A utilização de torques resistentes ao movimento compensatório dos dentes anteriores no tratamento da Classe III no paciente adulto / The use of torques resistant to compensatory movement of anterior teeth in the treatment of Class III in adult patients

Este trabalho visou relatar o caso clínico de um paciente padrão III com mordida cruzada anterior, através de um tratamento compensatório com o uso de bráquetes que geram torques resistentes nos incisivos. O paciente JPCN, 42 anos, leucoderma, gênero masculino, procurou a clínica ortodôntica com a queixa principal de mordida cruzada anterior. Na análise extrabucal, observou-se a presença de padrão horizontal, simetria facial, maxila deficiente, ângulo nasolabial fechado, presença de selamento labial passivo e perfil côncavo com o lábio inferior à frente do superior. A prescrição utilizada foi a biofuncional, apresentado 0° de torque nos incisivos superiores e 10° nos incisivos inferiores. Foram realizados o alinhamento e nivelamento, mecânica de acentuação da curva de Spee no arco superior e reversão no arco inferior simultaneamente aos elásticos intermaxilares. Ao final do tratamento, foram observados correção da relação anteroposterior e intercuspidação dentária, trespasse horizontal e vertical normais, linhas médias coincidentes e selamento labial passivo. Concluiu-se que a utilização de torques resistentes nos incisivos gerados pelo uso de bráquetes da técnica biofuncional foi eficiente para manter uma boa inclinação desses dentes durante a correção damá oclusão de Classe III com o uso de elásticos intermaxilares (AU)

This study aimed to report the clinical case of a patient with pattern III with anterior crossbite, through a compensatory treatment with the use of brackets that generate resistant torques in the incisors. Patient JPCN, 42 years old, caucasian, male, came to the orthodontic clinic with the main complaint of anterior crossbite. In the extraoral analysis, it was observed the presence of a horizontal pattern, facial symmetry, deficient maxilla, closed nasolabial angle, presence of passive lip seal, and concave profile with the lower lip in front of the upper. The prescription used was the biofunctional, with 0° of torque on the upper incisors and 10° on the lower incisors. Alignment and leveling, orthodontic mechanics of Spee curve accentuation in the maxillary arch and reversal in the mandibular arch were performed simultaneously with intermaxillary elastics. At the end of the treatment, Class III correction, correction of the anteroposterior relationship and dental intercuspation, normal overbite and overjet, coinci-dent midlines and passive lip seal were observed. It was concluded that the use of resistant torques on the incisors promoted by the use of biofunctional technique brackets was efficient to maintain a good inclination of these teeth during the correction of Class III malocclusion with the use of intermaxillary elastics (AU)

Effect of Photobiomodulation Combined with Physiotherapy on Functional Performance in Children with Myelomeningo-Cele-Randomized, Blind, Clinical Trial.

BACKGROUND: This study aimed to evaluate the electrical activity of the rectus femoris, tibialis anterior, and lateral gastrocnemius muscles during the sit-to-stand task and functional mobility after a neurofunctional physiotherapy protocol associated with PBM. METHODS: Twenty-five children were randomly allocated to either Active PBM + physiotherapy (n = 13) or PBM sham + physiotherapy (n = 12). PBM was carried out with a LED device (850 nm, 25 J, 50 s per point and 200 mW) at four points over the area with absence of a spiny process. Both groups completed a twelve-week supervised program with two weekly 45-60 min sessions. Pre-training and post-training assessments involved the Pediatric Evaluation of Disability Inventory (PEDI). Muscle activity was assessed using portable electromyography (BTS Engineering) and the electrodes were positioned on the lateral gastrocnemius, anterior tibialis, and rectus femoris muscles. The RMS data were recorded and analyzed. RESULTS: After 24 sessions of the treatment protocol, improvements were found in the PEDI score. The participants presented greater independence in performing the tasks, requiring less assistance from their caregivers. More significant electrical activity was found in the three muscles evaluated between the rest period and execution of the sit-to-stand tasks, both in the more compromised or less compromised lower limbs. CONCLUSION: Neurofunctional physiotherapy with or without PBM improved functional mobility and electrical muscle activity in children with myelomeningocele.

NEOTROPICAL FRESHWATER FISHES: A dataset of occurrence and abundance of freshwater fishes in the Neotropics.

The Neotropical region hosts 4225 freshwater fish species, ranking first among the world's most diverse regions for freshwater fishes. Our NEOTROPICAL FRESHWATER FISHES data set is the first to produce a large-scale Neotropical freshwater fish inventory, covering the entire Neotropical region from Mexico and the Caribbean in the north to the southern limits in Argentina, Paraguay, Chile, and Uruguay. We compiled 185,787 distribution records, with unique georeferenced coordinates, for the 4225 species, represented by occurrence and abundance data. The number of species for the most numerous orders are as follows: Characiformes (1289), Siluriformes (1384), Cichliformes (354), Cyprinodontiformes (245), and Gymnotiformes (135). The most recorded species was the characid Astyanax fasciatus (4696 records). We registered 116,802 distribution records for native species, compared to 1802 distribution records for nonnative species. The main aim of the NEOTROPICAL FRESHWATER FISHES data set was to make these occurrence and abundance data accessible for international researchers to develop ecological and macroecological studies, from local to regional scales, with focal fish species, families, or orders. We anticipate that the NEOTROPICAL FRESHWATER FISHES data set will be valuable for studies on a wide range of ecological processes, such as trophic cascades, fishery pressure, the effects of habitat loss and fragmentation, and the impacts of species invasion and climate change. There are no copyright restrictions on the data, and please cite this data paper when using the data in publications.

