Antimicrobial photodynamic therapy in the treatment of oral erythematous candidiasis: a controlled and randomized clinical trial.

OBJECTIVE: To analyze the clinical and microbiological efficacy of antimicrobial photodynamic therapy (aPDT) in patients with erythematous candidiasis (EC). METHODS: This study was a controlled and randomized clinical trial in patients diagnosed with EC, who were allocated into a control group (CG) and experimental group (EG) treated with nystatin oral suspension and aPDT with methylene blue 0.1%, respectively. A clinical index was used to classify the EC lesions from mild to severe and assess the treatment efficacy. Microbiological samples were collected before and after aPDT session and analyzed by counting colony-forming units (CFUs) of Candida and Staphylococcus sp. RESULTS: A total of 41 patients (CG (n = 18); EG (n = 23)) were analyzed in our research. Of these, 16 (94.1%) of the CG and 16 (84.2%) of the EG exhibited complete remission of the lesions. Regarding the degree of the lesion, it was observed that the severe lesions were more difficult to present remission, while all the mild and moderate lesions showed complete regression (p = 0.001). The microbiological analysis showed that Candida albicans and Staphylococcus sp. were the most prevalent microorganisms, and the aPDT group showed a decrease in CFUs of these microorganisms after the first aPDT session (p < 0.05). CONCLUSIONS: aPDT proved to be a clinically and microbiologically effective therapy for treating EC. TRIAL REGISTRATION: Registered at ClinicalTrials.gov; Set 12th, 2019; No. RBR-8w8599. CLINICAL RELEVANCE: aPDT is a promising alternative treatment since it presents satisfactory results and does not cause damage to oral tissues or develop resistance to the treatment.

Development and validation of predictive workable weight equations for Brazilian older adult residents in long-term care institutions.

BACKGROUND: Weight measurement is important in the nutritional anthropometric monitoring of older adults. When this measurement is not possible, estimates may be used. AIM: Developing and validating weight predictive equations for older adult residents in long-term care institutions in Brazil. SUBJECTS AND METHODS: The sample comprised 393 older adult residents in long-term care institutions. Data were collected in two stages, with 315 older adults in the first and 78 in the second. We have measured the arm, calf, and waist circumferences, as well as the triceps and subscapular skinfold and knee height. Multiple linear regression was used to develop the equations, which were evaluated through the coefficient of determination, standard error of estimation, Akaike information criterion, intraclass correlation coefficient (ICC), and Bland-Altmann plot. RESULTS: Five models with different anthropometric measurements were developed, (1) arm circumference as a discriminant variable (ICC: 0.842); (2) best statistical fit for men and women (ICC: 0.874) and its stratification by sex (3) (ICC: 0.876); (4) easy-to-perform measurement for men and women (ICC: 0.842) and its stratification by sex (5) (ICC: 0.828). CONCLUSION: Five models for estimating the weight of older adult residents in long-term care institutions were developed and validated. The choice to use the models should be based on the physical capacity of the older adults to be evaluated.

Impact of educational policies on access to health care in Brazil: A cross-sectional study.

INTRODUCTION: Various initiatives to improve access to health care have been implemented internationally. In Brazil, this has included policies intended to expand access to higher education for underrepresented socio-economic groups. These measures have reduced inequalities in access to medical education, but it is not known whether they influence career choices. We examine the effect of these educational policies on physician practice patterns in primary care and/or in medically underserved areas. METHODS: This is a cross-sectional study that analysed the association between affirmative educational policies and the career choices of physicians who graduated between 2010 and 2015. Multivariate binary regression analysis was used to evaluate the impact of affirmative educational policies on physician career choices, including primary care practice, practice in cities with ≤20 000 inhabitants, and practice in less developed municipalities 4 years after graduation. RESULTS: We identified the practice patterns of 65 304 (82.8%) physicians 4 years after their graduation. Most physicians included in our analysis were female (54.5%), aged ≤27 years (72.4%), born in developed cities and studied in private medical schools. Physicians admitted to medical school based on racial or social access policies were more likely to practice in municipalities with fewer than 20 000 inhabitants (odds ratio [OR]: 1.64; 1.36-1.98) and in primary care (OR: 1.55; 1.35-1.53). Physicians who benefited from scholarships for under-represented socio-economic groups were more likely to practice in small cities (OR: 1.24; 1.07-1.43) and primary care (OR: 1.23; 1.11-1.37). The provision of financial aid also improved the likelihood of practice in primary care and underserved areas. Graduation from medical schools located in smaller cities was associated with practice in municipalities ≤20 000 inhabitants and primary care. CONCLUSIONS: Our results demonstrated that educational policies implemented in the Brazilian context are effective in reducing inequities in physician distribution and led to an increase in the number of physicians practicing in primary care.

