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Há uma demanda de formação de profissionais para atuação nos contextos de saúde indígena e cresce o protagonismo indígena nos diversos campos de saber para tratar de suas próprias questões sociopolíticas. O presente artigo traz uma análise documental com abordagem qualitativa e análise temática de conteúdo. Os documentos analisados foram narrativas redigidas por participantes do curso Introdução à Saúde dos Povos Indígenas, ofertado por uma universidade, com participação de indígenas e não indígenas, lideranças, trabalhadores e estudantes da saúde de diversas regiões do Brasil. Analisaram-se três categorias de experiências: presença e protagonismo indígena na experiência do curso; aprendizagens no encontro de diversidades com metodologias ativas de ensino-aprendizagem; formação para o trabalho na saúde indígena. Percebeu-se que a utilização de metodologias ativas possibilitou um curso participativo, com valorização da presença e do protagonismo indígenas. Apresentou-se de forma inovadora ao ofertar espaços de construção de conhecimentos e de formação profissional de forma acessível, no modelo remoto, com valorização dos diferentes conhecimentos e trajetórias dos participantes.
There is a demand for training professionals to work in indigenous health contexts and indigenous protagonism is growing in different fields of knowledge to address their own sociopolitical issues. This article presents a documentary analysis with a qualitative approach and thematic content analysis. The documents analyzed were narratives written by participants in the Introduction to the Health of Indigenous Peoples course, offered by a university, with the participation of indigenous and non indigenous people, leaders, health workers and students from different regions of Brazil. Three categories of experiences were analyzed: indigenous presence and protagonism in the course experience; learning in the encounter of diversities with active teaching-learning methodologies; training for work in indigenous health. It was noticed that the use of active methodologies enabled a participatory course, valuing indigenous presence and protagonism. It presented an innovative way by offering spaces for knowledge construction and professional training in an accessible way, in a remote model, valuing the different knowledge and trajectories of the participants.
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RESUMO Objetivou-se descrever a condição de saúde bucal de idosos institucionalizados, com enfoque no edentulismo, na necessidade de prótese e na Autopercepção de Saúde Bucal (ASB), e explorar a associação com fatores individuais. Um estudo transversal foi realizado em Ponta Grossa, município do Sul do Brasil, com amostra de conveniência de idosos residentes em três Instituições de Longa Permanência para Idosos. Por meio de questionário estruturado, foram coletados dados sobre características demográficas, de saúde geral e bucal e acesso a serviços de saúde. No exame bucal, avaliou-se o Índice de dentes permanentes Cariados, Perdidos e Obturados (CPO-D), número de dentes presentes, uso e necessidade de prótese dentária e presença de lesões bucais. Foram avaliados 130 idosos, a maioria com mais de 80 anos (62,20%). O CPO-D médio foi de 30,62 (desvio-padrão 2,85), 62,31% dos idosos eram edêntulos, 41,54% usavam e 79,23% necessitavam de prótese dentária. As lesões bucais foram identificadas em 35,42% dos avaliados, e 64,86% dos idosos classificaram a ASB como boa. Conclui-se que a saúde bucal dos participantes foi considerada ruim, do ponto de vista clínico, levando em consideração a alta prevalência de edentulismo e a necessidade do uso de prótese dentária.
ABSTRACT The aim was to describe the oral health status of institutionalized older people, focusing on edentulism, need for dentures, and Self-Perception of Oral Health (SPOH), and to explore the association with individual factors. A cross-sectional study was carried out in Ponta Grossa, in the South of Brazil, with a convenience sample of older people living in three Long Stay Institutions for the Elderly. Using a structured questionnaire, data on demographic, general, and oral health characteristics and access to health services were collected. In the oral examination, the Index of Decayed, Missing and Filled permanent Teeth (DMFT), number of teeth present, use and need for dental prosthesis, and presence of oral lesions were evaluated. 130 older people were evaluated, most of them over 80 years old (62.20%). The mean DMFT was 30.62 (± 2.85), 62.31% of attendees were edentulous, 41.54% used, and 79.23% needed dental prosthesis. Oral lesions were identified in 35.42% of those evaluated and 64.86% of the participants classified their SPOH as good. It is concluded that the oral health of the participants was considered poor, from a clinical point of view, taking into account the high prevalence of edentulism and the need to use dental prosthesis.
