Clinical-epidemiological profile of traumatic brain injury associated with traffic accidents in southeastern Pará, in the Brazilian Amazon:

Introdução: No Brasil, os traumatismos cranioencefálicos (TCEs) representam cerca dois terços de todas as causas de óbitos e são frequentemente associados a acidentes de trânsito, causando sobrecarga dos serviços de média e alta complexidade. Objetivos: Descrever a ocorrência e o perfil clínico-epidemiológico de TCEs associados a acidentes de trânsito em um hospital regional no Sudeste do Estado do Pará. Materiais e Métodos: Trata-se de um estudo analítico de corte transversal. Baseou-se em dados provenientes do serviço de arquivos médicos e estatísticos de um hospital regional, através da análise de prontuários eletrônicos de pacientes diagnosticados com TCEdecorrentes de acidentes de trânsito no período de 2016 a 2020. Resultados: Das 20.077 internações gerais registradas, 4,0% foram associadas à ocorrência de TCE, das quais 75,3% foram diretamente causados por acidentes de trânsito envolvendo motocicletas. Os casos se concentraram em indivíduos pardos, do sexo masculino, com faixaetária entre 18 e 29 anos, com percentuais de 92,5%, 86% e 39%, respectivamente. Conclusões: A ocorrência de TCEs associados a acidentes automobilísticos é um problema que requer atenção na região. Além disso, verificou-se várias lacunas no preenchimento dos prontuários, o que dificultou a determinação da associação do desfecho, o consumo de álcool e a utilização dos EPIs. No entanto, considerando todas as informações apresentadas, políticas públicas assertivas locais que visem a prevenção podem ser implementadas. E esse pode ser o ponto de partida para promover mudanças que visem mitigação dos acidentes de trânsito e ocupações de leitos por causas evitáveis,impactando na qualidade da assistência em saúde e fatores econômicos.Introduction: In Brazil, traumatic brain injury (TBI) represents about two thirds of all causes of death and are often associated with traffic accidents, causing overload of medium and high complexity services. Objectives: To describe the occurrence and clinical-epidemiological profile of TBIs associated with traffic accidents in a regional hospital in the southeast of the state of Pará. Materials and Methods: This is a cross-sectional analytical study.It was based on data from the medical and statistical archives service of a regional hospital, through the analysis of electronic medical records of patients treated with TBI resulting from traffic accidents in the period from 2016 to 2020. Results: Of the 20,077 overall hospitalizations recorded, 4.0% were associated with the occurrence of TBI, of which, 75.3% were directly caused by traffic accidents involving motorcycles. The cases were concentratedin individuals of mixed race, male, aged between 18 and 29 years, with percentages of 92.5%, 86% and 39%, respectively. Conclusions: The occurrence of TBIs associated with automobile accidents is a problem that requires attention in the region. Moreover, there were several gaps in the completion of the medical records, which made it difficult to determine the association of the outcome, alcohol consumption and the use of PPE. However, considering all the information presented, assertive local public policies aimed at prevention can be implemented. And this can be the starting point for promoting changes aimed at mitigating traffic accidents and bed occupations due to preventable causes, impacting the quality of health care and economic factors

PRODH Polymorphisms, Cortical Volumes and Thickness in Schizophrenia

Schizophrenia is a neurodevelopmental disorder with high heritability. Several lines of evidence indicate that the PRODH gene may be related to the disorder. Therefore, our study investigates the effects of 12 polymorphisms of PRODH on schizophrenia and its phenotypes. To further evaluate the roles of the associated variants in the disorder, we have conducted magnetic resonance imaging (MRI) scans to assess cortical volumes and thicknesses. A total of 192 patients were evaluated using the Structured Clinical Interview for DSM-IV (SCID), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale, Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI) instruments. the study included 179 controls paired by age and gender. the samples were genotyped using the real-time polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP)-PCR and Sanger sequencing methods. A sample of 138 patients and 34 healthy controls underwent MRI scans. One polymorphism was associated with schizophrenia (rs2904552), with the G-allele more frequent in patients than in controls. This polymorphism is likely functional, as predicted by PolyPhen and SIFT, but it was not associated with brain morphology in our study. in summary, we report a functional PRODH variant associated with schizophrenia that may have a neurochemical impact, altering brain function, but is not responsible for the cortical reductions found in the disorder.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo UNIFESP, Disciplina Genet, Dept Morfol & Genet, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psiquiatria, São Paulo, BrazilFac Med ABC FMABC, Dept Ginecol & Obstet, Disciplina Genet & Reprod Humana, São Paulo, BrazilFed Univ Para, Lab Genet Humana & Med, BR-66059 Belem, Para, BrazilUniv Fed ABC, Ctr Math Computat & Cognit, Santo Andre, BrazilUniversidade Federal de São Paulo UNIFESP, Disciplina Genet, Dept Morfol & Genet, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, LiNC, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psiquiatria, São Paulo, BrazilFAPESP: 2011/50740-5FAPESP: 2007/58736-1Web of Scienc

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

Reasons of tooth loss in economically actives adults

Resumo: Os objetivos deste trabalho foram verificar as condições de saúde bucal de adultos de 20 a 64 anos (cap. 1), identificar os indicadores de risco associados às perdas dentárias (cap. 2), bem como avaliar o impacto da saúde bucal na qualidade de vida (cap. 3). Este estudo foi realizado nas 11 unidades de uma empresa do ramo atacadista, na Região metropolitana de São Paulo e Jundiaí. Foram examinados 386 adultos de 20 a 64 anos, a faixa etária foi dividida em classes, de 20 a 34 anos, de 35 a 44 anos, e de 45 a 64 anos. Os exames clínicos seguiram as recomendações da Organização Mundial da Saúde (1997) e um questionário foi aplicado para obtenção de dados demográficos, socioeconômicos, de autopercepção em saúde, e de utilização de serviços odontológicos, o impacto da saúde bucal na qualidade de vida foi avaliado através do OHIP 14 (Oral Health Impact Profile). Foi realizada uma análise descritiva das variáveis estudadas, o teste Kruskal Wallis para comparar o CPOD (índice que expressa a soma de dentes cariados, perdidos e obturados) entre os grupos etários, e teste do qui-quadrado para verificar as necessidades de tratamento entre os grupos. A perda dentária foi analisada em dois desfechos, a perda de algum dente, e a perda de quatro ou mais dentes, utilizando-se do modelo de Regressão de Poisson. O quartil de impacto mais severo do OHIP foi o desfecho do capítulo 03, que foi analisado pelo modelo de regressão de Poisson com as variáveis demográficas, socioeconômicas, clínicas e de utilização de serviços. O CPOD da amostra geral foi 14,56 (±8,31), variando de 10,79 (±6,95) a 22,10 (±7,32) nos grupos etários. Este aumento ocorreu pelo componente dentes perdidos. Quanto à condição periodontal observou-se que 78,8% apresentou sangramento, a perda de inserção foi observada em 46,4% da amostra. Necessidades de tratamento para a cárie foram encontradas em 53,5% dos adultos. A média de dentes perdidos foi 5,38, e variou de 1,30 nos mais jovens a 24,75 nos adultos de 60 a 64 anos. Encontrou-se maior prevalência de perda dentária de um ou mais dentes nos mais velhos, nos que apresentaram placa visível no momento do exame, e em quem foi ao dentista há menos de um ano. Os indicadores de risco da perda de quatro dentes ou mais foram: ser mais velho, apresentar placa visível e possuir renda familiar mais baixa. Observou-se neste estudo que as dimensões mais afetadas do OHIP foram dor física e desconforto psicológico. Ser mulher, possuir menor renda familiar, procurar o dentista motivado por dor, ter perdido 4 dentes ou mais e ter apresentado alguma necessidade de tratamento para a cárie foram fatores associados ao maior impacto na qualidade de vida. É necessária a implantação de programas de promoção de saúde bucal baseados na equidade, integralidade e universalidade, que visem ao empoderamento da população jovem e adulta, a fim de que sejam prevenidas novas perdas dentárias, melhorando a qualidade de vida de adultos trabalhadores e diminuindo os efeitos das desigualdades socioeconômicasAbstract: The objective of this study was to verify the oral health conditions of adults between the age of 20 and 64 years old (chapter 1), identify the risk indicators of tooth loss (chapter 2) and measure the impacts of oral disorders on quality of life (chapter 3). This study was conducted in 11 units of a company's supermarket business of Sao Paulo region. This cross-sectional study examined 387 adults aged 20 to 64 years, expanding the age range of adults recommended by WHO (35-44 years old). The age range was divided into classes of 20 to 34 years, from 35 to 44 years, and 45 to 64 years. The exams followed the recommendations of WHO (1997) and a questionnaire was administered to obtain demographic, socio-economic, health perception and use of dental services data. OHIP14 was used to evaluate the oral health impact on quality of life. A descriptive analysis was realized, Kruskal Wallis test to compare the DMFT between the groups, and chi-square test to determine differences in treatment needs among the groups were used. Tooth loss was analyzed in two outcomes, the loss of a tooth, and the loss of four or more teeth, using the model of Poisson regression. The quartile of greater impact of OHIP was analyzed by the model of regression of Poisson with the demographic, socioeconomic, clinical and service utilization. The DMFT of the sample was 14.56 (± 8.31), ranged from 10.79 to 22.10 (± 7.32) among age groups. The missing teeth component was responsible for this increase. Majority of the adults had bleeding gums, with the lost of insertion affecting more than the sextant 3 (tooth 24 to 28), especially in older age groups. Treatment needs for caries was found in 53.5% of adults. The mean of missing teeth was 5.38, ranging from 1.30 in the young adults to 24.75 in the 60 to 64 year group. Tooth loss was more pronounced in the age group between 30 and 35 years old. The outcome of losing some teeth showed a higher prevalence of tooth loss in older people, in those with visible plaque at the time of examination, and those who visited the dentist less than one year ago. The outcome of losing four teeth or more were associated with being older, visible plaque and lower family income. Higher scores among these workers were found in physical pain and psychological disconfort mainly. Being a woman, have lower family income, look for a dentist motivated by pain, having lost 4 or more teeth and have made some need treatment for tooth decay were factors associated with greater impact on quality of life. It is necessary to implement programs to promote oral health based on fairness, integrity and universality, aimed at the empowerment of young and adult population, so that they are prevented new tooth loss, improving the quality of life of adult workers and reducing the effects of socioeconomic inequalitie

