent, or severity of CAD in a middle-aged healthy population.
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Affiliation(s)
- E J F Peixoto de Miranda
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S Bittencourt
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - H L Staniak
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R Sharovsky
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A C Pereira
- Laboratório de Genética, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M Foppa
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - I S Santos
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P A Lotufo
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I M Benseñor
- Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
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Miotti LL, Santos IS, Nicoloso GF, Pozzobon RT, Susin AH, Durand LB. The Use of Resin Composite Layering Technique to Mask Discolored Background: A CIELAB/CIEDE2000 Analysis. Oper Dent 2017; 42:165-174. [DOI: 10.2341/15-368-l] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
The purpose of this study was to evaluate the ability of three resin composite systems to mask a severely discolored background by the application of a layering technique through CIELAB and CIEDE2000 analysis. Ninety 1.5-mm-thick disc specimens were produced from three different resin composite restoration systems: IPS Empress Direct (Ivoclar Vivadent), Charisma Diamond (Heraeus Kulzer), and Filtek Z350 XT (3M-ESPE). The specimens were divided into groups according to the restoration system and the resin composite shade combination used for the layering technique (enamel, body, and dentin shades). Color measurements were performed by a reflectance spectrophotometer (SP60, EX-Rite) against a C4 shade background and an inherent color background, which simulates a severely discolored background and a tooth surface with no discoloration, respectively. The total color difference between both color measurements was calculated by CIELAB (ΔE*ab) and CIEDE2000 (ΔE00) formulas. The mean ΔEab* and ΔE00 values were analyzed by analysis of variance (general linear models) and Tukey's post hoc tests (α=0.05). Three groups presented clinically acceptable color difference values (ΔE*≦3.46 and ΔE00≦2.25): 1.5 mm dentin, 1.0 mm dentin/0.5 mm body, and 1.0 mm dentin/0.5 mm enamel; ie, all the groups from the Z350 XT restoration system. The resin composite layering technique is an effective way to mask severely discolored backgrounds. The Filtek Z350 XT system was the only restoration system capable of masking the C4 background.
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Affiliation(s)
- LL Miotti
- Leonardo Lamberti Miotti, DDS, MS, Federal University of Santa Maria, Restorative Dentistry, Santa Maria, Brazil
| | - IS Santos
- Iuri Silveira dos Santos, DDS, MS, Federal University of Santa Maria, Restorative Dentistry, Santa Maria, Brazil
| | - GF Nicoloso
- Gabriel Ferreira Nicoloso, DDS, MS, Federal University of Santa Maria, Restorative Dentistry, Santa Maria, Brazil
| | - RT Pozzobon
- Roselaine Teresinha Pozzobon, DDS, MS, PhD, Federal University of Santa Maria, Restorative Dentistry, Santa Maria, Brazil
| | - AH Susin
- Alexandre H Susin, PhD, Federal University of Santa Maria, Restorative Dentistry, Santa Maria, Brazil
| | - LB Durand
- Leticia B Durand (Letícia Brandão Durand), Dr, Federal University of Santa Maria, Restorative Dentistry, Santa Maria, Brazil
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Peixoto de Miranda ÉJF, Bittencourt MS, Pereira AC, Goulart AC, Santos IS, Lotufo PA, Bensenor IM. Subclinical hypothyroidism is associated with higher carotid intima-media thickness in cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Nutr Metab Cardiovasc Dis 2016; 26:915-921. [PMID: 27389191 DOI: 10.1016/j.numecd.2016.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Although subclinical hypothyroidism (SCH) is associated with cardiovascular risk, there is scarce data about subclinical atherosclerosis in subjects with SCH. We aimed to analyze the association between SCH and carotid intima-media thickness (IMT) using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS AND RESULTS We included subjects with normal thyroid function (TSH: 0.4-4.0 mIU/l, and normal free thyroxine (FT4): 0.8-1.9 ng/dl) and SCH (TSH ≥ 4.0 mIU/l and normal FT4) evaluated for IMT in a cross-sectional analysis. We excluded individuals using medications that affect thyroid function and those with a history of cardiovascular disease. We performed logistic and linear regression models to evaluate the association with IMT (mean values and categorized at the 75th percentile) as a dependent variable and SCH as an independent variable, adjusted for other cardiovascular risk factors. From 8623 subjects (median age of 50 years; interquartile range: 44-57), 4624 (53.6%) were women, 8095 (93.9%) were euthyroid, and 528 (6.1%) had SCH. Groups varied in age, body mass index, Framingham risk score, Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), C-reactive protein, as well as, IMT, that were all higher in SCH compared to euthyroid participants. SCH is associated with IMT as a continuous variable (β = 0.010, P = 0.036) and IMT >75th percentile: OR = 1.30 (95% CI = 1.06-1.59) in logistic models. CONCLUSION Individuals with SCH presented higher IMT compared with euthyroid subjects, even after adjustment for potential confounders. IMT was independently associated with SCH in the baseline of the ELSA-Brasil study.
