Construção e validação de instrumento simplificado para diagnóstico de disfunção temporomandibular em pacientes adultos

As disfunções temporomandibulares (DTM) representam a maior causa de dor não dentária da região orofacial. Dada sua alta prevalência na população em geral e a existência de inúmeros instrumentos diagnósticos não padronizados, buscou-se elaborar e validar um questionário simples, de acessibilidade ampla e aplicação prática, com vistas a contribuir para o diagnóstico e o estudo epidemiológico das mesmas. A estratégia utilizada na montagem do instrumento foi estabelecida com base na avaliação criteriosa de questionários já existentes na literatura, validação de expertos na área de DTM, validação fatorial, de face (na primeira fase do estudo) e, frente ao padrão ouro (RDC/TMD), na segunda fase do estudo. Na primeira fase, participaram 160 indivíduos. A consistência interna resultou num Coeficiente Alfa de Cronbach de 0,752 para o questionário com sete itens; enquanto que para o questionário com cinco itens, este resultado foi de 0,694, não sendo o mesmo, considerado baixo por avaliar apenas cinco questões e ainda, em razão do tema central da pesquisa ser bastante subjetivo. A análise fatorial confirmatória apontou para uma variância total dos fatores extraídos do questionário com sete itens, de 58,2 % e do questionário com cinco itens de 70,04%. Portanto, o questionário com cinco questões, apresentou resultados estatísticos superiores ao de sete questões. Na validação frente ao padrão ouro (RDC/TMD), foram avaliados 99 indivíduos tendo sido testados os dois questionários, com sete e com cinco questões. Na estrutura com sete questões, ao se categorizar as mesmas por totais de pontos obtidos, em quatro condições, obteve-se o melhor resultado quando se considerou com DTM a faixa entre 10 e 21 pontos, sendo 85,1% positivos também no RDC/TMD, com acurácia de 90,1% e Kappa 0,817. Nesta condição, a sensibilidade encontrada foi de 95% (IC 95%, 91 a 99), especificidade de 87% (IC 95%, 81 a 93), VPP 85%, VPN 96%, LR+ 7,3 e LR- 17,4. Quando os dados foram avaliados para o questionário com cinco questões (QST/DTM), pode-se observar que o melhor ponto de corte foi quando se considerou como portadores de DTM, os indivíduos na faixa entre 7 e 15 pontos, com acurácia de 85,8% e Kappa 0,817. Nesta condição, a sensibilidade foi 88% (IC 95%, 81,6 a 94,4), especificidade 84% (IC 95%, 76,8 a 91,2), VPP 80%, VPN 90,5%, LR+ 5,5 e LR- 7,0. A simplicidade do presente questionário (QST/DTM) com apenas cinco questões, possibilita seu uso como elemento de triagem inicial na área da dor orofacial em disfunção temporomandibular, com boa compreensibilidade, confiabilidade, reprodutibilidade e possibilidade de aplicação em pesquisas epidemiológicas. Concluiu-se que o questionário aqui validado, permite sua aplicação de forma simples tanto por profissionais e pesquisadores da Odontologia como de outras áreas da saúde

Fatores associados à mortalidade dos idosos com as condições de vida da população do Nordeste do Brasil

