To evaluate whether there is a relationship between occlusion and body posture as delineated by a stabilometric platform: A systematic review.

OBJECTIVE: To evaluate whether there is a relationship between occlusion and body posture evaluated using a stabilometric platform. METHODS: Observational studies that analyzed the relationship between dental occlusion (changes in mandibular position and/or dental malocclusion) and body posture evaluated with a stabilometric platform in patients older than 13 years without orthodontic or orthopedic intervention and systemically healthy were considered eligible for inclusion. PubMed, EMBASE, Science Direct, LILACS, and Google Scholar databases were searched to obtain articles published from September 2019 up to March 2020. RESULTS: Twelve articles met the inclusion criteria, of which 66.7% showed a relationship between dental occlusion and body posture, and 33.3% found no relationship. The marked heterogeneity between studies did not allow data to be combined for meta-analyses. CONCLUSION: For the mandibular positions, the postural changes were mainly in the mediolateral direction, while in the malocclusions, they were in the anteroposterior direction.

Phase I safety and immunogenicity study of a Brazilian serogroup B vaccine.

Meningococcal disease by serogroup B has been a public health problem in Brazil in the last decades. The Brazilian Oswaldo Cruz Foundation has been working to develop a vaccine with detergent-treated outer membrane vesicles (OMV) and detoxified endotoxin (dLOS) from Neisseria meningitidis serogroup B prevalent strains. A phase I study, enrolling 26 adults (18-44 years of age) was performed using experimental vaccines combining B components and aluminum hydroxide as adjuvant. It was a dose escalation study testing vaccines made of 25, 50, and 100 µg OMV protein/mL (sum of both strains) and dLOS in half amount of total protein concentration, with three doses given two months apart. Adverse events were mild/moderate with frequency increasing with the amount of antigens. Pain in the site of injection was the most frequent reaction in all doses, reported in more than the 85% across vaccine groups. Considering all injections, cephalea was the most common systemic adverse event, detected in 11.1%, 17.2% and 32.1%, respectively with doses of 12.5 µg, 25 µg and 50 µg. High titers of total IgG (ELISA) were observed for the vaccine components before vaccination. Protective levels of bactericidal antibodies (titer ≥1:4) for both vaccine strains were also present. Considering a 4-fold increase of IgG titers compared to pre-immune values (seroconversion), 50%-70% of those who received intermediate and highest doses of antigens presented satisfactory response for OMV of N44/89 strain. The lowest dose vaccine induced no seroconversion for strain N44/89, and 11% for strain N603/95. For the three vaccines doses, 25% of seroconversion, in total IgG against LOS, was observed. Increased antibody bactericidal activity was observed for both strains in higher antigen concentrations. For IgG against LOS, all vaccine formulations showed 25% of seroconversion. In conclusion, MenB-Bio experimental vaccines were well tolerated and immunogenic, thus allowing phase II studies.

Effectiveness of pharmaceutical care for drug treatment adherence in women with lupus nephritis in Rio de Janeiro, Brazil: a randomized controlled trial.

OBJECTIVE: Studies have been conducted to determine the causal factors and clinical consequences of non-adherence to treatment in systemic lupus erythematosus (SLE). However, no interventions have been performed to increase drug adherence. Our objective was to assess the effectiveness of pharmaceutical care (PC) for drug treatment adherence in lupus nephritis (LN). METHODS: This was a randomized clinical trial (pragmatic trial) in patients with LN in Rio de Janeiro, Brazil, allocated in two groups: an intervention group (Dader Method for PC) and a control group (institution's usual care). Drug treatment adherence was measured by the combination of five questions normally used in clinical practice. RESULTS: A total of 131 patients were randomized, and 122 completed the study, with a mean follow-up of 12.7 months and use of six drugs per day and 10-12 doses per day. Low adherence was observed at baseline (intervention group: 30%; control group: 29%). PC showed 27% effectiveness (95% confidence interval (CI) -6% to 50%) in the intention to treat analysis and 31% (95% CI 0-52%) in per protocol analysis, considering all drugs. As for adherence to specific drugs for SLE, effectiveness of PC was 64% (95% CI 34-80%) with intention-to-treat analysis and 62% (95% CI 32-79%) in per protocol analysis. CONCLUSIONS: PC was effective for increasing drug treatment adherence in SLE. The detailed account provided by the Dader Method of the difficulties with patients' drug therapy proved invaluable to approach non-adherence.