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OBJECTIVE: This overview analyzed the quality of the systematic reviews (SRs) available on treatments for molar-incisor hypomineralization (MIH). MATERIAL AND METHODS: Six electronic databases were searched (PubMed/MEDLINE, Scopus, Web of Science, LILACS, Brazilian Bibliography of Dentistry and Cochrane Library) until March 2022. Two reviewers independently performed the selection, the quality assessment (Assessment of Multiple Systematic Reviews 2 - AMSTAR-2), and the risk of bias assessment of the SR (Risk of Bias in Systematic Reviews - ROBIS). RESULTS: Two hundred nine records were retrieved; after removing duplicates and applying the inclusion/exclusion criteria, 5 SRs remained. Three SRs were rated as showing critically low methodological quality and high risk of bias, and two were rated as moderate methodological quality and low risk of bias. The identified treatments that may be suitable for MIH were classified as (1) non-invasive - casein incorporated into toothpaste and sugar-free chewing gum, toothpaste containing arginine, 0.4% stannous fluoride gel; fluoride varnish; (2) micro-invasive - resin sealants for pits and fissures, microabrasion, dental whitening, resin infiltration; (3) invasive - ART restorations, indirect restorations (metal, composite, or ceramic); and (4) mixed intervention - stainless steel crowns. CONCLUSION: Despite the considerable number of published papers included in this set of systematic reviews, the evidence supporting the effectiveness of treatments for treating MIH is limited due to the methodological quality and risk of bias of the systematic reviews, as well as the quality of the primary studies (PROSPERO: CRD42020144831). CLINICAL RELEVANCE: Different treatments have been purposed for MIH treatment, but there is still not enough scientific evidence of good quality for the establishment of a definitive clinical protocol for the treatment of MIH.
Assuntos
Hipoplasia do Esmalte Dentário , Fluoretos Tópicos , Arginina , Caseínas/uso terapêutico , Goma de Mascar , Hipoplasia do Esmalte Dentário/terapia , Fluoretos Tópicos/uso terapêutico , Humanos , Incisivo , Dente Molar , Aço Inoxidável , Revisões Sistemáticas como Assunto , Fluoretos de Estanho , Cremes DentaisRESUMO
Para o alcance dos princípios do Sistema Único de Saúde é necessária a formação de profissionais de saúde integrados à rede de saúde e que reconheçam a necessidade das diferentes realidades brasileiras, como a atenção aos povos indígenas. O objetivo é apresentar um relato de experiência para a reorientação do modelo formador priorizando a integração ensino-serviço-comunidade e a contribuição da Faculdade de Odontologia de Ribeirão Preto da Universidade de São Paulo para a efetivação das Políticas Públicas de Educação e Saúde, explorando sua interface com a Política Nacional de Atenção à Saúde dos Povos Indígenas e a Política Nacional de Saúde Bucal. As ações formativas propostas no Projeto "Huka Katu" envolvem a reorientação do modelo formador e assistencialjunto à comunidade. As etapas preparatória e operacional são desenvolvidas nas disciplinas optativas livres -Atenção à Saúde Bucal em Populações Indígenas I e II. No período da pandemia da COVID-19, a disciplina I tem se desenvolvido em ambiente virtual com uso de metodologias ativas de ensino-aprendizagem e abordagem do cuidado intercultural. A disciplina II é desenvolvida no contexto da atenção primária nas aldeias do Parque Indígena do Xingu, com ênfase na integralidade da atenção em saúde e aprendizagem pela vivência do trabalho em saúde indígena, junto a equipes multiprofissionais. O Projeto tem contribuído na formação de profissionais de saúde para o trabalho em equipe colaborativo, com egressos envolvidos diretamente na assistência ou na gestão de saúde no subsistema de saúde indígena (AU).
To achieve the principles of the Sistema Único de Saúde, it is necessary to improve health professionals' education who are integrated into the health network and who recognize the need for different Brazilian realities, such as indigenous peoples' health care. The objective is to present an experience report for the reorientation of the educational model prioritizing the teaching-service-community integration and the contribution of the Ribeirão Preto School of Dentistry, University of São Paulo, to the implementation of Public Education and Health Policies, exploring its interface with the National Health Care Policy for Indigenous Peoples and the National Oral Health Policy. The education actions proposed in the "Huka Katu" Project involve the reorientation of the training and assistance model to the community. The preparatory and operational stages are developed in the open elective courses -Oral Health Care in Indigenous Populations I andII. During COVID-19 pandemic, Course I was carried out in a virtual environment using active teaching-learning methodologies and an approach to intercultural care. Course II is developed in the context of primary care in the villages of the Xingu Indigenous Park, with emphasis on comprehensive health care and learning through the experience of working in indigenous health, together with multidisciplinary teams. The Project has contributed to the training of health professionals for collaborative teamwork, with graduates directly involved in health care or management in the indigenous health subsystem (AU).
