Percepção de mães sobre a síndrome da erupção dentária e suas manifestações clínicas na infância

Objetivo Este estudo objetivou identificar a percepção de mães primíparas e multíparas sobre a erupção dentária e suas manifestações, ao mesmo tempo em que relacionou e discutiu a ocorrência destas manifestações a luz da literatura pertinente. Método Trata-se de um estudo qualitativo descritivo, onde os sujeitos foram 61 mães, com bebês na faixa etária entre 3 e 12 meses de idade, usuários do Hospital de Pediatria da UFRN,  na cidade de Natal, RN, Brasil. Utilizou-se uma entrevista semi-estruturada para coleta das informações. A análise dos dados foi feita pelo Software ALCESTE 4.5, utilizando-se as variáveis primíparas, para designar mães com apenas um filho e multíparas para mães com dois filhos ou mais. Resultados A presença de sintomatologia foi relatada por 75 % das mães entrevistadas. A percepção das mães de ambas as classes, provavelmente reflete desconhecimento do processo de desenvolvimento infantil e convergem para a presença de sintomas clínicos atribuídos ao processo eruptivo, porém, o grande diferencial está na forma de apreensão desta realidade. As primíparas manifestam claramente que o conhecimento foi adquirido através do senso comum, enquanto que as multíparas reproduzem este mesmo conhecimento baseado na experiência com os filhos anteriores. Discussão Concluiu-se que durante essa fase de erupção dentária os profissionais tenham uma posição firme e definida, baseada em evidências fartamente colocadas pela literatura, da relação direta entre erupção dentária e sintomatologia geral, dando a devida atenção a cada paciente e suas queixas, para desmistificar e melhor compreender esse processo na sua totalidade.Objetivo Este estudo objetivou identificar a percepção de mães primíparas e multíparas sobre a erupção dentária e suas manifestações, ao mesmo tempo em que relacionou e discutiu a ocorrência destas manifestações a luz da literatura pertinente.Método Trata-se de um estudo qualitativo descritivo, onde os sujeitos foram 61 mães, com bebês na faixa etária entre 3 e 12 meses de idade, usuários do Hospital de Pediatria da UFRN,  na cidade de Natal, RN, Brasil. Utilizou-se uma entrevista semi-estruturada para coleta das informações. A análise dos dados foi feita pelo Software ALCESTE 4.5, utilizando-se as variáveis primíparas, para designar mães com apenas um filho e multíparas para mães com dois filhos ou mais. Resultados A presença de sintomatologia foi relatada por 75 % das mães entrevistadas. A percepção das mães de ambas as classes, provavelmente reflete desconhecimento do processo de desenvolvimento infantil e convergem para a presença de sintomas clínicos atribuídos ao processo eruptivo, porém, o grande diferencial está na forma de apreensão desta realidade. As primíparas manifestam claramente que o conhecimento foi adquirido através do senso comum, enquanto que as multíparas reproduzem este mesmo conhecimento baseado na experiência com os filhos anteriores. Discussão Concluiu-se que durante essa fase de erupção dentária os profissionais tenham uma posição firme e definida, baseada em evidências fartamente colocadas pela literatura, da relação direta entre erupção dentária e sintomatologia geral, dando a devida atenção a cada paciente e suas queixas, para desmistificar e melhor compreender esse processo na sua totalidade

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

© The Author(s) 2018. Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries(1,2). However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world(3) and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health(4,5). However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular riskchanged from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Peer reviewe

O trabalho em equipe desenvolvido pelo cirurgião-dentista na Estratégia Saúde da Família: expectativas, desafios e precariedades

This study aimed to analyze the integration of the surgeon-dentist (SD) with other professionals belonging to the Family Health Strategy (FHS), as well as identify the work process within this team. The study was developed in the municipality of Parnamirim, State of Rio Grande do Norte, where all the dentists – in a total of 30, that work in the FHS took part in the survey. A semi-structured questionnaire was used for data collection. Teamwork was taken as dependent variable. Data were analyzed by descriptive statistics: absolute and percentage distributions. It was possible to observe that the dentists do not participate in an integrated way in the team. Joint actions among team members do not happen on a regular, systematic basis, as part of their work process (56.7%). The professionals, in general, are dissatisfied with the performance of their duties (63.3%). A reflection on the development of teamwork process in the FHS is needed.El objetivo de este estudio fue caracterizar la integración entre el dentista y los demás profesionales pertenecientes a la Estrategia de Salud Familiar (ESF) e identificar su proceso de trabajo dentro de ese equipo. Participaron de este estudio los 30 profesionales dentistas que trabajan en la ESF del municipio de Parnamirim-RN. Los datos se recolectaron con un cuestionario semi-estructurado, siendo el trabajo en equipo la variable dependiente, y fueron analizados mediante estadística descriptiva (distribuciones absolutas y porcentuales). Se observó que los dentistas no participaban en un equipo integrado. La articulación de las actividades entre los miembros del equipo no ocurrió de forma habitual y sistemática, como parte integrante de su proceso de trabajo (56,7%). De manera general, los profesionales se mostraron insatisfechos con el desempeño de sus funciones (63,3%). Se sugiere una reflexión con relación al desarrollo del proceso de trabajo en equipo, con una efectiva participación de los dentistas.Este estudo objetivou conhecer a integração do cirurgião-dentista (CD) com os demais profissionais pertencentes à Estratégia Saúde da Família (ESF), bem como identificar o seu processo de trabalho dentro dessa equipe. O estudo desenvolveu-se no município de Parnamirim-RN, e dele participaram todos os CDs que atuam na ESF do município, num total de 30 profissionais. O Instrumento de coleta de dados utilizado foi um questionário semiestruturado e a variável dependente foi o trabalho em equipe. Os dados foram analisados por meio da estatística descritiva (distribuições absolutas e percentuais). Observou-se que os CDs não participam de forma integrada na equipe. A articulação das ações entre os membros da equipe não acontece de forma habitual e sistemática, como parte integrante de seu processo de trabalho (56,7%). Os profissionais de maneira geral mostraram-se insatisfeitos no desempenho de suas funções (63,3%). Sugere-se uma reflexão no tocante ao desenvolvimento do processo de trabalho em equipe com a participação efetiva do CD

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure : A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

Background Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results In 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups