A joint approach to treating dental phobia:a re-evaluation of a collaboration between community dental services and specialist psychotherapy services ten years on

Objective To audit the records of a group of patients who had previously benefited from cognitive behavioural therapy (CBT) for dental phobia.Aim To ascertain if they had returned to the use of intravenous (IV) sedation to facilitate dental treatment. Ten years ago these patients were routinely requiring IV sedation to facilitate dental treatment due to severe dental phobia.Method Sixty patients entered the original pilot project. Of those, 30 were offered CBT and 21 attended. Twenty of those patients (95.2%) were subsequently able to have dental treatment without IV sedation. In this follow-up study the electronic records of 19 of the 20 patients who had originally been successful with CBT were re-audited. Our purpose was to see if there was any record of subsequent IV sedation administration in the intervening ten years.Results Of the 19 successful CBT patients available to follow-up, 100% had not received IV sedation since the study ten years ago. This may suggest the initial benefit of CBT has endured over the ten-year period.Conclusion This study indicates that the use of CBT for patients with dental phobia proves beneficial not only in the initial treatment but that the benefits may endure over time. This results in a significant reduction in health risks to the patient from repeated IV sedation. It may also translate into significant financial savings for dental care providers. Our evidence for CBT as treatment for dental phobia suggests dental services should be implementing this approach now rather than pursuing further research. © 2011 Macmillan Publishers Limited. All rights reserved.

Comparing cost-sharing practices for pharmaceuticals and health care services among four central European countries

The paper reviews the existing cost-sharing practices in four Central European countries namely the Czech Republic, Hungary, Poland and Slovakia focusing on patient co-payments for pharmaceuticals and services covered by the social health insurance. The aim is to examine the role of cost-sharing arrangements and to evaluate them in terms of efficiency, equity and public acceptance to support policy making on patient payments in Central Europe. Our results suggest that the share of out-of-pocket payments in total health care expenditure is relatively high (24–27%) in the countries examined. The main driver of these payments is the expenditure on pharmaceuticals and medical devices, which share exceeds 70% of the household expenditure on health care. The four countries use similar cost-sharing techniques for pharmaceuticals, however there are differences concerning the measure of exemption mechanisms for vulnerable social groups. Patient payment policies for health care services covered by the social health insurance are also converging. All the four countries apply co-payments for dental care, some hotel services or in the case of free choice of physician. Also the countries (except for Poland) tried to extend co-payments for physician services and hospital care. However, their introduction met strong political opposition and unpopularity among public.

Social determinants of dental treatment needs in Brazilian adults

Background The chronic cumulative nature of caries makes treatment needs a severe problem in adults. Despite the fact that oral diseases occur in social contexts, there are few studies using multilevel analyses focusing on treatment needs. Thus, considering the importance of context in explaining oral health related inequalities, this study aims to evaluate the social determinants of dental treatment needs in 35–44 year old Brazilian adults, assessing whether inequalities in needs are expressed at individual and contextual levels. Methods The dependent variables were based on the prevalence of normative dental treatment needs in adults: (a) restorative treatment; (b) tooth extraction and (c) prosthetic treatment. The independent variables at first level were household income, formal education level, sex and race. At second level, income, sanitation, infrastructure and house conditions. The city-level variables were the Human Development Index (HDI) and indicators related to health services. Exploratory analysis was performed evaluating the effect of each level through calculating Prevalence Ratios (PR). In addition, a three-level multilevel modelling was constructed for all outcomes to verify the effect of individual characteristics and also the influence of context. Results In relation to the need for restorative treatment, the main factors implicated were related to individual socioeconomic position, however the city-level contextual effect should also be considered. Regarding need for tooth extraction, the contextual effect does not seem to be important and, in relation to the needs for prosthetic treatment, the final model showed effect of individual-level and city-level. Variables related to health services did not show significant effects. Conclusions Dental treatment needs related to primary care (restoration and tooth extraction) and secondary care (prosthesis) were strongly associated with individual socioeconomic position, mainly income and education, in Brazilian adults. In addition to this individual effect, a city-level contextual effect, represented by HDI, was also observed for need for restorations and prosthesis, but not for tooth extractions. These findings have important implications for the health policy especially for financing and planning, since the distribution of oral health resources must consider the inequalities in availability and affordability of dental care for all.

