Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic / Hospitalizações por câncer bucal e orofaríngeo no Brasil pelo SUS: impactos da pandemia de covid-19

ABSTRACT OBJECTIVE To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS). METHODS We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change. RESULTS Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods. CONCLUSION After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

RESUMO OBJETIVO Analisar o impacto das diferentes fases da pandemia de covid-19 sobre as hospitalizações por câncer bucal (CaB) e de orofaringe (CaOR) no Brasil, realizadas no âmbito do Sistema Único de Saúde (SUS). MÉTODOS Os dados quanto às internações hospitalares por CaB e CaOR, entre janeiro de 2018 e agosto de 2021, foram obtidos no Sistema de Informações Hospitalares do SUS. As internações foram analisadas sob a forma de taxas por 100 mil habitantes. Os períodos de pandemia (janeiro de 2020 a agosto de 2021) e pré-pandemia (janeiro de 2018 a dezembro de 2019) foram divididos em quadrimestres; as taxas quadrimestrais do período pandêmico foram comparadas às taxas análogas do período pré-pandemia - para o Brasil, por macrorregião e por grupo de procedimentos realizados na internação. O impacto da pandemia sobre o valor médio das internações também foi analisado. Os resultados foram expressos em variação percentual. RESULTADOS As taxas de internação hospitalar no SUS por CaB e CaOR reduziram durante a pandemia no Brasil. Em comparação com os quadrimestres de 2019, a maior redução foi identificada no segundo quadrimestre de 2020 (18,42%), seguida das reduções do terceiro quadrimestre de 2020 (17,76%) e do primeiro e segundo quadrimestres de 2021 (respectivamente, 14,64% e 17,07%). Sul e Sudeste apresentaram as reduções mais expressivas e constantes entre as diferentes fases da pandemia. As internações para procedimentos clínicos sofreram maior redução do que para procedimentos cirúrgicos. No Brasil, o gasto médio por internação nos quadrimestres da pandemia foi maior do que nos quadrimestres de referência. CONCLUSÃO Após mais de um ano do início da pandemia no Brasil, a rede hospitalar de cuidado ao CaB e CaOR do SUS ainda não tinha se restabelecido. A demanda reprimida de hospitalizações por essas doenças, que são de rápida evolução, possivelmente resultará em atrasos para tratamento, com impacto negativo para a sobrevida desses pacientes; futuros estudos são necessários para monitorar essa situação.

How oral health literacy and parental behavior during the meals relate to dental caries in children

Abstract This cross-sectional study aimed to verify the influence of parental behavior on the development of dental caries in children by assessing parents' behavior during their children's meals and their parental level of oral health literacy. This study was conducted with children aged 2 to 4 in Diadema, São Paulo, Brazil. Six hundred and thirty children were examined to assess the prevalence of dental caries (dmft index). Parents answered a questionnaire related to socio-demographic conditions, oral health literacy (OHL), and the parents' behavior during the meal - Parent Mealtime Action Scale - (PMAS). The analysis fitted zero-inflated negative binomial regression (ZINB) models to assess unadjusted and adjusted associations between the study outcome and covariates. In the unadjusted analysis, the child's age, the number of siblings, household crowding, family income, socioeconomic status and OHL were associated with the outcome (p <0.05). In the adjusted model, dental caries was more prevalent among 3- (PR: 1.85, 95%CI: 1.19-2.87) and 4-year-old children (PR: 2.43, 95%CI: 1.60-3.71), those with at least one sibling (PR: 1.66, 95%CI:1.18-2.33). Poor children were more likely to have dental caries (PR: 0.66, 95%CI: 0.48-0.91); the Use of Rewards dimension of the PMAS was associated positively with dental caries severity (RR: 0.90, 95%CI: 0.84-0.97). Although OHL was not associated with caries, parents' mealtime behaviors were related to dental caries. This suggested that communication between parents and children related to good eating practices could play a protective role against dental caries in children.

The impacts of oral health-related quality of life of elderly people living at home: a cross-sectional study / Impactos da qualidade de vida relacionada à saúde bucal de idosos em domicílio: estudo transversal

Abstract The scope was to verify the impact of oral and sociodemographic conditions, the dental treatment needs and dental pain, on the quality of life of the elderly. This cross-sectional study was conducted in 15 primary health care areas. A backward multivariate linear regression model was used (p<0.05) with oral health related-quality of life as dependent variable. There were 335 elderly people with predominance of women (56.72%) and aged up to 74 years (59.40%). Those who had up to 8 years of education predominated (87.46%), and those who were still working were the minority (13.43%). Multivariate linear regression (p<0.05) showed association with missing teeth (β=0,12; IC 0,00:0,04; p<0,04) and dental prosthesis needs (β=0,14; IC 0,13:0,81; p<0,01), women (β=0,18; IC 0,23:0,85; p<0,01), less aged (β=-0,12; IC -0,05:0,00; p<0,02), not working (β=-0,15; IC -1,09:-0,20; p<0,01), with dental care need (β=0,24; IC 0,25:0,63; p<0,01) and dental pain (β=0,14; IC 0,10:0,64; p<0,01). Missing teeth, sociodemographic conditions, dental treatment needs and dental pain might impact oral health-related quality of life of elders.

