Letters away from the looking glass: Developmental trajectory of mirrored and rotated letter processing within words.

Discrimination of reversible mirrored letters (e.g., d and b) poses a challenge when learning to read as it requires overcoming mirror invariance, an evolutionary-old perceptual tendency of processing mirror images as equivalent. The present study investigated when, in reading development, mirror-image discrimination becomes automatic during visual word recognition. The developmental trajectory of masked priming effects was investigated from 2nd to 6th grade and in adults, by manipulating letter type (nonreversible; reversible) and prime condition (control; identity; mirrored; rotated). Standardized identity priming increased along reading development. Beginning readers showed mirror invariance during reversible and nonreversible letter processing. A mirror cost (slower word recognition in mirrored-letter than identity prime condition) was found by 5th-grade but only for reversible letters. By 6th grade, orthographic processing was no longer captive of mirror invariance. A multiple linear regression showed that letter representations, but not phonological processes or age, were a reliable predictor of the rise of mirror-image discrimination in 2nd-4th-graders. The present results suggest a protracted development of automatic mirror-image discrimination during orthographic processing, contingent upon the quality of abstract letter representations. RESEARCH HIGHLIGHTS: We traced the developmental trajectory of mirrored-letter and rotated-letter priming effects (e.g., ibea and ipea as primes of IDEA) in visual word recognition. Beginning readers (2nd-4th-graders) showed mirror invariance and plane-rotation sensitivity in orthographic processing, thus still being susceptible to the perceptual biases in charge in object recognition. A mirror cost was found in 5th-graders but only for reversible letters; orthographic processing was no longer captive of mirror invariance by 6th-grade. The automation of mirror-image discrimination during orthographic processing depends on the quality of letter representations but not on phonological processes or age.

Absent right common carotid artery with associated anterior communicating aneurysm: embryology and imaging correlation.

PURPOSE: To report an unusual absent right common carotid artery with embryological and clinical emphasis. METHODS: A 63-year-old female with a multilobulated anterior communicating artery saccular aneurysm was referred to our center for definite treatment. An analysis of her carotid system on CTA and DSA with 3D modeling was performed to assess the embryology of an absent right common carotid and its association with aneurysm development. RESULTS: Cerebral angiogram demonstrated an absent right common carotid artery and separate origin of the internal and external right carotid arteries arising from the brachiocephalic trunk. CONCLUSION: Absence of the common carotid artery is an uncommon anatomical variant, usually asymptomatic and commonly associated with other vascular abnormalities. It is important to be familiar with the association between this anatomical variant given its hemodynamic stress, high risk of stroke, and aneurysm formation.

Hepatocellular carcinoma with tumoral extension to the inferior vena cava and right atrium.

This case report describes an 81-year-old male with Child-Pugh B chronic liver disease presenting with dyspnea and atypical precordial pain. Evaluation revealed a third-degree atrioventricular block, necessitating temporary pacemaker placement. Portable cardiac ultrasound identified an intracavitary mass in the right atrium. A triphasic abdominal CT scan unveiled a solid lesion in hepatic segments VII and VIII, displaying arterial phase enhancement and late-phase washout. The neoplastic lesion, measuring 9.3 x 8.3 cm, exhibited lobulated, poorly defined borders, with extension into the right suprahepatic vein, inferior vena cava, and right atrium.

Challenges and strategies for conducting research in primary health care practice: an integrative review.