Visão dos profissionais de saúde frente à possibilidade de infecção de HIV/Aids em idosos

The HIV/Aids epidemic is today, in Brazil, a phenomenon of great magnitude and extent. The disease progresses over a physically weakened, and with more complex approach, portion of the population: the elderly. This study has the objective to know the vision of health professionals facing the possibility of HIV/Aids in the elderly. It is a cross-sectional observational study conducted in the city of Uberlandia, Minas Gerais, Brazil, from November 2013 to December 2015, with the participants Doctors, Dental Surgeons and nurses stationed in the Municipal Network of Primary Care, with a sample of 220. Using factor analysis, factors unrelated to the training of health professionals and others directly related; only the latter showed differences between the professions. The investigation of the professional view on the possibility of infection of HIV/Aids in the elderly should be crafted specifically for each type of professional, meeting the specific difficulties of training each degree course. It is crucial the need to update each professional in the health care field in order to be able to make an early diagnosis aimed at protecting the elderly patient's integrity affected by HIV/Aids.

Accessing dental anxiety online support groups: An exploratory qualitative study of motives and experiences

Objectives: In recent years, Internet access has grown markedly providing individuals with new opportunities for online information retrieval, psychological advice and support. The objectives of the present study were to explore the context through which dentally anxious individuals access an online support group and the nature of their online experiences. Methods: An online questionnaire was completed by 143 individuals who accessed the Dental Fear Central online support group bulletin board. Qualitative analysis was conducted on the responses. Results: Analysis revealed three emergent themes which reflected the motives and experiences of individuals: ‘Searching for help’, ‘Sharing fears’ and ‘I feel empowered’. Conclusion: This exploratory study suggests that for most individuals accessing this online support group was a positive and beneficial experience. Practice Implications: Online support groups may represent a convenient and beneficial tool that may assist certain individuals to confront their debilitating anxiety/phobia and successfully receive dental care.

Oral health quality of the workers of a telemarketing company and their satisfaction with the treatments provided by the corporative dental insurance plan

Aim: To evaluate the oral health quality of the workers of a telemarketing company and their satisfaction with the dental treatments provided by the corporative dental insurance plan. Methods: Data collection was by an online intranet questionnaire on dental service providers from Uberlândia/MG and Campinas/SP. It was addressed to 6000 associates, with objective and subjective questions, comprising the level of the telemarketing operators’ oral health, dental needs, satisfaction with dental care providers and the importance of having the laboral dental services provided by the company. Results: After analysis of the results, we observed that: 57.52% of the workers required improvement in their oral health and 56.03% mentioned prevention as the largest need, 66.70% use the dental providers’ services, but only 31.34% were satisfied with them. Conclusions: The results underscore that the workers have an intermediate level of dental needs, with prevention as top importance. Additionally, establishment of a basic attention program inside the company would increase the satisfaction and adhesion indexes of providers and the workers’ oral health.

