Profiling of the genetic features of patients with breast, ovarian, colorectal and extracolonic cancers: Association to CHEK2 and PALB2 germline mutations.

BACKGROUND AND AIMS: Cancer predisposition goes beyond BRCA and DNA Mismatch Repair (MMR) genes since multi-gene panel testing has become the routine diagnostic tool for hereditary cancer suspicion (HCS) cases. CHEK2 and PALB2 are some of the foremost-mutated non-BRCA/MMR actionable genes in families with a significant familial aggregation. Therefore, the purpose of this work is to unravel which tumours other than breast, ovary or colorectal display the patients. MATERIALS AND METHODS: We have analysed 528 probands that meet the inclusion criteria for Hereditary Breast and Ovarian Cancer and Lynch Syndrome established by our Hereditary Cancer Regional Program with a customized 35 genes-panel by using Ion Torrent™ Technology. RESULTS: We have identified pathogenic variants (PVs) in 61 families (1.55%), of which more than half (31 probands) harboured PVs in CHEK2 and PALB2 genes. Ours results reveal that not only were PVs CHEK2 and PALB2 carriers more likely to have family history of cancer not limited to breast, ovarian or colorectal cancers, but also they are prone to other extracolonic cancers, noteworthy endometrial and gastric cancers. CONCLUSIONS: Multigene panel testing improves the chance of finding PVs in actionable genes in families with HCS. In addition, the coexistence of variants should be recorded to implement a polygenic risk algorithm that might explain the missing heritability in the aforementioned families.

Disparities in the protagonism of oral health teams in the work process of Primary Healthcare / Disparidades do protagonismo das equipes de saúde bucal no processo de trabalho na APS

ABSTRACT OBJECTIVE Evaluate and compare the protagonism of Oral Health teams (OHt) in the teamwork process in Primary Healthcare (PHC) over five years and estimate the magnitude of disparities between Brazilian macro-regions. METHODS Ecological study that used secondary data extracted from the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Healthcare) from 2018 to 2022. Indicators were selected from a previously validated evaluative matrix, calculated from records in the Collective Activity Form on the degree of OHt's protagonism in team meetings and its degree of organization concerning the meeting agendas. A descriptive and amplitude analysis of the indicators' variation over time was carried out, and the disparity index was also calculated to estimate and compare the magnitude of differences between macro-regions in 2022. RESULTS In Brazil, between 3.06% and 4.04% of team meetings were led by OHt professionals. The Northeast and South regions had the highest (3.71% to 4.88%) and lowest proportions (1.21% to 2.48%), respectively. From 2018 to 2022, there was a reduction in the indicator of the "degree of protagonism of the OHt" in Brazil and macro-regions. The most frequent topics in meetings under OHt's responsibility were the work process (54.71% to 70.64%) and diagnosis and monitoring of the territory (33.49% to 54.48%). The most significant disparities between regions were observed for the indicator "degree of organization of the OHt concerning case discussion and singular therapeutic projects". CONCLUSIONS The protagonism of the OHt in the teamwork process in PHC is incipient and presents regional disparities, which challenges managers and OHt to break isolation and lack of integration, aiming to offer comprehensive and quality healthcare to the user of the Unified Health System (SUS).

RESUMO OBJETIVO Avaliar e comparar o protagonismo das equipes de Saúde Bucal (eSB) no processo de trabalho em equipe na Atenção Primária à Saúde (APS) ao longo de cinco anos, e estimar a magnitude das disparidades entre as macrorregiões brasileiras. MÉTODOS Estudo ecológico que utilizou dados secundários extraídos do Sistema de Informação em Saúde para a Atenção Básica (SISAB), de 2018 a 2022. Foram selecionados indicadores de matriz avaliativa previamente validada, calculados a partir dos registros na Ficha de Atividade Coletiva do grau de protagonismo das eSB nas reuniões de equipe, bem como do seu grau de organização em relação às pautas dos encontros. Foi realizada análise descritiva e da amplitude da variação dos indicadores ao longo do tempo, e também foi calculado o índice de disparidade para estimar e comparar a magnitude das diferenças entre as macrorregiões no ano de 2022. RESULTADOS No Brasil, entre 3,06% e 4,04% das reuniões de equipe foram lideradas por profissionais da eSB. No período, o Nordeste e o Sul foram as regiões que apresentaram maiores (3,71% a 4,88%) e menores proporções (1,21% a 2,48%), respectivamente. No período de 2018 a 2022, houve uma redução do indicador "grau de protagonismo das eSB" no Brasil e nas macrorregiões. Os temas mais frequentes em reuniões sob responsabilidade das eSB foram processo de trabalho (54,71% a 70,64%) e diagnóstico e monitoramento do território (33,49% a 54,48%). As maiores disparidades entre as regiões foram observadas para o indicador "grau de organização das eSB, em relação à discussão de caso e de projeto terapêutico singular". CONCLUSÕES O protagonismo das eSB no processo de trabalho em equipe na APS é incipiente e apresenta disparidades regionais, o que desafia gestores e eSB para o rompimento do isolamento e da falta de integração, visando a oferta de atenção à saúde integral e de qualidade ao usuário do Sistema Único de Saúde (SUS).

