A Challenging Case Of Pulmonary Arterial Hypertension: Never Judge By Appearances

Abstract We report the case of a patient with symptomatic pulmonary hypertension (PH) associated with diffuse systemic sclerosis (SSc) whose initial assessment suggested a group 3 (clinical classification) PH. The patient had a history of drugs/toxins consumption, which contributed to the development of intrinsic pulmonary vascular disease. This changed the panorama towards the diagnosis of pulmonary arterial hypertension (PAH), with important therapeutic and prognostic implications. In fact, the excellent clinical, laboratory and hemodynamic response to therapy confirmed the hypothesis of a case of drug-associated PAH (DPAH) in a patient with diffuse SSc and lung disease. Considering the presence of DPAH, it was deemed necessary to assess acute vasoreactivity during right heart catheterization (RHC). If criteria were met, the clinical scenario may change towards a favorable and sustained clinical and hemodynamic response with oral calcium channel blockers. However, the response to inhaled nitric oxide was negative in our patient and the therapeutic strategy with dual oral combination therapy with tadalafil and ambrisentan was continued. After six-months of therapy the patient significantly improved, from a high to a low risk of one-year mortality.

Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption

Abstract Policy evaluation and guidance on fluoride use and sugar consumption in Latin American and Caribbean countries (LACC) may provide a scientific evidence basis for policymakers, dental professionals, civil society organizations and individuals committed to improving public oral health. A cross-sectional study was conducted to evaluate the extent of implementation of policies/guidelines on fluoride use, and sugar consumption in LACC. The study had two stages. First a questionnaire covering four major areas was developed: fluoridation of public water supplies; salt fluoridation; fluoride dentifrices, and sugar consumption. Then, the questionnaire was applied to collect data among representative participants in public oral health from LACC. Ninety-six participants from 18 LACC answered the questionnaire. One-hundred seventy documents were attached, and 285 links of websites were provided by the respondents. Implementation of policies and guidelines on water and table salt fluoridation and processed and ultra-processed food consumption were found in most countries, with some issues in the consensus and coverage. Thus, differences were identified in the extent of implementation of public oral health strategies on sugar consumption and fluoridation among the countries. There is no consensus on the policies in LACC to reduce sugar consumption and for the use of fluoride. A few policies and guidelines were applied in isolated countries, with a variety of strategies and standards. For future actions, it will be important to encourage the development of strategies and public policies within countries, and to evaluate the effectiveness of existing policies in reducing dental caries and in improving oral health in LACC.

Dose-response relationship between toothpaste soluble fluoride absorbed in the gastrointestinal tract and saliva fluoride secretion

Aim: This study aimed to evaluate if there is a dose-response relationship between toothpaste chemically soluble fluoride absorbed in the gastrointestinal tract and fluoride secreted by saliva, giving support to the use of saliva as surrogate for plasma fluoride. Methods: A 4-phase single blind study was conducted, in which 10 participants were subjected in each phase to one of the assigned treatment groups: group I: fresh sample of a Na2FPO3/CaCO3-based toothpaste with 1,334 µg F/g of total soluble fluoride (TSF) and groups II­IV: aged samples of this toothpaste presenting TSF concentrations of 1,128, 808, and 687 µg F/g, respectively. In all phases, the participants ingested an amount of toothpaste equivalent to 70.0 µg F/Kg body weight, as total fluoride (TF). Saliva and blood samples were collected before (baseline) and up to 180 min after toothpaste ingestion as indicator of fluoride bioavailability. F concentration in saliva and blood plasma was determined with a fluoride ion-specific electrode. The areas under the curve (AUC) of F concentration versus time (AUC = ng F/mL × min) and the peaks of fluoride concentration (Cmax) in saliva and plasma were calculated. Results: A significant correlation between mg of TSF ingested and the AUC (r=0.47; p<0.01), and Cmax (r=0.59; p<0.01) in saliva was found; for TF, the correlation was not significant (p>0.05). In addition, the correlations between plasma and saliva fluoride concentrations were statistically significant for AUC (r=0.55; p<0.01) as for Cmax (r=0.68; p<0.01). Conclusion: The findings support that saliva can be used as a systemic biomarker of bioavailable fluoride present in Na2FPO3/CaCO3-based toothpaste

Spatial modeling of homicide mortality in the Northeast region of Brazil / Modelado espacial de la mortalidad por homicidios en la Región Noreste de Brasil / Modelagem espacial da mortalidade por homicídios na Região Nordeste do Brasil

ABSTRACT Objective: To analyze the spatiotemporal distribution of homicide mortality and association with social determinants of health in the Northeast Region of Brazil. Methods: Ecological study with spatiotemporal modeling of homicide deaths between 2000 and 2019. Temporal trends were analyzed by segmented linear regression. Crude mortality was calculated and adjusted by smoothing the local empirical Bayesian method and analyzed by the Global/Local Moran Index and spatiotemporal scan statistics. The association between social determinants of health and homicide mortality was performed using multiple linear regression and autoregressive spatial models. Results: 353,089 deaths were recorded. Mortality increased from 2000 to 2019, with an annual increase of 4.37 in males and 3.57 in females. High risk spatial and spatiotemporal clusters were identified in the coastal region of the states. The spatial regression model showed an association with socioeconomic inequalities. Conclusions: High risk areas for homicides associated with socioeconomic inequality, which should be considered as a priority for designing and investing in public health policies were investigated.

