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A ansiedade desempenha um papel significativo na experiência de tratamentos odontológicos e pode resultar em evasão por parte dos pacientes. Isso é especialmente relevante para grupos como pacientes pediátricos e aqueles com necessidades especiais, que muitas vezes requerem técnicas de controle de comportamento ou sedação devido à ansiedade. No entanto, a ansiedade não deve ser negligenciada mesmo em pacientes sem odontofobia grave, pois está relacionada à percepção da dor durante os procedimentos odontológicos. A sedação consciente com óxido nitroso surge como uma alternativa valiosa para reduzir a ansiedade e melhorar o conforto do paciente. Ao contrário dos benzodiazepínicos e da anestesia geral, o óxido nitroso atua no sistema nervoso de uma forma que deprime levemente o córtex cerebral, sem afetar o centro respiratório. Isso permite o uso de concentrações subanestésicas do gás, administradas com oxigênio por meio de uma máscara nasal. O óxido nitroso é de rápida ação, pouco solúvel e tem um período de recuperação breve, permitindo que os pacientes retornem rapidamente às atividades normais. Este estudo, uma revisão de literatura, explora o mecanismo de ação do óxido nitroso, suas indicações na prática odontológica e examina possíveis riscos e contraindicações associados ao seu uso. Em resumo, a sedação consciente com óxido nitroso se mostra como uma opção promissora para aliviar a ansiedade e melhorar a experiência de tratamentos odontológicos, beneficiando uma ampla gama de pacientes, não apenas aqueles com fobias graves.

Anxiety, in an outpatient dental environment, plays a fundamental role in pain and discomfort expectation, resulting in increase of treatment evasion. The groups that present greater difficulty in cooperation are children and special needs patients, with behavioral control and sedation being often necessary. Nevertheless, literature emphasizes that anxiety must be evaluated as a critical stage and its management done not only in patients with elevated anxiety levels, but being crucial on pain control of every dental patient, since higher grades of restlessness equals higher pain perception. It is known that the use of nitrous oxide in conscious sedation proves to be an useful tool on reducing anxiety and enabling comfortable interventions, indicating that it is an alternative to the use of benzodiazepines and general anesthesia. The drug acts on the nervous system, promoting a slight depression of the cerebral cortex and, unlike benzodiazepines, which act at the medulla level, it does not depress the respiratory center. The technique uses sub-anesthetic concentrations of nitrous oxide delivered with oxygen through a nasal mask. Nitrous oxide is poorly soluble and has a rapid onset of action, being therefore associated with a rapid recovery period. The duration of sedation is controlled and the patient can quickly return to normal activities. This paper is a narrative review with the objective of exploring the mechanism of action of this gas, evaluating its indications for use in dental clinic and verifying possible risks and contraindications.

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Abstract Objective: Dentistry from the Universidade Federal de Alfenas who were enrolled in the seventh period and who took the Integrated Clinic I Discipline (ICID) in the emergency remote learning model (ERLM). Material and Methods: This is a qualitative and descriptive study. The information was collected through questionnaires applied by the Professors during the ICID. Subsequently, the professor evaluated the treatment developed in virtual form by each student regarding its logical sequence and the most appropriate treatment for each case. The results of the answers were transcribed and submitted to lexicographical textual, Descending Hierarchical Classification, and Similitude analysis in the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ) program. Results: The students described the online situational treatment planning in five essential steps: adequacy of the oral environment, restorative need, prosthetic need, rehabilitation by prosthesis on the implant, and corrective orthodontic treatment. Conclusion: It was observed that the students who enrolled in ICID presented well-integrated planning during ERLM, despite the COVID-19 pandemic hindering these students' contact between theoretical teaching and the integrated practices in dentistry offered by the educational institution.

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Resumo O artigo apresenta uma análise sobre a difusão das clínicas médicas populares nos municípios que compõem a Região Metropolitana de Belém (RMB). Com o propósito de compreender as razões e as origens do avanço do setor de saúde popular, promoveu-se uma investigação sobre a atuação da rede de atenção básica à saúde (ABS) do Sistema Único de Saúde (SUS). A discussão se fundamenta na revisão de dados primários e secundários, captados via trabalho de campo nas 119 clínicas populares da RMB e via informações do DATASUS. Constatou-se que o setor das clínicas de saúde popular foi beneficiado amplamente nos últimos anos, mediante a intensificação do subfinanciamento do SUS, em particular da rede de ABS, que passa por um processo de fragmentação, responsáveis pela redução e pela desarticulação das equipes multiprofissionais de ABS, além das perdas apresentadas no setor de saúde suplementar. As clínicas populares seguem um modelo assistencial inacabado e contraditório, criado pela própria iniciativa privada para o preenchimento da demanda reprimida do SUS em razão de o acesso a essas instituições não garantir uma assistência universal e gratuita ou assegurar um tratamento continuo, motivo pelo qual uma ampla parcela destes usuários é devolvida ao SUS.

