Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

OBJECTIVE: To compare cytological and histological results from women > 64 years old who followed the Brazilian national cervical cancer screening guidelines with those who did not. METHODS: The present observational retrospective study analyzed 207 abnormal cervical smear results from women > 64 years old in a mid-sized city in Brazil over 14 years. All results were reported according to the Bethesda System. The women were divided into those who followed the screening guidelines and those who did not. RESULTS: Atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion cytology results were found in 128 (62.2%) cases. Of these, 112 (87.5%) had repeated cytology with positive results. The other 79 (38.1%) with abnormal results should have been referred to colposcopy and biopsy. Out of 41 (51.9%) biopsied women, 23 (29.1%) had a confirmed diagnosis of neoplasia or precursor lesion. In contrast, among the 78 (37.7%) biopsied patients, 40 (51.3%) followed the guideline recommendations, with 9 (22.5%) positive biopsies. Of the 38 (48.7%) women who did not follow the guidelines, there were 24 (63.1%) positive results. Women who did not follow the guidelines demonstrated higher chances of cancer and precursor lesions (odds ratio [OR]: 5.904; 95% confidence interval [CI]: 2.188-15.932; p = 0.0002). CONCLUSION: Women > 64 years old who did not follow the national screening protocol showed significant differences in the frequency of abnormal results and severity of diagnosis compared with those who followed the protocol.

OBJETIVO: Comparar os resultados citológicos e histológicos de mulheres > 64 anos que seguiram as diretrizes nacionais brasileiras de rastreamento do câncer do colo do útero com aquelas que não as seguiram. MéTODO: O presente estudo observacional retrospectivo analisou 207 resultados anormais de esfregaço cervical de mulheres > 64 anos de idade em uma cidade de médio porte no Brasil durante 14 anos. Todos os resultados foram relatados de acordo com o Sistema Bethesda. As mulheres foram divididas entre as que seguiram as diretrizes de rastreamento e as que não o fizeram. RESULTADOS: Resultados citológicos com células escamosas atípicas de significado indeterminado e lesão intraepitelial escamosa de baixo grau foram encontrados em 128 (62,2%) casos. Destes, 112 (87,5%) repetiram a citologia com resultados positivos. Os outros 79 (38,1%) com resultados anormais deveriam ter sido encaminhados para colposcopia e biópsia. Das 41 (51,9%) mulheres biopsiadas, 23 (29,1%) tiveram diagnóstico confirmado de neoplasia ou lesão precursora. Em contrapartida, entre as 78 (37,7%) pacientes biopsiadas, 40 (51,3%) seguiram as recomendações da diretriz, com 9 (22,5%) biópsias positivas. Entre as 38 (48,7%) mulheres que não seguiram as orientações, houve 24 (63,1%) resultados positivos. As mulheres que não seguiram as diretrizes demonstraram maiores chances de câncer e lesões precursoras (odds ratio [OR]: 5,904; intervalo de confiança [IC] de 95%: 2,188­15,932; p = 0,0002). CONCLUSãO: Mulheres > 64 anos que não seguiram a diretriz nacional de rastreamento apresentaram diferenças significativas na frequência de resultados anormais e gravidade do diagnóstico em comparação com aquelas que seguiram a diretriz.

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group? / Câncer cervical subestimado entre mulheres com mais de 65 anos: É hora de rever a faixa etária alvo do rastreamento?

