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ABSTRACT Objective: To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made. Conclusion: New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.

RESUMO Objetivo: Atualizar as recomendações para embasar as decisões para o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: A elaboração desta diretriz foi feita por especialistas, incluindo representantes do Ministério da Saúde e metodologistas. O método utilizado para o desenvolvimento rápido de diretrizes baseou-se na adoção e/ou adaptação de diretrizes internacionais existentes (GRADE ADOLOPMENT) e contou com o apoio da plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Chegaram-se a 21 recomendações, incluindo recomendações fortes quanto ao uso de corticosteroides em pacientes em uso de oxigênio suplementar e recomendações condicionais para o uso de tocilizumabe e baricitinibe, em pacientes com oxigênio suplementar ou ventilação não invasiva, e de anticoagulantes, para prevenção de tromboembolismo. Devido à suspensão da autorização de uso, não foi possível fazer recomendações para o tratamento com casirivimabe + imdevimabe. Foram feitas recomendações fortes contra o uso de azitromicina em pacientes sem suspeita de infecção bacteriana, hidroxicloroquina, plasma convalescente, colchicina e lopinavir + ritonavir, além de recomendações condicionais contra o uso de ivermectina e rendesivir. Conclusão: Foram criadas novas recomendações para o tratamento de pacientes hospitalizados com COVID-19, como as recomendações de tocilizumabe e baricitinibe. Ainda são recomendados corticosteroides e profilaxia contra tromboembolismo, esta em caráter condicional. Vários medicamentos foram considerados ineficazes e não devem ser usados, no intuito de proporcionar o melhor tratamento segundo os princípios da medicina baseada em evidências e promover a economia de recursos.

https://doi.org/10.5935/2965-2774.20230136-en

Decreasing delays in the diagnosis and treatment of rheumatoid arthritis in Brazil: a nationwide multicenter observational study
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Albuquerque, Cleandro Pires de

; Reis, Ana Paula Monteiro Gomides

; Santos, Ana Beatriz Vargas

; Bértolo, Manoel Barros

; Louzada Júnior, Paulo

; Giorgi, Rina Dalva Neubarth

; Radominski, Sebastião Cezar

; Guimarães, Maria Fernanda B. Resende

; Bonfiglioli, Karina Rossi

; Sauma, Maria de Fátima L. da Cunha

; Pereira, Ivânio Alves

; Brenol, Claiton Viegas

; Mota, Licia Maria Henrique da

; Santos Neto, Leopoldo

; Pinheiro, Geraldo R. Castelar

Advances in Rheumatology

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2023, Volume 63 elocation 3

Abstract: En | Text: En | PDF: En

Abstract Background Management delays imply worse outcomes in rheumatoid arthritis (RA) and, therefore, should be minimized. We evaluated changes in diagnostic and treatment delays regarding RA in the last decades in Brazil. Methods Adults fulfilling the ACR/EULAR (2010) criteria for RA were assessed. Delays in diagnosis and treatment, and the frequencies of early management initiation within thresholds (windows of opportunity) of 3, 6, and 12 months from symptoms onset were evaluated. The Mann–Kendall trend test, chi-squared tests with Cramer’s V effect sizes and analysis of variance were conducted. Results We included 1116 patients: 89.4% female, 56.8% white, mean (SD) age 57.1 (11.5) years. A downward trend was found in diagnostic (tau = - 0.677, p < 0.001) and treatment (tau = - 0.695, p < 0.001) delays from 1990 to 2015. The frequency of early management increased throughout the period, with ascending effect sizes across the 3-, 6-, and 12-month windows (V = 0.120, 0.200 and 0.261, respectively). Despite all improvements, even in recent years (2011–2015) the diagnostic and treatment delays still remained unacceptably high [median (IQR): 8 (4–12) and 11 (5–17) months, respectively], with only 17.2% of the patients treated within the shortest, 3-month window. Conclusion The delays in diagnosis and treatment of RA decreased during the last decades in Brazil. Improvements (effect sizes) were greater at eliminating extreme delays (≥ 12 months) than in attaining really short management windows (≤ 3 months). Very early treatment was still an unrealistic goal for most patients with RA.

https://doi.org/10.1186/s42358-022-00265-0

Do it fast! Early access to specialized care improved long-term outcomes in rheumatoid arthritis: data from the REAL multicenter observational study
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Albuquerque, Cleandro Pires

