Aspectos clinicoepidemiológicos de adultos con guía anterior de la oclusión dentaria disfuncional

Introducción: Los dientes anteriores tienen una función predominante en el sistema estomatognático, esencial para la estética, la fonación y la masticación. Objetivo: Caracterizar a los adultos con guía anterior de la oclusión dentaria disfuncional según variables clínicas y epidemiológicas. Métodos: Se realizó un estudio descriptivo y transversal, desde octubre de 2021 hasta abril de 2022, en la Clínica Estomatológica Docente 3 de Octubre de Las Tunas. El universo estuvo conformado por 825 historias clínicas que contenían el diagnóstico de pacientes con bruxismo, oclusión traumática y trastornos temporomandibulares, quienes presentaban disfunción de la guía anterior de la oclusión dentaria. Mediante el muestreo no probabilístico intencional, fue seleccionada una muestra de 615 con fórmula dentaria íntegra o desdentamiento parcial de clase III de Kennedy y atención estomatológica concluida o inactivación de los procesos de caries e inflamatorios agudos. Resultados: Primaron el sexo femenino (54,8 %) y las edades de 40-49 años (33,5 %). El bruxismo prevaleció como diagnóstico clínico (41,9 %) con predominio del correspondiente al sueño (39,1 %), el secundario (51,2 %), el probable (59,7 %) y el moderado (69,4 %); entre sus clasificaciones más relevantes se destacó el sistema estomatognático disfuncional (84,4 %). Las manifestaciones clínicas dentarias predominantes fueron las facetas de desgaste (87,5 %). Conclusiones: La caracterización de los pacientes con guía anterior de la oclusión dentaria disfuncional permite establecer una panorámica actualizada de esta problemática de salud para un mejor seguimiento y tratamiento a dichos pacientes.

Introduction: Anterior teeth have a predominant function in the stomatognatic system, essential for the aesthetics, phonation and mastication. Objective: To characterize adults with anterior guide of dysfunctional dental occlusion according to clinical and epidemiological variables. Methods: A descriptive and cross-sectional study, was carried out from October, 2021 to April, 2022, in the 3 de Octubre Teaching Stomatological Clinic from Las Tunas. The universe was formed by 825 medical records that contained the diagnosis of patients with bruxism, traumatic occlusion and temporomandibular disorders who presented anterior guide of the dysfunctional dental occlusion. By means of the intentional non probabilistic sampling, a sample of 615 with entire dental formula or class III partial toothlessness of Kennedy and concluded stomatologic care or inactivation of the cavity and acute inflammatory processes was selected. Results: There was a prevalence of the female sex (54.8%) and the 40-49 age group (33.5%). Bruxism prevailed as clinical diagnosis (41.9%) with prevalence of the corresponding to sleep (39.1%), secondary (51.2%), probable (59.7%) and moderate (69.4%); among the most outstanding classifications was the dysfunctional stomatognatic system (84.4%). The predominant dental clinical manifestations were the wear facets (87.5%). Conclusions: The characterization of patients with anterior guide of the dysfunctional dental occlusion allows to establish an up-to-date panoramic of this health problem, for a better follow-up and treatment to these patients.

The dysfunctional adiposity index is a clinical surrogate of pericardial fat in adults without premature CVD: A sub-analysis of the GEA Mexican study control group.

BACKGROUND AND AIM: The Dysfunctional Adiposity Index (DAI) is a clinical surrogate for evaluating adipose tissue functionality and cardiometabolic health. However, its association with Pericardial Fat Volume (PFV) has not been tested. The aim of this study was to evaluate DAI- PFV association, stratified by type 2 diabetes (T2D) status, and identify DAI thresholds for detecting increased PFV among patients without premature CVD. METHODS AND RESULTS: Participants from the GEA-Mexican study underwent a computed tomography scan to measure PFV. Adjusted logistic regression analyses tested the association between DAI and PFV. AUROC curves evaluated DAI's ability to identify elevated PFV (≥57.57 cm³), and the Youden method determined DAI thresholds, along with diagnostic metrics. The study analyzed 997 participants (women: 55%; mean age: 54 ± 9 years; median PFV: 42 cm³ [IQR: 29-58]), with a 13% prevalence of T2D. DAI was positively associated with elevated PFV (OR: 1.33, 95% CI: 1.07-1.70), which was more pronounced among subjects with T2D (OR: 3.01, 95% CI: 1.41-6.40). DAI thresholds were established for all participants (>1.176), individuals without T2D (>1.003), and with T2D (>1.936), yielding sensitivities of 71%, 81%, and 57%, and specificities of 48%, 38%, and 75%, respectively. The adjusted logistic regression tied DAI thresholds to a 1.68-fold elevation in PFV for all, 2.06-fold for those without T2D, and 6.81-fold for those with T2D. CONCLUSION: DAI was positively associated with increased PFV, particularly among participants with T2D. Established DAI thresholds demonstrated good diagnostic values for detecting increased PFV. DAI could serve as an accessible marker to identify PF in clinical settings.

Distorted thoughts as a mediator of depressive symptoms in patients with major depressive disorder: a longitudinal study.

