Compliance Analysis of the Dental Care Service Provided to Pregnant Women in Primary Health Care

ABSTRACT Objective: To analyze oral health services for pregnant women in the primary health care of a Brazilian metropolis, based on the performance of dentists who integrate these services. Material and Methods: Exploratory, descriptive and cross-sectional study was conducted through qualitative and quantitative approaches. A semi-structured questionnaire was used for data collection. This study was conducted in a Brazilian metropolis and included all dentists working in primary health care. The compliance analysis was performed considering access, adherence, group activity and individual dental care dimensions. Open questions were analyzed using the content analysis method and the closed questions were performed using frequency estimates. Bivariate statistics (Chi-square, Fisher's Exact Test, α<0.05) were analyzed through STATA. Results: 260 dentists agreed to participate in this study. Strategies to facilitate the scheduling of pregnant women to dental treatment occur in 93.9% of oral health teams, the main one being the scheduling and/or referral performed by the family health team. In terms of access and adherence to treatment, all variables in these dimensions showed relevant compliance results. The group activity dimension presented moderate compliance percentages, whereas individual care obtained high results, except for referral to radiography. Conclusion: The oral health service was compliant regarding access and adherence to treatment, but showed limitations in individual care and collective activities. Recommendations include improving oral health team coverage and permanent education programs.

Myositis Ossificans of the Breast Mimicking Breast Cancer: A Case Report.

Myositis ossificans (MO) is an uncommon tumor characterized by a rapidly growing mass following a history of local trauma. Few cases of MO affecting the breast have been reported, and some were misdiagnosed as primary osteosarcoma of the breast or metaplastic breast carcinoma. The following case report presents a patient with a growing breast lump whose core biopsy result was suspicious for breast cancer. MO was diagnosed after analysis of the mastectomy specimen. This case highlights the importance of MO as a differential diagnosis of a growing soft-tissue mass after trauma to avoid unnecessary overtreatment. Keywords: Myositis Ossificans, Osteosarcoma, Breast Cancer, Mastectomy, Heterotopic Ossification © RSNA, 2023.

Bacteria and antimicrobial resistance profile during the composting process of wastes from animal production.

Livestock waste is widely used in agriculture. Although they provide benefits to the soil, and consequently to plants, they have the potential to contaminate the environment, as they contain pathogenic microorganisms and determinants of antimicrobial resistance, if not properly managed. Therefore, this study aims to evaluate the effect of composting horse bedding and poultry litter in organic and conventional production systems on the occurrence of bacteria in the Enterobacteriales order and to identify their antimicrobial resistance profiles. Bacterial strains were isolated from Salmonella-Shigella and eosin methylene blue solid media from animal waste during the composting process that was conducted for 125 days. After isolation, the strains were identified by the MALDI-TOF technique; the disk diffusion test was then performed for phenotypic detection of antimicrobial resistance. A total of 158 bacterial strains were isolated during composting of three wastes. The Enterobacteriaceae family was the most abundant, whereas Proteus mirabilis and Escherichia coli were the species with the highest percentage in the wastes, which also exhibited a multi-resistance profile. Poultry litter showed a greater abundance of resistant bacteria than horse bedding did. Similarly, a greater number of resistant bacteria was detected in conventional poultry litter than in organic poultry litter. The results obtained reinforce that animal wastes are reservoirs of pathogenic bacteria that are resistant to antimicrobials and highlight the importance of developing management strategies that aim to reduce and/or eliminate these contaminants to guarantee their safe use in agriculture.

Atitudes de profissionais sobre o uso de drogas por gestantes / Health professional attitudes towards drug use for pregnant women / Actitudes de profesionales sobre el consumo de drogas en mujeres embarazadas

O uso de drogas é um dos fatores associados a gestações de alto risco. As crenças e atitudes dos profissionais configuram possíveis dificultadores dos cuidados em saúde. O presente estudo buscou verificar as atitudes profissionais em relação a gestantes usuárias de drogas. Realizou-se a busca bibliográfica de publicações entre 2000 e junho de 2022, nas bases de dados Scielo, Lilacs, Medline/Pubmed, Scopus e PsycINFO. Ao final foram analisados 27 artigos, todos de língua inglesa. Foram identificadas atitudes negativas em 33,3% dos artigos, e atitudes positivas em 44,5%; também foram encontradas atitudes ambivalentes (22,2%). Além disso, alguns dos estudos apontaram algumas barreiras quanto às intervenções. Atitudes negativas e moralizantes denotam um cunho individualizante. Em relação às atitudes positivas, essas podem ter um papel fundamental na atuação profissional e na saúde materna e do feto.

