Epidemiological Profile of Human Papillomavirus in a Healthcare Center in Portugal: Implications for Public Health Policies.

Introduction Human papillomavirus (HPV) infection, a prevalent sexually transmitted disease, affects the majority of sexually active individuals at least once in their lifetime. Cervical cancer stands as a significant contributor to mortality among women. Cervical cancer screening (CCS) and HPV vaccination are recent, with few studies about their impact on the prevalence of HPV types. The emergence of novel predominant pathogen strains can be driven by vaccine-induced pathogen strain replacement, thereby enhancing and altering selection. Objective The aim of the study was to characterize the high-risk (HR) HPV infection in two Portuguese primary care units (PCUs). Materials and methods In this observational, cross-sectional, and descriptive study, we included women aged 25-64 years and registered in two PCUs, who were screened by SiiMA Rastreios (population-based screening management application), and were HR-HPV positive, between August 2015 and May 2018. The results of cervical cancer screening (CCS) can be accessed through the SiiMA Rastreios information system. For data treatment, we used MS Excel (Microsoft Corporation, Redmond, Washington, USA), IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, USA), and non-parametric tests. Results In our study, we included 4,614 women aged between 25 and 64 years old. CCS was performed on 24.47%, of whom 39.95% were tested for HR-HPV. The infection rate was 18.85%, and all 14 types of infection were identified. The most common HPV type was 31, followed by 16 and 68. We found HPV other than 16/18 in 84.43%. We found coinfections in 34.1%, with no statistically significant difference by age group. In the 25-34 age group, the incidence of infection was 33.7% vs. 17.54% in the 35-54 age group and 4.55% in the 55-64 age group. HPV16 was the most common infection in the 25-34 age group. In nulliparous women, the most common was HPV31. The relationship between smoking habits and HR-HPV infection was statistically significant, but economic insufficiency was not. Conclusion The infection incidence in this study was slightly higher than in the 2011 national study. Statistically, the infection rate was significantly higher in the younger age groups. The most frequent type varied from the national and international study results. This may be due to regional differences in HPV infection, changes in the pattern of incidence, or the effect of vaccination. The HPV pattern may be changing, so the scientific community must keep updated to develop increasingly efficient screening and vaccination programs.

Ocorrência dos indicadores de risco para a deficiência auditiva em um centro de saúde do Rio Grande do Sul / Occurence of indicators for hearing loss in a center of health of Rio Grande do Sul

RESUMO Objetivo Verificar a ocorrência dos Indicadores de Risco para a Deficiência Auditiva em neonatos e lactentes de um programa de triagem auditiva neonatal do estado do Rio Grande do Sul. Métodos Estudo retrospectivo, observacional e descritivo. Realizado por fonoaudiólogas, em um centro de saúde auditiva de média complexidade. Casuística composta por 2.333 neonatos com indicadores de risco para a deficiência auditiva, que realizaram a triagem auditiva neonatal no período de janeiro de 2012 a dezembro de 2016. A análise de dados constituiu-se na descrição do perfil da amostra, segundo as variáveis categóricas e estatísticas descritivas das variáveis numéricas. Resultados Nos quatro primeiros anos analisados, o indicador de risco com maior ocorrência foi a permanência na unidade de terapia intensiva neonatal por mais de cinco dias e, no último ano, o nascimento pré-termo. Verificou-se o aumento de hereditariedade, toxoplasmose congênita, sífilis congênita, HIV congênito e nascimento pré-termo. Verificou-se, também, a diminuição dos seguintes indicadores de risco para a deficiência auditiva: permanência na unidade de terapia intensiva por mais de cinco dias, ventilação mecânica, drogas ototóxicas, hiperbilirrubinemia com necessidade de exsanguíneotransfusão, índice de Apgar de "0" a "6" no quinto minuto, peso inferior a 1500g, pequeno para a idade gestacional e síndromes genéticas. Conclusão O indicador mais prevalente na amostra foi a permanência na unidade de terapia intensiva neonatal por mais de cinco dias, que reduziu ao longo dos anos. No último ano analisado, o fator de risco mais recorrente foi o nascimento pré-termo, que aumentou no período avaliado.

