Oral health knowledge and attitude among healthcare professionals of long-term care units: a cross-sectional survey

BACKGROUND

This study aims to evaluate the knowledge and the attitude in oral health (OH) of nurses (NUR) and auxiliary health technicians (AHT) belonging to the Long-term Care Units (LTC).

METHODS

Observational cross-sectional study. A survey was applied in five MLTC in Porto (Portugal) to 145 healthcare works (HCW). Data were collected using structured questionnaires with questions about knowledge and attitude regarding oral care. Data analysis comparison was performed using non-parametric tests (α = 0.05).

RESULTS

Out of a total of 259 HCW, 145 responses were obtained (55.98% response rate). The median number of correct answers was significantly different for NUR and AHT without oral health training (OHT) (p = .035).AHT with OHT had a significantly lower number of correct answers compared to NUR with OHT (7 vs. 9, p < .001). There was no significant difference in the number of correct answers in NUR with or without OHT (p = .391) and that the AHT without OHT have a median of correct answers significantly higher than those who they have OHT (8 vs. 7, p = .020) CONCLUSIONS: Despite the positive attitude of the HCW, the knowledge is scarce. HCW recognized the urgence to update the protocols.

PRACTICAL IMPLICATIONS

Integrating dentists in the LTC team, implementation of OH protocols and providing OH training should be considered to bridge existing gaps.

Does participation in the European Trauma Course lead to new behaviours and organisational change? A Portuguese experience

BACKGROUND

Medical educational courses can be successful from an immediate feedback perspective but not lead to new behaviour or organisational changes in the workplace. The aim of this study was to assess the self-perceived impact of the European Trauma Course (ETC) on Reanima trainees' behaviour and organisational change.

METHODS

A 40-item questionnaire based on Holton's evaluation model was used to evaluate the candidate's perceptions. The results were analysed with descriptive and inferential statistical analysis using nonparametric tests with α = 0.05.

RESULTS

Out of 295 participants, 126 responded to the survey. Of these, 94% affirmed that the ETC modified their approach to trauma patients, and 71.4% described a change in their behaviour. Postcourse responders changed their behaviour in their initial approach to trauma care in the nontechnical skills of communication, prioritisation and teamwork. Being an ETC instructor strongly influenced the acquisition of new material, and this group was able to implement changes in attitudes. Individuals with no previous trauma course experience identified lack of self-efficacy as a significant obstacle to introducing new work-based learning. In contrast, responders with ATLS training noted a lack of ETC colleagues as the main impediment for moving from conceptualisation to experimentation in the workplace.

CONCLUSIONS

Participation in the ETC led to behavioural changes in the workplace. However, the ability to influence others and bring about wider organisational changes was more difficult to achieve. Major factors were the status of the person, their experience and self-efficacy. National organisational impact was obtained, which went far beyond our aspirations in acknowledging change in individual daily practice. Future research studies will include the effect of implementing the ETC methodology on the outcome of trauma patients.

Prevalence of dental floss use in deciduous dentition: A systematic review and meta-analysis

OBJECTIVES

Adherence to the daily use of dental floss in childhood is recommended by various international health institutions/organizations. This systematic review (PROSPERO number CRD42020205232) aims to evaluate the prevalence of dental floss use in deciduous dentition.

MATERIALS AND METHODS

A systematic review was conducted in six databases (B-on, Cochrane Library, PubMed, Scielo, Science Direct and Web of Science) up to December 2020. The CoCoPop mnemonic allowed for obtaining 2333 articles and resulted in the inclusion of 7 observational studies that evaluated the prevalence of dental floss use (primary outcome) in children up to 6 years old. The Joanna Briggs Institute critical appraisal checklist was used to evaluate the risk of bias, showing that most articles presented good quality. Meta-analyses were performed using the proportion of dental floss use (yes or once/day) and the random effects model.

RESULTS

The meta-analysis showed a prevalence of dental floss use of only 12.60% (95% CI: 7.69%-18.52%) based on studies with high heterogeneity of results (I²  = 94.75%; 95% CI: 91.44%-96.78%). Six of the seven studies showed that more than 70% of children never used dental floss.

CONCLUSIONS

A low prevalence of dental floss use was observed in children up to 6 years old. Given the diversity of evaluating the use of dental floss, different options should be the target of standardization in future studies.