Abstract Objective To compare cytological and histological results from women > 64 years old who followed the Brazilian national cervical cancer screening guidelines with those who did not. Methods The present observational retrospective study analyzed 207 abnormal cervical smear results from women > 64 years old in a mid-sized city in Brazil over 14 years. All results were reported according to the Bethesda System. The women were divided into those who followed the screening guidelines and those who did not. Results Atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesion cytology results were found in 128 (62.2%) cases. Of these, 112 (87.5%) had repeated cytology with positive results. The other 79 (38.1%) with abnormal results should have been referred to colposcopy and biopsy. Out of 41 (51.9%) biopsied women, 23 (29.1%) had a confirmed diagnosis of neoplasia or precursor lesion. In contrast, among the 78 (37.7%) biopsied patients, 40 (51.3%) followed the guideline recommendations, with 9 (22.5%) positive biopsies. Of the 38 (48.7%) women who did not follow the guidelines, there were 24 (63.1%) positive results. Women who did not follow the guidelines demonstrated higher chances of cancer and precursor lesions (odds ratio [OR]: 5.904; 95% confidence interval [CI]: 2.188-15.932; p = 0.0002). Conclusion Women > 64 years old who did not follow the national screening protocol showed significant differences in the frequency of abnormal results and severity of diagnosis compared with those who followed the protocol.

Resumo Objetivo Comparar os resultados citológicos e histológicos de mulheres > 64 anos que seguiram as diretrizes nacionais brasileiras de rastreamento do câncer do colo do útero com aquelas que não as seguiram. Método O presente estudo observacional retrospectivo analisou 207 resultados anormais de esfregaço cervical de mulheres > 64 anos de idade em uma cidade de médio porte no Brasil durante 14 anos. Todos os resultados foram relatados de acordo com o Sistema Bethesda. As mulheres foram divididas entre as que seguiram as diretrizes de rastreamento e as que não o fizeram. Resultados Resultados citológicos com células escamosas atípicas de significado indeterminado e lesão intraepitelial escamosa de baixo grau foram encontrados em 128 (62,2%) casos. Destes, 112 (87,5%) repetiram a citologia com resultados positivos. Os outros 79 (38,1%) com resultados anormais deveriam ter sido encaminhados para colposcopia e biópsia. Das 41 (51,9%) mulheres biopsiadas, 23 (29,1%) tiveram diagnóstico confirmado de neoplasia ou lesão precursora. Em contrapartida, entre as 78 (37,7%) pacientes biopsiadas, 40 (51,3%) seguiram as recomendações da diretriz, com 9 (22,5%) biópsias positivas. Entre as 38 (48,7%) mulheres que não seguiram as orientações, houve 24 (63,1%) resultados positivos. As mulheres que não seguiram as diretrizes demonstraram maiores chances de câncer e lesões precursoras (odds ratio [OR]: 5,904; intervalo de confiança [IC] de 95%: 2,188-15,932; p = 0,0002). Conclusão Mulheres > 64 anos que não seguiram a diretriz nacional de rastreamento apresentaram diferenças significativas na frequência de resultados anormais e gravidade do diagnóstico em comparação com aquelas que seguiram a diretriz.

The impact of transformation zone representation on the frequency of abnormal cervical cytological results.

OBJECTIVE: To compare the frequency of abnormal cervical cytological results with and without representation of the transformation zone (TZ) in a medium-sized city in Brazil according to the Bethesda categorization. METHODS: We performed an analytical observational study evaluating cytological results over 15 years from conventional smears collected within the Public Brazilian Health System in Araçatuba, Brazil. Tests were stratified by age and cytological result according to Brazilian guidelines and the Bethesda System. RESULTS: There were 261,881 examinations, 159,251 with and 102,630 without TZ representation. The global frequency of abnormal results was higher in smears with TZ representation (crude odds ratio [OR] 4.03; 95% confidence interval [CI] [3.71-4.38]). Considering only women between 25 and 64 years (the target of the national guidelines), there were higher results for high-grade squamous intraepithelial lesions (OR 11.54; 95% CI 6.74-19.78), low-grade squamous intraepithelial lesions (OR 2.82; 95% CI 2.17-3.67) atypical squamous cell in which high-grade intraepithelial lesion cannot be excluded (OR 6.90; 95% CI 4.91-9.66) and atypical squamous cell of undetermined significance (OR 3.53; 95% CI 3.11-4.01) among cases with TZ representation. CONCLUSION: Samples with TZ representation were associated with higher rates of abnormal results. Health professionals should be regularly trained to understand the weakness of cytological examinations when the TZ is not represented, especially in developing countries.

