Evaluation of public health development in Zhejiang Province during China's 12th Five-Year Plan period / 预防医学

Objective To evaluate the development level of public health in Zhejiang Province during China's 12th Five-Year Plan period (from 2011 to 2015)for health policy making in the future. Methods Totally 30 indexes were first summarized into 4 components, including the residents' health level, the allocation of public health resource, the level of public health service and public health security. The evaluation index system was developed by Delphi method. The indicators of 2010 were selected as the baseline for comparison with those corresponding indicators from 2011 to 2015. Each index(the comprehensive development index, the developmental speed, as well as the indicator index)calculated during 12th Five-Year Plan period was evaluated after the targeted indicators were weighed. Results Overall, at a provincial level of Zhejiang, the comprehensive development index was increased from 100 in 2010 to 138.44 in 2015, representing an annual average development speed of 6.72%. The annual average development speed of 13 indexes, ranging from 6.72% to 26.18%, were higher than those in the China's 11th Five-Year Plan period(6.72%); while the annual average development speed of another 17 indexes was lower, with 1 index below zero. However, the number of medical staff per 10000 population(5.23), the treatment success rate among new smear-positive cases (90.76%)and the number of annual outpatient visits in primary hospitals(49.45%)in Zhejiang Province were lower than those in China during the same period(6.39, 92.49%, 56.40%). At a prefectural level, the comprehensive development index fluctuated from 128.65 in Quzhou to 156.35 in Jiaxing and the developmental speed was from 3.90% to 11.26%. These results indicated that the coefficient variant(CV)was 5.76 during China's 12 th Five-year Plan period, which had recorded the historically lowest level since 2010. Conclusion During the China's 12th Five-year Plan period, the development of public health in Zhejiang Province was steadily enhanced. Public health variably developed across 11 prefectures with shrinking gaps. Nevertheless, the number of medical staff per 10 000 population, the treatment success rate among new smear-positive cases and the number of annual outpatient visits in primary hospitals should be improved.

Trends in alcohol and tobacco use among Brazilian students: 1989 to 2010 / Tendência no uso de álcool e tabaco em estudantes brasileiros: 1989-2010

OBJECTIVE To analyze temporal trends of the prevalence of alcohol and tobacco use among Brazilian students. METHODS We analyzed data published between 1989 and 2010 from five epidemiological surveys on students from the 6th to the 12th grade of public schools from the ten largest state capitals of Brazil. The total sample consisted of 104,104 students and data were collected in classrooms. The same collection tool - a World Health Organization self-reporting questionnaire - and sampling and weighting procedures were used in the five surveys. The Chi-square test for trend was used to compare the prevalence from different years. RESULTS The prevalence of alcohol and tobacco use varied among the years and cities studied. Alcohol consumption decreased in the 10 state capitals (p < 0.001) throughout 21 years. Tobacco use also decreased significantly in eight cities (p < 0.001). The highest prevalence of alcohol use was found in the Southeast region in 1993 (72.8%, in Belo Horizonte) and the lowest one in Belem (30.6%) in 2010. The highest past-year prevalence of tobacco use was found in the South region in 1997 (28.0%, in Curitiba) and the lowest one in the Southeast in 2010 (7.8%, in Sao Paulo). CONCLUSIONS The decreasing trend in the prevalence of tobacco and alcohol use among students detected all over the Country can be related to the successful and comprehensive Brazilian antitobacco and antialcohol policies. Despite these results, the past-year prevalence of alcohol consumption in the past year remained high in all Brazilian regions.

OBJETIVO Analisar a tendência temporal da prevalência de uso de álcool e tabaco por estudantes brasileiros. MÉTODOS Foram analisados, entre 1989 e 2010, dados de cinco inquéritos epidemiológicos com estudantes do sexto ano do ensino fundamental ao terceiro do ensino médio, matriculados em escolas públicas nas 10 maiores capitais do Brasil. A amostra foi de 104.104 estudantes e os dados foram coletados em sala de aula. O instrumento de coleta - questionário de autopreenchimento da Organização Mundial da Saúde - e os procedimentos de amostragem e ponderação foram os mesmos nos cinco inquéritos. Teste de Qui-quadrado de tendências foi utilizado para comparar as prevalências entre os anos. RESULTADOS A prevalência de uso de álcool e tabaco variou nos anos e entre as capitais estudadas. O uso de álcool diminuiu em todas as 10 capitais (p < 0,001), em 21 anos. Houve também diminuição significativa do uso de tabaco em oito capitais (p < 0,001). A maior prevalência de uso de álcool foi observada na região Sudeste, em 1993 (72,8% em Belo Horizonte), e a menor, em Belém (30,6%), em 2010. A maior prevalência de uso do tabaco no último ano foi na região Sul, em 1997 (28,0% em Curitiba) e a menor na região Sudeste, em 2010 (7,8% em São Paulo). CONCLUSÕES A tendência de queda na prevalência de tabagismo e uso de álcool entre estudantes, observada em todo o País, pode estar relacionada com políticas antitabaco e antiálcool bem-sucedidas e abrangentes. Apesar destes resultados, a prevalência de uso de álcool no último ano continuou elevada em todas as regiões brasileiras.