Construção e validação de conteúdo de instrumento de autoavaliação da qualidade do cuidado em instituição de longa permanência para pessoas idosas / Development and content validation for a self-assessment instrument of care quality in long-term care facilities for older adults

Resumo Objetivo Desenvolver e realizar a validação de conteúdo de um instrumento de autoavaliação da qualidade do cuidado em Instituições de Longa Permanência para Idosos (ILPI), denominado QualificaILPI. Método Estudo metodológico realizado entre março e dezembro de 2021. O instrumento foi desenvolvido com base em modelo multidimensional de qualidade, legislação brasileira e pesquisa bibliográfica e contém padrões de qualidade para autoavaliação das ILPI nas dimensões: ambiente, lar, cuidado, envolvimento familiar e da comunidade, equipe de trabalho e gestão. Cada padrão é descrito e seguido por uma escala, com parâmetros para classificar o nível de qualidade da ILPI em incipiente, intermediário, consolidado. A Técnica Delphi modificada foi empregada para validação por um comitê de 10 especialistas quanto a pertinência do padrão para avaliação da qualidade da ILPI, da adequação dos objetivos e da escala de avaliação, clareza, podendo fazer comentários. O padrão foi mantido quando houve 75% de concordância entre os especialistas. O instrumento foi também avaliado pelo público-alvo, constituído por coordenadores de 10 ILPI, selecionadas por conveniência. Resultados No primeiro ciclo de avaliação, foram excluídos três padrões e dois novos foram criados. No segundo, alterou-se a dimensão de um padrão e dois padrões foram unidos. Ao final, permaneceram 29 padrões divididos em seis dimensões. O público-alvo, gestores de ILPI, sugeriu alterações na redação de alguns padrões. Houve consenso de 80% ou superior em todos os padrões. Conclusão O QualificaILPI poderá contribuir para o monitoramento das ILPI favorecendo a melhoria do cuidado ofertado aos residentes.

Abstract Objective To develop and validate the content of a self-assessment instrument for the quality of care in Long-Term Care Facilities for Older Adults (Instituições de Longa Permanência para Idosos - ILPIs), named QualificaILPI. Method A methodological study conducted between March and December 2021. The instrument was developed based on a multidimensional quality model, Brazilian legislation, and literature research. It contains quality standards for self-assessment of ILPIs in the dimensions of environment, home, care, family and community involvement, work team, and management. Each standard is described and followed by a scale with parameters to classify the level of ILPI quality as incipient, intermediate, or consolidated. The modified Delphi Technique was employed for validation by a committee of 10 experts regarding the relevance of the standard for ILPI quality assessment, the appropriateness of objectives, the evaluation scale, and clarity, allowing for comments. The standard was retained when there was 75% agreement among the experts. The instrument was also evaluated by the target audience, consisting of coordinators from 10 ILPIs selected for convenience. Results In the first assessment cycle, three standards were excluded, and two new ones were created. In the second cycle, the dimension of one standard was changed, and two standards were combined. In the end, 29 standards remained, divided into six dimensions. The target audience, ILPI managers, suggested changes in the wording of some standards. There was a consensus of 80% or higher for all standards. Conclusion QualificaILPI has the potential to contribute to monitoring ILPIs, promoting the improvement of care offered to residents.

A 5-Lipoxygenase Inhibitor, Zileuton, Modulates Host Immune Responses and Improves Lung Function in a Model of Severe Acute Respiratory Syndrome (SARS) Induced by Betacoronavirus.

Exacerbated inflammatory responses are a hallmark of severe coronavirus disease 2019 (COVID-19). Zileuton (Zi) is a selective inhibitor of 5-lipoxygenase, an enzyme involved in the production of several inflammatory/pro-resolving lipid mediators. Herein, we investigated the effect of Zi treatment in a severe acute respiratory syndrome (SARS) model. Mouse hepatitis virus (MHV)3-infected mice treated with Zi significantly improved the clinical score, weight loss, cardiopulmonary function, and survival rates compared with infected untreated animals. The protection observed in Zi-treated mice was associated with a lower inflammatory score, reduced dendritic cell-producing tumor necrosis factor (TNF), and increased neutrophil-producing interleukin (IL)-10 in the lungs three days after infection (dpi). At 5 dpi, the lungs of treated mice showed an increase in Th2-, Treg CD4+-, and Treg CD8+-producing IL-10 and reduced Th1 infiltrating cells. Furthermore, similar results were found upon Zi treatment after SARS-CoV-2 infection in transgenic mice expressing the human angiotensin I-converting enzyme 2 (ACE2) receptor driven by the cytokeratin-18 (K18) gene promoter (K18-hACE2), significantly improving the clinical score, weight loss, and lung inflammatory score compared with untreated animals. Our data suggest that Zi protects against developing severe lung disease during SARS induced by betacoronavirus without affecting the host's capacity to deal with infection.

Avaliação das Instituições de Longa Permanência para Idosos no Brasil: um panorama das desigualdades regionais / Evaluation of Long-Term Institutions for Older People in Brazil: an overview of regional inequalities

Resumo O objetivo deste artigo é avaliar as Instituições de Longa Permanência para Idosos (ILPI) brasileiras, segundo o Modelo Teórico Multidimensional Integrado de Qualidade e Atendimento (MIQA), e comparar o desempenho alcançado entre as regiões do país. Estudo ecológico descritivo realizado com dados secundários públicos das ILPI participantes do Censo do Sistema Único da Assistência Social de 2018. Uma Matriz de Avaliação foi construída a partir das variáveis do Censo e do Modelo Teórico MIQA. Parâmetros de qualidade foram empregados para classificar o desempenho das instituições para cada indicador em "incipiente", "em desenvolvimento" ou "desejável. O índice de disparidade foi obtido para cada indicador. Foram analisadas 1.665 instituições. Observaram-se diferenças nos percentuais de ILPI com desempenho "desejável" entre as regiões brasileiras, e a necessidade de aprimoramento na maioria das ILPI em relação à proporção de cuidadores de pessoas idosas, a composição da equipe multiprofissional, a acessibilidade e a oferta de ações de promoção de saúde. Verificou-se a necessidade de apoio governamental para a supressão dos critérios de diferenciações excludentes e para a expansão dos serviços para superar as superlotações.

