Oral health of people with emotional disorders: A systematic review and meta-analysis.

OBJECTIVES: This study aims to determine the association between severe mental disorders and oral health among individuals over 18 years of age. METHODS: An electronic search was conducted in six electronic databases and gray literature. Qualitative and quantitative analyses were performed on studies that met the inclusion criteria. The methodology of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal tool. A meta-analysis of proportions with a random effect was carried out. The certainty of evidence was evaluated using the GRADE tool. RESULTS: After searching the databases, 5,734 references were retrieved, and twenty articles were selected for synthesis. Considering the DMFT index between the groups with mental disorders and the control group, the values of the DMFT index were higher among individuals with schizophrenia [MD = 5.27; 95% CI = 4.13 - 6.42; I2 = 35%] and bipolar disorder [MD = 1.90; 95% CI = 0.87 - 2.93]. Values were lower among individuals with obsessive-compulsive disorder [MD = -0.85; 95% CI = -1.46-0.24]. The risk of bias was considered low for 16 studies, and four were classified with a moderate risk of bias. The certainty of evidence was very low. CONCLUSION: Patients with schizophrenia and bipolar disorder exhibit increased frequency in the number of decayed, missing, or filled teeth. There was no effect in relation to periodontal probing depth, plaque index, and TMD, but the evidence is still uncertain for this outcome. CLINICAL RELEVANCE: These findings underscore the need for a comprehensive health approach.

Impact of chronic diseases on the periapical health of endodontically treated teeth: A systematic review and meta-analysis.

Systemic diseases affecting the immune system can influence the body's response time to endodontic treatment, potentially necessitating a longer duration for the complete resolution of existing infections when compared to healthy controls. This systematic review aims to evaluate the association between the presence of chronic diseases and periapical status after endodontic treatment through a systematic and comprehensive assessment of existing literature on this topic. The search strategy covered seven electronic databases and grey literature, encompassing articles published until October 2023. Two reviewers independently assessed potentially eligible studies based on the following criteria: Included were studies involving populations exposed to pre-existing chronic diseases who underwent endodontic treatment in permanent teeth. These studies evaluated periapical health status, making comparisons with healthy individuals. There were no language or publication date restrictions. Additionally, two reviewers independently extracted data regarding the characteristics of the included studies. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. Meta-analysis was conducted using random effects models. The certainty of evidence was assessed using the GRADE tool. Twenty-three studies were included in the synthesis. Patients with diabetes were found to have about half the odds of having periapical health compared to non-diabetic patients (OR = 0.46; 95% CI = 0.30-0.70%; I2 = 58%) in teeth that underwent endodontic treatment. On the other hand, other systemic diseases like HIV, cardiovascular disease, and rheumatoid arthritis did not demonstrate significant differences concerning the outcome. In conclusion, diabetic patients showed a lower likelihood of maintaining periapical health. Conversely, patients with HIV, cardiovascular disease, and rheumatoid arthritis did not exhibit significant differences, although the existing evidence is still considered limited. It is crucial to manage these patients in a multidisciplinary manner to provide appropriate care for this population.

Prevalence of orofacial injuries resulting from trauma in individuals with cerebral palsy: A systematic review and meta-analysis.

Individuals with cerebral palsy (CP) may have cognitive, sensitive, behavioral, communicative, and convulsive disorders. Because defensive reflexes are reduced by CP, the risk of orofacial trauma is greater in these individuals. This study aimed to evaluate the prevalence of orofacial injuries resulting from trauma in patients with CP. This review was reported according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews (PROSPERO-CRD42022293570). The search was performed for articles published until January 2023 in Embase, Latin American and Caribbean Literature on Health Sciences (LILACS), PubMed/Medline, Scopus, and Web of Science databases. Gray literature was also consulted through Google Scholar, OpenGrey, ProQuest Dissertations, and Theses. Studies in which orofacial injuries due to trauma were prevalent in individuals with CP were included. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Additionally, a random-effects meta-analysis was conducted. Twelve studies were included in the synthesis, of which nine presented a low risk of bias and three presented a moderate risk. When considering the general prevalence of orofacial injuries in patients with CP, a prevalence of 34% [95% CI = 18%-52%; I2 = 98%] was observed, with enamel and dentin fractures being the most common orofacial injuries. Approximately one in three patients with CP showed at least one type of orofacial injury involving dental trauma. There is a lack of literature assessing the prevalence of these traumas in soft tissues and the evidence for this outcome remains uncertain.

Effectiveness of auricular acupuncture and pelvic floor muscle training in the management of urinary incontinence following surgical treatment for prostate cancer: A randomized clinical trial.

PURPOSE: To evaluate the effectiveness of auricular acupuncture combined with pelvic floor muscle training to manage urinary incontinence following radical prostatectomy. METHODS: This is a randomized clinical trial that was conducted between April 2019 and April 2020 with 60 participants allocated into two groups, namely: control (pelvic muscle training) and intervention (auricular acupuncture + pelvic muscle training). Interventions were carried out during eight weekly sessions. Generalized estimating equations and proportion difference tests were applied in the statistical analysis with a significance level of 0.05. RESULTS: Urinary incontinence severity decreased between pre-test and post-test in both groups. There was a statistically significant difference of the impact of urinary incontinence on quality of life between the groups at post-test in the domain "severity measures" (p = 0.013), and only in the intervention group between pre-test and post-test in the domains "emotions" (p < 0.001) and "sleep and mood" (p = 0.008). The intervention group was 20.8% (p = 0.007) and 25.3% (p = 0.002) less likely to present nocturia and urinary urgency, respectively. CONCLUSIONS: Auricular acupuncture combined with pelvic floor muscle training was more effective, compared to pelvic floor muscle training alone, in reducing the impact of urinary incontinence on quality of life and reducing the odds of nocturia and urinary urgency.

May value-based healthcare practices contribute to comprehensive care for cancer patients? A systematic literature review.

BACKGROUND: The cancer incidence and mortality have increased both due to aging and population growth. There is an imbalance between this increasing incidence, the costs and the available budget. It highlights the importance of a value-based healthcare (VBHC) agenda, where value is what matters to patients, represented by outcomes over costs. OBJECTIVE: To identify how VBHC has been discussed in the context of cancer care and which practices could contribute to project value-based cancer care models. METHOD: This article conducted a Systematic Literature Review (SLR) on SCOPUS (n = 168 results) and PubMed (n = 222), between 1995 and 2020, using PRISMA Protocol; and analyzed the results through VOSviewer and Bibliometrix in R, in addition to qualitative analysis for classification of practices. RESULTS: The main themes were 'Costs' (34%), 'Outcomes' (24%), 'VBHC agenda' (24%), 'models of care' (18%). 19 practices were identified and classified into 5 categories of operations: process technology and patient pathway, information and systems management, patient care scheduling and monitoring, performance measurement and quality management and network and integration. CONCLUSION: The SLR points to the absence of a value-based care model for cancer patients, but the adherence to elements of the value agenda is an issue and currently a challenge. Costs are the main concerns, although this research does not identify significant structural changes. This research contributes to highlighting the gaps between theory and practice and it can be used as an input for designing value-based care services for cancer patients, as it synthesizes current practices and the main premises for implementing value agenda.

Micro-CT evaluation of four final irrigation protocols on hard-tissue debris removal from mesial roots of mandibular molars containing isthmus.

OBJECTIVES: To evaluate by means of microcomputed tomography (micro-CT), the efficacy of four final irrigation protocols in the removal of hard-tissue debris (HTD) in mesial roots of mandibular molars containing isthmus. MATERIALS AND METHODS: Forty standardized mesial roots of extracted mandibular molars presenting isthmus were selected. The root canals were prepared and randomly divided into 4 groups (n = 10): EA, EndoActivator (Dentsply Sirona); EC, Easy Clean (Easy Dental Equipment, Belo Horizonte, Brazil); XPF, XP-Endo Finisher (FKG Dentaire, La Chaus-de Fonds, Switzerland); and PUI, passive ultrasonic irrigation using Irrisafe tip (Satelec Acteon, Merignac, France). Each final irrigation protocol was performed in two cycles (60 s), using, respectively, 2.5% sodium hypochlorite and 17% EDTA. Micro-CT scans were obtained pre-operatory, post-preparation, and post-irrigation. The percentage of HTD reduction was calculated. Data was analyzed statistically (ANOVA and Kruskal-Wallis, significance set at 5%). RESULTS: The percentage of HTD reduction was greatest for the XPF group (77.92%), followed by EA (62.92%), PUI (47.48%), and EC (32.65%). Statistical differences (p < .05) were found between XPF and EC only. A significant difference (p < .05) was found between XPF and EC in all thirds and between PUI and EC in the middle third. CONCLUSIONS: XPF, EA, and PUI were similarly effective in HTD reduction. However, none of the evaluated protocols was able to completely remove all the debris. CLINICAL RELEVANCE: Final irrigation protocols aim to clean the canal complexities that are not addressed by the shaping procedures. Micro-CT allowed to assess the removal of hard-tissue debris in the isthmus and canals of mandibular molars.

Comparison of orthodontic root resorption of root-filled and vital teeth: A meta-analysis.

BACKGROUND: In this systematic review, the authors aimed to answer the following question: Do vital teeth differ in the level of external root resorption induced by means of orthodontic treatment compared with root-filled teeth? TYPES OF STUDIES REVIEWED: The search strategy was performed in 6 electronic databases and in gray literature for articles published until July 29, 2021. Two reviewers independently assessed potentially eligible studies according to the following criteria: studies that evaluated patients undergoing fixed orthodontic therapy and compared the mean difference in millimeters of orthodontically induced external root resorption in endodontically treated teeth with the vital contralateral tooth. Only randomized, quasi-randomized, nonrandomized, cohort, case-control, or cross-sectional studies were considered eligible. There were no restrictions on language or publication time. Two reviewers also independently extracted data on the characteristics of the included studies, methods, and results, and performed risk-of-bias analysis using the Meta-Analysis of Statistics Assessment and Review instrument. Estimates of interest were calculated using random-effects meta-analyses. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: Eleven studies were included in the quantitative synthesis. Endodontically treated teeth had a lower level of root resorption (mean difference, 0.45 mm; 95% CI, -0.69 to -0.21 mm). However, the level of certainty of the evidence was considered very low owing to confounding factors. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Endodontically treated teeth may have a lower level of orthodontically induced root resorption than vital teeth, but the evidence is still uncertain about this outcome. Furthermore, owing to the small effect size, this difference might not be clinically significant (up to 1 mm).

