Assistência odontológica diferenciada para crianças de 0 a 3 anos: avaliação de impacto no Serviço Público Municipal em Natal-RN

In Brazil, 0-5 years old children just have an oral health care system since 1990 s. Innumerable experiences of implantation of the attendance to the babies in the cities had appeared throughout the years, but it hasn´t been evaluated the comparative effect between children displayed and not displayed to the program. In this regard, the main of this research was describe the Early Childhood Oral Health Care in public health service in Natal, Rio Grande do Norte, Brazil and evaluate the impact of this specific oral health care for babies by comparison of indicators between exposed and non-exposed children. It was created an experimental group, formed by children covered by program which was paired, based on sex, age and socioeconomic status, with a control group, formed by uncovered children. After filling ethical application, the parents of children were questioned about some risk factors to dental caries and, in sequence, it was accomplish an oral examination in the child. It was verified the Visible Plaque Index (VPI), Gingival Bleeding Index (GBI), dmf-s and verification of caries activity. The sample was 40 children in each group. The results showed, for VPI, a difference of 7 percentile points for the experimental group, however this difference had no statistical significance, obtained by Student s t test (p=0.314). In relation to GBI, the control group showed a low mean (0.8%) comparing with experimental group (2.77%) and this difference was statistically significant (p=0.003). The results for dmf-s and evaluation of caries activity showed no statistical difference between groups. Among the probable reasons for absence of impact of intervention, could be included: (a) the practice model was the same in two groups, or the difference was very weak and (b) the oral health care has intrinsic limitations for to impact on oral health in low income populations

Condições de saúde bucal e capacidade funcional em idosos

Population aging is one of the greatest challenges to contemporary public health and, in this perspective, the functional capacity emerges as an important feature in geriatric assessment. The oral health of elderly, in turn, deserves special attention because, historically, in the dental services, this population group was not considered a priority for attention, which is verified by high rates of edentulism found even among these individuals. The present study proposes to examine the relationship between oral health status and functional capacity in an elderly population. To this end, intra-oral epidemiological examination was performed to assess the degree of dental caries, periodontal status, use and need of prosthesis and the presence of lesions. Functional capacity was assessed by the Independence in Activities of Daily Living, which considers the independence or not in the performance of six self-care functions. Socioeconomic and demographic characteristics and general health status were also investigated, in view of the possibility of intervention of these variables in the investigated relation. An factor analysis of the principal components was conducted which resulted four indicators of oral health conditions, representative of the population studied. 441 seniors were enrolled with mean age of 71.7 (± 8.7) years, the majority being female (68%). Functional capacity was dichotomized into completely independent individuals (89.6%) and dependent on at least one of the functions considered (10.4%). There was an association between functional capacity and the indicators related to the presence of many teeth and dental caries, and to that associated with the use and need of prostheses. These associations in turn, lost statistical significance when adjusting for confounding variables, combined in separate models for each indicator. Some of these variables, however, remained associated with functional capacity. It is considered that the study of oral health status of elderly, associeted with the search for an association with functional capacity is important in the construction of indicators necessary for planning preventive and therapeutic interventions that reduce the risk for loss of ability in daily physical functions and their consequences, as the harm in the oral self-care

Imunoexpressão da IL-17 e RORγt em carcinomas de células escamosas de lábio e língua

