Assessment of child's dental anxiety/fear and stress during dental treatment: a systematic review by CEDACORE

Abstract: There is a lack of evidence on the correlation between salivary biomarkers and subjective measures of dental fear and anxiety in children. This systematic review aimed to retrieve the scientific evidence comparing the results of dental anxiety measured by salivary biomarkers with patient-reported outcomes in pediatric dental setting. The PECOS was as follows: population: pediatric patients aged ≤ 18 years; exposure: patient-reported outcome measures, such as scales and/or questionnaires; comparator: salivary biomarkers; outcome: anxiety, fear, phobia or stress during dental treatment; study design: observational studies or controlled trials. Electronic searches were conducted in PubMed, Scopus, Web of Science, and Ovid databases. Studies that compared scales/questionnaires and salivary biomarkers for the evaluation of dental anxiety, fear, and stress in children/adolescents during dental treatment were included. Certainty of evidence was assessed with GRADE. Risk of bias of the included studies was assessed with the Cochrane tool or the University of Adelaide tool. From the 314 studies identified, eight were included. Participants' age ranged from three to 13 years. The most used salivary biomarkers and instruments were cortisol and the Dental Subscale of the Children's Fear Survey Schedule, respectively. Most studies showed a weak correlation between objective and subjective measures. The main issues regarding bias were on allocation concealment, blinding of assessors, follow up, and exposure assessment. Certainty of evidence was low/very low. Evidence of salivary biomarkers and patient-reported outcome measures to investigate anxiety, fear and stress in children during in the dental environment is limited. There was no correlation between subjective and objective measures in almost all included studies.

Patients´ Anxiety Related to Dental Radiographic Examinations: Levels, Perception and Management

ABSTRACT: This study evaluated patients´ anxiety levels related to dental radiographic examinations in addition to dentists' perception and management. Salivary alpha-amylase (sAA) activity of 47 patients was measured before and after exposure to radiographic examinations to assess their anxiety level and compared using Wilcoxon test. Mann-Whitney test assessed the sAA activity related to sex, type of examination, and previous experience with radiographic examinations. 50 dentists were interviewed using a semi-structured script containing open-ended questions perception on their patients' anxiety. Before the radiographic examination, sAA activity was significantly higher for women (p ≤0.05). SAA activity significantly increased after the examination for men, patients of both sexes with no previous experience and for those who underwent CBCT (p≤0.05). Anxiety was reported to be observed in adult patients' speech and pediatric patients' behavior. Dental radiographic examinations may be a source of anxiety for women before the examination. After the examination, men, patients with no previous experience, and those subjected to CBCT present higher anxiety levels. Dentists perceive anxiety in adult and pediatric patients differently.

RESUMEN: Este estudio evaluó los niveles de ansiedad en los pacientes relacionados con exámenes radiográficos dentales, además de la percepción y el manejo de los dentistas. Se midió la actividad de la alfa-amilasa salival (sAA) de 47 pacientes antes y después de la exposición a exámenes radiográficos para evaluar su nivel de ansiedad y se comparó mediante la prueba de Wilcoxon. La prueba de Mann-Whitney evaluó la actividad de la sAA relacionada con el sexo, el tipo de examen y la experiencia previa con exámenes radiográficos. Se entrevistó a 50 dentistas utilizando un guión semiestructurado de preguntas abiertas sobre la percepción de la ansiedad de sus pacientes. Antes del examen radiográfico, la actividad de la sAA era significativamente mayor para las mujeres (p≤0.05). La actividad de SAA aumentó significativamente después del examen para los hombres, pacientes de ambos sexos sin experiencia previa y para los que se sometieron a CBCT (p≤0.05). Se informó que se observa ansiedad en el habla de los pacientes adultos y en el comportamiento de los pacientes pediátricos. Los exámenes radiográficos dentales pueden ser una fuente de ansiedad para las mujeres antes del examen. Tras la exploración, los hombres, los pacientes sin experiencia previa y los sometidos a CBCT presentan niveles de ansiedad más elevados. Los dentistas perciben la ansiedad en los pacientes adultos y pacientes pediátricos de manera diferente.

Association of salivary alpha-amylase with anxiety and stress in nursing professionals / Associação da alfa amilase salivar com a ansiedade e o estresse de profissionais de enfermagem / Asociación de la alfa amilasa salival con la ansiedad y el estrés en profesionales de enfermería

Objective: to assess if changes in salivary alpha-amylase activity are associated with anxiety and stress among hospital nursing professionals and whether anxiety and stress are associated with sociodemographic, epidemiological, and occupational factors. Method: cross-sectional, quantitative study, carried out with 210 nursing professionals from a hospital. For data collection, we used a questionnaire to characterize workers, Beck's Anxiety Inventory, Lipp's Stress Symptoms Inventory for Adults and samples and saliva samples collected in work shifts. The data were analyzed descriptively and inferentially using the software Statistical Package for the Social Science and GraphPad Prism. Results: most professionals experienced stress and anxiety. The variables age group, number of children, use of medication and workload were associated with anxiety; age group, smoking and medication use were associated with stress. An increase in the salivary alpha-amylase activity was observed in the middle of the work shift. Professionals who had stress and anxiety had significant changes in alpha-amylase in the night shift. Conclusion: changes in salivary alpha-amylase were associated with anxiety and stress among nursing professionals, indicating that this enzyme can be a possible biomarker of anxiety and stress in workers.

Objetivo: avaliar se a alteração na atividade da alfa amilase salivar está associada à ansiedade e ao estresse dos profissionais de enfermagem hospitalar e, se a ansiedade e o estresse estão associados aos fatores sociodemográficos, epidemiológicos e laborais. Método: estudo transversal, quantitativo, desenvolvido com 210 profissionais de enfermagem de uma instituição hospitalar. Para a coleta de dados, utilizouse um questionário de caracterização dos trabalhadores, o Inventário de Ansiedade de Beck, o Inventário de Sintomas de Stress para Adultos de Lipp e as amostras de saliva coletadas durante os turnos de trabalho. Os dados foram analisados de forma descritiva e inferencial utilizando os softwares Statistical Package for the Social Science e GraphPad Prism. Resultados: a maioria dos profissionais apresentou estresse e ansiedade. As variáveis faixa etária, quantidade de filhos, uso de medicamentos e carga horária de trabalho estavam associadas à ansiedade; faixa etária, tabagismo e uso de medicamentos estavam associadas ao estresse. Observouse um aumento da atividade da alfa amilase salivar no meio do turno de trabalho. Os profissionais que tinham estresse e ansiedade apresentaram alteração significativa da alfa amilase no turno da noite. Conclusão: as alterações na atividade da alfa amilase estavam associadas à ansiedade e ao estresse dos profissionais de enfermagem, demonstrando que essa enzima pode ser um possível biomarcador de ansiedade e estresse em trabalhadores.

Objetivo: evaluar si la alteración en la actividad de la alfa amilasa salival está asociada a la ansiedad y al estrés de los profesionales de enfermería hospitalaria y, si la ansiedad y el estrés están asociados a factores sociodemográficos, epidemiológicos y laborales. Método: estudio transversal, cuantitativo, desarrollado en 210 profesionales de enfermería, en una institución hospitalaria. Para la recogida de datos, se utilizó un cuestionario de caracterización de los trabajadores, el Inventario de Ansiedad de Beck, el Inventario de Síntomas de Stress para Adultos de Lipp y las muestras de saliva recogidas durante los turnos de trabajo. Los datos fueron analizados de forma descriptiva e inferencial utilizando los softwares Statistical Package for the Social Science y GraphPad Prism. Resultados: la mayoría de los profesionales presentó estrés y ansiedad. Las variables intervalo etario, cantidad de hijos, uso de medicamentos y carga horaria de trabajo estaban asociadas a la ansiedad; el intervalo etario, el tabaquismo y el uso de medicamentos estaban asociados al estrés. Se observó un aumento de la actividad de la alfa amilasa salival en los ambientes de los turnos de trabajo. Los profesionales que tenían estrés y ansiedad presentaron alteración significativa de la alfa amilasa en el turno de la noche. Conclusión: las alteraciones en la actividad de la alfa amilasa estaban asociadas a la ansiedad y al estrés de los profesionales de enfermería, demostrando que esa enzima puede ser un posible biomarcador de ansiedad y estrés en trabajadores.

