HIPERTENSAO ARTERIAL NA CRIANCA

The objective of this report was to summarily review the concept and the prevalence of arterial hypertension in children, its peculiarities and the difficulties in measuring of blood pressure at this age. Considerations of clinical picture, diagnosis, laboratory and drug-induced test (Captopril) were discussed. The authors presented various therapies utilized in hypertension and hypertensive crisis.

Abuso sexual, transtornos mentais e doencas fisicas

Objective: to review and describe the different organic and psychic consequences of sexual abuse. Methodology: 71 papers were sorted in a ten-year literature search (1987-1997) in MedLine and Lilacs (South American Literature Index), besides 14 books in the subject. Results: sexual abuse is much less frequent (or less reported) in Brazil: 7% of the population, while in the USA the prevalence is 12.9% to 28% of women and 2% to 9% of men. Results showed women being more frequently sexually abused but less differences in physical abuse were found between genders. There was a significant association between sexual abuse and the following: eating disorders, depression, irritable bowel, chronic pain (mainly pelvic), neurological, rheumatic and venereal disorders. This association was not observed in chronic constipation, Chron disease and dissociative disorders. Conclusions: although it is important to think of sexual/physical abuse as a predisposing factor to several illnesses, caution is necessary specially in cultures with different moral and ethical values. Research in this subject in Brazil should be conducted with patients in treatment, using control groups, in order to take advantage of the existing rapport. It would be also quite important to separate acute and chronic abuse effects, as well as getting to know the meaning of the experienced abuse to each person.

Um transtorno delirante somático atípico

This paper describes the case of a 38 year-old single man with a previous history of social phobia and alcoholism, who presented an unusual pathological belief during the last 9 years. He believe that the muscles of his arms were loose, separated from the bones, and that a green fluid flowed from his shoulders, running under the skin towards his fingers, and returning to the shoulders. He also reported pain, weakness and sensations of loose and fluffy muscles, besides having visual and kinesthetic hallucinations and judgement impairment. No other psychopathological manifestations were observed. There was a worsening of the complaints and depressive symptoms with the use of pimozide and no improvement with fluoxetine, venlafaxine or risperidone. He is presently taking sulpiride. Psychopathological issues and difficulties in diagnosis and treatment are discussed.

Adaptação para o Português do questionário de auto-avaliação de percepção de saúde física e mental da mulher de meia-idade - Questionário da Saúde da Mulher

The objective of this study is to translate to Brazilian Portuguese, and validate (criterion) it to the Brazilian population, the Women's Health Questionnaire (WHQ), questionnaire was developed by Hunter (1992) in order to evaluate physical and mental symptoms, which were experienced by women, along their climacteric transition. A sample of 63 women, from 45 to 65 years old, was selected from the HC-UNESP staff and HC-Community Health School Center users. The WHQ and the General Health Questionnaire - GHQ (Goldberg-1972 - 60 items) were answered by all of them. The GHQ was used as reference. Pearson correlation coefficient, sensitivity and specificity were calculated for assessing the validity of the questionnaire. Cut-off points were determined in the WHQ by linear regressions (the reference was GHQ's cut-off points - higher than 2). Outcomes highlighted a general index of sensitivity of 0.83, specificity of 0.87, and correlation of - 0.82 and reliability of 0.89. The study sample does not portray the general population because the persons interviewed had high level of education. As the WHQ is easy to be applied and analyzed, it could be used in general, gynecologic, oncology and psychiatric practice.

Estados hiperprolactinêmicos - Inter-relações com o psiquismo

Hyperprolactinemia is the most frequent endocrine disorder of the hypothalamus-hypophysis axis observed in women of reproductive age. It is characterized by elevated serum prolactin levels. Prolactin production is regulated by the inhibitory action of a neurotransmitter, dopamine. Clinical manifestations include irregular menstrual cycle, amenorrhea, galactorrhea, infertility and libido decrease, but psychological symptoms, especially anxiety and depression, have also been associated with hyperprolactinemia. Nonetheless, few studies about this condition are available. In the pathogenesis of psychiatric disorders, prolactin may have either a direct action on the central nerve system or an indirect effect via gonadal hormones or function as independent factors as a result of dopamine depletion. Thus, since the prevalence of psychiatric disorders in patients with hyperprolactinemia was detected, it was concluded that further studies are necessary to investigate the basis of a potential relationship between both hyperprolactinemic and psychiatric conditions.