Enseñanza de la seguridad del paciente en el grado de enfermería / O ensino da segurança do paciente na graduação em enfermagem / Teaching Patient Safety in the Undergraduate Nursing Degree

Introducción: La importancia de utilizar metodologías/estrategias de enseñanza que incentiven la reflexión y la develación de nuevos conceptos se hace notar, así como la creación de problemas por parte del alumno, que tomen en cuenta no solo los conocimientos técnico-científicos, sino también los aspectos subjetivos del cuidado en salud. Objetivo: Identificar la evidencia en la literatura científica sobre los contenidos cubiertos y las metodologías/estrategias utilizadas para la enseñanza de la seguridad del paciente en los cursos de grado en enfermería. Métodos: Revisión de alcance, cuya recolección de datos se realizó en las bases de datos - Literatura Latino-americana e do Caribe em Ciências da Saúde, Catálogo de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Repositório Científico de Acesso Aberto de Portugal, MEDLINE/ PubMed, Cumulative Index of Nursing and Allied Health, Scopus, Web of Science, Education Resources Information Center, The National Library of Australia's, Electronic Theses Online Service, National ETD Portal e Theses Canada. Los criterios de inclusión fueron: artículos científicos, disertaciones y tesis disponibles en su totalidad y que describieran los contenidos y estrategias/metodologías que se han abordado en la enseñanza de la seguridad del paciente en el grado en enfermería. Se excluyeron editoriales, artículos de opinión, ensayos teóricos/reflexivos y reseñas. Los resultados se sintetizaron y se presentaron en figuras y tablas. Conclusión: Los enfoques pedagógicos se mantuvieron centrados en el docente, valorando la transmisión de contenidos y el desarrollo de competencias como condición sine qua non para la formación de los estudiantes(AU)

Introdução: denota-se a importância da utilização de metodologias/estratégias de ensino que estimulem a reflexão e o desvelar de novos conceitos, assim como a criação de problemas pelo discente, que considerem não somente os conhecimentos técnico-científicos, mas também os aspectos subjetivos do cuidar em saúde. Objetivo: identificar as evidências na literatura científica sobre os conteúdos abordados e as metodologias/estratégias empregadas para o ensino da segurança do paciente em cursos de Graduação em Enfermagem. Métodos: revisão de escopo, cuja coleta de dados foi realizada nas bases de dados - Literatura Latino-americana e do Caribe em Ciências da Saúde, Catálogo de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Repositório Científico de Acesso Aberto de Portugal, MEDLINE/ PubMed, Cumulative Index of Nursing and Allied Health, Scopus, Web of Science, Education Resources Information Center, The National Library of Australia's, Electronic Theses Online Service, National ETD Portal e Theses Canada. Os critérios de inclusão foram: artigos científicos, dissertações e teses disponíveis na íntegra e que descrevessem conteúdos e estratégias/metodologias que vêm sendo abordados no ensino da segurança do paciente na Graduação em Enfermagem. Foram excluídos editoriais, artigos de opinião, ensaios teóricos/reflexivos e revisões. Os resultados foram sintetizados de forma descritiva e apresentados em forma de figura e quadros. Conclusão: observou-se que as abordagens pedagógicas permaneceram centrada no docente, valorizando a transmissão de conteúdos e o desenvolvimento de competências como condição sine qua non para a formação do discente(AU)

Introduction: The importance of using teaching methodologies/strategies that encourage reflection and the unveiling of new concepts is noted, as well as the creation of problems by the student, which take into account not only technical-scientific knowledge, but also the subjective aspects of health care. Objective: To identify the evidence in the scientific literature on the contents covered and the methodologies/strategies used for teaching patient safety in undergraduate nursing courses. Methods: Scoping review, whose data collection was performed in the databases - Literatura Latino-americana e do Caribe em Ciências da Saúde, Catálogo de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Repositório Científico de Acesso Aberto de Portugal, MEDLINE/ PubMed, Cumulative Index of Nursing and Allied Health, Scopus, Web of Science, Education Resources Information Center, The National Library of Australia's, Electronic Theses Online Service, National ETD Portal e Theses Canada. Inclusion criteria were: scientific articles, dissertations and theses available in their entirety and describing the content and strategies/methodologies that have been addressed in the teaching of patient safety in undergraduate nursing. Editorials, opinion pieces, theoretical/reflective essays, and reviews were excluded. Results were synthesized and presented in figures and tables. Conclusion: Pedagogical approaches remained teacher-centered, valuing the transmission of content and the development of competencies as a sine qua non condition for student training(AU)

Vascular photobiomodulation in the treatment of children with temporomandibular disorders: Study protocol for a randomized, controlled, blind, clinical trial.

BACKGROUND: This study aims to verify if the use of intravascular laser irradiation of blood (ILIB) influences the reduction of pain and increases the range of motion in opening and closing of the mouth in children and adolescents with temporomandibular disorders (TMD). METHODS: This will be a blind, randomized, and controlled clinical trial, which will be carried out on children between 6 and 12 years of age who enter the Catholic University of Uruguay, Faculty of Health Sciences, Postgraduate School, for treatment. To be included, children must present temporomandibular disorders, based on the diagnostic criteria will be the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Forty-five participants will be randomized to three groups: Group 1-ILIB with 2 sessions of 20 minutes for 12 weeks (n = 15); Group 2-Placebo laser application with 2 sessions of 20 minutes for 12 weeks (n = 15); Group 3-Control with no treatment (n = 15). Irradiation will be performed by continuous and direct transcutaneous application to the radial artery, by means of a bracelet that inserts the laser beam. The laser to be used is infrared, power 100 mW ± 20%, wavelength 808 nm ± 10 nm, continuous application. RDC/TMD and pain evaluated through a visual analog scale will be the outcome measures. DISCUSSION: Due to the low level of evidence, new studies are needed on the effect of ILIB in children with TMD.

