Prejudice impairing quality of life in sickle cell disease patients in a developing country: faces of suffering

ABSTRACT Introduction: The perception of prejudice against, and stigmatization of, sickle cell disease (SCD) leads the patient to perceive a different treatment, due to the disease stigma and maybe related to a worse quality of life (QoL). Objectives: Describe and evaluate the perception of the prejudice against the disease and its impact on the quality of life of patients with sickle cell disease. Methods: This is a cross-sectional study conducted between March 2019 and February 2020, with patients diagnosed with SCD. Patients were questioned about the perception of prejudice in any kind of situation, choosing between "Yes" or "No", not differentiating situations related to prejudice. To assess the QoL and impact of the disease, the volunteers answered a version of the SF-36 questionnaire translated and validated into Brazilian Portuguese. Results: In this study, 113 patients with SCD were followed up, 92% were classified as HbSS and the rest, divided between HbSC and HbS-β-0. Regarding the SF-36, the worst scores were in the summary of the physical components (mean 48.19 ± 21.51) and the physical aspect had the lowest mean (30.75 ± €42.65). When questioned if they had already perceived any kind of prejudice, including the SCD, 32.74% answered "Yes". For this comparison, there was a significant difference in the summary of the physical and mental components, with worse QoL for those who had already suffered prejudice. Conclusion: Patients diagnosed with SCD who reported perception of prejudice had statistically significant worse QoL, revealing the negative impact, that might lead to sadness and social isolation.

Conhecimento das puérperas em relação ao parto humanizado e às vias de parto / Knowledge of puerperal women towards humanized delivery and modes of delivery

Objetivo: Avaliar o conhecimento das puérperas em relação ao parto humanizado e às vias de parto. Métodos: Estudo observacional transversal com 369 puérperas que realizaram seu parto em um hospital público de Curitiba, Paraná, Brasil. Aplicação de dois questionários que avaliaram características demográficas e socioeconômicas, informações sobre a gestação e o pré-natal, conhecimento de humanização e vias de parto, e atitude em relação às vias de parto. Resultados: Entre as puérperas, 72% afirmaram já terem ouvido falar no termo "parto humanizado", porém, dessas, 52,6% deram uma definição inadequada. E 48,2% obtiveram baixo conhecimento acerca das vias de parto, e 58,2% expressaram atitude positiva em relação à cesárea. Houve associação entre conhecimento prévio sobre parto humanizado e renda (p = 0,001), escolaridade (p < 0,0001), número de consultas de pré-natal (p = 0,023), busca de informações sobre as vias de parto (p < 0,0001) e preferência de parto (p = 0,011). Houve correlação do conhecimento acerca das vias de parto com renda (p = 0,044), escolaridade (p = 0,003), busca de informações sobre as vias de parto (p = 0,007) e atitude em relação à cesárea (p < 0,0001). Conclusão: Observou-se baixo conhecimento acerca das vias de parto e parto humanizado, e características como renda, escolaridade, busca por informações de forma independente e número de consultas de pré-natal possuem associação com esses conhecimentos. Um pré-natal com adequada transmissão de conhecimento relaciona-se à preferência pelo parto normal, sendo essa uma estratégia para a redução das taxas de cesárea e, consequentemente, da morbimortalidade materno-fetal.

Objective: To evaluate the knowledge of postpartum women in relation to humanized del ivery and delivery methods. Methods: Cross-sectional observational study with 369 postpartum women who delivered in a public hospital in Curitiba, Paraná, Brazil. Application of two questionnaires, which evaluated demographic and socioeconomic characteristics, information about pregnancy and prenatal care, knowledge of humanization and delivery methods, attitude towards delivery methods. Results: 72% of postpartum women said they had already heard the term "humanized childbirth", however, of these 52.6% gave an inadequate definition. 48.2% had low knowledge about delivery methods. 58.2% expressed a positive attitude towards cesarean section. There was an association between prior knowledge about humanized childbirth and income (p = 0.001), schooling (p < 0.0001), number of prenatal consultations (p = 0.023), search for information about delivery methods (p < 0 .0001), birth preference (p = 0.011). There was a correlation between knowledge about the modes of delivery with income (p = 0.044), education (p = 0.003), search for information about the modes of delivery (p = 0.007), attitude towards cesarean section (p < 0.0001). Conclusion: There was a low knowledge about the ways of delivery and humanized delivery, and characteristics such as income, education, search for information independently and the number of prenatal consultations have an association with this knowledge. A prenatal care with adequate transmission of knowledge is related to the preference for normal delivery, which is a strategy for reducing cesarean rates and, consequently, maternal-fetal morbidity and mortality.

Septic shock, hyperferritinemic syndrome, and multiple organ dysfunction without respiratory failure in a patient with disseminated histoplasmosis and advanced HIV disease

ABSTRACT AIDS-related disseminated histoplasmosis (DH) can cause septic shock and multiorgan dysfunction with mortality rates of up to 80%. A 41-year-old male presented with fever, fatigue, weight loss, disseminated skin lesions, low urine output, and mental confusion. Three weeks before admission, the patient was diagnosed with HIV infection, but antiretroviral therapy (ART) was not initiated. On day 1 of admission, sepsis with multiorgan dysfunction (acute renal failure, metabolic acidosis, hepatic failure, and coagulopathy) was identified. A chest computed tomography showed unspecific findings. Yeasts suggestive of Histoplasma spp. were observed in a routine peripheral blood smear. On day 2, the patient was transferred to the ICU, where his clinical condition progressed with reduced level of consciousness, hyperferritinemia, and refractory septic shock, requiring high doses of vasopressors, corticosteroids, mechanical ventilation, and hemodialysis. Amphotericin B deoxycholate was initiated. On day 3, yeasts suggestive of Histoplasma spp. were observed in the bone marrow. On day 10, ART was initiated. On day 28, samples of peripheral blood and bone marrow cultures revealed Histoplasma spp. The patient stayed in the ICU for 32 days, completing three weeks of intravenous antifungal therapy. After progressive clinical and laboratory improvement, the patient was discharged from the hospital on oral itraconazole, trimethoprim-sulfamethoxazole, and ART. This case highlights the inclusion of DH in the differential diagnosis of patients with advanced HIV disease, septic shock and multiorgan dysfunction but without respiratory failure. In addition, it provides early in-hospital diagnosis and treatment and comprehensive management in the ICU as determining factors for a good outcome.