BACKGROUND: Providing accessible and high-quality patient-centered healthcare remains a challenge in many countries, despite global efforts to strengthen primary health care (PHC). Research and knowledge management are integral to enhancing PHC, facilitating the implementation of successful strategies, and promoting the use of evidence-based practices. Practice-based research in primary care (PC-PBR) has emerged as a valuable approach, with its external validity to diverse PHC settings, making it an effective means of translating research findings into professional practice. OBJECTIVE: To identify challenges and strategies for conducting practice-based research in primary health care services. METHOD: An integrative literature review was conducted by searching the PubMed, Embase, Scopus, Web of Science, and Lilacs databases. The research question, guided by the PICo framework, directed the execution of study selection and data extraction. Data analysis followed the RAdAR method's three phases: pre-analysis, data analysis, and interpretation of results. RESULTS: Out of 440 initially identified articles, 26 met the inclusion criteria. Most studies were conducted in high-income countries, primarily the United States. The challenges and strategies for PC-PBR were categorized into six themes: research planning, infrastructure, engagement of healthcare professionals, knowledge translation, the relationship between universities and health services, and international collaboration. Notable challenges included research planning complexities, lack of infrastructure, difficulties in engaging healthcare professionals, and barriers to knowledge translation. Strategies underscore the importance of adapting research agendas to local contexts, providing research training, fostering stakeholder engagement, and establishing practice-based research networks. CONCLUSION: The challenges encountered in PC-PBR are consistent across various contexts, highlighting the need for systematic, long-term actions involving health managers, decision-makers, academics, diverse healthcare professionals, and patients. This approach is essential to transform primary care, especially in low- and middle-income countries, into an innovative, comprehensive, patient-centered, and accessible healthcare system. By addressing these challenges and implementing the strategies, PC-PBR can play a pivotal role in bridging the gap between research and practice, ultimately improving patient care and population health.

Relationship between oral health literacy of caregivers and the oral health-related quality of life of children: a cross-sectional study.

BACKGROUND: Oral health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate oral health decisions. However, scientific evidence about the oral health literacy of caregivers and the children's oral health-related quality of life. The purpose of this study was to verify the relationship between the level of oral health literacy of caregivers and the children's oral health-related quality of life (OHRQOL). METHODS: This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred thirty children were examined to assess the prevalence of dental caries (dmft index). Parents were interviewed to obtain sociodemographic status, oral conditions, and oral health literacy (OHL). The variable outcome was the children's OHRQOL as assessed by the Early Childhood Oral Health Impact Scale (ECOHIS). We fitted zero-inflated negative binomial regression (ZINB) models to evaluate associations between the study outcome and covariates in terms of PR (Prevalence Ratios), RR (Rate Ratios), and their respective Confidence Intervals (95% CI). RESULTS: Children's OHRQOL was not associated with OHL. Dental caries had a negative impact on the children's quality of life (p < 0.05). A reduced impact on OHRQOL is also associated with having siblings (PR = 0.70, 95% CI 0.52-0.95). A higher age of the mother reduced OHRQOL impacts (PR = 0.72, 95% CI 0.52-0.98). CONCLUSIONS: The factors associated with children's OHRQOL were the number of siblings, the mothers' age, and dental caries. This study observed no association between parental OHL and children's OHRQOL.

Adrenal functional reserve in the full spectrum of chronic kidney disease.

BACKGROUND: Altered cortisol levels have been associated with an increase in mortality and a decrease in health-related quality of life in patients with chronic kidney disease (CKD); however, adrenal response to adrenocorticotropic hormone (ACTH) stimulation test has not been evaluated in patients with stage 3a to 5 CKD with and without renal replacement therapy (RRT). OBJECTIVE: To evaluate adrenal function in patients with CKD. MATERIALS AND METHODS: Adults with CKD underwent a low-dose cosyntropin stimulation test (1 µg synthetic ACTH), with serum cortisol levels being measured at 0, +30 and +60 minutes post-test. RESULTS: Sixty participants with stage 3, 4 and 5 CKD (with and without RRT) were included. None of the patients had adrenal insufficiency (AI). The correlation observed between cortisol concentration at baseline and 30 minutes and 1 hour after stimulation and glomerular filtration rate (GFR) was negative and statistically significant (r: -0.39 [p = 0.002], r: -0.363 [p = 0.004], r: -0.4 [p = 0.002], respectively). CONCLUSION: Since CKD early stages, cortisol levels increase as GFR decreases. Therefore, we conclude that systematic screening for AI is not necessary in CKD patients.

