A aplicação prioritária do rol de procedimentos obrigatórios na saúde suplementar (pre-print)

In this preliminary version, which summarizes part of my research hypotheses, I argue that the best interpretation for the coverage limits in health plans, even after the enactment of Law No. 14.454/2022, is the one that recognizes the existence of a priority application of ANS regulation. The possibility of prescribing unregulated treatment is exceptional in the system and presupposes simultaneously: (1) the insufficiency of regulation for the treatment of the pathology; and (2) scientific evidence of effectiveness. I also present a brief summary of the argument I defended in my doctoral thesis on the coverage limits of health plans, a thesis developed before the modifications made to the legislation. At the time, I stated that the list of coverage was, in principle, exhaustive but allowed for expansion when the costs of the unregulated procedure reached the costs of the equivalent regulated procedure. It is possible to affirm, based on the comparison between the two arguments, that the system previously found its operational limit in the concept of cost. Now, with the new legislation, the functioning of the contract revolves around the concept of effectiveness.         Nesta versão preliminar, que resume parte de minhas hipóteses de pesquisa, defendo que a melhor interpretação para os limites de cobertura nos planos de saúde, mesmo após a edição da Lei nº 14.454/2022, é a que reconhece a existência de prioridade de aplicação da regulação da ANS. A possibilidade de prescrever tratamento não regulamentado é excepcional no sistema e pressupõe simultaneamente: (1) a insuficiência da regulação para o tratamento da patologia; e (2) evidências científicas de eficácia. Também apresento um brevíssimo resumo do argumento que defendi em minha tese de doutorado sobre os limites de cobertura dos planos de saúde, tese desenvolvida antes das modificações operadas na legislação. Na ocasião, afirmei que o rol de coberturas era, em princípio, taxativo, mas admitia ampliação quando os custos do procedimento não regulamentado alcançavam os custos do procedimento equivalente objeto de regulação. É possível afirmar, a partir da comparação entre os dois argumentos, que o sistema, antes, encontrava no conceito de custo o seu limite operacional. Agora, com a nova redação legislativa, o funcionamento do contrato ocorre em torno do conceito de efetividade

Laudo Pericial

Laudo técnico antropológico para estimativa de perfil biológico e fatores individualizantes para fins de identificação humana. Caso analisado: Indivíduo nº 014 - Coleção Cemiterial do IEPCF - Guarulhos/LEA UNIFES

Socioeconomic trends and differentials in mortality due to cervical cancer in the State of Paraná (Brazil), 1980-2000

O objetivo deste artigo é discutir a evolução da mortalidade por câncer de colo de útero no Estado do Paraná entre 1980 e 2000 e analisar seus diferenciais socioeconômicos em cada região. Taxas de mortalidade ajustadas por idade foram calculadas para as 22 regionais de saúde do Estado a cada ano. Análises comparativas avaliaram indicadores socioeconômicos associados com regiões que apresentaram tendência estacionária e crescente de mortalidade. A mortalidade por câncer de colo uterino cresceu no Estado como um todo a uma taxa de 1,68% (IC 1,20-2,17) ao ano. A maior parte das regiões apresentou tendência estacionária de mortalidade por câncer de colo de útero. As regionais com tendência de aumento na mortalidade apresentaram proporção significativamente mais elevada de analfabetismo (p<0,001) e de adultos (15 anos ou mais) com menos de 4 anos de estudo (p=0,001), e renda per capita (p=0,025) e IDH (p=0,023) inferiores. Houve tendência de aumento na mortalidade em todo o Estado; as regiões que contribuíram para o aumento experimentaram piores indicadores socioeconômicos.The scope of this paper is to discuss the evolution of mortality due to cervical cancer in the State of Paraná, Brazil, between 1980 and 2000 and analyze the socioeconomic differentials in each region of the State. Mortality data were gathered from the System for Information on Mortality by age and town of residence. Age-adjusted death rates were calculated for 22 regions of the state in each year. Comparative analysis evaluated socioeconomic indicators associated with regions that showed either stationary or increasing mortality trends. Cervical cancer deaths increased in the state of Paraná, with an annual percentage increase of 1.68% (1.20 to 2.17, 95% confidence interval). Most of the regions presented a stationary trend of cervical cancer deaths. The comparison of regions presenting an increasing trend indicated poorer socioeconomic indices for the former set: regions with an increase in cervical cancer mortality had a significantly higher illiteracy rate (p<0.001), percentage of individuals older than 15 years with less than 4 years schooling (p=0.001), and lower per-capita income (p=0.025) and human development index (p=0.023). An increasing mortality trend was thus observed throughout the State and areas with higher mortality rates had poorer socioeconomic indices

Guerra da Iugoslávia: a antropologia e a identificação de desaparecidos

No presente trabalho, discute-se brevemente o caminho percorrido para a discussão atual sobre Direitos Humanos, e seu contexto na Guerra da Iugoslávia, ocorrida no início da década de 1990. Mencionam-se a questão de violação dos direitos humanos no caso concreto, bem como as entidades envolvidas e que permearam o processo de julgamento dos responsáveis e a identificação dos desaparecidos. Conclui-se que de fato houve grave violação dos direitos humanos no episódio descrito, com responsabilização de parte dos responsáveis