Actividad hipoglucemiante in vitro de los polisacáridos digeridos de Nostoc sphaericum Vaucher ex Bornet & Flahault (cushuro) / In vitro hypoglycemic activity of polysaccharides digested from Nostoc sphaericum Vaucher ex Bornet & Flahault (cushuro)

Objetivo: Evaluar el potencial inhibitorio de las enzimas α-amilasa y α-glucosidasa, así como la inhibición de la difusión de la glucosa, por los polisacáridos aislados de Nostoc Sphaericum Vaucher ex Bornet & Flahault tratados mediante digestión gastrointestinal simulada a nivel in vitro. Materiales y métodos: Los polisacáridos obtenidos de microalga fueron purificados y tratados mediante digestibilidad gastrointestinal in vitro, con la finalidad de simular su digestión. Se evaluó la actividad hipoglucemiante mediante los métodos de inhibición de la α-glucosidasa, α-amilasa y la difusión de la glucosa de los polisacáridos digeridos, comparados con el medicamento acarbosa. Resultados: Los resultados mostraron que la concentración de 50 mg/mL de polisacáridos digeridos disminuye en un 85,26 % la difusión de la glucosa a nivel in vitro. La concentración inhibitoria (CI50) de la enzima α-glucosidasa fue de 314,23 ± 4,87 mg/mL y la enzima α-amilasa 113,59 ± 3,10 mg/mL. Conclusiones: Los polisacáridos de Nostoc sphaericum tratados mediante digestión gastrointestinal in vitro, mostraron capacidad de inhibir las enzimas α-amilasa, α-glucosidasa y la difusión de glucosa; motivo por el cual la especie sería considerado promisoria para un posible tratamiento coadyuvante de la diabetes tipo 2

Objective: To evaluate the inhibitory potential of the α-amylase and α-glucosidase enzymes, as well as the inhibition of glucose diffusion, using polysaccharides isolated from Nostoc sphaericum Vaucher ex Bornet & Flahault and treated by in vitro simulated gastrointestinal digestion. Materials and methods: The polysaccharides obtained from the microalga were purified and treated through in vitro gastrointestinal digestibility in order to simulate digestion. The hypoglycemic activity was evaluated by methods such as the inhibition of α-glucosidase and α-amylase, and glucose diffusion of the digested polysaccharides, and compared with the medication acarbose. Results: The results showed that the concentration of 50 mg/mL of digested polysaccharides decreases by 85.26 % the spread of in vitro glucose. The inhibitory concentration (IC50) of the α-glucosidase enzyme was 314.23 ± 4.87 mg/mL and that of the α-amylase enzyme was 113.59 ± 3.10 mg/mL. Conclusions: Nostoc sphaericum polysaccharides treated by in vitro gastrointestinal digestion showed the ability to inhibit the α-amylase and α-glucosidase enzymes, and glucose diffusion. Therefore, this species would be considered promising for a possible adjuvant treatment of type 2 diabetes

Existe associação entre α -amilase salivar, escala hospitalar de ansiedade e depressão e autorrelato em estudantes com sintomas de ansiedade? / Is there an association between salivary α -amylase, hospital scale of anxiety and depression and self-report in students with anxiety symptoms?

Objetivo: Verificar se existe associação entre a α-amilase salivar, a escala hospitalar de ansiedade e a depressão e autorrelato de estudantes universitários com sintomas da ansiedade. Métodos: Estudo observacional, realizado com 67 estudantes de uma universidade pública. Para a coleta de dados, foram utilizada a Escala Hospitalar de Ansiedade e Depressão, o autorrelato de ansiedade e a aferição da α-amilase salivar por meio do dispositivo Cocoro Meter®. Os dados foram analisados por meio do teste de qui-quadrado. Resultados: Não houve associação entre α-amilase salivar e a Escala Hospitalar de Ansiedade e Depressão (p=0,51), nem entre a α-amilase salivar e o autor- relato de ansiedade (p=0,51), o que indica que o biomarcador não produz resposta dessas duas variáveis ao mensurar a ansiedade. Conclusão: O biomarcador α-amilase salivar não possui a mesma capacidade em mensurar a ansiedade quando associado com à Escala Hospitalar de Ansiedade de Depressão e ao autorrelato em estudantes universitários com sintomas de ansiedade.

