Influence of gender on periodontal outcomes: A retrospective analysis of eight randomized clinical trials.

AIMS: To explore the influence of gender on periodontal treatment outcomes in a dataset of eight RCTs conducted in Brazil, United States, and Germany. METHODS: Clinical parameters were compared between men and women with stages III/IV grades B/C generalized periodontitis at baseline and 1-year post-therapy, including scaling and root planing with or without antibiotics. RESULTS: Data from 1042 patients were analyzed. Men presented a tendency towards higher probing depth (p = .07, effect size = 0.11) and clinical attachment level (CAL) than women at baseline (p = .01, effect size = 0.16). Males also presented statistically significantly lower CAL gain at sites with CAL of 4-6 mm at 1-year post-therapy (p = .001, effect size = 0.20). Among patients with Grade B periodontitis who took antibiotics, a higher frequency of women achieved the endpoint for treatment (i.e., ≤4 sites PD ≥5 mm) at 1 year than men (p < .05, effect size = 0.12). CONCLUSION: Men enrolled in RCTs showed a slightly inferior clinical response to periodontal therapy in a limited number of sub-analyses when compared to women. These small differences did not appear to be clinically relevant. Although gender did not dictate the clinical response to periodontal treatment in this population, our findings suggest that future research should continue to explore this topic.

Metronidazole may display anti-inflammatory features in periodontitis treatment: A scoping review.

AIM: Metronidazole (MTZ) is an antimicrobial agent used to treat anaerobic infections. It has been hypothesized that MTZ may also have anti-inflammatory properties, but the evidence is limited and has not been previously reviewed. Thus, this scoping review aimed to answer the following question: "What is the evidence supporting anti-inflammatory properties of metronidazole that are not mediated by its antimicrobial effects?" METHODS: A scoping review was conducted according to the PRISMA-ScR statement. Five databases were searched up to January 2023 for studies evaluating the anti-inflammatory properties of MTZ used as monotherapy for treating infectious and inflammatory diseases. RESULTS: A total of 719 records were identified, and 27 studies (21 in vivo and 6 in vitro) were included. The studies reported experimental evidence of MTZ anti-inflammatory effects on (1) innate immunity (barrier permeability, leukocyte adhesion, immune cell populations), (2) acquired immunity (lymphocyte proliferation, T-cell function, cytokine profile), and (3) wound healing/resolution of inflammation. CONCLUSION: Taken together, this scoping review supported a potential anti-inflammatory effect of MTZ in periodontitis treatment. We recommend that future clinical studies should be conducted to evaluate specific MTZ anti-inflammatory pathways in the treatment of periodontitis.

Can Muscular Parameters Predict Symptoms of Anxiety and Depression?

Major depressive disorder and anxiety disorders are among the major public health issues. Therefore, identifying predictors of symptoms of depression and anxiety holds fundamental importance to avoid the aggravation of these conditions. Muscle strength and function (e.g., handgrip strength and timed-stands test) are widely recognized predictors of health outcomes; however, their association with symptoms of depression and anxiety is still not completely understood. This study investigated the associations between handgrip strength and timed-stands test scores with symptoms of depression and anxiety. In addition, we examined whether individuals exhibiting greater strength levels demonstrate reduced symptoms of anxiety and depression compared to those with lower levels of strength. This is a community-based, cross-sectional study. Participants were recruited through social media and underwent a semi-structured interview to record sociodemographic characteristics, comorbidities, use of tobacco and medication, and symptoms of anxiety (Beck's Anxiety Inventory [BAI]) and depression (Beck's Depressive Inventory [BDI]). Subsequently, anthropometric characteristics, handgrip strength, and functionality (i.e., timed-stands test) were assessed. In all, 216 individuals were evaluated. The adjusted regression model showed an inverse association between handgrip strength and anxiety (ß = -0.22; 95% CI [-0.38, -0.07]; R2 = 0.07, p = .005) and depression symptoms (ß = -0.25; 95% CI [-0.42, -0.07]; R2 = 0.05, p = .006). Similarly, timed-stands test scores were associated with anxiety (ß = -0.33; 95% CI [-0.54, -0.13]; R2 = 0.09, p = .002) and depression (ß = -0.32; 95% CI [-0.56, -0.09]; R2 = 0.06, p = .008). Furthermore, the low-strength group showed higher values on the BAI (9.5 vs. 5.9 arbitrary units; p = .0008) and BDI than the high-strength group (10.8 vs. 7.9 arbitrary units; p = .0214). When individuals were stratified by the timed-stands test, the low timed-stands group demonstrated higher values on the BAI (9.9 vs. 5.5 arbitrary units; p = .0030) and BDI than the high timed-stands group (11.2 vs. 7.5 arbitrary units; p < .0001). The results highlight muscular parameters as significant predictors associated with anxiety and depression symptoms.

