Challenges to conducting research on oral health with older adults living in long-term care facilities.

BACKGROUND: The challenges to conducting oral health studies involving older people in long-term care facilities (LTCFs) must be debated. OBJECTIVE: This study aimed to investigate researchers' perceptions and experiences while conducting an epidemiological survey on oral health among older individuals residing in LTCFs. METHODS: A qualitative study was conducted involving six researchers who utilized field diaries to record their impressions during data collection through interviews (older individuals (or their proxies), caregivers, and LTCF coordinators) and oral examinations of the older people participants. Additionally, researchers responded to open-ended questions about their experiences. The collected material was subjected to content analysis by two researchers. RESULTS: The themes that emerged from the analysis were institutional context, aspects affecting the operationalization of the study, and data collection oriented by the clinical-functional profile of the older people. According to the researchers' perceptions, LTCF coordinators demonstrated concern for the study's benefits for older adults and the preservation of institutional routines during the research process. Caregivers emerged as vital sources of information, guiding researchers in navigating the challenges posed by the physical and mental complexities of the older people participants, necessitating empathy, sensitivity, and attentive listening from the researchers. The organization of materials and a streamlined data collection process proved essential for optimizing time efficiency and reducing stress for participants and researchers. CONCLUSION: The researchers recognized the important role played by LTCF coordinators and formal caregivers, underscoring the significance of empathetic methodologies and streamlined data collection processes in mitigating the challenges inherent to research conducted within LTCFs.

Estupro na primeira macrorregião do estado de Alagoas: resultados da pesquisa DVEAL, 2016-2018 / Rape in the first macro-region of the state of Alagoas: results from DVEAL survey, 2016-2018

Objetivos: apresentar resultados do eixo 2 do projeto Diagnóstico da Violência Fatal e Não Fatal no Estado de Alagoas (DVEAL). Neste artigo é comparado o padrão epidemiológico do estupro de crianças e adolescentes em relação aos adultos. Métodos: delineou-se uma investigação observacional e retrospectiva incluindo 380 registros de violência sexual no Instituto Médico Legal, entre 2016 e 2018. Por meio de regressão logística binária e múltipla calculou-se a chance de violência por faixa etária, associando os possíveis fatores relacionados. Resultados: metade das vítimas estupradas possuíam até 13 anos de idade, com média de 14 anos, e 9 em cada 10 casos eram de mulheres/meninas vitimadas. O padrão do estupro identificado foi de vítimas: em situação conjugal solteira; estudantes, abusadas por conhecidos; que realizaram exame pericial entre 1-7 dias; abusadas durante a madrugada; e em região genital. Cerca de 8 em cada 10 casos foram estupros confirmados pela perícia, o restante foi via relato oral. O modelo final identificou dois fatores mais associados à violência sexual em crianças/adolescentes. Conclusão: o padrão de vitimização sexual no estado impacta significativamente crianças e adolescentes e, principalmente, o gênero feminino

Aims: to present the results of axis 2 of the Diagnosis of Fatal and Non-Fatal Violence in the State of Alagoas (DVEAL) project. This article compares the epidemiological pattern of rape involving children/adolescents in relation to adults. Methods: an observational and retrospective investigation was designed, including 380 records of sexual violence at the Instituto Médico Legal, between 2016 and 2018. Through binary and multiple logistic regression, the chance of violence by age group was calculated, associating the possible related factors. Results: half of the raped victims were up to 13 years old, with an average of 14 years old, and 9 out of 10 cases were victimized women/girls. The pattern of rape identified was of victims: single marital status; students, abused by acquaintances; who underwent an expert examination between 1-7 days; abused during the dawn; and in the genital region. About 8 out of 10 cases were rapes confirmed by forensics, the rest were via oral report. The final model identified two factors most associated with sexual violence in children/adolescents. Conclusions: the pattern of sexual victimization in the state significantly impacts children and adolescents, especially the female gender

Knowledge of oral and oropharyngeal cancer by dental surgeons: an integrative review.

OBJECTIVES: to identify the evidence available in the literature on the knowledge of dentists regarding risk factors and early diagnosis of oral and oropharyngeal cancer. METHODS: it is an integrative review of the literature. Boolean descriptors and operators were searched in the PubMed and LILACS databases, using gray literature, in English, Spanish and Portuguese. RESULTS: of the 79 PubMed and 152 LILACS articles, 24 were selected. Of these, eight showed good knowledge of dentists, while most showed low or little knowledge of risk factors and early diagnosis in dentists. All studies, however, highlight the need for continuing education to improve and maintain knowledge about risk factors and early diagnosis. CONCLUSIONS: most dental surgeons have insufficient knowledge of oral/oropharyngeal cancer. Continued education is suggested, aiming at improving knowledge and early diagnosis.

