RESUMO

Introdução:A atenção à Saúde Bucal no Brasil foi qualificada a partir da Política Nacional de Saúde Bucal (PNSB), através do Sistema Único de Saúde (SUS), fomentando ações de promoção, prevenção e recuperação da saúde bucal da população. A avaliação da prevalência de cárie dentária em determinada comunidade, para Estudos Epidemiológicos em Saúde Bucal, pode ser realizada por meio do índice CPOD, que fornece a quantidade média de dentes cariados, perdidos e obturados. Objetivo:O presente trabalho objetivouaferir o índice CPOD dos moradores de uma área coberta pela Equipe de Saúde Bucal (ESB) de um município de pequeno porte, caracterizar seu perfil socioeconômico, verificar seu comportamento quanto ao uso de serviços odontológicos e identificar fatores associados ao índice. Metodologia:Foi realizado um estudo de prevalência do tipo exploratório e descritivo com abordagem quantitativaem residentes de um município de pequeno porte com cobertura pela Equipe de Saúde Bucal. Foi utilizado um questionário de caracterização individual abordando identificação socioeconômica e comportamento relacionado à saúde bucal.Resultados:Na análise do CPOD, a média de dentes perdidos (5,44) foi maior que a dos dentes obturados (4,31) e cariados (1,34). Odesfecho CPOD foi associado positivamente com a idade e a necessidade do uso de prótese dentária.Conclusões:Observou-se uma média mais alta de dentes perdidos, seguida por dentes obturados, e uma média menor de dentes cariados. Verificamos que o índice CPOD individual foi mais elevado em pessoas com mais de 34 anos e naqueles que necessitavam de próteses dentárias (AU).

Introduction:Oral Health care in Brazil was qualified basedon the National Oral Health Policy (PNSB), through the Unified Health System (SUS), promoting actions to promote, prevent and recover the oral healthof the population. Assessing the prevalence of tooth decay in a community, for Epidemiological Studies inOral Health, can be conductedusing the DMFT index, which provides the average number of Decayed, Missing and Filled Teeth. Objective:Thisstudy aimed to measure the DMFT index of residents of an area covered by anOral Health Team (ESB) of a small municipality, characterize their socioeconomic profile, verify their behavior regarding the use of dental services,and identify factors associated with this index. Methodology:An exploratory and descriptive prevalence study was conductedwith a quantitative approach in residents of a small municipality covered by the Oral Health Team. An individual characterization questionnaire addressing socioeconomic identification and behavior related to oral health was used. Results:The total samplewas of 283 individuals with an average of 34 years of age. In the DMFT analysis, the average number of missing teeth (5.44) was higher than that of filled (4.31) and decayed ones(1.34). The occurrence of a DMFTindexgreater than 11 was significantly higher in individuals over 34 years of age (p value 0.000) and in subjects who needed dental prosthesis (p value 0.001). Conclusions:A higher average of missing teeth was observed, followed by filled ones, and a lower average of decayed teeth. The DMFT outcome was positively associated with age and the need to use dental prostheses (AU).

Introducción:La atención a la salud bucal en Brasil ha sido calificada por la Política Nacionalde Saúde Bucal (PNSB), a través del Sistema Único de Saúde (SUS), promoviendo acciones de promoción, prevención y recuperación de la salud bucal de la población. Para estudios epidemiológicos de salud bucal, la prevalencia de caries dental en una determinada comunidad puede ser evaluada utilizando el índice DMFT, que proporciona el número medio de dientes cariados, perdidos y obturados. Objetivo:El objetivo de este estudio fue medir el índice DMFT de los residentes de un área cubierta por el Equipo de Salud Bucal (ESB) de un pequeño municipio, caracterizar su perfil socioeconómico, verificar su comportamiento en cuanto al uso de servicios odontológicos e identificar factores asociados al índice. Metodología:Se realizó un estudio exploratorio y descriptivo de prevalencia con abordaje cuantitativo en residentes de un pequeño municipio cubierto por un Equipo de Salud Bucal. Se utilizó un cuestionario de caracterización individual que abordaba la identificación socioeconómica y el comportamiento relacionado conla salud bucodental. Resultados:La muestra total fue de 283 individuos con una edad media de 34 años. En el análisis de la DMFT, la media de dientes ausentes (5,44) fue superior a la de dientes obturados (4,31) y cariados (1,34). La incidencia de un DMFTsuperior a 11 fue significativamente mayor en los individuos de más de 34 años (valor p 0,000) y en los que necesitaban un tratamiento dental. Conclusiones:Hubo un mayor número medio de dientes ausentes, seguido de dientes obturados, y un menor número medio de dientes cariados. El resultado del DMFT se asoció positivamente con la edad y la necesidad de prótesis dentales (AU).

