Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease. This article addresses several pertinent aspects related to the medical implications of periodontal disease in the elderly. There is moderate evidence that improved oral hygiene may help prevent aspiration pneumonia in high-risk patients. For other medical conditions, because of the absence of well-designed randomized clinical trials in elderly patients, no specific guidance can be provided regarding oral hygiene or periodontal interventions that enhance the medical management of older adults.

Oral inflammation and infection, and chronic medical diseases: implications for the elderly

JESUS, L.C. Religious and spiritual coping among nursing professionals who work in emergency units. 2011. 83p. Dissertation (MA) – Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, 2011. Researches published in the area of spiritual/religious coping (SRC) still not addressed this issue related to nursing professionals who are submitted to different stress factors arising not only from their work practice, but also from their everyday life outside the workplace. This study aimed to verify if nursing staff (assistants, technicians and nurses) uses the spiritual/religious coping to deal with the stress factors experienced both at work and in private life. It is a cross-sectional, descriptive, and quantitative study in which all nurses of the Emergency Unit of the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School were invited to participate, obtaining a sample of 126 participants who were given an envelope containing a free consent form, the General Questionnaire, and the Spiritual Religious Coping Scale (SRCOPE Scale), which were completely filled out by the participants out of the workplace and then returned to the researcher. The results showed that the SRC average was 3.66, the positive SRC average was 3.11, the negative SRC average was 1.78, and that women make more use of positive spiritual/religious coping than men. Regarding the situation of stress mentioned by the participants, it was found that the majority reported having experienced a stressful situation in the family setting (61.1%); 25.4% reported having experienced a stressful situation in the workplace; 2.4% reported having experienced stressful situations in both environments; and 10.3% reported not having experienced any stressful situation during the period of the study. Only 0.8% of the participants did not answer the questions. The results obtained through the index of the SRC Scale were expected in view of the religiosity of the Brazilian people, especially the religiosity of Brazilian women, however, it was not seen the impact of the use of spiritual/religious coping for the health of this professional category, which warrants further studies, particularly with respect to the impact of the use of negative dimension of the SRC, which, although it was rarely used by the participants in this study, it is an important information that can affect the health of those who make its use, leaving it to future researchers in this area also investigate possible ways to work to achieve the promotion of the spiritual dimension of nursing professionals.

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Universidade de são paulo escola de enfermagem de ribeirão preto

Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.

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Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review

BACKGROUND

Considering the increasing number of elderly people, dementia has gained an important role in today's society. Although the contributing factors for dementia have not been fully understood, chronic periodontitis (CP) seems to have a possible link to dementia.

AIM

To conduct a systematic review including meta-analysis in order to assess potential differences in clinical periodontal variables between patients with dementia and non-demented individuals.

METHODS

The following focused question was evaluated: is periodontitis associated with dementia? Electronic searches in two databases, MEDLINE and EMBASE, were conducted. Meta-analysis was performed with the collected data in order to find a statistically significant difference in clinical periodontal variables between the group of dementia and the cognitive normal controls.

RESULTS

Forty-two articles remained for full text reading. Finally, seven articles met the inclusion criteria and only five studies provided data suitable for meta-analysis. Periodontal probing depth (PPD), bleeding on probing (BOP), gingival bleeding index (GBI), clinical attachment level (CAL), and plaque index (PI) were included as periodontal variables in the meta-analysis. Each variable revealed a statistically significant difference between the groups. In an attempt to reveal an overall difference between the periodontal variables in dementia patients and non-demented individuals, the chosen variables were transformed into units that resulted in a statistically significant overall difference (p < 0.00001).

CONCLUSION

The current findings indicate that compared to systemically healthy individuals, demented patients show significantly worse clinical periodontal variables. However, further epidemiological studies including a high numbers of participants, the use of exact definitions both for dementia and chronic periodontitis and adjusted for cofounders is warranted.

CLINICAL RELEVANCE

These findings appear to support the putative link between CP and dementia. Consequently, the need for periodontal screening and treatment of elderly demented people should be emphasized.

