HEMATOLOGIC AND BIOCHEMICAL VALUES OF FREE-RANGING HAWKSBILL SEA TURTLES (ERETMOCHELYS IMBRICATA) IN GLOVER'S REEF, BELIZE.

Blood samples were obtained from the dorsal cervical sinus of free-ranging hawksbill sea turtles (Eretmochelys imbricata) collected at Glover's Reef Marine Reserve, 42 km east of the coast of Belize, for hematology and plasma biochemistry analysis. Unknown sex, subadult turtles (N = 32) were sampled in 2013 (n = 22) and 2017 (n = 10). To provide a more robust data set, parameters that did not have statistically significant differences were pooled and treated as a single population. Eleven hematologic parameters were evaluated; of these, five were pooled. Twenty-three plasma biochemical parameters were evaluated; of these, 15 were pooled. The PCV observed in this study (mean 33.44%) was double that observed in two studies of juvenile hawksbills in Dubai (means 17% and 16%), whereas the total WBC count was half that observed in immature and adult hawksbills sampled in the Galápagos (mean 2.91 × 103 versus 5.3 × 103/µl). Total protein and albumin were lower than regionally similar, adult female hawksbills in Brazil (means 3.36 versus 5.45 g/dl and 0.93 versus 2.11 g/dl, respectively). Globulins were higher (mean 2.43 versus 1.06 and 0.5 g/dl), driving the albumin:globulin ratio lower than that observed in two studies of juvenile hawksbills in Dubai (0.4:1 versus 1.1:1 and 1:1, respectively). These findings represent a geographically distinct population from previous reports, highlight the variability in blood parameters from disparate populations, and reaffirm the vital importance of considering a multitude of variables when interpreting reptilian blood values. The similarities in the majority of values observed in 2013 and 2017 provide confidence in the stability of these parameters in this population.

Attention Deficit Hyperactivity Disorder (ADHD) and its Comorbid Mental Disorders: An Evaluation of their Labor Market Outcomes.

BACKGROUND: Attention-deficit/hyper-activity disorder's (ADHD) prevalence rate has been increasing during the last decade. Evidence from different studies suggests that the effect of ADHD on earnings and employment could be more detrimental than other disorders such as depression or anxiety. Although it is widely known that these mental disorders can coexist with ADHD, none of these studies has considered the joint evaluation of ADHD and its comorbidities. OBJECTIVE: In this paper, we evaluate whether ADHD is a more severe disorder than three other comorbid mental disorders -- learning disabilities, depression, and anxiety -- regarding their effects on earnings and employment. METHODS: We use the National Longitudinal Study of Adolescent to Adult Health to estimate regression models of earnings and employment. We consider the use of the sampling weights, school fixed effects, and multiple imputation of missing values. Robustness checks include a more exogenous measure of depression. RESULTS: On average, an individual with ADHD or depression (but not both) has around 20% lower earnings than those without any of these disorders. The earnings gap for learning disabilities is around 25%. The probability of being employed is 5 percentage points lower for an individual who has any of these disorders. Anxiety is not associated with lower earnings. Females with learning disabilities have an earnings gap that is 20 percentage points larger than males. The employment gap for females or African Americans with learning disabilities is 8%. DISCUSSION AND LIMITATIONS: In contrast to existing evidence, we find that ADHD is not more serious than learning disabilities or depression. Although the magnitude of each employment gap is not substantial, the fact that these are comorbid disorders indicates that their joint occurrence could be detrimental for employment. Females and African Americans with learning disabilities could face more adverse labor market outcomes. Even though our results are robust to a more exogenous measure of depression, the potential endogeneity of the diagnosis of ADHD or anxiety could still bias the estimates. However, baseline results are also robust when individuals with an age of diagnosis equal to the year of the interview are dropped from the estimations. IMPLICATIONS FOR HEALTH POLICY AND FOR FUTURE RESEARCH: The increasing number of Supplemental Security Income beneficiaries with ADHD is in line with the observed tendency to screen for ADHD more frequently than for other comorbid disorders, and with the evidence of ADHD overdiagnosis. Since our study shows that other disorders are equally or potentially more disabling than ADHD in terms of labor market outcomes, mental health policies should be reoriented to prevent policies targeting ADHD from crowding out those for other mental disorders. It would be interesting to verify our findings using a more recent cohort with a higher rate of ADHD diagnosis. Since we show that there are unexplained gender and race differences that persist after controlling for educational attainment or the number of hours worked, more research is needed to determine the reason behind these differences. Further research about the positive school effect on the adulthood performance of ADHD children is needed.

