The aim of this ex vivo study was to compare visual clinical and radiographic examinations to the histological analysis for proximal caries diagnosis in extracted permanent molars and premolars. The relationship between clinical aspects and carious lesions was also evaluated. Eighty-eight proximal surfaces (44 freshly extracted teeth) were longitudinally sectioned with a 370-microm diamond disk, thinned with wet silicon carbide paper and observed with a stereomicroscope at x40 magnification. Sensitivity and specificity were 65.6% and 83.3% for clinical examination and 29.7% and 95.8% for radiographic examination, respectively. Kappa values ranged from 0.64 to 0.91. The white spots corresponded to lesions restricted to enamel, while the dark spots corresponded to lesions that reached the dentinoenamel junction. In most cases, cavitation corresponded to dentin lesions. It may be concluded that interproximal radiographic examination is not a reliable method for detection of incipient proximal carious lesions.
Objective
To analyse the mortality rate trend due to coronary heart disease (CHD) and stroke in the adult population in Brazil.
Methods
From 2000 to 2018, a time trend study with joinpoint regression was conducted among Brazilian men and women aged 35 years and over. Age-adjusted and age, sex specific CHD and stroke trend rate mortality were measured.
Results
Crude mortality rates from CHD decreased in both sexes and in all age groups, except for males over 85 years old with an increase of 1.78%. The most accentuated declining occurred for age range 35 to 44 years for both men (52.1%) and women (53.2%) due to stroke and in men (33%) due to CHD, and among women (32%) aged 65 to 74 years due to CHD. Age-adjusted mortality rates for CHD and stroke decreased in both sexes, in the period from 2000 to 2018. The average annual rate for CHD went from 97.09 during 2000–2008 to 78.75 during 2016–2018, whereas the highest percentage of change was observed during 2008 to 2013 (APC -2.5%; 95% CI). The average annual rate for stroke decreased from 104.96 to 69.93, between 2000–2008 and 2016–2018, and the highest percentage of change occurred during the periods from 2008 to 2013 and 2016 to 2018 (APC 4.7%; 95% CI).
Conclusion
The downward trend CHD and stroke mortality rates is continuing. Policy intervention directed to strengthen care provision and improve population diets and lifestyles might explain the continued progress, but there is no room for complacency.
Ione Grace do Nascimento Cidade-Konzen 3 José Moreira da Silva Neto 4 RESUMO Considerada um marco histórico legal no país, a Lei de Responsabilidade Fiscal (LRF) provoca maior rigor no controle, responsabilidade e transparência da gestão pública, o que torna imperativo novas práticas inovadoras. O artigo tem por objetivo fazer o levantamento das discussões sobre inovação no setor público brasileiro após a LRF. A pesquisa é descritiva e o estudo documental, representado pela revisão de artigos disponíveis na base de dados eletrônicos da Scientific Electronic Library Online (Scielo) entre os anos de 2000, ano de vigência da LRF, até 2014. Categorizou-se os dados por temas que resultaram em nove. Dos 20 artigos encontrados, cinco abrangem inovação na saúde pública, tema predominante nas discussões. Os outros são referentes à gestão federal; às gestões estaduais, às gestões municipais; às melhores práticas; à educação; à pesquisa e tecnologia, propriedade intelectual e à estudos bibliométricos ou levantamento na literatura sobre o tema estudado. Há pouca discussão, de acordo com os artigos na base levantada, porém há mais estudos recentes com cinco artigos em 2014. Verificou-se pouco interesse em estudos sobre inovação pública com foco na educação.
Palavras-chave:Inovação; Setor público; Discussão de publicações. Lei de Responsabilidade Fiscal.
ABSTRACTConsidered a historic milestone in the country, the Fiscal Responsibility Law (FRL) causes greater rigor in the control, responsibility and transparency of public management, which makes it essential to new innovative practices.
ObjectiveEstimate reductions in cardiovascular mortality achievable through improvement in nutrient intakes according to processing level (NOVA classification), that is, reducing consumption of culinary ingredients (G2), processed (G3) and ultra-processed foods (G4) while encouraging consumption of unprocessed and minimally processed foods (G1).DesignModelling study.SettingGeneral adult population of Brazil.ParticipantsMen and women aged 25 or more years (34 003) investigated in the Household Budget Survey 2017–2018, in the consumption data module.Main outcome measuresWe used the IMPACT Food Policy Model to estimate the reduction in deaths from cardiovascular diseases (CVD) up to 2048 in five scenarios with reductions in saturated fat, trans fat, salt and added sugar intakes resulting from changes in NOVA groups. (1) The optimistic scenario modelised an increase in the energy intake provided by G1 and a reduction in the energy intake from G2, G3 and G4, return to previous levels. (2) The minimal scenario modelised a 3.7% increase in the energy intake from G1, and a reduction in the energy intake from G4 to the 2008–2009 level. (3) The modest scenario only modelised a 25.0% reduction of the energy intake from G2 and G3. (4) The intermediary scenario modelised the minimal scenario plus a 25.0% reduction in the energy intake from G2. (5) Finally, the advanced scenario modelised the minimal scenario plus a 25.0% reduction in the energy intake from G2 and G3.ResultsProposed changes in the optimistic scenario could prevent or delay 52.8% CVD-related deaths by 2048. Changes modelled in the minimal, modest, intermediary and advanced scenarios may result in a 10.1%, 28.4%, 31.4% and 38.6% reduction in 2048 CVD mortality, respectively.ConclusionsSubstantial health gains can be achieved by improving the diet, through plausible modifications aimed at the level of processing as a tool for Brazilian food policies.
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