In vitro bleaching efficacy of violet LED associated with 10% hydrogen peroxide and 10% carbamide peroxide.

BACKGROUND: This in vitro study evaluated the efficacy and the effect over the dental enamel surface of violet LED dental bleaching associated to different concentrations of carbamide and hydrogen peroxide. METHODS: Human dental blocks (n = 100) were randomly distributed into 5 groups: 10% hydrogen peroxide (HP10), 10% carbamide peroxide (CP10), 10% hydrogen peroxide with violet LED (VHP10), 10% carbamide peroxide with violet LED (VCP10) and 35% hydrogen peroxide (HP35). The specimens were analyzed by Vickers microhardness test (n = 50) initially, immediately after and seven days after ending the bleaching protocol. For color analysis (n = 50), the specimens were evaluated for bleaching effectiveness (ΔE2000, ΔE1976) and whiteness index (ΔWID) with EasyShade spectrophotometer, before bleaching protocol and seven days after ending the bleaching protocol. The microhardness and color data were analyzed using one-way ANOVA with post-hoc Tukey test (α = 0.05). RESULTS: The microhardness values showed difference among the investigated groups only immediately after the end of the dental bleaching (p < 0.05), with reduction for the groups HP35 (p < 0.01) and HP10 (p < 0.05), however the microhardness values were reestablished after seven days. Regarding the color changes, a difference between VHP10 and the others groups evaluated for ΔE2000 and ΔE1976 index was observed (p < 0.05). For ΔWID, there was no difference between the studied groups. CONCLUSIONS: Violet LED associated with low concentration bleaching agents did not show a negative effect on dental enamel regarding the surface microhardness. All bleaching protocols were effective, therefore, perceptible to human eyes.

Methodological aspects and results of the baseline health monitoring of adults and elderly people infected with covid-19 (Sulcovid-19) / Aspectos metodológicos e resultados da linha de base do monitoramento da saúde de adultos e idosos infectados pela covid-19 (Sulcovid-19)

AIM: to describe the methodology used in the study, the sample and the prevalence of symptoms in the acute phase of the infection according to socioeconomic variables. METHODS: cross-sectional study carried out in Rio Grande with individuals infected with covid-19 from December 2020 to March 2021. Nineteen symptoms present during the acute phase of the infection were investigated and analyzed, separately and in categories of "0-4", "5-9" and "10 or more", according to gender, age and economic class. RESULTS: 2,919 people were part of the sample. The most prevalent symptoms were fatigue (73.7%), headache (67.2%), loss of taste (65.9%), loss of smell (63.9%) and muscle pain (62.3% ). Regarding the occurrence of symptoms stratified by gender, all symptoms, except productive cough, were statistically higher in females. Regarding age, it was found that headache, pain/discomfort to breathe, loss of taste, loss of smell, fatigue, sore throat, nasal congestion, diarrhea, joint pain and muscle pain were statistically higher among adults (18 -59 years). As for economic class, the prevalence of symptoms of shortness of breath, pain/discomfort in breathing, alteration in sensitivity and joint pain showed a linear increase with the reduction in economic class. CONCLUSION: the results of this study made it possible to identify the most frequent symptoms in the acute phase of covid-19 and their distribution in groups, providing data for the implementation of public policies by managers and support for health professionals in assisting this population.

OBJETIVO: descrever a metodologia utilizada no estudo, a amostra e a prevalência dos sintomas da fase aguda da infecção de acordo com variáveis socioeconômicas. MÉTODOS: estudo transversal realizado em Rio Grande com indivíduos infectados pela covid-19 no período de dezembro de 2020 a março de 2021. Foram investigados 19 sintomas presentes durante a fase aguda da infecção e analisados, em separado e em categorias de "0-4", "5-9" e "10 ou mais", de acordo com sexo, idade e classe econômica. RESULTADOS: 2.919 pessoas fizeram parte da amostra. Os sintomas mais prevalentes foram fadiga (73,7%), dor de cabeça (67,2%), perda de paladar (65,9%), perda de olfato (63,9%) e dores musculares (62,3%). Com relação a ocorrência de sintomas estratificado por sexo, todos os sintomas, exceto tosse produtiva, foram estatisticamente maiores no sexo feminino. Referente à idade, verificou-se que dor de cabeça, dor/desconforto para respirar, perda de paladar, perda de olfato, fadiga, dor de garganta, congestão nasal, diarreia, dores articulares e dores musculares foram estatisticamente maiores entre os adultos (18-59 anos). Quanto a classe econômica, a prevalência dos sintomas falta de ar, dor/desconforto para respirar, alteração de sensibilidade e dores articulares apresentaram aumento linear conforme a redução da classe econômica. CONCLUSÃO: os resultados deste estudo permitiram identificar os sintomas mais frequentes na fase aguda da covid-19 e sua distribuição nos grupos, fornecendo dados para implementação de políticas públicas pelos gestores e respaldo para os profissionais de saúde na assistência a essa população.

