Changes in Oral Health-Related Behaviors and Oral Health of Children in Early Childhood during Social Isolation Caused by COVID-19

ABSTRACT Objective: To assess changes in oral health-related behavior and oral health status in Brazilian children in early childhood perceived by their parents/caregivers during social isolation caused by COVID-19. Material and Methods: A cross-sectional study with parents/caregivers of children in southeastern Brazil aged 0-5 years who responded to an online questionnaire about sociodemographic data, dietary changes, oral hygiene, and oral health status of children during the COVID-19 pandemic. Results: Of the 119 parents/caregivers, 54.60% did not observe any changes in eating habits, and 81.50% maintained their children's oral hygiene. Associations were observed between the impact of the pandemic on the family income and changes in eating habits (p=0.02) and between lower family income and dental caries perceived by parents/caregivers (p=0.05). Z tests with Bonferroni correction showed that families with drastic income reduction were more likely to consume lower-cost foods (62.50%) than families with no impact or slight reduction on family income. Parents/caregivers did not identify dental caries (89.10%), toothache (92.40%), and dental trauma (92.40%) in their children. Conclusion: Parents/caregivers of children in southeastern Brazil aged 0-5 years observed behavioral changes in the dietary habits of families whose income was impacted by the pandemic, and their perception of dental caries was significantly associated with family income.

Overweight/obesity and dental caries in Brazilian children and adolescents: a systematic review and meta-analysis

Abstract This review aimed to assess the association between overweight/obesity and dental caries in Brazilian children/adolescents. Searches were performed in the Web of Science, Scopus, Cochrane, PubMed, Embase and SciELO, Lilacs and Open Grey literature databases up to June 2022. The Joanna Briggs Institute checklist for analytical cross-sectional studies, the checklist for cohort studies, and the checklist for case-control studies were used. A total of 41 publications were included, and 15 meta-analyses were performed. The authors analyzed the differences in weighted mean difference (MD) and odds ratios (OR), and their corresponding confidence intervals (CI) (95%) for dental caries among eutrophic and obese and/or overweight children/adolescents. Meta-analyses showed that there was no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI (Body Mass Index). A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve (OR = 2.53, 95% CI;1.49-4.29; p = 0.0006; I2 = 0%) in dichotomous outcome studies, and (MD = 0.61, 95%CI: 0.08-1.15; p = 0.02; I2 = 0%) in continuous studies. The strength of the evidence of the results was classified as very low, low or moderate. It was concluded that there is no association between overweight and/or obesity and dental caries in Brazilian children/adolescents for most anthropometric reference curves using BMI. A greater experience of dental caries was associated with well-nourished adolescents in permanent dentition, compared with obese individuals in the same dentition, as classified by the CDC 2000 curve.

Gênero e violência sexual contra crianças: um debate sobre relações de poder / Gender and sexual violence against children: a debate about power relations

Este artigo traz um debate teórico a partir da interlocução entre produção de gênero e violência sexual contra crianças e adolescentes. Amparado por uma perspectiva histórica e teórica acerca dos estudos de gênero, assume-se que o processo de socialização e construção das identidades dos sujeitos é marcada por práticas e discursos que incidem continuamente sobre os corpos desde sua gestação. Modelos hegemônicos de masculinidades e feminilidades atravessam as vivências dos sujeitos produzindo marcas, relações de poder, possibilidades e proibições. Assim, compreende-se o gênero enquanto categoria de análise produtora de relações de poder assimétricas que, entre outros fatores, contribuem para a reprodução da violência sexual contra crianças e adolescentes. Esta trata-se de um fenômeno complexo, considerado problema de saúde pública, que se articula com questões micro e macrossociais. Nesta perspectiva, elementos como machismo, patriarcado e adultocentrismo, aliado às desigualdades étnico-raciais, socioeconômicas e de gênero mostram-se enquanto alguns dos fatores que atravessam a violência sexual infantojuvenil, tais elementos são debatidos ao longo do artigo. A prevenção e enfrentamento à violência sexual traduz-se tanto pela ruptura de práticas silenciadoras, maginalizantes e de desigualdades de poder entre os sujeitos, quanto pela efetivação de políticas públicas e criação de estratégias questionadoras das normativas de gênero.

