Analysis of the ethical aspects of professional confidentiality in dental practice

From the point of view of deontological ethics, privacy is a moral right that patients are entitled to and it is bound to professional confidentiality. Otherwise, the information given by patients to health professionals would not be reliable and a trustable relationship could not be established. The aim of the present study was to assess, by means of questionnaires with open and closed questions, the awareness and attitudes of 100 dentists working in the city of Andradina, São Paulo State, Brazil, with respect to professional confidentiality in dental practice. Most dentists (91.43%) reported to have instructed their assistants on professional confidentiality. However, 44.29% of the interviewees showed to act contradictorily as reported talking about the clinical cases of their patients to their friends or spouses. The great majority of professionals (98.57%) believed that it is important to have classes on Ethics and Bioethics during graduation and, when asked about their knowledge of the penalties imposed for breach of professional confidentiality, only 48.57% of them declared to be aware of it. Only 28.57% of the interviewees affirmed to have exclusive access to the files; 67.14% reported that that files were also accessed by their secretary; 1.43% answered that their spouses also had access, and 2.86% did not answer. From the results of the present survey, it could be observed that, although dentists affirmed to be aware of professional confidentiality, their attitudes did not adhere to ethical and legal requirements. This stand of health professionals has contributed to violate professional ethics and the law itself, bringing problems both to the professional and to the patient.

Epidemiology of the Cnidarian Physalia physalis stings attended at a health care center in beaches of Adicora, Venezuela

Stings caused by jellyfish and jellyfish-like colonies are common all around the world, with serious manifestations and occasional deaths reported in some countries. Between December 2006 and 2007, epidemiological, clinical and treatment aspects of stings caused by the Portuguese man-of-war (Physalia physalis) in 59 patients consulting the ambulatory emergency in Adicora, Falcon State, Venezuela, were studied. Most of the stings occurred in males (59%) preschool and school-aged children (49%), visitors from other areas of the country (92%) during holidays when bathing or diving at the beach (97%). Injuries presented linear erythematous plaques at the point of contact with the animal, located in several anatomical sites. Most clinical manifestations observed were: intense burning pain, urticaria, erythema and inflammation (100%), as well dyspnea with laryngeal edema and fever (19%). Patients were treated with topical drugs, including antihistamine and antipyretic drugs, but also with systemic hydrocortisone. P. physalis stings in Adicora appeared to have a seasonal pattern, with systemic complications potentially life-threatening. Thus, epidemiological surveillance program is recommended, particularly in travelers. (C) 2012 Elsevier Ltd. All rights reserved.

Paracoccidioidomycosis: Survey and clinical aspects from the Department of Dermatology of the School of Medicine of Botucatu (Sao Paulo - Brazil)

Background - Paracoccidioidomycosis is the most frequent among the systemic mycoses in Brazil. Objective: To study the cases of paracoccidioidomycosis diagnosed from 1976 to 1996 at the Department of Dermatology of the School of Medicine of Botucatu. Methods - Descriptive study obtained from specific protocols comprising anamnesis, clinical- dermatological-laboratorial examination, treatment and follow-up of the patients. Results - Paracoccidioidomycosis was diagnosed in 1.04% of the dermatologic outpatients assisted from 1976 to 1996. In 315 cases, 89.8% were male, 61.9% were over forty and 53.7% were rural workers. The complaints were related more to oropharyngolaryngeal (53.6%) or cutaneous (23.8%) lesions or adenopathy (10.2%). Seventy patients had already been treated in other health services. The chronic multifocal clinical from was the most common: 80.6% of the cases, followed by the acute-subacute (juvenile type) 15.5%. The disease was pulmonary in 80.0%, oropharyngolaryngeal in 69.2% and cutaneous in 45.7%. Th treatment: Amphotericin B in 146 patients, Ketoconazole - 88, Itraconazole - 56, Sulfonamide derivatives - 146 and Terbinafine in 3. The lethality index resulting from the disease or its treatment was 2.0%. Conclusions - The high number of cases, showing the regional relevance of the disease and the high percentage of tegumentary complaints and the high number of relapsing are remarkable.

An hydrochemical answer to a legislative demand involving health risk related to water quality

Effluents and surface waters around an area involved with the inking of tissues at Itatiba municipality, São Paulo State, Brazil, were chemically analyzed with the purpose of evaluating the influence on the water quality of the chemicals released, as well to provide answers to legislative requirements related to the São Paulo State Register 997 published on 31 May 1976.