Potential for healthy eating in a Brazilian public university food environment / Potencial para alimentação saudável no ambiente alimentar de uma universidade pública brasileira

ABSTRACT Objective To identify the food environment healthy eating potential in the authorized food services on the campus of a Brazilian university. Methods This is an observational study carried out between March and April 2014 on a campus of a public university in Rio de Janeiro, Brazil. The elements of the food environment were evaluated using an audit instrument, containing 86 questions: availability (amount of food services and types of food offered), convenience (days and hours of operation), incentives and barriers to healthy eating (nutrition information, payment strategies and food advertisements). Preparations based on whole grains and fresh or minimally processed products were considered healthy foods; and, preparations with high caloric density, sugar-sweetened beverages, sweets, desserts, cookies, and savory snacks were considered unhealthy food. The questionnaire allowed us to calculate a score for each service, which could range from 0 to 36 points, and indicates the potential for promoting healthy eating in the establishment, with higher scores indicating a greater presence of elements that contribute to healthy eating. The different types of food service facilities were compared based on the scores (p<0.05 for statistical significance). Results Among the establishments evaluated, 24% were snack bars/cafeterias, 26%, restaurants, and 50% offered mixed services. Healthy food items were scarcely available in the establishments (fruits: 24%; vegetables: 20%; brown rice: 15%); while added-sugar beverages (98%), sweets and treats (76%) were widely offered. There was a higher frequency of advertising encouraging consumption of unhealthy items than that aimed at healthy foods (44% vs 30%). In general, the score was 13,2 points (SD=3.3) and the mean score for snack bars/cafeterias (9.3 points) was lower (p<0,05) than that of restaurants and mixed establishments (14,4 points). Conclusion On the campus assessed, the food environment had limited potential for healthy eating, since elements that did not favor healthy food choices were more frequent.

RESUMO Objetivo Identificar o potencial do ambiente alimentar para alimentação saudável em serviços permissionários no campus de uma universidade brasileira. Métodos Realizou-se um estudo observacional entre março e abril de 2014, em 54 serviços de alimentação permissionários de um campus de uma universidade pública do Rio de Janeiro, Brasil. Os elementos do ambiente alimentar foram avaliados por meio de instrumento de auditoria contendo 86 questões: disponibilidade (quantidade de serviços de alimentação e tipos de alimentos comercializados), conveniência (dias e horários de funcionamento), estímulos e barreiras para a alimentação saudável (informação nutricional, estratégias de pagamento e propagandas de alimentos). As preparações à base de cereais integrais e produtos frescos ou minimamente processados foram considerados alimentos saudáveis e aquelas com elevada densidade calórica, bebidas com adição de açúcar, doces, sobremesas, guloseimas, biscoitos e lanches salgados foram considerados não saudáveis. O questionário permitiu calcular um escore, para cada serviço, que poderia variar entre 0 a 36 pontos, e indica o potencial para promoção da alimentação saudável no estabelecimento, sendo que escores mais elevados indicam maior presença de elementos que favorecem a alimentação saudável. Os diferentes tipos de serviços de alimentação permissionários foram comparados segundo os escores (p<0,05 para significância estatística). Resultados Dos estabelecimentos avaliados, 24% eram lanchonetes/cafeterias, 26%, restaurantes e 50%, mistos. Itens saudáveis eram disponibilizados de forma incipiente nos estabelecimentos (frutas: 24%; hortaliças: 20%; arroz integral: 15%), enquanto bebidas com adição de açúcar (98%) e doces e guloseimas (76%) eram amplamente ofertados. Havia maior frequência de propagandas incentivando o consumo de itens não saudáveis do que aquelas voltadas para alimentos saudáveis (44% vs 30%). De modo geral, o escore foi de 13,2 pontos (DP=3,3) e a média do escore de lanchonetes/cafeterias (9,3 pontos) era menor (p<0,05) do que a de restaurantes e estabelecimentos mistos (14,4 pontos). Conclusão O ambiente alimentar do campus avaliado apresentou potencial limitado para a alimentação saudável, uma vez que eram mais frequentes os elementos que não favoreciam escolhas alimentares saudáveis.

A clinical model to predict successful renal replacement therapy (RRT) discontinuation in patients with Acute Kidney Injury (AKI)

Abstract Introduction Ideal timing of Renal Replacement Therapy (RRT) discontinuation in Acute Kidney Injury (AKI) is still unknown. We aimed to study the role of creatinine-related variables in predicting RRT successful discontinuation and to propose a clinical predictive score. Methods In this single-centre retrospective study, we evaluated all AKI patients in whom RRT was interrupted for at least 48 hours. Patients who were still RRT-independent 7 days after initial RRT cessation were included in the "Success" group and opposed to the "Failure" group. We evaluated baseline characteristics and variables collected at the time of RRT interruption, as well as the Kinetic estimated Glomerular Filtration Rate (KeGFR), the simple variation in serum Creatinine (ΔsCr), and the incremental creatinine ratio on the first three days after RRT interruption. Multivariable analysis was performed to evaluate prediction of success. Internal validation using a simple binomial generalized regression model with Lasso estimation and 5-fold cross validation method was performed. Results We included 124 patients, 49 in the "Failure" group and 75 in the "Success" group. All creatinine-related variables predicted success in simple and multiple logistic regression models. The best model generated a clinical score based on the odds ratio obtained for each variable and included urine output, non-renal SOFA score, fluid balance, serum urea, serum potassium, blood pH, and the variation in sCr values after RRT discontinuation. The score presented an area under the ROC of 0.86 (95% CI 0.76‒1.00). Conclusion Creatinine variation between the first 2 consecutive days after RRT discontinuation might predict success in RRT discontinuation. The developed clinical score based on these variables might be a useful clinical decision tool to guide hemodialysis catheter safe removal.

Influence of number and position of porcelain specimens in the furnace on flexural strength and translucency

The aim of this study was to investigate the influence of the quantity and positioning of feldspathic ceramic specimens inside the furnace on their flexural strength and translucency. The tested hypotheses were that the arrangement of specimens in the furnance would not influence 1) the translucency or 2) the biaxial strength of the porcelain. Methods: Ninety porcelain specimens were made (1.2 mm thickness and 13.5 mm diameter) and assigned into two main groups (n=15): G1 group - 15 firing cycles containing only one specimen each, always at the center of the refractory; and G5 group - 15 firing cycles containing five specimen each, where one specimen was at the center of the refractory and four specimens positioned equidistantly on the periphery. The translucency test was performed using a spectrophotometer, followed by the flexural strength test, according to ISO 6872:2015. T-student test was performed for both the mechanical and optical obtained data. Results: The flexural strength of the porcelain was not affected by the positioning (center x periphery) of the specimens inside the furnace (p =0.08), but the translucency was affected (periphery > center; p =0.009). Regarding to the number of feldspathic ceramic specimens, the biaxial flexural strength was affected (p =0.025), as well as the translucency (p <0.05). Conclusion: A higher quantity of feldspathic ceramic specimens for each firing cycle decreased its biaxial flexural strength and translucency. Also, specimens positioned at the center of the refractory became less translucent than those positioned at the periphery.

Color and translucency stability of CAD/CAM restorative materials

Aim: This study assessed the color and translucency stability of a polymer infiltrated ceramic network (PICN) and compared it with a resin composite (RC) and a feldspathic ceramic (FEL). Methods: Disc-shaped samples of a PICN (Vita Enamic), a feldspathic ceramic (Vitablocks Mark II), and a resin composite (Brava block) were prepared from CAD/CAM blocks. PICN and RC surfaces were finished with a sequence of polishing discs and diamond paste. FEL samples received a glaze layer. The samples were subjected to 30-min immersions in red wine twice a day for 30 days. CIEL*a*b* coordinates were assessed with a spectrophotometer at baseline and after 15 and 30 days of immersion. Color alteration (ΔE00) and translucency parameter (TP00) were calculated with CIEDE2000. Average roughness was measured before the staining procedures. Color difference and translucency data were analyzed with repeated-measures ANOVA and Tukey's tests. Roughness was analyzed with the Kruskal-Wallis test. Results: Roughness was similar among the experimental groups. All materials had their color alteration significantly increased from 15 to 30 days of staining. PICN reached an intermediate ΔE00 between FEL and RC at 15 days. PICN revealed a color alteration as high as the composite after 30 days. No statistical difference was observed regarding translucency. Conclusion: PICN was not as color stable as the feldspathic ceramic at the end of the study. Its color alteration was comparable to the resin composite when exposed to red wine. However, the translucency of the tested materials was stable throughout the 30-day staining

Desordens hiperostóticas em American Bully / Hiperostotic disorders in american bully

O complexo de desordens hiperostóticas é uma condição rara e autolimitante, que tem as mesmas características histopatológicas, que cursa com proliferação óssea de caráter não neoplásico. Acomete cães jovens de raças distintas, com variabilidade quanto ao tipo de proliferação óssea e quanto aos ossos acometidos. O complexo é composto pela osteopatia craniomandibular, hiperostose da calota craniana e osteodistrofia hipertrófica. Podendo estar presente nos ossos da calota craniana, mandíbulas, coluna cervical e esqueleto apendicular. O presente relato, descreveu o quadro de uma cadela, da raça American Bully, não castrada, três meses de idade, que foi atendida com queixa de aumento de volume doloroso das mandíbulas, hiporexia e sialorreia há 15 dias, apresentando ao exame físico, amplitude de movimento diminuída e sensibilidade dolorosa da articulação temporomandibular, espessamento firme bilateral do crânio em região de fossa temporal, espessamento palpável de consistência firme das mandíbulas e crepitação respiratória. Após avaliação clínica e realização de exames complementares, chegou-se ao diagnóstico presuntivo, de complexo de desordens hiperostóticas. Foi instituído como conduta terapêutica o suporte analgésico, sendo eficaz para a manutenção das necessidades fisiológicas até a paciente alcançar a fase adulta. O prognóstico para esta paciente foi considerado bom, uma vez que não havia indícios de anquilose da articulação temporomandibular e/ou manifestações neurológicas.

The complex of hyperostotic disorders is a rare and self-limiting condition, which has the same histophatological characteristics, which courses with non-neoplastic bone proliferations. It affects young dogs of different breeds, with variability the bones affected. The complex is composed of craniomandibular osteopathy, calvarial hyperostotic syndrome and hypertrophic osteodystrophy. It may be present in the bones of the skullcap, jaws, cervical spine and appendicular skeleton. The present report describes the condition of a female dog, American Bully breed, entire, three months old, with a complaint of painful swelling of the jaws, hyporexia and drooling for 15 days, presenting on physical examination, reduced amplitude and pain of the temporomandibular joint, bilateral firm thickening of the skull in the temporal fossa region, palpable firm-consistent thickening of the mandibles and respiratory crackle. After clinical evaluation and complementary tests, a presumptive diagnosis of hyperostotic disorders complex was reached. It was instituted pain management as a treatment, being effective for the maintenance of physiological needs until the patient reaches the adulthood. The prognosis for this patient was considered good, since there was no evidence of temporomandibular joint ankylosis and/or neurological manifestations.

