Comparison of the Role of Different Levels of Religiousness and Spirituality in Controversial Ethical Issues and Clinical Practice among Brazilian Resident Physicians: Results from the Multicenter SBRAMER Study.

This study compares clinical practice and objections to controversial ethical issues among 836 Brazilian resident physicians according to levels of religiousness/spirituality. Residents with low religiousness/spirituality (s/r) believed less in the influence of spirituality on clinical practice, were less comfortable addressing this issue, tended to listen less carefully and try to change the subject more than other groups. Residents with high spirituality and low religiousness (S/r) inquired more about religious/spiritual issues, while those with high religiousness/spirituality (S/R) were more supportive and reported fewer barriers to addressing these issues. Concerning ethical issues (e.g., physician-assisted suicide, withdrawal of life support, abortion), S/R had more objections than others.

Religiosity and Spirituality of Resident Physicians and Implications for Clinical Practice-the SBRAMER Multicenter Study.

OBJECTIVES: To assess the attitudes, knowledge, and experiences of Brazilian resident physicians regarding religiosity/spirituality (R/S), factors associated with addressing this issue, and its influence on clinical practice. METHODS: We report results of the multicenter "Spirituality in Brazilian Medical Residents" (SBRAMER) study involving 7 Brazilian university centers. The Network for Research Spirituality and Health (NERSH) scale (collecting sociodemographic data, opinions about the R/S-health interface, and respondents' R/S characteristics) and the Duke Religion Index were self-administered. Logistic regression models were constructed to determine those factors associated with residents' opinions on spirituality in clinical practice. RESULTS: The sample comprised 879 resident physicians (53.5% of total) from all years of residency with 71.6% from clinical specialties. In general, the residents considered themselves spiritual and religious, despite not regularly attending religious services. Most participants believed R/S had an important influence on patient health (75.2%) and that it was appropriate to discuss these beliefs in clinical encounters with patients (77.1%), although this was not done in routine clinical practice (14.4%). The main barriers to discussing R/S were maintaining professional neutrality (31.4%), concern about offending patients (29.1%), and insufficient time (26.2%). Factors including female gender, clinical specialty (e.g., internal medicine, family medicine, psychiatry) as opposed to surgical specialty (e.g., surgery, obstetrics/gynecology, orthopedics), having had formal training on R/S, and higher levels of R/S were associated with greater discussion of and more positive opinions about R/S. CONCLUSION: Brazilian resident physicians held that religious and spiritual beliefs can influence health, and deemed it appropriate for physicians to discuss this issue. However, lack of training was one of the main obstacles to addressing R/S issues in clinical practice. Educators should draw on these data to conduct interventions and produce content on the subject in residency programs.

Comportamentos agressivos de crianças na escola: evidência de validade interna da EPPCACE / Aggressive behaviors of children in school: evidence of EPPCACE internal validity / Coductas agresivas de niños en la escuela: evidencias de validez interna de la EPPCACE

O objetivo do presente estudo foi verificar se os padrões psicométricos da Escala de percepção, por professores, dos comportamentos agressivos de crianças na escola (EPPCACE) evidenciavam sua validade interna. No Estudo 1 (n = 210), foi realizada a adaptação do instrumento e executada uma análise fatorial exploratória. No Estudo 2 (n = 203), efetuou-se uma análise fatorial confirmatória. Participaram professores do ensino fundamental de escolas públicas e particulares. Esses responderam à EPPCACE e a perguntas sociodemográficas. Os resultados indicaram que o instrumento é composto por três fatores: Agressividade direcionada ao âmbito geral (α = 0,95), Comportamentos pró-sociais (α = 0,90) e Agressividade direcionada aos professores (α = 0,90). Conclui-se que a EPPCACE é válida e fidedigna, podendo auxiliar na avaliação do contexto escolar a partir da percepção do professor acerca do comportamento agressivo dos alunos. (AU)