Objective: Verifying if there is an association between the salivary α-amylase biomarker, the hospital scale of anxiety and depression, and a self-report of university students with anxiety symptoms. Methods: An observational study carried out with 67 students from a public university. For the data collection, the Hospital Anxiety and Depression Scale, the self-reported anxiety, and the salivary α-amylase measurement were carried out with the Cocoro Meter® device. The data were analyzed by using the chi-square test. Results: There is no association between salivary α-amylase and the Hospital Anxiety and Depression Scale (p = 0.51), and neither between the salivary α-amylase and the self-reported anxiety (p = 0.51), which indicates that the biomarker does not produce any response of these two variables when measuring anxiety. Conclusion: The salivary α-amylase biomarker does not have the same ability to measure anxiety when associated with the Hospital Anxiety and Depression Scale and with the self-report in university students with anxiety symptoms.

Comparison of clinical characteristics of severe hyperlipidemic pancreatitis and severe acute gallstone pancreatitis / 中华全科医师杂志

Objective To compare the clinical characteristics and the outcomes of severe hyperlipidemic pancreatitis (SHLP) and severe acute gallstone pancreatitis (SAGP).Methods The clinical data of 22 patients with SHLP and 91 patients with SAGP admitted from January 2009 to December 2015 were retrospectively reviewed.The clinical manifestations,laboratory tests,organ dysfunction,medical treatment,complications and outcomes in 30 d after admission were analyzed and compared between two groups of patients.Results There were 16 males and 6 females with a mean age of (60.5 ± 9.1) years in SHLP group;while 32 males and 59 females with a mean age of (54.3 ± 5.4) years in SAGP group.The blood and urine amylase levels in SHLP group were significantly lower than those in SAGP group [(715 ±99) U/L vs.(1 551 ± 107) U/L,t =4.65,P =0.00;(382 ±56) U/L vs.(773 ± 66) U/L,t =4.52,P =0.00,respectively].The incidence of circulation insufficiency,respiratory insufficiency,renal dysfunction,and long-term puhnonary infection in SHAP patients was significantly higher than that in SAGP patients [36 ％ (8/22) vs.14 ％ (13/91),x2 =5.22,P =0.01;41％ (9/22) vs.7 ％ (6/91),x2 =9.46,P =0.01;23％(51/22) vs.5％ (5/91),x2 =4.20,P=0.03;55％(12/22) vs.32％ (29/91),x2 =7.02,P =0.01].Two cases died in the SHLP group and 9 cases died in SAGP group due to critical infection,cardiac events and bleeding.Conclusion Compared to SAGP patients,the blood and urine amylase levels are usually not remarkably high in SHLP patients,and the prevention and management of multi-organ failure and lung infection are more important for SHLP patients.

Salivary stress biomarkers and anxiety symptoms in children with and without temporomandibular disorders

Abstract The etiology of temporomandibular disorders (TMD), which are considered as a heterogeneous group of psychophysiological disturbances, remains a controversial issue in clinical dentistry. This study aimed to evaluate whether the salivary alpha-amylase (sAA), cortisol levels, and anxiety symptoms differ between children with and without TMD. Initially, 316 young subjects were screened in public schools (nonreferred sample); 76 subjects aged 7-14 years were selected and comprised the TMD and control groups with 38 subjects each matched by sex, age, and the presence/absence of sleep bruxism. Four saliva samples were collected: upon waking, 30 min and 1 h after awakening (fasting), and at night (at 8 PM) on 2 alternate days to examine the diurnal profiles of cortisol and sAA. Anxiety symptoms were screened using the Multidimensional Anxiety Scale for Children (MASC-Brazilian version). Shapiro-Wilk test, Student's t-test/Mann-Whitney U test, and correlation tests were used for data analysis. No significant differences were observed in the salivary cortisol area under the curve (AUCG mean ± SD = 90.22 ± 63.36 × 94.21 ± 63.13 µg/dL/min) and sAA AUCG (mean ± SD = 2544.52 ± 2142.00 × 2054.03 ± 1046.89 U/mL/min) between the TMD and control groups, respectively (p > 0.05); however, the clinical groups differed in social anxiety domain (t = 3.759; CI = 2.609, 8.496), separation/panic (t = 2.243; CI = 0.309, 5.217), physical symptoms (U = 433.500), and MASC total score (t = −3.527; CI = −23.062, −6.412), with a power of the test >80% and large effect size (d = 0.80), with no significant correlation between the MASC total score, cortisol, and sAA levels. Although children with TMD scored higher in anxiety symptoms, no difference was observed in the salivary stress biomarkers between children with and without TMD.

