Cluster-Based Multinomial Logistic Regression Model for Health-Related Quality of Life Among People Living with HIV in Brazil.

Improvement in treatment options has increased the survival of people living with HIV (PLHIV). Thus, we evaluated the factors associated with better health-related quality of life (HRQoL) among PLHIV in Brazil. This was a cross-sectional study carried out among 349 PLHIV. Data were collected using an interview-based questionnaire, and HRQoL was assessed by the Brazilian version of the WHOQOL HIV BREF instrument. We used non-hierarchical cluster analysis (K-means) to compile the WHOQOL HIV BREF's overall and domain scores into a unique more multidimensional measure for HRQoL consisting of three clusters: poor, fair and good; associations with clusters of better HRQoL were assessed using multinomial logistic regression models. The mean and median overall HRQoL scores were 15.13 (SD = 3.39) and 16, respectively. The reliability and validity of the Brazilian version of the WHOQOL HIV BREF instrument was confirmed among PLHIV in a non-metropolitan, medium-sized municipality of Brazil, which reaffirmed the cross-cultural validity of this instrument. The factors male sex; heterosexual and asexual orientations; higher individual income; undetectable viral load; absence of any comorbidity and presence of an infectious or a chronic comorbidity, with mental illness as the reference; and never having consumed illegal substances were independently associated with good HRQoL. Thus, the compilation of the WHOQOL HIV BREF's overall and domain scores into a unique multidimensional measure for HRQoL, which this study proposed for the first time, may facilitate more robust interpretations and models of predictors. These differentials could simplify HRQoL as an indicator of health and wellbeing to be routinely used as a key outcome in the clinical management of patients and in the global monitoring of health system responses to HIV.

RESUMEN: La mejora en las opciones de tratamiento ha aumentado la supervivencia de las personas que viven con el VIH (PVVIH). Por lo tanto, evaluamos los factores asociados con una mejor calidad de vida relacionada con la salud (CVRS) entre las PVVIH en Brasil. Se trata de un estudio transversal realizado con 349 PVVIH. Los datos se recopilaron mediante un cuestionario basado en entrevistas y la CVRS se evaluó mediante la versión brasileña del instrumento WHOQOL VIH BREF. Usamos un análisis de conglomerados no jerárquico (K-medias) para compilar las puntuaciones generales y de dominios del WHOQOL HIV BREF en una medida única más multidimensional para la CVRS que consta de tres conglomerados: deficiente, regular y bueno; y las asociaciones con grupos de mejor CVRS se evaluaron mediante modelos de regresión logística multinomial. Las puntuaciones de la CVRS global media y mediana fueron 15,13 (DE = 3,39) y 16. La confiabilidad y validez del WHOQOL VIH BREF versión brasileña fue confirmada entre personas que viven con el VIH en un municipio no metropolitano de mediana población de Brasil, lo que reafirma la validez transcultural de este instrumento. Los factores sexo masculino; orientaciones heterosexuales y asexuales; mayores ingresos individuales; carga viral indetectable; ausencia de comorbilidad y presencia de comorbilidad infecciosa o crónica, teniendo como referencia la enfermedad mental; y nunca haber consumido sustancias ilegales se asociaron de forma independiente con una buena CVRS. Por lo tanto, la compilación de las puntuaciones generales y de dominio del WHOQOL HIV BREF en una medida multidimensional única para la CVRS, que este estudio propuso por primera vez, puede facilitar interpretaciones y modelos de predictores más robustos. Estos diferenciales podrían simplificar la HRQoL como un indicador de salud y bienestar para ser utilizado de forma rutinaria como un resultado clave en el manejo clínico de los pacientes y en el monitoreo global de las respuestas del sistema de salud al VIH.

Letters away from the looking glass: Developmental trajectory of mirrored and rotated letter processing within words.

