Implementation of an Integrated Lung Cancer Prevention and Screening Program Using a Mobile Computed Tomography (CT) Unit in Brazil.

INTRODUCTION: Lung cancer is the deadliest cancer worldwide and in Brazil. Despite strong evidence, lung cancer screening by low-dose computed tomography (LDCT) in high-risk individuals is far from a reality in many countries, particularly in Brazil. Brazil has a universal public health system marked with important inequalities. One affordable strategy to increase the coverage of resources is to use mobile units. OBJECTIVES: To describe the implementation and results of an innovative lung cancer prevention program that integrates tobacco cessation and lung cancer screening using a mobile CT unit. METHODOLOGY: From May 2019 to Dec 2020, health professionals from 18 public primary health care units in Barretos, Brazil, were trained to offer smoking cessation counseling and treatment. Eligible high-risk participants of this program were also invited to perform lung cancer screening in a mobile LDCT unit that was specially conceived to be dispatched to the community. A detailed epidemiological questionnaire was administered to the LDCT participants. RESULTS: Among the 233 screened participants, the majority were women (54.9%), and the average age was 62 years old. A total of 52.8% of participants showed high or very high nicotine dependence. After 1 year, 27.8% of participants who were involved in smoking cessation groups had quit smoking. The first LDCT round revealed that the majority of participants (83.7%) exhibited lung-Rads 1 or 2; 7.3% exhibited lung-Rads 3; 7.7% exhibited lung-Rads 4a; and 3% exhibited lung-Rads 4b or 4x. The three participants with lung-Rads 4b were further confirmed, and their surgery led to the diagnosis of early-stage cancer (1 case of adenocarcinoma and two cases of squamous cell carcinoma), leading to a cancer diagnosis rate of 12.8/1000. CONCLUSION: Our results indicate promising outcomes for an onsite integrative program enrolling high-risk individuals in a middle-income country. Evidence barriers and challenges remain to be overcome.

Socioeconomic and family influences on dental treatment needs among Brazilian underprivileged schoolchildren participating in a dental health program.

BACKGROUND: The objective of this study was to compare the socioeconomic and family characteristics of underprivileged schoolchildren with and without curative dental needs participating in a dental health program. METHODS: A random sample of 1411 of 8-to-10 year-old Brazilian schoolchildren was examined and two sample groups were included in the cross-sectional study: 544 presented curative dental needs and the other 867 schoolchildren were without curative dental needs. The schoolchildren were examined for the presence of caries lesions using the DMFT index and their parents were asked to answer questions about socioenvironmental characteristics of their families. Logistic regression models were adjusted estimating the Odds Ratios (OR), their 95% confidence intervals (CI), and significance levels. RESULTS: After adjusting for potential confounders, it was found that families earning more than one Brazilian minimum wage, having fewer than four residents in the house, families living in homes owned by them, and children living with both biological parents were protective factors for the presence of dental caries, and consequently, curative dental needs. CONCLUSIONS: Socioeconomic status and family structure influences the curative dental needs of children from underprivileged communities. In this sense, dental health programs should plan and implement strategic efforts to reduce inequities in oral health status and access to oral health services of vulnerable schoolchildren and their families.

Detection of HPV E6 oncoprotein from urine via a novel immunochromatographic assay.

Cervical cancer is a significant public health problem, especially in low- and middle-income countries, where women have little access to cervical cancer screening; consequently 80% of cervical cancer related mortality occurs in these regions. The development of screening methods that need less infrastructure thus represents an urgent medical need. The study aims to compare the detection rates of high-risk human papillomavirus 16 and 18 E6 oncoprotein in urine, vaginal self-collected, and cervical scrapes of women using the OncoE6™ Cervical Test and compare the HPV16 and/or HPV18 E6 detection rates with the HPV DNA testing. Paired urine, vaginal self-collected and cervical specimens were collected from 124 women who participated in cervical cancer screening or treatment in this proof-of-concept study and underwent to HPV16/18-E6 testing and high-risk HPV DNA testing prior to treatment of cervical neoplasia or cancer. Concordance between urinary, vaginal and cervical HPV16/18-E6 and HPV-DNA testing was evaluated for patients classified as negative group (

[Individual and contextual factors associated with malocclusion in Brazilian children]. / Fatores individuais e contextuais associados à má oclusão em crianças brasileiras.

OBJECTIVE: To assess the association between the prevalence of malocclusion in Brazilian 12 years-olds with individual and contextual variables. METHODS: A cross-sectional, analytical study was conducted with data from the Brazilian Oral Health Survey - SBBrazil 2010. The outcome studied was malocclusion, categorized as absent, set, severe and very severe. The independent variables were classified as individual and contextual. Data were analyzed using a multilevel model with a 5% significance level. RESULTS: It was found that the prevalence of severe and very severe malocclusion in 12-year-olds did not differ between the Brazilian regions, although variation between the cities was significant (p < 0.001). Male children (p = 0.033), those on lower income (p = 0.051), those who had visited a dentist (p = 0.009), with lower levels of satisfaction with mouth and teeth (p < 0.001) and embarrassed to smile (p < 0.001) had more severe malocclusion. The characteristics of the cities also affected the severity of malocclusion; cities with more families on social benefits per 1,000 inhabitants, with lower scores on the health care system performance index and lower gross domestic product per capita were significantly associated with malocclusion. CONCLUSION: Significant associations between the presence and severity of malocclusion were observed at the individual and contextual level.

