Utilização dos serviços públicos de saúde especializados por idosos no município de Porto Alegre/RS

Introdução: A população idosa responde por maior utilização dos serviços de saúde pelas particularidades dessa faixa etária. Conhecer as interfaces na utilização dos serviços é uma lacuna de conhecimento e pode auxiliar na identificação de fragilidades e potencialidades na assistência e na gestão. Objetivo: Analisar a utilização dos serviços públicos de saúde especializados por idosos no município de Porto Alegre/RS, por sexo e grupo etário. Métodos: Estudo transversal analítico com dados secundários dos sistemas Gerenciamento de Consultas e de Internações. Foram incluídos usuários com 60 anos ou mais, residentes no município e com consulta ambulatorial e/ou internação hospitalar, em 2019, excluindo-se os retornos e duplicados, com amostra final de 64.888 idosos. Variáveis quantitativas foram descritas por média e desvio padrão ou mediana e amplitude interquartílica e as categóricas por frequências absolutas e relativas. Utilizado teste qui-quadrado de Pearson, complementado pela análise dos resíduos ajustados para verificar as associações da utilização de serviços por sexo e grupo etário e motivos de atendimento com os tipos de serviço (p<0,05). Projeto aprovado pelo Comitê de Ética em Pesquisa da Secretaria Municipal de Saúde de Porto Alegre (CAAE 30418320.0.3001.5338). Resultados: A média de idade foi de 71 anos, mulheres (61,7%), na faixa etária de 60 a 79 anos (83,2%), com registro de um atendimento especializado durante o ano (57%), sendo a maioria em serviços ambulatoriais (82,8%) e referenciada por unidades de Atenção Primária à Saúde (74,7%). Atendimentos especializados em fisioterapia (14,1%), reabilitação (2,9%), odontologia (2%) e saúde mental (1,9%) foram mais prevalentes entre mulheres e idosos jovens. A Gerência Distrital Centro foi o local de origem da maioria dos idosos. Doenças do aparelho circulatório foram o principal motivo dos atendimentos especializados (21,4%), em longevos (25,6%) e nos homens (23,7%). Nos atendimentos ambulatoriais foram as doenças osteomusculares (22,5%), nas internações eletivas as neoplasias (35,2%) e, nas de urgência, as doenças do aparelho circulatório (37,9%). O tempo médio de espera para consulta ambulatorial foi de 121 dias, sendo a cirurgia bariátrica/obesidade com o maior período. A classificação azul (44,1%) foi a mais utilizada pelos profissionais solicitantes e a amarela (35,6%) pelos reguladores. Entre os idosos que não consultaram, todos necessitaram de internação hospitalar, sendo 82,6% de urgência, com maior prevalência entre os longevos (94,3%). Conclusões: Os serviços públicos de saúde especializados foram mais utilizados por mulheres e idosos jovens. A maior parte utilizou pelo menos um desses serviços durante o ano, sendo mais frequente o atendimento ambulatorial. O estudo demonstrou potencialidades e limitações, por sexo e grupo etário para o atendimento em serviços especializados, bem como sua relação com a APS, fornecendo subsídios para maior efetividade na constituição de redes assistenciais coordenadas para idosos

Plane curves and their fundamental groups: Generalizations of Uludag's construction

In this paper we investigate Uludag's method for constructing new curves whose fundamental groups are central extensions of the fundamental group of the original curve by finite cyclic groups. In the first part, we give some generalizations to his method in order to get new families of curves with controlled fundamental groups. In the second part, we discuss some properties of groups which are preserved by these methods. Afterwards, we describe precisely the families of curves which can be obtained by applying the generalized methods to several types of plane curves. We also give an application of the general methods for constructing new Zariski pairs.Comment: Published by Algebraic and Geometric Topology at http://www.maths.warwick.ac.uk/agt/AGTVol3/agt-3-21.abs.htm