Population and health in Latin America and the Caribbean: outstanding matters, new challenges

Spanish version available at the Library

Mucocele of the glands of Blandin-Nuhn-clinical, pathological, and therapeutical aspects

Purpose: This study aims to review anatomical, clinical, and pathological concepts as well as to discuss the most adequate therapeutic approach to the mucoceles of the glands of Blandin-Nuhn. Discussion: The glands of Blandin-Nuhn are localized in the ventral part of the tongue, next to the apex in the lingual median plane. Development of a mucocele in this site is rarely seen; besides, as the glands of Blandin-Nuhn are not encapsulated and are directly overlapped to the muscle tissues, their manipulation tends to be different from the other oral mucoceles. Conclusion: As Blandin-Nuhn mucoceles are uncommon and their clinical appearance could be similar to other lesions, it is important that health professionals know their clinical and histopathological features to avoid having them misdiagnosed. © 2010 Springer-Verlag.

Modernization and foreign trade in the health services

Includes bibliography

Chagas disease and triatomine biology (Heteroptera, Triatominae), with emphasis on aspects of spermatogenesis

A century after the discovery of Chagas disease, it is still one of the most important parasitic diseases affecting humans. The subfamily Triatominae is important in medical health, because these insects are vectors of Trypanosoma cruzi, the etiologic agent of Chagas disease. These insects are also of important cytological relevance because they have particular cell characteristics, such as persistence of nucleolar material in spermatogenesis. The germ cells of the animal kingdom have chromatoid bodies (CBs) in their cytoplasm that can originate from nucleolar material that is fragmented in the early stages of spermatogenesis and plays an important role in cellular communication between the spermatids during spermiogenesis. Currently, there are few studies on the function and formation of the CB in nucleologenesis, especially with emphasis on the ultrastructure of the cells involved in spermatogenesis of insects. Considering the importance of knowledge about the triatomine fauna, we conducted a study of the biogeography and reports of these insects and a survey of patients with Chagas disease in the northwestern region of São Paulo State. Data collected from 1995 to 2009 indicated 700 individuals with Chagas disease, demonstrating a range of 0 to 40 years, which shows that the disease may be active in this region. Moreover, of the 1150 patients treated for cardiomyopathy, 44% were chagasic. Regarding the triatomines noted and captured in the period from 2004 to 2009, the species were Triatoma sordida and Rhodnius neglectus, with T. sordida being the most abundant. In addition, some triatomines were infected by T. cruzi in various developmental stages. We also analyzed the nucleolar cycle and fibrillarin nucleolar protein expression in CB of spermatogenic cells of T. infestans and T. sordida, using histological, ultrastructural and immunocytochemical techniques. The results revealed fibrillarin nucleolar protein expression in the nucleus and in some cytoplasmic spots of germ cells during spermatogenesis in triatomines. These data suggest that fibrillarin could be a constituent of CB, which was most likely derived from nucleolar fragmentation. This is the first time that fibrillarin protein expression has been shown in CB during spermatogenesis progression in triatomines. Knowledge about the biology of triatomines was deepened in this study and, in particular, the structural and ultrastructural aspects of spermatogenesis in triatomines. This study showed that the disease may be active in the northwestern region of São Paulo and expanded our knowledge of the biology of triatomines, the main vectors of Chagas disease. © FUNPEC-RP.

Biologic and genetics aspects of chagas disease at endemic areas

The etiologic agent of Chagas Disease is the Trypanosoma cruzi, transmitted through blood-sucking insect vectors of the Triatominae subfamily, representing one of the most serious public health concerns in Latin America. There are geographic variations in the prevalence of clinical forms and morbidity of Chagas disease, likely due to genetic variation of the T. cruzi and the host genetic and environmental features. Increasing evidence has supported that inflammatory cytokines and chemokines are responsible for the generation of the inflammatory infiltrate and tissue damage. Moreover, genetic polymorphisms, protein expression levels, and genomic imbalances are associated with disease progression. This paper discusses these key aspects. Large surveys were carried out in Brazil and served as baseline for definition of the control measures adopted. However, Chagas disease is still active, and aspects such as host-parasite interactions, genetic mechanisms of cellular interaction, genetic variability, and tropism need further investigations in the attempt to eradicate the disease. Copyright 2012 Marilanda Ferreira Bellini et al.

Potential and limits of health management reform in Chile

Includes bibliography

Reforming health-care management in Latin America

Includes bibliography

The health insurance market: lessons on the conflict between equivalence and solidarity

Includes bibliography

Health-related quality of life and depression in patients with dentofacial deformity

Introduction: Patients with dentofacial deformities present difficulties at work and in social adaptation. At the same time, they often appear depressed, and as a consequence, the psychosocial aspects of surgery play an important role. The aim of this study was to investigate the effects that depression causes in the quality of life of patients with dentofacial deformity. Material and methods: Filthy patients were recruited 1 year before undergoing orthognathic surgery and correlated oral and general health with the presence and absence of depression. In order to accomplish this, these patients received an adapted questionnaires of quality of life and Beck Depression Inventory to fill out. Fisher's test was applied, with a significance level of 5 %. Intercooled Stata version 9.0 was used to analyze data. Results: Among the eight domains of quality of life, there were three associated with depression status: vitality (p < 0.001), social aspects (p = 0.011), and mental health (p = 0.008). Discussion: There is growing interest in the impact of dentofacial deformity conditions on patients' quality of life. The scientific literature has discussed the social aspects of these deformities and showed that untreated patients had low self-esteem and suffered social restrictions before making the orthodontic and surgical treatments. This study concluded that the depression interferes significantly in vitality, social aspects of the individual, and mental health and, at the same time, emphasizes that the orthognathic surgery aims to not only restore esthetics and function to the patient but also improve the quality of life. © 2012 Springer-Verlag.