; Reis, Ana Paula Monteiro Gomides

; Santos, Ana Beatriz Vargas

; Bértolo, Manoel Barros

; Louzada Júnior, Paulo

; Giorgi, Rina Dalva Neubarth

; Radominski, Sebastião Cezar

; Guimarães, Maria Fernanda B. Resende

; Bonfiglioli, Karina Rossi

; Sauma, Maria de Fátima L Cunha

; Pereira, Ivânio Alves

; Brenol, Claiton Viegas

; Mota, Licia Maria Henrique

; Santos Neto, Leopoldo

; Pinheiro, Geraldo Rocha Castelar

Advances in Rheumatology

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2023, Volume 63 elocation 17

Abstract: En | Text: En | PDF: En

Abstract Background Early rheumatoid arthritis (RA) offers an opportunity for better treatment outcomes. In real-life settings, grasping this opportunity might depend on access to specialized care. We evaluated the effects of early versus late assessment by the rheumatologist on the diagnosis, treatment initiation and long-term outcomes of RA under real-life conditions. Methods Adults meeting the ACR/EULAR (2010) or ARA (1987) criteria for RA were included. Structured interviews were conducted. The specialized assessment was deemed “early” when the rheumatologist was the first or second physician consulted after symptoms onset, and “late” when performed afterwards. Delays in RA diagnosis and treatment were inquired. Disease activity (DAS28-CRP) and physical function (HAQ-DI) were evaluated. Student's t, Mann-Whitney U, chi-squared and correlation tests, and multiple linear regression were performed. For sensitivity analysis, a propensity score-matched subsample of early- vs. late-assessed participants was derived based on logistic regression. The study received ethical approval; all participants signed informed consent. Results We included 1057 participants (89.4% female, 56.5% white); mean (SD) age: 56.9 (11.5) years; disease duration: 173.1 (114.5) months. Median (IQR) delays from symptoms onset to both RA diagnosis and initial treatment coincided: 12 (6–36) months, with no significant delay between diagnosis and treatment. Most participants (64.6%) first sought a general practitioner. Notwithstanding, 80.7% had the diagnosis established only by the rheumatologist. Only a minority (28.7%) attained early RA treatment (≤ 6 months of symptoms). Diagnostic and treatment delays were strongly correlated (rho 0.816; p < 0.001). The chances of missing early treatment more than doubled when the assessment by the rheumatologist was belated (OR 2.77; 95% CI: 1.93, 3.97). After long disease duration, late-assessed participants still presented lower chances of remission/low disease activity (OR 0.74; 95% CI: 0.55, 0.99), while the early-assessed ones showed better DAS28-CRP and HAQ-DI scores (difference in means [95% CI]: −0.25 [−0.46, −0.04] and − 0.196 [−0.306, −0.087] respectively). The results in the propensity-score matched subsample confirmed those observed in the original (whole) sample. Conclusions Early diagnosis and treatment initiation in patients with RA was critically dependent on early access to the rheumatologist; late specialized assessment was associated with worse long-term clinical outcomes.

https://doi.org/10.1186/s42358-023-00301-7

Factors associated with hospitalizations for Covid-19 in patients with rheumatoid arthritis: data from the Reumacov Brazil registry
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Gomides, Ana Paula Monteiro

; Albuquerque, Cleandro Pires de

; Mota, Licia Maria Henrique da

; Devidé, Guilherme

; Dias, Laiza Hombre

; Duarte, Angela Luzia Branco Pinto

; Giovelli, Raquel Altoé

; Karnopp, Thais Evelyn

; Lima, Hugo Deleon de

; Marinho, Adriana

; Oliveira, Marianne Schrader de

; Omura, Felipe

; Ranzolin, Aline

; Resende, Gustavo

; Ribeiro, Francinne Machado

; Ribeiro, Sandra Lúcia Euzébio

; Sacilotto, Nathália de Carvalho

; Santos, Wander Gonzaga dos

; Shinjo, Samuel Katsuyuki

; Studart, Samia Araujo de Sousa

; Teixeira, Flávia Patricia Sena

; Yazbek, Michel Alexandre

; Ferreira, Gilda Aparecida

; Monticielo, Odirlei A.

; Paiva, Eduardo

; Pileggi, Gecilmara Cristina Salviato

; Reis Neto, Edgard Torres dos

; Pinheiro, Marcelo de Medeiros

; Marques, Claudia D. L.