DISEASE SCREENING IN SOUTHERN RIVER TERRAPINS ( BATAGUR AFFINIS EDWARDMOLLI) IN CAMBODIA.

Southern River terrapins ( Batagur affinis) are among the most critically endangered turtles in the world. To augment the Cambodia population, a head-start program was established for the endemic subspecies Batagur affinis edwardmolli in 2006, and in 2015, prerelease health assessments were performed on 70 subadults (hatch years, 2006-2011). Combined choanal/cloacal swab samples ( n = 70) were collected and screened by polymerase chain reaction (PCR) for Mycoplasma, herpesvirus, and ranavirus. Cloacal samples ( n = 50) were also collected and cultured for Salmonella sp. Of 70 tested samples, six (8.6%) were positive for Mycoplasma, and all other PCR and culture test results were negative. Phylogenetic analysis of the 16S ribosomal RNA gene placed the Mycoplasma sp. from B. affinis edwardmolli in the chelonian Mycoplasma cluster that groups within the Mycoplasma pulmonis clade. This mollicute was not associated with clinical disease (defined as observable clinical abnormalities, such as depression, lethargy, respiratory signs, and anorexia) and is likely part of the endemic microbial flora of these terrapins.

Receptor-activated human α2-macroglobulin interacts with the envelope protein of dengue virus and protects virions from temperature-induced inactivation through multivalent binding.

Based on the hypothesis that interactions between virions and serum components may influence the outcome of dengue virus (DENV) infections, we decided to use affinity chromatography with domain III from the envelope (E) protein of DENV2 (DIIIE2) as a ligand to isolate virus-binding proteins from human plasma. This approach yielded serum amyloid P (SAP) and α2-macroglobulin (α2M) as novel viral interactors. After confirming the specific binding of both SAP and α2M to DIIIE2 by ELISA, the latter interaction was examined in greater detail. We obtain evidence suggesting that the binding species was actually the receptor-activated form of α2M (α2M*), that α2M* could bind monovalently to recombinant domain III from all four DENV serotypes with affinities in the micromolar range ranking as DENV4>DENV1~DENV2>DENV3 and that this interaction exhibited a strong avidity effect when multivalent binding was favoured (KD 8 × 10(-8) M for DIIIE2). We also showed that α2M* bound to DENV virions of the four serotypes, protecting the virus from temperature-induced inactivation in the absence of serum and enhancing infectivity. The latter effect exhibited an ED50 of 2.9 × 10(-8) M, also suggesting an avidity effect due to multivalent binding. These results will further contribute to the characterization of the virus-host factor interaction network during human DENV infection.

Ultrasound-guided Fat Graft of the Obliques-Serratus Complex.

Background: The idea of the anterolateral thoracic musculature in men during the contour procedure is very limited, particularly in terms of surgical techniques that improve its appearance and aesthetics. Therefore, this study aimed to describe a technique of deep definition liposuction with intramuscular grafting of the serratus external oblique muscle complex. Methods: A retrospective case series of a total of 11 cases of male patients aged between 29 and 60 years in the year 2022 is presented. These patients underwent body contouring surgery and subsequently underwent ultrasound-guided intramuscular fat grafting in the serratus external oblique complex. As part of the study, measurements were taken before and immediately after surgery. The data were stored in a database and analyzed with the statistical software SPSS, v23.0. Results: The patients were aged between 29 and 60 years, with a mean age of 38.3 years (±8.5). All cases had a body mass index of 30. Results were matched preinfiltration and postinfiltration; These results were subjected to statistical validation using the Student t test for related samples, and statistically significant differences were obtained in all the measures tested. Conclusions: The technique of fat grafting in the oblique-serratus complex allows for increasing muscle thickness. The measurements were made only immediately after the infiltration; it is important in the future to show the long-term follow-up. No adverse events occurred during the study.

Incorporation of the UGRAFT Technique to High-definition Liposuction.