Abstract This article aims to evaluate the Brazilian Long-Term Institutions for Older People (LTIE), according to the Integrated Multidimensional Theoretical Model of Quality and Service (MIQA), and compare the performance achieved between the regions of the country. Descriptive ecological study carried out with public secondary data from the LTIE participating in the 2018 Census of the Unified Social Assistance System. An Evaluation Matrix was constructed from the Census variables and the MIQA Theoretical Model. Quality parameters were used to classify the institutions' performance for each indicator as "incipient", "developing" or "desirable". The disparity index was obtained for each indicator. 1,665 institutions were analyzed. Differences were observed in the percentages of LTIE with "desirable" performance between Brazilian regions, and the need for improvement in most LTIE in relation to the proportion of caregivers of older people, the composition of the multidisciplinary team, accessibility and supply of health promotion actions. There was a need for government support for the suppression of exclusionary differentiation criteria and for the expansion of services to overcome overcrowding.

Assessment of calcinosis in Portuguese patients with systemic sclerosis - a multicenter study.

INTRODUCTION/OBJECTIVES: The study aims to define the clinical and subclinical calcinosis prevalence, the sensitivity of radiographed site and clinical method for its diagnosis, and the phenotype of Portuguese systemic sclerosis (SSc) patients with calcinosis. METHOD: A cross-sectional multicenter study was conducted with SSc patients fulfilling Leroy/Medsger 2001 or ACR/EULAR 2013 classification criteria, registered in the Reuma.pt. Calcinosis was assessed through clinical examination and radiographs of hands, elbows, knees, and feet. Independent parametric or non-parametric tests, multivariate logistic regression, and sensitivity calculation of radiographed site and clinical method for calcinosis detection were performed. RESULTS: We included 226 patients. Clinical calcinosis was described in 63 (28.1%) and radiological calcinosis in 91 (40.3%) patients, of which 37 (40.7%) were subclinical. The most sensitive location to detect calcinosis was the hand (74.7%). Sensitivity of the clinical method was 58.2%. Calcinosis patients were more often female (p = 0.008) and older (p < 0.001) and had more frequently longer disease duration (p < 0.001), limited SSc (p = 0.017), telangiectasia (p = 0.039), digital ulcers (p = 0.001), esophageal (p < 0.001) and intestinal (p = 0.003) involvements, osteoporosis (p = 0.028), and late capillaroscopic pattern (p < 0.001). In multivariate analysis, digital ulcers (OR 2.63, 95% CI 1.02-6.78, p = 0.045) predicted overall calcinosis, esophageal involvement (OR 3.52, 95% CI 1.28-9.67, p = 0.015) and osteoporosis (OR 4.1, 95% CI 1.2-14.2, p = 0.027) predicted hand calcinosis, and late capillaroscopic pattern (OR 7.6, 95% CI 1.7-34.9, p = 0.009) predicted knee calcinosis. Anti-nuclear antibody positivity was associated with less knee calcinosis (OR 0.021, 95% CI 0.001-0477, p = 0.015). CONCLUSIONS: Subclinical calcinosis high prevalence suggests that calcinosis is underdiagnosed and radiographic screening might be relevant. Multifactorial pathogenesis may explain calcinosis predictors' variability. Key Points • Prevalence of subclinical calcinosis in SSc patients is substantial. • Hand radiographs are more sensitive to detect calcinosis than other locations or clinical method. • Digital ulcers were associated with overall calcinosis, esophageal involvement and osteoporosis were associated with hand calcinosis, and late sclerodermic pattern in nailfold capillaroscopy was associated with knee calcinosis. • Anti-nuclear antibody positivity may be a protective factor for knee calcinosis.

Covid-19 pandemic: training caregivers to oral health care in nursing homes / Pandemia da COVID-19: capacitação dos cuidadores e a provisão de cuidados bucais aos idosos que vivem em Instituições de Longa Permanência

Aim: To assess the associated factors with oral hygiene practices of functionally dependent older adults by professionals working in long-stay elderly care homes during the COVID-19 pandemic. Methods:This was an exploratory study with a sample of 179 elderly care home professionals recruited through social media groups, applying "snowball" method. Data collection was performed using a structured questionnaire. The outcome variable was the practice of oral hygiene provided by caregivers to functionally dependent elderly individuals, including oral and denture hygiene. The independent variables included sociodemographic characteristics (sex, age group, education, race/skin color), professional performance (professional function and years of experience), training (for caregiving and oral health), elderly care home structure (availability of Personal Protective Equipment), working process (oral health protocols/guidelines), and perception of professional practices (Concerns about transmitting COVID-19 and feelings of being able to deal with cases of COVID-19, as well as the capacity to perform oral hygiene in dependent older adults). The association between the independent variables and oral hygiene practices was analyzed using Logistic Regression (p < 0.05). Results: Of the 179 professionals, 76.0% performed oral hygiene on the functionally dependent older adults, and 42.5% reported difficulties, including a lack of cooperation from the elders, a lack of time during working hours, and a lack of material. Professionals who received caregiver training for older adults (OR = 3.27, 95% CI 1.53 ­ 6.98) and those who were trained to perform oral hygiene in this age group (OR = 2.19, 95% CI 1.01 ­ 4.79) showed higher odds of performing oral hygiene in functionally dependent older adults. Conclusion: Oral hygiene practices were conducted in long-stay elderly care homes during the COVID-19 pandemic. Training caregivers of dependent older adults can enhance the provision of oral health care.

