Self-adhesive resin cement versus conventional cements on the failure rate of indirect single-tooth restorations: A systematic review and meta-analysis of randomized clinical trials.

STATEMENT OF PROBLEM: Cementation is one of the most critical steps that influence the failure rates of indirect restorations. Self-adhesive resin cements arose out of the need for technical simplification of this procedure to reduce the risk of operative errors, with good acceptance by clinicians. How the failure rate of indirect single-tooth restorations cemented with self-adhesive resin cements compares with the failure rate of those cemented conventionally is unclear. PURPOSE: The purpose of this systematic review and meta-analysis of randomized clinical trials was to compare self-adhesive resin cements versus conventional cements on the failure rates of indirect restorations. MATERIAL AND METHODS: The review was registered at the International Prospective Register of Systematic Reviews (PROSPERO - CRD42020215577). The search strategy was adapted for 5 databases (PubMed, The Cochrane Library, EMBASE, Web of Science, and LILACS) and 1 nonpeer-reviewed literature source (clinicaltrials.gov). The strategy was guided by the problem/population, intervention, comparison, outcome (PICO) question: adults indicated for indirect restorations -P, self-adhesive resin cement -I, conventional cement-C, failure rates-O. The risk of bias was assessed using the Cochrane risk of bias (RoB2) tool and guidelines. Meta-analysis merged the results from included studies by pooling the hazard ratios and standard errors, available or estimated. The certainty of evidence was assessed by using the classification of recommendations, evaluation, development, and evaluation (GRADE) approach. RESULTS: Nine randomized clinical trials were included in qualitative and quantitative analysis. Eight studies detected nonsignificant differences in failure rates between cements. Only 1 study reported a significantly higher failure rate on single-tooth ceramic crowns luted with self-adhesive resin cement. Nonsignificant differences were detected after the results from all studies had been pooled. CONCLUSIONS: Based on clinical evidence, self-adhesive resin cements can be recommended for the cementation of indirect single-tooth restorations with a similar risk of failure to conventional cements.

Inspiratory Training for Improving Respiratory Strength, Pulmonary Function, and Walking in Cerebral Palsy: A Meta-Analysis.

PURPOSE: To investigate the effects of inspiratory strength training on respiratory muscle strength, pulmonary function, and walking capacity in children with cerebral palsy, with Gross Motor Function Classification System I to III. METHODS: Searches were conducted in CINAHL, LILACS, MEDLINE, and Physiotherapy Evidence Database (PEDro) databases. The outcomes of interest were respiratory muscle strength, pulmonary function, and walking capacity. The quality was assessed by PEDro Scale. The Grading of Recommendations Assessment, Development, and Evaluation system was used to summarize the quality of evidence. RESULTS: Inspiratory strength training increased the strength of inspiratory muscles and may increase the strength of the expiratory muscles. No changes were observed in pulmonary function or walking capacity. CONCLUSIONS: This systematic review provides moderate-quality evidence that inspiratory strength training is effective for increasing inspiratory muscle strength in children with cerebral palsy. Benefits may be carried over to improving expiratory muscle strength but were not observed on pulmonary function or walking capacity.

Home-based self-management for sedentary individuals with mild walking disability after stroke: protocol for a randomised pilot study.

BACKGROUND: A Phase I study showed that it is feasible to implement a home-based self-management program aimed at increasing physical activity in individuals after stroke with mild walking disability in Brazil. The next step is to test this program against a control group in order to provide a power analysis for a fully-powered Phase III clinical trial. METHODS: A Phase II pilot randomised clinical trial with concealed allocation, blinded measurement, and intention-to-treat analyses will be carried out. The inclusion criteria will be individuals diagnosed with stroke, in the acute or subacute phase, with mild walking disability, sedentary, and no significant language impairment. The participants will be randomly allocated to the experimental or control group. The experimental group will receive six sessions of a home-based self-management program based on behaviour change techniques through the Social-Cognitive Theory and Control Theory over 11 weeks. The control group will receive one session of education about stroke (regarding the importance of practising physical activity after a stroke) and usual care. A total of 24 participants will be recruited. The primary outcome will be physical activity, measured through steps taken per day by an activity monitor (Actigraph wGT3X-BT, Pensacola, FL, USA). The mean of daily steps will be analysed to compare groups after intervention. Secondary outcomes will be cardiovascular risk (body mass index, waist circumference, and blood pressure), depressive symptoms (Geriatric Depression Scale), walking ability (6-Minute Walk Test and 10-Meter Walk Test), exercise self-efficacy (Self-Efficacy for Exercise scale), social participation (Stroke Impact Scale) and quality of life (EuroQual-5D). Two-way analyses of variance will be implemented for all parametric outcomes, and the Kruskal-Wallis test for non-parametric outcomes will be used to determine the statistical significance of the between-group differences and reported as mean differences between groups (95% CI). All analyses will be conducted intention-to-treat. All outcomes will be measured at baseline (Week 0), post-intervention (Week 12), and follow-up (Week 24). This pilot clinical trial was registered online at Clinical Trials under number NCT05461976 on 4th April 2022. DISCUSSION: If beneficial, this Phase II pilot randomised trial will provide data to plan a fully powered future Phase III clinical trial aimed at verifying the efficacy of this program to promote physical activity after stroke. TRIAL REGISTRATION: Clinical Trials NCT05461976 on 4th April 2022.