Advances in Rheumatology

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2022, Volume 62 elocation 13

Abstract: En | Text: En | PDF: En

Abstract Background: Patients using immunosuppressive drugs may have unfavorable results after infections. However, there is a lack of information regarding COVID 19 in these patients, especially in patients with rheumatoid arthritis (RA). Therefore, the aim of this study was to evaluate the risk factors associated with COVID 19 hospitalizations in patients with RA. Methods: This multicenter, prospective cohort study is within the ReumaCoV Brazil registry and included 489 patients with RA. In this context, 269 patients who tested positive for COVID 19 were compared to 220 patients who tested negative for COVID 19 (control group). All patient data were collected from the Research Electronic Data Capture database. Results: The participants were predominantly female (90.6%) with a mean age of 53 ±12 years. Of the patients with COVID 19, 54 (20.1%) required hospitalization. After multiple adjustments, the final regression model showed that heart disease (OR =4.61, 95% CI 1.06–20.02. P < 0.001) and current use of glucocorticoids (OR =20.66, 95% CI 3.09–138. P < 0.002) were the risk factors associated with hospitalization. In addition, anosmia was associated with a lower chance of hospitalization (OR =0.26; 95% CI 0.10–0.67, P < 0.005). Conclusion: Our results demonstrated that heart disease and the use of glucocorticoids were associated with a higher number of hospital admissions for COVID 19 in patients with RA. Trial registration: Brazilian Registry of Clinical Trials RBR 33YTQC.

https://doi.org/10.1186/s42358-022-00244-5

Association of clinical, social and environmental variables with dental caries prevalence in adolescents from a Brazilian municipality supplied with fluoridated water
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Marques, Ana Paula Ferreira

; Lattanzi, Aretuza Pires dos Santos

; Silveira, Flavia Maia

; Valente, Maria Isabel Bastos

; Cortellazzi, Karine Laura

; Assaf, Andréa Videira

Cadernos Saúde Coletiva

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dec 2021, Volume 29 N. 4 Pages 551 - 560

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Introdução A tendência de redução da cárie dentária tem sido constatada, apesar de maiores investigações sobre seu padrão e desenvolvimento serem ainda necessárias. Objetivo investigar a influência de variáveis clínicas, sociais e ambientais sobre a cárie em adolescentes de um município brasileiro com água fluoretada, no ano de 2018. Método Empregou-se uma amostra não probabilística de 277 adolescentes de 12 anos, de escolas públicas de Nova Friburgo, Rio de Janeiro, Brasil. Exames clínicos foram realizados por examinadores calibrados, para avaliação de cárie, doença periodontal e fluorose, sob critérios da Organização Mundial da Saúde (OMS). Questionários semiestruturados foram aplicados para coletar informações socioambientais. Resultados Indivíduos residentes em regiões com flúor na água em subdoses (OR=3,60, p=0,0006), e aqueles com baixa renda (OR =1,90, p=0,0444), com presença de gengivite (OR = 3,36; p = 0,0016) e cuja razão para a visita ao dentista foi para tratamento dentário (OR=2,41; 0,0203), apresentaram mais chances de terem cárie. Uma redução significativa (p<0,0001) nos índices de cárie foi observada entre 2012 (primeiro levantamento epidemiológico) e 2018. Conclusão A fluoretação das águas de abastecimento público, quando em níveis não adequados, assim como outras variáveis sociais e clínicas, podem influenciar o padrão de cárie nos adolescentes.

Abstract Background Although a trend towards dental caries reduction has been observed, further investigations on its pattern and development are still needed. Objective To investigate the influence of clinical, social and environmental variables on dental caries prevalence in adolescents from a Brazilian municipality supplied with fluoridated water in 2018. Method This study was conducted with a non-probabilistic sample of 277 adolescents aged 12 years of public schools in Nova Friburgo, state of Rio de Janeiro, Brazil. Clinical examinations were carried out by calibrated examiners to assess caries, periodontal disease, and fluorosis according to criteria of the World Health Organization (WHO). Semi-structured questionnaires were applied to record socio-environmental information. Results Individuals living in regions supplied with fluoridated water below the minimum required levels (OR=3.60, p=0.0006), with low income (OR=1.90, p=0.0444), presence of gingivitis (OR=3.36; p=0.0016), and whose reason for visiting the dentist was dental treatment (OR=2.41; p=0.0203) were more likely to have dental caries. A significant reduction (p<0.0001) in dental caries indexes was observed between 2012 and 2018. Conclusion Fluoridation of public water supply at unsuitable levels, as well as other social and clinical variables can influence the caries pattern in adolescents.

https://doi.org/10.1590/1414-462x202129040345

Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil
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Pileggi, Gecilmara Salviato