This article seeks to outline a theoretical debate based on the dialogue between gender production and sexual violence against children and adolescents. Drawing on a historical and theoretical perspective about gender studies, it is assumed that the process of socialization and construction of the subjects' identities is marked by practices and discourses that continuously affect bodies since their gestational period. Hegemonic models of masculinity and femininity cross the subjects' experiences producing marks, relations of power, possibilities and prohibitions. Thereby gender is understood as a category of analysis that produces asymmetric power relations that - among other factors - contribute to the reproduction of sexual violence against children and adolescents. This is a complex phenomenon considered a public health problem that articulates itself with micro and macro-social issues. In this perspective elements such as machismo, patriarchy, adult-centeredness combined with ethnic-racial, socioeconomic and gender inequalities are shown as some of the factors that promote sexual violence against children and adolescents and are discussed throughout this article. The prevention and confrontation of sexual violence is also reflected in the rupture of silencing and marginalizing practices and inequalities of power among the subjects, as well as the implementation of public policies and the creation of strategies that question gender norms.

Traumatic dental injuries in children: experience during the Covid-19 pandemic and parents' knowledge about their management

Abstract The social isolation measures adopted during the critical phase of the COVID-19 pandemic led children to spend most of their time at home. Isolation may alter the pattern of traumatic dental injury occurrences, inasmuch as studies point out that most traumatic accidents occur at home. Considering this scenario and the influence of emergency management on the prognosis of the injury, the aim of this study was to evaluate the experience of traumatic dental injuries in children before and during the pandemic, and the knowledge of this topic by the children's guardians. This cross-sectional study was conducted with guardians of children aged 0 to 6 years, residing in Juiz de Fora, MG, Brazil. The guardians answered an online questionnaire addressing personal information, traumatic dental injury experience before and during the pandemic, and knowledge of this topic. Descriptive and statistical analyses were performed using Pearson's chi-square test at a 5% significance level. The total sample consisted of 343 volunteers. A total of 95 and 92 injuries were reported before and during the pandemic, respectively; the home was the place of greatest occurrence. Most volunteers (88.1%) agreed that traumatic dental injuries are emergency situations, and were aware that the tooth/fragment had to be taken to the dentist after a fracture or avulsion (97.4%). This study revealed that the traumatic dental injury experience was similar before and during the pandemic, and that the volunteers had satisfactory knowledge, especially in recognizing the importance of immediate attention for a more favorable prognosis of these injuries.

Factor VIII prophylactic therapy reduces neurological complications in patients with Hemophilia A / Terapia profilática com Fator VIII reduz complicações neurológicas em paciente com Hemofilia A

ABSTRACT Background: Bleeding in hemophiliacs can cause complications in the central and peripheral nervous system (CNS and PNS). The incidence of intracranial hemorrhage has reduced after the introduction of prophylactic treatment with factor VIII or IX, but the benefits of this therapy have not yet been evaluated on PNS complications. Objective: The aim of this study was to determine the prevalence of neurological complications in hemophiliacs and verify the effect of prophylactic therapy in these patients, including PNS disorders. Methods: We retrospectively evaluated the prevalence of CNS and PNS disorders caused by bleeding in hemophiliacs seen at the Hemocentro Regional Norte, Ceará, Brazil, from 1992 to 2018, and we compared the incidence in different periods (before and after the introduction of prophylactic treatment in 2011). Results: Of 75 hemophilia A patients evaluated (4.61/100.000 population), 13.3% (n=10) had either CNS (n=5) or PNS (n=5) disorders secondary to bleeding. Patients submitted to factor VIII replacement prophylactic therapy were less likely to have CNS events: from 1992 to 2011, 5 of 63 patients had CNS disease, while from 2011 to 2018, there were no new cases (p=0.0181). From 2011 to 2018, 5 PNS events occurred in patients without prophylactic therapy, whereas none occurred in those covered by prophylactic therapy (5/20 versus 0/29, p=0.0081). Conclusions: The prevalence of neurological complications in hemophiliacs in our cohort is similar to other studies. Similar to CNS, prophylactic therapy also reduces the risk of PNS complications. This is the first report in the literature showing this benefit.

RESUMO Antecedentes: O sangramento em hemofílicos causa complicações no sistema nervoso central e periférico (SNC e SNP). A incidência de hemorragia intracraniana diminuiu após a introdução da profilaxia com fator VIII ou IX, entretanto esse benefício ainda não foi avaliado no SNP. Objetivo: O objetivo deste estudo foi determinar a prevalência de complicações neurológicas em hemofílicos, verificando o efeito da terapia profilática também no SNP. Métodos: Avaliamos retrospectivamente a prevalência de complicações neurológicas causadas ​​por sangramentos em hemofílicos atendidos no Hemocentro Regional Norte, Ceará, Brasil, de 1992 a 2018, comparando a incidência em diferentes períodos (antes e depois da introdução do tratamento profilático em 2011). Resultados: Foram avaliados 75 pacientes com hemofilia A (4,61/100 mil habitantes). Deles, 13,3% (n=10) tinham distúrbios do SNC (n=5) ou do SNP (n=5) secundários a hemorragias. Os pacientes submetidos à terapia profilática com fator VIII apresentaram menor probabilidade de eventos do SNC: de 1992 a 2011, cinco de 63 pacientes apresentaram hemorragia no SNC, enquanto de 2011 a 2018 não ocorreram novos casos (p=0,0181). De 2011 a 2018, cinco eventos no SNP ocorreram entre pacientes sem terapia profilática, e nenhum ocorreu entre aqueles cobertos pela profilaxia (5/20 × 0/29, p=0,0081). Conclusões: A prevalência de complicações neurológicas em hemofílicos em nossa coorte é similar à de outros estudos. Assim como no SNC, a terapia profilática também reduz o risco de complicações no SNP. Este é o primeiro relato na literatura a mostrar esse benefício.