Marginal staining of ultra-thin ceramic veneers

The pigmentation of the resin cement at the tooth/ceramic interface compromises the esthetic and longevity of ultra-thin ceramic veneers. Aim: The aim of this study was to evaluate marginal staining of ultra-thin ceramic veneers cemented to intact enamel (non-prepared) and prepared enamel. Methods:Thirty-two (32) permanent central incisors were selected and randomly divided into two groups: intact enamel (IE) and prepared enamel (PE). The ceramic veneers of PE group were bonded to the prepared enamel and the ceramic veneers of IE group were cemented directly onto the intact enamel, with no preparation. Both preparation and cementation were standardized and performed by a single operator. Each group was subdivided into two subgroups (n = 8) with different immersion media - coffee and water. After an immersion period of 10 days, stereomicroscope images were made at 20X magnification of the mesial, distal, cervical and incisal surface of each specimen. Three blinded, trained and calibrated examiners evaluated the images of the resin cement interface of each surface. The data were subjected to KruskalWallis and MannWhitney statistical analysis. Immersion media and enamel preparation influenced the marginal staining of the tooth/ceramic interface. Results: When immersed in coffee, prepared interfaces presented greater marginal staining than unprepared interfaces. When immersed in water, there was no statistically significant difference between the groups. Conclusion: The cementation of ultra-thin ceramic veneers onto intact enamel is associated with less marginal staining and, consequently, improved esthetics

Home enteral nutrition: clinical-nutritional analysis and outcomes of 10 years of public policy.

INTRODUCTION: Background and aims: home enteral nutrition (HEN) is an established treatment for clinically stable patients. The objective of this study was to determine the frequency and the situation of patients in HEN, in the capital city in the south of Brazil. Methods: in this retrospective study, we recorded all new cases of HEN in adults in Curitiba, Brazil, from January 2006 to December 2015. Data were collected by a dietitian from medical records of patients attending public health settings. The following data were analyzed: clinical diagnosis, diet prescribed during hospitalization and at discharge, and feeding access types. Kaplan-Meier and Cox regression analyses were used to calculate survival. Results: a total of 1,231 patients were included. There was a 425% increase in the frequency of HEN over the years studied. The mean age was 66.7 years, and 54.4% were men. Neurological diseases were the most prevalent (46.4%), followed by cancer (33.6%). Eight hundred and one patients (65.1%) died during this period. Mean HEN duration was 180 days (95% CI 163.6-193.4), with a significant difference between neurological diseases (median: 180 days) and cancer (median: 210 days) (p < 0.05). Neurological disease was an independent risk factor for mortality in patients on HEN (HR: 1.17; CI: 1.08-1.27). Conclusions: the study shows an increase in HEN. Neurological diseases prevailed and presented a risk of mortality, and more than half of the patients with NED died in this period.

INTRODUCCIÓN: Introducción y objetivos: la nutrición enteral domiciliaria (NED) es un tratamiento establecido para pacientes clínicamente estables. El objetivo de este estudio fue determinar la frecuencia y la situación de los pacientes con NED en la capital del sur de Brasil. Métodos: en este estudio retrospectivo se registraron todos los nuevos casos de NED en adultos en Curitiba, Brasil, de enero de 2006 a diciembre de 2015. Los datos fueron recolectados por un nutricionista de historiales clínicos de pacientes que frecuentan establecimientos de salud pública. Se analizaron los siguientes datos: diagnóstico clínico, dieta prescrita durante la estancia hospitalaria y en el momento del alta y acceso alimenticio. Se utilizaron los análisis de Kaplan-Meier y regresión de Cox para calcular la supervivencia. Resultados: fueron incluidos 1.231 pacientes. Hubo un aumento del 425% en la frecuencia de NED a lo largo de los años estudiados. La edad media fue de 66,7 años y el 54,4% eran hombres. Las enfermedades neurológicas fueron las más prevalentes (46,4%), seguidas de las neoplasias (33,6%). Durante este periodo murieron 801 pacientes (65,1%). La duración media de la NED fue de 180 días (IC 95%, 163,6-193,4), con una diferencia significativa entre enfermedades neurológicas (mediana: 180 días) y cáncer (mediana: 210 días) (p < 0,05). La enfermedad neurológica fue un factor de riesgo independiente para la mortalidad en pacientes en NED (HR: 1,17; IC: 1,08-1,27). Conclusiones: el estudio muestra un aumento en la NED. Las enfermedades neurológicas prevalecieron y presentaron riesgo de mortalidad y más de la mitad de los pacientes murieron durante la NED.