High-definition liposuction is now a reliable procedure that provides more athletic results. It is a trend among plastic surgeons and patients. The ultrasound-guided rectus abdominis fat transfer (UGRAFT) technique has expanded the range of patients who can benefit from rectus abdominis fat grafting, including those without skin laxity. Its advantage over isolated high-definition liposuction is a more natural-looking result because it increases muscle volume and provides a contoured abdomen even during movement, regardless of the patient's position. In this article, we describe one patient undergoing the UGRAFT technique after high-definition liposuction, versus one patient undergoing only high-definition liposuction. We determined that the use of the UGRAFT technique provides greater muscle definition over those in which this technique has not been performed. The UGRAFT technique opens the possibility of developing more complete body structures regarding definition, providing volume to muscular areas. The more muscle mass and less body fat, the greater the body definition in a liposuction. The less muscle mass and more body fat, the less definition a patient will have in a liposuction. Under these principles, we improve the result by increasing the volume of muscle mass.

Electronic Health Record: a systematic review of the implementation under the National Humanization Policy guidelines. / Prontuário Eletrônico: uma revisão sistemática de implementação sob as diretrizes da Política Nacional de Humanização.

As part of the evaluability study of the implementation of the Electronic Patient Record (EPR) evaluation, the aim of this Systematic Review (SR) was to identify the evaluation domains to be addressed. This SR, aligned with the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) encompassed articles published from 2006 to 2019. The search was carried out in the electronic databases SciELO, Oasis IBICT, BVS Regional and Scopus. The search resulted in 1,178 articles, 42 of which met the inclusion criteria. Most studies used qualitative methods for the analyses. The publications took place between 2006 and 2019, with a concentration in 2017 with 9 (21%) articles published in that year. No studies were published in 2008 and 2009. Only 10 studies included the description, analysis or results related to the domains of implementation. The main domains in which the EPR was problematized were: underutilization; professionals' resistance to its use; emphasis on usability; and EPR as an information source. Despite the inclusion of all studies that covered the principles and guidelines of the National Humanization Policy (NHP), they are still incipient.

Como parte do estudo de avaliabilidade da avaliação da implementação do Prontuário Eletrônico do Paciente (PEP), o objetivo desta Revisão Sistemática (RS) foi identificar os domínios de avaliação a serem abordados. Esta RS, alinhada com o Cochrane Handbook for Systematic Reviews of Interventions e o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) englobou artigos publicados de 2006 até 2019. Realizou-se a busca nas bases de dados eletrônicas SciELO, Oásis IBICT, BVS Regional e Scopus. A busca retornou 1.178 artigos, sendo 42 que atenderam aos critérios de inclusão. A maioria dos estudos utilizaram métodos qualitativos para análises. As publicações ocorreram entre 2006 e 2019, tendo sua concentração em 2017 com 9 (21%) artigos publicados. Não foram identificados estudos publicados em 2008 e 2009. Somente 10 estudos incluíam descrição, análises ou resultados relacionados aos domínios de implementação. Os principais domínios em que o PEP foi problematizado foram: subutilização; resistência dos profissionais ao seu uso; ênfase na usabilidade; e o PEP como repositório de informações. Apesar da inclusão de todos os estudos que contemplaram os princípios e diretrizes da Política Nacional de Humanização (PNH), eles ainda são incipientes.

Inequality in body mass indices across countries: Evidence from convergence tests.

This study examines the long-term inequality in body mass index (BMI) based on convergence tests applied to a database of 172 countries recently published by the NCD Risk Factor Collaboration. First, we find that countries converge in clubs, which indicates that country disparities in BMIs will persist over time. Second, there are three and six convergence clubs in BMIs for female and male individuals, respectively. That is, we would not observe a single convergence pattern in body weights as the nutrition transition theory and the dietary convergence hypothesis seem to suggest. Females have only one healthy club (18.5 ≤ BMI < 25) and two overweight clubs (BMI ≥ 25). Males have three healthy clubs and three overweight clubs. Third, the analysis of club convergence indicates that BMI inequality has increased due to the BMI growth observed in club 1 (the one with the highest average BMI and led by the US) in each gender group. Finally, potential determinants of BMI such as globalization, human capital, income, and urbanization are relevant to understand differences across clubs. We interpret the club convergence as the result of a heterogeneous integration of countries into the global economy, which is probably related to strong domestic preferences, policies designed to manage the impacts of globalization, and shifts in productive structures.

Characterization of the interaction of domain III of the envelope protein of dengue virus with putative receptors from CHO cells.

