Saúde gengival de adolescentes e a utilização de serviços odontológicos, Estado de São Paulo

OBJETIVO: Avaliar a associação de condições de saúde gengival com a utilização de serviço odontológico. MÉTODOS: Realizou-se levantamento epidemiológico de saúde bucal de 1.799 adolescentes, em 35 cidades do Estado de São Paulo, em 2002. A saúde gengival foi avaliada pela prevalência de sangramento na gengiva à sondagem e cálculo dentário (índice periodontal comunitário) e oclusão dentária (índice de estética dentária). A utilização de serviços odontológicos foi medida pelo índice de cuidado (O/CPO) para cada cidade. Análise multinível de regressão logística ajustou modelos explicativos para fatores associados aos desfechos de interesse. RESULTADOS: A prevalência de sangramento gengival à sondagem foi 21,5%; de cálculo dentário foi 19,4%. Os participantes do sexo masculino, negros e pardos, moradores em áreas rurais, residentes em domicílios aglomerados e com atraso escolar apresentaram chance significantemente mais elevada para os agravos que seus respectivos pares de comparação. Características de oclusão dentária também associaram com gengiva não-saudável: apinhamento dos segmentos incisais, mordida aberta vertical anterior, relação molar antero-posterior. Cidades com maior utilização de serviço odontológico tiveram menor proporção de adolescentes com sangramento gengival e cálculo. CONCLUSÕES: A utilização de serviços odontológicos foi significativamente associada a melhores condições de saúde gengival (sangramento e cálculo). Essa associação independeu das características sociodemográficas individuais e contextuais, e de oclusão dentária.

O papel das Classificações da OMS - CID e CIF nas definições de deficiência e incapacidade

A Organização Mundial de Saúde tem hoje duas classificações de referência para a descrição dos estados de saúde: a Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, que corresponde à décima revisão da Classificação Internacional de Doenças (CID-10) e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). A utilização da CIF vem sendo aguardada com grande expectativa pelas organizações de pessoas com deficiências e instituições relacionadas. A falta de definição clara de "deficiência" ou "incapacidade" tem sido apontada como um impedimento para a promoção de saúde de pessoas com deficiência. É importante que essas definições, especialmente no âmbito legislativo e regulamentar, sejam consistentes e se fundamentem num modelo coerente sobre o processo que origina as situações de incapacidade. Este artigo tem como objetivo apresentar elementos da CID-10 e da CIF, e o papel que desempenham para definir deficiência e incapacidade. Os componentes da CIF podem contribuir para diferentes campos de aplicabilidade no que diz respeito ao entendimento das definições de deficiência ou incapacidade a partir do conceito de funcionalidade e dos fatores contextuais.

O papel das Classificações da OMS-CID e CIF nas definições de deficiência e incapacidade

A Organização Mundial de Saúde tem hoje duas classificações de referência para a descrição dos estados de saúde: a Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, que corresponde à décima revisão da Classificação Internacional de Doenças (CID-10) e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). A utilização da CIF vem sendo aguardada com grande expectativa pelas organizações de pessoas com deficiências e instituições relacionadas. A falta de definição clara de "deficiência" ou "incapacidade" tem sido apontada como um impedimento para a promoção de saúde de pessoas com deficiência. É importante que essas definições, especialmente no âmbito legislativo e regulamentar, sejam consistentes e se fundamentem num modelo coerente sobre o processo que origina as situações de incapacidade. Este artigo tem como objetivo apresentar elementos da CID-10 e da CIF, e o papel que desempenham para definir deficiência e incapacidade. Os componentes da CIF podem contribuir para diferentes campos de aplicabilidade no que diz respeito ao entendimento das definições de deficiência ou incapacidade a partir do conceito de funcionalidade e dos fatores contextuais

Prevalência de cárie não tratada na dentição decídua em áreas urbanas e rurais do Estado de São Paulo, Brasil