RESUMEN Objetivo: Analizar distribución espaciotemporal de mortalidad por homicidios y relación con determinantes sociales de salud en el Noreste brasileño. Métodos: Estudio ecológico con modelado espaciotemporal de óbitos por homicidios entre 2000 y 2019. Las tendencias temporales fueron analizadas por regresión lineal segmentada. La mortalidad brutal fue calculada y acordada por moderación del método bayesiano empírico local y analizadas por Índice de Moran Global/Local y estadística de barrido espaciotemporal. La relación entre determinantes sociales de salud y mortalidad por homicidios fue realizada mediante la regresión lineal múltiple y modelos espaciales autorregresivos. Resultados: Fueron registrados 353.089 óbitos. La mortalidad aumentó de 2000 para 2019, con un incremento anual de 4,37 en el sexo masculino y 3,57 y en el femenino. Aglomeraciones espaciales y espaciotemporales de alto riesgo fueron identificadas en la región costera de los estados. El modelo de regresión espacial demostró relación con las desigualdades socioeconómicas. Conclusiones: Identificamos áreas de alto riesgo para homicídios relacionadas con la desigualdad socioeconómica, debiendo ser consideradas como prioridad para el delineamiento e inversión en políticas públicas en salud.

RESUMO Objetivo: Analisar a distribuição espaçotemporal da mortalidade por homicídios e associação com determinantes sociais da saúde na Região Nordeste do Brasil. Métodos: Estudo ecológico com modelagem espaço temporal dos óbitos por homicídios entre 2000 e 2019. As tendências temporais foram analisadas por regressão linear segmentada. A mortalidade bruta foi calculada e ajustada pela suavização do método bayesiano empírico local e analisadas pelo Índice de Moran Global/Local e estatística de varredura espaço temporal. A associação entre os determinantes sociais da saúde e a mortalidade por homicídios foi realizada por meio da regressão linear múltipla e modelos espaciais autorregressivos. Resultados: Foram registrados 353.089 óbitos. A mortalidade aumentou de 2000 para 2019, com um acréscimo anual de 4,37 no sexo masculino e 3,57 no feminino. Aglomerações espaciais e espaçotemporais de alto risco foram identificadas na região costeira dos estados. O modelo de regressão espacial demonstrou associação com as desigualdades socioeconômicas. Conclusões: Identificamos áreas de alto risco para homicídios associadas com a desigualdade socioeconômica, devendo ser consideradas como prioridade para o delineamento e investimento em políticas públicas em saúde.

Demystifying interactions between micro organisms in oral candidiasis biofilm: the key to enhancing treatments

Introduction: candida albicans is a fungal pathogen that can provoke diseases ranging from oral infections to life-threatening systemic disorders. It is now recognized that oral bacteria, such as the genus Streptococcus, establish synergistic relationships with C. albicans, which could potentially increase the fungi's virulence and pathogenicity. Objective: this narrative review aimed to discuss the Candida-Streptococcus mechanisms of interactions and their contribution to increasing oral candidiasis severity. In addition, it provides a background of biofilm formation and potential therapeutical targets. Sources of Data: searches for papers in English were performed in the Pubmed database until May 2022. MeSH and free terms related to the field were used. In vitro studies were selected, tabulated, and qualitative and quantitative data were analyzed descriptively. Synthesis of Data: among the early colonizers bacteria, evidence pointed out that S. gordonnii and S. oralis have major implications in oral candidiasis, in which mixed biofilms increase the infection severity and challenge the host's defense. On the other hand, the outcomes of the interaction between C. albicans and S. mitis, S. sanguinis, or S. mutans remain little explored in the oral candidiasis scenario, albeit evidence pointed out an enhanced fungus population and virulence factors. Conclusion: overall, considering the polymicrobial profile of the infection and the potential to increase Candida-related disease severity, therapeutical strategies should also consider bacteria management.

Introdução: candida albicans é um patógeno fúngico que pode provocar doenças que variam de infecções orais a distúrbios sistêmicos com risco de vida. Hoje se reconhece que as bactérias orais, como o gênero Streptococcus, estabelecem relações sinérgicas com C. albicans, o que pode potencialmente aumentar a virulência e patogenicidade do fungo. Objetivo: esta revisão narrativa teve como objetivo discutir os mecanismos de interação Candida-Streptococcus e sua contribuição para o agravamento da candidíase oral. Além disso, fornece uma breve explanação sobre a formação do biofilme e potenciais alvos terapêuticos. Fonte dos dados: foi realizada pesquisa na base de dados Pubmed para a busca de artigos publicados em Inglês até maio de 2022. Para isso, foram utilizados descritores relacionados ao tema. Estudos in vitro foram selecionados, tabulados e seus resultados quantitativos e qualitativos analisados descritivamente. Síntese dos dados: entre as bactérias denominadas colonizadores iniciais, evidências apontam que S. gordonnii e S. oralis têm implicações importantes na candidíase oral, na qual biofilmes mistos aumentam a gravidade da infecção e desafiam a defesa do hospedeiro. Por outro lado, os desfechos das interações entre C. albicans e S. mitis, S. sanguinis ou S. mutans permanecem pouco explorados no cenário da candidíase oral, apesar de evidências apontarem um aumento dapopulação fúngica e de fatores de virulência. Conclusão: de maneira geral, considerando o perfil polimicrobiano da infecção e o potencial agravamento das doenças provocadas por Candida spp, as estratégias terapêuticas não devem estar focadas apenas no fungo, mas também devem considerar o manejo da bactéria.