Fatores Prognósticos e Funcionalidade na Síndrome de Compressão Medular Metastática: um Estudo de Coorte / Prognostic Factors and Functionality in Metastatic Spinal Cord Compression: Cohort Study / Factores Pronósticos y Funcionalidad a Síndrome de Compresión Espinal Metástasico: un Estudio de Cohorte

Introdução: A síndrome de compressão medular metastática (SCMM) tem grande potencial de perda irreversível da função motora e sensitiva, sendo considerada uma emergência oncológica. Objetivo: Avaliar o prognóstico da SCMM e a funcionalidade dos pacientes com tumores sólidos. Método: Estudo de coorte que incluiu pacientes com câncer que desenvolveram SCMM entre janeiro de 2017 e dezembro de 2018. Os dados clínicos e sociodemográficos foram extraídos dos prontuários físicos e eletrônicos. Análise de sobrevida foi realizada pelo método Kaplan-Meier. Resultados: O estudo abrangeu 90 pacientes que apresentaram SCMM. Ao diagnóstico da SCMM, 55,5% dos pacientes não conseguiam realizar marcha. Os pacientes com SCMM após câncer de pulmão tiveram 4,1 vezes maior risco de morrer (IC 95%, 1,79-9,41; p=0,001), os pacientes com tumores geniturinários tiveram 1,9 vezes maior risco de morrer (IC 95%, 1,06- 3,45; p=0,02) e os pacientes com outros tipos de tumor tiveram 3,1 vezes maior risco de morrer (IC 95%, 1,58-6,24; p=0,001) quando comparados aos pacientes com SCMM após câncer de mama. Conclusão: Destaca-se a relevância clínica deste estudo ao descobrir que o tipo de tumor primário é um fator preditor independente para sobrevida da SCMM. Ao diagnóstico da SCMM, mais da metade dos pacientes não realizam marcha

Introduction: Metastatic Spinal Cord Compression (MSCC) has great potential of irreversible loss of motor and sensory function, and it is considered an oncological emergency. Objective: Evaluate the prognosis of MSCC and the functionality of patients with solid tumors. Method: Cohort study was conducted in patients with cancer who developed MSCC between January 2017 and December 2018. Clinical and socio-demographic data were extracted from physical and electronic charts. Survival analysis was performed by the Kaplan-Meier method. Results: The study included 90 patients who were diagnosed with MSCC. At the time of MSCC diagnosis, 55.5% of patients were unable to walk. Patients with MSCC after lung cancer had 4.1-fold more odds of death (95% CI: 1.79-9.41; p=0.001), those with genitourinary tumors, 1.9-fold higher risk of death (95% CI: 1.06-3.45; p=0,02), and with other types of tumors, 3.1-fold higher risk of death (95% CI: 1.58-6.24; p=0.001) when compared with patients with MSCC after breast cancer. Conclusion: The clinical relevance of this study relies on the findings that the primary type of tumor is a predictive factor for overall survival of MSCC. More than half of the patients were unable to walk at the MSCC diagnosis

Introducción: El síndrome de compresión espinal (SCE) tiene un gran potencial de pérdida irreversible de la función motora y sensorial, siendo considerado una emergencia oncológica. Objetivo: Evaluar el pronóstico de SCE y la funcionalidad de los pacientes. Método: Estudio de cohorte que incluyó pacientes con cáncer que desarrollaron SCE entre enero de 2017 y diciembre de 2018. Se extrajeron datos clínicos y sociodemográficos de historias clínicas físicas y electrónicas. El análisis de supervivencia se realizó mediante el método de Kaplan-Meier. Resultados: El estudio cubrió a 90 pacientes que tenían SCE. En el diagnóstico de SCE, 55,5% de los pacientes no pueden caminar. En comparación con los pacientes con cáncer de mama, los pacientes con cáncer de pulmón tenían 4,1 veces más riesgo de morir (IC 95%, 1,79-9,41; p=0,001), los pacientes con tumores genitourinarios 1,9 veces mayor de morir (IC 95%, 1,06-3,45; p=0,02) y aquellos pacientes con otro tipo de tumor, 3,1 veces mayor riesgo de morir (IC 95%, 1,58- 6,24; p=0,001). Conclusión: Este estudio encontró que el tipo de tumor primario es un factor predictivo para la supervivencia de le SCE. Más de la mitad de los pacientes no caminan en el momento del diagnóstico de SCE. Palabras clave: compresión de la médula espinal; neoplasias de la columna

