RESUMO
This clinical study evaluated the early effect of oral rehabilitation with dental implants and nocturnal bruxism on maximum occlusal force (MOF), before sensorimotor adaptation. A consecutive sample consisted of 127 patients divided into three groups according to their dental state: G1- implant-supported fixed complete denture (IFCD) opposing to a small fixed prosthesis or natural dentition; G2- IFCD opposing to a complete denture; and G3- small fixed prosthesis or natural dentition in both arches. Clinical data were collected after prosthesis installation: systemic and oral health conditions, MOF, self-reported bruxism, and bruxism severity (low, moderate, severe). Data were analysed by ANOVA and Tukey-Krammer tests. Dental state and the interaction sex-bruxism had significant effect on MOF. G1 had higher MOF than G3, but G2 was not significantly different from G1 and G3. Men with bruxism had the highest MOF. The levels of bruxism severity did not have a significant effect on MOF. The results suggest that MOF varies as a function of dental state and the interaction sex-bruxism. However, presence and severity of bruxism alone does not affect MOF.
Assuntos
Implantes Dentários , Prótese Dentária Fixada por Implante , Bruxismo do Sono , Força de Mordida , Estudos Transversais , Humanos , MasculinoRESUMO
Multi-center epidemiological studies must ascertain that their measurements are accurate and reliable. For laboratory measurements, reliability can be assessed through investigation of reproducibility of measurements in the same individual. In this paper, we present results from the quality control analysis of the baseline laboratory measurements from the ELSA-Brasil study. The study enrolled 15,105 civil servants at 6 research centers in 3 regions of Brazil between 2008-2010, with multiple biochemical analytes being measured at a central laboratory. Quality control was ascertained through standard laboratory evaluation of intra- and inter-assay variability and test-retest analysis in a subset of randomly chosen participants. An additional sample of urine or blood was collected from these participants, and these samples were handled in the same manner as the original ones, locally and at the central laboratory. Reliability was assessed with the intraclass correlation coefficient (ICC), estimated through a random effects model. Coefficients of variation (CV) and Bland-Altman plots were additionally used to assess measurement variability. Laboratory intra and inter-assay CVs varied from 0.86% to 7.77%. From test-retest analyses, the ICCs were high for the majority of the analytes. Notably lower ICCs were observed for serum sodium (ICC=0.50; 95%CI=0.31-0.65) and serum potassium (ICC=0.73; 95%CI=0.60-0.83), due to the small biological range of these analytes. The CVs ranged from 1 to 14%. The Bland-Altman plots confirmed these results. The quality control analyses showed that the collection, processing and measurement protocols utilized in the ELSA-Brasil produced reliable biochemical measurements.
Assuntos
Laboratórios/normas , Controle de Qualidade , Adulto , Brasil , Humanos , Estudos Longitudinais , Variações Dependentes do Observador , Padrões de Referência , Reprodutibilidade dos TestesRESUMO
BACKGROUND/OBJECTIVES: To investigate sex-specific associations of birth weight with body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) in mid-to-late adulthood. SUBJECTS/METHODS: ELSA-Brasil is a multicenter cohort study of adults aged 35-74 years affiliated with universities or research institutions of six capital cities in Brazil. After exclusions, we investigated 11 636 participants. Socio-demographic factors and birth weight were obtained by interview. All anthropometry was directly measured at baseline. We categorized birth weight as low (⩽2.5 kg); normal (2.5-4 kg) and high (⩾4 kg). We performed analysis of covariance (ANCOVA) for continuous outcomes and ordinal logistic regression for categorical adiposity outcomes. We examined interaction on the multiplicative scale by sex and by race. RESULTS: High birth weight uniformly predicted greater overall and central obesity in men and women. However, low (vs normal) birth weight, in ANCOVA models adjusted for participant age, family income, race, education, maternal education, and maternal and paternal history of diabetes, was associated with lower BMI, WC and WHR means for men, but not for women (Pinteraction=0.01, <0.0001 and <0.0001, respectively). In similarly adjusted ordinal logistic regression models, odds of obesity (odds ratio (OR)=0.65, 0.46-0.90) and of being in the high (vs low) tertile of WC (OR=0.66, 0.50-0.87) and of WHR (OR=0.79, 0.60-1.03) were lower for low (vs normal) birth weight men, but trended higher (BMI: OR=1.18, 0.92-1.51; WC: OR=1.21, 0.97-1.53; WHR: OR=1.44, 1.15-1.82) for low (vs normal) birth weight women. CONCLUSIONS: In this Brazilian sample of middle-aged and elderly adults who have lived through a rapid nutritional transition, low birth weight was associated with adult adiposity in a sex-specific manner. In men, low birth weight was associated with lower overall and central adult adiposity, while in women low birth weight was generally associated with greater central adiposity.
