Sleep hygiene measures combined with mindfulness meditation in the management of sleep bruxism in children: A randomized controlled clinical trial.

BACKGROUND: Sleep hygiene measures and meditation may reduce stress and improve sleep quality, but their effect on the occurrence of sleep bruxism in children has not yet been investigated. AIM: To explore the effects of sleep hygiene measures combined with mindfulness meditation (relaxation audio) in the management of probable sleep bruxism (SB) in children. DESIGN: This clinical trial (no. NCT04501237) randomized 36 children with 3-8 years of age. Probable SB detection was performed according to the criteria established by the International Consensus on The Assessment of Bruxism-2018. Intervention group was instructed to practice sleep hygiene measures and mindfulness meditation (i.e., the use of a digital app to broadcast audio relaxation) each night before bedtime for 5 weeks; control group did not receive guidance for therapies. Parents completed a bruxism diary for 5 weeks, and the outcome was the number of SB episodes-day reported in the week (ranging from 0 to 7) in each period. A multilevel mixed-effects Poisson regression model was performed. RESULTS: A total of 32 children (mean age: 6.1 years) completed the study. The children who received the therapies related to sleep hygiene measures and mindfulness meditation had a reduction in the SB incidence rate ratio (IRR) of 46% (IRR = 0.54 [Confidence Interval 95%, 0.45-0.65]) during a 5-week observation period. The sensitivity analyses did not show relevant changes in the measure of the effect. CONCLUSION: Sleep hygiene measures combined with mindfulness meditation reduced the SB in children.

Daily screen time, sleep pattern, and probable sleep bruxism in children: A cross-sectional study.

OBJECTIVE: This study aimed to evaluate the prevalence of probable sleep bruxism (SB) in children aged 7-8 years and its association with sleep pattern and the time spent using devices with a screen. MATERIAL AND METHODS: A cross-sectional study was conducted with children from Pelotas, Brazil (n = 556). Parents/caregivers were interviewed and provided demographic/socioeconomic information, children's daily screen time, nighttime tooth grinding or clenching, sleep duration and answered the Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K-sleep domain). Probable SB was determined based on a positive clinical inspection with/without a positive parental/caregiver's reports of tooth clenching or grinding. Hierarchical Poisson regression was performed. RESULTS: The prevalence of probable SB was 15.83% (n = 88). There was no difference in the probable SB prevalence according to the daily screen time (p = 0.744), and low family socioeconomic status was associated with higher SB prevalence (Prevalence Ratio [PR] = 1.95; 95% Confidence Interval [95% CI]: 1.21-3.17; p = 0.006). Higher scores in the sleep domain of the BRIAN-K scale were associated with probable SB [PR = 1.07; 95% CI: 1.01-1.30; p = 0.013]. CONCLUSIONS: Difficulties in maintaining sleep and low family socioeconomic status were associated with probable SB in schoolchildren, while screen time spent using devices with a screen was not associated.

Empowering fisherwomen leaders helped reduce the effects of the COVID-19 pandemic on fishing communities: Insights from Brazil.

Small-scale fishers in the developing world have been particularly affected by the COVID-19 pandemic given that they belong to one of the most socioeconomically vulnerable groups. In Brazil, one of the countries most affected by the pandemic, it was expected early on that the economy and wellbeing of fishers would be negatively impacted, yet fishers were expected to show some adaptive and coping mechanisms. To assess whether this was the case, 40 fishers, who are also leaders of fishing associations representing over 80 thousand fishers throughout the country, were interviewed. Results revealed that female leaders appraised the economic and health / wellbeing impacts to be harsher on fishers than men did. Moreover, fishers on the coast were found to be better able to adapt than those inland, although both had low levels of adaptive capacity. The nature of coping and adaptive mechanisms was also found to be different between locations. Whereas leaders from coastal associations stated that most of the adaptive responses occurred in the post-harvest sector (e.g., changes to the types of sales and changes to supply chain actors), leaders from inland communities stated that the changes that occurred related specifically to fishing (e.g., decrease in effort and changes in fishing grounds). These findings suggest that: 1) women may be better prepared to respond to COVID-19 because their appraisal may be more realistic than men, 2) the historic vulnerability of fishing communities may limit their adaptative capacity, and 3) coastal fishers have likely found ways to maintain part of their trade, contrary to inland fishers. Thus, to better help small-scale fisheries to cope with this particular pandemic or other large disruptive impacts, it would be recommended to invest in women in leadership roles while also guaranteeing that fishers have the minimal conditions to cope with and adapt to impacts. The latter can be done by assuring emergency cash transfers for the duration of the impact, as with the still ongoing pandemic, and investing in building fisher resilience for future shocks.

