The prevalence of obesity has increased to epidemic status worldwide. Thousands of morbidly obese individuals undergo bariatric surgery for sustained weight loss; however, mid- and long-term outcomes ...of this surgery are still uncertain. Our objective was to estimate the 10-year mortality rate, and determine risk factors associated with death in young morbidly obese adults who underwent bariatric surgery. All patients who underwent open Roux-in-Y gastric bypass surgery between 2001 and 2010, covered by an insurance company, were analyzed to determine possible associations between risk factors present at the time of surgery and deaths related and unrelated to the surgery. Among the 4344 patients included in the study, 79% were female with a median age of 34.9 years and median body mass index (BMI) of 42 kg/m(2). The 30-day and 10-year mortality rates were 0.55 and 3.34%, respectively, and 53.7% of deaths were related to early or late complications following bariatric surgery. Among these, 42.7% of the deaths were due to sepsis and 24.3% to cardiovascular complications. Male gender, age ≥50 years, BMI ≥50 kg/m(2), and hypertension significantly increased the hazard for all deaths (P<0.001). Age ≥50 years, BMI ≥50 kg/m(2), and surgeon inexperience elevated the hazard of death from causes related to surgery. Male gender and age ≥50 years were the factors associated with increased mortality from death not related to surgery. The overall risk of death after bariatric surgery was quite low, and half of the deaths were related to the surgery. Older patients and superobese patients were at greater risk of surgery-related deaths, as were patients operated on by less experienced surgeons.
Abstract
Background
Periportal fibrosis (PPF) is the major pathological consequence of Schistosoma mansoni infection. The Coutinho index—the alkaline phosphatase (ALP) to platelet ratio (ALP/upper ...limit of normality {ULN}/platelet count 106/L x 100)—was validated. Validation consisted of modest laboratory tests to predict advanced PPF.
Methods
A total of 378 individuals from an endemic area of Brazil with a previous history of the disease and/or a positive parasitological examination were evaluated. We used ultrasound examination as the gold standard for classification of the PPF pattern and measured the biological markers of the index.
Results
Forty-one individuals (10.8%) without PPF, 291 (77%) with moderate PPF and 46 (12.2%) with advanced PPF, were identified. ALP and platelet count were used for the index. The cut-off point ≥0.228 predicted the presence of fibrosis with an area under the receiver operating characteristic curve (AUROC) of 0.56, sensitivity of 68.6% and specificity of 46.3%. There was an absence of PPF in 46.3% of individuals without fibrosis and the presence of PPF in 68.5% of cases with moderate and advanced ultrasound fibrosis. The identification of advanced fibrosis with a cut-off point ≥0.316 revealed an AUROC curve of 0.70, sensitivity of 67.4% and specificity of 68.3%, thus confirming the advanced phase in 65.2% of cases compared with ultrasound.
Conclusion
The Coutinho index was able to predict advanced PPF in most individuals. It is valid as a new tool, uses routine laboratory tests and therefore is more accessible for screening patients with a severe form of the disease in endemic areas.
Purpose
Evidence has shown an inverse correlation between previous dental care experience and anxiety levels in children. This study aimed to determine the prevalence of dental anxiety in Brazilian ...schoolchildren and to evaluate the association between previous experience with the dentist and anxiety and fear of pain.
Methods
This was a cross-sectional descriptive study carried out in two cities in Brazil with 1191 schoolchildren aged 6–12 years. The data were collected through interviews and clinical examination. The interviews followed the
Dental Anxiety Question
(DAQ), the
Fear of Dental Pain Questionnaire Short Form
(S-FDPQ) adapted to children, and some sociodemographic questions.
Results
Dental anxiety was more prevalent in the younger group, with a higher prevalence of moderate and severe anxiety. The group with extreme anxiety showed a higher prevalence of extreme fear, whereas the group who did not present anxiety showed a higher prevalence of children with moderate fear of pain. Children who had not visited the dentist showed a higher prevalence of fear and a lot of fear (33.5%) as compared to those who had already experienced dental care (13.9%). The prevalence of severe anxiety and extreme fear of pain was higher in the group of female children aged 6–9 years, and with caries experience (
P
< 0.001).
Conclusions
The experience with the dentist was associated with less anxiety and fear of pain. The age of the child was a determining factor for changes in their anxiety level. Severe dental anxiety influences fear of pain experienced by the child.