Abstract The scope of this article is an analysis of the proliferation of community medical clinics in the municipalities that comprise the Metropolitan Region of Belem. An investigation was conducted into the performance of the primary health care network of Brazil's Unified Health System, with a view to getting a better understanding of the reasons for, and origins of, the proactive stance of the community health sector. The discussion is based on the review of primary and secondary data, obtained via fieldwork in 119 community clinics in the Metropolitan Region of Belem, and information from Brazil's Unified Health System data center. It was revealed that the community health clinic sector has benefited extensively in recent years from the intensification of underfunding of Brazil's Unified Health System, especially the primary health care network, which is undergoing a process of fragmentation. This is directly responsible for the reduction and disruption of multiprofessional primary health care teams, in addition to the losses suffered in the supplementary health sector. The community clinics adopt an spontaneous and contradictory care model created by the private sector to meet the repressed demand of Brazil's Unified Health System

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ABSTRACT Purpose: to analyze sociodemographic variables that may interfere with the clinical outcome of patients with voice or swallowing complaints. Methods: a descriptive, retrospective, cross-sectional, observational study in which the medical records of patients above 18 years old treated at the Voice Clinic of the Speech-Language-Hearing Service of the Rio de Janeiro University Hospital between 2010 and 2018, were analyzed, including 81 medical records - 47 from females and 34 from males. Patients were divided according to three types of outcomes, namely: discharge, dismissal, and abandonment. The sociodemographic variables were sex, marital status, education level, income, whether they were occupational voice users, and the main complaint. The relative and absolute frequencies were calculated to analyze the results, and the Pearson´s chi-square test was used for inferential analysis (significance level of 5%). Results: sociodemographic variables were not significantly associated with the outcomes when the type of complaint (voice or swallowing) was not considered, separately. The study found a significantly higher frequency of patients with voice complaints who were discharged from speech-language-hearing therapy (p = 0.020). The higher frequency of such patients who abandoned therapy was significantly associated with an income of up to one minimum wage (p = 0.041). People with swallowing complaints were not significantly associated with sociodemographic variables. Conclusion: the most frequent outcome was treatment abandonment. In this study, low family income was associated with treatment abandonment by patients with voice complaints. Patients with swallowing complaints had a lower frequency of treatment abandonment and discharge than patients with voice complaints.

RESUMO Objetivo: analisar as variáveis sociodemográficas que podem interferir no desfecho de casos clínicos de pacientes com queixas de voz ou deglutição. Métodos: estudo observacional, transversal, descritivo e retrospectivo. Foram analisados os prontuários de pessoas maiores de 18 anos atendidas na Clínica de Voz do Serviço de Fonoaudiologia do Hospital Universitário do Rio de Janeiro de 2010 a 2018. Foram incluídos 81 prontuários, sendo 47 de participantes do gênero feminino e 34 do masculino. Os pacientes foram divididos quanto a três tipos de desfecho: alta, desligamento e abandono. As variáveis sociodemográficas estudadas foram gênero, estado civil, escolaridade, renda, ser ou não profissional da voz e queixa principal. Para análise dos resultados, foram contabilizadas as frequências relativa e absoluta e, para análise inferencial, foi utilizado o teste Qui-Quadrado de Pearson (nível de significância de 5%). Resultados: as variáveis sociodemográficas não estiveram significantemente associadas aos desfechos estudados quando não se considerou o tipo de queixa (de voz ou de deglutição) de forma separada. Especificamente, observou-se uma frequência significativamente maior de pacientes com queixa de voz e que receberam alta fonoaudiológica (p=0,020). Nestes pacientes, houve associação significativa entre a frequência maior de pacientes que abandonaram a terapia e que possuíam renda de até um salário-mínimo (p=0,041). Não houve associações significativas nas pessoas com queixas de deglutição e as variáveis sociodemográfica estudadas. Conclusão: o desfecho mais frequente foi o abandono ao tratamento. Neste estudo, a baixa renda familiar esteve associada ao abandono do tratamento por pacientes com queixa de voz. Pacientes com queixas de deglutição apresentaram menor frequência de abandono ao tratamento e menos alta do que pacientes com queixas de voz.

