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

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.

A (bio)ética e a Odontologia: os (des)caminhos de uma formação humana

The present research carried out from three national dentistry magazines published in the period between 1990 and 2004, has as a goal to analyze how bioethics has been approached in this area, not only identifying the main concerns and tendencies, but also aiming to learn how this knowledge is produced and divulged in the dentistry circuit. We have articulated a quantitative-qualitative approach, studying 2995 articles. The articles were selected and assorted in twenty thematic categories, through their titles and key words. The analysis of the empiric material shows that, although there is a growth tendency of this discussion, little has been published about this theme (1,9%). Besides, it seems that there is an arrhythmia between the present bioethic approach in dentistry and the present life demands, where the deontology and legalist focuses are predominant, seeming to correspond to the inner aspects of the profession alone. In spite of this, through the qualitative approach it was possible to identify ways to build a more complex and integral odontological formation and practice. Within the conclusions, we still point out, that, this investigation, even face to its limitations, seems to offer subsidies for reflection and further studies about the theme, working as a parameter to keep up with the evolution of the bioethic thinking in the Odontology

A influência do tempo de diálise e do paratormônio sobre as condições clínico-radiográficas bucais de indivíduos com insuficiência renal crônica em diálise

Universidade Estadual do Rio Grande do Norte

Associação entre midazolam e detomidina na medicação pré-anestésica para indução da anestesia geral com cetamina em potros

Empregou-se a associação midazolam e detomidina para indução de anestesia com cetamina em 16 potros, machos e fêmeas, entre três e seis meses de idade, distribuídos aleatória e equitativamente em dois grupos (GI e GII). A todos os animais foram administrados midazolam, via intramuscular, na dose de 0,2mg/kg, e após 15 minutos, detomidina, via intravenosa, na dose de 0,02mg/kg. Os animais do GII receberam cetamina pela via intravenosa, dose 2,0mg/kg, três minutos após a administração de detomidina. Quinze minutos após o midazolam, ocorreram sedação e ligeira ataxia, e dois minutos após a administração da detomidina, decúbito lateral em todos os potros, com miorrelaxamento e presença dos reflexos de deglutição e miorrelaxamento, anal e oculo-palpebral. A associação midazolam/detomidina e cetamina provocou ausência dos reflexos de deglutição. Para todos os animais, o tempo de recuperação foi de 45-60 minutos, e temperatura retal e frequência respiratória permaneceram estáveis. Ocorreram bradicardia, bloqueio atrioventricular de segundo grau e aumento das pressões arteriais sistólica, diastólica e média após dois minutos da administração da detomidina. A associação midazolam/detomidina e cetamina demonstrou ser um método eficiente e seguro para a anestesia de potros hígidos.

Estimativas de mortalidade para a região nordeste do Brasil em 2010: uma associação do método demográfico equação geral de balanceamento, com o estimador bayesiano empírico

One of the greatest challenges of demography, nowadays, is to obtain estimates of mortality, in a consistent manner, mainly in small areas. The lack of this information, hinders public health actions and leads to impairment of quality of classification of deaths, generating concern on the part of demographers and epidemiologists in obtaining reliable statistics of mortality in the country. In this context, the objective of this work is to obtain estimates of deaths adjustment factors for correction of adult mortality, by States, meso-regions and age groups in the northeastern region, in 2010. The proposal is based on two lines of observation: a demographic one and a statistical one, considering also two areas of coverage in the States of the Northeast region, the meso-regions, as larger areas and counties, as small areas. The methodological principle is to use the General Equation and Balancing demographic method or General Growth Balance to correct the observed deaths, in larger areas (meso-regions) of the states, since they are less prone to breakage of methodological assumptions. In the sequence, it will be applied the statistical empirical Bayesian estimator method, considering as sum of deaths in the meso-regions, the death value corrected by the demographic method, and as reference of observation of smaller area, the observed deaths in small areas (counties). As results of this combination, a smoothing effect on the degree of coverage of deaths is obtained, due to the association with the empirical Bayesian Estimator, and the possibility of evaluating the degree of coverage of deaths by age groups at counties, meso-regions and states levels, with the advantage of estimete adjustment factors, according to the desired level of aggregation. The results grouped by State, point to a significant improvement of the degree of coverage of deaths, according to the combination of the methods with values above 80%. Alagoas (0.88), Bahia (0.90), Ceará (0.90), Maranhão (0.84), Paraíba (0.88), Pernambuco (0.93), Piauí (0.85), Rio Grande do Norte (0.89) and Sergipe (0.92). Advances in the control of the registry information in the health system, linked to improvements in socioeconomic conditions and urbanization of the counties, in the last decade, provided a better quality of information registry of deaths in small areas

