Sociodemographic and obstetric factors associated with health-related quality of life of high-risk pregnant women.

OBJECTIVE: To evaluate the association between sociodemographic and obstetric factors and the health-related quality of life of pregnant women in high-risk prenatal care. METHODS: A cross-sectional study of women in high-risk prenatal care in Ceara, Brazil. The investigated outcomes were health-related quality of life, using the Medical Outcomes Study 36-item short-form health survey; the investigated covariates were sociodemographic and obstetric data. Associative analyses were performed using the Jamovi® software version 0.9. RESULTS: Of the 276 women included in the study, women with the following characteristics presented a better quality of life in some domain of the scale: age equal to or greater than 35 years, higher income per dependent, religious, living with three or fewer persons, with their own home, in primigestation, nulliparous, with no history of previous abortion, and with up to two living children. The regression model showed an association between the total scale score, which means a higher quality of life in women with age equal to or greater than 35 years and a higher income per dependent. CONCLUSION: The study identified sociodemographic and obstetric factors that may affect the quality of life of high-risk pregnant women, providing subsidies to health providers so that they can promote better prenatal care.

Morbidity trend and space-time clusters of COVID-19 occurrence in children and adolescents.

OBJECTIVE: To analyze the morbidity trend and space-time distribution clusters of confirmed COVID-19 cases in children and adolescents. METHOD: An ecological study of COVID-19 cases confirmed in the Information System from 2020 to 2022 in the age group from 0 to 19 years old, residents in Mato Grosso municipalities, Brazilian Midwest region. A trend analysis of the monthly morbidity rate of cases/100,000 inhabitants was used, following Prais-Winsten's regression. A space-time distribution of the Bayesian incidence rate per 100,000 inhabitants was performed, in addition to a space-time scan to identify high-risk clusters. RESULTS: Of all 79,592 COVID-19 cases studied, 51.6% were in females and 44.21% in people aged 15-19 years old. The mean monthly rate was 265.87 cases per 100,000 inhabitants, with a stationary trend in the period analyzed (Monthly Percentage Variation [MPV]) = 12.15; CI95%[MPV]: -0.73;26.70). The morbidity rate due to COVID-19 was higher in the female gender (283.14/100,000 inhabitants) and in the age group from 15 to 19 years old (485.90/100,000 inhabitants). An increasing trend was observed with a greater monthly time variation of 14.42% (CI95%[MPV]: 1.28;29.28)] among those aged from 10 to 14 years old. The primary cluster, which was also the one with the highest Relative Risk (RR = 5,16, p-value = 0.001), included 19 municipalities located in the North health macro-region. CONCLUSION: The findings indicated a monthly stationary trend in the study population, an increase in the age group from 10 to 14 years old, and areas at a higher risk for the disease in the North health macro-region of the state.

Comparison between intraoral scanning and direct visual analysis for the assessment of developmental defects of enamel.

OBJECTIVE: To compare direct visual analysis (DVA) and intraoral scanning (IOS) for the assessment of developmental defects of the enamel (DDE). METHODS: Thirty-nine extracted permanent human teeth with DDE were selected by an experienced examiner and digitised using IOS. The scanning was recorded using the OBS Studio software parallel to the IOS software to obtain a coloured high-definition MP4 file of the process. Two other experienced, blinded, and calibrated examiners randomly analysed the same teeth through DVA and IOS. A third examiner resolved any disagreements between the two examiners. Descriptive statistics were used to analyse the frequencies of the scores. Cohen's kappa test was used to determine whether the DVA scores were different from those assigned using IOS. Spearman's test was used to verify non-random examiner errors. The Chi-square test was used to compare score frequencies. Statistical significance was set at p <0.05. RESULTS: Scores indicating more severe and extended DDE (p <0.05) were more frequently assigned with IOS than with DVA (IOS: 25.64%, 25.64%, 38.46%, and 35.90% between one-third to two-third of the lingual, occlusal, mesial, and distal surfaces, respectively; vs. DVA: 10.26%, 7.69%, 15.38%, and 10.26% for the respective aforementioned tooth surfaces). Contrarily, 'no visible enamel defect' was significantly less assigned for IOS than for DVA (IOS: 15.38%, 43.59%, 35.90%, 15.38%, and 17.95% for buccal, lingual, occlusal, mesial, and distal surfaces, respectively; vs. DVA: 38.46%, 66.67%, 56.41%, 51.28%, and 43.59% for the respective aforementioned tooth surfaces). Kappa agreement ranged from fair to moderate when comparing DVA and IOS; the correlation between both methods was positive, indicating that the examiners assigned the scores properly and the differences arose from employing different methods. CONCLUSION: The assessment of DDE differed depending on the method used. IOS scores indicated more severe and extended DDE than DVA scores. Clinical investigation is the next step in validating the use of IOS for DDE diagnosis. CLINICAL SIGNIFICANCE: This study showed that DDE can be assessed differently using IOS. It is clinically relevant as it directly affects the determination of the severity of the defect and dental treatment planning.

