The Brazilian version of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C): Reliability and validity in dementia

ABSTRACT Background: Patients with dementia may be unable to describe their symptoms, and caregivers frequently suffer emotional burden that can interfere with judgment of the patient's behavior. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C) was therefore developed as a comprehensive and versatile instrument to assess and accurately measure neuropsychiatric symptoms (NPS) in dementia, thereby using information from caregiver and patient interviews, and any other relevant available data. The present study is a follow-up to the original, cross-national NPI-C validation, evaluating the reliability and concurrent validity of the NPI-C in quantifying psychopathological symptoms in dementia in a large Brazilian cohort. Methods: Two blinded raters evaluated 312 participants (156 patient-knowledgeable informant dyads) using the NPI-C for a total of 624 observations in five Brazilian centers. Inter-rater reliability was determined through intraclass correlation coefficients for the NPI-C domains and the traditional NPI. Convergent validity included correlations of specific domains of the NPI-C with the Brief Psychiatric Rating Scale (BPRS), the Cohen-Mansfield Agitation Index (CMAI), the Cornell Scale for Depression in Dementia (CSDD), and the Apathy Inventory (AI). Results: Inter-rater reliability was strong for all NPI-C domains. There were high correlations between NPI-C/delusions and BPRS, NPI-C/apathy-indifference with the AI, NPI-C/depression-dysphoria with the CSDD, NPI-C/agitation with the CMAI, and NPI-C/aggression with the CMAI. There was moderate correlation between the NPI-C/aberrant vocalizations and CMAI and the NPI-C/hallucinations with the BPRS. Conclusion: The NPI-C is a comprehensive tool that provides accurate measurement of NPS in dementia with high concurrent validity and inter-rater reliability in the Brazilian setting. In addition to universal assessment, the NPI-C can be completed by individual domains. © International Psychogeriatric Association 2013.

Setting Time Affects In Vitro Biological Properties of Root Canal Sealers

Introduction: Biocompatibility of root canal sealers is important because of the long-term contact of their eluates and/or degradation products with periapical tissues. The literature still lacks studies about the genotoxic effects of these materials and the influence of setting time on biological properties. The cytotoxicity and genotoxicity of an epoxy resin-based sealer (AH Plus), a single methacrylate-based sealer (EndoRez), and a silicone-based sealer (RoekoSeal) were assessed. Methods: Chinese hamster fibroblasts (V79) were cultured and exposed to different dilutions of extracts from the sealers that were left to set for 0, 12, and 24 hours before contact with culture medium. Cell viability was measured by the methyl-thiazol-diphenyltetrazolium assay. Genotoxicity was assessed by the comet assay. Data were statistically analyzed by Kruskal-Wallis and Dunn tests (P < .05). Results: Root canal sealers were statistically more cytotoxic than the untreated control group, except for the silicon-based sealer. Cell viability ranking was the following (from the most to the least cytotoxic): methacrylate-based > epoxy resin-based > silicone-based. The setting time influenced the epoxy resin-based sealer cytotoxicity (decreased at 12 hours) and the general genotoxicity (increased at 24 hours). DNA damage ranking was the following (from the most to the least genotoxic): methacrylate-based > silicone-based = epoxy resin-based. Conclusions: The setting time had influence on the cytotoxicity of the epoxy resin-based sealer and genotoxicity of all tested sealers. The methacrylate-based sealer was the most cytotoxic, and the silicone-based sealer was not cytotoxic. Genotoxicity was observed for all sealers. © 2013 American Association of Endodontists.

Application of the concepts of agro-tourism, agricultural diversification and food and nutrition for the development of Caribbean communities with reference to standards and priority setting