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Atenção Primária à Saúde , Saúde de Populações Indígenas , Competência Cultural , Educação Interprofissional , Política de Saúde , Saúde Bucal , Relações Comunidade-Instituição , Currículo , Educação em Odontologia , Povos Indígenas , COVID-19RESUMO
O estudo transversal objetivou comparar as relações de trabalho e qualificação profissional de cirurgiões-dentistas atuantes na Atenção Básica nas regiões geográficas brasileiras. Utilizou-se dados do Módulo VI da avaliação externa do 2º ciclo do Programa Nacional do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). A comparação entre regiões foi realizada pelo teste qui-quadrado (p<0,05) e análises descritivas. Das 17.117 Equipes de Saúde Bucal avaliadas, a maioria dos cirurgiões dentistas era Servidor Público Estatutário (44,1%), sendo, este número, maior na região Sul (63,6%) e menor no Sudeste (37,8%), com ingresso por concurso público (49,6%), sendo maior no Sul (79,5%) e menor no Nordeste (40,9%). Em relação à qualificação profissional, (73,1%) possuíam formação complementare dentre estes, a maioria tem especialização em outras áreas que não Saúde Coletiva (53,2%), sendo maior no Norte (59,3%) e menor no Nordeste (50,4%). Os especialistas em Saúde da Família ou Saúde Pública/Saúde Coletiva (26,7% e 18,7%) respectivamente foram mais frequentes no Sudeste (38,7% e 21,4%) e menor no Norte (11,4% e 14,9%) respectivamente, para todas o valor de "p" foi (p≤0.001). Portanto, houve desigualdades regionais nas relações de trabalho e qualificação profissional no Brasil, e por isso, políticas indutoras para fixação dos profissionais e sua qualificação precisam ser reforçadas (AU).
Thistransversalstudy aimed to compare employment relationshipsand professional qualification of dentists that work in PrimaryCare in different geographical regions in Brazil. Data was obtained from theModuleVI of the external evaluation of the 2ndCycle of the Programa Nacional do Acesso e da Qualidade da Atenção Básica-PMAQ-AB(PrimaryCare Access and Quality National Program). The comparison between regions was carried out using the chi-square test(p<0.05) and descriptive analyses. In the 17,117 Oral Health Teams assessed, most of the dentists were statutory civil servants (44.1%), and among them, most were found in the south region(63.6%), while the lowest number was observed in the southeast(37.8%). Nearly half of these professionals were approved in a public test (49.6%), and the highest number was observed in the south(79.5%), while the lowest number was found in the northeast(40.9%). Regarding their professional qualification, (73.1%) had complementary education, and among them, most were specialized in varied areas other than Collective Health(53.2%), with the highest figures observed in thenorth(59.3%)and the lowest in the northeast(50.4%). Those specialized in Family Health or Collective/Public Health(26.7% and18.7%, respectively) were most frequently found in the southeast(38.7% and21.4%), while the lowest frequency was observed in the north(11.4% and 14.9%, respectively). In all comparisons, the "p" value was(p≤0.001). Therefore, regional inequalities were observed in employment relationshipsand professional qualification in Brazil, which reinforces the need for public policies that favor the retention and qualification of these professionals (AU).
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Atenção Primária à Saúde/métodos , Regionalização da Saúde , Odontólogos , Capacitação Profissional , Mão de Obra em Saúde , Distribuição de Qui-Quadrado , Saúde Bucal , Estudos Transversais/métodos , Interpretação Estatística de DadosRESUMO
OBJECTIVES: To conduct a systematic review of coronavirus disease 2019 (COVID-19)-related biosafety guidelines for dental clinical practice in the early stage of the pandemic, focusing on quality assessment. METHODS: Electronic (via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, and Cochrane Library) and gray literature searches were performed for documents published up to May 12, 2020. Guidelines updated until April 17, 2021 were identified. Documents were included as guidelines if they (1) consisted of a set of statements, directions, or principles presenting current or future rules or policy; (2) were developed by government agencies, institutions, organizations, or expert panels; and (3) were related to the general conduct of healthcare activities rather a particular condition. Two researchers, using the Appraisal of Guidelines for Research & Evaluation II, independently extracted the recommendations and evaluated the quality of the guidelines. RESULTS: Twenty-seven documents from 19 countries were included in the review. These documents presented 122 recommendations related to (1) professional biosafety; (2) patients'/companions' safety; (3) the organization and biosafety of the physical dental facility environment; and (4) the work process in dental care. Overall, the scientific quality of the guidelines was considered low. Some recommendations presented in these guidelines would require further research to establish their effectiveness. CONCLUSIONS: We found a wide variety of biosafety guidelines for dental practice regarding COVID-19 in the early months of the pandemic, but their quality was low. Biosafety recommendations should be frequently updated.