Association between Environmental Cadmium Exposure and Osteoporosis Risk in Postmenopausal Women: A Systematic Review and Meta-Analysis

Osteoporosis is a common and serious health issue among postmenopausal women. We conducted a systematic review and meta-analysis study to determine whether environmental exposure to cadmium (Cd) is a risk factor for postmenopausal osteoporosis. A PROSPERO-registered review of the literature was performed on studies evaluating the relationship between urinary Cd (UCd) concentration, an indicator of long-term Cd exposure, and bone mineral density or osteoporosis in women aged 50 years and older. PubMed, Embase, Science Direct, Web of Science, and B-on databases were searched for articles published between 2008 and 2021. The association between UCd levels and osteoporosis risk was assessed by pooled odds ratio (OR) and 95% confidence interval (CI) using random-effect models. Ten cross-sectional studies were included in the qualitative analysis, of which five were used for meta-analysis. We separately assessed the risk of osteoporosis in women exposed to Cd at low environmental levels (n = 5895; UCd ≥ 0.5 μg/g creatinine versus UCd < 0.5 μg/g creatinine) and high environmental levels (n = 1864; UCd ≥ 5 μg/g creatinine versus UCd < 5 μg/g creatinine). The pooled OR for postmenopausal osteoporosis was 1.95 (95% CI: 1.39−2.73, p < 0.001) in the low exposure level group and 1.99 (95% CI: 1.04−3.82, p = 0.040) in the high exposure level group. This study indicates that environmental Cd exposure, even at low levels, may be a risk factor for osteoporosis in postmenopausal women. Further research based on prospective studies is needed to validate these findings.

Barthel's Index: a better predictor for COVID-19 mortality than comorbidities

Background

The most consistent identified mortality determinants for the new coronavirus 2019 infection (COVID-19) are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous condition. The main goal of our study was to test if activities of daily living (ADL) dependence measured by Barthel's index could be a predictor for COVID-19 mortality.

Methods

Prospective cohort study with a consecutive sample of 340 COVID-19 patients representing patients from all over the Northern region of Portugal from 10/2020 to 03/2021. Mortality risk factors were determined controlling for demographics, activities of daily living (ADL) dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis we used T-Test/Chi-Square/Fisher Exact Test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. Statistical software: IBM®SPSS®27.

Results

The cohort included 340 patients (55.3% females, mean age 80.6±11.0) with a mortality rate of 19.7%. Aging, ADL dependence, pneumonia and dementia were associated with mortality and dyslipidemia and obesity with survival in univariate analysis. In multivariable analysis dyslipidemia (OR=0.35, 95%CI:0.17-0.71) was independently associated with survival. Age ≥ 86-year-old (pooled OR 2.239, 95% CI: 1.100-4.559), pneumonia (pooled OR 3.00, 95% CI: 1.362-6.606), and ADL dependence (pooled OR 6.296, 95% CI: 1.795-22.088) were significantly related to mortality (ROC AUC=82.1% (p<0.0001)).

Conclusion

ADL dependence, aging and pneumonia are the 3 main COVID-19 mortality predictors among an elderly population.

Are oral overuse behaviours associated with painful temporomandibular disorders? A cross-sectional study in Portuguese university students

BACKGROUND

Many different types of oral overuse behaviours occur frequently in adult populations with painful temporomandibular disorders (TMDs). Less is known regarding these behaviours and their associations with TMDs in university students.

OBJECTIVES

Test the association between frequency of different oral overuse behaviours evaluated by the Oral Behaviour Checklist (OBC) and the severity of painful TMDs.

METHODS

In this cross-sectional study, 1381 students from 19 universities in the Oporto District, Portugal, completed the Research Diagnostic Criteria for TMD (RDC/TMD) Personal History Questionnaire and the OBC, and they received an RDC/TMD clinical examination. The OBC sum score (ranging from 0 to 84 points) was classified as normal (0 ≤ 16 points), low overuse (17 ≤ 24) or high overuse (≥25). Painful TMD subtypes (myalgia, arthralgia or combined) were identified. Associations were tested using multivariable binary logistic regression models (α = .05), adjusted for age and sex, and referencing the normal parafunction group.