Objetivo: Avaliar os fatores associados às práticas de higiene bucal de idosos dependentes por profissionais que atuam em instituições de longa permanência para idosos (ILPI) durante a pandemia de COVID-19. Métodos: Estudo exploratório com amostra de 179 profissionais de ILPI recrutados por meio de grupos de mídia social e utilizando o método "bola de neve". Coleta de dados foi realizada empregando questionário estruturado. A variável resposta foi a prática de higiene bucal dos idosos dependentes por cuidadores, incluindo a realização de higiene bucal e de próteses. As variáveis independentes foram características sociodemográficas (sexo, faixa etária, escolaridade, raça/cor de pele), atuação (função da ILPI e tempo de atuação) e formação profissional (curso/treinamento para cuidador e em relação à saúde bucal), estrutura da instituição (disponibilidade de Equipamentos de Proteção Individual), processo de trabalho (protocolos/diretrizes de saúde bucal existentes na ILPI) e percepção sobre as práticas profissionais (Preocupações em transmitir e de ser capaz de lidar com casos de COVID-19, e de ser capaz de realizar higiene bucal dos idosos). A associação entre as variáveis independentes e as práticas de higiene bucal foi analisada por Regressão Logística (p < 0,05). Resultados: Dos 179 profissionais, 76,0% realizavam a higiene bucal dos idosos dependentes e 42,5% relataram dificuldades, como falta de cooperação do idoso, falta de tempo no turno de trabalho e falta de material. Os profissionais que possuíam formação para atuarem como cuidadores de idosos (OR = 3,27, IC 95% 1,53 ­ 6,98) e os que foram treinados para realizar higiene bucal nessa faixa etária (OR = 2,19, IC 95% 1,01 ­ 4,79) apresentaram maior chance de realização da higiene bucal em idosos dependentes. Conclusão: Práticas de higiene bucal foram realizadas em ILPI durante a pandemia de COVID-19. A formação de cuidadores de idosos dependentes pode potenciar a prestação de cuidados de saúde bucal.

Overview of Chagas disease surveillance in an endemic region in Southeastern Brazil

ABSTRACT Chagas disease (CD) is a neglected disease caused by the protozoan Trypanosoma cruzi. It has high morbidity and mortality rates and mainly affects socially vulnerable populations. This is a cross-sectional study, with retrospective and prospective data collection. Using questionnaires applied to environmental surveillance coordinators, we characterized the status of CD surveillance activities in municipalities endemic for the disease in Northern Minas Gerais State (MG) and Jequitinhonha Valley (Vale do Jequitinhonha). Moreover, we spatialized the vulnerability index for chronic CD in the study area. The population consisted of 22 environmental surveillance coordinators, active in 2020, from Northern MG and Jequitinhonha Valley, 21 municipalities included in the SaMi-Trop research project, and Montes Claros municipality. After applying the questionnaires to the coordinators, a descriptive analysis of the variables was performed. To characterize the active municipalities, the explanatory variables collected in the questionnaire were compared with the dichotomous variable. Bivariate descriptive analysis was performed. Finally, geoprocessing techniques were used to spatialize the data and prepare maps. Regarding the team of endemic combat agents (ECA), 90.9% reported the lack of a specific team for CD vector control actions. Of the 22 municipalities participating in this study, nine were active (41.1%). Only 25% (n=2) of active municipalities (9% of the municipalities studied) met the target of visiting 50% of households per year. Finally, 81.1% of the coordinators stated that in their municipality, they developed actions linked to primary health care (PHC). The implementation of CD surveillance activities weakened in the endemic region. Few municipalities have a surveillance team, with low regularity of active surveillance and noncompliance with the program's goal. The results suggest insufficient recording of activities in the information system, considering that there are municipalities that report performing the activities, but no production record was observed in the system.

Moradores de áreas rurais de municípios mineiros endêmicos para a doença de Chagas: ideias e concepções sobre a doença, os vetores e os serviços de saúde / Residents of rural areas in municipalities of Minas Gerais endemic for Chagas disease: their ideas and conceptions about the disease, vector, and health services

Resumo Introdução A vigilância da doença de Chagas (DC), baseada na participação popular, ocorre por meio da detecção e notificação de insetos suspeitos de serem vetores da DC aos Postos de Informação de Triatomíneos (PITs). Objetivo Compreender as ideias e concepções dos moradores em áreas rurais dos municípios da Microrregião de Saúde de Itaúna (MSI) em relação a aspectos relacionados à DC, seus vetores e serviços de saúde. Método Em 2016, foram realizados quatro grupos focais nos municípios da MSI. Esses grupos focais foram gravados, transcritos e analisados utilizando a técnica de análise de conteúdo. Neste processo, identificamos e categorizamos unidades de análise tanto dentro de cada grupo focal quanto entre eles. Resultados Descobrimos que há compreensão por parte de alguns moradores sobre a natureza da transmissão da DC, as características morfológicas e hábitos dos vetores, o encaminhamento do vetor para os PITs e o diagnóstico da DC. Também encontramos relatos da ausência de intervenções educacionais e de saúde relacionadas à DC. Conclusão Compreender as concepções e ideias sobre a DC das populações em áreas endêmicas é fundamental para desenvolver futuras estratégias envolvendo a participação popular.

Abstract Background The surveillance of Chagas disease (CD) based on public participation is carried out through the detection and notification of insects suspected of being vectors of CD to Triatomine Information Posts (TIPs). Objective To understand the ideas and conceptions of residents in rural areas of the municipalities of the Micro-region of Health de Itaúna (MHI) regarding aspects related to CD, its vectors, and health services. Method In 2016, four focus groups were conducted in the municipalities of MHI. These focus groups were recorded, transcribed, and analyzed using the content analysis technique. In this process, units of analysis, both within each focus group and between them, were identified and categorized. Results It was found that some residents have a good understanding of the nature of CD transmission and of the morphological characteristics and habits of the vectors, in addition to an understanding of the forwarding of the vector to TIPs, and the diagnosis of CD. Reports of the absence of education and health interventions related to CD were also found. Conclusion Understanding the conceptions and ideas about CD of populations in endemic areas is fundamental to developing future strategies involving public participation.

