One-step conservative surgery vs hysterectomy for placenta accreta spectrum: a feasibility randomized controlled trial.

BACKGROUND: Placenta accreta spectrum is a serious condition associated with significant maternal morbidity and even mortality. The recommended treatment is hysterectomy. An alternative is 1-step conservative surgery, which involves the en bloc resection of the myometrium affected by placenta accreta spectrum along with the placenta, followed by uterine reconstruction. Currently, there are no studies comparing the 2 techniques in the setting of a randomized controlled trial. OBJECTIVE: We performed a prospectively registered multicenter randomized controlled trial comparing hysterectomy with 1-step conservative surgery. The aim was to collect feasibility and clinical outcomes of the 2 techniques in women assigned to hysterectomy or 1-step conservative surgery. In addition to assessing participants' willingness to be randomized, we also collected data on intraoperative blood loss, transfusion requirement, serious adverse event, and other clinical outcomes. STUDY DESIGN: Sixty women with strong antenatal suspicion of placenta accreta spectrum were assigned randomly to either hysterectomy (n=31) or 1-step conservative surgery (n=29). RESULTS: During a 20-month period, 60 of the 64 eligible patients (93.7%) underwent randomization. Intention-to-treat analysis showed that the clinical outcomes for 1-step conservative surgery were comparable to those of hysterectomy (median intraoperative blood loss, 1740 mL [interquartile range, 1010-2410] vs 1500 mL [interquartile range, 1122-2753]; odds ratio, 1 [1-1]; P=.942; median duration of surgery, 135 minutes [interquartile range, 111-180] vs 155 minutes [interquartile range, 120-185]; odds ratio, 0.99 [0.98-1]; P=.151; transfusion rate, 58.6% vs 61.3%; odds ratio, 0.96 [0.83-1.76]; P=.768; and adverse event rate, 17.2% vs 9.7%; odds ratio, 1.77 [0.43-10.19]; P=.398; respectively). In the subgroup of women with type 1 class on topographic classification, all participants allocated to 1-step surgery had successful outcomes, which were superior to those of hysterectomy. This was evidenced by the shorter surgery duration (median, 125 [interquartile range, 98-128] vs 180 [129-226] minutes; P=.002), lower transfusion rates (46.2% vs 82.4%), and fewer units of red blood cells transfused (median, 1 [interquartile range, 1-1.8] vs 3 [interquartile range, 2-4] units; P=.007). CONCLUSION: A randomized controlled trial comparing 2 surgical techniques for the treatment of placenta accreta spectrum is feasible. One-step conservative repair is a valid alternative to hysterectomy in the large majority of cases, but this can only be ascertained following intraoperative surgical staging. El resumen está disponible en Español al final del artículo.

Concurrent progestogen and cerclage to reduce preterm birth: a multicenter international retrospective cohort.

BACKGROUND: Both progestogens and cerclage are individually effective in preterm birth prevention in high risk pregnancies. However, national and international guidelines cite a lack of data available to comment on the potential benefit of concurrent progestogen therapy after cerclage has been placed. Studies to date have been small with mixed results regarding benefit of concurrent progestogen with cerclage leaving uncertainty regarding best clinical practice. OBJECTIVE: This study aimed to evaluate whether cerclage with progestogen therapy was superior to cerclage alone in the prevention of spontaneous preterm birth in singleton pregnancies. METHODS: This is an international retrospective cohort study of singleton pregnancies, without major anomaly or aneuploidy, and with cerclage placed at 10 different institutions in the United States and Colombia from June 2016 to June 2020. Exclusion criteria were lack of documentation regarding whether progestogen was prescribed, unavailable delivery outcome, and pregnancy termination (spontaneous or induced) before 16 weeks' gestation. The exposure of interest was progestogen use with cerclage placement, which included those who continued to use progestogen or who started progestogen after cerclage. The comparison group consisted of those without progestogen use after cerclage placement, which included those who had no progestogen use during the entire pregnancy or who initiated progestogen and then stopped it after cerclage placement. Progestogen type, cerclage indication, maternal baseline characteristics, and maternal/neonatal outcomes were collected. The primary outcome was spontaneous preterm birth at <37 weeks. The secondary outcomes were spontaneous preterm birth at <34 weeks, gestational age at delivery, and a composite neonatal outcome including ≥1 of the following: perinatal mortality, confirmed sepsis, grade III or IV intraventricular hemorrhage, retinopathy of prematurity, respiratory distress syndrome, and bronchopulmonary dysplasia. There were planned subgroup analyses by cerclage indication, progestogen type (vaginal progesterone vs 17-hydroxyprogesterone caproate), preterm birth history, and site. Continuous variables were compared in adjusted analyses with analysis of covariance, and categorical variables were compared with multivariable logistic regression, adjusting for potential confounders with adjusted odds ratio. A Cox regression survival curve was generated to compare latency to spontaneous delivery, censored after 37 weeks. RESULTS: During the study period, a total of 699 singletons met the inclusion criteria: 561 in the progestogen with cerclage group and 138 with cerclage alone. Baseline characteristics were similar, except the higher likelihood of previous spontaneous preterm birth in the progestogen group (61% vs 41%; P<.001). Within the progestogen group, 52% were on 17-hydroxyprogesterone caproate weekly, 44% on vaginal progesterone daily, and 3% on oral progesterone daily. Progestogen with cerclage was associated with a significantly lower frequency of spontaneous preterm birth <37 weeks (31% vs 39%; adjusted odds ratio, 0.59 [0.39-0.89]; P=.01) and <34 weeks (19% vs 27%; adjusted odds ratio, 0.55 [0.35-0.87]; P=.01), increased latency to spontaneous delivery (hazard ratio for spontaneous preterm birth <37 weeks, 0.66 [0.49-0.90]; P=.009), and lower frequency of perinatal death (7% vs 16%; adjusted odds ratio, 0.37 [0.20-0.67]; P=.001). In planned subgroup analyses, association with reduced odds of preterm birth <37 weeks persisted in those on vaginal progesterone, those without a previous preterm birth, those with ultrasound- or examination-indicated cerclage, those who started progestogen therapy before cerclage, and in sites restricted to the United States. CONCLUSION: Use of progestogen with cerclage was associated with reduced rates of spontaneous preterm birth and early spontaneous preterm birth compared with cerclage alone. Although this study was not sufficiently powered for subgroup analysis, the strength of evidence for benefit appeared greatest for those with ultrasound- or examination-indicated cerclage, and with vaginal progesterone. El resumen está disponible en Español al final del artículo.