Resumo O objetivo foi verificar o impacto da condição bucal e sociodemográfica, necessidade de tratamento odontológico e dor dentária na qualidade de vida de idosos. Este estudo transversal realizou-se em 15 áreas de cuidados primários de saúde. O modelo de regressão linear multivariado foi utilizado (p <0,05) considerando qualidade de vida como variável dependente. Participaram 335 idosos, predomínio de mulheres (56,72%) com idade até 74 anos (59,40%). Ter até 8 anos de estudo predominou (87,46%) e os que trabalhavam eram minoria (13,43%). A regressão linear multivariada (p <0,05) apresentou associação da qualidade de vida com dentes perdidos (β=0,12; IC 0,00:0,04; p<0,04) e necessidade de próteses (β =0,14; IC 0,13:0,81; p<0,01), com mulheres (β=0,18; IC 0,23:0,85; p<0,01), idosos mais jovens (β=-0,12; IC -0,05:0,00; p<0,02), que não trabalham (β=-0,15; IC -1,09:-0,20; p<0,01), com necessidades de tratamento odontológico (β=0,24; IC 0,25:0,63; p<0,01) e dor dentária (β=0,14; IC 0,10:0,64; p<0,01). Dentes perdidos, aspectos sociodemográficos, necessidade de tratamento odontológico e dor dentária podem impactar a qualidade de vida relacionada à saúde bucal de idosos.

Dental caries spectrum profile in Brazilian public school children and adolescents

Abstract Dental caries remains a major public health problem, with a higher prevalence among in adolescence. The present study aimed to assess the dental caries spectrum profile in children and adolescents in Brazilian public schools. A cross-sectional study was performed in two public schools in Brazil to examine the permanent teeth of children and adolescents. The dental caries were assessed by applying the Caries Assessment Spectrum and Treatment (CAST) instrument, and the results were distributed as per disease status (healthy/codes 0-2; pre-morbidity/code 3; morbidity/code 4-5; severe morbidity/codes 6-7; mortality/code 8) and by severity as per the CAST-F1 formula (no severity, mild, moderate, and severe). The CAST data were described by age groups (8-9 y, 10-11 y, 12-13 y, 14-15 y, 16-17 y, and 18-19 y). The Kruskal-Wallis test was used to investigate differences in CAST prevalence and severity among the groups (p < 0.05). Total 598 students were enrolled. Most of the subjects were male (53.34%) and belonged to the age group of 12-13 y (34.95%). The variables CAST 0/1 (p = 0.024), CAST (p = 0.024), and CAST-F1 (p = 0.029) showed significant differences among age groups, and the post hoc test showed the differences in these variables as per the age groups of 14-15 y and 16-17 y (CAST 0/1, p = 0.047; CAST, p = 0.047; CAST-F1, p = 0.033). The dental caries spectrum increased from 8 to 19 y with a peak in the prevalence and severity in the middle of adolescence.

Alfabetismo em saúde bucal e comportamento de pais/cuidadores durante as refeições dos seus filhos: impactos na prevalência de cárie e qualidade de vida de pré-escolares em Diadema, São Paulo / Oral health literacy and behavior of parents / caregivers during their children's meals: impacts on the prevalence of caries and quality of life in preschoolers in Diadema, São Paulo