Supervisões clínicas: vivências emocionais dos psicoterapeutas-aprendizes / Clinical supervision: emotional experiences of apprentice psychotherapists

Considerando a supervisão clínica como um dos pilares da formação do psicólogo clínico, o presente estudo teve por objetivo investigar as emoções vivenciadas pelos psicoterapeutas-aprendizes durante as supervisões de estágio em psicoterapia psicanalítica. Realizou-se um estudo clínico-qualitativo por meio de entrevistas com 27 acadêmicos que realizavam estágios em psicoterapia psicanalítica, em quatro Instituições de Ensino Superior. Os dados coletados foram submetidos à análise de conteúdo e discutidos a partir do referencial psicanalítico. A análise dos resultados demonstrou que as vivências emocionais dos psicoterapeutas-aprendizes estavam relacionadas, preponderantemente: à aprendizagem de conteúdos teórico-metodológicos e à necessidade de ser acolhido e de compartilhar com o grupo de supervisão as intensidades emocionais vivenciadas na clínica. Finalmente, ressaltou-se a necessidade de acolher e compreender as experiências emocionais dos psicoterapeutas-aprendizes durante os estágios em psicoterapia psicanalítica.

Effect of photobiomodulation on fatigue in individuals with relapsing-remitting multiple sclerosis: a pilot study.

Multiple sclerosis is an autoimmune disease of the central nervous system characterized by inflammation and destruction of the myelin sheath. Fatigue is one of the main symptoms of this disease, with a negative impact on quality of life and few treatment options. Photobiomodulation is used for several inflammatory conditions and may be beneficial for the treatment of fatigue in individuals with multiple sclerosis. Conduct a pilot study to analyze the effect of photobiomodulation on fatigue in individuals with relapsing-remitting multiple sclerosis. The participants were recruited from the UNINOVE Integrated Health Clinic and randomly allocated to two groups: group 1, administration of photobiomodulation (808 nm, 36 J for 360 s) under the tongue and group 2, administration of photobiomodulation over the radial artery. Fatigue was measured using the Modified Fatigue Impact Scale (MFIS). No significant differences were found regarding the total MFIS score or subscale scores (p < 0.05, two-way ANOVA). Photobiomodulation with the parameters employed in the present study had no effect on fatigue in individuals with multiple sclerosis. ClinicalTrials.gov Identifier: NCT03360487.

AMAZONIA CAMTRAP: A data set of mammal, bird, and reptile species recorded with camera traps in the Amazon forest.

The Amazon forest has the highest biodiversity on Earth. However, information on Amazonian vertebrate diversity is still deficient and scattered across the published, peer-reviewed, and gray literature and in unpublished raw data. Camera traps are an effective non-invasive method of surveying vertebrates, applicable to different scales of time and space. In this study, we organized and standardized camera trap records from different Amazon regions to compile the most extensive data set of inventories of mammal, bird, and reptile species ever assembled for the area. The complete data set comprises 154,123 records of 317 species (185 birds, 119 mammals, and 13 reptiles) gathered from surveys from the Amazonian portion of eight countries (Brazil, Bolivia, Colombia, Ecuador, French Guiana, Peru, Suriname, and Venezuela). The most frequently recorded species per taxa were: mammals: Cuniculus paca (11,907 records); birds: Pauxi tuberosa (3713 records); and reptiles: Tupinambis teguixin (716 records). The information detailed in this data paper opens up opportunities for new ecological studies at different spatial and temporal scales, allowing for a more accurate evaluation of the effects of habitat loss, fragmentation, climate change, and other human-mediated defaunation processes in one of the most important and threatened tropical environments in the world. The data set is not copyright restricted; please cite this data paper when using its data in publications and we also request that researchers and educators inform us of how they are using these data.

Photobiomodulation for the Treatment of Primary Headache: Systematic Review of Randomized Clinical Trials.

The purpose of this study was to evaluate the efficacy and safety of photobiomodulation as an adjuvant treatment for primary headache. A systematic review of randomized clinical trials was performed. For such, electronic searches were performed in the MEDLINE, Embase, Cochrane Library, LILACS, PEDro, PsycInfo, Clinicaltrials.gov., and WHO/ICTRP databases, with no restrictions imposed regarding language or year of publication. We included studies that assessed any photobiomodulation therapy as an adjuvant treatment for primary headache compared to sham treatment, no treatment, or another intervention. The methodological assessment was conducted using the Cochrane Risk of Bias tool. The certainty of the evidence was classified using the GRADE approach. Four randomized clinical trials were included. Most of the included studies had an overall high risk of bias. Compared to sham treatment, photobiomodulation had a clinically important effect on pain in individuals with primary headache. Despite the benefits reported for other outcomes, the estimates were imprecise, and the certainty of the evidence was graded as low. These findings are considered insufficient to support the use of photobiomodulation in the treatment of primary headache. Randomized clinical trials, with higher methodological quality, are needed to enhance the reliability of the estimated effects.

Effect of antimicrobial photodynamic therapy with red led and methylene blue on the reduction of halitosis: controlled microbiological clinical trial.

To determine the effect of antimicrobial photodynamic therapy (aPDT) using a red light-emitting diode (LED) on the reduction of halitosis and microbiological levels in the tongue coating immediately after irradiation, 7, 14, and 30 days after treatment. Forty-five young adults diagnosed with halitosis were allocated to three groups: G1, aPDT with 0.005% methylene blue and red LED (660 nm, four irradiation points, 90 s per point, power of 400 mW, 36 J per point, radiant exposure of 95 J/cm2, continuous wave); G2, tongue scraping; and G3, tongue scraping and aPDT. Gas chromatography was performed before and immediately after treatment, as well as at the different follow-up times. Microbiological samples were collected at the same times from the dorsum of the tongue, and bacteria were quantified in the samples using real-time PCRq. The Wilcoxon test was used for the intragroup analyses, and the Kruskal-Wallis test was used for the intergroup analyses. In the intragroup analyses, differences were found before and immediately after treatment in all groups (p < 0.05). The effect was maintained after 7 days only in the tongue scraping group (p < 0.05). In the intergroup analysis, no statistically significant differences were found among the groups (p > 0.05). For the microbiological analyses, no statistically significant differences were found in the groups/bacteria that were analyzed (p > 0.05). aPDT using a red LED and 0.005% methylene blue caused an immediate reduction in halitosis, but the effect was not maintained after 7, 14, or 30 days. No reduction occurred in the number of bacteria investigated or the quantification of universal 16S rRNA. ClinicalTrials.gov Identifier: NCT03656419.