RESULTS

University students with high overuse were more likely to have a painful TMD: myalgia (OR = 1.9, 95% CL: 1.3-3.0); arthralgia (OR = 2.2; 95% CL: 1.4-3.4), combined (OR = 5.0; 95% CL: 3.1-8.1). Students with low overuse were more likely to have only the combined painful TMD (OR = 2.4; 95% CL: 1.4-4.0) but not the individual painful disorders. Of the 21 different behaviours, 13 were reported at least 50% of the time.

CONCLUSIONS

In this university student sample, oral overuse behaviours are widespread, and their overall extent exhibited a dose-response relationship with respect to severity of painful TMDs based on pain and chronicity. Only some behaviours were independently associated with painful TMDs, suggesting the value of further OBC instrument development.

Dietary Patterns and Oral Health Behaviours Associated with Caries Development from 4 to 7 Years of Age

The association between modifiable risk factors and caries in children has been documented; however, most studies have been cross-sectional and have not considered the complexity of dietary factors and oral health habits. This study aimed to investigate the prospective association between dietary patterns and oral health behaviours at 4 years of age and the development of new decayed, missing, and filled teeth (d_3–6mft/D_3–6MFT) over a period of three years. Participants were children from the Generation XXI population-based birth cohort. At 4 years of age, diet patterns were assessed using a food frequency questionnaire, with three dietary patterns being identified. For the purpose of capturing the new development of caries between 4 and 7 years of age, two dental outcomes were defined in the mixed dentition: “dental caries development” and “severe dental caries development” in the mixed dentition. Bivariate analysis and multivariate logistic regression were used. From 4 to 7 years of age, 51.2% of the children had at least one new d_3–6mft/D_3–6MFT and 27.4% had more than two new d_3–6mft/D_3–6MFT. Children belonging to the “energy-dense foods” (OR = 2.19; 95% CI: 1.20–4.00) and “snacking” (OR = 2.19; 95% CI: 1.41–3.41) dietary patterns at 4 years old were associated with severe dental caries development three years later. Preventive strategies should be implemented in an attempt to reduce snacking and the consumption of energy-dense, micronutrient-poor foods to promote children’s oral health.

DNA-based detection of Mycobacterium avium subsp. paratuberculosis in domestic and municipal water from Porto (Portugal), an area of high IBD prevalence

Mycobacterium avium subsp. paratuberculosis (MAP) may play a role in the pathology of human inflammatory bowel disease (IBD). Previously, we found a high frequency (98% in patients with active disease) of MAP DNA detection in the blood of Portuguese Crohn's Disease patients, suggesting this cohort has high exposure to MAP organisms. Water is an important route for MAP dissemination, in this study we therefore aimed to assess MAP contamination within water sources in Porto area (the residential area of our IBD study cohort). Water and biofilms were collected in a wide variety of locations within the Porto area, including taps connected to domestic water sources and from municipal water distribution systems. Baseline samples were collected in early autumn plus further domestic water samples in early winter, to assess the effect of winter rainfall. DNA was extracted from all 131 samples and IS900-based nested PCR used to assess the frequency of MAP presence. Our results show high MAP positivity in municipal water sources (20.7% of water samples and 41.4% of biofilm samples) and even higher amongst domestic sources (30.8% of water samples and 50% of biofilm samples). MAP positivity in biofilms correlated with positivity in water samples from the same sources. A significantly higher frequency of MAP-positivity was observed during winter rains as compared with samples collected in autumn prior to the winter rainfall period (61.9% versus 30.8%). We conclude that domestic and municipal water sources of Porto region have a high burden of MAP contamination and this prevalence increases with rainfall. We hypothesize that human exposure to MAP from local water supplies is commonplace and represents a major route for MAP transmission and challenge which, if positively linked to disease pathology, may contribute to the observed high prevalence of IBD in Porto district.

Effectiveness of voice therapy in patients with vocal fold nodules: a systematic search and narrative review

BACKGROUND/OBJECTIVE

An adult with vocal fold nodules can suffer from hoarseness, breathiness and vocal fatigue, which, in turn, significantly affects their vocal participation as well as activities. A well-designed voice therapy program improves the quality of life and vocal functionality. This is a narrative review with a systematic search of the current literature about the effectiveness of voice therapy interventions in adults with vocal fold nodules.