Repercussão geral e súmula vinculante: os efeitos no controle difuso

Brazil since its first republican constitution has adopted systems of laws control. The review activity was given to three state powers or functions state, Executive, Legislative and Judiciary. However, it appears that in the country along the constitutional history, has stood considerably the jurisdictional control of the most important control. Initially, back in 1891, Brazil adopted the jurisdictional control of diffuse from U.S, whose role in monitoring of standards is delivered to all organs of the judiciary, which may face a case, put on trial, ascertain whether or not the possibility of applying a law, removing its impact in case of unconstitutionality. In 1969, entered in the second legal model of judicial review, the concentrated control of constitutionality, whose inspiration comes from the positivist theory of Hans Kelsen, and was adopted by the Austrian Constitution of 1920. According to the abstract control the supervision of law is given to a Court or Constitutional Court, responsible for the analysis of the legal constitutionality independent of its application to a specific case. In Brazil the role of concentrated control was handed over exclusively to the Supreme Court, which serves as the Constitutional Court, which accumulates that function with other constitutionally provided jurisdiction. Throughout this period, from 1891 until today, Brazil has maintained a dual system of judicial control of legal constitutionality, where they coexist and harmonize the diffuse control exercised by any organ of the Judiciary, and concentrated control of competence the Supreme Court. However, one must recognize that with the advent of the Federal Constitution of 1988, the concentrated control has emerged on the national stage due to two important factors: the expansion of the legal capacity to sue and the inclusion of other ways control, besides the already known Direct Claim of Unconstitutionality. This concentrated control and projection of the Supreme Court s attempt to become a true constitutional court, led to a relative weakening of diffuse control even when performed by the Brazilian Constitutional Court. In order to become a true constitutional court, all decisions handed down by the Supreme in the exercise of constitutional jurisdiction should have the same weight and the same measure, or at least bring improvement to similar effects, once is the responsible for the final word when it comes to constitutional interpretation. Thus, the writs of certiorari and stare decisis were responsible for profound changes in the diffuse control, allowing the Supreme Court can strengthen its decisions even in the diffuse control. These two institutions have substantially changed the legal status of diffuse control, allowing an extension of the effects of decisions handed down by the Supreme Court, so that you can no longer be said that the effects of this control to restrict the disputing parties in the process

Ergonomia e Odontologia: determinantes da postura corporal dos estudantes da clínica-escola de uma Universidade Federal

Posture is one of the most worrying problems dentists face. That is because of the high incidence of low back pathologies regarding the professional activity, despite the development on the field of Dental Ergonomics. This work took place at the dental schoolclinic at a Federal University, and it was grounded on the Ergonomic Principles in the workplace. Its main objective was to analyze the determinants of inadequate posture adopted by students inasmuch as the adoption of non ergonomic methods at the school-clinic may influence them to develop inadequate postures in their working environment. The analysis of the activity showed us that it requires some complex procedures in the patient s mouth. Thus, when the students carry out the activity, they start to adopt, although unconsciously, inadequate postures which will make easier the visual accuracy and the access to the operation focus. In case there is no internal (body awareness) or external warning mechanisms (the professor s or the partner s counseling) regarding posture or possible risks which lead them to self-correction, the students become vulnerable to osteomuscle disorders. The time pressure, because the students are expected to perform their task in a predetermined clinical time. The facts related to each patient s variability as well as the stress caused by the expectations to get their work done in time make the students to advance it believing they will waste time if they help their partners or using an indirect view. We could also notice that there was no assistant to perform the job of minor ones, as well as there was no professor who could actually connect the knowledge on Ergonomics to its working practice. The conclusions of this work stand out the need of widen the discussion at the academic environment regarding health professionals in places such as universities. The ergonomic principles in the workplace aim a multidisciplinary analysis based on the experience of students, professors, staff members and janitors that can contribute to some reflection upon the issue and consequently actions which will bring positive changes at the working environment

Atividades experimentais no ensino de biologia em escolas públicas do estado do Rio Grande do Norte, Brasil: caracterização geral e concepção de professores

