Periodontal Status in Morbidly Obese Patients With and Without Obstructive Sleep Apnea Syndrome Risk: A Cross-Sectional Study.

BACKGROUND: This cross-sectional study aims to investigate the correlation between obstructive sleep apnea syndrome (OSAS) risk with periodontal disease and anthropometric measures in Class III obese patients. METHODS: Anthropometric measurements were taken from 108 patients of both sexes, aged 30 to 60 years. The Berlin questionnaire (Bq) and the Epworth sleepiness scale (ESS) were applied to determine the risk for OSAS. Full-mouth periodontal status was determined by probing depth, clinical attachment level, gingival bleeding index, and the presence of calculus. Unpaired Student t, χ(2), Fisher exact, and Mann-Whitney U tests were applied to analyze the differences between high and low risk for OSAS groups. RESULTS: Overall, 81.5% of the patients showed high risk for OSAS, 46.3% had excessive daytime sleepiness, 41.5% were positive for both the Bq and ESS, and 97.2% had periodontal disease (periodontitis = 85.2% and gingivitis = 60.2%). Patients with periodontal disease showed high risk for OSAS (82.9%) and ESS (45.7%). However, there was no influence of periodontal disease on OSAS risk. Periodontitis was not associated with the ESS (odds ratio [OR] = 1.84, 95% confidence interval [CI] = 0.54 to 6.26) or Bq (OR = 0.87, 95% CI = 0.10 to 7.84), nor was gingivitis associated with the ESS (OR = 1.25, 95% CI = 0.48 to 3.25) or Bq (OR = 0.23, 95% CI = 0.03 to 1.84). Waist circumference (P = 0.03), neck circumference (NC, P <0.001), and the percentage of predicted NC (PPNC, P <0.001) were significantly larger in the patients at high risk for OSAS than in those at low risk for OSAS. Daytime sleepiness was also associated with NC (P = 0.02) and PPNC (P = 0.02). CONCLUSION: There was no association between periodontal disease and OSAS risk in Class III obese patients, but OSAS risk was associated with both NC and PPNC.

Association between dental caries activity, quality of life and obesity in Brazilian adolescents.

OBJECTIVES: The impact of oral conditions on quality of life in overweight/obesity needs to be elucidated. The aim of this study was to evaluate the association between dental caries activity, quality of life and obesity in Brazilian adolescents. MATERIALS AND METHODS: This study was conducted at public schools in Brazil, on a sample of 202 adolescents, 12 years of age. For anthropometric evaluation, the body mass index (BMI)-for-age was used. In oral examinations, the Decayed, Missing, Filled teeth (DMFT), significant caries (SiC) and dental caries activity (DCA) indices were used (κ > 0.94). The Child-Oral Impacts on Daily Performance (Child-OIDP) index was applied. The sample was divided into two groups: O (overweight/obese; n = 101) and N (normal weight; n = 101). For data analysis, chi-square, odds ratio (OR), Wilcoxon and Pearson correlation tests were used (P < 0.05). RESULTS: The DMFT scores were 1.67 and 2.12 and the SiC scores were 3.85 and 4.26 for groups O and N, respectively. BMI-for-age was significantly related to DCA (OR = 0.579; P < 0.000) and to SiC (OR = 0.649; P = 0.024). There were differences between the groups in eating, cleaning mouth, emotional status, smiling, studying and the overall Child-OIDP (P < 0.05). Positive associations between the impacts on eating, cleaning mouth and smiling were found (P < 0.05). DMFT values showed significant correlation with the emotional status performance in group O and the DCA was positively correlated with performance at school in group O (P < 0.05). CONCLUSION: Obesity, dental caries and quality of life were not correlated. Adolescents with normal weight presented a low perception of the impact of oral conditions on quality of life; however, it seemed to affect psychological aspects in their daily performances. Providing adolescents with nutritional assistance may prevent obesity and dental caries, and improve their quality of life.