Assuntos
Adiposidade/fisiologia , Peso ao Nascer/fisiologia , Obesidade Abdominal/epidemiologia , Caracteres Sexuais , Adulto , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fenômenos Fisiológicos da Nutrição , Obesidade Abdominal/complicações , Prevalência , Fatores de Risco , Fatores Sexuais , Circunferência da Cintura/fisiologia , Relação Cintura-Quadril/estatística & dados numéricosRESUMO
Multi-center epidemiological studies must ascertain that their measurements are accurate and reliable. For laboratory measurements, reliability can be assessed through investigation of reproducibility of measurements in the same individual. In this paper, we present results from the quality control analysis of the baseline laboratory measurements from the ELSA-Brasil study. The study enrolled 15,105 civil servants at 6 research centers in 3 regions of Brazil between 2008–2010, with multiple biochemical analytes being measured at a central laboratory. Quality control was ascertained through standard laboratory evaluation of intra- and inter-assay variability and test-retest analysis in a subset of randomly chosen participants. An additional sample of urine or blood was collected from these participants, and these samples were handled in the same manner as the original ones, locally and at the central laboratory. Reliability was assessed with the intraclass correlation coefficient (ICC), estimated through a random effects model. Coefficients of variation (CV) and Bland-Altman plots were additionally used to assess measurement variability. Laboratory intra and inter-assay CVs varied from 0.86% to 7.77%. From test-retest analyses, the ICCs were high for the majority of the analytes. Notably lower ICCs were observed for serum sodium (ICC=0.50; 95%CI=0.31–0.65) and serum potassium (ICC=0.73; 95%CI=0.60–0.83), due to the small biological range of these analytes. The CVs ranged from 1 to 14%. The Bland-Altman plots confirmed these results. The quality control analyses showed that the collection, processing and measurement protocols utilized in the ELSA-Brasil produced reliable biochemical measurements.
Assuntos
Humanos , Adulto , Laboratórios/normas , Controle de Qualidade , Brasil , Estudos Longitudinais , Variações Dependentes do Observador , Padrões de Referência , Reprodutibilidade dos TestesRESUMO
AIMS: To evaluate the performance of fasting plasma glucose (FPG) in determining the need for a full oral glucose tolerance test (OGTT) to diagnose gestational diabetes (GDM) by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. METHODS: A multicenter cohort study of 4926 pregnant women 20 years or older consecutively enrolled in prenatal care clinics of the Brazilian National Health Service from 1991 to 1995. All women underwent a single 2 h 75 g OGTT by weeks 24-28 of pregnancy and were followed to detect adverse pregnancy outcomes. RESULTS: A FPG cut-off value of 80 mg/dl indicated that only 38.7% of all women needed to undergo a complete OGTT, while detecting 96.9% of all GDM cases. When the 85 mg/dl cut-off was used, the corresponding percentages were 18.7% and 92.5%, respectively. The fraction of women labeled with GDM who had adverse pregnancy outcomes was nearly identical when using FPG strategies and universal full testing. CONCLUSIONS: Using a FPG cut-off to diagnose GDM and to determine the need for post-load OGTT measurements is a valid strategy to diagnose GDM by IADPSG criteria. This approach may improve feasibility of applying IADPSG diagnostic criteria by reducing costs and increasing convenience.
