Musculoskeletal disorders in upper limbs in dental students: exposure level to risk factors

Aim: This study assessed the risk factors of undergraduate students to develop musculoskeletal disorders (MSD) in the upper limbs, regarding gender, type of dental clinical procedure, mouth region treated, and the four-handed dentistry practice. Methods: Dental students enrolled in the 8th semester in the Araraquara School of Dentistry, UNESP, Brazil, were photographed while practicing 283 dental procedures. The Rapid Upper Limb Assessment (RULA) method was used to evaluate the working postures of each student. The photographs were evaluated and a final risk score was attributed to each analyzed procedure. The prevalence of risk factors of developing MSD was estimated by point and by 95% confidence interval. The association between the risk factor of developing disorders and variables of interest were assessed by the chi-square test with a significance level of 5%. Results: The risk factors of developing MSD were high, regarding most dental procedures performed by the undergraduate students (score 5: 7.07%, CI95%: 4.08- 10.06%; score 6: 62.54%, CI95%: 56.90-68.18%). There was no significant association between the RULA final score and gender (p=0.559), and type of dental procedure (p=0.205), and mouth regions by arch (p=0.110) or hemi-arch (p=0.560), and the use of four-handed dentistry (p=0.366). Conclusions: It can be concluded that gender, type of dental clinical procedure, mouth region treated, and practice of four-handed dentistry did not influence the risk of developing MSD in the upper limbs among the dental students evaluated; however, they are at a high risk of developing such disorders.

IRS-1 gene polymorphism and DNA damage in pregnant women with diabetes or mild gestational hyperglycemia

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

Use of the probability of stone formation (PSF) score to assess stone forming risk and treatment response in a cohort of Brazilian stone formers

Introduction: The aim was to confirm that PSF (probability of stone formation) changed appropriately following medical therapy on recurrent stone formers.Materials and Methods: Data were collected on 26 Brazilian stone-formers. A baseline 24-hour urine collection was performed prior to treatment. Details of the medical treatment initiated for stone-disease were recorded. A PSF calculation was performed on the 24 hour urine sample using the 7 urinary parameters required: voided volume, oxalate, calcium, urate, pH, citrate and magnesium. A repeat 24-hour urine sample was performed for PSF calculation after treatment. Comparison was made between the PSF scores before and during treatment.Results: At baseline, 20 of the 26 patients (77%) had a high PSF score (> 0.5). Of the 26 patients, 17 (65%) showed an overall reduction in their PSF profiles with a medical treatment regimen. Eleven patients (42%) changed from a high risk (PSF > 0.5) to a low risk (PSF < 0.5) and 6 patients reduced their risk score but did not change risk category. Six (23%) patients remained in a high risk category (> 0.5) during both assessments.Conclusions: The PSF score reduced following medical treatment in the majority of patients in this cohort.

Genomic alterations in patients showing multiple primary tumors and family history of cancer

Multiple primary tumors (MPT) are a major cause of mortality and morbidity among patients that have survived after the treatment of a first cancer. It has been proposed that after the first primary tumor, high risk of a subsequent tumor could be associated with radiotherapy used as treatment for the first cancer. Other potential risk factors include unhealthy lifestyle, genetic predisposition, aging, environmental determinants or an interaction between these factors. However, an association between the presence of MPT and family history of cancer in cases without clinical and molecular evidence of a known hereditary cancer syndrome is rarely described. Genomic DNA from 12 patients with at least two primary tumors and without mutations on TP53 was evaluated by CytoScan HD Array (Affymetrix). Chromosome Analysis Suite (ChAS) software v.2.0.1 was used considering at least 50 markers for gains; 25 for losses and a minimum of 5Mb for cnLOHs. Data from 1038 phenotypically healthy individuals (Affymetrix) and from Database of Genomic Variants were used as reference. Only alterations found in <1% (rare) or never described (new rare) in the reference population were considered. All cases, except one, presented a family history of cancer. Five cases developed MTP after radiotherapy and only one was located in the same treated area. It was detected 67 rare and 15 new rare genomic alterations encompassing 5.906 genes: 17 losses, 29 gains, and 36 cnLOH. X chromosome presented the higher number of alterations. Two patients with breast cancer presented a large deletion/cnLOH on 7q21. Enrichment analysis revealed 1275 genes associated with breast cancer (p= 0.001), which was diagnosed in 6 patients and their family members (all negative for BRCA1/2 or TP53 mutations). cnLOHs accounted for 44% of all the alterations. A significant proportion of cases (11/12) presented family history of cancer and the patients were not submitted to radiotherapy (7/12). We demonstrated the presence of rare genomic alterations in patients with MPT suggesting their involvement in the MPT development. cnLOH may arise as a new mechanism associated with the risk to develop MPT. All authors have declared no conflicts of interest.

Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following complete hydatidiform mole: a historical database review

To re-evaluate the safety of hormonal contraceptives (HC) after uterine evacuation of complete hydatidiform mole (CHM). Historical database review. Charing Cross Hospital Gestational Trophoblastic Disease Centre, London, United Kingdom. Two thousand four hundred and twenty-three women with CHM of whom 154 commenced HC while their human chorionic gonadotropin (hCG) was still elevated, followed between 2003 and 2012. We compared time to hCG remission between HC users and nonusers. The relationship between HC use and gestational trophoblastic neoplasia (GTN) development was assessed. The relationship between HC use and a high International Federation of Gynecology and Obstetrics (FIGO) risk score was determined. Time to hCG remission, risk of developing postmolar GTN and proportion of women with high FIGO risk score. No relationship was observed between HC use with mean time to hCG remission (HC users versus non-users: 12 weeks in both, P = 0.19), GTN development (HC users versus non-users: 20.1 and 16.7%, P = 0.26) or high-risk FIGO score (HC users versus nonusers: 0% and 8%, P = 0.15). Moreover, no association between HC and GTN development was found, even when an age-adjusted model was used (OR = 1.37, 95% CI 0.91-2.08, P = 0.13). The use of current HC is not associated with development of postmolar GTN or delayed time to hCG remission. Therefore, HC can be safely used to prevent a new conception following CHM regardless of hCG level. Non-concurrent cohort study to re-evaluate the safety of low dose HCs after uterine evacuation of CHM.

Risco da síndrome da apneia obstrutiva do sono em amostra populacional da cidade de Botucatu - SP

The most common sleep disorder is obstructive sleep apnea syndrome (OSAS), that is characterized by repeated pauses in breathing during sleep, resulting in partial or complete obstruction of the upper airway. It is associated with systemic arterial hypertension and obesity. Objective: To assess the frequency of OSAS in the adult population of Botucatu by the Berlin questionnaire. Method: Transveral study was performed in which the sample size was estimated at 385 individuals. The Berlin questionnaire was administered to adults randomly on the streets, supermarkets and local shops. Data were analyzed taking into account age, gender, "high risk for OSAS", hypertension, obesity and correlations for OSAS. Results: 468 people interviewed were aged between 18 and 95 years, average of 59 years. 166 (35.25%) individuals were identified as "high risk for OSAS", being more frequent in the population above 40 years. Obesity was present in 23.3%, more common in women (60.2%). 83.5% of the population obese also had a "high risk for OSAS". Hypertension was observed in 27.3%, of these 71.9% were at "high risk for OSAS". Conclusion: The study showed a high frequency of "high risk for OSAS" in the adult population. Despite the dissemination by the media about sleep apnea, patients are not investigated, even under medical care for hypertension.

Muskuloskeletal disorders in upper limbs in dental students: exposure level to risk factors