Terapia Ocupacional com crianças e jovens em pandemia: análise de processos de trabalho e reflexões para uma prática emancipatória / Occupational Therapy with children and young people during pandemic: analysis of work processes and reflections for an emancipatory practice / Terapia Ocupacional con niños y jóvenes en pandemia: análisis de procesos de trabajo y reflexiones para una práctica emancipativa

Contextualização: A partir de práticas de terapeutas ocupacionais na cidade de São Paulo, durante a pandemia do coronavírus, este artigo apresenta dois processos de trabalhos de terapeutas ocupacionais com crianças e jovens. Síntese dos elementos do estudo: análise dos processos de trabalho das profissionais no âmbito do SUS. Ferramentas específicas fundadas emuma abordagem crítica foram identificadas e descritas: análise do cotidiano com desenvolvimento de recursos adaptativos; análise de elementos da reprodução social; mapeamento, análise, proposição e legitimação de atividades significativas; articulação de recursos materiais para engajamento nestas atividades. Conclusão: Enfatizaram-se as contradições do modo de produção capitalista e das estruturas sociais ao produzir reflexões sobre uma prática situada e contextualizada.(AU) Palavras-chave: Terapia Ocupacional. COVID-19. Infância. Juventude. Saúde Coletiva

Contextualization: Based on the practices of occupational therapists in the city of São Paulo, during the coronavirus pandemic, this article presented two work processes of occupational therapists with children and young people. Synthesis of the study's elements: analysis of the processes of professionals in the work within the scope of SUS. Specific tools based on a critical approach were identified and described: daily analysis and the development of adaptive resources; analysis of elements of social reproduction; mapping, analysis, proposition and legitimization of meaningful activities; articulation of material resources to engage in these activities. Conclusion: The contradictions of the mode of production and social structures were emphasized while producing reflections on a situated and contextualized practice.(AU) Keywords: Occupational Therapy. COVID-19. Childhood youth. Collective Health

Objetivo: A partir de las prácticas de los terapeutas ocupacionales en la ciudad de São Paulo, durante la pandemia del coronavirus, este artículo presentado dos procesos de trabajo de terapeutas ocupacionales con niños y jóvenes. Síntesis de los elementos del estudio: análisis de los procesos de trabajo de los profesionales, en el ámbito del SUS. Se identificaron y describieron herramientas específicas basadas en un enfoque crítico: análisis diario con el desarrollo de recursos adaptativos; análisis de elementos de reproducción social; mapeo, análisis, propuesta y legitimación de actividades significativas; articulación de recursos materiales para participación en estas actividades. ConclusiónLas contradicciones del modo de producción y las estructuras sociales se enfatizaron al producir reflexiones sobre una práctica situada y contextualizada.(AU) Palabras clave: Niñez. Colaboración intersectorial. Terapia ocupacional. Participación comunitaria

Adverse events following immunization of elderly with COVID-19 inactivated virus vaccine (CoronaVac) in Southeastern Brazil: an active surveillance study

ABSTRACT Healthcare workers, the elderly and other vulnerable populations were the first to receive COVID-19 vaccines in public health programs. There were few vaccine safety data available on the elderly. This observational study aimed to evaluate the inactivated vaccine (CoronaVac) safety in the elderly, at the beginning of the vaccination program, in Sao Paulo city, Brazil. The elderly people that received CoronaVac at the Reference Center for Special Immunobiologicals (CRIE) or at home, administered by the Interdisciplinary Home Care Team (NADI) of the Hospital das Clinicas were invited to participate in this phase 4 observational study. The vaccination schedule included two CoronaVac doses 28 days apart. The information on solicited and unsolicited adverse events following immunization were collected by phone calls on days 4 and 8 after each vaccine dose. We enrolled 158 adults aged 65 to 101 years (mean of 84.1 years); 63.9% were females and 95.6% had chronic conditions, 21.5% had moderate or severe impairment in daily living activities; 34.2% were pre-frail and 19.6% were frail. We were able to contact 95.6% and 91.6% of the vaccinated people, after the first and second doses, respectively; 31.8% and 23.4% of the contacted participants reported some adverse events (AE) following the first and second doses, respectively. Pain at the injection site, fatigue, myalgia and headaches were the most frequent solicited AE. Most AE were mild to moderate. There were eight severe adverse events, but none of them were considered related to the vaccine. The CoronaVac was safe and well tolerated by these adults of advanced age with frailty and comorbidities.

First case report of monkeypox in Brazil: clinical manifestations and differential diagnosis with sexually transmitted infections

ABSTRACT In 2022, an outbreak of monkeypox is being reported in non-endemic areas, with unusual clinical manifestations. The detailed clinical description of the first patient that received the diagnosis of monkeypox in Brazil is reported here, whose clinical manifestations can easily lead to misdiagnosis of sexually transmitted infections. A 41 years old male presented to an emergency room with a vesicular rash with eight days of evolution. He had traveled to Portugal and Spain and reported non-penetrative sexual involvement with three different male individuals. On the third day of symptoms, he sought medical care and received empirical treatment directed to sexually transmitted infections. As the symptoms did not improve, he sought medical attention at an infectious disease referral center presenting, on admission, an ulcerated penile lesion with central necrotic crusts, a disseminated pleomorphic skin rash and an oropharyngeal ulcer. The monkeypox diagnosis was suspected due to the characteristics of the lesions and the history of intimate contact with casual partners, and it was later confirmed by sequencing the almost complete monkeypox genome. The patient was hospitalized for pain control, which required opiate administration. He developed a secondary bacterial infection on the penile lesions, which were treated with oral antibiotics. He was discharged after 14 days, with lesions in process of re-epithelialization. Given the current outbreak, we must consider the possibility of monkeypox in patients with suggestive lesions, anywhere on the body (including the genitals), added to an epidemiological link or history of intimate contact with strangers or casual partners.

Shotgun metagenomic sequencing of the first case of monkeypox virus in Brazil, 2022

ABSTRACT Monkeypox virus (MPXV), a zoonotic virus endemic to the African continent, has been reported in 33 non-endemic countries since May 2022. We report an almost complete genome of the first confirmed case of MPXV in Brazil. Shotgun metagenomic sequencing was completed in 18 hours, from DNA extraction to consensus sequence generation.