Facilidades, dificuldades e oportunidades do controle social em saúde para a garantia do acesso à saúde / Facilities, difficulties and opportunities of social control in health to guarantee access to health / Facilidades, dificultades y oportunidades del control social en salud para garantizar el acceso a la salud

O Sistema Único de Saúde (SUS) trouxe a diretriz da participação da sociedade nas discussões e deliberações acerca das políticas públicas e ações de saúde, cuja importância é fundamental para a formulação, implementação e consolidação do sistema. O objetivo do estudo é descrever as facilidades, dificuldades e oportunidades na atuação do controle social para a garantia do acesso à saúde enquanto direito. Trata-se de uma revisão integrativa da literatura, cujos artigos selecionados podem ser encontrados nas bases de dados Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) e Banco de Dados em Enfermagem (BDENF), abrangendo as publicações no período de 2010 a 2019. Selecionaram-se dez artigos. As facilidades identificadas para a atuação do controle social foram a garantia de uma efetiva ação por parte do governo e a proximidade que a Estratégia Saúde da Família apresenta, considerando sua inserção dentro do serviço de saúde. As dificuldades correspondem à falta de representatividade e de conhecimento dos conselheiros, aos conflitos particulares, à influência partidária e à falta de autonomia dos conselhos de saúde. Algumas alternativas foram identificadas para diminuir as dificuldades, como a presença de diálogo entre os membros do conselho de saúde e a oportunidade de Educação Permanente. Assim, é importante que usuários, gestores, trabalhadores e conselheiros de saúde reconheçam o seu papel na defesa do sistema público de saúde, da democracia e do fortalecimento da participação social em busca de um SUS que garanta o acesso à saúde como direito de todo cidadão.

The Unified Health System (SUS) brought the guideline for society's participation in discussions and deliberations about public policies and health actions, which has been important for its formulation, implementation and consolidation. The objective of the study is to describe the facilities, difficulties and opportunities in the performance of social control to guarantee access to health as a right. It is an integrative literature review, whose articles were selected from the Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS) and Nursing Database (BDENF) databases, covering publications from 2010 to 2019. 10 articles were selected. The facilities identified for the performance of social control were the guarantee of effective action by the government and the proximity that the Family Health Strategy presents, considering its insertion within the health service. The difficulties relate to the lack of representation and knowledge of the counselors, private conflicts, party influence and the lack of autonomy of the health councils. Some alternatives were identified to reduce the difficulties, such as the presence of dialogue between the members of the health council and the opportunity for Permanent Education. Thus, it is important that users, managers, workers and health counselors recognize their role in defending the public health system, democracy and strengthening social participation in search of a SUS that guarantees access to health as a right for every citizen.

El Sistema Único de Salud (SUS) trajo consigo la pauta para la participación de la sociedad en las discusiones y deliberaciones sobre las políticas públicas y acciones de salud, lo que ha sido importante para la formulación, implementación y consolidación de ese sistema. El objetivo de este estudio es describir las facilidades, dificultades y oportunidades en el desempeño del control social para garantizar el acceso a la salud como derecho. Se trata de una revisión integradora de la literatura, cuyos artículos fueron seleccionados de las bases de datos Scientific Electronic Library Online (SciELO), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y Base de Datos de Enfermería (BDENF), abarcando las publicaciones de 2010 a 2019. Se seleccionaron diez artículos. Las instalaciones identificadas para la realización del control social fueron la garantía de la acción efectiva por parte del gobierno y la cercanía que presenta la Estrategia de Salud Familiar, considerando su inserción dentro del servicio de salud. Las dificultades se relacionan con la falta de representación y conocimiento de los consejeros, los conflictos privados, la influencia partidaria y la falta de autonomía de los consejos de salud. Se identificaron algunas alternativas para reducir las dificultades, como la presencia de diálogo entre los miembros del consejo de salud y la oportunidad de Educación Permanente. Por ello, es importante que usuarios, gestores, trabajadores y consejeros de salud reconozcan su rol en la defensa del sistema público de salud, la democracia y el fortalecimiento de la participación social en busca de un SUS que garantice el acceso a la salud como un derecho de todos los ciudadanos.

Evolution of individual registrations in SISAB from the new financing of Primary Care: A descriptive study / Evolución de las inscripciones individuales en el SISAB a partir de la nueva financiación de la Atención Primaria: Un estudio descriptivo / Evolução dos cadastros individuais no SISAB a partir do novo financiamento da Atenção Básica: Um estudo descritivo

It is understood that the new financing of Primary Care through Previne Brasil instituted in November 2019, implied the need for individual registrations as a premise for transferring resources to the municipalities. In the meantime, it is noteworthy that this study aims to highlight the evolution of the number of individual registrations of e-SUS AB among the Northeastern states in the period between the third quarter of 2019 (2019Q3) and the third quarter of 2020 (2020Q3). This is a descriptive cross-sectional study of a quantitative nature, based on secondary data collected from the Primary Care Information System between February and March 2021. When analyzing the results, the state that showed the greatest evolution in the number of registrations was Bahia with a percentage equivalent to 7.12%, while only Ceará showed no growth in the number of registrations. The other states in the Northeast region did not show an increase of more than 4%. After one year of implementation of the Program, it was observed that the evolution of the registrations is still incipient, and new investigations are needed with the municipalities in order to identify strategies to increase individual registrations and therefore maintain the cost of Primary Health Care.

