Effects of the COVID-19 pandemic on the implementation of NCD Care at the Primary Care Level in the Philippines: A qualitative inquiry

Background and Objective@#The focusing of resources to COVID-19 response hampered and disadvantaged primary care services including that for Non-Communicable Diseases (NCDs), compromising continuity of care and hence, patients’ disease status. However, studies from low- and middle-income countries (LMICs) remain sparse; therefore, evidence generation on how the pandemic impacted the provision of these primary care services in LMICs will help further understand how policies can be reframed, and programs be made more efficient and effective despite similar crises. To bridge this gap, the study investigated how the pandemic affected the implementation of NCD care at the primary care level in the Philippines.@*Methods@#Thirty-one online focus group discussions via Zoom Meetings were conducted among 113 consenting physicians, nurses, midwives, and community health workers from various facilities — community health centers and stations, free-standing clinics, infirmaries, and level 1 hospitals — located within two provinces in the Philippines. All interviews were video-recorded upon participants’ consent and transcribed verbatim. Inductive thematic analysis was employed through NViVo 12® to generate themes, identify categories, and describe codes. @*Results@#The impact of COVID-19 on NCD care at the primary care level revolved around heightened impediments to service delivery, alongside worsening of pre-existing challenges experienced by the healthcare workforce; subsequently compelling the public to resort to unhealthy practices. These detriments to the primary healthcare system involved resource constraints, discontinued programs, referral difficulties, infection, overburden among workers, and interrupted training activities. Citizens were also observed to adopt poor healthcare seeking behavior, thereby discontinuing treatment regimen. @*Conclusion@#Healthcare workers asserted that disadvantages caused by the pandemic in their NCD services at the primary care level possibly threaten patients’ health status. Besides the necessity to address such detriments, this also emphasizes the need for quantitative studies that will aid in drawing inferences and evaluating the effect of health crises like the pandemic on such services to bridge gaps in improving quality of care.

Geographical Health District and Distance Traveled Influence on Clinical Status at Admission of Patients with Gestational Trophoblastic Disease / A influência do distrito de saúde e da distância viajada sobre o estado clínico na apresentação de pacientes com doença trofoblástica gestacional

Abstract Objective To assess the potential relationship of clinical status upon admission and distance traveled from geographical health district in women with gestational trophoblastic disease (GTD). Methods This is a cross-sectional study including women with GTD from the 17 health districts from the São Paulo state (I-XVII), Brazil, referred to the Botucatu Trophoblastic Disease Center (specialized center, district VI), between 1990 and 2018. At admission, hydatidiform mole was assessed according to the risk score system of Berkowitz et al. Gestational trophoblastic neoplasia was evaluated using the International Federation of Gynecology and Obstetrics / World Health Organization (FIGO/WHO) staging/risk score. Data on demographics, clinical status and distance traveled were collected. Multiple regression analyses were performed. Results This study included 366 women (335 hydatidiform mole, 31 gestational trophoblastic neoplasia). The clinical status at admission and distance traveled significantly differed between the specialized center district and other districts. Patients referred from health districts IX (β = 2.38 [0.87-3.88], p = 0.002) and XVI (β = 0.78 [0.02-1.55], p = 0.045) had higher hydatidiform mole scores than those from the specialized center district. Gestational trophoblastic neoplasia patients from district XVI showed a 3.32 increase in FIGO risk scores compared with those from the specialized center area (β = 3.32, 95% CI = 0.78-5.87, p = 0.010). Distance traveled by patients from districts IX (200km) and XVI (203.5km) was significantly longer than that traveled by patients from the specialized center district (76km). Conclusion Patients from health districts outside the specialized center area had higher risk scores for both hydatidiform mole and gestational trophoblastic neoplasia at admission. Long distances (>80 km) seemed to adversely influence gestational trophoblastic disease clinical status at admission, indicating barriers to accessing specialized centers.

Resumo Objetivo Avaliar a possível relação entre estado clínico na apresentação e distância percorrida a partir do distrito de saúde em mulheres com doença trofoblástica gestacional. Métodos Estudo transversal incluindo mulheres com doença trofoblástica gestacional dos 17 distritos de saúde do estado de São Paulo (I-XVII), Brasil, encaminhadas ao Centro de Doenças Trofoblásticas de Botucatu (distrito VI), entre 1990 e 2018. Na admissão, avaliaram-se mola hidatiforme pelo sistema de pontuação de risco de Berkowitz et al. e neoplasia trofoblástica gestacional pelo escore de risco/estadiamento Federação Internacional de Ginecologia e Obstetrícia / Organização Mundial da Saúde (FIGO/OMS). Coletaram-se dados demográficos, clínicos e distância percorrida e análises de regressão múltipla foram realizadas. Resultados Este estudo incluiu 366 mulheres (335 mola hidatiforme, 31 neoplasia trofoblástica gestacional). O estado clínico na apresentação e distância percorrida diferiram significativamente entre o centro especializado e demais distritos. Nas pacientes encaminhadas pelos distritos IX (β = 2,38 [0,87-3,88], p = 0,002) e XVI (β = 0,78 [0,02-1,55], p = 0,045), os escores de mola hidatiforme foram maiores que no centro especializado. As pacientes com neoplasia trofoblástica gestacional do distrito XVI apresentaram escores FIGO 3,32 vezes maior que no centro especializado (β = 3,32, 95% CI = 0,78-5,87, p = 0,010). A distância percorrida pelas pacientes dos distritos IX (200km) e XVI (203,5km) foi significativamente maior do que a percorrida pelas pacientes do centro especializado (76km). Conclusão Pacientes de distritos de saúde fora da cobertura do centro especializado apresentaram escores de risco mais alto para mola hidatiforme e para neoplasia trofoblástica gestacional na admissão. Longas distâncias (>80 km) pareceram influenciar negativamente o estado clínico da doença trofoblástica gestacional na apresentação, indicando barreiras no acesso a centros especializados.

