Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil.

There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.

Pharmacological PI3K inhibition in head and neck squamous cell carcinoma: A systematic review.

BACKGROUND: This systematic review aimed to investigate the in vitro and in vivo effects of phosphatidylinositol-3-kinase (PI3K) inhibitors on head and neck squamous cell carcinoma (HNSCC). Considering the role of PI3K and its downstream effectors in cell proliferation, invasion, and survival, it is reasonable to expect that treatment with PI3K inhibitors could control HNSCC onset and progression. Thus, the research question for our review was whether pharmacological inhibition of PI3K affects HNSCC progression. METHODS: In vitro and in vivo studies were selected from six databases. We collected data regarding cell viability, apoptosis, and the regulation of protein expression levels from in vitro studies. For the in vivo studies, we analyzed the reduction in tumor size or gene and protein expression. RESULTS: The included studies showed reduced cell proliferation and apoptosis after treatment with PI3K inhibitors. PI3K inhibitors in combination with other drugs had an enhanced anticancer effects compared to those of single-drug treatments. CONCLUSIONS: The results support the potential of PI3K inhibitors as candidates for clinical trials in HNSCC.

Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil

There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.

Retention of Manually or CAD/CAM-customized Fiberglass Posts Luted to Enlarged Root Canals with Different Resin Cements.

The aim of this laboratory study was to evaluate the pull-out force of a prefabricated fiberglass post (PP), relined fiberglass post (RP), or milled fiberglass post (MP) luted with Multilink N (MN), RelyX Unicem 2 (RXU2) or RelyX Ultimate (RU) to enlarged root canals. The thickness of the resin cements and the presence of voids in the resin cement film were observed. The root canals of 90 bovine incisors were enlarged, endodontically treated, and randomly divided into 9 groups (n=10) according to the post type and resin cement. The specimens were scanned using micro-CT to analyze the thickness of the resin cement and the presence of voids. The specimens were submitted to mechanical cyclic loading (500,000 cycles at 50 N load) and subjected to pull-out force testing. Two-way ANOVA and Tukey's test analyzed the pull-out force and resin cement thickness data. Kruskal-Wallis and Bonferroni tests analyzed the void scores. The interaction between factors (post × resin cement) was significant (p=0.0001) for the pull-out force. Higher pull-out forces were obtained for RP and MP compared to PP. The post factor was significant (p=0.0001) for resin cement thickness, which was higher for PP (1054 µm), followed by MP (301 µm) and RP (194 µm). More void formation occurred for PP, being less for RP, differing significantly among the posts. Post customization (RP and MP) decreased resin cement thickness and void formation, favoring a higher pull-out force. Resin cements requiring an adhesive application (MN and RU) favored higher pull-out force than self-adhesive resin cement (RXU2).

A state level analyses of suicide and the COVID-19 pandemic in Mexico.

BACKGROUND: While suicide rates in high- and middle-income countries appeared stable in the early stages of the pandemic, we know little about within-country variations. We sought to investigate the impact of COVID-19 on suicide in Mexico's 32 states and to identify factors that may have contributed to observed variations between states. METHODS: Interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from Jan 1, 2010, to March 31, 2020), comparing the expected number of suicides derived from the model with the observed number for the remainder of the year (April 1 to December 31, 2020) for each of Mexico's 32 states. Next, we modeled state-level trends using linear regression to study likely contributing factors at ecological level. RESULTS: Suicide increased slightly across Mexico during the first nine months of the pandemic (RR 1.03; 95%CI 1.01-1.05). Suicides remained stable in 19 states, increase in seven states (RR range: 1.12-2.04) and a decrease in six states (RR range: 0.46-0.88). Suicide RR at the state level was positively associated with population density in 2020 and state level suicide death rate in 2019. CONCLUSIONS: The COVID-19 pandemic had a differential effect on suicide death within the 32 states of Mexico. Higher population density and higher suicide rates in 2019 were associated with increased suicide. As the country struggles to cope with the ongoing pandemic, efforts to improve access to primary care and mental health care services (including suicide crisis intervention services) in these settings should be given priority.