Levels of Anxiety and Salivary Alpha-Amylase in Children During Restorative Dental Treatment

Objective: To assess levels of anxiety and salivary alpha-amylase in children and its association with the use of informative or aversive behavioral management techniques during restorative dental procedures. Material and Methods: A cross-sectional study was performed with 69 children aged 4-12 years submitted to restorative dental treatment. The level of anxiety of patients was verified by means of the Modified Venham Picture Test and levels of salivary alpha-amylase were measured before and after the restorative procedure. The behavioral management techniques used during the dental procedure were registered. Associations between variables were analyzed using the chi-square test, considering statistically significant associations with p ≤ 0.05. Results: Salivary alpha-amylase showed high and moderate levels prior to dental procedure in 47 children (68.1%). Variables gender and behavioral management techniques were not associated with anxiety, as measured by VPT and salivary alphaamylase activity. However, younger children showed higher levels of alpha-amylase (p = 0.001). Conclusion: The sample revealed that the visit to the dentist has generated anxiety, manifested by behavioral and physiological changes, especially in children under 72 months; thus, no association between anxiety and the different management techniques was observed.

Correlation Between Salivary Alpha-Amylase Level and Heart Rate Variability in Pediatric Subjects with Sleep-Disordered Breathing

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the relationship between salivary alpha-amylase (sAA) and heart rate variability (HRV) indices in SDB children based on objective parameters of polysomnography (PSG). MATERIALS AND METHOD: This prospective study enrolled 67 children who underwent a physical examination and full-attended in-lab PSG with continuous electrocardiographic signal. The sAA were measured at night before PSG and in the early morning after PSG. RESULTS: The subjects were divided into control [n=26, apnea-hypopnea index (AHI)≤1] and obstructive sleep apnea syndrome (OSAS, n=41, AHI>1) groups; the OSAS group was subdivided into mild (1

Effect of alpha amylase on early childhood caries: a matchedcase-control study / Efeito da alfa-amilase na cárie precoce da infância: estudo caso-controle

Objective: This study was implemented in order to investigate the effect of salivary alpha-amylase level on early childhood caries (ECC). Methods: In this matched case-control study, which was carried out from November 2011 to March 2012 in Hamadan City, the west of Iran, mean levels of salivary alpha-amylase of 84 ECC-active cases were compared to that of 84 ECCfree controls using spectrophotometric method to assay enzyme kinetics. The two groups were matched by oral hygiene (frequency of tooth brushing per day) and food habits (frequency of sugar consumption between servings). Subsequently, a subsample of 28 cases was undergone emergency treatment of dental caries. Alpha amylase level was measured before treatment and 30 to 45 min later. Results: The results indicated an inverse relationship between alpha-amylase level and dental caries. The mean level of salivary alpha-amylase was 28.27 and 42.08 kU/L in cases and controls respectively (P = 0.001). In addition, emergency treatment of dental caries increased the level of salivary alphaamylase significantly from 15.05 kU/L before treatment to 23.94 kU/L thereafter (P = 0.001) although the level of alpha-amylase did not reach the normal level of ECC-free controls. Conclusion: Generally it can be concluded that low levels of alpha-amylase may promote early childhood caries. On the other hand, dental caries may subsequently reduce the level of salivary alpha-amylase. This vicious cycle may promote and then accelerate caries formation among susceptible people with low level of salivary alpha-amylase.