Se entiende que la nueva financiación de la Atención Primaria a través de Previne Brasil, instituida en noviembre de 2019, implicó la necesidad de registros individuales como premisa para la transferencia de recursos a los municipios. Mientras tanto, cabe destacar que este estudio tiene como objetivo mostrar la evolución del número de registros individuales de e-SUS AB entre los estados del noreste en el período comprendido entre el tercer trimestre de 2019 (2019Q3) y el tercer trimestre de 2020 (2020Q3). Se trata de un estudio descriptivo transversal de carácter cuantitativo, basado en datos secundarios recogidos del Sistema de Información de Atención Primaria entre febrero y marzo de 2021. Al analizar los resultados, el estado que mostró la mayor evolución en el número de registros fue Bahía con un porcentaje equivalente al 7,12%, mientras que sólo Ceará no mostró crecimiento en el número de registros. Los demás estados que componen la región noreste no registraron un crecimiento superior al 4%. Después de un año de implementación del programa, se observó que la evolución de las inscripciones es aún incipiente, lo que exige nuevas investigaciones con los municipios para identificar estrategias que permitan aumentar las inscripciones individuales y, por lo tanto, mantener el costo de la Atención Primaria de Salud. Traducción realizada con la versión gratuita del traductor www.DeepL.com/Translator

Compreende-se que o novo financiamento da Atenção Básica através do Previne Brasil instituído em novembro de 2019, implicou na necessidade de cadastros individuais como premissa para repasse de recursos aos municípios. Neste ínterim, ressalta-se que este estudo pretende evidenciar a evolução do número de cadastros individuais do e-SUS AB entre os estados do Nordeste no período entre o terceiro quadrimestre de 2019 (2019Q3) e o terceiro quadrimestre de 2020 (2020Q3). Trata-se de um estudo transversal descritivo de natureza quantitativa, pautado em dados secundários coletados do Sistema de Informação da Atenção Básica, entre fevereiro e março de 2021. Ao analisar os resultados, aquele estado que apresentou maior evolução no número de cadastros foi a Bahia com percentual equivalente a 7,12%, enquanto que apenas o Ceará não apresentou crescimento no número de cadastros. Os outros estados que compõem a região Nordeste, não apresentaram crescimento superior a 4%. Em um ano de implantação do Programa, observou-se que a evolução dos cadastros ainda é incipiente, sendo necessárias novas investigações junto aos municípios a fim de serem levantadas estratégias para incremento dos cadastros individuais e por conseguinte manutenção do custeio da Atenção Primária à Saúde.

Impact of orthodontic-surgical treatment on quality of life: a meta-analysis.

BACKGROUND: Orthognathic surgery involves a change in the patient's functional and aesthetic aspects. OBJECTIVE: The objective was to answer the following focused question: what is the impact on quality of life (QoL; aesthetic, function, social, and psychological aspects) in patients undergoing orthodontic-surgical treatment? SEARCH METHODS: Appropriate word combinations and truncations were selected and tailored specifically for each electronic database: PubMed/Medline, Scopus, Web of Science, PsycInfo, and Latin American and Caribbean Health Sciences Literature and gray literature. SELECTION CRITERIA: Studies that met the following criteria was included: patients with dentofacial deformity (P); surgical correction through orthodontic-surgical treatment (E/I); before orthodontic-surgical treatment or patients with no dentofacial deformity (C); QoL (O); cross-sectional, cohort, case-control and randomized or non-randomized clinical trial (S). DATA COLLECTION AND ANALYSIS: In phase 1, two reviewers independently reviewed the titles and abstracts of all references. All articles that did not meet the inclusion criteria were excluded. In phase 2, the same reviewers completely read the selected articles independently. RESULTS: A total of 2879 articles were retrieved during the final database search. Fifty-two articles were selected for full reading, of which 16 were excluded, resulting in 36 included articles. The meta-analysis was performed using 13 of the selected studies. When comparing the period before any treatment with the post-operative period of 4-8 weeks, there was an association only for facial aesthetics (mean difference = 3.00; 95 per cent confidence interval = 1.10-4.89; inconsistency index = 63 per cent). The comparison between the period before any treatment with the 6 month post-operative period showed an improved QoL in all of the domains evaluated and, when comparing data after the orthodontic-surgical preparation (before surgery) and after 5-12 months of surgery, there was also statistical significance with an increased QoL for all of the domains evaluated. CONCLUSIONS: In conclusion, based on the results of this systematic review and meta-analysis, the evidence suggests an improvement in the QoL of patients undergoing orthodontic-surgical treatment regarding aesthetic, functional, social, and psychological aspects. REGISTRATION: CRD42017069495.