Drug use is one of the factors related to high-risk pregnancy. The health professional beliefs and attitudes regarding this issue constitute possible difficulties in the health care. The present study sought to verify the health professional attitudes towards pregnant women who use drugs. A literature review for studies published between 2000 and june 2022 was carried out in the Scielo, Lilacs, Medline/Pubmed, Scopus, and PsycINFO databases. In the end, 27 articles were analyzed, all of them written in English. Negative attitudes were identified in 33,3% of the articles, and positive attitudes in 44,5%; ambivalent attitudes were also found in 22,2% of the studies. Additionally, some studies pointed out barriers to interventions. The negative and moralizing attitudes denote an individualizing nature. Concerning the positive attitudes, they can play a fundamental role on professional performance and, consequently, on the maternal and fetal health.

El uso de drogas es uno de los factores asociados a los embarazos de alto riesgo. Las creencias y actitudes de los profesionales se configuran como posibles obstáculos al cuidado en salud. El presente estudio buscó verificar las actitudes de los profesionales en relación a embarazadas usuarias de drogas. Se realizó una búsqueda bibliográfica de publicaciones entre 2000 y junio de 2022, en las bases de datos Scielo, Lilacs, Medline/Pubmed, Scopus y PsycINFO. Finalmente, fueron analizados 27 artículos, todos en idioma inglés. Se identificaron actitudes negativas en el 33,3% de los artículos, y actitudes positivas en el 44,5%; así también se encontraron actitudes ambivalentes (22,2%). Además, algunos de los estudios señalaron algunas barreras con respecto a las intervenciones. Las actitudes negativas y moralizantes denotan una impronta individualizadora. En relación con las actitudes positivas, estas pueden tener un papel fundamental en la actuación profesional y en la salud materna y del feto.

Sentinel Node Status is the Most Important Prognostic Information for Clinical Stage IIB and IIC Melanoma Patients.

BACKGROUND: Sentinel node biopsy (SNB) for melanoma patients has been questioned. We aimed to study high-risk stage II melanoma patients who underwent SNB to determine what the prognostic factors regarding recurrence and mortality were, and evaluate how relevant SNB status is in this scenario. METHODS: This was a retrospective analysis of clinical stage IIB/IIC melanoma patients who underwent SNB from 2000 to 2015 in a single institution. Prognostic factors related to distant recurrence-free survival (DRFS) and melanoma-specific survival (MSS) were assessed from multiple Cox regression. Relevant variables were used to create risk predictor nomograms for DRFS and MSS. RESULTS: From 1213 SNB, 259 were performed for clinical stage IIB/IIC melanoma patients. SNB status was the most important variable for both endpoints. Patients with positive SNB presented median DRFS of 35.73 months (95% CI 21.38-50.08, SE 7.32) and median MSS of 66.4 months (95% CI 29.76-103.03, SE 18.69), meanwhile both median DRFS and MSS were not achieved for those with negative SNB (logrank < 0.0001). Both nomograms have been internally validated and presented adequate calibration (C-index was 0.734 for DRFS and 0.718 for MSS). CONCLUSIONS: SNB status was the most important risk factor in our cohort of clinical stage IIB and IIC patients and, in conjunction with well-established primary tumor characteristics, should not be abandoned. Their use in prognosis for these patients remains extremely useful for daily practice.

Isolated perfused udder model for transcriptome analysis in response to Streptococcus agalactiae.