ABSTRACT Purpose Investigate the incidence of risk indicators for hearing loss in newborn and neonatal of a neonatal hearing screening program in the state of Rio Grande do Sul. Methods A retrospective, observational, descriptive study, performed by speech therapists, in a medium complexity auditory health center. Casuistry composed of 2,333 newborns with risk indicators for hearing loss, who underwent neonatal hearing screening from January 2012 to December 2016. The data analysis consisted on the description of the sample profile, according to the categorical variables and descriptive statistics of the numerical variables. Results From 2012 up to 2015, the risk indicator with higher occurrence was neonatal intensive care longer than five days, whereas preterm births prevailed in 2016. Increased heredity, congenital toxoplasmosis, congenital syphilis, congenital HIV and preterm births have also been observed. The risk indicators for hearing impairment that have decreased were: neonatal intensive care longer than five days, mechanical ventilation, ototoxic drugs, hyperbilirubinemia (serum level requiring exchange transfusion), Apgar score from 0-6 at minute five, weight below 1500g, being small for gestational age and congenital syndrome. Conclusion During the first four years, the risk indicator with higher occurrence was neonatal intensive care longer than five days, in spite of a decrease during the years. In the last year, the most frequent risk factor was preterm birth, which increased during the evaluated period.

Emissões Otoacústicas Evocadas por Estímulo Transiente: protocolos de Triagem Auditiva Neonatal / Transient evoked otoacoustic emissions (teoe): newborn hearing screening program protocols

OBJETIVO: descrever os resultados de três protocolos de EOAET de um equipamento automático utilizado em um Programa de TAN. MÉTODO: o equipamento utilizado foi programado com três critérios diferenciados de passa/falha. Protocolo A: Passar em 4 bandas de frequência, não precisando ser consecutivas; Protocolo B: Passar em 3 bandas de frequência, não precisando ser consecutivas e Protocolo C: Passar em 2 bandas de frequência, não precisando ser consecutivas. Os parâmetros para considerar presença de respostas foram: reprodutibilidade acima de 50%, relação sinal ruído > que 3dB em 1.0 e 1.5kHz e > 6dB em 2.0, 3.0 e 4.0kHz. RESULTADOS: 574 orelhas foram analisadas, sendo que as bandas de frequência de 2.0, 3.0 e 4.0kHz foram as que apresentaram percentuais de "passa" mais elevados (94,1; 95,8 e 92,7%, respectivamente). A banda de frequência de 1.0kHz obteve resposta presente em apenas 9,9% das orelhas testadas. Verificou-se que a análise do Protocolo C (2 bandas) foi a que apresentou o maior percentual de passa (96,9%). Porém este percentual não é considerado estatisticamente diferente do Protocolo B, 3 bandas, (96,2%) com valor de p=0,520. Assim, ambas as bandas são consideradas iguais, podendo-se utilizar qualquer uma das duas. Entretanto o Protocolo A (4 bandas) obteve 79,8% de percentual de passa, apresentando uma taxa de falha elevada (22,2%). CONCLUSÕES: deve-se pesquisar, com o padrão-ouro, todos os protocolos para verificação daquele com melhor sensibilidade e especificidade, apesar de terem apresentado resultados similares entre critérios de passa para 2 ou 3 bandas de frequência.

PURPOSE: to describe the results of three TEOE protocols obtained from automatic equipment used in a Newborn Hearing Screening Program. METHOD: during two months, TEOEs of 287 neonates in São Paulo were studied. To register them, we used a three-protocol, set up with different pass/fail criteria. The following protocols were registered: Protocol A: to pass in four frequency bands, not necessarily consecutive-; Protocol B: to pass in three frequency bands, not necessarily consecutive - and Protocol C: to pass in two frequency bands, not necessarily consecutive, as well. The parameters that we used to consider these answers were: reproducibility above 50%, as well as signal/noise ratio > 3dB at 1.0 and 1.5 kHz and > 6dB at 2.0, 3.0 and 4.0 kHz. RESULTS: TEOEs of 574 ears were analyzed and the 2.0, 3.0 and 4.0 frequencies showed the highest pass percentages (94.1, 95.8 and 92.7% for protocols A, B and C respectively). Protocol C showed the highest pass percentage, achieving 96,9%. Nevertheless, the results obtained in Protocol B, which had the presence of three bands, showed a similar percentage to Protocol C (96,2%). Therefore, there was a not statistically significant difference between Protocols B and C. 1.0 kHz frequency achieved a percentage of only 9.9 in the tested ears. CONCLUSIONS: one has to research Protocols A, B and C with gold standard in order to verify which one suits best in terms of sensibility and specificity, even though the three protocols studied showed similar results in pass criteria for two or three frequency bands.

