Generalized anxiety disorder in Brazilian undergraduate dental students during the COVID-19 pandemic: A cross-sectional study.

OBJECTIVE: Explore the prevalence of generalized anxiety disorder (GAD) and associated factors in undergraduate dental students during the first wave of the COVID-19 pandemic in Brazil. MATERIALS AND METHODS: Cross-sectional study. A semi-structured questionnaire addressing the variables of interest was shared with dental students between July 8 and 27 2020. The outcome was determined using the seven-item generalized anxiety disorder (GAD-7) scale. A 'positive' diagnosis was defined as a total of ≥10 points on the scale. Statistical analysis involved descriptive, bivariate and multivariate analyses, with the significance level set at 5%. RESULTS: Among the 1050 students evaluated, 53.8% had a positive diagnosis for GAD. The multivariate analysis revealed that the prevalence of symptoms was higher among individuals who resided with more than three people, those enrolled at teaching institutions that suspended all clinical and laboratory activities, those who did not have an adequate home situation to maintain distance learning, those who had been diagnosed with COVID-19, those who felt anxious about having to see patients with a suspicion or diagnosis of COVID-19 and those who preferred to interrupt in-person academic activities until the population is vaccinated for the COVID-19 virus. CONCLUSION: The prevalence of GAD was high. Aspects related to the composition and organization of the home, the suspension of academic activities, a history of COVID-19 contamination, feelings of anxiety in providing dental care to patients with symptoms/suspected of COVID-19 infection and the preference to interrupt in-person academic activities until the population is vaccinated for COVID-19 were factors predisposing the students to anxiety during the first wave of the pandemic.

Ultra-processed food consumption and dental caries in adolescents from the 2004 Pelotas Birth Cohort study.

OBJECTIVE: To investigate the relationship between ultra-processed food (UPF) consumption and dental caries in adolescents. METHODS: Data from 996 adolescents aged 12-13 years who participated in an oral health sub-study of the 2004 Pelotas Birth Cohort in southern Brazil were analysed. The main exposure was daily UPF consumption at age 10-11 years, measured by a food frequency questionnaire containing 24 UPF items defined based on the NOVA system. UPF consumption was calculated in frequency, grams and calories, in general and for six types of food (biscuits, savoury snacks and sugar-sweetened cereals; ultra-processed meats and fats; sweets; fast food and instant noodles; soft drinks and artificially flavoured drinks; and sweetened milk and powdered chocolate). The outcome was dental caries, measured according to the decayed, missing and filled indexes (DMFS and dmfs) at age 12-13 years. Poisson regression models were used to analyse the association between UPF consumption and dental caries, adjusting for socioeconomic and demographic variables, dental visits and oral hygiene. RESULTS: Overall, the daily UPF consumption in frequency, grams and calories was associated with caries. The findings were consistent for UPF consumption for all six food groups. The higher the UPF consumption, the higher the probability of having caries in adolescence. The associations between ultra-processed meats and fats, and fast food and instant noodles intake with dental caries alert to the cariogenic potential of such UPF foods. CONCLUSION: Ultra-processed food consumption was associated with greater caries burdens in young adolescents. The findings reinforce the need for interventions and public policies to reduce UPF consumption in adolescence.

COVID-19 pandemic and impact on dental education: perception of Brazilian dental students

Aim: The aim of the present study is to assess the perception of undergraduate students on the impact of the COVID-19 pandemic on Brazilian dental education. Methods: This crosssectional study was conducted using an online questionnaire hosted in Google Forms platform and publicized on Instagram® and Facebook®. The questionnaire was available between July 8-27, 2020. Absolute and relative frequencies were obtained for variables of interest using Pearson's chi-squared and considering 95% confidence intervals. Prevalence of learning resource variables according to self-reported skin color, educational institution, and Brazilian region were presented using equiplots. Results: A total of 1,050 undergraduate dental students answered the questionnaire. Most students reported being in full-distance learning mode. Among the undergraduate students, 65.4% reported perceiving a very high impact in dental education, and 16.6% of students reported not being able to follow distance learning. In addition, 14% reported not having a personal laptop or desktop to study with, with this condition being more prevalent among non-white than white individuals. Conclusion: We conclude that Brazilian dental students perceived a high impact of COVID-19 on dental education, as well as one-sixth of the students reported not having adequate resources to continue with distance learning. It is important that different policies are developed at the institutional and governmental levels to reduce the impact of the pandemic on dental education

Ultra-processed food consumption and dental caries in children and adolescents: a systematic review and meta-analysis.

This study summarised the association between ultra-processed food (UPF) consumption and dental caries in children and adolescents through a systematic review and meta-analysis. The search of PubMed, Cochrane, Web of Science and Scopus databases using the 'PECOS' strategy retrieved 1462 eligible articles. Only studies with humans aged ≤ 19 years; that assessed groups of any UPF or specific UPF items; that measured dental caries as the decayed, filled and missing surfaces or teeth indexes, based on the WHO criteria; cross-sectional, case-control, cohort and all types of interventions that examined the adjusted association between UPF consumption and dental caries were included. All studies received qualitative evaluation. Meta-analysis using random-effects models combined multivariable-adjusted OR for case-control and cross-sectional studies and risk ratio (RR) for longitudinal studies of the highest v. lowest category of UPF consumption. Forty-two studies were included in the qualitative synthesis and twenty-seven in the meta-analysis. The pooled RR was 1·71 (95 % CI 1·31, 2·24), and the pooled OR was 1·55 (95 % CI 1·37, 1·75). The highest OR was found among participants who had dental caries prevalence >70 % (OR = 3·67, 95 % CI 2·16, 6·23). Better evidence quality was found among cohort studies that evaluated children <6 years old. The findings suggest that higher UPF consumption is associated with greater dental caries in children and adolescents. Public health efforts to reduce UPF consumption are needed to improve the oral health of children and adolescents.

