Orientadores: Renato Mazzonetto, Roberto Henrique Barbeiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-17T15:43:20Z (GMT). No. of bitstreams: 1 Noia_ClaudioFerreira1986-_M.pdf: 8512475 bytes, checksum: 6fb7fe455350d248c9232dc63bb7caa6 (MD5) Previous issue date: 2011 / Resumo: Os enxertos ósseos autógenos são atualmente os tratamentos de escolha para aqueles pacientes com volume ósseo insuficiente e que desejam receber implantes osseointegráveis. Assim sendo, o presente trabalho teve a finalidade de avaliar alterações estéticas em pacientes submetidos à remoção de enxerto de mento, por meio de avaliação radiográfica. Para isso, foram selecionados 30 pacientes submetidos à remoção de enxertos de mento, avaliados por meio de uma telerradiografia de perfil no período pré-operatório, pós-operatório de um e pós-operatório de seis meses. Sobre as quais foram realizados traçados baseados em pontos e linhas que estabeleceram os parâmetros verticais e sagitais a serem analisados. Os resultados mostraram que as alterações estatisticamente significantes observadas nos parâmetros verticais foram em relação à posição vertical do vermelhão (V-VPV) e a exposição dos incisivos inferiores (V-ELI) que apresentaram-se aumentados no último período avaliado, sendo a expressão clínica desse aumento compatível com ptose labial. Nenhum dos parâmetros sagitais estabelecidos e avaliados apresentaram alteração estatisticamente significante no último período avaliado. Diante disso, podemos concluir que as alterações que ocorreram no perfil dos pacientes são causadas pelo não reposicionamento do músculo mentual a sua precisa posição original / Abstract: The autogenous bone grafts are currently the treatments of choice for those patients with insufficient bone volume and wish to receive dental implants. Therefore, this study aimed to evaluate the aesthetic changes in patients undergoing treatment for chin bone graft harvesting, by radiographic evaluation. For this, we selected 30 patients who underwent removal of chin grafts, assessed by means of a lateral cephalograms in preoperative, and postoperative period of one and six months. On which tracings were made based on dots and lines that set the vertical and sagittal parameters to be analyzed. The results showed that statistically significant changes were observed in the vertical parameters in relation to the vertical position of vermilion (V-VPV) and exposure of the lower incisors (VELI), which were increased in the last period evaluated, and the clinical expression of this increase is compatible with ptosis of lip. None of the sagittal parameters established and evaluated showed statistically significant change in the last period evaluated. The study concluded that the alterations to patients' soft tissue contours resulted mainly from failure to ensure precise reattachment of the mentalis muscles / Mestrado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Mestre em Clínica Odontológica

Orientador: Márcio de Moraes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-19T13:02:06Z (GMT). No. of bitstreams: 1 Noia_ClaudioFerreira1986-_D.pdf: 1385267 bytes, checksum: c4a0b0e7b226fcb2780050dd804f61ae (MD5) Previous issue date: 2011 / Resumo: Os enxertos ósseos autógenos são atualmente tratamentos viáveis para aqueles pacientes com volume ósseo insuficiente e que desejam receber implantes osseointegráveis. Sendo assim, no presente trabalho buscou-se avaliar prospectivamente as alterações funcionais que ocorrem na área doadora de 30 pacientes submetidos à remoção de enxerto de mento, por meio de avaliação clínica e radiográfica, em um período de 12 meses. CAPÍTULO I: Através dos testes neurosensoriais de discriminação de dois pontos, toque estático leve, toque com tração direcional, teste da agulhada e discriminação térmica com estímulo frio e quente, avaliou-se a morbidade da região do mento após remoção de enxerto ósseo. Observou-se que 50% (15) dos pacientes apresentaram morbidade no primeiro mês após a cirurgia, sendo que após 12 meses os testes neurosensoriais não revelaram a persistência de morbidade. O toque estático leve revelou que os pacientes evoluíram de um quadro de sensibilidade diminuída para um quadro de sensibilidade normal após 12 meses. Deste modo, podemos concluir que a morbidade que ocorre após a remoção de enxerto de mento alcança resolutividade em 12 meses. CAPÍTULO II: Por meio de teste de vitalidade pulpar ao frio com solução spray refrigerante "Endo Ice", foi avaliada a sensibilidade pulpar de elementos mandibulares após remoção de enxerto ósseo de mento. Sendo assim, 68,82% (181) dos dentes avaliados não apresentaram perda de sensibilidade pulpar no período pós-operatório de um mês, sendo que ao final de 12 meses esse percentual elevou-se para 100% (263) da amostra. Diante disso, conclui-se que 68,82% dos elementos dentários da amostra não sofreram perda de