Caracterización física y sensorial de 24 genotipos especiales de cacao Theobroma cacao

Colombia, se destaca como país productor de cacao fino y de aroma, por lo cual, resulta de gran importancia explorar las características físicas y sensoriales de la diversidad genética existente. Para el presente estudio, se seleccionaron 22 genotipos de colecciones de trabajo con atributos productivos sobresalientes y dos testigos comerciales, reconocidos por su productividad y calidad sensorial; las muestras evaluadas fueron tomadas, de acuerdo con un muestreo aleatorio simple y se realizó un proceso de poscosecha homogéneo, controlado e independiente por genotipo, para obtener muestras de cacao seco individuales. Se realizaron análisis físicos al grano de cada genotipo y se preparó licor de cacao con cada una de las muestras obtenidas. Posteriormente, se evaluó cada licor por medio del panel de evaluación sensorial entrenado, donde se identificó y cuantificó la intensidad de atributos básicos, atributos especiales y atributos adquiridos, característicos de cada muestra. La información fue analizada mediante estadística descriptiva y análisis de componentes principales, lo que permitió la identificación de tres genotipos sobresalientes por el índice de grano y el porcentaje de cascarilla. El análisis sensorial evidenció que, en diecisiete genotipos, predominaron los atributos especiales, como herbal, floral, frutal, frutos secos y dulce. Estos resultados son un aporte importante para la selección de nuevas variedades de alta productividad, con características sensoriales de interés para la comercialización, que pueden ser evaluadas en diferentes regiones, para aumentar la disponibilidad genética en futuros programas de renovación y siembra de cacao que está en expansión, en los distintos territorios del país.

Colombia stands out as a country that produces fine and aroma cocoa; therefore, it is of great importance to explore the physical and sensory characteristics of the existing genetic diversity. For the present study, 22 genotypes from working collections with outstanding productive attributes and two recognized commercial controls were selected and evaluated for its productivity and sensory quality; the evaluated samples were taken according to a simple random sampling and a homogeneous, controlled, and independent post-harvest process was carried out by genotype, to obtain individual dry cocoa samples. Physical analyzes were carried out on the grain of each genotype and cocoa liquor was prepared with each of the samples obtained. Subsequently, each liquor was evaluated by means of the trained sensory evaluation panel, where the intensity of basic attributes, special attributes and acquired attributes characteristic of each sample was identified and quantified. The information was analyzed through descriptive statistics and principal component analysis, which allowed the identification of three outstanding genotypes by the grain index, and the husk percentage. The sensory analysis showed that, in seventeen genotypes, special attributes predominated such as: herbal, floral, fruity, dried fruit and sweet. These results are an important contribution for the selection of new high productivity varieties with sensory characteristics of interest for commercialization, which can be evaluated in different regions, to increase genetic availability in future renewal and planting programs of cocoa that is expanding in the different territories of the country.

Asociación entre el acceso a los servicios odontológicos y la altitud de la residencia de niños peruanos / ssociation among the access to the services odontológicos and the altitude of the residence of Peruvian children

Introducción: El acceso a servicios odontológicos es importante para garantizar una adecuada salud bucal. Por ello, es importante evaluar las barreras geográficas que pueden repercutir en el acceso, como la altitud. Objetivo: Determinar la asociación entre el acceso a los servicios odontológicos y la altitud de residencia de los niños menores de 12 años en Perú, 2019. Métodos: El estudio fue de tipo transversal con una muestra de 42 350 registros de niños menores de 12 años. Las variables fueron acceso a la atención odontológica, tiempo de la atención odontológica, lugar de la atención odontológica, altitud, región, área de residencia, lugar de residencia, región natural, seguro de salud, índice de riqueza, sexo y edad. Se realizó un análisis descriptivo y bivariado con la prueba de chi cuadrado. Los resultados pasaron por un análisis multivariado mediante la regresión de Poisson para obtener las razones de prevalencia y razones de prevalencia ajustadas. Se contó con un nivel de confianza de 95 por ciento y un p < 0,05. Resultados: Se encontró que la altitud estuvo vinculada con el acceso a la atención odontológica (RP = 1,15; IC95 por ciento:1,12 - 1,18; p < 0,001), también cuando se consideran las variables área de residencia, lugar de residencia, región natural, seguro de salud, índice de riqueza, sexo y edad (RPa = 1,10; IC95 por ciento: ºº1,04 - 1,16; p < 0,001). Conclusiones: En 2019, los niños peruanos menores de 12 años, que viven a más de 2500 msnm, tuvieron mayor probabilidad de recibir una atención odontológica en los últimos 2 años(AU)

Introduction: Access to dental services is important to guarantee adequate oral health. Therefore, it is important to assess the geographical barriers that may affect access, such as altitude. Objective: To determine the association between access to dental services and the altitude of residence of children under 12 years of age in Peru, 2019. Methods: The study was a cross-sectional with a sample of 42,350 records of children under 12 years of age. The variables were access to dental care, time of dental care, place of dental care, altitude, region, area of residence, place of residence, natural region, health insurance, wealth index, sex and age. A descriptive and bivariate analysis was performed with the chi square test. The results underwent multivariate analysis using Poisson regression to obtain prevalence ratios and adjusted prevalence ratios. There was a confidence level of 95 percent and p < 0.05. Results: It was found that altitude was linked to access to dental care (PR = 1.15; 95 percent CI: 1.12 - 1.18; p < 0.001), it was also found when considering the variables area of residence, place of residence, natural region, health insurance, wealth index, sex and age (RPa = 1.10; 95 percent CI: ºº1.04 - 1.16; p < 0.001). Conclusions: In 2019, Peruvian children under 12 years, living at more than 2500 masl, were more likely to receive dental care in the last 2 years(AU)

