Detecção de microrganismos de infecções bucais: perspectivas e cuidados a serem seguidos

The diagnosis of head and neck infections constitutes relevant step in their treatment. However, in spite of the fact that most of diseases in head and neck region are infectious in nature, several reasons collaborated for dentists do not ask laboratory tests in order to help clinical diagnosis. By mean of this review literature, based on research articles about the newest and most reliable methods of diagnosis for clinical laboratories, the authors discuss the advantages and disadvantages of each selected method and the relevant aspects in transportation of the specimens to the laboratory. Saliva, biofilm, pus, and blood are the most frequent specimens for microbial diagnosis, being that the most used methods are culture and those based on detection of deoxyribonucleic acid by polymerase chain reaction method. Whereas, the culture depends on cellular viability, and has reduced sensitivity, as well as needs favorable conditions in the sample collection and transportation, PCR shows high sensitivity and specificity, but it does not allow the determination of antibiogram, what reduces its usefulness. In addition, few laboratories possess conditions to perform cultivation of obligate anaerobes or have experience in the molecular detection of these microorganisms.

Mortalidade Materna: uma abordagem atualizada

Purpose: to review literature, highlighting current aspects of maternal mortality.  Method: research initiated through electronic data base PubMed [http:// www.ncbi.nlm.nih.gov/pubmed], limited to the last 10 years. The selected cases which related to pre-defined aspects of interest to the study, such as vulnerable population, risk factors, causes, difficulties in obtaining data, preventive measures e new approaches to the problem, among them, ‘near misses’ and severe maternal morbidity.  Results: maternal death is directly related to the quality of life of the population, with relevant disparities among the different social economic areas. Although maternal mortality is the proper indicator to the female population health, its numbers are presented in unrealistic manners due to the difficulties in identifying the cases through death certificates. Preventive measures associated to early and adequate diagnose and treatment are benefic factors in decreasing those maternal deaths. Apart from these, identification and classification of ‘near misses’ and maternal morbidity are featured in the contemporary approach to the issue.  Final considerations: In spite of advanced technology and recognition of preventive measures, a large number of women die daily due to complications in the pregnancy and puerperal cycle. To decrease such tragedy political, social and economical commitment to Health is necessary, in order to promote the needed reforms in the assistance of such cycle.

Treatment of adolescents with early-onset schizophrenia spectrum disorders: in search of a rational, evidence-informed approach

Purpose of review: We aimed to review literature on the efficacy and tolerability of psychosocial and psychopharmacological interventions in youth with early-onset schizophrenia spectrum disorders (EOS). A rationale for pragmatic psychopharmacology in EOS, including dosing, switching and adverse effect monitoring and management, is provided. Recent findings: Three randomized controlled trials (RCTs) over the last 8 years demonstrated benefits of psychosocial interventions (i.e. psychoeducation, cognitive remediation, cognitive behavioural therapy) for EOS without clear advantages of one psychosocial treatment over another. Six large, placebo-controlled, short-term RCTs over the last 4 years demonstrated that aripiprazole, olanzapine, paliperidone, quetiapine and risperidone, but not ziprasidone, were superior to placebo. Except for clozapine's superiority in treatment-refractory EOS, efficacy appeared similar across studied first-generation and second-generation antipsychotics, but tolerability varied greatly across individual agents. Summary: Antipsychotics are efficacious in the treatment of EOS. Given the lack of efficacy differences between antipsychotics (except for clozapine for treatment-refractory EOS), we propose that tolerability considerations need to guide choice of antipsychotics. Further and longer-term efficacy and effectiveness studies are urgently needed that should also explore pharmacologic and nonpharmacologic augmentation strategies.