Introdução: O alfabetismo em saúde bucal é o grau em que os indivíduos têm a capacidade de obter, processar e compreender informações de saúde e utilizar os serviços básicos de saúde, para tomar decisões de saúde bucal apropriadas. Objetivos: 1) Avaliar a associação da cárie dentária em pré-escolares com o alfabetismo em saúde bucal (ASB) e o comportamento dos pais/cuidadores durante a refeição dos seus filhos 2) Avaliar a associação da Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) e cárie dentária das crianças e alfabetismo em saúde bucal dos pais. Métodos: Foi realizado um estudo transversal com crianças de 2 a 4 anos durante a Campanha Nacional de vacinação (setembro, 2017) em todas as 18 Unidades Básicas de Saúde (UBS) em Diadema, São Paulo, Brasil. O exame de 630 crianças teve como objetivo avaliar a prevalência de cárie dentária (índice ceo-d). Os pais foram entrevistados para obter informações sobre as condições sociodemográficas (idade parental, número de irmãos, renda familiar, nível de escolaridade dos pais e aglomeração domiciliar), comportamentos de saúde bucal (consumo de açúcar e frequência da escovação dentaria), comportamento dos pais durante a refeição (Parent Mealtime Action Scale PMAS) bem como o nível de alfabetismo em saúde bucal (ASB - Rapid Estimate of Adult Literacy in Dentistry - BREALD-30). A avaliação da qualidade de vida relacionada à saúde bucal (QVRSB) das crianças utilizou a Early Childhood Oral Health Impact Scale (ECOHIS). A análise utilizou modelos de regressão binomial negativa inflada de zeros (ZINB) para avaliar associações não ajustadas e ajustadas entre os desfechos do estudo e variáveis independentes. Resultados: No modelo ajustado, a cárie dentária foi mais prevalente entre crianças de 3 (RP = 1,85, IC 95% = 1,19-2,87) e 4 anos (RP = 2,43, IC 95% = 1,60-3,71), aquelas com um ou mais irmãos (RP = 1,66, IC 95% = 1,18-2,33). No entanto, crianças cujos pais / cuidadores recebiam 2 salários mínimos ou mais tiveram menos probabilidade de ter cárie dentária (RP = 0,66, IC 95% = 0,48-0,91). A dimensão Uso de Recompensas do PMAS associou-se diretamente à severidade da cárie dentária (RT = 0,90, IC 95% = 0,84-0,97). A qualidade de vida relacionada à saúde bucal das crianças não foi associada ao ASB. A cárie dentária teve impacto negativo na qualidade de vida das crianças (p <0,05). Um impacto positivo na qualidade de vida foi associado ao número de irmãos (RP = 0,70, IC 95% = 0,52-0,95) e a maior idade da mãe reduziu o impacto na QVRSB (RP = 0,72, IC 95% = 0,52-0,98). Conclusão: A idade dos filhos, número de irmãos, renda familiar e dimensão Uso de Recompensa estiveram associados à cárie dentária. O número de irmãos, a idade das mães e a cárie dentária foram associados à QVRSB das crianças. Este estudo não observou associação entre o alfabetismo dos pais, QVRSB das crianças e a cárie dentária.

Introduction: Oral health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and using health services to make appropriate oral health decisions. Objectives: 1) Assess the association of dental caries in preschoolers with oral health literacy (OHL) and the behavior of parents / caregivers during their children's meal 2) Assess the association of children's oral health-related quality of life (OHRQoL) with dental caries and parents' oral health literacy. Methods: This cross-sectional population-based study was conducted with preschool children of 2 to 4 years old, during the national vaccination campaign (September 2017) in all the 18 health centers in Diadema, São Paulo, Brazil. The examination of 630 children aimed at assessing the prevalence of dental caries (dmft index). Parents were interviewed to obtain information on socio-demographic conditions (parental age, the number of siblings, family income, parental level of education and household crowding), oral health behavior (sugar daily intake and tooth brushing frequency), parents' behavior during the meal (Parent Mealtime Action Scale PMAS) and oral health literacy (OHL- Rapid Estimate of Adult Literacy in Dentistry - BREALD-30). The evaluation of the children's oral health-related quality of life used the Early Childhood Oral Health Impact Scale (ECOHIS) The analysis used zero-inflated negative binomial regression (ZINB) models to assess unadjusted and adjusted associations between the study outcomes and covariates. Results: In the adjusted model, dental caries was more prevalent among 3 (PR=1.85, 95%CI=1.19-2.87) and 4-year-old children (PR=2.43, 95%CI=1.60-3.71), those with at least one sibling (PR= 1.66, 95%CI=1.18-2.33). However, children whose parents/caregivers gain 2 minimum wage or more were less likely to have dental caries (PR= 0.66, 95%CI=0.48-0.91). The Use of Rewards dimension of the PMAS was directed associated with dental caries severity (RR= 0.90, 95%CI=0.84-0.97). Children's OHRQoL was not associated with OHL. Dental caries had a negative impact on the children's quality of life (p<0.05). A positive impact on the quality of life was associated with the number of siblings (PR= 0.70, 95%CI=0.52-0.95). A higher age of the mother reduced the impact on the OHRQoL (PR= 0.72, 95%CI=0.52-0.98). Conclusion: Age of the children, number of siblings, family income and the Use of Reward dimension were associated with dental caries. Number of siblings, the mothers' age and dental caries were associated with the children's OHRQoL. This study found no association between parents' literacy, children's OHRQoL and dental caries.

The impact of the COVID-19 pandemic on the provision of dental procedures performed by the Brazilian Unified Health System: a syndemic perspective / O impacto da pandemia de Covid-19 na oferta de procedimentos odontológicos realizados pelo Sistema Único de Saúde: uma perspectiva sindêmica