Satisfacción en la atención odontológica especializada en pacientes militares durante la COVID-19

RESUMEN Introducción: La pandemia de la COVID-19 ha generado una transformación de la prestación de los servicios de salud a nivel mundial; los servicios odontológicos no han sido ajenos a esta. Conocer si las necesidades del paciente están satisfechas, es importante porque permitirá mejorar la calidad de atención. Objetivo: Determinar la satisfacción en los pacientes militares que recibieron atención odontológica especializada en el contexto de la pandemia de la COVID-19. Métodos: El estudio fue transversal, la muestra fue de 394 pacientes militares que recibieron atención estomatológica especializada en el Departamento de Estomatología del Hospital Militar Central, durante los meses de agosto a octubre del año 2021. Se aplicó el Cuestionario SERVQUAL modificado y se realizó análisis descriptivo y bivariado (ji cuadrado). Resultados: La satisfacción global de los pacientes militares fue de 82,49 %. De las dimensiones evaluadas, las que obtuvieron mayor satisfacción fueron la empatía (84,77 %), seguida de la seguridad (84,01 %), la fiabilidad (73,60 %), capacidad de respuesta (64,97 %) y elementos tangibles (44,67 %). Conclusiones: El nivel de satisfacción total corresponde a nivel de satisfacción "aceptable"; la dimensión de empatía presentó mayor satisfacción. Además, se estableció la asociación entre la satisfacción total y las variables sexo, edad, nivel de instrucción, unidad de referencia, grado militar, situación laboral y servicio de atención.

ABSTRACT Introduction: The COVID-19 pandemic has generated a transformation in the provision of health services worldwide, dental services have not been oblivious to this, knowing if the patient's needs are met is important because it will improve quality of patient care. Objective: To determine satisfaction in military patients who received specialized dental care in the context of the COVID-19 pandemic. Methods: The study was cross-sectional, the sample was 394 military patients who received specialized dental care in the Stomatology Department of the Central Military Hospital during the months of August to October 2021, the modified SERVQUAL Questionnaire was applied and a descriptive analysis was performed and bivariate (chi squared). Results: The overall satisfaction of the military patients was 82,49 %, of the dimensions evaluated, the one that obtained the greatest satisfaction was empathy (84,77 %), followed by safety (84,01 %), reliability (73,60 %), responsiveness (64,97 %) and tangible elements (44,67 %). Conclusions: The level of total satisfaction corresponds to the "acceptable" level of satisfaction, the empathy dimension being the one that presented the greatest satisfaction, in addition, the significant association between total satisfaction and the variables sex, age, level of instruction, unit of study was established reference, military rank, employment status and customer service.

Factors Associated with Oral Health-Related Quality of Life in Preschoolers of Concepción, Chile: A Cross-Sectional Study

Abstract Objective: To identify the factors associated with Oral Health-Related Quality of Life (OHRQoL) in preschool children of Concepción, Chile. Material and Methods: A cross-sectional study was conducted in a sample of enrolled preschoolers who attend public schools in Concepción, Chile. To measure OHRQoL, the chilean version of the Early Childhood Oral Health Impact Scale (ECOHIS) was used; sociodemographic variables of the children and their parents were also recorded, as well as variables regarding the last visit to the dentist. To determine differences in the ECOHIS score for categorical variables, ANOVA and t-test were used, while Pearson's r was used to correlate ECOHIS with quantitative variables (p<0.05). Results: A total of 175 children were surveyed, with a distribution of 89 boys and 86 girls aged 56-to-79 months. The total score of the ECOHIS had a mean of 4.48 ±5.96, with a score between 0-38. Statistically significant associations were with parent's educational attainment (r=−0.159), dmft (r=0.380), OHI-S debris (r=0.174) and reason for the last visit to the dentist, the highest average in the ECOHIS scores was registered in the urgency reason. Conclusion: Oral health status, dental service utilization and educational level are associated with the OHRQoL of preschoolers of Concepción (AU).

Detection of Sarcocystis spp. and Toxoplasma gondii in swine and detection of DNA of these protozoa in tissues and sausages / Soroprevalência de Sarcocystis spp. e Toxoplasma gondii em suínos e detecção do DNA desses protozoários em tecidos e embutidos

Abstract The seroprevalence of Sarcocystis spp. and Toxoplasma gondii was researched in swine raised in Santa Maria, RS, Brazil. Serum samples from 84 pigs from 31 farms were tested using indirect immunofluorescence assay (IFA) for both agents. Additionally, 53 samples of pork sausages and tissues destined for human consumption, including: salami, sausage, black pudding, heart, tongue, brain, and rib muscle, were submitted to PCR to detect DNA for each agent. The frequency of anti-Sarcocystis spp. antibodies was 36.9% (31/84), with titers ranging from 32 to 1024, and 25% (21/84) for anti-T. gondii antibodies, with titers ranging from 64 to 2048. Sarcocystis spp. and T. gondii DNA were detected in 67.9% (36/53) and 13.2% (7/53) of samples, respectively. The presence of antibodies and the detection of DNA from Sarcocystis spp., and T. gondii suggests that the pigs were infected and may serve as an important reservoir for both parasites. The infection by these protozoa in the swine population is relevant to public health due to their zoonotic potential.

