Equity Inthe Use Of Dental Services Provided By The Brazilian Unified Health System (sus) Among The Elderly: A Population-based Study

Propõe-se caracterizar os idosos usuários de serviços odontológicos ofertados pelo Sistema Único de Saúde, considerando o princípio da equidade. Trata-se de um estudo transversal analítico com modelagem hierarquizada, conduzido a partir de uma amostra probabilística, complexa, por conglomerados de idosos (65-74 anos) residentes em um município brasileiro de grande porte populacional. Foram incluídas variáveis independentes referentes a: características sociodemográficas, acesso a informações em saúde, comportamentos/sistema de atenção à saúde e desfechos em saúde. Realizou-se análises descritivas, bivariadas e múltiplas hierarquizadas. Dos 480 idosos incluídos, 138 (31,2%) utilizaram serviços odontológicos provenientes do SUS. O uso desses serviços foi maior à medida que diminuíam a renda per capita e a escolaridade dos idosos, menor entre os que não haviam realizado o autoexame da boca e maior entre os que usavam os serviços odontológicos para procedimentos que não fossem rotina. Além disso, verificou-se que utilizaram mais o SUS pessoas que tiveram o relacionamento afetado pela saúde bucal e uma autopercepção negativa da sua aparência. Conclui-se que o uso dos serviços odontológicos no SUS foi predominante entre os idosos que vivem sob condições de vulnerabilidade.21113509352

Estudo para detecção de fissuras labiopalatinas no pré-natal: revisão de literatura e relato de caso/ Study for crack detection prenatal labiopalatins: literature review and case report

As Fissuras Labiopalatinas (FLP) são anomalias congênitas orofaciais, caracterizadas por espaço anormal do palato, alvéolo e/ou lábio que atingem o terço médio da face em estruturas como nariz, gengiva e dentes. Tais fissuras são decorrentes de uma falha na migração ou fusão dos processos frontonasal e maxilares durante o desenvolvimento embriológico, entre a quarta e oitava semanas de vida intra-uterina.  A detecção pré-natal das FLP se faz possível com um exame ultrassonográfico transabdominal, que é oferecido rotineiramente no Brasil para mulheres grávidas durante o segundo trimestre. O presente trabalho tem por objetivo revisar a literatura sobre a prevenção e o reconhecimento precoce de fissuras labiopalatinas e relatar um caso em que o diagnóstico de descontinuidade no lábio superior da paciente foi feito através de ultrassonografia transabdominal realizada no pré-natal. A mãe, encaminhada por sua obstetra, procurou o serviço de Cirurgia e Traumatologia Bucomaxilofacial onde foi orientada sobre como proceder durante a amamentação para que o bebê não apresentasse dificuldades de se alimentar e sobre os cuidados que deveriam ser tomados até que a cirurgia de correção do lábio pudesse ser realizada. A paciente apresentava presença de fissura unilateral incompleta do lado esquerdo, classe C da classificação de Spina, com discreta deformidade de rebordo alveolar do lado esquerdo; notou-se ainda presença de deformidade da asa do nariz esquerdo e anciloglossia. Foi decidido preparar a paciente para a cirurgia aos quatro meses de vida. Em proservação, doze meses após a intervenção, a análise final do resultado obtido se mostrou satisfatória tanto para a equipe médica, quanto para a mãe da paciente, a qual pôde-se preparar da melhor forma para lidar com a situação de forma a oferecer melhor qualidade de vida à criança.

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Thresholds of freshwater biodiversity in response to riparian vegetation loss in the Neotropical region

Protecting riparian vegetation around streams is vital in reducing the detrimental effects of environmental change on freshwater ecosystems and in maintaining aquatic biodiversity. Thus, identifying ecological thresholds is useful for defining regulatory limits and for guiding the management of riparian zones towards the conservation of freshwater biota. Using nationwide data on fish and invertebrates occurring in small Brazilian streams, we estimated thresholds of native vegetation loss in which there are abrupt changes in the occurrence and abundance of freshwater bioindicators and tested whether there are congruent responses among different biomes, biological groups and riparian buffer sizes. Mean thresholds of native vegetation cover loss varied widely among biomes, buffer sizes and biological groups: ranging from 0.5% to 77.4% for fish, from 2.9% to 37.0% for aquatic invertebrates and from 3.8% to 43.2% for a subset of aquatic invertebrates. Confidence intervals for thresholds were wide, but the minimum values of these intervals were lower for the smaller riparian buffers (50 and 100 m) than larger ones (200 and 500 m), indicating that land use should be kept away from the streams. Also, thresholds occurred at a lower percentage of riparian vegetation loss in the smaller buffers, and were critically lower for invertebrates: reducing only 6.5% of native vegetation cover within a 50-m riparian buffer is enough to cross thresholds for invertebrates. Synthesis and applications. The high variability in biodiversity responses to loss of native riparian vegetation suggests caution in the use of a single riparian width for conservation actions or policy definitions nationwide. The most sensitive bioindicators can be used as early warning signals of abrupt changes in freshwater biodiversity. In practice, maintaining at least 50-m wide riparian reserves on each side of streams would be more effective to protect freshwater biodiversity in Brazil. However, incentives and conservation strategies to protect even wider riparian reserves (~100 m) and also taking into consideration the regional context will promote a greater benefit. This information should be used to set conservation goals and to create complementary mechanisms and policies to protect wider riparian reserves than those currently required by the federal law. © 2020 British Ecological Societ

Thresholds of freshwater biodiversity in response to riparian vegetation loss in the Neotropical region

Protecting riparian vegetation around streams is vital in reducing the detrimental effects of environmental change on freshwater ecosystems and in maintaining aquatic biodiversity. Thus, identifying ecological thresholds is useful for defining regulatory limits and for guiding the management of riparian zones towards the conservation of freshwater biota. Using nationwide data on fish and invertebrates occurring in small Brazilian streams, we estimated thresholds of native vegetation loss in which there are abrupt changes in the occurrence and abundance of freshwater bioindicators and tested whether there are congruent responses among different biomes, biological groups and riparian buffer sizes. Mean thresholds of native vegetation cover loss varied widely among biomes, buffer sizes and biological groups: ranging from 0.5% to 77.4% for fish, from 2.9% to 37.0% for aquatic invertebrates and from 3.8% to 43.2% for a subset of aquatic invertebrates. Confidence intervals for thresholds were wide, but the minimum values of these intervals were lower for the smaller riparian buffers (50 and 100 m) than larger ones (200 and 500 m), indicating that land use should be kept away from the streams. Also, thresholds occurred at a lower percentage of riparian vegetation loss in the smaller buffers, and were critically lower for invertebrates: reducing only 6.5% of native vegetation cover within a 50-m riparian buffer is enough to cross thresholds for invertebrates. Synthesis and applications. The high variability in biodiversity responses to loss of native riparian vegetation suggests caution in the use of a single riparian width for conservation actions or policy definitions nationwide. The most sensitive bioindicators can be used as early warning signals of abrupt changes in freshwater biodiversity. In practice, maintaining at least 50-m wide riparian reserves on each side of streams would be more effective to protect freshwater biodiversity in Brazil. However, incentives and conservation strategies to protect even wider riparian reserves (~100 m) and also taking into consideration the regional context will promote a greater benefit. This information should be used to set conservation goals and to create complementary mechanisms and policies to protect wider riparian reserves than those currently required by the federal law