Tillering dynamics in spring and summer of marandu palisade grass pastures previously used under deferred grazing / [Dinâmica de perfilhamento na primavera e no verão de pastagens de capim-marandu previamente utilizadas sob pastejo diferido]

This work was conducted to evaluate the effect of deferred pasture condition of Brachiaria brizantha cv. Marandu in the late winter on tillering during the growing season. The treatments were three pasture conditions at late winter: short pasture, tall pasture and tall/mown pasture. In September and October, tiller appearance rate (TApR) and tiller mortality rate (TMoR) were greater in the tall/mown pasture. In November and December, tall pasture presented greater TApR. From November to January the TMoR was greater in the tall pasture. The tiller stability index of short and tall/mown pastures were greater in October. The short pasture presented a greater tiller number than the tall and tall/mown pastures during the entire experimental period. Deferred and short pasture of marandu palisade grass at late winter presents in general lower tiller mortality and higher population density of tillers from the early spring onwards, in comparison to tall pasture. The mowing of marandu palisade grass with high forage mass at the late winter, although it only temporarily compromises the population stability of tillers, also stimulates its fast tillering from spring on.(AU)

Este trabalho foi conduzido com o objetivo de avaliar o efeito da condição da pastagem diferida de Brachiaria brizantha cv. Marandu ao final do inverno sobre o perfilhamento durante a estação de crescimento. Os tratamentos foram três condições de pastagem no final do inverno: pasto baixo, pasto alto e pasto alto/roçado. Nos meses de setembro e outubro, a taxa de aparecimento de perfilhos (TApP) e a taxa de mortalidade de perfilhos (TMoP) foram maiores na pastagem alta/roçada. Nos meses de novembro e dezembro, a pastagem alta apresentou maior TApP. De novembro a janeiro, a TMoP foi maior na pastagem alta. Os índices de estabilidade de perfilhos das pastagens baixas e altas/roçadas foram maiores em outubro. A pastagem baixa apresentou maior número de perfilhos do que as pastagens altas e altas/roçadas durante todo o período experimental. A pastagem diferida e baixa de capim-marandu no final do inverno apresenta, em geral, menor mortalidade de perfilhos e maior densidade populacional de perfilhos no início da primavera, em comparação com a pastagem alta. A roçada do capim-marandu com alta massa de forragem ao final do inverno, embora comprometa apenas temporariamente a estabilidade populacional dos perfilhos, também estimula o perfilhamento rápido a partir da primavera.(AU)

Morphogenesis of stockpiled Marandu, Piatã, Xaraés and Paiaguás brachiaria grass cultivars / [Morfogênese de cultivares de capins marandu piatã, xaraés e paiaguás diferidos]

The objective this study was to identify differences in the morphogenic patterns of four Urochloa brizantha cultivars (marandu, piatã, xaraés and paiaguás grasses) during the stockpiling period. A completely randomized design was used, with three replications, in experimental plots of 9m². The evaluations took place over 2 years. The grasses were stockpiled for 92 (Year 1) and 95 (Year 2) days. The leaf appearance rate of paiaguás grass was higher, compared to other grasses. In Year 1, the stem elongation rate of xaraés grass was higher than other grasses. At the end of stockpiling period of Year 1, the tiller population density (TPD) was higher in the paiaguás grass, intermediate in the xaraés and marandu grasses and lower in the piatã grass. At the end of the stockpiling period in Year 2, TPD was higher in the paiaguás grass canopy, intermediate in the marandu and piatã grasses canopies, and lower in the xaraés grass canopy. Paiaguás grass has greater leaf growth during the stockpiling period and is therefore suitable for use under stockpiled grazing. Xaraés grass has high stem elongation during the stockpiling period, which is why its use under stockpiled grazing must be accompanied by adjustments in pasture management.(AU)