The objective of this study was to verify whether the psychometric patterns of the Scale of teachers' perception of aggressive behavior of children in school (EPPCACE) showed evidence of its internal validity. In Study 1 (n = 210) the instrument was adapted and an exploratory factorial analysis was performed. In Study 2 (n = 203) a confirmatory factorial analysis was performed. Elementary school teachers in public and private schools participated and answered the EPPCACE and sociodemographic questions. Results indicated that the instrument is composed of three factors: Aggressiveness directed to the general scope (α = 0.95), Pro-social behaviors (α = 0.90), and Aggressiveness directed to teachers (α = 0.90). We concluded that the EPPCACE is valid and reliable, and it can help in the evaluation of the school context from the teacher's perception of the aggressive behavior of the students. (AU)

El objetivo del presente estudio fue comprobar si los patrones psicométricos de la Escala de percepción de los maestros sobre el comportamiento agresivo de los niños en la escuela (EPPCACE) evidencian su validez interna. En el estudio 1 (n = 210) se realizó la adaptación del instrumento y se ejecutó un análisis factorial exploratorio. En el estudio 2 (n = 203) se efectuó un análisis factorial confirmatorio. Participaron maestros de Enseñanza Primaria de escuelas públicas y privadas. Estos respondieron a la EPPCACE y preguntas sociodemográficas. Los resultados indicaron que el instrumento está compuesto por tres factores: agresividad dirigida al ámbito general (α = 0,95), comportamientos pro-sociales (α = 0,90) y agresividad dirigida a los maestros (α = 0,90). Se concluye que la EPPCACE es válida y fidedigna, pudiendo auxiliar en la evaluación del contexto escolar a partir de la percepción del maestro sobre el comportamiento agresivo de los alumnos. (AU)

Impacto da perícia na decisão sentencial trabalhista na área de saúde / Expertise impact on labor sentence decision on health

A perícia é uma ferramenta utilizada pelo sistema judiciário para que informações técnicas adicionais ou de melhor acurácia sejam apuradas e possam assim auxiliar na tomada de decisão sentencial. O presente estudo tem a proposta de analisar laudos de jurisprudências da justiça do trabalho visando determinar quão importante a perícia médica/odontológica tem sido para tomada de decisão pelo juiz.Trata-se de um estudo observacional, transversal, descritivo e analítico no qual foi realizado levantamento dos dados por meio de análise documental. Setenta e dois processos de ações trabalhistas foram avaliados e a seleção foi realizada eliminando-se as ementas repetidas e ações por dissídios coletivos resultando em 38 processos no período entre 1996 a 2014. As variáveis “DORT como consequência do dano” (p=0,1723), “Perícia do tipo médica/odontológica” (p=0,1504) e “Perícia do tipo Técnica” (p=0,1975) foram habilitadas para elaboração de modelo ajustado com emprego de regressão logística múltipla, método backward, com intervalo de confiança de 95%. As variáveis “Perícia do tipo Médica” (OR= 14,5319; IC 95%= 2,3263 a 90,7780) e “DORT como consequência do dano” (OR= 7,8989; IC 95%= 1,2755 a 48,9151) permaneceram no modelo ajustado final, revelando que a chance do juiz necessitar de perícia é 14 vezes maior quando esta é do tipo médica/odontológica e quando o dano sofrido envolve DORT, há 7,89 vezes mais chances de o juiz acatar a perícia. A análise do modelo ajustado com emprego da Curva ROC revelou ser muito boa sua capacidade preditiva (AUC=0,8661; SE=0,06194; IC 95%= 0,7163 a 0,9545). A perícia médica/odontológica possui alta relevância em ações trabalhistas, caracterizando-se como uma prova fundamental para a tomada de decisão pelos magistrados.

Expertise is a tool used by the judiciary for additional technical information or better accuracy can be cleared and can be assist in making decision sentence. This study is the proposal to examine case law reports of the labor courts in order to determine how important the medical/dental expertise has been for decision making by the judge. This is an observational, cross-sectional, descriptive and analytical study that was conducted through the data of document analysis. Seventy-two cases of labor claims have been assessed and the selection was carried out eliminating the repeated menus and actions for collective bargaining resulting in 38 cases from 1996 to 2014. The variables "WRMD as a result of damage" (p=0,1723), "Medical/dental Expertise" (p=0.1504) and "Technical Expertise" (p=0.1975) were able to elaborate adjusted model with the use of multiple logistic regression, backward method, with 95% confidence interval. The variable “Medical Expertise"(OR= 14,5319; IC 95%= 2,3263 to 90,7780) and "WRMD as a result of damage" (OR= 7,8989; IC 95%= 1,2755 to 48,9151) remained in the final model adjusted, revealing that the chance of the judge require expertise is 14 times more than when it is the medical /dental type and when the damage suffered involves WRMD there is 7,89 times more chance to the judge accept expertise. The analysis of the adjusted model with use of ROC curve was found to be very good its predictive capacity (AUC= 0,8661; SE= 0,06194; IC 95%= 0,7163 to 0,9545). The medical/dental expertise is of high relevance to labor actions, characterized as a essential proof for decision making by judges.

