Abstract The aim of this study was to assess the factors associated with dental pain in adolescents from the state of Minas Gerais, Brazil. Individual data on adolescents aged 15 to 19 years were collected from the SB Minas survey secondary database. Dental pain over the past 6 months, assessed by a questionnaire, was used as the dependent variable. Sex, income, skin color, prevalence of untreated dental caries, periodontal health, dental treatment needs, and time of last dental appointment were analyzed as individual covariates. Allocation factor, Human Development Index (HDI), Gini coefficient, illiteracy rate, unemployment, 50% and 25% of the Brazilian monthly minimum wage, primary healthcare coverage, oral health team coverage, access to individual healthcare, and supervised toothbrushing average rate were the analyzed contextual variables. A multilevel analysis was conducted for the individual and contextual variables. Statistical analyses used hierarchical linear and nonlinear modeling to infer an association between the different levels. Male adolescents had a lower prevalence of dental pain (OR = 0.53; 95%CI = 0.37–0.75). There was an association between dental pain and low income (OR = 1.58; 95%CI = 1.07–2.33), prevalence of untreated dental caries (OR = 1.25; 95%CI = 1.11–1.40), periodontal health (OR = 1.80; 95%CI = 1.04–3.09), and dental treatment needs (OR = 6.93; 95%CI = 3.96–12.14). Sociodemographic and clinical factors at the individual level were associated with the outcome but not with contextual variables. These findings reinforce the need to address these factors for effective community health actions.

Resumo Introdução: A hiperfosfatemia está associada a desfechos desfavoráveis, e o percentual de pacientes que apresentam essa condição em unidades de hemodiálise (HD) de uma mesma instituição no estado de Santa Catarina (SC) é historicamente maior que o de pacientes do estado do Tocantins (TO). Objetivo: Conhecer a frequência do consumo das principais fontes dietéticas de fósforo e compará-las entre os dois estados. Metodologia: Estudo transversal do qual participaram 123 pacientes, 66 de SC e 57 do TO: 52% homens; idade=46,9±15,7 anos; tempo de HD=48 (57-71) meses. Foi aplicado um questionário de frequência alimentar (QFA) com 33 itens, fontes dietéticas de fósforo. Uma pontuação de consumo foi calculada para fontes de fósforo orgânico, inorgânico e total, e obtida a média semestral da fosfatemia. Resultados: A média da fosfatemia dos pacientes de SC foi maior (6,2±1,5 vs 4,7±1,3 mg/dl; p<0001), bem como a prevalência de hiperfosfatemia (62% vs 28%; p<0001). Na amostra total, os alimentos mais frequentemente consumidos foram leite e feijão. Comparando a frequência de consumo entre os dois estados, houve diferença significativa em 17 itens. Em TO, maior frequência de consumo de carne bovina e feijão, e em SC, de outros quatorze itens do QFA (carne suína, embutidos, laticínios, etc.). A fosfatemia se correlacionou com a pontuação de frequência de consumo de fontes de fósforo inorgânico. Conclusão: a frequência de consumo de vários itens foi diferente entre os estados, e esse achado pode ser uma das razões que explicam as disparidades na fosfatemia entre as duas regiões.

Abstract Introduction: Hyperphosphatemia is associated with unfavorable outcomes, and the percentage of patients presenting with this condition in hemodialysis (HD) in kidney foundation units in the state of Santa Catarina (SC) is historically higher than that of patients in the state of Tocantins (TO). Objective: To assess the frequency of consumption of the main dietary sources of phosphorus and to compare them between the two states. Methodology: A cross-sectional study was carried out involving 123 patients, 66 of SC and 57 of TO: 52% were men, average age was 46.9 ± 15.7 years, and mean HD time 48 (57-71) months. A food frequency questionnaire (FFQ) with 33 items that are dietary sources of phosphorus was applied. A consumption score was calculated for sources of organic, inorganic, and total phosphorus, and the six-month average of phosphatemia was obtained. Results: The mean phosphatemia of SC patients was higher (6.2 ± 1.5 vs 4.7 ± 1.3 mg/dL, p <0001) than TO patients, as well as the prevalence of hyperphosphatemia (62% vs 28%; p <10001). In the total sample, the foods most frequently consumed were milk and beans. Comparing the frequency of consumption between the two states, a significant difference was found in 17 items. In TO, beef and beans were the foods most frequently consumed, and in SC, fourteen other items of the FFQ (pork, sausages, dairy products, etc.) were the most frequently consumed. Phosphatemia correlated with the frequency of consumption of inorganic phosphorus sources. Conclusion: the frequency of consumption of several items was different between the states, and this explains the differences in phosphatemia between the two regions.

Abstract INTRODUCTION Portal hypertension and periportal fibrosis commonly occur in severe Schistosoma mansoni infection. Changes in lipid profile and elevated levels of circulating liver enzymes have also been described in infected individuals. The present study sought to assess the alterations in laboratory parameters associated with liver disorder in individuals infected by S. mansoni who visited a private routine laboratory service. Levels of circulating liver enzymes (gamma-glutamyl transferase [γ-GT], aspartate transaminase [AST], alanine transaminase [ALT], and alkaline phosphatase [ALP]) and a lipid panel (total cholesterol [COL], high-density lipoprotein [HDL], low-density lipoprotein [LDL], very low-density lipoprotein [VLDL], and triglycerides [TRI]) were evaluated in both infected and non-infected individuals and relative risk was used to measure associations. METHODS Data were collected for analysis from a total of 1,078 cases identified in 379,600 individuals who submitted samples to the Datalab Laboratory (Salvador, Bahia) between 2004 and 2008. RESULTS S. mansoni infection led to increased circulating levels of γ-GT in both women and men, AST (women), and ALP (men). S. mansoni infection was a protective factor against increased levels of TRI, CHO, and VLDL for individuals aged 19 years or older. The results of our analysis indicate that alterations in lipid metabolism and circulating liver enzymes in asymptomatic S. mansoni-infected individuals might be attributed to eggs lodged in the hepatic sinusoids. CONCLUSIONS Parasitological testing for S. mansoni should be indicated in endemic areas when this pattern of alterations is detected.

ABSTRACT: Initial Maintenance Review Board Report (MRBR) uses in service operation experience as a reference to define maintenance tasks intervals. However, in general, there is no structured data to compare systems performance and provide useful information to the analysts' decision-making. Even when engineering judgment is based on certification process, structural design, components intrinsic reliability and so on, the analysts responsible for maintenance tasks definitions tend to choose rather conservative proposals. This article presents a method to optimize preventive maintenance tasks intervals and use structured data based on interval optimization process to define maintenance intervals to those of similar systems under development. The method has been applied in an aircraft manufacturing company using current operation database after regulatory authorities' approval. As a result, it has been feasible to propose to the selected system, a maintenance task interval 100% higher than the one applicable to a similar system under operation.

Resumo Introdução: a hiperinsuflação manual é uma técnica fisioterapêutica comumente empregada no ambiente de terapia intensiva e emergência, no entanto há pouco consenso sobre sua utilização. Objetivo: investigar o nível de conhecimento dos fisioterapeutas atuantes em unidades de terapia intensiva e setores emergências acerca da manobra de hiperinsuflação manual. Métodos: Foram entregues questionários acerca do conhecimento sobre hiperinsuflação manual para os fisioterapeutas atuantes em terapia intensiva e/ou setor de emergência em hospitais nos municípios de Itabuna e Ilhéus - Bahia. A coleta ocorreu entre setembro de 2014 e janeiro de 2015. Resultados: participaram 32 fisioterapeutas, cujo tempo de atuação profissional variaram entre 4 meses e 10 anos. Todos os entrevistados afirmaram que técnica é utilizada em sua prática profissional, no entanto, apenas 34,4% afirmaram que seu emprego é uma atividade de rotina no seu cotidiano laboral, 90,6% afirmaram que a posição mais comum dos pacientes durante a realização da técnica é a posição supina. Quantos aos benefícios percebidos , a remoção de secreção e o estímulo à tosse foram quase unânimes (93,8%), a precaução mais frequente foi o alto pico de pressão inspiratória (84,4%) e a contra-indicação relatada por 100% da amostra foi o pneumotórax não drenado. Conclusão: posição supina durante a técnica, percepção do estímulo de tosse e remoção de secreção, o entendimento do alto pico de pressão inspiratória como precaução e pneumotórax não drenado como contra-indicação foram as respostas mais uniformes dentre os entrevistados.

