Drug addiction and alcoholism as predictors for tuberculosis treatment default in Brazil: a prospective cohort study.

This study aimed to evaluate the risk factors for tuberculosis (TB) treatment default in a priority city for disease control in Brazil. A cohort of TB cases diagnosed from 2008 to 2009 was followed up from patients' entry into three outpatient sites, in Juiz de Fora, Minas Gerais (Brazil), until the recording of the outcomes. Drug addiction, alcoholism and treatment site appeared to be independently associated with default. Current users of crack as the hardest drug (odds ratio (OR) 12·25, 95% confidence interval (CI) 3·04-49·26) were more likely to default than other hard drug users (OR 5·67, 95% CI 1·34-24·03), former users (OR 4·12, 95% CI 1·11-15·20) and those not known to use drugs (reference group). Consumers at high risk of alcoholism (OR 2·94, 95% CI 1·08-7·99) and those treated in an outpatient hospital unit (OR 8·22, 95% CI 2·79-24·21%) also were more likely to default. Our results establish that substance abuse was independently associated with default. National TB programmes might be more likely to achieve their control targets if they include interventions aimed at improving adherence and cure rates, by diagnosing and treating substance abuse concurrently with standard TB therapy.

Evaluation of temporomandibular joint disc displacement as a risk factor for osteoarthrosis.

Temporomandibular joint (TMJ) disc displacement is a clinical sign often found in patients with temporomandibular disorders (TMDs) and associated with TMJ osteoarthrosis. Osteoarthrosis is a degenerative joint disease that may be associated with pain and functional disability. The aim of this study was to evaluate the odds ratio (OR) of joints with disc displacement presenting osteoarthrosis via magnetic resonance imaging (MRI) analysis. In total, 224 TMJ images from patients with signs and symptoms of a TMD were evaluated. The OR, a measure of association, was used to calculate the likelihood of TMJ disc displacement (with or without reduction) with osteoarthrosis. Joints with anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR) were 2.73- and 8.25-times, respectively, more likely to have osteoarthrosis. A nine-times greater likelihood of osteophyte occurrence was observed in cases of ADDwoR, whereas a lower OR for their occurrence (OR 2.96) was observed in cases of ADDwR. The significant OR of joints with disc displacement presenting osteoarthrosis, particularly in cases of ADDwoR, emphasizes the importance of accurate assessment of changes in disc position, which may be associated with other painful and functional disorders of the TMJ.

Aspectos da mortalidade atribuível ao tabaco: revisão sistemática / Aspects of tobacco attributable mortality: systematic review

O artigo teve por objetivo analisar as metodologias publicadas e empregadas no cálculo da mortalidade atribuível ao fumo. Foram pesquisadas as bases de dados eletrônicas MEDLINE, LILACS entre 1990 e 2006. Foram encontrados 186 estudos que apresentaram a mensuração de mortalidade a partir do cálculo da fração atribuível ao fumo. Desses, foram selecionados 41 artigos. Os estudos realizados nos Estados Unidos e Canadá apresentaram metodologia uniformizada e taxas de mortalidade entre 18 por cento-23 por cento; 25 por cento-29 por cento no sexo masculino e 14 por cento-17 por cento no feminino. As variações metodológicas podem justificar as diferenças da mortalidade entre os estudos e nas estimativas para as principais doenças tabaco-relacionadas.

The objective of the article was to assess methodologies published and applied in calculating mortality attributable to smoking. A review of the literature was made for the period 1990 to 2006, in the electronic databases MEDLINE and LILACS. A total of 186 studies were found, which measured mortality based on calculating the smoking-attributable risk. Of these, a total of 41 were selected. The studies that were carried out in the United States and Canada presented a more standard methodology and reported smoking attributable mortality to be 18 percent-23 percent, with male mortality being 25 percent-29 percent and female mortality 14 percent-17 percent. The variations can be attributed to methodological differences and to different estimates of the main tobacco-related illnesses.

[Aspects of tobacco attributable mortality: systematic review]. / Aspectos da mortalidade atribuível ao tabaco: revisão sistemática.

The objective of the article was to assess methodologies published and applied in calculating mortality attributable to smoking. A review of the literature was made for the period 1990 to 2006, in the electronic databases MEDLINE and LILACS. A total of 186 studies were found, which measured mortality based on calculating the smoking-attributable risk. Of these, a total of 41 were selected. The studies that were carried out in the United States and Canada presented a more standard methodology and reported smoking attributable mortality to be 18%-23%, with male mortality being 25%-29% and female mortality 14%-17%. The variations can be attributed to methodological differences and to different estimates of the main tobacco-related illnesses.

[The reform process and social participation in health in Latin America]. / Los procesos de reforma y la participación social en saluden América Latina.

Currently, many countries throughout the world are reforming their health services. Even though these reforms differ according to the country's characteristics, they share many policies, one of which is the promotion of social participation in health-related matters. This policy, however, is not new in the field of health service organization. Throughout the last century, individual or collective collaboration between the population and health services has been promoted by several philosophies and concepts with different aims: from the search for collaboration with the general public to broaden public health system coverage to the promotion of the creation of mechanisms that would allow society to exercise control over these services' performance. Nevertheless, for the public to be involved with these services, several factors concerning both the services themselves and the population, need to converge. Although the theoretical frameworks that have encouraged social participation throughout the history of the development of health systems differ considerably, their practical implementation shares many common elements in all periods, from participation as a means of obtaining certain objectives to being an end in itself, as a democratic process. This can also be applied to the current promotion of social participation policies in the context of health care reforms, which are analyzed using Colombia and Brazil as examples.

Dental caries in the primary dentition in public nursery school children in Juiz de Fora, Minas Gerais, Brazil.

The aim of this study was to assess the prevalence of dental caries in the primary dentition and associated variables in low socioeconomic preschool children enrolled in public nursery schools in Juiz de Fora, Minas Gerais, Brazil. Four public institutions were selected by geographic criteria (two in the central region and two in the peripheral region). The study population comprised 338 children (181 boys; 157 girls) aged 2-6 years old. Dental caries was recorded using the decayed, missing, and filled teeth (dmf-t) index. Among the examined children, 50.6% were caries-free. The mean dmf-t index was 2.03. It was higher in the peripheral nursery schools (p<0.01). A trend towards a difference between sexes (p = 0.06) was observed. Logistic regression analysis selected a previous child's visit to dentist (p<0.001), geographic location of the public nursery school (p<0.01), and age (p<0.01) as predictive variables for the dmf-t index. The study showed the need for an oral health program for this population, including both curative and preventive measures in order to achieve the WHO/FDI goals for the year 2000, namely 50% of children free of caries at age 5-6 years.

Survival analysis in a sample of oral cancer patients at a reference hospital in Rio de Janeiro, Brazil.

This article gives the results of a 5-year survival analysis of 371 oral cancer patients who received medical care at a cancer reference hospital in Rio de Janeiro between 1986 and 1987. Patient profiles based on selected risk factors for oral cancer and 5-year survival based on prognostically relevant variables are described.

[The development of diagnosis-related groups--DRG's. Methodology for classifying hospital patients]. / O desenvolvimento dos "Diagnosis Related Groups"--DRGs. Metodologia de classificação de pacientes hospitalares.

The history of Diagnosis Related Groups (DRG's), a system for classifying patients in acute care hospitals, developed by researchers at Yale University, USA, is reviewed. DRGs are an instrument for measuring the hospital product, primarily from a management viewpoint. Starting with a review of the definitions of hospital product, the article follows the course from the first DRGs through the most recent revision, providing a summary of potential and current applications of the system in several countries, which range from payment mechanism to uses in quality control.