Assuntos

RESUMO

Introdução:O diabetes mellitustipo 2éuma condição endócrino-metabólica caracterizada pela hiperglicemia crônica decorrente da progressiva perda de sensibilidade periférica à insulina. Com efeito, as mudanças ocorridas nos padrões alimentares e de atividade física nos últimos anos possuem estreita relação com o aumento na prevalência dediabetes mellitus tipo 2mundialmente. Dito isso, é imprescindível a identificação precoce dos hábitos de vida inadequados na população, para que seja possível atuar preventivamente e diminuir os riscos de desenvolvimento da doença. Objetivo:Analisar os fatores de risco e o risco de desenvolvimento de diabetes mellitustipo 2 entre os alunos do curso de medicina, por meio do Escore Finlandês de Risco de Diabetes. Metodologia:Estudo epidemiológico analítico realizado por meio de questionário auto aplicado. As prevalências dos fatores de risco foram calculadas, e o teste do qui-quadrado e/ou Exato de Fisher foram realizados para verificar possível associação dos fatores de risco e o perfil dos entrevistados. 343 estudantes participaram do estudo. Resultados:A pontuação foi de 4,45 na amostra geral, classificado como "risco baixo". Os fatores de risco mais prevalentes foram parentesco com indivíduo portador de diabetes, alimentação não-saudável e sedentarismo. Houve associação entre sexo feminino e sedentarismo e entre sexo masculino e sobrepeso/obesidade. Conclusões:O escore de risco dos estudantes de medicina é considerado baixo e a presença de fatores de risco pode ser associada ao perfil do entrevistado (AU).

Introduction:Diabetes mellitus type 2is an endocrine and metabolic condition characterized by chronic hyperglycemia arising from progressive loss of peripheral sensibility to insulin. Effectively, changes in diet and physical activity in the past years are closely related to the increase in prevalence of diabetes mellitus type 2worldwide. Considering that, it is indispensable to perform an early identification of inadequate populational lifestyles in order to allow preventative measures seeking to decrease the development of this disease. Objective:Analyzing the risk factors and risks of developing diabetes mellitus type 2 among the medicine school students through the Finnish Diabetes Risk Score. Methodology:Analytic epidemiologic study through a self-assessment questionnaire. Risk factors prevalence were calculated and the chi-square test and/or the Fisher's exact test were conducted to verify a possible association between risk factors and interviewees' profile. 343 students have participated in the study. Results:Within the general sampling, the final scorewas 4.45, which is classified as "low risk". The most prevalent risk factors were: being related to individuals with diabetes, unhealthy diet, and sedentarism. There was an association of female individuals and sedentarism, and of male individuals and overweight/obesity. Conclusions:The risk score of the medicine school students is considered low and the appearance of risk factors can be associated to the interviewee's profile (AU).