Indicadores e fatores de risco da cárie dentária em crianças no Brasil - uma revisão de literatura / Indicators and risk factors of dental caries in children in Brazil - a literature review

Atualmente, a prevalência de cárie dentária encontra-se localizada em uma parcela da população, o que carac-teriza sua polarização. A identificação desses grupos de risco permite que medidas preventivas, tanto comunitá-rias quanto individuais, sejam voltadas aos indivíduos desses grupos, resultando num uso mais eficiente dos recursos. Objetivo: este estudo objetiva verificar os fa-tores e preditores do risco da cárie estudados no Brasil, através de uma revisão da literatura. Materiais e méto-do: Realizou-se uma busca na base de dados PUBMED utilizando-se os termos dental caries, risk indicators, e Brazil, unidas pelo operador boleano AND, da qual limitou-se para estudos publicados de 2000 até 2012. Um total de 14 artigos longitudinais e transversais fo-ram incluídos nessa revisão e os fatores e preditores de risco investigados, tanto na dentição decídua quanto na permanente, foram divididos em componentes biológi-cos, comportamentais e socioeconômicos. Resultados: assim, foi possível observar que a cárie está associada a diferentes fatores e preditores de riscos e os mais con-solidados são: experiência passada de cárie, defeitos de esmalte, biofilme dental, dieta, escolaridade da mãe e renda. Considerações finais: os fatores e preditores de risco estudados são diversos, e sua identificação é de fundamental relevância para o desenvolvimento de es-tratégias direcionadas no intuito de diminuir a incidên-cia e a prevalência da cárie

Fatores individuais e contextuais associados a ma oclusao em criancas brasileiras / Factores individuales y contextuales asociados a la maloclusion en ninos brasilenos / Individual and contextual factors associated with malocclusion in Brazilian children

OBJETIVO: Avaliar a associação entre a prevalência de má oclusão em crianças aos 12 anos de idade com variáveis individuais e contextuais. MÉTODOS: Foi realizado um estudo transversal analítico com dados da Pesquisa Nacional de Saúde Bucal – SBBrasil 2010. O desfecho estudado foi a má oclusão, categorizada em ausente, definida, severa e muito severa. As variáveis independentes foram classificadas em individuais e contextuais. Os dados foram analisados por meio de modelo multinível, considerando nível de 5% de significância. RESULTADOS: A prevalência de má oclusão severa e muito severa nas crianças com 12 anos de idade não diferiu entre as regiões brasileiras, mas sim entre as cidades (p < 0,001). Crianças do sexo masculino (p = 0,033), de menor renda (p = 0,051), que consultaram o dentista (p = 0,009), com menor satisfação com a boca e os dentes (p < 0,001) e com vergonha de sorrir (p < 0,001) apresentaram má oclusão de maior gravidade. As características das cidades também afetaram a gravidade da má oclusão; cidades com mais famílias com benefício social por 1.000 habitantes, com menores notas do índice de desempenho do sistema de saúde e menor renda per capita foram estatisticamente associadas com a má oclusão. CONCLUSÕES: Associações significativas entre a presença e gravidade da má oclusão foram observadas em nível individual e contextual. .

OBJETIVO: Evaluar la asociación entre la prevalencia de maloclusión en niños a los 12 años de edad con variables individuales y contextuales MÉTODOS: Se realizó un estudio transversal analítico con datos de la Investigación Nacional de Salud Bucal – SBBrasil 2010. El aspecto estudiado fue la maloclusión, categorizada en ausente, definida, severa y muy severa. Las variables independientes fueron clasificadas en individuales y contextuales. Los datos fueron analizados por medio de modelo multinivel, considerando el nivel de 5% de significancia. RESULTADOS: La prevalencia de maloclusión severa y muy severa en los niños con 12 años de edad no se diferenció entre las regiones brasileñas, pero sí entre las ciudades (p<0,001). Niños del sexo masculino (p=0,033), de menor renta (p= 0,051), que consultaron el dentista (p<0,001) y con vergüenza de sonreír (p<0,001) presentaron maloclusión de mayor gravedad. Las características de las ciudades también afectaron la gravedad de la maloclusión; ciudades con más familias con beneficio social por 1.000 habitantes, con menores notas del índice de desempeño del sistema de salud y menor renta per capita fueron estadísticamente asociadas con la maloclusión. CONCLUSIONES: Asociaciones significativas entre la presencia y gravedad de la mala oclusión fueron observadas a nivel individual y contextual. .