Construção do nome social de pessoas trans e aspectos relacionados em um município de porte médio do Sul do Brasil / The construction behind chosen names of transgender individuals and related aspects in a medium-sized city in the South of Brazil

Resumo O trabalho analisou o processo de construção do nome social e aspectos relacionados em pessoas trans de um município de porte médio do Sul do Brasil. Foram utilizados dados qualitativos de um estudo de método misto descritivo e exploratório. Incluíram-se pessoas autodeclaradas trans com 18 anos ou mais. Foram conduzidos três grupos focais com dez participantes. Estes, com idade variando entre 19 e 52 anos, apresentam nome social documentado, porém metade ainda não fez a alteração nos registros civis. A técnica da análise de conteúdo produziu duas categorias: "construção do nome social como instrumento de validação da identidade trans" e "impactos da construção do nome social na autoaceitação e nas relações familiares e sociais". Os resultados reforçam a importância do respeito ao nome como forma de contribuição para a afirmação de gênero de sujeitos trans. O nome esteve atrelado às suas vivências, individualidades e valores. Seu uso adequado, muito mais do que o cumprimento de uma legislação, significou respeito às possibilidades diversas da existência humana. Espera-se que os resultados apresentados possam ser utilizados como ferramenta de reconhecimento acerca das questões e nuances que permeiam a construção do nome social, bem como contribuam para a validação identitária.

Abstract This study analyzed the construction process of the chosen name and related aspects among transgender individuals from a medium-sized municipality in southern Brazil. Qualitative data from a descriptive and exploratory mixed-method study was used. Self-declared trans people aged 18 or over were included. Three focus groups were conducted with ten participants. These individuals, aged between 19 and 52 years, have a documented chosen name, but half have not yet changed their civil records. The content analysis technique produced two categories: "construction of the chosen name as an instrument for validating the transgender identity" and "impacts of the construction of the chosen name on self-acceptance and on family and social relationships." The results reinforce the importance of respecting the name as a way of contributing to the gender affirmation of transgender individuals. The name was linked to the experiences, individuality and values of these individuals. Its proper use, much more than respect for legislation, meant respect for the different possibilities of human existence. It is expected that the results presented can be used as a tool for recognizing the issues and nuances that permeate the construction of the chosen name and contribute to identity validation.

Razões e consequências das perdas dentárias em adultos e idosos no Brasil: metassíntese qualitativa / Reasons for and consequences of tooth loss in adults and elderly people in Brazil: a qualitative metasynthesis

Resumo O objetivo foi analisar e sistematizar evidências levantadas por estudos qualitativos sobre razões e consequências de perdas dentárias em adultos e idosos no Brasil. Foi executada revisão sistemática da literatura de pesquisas de métodos qualitativos, e metassíntese dos resultados. A população de estudo foi de adultos acima de 18 anos e idosos brasileiros. Foi realizada busca nas bases de dados BVS, PubMed, Scopus, Web of Science, BBO, Embase, EBSCO e SciELO. A síntese temática definiu oito temas analíticos sobre razões das perdas dentárias e três temas analíticos sobre as consequências. A dor dentária, o modelo de atenção, a situação financeira e o desejo de reabilitação protética foram fatores determinantes para as exodontias. Houve reconhecimento da negligência com o cuidado bucal e da naturalidade das perdas dentárias ligada à velhice. Dentes perdidos causaram impactos psicológicos e fisiológicos. É imperativo verificar se os fatores que causaram as perdas dentárias persistem, e quanto influenciam as decisões de extrair dentes na população jovem e adulta atual. Há que se mudar o modelo de atenção pela inclusão e qualificação da atenção em saúde bucal da população adulta jovem e idosa, sob pena de persistir o modelo de mutilação dentária e a cultura de edentulismo.

Abstract The objective was to analyze and systematize evidence reported in qualitative studies on the reasons and consequences of tooth loss in adults and elderly people in Brazil. A systematic review of the literature on qualitative research methods and a meta synthesis of the results were performed. The study population consisted of adults over 18 years of age and elderly people in Brazil. Searches were performed in the BVS, PubMed, Scopus, Web of Science, BBO, Embase, EBSCO and SciELO databases. The thematic synthesis identified 8 analytical themes regarding reasons for tooth loss and 3 analytical themes regarding consequences of tooth loss. Dental pain, care model, financial situation and desire for prosthetic rehabilitation were determining factors for extractions. There was recognition of negligence in oral care, and the naturalness of tooth loss was linked to old age. Missing teeth caused psychological and physiological impacts. It is imperative to verify whether the factors that cause tooth loss persist, and how much those factors influence decisions to extract teeth among current young and adult populations. It is necessary to change the care model through the inclusion and qualification of oral health care for the young and elderly adult populations; otherwise, the model of dental mutilation and the culture of edentulism will persist.