Systematic and scoping reviews to assess biological parameters.

INTRODUCTION: An evidence synthesis approach compiling biological/laboratory data is effective in advancing health-related knowledge. However, this approach is still underused in the oral health field. METHODS: This commentary discusses the opportunities and challenges of systematic and scoping reviews of laboratory data in dentistry. Special focus is on the potential of these reviews to elucidate etiological and treatment concepts of oral diseases, such as periodontitis and peri-implantitis. RESULTS: The following difficulties associated with such studies are discussed: (i) selection of ideal study design, (ii) assessment of "risk of bias" and definition of "certainty of evidence", (iii) evidence assembly and summary, and (iv) the paper review process. DISCUSSION: Despite those challenges, high-quality reviews integrating laboratory data may generate relevant scientific information and help identify new avenues for future investigations. Experts in different oral health topics should build a process capable of helping researchers assemble and interpret these types of data.

Effectiveness of violet LED dental bleaching compared to 35% hydrogen peroxide: An in vitro study.

AIM: This in vitro study assessed the efficacy and adverse effects of violet LED bleaching with or without bleaching agents. MATERIAL AND METHODS: Dental blocks (n=40) were randomly distributed in 4 groups: violet LED (VL), 35% hydrogen peroxide (HP35), the association of hydrogen peroxide 35% with violet LED (VHP35) and the association of hydrogen peroxide 35% with blue LED (BHP35). Specimens were analyzed for Vickers microhardness initially, immediately after and seven days after ending bleaching protocol. The color analysis of the specimens was evaluated for bleaching effectiveness (ΔE2000, ΔE1976) and whiteness index (ΔWID) with EasyShade spectrophotometer, before bleaching protocol and seven days after ending bleaching protocol. The mineral composition of the enamel was evaluated by percentage of phosphorus and calcium on the enamel surface with energy dispersive spectroscopy (EDS). The color and the microhardness data were analyzed using one-way ANOVA with post-hoc Tukey (α=0.05). RESULTS: The microhardness test showed a difference among the groups only immediately after the completion of the protocol, in which there was a reduction in the value for the groups HP35 from 277,36 ± 21,56 to 198,76 ±32,2 (p<0,01); and BHP35 from 261,14 ± 36,01 to 212,66 ± 25,99 (p<0,01), but the microhardness was reestablished after seven days. Regarding EDS analysis, a reduction in the mineral percentage immediately after bleaching with the use of VL was observed, however, after seven days it was reestablished. Regarding the color analysis, there was no difference among the groups evaluated. CONCLUSIONS: The use of VL was effective as a dental bleaching tool and did not adversely affect the enamel surface after seven days of the ending of the bleaching protocol.

Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018.

This study aimed to analyze the presence of adequate infrastructure and work process in primary health care for the diagnosis, management, and treatment of syphilis in Brazil in 2012, 2014, and 2018. This is a cross-sectional, nationwide study with data from the three cycles of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB): 2012 (Cycle I), 2014 (Cycle II), and 2018 (Cycle III). Two outcomes were assessed: adequate infrastructure and work process. The independent variables were macroregion, municipality size, Municipal Human Development Index (HDI-M), and coverage of the Family Health Strategy (FHS). Variance-weighted least squares regression was used to estimate annual changes in percentage. In total, 13,842 primary basic health units (UBS) and 17,202 professional health care teams were assessed in Cycle I; 24,055 UBS and 29,778 teams in Cycle II, and 28,939 UBS and 37,350 teams in Cycle III. About 1.4% of UBS had adequate infrastructure in Cycle I; 17.5% had in Cycle II; and 42.7% had in Cycle III. Adequate work process also increased in the three cycles, ranging from 47.3% in Cycle I to 45.5% in Cycle II and 75.4% in Cycle III. However, inequities are observed, considering that richer regions and larger municipalities, with higher HDI-M and lower FHS coverage improved the most. The low prevalence of adequate infrastructure and work process for the care of patients with syphilis in Brazil reflects a significant weakness in the Brazilian health system.

Stage II and stage III periodontitis clinical burdens of HIV-1 undergoing antiretroviral therapy.

