Mudanças cefalométricas produzidas por Pistas Planas e Bionator na classe II divisão 1

Introduction: The Bionator and flat tracks are functional appliances that are among the treatment options for class II malocclusion division 1.   Objective: To compare the craniofacial and soft tissue changes resulting from orthopedic treatment to correct the class II division 1 malocclusion.   Methods: an almost experimental intervention study was carried out; the sample unit was 622 children between 6 and 9 years of age, of both sexes, of the Guerrillero Heroico Primary School, area II of the Cienfuegos municipality; Of these, 20 patients were selected, divided into two groups equally, with which the functional appliances of Pistas Planas and Bionator were used as therapy. Lateral cephalograms of the skull were taken at the beginning and after one year of treatment; linear and angular measurements were performed by Steiner, Ricketts and McNamara. Cephalometric changes in skeletal and soft tissues were evaluated before and after treatment.   Results: Changes were observed in measurements of lateral cranial radiographs, with cephalometric craniofa cial variations of significant statistical significance. In the soft tissues, the nasolabial angle increased, which was diminished due to the labial component, since there was light protrusion of the upper lip.   Conclusion: it was statistically proven that patients with flat tracks had statistically more significant craniofacial changes in most cephalometric measurements; soft tissue changes were not significant for any of the two therapies employed, and the biotype was positively modified with both devices.Introducción: el Bionator y las pistas planas son aparatos funcionales que se encuentra entre las opciones de tratamiento de la maloclusión clase II división 1. Objetivo: comparar los cambios cráneofaciales y de tejidos blandos resultantes del tratamiento ortopédico para la corrección de maloclusión clase II división 1. Métodos: se realizó un estudio de intervención, cuasiexperimental, la unidad muestral lo constituyó 622 niños entre 6 y 9 años de ambos sexos de la Escuela Primaria “Guerrillero Heroico” del Área II del municipio Cienfuegos, la muestra quedó constituida por 20 pacientes, se dividió en 2 grupos equitativamente y se utilizó como terapéutica los aparatos funcionales de Pistas Planas y el Bionator. Se tomaron telerradiografías laterales de cráneo al inicio y al año de tratamiento, se realizaron mediciones lineales y/o angulares de Steiner, Ricketts y McNamara. Se evaluaron los cambios cefalométricos esqueletales y de tejidos blandos antes y después del tratamiento. Resultados: se observaron cambios en las mediciones de las radiografías laterales de cráneo, con variaciones cefalométricas cráneofaciales de significación estadística importante; en los tejidos blandos aumentó el ángulo nasolabial, el cual se encontraba disminuido debido al componente labial ya que existía protrusión ligera del labio superior. Conclusión: se comprobó desde el punto de vista estadístico que los pacientes con pistas planas presentaron cambios craneofaciales estadísticamente más significativos en la mayoría de las medidas cefalométricas, los cambios en los tejidos blandos no fueron significativos para ninguno de las dos terapéuticas empleadas y el biotipo fue modificado positivamente con ambas aparatologías.Introdução: o Bionator e as pistas planas são aparelhos funcionais que se encontram entre as opções de tratamento da má-oclusão classe II divisão 1.   Objetivo: comparar as mudanças craniofaciais e de tecidos moles resultantes do tratamento ortopédico para corrigir a má-colusão classe II divisão 1.   Métodos: foi realizado um estudo de intervenção, quase experimental; a unidade de amostra foi de 622 crianças entre 6 e 9 anos, de ambos os sexos, da Escuela Primaria Guerrillero Heroico, da área II do município Cienfuegos; destas, foram selecionados 20 pacientes, divididos em dois grupos equitativamente, com os quais foram utilizados, como terapia, os aparelhos funcionais de Pistas Planas e Bionator. Foram tomadas telerradiografias laterais de crânio no início e depois de um ano do tratamento; foram realizadas medições lineares e angulares de Steiner, Ricketts e McNamara. Foram avaliadas as mudanças cefalométricas esqueletais e tecidos moles antes e depois do tratamento.   Resultados: foram observadas mudanças nas medições das radiografias laterais de crânio, com variações cefalométricas craniofaciais de significação estatística importante. Nos tecidos moles, aumentou o ângulo nasolabial, o qual se encontrava diminuído devido ao componente labial, já que existia protrusão leve do lábio superior.   Conclusão: foi comprovado, do ponto de vista estatístico, que os pacientes com pistas planas apresentaram mudanças craniofaciais estatisticamente mais significativas na maioria das medidas cefalométricas; as mudanças nos tecidos moles não foram significativas para nenhuma das duas terapias empregadas, e o biotipo foi modificado positivamente com ambas as aparatologias