Factors associated with the reduction of dental care in Primary Health Care in Brazil after the emergence of COVID-19: a cross-sectional study, 2020. / Fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde no Brasil, com o surgimento da COVID-19: estudo transversal, 2020.

OBJECTIVE: To analyze factors associated with the reduction of dental care in Primary Health Care, during the COVID-19 pandemic in Brazil. METHODS: This was a cross-sectional study conducted with dentists in primary healthcare centers (PHCCs). The reduction of dental care was the outcome, and the exposure variables were sociodemographic data, availability of personal protective equipment (PPE) and measures adopted by PHCCs during the pandemic. Poisson regression was performed to determine the prevalence ratio and 95% confidence interval (95%CI). RESULTS: Of the total of 958 participants, 62.6% reported a reduction of over 50% in dental visits after the beginning of the pandemic. Adoption of biosafety protocols (PR = 1.04; 95%CI 1.01;1.07), availability of PPE recommended by new protocols (PR = 0.94; 95%CI 0.89;0.99) and adoption of tele-screening (PR = 0.90; 95%CI 0.85;0.96) were associated with the reduction. CONCLUSION: The availability of new types of PPE and implementation of tele-screening in PHCCs seem to have minimized the reduction of dental care after the beginning of the pandemic.

Knowledge About Biosafety Measures in Clinical Setting During the COVID-19 Pandemic: A Cross-Sectional Study With Brazilian Dental Students.

OBJECTIVE: The aim of this study is to evaluate the knowledge of Brazilian dental students about biosafety measures that should be adopted in the clinical setting during the coronavirus disease (COVID-19) pandemic. METHODS: A cross-sectional study with 1050 dental students was conducted. A semi-structured questionnaire was shared with students. Mean knowledge score on biosafety guidelines during the COVID-19 pandemic was the outcome, with a maximum of 8 scores. Explanatory variables included sociodemographic and educational characteristics, aspects related to biosafety education, actions adopted by the dental schools during the pandemic, and sources of biosafety information. Multivariate linear regression analyses were performed. RESULTS: Mean knowledge score was 5.19 (1.28). Female students (ß = 0.346; 95% CI: 0.154-0.539), those enrolled in the intermediate (ß = 0.525; 95% CI: 0.167-0.883) or final (ß = 0.569; 95% CI: 0.200-0.937) stage of course, and those who had already received theoretical-practical training in biosafety (ß = 0.464; 95% CI: 0.063-0.866) presented higher mean knowledge scores. Students who did not receive guidance on aerosol control measures before the pandemic (ß = -0.324; 95% CI: -0.519 to -0.130) had the lowest score. CONCLUSION: Students presented a medium level of knowledge about dental biosafety measures concerning the COVID-19 pandemic. Sociodemographic characteristics and those related to the institutional profile of the participants, and access to orientation and training in biosafety, may influence their knowledge.

Fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde no Brasil, com o surgimento da COVID-19: estudo transversal, 2020 / Factores asociados a la reducción de la atención odontológica en Atención Primaria de Salud en Brasil con la aparición de COVID-19: estudio transversal, 2020 / Factors associated with the reduction of dental care in Primary Health Care in Brazil after the emergence of COVID-19: a cross-sectional study, 2020

Objetivo: Analisar fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde, durante pandemia de COVID-19 no Brasil. Métodos: Estudo transversal, com cirurgiões-dentistas das unidades básicas de saúde (UBS). O desfecho foi a redução dos atendimentos odontológicos, e as variáveis de exposição, dados sociodemográficos, disponibilidade de equipamentos de proteção individual (EPIs) e medidas adotadas pela UBS na pandemia. Realizou-se regressão de Poisson para determinar razão de prevalências e intervalo de confiança de 95% (IC95%). Resultados: A redução de atendimentos acima de 50% após o início da pandemia foi relatada por 62,6% dos 958 participantes. Adoção de protocolos de biossegurança (RP = 1,04; IC95% 1,01;1,07), disponibilidade de EPIs preconizados por novos protocolos (RP = 0,94; IC95% 0,89;0,99) e adoção da teletriagem (RP = 0,90; IC95% 0,85;0,96) estiveram associados à redução. Conclusão: A disponibilização dos novos EPIs e a implementação da teletriagem nas UBS parecem ter minimizado a redução dos atendimentos odontológicos após o início da pandemia.

Objetivo: Analizar factores asociados a la reducción de consultas odontológicas en Atención Primaria de Salud en Brasil durante el COVID-19. Métodos: Estudio transversal con cirujanos dentistas de las Unidades Básicas de Salud (UBS). El hecho investigado fue la reducción de consultas odontológicas y las variables de exposición incluyeron factores sociodemográficos, aspectos de los equipos de protección personal (EPPs) y las medidas adoptadas por la UBS tras la aparición del COVID. La regresión de Poisson se utilizó para determinar la razón de prevalencia y el intervalo de confianza del 95% (IC95%). Resultados: El 62,6% de los 958 participantes informó una reducción en la asistencia superior al 50% después del inicio de la pandemia. La adopción de protocolos (RP = 1,04; IC95% 1,01;1,07), disponibilidad de EPPs recomendados por los nuevos protocolos (RP = 0,94; IC95% 0,89;0,99) y la adopción de teletriaje (RP = 0,90; IC95% 0,85;0,96) fueron factores que se asociaron con esta reducción. Conclusión: La disponibilidad del nuevo EPP y la implementación de la teleprotección en las UBS parecen haber minimizado la reducción en la atención bucal después del inicio de la pandemia.