; Ferreira, Gilda Aparecida

; Gomides Reis, Ana Paula Monteiro

; Reis Neto, Edgard Torres

; Abreu, Mirhelen Mendes

; Albuquerque, Cleandro Pires

; Araújo, Nafice Costa

; Bacchiega, Ana Beatriz

; Bianchi, Dante Valdetaro

; Bica, Blanca

; Bonfa, Eloisa Duarte

; Borba, Eduardo Ferreira

; Brito, Danielle Christinne Soares Egypto

; Duarte, Ângela Luzia Branco Pinto

; Santo, Rafaela Cavalheiro Espírito

; Fernandes, Paula Reale

; Guimarães, Mariana Peixoto

; Gomes, Kirla Wagner Poti

; Kakehasi, Adriana Maria

; Klumb, Evandro Mendes

; Lanna, Cristina Costa Duarte

; Marques, Claudia Diniz Lopes

; Monticielo, Odirlei André

; Mota, Licia Maria Henrique

; Munhoz, Gabriela Araújo

; Paiva, Eduardo Santos

; Pereira, Helena Lucia Alves

; Provenza, José Roberto

; Ribeiro, Sandra Lucia Euzébio

; Rocha Junior, Laurindo Ferreira

; Sampaio, Camila Santana Justo Cintra

; Sampaio, Vanderson Souza

; Sato, Emília Inoue

; Skare, Thelma

; de Souza, Viviane Angelina

; Valim, Valeria

; Lacerda, Marcus Vinícius Guimarães

; Xavier, Ricardo Machado

; Pinheiro, Marcelo Medeiros

Advances in Rheumatology

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2021, Volume 61 elocation 60

Abstract: En | Text: En | PDF: En

Abstract Background: There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods: This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann-Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the presence of COVID-19. Results: From March 29th to May 17st, 2020, a total of 10,443 participants were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren’s syndrome and 0.8% systemic sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30 days prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant difference between rheumatic disease patients (4.03%) and controls (3.25%). After adjustments for multiple confounders, the main risk factor significantly associated with a COVID-19 diagnosis was lung disease (OR 1.63; 95% CI 1.03-2.58); and for rheumatic disease patients were diagnosis of systemic sclerosis (OR 2.8; 95% CI 1.19-6.63) and glucocorticoids above 10 mg/ day (OR 2.05; 95% CI 1.31-3.19). In addition, a recent influenza vaccination had a protective effect (OR 0.674; 95% CI 0.46-0.98). Conclusion: Patients with rheumatic disease on hydroxychloroquine presented a similar occurrence of COVID-19 to household cohabitants, suggesting a lack of any protective role against SARS-CoV-2 infection. Trial registration Brazilian Registry of Clinical Trials (ReBEC; RBR - 9KTWX6).

https://doi.org/10.1186/s42358-021-00217-0 22 downloads

Cardiovascular risk comorbidities in rheumatoid arthritis patients and the use of anti-rheumatic drugs: a cross-sectional real- life study
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Vicente, Gustavo Nogueira Schincariol

; Pereira, Ivânio Alves

; Castro, Gláucio Ricardo Werner de

; Mota, Licia Maria Henrique da

; Carnieletto, Ana Paula

; Souza, Dhara Giovanna Santin de

; Gama, Fabiana Oenning da

; Santos, Ana Beatriz Vargas

; Albuquerque, Cleandro Pires de

; Bértolo, Manoel Barros

; Louzada Júnior, Paulo

; Giorgi, Rina Dalva Neubarth

; Radominski, Sebastião Cezar

; Guimarães, Maria Fernanda Brandão Resende

; Bonfiglioli, Karina Rossi

; Sauma, Maria de Fátima Lobato da Cunha

; Brenol, Claiton Viegas

; Pinheiro, Geraldo da Rocha Castelar

Advances in Rheumatology

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2021, Volume 61 elocation 38

Abstract: En | Text: En | PDF: En

Abstract Background: Rheumatoid arthritis (RA) is a common autoimmune systemic inflammatory disease. In addition to joint involvement, RA patients frequently have other comorbidities, such as cardiovascular diseases. Drugs used for RA treatment may increase or decrease the risk of a cardiovascular event. This study aims to analyze cardiovascular risk comorbidities in patients with RA and the correlation with the use of anti-rheumatic drugs. Methods: Cross-sectional study conducted based on the real-life rheumatoid arthritis study database - REAL, a prospective observational cohort study. Associations between the use of anti-rheumatic drugs and the presence of comorbidities were represented by their prevalence ratio and evaluated using the Chi-square or Fisher’s Exact tests. Results: We assessed 1116 patients, 89.4% women, mean age of 55.15 years and predominance of seropositive disease. 63.3% had some cardiovascular comorbidity, predominantly hypertension (49.9%). The use of glucocorticoids was observed in 47.4% of patients and there was a significant tendency of lower use of these drugs in the presence of dyslipidemia (PR: 0.790; p = 0.007). We observed that the presence of cardiovascular comorbidities was associated with higher use of bDMARDs (PR:1.147; p = 0.003). Conclusions: The presence of cardiovascular risk comorbidities was confirmed to be higher in RA patients. Different treatment strategies using less glucocorticoids in the presence of dyslipidemia and more common use of bDMARDs in patients with cardiovascular comorbidities suggest that rheumatologists are aware of the potential influence of the DMARDs in the risk of cardiovascular event. Reinforcing these results, we highlight the need for a better baseline assessment to guide the choice of anti-rheumatic drugs in RA patients who have comorbidities.