METHODS

Several key terms were used for the database electronic search of articles. Strict inclusion criteria were used and a broad evaluation of the studies was performed. This included the level of evidence based on the National Health and Medical Research Council levels of evidence, assessment, and critical appraisal.

RESULTS

Nine out of 30 reviewed articles met the criteria of inclusion and reported positive effects of voice therapy intervention on adult patients with vocal fold nodules. The vast majority of the reviewed studies reported multidimensional voice measures outcome data, most of them containing visual-perceptual, auditory-perceptual, acoustic and self-assessment results. Regardless of receiving direct or indirect or a combination of both voice therapy contents, nearly all voice quality parameters were found to improve after treatment. Short-term treatment (< 3 weeks) may be as beneficial as longer traditional voice therapy programs, and using telepractice voice therapy may be an achievable and practical way of delivering treatment and enhance adherence to therapy. The study design and the evidence levels of the included studies were low (≤ III-2) and the risk of bias of the comparative studies was moderate.

CONCLUSION

This narrative review cannot conclude the general effectiveness of voice therapy programs. Further research and understanding of what specific parameters (exercise and techniques) of a therapy's content will improve voice outcome measures. More studies are required to investigate whether or not voice therapy benefits are sustainable 6 months after ending the therapy. However, improved evidence is required to suggest that short period treatments are as beneficial as traditional therapy programs. Telepractice voice therapy may be an achievable and practical way of delivering treatment and enhance adherence to therapy.

Efficacy of speech language therapy intervention in unilateral vocal fold paralysis - a systematic review and a meta-analysis of visual-perceptual outcome measures

OBJECTIVE

Unilateral vocal folds paralysis is a disorder that affects a patient's quality-of-life by disturbing their phonation, breathing, and swallowing activities. This systematic review aimed to estimate the efficacy of voice treatment on the vocal fold motility in adult patients with unilateral vocal folds paralysis.

METHODS

PubMed, CINAHL, CENTRAL, and Web of Science were searched for retrospective and prospective cohort, case-control, and cross-sectional with comparative studies with adults that were published between 1 January 2008 to 31 December 2018. After applying the inclusion and exclusion criteria a total of 10 studies containing morpho-functional evaluation results were included in the analysis. Pooled data analysis of the motility of the vocal folds before and after voice therapy allowed inferring about the efficacy of voice therapy intervention in patients with unilateral vocal folds paralysis. A random-effect model was used to estimate the effect size. Publication bias was considered.

RESULTS

The pooled data analysis of the visual-perceptual measures revealed that vocal fold motility improved in 72% (95% CI: 64.0-80.0) of all patients after the therapeutic interventions. The inconsistency index (I² = 18.35%) of the studies included in this meta-analysis revealed an extremely low heterogeneity. Funnel plot and Cochran's Q test showed no publication bias. The systematic review was limited to only English language articles.

CONCLUSION

This meta-analysis supports the evidence that voice therapy intervention can have a positive effect on the vocal fold motility, that is, they can improve the glottal gap closure, irrespective of the exercises and techniques used.

Dental tooth decay profile in an institutionalized elder population of Northern Portugal

 Objectives: the purpose of this study was to assess the dental tooth decay profile of an elderly population from Northern Portugal. Material and Methods: this is a descriptive, cross-sectional study where a questionnaire, intended to assess the institutionalized elders oral health condition, was applied with the purpose of quantifying certain oral conditions. Tooth decay was assessed using the DMFT Index for the crown’s tooth and the individual radicular caries index (RCIi) for the root’s condition assessment. Univariate analysis and multivariable logistical regressions were performed (p < 0.05) using the IBM© SPSS© Statistics vs.19.0. Results: three hundred and seventy-two elderly participants were assessed with an average age of 78.8 years, of which 260 were women (69.9%). Of the sample 30.4% had no literacy and 18.3% were dependent on their daily oral hygiene care, 30.9% (95%CI:26.2%-35.6%) were edentulous and 84.9% (95%CI:81.3%-88.5%) had less than 20 teeth. The average number of teeth was 8.9 (±8.7) and the DMFT was 25.6 (± 7.3). The RCIi for men was 44.3% (±  30.4%) and 39.4% (± 31.2%) for women. Using multivariate logistical regression model the outcome RCIi?20% was shown to be significantly and positively associated with the use of removable partial dentures (metal partial dentures: OR=5.348 (95%CI:1.176-24,329; p = 0.030) as well as with daily tooth brushing (no toothbrushing: OR = 2.802 (95%CI:1.445-5.433); p = 0.002). Conclusion: the prevalence of tooth decay in this elder institutionalized population of Northern Portugal is high, mostly due to bad oral hygiene habits associated to the use of metal removable partial dentures. Institutionalized elderly need protocols tailored to their oral health needs and integrated efforts in the institutions are needed to effectively answer the demands related to the elderly cognitive and motor skills (ageing deterioration) decline of physiological functions.KEYWORDSElderly; Oral health; Prosthesis; Root caries.