ABSTRACT: Objectives: This study investigated the impact of the COVID-19 pandemic on the provision of dental care procedures performed by the Brazilian Unified Health System (SUS) nationally and by regions. Considering that the most underprivileged population disproportionately suffers with the reduction in dental care provision, the study hypothesis suggests the presence of a syndemic nature. Methodology: The SUS Outpatient Information System (SIA-SUS) was assessed to gather data on dental care activities and procedures performed between April and July 2018, 2019, and 2020 by dentists registered in the SUS. The 30 most frequent activities and procedures performed by dentists were selected and classified into three categories (urgent dental care, nonemergency dental care, and case-dependent urgency procedures), based on the guidance for dental care during the pandemic published by the American Dental Association. Results: Results demonstrated a reduction in the provision of dental care of all categories during the pandemic. Urgency dental consultations and procedures in primary and specialized dental care services decreased by 42.5 and 44.1%, respectively, between 2020 and 2019. Non-urgent procedures decreased by 92.3%. Although decreases in dental care activities and procedures were reported in all Brazilian regions, the largest relative decreases in urgent procedures - that should have been maintained during the pandemic - occurred in the North and Northeast regions, which are the poorest regions of the country. Conclusions: These results suggest that the COVID-19 pandemic has a syndemic behavior. Further investigation into the pandemic-syndemic impacts on oral disease burden is necessary.

RESUMO: Objetivo: O presente estudo investigou o impacto da pandemia de Covid-19 na oferta de atendimento odontológico pelo Sistema Único de Saúde (SUS) no Brasil. Considerando que a população de menor nível socioeconômico sofre desproporcionalmente com a redução da oferta de atendimento odontológico, a hipótese do artigo sugere a presença de caráter sindêmico nessa situação. Métodos: O Sistema de Informação Ambulatorial do SUS (SIA-SUS) foi utilizado para coletar os dados das atividades e procedimentos odontológicos realizados entre abril e julho de 2018, 2019 e 2020 por dentistas cadastrados no SUS. Os 30 procedimentos mais frequentes realizados por dentistas foram selecionados e classificados em três categorias (atendimento odontológico de urgência, atendimento odontológico não emergencial e atendimento de urgência dependente de casos), com base nas orientações para atendimento odontológico durante a pandemia em curso, publicadas pela Associação Odontológica Americana. Resultados: Houve uma redução na oferta de atendimento odontológico em todas as categorias durante a pandemia. As consultas e procedimentos odontológicos de urgência em serviços de atenção básica e especializada diminuíram 42,5 e 44,1%, respectivamente, entre 2020 e 2019. Os procedimentos não urgentes diminuíram 92,3%. Embora as reduções nas atividades e procedimentos odontológicos tenham ocorrido em todas as regiões brasileiras, as maiores quedas relativas aos procedimentos de urgência — que deveriam ter sido mantidas durante a pandemia de covid-19 — ocorreram nas regiões Norte e Nordeste, que são as mais pobres do país. Conclusões: Os resultados sugerem que a pandemia covid-19 possui um comportamento sindêmico. Uma investigação mais aprofundada sobre os impactos da pandemia-sindemia na carga de doenças bucais é necessária.

Densidad escanográfica de los senos venosos en pacientes sanos a 2600 metros sobre el nivel del mar / Computed Tomography Density of the Venous Sinuses in Healthy Patients at 2600 Meters Above Sea Level

Introducción: Existe relación entre la densidad escanográfica de las estructuras vasculares medida en unidades Hounsfield (UH) y el hematocrito, el cual se incrementa en las personas que viven a mayor altitud sobre el nivel del mar. Se ha descrito que una densidad de 70 UH es el valor límite superior de normalidad de densidad de los senos venosos en personas sin trombosis venosa que habitan a una altitud de 1.000 m s. n. m.; sin embargo, no se ha establecido esta medida en personas que habitan en altitudes geográficas mayores. En este estudio se determinó dicho valor para personas sin trombosis de senos venosos que viven a 2.600 m s. n. m. Objetivo: Este estudio tiene como propósito caracterizar la densidad normal de los senos venosos en pacientes que habitan en altitudes geográficas de 2.600 m s. n. m. Metodología: Se analizaron las densidades escanográficas de los senos venosos longitudinal superior y de los sitios de unión entre los senos transversos y senos sigmoides de 240 sujetos que habitan a 2.600 m s. n. m., quienes asistieron a la institución entre enero de 2008 y junio de 2016. Estas personas consultaron por cefalea, convulsiones, alteración del estado de conciencia o focalización neurológica. A estos pacientes se les realizó inicialmente un estudio escanográfico de cráneo simple, hemoglobina y hematocrito con diferencia no mayor a 3 días entre el estudio escanográfico y el hemograma, así como estudios confirmatorios de positividad o ausencia de trombosis de senos intracraneales mediante resonancia magnética simple o angiorresonancia. Resultados: La media de UH fue de 59,8 con un rango entre 43,2 y 74,9, para pacientes normales. Se encontró una correlación positiva de 0,49 entre el hematocrito y las UH como es ampliamente conocido en la literatura. Conclusión: El rango en UH de los pacientes sin trombosis de senos venosos es amplio y supera por 4 puntos el informado en la literatura. Esto puede ser atribuible al aumento del hematocrito en individuos que viven a 2.600 m s. n. m. Para establecer normalidad en los pacientes con valores superiores a 70 UH se sugiere tomar en cuenta la simetría de la densidad escanográfica con respecto al seno venoso contralateral, así como evaluar la morfología del borde anterior del seno venoso y la adecuada localización del ROI (Region of Interest) para medir la densidad venosa.