Association of congenital Zika syndrome with dental alterations in children with microcephaly.

The effects of congenital Zika syndrome (CZS) on the tooth development of infected children are not well known. The aim of this study was to analyze the association of CZS with dental alterations in children with microcephaly seen at a referral hospital in Rio Grande do Norte, Brazil. The chronology and sequence of tooth eruption and the presence of dental alterations were evaluated by a single calibrated examiner (kappa > 0.80) in 62 children aged 7 to 35 months with microcephaly associated with CZS and other congenital infections. Medical data of the mother and child were collected from the records and the parents responded to a socioeconomic questionnaire. Descriptive analysis and Fisher's exact test were used (5% significance level). The mean age of the children was 26.4 months (SD = 7.52). The mean weight and head circumference at birth were 2,593 g (SD = 0.60) and 29.6 cm (SD = 2.48), respectively. Microcephaly was associated with congenital Zika virus infection in 79% of cases and with other congenital infections in 21%. No significant association was found between CZS and alterations in the chronology (p = 1.00) or sequence of tooth eruption (p = 0.16) or changes in enamel development (p = 1.00). In conclusion, children with microcephaly exhibit a delay and alterations in the sequence of tooth eruption of primary teeth, as well as developmental defects of enamel, which are not associated with Zika virus infection.

Mobility during walking and incidence and risk factors for mobility decline among institutionalized older adults: A two-year longitudinal study.

OBJECTIVE: To analyze the trajectory of changes in mobility during walking (i.e., maintenance and recovery) of institutionalized older adults and verify the incidence and risk factors for mobility decline. METHODS: A two-year longitudinal prospective study was conducted with 358 participants aged ≥ 60 years and institutionalized in ten nursing homes in Natal-RN (Brazil). Mobility was assessed using the "walking" item of the Barthel index. Sociodemographic, institution-related, and health-related variables were considered at baseline. Poisson regression was used to build a multiple model. RESULTS: The incidence of mobility decline during walking was 10.6% (95% confidence interval [95% CI] = 7.4 to 13.8) after 12 months and 37.7% (95% CI = 18.0 to 26.6) after 24 months. Age ≥ 83 years (relative risk = 1.58; 95% CI = 1.24 to 2.02; p < 0.001) and hospitalization (relative risk = 3.16; 95% CI = 1.55 to 6.45; p = 0.002) were predictors of mobility decline. The rate of mobility maintenance was 31.8% after 12 months (95% CI = 31.8 to 42.9) and 23.2% after 24 months (95% CI = 26.8 to 38.5). Also, the rate of recovery was 2.5% (95% CI = 1.0 to 5.0) and 1% (95% CI = 0.2 to 2.6) after 12 and 24 months, respectively. CONCLUSION: The trajectory of mobility during walking of institutionalized older adults in northeastern Brazil was dynamic (i.e., increasing incidence of mobility decline after 24 months) and associated with advanced age and hospitalization. The chances of recovering walking performance are minimal, and maintenance of independent mobility is challenging.

Efficacy of ILIB on periodontal clinical parameters and glycemic control in patients with periodontitis and type II diabetes-randomized clinical trial.

