Cléa Adas Saliba Garbin

Responsabilidade do profissional de saúde sobre a notificação de casos de violência doméstica

Domestic violence reporting by health providers contributes to the epidemiological assessment of the magnitude of the problem, which allows the development of specific programs and actions. The aim of the study was to assess the level of responsibility of these providers towards reporting violence, especially domestic violence, and potential related legal and ethical implications. The Brazilian legislation and ethics code of Medicine, Dentistry, Nursing and Psychology were studied. Legal sanctions are found in the Criminal Law of Misdemeanor Offenses, the Child and Adolescent Statute, the Elderly Statute and in the law establishing mandatory reporting of violence against women. There are also penalties in all ethics codes reviewed. It is concluded that health providers have the legal duty of reporting known domestic violence cases and they can even be charged with omission.

Violência doméstica: análise das lesões em mulheres

This study aimed to evaluate the prevalence of head and neck injuries in females based on complaints registered as bodily harm or cruel and unusual punishment at the Womens Defense Precinct in Aracatuba, Sao Paulo State, Brazil, in 2002. A total of 204 police inquiries were conducted in 2002, resulting in 33 police reports of bodily harm and cruel and unusual punishment to females. The police reports were examined as to victims age and site of injury. The results showed that injuries are inflicted on various age brackets, with a higher prevalence in children and adolescents. In addition, the highest prevalence of injuries was in the head and neck, encompassing the area where dentists work and where they should be prepared to treat victims of such violence.

Satisfação e percepção do usuário do SUS sobre o serviço público de saúde

A avaliacao do grau de satisfacao dos usuarios do sistema de saude e um importante indicador a ser considerado no planejamento das acoes. O objetivo deste estudo foi avaliar o grau de satisfacao de usuarios dos servicos de saude publica municipal quanto aos servicos utilizados. Este estudo tipo inquerito foi conduzido em cinco municipios do Estado de Sao Paulo. A amostra foi selecionada de forma estratificada e aleatoria, sendo entrevistados 471 chefes de familia ou respectivos conjuges. Os dados qualitativos foram analisados pelo metodo de Analise de Conteudo, e os dados quantitativos foram processados utilizando-se o software estatistico Epi Info. Dentre os usuarios dos cinco municipios, 93,0% utilizam o servico municipal de saude. Para 72,0%, os servicos de saude prestados estao resolvendo os problemas e necessidades da populacao. Com base no acesso ao atendimento, 57,6% da populacao queixaram-se da presenca de filas para o atendimento. Mais da metade (69,5%) afirmou ter confianca na equipe de saude; no entanto, muitos relatos demonstraram a carencia de um atendimento humanizado. Em relacao aos servicos de saude, 61,7% classificaram-os como otimo ou bom. Conclui-se que a maior parte dos usuarios mostrou-se satisfeita com os servicos de saude municipais, apesar da grande quantidade de queixas quanto ao atendimento, falta de humanizacao e acolhimento, deficiencia de recursos fisicos e materiais. A percepcao do usuario e de extrema importância ao se dimensionar o reflexo das acoes que vem sendo desenvolvidas no setor saude, e serve como vetor de direcionamento e planejamento do servico.

Perfil epidemiológico da violência física intrafamiliar: agressões denunciadas em um município do Estado de São Paulo, Brasil, entre 2001 e 2005

The aim of this study was to analyze complaints of household physical aggression filed in Araçatuba, São Paulo, Brazil, from 2001 to 2005. The study described the social characteristics of aggressors and victims, their family relationship, locale, time of day, day of week, causes of aggression, kind of injuries, and use of alcohol/drugs by aggressor. Of 7,750 complaints of aggression, 1,844 involved domestic violence: 81.1% involved the spouse or partner (group A), 11.6% parents/guardians and children (group B); and 7.3% other family members (group C). In the three groups, the aggressions occurred mainly at home, and the aggressors were mostly males. In group A, aggressions occurred mainly on weekends (38.9%), with jealousy as the most frequently reported cause (21.5%). In group B, children/adolescents constituted 68.1% of the victims, mostly girls, while 5.2% of victims were 60 years old. All three groups involved mostly minor injuries like bruises and excoriations to the head and upper limbs. Aggressors were frequently under the influence of alcohol: 26.8% (group A), 21.6% (group B), 17.1% (group C). Drug use was probably underestimated in the three groups (2.2%, 1.8%, and 4.5%, respectively).