Conhecimentos sobre a doença de Chagas entre escolares de dois municípios de Minas Gerais, Brasil / Knowledge about Chagas disease among schoolchildren from two municipalities of Minas Gerais, Brazil

Resumo Introdução: No Brasil, a vigilância entomológica da doença de Chagas (DCh) é respaldada na participação comunitária, que notifica a presença dos vetores nas habitações. Assim, a sustentabilidade desta medida de controle depende do conhecimento da população sobre os vetores. Objetivo: Avaliar o conhecimento de escolares sobre a doença de Chagas nos municípios mineiros de Itatiaiuçu (vigilância ativa) e Sabará (vigilância inativa). Método: Questionário semiestruturado foi aplicado para alunos matriculados no ensino médio em duas escolas de Sabará (rural e urbana) e uma em Itatiaiuçu (urbana). Resultados: Em geral, os alunos residentes em Sabará demonstraram conhecimento limitado acerca dos vetores, patógeno, transmissão e doença (sem diferenças relevantes quanto à localização entre área urbana e rural), quando comparados aos residentes em Itatiaiuçu, que apesar de ter uma vigilância mais atuante, também não apresentaram conhecimento totalmente satisfatório. Conclusões: Os resultados enfatizam a carência de informações sobre a DCh tanto em relação ao conhecimento acadêmico quanto às campanhas de educação firmadas pelo programa. Ações educativas para sensibilizar a comunidade e promover o conhecimento sobre esta doença mostram-se necessárias e fundamentais para a manutenção da vigilância ao longo do tempo e espaço.

Abstract Background: In Brazil, entomological surveillance of Chagas disease (ChD) is based on community participation, which notifies the presence of vectors inside their homes. Thus, the sustainability of this control measure depends on the knowledge of the population about the vectors. Objective: To evaluate the knowledge of schoolchildren about ChD in the municipalities of Itatiaiuçu (active surveillance) and Sabará (inactive surveillance). Method: A semi-structured questionnaire was given to students enrolled in two high schools in Sabará (rural and urban) and one in Itatiaiuçu (urban). Results: In general, students living in Sabará demonstrated only limited knowledge about vectors, pathogens, transmission, and disease (with no significant differences between the schools in urban and rural areas). Similarly, the schoolchildren in Itatiaiuçu, despite living in an area of active surveillance, also did not have a fully satisfactory knowledge of ChD. Conclusions: The results emphasize the lack of information about ChD, both in relation to academic knowledge and the education campaigns established by the program. Improvements in educational interventions to raise community awareness and promote knowledge about ChD are necessary and vital for maintaining vigilance against ChD over space and time.

Association between Dentin Hypersensitivity and Health/Oral Health-related Quality of Life: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To investigate the association between DH and Health (HRQoL) or Oral Health-Related Quality of Life (OHRQoL). Material and Methods: PubMed, Web of Science, Scopus, EMBASE, Cochrane, Scielo, LILACS/BBO, Biblioteca Digital de Teses e Dissertações (BDTD), Open Grey, and Google Scholar databases were screened in September 2019 (updated in October 2022). Observational studies were selected to compare HRQoL/OHRQoL(outcome) according to DH(exposure) or evaluate the association among these variables. Standardized Joanna Briggs Institute critical appraisal tool for analytical cross-sectional studies was used to analyze the risk of bias. A random-effects meta-analysis was conducted to synthesize evidence for the association between DH and OHRQoL. Results: 10 papers met inclusion criteria and were evaluated. In most studies, presenting or having a greater intensity of DH was associated with a negative impact on one's quality of life. However, most of these studies showed a moderate to high risk of methodological bias. The consistent finding from studies with a low risk of bias suggests a significant association between DH and OHRQoL. Meta-analysis was feasible for three studies with substantial heterogeneity. The pooled Odds Ratio was 2.14 (95%CI 1.15-3.99; I2= 57,44%). Conclusion: Many studies presented a high risk of bias; therefore, the actual effect of DH on one's quality of life remains uncertain.

Hipersensibilidade dentinária e satisfação com a saúde mediada pela presença de impacto físico e psicossocial das condições bucais: uma análise de caminhos / Dentin hypersensitivity and health satisfaction mediated by the presence of physical and psychosocial impacts of oral conditions: a pathway analysis

Objetivo: Objetivou-se investigar associação direta e mediada pela presença de impacto físico e psicossocial das condições bucais entre HD e satisfação com a saúde entre adultos. Métodos: Estudo transversal foi realizado entre 2018-2019 com amostra probabilística por conglomerado de adultos residentes em Rio Acima (MG). Entrevista e exame bucal foram realizados por examinadoras calibradas. Satisfação com a saúde foi avaliada por meio da pergunta doWHOQoL-bref "Quão satisfeito (a) você está com a sua saúde?" e suas respostas categorizadas entre "satisfeito" e "insatisfeito". HD foi avaliada por estímulo tátil na região cervical dos dentes. Presença de impactos físicos e psicossociais das condições bucais foi definida pelas respostas "repetidamente" ou "sempre" a pelo menos um dos itens do OHIP-14. Covariáveis foram dados sociodemográficos e econômicos, comportamentos em saúde, condições de saúde bucal e uso de serviços odontológicos. Associações foram investigadas por modelos de Regressão de Poisson e Modelagem de Equações Estruturais (MEE) para estimar associações diretas e indiretas (Stata 16). Resultados: Dos 197 adultos, 132 (66,18%) declararam estar satisfeitos com sua saúde e 73 indivíduos (38,75%) apresentavam HD. Houve associação significativa entre presença de HD e presença de impacto físico e psicossocial das condições bucais (RP: 1.34; IC 95%: 1.08­1.67), enquanto para satisfação a associação com HD não foi significativa (RP: 1.08; IC 95%: 0.75-1.54) após a inclusão da variável presença de impacto físico e psicossocial das condições bucais. MEE demonstrou associação direta não significativa entre HD e satisfação, enquanto a associação indireta mediada pela presença de impacto físico e psicossocial das condições bucais foi significativa. Conclusão: Indivíduos com HD podem relatar maior insatisfação com a vida quando esta experiência dolorosa está associada com impactos físicos ou psicossociais.

