ObjectivesWe investigated the factors associated with no dental visit within the last two years by adolescents in the state of São Paulo, Brazil, by using data from the Oral Health Conditions of São Paulo state population Project (SBSP-2015) conducted in 2015.MethodsThis was a cross-sectional epidemiological study with a representative sample of adolescents aged 15 to higher years residing in São Paulo State. The examiners were calibrated and dental visits were measured categorically as 1- Less than 1 year, 2- One to two years, 3 - Three years or more, 4- I have never visited the dentist. Based on the literature we dichotomized the outcome in two groups: response 1 plus 2 against response 3 plus 4. Then, Multilevel Poisson Regression (MPR) was used to estimate the prevalence ratios of last dental visit three years or had never been to a dentist by adolescents compared with those who had visited the dentist within the past two years, with contextual variables as the distal level; sociodemographic variables, mesial; and individual variables, proximal level.ResultsA high percentage of adolescents (84.9%) reported visiting the dentist in the last 2 years. Whereas, 626 (11.6%) had not visited the dentist for over 3 years and 188 (3.4%) had never been. A significantly higher proportion of females than males reported visiting the dentist in the past 2 years (p = 0.003). The oral and dental condition was reported as satisfactory by 4,350 respondents (80.6%), and when they accessed the health service, 2,286 (42.3%) went to the public service. Lower mean family income (1.62PR;95%CI;1.36–1.94); ≥ 1,000 inhabitant/Dental Surgeons (1.25PR;95%IC;1.03–1.56);male (1.26PR;95%CI; 1.11–1.43) non-Caucasian ethnicity (Mulatto:1.30PR;95%CI;1.13–1.50 and Black:1.58PR;95%CI;1.29–1.93); dissatisfaction with the oral health condition (1.20PR;95%CI;1.01–1.45),last visit to the public service versus private service (2.26PR; 95%CI;1.91–2.65) and presenting with periodontal disease in the form of dental calculus as the worst situation (1.38PR; 95%CI; 1.16–1.53) were associated with last visit to the dentist.ConclusionsA high proportion of adolescents had visited the dentist in the last two years. No dental visit within the last two years by adolescents were associated with contextual, health care system, sociodemographic, personal and oral health status, demonstrating that this is a complex phenomenon. Actions to promote regular dental visits by adolescents in Brazil should take these factors into consideration.

BackgroundSomatostatin analogues (SSAs) are indicated to relieve carcinoid syndrome but seem to have antiproliferative effects on neuroendocrine tumours (NETs). This is the first prospective study investigating tumour stabilisation with the long-acting SSA lanreotide Autogel in patients with progressive NETs.MethodsThis was a multicentre, open-label, phase II trial conducted in 17 Spanish specialist centres. Patients with well-differentiated NETs and radiologically confirmed progression within the previous 6 months received lanreotide Autogel, 120 mg every 28 days over ≤92 weeks. The primary endpoint was progression-free survival (PFS). Secondary endpoints were response rate, tumour biomarkers, symptom control, quality of life (QoL), and safety. Radiographic imaging was assessed by a blinded central radiologist.ResultsOf 30 patients included in the efficacy and safety analyses, 40% had midgut tumours and 27% pancreatic tumours; 63% of tumours were functioning. Median PFS time was 12.9 (95% CI: 7.9, 16.5) months, and most patients achieved disease stabilisation (89%) or partial response (4%). No deterioration in QoL was observed. Nineteen patients (63%) experienced treatment-related adverse events, most frequently diarrhoea and asthenia; only one treatment-related adverse event (aerophagia) was severe.ConclusionLanreotide Autogel provided effective tumour stabilisation and PFS >12 months in patients with progressive NETs ineligible for surgery or chemotherapy, with a safety profile consistent with the pharmacology of the class.Trial registrationClinicalTrials.gov Identifier NCT00326469; EU Clinical Trial Register EudraCT no 2004-002871-18.

Much has been learned about the chromosomal abnormalities of colorectal carcinomas but the cytogenetic relationship between the neoplastic clones present in primary versus metastatic tumour samples remains unclear. We analyse the frequency of abnormalities for 47 chromosome regions using the interphase fluorescence in situ hybridization technique in a group of 48 tumours, including 24 primary colorectal tumours and 24 paired liver metastases. All tumours showed complex karyotypes with numerical/structural abnormalities for seven or more different chromosomes/chromosome regions both in the primary tumours and in their paired metastases. Chromosome 8 was the most frequently altered (22/24 primary tumours), consistently showing del(8p22) and/or gains/amplification of 8q24, followed by abnormalities of the entire chromosome 7 (21/24 primary tumours) and of chromosomes 17p and 20q (20/24 primary tumours). Simultaneous staining for multiple chromosome probes revealed the presence of two or more tumour cell clones in 23/24 cases (46/48 tumour samples). Interestingly, the liver metastases typically contained tumour cell clones similar to those found in the primary tumours, suggesting the absence of selective selection of specific tumour clones. Despite this, additional chromosomal abnormalities were detected in 23/24 metastatic tumours, which preferentially consisted of del(17p13) and gains/amplification of 11q13 and 20q13; moreover, compared to primary tumours, metastases showed an increased number of abnormalities of chromosomes 1p, 7q, 8q, 13q, and 18q, and new chromosomal abnormalities involving chromosomes 6, 10q23, 14q32, 15q22, and 19q13. Owing to the high frequency of numerical abnormalities of the entire chromosome 7 and loss and/or gain/amplification of specific regions of chromosome 8, eg del(8p22) and/or gains/amplification of 8q24 in primary colorectal tumours with associated metastases, it is suggested that their assessment at diagnosis could be of great clinical utility for the identification of colorectal cancer patients at higher risk of developing liver metastases.