Intramedullary hemangioblastoma of the thoracic cord with a microsurgical approach: A case report and literature review.

Background: Spinal cord hemangioblastomas (HBs) account for 2-15% of all spinal cord neoplasms. They are the third most common primary intramedullary tumor (1-5%). Here, 72-year-old female presented with a thoracic intramedullary spinal HB that responded well to surgery. Case Description: A 72-year-old female presented with a 3-4 years of progressive paresthesias and paraparesis. On examination, she exhibited diffuse distal weakness of the lower extremities. The magnetic resonance scan showed an intramedullary expansive lesion at the T1-T2 level that markedly enhanced with contrast with both proximal and distal hydromyelia. Surgery included a C7 partial and T1-T2 total laminectomies performed under microscope visualization with intraoperative monitoring. At surgery, there was a well-documented cleavage plane between the tumor and the cord; excision was facilitated using the cavitron ultrasonic surgical aspirator device. Conclusion: Surgery is the gold standard treatment for treating/resecting HBs and should include utilization of an operating microscope and intraoperative monitoring.

Influence of metal artefact reduction on the diagnosis of contact between implant and mandibular canal in cone beam computed tomography: An ex-vivo study.

OBJECTIVE: To evaluate the influence of metal artefact reduction (MAR) in the diagnosis of dental implant contact with the mandibular canal (MC) using cone beam computed tomography (CBCT). METHODS: Dental implants were installed with surgical guides in the posterior hemiarches of 10 dry human mandibles: 0.5 mm above to the MC cortex (G1/n = 8) and 0.5 mm inside the MC (G2/n = 10). The experimental set-up was scanned with two CBCT equipment using 85 kV and 90 kV, MAR ON or OFF, and different tube currents (4 mA, 8 mA and 10 mA). Two dentomaxillofacial radiologists (DMFRs) and two dentists (DDS) scored the relation between the dental implant and MC. Descriptive statistics were used to observe the absolute frequency of scores. Sensitivity, specificity and accuracy were calculated considering the known relation between the dental implant and the MC interior. McNemar's test (α = .05) was applied to compare the diagnostic efficacy of MAR ON versus MAR OFF. RESULTS: Overall specificity was higher than sensitivity for both DDS and DMFR (97% vs. 50% and 92.0% vs. 78.0% respectively). There was a significant effect of MAR (p = .031) for DMFR in the case of contact between the dental implant with the MC interior, in which sensitivity decreased with MAR activation from 90% to 40%. DMFR observers showed a better diagnostic performance compared with the DDS observers (accuracy of 84.0% and 71.0%, respectively). CONCLUSIONS: Due to the limited efficacy of MAR, it should not be used when conducting CBCT scans for the evaluation of contact between the implant and the mandibular canal.

Relationship between adolescent lifestyle and emotional and behavioral problems.