Relação entre rigidez de fixador externo e quantidade de pinos: análise computacional por elementos finitos / Relationship between rigidity of external fixator and number of pins: computer analysis using finite elements

OBJETIVO: Analisar a rigidez da montagem de um fixador externo tipo plataforma, segundo diferentes números de pinos em cada clamp. MÉTODOS: Realizou-se simulação computacional do fixador externo dinâmico modelo Cromus tamanho grande (Baumer S.A.) por elementos finitos, conforme a norma ASTM F1541. Os modelos foram gerados com, aproximadamente, 450.000 elementos tetraédricos quadráticos. Compararam-se as montagens com dois, três e quatro pinos tipo Schanz com 5,5mm de diâmetro em cada clamp. Cada modelo foi submetido à força máxima de 200N, dividida em 10 sub-steps. Para os componentes foi assumido comportamento do material linear, elástico, isotrópico e homogêneo. Para cada modelo, avaliou-se a rigidez da montagem e a distribuição de tensão de Von Mises. RESULTADOS: A rigidez do sistema foi de 307,6N/mm para dois pinos, 369,0N/mm para três e437,9 N/mm para quatro. CONCLUSÃO: Os resultados demonstram que quatro pinos tipo Schanz por clamp promovem aumento de rigidez de 19% em relação à configuração com três e 42% em relação à configuração com dois. Maiores tensões ocorrem para configurações com menor quantidade de pinos. Nos modelos analisados, a tensão máxima ocorre na superfície do pino, próxima à área de fixação.

OBJECTIVE: To analyze the rigidity of a platform-type external fixator assembly, according to different numbers of pins on each clamp. METHODS: Computer simulation on a large-sized Cromus dynamic external fixator (Baumer SA) was performed using a finite element method, in accordance with the standard ASTM F1541. The models were generated with approximately 450,000 quadratic tetrahedral elements. Assemblies with two, three and four Schanz pins of 5.5 mm in diameter in each clamp were compared. Every model was subjected to a maximum force of 200 N, divided into 10 sub-steps. For the components, the behavior of the material was assumed to be linear, elastic, isotropic and homogeneous. For each model, the rigidity of the assembly and the Von Mises stress distribution were evaluated. RESULTS: The rigidity of the system was 307.6 N/mm for two pins, 369.0 N/mm for three and 437.9 N/mm for four. CONCLUSION: The results showed that four Schanz pins in each clamp promoted rigidity that was 19% greater than in the configuration with three pins and 42% greater than with two pins. Higher tension occurred in configurations with fewer pins. In the models analyzed, the maximum tension occurred on the surface of the pin, close to the fixation area.

RELATIONSHIP BETWEEN RIGIDITY OF EXTERNAL FIXATOR AND NUMBER OF PINS: COMPUTER ANALYSIS USING FINITE ELEMENTS.

OBJECTIVE: To analyze the rigidity of a platform-type external fixator assembly, according to different numbers of pins on each clamp. METHODS: Computer simulation on a large-sized Cromus dynamic external fixator (Baumer SA) was performed using a finite element method, in accordance with the standard ASTM F1541. The models were generated with approximately 450,000 quadratic tetrahedral elements. Assemblies with two, three and four Schanz pins of 5.5 mm in diameter in each clamp were compared. Every model was subjected to a maximum force of 200 N, divided into 10 sub-steps. For the components, the behavior of the material was assumed to be linear, elastic, isotropic and homogeneous. For each model, the rigidity of the assembly and the Von Mises stress distribution were evaluated. RESULTS: The rigidity of the system was 307.6 N/mm for two pins, 369.0 N/mm for three and 437.9 N/mm for four. CONCLUSION: The results showed that four Schanz pins in each clamp promoted rigidity that was 19% greater than in the configuration with three pins and 42% greater than with two pins. Higher tension occurred in configurations with fewer pins. In the models analyzed, the maximum tension occurred on the surface of the pin, close to the fixation area.