OBJECTIVES: The aim of this retrospective cross-sectional study was to estimate the association of HIV-1 infection under highly active antiretroviral treatment (HAART) on the clinical parameters of periodontitis. MATERIALS AND METHODS: A total of 205 patients were divided in two groups: 74 HIV + and 131 HIV - . Periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and visible supragingival biofilm (VSB) were recorded. The association of HIV-1 infection with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm in non-adjacent teeth was estimated using binary logistic regression models. RESULTS: The variables HIV-1 infection (OR = 5.53, p < 0.0001, 95% CI: 2.45-13.64), age [range 35-50 years old (OR = 5.73, p < 0.0001, 95% CI: 2.49-13.20); > 50 years old (OR = 6.29, p = 0.002, 95% CI: 1.94-20.42)], and VSB (OR = 23.68, p < 0.0001, 95% CI: 8.07-69.53) showed a significant direct association with BOP outcome. CONCLUSIONS: HIV-1 infection under HAART did not have association with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm. However, HIV patients on HAART had direct association of HIV-1 infection with BOP and an inverse association with PPD. CLINICAL RELEVANCE: These results support that monitoring gingival bleeding associated with oral prophylaxis would be beneficial in the prevention and management of periodontitis in HIV-1 patients on HAART.

Dental implants in individuals living with HIV-1: Results from a prospective study in patients undergoing highly active antiretroviral therapy.

OBJECTIVE: To assess survival and success rates of dental implants and the occurrence of peri-implant diseases (mucositis/peri-implantitis) in HIV-1-infected individuals. MATERIAL AND METHODS: In this prospective study, 13 HIV-1-infected individuals undergoing highly active antiretroviral therapy (with undetectable plasma HIV RNA levels, and CD4+ T cells > 350/mm3 ) were followed after implant placement, as well as 13 non-HIV-1-infected matched controls. Patients enrolled in this study were followed up to 120 months (mean = 40.6 months; standard deviation = 22.2; range 18 -120 months). Twenty-five implants were placed in pristine healed sites for each group and bone augmentation procedures, when needed, were done only for contour augmentation. Patients were enrolled in a strict periodontal/peri-implant supportive therapy protocol with three recalls per year. The two groups were compared regarding subject-level characteristics (age, gender, smoking, diabetes) and implant-level characteristics (marginal bone level, peri-implant health status). RESULTS: All the implants healed uneventfully and reached 100% survival rates (after at least 18 months) in both groups. There were no significant differences between groups for peri-implant diseases (mucositis/peri-implantitis) and for all subject-level co-variables (p > .05). Only the variables dental implant prosthesis type (DIPT) (p = .021, d = .86) and follow up (p = .011, d = .77) showed statistically significant differences between groups. CONCLUSION: The findings suggest that well-controlled HIV-1-infected individuals are eligible to undergo implant therapy, achieving survival and success rates comparable to non-HIV-1-infected controls.

Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018 / Avaliação do manejo adequado de pacientes com sífilis na atenção primária em diferentes regiões do Brasil entre 2012 e 2018 / Evaluación de una gestión apropiada de pacientes con sífilis en la atención primaria en diferentes regiones de Brasil entre 2012 y 2018

This study aimed to analyze the presence of adequate infrastructure and work process in primary health care for the diagnosis, management, and treatment of syphilis in Brazil in 2012, 2014, and 2018. This is a cross-sectional, nationwide study with data from the three cycles of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB): 2012 (Cycle I), 2014 (Cycle II), and 2018 (Cycle III). Two outcomes were assessed: adequate infrastructure and work process. The independent variables were macroregion, municipality size, Municipal Human Development Index (HDI-M), and coverage of the Family Health Strategy (FHS). Variance-weighted least squares regression was used to estimate annual changes in percentage. In total, 13,842 primary basic health units (UBS) and 17,202 professional health care teams were assessed in Cycle I; 24,055 UBS and 29,778 teams in Cycle II, and 28,939 UBS and 37,350 teams in Cycle III. About 1.4% of UBS had adequate infrastructure in Cycle I; 17.5% had in Cycle II; and 42.7% had in Cycle III. Adequate work process also increased in the three cycles, ranging from 47.3% in Cycle I to 45.5% in Cycle II and 75.4% in Cycle III. However, inequities are observed, considering that richer regions and larger municipalities, with higher HDI-M and lower FHS coverage improved the most. The low prevalence of adequate infrastructure and work process for the care of patients with syphilis in Brazil reflects a significant weakness in the Brazilian health system.

O estudo teve como objetivo analisar a presença de infraestrutura e processo de trabalho adequados na atenção primária para o diagnóstico, manejo e tratamento da sífilis no Brasil nos anos de 2012, 2014 e 2018, com um desenho transversal, de abrangência nacional, com dados dos três ciclos do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) em 2012 (Ciclo I), 2014 (Ciclo II) e 2018 (Ciclo III). Foram avaliados dois desfechos: infraestrutura e processo de trabalho adequados. As variáveis independentes foram macrorregião, tamanho do município, Índice de Desenvolvimento Humano Municipal (IDH-M) e cobertura da Estratégia Saúde da Família (ESF). Foi utilizada regressão de mínimos quadrados ponderada pela variância para estimar as mudanças anuais em pontos percentuais. No Ciclo I, foram avaliadas 13.842 unidades básicas de saúde (UBS) e 17.202 equipes de saúde, no Ciclo II, 24.055 UBS e 29.778 equipes e no Ciclo III, 28.939 UBS e 37.350 equipes. No Ciclo I, 1,4% das UBS apresentavam infraestrutura adequada, aumentando para 17,5% no Ciclo II e 42,7% no Ciclo III. Houve também um aumento no processo de trabalho adequado nos três ciclos, passando de 47,3% no ciclo I para 45,5% no ciclo II e 75,4% no Ciclo III. Entretanto, foram observadas inequidades, com melhoras mais expressivas nas regiões mais ricas, municípios com IDH-M mais alto, maiores e com menor cobertura da ESF. A baixa prevalência de infraestrutura e processo de trabalho adequados para o atendimento dos pacientes com sífilis no Brasil refletem uma insuficiência importante no sistema de saúde brasileiro.

El objetivo de este estudio fue analizar la presencia de infraestructura adecuada, así como de la existencia de procesos laborales dentro de la atención primaria para la diagnosis, gestión y tratamiento de sífilis en Brasil durante los años de 2012, 2014 y 2018. Se trata de un estudio transversal, nacional, con datos de los tres ciclos del Programa Nacional de Mejoría de Acceso y Calidad de la Atención Básica (PMAQ-AB) en 2012 (Ciclo I), 2014 (Ciclo II) y 2018 (Ciclo III). Se evaluaron dos resultados: infraestructura adecuada y proceso laboral. Las variables independientes fueron: macrorregión, tamaño del municipio, Índice de Desarrollo Humano Municipal (HDI-M), así como la cobertura de la Estrategia Salud de la Familia (ESF). Se utilizó la regresión de mínimos cuadrados ponderados por varianza para estimar los cambios anuales por puntos porcentuales. En el Ciclo I, se evaluaron 13.842 servicios de salud básicos (UBS) y 17.202 equipos profesionales de salud, en el Ciclo II 24.055 UBS y 29.778 equipos y en el Ciclo III 28.939 UBS y 37.350 equipos. En el Ciclo I un 1.4% de las UBS tenían una infraestructura adecuada, incrementándose hasta un 17.5% en el Ciclo II y a un 42.7% en el Ciclo III. Había también un incremento en el proceso laboral adecuado en los tres Ciclos, yendo de un 47.3% en el Ciclo I al 45.5% en el Ciclo II y un 75.4% en el Ciclo III. No obstante, se observaron inequidades, con mejoras más expresivas en regiones más ricas, municipios con un HDI-M mayor y con una cobertura ESF más baja. La prevalencia baja de una infraestructura adecuada y el proceso laboral para el cuidado de pacientes con sífilis en Brasil refleja una importante debilidad en el sistema de salud brasileño.

Did Omics change periodontal therapy?

The starting point for defining effective treatment protocols is a clear understanding of the etiology and pathogenesis of a condition. In periodontal diseases, this understanding has been hindered by a number of factors, such as the difficulty in differentiating primary pathogens from nonpathogens in complex biofilm structures. The introduction of DNA sequencing technologies, including taxonomic and functional analyses, has allowed the oral microbiome to be investigated in much greater breadth and depth. This article aims to compile the results of studies, using next-generation sequencing techniques to evaluate the periodontal microbiome, in an attempt to determine how far the knowledge provided by these studies has brought us in terms of influencing the way we treat periodontitis. The taxonomic data provided, to date, by published association and elimination studies using next-generation sequencing confirm previous knowledge on the role of classic periodontal pathogens in the pathobiology of disease and include new species/genera. Conversely, species and genera already considered as host-compatible and others less explored were associated with periodontal health as their levels were elevated in healthy individuals and increased after therapy. Functional and transcriptomic analyses also demonstrated that periodontal biofilms are taxonomically diverse, functionally congruent, and highly cooperative. Very few interventional studies to date have examined the effects of treatment on the periodontal microbiome, and such studies are heterogeneous in terms of design, sample size, sampling method, treatment provided, and duration of follow-up. Hence, it is still difficult to draw meaningful conclusions from them. Thus, although OMICS knowledge has not yet changed the way we treat patients in daily practice, the information provided by these studies opens new avenues for future research in this field. As new pathogens and beneficial species become identified, future randomized clinical trials could monitor these species/genera more comprehensively. In addition, the metatranscriptomic data, although still embryonic, suggest that the interplay between the host and the oral microbiome may be our best opportunity to implement personalized periodontal treatments. Therapeutic schemes targeting particular bacterial protein products in subjects with specific genetic profiles, for example, may be the futuristic view of enhanced periodontal therapy.

Infra-Abdominal Muscles Activation Brings Benefits to the Pulmonary Function of Patients with Sternal Instability after Cardiac Surgery.