Our study aimed to study the efficacy of ILIB on periodontal parameters and glycemic control in patients with periodontitis and type II diabetes. Twenty-one patients in a randomized clinical trial were divided into 2 groups: control group (CG), conventional periodontal therapy, and test group (TG), conventional periodontal treatment associated with 10 laser applications by the ILIB-Modified (ILIB-M) technique. Fasting blood glucose levels and glycated hemoglobin (HbA1c), visible plaque index (VPI), gingival bleeding index (GBI), and periodontal clinical parameters were evaluated at baseline and after 4 months (T4). Regarding periodontal parameters, the intragroup analysis showed a statistically significant reduction (p < 0.05) between baseline and T4, for the VPI, GBI, BOP, PD, and CAL indexes. However, in the intergroup analysis, no statistically significant improvements (p > 0.05) were observed between the TG and CG for the VPI, GBI, BOP, PD, and CAL indexes. Regarding HbA1C and fasting blood glucose values, no statistically significant improvements were observed in intergroup and intragroup analyses (p > 0.05). The Modified ILIB did not improve the periodontal clinical parameters and glycemic control in patients with type II diabetes.

Intra-urban differentials of congenital and acquired syphilis and syphilis in pregnant women in an urban area in northeastern Brazil.

BACKGROUND: Currently syphilis is considered an epidemic disease worldwide. The objective of this study was to identify intra-urban differentials in the occurrence of congenital and acquired syphilis and syphilis in pregnant women in the city of Natal, in northeast Brazil. METHODS: Cases of syphilis recorded by the municipal surveillance system from 1 January 2011 to 30 December 2018 were analysed. Spatial statistical analyses were performed using the kernel density estimator of the quadratic smoothing function (weighted). SaTScan software was applied for the calculation of risk based on a discrete Poisson model. RESULTS: There were 2163 cases of acquired syphilis, 738 cases of syphilis in pregnant women and 1279 cases of congenital syphilis. Kernel density maps showed that the occurrence of cases is more prevalent in peripheral areas and in areas with more precarious urban infrastructure. In 2011-2014 and 2015-2018, seven statistically significant clusters of acquired syphilis were identified. From 2011 to 2014, the most likely cluster had a relative risk of 3.54 (log likelihood ratio [LLR] 38 895; p<0.001) and from 2015 to 2018 the relative risk was 0.54 (LLR 69 955; p<0.001). CONCLUSIONS: In the municipality of Natal, there was a clustered pattern of spatial distribution of syphilis, with some areas presenting greater risk for the occurrence of new cases.

Analysis of Protein Immunoexpression and Its Interrelationship in the Pathogenesis of Odontomas and Ameloblastic Fibro-Odontomas: A Systematic Review.

Odontomas and ameloblastic fibro-odontomas (AFOs) are the result of a developmental anomaly of odontogenic tissues. A literature review of proteins immunoexpressed in odontomas and AFOs was conducted in order to determine which proteins are involved in the pathogenesis of these lesions. AFO was changed to early odontoma in the 2017 WHO classification and will also be discussed in this article. A literature search was performed in the following electronic databases: PubMed/MEDLINE, Web of Science, Scopus, EMBASE, Lilacs, Cochrane Collaboration Library, and Science Direct. The research question was developed according to the population, intervention, comparison, and outcome (PICO) framework: Which proteins are related to the differentiation of odontomas and what is their interrelationship with AFOs? Thirty articles met all inclusion criteria and were selected for this systematic review, totaling 355 cases of odontomas and 43 cases of AFO. Similar immunoexpression was observed in odontomas and AFOs. Immunoexpression of proteins involved in cell differentiation was higher in compound odontomas than in complex odontomas. Proteins involved in histodifferentiation and enamel formation were more frequent in odontomas. The immunoexpression of enamel matrix proteins differs between odontomas and tooth germs, with their persistence being related to the development of odontomas. Compound odontomas exhibit the highest immunoexpression of proteins involved in cellular histodifferentiation and the Wnt/beta-catenin pathway is involved in tumor formation.

Recurrence-free survival and prognostic factors of odontogenic keratocyst: a single-center retrospective cohort.