Functional dentition and associated factors: the evaluation of three indicators

Studying the different indicators of functional dentition classification can contribute to the understanding of the associated factors, and thus help in the definition of strategies associated with oral health care. This approach has been little explored in the literature, especially when considering the older age group. Aim:The aim of this study is to evaluate the factors associated with three distinct functional dentition classification. Methods: Cross-sectional exploratory study using secondary data from the Frailty in Older Brazilians (FIBRA) Project of 876 older adults living in Campinas, Brazil. The indicators of dental function assessed was number of natural teeth present, occluding pairs of teeth and the Eichner index, which were verified by trained dentists, following the World Health Organization criteria for epidemiological studies in oral health. The explanatory variable assessed was the self-perception of oral health-related quality of life measured by the Geriatric Oral Health Assessment Index (GOHAI) and its dimensions. It was also collected sociodemographic information such as age, gender, race/ethnicity, schooling, family income, smoking behavior and frailty status. The association was verified through Poisson regressions for number of teeth and pairs of teeth in occlusion and multinomial regression for the Eichner index, adjusted by sociodemographic and health variables. Results: Lower prevalence of participants with less than 21 teeth who negatively perceived GOHAI ́s pain and discomfort dimension and higher prevalence of having less teeth among the ones that negatively perceived GOHAI ́s physical and functional dimensions. No association was found between the perception of quality of life and occlusion pairs of teeth and the Eichner Index. Conclusion: Two out of three indicators assessed were associated with quality of life. Therefore, it is important to select sensitive indicators to be able to identify and better comprehend this relationship

Retention, Fasting Patterns, and Weight Loss With an Intermittent Fasting App: Large-Scale, 52-Week Observational Study.

BACKGROUND: Intermittent fasting (IF) is an increasingly popular approach to dietary control that focuses on the timing of eating rather than the quantity and content of caloric intake. IF practitioners typically seek to improve their weight and other health factors. Millions of practitioners have turned to purpose-built mobile apps to help them track and adhere to their fasts and monitor changes in their weight and other biometrics. OBJECTIVE: This study aimed to quantify user retention, fasting patterns, and weight loss by users of 2 IF mobile apps. We also sought to describe and model starting BMI, amount of fasting, frequency of weight tracking, and other demographics as correlates of retention and weight change. METHODS: We assembled height, weight, fasting, and demographic data of adult users (ages 18-100 years) of the LIFE Fasting Tracker and LIFE Extend apps from 2018 to 2020. Retention for up to 52 weeks was quantified based on recorded fasts and correlated with user demographics. Users who provided height and at least 2 readings of weight and whose first fast and weight records were contemporaneous were included in the weight loss analysis. Fasting was quantified as extended fasting hours (EFH; hours beyond 12 in a fast) averaged per day (EFH per day). Retention was modeled using a Cox proportional hazards regression. Weight loss was analyzed using linear regression. RESULTS: A total of 792,692 users were followed for retention based on 26 million recorded fasts. Of these, 132,775 (16.7%) users were retained at 13 weeks, 54,881 (6.9%) at 26 weeks, and 16,478 (2.1%) at 52 weeks, allowing 4 consecutive weeks of inactivity. The survival analysis using Cox regression indicated that retention was positively associated with age and exercise and negatively associated with stress and smoking. Weight loss in the qualifying cohort (n=161,346) was strongly correlated with starting BMI and EFH per day, which displayed a positive interaction. Users with a BMI ≥40 kg/m2 lost 13.9% of their starting weight by 52 weeks versus a slight weight gain on average for users with starting BMI <23 kg/m2. EFH per day was an approximately linear predictor of weight loss. By week 26, users lost over 1% of their starting weight per EFH per day on average. The regression analysis using all variables was highly predictive of weight change at 26 weeks (R2=0.334) with starting BMI and EFH per day as the most significant predictors. CONCLUSIONS: IF with LIFE mobile apps appears to be a sustainable approach to weight reduction in the overweight and obese population. Healthy weight and underweight individuals do not lose much weight on average, even with extensive fasting. Users who are obese lose substantial weight over time, with more weight loss in those who fast more.

Perda de função mastigatória e risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo / Masticatory function loss and frailty risk in community-dwelling older people in the State of São Paulo

Resumo Objetivo Verificar se a perda de função mastigatória aumenta o risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo. Métodos Foi adotado um delineamento de coorte prospectivo sobre a base de dados do estudo FIBRA (Fragilidade em Idosos Brasileiros), com linha de base realizada em 2008-2009 e seguimento em 2016-2018, transcorrendo em média 100,2 ± 9,2 meses. A variável desfecho foi a incidência de fragilidade, a variável de exposição foi a função mastigatória conforme a condição de edentulismo e autorrelato de dificuldade mastigatória. As variáveis de ajuste foram condições sociodemográficas, comportamentais e de saúde geral. Foi utilizado um modelo de regressão de Poisson, com variância robusta, estimando o risco relativo Resultados a incidência acumulada de fragilidade aos oito anos em média foi de 30 casos a cada 100 participantes edêntulos com dificuldade mastigatória, que apresentaram maior risco de desenvolver fragilidade (RR:1,75 IC 95% 1,09-2,81) do que os idosos dentados sem dificuldade mastigatória, independentemente de tabagismo (RR: 1,71 IC 95% 1,07-2,73) e de condição socioeconômica (RR: 1,72 IC 95% 1,13-2,62). Conclusão A perda de função mastigatória aumentou o risco de fragilidade em idosos.Futuras pesquisas deverão estudar se a reabilitação da função mastigatória contribui para diminuir esse risco.