Introducción: El diabetes mellitus clase 2es una condición endocrino-metabólica caracterizada por la hiperglucemia crónica originada por la progresiva pérdida de sensibilidad periférica a la insulina. En efecto, los cambios que ocurren en los estándares alimentarios y de actividad física en los últimos años tienen relación con el aumento de la prevalencia dediabetes mellitus classe 2mundialmente. Por ello, es importante la identificación temprana de los hábitos de vida no adecuados en la población para que se pueda actuar de manera preventiva y disminuir los riesgos de desarrollo de esta enfermedad. Objetivo: Analizar los factores de riesgo y el riesgo del desarrollo de diabetes mellitus clase 2 entre los alumnos del curso de medicina, a través del Score Finlandés de Riesgo de Diabetes. Metodología: Estudios epidemiológico-analíticos hechos a través de encuestas auto aplicadas. Las prevalencias de los factores de riesgo se calculan y el test de chicuadrado y/o Exacto de Fisher serealizan para verificar la posible asociación de los factores de riesgo y el perfil de los entrevistados. 343 estudiantes participan del estudio. Resultados: La puntuación es de 4,45 en la muestra general, clasificado como "riesgo bajo". Los factores de riesgo más prevalentes fueron parentesco con individuo que tiene diabetes, alimentación no sana y sedentarismo. Hubo asociación entre sexo femenino y sedentarismo y entre sexo masculino y sobrepeso/obesidad.Conclusiones: El score de riesgo de los estudiantes de medicina es considerado bajo y la presencia de factores de riesgo puede asociarse al perfil del entrevistado (AU).

Assuntos

RESUMO

Context: French Guiana is a French overseas department where very different linguistic, cultural and societal populations live together in a small area. Health issues and their specific epidemiological profiles call for research projects crossing several cultures. In this context, health mediators have a role to play in research. The aim of this study was to describe the perceptions, attitudes and opinions on research of mediators and researchers collaborating on research projects, and to describe the strengths and difficulties encountered during this cooperation. Methods: The Inter-med project was conducted in French Guiana between February 2022 and April 2023 on the base of semi-directive interviews with mediators, or researchers, all working in health research in the intercultural context of French Guiana. The socio-demographic characteristics of the participants were described. An inductive thematic analysis was carried out on all the interviews, and word occurrence analysis on certain themes. The information was triangulated with field coordination notebooks from two epidemiological surveys conducted in French Guiana between 2021 and 2022. Results: A total of 26 semi-structured interviews were conducted and 1,328 notebook pages analyzed. Mediation was described as an indispensable interface between the world of research and that of the population targeted by a survey. Mediators have a role to play at different stages of projects, in respect of good clinical practice, ethics and legislation. They act as interfaces between languages, concepts and representations. Their profession remains under-defined and under-dimensioned. The jobs offered are often precarious. Mediation work is emotionally costly, calls on soft skills and requires a combination of rigor and flexibility. All these aspects are implemented in the specific world of research, where there are common concepts and divergent perceptions. Researchers and mediators converge on a common goal: improving health. Conclusion: This study covers several aspects of the development and implementation of research projects. Respect for good clinical practice and people, transparency and data quality are redundant concerns, and this study touches on ethnocentrism, stigmatization and cultural representations. This study points out that the integration and recognition of mediators could be beneficial in research conducted in a cross-cultural context.

Assuntos

Assuntos

RESUMO

Cumulative trauma is usually devastating and can lead to severe psychological consequences, including posttraumatic stress disorder (PTSD). Exposure to various types of traumas, particularly during childhood, can be even more deleterious than the sheer number of events experienced. This epidemiological study is the first to investigate the impact of discrete childhood traumatic exposure on the risk of developing lifetime PTSD in a representative sample of the general population of the two biggest Brazilian cities. Participants were aged between 15 and 75 years old, living in São Paulo and Rio de Janeiro, Brazil, who had experienced traumatic events (N = 3,231). The PTSD diagnosis was assessed using the DSM-IV criteria through the version 2.1 of Composite International Diagnostic Interview. To operationalize childhood cumulative trauma, we considered the sum of 15 different childhood trauma categories that occurred before PTSD onset. The final multivariate logistic regression model indicated a strong relationship between the number of discrete types of childhood traumas and the likelihood of the lifetime PTSD development. The lifetime PTSD risk increased 28 % with each different type of childhood trauma when adjusted by confounds. Our study strengthens the evidence associating childhood cumulative trauma to increased lifetime PTSD risk.