Objective: To analyze factors associated with the reduction of dental care in Primary Health Care, during the COVID-19 pandemic in Brazil. Methods: This was a cross-sectional study conducted with dentists in primary healthcare centers (PHCCs). The reduction of dental care was the outcome, and the exposure variables were sociodemographic data, availability of personal protective equipment (PPE) and measures adopted by PHCCs during the pandemic. Poisson regression was performed to determine the prevalence ratio and 95% confidence interval (95%CI). Results: Of the total of 958 participants, 62.6% reported a reduction of over 50% in dental visits after the beginning of the pandemic. Adoption of biosafety protocols (PR = 1.04; 95%CI 1.01;1.07), availability of PPE recommended by new protocols (PR = 0.94; 95%CI 0.89;0.99) and adoption of tele-screening (PR = 0.90; 95%CI 0.85;0.96) were associated with the reduction. Conclusion: The availability of new types of PPE and implementation of tele-screening in PHCCs seem to have minimized the reduction of dental care after the beginning of the pandemic.

Anxiety symptoms and alcohol abuse during the COVID-19 pandemic: A cross-sectional study with Brazilian dental undergraduate students.

AIM: The aim of this study is to assess whether anxiety symptoms are associated with alcohol abuse in Brazilian undergraduate dental students during the COVID-19 pandemic. METHOD: A cross-sectional study was conducted. A semi-structured questionnaire addressing the variables of interest was hosted on Google Forms and shared with dental undergraduate students from all Brazilian regions between July 8 and 27, 2020. Alcohol abuse was measured using the Cut down, Annoyed, Guilty, Eye opener (CAGE) questionnaire score of ≥2. All participants responded to the seven-item Generalized Anxiety Disorder Scale (GAD-7). Hierarchical logistic regression was also conducted. RESULTS: Among the 1050 students evaluated, 18.7% (n = 196) had a positive screening for alcohol abuse during the pandemic. The prevalence of mild (GAD-7 = 5-9), moderate (GAD-7 = 10-14), and severe (GAD-7 ≥15) anxiety among students were 31.3%, 29.6%, and 24.2%, respectively. The final hierarchical logistic regression model showed that during the COVID-19 pandemic, anxiety levels predict the likelihood of alcohol abuse among students with moderate (OR 10.05 [95% IC: 4.12-24.52]) or severe (OR 15.82 [95% IC: 6.46-38.73]) anxiety, especially for male students (moderate anxiety: OR 17.06 [95% CI: 8.36-34.78]; severe anxiety: OR 28.38 [95% CI: 8.62-38.24]). CONCLUSION: The prevalence of alcohol abuse and moderate or severe anxiety in Brazilian undergraduate dental students during the COVID-19 pandemic was high. Male students may be more sensitive to the presence of anxiety symptoms in this period, thus contributing to higher levels of alcohol consumption, in comparison to female students. Intervention strategies that promote the adoption of healthier lifestyles can enable the effective management of anxiety symptoms during the pandemic and thus, hold the potential to reduce exacerbated alcohol intake in this population.

Factors Associated with the Oral Health-Related Quality of Life in Children with Intellectual Disabilities / Factores asociados con la calidad de vida relacionada con la salud bucal en niños con discapacidad intelectual

Abstract: Different factors can influence the perception of quality of life in individuals with intellectual disabilities. This study investigated the factors associated with quality of life related to oral health in children with intellectual disabilities from the perspective of their parents. A cross-sectional study was carried out with Brazilian children from specialized institutions and their respective guardians. Data were collected through medical records, application of instruments and oral clinical examination (n=92). Most children had poor oral hygiene (64.10%) and a high caries experience (59.8%). The mothers' perception of quality of life related to oral health was low, however there was an association of greater perception when they had low education, female child, less brushing frequency and history of breastfeeding (p≤0.05). Although the perception of quality of life was low, the oral condition found evidences the need to promote oral health education actions with children with intellectual disabilities and their respective guardians.

Resumen: Diferentes factores pueden influir en la calidad de vida de personas con discapacidad intelectual. Este estudio investigó los factores asociados con la calidad de vida relacionada con la salud oral en niños con discapacidades intelectuales desde la perspectiva de sus cuidadores. Se realizó un estudio transversal con niños brasileños institucionalizados, que fueron evaluados clínicamente y sus respectivos tutores, quienes respondieron cuestionarios. Los datos fueron recolectados a través de registros médicos, aplicación de instrumentos de evaluación y examen clínico oral (n=92). La mayoría de los niños presentaban una higiene oral deficiente (64,10%) y una experiencia de caries alta (59,8%). Si bien la percepción específicamente de las madres respecto del impacto de las condiciones de la salud oral en la calidad de vida fue baja, mostró una tendencia a aumentar en cuanto disminuía el nivel educacional, la frecuencia de cepillado y la historia de lactancia materna (p≤0.05). El hecho de que la percepción del impacto en la calidad de vida por parte de los tutores no se condiga con las precarias condiciones de salud oral exhibida por los niños con discapacidad intelectual, no sólo demuestra el desconocimiento respecto de la importancia de la salud oral en un contexto general, sino que también evidencia la necesidad de promover acciones que incentiven el cuidado y educación en relación con este aspecto, tanto en los tutores como en los niños afectados.