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COVID-19 , Pandemias , Brasil , Contenção de Riscos Biológicos , Humanos , Pandemias/prevenção & controleRESUMO
PURPOSE: To assess the effects of metformin use on lung cancer (LC) survival according to summarized results from observational studies (OBs) and randomized clinical trials (RCTs). METHODS: We systematically searched electronic databases and, to our knowledge, for the first time, RCTs were included in a systematic review and meta-analysis about the role of metformin on LC survival. We carried out meta-analyses separately for OBs and RCTs. Analyses for overall survival (OS) concerning OBs were stratified by studies with and without time-dependent approach. Subgroup analyses were adopted for OBs to identify the sources of heterogeneity. Included studies were assessed for quality. RESULTS: We identified ten OBs and four RCTs. For OBs, metformin use was associated with improved OS for LC patients. Only two studies used time-dependent approach in which a higher ratio was found when compared to the non-use of the time-dependent analysis in eight studies. OBs were classified as high quality but the risk of bias was "unclear" in eight OBs due to absence of the time-dependent analysis. For RCTs, metformin use was not beneficial for OS and neither for progression-free survival. Heterogeneous quality was found among RCTs. Sources of bias that could alter significantly the results or raise doubts were identified in RCTs. CONCLUSION: Time-dependent analysis should be considered an appropriate strategy for OBs focused on the metformin use for LC patients' survival, and further studies applying this approach are required. More well-designed RCTs are needed to provide consistent results for the association between metformin use and LC survival.
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Hipoglicemiantes/uso terapêutico , Neoplasias Pulmonares/mortalidade , Metformina/uso terapêutico , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Estudos Observacionais como Assunto , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Taxa de SobrevidaRESUMO
Convulsions occur in response to a loss of balance between excitatory and inhibitory neurotransmitters, and the treatment for this condition consists in restore such lost balance. Many anticonvulsant drugs present side effects which may limit their use. This fact has stimulated the search for new sources of treatment from aromatic plants. Many monoterpenes commonly present in essential oils are known because of their anticonvulsant properties. The anticonvulsant effect of α- and ß-pinene, two structural isomers, is still little studied. Thus, the present work evaluated the anticonvulsant effect of α- and ß-pinene in pentylenetetrazole-induced convulsions model. Initially, the oral LD50 for α- and ß-pinene was estimated. Following the oral administration, a mild sedation was observed and no deaths were recorded; the LD50 estimated for both monoterpenes was greater than 2 000 mg/kg, p.o. Further, animals were orally treated with α-pinene (100, 200 and 400 mg/kg), ß-pinene (100, 200 and 400 mg/kg) and the equimolar mixture of α- and ß-pinene (400 mg/kg) and subjected to the pentylenetetrazole-induced convulsions model. In this model, only the dose of 400 mg/kg of the compounds was able to significantly decrease the seizure intensity. The latency of first convulsion was significantly increased by the mixture of α- and ß-pinene (400 mg/kg). In addition, ß-pinene and the mixture of the two monoterpenes, both at a dose of 400 mg/kg, significantly increased the time of death of animals. The treatment with ß-pinene and the equimolar mixture of the two monoterpenes significantly reduced hippocampal nitrite level and striatal content of dopamine (DA) and norepinephrine (NE). Taken together, the results suggest that α-pinene appears to be devoid of anticonvulsant action. This fact, however, seems to be dependent on the chemical structure of the compound, since pretreatment with the ß-pinene increased the time of death pf PTZ-treated mice, which seems to depend on the ability of the compound to reduce nitrite concentration and NE and DA content, during the pentylenetetrazole-induced seizure.