PURPOSE: The aim of the present study was to evaluate the 5-year recurrence-free survival and prognostic factors of odontogenic keratocyst (OKC) from a single-center retrospective cohort in the northeastern region of Brazil. METHODS: Forty cases of OKC comprised the study population. In the cohort analyzed, 18 (45%) cases were recurrent OKCs and 22 (55%) were non-recurrent OKCs. Recurrence-free survival was defined as the period from the release of the histopathological report to the occurrence of relapse or last visit to the service. RESULTS: Comparison of the clinicopathological variables between primary and recurrent OKC lesions revealed no differences in the frequency of epithelial thickness, presence of satellite cysts and cystic spaces, presence of an inflammatory infiltrate, locularity, and lesion borders. The frequency of symptoms was practically the same even after recurrence. Satellite cysts were more frequent in the group of recurrent lesions (n = 9, p = 0.002) and the presence of an inflammatory infiltrate was also significantly associated with recurrent lesions (n = 15, p = 0.006). Previous decompression or marsupialization was associated with recurrence of the lesion (p = 0.010). CONCLUSIONS: In conclusion, the most significant prognostic factors were previous decompression or marsupialization, as well as, morphological parameters associated with the recurrence cases were the presence of an inflammatory infiltrate and satellites cysts. The risk of recurrence is low but continues due to the particularities of epithelial proliferation in OKC.

Spatio-temporal dynamics of Aedes aegypti and Aedes albopictus oviposition in an urban area of northeastern Brazil.

OBJECTIVE: The objective of this study was to analyse abundance and spatial distribution of Aedes aegypti and Aedes albopictus oviposition in the city of Natal-RN, 2016 to 2018. METHODS: Three hundred and seven oviposition traps were installed covered the whole city and were monitored weekly from January 2016 to December 2018. To verify the abundance of the vector based on its location, the formation of oviposition clusters was studied using the Kernel statistics. Egg Density Index (EDI) and Oviposition Positivity Index (OPI) values were calculated. RESULTS: Temperature and humidity presented weak and very weak correlation, respectively, with the oviposition indicators. The median of oviposition positivity index (OPI) was 60.5%, and the egg density index (EDI) was 45.4 eggs/trap. The OPI (71.1%) was higher in the second quarter of the year. The areas with the most persistent oviposition are located in a continuous strip that extends from the extreme of the northern district and extends along the western district of the city. Also noteworthy is the proximity to the strategic points. CONCLUSION: The spatio-temporal distribution of oviposition revealed that there is spatial segregation and marked seasonality. Therefore, this study highlights the importance of maintaining surveillance targeting and control strategies focused on these areas, especially during the most important period of the year.

OBJECTIF: L'objectif de cette étude était d'analyser l'abondance et la distribution spatiale de la ponte d'Aedes aegypti et d'Aedes albopictus dans la ville de Natal-RN, de 2016 à 2018. MÉTHODES: 307 pièges de ponte ont été installés dans toute la ville et surveillés chaque semaine de janvier 2016 à décembre 2018. Pour vérifier l'abondance du vecteur en fonction de sa localisation, la formation de grappes de ponte a été étudiée à l'aide des statistiques de Kernel. Les valeurs de l'indice de densité des œufs (IDO) et de l'indice de positivité de la ponte(IPP) ont été calculées. RÉSULTATS: La température et l'humidité ont présenté une corrélation faible et très faible, respectivement, avec les indicateurs de ponte. L'indice médian de positivité de ponte (IPP) était de 60,5% et l'indice de densité des œufs (IDO) était de 45,4 œufs/piège. L'IPP (71,1%) était plus élevé au deuxième trimestre de l'année. Les zones avec la ponte la plus persistante sont situées dans une bande continue qui s'étend de l'extrémité du district nord et s'étend le long du district ouest de la ville. A noter également la proximité des points stratégiques. CONCLUSIONS: La distribution spatiotemporelle de la ponte a révélé une ségrégation spatiale et une saisonnalité marquée. Par conséquent, cette étude met en évidence l'importance de maintenir des stratégies de surveillance ciblée et de contrôle axés sur ces zones, en particulier pendant la période la plus importante de l'année.