Não é somente sobre Kevin que precisamos falar / No es solo Kevin de quien tenemos que hablar / It's not just Kevin that we need to talk about / Il n'y a pas que Kevin dont nous devons parler

O objetivo deste estudo consiste em apresentar uma análise do filme Precisamos falar sobre Kevin, partindo das reflexões teóricas de Jean Laplanche sobre a teoria da sedução generalizada. O artigo apresenta as contribuições teóricas do autor e de seus seguidores, principalmente no que diz respeito às mensagens enigmáticas e à construção de um modelo tópico e unificado do aparelho psíquico. A análise do filme permitiu chamar a atenção para os efeitos das vicissitudes da sedução, explorando as especificidades presentes na comunicação entre o adulto e a criança que repercutem sobre as possibilidades de tradução das mensagens enigmáticas e seus efeitos na constituição do psiquismo. Verifica-se a fecundidade do aporte teórico na compreensão do trauma psíquico infantil, uma vez que as consequências deste encontro assimétrico podem ser devastadoras e desorganizadoras, conforme elucidado pela história de Kevin

El objetivo de este estudio es presentar un análisis de la película Necesitamos hablar de Kevin, a partir de las reflexiones teóricas de Jean Laplanche sobre la teoría de la seducción generalizada. El artículo presenta los aportes teóricos del autor y sus seguidores, principalmente en lo que se refiere a los mensajes enigmáticos y la construcción de un modelo tópico y unificado del aparato psíquico. El análisis de la película permitió llamar la atención sobre los efectos de las vicisitudes de la seducción, explorando las especificidades presentes en la comunicación entre el adulto y el niño que inciden en las possibilidades de traducción de los mensajes enigmáticos y sus efectos en la constitución de la psique. Se verifica la fecundidad del aporte teórico en la comprensión del trauma psíquico infantil, ya que las consecuencias de este encuentro asimétrico pueden ser devastadoras y desorganizadoras, conforme esclarecido por la historia de Kevin

The aim of this study is to present an analysis of the film We need to talk about Kevin, based on the Jean Laplanche's theoretical reflections on the theory of generalized seduction. The article presents the theoretical contributions of the author and his followers, mainly with regard to the enigmatic messages and in the construction of a topical and unified model of the psychic apparatus. The film's analysis allowed to draw attention to the vicissitudes's effects of seduction, exploring the specificities present in the communication between the adult and child that reflect on the translation's possibilities of the enigmatic messages and their effects on the constitution of the psyche. It is verified the fecundity of the theoretical contribution to the understanding of the childhood psychic trauma, since the consequences of this asymmetrical encounter can be devastating and disorganizing, as elucidated by Kevin's story

Le but de cette étude est de présenter une analyse du film Nous devons parler de Kevin, à partir des réflexions théoriques de Jean Laplanche sur la théorie de la séduction généralisée. L'article présente les contributions théoriques de l'auteur et de ses adeptes, principalement en ce qui concerne les messages énigmatiques et dans la construction d'un modèle d'actualité et unifié de l'appareil psychique. L'analyse du film permis d'attirer l'attention sur les effets des vicissitudes de la séduction, explorant les spécificités présentes dans la communication entre l'adulte et l'enfant qui réfléchissent sur les possibilités de traduction des messages énigmatiques et leurs effets sur la constitution de la psyché. La fécondité de l'apport théorique à la compréhension du traumatisme psychique infantile est vérifiée, puisque les conséquencesde cette rencontre asymétrique peuvent être dévastatrices et désorganisantes, comme l'elucide par l'histoire de Kevin

Emoções vivenciadas pelos psicoterapeutas-aprendizes nos serviços-escolas: uma leitura psicanalítica / Emociones vivenciadas por los psicoterapeutas-aprendices em las escuelas-clínicas: una lectura psicanalítica / Emotions experienced by apprentice psychotherapists at school-clinics: a psychoanalytic reading

RESUMO Os atendimentos clínicos realizados nos serviços-escolas são permeados por uma série de experiências emocionais vivenciadas pela díade psicoterapeuta-aprendiz/paciente. Diante das diversas nuances da clínica psicanalítica, o psicoterapeuta-aprendiz vivencia experiências que refletem em sua subjetividade. Este estudo teve como objetivo investigar as vivências emocionais dos estudantes de graduação em psicologia durante os estágios em clínica psicanalítica e analisar as emoções percebidas em si mesmos pelos psicoterapeutas-aprendizes nos atendimentos em psicoterapia psicanalítica. Trata-se de um estudo clínico-qualitativo, utilizando-se o referencial teórico psicanalítico. Participaram 27 estudantes de psicologia, que realizavam atendimentos nos serviços-escolas de quatro Instituições de Ensino Superior. A coleta de dados foi realizada através de entrevistas semidirigidas, as quais foram submetidas à análise de conteúdo. Nos resultados observou-se a presença das vivências de ansiedade, medo, insegurança e nervosismo, presentes no processo psicoterapêutico. A identificação com as vivências emocionais dos pacientes e as dúvidas referentes à percepção das próprias emoções, foram importantes aspectos encontrados neste estudo. Tais resultados podem contribuir para a reflexão sobre a vivência desta experiência para o psicoterapeuta-aprendiz, a fim de melhor prepará-lo para os desafios da prática clínica psicanalítica.