Transmission of composite polymerization contraction force through a flowable composite and a resin-modified glass ionomer cement

The purpose of this study was to evaluate the individual contraction force during polymerization of a composite resin (Z-250), a flowable composite (Filtek Flow, FF) and a resin-modified glass ionomer cement (Vitrebond, VB), and the transmission of Z-250 composite resin polymerization contraction force through different thicknesses of FF and VB. The experiment setup consisted of two identical parallel steel plates connected to a universal testing machine. One was fixed to a transversal base and the other to the equipment's cross head. The evaluated materials were inserted into a 1-mm space between the steel plates or between the inferior steel plate and a previously polymerized layer of an intermediate material (either FF or VB) adhered to the upper steel plate. The composite resin was light-cured with a halogen lamp with light intensity of 500 mW/cm² for 60 s. A force/time graph was obtained for each sample for up to 120 s. Seven groups of 10 specimens each were evaluated: G1: Z-250; G2: FF; G3: VB; G4: Z-250 through a 0.5-mm layer of FF; G5: Z-250 through a 1-mm layer of FF; G6: Z-250 through a 0.5-mm of VB; G7: Z-250 through a 1-mm layer of VB. They were averaged and compared using one-way ANOVA and Tukey test at a = 0.05. The obtained contraction forces were: G1: 6.3N + 0.2N; G2: 9.8 + 0.2N; G3: 1.8 + 0.2N; G4: 6.8N + 0.2N; G5: 6.9N + 0.3N; G6: 4.0N + 0.4N and G7: 2.8N + 0.4N. The use of VB as an intermediate layer promoted a significant decrease in polymerization contraction force values of the restorative system, regardless of material thickness. The use of FF as an intermediate layer promoted an increase in polymerization contraction force values with both material thicknesses.

Crenças e influências sobre dietas de emagrecimento entre obesos de baixa renda / Beliefs and influences on weight loss diets among low-income obese individuals

A obesidade tornou-se uma epidemia carente de controle imediato, principalmente entre pobres, mulheres e pessoas de baixa escolaridade. A OMS solicita e vários estudos corroboram que estudos esclarecedores sobre os comportamentos psicológicos e sociais interferentes na aderência terapêutica aos regimes devem ser encorajados. Este estudo usou a Teoria da Ação Racional - TAR, de M. Fishbein, em Psicologia Social, e comparou duas séries de entrevistas abertas (em 2001 e 2005) que eliciaram as crenças positivas (vantagens) e negativas (desvantagens) sobre fazer dieta entre obesos de baixa renda de João Pessoa, Paraíba, além dos referentes (pessoas de opinião influente) destes pacientes quanto a segui-la. Os resultados de 2001 foram corroborados em 2005, revelando o medo das doenças relacionadas à obesidade e a vontade de sentir mais saúde e leveza de corpo. Mães, filhos e principalmente o cônjuge aparecem como apoiadores do regime. Ressaltou-se que não bastaria força de vontade, mas também reflexão e construção de habilidades de controle, apropriação e modificação das condições de vida. Preocupações estéticas não foram prioritárias. Estas informações podem fomentar melhores resultados na aderência terapêutica.

Obesity has become an epidemic that requires immediate control, mainly among the poor, particularly women and the less educated. The WHO requests and several studies confirm that support is needed for research projects examining psychological and social behavior that hampers compliance with weight loss diets. This paper uses the Theory of Reasoned Action (TRA) of M. Fishbein (1975) in social psychology, comparing two series of open interviews (conducted in 2001 and 2005) that disclosed positive (advantageous) and negative (harmful) beliefs about weight loss diets among low-income obese patients in João Pessoa, Paraíba State, as well as their guides (people of influential opinion) on following their diets. The 2001 findings were corroborated in 2005, revealing fears of diseases related to obesity and the wish to feel healthier and lighter. Mothers, children and above all spouses were mentioned as diet supporters. It was stressed that will-power is not be enough, but also reflection and building up control skills, in addition to allocating and altering life styles. Concerns related to appearance were not high priority. This information may lead to better diet compliance.