Domain III (DIII) of the envelope protein of dengue virus (DENV) contains structural determinants for the interaction with cellular receptors. In the present study a solid phase assay and recombinant fusion proteins containing DENV-DIII of serotypes 1 and 2 were used to study structural features of the interaction of the envelope protein with putative receptors present in the microsomal fraction of CHO cells. Recombinant fusion proteins showed specific interaction with proteins present in the microsomal fraction. Binding of the fusion proteins across the pH range of 5.5-8.0 resembled that of virus particles, peaking at pH 6.0. This suggests that the interaction of DIII with cell receptor(s) is strengthened at endosomal pH. The effect of reduction and carbamidomethylation of cysteine residues on the binding to the microsomal fraction and in their recognition by antibodies suggests that the region of DIII that is interacting with putative receptor(s) overlaps only partially with a dominant epitope of the antibody response. The analysis of the residue conservation profile indicates that the surface of DIII is composed typically of specific sub-complex residues with an increased representation of specific type/subtype residues found at the surface that closely correlates with the dominant neutralizing epitope.

Long-run overweight levels and convergence in body mass index.

We evaluate the hypothesis of convergence to an optimal long-run body weight worldwide. We formulate a simple rational non-addiction eating model to derive a testable equation that allows us to verify the existence of a long-run body weight as well as its estimation. We use a database of body mass index (BMI) estimates across countries over four decades published by the NCD Risk Factor Collaboration. We find that BMIs converge among European countries but not in the rest of the world. Consistent with the theoretical model, our long-run estimates suggest that European nations will show an average BMI above healthy levels. In particular, females and males will show average BMIs classified as overweight levels (BMI = 28.3). Confidence intervals and sensitivity analysis suggest that males might reach long-term BMI levels associated with obesity (BMI > 30). We discuss the implications of our findings from the perspectives of health economics and economic development.

Comparison of reversed-phase liquid chromatography-mass spectrometry with electrospray and atmospheric pressure chemical ionization for analysis of dietary tocopherols.

ESI and APCI ionization techniques in both negative and positive ion modes were evaluated for simultaneous LC-MS analysis of the four tocopherol homologues (alpha, beta, gamma and delta). The ESI and APCI ionization of tocopherols in positive ion mode was not efficient and proceeded via two competitive mechanisms, with the formation of protonated pseudo-molecular ions and molecular ions, which adversely influenced the repeatability of MS signal. Ionization in negative ion mode in both ESI and APCI was more efficient as it only produced target deprotonated pseudo-molecular ions. The APCI in negative ion mode showed larger linearity range, lower detection limits and was less sensitive to the differences in chemical structure of analytes and nature of applied solvents than negative ion ESI. Negative ion APCI was, therefore, chosen for the development of LC-MS method for simultaneous determination of the four tocopherols in foods. A baseline separation of the tocopherols was achieved on novel pentafluorophenyl silica-based column Fluophase PFP. The use of methanol-water (95:5, v/v) as a mobile phase was preferable to the use of acetonitrile-water due to considerable gain in MS signal. The limits of quantifications were 9 ng/mL for alpha-tocopherol, 8 ng/mL for beta- and gamma- and 7.5 ng/mL for delta-tocopherol when 2 microL was injected. This method was successfully applied to determination of tocopherols in sunflower oil and milk.

Novel interactions of domain III from the envelope glycoprotein of dengue 2 virus with human plasma proteins.

Blood cells and plasma are important media for the four serotypes of dengue virus (DENV1-4) spreading into an infected person. Thus, interactions with human plasma proteins are expected to be decisive in the course of the viral infection. Affinity purification followed by MS analysis (AP/MS) was used to isolate and identify plasma-derived proteins capable to interact with a recombinant protein comprising the domain III of the envelope protein of DENV2 (DIIIE2). The elution of the AP potently inhibits DENV2 infection. Twenty-nine proteins were identified using a label-free approach as specifically captured by DIIIE2. Of these, a direct interaction with C reactive protein, thrombin and Inter-alpha-inhibitor complexes was confirmed by ELISA. Results provide further evidence of a significant representation of proteins from complement and coagulation cascades on DENV2 interactome in human plasma and stand out the domain III of the viral envelope protein as participant on these interactions. A functional clustering analysis highlights the presence of three structural motifs among putative DIIIE2-binding proteins: hydroxylation and EGF-like calcium-binding- and Gla domains. BIOLOGICAL SIGNIFICANCE: Early cycles of dengue virus replication take place in human blood cells. Thus, the characterization of the interactome of dengue virus proteins in human plasma can lead to the identification of pivotal interactions for the infection that can eventually constitute the target for the development of methods to control dengue virus-caused disease. In this work we identified 29 proteins from human plasma that potentially interact with the envelope protein of dengue 2 virus either directly or through co-complex formation. C reactive protein, thrombin and Inter-alpha-inhibitor complexes were validated as interactors of the domain III of the envelope protein of dengue 2. Results highlight the presence of three structural motifs among putative DIIIE2-binding proteins: hydroxylation and EGF-like calcium-binding- and Gla domains. This finding together with the participation of domain III of the envelope protein on the interactions with human plasma proteins should contribute to a better understanding of dengue virus interactome in human plasma. Such knowledge can contribute to the development of more effective treatments to infected persons.

Prontuário Eletrônico: uma revisão sistemática de implementação sob as diretrizes da Política Nacional de Humanização / Electronic Health Record: a systematic review of the implementation under the National Humanization Policy guidelines

Resumo Como parte do estudo de avaliabilidade da avaliação da implementação do Prontuário Eletrônico do Paciente (PEP), o objetivo desta Revisão Sistemática (RS) foi identificar os domínios de avaliação a serem abordados. Esta RS, alinhada com o Cochrane Handbook for Systematic Reviews of Interventions e o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) englobou artigos publicados de 2006 até 2019. Realizou-se a busca nas bases de dados eletrônicas SciELO, Oásis IBICT, BVS Regional e Scopus. A busca retornou 1.178 artigos, sendo 42 que atenderam aos critérios de inclusão. A maioria dos estudos utilizaram métodos qualitativos para análises. As publicações ocorreram entre 2006 e 2019, tendo sua concentração em 2017 com 9 (21%) artigos publicados. Não foram identificados estudos publicados em 2008 e 2009. Somente 10 estudos incluíam descrição, análises ou resultados relacionados aos domínios de implementação. Os principais domínios em que o PEP foi problematizado foram: subutilização; resistência dos profissionais ao seu uso; ênfase na usabilidade; e o PEP como repositório de informações. Apesar da inclusão de todos os estudos que contemplaram os princípios e diretrizes da Política Nacional de Humanização (PNH), eles ainda são incipientes.

Abstract As part of the evaluability study of the implementation of the Electronic Patient Record (EPR) evaluation, the aim of this Systematic Review (SR) was to identify the evaluation domains to be addressed. This SR, aligned with the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) encompassed articles published from 2006 to 2019. The search was carried out in the electronic databases SciELO, Oasis IBICT, BVS Regional and Scopus. The search resulted in 1,178 articles, 42 of which met the inclusion criteria. Most studies used qualitative methods for the analyses. The publications took place between 2006 and 2019, with a concentration in 2017 with 9 (21%) articles published in that year. No studies were published in 2008 and 2009. Only 10 studies included the description, analysis or results related to the domains of implementation. The main domains in which the EPR was problematized were: underutilization; professionals' resistance to its use; emphasis on usability; and EPR as an information source. Despite the inclusion of all studies that covered the principles and guidelines of the National Humanization Policy (NHP), they are still incipient.

Participação dos atores na avaliação do Projeto QualiSUS-Rede: reflexões sobre uma experiência de abordagem colaborativa / Stakeholder participation in the evaluation of QualiSUS-Network Project: Reflections on a collaborative approach experience

RESUMO A incorporação dos diferentes interessados ao processo avaliativo é estratégica para facilitar a compreensão da avaliação e a apropriação de seus resultados. Este artigo se propõe a descrever e analisar criticamente a participação dos atores (stakeholders) no processo de avaliação, utilizando a pesquisa avaliativa do Projeto de Formação e Melhoria da Qualidade de Rede de Atenção à Saúde (Projeto QualiSUS-Rede). Para isto, foram tomadas como base as memórias das reuniões de trabalho, das oficinas de alinhamento conceitual e de validação dos Modelos Lógicos dos seminários realizados, assim como dos relatórios elaborados no período de agosto de 2012 a dezembro de 2015. A abordagem colaborativa envolveu inúmeros desafios, englobando 15 projetos, com distintos níveis de abrangência e complexidade, e com diversos stakeholders, com diferentes tipos e níveis de colaboração, o que condicionou os limites e as possibilidades de participação. Esta experiência gerou a adaptação do Modelo de Avaliação Colaborativa de Rodriguez-Campos e Rincones-Gomez (2013). A abordagem colaborativa exige por parte dos avaliadores um exercício de flexibilização e de ajuste às distintas particularidades e aos contextos locais, sem perder de vista o alinhamento às teorias da intervenção e ao modelo teórico da avaliação.