BACKGROUND: Distorted thoughts are common in Major Depressive Disorder (MDD), and can impact patients' perceptions of depression severity, and predict chronicity and treatment response. This study aimed to investigate whether distorted thoughts mediate depressive symptoms in MDD over a 6-month period. METHOD: These are secondary results from a study that followed 119 patients diagnosed with moderate to severe MDD for 6 months. Diagnoses were confirmed by the Structured Interview for DSM-IV (SCID-CV). The analysis was composed of results from the Hamilton Depression Rating Scale (HAMD-17), the Montgomery-Asberg Depression Rating Scale (MADRS), the second edition of the Beck Depression Inventory (BDI-II), and the Depression Thoughts Scale (DTS) collected at weeks 1, 8, 12 and 24. RESULTS: Results showed that the DTS mediated the relationship between depressive symptoms experienced approximately 3 months after starting antidepressant treatment. CONCLUSION: Cognitive distortions were linked as a mediator to depressive symptoms, highlighting the importance of early psychological interventions in patients with MDD who exhibit these distortions. TRIAL REGISTRATION: NCT02268487.

Food Insecurity Is Associated With Dysfunctional Eating Behaviors Among Adults in Puerto Rico.

OBJECTIVE: To examine the association between food insecurity and dysfunctional eating behaviors among adults in Puerto Rico. METHODS: Data from 865 participants were obtained from baseline interviews from the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) cohort. The association between food insecurity and emotional eating (EE) and uncontrolled eating (UE) (categorized as no/moderate/high) was examined using multinomial logistic models. Potential mediation by perceived stress was explored. RESULTS: The prevalence of food insecurity was 20.3%. Compared with adults with food security, adults with food insecurity had higher odds of both moderate EE (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.18-3.09) and high EE (OR, 2.85; 95% CI, 1.75-4.64), and both moderate UE (OR, 1.78; 95% CI, 0.91-3.50) and high UE (OR, 3.28; 95% CI, 1.70-6.33). Perceived stress slightly attenuated these associations. CONCLUSIONS AND IMPLICATIONS: Food insecurity was associated with a higher likelihood of engaging in dysfunctional eating behaviors. Interventions alleviating food insecurity or stress might help adults sustain healthy eating behaviors.

Cardiopulmonary exercise testing to indicate increased ventilatory variability in subjects with dysfunctional breathing.

BACKGROUND: Dysfunctional breathing (DB) is a common, but largely underappreciated, cause of chronic dyspnoea. Under visual inspection, most subjects with DB present with larger sequential changes in ventilation (V̇E) and breathing pattern (tidal volume (VT) and breathing frequency (f)) before and/or during incremental cardiopulmonary exercise testing (CPET). Currently, however, there are no objective criteria to indicate increased ventilatory variability in these subjects. METHODS: Twenty chronically dyspnoeic subjects with DB and 10 age- and sex-matched controls performed CPET on a cycle ergometer. Cut-offs to indicate increased V̇E, VT, f, and f/VT ratio variability (Δ = highest-lowest 20 s arithmetic mean) over the last resting minute (rest ), the 2sd min of unloaded exercise (unload ), and the 3rd min of loaded exercise (load ) were established by ROC curve analyses. RESULTS: Subjects with DB presented with increased V̇E, higher ventilatory variability, higher dyspnoea burden, and lower exercise capacity compared to controls (p < 0.05). ΔV̇Eload (>4.1 L/min), Δfrest (>5 breaths/min; bpm), Δfunload (>4 bpm), Δfload (>5 bpm), Δf/VTrest (>4.9 bpm/L), and Δf/VTload (>1.3 bpm/L) differentiated DB from a normal pattern (areas under the curve ranging from 0.729 to 0.845). High Δf, in particular, was associated with DB across all CPET phases. CONCLUSIONS: This study provides objective criteria to indicate increased ventilatory variability during incremental CPET in dyspnoeic subjects with DB. Large variability in breathing frequency seems particularly useful in this context, a finding that should be prospectively confirmed in larger studies.

Effect of cognitive retraining treatment in mild to moderate depressive disorders

Background: Cognitive retraining or remediation approaches dispense high levels of stimulation and new learning tasks, leading to an increased neural connections, which facilitate rapid recovery in patients with neurological as well as psychiatric conditions. Objectives: The current study aimed to investigate the effect of cognitive retraining (CR) in depressive disorders. We assigned 40 patients with mild to moderate depression to two sample groups, with 20 participants each: CR alone and CR with medicine. A 6-week CR module was delivered, and participants' scores on measures such as the Beck Depression Inventory-II, Metacognition Questionnaire 30, World Health Organization Quality of Life- Brief, and Global Assessment of Functioning were compared. Results: Analysis using Stata/IC version 16 included descriptive statistics, paired and independent t-tests, analysis of covariance, and propensity score matching. Cohen's d was computed to determine the effect size. Within-group analysis revealed statistically significant differences in pre-post scores of the outcome measures (p < .05) and large effect size (d = 3.41; d = 3.60) in both groups. The difference in scores of outcome measures between the groups was not significant (p > .05) even when covariates were controlled, or nearest neighbor match analysis was carried out. CR is effective in alleviating symptoms and dysfunctional metacognitive beliefs in addition to enhancing functioning and quality of life. Conclusions: CR-based interventions may be essential mental health services owing to growing research in psychotherapy via virtual modes such as tele- and video-conferencing. These interventions can substantiate both prevention and remedy. (AU)

Valve in valve en posición tricuspídea: reconociendo opciones de manejo para la válvula «olvidada¼ / Valve in valve in tricuspid position: recognizing management options for the "forgotten" valve

Resumen Presentamos el caso de una paciente con bioprótesis tricuspídea disfuncionante a quien se le realizó un implante valve in valve con una prótesis transcatéter SAPIEN XT, demostrando que esta técnica es una alternativa terapéutica válida frente a la reintervención de la válvula tricúspide.

