Relationship between internal derangement of temporomandibular joint and changes in body posture

Background: The presence of body posture changes among patients with temporomandibular disorders (TMD) has been a controversial issue in the literature, in which it supporters point out the muscular origin as the main etiological factors, mainly associated with postural changes in head. Due to this controversy, it is pertinent to check whether this relationship exists on the most common etiology of TMD, the disk displacement, which translates a biomechanical internal disorder of the temporomandibular joint (TMJ). Objectives: Assess body posture changes in subjects with internal derangement of the TMJ when compared to subjects without this biomechanical dysfunction, characterize the patterns of the jaw movements and assess to the muscle activation during jaw movements. Methods: 21 subjects with TMJ disc displacement (DD) (test group) and 21 subjects without any TMD (control group) was assessed for body posture changes through evaluation of several body segments by posturography and also was evaluated the postural balance reactions through the center of mass during jaw movements using a balance platform. For the characterization of the jaw movement patterns it was done a kinematic analysis during jaw movements (active ROM and path of the jaw). For the muscle activation during jaw movements it was evaluated the masseter, sternocleidomastoid and spinae erector muscles by surface electromyography (EMG). Results Discussion: Both groups show forward head posture and extension of the cervical spine, not noticing any other significant body posture changes in subjects with DD, and if we had to see in detail, in general, subjects without TMD shows more body posture changes than subjects with DD. The pattern of jaw movements is similar in both groups, but in subjects with DD the closing movements are more instable than the opening movements, related to a less effective movement control to counteract the force of gravity and the disk displacement. The bilateral muscle activation during jaw movements is higher in subjects with DD, likely related to a less stable pattern of movement which leads in a higher muscle activation to guide the movement and ensure the best as possible articular stability. Conclusion: The disk displacement with reduction should be viewed as part of a set of signs and symptoms that require an accurate musculoskeletal and psychosocial assessment towards an earlier diagnosis for reduction and control of the functional limiting factors. In this direction, it seems that the relevant set of limiting signs and symptoms deserve a particular attention by health care practitioners involved in the assessment and treatment of TMD, in order to define effective therapeutic options.

O Lean Management e os desafios da gestão de recursos humanos na FAP

O estudo que se apresenta teve como objetivo analisar a implementação do modelo de Serviços Partilhados, com recurso à metodologia lean, nos serviços de apoio de pessoal do Complexo de Alfragide que decorreu no contexto da sua implementação na Força Aérea Portuguesa, determinada pelo Despacho do CEMFA n.º 59/2015, de 31 de julho. Para desenvolver este trabalho foi utilizada uma estratégia de investigação mista (quantitativa e qualitativa), seguindo o raciocínio hipotético-dedutivo. O desenho de pesquisa utilizado foi o estudo de caso, recorrendo a entrevistas, à análise documental e a um questionário para recolha de dados. Os resultados apurados através das entrevistas e do inquérito permitem concluir que a implementação do novo modelo alcançou alguns dos objetivos a que se propunha, nomeadamente, a melhoria dos serviços de apoio de pessoal prestados aos militares e civis. Apesar de se antever um elevado potencial ao nível da racionalização de Recursos Humanos, de momento, esse objetivo ainda não foi inteiramente alcançado. Conclui-se a presente investigação sugerindo a reavaliação numa fase mais adiantada da implementação do modelo de Serviços Partilhados no Complexo de Alfragide e o alargamento a outras Unidades de modo a obter uma visão mais abrangente da realidade na Força Aérea. Abstract: The study aimed to analyze the implementation of the Shared Services model, using the lean methodology, in the personnel support services in Complexo de Alfragide. This process took place in the context of implementation of this model in the Portuguese Air Force, determined by CEMFA Order No. 59/2015 of 31 July. To develop this work was used a mixed research strategy (quantitative and qualitative), following the hypothetical-deductive reasoning. The research design used was the case study, interviews, document analysis and a questionnaire. By the results obtained through the views expressed in the interviews and in the investigation, it can be concluded that the implementation of the Shared Services model has achieved some of the goals that it proposed like the improvement in personnel support services. Although foreseen great potential in terms of gains of Human Resources rationalization and due to several factors, has not yet been possible to achieve this goal. This research is concluded suggesting a reevaluation at a later stage of the implementation of the Shared Services model in the Complexo de Alfragide and extension to other Units for a more comprehensive view of reality in the Air Force.