Detection of Staphylococcus aureus (MRSA/MSSA) in surfaces of dental medicine equipment

Methicillin-Resistant Staphylococcus aureus (MRSA) represents one of the major causes of nosocomial infections, leading to high mortality. Surfaces in clinics, as well as the attending uniform and the hands of the dental doctor can be MRSA reservoirs. Having this in mind, the purpose of this study was to evaluate the presence of Methicillin-Sensitive Staphylococcus aureus (MSSA) and MRSA on dental medicine equipment surfaces. 354 Samples were collected from six equipment surfaces in six attendance areas before and after patient consultation and cultured in a selective medium. Polymerase Chain Reaction (PCR) was used to confirm the identity of bacterial strains as MRSA or MSSA. Data analysis was performed with chi-square tests with Bonferroni correction. It was observed 55.6% of uncontaminated samples. Contamination was: 17.5% MRSA (5.9% of samples collected before patient attendance and 11.6% after); 39.3% MSSA (14.1% collected before and 25.2% after). The prevalence of MRSA and MSSA was significantly higher after patient care. Integrated Clinic represented the most contaminated attendance area (MRSA − 41.7%, MSSA − 51.2%), the chair arm rest was the most contaminated surface for MRSA (29.7%) and the dental spittoon the most contaminated surface for MSSA (23.5%). Although a low level of contamination was observed, dental clinics, through patients possibly carrying bacteria, may be reservoirs for MRSA and MSSA transmission, and might contribute to potential nosocomial infections.

Multi-Mode adhesives performance and success/retention rates in NCCLs restorations: randomised clinical trial one-year report

Aim: Compare clinical performance and success/retention rates of two multi-mode (MM) adhesives, applied in self-etch (SE) or etch-and-rinse (ER) modes, with SE-all-in-one adhesive (SE/SE with enamel etching) in NCCL restorations at one-year follow-up.

Material and methods: Prospective, double-blind RCT approved by the University Fernando Pessoa and the National-Clinical-Research-Ethics Committees (CEIC-20150305), ClinicalTrials.gov registered (NCT02698371), in 38 participants with 210 restorations (AdmiraFusion^®) randomly allocated to six groups (Adhesives_Adhesion mode), each with 35 restorations: G1-Control Futurabond^®DC_SE; G2-Control Futurabond^®DC_SE with enamel etching; G3-Futurabond^®U_ER; G4-Futurabond^®U_SE; G5-Adhese^®Universal_ER; G6-Adhese^®Universal_SE. Restorations evaluated at baseline and one-year by three calibrated examiners (ICC ≥0.952) using FDI criteria and statistical analysis with nonparametric tests (alpha = 0.05).

Results: At one-year recall 36 participants, 199 restorations were available for examination; five (2.5%) restorations (G1 n = 2; G2, G3, G4 n = 1) were lost due to retention (p > .05); G1 showed less satisfying marginal adaptation (p < .05) than G2 and MM adhesives groups, particularly G6. Overall success rates (p > .05) were: 93.9% (G1), 97.0% (G2; G3; G4) and 100.0% (G5; G6).

Conclusions: MM adhesives (Futurabond^®U and Adhese^®Universal) showed similar and acceptable performance/success rates but also better clinical outputs than the SE-all-in-one adhesive (Futurabond^®DC), particularly in SE mode. Success and retention rates were similar and not dependent on materials or adhesion modes.