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Clinical periodontal variables in patients with and without dementia—a systematic review and meta-analysis

The scope of this article is to compare the effect of three health and nutrition education strategies on adherence to the non-pharmacological treatment of systemic arterial hypertension (SAH), using anthropometric, biochemical, clinical and dietetic parameters. It is a longitudinal intervention study of the comparative and quantitative approach community test. The sample was comprised of 212 individuals diagnosed with SAH, who met the inclusion/exclusion criteria. Participants were allocated into three groups, in order to evaluate different methods of intervention, carried out on a monthly basis, for twelve months. The Kolmogorov-Smirnov, ANOVA and Kruskal-Wallis tests were performed for the analyses. Educational interventions in Group 1 and 2 provided the best results on adherence to the non-pharmacological treatment of SAH. In the comparative analysis of different groups, the reduction of glucose showed statistical significant difference, with Group 2 showing the best evolution. Group 1 and 2 had better results on adherence to non-pharmacological treatment of SAH. It is important to stress that in health service practices there is a challenge to promote health education able to intervene on the issue of adherence to the treatment of SAH.

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Análise de três estratégias de educação em saúde para portadores de hipertensão arterial

OBJECTIVE: To verify the efficacy of health education on the adherence to non-pharmacological treatment in arterial hypertension. METHODS: Habits related to nutrition, physical activity and use of tobacco and alcohol were analyzed, as well as assessment of anthropometric and blood pressure levels, before and after the performance of group health education in 216 hypertensive patients. RESULTS: There was a statistically significant change in the consumption of legumes, in the adherence to physical activity, in the reduction of body mass index and abdominal circumference, and in the control of arterial pressure, after the health education groups. CONCLUSION: The proposed health education was effective in incentivizing the adherence to non-pharmacological treatment in arterial hypertension, evidenced by the relevance of the adoption of these educational strategies

https://www.scielo.br/pdf/ape/v26n2/v26n2a12.pdf

Eficácia da educação em saúde no tratamento não medicamentoso da hipertensão arterial

doi: 10.1111/j.1741-2358.2011.00541.x



Cognitive impairment, the Mini-Mental State Examination and socio-demographic and dental variables in the elderly in Brazil



Background:  Dementia, a syndrome characterised by multiple cognitive impairments, is an increasing medical and social problem across the world. The Mini-Mental State Examination (MMSE) is the instrument most often used in the evaluation of cognitive compromise and dementia in elderly individuals. It is noteworthy that there is a scarcity of works in the literature on the dimensions of the MMSE and its relation to dental variables in the elderly.



Objectives:  To evaluate the condition of cognitive impairment, the dimensions of the MMSE, and the latter’s relation to socio-demographic and dental variables in elderly individuals of Montes Claros, Minas Gerais, Brazil.



Material and methods:  This is a cross-sectional descriptive study, whereby 218 elderly users of the system were evaluated at the Sistema Unico de Saude (Brazilian health service) in Montes Claros. The collection of data involved the realisation of structured interviews and clinical dentistry examinations. The screening of cognitive impairment was carried out with the Portuguese version of MMSE. The data were subjected to descriptive and bivariate analyses.



Results:  The prevalence of cognitive impairment found was 6.4%. A statistically significant association was observed between cognitive decline and age, marital status and use of dental prostheses. An association was also noted between several dimensions of MMSE and edentulism (time orientation, attention and calculation, and final score) and use of prostheses (except evocation memory and language).



Conclusions:  It was noticed that those who were 80 years old or more, not married and using prostheses were more likely to manifest cognitive impairment. Associations between some MMSE dimensions were established, including the final score, with edentulism and the use of prostheses.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1741-2358.2011.00541.x

Cognitive impairment, the Mini‐Mental State Examination and socio‐demographic and dental variables in the elderly in Brazil

Objective: To verify the efficacy of health education on the adherence to non-pharmacological treatment in arterial hypertension. Methods: Habits related to nutrition, physical activity and use of tobacco and alcohol were analyzed, as well as assessment of anthropometric and blood pressure levels, before and after the performance of group health education in 216 hypertensive patients. Results: There was a statistically significant change in the consumption of legumes, in the adherence to physical activity, in the reduction of body mass index and abdominal circumference, and in the control of arterial pressure, after the health education groups. Conclusion: The proposed health education was effective in incentivizing the adherence to non-pharmacological treatment in arterial hypertension, evidenced by the relevance of the adoption of these educational strategies for health professionals.

