Prevalence of cleft lip and palate and associated factors in Brazil's Midwest: a single-center study

Abstract: The aim of this study was to evaluate the prevalence of cleft lip and/or palate (CL/P) and associated factors in patients treated at a referral service in Brazil's Midwest. Data were obtained from medical records on file between 2010 and 2017 for this epidemiologic and associational study. A descriptive analysis of the sociodemographic and clinical data was carried out, after which the data were analyzed using the chi-square test and Poisson regression with robust variance. A total of 1,696 medical records were eligible. The requests for rehabilitation were mainly for children in the early years of life, and were mostly for patients from low-income families in the state of Goiás. CL/P was more prevalent in its most severe morphological representation (cleft lip and palate), and the most frequently affected side was the left. Syndromic cleft was present in 4.1% of the cases, and the Pierre Robin sequence and Apert syndrome appeared more frequently. Adjusted multivariate Poisson regression showed an association between cleft palate and the presence of syndromes, since the prevalence was 2.33 times higher in this case than that of no syndrome. Cleft lip and palate were associated with males, whereas cleft palate was associated with females. This study highlights the importance of collecting and analyzing epidemiological data, managing health service planning, and allocating funds to assist cleft patients.

Consumo de alimentos ultraprocessados reduz a qualidade global da dieta de gestantes / El consumo de alimentos ultraprocesados reduce la calidad global de la dieta de gestantes / The consumption of ultra-processed foods reduces overall quality of diet in pregnant women

Este trabalho analisou a contribuição dos alimentos ultraprocessados (AUP) no perfil alimentar e nutricional da dieta de gestantes. Trata-se de um estudo transversal conduzido com uma amostra representativa de gestantes usuárias de unidades básicas de saúde de Maceió, Alagoas, Brasil. O consumo alimentar foi avaliado pela aplicação de dois recordatórios de 24 horas em dias não consecutivos e os itens de consumo agrupados segundo a classificação NOVA. As estimativas gerais foram expressas no consumo alimentar absoluto (média de ingestão calórica) e relativo (percentual da ingestão energética total segundo grupos de alimentos e itens de consumo). Análises de variâncias foram utilizadas para comparar as médias do consumo energético e de nutrientes, segundo grupos alimentares. A associação entre os quintis de contribuição energética dos AUP (variável de exposição) e (1) itens de consumo e grupos alimentares, (2) contribuição percentual para o total de energia de macronutrientes e (3) densidade de micronutrientes foi analisada por meio de modelos ajustados de regressão linear. O consumo médio de energia das gestantes foi de 1.966,9Kcal/dia, sendo 22% proveniente dos AUP. Observou-se relação direta entre a contribuição energética dos AUP na dieta e o consumo energético total (β = 228,78Kcal; EP = 21,26). Ainda, o aumento da participação de AUP implicou a redução estatisticamente significativa da ingestão de proteínas, fibras, magnésio, ferro, pótassio, zinco, selênio, folato e vitaminas D e E, assim como o consumo de alimentos tradicionais, como arroz, feijão, raízes e tubérculos. Portanto, nossos dados apontam que o consumo de AUP reduz a qualidade global (nutricional e alimentar) da dieta de gestantes.

Este estudio analizó la contribución de los alimentos ultraprocesados (AUP) al perfil alimentario y nutricional de la dieta de gestantes. Se trata de un estudio transversal, realizado con una muestra representativa de gestantes usuarias de unidades básicas de salud de Maceió, Alagoas, Brasil. El consumo alimentario se evaluó mediante la aplicación de dos recordatorios de 24 horas en días no consecutivos y los ítems de consumo agrupados según la clasificación NOVA. Las estimaciones generales fueron expresadas en el consumo alimentario absoluto (media de ingestión calórica) y relativo (porcentaje de la ingestión energética total según grupos de alimentos e ítems de consumo). Se utilizaron análisis de variancias para comparar las medias del consumo energético y de nutrientes, según grupos alimentarios. La asociación entre los quintiles de contribución energética de los AUP (variable de exposición) y (1) ítems de consumo y grupos alimentarios, (2) porcentaje de contribución para el total de energía de macronutrientes y (3) se analizó la densidad de micronutrientes mediante modelos ajustados de regresión lineal. El consumo medio de energía de las gestantes fue 1.966,9Kcal/día, siendo un 22% proveniente de los AUP. Se observó una relación directa entre la contribución energética de los AUP en la dieta y el consumo energético total (β = 228,78Kcal; EP = 21,26). Asimismo, el aumento de la participación de AUP implicó la reducción estadísticamente significativa de la ingestión de proteínas, fibras, magnesium, hierro, potasio, zinc, selenio, folato y vitaminas D y E, así como en el consumo de alimentos tradicionales como: arroz, frijoles, raíces y tubérculos. Por tanto, nuestros datos apuntan que el consumo de AUP reduce la calidad global (nutricional y alimentaria) de la dieta de gestantes.