This study aimed at verifying the relationship between lifestyle and emotional and behavioral problems in adolescents. This is an observational and cross-sectional study developed with adolescents from a capital city in the Brazilian Amazon. Data collection was performed using an electronic form containing items from the Fantastic Lifestyle and Strengths and Difficulties Questionnaire instruments. For data analysis, the bootstrap t-Test and calculation of Cohen's d statistic value were performed to assess the effect size of the difference between means. A total of 479 adolescents participated in the study. There was a high relationship between emotional and behavioral problems and lifestyle (p < 0.01; d = 1.36), especially regarding emotional problems (p < 0.01; d = 1.09), hyperactivity (p < 0.01; d = 0.92) and peer problems (p < 0.01; d = 0.78). The lifestyle attributes that were highly related to emotional and behavioral problems were insight (p < 0.01; d = 1.30), sleep, seatbelt, stress and safe sex (p < 0.01; d = 0.93), type of behavior (p < 0.01; d = 0.86) and career (p < 0.01; d = 0.85). It is therefore concluded that there was a high relationship between lifestyle and emotional and behavioral problems among the adolescents surveyed. Thus, it becomes necessary to promote socio-emotional skills and restorative and health-protective lifestyles in this population.

Mechanical comparison of milled fiber-reinforced resin composite and Co-Cr frameworks with different connector cross-sectional geometries: An in vitro study.

This study compared the effect of using milled fiber-reinforced resin composite and Co-Cr (milled wax and lost-wax technique) frameworks for 4-unit implant-supported partial fixed dental prostheses; and also, evaluated the influence of the connector's cross-sectional geometries on the mechanical behavior. Three groups of milled fiber-reinforced resin composite (TRINIA) for 4-unit implant-supported frameworks (n = 10) with three connectors geometries (round, square, or trapezoid), and three groups of Co-Cr alloy frameworks manufactured by milled wax/lost wax and casting technique, were analyzed. The marginal adaptation was measured before cementation using an optical microscope. Then, the samples were cemented, thermomechanical cycled (load of 100 N/2 Hz, 106 cycles; 5, 37, and 55 ᵒC, a total of 926 cycles at each one), and cementation and flexure strength (maximum force) analyzed. Analysis of stress distribution in framework veneered considering resin and ceramic properties for fiber-reinforced and Co-Cr frameworks, respectively, implant, and bone was by finite element analysis under three contact points (100 N) on the central region. ANOVA and Multiple paired test-t with Bonferroni adjustment (α = 0.05) were used for data analysis. Fiber-reinforced frameworks showed better vertical adaptation (mean ranged from 26.24 to 81.48 µm) compared to the Co-Cr frameworks (mean ranged from 64.11 to 98.12 µm), contrary to horizontal adaptation (respectively, means ranged from 281.94 to 305.38 µm; and from 150.70 to 174.82 µm). There were no failures during the thermomechanical test. Cementation strength showed three times higher for Co-Cr compared to fiber-reinforced framework, as well as flexural strength (P < .001). Regarding stress distribution, fiber-reinforced had a pattern of concentration in the implant-abutment complex. There were no significant differences in stress values or changes observed among the different connector geometries or framework materials. Trapezoid connector geometry had a worse performance for marginal adaptation, cementation (fiber-reinforced 132.41 N; Co-Cr 255.68 N) and flexural strength (fiber-reinforced 222.57 N; Co-Cr 614.27 N). Although the fiber-reinforced framework showed lower cementation and flexural strength, considering the stress distribution values and absence of failures in the thermomechanical cycling test, it can be considered for use as a framework for 4-unit implant-supported partial fixed dental prostheses in the posterior mandible. Besides, results suggest that trapezoid connectors mechanical behavior did not perform well compared to round or square geometries.

Comparison of intraoral scanning and CBCT to generate digital and 3D-printed casts by fused deposition modeling and digital light processing.

