Diss. (sammanfattning) Stockholm : Karol inst., 2004. / Härtill 5 uppsatser.

Thesis (M.S.)--University of Michigan, 1984.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.

Thesis (M.S.)--University of Michigan, 1947.

Thesis (M.S.)--University of Michigan, 1984.

Respiratory assistance devices bypass essential host defenses and allow these pathogens direct access to the lower respiratory tract and hinder these defense systems to effectively clear respiratory pathogens (1). Mechanical ventilation in the presence of dental plaque with respiratory pathogens has the potential to lead to ventilator-associated pneumonia (VAP). Ventilator-associated pneumonia is the leading cause of morbidity and mortality in intensive care units. VAP influences increasing need for medical treatment and hospital length of stay (LOS) (2-4). Lower respiratory tract infections (LRTI) have been found to be the most expensive site per infection with 13% of all infections accounting for 29% of the total recorded cost (5). The purpose of this systematic review is to perform a comprehensive literature search to identify published randomized clinical trials relating to the efficacy of chlorhexidine gluconate (CHX) oral rinse in preventing VAP. CHX has been identified as the "gold standard" to reduce the number of microorganisms. This review also addresses the importance of oral health and the increased risk of respiratory infections from colonization by harmful pathogens within the oral mucosa. Clinical trials relating to the hypothesis in question were evaluated using Consolidated Standards of Reporting Trials (CONSORT) checklist for validity. Quality and strength of each randomized clinical trial were evaluated based on the requirements of the Agency for Healthcare Research and Quality (AHRQ). Nine bibliographic databases, from 1965-2012 were used to conduct the literature inquiry. Ten studies included populations greater than or equal to 18 years of age and admitted to the intensive care unit receiving mechanical ventilation. The patients were, ventilated due to either trauma, undergoing elective cardiothoracic surgery, or from some other form of surgery, at risk for VAP. In one study, CHX oral rinse decreased microbial colonization of the respiratory tract and hospital-acquired pneumonia (HAP) in patients who underwent open-heart surgery and were intubated less than 24 hours. Yet the difference was not significant in patients intubated more than 24 hours who had a higher amount of bacterial colonization (6). Modulation of oropharyngeal colonization by the use of oral chlorhexidine has reduced the number of ICU-acquired HAP in selected patient populations such as those undergoing coronary bypass grafting, but its routine use is not recommended until more data become available (7). Findings from several studies suggest a significant decrease in the incidence of total nosocomial respiratory infections and systemic antibiotic use in patients who underwent open heart and used a CHX oral rinse as compared with ventilator patients who did not use the rinse; there was also a 65% decrease (13% vs. 4%) in the overall nosocomial infection rate in the chlorhexidine group (7,8,9). Using 2% chlorhexidine solution presents the strongest evidence for decreasing VAP (10,11). From Scannapieco and colleagues' study we can conclude that twice daily is not necessarily better than once daily, but maybe a four times daily regimen with 2% instead of 0.12% CHX does make a difference in reducing the incidence of VAP (12).