Restrição ao uso de tabaco e a prevenção do câncer bucal / Restriction of tobacco use and the prevention of oral cancer

A Organização Mundial da Saúde relata que a epidemia mundial de tabagismo é uma das maiores ameaças à saúde pública dos tempos modernos. O objetivo deste estudo foi relacionar a adoção de medidas restritivas ao uso do tabaco e suas implicações na prevenção ao câncer bucal, por meio de revisão crítica. As evidencias científicas apontam que o uso de tabaco é considerado como causa primária de muitos problemas e doenças bucais, dentre às quais se destacam o câncer bucal, doença periodontal, perdas dentárias e defeitos congênitos. No Brasil e no mundo os principais documentos que regulam a disposição, uso e estratégias de combate aotabaco são relacionados à legislação vigente, documentos internacionais e aos estudos epidemiológicos. Conclui-se que a prevenção ao câncer bucal está relacionada à conscientização das populações quanto aos malefícios causados por hábitos deletérios, como o uso de tabaco, à adoção de práticas saudáveis, bem como se evidencia a necessidade de desenvolvimento de ações abrangentes para o controle do câncer, nos diferentes níveis de atuação e a adoção de medidas mais amplas de restrição ao uso de tabaco pelos diversossetores da sociedade.

The World Health Organization reports that the worldwide epidemic of smoking is the major threat to the public health of modern times. The objective of this study was to relate the adoption of restrictive measures to tobacco use and its implications in the prevention of oral cancer, through critical review. The scientific evidence suggests that the use of tobacco is considered as the primary cause of many problems and oraldiseases, among which are the oral cancer, periodontal disease, tooth loss and congenital defects. In Brazil and the world the main documents regulating the provision, use and strategies to combat tobacco use are related to legislation, international documents and the epidemiological studies. It is concluded that prevention of oral cancer is related to awareness of people about the harm caused by deleterious habits such as use of tobacco, the adoption of healthy practices, and as well as highlighting the need for development ofcomprehensive actions to control the cancer, the different levels of performance and the adoption of furthermeasures to restrict the use of tobacco by the different sectors of society.

O ensino da ética, bioética e deontologia na graduação defonoaudiologia. / The teaching of ethics, bioethics and deontology in phonoaudiology graduation.

O ensino da bioética nos cursos de graduação nas áreas da saúde é um tema emergente, decorrente da evolução científica e tecnológica. O curso de fonoaudiologia atende a problemas relativos a comunicação humana, e tem impacto direto sobre a qualidade de vida dos pacientes. O objetivo deste estudo foi identificar quais os cursos de graduação em Fonoaudiologia no país, apresentam em sua matriz curricular a disciplina de bioética, ética e/ou deontologia, e verificar qual ano do curso esta é ministrada. Os dados foram obtidos da lista de cursos disponibilizada pelo CFFa, via endereço eletrônico acessados entre os meses de março e abril de 2009. Junto ao CFFa estavam cadastradas 90 instituições. Destas, apenas 60 possuíam endereço eletrônico, sendo que 9 não possuíam a matriz curricular do curso, 9 não puderam ser acessadas por problemas no endereço eletrônico e 5 não constavam o curso de graduação em Fonoaudiologia e em 7 endereços não constavam as disciplinas de ética, bioética e/ou deontologia na matriz curricular. A Bioética, Ética, e Deontologia foram distribuídas de forma diferente em cada Instituição ao longo dos anos. Concluiu-se que nenhuma instituição adota os três termos e não há consenso em que período esta(s) deve(m) ser ministradas.

The teaching of bioethics in health sciences graduation is an issue that needs to be addressed, considering the scientific and technological development. The phonoaudiology deals with human communication issues, and has direct impact on patients life quality. The aim of this study was to identify which Brazilian phonoaudiology graduation courses included the disciplines of bioethics, ethics and/or deontology, and verify in which year of the course it is ministered. Data were obtained from the Conselho Federal de Fonoaudiologia (CFFa ? national phonoaudiology council) online database, in the period from March to April 2009. There were 90 institutions registered in the CFFa database. 60 of themhave available websites; of those, 9 did not display the curriculum online, 9could not be verified due to website problems, 5 had no phonoaudiology graduation course information and 7 had no bioethics, ethics and/or deontology in the displayed curriculum. Those disciplines were distributed differently in each institution, over the course years. The conclusion is that no institution uses the three terms and there is no consensus about on which period the disciplines must be ministered.