https://doi.org/10.1186/s42358-021-00186-4 82 downloads

Strategies to deal with the COVID-19 pandemic
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NADANOVSKY, Paulo

; SANTOS, Ana Paula Pires dos

Brazilian Oral Research

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2020, Volume 34 elocation e068

Abstract: En | Text: En | PDF: En

Abstract The World Health Organization declared a COVID-19 pandemic on March 11, 2020, when there were 4,293 confirmed cumulative deaths. By May 17, 2020 this number increased to 315,005. The risk of death is higher above the age of 60, but there are many deaths below 60 (for example, in Sao Paulo, 25%). Due to the lack of a vaccine or specific treatment, there are at least three types of interventions used in the first wave of this pandemic: increased alertness and hygiene (e.g. Sweden); identification and isolation of infected people and their contacts (e.g. South Korea); lockdown (e.g. Italy). These interventions are complementary. Choices of the right mix of interventions will vary from society to society and in the same society at different times. The search for a miracle drug is dangerous because it is based on the mistaken belief that any treatment option is better than “nothing”. Brazilian society will not be able to maintain lockdown for a long period. Naturally, in the near future, regardless of the advice from scientists, doctors and authorities, commerce, services and schools will reopen. In order to implement any strategy aimed to control the pandemic and preserve the economy, the country needs leadership that centralizes and coordinates actions. Unfortunately, the Brazilian government is not fulfilling this role; on the contrary, it is a hindrance. This negative leadership and lack of coordination are causing many deaths and are severely damaging the lives of survivors by delaying the resuming of economic and social activities.

https://doi.org/10.1590/1807-3107bor-2020.vol34.0068 4044 downloads

Risk communication in the context of clinical research
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NADANOVSKY, Paulo

; COSTA, Luciane Rezende

; SANTOS, Ana Paula Pires dos

Brazilian Oral Research

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2020, Volume 34 Suppl. 2 elocation e078

Abstract: En | Text: En | PDF: En

Abstract Physicians and dentists usually make clinical decisions and recommendations without a clear understanding of the meaning of the numbers regarding the accuracy of diagnostic tests and the efficacy of treatments. This critical review aimed to identify problems in the communication of diagnostic test accuracy and treatment benefits and to suggest strategies to improve risk communication in these contexts. Most clinical decisions are taken under uncertainty. Health professionals cannot predict the outcome in one individual patient. This uncertainty invites these professionals to make decisions based on heuristics, which gives rise to several cognitive biases. Cognitive biases are automatic and unconscious, so how is it possible to mitigate their undesirable effects on risk interpretation in the context of clinical practice? Some forms of risk communication reinforce cognitive bias, while others weaken them. Maybe one of the most difficult obstacles to overcome is the difficulty to think with numbers. This difficulty probably arises from a mismatch of ancestral adaptations of the brain having to deal with modern environments, which are quite different from the ancestral ones. There are two quite common, but bad, forms of risk communication: the conditional probability and the relative risk reduction or efficacy. People, including physicians and dentists, are confused with this kind of information. The main methods discovered so far to facilitate a clearer understanding are to emphasize the base rates of the events and to use absolute numbers, that is to use natural frequencies, instead of percentages and conditional probabilities.

https://doi.org/10.1590/1807-3107bor-2020.vol34.0078 550 downloads

10.

Searching and selecting the best evidence efficiently: a tool for clinicians, professors and dental students
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NADANOVSKY, Paulo

; SANTOS, Ana Paula Pires dos

RGO - Revista Gaúcha de Odontologia

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jun 2018, Volume 66 N. 2 Pages 172 - 176

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO O objetivo deste artigo foi apresentar uma estratégia de busca sistemática e eficiente, apropriada para cirurgiões-dentistas, professores e alunos de Odontologia, para ser utilizada quando eles tiverem dúvidas sobre a efetividade de uma intervenção clínica. O sistema proposto para a Medicina, chamado de “Sistema 6-S”, foi adaptado para que uma estratégia de busca com foco na Odontologia fosse construída. Essa estratégia é fácil e rápida de usar e alcança a melhor evidência científica disponível. A sequência de busca proposta, com foco na validade da evidência e eficiência da busca, consiste em: resumos críticos de revisões sistemáticas (RS) de ensaios controlados randomizados (ECR), RS de ECR, resumos críticos de ECR e, por último, ECR. A busca por esses artigos pode ser feita na biblioteca Cochrane; em revistas de odontologia baseada em evidência; sites da Internet e blogs; e no Pubmed através da ferramenta "Clinical Queries”. Essa estratégia pode aprimorar a habilidade de obter rapidamente evidência importante para informar a prática clínica, a educação em Odontologia e o cuidado em saúde bucal. A adoção de estratégias como a proposta neste artigo pode aumentar a prática da Odontologia Baseada em Evidência.