Accuracy of a questionnaire on xerostomia as a screening tool for hyposalivation.

OBJECTIVE: Determine the accuracy of a questionnaire on xerostomia as a screening tool for hyposalivation. METHODS: A total of 402 adults awaiting dental care at a public healthcare service answered an eight-item questionnaire addressing xerostomia and were submitted to stimulated sialometry, with ≤ 0.7 mL/min considered indicative of hyposalivation. Reproducibility and internal consistency of the questionnaire were evaluated. The correlation between the score and salivary flow was investigated. The total score was also compared between groups with and without hyposalivation and diagnostic precision measures were calculated. RESULTS: Hyposalivation was identified in 162 participants (40.3%) and a total of 229 (57.0%) answered affirmatively to at least one question. The responses to each question revealed variable reproducibility (κ = 0.450-0.785) and satisfactory internal consistency (Cronbach's α = 0.70). Individuals with a larger number of positive answers had lower salivary flow (Spearman's ρ = -0.193; P < 0.001). The mean number of positive answers was greater in the group with a clinical diagnosis of hyposalivation compared to those without low salivary flow. The sensitivity of the screening tool was 64.8%, with an area under the ROC curve of 0.60 (95% confidence interval: 0.547-0.645; P < 0.001). CONCLUSION: The questionnaire proved to be useful for the epidemiological screening of individuals with possible hyposalivation.

Relationship between normative and self-perceived criteria for orthodontic treatment need and satisfaction with esthetics and mastication in adolescents.

INTRODUCTION: Orthodontic treatments are performed to improve esthetics and masticatory functions. In general, clinical criteria are used to recommend such treatments without considering the opinion of the patient. This study aimed to evaluate the relationship between technically defined orthodontic need (normative criteria) and the need for treatment perceived by adolescent patients. METHODS: A total of 215 students aged between 15 and 19 years were selected and asked to respond to a questionnaire concerning their perception of need for orthodontic treatment and their satisfaction with their own esthetics and mastication. One trained and calibrated examiner obtained normative data using the Dental Aesthetic Index (DAI) on the need for orthodontic treatment of these students. RESULTS: Associations were found between the DAI score and the patient's perception of need for orthodontic treatment (P <0.001), satisfaction with esthetics (P = 0.003), and satisfaction with mastication (P = 0.047). When occlusal characteristics were analyzed separately, associations between several normative and perceived needs, as well as for satisfaction with esthetics, were found. Satisfaction with mastication analysis was only found to be associated with open bite malocclusion (P = 0.003). CONCLUSIONS: The DAI revealed a consistent opinion in adolescents to link their perceived malocclusion-related conditions to esthetics.

Prevalence and Associated Factors With Voice Disorders in Brazilian Community-dwelling Older Adults.

OBJECTIVES: This study aimed to estimate the prevalence and factors associated with voice disorders (VDs) in Brazilian community-dwelling older adults. STUDY DESIGN: This is a cross-sectional study. METHODS: The sample comprised 463 older adults (60 years or more) of both sexes living in a Brazilian northeastern city. Variables were related to socioeconomic and demographic profile, lifestyle, and general health conditions, in addition to the validated "Screening for Voice Disorders in Older Adults" (RAVI) questionnaire. A bivariate analysis was performed using the Pearson chi-square test or the Fisher exact test, and the magnitude of the association was the prevalence ratio (PR). Poisson regression model was performed, considering only the variables with a critical value of P < 0.20. The significance level was 5%. RESULTS: There was a prevalence of women (60.9%), and the average age of participants was 70 (±7.74) years. The prevalence of VDs was 51.4% (95% confidence interval [CI]: 46.8-55.9). The most common symptoms were throat sensation of phlegm (46.9%) and dry throat (46.7%), both related to physical sensations of laryngeal discomfort. Multivariate analysis indicated that the prevalence of VDs was independently associated with hyposalivation (PR = 2.28, 95% CI = 1.80-2.88), smoking (PR = 2.04, 95% CI = 1.65-2.52), self-reported hearing loss (PR = 1.51, 95% CI = 1.28-1.78), and not seeking a physician or other health professional care for VDs (PR = 0.73, 95% CI = 0.60-0.88). CONCLUSION: VDs are prevalent among Brazilian community-dwelling older adults and are associated with variables related to general health and lifestyle.