Desempenho intelectual e crenças disfuncionais em crianças vítimas de abuso sexual / Intellectual performance and dysfunctional beliefs in children victims of sexual abuse

O abuso sexual infantil pode gerar consequências que afetam a cognição em níveis intelectuais e socioemocionais. Desse modo, o presente estudo buscou avaliar a inteligência de um grupo de crianças que sofreu abuso sexual e relacioná-la com crenças disfuncionais. Foi realizado no Hospital Universitário Júlio Müller em Cuiabá, Mato Grosso, no Programa de Atendimento às Vítimas de Violência Sexual. A amostra foi constituída de 17 participantes, de 6 a 10 anos e 11 meses de idade (M=8,1 anos; DP=1,4). A ela, foram administrados o teste Matrizes Progressivas Coloridas de Raven (MPCR), para avaliação da inteligência, e a Escala de Atribuições e Percepções de Crianças (CAPS), para avaliação das crenças disfuncionais. Por meio da análise das classificações obtidas no MPCR, não foram encontradas crianças com déficits intelectuais. Por meio da correlação de Spearman, constatou-se que houve correlações moderadas entre o MPCR e o CAPS, com médio e grande tamanhos de efeito, mas inversamente proporcionais. Ou seja, quanto maior foi o desempenho intelectual, menores foram as crenças disfuncionais, e vice-versa. Tais dados encontrados permitiram concluir que o investimento em processos educacionais e interventivos psicoterápicos que visem o atendimento a ambas as variáveis se torna um dos fatores protetivos a esse grupo clínico.

Sexual abuse against children can have consequences that affect cognition at an intellectual and socio-emotional levels. Thus, the present study sought to assess the intelligence of a group of children who suffered sexual abuse and to relate it to dysfunctional beliefs. It was carried out at the Júlio Müller University Hospital in Cuiabá, Mato Grosso, in the Program of Assistance to Victims of Sexual Violence. The sample consisted of 17 participants, aged from 6 to 10 years and 11 months old (M=8.1 years; SD=1.4). Was administered the Raven's Progressive Color Matrices (RPCM) test, to assess intelligence, and the Scale of Attributions and Perceptions of Children (CAPS), to assess dysfunctional beliefs. Through the analysis of the classifications obtained in the RPCM, children with intellectual deficits were not found. Through Spearman's correlation, it was found that there were moderate correlations between RPCM and CAPS, with medium and large effect sizes, but inversely proportional. In other words, the higher the intellectual performance, the lower the dysfunctional beliefs, and vice versa. Results provided enough information to conclude that investments in educational process and interventional psychotherapeutic that seeks the accomplishment of both variables becomes one of the protective factors for this clinical group.

Association Between Dental Caries Experience and Socioeconomic Determinants on Oral Health-Related Quality of Life among Children and their Families

ABSTRACT Objective: To assess the association between dental caries experience, severe dental caries experience and socioeconomic determinants on oral health-related quality of life among children and their families. Material and Methods: This is a cross-sectional study whose sample was composed of children aged 4-12 years, who sought dental care in a dentistry school clinic, and their parents/caregivers. Dental caries experience and severe dental caries experience were assessed according to the DMF-T/dmf-t indexes. Parents/caregivers answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ), the Family Impact Scale (FIS) and a questionnaire on socioeconomic and demographic conditions. Data analysis included the chi-square test and Poisson regression (PR). Results: The sample was composed of 105 children and their parents/caregivers. Severe dental caries experience in children was determinant for negative perception of children's OHRQoL by parents/caregivers (PR = 1.22; CI = 1.05-1.41). Negative impact on OHRQoL perceived by family members was determined by severe dental caries experience in children (PR = 1.22; CI = 1.05-1.42) and family income <5 minimum wage (PR = 1.32; CI = 1.08-1.61). Conclusion: Severe dental caries experience was associated with a negative impact on OHRQoL perceived by children and their families. Low family income was associated with a negative impact on the OHRQoL perceived by children and their families.