Abstract Introduction: Although manual hyperinflation (MHI) is a physical therapy technique commonly used in intensive care and emergency units, there is little consensus about its use. Objective: To investigate the knowledge of physical therapists working in intensive care and emergency units about manual hyperinflation. Methods: Data were collected through self-administered questionnaires on manual hyperinflation. Data collection took place between September 2014 and January 2015, in Itabuna and Ilhéus, Bahia, Brazil. Results: The study sample was composed of 32 physical therapists who had between 4 months and 10 years working experience. All respondents affirmed that they used the technique in their professional practice. However, only 34.4% reported it to be a routine practice. 90.6% stated that the most common patient position during manual hyperinflation is “supine”. Participants were almost unanimous (93.8%) in citing secretion removal and cough stimulation as perceived benefits of MHI. High peak airway pressure was identified as being a precaution to treatment with MHI by 84.4% of participants, whilst 100% of the sample agreed that an undrained pneumothorax was a contraindication to MHI. Conclusion: The most common answers to the questionnaire were: supine position during MHI; secretion removal and cough stimulation as perceived benefits; high peak airway pressure as a precaution; and an undrained pneumothorax as a contraindication.

INTRODUÇÃO: A ingestão de sal tem sido diretamente relacionada ao aumento da ingestão hídrica e, consequentemente, ao incremento dos níveis da pressão arterial (PA) e do ganho de peso interdialítico (GPID), fatores de risco de morbimortalidade em pacientes em hemodiálise (HD). OBJETIVO: Avaliar a ingestão de sal e suas fontes alimentares, bem como sua associação com parâmetros demográficos, clínicos e nutricionais. MÉTODOS: Estudo transversal no qual participaram 109 pacientes (66% mulheres; idade = 49,0 ± 12,6 anos) de cinco centros de diálise. Para obtenção da ingestão de sal total, foi utilizado um questionário de frequência alimentar (QFA) validado somado à estimativa da ingestão de sal de adição. Os dados obtidos foram relacionados a diversos parâmetros. RESULTADOS: A ingestão de sal média foi elevada (8,6 ± 5,4 g/dia), sendo 72% proveniente do sal de adição. Apenas a escolaridade se correlacionou tanto com a ingestão de sal total (r = -0,29; p < 0,01) como com o sal de adição (r = -0,30; p < 0,01). Com o sal dos itens alimentares do QFA, houve correlação direta com o percentual de GPID (%GPID) (r = 0,26; p < 0,01) e inversa com a idade (r = -0,35; p < 0,001). Relação direta da ingestão de sal total com o %GPID foi encontrada no subgrupo de pacientes anúricos (r = 0,26; p < 0,05). Associação positiva da ingestão de sal total com a PA média (PAM) foi evidenciada apenas nos que não faziam uso de hipotensores (r = 0,35; p < 0,05). CONCLUSÃO: A ingestão de sal total foi elevada devido, principalmente, ao sal de adição. A mesma associou-se com a escolaridade e afetou adversamente o %GPID nos pacientes anúricos e a PAM nos que não utilizavam drogas hipotensoras.