Atualmente, há uma escassez de estudos que avaliem desfechos positivos. A relação existente entre a autopercepção positiva de saúde bucal e processos de enfrentamento relacionados com a resiliência, por exemplo, parece ainda não ter sido investigada. O objetivo deste trabalho foi avaliar a autopercepção positiva de saúde bucal e sua associação com um conjunto de variáveis, entre elas a resiliência, através de um modelo teórico conceitual, em idosos vivendo na comunidade, na região Sul do Brasil. Foram avaliados 498 indivíduos, através de um estudo transversal aninhado em um estudo de coorte. Os participantes responderam a um questionário sócio-demográfico, a Escala de Resiliência e passaram por um breve exame aonde os pesquisadores realizaram a contagem do número de dentes. Baseado em uma análise hierárquica realizada através de regressão de Poisson com variância robusta, as razões de prevalência estimadas das variáveis que ficaram significativamente associadas com o desfecho em estudo, após a análise totalmente ajustada, foram: 1) alto potencial de resiliência: RP= 0,83, 95% IC (0,75-0,93), 2) localização geográfica do domicílio na área rural: RP= 1,18, 95% IC (1,06-1,32), 3) renda: RP= 1,18, 95% IC (1,07-1,3) e 4) não necessidade de mudanças de dieta: RP= 1,34, 95% IC (1,13-1,6). Portanto, os resultados confirmam a hipótese de associação entre elevado potencial de resiliência e autopercepção positiva de saúde bucal. / Currently, there are a few studies that assess positive outcomes. The importance of coping strategies, lead by resilience, on positive perception of oral health has drawn little attention from oral health researchers. The objective of this study was to evaluate positive self-perceived oral health and its association with a set of variables, including resilience, using a theoretical framework, among independent-living older persons in Southern Brazil. We studied 498 persons in a cross-sectional study nested in a cohort study. The participants were evaluated using a structured questionnaire to assess socio-demographic data and resilience potential (Resilience Scale). Furthermore, a brief oral examination assessing the number of teeth was performed. A hierarchical analysis was carried out using Poisson regression with robust variance. A final, fully adjusted regression model showed that the following variables were associated with positive self-perceived oral health 1) elevated resilience potential: PR=0,83, 95% IC (0,75-0,93), 2) living in the rural area: PR=1,18, 95% IC (1,06-1,32), 3) income: PR=1,18, 95% IC (1,07-1,3), and 4) unchanged diet due to oral problems: RP= 1,34, 95% IC (1,13-1,6). Therefore, the results confirm the hypothesis of an association between elevated resilience potential and positive self-perceived oral health.

Introdução: A prevalência de obesidade cresce rapidamente na população brasileira. Para obesidade mórbida, o único tratamento efetivo é a cirurgia bariátrica, que proporciona redução do peso, das comorbidades associadas e aumento da qualidade de vida. O objetivo deste estudo foi verificar o impacto da cirurgia bariátrica na saúde bucal dos pacientes com obesidade mórbida através de uma coorte prospectiva. A hipótese é que a cirurgia bariátrica poderia causar piora da saúde bucal. Método: Todos os pacientes que realizaram cirurgia bariátrica no Hospital Nossa Senhora da Conceição entre outubro de 2009 e janeiro de 2011 foram convidados a participar do estudo. Medidas: foram realizados exames bucais (cárie, pelo índice ICDAS; índices de placa e sangramento gengival; fluxo salivar em repouso e estimulado; uso de próteses) e entrevistas (dados sócio-demográficos, hábitos bucais, sensação subjetiva de boca seca, doenças sistêmicas e medicamentos em uso) em duas etapas, uma linha de base um dia antes da cirurgia e um exame de acompanhamento seis meses após a cirurgia. Foi realizada análise descritiva das variáveis, qui-quadrado, teste exato de Fischer, teste t de student para amostras pareadas e teste de Mann-Whitney. 9Continua) Resultados: Trinta e nove pacientes concluíram as duas etapas do estudo. Houve redução estatisticamente significativa na prevalência de hipertensão arterial (p<0,01), diabetes (p<0,01), número de medicamentos utilizados diariamente (p<0,01), sensação subjetiva de boca seca (p<0,01) e aumento do fluxo salivar estimulado (p<0,01). Conclusão: Os resultados mostram melhora na saúde bucal dos pacientes submetidos à cirurgia bariátrica, já que a sensação de boca seca diminuiu e o fluxo salivar aumentou. Estes 6 resultados rejeitam a hipótese do estudo e podem ser reflexo da melhora na saúde sistêmica destas pessoas e da redução significativa do número de medicamentos utilizados por elas diariamente. / Background: The prevalence of obesity is increasing in the Brazilian population. For morbid obesity, the only effective treatment is bariatric surgery, resulting in weight reduction, less comorbidities and icreased quality of life. The aim of this study was to assess the impact of bariatric surgery in oral health parameters of morbid obese patients by a prospective cohort study. The hypothesis is that bariatric surgery causes oral health deterioration. Methods: All patients who underwent bariatric surgery at the Nossa Senhora da Conceição Hospital between October 2009 an January 2011 were invited to participate. Thirty-nine patients completed the two stages of the study, a baseline one day before surgery and a follow-up after six months. Measurements: Oral examinations were performed (caries by means of the ICDAS index, plaque index, gingival index, rest and stimulated saliva flow and use of prostheses) and followed by a questionnaire (socio-demographic data, oral health behavior, xerostomia, systemic diseases and medicines intake) in two distinct moments, a baseline 1 day before surgery and a follow-up examination six months after surgery. Analysis was carried out by means of, chi-square, Fischer’s exact test, paired samples Student’s t test and Mann-Whitney test. Results: There was a statistically significant reduction in the prevalence of hypertension (p<0,01), diabetes (p<0,01), number of medications taken daily (p<0,01), subjective sensation of dry mouth (p<0,01) and increased stimulated salivary flow (p<0,01). Conclusions: The results show improvement in oral health of patients undergoing bariatric surgery, as the sensation of dry mouth decreased and salivary flow increased. These results reject the hypothesis of the study and may reflect the improvement in the systemic health of morbid obese people and the significant reduction in the number of drugs used by them.