Firearms, Violence-Related Injuries, and Victimization Profiles: An Approach Using Cluster Analysis.

The aim of this study was to characterize the profile of nonlethal victims of urban violence by firearms and to describe traumas suffered by victims, according to a medical-legal and forensic perspective. A cross-sectional and exploratory study was conducted at the Center of Forensic Medicine and Dentistry in northeastern Brazil. The sample consisted of 233 victims of urban violence by firearm who presented some type of trauma. Descriptive and multivariate statistics using cluster analysis (CA) were performed. The TwoStep Cluster method was chosen to characterize the profile of victims. The night shift (56.8%) and the period corresponding to Saturdays (20.0%) and Sundays (20.4%) concentrated the largest number of occurrences. Cases of trauma in more than one region of the body simultaneously prevailed (31.8%). Based on the CA results, the formation of two clusters with distinct victimization profiles was verified. Cluster 1 was mostly characterized by younger single victims who suffered violence by firearm in the urban area perpetrated by an unknown perpetrator, resulting in greater occurrence of isolated upper and lower limb traumas. In contrast, Cluster 2 consisted essentially of older, married, or stable-union victims who experienced firearm violence in the suburban area, perpetrated by a known aggressor, resulting in greater occurrence of multiple traumas, that is, affecting several regions of the body at the same time. These findings reveal different risk groups for urban violence by firearms and traumas, contributing to the planning of strategies with emphasis on health care, prevention, and promotion.

Knowledge of oral and oropharyngeal cancer by dental surgeons: an integrative review / Conocimiento de los quirúrgicos dentistas sobre cáncer de boca y orofaríngeo: una revisión integrativa / Conhecimento dos cirurgiões-dentistas sobre câncer de boca e orofaringe: uma revisão integrativa

ABSTRACT Objectives: to identify the evidence available in the literature on the knowledge of dentists regarding risk factors and early diagnosis of oral and oropharyngeal cancer. Methods: it is an integrative review of the literature. Boolean descriptors and operators were searched in the PubMed and LILACS databases, using gray literature, in English, Spanish and Portuguese. Results: of the 79 PubMed and 152 LILACS articles, 24 were selected. Of these, eight showed good knowledge of dentists, while most showed low or little knowledge of risk factors and early diagnosis in dentists. All studies, however, highlight the need for continuing education to improve and maintain knowledge about risk factors and early diagnosis. Conclusions: most dental surgeons have insufficient knowledge of oral/oropharyngeal cancer. Continued education is suggested, aiming at improving knowledge and early diagnosis.

RESUMEN Objetivos: identificar evidencias disponibles en la literatura sobre el conocimiento de los quirúrgicos dentistas cuanto a los factores de riesgo y diagnóstico precoz del cáncer de boca/ orofaríngeo. Métodos: revisión integrativa de la literatura. Se realizaron búsquedas mediante los descriptores y operadores booleanos en base de datos PubMed y LILACS, con uso de literatura gris, en los idiomas inglés, español y portugués. Resultados: de los 79 artículos del PubMed y 152 del LILACS, 24 seleccionados. De estos, ocho mostraron bueno conocimiento de los dentistas, mientras la mayoría mostró bajo o poco conocimiento sobre factores de riesgo y diagnóstico precoz en dentistas. Todos los estudios, aunque, destacan la necesidad de educación continuada para mejorar y mantener el conocimiento sobre factores de riesgo y diagnóstico precoz. Conclusiones: gran parte de los quirúrgicos dentistas presenta un conocimiento insuficiente sobre cáncer de boca/orofaríngeo. Sugerida educación continuada, objetivando mejorar el conocimiento y el diagnóstico precoz.

RESUMO Objetivos: identificar as evidências disponíveis na literatura sobre o conhecimento dos cirurgiõesdentistas quanto aos fatores de risco e diagnóstico precoce do câncer de boca e orofaringe. Métodos: trata-se de uma revisão integrativa da literatura. Foram realizadas buscas mediante os descritores e operadores booleanos na base de dados PubMed e LILACS, com uso de literatura cinza, nos idiomas inglês, espanhol e portugês. Resultados: dos 79 artigos do PubMed e 152 do LILACS, 24 foram selecionados. Destes, oito mostraram bom conhecimento dos dentistas, enquanto a maioria mostrou baixo ou pouco conhecimento sobre fatores de risco e diagnóstico precoce em dentistas. Todos os estudos, no entanto, destacam a necessidade de educação continuada para melhorar e manter o conhecimento sobre fatores de risco e diagnóstico precoce. Conclusões: grande parte dos cirurgiões-dentistas apresenta um conhecimento insuficiente sobre câncer de boca/orofaringe. É sugerida a educação continuada, visando melhorar o conhecimento e o diagnóstico precoce.