This study aimed to evaluate the transcriptional changes occurring in isolated perfused mammary alveolar tissue in response to inoculation with S. agalactiae and to identify the most affected biological functions and pathways after 3 h. Four udders taken at slaughter from cows with healthy mammary gland were perfused ex situ with warmed and gassed Tyrode's solution. Mammary alveolar tissue samples were taken from the left fore and rear quarters (IQ-inoculated quarters) before inoculation (hour 0) and at 3 h post inoculation (hpi) and at the same times from control right fore and rear quarters (not inoculated: NIQ). A total of 1756 differentially expressed genes (DEGs) were identified between IQ and NIQ at 3 hpi using edgeR package. Within this set of DEGs, 952 were up regulated and mainly involved with innate immune response and inflammatory response, e.g., CD14, CCL5, TLR2, IL-8, SAA3, as well as in transcriptional regulation such as FOS, STAT3 and NFKBIA. Genes down-regulated (804) included those involved with lipid synthesis e.g., APOC2, SCD, FABP3 and FABP4. The most affected pathways were chemokine signaling, Wnt signaling and complement and coagulation cascades, which likely reflects the early stage response of mammary tissue to S. agalactiae infection. No significant gene expression changes were detected by RNA-Seq in the others contrasts. Real time-PCR confirmed the increase in mRNA abundance of immune-related genes: TLR2, TLR4, IL-1ß, and IL-10 at 3 hpi between IQ and NIQ. The expression profiles of Casp1 and Bax for any contrasts were unaffected whereas Bcl2 was increased in IQ, which suggests no induction of apoptosis during the first hours after infection. Results provided novel information regarding the early functional pathways and gene network that orchestrate innate immune responses to S. agalactiae infection. This knowledge could contribute to new strategies to enhance resistance to this disease, such as genomic selection.

Pré-natal odontológico: assistência às gestantes na rede pública de atenção básica em saúde / Prenatal dental care: dental care for pregnant woman in the public primary healthcare network

Objetivo: avaliar como se dá a assistência odontológica a pacientes gestantes na rede pública de atenção básica em saúde, através das práticas descritas pelos cirurgiões-dentistas que compõe essa rede.Métodos: trata-se de um estudo transversal, em que os dados foram coletados por meio de questionário estruturado, entre maio e julho/2017 com cirurgiões-dentistas da rede pública de atenção básica em saúde do município de Belo Horizonte (MG). A análise foi por meio de cálculo de prevalência, utilizando o pacote estatístico STATA.Resultados: participaram deste estudo 260 cirurgiões-dentistas. Dentre eles, 98,5% atendiam gestantes, com média mensal de 1 a 4 atendimentos, havendo adesão ao tratamento em 54,5% dos casos. O acesso se deu, majoritariamente, através de encaminhamentos do médico e enfermeiro, ou livre demanda. Quase todos os dentistas (94,9%) sentem-se seguros para o atendimento da gestante. As principais dificuldades referiram-se à encaminhamento para tomadas radiográficas e falta de informação dos profissionais envolvidos no pré-natal e das gestantes sobre o atendimento odontológico.Conclusão: As gestantes estão recebendo assistência odontológica na rede pública de atenção básica e os cirurgiões-dentistas neste estudo não apresentaram receio em atende-as. O acesso facilitado aos serviços odontológicos disponíveis nos Centros de Saúde está sendo executada; pelas informações prestadas pelos cirurgiões-dentistas pôde-se ver que o encaminhamento das gestantes feito pelos profissionais de saúde envolvidos no pré-natal, seja ele médico, enfermeiro, Agente Comunitário de Saúde, está sendo realizado.

Aim: To evaluate the prenatal dental care provided for pregnant women in the public primary healthcare network, based on the perception of dentists who work in this service.Methods: This study was cross-sectional with a quantitative approach. The data were collected through a structured questionnaire between May and July 2017 with dentists who provide dental care in the public primary healthcare network in Belo Horizonte (MG). Data were analyzed using prevalence estimates calculated using the STATA statistics package. Results: Two hundred sixty dental surgeons participated in this study. Among them, 98.5% provided dental care for pregnant women in their healthcare center, with a monthly average of 1 to 4 visits and with treatment adherence in 54.5% of the cases. The access was mainly through referral given by the doctor or nurse or by free application. Almost all of the dentists (94.9%) considered themselves prepared to provide dental care to pregnant women. The main difficulties were related to the use of radiography and the lack of information of healthcare professionals involved in providing prenatal dental care and dental care for pregnant women during this period. Conclusion: The pregnant women are receiving dental care in the public primary healthcare network, and the dentists in this study were not afraid to attend to them. The facilitated access to the dental care services available at the Health Centers is being carried out; through the information provided by the dentists, it was possible to see that the referral of the pregnant women by the healthcare professionals involved in prenatal dental care, whether they are a doctor, a nurse, or a Community Healthcare Agent, is being carried out.