ANTECEDENTES: Niveles alterados de cortisol se han asociado a un incremento en la mortalidad y disminución en la calidad de vida en pacientes con enfermedad renal crónica (ERC), sin embargo, la respuesta adrenal a la prueba de estimulación con adrenocorticotropina (ACTH) no ha sido evaluada en pacientes con ERC etapas 3a a 5 con y sin terapia de reemplazo renal (TRR). OBJETIVO: Evaluar la función adrenal de pacientes con ERC. MATERIALES Y MÉTODOS: Adultos con ERC se sometieron a una prueba de estimulación con cosintropina a dosis baja (1 mg de ACTH sintética) y se midieron los niveles séricos de cortisol a los 0, +30 y +60 minutos postestimulación. RESULTADOS: 60 participantes con ERC en etapas 3, 4 y 5 (con y sin TRR) fueron incluidos. Ninguno de los pacientes presentó insuficiencia adrenal (IA). La correlación observada entre la concentración basal, a los 30 minutos y 1 hora de cortisol postestimulación y la tasa de filtrado glomerular (TFG) fue negativa y estadísticamente significativa (r: ­0.39 [p = 0.002], r: ­0.363 [p = 0.004], r: ­0.4 [p = 0.002], respectivamente). CONCLUSIÓN: Desde etapas tempranas de la ERC los niveles de cortisol se incrementan a medida que la TFG disminuye. Concluimos que no es necesario un tamizaje sistemático para detectar IA en pacientes con ERC.

Evaluation of low-cost telemammography screening configurations: a comparison with film-screen readings in vulnerable areas.

The aim of this study was to evaluate the diagnostic accuracy for detecting breast cancer using different telemammography configurations, including combinations of both low-cost capture devices and consumer-grade color displays. At the same time, we compared each of these configurations to film-screen readings. This study used a treatment-by-reader-by-case factorial design. The sample included 70 mammograms with 34 malignant cases. The readers consisted of four radiologists who classified all of the cases according to the categories defined by the Breast Imaging Reporting and Data System (BI-RADS). The evaluated capture devices included a specialized film digitizer and a digital camera, and the evaluated displays included liquid crystal display (LCD) and light-emitting diode (LED) consumer-grade color displays. Receiver operating characteristic curves, diagnostic accuracy (measured as the area under these curves), accuracy of the composition classification, sensitivity, specificity, and the degree of agreement between readers in the detection of malignant cases were also evaluated. Comparisons of diagnostic accuracy between film-screen and the different combinations of digital configurations showed no significant differences for nodules, calcifications, and asymmetries. In addition, no differences were observed in terms of sensibility or specificity when the degree of malignancy using the film-screen method was compared to that provided with digital configurations. Similar results were observed for the classification of breast composition. Furthermore, all observed reader agreements of malignant detection between film-screen and digital configurations were substantial. These findings indicate that the evaluated digital devices showed comparable diagnostic accuracy to the reference treatment (film-screen).

Is the invasive Caprella scaura Templeton, 1836 displacing its resident congener Caprella equilibra Say, 1818 in marinas of the South Iberian Peninsula? A long-term spatio-temporal approach.

Although marine invasions are increasingly a matter of concern, the impact of invasive species in the ecosystem and their ability to replace native taxa is still little understood. Data from 2011 to 2021 in marinas of the Southern Iberian Peninsula supported that the invasive amphipod Caprella scaura is replacing the resident Caprella equilibra over time. Six marinas where C. equilibra was abundant in 2011 and C. scaura was absent, are now dominated by C. scaura. Although this displacement is more evident in Mediterranean shores than in Atlantic coasts, it is very variable between marinas. The spreading of the invasive species in marinas of the Alboran Sea mainly occurred from 2011 to 2017, preventing C. equilibra from regaining its former distribution. The ultimate factors responsible for the displacement, such as the aggressive behaviour of C. scaura, environmental influences or physiological performance in a global warming context, should be further investigated experimentally.

Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic.

OBJECTIVE: To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS). METHODS: We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change. RESULTS: Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods. CONCLUSION: After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

Estuarine versus coastal marinas: Influence of the habitat on the settlement of non-indigenous peracarids on the polychaete Sabella spallanzanii (Gmelin, 1791).

Recreational marinas are key points for the introduction and secondary spread of non-indigenous species (NIS). However, little is known about the influence of the habitat surrounding the marina on NIS communities. To explore this issue, we compared peracarid assemblages associated to the widespread ecosystem engineer Sabella spallanzanii in lower estuarine marinas (with oceanic salinity) and coastal marinas of the south of the Iberian Peninsula. Sabella spallanzanii hosted a total of 23 species, 7 of them NIS. While NIS richness was similar between marinas located in estuaries and coastal habitats, NIS abundance was significantly higher in estuarine marinas. The NIS community structure was influenced by both the marina itself and the surrounding habitat. These results suggest that lower estuarine conditions promote NIS abundance in marinas, increasing potential invasion risks. This supports prioritization of estuarine marinas in NIS monitoring programs and the suitability of S. spallanzanii as a bioinvasion monitoring tool.

How oral health literacy and parental behavior during the meals relate to dental caries in children.

This cross-sectional study aimed to verify the influence of parental behavior on the development of dental caries in children by assessing parents' behavior during their children's meals and their parental level of oral health literacy. This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred and thirty children were examined to assess the prevalence of dental caries (dmft index). Parents answered a questionnaire related to socio-demographic conditions, oral health literacy (OHL), and the parents' behavior during the meal - Parent Mealtime Action Scale - (PMAS). The analysis fitted zero-inflated negative binomial regression (ZINB) models to assess unadjusted and adjusted associations between the study outcome and covariates. In the unadjusted analysis, the child's age, the number of siblings, household crowding, family income, socioeconomic status and OHL were associated with the outcome (p <0.05). In the adjusted model, dental caries was more prevalent among 3- (PR: 1.85, 95%CI: 1.19-2.87) and 4-year-old children (PR: 2.43, 95%CI: 1.60-3.71), those with at least one sibling (PR: 1.66, 95%CI:1.18-2.33). Poor children were more likely to have dental caries (PR: 0.66, 95%CI: 0.48-0.91); the Use of Rewards dimension of the PMAS was associated positively with dental caries severity (RR: 0.90, 95%CI: 0.84-0.97). Although OHL was not associated with caries, parents' mealtime behaviors were related to dental caries. This suggested that communication between parents and children related to good eating practices could play a protective role against dental caries in children.

Intensive vs. conventional blood pressure goals in older patients with type 2 diabetes: a systematic review and meta-analysis.

PURPOSE: Assess the effect of intensive vs conventional blood pressure goals on patient-important outcomes in older adults with type 2 diabetes. METHODS: A comprehensive search was performed using electronic databases. Randomized controlled trials comparing intensive vs conventional blood pressure goals in adults over 60 years of age with type 2 diabetes were included. Events were evaluated using a modified Mantel-Haenszel meta-analysis with Peto's method. Study selection and data extraction were performed independently and in duplicate. RESULTS: Seven trials were included. A 19% risk reduction (OR 0.81; 95% CI 0.69-0.95; I2 = 8%; p = 0.35) in the occurrence of major adverse cardiovascular events (MACE) and 37% risk reduction (OR 0.63; 95% CI 0.51-0.79; I2 = 0%; p = 0.56) in the occurrence of fatal or non-fatal stroke was documented in the intensive treatment group. There were no differences in the occurrence of all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and peripheral vascular disease. Data regarding treatment adverse effects and microvascular outcomes was scarce. CONCLUSIONS: Intensive blood pressure goals in older patients with diabetes were associated with a lower risk of stroke and MACE, but not with all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and peripheral vascular disease.

The impact of the COVID-19 pandemic on the provision of dental procedures performed by the Brazilian Unified Health System: a syndemic perspective.

OBJECTIVES: This study investigated the impact of the COVID-19 pandemic on the provision of dental care procedures performed by the Brazilian Unified Health System (SUS) nationally and by regions. Considering that the most underprivileged population disproportionately suffers with the reduction in dental care provision, the study hypothesis suggests the presence of a syndemic nature. METHODOLOGY: The SUS Outpatient Information System (SIA-SUS) was assessed to gather data on dental care activities and procedures performed between April and July 2018, 2019, and 2020 by dentists registered in the SUS. The 30 most frequent activities and procedures performed by dentists were selected and classified into three categories (urgent dental care, nonemergency dental care, and case-dependent urgency procedures), based on the guidance for dental care during the pandemic published by the American Dental Association. RESULTS: Results demonstrated a reduction in the provision of dental care of all categories during the pandemic. Urgency dental consultations and procedures in primary and specialized dental care services decreased by 42.5 and 44.1%, respectively, between 2020 and 2019. Non-urgent procedures decreased by 92.3%. Although decreases in dental care activities and procedures were reported in all Brazilian regions, the largest relative decreases in urgent procedures - that should have been maintained during the pandemic - occurred in the North and Northeast regions, which are the poorest regions of the country. CONCLUSIONS: These results suggest that the COVID-19 pandemic has a syndemic behavior. Further investigation into the pandemic-syndemic impacts on oral disease burden is necessary.

Dental caries spectrum profile in Brazilian public school children and adolescents.

Dental caries remains a major public health problem, with a higher prevalence among in adolescence. The present study aimed to assess the dental caries spectrum profile in children and adolescents in Brazilian public schools. A cross-sectional study was performed in two public schools in Brazil to examine the permanent teeth of children and adolescents. The dental caries were assessed by applying the Caries Assessment Spectrum and Treatment (CAST) instrument, and the results were distributed as per disease status (healthy/codes 0-2; pre-morbidity/code 3; morbidity/code 4-5; severe morbidity/codes 6-7; mortality/code 8) and by severity as per the CAST-F1 formula (no severity, mild, moderate, and severe). The CAST data were described by age groups (8-9 y, 10-11 y, 12-13 y, 14-15 y, 16-17 y, and 18-19 y). The Kruskal-Wallis test was used to investigate differences in CAST prevalence and severity among the groups (p < 0.05). Total 598 students were enrolled. Most of the subjects were male (53.34%) and belonged to the age group of 12-13 y (34.95%). The variables CAST 0/1 (p = 0.024), CAST (p = 0.024), and CAST-F1 (p = 0.029) showed significant differences among age groups, and the post hoc test showed the differences in these variables as per the age groups of 14-15 y and 16-17 y (CAST 0/1, p = 0.047; CAST, p = 0.047; CAST-F1, p = 0.033). The dental caries spectrum increased from 8 to 19 y with a peak in the prevalence and severity in the middle of adolescence.

The impacts of oral health-related quality of life of elderly people living at home: a cross-sectional study.

The scope was to verify the impact of oral and sociodemographic conditions, the dental treatment needs and dental pain, on the quality of life of the elderly. This cross-sectional study was conducted in 15 primary health care areas. A backward multivariate linear regression model was used (p<0.05) with oral health related-quality of life as dependent variable. There were 335 elderly people with predominance of women (56.72%) and aged up to 74 years (59.40%). Those who had up to 8 years of education predominated (87.46%), and those who were still working were the minority (13.43%). Multivariate linear regression (p<0.05) showed association with missing teeth (ß=0,12; IC 0,00:0,04; p<0,04) and dental prosthesis needs (ß=0,14; IC 0,13:0,81; p<0,01), women (ß=0,18; IC 0,23:0,85; p<0,01), less aged (ß=-0,12; IC -0,05:0,00; p<0,02), not working (ß=-0,15; IC -1,09:-0,20; p<0,01), with dental care need (ß=0,24; IC 0,25:0,63; p<0,01) and dental pain (ß=0,14; IC 0,10:0,64; p<0,01). Missing teeth, sociodemographic conditions, dental treatment needs and dental pain might impact oral health-related quality of life of elders.