Discrimination of reversible mirrored letters (e.g., d and b) poses a challenge when learning to read as it requires overcoming mirror invariance, an evolutionary-old perceptual tendency of processing mirror images as equivalent. The present study investigated when, in reading development, mirror-image discrimination becomes automatic during visual word recognition. The developmental trajectory of masked priming effects was investigated from 2nd to 6th grade and in adults, by manipulating letter type (nonreversible; reversible) and prime condition (control; identity; mirrored; rotated). Standardized identity priming increased along reading development. Beginning readers showed mirror invariance during reversible and nonreversible letter processing. A mirror cost (slower word recognition in mirrored-letter than identity prime condition) was found by 5th-grade but only for reversible letters. By 6th grade, orthographic processing was no longer captive of mirror invariance. A multiple linear regression showed that letter representations, but not phonological processes or age, were a reliable predictor of the rise of mirror-image discrimination in 2nd-4th-graders. The present results suggest a protracted development of automatic mirror-image discrimination during orthographic processing, contingent upon the quality of abstract letter representations. RESEARCH HIGHLIGHTS: We traced the developmental trajectory of mirrored-letter and rotated-letter priming effects (e.g., ibea and ipea as primes of IDEA) in visual word recognition. Beginning readers (2nd-4th-graders) showed mirror invariance and plane-rotation sensitivity in orthographic processing, thus still being susceptible to the perceptual biases in charge in object recognition. A mirror cost was found in 5th-graders but only for reversible letters; orthographic processing was no longer captive of mirror invariance by 6th-grade. The automation of mirror-image discrimination during orthographic processing depends on the quality of letter representations but not on phonological processes or age.

Oral manifestations of syphilis: Knowledge and skills of senior dental students and newly graduated dentists.

OBJECTIVES: To evaluate the knowledge of senior dental students and newly graduated dentists about the prevention, diagnosis and treatment of oral manifestations of syphilis. MATERIALS AND METHODS: A 32-question questionnaire was designed with three domains: (I) demographic, academic and professional data of the participants, (II) attitudes, practices and self-perception regarding training about syphilis and (III) knowledge about syphilis. All knowledge responses were classified as correct or incorrect. Scores ranging from 1 to 14 were calculated, and grades were assigned to each participant according to their level of knowledge. RESULTS: The sample comprised 408 dental students and 339 newly graduated dentists. The mean score was 7.70 ± 3.35 for undergraduates and 9.09 ± 3265 for dentists. The highest frequency of correct answers (>70%) was attributed to questions about the aetiology, transmission and treatment of syphilis. The questions with the lowest frequency of correct answers (<50%) were about the identification of oral manifestations and stages of syphilis. CONCLUSIONS: The knowledge of dental practitioners and academics about the oral manifestations of syphilis was unsatisfactory. The lack of understanding of these aspects can delay the diagnosis and treatment of patients with this disease, which is concerning given the steady increase in cases in recent years.

Factors associated with recent and regular non-use of dental services by students from a university in southeastern Brazil: a cross-sectional study.

BACKGROUND: Lack of use of dental services can be a risk factor for oral health. In addition to recent visits to dental services, it is important to assess the regularity of use of these services, as well as the motivations for visiting the dentist. There is a gap in literature studies on the patterns of use of oral health services by the young university students. The goal of this study was to assess the factors associated with recent and regular non-use of dental services by young university students, using the Andersen model as a reference. METHODS: This was a cross-sectional study with 477 university students between 18 and 24 years old, carried out as a web survey, through which predisposing, enabling and need variables were collected, according to the model proposed by Andersen, to test the factors associated with recent and regular non-use of dental services. Bivariate analyses and robust Poisson regression were performed, with estimation of crude and adjusted prevalence ratios, using confidence intervals of 95%. The variables with p < 0.05 remained in the final model. RESULTS: The prevalence of recent non-use was of 19.5% (95% CI 16.0-23.3%), and of regular non-use, of 53.5% (95% CI 48.9-58.0%). After the adjusted analysis, the following were found to be associated with the outcome of recent non-use: type of service used (PR = 0.91; 95% CI 0.85-0.98) and perceived need for dental treatment (PR = 0.98; 95% CI 0.97-0.99); and the following variables were associated with regular non-use: father's level of education (PR = 0.86; 95% CI 0.78-0.96), area of study (PR = 1.08; 95% CI 1.02-1.15), reason for last dental appointment (PR = 0.81; 95% CI 0.75-0.88), use of dental services throughout childhood (PR = 0.92; 95% CI 0.86-0.97), self-perceived oral health (PR = 0.86; 95% CI 0.76-0.88), and toothaches over the last 2 years (PR = 0.93; 95% CI 0.87-0.99). CONCLUSION: The motivation for young university students to use dental services are curative treatment needs, not prevention. The results point to the need to implement health prevention and promotion policies in higher education institutions and to expand access to dental services for this young population.

