A fluoretação da água de abastecimento público e seus benefícios no controle da cárie dentária: cinqüenta anos no Brasil Fifty years of fluoridation of public water supplies in Brazil: benefits for the control of dental caries

A fluoretação da água de abastecimento público representa uma das principais e mais importantes medidas de saúde pública no controle da cárie dentária. O objetivo deste trabalho foi o de reafirmar, através de uma revisão de literatura, a importância e o alcance da fluoretação no controle da cárie dentária. Um dos meios mais efetivos para manter constante a presença de flúor na cavidade bucal, fundamental para controle da cárie dentária, a fluoretação da água é reconhecida como um importante fator para o declínio da prevalência da cárie dentária. Portanto, além de ser mantida, deve ser monitorada, a fim de que o teor de flúor seja mantido dentro dos padrões adequados para o controle da cárie e prevenção da fluorose dentária.<br>Fluoridation of public water supplies is among the most important public health measures for control of dental caries. Through a review of the literature, this study intends to reaffirm the importance and scope of fluoridation for caries control, as this is acknowledged as one of the most effective ways of ensuring the constant presence of fluoride in the oral cavity, which is vital for controlling caries. Water fluoridation is rated as an important factor for reducing caries, meaning that it should be maintained and also monitored, ensuring adequate fluoride levels for controlling caries while avoiding dental fluorosis

Sleep Physiology, Circadian Rhythms, Waking Performance and the Development of Sleep-Wake Therapeutics

Disturbances of the sleep-wake cycle are highly prevalent and diverse. The aetiology of some sleep disorders, such as circadian rhythm sleep-wake disorders, is understood at the conceptual level of the circadian and homeostatic regulation of sleep and in part at a mechanistic level. Other disorders such as insomnia are more difficult to relate to sleep regulatory mechanisms or sleep physiology. To further our understanding of sleep-wake disorders and the potential of novel therapeutics, we discuss recent findings on the neurobiology of sleep regulation and circadian rhythmicity and its relation with the subjective experience of sleep and the quality of wakefulness. Sleep continuity and to some extent REM sleep emerge as determinants of subjective sleep quality and waking performance. The effects of insufficient sleep primarily concern subjective and objective sleepiness as well as vigilant attention, whereas performance on higher cognitive functions appears to be better preserved albeit at the cost of increased effort. We discuss age-related, sex and other trait-like differences in sleep physiology and sleep need and compare the effects of existing pharmacological and non-pharmacological sleep- and wake-promoting treatments. Successful non-pharmacological approaches such as sleep restriction for insomnia and light and melatonin treatment for circadian rhythm sleep disorders target processes such as sleep homeostasis or circadian rhythmicity. Most pharmacological treatments of sleep disorders target specific signalling pathways with no well-established role in either sleep homeostasis or circadian rhythmicity. Pharmacological sleep therapeutics induce changes in sleep structure and the sleep EEG which are specific to the mechanism of action of the drug. Sleep- and wake-promoting therapeutics often induce residual effects on waking performance and sleep, respectively. The need for novel therapeutic approaches continues not at least because of the societal demand to sleep and be awake out of synchrony with the natural light-dark cycle, the high prevalence of sleep-wake disturbances in mental health disorders and in neurodegeneration. Novel approaches, which will provide a more comprehensive description of sleep and allow for large-scale sleep and circadian physiology studies in the home environment, hold promise for continued improvement of therapeutics for disturbances of sleep, circadian rhythms and waking performance

End-of-life decision-making across cancer types : results from a nationwide retrospective survey among treating physicians

BACKGROUND: The treatment of advanced cancer often involves potentially life-shortening end-of-life decisions (ELDs). This study aimed to examine the prevalence and characteristics of ELDs in different cancer types. METHODS: A nationwide death certificate study was conducted based on a large random sample of all deaths in Flanders, Belgium, between 1 January and 30 June 2013. All cancer deaths were selected (n = 2392). Attending physicians were sent a questionnaire about ELDs and the preceding decision-making process. RESULTS: The response rate was 58.3%. Across cancer types, a non-treatment decision occurred in 7.6-14.0%, intensified pain and symptom alleviation in 37.5-41.7%, euthanasia or physician-assisted suicide in 8.7-12.6%, and life shortening without explicit patient request in 1.0-2.4%. ELD prevalence did not differ significantly by cancer type. Reasons for ELDs were most frequently patient's physical suffering and lack of prospect of improvement. 'Anticipated further suffering' and 'unbearable situation for relatives' were reasons more often reported in haematological cancer than in other cancer types. Patient, family, and caregiver involvement in decision-making did not differ across cancer types. CONCLUSIONS: Euthanasia or physician-assisted suicide rates were relatively high in all cancer types. Neither the prevalence of ELDs nor characteristics of the decision-making process differed substantially between cancer types. This indicates a uniform approach to end-of-life care, including palliative care, across oncological settings