Abstract Objective To verify if the loss of masticatory function increases the risk of frailty in community-dwelling older people in the state of São Paulo. Methods A prospective cohort design was adopted based on the FIBRA study database (Fragility in Brazilian Elderly), with a baseline performed in 2008-2009 and follow-up in 2016-2018, elapsed on average 100.2 ± 9.2 months. The outcome variable was the incidence of frailty. The exposure variable was masticatory function according to edentulism and self-reported chewing difficulty. Adjustment variables were sociodemographic, behavioral, and general health conditions. A Poisson regression model with robust variance was used to estimate the relative risk. Results the cumulative incidence of frailty over eight years was 30 cases per 100 edentulous participants with chewing difficulties, who had a higher risk of developing frailty (RR: 1.75 95% CI 1.09-2.81) than the dentate elderly without chewing difficulties, regardless of smoking (RR: 1.71 95% CI 1.07-2.73) and socioeconomic status (RR: 1.72 95% CI 1.13-2.62) Conclusion Loss of masticatory function increases the risk of frailty in older people. Future research should study whether the rehabilitation of oral function reduces this risk.

Self-assessed masticatory function and frailty in Brazilian older adults: the FIBRA Study

ABSTRACT OBJETIVE To investigate the relationship between the masticatory function and the frailty of older people. METHODS Exploratory cross-sectional study using secondary data from the FIBRA Project on the frailty conditions of older people living in urban areas of six Brazilian municipalities, from 2008 to 2009. The population consisted of older adults aged 65 and over with no cognitive impairment. A single session identification questionnaire and the Mini-Mental State Examination (MMSE) were applied, followed by collecting sociodemographic data and data on the participants' self-assessment of masticatory function, general health, and oral health. RESULTS 2,341 older people (164 frail older adults), of whom 63.2% reported not having seen a dentist in the last year, and approximately 26% of them had three or more functional feeding problems. Older participants (OR = 2.88; 95%CI: 2.01-4.13), who are retired (OR = 2.31; 95%CI: 1.18-5.53), those who were depressed (OR = 2.31; 95%CI: 1.58-3.38), and those who self-assessed their general health as worse compared to others of the same age (OR = 3.91; 95%CI: 2.39-6.40) were at higher risk of frailty. Three or more problems related to the functional aspects of mastication were associated with a greater chance of frailty (OR = 2.06; 95%CI: 1.25-3.41). CONCLUSION This study found an association between masticatory function and a greater chance of frailty among the studied population.

Effect of Perfluorooctanesulfonic acid (PFOS) on immune cell development and function in mice.

Perfluoroctanesulfonate (PFOS) belongs to a larger family of compounds known as Per- and polyfluoroalkyl substances (PFAS). The strength of the carbon-fluorine bond makes PFOS extremely resistant to environmental degradation. Due to its persistent nature, research has been directed to elucidating possible health effects of PFOS on humans and laboratory animals. Here we have explored the effects of PFOS exposure on immune development and function in mice. We exposed adult mice to 3 and 1.5 µg/kg/day of PFOS for 2 and 4 weeks, respectively, and examined the effects of PFOS exposure on populations of T cells, B cells, and granulocytes. These doses of PFOS resulted in serum levels of approximately 100 ng/mL with no weight loss during exposure. We find that PFOS does not affect T-cell development during this time. However, while PFOS exposure reduced immune cell populations in some organs, it also led to an increase in the numbers of cells in others, suggesting possible relocalization of cells. We also examined the effect of PFOS on the response to influenza virus infection. We find that exposure to PFOS at 1.5 µg/kg/day of PFOS for 4 weeks does not affect weight loss or survival, nor is viral clearance affected. Analysis of antibody and T cell specific antiviral responses indicate that at this concentration, PFOS does not suppress the immune cell development or antigen specific immune response.

High density lipoprotein-associated miRNA is increased following Roux-en-Y gastric bypass surgery for severe obesity.

Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed weight-loss procedures, but how severe obesity and RYGB affect circulating HDL-associated microRNAs (miRNAs) remains unclear. Here, we aim to investigate how HDL-associated miRNAs are regulated in severe obesity and how weight loss after RYGB surgery affects HDL-miRNAs. Plasma HDLs were isolated from patients with severe obesity (n = 53) before and 6 and 12 months after RYGB by immunoprecipitation using goat anti-human apoA-I microbeads. HDLs were also isolated from 18 healthy participants. miRNAs were extracted from isolated HDL and levels of miR-24, miR-126, miR-222, and miR-223 were determined by TaqMan miRNA assays. We found that HDL-associated miR-126, miR-222, and miR-223 levels, but not miR-24 levels, were significantly higher in patients with severe obesity when compared with healthy controls. There were significant increases in HDL-associated miR-24, miR-222, and miR-223 at 12 months after RYGB. Additionally, cholesterol efflux capacity and paraoxonase activity were increased and intercellular adhesion molecule-1 (ICAM-1) levels decreased. The increases in HDL-associated miR-24 and miR-223 were positively correlated with an increase in cholesterol efflux capacity (r = 0.326, P = 0.027 and r = 0.349, P = 0.017, respectively). An inverse correlation was observed between HDL-associated miR-223 and ICAM-1 at baseline. Together, these findings show that HDL-associated miRNAs are differentially regulated in healthy participants versus patients with severe obesity and are altered after RYGB. These findings provide insights into how miRNAs are regulated in obesity before and after weight reduction and may lead to the development of novel treatment strategies for obesity and related metabolic disorders.

Evaluation of the Pink Luminous Breast LED-Based Technology Device as a Screening Tool for the Early Detection of Breast Abnormalities.