Deficits in dynamic balance were the motor impairments that best explained limitations in community ambulation after stroke.

BACKGROUND: Improving walking capacity, in order to achieve community ambulation, is an important goal for both patients and rehabilitation professionals. However, only about 7 to 27% of the stroke survivors will be able to walk in the community. AIM: The aim of this study was to determine which measures of motor impairments would impair community ambulation in 90 individuals with chronic stroke. DESIGN: Cross-sectional study. SETTING: Research laboratory at Federal University of Minas Gerais. POPULATION: Chronic stroke patients. METHODS: For this exploratory study, the dependent variable, community ambulation, was determined by the distance covered during the 6-Minute Walking Test (6MWT). Participants, who covered ≥288 meters during the 6MWT, were classified as unlimited-community ambulators, whereas those who covered <288 meters were considered limited-community ambulators. Logistic regression analysis was carried-out to investigate which measures of motor impairments (deficits in strength of the knee extensor muscles, dynamic balance, and lower-limb motor coordination, as well as increased tonus of the ankle plantarflexor muscles) would explain the variance in community ambulation, i.e., the distance covered during the 6MWT. RESULTS: Out of the 90 participants, 51 were unlimited and 39 were limited-community ambulators. Only the measure of dynamic balance (OR=0.81, 95% CI: 0.72-0.91) reached significance and was kept in the logistic regression model. CONCLUSIONS: Deficits in dynamic balance best explained limitations in community ambulation in individuals with chronic stroke. Future studies are needed to determine whether rehabilitation interventions aiming at improving dynamic balance would lead to unlimited-community ambulation. CLINICAL REHABILITATION IMPACT: Amongst common motor impairments observed after stroke, such as increased tonus of the ankle plantarflexor muscles and deficits in strength of the knee extensor muscles and lower-limb motor coordination, dynamic balance, was the only variable that explained limitations in community ambulation after stroke. Future studies aiming at investigating community ambulation after stroke could take into account measures of dynamic balance.

Adherencia al tratamiento y nivel de conocimiento en adultos con hipertensión arterial, Asunción 2022

Introducción: la adherencia al tratamiento y el nivel de conocimientos en pacientes con hipertensión arterial son factores claves para controlar esta afección y evitar complicaciones. Objetivos: determinar el grado de adherencia al tratamiento, el nivel de conocimientos y comorbilidades en pacientes con hipertensión arterial de un área urbana de Asunción, Paraguay, en 2022. Metodología: se aplicó un diseño observacional, descriptivo, transversal. Se incluyeron varones y mujeres mayores de 18 años, conocidos portadores de hipertensión arterial, que residen en el barrio Sajonia entre mayo y octubre del 2022. Los datos fueron obtenidos con entrevistas realizadas casa por casa. Se midieron variables demográficas, el nivel de adherencia con el cuestionario de Morisky Green y el de conocimientos sobre la enfermedad con el cuestionario de Batalla. La investigación fue aprobada por el Comité de ética de la Universidad Privada del Este, Paraguay. Resultados: participaron del estudio 425 sujetos, con predominio del sexo femenino (61,1%). La diabetes mellitus fue referida en 28,9% de los entrevistados. El cuestionario de Morisky Green detectó que 60% de los sujetos olvida de tomar su medicación, 25% no la toma en el horario indicado, 29% de la toma si se siente bien y 44% deja de tomarla si siente efectos indeseables. El cuestionario de Batalla halló 7% cree que la hipertensión arterial no es para toda la vida, 9% cree que la afección no se controla con dieta y medicación, y 5,8% no pudo referir al menos un órgano blanco. Conclusión: la adherencia al tratamiento de la hipertensión arterial y el nivel de conocimientos sobre esta afección no fue adecuada.

Introduction: Adherence to treatment and level of knowledge in patients with arterial hypertension are key factors to control this condition and avoid complications. Objectives: To determine the degree of adherence to treatment, the level of knowledge and comorbidities in patients with arterial hypertension in an urban area of ​​Asunción, Paraguay, in 2022. Methodology: An observational, descriptive, cross-sectional design was applied. Men and women over 18 years of age, known carriers of arterial hypertension, residing in Sajonia neighborhood between May and October 2022, were included. The data were obtained through house-to-house interviews. Demographic variables, the level of adherence with the Morisky Green test and the level of knowledge about the disease with the Batalla test were measured. The research was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: Four hundred twenty-five subjects participated in the study, predominantly female (61.1%). Diabetes mellitus was referred to by 28.9% of the interviewees. The Morisky Green test detected that 60% of the subjects forget to take their medication, 25% do not take it at the indicated time, 29% take it if they feel well, and 44% stop taking it if they feel undesirable effects. The Batalla test found that 7% believe that arterial hypertension is not for life, 9% believe that the condition is not controlled with diet and medication, and 5.8% could not refer to at least one target organ. Conclusion: Adherence to the treatment of arterial hypertension and the level of knowledge about this condition was not adequate.

Correlações simbólicas entre o Bhagavad Gita e o processo de individuação / Symbolic Correlations between the Bhagavad Gita and the Individualization Process / Correlaciones Simbólicas entre el Bhagavad Gita y el Proceso de Individuación

O artigo propõe uma correlação simbólica entre o texto do Bhagavad Gita e o processo de individuação proposto por Jung. Interpreta a guerra entre os guenos dos Pândavas e dos Káuravas como um processo simbólico, em função do qual, Arjuna (personagem líder dos Pândavas) poderá incorporar, em sua psique, os conteúdos, simbolicamente representados e depositados no grupo dos Káuravas, sejam as características sombrias, defensivas, bem como as criativas ou iluminadas.

This paper proposes a symbolic correlation between the Bhagavad Gita text and the individuation process proposed by Jung. It interprets the war between the Pandavas' guenos and the Káuravas as a symbolic process, as a result of which Arjuna (leader of the Pândavas) will be able to embody, in his psyche, the contents, symbolically represented and deposited in the group of the Káuravas, whether the characters dark, defensive, as well as creative or light ones.

El artículo propone una correlación simbólica entre el texto del Bhagavad Gita y el proceso de individuación propuesto por Jung. Interpreta la guerra entre los guenos de los Pándavas y de los Káuravas como un proceso simbólico, en función del cual, Arjuna (personaje líder de los Pándavas) podrá incorporar en su psique los contenidos, simbólicamente representados y depositados en el grupo de los Káuravas, sean las características oscuras, defensivas, así como las creativas o iluminadas.

Depressão: a dor da alma de quem perdeu-se de si mesmo / Depression: The pain of the soul of those who lost themselves / Depresión: el dolor del alma de los que se perdieron

A depressão, no sentido simbólico, é a melhor expressão da dor da alma que se perdeu de sua própria natureza. Depressão como um estado de aprisionamento. Os seres vivos estão sempre em transformações físicas, psíquicas, socioculturais e noéticas. Quando as transformações não encontram espaço para se expressar, surge o sofrimento. A solução seria romper e, quando não se consegue, a depressão surge. A busca da possibilidade de refazer a ligação com o outro poderá ser feita por um processo via logos espiritualizado. O mito de Orfeu é usado para explicitar a perda da coniunctio com a anima e a segunda busca de si mesmo pelo caminho da Sabedoria Profunda. Essa busca pode ser traduzida também pelas questões kantianas: Quem sou eu? Por que estou aqui? Qual o sentido da minha vida? Qual é minha responsabilidade diante de tudo que me cerca? A conclusão sobre o texto define a condição do entender que o se perder de si mesmo, fundamento da depressão, encontra respostas, num segundo momento da vida, pelo conhecimento, via logos espiritualizado e veiculado pela Sabedoria Profunda.

Depression, in the symbolic sense, is the best expression of the pain of the soul that has lost its own nature. Depression as a state of imprisonment. Living beings are always undergoing physical, psychic, sociocultural, and noetic transformations. When transformations do not find space to express themselves, suffering arises. The solution would be to break up and when you don't succeed, depression arises. The search for the possibility of remaking the connection with the other can be done through a process via spiritualized logos. The myth of Orpheus is used to explain the loss of the coniunctio with the anima and the second search for oneself along the path of Profound Wisdom. This search can also be translated by the Kantian questions: "Who am I? Why am I here? What is the meaning of my life? What is my responsibility to everything around me?" The conclusion on the text defines the condition of understanding that losing oneself, the basis of depression, finds answers, in a second moment of life, through knowledge, via spiritualized logos and conveyed by Profound Wisdom.

La depresión, en sentido simbólico, es la mejor expresión del dolor del alma que ha perdido su propia naturaleza. La depresión como estado de encarcelamiento. Los seres vivos siempre están pasando por transformaciones físicas, psíquicas, socioculturales y noéticas. Cuando las transformaciones no encuentran espacio para expresarse, surge el sufrimiento. La solución sería romper y cuando no lo consigues, surge la depresión. La búsqueda de la posibilidad de rehacer la conexión con el otro puede hacerse a través de un proceso vía logos espiritualizados. Se utiliza el mito de Orfeo para explicar la pérdida del coniunctio con el ánima y la segunda búsqueda de uno mismo por el camino de la Sabiduría Profunda. Esta búsqueda también puede traducirse por las preguntas kantianas: ¿Quién soy yo? ¿Por qué estoy aquí? ¿Cuál es el significado de mi vida? ¿Cuál es mi responsabilidad con todo lo que me rodea? La conclusión del texto define la condición de comprensión de que el perderse a sí mismo, base de la depresión, encuentra respuestas, en un segundo momento de la vida, a través del conocimiento, a través del logos espiritualizado y transmitido por la Sabiduría Profunda.

Treatment for dental erosion: a systematic review of in vitro studies.