Frailty among institutionalized older people: a cross-sectional study in Natal (Brazil).

OBJECTIVE: Verify the prevalence of frailty and its associated factors in institutionalized older people. METHODS: Cross-sectional study carried out in 10 nursing homes in Natal (Brazil), between October/2013 and January/2014. All institutionalized older people 60+ that were not hospitalized, in terminal state, coma or under palliative care were included in the study. The dependent variable of the study was the presence/absence of frailty, classified according to the following criteria: severe cognitive decline and/or impossibility of independent walking or being bedridden. The 5 criteria (muscular weakness, unintentional weight loss, low physical activity level, slowness and exhaustion) of Fried et al. were considered for those with preserved cognitive and walking capacity. The chi-square test or Fisher's test and logistic regression were used for bivariate and multiple analysis, respectively. Sociodemographic, institution-related and health-related variables were also included. RESULTS: Of the 321 participating older people, 80.1% were considered frail, 16.8% pre-frail and 3.1% non-frail. The final model demonstrated association of frailty with age (OR=2.67; 95%CI 1.39-5.14; p=0.003), presence of chronic diseases (OR=10.27; 95%CI 3.42-30.90; p<0.001), systemic arterial hypertension (OR=0.11; 95%CI 0.05-0.27; p<0.001) and institutionalization due to lack of caregiver (OR=2.55; 95%CI 1.36-4.76; p=0.003) adjusted by sex and type of institution. DISCUSSION: Frailty was highly prevalent in institutionalized older people and its association with multi-factor aspects suggested that action of health services and government representations could aid in the prevention or delay of frailty onset, improving the life quality of older people.

Estimating the height of elderly nursing home residents: Which equation to use?

Estimating equations can be used when measuring the height of elderly persons is not possible. However, such methods are not always applicable; therefore, it is necessary to consider several aspects, such as sex, age, and ethnicity of the studied population to generate these equations. This study aimed to compare and validate methods of estimating the height of the Brazilian elderly nursing home residents. An accuracy study was conducted with 168 elderly persons. A total of 23 equations were quantitatively evaluated by plotting the differences in means, the Student's t-test for paired samples, the coefficient of determination (R2), the root-mean-square error (RMSE), the interclass correlation coefficient (ICC), and by graphic analysis of the residuals. A significance value of p <0.05 was adopted. An equation was considered applicable when it had R2 >0.7, the lowest RMSE among the equations evaluated, ICC >0.7, and a confidence interval of 95%, with the smallest difference between the upper and lower limits. A greater mean height was noted among younger elderly persons and elderly men compared to up to 80 years and women elderly. Quantitative analysis revealed that equation for Puerto Ricans, using knee height and age, was the most applicable for the overall population (ICC = 0.802). The same equation was applicable for the elderly Brazilian male participants (ICC = 0.838) and for those aged 60-69 years (ICC = 0.895). None of the equations used were applicable for the height estimation of elderly women or individuals aged 70 years or more.

Plasma zinc in institutionalized elderly individuals: Relation with immune and cardiometabolic biomarkers.