Kummer covers and braid monodromy

In this work we describe a method to reconstruct the braid monodromy of the preimage of a curve by a Kummer cover. This method is interesting, since it combines two techniques, namely, the reconstruction of a highly non-generic braid monodromy with a systematic method to go from a non-generic to a generic braid monodromy. This "generification" method is independent from Kummer covers and can be applied in more general circumstances since non generic braid monodromies appear more naturally and are oftentimes much easier to compute. Explicit examples are computed using these techniques.Comment: 34 pages, 16 figure

Impacto da pandemia COVID-19 no Pré-natal, Diabetes e consulta médica no Sistema Único de Saúde Brasileiro

Objectives: the purpose of this study was to describe the impact of the COVID-19 pandemic on Primary Health Care in Brazil. Methods: This retrospective ecological study was carried out using Brazilian municipality data obtained from the information systems of the National Public Health System. The outcomes were medical appointments, prenatal procedures and diabetes care. The exposure variable was the occurrence of the COVID-19 pandemic, based on the first case notified in Brazil. Multilevel mixed-effects negative binomial regression was used to analyze the association between the number of procedures per 10,000 inhabitants and COVID-19. Results: Data from 5,564 Brazilian municipalities were included in the present study. Regarding medical appointments, the largest reduction occasioned by the pandemic occurred in May (IRR = 0.27, CI 95% [0.24 – 0.30]). As far as prenatal procedures are concerned, the reduction was 65% (IRR= 0.35, CI 95% [0.32 – 0.38], also in May. In addition, diabetes care saw the biggest reductions in April 2020 (IRR = 0.24, CI 95% [0.11 – 0.53]) and May 2020 (IRR = 0.19, CI 95% [0.09 – 0.43]). From February to December 2020, the pandemic had a significant effect on the total number of procedures evaluated. Conclusion: The findings showed a reduction in prenatal procedures, diabetes and medical consultations performed in Brazil’s Primary Health Care, subsequent to the onset of the COVID-19 pandemic.Objetivos: o objetivo do estudo foi descrever o impacto da pandemia COVID-19 na Atenção Primária à Saúde Brasileira. Métodos: Estudo ecológico retrospectivo realizado com dados de municípios Brasileiros dos sistemas de informação do Sistema Único de Saúde. Os desfechos do estudo foram as consultas médicas, procedimentos de pré-natal e tratamento de diabetes. A exposição foi a ocorrência da pandemia de COVID-19, a partir do primeiro caso notificado no Brasil. Regressões binomiais negativas de efeitos mistos multinível foram utilizadas para analisar a associação entre o número de procedimentos por 10.000 habitantes e a pandemia de COVID-19. Resultados: Dados de 5.564 municípios brasileiros foram incluídos no presente estudo. Em relação à consulta médica, a maior redução devido à pandemia ocorreu em maio (IRR = 0,27, IC 95% [0,24 - 0,30]). Para os procedimentos de pré-natal, a redução foi de 65% (IRR= 0.35, IC 95% [0.32 – 0.38]) em maio. Ainda assim, os procedimentos de tratamento do diabetes tiveram maiores reduções em abril (IRR = 0,24, IC 95% [0,11 - 0,53]) e maio (IRR = 0,19, IC 95% [0,09 - 0,43]) de 2020. De fevereiro a dezembro de 2020 a pandemia impactou significantemente no total de procedimentos avaliados. Conclusão: Os achados mostraram uma redução de procedimentos de pré-natal, diabetes e consultas médicas realizadas na Atenção Primária à Saúde do Brasil, após o início da pandemia de COVID-19

Bone, Periodontal and Dental Pulp Regeneration in Dentistry: A Systematic Scoping Review