Genital ulcers caused by sexually transmitted agents,

Abstract Genital ulcers (GUs) represent a diagnostic challenge and can be secondary to neoplastic and inflammatory processes of different causes. Among those of infectious etiology, there are sexually transmitted infections (STIs), a very frequent reason for seeking the health service. The most common agents are herpes simplex virus and Treponema pallidum and, more rarely, Haemophilus ducreyi, Klebsiella granulomatis and Chlamydia trachomatis. A careful dermatological examination offers important diagnostic elements; however, atypical manifestations are very common. Distinctive characteristics of ulcers to look out for include their margin, edge, bottom, and base. Regional lymph node chain alterations should be evaluated regarding their number, size, mobility, consistency, inflammation, and pain on palpation. Diagnostic tests have variable sensitivity and specificity, and molecular tests are currently considered the reference exams. The rapid immunochromatographic tests represented a significant advance, as they can be performed with blood obtained from the digital pulp, offer results in up to 30 minutes, and do not require a laboratory structure. The treatment of persons affected by GU/STIs must be immediate, as it aims to prevent complications, as well as reduce transmission. It is not always considered that people with GUs/STIs have varying degrees of depression, anxiety, and self-reproach, with an impact on relationships. Establishing a bond and trusting the professional is essential for adherence to treatment and preventive measures that must be discussed individually.

Necrotic erythema nodosum reaction associated with histological alterations of Lucio's phenomenon

Abstract Patients with lepromatous or borderline leprosy may present two types of vasculonecrotic reactions: Lucio's phenomenon (LP) and necrotic erythema nodosum leprosum (nENL). These are serious conditions, which mostly lead to life-threatening infectious and thrombotic complications. The authors report the case of a patient with leprosy recurrence associated with an atypical type II reaction with LP characteristics on histopathology.

Fluoride concentration in toothpaste marketed to children in Brazil and Mexico, and discussion on current regulations

Resumo Os dentifrícios fluoretados comercializados para crianças devem conter concentração mínima de 1000 ppm de fluoreto (F), que deve ser quimicamente solúvel para ter efeito anticárie. Portanto, determinamos as concentrações de fluoreto total (FT) e fluoreto solúvel total (FST) em dentifrícios comercializados para crianças no Brasil e no México e analisamos as regulamentações vigentes em ambos os países. Vinte e quatro marcas foram encontradas e adquiridas no Brasil (19 formuladas com NaF/SiO2, três com Na2FPO3/CaCO3 e duas com Na2FPO3/SiO2) e seis no México (todas com NaF/SiO2). As concentrações de FT e FST foram determinadas após a compra (amostras frescas), e a estabilidade do fluoreto nas formulações de Na2FPO3/CaCO3 foi verificada após 18 meses. As análises foram realizadas com eletrodo íon-específico e os resultados expressos em ppm F (mg F/kg). As concentrações de FT encontradas variaram de 476,0 a 1.385,3 ppm F e foram próximas às declaradas pelos fabricantes (500 a 1.450 ppm F). As concentrações de FT encontradas não ultrapassaram 1.500 ppm F, de acordo com as regulamentações vigentes de ambos os países. No entanto, dentifrícios com concentrações de FST inferiores a 1.000 ppm F foram encontrados tanto em dentifrício com baixa concentração (500 ppm F) formulado com NaF/SiO2 como em dentifrícios com Na2FPO3/CaCO3 frescos e envelhecidos, originalmente fabricados com 1.000-1.100 ppm de FT. Em conclusão, embora a maioria dos dentifrícios analisados apresentasse concentração de FST superior a 1.000 ppm F, as regulamentações vigentes em ambos os países permitem que produtos que não estejam de acordo com a melhor evidência disponível estejam presentes no mercado.

