Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications

Objective: To determine the variation in prevalence of temporomandibular disorders (TMD), other side effects, and technical complications during 5 years of sleep apnea treatment with a mandibular advancement device. Materials and Methods: Forty patients diagnosed with obstructive sleep apnea received an adjustable appliance at 70% of the maximum protrusion. The protrusion was then progressively increased. TMD (diagnosed according to the Research Diagnostic Criteria for TMD), overjet, overbite, occlusal contacts, subjective side effects, and technical complications were recorded before and a mean of 14, 21, and 58 months after treatment and analyzed by the Wilcoxon test (P Less-than .05). Results: Fifteen patients still used the oral appliance at the 5-year follow-up, and no significant variation in TMD prevalence was observed. Subjective side effects were common, and a significant reduction was found in overjet, overbite, and in the number of occlusal contacts. Furthermore, the patients made a mean of 2.5 unscheduled dental visits per year and a mean of 0.8 appliance repairs/relines per year by a dental technician. The most frequent unscheduled visits were needed during the first year and were a result of acrylic breakage on the lateral telescopic attachment, poor retention, and other adjustments to improve comfort. Conclusions: Five-year oral appliance treatment does not affect TMD prevalence but is associated with permanent occlusal changes in most sleep apnea patients during the first 2 years. Patients seek several unscheduled visits, mainly because of technical complications.

Participació i associacionisme de les dones a Vic

L’objectiu d’aquest treball és visibilitzar la participació de les dones a la ciutat de Vic, per tal de reconèixer el seu paper dins la societat. Aquest treball pretén doncs, ressaltar una presència visible i empoderada de les dones dins les associacions i, també, un canvi de mirada que permeti veure les dones com a protagonistes de canvis i transformacions. La divisió tradicional del treball va confinar la dona a l’espai privat, de manera que l’allunyà de la participació política, institucional i social de la vida. L’aportació del moviment associatiu femení ha estat clau, i la influència que ha exercit en les conquestes socials és evident. Com a producte final i per tal de donar evidència de la participació de les dones a la ciutat, adjunto un llibret on es pot trobar totes les associacions de dones que hi ha Vic, amb la seva fitxa tècnica pertinent i la mirada d’algunes de les dones que participen activament d’aquest associacionisme femení.

Afrontamiento de situaciones de hostilidad y desempeño de la función directiva. Planteamientos y reflexiones a raíz de una actividad de formación permanente de directivos de centros educativos de titularidad pública

The intervention in the organized conflicts and, particularly, the confrontation of hostile situations (based on the emotional alteration, the strain, the verbal aggressiveness, etc) is one of the aspects that worry the principals of the educative centres and, therefore, a main attention must be given to the initial and permanent training to have managing duties. Throughout the text we take some aspects into account in the development of these managing skills:a) we set the distinctive features; b) we answer to the dilemma about the existence of improvement possibilities; c) we state the need to star from the motivation and the active participation of the principals in their own personal development and, finally, d) we contribute with the design of a training activity to develop skills to confront hostile situations, addressed to the principals of primary and secondary schools, that was done in Girona, in November 2005