OBJECTIVE: To compare physical therapy strategies involving abdominal muscle stabilization, with and without upper limb movement, in patients with sternal instability after heart surgery and during in-hospital care. METHODS: This prospective, longitudinal, randomized, and comparative clinical study included 20 patients, which were divided into two groups: ARM, the arm group (n=10), and LEG, the leg group (n=10). The study involved the evaluation of scores of visual analog scales for sternal instability, pain, discomfort, functional impairment, lung function, and maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) before and after the interventions. Two protocols consisting of abdominal exercises in both groups with upper limb movements (ARM) and just abdominal activation with leg movements (LEG) were used for three weeks. RESULTS: There were statistically significant (P≤0.01) improvements in pain, discomfort, and functional impairment scores, and in MIP (P=0.04) and MEP (P≤0.01) after intervention in both groups and just LEG showed improvement in forced vital capacity (P=0.043) and forced expiratory volume in one second (P=0.011). CONCLUSION: Both strategies promoted improvement in pain, discomfort, and functional impairment scores and in the values of inspiratory and expiratory pressures. Perhaps they were influenced by the time and resolution of the infection process, although exercises with upper limb movements seem to be safe in this population. The activation of the infra-abdominal muscles through leg movements seems to bring more benefits to lung function.

Centro de oncologia e infusão: desafios da equipe interprofissional frente à pandemia Coronavírus / Centro de oncología e infusión: retos del equipo interprofesional ante la pandemia de Coronavírus / Oncology and infusion center: challenges of the interprofessional team in the Coronavirus pandemic

Objetivo: relatar a experiência da equipe interprofissional quanto às medidas de segurança adotadas frente a pandemia ocasionada pelo novo Coronavírus em um centro de oncologia e infusão no sul do Brasil. Método: relato de experiência da equipe interprofissional de oncologia relacionado às medidas adotadas entre os meses de março a abril de 2020 para manutenção das atividades de forma segura em meio a pandemia. Resultados: medidas de distanciamento, intensificação de higiene, redução de fluxo de pessoas e uso de equipamentos de proteção individual foram adotadas. Além destas, adequações na estrutura e fluxos operacionais do serviço foram implementados para otimização de novas práticas de atendimento que busquem minimizar a exposição do paciente ao vírus. Conclusões: ajustes nas práticas organizacionais e operacionais para um atendimento interprofissional organizado e seguro ao paciente em um centro de oncologia e infusão garante o atendimento na unidade e assegura o adequado tratamento aos pacientes.(AU)

Objective: to report the experience of the interprofessional team regarding the safety measures adopted in the face of the pandemic caused by the new Coronavirus in an oncology and infusion center in southern Brazil. Method: experience report of the interprofessional oncology team related to the measures adopted between the months of March to April 2020 to maintain activities safely in the middle of the pandemic. Results: distance measures, intensified hygiene, reduced flow of people and use of personal protective equipment were adopted. In addition to these, adjustments to the structure and operational flows of the service were implemented to optimize new care practices that seek to minimize patient exposure to the virus. Conclusions: adjustments in organizational and operational practices for organized and safe interprofessional care for patients in an oncology and infusion center guarantees care at the unit and ensures adequate treatment for patients.(AU)

Objetivo: informar la experiencia del equipo interprofesional sobre las medidas adoptadas ante la pandemia provocada por el nuevo Coronavirus en un centro de oncología e infusión en Sul del Brasil. Método: informe de experiencia del equipo interprofesional de oncología relacionado con las medidas adoptadas entre los meses de marzo a abril de 2020 para mantener las actividades de forma segura en medio de la pandemia. Resultados: se adoptaron medidas de distancia, higiene intensificada, flujo reducido de personas y uso de equipo de protección personal. Además de estos, se implementaron ajustes a la estructura y flujos operativos del servicio para optimizar nuevas prácticas de atención que buscan minimizar la exposición del paciente al virus. Conclusiones: los ajustes en las prácticas organizativas y operativas para la atención interprofesional organizada y segura de los pacientes en un centro de oncología e infusión asegura un tratamiento adecuado a los pacientes.(AU)

Infra-abdominal muscles activation brings benefits to the pulmonary function of patients with ternal instability after cardiac surgery

Abstract Objective: To compare physical therapy strategies involving abdominal muscle stabilization, with and without upper limb movement, in patients with sternal instability after heart surgery and during in-hospital care. Methods: This prospective, longitudinal, randomized, and comparative clinical study included 20 patients, which were divided into two groups: ARM, the arm group (n=10), and LEG, the leg group (n=10). The study involved the evaluation of scores of visual analog scales for sternal instability, pain, discomfort, functional impairment, lung function, and maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) before and after the interventions. Two protocols consisting of abdominal exercises in both groups with upper limb movements (ARM) and just abdominal activation with leg movements (LEG) were used for three weeks. Results: There were statistically significant (P≤0.01) improvements in pain, discomfort, and functional impairment scores, and in MIP (P=0.04) and MEP (P≤0.01) after intervention in both groups and just LEG showed improvement in forced vital capacity (P=0.043) and forced expiratory volume in one second (P=0.011). Conclusion: Both strategies promoted improvement in pain, discomfort, and functional impairment scores and in the values of inspiratory and expiratory pressures. Perhaps they were influenced by the time and resolution of the infection process, although exercises with upper limb movements seem to be safe in this population. The activation of the infra-abdominal muscles through leg movements seems to bring more benefits to lung function.