Vaccination against hepatitis B with 4-double doses increases response rates and antibodies titers in HIV-infected adults.

BACKGROUND: Antibody responses to standard regimens of hepatitis B (HBV) vaccination are lower in HIV-infected subjects and the best hepatitis B vaccine schedule in this population is not known. OBJECTIVE: To assess the immunogenicity and to evaluate predictors of serologic response of a modified regimen of a HBV recombinant vaccine in a cohort of HIV-infected subjects. METHODS: HIV-infected subjects received 4 doses (40 µg) of a recombinant HBV vaccine at 0, 1, 2 and 6 months. Demographic information as well as CD4 cell count and plasma viral load were assessed at baseline. Protective and strong responses were defined as an anti-HBs titer ≥10 mIU/mL and ≥100 mIU/mL, respectively and were evaluated one month after the third and the fourth doses. RESULTS: 163 HIV-infected individuals were evaluated 67 (40%) were male and median age was 37 years. Median CD4 cell count was 385 cells/mm(3) and 113 (70%) had undetectable HIV-1 viral load. Protective antibody response was observed in 83 and 91% and a strong antibody response was observed in 62 and 80% of the subjects after 3 and 4 doses, respectively. In a multivariate logistic model undetectable HIV-1 viral load and higher CD4 cell counts were independent predictors of a strong antibody response after 4 doses. Patients with undetectable HIV viral load were almost 3 times more likely to have anti-HBs titers above 100 mIU/mL than those with detectable viral load. CONCLUSIONS: A 4-double-dose regimen of a recombinant HBV vaccine increased response rates and determined higher antibody titers which may translate in prolonged protection against HBV. Inclusion of a fourth dose of HBV vaccine for HIV-infected subjects should be considered in the public health setting.

Extensive Mycobacterium tuberculosis circulation in a highly endemic prison and the need for urgent environmental interventions.

Aimed at assessing the circulation of Mycobacterium tuberculosis in a highly endemic prison, this 13-month prospective study was performed on strains isolated from tuberculosis (TB) cases detected passively and actively. We used X-ray screening of newly admitted inmates and mass screening at the beginning of the study and again 1 year later. Of the 94 strains genotyped by restriction fragment-length polymorphism, 79 (84·0%) belonged to one of the 12 identified clusters (2-21 strains each), including two main clusters (18 and 21 cases, respectively). A history of TB treatment was reported in 22/79 (27·8%) clustered cases. Time-space distribution of clustered cases was predominantly consistent with transmission, in micro-epidemics. Given the dominant pattern of exogenous infection and the extensive strain circulation, effective TB control should emphasize reduction of overcrowding and improvement of environmental measures as a complement to detection and treatment of cases.

High rates of serological response to a modified hepatitis B vaccination schedule in HIV-infected adults subjects.

We evaluated a modified HBV regimen in a cohort of HIV-infected subjects in Rio de Janeiro, Brazil. HIV-infected subjects with no serologic evidences of previous hepatitis B infection were immunized with 4 doses (40 microg each) of recombinant hepatitis B vaccine given at 0, 1, 2 and 6 months. Blood samples were collected 1 month after the last dose and anti-HBs titers were measured. A protective antibody response was defined as an anti-HBs titer >or=10 mIU/mL. Forty-seven subjects (30 women, 17 men; mean age was 36 years, ranging from 21 to 58 years) were included in the final analysis. Median baseline CD4+ lymphocyte count was 402 cells/mm(3) and 33 subjects (70%) had an HIV viral load below 80 copies/mL. A protective antibody response was observed in 42 (89%) subjects. Thirty-seven (78%) and 28 (60%) patients developed anti-HBs titers higher than 100 mIU/mL and 1000 mIU/mL, respectively. 1 out of 5 non-responders (20%) had an HIV viral load below the detection limit, in contrast with 32 (76%) of those with an adequate serologic response (p=0.02). These findings suggest that 4-double dose alternative schedule may be considered to overcome the lower seroconversion rates observed with the standard regimens in HIV-infected subjects.