Transmission of composite polymerization contraction force through a flowable composite and a resin-modified glass ionomer cement.

The purpose of this study was to evaluate the individual contraction force during polymerization of a composite resin (Z-250), a flowable composite (Filtek Flow, FF) and a resin-modified glass ionomer cement (Vitrebond, VB), and the transmission of Z-250 composite resin polymerization contraction force through different thicknesses of FF and VB. The experiment setup consisted of two identical parallel steel plates connected to a universal testing machine. One was fixed to a transversal base and the other to the equipment's cross head. The evaluated materials were inserted into a 1-mm space between the steel plates or between the inferior steel plate and a previously polymerized layer of an intermediate material (either FF or VB) adhered to the upper steel plate. The composite resin was light-cured with a halogen lamp with light intensity of 500 mW/cm(2) for 60 s. A force/time graph was obtained for each sample for up to 120 s. Seven groups of 10 specimens each were evaluated: G1: Z-250; G2: FF; G3: VB; G4: Z-250 through a 0.5-mm layer of FF; G5: Z-250 through a 1-mm layer of FF; G6: Z-250 through a 0.5-mm of VB; G7: Z-250 through a 1-mm layer of VB. They were averaged and compared using one-way ANOVA and Tukey test at a = 0.05. The obtained contraction forces were: G1: 6.3N + 0.2N; G2: 9.8 + 0.2N; G3: 1.8 + 0.2N; G4: 6.8N + 0.2N; G5: 6.9N + 0.3N; G6: 4.0N + 0.4N and G7: 2.8N + 0.4N. The use of VB as an intermediate layer promoted a significant decrease in polymerization contraction force values of the restorative system, regardless of material thickness. The use of FF as an intermediate layer promoted an increase in polymerization contraction force values with both material thicknesses.

[Beliefs and influences on weight loss diets among low-income obese individuals]. / Crenças e influências sobre dietas de emagrecimento entre obesos de baixa renda.

Obesity has become an epidemic that requires immediate control, mainly among the poor, particularly women and the less educated. The WHO requests and several studies confirm that support is needed for research projects examining psychological and social behavior that hampers compliance with weight loss diets. This paper uses the Theory of Reasoned Action (TRA) of M. Fishbein (1975) in social psychology, comparing two series of open interviews (conducted in 2001 and 2005) that disclosed positive (advantageous) and negative (harmful) beliefs about weight loss diets among low-income obese patients in João Pessoa, Paraíba State, as well as their guides (people of influential opinion) on following their diets. The 2001 findings were corroborated in 2005, revealing fears of diseases related to obesity and the wish to feel healthier and lighter. Mothers, children and above all spouses were mentioned as diet supporters. It was stressed that will-power is not be enough, but also reflection and building up control skills, in addition to allocating and altering life styles. Concerns related to appearance were not high priority. This information may lead to better diet compliance.

Influence of light intensity and curing cycle on microleakage of Class V composite resin restorations