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Affiliation(s)
- É J F Peixoto de Miranda
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - M S Bittencourt
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - A C Pereira
- Laboratório de Genética, Instituto do Coração, Av. Dr. Enéas de Carvalho Aguiar, 4 Bloco 2, 10° andar, ZIP: 05403-000 São Paulo, SP, Brazil
| | - A C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - I S Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - P A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - I M Bensenor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
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11
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Baena CP, Lotufo PA, Santos IS, Goulart AC, Bittencourt MS, Duncan BB, Liu S, Benseñor IM. Neck circumference is associated with carotid intimal-media thickness but not with coronary artery calcium: Results from The ELSA-Brasil. Nutr Metab Cardiovasc Dis 2016; 26:216-222. [PMID: 26874907 DOI: 10.1016/j.numecd.2016.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS It is uncertain whether neck circumference can be a risk indicator for subclinical atherosclerosis. We aimed to investigate their relationships measured by coronary artery calcium (CAC) and common carotid intima-media thickness (cc-IMT) with neck circumference in ELSA-Brasil. METHODS AND RESULTS In cross-sectional and sex-specific analyses of 2266 women (50.6 ± 8.4 yrs) and 1886 men (50.7 ± 9.0 yrs) with both cc-IMT and CAC, free from previous cardiovascular disease at baseline, we built logistic models using diverse cut-off points for CAC score (0 vs > 0, < 100 vs ≥ 100, < 400 vs ≥ 400 Agatston units) and cc-IMT (< 75 th percentile vs ≥ 75 th; <90th percentile vs ≥ 90 th) as dependent variables, after which adjustments for age and traditional cardiovascular risk factors were made. Mean neck circumference was 33.6 (± 2.4 cm) for women and 38.8 (± 2.6 cm) for men. In fully adjusted models including sociodemographic, cardiovascular risk factors and body-mass index and waist circumference, for each 1 standard deviation increase in neck circumference we found an odds ratio (OR, 95% CI) for IMT above the 75th percentile of (1.52, 1.16; 1.99) for women and (1.66, 1.28; 2.14) for men, and above the 90th cc-IMT percentile [1.66 (1.19; 2.32) for men but not for women [1.21 (0.80; 1.82)]. We found no association between neck circumference and CAC using different cut-off points (p > 0.05 for all). CONCLUSION Neck circumference was significantly and independently associated with cc-IMT but not with CAC in women and men, indicating a possible effect of perivascular fat tissue on atherosclerosis.
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Affiliation(s)
- C P Baena
- Center for Clinical and Epidemiologic Research, Hospital Universitario, São Paulo, Brazil; School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - P A Lotufo
- Center for Clinical and Epidemiologic Research, Hospital Universitario, São Paulo, Brazil; School of Medicine, University of São Paulo, São Paulo, Brazil
| | - I S Santos
- Center for Clinical and Epidemiologic Research, Hospital Universitario, São Paulo, Brazil; School of Medicine, University of São Paulo, São Paulo, Brazil
| | - A C Goulart
- Center for Clinical and Epidemiologic Research, Hospital Universitario, São Paulo, Brazil
| | - M S Bittencourt
- Center for Clinical and Epidemiologic Research, Hospital Universitario, São Paulo, Brazil
| | - B B Duncan
- Postgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - S Liu
- School of Public Health, Brown University, Providence, RD, USA
| | - I M Benseñor
- Center for Clinical and Epidemiologic Research, Hospital Universitario, São Paulo, Brazil; School of Medicine, University of São Paulo, São Paulo, Brazil
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Santos LP, Ong KK, Day F, Wells JCK, Matijasevich A, Santos IS, Victora CG, Barros AJD. Body shape and size in 6-year old children: assessment by three-dimensional photonic scanning. Int J Obes (Lond) 2016; 40:1012-7. [PMID: 26880232 PMCID: PMC4899819 DOI: 10.1038/ijo.2016.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/11/2015] [Accepted: 12/22/2015] [Indexed: 02/06/2023]
Abstract
Background: Body shape and size are typically described using measures such as body mass index (BMI) and waist circumference, which predict disease risks in adults. However, this approach may underestimate the true variability in childhood body shape and size. Objective: To use a comprehensive three-dimensional photonic scan approach to describe variation in childhood body shape and size. Subjects/Methods: At age 6 years, 3350 children from the population-based 2004 Pelotas birth cohort study were assessed by three-dimensional photonic scanner, traditional anthropometry and dual X-ray absorptiometry. Principal component analysis (PCA) was performed on height and 24 photonic scan variables (circumferences, lengths/widths, volumes and surface areas). Results: PCA identified four independent components of children's body shape and size, which we termed: Corpulence, Central:peripheral ratio, Height and arm lengths, and Shoulder diameter. Corpulence showed strong correlations with traditional anthropometric and body composition measures (r>0.90 with weight, BMI, waist circumference and fat mass; r>0.70 with height, lean mass and bone mass); in contrast, the other three components showed weak or moderate correlations with those measures (all r<0.45). There was no sex difference in Corpulence, but boys had higher Central:peripheral ratio, Height and arm lengths and Shoulder diameter values than girls. Furthermore, children with low birth weight had lower Corpulence and Height and arm lengths but higher Central:peripheral ratio and Shoulder diameter than other children. Children from high socio-economic position (SEP) families had higher Corpulence and Height and arm lengths than other children. Finally, white children had higher Corpulence and Central:peripheral ratio than mixed or black children. Conclusions: Comprehensive assessment by three-dimensional photonic scanning identified components of childhood body shape and size not captured by traditional anthropometry or body composition measures. Differences in these novel components by sex, birth weight, SEP and skin colour may indicate their potential relevance to disease risks.
