Resolubilidade da estratégia saúde da família e unidades básicas de saúde tradicionais: contribuições do Pet-Saúde

O Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) materializa uma política indutora de novas relações entre instituições de ensino de nível superior e a rede assistencial à saúde. A Universidade de São Paulo - Campus de Ribeirão Preto e a Secretaria de Saúde do município, selecionadas pelo PET-Saúde/2009, avaliaram a resolubilidade das Unidades Básicas de Saúde (UBS) e das Unidades de Estratégia Saúde da Família (ESF), como forma de contribuir para a qualificação da Atenção Básica. Foi realizado um estudo transversal em 13 Unidades de Saúde (oito ESF e cinco UBS), com a participação de 216 alunos dos cursos da área da saúde, 30 preceptores (profissionais) da rede pública de saúde e cinco tutores (docentes). Foram coletados dados de 12.494 atendimentos, sendo 7.129 (58,9%) em ESF e 4.963 (41,1%) em UBS, compostos por 4.059 (33,6%) pessoas do sexo masculino e 8.035 (66,4%) do feminino.As UBS referenciaram mais pacientes do que as Unidades de ESF (OR = 1,67; IC 95% 1,46 - 1,90; [p < 0,05]). As especialidades com maior demanda por encaminhamentos foram oftalmologia, cardiologia e ortopedia. A ESF apresenta-se como modelo assistencial com maior resolubilidade, e o PET-Saúde é uma iniciativa importante, considerando-se que estimula a ampliação desse modelo.

Aprendizado eletrônico na formação multiprofissional em saúde: avaliação inicial

O objetivo deste relato é apresentar, dentro da proposta do Programa Nacional de Reorientação da Formação Profissional em Saúde (Pró-Saúde), uma parte do projeto da Faculdade de Medicina de Ribeirão Preto (USP). Trata-se da estratégia de inserção das Tecnologias de Informação e Comunicação (TIC) no ensino de graduação extramuros da FMRP, que visa definir e implantar recursos tecnológicos de Aprendizado Eletrônico para apoiar atividades discentes e docentes, gestão da informação, educação continuada e segunda opinião formativa. A trajetória metodológica delineou tanto o processo de atendimento de parte das ações do eixo Cenário de Prática em Atenção Básica de saúde relativa ao processo de ampliação da rede de malha ótica, essencial para suporte às atividades de desenvolvimento do uso das TIC, quanto a abordagem qualitativa de um estudo exploratório sobre a utilização do Teleduc no primeiro ano do eixo de Atenção à Saúde da Comunidade (ASC) do curso de Medicina. Nesta investigação foram realizados dois grupos focais com aplicação de questionário estruturado a discentes e docentes.

Os proprietários de escravos e a estrutura da posse na antiga freguesia de São Simão, 1835

Este artigo estuda a estrutura da posse de escravos em São Simão, localidade do nordeste paulista, utilizando a lista nominativa de 1835. O objetivo principal é analisar a estrutura da posse de escravos na região pouco antes da chegada do café, pois, ao que tudo indica, a estrutura produtiva formada nesse período teria contribuído para o rápido desenvolvimento da cultura cafeeira durante a segunda metade do século XIX. Destaca-se o caso de Ribeirão Preto, localidade desmembrada de São Simão nos primeiros anos da década de 1870, que chegou a ser a maior produtora de café do Estado de São Paulo.

Bem-estar subjetivo: autoavaliação em estudantes universitários

O bem-estar subjetivo surgiu como um interessante tema da Psicologia Positiva e tem recebido cada vez mais atenção de pesquisadores da área. Este estudo teve como objetivo principal verificar a eficácia de três instrumentos de autoavaliação do bem-estar subjetivo, a partir de uma população de estudantes universitários da cidade de Ribeirão Preto. Foi realizada a análise estatística descritiva e a análise de componentes principais para os resultados apresentados no Questionário de Felicidade Oxford e na Escala de Felicidade Subjetiva. O Item de Felicidade Global foi analisado apenas por intermédio da estatística descritiva, pois apresentava uma única questão. Partindo do fato de que pesquisas realizadas indicam uma diferença pouco significativa entre autoavaliações realizadas por homens e por mulheres, este estudo traz resultados que confirmam essa constatação quanto às medianas apresentadas em todos os instrumentos, porém aponta diferenças significativas em relação à estrutura dos instrumentos de homens e mulheres para o Questionário de Felicidade Oxford.

