Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries.

This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50 y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7% and ranged from 18.7% in China to 81.2% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20 percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.

Historical Expansion of Kyasanur Forest Disease in India From 1957 to 2017: A Retrospective Analysis.

A highly infectious tick-borne virus causes Kyasanur Forest disease (KFD), which has been expanding in recent decades in India. Current studies do not provide an updated understanding of the disease trends and its expansion in India. We address this gap in the literature through a detailed review to reveal the annual historic expansion of KFD cases across the span of years from 1957 to 2017. In addition, we explore the factors that may have led to the geographic expansion of KFD. The annual numbers of cases of KFD among humans are estimated using peer-reviewed journal articles, Pro-MED database, historical and archived newspapers, and government reports, technical reports, publications, and medical websites. From 1957 to 2017, there were an estimated 9,594 cases of KFD within 16 districts in India. The most significant human outbreaks of the disease were in the years 1957-1958 (681 cases), 1983-1984 (2,589 cases), 2002-2003 (1,562 cases), and 2016-2017 (809 cases). In 2015, KFD appeared in Goa. In 2016, new cases emerged in Belgaum, a district in Karnataka state, and in the Sindhudurg district in Maharashtra state. The processes by which KFD persists and spreads are not clear, but demographic, socioeconomic, political, and environmental factors seem to play a role.

The Relationship between Anemia, Hemoglobin Concentration and Frailty in Brazilian Older Adults.

OBJECTIVE: to explore the relationship between anemia, hemoglobin concentration and frailty syndrome in older adults. RESEARCH METHODS AND PROCEDURES: This was a cross-sectional population-based study, with adults ≥60 years (n=1,256) from the third wave of the SABE Cohort Study (Health, Well-being and Aging) conducted in 2010 in São Paulo, Brazil. Frailty syndrome was evaluated according to Fried´s phenotype. Anemia was defined using the WHO criteria (hemoglobin concentration <12 g/dL for women and <13 g/dL for men). Four approaches were used to verify the associations between anemia, hemoglobin concentration and frailty status or number of frailty criteria. We used logistic regression and Poisson regression in the analyses, and they were adjusted in three hierarchical models using three blocks of variables: basic characteristics; clinical characteristics; cognitive status. RESULTS: Mean hemoglobin concentration was significantly lower in frail elderly (13.3g/dL, versus 14.3g/dL in non-frail; p<0.001). Prevalence of anemia was also significantly higher in frail when compared to non-frail elderly (24.2% and 3.8%; p<0.001). Anemia was significantly associated to low physical activity, weakness and slowness. In the fully adjusted regression models, anemia was strongly associated to frailty (OR=3.27, 95%IC=1.89,5.65; p<0.001), and lower levels of hemoglobin were associated to higher number of frailty criteria. CONCLUSIONS: We found important associations between anemia, hemoglobin concentration and frailty; anemic older adults were more likely to be frail, and lower levels of hemoglobin were associated to higher number of frailty criteria showing a clear dose-response effect.

Do physical fitness measures influence internal training load responses in high-level futsal players?

BACKGROUND: The aim of the present study was to verify whether aerobic fitness and ability to perform repeated high-intensity efforts influence the internal training load (ITL), which consists of the actual stress imposed in the athletes' organisms, in professional futsal players. METHODS: Twelve high-level futsal players (age: 26.3±4.9 years, body mass: 73.5±7.5 kg) participated in the study. The investigated athletes took part in a 5-week pre-season period. The ITL was quantified by means of the session-Rating of Perceived Exertion method. The athletes performed the Yo-yo Intermittent Recovery Test level 2 (YYIR2) in order to assess the ability to perform repeated high-intensity actions, and the multistage shuttle-run test (MSRT) in order to evaluate aerobic fitness, before (T0) and after (T1) the pre-season period. Maximal oxygen uptake (VO2max.), oxygen uptake at Respiratory compensation point (VO2-RCP) and maximal aerobic speed (MAS) obtained in MSRT were retained for analyses. RESULTS: The results from Pearson's correlation test showed significant and a very large correlation between ITL and YYIR2 performance (r=-0.75). Moreover, a significant and large correlation between ITL and VO2max. (r=-0.62), ITL and MAS (r=-0.67), and ITL and VO2-RCP (r=-0.58) were also observed. CONCLUSION: It can be concluded that aerobic fitness and ability to perform repeated high-intensity actions may influence ITL responses in professional futsal players.

The association of hemoglobin concentration with disability and decreased mobility among older Brazilians.

OBJECTIVE: To examine the association between hemoglobin concentration and disability and mobility difficulty among older adults living in São Paulo, Brazil. DESIGN: Cross-sectional study. SETTING: Population-based study conducted in São Paulo, Brazil. PARTICIPANTS: Adults age 60 and over (n=1,256) from the third data collection wave of the SABE Study (Health, Well-being, and Aging) conducted in 2010. MEASUREMENTS: Two outcome measures were included in the analyses: 1) a difficulty to perform at least one of the instrumental activities of daily living (IADL) and 2) mobility difficulty, which was assessed using the Short Physical Performance Battery (SPPB). Logistic regression models assessed the association between hemoglobin and each of the outcome measures. All analyses were adjusted for sociodemographic and health characteristics. RESULTS: The prevalence of IADL disability was 26.8% and 10.7% of participants had mobility difficulty. The mean hemoglobin concentration was significantly lower in older adults who already presented disability (13.7g/dL versus 14.4g/dL among independent elderly) or decreased mobility (13.4g/dL versus 14.3g/dL among elderly with preserved mobility). Higher values of hemoglobin concentration were associated with lower the risk of IADL disability (OR=0.88; p=0.04) and mobility difficulty (OR=0.81; p=0.02). Hemoglobin concentrations showed a dose-response effect in the probability of each outcome. CONCLUSIONS: Lower hemoglobin concentration was associated with a higher probability of IADL disability and mobility difficulty, showing a clear dose-response effect.