Assuntos

RESUMO

Introducción: la colocación de prótesis metálicas autoexpansibles (PAE) por vía endoscópica surge como opción terapéutica para la obstrucción colónica neoplásica en dos situaciones: como tratamiento paliativo y como puente a la cirugía curativa. Este procedimiento evita cirugías en dos tiempos y disminuye la probabilidad de colostomía definitiva y sus complicaciones con el consecuente deterioro de la calidad de vida. Objetivo: comunicar nuestra experiencia en la colocación de PAE para el tratamiento paliativo de la obstrucción colorrectal neoplásica. Diseño: retrospectivo, longitudinal, descriptivo y observacional. Material y métodos: se incluyeron todos los pacientes a quienes el mismo grupo de endoscopistas les colocó PAE con intención paliativa por cáncer colorrectal avanzado entre agosto de 2008 y diciembre de 2019. Fueron analizadas las variables demográficas y clínicas, el éxito técnico y clínico, las complicaciones tempranas y tardías y la supervivencia. Resultados: se colocó PAE en 54 pacientes. La media de edad fue 71 años. El 85% de las lesiones se localizó en el colon izquierdo. En el 57% de los pacientes se realizó en forma ambulatoria. El éxito técnico y clínico fue del 92 y 90%, respectivamente y la supervivencia media de 209 días. La tasa de complicaciones fue del 29,6%, incluyendo un 14,8% de obstrucción y un 5,6% de migración. La mortalidad tardía atribuible al procedimiento fue del 5,6%, ocasionada por 3 perforaciones tardías: 2 abiertas y 1 microperforación con formación de absceso localizado. Conclusiones: la colocación de PAE como tratamiento paliativo de la obstrucción neoplásica colónica es factible, eficaz y segura. Permitió el manejo ambulatorio o con internación breve y la realimentación temprana, mejorando las condiciones para afrontar un eventual tratamiento quimioterápico paliativo. Las mayoría de las complicaciones fueron tardías y resueltas endoscópicamente en forma ambulatoria. (AU)

Introduction: endoscopic placement of self-expanding metal stents (SEMS) emerges as a therapeutic option for neoplastic obstruction of the colon in two situations: as palliative treatment and as a bridge to curative surgery. This procedure avoids two-stage surgeries and reduces the probability of permanent colostomy and its complications with the consequent deterioration in quality of life. Objective: to report our experience in the placement of SEMS as palliative treatment in neoplastic colorectal obstruction. Design: retrospective, longitudinal, descriptive and observational study. Methods: all patients in whom the same group of endoscopists performed SEMS placement with palliative intent for advanced colorectal cancer between August 2008 and December 2019 were analyzed. Data collected were demographic and clinical variables, technical and clinical success, early and late complications, and survival. Results: SEMS were placed in 54 patients. The average age was 71 years. Eighty-five percent were left-sided tumors. In 57% of the patients the procedure was performed on an outpatient basis. Technical and clinical success was 92 and 90%, respectively, and median survival was 209 days. The complication rate was 29.6%, including 14.8% obstruction and 5.6% migration. Late mortality attributable to the procedure was 5.6%, caused by 3 late perforations: 2 open and 1 microperforation with localized abscess formation. Conclusions: The placement of SEMS as a palliative treatment for neoplastic colonic obstruction is feasible, effective and safe. It allowed outpa-tient management or brief hospitalization and early refeeding, improving the conditions to face an eventual palliative chemotherapy treatment. Most complications were late and resolved endoscopically on an outpatient basis. (AU)