Objetivo: Este estudo foi implementado para investigar o efeito do nível de alfa-amilase salivar sobre a cárie precoce da infância (CPI). Métodos: Neste estudo de caso-controle pareado conduzido entre novembro de 2011 e março de 2012, na cidade de Hamadan – oeste do Irã, os níveis médios da alfa-amilase salivar de 84 pacientes apresentando CPI ativa foram comparados ao níveis de 84 pacientes-controle, livres de CPI, utilizando-se método espectrométrico para analisar a cinética enzimática. Os dois grupos foram agrupados de acordo com a higiene oral (frequência de escovação dentária diária) e hábitos de dieta (frequência de consumo de açúcar entre refeições). Posteriormente, uma parcela da amostra, composta de 28 casos, foi submetida ao tratamento de urgência da cárie dentária. O nível de alfa-amilase foi mensurada antes do tratamento e após 30 a 45 minutos. Resultados: Os resultados mostraram relação inversa entre o nível de alfa-amilase e cárie dentária. O nível médio de amilase salivar foi de 28,27 e 42,08 kU/L para os grupos teste e controle, respectivamente (P = 0,001). Adicionalmente, o tratamento de urgência da cárie dentária resultou em aumento significativamente dos níveis de alfa-amilase salivar, de 15,05 kU/L antes do tratamento para 23,94 kU/L após o tratamento (P = 0,001), embora os níveis de alfa-amilase salivar não tenham atingido os níveis normais apresentados pelos controles livres de CPI. Conclusão: Conclui-se que os baixos níveis de alfa-amilase podem produzir a cárie precoce da infância. Por outro lado, a cárie dentária deve reduzir subsequentemente os níveis de alfa-amilase salivar. Este ciclo vicioso deve promover e acelerar a formação de lesões cariosas em pessoas susceptíveis com baixo nível de alfa-amilase salivar.

The application of Reiki in nurses diagnosed with Burnout Syndrome has beneficial effects on concentration of salivary IgA and blood pressure / Uma sessão de Reiki em enfermeiras diagnosticadas com síndrome de Burnout tem efeitos benéficos sobre a concentração de IgA salivar e a pressão arterial / Una sesión de Reiki en enfermeras diagnosticadas con síndrome de Burnout tiene efectos beneficiosos sobre la concentración de IgA salival y la presión arterial

This study aimed to investigate the immediate effects of the secretory immunoglobulin A (sIgA), α-amylase activity and blood pressure levels after the application of a Reiki session in nurses with Burnout Syndrome. A randomized, double-blind, placebo-controlled, crossover design was conducted to compare the immediate effects of Reiki versus control intervention (Hand-off sham intervention) in nurses with Burnout Syndrome. Sample was composed of eighteen nurses (aged 34-56 years) with burnout syndrome. Participants were randomly assigned to receive either a Reiki treatment or a placebo (sham Reiki) treatment, according to the established order in two different days. The ANOVA showed a significant interaction time x intervention for diastolic blood pressure (F=4.92, P=0.04) and sIgA concentration (F=4.71, P=0.04). A Reiki session can produce an immediate and statistically significant improvement in sIgA concentration and diastolic blood pressure in nurses with Burnout Syndrome.

O objetivo deste estudo foi investigar os efeitos imediatos na imunoglobulina A salivar (IgAs), na atividade de α-amilase e na pressão arterial, após uma aplicação de Reiki em enfermeiras que sofrem da síndrome de Burnout. Foi realizado ensaio clínico randomizado duplo-cego e placebo controlado, com desenho cruzado. Dezoito enfermeiras (idade entre 34 e 56 anos), com síndrome de Burnout, participaram do estudo. As participantes receberam tratamento com Reiki ou Reiki falso, de acordo com a ordem estabelecida, através da randomização em dois dias distintos. O teste de Anova mostrou interação significativa entre o momento da intervenção e a pressão arterial diastólica (F=4,92, p=0,04) e os níveis de sIgA (F=4,71, p=0,04). Conclui-se que uma sessão de Reiki de 30 minutos pode melhorar de forma imediata a resposta de IgAs e da pressão arterial diastólica em enfermeiras com síndrome de Burnout.