Breast cancer is the leading cause of sex-specific female cancer deaths in the United States. Detection at earlier stages contributes to decreasing the mortality rate. The mammogram is the "Gold Standard" for breast cancer screening with an estimated sensitivity of 86.9% and a specificity of 88.9%. However, these values are negatively affected by the breast density considered a risk factor for developing breast cancer. Herein, we validate the novel LED-based medical device Pink Luminous Breast (PLB) by comparison with the mammogram using a double blinded approach. The PLB works by emitting a LED red light with a harmless spectrum of 640-800 nanometers. This allows the observation of abnormalities represented by dark or shadow areas. In this study, we evaluated the sensitivity and specificity of the PLB device as a screening tool for the early detection of breast abnormalities. Our results show that the PLB device has a high sensitivity (89.6%) and specificity (96.4%) for detecting breast abnormalities comparable to the adjusted mammogram values: 86.3 and 68.9%, respectively. The percentage of presence of breast density was 78.2% using PLB vs. 72.9% with the mammogram. Even with higher findings of breast density, the PLB is still capable of detecting 9.4% of calcifications compared to 6.2% in mammogram results and the reported findings for cysts, masses, or tumor-like abnormalities was higher using the PLB (6.5%) than the mammogram (5.6%). A 100% of the participants felt comfortable using the device without feeling pain or discomfort during the examination with 100% acceptability. The PLB positive validation shows its potential for routine breast screening at non-clinical settings. The PLB provides a rapid, non-invasive, portable, and easy-to-use tool for breast screening that can complement the home-based breast self-examination technique or the clinical breast examination. In addition, the PLB can be conveniently used for screening breasts with surgical implants. PLB provides an accessible and painless breast cancer screening tool. The PLB use is not intended to replace the mammogram for breast screening but rather to use it as an adjunct or complemental tool as part of more efficient earlier detection strategies contributing to decrease mortality rates.

Avaliação dos serviços de saúde bucal na atenção primária à saúde: perspectivas regionais com base no PMAQ / Evaluation of oral health services in primary health care: regional perspectives based on PMAQ / Evaluación de los servicios de salud bucal en la atención primaria de salud: perspectivas regionales basadas en PMAQ

Objetivo:O objetivo do estudo foi analisar o perfil epidemiológico da assistência odontológica dos municípios da 4ª Coordenadoria Regional de Saúde do Rio Grande do Sul (4ª CRS/RS) a partir dos dados gerados no 2ª ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Metodologia:Trata-se de um estudo observacional transversal utilizando como instrumento os microdados da avaliação externa do PMAQ-AB divididos nas dimensões de estrutura das unidades básicas, processo de trabalho das equipes de atenção à saúde bucal e usuários do serviço. Dos 32 municípios pertencentes à 4ª CRS/RS, 21 aderiram ao programa e fazem parte deste estudo, sendo que estes sãodivididos em duas regiões de saúde. Esse estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Santa Maria e a análise estatística dos dados foi realizada através do programa Stata 14.0, onde foram realizadas análises de frequência para variáveis selecionadas. Resultados:Participaram da avaliação 56 Unidades de Atenção Básica, 44 equipes de saúde bucal e 261 usuários do serviço de atenção básica e com isso observamos que, apesar da maioria das unidades possuírem atendimento odontológico com agendamento e capacidade de resolução dos casos, a maioria dos usuários não o utilizam. Conclusão:Com estes resultados almejamos desencadear processos que tragam melhorias para as unidades, equipes e usuários da atenção básica no que tange o planejamento, organização e cuidado em saúde e concluímos que este tipo de avaliação se mostra importante para o desenvolvimento de ações de saúde pública. (AU)

Objective: The aim of this study was to analyze the epidemiological profile of dental attendance of the municipalities of the 4th Regional Health Coordination of Rio Grande do Sul (4th CRS/RS) from the data generated in the 2nd cycle of the National Program for Improving Access and Quality in Primary Care (PMAQ-AB). Methods: This is an observational cross-sectional study using microdata of the external evaluation of PMAQ-AB divided into the structure dimensions of the basic units, work process of the oral health care teams and service users. Of the 32 municipalities belonging to the 4th CRS/RS, 21 joined the program and are part of this study, and these are divided into two health regions. This study was approved by the Research Ethics Committee of the Federal University of Santa Maria and the statistical analysis of the data was performed using the software Stata 14.0, where frequency analyzes were performed for selected variables. Results: Participated in this evaluation 56 Primary Care Units, 44 oral health teams and 261 users of the primary care service. Thus, despite the fact that most units have dental care with programming and resolution of cases, most users do not use it. Conclusion: With these results we intention to provoke processes that bring improvements to primary care units, teams and users regarding planning, organization and health care and we conclude that this type of evaluation is important for the development of public health actions. (AU)

Objetivo: El objetivo del estudio fue analizar el perfil epidemiológico de la atención odontológica de los municipios de la 4ta Coordinación Regional de Salud de Rio Grande do Sul (4to CRS/RS) a partir de los datos generados en el 2do ciclo del Programa Nacional de Mejora del Acceso y Calidad de la Atención Primaria (PMAQ-AB). Metodología: Este es un estudio observacional transversal de evaluación externa de PMAQ-AB divididos en las dimensiones de la estructura de las unidades básicas, el proceso de trabajo de atención de la salud bucal y los usuarios del servicio. De los 32 municipios que pertenecen al 4to CRS/RS, 21 se unieron al programa. Este estudio fue aprobado por el Comité de Ética en Investigación de la Universidad Federal de Santa María y el análisis estadístico de los datos se realizó utilizando el programa Stata 14.0, donde se realizaron análisis de frecuencia para variables seleccionadas. Resultados: Participaron en la evaluación 56 Unidades de Atención Primaria, 44 equipos de salud bucal y 261 usuarios del servicio, a pesar de que la mayoría de las unidades tienen atención dental con programación y resolución de casos, la mayoría de los usuarios no lo usan. Conclusión: Con estos resultados, nuestro objetivo es desencadenar procesos que traigan mejoras a las unidades de atención primaria, los equipos y los usuarios con respecto a la planificación, la organización y la atención médica y odontológica y concluimos que este tipo de evaluación es importante para el desarrollo de acciones de salud pública. (AU)

Baixa cobertura de saúde bucal: como potencializar o cuidado? / Low oral health coverage: how to improve care? / Un informe de experiencia del proyecto de extensión de cuidado dental vinculado al sistema único de salud de Brasil