Th17 cells have been strongly associated to the pathogenesis of inflammatory and autoimmune diseases, although their influence on the carcinogenesis is still little known, there are reports of anti-tumor and protumoral actions. The objective of this study is to research the presence of Th17 lineage in lip and tongue SCC, using the analysis of the immunoexpression of IL-17 and RORγt, relating this immunoexpression with clinical and morphological findings in the attempt to better comprehend the role of these cells on the tumoral immunity of OSCCs. The results were submitted to non-parametric statistical tests with significance level of 5%. On the histomorphological analysis, it was observed the predominance of low level lesions on lip and high level lesions on tongue (p=0,024). It was not observed statistical significance between clinical stage and histological gradation of malignancy (p=0,644). For the immunohistochemical study, 5 random fields with greater immunoreactivity of the peritumoral inflammatory infiltrate were photomicrographed on the 400x magnification. It was done the count of lymphocytes which showed cytoplasmic and pericytoplasmic staining for the IL-17 cytokine as well as nuclear and cytoplasmic staining for RORγt. It was observed statistical significance difference on the quantity of immunopositive lymphocytes to IL-17 between the groups of SCC of lip and tongue (p=0,028). For the RORγt it was not observed statistical significance difference between the groups of SCC of lip and tongue (p=0,915). It was not observed statistical difference between the immunostaining of IL-17 and RORγt with histological gradation of malignancy and clinical staging. The findings of this research suggest a possible anti-tumor role of IL-17 for cases of lip. The results of the analysis of the RORγt are possibly due to the wide duality of the anti-tumor and protumoral role of the Th17 cells and their plasticity which, in the presence of different cytokines expressed on the tumor microenvironment, can alter its phenotype.

Avaliação da expressão da BMP -2/4 e BMPR-IA em Carcinoma Epidermóide Oral metastático e não metastático

The expression of bone morphogenetic proteins (BMPs) is altered in a variety of human canceres. The BMP-2/4 and BMPR-IA were recently shown to be overexpressed in high-risk premalignant and malignant lesions of oral epithelium. The present study analysed the expression of BMP-2/4 and BMPR-IA in Oral Squamous Cell Carcinoma (OSCC) such as their implications in disease prognostic using munohistochemistry. Ten cases of Oral Fibroepithelial Hiperplasia were selected as a control group. The experimental group included 16 cases of OSCC without metastases and 7 cases of OSCC metastatic. The presence or absence of nodal metastases was used as parameter to evaluated the disease prognostic. The results demonstrated weak immunoreactivity for BMP-2/4 and BMPR-IA in every case of the control group. In the cases of OSCC with metastases an overexpression of BMP-2/4 (71,4%) was observed while the BMPR-IA showed weak expression (85,7%). In the cases of OSCC without metastases BMP-2/4 (62,5%) and BMPR-IA showed strong immunostaining standing out an overexpression of the receptor in all the specimens. Observed statistical significance for correlation between the oral cancer prognostic and the staining intensity of the BMP-2/4 (p=0,002). There wasn t statistical significance for association between the staining intensity of the BMPR-IA and the disease prognostic (p<0,001). In conclusion, this findings suggest that the overexpression of BMP-2/4 associated with the loss of expression of the BMPR-IA in OSCC metastatic has prognostic relevance, as the loss of sensitivity to BMPs can be an indicative of metastases development in OSCC

Avaliação imuno-histoquímica das galectinas-1, -3, -4 e -7 em carcinoma epidermóide de língua.

Several studies are carried out with aim to establish parameters to determine biologic behavior of oral squamous cell carcinoma, in order this neoplasm presents high rates of morbidity and mortality. The purpose of present research was to performe a clinic, morphologic and immunohistochemical analysis by the expression of galectins 1, 3, 4 and 7 in 65 cases of tongue squamous cell carcinoma, correlating this expression with clinics (outcome of the disease, metastasis and clinical staging) and morphologic parameters (malignancy histologic gradation system). The clinical and morphologic parameters analysed and expression of galectins 1, 3, 4 and 7 were submitted to statistical analysis (Qui2 test), observing that can be utilized as indicators of the biological behavior of the tongue squamous cell carcinoma. The galectin 1 was expressed in 87,7% of cases studied and it exhibit statistically significant correlation with metastasis (p=0,033) and clinical staging (p=0,016), it is located mostly in the citoplasm of the stomal cells. The immunoexpression of galectin 3 in 87,7% of cases was correlated with the presence of metastasis (p=0,033) and malignancy histological gradation system (p=0,031), observed, mostly of cases, in tongue squamous cell carcinoma of malignancy high grading. The galectin 4 showed no statistical significance to any of the parameters evaluated. The expression of galectin 7 in 73,8% of cases showed statistically significant correlation with the malignancy histologic grading (p=0,005), which is marking exclusively found in neoplastic epithelial cells, in the mostly of cases, it is found in cytoplasm and membrane (50%). The expressive immunopositivy of the galectins 1, 3 and 7, observed in this research, leads us to suggest a broad participation of these proteins in oral carcinogenesis, and its possible use as markers of biological behavior and tumor progression in cases of squamous cell carcinoma of the tongue