Cumulative Helicobacter Pylori Eradication Rates by Adopting First- and Second- Line Regimens Proposed by the Maastricht IV Consensus in Obese Patients Undergoing Gastric Bypass Surgery

AIMS AND METHODS

Our aim was to assess, in obese patients undergoing Roux-en-Y gastric bypass (RYGB) surgery, the cumulative Helicobacter pylori (HP) eradication rates by adopting Maastricht IV guidelines in areas of high clarithromycin resistance rates (CLT)-14 days concomitant first-line therapy with proton-pump inhibitor (PPI) bid, CLT 500 mg bid, metronidazole (MTZ) 500 bid, and amoxicillin (AMX) 1000 mg bid and 14 days second-line therapy with PPI bid, AMX 1000 mg bid and levofloxacin (LVF) 500 mg od. Single-center prospective study was over 4 years. Endoscopy and HP assessment (by histology or C13 urea breath test) were performed at baseline and post-treatment HP status was assessed by C13 urea breath test 4-6 weeks after the end of therapy.

RESULTS

Seven hundred seventy-seven consecutive HP-positive patients completed concomitant first-line treatment: 636 (81.9%) female, age 41.1 (± 10.2) years. HP was eradicated in 556 patients-71.56% (95% CI: 68.28-74.62%). In the remaining 221 patients, second-line LVF-based regimens eradicated HP in 121 patients-54.75% (95% CI: 48.16-61.18%). These results give 87.13% (95% CI: 84.58-89.31%) ITT and 89.43% (95% CI: 87.03-91.44%) PP cumulative eradication rates. Eradication rates were not significantly different by gender, age, endoscopy findings, and smoking habits.

CONCLUSIONS

By adopting Maastricht IV consensus quadruple concomitant first-line treatment and second-line LVF-based therapy, high cumulative HP eradication rates are achieved but still leaves around 10.6% of obese patients undergoing RYGB in need of the culture and susceptibility testing prior to third-line treatment.

Oral hygiene of children with cleft lip and palate: Efficacy of the cleft toothbrush - A designed add-on to regular toothbrushes

BACKGROUND

The anatomical and morphological alterations associated with cleft lip and palate (CLP) favour the buildup of dental plaque.

AIM

To assess the efficacy of a new add-on to regular toothbrush-the Cleft Toothbrush, in removing the dental plaque of CLP patients, compared to a regular toothbrush.

DESIGN

Forty-five children with CLP were randomly organized into two groups: A (n = 26, 2-6 years old) and B (n = 19, 7-12 years old). They were evaluated at days 0, 15, 30, and 60. After brushing their teeth with a regular toothbrush or with the Cleft Toothbrush, the dental plaque was recorded using an adapted Plaque Index (aPI). Data analyses were performed in IBM SPSS(c) , and all statistic inference comparisons were made using non-parametric tests.

RESULTS

In the first 15 days, children used a new regular toothbrush and aPI-C (teeth adjacent to the cleft) was recorded. The Cleft Toothbrush, used by all children from day 15 to day 30, showed high efficacy in removing dental plaque in the cleft area, evidenced by significantly lower aPI-C values, compared to those observed with the regular toothbrush (P < 0.001). When given free option of brushing technique, from day 30 to day 60, most of the children (38 out of 45) chose the Cleft Toothbrush.

CONCLUSIONS

The Cleft Toothbrush showed high efficacy in removing dental plaque in the cleft area, and presented high level of acceptance by parents and children, compared to a regular toothbrush. This is expected to improve the health status of the local adjacent tissues, a requirement for their rehabilitation.