A condição bucal e a falta de condições mastigatórias adequadas têm sido implicadas como indicadores de risco para má alimentação e desnutrição. Indivíduos com um número menor de dentes ou edêntulos são considerados menos propensos a comer alimentos ricos em nutrientes, como vegetais, frutas, carne e grãos integrais. Há evidências que a condição bucal alterada causa restrições dietéticas através da dificuldade em mastigar, comprometendo o estado nutricional e bem-estar dos indivíduos. Esta dissertação é composta por dois estudos, uma revisão sistemática da literatura com meta- análise e um estudo transversal. A revisão sistemática da literatura com meta-analise avaliou e comparou o estado de saúde bucal (perda de dentes, uso de prótese e DMFT) em idosos bem-nutridos, em risco de desnutrição e indivíduos desnutridos. Dois pesquisadores analisaram a inclusão dos títulos, resumos, leitura completa (MPT e FWMGM), outros dois fizeram a extração de dados dos artigos (PSA e MPT) e se um consenso não fosse possível, um terceiro pesquisador estaria incluído neste processo. De 110 artigos lidos na íntegra, 26 foram incluídos na revisão sistemática, dos quais 23 eram transversais. Foi demonstrado que os sujeitos com estado nutricional normal tinham um número significativamente maior de pares de dentes / Unidades Funcionais de Dentes (FTU) em comparação com aqueles que estavam desnutridos ou em risco de desnutrição. As meta-análises não mostraram associação estatisticamente significante entre edentulismo e uso de prótese, pois o risco relativo combinado foi de 1,072 (IC 95% 0,957 - 1,200, p = 0,230) e 0,874 (IC 95%: 0,710 - 1,075, p = 0,202). Por outro lado, o desvio padrão médio do número médio de dentes presentes foi de -0,141 (IC 95% -0,278 - 0,005, p = 0,042) em indivíduos com desnutrição / risco de desnutrição. O estudo transversal avaliou a condição bucal e o estado nutricional de pacientes que se encontravam internados nas enfermarias do Hospital de Clínicas de Porto Alegre (HCPA), no período de dezembro de 2015 e junho de 2016. O presente estudo incluiu 394 participantes com idade média de 63.43±10.76 entre os indivíduos diabéticos (87 mulheres e 110 homens) e 59,85±15,18 entre os não diabéticos (93 mulheres e 104 homens). Os indivíduos diabéticos (18,33±12,79) permaneceram em média mais tempo internados do que os indivíduos não diabéticos (16,53±14,54). As variáveis sexo, número de dentes, tempo de internação e capacidade funcional mastigatória estavam associadas à desnutrição na análise uni-variada. Na análise multivariada, sexo, número de dentes e tempo de internação mantiveram-se associados à desnutrição. Apresente dissertação conclui que existe associação entre a condição bucal e a desnutrição. Indivíduos com perdas dentárias apresentam maior risco desnutrição, o que foi demostrado tanto na meta análise quanto no estudo transversal. / The oral condition and the lack of adequate masticatory conditions have been implicated as risk indicators for malnutrition and malnutrition. Individuals with fewer teeth or edentulous are considered less likely to eat foods rich in nutrients such as vegetables, fruits, meat and whole grains. There is evidence that altered oral status causes dietary restrictions through difficulty in chewing, compromising the nutritional status and well-being of individuals. This dissertation is composed of two studies, a cross-sectional study and a systematic review of the literature with meta-analysis. The cross-sectional study evaluated the oral condition and nutritional status of patients hospitalized in the Hospital das Clinicas de Porto Alegre (HCPA), from December 2015 to June 2016. The present study included 394 middle-aged participants Of 63.43 ± 10.76 among diabetic subjects (87 women and 110 men) and 59.85 ± 15.18 among non-diabetics (93 women and 104 men). Diabetic individuals (18.33 ± 12.79) remained on average longer hospitalized than non-diabetic individuals (16.53 ± 14.54). The variables gender, number of teeth, length of hospital stay and functional masticatory capacity were associated with malnutrition in the univariate analysis. In the multivariate analysis, sex, number of teeth and length of stay remained associated with malnutrition. The systematic review of the literature with meta-analysis evaluated and compared the state of oral health (tooth loss, prosthesis use and FWD) in well-nourished elderly, at risk of malnutrition, and malnourished individuals. Two researchers analyzed the inclusion of titles, abstracts, full reading (MPT and FWMGM), two others extracted data from articles (PSA and MPT) and if a consensus was not possible, a third researcher would be included in this process. Of 110 articles read in full, 26 were eligible for inclusion. Twenty-six studies were included in the systematic review, of which 23 were cross-sectional. It was shown that subjects with normal nutritional status had significantly more pairs of teeth / functional tooth units (FTU) compared to those who were malnourished or at risk of malnutrition. The meta-analyzes did not show a statistically significant association between edentulism and prosthesis use, since the combined relative risk was 1.072 (95% CI 0.957-1.1200, p = 0.230) and 0.874 (95% CI: 0.710-0.075, p = 0.202 ). On the other hand, the mean standard deviation of the mean number of teeth present was -0.141 (95% CI -0.278-0.005, p = 0.042) in subjects with malnutrition / risk of malnutrition. The present dissertation concludes that there is an association between the oral condition and malnutrition. Individuals with dental losses present a greater risk of malnutrition, which was demonstrated both in the meta-analysis and in the cross-sectional study.