Resumo A soroprevalência de Sarcocystis spp. e Toxoplasma gondii foi pesquisada em suínos criados em Santa Maria, RS, Brasil. Amostras de soro de 84 suínos de 31 fazendas foram testadas pela reação deimunofluorescência indireta (IFA) para ambos os agentes. Adicionalmente, 53 amostras de embutidos suínos e tecidos cárneos destinados ao consumo humano, incluindo: salame, linguiça, morcela, coração, língua, cérebro e músculo da costela foram submetidas à PCR para detecção de DNA para cada agente. A frequência de anticorpos anti-Sarcocystis spp. foi de 36,9% (31/84), com títulos variando de 32 a 1.024; e 25% (21/84) para anticorpos anti-T. gondii, com títulos variando de 64 a 2048. A presença de DNA de Sarcocystis spp. e T. gondii foi detectada em 67,9% (36/53) e 13,2% (7/53) das amostras avaliadas, respectivamente. A detecção de anticorpos e DNA de Sarcocystis spp. e T. gondii sugere que os suínos foram infectados e podem servir como um importante reservatório de ambos os parasitas. A circulação desses agentes na população suína é relevante para a saúde pública devido ao seu potencial zoonótico.

Association between Adverse Maternal Clinical Outcomes and Imbalance of Cytokines and Angiogenic Factors in Preterm Preeclampsia / Associação entre desfechos maternos adversos e desbalanço de citocinas e fatores angiogênicos em pré-eclâmpsia pré-termo

Abstract Objective Preeclampsia (PE) is a pregnancy-specific syndrome characterized by abnormal levels of cytokines and angiogenic factors, playing a role in the disease development. The present study evaluated whether immunological markers are associated with the gestational age and with the disease severity in preeclamptic women. Methods Ninety-five women who developed PE were stratified for gestational age as preterm PE (< 37 weeks) and term PE (≥ 37 weeks of gestation) and compared for disease severity as well as plasma concentration of angiogenic factors and cytokines. The concentrations of placental growth factor (PlGF), vascular endothelial growth factor (VEGF), Fms-like soluble tyrosine kinase (sFlt-1) and soluble endoglin (sEng), as well as the cytokines, tumor necrosis factor-α (TNF-α) and interleukin 10 (IL-10), were determined by enzyme-linked immunosorbent assay (ELISA). Results The comparison between preeclamptic groups showed a higher percentage of severe cases in preterm PE (82.1%) than in term PE (35.9%). Similarly, the concentrations of TNF-α, sFlt-1, and sEng, as well as TNF-α/IL-10 and sFlt-1/PlGF ratios were significantly higher in the preterm PE group. In contrast, concentrations of PlGF, VEGF, and IL-10 were significantly lower in women with preterm PE. Negative correlations between TNF-α and IL-10 (r = 0.5232) and between PlGF and sFlt1 (r = 0.4158) were detected in the preterm PE. Conclusion In pregnant women with preterm PE, there is an imbalance between immunological markers, with the predominance of anti-angiogenic factors and TNF-α, associated with adverse maternal clinical outcomes.

Resumo Objetivo A pré-eclâmpsia (PE) é uma síndrome específica da gravidez caracterizada por níveis anormais de citocinas e fatores angiogênicos, que desempenham um papel no desenvolvimento da doença. Este estudo avaliou se os marcadores imunológicos estão associados à idade gestacional e à gravidade da doença em mulheres com pré-eclâmpsia. Métodos Noventa e cinco mulheres que desenvolveram PE foram estratificadas pela idade gestacional em PE pré-termo (< 37 semanas) e PE a termo (≥ 37 semanas de gestação) e comparadas quanto à gravidade da doença, bem como à concentração plasmática de fatores angiogênicos e citocinas. As concentrações de fator de crescimento placentário (PlGF), fator de crescimento endotelial vascular (VEGF), tirosina quinase solúvel semelhante a Fms (sFlt-1) e endoglina solúvel (sEng), bem como as citocinas, fator de necrose tumoral alfa (TNF- α) e interleucina 10 (IL-10), foram determinados porensaio de imunoabsorção enzimática (ELISA, na sigla em inglês). Resultados A comparação entre os grupos com pré-eclâmpsia mostrou maior porcentagem de casos graves em PE pré-termo (82,1%) do que em PE a termo (35,9%). Da mesma forma, as concentrações de TNF-α, sFlt-1 e sEng, bem como as razões TNF-α/IL-10 e sFlt-1/PlGF foram significativamente maiores no grupo de PE pré-termo. Em contraste, as concentrações de PlGF, VEGF e IL-10 foram significativamente menores em mulheres com PE pré-termo. Correlações negativas entre TNF-α e IL-10 (r = 0.5232) e entre PlGF e sFlt1 (r = 0.4158) foram detectadas no grupo de PE pré-termo. Conclusão Em gestantes com PE pré-termo, ocorre um desequilíbrio entre os marcadores imunológicos, com predomínio de fatores antiangiogênicos e TNF-α, associados a desfechos clínicos maternos adversos.

Estilos de vida y estado nutricional en el personal militar sanitario durante la COVID-19 / Lifestyles and nutritional status in military health personnel during COVID-19

Introducción: El personal militar sanitario posee características laborales y factores propios de la vida militar, que los predisponen a alterar sus estilos de vida, más aún con las medidas restrictivas que se establecen por la emergencia sanitaria de la COVID-19. Objetivo: Determinar la asociación entre los estilos de vida y el estado nutricional del personal militar sanitario. Métodos: El estudio fue transversal, la muestra estuvo conformada por 104 profesionales sanitarios militares que laboran en el Hospital Militar Central. Se aplicó el Cuestionario de Estilos de Vida de Arrivillaga, Salazar y Gómez; se pesó y talló a los sujetos, para obtener el índice de masa corporal, también se obtuvo la medida del perímetro abdominal, que indicó el riesgo cardiometabólico, se realizó el análisis descriptivo, bivariado (prueba de ji cuadrado) y multivariado para obtener razones de prevalencia. Resultados: Se evidenció asociación entre estilo de vida poco saludable con el índice de masa corporal (razón de prevalencia = 15,467; IC 95 por ciento: 2,228 - 107,357: p < 0,001) de igual manera cuando fue ajustado para las variables edad, sexo, profesión y grado militar (razón de prevalencia ajustado =18,515; IC 95 por ciento: 2,98 - 114,913: p < 0,001). Conclusiones: Se concluye que existe asociación entre el estilo de vida y el estado nutricional, determinado por el IMC y el PA en el personal militar sanitario estudiado(AU)