Aim: Dentin Hypersensitivity (DH) is a painful condition that affects the Oral Health-related Quality of Life and can affect the satisfaction with health of individuals who have it. This study aimed to investigate the direct association mediated by the presence of physical and psychosocial impacts of oral conditions between DH and satisfaction with health among adults. Methods: A cross-sectional study was carried out between 2018-2019 with a probabilistic sample consisting of a cluster of adults living in Rio Acima (MG). Interviews and epidemiological examinations were performed using calibrated tests. The dependent variable of satisfaction with health was assessed using the WHOQoL-bref question "How satisfied are you with your health?" Participants' answers were categorized between "satisfied" and "dissatisfied". The independent DH variable was assessed by tactile stimulation in the cervical region of the teeth. The presence of physical and psychosocial impacts of oral conditions was defined by the answers "farly often" or "very often" to at least one of the OHIP-14 items. Covariates were sociodemographic and psychological data, health behavior, oral health conditions, and use of dental services. Associations were investigated by Poisson Regression and Structural Equation Modeling (SEM) models to estimate direct and indirect associations (Stata 16). Results: Of the 197 adults, 132 (66.18%) reported being satisfied with their health, and 73 individuals (38.75%) had DH. There was a significant association between the presence of DH and the presence of physical and psychosocial impacts of oral health (PR:1.34; 95% CI: 1.08­1.67), while for receiving the association with DH, it was not significant (PR:1 .08; 95% CI: 0.75-1.54) after including the presence of impact variables. SEM showed a non-significant direct association between DH and satisfaction, while the indirect association mediated by the presence of impact was significant. Conclusion: Individuals with HD may report greater dissatisfaction with life when this painful experience is associated with physical or psychosocial effects.

A multilevel analysis model for dental caries determinants in independently-living elderly

To evaluate the prevalence of untreated caries and its association with biological, individual, and environmental variables in independently-living elderly people. Methods: This cross-sectional study included 72 elderly (≥60 years) patients of a university dental clinic in Belo Horizonte, Brazil. Sociodemographic data, systemic diseases, medications, and free sugar intake were collected. Visible plaque, Decayed, Missing, and Filled Teeth (DMFT), and Decayed and Filled Root (DFR) indexes were assessed through clinical examination. Unstimulated saliva was collected to determine salivary flow, pH, and buffering capacity. Descriptive analysis and multilevel logistic regression analysis were performed following a dental caries theoretical model (p <0.05, 95% CI). Results: The mean DMFT and DFR were 24.44 (SD=4.59) and 3.21 (SD=2.93), respectively. The prevalence of untreated caries was 61.11%. In the adjusted multilevel regression model involving 1639 teeth, untreated dental caries was significantly associated with the presence of biofilm (OR = 1.84; 95% CI: 1.24­2.74), salivary buffering capacity (OR = 0.87; 95% CI: 0.77­0.99) and per capita income (OR = 0.06; 95% CI: 0.004­0.74). Conclusion: The experience of dental caries was widespread among independently-living elderly patients, and its variability was best explained by the presence of biofilm, reduced salivary buffering capacity, and low per capita income. A comprehensive assessment is needed of the biological, individual, and environmental factors related to the presence of dental caries in independently-living elderly people

A comunicação de risco nas plataformas digitais oficiais da pandemia no Brasil / Risk communication in the official digital media of the pandemic in Brazil

Considerando a primeira onda do cenário pandêmico e a necessária operação de políticas e estratégias que promovam o autocuidado da população para a mitigação da disseminação do vírus da COVID-19, constatamos aqui, as ações adotadas nas plataformas digitais oficiais da administração pública federal no período de março a outubro de 2020. Para tal, utilizamo-nos do método da análise de conteúdo sobre tudo o material publicitado pelo Ministério da Saúde nas plataformas Twitter, Youtube, Facebook, Instagram, Spotify, Soundcloud, e sites oficiais; ministério da saúde, hotsite da pandemia, e blog da saúde. Com a análise, constatamos o prevalecimento de conteúdos que privilegiam a ilustração dos feitos do ministério, a 1. Autopromoção da própria gestão, com 27,57 parcent do total das publicações, 2. Promoção do autocuidado 18,87 por cento, 3. Dados oficiais com 18,55 por cento, 4. Notícias do cotidiano com 18,03 por cento 5. Comunicação técnica para públicos especializados com 9,25 por cento, e 6. Operação técnica estrutural com 7,73 por cento. Com 3428 postagens e 428 073 246 interações avaliadas, vimos os conteúdos de promoção do autocuidado (18,87 por cento) serem suprimidos por 81,13 por cento e outros aspectos abordados pela comunicação oficial do governo. Constatamos dessa forma que a ausência do devido suporte comunicativo oficial em nível equivalente às demandas sanitárias apresentadas na pandemia que se instaurou, abre espaço para lacunas de orientações essenciais à população, e até mesmo de desinformação, o que pode ter comprometido o enfrentamento rigoroso da disseminação do vírus(AU)

Considerando la primera ola del escenario pandémico y el necesario funcionamiento de políticas y estrategias que promueven el autocuidado de la población para mitigar la propagación del virus COVID-19, se recogen en este trabajo las acciones realizadas en los medios digitales oficiales de la ciudadanía federal en el período comprendido entre marzo y octubre de 2020. Para ello se utilizó el método de análisis de contenido en todo el material publicitado por el Ministerio de Salud en las plataformas Twitter, Youtube, Facebook, Instagram, Spotify, Soundcloud y sitios web oficiales; Ministerio de Salud, sitio de acceso a la pandemia y blog de salud. Con el análisis se constató la prevalencia de contenidos que privilegian la ilustración de los logros del Ministerio: 1. La autopromoción de la propia gestión, con el 27,57 por ciento del total de publicaciones, 2. promoción del autocuidado,18,87 por ciento, 3. Datos oficiales con 18,55 por ciento, 4. Noticias diarias con el 18,03 por ciento, 5. Comunicación técnica para públicos especializados con 9,25 por ciento, y 6. Operación técnica estructural con 7,73 por ciento. En las 3428 publicaciones y 428 073 246 interacciones evaluadas se apreció que el contenido de promoción del autocuidado (18,87 por ciento) fue suprimido por el 81,13 por ciento de otros aspectos abordados por la comunicación oficial del gobierno. De esta forma se encuentra que la ausencia de un adecuado soporte comunicativo oficial, que sea equivalente a las demandas de salud presentadas en la pandemia, abre espacio a lagunas en los lineamientos esenciales para la población e, incluso, a la desinformación que puede haber comprometido la situación para el enfrentamiento riguroso a la diseminación del virus(AU)