Hemispheric asymmetry in holistic processing of words.

Holistic processing has been regarded as a hallmark of face perception, indicating the automatic and obligatory tendency of the visual system to process all face parts as a perceptual unit rather than in isolation. Studies involving lateralized stimulus presentation suggest that the right hemisphere dominates holistic face processing. Holistic processing can also be shown with other categories such as words and thus it is not specific to faces or face-like expertize. Here, we used divided visual field presentation to investigate the possibly different contributions of the two hemispheres for holistic word processing. Observers performed same/different judgment on the cued parts of two sequentially presented words in the complete composite paradigm. Our data indicate a right hemisphere specialization for holistic word processing. Thus, these markers of expert object recognition are domain general.

Construction and validation of an questionnaire for evaluating self-medication practised by patients with temporomandibular disorders.

AIMS: Despite the fact that self-medication associated with temporomandibular disorders is clinically quite common and is considerably harmful, there is no instrument in the literature to assess this practice. The aim of this study was to construct and validate a questionnaire to study this important issue specifically. METHODS: After completing the literature review, semi-structured interviews, focus group and pretest, the first version of the instrument resulted in 62 questions. After face validity testing, pretest and the necessary corrections and changes, the instrument had 41 questions and was administered for validation to a sample of 110 patients diagnosed with TMD according to the RDC/TMD (1992) criteria. RESULTS: According to factor analysis, seven questions with loadings below 0.30 were removed, with the final version consisting of 34 questions. The analysis of internal consistency and temporal stability showed values of 0.844 for Cronbach's alpha coefficient and a Kappa coefficient of 0.810, respectively, indicating that the instrument presents sufficient reliability and reproducibility for its proposed objective. After validation, with the ultimate goal of classifying patients according to the degree/intensity of self-medication, a classification was proposed that allowed the discrimination of results into three distinct groups regarding self-medication exposure: mild, moderate or severe, based on the self-medication raw point score. CONCLUSION: The results of the instrument validation process showed that it has suitable properties for evaluating the practice of self-medication in patients with TMD.

Brazilian adolescents' perception of the orthodontic appliance: A qualitative study.

INTRODUCTION: Orthodontic treatment has a significant impact on the quality of life and self-esteem of adolescents, with emotional and behavioral implications. The objective of this research was to understand Brazilian adolescents' perception of the orthodontic treatment. METHODS: A qualitative research study was carried out through content analysis of data collected from 142 adolescents using the word-association technique (WAT), followed by 8 focus groups with 71 of these students. RESULTS: The most recurrent words on the WAT demonstrated a positive esthetic impact of the orthodontic appliance, both for the adolescents' self-assessment and in the assessment of friends. Several themes were identified in the qualitative analysis, with the esthetic benefit of orthodontic treatment and the esthetic impact of the appliance being the most relevant positive points. The most-cited negative aspect in the study was the pain associated with the treatment, followed by the discomfort and trauma caused by the fixed appliance. CONCLUSIONS: Orthodontic treatment has a positive esthetic impact for Brazilian adolescents, with improvement of their self-image. Fixed orthodontic appliances have an immediate positive impact on appearance and are an important factor in behavioral relationships among Brazilian adolescents, particularly owing to their association with social status. The understanding of the sociobehavioral aspects involved in orthodontic treatment is of fundamental importance for the clinical relationship between patient and professional.

