The influence of orthodontic treatment on the dental archs of unilateral cleft lip and palate patients

Objective: The present study evaluated the effect of orthopedic/orthodontic treatment on development and sagital growth of mandibible and maxila using the occlusal index evaluation method known as Goslon Yardstick. Material and methods: One hundred and nine patients were evaluated and ranked first in the deciduous / early mixed dentition and again after orthopedic / orthodontic treatment in late.permanent dentition. Results: The G3 group showed positive influence of orthodontic/orthopedic treatment in about half of the sample. In the remainder, the treatment was not effective enough to compensate the expected already restrictive effect and residual mandibular growth . The group initially classified as G4 and G5, the success on treatment, when realized, was not enough to influence positively the sagital discrepancy. So, there was need for orthognathic surgery in almost every G4 and G5 sample

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Avaliação retrospectiva dos pacientes atendidos e do tratamento oferecido no serviço de emergencias da FOP/UNICAMP entre os anos de 1989 e 1997

Orientador: Jacks Jorge JuniorDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Os serviços de emergências odontológicas são oferecidos por várias instituições brasileiras. Entretanto não há estudos verificando a eficácia do tratamento emergencial e o tipo de atendimento recebido pelo paciente. Neste trabalho verificou-se o grau de eficácia do tratamento oferecido aos pacientes no SE da FOPIUNICAMP, o grau de adesão do paciente ao tratamento odontológico regular, antes e após a emergência e o nível da satisfação do paciente com o serviço. Foram examinados 509 pacientes que utilizaram o SE da FOPIUNICAMP entre os anos de 1989 e 1997. Os pacientes foram convidados para consulta, durante a qual foram entrevistados e passaram por exame clínico e radiográfico. As informações obtidas foram digitadas em banco de dados construido com auxílio de software EPI-INFO 6.04b@ e analisadas estatisticamente pelo mesmo programa. Dentre os 509 pacientes atendidos, antes do atendimento no SE da FOPIUNICAMP, 40,9% dos pacientes só comparecia ao dentista em caso de dor e 26,7% freqüentavam regularmente o consultório dentário. Depois da consulta, 43,6% dos pacientes passaram a freqüentar o dentista só em emergências e 28,7% regularmente. Muitos dos dentes tratados no SE da FOPIUNICAMP, no momento da entrevista estavam ausentes (32,2%) ou cariados (23,0%). A maioria dos pacientes (76,4%) relatou que seu problema havia sido resolvido após a consulta e 41,7% dos pacientes relataram que gostaram dos alunos do SE da FOPIUNICAMP. O grau de adesão dos pacientes ao tratamento odontológico regular não foi satisfatório, o atendimento emergencial não motivou um grande número de pacientes a cuidar melhor dos seus dentes, podem ter ocorrido falhas no tratamento oferecido no SE da FOPIUNICAMP ou na continuidade do tratamento após a emergência e a população usuária está satisfeita com o serviço recebidoAbstract: The services of dental emergencies (ES) are offered by several Brazilian institutions. However there are no studies regarding the treatments given to the patients. In this work the rate of effectiveness of the treatment offered to the patients at ES at Dentistry School - University of Campinas (FOP fUNICAMP), the rate of adherence of the patient to the regular dental treatment before and after the emergency treatment and the leveI of the patient's satisfaction with the service were evaluated. The total of patients examined at the ES at FOPIUNICAMP ITom 1989 to 1997 was 509. The patients were recalled to receive a dental check-up. They were submitted to an interview and after that they went through a c1inical examination and radiographic inspection. The information obtained with this research were transferred to a database which used the software aid EPI-INFO 6. 04@ and it was statistically analyzed for the same programo Before this treatment at SE at FOPfUNICAMP, 40,9% ofthe total of 509 patients, used to go to the dentist just in case of pain, and 26,7% used to go to a dentistry evaluation on regular basis. After the emergency treatment, 43,6% of the patients continued to visit a dentist just in emergencies all situations and 28,7% did it regularly. We registered that many ofthe treated teeth at ES at FOPfUNICAMP were absent (32,2%) or with decays (23,0%). Most ofthe patients (76,4%) reported that their dental problem had been solved in emergency. The rate of adherence of the patients to the regular dental treatment was not satisfactory, the emergency service didn't motivate a great number of patients to take better care of their teeth, however apart ITom the fact that the patients were satisfied with the received treatment at the ES, they haven't had the chance to continue dental treatment after the emergencyMestradoMestre em Biologia e Patologia Buco-Denta

