Validade de peso, estatura e IMC referidos por puérperas do estudo Nascer no Brasil

OBJETIVO: Avaliar a acurácia das informações de peso pré-gestacional, estatura, índice de massa corporal pré-gestacional e peso na última consulta de pré-natal, segundo características maternas, variáveis sociodemográficas e de pré-natal. MÉTODOS: O estudo foi desenvolvido com dados do questionário face a face e do cartão da gestante (padrão-ouro) do estudo “Nascer no Brasil, 2011–2012”. Para avaliar as diferenças entre as variáveis antropométricas medidas e referidas, utilizou-se o teste de Kruskal-Wallis para as variáveis dividas em quartis. Para as variáveis contínuas, adotou-se o teste de Wilcoxon, gráficos de Bland e Altman, diferença média entre as informações medidas e referidas pelas mulheres. Estimou-se a sensibilidade e o coeficiente de correlação intraclasse. RESULTADOS: No estudo, 17.093 mulheres possuíam cartão de gestante. Observou-se uma subestimação do peso pré-gestacional em 1,51 kg (DP = 3,44) e do índice de massa corporal em 0,79 kg/m2 (DP = 1,72), e superestimação da estatura em 0,75 cm (DP = 3,03) e do peso na última consulta em 0,22 kg (DP = 2,09). Os coeficientes de correlação intraclasse (CCIC) obtidos para as variáveis antropométricas foram: estatura (CCIC = 0,89), peso pré-gestacional (CCIC = 0,96), índice de massa corporal pré-gestacional (CCIC = 0,92) e peso na última consulta (CCIC = 0,98). CONCLUSÕES: Os resultados sugerem que as variáveis antropométricas referidas foram válidas para a população de estudo, e podem ser utilizadas em estudos com populações que tenham características semelhantes.OBJECTIVE: To evaluate the accuracy of information on pre-gestational weight, height, pre-gestational body mass index, and weight at the last prenatal appointment, according to maternal characteristics and sociodemographic and prenatal variables. METHODS: The study was developed using data from the face-to-face questionnaire and prenatal card (gold standard) of the study “Birth in Brazil, 2011–2012”. To evaluate the differences between the measured and self-reported anthropometric variables, we used the the Kruskal-Wallis test for the variables divided into quartiles. For the continuous variables, we used the Wilcoxon test, Bland-Altman plot, and average difference between the information measured and reported by the women. We estimated sensitivity and the intraclass correlation coefficient. RESULTS: In the study, 17,093 women had the prenatal card. There was an underestimation of pre-gestational weight of 1.51 kg (SD = 3.44) and body mass index of 0.79 kg/m2 (SD = 1.72) andoverestimation of height of 0.75 cm (SD = 3.03) and weight at the last appointment of 0.22 kg (SD = 2.09). The intraclass correlation coefficients (ICC) obtained for the anthropometric variables were: height (ICC = 0.89), pre-gestational weight (ICC = 0.96), pre-gestational body mass index (ICC = 0.92), and weight at the last appointment (ICC = 0.98). CONCLUSIONS: The results suggest that the mentioned anthropometric variables were valid for the study population, and they may be used in studies of populations with similar characteristics

Impact of Non-Weighting in the Analysis of Data Obtained from Complex Samples

Objective: To compare the estimates obtained, considering or not the weighting data. Material and Methods: Secondary data from the Oral Health Survey of the State of São Paulo (SBSP2015) was used for calculation of mean estimates, standard errors of the mean and confidence intervals (CI) for the DMFT index and components (decayed, lost and filled), in the age group of 35-44 years. Multiple logistic regression models were estimated, considering or not the weighting from the sampling plan (p<0.05). Results: It was observed that the estimates of the DMFT index and the carious component did not vary much when the design was considered or not (1.1% and 2.0%, respectively). However, the data referring to the lost and filled component showed greater differences between the values of the means. The averages fluctuated up and down by up to 6.7% for weighted versus unweighted analyses. The standard error was underestimated in the unweighted analysis and the confidence interval showed variations. Differences between the regression models obtained by the weighted and unweighted analysis of the data were detected. Conclusion: Although weighted and unweighted models presented differences of less than 10% in estimates of the mean, confidence intervals, as well as statistical inferences, were different.  Thus, weighting should be applied in the population base data analysis collected by sampling with complex designs