Introduction: There is a relationship between the intravascular density measured in Hounsfield units (HU) in computed tomography (CT) and the hematocrit levels, which increases in people who live above sea level. The expected density in venous sinuses is lower than 70 HU in healthy people living at 1000 meters above sea level. However, this measure has not been established in people living at higher geographic altitudes. In this study, this value was determined for normal people living at 2,600 meters above sea level. Objective: The purpose of this study is to characterize the normal density of the venous sinuses in patients who live at geographical altitudes of 2,600 m above sea level. Methodology: We measured the density on CT at the superior longitudinal venous sinus and at the junction between the transverse sinus and sigmoid sinus of 240 subjects living at 2600 meters above sea level from January 2008 to June 2016. These patients consulted for headache, seizures, altered state of consciousness or neurological focus. Initially, all participants had a non-enhanced CT brain, hemoglobin and hematocrit levels with a difference of no more than 3 days between the CT study and the hemogram, as well as confirmatory studies of positivity or absence of intracranial sinus thrombosis by non-enhanced MR or MRA. Results: The mean HU was 59.8 with a range between 43.2 and 74.9, for normal patients. A positive correlation of 0.49 was found between hematocrit and HU, as is widely known in the literature. Conclusion: We obtained a wide range in the HU of healthy patients compared to the values reported in other papers, and exceeds the highest value by 4 points. This may be attributable to the increased hematocrit in healthy patients living at 2,600 meters above sea level. In order to establish whether patients with venous sinus densities greater than 70 HU have venous thrombosis, our suggestion is to evaluate the symmetry of the density compared to the contralateral venous sinus, as well as to evaluate the morphology and the location of the ROI used to measure venous density.

A prospective and randomized clinical trial evaluating the effectiveness of ART restorations with high-viscosity glass-ionomer cement versus conventional restorations with resin composite in Class II cavities of permanent teeth: two-year follow-up

Abstract Objective To compare the effectiveness of ART restorations using High Viscosity Glass-ionomer cement (HVGIC) with conventional restorations using resin composite in Class II cavities of permanent teeth, in a 2-year follow-up. Methodology Seventy-seven restorations were made with each restorative material, Equia Fil-GC Corporation (ART restorations) and Z350-3M (conventional restoration), in 54 participants in this parallel and randomized clinical trial. Restorations were evaluated at 6 months, 1 and 2 years using the ART and the modified United States Public Health Service (USPHS) criteria. Chi-square test and Survival Analysis (p<0.05) were used for statistical analysis. Results The success rates for ART restorations were 98.7% (6 months) and 95.8% (1 year) for both criteria. At 2 years, success rate was 92% and 90.3% when scored by the modified USPHS and ART criteria (p=0.466), respectively. The success rates for conventional restorations were 100% (6 months), 98.7% (1 year) and 91.5% (2 years) for both assessment criteria. ART restorations presented a lower survival rate by the criterion of ART (83.7%) when compared to the modified USPHS criterion of (87.8%), after 2 years (p=0.051). The survival of conventional restorations was 90.7% for both evaluation criteria. Conclusion At the 2-years follow-up evaluation, no statistically significant difference was observed between the success rate of ART restorations with HVGIC compared to conventional restorations with resin composite in Class II cavities of permanent teeth.

Riesgo de Desarrollo y Progresión de Cáncer Tiroideo Bien Diferenciado en pacientes con Variantes Genéticas del Gen de Tiroglobulina SER 734ala y ARG1980trp / Risk of Development and Progression of Well Differentiated Thyroid Cancer in patients with Genetic Variations of the Thyroglobulin SER734ala and ARG1980trp Genes

Introducción: Existen factores de riesgo que se asocian a desarrollo cáncer de tiroides diferenciado; la Tiroglobulina es una proteína ligada al tamaño tumoral, su rol dentro de las patologías oncológicas es controversial. El objetivo del estudio fue determinarsi las variaciones del gen de Tiroglobulina se asocian a la presencia de cáncer tiroideo. Métodos:Este estudio observacional de casos y controles se realizó con muestra no probabilística con muestras de patología de casos de cáncertiroideo diagnosticados en elHospital Oncológico Solón Espinosa Ayala de Quito. Se estableció un grupocontrol con voluntarios sanos. Se mide las variaciones SER734Ala y ARG1980 trp del gen de la Tiroglobulina. Se comparan las frecuencias con Chi cuadrado. Resultados:Un total de 51casos de cáncertiroideo y 50 controles. Variaciones en SER734Ala en el grupo de casos fueron homocigotos 24/51casos (53.3% (IC95% 38.8 -67.9%)en el grupo controlfueron24/50(53.3% (IC95% 38.8-67.9%)P=0.83. La variaciónheterocigotaARG1980 trp fueron en el grupo de casos 47/51(92.2%IC95% 84.3 -100%), en los controles 35/50(70% IC95% 56.6-83.4%)P=0.004. Conclusión:Se demostró que lasvariaciones del gen de laTiroglobulina pueden presentarse en pacientes con Cáncer Tiroideo en igual frecuencia que en voluntarios sanos