ABSTRACT The aim of this article was to offer an efficient systematic search strategy appropriate for clinicians, professors and dental students, for when they have a question regarding the effectiveness of clinical intervention. We adapted the “6-S System” proposed for Medicine in order to build a search strategy focused on oral health, which is speedy, easy to use and arrives at the appropriate evidence. With a focus on validity and search efficiency, the following searching sequence is proposed: critical abstracts of systematic reviews (SR) of randomized controlled trials (RCTs), SR of RCTs, critical abstracts of RCTs, and RCTs. These can be searched in the Cochrane library; evidence-based journals; websites and blogs; and in Pubmed using the tool Clinical Queries. This strategy can enhance the ability to quickly retrieve evidence that is important to dental education, clinical practice and delivery of oral health care. The adoption of strategies such as the one proposed in this paper is likely to increase evidence based dental practice.

https://doi.org/10.1590/1981-8637201800020000660200172 802 downloads

11.

Efecto del ataque de Leptocybe invasa en plantaciones de eucalipto destinadas a la producción de pulpa de celulosa kraft
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Bobadilha, Gabrielly dos Santos

; Vidaurre, Graziela Baptista

; Câmara, Ana Paula

; Valin, Marina

; Oliveira, José Tarcísio da Silva

; Soliman, Everton Pires

; Lopez, Yonny Martinez

Maderas. Ciencia y tecnología

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jun 2018, Volume 20 N. 2 Pages 171 - 182

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract: The aim of the research was to evaluate the effect of the attack Leptocybe invasa in dendrometric variables and wood properties of two clones of eucalyptus (Eucalyptus urophylla and Eucalyptus tereticornis), grown in the municipalities of Imperatriz (state of Maranhão) and Darcinopolis (state of Tocantins), Brazil, for Kraft pulping. Data were collected 10 trees for each clone, the 3-year-old attacked by L. invasa. The diagnosed was based on formation of large guts all over the glass, and emergency hole (closing the loop). The results were confirmed by the variation of the characteristics of species assessed relative to their total height, diameter, volume of bark, vessel frequency, fiber size, radial density profile vessel frequency, fiber size, radial density profile, and ash content. Host trees obtained alterations in dendrometric variables, content of pentosans and wood ashes for both genetic materials, not being observed variations in specific gravity, and size of vessels and fibers, as well as the contents of lignin and wood extractives.

Resumen: El objetivo de la investigación fue evaluar el efecto del ataque de Leptocybe invasa en las propiedades dendrométricas de la madera de dos clones de eucalipto (Eucalyptus urophylla y Eucalyptus tereticornis), cultivados en los municipios de Imperatriz (Estado do Maranhão) y Darcinópolis (Estado de Tocantins), Brasil, destinados a la producción de pulpa kraft. Se analizaron 10 árboles de 3 años de edad atacados por Leptocybe invasa, para cada clon. El diagnóstico fue basado en la formación de grandes agallas en la copa, y con orificio de emergencia (cerrando el ciclo). Los resultados fueron constatados por la variación de las características de las especies evaluadas con relación a su altura total, diámetro, volumen de corteza, frecuencia de vasos, longitud de fibras, perfil radial de densidad y contenido de cenizas. Los árboles hospederos presentaron alteraciones en las variables dendrométricas, contenido de pentosanos y cenizas en la madera para ambos materiales genéticos, no siendo observadas variaciones en la densidad básica, dimensión de vasos y fibras, así como en los contenidos de lignina y extractivos de la madera.

629 downloads

12.