Craniometric variation among Brazilian and Scottish populations: a physical anthropology approach

The present investigation intended to compare the craniometric variations of two samples of different nationalities (Brazilian and Scottish). Materials and methods: The Brazilian sample consisted of 100 modern complete skulls, including 53 female skulls and 47 male skulls, and the Scottish sample consisted of 100 historical skulls (61 males, 39 females) and 36 mandibles (24 males, 12 females). The cranial measurement protocol was composed of 40 measurements, 11 bilateral and 29 unilateral, and the measurement protocol of the mandible was composed of 15 measurements, with six that were bilateral and nine that were unique. The comparative analysis of the metric variability between the two samples was performed using the means and medians analysis, the t-test, the Wilcoxon test, and the coefficient of variance, with a significance level of 5%. Results: The results showed that, among the 72 analysed variables, 44 measurements (61.11%) presented statistical differences between the samples. The Scottish skull tends to have a cranial length (GOL diff=5.53), breadth (XCB diff=3.78) and height (NPH diff=5.33) greater than the Brazilian skulls, and the Scottish mandibles tend to show a higher mandibular ramus height (MRH diff=9.25), a higher mandibular body height (HMB diff=6.37) and a larger bigonial breadth (BGB diff=5.29) than the Brazilians. The discriminant analysis of the 51 cranial measurements and 21 mandibular measurements showed a variation of the percentage of accuracy between 46.3- 83.8%. Conclusion: The metric analysis demonstrated that there is variability between the two samples studied (61.11%), but a concrete cause cannot be determined considering the multifactorial aspects of the variations of form and size

Estimation of age at death based on the analysis of third molar mineralization in individuals from Brazilian archaeological populations

Estimating the age at death of archaeological individuals is critical for the reconstruction of the demographic profile of past populations. Teeth are very resistant to mechanical, chemical and physical damage. Thus, dental age estimation methods have been proven remarkably useful, especially when the other available bone remains are poorly preserved. In this study, we estimated the age of subadult individuals from pre-colonial archaeological sites in the state of São Paulo, Brazil, which are under the curation of the Museum of Archaeology and Ethnology at the University of São Paulo (MAE-USP). Age estimation was based on the analysis of dental mineralization stages originally proposed by Demirjian et al. (7) and applied to third molars by Soares et al. (11). Teeth (n = 18) were radiographed on a portable X-ray device and the images were analyzed in DICOM extension. The intraexaminer reliability test showed excellent agreement regarding the classification of mineralization stages (Kappa value = 0.94). This age estimation method showed good agreement with the previously cataloged age estimates, which were used for comparison. Of the 18 teeth examined, 15 had their age correctly estimated within the comparative range and only three did not match, of which two were very close to the cataloged estimates and one was underestimated by several years. Collectively, our findings suggest this method can be accurately applied to archaeological individuals

Translation and validation of the Brazilian version of the Dentist Satisfaction Survey

Objetivos: avaliar o nível de satisfação geral com o trabalho de um grupo de dentistas brasileiros e testar a validade de uma tradução transcultural para o português do Brasil da versão modificada do Dentist Satisfaction Survey (DSS). Métodos: Participaram deste estudo transversal 605 dentistas que prestavam à época serviços públicos de atendimento odontológico em São Paulo, SP, Brasil. A satisfação no trabalho foi medida por meio de uma versão modificada do DSS, que é baseado em respostas a 29 itens de um questionário auto-administrado, usando a escala de Likert de 5 pontos. Os itens foram traduzidos para o Português, retraduzidos e comparados com os itens da versão original. Foram calculadas as medidas de consistência interna e validade externa, respectivamente, por meio do coefi ciente de Cronbach e do coeficiente de correlação de Spearman. Resultados: O nível de satisfação geral com o trabalho foi de 2,86 (± 0,20) em 5 na escala de Likert. O α de Cronbach (0,83) mostrou uma boa consistência interna e homogeneidade entre os itens. As correlações de confiabilidade entre item e escala foram boas. Conclusão: O nível de satisfação geral com o trabalho foi neutro. Outras ações e políticas foram desenvolvidas para aumentar o nível de satisfação com o trabalho entre os dentistas brasileiros que trabalham no setor público. A versão em português do DSS modificado apresentou propriedades psicométricas satisfatórias quanto à sua confiabilidade, reprodutibilidade e validade para o Brasil.Objectives: The aims of this study were to evaluate the level of overall job satisfaction among a group of Brazilian dentists and to test the validity of a cross-cultural translation to Brazilian Portuguese of the modifi ed version of the Dentist Satisfaction Survey (DSS). Methods: This cross-sectional study had the participation of 605 dentists practicing in public dental care services in São Paulo, SP, Brazil. Job satisfaction was measured by a modifi ed version of the DSS, which is based on responses to a 29-item self-administrated questionnaire, using a 5-point Likert scale. The items were translated into Brazilian Portuguese, back-translated and compared with the original English version. Measures for internal consistency and concurrent validity were calculated, respectively, by Cronbach’s α coeffi cient and Spearman’s correlation coeffi cient. Results: The level of overall job satisfaction among the sample was 2.86 (± 0.20) out of 5 on the Likert scale. Cronbach’s α (0.83) showed a good internal consistency and homogeneity between items. Item-scale reliability correlations were good. Conclusion: The level of overall job satisfaction was neutral. Further actions and policies have been developed to increase the level of job satisfaction among Brazilian dentists working in the public sector. The Portuguese version of the modifi ed DSS showed satisfactory psychometric properties regarding its reliability, reproducibility and validity for the Brazilian culture