OBJETIVO: Descrever os diferenciais urbano-rurais da prevalência de cárie dentária em crianças com dentição decídua no Estado de São Paulo e identificar fatores associados. MÉTODOS: Participaram do estudo 24 744 crianças de 5 a 7 anos examinadas no Levantamento Epidemiológico de Saúde Bucal do Estado de São Paulo. Utilizou-se a análise multinível para verificar se havia associação entre a prevalência de cárie não tratada e as características sociodemográficas das crianças examinadas ou os aspectos socioeconômicos das cidades participantes. RESULTADOS: Ser negro ou pardo (razão de chances, ou OR, ajustada = 1,27), estudar na área rural (OR ajustada = 1,88) e freqüentar a escola pública (OR ajustada = 3,41) foram identificados como determinantes individuais de chance mais elevada de apresentar um ou mais dentes decíduos com cárie não tratada. Ser do sexo feminino (OR ajustada = 0,83) foi identificado como fator de proteção para essa condição. Os coeficientes negativos obtidos para as variáveis independentes de segundo nível indicaram que o perfil de saúde bucal das cidades participantes se beneficiou de valores mais elevados de índice de desenvolvimento humano municipal (b = -0,47) e da adição de flúor à rede de águas (b = -0,32). CONCLUSÕES: A prevalência de cárie não tratada é influenciada por fatores sociodemográficos de ordem individual e contextual. O presente estudo apresenta informações epidemiológicas das áreas rurais do Estado de São Paulo, oferecendo subsídios para o planejamento estratégico e normativo das ações de saúde bucal nos sistemas locais de saúde, com o intuito de contribuir para a promoção de eqüidade em saúde bucal

Geographic Information Systems (GIS) in Assessing Dental Health

The present study investigated the distribution profile of dental caries and its association with areas of social deprivation at the individual and contextual level. The cluster sample consisted of 1,002 12-year-old schoolchildren from Piracicaba, SP, Brazil. The DMFT Index was used for dental caries and the Care Index was used to determine access to dental services. On the individual level, variables were associated with a better oral status. On the contextual level, areas were not associated with oral status. However, maps enabled determining that the central districts have better social and oral conditions than the deprived outlying districts.

Complete Genome Viral Phylogenies Suggests the Concerted Evolution of Regulatory Cores and Accessory Satellites

We consider the concerted evolution of viral genomes in four families of DNA viruses. Given the high rate of horizontal gene transfer among viruses and their hosts, it is an open question as to how representative particular genes are of the evolutionary history of the complete genome. To address the concerted evolution of viral genes, we compared genomic evolution across four distinct, extant viral families. For all four viral families we constructed DNA-dependent DNA polymerase-based (DdDp) phylogenies and in addition, whole genome sequence, as quantitative descriptions of inter-genome relationships. We found that the history of the polymerase gene was highly predictive of the history of the genome as a whole, which we explain in terms of repeated, co-divergence events of the core DdDp gene accompanied by a number of satellite, accessory genetic loci. We also found that the rate of gene gain in baculovirus and poxviruses proceeds significantly more quickly than the rate of gene loss and that there is convergent acquisition of satellite functions promoting contextual adaptation when distinct viral families infect related hosts. The congruence of the genome and polymerase trees suggests that a large set of viral genes, including polymerase, derive from a phylogenetically conserved core of genes of host origin, secondarily reinforced by gene acquisition from common hosts or co-infecting viruses within the host. A single viral genome can be thought of as a mutualistic network, with the core genes acting as an effective host and the satellite genes as effective symbionts. Larger virus genomes show a greater departure from linkage equilibrium between core and satellites functions.

AMBIVALENT IMPLICATIONS OF HEALTH CARE INFORMATION SYSTEMS: A STUDY IN THE BRAZILIAN PUBLIC HEALTH CARE SYSTEM

This article evaluates social implications of the ""SIGA"" Health Care Information System (HIS) in a public health care organization in the city of Sao Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

Hemispheric contributions to lexical ambiguity resolution: Evidence from individuals with complex language impairment following left-hemisphere lesions

Nine individuals with complex language deficits following left-hemisphere cortical lesions and a matched control group (n 5 9) performed speeded lexical decisions on the third word of auditory word triplets containing a lexical ambiguity. The critical conditions were concordant (e.g., coin–bank–money), discordant (e.g., river–bank–money), neutral (e.g., day–bank– money), and unrelated (e.g., river–day–money). Triplets were presented with an interstimulus interval (ISI) of 100 and 1250 ms. Overall, the left-hemisphere-damaged subjects appeared able to exhaustively access meanings for lexical ambiguities rapidly, but were unable to reduce the level of activation for contextually inappropriate meanings at both short and long ISIs, unlike control subjects. These findings are consistent with a disruption of the proposed role of the left hemisphere in selecting and suppressing meanings via contextual integration and a sparing of the right-hemisphere mechanisms responsible for maintaining alternative meanings.