Avaliacao de polimorfismos nos genes XPD e XRCC3 em carcinomas orais de celulas escamosas

Oral squamous cell carcinoma (OSCC) is an important cause of morbidity and mortality worldwide despite recent advances in treatment. There are several studies aiming to find markers that may improve the assessment of this disease prognosis. Studies about genetic polymorphisms have gained prominence due to their influence on individual susceptibility to cancer development. The aim of this study was to evaluate the association between the frequency of polymorphisms XPD Lys751Gln and XRCC3 Thr241Met and clinicopathological features of OSCC cases, including age, sex, presence or absence of metastases, and histological grading of malignancy according to Bryne (1998). Sample consisted of 54 cases of OSCC and 40 cases of inflammatory fibrous hyperplasia (IFH). OSCC cases were classified as low or high grade. DNA samples were previously extracted from paraffin blocks. Genotypes for each case were determined through PCR-RFLP (polymerase chain reaction - restriction fragment length polymorphism). Results were analyzed by Fisher s exact test and Chi-square test and the odds ratio was calculated considering p < 0.05 to indicate statistical significance. For XPD, Lys/Gln genotype was more common in IFHs (n=28; 70%) than in OSCCs (n=24; 44.4%) (OR: 0.3; p<0.05). Frequency of Gln allele was higher in high-grade lesions when compared to low grade lesions (0.48 and 0.21, respectively) (OR: 3.4; p<0.05). For XRCC3, Met allele was more common in OSCC than in IFH (0.49 and 0.35, respectively) (OR: 2.6; p<0.05). Met/Met genotype was associated with presence of metastases (OR: 8.1; p<0.05). There was no statistically significant association between the genotypes and the age or sex of patients. In the present sample, the higher frequency of XPD Gln allele in IFH reveals a possible protective role of this variant against the development of OSCC. However, its association with high-grade lesions indicates that this allele could influence the tumor progression after the neoplasia development. The presence of XRCC3 Met allele, in turn, seems to contribute to the development of OSCC and metastases

Avaliação mecânica in vitro utilizando miniplacas quadradas e retangulares do sistema 2.0 mm em fraturas da região anterior de mandíbula

The aim of this study was to comparatively evaluate the mechanical strength of squared and rectangular 2.0 mm system miniplates comparing them to the standard configuration with 2 straight miniplates in stabilizing fractures in the anterior mandible. Ninety synthetic polyurethane mandible replicas were used in mechanical test. The samples were divided into six groups of three different methods for fixation. Groups 1, 2 and 3 showed complete fractures in symphysis, characterized by a linear separation between the medial incisor, and groups 4, 5 and 6 showed complete fractures in parasymphysis with oblique design. Groups 1 and 4 were represented by the standard technique with two straight miniplates parallel to each other. Groups 2 and 5 were stabilized by squared miniplates and groups 3 and 6 were fixed by rectangular design. Each group was subjected to a mechanical test at a displacement speed of 10 mm/min on a universal testing machine, receiving linear vertical load on the region of the left first molar. The values of the maximum load and when displacements reached 5 mm were obtained and statistically analyzed by calculating the confidence interval of 95%. Fixation systems using squared (G2) and rectangular (G3) miniplates obtained similar results. No statistically significant differences with respect to the maximum load and the load at 5 mm displacement were found when compared to standard method in symphyseal fractures (G1). In parasymphysis the fixation method using squared miniplates (G5) obtained results without significant differences regarding the maximum load and the load at 5 mm when compared to the standard configuration (G4). The fixation method using rectangular miniplates (G6) showed inferior results which were statistically significant when compared to the standard configuration (G4) for parasymphysis fractures. The mechanical behavior of the fixation methods was similar, except when rectangular miniplates were used. The fixation methods showed better results with statistical significance in symphyseal fractures