Surface treatment and adhesion approaches on polymer-infiltrated ceramic network: influence on the bond strength to resin cement

Aim: To evaluate the effect of different surface treatments and adhesive approaches on the microshear bond strength of resin cement to a polymer-infiltrated ceramic network (PICN). Methods: PICN blocks were randomly assigned into 9 groups (n=10): CTRL: no treatment; HF: 5% hydrofluoric acid etching; HF-S: HF + silane; HF-S-A: HF-S + adhesive (Adper Single Bond 2); HF-UA: HF + universal adhesive (Single Bond Universal); SB: sandblasting with 50 µm Al2O3 particles; SB-S: SB + silane; SB-S-A: SB-S + adhesive; SB-UA: SB + universal adhesive. Resin cement microcylinders (Ø = 0.96 mm; height = 1 mm) (RelyX Ultimate) were built upon the PICN surface after roughness and contact angle measurements. Next, microshear bonding tests (µSBS) were performed (0.5 mm/min) after water storage (37ºC, 90 days) and thermocycling (12,000 cycles; 5ºC-55ºC). Failure modes were observed under stereomicroscope. Bond strength data were analyzed by two-way ANOVA/Tukey's test and t-tests. Kruskal-Wallis/Dunn's tests were conducted for roughness and contact angle data (α = 0.05). Results: A rougher surface and lower contact angles were observed for Sandblasting. HF-S (18.54 ± 2.03 MPa), SB-S (19.00 ± 1.66 MPa) and SB-UA (18.07 ± 2.36 MPa) provided the highest bond strength values, followed by the other treated groups. The CTRL group resulted in lower bond strength (7.18 ± 2.34 MPa). Conclusion: Hydrofluoric acid etching followed by silane application and sandblasting followed by silane or universal adhesive are useful clinical steps to enhance bonding to PICN. Adhesive applications after HF etching have no advantages in bonding to PICN

Effect of a Prebrushing Mouthwash on Color Stability of Composite Resins / Efeito de um Evidenciador de Placa na Estabilidade de Cor de Resinas Compostas

Despite composite resins capacity to mimic dental tissues, they can discolor over time. However, there is no information on the effect of prebrushing mouthwashes on the composite resin staining. This study aimed to evaluate the effect of prebrushing mouthwashes on the color stability of three composite resins. Twenty specimens of each resin were prepared: Filtek Z250 (3M ESPE ­S Paul, MN, USA), Charisma (Heraeus Kulzer GmbH - Hanau - Germany) e EvoluX (Dentsply- Petrópolis - Brazil). Groups were randomly divided accord to the treatment: immersion in prebrushing mouthwash (test group) or immersion in deionized water (control group). Test groups were immersed in 10 ml of prebrushing mouthwash Plax Magic (Colgate-Palmolive, São Bernardo do Campo, SP, Brazil) for 60 s three times a day during 35 days following the manufacturer's instructions. Color measurements were performed after 24 h of specimen's preparation and after 7, 14, 21, and 35 days of immersion time. Results showed that prebrushing mouthwash Plax Magic promoted a color change in all the tested materials and evaluation time. The color change was greater in composite resin Charisma, followed by Z250 and EvoluX. Therefore, prebrushing mouthwash promoted a color change in all the materials used. Composite resin Charisma demonstrated less color stability than Filtek Z250 resin and EvoluX resin, which was the most stable. (AU)

Apesar da capacidade das resinas compostas de mimetizar os tecidos dentais, esses materiais podem ter sua cor alterada com o tempo. No entanto, não há informação na literatura sobre o efeito de evidenciadores de placa na estabilidade de cor desses materiais. Este estudo teve por objetivo avaliar o efeito de um evidenciador de placa na estabilidade de cor e três resinas compostas. Para isso, 20 espécimes de cada resina foram preparados: Filtek Z250 (3M ESPE ­S Paul, MN, EUA), Charisma (Heraeus Kulzer GmbH - Hanau - Alemanha) e EvoluX (Dentsply- Petrópolis - Brasil). Os grupos foram aleatoriamente divididos de acordo com o tratamento a ser submetido: imersão no evidenciador de placa (grupo teste) ou imersão em água deionizada (grupo controle). Os grupos teste foram imersos em 10 ml do evidenciador de placa Plax Magic (Colgate Palmolive, São Bernardo do Campo, SP, Brasil) por 60 s três vezes por dia durante 35 dias, de acordo com a orientações de uso do fabricante. As leituras de cor foram feitas após 24 h da preparação dos espécimes e após 7, 14, 21 e 35 dias de imersão. Os resultados mostraram que o evidenciador de placa Plax Magic promoveu alteração de cor em todos os materiais usados e em todos os tempos de leitura. A alteração de cor foi maior na resina Charisma, seguida da Z250 e EvoluX. Portanto, o evidenciador de placa promove alteração de cor em todos os materiais testados. A resina composta Charisma demonstrou menor estabilidade de cor que as resinas Z250 e EvoluX, que, por sua vez, foi a mais estável. (AU)

Dentists' Attitudes towards the Dental Ceramic Choice for Metal-Free Restorations: a Questionnaire Survey / Atitudes de Dentistas Frente à Escolha de Cerâmicas Dentárias para Restaurações Livres de Metal: uma Pesquisa de Questionário

A wide variety of dental ceramics is launched every year. Therefore, clinicians should constantly study and update themselves to correctly indicate these materials. This cross-sectional study aimed to assess the association of dentists' academic aspects with their knowledge and the indication of dental ceramics for metal free restorations. All the dentists from private clinics who affirmed to perform prosthetic treatments on their patients in a Southern Brazilian city were personally invited to this research to avoid dropouts. Participants answered questions related to their knowledge of different dental materials, their information sources and usage frequency of ceramic materials, and related to their academic training/education. Chi-square tests were performed to evaluate the association among the outcomes (knowledge of different materials, information sources considered for material selection and their frequencies of use) and exposure variables (time since graduation and post-graduation degree). Significant associations were also submitted to Chi-square residual analysis. A response rate of 73.3% was reached. The most known and used materials were Y-TZP and porcelain veneered zirconia, respectively, whereas the least known was leucite-based ceramic. The majority of the professionals with at least 25 years since graduation claimed not to know lithium disilicate or leucite-based ceramics, and a significant number of these professionals allow the laboratory prostheses technician to choose the restorative material. In addition, most of dentists with no post-graduation said they did not have knowledge about leucite and lithium disilicate. It was evidenced that continuing education plays an important role in the dentists' attitudes regarding ceramic materials. (AU)