Changes in zinc metabolism caused by aging and the institutionalization process may contribute to zinc deficiency in elderly individuals. Hypozincemia results in changes in glycemic, lipid, and inflammatory profiles. The aim of this study was to evaluate plasma zinc concentrations and their relationships with sociodemographic, dietary, inflammatory, and cardiometabolic biomarkers in institutionalized elderly individuals. A cross-sectional study was carried out including 255 elderly adults living in nursing homes. The associations between plasma zinc and dietary zinc intake, sociodemographic indicators, and glycemic, lipid, and inflammatory biomarkers were evaluated. Independent variables were analyzed according to quartiles of plasma zinc concentrations (Q1: <71.1 µg/dL; Q2: 71.1-83.3 µg/dL; Q3: <83.3-93.7 µg/dL; Q4: >93.7 µg/dL). The relationship between plasma zinc concentrations and predictor variables was also tested. In Q1, higher concentrations of the following variables were observed, compared with those in other quartiles: total cholesterol and low-density lipoprotein cholesterol (LDL-c; Q1 > Q2, Q3, Q4; all p <0.001); triglycerides (Q1 > Q3, Q4; all p < 0.001); interleukin (IL)-6 (Q1 > Q3, Q4; p = 0.024 and p = 0.010, respectively); tumor necrosis factor (TNF)-α (Q1 > Q3, p = 0.003). A significant reduction in plasma zinc concentrations was observed with increasing age-adjusted institutionalization time (Δ = - 0.10; 95% confidence interval [CI]: -0.18 to -0.01). The concentrations of total cholesterol (Δ = - 0.19; 95% CI: -0.23 to -0.15), LDL-c (Δ = - 0.19; 95% CI: -0.23 to -0.15), triglycerides (Δ = - 0.11; 95% CI: -0.16 to -0.06), IL-6 (Δ = - 1.41; 95% CI: -2.64 to -0.18), and TNF-α (Δ = - 1.04; 95% CI: -1.71 to -0.36) were also significantly increased. In conclusion, decreased plasma zinc concentrations were associated with longer institutionalization time and worse lipid and inflammatory profiles in elderly institutionalized individuals.

Social Context and Geographic Space: An Ecological Study about Hospitalizations of Older Persons.

OBJECTIVES: To identify the diseases that lead older persons to hospitalizations in the public health system in the state of Rio de Janeiro and, through a study of spatial distribution among hospitalization rates of the municipal districts, discuss the social contexts involved in the hospitalization of the elderly. METHODS: An ecological cross-sectional study using secondary data from the Brazilian hospital information system from the period 2009 to 2015 was performed. The hospitalization rates of people 60 years and older, residing in 92 municipalities in the state of Rio de Janeiro, were calculated. The municipal districts were grouped according to the similarity of such rates using K-means nonhierarchical clustering analysis. RESULTS: Diseases of the circulatory and respiratory systems, endocrine disorders, illnesses of the genitourinary system or the digestive tract, and certain infectious and parasitic diseases were the most discriminatory diseases for cluster composition. The first cluster, the municipal districts with the lowest hospitalization rates, which were more urbanized and had greater access to social and health services, was named Access and Inclusion. The second group, which had the highest hospitalization rates, was named Isolation and Vulnerability. CONCLUSIONS: The primary care-sensitive conditions are the main causes of hospitalization of the elderly in the state, with greater intensity in the municipalities that are geographically rugged and remote. These outcomes reinforce the importance of valuing geographical knowledge, the guidelines of the unified health system concerning equity and regionalization, and the determinants and social determinations involved in the process of health and disease.

Voice Disorders in Older Adults Living in Nursing Homes: Prevalence and Associated Factors.

OBJECTIVES: To estimate the prevalence and the associated factors with voice disorders (VDs) in older adults living in nursing homes. STUDY DESIGN: Cross-sectional. METHODS: A sample of 117 Brazilian individuals of both sexes and preserved cognitive function, aged >59 years, living in 10 nursing homes, was studied. VDs were screened using the validated tool "Rastreamento de Alterações Vocais em Idosos" (RAVI-Screening for Voice Disorders in Older Adults). Associated factors included variables related to socioeconomic and demographic profile; nursing home; general health; ear, nose, and throat conditions; lifestyle; functionality; and psychosocial status. Bivariate analysis was performed by Pearson's chi-square or Fisher's exact test. Multivariate analysis was performed by multiple binomial regression. The significance level was 5%. RESULTS: The prevalence of VDs was 39.3% (95% confidence interval [CI] = 30.4-48.1). There was no significant difference in prevalence according to age and sex. Multivariate analysis revealed that the prevalence of VDs were independently associated with anxiety symptoms (prevalence ratio [PR] = 1.97, 95% CI = 1.17-3.29), smoking (PR = 1.56, CI = 1.02-2.38), general daily inactivity (PR = 1.62, CI = 1.10-2.38), temporomandibular disorder (PR = 1.68, CI = 1.11-2.54), choking (PR = 1.53, CI = 1.06-2.20), and self-reported hearing loss (PR = 1.52, CI = 1.04-2.21). CONCLUSION: VDs are common among older adults with preserved cognitive function living in nursing homes. The associated factors with VDs in this population can be prevented, diagnosed, controlled, or treated. Screening procedures and early intervention should be considered.