RESUMEN Los atendimientos clínicos realizados en las escuelas clínicas están impregnados por una serie de experiencias emocionales vivenciadas por la díada psicoterapeuta-aprendiz / paciente. Ante los diversos matices de la clínica psicoanalítica, el psicoterapeuta-aprendiz vivencia experiencias que reflejan en su subjetividad. Este estudio tuvo como objetivo investigar las vivencias emocionales de los estudiantes de graduación en psicología durante las etapas en clínica psicoanalítica y analizar las emociones percibidas en sí mismos por los psicoterapeutas-aprendices en las atenciones en psicoterapia psicoanalítica. Se trata de un estudio clínico-cualitativo, utilizando el referencial teórico psicoanalítico. Participaron veintisiete estudiantes de psicología, que realizaban atendimientos en las escuelas clínicas de cuatro Instituciones de Enseñanza Superior. La recolección de datos fue realizada a través de entrevistas semidirigidas las cuales fueron sometidas a análisis de contenido. En los resultados se observó la presencia de las vivencias de ansiedad, miedo, inseguridad y nerviosismo, presentes en el proceso psicoterapéutico. La identificación con las vivencias emocionales de los pacientes y las dudas referentes a la percepción de las propias emociones, fueron importantes aspectos encontrados en este estudio. Tales resultados pueden contribuir a la reflexión sobre la vivencia de esta experiencia para el psicoterapeuta-aprendiz, a fin de prepararlo mejor para los desafíos de la práctica clínica psicoanalítica.

ABSTRACT The psychotherapeutic clinic services in the school-clinics are permeated by a series of emotional experiences lived by the apprentice psychotherapist/patient dyad. In the light of the various nuances of the psychoanalytic practice, the apprentice psychotherapist goes through experiences that reflect on his subjectivity. This study aimed to investigate the emotional experiences of undergraduate psychology students during their stages in school-clinics and to analyze the emotions perceived in themselves in the attendance in psychoanalytic psychotherapy. This is a clinical-qualitative study using the psychoanalytic theoretical framework. Twenty-seven psychology students participated in this study who attended the school-clinics of four Higher Education Institutions. Data collection was carried out through semi-structured interviews, which were submitted to content analysis. The results showed the presence of anxiety, fear, insecurity and nervousness feelings in the psychotherapeutic process. Identification with the emotional experiences of patients and doubts regarding the perception of their own emotions were essential aspects found in this study. Such results may contribute to the reflection on the experience of the apprentice psychotherapist to better prepare him for the challenges of psychoanalytic clinical practice.

Evaluation of the effects of high-level laser and electrocautery in lingual frenectomy surgeries in infants: protocol for a blinded randomised controlled clinical trial.

INTRODUCTION: Ankyloglossia (tongue-tie) is an anomaly characterised by an abnormally short, thick or small lingual frenulum that restricts tongue movements. This condition is considered one of the factors that can interfere with breast feeding by diminishing the ability of the newborn to latch adequately. According to the Brazilian Health Ministry, the prevalence of this anomaly among newborns is 3%-16%. Frenectomy is the most suitable surgical procedure for the treatment of ankyloglossia. The aim of this study is to compare the performance of electrocautery and high-power diode laser as forms of frenectomy. METHODS AND ANALYSIS: The proposed study will be a randomised, controlled, blind clinical trial involving the participation of healthy infants 0-3 months of age with breastfeeding difficulty and a diagnosis of tongue-tie with an indication for lingual frenectomy. The guardians will receive clarifications regarding the procedures and will authorise the participation of the infants by signing a statement of informed consent. A non-blinded researcher will perform the screening and procedures and a blinded researcher will perform the postoperative evaluations. Fifty-six infants will be randomly allocated into two groups (n=28): the electrocautery group or the high-power laser group. The preparation of the patients, asepsis and infection control procedures will rigorously follow biosafety norms. For both groups, patient histories will be taken, clinical evaluations will be performed and a standardised photograph of the lingual frenulum will be taken before surgery. The Bristol Tongue Assessment Tool will be used. We will evaluate pain in the mother during breast feeding before, immediately after, and 15 days after surgery. ETHICS AND DISSEMINATION: This protocol was submitted to the Research Ethics Committee of Nove de Julho University, having been given a favourable opinion (Number: 4387769). Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: NCT04487418.

Saúde da população negra e as ações educativas de uma escola do SUS em tempos de pandemia da covid-19 / Health of the black population and the educational actions of school from the unified health system during covid-19 pandemic / Salud de la población negra y acciones educativas de una escuela SUS en tiempos de la pandemia de covid-19

O estudo tem como objetivo evidenciar a necessidade de construção de propostas educativas que discutam o lugar do negro na sociedade brasileira e sua relação intrínseca com as determinações sociais de saúde, no contexto da pandemia da Covid-19. Trata-se de um relato de experiência da primeira turma do Curso de Atualização em Cuidado à Saúde da População Negra, desenvolvido pela Escola de Saúde Pública da Bahia Professor Jorge Novis (ESPBA), em parceria com a Diretoria de Gestão do Cuidado (DGC). O referido curso nasceu da necessidade de investir na implementação da política voltada para esse segmento social. No processo de estruturação do curso, foram realizadas reuniões com atores sociais relevantes, potenciais docentes, escolhidos pela aproximação com a temática e experiência com movimentos e causas sociais. No âmbito do SUS, as Escolas de Governo são responsáveis pelos processos formativos dos trabalhadores da saúde, sob a perspectiva da educação permanente. A inserção da temática da saúde da população negra nos currículos trabalhados se tornou imagem-objetivo a ser alcançada pela instituição, não apenas a partir dos cursos desenvolvidos, mas também com a realização de um estudo piloto para enfrentamento da Covid-19 em comunidades quilombolas do estado. Reconhecendo o racismo como um dos determinantes sociais do processo de adoecimento e morte, defende-se que gestores e profissionais de saúde tenham acesso a ações educativas que oportunizem a reflexão sobre os processos sócio-históricos de construção da nossa sociedade, ampliem o conhecimento sobre a saúde da população negra e a importância do preenchimento do quesito raça/cor em todos os protocolos da rede SUS.