Effect of evidence based medicine training in the quality of journal clubs: a road to evidence based journal clubs

Journal clubs play an important role in teaching Evidence Based Medicine [EBM]. Evidence based journal clubs focus on real problems of the group, and set a minimum level of evidence for articles to be presented, and in the end a clinical bottom line is set to be used in the daily clinical practice. In this article, we have explained our experience in running evidence based journal clubs in the previous year and the challenges in the path of this goal are discussed. Before starting the evidence based journal clubs, we set up several lectures on EBM for the teachers of the research center as well as the residents. From September 2010 to November 2010, we ran the journal clubs of our research center by a two-session plan: first identifying an important clinical question, second presenting the best available evidence. The assigned levels of evidence for evidence based journal clubs as well as previous traditional one were compared. Twelve journal clubs were presented in the study period: Five systematic reviews, 2 guidelines, 3 narrative review articles, and 2 individual articles. Ten out of 12 traditional journal club articles were narrative review articles and 2 were clinical guidelines. 41.6% of the evidence based journal clubs were assigned level 1 of evidence. In contrast 83.3% of traditional journal clubs were in the 4[th] level of evidence. Evidence based journal clubs can be very useful in improving the quality of presented articles in the journal clubs and are invaluable for teaching EBM

Líquen plano mimetizando molusco contagioso / Lichen planus mimicking contagious mollusk

Introdução: Líquen plano é uma doença inflamatória e pruriginosa que afeta pele, mucosas e anexos, podendo apresentar achados clínicos incomuns. Possui etiologia desconhecida e pico de incidência na vida adulta, pouco comum em crianças. Por estas razões, os autores relatam um caso raro, de difícil diagnóstico, no qual uma criança apresentava manifestações cutâneas semelhantes a molusco contagioso. Descrição do caso: VCN, cinco anos, feminina, com lesões pruriginosas pelo corpo, há um ano. Negava história familiar, antecedentes de atopia ou uso de drogas prévias à erupção. Já havia recebido inúmeras medicações, sem melhora. Foi encaminhada ao serviço de Dermatologia da Faculdade de Medicina do ABC onde, ao exame dermatológico, apresentava pápulas violáceas, brilhantes e umbilicadas, disseminadas pelo tegumento, incluindo palmas e plantas, com a presença de fenômeno de Koebner, poupando couro cabeludo. Na mucosa jugal, placa esbranquiçada semelhante à leucoplasia, ligeiramente arboriforme. Apresentou exames laboratoriais inalterados e achados da biópsia compatíveis com líquen plano. Iniciou-se tratamento com corticoide e anti-histamínico oral e emoliente tópico levando à melhora progressiva, evoluindo com máculas hipercrômicas residuais após quatro meses de tratamento. Discussão: Há evidências de que ocorram modificações nos ceratinócitos basais, desencadeando resposta imune com recrutamento e ativação de linfócitos T. As lesões caracterizam-se por pápulas poligonais, violáceas, descamativas, achatadas, com distribuição bilateral e simétrica acometendo faces flexoras. O objetivo deste relato é descrever um caso atípico de líquen plano extenso numa criança, com algumas lesões simulando quadro clínico de molusco contagioso. Diagnóstico correto e precoce e tratamento adequado diminuem riscos de complicações e melhoram a qualidade de vida.

Introduction: Lichen planus is a pruriginous and inflammatory disease that affects skin, mucous membrane and annex and may present unusual clinical findings. Its etiology is unknown and its peak incidence is in adult life, being uncommon in childhood. For these reasons, the authors report a rarecase of difficult diagnosis, in which a child presented cutaneous manifestations similar to molluscum contagiosum. Case report: VCN, five years old, female, complaining of disseminated cutaneous ichthing lesions for one year. There was no previous family history, atopyc precedents or use of drugs previous to the eruption. She had already received several drugs, without any improvement. She was sent to the Service of Dermatology of Faculdade de Medicina do ABC in which, at dermatological examination, presented violaceae, brilliant and umbilicated papules, throughout the tegument including palms and soles, with presence of Koebner phenomenon, saving scalp. In buccal mucous membrane, there was whitish plaque resembling leukoplakia, slightly tree-shaped. She presented normal laboratory exams and biopsy findings compatible to lichen planus. The treatment was initiated with oral corticosteroids and antihistaminics and topical emollient, leading to progressive improvement, evolving with residual hyperchromic macules after four months of treatment. Discussion: There are evidences that basal keratinocytes damage involves the cellular immune response with CD4+ lymphocytes recruitment and activation. The lesions are characterized by polygonal, violaceae, scaling, flattened papules, with bilateral and symmetric distribution affecting flexor surfaces. The objective of this report is to describe an atypical case of generalized lichen planus in a child, simulating an extensive molluscum contagiosum. Correct and early diagnosis and adequate treatment decrease complication risks and improve quality of life.

Evaluation of final-year dental students concerning therapeutic decision making for proximal caries

This cross-sectional study aimed to determine the radiographic criteria used by fi nal-year dental students when defi ning the need for restorative treatment for proximal caries, as well as investigating potentially associated factors in this therapeutic decision. A questionnaire with two schematic diagrams presenting five levels of proximal lesion penetration was administered to students attending the six private and three public dental schools in the state of Rio Grande do Sul, Southern Brazil. Absolute and relative frequencies were described and inferential statistics involving Chi-square and McNemar tests and simple logistic regression were carried out to assess variations in therapeutic decisions related to patient dentition (deciduous/permanent) and gender, ageand dental school (public/private). Of the 346 dental students assessed, 28.6% (99/346) indicated restorative treatment for lesions restricted to the enamel in deciduous teeth and 38.2% (132/346) indicated the same for permanent teeth, revealing a statistically significant difference (p = 0.001). Student gender and age were not associated with the therapeuticdecision; however, a signifi cant difference between dental schools was found when comparing restorative criteria in deciduous (p < 0.001) and permanent molars (p < 0.001). The odds of restorative decision in permanent teeth when the caries lesion was restricted to the enamel was 72% higher for students graduating from private schools compared to public schools (Odds Ratio: 1.72; 95% Confi dence Interval: 1.03-2.90). These data demonstrate a large variation between the therapeutic decisions regarding proximal caries reported by final-year dental students and suggest that deep refl ection is needed on the part of faculty in order to provide an evidence-based education.