Introduction There is a renewed call for a new approach to development with emphasis on community empowerment or participation, with the belief that more sustainable activities will be undertaken in those communities. Much of that call, however, is coming not from within the communities, but primarily from advocates of change who may have little to do with those communities. What then will the new approach bring apart from a change in who are the decision-makers? And how do we ensure that the change that is called for will, in fact, bring added benefits to the communities themselves? To be sure, there are some successful stories of a community approach to problem solving. However, there are also many more stories of project failures. Serious analytical work, therefore, needs to be done to determine the factors that promote a successful community-based approach; when this approach should be used; and the methodology that should be employed. In an attempt to determine these factors, a brief analysis will be made of some of the governing structures in the subregion and their possible impact on the proposed new approach. Some of the earlier efforts at stakeholder and community approach to projects will also be examined as well as the new development strategy that is prompting the call for this new paradigm. The new paradigm focuses to a large extent on decision-making and community empowerment. With few exceptions, it is short on the promotion of tangible activities that are based on the resource inventory of the communities. This is not surprising, since, as noted before, the advocates of community empowerment may have very little connection with the communities and, in most cases, are unfamiliar with the resource base. Hence, a theoretical case is made, suggesting more style than substance. Another obvious shortcoming of this new paradigm is its continued over- dependence on assistance from the outside to build communities. Externally funded projects, seminars and meetings outside of the communities and foreign technical assistance continue to dominate these projects. While, of course, all communities have basic common needs such as water, health, education and electricity, there is sufficient diversity within communities to allow for tailoring of activities and programmes such that their differences become assets. It is in that context, that agro-tourism activities, standards, agricultural diversification, food and nutrition and priority setting have been chosen as aspects and activities for promoting community development, drawing on the various strengths of communities, rural or urban.

Análise dos efeitos de um treino parental sobre comportamentos de crianças com TDAH: comparação entre setting terapêutico e ambiente domiciliar

Esse estudo foi realizado com o objetivo de contribuir com a avaliação dos efeitos de uma intervenção comportamental direcionada a pais/responsáveis de crianças com Transtorno do Déficit de Atenção e Hiperatividade-TDAH, investigando os efeitos desse modelo de treino parental em duas condições, setting terapêutico (Condição 1) e ambiente domiciliar (Condição 2), sobre a ocorrência de comportamentos de hiperatividade versus autocontrole. Os participantes foram pais de quatro crianças, na faixa etária entre cinco e nove anos. Utilizaram-se como instrumentos: Termo de Consentimento Livre e Esclarecido-TCLE, Inventário de Estilos Parentais-IEP, Lista de Verificação Comportamental para Crianças e Adolescentes-CBCL/TRF, Escala do TDAH versão para professor, Roteiro de Entrevista Inicial, Roteiro de Entrevista de Avaliação, Roteiro de Entrevista Final, Critério de Classificação Econômica Brasil-CCEB. O procedimento de pesquisa consistiu em: (a) contato com neuropediatra; (b) triagem e convite aos participantes; (c) distribuição de dois participantes para cada condição de intervenção; (d) avaliação inicial, incluindo entrevista com os responsáveis, aplicações do TCLE, IEP e CBCL; (e) visita à escola e aplicações do TCLE, da Escala do TDAH e do TRF, versões para professor; (f) realização de cinco sessões de intervenção, gravadas em áudio e vídeo, duas de linha de base, uma de habituação às regras e duas de manutenção das regras e instalação de comportamento de auto-observação, que envolveram situações de interação em jogos de regras, com participação da terapeuta-pesquisadora, da mãe e da criança; (g) realização de entrevista de avaliação da primeira fase; (h) reversão de contextos para os participantes e (i) avaliação final, realizada por meio de entrevista com os responsáveis e re-aplicação dos instrumentais padronizados com pais e professores, utilizados anteriormente, mais o CCEB. Os dados obtidos por meio dos instrumentos padronizados receberam o tratamento indicado nos manuais. Dois sistemas de categorias de análise do comportamento foram utilizados, um para descrever os comportamentos das mães e outro para comportamentos observados nas crianças. Os principais resultados sugerem que as crianças em ambiente de consultório tiveram maior ocorrência de emissão de comportamentos de autocontrole do que as em ambiente de domicílio, as quais, por sua vez, tiveram prevalência de comportamentos de hiperatividade/impulsividade. Do mesmo modo, as mães em ambiente de consultório obtiveram maiores escores em práticas educativas positivas e menos em negativas, comparadas às mães do grupo de domicílio. Houve aumento de práticas educativas positivas para a maioria das mães. Discute-se o contexto de consultório enquanto um ambiente eficaz de intervenção, embora se reconheça que as dificuldades de controle de comportamentos inadequados são maiores para os pais em ambiente domiciliar, por isso, intervenções em ambiente natural devem ser consideradas no processo terapêutico. Por outro lado, o treino parental demonstrou ser efetivo na aquisição, fortalecimento e manutenção de práticas educativas positivas em todas as mães, o que pode influenciar beneficamente os comportamentos das crianças com TDAH.