Salivary cortisol level and uncooperative behavior in pediatric dental practice

Aim: To investigate the relation between uncooperative behavior and salivary cortisol level in children who underwent preventive dental care. Methods: The sample was composed by 10 children of both sexes aged 40 to 52 months, presenting uncooperative behavior during dental preventive treatments. The saliva collection was performed using a cotton wheel and an Eppendorf tube (Sarstedt Salivete®) in 3 different moments: a) at home, on a day without dental treatment and at the same time on the day of the sessions treatment; b) 30 min after the end of the session, when there was manifestation of uncooperative behavior; c) 30 min after the end of the session, when there was a cooperative behavior of the child. A sample of saliva was centrifuged for 5 minutes at 2400 rpm, 1 of mL of saliva was pipetted in an Eppendorf tube and stored in a freezer at -20 ° C. For the determination of the levels of salivary cortisol was used an Active® kit for cortisol enzyme immunoassay (EIA) DSL-10-67100, composed of specific rabbit antibody anti-cortisol. Data were analyzed statistically for the uncooperative behavior issued in the beginning and at the end of sessions, using the paired t test (p<0.05) and for cortisol levels in saliva samples at home, after the beginning and at the end of sessions, using repeated-measures ANOVA and Tukey’s test (p<0.05). Results: During expression of uncooperative behavior in preventive dental care sessions the salivary cortisol level was significantly higher (0.65 ± 0.25 μg/dL) compared with expression of collaborative behavior (0.24 ± 0.10 μg/dL). Conclusions: It is possible to conclude that, even under preventive intervention, the stress must be controlled in order to reduce dental anxiety and fear.

Different Aspects of General Anesthesia in Pediatric Dentistry: A Review

Context:Most child population is able to undergo dental treatment in the conventional setting. However, some children fail to cope with in-office conscious state and cannot respond to usual management modalities. This review aims to discuss the topic further. Evidence Acquisition: A computerized search in databases PubMed, MEDLINE, EMBASE, Google Scholar and Google were performed using dental general anesthesia related keywords. Original and review English-written articles that were limited to child population were retrieved without any limitation of publication date. The suitable papers were selected and carefully studied. A data form designed by author was used to write relevant findings. Results: Preoperative oral examination and comprehensive evaluation of treatment needs is only possible after clinical and radiographic oral examination. Effective collaboration in dental GA team should be made to minimize psychological trauma of children who undergo dental GA. Before conducting comprehensive dental treatment under GA, the general health of the child and the success rate of procedures provided needs to be accurately evaluated. It is noteworthy that determination of the optimal timing for GA dental operation is of great importance. Providing safety with pediatric dental rehabilitation under GA is critical. Conclusions: Besides criteria for case selection of dental GA, some degree of dental practitioner’s judgment is required to make decision. Pre- and post-operative instructions to parents or caregiver decrease the risk of complications. However, trained resuscitation providers, careful monitoring and advanced equipment minimize adverse outcomes.

Impact on hip fracture mortality after the establishment of an orthogeriatric care program in a colombian hospital

El objetivo del estudio es evaluar la mortalidad a un año en pacientes con fractura de cadera, mayores de 65 años tratados en un programa establecido de orto-geriatría. 298 se trataron de acuerdo al protocolo de orto-geriatría, se calculo la mortalidad a un año, se establecieron los predictores de mortalidad orto-geriátrico. La sobrevida anual se incremento de 80% a 89% (p = .039) durante los cuatro años de seguimiento del programa y disminuyo el riesgo de mortalidad anual postoperatorio (Hazard Ratio = 0.54, p = .049). La enfermedad cardiaca y la edad maor a 85 años fueron predictores positivos para mortalidad.

Exercise and cancer survivorship

Exercise has been identified as an integral component of comprehensive survivorship care and a promising adjuvant therapy to aid in the management of cancer. Leading organisations worldwide now advocate exercise for cancer survivors. Here we briefly review the existing evidence for exercise and survivorship, as well as current research endeavours in Australia. Discussion extends to identify the gaps between research and practice, as well as future research directions needed to drive the field forward. With continued efforts by scientists, clinicians and consumers, there is real potential to strengthen the nexus between scientific evidence and clinical practice and integrate exercise into standard cancer care.