Developmental tasks as a framework to study personality development in adulthood and old age

Research consistently shows that personality development is a lifelong phenomenon, with mean-level and rank-order changes occurring in all life phases. What happens during specific life phases that can explain these developmental patterns? In the present paper, we review literature linking personality development in different phases of adulthood to developmental tasks associated with these phases. Building on previous work, we describe several categories of developmental tasks that are present in all phases of adulthood. However, the specific tasks within these categories change across adulthood from establishing new social roles in early adulthood to maintaining them in middle adulthood and preventing losses in old age. This trajectory is reflected in mean-level changes in personality, which indicates development towards greater maturity (increases in social dominance, conscientiousness, and emotional stability) in early and middle adulthood, but less so at the end of life. Importantly, developmental tasks are not only associated with mean-level changes, but the way in which people deal with these tasks is also related to rank-order changes in personality. We provide an outlook for future research on how the influence of historical time on the normativeness of developmental tasks might be reflected in personality development.

Integrating attentional control theory and the strength model of self-control

In the present article, we argue that it may be fruitful to incorporate the ideas of the strength model of self-control into the core assumptions of the well-established attentional control theory (ACT). In ACT, it is assumed that anxiety automatically leads to attention disruption and increased distractibility, which may impair subsequent cognitive or perceptual-motor performance, but only if individuals do not have the ability to counteract this attention disruption. However, ACT does not clarify which process determines whether one can volitionally regulate attention despite experiencing high levels of anxiety. In terms of the strength model of self-control, attention regulation can be viewed as a self-control act depending on the momentary availability of self-control strength. We review literature that has revealed that self-control strength moderates the anxiety-performance relationship, discuss how to integrate these two theoretical models, and offer practical recommendations of how to counteract negative anxiety effects.

Do we really know the prevalence of accomodative and nonstrabismic binocular dysfunctions?

Purpose: To determine the scientific evidence about the prevalence of accommodative and nonstrabismic binocular anomalies. Methods: We carried out a systematic review of studies published between 1986 and 2009, analysing the MEDLINE, CINAHL, FRANCIS and PsycINFO databases. We considered admitting those papers related to prevalence in paediatric and adult populations. We identified 660 articles and 10 papers met the inclusion criteria. Results: There is a wide range of prevalence, particularly for accommodative insufficiency (2 %-61.7 %) and convergence insufficiency (2.25 %-33 %). More studies are available for children (7) compared with adults (3). Most of studies examine clinical population (5 studies) with 3 assessed at schools and 1 at University with samples that vary from 65 to 2048 patients. There is great variability regarding the number of diagnostic signs ranging from 1 to 5 clinical signs. We found a relation between the number of clinical signs used and prevalence values for convergence insufficiency although this relationship cannot be confirmed for other conditions. Conclusion: There is a lack of proper epidemiological studies about the prevalence of accommodative and nonstrabismic binocular anomalies. Studies reviewed examine consecutive or selected patients in clinical settings and schools but in any case they are randomized and representative of their populations with no data for general population. The wide discrepancies in prevalence figures are due to both sample population and the lack of uniformity in diagnostic criteria so that it makes difficult to compile results. Biases and limitations of reports determine that prevalence rates offered are only estimations from selected populations.

Is there any evidence for the validity of diagnostic criteria used for accommodative and nonstrabismic binocular dysfunctions?

Purpose: To analyze the diagnostic criteria used in the scientific literature published in the past 25 years for accommodative and nonstrabismic binocular dysfunctions and to explore if the epidemiological analysis of diagnostic validity has been used to propose which clinical criteria should be used for diagnostic purposes. Methods: We carried out a systematic review of papers on accommodative and non-strabic binocular disorders published from 1986 to 2012 analysing the MEDLINE, CINAHL, PsycINFO and FRANCIS databases. We admitted original articles about diagnosis of these anomalies in any population. We identified 839 articles and 12 studies were included. The quality of included articles was assessed using the QUADAS-2 tool. Results: The review shows a wide range of clinical signs and cut-off points between authors. Only 3 studies (regarding accommodative anomalies) assessed diagnostic accuracy of clinical signs. Their results suggest using the accommodative amplitude and monocular accommodative facility for diagnosing accommodative insufficiency and a high positive relative accommodation for accommodative excess. The remaining 9 articles did not analyze diagnostic accuracy, assessing a diagnosis with the criteria the authors considered. We also found differences between studies in the way of considering patients’ symptomatology. 3 studies of 12 analyzed, performed a validation of a symptom survey used for convergence insufficiency. Conclusions: Scientific literature reveals differences between authors according to diagnostic criteria for accommodative and nonstrabismic binocular dysfunctions. Diagnostic accuracy studies show that there is only certain evidence for accommodative conditions. For binocular anomalies there is only evidence about a validated questionnaire for convergence insufficiency with no data of diagnostic accuracy.