A relação entre os determinantes sociais em saúde e os investimentos setoriais e a mortalidade infantil em municípios brasileiros com mais de 80 mil habitantes

Investments in health have controversial influence on results of the health of populations, besides being subject rarely explored in literature. Moreover, from the 1970s, the social determinants of health have been consolidated in the disease process as multifactorial factors (social, economic, cultural, etc.) that directly or indirectly influence the occurrence of health problems of populations, as well as mortality rates. This study aimed to evaluate the influence of these investments and the social determinants of health on infant mortality and its neonatal and post-neonatal mortality. This is an ecological study, in which the sample was composed of Brazilians cities with over 80,000 inhabitants, avoiding fluctuations in mortality rates for common small populations, and ensure greater coverage of information systems on mortality and births Brazilians and, therefore, increase data consistency. To isolate the effect of investments in health, we used multiple linear regression. The socioeconomic indicators (p <0.001, p = 0.004, p <0.001), the inequality index (p <0.001, p = 0.001, p = 0.006) and coverage of prenatal visits (p <0.001, p <0.001; p = 0.005) were associated with infant mortality rate total, neonatal and post-neonatal, and the Gross Domestic Product per capita only influenced the overall infant mortality rate and neonatal (p=0.022; 0.045). Investments in health, in this model, lost statistical significance, showing no correlation with mortality rates among children under one year. We conclude that the social determinants of health has an influence on the variation in mortality rates of Brazilian cities, however the same was not observed for indicators of health investment

Impacto da cárie precoce severa na infância na qualidade de vida relacionada à saúde bucal de pré-escolares sob privação social

Early childhood caries, especially in its severe form, which is characterized by an acute and aggressive nature, can have negative impacts on thequality of life of a child, due to effects such as difficulty in chewing, decreased appetite, weight loss, insomnia, changes in behavior and a decreased performance in school, among others. Moreover, the quality of life of the child`s family can also be affected, as the pain and discomfort caused by this type of caries result in loss of working days of parents, spending on dental treatments, changes in sleep patterns and stress. The aim of this study was to evaluate the impact of severe early childhood caries in the Oral Health-Related Quality of Life (OHRQoL) of public daycares`s preschool children through the Escala de Impacto da Saúde Bucal na Primeira Infância, a Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS). A single calibrated examiner (kappa=1.0) evaluated, through the dmfs index, the oral health of 116 children aged between 3 and 5, which were included in one of three study groups: "caries-free", "not-severe early childhood caries" and "severe early childhood caries". The parents responded to ECOHIS, to assess their perception regarding the OHRQoL of their children, and a questionnaire on socioeconomic conditions. The OHRQoL was measured through the total scores and domains of ECOHIS. Descriptive analysis, Mann-Whitney test, Kruskal-Wallis test, chi-square test and Poisson multiple regression with robust variance were used. Among the children observed, 38.8% were caries-free, 27.6% showed not-severe early childhood caries and 33.6% showed severe early childhood caries. Regarding the total score of ECOHIS, severe early childhood caries had a greater negative impact on OHRQoL, compared to caries-free and not-severe early childhood caries groups (p <0.001). Regarding the child subscale, there was significant difference between the "severe early childhood caries" group and the other groups in all domains, except for theone of self-image / social interaction. In the family subscale domains, there was statistical significance between the severe early childhood caries and the caries-free groups in all domains (p <0.001), whereas between the "severe early childhood caries and not-severe early childhood caries groups there was a statistically significant difference only in the domain of parental anguish (p <0.001). Multivariate analysis showed that early childhood caries and the parent`s age were significantly associated to OHRQoL (p <0.05), independently of the other variables in the model. The presence of severe early childhood caries resulted in greater negative impact on OHRQoL (AdjPR= 6.016; 95%CI = 3.12 11.56; p<0.001), while older parents reported better OHRQoL (AdjPR = 0.603; 95%CI = 0.428 - 0.850; p = 0.004). The presence of severe early childhood caries had a negative impact on OHRQoL of preschool children and their families.