OBJECTIVES: to evaluate trueness and precision of digital casts from intraoral scanning (IOS) and cone beam computed tomography (CBCT); trueness and precision of 3D-printed casts using digital light processing (DLP) and fused deposition modeling (FDM); the influence of digitizing method in the 3D-printed casts and, to compare STL data after DICOM segmentation and conversion. METHODS: a reference cast was digitized with IOS and CBCT, and 3D-printed using FDM and DLP. Linear measurements of occlusocervical (OC), interarch (IEA), and mesiodistal (MD) dimensions were taken on reference, digital and 3D-printed casts. Trueness was observed as the distortion, and precision was observed as the variation of measurements. One and Two-way ANOVA, Student t-test, and Chi-Square were applied to analyze data. RESULTS: distortion varied between digital casts for all dimensions; at OC, both showed expanded dimensions with IOS being significantly greater; in turn, CBCT digital casts showed higher distortion at IEA and MD. Dimensions of 3D-printed casts showed a predominance of shrinkage, DLP presented higher distortion compared to FDM for both digitizing methods. Digitizing methods influenced the 3D-printing of casts, especially for DLP. Regarding precision, no statistical difference was found. STL converted from DICOM showed statistical difference in IEA (p < 0.001). CONCLUSIONS: digital casts showed distortion depending on the digitizing method. IOS was better in IEA and MD, and CBCT in OC dimensions. Overall, DLP casts presented higher distortion compared to FDM. The digitizing method influences trueness on 3D-printed casts. File conversion from DICOM to STL per se could change the dimension. CLINICAL SIGNIFICANCE: This investigation showed that digital casts from IOS and CBCT as well 3D-printed casts from FDM and DLP can show different trueness. It is clinically relevant as clinicians have various workflows available in Digital Dentistry which involve these digitizing and manufacturing methods.

Factors related to self-reported smartphone addiction among Brazilian adolescents in the face of the COVID-19 pandemic: A mixed-method study.

PROBLEM: (1) To identify the factors associated with self-reported smartphone addiction (SRSA) among adolescents in the face of the COVID-19 pandemic; and (2) to analyze the adolescents' perception of these factors related to SRSA. METHODS: A mixed-method study with a sequential explanatory design, carried out with Brazilian adolescents aged between 15 and 18 years old. FINDINGS: The prevalence of SRSA was 56.37%, and the variables that remained in the final model of association were as follows: public schools; longer smartphone use during the COVID-19 pandemic; number of hours connected to the smartphone; preference for sleeping during the day; use of the device immediately after waking up, smartphone use after 9 p.m., amount of sleep less than 8 h a day; and smartphone use during meals. Sequentially, after analyzing the data obtained in the focus groups, it was possible to describe how adolescents perceive the intensification of smartphone uses, its repercussions, and activities carried out on it during the pandemic. CONCLUSIONS: The pandemic had repercussions on the behavior established with the smartphone, such as time and period of use, being associated with the SRSA. In addition, it was found that such conditions also affect the adolescents' sleep quality, diet, and studies.

Umbilical cord milking in newborns: scoping review

Objective: To map the available evidence on umbilical cord milking in newborns. Material and Method: Scoping Review based on the protocol proposed by the Joanna Briggs Institute. A search for full-text articles published in MEDLINE, SCOPUS, WOS and CINAHL was carried out using the following keywords: infant, newborn, umbilical cord milking, placental transfusion and umbilical cord blood. Results: The results indicated umbilical cord milking has superior benefits to the immediate cord clamping, among the main ones are higher levels of Hemoglobin, Hematocrit and Serum Ferritin, and reduction of complications in preterm newborns, such as intraventricular hemorrhage and the need for blood transfusion. When compared to delayed cord clamping, it has similar benefits, but milking is considered a faster method of placental blood transfusion. Conclusions: Umbilical cord milking has similar potential to delayed cord clamping. Therefore, it can be an alternative for obstetric nurses and midwives when delayed cord clamping cannot be performed in order to ensure the benefits of placental transfusion to the neonate.

Objetivo: Mapear la evidencia disponible sobre la ordeña del cordón umbilical en recién nacidos. Material y Método: Revisión de Alcance con base en el protocolo propuesto por el Instituto Joanna Briggs. Se realizó una búsqueda de artículos de texto completo publicados en MEDLINE, SCOPUS, WOS y CINAHL utilizando las siguientes palabras clave: lactante, recién nacidos, ordeña cordón umbilical, transfusión placentaria y sangre de cordón umbilical. Resultados: La ordeña del cordón umbilical tiene beneficios superiores al pinzamiento inmediato del cordón, entre los principales se encuentran: mayores niveles de hemoglobina, hematocrito y ferritina sérica y reducción de complicaciones en recién nacidos prematuros, tales como hemorragia intraventricular y necesidad de transfusión sanguínea. En comparación con el pinzamiento tardío del cordón, tiene beneficios similares, pero la ordeña se considera el método más rápido de transfusión de sangre placentaria. Conclusiones: La ordeña del cordón umbilical tiene potencial similar al pinzamiento tardío del cordón, por lo tanto, puede ser una alternativa para enfermeras obstétricas y parteras cuando no se puede realizar el pinzamiento tardío del cordón para asegurar los beneficios de la transfusión placentaria al neonato.