Impacto de la mutilación genital femenina en los objetivos del milenio

Objetivo: Relacionar la Mutilación Genital Femenina como factor negativo para la consecución de los Objetivos de Desarrollo del Milenio 1, 3, 4, 5 y 6. Métodos: Se ha realizado la recogida de datos a través de una revisión integradora de la literatura en los años 2014 y 2015. Se consultaron las bases de datos Medline/PubMed, Web of Science, LILACS, SCIELO, Tesis Doctorales TESEO y en las webs de WOK, UNICEF, UNAF y WHO utilizando los descriptores: circuncisión femenina, objetivos de desarrollo del milenio y mutilación genital femenina. Se incluyeron artículos publicados entre los años de 2010 y 2015, y se seleccionaron finalmente 24 artículos. Resultados: La Mutilación Genital Femenina es una práctica basada en discriminaciones de género que refuerza e incentiva el círculo de la pobreza. Provoca complicaciones físicas que pueden repercutir en la mortalidad y morbilidad infantil, así como en complicaciones en el embarazo y el parto y en la adquisición del virus de la inmunodeficiencia humana. Conclusión: La lucha contra la Mutilación Genital Femenina contribuye a la consecución de cinco de los ocho Objetivos del Milenio.

Centralblatt für die Grenzgebiete der Medizin und Chirurgie.

Mode of access: Internet.

Impacts of climate change on vegetation distribution. No. 1: Climate change induced vegetation shifts in the palearctic region

Global average temperature has increased and precipitation pattern has altered over the past 100 years due to increases in greenhouse gases. These changes will alter numerous site factors and biochemical processes of vegetative communities such as nutrient and water availability, permafrost thawing, fire regime, biotic interactions and invasion. As a consequence, climate change is expected to alter distribution ranges of many species and communities as well as boundaries of biomes. Shifting of species and vegetation zones northwards and upwards in elevation has already been observed. Besides, several experiments have been conducted and simulations have been run all over the world in order to predict possible range shifts and ecological risks. In this paper, we review literature available in Web of Science on Europe and boreal Eurasia and give an overview of observed and predicted changes in vegetation in these regions. The main trends include advance of the tree line, reduction of the alpine vegetation belt, drought risk, forest diebacks, a shift from coniferous forests to deciduous forests and invasion. It is still controversial if species migration will be able to keep pace with climate change.

A comparative study of perceptions about social relations between black Caribbean nationals and African Americans in a black institution

The present study researched how first-generation black national Caribbean groups and native born black Americans perceived each other socially within an African American institution. Each group rated the other group on items dealing with perceived social relations. Two black ethnically-distinct communities totaling 151 participants were studied. Chi-square ($\chi\sp2$) and one-way analyses of variances (ANOVAs) were employed to test the collected data. The study yielded results about the researched groups that supported both the major findings in the review literature and the thesis's hypothesis; namely, that black Caribbean nationals tend to perceive that they relate socially more with their own group than with African Americans even as mutual participants in a monoracial institution. The present study was unique, as it incorporated a multinational Caribbean group and an African American group that the literature has not previously researched together, and especially as it surveyed these two groups in the context of a black-owned institution. ^

La thérapie cognitive-comportementale dans le traitement du TDAH chez l'adulte: état des connaissances

Essai doctoral présenté à la Faculté des Arts et des Sciences en vue de l'obtention du grade de doctorat en psychologie clinique (D.psy.)