The aim of presented systematic scoping review was to investigate the actual and future clinical possibilities of regenerative therapies and their ability to regenerate bone, periodontal and pulp with histological confirmation of the nature of formed tissue. Electronic search was conducted using a combination between Keywords and MeSH terms in PubMed, Scopus, ISI-Web of Science and Cochrane library databases up to January 2016. Two reviewers conducted independently the papers judgment. Screened studies were read following the predetermined inclusion criteria. The included studies were evaluated in accordance with Arksey and O’Malley’s modified framework. From 1349 papers, 168 completed inclusion criteria. Several characterized and uncharacterized cells used in Cell Therapy have provided bone regeneration, demonstrating bone gain in quantity and quality, even as accelerators for bone and periodontal regeneration. Synthetic and natural scaffolds presented good cell maintenance, however polyglycolid–polylactid presented faster resorption and consequently poor bone gain. The Growth Factor–Mediated Therapy was able to regenerate bone and all features of a periodontal tissue in bone defects. Teeth submitted to Revascularization presented an increase of length and width of root canal. However, formed tissues not seem able to deposit dentin, characterizing a repaired tissue. Both PRP and PRF presented benefits when applied in regenerative therapies as natural scaffolds. Therefore, most studies that applied regenerative therapies have provided promising results being possible to regenerate bone and periodontal tissue with histological confirmation. However, pulp regeneration was not reported. These results should be interpreted with caution due to the short follow-up periods

Triple-blinded randomized clinical trial comparing efficacy and tooth sensitivity of in-office and at-home bleaching techniques

Objective: Our study aims to compare the efficacy and tooth sensitivity following in-office (35% hydrogen peroxide) or at-home (10% carbamide peroxide) bleaching treatments both preceded by 2% potassium nitrate (2%KF) desensitizing gel. Methodology: 130 volunteers were randomly allocated to a) in-office bleaching and a placebo at-home protocol; or b) in-office placebo and at-home bleaching treatment. 2% KF was applied for 10 min before both treatments. Objective: color evaluation was performed (spectrophotometer CIEL*a*b* system and CIEDE2000) to calculate the color change (ΔE00). Subjective evaluation was performed using the VITA classical shade guide followed by shade variation (ΔSGU) at the beginning and end of bleaching treatment and 2 weeks post-bleaching. Tooth sensitivity was daily recorded using a Likert scale varying from 1 (no sensitivity) to 5 (severe sensitivity). Analysis was carried out using non-parametric tests. Results: Regarding the color change, at-home bleaching resulted in significant color improvement compared to in-office treatment for the parameters Δb* (p=0.003) and Δa* (p=0.014). Two weeks post-bleaching, the at-home treatment resulted in significant color improvement compared to in-office treatment for the parameters Δb* (p=0.037) and ΔE00 (p=0.033). No differences were observed in either ΔSGU parameters. Concerning sensitivity, patients treated with in-office bleaching reported more tooth sensitivity than the at-home group only on the first day after bleaching started, without significant differences in the other periods evaluated (p&gt;0.05). Conclusions: At-home and in-office bleaching, preceded by a desensitizing agent, were effective for vital teeth bleaching and 10% carbamide peroxide produced a higher whitening effect than 35% hydrogen peroxide in the short time evaluation. Tooth sensitivity rates were similar for the two techniques tested

Venous Blood Derivatives as FBSSubstitutes for Mesenchymal Stem Cells: A Systematic Scoping Review

Although the biological properties of mesenchymal stem cells (MSC) are well-characterized in vitro, MSC clinical application is still far away to be achieved, mainly due to the need of xenogeneic substances for cell expansion, such as fetal bovine serum (FBS). FBS presents risks regarding pathogens transmissions and internalization of animal’s proteins, which can unleash antigenic responses in patients after MSC implantation. A wide range of venous blood derivatives (VBD) has been reported as FBS substitutes showing promising results. Thus, the aim of this study was to conduct a systematic scoping review to analyze whether VBD are effective FBS substitutes for MSC ex vivo expansion. The search was performed in SciVerse ScopusTM, PubMed, Web of ScienceTM, BIREME, Cochrane library up to January 2016. The keywords were selected using MeSH and entry terms. Two independent reviewers scrutinized the records obtained considering specific inclusion criteria. The included studies were evaluated in accordance with a modified Arksey and O’ Malley’s framework. From 184 found studies, 90 were included. Bone marrow mesenchymal stem cells (BMMSC) were presented in most of these studies. Overall, VBD allowed for either, maintenance of MCS’s fibroblast-like morphology, high proliferation, high colony-formation ability and maintenance of multipotency. Besides. MSC expanded in VBD supplements presented higher mitogen activity than FBS. VBD seems to be excellent xeno-free serum for ex vivo expansion of mesenchymal stem cells. However, an accentuated heterogeneity was observed between the carried out protocols for VBD isolation did not allowing for direct comparisons between the included studies