Cambios cefalométricos producidos por Pistas Planas y Bionator en la clase II división 1

Introducción: el Bionator y las pistas planas son aparatos funcionales que se encuentran entre las opciones de tratamiento de la maloclusión clase II división 1. Objetivo:comparar los cambios cráneofaciales y de tejidos blandos resultantes del tratamiento ortopédico para la corrección de maloclusión clase II división 1. Métodos: se realizó un estudio de intervención, cuasiexperimental, la unidad muestral fue de 622 niños entre 6 y 9 años de ambos sexos de la Escuela Primaria Guerrillero Heroico del área II del municipio Cienfuegos, la muestra quedó constituida por 20 pacientes, se dividió en 2 grupos equitativamente y se utilizaron como terapéutica los aparatos funcionales de Pistas Planas y el Bionator. Se tomaron telerradiografías laterales de cráneo al inicio y al año de tratamiento, se realizaron mediciones lineales y angulares de Steiner, Ricketts y McNamara. Se evaluaron los cambios cefalométricos esqueletales y de tejidos blandos antes y después del tratamiento. Resultados: se observaron cambios en las mediciones de las radiografías laterales de cráneo, con variaciones cefalométricas cráneofaciales de significación estadística importante. En los tejidos blandos aumentó el án-gulo nasolabial, el cual se encontraba disminuido debido al componente labial ya que existía protrusión ligera del labio superior. Conclusión: se comprobó desde el punto de vista estadístico que los pacientes con pistas planas presentaron cambios craneofaciales estadísticamente más significativos en la mayoría de las medidas cefalométricas, los cambios en los tejidos blandos no fueron significativos para ninguno de las dos terapéuticas empleadas y el biotipo fue modificado positivamente con ambas aparatologíasIntroduction: The Bionator and flat tracks are functional appliances that are among the treatment options for class II malocclusion division 1.Objective: To compare the craniofacial and soft tissue changes resulting from orthopedic treatment to correct the class II division 1 malocclusion.Methods: an almost experimental intervention study was carried out; the sample unit was 622 children between 6 and 9 years of age, of both sexes, of the Guerrillero Heroico Primary School, area II of the Cienfuegos munici-pality; Of these, 20 patients were selected, divided into two groups equally, with which the functional appliances of Pistas Planas and Bionator were used as therapy. Lateral cephalograms of the skull were taken at the be-ginning and after one year of treatment; linear and angular measurements were performed by Steiner, Ricketts and McNamara. Cephalometric changes in skeletal and soft tissues were evaluated before and after treatment.Results: Changes were observed in measurements of lateral cranial radiographs, with cephalometric craniofa-cial variations of significant statistical significance. In the soft tissues, the nasolabial angle increased, which was diminished due to the labial component, since there was light protrusion of the upper lip.Conclusion: it was statistically proven that patients with flat tracks had statistically more significant craniofa-cial changes in most cephalometric measurements; soft tissue changes were not significant for any of the two therapies employed, and the biotype was positively modified with both devices1. Resumen. -- 2. Introducción. -- 3. Materiales y métodos. -- 4. Resultados. -- 5. Discusión. -- 6. Conclusiones.https://orcid.org/0000-0002-9862-7199https://orcid.org/0000-0002-2671-6360https://orcid.org/0000-0001-9287-0609https://orcid.org/[email protected]

Efetividade da intervenção em crianças de 5 a 11 anos portadores de hábitos bucais deletérios