Legalidade e ética entre obstetras do serviço de aborto legal em Alagoas no atendimento às vítimas de estupro / Legality and ethics among obstetricians of the legal abortion service in Alagoas during the care for rape victims

Objetivo: Determinar o perfil ético profissional dos obstetras do serviço de aborto legal no estado de Alagoas (Brasil) e delinear um protocolo e fluxograma para auxiliar no atendimento de mulheres estupradas. Métodos: Realizamos um estudo observacional-transversal, prospectivo e descritivo, incluindo todos os 26 obstetras do serviço de aborto legal. Na fase 1, investigaram-se o conhecimento legal e a posição ética, enquanto na fase 2 foram construídos um protocolo e um fluxograma para guiar o serviço nos casos de aborto legal. Resultados: Na fase 1, identificamos que a maioria dos obstetras não conhecia os aspectos legais sobre o aborto, não se sentiam confortáveis em estar no serviço e apontaram várias limitações no funcionamento dele. Na fase 2, foram desenvolvidos um protocolo e um fluxograma aplicados aos casos em que uma mulher estuprada deseja abortar por métodos legais. Conclusão: O perfil dos obstetras do serviço de aborto legal é insuficiente para lidar com a complexidade do aborto no estado. O protocolo e o fluxograma delineados tiveram o propósito de ajudar o serviço de aborto legal do estado a lidar com esse problema público/social.(AU)

Objective: To determine the professional ethical profile of obstetricians from the legal abortion service in Alagoas state (Brazil) and to design a protocol and flowchart to help the attendance of raped woman. Methods: We performed an observational- -sectional, prospective and descriptive study including all 26 obstetricians from the legal abortion service. Phase 1 investigated the legal knowledge and ethical position, while phase 2 was the construction of a protocol and flowchart to guide the service in cases of legal abortion. Results: In the phase 1 we identified that most obstetrician did not know the legal aspects about abortion; did not few comfortable to be in the service and they pointed out several limitations of how service works. Phase 2 of the study was the development of a protocol and flowchart applied to the cases which a raped woman wants to abort by legal methods. Conclusion: The profile of obstetrician from the legal abortion service is insufficient to deal with the complexity of abort in the state. The protocol designed have the purpose to help the state legal abortion service to deal with this public/social problem.(AU)

Towards a Situated Spatial Epidemiology of Violence: A Placially-Informed Geospatial Analysis of Homicide in Alagoas, Brazil.

This paper presents an empirically grounded call for a more nuanced engagement and situatedness with placial characteristics within a spatial epidemiology frame. By using qualitative data collected through interviews and observation to parameterise standard and spatial regression models, and through a critical interpretation of their results, we present initial inroads for a situated spatial epidemiology and an analytical framework for health/medical geographers to iteratively engage with data, modelling, and the context of both the subject and process of analysis. In this study, we explore the socioeconomic factors that influence homicide rates in the Brazilian state of Alagoas from a critical public health perspective. Informed by field observation and interviews with 24 youths in low-income neighbourhoods and prisons in Alagoas, we derive and critically reflect on three regression models to predict municipal homicide rates from 2016-2020. The model results indicate significant effects for the male population, persons without elementary school completion, households with reported income, divorced persons, households without piped water, and persons working outside their home municipality. These results are situated in the broader socioeconomic context, trajectories, and cycles of inequality in the study area and underscore the need for integrative and contextually engaged mixed method study design in spatial epidemiology.

Percepção sobre uso de substâncias psicoativas em estudantes universitários: uma revisão integrativa / Perception of psychoactive substance use in university students: an integrative review

A pesquisa buscou integrar o conhecimento relativo à percepção dos estudantes universitários em relação aos riscos no uso e abuso de substâncias psicoativas. Objetivou-se verificar se a percepção em relação ao risco poderia ser um fator que contribui para o uso, bem como a proximidade com os colegas e o pertencimento a grupos que façam uso dessas substâncias. Foram seguidos os passos de uma revisão integrativa. 27 estudos foram incluídos por estarem de acordo com os critérios estabelecidos. Os achados sugerem que há uma associação significativa entre a maneira como o estudante universitário percebe os riscos e o seu padrão de consumo de drogas, bem como a relação que ele estabelece com os pares e demais colegas. Outro aspecto relevante foi a evidência sobre o uso de substâncias que só podem ser adquiridas com prescrição médica e que são utilizadas de forma indiscriminada para o aumento do desempenho acadêmico.