The study aims to emphasize the need to build educational proposals that discuss the place of blacks in Brazilian society and their intrinsic relationship with social determinations of health, in the context of the pandemic of Covid-19. This is an experience report of the first class of the Course on Updating Health Care for the Black Population, developed by Escola de Saúde Pública da Bahia Professor Jorge Novis (ESPBA), in partnership with the Department of Care Management (DGC). This course arises from the need to invest in the implementation of the policy aimed at this social segment. In the process of structuring the course, meetings were held with relevant social actors, potential teachers, chosen by the approach to the theme and experience with social movements and causes. Within the scope of the Unified Health System, the Schools of Government are responsible for the training processes of health workers, from the perspective of Permanent Education. The insertion of the theme of health of the black population in the curricula worked became an objective image to be achieved by the institution, not only from the courses developed, but also with the realization of a pilot study to confront Covid-19 in quilombola communities of the state. Recognizing racism as one of the social determinants of the process of illness and death, the article argues that managers and health professionals have access to educational actions that enable them to reflect on the socio-historical processes of building our society, expand knowledge about the health of the black population and the importance of filling the question race/color in all protocols of the Unified Health System Network.

Este estudio propone identificar la necesidad de construir propuestas educativas que discutan el lugar de los negros en la sociedad brasileña y su relación intrínseca con las determinaciones sociales de la salud, en el contexto de la pandemia de covid-19. Este es un relato de experiencia de la primera clase del Curso de Actualización de la Atención de Salud para la Población Negra, desarrollado por la Escola de Saúde Pública da Bahia Professor Jorge Novis (ESPBA) en colaboración con la Dirección de Gestión de la Atención (DGC). Este curso surge de la necesidad de invertir en la implementación de políticas dirigidas a este segmento social. En el proceso de estructuración del curso, se realizaron encuentros con actores sociales relevantes, potenciales docentes, elegidos por acercarse al abordaje del tema y por la experiencia con los movimientos y causas sociales. En el ámbito del SUS, las Escuelas de Gobierno son las responsables de los procesos de formación de los trabajadores de la salud, desde la perspectiva de la educación permanente. La inserción del tema salud de la población negra en los planes de estudio trabajados se convirtió en una imagen objetivo a alcanzar por la institución no solo a partir de los cursos desarrollados, sino también con la realización de un estudio piloto para enfrentar el covid-19 en comunidades quilombolas del estado. Al reconocer el racismo como uno de los determinantes sociales del proceso de enfermedad y muerte, se propugna que los gestores y profesionales de la salud tengan acceso a acciones educativas que les permitan reflexionar sobre los procesos sociohistóricos de construcción de nuestra sociedad, para ampliar el conocimiento sobre la salud de la población negra y la importancia de llenar la pregunta raza/color en todos los protocolos de la Red SUS.

In Vitro Evaluation of the Effectiveness of Dental Bleaching with Carbamide Peroxide and Violet Light.

Objective: The aim of the current study was to use the CIELab system to evaluate the performance of the whitening treatment involving violet light-emitting diode (LED) combined with a home 10% and 22% carbamide peroxide dental bleaching technique on dental enamel. Methods: Fifty blocks of bovine dental enamel were divided into five groups: control group (control), receiving only LED irradiation; Whitening 10%, receiving 10% carbamide peroxide treatment; Whitening 10%+VL, receiving 10% carbamide peroxide treatment combined with LED irradiation; Whitening 22%, receiving 22% carbamide peroxide treatment; and Whitening 22%+VL, receiving 22% carbamide peroxide treatment combined with violet LED irradiation. Color tests were performed before the protocols, after 1 week and after 2 weeks of treatment by using a spectrophotometer and the CIELab parameters: L*, (a*) and (b*). The Whitening 10%, Whitening 10%+VL, Whitening 22% and Whitening 22%+VL groups were submitted to 10% and 22% carbamide peroxide 8 h per day for 14 days, whereas the Control was only stored in artificial saliva. For irradiation in the Control, Whitening 10%+VL, and Whitening 22%+VL groups, we used violet LED at a wavelength of 405-410 nm activated for 60 permanent seconds and 30 sec of pause once per week. As all data exhibited normal distribution, the comparisons were performed by using two-way repeated-measures analysis of variance. A post hoc t-test was employed, followed by the Ryan-Holm stepdown Bonferroni procedure. Results: After 1 week, the Whitening 22%+VL group differed significantly from all other groups in relation to hue, while no difference was found between the remaining groups (p < 0.05). Analyzing lightness, the Whitening 22%+VL and Whiteness10%+VL groups differed from the other groups (p > 0.05). In the 2nd week, the Whitening 22%+VL groups differed significantly from all other groups (p < 0.05) in hue, chroma, and lightness. The comparative analysis of bleaching times within the same group revealed significant differences in the Whitening 22%+VL group between baseline and week 1, baseline and week 2, as well as weeks 1 and 2 in terms of hue (p > 0.05). In the Whitening 22%+VL group, significant differences (p < 0.05) were found between baseline and week 2 as well as between weeks 1 and 2 in chroma (p > 0.05). In the Whitening 22%+VL group, statistically significant differences (p < 0.05) were found between baseline and week 1, baseline and week 2, as well as between weeks 1 and 2 in lightness. In the Whitening 10%+VL group, statistically significant differences (p < 0.05) were found between baseline and week 1, between baseline and week 2, as well as between weeks 1 and 2 in lightness. Conclusions: Tooth whitening treatment involving 10% and 22% carbamide peroxide combined with violet light promoted changes in the three axes of color (ΔH, ΔC, and ΔL) of the specimens evaluated. The use of the gel bleach alone was more efficient when the higher concentration was used. When violet light was combined with the gel, the lower concentration was more efficient.