Paródia e carnavalização no cancioneiro Chico Buarque de Hollanda

A pesquisa Paródia e carnavalização no cancioneiro Chico Buarque de Hollanda investiga os aspectos paródicos e carnavalescos presentes no repertório de Chico Buarque, enfatizando a carnavalização, inicialmente, como uma prática cultural medieval, baseada nas teorias de Mikhail Bakhtin, a cerca do carnaval medieval e renascentista analisado na obra do francês François Rabelais, proposições desenvolvidas no livro A cultura popular: na Idade Média e no. Desta análise, o presente estudo destaca os principais elementos constituintes dos ritos carnavalescos: 1) o dialogismo entre o discurso popular e o discurso poético, uma vez que toda comunicação é uma ação recíproca; 2) a ambivalência da linguagem carnavalesca que primava por estabelecer a ligação entre os pólos positivos e negativos referentes ao ciclo nascimento-morte; 3) o riso e as suas complexidades de significações e realizações que oscilam entre a ingenuidade e a sátira; e por fim 4) a paródia que incorpora todos os elementos citados anteriormente para sua realização. Partindo da apreensão destes conceitos, será traçado também um breve panorama histórico para compreender as múltiplas facetas artísticas de Chico Buarque e a sua relação com a vida social, a fim de percebê-lo por meio de sua produção como poeta lírico social. Para comprovar a importância do carnaval na cultura universal, dando ênfase à cultura brasileira, as canções Tem mais samba (1964), Sonho de um carnaval (1965), Amanhã, ninguém sabe (1966), Noite dos mascarados (1966), Roda-viva (1967), Ela desatinou (1968), Apesar de você (1970), Quando o carnaval chegar (1972) e Vai passar (1984) serão analisadas num estabelecimento comparativo entre o carnaval contemporâneo e o carnaval medieval, observando as confluências e dissonâncias, que ainda fazem parte desta festa popular. Desta apreciação, o presente estudo assinala a importância da obra de Chico Buarque pelo valor poético e cultural presente em todas as suas atividades artísticas. Os critérios de análise serão pautados num estudo bibliográfico entre as teorias carnavalescas de Bakhtin e as músicas de Chico Buarque, que aqui serão compreendidas como poemas-canções, destacando dessas a temática do carnaval.

Setting boundaries: Environmental and spatial effects on Odonata larvae distribution (Insecta)

Características ambientais e distâncias espaciais entre os locais foram utilizadas para explicar a distribuição das espécies no ambiente, através das predições da teoria Neutra (espaço) e teoria do Nicho (ambiente). Foram avaliados os efeitos de fatores geográficos e ambientais sobre a distribuição de larvas de Odonata ao longo da Bacia do Rio Suiá-Missu, no estado de Mato Grosso. Nós testamos a hipótese de que (1) o ambiente é o principal fator de estruturação da comunidade devido às suas exigências ecofisiológicas; e (2) o padrão, se presente, é mais expressivo para Zygoptera. As amostras foram feitas em 12 locais na Bacia do Rio Suiá-Missu, em três campanhas (2007/2008), com um total de 1.382 larvas de Odonata, composta por 10 famílias, 51 gêneros e 100 morfoespécies. Os Anisoptera foram mais abundantes que Zygoptera, que compreende 81% de todas as amostras. O ambiente afetou Zygoptera (R = 0,291; p = 0,007) e foi o principal fator de estruturação da assembléia. Assim, a teoria do nicho foi confirmada. A ausência deste efeito sobre Anisoptera pode ser devido às adaptações ecofisiológicos que lhes permitem ocupar diferentes habitats. Larvas de Zygoptera são indicadores de mudanças na estrutura do habitat. Os efeitos das variáveis ambientais sobre a ecologia das larvas enfatizam a forte relação entre esses organismos e integridade ambiental.

Clinical and Microbiologic Evaluation of Chronic Leg Ulcers: A Cross-sectional Study

