SummaryBackgroundA key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.MethodsDrawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.FindingsIn 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China,...

SummaryBackgroundPolitical, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses.MethodsWe analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries.FindingsNationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0–68·9) in 1990 to 75·2 years (74·7–75·7) in 2016, and HALE increased from 59·8 years (57·1–62·1) to 65·5 years (62·5–68·0). All-cause age-standardised mortality rates decreased by 34·0% (33·4–34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7–32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index.InterpretationHealth improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities.FundingBill & Melinda Gates Foundation and the Brazilian Ministry of Health.

A Bioengenharia tecidual compila conhecimentos de grandes áreas da ciência, os quais são aplicados atualmente em tratamentos de saúde com finalidade reparadora. No HRAC/USP pacientes com fissura labiopalatina são atualmente reabilitados com uso da rhBMP-2. Diante disso, o objetivo do presente estudo foi realizar um trabalho de revisão e atualização enfatizando as características principais da rhBMP-2. O tratamento com este biomaterial tem mostrado taxas de sucesso semelhantes às do tratamento convencional obtido de osso ilíaco para este grupo de pacientes, bem como vantagens adicionais. O conhecimento sobre suas aplicações e cuidados necessários é de grande valia para profissionais e acadêmicos da área de Ciências Biológicas e da Saúde durante o seu processo de formação universitária.

Descripción de pacientes que por sus características clínicas, de diagnóstico, forma de presentación infrecuente, imágenes radiológicas o estudios histopatológicos demostrativos puedan resultar de interés para nuestros lectores. www.siicsalud.com/tit/casiic.php Introducción Desde el momento del nacimiento, el tracto gastrointestinal es colonizado por numerosos microorganismos que son incorporados con los alimentos y por el contacto con el medio ambiente. Cualquier modificación en la microbiota nativa del hospedero implica alteraciones en la población de microorganismos, de forma que diversos factores pueden ejercer su influencia sobre la microbiota, especialmente la edad del individuo, el modo de nacimiento (parto normal o quirúrgico), la dieta, la localización geográfica, las cirugías del tracto gastrointestinal, la etnia, el uso de mamaderas, la hospitalización y, principalmente, el uso de antibióticos. 1,2 En razón de esto, es importante destacar que los microorganismos que integran la microbiota de la orofaringe constituyen una importante fuente de infecciones, sobre todo en individuos cuyas defensas, particularmente de las vías aéreas, están alteradas por deformaciones anatómicas, la edad y las inmunodeficiencias, y el consumo de alcohol, drogas ilícitas y tabaco. 1,2 Con especial énfasis desde el punto de vista microbiológico, se destacan las fisuras labiopalatinas, un grupo peculiar y heterogéneo de anomalías que afectan el rostro y la cavidad bucal, las cuales alteran el mecanismo de desarrollo facial embrionario, con gran variabilidad fenotípica. 1-4 Asociadas con la etiología de naturaleza multifactorial resultante de la interacción entre factores genéticos y ambientales, las fisuras aparecen precozmente en el período embrionario y el inicio del período fetal, es decir, entre la cuarta y la vigésimo segunda semana de vida intrauterina. 1-4 Con respecto a su epidemiología, este trastorno tiene una prevalencia de aproximadamente 1 en 650 nacidos vivos en el Brasil, por lo que, es la más prevalente de las malformaciones craneofaciales en la especie humana. De manera frecuente, involucra pérdida de continuidad de los tejidos labiales, alveolares y palatinos del maxilar, de manera que, en la mayoría de los casos, se hacen necesarios procedimientos quirúrgicos para la rehabilitación funcional y estética de las alteraciones. 1-5 Un ejemplo bastante demostrativo constituye lo vivido por los individuos con fisuras que comprometen el paladar y que aún Autoevaluación del artículo Los microorganismos que integran la microflora de la orofaringe pueden constituir una fuente de infecciones en individuos con alteraciones anatómicas locales. ¿Cuál de estas anomalías congénitas adquiere especial relevancia en términos microbiológicos? A, Los quistes parotídeos; B, Las fisuras labiopalatinas; C, La quelitis angular congénita; D, Todas son correctas; E, Ninguna es correcta. Verifique su respuesta en www.siicsalud.com/dato/evaluaciones.php/144114

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