Objetivo: Mapear as evidências disponíveis sobre a ordenha de cordão umbilical em recém-nascidos. Material e Método: Revisão de escopo baseada no protocolo proposto pelo Joanna Briggs Institute. A busca de artigos completos publicados na MEDLINE, SCOPUS, WOS e CINAHL foi realizada utilizando as seguintes palavras-chave: lactente, recém-nascido, ordenha do cordão umbilical, transfusão de placenta e sangue do cordão umbilical. Resultados: Os resultados indicaram que a ordenha do cordão umbilical tem benefícios superiores ao clampeamento imediato do cordão, entre os principais estão: níveis mais elevados de hemoglobina, hematócrito e ferritina sérica e redução de complicações em recém-nascidos pré-termo, como hemorragia intraventricular e necessidade de transfusão sanguínea. Quando comparado ao clampeamento tardio do cordão umbilical, tem benefícios semelhantes, mas a ordenha é considerada um método mais rápido de transfusão de sangue da placenta. Conclusões: A ordenha do cordão umbilical tem potencial semelhante ao clampeamento tardio do cordão umbilical, portanto, pode ser uma alternativa às enfermeiras obstetras e parteiras quando o clampeamento tardio do cordão não pode ser executado a fim de garantir os benefícios da transfusão placentária ao neonato.

Clinical decision-making in anterior resin composite restorations: a multicenter evaluation.

OBJECTIVE: This study investigated whether a sample of anterior resin composite restorations could be differently evaluated in different centers of evaluation by clinical and lay evaluators. METHODS: Anterior resin composite restorations on high-quality intraoral digital photography were evaluated using FDI criteria (1-5 score) by pairs of clinical and lay evaluators in Brazil (BR), France (FR), Peru (PE), and the United States of America (USA). Scores were allocated as maintenance (1, 2, 3), repair (4) and replacement (5) when comparing clinical evaluators and, as acceptable (1, 2, 3) and unacceptable (4, 5) when comparing clinical vs. lay evaluators and lay vs. lay evaluators. The Chi-square test compared the frequencies of scores among the centers. RESULTS: The frequencies of maintaining, repairing, or replacing anterior resin composite restorations given by clinical evaluators varied depending on the evaluation center. BR and PE showed the highest frequencies for repair and replacement, while FR and USA showed the highest frequencies for maintenance. The comparison of frequencies of anterior resin composite restorations accepted or unaccepted by the clinical vs lay evaluators in the same centers showed a significantly higher frequency of acceptable dental restorations coming from clinical evaluators. Comparison between lay evaluators from different centers showed significant higher frequency of unacceptable dental restorations by BR, compared to other centers. CONCLUSIONS: In the evaluation of anterior resin composite restorations, the maintenance, repair, or replacement trends can vary among different centers. The unacceptable rate came more frequently from lay than from clinical evaluators. Lay evaluators from different centers differed significantly. CLINICAL SIGNIFICANCE: Clinical and lay evaluators in distant evaluation centers can present different trends when assessing anterior resin composite restoration. Multicenter evaluations can help to understand such differences and it is important because clinical decision-making based on scientific evidence comes from clinical studies done in different research centers.