Frequency and associated factors with failure to perform the puerperal consultation in a cohort study / Frequência e fatores associados à não realização da consulta puerperal em um estudo de coorte

Abstract Objectives: to identify the frequency and factors associated with the non-realization of puerperal consultations in women resident of a medium-sized municipality in Brazil. Methods: a prospective cohort study based on data collected in two time points, the first 48h and after the 42nd day post-childbirth. In order to analyze data, proportions were compared using the chi-square test, and the adjusted analysis was performed using Poisson regression, according to a predetermined hierarchical model. Significance level was set at 5%. Results: of the 572 women included in the study, 24.8% did not perform puerperal consul-tations. The factors associated with the non-realization of puerperal consultations were: lower income (1 st tercile PR= 2.01; CI95%= 1.21-3.33 - 2 nd tercile PR= 1.94; CI95%=1.17-3.20) and schooling (≤ 8 years PR= 2.00; CI95%= 1.24-3.24), comorbidities during preg-nancy (PR= 1.45; CI95%= 1.01-2.09), realization of antenatal care in the public service (PR= 1.74; CI95%= 1.18-2.58) and non-use of contraceptive methods (PR= 3.10; CI95%=1.86-5.16). Conclusions: puerperal revision does not seem to be valued in the antenatal care, mainly in the public health system. An important inequality was identified in the provision of this service, since women more prone to recurring pregnancy and with lower income and schooling were the ones that least returned to the puerperal consultation.

Resumo Objetivos: identificar a frequência da não realização das consultas de puerpério e fatores associados em mulheres residentes de um município de médio porte no Brasil. Métodos: estudo de coorte prospectiva através da coleta de dados em dois momentos, nas primeiras 48h e após o 42º dia pós-parto. Para a análise dos dados, utilizou-se o teste qui-quadrado para comparar proporções e, para a análise ajustada, Regressão de Poisson obedecendo ao modelo hierárquico pré-determinado. O nível de significância adotado foi de 5%. Resultados: das 572 mulheres incluídas no estudo, 24,8% não realizaram consulta de puerpério. Os fatores associados a não realização da consulta de puerpério foram: menor renda (1º tercil RP= 2,01 IC95%= 1,21-3,33 - 2º tercil RP= 1,94 IC95%= 1,17-3,20), escolaridade (≤ 8 anos RP= 2,00 IC95%= 1,24-3,24); mulheres que apresentaram alguma comorbidade durante a gestação (RP 1,45; IC95%= 1,01-2,09), realizaram o pré-natal em serviço público (RP= 1,74; IC95%= 1,18-2,58) e que não usaram método anticoncepcional (RP= 3,10; IC95%= 1,86-5,16). Conclusões: a revisão puerperal não parece estar sendo valorizada no pré-natal, principalmente no sistema público de saúde. Foi identificada uma importante iniquidade na prestação desse serviço, pois as mulheres de menor renda, escolaridade e mais expostas a uma gravidez recorrente foram as que menos retornaram à consulta puerperal.

Sobrecarga e satisfação dos familiares de pacientes com esquizofrenia / Sobrecarga y satisfacción de los familiares de pacientes con esquizofrenia / Overload and satisfaction of family members of patients with schizophrenia

RESUMO Objetivo avaliar a atenção psicossocial pela ótica do familiar do paciente esquizofrênico. Metódo estudo correlacional com 40 familiares no Centro de Atenção Psicossocial III de Londrina-PR, entre 2015 e 2016. Foram obtidas variáveis relacionadas à caracterização sociodemográfica e das escalas de avaliação da sobrecarga e de satisfação de familiares. Os dados foram analisados com medidas de tendência central e de correlação. Resultados 24 cuidadores eram mulheres, 23 eram casados e a idade média foi 46 anos. A média de satisfação foi 4,37, a média global para a sobrecarga objetiva foi 2,26 e a sobrecarga subjetiva foi de 2,09. Conclusão Embora muito satisfeitos, diferenças nos escores de sobrecarga revelaram que os familiares recebem bom suporte psicoeducativo, mas a sobrecarga gerada pela preocupação com o ente familiar é o aspecto que mais gera sorimento. Tais resultados podem nortear o enfermeiro no direcionamento das ações de suporte aos familiares, reduzindo a sobrecarga familiar.