Objetivo:Este estudo trata-se de um relato de experiência acerca de um programa da prefeitura da cidade de Santa Maria, sul do Brasil, vinculado à um projeto de extensão denominado Sorria Santa Maria que teve seu início em 2017 e permanece em andamento. Nosso objetivo com isso foi, além de contribui com os usuários que têm dificuldade em acessar os atendimentos odontológicos na atenção básica, promover e demonstrar as práticas em saúde coletiva, construídas em diferentes processos de trabalho e estreitamente ligadas a estruturas da sociedade.Relato de experiência:O programa destina-se aos usuários do Sistema Único de Saúde do município que não conseguem acessar as Unidades Básicas de Saúde, devido à baixa cobertura de saúde bucal municipal e às funções profissionais exercidas durante horário comercial pelos usuários. Os agendamentos são realizados segundo uma lista de espera com o contato de pacientes que manifestaram desejo de uma avaliação odontológica. Nas consultas, realiza-se então acolhimento, avaliação e atendimento destes pacientes até a conclusão do plano de tratamento. Conclusão:Importantes impactos foram alcançados até o presente momento, tanto em relação ao expressivo número de atendimentos odontológicos realizados quanto à redução das listas de espera para atendimento odontológico. Além disto, ressaltam-se que as ações de promoção de saúde ligadas ao projeto resultamem uma maior integração entre ensino-serviço-comunidade no município. (AU)

Objective: This study is an experience report about an extension project linked to a program of the city of Santa Maria, southern Brazil, called Sorria Santa Maria that started in 2017 and remains in progress. Our aim with this was, in addition to contributing with the users who have difficulty accessing dental attendance in primary care, promoting and demonstrating collective health practices, built on different work processes and closely linked to societal structures. Experience report: The program is intended for users of the municipality's Unified Health System who cannot access the Basic Health Units, due to the low coverage of municipal oral health and the professional functions performed during business hours by users. Arranges are made according to a waiting list with the contact of patients who expressed the desire for a dental evaluation. In consultations, these patients are welcomed, evaluated and treated until the treatment plan is completed. Conclusion: Important impacts have been achieved until now, both in relation to the significant number of dental cares, provided and the reduction of waiting lists for dental attendance. In addition, the health promotion actions linked to the project result in greater integration between teaching-service-community in the municipality. (AU)

Objetivo: Este estudio es un informe de experiencia sobre un proyecto de extensión vinculado a un programa de la ciudad de Santa María, sur de Brasil, llamado Sorria Santa María, que comenzó en 2017 y sigue en progreso. Nuestro objetivo con esto era, además de contribuir a los usuarios que tienen dificultades para acceder a la atención dental en la atención primaria, promover y demostrar prácticas colectivas de salud, basadas en diferentes procesos de trabajo y estrechamente vinculados a las estructuras sociales. Informe de experiencia: El programa está destinado a usuarios del Sistema de Salud Unificado de la municipalidad que no pueden acceder a las Unidades Básicas de Salud, debido a la baja cobertura de salud bucal municipal y las funciones profesionales realizadas por los usuarios durante el horario comercial. Los horarios se hacen de acuerdo con una lista de espera con el contacto de pacientes que expresaron el deseo de una evaluación dental. En las consultas, estos pacientes son bienvenidos, evaluados y tratados hasta que se completa el plan de tratamiento. Conclusión: Hasta ahora se han logrado impactos importantes, tanto en relación con el número significativo de atención dental brindada como con la reducción de las listas de espera para la atención dental. Además, es digno de mención que las acciones de promoción de la salud vinculadas al proyecto dan como resultado una mayor integración entre la comunidad de servicios de enseñanza en el municipio. (AU)

Self-rated general and oral health and associated factors in independently-living older individuals

Abstract The aim of this study was to verify the association between sociodemographic, general health, and oral health data with self-rated general health (SRGH) and self-rated oral health (SROH) in independent-living older Brazilians. This cross-sectional study was part of a larger study with older individuals living independently in the city of Campinas, Brazil - the "Rede FIBRA" Study (the Frailty in Brazilian Elderly Study). A random sample of 688 older individuals responded the SRGH and 673, the SROH. SRHG and SROH were both assessed using a single item. The questionnaire included sociodemographic, general, and oral health data. The mean age was 72.28 ± 5.4 years. The adjusted analysis revealed that the probability of rating general health as bad was higher for illiterate participants (PR: 1.77, 95%CI: 1.13-2.77) or with low educational level (PR: 1.76, 95%CI: 1.17-2.65), those with depressive symptoms (PR: 1.45, 95%CI:1.21-1.74), participants that self-reported food limitation due to problems with denture or lack of it (PR: 1.29, 95%CI: 1.05-1.56), and those with xerostomia (PR 1.40, 95%CI: 1.17-1.67). The probability of rating general health as bad was lower for participants that presented 0-2 chronic diseases (PR: 0.64, 95%CI: 0.53-0.78) and were pre-frail (PR: 0.76, 95%CI: 0.61-0.96). With regard to SROH, the probability of rating oral health as bad was higher for participants with natural teeth (PR:1.61, 95%CI: 1.24-2.08), that reported xerostomia (PR: 1.44, 95%CI: 1.13-1.84), and food limitation due to problems with denture or lack of it (PR: 1.43, 95%CI: 1.07-1,91), and lower for participants that reported having enough money to cover daily expenses (PR: 0.78, 95%CI: 0.61-0.99). Oral health data and income seem to be related to self-perceptions of general and oral health.