Higher Education students from health and non-health subject areas: aspects of oral health

ABSTRACT Objetive To evaluate whether the area of study of undergraduate students influences oral health knowledge, attitudes and practices, in addition to the use of dental services, self-reported oral morbidity, self-perception and impacts of oral health. Methods A cross-sectional study was performed, with a probabilistic sample of 681 students from the second semester of a Higher Education Institution, who were allocated into Health (H; n = 347) and Non-Health (NH; n = 334) groups, and answered a questionnaire encompassing their sociodemographic profile and aspects of oral health. Data were analyzed by Fisher’s Chi-Square/Exact Test (α = 5%). Results The majority of students were female (H = 70.0%, NH = 56.9%, p = 0.0004), single (H = 82.7%, NH = 76.0%, p = 0.0429) and did not work (H = 30.5%, NH = 37.7%, p = 0.0482). The groups differed in terms of receiving oral health guidelines from the media (H = 19.9%, NH = 13.8%, p = 0.0333) or from other health professionals (H = 25.6%, NH = 13.2%, p 0.05). Conclusions The groups differed regarding the source of information on oral health, the reason for seeking and type of treatment, and the self-perception of bad breath, with the Health group reporting greater satisfaction with their oral health

Liposomal butamben gel formulations: toxicity assays and topical anesthesia in an animal model

CAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL E NÍVEL SUPERIORFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOThe aim of this study was to evaluate the in vitro cytotoxicity and the in vivo analgesic effect and local toxicity of the local anesthetic butamben (BTB) encapsulated in conventional or elastic liposomes incorporated in gel formulations. The results showed that both gel formulations of liposomal BTB reduced the cytotoxicity (p<0.001; one-way ANOVA/Tukey's test) and increased the topical analgesic effect (p<0.05; one-way ANOVA/Tukey's test) of butamben, compared to plain BTB gel. The gel formulations presented good rheological properties, and stability assays detected no differences in physicochemical stability up to 30 d after preparation. Moreover, histological assessment revealed no morphological changes in rat skin after application of any of the gel formulations tested.The aim of this study was to evaluate the in vitro cytotoxicity and the in vivo analgesic effect and local toxicity of the local anesthetic butamben (BTB) encapsulated in conventional or elastic liposomes incorporated in gel formulations. The results showed that both gel formulations of liposomal BTB reduced the cytotoxicity (p<0.001; one-way ANOVA/Tukey's test) and increased the topical analgesic effect (p<0.05; one-way ANOVA/Tukey's test) of butamben, compared to plain BTB gel. The gel formulations presented good rheological properties, and stability assays detected no differences in physicochemical stability up to 30 d after preparation. Moreover, histological assessment revealed no morphological changes in rat skin after application of any of the gel formulations tested2717482CAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL E NÍVEL SUPERIORFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL E NÍVEL SUPERIORFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO2611/09–02006/00121-

Active teaching methodologies in health education

ABSTRACT This study is a literature review on the contributions of active methodologies in Higher Education in the health area. From the reviewed literature (texts, articles and books), an academic essay was written, addressing ideas, reflections, literature citations and authors’ personal impressions on the theme. After analyzing the literature, it was realized that active methodologies despite being involved in the teaching-learning process for several years, still require that teachers and students widely appropriate their benefits. The implementation of this change will help in coping with the factors that have negatively interfered in higher health education. It is a challenge that needs to be embraced by teachers and students. Conclusions: Active teaching methodologies can be included in all teaching models and methods and aim to promote learning and expand the possibilities for students to develop their competencies

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)