Introduction: Military health personnel have work characteristics and factors inherent to military life that predispose them to alter their lifestyles, even more so with the restrictive measures that were established by the health emergency of COVID-19. Objective: To determine the association between lifestyles and nutritional status of military health personnel. Methods: The study was cross-sectional, the sample consisted of 104 military health professionals who work in the Central Military Hospital. The Lifestyle Questionnaire of Arrivillaga, Salazar and Gómez was applied; subjects were weighed and carved to obtain the body mass index, the measurement of the abdominal perimeter was also obtained, which indicated the cardiometabolic risk, the descriptive, bivariate analysis (chi-square test) and multivariate analysis was performed to obtain prevalence ratio values. Results: The association between "unhealthy" lifestyle with the Body Mass Index (prevalence ratio = 15,467; 95 percent CI: 2,228-107,357: p < 0,001) was evidenced in the same way when it was adjusted for the variables age, sex, profession and military rank (adjusted prevalence ratio = 18,515; 95 percentCI: 2,98-114,913: p < 0,001). Conclusions: There is an association between lifestyle and nutritional status determined by body mass index and abdominal circumference in military health personnel(AU)

Internato na pandemia Covid-19: a experiência de uma escola médica / Medical internship in the Covid-19 pandemic: the experience of a medical school

Resumo: Introdução: A pandemia da Covid-19 provocou milhares de mortes e levou a incontáveis mudanças na forma de organização de serviços de saúde e nas escolas de Medicina mundo afora. Relato de experiência: Este artigo relata a experiência da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista (Unesp), cujas aulas foram suspensas em função da pandemia. Discussão: Descrevem-se as motivações para a suspensão e os procedimentos para a retomada das aulas do internato, depois de 15 semanas da interrupção. Conclusão: Ressalta-se a importância das decisões coletivas, da comunicação empática, do acolhimento e cuidado com a saúde mental e da parceria com o Hospital das Clínicas na realização de rastreamento para a presença do vírus entre os estudantes. Por fim, destaca-se o aprendizado para o professor ao se defrontar, por um lado, com a impotência diante da morte e do desconhecido, e, por outro, com a potência do cuidado que pode ser oferecido em situação tão singular quanto uma pandemia.

Abstract: Introduction: The COVID-19 pandemic has caused thousands of deaths and led to countless changes in the way health services and medical schools are organized around the world. Experience report: This article reports on the experience of the Botucatu Faculty of Medicine, UNESP, located in the interior of the state of São Paulo, where classes were suspended due to the pandemic. Discussion: The reasons for the suspension of internship classes and the procedures for their resumption, after 15 weeks, are described. Conclusions: The study highlights the importance of collective decisions, empathic communication, mental health care and attention and the partnership with the Hospital das Clínicas in performing track and trace for presence of the virus among the students. Finally, particular emphasis is given to the learning gained by teachers who found themselves feeling, on the one hand, powerless in the face of death and the unknown and, on the other, the strength of the care that can be offered in a situation as unique as the pandemic.

Association between access to oral hygiene information and toothbrushing among children in Peru / Asociación entre el acceso a la información sobre higiene oral y el cepillado dental en niños en el Perú

Abstract Introduction: the aim of this study was to determine the association between access to oral hygiene information and toothbrushing in children under 12 years in Peru in 2017. Methods: cross-sectional study of secondary data using the database of the 2017 Demographic and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES). The association between access to oral hygiene information and toothbrushing was estimated using multivariate regression analysis. The sample consisted of 24,076 records of children. The dependent variable was information about toothbrushing practices (daily toothbrushing, toothbrushing frequency and toothpaste use) and the independent variable was access to oral hygiene information. Covariables included sex, age, area of residence, and natural region. Results: the prevalence of access to oral hygiene information was 62.39%. A significant association was found between 2 of the 3 reported toothbrushing practices and access to oral hygiene information, with children under 12 years being more likely to brush teeth daily (PR = 1.03; 95% CI 1.02-1.05) and with a toothbrushing frequency 2 to more times a day (PR = 1.06; 95% CI 1.04 - 1.08) compared to children who did not receive hygiene and oral care information. The use of toothpaste was not associated with access to oral hygiene information. Conclusion: there was an association between daily toothbrushing, toothbrushing frequency and access to oral hygiene information in children in Peru in 2017.

Resumen Introducción: el objetivo del presente estudio consistió en determinar la asociación entre el acceso a la información sobre higiene oral y el cepillado dental en niños menores de 12 años en el Perú, en el año 2017. Métodos: estudio transversal de datos secundarios utilizando la base de datos de la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2017. Se estimó la asociación entre el acceso a la información de hygiene oral y el cepillado mediante un análisis multivariado de regresión. La muestra fue conformada por 24.076 registros de niños. La variable dependiente fue la información acerca de las prácticas de cepillado dental (cepillado diario, frecuencia del cepillado y uso de la pasta dental) y la variable independiente fue el acceso a la información de higiene oral. Las covariables incluyeron sexo, edad, área de residencia y región natural. Resultados: la prevalencia del acceso a la información de higiene oral fue 62.39%. Se encontró asociación significativa entre 2 de las 3 prácticas de cepillado reportadas y el acceso a la información de higiene oral; los niños menores de 12 años tuvieron más probabilidades de cepillarse diariamente (PR=1.03; 95% IC 1.02-1.05), con una frecuencia de cepillado de 2 o más veces al día (PR = 1.06; 95% IC 1.04-1.08), en comparación con niños que no recibieron información de higiene y cuidado oral. El uso de pasta dental no estuvo asociado al acceso a la información de higiene oral. Conclusión: existe asociación entre el cepillado diario, la frecuencia del cepillado y el acceso a la información sobre higiene oral en niños del Perú en 2017.

Analysis of Adherence to Antihypertensive Drug Treatment in an Argentinean Cohort

Abstract Background Adherence to antihypertensive medication is a major challenge in the management of hypertension, and non-adherence is an important barrier to effective management of hypertension. Objectives To determine the adherence rate to hypertensive drug treatment and the factors that influence non-adherence in a cohort of the Argentinean population. Methods A multicenter cross-sectional study was conducted in eight cities of Argentina. Consecutive hypertensive patients seen in general practice offices, receiving pharmacological treatment for at least six months were included. Blood pressure measurements were performed by physicians during the patient visit. The level of adherence was assessed using the Morisky questionnaire, and patients were divided into non-adherent and adherent. Continuous variables were compared using independent t-test. Categorical variables were compared using the χ2 test. To identify the variables independently associated with non-adherence, a forward stepwise binary regression logistic model was performed, and the results expressed as odds ratio (OR) with 95% of confidence interval. All tests were two-tailed, and p-values < 0.05 were considered statistically significant. Results A total of 852 individuals (52% women, 62 ± 13 years) were included. The main reason for lack of adherence was forgetfulness of medication intake and errors in the time of intake (~ 40% in both). Individuals with more cardiovascular risk factors (smoking, diabetes, dyslipidemia and previous cardiovascular events) had lower adherence to antihypertensive treatment, and considerably younger (~ five years younger). Conclusions Adherence rate to antihypertensive drug treatment in our study group was higher than the one reported in previous studies, and the main reason for non-adherence was forgetfulness of medication intake. (Int J Cardiovasc Sci. 2020; 33(3):272-277)

Concordancia entre la radiografía panorámica y la tomografía computarizada de haz cónico en la relación de los terceros molares mandibulares con el conducto dentario inferior / Concordance between panoramic radiography and cone beam computed tomography in the relationship of mandibular third molars with inferior dental canal

RESUMEN Objetivo : determinar la concordancia entre la radiografía panorámica y la tomografía computarizada de haz cónico en el análisis de la relación de los terceros molares mandibulares con el conducto dentario inferior en una población peruana. Material y métodos : la investigación fue observacional, descriptiva, transversal y retrospectiva. La muestra fue de 112 terceros molares y para la evaluación radiográfica se utilizó la clasificación modificada de Robert Langlais. Así mismo, otras variables fueron edad, sexo y lado. Las pruebas estadísticas empleadas fueron chi cuadrado, prueba U de Mann Whitney, prueba de Kruskall Wallis y el Índice de Kappa de Cohen. Resultados : según la radiografía panorámica, el 82,1% (n=92) de los terceros molares presentó superposición, del cual el mayor porcentaje fue para el signo "discontinuidad" con 25,9% (n =29). Según la tomografía computarizada de haz cónico, el 65,2% (n=73) de los molares presentó "contacto". El signo radiográfico "banda oscura + discontinuidad" tuvo una correspondencia del 88,9% (n=24) con la presentación tomográfica de "contacto". Conclusiones : existe una baja concordancia diagnóstica entre la radiografía panorámica y la tomografía computarizada de haz cónico en el análisis de la relación del tercer molar mandibular con el conducto dentario inferior. Además, no existe diferencia estadísticamente significativa de esta relación con el sexo, ni con la edad y ni tampoco con el lado.

SUMMARY Objective : to determine the concordance between panoramic radiography and cone beam computed tomography in analysis of the relationship of mandibular third molars with inferior dental canal in patients attended in a peruvian population. Material and methods : this research was observational, descriptive, cross-sectional and retrospective. The sample was 112 mandibular third molars and modified classification of Robert Langlais was used for radiographic evaluation. Likewise, other variables were age, sex and side. The statistical tests used were chi square, Mann Whitney U test, Kruskall Wallis test and Cohen's kappa coefficient. Results : according to panoramic radiography, 82.1% (n = 92) of third molars showed superposition, of which the highest percentage was for "interruption of white line" with 25.9% (n = 29). According to cone beam computed tomography, 65.2% (n = 73) of the molars showed "contact". Radiographic sign "darkening of root + interruption of white line" had correspondence of 88.9% (n = 24) with tomographic presentation of "contact". Conclusions : there is low diagnostic concordance between panoramic radiography and cone beam computed tomography in analysis of the relationship of mandibular third molar with inferior dental canal and there is also no statistically significant difference of this relationship with sex, neither with age nor with side.

Rastreamento e diagnóstico de diabetes mellitus gestacional no Brasil / Screening and diagnosis of gestational diabetes mellitus in Brazil

Em primeiro de agosto de 2016, considerando-se a relevância do Diabetes Mellitus Gestacional (DMG), tanto por sua prevalência como pelas consequências para o binômio materno-fetal em curto e em longo prazo, foi realizado, em São Paulo, um fórum de discussão sobre o tema, com o objetivo de definir uma proposta para o diagnóstico de DMG para o Brasil. Nesse contexto, participaram da reunião médicos especializados na assistência a mulheres com DMG: obstetras da Federação Brasileira de Ginecologia e Obstetrícia (Febrasgo), endocrinologistas da Sociedade Brasileira de Diabetes (SBD) e consultores da Organização Panamericana de Saúde (Opas/OMS Brasil) e assessores técnicos do Ministério da Saúde. Apresentamos neste documento os principais pontos debatidos visando à análise cuidadosa das possibilidades para diagnóstico de DMG, considerando-se as diferenças de acesso aos serviços de saúde existentes no Brasil.(AU)

The impact of mass media on the access to oral care and hygiene information in Peru, 2013-2016 / Impacto de los medios de comunicación en el acceso a información sobre el cuidado e higiene bucal en el Perú, 2013-2016