Abstract Fluoride toothpastes market to children should contain a minimum concentration of 1000 ppm of fluoride (F), which must be chemically soluble to provide anti-caries effect. Therefore, we determined the concentrations of total fluoride (TF) and total soluble fluoride (TSF) in toothpastes marketed to children in Brazil and Mexico and analyzed the current regulations in force in both countries. Twenty-four brands were found and purchased in Brazil (19 formulated with NaF/SiO2, three with Na2FPO3/CaCO3 and two with Na2FPO3/SiO2) and six in Mexico (all with NaF/SiO2). TF and TSF concentrations were determined after the purchase (fresh samples) but fluoride stability in Na2FPO3/CaCO3-formulations was checked after 18 months. The analyses were performed with an ion-specific electrode and the results expressed in ppm F (mg F/kg). The TF concentrations found ranged from 476.0 to 1385.3 ppm F and they were close the declared by the manufactures (500 to 1450 ppm F). The TF concentrations found were not greater than 1500 ppm F, in accordance with the current regulations of both countries. However, toothpastes presenting TSF concentrations lower than 1000 ppm F were found either in low fluoride toothpaste (500 ppm F) formulated with NaF/SiO2 as in fresh and aged Na2FPO3/CaCO3-toothpastes, originally fabricated with 1000-1100 ppm of TF. In conclusion, although most toothpastes analyzed showed TSF concentration higher than 1000 ppm F, the regulations in force in both countries allow that products not in agreement with the best available evidence are available in the market.

Fatores impulsores e restritivos da prática com grupos em serviços comunitários de atenção psicossocial / Driving and restrictive factors of group practice in community psychosocial care services

Resumo O objetivo desta pesquisa qualitativa foi investigar as concepções teóricas dos trabalhadores sobre o grupo bem como analisar os fatores impulsores e restritivos da prática terapêutica grupal nos Centros de Atenção Psicossocial (CAPS). Participaram do estudo 66 trabalhadores de CAPS e ambulatórios da Rede de Atenção Psicossocial (RAPS) de 23 municípios do estado de Goiás. A coleta de dados se deu por meio de questionário estruturado e entrevista grupal registrada em gravação de áudio e fotografias. Da análise temática dos dados emergiram o conceito do que o grupo é e do que o grupo não é. Tanto no eixo das forças impulsoras, quanto das forças restritivas, as categorias foram organizadas em três blocos de análise: aspectos relacionados ao serviço, aos profissionais e aos usuários. Aspectos relacionais, estruturais, terapêuticos e a competência profissional para a coordenação de grupo se integram de modo antagônico, complementar e indissociável para apreensão da realidade estudada. Conclui-se que evidenciar os aspectos restritivos que precisam ser reconhecidos e aprimorados bem como os impulsores que precisam ser mantidos e potencializados pode contribuir ativamente para ampliar a capacidade terapêutica do uso da tecnologia grupal no contexto da saúde mental.

Abstract This qualitative research aimed to investigate workers' theoretical conceptions regarding group work and analyze the driving and restrictive factors of group therapeutic practice in Psychosocial Care Centers (CAPS). Sixty-six workers from CAPS and outpatient clinics from the Psychosocial Care Network from twenty-three municipalities in the State of Goiás participated in the study. Data were collected through a structured questionnaire and a group interview audio-recorded and documented with photographs. The concept of what the group is and is not emerged from the thematic analysis of the data. The categories were organized into three analysis blocks concerning driving and restrictive forces: service-related, professional-related, and user-related. Relational, structural, and therapeutic aspects and professional competence for group coordination are integrated in an antagonistic, complementary, and inseparable way to apprehend the studied reality. We conclude that highlighting the restrictive aspects that must be recognized and improved and the drivers that must be maintained and enhanced can actively contribute to expanding the therapeutic capacity related to the use of group technology in mental health.

Direct-Indirect Technique Restoration for Non-Carious Cervical Lesions Treatment: a Case Report / Técnica Direta-Indireta para Restauração de Lesões Cervicais não Cariosas: um Relato de Caso

Non-Carious Cervical Lesions are characterized by slow and progressive loss of hard tissue at the level of enamel-cement junction, without bacterial involvement. This work aimed to address a case report of restorative treatment in Class V cavities in multiple premolars using the directindirect technique with composite resin. A 42 year-old male patient presented for esthetic restorative treatment with the complaint of severe dentin hypersensitivity and wedged-shaped non-carious cervical lesions affecting the maxillary premolars. The restorative treatment chosen was a direct-indirect technique with composite performed into three sessions as follows: making the class V composite inlays, cementation, and final polishing. The direct-indirect technique as an alternative to the traditional direct technique has the benefits of a better contour of the restoration, since the finishing and polishing are made extraorally. Besides, the control of the polymerization stress and less discomfort to the patient are other advantages. In the case of direct-indirect class V restoration, the advantages far surpass those of the direct technique. (AU)

As Lesões Cervicais Não Cariosas se caracterizam pela perda lenta e progressiva de tecido duro próximo a junção cemento-esmalte, sem envolvimento bacteriano. Este trabalho tem o objetivo de relatar um caso clínico de tratamento restaurador em cavidades do tipo Classe V em pré-molares pela técnica direta-indireta com resina composta. Paciente do sexo masculino, 42 anos, queixava-se de forte sensibilidade e múltiplas Lesões Cervicais Não Cariosas na forma de cunha nos pré-molares superiores. O tratamento restaurador escolhido foi a técnica direta-indireta com resina composta realizado em três sessões distribuídas em confecção da peça em resina composta, cimentação e polimento final. A técnica direta-indireta surge como alternativa a técnica direta tradicional trazendo como benefícios um melhor contorno da restauração, uma vez que esta é acabada e polida fora da boca, além do controle do estresse de polimerização e menor desconforto ao paciente. A intervenção restauradora direta-indireta se mostra eficaz devido ao fato de conseguir contornar dificuldades encontradas em técnicas restauradoras diretas. (AU)