Background: Dental erosion is a chemical loss of the mineralized dental tissue caused by exposure to nonbacterial acids. Different treatment protocols have been adopted with the use of fluoride compounds to promote the formation of a layer of mineral precipitation in eroded lesions. Aim: This systematic review aimed to evaluate the main treatments for dental erosion. Methodology: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recorded in the Open Science Framework database (OSF) under DOI 10.17605/OSF.IO/XMFNZ. The searches were conducted in six electronic databases (Pubmed, Embase, Web of Science, Cochrane, Scopus, Lilacs) and two grey literature sources (Google Scholar and OpenGrey). The eligibility criteria included in vitro studies that evaluated eroded teeth under treatment with some topical agent. Risk of bias assessment and qualitative synthesis were performed using the Cochrane collaboration's tool for assessing risk of bias modified for in vitro studies. Results: A total of 522 studies were identified, and only four studies that fulfilled our eligibility criteria were included in this review. Among these studies, three were considered to have a low risk of bias, and one to have a high risk of bias. Two studies evaluated the anti-erosion effect of fluoride toothpaste, and the other two assessed the action of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on the surface of human teeth. Among the products analyzed, CPP-ACP was the only one that promoted a significant increase in enamel microhardness and reduced tooth wear. Conclusion: Based on the in vitro studies included in this review, there was no anti-erosion effect after using different fluoride toothpaste. However, it should be considered that one of these studies presented a high risk of bias. On the other hand, studies with CPP-ACP showed anti-erosion efficacy when applied before or after erosive wear.

Walking confidence and perceived locomotion ability explain participation after stroke: A cross-sectional experimental study.

OBJECTIVE: To explore the relationship between walking measurements (i.e., walking speed, walking performance and walking confidence), and participation in ambulatory people with chronic stroke. MATERIALS AND METHODS: Participation was measured using the mobility domain of Brazilian version of the Stroke Impact Scale 3.0. Walking measures were walking speed, assessed by 10-m Walk Test, walking performance, assessed by ABILOCO, walking confidence, assessed by mGES. Pearson correlation coefficients were used to explore the relationships between the walking measures and social participation, and step-wise multiple linear regression analysis was used to identify which walking measures would explain participation after stroke. RESULTS: Ninety-five chronic stroke individuals (38 men), with a mean age of 67 (SD 13) years were assessed. Significant positive correlations, of high magnitude, were found between participation and all walking measures (r ≥ .53; p < .001). Regarding the regression analysis, walking confidence alone explained 44% (F = 72.4; p < .001) of the variance in participation. When perceived locomotion ability was included in the model, the explained variance increased to 48% (F = 42.8; p < .001). CONCLUSION: All walking measures were correlated with social participation after stroke, but only perceived locomotion ability and walking confidence explained the variance in participation. Clinicians should be encouraged to evaluate real-life performance and personal factors that may limit community participation after stroke.

Walking speed, hip muscles strength, aerobic capacity, and self-perceived locomotion ability most explain walking confidence after stroke: a cross-sectional experimental study.

Identifying the determinants of walking confidence can be crucial in therapeutic terms. On these bases, interventions to improve these factors could improve, in turn, walking confidence. Objective is to explore the relationship between motor impairments and activity limitation measures and walking confidence in people with chronic stroke. Walking confidence was assessed using the modified Gait Efficacy Scale. The independent variables were: strength of the hip flexors and knee flexors/extensors (measured with a dynamometer), lower limb coordination (assessed by the Lower Extremity Motor Coordination Test), dynamic balance (assessed by the Four-Square Step Test), walking speed (from the 10-m Walk Test), aerobic capacity (from the 6-Minute Walk Test), and self-perceived locomotion ability (assessed by the ABILOCO). Pearson correlation was used to explore the relationships between the variables, and multiple linear regression to identify the independent explainers of walking confidence after stroke. Ninety chronic stroke individuals (35 men), with a mean age of 68 (SD 13) years were assessed. All independent variables were significantly correlated with walking confidence. Regarding the regression analysis, these measures explained 44% ( F = 9.21; P < 0.001) of the variance in walking confidence; however, only walking speed, strength of the hip flexor muscles, aerobic capacity, and perceived locomotion ability showed significance. All motor impairment and activity limitation measures correlated with walking confidence. However, the regression analysis highlighted that only walking speed, aerobic capacity, the strength of the hip flexor muscles, and perceived locomotion were independent explainers of walking confidence after stroke.

Symbolic reading of panic disorder: experience of imminent death and self alerts.

The author proposes a symbolic reading of panic disorder as a psychopathological emergency that currently overwhelms our society, relating to an explicit process of transformation. She understands this phenomenon as resulting from the lack of the creative feminine in people's lives, which contributes to the emergence of symptoms that are understood as alerts from the Self, which decry the danger under which the person lives. She amplifies the proposition with a symbolic reading of two great mythical moments: Oedipus' encounter with the Sphinx, and the institution of the first jury court, dramatized in the tragic play The Eumenides, by Aeschylus (Ésquilo).

L'autrice propose une lecture symbolique du trouble panique comme une urgence psychopathologique qui submerge notre société actuelle, dans un franc processus de transformation. Elle comprend ce phénomène comme une réalité qui résulte du manque de féminin créatif dans la vie des personnes. Ceci contribue à l'émergence de symptômes qui sont compris comme des alertes venant du Soi parce qu'ils dénoncent le danger dans lequel la personne vit. L'autrice amplifie la proposition avec une lecture symbolique de deux grands moments mythiques: Œdipe et sa rencontre avec le Sphinx et l'institution du premier tribunal avec jury, exprimé dans la tragédie d'Eschyle, Les Euménides.