Aim: This study assessed the risk factors of undergraduate students to develop musculoskeletaldisorders (MSD) in the upper limbs, regarding gender, type of dental clinical procedure, mouthregion treated, and the four-handed dentistry practice. Methods: Dental students enrolled in the8th semester in the Araraquara School of Dentistry, UNESP, Brazil, were photographed whilepracticing 283 dental procedures. The Rapid Upper Limb Assessment (RULA) method was usedto evaluate the working postures of each student. The photographs were evaluated and a finalrisk score was attributed to each analyzed procedure. The prevalence of risk factors of developingMSD was estimated by point and by 95% confidence interval. The association between the riskfactor of developing disorders and variables of interest were assessed by the chi-square test witha significance level of 5%. Results: The risk factors of developing MSD were high, regardingmost dental procedures performed by the undergraduate students (score 5: 7.07%, CI95%: 4.08-10.06%; score 6: 62.54%, CI95%: 56.90-68.18%). There was no significant association betweenthe RULA final score and gender (p=0.559), and type of dental procedure (p=0.205), and mouthregions by arch (p=0.110) or hemi-arch (p=0.560), and the use of four-handed dentistry (p=0.366).Conclusions: It can be concluded that gender, type of dental clinical procedure, mouth regiontreated, and practice of four-handed dentistry did not influence the risk of developing MSD in theupper limbs among the dental students evaluated; however, they are at a high risk of developingsuch disorders.(AU).

Indeterminate form of chagas disease and metabolic syndrome: a dangerous combination

Chagas’ disease (CD) has been a major concern in public health in Latin America countries and in Brazil there are about 3 million people suffering from this disease. With the social and economic changes which have been occurring in the last 6 decades in the country, there have been a lot of changes in the population life style with severe metabolic consequences, especially for those with Chagas' disease. The objective of this study was to evaluate the prevalence of metabolic syndrome in individuals with the indeterminate form of CD. A total of 74 individuals, mean age of 55.6 years, participated in the study. Anthropometric and biochemical evaluations were performed. Overweight/obesity was found in 86.5 % of individuals, increased waist circumference in 72.5%, and 67% had more than 30% of fat mass. Hyperglycemia and dyslipidemia were observed in 24.3% and 75.7% of patients, respectively. Metabolic syndrome was diagnosed in 48.2% of patients. The family history revealed high prevalence of cardiovascular diseases (80.3%), systemic arterial hypertension (57.1%) and diabetes mellitus (42.8%). A total of 90% of patients were overweight/obese, and it is well known that increased adipose tissue, specially visceral adipose tissue is highly associated with dyslipidemia and cardiovascular diseases, as well as imbalance in production of proinflammatory and antiinflammatory cytokines produced by that tissue. Adipocytes are also known as a reservoir for Trypanosoma cruzi, favoring an increase in parasite load and a possible reacutization of the disease. Therefore, the study individuals are at high risk of developing cardiovascular diseases as well as further symptomatic form of the Chagas' disease, mainlychagastic cardiopathy.

Caracterização clínica epidemiológica e geográfica da hanseníase em município hiperendêmico do Brasil

Pós-graduação em Saúde Coletiva - FMB

Caracterização clínica epidemiológica e geográfica da hanseníase em município hiperendêmico do Brasil

Pós-graduação em Saúde Coletiva - FMB

Implementing Human Papillomavirus Testing in a Public Health Hospital: Challenges and Opportunities

Objectives: Robust evidence now supports human papillomavirus (HPV) testing as a more effective option to screening and as more sensitive than cytology in detecting high-grade cervical intraepithelial neoplasia. Our goal was to analyze the performance of the Hybrid Capture II (HC2) assay for high-risk HPV (hrHPV) in women undergoing gynecological examination at a public health hospital as part of the evaluation of HPV screening as an alternative or complement to cytology. Study Design: This analysis is a subset of a cross-sectional study carried out at a large public hospital serving a predominantly low-resource population. A total of 705 women were enrolled; the sensitivity and specificity of each test were estimated and compared. Results: The analysis identified 272 hrHPV-positive women (mean age 36.3 years) and 433 hrHPV-negative women (mean age 41.2 years). HPV testing showed a significantly increased sensitivity of the HC2 assay versus cytology (84.5 vs. 69.7%; p < 0.0001) but a lower specificity (49.90 vs. 88.78%; p < 0.0001). Conclusion: The combination of both methods seems to be useful in improving detection of cervical lesions. Copyright (C) 2012 S. Karger AG, Basel

Clusters of leprosy transmission and of late diagnosis in a highly endemic area in Brazil: focus on different spatial analysis approaches