Occurrence of Dental Trauma in a Group of Children with Autistic Spectrum Disorder

ABSTRACT Objective: To assess the occurrence of dental trauma in a group of children with Autistic Spectrum Disorder (ASD) in comparison to children without the disorder. Material and Methods: This is a cross-sectional study conducted at the Department of Children and Adolescents Health in the Department of Health of Juiz de Fora, Brazil. The study included individuals with and without ASD, between three and 16 years old, and their parents/caregivers. Children/adolescents were assessed for dental trauma by clinical examination. All exams were performed by a trained and calibrated examiner (MCT), and intra-examiner reliability was previously established (Kappa=0.93). The Socio-demographic status was reported by parents/caregivers. Data analysis included descriptive statistics and generation of frequency distributions. Fisher's exact test was used to evaluate the association between groups of children/adolescents with and without ASD about the presence of dental trauma. The significance level was set at p < 0.05. Results: Sixty children of both sexes participated in the study, thirty with a diagnosis of ASD and thirty without. The age ranging from 3 to 13 years, with an average of 7.5 ± 3.2 years. Children with ASD had a higher frequency of dental trauma than children without ASD (p=0.02), and the most frequent type of trauma was enamel fracture (57.10%), followed by enamel/dentin fracture without pulp exposure (42.90%). Conclusion: Children with ASD, when compared to children who did not have ASD, had a higher occurrence of dental trauma.

Early Childhood Caries Experience of Children from Poor Families Living Below and Above Poverty Line

ABSTRACT Objective: To evaluate the role of poverty and its related factors on early childhood caries (ECC) experience among deprived children. Material and Methods: This population-based cross-sectional study surveyed 418 children aged one to six years enrolled in Brazilian public preschools from an area of the country known for its high social deprivation. Intraoral examination of children evaluated dental caries experience (dmft). Parents/caregivers answered a questionnaire with sociodemographic indicators. Family income was dichotomized into below or above poverty line. Data analysis used Chi-square test, Mann-Whitney test, and Multivariate Logistic Regression analysis (p<0.05). Results: Predisposing variables for an increased chance of ECC were: age group 3-4 years (OR: 4.89; 95% CI: 2.32-10.31), age group 5-6-years (OR: 5.60; 95% CI: 2.60-12.04), being part of families living below poverty line (OR: 1.88; 95% CI: 1.04-3.38) and having mothers with less than nine years of schooling (OR: 2.86; 95% CI: 2.77-7.14). Children from families living below poverty line presented higher dmft (2.9 +3.8; p=0.001) and untreated dental caries (d component) (2.7 +3.7; p=0.002). Conclusion: ECC in a poor population was influenced by indicators of social deprivation. The poorest of poor children from mothers with less years of schooling were at higher risk.

Sintomas depressivos e fatores associados em puérperas de um hospital-escola em Cuiabá/MT / Depressive symptoms and associated factors in postpartum women at a teaching hospital in Cuiabá/MT

A Depressão Pós-Parto (DPP) é um problema de saúde pública mundial. Os fatores de risco para seu desenvolvimento podem variar considerando-se aspectos psicossociais. Este estudo objetivou identificar sintomas depressivos e fatores associados em puérperas no Hospital Universitário Júlio Muller (HUJM), na cidade de Cuiabá - MT. Participaram 30 puérperas, entre 18 anos e 39 anos (M= 26,96 anos). Como instrumentos foram utilizados entrevista semiestruturada e questionário PHQ-9. Os dados foram analisados por meio de estatística descritiva e do modelo de regressão linear simples (Teste F), que correlacionou dados da entrevista e escores do PHQ-9. Como resultados, constatou-se que a maioria eram multíparas, com baixa escolaridade e em relacionamento estável. Apresentaram sinais de risco para o desenvolvimento da DPP metade das participantes, sendo o estresse gestacional o principal fator associado. Os resultados evidenciam a importância da identificação precoce dos sintomas depressivos e ressaltam a importância da avaliação psicológica para tal identificação na área da saúde.

Postpartum depression (PPD) is a worldwide public health problem. The risk factors for its development can vary considering psychosocial aspects. This study aimed to identify depressive symptoms and associated factors in puerperal women at the Júlio Muller University Hospital (HUJM), in the city of Cuiabá - MT. 30 puerperal women participated, between 18 years and 39 years (M = 26.96 years). As instruments, semi-structured interviews and a PHQ-9 questionnaire were used. The data were analyzed using descriptive statistics and the simple linear regression model (Test F), which correlated interview data and PHQ-9 scores. As a result, it was found that the majority were multiparous, with low education and in a stable relationship. Half of the participants showed signs of risk for the development of PPD, with gestational stress being the main associated factor. The results show the importance of early identification of depressive symptoms and emphasize the importance of psychological assessment for such identification in the health area.