Prevalência de incontinência urinária e fatores associados em idosos institucionalizados

Urinary incontinence (UI) is a geriatric syndrome that is especially prevalent in institutionalized individuals, and that causes economic and social impacts derived from treatment costs and overload of caregiver. UI also entails physical consequences to the health of the elderly, such as urinary tract infections or pressure ulcers, among other health problems. However, the existing national research on this condition is still scarce and comprises serious methodological biases. Therefore, the objective of this study is to determine the prevalence of urinary incontinence and associated factors in institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December, 2013 and carried out in 10 nursing homes in the city of Natal (Northeast Brazil). UI was verified through the program Minimum Data Set version 3.0, which was also used to assess fecal incontinence, urinary devices and UI control programs. Data collection included sociodemographic information, UI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity and Pfeiffer test for cognitive status). Bivariate analysis was performed using the Chi-Square Test (or Fisher‟s Exact Test) and the Linear Chi-Square Test, calculating the prevalence ratio with 95% confidence interval. Variables with p value under 0.20 were included in the multivariate analysis, which was performed using the Stepwise Forward logistic regression. The inclusion of variables in the final model depended on the likelihood ratio test, absence of multicollinearity and on the Hosmer-Lemeshow test. A statistical significance level of 0.05 was considered. Six (1.8%) hospitalized elderly, one individual in palliative care (0.3%) and one (0.3%) individual under the age of 60 were excluded from the study. The final sample consisted of 321 elderly, mostly females, with a mean age of 81.5 years. The prevalence of UI was 59.43% and the final model revealed statistically a significant association between UI and white race, physical inactivity, stroke, mobility constraints and cognitive decline. The most frequent UI type was functional UI due to physical or cognitive disability, and incontinence control measures were applied only to a minority of residents (approximately 8%). It is concluded that UI is a health issue that affects more than half of the institutionalized elderly, and is associated with white race, physical inactivity, stroke and other geriatric syndromes such as immobility and cognitive disability. Most of these associated factors are modifiable and therefore the findings of this study highlight the importance of UI prevention and treatment in nursing homes, which include general measures, such as physical and psychosocial activities, and specific measures, such as prompted voiding

Textura do recurso pedagógico e implicações em atividade de encaixe realizada por indivíduos com paralisia cerebral

O estudo teve o propósito de verificar a influência da textura do recurso pedagógico no tempo despendido e no índice de retidão para execução de uma atividade de encaixe realizada por indivíduos com paralisia cerebral. Participaram do estudo 6 alunos com sequelas de paralisia cerebral do tipo espástica, com idade entre 7 anos e 8 meses e 28 anos e 1 mês. O participante deveria segurar o objeto e levá-lo a um ponto demarcado previamente para o encaixe e, após, retorná-lo à posição inicial. O objeto foi apresentado nas texturas lisa, intermediária e áspera, de forma aleatória. Para a coleta de dados, foi utilizada filmagem para posterior leitura pelo programa Kavideo, que possibilitou cálculos para observar o tempo despendido na tarefa e o índice de retidão. Foi realizado o estudo da normalidade das distribuições, verificada por meio do teste de normalidade de Kolmogorov-Smirnov (Teste KS) e a comparação entre as texturas lisa, intermediária e áspera, no movimento de encaixe, por meio da análise de variância de medidas repetidas. Adotou-se para todos os testes nível de significância de 5% de probabilidade para a rejeição da hipótese de normalidade. O resultado do teste de análise de variância de medidas repetidas mostrou que não houve significância para as variáveis estudadas com o recurso apresentado nas três texturas. Porém, os dados da estatística descritiva mostraram que o encaixe do recurso com a textura lisa despendeu um menor tempo para execução da tarefa e, também, determinou um melhor desempenho com relação à trajetória do movimento.

