Topographical and histological analysis of keratinized mucosal grafts removal techniques an ex-vivo study in porcine mandibles.

The aim of this study was to assess the surface and tissue quality of keratinized mucosa grafts (KMG) obtained using the conventional scalpel and mucotome techniques. This was an experimental in vitro/ex vivo study involving six porcine hemi-mandibles. Specimens were harvested using both the mucotome and conventional scalpel techniques, with randomization determining the choice of technique for tissue removal. The specimens were prepared following predefined laboratory protocols and subsequently subjected to optical microscopy for evaluating epithelial and connective tissue and scanning electron microscopy for topographical and 3D profilometry analysis. Tissues harvested using the mucotome exhibited a linear base and uniform thickness, along with the presence of submucosa and fibrous connective tissue, all of which are ideal for graft success. Differences in the surface characteristics of specimens obtained through the two techniques were observed during a comparative analysis of images obtained through both microscopy types. KMG obtained using the mucotome technique displayed greater uniformity and reduced undesirable cell presence compared to the scalpel technique, thereby enhancing the likelihood of success in soft tissue graft surgical procedures. This study provides valuable insights to oral healthcare professionals and may contribute to future research aimed at achieving more successful surgeries, shorter postoperative recovery times, reduced discomfort, and an overall more positive patient experience.

Recriando a vida a partir do clown: um estudo com idosos em um centro de convivência em Portugal / Recreating life through clown: a study with seniors at a social center in Portugal

O presente artigo visa apresentar parte de uma investigação empírica que teve como objetivo: verificar de que forma um processo de criação do clown aplicado com idosos pode contribuir para o bem-estar e a vida com qualidade. Orientando-se com base em uma abordagem qualitativa, foi realizada uma pesquisa-ação com um grupo de idosos residentes em um centro para o convívio de idosos na cidade do Porto/Portugal. Desse modo, foi realizado um conjunto de atividades com os idosos: atividades de relaxamento; atividades corporais; e atividades de expressão corporal. O que contribuiu para uma maior vitalidade corporal, aquisição de uma maior desenvoltura dos movimentos, mais segurança em relação ao próprio corpo, mais independência pessoal, e uma melhor respiração, interação, criação, comunicação e desinibição corporal. Assim gerando impactos no seu bem-estar e para a melhoria da qualidade de vida dos idosos em questão.

This article aims to present part of an empirical investigation that aimed to: verify how a clown creation process applied to the elderly can contribute to well-being and quality of life. In this sense, guided by a qualitative approach, an action-research was carried out with a group of elderly residents in a center for the conviviality of the elderly in the city of Porto/Portugal. Thus,a set of activities was carried out with the elderly: relaxation activities; bodily activities; and body expression activities. This contributed to greater bodily vitality, acquisition of greater ease of movement, greater security in relation to one's own body, greater personal independence, and better breathing, interaction, creation, communication and bodily disinhibition. Thus, generating impacts on their well-being and improving the quality of life of the elderly in question.

A comparison of absolute, ratio standard and allometric approaches for bench press performance assessment in men over 60 / Comparação das abordagens absoluta, razão padrão e alométrica para a performance no supino em homens acima de 60 anos

ABSTRACT Body mass is known to affect muscle strength and the outcome of some functional tests, so that heavier and taller people will be stronger than lighter and smaller ones. Ratio standard (RS) has been widely used to remove the body mass effect, despite long date criticism due to its inadequacy. Allometry (ALLO), in turn, has been applied as an efficient method for normalizing muscular strength. As the bench press (BP) is a well-recognized strength and conditioning exercise for older adults, the aim of the present study was to verify the influence of body mass on the performance assessment of a group of older men in the BP, by comparing the absolute, RS and ALLO approaches. Sixteen healthy old men (65.5±5.13 years old; 75.42±9.78Kg; 1.73±5.98m; 25.11±2.71 kg/m2; 24.76±4.10 %fat) volunteered to participate in the study. Maximum dynamic load was verified by individual one-repetition maximum (1-RM) tests. Comparisons of means revealed that significant 1-RM difference between lighter (54.9±8.85Kg) and heavier (66.2±8.86Kg) participants was identified only in absolute approach (p<0.05; ES=0.57). RS failed in completely remove the body mass effect, allowing correlation between normalized muscular strength and BM (r=0.23), in contraire of ALLO (r=0.03 and 0.06). Kendall's concordance coefficient revealed an absolute lack of agreement between approaches when compared their respective ordinal classifications (kw=0.003; p>0.05). In line with previous research, ALLO has shown to be the only suitable method to remove adequately the body mass effect and to provide appropriated performance scores for the older men evaluated in this study.