O objetivo deste estudo foi identificar diferenças nos padrões morfogênicos de quatro cultivares de Urochloa brizantha (marandu, piatã, xaraés e paiaguás) durante o período de diferimento. Foi utilizado o delineamento inteiramente ao acaso, com três repetições, em parcelas experimentais de 9m². As avaliações ocorreram por dois anos. Os capins foram diferidos por 92 (Ano 1) e 95 (Ano 2) dias. A taxa de aparecimento foliar do capim-paiaguás foi maior, em comparação aos demais capins. No Ano 1, a taxa de alongamento do colmo do capim-xaraés foi superior aos demais capins. No final do diferimento do Ano 1, a densidade populacional de perfilho (DPP) foi maior no capim-paiaguás, intermediária nos capins xaraés e marandu e inferior no capim-piatã. No fim do período de diferimento do Ano 2, a DPP foi superior no dossel de capim-paiaguás, intermediária nos dosséis dos capins marandu e piatã, e menor no dossel de capim-xaraés. O capim-paiaguás tem maior crescimento foliar durante o período de diferimento, sendo, portanto, apropriado para uso sob pastejo diferido. O capim-xaraés apresenta elevado alongamento de colmo durante o período de diferimento, razão pela qual seu uso sob pastejo diferido deve vir acompanhado de ajustes no manejo da pastagem.(AU)

Does the lowering strategy before the stockpiling period modify the marandu palisade grass production and structure? / [A estratégia de desfolhação prévia ao período de diferimento modifica a produção e a estrutura do capim-marandu?]

The objective was to identify lowering strategies for Urochloa brizantha cv. Marandu in the beginning of the stockpiling period that increase forage production and improve the structure of stockpiled canopies. Three lowering strategies were evaluated: maintenance of marandu palisade grass with 15cm four months before the stockpiling period; maintenance of palisade grass with 30cm for four months, and lowering to 15cm before the stockpiling period; and maintaining of palisade grass at 45cm for four months, and lowering to 15cm before the stockpiling period. The experimental design was completely randomized, with four replications. At the end of stockpiling, the number of reproductive tillers and forage mass were higher in the canopy under 15/15cm than in the others; the percentage of live leaf was higher in the canopy under 45/15cm than under 15/15cm. Forage production during the stockpiling period was higher in the canopy under 15/15cm and lower in the under 45/15cm. Maintaining 15cm marandu palisadegrass for four months before the stockpiling period increases forage production during this period. The lowering of the marandu palisadegrass from 45 to 15cm at the beginning of the stockpiling period improves the structure of the stockpiled canopy.(AU)

Objetivou-se identificar estratégias de rebaixamento da Urochloa brizantha cv. Marandu no início do diferimento, as quais resultem em aumento da produção e em melhoria da estrutura do dossel diferido. Foram avaliadas três estratégias de rebaixamento no início do diferimento: manutenção do capim-marandu com 15cm por quatro meses antes do início do diferimento; manutenção do capim-marandu com 30cm por quatro mese, e rebaixamento para 15cm no início do diferimento; e manutenção do capim com 45cm por quatro meses e rebaixamento para 15cm no início do diferimento. O delineamento foi inteiramente ao acaso, com quatro repetições. No fim do diferimento, o número de perfilho reprodutivo e a massa de forragem foram superiores no dossel sob 15/15cm do que nos demais; a percentagem de folha viva foi maior no dossel sob 45/15cm do que sob 15/15cm. A produção de forragem durante o diferimento foi superior no dossel sob 15/15cm e inferior no sob 45/15cm. A manutenção do capim-marandu com 15cm por quatro meses antes do período de diferimento aumenta a produção de forragem neste período. O rebaixamento do capim-marandu de 45 para 15cm no início do diferimento melhora a estrutura do dossel diferido.(AU)

The role of ageing in the wish to be dead: disentangling age, period and cohort effects in suicide ideation in European population.