Effectiveness of BCG vaccination among leprosy contacts: a cohort study.

The study assessed the effectiveness of BCG vaccination against leprosy among the contacts of 1161 leprosy patients at the FIOCRUZ Leprosy Outpatient Clinic, RJ, Brazil, from June 1987 to December 2006. Following National Leprosy Program guidelines, the clinic has administered one-to-two doses to all healthy contacts since 1991. Among the 5680 contacts, 304 (5.4%) already had leprosy. Of the 5376 eligible healthy contacts, 3536 were vaccinated, 30 of whom were excluded due to previous or current tuberculosis, or HIV. In 18 years of follow up, 122 (2.15%) incident cases were diagnosed (58 vaccinated and 64 not), 28 occurring in the first year of follow up (21 vaccinated, 16 with no scar). The protection conferred by BCG was 56% and was not substantially affected by previous BCG vaccination (50% with a scar and 59% without). The risk of tuberculoid leprosy during the initial months was high among those vaccinated with no scar. However, it had substantially declined by the first year and in the following years, when the protection rate in this group reached 80%. Since Brazil is endemic for leprosy and the detection rate is not declining satisfactorily, vaccinating all contacts could be an effective means of substantially reducing the incidence of leprosy.

Risk of tuberculous infection in an indigenous population from Amazonia, Brazil.

SETTING: Suruí Indians, Amazonia, Brazil. OBJECTIVE: To estimate the prevalence and the annual risk of infection (ARI) of tuberculosis (TB) in an indigenous population in Brazil. METHODS: We applied a method to estimate the prevalence of TB infection in populations with high bacille Calmette-Guérin (BCG) vaccine coverage. The method consisted of comparing levels of skin test reactivity in individuals tested with purified protein derivative (PPD) before and after stimulation with intradermal BCG. Fieldwork was carried out among the Suruí Indians (n = 993) in two phases, 3 months apart. RESULTS: A total of 645 subjects were tested. In pre-BCG revaccination, tuberculin skin test (TST) indurations averaged 5.9 mm (33.5% > or =10 mm). In post-BCG revaccination TST, indurations averaged 9.4 mm (48.7% > or =10 mm). Conversion from non-reactor to reactor was 54.4%. The ARI ranged from 1.2% to 2.2%. In the logistic regression, age and history of TB were the strongest independent predictors of TB infection. BCG scar and the number of individuals per house were also associated with infection. CONCLUSION: Tuberculous transmission is very high in the Suruí, surpassing the ARI reported for Brazil (0.6%). The epidemiology of TB in this indigenous population is related to unfavourable social and economic conditions, as well as to deficient health care services.

Tuberculin reactivity and tuberculosis epidemiology in the Pakaanóva (Wari') Indians of Rondônia, south-western Brazilian Amazon.

OBJECTIVE: To investigate the characteristics of tuberculin skin test reactivity in the Pakaanóva Indians, in Amazonia, Brazil, after revaccination of all study participants with bacille Calmette-Guerin (BCG). METHODS: The investigation was designed as a post-BCG vaccination purified protein derivative (PPD) survey. Data included PPD readings, age, sex, nutritional status, place of residence, previous tuberculosis, physical examinations and BCG status. Bivariate and multivariate logistic regression analyses were conducted. RESULTS: About 90% (n = 505) of the total population participated. One third (32.1%) of the subjects presented induration > or = 10 mm at 72 h. Induration sizes showed weak linear correlation with age; differences between sexes were not observed. Skin reaction was not associated with nutritional status. Individuals with a history of tuberculosis were six times more likely to test positive. History of tuberculosis, age, and previous BCG vaccination were significantly associated with PPD reactivity in the multivariate analyses. CONCLUSION: The Pakaanóva showed a high proportion (58.4%) of non-reactors, even with a recent BCG booster. Sex differences in PPD reactivity were either not present or could not be demonstrated. The association between age and PPD reactivity resembles that observed in other Amazonian populations. The authors discuss the potential of PPD testing as a screening tool to enhance tuberculosis detection, especially in indigenous populations in Amazonia with limited access to health services.