Introduction: The who states “that deforming oral habits are a frequent health problem in children.”   Aim: To evaluate the effectiveness of an intervention carried out in schoolchildren of 5-11 years of age with deforming oral habits in the municipalities of Cienfuegos, Cumanayagua, Abreu and Lajas, Cuba.   Methods: Quasi-experimental study with before and after intervention in a child population between 5 and 11 years old, in the period between January 2013 and September 2015. The different types of habits and anomalies present in each child were identified; the Para Sonreír Feliz program was applied weekly. A knowledge survey was applied to children, parents and educators, before and after taking educational, preventive and therapeutic actions.   Results: 64.06 % of the deforming habits were eradicated (the most frequent being protractile tongue, baby bottle sucking, and nail biting), and there was a reduction in dentomaxillofacial anomalies. The level of knowledge of children, parents and educators increased at the end of the intervention.   Conclusions: The intervention was effective in reducing deforming habits and dentomaxillofacial anomalies, as well as for the satisfactory results in the level of knowledge about this entity, a health problem that can be prevented early to improve harmony in the components of the stomatognathic apparatus.Introducción:la OMSplantea “que los hábitos deformantes bucales constituyen un problema de salud frecuente en la población infantil”. Objetivo: evaluar la efectividadde la intervención realizada en escolares de 5-11 años  portadora de hábitos deformantes bucales de los municipios Cienfuegos, Cumanayagua, Abreu y Lajas. Métodos:estudio cuasiexperimental con intervención antes y después, en la población infantil entre un rango de 5 a 11 años  en el período comprendido de enero  del 2013 a septiembre del 2015. Se identificaron los diferentes tipos de hábitos y anomalías presentes en cada niño, se aplicó el programa “Para Sonreír Feliz” con frecuencia semanal. Se aplicó una encuesta de conocimientos a niños, padres y educadores, antes y después de aplicar acciones educativas, preventivas y terapéuticas. Resultados: se erradicó el 64,06 % de los hábitos deformantes (más frecuentes protracción lingual, succión de biberón y onicofagia) y hubo reducción de las anomalías dentomaxilofaciales. El nivel de conocimiento de niños, padres y educadores se elevó al concluir la intervención. Conclusiones: la intervención fue efectiva por la reducción de loshábitos deformantes, de las anomalías dentomaxilofaciales (ADMF), así como los resultados satisfactorios en el nivel de conocimientos sobre esta entidad,  un problema de salud que se puede prevenir tempranamente para mejorar la armonía de los componentes del aparato Estomatognático. Introdução: segundo a Organização Mundial da Saúde, “os hábitos bucais deletérios constituem um problema de saúde frequente na população infantil”.   Objetivo: avaliar a efetividade da intervenção realizada em crianças de 5 a 11 anos portadoras de hábitos bucais deletérios dos municípios Cienfuegos, Cumanayagua, Abreu e Lajas, em Cuba.   Métodos: estudo quase-experimental com intervenção antes e depois na população infantil, numa faixa etária de 5 a 11 anos, no período compreendido entre janeiro de 2013 a setembro de 2015. Foram identificados os diferentes tipos de hábitos e anomalias presentes em cada criança; aplicou-se o programa Para Sorrir Feliz com frequência semanal. Realizou-se um questionário de conhecimentos a crianças, pais e educadores, antes e depois de aplicar ações educativas, preventivas e terapêuticas.   Resultados: foram erradicados 64,06% dos hábitos deletérios (mais frequentes: protrusão lingual, sucção de mamadeira e onicofagia) e houve redução das anomalias dentomaxilofaciais. O nível de conhecimento de crianças, pais e educadores foi elevado ao finalizar a intervenção.   Conclusões: a intervenção foi efetiva pela redução dos hábitos deformantes e das anomalias dentomaxilofaciais, bem como pelos resultados satisfatórios no nível de conhecimento sobre essa entidade, um problema de saúde que pode ser prevenido precocemente para melhorar a harmonia dos componen- tes do aparelho estomatognático

Efectividad de la Intervención en niños de 5 a 11 años portadores de hábitos bucales deformantes

Introducción:la OMSplantea “que los hábitos deformantes bucales constituyen un problema de salud frecuente en la población infantil”. Objetivo: evaluar la efectividadde la intervención realizada en escolares de 5-11 años  portadora de hábitos deformantes bucales de los municipios Cienfuegos, Cumanayagua, Abreu y Lajas. Métodos:estudio cuasiexperimental con intervención antes y después, en la población infantil entre un rango de 5 a 11 años  en el período comprendido de enero  del 2013 a septiembre del 2015. Se identificaron los diferentes tipos de hábitos y anomalías presentes en cada niño, se aplicó el programa “Para Sonreír Feliz” con frecuencia semanal. Se aplicó una encuesta de conocimientos a niños, padres y educadores, antes y después de aplicar acciones educativas, preventivas y terapéuticas. Resultados: se erradicó el 64,06 % de los hábitos deformantes (más frecuentes protracción lingual, succión de biberón y onicofagia) y hubo reducción de las anomalías dentomaxilofaciales. El nivel de conocimiento de niños, padres y educadores se elevó al concluir la intervención. Conclusiones:la intervención fue efectiva por la reducción de loshábitos deformantes, de las anomalías dentomaxilofaciales (ADMF), así como los resultados satisfactorios en el nivel de conocimientos sobre esta entidad,  un problema de salud que se puede prevenir tempranamente para mejorar la armonía de los componentes del aparato Estomatognático.