AIMS: To investigate potential age, period and birth cohort effects in the prevalence of suicide ideation in European ageing population. METHODS: A total of 50 782 community-dwelling adults (aged + 50) from 20 different European countries were collected in the Survey Health Ageing and Retirement study. A multilevel logistic regression model of repeated measures was modelled to assess the effects of age and other variables, including the variability of observations over three levels: birth cohort groups, time period assessment and individual differences. RESULTS: The larger effect of variability was attributed to individual-level factors (57.8%). Youngest-old people (65-79 years) showed lower suicide ideation than middle-aged people (50-64 years). No significative differences were found for suicide ideation between middle-aged people and oldest-old (80 + years). Only 0.85% and 0.13% of the total variability of suicide ideation accounted for birth cohort and period effects, respectively. Cohorts born between 1941 and 1944 possessed the lowest estimates of suicide ideation. Conversely, suicide ideation started to rise with post-War generations and reached a significant level for people born from 1953-1957 to 1961-1964. Regarding the time period, participants assessed in 2006-2007 showed a lower likelihood of suicide ideation. The rest of the cohorts and period groups did not show any significant effect on the prevalence of suicide ideation. CONCLUSIONS: Our results suggest that age and suicide ideation relationship is not linear in middle and older age. The European Baby boomers born from 50s to mid-60s might report higher suicide ideation than their ancestors. This scenario would imply a greater need for mental healthcare services for older people in the future.

Effect of pH Cycling Followed by Simulated Toothbrushing on the Surface Roughness and Bacterial Adhesion of Bulk-fill Composite Resins.

The aim was to evaluate, in vitro, quantitatively and qualitatively, the effect of pH cycling and simulated toothbrushing on surface roughness (Ra) and bacterial adhesion (Cn) of bulk-fill composite resins. Thirty specimens of each composite resin, 5 mm wide and 4 mm high, were obtained: group 1 (control): Filtek Z250 (Z250); group 2: Filtek Bulk-Fill (FTK); group 3: Tetric N-Ceram Bulk-Fill (TTC); and group 4: Aura Bulk-Fill (AUR). After 24 hours, the specimens were polished and then alternated with demineralization/remineralization solutions for 15 cycles of 24 hours each at 37°C. Then the specimens were submitted to simulated toothbrushing. The Ra and Cn measurements were quantitatively analyzed in three stages: after polishing (Ra0 and Cn0), after pH cycling (Ra1 and Cn1), and after simulated toothbrushing (Ra2 and Cn2). The Ra values were submitted to two-way analysis of variance, followed by the Tukey test (α=0.05). The Kruskal-Wallis test, followed by multiple comparisons, was applied for Cn analysis. Surface topography and bacterial adhesion were observed by scanning electron microscopy (SEM). Z250, FTK, and TTC showed no significant change in Ra regardless of the treatment performed; AUR obtained increased Ra at Ra2 (p<0.05). FTK differed from the others at Cn0 and Cn1 (p<0.05). At Cn2, there was no difference among the composite resins. SEM images showed the exposure of fillers and microcavities at Ra1 and Ra2. There was greater bacterial adhesion at Cn1 for Z250 and FTK. It was concluded that the pH cycling caused surface degradation of all composite resins, which was potentiated by simulated toothbrushing. However, only AUR presented an increased Ra. Bacterial adhesion occurred on all composite resins after pH cycling; however, after simulated toothbrushing, adhesion of dispersed bacteria was similar for all the composite resin groups.

Associação entre eficiência alimentar e ganho em acabamento de carcaça de bovinos da raça Nelore / Association between feed efficiency and carcass finishinging gain of Nellore cattle

Objetivou-se estimar a associação fenotípica entre a eficiência alimentar e o ganho em acabamento de carcaça de touros jovens da raça Nelore. Utilizaram-se informações de 98 touros jovens da raça Nelore, participantes de duas provas de eficiência alimentar que empregaram o sistema de cochos eletrônicos Growsafe®, as quais foram realizadas nos anos de 2015 e 2016, na fazenda Capim Branco, da Universidade Federal de Uberlândia. As provas de eficiência alimentar tiveram duração de 91 dias, sendo 21 dias de adaptação e 70 dias de avaliação. Os animais apresentavam idade média ao início e ao término do confinamento de 19,98 e 22,16 meses e peso inicial e final médio de 428,17 e 542,27kg, respectivamente. Verificou-se que os animais mais eficientes depositaram menos gordura, e os animais menos eficientes depositaram mais gordura durante o período de avaliação em confinamento. Observou-se que há uma associação fenotípica de baixa magnitude (0,29) entre o consumo alimentar residual (CAR) e o ganho em acabamento de carcaça (GACAB). Assim, pode-se inferir que, ao serem selecionados menores valores de CAR, haverá alguma interferência negativa em GACAB. Concluiu-se que animais mais eficientes (CAR negativo) podem apresentar menor deposição de gordura subcutânea, influenciando na qualidade de carcaça de bovinos da raça Nelore.(AU)

This study aimed to estimate the phenotypic association between feed efficiency and gain in carcass finishing of young Nelore bulls. Information from 98 young Nelore bulls participating in two feed efficiency tests using the Growsafe® electronic trough system, carried out in the years 2015 and 2016, at the Capim Branco farm of the Universidade Federal de Uberlândia was used .The feed efficiency tests lasted for 91 days, with 21 days of adaptation and 70 days of evaluation. The animals had a mean age at the beginning and end of the confinement of 19.98 and 22.16 months, and mean weight initial and end of 428.17 and 542.27kg, respectively. It was verified that most efficient animals deposited less fat, and the efficient animals deposited more fat during the evaluation period at the confinement. It was observed that there is a low magnitude phenotypic association (0.29) between the residual feed intake (RFI) and the gain in carcass finishing (GACAB). Thus, it can be inferred that by selecting lower values of residual feed intake there will be some negative interference in GACAB. It was concluded that the most efficient animals (negative RFI) may present lower deposition of subcutaneous fat, influencing the carcass quality of Nelore cattle.(AU)

Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys.

AIMS: To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. METHODS: Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. RESULTS: Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. CONCLUSIONS: These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.

Propuesta de protocolo diagnóstico, estadificador y quirúrgico para el cáncer de endometrio / Proposal for a diagnostic, staging and surgical protocol for endometrial carcinoma

El carcinoma de endometrio es la neoplasia más frecuente del tracto genital de la mujer en el mundo occidental es una patología que va en ascenso en los países en vías de desarrollo. En general, el pronóstico de carcinoma endometrial es bueno, con una supervivencia global de alrededor del 80 %. Se pueden definir tres grupos de acuerdo al riesgo de recurrencia, en alto, medio y bajo. Se realiza revisión bibliográfica y casuística para proponer protocolo de manejo quirúrgico en pacientes con cáncer de endometrio. Se definen tres etapas durante el protocolo: clínica, patológica y quirúrgica. Se realizan recomendaciones basados en la vía de abordaje, tipo de histerectomía, lavado peritoneal, linfadenectomía, omentectomía, y cito-reducción. Se plantean situaciones especiales y la importancia del ganglio centinela. La realización de protocolos quirúrgicos para el manejo de carcinoma endometrial permite la unificación de criterios, mejora la evaluación de respuesta rapéutica y facilita revisiones y mejoras a futuro.(AU)

The endometrial carcinoma is the most common neoplasia in the genital tract of women in the western world and is a condition that is increasing in the developing countries. In general, the rognosis of endometrial carcinoma is good, with an overall survival of about 80 %. It can define three groups according to the risk of the recurrence in high, medium and low. The literature review and case mix is performed to propose the surgical management protocol in patients with endometrial cancer. Three stage the clinical, the pathological and the surgical defined for the protocol. The recommendations based on the approach, type of the ysterectomy, te peritoneal washing, the lymphadenectomy, the omentectomy, and the debulking are made. The special situations and the importance of sentinel node arise. Performing the surgical protocol for the management of endometrial carcinoma allows the unification of criteria, the improved therapeutic response assessment and facilitates future revisions and improvements.(AU)

Effect of Different Computer-aided Design/Computer-aided Manufacturing (CAD/CAM) Materials and Thicknesses on the Fracture Resistance of Occlusal Veneers.