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Affiliation(s)
- L P Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - K K Ong
- Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - F Day
- Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - J C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - A Matijasevich
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - I S Santos
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - C G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - A J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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13
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Castillo H, Santos IS, Matijasevich A. Maternal pre-pregnancy BMI, gestational weight gain and breastfeeding. Eur J Clin Nutr 2016; 70:431-6. [PMID: 26813940 PMCID: PMC4827014 DOI: 10.1038/ejcn.2015.232] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES The aims were to investigate the association of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with breastfeeding (BF) duration and BF pattern at 3 months of age. SUBJECTS/METHODS This was a prospective cohort study of 4231 children who were enrolled at birth and were followed-up at 3, 12, 24 and 48 months of age to gather information on maternal and offspring characteristics including BF patterns and BF duration. Maternal pre-pregnancy BMI was categorized according to the WHO classification and GWG according to the 2009 Institute of Medicine recommendations. Cox's proportional hazards model was used to assess whether pre-pregnancy BMI and GWG were associated with BF and exclusive breastfeeding (EBF) duration. Predicted probabilities of BF patterns at 3 months were estimated by multinomial logistic regression. RESULTS Information on BF was available to 4011 infants. The total BF and EBF median durations were 7.0 months and 1.5 months, respectively. There were no differences in duration of any BF or EBF according to pre-pregnancy BMI or GWG categories. There was an increased predicted probability for weaning before the age of 3 months among infants from obese women, compared with those from mothers with normal pre-pregnancy BMI, with margins adjusted predictions of 0.36 (95% confidence interval (CI) 0.31-0.41) and 0.23 (95% CI 0.21-0.25), respectively. CONCLUSIONS Infants from pre-pregnancy overweight/obese mothers presented higher probability of early weaning compared with infants from normal-weight mothers. Obese/overweight pregnant women need supplementary guidance about BF benefits to infant health during prenatal and postnatal care.
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Affiliation(s)
- H Castillo
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - I S Santos
- Department of Social Medicine, Postgraduate Program in Epidemiology, School of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - A Matijasevich
- Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
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Abstract
Brain-derived neurotrophic factor (BDNF) is associated with neuroplasticity and
synaptic strength, and is decreased in conditions associated with chronic stress.
Nevertheless, BDNF has not yet been investigated in psoriasis, a chronic inflammatory
systemic disease that is exacerbated by stress. Therefore, our aim was to determine
BDNF plasma levels in psoriasis patients and healthy controls. Adult patients (n=94)
presenting with psoriasis for at least 1 year were enrolled, and age- and
gender-matched with healthy controls (n=307) from the Brazilian Longitudinal Study of
Adult Health (ELSA-Brasil). Participants had neither a previous history of coronary
artery disease nor current episode of major depression. BDNF plasma levels were
determined using the Promega ELISA kit. A general linear model was used to compare
BDNF levels in psoriasis patients and controls, with age, gender, systolic blood
pressure, serum fasting glucose, blood lipid levels, triglycerides, smoking status,
and body mass index examined. After adjusting for clinical and demographic variables,
significantly decreased BNDF plasma levels were observed in psoriasis patients
(P=0.01) (estimated marginal means of 3922 pg/mL; 95%CI=2660-5135) compared with
controls (5788 pg/mL; 95%CI=5185-6442). Similar BDNF levels were found in both mild
and severe cases of psoriasis. Our finding, that BDNF is decreased in psoriasis,
supports the concept of a brain-skin connection in psoriasis. Further studies should
determine if BDNF is increased after specific psoriasis treatments, and associated
with different disease stages.
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Affiliation(s)
- A R Brunoni
- Centro de Pesquisa Clínica e Epidemiológica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C Sabbag
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I S Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I M Benseñor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
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Brunoni AR, Santos IS, Sabbag C, Lotufo PA, Benseñor IM. Psoriasis severity and hypothalamic-pituitary-adrenal axis function: results from the CALIPSO study. ACTA ACUST UNITED AC 2014. [PMID: 25387679 PMCID: PMC4244678 DOI: 10.1590/1414-431x20143762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Psoriasis is a chronic inflammatory disease that significantly impacts life quality, being associated with stress and mental disorders. We investigated whether the activity of the hypothalamic-pituitary-adrenal (HPA) axis was associated with psoriasis severity, daily life stress and anxiety, and depressive symptoms. In this ancillary study, which was part of the CALIPSO (coronary artery calcium in psoriasis) study, saliva was collected from 102 patients with psoriasis immediately upon awakening, 30, and 60 min after awakening, at 2:00 pm and at bedtime (five time points) to determine salivary cortisol levels. We used Pearson's correlation coefficient to evaluate the association of clinical and psychopathological variables with HPA activity. We found a direct correlation between bedtime cortisol and psoriasis severity evaluated by the psoriasis area severity index (PASI; r=0.39, P<0.001). No correlations between other clinical and psychopathological variables or with other cortisol assessments were observed. The findings indicated that HPA dysfunction may be present in psoriasis, as bedtime cortisol was correlated with psoriasis severity. Our study is limited by the lack of a control group; therefore, we were not able to explore whether these cortisol values were different compared with a concurrent, healthy sample.
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Affiliation(s)
- A R Brunoni
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I S Santos
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C Sabbag
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I M Benseñor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil
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Boeira GF, Correa MB, Peres KG, Peres MA, Santos IS, Matijasevich A, Barros AJD, Demarco FF. Caries is the main cause for dental pain in childhood: findings from a birth cohort. Caries Res 2012; 46:488-95. [PMID: 22813889 DOI: 10.1159/000339491] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/27/2012] [Indexed: 11/19/2022] Open
Abstract
AIM The aim of the study was to evaluate the prevalence of dental pain in preschool children and its association with socioeconomic, demographic, clinical, and behavior variables. SUBJECTS AND METHODS The study was nested in a population-based birth cohort from Pelotas, Brazil, started in 2004. A sample of 1,129 children aged 5 years was dentally examined, and their mothers were interviewed. Exploratory variables included demographics, socioeconomic status, mothers' oral health status and associated behaviors, and caries in primary teeth. Data were analyzed using multivariable Poisson regression. RESULTS The prevalence of dental pain was 16.5% (95% CI: 14.4-18.8). Multivariate analysis showed that dark-skinned children (prevalence ratio, PR = 1.6, 95% CI: 1.1-2.4) from low socioeconomic level (PR 1.9, 1.2-3.0) whose mothers had less than 4 years of education (PR 1.9, 1.0-3.6), from mothers with less than 10 teeth in at least one arch (PR 1.7, 1.2-2.5) and less than 10 in two arches (PR 1.6, 1.0-2.6), and those with high caries prevalence at the age of 5 years (PR 4.8, 3.3-7.1) were more likely to experience dental pain. CONCLUSIONS Unrestored caries is the main factor associated with dental pain in childhood. Socioeconomic aspects and family context in which dental pain occurs should also be taken into account when dental pain preventive measures are implemented.
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Affiliation(s)
- G F Boeira
- Postgraduate Programs in Dentistry, Federal University of Pelotas, Pelotas, Brazil
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Santos IS, Benseñor IM, Machado JBA, Fedeli LMG, Lotufo PA. Intervention to reduce C-reactive protein determination requests for acute infections at an emergency department. Emerg Med J 2012; 29:965-8. [PMID: 22307925 DOI: 10.1136/emermed-2011-200787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION C-reactive protein (CRP) levels rise during inflammatory processes and have been ordered for rheumatic disease follow-up since the 1950s. The number of tests ordered in the emergency setting has increased, but without evident improvement in medical care quality. OBJECTIVE To determine the pattern of CRP determinations in the emergency department (ED) of a university hospital in Sao Paulo, Brazil, and to evaluate the effect of an intervention with staff and students about the best use of the test in the ED. METHODS Data regarding CRP testing requests, related diagnoses and the number of monthly consultations in the hospital ED were analysed before and after the intervention. Because of an increase in CRP measurement requests from 2007 to 2009, the author started discussing the role of CRP determinations in the medical decision-making process in early 2010. Staff and faculty members openly discussed the pattern of requests in the hospital and related current medical literature. During 2010, the medical staff worked as multipliers to change the behaviour of new students and residents. The results of the first 4 months after the intervention were presented at another general meeting in July 2010. RESULTS From 2007 to 2009, there were 11,786 CRP measurement requests with a clear exponential trend. After the intervention, during the calendar year 2010, there was a 48% reduction in adjusted annual CRP requests. Pneumonia, fever and urinary tract infections were the most common reasons for CRP requests. DISCUSSION Inexpensive, well-directed, interactive educational interventions may affect professional behaviour and curb rates of laboratory tests.