Explorando os estresses oxidativo e nitrosativo contra fungos: um mecanismo subjacente à ação de tradicionais antifúngicos e um potencial novo alvo terapêutico na busca por indutores oriundos de fontes naturais / Explorando los estréses oxidativos y nitrosativos contra hongos: un mecanismo subyacente a la acción de los antifúngicos tradicionales y un potencial nuevo objetivo terapéutico en la búsqueda de inductores de fuentes naturales / Exploring the oxidative and nitrosative stresses against fungi: an underlying mechanism beyond the action of traditional antifungal agents and a potential new therapeutic target in searching for inducers from natural sources

RESUMO Objetivo: Nesta revisão sistemática, nós avaliamos o link entre indutores de estresse oxidativo e/ou nitrosativo (EO/EN) com atividade antifúngica, através de uma ação direta sobre a célula fúngica e/ou modulando a resposta de fagócitos contra fungos de interesse médico (incluindo Candida spp., Cryptococcus spp. e Aspergillus spp.). Ainda, foram avaliadas as implicações clínicas deste evento bioquímico, bem como as perspectivas quanto à busca por novos compostos com atividade antifúngica, principalmente, os provenientes de fonte natural e, que explorem a indução de um EO ou EN como parte de seu mecanismo de ação. Metodologia: Foram avaliados artigos, provenientes de diferentes bases de dados e publicados a qualquer período, acessados entre abril e junho de 2017, através da utilização de diferentes descritores. Resultados: Primeiramente, estabelecemos as definições de EO/EN, como sendo o aumento das concentrações de espécies reativas do oxigênio e/ou nitrogênio (ERO/ ERN) quantificado diretamente e, provenientes de fontes fúngicas mitocondriais, Reação de Fenton, retículo endoplasmático ou outras não definidas, e excedendo a capacidade de defesa antioxidante do microrganismo (avaliados por análises de perfis transcriptômicos ou proteômicos ou metabolômicos ou níveis de atividade enzimática). Este aumento de ERO/ERN causando EO/EN é definido por tempo e condições que conduzem a sinalização de apoptose ou reais danos a biomoléculas com perda de função (peroxidação lipídica ou oxidação proteica ou danos ao DNA) e, consequentemente, gerando morte fúngica ou outro efeito antifúngico associado. Portanto, 64 artigos (apenas um publicado antes do ano 2000 e 50 entre 2007-2017) abordam que a indução de EO ou EN na célula fúngica é parte do mecanismo de ação de clássicos agentes antifúngicos (22 publicações), tais como azóis (fluconazol, itraconazol e miconazol), polienos (anfotericina B [AnB]) e equinocandinas (mica-fungina), assim como tal modulação redox tem sido reportada como um importante alvo terapêutico na busca por novos e promissores compostos naturais com atividade antifúngica (32 publicações), que tem respaldo pela grande variedade de indutores que podem provir da natureza. Ainda, compostos que também induzem o burst oxidativo de fagócitos, incluindo AnB, são potencializadores do efeito antifúngico in vivo. Além do efeito antifúngico contra células planctônicas, os efeitos dos EO ou EN sobre biofilmes fúngicos, também têm sido reportados. Tem sido firmado na literatura recente um claro link entre EO ou EN e a atividade antifúngica, tanto para aqueles agentes antifúngicos já utilizados na terapêutica em humanos, quanto para possíveis candidatos a fármaco. Portanto, a indução do EO ou EN como parte do mecanismo de ação de antifúngicos demonstra ser um importante alvo terapêutico, com perspectivas favoráveis sobre os desfechos na prática clínica.

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SUMMARY Aim: In this systematic review, we evaluated the link between inducers of oxidative or nitrosative stresses (OS/NS) and antifungal activity against fungi of medical relevance (including Candida spp., Cryptococcus spp., and Aspergillus spp.), through a direct action on the fungal cell or modulating phagocyte response. Moreover, the clinical implications of this biochemical event, as well as the perspectives, were examined, highlighting the search for new compounds with antifungal activity, mainly those from natural sources and, which explores the induction of OS or NS as part of the mechanism of action. Methodology: Articles from different databases and published at any time were evaluated, between April and June 2017, and using different descriptors. Results: First, a definition of OS and NS was established in which an increase in reactive oxygen or nitrogen species (ROS/ RNS, quantified directly and from mitochondrial, Fenton reaction, endoplasmic reticulum or other fungal sources) should exceed the antioxidant defense capacity of the microorganism (evaluated by transcriptomic or proteomic or metabolomic profiles or enzyme activity levels). These events, by time and conditions delimited, can lead to the signaling of apoptosis or an actual damage toward biomolecules (lipid peroxidation or protein oxidation or DNA damage) and, consequently, they can cause cell death or other associated antifungal effect. Therefore, 64 articles were found, of these, only one was published before 2000 and 50 between 20072017, reporting the induction of OS or NS directly into the fungal cell via an increase in ROS or RNS as part of the mechanism of action of classical antifungal agents (22 publications), such as: azoles (fluconazole, itraconazole, and miconazole), polyenes (amphotericin B, [AnB]), and echinocandins (micafungin). This redox modulation has also been reported as an important therapeutic target in the search for new natural compounds with antifungal activity (32 publications), which is supported for the great variety of inducers from nature. Compounds that also induce the oxidative burst of phagocytes, including AnB, promote a combinatorial antifungal effect in vivo. In addition to the antifungal effect against plank-tonic cells, the relation between OS or NS and antifungal activity against fungal biofilms has also been reported. It has been established in the recent literature a clear link between OS or NS and antifungal effect, during the action of anti-fungal agents already used in the therapy in humans as well as for possible drug candidates. Thus, the induction of OS or NS as part of the mechanism of action proves to be an important therapeutic target with favorable perspectives on the outcomes in clinical practice.