Gingival health of adolescents and the utilization of dental services, state of São Paulo, Brazil

OBJETIVO: Avaliar a associação de condições de saúde gengival com a utilização de serviço odontológico. MÉTODOS: Realizou-se levantamento epidemiológico de saúde bucal de 1.799 adolescentes, em 35 cidades do Estado de São Paulo, em 2002. A saúde gengival foi avaliada pela prevalência de sangramento na gengiva à sondagem e cálculo dentário (índice periodontal comunitário) e oclusão dentária (índice de estética dentária). A utilização de serviços odontológicos foi medida pelo índice de cuidado (O/CPO) para cada cidade. Análise multinível de regressão logística ajustou modelos explicativos para fatores associados aos desfechos de interesse. RESULTADOS: A prevalência de sangramento gengival à sondagem foi 21,5%; de cálculo dentário foi 19,4%. Os participantes do sexo masculino, negros e pardos, moradores em áreas rurais, residentes em domicílios aglomerados e com atraso escolar apresentaram chance significantemente mais elevada para os agravos que seus respectivos pares de comparação. Características de oclusão dentária também associaram com gengiva não-saudável: apinhamento dos segmentos incisais, mordida aberta vertical anterior, relação molar antero-posterior. Cidades com maior utilização de serviço odontológico tiveram menor proporção de adolescentes com sangramento gengival e cálculo. CONCLUSÕES: A utilização de serviços odontológicos foi significativamente associada a melhores condições de saúde gengival (sangramento e cálculo). Essa associação independeu das características sociodemográficas individuais e contextuais, e de oclusão dentária.OBJECTIVE: To evaluate the association between gingival health conditions and dental service utilization. METHODS: An epidemiological survey of the oral health of 1,799 adolescents was carried out in 35 cities of the state of São Paulo, in 2002. Gingival health was assessed through the prevalence of gingival bleeding on probing and dental calculus (community periodontal index), and dental occlusion was assessed through the dental aesthetic index. The utilization of dental services was measured by means of the dental care index (F/DMFT) for each city. Multilevel logistic regression analysis was used to adjust explanatory models to factors associated with the outcome variables of interest. RESULTS: The prevalence of gingival bleeding on probing was 21.5%, whereas dental calculus was prevalent in 19.4%. Male participants, who were either black or dark-skinned, lived in crowded homes, in rural areas, and showed schooling delay, were at a significantly higher risk than their respective counterparts. The following dental occlusion characteristics were also associated with unhealthy gum: incisor segment crowding, vertical anterior open bite, and antero-posterior molar relationship. Cities with a higher utilization of dental services showed a smaller proportion of adolescents with gingival bleeding and dental calculus. CONCLUSIONS: The utilization of dental services was significantly associated with better gingival health conditions (gingival bleeding and dental calculus). This association did not depend on contextual and individual sociodemographic characteristics or dental occlusion

Relationship between oral health and its impact on quality of life among adolescents

The aim of this study was to assess oral health status and its relationship with quality of life. A household population, cross-sectional study was carried out; participants were between 15 and 17 years of age (n = 247) and were examined by two calibrated dentists. Socio-economic status was classified according to ANEP-ABIPEME criteria. Clinical examinations to observe DMFT, CPI and Dean indices were performed as per WHO criteria. The Significant Caries Index (SiC) was used to evaluate polarization of the occurrence of caries among participants of the tercile with higher DMF-T. The OHIP instrument was used to measure quality of life. The Spearman and Mann-Whitney tests were used for assessing correlations (5% significance level). Examinations were carried out in 117 (47.37%) females and in 130 (52.63%) males. Of the examined participants, 45.75% were classified as belonging to socio-economic class C. Caries occurrence was observed in 218 subjects (88.26%); the mean DMFT was 5.40. The SiC index was 9.97. Almost half (47.77%) of the participants examined did not present sextants affected by periodontal disease. Of the participants examined, 80.16% presented absence of fluorosis. The mean OHIP was 3.95. The following correlations were observed: a positive and statistically significant correlation between the highest score in the OHIP and decayed teeth; a positive correlation with threshold significance between OHIP and DMFT; an inverse correlation between intact teeth and OHIP; and a positive and non statistically significant correlation between SiC and OHIP (correlation coefficient = 0.13, p = 0.245). Association between the mean OHIP and the terciles was not significant (p = 0.146); there were also no associations between periodontal condition and OHIP nor were there associations between the presence of fluorosis and mean OHIP