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Anticonvulsivantes/farmacologia , Encéfalo/efeitos dos fármacos , Compostos Bicíclicos com Pontes/farmacologia , Monoterpenos/farmacologia , Pentilenotetrazol , Convulsões/prevenção & controle , Animais , Anticonvulsivantes/toxicidade , Monoterpenos Bicíclicos , Encéfalo/metabolismo , Encéfalo/fisiopatologia , Compostos Bicíclicos com Pontes/toxicidade , Modelos Animais de Doenças , Dopamina/metabolismo , Relação Dose-Resposta a Droga , Dose Letal Mediana , Masculino , Camundongos , Monoterpenos/toxicidade , Nitritos/metabolismo , Norepinefrina/metabolismo , Tempo de Reação/efeitos dos fármacos , Convulsões/induzido quimicamente , Convulsões/metabolismo , Convulsões/fisiopatologia , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo , Fatores de TempoRESUMO
RESUMO O Brasil teve atos e políticas excludentes que levaram à quase dizimação dos variados povos indígenas. Buscando voz e inclusão, o movimento dos povos originários contou com a presença de representantes das próprias comunidades para a consolidação da Reforma Sanitária nesse contexto. Conselheiros indígenas de saúde e agentes indígenas de saúde fomentam a resiliência para reivindicar, proteger e curar relações, lidando com a perspectiva biomédica, e atuação de profissionais não indígenas. Este trabalho objetiva evidenciar as aprendizagens colaborativas e práticas interdisciplinares no atual sistema de saúde brasileiro, para a promoção da saúde dos povos originários. Em uma revisão integrativa, propôs-se discorrer sobre o impacto da formação profissional com ênfase na questão étnica, possibilidades de atuação não colonizadora e inclusiva, e a contribuição dos diversos atores, indígenas ou não, que possibilitam a consolidação desse subsistema de atenção, considerando suas especificidades e sua maneira própria do fazer da saúde. A autonomia, com foco no empoderamento, fortalecida por meio do reconhecimento do papel fundamental dos próprios indígenas e de pessoas ligadas à causa indigenista que se estabeleceram para tal assistência, consolidaram a Reforma Sanitária também nesses territórios, na tentativa de universalidade no acesso, integralidade da atenção, promoção da equidade e redução de iniquidades.
ABSTRACT Brazil has always had historic practices and excluding politics that almost decimated the varied indigenous peoples. Seeking a voice and inclusion, the movement of original populations counted on the presence of communities' representatives to consolidate the Health Care Reform. Health indigenous advisors and indigenous heath agents promoted resilience to claim, protect, and cure relations, dealing with the biomedical perspective, and the performance of non-indigenous professionals. The present study aims to emphasize interdisciplinary placement and collaborative learnings among original populations' heath actors in the current Brazilian health system for the promotion of health among original peoples. Through an integrative review, it was proposed a glossing over the impact of professional qualification emphasizing ethnic issues and practices proper to such context, possibilities of a non-colonizational and inclusive actuation, and the contribution of several actors, indigenous or not, that made such health sub-system possible, considering its specificities and its own way of working in health. Autonomy, focused on empowerment, strengthened by the recognition of the essential role of indigenous peoples and non-indigenous contributors established for such health assistance, consolidated Health Reform also in these territories, trying to achieve universality in service access, integrality of care, promotion of equity, and reduction of inequities.
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OBJECTIVE: To evaluate the effect of isoflavone administration, either in conjunction with probiotic use or not, on the symptoms of genitourinary syndrome of menopause, and compare the effects with those of hormone therapy. METHODS: A randomized clinical trial was conducted on 60 postmenopausal women aged 40 to 60 years, randomly assigned to receive oral isoflavone (150âmg dry extract of glycine max) alone or isoflavone plus probiotic (Lactobacillus acidophilus, Lactobacillus casei, Lactococcus lactis, Bifidobacterium bifidum, and Bifidobacterium lactis) or hormone therapy (1âmg estradiol and 0.5âmg norethisterone acetate). The urogenital symptom subscale of the Menopause Rating Scale and International Consultation on Incontinence Questionnaire-Short Form were used to assess genitourinary symptoms. Vaginal maturation value, pH, vaginal health score, and vaginal flora were used to evaluate vaginal atrophy. Equol, equol intermediate, O-dimethylangolensin, and aglycones were measured using gas chromatography coupled to mass spectrometry. RESULTS: After 16 weeks of treatment, the urogenital symptoms, mainly vaginal dryness and sexual problem complaints, improved significantly in the hormone therapy group. There was a significant increase in the daidzein, glycitein, equol intermediate, and O-dimethylangolensin contents after 16 weeks in the isoflavone plus probiotic group. The maturation value, vaginal pH, and vaginal flora improved in the hormone therapy group. The vaginal health score increased in the isoflavone and hormone therapy groups. CONCLUSIONS: Probiotics improved the metabolism of isoflavones after 16 weeks of treatment. However, the increase in the contents of isoflavones and their metabolites failed to yield an estrogenic effect on the urogenital tract and relieve the vulvovaginal symptoms.