A percepção dos familiares sobre a unidade de internação psiquiátrica em um hospital geral / Percepción de la familia de la unidad psiquiátrica en um hospital general / Perception of family members about the psychiatric hospitalization unit in a general hospital

RESUMO Objetivo: identificar a percepção dos familiares sobre assistência e organização da unidade de internação psiquiátrica em um hospital geral. Método: Pesquisa descritiva exploratória, com abordagem qualitativa, realizada em um hospital geral no interior do Oeste Paulista, junto a 13 familiares de pessoas com transtorno mental. O instrumento de coleta de dados foi um roteiro de entrevista semiestruturado e a análise ocorreu mediante ao referencial metodológico da análise temática de conteúdo proposta por Bardin. Resultados: A partir da análise dos discursos, emergiram duas categorias: a) "Relevância da ambiência e equipe multidisciplinar no tratamento de pessoas com transtornos mentais", destacando o ambiente físico, o tratamento ministrado pela equipe multidisciplinar e o contato e participação dos familiares durante a internação; e b) "Fragilidades da dinâmica assistencial como suporte nas relações interpessoais", na qual foram evidenciados os aspectos apontados como ainda frágeis na assistência. Considerações Finais: A percepção familiar foi predominantemente positiva em relação ao serviço oferecido e, mesmo com as fragilidades apontadas, estes sentem-se satisfeitos com o ambiente hospitalar no que tange ao trabalho realizado pela equipe multidisciplinar e o cuidado inclusivo da família na terapêutica.

RESUMEN Objetivo: identificar la percepción de los parientes sobre la atención y la organización de la unidad de hospitalización psiquiátrica en un hospital general. Método: Investigación exploratoria descriptiva, con enfoque cualitativo, efectuada en un hospital general del interior del Oeste de São Paulo, abarcando 13 parientes de personas con trastornos mentales. El instrumento de recolección de datos fue un guion de entrevista semiestructurado y el análisis se llevó a cabo utilizando el marco metodológico del análisis de contenido temático propuesto por Bardin. Resultados: Del análisis de los discursos, surgieron dos categorías: a) "Relevancia del ambiente y equipo multidisciplinario en el tratamiento de personas con trastornos mentales", subrayando el entorno físico, el trato brindado por el equipo multidisciplinario y el contacto y la participación de los parientes durante la hospitalización; yb) "Debilidades en la dinámica de atención como apoyo en las relaciones interpersonales", donde se resaltaron los aspectos señalados como aún débiles en la atención. Consideraciones finales: La percepción familiar fue predominantemente positiva con relación al servicio ofrecido e, incluso con las debilidades señaladas, los parientes sienten satisfechos con el entorno hospitalario en cuanto al trabajo desarrollado por el equipo multidisciplinario y la atención inclusiva de la familia en la terapia.

ABSTRACT Objective: to identify the perception family members about the care and organization of the psychiatric hospitalization unit in a general hospital. Method: Descriptive and exploratory research, with a qualitative approach, conducted in a general hospital in western São Paulo, including 13 relatives of people with mental disorders. The data collection instrument was a semi-structured interview script and the analysis took place using the methodological framework of the thematic content analysis proposed by Bardin. Results: From the analysis of the speeches, two categories were raised: a) "Relevance of environment and multidisciplinary team in the treatment of people with mental disorders", highlighting the physical environment, the treatment given by the multidisciplinary team and the contact and participation of family members during hospitalization; and b) "Weaknesses in care dynamics as a support in interpersonal relationships", where the aspects pointed out as still fragile in health care were highlighted. Final Considerations: The relatives' perception was predominantly positive in relation to the service offered and, even with the weaknesses pointed out, they feel satisfied with the hospital environment regarding the work performed by the multidisciplinary team and the inclusive care of the family in the therapy.

Obesity is associated with lack of access to dental care and physical activity among older adults: a cross-sectional study / Obesidade está associada com falta de acesso a serviços odontológicos e atividade física em idosos: um estudo transversal

OBJECTIVE: This study evaluated the prevalence of obesity and associated factors among older adults. METHODS: This was a household-based cross-sectional study involving 282 individuals aged ≥ 60 years recruited in the city of Veranópolis, Brazil, using random probabilistic sampling. Participants underwent a clinical oral examination and completed a structured questionnaire. Obesitywas determined based on body mass index (BMI). Individuals were divided into two groups based on the presence (BMI ≥ 30 kg/m2) or absence of obesity (BMI < 30 kg/m2). Uni- and multivariate analyses were performed using Poisson regression with robust variance. RESULTS: The prevalence of obesity was 34% (n = 96). Each 1-year increase in age resulted in a 3.09% decrease in the likelihood of being classified as having obesity (prevalence ratio [PR] = 0.969; 95% confidence interval [95%CI] 0.949 ­ 0.989). Older adults that reported walking < 5 or ≥ 5 times per week were 39.65 and 37.20% less likely to be classified as obese. The PRs of obesity in former and non-smokers were 4.40 and 5 times higher, respectively, than in current smokers (p < 0.05). Older adults with no access to dental care were 51.72% (p = 0.013) more likely to present with obesity. CONCLUSIONS: There was a high prevalence of obesity among older adults. Obesity was associated with lower age, smoking status, no access to dental care, and a lack of physical activity