The research aimed to integrate the knowledge related to the perception of university students regarding the risks in the use and abuse of psychoactive substances. The objective was to verify if the perception in relation to risk could be a factor that contributes to the use, as well as the proximity with colleagues and belonging to groups that make use of these substances. The steps of an integrative review were followed. 27 studies were included because they were in accordance with the established criteria. The findings suggest that there is a significant association between the way the university student perceives risks and his pattern of drug use, as well as the relationship he establishes with peers and other colleagues. Another relevant aspect was the evidence on the use of substances that can only be acquired with a medical prescription and that are used indiscriminately to increase academic performance.

Trends of maxillofacial injuries resulting from physical violence in Brazil.

BACKGROUND/AIM: A large proportion of interpersonal violence results in maxillofacial injuries. The monitoring of maxillofacial injuries in the context of gender violence has been little explored. The aim of this study was to analyze trends in cases of maxillofacial injuries resulting from interpersonal physical violence considering the gender of the victim and perpetrator. MATERIALS AND METHODS: A time-series study was conducted. Data regarding maxillofacial injury cases due to interpersonal physical violence were collected from reports at a forensic institute of a city in northeastern Brazil, between 2008 and 2014 (84 months). Rates of interpersonal physical violence per 100 000 inhabitants were determined for each gender. A negative binomial regression model was used to evaluate trends. The cycle plot was used to investigate the occurrence of seasonality, considering subseries for each month. RESULTS: A total of 3561 reports were analyzed, revealing higher rates of female victims and male perpetrators throughout the series. There was no indication of seasonality. The annual percentage of injuries involving male victims reduced significantly by 6.8% (P < .001), while injuries involving female victims increased significantly by 4.5% (P = .002). Regarding perpetrators, rates remained constant over time, following the same pattern for both genders. CONCLUSIONS: The data demonstrate greater victimization involving maxillofacial injuries against women perpetrated more often by men, with a trend toward an increase in female victims and a reduction in male victims.

Smoking-Alcohol-Sex Exposure and Knowledge About Oral and Oropharyngeal Cancer Among Brazilian Adolescents: An Exploratory-Observational Approach

Abstract Objective: To investigate the involvement of young Brazilian students about five behaviors: tobacco use, alcohol consumption, sexual intercourse, knowledge about HPV, and knowledge about oral and oropharyngeal cancer. Material and Methods: Through a cross-section design, we explored some factors that might be associated with boys and girls. Statistical Regression methods were applied to identify differences, considering the estimation of the Odds Ratio. Results: Half of the sample had already consumed alcohol and at least 1 in 10 individuals had already tried smoking. One-third of adolescents have had sexual intercourse. Three factors related to boys were associated in the multiple regression analysis: have heard about HPV, have not heard about oral cancer, and think that HPV can cause oropharyngeal cancer. In conclusion, it seems that boys and girls were equally exposed to smoking-alcohol-sex; however, some differences were verified concerning the knowledge about HPV and oral / oropharyngeal cancer. Conclusion: Keep monitoring adolescents should be a priority to our study area, considering that those youngers had already being exposed to the risk factors for cancer.

Prolonged APTT of unknown etiology: A systematic evaluation of causes and laboratory resource use in an outpatient hemostasis academic unit.

BACKGROUND: A prolonged activated partial thromboplastin time (APTT) of unknown cause is one of the most frequent reasons why outpatients are referred for hemostasis consultation. Nevertheless, very few data are available on the relative contribution of individual causes of this common clinical scenario. Here, we present a systematic evaluation of all causes of APTT prolongation in a consecutive population of outpatients referred for specialized hemostasis consultation during a 14-year period. METHODS: All cases referred to an academic specialized hemostasis outpatient unit due to APTT prolongation of unknown etiology whose prolonged APTT was confirmed in the first visit were included in the study. Data were obtained from the electronic medical records. RESULTS: Among 187 consecutive patients, the most frequent causes were antiphospholipid antibodies in 22.6%, contact pathway factor deficiencies in 17.4%, other coagulation factor deficiencies in 11.6%, and vitamin K deficiency/liver disease in 11.6%. A definite cause was not identified in 22.1% of patients. Presence of antiphospholipid antibodies, and absence of bleeding symptoms were both associated with significantly longer APTT values compared to other categories/clinical scenarios. The investigation of each case required a mean of 18.2 additional tests per patient, with estimated costs ranging from US$191.60 to US$1055.60. CONCLUSIONS: Our results describe the main causes of APTT prolongation in outpatients, as well as estimates of resource use required to investigate this condition, thus providing evidence supporting the importance of measures to minimize the indiscriminate use of this assay.