Síndrome de fragilidade relacionada à incapacidade funcional no idoso

OBJETIVOS: Caracterizar o perfil sociodemográfico de idosos, verificar os níveis de fragilidade segundo sexo, independência funcional e atividades instrumentais da vida diária e correlacionar as dimensões da Medida da Independência Funcional e Atividades Instrumentais da Vida Diária com idade, escolaridade, fragilidade e morbidades. MÉTODOS: Estudo de natureza observacional e transversal utilizando amostra de 240 idosos que residiam em Ribeirão Preto, São Paulo. O período de coleta foi de novembro/2010 e fevereiro/2011. Os questionários: perfil sociodemográfico, Escala de Fragilidade de Edmonton, Medida da Independência Funcional e Escala de Lawton e Brody foram utilizados. Para análise, foram empregados a estatística descritiva e o teste t-student e Pearson. RESULTADOS: A média de idade foi de 73,5 anos (±8,4), 57,5% eram casados, 39,1% apresentaram algum nível de fragilidade. Entre os idosos frágeis, 29,8% tinham dependência mínima/supervisão, e 81,9% dependência parcial para as atividades instrumentais da vida diária. CONCLUSÃO: Evidenciou-se maior dependência para as atividades nos idosos frágeis, sendo o sexo feminino com maior prevalência de fragilidade.

Accessibility and demand at an Emergency Care Unit: the user's perspective

AIM: To analyze the search for Emergency Care (EC) in the Western Health District of Ribeirão Preto (São Paulo), in order to identify the reasons why users turn to these services in situations that are not characterized as urgencies and emergencies. METHODS: A qualitative and descriptive study was undertaken. A guiding script was applied to 23 EC users, addressing questions related to health service accessibility and welcoming, problem solving, reason to visit the EC and care comprehensiveness. RESULTS: The subjects reported that, at the Primary Health Care services, receiving care and scheduling consultations took a long time and that the opening hours of these services coincide with their work hours. At the EC service, access to technologies and medicines was easier. CONCLUSION: Primary health care services have been unable to turn into the entry door to the health system, being replaced by emergency services, putting a significant strain on these services' capacity.

Effect of experimental Ricinus communis solution for denture cleaning on the properties of acrylic resin teeth

This study evaluated Knoop hardness, surface roughness and color alteration of artificial teeth for dentures after immersion in water, 1% sodium hypochlorite and an experimental solution of 2% Ricinus communis (RC). Thirty specimens of Vipi, Biolux and Trilux were analyzed. Tests of Knoop hardness, surface roughness and color alteration were conducted immediately after specimen preparation (T0) and after two immersion protocols for 15 days (ΔT15) and 183 days (ΔT183). Data variation (ΔT) were subjected to ANOVA and Tukey's test (p<0.05). At ΔT15, Vipi presented hardness increase and Biolux presented the highest variation (p=0.01). RC caused the highest increase in hardness (p=0) and the lowest increase (p=0.005) in roughness. Biolux presented the lowest color alteration (p =0). At ΔT183, Trilux underwent the highest hardness variation (p=0). Biolux presented an increase in roughness (p=0). There was no significant differences in color alteration among the artificial teeth (p=0.06) and among solutions (p=0.08) after 183 days of immersion. All solutions (distilled water, 1% sodium hypochlorite and 2% RC) caused alterations on the analyzed properties. Both immersion protocols caused alterations on the analyzed properties.

Antioxidant activity by DPPH assay of potential solutions to be applied on bleached teeth

The aim of this study was to assess, using the DPPH assay, the antioxidant activity of several substances that could be proposed to immediately revert the problems caused by bleaching procedures. The percentage of antioxidant activity (AA%) of 10% ascorbic acid solution (AAcidS), 10% ascorbic acid gel (AAcidG), 10% sodium ascorbate solution (SodAsS), 10% sodium ascorbate gel (SodAsG), 10% sodium bicarbonate (Bicarb), Neutralize® (NE), Desensibilize® (DES), catalase C-40 at 10 mg/mL (CAT), 10% alcohol solution of alpha-tocopherol (VitE), Listerine® (LIS), 0.12% chlorhexidine (CHX), Croton Lechleri (CL), 10 % aqueous solution of Uncaria Tomentosa (UT), artificial saliva (ArtS) and 0.05% sodium fluoride (NaF) was assessed in triplicate by 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) free radical assay. All substances exhibited antioxidant activity, except for CL. AAcidS, AAcidG and VitE exhibited the highest AA% (p<0.05). On the contrary, CHX, NE, LIS and NaF showed the lowest AA% (p<0.05). In conclusion, AAcidS, AAcidG, SodAsS, SodAsG and VitE presented the highest antioxidant activity among substances tested in this study. The DPPH assay provides an easy and rapid way to evaluate potential antioxidants.