Reporte de serie de casos: neovagina en pacientes con Síndrome Mayer-Rokitansky-Kuster-Hauser / Case series report: neovagina in patients with Mayer-Rokitansky-Kuster-Hauser Syndrome

RESUMEN INTRODUCCIÓN: La ausencia congénita de vagina es una condición poco común, algunas causas son el síndrome de Mayer-Rokitansky-Kuster-Hauser y la insensibilidad periférica a los andrógenos. Múltiples técnicas quirúrgicas y no quirúrgicas se han descrito para el manejo de esta condición, siendo el objetivo principal la creación de un canal vaginal de diámetro y longitud adecuada que permitan restaurar la función coital. El objetivo de este estudio es detallar la experiencia del procedimiento de neovagina con la técnica quirúrgica de McIndoe en pacientes con Mayer-Rokitansky-Kuster-Hauser realizados en la Unidad de Uroginecología de la Clínica Universitaria Bolivariana. METODOLOGÍA: Reporte de 5 casos de pacientes con agenesia de vagina secundarios al síndrome de Mayer-Rokitansky-Kuster-Hauser, a las cuales se les realizó neovagina con la técnica de McIndoe con algunas modificaciones en el molde para el implante de piel. RESULTADOS: Se incluyeron cinco pacientes con diagnóstico de Mayer-Rokitansky-Kuster-Hauser, todas tenían desarrollo de características sexuales secundarias, perfil hormonal normal, y un cariotipo XX. Se utilizó la técnica quirúrgica de McIndoe para la realización de la neovagina sin complicaciones intraoperatorias asociadas y con adecuada evolución posoperatoria, con una longitud vaginal entre 7-9 cm y 3 pacientes con vida sexual activa. El tiempo de estancia hospitalaria fue 7 a 9 días. CONCLUSIÓN: La técnica quirúrgica de McIndoe es una opción para restaurar la función sexual en mujeres con agenesia vaginal con resultados favorables. El tiempo para decidir su realización es electivo, sin embargo, se debe contar con madurez física y emocional para ser llevado a cabo. Las pacientes de nuestro reporte tenían una edad promedio de 18 años.

SUMMARY INTRODUCTION: The congenital absence of the vagina is an uncommon condition, some causes are the Mayer-Rokitansky-Küster-Hauser syndrome and peripheral insensitivity to androgens. Multiple surgical and non-surgical techniques have been described for the management of this condition, being the main objective the creation of a vaginal canal of adequate diameter and length to restore coital function. The objective of this study is to detail the experience of the neovagina procedure with the McIndoe surgical technique performed in patients with Mayer-Rokitansky-Küster-Hauser syndrome at the Clinica Universitaria Bolivariana. METHODOLOGY: Report of five cases of patients with vaginal agenesis secondary to the Mayer-Rokitansky-Kuster-Hauser syndrome, who underwent neovagina with the McIndoe technique and some modifications in the mold for the skin implant. RESULTS: Five patients with diagnosis of Mayer-Rokitansky-Kuster-Hauser were included, all had development of secondary sexual characteristics, normal hormonal profile, and a XX karyotype. The McIndoe surgical technique was used to perform the neovagina without associated intraoperative complications and with adequate postoperative evolution, with a vaginal length between 7-9 cm and three patients with active sexual life. The length of hospital stay was 7 to 9 days. CONCLUSION: The McIndoe surgical technique is an option to restore sexual function in women with vaginal agenesis with favorable results. The time to decide its realization is elective, however, they must have the physical and emotional maturity to be carried out. The patients in our report have an average age of 18 years.

High-density lipoproteins induce miR-223-3p biogenesis and export from myeloid cells: Role of scavenger receptor BI-mediated lipid transfer.

BACKGROUND AND AIMS: We recently showed that miR-223-3p on high-density lipoproteins (HDL) is exported to endothelial cells, where it inhibits inflammation. However, the origin of miR-223-3p on HDL is unknown. We hypothesize that HDL-associated miR-223-3p originates in myeloid cells and is exported to HDL in a scavenger receptor BI (SR-BI)-dependent manner. METHODS: Polymorphonuclear neutrophils (PMNs) and human monocyte derived macrophages (HMDMs) were incubated with native HDL (nHDL) or discoidal reconstituted HDL (rHDL). Total RNA was isolated before and after incubation. Mature and primary miR-223-3p (pri-mir-223-3p) levels were quantified by real-time PCR. RESULTS: Incubation with nHDL and rHDL increased miR-223-3p export from PMNs and HMDMs. In PMNs, nHDL but not rHDL, increased mature and pri-mir-223-3p. Incubation with HDL also increased Dicer mRNA, a critical regulator of miRNA biogenesis. Incubation of HMDMs with nHDL did not increase cellular levels of mature miR-223-3p, but significantly increased pri-mir-223 levels. Incubation with rHDL had no effect on either mature or pri-mir-223-3p levels. Activated PMNs increased miR-223-3p export to HDL and the production of reactive oxygen species and activated protein kinase C. Blocking HDL binding to SR-BI increased miR-223-3p export to HDL in both PMNs and HMDMs, but did not affect mature and primary miR-223-3p levels. Chemical inhibition of cholesterol flux by Block Lipid Transport (BLT)-1 inhibited HDL-induced pri-mir-223 expression in PMNs. CONCLUSIONS: HDL-associated miR-223-3p originates in PMNs and macrophages. HDL stimulates miR-223-3p biogenesis in PMNs in a process that is regulated by SR-BI-mediated lipid flux.