Exploring the effect of time and sex in family and community violence from 2008 to 2014.

OBJECTIVE: To evaluate the effect of the time and the sex of victims and perpetrators on the rates of family and community physical violence in a Brazilian municipality over seven years (2008-2014). METHODS: We made a census analysis from non-fatal victims attended in the Forensic Institute of the Scientific Civil Police. The monthly and annual violence rates were calculated based on the population size of the municipality. Time series was evaluated by negative binomial regression models, based on the number of cases with population offset and considering the effect of the sex of victims and perpetrators. RESULTS: A total of 3,324 cases of family and 4,634 cases of community violence were analyzed. There was a significant increase in family violence rates for female victims and male perpetrators. Family violence rates were always higher for female victims than for male and it was always lower for female perpetrators than for male (p < 0.001). There was a lower risk of community violence for male victims after 2013 and a decrease of aggression perpetrated by men over time. Men and women were similarly affected by community violence; however, the perpetrators were more frequently men. CONCLUSIONS: The results indicate a trend of increasing female victims in the family violence, mainly perpetrated by men. The reduction in community violence rates could be the result of policies to reduce crime.

Epidemiological and spatial characteristics of interpersonal physical violence in a Brazilian city: A comparative study of violent injury hotspots in familial versus non-familial settings, 2012-2014.

This study explores both epidemiological and spatial characteristics of domestic and community interpersonal violence. We evaluated three years of violent trauma data in the medium-sized city of Campina Grande in North-Eastern Brazil. 3559 medical and police records were analysed and 2563 cases were included to identify socioeconomic and geographic patterns. The associations between sociodemographic, temporal, and incident characteristics and domestic violence were evaluated using logistic regression. Using Geographical Information Systems (GIS), we mapped victims' household addresses to identify spatial patterns. We observed a higher incidence of domestic violence among female, divorced, or co-habitant persons when the violent event was perpetrated by males. There was only a minor chance of occurrence of domestic violence involving firearms. 8 out of 10 victims of domestic violence were women and the female/male ratio was 3.3 times greater than that of community violence (violence not occurring in the home). Unmarried couples were twice as likely to have a victim in the family unit (OR = 2.03), compared to married couples. Seven geographical hotspots were identified. The greatest density of hotspots was found in the East side of the study area and was spatially coincident with the lowest average family income. Aggressor sex, marital status, and mechanism of injury were most associated with domestic violence, and low-income neighbourhoods were coincident with both domestic and non-domestic violence hotspots. These results provide further evidence that economic poverty may play a significant role in interpersonal, and particularly domestic violence.

Exploring the effect of time and sex in family and community violence from 2008 to 2014

ABSTRACT OBJECTIVE To evaluate the effect of the time and the sex of victims and perpetrators on the rates of family and community physical violence in a Brazilian municipality over seven years (2008-2014). METHODS We made a census analysis from non-fatal victims attended in the Forensic Institute of the Scientific Civil Police. The monthly and annual violence rates were calculated based on the population size of the municipality. Time series was evaluated by negative binomial regression models, based on the number of cases with population offset and considering the effect of the sex of victims and perpetrators. RESULTS A total of 3,324 cases of family and 4,634 cases of community violence were analyzed. There was a significant increase in family violence rates for female victims and male perpetrators. Family violence rates were always higher for female victims than for male and it was always lower for female perpetrators than for male (p < 0.001). There was a lower risk of community violence for male victims after 2013 and a decrease of aggression perpetrated by men over time. Men and women were similarly affected by community violence; however, the perpetrators were more frequently men. CONCLUSIONS The results indicate a trend of increasing female victims in the family violence, mainly perpetrated by men. The reduction in community violence rates could be the result of policies to reduce crime.

Patterns of Oral-Maxillofacial Trauma and Determinant Factors among Brazilian Victims of Physical Aggression: A 4-Year Study.