Bacteriostatic effect of copaiba oil (Copaifera officinalis) against Streptococcus mutans

This study evaluated the inhibitory activity of copaiba oil (Copaifera officinalis against the cariogenic microorganism, Streptococcus mutans. For such purpose, a minimum inhibition concentration test of copaiba oil against S. mutans was performed, using the serial dilution in broth technique, with a negative control, a positive control (0.12% chlorhexidine) and a 10% copaíba oil solution as a test. A minimum bactericidal concentration test with tubes presenting microbial inhibition was also conduced. In the minimum inhibitory concentration test, copaiba oil showed inhibition of bacterial growth at all concentrations tested up to 0.78 µL/mL of the 10% copaiba oil solution in the broth. In addition, the negative control had no inhibition, and the 0.12% chlorhexidine solution was effective up to 6.25 µL/mL in the broth. Copaiba oil showed a bacteriostatic activity against S. mutans at low concentrations, and could be a an option of phytotherapic agent to be used against cariogenic bacteria in the prevention of caries disease.

Comparison of different ultrasonic vibration modes for post removal

This in vitro study compared different ultrasonic vibration modes for intraradicular cast post removal. The crowns of 24 maxillary canines were removed, the roots were embedded in acrylic resin blocks, and the canals were treated endodontically. The post holes were prepared and root canal impressions were taken with self-cured resin acrylic. After casting, the posts were cemented with zinc phosphate cement. The samples were randomly distributed into 3 groups (n=8): G1: no ultrasonic vibration (control); G2: tip of the ultrasonic device positioned perpendicularly to core surface and close to the incisal edge; and G3: tip of the ultrasonic device positioned perpendicularly to core surface at cervical region, close to the line of cementation. An Enac OE-5 ultrasound unit with an ST-09 tip was used. All samples were submitted to the tensile test using an universal testing machine at a crosshead speed of 1 mm/min. Data were subjected to one-way ANOVA and Tukey's post-hoc tests (α=0.05). Mean values of the load to dislodge the posts (MPa) were: G1 = 4.6 (± 1.4) A; G2 = 2.8 (± 0.9) B, and G3= 0.9 (± 0.3) C. Therefore, the ultrasonic vibration applied with the tip of device close to the core's cervical area showed higher ability to reduce the retention of cast post to root canal.

An in vivo radiographic evaluation of the accuracy of Apex and iPex electronic Apex locators

The aim of this study was to evaluate in vivo the clinical applicability of two electronic apex locators (EALs) - Apex (Septodont) and iPex (NSK) - in different groups of human teeth by using radiography. The working lengths (WLs) of 100 root canals were determined electronically. The EAL to be used first was chosen randomly and a K-file was inserted into the root canal until the EAL display indicated the location of the apical constriction (0 mm). The K-file was fixed to the tooth and a periapical radiograph was taken using a radiographic film holder. The K-file was removed and the WL was measured. The same procedure was repeated using the other EAL. Radiographs were examined with the aid of a light-box with lens of ×4 magnification by two blinded experienced endodontists. The distance between the file tip and the root apex was recorded as follows: (A) +1 to 0 mm, (B) -0.1 to 0.5 mm, (C) -0.6 to 1 mm, (D) -1.1 to 1.5 mm, and (E) -1.6 mm or greater. For statistical purposes, these scores were divided into 2 subgroups according to the radiographic apex: acceptable (B, C, and D) and non-acceptable (A and E). Statistically significant differences were not found between the results of Apex and iPex in terms of acceptable and non-acceptable measurements (p>0.05) or in terms of the distance recorded from file tip and the radiographic apex (p>0.05). Apex and iPex EALs provided reliable measurements for WL determination for endodontic therapy.

Treatment of gingival recessions in heavy smokers using two surgical techniques: a controlled clinical trial

Smokers have small root coverage which is associated with bad vascularity of periodontal tissues. This study evaluated a technique that can increase the blood supply to the periodontal tissues compared with a traditional technique. Twenty heavy smokers (10 males and 10 females) with two bilateral Miller class I gingival recessions received coronally positioned flaps in one side (Control group)and extended flap technique in the other side (Test group). Clinical measurements (probing pocket depth, clinical attachment level, bleeding on probing, gingival recession height, gingival recession width, amount of keratinized tissue, and width and height of the papillae adjacent to the recession) were determined at baseline, 3 and 6 months postoperatively. Salivary cotinina samples were taken as an indicator of the nicotine exposure level. No statistically significant differences (p>0.05) were detected for the clinical measurements or smoke exposure. Both techniques promoted low root coverage (Control group: 43.18% and Test group: 44.52%). In conclusion, no difference was found in root coverage between the techniques. Root coverage is possible and uneventful even, if rather low, in heavy smoker patients with low plaque and bleeding indices.