ABSTRACT Introduction: mass media are new ways of transmitting health information, making it easily available to the public. The aim of the present study was to determine the impact of mass media on the access to oral care and hygiene information among the Peruvian population in the period 2013-2016. Methods: longitudinal observational study using databases of the Demography and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES) from 2013 to 2016 and the following variables: access to information, organism and sector supplier of information, geographic area, natural region, and year. This study also involved a descriptive, bivariate (chi-squared) and multivariate analysis (Poisson Loglinear Regression) with a confidence level of 95% and p < 0.05. Results: the proportion of access to oral care and hygiene information in the mass media by children under 12 years of age was 12.8% in 2013, decreasing to 8.94% in 2016. There was a positive impact of mass media as providers of information on oral health care adjusted by geographic area and natural region: 2013 with prevalence ratio (PR) 1.96 (1.89-2.02); 2014 with PR 1.85 (1.82-1.87); 2015 with PR 1.61 (1.60-1.63); 2016 with PR 1.62 (1.60-1.64) and 2013-2016 with PR 1.69 (1.68-1.79). Conclusions: access to oral care and hygiene information provided by the media has been declining in Peru; however, the media generally have an increased positive impact in this regard, compared to other information suppliers, even considering users' geographic area and natural region.

RESUMEN Introducción: los medios de comunicación son nuevas formas para transmitir información en salud debido al fácil acceso en la población. El objetivo del presente estudio consistió en determinar el impacto de los medios de comunicación en el acceso a la información sobre el cuidado e higiene bucal en la población peruana entre 2013 y 2016. Métodos: estudio longitudinal y observacional. Se utilizaron las bases de datos de las Encuesta Demográfica y de Salud Familiar (ENDES) de 2013 a 2016, siendo las variables el acceso a información, entidad y sector proveedor de información, ámbito geográfico, región natural y año. Se realizó un análisis descriptivo, bivariado (Chi-cuadrado) y multivariado (Regresión Loglineal de Poisson), con un nivel de confianza de 95% y un p<0.05. Resultados: el acceso a información sobre el cuidado e higiene bucal por los medios de comunicación en menores de 12 años de edad fue 12.8% en 2013 y disminuyó hasta 8.94% en 2016. Se encontró un impacto positivo de los medios de comunicación para obtener información sobre el cuidado en salud bucal ajustado por ámbito geográfico y región natural: 2013 con RP: 1,96 (1,89-2,02); 2014 con RP: 1,85 (1,82-1,87); 2015 con RP: 1,61 (1,60-1,63); 2016 con RP: 1,62 (1,60-1,64) y 2013-2016 con RP: 1,69 (1,68-1,79). Conclusiones: el acceso a la información sobre el cuidado e higiene bucal brindado por los medios de comunicación ha ido disminuyendo en el Perú; sin embargo, tienen un impacto positivo en el acceso, aumentado la probabilidad de quienes usan este medio en comparación con los otros proveedores de información, inclusive considerando el ámbito geográfico y la región natural.

Descenso transanal endorrectal De la Torre como tratamiento de enfermedad de hirschsprung, Hospital Escuela, 2013-2015 / Transanal endorectal pull-through de la torre as treatment for Hirschsprung ́s disease, University Hospital, 2013-2015

. Antecedentes: La enfermedad de Hirschsprung (EH) es causa de obstrucción intestinal baja en neonatos. En 1998, De la Torre y Ortega publicaron una importante modificación a la técnica de Soave, realizando un descenso transanal endorrectal. Objetivo:Describir la experiencia en el tratamiento de la Enfermedad de Hirschsprung mediante la técnica descrita por De la Torre, Hospital Escuela, Tegucigalpa, 2013-2015. Metodología: Estudio descriptivo transversal. Se revisaron expedientes clínicos y se registró información sobre características sociodemográficas y clínicas de los pacientes. Los resultados se presentan como frecuencias y porcentajes de las variables estudiadas. La información personal de los pacientes se manejó confidencialmente. Resultados: Se identificó un total de26 casos intervenidos en el periodo del estudio. El 73.1% (19) pertenecía al sexo masculino, 46.2% (12) se diagnosticó antes de 12 meses de vida; sin enfermedades asociadas. La biopsia diagnosticó la enfermedad en el 100% de los casos. La longitud del colon resecado fue de 10-20 cm en 88.5% (23), con un tiempo quirúrgico de 4-5 horas 69.2% (18). El 19.2% (5) presentó complicaciones. Se inició alimentos en menos de 5 días en 96.1% (25), la estancia hospitalaria fue menor a 7 días en 88.5% (23). Discusión: El descenso endorrectal transanal es una operación segura con pocas complicaciones operatorias y postoperatorias. En este estudio, la estancia hospitalaria y el tiempo hasta la alimentación oral completa fueron más cortos que los procedimientos convencionales lo que generó menores costes hospitalarios. Consideramos que ésta es la técnica de elección para enfermos con la Enfermedad de Hirschsprung...(AU)

Caracterización de los medicamentos e insumos médicos aptos para la disposición final en el Primer Nivel de Atención de la Región de Salud Central/Ministerio de Salud, Enero 2016 a Diciembre de 2018 / Characterization of drugs and medical supplies suitable for final disposal in the First Level of Care of the Central Health Region / Ministry of Health, January 2016 to December 2018