Qualitative and quantitative molecular analysis of bacteria in root canals of primary teeth with pulp necrosis

Abstract Information about bacterial diversity, such as the number of each species in the root canals of primary teeth, contributes to improving our effective management of infections of endodontic origin in primary teeth. This study made a qualitative and quantitative assessment of the bacteria in the root canals of primary teeth with necrotic pulp, using the fluorescence in situ hybridization (FISH) technique. Thirty-one primary teeth with pulp necrosis from 31 children were evaluated using the FISH technique, to detect the presence and density of Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Enterococcus faecalis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Streptococcus, Streptococcus mutans, Streptococcus sobrinus, Tannerella forsythia and Treponema denticola. Descriptive measures explained the data related to density, and Student's t-test assessed the differences among the densities of each bacterium, according to signs and symptoms. The bacterial density was paired and correlated. All bacteria tested were detected and identified in all the samples. The average number of bacterial individuals from each species ranged from 1.9 x 108 cells/mL (S. mutans) to 3.1 x 108 cells/mL (F. nucleatum) (p > 0.05). The sum of the mean counts of each bacterium represented almost 80% of the entire microbial community. Patients with pain had significantly more T. denticola, and those with edema showed a greater density of Streptococcus and P. nigrescens (p < 0.05). This study revealed that all 12 bacteria evaluated were found in all primary teeth with pulp necrosis. There was no predominance among the species studied; all species had a similar number of individuals.

Situação epidemiológica da coqueluche no Distrito Federal entre 2007 e 2016 / Epidemiological situation of pertussis in the Federal District between 2007 and 2016 / Situación epidemiológica de tos ferina en el Distrito Federal entre 2007 y 2016

Resumo A vigilância da coqueluche intensificou-se no Brasil com o aumento de casos a partir de 2012. Em 2015, a quantidade de notificações no Distrito Federal diminuiu, possivelmente devido à introdução da vacina adsorvida difteria, tétano e pertussis acelular para gestantes em novembro de 2014 no país. Trata-se de estudo descritivo, baseado na revisão das notificações compulsórias de coqueluche no Sistema de Notificação Nacional entre 2007 e 2016. Constatou-se que a doença atinge principalmente crianças menores de 1 ano com esquemas vacinais incompletos. A administração dessa vacina para gestantes mostrou-se importante ferramenta para proteger bebês menores de 6 meses.

Abstract Pertussis monitoring intensified in Brazil with the increase of cases since 2012. In 2015, the number of notifications in the Federal District decreased, possibly due to the introduction of diphtheria, tetanus and acellular pertussis vaccine for pregnant women in November 2014 in the country. This is a descriptive study based on the review of compulsory pertussis reporting in the National Notification System between 2007 and 2016. It was found that the disease mainly affects children under one year of age with incomplete vaccination regimens. The administration of this vaccine to pregnant women has proved to be an important tool to protect babies under six months.

Resumen La vigilancia de la tos ferina se intensificó en Brasil con el aumento de casos a partir de 2012. En 2015, la cantidad de notificaciones en el Distrito Federal disminuyó, posiblemente debido a la introducción de la vacuna contra la difteria, el tétanos y la pertussis acelular para gestantes, en noviembre de 2014, en el país. Se trata de un estudio descriptivo, basado en la revisión de las notificaciones obligatorias de tos ferina en el Sistema de Notificación Nacional, entre 2007 y 2016. Se constató que la enfermedad afecta principalmente a niños menores de 1 año con regímenes de vacunación incompletos. La administración de esta vacuna a mujeres embarazadas se mostró como una importante herramienta para proteger a los bebés menores de 6 meses.