Panorama das iniciativas de pagamento por serviços ambientais hídricos no Brasil / Overview of payment initiatives for hydrological environmental services in Brazil

RESUMO O número de municípios e estados brasileiros que estão aderindo ao pagamento por serviços ambientais (PSA) vem crescendo ao longo dos últimos anos. Por meio de uma pesquisa documental e científica, buscou-se compreender a evolução de quase 20 anos de experiências brasileiras em PSA hídricos. A investigação foi fundamentada em um inventário das iniciativas (já encerradas ou em desenvolvimento), de sua localização, da base legal e dos métodos de valoração. Considerando o universo amostral de 68 iniciativas brasileiras de PSA hídricos, observaram-se: maior concentração dos programas no sul e sudeste, com tendência à expansão para as demais regiões brasileiras, especialmente a Centro-Oeste; e as primeiras iniciativas de PSA hídricos do Brasil adotavam o pagamento por valor fixo, sem a consideração da qualidade biótica das propriedades rurais, padrão que foi gradualmente substituído pelo cálculo do custo de oportunidade da terra e pela inclusão de indicadores físico-ambientais e socioeconômicos nas metodologias de valoração. O estudo permite concluir que, na última década, existe a tendência de os programas de PSA hídricos adotarem metodologias com abordagem interdisciplinar e sistêmica para valoração da provisão de serviços ambientais.

ABSTRACT The number of Brazilian municipalities and states engaging in payment for environmental services (PES) has been increasing over the last few years. Through a documentary and scientific research, we sought to understand the evolution of almost 20 years of Brazilian experiences in hydrological PES. The research was based on an inventory of the initiatives (already finished or under development), their location, legal basis, and valuation methods. Considering the sampling universe of 68 Brazilian hydrological PES initiatives, we observed: higher concentration of programs in the South and Southeast, with a tendency to expand them to other Brazilian regions, especially the Midwest; the first initiatives of hydrological PES in Brazil adopted the payment of a fixed value, without considering the biotic quality of the rural properties, a pattern which was gradually replaced by the calculation of the opportunity cost of land and the inclusion of physical-environmental indicators and socioeconomic factors in the valuation methodologies. The study allows to conclude that, in the last decade, there has been a tendency for hydrological PES programs to adopt methodologies with an interdisciplinary and systemic approach to assess the provision of environmental services.

Erdafitinib treatment in Brazilian patients with metastatic urothelial carcinoma (mUC): real-world evidence from an Expanded Access Program.

BACKGROUND: Erdafitinib is the first targeted therapy approved for the treatment of patients with metastatic urothelial carcinoma (mUC). Approval was based on a phase II single-arm trial that demonstrated significant activity of erdafitinib in patients with tumors harboring FGFR2/3 alterations. In Brazil, an Expanded Access Program (EAP) provided patients with early access to erdafitinib prior to market authorization. The current report describes characteristics and outcomes of patients with mUC on erdafitinib therapy. METHODS: Patients with mUC that failed first- and second-line systemic therapies were screened for FGFR2/3 alterations in primary or metastatic tumor tissues. Patients with FGFR2/3 alterations were selected to receive erdafitinib at the standard dosing schedule and were followed prospectively to evaluate the efficacy and safety outcomes. RESULTS: From 19 April 2019, through 13 March 2020, 47 patients with mUC from 10 Brazilian centers were tested for FGFR2/3 alterations. Alterations in FGFR2/3 were found in 12 patients (25.5%) and all of them were eligible for the EAP. Four patients (33%) had partial response, while two patients (17%) had stable disease. Progressive disease, the best response, was observed in five patients (42%). At a median follow-up of 16.2 months, the median time to treatment failure (TTF) was 2.8 months. When considering only patients with objective response, the median TTF was 5.3 months. Adverse events (AEs) were reported for any grade and grade 3 or higher in 10 patients (83%) and 5 patients (42%), respectively. The most common AE was hyperphosphatemia. CONCLUSION: This first real-world evidence report of heavily treated patients with mUC confirms the efficacy and safety of erdafitinib in a disease setting with a lack of treatment options.

The Effect of Photobiomodulation on Analgesia During Childbirth: A Controlled and Randomized Clinical Trial.

Background: Pain during labor can be a barrier when choosing vaginal delivery. In an attempt to relief pain during labor, several pharmacological and nonpharmacological methods are proposed. Objective: To assess the effect of light-emitting diode (LED) photobiomodulation on analgesia during labor. Methods: A clinical trial was conducted with 29 women who were divided into two groups: G1 (experimental group-LED) and G2 (control group-hot shower). In the experimental group, an LED plate with red and infrared merged [red 660 ± 20 nm, 5 mW/cm2, 3 J per LED (108 J) and infrared 850 ± 20 nm, 5 mW/cm2, 3 J per LED (108 J), total energy = 216 J] was placed on the subjects' dorsal region, at the level of T10 to S4, for 10 min, with the plate automatically turning off. Hot shower at controlled temperature was offered for 30 min. To verify the effect of LED on analgesia during labor, the following variables were assessed: (1) perception of pain, (2) fetal well-being assessed by cardiotocography or intermittent auscultation of fetal heart rate, (3) Apgar score at minutes 1 and 5 after birth, and (4) labor duration. Results: There was a statistically significant difference (p < 0.05) in pain reduction evidenced by a millimetric visual scale, before and after application on G1-LED (7.92 ± 1.78). Regarding the other variables, there was no statistical difference between the groups when comparing fetal well-being, Apgar score and labor duration. Conclusions: It is concluded that LED can be considered an alternative, since it caused pain reduction without changing other parameters during labor, compared with hot shower, a method included in hospital protocols, proving to be safe. Clinical Trial Registration number: NCT03496857.