This study analyzed the role of ultra-processed foods (UPFs) in the food and nutritional profile of pregnant women's diet. This was a cross-sectional study conducted in a representative sample of pregnant women attending primary healthcare units in Maceió, capital of the State of Alagoas, Brazil. Food consumption was assessed with the application of two 24-hour food recalls on nonconsecutive days, and the consumption items were grouped according to the NOVA classification. Overall estimates were expressed as absolute dietary consumption (mean calorie intake) and relative consumption (percentage of total energy intake according to food groups and consumption items). Analysis of variance was used to compare mean energy and nutrient intake according to food groups. The association between quintiles of the energy share from UPFs (exposure variable) and (1) consumption items and food groups, (2) percentage of total energy from macronutrients, and (3) micronutrient density was analyzed via adjusted linear regression models. Mean energy intake in pregnant women was 1,966.9Kcal/day, 22% of which from UPFs. A direct relationship was observed between the percentage of energy from UPFs and total energy consumption (β = 228.78Kcal; SE = 21.26). In addition, an increase in the share of UPFs was associated with a statistically significant reduction in the intake of protein, fiber, magnesium, iron, potassium, zinc, selenium, folate, and vitamins D and E, as well as in the consumption of traditional foods such as protein, beans, roots, and tubers. Our data thus indicate that the consumption of UPFs reduces the overall nutritional and food quality of diet in pregnant women.

Riesgo: concepto básico de la epidemiología / Risk: basic concept of epidemiology

Este artículo propone la formalización del concepto de "riesgo" como objeto de conocimiento de la ciencia epidemiológica, con el objetivo de sistematizar sus aspectos lingüísticos, epistemológicos y metodológicos, compilando para ello contribuciones anteriores de los autores. En primer lugar, los sentidos del término "riesgo" son analizados desde un punto de vista etimológico y semántico, evaluando su utilización en la constitución de discursos sociales comunes. En segundo lugar, el concepto epidemiológico de riesgo es enfocado desde una perspectiva hermenéutica, explicitando los ejes epistemológicos y los elementos conceptuales involucrados en la construcción del discurso epidemiológico. En tercer lugar, se discuten correlaciones teóricas, metodológicas y políticas entre el objeto riesgo, conceptos de salud y teorías críticas de la sociedad, apuntando a una evaluación de perspectivas y desafíos para futuros desarrollos del campo científico de la epidemiología.

This paper suggests a formalization of the "risk" concept as the object of knowledge of epidemiological science, in order to categorize linguistic, epistemological and methodological aspects of this concept, following upon former contributions of the authors. Firstly, the meanings of risk are analyzed from an etymological and semantic viewpoint, evaluating its use for the constitution of common social discourses. Secondly, the epidemiological concept of risk is focused in hermeneutical perspective, making explicit epistemological axes and conceptual elements for the construction of the epidemiological discourse. Thirdly, theoretical, methodological and political correlations among the object risk, concepts of health and critical theories of society are discussed, aiming at an evaluation of perspectives and challenges for future developments of the scientific field of epidemiology.

