Fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde no Brasil, com o surgimento da COVID-19: estudo transversal, 2020

Objective: To analyze the associated factors of reductions for dental visits performed in Primary Health Care (PHC) in Brazil during COVID-19 pandemic. Methods: Crosssectional study with PHC dentists. The outcome was a reduction in dental care appointments and that the exposure variables included sociodemographic factors, aspects about personal protective clothing and equipment (PPE) and measures adopted by the Basic Health Unit (UBS) in Brazil after the appearance of COVID. Poisson regression was performed, used to determine the prevalence ratio and 95% confidence interval. Results: Reduction in visits above 50% after the onset of the pandemic was reported by 62.6% of 958 participating. Biosafety protocols (PR=1.04 – 95%CI 1.01;1.07), PPE suggested by the protocols (PR=0.94 – 95%CI 0.89;0.99), and telescreening (PR=0.90 – 95%CI 0.85;0.96) were factors associated with this reduction. Conclusion: The availability of the new PPE and the implementation of telescreening at UBS seem to have minimized the reduction in dental care after the onset of the pandemicObjetivo: Analizar factores asociados a la reducción de consultas odontológicas en Atención Primaria de Salud (APS) en Brasil durante COVID-19. Métodos: Estudio transversal con dentistas de APS. El hecho investigado fue reducción de consultas odontológicas y las variables de exposición incluyeron factores sociodemográficos, aspectos de los equipos de protección personal (EPI) y las medidas adoptadas por la Unidad Básica de Salud (UBS) tras la aparición del COVID. Regresión de Poisson utilizada para determinar la razón de prevalencia y el intervalo de confianza del 95%. Resultados: El 62,6% de los 958 participantes informó una reducción en la asistencia superior al 50% después del inicio de la pandemia. La adopción de protocolos (RP=1,04 – IC95% 1,01;1,07), disponibilidad de EPI recomendado por los nuevos protocolos (RP=0,94 – IC95% 0,89;0,99) y la adopción de televaluación (RP=0,90 – IC95% 0,85;0,96) fueron factores que se asoció con esta reducción. Conclusión: La disponibilidad del nuevo EPP y la implementación de la teleprotección en UBS parecen haber minimizado la reducción en la atención dental después del inicio de la pandemia.Objetivo: Analisar fatores associados à redução de atendimentos odontológicos na Atenção Primária à Saúde, durante pandemia de COVID-19 no Brasil. Métodos: Estudo transversal, com cirurgiões-dentistas das unidades básicas de saúde (UBS). O desfecho foi a redução dos atendimentos odontológicos, e as variáveis de exposição, dados sociodemográficos, disponibilidade de equipamentos de proteção individual (EPIs) e medidas adotadas pela UBS na pandemia. Realizou-se regressão de Poisson para determinar razão de prevalências e intervalo de confiança de 95%. Resultados: A redução de atendimentos acima de 50% após o início da pandemia foi relatada por 62,6% dos 958 participantes. Adoção de protocolos de biossegurança (RP=1,04 – IC95% 1,01;1,07), disponibilidade de EPI preconizados por novos protocolos (RP=0,94 – IC95% 0,89;0,99) e adoção da teletriagem (RP=0,90 – IC95% 0,85;0,96) estiveram associados à redução. Conclusão: A disponibilização dos novos EPIs e a implementação da teletriagem nas UBS parecem ter minimizado a redução dos atendimentos odontológicos após o início da pandemia

Obesity throughout childhood and early adolescence and dental caries at 12-13 years of age in a birth cohort participants