As condições de vida são usualmente entendidas como importantes fatores intervenientes das causas básicas de mortalidade e da qualidade de vida da população. Ao considerar esta questão em uma população idosa e sua influência nas causas mais relevantes que as levam à morte, teve-se como objetivo principal, estudar a associação da mortalidade dos idosos por doenças cardiovasculares para ambos os sexos, com indicadores que expressam as condições de vida da população do Nordeste, nos anos 2000 e 2010. Para atingir tal propósito foi traçado um desenho de estudo ecológico com cortes transversais nos anos 2000 e 2010 tendo como unidades de análises as microrregiões e a mesorregiões do Nordeste. Utilizou-se a Modelagem de Equações Estruturais (MEE) para explicar essas associações, tomando como base as estatísticas de óbitos por doenças cardiovasculares (construto endógeno) e variáveis socioeconômicas e demográficas (construto exógeno) das microrregiões do Nordeste, para o ano 2000. Utilizou-se o Método dos Componentes Principais como recurso metodológico na construção de um índice sintético que permitiu classificar as condições de vida nas mesorregiões do Nordeste, tomadas como unidades de análises, nos anos 2000 e 2010, de acordo com as condições de vida e as principais causas de mortalidade por doenças cardiovasculares. A aplicação da MEE sugeriu uma forte associação do construto exógeno condições de vida, composto pelos indicadores: anos de estudo dos homens idosos, percentual de idosos em domicílios com banheiro/água encanada e probabilidade de sobrevivência aos 60 anos, com a variável desfecho taxa de mortalidade por doenças cardiovasculares dos homens e mulheres idosos. O índice sintético construído permitiu identificar os diferentes ritmos de envelhecimento populacional entre as regiões e distintos processos de evolução dos níveis de mortalidade pelas doenças cardiovasculares, muitas delas compatíveis com as condições de vida no Nordeste. Os resultados sugerem que o construto condições de vida está fortemente associado por esta causa de morte entre os idosos para ambos os sexos no Nordeste do Brasil. Neste sentido, sugere-se que estes resultados sejam considerados como relevantes para formulação de políticas de saúde regionais voltadas para este contingente populacional do Nordeste do Brasil

Comparação da incidência de câncer em infectados pelo HIV e em transplantados com a população geral

Introdução: Estudos demonstram uma relação entre a queda da imunidade e o aumento da incidência de câncer. Objetivo: Comparar a incidência de câncer em pacientes infectados pelo HIV e em transplantados com a da população geral. Métodos: Foi realizada revisão sistemática com metanálise, combinando descritores específicos nas bases de dados Pubmed, Scielo, Cancerlit e Google Scholar, buscando alta sensibilidade para responder o objetivo da pesquisa. Os artigos considerados de alta qualidade metodológica por apresentarem todos os critérios de inclusão foram avaliados por metanálise. Resultados: Foram incluídos 25 estudos envolvendo 866776 pessoas com HIV/AIDS e transplantados, em que foram diagnosticados 21260 novos casos de carcinoma. Observou-se que o risco para o surgimento de novos casos de câncer foi maior entre indivíduos com HIV/AIDS (SIR= 4, IC95% 3,78-4,24) e entre os transplantados (SIR= 3,28, IC95% 3,06-3,52) quando comparado com a população em geral. Conclusão: A incidência similar em ambas as populações pesquisadas sugere que o comprometimento do sistema imune, comum em ambas, é responsável pelo risco aumentado de novos casos de câncer. Investimentos em pesquisas que desenvolvam estratégias de prevenção mais eficazes para os dois grupos são necessários, pois podem contribuir para a redução da incidência e para a diminuição da mortalidade.

Estudo epidemiológico das parasitoses oculares na população de escolares da cidade de Natal-RN, Brasil