Dependência de smartphone em adolescentes, parte 1: revisão de escopo / La dependencia de smartphone en adolescentes, parte 1: revisión del alcance / Smartphone Addiction in Adolescents, Part 1: A Scoping Review

Face a presença constante dos smartphones na vida dos adolescentes e ao aumento do tempo de tela observa-do nos últimos anos, este estudo objetivou mapear as evidências disponíveis sobre a dependência de smar-tphone em adolescentes. Trata-se da primeira parte de uma revisão de escopo. Um total de 67 artigos foram publicados entre 2009 e 2019, com um incremento de 31,74 % ao ano. A maioria das pesquisas (n=28; 41,79 %), foram desenvolvidas na Coreia do Sul, pe-la área de psicologia (n=21; 31,34 %) e pelo método transversal (n=49; 73,13 %). 14 escalas autoaplicáveis foram identificadas para o uso com adolescentes, sendo que, as mais utilizadas foram a Smartphone Addiction Proneness Scale e a Smartphone Addiction Scale- Short Version. Grande parte das escalas contempla os domí-nios: abstinência, tolerância, compulsão e efeito da dependência na vida diária.Conclui-se que a depen-dência de smartphone é um problema de saúde pública em ascensão no mundo e pode comprometer a saúde dos adolescentes. Tal construto tem sido mensurado por escalas validadas e confiáveis, porém, não foram identificados estudos brasileiros no período investigado. Portanto, faz-se necessário adaptar e validar instrumen-tos com esta população para melhor compreensão do fenômeno no Brasil

Dada la presencia constante de los teléfonos inteligentes en la vida de los adolescentes y el aumento del tiempo de pantalla observado en los últimos años, el presente estudio tuvo como objetivo mapear la evidencia disponible sobre la dependencia del smartphoneen adolescentes. Esta es una revisión del alcance. Se publicaron un total de 67 artículos entre 2009 y 2019, con un aumento del 31.74 % por año. La mayor parte de la investigación se realizó en Corea del Sur (n=28; 41,79 %), por el área de psicología (n=21; 31,34 %) y por el método transversal (n=49; 73,13 %). Se identi-ficaron catorce escalas autoaplicables para su uso con adolescentes, y las más utilizadas fueron la Smartphone Addiction Proneness Scale y la Smartphone Addiction Scale- Short Version. La mayoría de las escalas incluyen los siguientes dominios: abstinencia, tolerancia, compulsión y el efecto de la dependencia en la vida diaria. Se concluye que la dependencia de los smartphones es un problema de salud pública creciente en el mundo y puede comprometer la salud de los adolescentes. Esta construcción se ha medido mediante escalas validadas y confiables, pero no se han identificado estudios brasileños en el periodo investigado, por lo que es necesario adaptar y validar los instrumentos con esta población, para comprender mejor el fenómeno en Brasil

Given the constant presence of smartphones in adoles-cents' lives and the increase in screen time observed in recent years, this study aimed to map the evidence avail-able on adolescents' smartphone addiction. This is the first part of a scoping review. A total of 67 articles were published between 2009 and 2019, with an increase of 31.74 % per year. Most of the research was conducted in South Korea (n=28; 41.79 %), in psychology (n=21; 31.34 %) and by the cross-sectional method (n=49; 73.13 %). Fourteen self-applicable scales were identified for use with adolescents, the most used being the Smart-phone Addiction Proneness Scale and the Smartphone Addiction Scale-Short Version. Most scales include the ollowing domains: abstinence, tolerance, compulsion, and the effect of addiction on daily life. It was conclud-ed that smartphone addiction is a growing public health problem on a global scale that may compromise adoles-cents' health. This construct has been measured by val-idated and reliable scales, but no Brazilian studies have been identified in the period investigated, so it is necessary to adapt and validate instruments with this population to better understand the phenomenon in Brazil

Ventral pallidum DRD3 potentiates a pallido-habenular circuit driving accumbal dopamine release and cocaine seeking.

Drugs of abuse induce persistent remodeling of reward circuit function, a process thought to underlie the emergence of drug craving and relapse to drug use. However, how circuit-specific, drug-induced molecular and cellular plasticity can have distributed effects on the mesolimbic dopamine reward system to facilitate relapse to drug use is not fully elucidated. Here, we demonstrate that dopamine receptor D3 (DRD3)-dependent plasticity in the ventral pallidum (VP) drives potentiation of dopamine release in the nucleus accumbens during relapse to cocaine seeking after abstinence. We show that two distinct VP DRD3+ neuronal populations projecting to either the lateral habenula (LHb) or the ventral tegmental area (VTA) display different patterns of activity during drug seeking following abstinence from cocaine self-administration and that selective suppression of elevated activity or DRD3 signaling in the LHb-projecting population reduces drug seeking. Together, our results uncover how circuit-specific DRD3-mediated plasticity contributes to the process of drug relapse.