Introduction: There are risk factors associated with the development of differentiated thyroid cancer; Thyroglobulin is a protein linked to tumor size, its role in oncological pathologies is controversial. The objective of the study was to determine whether variations in the thyroglobulin gene are associated with the presence of thyroid cancer. Methods: This observational case-control study was conducted with a non-probabilistic sample with pathology samples from thyroid cancer cases diagnosed at the Solón Espinosa Ayala Oncological Hospital in Quito. A control group with healthy volunteers was established. The SER734Ala and ARG1980 trp variations of the Thyroglobulin gene are measured. The frequencies werecompared with Chi square. Results:A total of 51 thyroid cancer cases and 50 controls. Variations in SER734Ala in the group of cases were homozygous 24/51 cases (53.3% (CI95% 38.8 -67.9%) in the control group were 24/50 (53.3% (CI95% 38.8-67.9%) P = 0.83. Heterozygous ARG1980 trp were in the case group 47/51 (92.2% 95% CI 84.3 -100%), in the controls 35/50 (70% 95% CI 56.6-83.4%) P = 0.004. Conclusion:It was shown that variations of the Thyroglobulin gene couldoccur in patients with Thyroid Cancer in the same frequency as in healthy volunteers

Association Between Presence of Enamel Defects, Dental Caries and Socioeconomic Conditions on Brazilian Children

Objective: To verify the relationship between developmental enamel defects (DED) in permanent incisors and socioeconomic conditions and dental caries in children within the life course context. Material and Methods: A total of 350 children aged 9-11 years from 13 public schools in the city of Bauru, Brazil were examined. Clinical exams were performed to observe the presence of caries and developmental enamel defects using the DMFT and DED indexes, respectively. In addition, information about family income and parental schooling was collected. Statistical analysis used the Spearman Correlation Coefficient and the Chi-square test to verify the association between DED, socioeconomic conditions and dental caries. The significance level adopted was 5%. Results: Association between presence of dental caries and DED (p=0.04), delimited opacity (p=0.02) and opacity (p=0.01) was observed. Inverse correlation for the decayed component with maternal schooling and family income was also verified. Regarding the types of development enamel defect (DED), correlation between delimited opacity, opacity and DED with the DMFT index was observed. Conclusion: The results of this study indicated association between enamel defects and caries, as well as correlation between income and parental schooling and dental caries.

Tumor de células gigantes de la vaina sinovial en la región intercondilar posterior de la rodilla: Presentación de caso / Giant Cell Tumor of the Tendon Sheath in the Posterior Intercondylar Region of the Knee: Case Report

El tumor de células gigantes de la vaina tendinosa es, después del ganglión, la masa más común en la mano; se ha descrito su localización en articulaciones de mayor tamaño como el tobillo y el pie. La rodilla es la localización menos frecuente y suele presentarse en niños. En la rodilla la forma de presentación usual es intraarticular y la localización más frecuente es infrapatelar, seguido de la suprapatelar y en menor frecuencia la región posterior intercondilar. Se expone el caso de una mujer sana de 26 años de edad con dolor en la fosa poplítea izquierda asociado a aumento de volumen. La resonancia magnética (RM) mostró una masa sólida, heterogénea, intraarticular, localizada en la región posteromedial de la rodilla, con realce difuso con el medio de contraste. Se consideró como primera posibilidad diagnóstica una sinovitis vellonudar pigmentada. El estudio histopatológico mostró un tumor de células gigantes de la vaina tendinosa de la cápsula articular. El objetivo de esta presentación de caso es demostrar las características en RM de un tumor de células gigantes de la vaina tendinosa de la cápsula de la rodilla, una de las localizaciones menos frecuentes de esta lesión.

The giant cell tumor of the tendon sheath, after the ganglion cyst, is the most common mass in the hand; followed by the ankle and the foot. The knee represents a less common location and it usually occurs in children. In the knee, the usual presentation is intrarticular, and the most frequent location is in the infrapatellar region, followed by the suprapatellar region, and less frequently the posterior intercondylar region. A case of a healthy 26-year-old woman with pain in the right popliteal fossa associated with increased volume is presented. The MRI showed an intra articular heterogeneous solid mass, centrally located in the posterior intercondylar region, with heterogeneous enhancement. Pigmented villonodular synovitis was considered as the first possible differential diagnoses. Histopathological analysis demonstrated a giant cell tumor of the tendon sheath of the joint capsule. The objective of this case report is to show the magnetic resonance (MR) characteristics of a giant cell tumor of the tendon sheath arising from the joint capsule, an uncommon location of this type of lesion.