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Affiliation(s)
- I S Santos
- University of São Paulo Medical School, Internal Medicine Department, São Paulo, Brazil.
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Matijasevich A, Victora CG, Lawlor DA, Golding J, Menezes AMB, Araújo CL, Barros AJD, Santos IS, Barros FC, Smith GD. Association of socioeconomic position with maternal pregnancy and infant health outcomes in birth cohort studies from Brazil and the UK. J Epidemiol Community Health 2012; 66:127-35. [PMID: 20628081 PMCID: PMC3245894 DOI: 10.1136/jech.2010.108605] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Socioeconomic inequalities in health outcomes are dynamic and vary over time. Differences between countries can provide useful insights into the causes of health inequalities. The study aims to compare the associations between two measures of socioeconomic position (SEP)-maternal education and family income-and maternal and infant health outcomes between ALSPAC and Pelotas cohorts. METHODS Birth cohort studies were started in Avon, UK, in 1991 (ALSPAC) and in the city of Pelotas, Brazil, in 1982, 1993 and 2004. Maternal outcomes included smoking during pregnancy, caesarean section and delivery not attended by a doctor. Infant outcomes were preterm birth, intra-uterine growth restriction (IUGR) and breast feeding for <3 months. The relative index of inequality was used for each measure of SEP so that results were comparable between cohorts. RESULTS An inverse association (higher prevalence among the poorest and less educated) was observed for almost all outcomes, with the exception of caesarean sections where a positive association was found. Stronger income-related inequalities for smoking and education-related inequalities for breast feeding were found in the ALSPAC study. However, greater inequalities in caesarean section and education-related inequalities in preterm birth were observed in the Pelotas cohorts. CONCLUSIONS Mothers and infants have more adverse health outcomes if they are from poorer and less well-educated socioeconomic backgrounds in both Brazil and the UK. However, our findings demonstrate the dynamic nature of the association between SEP and health outcomes. Examining differential socioeconomic patterning of maternal and infant health outcomes might help understanding of mechanisms underlying such inequalities.
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Affiliation(s)
- A Matijasevich
- Rua Marechal Deodoro, 1160-3rd floor, CEP 96020-220, Pelotas, RS, Brazil.
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Menezes AMB, Hallal PC, Matijasevich AM, Barros AJD, Horta BL, Araujo CLP, Gigante DP, Santos IS, Minten G, Domingues MR, Dumith SC, Barros FC. Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil. Clin Exp Allergy 2010; 41:218-23. [PMID: 20840395 PMCID: PMC3505367 DOI: 10.1111/j.1365-2222.2010.03611.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background There is evidence from two meta-analyses that children born through caesarean section (C-section) may have an increased risk of developing asthma compared with those born through vaginal delivery. Objective To evaluate the association between mode of delivery and wheezing (current and persistent) in childhood and adolescence, in two birth cohort studies in Brazil. Methods The outcome variable was based on the International Study of Allergy and Asthma questionnaire, which collects information about wheezing within the 12 months before the interview. Persistent wheezing was defined when it was present in more than one follow-up at different ages, in the 1993 cohort. The questions were asked to mothers when children were aged 4 years (1993 and 2004 cohorts) and directly to cohort participants at 11 and 15 years (1993 cohort). Mode of delivery was collected by the research team of each cohort when children were born. Results Response rates in the last follow-up visit of the 1993 and 2004 cohorts were 85% and 92%, respectively. The prevalence of current wheezing increased from 20% to 28% at 4 years from 1993 to 2004; at 11 and 15 years, the prevalence was around 14% and 12%, in the 1993 cohort. The proportion of C-sections increased from 30.5% to 45% between 1993 and 2004. In each cohort, the prevalence of current wheezing was similar among children born through vaginal and C-section. The risk for persistent wheezing in the 1993 cohort was higher among girls born through C-section than boys. Conclusion Despite the increase in the proportion of C-section in two cohorts in Southern Brazil, we found no evidence of an association between mode of delivery and the subsequent risk of wheezing. Among girls, although there was no statistical significance, the risk was higher for those born by C-section, especially regarding persistent wheezing.