RESUMO Sabe-se que a massa corporal afeta a força muscular e o resultado de alguns testes funcionais, de modo que pessoas mais pesadas e altas serão mais fortes que as mais leves e menores. A razão-padrão (RP) tem sido largamente utilizada para remover o efeito da massa corporal, apesar de críticas conhecidas há muito tempo devido sua inadequação. Alometria (ALO), do contrário, tem sido aplicada como um método eficiente para normalizar a força muscular. Como o supino é um exercício de força e condicionamento bem reconhecido para idosos, o objetivo deste estudo foi verificar a influência da massa corporal sobre a avaliação do desempenho de um grupo de idosos no supino, comparando as abordagens absoluta (AB), RP e ALO. Dezesseis idosos saudáveis (65,5±5,13 anos de idade; 75,42±9,78Kg; 1,73±5,98m; 25,11±2,71 kg/m2; 24,76±4,10 %gordura) se voluntariaram para participar no estudo. A máxima carga dinâmica foi verificada pelos testes de 1 repetição máxima (1RM). Na comparação das médias, a diferença significante do 1RM entre os participantes leves (54,9±8,85Kg) e pesados (66,2±8,86Kg) foi identificada apenas na abordagem ABS (p<0,05; ES=0,57). A RP falhou em remover completamente o efeito da massa corporal, permitindo correlação entre a força muscular e a massa corporal normalizadas (r=0,23), ao contrário da ALO (r=0,23 e 0,06). O coeficiente de Kendall revelou ausência de concordância entre as abordagens quando comparadas as suas respectivas classificações ordinais (kw=0,003; p>0,05). Em linha com pesquisas anteriores, ALO tem se mostrado como o único método viável para remover adequadamente o efeito da MC e para oferecer escores de desempenho mais apropriados para homens idosos, como os avaliados por este estudo.

Efficacy of two low-level laser therapy protocols following lower third molar surgery - a randomized, double-blind, controlled clinical trial.

The aim of this study was to test two low-level laser therapy protocols by evaluating pain control, swelling and trismus in the postoperative period of lower third molar surgeries. This was a randomized, double-blind, placebo-controlled, crossover trial. Patients presenting two symmetrically impacted mandibular third molars were included. One side was randomly assigned for LLLT applied immediately after surgery (T1) and then after 24 (T2) and 48 hours (T3) (Protocol A). The other side received LLLT applied immediately after surgery and placebo after 24 and 48 hours (Protocol B). LLLT was given by intraoral application (660nm, 5 J/cm2, 10 s, 20 mW, 4 points) followed by extraoral application (789 nm, 30 J/cm2, 20 s, 60 mW, 8 points). The placebo application was similar to that of the experimental side but with laser simulation. The primary outcomes were pain control, swelling and trismus intensity at T1, T2, T3 and 7 days after surgery (T4). Data were analyzedbyANOVArepeated measures and Wilcoxon test (p<.05). The final sample consisted of 21 patients (42 teeth). There were no statistical differences for pain level between protocols A and B over time (p= .909), although the amount of analgesic medication was lower with protocol A at T2 (p=.022). There were no differences in swelling (p=.958) or trismus (p=.837) between the protocols used over time. Both protocols performed similarly for pain control, swelling and trismus. Therefore, for practical reasons, a single laser application in the immediate postoperative period could be indicated for the management of postoperative discomfort in lower third molar surgery.

O objetivo deste estudo foi testar dois protocolos de terapia com laser de baixa intensidade (LBI) para controle da dor, edema e trismo no período pós-operatório de cirurgias de terceiro molar inferior. Neste estudo randomizado, duplo-cego, controlado, de boca dividida foram incluídos pacientes que apresentavam os terceiros molares inferiores simetricamente. Um lado foi aleatoriamente designado para receber LBI aplicada imediatamente após a cirurgia (T1) e após 24 (T2) e 48 (T3) horas (Protocolo A). O lado oposto recebeu LBI imediatamente após a cirurgia e placebo após 24 e 48 horas (Protocolo B). A aplicação de LBI foi realizada intraoralmente (660nm, 5 J/cm2, 10 s, 20 mW, 4 pontos), seguida pela aplicação extraoral (789 nm, 30 J/cm2, 20 s, 60 mW, 8 pontos). O efeito do placebo foi similar ao experimental. Os desfechos primários eram dor, edema e intensidade do trismo nos tempos T1, T2, T3 e 7 após a cirurgia (T4). Os dados foram analisadosporANOVA e teste deWilcoxon (p<.05). A amostra final consistiu de 21 pacientes (43 dentes). Não houve diferença estatística para o nível de dor entre os protocolos A e B ao longo do tempo (p=.909), embora a quantidade de medicação analgésica tenha sido menor com o protocolo A em T2 (p= .022). Não houve diferença para edema (p=.958) ou trismo (p=.837) entre os protocolos ao longo do tempo. Em conclusão, a aplicação de LBI imediatamente após a cirurgia e após 24 e 48 horas (Protocolo A) apresenta melhor resultado para controle da dor. Ambos os protocolos foram similares para dor, edema e trismo. Portanto, por razões de praticidade, uma aplicação única de laser imediatamente após a cirurgia pode estar indicada para o manejo do desconforto pós-operatório em cirurgias de terceiros molares inferiores.