The objective of this study is to estimate the prevalence of Ocular Toxocariasis, Diffuse Unilateral Subacute Neuroretinitis (DUSN), Toxoplasma gondii infection and Ocular Toxoplasmosis in a student population in Natal-RN/Brazil and relate it to demographic, epidemiologic and socio-economic risk factors. The incidence of DUSN was observed in patients at the Federal University of Rio Grande do Norte Ophthalmology Service and the Prontoclinica de Olhos Ophthalmology clinic in Natal. In cases where a worm was found in the subretinal space, the result of treatment with photocoagulation using Green Laser (Eye Light ALCON) was evaluated in relation to final visual result. The sample was randomly selected among the schools of the four districts of Natal, according to the type of institution (public or private), its level (elementary or secondary), and study period (morning, afternoon or evening). The school population was studied from March to May, 2001. Initially, the students answered a questionnaire to evaluate demographic, epidemiologic and socio-economic risk factors. Afterwards, the following procedures were carried out: blood samples were taken for Toxoplasmosis (IgG, IgM) serology, hemogram, ophthalmological examination, consisting of clinical history, measurement of visual acuity, refraction under cycloplegia, biomicroscopy of the anterior segment and annexa, funduscopy and examination of extrinsic motility. The prevalence of Toxocariasis was 0.2% or 2 per one thousand students. The sample was insufficient to estimate the prevalence of DUSN. Seventy patients with DUSN diagnosis were examined from January, 2001 to January, 2003. A live worm was found in the subretinal space of all four patients in the acute phase, and these were treated with laser photocoagulation. After follow-up (average = 11.5 months), visual acuity improved in three eyes and remained unaltered in one eye. Worms were found in 22 of the 66 patients in the chronic phase, and these also were treated with laser photocoagulation. After a follow-up period of 13.1 months, on average, visual acuity improved in two of the patients, remained unchanged in 19 and worsened in one. The comparison of visual result before and after treatment was not statistically significant (p = 0.302). The diagnosis of DUSN in the acute phase, followed by prompt localization and destruction of the worm by photocoagulation, can improve the patient s vision. However, destruction of the worm by laser photocoagulation in eyes with DUSN in the chronic phase does not improve visual acuity. Seroprevalence for IgG was 46% (Confidence Interval CI 95%-42.9-49.2%) and for IgM it was 1.4% (CI 95% = 0.8-2.4%). The prevalence of ocular lesion was 1.15% (CI 95% = 0.6 - 2.0%). Socio-economic conditions were determinants in the prevalence of Systemic and Ocular Toxoplasmosis in the bivaried analysis and confirmed in the multivaried analysis (mother s scholarity illiterate/ OR = 2.9 and p < 0.001). The T. gondii infection prevalence, although high, was less than that found in studies performed in the South and Southeast of Brazil and that of Ocular Toxoplasmosis was completely discrepant, varying from 5 to 17 times less. Although important epidemiological variables such as owning a cat, drinking unfiltered water, and coming into contact with rivers or lakes showed an association in the preliminary analysis, they lost their influence when included in the logistic model. Future studies are scheduled to begin in March, 2004, in collaboration with other Brazilian and American universities in an attempt to discover the reason for these findings, as well as identifying the different strains of Toxoplasma gondii, and studying the sources of water utilized by the population of Natal Brazil

Análise do vetor de impedância bioelétrico na avaliação da suplementação de zinco em crianças prepuberais e sadias

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Análise da frequência alélica de 15 LOCI STR na população do Rio Grande do Norte

Human population have a significant number of polymorphic loci, whose use and applications range from construction of linkage maps, to study the evolution of populations, through the determination of paternity, forensic medicine and migration. Currently, STRs (Short Tanden Repeats) markers are considered the major markers for human identification, mainly due to its abundance and high variability because of the fact that they are easily amplifiable by PCR (Polymerase Chain Reaction), work with low amounts of DNA and be capable of automation processes involving fluorescence detection. The creation of regional databases containing allele frequencies of population provide subsidies to increase the reliability of the results of determining the genetic link. This paper aims to obtain a database of allele frequencies of 15 polymorphic molecular loci (D8S1179, D21S11, D7S820, CSF1PO, D19S433, vWA, TPOX, D18S51, D3S1358, TH01, D13S317, D16S539, D2S1338, D5S818 e FGA) in a population classifies as born in the State of Rio Grande do Norte, Brazil, totaling 1100 unrelated individuals. To evaluate the frequency, DNA samples were submitted to PCR amplification, followed by capilarry electrophoresis genetic sequencer. The frequencies identified in this study were compared with brazilian population in general and other states in Brazil. Except for the loci D21S11, D19S433 and D2D1338, the genotypes found were in Hardy-Weinberg equilibrium and no significant differences among the frequencies were found in the populations studied. The most informative loci was D2S1338 and D18S51, and the less informative is the locus TPOX

Uso sustentável da Copernicia prunifera (Miller) H. E Moore no semiárido potiguar: valorização de saberes e conservação dos recursos genéticos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Avanços e retrocessos na articulação de um pacto territorial: a experiência do PRONAF Infra-Estrutura

Since minetics The economics and political promotion along the necessity of flexibility in states actions admited actors partipction and social controlo on process of construction in local development. The Programa Nacional de Fortalecimento à Agricultura Familiar (PRONAF) by this framework consists suprass the specific points about contry world in order to embrace territorial dimension of development, focalizing actions that estimulate co-operative pratices among local agents. This work proposal intends to identify advances and regression of PRONAF Infra-estrutura (Framework) by one territorial pact organization considering its administration about mechamisms on advantage conmflicts between distinct actor and their ables to atimulates a construction of new relationships between governors and population. Undderstanding PRONAF action like a process that come from its instrumental proportion surpass looking for substantial elements constructionm on intervention of local development considering administration mechamisms in São Paulo do Potengi (RN) city-council-starting by Conselho Municipal de Desenvolvimento Rural as well changes of institutional arrangement with território da Borborema erection. Throngh documental studies, bibliography researches and interviews we indenttfy an articulante power of Territorial pact partnerships like one of these political process and its sector character as their limits