OBJETIVO: O presente estudo avaliou a prevalência de obesidade e fatores associados em idosos. METODOLOGIA: Um estudo transversal domiciliar, com amostragem probabilística, foi realizado com 282 indivíduos de idade ≥60 anos de Veranópolis, Brasil. Um exame clínico de saúde bucal foi realizado e um questionário estruturado foi aplicado. A obesidade foi determinada pelo Índice de Massa Corporal (IMC). Os indivíduos foram categorizados com obesidade (IMC ≥ 30kg/m2) e sem obesidade (IMC < 30kg/m2). Análises uni e multivariadas foram feitas por meio de regressão de Poisson com variância robusta. RESULTADOS: A prevalência de obesidade foi de 34% (n = 96). Cada ano de aumento na idade resultou em uma diminuição de 3,09% (razão de prevalência [RP] = 0,969; intervalo de confiança de 95% [IC95%] = 0,949 ­ 0,989) na RP de ser do grupo de obesos. Idosos que reportaram caminhar < cinco ou ≥ cinco vezes por semana apresentaram menor RP para obesidade, 39,65 e 37,20%, respectivamente. Ex-fumantes e não fumantes obtiveram, respectivamente, 4,40 e 5 vezes maior RP de serem do grupo de obesos quando comparados aos fumantes (p < 0,05). Idosos sem acesso a serviços odontológicos demonstraram 51,72% (p = 0,013) maior RP de serem do grupo com obesidade. CONCLUSÕES: Houve uma alta prevalência de obesidade em idosos, que foi associada com menor idade, estado de fumo e ausência de acesso ao dentista e atividade física.

Ambientalidade, Co-existência e Sustentabilidade: Uma Gestalt em Movimento / Environmentality, Co-existence and Sustainability: A Gestalt in Motion / Ambientalidad, Co-existencia y Sostenibilidad: Una Gestalt en Movimiento

O artigo tem como objetivo propor e discutir a noção de ambientalidade, colocando-a em diálogo com as noções de sustentabilidade e co-existência, visando promover, no âmbito da Gestalt-Terapia, discussões acerca de nossa implicação ética e existencial com o Planeta Terra. Ambientalidade é um termo inexistente no dicionário e que está aqui proposto como derivação da palavra ambiente para, juntamente com animalidade e racionalidade, constituir a definição da estrutura de nossa essência humana. Animal-racional, o ser humano tem sido definido, frequentemente, de uma maneira inadequada, pois falta-lhe o terceiro existencial: ambientalidade, que estou constituindo e definindo a partir dos modos de existência que constituem a experiência humana de ser pessoa. Ambientalidade é uma dimensão da essência humana, através da qual somos co-constituintes do universo, somos partes fundantes consubstanciais de uma totalidade através da qual tudo muda, tudo está ligado a tudo. Considerando a noção de Campo organismo/ambiente da Gestalt-Terapia como um construto central na abordagem, o desenvolvimento da noção de ambientalidade pode contribuir para ampliar o escopo da perspectiva gestáltica na direção de discussões que englobem de modo mais efetivo as relações das pessoas com o mundo e coloquem em relevo sua implicação com a sustentabilidade do planeta. (AU)

The article aims to propose and discuss the notion of environmentality, placing it in dialogue with the notions of sustainability and co-existence, aiming to promote discussions in the Gestalt Therapy field about our ethical and existential implications with Planet Earth. Environmentality is a non-existent term in the dictionary which is here proposed as a derivation of the word environment to, together with animality and rationality, constitute the definition of the structure of our human essence. Animal-rational, the human being has often been defined in an inadequate way, for he lacks the third existential: environmentality, which I am constituting and defining from the modes of existence that constitute the human experience of being a person. Environmentality is a dimension of the human essence, through which we are co-constituents of the universe, we are consubstantial founding parts of a totality through which everything changes, everything is connected to everything. Considering the notion of Field organism / environment field as a central construct in the approach, the development of the notion of environmentality can contribute to broaden the scope of the gestaltic perspective towards discussions that more effectively encompass people's relationships with the environment, highlighting their implication for the sustainability of the planet. (AU)

El artículo tiene como objetivo proponer y discutir la noción de ambientalidad, colocándola en diálogo con las nociones de sostenibilidad y coexistencia, para promover discusiones en el ambito de la Terapia Gestalt sobre nuestras implicaciones éticas y existenciales con el Planeta Tierra. La ambientalidad es un término que no existe en el diccionario y que se propone aquí como una derivación de la palabra ambiente para, junto con la animalidad y la racionalidad, constituir la definición de la estructura de nuestra esencia humana. Animal-racional, el ser humano ha sido muchas veces definido de manera inadecuada, ya que carece de la tercera existencial: la ambientalidad, que estoy constituyendo y definiendo a partir de los modos de existencia que constituyen la experiencia humana de ser una persona. La ambientalidad es una dimensión de la esencia humana, a través de la cual somos co-constituyentes del universo, somos partes consustanciales fundadoras de una totalidad a través de la cual todo cambia, todo está ligado a todo. Teniendo en cuenta la noción de campo organismo / ambiente de la Terapia Gestalt como una construcción central en el enfoque, el desarrollo de la noción de ambientalidad puede contribuir a ampliar el alcance de la perspectiva gestáltica hacia discusiones que abarquen más efectivamente las relaciones de las personas con el mundo y destacar su implicación en la sostenibilidad del planeta. (AU)

Doença por Coronavírus 2019: desafios emergentes e o ensino odontológico brasileiro / Coronavirus disease 2019: emerging challenges and Brazilian dental education