The perceptual magnet effect in Australian English vowels

Recent research (Kuhl, 1991) has suggested that the internal structure of vowel categories is graded in terms of stimulus goodness. It has been proposed that a best instance stimulus reflects a central point or prototype, which effectively renders within-category members perceptually more similar. Discrimination experiments suggest a nonlinear relationship between acoustic and perceptual space near category centers (Iverson & Kuhl, 1995b). This phenomenon has been described as the perceptual magnet effect. The present study investigated the presence of the perceptual magnet effect in five Australian vowel categories. Australian English speakers identified, rated, and discriminated between a pool of 32 vowel stimuli that varied in F1 and F2 values. The results from Experiments 1 and 2 showed that subjects were able to judge the quality and identity of each stimulus and that a general grading of stimulus quality was reported. This was not symmetrical, and the subjects' responses varied considerably. In Experiment 3, closer control of the methodology in the discrimination task and of contextual factors influencing the test materials was exercised. Despite this, evidence of the warping of perceptual space in discrimination data was not found. In general, these results do not provide support for the existence of the perceptual magnet effect, and explanations for this finding are discussed.

Volunteer decision making by older people: A test of a revised theory of planned behavior

This study was designed to test the utility of a revised theory of planned behavior in the prediction of intentions to volunteer among older people. Such a perspective allowed for the consideration of a broader range of social and contextual factors than has been examined in previous research on volunteer decision making among older people. The article reports the findings from a study that investigated volunteer intentions and behavior in a random sample of older people aged 65 to 74 years living in an Australian capital city. Results showed that, as predicted by the revised theory of planned behavior, intention to volunteer predicted subsequent reported volunteer behavior. Intention was, in turn, predicted by social norms (both subjective and behavioral), perceived behavioral control, and moral obligation, with the effect of attitude being mediated through moral obligation.

Spatial data mining for enhanced soil map modelling

The principle of using induction rules based on spatial environmental data to model a soil map has previously been demonstrated Whilst the general pattern of classes of large spatial extent and those with close association with geology were delineated small classes and the detailed spatial pattern of the map were less well rendered Here we examine several strategies to improve the quality of the soil map models generated by rule induction Terrain attributes that are better suited to landscape description at a resolution of 250 m are introduced as predictors of soil type A map sampling strategy is developed Classification error is reduced by using boosting rather than cross validation to improve the model Further the benefit of incorporating the local spatial context for each environmental variable into the rule induction is examined The best model was achieved by sampling in proportion to the spatial extent of the mapped classes boosting the decision trees and using spatial contextual information extracted from the environmental variables.

Extracellular serotonin level in the basolateral nucleus of the amygdala and dorsal periaqueductal gray under unconditioned and conditioned fear states: An in vivo microdialysis study

Serotonin (5-HT) plays a key role in the neural circuitry mediating unconditioned and conditioned fear responses related to panic and generalized anxiety disorders. The basolateral nucleus of the amygdala (BLA) and the dorsal periaqueductal gray (dPAG) appear to be mainly involved in these conditions. The aim of this study was to measure the extracellular level of 5-HT and its metabolite 5-hydroxyindolacetic acid (5-HIAA) in the BLA and dPAG during unconditioned and conditioned fear states using in vivo microdialysis procedure. Thus, for the unconditioned fear test, animals were chemically stimulated in the dPAG with semicarbazide, an inhibitor of the gamma-aminobutyric acid-synthesizing enzyme glutamic acid decarboxylase. For the conditioned fear test, animals were subjected to a contextual conditioned fear paradigm using electrical footshock as the unconditioned stimulus. The results show that the 5-HT and 5-HIAA level in the BLA and dPAG did not change during unconditioned fear, whereas 5-HT concentration, but not 5-HIAA concentration, increased in these brain areas during conditioned fear. The present study showed that the 5-HT system was activated during conditioned fear, whereas it remained unchanged during unconditioned fear, supporting the hypothesis that 5-HT has distinct roles in conditioned and unconditioned fear (dual role of 5-HT in anxiety disorders). (C) 2009 Elsevier B.V. All rights reserved.

Involvement of dopaminergic mechanisms in the nucleus accumbens core and shell subregions in the expression of fear conditioning

The involvement of dopamine (DA) mechanisms in the nucleus accumbens (NAC) in fear conditioning has been proposed by many studies that have challenged the view that the NAC is solely involved in the modulation of appetitive processes. However, the role of the core and shell subregions of the NAC in aversive conditioning remains unclear. The present study examined DA release in these NAC subregions using microdialysis during the expression of fear memory. Guide cannulae were implanted in rats in the NAC core and shell. Five days later, the animals received 10 footshocks (0.6 mA, 1 s duration) in a distinctive cage A (same context). On the next day, dialysis probes were inserted through the guide cannulae into the NAC core and shell subregions, and the animals were behaviorally tested for fear behavior either in the same context (cage A) or in a novel context (cage B). Dialysates were collected every 5 min for 90 min and analyzed by high-performance liquid chromatography. The rats exhibited a significant fear response in cage A but not in cage B. Moreover, increased DA levels in both NAC subregions were observed 5-25 min after the beginning of the test when the animals were tested in the same context compared with accumbal DA levels from rats tested in the different context. These findings Suggest that DA mechanisms in both the NAC core and shell may play an important role in the expression of contextual fear memory. (c) 2008 Elsevier Ireland Ltd. All rights reserved.