Overweight/obesity and dental caries are considered public health problems with worldwide relevance, which share common risk factors. Although widely discussed in the literature, the relationship between them remains uncertain. The aim of the present study was to investigate the association between nutritional status childhood and early adolescence and dental caries at 12-13 years of age in a birth cohort. Longitudinal study in a birth cohort, using perinatal and follow-up data performed at 6-7, 10-11 and 12-13 years of age of the 2004 birth cohort from the city of Pelotas, Rio Grande do Sul, Brazil. The exposure variable studied was the nutritional status, which was evaluated at 6-7 and 10-11 years using three different methods: Body Mass Index (BMI), waist circumference (WC), and percentage of body fat (%BF) measured by dual energy X-ray absorptiometry. The outcome variable studied was dental caries at age 12-13 years, which was measured through the index of permanent decayed/lost/filled surfaces (DMF). A sample of 996 participants was analyzed. The prevalence of dental caries at 12-13 years of age was 39.6% (95%CI: 36.6-42.6); and the mean DMS was 1.9. Considering BMI/age, 17.4% of the participant remained overweight from 6 to 11 years old; considering the WC, 36% of the participants remained in the highest tertile from 6 to 11 years old; and considering the %BF, 34.2% of the participants remained overweight from 6 to 11 years old. No relationship was found between dental caries and the accumulation of excess weight, abdominal adiposity and body fat. The results found showed that there is no association between the diseases studied, regardless of the method used to diagnose the nutritional status.Sem bolsaSobrepeso/obesidade e cárie dentária são considerados problemas de saúde pública de grande relevância mundial, que compartilham fatores de risco comuns. Apesar de amplamente discutida na literatura, a relação entre ambas segue incerta. O objetivo do presente estudo foi avaliar a associação entre o estado nutricional ao longo da infância e início da adolescência e a ocorrência de cárie dentária aos 12-13 anos de idade em uma coorte de nascimentos. Estudo longitudinal em uma coorte de nascimentos, utilizando dados perinatais e dos acompanhamentos realizados aos 6-7, 10-11 e 12-13 anos de idade da coorte de nascimentos de 2004 da cidade de Pelotas, Rio Grande do Sul, Brasil. A variável de exposição estudada foi o estado nutricional que foi avaliado aos 6-7 e aos 10-11anos através de três diferentes métodos: Índice de Massa Corporal (IMC), circunferência da cintura (CC), e percentual de gordura corporal (%GC) medido por absortometria de raios-X de dupla energia. A variável de desfecho estudada foi a cárie dentária aos 12-13 anos que foi medida através do índice de superfícies dentárias permanentes cariadas, perdidas e obturadas (CPOS). Uma amostra de 996 participantes foi analisada. A prevalência de cárie dentária aos 12-13 anos de idade foi de 39,6% (IC95%: 36,6-42,6) e a média de CPOS foi de 1,9. Considerando o IMC/idade, 17,4%, dos participantes se mantiveram com excesso de peso dos 6 aos 11 anos; considerando a CC, 36,0% dos participantes se mantiveram no maior tercil dos 6 aos 11 anos; e considerando o %GC, 34,2% dos participantes se mantiveram com excesso de peso dos 6 aos 11 anos. Não foi encontrado relação entre cárie dentária e o acúmulo de excesso de peso, adiposidade abdominal e gordura corporal. Os resultados encontrados mostraram que não existe associação entre as doenças estudadas, independente do método utilizado para diagnóstico do estado nutricional

Changes in dental practice in times of COVID-19: review and recommendations for dental health care

ABSTRACT The aim of this article was to discuss biosafety measures described in the main protocols for minimizing the risk of COVID-19 transmission during dental care. COVID-19 appeared in China in late 2019 and quickly spread to other countries. Factors inherent to dental practice, such as proximity to the patient, transmission through saliva and breath, and the generation of aerosols during procedures, place the dental team at the top of the list among the most vulnerable healthcare providers. Health authorities initially recommended only maintaining urgent and emergency care and suspending elective dental procedures. Currently, elective care is gradually being resumed and requires numerous adjustments to the environment and professional routine in terms of biosafety. Several methods had been recommended to prevent the spread of other infectious diseases prior to the outbreak of COVID-19. However, further modifications are needed for the waiting room, patient screening and flow, procedures, garments, and even in dental office itself. Thus, dental professionals need to be prepared to adopt the new recommendations in order to reduce the chance of disease transmission

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

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 < 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)