Assuntos
Suplementos Nutricionais , Terapia de Reposição de Estrogênios , Isoflavonas/uso terapêutico , Menopausa , Probióticos/uso terapêutico , Incontinência Urinária/tratamento farmacológico , Vagina/patologia , Adulto , Atrofia , Quimioterapia Combinada , Feminino , Humanos , Isoflavonas/administração & dosagem , Pessoa de Meia-Idade , Fitoterapia , Probióticos/administração & dosagem , Glycine max , Síndrome , Resultado do TratamentoRESUMO
RESUMO O objetivo deste estudo exploratório foi identificar desigualdades na organização do processo de trabalho das Equipes de Saúde Bucal (ESB) na Estratégia Saúde da Família, comparando municípios do Estado do Paraná quanto à condição social, econômica e demográfica. Foram utilizados dados secundários obtidos na etapa de avaliação externa do Programa de Nacional do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), referentes aos padrões de certificação de acesso, qualidade e organização do processo de trabalho das equipes. Os municípios foram estratificados segundo o índice proposto pelo programa. Houve ampla participação dos municípios no PMAQ-AB, com predominância de equipes de saúde da família com saúde bucal. Os resultados demonstram desigualdades desfavoráveis aos municípios menores e mais carentes, o que revela a necessidade de compreender o papel da gestão como apoiadora das ESB, favorecendo o resgate de competências e habilidades necessárias para a boa gestão da clínica e do cuidado na Atenção Primária à Saúde. Evidencia-se a necessidade da qualificação da gestão, com apoio federal e estadual, principalmente aos municípios menores e com baixa capacidade de resposta dos sistemas de saúde. É importante que a regionalização seja efetiva, e que a rede de atenção à saúde bucal seja organizada de forma equânime, para incluir esses municípios.(AU)
ABSTRACT The objective of this exploratory study was to identify inequalities in the organization of the work process of Oral Health Teams in the Family Health Strategy, comparing municipalities of the Paraná State, Brazil, regarding social, economic and demographic conditions. We used secondary data obtained in the external evaluation stage of the National Program of Access and Quality Improvement in Primary Health Care (PMAQ-AB), referring to the certification standards for access, quality, and organization of the work process of the teams. The municipalities were stratified according to the index proposed by the program. We observed wide participation of the municipalities in the program, with predominance of family health teams with oral health. The results show inequalities, unfavorable to the smaller and poorer municipalities, which reveals the need to understand the role of management as a supporter of the Oral Health Teams, favoring the rescue of skills and abilities necessary for the good governance of the clinic and of care in PHC .There is evidence of the need for management qualification, with federal and state support, mainly to smaller municipalities and with a low response capacity of health systems. It is important that regionalization be effective, and that the oral health care network be organized in an equitable way to include those municipalities.(AU)
Assuntos
Equipe de Assistência ao Paciente/organização & administração , Estratégias de Saúde Nacionais , Serviços de Saúde Bucal/organização & administração , Brasil , Estudos Transversais/instrumentação , Avaliação de Processos em Cuidados de Saúde/métodosRESUMO
Valproic acid (VA) is an antiepileptic that is also used for the treatment of bipolar disorders. The objective was to evaluate the neuroprotective effects of VA on a brain ischemia model. The groups of male Wistar rats were: SO (sham-operated), ischemic and ischemic treated with VA (25, 50 and 100â¯mg/kg, p.o.). After anesthesia with ketamine and xilazine, the animals were subjected to clamping of carotid arteries (30â¯min) and reperfusion. Except for the carotid clamping, the SO group was submitted to the same procedure. On the 7th day, the animals were behaviorally evaluated, euthanized and had their brain dissected for neurochemical and immunohistochemical assays. The data were analyzed by ANOVA and Tukey as the post hoc test. The results showed that VA reversed partly or completely the behavioral (locomotor activity and memory deficits), neurochemical (striatal DA and DOPAC levels, brain nitrite and lipid peroxidation) and immunohistochemical alterations (iNOS, COX-2, HDAC and GSK3) observed in the untreated ischemic group. VA neuroprotective effects are probably related to its anti-inflammatory and antioxidant properties, as well as to HDAC and GSK3 inhibitory effects. These findings stimulate translational studies focusing on VA as a neuroprotective drug to be potentially used in the clinic for several neurological conditions.