Abstract We present the case of a patient who was implanted with a transcatheter prosthesis on a dysfunctional bioprosthesis, demonstrating that it is a valid therapeutic alternative to reoperation in those patients with high surgical risk.

Ejercicio físico y terapia nutricional en el tratamiento de los trastornos de la conducta alimentaria. Revisión Sistemática / Physical exercise and nutritional therapy in the treatment of eating disorders

Los Trastornos de la Conducta Alimentaria (TCA) son una enfermedad mental grave, causante de morbilidad física y psicosocial. Esta enfermedad tiene una mayor prevalencia entre mujeres jóvenes, y en población deportista. La terapia cognitiva conductual (TCC) es el tratamiento actual más adecuado para este tipo de trastornos, no obstante, cada vez son más los programas que incluyen pautas de ejercicio físico (EF) y Terapia Nutricional (TN) para el tratamiento de los TCA. Objetivo. Realizar una revisión sistemática exploratoria de la literatura que permita conocer el estado actual de los programas de intervención a través del EF y la TN para el tratamiento de los TCA. Materiales y métodos. Se realizó una búsqueda y recopilación de documentos científicos mediante un modelo de acumulación de datos y selección de estudios, en la que se utilizaron las bases de datos informatizadas SCOPUS, Web of Science, y PubMed. En todas las bases de datos consultadas, se empleó la misma frase de búsqueda. Para acotar los resultados, se introdujeron una serie de criterios de inclusión y exclusión. Resultados. La revisión contó con cinco documentos relacionados con la temática de estudio, que cumplían los criterios de inclusión. Conclusión. Las intervenciones con EF y TN para el tratamiento de los TCA suponen una reducción en la severidad de la sintomatología de los pacientes. Estos programas se muestran como una herramienta terapéutica alternativa o complementariaa la terapia convencional. Se requieren más estudios que combinen programas de intervención de EF y TN dirigidos a pacientes con TCA(AU)

Eating Disorders (ED) are a severe mental illness that causes physical and psychosocial problems. This illness has a higher prevalence among young women, and between athletes. cognitive behavioural therapy (CBT) is the current treatment for this type of disorder. However, more and more programs are including physical exercise (PE) and nutritional therapy (TN) for eating disorders treatment. Objective. To carry out an exploratory systematic review of the literature that allows us to know the current state of intervention programs through physical exercise and nutritional therapy for the treatment of eating disorders. Materials and methods. For the reference search thesame search phrase was used. The terms were entered in English in the following computerized databases: SCOPUS, Web of Science, and PubMed. To limit the search, four inclusion criteria were introduced. Results. The review included five scientific articles related to the study topic, which met the inclusion criteria. Conclusion. Intervention programs for the treatment of eating disorders that include physical exercise and nutritional therapy are shown as an alternative or complementary tool to conventional therapy. These programs involve a reduction in the severity of ED symptoms and an improvement in anthropometric parameters and physical condition. More studies that combine PE and TN programs for people with ED are required(AU)

Esquemas disfuncionales tempranos y consumo de sustancias psicoactivas como riesgo a VIH/Sida en adolescentes en conflicto con la ley penal / Early dysfunctional schemes and consumption of psychoactive substances as a risk for HIV/AIDS in adolescents in conflict with the criminal law

Este estudio no experimental de tipo transversal y descriptivo tuvo como objetivo identificar los esquemas disfuncionales tempranos (EDT) en adolescentes infractores de los Centros Juveniles de Diagnóstico y Rehabilitación. Asimismo, se buscó analizar los EDT como factores predictores del consumo de sustancias psicoactivas (SPA) y el riesgo de VIH/Sida por comportamiento sexual. Se aplicaron: ficha de datos sociodemográficos, encuesta de Riesgo Sexual (Sexual Risk Scale - SRS) y cuestionario de esquemas de Young- versión reducida (Young Schema Questionare ­ Short Form: YSQ-SF) a 388 adolescentes infractores de ambos sexos (H=316 y M=72), escogidos con un muestreo no probabilística y de tipo intencional; los resultados indicaron asociación estadisticamentes significativa entre la variable "Riesgo de VIH/Sida por comportamiento sexual" y EDT: subyugación, privación emocional y autosacrificio, con mayor prevalencia en adolescentes infractores con comportamiento riesgoso. Sugieren que, los y las adolescentes infractores con los EDT de privación emocional, autocontrol insuficiente y subyugación tienen, más probabilidades de mostrar comportamientos de riesgo a VIH/Sida. Mientras que, no se encontró asociación estadísticamente significativa entre la variable "Consumo de SPA" y "Riesgo de VIH/Sida por comportamiento sexual" en los y las adolescentes infractores, lo cual evidencia que el consumo de SPA se encuentra presente y de manera equitativa en los grupos con riesgo bajo y alto de de VIH/Sida por comportamiento sexual. Se recomienda realizar abordaje psicológico, estrategias de intervención educativa en materia de educación sexual y despistaje con pruebas diagnóstica para VIH en los diferentes CJDR estudiados(AU)