La autora propone una lectura simbólica del trastorno de pánico como una emergencia psicopatológica que abruma a nuestra sociedad actual, en franco proceso de transformación. Ella comprende este fenómeno como una realidad que es resultado de la falta de lo femenino creativo en la vida de las personas, lo cual contribuye a la emergencia de síntomas que son comprendidos como alertas del Self, debido a que denuncian el peligro en el cual la persona vive. La autora amplifica esta propuesta a partir de la lectura simbólica de dos importantes momentos míticos: Edipo: su encuentro con la Esfinge, y la institución de la primera corte de justicia, expresada en la obra trágica, Las Euménides de Esquilo.

O autor propõe a leitura simbólica do transtorno de pânico como uma emergência psicopatológica que sobrecarrega nossa sociedade atual, em um processo franco de transformação. Ela entende esse fenômeno como uma realidade resultante da falta do criativo feminino na vida das pessoas, o que contribui para o surgimento de sintomas que são entendidos como alertas do Si Mesmo, porque denunciam o perigo sob o qual a pessoa vive. Ela amplifica a proposição com uma leitura simbólica de dois grandes momentos míticos: Édipo: seu encontro com a Esfinge e a instituição da primeira corte do júri, expressa na trágica peça: Os Eumênides de Ésquilo.

A concessão da outorga: o arquétipo do pai e os fundamentos simbólicos da depressão / The granting of the bestowal: The father archetype and the symbolic foundations of depression / La concesión de la otorga: El arquetipo del padre y los fundamentos simbólicos de la depresión

O mito de Tântalo como referencial primordial da conferência da outorga. Concessão de Outorga como atributo do Arquétipo do Pai. Os sofrimentos do tutelado e comprometimentos severos da psique decorrentes da negação ou da perda da outorga. Reações psíquicas, em função da perda da outorga como: vergonha, sentimento de culpa. A vergonha de se saber incompetente. E a humilhação por ser ridículo. Os fundamentos simbólicos da emergência da depressão. Pai-Narciso, aquele que não outorga. Pais com estruturas patriarcais rigidamente defensivas. Os conflitos de filhos de casais cindidos, em que um confere a outorga e o outro a nega. A possibilidade de saída resiliente com a automobilização da outorga. Correlações simbólicas entre os castigos de Tântalo e a grandiosidade da outorga.

The myth of Tantalus as a primary reference for the granting conference. Granting of Bestowal (the act of conferring an honor or presenting a gift) as an attribute of the Father Archetype. Sufferings of the ward and severe impairments of the psyche resulting from the denial or loss of the bestowal. Psychic reactions, due to the loss of the grant, such as: shame, feeling of guilt. The shame of being incompetent. And the humiliation for being ridiculous. The symbolic foundations of the emergence of depression. Father-Narcissus, the one who does not bestow. Parents with rigidly defensive patriarchal structures. The conflicts of children of split couples in which one grants and the other denies it. The possibility of a resilient exit with the automobilization of the grant. Symbolic correlations between Tantalus' punishments and the grandiosity of the bestowal.

El mito de Tántalo como referencia principal para la conferencia de concesión. Otorgamiento como un atributo del Arquetipo del Padre Los sufrimientos del pupilo y los severos impedimentos de la psique resultantes de la negación o pérdida del otorgamiento. Reacciones psíquicas, por la pérdida de la beca, tales como: vergüenza, sentimiento de culpa. La vergüenza de ser incompetente. Y la humillación por hacer el ridículo. Los fundamentos simbólicos de la aparición de la depresión. Padre-Narciso, el que no da. Padres con estructuras patriarcales rígidamente defensivas. Los conflictos de hijos de parejas escindidas en los que uno lo concede y el otro lo niega. La posibilidad de una salida resiliente con la automovilización de la subvención. Correlaciones simbólicas entre los castigos de Tántalo y la grandiosidad del otorgamiento

A intencionalidade das decisões e das escolhas - "Liberdade é escolher Deus!" / The intentionality of decisions and choices - "Freedom is choosing God!" / La intencionalidad de las decisiones y de las elecciones - "¡La libertad es elegir a Dios!"

O texto contém proposições de diferentes autores sobre a existência de "pensantes" em todos os seres mineral, vegetal e animal com os quais uma interação se faz e, como decorrência, nos leva a entender o fenômeno das intencionalidades de decisões e escolhas como um fato que tem origem e fundamento inconscientes. Esses relatos comprovam o quanto o processo decisório na vida dos humanos se exerce de forma autônoma. O processo se apresenta, como intuições, desejos inexplicáveis, sincronicidades, sonhos, bem como outras realidades aleatórias para as quais o Ego se sente inclinado a aceitar o esforço necessário para cumprir o compromisso demandado. Uma das conclusões implica atentar para o quanto essas decisões e intencionalidades se fazem fundamentais para que o processo de individuação se cumpra.

