Experience report on the training of Brazilian dental managers using active methodologies

This is an account on the training of dental managers in a Social Welfare, not-for-profit, non-governmental institution present in all Brazilian states. Given the continental dimension of Brazil, its regional inequalities and the need for uniformity in the management conduct, as well as in the planning and evaluation of services, it is understood that developing managers' skills and competences is fundamental. Bearing in mind that the model adopted by the company is based on collective health, and its structure is organized in Primary Care, this proposal can be applied by other organizations that offer services of a similar nature. The aim of this study is to describe the training of oral health managers (n = 54) on the themes of sustainability, practices based on evidence/health economics and social determinants - themes that were requested by the managers themselves. Using problem-based learning, active and distance-learning methodologies, three working groups were set up among the managers to go through the contents of the training program, which aimed at training mentors and identifying successful service experiences for sharing. This process peaked at a face-to-face session with all participants where a specialist and their respective mentors presented each topic. The products obtained were: (1) three scientific-economic studies for decision making on the incorporation of hard technologies; (2) a guide to sustainable practices in dentistry and (3) a set of criteria for prioritizing access based on social determinants. In the evaluation of the training, 89% of managers were very satisfied, 8.98% were satisfied and 1.79% were dissatisfied. It is concluded that the methodology used in this process significantly contributed to the development of the company's regional service managers and such improvement stemmed from the empowerment, engagement and alignment of these managers, to which action plans were directed, with measures for monitoring and evaluation.

Key messages

Active methodologies in training contributes to the empowerment, engagement and alignment of dental managers before epidemiological, economic and social challenges faced in the management of services. Trainings where the participants are protagonists in all stages of the educational processes, are those that produce the best results and the highest degree of satisfaction among employees.

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

Transfer of innovation on allergic rhinitis and asthma multimorbidity in the elderly (MACVIA-ARIA) - EIP on AHA Twinning Reference Site (GARD research demonstration project)

The overarching goals of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) are to enable European citizens to lead healthy, active and independent lives whilst ageing. The EIP on AHA includes 74 Reference Sites. The aim of this study was to transfer innovation from an app developed by the MACVIA-France EIP on AHA reference site (Allergy Diary) to other reference sites. The phenotypic characteristics of rhinitis and asthma multimorbidity in adults and the elderly will be compared using validated information and communication technology (ICT) tools (i.e. the Allergy Diary and CARAT: Control of Allergic Rhinitis and Asthma Test) in 22 Reference Sites or regions across Europe. This will improve the understanding, assessment of burden, diagnosis and management of rhinitis in the elderly by comparison with an adult population. Specific objectives will be: (i) to assess the percentage of adults and elderly who are able to use the Allergy Diary, (ii) to study the phenotypic characteristics and treatment over a 1-year period of rhinitis and asthma multimorbidity at baseline (cross-sectional study) and (iii) to follow-up using visual analogue scale (VAS). This part of the study may provide some insight into the differences between the elderly and adults in terms of response to treatment and practice. Finally (iv) work productivity will be examined in adults.

BEM-ESTAR DE GALINHAS POEDEIRAS EM DIFERENTES DENSIDADES DE ALOJAMENTO

O estudo foi realizado com objetivo de avaliar os parâmetros fisiológicos de poedeiras alojadas em diferentes densidades de alojamento e períodos. Foram utilizadas 150 poedeiras Dekalb White com 20 semanas de idade alojadas em um galpão convencional com gaiolas metálicas com duas subdivisões de 50x45x40 cm2 e distribuídas em três tratamentos: 8 aves por gaiola (562,5 cm2/ave); 10 aves por gaiola (450 cm2/ave) e 12 aves por gaiola (375 cm2/ave), com cinco repetições cada. Avaliaram-se parâmetros fisiológicos (frequência respiratória, temperatura cloacal e temperatura superficial) e condições ambientais (temperatura ambiente e umidade relativa) durante três ciclos de 28 dias. Adotou-se um delineamento inteiramente casualizado com arranjo fatorial 3x3 (três densidades de alojamento e três períodos). Os resultados demonstraram que a densidade de alojamento não prejudicou a frequência respiratória e a temperatura superficial, porém, a temperatura cloacal diferiu significativamente, sendo superior às 16 horas e a densidade de alojamento com 10 aves/gaiola permaneceu intermediário às outras densidades. Os parâmetros voltados à busca do conforto térmico evidenciaram que nos horários mais quentes do dia (até as 16:00 horas), independente da densidade, as aves apresentaram temperaturas maiores que na parte da manhã.