Validity of self-report of oral conditions in older people

Aim: To verify if self-report is a valid instrument to study the clinical oral condition in older people without cognitive deficit. Methods: A Cross-sectional study was conducted with 647 older people from the community, without cognitive deficit, living in Campinas, Brazil. A self-report questionnaire assessing the presence or absence of teeth (edentulism) and use of complete denture was applied, identifying the location of the denture, whether in the upper and/or lower arch. In the same session oral clinical exams were performed, considered the gold standard. The self-report validation was performed by calculating sensitivity, specificity, predictive values, odds ratios and Kappa agreement. Results: There were high percentages of sensitivity (95­99%), specificity (84­97%), positive (81­97%) and negative (95­98%) predictive values, obtaining an elevated level of confidence and quality intrinsic value of self-report. Agreement with the clinical examination was excellent for all variables (greater than 0.80). The likelihood ratios showed compelling evidence that with self-report an edentulous individual (+LR 32), non-edentulous (-LR 0.06) and absence of complete denture (-LR 0.01) could be correctly identified, with moderate evidence to identify the presence and location of complete denture use (+LR 6.5 to 6.9). Conclusion: Self-report is a valid instrument to study the clinical oral condition in the older people of the community

Condição de saúde bucal autopercebida, capacidade mastigatória e longevidade em idosos / Self-perceived oral health status, chewing ability and longevity in the elderly

Resumo O objetivo deste artigo é verificar a condição bucal e a capacidade mastigatória autopercebidas em idosos longevos (≥ 80 anos). Foram utilizados dados do estudo multicêntrico FIBRA. A amostra foi composta por 2.341 indivíduos com ausência de déficit cognitivo, com idade ≥ 65 anos, no período entre 2008 e 2009, quando os idosos foram submetidos à coleta de dados. Quanto ao desfecho, a idade foi dicotomizada em 65-79 e 80 anos ou mais. A associação entre longevidade e as variáveis sociodemográficas, comportamentais, de saúde geral e bucal e a capacidade mastigatória autopercebida foram avaliadas pela regressão de Poisson. Dados completos disponíveis para 2.126 idosos. A idade média foi 70,91 (DP = ±4,11) anos entre os idosos jovens e 82,70 (DP = ±2,61) entre os longevos. A amostra de idosos com idade ≥ 80 anos foi de 11,7%. Baixa escolaridade, estado civil solteiro e ausência de trabalho estiveram associados à longevidade, assim como autorrelato de não possuir dentes naturais e dificuldade ou dor ao mastigar alimentos duros. Os resultados sugerem a associação entre longevidade com características sociodemográficas e de saúde bucal.

Abstract The scope of this article is to assess the oral health conditions and self-perceived chewing ability among the elderly seniors (≥ 80 years). Data from the FIBRA multicentric study were used. The sample consisted of 2,341 individuals with no cognitive impairment, aged ≥ 65 years, between 2008 and 2009, where the elderly were subjected to data collection. Regarding the outcome, age was dichotomized into 65-79 and 80 and over. The association between longevity and the socio-demographic and behavioral variables, general and oral health and self-perceived chewing ability was assessed by Poisson regression. Complete data are now available for 2,126 seniors. The mean age was 70.91 (SD =± 4.11) years among the young elderly and 82.70 (SD =± 2.61) among the elderly seniors. The sample of individuals aged ≥ 80 years was 11.7%. Low education, single marital status and lack of work were associated with longevity, as well as self-reporting of having no natural teeth and difficulty or pain when chewing hard foods. The results suggest an association between longevity with sociodemographic characteristics and oral health.

Risk assessment of human exposure to Ra-226 in oil produced water from the Bakken Shale.

Unconventional oil production in North Dakota (ND) and other states in the United States uses large amounts of water for hydraulic fracturing to stimulate oil flow. Most of the water used returns to the surface as produced water (PW) containing different constituents. Some of these contents are total dissolved solids and radionuclides. The most predominant radionuclide in PW is radium-226 (Ra-226) of which level depends on several factors including the content of certain cations. A multivariate regression model was developed to predict Ra-226 in PW from the Bakken Shale based on the levels of barium, strontium, and calcium. The simulated Ra-226 activity concentration in PW was 535 pCi/L supporting extremely limited actual data based on three PW samples from the Bakken (527, 816, and 1210 pCi/L). The simulated activity concentration was further analyzed by studying its impact in the event of a PW spill reaching a surface water body that provides drinking water, irrigation water for crops, and recreational fishing. Using food transfer factors found in the literature, the final annual effective dose rate for an adult in ND was estimated. The global average annual effective dose rate via food and drinking water is 0.30 mSv, while the predicted dose rate in this study was 0.49 mSv indicating that there is potential risk to human health in ND due to Ra-226 in PW spills. This predicted dose rate is considered the best case scenario as it is based on the simulated Ra-226 activity concentration in PW of 535 pCi/L which is close to the low end actual activity concentration of 527 pCi/L.

Toxoplasma gondii alters NMDAR signaling and induces signs of Alzheimer's disease in wild-type, C57BL/6 mice.

BACKGROUND: Alzheimer's disease (AD) is a progressive neurodegenerative disease associated with cognitive decline and complete loss of basic functions. The ubiquitous apicomplexan parasite Toxoplasma gondii (T. gondii) infects up to one third of the world's population and is implicated in AD. METHODS: We infected C57BL/6 wild-type male and female mice with 10 T. gondii ME49 cysts and assessed whether infection led to behavioral and anatomical effects using immunohistochemistry, immunofluorescence, Western blotting, cell culture assays, as well as an array of mouse behavior tests. RESULTS: We show that T. gondii infection induced two major hallmarks of AD in the brains of C57BL/6 male and female mice: beta-amyloid (Aß) immunoreactivity and hyperphosphorylated Tau. Infected mice showed significant neuronal death, loss of N-methyl-D-aspartate receptor (NMDAR) expression, and loss of olfactory sensory neurons. T. gondii infection also caused anxiety-like behavior, altered recognition of social novelty, altered spatial memory, and reduced olfactory sensitivity. This last finding was exclusive to male mice, as infected females showed intact olfactory sensitivity. CONCLUSIONS: These results demonstrate that T. gondii can induce advanced signs of AD in wild-type mice and that it may induce AD in some individuals with underlying health problems.