Functional status of patients with metastatic spinal cord compression.

PURPOSE: This prospective study was conducted to evaluate the functional status and clinical features of inpatients with metastatic spinal cord compression and to explore possible associated factors and the correlation with neurological deficits. METHODS: Cases were identified through an active search in the hospital units of the National Cancer Institute. For 47 patients, clinical and demographic characteristics were collected; functional status was measured by the Functional Independence Measure; modified Tokuhashi score was used to predict survival time; neurological deficits were measured using the American Spinal Injury Association Impairment Scale; and general condition was evaluated using the Karnofsky Performance Status Scale. The correlation between the level of neurological deficits and functional status was calculated using the Spearman correlation test. The difference in the functional independence score according to neurological status was assessed with the Kruskall-Wallis test. RESULTS: The degree of functional status was associated with Karnofsky Performance Status, level of neurological deficits, ability to walk, survival time, and skin color (p < 0.05). There was difference in the functional status (p = 0.004) and in the motor domain (p = 0.001) according to the level of neurological deficits. The correlation of the Functional Independence Measure with level of neurological deficits and with Karnofsky Performance Status was moderate (r = 0.46, p < 0.02). CONCLUSION: The Functional Independence Measure was adequate for evaluating the functional status of patients with metastatic spinal cord compression. Palliative rehabilitation should be integrated early and strategies should be linked to the prognosis of survival.

Mirrors are hard to break: A critical review and behavioral evidence on mirror-image processing in developmental dyslexia.

The relation between reversal errors (e.g., d for b, Я for R) and developmental dyslexia has been elusive. In this study, we investigated the roles of reading level, visual category, and orientation processing in this relation. Children with developmental dyslexia, chronological-age-matched controls, and reading-level-matched controls performed two "same-different" matching tasks on reversible (e.g., b) and nonreversible (e.g., e) letters and on geometric shapes (e.g., ). In the orientation-based task, orientation processing was explicitly required; in the shape-based task, orientation processing would be automatic inasmuch as it was task irrelevant and would hinder successful performance. Two orientation contrasts were examined: mirror images (e.g., d-b) and plane rotations (e.g., d-p). For the latter, dyslexics behaved as controls; all were worse on shape-based judgments of plane rotation than on identical (e.g., d-d) pairs and were better able to attend to orientation than to shape. In contrast, for mirror images and across visual categories, dyslexics showed an advantage over typical readers on shape-based judgments. Both control groups had worse performance on shape-based judgments of mirror images than of identical pairs and exhibited similar magnitudes of mirror interference. Dyslexic children were the only group whose shape-based judgments were immune to mirror-image differences because they failed to automatize mirror discrimination during visual object processing. This deficit is not a consequence of reading level, is found across visual categories, and is specific to mirror images.

Into the Looking Glass: Literacy Acquisition and Mirror Invariance in Preschool and First-Grade Children.

At what point in reading development does literacy impact object recognition and orientation processing? Is it specific to mirror images? To answer these questions, forty-six 5- to 7-year-old preschoolers and first graders performed two same-different tasks differing in the matching criterion-orientation-based versus shape-based (orientation independent)-on geometric shapes and letters. On orientation-based judgments, first graders outperformed preschoolers who had the strongest difficulty with mirrored pairs. On shape-based judgments, first graders were slower for mirrored than identical pairs, and even slower than preschoolers. This mirror cost emerged with letter knowledge. Only first graders presented worse shape-based judgments for mirrored and rotated pairs of reversible (e.g., b-d; b-q) than nonreversible (e.g., e-ә) letters, indicating readers' difficulty in ignoring orientation contrasts relevant to letters.

Sexual function of women surviving cervical cancer.