This non-experimental, cross-sectional, descriptive study aimed to identify early dysfunctional schemes (EDT) in adolescent offenders at Juvenile Diagnosis and Rehabilitation Centers. Likewise, it was sought to analyze the EDT as predictive factors of the consumption of psychoactive substances (PAS) and the risk of HIV/AIDS due to sexual behavior. The following were applied: sociodemographic data sheet, Sexual Risk Scale - SRS survey and Young Schema Questionnaire - Short Form: YSQ-SF) to 388 adolescent offenders of both sexes (H= 316 and M=72), chosen with a non-probabilistic and intentional sampling; The results indicated a statistically significant association between the variable "Risk of HIV/AIDS due to sexual behavior" and EDT: subjugation, emotional deprivation and self-sacrifice, with a higher prevalence in adolescent offenders with risky behavior. They suggest that adolescent offenders with the EDTs of emotional deprivation, insufficient self-control and subjugation are more likely to show risk behaviors for HIV/AIDS. While, no statistically significant association was found between the variable "PA Consumption" and "Risk of HIV/AIDS due to sexual behavior" in the adolescent offenders, which shows that the consumption of SPA is present and in an equitable manner. in groups with low and high risk of HIV/AIDS due to sexual behavior. It is recommended to carry out a psychological approach, educational intervention strategies in terms of sexual education and despitaje with diagnostic tests for HIV in the different CJDR studied(AU)

Quantitative evaluation of family functions and changes in a postmodern context.

Society lives the transition between modernity and postmodernity. In this context, the family is considered as a fully dynamic system that changes over time. Therefore, family structures are in constant motion, and family functions also require changes. Sometimes the functions in the family change, but the structures do not, so conflicts within the family may appear. The objective of this research is to show how families evaluate their role in the postmodern context. Hence, the evaluation was carried out in 37 families through the APGAR test, a questionnaire that explores five areas of family function. Statistical analysis and data processing were performed with free software tools and the experiments may be reproduced as the data and code are hosted in open repositories. The results show that the perception of dysfunction at the individual level does not differ from the family perception. The families typically deny the conflict and the implicit changes in the family's functions because they do not know how to handle these changes. Likewise, the study shows that the changes in the family, attributed by several authors to the transition related to the postmodern paradigm, outline a growing trend towards the perception of the dysfunctionality of the family system over time.

Dysfunctional mitochondria as critical players in the inflammation of autoimmune diseases: Potential role in Sjögren's syndrome.

Relevant reviews highlight the association between dysfunctional mitochondria and inflammation, but few studies address the contribution of mitochondria and mitochondria-endoplasmic reticulum (ER) contact sites (MERCs) to cellular homeostasis and inflammatory signaling. The present review outlines the important role of mitochondria in cellular homeostasis and how dysfunctional mitochondrion can release and misplace mitochondrial components (cardiolipin, mitochondrial DNA (mtDNA), and mitochondrial formylated peptides) through multiple mechanisms. These components can act as damage-associated molecular patterns (DAMPs) and induce an inflammatory response via pattern recognition receptors (PRRs). Accumulation of damaged ROS-generating mitochondria, accompanied by the release of mitochondrial DAMPs, can activate PRRs such as the NLRP3 inflammasome, TLR9, cGAS/STING, and ZBP1. This process would explain the chronic inflammation that is observed in autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), type I diabetes (T1D), and Sjögren's syndrome. This review also provides a comprehensive overview of the importance of MERCs to mitochondrial function and morphology, cellular homeostasis, and the inflammatory response. MERCs play an important role in calcium homeostasis by mediating the transfer of calcium from the ER to the mitochondria and thereby facilitating the production of ATP. They also contribute to the synthesis and transfer of phospholipids, protein folding in the ER, mitochondrial fission, mitochondrial fusion, initiation of autophagosome formation, regulation of cell death/survival signaling, and regulation of immune responses. Therefore, alterations within MERCs could increase inflammatory signaling, modulate ER stress responses, cell homeostasis, and ultimately, the cell fate. This study shows severe ultrastructural alterations of mitochondria in salivary gland cells from Sjögren's syndrome patients for the first time, which could trigger alterations in cellular bioenergetics. This finding could explain symptoms such as fatigue and malfunction of the salivary glands in Sjögren's syndrome patients, which would contribute to the chronic inflammatory pathology of the disease. However, this is only a first step in solving this complex puzzle, and several other important factors such as changes in mitochondrial morphology, functionality, and their important contacts with other organelles require further in-depth study. Future work should focus on detecting the key milestones that are related to inflammation in patients with autoimmune diseases, such as Sjögren´s syndrome.