Considering the first wave of the pandemic scenario and the necessary operation of policies and strategies that promote the population's self-care to mitigate the spread of the COVID-19 virus, we see here the actions taken in the official digital media of the federal public administration in the period from March to October 2020. To this end, we used the method of content analysis on all material advertised by the Ministry of Health on the platforms Twitter, Youtube, Facebook, Instagram, Spotify, Soundcloud, and official websites; ministry of health, pandemic hotsite, and health blog. With the analysis, we verified the prevalence of contents that privilege the illustration of the ministry's achievements, the 1. Self-promotion of the management itself, with 27.57percent of the total publications, 2. Self-care promotion 18.87percent, 3. Official data with 18.55percent, 4. Daily news with 18.03percent, 5. Technical communication for specialized audiences with 9.25percent and 6. Structural technical operation with 7.73percent. With 3428 posts and 428,073,246 interactions evaluated, we saw self-care promotion content (18.87percent) being suppressed by 81.13percent of other aspects addressed by official government communication. In this way, we found that the absence of proper official communicative support at a level equivalent to the health demands presented in the pandemic that was established, leaves gaps in essential guidelines for the population, and even misinformation, which may have compromised the rigorous confrontation of the dissemination of the virus(AU)

Psychometric properties of an oral health literacy scale for people living with diabetes

Abstract This study evaluated the construct validity of the instrument Oral Health Literacy among diabetics. A probabilistic random sample of 239 diabetics from an infinite population answered the 10 items of the questionnaire. The structural validity was assessed by confirmatory factor analysis and goodness of fit, chi-square per degrees of freedom ratio (X2/df), comparative fit index (CFI), goodness-of-fit index (GFI), and root-mean-square error of approximation (RMSEA). Internal consistency was estimated by the average variance extracted (AVE) and composite reliability (CR). The scores were dichotomized with the upper limit of the 95% confidence interval as the cutoff point. The three-dimensional model presented good quality parameters (X2 /df = 2.459; CFI = 0.988; TLI = 0.981) and poor RMSEA (0.078). Internal consistency was adequate; AVE for the Access, Understand/appraise, and Apply subscales were 0.831, 0.981, and 0.954 and the CR for these subscales were 0.893, 0.962, and 0.822, respectively. Inadequate literacy ranged from 41.8 to 48.1%. The three-dimensional model identified (access, understand/appraise, and apply) showed structural validity, good internal consistency, and understandability.

Vigilância à saúde da doença de Chagas em municípios endêmicos de Minas Gerais: percepção e conhecimento de profissionais da vigilância entomológica / Health surveillance of Chagas disease in endemic municipalities of Minas Gerais state, Brazil: perception and knowledge of Entomological Surveillance professionals

Resumo Objetivo Traçar o perfil sociodemográfico dos agentes de combate a endemias (ACEs) dos municípios que compõem a microrregional de saúde de Itaúna, Minas Gerais; e apreender a percepção dos profissionais da vigilância entomológica sobre a doença de Chagas e serviços de saúde. Metodologia Aplicou-se um questionário semiestruturado aos ACEs e foi realizado um grupo focal com os coordenadores de endemias e digitadores. Resultados Dentre os ACEs, a maioria era do sexo feminino, entre 21 e 40 anos, com ensino médio, possuindo contrato de trabalho temporário há menos de 5 anos. Foi possível apreender: as más condições de trabalho dos ACEs, destacando-se a alta rotatividade e defasagem salarial; ausência de ações de promoção à saúde relacionadas à doença de Chagas; desarticulação entre a Atenção Primária à Saúde (APS) e Vigilância à Saúde (VS); e críticas às ações de controle da doença pós-processo de descentralização da saúde. Conclusões Há urgência na concretização da legislação inerente à natureza trabalhista e às condições de trabalho dos ACEs, bem como ao planejamento conjunto das ações de APS e VS, garantindo a atenção integral por meio de ações de promoção à saúde voltadas à população, focando especialmente a doença de Chagas, consolidando o SUS.

Abstract Objective To trace the sociodemographic profile of endemic disease combat agents (ACEs) in the municipalities that make up the health microregion of Itaúna, Minas Gerais; and apprehend the perception of entomological surveillance professionals about Chagas disease and health services. Methodology A semi-structured questionnaire was applied to the ACEs and a focus group was held with coordinators of endemic diseases and typists. Results Among the ACEs, the majority were female, between 21 and 40 years old, with high school education, with a temporary work contract for less than 5 years. It was possible to apprehend: the poor working conditions of the ACEs, highlighting the high turnover and wage gap; absence of health promotion actions related to Chagas disease; disarticulation between Primary Health Care (PHC) and Health Surveillance (HS); and criticism of disease control actions after the health decentralization process. Conclusions There is an urgent need to implement the legislation inherent to the labor nature and working conditions of the ACEs, as well as the joint planning of PHC and SV actions, guaranteeing comprehensive care through health promotion actions aimed at the population, focusing especially on Chagas disease, consolidating the SUS.