Preventive orientation and caries management by Iranian dentists

Ehkäisypainotteisuus karieksen hoidossa: iranilaishammaslääkärien hoitovalinnat Karies aiheuttaa hampaiden kovan pinnan ja hammasluun syöpymistä, joka lopulta näkyy ”reikänä”. Iästä riippumatta kariesvaara vaanii kaikkia hampaiden omistajia, vauvasta vaariin, ja lähes kaikilla aikuisilla on suussaan merkkejä karieksesta. Karies etenee yleensä hitaasti ja antaa siten aikaa ehkäisevälle hoidolle. Tämä etsikkoaika jää usein käyttämättä, ja karieksen hoito painottuu reikien paikkaamiseen. Karies voitaisiin pitää kurissa sen ehkäisyyn kehitetyillä monipuolisilla keinoilla. Hammaslääkärit ovat avainasemassa, sillä he tekevät kauaskantoisia valintoja — hoidetaanko kariesta paikkaamalla vai valitaanko ehkäisevä hoito? Valintojen taustalla ovat hammaslääkärin tietotaso, asenteet ja omat terveystavat sekä potilaiden ja vastaanoton aiheuttamiksi koetut esteet. Tämä kyselytutkimus selvitti karieksen hoitovalintoja ja niiden taustoja Iranissa. Kysymyslomakkeet jaettiin kahdessa hammaslääkärien kongressissa Teheranissa (2004─2005) ja palautettiin nimettöminä. Kysely kartoitti hammaslääkärien tietoja karieksen ehkäisykeinoista ja asenteita ehkäisyä kohtaan sekä koettuja esteitä sen toteuttamisessa. Hoitovalintoja selvitettiin tarkasti kuvattujen esimerkkipotilaiden avulla. Kysely kartoitti myös hammaslääkärien omat terveystavat: suun omahoidon, tupakoinnin ja hammaslääkärissä käynnin. Aineisto käsitti 980 iältään keskimäärin 37-vuotiasta hammaslääkäriä, joista 64 % oli miehiä. Iranilaishammaslääkärien tiedot karieksen ehkäisystä olivat fluorihammastahnan merkitystä lukuun ottamatta hyvät ja heidän asenteensa ehkäisyä kohtaan valtaosin myönteiset. Tästä huolimatta 77 % heistä olisi valinnut suuren kariesvaaran potilaalle hammaskiilteessä olevan reiän hoidoksi paikkauksen. Ehkäisyhoidoksi tarjotuista 8:sta keinosta lähes kaikki hammaslääkärit valitsivat suuren kariesvaaran potilaalle hoidoksi harjausopetuksen ja säännölliset hammastarkastukset, noin 80 % valitsi hampaiden puhdistamisen vastaanotolla ja ravintoneuvonnan, 70 % ohjeet fluorihuuhteluista kotona ja 53 % vastaanotolla tehtävän fluorikäsittelyn. Potilaiden vastustavat mielipiteet arvioitiin suurimmaksi esteeksi ehkäisevän hoidon toteuttamiselle. Hammaslääkäreistä 59 % ilmoitti harjaavansa hampaansa kahdesti päivässä; 76 % ei tupakoinut ja 56 % kertoi aina ehdottavansa tupakoivalle potilaalle tupakoinnin lopettamista. Hammaslääkärien ehkäisypainotteisuus karieshoidossa oli naisilla vahvempi kuin miehillä. Tulosten perusteella voi päätellä, että Iranissa tulisi nykyistä selvemmin suosia ehkäisevää linjaa karieksen hoitovalintoja tehtäessä ja hammaslääkäreitä koulutettaessa. Potilastyössä koettujen ehkäisyhoidon esteiden syvällisempi ymmärtäminen edesauttaisi niiden poistamisessa.