One-year follow-up changes in weight are associated with changes in blood pressure in young Mexican adults.

OBJECTIVE: Increasing overweight and obesity rates in Mexico have been associated with increases in mortality from cardiovascular disease (CVD). This study assessed changes in body mass index (BMI) and body weight over 1 year, and explored whether these were associated with changes in CVD risk factors of blood pressure and fasting glucose in a cohort of young Mexican adults. STUDY DESIGN: Longitudinal data were obtained from a cohort of young Mexican adults applying to college. METHODS: Data were collected from college applicants for the 2008 academic year who re-applied in 2009. In total, 795 college applicants aged 18-20 years, of both sexes (48% males and 52% females), were included in the study. The screen included height, weight, and systolic (SBP) and diastolic (DBP) blood pressure measurements plus a blood draw following an overnight fast for fasting glucose. RESULTS: At baseline, 31.8% of the participants were overweight or obese. The mean 1-year change in body weight and BMI were 0.80 kg and 0.35 kg/m(2), respectively. One-year changes in body weight and BMI were associated with increased SBP and DBP for both men and women (P < 0.05), independent of baseline BMI. A weight gain of 5% or more was positively associated with increases in blood pressure among women (P < 0.05), but not among men. A weight loss of 5% or more was associated with reductions in SBP among women. CONCLUSIONS: One-year changes in weight were associated with changes in blood pressure.

Low-grade cervical squamous intraepithelial lesion during pregnancy: conservative antepartum management.

The purpose of this retrospective study was to determine the regression rate and management of low-grade squamous intraepithelial lesions (LSIL) in pregnancy. Seventy-four women with cytological findings of LSIL were analysed during the pregnant-puerperal period (until 12 months postpartum). Age, parity, cytological and colposcopic findings, route of delivery, and postpartum follow-up were studied. The age and parity of patients ranged (average) from 12 to 32 years (21.2 +/- 4.9), 0-5 (0.89 +/- 1.14), and 9-32 years (16.1 +/- 3.5), respectively. Thirty-nine of 55 (70.9%) and 12 of 19 (63.1%) pregnant women had normal cytology after vaginal delivery and caesarean section, respectively (p > 0.05). In postpartum, eight patients (10.8%) persisted with LSIL and ten (13.5%) presented high-grade squamous intraepithelial lesions. No case of unsatisfactory colposcopy and invasive carcinoma were found. LSIL during pregnancy has a high rate of regression, regardless of the route of delivery. Conservative management with colposcopic evaluation is proposed during gestation.

[Uses and abuses of hyperventilation in severe traumatic brain injury]. / Usos e abusos da hiperventilação nos traumatismo crânio-encefálicos graves.

A critical evaluation was done about the guidelines and effects of the hyperventilation maneuver on prevention and treatment of increased intracranial pressure (ICP) that follows severe traumatic brain injury (TBI). The prophylactic use of hyperventilation should be avoided after severe TBI acute phase, unless high venous O2 values are recorded at jugular bulb blood (SjO2), or to allow time when there are evidences of neurologic deterioration with posturing. The lack of cerebrovascular response to hyperventilation to low the ICP means that the blood brain barrier (BBB) function is extensively impaired. Then, hyperventilation may be used as a screening therapeutic test in acute severe TBI, since BBB impairment is the pointer that other available clinical procedures for high ICP control (sedation, paralysis and osmotic diuretics) are not workable. A new pathogenetic hypothesis about traumatic brain edema and its therapeutic approach is presented.

Dysfunction of the temporalis muscle after pterional craniotomy for intracranial aneurysms. Comparative, prospective and randomized study of one flap versus two flaps dieresis.

Patients with intracranial aneurysm(s) of the carotid artery territory, treated with pterional craniotomy, were prospectively and randomly addressed to one layer flap (n = 36) or myocutaneous (MC) versus two layers' dieresis (n = 32) or interfascial (IF). The study protocol included the patient's sex, age, area of craniotomy, time of flap dieresis and synthesis, time of bone dieresis and synthesis, the intracranial time, including dura mater dieresis and synthesis and time of flap retraction. Before and after surgery, the patients were evaluated with examination specially oriented to V and VII cranial nerves, bi-temporal diameter measurement, the symmetry of the temporal region, tempora-mandibularis joint (TMJ) movements and cranial CT scan. The evaluations of the TMJ dysfunctions were postoperative pain, movement limitations at mastication, occlusion, mouth aperture and lateral movements of the jaw. The statistical analysis showed that the incidence of pain at TMJ and moderate and severe temporalis muscle atrophy was observed, comparing MC and IF, and there were significant differences among these ones, being greater in IF group. We concluded that both techniques permit equivalent access to the studied intracranial aneurysm(s), and the atrophy of temporalis muscle, pain and movement limitations of the temporomandibularis joint were prevalent, worse and more long-lasting in two-layers flap dieresis than in one-layer flap dieresis.