ABSTRACT Stakeholder approaches to evaluation imply the incorporation of different stakeholders in the evaluation process as to facilitate its comprehension and the appropriation of its results. This article aims to describe and critically analyze the participation of the stakeholders in the evaluation process taking into account the evaluation study Projeto de Formação e Melhoria da Qualidade de Rede de Atenção à Saúde (Projeto QualiSUS-Rede). For this purpose, we analyzed the reports regarding work meetings, workshops for conceptual alignment and validation of the projects Logical Models, seminars, as well as partial and final reports, during the period of August 2012 to December 2015. The collaborative approach involved numerous challenges encompassing 15 projects, with different levels of complexity, and with a diverse number and variety of stakeholders, which brought us to the limits and possibilities of participation of the different actors. We adapted the Collaborative Evaluation Model, from Rodriguez-Campos and Rincones-Gomez (2013). This type of approach requires the evaluators to exercise flexibility and adjustment to different local contexts and particularities, without losing sight of conformity to the theory of intervention and to the evaluation theoretical model.

Charge state-selective separation of peptides by reversible modification of amino groups and strong cation-exchange chromatography: evaluation in proteomic studies using peptide-centric database searches.

Here we describe an integrated approach for the selective separation of peptides from complex mixtures using strong cation-exchange chromatography. The procedure exploits the charge differences produced by reversible modification of primary amino groups in peptides, enabling their separation into three major fractions: 1) neutral peptides 2) peptides with one positive charge and 3) peptides with 2 or more positive charges. The procedure demonstrated an excellent selectivity which allowed restricted MS/MS ion searches with peptide-centric databases.

Tratamiento Odontológico Ambulatorio de Pre-Escolar con Parálisis Cerebral / Dental Treatment in Pre-School Outpatient with Cerebral Palsy

Los avances en medicina y en particular en pediatría han permitido sobrevivir a más niños que nacen prematuros. Aunque la mayoría de los sobrevivientes no tienen inconvenientes en su desarrollo, un significativo número de niños demuestran discapacidad en su neurodesarrollo. En los prematuros, las complicaciones y las secuelas neurológicas, aumentan con la disminución de la edad gestacional y el peso al nacer. La parálisis cerebral es la discapacidad neuromuscular más frecuente que afecta a los niños, y constituyen un grupo de alto riesgo de patologías orales. El reporte del presente caso clínico, muestra el tratamiento odontológico de un pre-escolar con parálisis cerebral, realizado en forma ambulatoria, sin premedicación ni anestesia general, sustentado en un conocimiento profundo de la patología basal médica y características individuales. La compresión de las enfermedades orales, la aplicación de técnicas de manejo conductual y la sensibilización del clínico, permitieron controlar y mejorar el deplorable estado de salud oral del pre-escolar, contribuyendo por lo tanto a una mejor calidad de vida. La promoción, la prevención y recuperación de la salud oral en los pacientes con necesidades de cuidados especiales de salud debe ser una parte integral de la odontología, para lo cual el odontopediatra debe estar integrado al equipo multidisciplinario, que busca brindar atenciones adecuadas a las necesidades de este grupo en particular.

Advances in medicine, particularly in pediatric medicine, have enabled more premature babies to survive. While the majority of the survivors present trouble-free development, a significant number of all children present disabilities in their neural development. In premature babies, the neurological complications and consequences increase inversely with the gestational age and weight at birth. Cerebral palsy is the most common neuromuscular disability affecting these children, and as a group they also present a high risk of oral pathologies. The report of the present clinical case describes the dental treatment of a pre-school child with cerebral palsy, in outpatient conditions and without either pre-medication or general anaesthesia, based on a profound knowledge of the basic medical pathology and individual characteristics. The understanding of oral disease, the use of behavioral management techniques and raising awareness in the clinic, enabled the child's deplorable state of oral health to be controlled and improved, thus contributing to a better quality of life. Preventative measures and the promotion and recovery of oral health in patients requiring special health care must be an integral part of dentistry. This requires the dental-pediatrician to form part of a multidisciplinary team specializing in providing proper treatment for the needs of this particular group.