Potentially inappropriate medications used by the elderly: prevalence and risk factors in Brazilian care homes

BackgroundThe use of potentially inappropriate medications (PIM) among the elderly is a serious public health problem because it is intrinsically linked to increased morbidity and mortality, causing high costs to public health systems. This study’s objective was to verify the prevalence of and the factors associated with the use of PIMs by elderly Brazilians in institutional settings.MethodsWe performed a transversal study, by consulting the case files of elderly people living in Long Term Care for the Elderly (LTC) in towns in the State of São Paulo, Brazil, as well as structured interviews with the nurses responsible for them.We identified PIMs using the list of recently updated Beers criteria developed by a group of specialists from the American Geriatrics Society (AGS), who reviewed the criteria based on studies with high scientific evidence levels. We defined the factors studied to evaluate the association with PIM use prior to the statistical analyses, which were the chi-square test and multiple logistic regression.ResultsAmong the elderly who used drugs daily, 82.6% were taking at least one PIM, with antipsychotics (26.5%) and analgesics (15.1%) being the most commonly used. Out of all the medications used, 32.4% were PIMs, with 29.7% of these being PIMs that the elderly should avoid independent of their condition, 1.1% being inappropriate medication for older adults with certain illnesses or syndromes, and 1.6% being medications that older adults should use with caution. In the multivariate analysis, the factors associated with PIM use were: polypharmacy (p = 0.0187), cerebrovascular disease (p = 0.0036), psychiatric disorders (p < 0.0001) and dependency (p = 0.0404).ConclusionsThe results of this study showed a high prevalence of PIM use in institutionalized elderly Brazilian patients. and the associated factors were polypharmacy, psychiatric disorders, cerebrovascular diseases and dependency.

Declínio da cárie em um município da região noroeste do Estado de São Paulo, Brasil, no período de 1998 a 2004

This study analyzes the DMF and DEF indices, SiC index, and percentage of caries-free public schoolchildren in the municipality of Bilac, Sao Paulo State, Brazil, in 1998, 2000, 2002, and 2004. The same methodology was employed (WHO-1997) in all the surveys. Kappa test was carried out at each stage, and the minimal and maximum inter-examiner agreement values obtained were 0.86 and 0.89, respectively, while minimal intra-examiner agreement values were 0.91. DEF indices decreased slightly in the years 1998 and 2004. There was a continuous reduction in the DMF index, as well as the phenomenon of polarization at 12 years of age. The rate was 5.28 in 1998, decreasing to 4.11 in 2000, 3.47 in 2002, and 2.62 in 2004. Inversely, the proportion of caries-free 5-year-olds increased from 37.9% in 1998 to 40% in 2000 and 2002 and 45.3% in 2004. In conclusion, there has been a decrease in dental caries in 12 year-old public schoolchildren in the municipality.

Periodontal Disease Decreases Insulin Sensitivity and Insulin Signaling

BACKGROUND The purpose of this study is to investigate whether local inflammatory events, such as periodontal disease, are able to increase tumor necrosis factor-alpha (TNF-α) plasmatic concentration and decrease insulin sensitivity and insulin signaling in non-diabetic rats. METHODS Forty-eight male Wistar rats (2 months old) were divided into two groups, with either ligature-induced periodontal disease (LPD) or control conditions (CN). Experiments were performed in both groups 28 days after ligature placement. Plasmatic concentration of glycemia and TNF-α (n = 10) were analyzed by the glucose oxidase and enzyme-linked immunosorbent assay method, respectively. Insulin sensitivity (n = 7) was measured using the insulin tolerance test. Insulin signal transduction (n = 7) was measured by pp185 tyrosine phosphorylation status in insulin-sensitive tissues using the Western blotting method. RESULTS The LPD group showed decreased insulin sensitivity (P <0.05), although no glycemic alterations were noted (P >0.05). TNF-α plasmatic concentration was higher in LPD rats compared to CN rats. In addition, a decrease in the pp185 tyrosine phosphorylation status was observed after insulin stimulus in both white adipose and skeletal muscle tissues of the LPD group compared with the CN group. CONCLUSIONS LPD is able to cause alterations to both insulin signaling and insulin sensitivity, probably because of the elevation of TNF-α plasmatic concentration. Thus, the present results emphasize the importance of the prevention of local inflammatory diseases, such as periodontitis, to prevent diabetes mellitus.