Dinâmica organizativa do acesso dos usuários aos serviços de saúde de média e alta complexidade / Organizational dynamics of user access to average and high complexity health services

Estudo sobre o acesso dos usuários aos serviços de saúde de média e alta complexidade. Tem-se como objetivo analisar a dinâmica organizativa do acesso dos usuários aos serviços públicos de saúde de média e alta complexidade. Pesquisa qualitativa, crítica analítica, realizada com 26 participantes (profissionais, usuários e gestores dos serviços de saúde). As técnicas de coleta de dados foram: entrevista semiestruturada, observação sistemática e documentos. O método de análise foi o hermenêutico-dialético. O acesso aos serviços de saúde "transversalizam" as dimensões política, técnica e simbólica, as quais caminham para o atendimento das necessidades de saúde, apesar de ainda necessitar da participação da população para sua concretização como direito de cidadania.

Study about the user access to medium and high complexity health services. It has as objective to analyze the organizational dynamics of user access to medium and high complexity public health services. Qualitative research and critical analysis were conducted with 26 participants (professionals, users and managers of health services). The data collection techniques were semi-structured interview, systematic observation and document review. The method of analysis was hermeneutic-dialectic. The access to health services cross the political, technical and symbolic dimensions, which move to meet the health needs, although it still requires the participation of the population for its implementation as a citizenship right.

Fatores Preditores para a Falha da Ventilação não Invasiva em Pacientes Hospitalizados com Câncer / Predictive Factors for Failure of Non-Invasive Ventilation in Hospitalized Patients with Cancer / Factores Predictores para la Falla de la Ventilación no Invasiva en Pacientes Hospitalizados con Câncer

Introdução: A ventilação não invasiva (VNI) apresenta benefícios comprovados em diversas condições clínicas, entretanto, os resultados em pacientes com câncer são controversos. Objetivos: Analisar os fatores preditores para falha da VNI em pacientes oncológicos; descrever a mortalidade hospitalar e a sobrevida global após internação. Método: Estudo de coorte retrospectiva incluindo pacientes com tumores sólidos e neoplasias hematológicas, admitidos para internação hospitalar no Hospital do Câncer I do Instituto Nacional de Câncer José Alencar Gomes da Silva (HC I/INCA), entre 1º de janeiro e 31 de dezembro de 2017, e que foram submetidos à VNI. A associação entre as variáveis de exposição (variáveis clínicas e sociodemográficas) e os desfechos (falha na VNI) foi realizada pela regressão logística bruta e ajustada. Foi utilizado o método de Kaplan-Meier para análise da sobrevida global. Resultados: Foram incluídos 66 pacientes com média de idade de 62,3 anos (±15,0). O tempo médio de VNI na primeira sessão foi de 49,8 minutos (±30,9); o número médio de sessões foi de 2,1 (±1,4). Os pacientes que apresentaram falha tiveram maior tempo de internação hospitalar (11,8 dias vs 6,0 dias) e maior mortalidade hospitalar (90,9 vs 43,6%). Os pacientes com infecção pulmonar tiveram um risco de 4,71 vezes maior de falharem na VNI, em relação àqueles pacientes que apresentaram sucesso (OR 4,71; IC 95%, 1,14-19,47; p=0,032). Conclusão: Pacientes que apresentaram infecção pulmonar tiveram maior probabilidade em falha na VNI. Foi observada pior sobrevida global entre aqueles pacientes que falharam na VNI.

Introduction: The non-invasive ventilation (NIV) presents confirmed benefits in various clinical conditions, however, the results in patients with cancer are controversial. Objectives: To analyze the predicting factors for failure of the NIV in cancer patients; To describe hospital mortality and overall survival after admission. Method: Study of retrospective cohort including patients with solid tumors and hematological neoplasm who have been admitted to the hospital stay at Hospital of Cancer I of the National Cancer Institute José Alencar Gomes da Silva (HCI/INCA) between Jan 1 st and Dec 31 2017 and were submitted to NIV. The association between the exposure (clinical and socio-demographic variables) and the outcome (NIV failure) was performed by gross and adjusted logistic regression. The Kaplan-Meier method was used to analyze the overall survival. Results:Sixty-six patients with mean age of 62.3 years (± 15.0 years) were included. The average lasting time of the first session was 49.8 min (±30.9), the average number of sessions was 2.1 (±1.4). The patients who showed failure had longer time hospital stay (11.8 days vs 6.0 days) and higher hospital mortality (90.9 vs 43.6%).The patients with lung infection showed a higher risk of 4.71 times of failure in NIV related to those patients who showed succeeding (OR 4.71; IC 95%, 1.14-19.47; p=0.032). Conclusion: Patients who showed lung infection were more likely to failure in NIV. Was observed a worst overall survival between those patients who failed in NIV.