INTRODUCTION: Salt intake increases fluid intake and, consequently, blood pressure (BP) and interdialytic weight gain (IDWG), known as morbi-mortality risk factors for hemodialysis (HD) patients. OBJECTIVE: Evaluate salt intake and food sources, as well as its relationship with demographics, clinical and nutritional parameters. METHODS: Cross-sectional study with 109 patients (66% women, age = 49.0 ± 12.6 years) from five dialysis centers. For total salt intake, a validated food frequency questionnaire (FFQ) and the use of discretionary salt were estimated. The relationship of salt intake with many factors was studied. RESULTS: Salt intake was high (8.6 ± 5.4 g/day) and 72% came from discretionary salt. Only literacy was significantly correlated total salt intake (r = -0.29, p < 0.01) and discretionary salt (r = -0.30, p < 0.01). With FFQ food items, there was a positive correlation with the %IDWG (r = 0.26, p < 0.01) and negative with age (r = -0.35, p < 0.001). Direct relationship between salt intake with %IDWG was found in the anuric subgroup (r = 0.26, p < 0.05) and with medium BP in those with no prescription of hypotensive drugs (r = 0.35, p < 0.05). CONCLUSION: Salt intake was high mainly due to discretionary salt. It was associated with education and adversely affected %IDWG in anuric patients and medium BP in those not taking hypotensive drugs.

INTRODUÇÃO: Estudos têm demonstrado que o ganho de peso interdialítico (GPID) de pacientes em hemodiálise (HD) é influenciado por vários fatores e que o GPID elevado afeta negativamente os níveis pressóricos desta população. OBJETIVO: Avaliar a relação entre fatores clínicos, demográficos e nutricionais com o GPID de pacientes em hemodiálise. MÉTODOS: Estudo transversal, no qual foram incluídos 278 pacientes em hemodiálise (54% de homens; idade = 54,4 ± 14,4 anos) de 6 centros de diálise de Santa Catarina. Para análise do percentual de ganho de peso obtido entre uma e outra sessão de HD (%GPID) e da pressão arterial (PA), foi calculada a média obtida das sessões de HD no período de quatro semanas. Como indicadores de estado nutricional foram utilizados o índice de massa corporal (IMC) e a avaliação subjetiva global (ASG) dos sete pontos. RESULTADOS: A média de %GPID foi 4,06 ± 1,55% da PA pré-diálise 140 ± 50 / 99 ± 25 mmHg e PA pós-diálise 110 ± 27 / 78 ± 10 mmHg. O %GPID se correlacionou inversamente com a idade e com o IMC e diretamente com a PA sistólica pré-diálise e com o tempo em tratamento hemodialítico. O %GPID foi maior no grupo de mulheres e no dos pacientes sem diagnóstico de diabetes mellitus. Pacientes com desnutrição tiveram maior %GPID apenas no subgrupo de pacientes mais jovens, quando comparados aos bem nutridos, segundo a ASG. Quando classificados pelo IMC, este achado foi encontrado no grupo total, no subgrupo das mulheres e no dos pacientes mais jovens. Do total, 24% dos pacientes tinham %GPID elevado (> 5%) e quando comparados ao grupo com %GPID adequado, estes apresentaram níveis de PA sistólica pré-diálise elevados e significativamente maiores (144 ± 21 versus 138 ± 20 mmHg; p < 0,05), eram mais novos e tinham menor IMC. CONCLUSÃO: Os resultados deste trabalho mostraram que o %GPID dos pacientes estudados foi influenciado pelo gênero, tempo de diálise, idade e estado nutricional, e que o %GPID elevado afetou adversamente os níveis pressóricos desta população.