Análise da estrutura interna da Bateria de Avaliação Intelectual de Jovens e Adultos / Analysis of the internal structure of the Battery for Assessing Youth and Adults' Intelligence / Análisis de la estructura interna de la Batería de Evaluación Intelectual de Jóvenes y Adultos

O objetivo deste estudo foi analisar a estrutura interna e a relação das habilidades cognitivas avaliadas pela Bateria de Avaliação Intelectual de Adultos (BAIAD). A amostra foi composta por 963 indivíduos (615 F, 348 M), idades entre 15-64 anos (M = 21, DP/SD/DS = 8). A BAID é composta de sete subtestes: sinônimos, antônimos, analogias, pensamento lógico, pensamento viso-espacial, memória visual-auditiva, rapidez de raciocino. A análise de itens permitiu a redução da BAIAD e índices de precisão de 0,99. A análise confirmatória seguiu o modelo CHC (inteligência cristalizada, inteligência fluída e um fator geral - G) e indicou seu ajuste aos dados. A análise de rede que buscou explorar a relação entre os pares dos indicadores cognitivos e o agrupamento das comunidades apoiou o modelo teórico. Conclui-se que a BAIAD possui evidências de validade e índices de precisão adequados para avaliar a inteligência de adultos. (AU)

The purpose of this study was to analyze the internal structure and the relation of the cognitive abilities evaluated by the Battery of Intellectual Assessment of Adults (BAIAD). The sample consisted of 963 subjects (615 F, 348 M), ages 15-64 years (Median = 21, DP/SD/DS = 8). The BAIAD is composed of seven tests: synonyms, antonyms, analogies, logical thinking, visual spatial thinking, visual-auditory memory and speed of reasoning. Item analysis allowed the reduction of BAIAD and reached the reliability indexes of 0.99. The confirmatory analysis followed the CHC model (crystallized intelligence, fluid intelligence and a general factor -G) and indicated its fit to the data. The network analysis which explored the relationship between the pairs of cognitive indicators and the communities grouping supported the theoretical model. We conclude that BAIAD has validity evidences and adequate reliability to assess adults' intelligence. (AU)

El objetivo de este estudio fue analizar la estructura interna y la relación de las habilidades cognitivas evaluadas por la Batería de Evaluación Intelectual de Adultos BAIAD). La muestra fue compuesta por 963 individuos (615 F, 348 M), con edades entre 15-64 años (Mediana = 21, DP/SD/DS = 8). La BAIAD está compuesta de 7 subtests: sinónimos, antónimos, analogías, pensamiento lógico, pensamiento visoespacial, memoria visual auditiva, rápidez de razonamiento.El análisis de ítems permitió la reducción de la BAIAD e índices de precisión de 0,99. El análisis confirmatorio siguió el modelo CHC (inteligencia cristalizada, inteligencia fluída y un factor general-G) e indicó su ajuste a los datos. El análisis de red que buscó explorar la relación entre los pares de indicadores cognitivos, y el agrupamiento de las comunidades, apoyó el modelo teórico. Se concluye que la BAIAD posee evidencias de validez e índices de precisión adecuados para evaluar la inteligencia de adultos. (AU)

Proposal of treatment algorithm for immune thromocytopenia in adult patients of a hematology service at a referral center in Northeastern Brazil

ABSTRACT Introduction: The management of adult (≥18 years) immune thrombocytopenia patients relies on platelet count, the risk of bleeding and presence of bleeding. Objective: Confirming the diagnosis of immune thrombocytopenia and the start of therapy, our hematology service, a referral center, favors the establishment of this algorithm to treat those patients. Results: Presentation, recently diagnosed or recurrence - group 1: life-threatening bleeding: high-dose intravenous immunoglobulins with methylprednisolone or dexamethasone. Hospitalization and platelet transfusion are considered. Group 2: Platelets <30 × 109/L with bleeding or risk factor for bleeding, or platelets <20 × 109/L: prednisone or dexamethasone. No response, platelets <20 × 109/L: replace corticoid or increase doses. If platelets continue <20 × 109/L: immunization and splenectomy. Investigation of Helicobacter pylori, if positive: treatment for H. pylori. Chronic immune thrombocytopenia with platelets <20 × 109/L we propose two new groups (A and B): Group A: <65 years, no or low surgical risk, patient declines maintenance therapy or patient intends to get pregnant: immunization and splenectomy. Group B: failure of splenectomy (refractory) or no splenectomy indication or history of exposure to malaria or babesiosis and no response to corticoids or corticoid dependence: choose thrombopoietin receptor agonists: eltrombopag or romiplostim. Patient at high risk for arterial or venous thrombosis: recommend rituximab. After rituximab or thrombopoietin receptor agonists, if platelets continue <20 × 109/L: indicate immunosuppressants (azathioprine or cyclophosphamide), dapsone or mycophenolate mofetil or vinca alkaloids. The goals of treatment for chronic or refractory immune thrombocytopenia are to keep platelets >20 × 109/L and stop bleeding.