The aim was to evaluate, in vitro, the influence of different computer-aided design/computer-aided manufacturing (CAD/CAM) materials (IPS e.max CAD, Vita Enamic, and Lava Ultimate) and thicknesses (0.6 mm and 1.5 mm) on the fracture resistance of occlusal veneers. Sixty human third molars were prepared to simulate advanced erosion of the occlusal surface, and the teeth were randomly divided into six experimental groups (n=10) according to the material and thickness used to build the veneers. Ten sound teeth formed the control group. The veneers were adhesively luted and submitted to mechanical cyclic loading (1 million cycles at 200-N load). The fracture resistance test was performed in a universal testing machine. The failures were classified as "reparable" and "irreparable." According to two-way analysis of variance and the Tukey test, the interaction (material × thickness) was significant ( p=0.013). The highest fracture resistance was obtained for IPS e.max CAD at a 1.5-mm thickness (4995 N) and was significantly higher compared to the other experimental groups ( p<0.05). The lowest fracture resistance was obtained for Vita Enamic at 0.6 mm (2973 N), although this resistance was not significantly different from those for IPS e.max CAD at 0.6 mm (3067 N), Lava Ultimate at 0.6 mm (3384 N), Vita Enamic at 1.5 mm (3540 N), and Lava Ultimate at 1.5 mm (3584 N) ( p>0.05). The experimental groups did not differ significantly from the sound teeth (3991 N) ( p>0.05). The failures were predominantly repairable. The occlusal veneers of IPS e.max CAD, Vita Enamic, and Lava Ultimate, with thicknesses of 0.6 mm and 1.5 mm, obtained fracture resistances similar to those associated with sound teeth.

Psychotic experiences and religiosity: data from the WHO World Mental Health Surveys.

OBJECTIVES: Religiosity is often associated with better health outcomes. The aim of the study was to examine associations between psychotic experiences (PEs) and religiosity in a large, cross-national sample. METHODS: A total of 25 542 adult respondents across 18 countries from the WHO World Mental Health Surveys were assessed for PEs, religious affiliation and indices of religiosity, DSM-IV mental disorders and general medical conditions. Logistic regression models were used to estimate the association between PEs and religiosity with various adjustments. RESULTS: Of 25 542 included respondents, 85.6% (SE = 0.3) (n = 21 860) respondents reported having a religious affiliation. Overall, there was no association between religious affiliation status and PEs. Within the subgroup having a religious affiliation, four of five indices of religiosity were significantly associated with increased odds of PEs (odds ratios ranged from 1.3 to 1.9). The findings persisted after adjustments for mental disorders and/or general medical conditions, as well as religious denomination type. There was a significant association between increased religiosity and reporting more types of PEs. CONCLUSIONS: Among individuals with religious affiliations, those who reported more religiosity on four of five indices had increased odds of PEs. Focussed and more qualitative research will be required to unravel the interrelationship between religiosity and PEs.

Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys.

BACKGROUND: Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors. METHODS: The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD. RESULTS: 20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2-0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66-55% v. 43%) and later-recovery (75-68% v. 39%). CONCLUSIONS: We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.

The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas.

Although earlier trauma exposure is known to predict posttraumatic stress disorder (PTSD) after subsequent traumas, it is unclear whether this association is limited to cases where the earlier trauma led to PTSD. Resolution of this uncertainty has important implications for research on pretrauma vulnerability to PTSD. We examined this issue in the World Health Organization (WHO) World Mental Health (WMH) Surveys with 34 676 respondents who reported lifetime trauma exposure. One lifetime trauma was selected randomly for each respondent. DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) PTSD due to that trauma was assessed. We reported in a previous paper that four earlier traumas involving interpersonal violence significantly predicted PTSD after subsequent random traumas (odds ratio (OR)=1.3-2.5). We also assessed 14 lifetime DSM-IV mood, anxiety, disruptive behavior and substance disorders before random traumas. We show in the current report that only prior anxiety disorders significantly predicted PTSD in a multivariate model (OR=1.5-4.3) and that these disorders interacted significantly with three of the earlier traumas (witnessing atrocities, physical violence victimization and rape). History of witnessing atrocities significantly predicted PTSD after subsequent random traumas only among respondents with prior PTSD (OR=5.6). Histories of physical violence victimization (OR=1.5) and rape after age 17 years (OR=17.6) significantly predicted only among respondents with no history of prior anxiety disorders. Although only preliminary due to reliance on retrospective reports, these results suggest that history of anxiety disorders and history of a limited number of earlier traumas might usefully be targeted in future prospective studies as distinct foci of research on individual differences in vulnerability to PTSD after subsequent traumas.

Hazardous drinking and exposure to interpersonal and community violence on both sides of the U.S. -Mexico border.