O objetivo deste estudo foi determinar o efeito da polimerização gradual, mediante a utilização de aparelhos de Quartzo-Tungustênio-Halógena (QTH) e Arco de Plasma de Xenônio (PAC), no selamento marginal de restaurações classe V em resina composta com margens localizadas em dentina. Setenta e cinco incisivos bovinos receberam preparos de cavidades classe V, na raiz, com o intuito de situar as margens cavitárias em dentina. Os dentes foram divididos em cinco grupos de acordo com o método de fotoativação. As cavidades, depois de condicionadas, foram tratadas com o sistema adesivo Single Bond (3M Dental) e restauradas com a resina composta Z100 (3M Dental) pela técnica incremental. A fotoativação foi realizada para cada grupo como descrito a seguir: Grupo I: PAC pelo método de fotoativação constante: 1600mW/cm2 – 3s; Grupo II: PAC pelo método de fotoativação por passos (800mW/cm2 – 2s, subindo automaticamente para 1600mW/cm2 – 4s); Grupo III: QTH pelo método de fotoativação constante: 400 mW/cm2 – 40s; Grupo IV: QTH pelo método de fotoativação em rampa: 100 a 600 mW/cm2 – 15s, permanecendo a 600mW/cm2 por mais 25s; Grupo V: QTH pelo método de fotoativação por pulso: 200 mW/cm2 – 3s, tempo de espera de 3min.e a seguir 600mW/cm2 – 30s. Os dentes foram armazenados em água destilada a 37ºC por 30 dias e então submetidos à ciclagem térmica, por 500 ciclos à 5 ºC e 55 ºC. Os ápices dos dentes foram selados com resina composta e os dentes foram cobertos com duas camadas de esmalte para unha, antes da sua imersão em fucsina básica a 0,5%. Os dentes foram seccionados e os cortes foram escaneados para avaliação da área infiltrada por corante por um programa de computador (Image Tools). Os cortes foram também visualizados com lupa para a determinação do grau de penetração do corante na interface dente-restauração por escores. Diferenças estatisticamente significantes foram observadas entre os grupos quanto ao grau e à área de penetração de corante (p < 0,05). Os grupos I e II apresentaram valores significantemente mais altos de infiltração e penetração do corante que os grupos III, IV e V. Em conclusão, o uso da fonte de PAC, no modo constante e por passos, resultou em valores significantemente maiores de infiltração marginal quando comparados com a intensidade de luz média emitida pelos aparelhos de QTH. Os métodos de fotoativação por pulso, rampa e continuo com a fonte de QTH resultaram num grau similar de microinfiltração.

Psicologia e nutrição: predizendo a intenção comportamental de aderir a dietas de redução de peso entre obesos de baixa renda / Psychology and nutrition: predicting behavioral intention to follow weight reduction diets among low-income obese patients

O presente estudo foi realizado entre 189 obesos de baixa renda atendidos por nutricionistas na rede pública de saúde de João Pessoa, Paraíba. Levantou as crenças positivas e negativas e os referentes mais expressivos sobre estes pacientes quanto ao comportamento de seguir uma dieta médica para redução de peso. Um instrumento de medida da intenção comportamental de efetivamente seguir tais dietas foi construído, o que permitiu verificar a ênfase do aspecto normativo geral e atitudinal nos obesos com renda de até um salário-mínimo sobre sua intenção comportamental. Isto pode indicar dois pontos eficazes a serem explorados em comunicações dirigidas a esta classe social em campanhas de saúde para redução de peso. Esta medição torna-se útil para ações preventivas de saúde; a obesidade é considerada uma epidemia mundial carente de controle imediato, aumentando em incidência principalmente nas classes mais baixas dos países em desenvolvimento.(AU)

The present study was accomplished with 189 low income obese attended by public health nutritionists of João Pessoa, Paraíba. We found out positive and negative beliefs plus the most expressive referees on these patients about the behavior of following a medical diet to reduce weight. This permitted to build a behavioral intention measurement instrument to check those who might really follow these diets. It was verified the emphasis on general normative and attitudinal aspects over obese who had up to one minimum-wage income. This may indicate two efficacious points to be explored on targeted communications to this social class during weight loss public health campaigns. This measurement can be turned into preventive health actions; obesity is considered worldwide as epidemics, in need of immediate control, growing in incidence mainly among lower ranks of the population of developing countries.(AU)

Psicologia e nutrição: predizendo a intenção comportamental de aderir a dietas de redução de peso entre obesos de baixa renda / Psychology and nutrition: predicting behavioral intention to follow weight reduction diets among low-income obese patients

O presente estudo foi realizado entre 189 obesos de baixa renda atendidos por nutricionistas na rede pública de saúde de João Pessoa, Paraíba. Levantou as crenças positivas e negativas e os referentes mais expressivos sobre estes pacientes quanto ao comportamento de seguir uma dieta médica para redução de peso. Um instrumento de medida da intenção comportamental de efetivamente seguir tais dietas foi construído, o que permitiu verificar a ênfase do aspecto normativo geral e atitudinal nos obesos com renda de até um salário-mínimo sobre sua intenção comportamental. Isto pode indicar dois pontos eficazes a serem explorados em comunicações dirigidas a esta classe social em campanhas de saúde para redução de peso. Esta medição torna-se útil para ações preventivas de saúde; a obesidade é considerada uma epidemia mundial carente de controle imediato, aumentando em incidência principalmente nas classes mais baixas dos países em desenvolvimento.