Uma grande variedade de cerâmicas é lançada no mercado a cada ano. Portanto, os clínicos devem se manter em constante estudo e atualização para indicar corretamente o uso desses materiais. Assim, este estudo transversal teve por objetivo avaliar a associação entre aspectos acadêmicos de dentistas com seus conhecimentos e as indicações de cerâmicas dentárias para uso em restaurações livres de metal. Para isso, todos os dentistas de clínicas privadas que afirmaram realizar tratamentos protéticos em seus pacientes em uma cidade do sul do Brasil foram pessoalmente convidados a participar desta pesquisa para evitar desistências. Os participantes responderam a questões relacionadas ao seu conhecimento sobre diferentes materiais dentários, suas fontes de informação, a frequência de uso de materiais cerâmicos, e, também, sobre sua formação acadêmica. Testes qui-quadrado foram realizados para avaliar a associação entre os desfechos (conhecimento de diferentes materiais, fontes de informação consideradas para a seleção do material e sua frequência de uso) e as variáveis de exposição (tempo desde a graduação e grau de pós-graduação). As associações significativas foram submetidas à análise de resíduos do qui-quadrado. A taxa de resposta obtida foi de 73,3%. O material mais conhecido e usado foi a Y-TZP e zircônia recoberta por porcelana, respectivamente, enquanto que o material menos conhecido foi a cerâmica a base de leucita. A maioria dos profissionais com pelo menos 25 desde a graduação afirmaram não conhecer as cerâmicas a base de dissilicato de lítio ou leucita, e um significativo número desses profissionais permitem que o técnico em prótese dentária escolha o material restaurador. Ainda, a maioria dos dentistas sem pós-graduação disseram não conhecer as cerâmicas a base de dissilicato de lítio ou leucita. Concluiu-se que a educação continuada é um fator determinante nas atitudes de dentistas em relação aos materiais cerâmicos. (AU)

O impacto do ensino público e privado na memória de crianças / The impact of public and private education on children's memory / El impacto de la educación pública y privada en la memoria de los niños

Esse estudo teve como objetivo comparar o desempenho de memória operacional e memória episódica em estudantes do ensino público e privado. A amostra foi composta por 79 crianças, com idades entre 9 e 12 anos, divididos por gênero, idade e tipo de escola. A avaliação foi realizada individualmente por meio da CMS e Raven. Para a análise dos dados, foi utilizado o teste t de Student, com nível de significância adotado de 5%. Os resultados evidenciam melhor desempenho das crianças de escola pública nas tarefas de inteligência e memória visual, enquanto os estudantes de escola particular apresentaram melhor desempenho em memória verbal e visual, corroborando com estudos que apontam diferenças em tarefas cognitivas para crianças de níveis socioeconômicos diferentes. Esses resultados fomentam a importância de mais pesquisas na área, para compreensão e melhorias no desenvolvimento cognitivo das crianças e adolescentes brasileiros. (AU)

This study aimed to compare the performance of working memory and episodic memory in students from public and private schools. A sample consisted of 79 children, aged between 9 and 12 years; divided by gender, age and type of school. The assessment was carried out individually using the CMS and Raven's test. For the data analysis student's t-test was used, the level of significance adopted was 5%. The results showed better performance by the public school children in tasks of intelligence and visual memory, while the students from private schools showed better performance in verbal and visual memory, corroborating studies that highlight differences in cognitive tasks for children with different socioeconomic levels. These results demonstrate the importance of more research in the area, aiming to better understand and improve the cognitive development of Brazilian children and adolescents. (AU)

Este estudio tuvo como objetivo comparar el rendimiento de la memoria de trabajo y la memoria episódica en estudiantes de escuelas públicas y privadas. La muestra se compuso por 79 niños, con edades comprendidas entre 9 y 12 años; divididos por género, edad y tipo de escuela. La evaluación se realizó individualmente a través de la CMS y Raven. Se utilizó la prueba t de student para el análisis de datos, el nivel de significación adoptado fue del 5%. Los resultados evidenciaron un mejor rendimiento de los niños de las escuelas públicas en tareas de inteligencia y memoria visual, mientras que los estudiantes de la escuela privada mostraron un mejor rendimiento en la memoria verbal y visual, corroborando con estudios que señalan diferencias en las tareas cognitivas para niños de diferentes niveles socioeconómicos. Estos resultados alientan la importancia de una mayor investigación en el área, para comprender y mejorar el desarrollo cognitivo de los niños y adolescentes brasileños. (AU)

Situação dos leitos neonatais em maternidades brasileiras: uma análise exploratória / Neonatal bed status in Brazilian maternity hospitals: an exploratory analysis

Resumo As unidades neonatais devem ser organizadas como uma linha de cuidados progressivos com leitos de cuidado intensivo e intermediário (convencional e canguru). O objetivo deste estudo foi avaliar a situação e a adequação dos leitos neonatais em maternidades da Rede Cegonha. Estudo descritivo, realizado em 606 maternidades em todas as regiões do Brasil. Os bancos de dados utilizados foram os da Avaliação da Atenção ao Parto e Nascimento em Maternidades da Rede Cegonha e do Sistema Nacional de Nascidos Vivos. Para avaliar a distribuição de leitos neonatais por tipologia, foram utilizados os parâmetros propostos na Portaria GM/MS nº 930/2012. A minoria das unidades se organiza como uma linha de cuidados progressiva com as três tipologias de leito previstas (24,42%). Os leitos de cuidado intermediário Canguru são a minoria dos leitos implantados (11,27%). Há uma concentração de leitos intensivos e intermediários nas regiões Sudeste e Sul, que apresentam déficit de leitos de cuidado intermediário Canguru. Ao analisar a adequação dos leitos pelo número de nascidos vivos, verifica-se inadequação dos leitos de cuidado Canguru em todas as regiões do Brasil, déficit de leitos intensivos nas regiões Norte e Nordeste e adequação de leitos de cuidado intermediário convencional em todas as regiões.