RESUMEN Objetivo Evaluar la atención psicosocial acorde la visión del familiar del paciente esquizofrénico. Método Estudio correlacional con 40 familiares en el Centro de Atención Psicosocial III de Londrina-PR, entre 2015 y 2016. Fueron obtenidas variables de caracterización sociodemográfica, de escalas de evaluación de sobrecarga y de satisfacción de familiares. Datos analizados con medidas de tendencia central y de correlación. Resultados Veinticuatro cuidadores eran mujeres; 23 casadas; media etaria de 46 años. El promedio de satisfacción fue 4,37; el promedio global de sobrecarga objetiva fue 2,26; la sobrecarga subjetiva fue 2,09. Conclusión A pesar de la satisfacción, las diferencias en los puntajes de sobrecarga indican que los familiares reciben buen soporte psicoeducativo, pero la sobrecarga determinada por la preocupación por el familiar es el aspecto generador del mayor sufrimiento. Estos resultados pueden orientar al enfermero para que enfoque las acciones de soporte a los familiares, reduciendo la sobrecarga familiar.

ABSTRACT Objective To assess psychosocial care from the perspective of family members of schizophrenic patients. Method A correlational study with 40 family members at a Psychosocial Care Center III of Londrina, Paraná, was conducted in 2015 and 2016. Variables related to the sociodemographic characterization and evaluation scales of the overload and satisfaction of the family members were obtained. Data were analyzed with measures of central tendency and correlation. Results 24 caregivers were women, 23 were married, and the mean age was 46 years. The mean rate of satisfaction was 4.37, the overall mean value for objective overload was 2.26, and the overall mean value for subjective overload was 2.09. Conclusion Although the family members were very satisfied, differences in overload scores revealed that they received good psychoeducational support, but the overload generated by their concern for their family member was the aspect that generated the highest levels of suffering. Such results may guide nurses to give directions to family members, to support then and reduce their overload.

Lack of Impact of Race Alone on Cervical Cancer Survival in Brazil

Objective: To analyze differences in survival between black and non-black women diagnosed with cervical cancer and treated at the National Cancer Institute in Brazil. Methods: This retrospective cohort study was conducted using medical records of patients who were treated for cervical cancer between 2006 and 2009 at the Brazilian National Cancer Institute - Rio de Janeiro - Brazil. The clinical and epidemiological characteristics of black and non-black patients were compared using the chi-square test. Survival functions over five years were calculated using the Kaplan-Meier estimator and compared using the log-rank test. Associations between race and mortality risk were analyzed using the Cox proportional hazards model. P-values <0.05 were considered statistically significant. Results: The study included 1,482 women, of whom 188 (12.7%) were black, 1,209 (81.6%) were non-black and 85 (5.7%) were of unspecified race. The age at diagnosis of the patients ranged from 19 to 84 years (mean 50.1 years; SD±13.2). Hemoglobin <12 g/dL at the time of diagnosis (p=0.008) and absence of surgery as primary treatment (p = 0.005) were more frequent among black women. Cox analysis adjusted for these two factors showed no statistically significant difference in the mortality risk associated with cervical cancer among black and non-black women (HR=1.1 95% CI 0.9-1.5; p=0.27). Conclusion: After adjusting for hemoglobin levels and surgery, race alone was not shown to be a prognostic factor for patients with cervical cancer.

Cartografia e hermenêutica nos enlaces da pesquisa participativa / Interlacings of cartography and hermeneutics in participatory research / Cartografía y hermeneutica en los vínculos de la investigación participativa

Avaliação de Quarta Geração e Método Cartográfico têm sido referências importantes para pesquisas no campo da saúde mental, mas são poucos os registros de suas conexões. A análise da investigação "Qualificação da Saúde Mental na Atenção Básica" visa contribuir para discutir características que a composição entre os dois referenciais metodológicos pode imprimir às pesquisas deste campo. A maneira como a investigação conectou os dois referenciais resultou em ampliação da participação. (AU)

Fourth Generation Evaluation and Cartographic Methods have been important references for researches in the field of mental health even if there is little substantiation as to their connection. The analysis of the "Appraisal of Mental Health Care in Primary Health Care" study looks to contribute to the discussion on what the combination of these two key methodological approaches can contribute to research in this field. The way the study connected these two key approaches resulted in increased participation. Entwine (AU)

Evaluación de Cuarta Generación y Método Cartográfico han sido referencias importantes para investigaciones en el campo de la salud mental, pero son pocos los registros de sus conexiones. El análisis de la investigación "Cualificación de la Salud Mental en la Atención Básica" pretende contribuir para discutir características que la composición entre los dos referenciales metodológicos puede imprimir a las investigaciones de este campo. La manera como la investigación conectó los dos referenciales resultó en la ampliación de la participación. (AU)