Honey bee colonies act as reservoirs for two Spiroplasma facultative symbionts and incur complex, multiyear infection dynamics.

Two species of Spiroplasma (Mollicutes) bacteria were isolated from and described as pathogens of the European honey bee, Apis mellifera, ~30 years ago but recent information on them is lacking despite global concern to understand bee population declines. Here we provide a comprehensive survey for the prevalence of these two Spiroplasma species in current populations of honey bees using improved molecular diagnostic techniques to assay multiyear colony samples from North America (U.S.A.) and South America (Brazil). Significant annual and seasonal fluctuations of Spiroplasma apis and Spiroplasma melliferum prevalence in colonies from the U.S.A. (n = 616) and Brazil (n = 139) occurred during surveys from 2011 through 2013. Overall, 33% of U.S.A. colonies and 54% of Brazil colonies were infected by Spiroplasma spp., where S. melliferum predominated over S. apis in both countries (25% vs. 14% and 44% vs. 38% frequency, respectively). Colonies were co-infected by both species more frequently than expected in both countries and at a much higher rate in Brazil (52%) compared to the U.S.A. (16.5%). U.S.A. samples showed that both species were prevalent not only during spring, as expected from prior research, but also during other seasons. These findings demonstrate that the model of honey bee spiroplasmas as springtime-restricted pathogens needs to be broadened and their role as occasional pathogens considered in current contexts.

A new approach to characterization of the resistance of populations of Rhipicephalus microplus (Acari: Ixodidae) to organophosphate and pyrethroid in the state of Minas Gerais, Brazil.

The monitoring of resistance of cattle tick populations in Brazil to the chemical bases in use is largely limited to investigation of the phenotypic profile. There are few studies investigating the role played by the genotypic profile in acaricide resistance in the country. Therefore, the aim of the present study was to carry out molecular characterization and trace out the genetic profile of populations of Rhipicephalus microplus with respect to resistance to the organophosphate and pyrethroid chemical groups. For that purpose, larvae were genotyped belonging to 587 populations for pyrethroids and 306 for organophosphates, using the polymerase chain reaction technique. It was found that 75.49% and 97.44% of the larvae studied showed resistance to the organophosphates and pyrethroids, respectively. Among the populations resistant to pyrethroids, 91.9% were heterozygotes, showing that most of the resistant populations have only one allele responsible for resistance. Therefore, it is possible to conclude that the genotyped populations have high resistance to organophosphates, and even more so to pyrethroids. This information is fundamental for understanding the mechanisms of resistance of R. microplus to acaricides, to enable improvement of control techniques.

Expression profile of genes associated with mastitis in dairy cattle.

In order to characterize the expression of genes associated with immune response mechanisms to mastitis, we quantified the relative expression of the IL-2, IL-4, IL-6, IL-8, IL-10, IFN-γ and TNF- α genes in milk cells of healthy cows and cows with clinical mastitis. Total RNA was extracted from milk cells of six Black and White Holstein (BW) cows and six Gyr cows, including three animals with and three without mastitis per breed. Gene expression was analyzed by real-time PCR. IL-10 gene expression was higher in the group of BW and Gyr cows with mastitis compared to animals free of infection from both breeds (p < 0.05). It was also higher in BW Holstein animals with clinical mastitis (p < 0.001), but it was not significant when Gyr cows with and without mastitis were compared (0.05 < p < 0.10). Among healthy cows, BW Holstein animals tended to present a higher expression of all genes studied, with a significant difference for the IL-2 and IFN- γ genes (p < 0.001). For animals with mastitis no significant difference in gene expression was observed between the two breeds. These findings suggest that animals with mastitis develop a preferentially cell-mediated immune response. Further studies including larger samples are necessary to better characterize the gene expression profile in cows with mastitis.

