Patient perception of orthodontists with different stereotypes: development, psychometric properties, and application of an assessment instrument.

INTRODUCTION: This research aimed to develop and validate a questionnaire that considers social judgments and, through its application, assesses whether the presence of piercings, tattoos, beards, and loose hair visible in the face and neck region reflect on the patient perception regarding characteristics of the orthodontist's professional scope. METHODS: The developed questionnaire had its psychometric properties evaluated and was applied to 220 young people and adults, aged 18-70 years, who responded according to their perception of 12 manipulated images of orthodontists with different stereotypes, considering the following items: hygiene, care, punctuality, experience and knowledge in orthodontics. RESULTS: The developed questionnaire showed high acceptability, confirmed reliability and validity of the construct, and satisfactory internal consistency. The stereotype interfered with the perception of professionalism (P <0.01), in which the orthodontist with combined characteristics (beard/loose hair, piercing, earrings, and tattoo) obtained the lowest mean scores, both for each item of the questionnaire individually (P <0.01) and in total (P <0.01). Health professional (P = 0.427) and educational level (P = 0.285) status did not influence the perception; however, there was a significant difference for the age groups (P = 0.041). CONCLUSIONS: The developed questionnaire proved to be valid and reliable for application. Orthodontists with piercings and tattoos on the face and neck were considered less professional. Being a health professional and educational level status did not influence the perception. However, older subjects (aged 51-70 years) were more critical in judging stereotypes than younger subjects (aged 18-30 years).

Maternal-child exposure to metals during pregnancy in Rio de Janeiro city, Brazil: The Rio Birth Cohort Study of Environmental Exposure and Childhood Development (PIPA project).

BACKGROUND: Environmental metal exposure during pregnancy can affect intrauterine growth and disrupt child development. Metal exposure in urban areas can occur through the air, water and food routes. The city of Rio de Janeiro is the second more populous of Brazil and the sixth most populous in the American continent and is characterized by a significant social-economic inequality and a large range of urban organization problems. OBJECTIVES: To evaluate environmental heavy metal (arsenic, cadmium, lead and mercury) exposure in mother-newborns pairs in an urban area in Rio de Janeiro, Brazil. METHODS: All pregnant women, over 16 years of age, who came to the University Maternity School for newborn delivery orientation, between October and November 2017, were invited to participate in the project. Socioeconomic, cultural, leisure, and living conditions data of from the parents were collected via questionnaire; whole maternal blood and umbilical cord blood samples were also collected. RESULTS: Of the 209 eligible pregnant women 142 (68%) accepted the invitation to participate in the study. A total of 131 (92.3%) mothers delivered live born children, and maternal blood and umbilical cord blood were collected from 117 mother-newborn pairs. Metal concentrations above the detection limit were detected in all maternal and cord blood samples. Strong correlations of arsenic, cadmium, lead and mercury concentrations between maternal and umbilical cord blood were observed. Median lead and arsenic concentrations in maternal and umbilical cord blood were higher than values reported in other studies conducted in Brazil and worldwide. Lead concentrations in 25% of the umbilical cord blood samples were near of 5 µg/dL (P75 = 4.92 µg/dL). CONCLUSION: The results reported herein indicate the need for the establishment of health surveillance programs in Brazil, in order to investigate and monitor the health effects of environmental heavy metal exposure in children since the gestation period.

Quantitative assessment of S. mutans and C. albicans in patients with Haas and Hyrax expanders

OBJECTIVE: To assess and compare the number of Streptococcus mutans and Candida albicans colonies in patients with Haas and Hyrax appliances before and after insertion. METHODS: The sample consisted of 84 patients requiring orthodontic treatment. For all patients a midpalatal suture expansion was indicated. Patients were randomly divided into Group HA, who used the Haas appliance (n = 42) and Group HY, who used the Hyrax appliance (n = 42). Initially and thirty days after appliance insertion all patients were submitted to saliva collections. The saliva was diluted followed by seeding in Mitis Salivarius and CHROMagar media, for growth of S. mutans and C. albicans respectively. RESULTS: Results showed statistically significant difference between groups HA and HY for Streptococcus mutans and Candida albicans (p <0.05). Haas appliance promoted greater S. mutans and C. albicans proliferation when compared to Hyrax appliance. CONCLUSION: The Haas appliance favored greater proliferation of S. mutans and C. albicans when compared with the Hyrax appliance. Insertion of the appliances resulted in greater buildup of microorganisms.

Dor torácica na sala de emergência: a importância de uma abordagem sistematizada / Chest pain in the emergency room: importance of a systematic approach

OBJECTIVE: To evaluate the efficiency of a systematic diagnostic approach in patients with chest pain in the emergency room in relation to the diagnosis of acute coronary syndrome (ACS) and the rate of hospitalization in high-cost units. METHODS: One thousand and three consecutive patients with chest pain were screened according to a pre-established process of diagnostic investigation based on the pre-test probability of ACS determinate by chest pain type and ECG changes. RESULTS: Of the 1003 patients, 224 were immediately discharged home because of no suspicion of ACS (route 5) and 119 were immediately transferred to the coronary care united because of ST elevation or left bundle-branch block (LBBB) (route 1) (74 per cent of these had a final diagnosis of acute myocardial infarction [AMI]). Of the 660 patients that remained in the emergency room under observation, 77 (12 per cent) had AMI without ST segment elevation and 202 (31 per cent) had unstable angina (UA). In route 2 (high probability of ACS) 17 per cent of patients had AMI and 43 per cent had UA, whereas in route 3 (low probability) 2 per cent had AMI and 7 per cent had UA. The admission ECG has been confirmed as a poor sensitivity test for the diagnosis of AMI ( 49 per cent), with a positive predictive value considered only satisfactory (79 per cent). CONCLUSION : A systematic diagnostic strategy, as used in this study, is essential in managing patients with chest pain in the emergency room in order to obtain high diagnostic accuracy, lower cost, and optimization of the use of coronary care unit beds.