OBJECTIVE: The objective of this study was to evaluate the sexual function of survivors of cervical cancer (CC) in comparison to the control group of women without a history of cancer. METHODS: This was an observational, analytical, case-control study. In the cancer group, women subjected to CC treatment of at least 3 months in the past were included (n = 37). For each survivor, one random selection from a base population control group was made (n = 37) of a woman without a history of cancer and with similar socioeconomic and demographic characteristics. The sexual function was evaluated through the female sex function index (FSFI) instrument. Data collection occurred through the application of questions in a face-to-face interview. RESULTS: In the cancer group, 64.9 % related vaginal stenosis or shortening; 59.5 % were not sexually active and of those which had sexual relations, 80 % showed dysfunction. The total FSFI score varied between 9.60 and 35.10 in the cancer group and 23.90 and 36.00 in the control group. The means of the cancer group were statistically inferior (P < 0.05) to the control group in all the FSFI domains and in the total score. The mean total score was 21.72 in the cancer group, classified as sexual dysfunction when considering a score of 26 as the cutoff point. CONCLUSION: CC treatment was found to have a negative impact on the sexual function of women. Further, sexual function should be monitored routinely by interdisciplinary teams to provide comprehensive care with the objective of an improved quality of life post-cancer.

The quality of life of Brazilian adolescents with asthma: associated clinical and sociodemographic factors.

OBJECTIVE: Asthma is the most common chronic disease among adolescents. This study assessed the quality of life (QOL) related to health in adolescents with asthma and its determining factors (demographic, socioeconomic, and clinical). We also separately evaluated each of the parameters that comprised the asthma control classification. METHODS: This was an observational, cross-sectional study of 114 adolescents who had doctor-diagnosed asthma. QOL was assessed using a version of the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) that was adapted and validated for Brazil, and higher scores indicated a better QOL. The level of asthma control was assessed using the rating system proposed by the Global Initiative for Asthma, and sociodemographic factors were evaluated. RESULTS: When the averages of the PAQLQ domains and overall scores were compared to the potentially explanatory variables, significantly lower average PAQLQ scores were obtained for individuals with an inadequate level of asthma control (p < 0.001). Of the control components, daytime symptoms, nighttime symptoms, and limited physical activity were related to QOL. However, the use of the ß2 agonist and the peak flow functional parameter were not related to QOL. CONCLUSIONS: The level of asthma control was related to QOL, but this association manifested mainly in the subjective control domains, such as nighttime and daytime symptoms and physical activity limitations. The objective domain for control classification, represented by pulmonary function, was not an independent predictor or determinant of the QOL of adolescent asthma patients.

Association of vitamin D insufficiency with adiposity and metabolic disorders in Brazilian adolescents.

OBJECTIVE: The present study aimed to evaluate the frequency of deficiency/insufficiency of vitamin D in adolescents and its relationship to overweight and metabolic disorders. DESIGN: Cross-sectional study. Nutritional status was assessed by BMI according to WHO recommendations. Dietary intake was evaluated using a 3 d dietary record. The biochemical evaluation comprised measurements of serum lipids, lipoproteins, glucose, insulin, calcidiol (25(OH)D) and parathyroid hormone. Insulin resistance was calculated using the homeostasis model assessment. Body composition and blood pressure were assessed. SETTING: Fifteen schools (eight public and seven private) in the central city of Juiz de Fora, Brazil. SUBJECTS: The analysis included a study population of 160 adolescents (seventy-seven eutrophic and eighty-three overweight) aged 15 to 17 years. RESULTS: Vitamin D deficiency and insufficiency was observed in 1.25 and 70.6 % of adolescents, respectively. Serum 25(OH)D levels were statistically lower in adolescents with weight excess, abdominal obesity, hypercholesterolaemia, higher levels of parathyroid hormone, insulin resistance, hyperinsulinaemia and hypertension (P < 0.05). Lower BMI and waist circumference were observed in the third (highest) tertile of vitamin D intake for all adolescents. The high prevalence of vitamin D insufficiency is primarily nutritional and reflects a low vitamin D intake. CONCLUSIONS: Our results support the negative association among serum 25(OH)D levels and vitamin D intake with non-skeletal outcomes in Brazilian adolescents. Vitamin D fortification of foods and/or the use of vitamin D supplements need to be considered to raise vitamin D intake in the adolescent population, even in a sunny country like Brazil.