Use of RT-PCR on oral fluid samples to assist the identification of measles cases during an outbreak.

This study investigated the occurrence of mild modified measles cases during an outbreak in Niterói, RJ, Brazil by using RT-PCR on oral fluid samples. From August to December 1997 a total of 76 patients with rash were seen at the study sites. Confirmed diagnosis by serology was achieved in 47 cases: measles (39.5%), rubella (13.2%), HHV-6 (3.9%), human parvovirus B19 (3.9%), dengue fever (3%). For 19 of the 29 patients without a conclusive diagnosis paired serum and saliva samples were available for further tests. In four of them, measles virus RNA was detected by RT-PCR in saliva samples in the absence of specific IgM in serum samples. Vaccination histories obtained from three of the RT-PCR positive cases showed that individuals previously immunized can still be infected and contribute to the circulation of measles virus. This study demonstrated the usefulness of RT-PCR on non-invasive clinical samples for the investigation of measles cases.

[Tuberculosis among indigenous populations in Rondonia, Amazonia, Brazil]. / Tuberculose em populações indígenas de Rondônia, Amazônia, Brasil.

Tuberculosis persists as a serious public health problem in Brazil. Prevalence rates are alarming in certain social groups, including indigenous peoples. This article presents an epidemiological analysis of records in the Rondonia State Tuberculosis Control Program, identifying the disease's profile among indigenous groups, which are socially more vulnerable and have different issues involved in controlling the disease. The study includes a descriptive statistical and multivariate multinomial analysis of cases reported in 1992 and from 1994 to 1998, attempting to identify factors associated with tuberculosis-related deaths, treatment drop-out, and missing data. Associations were identified between variables related to the disease, to the health service, and to treatment results. There is evidence that the indigenous populations in Rondonia have an increased risk of acquiring and dying from tuberculosis as compared to other residents of the State. Attention is called to the need for prevention and control measures specifically tailored to the reality of indigenous peoples.

The aetiology of maculopapular rash diseases in Niterói, State of Rio de Janeiro, Brazil: implications for measles surveillance.

A study investigating the causes of rash diseases using systematic laboratory testing was conducted in Niterói, Rio de Janeiro, between January 1994 to April 1998. Sera from 327 patients were tested for evidence of anti-rubella virus, measles virus, human parvovirus B19 and dengue fever virus specific immunoglobulin IgM and anti-human herpes virus type 6 (HHV-6) IgG antibodies. A laboratory confirmed diagnosis was achieved in 71.3% of the cases investigated: dengue fever (33.0%), rubella (20.2%), parvovirus B19 (9.2%), measles (6.7%) and HHV-6 (2.1%). No diagnosis was established for 94 cases (28.7%). An outbreak of measles was detected during 1997, with a peak in September and October. All of the diseases studied here presented with clinical features similar to measles and classical symptoms were found in all measles confirmed cases. The large overlap of combinations of signs and symptoms seen in this study highlights the difficulties of diagnosing a rash illness on clinical grounds alone.

Extending breastfeeding duration through primary care: a systematic review of prenatal and postnatal interventions.

This literature review provides an overview of the effectiveness of strategies and procedures used to extend breastfeeding duration. Interventions carried out during pregnancy and/or infant care conducted in primary health care services, community settings, or hospital clinics were included. Interventions covering only the delivery period were excluded. Interventions that were most effective in extending the duration of breastfeeding generally combined information, guidance, and support and were long term and intensive. During prenatal care, group education was the only effective strategy reported. Home visits used to identify mothers' concerns with breastfeeding, assist with problem solving, and involve family members in breastfeeding support were effective during the postnatal period or both periods. Individual education sessions were also effective in these periods, as was the combination of 2 or 3 of these strategies in interventions involving both periods. Strategies that had no effect were characterized by no face-to-face interaction, practices contradicting messages, or small-scale interventions.

