[Current status of requirements in the design of healthcare facilities to ensure accessibility for patients with disabilities]. / Estado actual de los requerimientos en el diseño de centros sanitarios para asegurar accesibilidad a pacientes con discapacidad.

BACKGROUND AND OBJECTIVE: People with disabilities are one of the groups that usually frequent healthcare centers, so it is essential to attend to their specific needs, especially from the point of view of universal accessibility, safety and healthcare quality. The aim of the study is to summarize the available evidence on the needs of groups of patients with some type of disability in access, navigation and stay during the reception of healthcare in various health centers and to identify successful solutions. MATERIALS AND METHODS: A scoping review had been designed, based on a literature review without time limit in three databases (PubMed, WOS, and Embase). RESULTS: Of the 2562 articles identified, 11 were included. Recommendations for improvement in the design of healthcare services focused on the following aspects: improving access to primary care centers; navigation, signage, and orientation in the hospital environment; elevator design; hospital room bathroom design; meeting the needs of wheelchair users; importance of the participation of the patient with a disability; involvement of stakeholders in the design process; and the need for appropriate policies to ensure accessibility to buildings. CONCLUSIONS: The promotion of artistic programs in healthcare settings and the participation of people with disabilities in the design process of healthcare settings could provide beneficial solutions. More studies are needed, given the scarcity of evidence found, to ensure that care for this group is based on criteria of patient safety, universal accessibility, healthcare quality and humanization.

Ultrasound and microwave techniques for assisting ageing on lees of red wines.

Ageing on lees is a slow process that carries microbiological and economic risks in the wineries. This study evaluates the possibility of enhancing the extraction of different compounds from the lees, using combined strategies, such as ultrasound (US) or microwaves (MW) and the addition of inactive dry yeasts (IDY), to reduce the lees ageing time. The complete chemical analysis of the wine was done, amino acids, polysaccharides, colour and volatile compounds, together with the sensory analysis. The combined treatments increased the release of total polysaccharides, mannoproteins and total monosaccharides in the wines, and some amino acids like proline. However, wines treated with US and MW, with and without lees, showed a decrease in tannins and colour intensity, and in some volatile compounds like fatty acid esters, acetates and terpenes. The wines treated with IDY and MW were the best valued for their floral and red berry flavours and less astringency.

Use of probiotic yeasts with biocontrol activity for fermentation of ewe's milk.

BACKGROUND: There are sufficient scienctific studies that support the benefit that fermented dairy products produce in those who consume them. Traditionally, cow's milk has been the most commonly used milk but there is a growing interest in the development of new dairy products, substituting cow's milk with milk from other sources, as well as in the use of microorganisms in fermentation to replace artificial preservatives or treatments that may affect the chemical and organoleptic characteristics of the product. For these reasons, the aim of the present work was to understand the behavior of five potential probiotic yeasts during the fermentation of ewe's milk and to consider their potential use as biocontrol agents. RESULTS: Saccharomyces cerevisiae 3 and Hanseniaspora osmophila 1056 provided the most promising kinetic parameters in the different salt, temperature and pH conditions tested in their technological characterization. The profiles of organic acids and volatile compounds after the fermentation period was noteworthy for contributing to the final aroma of the dairy product. Sensory analysis revealed the sour taste of all samples, and S. cerevisiae 3, Lachancea thermotolerans 1039, and H. osmophila 1056 stood out for an accentuated cheese flavor. In addition, all strains showed biocontrol activity; they reduced the mycelium of the mycotoxigenic molds. CONCLUSION: Saccharomyces cerevisiae 3 and H. osmophila 1056 could be inoculated along with bacterial starters to provide a functional fermented beverage with improved flavor. These strains also have an added value as they act as biocontrol agents. © 2022 Society of Chemical Industry.

Power ultrasound treatment of Viognier grapes as a tool to increase the aromatic potential of wines.

BACKGROUND: High-power ultrasound is a novel and non-thermal technique normally used in red vinification to increase the extraction of phenolic compounds. However, few studies have been carried out on its effect on the extraction of aroma compounds and their precursors in white grapes. This study evaluates the effect of high-power ultrasound at winery scale in the maceration of Viognier grapes on the content of varietal volatile compounds (free and glycosidically bound) in musts and wines, in comparison with wines from direct pressing and from short skin maceration. RESULTS: The pre-fermentative ultrasound treatment of the grapes produced an increase in most of the varietal compounds of musts and wines, both in the free fraction and in the bound one, especially in the C6 alcohols, terpenes and norisoprenoids, some of them of sensory relevance, while the effect on esters and lactones was less evident. Ultrasound maceration allowed us to obtain wines of higher aromatic intensity, with a more pronounced varietal character. CONCLUSION: The pre-fermentative ultrasound treatment of Viognier grapes increases the aromatic potential of the wines, as it favors the extraction of free and bound varietal volatile compounds. In addition, it allows the maceration time of the grapes to be reduced compared to conventional pre-fermentation techniques, thus avoiding oxidative processes that could negatively affect the aroma of the wines. © 2022 Society of Chemical Industry.

La resiliencia como predictora del impacto negativo (depresión, ansiedad y estrés) del COVID-19 en médicos de atención primaria / Resilience as a predictor of the negative impact (depression, anxiety and stress) of COVID-19 in primary care physicians

Antecedentes La actual situación sanitaria está provocando un detrimento de la salud mental, siendo los médicos de atención primaria un colectivo muy afectado. Objetivo El objetivo es descubrir si la variable resiliencia es predictora del impacto negativo que está generando el COVID-19, entendido en las variables de depresión, ansiedad y estrés; y analizar, a su vez, qué factores resilientes contribuyen a explicar las varianzas de dichas variables y qué variables control son también predictoras. Método Se ha llevado a cabo una investigación cuantitativa, concretamente un diseño ex post facto no experimental de grupo único. La muestra seleccionada fueron 268 médicos de atención primaria, colectivo muy afectado por la pandemia, a quienes se les administró un cuestionario sociodemográfico, la Escala de Resiliencia SV-RES, en su versión reducida de 36 ítems, y la Escala de Depresión, Ansiedad y Estrés DAS-21. Resultados Los resultados de las regresiones lineales mostraron que la resiliencia, con una relación negativa, predice la depresión (un 22,2%), la ansiedad (un 8,3%) y el estrés (un 12,3%), siendo los factores metas e identidad los que contribuyen significativamente a explicar las distintas varianzas. A su vez, dentro de las variables control, la toma de psicofármacos, el sexo (excepto para la variable depresión) y la decisión de acudir al psicólogo fueron predictoras de las diversas variables. Conclusiones Los hallazgos de esta investigación avivan la necesidad de promover la resiliencia entre los médicos de atención primaria, con la intención de reducir sus niveles de depresión, ansiedad y estrés (AU)

Background The current health situation is causing a detriment to mental health, where primary care physicians is a very affected group. Objective The objective is to discover whether the resilience variable is a predictor of the negative impact generated by COVID-19, understood in the variables of depression, anxiety and stress; and analyze, in turn, which resilient factors help to explain the variances of the variables and which control variables are also predictors. Method A quantitative research has been carried out, specifically a single group non-experimental ex post facto design. The selected sample consisted of 268 primary care physicians, a group highly affected by the pandemic, who were administered a sociodemographic questionnaire, the SV-RES Resilience Scale, in its reduced version of 36 items, and the Depression, Anxiety and Depression Scale, DAS-21 stress. Results The results of the linear regressions showed how resilience, with a negative relationship, predicts depression (22.2%), anxiety (8.3%) and stress (12.3%), being the goals and identity factors that contribute significantly to explain the different variances. In turn, within the control variables, taking drugs, gender (except for the depression variable) and the decision to go to the psychologist were predictors of the various variables. Conclusions The findings of this research intensify the necessity of promoting resilience among primary care physicians, with the intention of reducing their levels of depression, anxiety, and stress (AU)

[Resilience as a predictor of the negative impact (depression, anxiety and stress) of COVID-19 in primary care physicians]. / La resiliencia como predictora del impacto negativo (depresión, ansiedad y estrés) del COVID-19 en médicos de atención primaria.

BACKGROUND: The current health situation is causing a detriment to mental health, where primary care physicians is a very affected group. OBJECTIVE: The objective is to discover whether the resilience variable is a predictor of the negative impact generated by COVID-19, understood in the variables of depression, anxiety and stress; and analyze, in turn, which resilient factors help to explain the variances of the variables and which control variables are also predictors. METHOD: A quantitative research has been carried out, specifically a single group non-experimental ex post facto design. The selected sample consisted of 268 primary care physicians, a group highly affected by the pandemic, who were administered a sociodemographic questionnaire, the SV-RES Resilience Scale, in its reduced version of 36 items, and the Depression, Anxiety and Depression Scale, DAS-21 stress. RESULTS: The results of the linear regressions showed how resilience, with a negative relationship, predicts depression (22.2%), anxiety (8.3%) and stress (12.3%), being the goals and identity factors that contribute significantly to explain the different variances. In turn, within the control variables, taking drugs, gender (except for the depression variable) and the decision to go to the psychologist were predictors of the various variables. CONCLUSIONS: The findings of this research intensify the necessity of promoting resilience among primary care physicians, with the intention of reducing their levels of depression, anxiety, and stress.

[Impact of the COVID-19 pandemic on patient safety incident and medication error reporting systems]. / Impacto de la pandemia COVID-19 en los sistemas de notificación de incidentes de seguridad del paciente y errores de medicación.

BACKGROUND AND AIM: To determine the impact of the COVID-19 pandemic on the epidemiology of safety incidents (SI) and medication errors (ME) reported to the CISEMadrid notification system in the hospital and primary care settings of the Madrid Health Service (SERMAS). MATERIALS AND METHODS: Observational and descriptive study with a retrospective analysis of data including all CISEMadrid notifications from 01-Jan-2018 to 31-Dec-2020, from 33 hospitals and 262 health care centres of the SERMAS. The two periods in 2020 with the greatest increase in COVID-19 cases were identified to compare incidents reported in the pre-pandemic and pandemic periods. RESULTS: 36,494 incidents were reported. Comparing both periods, an overall decrease in pandemic notifications of 60.7% was observed, being higher in primary care, falling to 33% of previous levels. The reduction in notifications was similar in the peaks and valleys of the waves. The three most frequent SIs in both periods and care settings were: diagnostic tests, medical devices/equipment/clinical furniture and organisational management/citations. In ME, dose failure and inappropriate selection were the most frequent in both settings and periods. There were no relevant differences in patient consequences in both periods. CONCLUSIONS: During the pandemic, patient safety notifications decreased although the most frequent types remained the same, as did their impact on the patient, both in hospitals and in primary care. The safety culture of organisations is a critical aspect for the maintenance of reporting systems.

Corky off-flavor compounds in cork planks at different storage times before processing. Influence on the quality of the final stoppers.

BACKGROUND: Cork companies store cork planks before processing them for a minimum of 6 months to dry up and to stabilize their texture and chemical composition, although many companies extend this storage period up to 12 months. However, there is no information about the influence of this seasoning period on their 'corky' off flavors. For this reason, the main compounds responsible for the 'cork taint' of planks stored before processing from 6 to 12 months were investigated. RESULTS: Four haloanisoles and three halophenols were identified: 2,4,6-trichloroanisole (TCA), 2,3,4,6-tetrachloroanisole (TeCA), pentachloroanisole (PCA), 2,4,6-tribromoanisole (TBA), 2,4,6-trichlorophenol (TCP), 2,3,4,6-tetrachlorophenol (TeCP), and 2,4,6-tribromophenol (TBP). All of the planks presented some haloanisole or halophenol after 6 and 9 months of storage, which practically disappeared after a year of storage. These compounds were only detected in the cork stoppers made from planks with 6 and 9 months of storage. Of the alkylmethoxypyrazines, 2-methoxy-3,5-dimethylpyrazine (MDMP), 3-isopropyl-2-methoxypyrazine (IPMP), and 3-isobutyl-2-methoxypyrazine (IBMP) were identified. The MDMP was detected in a larger number of planks with 6 months of storage and at higher concentrations than IPMP and IBMP. However, MDMP was not detected in the cork stoppers made from planks at 6, 9, and 12 months of storage. CONCLUSION: A storage time of 6 months before processing of raw cork planks would be sufficient to obtain cork stoppers with low concentrations of corky off-flavor compounds. An increase in storage up to 9 or 12 months would result in practically 'cork taint'-free natural stoppers. © 2021 Society of Chemical Industry.

Management of odonto-stomatological emergencies during the COVID-19 alarm state in dental clinics in the Autonomous Community of Madrid (CAM), Spain: An observational study.

BACKGROUND: Odontology practice has been severely compromised by the pandemic caused by COVID-19 and Spain is one of the countries with higher incidence. Our aim with this study is to find out the number of cases and type of odonto-stomatological emergencies (OSE) treated in four dental clinics of the Madrid capital area and region (CAM) in the period covered between March 17th and 4th of May. MATERIAL AND METHODS: We search the cases in the demographic/epidemiological databases of the CAM regional government and the Illustrious Official College of Dentists and Stomatologists of the First Region (Madrid). RESULTS: We found that the most prevalent pathology was acute apical periodontitis whereas odontogenic abscess showed the lowest frequency. Prosthetic-orthodontic OSE represented 14% of cases. CONCLUSIONS: In this period of time, the most prevalent pathology acute apical periodontitis, odontogenic abscess reported the lowest frequency and prosthetic-orthodontic treatments were the third in number of cases. Most of OSE were resolved, without referring the patient to a hospital emergency department.

Implementation of subcritical water extraction with natural deep eutectic solvents for sustainable extraction of phenolic compounds from winemaking by-products.

In attempt to recover valuable phenolic compounds from grape pomace by-products, a new implemented methodology has been proposed. The subcritical water extraction technique has been implemented with the use of emerging eco-solvents such as natural deep eutectic solvents (NADESs). The extraction efficiency of different NADESs were screened. Among them, choline chloride containing urea as hydrogen bond donor was selected (ChClU). However, due to pressurised system and the viscosity of NADESs, ChClU could not be used as truly solvent but as a solvent modifier in an promising percentage of 30%. The optimum extraction temperature for the isolation of phenolic compounds was 100 °C since extractions above this temperature implied the loss of the original composition of grape pomace due to thermaldegradation reactions and neoformation of Maillard compounds. The employ of subcritical water combined with 30% of ChClU led to a significant rise of extracted phenolic compounds quantities in comparison with the solely use of subcritical water. Among them, the extraction of catechin and epicatechin suffered an increase of 45.05 and 47.98% respectively, so this implementation led to highly efficient and truly eco-friendly extraction method. The implementation of subcritical water with NADESs to extract valuable compounds from winery by-products has not been applied until now.

Potential of Different Natural Antioxidant Substances to Inhibit the 1-Hydroxyethyl Radical in SO2-Free Wines.

The potential of different natural antioxidants to inhibit the 1-hydroxyethyl radical formation in SO2-free wines was analyzed by electron paramagnetic resonance (EPR). Chitosan, glutathione, inactive dry yeast, oak and grape seed extracts, and ascorbic acid were tested in white and red wines. The ability of these substances to prevent the formation of acetaldehyde after the Fenton reaction and the oxygen consumption capacity were measured. Ascorbic acid was the antioxidant substance that offered higher percentages of 1-hydroxyethyl radical inhibition at 30 min of reaction. However, wines with ascorbic acid showed higher concentrations of acetaldehyde after the Fenton reaction. Grape seed extract and chitosan provided higher percentages of radical inhibition in red wine than those in white wine, in contrast to the inactive dry yeast that only produced radical inhibition in white wine. Although oak extract did not produce changes in the 1-hydroxyethyl radical, wines with that extract had lower concentrations of acetaldehyde.

Las unidades de calidad asistencial hospitalarias y la pandemia de la COVID-19. ¿Hay que reinventarse? / Quality healthcare hospital units and COVID-19 pandemic. Should we reinvent ourselves?

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Natural extracts from grape seed and stem by-products in combination with colloidal silver as alternative preservatives to SO2 for white wines: Effects on chemical composition and sensorial properties.

The search for alternative additives to sulfur dioxide, with antioxidant and antimicrobial activity, in the production of wines is one of the current objectives of the enological industry. In the present study, aqueous extracts obtained from winery byproducts (grape seeds and stems), alone or in combination with colloidal silver complex, have been used in white vinification. The antimicrobial effect of the extracts was similar to that of sulfur dioxide, being more effective on lactic and acetic bacteria in those wines to which colloidal silver was added. The effect on the color, the phenolic compounds and the volatile fraction of the wines was evaluated, as well as their sensory profile. The use of both extracts modified the color of the wines, increasing the chromatic parameters a* and b*, indicating a browning tendency, although no other signs of oxidation were found. Wines with seed extracts contained higher amounts of flavan-3-ols, and a significant increase in some volatile compounds such as fatty acid ethyl esters and benzene compounds, which were identified in the extracts. From a sensorial point of view, the wines with stem extracts were the most similar to those elaborated with SO2, detecting a certain bitterness in wines with seed extracts.

Portland cement as pulp dressing agent in pulpotomy treatment of primary molars: a 12-month clinical study.

AIM: Pulpotomy is the most frequent endodontic treatment performed on primary teeth. Different pulpotomy procedures and materials have been studied during the last years and recently interest has been focused on the use of Portland Cement (PC) as an alternative to these materials including Mineral Trioxide Aggregate (MTA), but still few clinical studies have been carried out. The aim of this study was to analyse the clinical and radiographic response to the use of Portland cement (PC) in primary molars pulpotomies through a clinical study in paediatric patients. MATERIALS AND METHODS: Eleven carious primary mandibular molars of children aged 3-9 years old were treated by a conventional pulpotomy technique using PC. The teeth were restored with stainless steel crown. Clinical and radiographic follow-up was performed 6 and 12 months after the treatment. RESULTS: All the treated molars were clinically and radiographically successful at all the follow-up appointments as no pathological findings were observed in any molar. Reparative dentin formation was observed in 100% of the treated molars. CONCLUSIONS: PC could be considered a reasonable alternative to the use of MTA in pulpotomy treatments in primary molars, although more long-term clinical studies are needed to confirm these results.

Oenological potential of extracts from winery and cooperage by-products in combination with colloidal silver as natural substitutes to sulphur dioxide.

The aim of this study was to evaluate the oenological potential of natural extracts from winery and cooperage by-products, either alone or with a colloidal silver complex (CSC), on the quality of red wines, as possible substitutes to SO2. Natural extracts were obtained from grape seeds and American oak wood by accelerated extraction with subcritical water. The prefermentative addition of grape seed or oak wood extracts was an useful tool to control acetic acid bacteria development, without affecting the alcoholic and malolactic fermentations. Both extracts protected the wines against oxidation, without negatively modifying their phenolic and volatile composition. They did not cause organoleptic defects in wines, which presented greater aromatic complexity and were positively evaluated by the tasters. Therefore, the use of grape seed or oak wood extracts in red vinification could be a good alternative to replace or reduce the doses of SO2.

Para avanzar en el conocimiento de la seguridad del paciente: a propósito de la biblioteca breve de seguridad del paciente / To promote knowledge on patient safety: the case of the Biblioteca Breve de Seguridad del Paciente(Brief Patient Safety Library)

FUNDAMENTOS: En el marco de la Estrategia de Seguridad del Paciente 2015-2020 la Consejería de Sanidad de la Comunidad de Madrid desarrolló dos líneas de actuación para consolidar la cultura de seguridad a través de la difusión del conocimiento científico en Seguridad del Paciente. El objetivo principal fue identificar, difundir y mejorar el acceso a la información relevante en seguridad del paciente a pacientes-ciudadanos, profesionales y a la propia organización mediante un catálogo de recursos accesible en internet e intranet. MÉTODOS: Tras un análisis de las herramientas y canales de comunicación disponibles para difundir el conocimiento en seguridad del paciente, se seleccionaron las referencias de interés por un grupo de expertos, se desarrolló una herramienta de consulta en un formato navegable en internet y se realizaron distintas acciones de difusión para darla a conocer. RESULTADOS: Se desarrolló la Biblioteca Breve de Seguridad del Paciente, accesible en la web de la Comunidad de Madrid para navegación y como documento para descargar, con 154 referencias, estructuradas en 4 áreas: Recursos generales (74 referencias), Recursos por Área temática (51 referencias), Videos y multimedia (12 referencias) y Organismos y sitios web de interés (17 referencias). CONCLUSIONES: La Biblioteca Breve de Seguridad del Paciente puede contribuir a impulsar la cultura de seguridad en los centros sanitarios y a lograr mayor implicación de los ciudadanos en su seguridad, al poner a su disposición información fiable sobre esta dimensión transversal de la práctica clínica

BACKGROUND: Within the framework of the Patient Safety Strategy 2015-2020, the Regional Ministry of Health of the Community of Madrid developed two lines of action to consolidate the Patient Safety Culture through the dissemination of scientific knowledge in Patient Safety. The main objective was to identify, disseminate and improve access to relevant information on patient safety for patient-citizens, professionals and the organization itself through a pool of resources accessible on the Internet and intranet. METHODS: After an analysis of the tools and communication channel savailable to disseminate knowledge in patient safety, the references of interest were selected by a group of experts, a consultation tool was developed in a navigable format on the internet and various dissemination actions were carried out to make it known. RESULTS: The Biblioteca Breve de Seguridad del Paciente( Brief Patient Safety Library) was developed, accessible for navigation on the web of the Community of Madrid and as a download document, with 154 references, structured in 4areas: General resources (74 references), Resources by thematic area (51references), Videosand multimedia (12references) and Organizations and websites of interest (17references). CONCLUSIONS: The Biblioteca Brevede Seguridad del Paciente (Brief Patient Safety Library) can help to promote the safety culture in health centers and to achieve greater citizen involvement in their safety, by providing reliable information on this crosscutting dimension of clinical practice

Oak wood extracts as natural antioxidants to increase shelf life of raw pork patties in modified atmosphere packaging.

The use of antioxidants and refrigeration storage in modified atmosphere packaging, MAP, are the main strategies to slow down the oxidative and microbial deterioration of fresh meat. Synthetic antioxidants are commonly used for this purpose, however due to their controversial health effects, natural alternatives for their replacement are being looked for. The main aim of this work is the evaluation of pressurised aqueous extracts from oak wood as natural preservative of pork patties. The effect of different amounts of oak wood extracts (0.05, 0.5 and 1.0%) on the self-life of pork patties packed in MAP in refrigeration during 12 days were studied in comparison with the use of sodium ascorbate as synthetic preservative. Samples treated with oak wood extracts showed lower lipid oxidation, higher antioxidant capacity and an inhibitory effect on the enterobacteria growth. Furthermore, the addition of oak wood extracts resulted in a dramatically decrease of the volatile compounds coming from the lipid oxidation reactions. On the other hand, it is noteworthy that the use of oak wood extracts modified sensorial characteristics. Intensity colour was higher and new sensorial features such as oak wood and sweet spices appeared which were well appreciated.

Alternative amendment for vineyards from by-products of pyro-bituminous shale: Effect on wine amino acids and biogenic amines.

With the aim of looking for a model of agroecological production, the use of by-products from pyro-bituminous shale as amendment, and its effect on wine amino acids and biogenic amines has been evaluated. Field trials aimed to compare the effect of different doses of conventional and limestone shale from by-products of pyro-bituminous. Four replicates for six different fertilization treatments were arranged in a split plot design during 2009/2010 and 2010/2011 vintage. A chromatographic analysis was carried out to evaluate the impact of fertilization treatments on the amino acid and biogenic amine content of wines produced. Results showed few significant differences among fertilization treatments tested according to the amino acids composition of wines, although it seemed that a combination of conventional and pyro-bituminous shale could be the best option. By-products of pyro-bituminous shale seem to be a good partial substitutive amendment for Brazilian vineyards. This research seems to be a new approach for sustainable revalorization of domestic fertilizers to enable minor environmental impacts and lower production costs without detriment to quality.

The impact of dental appearance and anxiety on self-esteem in adult orthodontic patients.

OBJECTIVES: To analyse the relationship between different dimensions of dental appearance impact and self-esteem in adult patients undergoing orthodontic treatment, with special attention to the possible mediating role of anxiety. SETTING AND SAMPLE POPULATION: A quasi-experimental design was used with a matched control group (without orthodontic treatment). In each group (experimental and control), there were 85 patients. MATERIAL AND METHODS: The impact of dental appearance was measured using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). State anxiety was assessed with the State Anxiety Inventory (STAI-S) and self-esteem with Rosenberg's self-esteem scale. RESULTS: In both groups (experimental and control), self-esteem correlates negatively, ranging between 0.26 and 0.43, with all dimensions of dental appearance impact (except for the positive dental self-confidence dimension, where all correlations were positive). Anxiety correlates positively, ranges between 0.35 and 0.44, with social impact, psychological impact and aesthetic concern, although it maintains no significant correlations with dental self-confidence. Nevertheless, in patients undergoing orthodontic treatment, anxiety plays a mediating role between dental impact dimensions and self-esteem, whilst for the control group anxiety only plays a mediator role between psychological impact and self-esteem. CONCLUSION: Anxiety plays a fundamental role in the effect of perceived dental impact on self-esteem in adult patients undergoing orthodontic treatment. These results have important practical implications for the design of bio-psycho-social intervention programs that contemplate cognitive-affective variables as an essential part of orthodontic treatment in adults.