Does Cryopreservation Affect the Biological Properties of Stem Cells from Dental Tissues? A Systematic Review

This systematic review evaluated if different cryopreservation protocols could affect biological properties (Cell survival rate (CSR), proliferation, differentiation, maintenance of stem cell markers) of stem cells obtained from dental tissues (DSC) post-thaw. An electronic search was carried out within PubMed and ISI Web Science by using specific keyword. Two independent reviewers read the titles and abstracts of all reports respecting predetermined inclusion/exclusion criteria. Data were extracted considering the biological properties of previously cryopreserved DSCs and previously cryopreserved dental tissues. DSCs cryopreserved as soon as possible after their isolation presents a CSR quite similar to the non-cryopreserved DSC. Dimethyl sulfoxide (DMSO) [10%] showed good results related to cell recovery post-thaw to cryopreserve cells and tissues for periods of up to 2 years. The cryopreservation of DSC in a mechanical freezer (-80°C) allows the recovery of stem cells post-thaw. The facilities producing magnetic field (MF), demand a lower concentration of cryoprotectant, but their use is not dispensable. It is possible to isolate and cryopreserve dental pulp stem cell (DPSC) from healthy and diseased vital teeth. Cryopreservation of dental tissues for late DSC isolation, combined with MF dispensability, could be valuable to reduce costs and improve the logistics to develop teeth banks.This systematic review evaluated if different cryopreservation protocols could affect biological properties (Cell survival rate (CSR), proliferation, differentiation, maintenance of stem cell markers) of stem cells obtained from dental tissues (DSC) post-thaw. An electronic search was carried out within PubMed and ISI Web Science by using specific keyword. Two independent reviewers read the titles and abstracts of all reports respecting predetermined inclusion/exclusion criteria. Data were extracted considering the biological properties of previously cryopreserved DSCs and previously cryopreserved dental tissues. DSCs cryopreserved as soon as possible after their isolation presents a CSR quite similar to the non-cryopreserved DSC. Dimethyl sulfoxide (DMSO) [10%] showed good results related to cell recovery post-thaw to cryopreserve cells and tissues for periods of up to 2 years. The cryopreservation of DSC in a mechanical freezer (-80°C) allows the recovery of stem cells post-thaw. The facilities producing magnetic field (MF), demand a lower concentration of cryoprotectant, but their use is not dispensable. It is possible to isolate and cryopreserve dental pulp stem cell (DPSC) from healthy and diseased vital teeth. Cryopreservation of dental tissues for late DSC isolation, combined with MF dispensability, could be valuable to reduce costs and improve the logistics to develop teeth banks.This systematic review evaluated if different cryopreservation protocols could affect biological properties (Cell survival rate (CSR), proliferation, differentiation, maintenance of stem cell markers) of stem cells obtained from dental tissues (DSC) post-thaw. An electronic search was carried out within PubMed and ISI Web Science by using specific keyword. Two independent reviewers read the titles and abstracts of all reports respecting predetermined inclusion/exclusion criteria. Data were extracted considering the biological properties of previously cryopreserved DSCs and previously cryopreserved dental tissues. DSCs cryopreserved as soon as possible after their isolation presents a CSR quite similar to the non-cryopreserved DSC. Dimethyl sulfoxide (DMSO) [10%] showed good results related to cell recovery post-thaw to cryopreserve cells and tissues for periods of up to 2 years. The cryopreservation of DSC in a mechanical freezer (-80°C) allows the recovery of stem cells post-thaw. The facilities producing magnetic field (MF), demand a lower concentration of cryoprotectant, but their use is not dispensable. It is possible to isolate and cryopreserve dental pulp stem cell (DPSC) from healthy and diseased vital teeth. Cryopreservation of dental tissues for late DSC isolation, combined with MF dispensability, could be valuable to reduce costs and improve the logistics to develop teeth banks