Infrastructure, integration and equity: The social impact of the health and public transportation infrastructure.

Academicians and practitioners generally agree that there is a positive correlation between more and better infrastructure and economic growth. From the broader perspective of development, attempts have been made in the literature to identify the different theoretical connections and the empirical patterns that link infrastructure to productivity, on the one hand, and those that link it to social inclusion and equity, on the other hand. Infrastructure contributes to development in different ways. The capital involved is not homogeneous, nor is its effect on the distributive aspects. Water and sanitation have a particularly strong association with the health of the general population and with infant mortality, early childhood health, learning abilities and the acquisition of labour skills. With respect to transportation, the reduction of costs and travel times has a direct economic impact on economic activities of production and domestic and international distribution. That infrastructure also has a social and distributive role to play by reducing the number of fatal accidents and serious injuries in the sectors that are naturally most susceptible to them, namely, the poor. Under the broad umbrella of infrastructure, we can include a number of facilities that make possible the provision of certain services. Some of these facilities require very significant fixed capital investments; some of them are residential, while others are not necessarily. What they all have in common is the existence of networks (transportation, wiring, pipelines) and a strong convergence of physical capital and/or technology, as well as the need for major investments in periodic maintenance.

Planting coconuts in Indian villages: ethnoecological aspects and evaluation of a "sustainable development" project

Apesar de cientistas e tomadores de decisão abraçarem o conceito geral de "desenvolvimento sustentável", há pouco acordo sobre como se atingir esta meta em situações específicas. Assim, projetos de desenvolvimento sustentável são amplamente criticados por etno-cientistas quanto à forma como são inter-culturalmente formulados. Aqui reportamos um caso controverso de plantio de coco-da-Bahia em aldeias Kayapó do sul do Pará, e fazemos a nossa autocrítica. Nós partimos da premissa de que o reflorestamento e o estado geral de saúde/nutrição caminham lado a lado. Portanto, o desenvolvimento da cultura de cocos por si só deve contribuir para a conservação da floresta no longo prazo e, simultaneamente, contribuir para o bom estado nutricional do povo Kayapó que protege a floresta da ameaça de práticas não-sustentáveis. Nós buscamos descobrir como que o comportamento dos Kayapó afeta o desenvolvimento da cultura de cocos quando amparada com suporte externo. Nós apresentamos resultados de duas viagens de campo para a terra Kayapó, onde detectamos fatores sócio-ecológicos relevantes para o sucesso de nosso projeto de apoio à cultura de coqueiros nas aldeias indígenas. Primeiro, em novembro de 2007, nós visitamos as aldeias Kikretum, Moikarakô e Aukre (dentre 10 aldeias que receberam mudas de coqueiros de nosso programa de apoio) para entregar um segundo carregamento de mudas de coqueiro (o primeiro carregamento aconteceu em abril de 2006). E descrevemos quantitativamente um aspecto do comportamento dos dispersores de sementes de coco (os Kayapó). Especificamente, como as palmeiras pré-existentes nas aldeias são distribuídas dentre as famílias dos índios e como este carregamento sobreviveu a fatores etno-ecológicos. Segundo, em julho de 2008 nós visitamos as aldeias Kokraimoro e Pykararankre e estimamos a posição dos coqueiros pré-existentes e dos novos em relação a outras árvores cultivadas, fazendo uso de censos partindo do centro das aldeias para seus limites exteriores. Nas três aldeias indígenas visitadas em 2007, virtualmente todos os coqueiros pré-existentes pertenciam a poucas famílias e a distribuição de frutos era, na maior parte dos casos, altamente concentrada dentre os membros destas famílias. Entretanto, assumindo que todos os coqueiros jovens que sobreviveram ao primeiro ano chegarão à maturidade (do primeiro carregamento em abril de 2006), eles representam um aumento considerável no numero projetado de coqueiros adultos nas três aldeias visitadas (48, 195 e 101% em Kikretum, Moikarakô e Aukre, respectivamente). E uma redução substancial na desigualdade de acesso aos cocos. Na expedição de 2008, encontramos que os índios geralmente plantam coqueiros bem próximos das suas casas onde a competição com outras árvores cultivadas podem limitar o desenvolvimento das palmeiras.