Economic and sociodemographic inequalities in complete denture need among older Brazilian adults: a cross-sectional population-based study.

BACKGROUND: Brazil has severe socioeconomic inequalities, resulting in major oral health problems for the Brazilian elderly, such as tooth loss and, consequently, a need for oral rehabilitation. The aim of this study was to evaluate inequalities in complete denture need among older Brazilian adults in relation to social determinants at individual and contextual levels. METHODS: This retrospective study was based on data from the national oral health survey, SB Brasil 2010, in which 7,619 older adults aged 65-74 years participated. The dependent variable was complete denture need. The independent variables at the first level were age, sex, race, and socioeconomic status. The independent variables that were used to identify inequality at the contextual level were geographic region of Brazil, the population of the municipality where the subject lived, whether the subject lived in the state capital or not, and the Human Development Index. In order to describe the socioeconomic characteristics, a socioeconomic cluster variable was created using the multivariable cluster analysis technique. Prevalence ratios (PRs) with 95 % confidence intervals (CIs) were determined to evaluate the effect of each variable. Two-level multivariable modeling was performed to examine the individual and contextual effects. RESULTS: There was a high prevalence of complete denture need among older Brazilian adults. The main factors associated with the prevalence of complete denture need were individual socioeconomic status (PR: 1.81; 95 % CI: 1.65-1.99), and the city-level contextual effect (PR: 1.20; 95 % CI: 1.08-1.34). CONCLUSIONS: Consistently poor rates of oral health rehabilitation were found among older Brazilian adults, and were associated with significant social inequality. Complete denture need was strongly associated with individual socioeconomic position. It was also verified that the Human Development Index, the city-level contextual effect, was associated with complete denture need.

Solitary pulmonary nodule and (18)F-FDG PET/CT. Part 2: accuracy, cost-effectiveness, and current recommendations.

A solitary pulmonary nodule is a common, often incidental, radiographic finding. The investigation and differential diagnosis of solitary pulmonary nodules remain complex, because there are overlaps between the characteristics of benign and malignant processes. There are currently many strategies for evaluating solitary pulmonary nodules. The main objective is to identify benign lesions, in order to avoid exposing patients to the risks of invasive methods, and to detect cases of lung cancer accurately, in order to avoid delaying potentially curative treatment. The focus of this study was to review the evaluation of solitary pulmonary nodules, to discuss the current role of (18)F-fluorodeoxyglucose positron-emission tomography, addressing its accuracy and cost-effectiveness, and to detail the current recommendations for the examination in this scenario.

O nódulo pulmonar solitário corresponde a um achado radiológico comum, cuja detecção ocorre frequentemente de forma incidental. A investigação desta entidade permanece complexa, uma vez que existem sobreposições entre as características dos processos benignos e malignos no seu diagnóstico diferencial. Atualmente, muitas estratégias estão disponíveis para a avaliação do nódulo pulmonar solitário, e o objetivo principal consiste em caracterizar da melhor forma possível as alterações benignas, não expondo os pacientes aos riscos de métodos invasivos, e detectar corretamente os casos de câncer de pulmão, não retardando potencial tratamento curativo. O foco deste estudo é revisar a avaliação do nódulo pulmonar solitário, discutindo o papel atual da tomografia por emissão de pósitrons com 18-fluordesoxiglicose, apresentar sua acurácia e custo-efetividade, bem como salientar as recomendações atuais do exame neste cenário.