[Seroconversion study of Biken CAM-70 measles vaccine formulations]. / Estudo de soroconversão com formulações da vacina Biken CAM-70 contra sarampo.

OBJECTIVES: To compare seroconversion rates induced by Biken CAM-70 measles vaccines at different viral concentrations. METHODS: Healthy children aged 9 to 18 months from a primary health care unit in Rio de Janeiro, Brazil, and whose guardians agreed with their participation, were randomly assigned to receive one of the following vaccine formulations: 5,000, 1,000 or 200 CCID50 (50% Tissue Culture Infective Dose). The research team, participants, and data analysts were blinded to the type of vaccine administered. Pre- and post-vaccination antibody levels were assessed through Plaque Reduction Neutralization Test. Two interim data analyses were planned to assess unequivocal evidence of the superiority of one of the vaccine types. RESULTS: From 223 recruited children, 84% completed the whole course. Of them, 79% were less than 10 months of age, and 93% did not show detectable measles antibodies in pre-vaccination serum. Seroconversion (four-fold increase in antibody levels) in groups vaccinated with 5,000, 1,000 or 200 CCID50, were 82%, 55%, and 37% (p<0.0000), respectively. Differences in the mean concentration of post-vaccination antibodies were also substantial and statistically significant (p<0.000). Seroconversion rates (pooling data from all vaccine formulations) were 73% to children aged 10 months or more, and 53% in those below 10 months. CONCLUSIONS: Vaccines with concentrations below 5,000 CCID50 did not produce satisfactory seroconversion rates. The vaccine performance by age was consistent with that seen in other studies using Biken CAM-70 strain in which a sizable proportion of 9-month-old children failed to achieve full immunological response.

Diagnosis of rubella infection by detecting specific immunoglobulin M antibodies in saliva samples: a clinic-based study in Niterói, RJ, Brazil.

This study was designed to investigate whether saliva could be a feasible alternative to serum for the diagnosis of recent rubella infection in a clinic setting. Forty-five paired blood and saliva samples collected 1 to 29 days after onset of illness were tested for specific immunoglobulin (Ig) M by antibody-capture radioimmunoassay (MACRIA). Rubella IgM was detected in all serum samples and in 38 (84.4%) saliva specimens. Forty-six serum and saliva samples from other patients with rash diseases were tested by MACRIA for control purposes and two saliva specimens were reactive. The saliva test had specificity of 96%. These results indicate that salivary IgM detection may be a convenient non-invasive alternative to serum for investigation of recent rubella cases, especially for disease surveillance and control programmes.

Factors associated with immediate dropout of outpatient treatment for drug abuse in Rio de Janeiro.

BACKGROUND: The advantage of treatment of drug addiction over no intervention has long been recognized. The high dropout rates that are often reported in outpatient clinics may limit treatment effectiveness. This study aimed to analyze adherence to an outpatient program for drug addicts, mainly cocaine addicts, in Rio de Janeiro, Brazil, and its correlates. METHODS: Of particular interest was immediate dropping out, defined as coming just once to the facility. The data were collected from medical charts and registers of a randomly selected sample of 480 patients. RESULTS: A total of 468 medical records were available for review, and 57% of the patients came just once to the facility. A negative association was found between immediately dropping out and female gender, being white, prescription of medication and use of multiple management resources by the therapist (referral to mutual support groups, social workers, family therapy and medical assessment, even with no prescription). A positive association was found with parental death in childhood, history of mental illness in the family and addiction to alcohol combined with abuse of other illicit substance(s). CONCLUSIONS: The high dropout rates associated with certain treatment approaches strongly indicate opportunities for improving care of drug addicts at that outpatient center.

[The joint manifestations of exanthematous viroses]. / Manifestações articulares nas viroses exantemáticas.