Efficacy of two low-level laser therapy protocols following lower third molar surgery - a randomized, double-blind, controlled clinical trial / Eficácia de dois protocolos de terapia a laser de baixa intensidade após cirurgia de terceiros molares inferiores - ensaio clínico duplo-cego, randomizado

ABSTRACT The aim of this study was to test two low-level laser therapy protocols by evaluating pain control, swelling and trismus in the postoperative period of lower third molar surgeries. This was a randomized, double-blind, placebo-controlled, crossover trial. Patients presenting two symmetrically impacted mandibular third molars were included. One side was randomly assigned for LLLT applied immediately after surgery (T1) and then after 24 (T2) and 48 hours (T3) (Protocol A). The other side received LLLT applied immediately after surgery and placebo after 24 and 48 hours (Protocol B). LLLT was given by intraoral application (660nm, 5 J/cm2, 10 s, 20 mW, 4 points) followed by extraoral application (789 nm, 30 J/cm2, 20 s, 60 mW, 8 points). The placebo application was similar to that of the experimental side but with laser simulation. The primary outcomes were pain control, swelling and trismus intensity at T1, T2, T3 and 7 days after surgery (T4). Data were analyzed by ANOVA repeated measures and Wilcoxon test (p<.05). The final sample consisted of 21 patients (42 teeth). There were no statistical differences for pain level between protocols A and B over time (p= .909), although the amount of analgesic medication was lower with protocol A at T2 (p=.022). There were no differences in swelling (p=.958) or trismus (p=.837) between the protocols used over time. Both protocols performed similarly for pain control, swelling and trismus. Therefore, for practical reasons, a single laser application in the immediate postoperative period could be indicated for the management of postoperative discomfort in lower third molar surgery.

RESUMO O objetivo deste estudo foi testar dois protocolos de terapia com laser de baixa intensidade (LBI) para controle da dor, edema e trismo no período pós-operatório de cirurgias de terceiro molar inferior. Neste estudo randomizado, duplo-cego, controlado, de boca dividida foram incluídos pacientes que apresentavam os terceiros molares inferiores simetricamente. Um lado foi aleatoriamente designado para receber LBI aplicada imediatamente após a cirurgia (T1) e após 24 (T2) e 48 (T3) horas (Protocolo A). O lado oposto recebeu LBI imediatamente após a cirurgia e placebo após 24 e 48 horas (Protocolo B). A aplicação de LBI foi realizada intraoralmente (660nm, 5 J/cm2, 10 s, 20 mW, 4 pontos), seguida pela aplicação extraoral (789 nm, 30 J/cm2, 20 s, 60 mW, 8 pontos). O efeito do placebo foi similar ao experimental. Os desfechos primários eram dor, edema e intensidade do trismo nos tempos T1, T2, T3 e 7 após a cirurgia (T4). Os dados foram analisados por ANOVA e teste de Wilcoxon (p<.05). A amostra final consistiu de 21 pacientes (43 dentes). Não houve diferença estatística para o nível de dor entre os protocolos A e B ao longo do tempo (p=.909), embora a quantidade de medicação analgésica tenha sido menor com o protocolo A em T2 (p= .022). Não houve diferença para edema (p=.958) ou trismo (p=.837) entre os protocolos ao longo do tempo. Em conclusão, a aplicação de LBI imediatamente após a cirurgia e após 24 e 48 horas (Protocolo A) apresenta melhor resultado para controle da dor. Ambos os protocolos foram similares para dor, edema e trismo. Portanto, por razões de praticidade, uma aplicação única de laser imediatamente após a cirurgia pode estar indicada para o manejo do desconforto pós-operatório em cirurgias de terceiros molares inferiores.

A psicanálise como possibilidade de escuta do mal-estar na contemporaneidade / El psicoanálisis como posibilidad de escuchar el malestar en la actualidad / Psychoanalysis as a possibility of listening to malaise in contemporary times / La psychanalyse comme possibilité d'écouter le malaise à l'époque contemporaine

Este artigo realiza uma investigação acerca das manifestações de mal-estar e das facetas do adoecimento psíquico dos sujeitos no cenário atual. Na contemporaneidade, o processo cultural evidencia o desafio em abordar as formas de subjetivação diante da relação inescapável entre sujeito e discurso civilizatório. Assim, este estudo pretende, primeiramente, localizar possíveis diretrizes psicanalíticas para suspender os impasses clínicos que surgem diante do sujeito, uma vez que este está à mercê e atravessado pela linguagem. Por fim, com alicerce dos fundamentos psicanalíticos, constata-se que as ideias de Freud e Lacan ainda permitem importantes articulações entre a teoria do inconsciente e o fazer clínico

Este artículo investiga las manifestaciones del malestar y las facetas de la enfermedad psicológica de los sujetos en el escenario actual. En el mundo contemporáneo, el proceso cultural ressalta el desafío de abordar formas de subjetivación ante la ineludible relación entre sujeto y discurso civilizador. Así, este estudio tiene como objetivo, en primer lugar, ubicar posibles pautas psicoanalíticas para suspender los impasses clínicos que se presentan ante el sujeto, ya que está a merced y atravesado por el lenguaje. Finalmente, partiendo de los fundamentos psicoanalíticos, parece que las ideas de Freud y Lacan aún permiten importantes articulaciones entre la teoría del inconsciente y la práctica clínica

This article investigates the manifestations of malaise and the facets of the subjects' psychological illness in the current scenario. In the contemporary world, the cultural process highlights the challenge of addressing forms of subjectivation in view of the inescapable relationship between subject and civilizing discourse. Thus, this study aims, first, to locate possible psychoanalytic guidelines to suspend the clinical impasses that arise before the subject, since he is at the mercy and crossed by language. Finally, based on the psychoanalytical foundations, it appears that the ideas of Freud and Lacan still allow important articulations between the theory of the unconscious and the clinical practice

Cet article explore les manifestations du malaise et les facettes de la maladie psychologique des sujets dans le scénario actuel. Dans le monde contemporain, le processus culturel met en évidence le défi de traiter les formes de subjectivation au regard de la relation incontournable entre sujet et discours civilisateur. Ainsi, cette étude vise, dans un premier temps, à repérer d'éventuelles lignes directrices psychanalytiques pour suspendre les impasses cliniques qui surgissent devant le sujet, puisqu'il est à la merci et traversé par le langage. Enfin, à partir des fondements psychanalytiques, il apparaît que les idées de Freud et de Lacan permettent encoredes articulations importantes entre la théorie de l'inconscient et la pratique clinique

Accuracy of the mid-trimester ultrasound scan in the detection of fetal congenital anomalies in a reference center in Northeastern Brazil.