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Grupos psicoterapêuticos encontram crescente receptividade nos serviços públicos e privados de saúde. Eles conjugam a expansão da capacidade de atendimento com atuação clínica crítica e propositiva frente ao individualismo da sociedade contemporânea. É importante assim pensarmos os desafios da formação dos psicólogos para este trabalho. Este artigo parte de uma dificuldade encontrada por estagiários de 4° e 5° ano do curso de psicologia, na condução de um grupo psicoterapêutico. Coloca-se como objetivo analisar a relação entre um pacto denegativo que obstaculiza o processo terapêutico com as experiências iniciais de atendimento dos estagiários. Aspectos vivenciados serão apresentados e debatidos à luz da teoria. Descreve-se a existência de um pacto denegativo neste grupo, que se opõe ao processo terapêutico dos pacientes e complexifica o desenvolvimento dos estagiários ao desafiar a confiança em suas percepções e associações, dificultando a realização de intervenções. Conclui-se que o pacto denegativo que obstaculiza o grupo se apresenta, a princípio, como um desafio aos estagiários, porém, mediante o apoio na relação entre os estagiários e supervisão é possível transformar este desafio em fonte de aprendizado.

Grupos psicoterapéuticos son cada vez más recibidos en los servicios de salud. Combinan la expansión de la capacidad de servicio con una acción clínica crítica y decidida frente al individualismo de la sociedad contemporánea. Es importante pensar en los desafíos de formar psicólogos para este trabajo. Este artículo se basa en una dificultad que enfrentan los pasantes de 4° y 5° año de psicología al momento de conducir un grupo psicoterapéutico. El objetivo es analizar la relación entre un pacto negativo que obstruye el proceso terapéutico y las experiencias de cuidado de los internos. Se debatirán experiencias y la teoría. Se describe la existencia de un pacto negativo, que se opone al proceso terapéutico de los pacientes e intensifica el desafío de los alumnos al desafiar la confianza en sus percepciones y asociaciones, lo que dificulta la realización de intervenciones. Se concluye que el pacto negativo que obstaculiza al grupo se presenta, en un primer momento, como un reto para los aprendices, sin embargo, a través del apoyo en la relación entre los aprendices y la supervisión es posible transformar este reto en una fuente de aprendizaje.

Psychotherapeutic groups are increasingly employed in health services. They combine the expansion of the service capacity with critical and purposeful clinical action in face of the individualism of contemporary society. It is important to think about the challenges of training psychologists for this work. This article is based on a difficulty encountered by 4th and 5th year psychology students, acting as trainees, when conducting a psychotherapeutic group. The objective is to analyze the relationship between a denegative pact that obstructs the therapeutic process and the trainees' initial clinical experience. This text debates aspects of this practice in light of theory. It describes a denegative pact in this group, which opposes the patients' therapeutic process and intensifies the trainees' challenge by challenging the trust in their perceptions and associations, making it more difficult for them to find spaces to intervene. It concludes that the negative pact that hinders the group presents itself, in principle, as a challenge to the trainees, however, through support in the relationship between the trainees and supervision it is possible to transform this challenge into a source of learning.

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Resumen: La ketamina es un medicamento conocido por sus bondades como inductor anestésico y para disminuir la posibilidad de complicaciones, por ejemplo, exacerbación del dolor neuropático e hiperalgesia asociada a opioides. En esta revisión nos enfocaremos en otras indicaciones en las que también ha demostrado ser útil y que, bajo observación e instrucción adecuadas en una infraestructura diseñada para ello (clínicas de ketamina), mejora la calidad en el comportamiento y disminuye el estrés, ansiedad y dolor. Entre las indicaciones para su uso se encuentran los trastornos depresivos, el trastorno de ansiedad, el trastorno obsesivo compulsivo y los relacionados con traumas emocionales; el trastorno bipolar, anormalidades en conducta e ingesta alimentaria, al igual que los trastornos adictivos.

Abstract: Ketamine is a drug known for its benefits as an anesthetic inducer and to reduce the possibility of complications such as exacerbation of neuropathic pain and hyperalgesia associated with opioids. In this review we will focus on other indications in which it has also proven to be useful and that, under adequate observation and instruction in an infrastructure designed for it (ketamine clinics), improves the quality of behavior and decreases stress, anxiety and pain. Among the indications for its use are depressive disorders, anxiety disorder, obsessive-compulsive disorder and those related to emotional trauma; bipolar disorder, abnormalities in behavior and eating intake as well as addictive disorders.