Avaliação clínica da eficácia do clareamento dental pela técnica caseira utilizando moldeiras com e sem alívio / Clinical evaluation of home bleaching using trays constructed with or without reservoirs

O objetivo desse trabalho foi avaliar clinicamente a eficácia do clareamento dental com peróxido de carbamida a 16%, utilizando a técnica caseira com e sem alívio na moldeira, e analisar a hipersensibilidade dentinária provocada pelo procedimento clareador. Esse estudo randomizado, duplo-cego e com desenho experimental de boca dividida avaliou onze pacientes, sendo os dentes 11 e 21 avaliados previamente por dois examinadores calibrados (Kappa 0,75). A hemi-arcada direita recebeu alívio no modelo de gesso para a confecção da moldeira, enquanto a esquerda não recebeu. O clareamento foi realizado durante 2 semanas, 6 horas por dia. Logo após esse período, os dentes 11 e 21 foram reavaliados pelos mesmos examinadores e os pacientes foram questionados sobre a hipersensibilidade. Os dados foram analisados pelo teste exato de Fisher (p>0,05) e mostraram que não houve diferença significativa no clareamento entre as técnicas com e sem alívio. Todos os pacientes relataram hipersensibilidade dentinária durante o clareamento. Concluiu-se que a técnica caseira foi eficaz no clareamento dental, independentemente da presença do alívio na moldeira. O clareamento provocou hipersensibilidade dentinária em todos os casos.

The aim of this study was to evaluate the clinical performance of 16% carbamide peroxide home vital bleaching, using trays constructed with or without reservoirs, and analyze thepostoperative hypersensitivity. This was a randomized, double-blind and split-mouth study. Two examinators evaluated 11 and 21 teeth from eleven patients (Kappa 0,75). Right side of upper stone models received reservoirs before trays were constructed, left side didn’t. Home bleaching was performed through two weeks, 6 hours-day. After this time, 11 and 21 teeth was evaluatedagain by the same examinators. Patients were asked about ostoperative hypersensitivity. Data were statistically analyzed by Fisher’s exact test (p>0,05), and didn’t show any statistically significant difference between trays with or without reservoirs. All patients related postoperative hypersensitivity during bleaching time. Home bleaching technique was effective on dental bleaching, with or without reservoirs on the trays. Home bleaching promoted postoperative hypersensitivityin all cases.

Relação processo de trabalho e sofrimento mental: a percepção dos profissionais de enfermagem de Unidades Básicas de Saúde / Relation work process and mental suffering: the perception of nurses in basic health unit

Este estudo investigou a percepção dos profissionais de Enfermagem sobre a relação processo de trabalho e sofrimento. O campo de estudo constitui-se por Unidades Básicas de Saúde dos municípios de Alvorada, Caxias do Sul, Osório e Porto Alegre (Centro de Saúde-Escola Murialdo). Participaram da pesquisa 36 trabalhadores na faixa etária de 26 a 60 anos. Os dados foram obtidos através de entrevistas individuais semi-estruturadas, sendo analisadas de forma qualitativa baseando-se na análise de conteúdo proposta por Minayo. Os profissionais percebem que o processo de trabalho em que estão inseridos desencadeia tanto satisfação como sofrimento mental. Como causas geradoras desse sofrimento citam a relação com os usuários, principalmente, no que diz respeito às suas condições sociais, a desestruturação do sistema de saúde local, que interfere nas suas condições de trabalho, e as dificuldades em trabalhar em equipe.