Assuntos

RESUMO

Introducción: el divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. Puede presentarse con hemorragia, obstrucción intestinal o diverticulitis, complicaciones que disminuyen con la edad, por lo que en el adulto el diagnóstico suele ser incidental. El tratamiento de las complicaciones es quirúrgico, mediante diverticulectomía o resección segmentaria del intestino delgado, dependiendo de sus características morfológicas. Objetivo: analizar nuestra experiencia en el manejo del divertículo de Meckel complicado en un período de 15 años. Diseño: estudio descriptivo, observacional, transversal, retrospectivo. Material y métodos: se revisaron las historias clínicas de los pacientes operados por divertículo de Meckel complicado en el Servicio de Cirugía General del Hospital San Roque durante el periodo 2007-2022. Se registraron datos demográficos, presentación clínica, diagnóstico preoperatorio, tratamiento quirúrgico, complicaciones postoperatorias y hallazgos histopatológicos. Resultados: se incluyeron 25 pacientes, 21 (84%) hombres, 3 menores de 18 años. La presentación clínica fue un síndrome de fosa iliaca derecha en el 80% de los casos, obstrucción intestinal en el 16% y hemorragia en el 4%. En solo 2 casos se realizó el diagnóstico preoperatorio, confirmado mediante tomografía computada. Se realizó diverticulectomía en el 68% de los pacientes y resección segmentaria el 32%. El abordaje fue laparotómico en el 64%, principalmente en el periodo inicial y laparoscópico en el 36%. Hubo una complicación IIIb de Clavien-Dindo en un paciente pediátrico tratado con drenaje percutáneo. En un solo paciente (4%), que se presentó con hemorragia digestiva masiva, se encontró epitelio de tipo gástrico y páncreas ectópico en el divertículo. Conclusiones: En nuestra experiencia el divertículo de Meckel complicado se presentó predominantemente en hombres. La complicación más frecuente en el adulto fue la diverticulitis. El diagnóstico preoperatorio fue infrecuente y realizado por tomografía computada. La diverticulectomía es suficiente en la mayoría de los casos. Actualmente, la laparoscopia es una herramienta segura, rentable y eficiente que permite el diagnóstico y tratamiento oportunos de esta entidad. (AU)

Introduction: Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. It can present with bleeding, intesti-nal obstruction or diverticulitis, complications that decrease with age, so in adults the diagnosis is usually incidental. Treatment of complications is surgical, through diverticulectomy or segmental resection of the small intestine, depending on its morphological characteristics. Objective: to analyze our experience in the management of complicated Meckel's diverticulum over a period of 15 years. Design: descriptive, observational, cross-sectional, retrospective study. Materials and methods: the medical records of patients operated on for complicated Meckel's diverticulum in the General Surgery Service of the San Roque Hospital during the period 2007-2022 were reviewed. Demo-graphic data, clinical presentation, preoperative diagnosis, surgical treatment, postoperative complications, and histopathological findings were recorded. Results: twenty-five patients were included, 21 (84%) men, 3 under 18 years of age. The clinical presentation was a right iliac fossa syndrome in 80% of cases, intestinal obstruction in 16% and hemorrhage in 4%. In only 2 cases was the preoperative diagnosis made, confirmed by computed tomography. Diverticulectomy was performed in 68% of patients and segmental resection in 32%. The approach was by laparotomy in 64%, mainly in the initial period, and by laparoscopy in 36%. There was a Clavien-Dindo IIIb complication in a pediatric patient treated with percutaneous drain-age. In only one patient (4%), who presented with massive gastrointestinal bleeding, gastric-type epithelium and ectopic pancreas were found in the diverticulum. Conclusions: In our experience, complicated Meckel's diverticulum occurred predominantly in men. The most frequent complication in adults was diverticulitis. Preoperative diagnosis was infrequent and was made by computed tomography. Diverticulectomy is sufficient in most cases. Currently, laparoscopy is a safe, profitable and efficient tool that allows for the timely diagnosis and treatment of this entity. (AU)