Assuntos
Isquemia Encefálica/prevenção & controle , Quinases da Glicogênio Sintase/antagonistas & inibidores , Inibidores de Histona Desacetilases/farmacologia , Fármacos Neuroprotetores/farmacologia , Ácido Valproico/farmacologia , Ácido 3,4-Di-Hidroxifenilacético/metabolismo , Animais , Encéfalo/metabolismo , Inibidores de Ciclo-Oxigenase 2/farmacologia , Dopamina/metabolismo , Relação Dose-Resposta a Droga , Peroxidação de Lipídeos , Masculino , Óxido Nítrico Sintase Tipo II/metabolismo , Nitritos/metabolismo , RatosRESUMO
Estudos realizados no Brasil e no mundo relataram desigualdades sociais relacionadas à saúde bucal de idosos, porém ainda faltam esclarecimentos sobre as medidas subjetivas da saúde bucal desta população e a relação com as condições socioeconômicas. Este estudo tem o objetivo de avaliar a desigualdade social relacionada à autopercepção de saúde bucal entre idosos no município de São Paulo entre 2000 e 2010. Foram utilizados dados do estudo Saúde, Bem-Estar e Envelhecimento (SABE), cuja amostra foi representativa de idosos residentes no município em 2000, 2006 e 2010. A variável de interesse foi o impacto da saúde bucal na qualidade de vida, obtida por meio do Geriatric Oral Health Assessment Index (GOHAI), categorizada em autopercepção de saúde bucal (ASB) boa (impacto positivo) e ruim (impacto negativo). O nível educacional foi a variável socioeconômica utilizada. Foram utilizados modelos de regressão de Poisson ajustados por dados sociodemográficos, acesso a serviços de saúde, saúde geral e bucal. Para a análise da desigualdade social utilizou-se as medidas complexas Slope Index of Inequality (SII) e Relative Index of Inequality (RII), assim como equiplots. A prevalência de ASB boa foi 46,02 por cento, 54,51 por cento e 54,36 por cento, em 2000, 2006 e 2010, respectivamente. Fatores sociodemográficos, percepção de saúde geral, depressão, número de dentes presentes, uso e necessidade de prótese estiveram associados a autopercepção de saúde bucal ruim nos anos analisados. Em 2010, oito anos ou mais de escolaridade (RP:0,74;IC 0,63;0,87), autopercepção ruim da saúde geral (RP:1,33; IC 1,17;1,50) e não ter necessidade de prótese (RP:0,71; IC 0,62;0,82) foram alguns fatores associados a ASB ruim. Nota-se a presença de desigualdade social absoluta e relativa relacionada a ASB boa em 2006 e 2010, principalmente entre idosos dentados (2010 - SII:33,90;IC18,80;48,99 e RII:2,03;IC 1,47;2,82) e de 60 a 69 anos. A desigualdade social relacionada a autopercepção de saúde bucal aumentou entre os idosos no período avaliado, portanto, são necessárias ações destinadas à esta população para eliminar as iniquidades
Studies conducted in Brazil and in the world have reported social inequalities in oral health among the elderly, but the role of socieconomic conditions on the subjective measures of oral health in this population is still not clear. This study aims to assess social inequalities on self-perceived oral health across among the elderly from São Paulo between 2000 and 2010. Datarom the Saúde, Bem estar e Envelhecimento (SABE) study were used, which sought to evaluate elderly people living in the city of São Paulo in 2000, 2006 and 2010. The variable of interest was the impact of oral health on the quality of life obtained by means of the Geriatric Oral Health Assessment Index (GOHAI), categorized as good (positive impact) and poor (negative impact) oral health self-perception (OHSP). Education level was the socioeconomic variable used. Poisson regression models, adjusted by sociodemographic, access to health services, general health and oral health, were fitted. For the analysis of social inequality complex measures were used: Slope Index of Inequality (SII) and Relative Index of Inequality (RII), as well as equiplots. The prevalence of good OHSP was 46.02 per cent, 54.51 per cent and 54.36 per cent, in 2000, 2006 and 2010, respectively. Socio-demographic factors, general health perception, depression, number of teeth present, use and need for prosthesis were associated with poor OHSP in the analyzed years. In 2010, eight years or more of schooling (PR: 0.74; CI: 0.63, 0.87), poor self-perceived health (PR: 1.33, CI: 1.17, 1.50) and have no need for a prosthesis (PR: 0.71; CI 0.62, 0.82) were associated with poor OHSP. Absolute and relative social inequality related to good OHSP was observed in 2006 and 2010, especially among dentate elderly (2010 - SII: 33.90; CI: 18.80, 48.99 and RII: 2.03; CI: 1.47, 2.82) and in those aged from 60 to 69 years. Social inequality related to self-perception of oral health increased among the elderly in the period evaluated, therefore, actions aimed at this population are necessary to diminish inequities
Assuntos
Humanos , Idoso , Saúde Bucal/etnologia , Autoimagem , Fatores Socioeconômicos , Fatores Socioeconômicos , Qualidade de Vida , Percepção SocialRESUMO
Neste trabalho, busca-se analisar processos discursivos ligados à produção e à leitura de textos multimodais (charges) gerados por um evento político e midiático amplamente conhecido como Mais Médicos. Em um momento histórico em que o governo brasileiro contratou médicos estrangeiros para o atendimento de parcelas desassistidas da população, especialmente em localidades precárias e de difícil acesso, muitos textos foram produzidos e publicados, em todas as mídias, explicitando posicionamentos pró e contra essa ação. Sob forte polêmica, o Mais Médicos foi mantido. Os argumentos e contraargumentos ao programa foram muitos. Com base, principalmente, em Kress (2003), discute-se aqui a questão da circulação de textos multimodais na contemporaneidade, assim como os processos de produção de sentidos a partir de dezoito charges publicadas e amplamente compartilhadas em redes sociais, naquele momento.
This paper discusses discoursive processes in writing and reading multimodal texts generated by a politician and midiatic brazilian event called Mais Médicos (More Doctors). In a historical moment in which the Brazilian government hires foreign doctors to care for underserved segments of the population, especially in poor localities of difficult access, many texts were produced and published in all media, explaining positions pro and against this action. Under strong controversy, the Best Doctors was maintained. The arguments and counter-arguments to the program were many. Based mainly in Kress (2003), this paper discusses the issue of movement of multimodal texts in contemporary as well as the senses of production processes from eighteen published cartoons widely shared on social networks at that time.
Assuntos
Desenhos Animados como Assunto , Programas Nacionais de Saúde , Avaliação de Programas e Projetos de Saúde/métodos , Mídias Sociais , BrasilRESUMO
The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Candida/classificação , Candidíase Bucal/microbiologia , Doenças Periodontais/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Brasil/epidemiologia , Contagem de Linfócito CD4 , Candida/isolamento & purificação , Candidíase Bucal/epidemiologia , Portador Sadio , Feminino , Humanos , Masculino , Boca/microbiologia , Doenças Periodontais/epidemiologia , Carga ViralRESUMO
ABSTRACT The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.
Assuntos
Humanos , Masculino , Feminino , Adulto , Doenças Periodontais/microbiologia , Candida/classificação , Candidíase Bucal/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Doenças Periodontais/epidemiologia , Brasil/epidemiologia , Candida/isolamento & purificação , Candidíase Bucal/epidemiologia , Portador Sadio , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Contagem de Linfócito CD4 , Carga Viral , Boca/microbiologiaRESUMO
Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/complicações , Doenças da Boca , Saúde Bucal , Adolescente , Adulto , Brasil , Contagem de Linfócito CD4 , Candidíase Bucal , Queilite , Criança , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Boca/diagnóstico , Doenças da Boca/etiologia , Estudos Retrospectivos , População Urbana , Carga Viral , Adulto JovemRESUMO
Given the high frequency of psychiatric disorders (PDs) observed among patients with epilepsy, studies have highlighted the necessity of psychiatric evaluation for these patients, especially for those with refractory temporal lobe epilepsy with mesial temporal sclerosis (TLE-MTS) who are surgical candidates. Current evidence highlights the safety of video-electroencephalography (VEEG) as a means of investigation in patients with TLE-MTS and PDs. However, the presence of such disorders has still been seen as a contraindication for presurgical evaluation with VEEG in some epilepsy centers mainly because of the risk of negative behavioral events. The present retrospective cohort study performed in a Brazilian tertiary epilepsy center aimed to identify whether the presence of a PD remains a contraindication for presurgical VEEG. Clinical, sociodemographic, and psychiatric data from 41 patients who underwent VEEG as part of their presurgical evaluation were compared to data from 32 patients with refractory TLE-MTS who had not undergone VEEG. Psychiatric diagnoses were determined using the DSM-IV and ILAE criteria. Psychiatric disorders were diagnosed in 34 patients (46.6%). Major depressive disorder was the most frequent PD and was observed in 22 patients (30.1%). Anxiety disorders were observed in 14 patients (19.2%). Of the 41 patients (56.2%) who underwent presurgical VEEG, only 12 (29.2%) were found to have a PD during the presurgical psychiatric evaluation compared to 22 of the 32 (68.7%) who did not undergo VEEG (p=0.001; RR=2.35). The present findings suggest that the presence of a PD alone should not be a contraindication for VEEG monitoring and epilepsy surgery.
Assuntos
Transtornos de Ansiedade/complicações , Transtorno Depressivo Maior/induzido quimicamente , Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia , Epilepsia do Lobo Temporal/cirurgia , Adulto , Transtornos de Ansiedade/diagnóstico , Brasil , Estudos de Coortes , Contraindicações , Transtorno Depressivo Maior/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Epilepsia Resistente a Medicamentos/complicações , Epilepsia do Lobo Temporal/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.