The text contains propositions from different authors about the existence of "thinkers" among all mineral, plant and animal beings with which an interaction takes place and, as a result, we understand the phenomenon of intentionality of decisions and choices as a fact that has an unconscious origin and foundation. These reports prove how much the decision making process in human life is exercised autonomously. The process presents itself as intuitions, inexplicable desires, synchronicities, dreams, as well as other random realities for which the Ego feels inclined to accept the effort necessary to fulfill the demanded commitment. One of the conclusions implies paying attention to how fundamental these decisions and intentions are for the individuation process to be fulfilled.

El texto contiene proposiciones de diferentes autores sobre la existencia de "pensar" en todos los seres minerales, vegetales y animales con los que se realiza una interacción y, como resultado, nos lleva a comprender el fenómeno de la intencionalidad de las decisiones y elecciones como un hecho que tiene origen y base inconscientes. Estos informes demuestran cómo el proceso de toma de decisiones en la vida de los humanos se ejerce de forma autónoma. El proceso se presenta como intuiciones, deseos inexplicables, sincronicidades, sueños, así como otras realidades aleatorias para las cuales el Ego se siente inclinado a aceptar el esfuerzo necesario para cumplir con el compromiso exigido. Una de las conclusiones implica la atención sobre cómo estas decisiones e intenciones son fundamentales para que el proceso de individualización se cumpla.

Test-retest reliability and measurement error of the modified gait efficacy scale in individuals with stroke.

PURPOSE: To investigate the test-retest reliability and measurement error of the Brazilian version of the modified Gait Efficacy scale (mGES-Brazil) in individuals who have had stroke. METHODS: The mGES-Brazil was applied on two occasions, five to seven days apart, in a research laboratory setting. Test-retest reliability and measurement error, which included the standard error of measurement (SEM), smallest detectable change (SDC), and analysis of the limits of agreement by the Bland-Altman plots, were examined. RESULTS: Fifty individuals who have had stroke (18 men), with a mean age of 64 ± 11 years, were evaluated. All individual items showed good reliability (Intra-class Correlation Coefficient - ICC2,1 > 0.90). The ICC was 0.98 (95% CI 0.97 to 0.99) and the Bland and Altman plots revealed no systematic changes in the mean test-retest scores. The SEM (SEM%) was 3 (5%), within the recommended values, while the SDC was 8 points. CONCLUSION: The mGES-Brazil demonstrated to be reliable to be applied within clinical and research contexts for the assessment of changes in walking confidence of individuals who have had stroke. Changes in mGES scores ≥8 points reflect real changes.

COVID-19 outbreak: Should dental and medical practices consider uv-c technology to enhance disinfection on surfaces? - A systematic review.

AIMS: During the COVID-19 pandemic the search for complementary methods to enhance manual disinfection in dental and medical practices raised relevance. We sought evidence for the addition of ultraviolet-C (UV-C) disinfection to manual cleaning protocols -and whether it improves the logarithmic (log) reduction of surface pathogen colonies. METHODS: This review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD420200193961. Six electronic sources were consulted looking for clinical trials performed in healthcare environments in which pathogens were quantified by colony-forming unit (CFU)-enumeration before and after interventions, all databases were last consulted on May 2021. We assessed the risk of bias using an adapted Revised Cochrane Risk of Bias Tool (RoB 2). The certainty of the evidence was qualified according to the Classification of Recommendations, Evaluation, Development, and Evaluation (GRADE) approach. RESULTS: We identified 1012 records and 12 studies fulfilled the inclusion criteria. All included studies reported enhanced disinfection in the UV-C arm; most of them reported 1-log to 2-log reduction in approximately 10 to 25 min. Only three studies reached a 5-log and 6-log reduction. When manual cleaning was performed alone, only two studies reported a 1-log reduction using a chlorine-based disinfectant. We detected a high risk of bias in 1 study. Certainty of evidence was classified as moderate and low. CONCLUSIONS: The evidence points out the effectiveness of UV-C technology in reducing manual cleaning failures, enhancing the logarithmic reduction of surface pathogen colonies. However, the safety and success of these devices will depend on several physical and biological factors. A judicious project must precede their use in clinical and medical offices under the supervision of a physicist or other trained professional.

A systematic review and meta-analysis of the association between fluoride exposure and neurological disorders.

Different studies have suggested that fluoride is related to neurological disorders in children and adolescents, but clinical evidences of which neurological parameters associated to fluoride exposure are, in fact, still controversial. In this way, this systematic review and meta-analysis aimed to show if there is an association between fluoride exposure from different sources, doses and neurological disorders. Terms related to "Humans"; "Central nervous system"; "Fluorides"; and "Neurologic manifestations" were searched in a systematic way on PubMed, Scopus, Web of Science, Lilacs, Cochrane and Google Scholar. All studies performed on humans exposed to fluoride were included on the final assessment. A meta-analysis was then performed and the quality level of evidence was performed using the GRADE approach. Our search retrieved 4,024 studies, among which 27 fulfilled the eligibility criteria. The main source of fluoride was naturally fluoridated water. Twenty-six studies showed alterations related to Intelligence Quotient (IQ) while only one has evaluated headache, insomnia, lethargy, polydipsia and polyuria. Ten studies were included on the meta-analysis, which showed IQ impairment only for individuals under high fluoride exposure considering the World Health Organization criteria, without evidences of association between low levels and any neurological disorder. However, the high heterogeneity observed compromise the final conclusions obtained by the quantitative analyses regarding such high levels. Furthermore, this association was classified as very low-level evidence. At this time, the current evidence does not allow us to state that fluoride is associated with neurological damage, indicating the need for new epidemiological studies that could provide further evidences regarding this possible association.