Developing a Social Cognition Task for fMRI in Patients with Mild Traumatic Brain Injury / Desarrollo de una tarea de Cognición Social para IRMf en pacientes con trauma craneoencefálico leve

Social cognition impairments are frequently found in patients with mild traumatic brain injury (TBI) when structural lesions may not reveal the severity of the injury. Though instruments used to assess social behavior are thought to be sensitive, the absence of structural damage in TBI patients may lead to underscore such problems. The aim of this study was to develop a complementary diagnostic tool such as a paradigm for functional Magnetic resonance Imaging (fMRI) involving a simple task that could tell how patients understand certain complex social behavior by identifying different movements with or without social intentions where language and complex cognitive process were not required. Eleven patients with mild TBI and social cognition difficulties and twelve control subjects were matched by demographic variables. A paradigm of social fMRI was developed by using dots in movement representing human motion, human motion with social intention such as dancing or sharing, and dots moving without meaning. Patients had less activation in parietotemporal junction and bilateral middle frontal gyrus in the social perception task movement compared with control group subjects. The fMRI paradigm developed can be an additional diagnostic tool for identifying social cognition impairments in mild TBI patients. Regardless the absence of structural injury, changes in activation areas suggest a prospective use of this tool since clinical, cognitive and functional outcomes support such finding.

Los cambios en la cognición social son encontrados frecuentemente en pacientes con trauma craneoencefálico leve (TCE) aunque no exista evidencia de lesiones estructurales. Aunque los instrumentos utilizados para evaluar la cognición social son sensibles al cambio, la ausencia de daño estructural en los pacientes con TCE puede llevar pasar por inadvertidos estos problemas. El objetivo de este estudio fue desarrollar una herramienta diagnóstica complementaria como un paradigma para resonancia magnética funcional (RMf), la cual involucra una tarea simple que pudiera explicar cómo los pacientes entienden ciertos comportamientos sociales complejos por medio de movimientos con o sin intención social sin intermediación del lenguaje. Participaron once pacientes con TCE leve y con reporte de alteraciones en cognición social, estos fueron emparejados con doce sujetos control por variables demográficas. Un paradigma de RMf fue desarrollado por medio de la animación puntos blancos sobre una pantalla negra que representan el movimiento humano, el movimiento humano con la intención social como el baile o el compartir, y puntos que se mueven sin significado. Los pacientes tuvieron menos activación en la unión parietotemporal y giro frontal medio bilateral frente al movimiento social en comparación con los sujetos del grupo de control. El paradigma de fMRI desarrollado puede ser una herramienta de diagnóstico adicional para identificar las alteraciones cognitivas sociales en pacientes con TCE leve. Independientemente de la ausencia de lesión estructural, los cambios en las áreas de activación sugieren la posibilidad de usar esta herramienta como pronóstico dado que los resultados clínicos, cognitivos y funcionales soportan este hallazgo.

Equidade na estratégia saúde da família (ESF) / Equity in the family health strategy (FHS) / Equidad de la estrategia de salud de la família (ESF)

OBJETIVO: Relacionar a implantação da Estratégia de Saúde da Família (ESF) entre 2001 e 2010 ]com as variáveis do Índice de Desenvolvimento Humano Municipal (IDH-M) e indicadores socioeconômicos. MÉTODOS: Estudo ecológico coletou informações sobre o IDH-M,indicadores socioeconômicos e da ESF referentes ao número de Agentes Comunitários de Saúde (ACS), Equipes de Saúde da Família (ESF), Equipes de Saúde Bucal (ESB), cobertura populacional e relativa (%) em 645 municípios do estado de São Paulo no período de 2001 a 2010. A análise descritiva foi conduzida por meio de frequências absoluta e relativa para avaliação de cada indicador. Utilizaram-se testes não paramétricos: coeficientes de correlação de Spearman para as variáveis da ESF e os indicadores socioeconômicos, e Wilcoxon Test (p<0,05) para a comparação entre as duas datas. RESULTADOS: Houve correlação positiva para o incremento das equipes de ESF e da ESB com o IDH-M (p<0,01). Os dados sociais (acesso à água, percentual de lixo coletado e renda média) apresentaram correlação positiva com ESF e cobertura populacional (p<0,05). Encontrou-se correlação negativa entre todas as variáveis sociais, exceto analfabetismo, com cobertura populacional (%). CONCLUSÃO: A evolução da ESF no estado de São Paulo durante o período estudado foi positiva no combateàs iniquidades em saúde