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Effectiveness of education in health in the non- medication treatment of arterial hypertension Eficácia da educação em saúde no tratamento não medicamentoso da hipertensão arterial

Resumo O objetivo deste artigo e identificar os fatores associados aos custos das internacoes hospitalares por Condicoes Sensiveis a Atencao Primaria (CSAP) no Sistema Unico de Saude (SUS). Trata-se de um estudo transversal, analitico, com amostras aleatorias de hospitalizacoes no SUS, ao longo de dois anos. Foram avaliadas a distribuicao dos custos e a duracao de 414 internacoes segundo sexo, faixa etaria e CSAP. O alto custo teve uma prevalencia de 37,8% e esteve associado a idade superior a 40 anos, nao casados, renda menor que 1,5 salarios minimos, internacao superior a sete dias e internacao na unidade de tratamento intensivo (UTI). O periodo medio das internacoes foi de 9,35 dias e o custo medio de R$ 3.606,09. A internacao do jovem teve um custo/dia de R$ 207,08, enquanto os idosos tiveram um custo/dia de R$ 399,53. Os homens tiveram maior prevalencia de internacoes e foram responsaveis pelo maior custo medio de internacao. Foram prevalentes as doencas cardiacas, as pulmonares e as cerebrovasculares, sendo que as cardiacas foram responsaveis pelo maior custo de internacao. Esses resultados apontam a urgente necessidade de fortalecimento da Atencao Primaria a Saude, com monitorizacao constante dessas doencas, visto que os recursos disponiveis deveriam ser suficientes para trata-las, sem que haja a necessidade de internacao hospitalar e gastos desnecessarios.

Fatores associados ao custo das internações hospitalares por doenças sensíveis à Atenção Primária no Sistema Único de Saúde

Resumo Objetivo: investigar a condicao de saude bucal, o acesso a servicos odontologicos e fatores sociodemograficos associados a essa acessibilidade em idosos quilombolas rurais do norte do estado de Minas Gerais, Brasil. Metodo: trata-se de um estudo analitico e transversal de base populacional, no qual foi utilizada uma amostragem por conglomerados com probabilidade proporcional ao tamanho (n=406). A coleta de dados envolveu a realizacao de entrevistas estruturadas e exames clinicos odontologicos. Resultados: verificou-se que a maioria dos idosos possuia baixa renda e baixa escolaridade. Observou-se que parcela expressiva dos individuos relatou acesso a um cirurgiao-dentista (97,5%) e que havia realizado a ultima consulta odontologica ha tres anos ou mais (60,4%). Foi verificado ainda que a maior parte dos idosos era edentula (52,0%) e que a maioria dos pesquisados necessitava de proteses (88%). Um alto indice CPO-D foi constatado nos individuos estudados (valor medio de 27,25). Idade avancada, ausencia de companheiro e aposentadoria se mostraram associadas ao acesso irregular aos servicos odontologicos. Conclusao: os idosos quilombolas locais possuiam uma condicao precaria de saude bucal e tinham acesso restrito aos servicos odontologicos. Idade, estado conjugal e situacao laboral demonstraram associacao com baixa acessibilidade aos servicos de saude bucal nos idosos investigados.

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Thatiane Lopes Oliveira

Papers

Eficácia da educação em saúde no tratamento não medicamentoso da hipertensão arterial

Cognitive impairment, the Mini‐Mental State Examination and socio‐demographic and dental variables in the elderly in Brazil

Effectiveness of education in health in the non- medication treatment of arterial hypertension Eficácia da educação em saúde no tratamento não medicamentoso da hipertensão arterial

Fatores associados ao custo das internações hospitalares por doenças sensíveis à Atenção Primária no Sistema Único de Saúde

Saúde bucal e acesso aos serviços odontológicos em idosos quilombolas: um estudo de base populacional