Efectividad de la Intervención en niños de 5 a 11 años portadores de hábitos bucales deformantes

Introduction: The who states “that deforming oral habits are a frequent health problem in children.”   Aim: To evaluate the effectiveness of an intervention carried out in schoolchildren of 5-11 years of age with deforming oral habits in the municipalities of Cienfuegos, Cumanayagua, Abreu and Lajas, Cuba.   Methods: Quasi-experimental study with before and after intervention in a child population between 5 and 11 years old, in the period between January 2013 and September 2015. The different types of habits and anomalies present in each child were identified; the Para Sonreír Feliz program was applied weekly. A knowledge survey was applied to children, parents and educators, before and after taking educational, preventive and therapeutic actions.   Results: 64.06 % of the deforming habits were eradicated (the most frequent being protractile tongue, baby bottle sucking, and nail biting), and there was a reduction in dentomaxillofacial anomalies. The level of knowledge of children, parents and educators increased at the end of the intervention.   Conclusions: The intervention was effective in reducing deforming habits and dentomaxillofacial anomalies, as well as for the satisfactory results in the level of knowledge about this entity, a health problem that can be prevented early to improve harmony in the components of the stomatognathic apparatus.Introducción:la OMSplantea “que los hábitos deformantes bucales constituyen un problema de salud frecuente en la población infantil”. Objetivo: evaluar la efectividadde la intervención realizada en escolares de 5-11 años  portadora de hábitos deformantes bucales de los municipios Cienfuegos, Cumanayagua, Abreu y Lajas. Métodos:estudio cuasiexperimental con intervención antes y después, en la población infantil entre un rango de 5 a 11 años  en el período comprendido de enero  del 2013 a septiembre del 2015. Se identificaron los diferentes tipos de hábitos y anomalías presentes en cada niño, se aplicó el programa “Para Sonreír Feliz” con frecuencia semanal. Se aplicó una encuesta de conocimientos a niños, padres y educadores, antes y después de aplicar acciones educativas, preventivas y terapéuticas. Resultados: se erradicó el 64,06 % de los hábitos deformantes (más frecuentes protracción lingual, succión de biberón y onicofagia) y hubo reducción de las anomalías dentomaxilofaciales. El nivel de conocimiento de niños, padres y educadores se elevó al concluir la intervención. Conclusiones: la intervención fue efectiva por la reducción de loshábitos deformantes, de las anomalías dentomaxilofaciales (ADMF), así como los resultados satisfactorios en el nivel de conocimientos sobre esta entidad,  un problema de salud que se puede prevenir tempranamente para mejorar la armonía de los componentes del aparato Estomatognático. Introdução: segundo a Organização Mundial da Saúde, “os hábitos bucais deletérios constituem um problema de saúde frequente na população infantil”.   Objetivo: avaliar a efetividade da intervenção realizada em crianças de 5 a 11 anos portadoras de hábitos bucais deletérios dos municípios Cienfuegos, Cumanayagua, Abreu e Lajas, em Cuba.   Métodos: estudo quase-experimental com intervenção antes e depois na população infantil, numa faixa etária de 5 a 11 anos, no período compreendido entre janeiro de 2013 a setembro de 2015. Foram identificados os diferentes tipos de hábitos e anomalias presentes em cada criança; aplicou-se o programa Para Sorrir Feliz com frequência semanal. Realizou-se um questionário de conhecimentos a crianças, pais e educadores, antes e depois de aplicar ações educativas, preventivas e terapêuticas.   Resultados: foram erradicados 64,06% dos hábitos deletérios (mais frequentes: protrusão lingual, sucção de mamadeira e onicofagia) e houve redução das anomalias dentomaxilofaciais. O nível de conhecimento de crianças, pais e educadores foi elevado ao finalizar a intervenção.   Conclusões: a intervenção foi efetiva pela redução dos hábitos deformantes e das anomalias dentomaxilofaciais, bem como pelos resultados satisfatórios no nível de conhecimento sobre essa entidade, um problema de saúde que pode ser prevenido precocemente para melhorar a harmonia dos componen- tes do aparelho estomatognático

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research