Dysfunctional lens syndrome: a prospective review / Síndrome do cristalino disfuncional: uma revisão prospectiva

ABSTRACT The term dysfunctional lens syndrome has gained acceptance in the field and encompasses natural changes due to aging of crystalline lens. The evolution of diagnostic devices has been a key factor in better staging, understanding and characterizing of these degenerative changes. Even with these technological advances and the use of subjective classifications, such as the classic Lens Opacities Classification System, an objective staging of early dysfunctional lens syndrome has yet to be established. Ocular wavefront aberrometry and objective scatter index, associated with Scheimpflug backscatter densitometry, have proven instrumental in detecting early dysfunctional lens syndrome. Staging of early dysfunctional lens syndrome has been proposed in the literature, but no classification has been recognized worldwide. The purpose of this literature review is to assess the current state of dysfunctional lens syndrome from a technological perspective and propose a new staging system to assist surgeons in making surgical decisions.

RESUMO O termo "síndrome disfuncional do cristalino" tem sido mais aceito na área e engloba mudanças naturais devido ao envelhecimento do cristalino. A evolução dos dispositivos diagnósticos tem sido fator fundamental para melhor estadiamento, compreensão e caracterização dessas alterações. Mesmo com esses avanços tecnológicos e o uso de classificações subjetivas, como o Lens Opacities Classification System , um estadiamento objetivo da síndrome disfuncional do cristalino precoce ainda não foi estabelecido. A aberrometria ocular total e o índice de superfície ocular, associado à densitometria de Scheimpflug, mostraram-se instrumentais na detecção da síndrome disfuncional do cristalino precoce. Embora estadiamentos precoces de síndrome disfuncional do cristalino tenham sido propostos na literatura, nenhum foi reconhecido mundialmente até o momento. O objetivo desta revisão de literatura é avaliar o estado atual da síndrome disfuncional do cristalino a partir de uma perspectiva tecnológica, e propor um novo sistema de estadiamento para auxiliar os cirurgiões na tomada de decisões cirúrgicas.

Validation of the Interpretation of Intrusions Inventory for the Mexican Population: Cross-Cultural Discrepancies.

To facilitate research on the cognitive model of obsessive-compulsive disorder (OCD), leaders in the field of OCD (Obsessive-Compulsive Cognitions Working Group [OCCWG]) developed and validated the Interpretation of Intrusions Inventory-31 (III-31). The current sought to adapt and validate this important measure for the Mexican population using a large sample of emerging adults (N = 457). Specifically, we evaluated the factor structure and convergent validity of the III-31 for the Mexican population. Based on a series of confirmatory factor analyses, previously established one-, two-, and three-factor models were found to be a poor fit with current data. However, an exploratory factor analysis yielded a two-factor solution, with one factor assessing the harmfulness and danger of intrusive thoughts (Harmfulness/Danger), and the other assessing exaggerated responsibility and efforts to control intrusions (Responsibility/Control). Satisfactory convergent validity was found with the severity of dysfunctional beliefs and OCD symptoms. Implications and limitations of study results are discussed.

Eating behaviours related to psychological stress are associated with functional hypothalamic amenorrhoea in exercising women.

Functional hypothalamic amenorrhoea (FHA) can occur due to the independent or combined effects of psychogenic and energetic stressors. In exercising women, research has primarily focused on energy deficiency as the cause of FHA while psychological stressors have been ignored. To assess both psychological and metabolic factors associated with FHA in exercising women, we performed across-sectional comparison of 61 exercising women (≥2 hours/week, age 18-35 years, BMI 16-25kg/m2), who were eumenorrheic or amenorrhoeic confirmed by daily urine samples assayed for reproductive hormone metabolites. Psychological factors and eating behaviours were assessed by self-report questionnaires. Exercising women with FHA had lower resting metabolic rate (p=0.023), T3 (p<0.001), T4 (p=0.013), leptin (p=0.002), higher peptide YY (p<0.001), greater drive for thinness (p=0.017), greater dietary cognitive restraint (p<0.001), and displayed dysfunctional attitudes, i.e., need for social approval (p=0.047) compared to eumenorrheic women. Amenorrhoeic women displayed asignificant positive correlation between the need for social approval and drive for thinness with indicators of stress, depression, and mood, which was not apparent in eumenorrheic women. In exercising women with FHA, eating behaviours are positively related to indicators of psychological stress and depression.

Dysfunctional personality beliefs and executive performance in patients with juvenile myoclonic epilepsy.