The frequency of arthropathy was evaluated in 251 patients with clinical and serological diagnosis (specific IgM detection by enzyme immunoassay) of exanthematous disease. Arthropathy (arthralgia and/or arthritis) was more frequent in dengue fever (49%) and rubella (38.2%) cases than in human parvovirus (30%) and measles (28.1%) cases. Except for measles cases, joint complaints prevailed in adults (> or = 15 years of age) and this difference was significant. The higher frequency of arthropathy in adults was more evident in human parvovirus (75%), rubella (65%) and dengue fever (57.7%) cases than in measles cases (31%). Arthropathy was also more frequent in females for all rash diseases studied. The results of this study showed the high occurrence of joint complaints in the disease described here and the importance of laboratory confirmation for their differential diagnosis.

[Anthropometric profile of employees from a government bank in the state of Rio de Janeiro, Brazil. 1 Body mass index and sociodemographic factors]. / Perfil antropométrico de funcionários de banco estatal no Estado do Rio de Janeiro/Brasil: 1: índice de massa corporal e fatores sócio demográficos.

This study first describes the anthropometric profile of employees at Banco do Brasil and then compares these results to those of the Brazilian National Health and Nutritional Survey, PNSN/1989, for the Southeastern region of the country. It is a cross-sectional study with a sample comprising 647 bank clerks. Weight and height informed by respondents were used to compute the body mass index (BMI). Among bank clerks, 8.8% were underweight, 27.8% were overweight and 6.4% were obese. Overweight increased with age and was about 3 times greater in men than in women. Among social and demographic variables, sex, age, and schooling best explained BMI variance. For men, proportion of overweight was higher in bank clerks than in the PNSN population, while for women, PNSN showed higher frequencies of overweight as compared to female bank clerks. High prevalence of overweight in the general population, as well as in specific groups like bank clerks, highlights the urgent need for definition and development of prevention and control policies capable of impacting risk factors and ultimately leading to a decrease in social cost due to mortality from chronic diseases.

Diagnosis of dengue infection by detecting specific immunoglobulin M antibodies in saliva samples.

To investigate whether saliva could be used for diagnosis of recent dengue, serum and saliva samples were collected simultaneously from patients with suspected dengue infection. Sera (1:10 dilution) and saliva (undiluted) were tested by using an IgM capture enzyme linked immunosorbent assay (MAC-ELISA) with minor modifications (serum and saliva absorption for 3 h at 37 degrees C). The quality of saliva was evaluated by determining the IgG total concentration (enzyme immunoassay) which ranged from 2.7 to > 50 mg/l. Recent dengue infection was confirmed in 38 cases. Forty-six serum and saliva specimens were collected from these patients 1-30 days after the onset of symptoms. IgM was detected in 65.8% saliva samples. High rate of positivity ( > 80%) was observed for the saliva samples collected > or = 5 days after the onset of the disease. Fifty serum and saliva samples from other 32 patients with rash diseases were also tested and all the specimens were unreactive by MAC-ELISA. These results indicate that saliva may be a convenient non-invasive alternative to serum for diagnosis of recent dengue fever infection, especially for epidemiological studies during outbreaks of the disease.

[Client characteristics at a center for treatment of drug dependence]. / Características da clientela de um centro de tratamento para dependência de drogas.

OBJECTIVE: Sociodemographic and psychopathological characteristics as well as treatment approaches to patients at an outpatient clinic for drug addicts are described. METHODS: Descriptive study based on randomly sampled medical charts and registration forms of subjects presenting for treatment from 1986 to 1993. RESULTS: The sample was made up predominantly of young white unmarried men, with low occupational status. The number of years of schooling was greater than that of individuals of the same age group in the general population. Thirty-six percent of the subjects were sons of broken-down marriages, 14% had been abandoned by parents during childhood and 14% had lost one of their parents by death. Fifty percent complained of an absent father in their upbringing. Sixteen percent of the patients reported physical abuse in their childhood and the father was the perpetrator in 68% of the cases. The mean age at which subjects started to use drugs was 17.4 years. Cocaine was by far the most abused drug, either alone (34%) or together with other drugs (52%). Slightly less than half of the individuals used marijuana, whereas one fifth were also addicted to alcohol. In the time interval covered by the study the proportion of cocaine abusers increased, whereas marijuana and intravenous drug users decreased among those subjects who attended the program. CONCLUSION: The results of this study provided information for services assessment and for the modification of the organization of the treatment of drug abuse.