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

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

Descrição do movimento da articulação metacarpofalangiana de equinos pela metodologia baseada em videogrametria

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A elasticidade do ligamento colateral medial da articulação do cotovelo de cão não advém de elastina

A literatura relata que ligamentos consistem de tecido conjuntivo denso, composto por água, colágeno tipos I e III, diversas proteoglicanas, pouca elastina e várias outras substâncias. Além disso, os ligamentos, quando testados in vitro com tensão longitudinal e unidirecional, apresentam um comportamento mecânico não-linear, ou seja, as fibras colágenas são alongadas aos poucos, perdendo seu padrão ondulado, até que todas estejam no limite máximo de tração e iniciem o rompimento. Portanto, no presente estudo avaliou-se a presença de fibras elásticas (elastina) no ligamento colateral medial do cotovelo de cães adultos para ponderar se a elasticidade do referido ligamento deve-se à presença de fibras elásticas ou às propriedades elásticas do colágeno ou à combinação de ambas. Foram utilizadas quatro articulações, de machos e fêmeas em igual proporção, das quais foram adquiridas as amostras das porções médias dos ligamentos colaterais mediais para a rotina histológica. Os cortes foram corados pela técnica de Weigert, e não foi observada a presença de fibras elásticas, detectável por esta técnica à microscopia de luz. Concluiu-se que a elasticidade do ligamento colateral medial do cotovelo de cão deve-se, principalmente, ao padrão ondulado das fibras colágenas, devido à quantidade ínfima ou até à inexistência de fibras elásticas nesta estrutura.

EJA: saberes na articulação curricular da Escola Municipal Professor Amadeu Araújo

The target of this paper is to investigate the possibilities of inscribing into the EJA curriculum the knowledge detected in the neighborhood of a school if the point of view of the student body regarding the basic schooling deserves its due consideration. The empirical field of our research focuses on the elementary school of professor Amadeu Araújo Municipal School in Natal. Our investigative course tried to understand the way pupils think the curriculum contents of knowledge spread around the school from the vision furnished by their elementary school. With this, we hoped to develop a creative understanding concerning that question. Then we reviewed, along the debate, questions related to Nova Natal Housing Estate and its historic, social and cultural beginnings taking in account the participants memories of this research and their suggestions concerning the utility of the community knowledge to the curriculum practices. This project is supplied by the qualitative research and reinforced by the Focal Group s methodological procedures and semi-structured interviews. This procedure allowed us to discern different points of viewing, feeling and understanding in the complexity of the daily life around school and its environment. With these elements, we could note that some students perceptions pointed to a basic schooling fomented by traditionalized pedagogical practices in which teacher and pupil seldom dialogue with each other, what corroborates the impression of undervaluation of the pupil s role. Consequently, the nets of knowledge waved around the school in Nova Natal Housing Estate become useless, when they could be of great utility if inserted in the curriculum contents

Articulação ensino/serviço na visão de discentes de enfermagem

It is a descriptive study with a qualitative approach aimed at understanding the impact of the teaching / service between the Nursing College of University of Rio Grande do Norte (FAEN / UERN) and health services in the city of Mossoró / RN on student s learning process. Hence, it was inquired to rescue and over-elaborate the trajectories experienced by students who were graduating in the year of 2009 the Nursing graduation course. It was used, as guidance tool a questionary with both open and objective questions to support the data collection. The data analysis was accomplished based on the precepts proposed by Bardin. The research revealed a clear need of bond establishments with the involvement of the students on services as well as professionals inserted on Academy, in a way that knowledge can be built collectively and the difficulties can be eased.

Fontes primárias da história do vácuo e da pressão atmosférica na sala de aula: cartas e jornais históricos em articulação com o livro-texto do ensino médio

The use of the History and the Philosophy of Science (HPS) for the teaching of science and scientific subjects has been advocated in recent decades. It has been pointed out that the History of Science could make for a deeper learning of scientific concepts, since it would promote a contact with the problems which that knowledge has set out to solve. Furthermore, historical episodes would serve to put the discussions about the nature of scientific knowledge into context. With a view to explore those potentialities, the literature in the field has sought to identify the challenges and obstacles for the didactic transposition of subjects from the History of Science. Amongst many aspects, the deficiencies in the training of teachers, so that they can work with the insertion of HPS in the classroom have been highlighted. Another aspect that has been mentioned to be a challenge has to do with the didactic transposition of the Primary Sources, that is, of the original texts on the History of Science. The Primary Sources have significant potentialities: making a connection possible between scientists and concepts, showing the difficulties faced during scientific endeavors, perceiving the role of mistakes as obstacles to be surpassed, not as defeat, etc. On the other hand, there has been little exploration of these concepts in an educational context, due to their own peculiarities. The original texts are often hard to understand and their interpretation demands knowledge of the historical and scientific context in which they were written, as well as skills pertaining to the conduction of research in the field of the History of Science. With this scenario in mind, the research towards this Professional MSc degree starts from the challenge of elaborating and discussing proposals which could enable the didactical transposition of the Primary Sources. We have worked specifically with Primary Sources on the History of the Vacuum and of the Atmospheric Pressure, because of the insertion of these subjects in the Brazilian High School curriculum, in connection with the didactical textbooks. "Historic Journals" were made up from clippings of the original historical texts, as was a Didactical Unit, which takes the usual textbooks as a basis and contemplates using the Journals and the entire Primary Sources in High School. At last, we have elaborated and implemented a course designed for the preparation of teachers and for being an opportunity for the discussion of the feasibility of putting these kinds of proposal into practice

Qualidade de Vida, Saúde Geral e Ansiedade em pacientes com diferentes tipos e níveis de disfunção temporomandibular

Some studies reported in the literature that emotional factors and quality of life may be involved both in aetiology, as in the progression of Temporomandibular disorders (TMD). Proposition: The purpose of this study is to observe a possible association between different forms of anxiety, quality of life and general health of patients diagnosed as carriers of various types and levels of Temporomandibular Dysfunction. Methodology: The sample consisted of 60 patients diagnosed as carriers of TMJD origin of muscle, joint, or both, with different levels of severity (mild TMD, moderate and severe). The patients were diagnosed with TMD-RDC (Research Diagnostic Criteria) to assess the type of dysfunction (muscle or joint) and by the Protocol of Fonseca to verify the degree of dysfunction (mild, moderate or severe). To evaluate the psychosocial aspects were used three self-applied, with the purpose of obtaining information about the general health (General Health Questionnaire - GHQ), the type of anxiety (Trait Anxiety Inventory-State - STAI) and quality of life (World Health Organization Quality Of Life Short WHOQOL-brief). Results: There was a correlation between all indicators studied in several forms of TMD with varying degrees of commitment. Quality of life appeared linked to the type and the level of TMD: Muscular and Articular TMD (p = 0,037), Disk Displacement With Reduction (p = 0.01) and Mild TMD (p = 0.042). The General Health showed association with the level of TMD, with the exception of the stress factor (p = 0.78). For the analysis of the types and levels to Severe Muscular TMD had a statistically significant indicator of the quality of life (p = 0049). The anxiety only showed association with the level of TMD (p = 0,047 for anxiety-trait). Conclusion: Besides the limitations of the study, it was concluded that anxiety, quality of life and general health are important psychosocial indicators, which are linked to several forms of TMD in different levels of severity

A articulação da instrumentalidade no exercício profissional do assistente social em Natal/RN

Presents the discussion of practical and social dimensions that comprise the instrumentality (formative; theoretical and intellectual; investigative; technical-instrumental; and ethical-political) Social Work from research in social and occupational areas in which they operate social workers in Natal in Rio Grande do Norte. Chapters expose positions, experiences and reality of the respondents and the theoretical constructs and analytical, to understand: the evaluation of the training process, relating the teaching practice, the role of knowledge and the importance of research in professional practice of social workers, the seizure of technical-instrumental dimension, articulating demands, duties, powers and instruments, as elements that comprise it, and finally the ethical-political dimension, discussing the challenges of ethics and materialization of the ethical-political in daily work. In this sense, the dissertation sought add to production and academic debate about the work of the social worker, as well as contribute to their own professional practice, revealing how professionals articulate the practical and social dimensions that comprise the instrumentality in their daily work

Luxação aguda isolada da articulação tibiofibular proximal

A luxação traumática isolada da articulação tibiofibular proximal é rara. Esta lesão pode não ser reconhecida ou diagnosticada no atendimento inicial. A ausência de suspeita clínica pode causar problemas para o diagnóstico. O diagnóstico necessita de história precisa do mecanismo e sintomas da lesão, avaliação clínica e radiográfica adequada de ambos joelhos. Casos não reconhecidos são fonte de alterações crônicas. O tratamento é feito por redução fechada e imobilização ou, em casos irredutíveis ou instáveis, redução aberta com fixação interna temporária. Um caso raro de luxação tibiofibular proximal isolada em um jogador de basquetebol é relatado para ilustrar essa lesão.

Origin of sensory and autonomic innervation of the rat temporomandibular joint: A retrograde axonal tracing study with the fluorescent dye fast blue

Previous studies that have used retrograde axonal tracers (horseradish peroxidase alone or conjugated with wheat germ agglutinin) have shown that the temporomandibular joint (TMJ) is supplied with nerve fibers originating mainly from the trigeminal ganglion, in addition to other sensory and sympathetic ganglia. The existence of nerve fibers in the TMJ originating from the trigeminal mesencephalic nucleus is unclear, and the possible innervation by parasympathetic nerve fibers has not been determined. In the present work, the retrograde axonal tracer, fast blue, was used to elucidate these questions and re-evaluated the literature data. The tracer was deposited in the supradiscal articular space of the rat TMJ, and an extensive morphometric analysis was performed of the labeled perikaryal profiles located in sensory and autonomic ganglia. This methodology permitted us to observe labeled small perikaryal profiles in the trigeminal ganglion, clustered mainly in the posterior-lateral region of the dorsal, medial and ventral thirds of horizontal sections, with some located in the anterior-lateral region of the ventral third. Sensory perikarya were also labeled in the dorsal root ganglia from C2 to C5. No labeled perikaryal profiles were found in the trigeminal mesencephalic nucleus. on the other hand, autonomic labeled perikaryal profiles were distributed in the sympathetic superior cervical and stellate ganglia, and parasympathetic otic ganglion. Our results confirmed those of previous studies and also demonstrated that: (i) there is a distribution pattern of labeled perikaryal profiles in the trigeminal ganglion; (ii) some perikaryal profiles located in the otic ganglion were labeled; and (iii) the trigeminal mesencephalic nucleus did not show any retrogradely labeled perikaryal profiles.

PAR(2) and Temporomandibular Joint Inflammation in the Rat

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Putative antinociceptive action of nitric oxide in the caudal part of the spinal trigeminal nucleus during chronic carrageenan-induced arthritis in the rat temporomandibular joint

In order to investigate a putative role for nitric oxide (NO) in the central nociceptive processing following carrageenan-induced arthritis in the rat temporomandibular joint (TMJ), we analyzed the immunoreactivity, gene expression and activity of nitric oxide synthases (NOS) in the caudal part of the spinal trigeminal nucleus (Sp5C) during the acute (24 h), chronic (15 days) and chronic-active (14 days-24 h) arthritis. In addition, evaluation of head-withdrawal threshold was carried out in all phases of arthritis under chronic inhibition of nNOS with the selective inhibitor 7-nitroindazole (7-NI). Neurons with nNOS-like immunoreactivity (nNOS-LI) were concentrated mainly in the lamina II of the Sp5C, showing no significant statistical difference during arthritis. Only a discrete percentage of nNOS-LI neurons expressed Fos immunoreactivity. The mRNA expression for both nNOS and endothelial nitric oxide synthases (eNOS) presented no noticeable differences among the groups. No expression of inducible nitric oxide synthase (iNOS) was detected in the Sp5C by either immunohistochemistry or reverse-transcription polymerase chain reaction (RTPCR). Ca(2+)-dependent NOS activity in the ipsilateral Sp5C was significantly higher (108.3 +/- 49.2%; P<0.01) in animals during the chronic arthritis. Interestingly, this increased activity was completely abolished 24 h later, in the chronic-active arthritis. Finally, head-withdrawal threshold decreased significantly in the chronic arthritis in animals under 7-NI chronic inhibition. In conclusion, nNOS immunoreactivity and mRNA expression are stable in the Sp5C during TMJ arthritis evolution, but its activity significantly increases in the chronic-phases supporting an antinociceptive role of the nNOS as evidenced by pain threshold experiment. (C) 2009 Elsevier B.V. All rights reserved.

Phenotypic alterations of neuropeptide Y and calcitonin gene-related peptide-containing neurons innervating the rat temporomandibular joint during carrageenan-induced arthritis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)