A doença por coronavírus (COVID-19) surgiu na China no final de 2019, disseminando-se rapidamente por mais de 200 países. Devido às características dos ambientes e procedimentos odontológicos, há um maior risco de infecção cruzada entre a equipe de saúde bucal e os usuários desse serviço. Para consultórios odontológicos, escolas de Odontologia e seus hospitais associados, localizados em áreas que são (potencialmente) afetadas pelaCOVID-19, protocolos rigorosos e eficazes de controle de infecção estão sendo urgentemente desenvolvidos pelas agências reguladoras competentes, tanto a nível nacional, quanto internacional. Além disso, a pandemia teve um impacto imediato e dramático na educação odontológica, visto que nesse momento as instituições estão à frente do desafio de reorganizar sua infraestrutura e seus métodos de ensino para encarar as possíveis consequências dessa nova realidade, preservando e fomentando o progresso contínuo de seus futuros profissionais. Nesse sentido, o objetivo deste estudoé apresentar importantes informações relacionadas ànova síndrome respiratória aguda por coronavírus-2 e seu impacto na Odontologia, abordando as principais orientações de biossegurança que devem ser adotadas nos atendimentos clínicos, bem como discutir as mudanças no ensino odontológico brasileiro frente à pandemia de COVID-19 (AU).

Coronavirus disease (COVID-19) emerged in China in late 2019, spreading rapidly to more than 216countries. Due to the characteristics of the dental environments and procedures, there is a greater risk of cross-infection between the oral health team and the users of this service. For dental offices, dental schools, and their associated hospitals, located in areas (potentially) affected by COVID-19, rigorous and effective infection control protocols havebeing urgently developed by the competent regulatory agencies, both nationally and internationally. In addition, the pandemic had an immediate and dramatic impact on dental education, as institutions are now facing the challenge of reorganizing their infrastructure and teaching methods to face the possible consequences of this new reality, preserving and fostering continuous progress future professionals. In this sense, the objective of this study is to present important information related to the new acute respiratory syndrome caused by coronavirus-2 and its impact on Dentistry, addressing the main biosafety guidelines that must be adopted in clinical care, as well as discussing changes in Brazilian dental education. against the COVID-19 pandemic (AU).

Classification System for Cardiorespiratory Fitness Based on a Sample of the Brazilian Population

Peak oxygen consumption (VO2peak) is an important prognostic marker and its classification helps the cardiologist in the therapeutic decision-making process. The most commonly used cardiorespiratory fitness (CRF) classification has not been validated for the Brazilian population. Objective: To elaborate a CRF classification using a Brazilian sample and to compare it with the American Heart Association (AHA), Cooper and UNIFESP classifications. Methods: A total of 6,568 healthy subjects were analyzed through cardiopulmonary exercise testing (CPET). They were distributed by sex and the following age groups (years): 7-12, 13-19, 20-79 (per decades) and > 80 years. After measurement of the VO2peak, participants were distributed into quintiles of CRF in very poor, poor, moderate, high and very high (AEMA Table). The CRF classifications by AEMA, AHA, Cooper, and UNIFESP were compared using the Wilcoxon, Kappa and concordance percentages. Results: VO2peak presented an inverse and moderate correlation with age considering both sexes (R = -0.488, p < 0.001). All paired comparisons between CRF classification systems showed differences (p < 0.001) and disagreement percentage - AEMA versus AHA (k = 0.291, 56.7%), AEMA versus Cooper (k = 0.220, 62.4%) and AEMA versus UNIFESP (k = 0.201, 63.9 %). Conclusion: The AEMA table showed important discrepancies in the classification of CRF when compared to other tables widely used in our setting. Because it was obtained from a large sample of the Brazilian population, the AEMA table should be preferred over other classification systems in our population

Speed and Grade Increment During Cardiopulmonary Treadmill Testing: Impact on Exercise Prescription

Maximal oxygen uptake (VO2max) and both first (VT1) and second (VT2) thresholds have been used as reference points for exercise prescription in different populations. Objective: We aimed to test the hypothesis that exercise prescription, based on VTs determined by treadmill cardiopulmonary exercise testing (CPET), is influenced by the rate of increase in treadmill workload. Methods: Nine healthy individuals underwent two CPETs, followed by two sessions of submaximal exercise, both in randomized order. For the "speed" protocol, there was an increment of 0.1 to 0.3 km.h-1 every 15s. The "grade" incremental protocol increased 1% every 30s and 0.1 km.h-1 every 45s. This was followed by submaximal exercise sessions lasting 40min at an intensity corresponding to heart rate (HR) between the VT1 and VT2. Results: The "speed" protocol resulted in higher VT1 (p = 0.01) and VT2 (p = 0.02) when compared to the "grade" incremental protocol, but there was no effect on VO2max. The target HR for the submaximal exercise sessions was higher in the "speed" protocol compared to the "grade" incremental protocol (p < 0.01) and remained stable during the two steady-state exercise sessions. Blood lactate remained stable during the submaximal exercise sessions, with higher values observed during the "speed" protocol than those "grade" incremental protocol (p < 0.01). Conclusions: Compared to a grade-based protocol, a speed-based protocol resulted in higher VT1 and VT2, which significantly affected cardiorespiratory and metabolic responses to prescribed exercise intensity in healthy young adults

Candida spp. and phagocytosis: multiple evasion mechanisms.