Platelet count response to Helicobacter pylori eradication for idiopathic thrombocytopenic purpura in northeastern Brazil

Abstract Background: Several studies have demonstrated that platelet counts in Helicobacter pylori-positive patients with chronic idiopathic thrombocytopenic purpura improved significantly after successful eradication of the infection. However, depending of the geographical region of the study the results have been highly divergent. Objective: The purpose of this study was to evaluate the effect of H. pylori eradication therapy on platelet count in a cohort of chronic idiopathic thrombocytopenic purpura patients from northeastern Brazil. Method: H. pylori status was determined in 28 chronic idiopathic thrombocytopenic purpura patients using the rapid urease test and histology. H. pylori-positive patients received standard triple therapy for one week. The effect of the eradication therapy was evaluated using the 13C-urea breath test two to three months after treatment. Results: The prevalence of H. pylori infection was similar to that found in the general population. Twenty-two patients (78.5%) were H. pylori-positive. Fifteen were treated, 13 (86%) of whom successfully. At six months, 4/13 (30%) displayed increased platelet counts, which remained throughout follow-up (12 months). Platelet response was not associated to mean baseline platelet count, duration of chronic idiopathic thrombocytopenic purpura, gender, age, previous use of medication, or splenectomy. Conclusions: H. pylori eradication therapy showed relatively low platelet recovery rates, comparable with previous studies from southeastern Brazil. The effect of H. pylori eradication on platelet counts remained after one year of follow-up suggesting that treating H. pylori infection might be worthwhile in a subset of chronic idiopathic thrombocytopenic purpura patients.

Visceral leishmaniasis and leishmaniasis-HIV coinfection: comparative study

Abstract INTRODUCTION: This study aimed to draw clinical and epidemiological comparisons between visceral leishmaniasis (VL) and VL associated with human immunodeficiency virus (HIV) infection. METHOD: Retrospective study. RESULTS: Of 473 cases of VL, 5.5% were coinfected with HIV. The highest proportion of cases of both VL and VL/HIV were found among men. A higher proportion of VL cases was seen in children aged 0-10 years, whereas coinfection was more common in those aged 18-50 years. CONCLUSIONS: VL/HIV coinfected patients presented slightly differently to and had a higher mortality rate than those with VL only.

Daily life and playful activities in the first year of elementary school / A vida cotidiana e as brincadeiras no primeiro ano do ensino fundamental

RESUMO: Discute-se se e de que forma a atividade lúdica tem integrado o currículo de primeiros anos do ensino fundamental. Para tal, apresentam-se resultados de pesquisa bibliográfica, realizada na Biblioteca Digital Brasileira de Teses e Dissertações (BDTD), articulados a resultados de pesquisa empírica, realizada em uma turma de primeiro ano de uma escola municipal. A partir desses, problematizam-se: (i) escassa inserção de brincadeiras no cotidiano escolar; (ii) identificação de algumas brechas em que elas ocorrem; (iii) predomínio de jogos de exercício e de regras; e (iv) baixa frequência, curta duração e simplicidade das brincadeiras de faz de conta.

ABSTRACT: The discussion is about if and how playful activities have been added to the syllabus of the initial years of the elementary school. To support it, the results of the bibliographic research, conducted in the Brazilian Digital Library of Theses and Essays (Biblioteca Digital Brasileira de Teses e Dissertações - BDTD), are presented in connection with the results of the empirical research conducted in a first-year classroom of a municipal school in Campinas, São Paulo, Brazil. Based on such results, the following points are raised: (i) scarce games/playful activities in the school routine; (ii) identification of some gaps where such activities may take place; (iii) majority of exercise and rule-driven games; and (iv) low-frequency, short-duration and simple role-play activities.

Salivary density of Streptococcus mutans and Streptococcus sobrinus and dental caries in children and adolescents with Down syndrome

Abstract Streptococcus mutans and Streptococcus sobrinus are strongly associated with dental caries. However, the relationship between oral streptococci and dental caries in children with Down syndrome is not well characterized. Objective To assess and compare dental caries experience and salivary S. mutans, S. sobrinus, and streptococci counts between groups of Down syndrome and non-Down syndrome children and adolescents. Material and Methods This study included a sample of 30 Down syndrome children and adolescents (G-DS) and 30 age- and sex-matched non-Down syndrome subjects (G-ND). Dental caries experience was estimated by the number of decayed, missing, and filled teeth in the primary dentition and the permanent dentition. Unstimulated whole saliva samples were collected from all participants. The fluorescence in situ hybridization technique was used to identify the presence and counts of the bacteria. The statistical analysis included chi-square, Student's t-test and Spearman's correlation. Results The G-DS exhibited a significantly higher caries-free rate (p<0.001) and a lower S. mutans salivary density (p<0.001). No significant differences were found in the salivary densities of S. sobrinus or streptococci between the groups (p=0.09 and p=0.21, respectively). The salivary S. mutans or S. sobrinus densities were not associated with dental caries experience in neither group. Conclusion The reduced dental caries experience observed in this group of Down syndrome children and adolescents cannot be attributed to lower salivary S. mutans densities, as determined with the fluorescence in situ hybridization technique.