OBJECTIVE: This study aimed at evaluating the flora and bacterial load of chronic leg ulcers (CLUs) according to the clinical judgment of colonization or infection.DESIGN: This was an analytical and cross-sectional study.SETTING: This study was conducted in an outpatient wound care unit in the Dermatology Department of the Botucatu School of Medicine-UNESP, Brazil.PARTICIPANTS: The participants were patients with CLUs who did not use systemic antibiotics.METHODS: The ulcers were clinically divided into 3 groups: ulcers with good granulation tissue (GGT), critical colonization (CC), and infection. Secretion was collected from a 1-cm(2) area using a swab and seeded by the semiquantitative method.OUTCOME MEASURES: The main outcome measures were genus and species of the bacteria found in the cultures and result of the semiquantitative culture correlating with the clinical diagnosis of GGT, CC, and infection.MAIN RESULTS: Seventy-seven ulcers were evaluated: 27 with GGT, 29 with CC, and 21 with infection. Gram-negative bacteria were most often found in all groups (81%): Pseudomonas aeruginosa, in granulation and colonized ulcers, and Proteus mirabilis, in infected ulcers. Ulcers from the infected group showed higher bacterial load.CONCLUSIONS: The flora of CLUs was predominantly constituted by gram-negative bacteria, and P aeruginosa was the most prevalent. The bacterial load of infected ulcers was higher as compared with the others, although some ulcers with GGT also presented a high load. The interpretation of microbiologic tests based on the swab techniques and even on semiquantitative analysis requires close clinical correlation.

Non-destructive thermal wave method applied to study thermal properties of fast setting time endodontic cement

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Compressive strength and setting time of MTA and portland cement associated with different radiopacifying agents

The aim of this study was to evaluate the compressive strength and setting time of MTA and Portland cement (PC) associated with bismuth oxide (BO), zirconium oxide (ZO), calcium tungstate (CT), and strontium carbonate (SC). Methods. For the compressive strength test, specimens were evaluated in an EMIC DL 2000 apparatus at 0.5 mm/min speed. For evaluation of setting time, each material was analyzed using Gilmore-type needles. The statistical analysis was performed with ANOVA and the Tukey tests, at 5% significance. Results. After 24 hours, the highest values were found for PC and PC + ZO. At 21 days, PC + BO showed the lowest compressive strength among all the groups. The initial setting time was greater for PC. The final setting time was greater for PC and PC + CT, and MTA had the lowest among the evaluated materials (< 0.05). Conclusion. The results showed that all radiopacifying agents tested may potentially be used in association with PC to replace BO.

Reflexões psicanalíticas winnicottianas sobre o sentido do silêncio no setting

We tried to analyze in this paper the meaning of silence into the analytical setting, based in Winnicott’s proposal of psychoanalysis and from clinical experience fragments of one the authors. Therefore, we surveyed the meaning of silence in the setting for some psychoanalysts and, afterwards, we made reference mainly to the concepts related to Winnicott’s Theory of the Emotional Maturity, such as holding, handling, the presentation of objects, and those concerning hesitation and transitionality. We further availed ourselves of the concepts of transference and count transference to ponder on the therapeutic dyad into the analytical setting. Our final considerations point to the need to consider silence as an important communication in certain circumstances of the therapeutic work, as well as suggesting that the setting, in this case study, requested hopeful non-invasive approach of the therapist, to allow the appearance of transitional space through which the emotional maturity can be resumed in this patient.

Double-setting alpha-tricalcium phosphate cement provided with interconection channels in rabbits after enucleation: a potential implant for the anophthalmic socket

The purpose of this study was to evaluate the macroscopy and microstructure of a double setting alpha-tricalcium phosphate bone cement sphere provided with interconnection channels (alpha-TCP-i), as well as the integration of the implant with the rabbits' orbital tissue, through macroscopic analysis and histopathology. The external and internal surfaces of the alpha-TCP-i were evaluated macroscopically and by electron microscopy. Twelve New Zealand rabbits received 12mm implants of alpha-TCP-i following enucleation of the left eye. The clinical assessment was undertaken daily during the first 15 days, followed by fortnightly assessment until the end of the study period. For the morphological analysis, exenteration was performed in 3 animals per experimental period (15, 45, 90 and 180 days). The external and internal surfaces of the implant appeared solid, smooth and compact, with six channels which interconnected centrally. The micro-architecture was characterized by the formation of columns of hexagonal crystals. No signs of infection, exposure, dehiscence of sutures or extrusion of the implant were noted in any of the animals during the entire period of the study. The morphological evaluation demonstrated the presence of a thin capsule around the implant, from whence appeared fibro-vascular projections, which penetrated it through the interconnecting channels. In the first days after the insertion of the implant, an intense inflammatory reaction was noted. At 180 days, however, there were no signs of inflammation. The alpha-tricalcium phosphate cement implant was well tolerated in this rabbit model and appeared to be relatively inert with some fibrovascular ingrowth through the large channels.

Impact of inter-judge agreement on perceptual judgment of nasality

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)