High-risk behaviors for hepatitis B and C infections among female sex workers
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Puga, Marco Antonio Moreira

; Bandeira, Larissa Melo

; Weis, Sabrina Moreira dos Santos

; Fernandes, Fernanda Rodas Pires

; Castro, Lisie Souza

; Tanaka, Tayana Serpa Ortiz

; Rezende, Grazielli Rocha de

; Teles, Sheila Araújo

; Castro, Vivianne de Oliveira Landgraf de

; Murat, Paula Guerra

; Capelin, Gina Jonasson Mousquer

; Motta-Castro, Ana Rita Coimbra

Revista da Sociedade Brasileira de Medicina Tropical

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apr 2018, Volume 51 N. 2 Pages 198 - 202

Abstract: En | Text: En | PDF: En

Abstract INTRODUCTION: The prevalence of hepatitis B and hepatitis C and risk behaviors among 402 female sex workers in Central Brazil were investigated by respondent-driven sampling. METHODS: Blood samples were tested for hepatitis B and C markers by enzyme-linked immunosorbent assay. Two hepatitis B vaccination schedules were performed. RESULTS: The prevalence of hepatitis B and C infections were 9.3% and 0.5%, respectively. Susceptibility to hepatitis B infection was observed in 61.5% of subjects. There was no significant difference in adherence index (p=0.52) between vaccination schedules and all participants had protective antibody titers. CONCLUSIONS: This hard-to-reach population requires hepatitis B and C surveillance.

https://doi.org/10.1590/0037-8682-0231-2017 1981 downloads

13.

PHYSIOLOGICAL DISORDERS AFFECTING DENDROMETRIC PARAMETERS AND EUCALYPTUS WOOD QUALITY FOR PULPING WOOD
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Câmara, Ana Paula

; Oliveira, José Tarcísio da Silva

; Bobadilha, Gabrielly dos Santos

; Vidaurre, Graziela Baptista

; Tomazello Filho, Mario

; Soliman, Everton Pires

CERNE

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mar 2018, Volume 24 N. 1 Pages 27 - 34

Abstract: En | Text: En | PDF: En

ABSTRACT The productive sustainability of eucalyptus planting is threatened when both diseases and disorders of growth occur. These interferences can have abiotic origin as environmental conditions can negatively affect the wood quality. This study has the goal of evaluating influence of different levels of physiological disorders in dendrometric variables and wood quality from seven-year-old Eucalyptus grandis x Eucalyptus urophylla hybrids intended for wood pulping production. The trees from commercial plantations in State of Maranhão, Brazil were separated into three levels of physiological disorders by means of morphologic changes. Then, they were evaluated according to dendrometric variables, anatomical characteristics, chemical properties, density of wood, and kraft pulp process. The physiological disorder levels significantly influenced all evaluated properties. Moreover, the wood from trees with higher severity of symptoms resulted in higher average values of dendrometric variables, basic density, and fibers dimensions. In addition, apparent density exhibited a different standard in the pith region with increase on radial wood profile. Trees with the least severe disorders exhibited changes in dendrometric and anatomical variables, mainly in wood volume and fibers dimensions, respectively.

https://doi.org/10.1590/01047760201824012480 1220 downloads

14.

Evidence-based pediatric dental practice within the clinician's reach: the case of the esthetic effect of topical silver diamine fluoride for caries control in primary dentition
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SOUSA, Fernanda Santos de Oliveira de

; SANTOS, Ana Paula Pires dos

; BARJA-FIDALGO, Fernanda

; OLIVEIRA, Branca Heloisa de

RGO - Revista Gaúcha de Odontologia

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dec 2016, Volume 64 N. 4 Pages 369 - 375

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Mostrar como um cirurgião-dentista clínico geral procurou responder, com base em evidência científica, à pergunta: "O escurecimento das lesões de cárie em dentes decíduos tratados com diaminofluoreto de prata contribui para a redução da aceitação desse tipo de tratamento pelos pais?". Métodos: O dentista seguiu o seguinte roteiro: formulação de uma pergunta específica; realização da busca bibliográfica utilizando descritores e termos livres; seleção dos artigos científicos completos para leitura; leitura e avaliação crítica dos artigos selecionados; resumo da evidência disponível e aplicação da evidência à sua prática clínica. O dentista localizou 45 trabalhos e selecionou 20 para leitura na íntegra, mas apenas três puderam ser utilizados, sendo dois ensaios controlados realizados na China e um no Brasil. Resultados: Os resultados mostraram que a estética não foi uma questão importante nem um fator decisivo para a indicação do tratamento proposto. No entanto, embora haja evidência científica robusta sobre a efetividade do diaminofluoreto de prata em paralisar e prevenir lesões de cárie, há pouca informação sobre seu efeito estético. Assim, a falta de estudos que avaliam o impacto do escurecimento das lesões de cárie e o efeito estético do tratamento sobre a qualidade de vida das crianças e seus familiares deve ser ressaltada. Conclusão: O dentista concluiu que não existe evidência suficiente sobre o efeito estético das aplicações de diaminofluoreto de prata em dentes decíduos e optou por informar os responsáveis por seus pacientes a respeito e compartilhar com eles a decisão sobre a indicação do mesmo para cada caso específico.