Ofensores sexuais avaliados pelo desenho da figura humana / Sex offenders evaluated using the human figure drawing / Delincuentes sexuales evaluados por el dibujo de la figura humana

Este estudo se propôs a avaliar características psicológicas de ofensores sexuais intrafamiliares. Participaram do estudo 10 homens, entre 23 e 59 anos de idade, em situação de reclusão em um Centro de Ressocialização, pelo artigo 213 do Código Penal Brasileiro. Uma entrevista semidirigida e o Desenho da Figura Humana foram utilizadas como instrumentos. A coleta dos dados ocorreu de forma individual, sendo analisados no programa estatístico SPSS versão 22.0, para elaboração de análises descritivas simples. Os resultados dessa amostra apontam indicativos de dificuldade em lidar com impulsos corporais na busca pela satisfação imediata das necessidades, inclusive e, sobretudo, sexuais. Essas características foram recorrentes em alguns elementos dos desenhos, como a perspectiva em relação à localização na página, o tronco omitido e ausência de pupila nos olhos. Os principais resultados corroboram as características de personalidade retratadas comumente na literatura e confirmam a inexistência de um perfil psicológico para o ofensor sexual.

The aim of this study was to evaluate psychological characteristics of intra-family sexual offenders. The study included 10 men, between 23 and 59 years of age, who are inmates in a Resocialization Center as a function of Article 213 of the Brazilian Penal Code. A semi-structured interview and Human Figure Drawing were used, individually, as data collection instruments. Findings were analyzed by the statistic program SPSS version 22.0 for preparation of simple descriptive analyses. The results from this sample indicated difficulty in dealing with physical impulses in seeking immediate satisfaction of needs, including, and primarily, sexual needs. These characteristics were recurrent in some elements of the drawings, such as the location on the paper, the omission of the midsection and the absence of pupils in the eyes. The main findings corroborate the personality characteristics commonly portrayed in the literature and confirm the inexistence of a psychological profile of a sexual offender.

Este estudio se propuso evaluar las características psicológicas de delincuentes que han cometido violencia sexual intrafamiliar. Participaron del estudio 10 hombres, entre 23 y 59 años de edad, en estado de reclusión en un centro de reinserción social, por el artículo 213 del Código Penal Brasileño. Se utilizaron como instrumentos una entrevista semi-dirigida y el dibujo de la figura humana. La recolección de los datos se realizó en forma individual y se analizaron los mismos mediante la programación estadística SPSS versión 22.0, para la elaboración de análisis descriptivos simples. Los resultados de esta muestra señalan indicativos de dificultad en lidiar con impulsos corporales, en la búsqueda de satisfacción inmediata de las necesidades, principalmente sexuales. Esas características fueron recurrentes en algunos elementos de los dibujos, como la perspectiva en relación a la ubicación en la página, el tronco omitido y ausencia de pupila en los ojos. Los principales resultados confirman las características de la personalidad comúnmente retratadas en la literatura y también la ausencia de un perfil psicológico para el delincuente sexual.

Longitudinal study on clinical and microbial analysis of periodontal status in pregnancy

Abstract This study was aimed to provide a longitudinal overview of the subgingival bacterial microbiome using fluorescence in situ hybridization (FISH) technique, in women in the second trimester of pregnancy (between 14 and 24 weeks), and 48 h and 8 weeks postpartum. Of 31 women evaluated during pregnancy, 24 returned for the 48-h and 18 for their 8-week exams postpartum. Probing depth (PD), bleeding on probing, clinical attachment level, and presence of calculus were recorded. Subgingival plaque samples were collected, and FISH was used to identify the numbers of eight periodontal pathogens. Friedman test was used to compare differences between follow-up examinations, followed by a multiple comparison test for a post hoc pairwise comparison. Clinically, a significantly greater number of teeth with PD = 4-5 mm were found during pregnancy than on postpartum examinations. Microbial analysis showed a statistically significant decrease in cell count over the study period for Prevotella nigrescens. P. intermedia, Campylobacter rectus, and Porphyromonas gingivalis also decrease, although not significantly, and Aggregatibacter actinomycetemcomitans increased. No significant changes were found for Fusobacterium nucleatum, Treponema denticola, or Tannerella forsythia. Our data demonstrate a change in the subgingival microbiota during pregnancy, at least for P. nigrescens.