INFLUENCE OF THE PROCESSING STEPS ON CASHEW NUT QUALITY

Cashew nuts have high nutritional value. This nut providesmacronutrients, micronutrients and a large variety of antioxidants,such as phenolic compounds. There are losses in some compoundsduring the processing of fruits and there are very few studies onthis aspect. Given the above, this research aimed to determine theeff ect of the processing steps on cashew nut characteristics withemphasis on total antioxidant activity. Signifi cant diff erences wereobserved between the processing steps for all the chemical andphysical-chemical characteristics studied. Cashew nuts containedhigh levels of lipids and energy, low content of moisture and wateractivity and medium content of phenolic compounds (51.33 GAE/100g) and antioxidant activity by the ABTS•+ radical (6.49 μM Trolox/g)at the end of the process. Regarding the total antioxidant activity,it was observed that the ABTS•+ radical method can be consideredappropriate to measure the antioxidant activity of cashew nuts, sincethe results presented lower coeffi cients of variation and expressproportionate results to other methods

Estudo Quanti-Qualitativo do Fluxo de Regulação de Leitos Hospitalares no Paraná

Este estudo teve o objetivo de identificar possibilidades e limites na regulação das internações de média e alta complexidade na central de leitos da Macro Norte do Estado do Paraná. Na primeira etapa (quantitativa), foram obtidos dados relativos ao cadastro da central de regulação de leitos da Macro Norte. A segunda etapa (qualitativa) consistiu em entrevista junto aos gestores municipais e estaduais. 11% dos casos cadastrados não foram regulados e, em 35% dos casos cadastrados, o acesso não se deu por mecanismos rotineiros. O desempenho e a ocupação dos leitos em cada regional de saúde foi diferente, devido à infraestrutura assistencial deficitária, fragilidade das pactuações entre os gestores e prestadores, redes de atenção à saúde fragmentadas, atuação da regulação e interferências nas ações regulatórias. Conclui-se que a regulação da Macro Norte procura garantir o acesso do usuário na urgência, embora não apresente desempenho máximo por problemas organizacionais e estruturais

Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis

To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implant-supported total dental prosthesis versus conventional total dental prosthesis). METHODS: A Markov model was developed to capture long-term clinical and economic outcomes. The model's population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost - in BRL, and effectiveness - measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS: Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS: The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed53COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESSem informaçã

Custo-efetividade da prótese implanto-suportada comparada à prótese total convenciona

OBJETIVO: Conduzir uma análise de custo-efetividade das alternativas para tratamento reabilitador do edentulismo mandibular no contexto do Sistema Único de Saúde (prótese total implanto-suportada e prótese total convencional). MÉTODOS: Foi desenvolvido um modelo de Markov para captar os resultados clínicos e econômicos de longo prazo. A população do modelo consistiu em uma coorte hipotética de 1.000.000 pacientes, com 55 anos, desdentados totais mandibulares e sem contraindicações médicas para a realização de procedimentos cirúrgicos. A perspectiva de análise adotada foi a do Sistema Único de Saúde. Com base no modelo proposto, calculamos o custo (em reais) e a efetividade, medida pelo ano de prótese ajustado à qualidade (QAPY). O horizonte temporal da análise foi de 20 anos. RESULTADOS: Considerando o desconto de 5% nos custos e efeitos, a razão de custo-efetividade incremental da prótese total implanto-suportada em relação à prótese total convencional (R$464,22/QAPY) foi menor que o limiar de disposição a pagar adotado no modelo (R$ 3.050,00/QAPY). CONCLUSÕES: Os resultados desta análise econômica mostraram que a reabilitação de edêntulos mandibulares por meio da prótese total implanto-suportada é muito custo-efetiva em comparação à prótese total convencional, de acordo com os limites de custo-efetividade empregados.OBJECTIVE: To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implantsupported total dental prosthesis versus conventional total dental prosthesis). METHODS: A Markov model was developed to capture long-term clinical and economic outcomes. The model’s population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost – in BRL, and effectiveness – measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS: Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS: The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed

Clinical and x-ray oral evaluation in patients with congenital Zika Virus

Objective: The aim of this study was to investigate possible malformations in the soft, bone and/or dental tissues in patients with congenital Zika Virus (ZIKV) by clinical and x-ray evaluation. Methodology: Thirty children born with ZIKV and 30 children born without ZIKV (control group) were included in the study. Patients were evaluated over 24 consecutive months according to the variables: sex, age, cleft palates, soft tissue lesions, alveolar ridge hyperplasia, short labial and lingual frenums, inadequate posture of the lingual and perioral muscles at rest, micrognathia, narrow palatine vaults, changes in the teeth shape and/or number, sequence eruption, spasms, seizures and eruption delay were evaluated. Chi-square test, Student’s t-test and nominal logistic regression were used (p<0.05). Results: Among the 30 babies examined, the mean age of the first dental eruption was 10.8±3.8 with almost two-thirds of the children (n=18, 60%) experiencing eruptions of their first tooth after 9 months of age, nine children (30%) had inadequate lingual posture at rest, more than half of the children (n=18, 60%) had short labial or lingual frenums. ZIKV babies showed a high prevalence of clef palate (p<0.001), inadequate lingual posture at rest (p=0.004), micrognathia (p=0.002), changes in the shape and/or number of teeth (p=0.006), alteration in sequence of dental eruption (p<0.001) and muscles spasms (p=0.002). The delay eruption was associated with inadequate lingual posture at rest (p=0.047), micrognathia (p=0.002) and changes in the shape and/or number of teeth (p=0.021). The delayed eruption (p=0.006) and narrow palatine vaults (p=0.008) were independently associated with ZIKV. Moreover, female patients showed the most narrow palatine vaults (p=0.010). Conclusions: The children with ZIKV showed a greater tendency to have delayed eruption of the first deciduous tooth, inadequate lingual posture and short labial and lingual frenums

Diferentes métodos para avaliação do ganho de peso gestacional e sua associação com o peso ao nascer

Objective: To analyze different methods of assessment gestational weight gain in identifying women with a greater chance of live births small for gestational age (SGA) and large for gestational age (LGA). Methods: Cross-sectional study, with adult women, pregestational BMI normal, single pregnancy and gestational age at delivery ≥28 weeks, from Birth in Brazil study, between 2011 and 2012. Results: In the 11,000 women in the study, the prevalence of excessive weight gain was 33.1% for Brandão and IOM and Intergrowth 21st . 37.9%. The chance of being born SGA for insufficient weight gain was OR=1.52 (95%CI 1.06;2.19), OR=1.52 (95%CI 1.05;2.20) and OR=1.56 (95%CI 1.06;2.30) for Brandão, IOM and Intergrowth, respectively. Excessive gain, in the same methods, presented OR=1.53 (95%CI 1.28;1.82), OR=1.57 (95%CI 1.31;1.87) and OR=1.65 (95%CI 1.40;1.96) for LGA. Conclusion: compared to the recommendations of the IOM, Intergrowth and Brandão present themselves as alternatives in the identification of SGA and LGA.Objetivo: Analisar a associação de diferentes métodos para avaliação do ganho de peso gestacional com nascidos vivos pequenos para idade gestacional (PIG) ou grandes para idade gestacional (GIG). Métodos: Estudo transversal, com mulheres adultas, IMC prégestacional de eutrofia, gestação única e idade gestacional no parto ≥28 semanas, da pesquisa ‘Nascer no Brasil’, em 2011-2012. Resultados: Participaram do estudo 11.000 mulheres; a prevalência de ganho excessivo foi de 33,1% segundo os métodos Brandão et al. e IOM, e 37,9% segundo Intergrowth 21st. A chance de nascer PIG para ganho de peso insuficiente foi de OR=1,52 (IC95% 1,06;2,19), OR=1,52 (IC95% 1,05;2,20) e OR=1,56 (IC95% 1,06;2,30) para Brandão et al., IOM e Intergrowth 21st , respectivamente, enquanto o ganho de peso excessivo apresentou OR=1,53 (IC95% 1,28;1,82), OR=1,57 (IC95% 1,31;1,87) e OR=1,65 (IC95% 1,40;1,96), respectivamente. Conclusão: Comparados às recomendações do IOM, Intergrowth 21st e Brandão et al. apresentam-se como alternativas para identificar PIG e GIG