The International Agency for Research on Cancer (IARC) classifies benzene in group 1 (carcinogenic to humans). Particulate matter (PM) has recently also been classified in this category. This was an ...advance toward prioritizing the monitoring of particles in urban areas. The aim of the present study was to assess levels of PM
2.5
and BTEX (benzene, toluene, ethylbenzene, and xylene), the influence of meteorological variables, the planetary boundary layer (PBL), and urban variables as well as risks to human health in the city of Fortaleza, Brazil, in the wet and dry periods. BTEX compounds were sampled using the 1501 method of NIOSH and determined by GC-HS-PID/FID. PM
2.5
was monitored using an air sampling pump with a filter holder and determined by the gravimetric method. Average concentrations of BTEX ranged from 1.6 to 45.5 μg m
−3
, with higher values in the wet period, which may be explained by the fact that annual distribution is influenced by meteorological variables and the PBL. PM
2.5
levels ranged from 4.12 to 33.0 μg m
−3
and 4.18 to 86.58 μg m
−3
in the dry and wet periods, respectively. No seasonal pattern was found for PM
2.5
, probably due to the influence of meteorological variables, the PBL, and urban variables. Cancer risk ranged from 2.46E
−04
to 4.71E
−03
and 1.72E
−04
to 2.01E
−03
for benzene and from 3.07E
−06
to 7.04E
−05
and 3.08E
−06
to 2.85E
−05
for PM
2.5
in the wet and dry periods, respectively. Cancer risk values for benzene were above the acceptable limit established by the international regulatory agency in both the dry and wet periods. The results obtained of the noncarcinogenic risks for the compounds toluene, ethylbenzene, and xylene were within the limits of acceptability. The findings also showed that the risk related to PM is always greater among smokers than nonsmokers.
We investigated whether high adherence to the Dietary Approaches to Stop Hypertension (DASH) diet was independently associated with lower risk of incident hypertension. Participants included 5632 ...adults, without hypertension at the baseline (2008-2010) of the Longitudinal Study of Adult Health, who took part in the second follow-up visit (2012-2014). Adherence to the DASH diet was estimated at baseline using a score based on eight food items (final scores from 8 to 40 points) and was categorised as high adherence (≥30 points, or ≥75 %) and low adherence (<75 %; reference). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg, or use of antihypertensive drugs. The association between adherence to the DASH diet and the risk of incident hypertension was estimated using Cox regression models adjusted by covariates. In total, 780 new cases of hypertension (13·8 %) were identified in about 3·8-year follow-up. Participants with high adherence to the DASH diet had 26 % lower risk of hypertension (hazard ratio (HR) 0·74; 95 % CI 0·57, 0·95) after adjustment for socio-demographic characteristics, health-related behaviours, diabetes and family history of hypertension. The HR reduced to 0·81 (95 % CI 0·63, 1·04) and was of borderline statistical significance after adjustment for BMI, suggesting that lower body weight explains about 10 % of the association between high adherence to the DASH diet and hypertension risk reduction. The results indicate that high adherence to the DASH diet lowered the risk of hypertension by one-fourth over a relatively short follow-up period.
Abstract Statement of problem Despite the advances in materials and techniques, adhesion to dentin is challenging because of the complex composition of dentin’s mineral, organic, and fluid phases. ...Purpose The purpose of this in vitro study was to evaluate the bond strength of 2 different resin cements (conventional and self-adhesive) with or without previous dentin sealing and the effect of interim cement. Material and methods Forty-five molars were embedded into acrylic resin blocks and a flat dentin surface was exposed. Twenty teeth (n=5 per group) were treated with the conventional resin cement associated with etch-and-rinse or self-etch adhesive approaches, applied before (immediate dentin sealing) or after (delayed dentin sealing) the application/removal of interim cement. Another 25 teeth (n=5, per group) were treated with self-adhesive resin cement with (self-etch mode immediate dentin sealing or delayed dentin sealing) or without adhesive application. Furthermore, in the self-adhesive resin cement group, the application of polyacrylic acid for dentin etching before cementation was evaluated. Composite resin blocks were cemented onto flat, treated dentin surfaces, and the assemblies were sectioned into bar-shaped specimens for microtensile bond strength testing. The data were subjected to 1-way ANOVA followed by the post-hoc Tukey test (α=.05). The failure patterns were classified as cohesive, adhesive, or mixed. Results The application of adhesive before interim cement (immediate dental sealing) promoted the highest values of bond strength for both resin cements ( P <.001). For self-adhesive resin cement, polyacrylic acid-enhanced bond strength after the application of interim cement. Conclusions The application of dental adhesive immediately after tooth preparation (immediate dentin sealing) and before the use of an interim cement promoted the highest values of bond strength to dentin with the resin cements tested.
The malnutrition-inflammation score (MIS) combines ten components to assess nutritional status. Higher MIS has been associated with higher mortality and poorer health-related quality of life (HRQOL) ...in maintenance hemodialysis (MHD) patients. It is interesting to investigate associations of each component with mortality and patient-reported outcomes (PROs), that is, HRQOL and depression symptoms, and if MIS associations are generalizable for diverse populations. This study assessed associations of MIS and its components with mortality and PROs in an African descent MHD population.
Prospective cohort for mortality and cross-sectional design for PROs using data of the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO).
A total of 632 MHD patients (92% black or mixed race) treated in Salvador, Brazil.
MIS (range: 0-30, higher worse) and each of its ten components (range: 0-4, higher worse).
Mortality, HRQOL using the KDQOL-SF, and depression symptoms using the 20-item Center for Epidemiological Studies Depression Scale.
Linear regression for comparing scores and Cox regression for mortality.
After extensive adjustments, MIS ≥6 was associated with 52% higher mortality (hazard ratio = 1.52; 95% confidence interval = 1.13-2.05), higher depression symptoms, and poorer HRQOL, including physical, mental, and kidney disease-targeted HRQOL measures. Weight change, comorbidity, muscle wasting, and albumin were the MIS components indicating associations between poor nutrition and higher mortality. By contrast, gastrointestinal symptoms and functional capacity were the MIS components denoting detrimental associations of poorer nutritional status with PROs.
Causal conclusions are not possible.
The PROHEMO results indicate that MIS components associated with mortality are not the same associated with PROs. However, the MIS showed consistent associations with mortality and PROs. These results in a population that were not the target of previous investigations, add support for using tools combining nutritional components, such as MIS, to predict outcomes in MHD populations.
Aim
The study explored the views and attitudes of nurses and physicians on family presence during resuscitation in emergency departments in Brazil.
Background
International emergency associations ...endorse family presence during resuscitation; however, the extent to which it is practiced remains unclear, particularly in the Brazilian context. Research of emergency staff views and attitudes towards this practice is desirable so that actions can be identified to support families at the bedside.
Methods
A qualitative research was conducted. Thirty‐two health professionals (11 physicians and 21 nurses) working in two emergency departments in southern Brazil were purposefully recruited in January 2015. In‐depth interviews were conducted, and data were analysed using content analysis.
Findings
Nurses and physicians found family presence during resuscitation controversial and the general attitude towards this practice was negative. They reported that ‘changes are needed’ to adapt hospital infrastructures for family presence, and to train staff to respond to the information and emotional needs of families.
Discussion
Translating a family nursing framework into clinical practice involves the need for reassessing educational and management policies in clinical contexts.
Conclusion
This research brings new understanding about the attitudes of some Brazilian nurses and physicians on the implementation of family presence during resuscitation and identifies the need to develop policies and strategies to improve family presence in emergency departments.
Implications for nursing and health policy
Hospital‐based policies are required to improve family‐centred care in emergency departments while providing a criterion of legality and safety to professionals to invite families to be present during invasive procedures. Also, family‐focused education in health science degrees, continuing education and in the community is required.
Aim
To estimate the association between consumption of sugar-sweetened soft drinks and unsweetened fruit juice with metabolic syndrome (MetS) and its components in participants of the Brazilian ...Longitudinal Adult Health Study (ELSA-Brasil) after 4 years of follow-up.
Methods
We used data from ELSA-Brasil cohort (
N
= 15,105). The sample consisted of 6,124 civil servants free of the MetS at baseline (35 to 74 years, both sexes). The consumption of sugar-sweetened soft drinks and unsweetened fruit juice was estimated by a food frequency questionnaire previously validated. The outcome was MetS and its components (Joint Interim Statement criteria). To test the association between beverage consumption at baseline (2008–2010) and MetS and its components at follow-up (2012–2014), we used Poisson regression models with robust variance adjusting for potential confounders.
Results
After 4-year follow-up, the higher consumption of sugar-sweetened soft drinks (≥ 1 serving/day = 250 mL/day) increased the relative risk of MetS (RR = 1.22; 95% CI 1.04–1.45), high fasting glucose (RR = 1.23; 95% CI 1.01–1.48), and high blood pressure (RR = 1.23; 95% CI 1.00–1.54). Moderate consumption of this beverage (0.4 to < 1 serving/day) increased the relative risk of high waist circumference (WC) (RR = 1.21; 95% CI 1.02–1.42). After adjustment for confounding variables, the consumption of unsweetened fruit juice was not associated with the MetS and its components.
Conclusion
Higher sugar-sweetened soft drinks consumption was associated with a higher risk relative of MetS, high fasting glucose, and high blood pressure, while moderate consumption of this beverage increased the relative risk of high WC in Brazilian adults.
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