Introducción: La ventilación no invasiva (VNI) muestra beneficios comprobados en diversos cuadros clínicos, sin embargo, hay controversia en los resultados presentados en pacientes con cáncer. Objetivos: Analizar los factores predictores para falla de la VNI en pacientes oncológicos; Describir la mortalidad hospitalaria y sobrevida global después de la internación. Método: Estudio de corte retrospectivo incluyendo pacientes con tumores sólidos y neoplastias hematológicas, admitidos para internación hospitalar en el Hospital de Cáncer I del Instituto Nacional de Cáncer José Alencar Gomes da Silva (HCI/INCA) entre el 1ro de enero y 31 de diciembre de 2017 y que fueron sometidos a la VNI. La asociación entre las variables de exposición (variables clínicas y socio demográficas) y los resultados (falla en la VNI) fue realizada por regresión logística bruta y ajustada. Fue utilizado el método de Kaplan-Meier para el análisis de sobrevida global. Resultados: Fueron incluidos 66 pacientes con un promedio de edad de 62,3 años (±15,0). El tiempo promedio de VNI em primera sesión fue de 49,8 minutos (±30,9). El número promedio de sesiones fue de 2,1 (±1,4). Los pacientes que presentaron falla tuvieron mayor tiempo de internación hospitalaria (11,8 días vs 6,0 días) y mayor mortalidad hospitalaria (90,9 vs 43,6%). Los pacientes con infección pulmonar presentaron un riesgo 4,71 veces mayor de fallar en VNI en relación a aquellos pacientes que presentaron suceso (OR 4,71; IC 95%, 1,14-19,47; p=0,032). Conclusión: Pacientes que presentaron infección pulmonar tuvieron mayor probabilidad en fallar en la VNI. Se observó peor sobrevida global entre aquellos pacientes que fallaron en la VNI.

Effect of acute administration of nicotine and ethanol on tooth movement in rats.

The aim of this study was to evaluate the effect of acute administration of nicotine and ethanol on tooth movement in rats. Two hundred rats were divided into eight groups: S: saline; N: nicotine; E: ethanol; NE: nicotine and ethanol; SM: saline with tooth movement; NM: nicotine with tooth movement; EM: ethanol with tooth movement; and NEM: nicotine and ethanol with tooth movement. All the solutions were applied for 32, 44, or 58 days, according to the subgroup. Orthodontic movement (25 cN) was initiated 30 days after solution administration in the groups with tooth movement. The rats were euthanized 2, 14, or 28 days after initiation of tooth movement. Tooth sections were stained using picrosirius and tartrate-resistant acid phosphatase (TRAP). The data were compared by ANOVA using Tukey's HSD and Games-Howell. On day 28 of tooth movement, the NEM group had a lower percentage of type I collagen compared to the SM group (p = 0.0448), and the S group had a higher number of osteoclasts/µm2 compared to the N group (p = 0.0405). Nicotine and ethanol did not affect the tooth movement rate, regardless of induction of orthodontic movement. Nicotine influenced the number of osteoclasts by decreasing their quantity when dental movement was not induced. When nicotine was associated with ethanol, it interfered in the maturation of collagen fibers during orthodontic movement.

Tubular dentin sealer penetration after different final irrigation protocols: A confocal laser scanning microscopy study.

The aim of this study was to evaluate tubular dentin sealer penetration, comparing different final irrigation protocols using a conventional needle (CONV), EndoActivator system (EAS), EndoVac system (EVS), and ultrasound (PUI). Initially, fifty-two first maxillary molars with a single canal in the palatal root, without abrupt curvatures, resorptive processes, or previous endodontic treatment were selected for this study. Then, the crowns were sectioned to obtain palatal roots 15 mm in length. The root canals were prepared with the ProTaper Universal System and irrigated with 5% NaOCl. Afterwards, the specimens were divided into four groups (n. 13), according to the final irrigation protocol: CONV, EAS, EVS, and PUI. After filling, slices at 3 mm and 5 mm from the apex were obtained for analysis by confocal laser scanning microscopy. Two-way comparisons between the groups and the levels were performed with Games Howell's test (p < .05). Tubular dentin sealer penetration was higher at 5 mm compared with 3 mm from the apex (p < .05). The EAS group showed a higher percentage of tubular dentin sealer penetration, compared with the CONV group, at both levels. At 3 mm, there was no statistically significant difference among EAS, EVS, and PUI; however, these groups showed better performance, compared with the CONV group. At 5 mm, there was no statistically significant difference between the EAS and EVS groups, but both showed higher sealer penetration than the PUI group (p < .05). The EAS and EVS groups achieved better degrees of tubular dentin sealer penetration, compared with the other groups.