PURPOSE: To determine the prevalence of oral-maxillofacial trauma among Brazilian victims of physical aggression and identify its associated factors from a medico-legal and forensic perspective. MATERIALS AND METHODS: A cross-sectional study was carried out involving the analysis of complete medico-legal and social reports of 3668 victims of physical aggression treated at a centre of legal medicine and forensic dentistry over the course of four years. The dependent variable was the occurrence of oral-maxillofacial trauma. The independent variables were sociodemographic status and characteristics of physical aggression. Statistical analyses included the chi-squared test (p < 0.05) as well as univariate and multivariate logistic regression analyses. RESULTS: Oral-maxillofacial trauma occurred in 1655 cases (45.1%). Individuals who lived in suburban areas (OR = 1.32; 95%CI = 1.11-1.58) and those who were victims of community violence (OR = 1.20; 95%CI = 1.03-1.40) perpetrated by someone known to them (OR = 1.24; 95%CI = 1.03-1.40) using physical force (OR = 2.31; 95%CI = 1.96-2.72) on weekends (OR = 1.19; 95%CI = 1.04-1.37) and during nighttime hours (OR = 1.23; 95%CI = 1.08-1.41) were more likely to exhibit oral-maxillofacial trauma. CONCLUSION: The prevalence of oral-maxillofacial trauma was high and the associated factors were area of residence, type of violence, type of offender, mechanism of violence, day, and period of occurrence.

Violência física interpessoal: uma análise de série temporal e espacial dos casos de agressão familiar e comunitária par a região metropolitana de Campina Grande, Paraíba / Interpersonal physical violence: a temporal and spatial series analysis of cases of family and community aggression in the metropolitan region of Campina Grande, Paraíba

A presente tese analisou do ponto de vista temporal, espacial e epidemiológica as vítimas de violência física interpessoal. Dados foram obtidos por consulta aos laudos médico-odontológicos do Núcleo de Medicina e Odontologia Legal‒NUMOL de Campina Grande. Foi realizado o censo para os casos de violência física entre os anos de 2008‒2014. A análise temporal descreveu as taxas por 100,000 habitantes e utilizou o correlograma (associação da série). Inspeções visuais das séries se baseou na construção gráfica por meio do método lowess (locally weigthed scatterplot smoothing) a partir da função tri-cúbica. A análise inferencial da série foi feita por meio da regressão binomial negativa. Utilizou-se o medidor Incidence Rate Ratio (IRR) para cálculo do efeito do tempo; do sexo das vítimas e dos agressores bem como da interação dummy (corte temporal na série). A análise epidemiológica usou o modelo de regressão logística binária e múltipla para verificar associações entre as variáveis (tendo como referência de comparação a violência familiar). O estudo da distribuição espacial baseou-se na Estimativa de Densidade de Kernel (EDK). Ainda foi utilizado dados do Censo Brasil IBGE‒2010 para caracterizar a localidade do setor censitário ao qual cada vítima residia. Entre 2008‒2014 ocorreram 3.321 casos de violência familiar e 4.634 de comunitária. A taxa média anual de violência familiar foi de 6,8/100.000 em 2008, aumentando para 12,6/100,000 em 2014 (aumento da taxa de 11,3% ao ano, p<0,001). A violência comunitária registrou redução de 18,8/100.000 em 2008 para 9,6/100.000 em 2014 (queda de 11% ao ano, p<0,001). Houve um aumento significativo dos casos de violência familiar ao longo do tempo envolvendo vítimas do sexo feminino (p<0,001) e agressores do sexo masculino (p<0,001). Para violência comunitária, as taxas apresentaram redução significativa independentemente do sexo da vítima (p<0,001), e redução significativa nos casos de violência praticada por agressores do sexo masculino p=0,017). Ao analisar a interação dummy na série (2012 como ponto de corte), percebeu-se que após 2012 o aumento de vítimas de violência familiar do sexo feminino foi ainda superior ao período anterior (p=0,007) e uma queda significativa dos casos de violência comunitária entre agressores homens (p<0,001) após 2012. A distribuição epidemiológica mostrou associação para: vítima mulheres; estado civil solteiro; estado civil divorciado; uso de arma de fogo; uso de objetos mistos e agressores homens. A análise espacial evidenciou sete hotspots para violência, com maior densidade de vítimas residentes na Zona Leste da cidade. Os hotspots para violência física estiveram concentrados para vítimas residentes em áreas coincidentes com menor renda familiar por setor censitário. A presente tese sugere um fato preocupante para a situação de violência familiar contra a mulher, devido a um aumento temporal significativo dos casos. Em contrapartida, apontou-se para um declínio de violência comunitária e uma queda para agressores do sexo masculino, sendo este um fator positivo. A análise espacial tornou evidente que algumas áreas da zona urbana em estudo possuem considerável concentração de vítimas residentes, bem como residindo em setores censitários com baixo nível econômico (renda).(AU)