Case for diagnosis. Erythematous and infiltrated plaques in the infrahyoid region

Abstract Leprosy is a chronic infectious disease caused by Mycobacterium leprae and, depending on the host immune status, presents different clinical forms. This report describes the case of a 46-year-old man who had hypoesthetic lesions in the infrahyoid region for 30 days. The bacilloscopy was negative. The anatomopathological examination showed alterations corresponding to the tuberculoid pole (epithelioid histiocytes) and virchowian pole (foamy histiocytes), compatible with borderline-virchowian leprosy (Ridley and Jopling classification). Rapid tests for HIV I, II, and syphilis were positive, with a CD4 count of 223. The patient started treatment with multibacillary multidrug therapy, antiretroviral therapy, and benzathine penicillin, with marked clinical improvement in two months.

Clock hours of food and nutrition education in curricula of undergraduate nutrition programs: a two-country comparison / Horas de instrução de educação alimentar e nutricional nos currículos de cursos de graduação em nutrição: comparação entre dois países

ABSTRACT Objective To make a critical and comparative analysis of curricula of Brazilian and Portuguese higher education institutions in terms of clock hours and semester distribution of food and nutrition education in undergraduate nutrition programs, also assessing the main differences among courses classified into thematic axes and professional practice areas. Methods The curricula of fifteen Brazilian and eleven Portuguese nutrition programs were collected and classified into thematic axes and professional practice areas with the method of Document Analysis. Next, we performed statistical analysis regarding the total and proportional clock hours of instruction and their semester distribution to assess the differences between the two countries. The variables of interest were the hours of Food and Nutrition Education and their semester distribution. Results The Food and Nutrition Education axis was the second smallest one, with statistically significant differences among the axes (2.2% of curricula; p<0.001). Brazilian higher education institutions showed greater total clock hours of Food and Nutrition Education (p=0.018), Human and Social Sciences (p=0.003), Public Health (p<0.001), as well as a wider dispersion and lower relative weighted mean for the semester offering of courses (p=0.004) of Food and Nutrition Education courses. Portuguese higher education institutions showed greater total and proportional clock hours of instruction for Exact Sciences (p<0.005; p=0.001, respectively) and more proportional hours of Biologic and Health Sciences (p<0.001). Conclusion Our study found a reduced presence of the area of Food and Nutrition Education in the undergraduate training of nutritionists in both countries.

RESUMO Objetivo Realizar uma análise crítica e comparativa das horas de instrução e distribuição semestral da Educação Alimentar e Nutricional nos cursos de graduação em nutrição. Além disso, analisar as principais diferenças entre disciplinas classificadas em Eixos Temáticos e em Áreas De Atuação Profissional de currículos de cursos de nutrição das Instituições de Ensino Superior brasileiras e portuguesas. Métodos Os currículos de quinze instituições brasileiras e onze portuguesas foram coletados, e o método Análise Documental foi usado para classificar as disciplinas de cada curso em Eixos Temáticos e em Áreas de Prática Profissional. Em seguida, foi feita uma análise estatística das horas de aula totais e proporcionais e do semestre de oferta, para verificar a diferença entre os países. As horas de instrução de Educação Alimentar e Nutricional e a distribuição semestral foram as variáveis de interesse. Resultados O eixo Educação Alimentar e Nutricional foi o segundo menor, com diferença estatisticamente significativa entre eixos (2,2% dos currículos; p<0,001). As Instituições de Ensino Superior brasileiras apresentaram maior carga horária absoluta para Educação Alimentar e Nutricional (p=0,018), Ciências Humanas e Sociais (p=0,003) e Saúde Pública (p<0,001), e maior dispersão e menor média ponderada relativa de localização do curso (p=0,004) para as disciplinas de Educação Alimentar e Nutricional. As Instituições de Ensino Superior portuguesas apresentaram maior carga horária absoluta e proporcional em Ciências Exatas (p<0.005; p=0,001 respectivamente) e maior proporcional em Ciências Biológicas e da Saúde (p<0.005). Conclusão Este estudo encontrou uma presença reduzida da área de Educação Alimentar e Nutricional na formação de nutricionistas em ambos os países.