Objective The Brazilian National Hansens Disease Control Program recently identified clusters with high disease transmission. Herein, we present different spatial analytical approaches to define highly vulnerable areas in one of these clusters. Method The study area included 373 municipalities in the four Brazilian states Maranha o, Para ', Tocantins and Piaui '. Spatial analysis was based on municipalities as the observation unit, considering the following disease indicators: (i) rate of new cases / 100 000 population, (ii) rate of cases < 15 years / 100 000 population, (iii) new cases with grade-2 disability / 100 000 population and (iv) proportion of new cases with grade-2 disabilities. We performed descriptive spatial analysis, local empirical Bayesian analysis and spatial scan statistic. Results A total of 254 (68.0%) municipalities were classified as hyperendemic (mean annual detection rates > 40 cases / 100 000 inhabitants). There was a concentration of municipalities with higher detection rates in Para ' and in the center of Maranha o. Spatial scan statistic identified 23 likely clusters of new leprosy case detection rates, most of them localized in these two states. These clusters included only 32% of the total population, but 55.4% of new leprosy cases. We also identified 16 significant clusters for the detection rate < 15 years and 11 likely clusters of new cases with grade-2. Several clusters of new cases with grade-2 / population overlap with those of new cases detection and detection of children < 15 years of age. The proportion of new cases with grade-2 did not reveal any significant clusters. Conclusions Several municipality clusters for high leprosy transmission and late diagnosis were identified in an endemic area using different statistical approaches. Spatial scan statistic is adequate to validate and confirm high-risk leprosy areas for transmission and late diagnosis, identified using descriptive spatial analysis and using local empirical Bayesian method. National and State leprosy control programs urgently need to intensify control actions in these highly vulnerable municipalities.

Frequency of subtype B and F1 dual infection in HIV-1 positive, Brazilian men who have sex with men

Background: Because various HIV vaccination studies are in progress, it is important to understand how often inter- and intra-subtype co/superinfection occurs in different HIV-infected high-risk groups. This knowledge would aid in the development of future prevention programs. In this cross-sectional study, we report the frequency of subtype B and F1 co-infection in a clinical group of 41 recently HIV-1 infected men who have sex with men (MSM) in Sao Paulo, Brazil. Methodology: Proviral HIV-1 DNA was isolated from subject's peripheral blood polymorphonuclear leukocytes that were obtained at the time of enrollment. Each subject was known to be infected with a subtype B virus as determined in a previous study. A small fragment of the integrase gene (nucleotide 4255-4478 of HXB2) was amplified by nested polymerase chain reaction (PCR) using subclade F1 specific primers. The PCR results were further confirmed by phylogenetic analysis. Viral load (VL) data were extrapolated from the medical records of each patient. Results: For the 41 samples from MSM who were recently infected with subtype B virus, it was possible to detect subclade F1 proviral DNA in five patients, which represents a co-infection rate of 12.2%. In subjects with dual infection, the median VL was 5.3 x 10(4) copies/ML, whereas in MSM that were infected with only subtype B virus the median VL was 3.8 x 10(4) copies/ML (p > 0.8). Conclusions: This study indicated that subtype B and F1 co-infection occurs frequently within the HIV-positive MSM population as suggested by large number of BF1 recombinant viruses reported in Brazil. This finding will help us track the epidemic and provide support for the development of immunization strategies against the HIV.

Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: Regional analyses according to the endemic context

Objective: To To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil. Methods: An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South + Southeast (low endemicity) and one for the North + Northeast + Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real). Results: A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs. Conclusions: Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program. (C) 2012 Elsevier Ltd. All rights reserved.

RISK FOR INJURIES AMONG MOTORCYCLISTS INVOLVED IN TRAFFIC INCIDENTS

The objective of this study was to identify, among motorcyclists involved in traffic incidents, the factors associated with risk of injuries. In 2004, in the city of Maringa-PR, it was determined that there were a total of 2,362 motorcyclists involved in traffic incidents, according to records from the local Military Police. Multivariate analysis was applied to identify the factors associated with the presence of injury. A significantly higher probability of injury was observed among motorcyclists involved in collisions (odds Ratio = 11.19) and falls (odds Ratio = 3.81); the estimated odds ratio for females was close to four, and those involved in incidents including up to two vehicles were 2.63 times more likely to have injuries. Women involved in motorcycle falls and collisions with up to two vehicles stood out as a high-risk group for injuries.