Capacidade, desempenho e confiança da marcha como preditores de quedas em indivíduos pós-acidente vascular encefálico / Capacidad de la marcha, rendimiento y confianza como los predictores de caídas en personas pos accidente cerebrovascular / Walking capacity, performance, and confidence as predictors of falls in post-stroke individuals

RESUMO O objetivo deste estudo foi avaliar a correlação entre capacidade, desempenho e confiança da marcha e número de quedas em indivíduos após sofrerem acidente vascular encefálico (AVE), além de investigar quais dessas variáveis relacionadas à marcha poderiam predizer as quedas nessa população. Foram avaliados 95 indivíduos pós-AVE, de acordo com número de quedas no último ano e capacidade de marcha (por meio de teste de caminhada de 10 metros), desempenho na marcha (pela aplicação do questionário ABILOCO-Brasil) e confiança na marcha (pela análise de modified gait efficacy scale). O coeficiente de correlação de Pearson foi utilizado para avaliar as correlações entre as variáveis. A regressão linear múltipla foi aplicada para avaliar se as variáveis relacionadas à marcha são capazes de predizer as quedas em indivíduos pós-AVE. Não foram encontradas correlações significativas entre capacidade (p=0,87) e performance na marcha (p=0,06) e número de quedas. Correlação significativa, negativa, de magnitude moderada, foi encontrada somente entre confiança na marcha e quedas (r=−0,43; p<0,01). Na análise de regressão, apenas a confiança na marcha permaneceu no modelo (p<0,01) como preditora do número de quedas em indivíduos pós-AVE, sendo capaz, sozinha, de explicar 18% (R2=0,18) dessa variável. Assim, os achados do estudo demonstraram que apenas a confiança na marcha está diretamente relacionada com o número de quedas em indivíduos pós-AVE, sendo essa também a única variável que pode ser considerada preditora desse evento nessa população.

RESUMEN El objetivo de este estudio fue evaluar la correlación entre la capacidad de la marcha, rendimiento y confianza con el número de caídas en personas después del accidente cerebrovascular (ACV), además de identificar las variables relacionadas con la marcha que podrían predecir caídas en esta población. Se evaluó a un total de 95 personas pos-ACV de acuerdo al número de caídas en el último año y la capacidad de la marcha (por medio de la prueba de caminata de 10 metros), el rendimiento de la marcha (aplicando el cuestionario ABILOCO-Brasil) y la confianza en la marcha (por el análisis de modified gait efficacy scale). Para evaluar las correlaciones entre variables, se utilizó el coeficiente de correlación de Pearson. Para determinar si las variables relacionadas con la marcha pueden predecir caídas en personas pos-ACV, se aplicó regresión lineal múltiple. No se encontraron correlaciones significativas entre la capacidad (p=0,87) y rendimiento de la marcha (p=0,06) con el número de caídas. Se encontró únicamente una correlación negativa significativa de magnitud moderada entre la confianza en la marcha y las caídas (r=−0,43; p<0,01). En el análisis de regresión, solamente la confianza en la marcha permaneció en el modelo (p<0,01) como la predictora del número de caídas en personas pos-ACV pudiendo explicar, por sí sola, el 18% (R2=0,18) de esta variable. Los hallazgos del estudio demostraron que la confianza en la marcha fue la única variable que estuvo directamente relacionada con el número de caídas en personas pos-ACV, además de ser la única predictora de caídas en esta población.

ABSTRACT This study aims to assess the correlation between walking capacity, performance, and confidence and the number of falls in post-stroke individuals, in addition to investigate which of these walking-related variables could predict falls in this population. In total, 95 post-stroke individuals were evaluated according to the number of falls in the last year and walking capacity (10-meter walk test), walking performance (ABILOCO-Brazil) and walking confidence (modified Gait Efficacy Scale). Pearson''s correlation coefficient was used to assess the correlations between variables. Multiple linear regression was used to assess whether walking-related variables can predict falls in post-stroke individuals. No significant correlations were found between capacity (p=0.87) and walking performance (p=0.06) and number of falls. A significant, negative correlation, with moderate magnitude, was found only between walking confidence and falls (r=−0.43; p<0.01). In the regression analysis, only walking confidence remained in the model (p<0.01) as a predictor of the number of falls in post-stroke individuals, explaining 18% (R2=0.18) of this variable. Thus, this study results demonstrated that only walking confidence is directly related to the number of falls in post-stroke individuals, which is also the only variable that can be considered a predictor of this event in this population.

Is There Any Association Between Neurodegenerative Diseases and Periodontitis? A Systematic Review.