Abstract Neonatal units should be organized as a progressive care line, with intermediate and intensive care beds (conventional and kangaroo). The aim of this study was to evaluate the status and adequacy of neonatal beds in maternity hospitals linked to the 'Stork Network' ("Rede Cegonha"). A descriptive study was conducted in 606 maternity hospitals in all regions of Brazil. The databases used belonged to the Stork Network Evaluation Survey and the National Live Birth System. To assess the distribution of neonatal beds by typology, the parameters proposed in Ordinance N. 930/2012 of the Ministry of Health were used. Most neonatal units are not organized as a progressive care line with the three types of bed planned. Kangaroo intermediate care beds comprise the minority of implanted beds. There is a concentration of intensive and intermediate beds in the Southeast and South regions, which show a kangaroo intermediate care bed deficit. Analyzing the adequacy of beds by the number of live births, one can observe an inadequacy of Kangaroo care beds in all regions of Brazil, as well as intensive bed deficit in the North and Northeast regions, and adequacy of conventional intermediate care beds in all regions.

Ambiente alimentar em um campus universitário: desenvolvimento e análise de instrumento para avaliação de estabelecimentos comerciais / Food environment on a university campus: development and analysis of an instrument for the evaluation of commercial foodservices

Introdução: O ambiente alimentar do consumidor apresenta características que podem interferir nas escolhas alimentares, favorecendo ou limitando a promoção da alimentação saudável. Para identificar essas características, são necessários instrumentos específicos, apropriados e testados. Objetivo: Avaliar a reprodutibilidade do Questionário para Avaliação do Ambiente Alimentar em Estabelecimentos que Comercializam Refeições e Lanches Prontos para Consumo (QAA), desenvolvido com o intuito de identificar as barreiras e os facilitadores para escolhas alimentares saudáveis em campus universitário. Métodos: O QAA contém 86 questões divididas em descrição do serviço, disponibilidade de itens e barreiras e facilitadores para a alimentação saudável. A reprodutibilidade foi avaliada usando coeficiente kappa, p<0,05. Estimou-se escore baseado no QAA, com pontuação máxima de 36 pontos. A consistência interna do instrumento final foi verificada por meio do alfa de Cronbach, adotando α= 0,70 como o mínimo aceitável. Resultados: A reprodutibilidade foi elevada ou boa para 64% das questões, com média do kappa=0,72. A média do escore do QAA foi de 15,4 (DP=4,4), destacando-se que os restaurantes (escore médio=18,8) apresentaram pontuações mais elevadas quando comparados aos outros tipos de estabelecimentos (p-valor<0,01). Observou-se que 67% dos restaurantes e 13% dos quiosques/trailer estavam no tercil 3 do escore do QAA. Conclusão: O questionário foi considerado adequado para avaliar ambiente alimentar de serviços de alimentação comerciais, com capacidade de discriminação para inferir sobre o potencial para a promoção da alimentação saudável. (AU)

Introduction: Consumer food environments have characteristics that can influence food choices, favoring or limiting the promotion of healthy eating. To identify these characteristics, specific, appropriate and reliable instruments are necessary. Objective: To assess the reproducibility of the Questionnaire for Assessment of Food Environment in Establishments that Sell Ready-to-eat Meals and Snacks (QFE), which was built to identify barriers to and facilitators of healthy food choices on a university campus. Methods: The QFE comprises 86 questions on the description of the service, availability of foods items, and barriers to and facilitators of healthy diets. Reproducibility was assessed using the kappa coefficient, p<0.05. The score scale was estimated based on the QFE, with a maximum 36 points. The final internal consistency was determined by the Cronbach's alpha, adopting the value of 0.70 as the minimum acceptable. Results: Reproducibility was almost perfect or substancial for 64% of the questions, with a mean kappa of 0.72. The mean score of the QFE was 15.4 (SD=4.4), and the restaurants had higher scores (mean=18.8) when compared with the other types of foodservices (p-value<0.01). It was found that 67% of the restaurants and 13% of kiosks/trailers fell into the 3rd tertile of the QFE score. Conclusion: The questionnaire was considered appropriate to assess food environment of commercial foodservices, allowing to discriminate the establishments with potential to promote healthy eating. (AU)

Hardy-Weinberg Equilibrium in different mitochondrial haplogroups of four genes associated with neuroprotection and neurodegeneration / Equilíbrio de Hardy-Weinberg em diferentes haplogrupos mitocondriais de quatro genes associados à neuroproteção e neurodegeneração

ABSTRACT Background: Malfunctioning or damaged mitochondria result in altered energy metabolism, redox equilibrium, and cellular dynamics and is a central point in the pathogenesis of neurological disorders such as Alzheimer's disease, Parkinson's disease, Huntington's disease and Amyotrophic Lateral Sclerosis. Therefore, it is of utmost importance to identify mitochondrial genetic susceptibility markers for neurodegenerative diseases. Potential markers include the respiratory chain enzymes Riboflavin kinase (RFK), Flavin adenine dinucleotide synthetase (FAD), Succinate dehydrogenase B subunit (SDHB), and Cytochrome C1 (CYC1). These enzymes are associated with neuroprotection and neurodegeneration. Objective: To test if variants in genes RFK, FAD, SDHB and CYC1 deviate from Hardy-Weinberg Equilibrium (HWE) in different human mitochondrial haplogroups. Methods: Sequence variants in genes RFK, FAD, SDHB and CYC1 of 2,504 non-affected individuals of the 1,000 genomes project were used for mitochondrial haplogroup assessment and HWE calculations in different mitochondrial haplogroups. Results: We show that RFK variants deviate from HWE in haplogroups G, H, L, V and W, variants of FAD in haplogroups B, J, L, U, and C, variants of SDHB in relation to the C, W, and A and CYC1 variants in B, L, U, D, and T. HWE deviation indicates action of selective pressures and genetic drift. Conclusions: HWE deviation of particular variants in relation to global populational HWE, could be, at least in part, associated with the differential susceptibility of specific populations and ethnicities to neurodegenerative diseases. Our data might contribute to the epidemiology and diagnostic/prognostic methods for neurodegenerative diseases.