OBJECTIVE: To associate the implementation of the Family Health Strategy (FHS) between2001 and 2010 with the variables of the Municipal Human Development Index (MHDI) and socioeconomic indicators. METHODS: Ecological study collected information on the MHDI, socioeconomic indicators, and the FHS, regarding the number of Community Health Workers (CHW), Family Health Teams (FHT), Oral Health Teams (OHT), and population and relative(%) coverage in 645 municipalities in the state of São Paulo, Brazil, in the period from 2001 to 2010. Descriptive analysis was conducted by means of absolute and relative frequencies for evaluation of each indicator. Non-parametric tests were used: Spearman's correlation coefficient for the FHS variables and the socioeconomic indicators, and Wilcoxon test (p<0.05) for comparison between the two dates. RESULTS: There was positive correlation between the increase in FHS and OHT teams, and the MHDI (p<0.01). Social data (access to water, waste collection percentage, and average income presented positive correlation with FHS and population coverage. A negative correlation was found between population coverage (%) and all the social variables except illiteracy. CONCLUSION: The evolution of the FHS in the state of São Paulo during the studied period was positive in fighting the health inequalities

OBJETIVO: Relacionar la implantación de la Estrategia de Salud de la Familia (ESF) entre 2001 y 2010 con las variables del Índice de Desarrollo Humano Municipal (IDH-M) y los indicadores socioeconómicos. MÉTODOS: El estudio ecológico recogió informaciones del IDH-M, indicadores socioeconómicos y de la ESF referentes al número de Agentes Comunitarios de Salud (ACS), Equipos de Salud de la Familia (ESF), Equipos de Salud Bucal (ESB), cobertura poblacional y relativa (%) en 645 municipios del estado de São Paulo en el período entre 2001 y 2010. El análisis descriptivo fue realizado a través de las frecuencias absoluta y relativa para la evaluación de cada uno de los indicadores. Se utilizó las pruebas no paramétricas: coeficientes de correlación de Spearman para las variables de la ESF y los indicadores socioeconómicos; y la Prueba de Wilcoxon (p<0,05) para la comparación de las dos fechas. RESULTADOS: Hubo correlación positiva para el aumento de los equipos de la ESF y de la ESB con el IDH-M (p<0,01). Los datos sociales (acceso al agua, el porcentaje de basura recogida y la renta media) presentaron correlación positiva entre el ESF y la cobertura poblacional (p<0,05). Se encontró correlación negativa entre todas las variables sociales, excepto entre el analfabetismo y la cobertura poblacional (%). CONCLUSIÓN: La evolución de la ESF en el estado de São Paulo durante el período del estudio fue positiva para la lucha con las iniquidades en salud

Disponibilidad de servicios de mamografía en Colombia / Availability of mammography services in Colombia

Objetivos: Determinar la disponibilidad de servicios de mamografía a nivel nacional para mujeres colombianas entre los 50 y 69 años. Adicionalmente, describir la disponibilidad del servicio de mamografía dentro y fuera del departamento de residencia. Métodos: Se elige Sistema Integral de Información de la Protección Social (SISPRO) como la fuente de información adecuada para desarrollar la investigación. Se calculó la tasa de lugar de prestación de servicio de mamografía por 10.000 mujeres entre los 50 y 69 años. Se dispuso esta información en mapas, y se calculó la proporción de mujeres que recibieron el servicio según el lugar de residencia. Resultados: A nivel nacional se observó una tasa de lugar de prestación promedio de 5,4 por 10.000 mujeres entre los 50 y 69 años, con un máximo de 9,6 y un mínimo de 0. El 23% de las mujeres colombianas entre los 50 y 69 años deben salir de su departamento de residencia para recibir el servicio de mamografía, con un mínimo de 3% y un máximo de 100%. Conclusiones: Existe una distribución heterogénea de los lugares de prestación del servicio de mamografía. En algunos departamentos no existe prestación del servicio y el total de la población reportada en estos lugares debe salir de su departamento de residencia para recibir la prestación. Determinar la disponibilidad de los servicios de mamografía permitió conocer la situación de la oferta para enfocar los recursos y mejorar la disponibilidad de estos, pues tienen un impacto directo en los resultados de cáncer de mama en el país.

Objective: To determine the availability of mammography services at national level targeted at women between 50 and 69 years, as well as to report on the availability of these services within and outside the area of residence. Methods: The Integrated Information System on Social Protection (SISPRO, in its abbreviation in Spanish) was chosen as the source of information to develop an appropriate research study. The rate of places providing mammography services per 10,000 women aged 50 to 69 years was calculated. This information was then displayed on maps. Finally, an estimation of was made of the proportion of women who received the service related to the place of residence. Results: Nationally, an average rate of 5.4 centers providing mammography services per 10,000 women aged 50 to 69 years was observed, with a maximum of 9.6 and a minimum of 0 services per 10,000 women aged 50 to 69 years. It was observed that around 23% of Colombian women had to travel from their department of residence to use the mammography service, with a maximum of 100% and a minimum of 3%. Conclusions: There is a heterogeneous distribution of mammography service delivery. Some departments completely lack mammography service facilities. The population reported in those departments had to travel from their department of residence to receive the service. Determining the availability of mammography services has the aim of finding out the status of the mammogram services offered, and to focus resources to improve access to mammography services, which have a direct impact on health outcomes.