Carcinoma epidermoide em mucosa bucal: um breve levantamento / Squamous cell carcinoma in mouth mucosa: a short survey

O câncer bucal é um problema de saúde pública em muitos países, inclusive no Brasil. Todavia, a prevenção e o diagnóstico precoce continuam sendo as formas mais eficazes de combate ao câncer. Traçar um perfil dos casos de carcinoma epidermoide na cidade de São José dos Campos, SP. Foram levantados todos os laudos emitidos no período de 1972 a 2004, sendo que desses, apenas 224 continham o diagnóstico de interesse. A seguir, foram coletados os dados referentes ao sexo, à raça, à idade e à localização da lesão primária. Estes foram, então, tabulados e analisados, utilizando-se da estatística descritiva. Quanto ao sexo, observou-se uma forte predileção pelo masculino (80,4%), o mesmo acontecendo em relação à raça branca (74,6%). Já a respeito da idade dos pacientes no momento do diagnóstico, 86,2% estavam entre a quinta e a oitava década de vida. Neste estudo, também se pode notar que a língua foi a região mais acometida, com 22,8% dos casos, seguida do lábio inferior, 19,7%, e do soalho bucal, 14,3%. O padrão epidemiológico apresentado pelo câncer bucal na cidade de São José dos Campos, SP e região não difere daquele observado no restante do Brasil.

Oral cancer is a public health issue in many countries, including Brazil. Thus, prevention and early diagnosis still remain as the most effective ways to combat cancer. The present study aimed to obtain a profile of squamous cell carcinoma cases in the city of São José dos Campos. All case files from 1972 to 2004 were analyzed and only 224 had the diagnosis of interest. Data regarding gender, race, age and location of the primary lesion were tabled and analyzed, using descriptive statistics. Regarding gender, a strong occurrence in males (80.4% of the cases) was observed, the same regarding white race (74.6%). In regards to age, 86.2% of the patients were between the fifth and eighth decade of life at the moment of the diagnosis. In this study, is was also noticeable that tongue was the most affected region, with 22.8% of the cases, followed by inferior lip (19.7%) and mouth floor (14.3%). The epidemiological pattern presented by oral cancer in the city of São José dos Campos does not differ from the one observed in the other parts of Brazil.

Avaliação da esterilização em autoclaves odontológicas através do monitoramento biológico / Evaluation of dental autoclave sterilization through biological monitoring

O objetivo deste estudo foi avaliar a ocorrência de esterilização em autoclaves de consultórios odontológicos, mediante o emprego de indicadores biológicos, assim como, através de questionário, conhecer a prática clínica do processamento do instrumental contaminado. Foram introduzidos em 40 autoclaves, juntamente como instrumental, três indicadores biológicos (próximo ao filtro, no centro e junto à porta). Após, os indicadores (testes e controle) foram incubados por 48 horas, para aferição do meio de cultura. Os indicadores-teste apresentaram mudança da cor do meio de cultura de roxo para amarelo em 14 (35%) das autoclaves, indicando ausência de esterilização. A maioria dos cirurgiões-dentistas (CDs) associa ao calor úmido, outros métodos de esterilização, como o químico e o calor seco. Nenhum cirurgião-dentista emprega rotineiramente o monitoramento biológico em seu consultório. Dos 31 cirurgiões-dentistas (77,5%) que empregam o controle físico e/ou químico da esterilização, apenas 74,2% dos mesmos, o fazem a cada ciclo. A grande maioria dos cirurgiões-dentistas (75%) emprega o envelope para o empacotamento do instrumental. No entanto, 77,5% dos mesmos não escrevem na embalagem a data da esterilização. Concluiu-se que 35% das autoclaves analisadas não estão realizando o processo de esterilização do instrumental e que algumas falhas durante o processamento do instrumental contaminado ainda existem e deveriam ser corrigidas.

The aim of this study was to evaluate the occurrence of autoclave sterilization at dental offices by means of biological indicators and questionnaires, as well as to know the clinical practice of processing the contaminated instruments. Three biological indicators (close to the filter, at the center and close to the door) were introduced into 40 autoclaves along with instruments. Next, indicators (test and control) were incubated for 48 hours in order to check the culture medium. The test-indicators had a change in the color of the culture medium from purple to yellow in 14 (35%) of autoclaves. Most dental surgeons (DS) associate other sterilization methods, such as chemical and dry heat, with damp heat. No Dental Surgeon routinely use biological monitoring at their offices. From the 31 Dental Surgeons (77.5%) who use physical and/or chemical control of sterilization, only 74.2% do it every cycle. The great majority of DS (75%) use the envelope for packing instruments. However, 77.5% of them do not write the sterilization date on the package. It was concluded that 35% of the analyzed autoclaves did not perform the instrument sterilization process and that some flaws during processing of the contaminated instruments still occur and should be corrected.