RESUMO Introdução: Mitocôndrias defeituosas ou danificadas resultam em alterações do metabolismo energético, equilíbrio redox e dinâmica celular e são, portanto, identificadas como o ponto central da patogênese em muitos distúrbios neurológicos, como a doença de Alzheimer, a doença de Parkinson, a doença de Huntington e a Esclerose Lateral Amiotrófica. Portanto, é de fundamental importância identificar marcadores de susceptibilidade genética mitocondrial para doenças neurodegenerativas. Entre os potenciais marcadores relevantes estão as enzimas da cadeia respiratória riboflavina quinase (RFK), flavina adenina dinucleotídeo sintetase (FAD), succinato desidrogenase subunidade B (SDHB) e citocromo C1 (CYC1). Estas enzimas estão associadas à neuroproteção e à neurodegeneração. Objetivo: Testar se variantes nas sequências dos genes RFK, FAD, SDHB e CYC1 desviam do Equilíbrio de Hardy-Weinberg (HWE) em diferentes haplogrupos mitocondriais humanos. Métodos: Neste trabalho utilizamos os variantes nos genes RFK, FAD, SDHB e CYC1 de sequências de 2.504 indivíduos não afetados do projeto de 1.000 genomas para o cálculo dos valores de HWE em diferentes haplogrupos mitocondriais. Resultados: As variantes de RFK desviam de HWE nos haplogrupos G, H, L, V e W, variantes de FAD nos haplogrupos B, J, L, U e C, variantes de SDHB em relação às variantes C, W e A e CYC1 em B, L, U, D e T. O desvio de HWE indica a ação de pressões seletivas e desvio genético. Conclusões: O desvio do HWE de variantes particulares em relação ao HWE populacional global poderia estar, pelo menos em parte, associado à suscetibilidade diferencial de populações e etnias específicas a doenças neurodegenerativas. Nossos dados podem contribuir para a epidemiologia e métodos diagnósticos/prognósticos para doenças neurodegenerativas.

Evaluation of Burnout Syndrome Prevalence in Medical Students / Avaliação da Prevalência da Síndrome de Burnout em Estudantes de Medicina

Abstract: Introduction: Burnout Syndrome (BS) is related to chronic occupational stress, present in the life of medical students. This syndrome comprises three basic dimensions: I- emotional exhaustion; II- increased mental distancing from the work itself or feelings of negativism and cynicism related to the work itself; and III - reduced professional effectiveness. This study aims to assess the prevalence, risk factors for the development and symptoms associated with Burnout Syndrome in medical students from a district college, in addition to establishing a profile of students with a higher risk of having a BS diagnosis. Method: This is a cross-sectional observational study. The Maslach Burnout Inventory (MBI) - Student Survey questionnaire, specific version for students, which is a questionnaire of sociodemographic factors, one of predictive factors and another of possible somatic symptoms associated with BS were applied. The sample was obtained by convenience and its representativeness was calculated in relation to the total number of students. A student was considered to be at moderate or high risk of developing BS when they had one or two altered BS dimensions, respectively. Results: 67.11% of the total students regularly enrolled from the 1st to the 6th year of the medical course answered the questionnaires. Of the total sample, 80.63% of male students and 81.06% of female students were identified as having a high or moderate risk for BS. The sociodemographic factors associated with the risk of developing BS were: age, who the student lives with, having children and doing paid work. The most statistically significant predictor was the self-management of tasks proposed by the Medical School. Conclusion: The prevalence of high risk and diagnosis of BS found among medical students was 26.44% and 3.95%, respectively. Differences were identified between the high-risk profiles for female and male students.

Resumo: Introdução: A síndrome de burnout (SB) está relacionada ao estresse ocupacional crônico, presente na vida do acadêmico de Medicina. Essa síndrome compreende três dimensões básicas: 1. exaustão emocional; 2. aumento do distanciamento mental do próprio trabalho ou sentimentos de negativismo e cinismo relacionados ao próprio trabalho; e 3. redução da eficácia profissional. Este estudo teve como objetivos identificar a prevalência da SB, os fatores de risco para o desenvolvimento da síndrome e os sintomas associados a ela em estudantes de Medicina de uma faculdade distrital, e estabelecer um perfil de discentes com maior risco de apresentar diagnóstico de SB. Método: Trata-se de um estudo observacional transversal. Foram aplicados o Maslach Burnout Inventory - Student Survey (MBI-SS), versão específica para estudantes, um questionário de fatores sociodemográficos, um de fatores preditores e outro de possíveis sintomas somáticos associados à SB. Obteve-se o universo amostral por conveniência, e calculou-se sua representatividade diante do total de estudantes. Foi considerado como moderado ou de alto risco o estudante que apresentou uma ou duas dimensões da SB alteradas, respectivamente. Resultados: Do total de estudantes regularmente matriculados do primeiro ao sexto ano do curso de Medicina, 67,11% responderam aos questionários. Da amostra total, 80,63% estudantes do gênero masculino e 81,06% dos estudantes do gênero feminino foram identificados como de alto ou moderado risco para SB. Os fatores sociodemográficos associados ao risco de desenvolvimento de SB foram: idade, com quem reside, possuir filhos e realizar trabalho remunerado. Já o fator preditor com maior relevância estatística foi o autogerenciamento de tarefas propostas pela faculdade. Conclusão: As prevalências de alto risco e diagnóstico de SB encontradas entre os estudantes de Medicina foram 26,44% e 3,95%, respectivamente. Identificaram-se diferenças entre os perfis de alto risco para os gêneros feminino e masculino.