Effect of Nd:YAG laser combined with fluoride on the prevention of primary tooth enamel demineralization

Most studies dealing with the caries preventive action of Nd:YAG laser have been done in permanent teeth and studies on primary teeth are still lacking. The aim of this study was to evaluate in vitro the effect of Nd:YAG laser combined or not with fluoride sources on the acid resistance of primary tooth enamel after artificial caries induction by assessing longitudinal microhardness and demineralization depth. Sixty enamel blocks obtained from the buccal/lingual surface of exfoliated human primary molars were coated with nail polish/wax, leaving only a 9 mm² area exposed on the outer enamel surface, and randomly assigned to 6 groups (n=10) according to the type of treatment: C-control (no treatment); APF: 1.23% acidulated phosphate fluoride gel; FV: 5% fluoride varnish; L: Nd:YAG laser 0.5 W/10 Hz in contact mode; APFL: fluoride gel + laser; FVL: fluoride varnish + laser. After treatment, the specimens were subjected to a des-remineralization cycle for induction of artificial caries lesions. Longitudinal microhardness data (%LMC) were analyzed by the Kruskal-Wallis test and demineralization depth data were analyzed by oneway ANOVA and Fisher’s LSD test (á=0.05). APFL and APF groups presented the lowest percentage of microhardness change (p<0.05). Demineralization depth was smaller in all treated groups compared with the untreated control. In conclusion, Nd:YAG laser combined or not with fluoride gel/varnish was not more effective than fluoride alone to prevent enamel demineralization within the experimental period.

Influence of apical foramen lateral opening and file size on cemental canal instrumentation

Since instrumentation of the apical foramen has been suggested for cleaning and disinfection of the cemental canal, selection of the file size and position of the apical foramen have challenging steps. This study analyzed the influence of apical foramen lateral opening and file size can exert on cemental canal instrumentation. Thirty-four human maxillary central incisors were divided in two groups: Group 1 (n=17), without flaring, and Group 2 (n=17), with flaring with LA Axxess burs. K-files of increasing diameters were progressively inserted into the canal until binding at the apical foramen was achieved and tips were visible and bonded with ethyl cyanoacrylate adhesive. Roots/files set were cross-sectioned 5 mm from the apex. Apices were examined by scanning electron microscopy at ×140 and digital images were captured. Data were analyzed statistically by Student’s t test and Fisher’s exact test at 5% significance level. SEM micrographs showed that 19 (56%) apical foramina emerged laterally to the root apex, whereas 15 (44%) coincided with it. Significantly more difficulty to reach the apical foramen was noted in Group 2. Results suggest that the larger the foraminal file size, the more difficult the apical foramen instrumentation may be in laterally emerged cemental canals.

Effects of chemical composition on the corrosion of dental alloys

The aim of this study was to determine the effect of the oral environment on the corrosion of dental alloys with different compositions, using electrochemical methods. The corrosion rates were obtained from the current-potential curves and electrochemical impedance spectroscopy (EIS). The effect of artificial saliva on the corrosion of dental alloys was dependent on alloy composition. Dissolution of the ions occurred in all tested dental alloys and the results were strongly dependent on the general alloy composition. Regarding the alloys containing nickel, the Ni-Cr and Ni-Cr-Ti alloys released 0.62 mg/L of Ni on average, while the Co-Cr dental alloy released ions between 0.01 and 0.03 mg/L of Co and Cr, respectively.The open-circuit potential stabilized at a higher level with lower deviation (standard deviation: Ni-Cr-6Ti = 32 mV/SCE and Co-Cr = 54 mV/SCE). The potenciodynamic curves of the dental alloys showed that the Ni-based dental alloy with >70 wt% of Ni had a similar curve and the Co-Cr dental alloy showed a low current density and hence a high resistance to corrosion compared with the Ni-based dental alloys. Some changes in microstructure were observed and this fact influenced the corrosion behavior for the alloys. The lower corrosion resistance also led to greater release of nickel ions to the medium. The quantity of Co ions released from the Co-Cr-Mo alloy was relatively small in the solutions. In addition, the quantity of Cr ions released into the artificial saliva from the Co-Cr alloy was lower than Cr release from the Ni-based dental alloys.