vitalidade pulpar, e que no período de doze meses houve resolutividade dos casos perda de sensibilidade pulpar. CAPÍTULO III: Com o objetivo de avaliar a percepção dos pacientes quanto às alterações que ocorrem após a remoção de enxerto do mento, realizou-se uma análise subjetiva utilizando escala visual analógica (EVA) relacionada à sensibilidade, estética facial, alimentação, fonação e movimentação do lábio inferior. Foi realizada também uma análise objetiva através do teste neurosensorial de toque estático leve. A análise subjetiva revelou que a sensibilidade evoluiu de um quadro de muita alteração para pouca alteração na região do mento ao final do estudo. Já a análise objetiva mostrou que ao final do estudo a sensibilidade encontrava-se normal. Desta forma concluímos que a análise subjetiva evidenciou resultado distinto da análise objetiva. CAPÍTULO IV: Através de telerradiografias de perfil realizadas no período pré-operatório, e pós-operatório imediato e tardio, avaliou-se o reparo ósseo após remoção de enxerto do mento. Para isso foram realizadas medições verticais (altura do enxerto) e horizontais (profundidade do enxerto) do defeito ósseo das telerradiografias. Logo após a remoção do enxerto observou-se um defeito vertical de 12.80 ± 1.99 mm e horizontal de 8.33 ± 1.77 mm. Após um ano houve uma diminuição de 32.8% no defeito vertical e 50.3% no defeito horizontal, levando-nos a concluir que o reparo do defeito ósseo foi próximo de 30-50% respectivamente / Abstract: The autogenous bone grafts are currently the treatments of choice for patients with insufficient bone volume and wish to receive dental implants. Therefore, this work evaluated alterations occurred in the donor area of 30 patients who undergoing chin bone harvesting by conducting clinical and radiographic assessments over a 12-month period. CHAPTER I: To evaluate morbidity in the mental region after bone graft removal the following neurosensory tests were used: two-point discrimination, static light touch, brush directional stroke, pin-prick and thermal discrimination of cold and warm. Therefore, 50% of the patients showed signs of morbidity in the first month after surgery but, after 12 months, it was no longer detectable by neurosensory testing. The static light touch test showed that, over the 12-month period, patients had progressed from a situation of diminished sensitivity to one of normal sensitivity. Accordingly, we conclude that morbidity occurring after chin bone harvesting disappears within 12 months. CHAPTER II: Pulp vitality testing was done using cotton swabs sprayed with Endo Ice refrigerant spray to evaluate pulpal sensitivity to cold of lower jaw teeth after chin bone harvesting. Therefore, 68,82% (181) of the teeth tested showed no loss of sensitivity at one month into the post operative period and by the end of the study that figure was up to 100% of the 263 teeth tested in the sample group. It was concluded that loss of pulpal sensitivity not affected 68,82% of the teeth tested and that within twelve months all pulpal sensitivity had been entirely restored. CHAPTER III: To evaluate patient's perceptions of the alterations that occur after chin bone harvesting, a Visual Analogue Scale (VAS) was used to investigate aspects of sensitivity, facial aesthetics, eating, speaking and lower lip movement. To make an objective analysis of sensitivity, the static light touch neurosensorial test was applied. Subjective analysis showed that sensitivity in the mental region evolved from a condition of considerable alteration initially, to one of little alteration by the end of the study. The objective analysis however showed sensitivity as being back to normal by the end of the study. Thus conclude that there was a difference between the subjective and objective analysis results. CHAPTER IV: Lateral cephalograms of the region taken immediate, intermediate and late postoperative period were used to evaluate bone repair occurring after chin bone harvesting. Vertical and horizontal measurements were made of the resulting bone defect. Immediately after graft removal there was a vertical defect of 12.80 ± 1.99 mm and a horizontal defect of 8.33 ± 1.77 mm. After one year there was a reduction of 32.8% in the vertical defect and 50.3% in the horizontal defect leading us to conclude that 30- 50% of the bone defect had been repaired / Doutorado / Cirurgia e Traumatologia Buco-Maxilo-Faciais / Doutor em Clínica Odontológica