Study of serum and urinary markers of the reninangiotensin-aldosterone system in myelomeningocele patients with renal injury detected by DMSA

ABSTRACT Introduction: The Renin-Angiotensin-Aldosterone System (RAAS) has been suggested as a possible marker of renal injury in chronic diseases. This study proposes to analyze the serum and urinary markers of the RAAS in myelomeningocele patients with renal function abnormalities detected on DMSA. Material and Methods: Seventeen patients followed in our institution that presented with renal injury on DMSA. We review nephrologic and urologic clinical aspects and evaluated ultrassonagraphy, voiding urethrocystography and urodynamics. Urinary and serum samples were collected to evaluate possible correlations of renal lesions with RAAS. Control group urine and serum samples were also sent for analysis. Results: Serum ACE 2 activity means in relation to urodynamic findings were the only values that had a statistically significant difference (p = 0.040). Patients with normal bladder pattern presented higher ACE 2 levels than the high risk group. Statistical analysis showed that the study group (SG) had a significantly higher mean serum ACE than the CG. The means of ACE 2 and urinary ACE of the SG and CG were not statistically different. The ROC curve for serum ACE values had a statistically significant area for case and non-case differentiation, with 100% sensitivity and 53% specificity for values above 60.2 mg/dL. No statistically significant areas were observed in relation to ACE 2 and urinary ACE values between SG and CG. Conclusion: The analysis of serum ACE, ACE 2 and urinary ACE were not significant in patients with myelomeningocele and neurogenic bladder with renal injury previously detected by renal DMSA.

Study of serum and urinary markers of the renin-angiotensin-aldosterone system in myelomeningocele patients with renal injury detected by DMSA.

INTRODUCTION: The Renin-Angiotensin-Aldosterone System (RAAS) has been suggested as a possible marker of renal injury in chronic diseases. This study proposes to analyze the serum and urinary markers of the RAAS in myelomeningocele patients with renal function abnormalities detected on DMSA. MATERIAL AND METHODS: Seventeen patients followed in our institution that presented with renal injury on DMSA. We review nephrologic and urologic clinical aspects and evaluated ultrassonagraphy, voiding urethrocystography and urodynamics. Urinary and serum samples were collected to evaluate possible correlations of renal lesions with RAAS. Control group urine and serum samples were also sent for analysis. RESULTS: Serum ACE 2 activity means in relation to urodynamic findings were the only values that had a statistically significant difference (p = 0.040). Patients with normal bladder pattern presented higher ACE 2 levels than the high risk group. Statistical analysis showed that the study group (SG) had a significantly higher mean serum ACE than the CG. The means of ACE 2 and urinary ACE of the SG and CG were not statistically different. The ROC curve for serum ACE values had a statistically significant area for case and non-case differentiation, with 100% sensitivity and 53% specificity for values above 60.2 mg/dL. No statistically significant areas were observed in relation to ACE 2 and urinary ACE values between SG and CG. CONCLUSION: The analysis of serum ACE, ACE 2 and urinary ACE were not significant in patients with myelomeningocele and neurogenic bladder with renal injury previously detected by renal DMSA.

Perinatal health and malocclusions in preschool children: Findings from a cohort of adolescent mothers in Southern Brazil.

INTRODUCTION: Pregnancy in adolescence has long-term consequences that can negatively influence oral conditions. In this study, we aimed to assess malocclusion in deciduous dentition and its association with prolonged breastfeeding, pacifier use, and perinatal health indicators pertaining to the periods immediately before and after birth. METHODS: This cross-sectional study was nested in a cohort of adolescent mothers who became pregnant from 13 to 19 years of age (mean age, 17.3 ± 1.6 years). A total of 509 mother-child dyads were included. Information on perinatal indicators, including Apgar score (0-10), which is a standardized assessment of the condition of the infant at birth (heart rate, breath rate, muscle tone, reflex irritability, and skin color), head circumference, birth weight, and need for intensive care unit admission were collected after delivery through interviews with the mothers. By the time the children were 24 to 36 months of age, malocclusion was assessed, and information on the use of pacifiers and breastfeeding was collected. Multivariate Poisson regression was used to assess the effect of independent variables on the outcome (malocclusion). RESULTS: The prevalence of malocclusion was 62.33%, and open bite was the most frequent one (47.45%). After adjustments, children with no need for intensive care unit admission had a lower risk of malocclusion (prevalence ratio [PR] = 0.75; 95% CI, 0.56-0.99), whereas those with an Apgar score less than 7 had a higher risk (PR = 1.32; 95% CI, 1.06-1.64). Children who had used a pacifier (PR = 1.82; 95% CI, 1.02-3.24) or were still using it (PR = 3.88; 95% CI, 2.65-5.68) had a higher chance of malocclusion compared with children who never used a pacifier. Children breastfeeding for 24 months or longer were less likely to have malocclusion (PR = 0.46; 95% CI, 0.34-0.73). CONCLUSIONS: Poor perinatal health and pacifier use may be risk factors for malocclusion development in deciduous teeth. Long duration of breastfeeding is associated with better occlusal conditions in children of adolescent mothers. Further studies are needed with other age groups.