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OBJECTIVE: To compare dispensed oral antibiotic prescription rates (DAPRs) after implementation of pneumococcal conjugate vaccine (PCV) in high antibiotic-prescribing clinics (HPC) with low antibiotic-prescribing clinics (LPC) in 2 distinct ethnic groups of children (Jewish and Bedouin children) <5 years of age. METHODS: Clinics with ≥50 insured children, active both pre-PCV (2005-2009) and post-PCV (2010-2018) implementation, were included. HPC and LPC were defined by DAPRs above or below the median in each age and ethnic group. Monthly dispensed antibiotic prescription rate (DAPR) trends (adjusted for age and ethnicity) were calculated using interrupted time series. Mean yearly incidence rate-ratios (late PCV13 vs pre-PCV) were calculated. RESULTS: Bedouin HPC had the highest pre-PCV overall-DAPR per 1000 child-years ± SD (2520.4 ± 121.2), followed by Jewish HPC (1885.5 ± 47.6), Bedouin LPC (1314.8 ± 81.6), and Jewish LPC (996.0 ± 19.6). Shortly after PCV implementation, all DAPRs and amoxicillin/amoxicillin-clavulanate DAPRs declined in all groups except Jewish LPC, stabilizing within 4-5 years post-PCV. The rates and magnitudes of declines were directly proportional to the pre-PCV DAPR magnitudes, achieving near-complete closure of the pre-PCV DAPR gaps between the 4 groups (rates during late-PCV13 ranging from 1649.4 ± 23.5 [Bedouin HPC] to 1200.3 ± 72.4 [Jewish LPC]). CONCLUSIONS: PCVs are a powerful tool in reducing outpatient antibiotic consumption among young children, especially in HPC, resulting in partial closure of DAPR gap between HPC and LPC. The higher impact on HPC suggests that PCV-associated declines of respiratory disease may strongly contribute to a judicious antibiotic approach in clinics with high antibiotic consumption.

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Resumen Objetivo: Evaluar el nivel de satisfacción en la atención recibida por los usuarios de la Clínica Odontológica de la Universidad México Americana del Norte (CO-UMAN) Allende. Material y método: El estudio fue descriptivo, observacional, transversal y prospectivo; se aplicó una encuesta de opinión a 200 pacientes, seleccionados mediante muestreo por conveniencia en 2019, sobre la estructura, proceso y resultados de la atención; así como bio-demográficos de cada paciente. Resultados: Predominaron pacientes con edades entre 21 y 60 años (71%), mujeres (63%), casados(as) (45%), empleados(as)/amas de casa (57%) y baja frecuencia de enfermedades concomitantes (10%). A mayor edad hubo mayor frecuencia de enfermedades concomitantes (r=0.26; p<0.05) y satisfacción en el servicio (r=0.26; p<0.05); con otras enfermedades concomitantes la satisfacción del paciente fue menor (r=-0.39; p<0.05). Los pacientes indican que hay más satisfacción (de 2.6 a 5.4 veces) al recibir un servicio adecuado o mejor. La satisfacción del paciente y la calidad de la atención de la clínica se asoció positivamente (p<0.05) con los trámites sencillos, trato por parte del odontólogo; confianza en la calidad de los servicios recibidos; relación costo/beneficio; puntualidad en la atención y efectividad del tratamiento odontológico recibido. Los coeficientes canónicos estandarizados indicaron mayor contribución en la satisfacción del usuario: las instalaciones e infraestructura de la clínica (0.479); atención del personal y proceso administrativo (0.543); atención del odontólogo (0.700); confianza en la atención y percepción del servicio recibido (0.660) y pobre relación con edad (0.078), género (0.030), estado civil (-0.040) y ocupación del paciente (0.065). Conclusión: No obstante que la cantidad y calidad del servicio de la CO-UMAN se ha incrementado y mejorado sustantivamente, es necesario desarrollar un plan de mejora continua para alcanzar estándares de calidad total.