Regulation of conditioned and unconditioned fear in rats by 5-HT1A receptors in the dorsal periaqueductal gray

Studies on the involvement of 5-HT1-mediated mechanisms in the dorsal periaqueductal gray (dPAG) of animals with past stressful experiences have not been conducted so far. We investigated the role of 5-HT1 receptors in the dPAG of rats previously submitted to contextual fear conditioning. Defensive behaviors induced by activation of the dPAG were assessed by measuring the lowest electric current applied to this structure (threshold) able to produce freezing and escape responses during testing sessions of contextual fear conditioning, in which animals were placed in a context previously paired to footshocks. The 5-HT1A function of the dPAG was evaluated by local injections of 8-OH-DPAT (4 and 8 nmol/0.2 mu L) and WAY-100635 (10 nmol/0.2 mu L), selective agonist and antagonist of 5-HT1A receptors, respectively. In accordance with previous studies, 8-OH-DPAT increased aversive thresholds (antiaversive effects) but injections of WAY 100635 into the dPAG did not produce significant effects on the aversive thresholds in naive rats. However, the aversive thresholds of animals exhibiting contextual fear remained unchanged with both treatments. Moreover, 8-OH-DPAT and WAY 100635 did not change the dPAG post-stimulation freezing. The present results suggest that the stressful experience of being fear conditioned has an effect on the role of the 5-HT1A receptors in mediating unconditioned fear. Also, the reduction in the regulation of the defensive behaviors by 5-HT1A-mediated mechanisms in the dPAG of these animals may underlie the stress precipitated psychopathology associated with the neural substrates of aversion of the dPAG. (c) 2007 Elsevier Inc. All rights reserved.

GABAergic REGULATION OF AUDITORY SENSORY GATING IN LOW- AND HIGH-ANXIETY RATS SUBMITTED TO A FEAR CONDITIONING PROCEDURE

The inferior colliculus (IC) is primarily involved in the processing of acoustic stimuli, being in a position to send auditory information to motor centers that participate in behaviors such as prey catching and predators` avoidance The role of the central nucleus of the IC (CIC) on fear and anxiety has been suggested on the basis that rats are able to engage in tasks to decrease the aversiveness of CIC stimulation, increased Fos immunolabeling during diverse aversive states and increased CIC auditory evoked potentials (AEP) induced by conditioned fear stimuli Additionally it was shown that brainstem AEP, represented by wave V, for which the main generator is the IC, is increased during experimentally induced anxiety Rats segregated according to their low or high emotional reactivity have been used as an important tool in the study of fear and anxiety The IC contains a high density of GABA receptors Since the efficacy of an anxiolytic compound is a function of the animal`s anxiety level, it is possible that GABA-benzodiazepine (Bzp) agents affect LA and HA animals differently In this study we investigated the GABA-Bzp influence on the modulation of AEP in rats with low (LA) or high-anxiety (HA) levels, as assessed by the elevated plus maze test (EPM) GABA-Bzp modulation on the unconditioned AEP response was analyzed by using intra CIC injections (0 2 mu l) of the GABA-Bzp agonists muscimol (121 ng) and diazepam (30 mu g) or the GABA inhibitors bicuculline (10 ng) and semicarbazide (7 mu g) In a second experiment, we evaluate the effects of contextual aversive conditioning on AEP using foot shocks as unconditioned stimuli On the unconditioned fear paradigm GABA inhibition in creased AEP in LA rats and decreases this measure in HA counterparts Muscimol was effective in reducing AEP in both LA and HA rats Contextual fear stimuli increased the magnitude of AEP In spite of no effect obtained with diazepam in LA rats the drug inhibited AEP in HA animals The specificity of the regulatory mechanisms mediated by GABA Bzp for the ascending neurocircuits responsible for the acquisition of aversive information in LA and HA animals shed light on the processing of sensory information underlying the generation of defensive reactions (C) 2010 IBRO Published by Elsevier Ltd All rights reserved