Effect of acute administration of nicotine and ethanol on tooth movement in rats

Abstract The aim of this study was to evaluate the effect of acute administration of nicotine and ethanol on tooth movement in rats. Two hundred rats were divided into eight groups: S: saline; N: nicotine; E: ethanol; NE: nicotine and ethanol; SM: saline with tooth movement; NM: nicotine with tooth movement; EM: ethanol with tooth movement; and NEM: nicotine and ethanol with tooth movement. All the solutions were applied for 32, 44, or 58 days, according to the subgroup. Orthodontic movement (25 cN) was initiated 30 days after solution administration in the groups with tooth movement. The rats were euthanized 2, 14, or 28 days after initiation of tooth movement. Tooth sections were stained using picrosirius and tartrate-resistant acid phosphatase (TRAP). The data were compared by ANOVA using Tukey's HSD and Games-Howell. On day 28 of tooth movement, the NEM group had a lower percentage of type I collagen compared to the SM group (p = 0.0448), and the S group had a higher number of osteoclasts/μm2 compared to the N group (p = 0.0405). Nicotine and ethanol did not affect the tooth movement rate, regardless of induction of orthodontic movement. Nicotine influenced the number of osteoclasts by decreasing their quantity when dental movement was not induced. When nicotine was associated with ethanol, it interfered in the maturation of collagen fibers during orthodontic movement.

The magnitude of syphilis: from prevalence to vertical transmission.

INTRODUCTION: In 2013, the World Health Organization (WHO) reported that 1.9 million pregnant women were infected with syphilis worldwide, of which 66.5% had adverse fetal effects in cases of untreated syphilis. Congenital syphilis contributes significantly to infant mortality, accounting for 305,000 perinatal deaths worldwide annually. AIM: To estimate the prevalence of syphilis in parturients, the incidence of congenital syphilis and the vertical transmission rate. MATERIAL AND METHODS: a cross-sectional study with data collected from 2041 parturients who had undergone treatment between 2012 and 2014 in the maternity section of the Pedro Ernesto Hospital of the State University of Rio de Janeiro, in the metropolitan area of Rio de Janeiro. The inclusion criterion was positive VDRL and treponemal test in a hospital environment. RESULTS: the prevalence of syphilis in pregnant women was 4.1% in 2012, 3.1% in 2013 and 5% in 2014, with official reporting of 15.6%, 25.0% and 48.1%, respectively. The incidence of congenital syphilis (CS) was 22/1,000 in live births (LB) in 2012; 17/1,000 LB in 2013 and 44.8/1,000 LB in 2014. CS underreporting during the period was 6.7%. Vertical transmission occurred in 65.8% of infants from infected mothers. It was concluded that, in 34.6% of the CS cases, maternal VDRL titers were = 1/4. CONCLUSION: Results demonstrate the magnitude of the disease, fragility of the reporting system in the assessment of the actual prevalence, impact on perinatal outcomes, and they are a warning about the real situation of syphilis, which is still underestimated in the State.

Avaliação da aplicabilidade do método descrito por Murdoch e Greenleens para identificação presuntiva de Staphylococcus aureus utilizando garrafas de hemocultura com carvão em garrafas FAN Plus® com esferas poliméricas adsorventes / Aplicability evaluation of the methoAplicability evaluation of the method described by Murdoch and Greenleens for Staphylococcus aureus presumptive identification in blood culture bottles with vegetable coal in bottles FAN Plus® with polymer spheres adsorbentsd described by Murdoch and Greenleens for Staphylococcus aureus presumptive identification in blood culture bottles with vegetable coal in bottles FAN Plus® with polymer spheres adsorbents

Objetivo: Avaliar se o método de identificação rápida descrito por Murdoch e Greenleens (2004) utilizando garrafas de cultura de sangue FAN com carvão vegetal se aplica às novas garrafas FAN Plus® com esferas poliméricas adsorventes. Métodos: Foi realizado um estudo analítico retrospectivo a fim de identificar presuntivamente Staphylococcus aureus em garrafas de hemocultura a partir da análise da bacterioscopia direta por coloração de Gram. Resultados: Um total de 291 lâminas de bacterioscopia que evidenciaram cocos Gram positivos agrupados semelhantes à Staphylococcus foram analisadas; o teste aplicado revelou 51,75% de sensibilidade, 86,15% de especificidade e valores preditivos positivo e negativo de 66,85% e 76,8% respectivamente. Conclusão: Com base nos resultados, propomos que mais estudos como estes sejam realizados para verificar se existe um novo padrão morfológico diferente do descrito por Murdoch para os frascos de hemocultura FAN Plus®, o que auxiliaria em um diagnóstico mais rápido em casos de bacteremias verdadeiras por S. aureus

Objective: To assess whether rapid identification method described by Murdoch and Greenleens (2004) using blood culture bottles FAN with charcoal applies the new Plus® FAN bottles adsorbent polymer beads. Methods: A retrospective analytical study was performed to identify presumptive Staphylococcus aureus in blood culture bottles from the analysis of the direct Gram stain Gram staining. Results: A total of 291 Gram stain slides that showed positive cocci grouped similar to Staphylococcus were analyzed; the applied test showed 51.75% sensitivity, 86.15% specificity and positive and negative predictive values of 66.85% and 76.8% respectively. Conclusion: Based on the results, we propose that more studies like these are carried out to check if there is a new different morphological pattern described by Murdoch for bottles FAN Plus® blood culture which would help in faster diagnosis in true bacteremia cases by S. aureus