Assuntos
Glicemia/análise , Diabetes Gestacional/diagnóstico , Jejum/sangue , Teste de Tolerância a Glucose/estatística & dados numéricos , Adulto , Brasil , Estudos de Coortes , Diabetes Gestacional/sangue , Feminino , Humanos , Gravidez , Sensibilidade e EspecificidadeRESUMO
The aim of this study was to investigate the relationship between feeding practices in the first year of life and the occurrence of severe early childhood caries (S-ECC) at 4 years of age. A birth cohort study (n = 500) was conducted in children who were born within the public health system in São Leopoldo, Brazil. Feeding practices were assessed using standardized methods at 6 and 12 months of age. A total of 340 children were examined at 4 years of age. S-ECC was defined as recommended by an expert panel for research purposes: ≥1 cavitated, missing or filled smooth surfaces in primary maxillary anterior teeth or d(1+) mfs ≥5. Poisson regression with robust variance was used in order to determine the early feeding practices which represent risk factors for the occurrence of S-ECC at 4 years of age. The multivariable model showed a higher adjusted risk of S-ECC for the following dietary practices at 12 months: breastfeeding ≥7 times daily (RR = 1.97; 95% CI = 1.45-2.68), high density of sugar (RR = 1.43; 95% CI = 1.08-1.89), bottle use for liquids other than milk (RR = 1.41; 95% CI = 1.08-1.86), as well as number of meals and snacks >8 (RR = 1.42; 95% CI = 1.02-1.97). Mother's education ≤8 years was also associated with the outcome. The present study identified early feeding practices which represent risk factors for caries severity in subsequent years. These findings may contribute to developing general and oral health interventions, with special attention to families with low maternal education.
Assuntos
Cárie Dentária/epidemiologia , Comportamento Alimentar , Bebidas/estatística & dados numéricos , Alimentação com Mamadeira/estatística & dados numéricos , Brasil/epidemiologia , Aleitamento Materno/estatística & dados numéricos , Pré-Escolar , Estudos de Coortes , Dente Canino/patologia , Índice CPO , Restauração Dentária Permanente/estatística & dados numéricos , Sacarose Alimentar/administração & dosagem , Escolaridade , Feminino , Seguimentos , Humanos , Incisivo/patologia , Renda/estatística & dados numéricos , Lactente , Masculino , Maxila , Mães/educação , Estudos Prospectivos , Fatores de Risco , Classe Social , Perda de Dente/epidemiologia , Dente Decíduo/patologia , Escovação Dentária/estatística & dados numéricosRESUMO
To efficiently examine the association of glutamic acid decarboxylase antibody (GADA) positivity with the onset and progression of diabetes in middle-aged adults, we performed a case-cohort study representing the ~9-year experience of 10,275 Atherosclerosis Risk in Communities Study participants, initially aged 45-64 years. Antibodies to glutamic acid decarboxylase (GAD65) were measured by radioimmunoassay in 580 incident diabetes cases and 544 non-cases. The overall weighted prevalence of GADA positivity (>or=1 U/mL) was 7.3%. Baseline risk factors, with the exception of smoking and interleukin-6 (P
Assuntos
Autoanticorpos/sangue , Diabetes Mellitus/imunologia , Glutamato Descarboxilase/imunologia , Idade de Início , Autoanticorpos/imunologia , Biomarcadores/sangue , Estudos de Coortes , Diabetes Mellitus/enzimologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radioimunoensaio , Fatores de RiscoRESUMO
To efficiently examine the association of glutamic acid decarboxylase antibody (GADA) positivity with the onset and progression of diabetes in middle-aged adults, we performed a case-cohort study representing the ~9-year experience of 10,275 Atherosclerosis Risk in Communities Study participants, initially aged 45-64 years. Antibodies to glutamic acid decarboxylase (GAD65) were measured by radioimmunoassay in 580 incident diabetes cases and 544 non-cases. The overall weighted prevalence of GADA positivity (³1 U/mL) was 7.3 percent. Baseline risk factors, with the exception of smoking and interleukin-6 (P ú 0.02), were generally similar between GADA-positive and -negative individuals. GADA positivity did not predict incident diabetes in multiply adjusted (HR = 1.04; 95 percentCI = 0.55, 1.96) proportional hazard analyses. However, a small non-significant adjusted risk (HR = 1.29; 95 percentCI = 0.58, 2.88) was seen for those in the highest tertile (³2.38 U/mL) of positivity. GADA-positive and GADA-negative non-diabetic individuals had similar risk profiles