Análise do equilíbrio estático e de deformidades nos pés de crianças com paralisia cerebral

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Contrastes e contrastes encobertos na produção da fala de crianças

TEMA: análise acústica da fala. OBJETIVO: analisar acusticamente as substituições envolvendo o contraste entre /t/ e /k/ na fala de crianças em aquisição típica e desviante do contraste acima referido, a fim de identificar e quantificar a existência de contrastes encobertos. MÉTODO: foi elaborado um experimento de produção de fala que envolveu a repetição de palavras, que combinavam /t/ e /k/ com /a/ e /u/ na posição acentuada, por 9 crianças divididas em três grupos: crianças em processo de aquisição do contraste investigado (G1); crianças com transtorno fonológico (G2) e crianças com produções típicas (G3). Com o uso do software Praat, as produções foram editadas e analisadas de acordo com os seguintes parâmetros acústicos: características espectrais do burst; transição CV e características temporais. Os testes estatísticos utilizados foram ANOVA de Friedman e Manova. A significância estatística adotada foi menor que 0,05. RESULTADOS: tanto nas produções das crianças do G2 quanto nas produções das crianças do G1, detectamos, em grande medida (80% e 57,4%, respectivamente), a presença de contrastes encobertos nos erros de substituição das oclusivas investigadas. Adicionalmente, a análise acústica revelou diferenças em como as crianças utilizam as pistas fonético-acústicas para marcarem a distinção entre /t/ e /k/. CONCLUSÃO: muitas das substituições presentes da produção de fala de crianças em processo de aquisição típico e desviante tratam-se na verdade de contrastes fônicos encobertos. Além disso, o uso da análise acústica permitiu a detecção de diferenças sutis da produção da fala das crianças.

Nasoendoscopy of velopharynx before and during diagnostic therapy

Nasoendoscopy is an important tool for assessing velopharyngeal function. The purpose of this study was to analyze velar and pharyngeal wall movement and velopharyngeal gap during nasoendoscopic evaluation of the velopharynx before and during diagnostic therapy. Nasoendoscopic recordings of 10 children with operated cleft lip and palate were analyzed according to the International Working Group Guidelines. Ratings of movement of velum and pharyngeal walls, and size, location and shape of gaps were analyzed by 3 speech-language pathologists (SLPs). Imaging was obtained during repetitions of the syllable /pa/ during a single nasoendoscopic evaluation: (a) before diagnostic therapy, and (b) after the children were instructed to impound and increase intraoral air pressure (diagnostic therapy). Once the patients impounded and directed air pressure orally, the displacement of the velum, right, left and posterior pharyngeal walls increased 40, 70, 80, and 10%, respectively. Statistical significance for displacement was found only for right and left lateral pharyngeal walls. Reduction in gap size was observed for 30% of the patients and other 40% of the gaps disappeared. Changes in gap size were found to be statistically significant between the two conditions. In nasoendoscopic assessment, the full potential of velopharyngeal displacement may not be completely elicited when the patient is asked only to repeat a speech stimulus. Optimization of information can be done with the use of diagnostic therapy's strategies to manipulate VP function. Assuring the participation of the SLP to conduct diagnostic therapy is essential for management of velopharyngeal dysfunction.

Avaliação da contribuição de desenvolvedores para projetos de software usando mineração de repositórios de software e mineração de processos

Software Repository Mining (MSR) is a research area that analyses software repositories in order to derive relevant information for the research and practice of software engineering. The main goal of repository mining is to extract static information from repositories (e.g. code repository or change requisition system) into valuable information providing a way to support the decision making of software projects. On the other hand, another research area called Process Mining (PM) aims to find the characteristics of the underlying process of business organizations, supporting the process improvement and documentation. Recent works have been doing several analyses through MSR and PM techniques: (i) to investigate the evolution of software projects; (ii) to understand the real underlying process of a project; and (iii) create defect prediction models. However, few research works have been focusing on analyzing the contributions of software developers by means of MSR and PM techniques. In this context, this dissertation proposes the development of two empirical studies of assessment of the contribution of software developers to an open-source and a commercial project using those techniques. The contributions of developers are assessed through three different perspectives: (i) buggy commits; (ii) the size of commits; and (iii) the most important bugs. For the opensource project 12.827 commits and 8.410 bugs have been analyzed while 4.663 commits and 1.898 bugs have been analyzed for the commercial project. Our results indicate that, for the open source project, the developers classified as core developers have contributed with more buggy commits (although they have contributed with the majority of commits), more code to the project (commit size) and more important bugs solved while the results could not indicate differences with statistical significance between developer groups for the commercial project