Dental caries prevalence, prospects, and challenges for Latin America and Caribbean countries: a summary and final recommendations from a Regional Consensus

Abstract Dental caries can be effectively managed and prevented from developing into cavitated lesions while preserving tooth structure at all levels. However, the strong correlation between caries and socioeconomic factors may compromise the efficacy of preventive strategies. The high prevalence of persistent inequalities in dental caries in Latin American and Caribbean countries (LACC) is a matter of concern. The estimates of the burden of disease in some countries in this region are outdated or absent. This paper aims to summarize and present the final recommendations of a regional Consensus for Dental Caries Prevalence, Prospects, and Challenges for LACC. This consensus is based on four articles that were written by a team of Latin American experts, reviewed by dental associations, and presented and discussed in two consensus events. The following domains were explored: epidemiology, risk factors, prevention strategies, and management of dental caries with a focus on restorative procedures. Dental caries can manifest throughout the lifespan of an individual, making it a matter of concern for infants, children, adults, and older people alike. The prevalence rates of untreated caries in deciduous and permanent teeth are high in many parts of the world, including LACCs. Previous evidence suggests that the prevalence of dental caries in 12-year-olds is moderate to high in most Latin American countries. Moreover, the prevalence of treatment needs and dental caries in the adult and elderly population can also be regarded as high in this region. The risk/protective factors (e.g., sugar consumption, exposure to fluoride, and oral hygiene) probably operate similarly in all LACCs, although variations in the interplay of these factors in some countries and within the same country cannot be ruled out. Although salt and water fluoridation programs are implemented in many countries, there is a need for implementation of a surveillance policy. There is also room for improvement with regard to the introduction of minimal intervention techniques in practice and public health programs. Dental caries is a marker of social disadvantage, and oral health promotion programs and interventions aimed at reducing the burden of dental caries in LACCs must consider the complexity of the socioeconomic dynamics in this region. There is an urgent need to promote engagement of stakeholders, policymakers, medical personnel, universities, dental associations, community members, and industries to develop regional plans that enhance the oral health agenda for LACCs. A list of recommendations has been presented to underpin strategies aimed at reducing the prevalence and severity of dental caries and improving the quality of life of the impacted LACC population in the near future.

Community interventions and strategies for caries control in Latin American and Caribbean countries

Abstract Dental caries remains highly prevalent in Latin American and Caribbean countries (LACC). However, this disease can be controlled through interventions that implement evidence-based strategies in an affordable manner and that target all population groups instead of the most affluent only. Therefore, the aim of this report was to summarize the main scientifically documented community interventions and strategies based on restriction of sugars consumption, use of fluoride, and the use of occlusal sealants for caries control in LACC. A critical literature review was carried out in a systematic manner that included defined search strategies, independent review of the identified publications, and compilation of results in this report. Three systematic searches were conducted using the PubMed, LILACS, and SciELO databases to identify studies related to community interventions and strategies for caries control in LACC. Of the 37 publications identified, twenty-six focused on fluoride use, eight on occlusal sealant use, and three on the restriction of sugar consumption. Documented community interventions for sugars restriction were scarce in the region and were based on food supplementation, sugar replacement, and education. Thus, local and/or national policies should prioritize investment in upstream, coherent, and integrated population-wide policies such as taxes on sugary drinks and stronger regulation of advertising and promotion of sugary foods and drinks mainly targeting children. The main fluoride-based strategies used drinking water, refined domestic salt, cow milk, toothpaste and, to a lesser extent, mouth-rinses, acidulated phosphate fluoride (APF) gels, and varnishes to deliver fluoride to the population. Evidence of fluoride use was seen in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. Studies reporting the use of occlusal sealants were mainly located in Brazil, Chile, Colombia, Costa Rica, Peru, Mexico, and Venezuela. Community interventions restricting sugar consumption should be implemented at the individual level and through public policies. The use of fluoride must be monitored at the local, regional, and national levels so as to achieve maximum anti-caries effect while also minimizing the risk of dental fluorosis. Moreover, fluoridated water and salt programs, used as a mutually exclusive community level strategy for caries control, should expand their benefits to reach non-covered areas of the LACC while also simultaneously providing adequate surveillance of the fluoride concentration delivered to the population. Regulating the concentration of soluble fluoride (for anti-caries effect) in dentifrice formulations is also necessary in order to provide the population with an effective strategy for disease control. Targeting culturally appropriate, economically sustainable caries control interventions to rural populations and native ethnic groups such as indigenous people, quilombolas (African-origin), and riverside Amazonian people remains a crucial challenge.

Depression, anxiety, and drug usage history indicators among institutionalized juvenile offenders of Brasilia

Abstract Introduction: One of the most serious socio-educational measures for children and adolescents in conflict with the law in Brazil is their internment. This measure may represent an additional source of stress to this population and present significant impacts in the mental health context. This study aims to describe anxiety levels, depression, and addictive consumption, as well as to estimate the causalities and interactions of these variables. Methods: Herein, we report a study in which 175 male juveniles from youth detention institutions of the Federal District voluntarily completed the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and a short self-rating questionnaire asking whether and how often they had experienced cannabis, alcohol, and other "hard" psychotropic drugs (e.g., crack, cocaine, amphetamine) 1 year prior to institutionalization. Results: Of the total participants, 28.00% showed moderate to severe depression scores and 34.28% showed moderate to severe anxiety scores. In addition, the vast majority of participants also reported some antecedent drug abuse, including cannabis, alcohol, and other "hard drugs." The BDI scores moderately correlated with BAI, but none of these parameters considerably correlated with the antecedent drug abuse. Conclusions: The data indicate potentially concerning levels of emotional distress in these institutionalized juveniles which seem to be independent of addictive behaviors. These data deserve attention and further investigation. Thus, a need for preventative mental health for the general population and socio-educational intervention aimed at interned youth which can decrease levels of emotional stress is emphasized.