Rapid Maxillary Expansion without Posterior Anchorage.

This work aimed to evaluate an alternative form of maxillary expansion anchored with mini-implants. A patient 12 years, class III in permanent canine teeth, with multiple agenesis of upper posterior teeth was treated with the aid of four mini-implants in the palate and Haas modified type appliance. During the period of expansion, an interincisal diastema was observed as the first clinical sign of disjunction of the sutures. After correction of cross bite, the expansion of the palate was confirmed by upper occlusal radiographs. Thus, the evaluations showed that the technique was effective and that new scientific studies should be conducted to further develop this subject. Keywords: Appliances; Biomechanics; Implants; Malocclusions

Maternal perception of the occurrence of traumatic dental injuries in children: a cohort study of south Brazil.

BACKGROUND: Adolescent mothers may have an inaccurate perception and awareness of dental trauma occurrence in children, which may influence whether or not they seek treatment. OBJECTIVE: This study evaluated maternal perception of traumatic dental injury (TDI) occurrence and related factors in children, 24-36 months of age, of adolescent mothers from a cohort in the city of Pelotas/RS, Brazil. METHODS: Clinical data from 508 children were collected through physical examination; demographic variables (including socio-economic status) and maternal perception of trauma occurrence were collected through interviews with the children's mothers. Statistical analysis was performed using STATA 12.0. RESULTS: The prevalence of dental trauma was 12.6% (64). A total of 291 (57.9%) mothers reported that their child had hit his or her teeth/mouth at least once. Only 69 (24.8%) mothers who perceived a TDI sought care. The maternal perception of dental trauma experienced by children showed no relationship with diagnosis on clinical examination. Enamel fracture was the most prevalent type of trauma (71.6%), and the maxillary central incisors were the teeth most affected. CONCLUSIONS: Owing to lack of awareness about TDI, the adolescent mothers in this study sample did not seek treatment for their children. Awareness campaigns for parents and caregivers about the possible consequences of TDI and the importance of follow up after dental trauma are required.

A Modified Photoactivation Protocol Using Two Simultaneous Light-Curing Units for Bonding Brackets to Enamel.

UNLABELLED: This study investigated the effect of a modified photoactivation protocol using two simultaneous light-curing units on the shear bond strength (SBS) of brackets to enamel. Metal brackets were bonded to bovine incisors using the resin-based orthodontic cement Transbond XT (3M Unitek). Four photoactivation protocols of the orthodontic cement were tested (n = 15): CONTROL: photoactivation for 10 s on each proximal face of the bracket at a time; Simultaneous: photoactivation for 10 s on both proximal faces of the bracket at the same time; One side-20s: photoactivation for 20 s at one proximal face of the bracket only; and One side-10s: photoactivation for 10 s only at one proximal face of the bracket. SBS was tested immediately or after 1000 thermal cycles. Adhesive remnant index (ARI) was classified. Data were subjected to two-way ANOVA and Student-Newman-Keuls' test (α = 0.05). Pooled means ± standard deviations for SBS to enamel (MPa) were: 10.2 ± 4.2 (CONTROL), 9.7 ± 4.5 (Simultaneous), 5.6 ± 3.1 (One side-20s), and 4.6 ± 1.9 (One side-10s). Pooled SBS data for immediate and thermal cycled groups were 6.3 ± 2.6 and 8.8 ± 5.2. A predominance of ARI scores 1-2 and 0-1 was observed for the immediate and thermally cycled groups, respectively. In conclusion, simultaneous photoactivation of the orthodontic cement using two light-curing units, one positioned at each proximal face of the bracket, yielded similar bonding ability compared to the conventional light-curing method. Photoactivation of the orthodontic cement at one proximal face of the bracket only is not recommended, irrespective of the light-curing time used.