A saúde na percepção do adolescente

Na fase da adolescencia, o individuo experimenta os melhores indices de saude, os quais podem ser mantidos e/ou melhorados, dependendo da percepcao e valorizacao dos mesmos, influenciando na sua qualidade de vida. O estudo avaliou a opiniao de adolescentes (n=493) da Fundacao Mirim do Municipio de Aracatuba - SP, quanto a saude geral e bucal, bem como sua percepcao sobre elas, por meio questionario semiestruturado, durante o ano letivo de 2006, ja que os mesmos possuem acesso a atencao a saude bucal e palestras sobre saude. Dentre os entrevistados 34,5% conceituaram a saude como coisa ou algo que precisa(mos) cuidar; 26,6%, como bem-estar; 18,1%, como a propria existencia; e 14,5%, como ausencia de doenca. Em relacao aos conceitos de saude bucal, 68,4% definiram como higiene; 16,2%, como aparencia; e 15,5%, como ausencia de doencas bucais. A percepcao desses jovens quanto a sua saude em geral foi para 46,5%, otima, e 44,1%, boa, enquanto que a da sua saude bucal foi para 53,6%, boa, e 24%, otima. Pode-se concluir que os adolescentes tem uma ideia tanto sobre saude geral como saude bucal, porem a classificacao e menor no que tange a saude bucal, pois envolve aspectos afetivos, esteticos e sociais. Ademais, percebe-se a necessidade de programas educativo-preventivos direcionados a esse grupo.

Dental students’ knowledge of ergonomic postural requirements and their application during clinical care

AIM To examine how much final-year undergraduate dental students know about postural dental ergonomic requirements, and how well they apply these requirements clinically. BACKGROUND Dentists are vulnerable to diverse mechanical (e.g. postural) and non-mechanical occupational risks. MATERIALS AND METHODS Eight postural requirements found in normalising documents were identified, reproduced, photographed, and analysed to develop a test of visual perception (TVP). Photographs of the 69 participating students were taken during their clinical care to ascertain ergonomics compliance, after which the students were administered the TVP. Pearsons test was used to correlate the level of knowledge (TVP) and its clinical application (photographic analysis) among the 552 observations made for each test (total of 1104 observations). RESULTS 65.7% of the TVP questions were answered correctly and 35% of the photographic cases were in compliance with ergonomic requirements (+ 0.67, P < 0.0001). CONCLUSION The knowledge of ergonomics postural requirements and their clinical application among the dental students surveyed were not satisfactory. The reasons for the learning difficulties encountered by the students should be identified to improve the learning process. The didactic use of digital images in this study may help in this endeavour.

Epidemiologia do câncer de boca em laboratório público do Estado de Mato Grosso, Brasil

This study analyzed oral cancer epidemiology based on histopathology reports from a public laboratory in Mato Grosso, Brazil, after a specific policy was implemented for treating oral and facial diseases in the State. This was a cross-sectional epidemiological study, based on 1,324 histopathology reports issued from January 2005 to December 2006. The study identified 44 cases of oral cancer, or 3% of all oral lesions, and analyzed them in relation to the following variables: histological type, gender, age, and patients place of residence (capital versus rest of State). The most common histological type was squamous cell carcinoma. Most of the diagnoses occurred in men in their 50s and 60s living in the interior of the State. During two years in operation, this public oral pathology service had recorded a considerable number of oral cancer cases.