The use of narrative research for the learning of group dynamics by professionals from Psychosocial Care Centers / Uso de narrativas para el aprendizaje de la tecnología grupal por parte de los profesionales de Centros de Atención Psicosocial / Uso de narrativas para o aprendizado da tecnologia grupal por profissionais de Centros de Atenção Psicossocial

ABSTRACT Objective: To analyze the results of the use of narratives in group therapy for the qualification process of professionals in the Psychosocial Care Centers on the use of group dynamics. Method: This is an action research involving 21 workers from 11 Psychosocial Care Centers in the Brazilian Central-West region. For data collection, narratives written by the participants about their work practices with therapeutic groups and theoretical discussion based on in-person workshops were used. Data were subjected to narrative analysis with the support of qualitative analysis software. Results: The category "Concerns and Questioning" showed the workers' lack of knowledge regarding the concept of group and group dynamics, the group management challenges, and the discomfort with the frustrations experienced by the group. The category "Learning for Group Coordination" showed knowledge acquisition for group planning and functioning, and understanding of the role of the group coordinator for mental health care. Conclusion: Narrating the scenes of group care allowed participants to exercise critical reflexive thinking, recognize the theory of group dynamics, and develop skills to coordinate groups.

RESUMEN Objetivo: Analizar los resultados sobre el uso de narrativas de atención grupal en el proceso de cualificación de los profesionales de los Centros de Atención Psicosocial para el aprendizaje del uso de la tecnología grupal. Método: Investigación-acción realizada con 21 trabajadores de 11 Centros de Atención Psicosocial ubicados en la región centro occidental de Brasil. Los datos se recogieron mediante narrativas escritas por los participantes acerca de sus prácticas de trabajo con grupos terapéuticos y talleres presenciales de discusión teórica basados en ellas. Estos datos se sometieron a un análisis narrativo con el apoyo de un software de análisis cualitativo. Resultados: La categoría "Angustias y Cuestionamientos" evidenció el desconocimiento de los trabajadores con respecto a la conceptualización de grupo y de dinámica de grupo; los desafíos de la gestión de grupo y la incomodidad con las frustraciones vividas en el grupo. La categoría "Aprendizajes para la Coordinación de Grupos" reveló la adquisición de conocimientos para la planificación y el funcionamiento del grupo, y la comprensión del papel de coordinador de grupos para la atención a la salud mental. Conclusión: La narración de las escenas de atención grupal les posibilitó a los participantes ejercitar el pensamiento crítico reflexivo, reconocer la teoría de la tecnología grupal y desarrollar habilidades para coordinar grupos.

RESUMO Objetivo: Analisar os resultados sobre o uso de narrativas de cuidado grupal no processo de qualificação dos profissionais dos Centros de Atenção Psicossocial para o aprendizado do uso da tecnologia grupal. Método: Pesquisa-ação envolvendo 21 trabalhadores de 11 Centros de Atenção Psicossocial do Centro-Oeste brasileiro. Para coleta de dados foram utilizadas narrativas escritas pelos participantes sobre suas práticas de trabalho com grupos terapêuticos e oficinas presenciais para discussão teórica a partir das mesmas. Os dados foram submetidos à análise de narrativas com o suporte do software de análise qualitativa. Resultados: A categoria "Angústias e Questionamentos" evidenciou o desconhecimento dos trabalhadores quanto à conceituação de grupo e dinâmica de grupo, os desafios do manejo grupal e o desconforto com as frustrações vividas no grupo. A categoria "Aprendizados para Coordenação de Grupo" revelou aquisição de conhecimento para o planejamento e funcionamento grupal, e compreensão do papel de coordenador de grupos para o cuidado em saúde mental. Conclusão: Narrar as cenas de cuidado grupal possibilitou aos participantes exercitar o pensamento crítico reflexivo, reconhecer a teoria da tecnologia grupal e desenvolver habilidades para coordenar grupos.

Prevalence of sarcopenia in kidney transplants and their association with determinant factors of muscle homeostasis

SUMMARY INTRODUCTION: Sarcopenia is characterized by the involuntary loss of lean body mass associated with a progressive reduction of muscle strength. OBJECTIVE: To determine the prevalence of sarcopenia in kidney transplant recipients and its association with the determining factors that control muscle homeostasis. METHODS: We evaluated renal transplant recipients undergoing follow-up at the University Hospital of the Federal University of Maranhão from June 2017 to July 2018 and who met the inclusion criteria. Sarcopenia was defined according to the European criteria. The skeletal muscle mass index was measured by dual-energy radiological absorptiometry; the values <7,26 kg/m2 for men and <5,5 kg/m2 for women were adopted for muscle depletion. For handgrip strength, values of <30 kg for men and <20 kg for women were considered as reduced muscle strength. In both sexes, the cutoff point for walking speed was <0,8 m/s. RESULTS: We evaluated 83 renal transplant recipients with a mean age of 48.8 ± 12,1 years and predominantly males (57,8%). The prevalence of sarcopenia was 19,3%. Among individuals without sarcopenia, 17,9% had a decrease in handgrip strength and 40,3% has altered gait speed. DISCUSSION: Individuals submitted to renal transplant may develop sarcopenia while still young and already present altered muscle function and strength even before the depletion of lean body mass. CONCLUSION: Early diagnosis may allow the prevention of sarcopenia and provide a better quality of life for patients.