Prevalência e perfil de resistência de bactérias isoladas de hemoculturas de pacientes atendidos em um hospital de referência cardiológica de Pernambuco / Prevalence and resistance profile of bacteria isolated from blood cultures of patients attended in a cardiological reference hospital in Pernambuco

Objetivo: A sepse está envolvida com as principais causas de morbidade e mortalidade em pacientes internados em unidades hospitalares. Esses pacientes são vulneráveis a esse tipo de infecção devido a vários fatores como tempo de internamento, procedimentos invasivos, infecções recorrentes e terapias prolongadas por uso de antibióticos. Portanto, este estudo teve como objetivo identificar o perfil microbiológico e de resistência nas hemoculturas positivas de pacientes internados no Pronto-Socorro Cardiológico de Pernambuco (Procape) no ano de 2017. Métodos: Foram analisadas hemoculturas do período de janeiro a dezembro de 2017. As amostras de hemoculturas foram processadas no equipamento de automação BACT/ALERT® 3D sistemas de detecção microbiana e depois identificada pelo Vitek 2 compact da Biomerieux®. Resultados: Do total de 3.323 amostras de hemoculturas enviadas ao Laboratório do Hospital, foi verificada a prevalência de positividade de 120 (3,62%), das quais houve a prevalência de K. pneumoniae 18 (15%), seguido de S. haemolyticus 17 (14,16%), logo após, S. epidermidis 16 (13,33%). Várias bactérias apresentaram perfil de multirresistência como E. cloacae, A. baumannii, K. pneumoniae, P. aeruginosa, S. aureus e Staphylococcus coagulase negativa. Conclusão: Os resultados demonstraram a presença de bactérias resistentes e multirresistentes, com diferentes perfis de resistência. É importante conhecer o perfil de resistência bacteriano, visando o tratamento adequado de pacientes com quadro de sepse, prevenindo infecções hospitalares.

Objective: Sepsis is involved with the main causes of morbidity and mortality in hospitalized patients. These patients are vulnerable to this type of infection due to various factors such as length of stay, invasive procedures, recurrent infections, and antibiotic therapy prolonged. Therefore, this study aimed to identify the microbiological and resistance profile in positive blood cultures of patients admitted to the Cardiac Emergency of Pernambuco (Procape) in 2017. Methods: Blood cultures from January to December 2017 were analyzed. Blood cultures were processed on BactT/Alert® 3D automation equipment, microbial detection systems and then identified by Biomerieux® Vitek 2 compact. Results: From a total of 3,323 blood culture samples sent to the Hospital Laboratory, the prevalence of positivity of 120 (3.62%) samples was verified, of which there was the prevalence of K. pneumoniae 18 (15%), followed for S. haemolyticus 17 (14.16%), shortly after, S. epidermidis 16 (13.33%). Several bacteria showed multiresistance profile such as E. cloacae, A. baumannii, K. pneumoniae, P. aeruginosa, S. aureus and coagulase negative Staphylococcus. Conclusion: Results demonstrated the presence of resistant and multiresistant bacteria, with different resistance profiles. It is important to know bacterial resistance profile, aiming at the adequate treatment of patients with sepsis, preventing hospital infections.

Effect of Photobiomodulation on Salivary Cortisol, Masticatory Muscle Strength, and Clinical Signs in Children with Sleep Bruxism: A Randomized Controlled Trial.

Background: The diagnosis of sleep bruxism (SB) in children is difficult due to the lack of a polysomnographic protocol for this population. Moreover, the gold standard treatment [occlusal splint (OS) therapy] has limitations, as adequate use depends on the child's cooperation. The etiology of SB may include stress factors. Salivary cortisol is a biomarker used as a noninvasive method to evaluate the response to stress. Besides physiological aspects, it is also important to investigate morphological aspects, such as masticatory muscle strength. The aim of the present study was to determine the occurrence of bite marks on the buccal mucosa in children as a complementary sign for the diagnosis of SB and investigate and the effectiveness of photobiomodulation as an alternative treatment for this condition. Methods: Seventy-six children 6-12 years of age were divided into four groups: G1-with SB and submitted to laser therapy over acupuncture points (λ = 786.94 nm, 20 sec per point, fluency = 33.5 Jcm2, energy = 1 J, number of points = 12); G2-with SB, use of OS, G3-with SB and submitted to sham laser therapy; and G4-control group without SB. Clinical signs (bite marks on buccal mucosa and headaches), bite force (BF), and salivary cortisol (biomarker of stress) were evaluated before and after treatment. Statistical analysis involved the Kolmogorov-Smirnov, Shapiro-Wilk, and analysis of variance (ANOVA) tests. Results: Bite marks on the buccal mucosa were significantly associated with SB (p < 0.001). A statistically significant difference was found between the frequency of children with headache before and after treatment in G1 (p = 0.0005) and G2 (p = 0.0001), with no significant differences between the two groups (G1 and G2). The children in G1 had lower BF on both sides compared to the other groups. In the intragroup analysis after treatment, all groups exhibited an increase in salivary cortisol levels. Conclusions: Bite marks on the buccal mucosa can be used as a complementary sign for the clinical diagnosis of SB. Children with SB responded well to photobiomodulation therapy, as evidenced by the reduction in BF and reports of headache.