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BACKGROUND: Severe maternal morbidity (SMM) is defined as having unexpected outcomes at labor and delivery that result in significant consequences to a woman’s health. The rate of SMM has risen 99% domestically between 1998 and 2015, and has been found to increase postpartum rehospitalizations, but more research needs to be done to understand the impact by race/ethnicity. The postpartum period is a critical time for monitoring the health of women. It is possible that the impact of SMM on postpartum rehospitalizations could be mediated through more effective and frequent follow-up. However, there is a gap in the literature around the experiences of Black women and postpartum care. METHODS: A mixed methods study was conducted to determine 90-day postpartum rehospitalization rates among a population of Black women in the state of Georgia (retrospective cohort study). Additionally, an assessment of the barriers, facilitators, and preferences for postpartum care among low-income Black women in the Atlanta Healthy Start Initiative was conducted (in-depth interviews). The quantitative analysis was based on 317,735 births between 2015-2017, while the qualitative analysis involved 26 in-depth interviews conducted May 2020-August 2020. RESULTS: Black women had a 78% greater likelihood of experiencing SMM (207/10,000 to 116/10,000 deliveries) than White women. The relative risk of SMM was 60% higher for Blacks, compared to Whites, even after adjusting for confounders (1.6: 95% CI 1.4-1.7). The relative risk of 90-day postpartum rehospitalization for women with SMM was 100% higher (RR 2.0, 95% CI: 1.6-2.5) than without SMM, though there was no difference between the likelihood of rehospitalization for Black or White women with SMM. Qualitatively, interviewees reported an array of difficulties in accessing Medicaid, challenges with scheduling appointments, and a lack of coordination of care. Facilitators to care included appointment reminders, consistent childcare, and positive coordination of care. Our study also documents the stigma that some Black women face in healthcare, such as unfair treatment or feeling ignored during their maternal healthcare experience. CONCLUSION: Strategies implemented at hospital discharge and early postpartum should be explored to prevent rehospitalizations in the SMM population. In addition, reducing policy-related and organizational-related barriers are key to improving access to postpartum care for low-income Black women in Atlanta. / 2022-05-14T00:00:00Z

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BACKGROUND: Social isolation (SI) has been seen as an emerging socioeconomic factor that negatively affects health. A considerable body of research has found that SI is associated with increased risk of all-cause mortality. However, the magnitude of the association varies in different studies. Besides that, these studies were conducted mainly in high-income countries. METHODS: We conducted a systematic review and meta-analysis to examine the effect size of SI on mortality. Also, we examined the associated mortality risk using data from the Prospective Urban and Rural Epidemiology (PURE) study of over 140,000 middle-aged adults from 21 countries with different income levels. RESULTS: Our systematic review and meta-analysis showed that the pooled hazard ratio of SI for all-cause mortality was 1.37 (95% confidence interval (CI) 1.28-1.46). The PURE study showed that the hazard ratio of SI for all-cause mortality was 1.26 (95% CI 1.16-1.36). Similar associations of SI with cardiovascular- and non-cardiovascular mortality as well as with incident diseases including stroke, cardiovascular disease, and injury were observed. The associations between SI and health outcomes were observed in diverse populations with different social structures and different country income levels. CLINICAL IMPLICATIONS: The impact of SI on mortality would be expected to be greater in the future as the number of people with SI is projected to increase with population ageing in most societies. Our findings can be used by public health providers and policy makers to develop targeted strategies to reduce the risks associated with SI. / Thesis / Master of Health Sciences (MSc) / Social isolation (SI) is an emerging socioeconomic factor that could negatively affect health. Prior studies regarding SI were conducted mainly in high income countries. This thesis examines the effect of SI on mortality. This was done first in a systematic review and meta-analysis and, second, by examining the association between SI and health in an international large-scale cohort study (PURE: Prospective Urban Rural Epidemiology) conducted in 21 countries at different country income levels. Our systematic review and meta-analysis showed that SI was associated with 37% increased risk for mortality. The PURE study showed that the association of SI with mortality was seen in diverse populations with different social structures. The impact of SI on mortality would be expected to increase in the future as the number of people with SI is projected to increase with population ageing. This calls for measures to reduce mortality and morbidity in the socially isolated.

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