Objective: Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico border. Few studies describe the impact of violence on drinking between countries and along the border. Methods: Survey data is from U.S. Mexican origin adults living in Texas and Mexican border and non-border cities, N=4,796. Participants were asked about alcohol consumption, interpersonal physical violence (IPV) and exposure to community violence. Monthly hazardous drinking (5+/4+ for men/women) was the primary outcome. Multivariate logistic regression model comparisons identified best predictors. Results: In the U.S. hazardous drinking was associated with past year IPV (ORadj=2.5; 1.8-3.5) and community violence (ORadj=1.4; 1.1-1.8). In Mexico, IPV (ORadj=3.9; 2.0-7.4) and border proximity (ORadj=0.5; 0.4-0.8) were associated with hazardous drinking but not community violence. Conclusion: Hazardous drinking is associated with IPV in both countries, but violence did not explain border hazardous drinking differences where they existed in Mexico.

Effect of Hydrofluoric Acid Concentration and Etching Time on Bond Strength to Lithium Disilicate Glass Ceramic.

The aim of this study was to evaluate the influence of different concentrations of hydrofluoric acid (HF) associated with varied etching times on the microshear bond strength (µSBS) of a resin cement to a lithium disilicate glass ceramic. Two hundred seventy-five ceramic blocks (IPS e.max Press [EMX], Ivoclar Vivadent), measuring 8 mm × 3 mm thickness, were randomly distributed into five groups according to the HF concentrations (n=50): 1%, 2.5%, 5%, 7.5%, and 10%. Further random distribution into subgroups was performed according to the following etching times (n=10): 20, 40, 60, 120, and 20 + 20 seconds. After etching, all blocks were treated with a silane coupling agent followed by a thin layer of an unfilled resin. Three resin cement cylinders (∅=1 mm) were made on each EMX surface, which was then stored in deionized water at 37°C for 24 hours before testing. The µSBS was in a universal testing machine at a crosshead speed of 1 mm/min until failure. Data were submitted to two-way analysis of variance, and multiple comparisons were performed using the Tukey post hoc test (α=0.05). One representative EMX sample was etched according to the description of each subgroup and evaluated using scanning electron microscopy for surface characterization. The HF concentrations of 5%, 7.5%, and 10% provided significantly higher µSBS values than 1% and 2.5% (p<0.05), regardless of the etching times. For 1% and 2.5% HF, the etching times from 40 to 120 seconds increased the µSBS values compared with 20 seconds (p<0.05), but etching periods did not differ within the 5%, 7.5%, and 10% HF groups (p>0.05). The effect of re-etching was more evident for 1% and 2.5% HF (p<0.05). Different HF concentrations/etching times directly influenced the bond strength and surface morphology of EMX.

A meta-analysis of acute use of alcohol and the risk of suicide attempt.

BACKGROUND: No review has used a meta-analytic approach to estimate common odds ratios (ORs) for the effect of acute use of alcohol (AUA) on suicide attempts. We aim to report the results of the first meta-analysis of controlled epidemiological studies on AUA and suicide attempt. METHOD: The English-language literature on Medline, PsycINFO and Google Scholar was searched for original articles and critical review on AUA and suicide attempt (period 1996-2015). Studies had to report an OR estimate for this association. Common ORs and 95% confidence intervals (CIs) from random effects in meta-analyses for any AUA and two levels of alcohol use on suicide attempt were calculated. RESULTS: In all, seven studies provided OR estimates for the likelihood of suicide attempt by AUA, compared with those who did not drink alcohol. Studies used case-control (n 3) and case-crossover designs (n 4). Meta-analysis revealed a common OR of 6.97 (95% CI 4.77-10.17) for any AUA. Using four studies, 'low levels of acute drinking' resulted in an OR of 2.71 (95% CI 1.56-4.71) and 'high levels' had an OR of 37.18 (95% CI 17.38-79.53). CONCLUSIONS: AUA is associated with increased likelihood of a suicide attempt, particularly at high doses. Such data should be incorporated into estimates of the burden of disease associated with alcohol use, which are currently limited by a consideration of only alcohol's chronic effects. Future research should focus on the mechanisms through which AUA confers risk for attempt.