OBJECTIVE: To assess the performance of a basic mid-trimester fetal ultrasound scan protocol for the diagnosis of congenital anomalies by calculating its accuracy, sensitivity, and specificity. METHODS: This longitudinal cohort study involved singleton pregnant women recruited at the mid-trimester fetal ultrasound scan through the postnatal evaluation of congenital anomalies. Pregnant women who underwent a routine mid-trimester ultrasound scan for fetal abnormalities at 20-24 weeks of gestation were enrolled in this study. After childbirth, we searched their medical records on gestational outcomes and neonatal examination records, as well as complementary medical examinations, to assess the ultrasound performance in diagnosing congenital malformations. RESULTS: We included 967 pregnant women in the study population, and prenatal ultrasound scans detected congenital abnormalities in 67 fetuses (6.9%). Among newborns, 54 (5.6%) were postnatally diagnosed with malformations. The overall sensitivity and specificity of the mid-trimester ultrasound scan for congenital malformation detection were 61.1% and 96.3%, respectively, with an accuracy of 94.3% (p < .05). CONCLUSION: The mid-trimester ultrasound scan had good accuracy in the detection of congenital malformations, although the overall sensitivity does not support it as the only screening test for anomalies throughout pregnancy.

Harmonização do sorriso por meio de cirurgia periodontal e restaurações diretas em resina composta: relato de caso / Smile harmonization by means of periodontal surgery and direct restoration in composite resin: case report

Procedimentos estéticos odontológicos estão cada vez mais integrados com outras áreas, trabalhando em prol da otimização de resultados psicossociais e funcionais, e aumentando as possibilidades inclusas no plano de tratamento. A estética apresenta grande relevância na odontologia moderna, a demanda por sorrisos brancos e harmoniosos aumenta proporcionalmente às novas técnicas existentes. O presente trabalho objetiva relatar um caso de reabilitação estética a partir do planejamento digital do sorriso que dará informações benéficas para avaliar as diversas possibilidades frente ao segmento restaurador e periodontal cirúrgico. Paciente R. C. C., 22 anos, sexo masculino, compareceu a clínica integrada com queixa estética nos dentes anteriores. A partir do exame clínico inicial, foram solicitados exames de rotina concomitantemente à moldagem para modelo de estudo. Após o estudo de caso, esclarecimento do planejamento ao paciente e frente as expectativas estéticas, foi solicitado o exame de Planejamento Digital do Sorriso (Digital Smile Design ­ DSD). Foi realizada a cirurgia de gengivoplastia e osteoplastia dos pré- -molares nos dentes 12, 14, 15, 24 e 25, fundamentada nos parâmetros fornecidos pelo exame digital e restaurações diretas em resina composta após o período de cicatrização adequado. Cada vez mais, é exigido do cirurgião-dentista, uma visão ampla que permita explorar as diversas perspectivas vigentes atendendo aos interesses e necessidades do paciente. Conclui-se, independentemente da área da atuação, a realização e otimização de resultados caminha lado a lado com a multidisciplinariedade que, a cada dia que se passa, ganha importância na formação acadêmica profissional.

Aesthetic dental procedures are increasingly integrated with other areas, working towards the optimization of psychosocial and functional outcomes, and increasing the possibilities included in the treatment plan. Aesthetics has great relevance in modern dentistry, the demand for harmonious white smiles increases in proportion to new techniques. The present abstract aims to report a case of aesthetic rehabilitation from the digital smile planning that will give beneficial information to evaluate the various possibilities before the restorative segment and surgical periodontal. Patient R. C. C., 22 years old, male, attended the integrated clinic with aesthetic complaint in the anterior teeth. From the initial clinical examination, routine exams were requested concomitantly with the modeling of the study model. After the case study, clarification of patient planning and aesthetic expectations, the Digital Smile Design (DSD) exam was requested. Gingival surgery was performed on teeth allied to osteoplasty of the premolars 12, 14, 15, 24 and 25, based on the parameters provided by the digital examination and direct restorations in composite resin after the appropriate healing period. Increasingly, the dental surgeon is required to have a broad vision that allows exploring the diverse perspectives that are in place, taking into account the interests and needs of the patient. We can conclude that, regardless of the area of performance, the realization and optimization of results goes hand in hand with the multidisciplinarity that, every day that passes, gains importance in the professional academic formation.

Tratamento conservador de ameloblastoma sólido recidivante em paciente jovem: relato de caso / Conservative treatment for recurrent solid ameloblastoma in young patient: case report

Introdução: O ameloblastoma é um tumor odontogênico benigno, embora seja localmente agressivo. As modalidades de tratamento para o ameloblastoma podem ser classificadas em radicais ou conservadoras, contudo a determinação da técnica de eleição permanece um tema controverso. Este trabalho tem como objetivo relatar e discutir um caso de ameloblastoma recorrente, tratado de forma conservadora, com enucleação e curetagem em um indivíduo adolescente. Relato do Caso: Paciente, sexo masculino, de 12 anos, foi encaminhado ao serviço de CTBMF do Hospital Universitário Oswaldo Cruz com aumento de volume assintomático em região de parassínfise mandibular direita. Foi realizada biópsia incisional e obtido o diagnóstico de ameloblastoma. Após dois anos de descompressão, foi realizada enucleação com curetagem da lesão. Cinco anos após a intervenção, o paciente apresentou recidiva do tumor, sendo realizada nova abordagem conservadora. Em acompanhamento de sete meses, ele evoluiu assintomático e sem sinais de recidiva. Considerações Finais: A abordagem conservadora é uma alternativa viável no tratamento de ameloblastomas, em especial quando se trata de indivíduos jovens, entretanto esta deve ser seguida de um rigoroso protocolo de acompanhamento clínico e radiográfico pós-operatório... (AU)

Introduction: The ameloblastoma is a benign but localy agressive odontogenic tumour. The modalities of treatment for ameloblastoma can be classified as radical or conservative, although the determination of the preferred technique remains a controversial field. The objective of this study is to report and discuss a case of recurrent ameloblastoma treated with a conservative approach with enucleation and curettage in a young patient. Case Report: 12-years old man, referred to the service of oral and maxillofacial surgery of Oswaldo Cruz University Hospital with an asymptomatic swelling in the right mandibular parasymphysis. Incisional biopsy was performed and the diagnosis of ameloblastoma was obtained. After two years of decompression, enucleation and curettage of the lesion were performed. Five years after the intervention, the patient presented with recurrence of the tumour and a new conservative approach was performed. In a seven month follow-up, the patient presents asymptomatic and without signs of recurrence. Final Considerations: The conservative approach is a viable option in the treatment of ameloblastomas, especially in young individuals. However, it should be followed by a strict protocol of clinical and radiographic postoperative follow-up... (AU)

Wodyetia bifurcata biochar for methylene blue removal from aqueous matrix.

The endocarp of Wodyetia bifurcata was used to produce biochar by vacuum pyrolysis as an alternative adsorbent for methylene blue (MB) removal. The influence of different pyrolysis temperatures, particle diameters and activation agents in the adsorption process was studied. Kinetics and adsorption equilibrium were also evaluated. Biochar obtained at higher pyrolysis temperatures and activated with H3PO4 showed the best adsorptive capacities, achieving 83% of MB removal. The experimental data fitted better with pseudo-second order model. Isotherms performed at 25, 40, 50 and 60 °C showed that the adsorption of MB onto the activated biochar had no concentration dependence in the range studied. Experimental isotherms fitted well with the Freundlich and Sips models and the thermodynamic parameters suggested a physical adsorption mechanism in a heterogeneous surface, spontaneous at all temperatures evaluated. In brief, the activated carbon obtained from Wodyetia bifurcata can be a promising material for MB removal from aqueous solutions.

Syagrus oleracea-activated carbon prepared by vacuum pyrolysis for methylene blue adsorption.

This work aims to produce activated carbon from the endocarp of Syagrus oleracea by vacuum pyrolysis and evaluate its potential as an adsorbent. The effects of pyrolysis temperature (400 °C, 500 °C, 600 °C, and 700 °C), particle diameter (0.467 mm, 0.267 mm, and lower than 0.234 mm), and activation agent (H2SO4, H2PO3, and KOH) on the potential for methylene blue adsorption were investigated. In addition, kinetics and adsorption equilibrium were evaluated. The best condition found was particle diameter < 0.234 mm, final pyrolysis temperature of 700 °C, and using KOH. Adsorption kinetics followed pseudo-second order, with equilibrium reached within 20 min. Isotherms followed the Freundlich model. Values of adsorption capacity were in the order of 30 mg/g. Thermodynamic parameters indicated that adsorption occurred spontaneously with a reduction in the heterogeneity of the solid interface/solution. The results obtained demonstrate the great adsorption capacity of the activated carbon prepared from endocarp of Syagrus oleracea via vacuum pyrolysis for the removal of up to 98% methylene blue from aqueous solutions.

Shift work and sex are variants across Karolinska Sleep Questionnaire and the application of linking analysis as a step forward using Item Response Theory.

The frequency of sleep disturbances is considerably higher in the night and shift workers and in females than in day workers and males, respectively. However, a subjective sleep scale must be invariant across these groups, independently of the level of their members on the scale. This study is aimed to test the invariance of the Karolinska Sleep Questionnaire's (KSQ) items by shift work and sex. We used the data from a census that covered more than 90% (N = 1648) of the nurses from the main institute of the largest public hospital complex of Brazil. Firstly, we intend to find the KSQ's dimensionality using factorial analysis and Item Response Theory (IRT) performed by Graded Response Model. Differential Item Functioning (DIF) was the technique used to test the invariance of each KSQ's dimensions. In case of variance detection, we applied the linking analysis. Intending to test the KSQ's consistency with external variables, we assessed correlations between KSQ's dimensions with health variables, i.e., self-reported health status and musculoskeletal pain. We have found one scale and two subscales from one general and another bidimensional factor structure of the KSQ, respectively. In these dimensions, the KSQ's items fitted well to the IRT and we have identified DIF by shift work. However, we have found DIF by sex just in one item on the general factor. Linking analysis showed as a possible step forward in the variance issue placing on to the same scale the shift work groups in the items with DIF. All correlations between KSQ's dimensions with health variables were significant. Our findings allow us to argue that KQS's items were variant by shift work and sex in a nursing staff census from the largest public hospital complex of Brazil, but we can go on using linking analysis. This could be used as an evidence for the construct validity should go beyond the traditional dimensionality assessment. The dimensionalities of KSQ fit well for other population but individuals living in Scandinavian countries.

Methylphenidate improves the quality of life of children and adolescents with ADHD and difficult-to-treat epilepsies.

OBJECTIVE: Comorbidity between difficult-to-treat epilepsies and ADHD is frequent and impacts negatively on quality of life. The commonly held (yet poorly substantiated) view that stimulants may worsen seizure control has prevented studies from evaluating the impact of such treatment in this population. Our aim was to study the effect of methylphenidate on the quality of life of children and adolescents with difficult-to-treat epilepsies and comorbid ADHD. METHODS: The study was an open-label, noncontrolled trial with intention-to-treat analysis following 30 patients for 6months. Subjects received methylphenidate following 3months of baseline, during which antiepileptic drugs (AEDs) were adjusted and epilepsy, ADHD, and quality-of-life variables were assessed. Multivariate regression analysis identified the main variables correlated with outcome. RESULTS: Only one patient withdrew because of seizure worsening. Following methylphenidate introduction, doses were titrated up to 0.40-0.50mg/kg/day. A marked improvement in quality-of-life scores and a significant reduction in seizure frequency and severity were observed. Female sex, reduction of core ADHD symptoms, and tolerability to adequate doses of methylphenidate were significantly associated with improved quality-of-life scores. CONCLUSION: These preliminary data suggest that methylphenidate treatment is safe and effective in patients with ADHD and difficult-to-treat epilepsies, positively impacting on quality-of-life scores.

Acidentes com material biológico e sua relação com os fatores de dentro e de fora do trabalho: estudo multinível com trabalhadores da enfermagem de um hospital publico / Accidents to biological fluid and its relationship with factors' from inside and outside work multilevel study with nursing staff of a public hospital

Os acidentes de trabalho com exposição ao material biológico (ATMB) entre os profissionais da enfermagem são recorrentes e os seus potenciais agravos os tornam um caso de Saúde Pública mundial. O paradigma hegemônico de análise de acidente de trabalho, conhecido como modelo tradicional, considera apenas os elementos visíveis e pontuais presentes no momento do acidente. Já o modelo sistêmico, além destes elementos, elenca os de natureza distal ou latente ao evento como possíveis fatores causais do acidente. O Modelo de Análise e Prevenção de Acidentes do Trabalho (MAPA) é um instrumento desenvolvido a partir do paradigma sistêmico de causalidade de acidentes e de conceitos da Ergonomia da Atividade. O objetivo deste estudo epidemiológico transversal foi identificar a contribuição dos fatores no nível do trabalhador (individual), variáveis de dentro e de fora do trabalho, e no nível do setor de trabalho, relevantes pelo MAPA para a ocorrência dos acidentes de trabalho com exposição aos ATMB, nos profissionais da enfermagem do Instituto Central do Hospital das Clínicas (ICHC) da Faculdade de Medicina da USP. Os desfechos foram o ATMB por perfurocortante e por contato com fluído do paciente. Um censo que obteve cobertura de aproximadamente 92% (N=1648) foi realizado entre fevereiro e setembro de 2013. Houve a aplicação de seis análises de regressão logística multinível multivariada porque para cada desfecho foi feita uma análise que considerou todos os trabalhadores entrevistados e outras duas, uma para cada turno de trabalho.

Work accidents from exposure to biological material (ATMB) among nursing professionals are recurrent and their potential health problems make them a public health issue worldwide. The hegemonic paradigm accident analysis work, known as the traditional model, considers only the visible and specific elements present when the accident occurred. The systemic model, however, also lists the distal or latent nature to the event as possible causes of the accident. The Model of Analysis and Accident Prevention (MAPA) is an instrument developed from the systemic paradigm of causality of accidents and concepts of ergonomics of activity. The aim of this cross-sectional epidemiological study was to identify the contribution of factors at worker level (individual), variables from inside and outside work, and in the labor sector. These are stated in MAPA for the occurrence of occupational accidents involving exposure to ATMB in nursing professionals of the Instituto Central do Hospital das Clínicas (ICHC), USPs Faculdade de Medicina. The outcome was the ATMB for sharp injuries or by contact with patient fluid. A census was performed between February and September 2013 with a response rate of approximately 92 per cent (N = 1648). Six analyses were conducted using multivariate multilevel logistic regression because, for each outcome, an analysis was performed that considered all the interviewed workers. A further two analyses were realized for each shift. For each analysis, model-building was performed introducing the worker level variables in the model.