Oferta de Prótese Dentária na Atenção Básica: Expansão e Diferenças Regionais no Brasil

O objetivo do presente estudo foi analisar a expansão da oferta de prótese dentária pelas Equipes de Saúde Bucal (ESBs) conforme as regiões geográficas brasileiras. O estudo de série temporal foi realizado com dados secundários do Módulo II do 1º ciclo (2011-2012), Módulo VI do 2º ciclo (2013- 2014) e Módulo V e VI do 3º ciclo (2015-2018) do instrumento de Avaliação Externa do Programa de Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB). Houve comparação das proporções entre as regiões brasileiras pelo teste Qui-quadrado, e entre os anos pelo teste Q de Cochran, com uso do teste z ajustado pelo método Bonferroni (p0,05). A Prótese Parcial Removível aumentou no Brasil de 2012 (25,7%) para 2014 (30,5%) (p<0,001), e aumentou no Sul e Nordeste (p<0,05). Houve aumento de ESBs que ofertam serviços de prótese dentária na Atenção Básica, no entanto ainda existem disparidades entre as regiões geográficas

SEGUIMENTO DE RESULTADOS ALTERADOS DE PAPANICOLAU NAS UNIDADES BÁSICAS DE SAÚDE DO MUNICÍPIO DE SÃO PAULO

Cervical cancer is the one with one of the highest potential for prevention and cure. The aim of the study was to: a) assess the proportion abnormal Pap test results in 20 units of Health Supervision in the region of Penha city São Paulo, Brazil; b) diagnose the correct monitoring flows in health facilities; c) investigate the monitoring of exams altered in the health units. We used it for the verification of the existence of tests record books, their correct completion, and data collection time and results of these tests. Data were analyzed using descriptive statistics, frequency distribution tables and Spearman correlation analysis. It was found that the subjects had an average of 32 years (95% confidence interval), higher prevalence of CIN (Epithelial Neoplasia Intra) I (79.3%) and the time between collection and examination of final diagnosis 91-123 days. They met only nine units in accordance with Tracking Protocols of the Ministry of Health and in these the time between collection and final diagnosis was lower. It was concluded that the implementation of protocols is a major factor for a volley of altered Pap tests.O câncer de colo do útero, quando diagnosticado precocemente, apresenta um dos mais altos potenciais de prevenção e cura. Os objetivos do estudo foram: a) avaliar a proporção de resultados alterados de Papanicolau nas 20 unidades da Região da Supervisão de Saúde da Penha da cidade São Paulo, Brasil; b) diagnosticar os fluxos de acompanhamento corretos nas unidades de saúde e c) averiguar o acompanhamento dos exames alterados nas unidades de saúde. Utilizou-se a verificação dos livros de registro de exames, seu preenchimento correto e a coleta de dados, bem como os resultados destes exames. Os dados foram analisados por meio de estatística descritiva, tabelas de distribuição de frequências e análise de correlação de Spearman. Verificou-se que os indivíduos apresentaram em média 32 anos (intervalo de confiança de 95%), maior prevalência de NIC (Neoplasia Intra Epitelial) I (79,3%) e o tempo entre coleta de exame e diagnóstico final foi de 91 a 123 dias. Encontraram-se apenas nove unidades em conformidade com Protocolos de Seguimento do Ministério da Saúde e, nestas, o tempo entre coleta e diagnóstico final era menor. Concluiu-se que a implantação de protocolos é fator preponderante para um melhor seguimento dos exames alterados de Papanicolau