ABSTRACT Objective: The aim of this paper was to demonstrate how a general dental practitioner tried to answer, based on scientific evidence, to the question: "Does the darkening of caries lesions caused by silver diamine fluoride treatment contribute to reducing parents' acceptance of such treatment?". Methods: The dentist adopted the following approach: formulation of a specific question; bibliographic search using controlled vocabulary and free terms; selection of full-text articles for reading; reading and critical appraisal of selected articles; summary of the available evidence; translation of the evidence into clinical practice. The dentist identified 45 studies and selected 20 to be read in full, but only three could be used; two controlled trials from China and one from Brazil. Results: Results showed that the esthetic effect was neither a major issue nor a decisive factor for the indication of the proposed treatment. However, although there is robust scientific evidence on the effectiveness of silver diamine fluoride in arresting and preventing caries lesions, there is scarce information about its esthetic effect. Thus, the lack of studies assessing the impact of the darkening of caries lesions and the esthetic effect of the treatment on the quality of life of children and their parents must be emphasized. Conclusion: The dentist concluded that there is insufficient evidence about the esthetic effect of silver diamine fluoride applications on primary teeth and opted to inform it to his/her patients' caregivers and to share with them the decision whether to use it or not in each specific case.

https://doi.org/10.1590/1981-863720160003000013231 2436 downloads

15.

Grupo PET-Saúde/Vigilância em Saúde do Trabalhador Portuário: vivência compartilhada
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Queiróz, Maria de Fátima Ferreira

; Valeiras, Ana Paula Nunes Viveiros

; Lerin, Rafaela dos Santos

; Lino, Francine de Souza

; Fornazier, Vivian de Castro Pires

; Dias Junior, Ubiratan de Souza

; Yano, Vinicius Akio

; Nogueira, Juliana Rebecca Capelletti Imperatore

Interface - Comunicação, Saúde, Educação

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aug 2015, Volume 19 Suppl. 1 Pages 941 - 951

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Trata-se de um relato de vivência compartilhada do Grupo PET-Saúde/ Vigilância em Saúde do Trabalhador Portuário, da Universidade Federal de São Paulo – Unifesp e o Centro de Referência em Saúde do Trabalhador – CEREST, de Santos, SP. O objetivo é descrever a experiência desse grupo tutorial e sua contribuição para o fortalecimento de ações de vigilância em saúde do trabalhador de Santos. O trabalho portuário é a temática do PET-Saúde por sua importância no cenário nacional e por sofrer transformações que geram fatores de agravos à saúde dos trabalhadores. As ações são desenvolvidas englobando o CEREST, os serviços da rede de saúde de Santos e a comunidade portuária santista. Observa-se que os participantes têm compartilhado conhecimento teórico e prático profissional, contribuindo nas ações dos trabalhadores do CEREST e apontando na direção de aproximação com a rede básica de atenção à saúde.

This is a report on the shared experience of the PET-Health/surveillance of port workers, developed by the Federal University of São Paulo (Unifesp) and the Worker’s Health Reference Center (CEREST), in Santos, Spain. The purpose of this study was to describe the experience of this tutorial group and its contribution to strengthening the surveillance of occupational health in Santos. Port work is subject to PET-Health because of its importance to the national scenery and also because this type of work has a changing nature as well as imparting potential risks on the workers’ health. Actions were developed that embrace CEREST, Santos Health Services, and the Santos port community. Participants shared their professional, theoretical, and practical knowledge, contributing to the actions of CEREST workers and pointing towards a rapprochement with the basic health care network.

Se trata de un relato de la experiencia compartida del grupo PET-Salud/ Vigilancia en Salud del Trabajador Portuario, desarrollado por la Universidad Federal de São Paulo - Unifesp y el Centro de Referencia en Salud del Trabajador (CEREST), en Santos. El objetivo es describir la experiencia de ese grupo tutorial y su contribución en el fortalecimiento de acciones de vigilancia en salud de los trabajadores. El trabajo en los puertos es tema del PET-Salud debido a su importancia en el escenario nacional y por sufrir transformaciones que generan riesgos para la salud. Las acciones se desarrollaron cubriendo el CEREST, los servicios de la red de salud de Santos y la comunidad portuaria. Hemos verificado que los participantes han compartido conocimientos teóricos y prácticos profesionales, contribuyendo en las acciones de los trabajadores del CEREST y apuntando en la dirección de una aproximación a la rede de básica de salud.

https://doi.org/10.1590/1807-57622014.1081 1328 downloads

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