The impact of methylphenidate on seizure frequency and severity in children with attention-deficit-hyperactivity disorder and difficult-to-treat epilepsies.

AIM: Difficult-to-treat epilepsies and attention-deficit-hyperactivity disorder (ADHD) often co-occur. Because of concerns about the use of stimulants in children with this comorbidity, the impact of ADHD treatment on seizure frequency and severity is not known. This pilot study evaluated the safety and efficacy of methylphenidate in this population. METHOD: After a 3 month period in which antiepileptic drugs were adjusted, 22 patients recruited from a specialist outpatient clinic for severe epilepsy (16 males, six females; mean age 11 y 2 mo, SD 3 y 2 mo) received methylphenidate for 3 months in an open label, non-controlled trial; four with generalized or multifocal (symptomatic/cryptogenic) epilepsy, one with generalized (idiopathic) epilepsy, 17 with partial (symptomatic/cryptogenic) epilepsy; five with partial seizures only, 17 with primarily or secondarily generalized seizures). Epilepsy, ADHD symptoms, and side effects were assessed using the Swanson, Nolan, and Pelham Questionnaire, the Child Behavior Checklist, the Hague Seizure Severity Scale, and the Side Effects Rating Scale. RESULTS: Methylphenidate significantly improved ADHD. After 3 months of treatment, 73% of patients no longer had clinically significant symptoms. Methylphenidate also reduced seizure severity (9-point median decrease on the Hague Seizure Severity Scale). Seizure frequency increased in four out of 22 patients, but only one patient withdrew from the study for this reason. Most patients experienced no major side effects. INTERPRETATION: These data are among the first showing that low doses of methylphenidate are safe and effective to treat ADHD symptoms in patients with difficult-to-treat epilepsies. Randomized controlled trials are needed to replicate the findings.

Evaluation of the quality of life of patients with chronic rhinosinusitis by means of the SNOT-22 questionnaire.

UNLABELLED: SNOT-22 is a questionnaire used to assess the quality of life of patients with chronic rhinosinusitis (CRS). It is broadly utilized to assess the surgical treatment of patients with CRS. In Brazil there are no studies utilizing the SNOT-22 in non-surgical patients. OBJECTIVE: To use the SNOT-22 questionnaire to assess the quality of life of individuals with chronic rhinosinusitis without previous surgery and with indication for clinical treatment. METHOD: Prospective and analytical cohort and cross-sectional controlled clinical trial. We had 2 groups, one made up of patients with CRS and another one with adult individuals without the sinonasal disease, consecutively seen in an otorhinolaryngology clinic in Salvador, Bahia, between August of 2011 and June of 2012. They all filled out the Consent Form, a registration form and the SNOT-22. RESULTS: 176 patients, 78 with CRS and 98 without the disease, the groups matched as far as gender, medication and respiratory allergies were concerned. Age was 40.7 + 13.5 years in the study group and 37.8 + 12.9 in controls (p = 0.26). The SNOT-22 median value in the study group was 53, compared to 8 in the control group (p = 0.001). CONCLUSION: Chronic rhinosinusitis reduces the quality of life of patients, according to the SNOT-22 questionnaire.

Avaliação da qualidade de vida de pacientes com rinossinusite crônica por meio de questionário SNOT-22 / Evaluation of the quality of life of patients with chronic rhinosinusitis by means of the SNOT-22 questionnaire

O SNOT-22 é um questionário para avaliação da qualidade de vida dos pacientes com rinossinusite crônica (RSC). Ele é largamente utilizado para avaliação do tratamento cirúrgico na RSC. No Brasil, não existem estudos utilizando o SNOT-22 em pacientes não cirúrgicos. OBJETIVO: Avaliar por meio do questionário SNOT-22 a qualidade de indivíduos com rinossinusite crônica sem cirurgia prévia e com indicação de tratamento clínico. MÉTODO: Estudo clínico prospectivo e analítico, tipo corte transversal com controle. Foram dois grupos, sendo um constituído de pacientes com RSC e outro por indivíduos sem doença nasossinusal, adultos, atendidos consecutivamente num serviço de otorrinolaringologia em Salvador, Bahia, de agosto de 2011 a junho de 2012. Todos preencheram o termo de consentimento, um cadastro e o SNOT-22. RESULTADOS: Cento e setenta e seis pacientes, sendo 78 com RSC, e 98 sem a doença. Os grupos foram homogêneos quanto ao gênero, alergias medicamentosas e respiratórias. A idade foi de 40,7 + 13,5 anos no grupo caso e 37,8 + 12,9 no controle (p = 0,26). A mediana do SNOT-22 no grupo caso foi 53 contra 8 do controle (p = 0,001). CONCLUSÃO: A rinossinusite crônica reduz a qualidade de vida do paciente de acordo com o questionário SNOT-22.