Estudo transversal de base populacional cujo objetivo é investigar a prevalência do impacto odontológico no desempenho diário e sua relação com variáveis demográficas e sociais em indivíduos com 50 anos a 74 anos (n= 720), em três Distritos Sanitários de Porto Alegre-RS. Utilizou-se uma amostragem por múltiplos estágios. Foram realizadas entrevistas domiciliares utilizando um questionário contendo informações sobre aspectos sociais e demográficas e o indicador sócio-dental: “Oral impact on daily performances” (OIDP). Mais da metade dos sujeitos, (57,8%), relataram pelo menos um desempenho diário afetado por problemas bucais. Comer, (36,8%), sorrir, dar risada e mostrar os dentes sem ficar envergonhado (30,7%) e falar claramente (19,6%) foram os desempenhos diários de maior impacto odontológico. Não se observou relação estatisticamente significativa entre o impacto e as variáveis sociais e demográficas. Os principais problemas bucais causadores de impactos foram dentadura mal-ajustada e perda de dentes. A alta prevalência de impacto encontrada demonstra a influência dos problemas bucais no desempenho das atividades diárias dos indivíduos. / Cross-sectional study of population base whose main objective is to investigate the prevalence of dental impacts on daily performance and its relationship with demographic and social variables in individuals aged 50 to 74 years (n = 720) from 3 Health Districts in Porto Alegre-RS. A sample for multiple stages was used. Data were collected through interviews using a questionnaire containing information on social and demographic aspects and the socio-dental pointer: "Oral impact on daily performances” (OIDP). More than half of the subjects (57,8%), reported at least one daily performances affected by oral health problems in this population. Eating (36.8%), smiling , laughing and showing teeth without being ashamed (30,7%) and speaking clearly (19,6%) were the daily performances of the greatest dentistry impact. There was no statistical significant relation between oral impact and socio-demographic variables. The main oral problems causing impacts were ill-fitting dentures and tooth loss. The high prevalence of oral impact which was reported demonstrates the influence of oral problems in the performance of daily activities of the individuals.