A integralidade no ensino de enfermagem na saúde da mulher: concepções e práticas de docentes

Este estudo teve como objetivos analisar as concepções teóricas e práticas docentes de enfermagem no cuidado à saúde da mulher a partir da ideia de integralidade e discutir as estratégias utilizadas pelos docentes para inserir o conteúdo da integralidade no ensino de enfermagem na saúde da mulher. A política atual de atenção integral à saúde da mulher propõe a incorporação do princípio da integralidade como eixo norteador que articule o mundo do ensino ao mundo do trabalho e da realidade social. Neste contexto, muitos sentidos se combinam e se conflitam na formação da ideia de integralidade no cuidado à saúde da mulher. A metodologia envolveu a abordagem qualitativa realizada nas Instituições Públicas de Ensino Superior do Estado do Rio de Janeiro que oferecem o Curso de Graduação em Enfermagem. Utilizou-se como técnica de coleta de dados a entrevista com dezessete docentes de enfermagem da área de saúde da mulher de acordo com os critérios de inclusão selecionados pela pesquisa. Da análise do material produzido surgiram quatro categorias, a saber: Concepções de integralidade no cuidado à saúde da mulher; Integralidade do cuidado no ensino da saúde da mulher; Estratégias utilizadas para inserir a integralidade no ensino de enfermagem na saúde da mulher; Dificuldades para implantar a integralidade no cuidado à saúde da mulher. Identificou-se que foram muitos os avanços do Sistema Único de Saúde na última década. Contudo, no que diz respeito à sua consolidação como sistema público de saúde, ainda estamos diante de grandes desafios, entre os quais se destaca o relativo à incorporação efetiva dos princípios e valores do SUS nos processos de trabalho, bem como nos processos formativos para a enfermagem na área da saúde da mulher. Desta maneira, faz-se necessário construir novas formas de trabalhar melhor com a assistência, perceber como efetivas as políticas publicas na área da saúde da mulher, considerando as necessidades e demandas locorregionais no país. É evidente a dificuldade em seguir os princípios aqui defendidos, porém a integralidade no cuidado à saúde da mulher, só será possível quando houver compromisso ético com as ações e relações necessárias para sua efetivação.

Técnica do tratamento restaurador atraumatico em estudantes de escola municipal do Rio de Janeiro: avaliação in vitro da influência da proteção superficial e do tempo de entrada em serviço na resistência a tração diametral do cimento de ionômero de vidro utilizado

Tratamento restaurador atraumático tornou-se uma opção real para o tratamento da cárie dentária em saúde pública no Brasil. O presente estudo teve como objetivo avaliar durabilidade, resistência e eficácia de 70 restaurações em 31 alunos (entre 6 a 12 anos de idade na Escola Municipal Rotary, RJ - Brasil). Depois de CPO-D e ceo-exame de acordo com critérios da OMS, todos os alunos com selecionados receberam TRA com VITRO MOLAR - DFL, juntamente com instruções de saúde bucal. Os critérios de exclusão foram a presença de cavidades muito profundas e exposição pulpar, casos em que os alunos foram encaminhados para o Postos de Saúde Municipal. In vitro avaliou-se a influência do tempo de entrada em serviço e do tipo de cobertura protetora utilizada na resistência coesiva do Cimento de Ionômero de Vidro utilizado, por meio de ensaios de tração diametral. Confeccionou-se para o teste de tração diametral 6 espécimes para cada variante, 72 no total, com dimensões de 4 mm de diâmetro por 8 mm de comprimento, divididos entre os grupos: grupo1 sem protetor (controle); grupo2 vaselina sólida; grupo3 verniz para unhas. Realizou-se ensaios mecânicos em uma máquina universal de ensaios EMIC DL 500 MF, após a confecção e estocagem individual dos espécimes em potes plásticos contendo 5 ml de água deionizada, que formaram os subgrupos descritos a seguir: a - 20 minutos; b - 2 horas; c - 24 horas; d - 7 dias. Os dados obtidos foram tratados por ANOVA e por Student Newman-Keuls (p<0,05). Ao se avaliar a influência dos diferentes protetores de superfície no CIV utilizado no presente trabalho observou-se que, os protetores de superfície tiveram influência no comportamento do material (p=0,000), com o verniz para unhas mostrando um desempenho superior ao da vaselina sólida. Quanto ao tempo, não foi possível verificar ruptura do material no prazo de 20 minutos, pois os corpos de prova sofriam deformação elástica catastrófica não sendo adequado para a finalidade desejada. Os tempos de 24 horas e sete dias foram semelhantes entre si e diferentes do tempo de duas horas. As restaurações foram clinicamente avaliadas depois de 6, 12, e 24 meses após sua alocação. No total 72 restaurações foram realizadas em 31 escolares. Depois de seis meses, 5 restaurações fraturaram e 3 perderam algum material. Após 12 meses, oito restaurações foram perdidas e apenas 1 fraturou. Na avaliação após 24 meses, mais 12 restaurações foram perdidas e 3 perderam material. Não foram registradas lesões cariosas secundarias após esse período, mesmo quando as restaurações foram parcialmente perdidas. Clinicamente conclui-se que quando a técnica do TRA é bem indicada e aplicada corretamente pode haver uma redução significativa no número de dentes perdidos por lesões de cárie nos indivíduos que participaram do nosso estudo.