As razões da esquerda radical PCB, PSTU e PSOL: estrutura organizativa e objetivos políticos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Processo participativo da população na construção da agenda 21 local:o caso de Parnamirim

One of the agreements assumed at the conference of the United Nations for the Environments and Development which took place in Rio de Janeiro in 1992; through Global Agenda 21, was that the signatory countries would create a national Politics of sustainable development, by means of their national Agenda 21. Demonstrating the relevance of municipal districts and the local communities, during the definitions of new development standards compromised to the transformation of the society, socia1ly and environmentally well-balanced world, it was also agreed on that places under the responsibilities of the municipal districts would promote their own local Agenda 21. We need to point out though that the government has the prerogative and the responsibly of facilitating the population participation process in the construction of national and local Agenda. This made it possible again, to plan the scheming process directly towards the insertion of population participation at the different levels, involving the entire local sectors while establishing a new local partnership through the local municipal government. Thus, we decide to verify the participation of the population in the construction of their local Agenda 21, choosing for the study case Parnamirim municipality from RN. The question which originated the objectives and analysis was formulated on the following terms: Up to which stage was the process of population participation effective in the elaboration of Parnamirims's local Agenda 21? Based on this uneasiness, it was defined as the general objective, the verification of population participation process during the elaboration of Parnamirims's local Agenda 21, aiming at its effectiveness as well as specific objectives; to identify the population representivity, the construction of the local AG 21 in order to identify on which level is the participation based, to verify the strategies used in order to promote the process participation, to identify the motives guiding those involved in the construction of the local Agenda 21. This case study at Parnamirim municipal district demonstrated that there was effective population participation as far as the local Agenda 21 is concerned

A casa própria: sonho ou realidade? : um olhar sobre os conjuntos habitacionais em Natal

This dissertation is about housing provision under a capitalist system. It aims at analyzing the economic relevance of the Brazilian housing policy, in particular, looking at the housing estates built in Natal city. It also draws on a data-base about living and housing conditions in Natal, produced in the wake of a more comprehensive research of the 50 largest housing estates in the city. Theoretically, the dissertation discusses: the symbolic dimension of housing; housing as a commodity; the alleged social and economic stability of homeownership; and the urban dynamic of housing estates. It also discusses the historic and conceptual references of the Brazilian housing policy and its consequences to Natal city. From the 1960s, polilcy under the BNH privileged the production of large housing estates. Although this was more closely related to economic rather than social objectives, this policy helped expand the urban limits. This was the case for Natal. At the end, this policy was not targeted towards the poorest in society but towards those low income house buyers who could afford to pay for the mortgages on offer

Mudanças demográficas e homicídios. Que relação é essa? Um estudo nas Regiões Metropolitanas de Maceió, Natal, Recife e São Paulo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Envelhecimento populacional: um diagnóstico dos idosos institucionalizados, em Natal/RN

The aging process lived by the Brazilian population concurred to the transformation in the family models, causing difficulties related to the elderly care on the Family environment, a fact that is one of the main reasons for their institutionalization. Facing this scenario, the need of investigating how the elderly lives on the long-term facilities (ILPI) has aroused. In this study, it has been conducted an analysis of the populational aging process, contrasting the Rio Grande do Norte to Brazil and the Northeast Region, between 1980 to 2010. Faced with the realization of this process, and the rising number of long-term facilities for the elderly (ILPI), it was needed to make a rescue of the abiding laws regarding elderly institutionalization, on the scope of Natal, which surged after the 1988 Federal Constitution, checking what were the impacts on the assistance of the institutionalized elderly. Lastly, it were investigated the possible determinants associated with the institutionalization, in Natal-RN, considering the aspects of the family structure, family relationship, economic, health and well being of the elderly. The results showed that Rio Grande do Norte, particularly Natal, follows the national scene, since between 1980 and 2000 its population passed the intermediate level in the process of population aging for, in 2010, to be considered elderly. Throughout this process, it was observed that Natal has been adapting to the federal legislation, through the creation of the municipal policy, City Council and other relevant standards for the elderly, promoting significant changes in ILPI.However, philanthropic institutions needs better resources for their maintenance. In research with the elderly, it was found that although the majority of the elderly have declared themselves satisfied with life, they had indicators of impairment of functional capacity and cognitive, isolated social behavior and depression, affecting the life quality of these elderly. These results reflect the need for greater investment of public power in the drafting, implementation and monitoring of public policies aimed at promoting changes that raise the level of life quality of this segment of the population

Estrutura genética populacional de Heliconius erato e Heliconius melpomene (Lepidoptera: Nymphalidae) em fragmentos de Mata Atlântica do Rio Grande do Norte

Extensive studies using molecular markers on butterflies have shown how a highly fragmented landscape may result in the reduction of gene flow among patches of habitat and, consequently, increase genetic differentiation among populations. However, little is known about Heliconius geographical structure and the effects of fragmentation on the connectivity of populations. Furthermore, findings on the effects of the population structure on the dynamics of mimicry evolution in Heliconius butterflies need to be tested in H. erato and H. melpomene specimens found in other locations other than Central and northern South Americas. For the present study, we had two motivations: (1) compare the population structure of H. erato and H. melpomene given the highly fragmented Brazil s Atlantic Forest habitat; and (2) studying population structure of co-mimics could give us insights into the dynamics of mimicry evolution. For this, we analysed the spatial structure and connectivity of eight populations of Heliconius butterflies, in a total of 137 H. erato specimens and 145 H. melpomene specimens, using nine microsatellites loci, 1144 AFLPs markers and 282 mitochondrial DNA sequences. In general, both species exhibited evidence of population subdivision but no isolation by distance indicating some extent of genetic differentiation among populations. Contrary to Kronforst & Gilbert s (2008) Costa Rican Heliconius, H. melpomene exhibited more genetic differentiation than H. erato based on nuclear markers. However, for mitochondrial DNA, H. erato populations showed more genetic differentiation than H. melpomene. Our results corroborate to other studies on Heliconius butterflies concerning the pronounced population subdivision and local genetic drift found in this genus. Nevertheless, the pattern of this differentiation varies significantly from the pattern found in studies conducted in Central America, where H. erato is generally more differentiated and structured than H. melpomene, based on nuclear markers. This different pattern may reflect different evolutionary histories of Heliconius species in Northeastern Brazil s Atlantic Forest

Caracterização do nicho alimentar do polvo octopus insularis (cephalopoda: octopodidae): da população ao indivíduo

Octopus insularis, target species in this study, is the dominant benthic octopus of the North and Northeast Brazil. Studies on behavior and ecology of the species have been conducted primarily on oceanic islands, with little information on the continental populations. In this study, two regions of the coast of RN, Rio do Fogo and Pirangi, were chosen for the characterization of the niche by O. insularis populations. The dietary niche, habitat and distribution of O. insularis of oceanic islands and the mainland, were compared. In addition, individual characteristics of feeding behavior in a population at Atol das Rocas was studied, taking into account the size of individuals, the proximity of the dens and characteristics of their "personality". The diet of the Rio do Fogo population was composed mainly of bivalve molluscs (82%), unlike Pirangi population that has a diet consisting mainly of crustaceans Decapoda (68%), similar to that described for the populations of the islands. Consequently, the feeding niches of the island populations were more similar, with greater overlap, but the niche breadth of the continent was larger. The habitats of occurrence on the coast includes reefs, rocks, gravel and an environment called Restinga, a plateau composed of biogenic gravel, sand, sponges and algae, showed a high density of animals. Similarly to that found in the islands, O. insularis in the continent, had a clumped distribution, and a bathymetric segregation between small and large individuals. The differences in diet composition among populations were explained by differences in habitat and coverage of the substrate, which may be directly influencing the diversity and prey availability in these environments. The individual analyzes of the population at Atol das Rocas, showed no relationship between the degree of individual specialization and the different personalities, or the distance between dens. The results suggest that the foraging strategy with greater availability of prey in the environment has an influence on diet octopuses over preferences or personalities