Psychopathological Symptoms in School Children: Analysis in a Sample from a State in the Brazilian Amazon.

OBJECTIVE: This study sought to identify and analyze the psychopathological symptoms of schoolchildren from a state in the Brazilian Amazon region. METHODS: This is a convergent parallel mixed study conducted with school-age children (6 to 12 years) from Amapá, located in the Brazilian Amazon region. For data collection, the Psychopathological Symptom Identification Scale was used with schoolchildren in addition to individual interviews. RESULTS: Most children had few psychopathological symptoms, and 12.65% required referral to a specialist. The symptoms were positively and significantly related to age and negatively and significantly related to the frequency of physical exercise. Participants who had relatives with mental disorders and who used psychoactive substances had significantly more symptoms. Some symptoms related to anxiety, mood, social behavior, attention and eating patterns had an average of answers that was higher than expected (1.5), which, in the children's discourses, were likely related to family situations such as poverty, violence, illness, abandonment, and social pressure due to aesthetic standards. CONCLUSION: Psychopathological symptoms such as anxiety, mood, social behaviors, and eating patterns were the most frequent among the students investigated, suggesting a relationship between these symptoms and the greater social vulnerability to which these children are exposed. PRACTICE IMPLICATIONS: This study supports the promotion of a social practice based on the use of observational power for the transformation of reality, with pediatric nurses, primary care providers and health and education systems as important agents of social change through actions designed to promote mental health in schools, families and society.

Digital photography vs. clinical assessment of resin composite restorations.

PURPOSE: To compare direct clinical and indirect digital photographic assessment of resin composite restorations. Ninety-two posterior resin composite restorations were classified using World Dental Federation (FDI) criteria by two different clinical examiners (C1 and C2). In the same appointment of clinical assessment, intraoral high-quality digital photographs were taken and posteriorly two different digital examiners (D1 and D2) classified the images of each restoration. Restorations of each patient were assessed once by C1 and C2 independently. D1 and D2 assessed the digital images from different locations and in different time. Data were analyzed using the Cohen's kappa coefficient, Kruskal-Wallis non-parametric test and Dunn's multiple shared test, with 95% confidence. Agreement levels varied from very good (0.81-1.00) to fair (0.21-0.40). Statistically significant differences (p < 0.05) between assessments were found for surface lustre, staining, color match and translucency, esthetic anatomical form, fracture of material and retention and marginal adaptation. The classification of the resin composite restorations varied significantly according to clinical or high-quality digital photographic assessments. Overall, clinical assessment detected more demand for repair or replacement.

Timed immersion expiration measures in patients with muscular dystrophies.

INTRODUCTION: Muscular dystrophies (MD) cause muscle weakness, affecting motor and respiratory functions. Aquatic activities maintain strength and ventilatory function and may require immersion expiration control. OBJECTIVES: (1) To describe the evolution of timed immersion expiration in patients with MD in one-year follow-up. (2) to describe motor and respiratory outcomes in one-year follow-up. (3) to investigate possible relationships between timed immersion expiration and age, motor and respiratory functions. METHOD: Fifty-seven patients with MD (12-35 years, Vignos scale 2-8) were evaluated twice, with one-year interval. Immersion expiration control was timed with a chronometer. Motor function was assessed by Motor Function Measure. The respiratory function was evaluated by spirometry. Analysis of variance compared assessments and Pearson tests investigated relationships between variables and age. RESULTS: Motor and respiratory functions decreased (p < 0.001) but timed immersion expiration was maintained. Timed immersion expiration was not correlated to motor and respiratory functions. CONCLUSION: As patients maintained timed immersion expiration in the one-year follow-up, aquatic therapy might be a facilitator for people with MD.