SNOT-22 is a questionnaire used to assess the quality of life of patients with chronic rhinosinusitis (CRS). It is broadly utilized to assess the surgical treatment of patients with CRS. In Brazil there are no studies utilizing the SNOT-22 in non-surgical patients. OBJECTIVE: To use the SNOT-22 questionnaire to assess the quality of life of individuals with chronic rhinosinusitis without previous surgery and with indication for clinical treatment. METHOD: Prospective and analytical cohort and cross-sectional controlled clinical trial. We had 2 groups, one made up of patients with CRS and another one with adult individuals without the sinonasal disease, consecutively seen in an otorhinolaryngology clinic in Salvador, Bahia, between August of 2011 and June of 2012. They all filled out the Consent Form, a registration form and the SNOT-22. RESULTS: 176 patients, 78 with CRS and 98 without the disease, the groups matched as far as gender, medication and respiratory allergies were concerned. Age was 40.7 + 13.5 years in the study group and 37.8 + 12.9 in controls (p = 0.26). The SNOT-22 median value in the study group was 53, compared to 8 in the control group (p = 0.001). CONCLUSION: Chronic rhinosinusitis reduces the quality of life of patients, according to the SNOT-22 questionnaire.

Hydrogen sulfide inhibits oxidative stress in lungs from allergic mice in vivo.

Recent studies show that endogenous hydrogen sulfide (H(2)S) plays an anti-inflammatory role in the pathogenesis of airway inflammation. This study investigated whether exogenous H(2)S may counteract oxidative stress-mediated lung damage in allergic mice. Female BALB/c mice previously sensitized with ovalbumin (OVA) were treated with sodium hydrosulfide (NaHS) 30 min before OVA challenge. Forty eight hours after antigen-challenge, the mice were killed and leukocyte counting as well as nitrite plus nitrate concentrations were determined in the bronchoalveolar lavage fluid, and lung tissue was analysed for nitric oxide synthase (NOS) activity, iNOS expression, superoxide dismutase (SOD), catalase, glutathione reductase (GR) and glutathione peroxidase (GPx) activities, thiobarbituric acid reactive species and 3-nitrotyrosine containing proteins (3-NT). Pre-treatment of OVA-sensitized mice with NaHS resulted in significant reduction of both eosinophil and neutrophil migration to the lungs, and prevented the elevation of iNOS expression and activity observed in the lungs from the untreated allergic mice, although it did not affect 3-NT. NaHS treatment also abolished the increased lipid peroxidation present in the allergic mouse lungs and increased SOD, GPx and GR enzyme activities. These results show, for the first time, that the beneficial in vivo effects of the H(2)S-donor NaHS on allergic airway inflammation involve its inhibitory action on leukocyte recruitment and the prevention of lung damage by increasing endogenous antioxidant defenses. Thus, exogenous administration of H(2)S donors may be beneficial in reducing the deleterius impact of allergic pulmonary disease, and might represent an additional class of pharmacological agents for treatment of chronic pulmonary diseases.

Efeitos da prática da ioga no controle postural e bem estar de trabalhadores / Effects of Yoga practice on postural control and well-being fo workers

A busca pela qualidade de vida dos trabalhadores é um aspecto de reconhecida importância entre gestores e profissionais da área da Saúde do Trabalhador e a prática da Ioga pode contribuir nesse contexto. Os objetivos do presente estudo são investigar os efeitos de um programa de intervenção em Ioga sobre o controle postural e o bem-estar de trabalhadores saudáveis. Uma revisão bibliográfica narrativa foi realizada na primeira parte deste estudo e revelou os diversos efeitos da prática da Hatha Yoga na saúde física e mental. Em seguida, foi realizado um estudo experimental, no qual vinte e quatro voluntários de uma empresa da cidade compuseram um grupo experimental e um grupo controle. O grupo experimental participou de 16 aulas de Ioga (com duração de 60 minutos) em seu local de trabalho. Foram utilizados o questionário de Distúrbios Musculoesqueléticos Nórdico e do Bem-estar e Trabalho (UWES-17). Os efeitos da prática da Ioga sobre o controle postural foram mensurados por uma plataforma de força e o centro de pressão foi a variável estudada.Os resultados evidenciaram que apenas o grupo experimental apresentou diminuição significativa nas queixas musculoesqueléticas e melhores graus de bem-estar e satisfação com o trabalho após o período da intervenção. No controle postural, apenas o grupo experimental apresentou áreas de oscilação e velocidades médias do centro de pressão significativamente menores após a intervenção. Portanto, conclui-se que a prática da Ioga proporcionou melhoria nas queixas musculoesqueléticas, no bem-estar no ambiente de trabalho, bem como na integração sensorial no grupo estudado.(AU)

Workers quality of life is a very important aspect to be considered by both health professionals and executives and the Yoga practice can contribute in this context. Therefore the aim of this study is to identify the effects of a Yoga intervention program onpostural control and well-being of healthy workers.The effects of Yoga on different physical and mental health conditions werereviewed in the first part of thisstudy. Then an experimental study was conducted with twenty-four healthy workers from the same company as volunteers. Two groups were distinguished, one as experimental group, which engaged in a program of 16 Yoga classes (each class with 60 minutes of duration) at the company twice a week, and the other as control group.The effects of Yoga practice were evaluated through the Nordic Musculoskeletal Questionnaire and Work & Well-Being Survey Questionnaire (UWES 17) . The degree of postural stability was evaluated by a force plate and the center of pressure was the studied variable. After the intervention only the experimental group showed significantly improvements in musculoskeletal conditions and working engagement. Additionally significantly lower oscillation areas and center of pressure mean velocities were observed only for the experimental group. We conclude that the Yoga practice has improved musculoskeletal complaints and wellness in the workplace, as well as the sensory integration of the healthy workers.(AU)