Learned Attentional Strategies in Word Holistic Processing.

Previous research has shown that, like faces, words are processed either holistically or through the automatic representation of their parts combined. The automaticity assumed to underlie the holistic processing of words presupposes that individuals have a relatively low level of control over these processes. However, they may also be capable of learning from their environments whether processing words as a whole is the most efficient processing strategy-which would require at least some control over the corresponding processes. In fact, previous research supports this latter account in the context of the holistic processing of faces: when provided a task in which participants should ignore half of a stimuli (the irrelevant part) and pay selective attention to the other half (the target part), the participants become better at ignoring the irrelevant part when it is commonly misleading (i.e., this suggests a response that is different from that of the relevant part in the context of the task). In the present work, we extend these considerations to holistic word processing. Our results support a learned attentional account in the context of holistic word processing. When an irrelevant word part is systematically helpful for the judgment of a target word half, participants engage more in holistic processing (vs. when the irrelevant word half is misleading). This reflects an incidental statistical learning process in which individuals identify the irrelevant word half as either providing helpful or misleading information about the target half.

Spatial analysis of care for patients undergoing dialysis therapy in the state of Minas Gerais, Brazil, between 2015 and 2019.

OBJECTIVE: To analyze the spatial flow of care for patients undergoing dialysis therapy in the health regions of the State of Minas Gerais. METHODS: Ecological study whose population was patients undergoing dialysis therapy in public, philanthropic institutions or whose treatment was paid for by the Unified Health System in private clinics in partnership, in the State of Minas Gerais. Patients were grouped by health region of residence. The proportions of patients who underwent dialysis were calculated, as well as enrollment on the kidney transplant list in their own region of residence or outside it. Person correlations of these proportions with socioeconomic and care indicators of the health regions were estimated. Spatial exploratory techniques estimated general (Moran's I) and local (LISA) spatial correlation coefficients. RESULTS: Regions with higher GDP had a higher number of nephrologists and a higher proportion of registrations in the region of residence. A cluster of regions with low GDP was identified further to the northeast of the State (also with lower nephrologist ratio values), a cluster with a high proportion of those registered on the transplant list in the center of the State, and a cluster with a low proportion of dialysis in the same region of residence further southeast. CONCLUSION: Regional disparities were evident in relation to the proportion of patients registered on the waiting list for kidney transplantation, the proportion of patients undergoing dialysis in the same region of residence and the proportion of patients registered on the waiting list for kidney transplantation in the same region of residence. residence.

Effectiveness of pharmacological interventions for managing ADHD symptoms in individuals with autism spectrum disorder: A systematic review and meta-analysis.