Propósito: Determinar cuáles son las causa y montos del vencimiento y avería de los medicamentos e insumos médicos aptos para su disposición final, en el primer nivel de atención de la Región de Salud Central. Material y Métodos: Tipo de Estudio: observacional, descriptivo y retrospectivo; área de estudio: Región de Salud Central; universo y muestra fue el 100% de la información existente y proveniente de los 108 establecimientos de salud del Primer Nivel de Atención de la Región de Salud Central. Resultados: La principal causa que provoca el vencimiento de medicamentos es el no lograr su transferencia. La avería de medicamentos e insumos médicos, y el vencimiento de insumos médicos tienen como principal causa el incumplimiento de las buenas prácticas de almacenamiento. El mayor costo lo tiene la causa denominada No lograr su transferencia. Conclusiones: Los montos y las causas del vencimiento y avería, se encuentran principalmente, en el SIBASI La Libertad y Almacén Regional, respectivamente. El vencimiento de medicamentos e insumos médicos es menor al estándar internacional. Recomendaciones: Fortalecer, como parte de la gestión de medicamentos e insumos, el Sistema de Transferencia Regional a fin de evitar el vencimiento de todo medicamento que le es notificado. Crear un nuevo Instrumento Técnico Jurídico sobre Buenas Prácticas de Almacenamiento que considere el escenario nacional, regional y local; evitando las asignaciones por encima de la política de cobertura

Use of an anatomical mid-sagittal plane for 3-dimensional cephalometry: A preliminary study

PURPOSE: Cone-beam computed tomography (CBCT) is widely used for 3-dimensional assessments of cranio-maxillofacial relationships, especially in patients undergoing orthognathic surgery. We have introduced, for reference in CBCT cephalometry, an anatomical mid-sagittal plane (MSP) identified by the nasion, the midpoint between the posterior clinoid processes of the sella turcica, and the basion. The MSP is an updated version of the median plane previously used at our institution for 2D posterior-anterior cephalometry. This study was conducted to test the accuracy of the CBCT measures compared to those obtained using standard posterior-anterior cephalometry. MATERIALS AND METHODS: Two operators measured the inter-zygomatic distance on 15 CBCT scans using the MSP as a reference plane, and the CBCT measurements were compared with measurements made on patients' posterior-anterior cephalograms. The statistical analysis evaluated the absolute and percentage differences between the 3D and 2D measurements. RESULTS: As demonstrated by the absolute mean difference (roughly 1 mm) and the percentage difference (less than 3%), the MSP showed good accuracy on CBCT compared to the 2D plane, especially for measurements of the left side. However, the CBCT measurements showed a high standard deviation, indicating major variability and low precision. CONCLUSION: The anatomical MSP can be used as a reliable reference plane for transverse measurements in 3D cephalometry in cases of symmetrical or asymmetrical malocclusion. In patients who suffer from distortions of the skull base, the identification of landmarks might be difficult and the MSP could be unreliable. Becoming familiar with the relevant software could reduce errors and improve reliability.

Caries dental en niños con necesidades especiales de un colegio de bajos recursos en el Perú / Dental caries in children with special needs from a low resource school in Peru

Objetivos: Determinar la prevalencia de caries dental en los niños del centro de educación básica especial Helen Keller situado en el Callao, Perú durante el 2015. Material y Métodos: Estudio observacional, transversal sobre los datos de 30 niños del centro de educación básica especial Helen Keller. Información recogida por alumnos de la Facultad de Estomatología de la Universidad Peruana Cayetano Heredia (UPCH), en el centro educativo durante el año 2015. Se analizaron las características de los niños (edad, sexo, y diagnóstico sistémico). Para caries dental se utilizó el índice CPOD/ceod y el índice CPOS/ceos. Resultados: El 90% (n=27) de los escolares presentó caries dental. El retardo mental fue la condición más prevalente (43,3%, n=13). Se encontró un índice de CPOD de 2,9 (DE 3,8) y en dientes deciduos (ceod) de 6,0 (DE 4,0). Conclusiones: Existe una alta prevalencia de caries dental en los niños del centro de educación básica especial Helen Keller Callao, Perú en el año 2015.

Objectives: Determine dental caries prevalence of children from a basic educational center for special needs, Helen Keller school situated at Callao, Perú during 2015. Material and Methods: Cross-sectional study on a sample of 30 children from the basic educational center for special needs, Helen Keller school. The data was collected from Universidad Peruana Cayetano Heredia (UPCH) during 2015 at mentioned school. Children characteristics were analyzed (age, sex, systemic diagnosis) in frequencies, and dental caries prevalence. We analyzed dental caries per each tooth (DMFT/dmft index) and each surface (DFMS/dmfs index). Results: 90% (n=27) of scholars had dental caries. Mental retardation, was the most common condition (43.3%, n=13). We found a DMFT index of 2.0 (SD 3.8) and in deciduous teeth (dmft index) of 6.0 (SD 4.0). Conclusions: There is a considerable proportion of children that have dental caries in Basic educational center for special needs Helen Keller, Callao, Perú during 2015.

Influence of hydrogel use on soybean cultivation hydrical stress / Influência do uso do hidrogel no cultivo da soja sob estresse hídrico

Among the agricultural production factors, the water deficit is one of the main reasons that limits soy production in Brazil. In order to mitigate losses due to water stress in the plants, hydrogels appear as soil water conditioners. They are polymers capable of absorbing large amounts of water and are being used as a viable alternative to improve the storage of water in areas of scarcity. Hydrogen concentrations between 14 and 18 kg ha-1 resulted in higher plant height, number of pods, one hundred grain mass and grain yield.

Dentre os fatores de produção agrícola, o déficit hídrico é um dos principais motivos que mais limita a produção de soja no Brasil. A fim de amenizar os prejuízos por estresse hídrico nas plantas, os hidrogéis surgem como condicionadores de água no solo, já são polímeros capazes de absorver grande quantidade de água e estão sendo utilizados como alternativa viável para melhorar o armazenamento de água em áreas de escassez. Objetivou-se com este trabalho avaliar a eficiência da utilização do hidrogel na retenção e disponibilização de água para o desenvolvimento e produção da cultura da soja quando submetido a estresse hídrico. As concentrações de hidrogéis entre 14 e 18 kg ha-1 resultaram em maior altura de plantas, número de vagens, massa de cem grãos e produtividades de grãos.