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Affiliation(s)
- A M B Menezes
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
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Meireles SS, Santos IS, Bona AD, Demarco FF. A double-blind randomized clinical trial of two carbamide peroxide tooth bleaching agents: 2-year follow-up. J Dent 2010; 38:956-63. [PMID: 20709137 DOI: 10.1016/j.jdent.2010.08.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 05/27/2010] [Accepted: 08/07/2010] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This double-blind randomized clinical trial aimed to evaluate the whitening effect of two at-home tooth bleaching agents and the effect of dietary habits after 2 years. The patients' view about bleaching longevity was also investigated. METHODS Ninety-two subjects with mean shade of C1 or darker for the six maxillary anterior teeth were randomized into two groups (n=46) according to the carbamide peroxide (CP) concentration: 10% (CP10) or 16% (CP16). The treatment was performed using the whitening agent in a tray for 2h/day during 3 weeks. Shade evaluations were done with a shade guide and a spectrophotometer at baseline, 1-month, 6-month, 1-year and 2-year post-bleaching. RESULTS Eighty-one (88%) of the original 92 subjects enrolled in the study were recalled at 2-year follow-up and, the tooth shade remained significantly lighter than at baseline, in both treatment groups, considering the tooth shade median values (p<0.001) or the color parameters: L*a* (p<0.001) for CP10 and, L*b* for CP16 group (p<0.001). Subjects from CP10 and CP16 reported a consumption of beverage and food stains as high as at 6-month and 1-year recalls and, more than 66% of the participants from each group reported a tooth shade relapse from mild to moderate (p=0.6). SIGNIFICANCE At 2-year post-bleaching, tooth shade remained lighter than at baseline for both CP concentrations tested. Tooth shade relapse associated to increasing of a* and b* color parameters were observed for both groups when compared to the end of the treatment (CEP # 37/05).
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Affiliation(s)
- S S Meireles
- Department of Operative Dentistry, Federal University of Paraíba, João Pessoa, PB, Brazil
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Meireles SS, Heckmann SS, Santos IS, Della Bona A, Demarco FF. A double blind randomized clinical trial of at-home tooth bleaching using two carbamide peroxide concentrations: 6-month follow-up. J Dent 2008; 36:878-84. [PMID: 18722039 DOI: 10.1016/j.jdent.2008.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 07/03/2008] [Accepted: 07/08/2008] [Indexed: 11/15/2022] Open
Affiliation(s)
- S S Meireles
- Department of Operative Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
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Boeing M, Paiva LDC, Garcias GDL, Roth MDG, Santos IS. [Epidemiology of polydactylies: a case-control study in the population of Pelotas-RS]. J Pediatr (Rio J) 2001; 77:148-52. [PMID: 14647607 DOI: 10.2223/jped.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE: To identify and compare cases of isolated polydactyly with healthy newborns regarding familial and maternal characteristics. METHODS: We conducted this hospital-based case-control study from 1990 to 1998. We collected data in interviews with mothers of cases and controls during the post-delivery period. Cases were defined as newborns presenting an extra or a bifid digit in hands and/or feet. Controls were the four healthy newborns that were born after the case, at the same hospital. Information was gathered on type of polydactyly, gender and birthweight, twin pregnancy, parental consanguinity, ethnicity. RESULTS: African ancestry and positive family history of congenital malformation, especially polydactyly, were significantly associated with the occurrence of this type of congenital anomaly (crude OR of 3.3; 10.0; and 55.0, respectively). CONCLUSION: Isolated polydactyly was one of the most frequent malformations found in the studied population. The findings associated with black African ancestry confirm the data presented in the literature. Studies conducted on this same population, with a larger population of patients with this type of malformation, could investigate this association better and justify the results presented here.
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Affiliation(s)
- M Boeing
- Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil
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Abstract
With the aim of describing the structure and process by which prenatal care is provided at the primary health care level in the city of Pelotas in southern Brazil, a descriptive cross-sectional study was conducted. All 31 urban health care facilities were visited and their structure analyzed. A total of 839 prenatal records from mothers who delivered in the six months prior to the beginning of the study were reviewed. The structure as a whole was classified as poor (only 70% of standard parameters were present), mainly due to deficiencies in the physical plant. Process assessment showed low coverage (53%) and an average of 5.3 visits. Only 37% of patient records showed adequate results (Kessner Index). Adding laboratory test results and routine procedures as complementary criteria, 31% and 5% of the records scored as adequate, respectively. In summary, overall quality of prenatal care provided at the primary health care level in Pelotas is poor. Mechanisms to increase staff adherence to both procedures and program logistics need to be developed.
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Affiliation(s)
- D S Silveira
- Secretaria Municipal de Saúde e Bem-Estar de Pelotas, Pelotas, RS, 96010-150, Brasil
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Abstract
OBJECTIVE To describe the prenatal care delivered to a representative sample of mothers, identifying the health care facility they attended and to explore the reasons that led them to choose that specific health facility. METHOD A cross-sectional study was conducted at four maternity hospitals in Pelotas, in Southern Brazil, from March to April 1997. A total of 401 mothers were interviewed at the hospital, immediately after delivery. RESULTS The majority of mothers (51%) were followed up at a primary health care facility (PHCF). The main reported reason for choosing a PHCF was its geographic accessibility (46.8%). For 85% of the mothers, the nearest health service was a PHCF. However, 52.2% of them did not attend the consultations at this setting mainly because of a supposed low quality care (37.4%). Except for immunization with tetanus toxoids, all other usual prenatal care procedures recommended by the local health ministry, including promotion of breastfeeding, were performed less frequently at the PHCF than in other health care settings. CONCLUSION Given the high coverage of the public prenatal care program, efforts should be made to improve the quality of care delivered to pregnant women, mainly by encouraging health professionals, especially doctors, to follow the established guidelines.
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Affiliation(s)
- I S Santos
- Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Pelotas, RS, Brasil.
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Abstract
Eyeblink classical conditioning is a widely used associative learning paradigm that has striking behavioral and neurobiological parallels between humans and other mammals. Eyeblink conditioning is impaired in older organisms, and patients with Alzheimer's disease (AD) are impaired beyond the normal aging deficit. The cholinergic system is of demonstrated involvement in eyeblink conditioning. Blockade of nicotinic cholinergic receptors with mecamylamine prolonged acquisition of conditioned responses (CRs) in young adult rabbits, and the nicotinic agonist, GTS-21 ameliorated conditioning deficits in older rabbits. Galantamine induces allosteric modulation of nicotinic cholinergic receptors to increase acetylcholine release as well as acting as an acetylcholinesterase inhibitor. Galantamine doses of 0.0, 1.0, 2.0, 3.0, and 4.0 mg/kg were tested in ten daily sessions in 40 retired breeder rabbits (mean age = 29 months) in the 750 ms delay conditioning paradigm. A dose of 3 mg/kg galantamine was effective in improving conditioning in older rabbits, enabling them to achieve learning criterion rapidly and to produce a very high percentage of CRs. Control tests of rabbits in explicitly unpaired conditions demonstrated that non-associative factors could not account for the results. The efficacy of galantamine in a learning paradigm that shows severe impairment in AD indicates that the drug may be effective as a cognition-enhancer in AD.
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Affiliation(s)
- D S Woodruff-Pak
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA.
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Abstract
The purpose of this article was to investigate the effect of personal awareness and attitudes, the dentist's role, oral hygiene habits, and fluoride use on total absence of caries in adults, using a case-control study, matched for sex and age with undergraduate students from two private Brazilian universities. Crude analysis using conditional logistic regression failed to show any effect for the related variables regarding fluoride use and oral hygiene habits (p > 0.20). Use of dental floss was the only exception in this set. It appeared as a risk factor, since individuals who stated not flossing presented a crude odds ratio (OR) of 0.70, or 0.73 when adjusted for regular visits to the dentist. The effect for regular visits to the dentist was that of a risk. Those with a history of caries presented a crude odds ratio of 1.55; after adjusting for dental floss use, the risk was slightly higher (OR = 1.67). Oral hygiene habits, contrary to the formulated hypothesis, did not display the expected protective effect. Likewise, fluoride use was not significantly associated with absence of caries. Individuals with a history of caries were used to visiting more professionals, confirming the formulated hypothesis for this variable. Nevertheless, it is still intriguing that some people fail to develop caries, even they report not practicing measures considered ideal for oral health.
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Affiliation(s)
- P C Petry
- Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2492, Porto Alegre, RS 90035-003, Brasil
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César JA, Victora CG, Barros FC, Santos IS, Flores JA. Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study. BMJ 1999; 318:1316-20. [PMID: 10323815 PMCID: PMC27869 DOI: 10.1136/bmj.318.7194.1316] [Citation(s) in RCA: 165] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether breast feeding protects infants against pneumonia and whether the protection varies with age. DESIGN Nested case-control study. SETTING Pelotas, southern Brazil. SUBJECTS Cases were 152 infants aged 28-364 days who had been admitted to hospital for pneumonia. Controls were 2391 cases in a population based case-control study. MAIN OUTCOME MEASURE Odds ratio of admission for pneumonia according to type of milk consumed (breast milk alone, breast and formula milk, or formula milk and other fluids only), use of fluid supplements apart from formula milk, and use of solid supplements. RESULTS Infants who were not being breast fed were 17 times more likely than those being breast fed without formula milk to be admitted to hospital for pneumonia (95% confidence interval 7.7 to 36.0). This relative risk was 61 (19.0 to 195.5) for children under 3 months old, decreasing to 10 (2.8 to 36. 2) thereafter. Supplementation with solids was associated with a relative risk of 13.4 (7.6 to 23.5) for all infants and 175 (21.8 to 1405.1) for those under 3 months old. CONCLUSION Breast feeding protects young children against pneumonia, especially in the first months of life. These results may be used for targeting intervention campaigns at the most vulnerable age groups.
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Affiliation(s)
- J A César
- Departamento Materno Infantil, Fundação Universidade do Rio Grande, Rio Grande do Sol, Brazil
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Abstract
Epidemiological publications on the relationship of caffeine to birth weight and duration of human pregnancy, from 1966 to 1995, were searched through Medline. Each study was treated as the stratification variable, and its weight average was proportional to the inverse of its variance. Twenty-six studies were located. Among the twenty-two studies on birth weight, eleven were on mean birth weight, nine on low birth weight (LBW), and four on intrauterine growth retardation (IUGR). Combined analysis of mean birth weight study results showed a significant decrease in birth weight of nearly 43g among newborns of the heaviest caffeine-consuming mothers. LBW, IUGR, and preterm delivery displayed significant homogeneity in the test results, indicating that a pooled estimate should not be taken as na adequate measure. The high heterogeneity of the available literature on the effects of caffeine on LBW, IUGR, and preterm delivery prevents estimation of reliable pooled estimates through meta-analysis. Further assessment of caffeine intake during pregnancy is needed in future research.
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Affiliation(s)
- I S Santos
- Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Caixa Postal 464, Pelotas, RS, 96001-970, Brasil
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Abstract
The authors conducted a matched case-control study to investigate the effects of caffeine intake during pregnancy on birth weight. From January to November 1992, in the first 24 hours after delivery, 1,205 mothers (401 cases and 804 controls) were interviewed and their newborns were examined to assess birth weight and gestational age by means of the method of Capurro et al. (J Pediatr 1978;93:120-2). The cases were children with birth weight < 2,500 g and gestational age > or = 28 weeks. Cases and controls were matched for time of birth and hospital of delivery and were recruited from the four maternity hospitals in Pelotas, southern Brazil. Daily maternal caffeine intake during pregnancy for each trimester was estimated. To assess caffeine intake, 10% of the mothers were reinterviewed at their households and samples of reported information on drip coffee and maté (a caffeine-containing drink widely used in South America) were collected and sent to the laboratory for caffeine determination through liquid chromatography. When instant coffee was reported, the weight of powder was measured using a portable scale, and caffeine intake was estimated from a reference table. Caffeine intake from tea, chocolate, soft drinks, and medicines was estimated from a reference table. Analyses were performed by conditional logistic regression. Crude analyses showed no effect of caffeine on low birth weight, preterm births or intrauterine growth retardation. The results did not change after allowing for confounders.
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Affiliation(s)
- I S Santos
- Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Brazil
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César JA, Victora CG, Santos IS, Barros FC, Albernaz EP, Oliveira LM, Flores JA, Horta BL, Weiderpass E, Halpern R. [Hospitalization due to pneumonia: the influence of socioeconomic and pregnancy factors in a cohort of children in Southern Brazil]. Rev Saude Publica 1997; 31:53-61. [PMID: 9430926 DOI: 10.1590/s0034-89101997000100008] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the influence of socioeconomic and gestational factors on admission due to pneumonia in the post-neonatal period. METHODOLOGY Cohort. Children born in the city Pelotas, Brazil, in 1993. Cases were children admitted to hospital for 24 hours or more, between the ages of 28 and 364 days, with a diagnosis of pneumonia. RESULTS Of the 5,304 children in the cohort, 152 (2.9%) were hospitalized with pneumonia. The positive predictive value of the clinical diagnosis compared to the radiological assessment was 76%. Analysis by conditional logistic regression showed that social class and maternal schooling were strongly inversely associated with pneumonia Children of adolescent mothers were twice as likely to be admitted. The relative risk for children whose mothers were of parity three or greater was 2.8 relative to primiparae. Maternal weight gain during pregnancy of less than 10 kg was associated with a 40% increase in risk. CONCLUSION Socioeconomic factors were important determinants of pneumonia admissions. Maternal age, parity and weight gain were also significant risk factors.
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Affiliation(s)
- J A César
- Departamento Materno-Infantil, Universidade do Rio Grande, Brasil. jura@vetorial net.com.br
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