El objetivo fue investigar los efectos inmediatos en inmunoglobulina A salival (IgAs), actividad de α-amilasa y presión arterial de una aplicación de reiki en enfermeras sufriendo síndrome de Burnout. Se utilizó un ensayo preliminar placebo randomizado con cegamiento doble utilizando un diseño cruzado. Dieciocho enfermeras (edad 34-56) con síndrome de Burnout participaron en el estudio. Las participantes recibieron tratamiento con Reiki o Reiki fingido según el orden establecido por la randomización en dos días distintos. El test de ANOVA mostró un interacción significativa momento intervención para la presión arterial diastólica (F=4.92, P=0.04) a y la concentración de sIgA (F=4.71, P=0.04). Una sesión de Reiki de 30 minutos puede mejorar de manera inmediata la respuesta de IgAs y la presión arterial diastólica en enfermeras con síndrome de Burnout.

Influência do fumo na atividade da amilase salivar e na curva glicêmica / Influence of smoking on salivary amylase activity and glycemic curve

OBJETIVO: Determinar a atividade da amilase salivar e a relação com a glicemia, antes e após a ingestão de carboidratos em fumantes e não fumantes, uma vez que in vitro a exposição da saliva à fumaça do cigarro induz à redução da atividade da amilase salivar e poderia influenciar na absorção dos carboidratos da dieta. MÉTODOS: Foram avaliados voluntários fumantes (n=10) e não fumantes (n=10). Realizou-se coletas da saliva antes e após o fumo e determinou-se a glicemia antes e após a ingestão de 72g de carboidratos. Para glicemia usaram-se tempos de 0, 15, 30, 60, 120 minutos. A determinação da atividade da amilase salivar foi realizada por meio de kits comerciais. A glicemia foi determinada utilizando o aparelho Glicomiter (Accu-Chek-Roche). As análises estatísticas foram realizadas no software Sigmastat, utilizou-se o método Teste t pareado (p<0,05). RESULTADOS: O aumento da glicemia aos 15, 30, 60 e 90 minutos foi de 3,9; 11,9; 34,8 e 22,7 por cento para os não fumantes e 4,9; 6,5; 13,8 e 9,7 por cento para os fumantes, respectivamente. No pico máximo de absorção tem-se uma glicemia de 21,0 por cento maior nos pacientes não fumantes. A atividade da amilase salivar antes e após alimentação apresentou-se 75,0 por cento menor nos indivíduos fumantes. CONCLUSÃO: Estes resultados sugerem que o fumo inibe a amilase e influencia na diminuição da digestão/absorção de carboidratos, consequentemente na concentração de glicose sanguínea, reduzindo assim o aporte energético ingerido.

OBJECTIVE: The objective of this study was to determine salivary amylase activity and its relationship with glycemia before and after smokers and nonsmokers ingested carbohydrates. Since cigarette smoke reduces salivary amylase activity in vitro, it may affect dietary carbohydrate absorption. METHODS: Twenty volunteers participated in this study, 10 smokers and 10 nonsmokers. Samples of saliva were collected before and after the smokers had a cigarette and glycemia was determined before and after the ingestion of 72g of carbohydrates. Glycemia was measured 0, 15, 30, 60 and 120 minutes after carbohydrate intake. Salivary amylase activity was determined by commercial kits. Glycemia was determined by a glucometer (Accu-Chek-Roche). The paired t-test was used for the statistical analyses, done by the software Sigmastat, with p<0.05. RESULTS: Glycemia 15, 30, 60 and 90 minutes after carbohydrate intake rose 3.9 percent, 11.9 percent, 34.8 percent and 22.7 percent in nonsmokers and 4.9 percent, 6.5 percent, 13.8 percent and 9.7 percent in smokers, respectively. The peak glucose absorption in nonsmokers was 21.0 percent greater than in smokers. Salivary amylase activity before and after eating was 75.0 percent smaller in smokers. CONCLUSION: These results suggest that smoking inhibits amylase and has a negative impact on the digestion/absorption of carbohydrates, consequently in blood glucose levels, thereby reducing the amount of energy absorbed.