O diagnóstico anti-HIV no município do Rio de Janeiro: processos dos cuidados em saúde.

A magnitude e as modificações resultantes da epidemia de Aids no Brasil levaram o Ministério da Saúde a recomendar, a partir de 2001, a incorporação do diagnóstico sorológico da infecção pelo HIV em serviços de atenção básica da rede pública de saúde, visando a universalidade e a ampliação do acesso da população a esses exames. O processo diagnóstico, no caso da AIDS, envolve para além da simples disponibilização da testagem; cobre demandas de prevenção, profilaxia, tratamento e referências adequadas para o interior do sistema assistencial. O estudo realizado teve por objetivo investigar como vem se dando a oferta deste diagnóstico, previsto de estar acontecendo acompanhado de aconselhamento pré e pós-teste, usando como lócus um conjunto de serviços da rede básica de saúde no Município do Rio de Janeiro. Do tipo descritivo-analítico, o trabalho utilizou-se de uma abordagem metodológica qualitativa, realizando entrevistas semi-estruturadas com vinte e dois profissionais de saúde de diversas categorias, envolvidos nos processos de testagem anti-HIV, e com três gestores, buscando compreender como vem sendo ofertado esse cuidado em saúde. O exame do material obtido permitiu a identificação das seguintes categorias analíticas: oferta do teste na rede de atenção básica e dilemas relacionados a esse processo; ações de aconselhamento que acompanham a testagem; resultados do teste anti-HIV e dificuldades na sua comunicação aos usuários; dimensões estrutural e organizacional e gestão do processo de testagem; capacitação dos recursos humanos. Identificou-se que o processo de oferta do teste anti-HIV se circunscreve frequentemente à representação da doença e é necessária maior interlocução na relação profissional de saúde/usuário, considerando a intersubjetividade dos sujeitos envolvidos. Este processo diagnóstico demanda técnicas como apoio, acolhimento e escuta qualificada das necessidades de saúde, entendidas para além das queixas biológicas dos sujeitos, que nem sempre estão se fazendo presentes nos serviços de atenção investigados. Como desafio premente na oferta do diagnóstico anti-HIV, destaca-se que o aconselhamento deve ser uma ferramenta utilizada e reforçada no contexto dos serviços de saúde que atendem pacientes com DST/Aids. Outro desafio, além da capacitação qualificada dos recursos humanos envolvidos, é necessidade de permanente avaliação do processo de oferta que vem sendo oferecido nos serviços da rede básica, que possibilite repensar as atividades de prevenção, o acolhimento e a escuta, e o compartilhamento de idéias entre profissionais que atuam no cotidiano das unidades de saúde e os gestores locais. A pluralidade de questões no fazer em saúde exige que os serviços de saúde e seus responsáveis promovam novos arranjos para que a oferta do teste anti-HIV, como ação de saúde, seja realizada com base na humanização, na integralidade e no respeito aos direitos de cidadania, contribuindo para que a melhoria do atendimento na rede básica se concretize com qualidade.