RESUMO INTRODUÇÃO: A sarcopenia é caracterizada pela perda involuntária da massa magra associada à redução da força e função muscular, de modo progressivo. OBJETIVO: Determinar a prevalência de sarcopenia em transplantados renais e sua associação com os fatores determinantes que controlam a homeostase do músculo. MÉTODOS: Foram avaliados indivíduos transplantados renais em acompanhamento no Hospital Universitário da Universidade Federal do Maranhão no período de junho de 2017 a julho de 2018 e que preencheram os critérios. A sarcopenia foi definida de acordo com o critério europeu. O índice de massa muscular esquelética foi medido por meio da densitometria computadorizada por absorciometria radiológica de dupla energia; valores <7,26 kg/m2 para homens e <5,5 kg/m2 para mulheres foram adotados para depleção muscular. Para força de preensão manual, valores de <30 kg para homens e <20 kg para mulheres foram considerados como redução da força muscular. Em ambos os sexos, o ponto de corte para velocidade de marcha reduzida foi <0,8 m/s. RESULTADOS: Foram avaliados 83 transplantados renais, com média de idade de 48,8±12,1 anos e predominância de indivíduos do sexo masculino (57,8%). A prevalência de sarcopenia foi de 19,3%. Entre os indivíduos sem sarcopenia, 17,9% já tinham diminuição da força de preensão manual e 40,3%, alteração do teste de marcha. DISCUSSÃO: Indivíduos submetidos ao transplante renal podem desenvolver sarcopenia jovens e apresentar alteração da função e da força muscular mesmo antes da depleção da massa magra. CONCLUSÃO: O diagnóstico precoce pode permitir a prevenção da sarcopenia e propiciar melhor qualidade de vida aos pacientes.

Osteonevus of Nanta: a case report in a combined melanocytic nevus

Abstract Secondary osteoma cutis is a phenomenon that may occur in several conditions. When it occurs in a melanocytic nevus it is named osteonevus of Nanta, an event considered uncommon and characterized by the presence of bone formation adjacent or interposed with melanocytic cells. There are reports of its occurrence in various melanocytic lesions, being more frequently associated with intradermal nevus. We report a case of osteonevus of Nanta in combined nevus, possibly the first description of this association.

Reflexiones en torno a la investigación con métodos mixtos / Reflexão sobre pesquisa com métodos mistos / Reflections on research with mixed methods

Objetivo Se presenta una reflexión teórica basada en la experiencia de los autores como investigadores y docentes de unidades curriculares de Metodologías de Investigación. Método reflexión teórica-filosófica. Resultados la dicotomía entre los enfoques cualitativos y cuantitativos dio lugar a la discusión sobre la necesidad de pensar en la posibilidad de combinar estos métodos con el objetivo de responder a los nuevos y complejos problemas de investigación con los que actualmente nos enfrentamos. Esta discusión se transformó en una disputa que algunos autores apodaron "Science War", debido a los desafíos metodológicos y epistemológicos de esta combinación que, por su vez, dio origen a los Métodos Mixtos (Mixed Methods). La reflexión que se propone se centra en algunas de las principales cuestiones que surgen en el ámbito de las actuales discusiones entre investigadores y reflejan/traducen algunas de las inquietudes de los mismos.

Objetivo se presenta una reflexión teórica basada en la experiencia de los autores como investigadores y docentes de unidades curriculares de Metodologías de Investigación. Método reflexión teórica-filosófica. Resultados la dicotomía entre los enfoques cualitativos y cuantitativos dio lugar a la discusión sobre la necesidad de pensar en la posibilidad de combinar estos métodos con el objetivo de responder a los nuevos y complejos problemas de investigación con los que actualmente nos enfrentamos. Esta discusión se transformó en una disputa que algunos autores apodaron "Science War", debido a los desafíos metodológicos y epistemológicos de esta combinación que, por su vez, dio origen a los Métodos Mixtos (Mixed Methods). La reflexión que se propone se centra en algunas de las principales cuestiones que surgen en el ámbito de las actuales discusiones entre investigadores y reflejan/traducen algunas de las inquietudes de los mismos.

Objective this study presents a theoretical reflection based on the experience of the authors as researchers and professors of curricular units of research methodologies. Method theoretical-philosophical reflection. Results the dichotomy between qualitative and quantitative approaches originated the discussion on the need to think about the possibility of combining these methods aiming to answer the new and complex research problems currently facing us. This discussion was transformed into a dispute that some authors nicknamed "Science War", due to the methodological and epistemological challenges of this combination, which, in its turn, originated the Mixed Methods. The proposed reflection focuses on some of the main issues that arise in the scope of the current discussions between researchers and reflecting/translating some of their concerns.