A study on epidemiological characteristics and control methods of EHEC infection in Korea / 한국역학회지

E. coli is a bacterium that is commonly found in the gut of humans and warm-blooded animals. Most strains of E. coli are harmless. But some strains such as Enterohaemorrhagic E. coli(EHEC), can cause severe food borne disease. It is transmitted to humans primarily through consumption of contaminated foods, such as raw or undercooked ground meat. There is no widely agreed definition of when a shiga-toxin producing E. coli is considered to be an EHEC. But in Korea, the word "EHEC", "STEC", "VTEC" are often used as same meaning, which refer to the E.coli those producing shiga-toxin. We suggest the term STEC refers to those E. coli produce one or more shiga-toxins(stx), and the term EHEC refers only to STEC that cause a clinical illness. EHEC infection were designated as the class 1 notifiable disease in Korea in 2000. Although EHEC/STEC cases were not common in Korea, the number of STEC infection cases reported has increased since 2001. From 2001 to 2004, the number of STEC infection cases in Korea were 11, 8, 52, 118 respectively. These cases included 17 due to E. coli O157, 136 due to E. coli, serogroup non-O157, and 15 due to E. coli that were not serogrouped. The most common serotype implicated is E. coli O91 without virulent factor and clinical symptoms. But those cases involve in one epidemic in primary school in 2004. STEC infections in Korea occur in all age groups, with the highest frequencies in children less than 5 years old. Healthy cattle are the main animal reservoir for STEC and they harbor the organism as part of the bowel flora. The proportion of STEC in E. coli in animal feces was examined by using stool samples from 283 Korean beef cattle on 27 farms, 169 milk cattle on 28 frams, 455 swine on 50 farms. As determined by culture and toxin assay, the proportion of STEC was 25.8%(16 STEC/62 E. coli) in milk cattle, 18.8%(19 STEC/101 E.coli) in Korean beef cattle, 14.0%(25 STEC/178 E. coli) in swine. Effective surveillance of EHEC/STEC in humans is essential in order to protect the public health. EHEC infection is notifiable in many countries including USA, Japan, and Belgium, Finland, Italy, Netherlands, and the United Kingdom(UK), have sentinel systems. England, Wales, and Scotland have comprehensive national laboratory reporting schemes for STEC. And there has been an increase in the number of reported cases and outbreaks during the past decades in many countries Prevention of STEC infection requires control measures at all stages of surveillace, investigations and special pathogen tracing such as PulseNet.

Algumas reflexões sobre o uso público do conhecimento gerado pela Epidemiologia Nutricional / Some reflections on the public use of knowledge generated by Nutritional Epidemiology

A Epidemiologia Nutricional gerou, nas últimas décadas, uma grande quantidade de conhecimentos relacionando doenças específicas com nutrientes. Este artigo visa a mostrar como esse conhecimento da Epidemiologia Nutricional normatiza a dieta e absolutiza a informação, inserindo na socie­ dade conceitos, muitas vezes inadequados, como é o caso da pirâmide alimentar desenvolvida nos Estados Unidos e utilizada em diversos países, entre eles o Brasil. Fatos como este decorrem de uma transposição acrítica de conhecimentos a serem aplicados na Saúde Pública. Ainda neste contexto, a industrialização se apropria de alguns desses conhecimentos e os transfor­ ma em cultura de massa, reorganizando, assim, os hábitos alimentares, independentemente do seu papel na saúde.

In recent decades Nutritional Epidemiology has generated a large amount of knowledge on the relationship between specific diseases and nutrients. This artic1e analyzes how such knowledge from Nutritional Epidemiology standardizes diet and absolutizes information, introducing concepts into society which are often inadequate, as in the case of the food pyramid developed in the United States and utilized in various countries, inc1uding Brazi1. Such facts result from an uncritical transposition of knowledge for use in Public Health. Furthermore, industrialization takes some of this knowledge and turns it into mass culture, thereby reorganizing eating habits, regardless of their role in health.