Adaptation accuracy of milled lithium disilicate crowns: A 2D and 3D microCT analysis.

OBJECTIVE: Evaluate the effects of the scanning techniques and the crystallization in the internal and marginal adaptation of milled lithium disilicate crowns by two techniques computer microtomography analysis. MATERIALS AND METHODS: Sixteen polyurethane teeth prepared for a complete crown were divided into two groups according to the scanner method (n = 8): indirect (IND), dental stone models were scanned with laser-surface scanner, and direct (DIR), digital typodont creates with an intraoral scanner. Internal and marginal gap were evaluated by micro-computed tomography (microCT). The replica technique (RT) was applied for analysis of total volume (TV) and marginal volume (MV) gap in microCT. The data showed normal distribution (Shapiro-Wilk test). One-way ANOVA (scanner techniques) with repeated measures (crystallization) was performed. Multiple comparisons were performed with Bonferroni adjustment (α = .05). RESULTS: The axial gap showed a significant difference between the times (P = .017) for lower values after crystallization. The vertical marginal gap presented a significant difference in times for higher value after crystallization (P = .001). The marginal horizontal gap IND was greater than DIR after crystallization (P = .001) and IND before lower than after crystallization. For TV was not significant difference and MV in DIR was reduction (P = .002) after crystallization. CONCLUSION: Crystallization changes the relationship between the crown and tooth, reducing internal gap and preventing the adequate fit in indirect and direct scanning. CLINICAL SIGNIFICANCE: The measure gap under technological methodology is useful for adjust clinical parameters prosthetic in the CAD/CAM and the applicability of the new possibilities of analysis.

Analysis of Different Device Interactions in a Virtual Reality Task in Individuals With Duchenne Muscular Dystrophy-A Randomized Controlled Trial.

There is a need to support individuals with Duchenne Muscular Dystrophy (DMD) to achieve optimal functionality in everyday life and with meaningful tasks and activities, throughout stages of the disease progression. Thus, technological developments have created an exciting opportunity for the use of affordable virtual reality (VR) systems with different kinds of interaction devices, providing an efficient and fun tool for enabling improvement in motor performance. Objective: To compare performance on a virtual task using interfaces with and without physical contact in order to identify functionality by using different devices in individuals with DMD. Methods: One hundred and twenty male individuals took part on this study: 60 with DMD with a mean age of 16 ± 5 (range 9-34 years old) and 60 without DMD in the control group (CG) matched by age. Participants were divided into three groups of 20 individuals each which performed a virtual task in three different interfaces: Kinect®, computer Touch Screen and Leap Motion®, in a cross over design in which all participants used all devices. Motor impairment in the DMD group was measured by using the Motor Function Measurement and Vignos scales. Results: All participants improved performance through practice, regardless of the interface used, although the DMD group had a continuous lower performance compared to the CG. In addition, the DMD group obtained a significant better performance with Leap Motion interface compared to the other interfaces, while the CG presented better performance on Touch Screen interface. Conclusion: Leap Motion provided better performance for individuals with DMD due to enablement of distal muscle function and ease of instrument adjustment using the virtual interface. Therefore, this type of interface should be encouraged for promoting functionality on general tasks using computer systems. Clinical Trial register number: NCT02891434.

The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review.

BACKGROUND: Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However, the impact of VR as an approach to rehabilitation is not fully understood, and its advantages over traditional rehabilitation techniques are yet to be established. METHOD: We present a systematic review which was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During February and March of 2018, we conducted searches on PubMed (Medline), Virtual Health Library Search Portal databases (BVS), Web of Science (WOS), and Embase for all VR-related publications in the past 4 years (2015, 2016, 2017, and 2018). The keywords used in the search were "neurorehabilitation" AND "Virtual Reality" AND "devices." RESULTS: We summarize the literature which highlights that a range of effective VR approaches are available. Studies identified were conducted with poststroke patients, patients with cerebral palsy, spinal cord injuries, and other pathologies. Healthy populations have been used in the development and testing of VR approaches meant to be used in the future by people with neurological disorders. A range of benefits were associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function. CONCLUSIONS: The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery.