A utilização do tratamento restaurador atraumático modificado na clínica de odontopediatria / Use of modified atraumatic restorative treatment in paediatric dentistry clinic

Apesar da redução dos índices epidemiológicos ao longo dos anos, a cárie dentária é uma doença que até hoje acomete populações do mundo inteiro, podendo causar infecção, dor e perda dentária prematura. O propósito desse trabalho foi relatar o caso clínico de uma criança portadora de múltiplas lesões extensas de cárie por meio da estruturação do tratamento em quatro fases, visando à promoção de saúde bucal. O tratamento restaurador atraumático modificado (ARTm) foi a técnica utilizada na reabilitação oral do paciente, o que proporcionou redução da ansiedade frente ao tratamento odontológico e maior colaboração por parte da criança, bem como melhora da qualidade de vida de toda a família envolvida.

Despite the reduction on epidemiological rates over the years, dental caries is a disease that still affects populations worldwide and causes infection, pain and premature tooth loss. The main purpose of this study was to report the clinical case of a child with multiple extensive carious lesions by using a four-step treatment organization, aimed at oral health promotion. The atraumatic restorative treatment modified (ARTm) was the technique that was applied at the pacient´s oral rehabilitation and was able to reduce the child´s anxiety and increase it´s colaboration during dental treatment, as well as improve the life quality levels of the whole family involved.

Psychometric Field Study of Hereditary Angioedema Quality of Life Questionnaire for Adults: HAE-QoL.

BACKGROUND: Hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE) may affect health-related quality of life (HRQoL). A specific HRQoL questionnaire for adult patients with C1-INH-HAE, the HAE-QoL, has recently been developed in Spain. OBJECTIVE: The objective of this study was to perform a cross-cultural validation and psychometric study of the HAE-QoL in an international setting. METHODS: Cross-cultural adaptation of the Spanish HAE-QoL draft version and an international rating phase with experts were performed. The resultant version of the HAE-QoL, a clinical questionnaire, and Short Form 36-item Health Survey Version 2.0 (SF-36v2) were pilot tested internationally. Item reduction was based on both descriptive and exploratory factor analysis. Psychometric properties were assessed. RESULTS: Cross-cultural adaptation of the HAE-QoL was performed in 18 countries. The draft version of the HAE-QoL was pilot tested in 332 patients, and accurate data were obtained from 290 patients from 11 countries. The reduction process resulted in a new version with 25 items and 7 dimensions (treatment difficulties, physical functioning and health, disease-related stigma, emotional role and social functioning, concern about offspring, perceived control over illness, and mental health). Strong psychometric properties were observed (Cronbach's α 0.92; test-retest reliability 0.87). Convergent validity showed mild to moderate correlations with SF-36v2 physical and mental component summaries (0.45 and 0.64, respectively) and with SF-36v2 dimensions (P < .004). HAE-QoL scores discriminated significantly among severity groups (median: asymptomatic 133.5 vs severe 84.0; P < .001); between patients with and without long-term prophylaxis (median: 101 vs 90; P = .001); and between patients with and without psychiatric and/or psychological care (median: 74 vs 103; P ≤ .001). CONCLUSIONS: The HAE-QoL, currently available in 18 languages, showed good reliability and validity evidence.

Hereditary angioedema: quality of life in Brazilian patients.

OBJECTIVE: Hereditary angioedema is a serious medical condition caused by a rare autosomal dominant genetic disorder and it is associated with deficient production or dysfunction of the C1 esterase inhibitor. In most cases, affected patients experience unexpected and recurrent crises of subcutaneous, gastrointestinal and laryngeal edema. The unpredictability, intensity and other factors associated with the disease impact the quality of life of hereditary angioedema patients. We evaluated the quality of life in Brazilian hereditary angioedema patients. METHODS: Patients older than 15 years with any severity of hereditary angioedema and laboratory confirmation of C1 inhibitor deficiency were included. Two questionnaires were used: a clinical questionnaire and the SF-36 (a generic questionnaire). This protocol was approved by the Ethics Committee of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTS: The SF-36 showed that 90.4% (mean) of all the patients had a score below 70 and 9.6% had scores equal to or higher than 70. The scores of the eight dimensions ranged from 51.03 to 75.95; vitality and social aspects were more affected than other arenas. The internal consistency of the evaluation was demonstrated by a Cronbach's alpha value above 0.7 in seven of the eight domains. CONCLUSIONS: In this study, Brazilian patients demonstrated an impaired quality of life, as measured by the SF-36. The most affected domains were those related to vitality and social characteristics. The generic SF-36 questionnaire was relevant to the evaluation of quality of life; however, there is a need for more specific instruments for better evaluation.