Acolhimento aos usuários: uma revisão sistemática do atendimento no Sistema Único de Saúde / The user’s attendance: a Systematic Review on the Brazilian Health Care System (SUS)

Introdução: O Ministério da Saúde (MS) propôs por meio do programa Humaniza SUS, a humanização como eixo norteador das práticas de atenção e gestão em todas as instâncias do Sistema Único de Saúde (SUS). De acordo com tal programa, humanizar é: “ofertar atendimento de qualidade articulando os avanços tecnológicos com acolhimento, como melhoria nos ambientes de cuidado e das condições de trabalho dos profissionais”.Objetivo: O presente artigo apresenta uma revisão sistemática para investigar o modo de operacionalização do acolhimento aos usuários nos serviços públicos de saúde e sua incorporação frente aos princípios do SUS. Metodologia: Foram revisadas informações apresentadas em trabalhos anteriores, incluídas em artigos publicados nos últimos dez anos, considerando-se a produção registrada nas seguintes bases de dados bibliográficos: LILACS, MEDLINE e SciELO. Resultados: Dos 148 trabalhos identificados, 10 artigos foram selecionados conforme os critérios pré-estabelecidos e serviram de base para este trabalho. Conclusão: Apostura de acolhimento aos usuários do SUS deve se estender desde a porta de entrada aos serviços deníveis de complexidade, segundo a necessidade de cada usuário. Para que o acesso possa contemplar os princípios da integralidade, torna-se relevante a presença de uma equipe humanizada que atue como facilitadora na consolidação de estratégias de acolhimento.

Introduction: The Ministry of Health proposed by means of Humanize-SUS Program the humanization as guideline for the practice of care and management in all the instances of the SUS. According to such program, to humanize is: “to offer quality of health care articulating the technological advances with the user´s attendance to improve health care environment and the professionals´working conditions”. Objective: This work presents a systematic review of related studies with the purpose of investigating the way to operationalize the user´s attendance in the public health services and its incorporation according to the SUS principles. Methodology: A review was performed on studies mainly in papers published in the last ten years; considering the following bibliographical databases: LILACS, MEDLINE and SciELO. Results: Out of 148 studies, 10 papers were selected according to the pre-established criterion and used as guideline for this study. Conclusion:The care related to the user´s attendance must start from the entrance door to the wards of complexity levels, according to each user´s needs. In such way, the access can contemplate the principles of the Integral HealthCare; being important the presence of a humanized team to perform as facilitator to consolidate some attendance strategies.

A genética e os seguros: correlação e analogia ao estudo do genoma humano: [revisão] / Genetics and insurance companies: correlationship and analogy with human genome studies: [revision]

O mapeamento genético possibilitou a detecção de alterações que provocam o aparecimento de certas doenças, mesmo antes do aparecimento dos sintomas, e a otimização das terapêuticas de algumas patologias e prevenção de doenças multifatoriais. Com os avanços na tecnologia genética, aumentaram também as discussões sobre o fato de que as seguradoras podem usar os testes genéticos para o estabelecimento de taxas. Também existe a possibilidade das seguradoras conduzirem seus próprios testes ou questionar o consumidor sobre a sua história genética. Isso representa um possível conflito entre interesses do consumidor e das seguradoras. Casos de discriminação genética têm sido documentados em muitos países e, conseqüentemente, leis têm sido criadas no sentido de se frear o uso abusivo das informações do mapeamento genético pelas seguradoras. No entanto, no Brasil, esse assunto tem sido pouco discutido pelas autoridades e desconhecido pela maioria da população. Dessa forma, já que a saúde é um direito de todos, uma informação genética não deveria influenciar no pagamento e na disponibilidade de emprego e de assistência médica. Aexigência do conhecimento do conteúdo genético de um cidadão, por uma seguradora, é de ordem discriminatória, invade a privacidade, além de contrariar os princípios éticos.

The genetic mapping enabled some detections of changes that trigger some diseases, even before the symptoms appear. Moreover, it provided therapeutics optimization and prevention of some multifactorialdiseases. The advances of genetic technology also increased discussions about the fact that insurance companies can use the genetic tests to establish their fees. They may also provide their own tests or ask the clients their own genetic history. This represents a possible conflict between the client’s interest and the insurance company. Cases of genetics discrimination has been registered in several countries. Consequently, laws that reduce information on the genetic mapping have been launched. However, in Brazil, this issue hasbeen little discussed by official government, and it is also unknown by most of the population. Thus, since health is a right of all citizens, some genetic information should not influence the fee payment, the job availability and medical care. The right to know the citizens´genetic content by an insurance company canbe considered discrimination, invading their privacy, moreover, going against the ethical principles.