Metabolic syndrome in human immunodeficiency virus-infected patients

The objective of this study was to investigate the factors underlying the development of metabolic syndrome (MetS) in HIV-infected patients. Two hundred and sixty-six clinical cases were selected for a retrospective study. The sample was classified using the Adult Treatment Panel III guidelines and the identification of risk or protective factors associated with MetS evaluated via multivariate logistic or multinomial regressions. HIV-infected individuals diagnosed with MetS tend to be older, overweight, or obese (85% have a BMI ≥ 25), with a waist circumference > 90 cm (96.5 [88.8-105.5] cm, median [interquartile range]). Blood testing these individuals revealed high fasting levels of insulin (8.1 [5.8-21.6] pg/ml), glucose (98.0 [84.0-116.0] mg/dl), triglycerides (201.0 [142.0-267.3] mg/dl), and high-density lipoprotein cholesterol (36.5 [29.8-43.3] mg/dl) in addition with higher levels of inflammatory mediators such as high-sensitivity C-reactive protein (2.5 [1.0-4.9] mg/dl) and interleukin-6 (3.4 [2.8-3.8] pg/ml). The likelihood of HIV-infected individuals who are virally suppressed developing MetS is about 60% higher than those with acute infection. Treatment with nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors (PIs) increases the chance of developing MetS by around 2.4 times. Individuals with a lower antioxidant capacity (total antioxidant status [TAS] <1.33) have a 2.6 times higher risk of developing MetS. HIV-related chronic inflammation, a low TAS, and treatment with NRTIs in association with PIs are additional MetS risk factors.

Trends in Singing Voice Research: An Innovative Approach

OBJECTIVES

The objectives of this study were to trace and describe research patterns in singing voice, to compare the amount of published research over time, to identify journals that published most papers on "singing voice," and to establish the most frequent research topics.

MATERIALS AND METHODS

The study uses qualitative and quantitative approaches through descriptive statistics, text mining, and clustering. The authors conducted a search to identify scientific papers. The titles and abstracts were analyzed regarding word frequency and relations between them, through hierarchical cluster analysis and co-occurrence networks. The frequency of journals was calculated, as well as the amount of papers across time.

RESULTS

Since 1949, 754 papers were published and an increase was noticed. Even though 162 journals were identified by the authors, the Journal of Voice holds the majority of papers, in every analyzed period. An evolution of studied topics is described. Up to 2010, the main theme was professional singers, especially classical and opera interpreters. Since then, voice quality and the effects of training gathered more attention.

CONCLUSIONS

The growing interest in singing has been conspicuous since the first indexed paper. However, it has been slightly slowing down. Until 2010, great importance was given to the voice quality of singers and their occupational demands. Acoustic analysis was widely used to study the effects of training. Since 2010, the concern with functionality is increasing, rather than the organic voice structures. Musical perception studies have been a trend, as well as the use of electroglottography.

Coincidence and Awareness of the Relationship Between Temporomandibular Disorders and Jaw Injury, Orthodontic Treatment, and Third Molar Removal in University Students

AIMS

To determine whether there is an association between temporomandibular disorders (TMD) and a history of facial/jaw injury (FJI), orthodontic treatment (OT), or third molar removal (TMR) in university students, and to evaluate the students' awareness of a possible relationship between jaw pain or other TMD symptoms, FJI, OT, and TMR, and the presence of TMD.

METHODS

This cross-sectional study involved 1,381 Oporto District university students. The Portuguese version of the Research Diagnostic Criteria for TMD was used for TMD diagnosis. FJI, OT, and TMR histories were evaluated by questionnaire. Univariate associations between categorical variables were tested by using chi-square tests. Multivariate logistic regression was applied to predict independent factors associated with TMD.

RESULTS

Of the 1,381 students (mean age ± standard deviation [SD]: 21.7 ± 3.9 years), 39.3% had TMD, 23.2% had a history of FJI, 44.5% had undergone OT, and 26.2% had undergone TMR. Univariate analyses showed significant associations between OT and TMD (P = .044) and between TMR and TMD (P = .003). Multivariate regression analyses using FJI, OT, TMR, OT × TMR interaction, sex, and age in the first step showed TMR (Odds Ratio [OR] = 1.30; P = .041), sex (OR = 1.59; P = .001), and age (OR = 1.04; P = .013) as significant. A positive correlation between TMD and awareness of the relationship between jaw pain or TMD symptoms and a history of FJI or OT (P < .001 and P = .002, respectively) was documented.

CONCLUSION

TMR, female sex, and older age were risk factors independently associated with TMD. The results also suggest that patients' awareness of potential risk factors for TMD should be taken into account on an individual basis.