Frailty and oral health-related quality of life in community-dwelling older adults: a cross-sectional study.

Poor oral health has been associated with frailty among older adults. However, limited evidence has been available on whether frailty can affect oral health-related quality of life (OHRQoL) in older adults. This study aimed to investigate the relationship between frailty and OHRQoL among community-dwelling older adults. A household-based cross-sectional study involving community-dwelling older adults aged 65 years and older was conducted in the city of Bauru, Brazil. Data on frailty status, sociodemographic characteristics, self-perceived dental care needs, and OHRQoL (OHIP-14) were collected through individual interviews. The use of and the need for total dental prostheses were assessed through clinical examinations. Logistic regression was used to determine whether frailty status and covariates were associated with OHRQoL prevalence measures (OHIP-14 total score ≥ 1 and OHIP-14 fairly/very often ≥ 1). The sample comprised 334 participants, among whom 58.7% and 41.3% were between 65-74 and 75-102 years old, respectively. The prevalence of moderate to severe frailty was 12.3%. Moderate to severe frailty (OR = 4.49; 95%CI 1.29-15.66), the need for lower dental prosthesis (OR = 2.20; 95%CI 1.27-3.81), and self-perceived dental care need (OR = 3.90; 95%CI 2.14-7.14) were associated with OHIP-14 total score ≥1. Moderate to severe frailty (OR = 2.95; 95%CI 1.33-6.55), being female (OR = 2.24; 95%CI 1.34-3.75), and self-perceived dental care need (OR = 4.80; 95%CI 2.86-8.03) were associated with OHIP-14 fairly/very often ≥1. Overall, our results showed that moderate to severe frailty was significantly associated with poor OHRQoL in community-dwelling older adults.

A prospective and randomized clinical trial evaluating the effectiveness of ART restorations with high-viscosity glass-ionomer cement versus conventional restorations with resin composite in Class II cavities of permanent teeth: two-year follow-up.

OBJECTIVE: To compare the effectiveness of ART restorations using High Viscosity Glass-ionomer cement (HVGIC) with conventional restorations using resin composite in Class II cavities of permanent teeth, in a 2-year follow-up. METHODOLOGY: Seventy-seven restorations were made with each restorative material, Equia Fil-GC Corporation (ART restorations) and Z350-3M (conventional restoration), in 54 participants in this parallel and randomized clinical trial. Restorations were evaluated at 6 months, 1 and 2 years using the ART and the modified United States Public Health Service (USPHS) criteria. Chi-square test and Survival Analysis (p<0.05) were used for statistical analysis. RESULTS: The success rates for ART restorations were 98.7% (6 months) and 95.8% (1 year) for both criteria. At 2 years, success rate was 92% and 90.3% when scored by the modified USPHS and ART criteria (p=0.466), respectively. The success rates for conventional restorations were 100% (6 months), 98.7% (1 year) and 91.5% (2 years) for both assessment criteria. ART restorations presented a lower survival rate by the criterion of ART (83.7%) when compared to the modified USPHS criterion of (87.8%), after 2 years (p=0.051). The survival of conventional restorations was 90.7% for both evaluation criteria. CONCLUSION: At the 2-years follow-up evaluation, no statistically significant difference was observed between the success rate of ART restorations with HVGIC compared to conventional restorations with resin composite in Class II cavities of permanent teeth.

Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic / Hospitalizações por câncer bucal e orofaríngeo no Brasil pelo SUS: impactos da pandemia de covid-19

ABSTRACT OBJECTIVE To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS). METHODS We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change. RESULTS Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods. CONCLUSION After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

RESUMO OBJETIVO Analisar o impacto das diferentes fases da pandemia de covid-19 sobre as hospitalizações por câncer bucal (CaB) e de orofaringe (CaOR) no Brasil, realizadas no âmbito do Sistema Único de Saúde (SUS). MÉTODOS Os dados quanto às internações hospitalares por CaB e CaOR, entre janeiro de 2018 e agosto de 2021, foram obtidos no Sistema de Informações Hospitalares do SUS. As internações foram analisadas sob a forma de taxas por 100 mil habitantes. Os períodos de pandemia (janeiro de 2020 a agosto de 2021) e pré-pandemia (janeiro de 2018 a dezembro de 2019) foram divididos em quadrimestres; as taxas quadrimestrais do período pandêmico foram comparadas às taxas análogas do período pré-pandemia - para o Brasil, por macrorregião e por grupo de procedimentos realizados na internação. O impacto da pandemia sobre o valor médio das internações também foi analisado. Os resultados foram expressos em variação percentual. RESULTADOS As taxas de internação hospitalar no SUS por CaB e CaOR reduziram durante a pandemia no Brasil. Em comparação com os quadrimestres de 2019, a maior redução foi identificada no segundo quadrimestre de 2020 (18,42%), seguida das reduções do terceiro quadrimestre de 2020 (17,76%) e do primeiro e segundo quadrimestres de 2021 (respectivamente, 14,64% e 17,07%). Sul e Sudeste apresentaram as reduções mais expressivas e constantes entre as diferentes fases da pandemia. As internações para procedimentos clínicos sofreram maior redução do que para procedimentos cirúrgicos. No Brasil, o gasto médio por internação nos quadrimestres da pandemia foi maior do que nos quadrimestres de referência. CONCLUSÃO Após mais de um ano do início da pandemia no Brasil, a rede hospitalar de cuidado ao CaB e CaOR do SUS ainda não tinha se restabelecido. A demanda reprimida de hospitalizações por essas doenças, que são de rápida evolução, possivelmente resultará em atrasos para tratamento, com impacto negativo para a sobrevida desses pacientes; futuros estudos são necessários para monitorar essa situação.

Reliability of the BI-RADS Final Assessment Categories and Management Recommendations in a Telemammography Context.

PURPOSE: The aim of this study was to evaluate the intradevice and interdevice reliability of four alternatives for telemammography-computed radiography, printed film, a film digitizer, and a digital camera-in terms of interpretation agreement when using the BI-RADS® lexicon. METHODS: The ethics committee of the authors' institution approved this retrospective study. A factorial design with repeated measures with 1,960 interpretations was used (70 patients, seven radiologists, and four devices). Reliability was evaluated using the κ coefficient for intradevice and interdevice agreement on malignancy classification and on BI-RADS final assessment category. RESULTS: Agreement on malignancy classification was higher than agreement for BI-RADS final assessment category. Interdevice agreement on malignancy classification between the film digitizer and computed radiography was ranked as almost perfect (P < .001), whereas interdevice agreement for the other alternatives was ranked as substantial (P < .001), with observed agreement ranging from 85% to 91% and κ values ranging from 0.70 to 0.81. Interdevice agreement on BI-RADS final assessment category was ranked as substantial or moderate (P < .001), with observed agreement ranging from 64% to 77% and κ values ranging from 0.52 to 0.69. Interdevice agreement was higher than intradevice agreement. CONCLUSIONS: The results of this study show very high interdevice agreement, especially for management recommendations derived from malignancy classification, which is one of the most important outcomes in screening programs. This study provides evidence to suggest the interchangeability of the devices evaluated, thereby enabling the provision of low-cost medical imaging services to underserved populations.