Continuous, high-resolution biospeckle imaging reveals a discrete zone of activity at the root apex that responds to contact with obstacles

BACKGROUND AND AIMS

Shining a laser onto biological material produces light speckles termed biospeckles. Patterns of biospeckle activity reflect changes in cell biochemistry, developmental processes and responses to the environment. The aim of this work was to develop methods to investigate the biospeckle activity in roots and to characterize the distribution of its intensity and response to thigmostimuli.

METHODS

Biospeckle activity in roots of Zea mays, and also Jatropha curcas and Citrus limonia, was imaged live and in situ using a portable laser and a digital microscope with a spatial resolution of 10 μm per pixel and the ability to capture images every 0.080 s. A procedure incorporating a Fujii algorithm, image restoration using median and Gaussian filters, image segmentation using maximum-entropy threshold methods and the extraction of features using a tracing algorithm followed by spline fitting were developed to obtain quantitative information from images of biospeckle activity. A wavelet transform algorithm was used for spectral decomposition of biospeckle activity and generalized additive models were used to attribute statistical significance to changes in patterns of biospeckle activity.

KEY RESULTS

The intensity of biospeckle activity was greatest close to the root apex. Higher frequencies (3-6 Hz) contributed most to the total intensity of biospeckle activity. When a root encountered an obstacle, the intensity of biospeckle activity decreased abruptly throughout the root system. The response became attenuated with repeated thigmostimuli.

CONCLUSIONS

The data suggest that at least one component of root biospeckle activity resulted from a biological process, which is located in the zone of cell division and responds to thigmostimuli. However, neither individual cell division events nor root elongation is likely to be responsible for the patterns of biospeckle activity.

Specific and non-specific nasal provocation tests in children with perennial allergic rhinitis

BACKGROUND

nasal provocation tests (NPT) have been extensively used in clinical practice to evaluate chronic rhinopathies, mainly allergic rhinitis (AR).

METHODS

we submitted 10 perennial AR children (aged from six to 15 years) to histamine (H), Dermatophagoides pteronyssinus (Dp) and Blomia tropicalis (Bt) NPT. All children were sensitized (positive skin prick test, mean wheal > 3 mm) to both mites. Dp and Bt specific NPT were realized in two occasions, apart one week, always preceeded 24 hours by H challenge. Increased concentrations were applied to the nasal mucosa during each NPT: H (0,03 to 16 mg/ml), Dp (1/100,000 to 1 /2.5) and Bt (1/125,000 to 1/10). NPT were evaluated by clinical and rhinomanometric parameters (total score, TS), and by lung function tests. NPT was considered positive, when total nasal resistance (TNR) doubled in relation to basal value.

RESULTS

H NPT was positive twice in 8/10 patients. Concordance between H concentration that induces a positive NPT measured by TNR or TS was observed. Regarding to specific NPT, 90 % of patients were positive to Dp and 60 % to Bt. There was no concordance between the allergen concentration that induces a positive SPT and a positive NPT, considering the different concentrations. There were no modification in lung function tests during both specific and non-specific provocation tests.

CONCLUSIONS

NPT with H is an objective and reproducible method which allow evaluate nasal reactivity. Specific NPT have restricted indications, mainly when there where doubts about AR's etiology.

[Effect of inhaled terbutaline sulphate (dry powder, Turbuhaler and nebulizer solution) in children with acute asthma]

Forty seven children (6-14 years), with an acute mild or moderate attack of asthma (clinical score 3 or FEV1 > 50% of the predicted), were treated with terbutaline sulphate, by inhalation route with a dry powder inhaler (Turbuhaler - 0,5 mg - group T; N=27, or by a nebulizer 1% solution-in saline-compressed air (6 l/min.) group S; N=20. The children were evaluated at 5, 15, 25 and 30 minutes after the initial treatment. In both groups a significant fall of the clinical score (starting at 15 minutes) (p < 0.05) and a significant improvement of the FEV(1), VC and FEF25-75% (starting at 5 minutes), were observed (p < 0.05). There were no significant changes in heart rates, respiratory rates and blood pressure (p > 0.05). At the end of the first treatment, the number of patients with a FEV(1) < 80% was similar in both groups (T = 13/27 and S = 10/20). The same treatment was repeated, and all the children showed a marked improvement, except for one boy of the group T was hospitalized. In conclusion, children with mild or moderate acute attacks of asthma can be treated up to a week with an inhalation of dry powder, resulting in adequate bronchodilatation without important side effects.