BACKGROUND: This article intends to verify the association of dysfunctional beliefs of personality disorders with the executive performance in people with juvenile myoclonic epilepsy (JME). METHODS: Fifty-two patients (35 women, 67.3%) with JME aged 18-50 yrs. (32.3 ±â€¯9.7) were evaluated between May 2017 and April 2018 and compared with controls. All subjects were submitted to the Personality Beliefs Questionnaire (PBQ) (Beck & Beck, 1991; Savoia et al., 2006), Dysexecutive Questionnaire (DQ; Wilson et al., 1996; Macuglia et al., 2016), estimated intelligence quotient (IQ) using Vocabulary and Block Design tests, attention and executive functions evaluation (Controlled Oral Word Association (COWA), Digit Span, Trail Making Tests (TMT) A and B, Stroop and Wisconsin Card Sorting Test (WCST)). The inclusion criteria were as follows: diagnosis of JME (ILAE, 1989); age ≥18 yrs., schooling ≥ 11 yrs. and IQ ≥70. The inclusion criteria for the control group were the same except diagnosis of epilepsy. RESULTS: Compared with controls, patients presented higher scores in PBQ for personality disorders, namely Narcissistic (z = -0.79; p < 0.001), Borderline (z = -0.58; p = 0.002), Paranoid (z = -0.43; p = 0.017), and Histrionic (z = -0.39; p = 0.041). Executive functions were impaired when compared with controls in TMT A (z = -0.97; p = 0.038), TMT B (z = -0.65; p = 0.023), and COWA (z = -0.51; p = 0.001). Patients showed higher WCST scores for Errors (z = -1.62; p ≤ 0.001), Perseverative Errors (z = -0.77; p = 0.001), Non-Perseverative Errors (z = -1.01; p = 0.001), Conceptual Level Response (z = -1.56; p ≤ 0.001), Completed Categories (z = -2.12; p = 0.002), and Failure to Maintain Context (z = -0.49; p = 0.015). Personality Beliefs Questionnaire results showed correlation with lower values in TMT A, Antisocial (r = -0.298; p = 0.032), Narcissistic (r = -0.303; p = 0.029), Schizoid (r = - 0.410; p = 0.003), Histrionic (r = -0.341; p = 0.013), Passive-aggressive (r = -0.341; p = 0.015), and Obsessive-compulsive (r = -0.319; p = 0.021); TMT B results showed a trend for Obsessive-compulsive traits (r = -0.261; p = 0.052); COWA was correlated to Dependent (r = 0.319; p = 0.021); and Digit Span to Passive-aggressive (r = 0.287; p = 0.039). On WCST, Failure to Maintain Context was correlated to Avoidant (r = 0.335; p = 0.017). The DQ was not correlated with PBQ. CONCLUSION: People with JME presented dysfunctional beliefs of personality disorder that were correlated with executive dysfunction. These findings reinforce the need for psychological rehabilitation in these patients.

Interpretation of uroflow curves: A global survey measuring inter and intra rater reliability.

INTRODUCTION: There is a large amount of intra and inter observer variability in defining curve shapes. This study aims to evaluate inter and intra rater reliability (RR) on evaluating uroflow curves in a broad spectrum of international practitioners. METHODS: Eight hundred sixty-four questionnaires were sent by email to health professionals that care for children with voiding dysfunction. It included demographic questions and 11 different uroflow curves and two duplicates. RESULTS: Four hundred forty-one emails were opened and 29.5% of those responded. Seventy percent of responders were physicians, including 46% pediatric urologists. Europe, South America, North America, Oceania, and Asia represented respondents. For the repeated bell smooth curve the intra rater agreement was 82.1% utilizing the International Children's Continence Society (ICCS) classification and 92.3% for the shape of the curve (bell, plateau, and tower [BPT]) (P = .04). For the repeated interrupted plateau curve it was 69.5% and 97.5% for ICCS and for the continuity of the curve (smooth or fractionated [SF]) classifications, respectively (P < .001). The curves were then divided into two groups for evaluation of inter RR. For the set of seven smooth curves, the inter RR was low in all classifications with α = .282, .497, and .242 for ICCS, SF, and BPT, respectively. The group of six fractionated curves showed a slightly better agreement with α = .533, .404, and .662 for ICCS, SF, and BPT, respectively. CONCLUSIONS: This is the largest study looking at inter and intra RR of uroflows in a disparate population of readers. It was evident from our findings that inter RR was poor and additionally intra RR was equally poor, indicating the unreliability of uroflow shapes to be used for research purposes.

Dysfunctional parenting styles, empathy and socio-demographic variables in Nursing, Human Medicine and Psychology students / Relação entre estilos parentais disfuncionais, empatia e variáveis sociodemogpaficas em estudantes de Enfermagem, Medicina Humana e Psicologia / Relación entre estilos parentales disfuncionales, empatía y variables sociodemográficas en estudiantes de Enfermería, Medicina Humana y Psicologia

Abstract The objective of this study was to establish the relationship between dysfunctional parenting styles and empathy in Nursing, Human Medicine and Psychology students. The study's sample consisted of 599 students, from both genders, and from different cycles of their university studies. Their ages ranged between 21 and 25 years. To assess them, the Dysfunctional Parenting Styles Scale by Parker, et al. (1979) was used, previously adapted to Peruvian population. The participants were also evaluated with the Personal and Professional Empathy Scale designed by Yaraskavitch (2009), and completed a socio-demographic data sheet created ad hoc. General results showed no significant relationships between the dysfunctional parenting styles and empathy total scores. In contrast, considering the father figure, an inverse relationship between the authoritarian-controlling dysfunctional parenting style and the personal and professional cognitive empathy was found, while the indifference - negligence dysfunctional parenting style was inversely associated with the emotive personal empathy. As to the mother figure, there is a significant and direct relationship between authoritarian-controlling dysfunctional parenting style and personal and professional emotive empathy. It was also found that regarding gender, women have higher levels of empathy. With respect to professional degree courses, Nursing students have a higher level of empathy than Medicine and Psychology students, while Medicine students have more dysfunctional parenting styles than the Nursing and Psychology groups. Finally, students that had taken personal development courses showed a higher level of empathy.