Validation of pairs of antagonist teeth for the evaluation of shortened dental arch in epidemiological studies

Abstract The aim of this study was to evaluate the accuracy of pairs of antagonist teeth (epidemiological criterion) for defining pairs of teeth in occlusal contact (clinical criterion) and to estimate the agreement between the prevalence of "shortened dental arch" (SDA) and "functional dentition" (FD) when occlusal units (OUs) or posterior occluding pairs (POPs) are defined by the epidemiological or clinical criterion. Data were collected in an epidemiological oral health survey conducted in a municipality in Minas Gerais, Brazil. OUs and POPs were defined by the epidemiological criterion (dental crown status) or clinical criterion "gold standard" (carbon paper record of occlusal contacts during habitual maximum intercuspation). SDA corresponded to the presence of an intact anterior region and three to five OUs. FD was based on the concomitant presence of ≥ 1 tooth in each arch, 10 teeth in each arch, 12 anterior teeth, ≥ 3 premolar POPs, and ≥ 1 molar POP bilaterally. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the epidemiological criterion were calculated. The study included 197 adults. Sensitivity, specificity, PPV, and NPV were 88.5, 87.9, 92.5, and 81.9%, respectively, and accuracy was 88.3%. The epidemiological criterion proved to be valid and could be used in epidemiological studies to calculate the prevalence of reduced dental configurations that consider POPs. The assessment of oral functionality is an aspect that should be included in the diagnosis of the clinical condition of patients, contributing to a more effective individual and collective oral health care plan.

Increased Co-Occurrence of Pathogenic Variants in Hereditary Breast and Ovarian Cancer and Lynch Syndromes: A Consequence of Multigene Panel Genetic Testing?

The probability of carrying two pathogenic variants (PVs) in dominant cancer-predisposing genes for hereditary breast and ovarian cancer and lynch syndromes in the same patient is uncommon, except in populations where founder effects exist. Two breast cancer women that are double heterozygotes (DH) for both BRCA1/BRCA2, one ovarian cancer case DH for BRCA1/RAD51C, and another breast and colorectal cancer who is DH for BRCA2/PMS2 were identified in our cohort. Ages at diagnosis and severity of disease in BRCA1/BRCA2 DH resembled BRCA1 single-carrier features. Similarly, the co-existence of the BRCA2 and PMS2 mutations prompted the development of breast and colorectal cancer in the same patient. The first BRCA1/BRCA2 DH was identified by HA-based and Sanger sequencing (1 of 623 families with BRCA PVs). However, this ratio has increased up to 2.9% (1 DH carrier vs. 103 single PV carriers) since using a custom 35-cancer gene on-demand panel. The type of cancer developed in each DH patient was consistent with the independently inherited condition, and the clinical outcome was no worse than in patients with single BRCA1 mutations. Therefore, the clinical impact, especially in patients with two hereditary syndromes, lies in genetic counseling tailor-made for each family based on the clinical guidelines for each syndrome. The number of DH is expected to be increased in the future as a result of next generation sequencing routines.

Recomendações para o enfrentamento da pandemia de COVID-19 em Instituições de Longa Permanência para Idosos: rapid review / Recommendations for managing COVID-19 pandemic in long-term care facilities for the older people: a rapid review

Resumo Introdução O controle da disseminação do coronavírus em Instituições de Longa Permanência para Idosos (ILPI) é considerado um desafio, uma vez que os idosos fazem parte do grupo de risco e apresentam prognóstico bastante desfavorável e também alta letalidade. Objetivo Conduzir uma rapid review para mapear e sintetizar a literatura sobre medidas de enfrentamento de Coronavirus Disease-2019 (COVID-19) em ILPI. Método Foi realizada uma Rapid review, e as buscas foram conduzidas nas bases de dados eletrônicas Biblioteca Cochrane, Web of Science, Scopus, Scielo, Medline/Pubmed e Google Scholar. Foram incluídas publicações a partir de 2019, nos idiomas português, inglês ou espanhol. A seleção das publicações ocorreu em duas etapas: leitura dos títulos/resumos; e leitura na íntegra de todas as publicações selecionadas. As recomendações para enfrentamento da COVID-19 em Instituições de Longa Permanência para Idosos foram extraídas e agrupadas de acordo com o conteúdo. Resultados Foram selecionadas 59 publicações que descreviam recomendações referentes aos temas: controle da disseminação do vírus; formação / educação continuada dos trabalhadores responsáveis pelo cuidado ao idoso; bem como o cuidado no contexto da pandemia: residentes, trabalhadores e familiares, e planejamento e gerenciamento de ações para o enfrentamento. Conclusão As recomendações para o enfrentamento da COVID-19 demandam comportamentos para evitar a disseminação do vírus, adaptações nas dinâmicas de cuidado e de convivência nas instituições, planejamento de ações específicas e suporte familiar, institucional e do Estado para assegurar a proteção da saúde física e psicossocial dos idosos e trabalhadores.

Abstract Background Controlling the spread of the coronavirus in Long-Term Care Facilities for older adults is considered a challenge, since this group have a very unfavorable prognosis and also high lethality. Objective To conduct a rapid review of guidelines to manage COVID-19 in Long-Term Care Facilities for older adults. Method A Rapid review was carried out, searches were conducted in the electronic databases Cochrane Library, Web of Science, Scopus, Scielo and Medline/Pubmed. Publications from 2019 were included, in Portuguese, English, or Spanish. The selection of publications took place in two stages: reading the titles/abstracts and reading in full all selected publications by two independent researchers. Guidelines for managing COVID-19 in LCTFs were extracted and grouped according to content. Results 59 publications were selected describing guidelines regarding control of the spread of the virus; training/continuing education of staff responsible for caring for the elderly residents; care addressing residents, staff and family during the pandemic and planning and management of actions to manage the disease. Conclusion Guidelines for managing COVID-19 demand for behaviors to prevent the spread of the virus and adaptations in the dynamics of care and the coexistence inside facilities. They also require planning for specific actions that include family, institutional and State support so the protection of physical and psychosocial health of the elderly residents and staff is ensured.