Recent research has revealed that the majority of Biology teachers believe the practice of experimental activities as a didactical means would be the solution for the improvement of the Biology teaching-learning process. There are, however, studies which signal the lack of efficiency in such practice lessons as far as building scientific knowledge is concerned. It is also said that despite the enthusiasm on the teachers‟ part, such classes are rarely taught in high school. Several studies point pedagogical difficulties as well as nonexistence of a minimal infrastructure needed in laboratories as cause of low frequency in experimental activities. The poor teacher performance in terms of planning and development of classes; the large number of students per class; lack of financial stimulus for teachers are other reasons to be taken into account among others, in which can also be included difficulties of epistemological nature. That means an unfavorable eye of the teacher towards experimental activities. Our study aimed to clarify if such scenario is generalized in high schools throughout the state of Rio Grande do Norte Brazil. During our investigation a sample of twenty teaching institutions were used. They were divided in two groups: in the first group, five IFRN- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Norte schools. Two of those in Natal, and the other three from the country side. The second group is represented by fifteen state schools belonging to the Natal metropolitan area. The objectives of the research were to label schools concerning laboratory facilities; to identify difficulties pointed by teachers when performing experiment classes, and to become familiar with the conceptions of the teachers in regarding biology experiment classes. To perform such task, a questionnaire was used as instrument of data collecting. It contained multiple choice, essay questions and a semi-structured interview with the assistance of a voice recorder. The data analysis and the in loco observation allowed the conclusion that the federal schools do present better facilities for the practice of experimental activities when compared to state schools. Another aspect pointed is the fact that teachers of federal schools have more time available for planning the experiments; they are also better paid and are given access a career development, which leads to better salaries. All those advantages however, do not show a significantly higher frequency regarding the development of experiments when compared to state school teachers. Both teachers of federal and state schools pointed infra-structure problems such as the availability of reactants, equipments and consumption supplies as main obstacle to the practice of experiments in biology classes. Such fact leads us to conclude that maybe there are other problems not covered by the questionnaire such as poor ability to plan and execute experimental activities. As far as conceptions about experimental activities, it was verified in the majority of the interviewees a inductive-empiric point of view of science possibly inherited during their academic formation and such point of view reflected on the way they plan and execute experiments with students

Fortalecimento do controle interno governamental: diagnóstico e propostas para a Controladoria Geral do Estado do RN

O objetivo deste trabalho é fazer uma proposta de intervenção na Controladoria Geral do Estado do Rio Grande do Norte, com o intuito de fortalecê-la, tendo como base a Emenda Constitucional nº 45/2009, que propõe a inserção das macrofunções do Controle Interno: Auditoria Governamental, Controladoria, Corregedoria, Ouvidoria e Carreiras Específicas para os órgãos de Controle Interno. Para dar suporte a proposta, foi feita uma revisão da literatura sobre controles públicos, controle interno governamental, macrofunções do controle interno e sobre carreiras públicas no Brasil. Para propor as mudanças foram realizados dois diagnósticos no órgão, por meio de entrevistas, e constatados problemas na área de gestão organizacional e de pessoal. Diante dos resultados apresentados por meio dos diagnósticos, foram propostas mudanças e feitas comparações entre a estrutura atual e a proposta, procurando evidenciar a vantagem da última sobre a primeira, em termos de eficiência operacional, economia de meio, economia de execução, amplitude no atendimento a população, proteção e combate à corrupção, fomento ao controle social, promoção da cidadania e justiça social

As Memórias de Lacroix: a instrução pública na França revolucionária, em geral, e o ensino de Matemática, em particular

O artigo - um exame hermenêutico do livro Essais sur l'enseignement en général, et sur celui des mathématiques en particulier, de 1805, de Sylvestre-François Lacroix, enfatizando sua segunda parte, na qual o autor discute seu Curso de Matemática Elementar, uma série de manuais escolares elaborados para a Escola Central das Quatro Nações - tem sua fundamentação ligada à Hermenêutica de Profundidade de Thompson conjugada a procedimentos de investigação textual sugeridos por Genette quanto aos paratextos editoriais. Defende que o livro de Lacroix é uma obra auto-referencial, de cunho claramente autobiográfico, que responde mais aos ideais iluministas da França do Setecentos que às perspectivas do século XIX, quando a obra circulou, tendo sido reeditada por quatro vezes, sob Napoleão, na primeira metade do Oitocentos. Raramente focalizado em trabalhos de pesquisa, o livro - cujas edições estão disponíveis eletronicamente - tem uma única tradução, ainda inédita, para o português.

Estimadores do tipo núcleo para Variávei s I.I.D. com espaço de estados geral

In this work, the paper of Campos and Dorea [3] was detailed. In that article a Kernel Estimator was applied to a sequence of random variables with general state space, which were independent and identicaly distributed. In chapter 2, the estimator´s properties such as asymptotic unbiasedness, consistency in quadratic mean, strong consistency and asymptotic normality were verified. In chapter 3, using R software, numerical experiments were developed in order to give a visual idea of the estimate process

Fatores associados à condição de saúde bucal de pacientes internados em hospitais públicos do município de Natal-RN

The hospitalization is an event that can attack any person, independent of gender, race, social and economical condition. Last year, the prevalence of hospitalization was 8.1 for 100 inhabitants and the average time of hospitalization was 8.5 days for each patient one in Natal city. Therefore, an important point is whether the attention to the patients during the permanence in these health establishments incorporates the health integral model suggested by the principles proposed by the National Health System in Brazil (SUS), with actions of promotion and protection by different kinds of professionals, beside those called convalescence. Then, the aim of this study was to evaluate the patient s oral health conditions hosted in public hospitals of the Natal city, looking for to establish its relationship with several risk factors by two dimensions: the characteristics of the hospitalization and the patient s general and economical conditions. We accomplished a cross-sectional study with 205 patients distributed among the hospitals Onofre Lopes, Giselda Trigueiro and Monsenhor Walfredo Gurgel, looking for to know the socio-demographic characteristics, the food habits and of oral hygiene and the conditions of oral health, through the Visible Plaque Index and Gingival Bleeding Index. We observed that the conditions of the patient s oral health interned at public hospitals of reference of the municipal district of Natal is bad, existing accumulation of dental plaque and, consequently, a great number of patients with gingival bleeding. However, the time of hospitalization and its reason, the type of medicine used in this time and the toothbrush frequency were not configured as risk factors for this oral health condition

Hipossalivação e seus fatores de risco em idosos funcionalmente independentes e não institucionalizados

The aim of this study was to investigate the risk factors related to hyposalivation among non-institutionalized independently living elderly people, living in Natal-RN, Brazil. The study was a control-case type and the data collection was accomplished by carrying a questionnaire, oral examination and a non-stimulated and stimulated sialometry. The cases were identified by values of salivary flow rate <0,1mL/min and stimulated ≤ 0,5 mL/min, and the controls were by observing the values of sialometry that were bigger than the previously defined parameters. Age and gender were used as pairing variables. The data were analyzed using X2 (α = 0,05) and odds ratio. The sample was composed of 98,1% female and 1,9% male, with mean age 68. There was not association between hyposalivation and the following studied variables: income, schooling, profession, dwelling conditions, domiciliary density, illness, number of teeth and use of prothesis. However, a link was found between hyposalivation and smoking frequency in the passet (OR=5,14), indicating that, referring to elderly people, the tabagism frequency habit was a risk factor to the studied condition. Therefore, refering to non-institutionalized independently elderly people, economic-social-demographic conditions, general and bucal health, diet and habits such as alcoholism have been not risk factors to hyposalivation. However, people that have been smoking have more risk to have the studied conditions

Prevalência e determinantes de oclusopatias nas dentições decídua, mista e permanente na cidade do Natal/RN

This work is intended to bring a contribuition to the verification of the prevalance of malocclusion in the deciduous, permanent and mixed dentition in the student population in the city of Natal, Brazil. In this purpose, a sectional study of infantiles aging 5, 8 and 12 years old was carried out. The average prevalance of malocclusions in the group as a whole was 76,5%. Considering the different dentitions separately, the study showed malocclusion prevalence as follows: Deciduous Dentition 75,5%; Mixed Dentition 84% and Permanent Dentition 70,5%. The most common malocclusion cases found in the deciduous dentition were openbite (20.6%); overbite (16.6%) and maxillary overjet (14,7). Mixed Dentition: the most commonly found occlusional malfunctions in this dentitional phase were maxillary overjet (33,8%); crowding (28,3%), and mandillary discrepancy (19,9%). In the univaried analysis, he application of the Chi square test of independence, (significance 5%), has indicated a meaningful association of the variables social class (p=0,019), primata space (p = 0,036), habits (p= 0,002) and time-and-habit (P=0,03). The same test on the permanent dentition group revealed a significant association for the independent variables, as follows: Social class (p=O,OOO), School (p=O,OOI), Income (p=O,OOO), housing standard (p=0,001), facial pattem (p=0,004), caries record (p=0,031). No significant association was found in the mixed dentition. The Logistic Regression analysis on the deciduous dentition has shown that income, ethnicity, habit and canine relationship constitute factors of risk regardless of the other variables. As for the permanent dentition, only Facial Pattem was pointed as a factor of risk for the formation of malocclusion