Hereditary angioedema: quality of life in Brazilian patients

OBJECTIVE: Hereditary angioedema is a serious medical condition caused by a rare autosomal dominant genetic disorder and it is associated with deficient production or dysfunction of the C1 esterase inhibitor. In most cases, affected patients experience unexpected and recurrent crises of subcutaneous, gastrointestinal and laryngeal edema. The unpredictability, intensity and other factors associated with the disease impact the quality of life of hereditary angioedema patients. We evaluated the quality of life in Brazilian hereditary angioedema patients. METHODS: Patients older than 15 years with any severity of hereditary angioedema and laboratory confirmation of C1 inhibitor deficiency were included. Two questionnaires were used: a clinical questionnaire and the SF-36 (a generic questionnaire). This protocol was approved by the Ethics Committee of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. RESULTS: The SF-36 showed that 90.4% (mean) of all the patients had a score below 70 and 9.6% had scores equal to or higher than 70. The scores of the eight dimensions ranged from 51.03 to 75.95; vitality and social aspects were more affected than other arenas. The internal consistency of the evaluation was demonstrated by a Cronbach's alpha value above 0.7 in seven of the eight domains. CONCLUSIONS: In this study, Brazilian patients demonstrated an impaired quality of life, as measured by the SF-36. The most affected domains were those related to vitality and social characteristics. The generic SF-36 questionnaire was relevant to the evaluation of quality of life; however, there is a need for more specific instruments for better evaluation.

Fatores associados à alta demanda de pacientes com hanseníase em centro de referência em Manaus, Amazonas / Associated factors with the high demand of leprosy patients in a reference center in Manaus, Amazonas state

Esta pesquisa objetivou identificar fatores que contribuem com a alta demanda de indivíduos com hanseníase no centro de referência Fundação Alfredo da Matta (FUAM) em Manaus (AM). Realizamos três grupos focais com usuários da FUAM e de Unidades Básicas de Saúde, e 25 entrevistas semi-estruturadas com coordenadores do Programa de Saúde da Família (PSF), diretores de Unidades Básicas, profissionais de saúde da rede básica, dermatologistas dos Centros de Referências e profissionais de saúde da FUAM. Foram identificadas duas categorias de fatores que mantém a alta demanda na FUAM: (1) Fatores de demanda, como o conhecimento popular e histórico da FUAM; desconhecimentos dos profissionais a respeito do fluxo do sistema de referência e contra-referência; postura dos coordenadores e diretores; a falta de um bom atendimento nas unidades básicas; (2) Fatores de retenção, como o estigma que impulsiona o portador de hanseníase a retornar para a FUAM; o atendimento humanizado na instituição; e o cartão amarelo que facilita o retorno do usuário na pós-alta à FUAM. Essa situação interfere na eficiência do sistema de saúde, na consolidação do vínculo entre serviços e população, contribuindo para o não cumprimento dos princípios do Sistema Único de Saúde. O papel da FUAM como centro de referência deve ser estabelecido em um diálogo com os gestores de saúde para que o processo de descentralização seja implementado adequadamente.

Displasia ectodérmica - acompanhamento de caso clínico por dez anos / Ectodermal dysplasia - ten years follow-up case report

Os autores relatam um caso de displasia ectodérmica em uma paciente com sete anos de idade e sinais discretos dessa afecção, com destaque para as anomalias dentárias de número (agenesia parcial) e forma. Os pais receberam orientação sobre a síndrome, e a paciente foi acompanhada por dez anos consecutivos. Durante esse período, foram proporcionados cuidados restauradores (reconstrução de coroa de dentes decíduos e permanentes), ortodônticos (manutenção de espaços e alinhamento dentário), além de manutenção preventiva para promoção de saúde bucal. O diagnóstico da displasia ectodérmica na criança e o atendimento odontológico são necessários para que os pacientes possam ter restituído o seu equilíbrio mastigatório, fonético, estético e emocional

Aparelho ortodôntico removível com alça invertida de Balters (Bionator) / Removable appliance with Balter's reverse labial arch for the early treatment of Class III malocclusion

O presente trabalho tem a finalidade de descrever um método detratamento, numa idade jovem, de pacientes portadores de má oclusäo de Classe III de Angle. Trata-se de um aparelho removível superior de expansäo, com plano de mordida posterior e alça invertida de Balters (Bionator). Será apresentada pesquisa clínica para avaliar seus efeitos