Transtorno bipolar do humor e gênero

Although the bipolar disorder (BD) occurs almost with the same frequency in both genders, the phenomenology and the outcome of the illness differ between them. Nevertheless, there is evidence that women with BD show, more than men, delayed beginning, especially in their fifth decade, more rapid cycling outcome, more depressive episodes, more dysphoric mania, more mixed states and more BD type II. Even so, the findings are not always consistent. Although the risk of comorbidities in BD includes, for both the sorts, excessive alcoholic consumption and drugs, bipolar men would have greater probability of being alcohol dependent, of not seeking treatment and of committing suicide. Suggested hypotheses to explain such differences vary from those centered in cultural or psychological aspects to those that focus on the steroids hormones, and other hormones such as cortisol, thyroid hormones and even on the cerebral anatomy. The reproductive cycle (menstrual cycle, pregnancy and menopause) influences on the BD phenomenology and its relevance to the therapeutical options in the treatment of the BD in women are presented in the last part of this review. Further investigations must to be done in order to clarify this controversy. However, up to now the data indicate that estrogen therapy is not to be primarily indicated to prevent depression, Alzheimer disease or cognition impairment.

Influência da fotopolimerização e da cor da resina composta na microdureza

Objective: To study the influence of color opacity and light-curing systems (halogen light vs blue LED) on the microhardness of a composite resin. Methods: Esthet-X composite resin (Dentsply), shades A2 and A2-O, was inserted in a stainless steel matrix (5 mm diameter and 2 mm deep) and was light cured for 40 seconds with a halogen light source (XL 3000; 3M/ESPE) or a blue LED (Optilight LD II; Gnatus). Eight groups of 15 specimens each were formed, and were further divided according to the light-curing systems, the exposed area (base and surface), and the opacity of the composite resin, producing 120 specimens. The specimens were next stored in distilled water for 24 hours, embedded in a chemically activated acrylic resin, then subjected to finishing and polishing with sandpaper and felt discs. Microhardness was measured with a Vickers Digital Microhardness meter, with a 50 g load for 30 seconds. The obtained microhardness means were analyzed by ANOVA and Tukey's multiple-comparison test at 5% significance level. Results: The surface microhardness was always greater than the base microhardness, regardless of the light-curing source. The halogen light lamp produced significantly higher composite resin microhardness means than the blue LED (57.61 vs. 42.53 HV) (p<0.05). Statistically significant differences (p<0.05) were obtained between the microhardness means for the different composite opacities; lowest microhardness in depth was produced by the A2-O shade. Conclusion: Composite resin opacity as well as the light-curing system influenced the microhardness of the material.

Subjetividade sujeitada e prática psicológica: Perspectivas do sujeito da ação

Research problematizes readings on the so-called subject or agent of action as associated to group constitution and analyzes the implications of such interpretations in psychological practice and in the constitution of subjectivity. The article is based on interdisciplinary readings and on different areas of knowledge so that identity references overlying the modern subject of action may be problematized. Critical emphasis is foregrounded on the classical logic, identity and subjected subjectivity as a-temporal and universal factors of action in the real world. The problematization of subjectivity's construction and its relationships with modes of knowledge will contribute towards the establishment of critical theoretic and strategic interventions.

A ótica do usuário na avaliação da qualidade do programa de atenção odontológica à gestante

Objective: To evaluate the pregnant women's perception of the FOA-UNESP's Pregnant Women Dental Care Program (Araraquara, SP, Brazil). Method: The sample included 75 pregnant women and used a questionnaire with 16 closed questions, containing variables grouped in the following categories: the didactic-psychological meetings, clinical treatment, professional's profile, clinical facility, fear/confidence in the treatment, and learning. Except for the variables fear/confidence in the treatment and learning, to which 'yes' or 'no' answers were attributed, the remaining variables were attributed answers varying from weak to excellent. The questionnaire pretested in a pilot-study and applied after informed consent was obtained from all pregnant women treated between 2005 and 2006. Results: Most women rated as excellent the information addressed during the didactic-psychological meetings (81.1%), the clinical treatment (90.6%), the professional as to personal appearance, kindness and attention (88.7%, 96.2% and 90.6%, respectively), and the clinical facility as to cleanness, ventilation and comfort (92.5%, 86.8% and 90.6%, respectively). Most of them stated to feel confident (96.2%) and have no fear (86.8%) during the treatment and also affirmed having learned new information in the didactic-psychological meetings of the program (92.5%). Conclusion: The services and actions developed in the program have reached successful outcomes, providing health to the pregnant women and their forthcoming babies.

Razões para substituição de restaurações em clínica integrada

Objective: To analyze the reasons for replacing amalgam and composite resin restorations of patients treated at the Integrated Clinic Discipline of the Dental School of Araçatuba (UNESP), SP, Brazil. Method: After examining the patients for data collection to obtain a diagnosis, the treatment plan was outlined using a clinical form containing the restorations to be replaced, the reasons for replacing, the restorative material of choice and the number of restored surfaces. Next, all restorations indicated for replacement were examined as to their real need of replacement by 5 calibrated examiners taking into account the theorical concepts on the proposed criteria for the need of replacing or not. The analyzed period comprised 5 years (2001 to 2005). The criteria adopted for replacement were attached to the data collecting form in order to standardize the analysis of the restorations. Results: 856 patients were treated within the studied period and 753 needed restoration replacement. The main reasons for replacing amalgam restorations were defective marginal adaptation (40.9%), recurent caries (24.1%) and deficient anatomical form (15.4%). The main reasons for replacing resin restorations were esthetics (31.4%), defective marginal adaptation (29.2%) and recurent caries (20.7%). Conclusion: In spite of the little clinical experience of the studied population (undergraduate students), the reasons for replacing restorations were in accordance with the literature, having estehtics as the main reason for the replacement of composite resin restorations and defective marginal adaptation for amalgam restorations.

Educação em saúde: Efeito de um método de auto-instruçáo sobre os níveis de higiene oral em escolares

Objective: To identify the effect of a self-instructive method (comic strip), applied with distinct approaches and evaluated over two periods, on the oral health of schoolchildren. Method: The sample comprised 2nd year elementary schoolchildren chosen randomly and divided into four groups: a control group (G1) which received no material, a reading group (G2), which was given the comic strip and read it in the classroom, a discussion group (G3), who received the comic strip, which was read out loud in the classroom and discussed, and a complete group (G4), which received the comic strip and which, after reading it, was asked to rewrite the story. O'Leary's plaque index was used as an evaluation instrument, measured immediately prior to application of the program and again 30 days later. The plaque index measured after and 30 days was compared, in each group, using the Wilcoxon test. The plaque index of the diferents groups was compared using the Kruskal-Walis test, in two moments diferents. The significance level was 5%. Results: The results of the evaluation revealed a statistically significant reduction (p<0.05) of the plaque index presented between the two periods in the four groups studied here. However, this reduction was considerably greater in the discussion and complete groups. Conclusion: The use of the self-instruction method associated with work on its content, as occurred in the discussion and complete groups, led to a better understanding of the subject matter, resulting in a higher reduction of plaque indices.

Limpeza do forame e extrusão apical de raspas de dentina em dentes unirradiculares submetidos ao procedimento de patência apical

Objective: To verify the cleaning of the apical foramen and apical extrusion of dentin chips in single-rooted teeth instrumented with two techniques, one of which including the apical patency procedure. Method: Thirty teeth were internally stained with Indian ink, divided in two groups, of which only group I was subjected to apical patency. The dentin chips extruded through the apical foramen were collected in a glass receptacle and quantified. The apical foramen region was divided in quadrants and analyzed with a stereomicroscope to verify the action of the instrument on the cemental canal walls. The teeth were scored 0 4 according to the number of clean walls (without Indian ink), 0 corresponding to no clean wall. Results: In group I, there was no dentin plug, but only 1 tooth was scored 4. In group II, 10 teeth presented dentin plug and all of them were scored 0. There was no statistically significant difference between groups I and II regarding the extruded dentin mass (Scheffé test; p<0.05). Conclusion: The use of the apical patency procedure in single-rooted teeth does not modify the amount of dentin chips extruded through the apical foramen, does not produce an adequate cleaning of the cemental canal walls, but remove the plug of dentin chips from the cemental canal.

Avaliação das condutas de biossegurança em laboratórios de prótese dentária de João Pessoa, PB, Brasil

Objective: To evaluate the biosecurity measures adopted in dental prosthesis laboratories of the city of João Pessoa, PB, Brazil with respect to prosthetic works sent by dentists. Method: Twenty-five dental prosthesis technicians (DPT) of the city of João Pessoa, PB, filled out a questionnaire referring to their knowledge of the biosecurity principles, disinfection of impressions and other prosthetic items, and the use of individual protection equipment (IPE). Results: Although 92% of the interviewees believed in the possible occurrence of cross-infection between dental prosthesis laboratories and dental offices, 64% declared that the prosthetic works received in their laboratories do not undergo any disinfection procedure. It was also observed that, for disinfection of impressions and stone casts, the chemical substances are not used as recommended by the manufacturers or are innocuous to microorganisms. Regarding the use of IPE, 60% of the DPT used mask, but only 4% used gowns. With respect to the measures taken regarding the impressions received from dental offices, 56% of the interviewees only wash them in running tap water, and 56% of the stone casts that arrive at the laboratory are not disinfected in any way. Conclusion: There is a need for more motivation and instructions to DPT regarding the prevention of cross-contamination during sending and receiving of prosthetic works between dental prosthesis laboratories and dental offices because the DPT evaluated in this study were found negligent with respect to disinfection procedures.

Associação entre condição periodontal de gestantes e variáveis maternas e de assistência à saúde

Objective: To evaluate the periodontal condition of pregnant women and to analyze the influence of maternal variables - socioeconomic-demographic data, health, deleterious habits and access to dental service - and the existence of the Family Health Program (FHP) at the public assistance services to pregnant women. Method: This evaluation was part of a cohort study with pregnant women and children conducted in two cities of the São Paulo State, one of which with an implemented FHP. Oral examinations were done using the Community Periodontal and Periodontal Attachment Loss Indexes, and semi-structured interviews with the pregnant women at their homes. Data were analyzed statistically by the chi-square test and Fisher's exact test at 5% significance level (α=0.05). Results: All pregnant women (n=119) registered at the public health service of each city were examined. The mean age was 24.7 years; 61.4% were black or black/white mixed-race women; most (65.5%) earned 2-3 minimum wages, and only 6.7% initiated higher education. Only 8% of the patients presented periodontal health. Bleeding and calculus were observed in 66% of them, and shallow and deep periodontal pockets in 20%. Periodontal attachment loss > 4 mm was observed in 24% of the pregnant women. The group was homogeneous as to the maternal characteristics, age (p=0.0384) and smoking (p=0.0102) being the only factors associated with periodontal disease. The existence of a FHP at the public assistance service was not associated with a lower prevalence of the disease. Conclusion: The findings of this study show a high prevalence of periodontal alterations during pregnancy, with no influence from the existence of a FHP on the observed conditions. Among the risk variables, age and smoking were the factors associated with the presence of periodontal disease. There is a need for a better planing and accomplishment of oral health actions during the prenatal period.

Conhecimento Odontológico e Comportamento de Retorno de Escolares em Função do Tipo de Instituição (Pública ou Privada)

Objective: To evaluate the dental knowledge and attendance of elementary schoolchildren according to the type of institution (public or private). Method: The sample was composed of 800 children from the 5th to 8th grades of the elementary education. The research instrument was a questionnaire composed of open questions referring to the last recall visit, type and importance of the recall visit, and knowledge of dental caries and periodontal disease. Descriptive statistical analysis was done and the chisquared test was used with a significance level of 5%. Results: There was statistically significant difference between the students from the different institutions regarding the time (p=0.001) and main reason (p=0.001) of the last visit to the dentist, knowledge of the need of periodic visits to the dentist (p=0.001), importance (p=0.001) and frequency (p=0.001) of periodic recalls, and knowledge of dental caries (p=0.001) and periodontal disease (p=0.001). Conclusion: The adolescents presented different dental knowledge and attendance, according to the type of teaching institution.