for diabetes, with central obesity and elevated inflammation markers, aside from glucose, being the main predictors. Among diabetes cases at study's end, progression to insulin treatment increased monotonically as a function of baseline GADA level. Overall, being GADA positive increased risk of progression to insulin use almost 10 times (HR = 9.9; 95 percentCI = 3.4, 28.5). In conclusion, in initially non-diabetic middle-aged adults, GADA positivity did not increase diabetes risk, and the overall baseline profile of risk factors was similar for positive and negative individuals. Among middle-aged adults, with the possible exception of those with the highest GADA levels, autoimmune pathophysiology reflected by GADA may become clinically relevant only after diabetes onset.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autoanticorpos/sangue , Diabetes Mellitus/imunologia , Glutamato Descarboxilase/imunologia , Idade de Início , Autoanticorpos/imunologia , Biomarcadores/sangue , Estudos de Coortes , Progressão da Doença , Diabetes Mellitus/enzimologia , Seguimentos , Radioimunoensaio , Fatores de RiscoRESUMO
AIMS/HYPOTHESIS: The aim of this study was to investigate the association of leptin levels with incident diabetes in middle-aged adults, taking into account factors purportedly related to leptin resistance. SUBJECTS AND METHODS: We conducted a case-cohort study (570 incident diabetes cases and 530 non-cases) representing the 9-year experience of 10,275 participants of the Atherosclerosis Risk in Communities Study. Plasma leptin was measured by direct sandwich ELISA. RESULTS: In proportional hazards models adjusting for age, study centre, ethnicity and sex, high leptin levels (defined by sex-specific cut-off points) predicted an increased risk of diabetes, with a hazard ratio (HR) comparing the upper with the lower quartile of 3.9 (95% CI 2.6-5.6). However, after further adjusting additionally for obesity indices, fasting insulin, inflammation score, hypertension, triglycerides and adiponectin, high leptin predicted a lower diabetes risk (HR=0.40, 95% CI 0.23-0.67). Additional inclusion of fasting glucose attenuated this protective association (HR=0.59, 95% CI 0.32-1.08, p<0.03 for linear trend across quartiles). In similar models, protective associations were generally seen across subgroups of sex, race, nutritional status and smoking, though not among those with lower inflammation scores or impaired fasting glucose (interaction p=0.03 for both). CONCLUSIONS/INTERPRETATION: High leptin levels, probably reflecting leptin resistance, predict an increased risk of diabetes. Adjusting for factors purportedly related to leptin resistance unveils a protective association, independent of adiponectin and consistent with some of leptin's described protective effects against diabetes.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Leptina/sangue , Adiponectina/sangue , Negro ou Afro-Americano/estatística & dados numéricos , Glicemia/análise , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos de Coortes , Diabetes Mellitus Tipo 2/sangue , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Humanos , Incidência , Inflamação/sangue , Insulina/sangue , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Obesidade/sangue , Fatores de Risco , Fumar , Triglicerídeos/sangue , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
Con el propósito de estudiar la utilidad del test de provocación con progesterona para la detección precoz de patología endometrial en mujeres postmenopáusicas asintomáticas; procedimos a la aplicación de 250 mg. de Caproato de Hidroxiprogesterona via intramuscular a 70 mujeres postmenopáusicas asintomáticas, captadas en el consultorio externo de Ginecología del Hospital Nacional Almanzor Aguinaga Asenjo - IPSS - Chiclayo. Se consideró el test positivo o negativo de acuerdo con la presencia o ausencia de sangrado uterino; se esperó 30 días y a todas las pacientes independientemente del resultado se sometieron a la biopsia con cureta de Novak; para posteriormente efectuarse el estudio histológico del endometrio. El test positivo mostró el 14.29 por ciento de endometrio hiperplásico en mujeres postmenopáusicas asintomáticas; permitiendo en el futuro un poder selectivo de las pacientes, puesto que el curetaje diagnóstico estará dirigido solo a las postmenopáusicas que sangran con el test y de esta manera detectar e instituir de forma precoz el tratamiento de lesiones consideradas en algunas mujeres como premalignas para el carcinoma endometrial