OBJECTIVES: This systematic review sought to provide evidence for the effectiveness of common pharmacological interventions used for treating attention deficit hyperactivity disorder (ADHD) symptoms in the autism spectrum disorder (ASD) population, considering studies attempting to find safe and effective drugs. METHODS: We searched for randomized controlled trials describing the effectiveness and/or safety profile of pharmacological interventions for treating ASD and ADHD or ASD with ADHD symptoms using three bibliographic databases: PubMed, Cochrane Library, and Embase. We have chosen ADHD symptoms measured by any clinical scale as the primary outcome. As additional outcomes, we have used other symptoms of aberrant behavior measured by the aberrant behavior checklist, satisfaction with treatment, and peer satisfaction. RESULTS: Twenty-two publications met the inclusion criteria for the systematic review and eight for the meta-analysis. In our investigation, we found a few articles using clonidine, modafinil, and bupropion as interventions when compared to methylphenidate (MPH). Our meta-analysis showed that MPH had positive changes compared to placebo in symptoms such as hyperactivity, irritability, or inattention. However, no effect was found in stereotyped symptoms, and our data's quantitative analysis revealed a large effect of MPH-induced adverse effects on the dropout rate. On the other hand, atomoxetine initiation had positive effects when compared to placebo on symptoms of hyperactivity and inattention. We have found no effect of atomoxetine on stereotypes or irritability. Furthermore, atomoxetine did not influence side effects that caused dropouts from studies. CONCLUSION: Our results indicated that atomoxetine has a modest effect on hyperactivity and inattention symptoms, with a relatively benign profile of side effects. MPH appears to be effective in handling hyperactivity, inattention, and irritability symptoms. However, our results on atomoxetine revealed increased dropouts due to adverse effects when compared to MPH or placebo. Evidence for other substances such as guanfacine, clonidine, bupropion, or modafinil is either preliminary or nonexistent.

Prevalence of lymphedema in women undergoing treatment for breast cancer in a referral center in southeastern Brazil.

BACKGROUND: Lymphedema is a highly prevalent condition in women who have undergone treatment for breast cancer. Lymphedema negatively affects the quality of life. The objective of this study was to estimate the prevalence of lymphedema and associated factors in women treated for breast cancer in the municipality of Juiz de Fora. METHODS: We performed a cross-sectional study that evaluated 250 women who were being treated for breast cancer. Pre-screening of the sample by analysis of medical records was performed to select women who met the inclusion criteria as follows: women who had an operation more than 6 months ago; absence of active disease, locoregional or distant; the absence of functional change in the affected limb before surgery, which could lead to swelling of the limb; and simulating or masking symptoms of lymphedema, such as bursitis, tendonitis, and work-related musculoskeletal disorders. Women with bilateral breast cancer, absence of axillary intervention (partial or complete axillary dissection and/or SLN biopsy), active disease in the region, or lympho-venous alteration of the limb before surgery were excluded. Data were collected from the medical records of the selected cases, and they subsequently underwent an interview and a physical assessment. RESULTS: The prevalence of lymphedema was 44.8%. There were medical records on the presence of this condition in 5.4% of cases. With regard to shoulder joint mobility, restrictions on abduction movements, internal and external rotation, and anterior shoulder adduction were significantly associated with lymphedema. Variables, including the presence of seroma, vascular changes, time elapsed after surgery, episodes of redness in the extremities, and cuticle removal from the hand with pliers were considered as major associated factors for lymphedema (p<0.05). CONCLUSIONS: The prevalence of 44.8% for lymphedema found in this study is considered to be relevant because it is a morbidity that produces psychological, physical, and functional damage in patients with this condition. The planning of health programs and services appropriate for the immediate postoperative treatment of women with breast cancer, and increasing the awareness of health professionals regarding the early diagnosis of lymphedema, can help minimize the morbidity of this disease.

The impact of socioenvironmental characteristics on domains of oral health-related quality of life in Brazilian schoolchildren.

BACKGROUND: Recent researches have pointed out the need to consider the functional and psychosocial dimensions of oral health, such as Oral Health-related Quality of Life (OHRQoL). The aim of this study was to investigate the influence of oral health status, socioeconomic factors and home environment of children on the four health domains of Child Perceptions Questionnaire (CPQ11-14). METHODS: A cross-sectional study was conducted in Brazil with a sample of 286 schoolchildren aged 12 years and their parents. The schoolchildren were clinically examined, and participants were asked to complete the CPQ11-14, as well as a questionnaire about home environment. In addition, a questionnaire was sent to each child's parents asking them about family socioeconomic status. The chi-square test and Poisson's regression analysis were performed. RESULTS: After adjusting for potential confounders, variables sex, monthly family income, mothers' education showed a statistically significant association with all health domains of the CPQ11-14. The family structure and presence of bleeding impacted on emotional (p = 0.0135), and social (p = 0.0010) well-being health domain scores. Orthodontic treatment need showed a strong negative effect on functional limitations domain score (p = 0.0021). CONCLUSIONS: Clinical and socio-environmental factors had different impacts on domains of oral health-related quality of life, demonstrating the need to consider these conditions in planning strategies for the oral health of schoolchildren.

Randomized clinical trial with fractional CO2 laser and Clobetasol in the treatment of Vulvar Lichen Sclerosus: a clinic study of feasibility.

OBJECTIVES: The main objective of the study was to describe and compare the feasibility of using fractional CO2 laser to the usual treatment with Clobetasol. Randomized clinical trials brought together 20 women from a Brazilian university hospital, 9 of them were submitted to Clobetasol treatment and 11 to laser therapy. Sociodemographic data were obtained and quality of life parameters, vulvar anatomy, self-perception and histopathological analysis of vulvar biopsies were evaluated. Evaluations were made before the beginning of the treatment, during its implementation, right after its completion (3 months), and 12 months after. The SPSS 14.0 software was used, obtaining descriptive measurements. The level of significance adopted was 5%. RESULTS: The clinical/anatomical characteristics of the vulva did not differ between the treatment groups, as much before as after its performance. There was no statistically significant difference between the treatments performed regarding the impact on the life quality of the patients. A higher satisfaction degree with the treatment was obtained with the patients in the Laser group in the third month of evaluation. Laser therapy also revealed higher occurrence of telangiectasia after treatment completion. Fractional CO2 laser has proven to be well accepted and is a promising therapeutic option. Registration number and name of trial registry The institutional review board status was approved by the Research Ethics Committee of HU/ UFJF under advisory number 2881073 and registered in the Brazilian Clinical Trials, with consent under registration RBR-4p9s5y. Access link: https://ensaiosclinicos.gov.br/rg/RBR-4p9s5y.

The influence of oral health conditions, socioeconomic status and home environment factors on schoolchildren's self-perception of quality of life.

BACKGROUND: The objective this study was to investigate the influence of clinical conditions, socioeconomic status, home environment, subjective perceptions of parents and schoolchildren about general and oral health on schoolchildren's oral health-related quality of life (OHRQoL). METHODS: A sample of 515 schoolchildren, aged 12 years was randomly selected by conglomerate analysis from public and private schools in the city of Juiz de Fora, Brazil. The schoolchildren were clinically examined for presence of caries lesions (DMFT and dmft index), dental trauma, enamel defects, periodontal status (presence/absence of bleeding), dental treatment and orthodontic treatment needs (DAI). The SiC index was calculated. The participants were asked to complete the Brazilian version of Child Perceptions Questionnaire (CPQ11-14) and a questionnaire about home environment. Questions were asked about the presence of general diseases and children's self-perception of their general and oral health status. In addition, a questionnaire was sent to their parents inquiring about their socioeconomic status (family income, parents' education level, home ownership) and perceptions about the general and oral health of their school-aged children. The chi-square test was used for comparisons between proportions. Poisson's regression was used for multivariate analysis with adjustment for variances. RESULTS: Univariate analysis revealed that school type, monthly family income, mother's education, family structure, number of siblings, use of cigarettes, alcohol and drugs in the family, parents' perception of oral health of schoolchildren, schoolchildren's self perception their general and oral health, orthodontic treatment needs were significantly associated with poor OHRQoL (p < 0.001). After adjusting for potential confounders, variables were included in a Multivariate Poisson regression. It was found that the variables children's self perception of their oral health status, monthly family income, gender, orthodontic treatment need, mother's education, number of siblings, and household overcrowding showed a strong negative effect on oral health-related quality of life. CONCLUSIONS: It was concluded that the clinical, socioeconomic and home environment factors evaluated exerted a negative impact on the oral health-related quality of life of schoolchildren, demonstrating the importance of health managers addressing all these factors when planning oral health promotion interventions for this population.