A Modified Photoactivation Protocol Using Two Simultaneous Light-Curing Units for Bonding Brackets to Enamel

This study investigated the effect of a modified photoactivation protocol using two simultaneous light-curing units on the shear bond strength (SBS) of brackets to enamel. Metal brackets were bonded to bovine incisors using the resin-based orthodontic cement Transbond XT (3M Unitek). Four photoactivation protocols of the orthodontic cement were tested (n=15): Control: photoactivation for 10 s on each proximal face of the bracket at a time; Simultaneous: photoactivation for 10 s on both proximal faces of the bracket at the same time; One side-20s: photoactivation for 20 s at one proximal face of the bracket only; and One side-10s: photoactivation for 10 s only at one proximal face of the bracket. SBS was tested immediately or after 1000 thermal cycles. Adhesive remnant index (ARI) was classified. Data were subjected to two-way ANOVA and Student-Newman-Keuls' test (α=0.05). Pooled means ± standard deviations for SBS to enamel (MPa) were: 10.2±4.2 (Control), 9.7±4.5 (Simultaneous), 5.6±3.1 (One side-20s), and 4.6±1.9 (One side-10s). Pooled SBS data for immediate and thermal cycled groups were 6.3±2.6 and 8.8±5.2. A predominance of ARI scores 1-2 and 0-1 was observed for the immediate and thermally cycled groups, respectively. In conclusion, simultaneous photoactivation of the orthodontic cement using two light-curing units, one positioned at each proximal face of the bracket, yielded similar bonding ability compared to the conventional light-curing method. Photoactivation of the orthodontic cement at one proximal face of the bracket only is not recommended, irrespective of the light-curing time used.

Este estudo investigou o efeito de um protocolo modificado de fotoativação utilizando duas unidades de fotopolimerização simultâneas na resistência de união ao cisalhamento (RUC) de braquetes ao esmalte. Braquetes metálicos foram fixados a incisivos bovinos utilizando o cimento ortodôntico resinoso Transbond XT (3M Unitek). Quatro protocolos de fotoativação do cimento ortodôntico foram testados (n=15): Controle: fotoativação por 10 s em cada face proximal do braquete de cada vez; Simultâneo: fotoativação por 10 s em ambas as faces proximais do braquete ao mesmo tempo; Um lado-20s: fotoativação por 20 s em uma face proximal do braquete apenas; e Um lado-10s: fotoativação por 10 s apenas em uma face proximal do braquete. A RUC foi testada imediatamente ou após 1000 ciclos térmicos. O Índice de Remanescente de Adesivo (IRA) foi classificado. Os dados foram submetidos a ANOVA de duas vias e teste de Student-Newman-Keuls (α=0,05). As médias agrupadas ± desvios-padrão de RUC ao esmalte (MPa) foram: 10,2±4,2 (Controle), 9,7±4,5 (Simultâneo), 5,6±3,1 (Um lado-20s), e 4,6±1,9 (Um lado-10s). Os dados agrupados de RUC para os grupos imediatos e termociclados foram 6,3±2,6 e 8,8±5,2. Predominância de escores IRA 1-2 e 0-1 foi observada para os grupos imediatos e termociclados, respectivamente. Em conclusão, a fotoativação simultânea do cimento ortodôntico utilizando duas fontes de luz, uma posicionada em cada face proximal do braquete, gerou similar capacidade de união ao método convencional de fotopolimerização. Fotoativação do cimento ortodôntico em apenas uma face proximal do braquete não é recomendada, independente do tempo de fotoativação utilizado.

Avaliação dos sintomas de disfunção miscional em crianças e adolescente com paralisia cerebral / Evaluation of voiding dysfunction symptoms in children and adoscents with cerebral palsy

Avaliar as disfunções miccionais em pacientes comparalisia cerebral (PC) e sua relação com variáveis como: diagnóstico neurológico, idade, sexo, realização ou não de pré-natal durante o período gestacional, peso ao nascer, deambulação, fala, cognifivo, constipação intestinal e história de infecção do trato urinário (ITU), além de verificar, entre os casos estudados, a presença de bexiga neurogênica. Métodos: Estudo tranversal que avaliou 100 pacientes com idade entre 2 e 18 anos completos com diagnóstico de PC que compareceram em consulta pediátrica no ambulatório de pediatria da Associação de Assistência à Criança Deficiente, sem deficiência mental (DM) grave através da avaliação psicológica de QI, entrevista pediátrica e estudo urodinâmico. Resultados: após a avaliação de 100 casos de PC entre crianças e edolescentes de 2 a 18 anos, foram verificados 30 casos de pacientes com sintomas urinários, 11 desses com quadros urológicos de bexiga neurogênia. Entre as variáveis analisadas, apenas a média de idade (5,35 anos) apresentou relação estatisticamente significativa com a presença de sintomas urinários. Conclusão: As crianças e adolescentes com PC apresentaram sintomas de disfunção do trato urinário independente das variáveis analisadas, exeto pela idade, o que pode estar relacionado talvez à menor gravidade de seus quadros de DM e deficiência motora...