INTRODUCTION: Studies have shown that interdialytic weight gain (IDWG) of hemodialysis (HD) patients is influenced by many factors, a high IDWG negatively affecting the blood pressure (BP) of this population. OBJECTIVE: To evaluate the relation of clinical, demographic and nutritional factors and the IDWG of HD patients. METHODS: Cross-sectional study of 278 HD (54% males; age=54.4 ± 14.4 years) from 6 dialysis centers in the State of Santa Catarina, Brazil. The means of percentage interdialytic weight gain (%IDWG) and BP during a four-week period were calculated. Body mass index (BMI) and the 7-point subjective global assessment (SGA) scale were used to assess nutritional status. RESULTS: The means were: %IDWG 4.06 ± 1.55%, pre-HD BP 140 ± 50 / 99 ± 25 mmHg, and post-HD BP 110 ± 27 / 78 ± 10 mmHg. %IDWG inversely correlated with age and BMI and directly correlated with pre-HD systolic BP and time on HD. Women and patients without diabetes mellitus had higher %IDWG. Only the younger subgroup of patients with SGA-defined malnutrition had higher %IDWG than well-nourished ones. When malnutrition was BMI-defined, higher %IDWG was found in the whole study population and in the female and younger age subgroups. 24% of the patients had increased %IDWG (> 5%) and, when compared with those with adequate %IDWG, had inadequate and higher levels of systolic BP (144 ± 21 versus 138 ± 20 mmHg, p < 0.05), were younger and had lower BMI. CONCLUSION: These results showed that %IDWG of HD patients was influenced by gender, time on dialysis, age and nutritional status, and that high %IDWG adversely affected the BP of this population.

O objetivo do trabalho foi relatar um caso clínico sobre a síndrome de Goldenhar e realizar um levantamento das alterações fonoaudiológicas encontradas no mesmo. O presente estudo foi realizado com uma criança de seis anos e oito meses, do gênero masculino, com diagnóstico da síndrome de Goldenhar. Para o estudo foi realizada anamnese e o paciente foi submetido às avaliações de motricidade orofacial, audiologia clínica completa, educacional e vectoeletronistagmografia computadorizada, voz e linguagem oral e escrita. Foram observadas as seguintes alterações: dificuldade de vedamento labial, bochechas e olhos assimétricos, mordida aberta anterior, amígdalas palatinas hipertróficas e micrognatia, respiração do tipo oro-nasal, dificuldade de coordenação pneumofônica, hábito bucal de apertamento; qualidade vocal ruim com presença de tensão laríngea durante a fonação, habilidades auditivas alteradas, perda auditiva neurossensorial de grau profundo bilateral, curva timpanométrica do tipo A, com ausência de reflexos acústicos, ausência de dados patognomônicos de alteração central no teste vestibular. O paciente não possui fala fluente, faz uso da Língua Brasileira de Sinais, leitura orofacial e gestos para se comunicar, apresenta dificuldades de leitura e escrita e o desenvolvimento de linguagem está adequado à sua faixa etária. Pode-se concluir que é importante que o paciente com a síndrome de Goldenhar receba um acompanhamento multidisciplinar, o que lhe proporcionará um diagnóstico precoce, uma intervenção adequada e um desenvolvimento global satisfatório.

The aim of this study was to report a case and analyze the speech, language and hearing deficits observed in the Goldenhar syndrome. The study reports the case of a male six years, eight months old child diagnosed with Goldenhar syndrome. The history of the patient was carried out, and he was submitted to oral motricity, voice, educational, verbal and written language evaluations, full audiological exam, and computerized vectoeletronistagmography. The following alterations were observed: difficulty in closing the lips, asymmetrical cheeks and eyes, anterior open bite, hypertrophic palatine tonsils, micrognathia, oro-nasal breathing, difficulty with pneumophonic coordination, dental tightness, poor vocal quality with presence of laryngeal tension during phonation, poor auditory abilities, profound bilateral sensory loss, type A tympanometric curve with absence of acoustic reflexes, absence of pathognomonic signs of central alteration on the vestibular test. The patient does not have fluent speech, uses the Brazilian Sign Language, orofacial reading and gestures to communicate, presents reading and writing difficulties and chronologically adequate language development. It can be concluded that it is important to the patient with the Goldenhar syndrome to receive multidisciplinary follow-up, which will provide early diagnosis, adequate intervention and satisfactory global development.