Abstract Objective: To evaluate the level of satisfaction in the care received by the users of the Dental Clinic of the Universidad México Americana del Norte (DC-UMAN) Allende. Material and method: The study was descriptive, observational, cross-sectional, and prospective. In 2019, an opinion survey on the structure, proceedings, and results of the care, as well as bio-demographics of each patient was applied to 200 patients selected by convenience sampling. Results: Patients aged between 21 and 60 years (71%), women (63%), married (45%), employees/housewives (57%) and a low frequency of concomitant diseases (10%) predominated. At an older age, there was a higher frequency of concomitant diseases (r=0.26; p<0.05) and satisfaction in the service (r=0.26; p<0.05); with other concomitant diseases, patient satisfaction was lower (r=-0.39; p<0.05). Patients indicated that there is more satisfaction (from 2.6 to 5.4 times) when receiving an adequate or better service. Patient satisfaction and the quality of clinic care were positively associated (p<0.05) with simple procedures, treatment by the dentist, confidence in the quality of the services received, cost-benefit ratio, punctuality in the care and effectiveness of the dental treatment received. The standardized canonical coefficients indicated a greater contribution to user satisfaction from the facilities and infrastructure of the clinic (0.479), staff attention and administrative process (0.543), dental care (0.700), trust in care and perception of the service received (0.660) and poor relationship with age (0.078), gender (0.030), marital status (-0.040), and occupation (0.065) of the patient. Conclusion: Although the quantity and quality of the DC-UMAN service has increased and improved substantially, it is necessary to develop a continuous improvement plan to achieve total quality standards.

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As clínicas integradas em Odontologia constituem em um desafio para o ensino superior na formação do profissional, que deverá aprender a tratar as condições orofaciais de seu paciente de forma diferenciada no futuro próximo, aliando cada vez mais a Odontologia e as novas tecnologias. Objetivou-se com este estudo de revisão discutida entender o conceito de clínica integrada e suas perspectivas em consonância com as Diretrizes Curriculares Nacionais. Foi realizado um levantamento bibliográfico sistematizado nos bancos de dados eletrônicos: Lilacs, PubMed e Scielo. Os termos em português e inglês "Educação em Odontologia" (Dental Education), "Clínicas Odontológicas" (Dental Clinics), "Graduação" (Undergraduate Program), "Prestação Integrada de Cuidados de Saúde" (delivery of health care, integrated) e "Currículo" (Curriculum) foram utilizados como palavras-chave. Foram eleitos 23 artigos para esta revisão e extraídas as ideias principais dos textos tendo como base as metodologias utilizadas e os principais resultados. Os autores foram unânimes em ressaltar que as clínicas integradas em Odontologia exercem influência na formação e no preparo do egresso generalista através do treinamento sobre um planejamento global, inter e multidisciplinar como pilar essencial para um currículo integrativo e inovador.

ntegrated clinics in Dentistry present a challenge for higher education in the training of professionals, who must adapt their approach to treating orofacial conditions in the near future, increasingly incorporating Dentistry and new technologies. This review study aimed to comprehend the concept of integrated clinics and its alignment with the National Curricular Guidelines. A systematic bibliographic survey was conducted in the following electronic databases: Lilacs, PubMed, and Scielo. The search employed keywords in both Portuguese and English, including "Education in Dentistry" (Dental Education), "Dental Clinics", "Graduation" (undergraduate program), "Integrated Provision of Health Care" (delivery of health care, integrated), and "Curriculum." Approximately 23 articles were selected for this review, and the primary ideas within the texts were extracted based on the employed methodologies and the principal results. The authors unanimously emphasized that integrated dentistry clinics significantly impact the training and preparation of generalist graduates. This influence stems from emphasizing global, inter, and multidisciplinary planning as an indispensable foundation for an integrative and innovative curriculum.

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INTRODUCTION: Diuretic efficiency (DE) is an independent predictor of all-cause mortality in acute heart failure (HF) at long-term follow-up. The performance of DE in advanced HF and the outpatient scenario is unclear. METHODS: Survival function analysis on a retrospective cohort of patients with advanced HF followed at the outpatient clinic of Hospital Universitario San Ignacio (Bogotá, Colombia) between 2017 and 2021. DE was calculated as the average of total diuresis in milliliters divided by the dose of IV furosemide in milligrams for each 6-h session, considering all the sessions in which the patient received levosimendan and IV furosemide. We stratified DE in high or low using the median value of the cohort as the cutoff value. The primary outcome was a composite of all-cause mortality and HF hospitalizations during a 12-month follow-up. Kaplan-Meier curves and log-rank test were used to compare patients with high and low DE. RESULTS: In all, 41 patients (66.5 ± 13.2 years old, 75.6% men) were included in the study, with a median DE of 24.5 mL/mg. In total, 20 patients were categorized as low and 21 as high DE. The composite outcome occurred more often in the high DE group (13 versus 5, log-rank test p = 0.0385); the all-cause mortality rate was 29.2% and was more frequent in the high DE group (11 versus 1, log-rank test p = 0.0026). CONCLUSION: In patients with advanced HF on intermittent inotropic therapy, a high DE efficiency is associated with a higher risk of mortality or HF hospitalization in a 12-month follow-up period.

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