Prevalencia de caries temprana de la infancia y sus factores asociados en niños chilenos de 2 y 4 años / Prevalence of early childhood caries and associated factors in 2 and 4 year-old Chilean children

Se realizó un estudio de corte transversal durante el año 2008 con una muestra 301 niños de 2 y 4 años que asisten por primera vez al servicio dental del Hospital de Calbuco, cuyo objetivo fue determinar la prevalencia de caries temprana de la infancia (CTI), severa caries temprana de la infancia (CTI-S) y sus factores asociados. El diagnóstico de caries siguió los criterios establecidos por la OMS, considerando a las caries incipientes dentro del componente caries. Además se investigó su relación con factores socio-demográficos, dietarios y hábitos de higiene oral. La información fue analizada usando test exacto de Fisher y modelos de regresión logística. La prevalencia de CTI fue de un 70 por ciento con una severidad de un 52 por ciento. Se encontró asociación estadísticamente significativa entre CTI y variables como edad, ruralidad, estado nutricional, uso de biberón, uso biberón nocturno e índice de higiene oral simplificado (p<0,05). Del estudio multivariado se determinó que a los 2 años el usar biberón nocturno es un factor protector (OR=2,6). La alta prevalencia de CTI en la población estudiada evidencia la necesidad de incorporar programas educativos y preventivos durante el primer año de vida.

A cross-sectional study was performed during 2008, with a sample of 301 two and four year-old children attending their first dental appointment in the Calbuco Hospital. The aim of the study was to determine the prevalence of early childhood caries (ECC), severe early childhood caries (S-ECC) and their associated factors. The children´s dental examination and caries diagnosis were carried out using standardized methods (World Health Organization). White spot lesion was recorded as caries. The relationship of socio-demographic factors, dietary habits and oral hygiene was also investigated. The data was analyzed using Fisher's exact test and logistic regression models. The prevalence of ECC, including white spot lesions was 70 percent with a severity of 52 percent. A significant statistical association was found between ECC and variables such as age, rurality, nutritional status, bottle-feeding, bottle-feeding at bedtime and simplified oral hygiene index (OHI-S) (p<0.05). The multivariate study determined that the presence of bottle-feeding at bed time is a protective factor in 2 year-old children (OR = 2.6). The high prevalence of ECC highlighted the need to incorporate educational and preventive programs during the first year of life.

Diversidade sexual: problematizando as identidades na experiência escolar a partir do ensino em saúde / Sexual diversity: problematizing identities in the school experience from health education

Este estudo problematiza a diversidade sexual na experiência escolar, a partir doensino em saúde, e sob a ótica de quem viveu a experiência. Buscamos descrever ecompreender as repercussões da identidade sexual na trajetória escolar, bem comoa atuação do educador neste contexto. Analisamos de que maneira as questõesligadas às identidades de gênero e sexual poderiam ou não contribuir para ainterrupção dos estudos ou afastamento do ambiente escolar. A marcação degênero relacionada às identidades sexuais mostrou-se relevante nos depoimentosdos participantes. Deste modo, observamos que os debates que envolvem aconstrução das identidades de gênero, das identidades sexuais e da própriasexualidade, compreendem dimensões políticas e sociais que estão intrinsecamenterelacionadas à escola e a função de educador. Os resultados obtidos demonstram anecessidade de ampliar a voz do sujeito com o intuito de tentar compreender de quemaneira aspectos associados à diversidade sexual ressoam na trajetória escolar...

This study examines the issue of sexual diversity in the school experience, fromhealth education, and from the perspective of those who lived the experience. Weseek to describe and understand the repercussions of sexual identity in schoolhistory, as well as the role of the educator in this context. We analyze how issuesrelated to gender and sexual identities may or may not contribute to the interruptionof studies or withdrawal from the school environment. The marking of gender relatedto sexual identities proved relevant in the testimonies of participants. Thus, weobserve that discussions involving the construction of gender identities, sexualidentities and sexuality itself, comprising political and social dimensions that areintrinsically related to the school and the role of educator. The results demonstratethe need to amplify the voice of the subject in order to try to understand how aspectsassociated with sexual diversity resonate in school history...