Background: Neurodegenerative diseases are a group of progressive disorders that affect the central nervous system (CNS) such as Alzheimer, Parkinson, and multiple sclerosis. Inflammation plays a critical role in the onset and progression of these injuries. Periodontitis is considered an inflammatory disease caused by oral biofilms around the tooth-supporting tissues, leading to a systemic and chronic inflammatory condition. Thus, this systematic review aimed to search for evidence in the association between neurodegenerative disorders and periodontitis. Methods: This systematic review was registered at International Prospective Register of Systematic Reviews (PROSPERO) under the code CRD 42016038327. The search strategy was performed in three electronic databases and one gray literature source-PubMed, Scopus, Web of Science, and OpenGrey, based on the PECO acronym: observational studies in humans (P) in which a neurodegenerative disease was present (E) or absent (C) to observe an association with periodontitis (O). The Fowkes and Fulton checklist was used to critically appraise the methodological quality and the risk of bias of individual studies. The quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: From 534 articles found, 12 were included, of which eight were case-control, three were cross-sectional, and one was a cohort, giving a total of 3,460 participants. All the included studies reported an association between some neurodegenerative diseases and periodontitis and presented a low risk of bias. According to the GRADE approach, the level of evidence of probing pocket depth was considered very low due to the significant heterogeneity across the studies' upgrading imprecision and inconsistency. Conclusions: Although all the included studies in this review reported an association between neurodegenerative diseases and periodontitis, the level of evidence was classified to be very low, which suggests a cautious interpretation of the results.

A busca do quaternio: A instituição da quarta função / The search of quaternio: The institution of the fourth function / La búsqueda del cuaternión: La institución de la cuarta función

O texto inventaria a evolução dos pensamentos e das proposições teóricas da autora que a levaram à formulação do presente texto. O quarto padrão de Inteligência, a questão do mito do pecado original e o mito prometeico de criação da criatura humana e as virtudes roubadas e as cedidas por Zeus. Cristo e a proposição da quarta dinâmica de consciência, como possibilidade de salvação da humanidade. O texto constata a condição de mantermos regências trinas em muitas de nossas instâncias governamentais e a necessidade de implantarmos um quarto poder que traduza um verdadeiro regime democrático e concorra para a forja de uma dinâmica de consciência que abarque tanto o relacionamento individual quanto o coletivo, concorrendo para a implantação de um regime de encontro e continência do outro.

The text would invent the evolution of the author's thoughts and theoretical propositions that led her to the formulation of the present text. The fourth pattern of Intelligence, the question of the myth of original sin and the Promethean myth of creation of the human creature and the virtues stolen and those ceded by Zeus. Christ and the proposition of the fourth dynamic of conscience, as a possibility for the salvation of humanity. The text confirms the condition of maintaining triune regencies in many of our governmental bodies and the realization of the need to stablish a fourth power that translates a true democratic regime and contributes to the forge of a dynamic of conscience that embraces both individual and collective relationships, contributing to the establishment of a regime of encounter and continence of the other.

El texto inventaría la evolución del pensamiento y las proposiciones teóricas de la autora que la llevaron a la formulación de este texto. El cuarto patrón de Inteligencia, la cuestión del mito del pecado original y el mito prometeico de la creación de la criatura humana y las virtudes robadas y cedidas por Zeus. Cristo y la propuesta de la cuarta dinámica de la conciencia, como posibilidad para la salvación de la humanidad. El texto establece la condición de mantener regencias trinitarias en muchas de nuestras instancias gubernamentales y la realización de la necesidad de implantar un cuarto poder que traduzca un verdadero régimen democrático y contribuya a forjar una dinámica de conciencia que abarque tanto al individuo como al colectivo, contribuyendo a la implantación de un régimen de encuentro y continencia del otro.

Retrospective analysis of bleeding events after central venous catheter placement in thrombotic thrombocytopenic purpura.

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a thrombotic disorder caused by severe deficiency of ADAMTS13. Platelets are transfused prophylactically in non-TTP patients for central venous catheter (CVC) with a count <20 × 109/L to prevent bleeding. However, transfusing platelets in TTP prior to CVC placement remains controversial due to concern for arterial thrombosis and mortality. At our center, platelet transfusion is contraindicated in TTP, therefore, we analyzed data for bleeding complications following CVC placement. STUDY DESIGN AND METHODS: 95 acute episodes of TTP were identified. Twenty-six episodes were excluded for insufficient documentation or no CVC placement. The charts of 69 remaining episodes were reviewed. RESULTS: Of 69 TTP episodes, nine (13 %) had bleeding after a CVC placement. Of these, seven bleeds were minor, and the two were major related to the technical issues during femoral venous access causing arterial bleeds. Median platelet count before the CVC placement among those experiencing bleeding complications was 12 × 109/L (range 3-44) as compared to median count of 15 × 109/L (range 4-257) in those who did not bleed (p = 0.258). Among 44 episodes with a platelet count <20 × 109/L, seven (16 %) had bleeds. CONCLUSION: Major bleeding complications following CVC placement in TTP is uncommon and most likely related to technical challenges. Median platelet count was similar in patients who bled versus those who did not, suggesting that platelet transfusion is unnecessary to correct platelet count prior to a CVC placement in TTP.