Invasive fungal infections are a global health problem, mainly in hospitals, where year by year hundreds of patients die because of these infections. Commensal yeasts may become pathogenic to human beings, affecting mainly immunocompromised patients. During infectious processes, the immune system uses phagocytes to eliminate invader microorganisms. In order to prevent or neutralize phagocyte attacks, pathogenic yeasts can use virulence factors to survive, as well as to colonize and infect the host. In this review, we describe how Candida spp., mainly Candida albicans, interact with phagocytes and use several factors that contribute to immune evasion. Polymorphism, biofilm formation, gene expression and enzyme production mediate distinct functions such as adhesion, invasion, oxidative stress response, proteolysis and escape from phagocytes. Fungal and human cells have similar structures and mechanisms that decrease the number of potential targets for antifungal drugs. Therefore, research on host-pathogen interaction may aid in the discovery of new targets and in the development of new drugs or treatments for these diseases and thus to save lives.

Ozone against Pseudomonas aeruginosa biofilms in contact lenses storage cases.

Pseudomonas aeruginosa is associated with ocular infections such as keratitis. Multipurpose contact lens solutions can be used for washing, disinfection and storage of contact lenses, however, P. aeruginosa biofilm disinfection by this method is unsatisfactory. The present study aimed to investigate the effectiveness of ozonated water in reducing P. aeruginosa colony count. Lenses kept in storage cases were contaminated with P. aeruginosa and disinfected using ozonized water, chlorhexidine, ultrasound and multipurpose solutions. The multipurpose solutions and ultrasound methods reduced colony count from 1.17 to 1.63 log10 CFU/cm2 (92.93% to 97.31%), respectively, of P. aeruginosa biofilm cell viability when compared to the positive control. Both, ozonated water and chlorhexidine showed 7.42 log reduction in the number of viable cells of P. aeruginosa biofilm. As compared to chlorhexidine, ozonized water did not depose any known toxic residues, so that we recommend it as an alternative disinfectant solution for contact lenses storage cases.

Gestalt-terapia: um método de trabalho para o processo saúde-doença em oncologia / Gestalt-terapy: a method of work for the health-disease process in oncology / Gestalt-therapy: un método de trabajo para el proceso de salud-enfermedad en oncología

A Gestalt-terapia é proposta como um método de trabalho para atendimentos, intervenções, acompanhamentos psicológicos e psicoterapia no tratamento oncológico. Por olhar o ser humano em sua totalidade, essa abordagem proporciona a abertura de consciência aos indivíduos para que não se percebam somente como pessoas adoecidas e entendam as implicações causadas por essa experiência, desenvolvendo ajustamentos criativos e ampliando o contato consigo, com o mundo e com o próprio adoecer. O processo saúde-doença é concebido nesse artigo como um processo complexo, pensa-se sobre a importância da atuação do psicólogo ao longo de todo o caminho para a saúde, como agente que media a relação do sujeito com o adoecimento, partindo dos paradigmas da Psicologia da Saúde, Psicologia Hospitalar e Psico-oncologia.

Gestalt-therapy is propose as a method of psychological treatment, interventions, counselling and psychotherapy in cancer treatment. By looking at the human being as a totality, this approach provides the opening of conscience to individuals so that they do not see themselves only like sick persons and understand the implications caused by this experience, developing creative adjustments and expanding contact with themselves, with the world and with their own sickness. The health-disease process is considered in this article as a complex process. It reflects upon the importance of the psychologist in all the way to health, as an agent that mediates the individual relationship with the illness, based on the paradigms of Health Psychology and Oncology Psychology.

La Gestalt-terapia se propone como un método de trabajo para la atención, intervenciones, acompañamientos psicológicos y psicoterapia en el tratamiento del cáncer. Al observar el ser humano en su totalidad, este enfoque proporciona abertura de conciencia a las personas para que no se consideren sólo como personas enfermas y entiendan las consecuencias causadas por esta experiencia, el desarrollo de ajustes creativos y aumentando el contacto con si mismo, con el mundo y con los enfermos a sí mismo. El proceso de salud-enfermedad está diseñado en este artículo como un proceso complejo, se piensa acerca de la importancia del psicólogo a lo largo de todo el camino a la salud, como un agente que media en la relación del sujeto con la enfermedad, a partir de los paradigmas de Psicología de la Salud y la Psicogía Oncológica.

Severity of obstructive sleep apnea and extension of coronary artery disease.

PURPOSE: Obstructive sleep apnea (OSA) is highly prevalent among patients with coronary artery disease (CAD). The relationship between the severity of OSA and the severity of CAD has not been entirely established. The objective was to explore the type of correlation existent between the apnea-hypopnea index and the Gensini score, which provides granularity in terms of CAD extension and severity, in search of a dose-response relationship. METHODS: A cross-sectional study was conducted among patients that underwent cardiac catheterization due to the suspicion of CAD. Coronary lesions were classified according to one's Gensini score. The severity of OSA was determined by the apnea-hypopnea index (AHI), obtainable through a respiratory polysomnography. RESULTS: Eighty patients were eligible for the study. The mean age was 55 years, and 37% had AHI ≥ 15. Forty-four subjects (55%) had a Gensini score of 0, and five had a score < 2, indicating a 25% obstruction in a non-proximal artery; these individuals were considered non-CAD controls; and clinical characteristics were similar between them and CAD cases. Attempts to correlate the AHI with the Gensini score either converting both variables to square root (r = 0.08) or using Spearman's rho (rho = 0.13) obtained small, non-significant coefficients. AHI ≥ 15 was a predictor of a Gensini score ≥ 2 with a large effect size (OR 4.46) when adjusted for age ≥ 55 years, BMI ≥ 25 kg/m2, uric acid, and hypertension. CONCLUSIONS: In patients undergoing coronary angiography due to suspected CAD, moderate-severe OSA was associated with the presence of CAD but no significant correlation was found between the lesion severity and the AHI. Our results suggest that OSA influences CAD pathogenesis but a dose-response relationship is unlikely.