Expression profile of genes associated with mastitis in dairy cattle

In order to characterize the expression of genes associated with immune response mechanisms to mastitis, we quantified the relative expression of the IL-2, IL-4, IL-6, IL-8, IL-10, IFN-γ and TNF-α genes in milk cells of healthy cows and cows with clinical mastitis. Total RNA was extracted from milk cells of six Black and White Holstein (BW) cows and six Gyr cows, including three animals with and three without mastitis per breed. Gene expression was analyzed by real-time PCR. IL-10 gene expression was higher in the group of BW and Gyr cows with mastitis compared to animals free of infection from both breeds (p < 0.05). It was also higher in BW Holstein animals with clinical mastitis (p < 0.001), but it was not significant when Gyr cows with and without mastitis were compared (0.05 < p < 0.10). Among healthy cows, BW Holstein animals tended to present a higher expression of all genes studied, with a significant difference for the IL-2 and IFN-γ genes (p < 0.001). For animals with mastitis no significant difference in gene expression was observed between the two breeds. These findings suggest that animals with mastitis develop a preferentially cell-mediated immune response. Further studies including larger samples are necessary to better characterize the gene expression profile in cows with mastitis.

Percepção dos enfermeiros sobre a importância do uso dos equipamentos de proteção Individual para Riscos biológicos em um serviço de atendimento móvel de urgência / Opinión de enfermeras acerca de la importancia del uso de aparatos de protección individual contra los riesgos biológicos en un servicio móvil de cuidado urgencia / Perception of nurses on the importance of the use of individual protection equipment for biological risks in a service of mobile urgency care

Este estudo teve como objetivo perceber a importância para os enfermeiros do uso de equipamentos de proteção individual (EPI’s) relacionados a riscos biológicos no atendimento de suporte avançado em um serviço móvel de urgência, e identificar os EPI’s usados por eles no serviço móvel de urgência da cidade de Sete Lagoas. O estudo é de natureza descritiva exploratória com análise qualitativa baseada no método de Bardin. As unidades temáticas estabelecidas foram: identificando os riscos biológicos no atendimento pré-hospitalar; vulnerabilidade dos profissionais para o risco de exposição ocupacional no atendimento pré-hospitalar; percebendo a importância do uso dos equipamentos de proteção individual; o enfermeiro como elo na promoção da saúde. Os resultados revelam que os enfermeiros têm consciência da importância do uso de EPI’s, porém não os utilizam com a devida freqüência na prática de seu cotidiano laboral, conforme evidencia-se na amostra em que se comprova que 100 por cento usam luvas, botas e macacão, apenas 41,6 por cento usam máscara e somente 16,6 por cento utilizam óculos em todos os atendimentos.

This study had as its objective to perceive the importance for nurses of the use of individual protection equipment (IPE) related to biological risks in the work of advanced support in a mobile service of urgency care, and to identify the IPE’s used by nurses in the mobile service of urgency care of the city of Sete Lagoas. The study has a exploratory descriptive nature with qualitative analysis based in Bardin’s method. The established thematic units were: identifying the biological risks in the pre-hospital care; vulnerability of theprofessionals for the risk of occupational exposition in the pre-hospital attendance; perceiving the importance of the use of individual protection equipment; the nurse as a link in the promotion of health. Results show that nurses have conscience of the importance of the use of IEP’s, but they do not use them duly in their work practice, as is proven in the sample where one sees that 100 per cent of them use gloves, boots and overalls, but only 41.6 per cent use masks and only 16.6 per cent use eyeglasses in all cases they care for.

Este estudio tubo como su objetivo percibir la importancia para las enfermeras del uso de aparatos de protección individual (API) relacionados con los riesgos biológicos en el trabajo de ayuda avanzada en un servicio móvil de cuidado de urgencia, y identificarlos APIs usados por las enfermeras en el servicio móvil de cuidado de urgencia de la ciudad de Sete Lagoas. El estudio tiene una naturaleza descriptiva exploratoria con análisis cualitativo basado en el método de Bardin. Las unidades temáticas establecidas fueran: identificando los riesgos biológicos en el cuidado prehospitalario; vulnerabilidad de los profesionales a los riesgos de exposición ocupacional en la atención prehospitalaria; percibir la importancia del uso de aparatos de protección individual; la enfermera como agente de promoción de la salud. Los resultados demuestran que las enfermeras tienen conciencia de la importancia del uso de APIs, pero no los utilizan debidamenteen su práctica de trabajo, lo que se prueba en la muestra donde se ve que 100 por ciento de ellas usan guantes, botas y guardapolvos, pero solamente 41,6 por ciento utilizan máscaras y solamente 16,6 por ciento utilizan anteojos en todos los casos de cuidados.