Assuntos

RESUMO

BACKGROUND: Trachoma is a notifiable disease in the state of São Paulo- Brazil. However, in Jaú, a municipality located in this state, in the last 10 years there are no records of cases. This study purpose is to assess if there are cases of inflammatory trachoma in schoolchildren aged 1 to 9 years in the municipality of Jaú as well if it is possible to detect clusters areas of the disease to establish elimination programs. METHODS: An epidemiological study was performed in 2018, involving a stratified random sample of schoolchildren aged 1- to 9-year-old, from public day care centers and elementary schools in the municipality of Jaú. A trachoma screening following the criteria of the World Health Organization (WHO) and the distribution of cases was assessed using geoprocessing. RESULTS: Four thousand-six hundred-nineteen children from 44 elementary schools were examined, and 126 children with active trachoma were detected, with an adjusted prevalence rate of 2.65%. The prevalence was higher (3.01%) in children aged 6- to 9-year-old compared to children aged 1-to 5-year-old (2.42%). There were clusters with a higher concentration of positive cases of the disease in three schools located in the neighborhoods with lower socioeconomic conditions. CONCLUSION: Inflammatory trachoma still present in children aged 1- to 9-year-old in the city of Jaú. The positive cases were located mainly in areas with low socioeconomic conditions. Health promotion with active search and periodical treatment must be planned to fight this important blinding cause, that persists in our municipality.

Assuntos

RESUMO

Sexual violence is a pervasive global issue that affects individuals of all genders. However, the experiences of male survivors have often been marginalized and inadequately represented. Male rape, which encompasses several forms of sexual violence against men, remains a sensitive and under-discussed topic in academic literature and public discourse. This study presents a descriptive cross-sectional analysis based on data collected from the Legal Medicine Institute (IML-São Paulo, Brazil) between 2014 and 2017. The analysis includes 7386 reports of sexological examinations performed on male victims of alleged rape. The analysis reveals that a significant majority of rape reports involved victims under the age of 12 or 14, which is considered vulnerable rape by the Brazilian legislation. Regarding the examination of reported cases of abuse against men, it was observed that only the minority of these cases exhibited visible injuries consistent with rape or tested positive for the presence of spermatozoa in the perianal region. Since the absence of visible injuries or spermatozoa does not negate the possibility of rape, this work highlights the challenges in obtaining conclusive evidence, necessitating a comprehensive approach to investigate and prosecute these crimes, creating a more inclusive and supportive environment for all survivors of rape, irrespective of their gender.

Assuntos

RESUMO

BACKGROUND: Systematic reviews of Randomized Controlled Trials (RCTs) are considered high-level evidence to support a decision on therapeutic interventions, and their methodological quality is essential to provide reliable and applicable results. OBJECTIVE: This meta-epidemiological study aimed to map and critically appraise systematic reviews assessing treatments for vesiculobullous skin diseases. METHODS: We conducted a comprehensive search strategy on MEDLINE (via Pubmed) in December 2022 without restrictions to find systematic reviews evaluating pharmacological interventions for vesiculobullous skin diseases. The methodological quality was assessed using the AMSTAR-2 tool, and additional information was extracted. We identified nine systematic reviews published between 2002 and 2021, seven assessing pemphigus. RESULTS: According to the AMSTAR-2 tool, 55.6% were classified as critically low quality, 22.2% as moderate quality, 11.1% as low and 11.1% as high quality. No review assessed the certainty of the evidence (GRADE); 86% of pemphigus reviews had at least two overlapping RCTs. There were some limitations regarding methodological flaws and the AMSTAR-2 tool use CONCLUSIONS: These findings reveal a frail methodological quality of systematic reviews about vesiculobullous diseases treatment that may impact the results. Therefore, methodological rigor is mandatory for future systematic reviews to avoid duplication of effort and increase the certainty of the evidence supporting decision-making.

Assuntos