BackgroundFor years, the genetics of metastatic colorectal cancer (CRC) have been studied using a variety of techniques. However, most of the approaches employed so far have a relatively limited resolution which hampers detailed characterization of the common recurrent chromosomal breakpoints as well as the identification of small regions carrying genetic changes and the genes involved in them.Methodology/Principal FindingsHere we applied 500K SNP arrays to map the most common chromosomal lesions present at diagnosis in a series of 23 primary tumours from sporadic CRC patients who had developed liver metastasis. Overall our results confirm that the genetic profile of metastatic CRC is defined by imbalanced gains of chromosomes 7, 8q, 11q, 13q, 20q and X together with losses of the 1p, 8p, 17p and 18q chromosome regions. In addition, SNP-array studies allowed the identification of small (<1.3 Mb) and extensive/large (>1.5 Mb) altered DNA sequences, many of which contain cancer genes known to be involved in CRC and the metastatic process. Detailed characterization of the breakpoint regions for the altered chromosomes showed four recurrent breakpoints at chromosomes 1p12, 8p12, 17p11.2 and 20p12.1; interestingly, the most frequently observed recurrent chromosomal breakpoint was localized at 17p11.2 and systematically targeted the FAM27L gene, whose role in CRC deserves further investigations.Conclusions/SignificanceIn summary, in the present study we provide a detailed map of the genetic abnormalities of primary tumours from metastatic CRC patients, which confirm and extend on previous observations as regards the identification of genes potentially involved in development of CRC and the metastatic process.

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Objective: To investigate factors associated with the use of dental care services. Methods: A cross-sectional study with a representative sample of elderly individuals aged 65 years or older residing in the state of São Paulo in 2015 was performed. Hierarchical multivariate logistic regression analysis was used based on the theoretical model of access determination proposed by Andersen (1995) to predict dental care visits. Results: The prevalence of public service use by the elderly was 1.981 (37.8%), while 3.253 (62.2%) used the private service/ health plan/ other type of service. Hierarchical multiple analysis ( p≤0.05) identified that less schooling or never having studied, non-white, lower income and motivated by pain/extraction were associated with the use of public dental services. The study showed a reduced use of public dental care among elderly persons who required some type of upper dentures (except complete dentures), need for some type of lower dentures (including complete dentures) and demonstrated a positive self-perception of oral health condition. Conclusions: A higher prevalence of the use of private dental care/ health plan/other type of service was identified. Less schooling or never having studied, non-white skin color, lower income and seeking the dentist with pain or to extract teeth were factors associated with the use of public dental services by the elderly.

Resumo O objetivo deste artigo é analisar os fatores associados ao uso dos serviços odontológicos públicos por adultos. Estudo transversal com amostra representativa de adultos de 35 a 44 anos, com dados do Levantamento Epidemiológico das Condições de Saúde Bucal da População do Estado de São Paulo (SBSP-2015). Utilizou-se análise de regressão logística multivariada, baseada em modelo proposto por Andersen para predizer o acesso aos serviços odontológicos públicos. Visitaram o serviço privado 3.421 (59,9%) adultos e 2.288 (40,1%), o público. Os serviços odontológicos públicos foram mais acessados por mulheres (41,8%) e menos escolarizados (50,2%). Indivíduos não brancos (OR = 1,32; IC95%:1,16; 1,50), menor renda familiar (OR = 2,37; IC95%:2,11; 2,65), histórico de dor de dente (OR = 1,60; IC95%:1,39; 1,83) e necessidade de tratamento endodôntico (OR = 1,44; IC95%:1,12; 1,85) foram associados ao uso dos serviços odontológicos públicos. Fatores contextuais, individuais e necessidade de tratamento foram associados à utilização dos serviços odontológicos públicos por adultos residentes no estado de São Paulo, em 2015.

ResumoAs Diretrizes Curriculares Nacionais (DCN) para o curso de Odontologia no Brasil foram instituídas em 2002 em paralelo aos cursos de enfermagem e medicina. Em termos específicos a formação do cirurgião dentista requer o desenvolvimento das seguintes habilidades e competências: ética; atuar em todos os níveis de atenção; de forma multiprofissional; reconhecer a saúde como direito; participativo e socialmente envolvido; conhecer técnicas de investigação; desenvolver assistência odontológica individual e coletiva; saber diagnosticar doenças do complexo maxilo-facial; realizar investigações básicas, promover a saúde e prevenir doenças bucais; analisar e interpretar os resultados relevantes de pesquisas; propor e executar planos de tratamento adequados; reconhecer as limitações e estar apto e flexível às mudanças circunstanciais; acompanhar e incorporar inovações tecnológicas no exercício profissional; dentre outros. O objetivo deste estudo é promover a reflexão sobre a importância do currículo para a formação profissional odontológica contemporânea. O objetivo deste estudo é estimular a reflexão sobre a importância do currículo para a formação profissional odontológica contemporânea. AbstractNational Curriculum Guidelines (DCN) to the course of Dentistry in Brazil was imposed in 2002 in parallel to courses of nursing and medicine. Specifically formation requires the dentist to develop the following skills and competencies: ethics; act at all levels of care, so multiprofessional; recognize health as a right; participating and socially engaged; known investigative techniques, developing dental care individual and collective; know diagnose diseases of the maxillofacial complex; conduct basic research, promote health and prevent oral diseases, analyze and interpret the results of relevant research, to propose and implement appropriate treatment plans; recognize the limitation and being fit and flexible to changing circumstances; track and incorporate technological innovations in the professional practice, among others. The objective of this study is to stimulate reflection on the importance of the curriculum for vocational dental contemporary.