OBJECTIVE: To assess the association between the prevalence of malocclusion in Brazilian 12 years-olds with individual and contextual variables. METHODS: A cross-sectional, analytical study was conducted with data from the Brazilian Oral Health Survey – SBBrazil 2010. The outcome studied was malocclusion, categorized as absent, set, severe and very severe. The independent variables were classified as individual and contextual. Data were analyzed using a multilevel model with a 5% significance level. RESULTS: It was found that the prevalence of severe and very severe malocclusion in 12-year-olds did not differ between the Brazilian regions, although variation between the cities was significant (p < 0.001). Male children (p = 0.033), those on lower income (p = 0.051), those who had visited a dentist (p = 0.009), with lower levels of satisfaction with mouth and teeth (p < 0.001) and embarrassed to smile (p < 0.001) had more severe malocclusion. The characteristics of the cities also affected the severity of malocclusion; cities with more families on social benefits per 1,000 inhabitants, with lower scores on the health care system performance index and lower gross domestic product per capita were significantly associated with malocclusion. CONCLUSION: Significant associations between the presence and severity of malocclusion were observed at the individual and contextual level. .

Organização da demanda em unidade de saúde do exército: estudo de caso / Organization of demand in an army health unit: a case study

Objetivo: este estudo tem como objetivo, através de uma revisão de literatura e apresentação de um relato de caso, a busca de idéias e experiências de planejamento, em particular o Planejamento Estratégico Situacional (PES) associado ou não a outros modelos de assistências. Inicialmente foi estabelecida para o estudo em questão como proposta, a obtenção de mudanças no processo de trabalho principalmente no que se refere à organização da demanda no serviço de saúde odontológico do Posto Médico da Guarnição de Campinas. Metodologia: elaborou-se uma lista de palavras chaves e pesquisou-se nos seguintes bancos de dados eletrônicos: Medline, Lilacs, AdSaúde, BBO e Paho. Procurou-se também, estudos adicionais através de manual, além da pesquisa eletrônica nos sites do Exército Brasileiro. Partiu-se então para o relato de caso, tendo sido pesquisado o período mais crítico vivenciado pelo setor odontológico do Posto Médico da Guarnição de Campinas, os últimos três anos. Conclusão: ao final conclui-se que a idéia básica é limitar o horário de atendimento e não o número de pessoas atendidas e que, através da implantação do vínculo e acolhimento, é possível respeitar as necessidades sentidas do usuário, contrabalançando a necessidade real e a capacidade do serviço, e ainda assim manter uma assistência de qualidade, primando pela humanização da assistência, reconstruindo a dignidade tanto do trabalhador como do usuário.

Aim: of this study was to elaborate a search of ideas and experiences of planning, particularly the Situational Strategic Planning associated or not to other models of assistance by reviewing critical literature, and additionally to present of a case report. Initially, this study intended to analyze “working process” in a dental health serviceof the military medical support office in Campinas. Methodology: afterwards a list of key words was prepared and a research in electronic data was done: Medline, Lilacs, AdSaúde, BBO and Paho. An additional manual research was also carried out in Brazilian Army sites. The last three years period, which was the most critical period experienced by dental service, was used to analyze working process. Conclusion: the basic idea would be to limit the attendance time instead of the number of people attended and that, through the implementation of the user embracement and hearing, it is possible to respect user needs, balancing real need and service capacity, and still maintaining a quality assistance, surpassing the humanization of the assistance, reconstructing dignity of the worker as well as the user.

Perfil da demanda de um pronto-socorro em um município do interior do estado de São Paulo / Demand profile of a casualty yard in a countryside city of São Paulo state

Este estudo teve como objetivo caracterizar a demanda populacional dos serviços do Pronto-Socorro Munici-pal de Capão Bonito, enfatizando aspectos socioeconômicos e de saúde, buscando identificar os principais motivos de saúde que geram a busca pelo usuário ao serviço de pronto-atendimento. Métodos: Foi realizado um inquérito epidemiológico transversal utilizando um questionário aplicado a 668 indivíduos que buscaram atendimento durante um período de sete dias. O instrumento buscou identificar o sexo, faixa etária, o modelo de assistência à saúde que os usuários utilizavam, a ocupação atual, a cidade de residência, a presença de enfermidades associadas e a queixa principal dos usuários. Resultados: Os resultados mostraram maior procura por atendimentos efetuada pelo sexo feminino (54,34%) e para a faixa etária de 18-29 anos (25,30%); a maior parte da demanda é residente no município de Capão Bonito (87,12%) e utiliza assistência pública por meio do SUS (97,71%); 76,35% dos entrevista-dos relataram não possuir doenças associadas ao motivo principal da procura pelo atendimento de saúde. Conclusões: a oferta dos serviços do Pronto Socorro, na maioria das vezes, foi direcionada ao ato agudo da queixa dos usuários, não ampliando o foco da atenção para um histórico clínico.