The present thesis analyzed from a temporal, spatial and epidemiological perspective the victims of interpersonal physical violence. Data were obtained consulting the medical-dental reports of the Nucleus of Medicine and Dentistry Legal‒NUMOL of Campina Grande. The census was conducted for cases of physical violence between 2008‒2014. The temporal analysis described the rates per 100,000 population and used the correlogram (series association). Visual inspection of the series was based on the graphical elaboration through lowess method (locally weighted scatterplot smoothing) from the tri-cubic function. The inferential analyze was carried out through negative binomial regression. We used the meter Incidence Rate Ratio (IRR) to calculate the time effect; the sex of the victims and perpetrators effect, as well as the dummy interaction (cut time in the series). The epidemiological analysis used the binary and multiple logistic regression to verify significant associations among the variables (as reference comparison the familial violence). The spatial distribution was based on Kernel Density Estimation (KDE). Data from the Brazil IBGE-2010 Census was also used to characterize the location of the census tract which each victim resided. Between 2008‒2014 occurred 3.321 cases familial violence and 4.634 cases of community violence. The annual rate of familial violence was 6.8/100,000 in 2008, increasing to 12.6 /100,000 in 2014 (an increase of 11.3% per year, p<0,001). The community violence registered a decrease of 18.8 /100,000 in 2008 to 9.6/100,000 in 2014 (decline of 11% per year, p<0,001). There was a significant increase in the familial violence cases over time involving female victims (p<0,001) and male perpetrators (p<0,001). In the community violence, the rates significant declined regardless the victim's sex (p<0,001), and significant reduction for violence perpetrated by men (p=0,017). The analysis for dummy interaction (2012 as cut time), we observed that after 2012 the growth of female victims was even higher than the previous time in the familial violence (p=0,007) and a significant decrease of men perpetrators in the community violence (p<0,001) after 2012. The epidemiologic distribution showed the following association: woman victims; single; divorced; firearm use; mixed object use and men perpetrator. The spatial analysis evidenced seven hotspots for violence, with most victims resident on the East side of the city. Hotspots for physical violence were concentrated for victims living in areas coinciding with lower familial income by census tract. The data of the present thesis suggests an alarming fact for the situation of domestic violence against woman, due to a significant temporal increase of the cases. In addition, man has been predominantly responsible for the aggression in this type of violence. On the other hand, there was a decline in community violence and a drop for male aggressors, a positive factor. The spatial analysis made it clear that some areas of the urban zone under study have a considerable concentration of resident victims, as well as residing in the census tracts with low economic level (income).(AU)

Interpersonal violence, circumstances of aggressions and patterns of maxillofacial injuries in the metropolitan area of Campina Grande, State of Paraíba, Brazil (2008-2011). / Violência interpessoal, circunstâncias das agressões e padrões dos traumas maxilofaciais na região metropolitana de Campina Grande, Paraíba, Brasil (2008-2011).

The aim of this study was to determine the circumstances of aggressions and patterns of maxillofacial injuries among victims of interpersonal violence. This was a cross-sectional and exploratory study conducted from the analysis of 7,132 medical-legal and social records of interpersonal violence victims seen in a Forensic Medicine and Dentistry Center. Descriptive and multivariate statistics were performed using Multiple Correspondence Analysis. Three groups with different victimization profiles were identified. The first group was mainly composed of men of different age groups, victims of community violence that resulted in facial bones or dentoalveolar fracture. The second group was mainly composed of adolescents (10-19 years) of both sexes, victims of interpersonal violence and without specific pattern of injuries. The third group was composed of adult women (≥ 20 years) victims of domestic violence that resulted in injuries of soft tissues of face or other body regions. The results suggest that sociodemographic and circumstantial characteristics are important factors in victimization by maxillofacial injuries and interpersonal violence.

Violência interpessoal, circunstâncias das agressões e padrões dos traumas maxilofaciais na região metropolitana de Campina Grande, Paraíba, Brasil (2008-2011) / Interpersonal violence, circumstances of aggressions and patterns of maxillofacial injuries in the metropolitan area of Campina Grande, State of Paraíba, Brazil (2008-2011)

RESUMO O objetivo deste estudo foi determinar as circunstâncias das agressões e os padrões dos traumas maxilofaciais entre vítimas de violência interpessoal. Tratou-se de um estudo transversal e exploratório feito a partir da análise de 7.132 registros médico-legais e sociais de vítimas de violência interpessoal atendidas em um Centro de Medicina Legal e Odontologia Forense. Foi feita estatística descritiva e multivariada, usando Análise de Correspondência Múltipla. Três grupos com perfis distintos de vitimização foram identificados. O primeiro grupo foi formado majoritariamente por homens, de diferentes faixas etárias, vítimas de violência comunitária, resultando em fratura de ossos faciais ou fratura dentoalveolar. O segundo grupo foi composto essencialmente por adolescentes (10-19 anos), de ambos os sexos, vítimas de violência interpessoal e que não apresentaram um padrão específico de trauma. O terceiro grupo reuniu mulheres, adultas (≥ 20 anos), vítimas de violência doméstica, resultando em lesão de tecidos moles da face ou em outras regiões do corpo. Os resultados sugerem que as características sociodemográficas e circunstanciais são fatores importantes na vitimização por traumatismo maxilofacial e violência interpessoal.

Abstract The aim of this study was to determine the circumstances of aggressions and patterns of maxillofacial injuries among victims of interpersonal violence. This was a cross-sectional and exploratory study conducted from the analysis of 7,132 medical-legal and social records of interpersonal violence victims seen in a Forensic Medicine and Dentistry Center. Descriptive and multivariate statistics were performed using Multiple Correspondence Analysis. Three groups with different victimization profiles were identified. The first group was mainly composed of men of different age groups, victims of community violence that resulted in facial bones or dentoalveolar fracture. The second group was mainly composed of adolescents (10-19 years) of both sexes, victims of interpersonal violence and without specific pattern of injuries. The third group was composed of adult women (≥ 20 years) victims of domestic violence that resulted in injuries of soft tissues of face or other body regions. The results suggest that sociodemographic and circumstantial characteristics are important factors in victimization by maxillofacial injuries and interpersonal violence.

Systematic review and meta-analysis to determine the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents.

PURPOSE: This study aimed to determine via systematic review and meta-analysis the proportion of maxillofacial trauma resulting from different etiologies among children and adolescents. METHODS: A systematic review of articles published from 2006 to 2015 (10 years) in English language was performed. The following databases were used: PubMed/MEDLINE, Scopus, and Web of Science. Observational studies reporting the number of children and/or adolescents who suffered maxillofacial trauma resulting from different etiologies were included. Studies were selected by two independent reviewers (Kappa = 0.737). A proportion meta-analysis using random-effect models was performed to estimate the pooled prevalence and the 95% confidence intervals (CI) using Der-Simonian and Laird weights. Heterogeneity among studies was assessed using the I 2 statistics. RESULTS: A total of 27 studies remained after qualitative analysis including 402,339 patients. The male/female ratio ranged from 1.5:1 to 3.5:1. Road traffic accidents corresponded to the main etiology agent of maxillofacial trauma (34%; 95% CI, 25-44), followed by falls (31%; 95% CI, 25-37), violence (11%; 95% CI, 4-19), sports (4%; 95% CI, 3-5), and others (5%; 95% CI, 2-8). Heterogeneity among studies was high, even stratifying by world region. The adapted version of the Newcastle-Ottawa scale for observational studies showed an intermediate score for most of the included studies. CONCLUSIONS: Results suggest that road traffic accidents represent the main cause of maxillofacial trauma among children and adolescents. However, results should be interpreted with caution due to the high heterogeneity.

Pattern of oral-maxillofacial trauma from violence against women and its associated factors.

BACKGROUND/AIM: Violence against women is a global public health problem. The aim of this study was to characterize the profile of women victims of violence and identify factors associated with maxillofacial injuries. MATERIAL AND METHODS: A cross-sectional study was performed based on an evaluation of 884 medico-legal and social records of women victims of physical aggression treated at the Center of Forensic Medicine and Dentistry in Brazil. The variables investigated were related to the sociodemographic characteristics of victims, circumstances of aggressions, and patterns of trauma. Descriptive and multivariate statistics using decision tree analysis by the Chi-squared automatic interaction detector (CHAID) algorithm, as well as univariate and multivariate Poisson regression analyses were performed. RESULTS: The occurrence of maxillofacial trauma was 46.4%. The mean age of victims was 29.38 (SD=12.55 years). Based on decision tree, the profile of violence against women can be explained by the aggressor's gender (P<.001) and sociodemographic characteristics of victims, such as marital status (P=.001), place of residence (P=.019), and educational level (P=.014). Based on the final Poisson regression model, women living in suburban areas were more likely to suffer maxillofacial trauma (PR=1.752; CI 95%=1.153-2.662; P=.009) compared to those living in rural areas. Moreover, aggression using a weapon resulted in a lower occurrence of maxillofacial trauma (PR=0.476; CI 95%=0.284-0.799; P=.005) compared to cases of aggression using physical force. CONCLUSIONS: The prevalence of oral-maxillofacial trauma was high, and the main associated factors were place of residence and mechanism of aggression.