Resumo O presente estudo teve como objetivo estabelecer a relação entre os estilos parentais disfuncionais e a empatia em estudantes universitários de Lima, além de comparações de acordo com a carreira profissional (Enfermagem, Medicina Humana e Psicologia). A amostra foi composta por 599 estudantes de ambos os sexos, com idades entre 21 e 25 anos, a quem foi aplicada a Escala de Estilos Parentais Disfuncionais -de Parker et a. (1979)-, a Escala de Empatia Pessoal e Profissional -desenhada por Yaraskavitch et al. (2009)-, ambas adaptadas para os fins do estudo, e uma ficha sociodemográfica elaborada pelos autores. Os resultados mostram uma relação não significativa entre as pontuações totais de estilos parentais disfuncionais e de empatia, mas obteve-se uma relação inversa entre a subescala de estilo disfuncional paterno "autoritário-controlador" com as dimensões "empatia pessoal cognitiva" e "empatia profissional cognitiva", e uma relação direta entre a subescala de estilo disfuncional materno com as dimensões "empatia pessoal emotiva" e "empatia profissional emotiva". Além disso, com respeito ao gênero, as mulheres apresentaram maior nível de empatia e, de acordo com o curso, os estudantes de Enfermaria apresentaram maiores níveis de empatia, enquanto os de Medicina mostraram mais estilos parentais disfuncionais. Finalmente, os estudantes que fizeram cursos de desenvolvimento pessoal em sua formação profissional apresentaram maior nível de empatia.

Resumen El presente estudio tuvo como objetivo establecer la relación entre los estilos parentales disfuncionales y la empatía en estudiantes universitarios de Lima, además de comparaciones según su carrera profesional (Enfermería, Medicina Humana y Psicología). La muestra estuvo compuesta por 599 estudiantes de ambos sexos, con edades entre los 21 y 25 años, a quienes se les aplicó la Escala de Estilos Parentales Disfuncionales -de Parker et al. (1979)-, la Escala de Empatía Personal y Profesional -diseñada por Yaraskavitch et al. (2009)-, ambas adaptadas para los fines del estudio, y una ficha sociodemográfica elaborada por los autores. Los resultados muestran una relación no significativa entre los puntajes totales de estilos parentales disfuncionales y de empatía, aunque se obtuvo una relación inversa entre la subescala de estilo disfuncional paterno "autoritario-controlador" con las dimensiones "empatía personal cognitiva" y "empatía profesional cognitiva", y una relación directa entre la subescala de estilo disfuncional materno con las dimensiones "empatía personal emotiva" y "empatía profesional emotiva"; además de que, respecto al género, las mujeres presentaron mayor nivel de empatía, y, según carrera, los estudiantes de Enfermería presentaron mayores niveles de empatía, mientras que los de Medicina mostraron más estilos parentales disfuncionales. Finalmente, los estudiantes que llevaron a cabo cursos de desarrollo personal en su formación profesional presentaron un mayor nivel de empatía.

Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: a systematic review / Uroterapia no tratamento de crianças e adolescentes com disfunção vesical e intestinal: revisão sistemática

ABSTRACT Objective: To identify and describe the protocols and clinical outcomes of urotherapy interventions in children and adolescents with bladder bowel dysfunction. Method: Systematic review carried out in June 2018 on Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL),Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library, and PsycInfo databases. Clinical trials and quasi-experimental studies carried out in the last ten years in children and/or adolescents with bladder and bowel symptoms and application of at least one component of urotherapy were included. Results: Thirteen clinical trials and one quasi-experimental study were included, with moderate methodological quality. The heterogeneity of the samples and of the methodological design of the articles prevented the performance of a meta-analysis. The descriptive analysis through simple percentages showed symptom reduction and improvement of uroflowmetry parameters. The identified urotherapy components were: educational guidance, water intake, caffeine reduction, adequate voiding position, pelvic floor training, programmed urination, and constipation control/management. Conclusion: This review indicates positive results in terms of symptom reduction and uroflowmetry parameter improvement with standard urotherapy as the first line of treatment for children and adolescents with bladder bowel dysfunction. It is recommended that future studies bring contributions regarding the frequency, number, and time of urotherapy consultations.