Enamel lesions: Meta-analysis on effect of prophylactic/therapeutic agents in erosive tissue loss

This study aims to perform a meta-analysis on the effect of prophylactic/therapeutic agents in enamel tissue loss due to erosion. A paper search was done on Medline, PubMed, Embase, and Cochrane Library, and 732 papers were identified. The inclusion criteria were very restrictive in order to be able to compare different protocols and methodologies used on those studies. Sixteen papers were eligible, grouped according to the measurement method of enamel tissue loss, and a meta-analysis was done for each type of fluoride- and casein-based agent applied. Standardized mean differences were pooled across studies. There was a significant difference between all the treatment groups and their respective control groups. The highest standardized mean difference on enamel tissue loss (mean; 95% confidence interval) was obtained by stannous fluoride (4.789 μm; 1.968-7.610; P < 0.001), followed by amine fluoride (2.485 μm; 0.746-4.225; P < 0.010), and titanium tetrafluoride (1.787 μm; 1.106-2.469; P < 0.001); the lowest difference was obtained by casein phosphopeptide-amorphous calcium phosphate (0.869 μm; 0.007-1.731; P < 0.050) and sodium fluoride (0.820 μm; 0.417-1.223; P < 0.001). Stannous fluoride as a fluoride-based prophylactic/therapeutic agent allowed the lowest enamel tissue loss in erosive conditions. Standardization among future study protocols will allow better comparison regarding the prophylactic/therapeutic agent with the best clinical efficacy.

Effectiveness of two intracanal dressings in adult Portuguese patients: a qPCR and anaerobic culture assessment

AIM

To quantify bacterial equivalents before and after chemomechanical preparation using 3% sodium hypochlorite (NaOCl) and intracanal dressing with calcium hydroxide paste (Ca(OH)2 ) or 2% Chlorhexidine digluconate gel (CHX) in necrotic pulps associated or not with apical periodontitis and to further compare this quantification with counts of anaerobic microorganisms.

METHODOLOGY

Prospective clinical trial in 69 single-rooted adult teeth (strict inclusion criteria); CHX group: 34; Ca(OH)2 group: 35. Bacteria samples were taken at baseline (S1), after chemomechanical preparation (S2) and after 14 days of intracanal dressing (S3). Bacterial equivalents were assessed by broad-range real-time polymerase chain reaction (qPCR), and live viable bacteria measured with conventional anaerobic culture (CFU/mL). Descriptive/inferential analysis was performed with spss vs. 20.0 (α = 0.05) using the Kruskal-Wallis, Mann-Whitney and chi-squared tests and Spearman's correlation coefficients.

RESULTS

Both groups showed a significant decrease between S1 and S2 (Mann-Whitney U-test; P < 0.001) both in qPCR and in culture. In the Ca(OH)2 -group, no variation was observed between S2 and S3 by qPCR and culture. In contrast, the CHX group showed a significant increase from S2 to S3 by both techniques. The two groups were only significantly different in S3 (Mann-Whitney U-test; P ≤ 0.001), with a worse performance in the CHX group. Again, these results were congruent by both approaches. Data from both approaches correlate reasonably (rS < 0.5).

CONCLUSIONS

Infected root canals contained a high bacterial load, and the chemomechanical root canal preparation reduced bacterial equivalents by 99.1% and anaerobic counts by 98.5%. Intracanal dressings were not efficient at reducing bacterial load, but the 14-day intracanal dressing with Ca(OH)2 performed significantly better than CHX, particularly in cases with apical periodontitis.

Adhesion of Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa onto nanohydroxyapatite as a bone regeneration material

In orthopedics due to the enormous number of surgical procedures involving invasive implant biomaterials, infections have a huge impact in terms of morbidity, mortality, and medical costs. In this study the initial adhesion of several strains namely Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa, to nanohydroxyapatite, previously heat-treated at 725 °C and 1000 °C was assessed. Adherent cells were evaluated by scanning electron microscopy and quantified by confocal laser scanning microscopy and as colony forming units after being released by sonication. The wettability and roughness of samples surfaces were assessed by contact angle measurements and atomic force microscopy, respectively. Nanohydroxyapatite heat-treated at 1000 °C appeared to be more resistant to bacterial adhesion, over time, in five of the six tested strains while the clinical strains isolated from orthopedic infections presented superior ability to adhere, as well as better capacity to produce slime. The increase in materials sintering temperature resulted in increased hydrophobicity and roughness; however, other surface features such as the decrease in surface area and on porosity as well as the decrease on zeta potential may be the aspects that contributed to a lower bacterial adhesion on the materials sintered at 1000 °C.