Tooth Loss Classification: Factors Associated With A New Classification In An Adult Population Group

This study evaluated tooth loss and factors associated with a new classification, which considers not only the number of teeth lost, but also the number and position that they occupied in the mouth. In Piracicaba, State of Sao Paulo, Brazil, 248 adults (20-64 year-olds) were examined using a household probability sample. The oral examinations followed the WHO criteria for caries and periodontal disease. Socioeconomic, demographic and dental service use data were collected. The tooth loss outcome, based on tooth position and number of missing teeth, was analyzed by hierarchical multinomial logistic regression using a conceptual model. The mean number of missing teeth was 8.52 (DP = 9.24). For those who had lost up to 12 posterior teeth, age (PR = 1.1) and low social class (PR = 2.6) were significant; for those who lost up to 12 including anterior teeth, age (PR = 1.1) and clinical attachment loss>4mm (PR = 2.9); and for tooth loss in excess of 13 teeth, age (PR = 1.3), low social class (PR = 3.8), and visiting a dentist due to emergency (PR = 9.4) were significant. Age was associated with tooth loss. The classification made it possible to differentiate variables in accordance with position or the number of teeth lost.2092825283

Risk factors for tooth loss in adults: a population-based prospective cohort study

The aim of this study was to identify the risk factors for tooth loss in an extended age group of adults over 4 years. The prospective cohort study assessed adults (20-64 years old) in 2011 and 2015, from Piracicaba, Sao Paulo, Brazil. The sample selection was planned based on the adult population in the city. The inclusion criteria were randomly selected residences per census tract unit (one adult per household). The exclusion criteria comprised of a physical or psychological state that prevented the achievement of clinical procedures or understanding of the questionnaire. The home oral examination was performed using the index of decayed, missing, and filled teeth (DMFT), the Community Periodontal Index according to the World Health Organization, and visible biofilm. Demographic and socio-economic data, information on health habits, and the use of dental services were obtained by questionnaire. The outcome was a presence incidence of tooth loss, assessed by the difference between Missing teeth (M>0) from DMFT in 2011 and that in 2015. The conceptual theoretical model 'Ethnicity, aging and oral health outcomes' was adapted for tooth loss and used in a Hierarchical multivariate Poisson Regression analysis (p<0.20). The reference category for the Poisson regression were individuals who had no missing teeth (M) due to caries or periodontal disease (p<0.05). There were a total of 143 (follow-up rate = 57.7%) participants in the four-year study, and there was incidence of tooth loss in 51 (35.7%) adults over this period. The risk factors for tooth loss were reason for seeking dental services by pain (RR = 2.72; 95.0% CI: 1.04-7.37), previous tooth loss (RR = 3.01; 95.0% CI: 1.18-7.73) and decayed teeth (RR = 2.87; 95.0% CI: 1.22-6.73). The risk factors for tooth loss were: reason for seeking dental services by pain, previous tooth loss and dental caries147COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2014/15184-22009/16560-0; 2011/00545-1; 2014/15184-2; 2009/16560-0; 2011/00545-

El Eco de Santiago : diario independiente: Año XIII Número 3713 - 1908 Marzo 17

This study investigated the impacts of oral health-related quality of life (OHRQoL) on daily activities and work productivity in adults. A cross-sectional study was conducted in a supermarket chain in the state of São Paulo, which included 386 workers, age-range 20 – 64 years. Participants were examined for oral disease following WHO recommendations, and the oral health impact profile (OHIP) assessment was used to determine OHRQoL. Demographic, socio-economic, use of dental services, and OHRQoL data were obtained. Answers to the OHIP were dichotomized into no impact and some impact, and the relationship to OHRQoL was determined. Poisson regression with robust variance was performed using SPSS version 17.0. Dimensions with highest OHIP scores were physical pain and psychological discomfort. Sex (male: PR = 0 .55, 9 5% C I 0 .38 – 0.80), lower family i ncome (PR = 1.49, 95% CI 1.04 – 2.12), visiting a dentist due to pain (PR = 2.14, 95% CI 1.57 – 3.43), tooth loss (PR = 1.59, 95% CI 1.09 – 2.32), and needing treatment for caries (PR = 1.59, 95% CI 1.09 – 2.32) were most likely to impact OHRQoL. Therefore, socioeconomic and demographic status and use of dental services impacted OHRQoL. These results indicate that oral health promotion strategies should be included in work environments