RESUMO Objetivo: Identificar e descrever os protocolos e desfechos clínicos das intervenções de uroterapia em crianças e adolescentes com disfunção vesical e intestinal. Método: Revisão sistemática realizada em junho de 2018 nas bases Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library e PsycInfo. Foram incluídos ensaios clínicos e estudos quase-experimentais dos últimos 10 anos, em crianças e/ou adolescentes com sintoma urinário e intestinal e aplicação de no mínimo um componente de uroterapia. Resultados: 13 ensaios clínicos e 1 estudo quase-experimental foram incluídos, sendo a qualidade metodológica moderada. A heterogeneidade da amostra e de delineamento metodológico dos artigos impediu a realização de meta-análise. A análise descritiva por meio de percentual simples demonstrou redução dos sintomas e melhora dos parâmetros de urofluxometria. Os componentes de uroterapia identificados foram: orientação educacional, ingestão hídrica, redução de cafeína, posicionamento adequado para eliminação, treinamento do assoalho pélvico, micção programada e controle/manejo da constipação. Conclusão: Esta revisão sinaliza resultados positivos em termos de redução de sintomas e melhora nos parâmetros de urofluxometria com aplicação de uroterapia padrão como primeira linha de tratamento nos casos de crianças e adolescentes com disfunção vesical e intestinal. Recomenda-se que estudos futuros tragam contribuições no que tange a frequência, número e tempo para as consultas de uroterapia.

Association between a constipation scoring system adapted for use in children and the dysfunctional voiding symptom score in children and adolescents with lower urinary tract symptoms.

INTRODUCTION: A presumed association between more severe lower urinary tract symptoms (LUTS) and more severe functional constipation (FC) remains unconfirmed. Because the Rome IV criteria do not quantify FC, an adult constipation scoring system was modified and adapted for use in children. OBJECTIVES: The objective of this study was to assess the correlation between FC severity as determined by the modified constipation scoring system and LUTS severity in children/adolescents and the correlation between this modified scoring system and the Rome IV criteria. STUDY DESIGN: This was a cross-sectional study including 5- to 17-year-old patients with LUTS, with or without FC. Patients with neurological and/or anatomical abnormalities of the genitourinary and/or gastrointestinal tract were excluded. Girls with Dysfunctional Voiding Symptom Score (DVSS) ≥6 and boys with DVSS ≥9 were diagnosed with lower urinary tract dysfunction (LUTD). Patients with at least two positive Rome IV criteria were considered constipated. The severity of FC according to the adapted constipation scoring system was classified as mild for scores of 1-10, moderate for scores 11-20, and severe for scores 21-30. RESULTS: Of 128 patients with LUTS, 71 (55.5%) were female. Lower urinary tract dysfunction was detected in 107 patients (83.6%) and was more common in girls. Functional constipation was present in 80 patients (62.5%). Constipated children had higher constipation scores and DVSS, with both scores increasing with the severity of FC. Correlation was moderate between the constipation score and the DVSS (þ = 0.5, p < 0.001) and was strong between positivity for a greater number of Rome IV criteria and the constipation score (þ = 0.7, p < 0.001). Most of the constipated patients had mild or moderate FC, while in 30 non-constipated patients, the constipation score indicated mild FC. DISCUSSION: Patients from a specialist center are more likely to have more severe medical problems, and this may have influenced the correlation between the scores. The modifications made to the constipation scoring system require a future validation study. Nevertheless, this study provides new data on urinary dysfunction and its association with FC and highlights the need to investigate occult bowel symptoms that could affect the treatment of urinary dysfunction. CONCLUSION: The intensity of FC as measured by the modified constipation scoring system correlated with the severity of the urinary symptoms in children/adolescents with LUTS/LUTD. In constipated patients, there was a correlation between the modified constipation scoring system and the Rome IV criteria. In non-constipated patients, the constipation scoring system identified symptoms/signs of bowel dysfunction not picked up by the Rome IV criteria. Finally, constipation score modified for use in children and adolescents could be important for research purpose and particularly having a prognostic importance.

Gastrostomy Tube Feeding in Extremely Low Birthweight Infants: Frequency, Associated Comorbidities, and Long-term Outcomes.

OBJECTIVE: To assess the frequency of gastrostomy tube (GT) placement in extremely low birth weight (ELBW) infants, associated comorbidities, and long-term outcomes. STUDY DESIGN: Analysis of ELBW infants from 25 centers enrolled in the National Institute of Child Health and Human Development Neonatal Research Network's Generic Database and Follow-up Registry from 2006 to 2012. Frequency of GT placement before 18-22 months, demographic and medical factors associated with GT placement, and associated long-term outcomes at 18-22 months of corrected age were described. Associations between GT placement and neonatal morbidities and long-term outcomes were assessed with logistic regression after adjustment for center and common co-variables. RESULTS: Of the 4549 ELBW infants included in these analyses, 333 (7.3%) underwent GT placement; 76% had the GT placed postdischarge. Of infants with GTs, 11% had birth weights small for gestational age, 77% had bronchopulmonary dysplasia, and 29% severe intraventricular hemorrhage or periventricular leukomalacia. At follow-up, 56% of infants with a GT had weight <10th percentile, 61% had neurodevelopmental impairment (NDI), and 55% had chronic breathing problems. After adjustment, small for gestational age, bronchopulmonary dysplasia, intraventricular hemorrhage/periventricular leukomalacia, poor growth, and NDI were associated with GT placement. Thirty-two percent of infants with GTs placed were taking full oral feeds at follow-up. CONCLUSIONS: GT placement is common in ELBW infants, particularly among those with severe neonatal morbidities. GT placement in this population was associated with poor growth, NDI, and chronic respiratory and feeding problems at follow-up. The frequency of GT placement postneonatal discharge indicates the need for close nutritional follow-up of ELBW infants. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00063063.