The present study was accomplished with 189 low income obese attended by public health nutritionists of João Pessoa, Paraíba. We found out positive and negative beliefs plus the most expressive referees on these patients about the behavior of following a medical diet to reduce weight. This permitted to build a behavioral intention measurement instrument to check those who might really follow these diets. It was verified the emphasis on general normative and attitudinal aspects over obese who had up to one minimum-wage income. This may indicate two efficacious points to be explored on targeted communications to this social class during weight loss public health campaigns. This measurement can be turned into preventive health actions; obesity is considered worldwide as epidemics, in need of immediate control, growing in incidence mainly among lower ranks of the population of developing countries.

Influence of light intensity and curing cycle on microleakage of Class V composite resin restorations.

The aim of this study was to determine the effect of a softstart polymerization method from Quartz-Tungsten-Halogen (QTH) and Plasma Arc (PAC) curing units on microleakage of Class V composite resin restorations with dentin cavosurface margins. Seventy-five bovine incisors received standardized class V cavities in all dentin margins. Teeth were divided into 5 equal groups according to the curing cycle. The cavities were incrementally restored with a composite resin (Single Bond/Z-100, 3M). Light curing was applied as follows: Group I: PAC light continuous-cycle curing at 1600 mW/cm² for 3s; Group II: PAC light step-cycle curing (2s at 800 mW/cm² then 4s at 1600 mW/cm²); Group III: QTH light continuous-cycle curing at 400 mW/cm² for 40s; Group IV: QTH light ramp-cycle curing (from 100 to 600 mW/cm² in 15s followed by 25s at 600 mW/cm²); Group V: QTH light pulse-delay curing (200 mW/cm² for 3s followed by 3 min delay then 600 mW/cm² for 30s). Teeth were stored in distilled water at 37ºC for 30 days and then subjected to thermocycling for 500 cycles at 5 and 55ºC. Root apices were sealed and teeth coated with nail varnish before they were immersed in 0.5% fuchsine red dye solution. Teeth were then sectioned and slices were scanned with a computer scanner to determine the area of dye leakage using a computer program (Image Tools). Images of tooth slices were also visually examined under magnification and dye penetration along the tooth/restoration interface was scored. Significant differences in the degree of dye penetration and leakage were detected between groups (p<.05). Groups I and II had significantly higher values of dye penetration and leakage than groups III, IV and V. In conclusion, the use of PAC light curing in a continuous or step cycle modes resulted in increased microleakage of Class V resin composite restorations compared with medium intensity QTH light curing. Pulse, ramp and continuous-cycle curing modes with QTH light resulted in similar degrees of microleakage.

Métodos inovadores do tratamento da obesidade / Innovative Methods to Treat Obesity

A obesidade tornou-se uma patologia epidêmica e prioritária para estudo, e seu controle foi aconselhado em caráter emergencial pela OMS. Os resultados obtidos no controle da obesidade subsidiado por tratamento médico e dietoterapia não têm se mostrado tão eficazes. O emprego da psicologia social no tratamento da obesidade deveria ser mais explorado, considerando-se que através de abordagem cognitivo-comportamentais, tem-se obtido êxito na modificação de comportamento ligados à saúde, especialmente a Teoria da Ação Racional, que busca medir a intenção pessoal de aderir a uma modificação de hábitos para, através de comunicações persuasivas específicas, promover a adesão a comportamentos mais saudáveis. Verifica-se ainda um número pequeno de estudos contemplando Nutrição e Psicologia. Estas disciplinas estão separadas pela tradição acadêmica, mas interligam-se inevitavelmente no contexto da Saúde Pública, especialmente no tratamento da obesidade. Espera-se que futuramente a utilização desta teoria conjuntamente com o tratamento nutricional inovador leve os pacientes obesos a assumir comportamentos mais favoráveis à perda de peso, aumentando sua persistência terapêutica