Health Knowledge, Attitudes, and Practices among Street Children in LMICs

Background: Worldwide, it is estimated that there are up to 150 million street children. Street children are an understudied, vulnerable population. While many studies have characterized street children’s physical health, few have addressed the circumstances and barriers to their utilization of health services.

Methods: A systematic literature review was conducted to understand the barriers and facilitators that street children face when accessing healthcare in low and middle income countries. Six databases were used to search for peer review literature and one database and Google Search engine were used to find grey literature (theses, dissertations, reports, etc.). There were no exclusions based on study design. Studies were eligible for inclusion if the study population included street children, the study location was a low and middle income country defined by the World Bank, AND whose subject pertained to healthcare.

In addition, a cross-sectional study was conducted between May 2015 and August 2015 with the goal of understanding knowledge, attitudes, and health seeking practices of street children residing in Battambang, Cambodia. Time location and purposive sampling were used to recruit community (control) and street children. Both boys and girls between the ages of 10 and 18 were recruited. Data was collected through a verbally administered survey. The knowledge, attitudes and health seeking practices of community and street children were compared to determine potential differences in healthcare utilization.

Results: Of the 2933 abstracts screened for inclusion in the systematic literature review, eleven articles met all the inclusion criteria and were found to be relevant. Cost and perceived stigma appeared to be the largest barriers street children faced when attempting to seek care. Street children preferred to receive care from a hospital. However, negative experiences and mistreatment by health providers deterred children from going there. Instead, street children would often self treat and/or purchase medicine from a pharmacy or drug vendor. Family and peer support were found to be important for facilitating treatment.

The survey found similar results to the systematic review. Forty one community and thirty four street children were included in the analysis. Both community and street children reported the hospital as their top choice for care. When asked if someone went with them to seek care, both community and street children reported that family members, usually mothers, accompanied them. Community and street children both reported perceived stigma. All children had good knowledge of preventative care.

Conclusions: While most current services lack the proper accommodations for street children, there is a great potential to adapt them to better address street children’s needs. Street children need health services that are sensitive to their situation. Subsidies in health service costs or provision of credit may be ways to reduce constraints street children face when deciding to seek healthcare. Health worker education and interventions to reduce stigma are needed to create a positive environment in which street children are admitted and treated for health concerns.

La thérapie cognitive-comportementale dans le traitement du TDAH chez l'adulte: état des connaissances

Essai doctoral présenté à la Faculté des Arts et des Sciences en vue de l'obtention du grade de doctorat en psychologie clinique (D.psy.)

Proposta de implementação de uma metodologia SMED numa metalomecânica

O presente trabalho é o resultado de um projecto experimental que teve como principal objetivo a redução dos tempos de setup, através da implementação da metodologia Single Minute Exchange of Die (SMED) em equipamentos de eletroerosão (EDM) por fio e penetração. Para garantir o sucesso da implementação, após uma revisão bibliográfica centrada no tema SMED, estabelece-se uma metodologia, numa lógica de melhoria contínua análoga a um ciclo PDCA. A metodologia estabelecida envolve as seguintes fases: caracterização da situação inicial, observação, recolha de dados, análise dos dados e implementação SMED. A caracterização da situação inicial visa qualificar a situação encontrada e identificar a zona de atuação - equipamentos em estudo. A observação do processo produtivo é suportada pela ferramenta fluxograma do processo, por sua vez, a recolha de dados visa a avaliação inicial e nessa perspectiva recorre-se à abordagem OEE. Na fase de análise dos dados são introduzidas as ferramentas de análise VSM e diagrama de causa e efeito que auxiliam a identificação de um conjunto de acções de melhoria, a realizar previamente à fase de implementação SMED, culminando assim uma fase PRÉ-SMED. Reunidas as condições ideais iniciou-se a implementação efectiva da metodologia SMED obtendo-se reduções do tempo total de setup superiores a 60%. O presente estudo permite concluir que podem surgir diferenças significativas em diversas aplicações SMED, enfatizando a importância de uma fase PRÉ-SMED de modo a potenciar os resultados alcançados com uma implementação SMED.