Signs of Temporomandibular Disorders in Migraine Patients: A Prospective, Controlled Study

Objectives: To identify signs of temporomandibular disorders and cervical pain in individuals with episodic and chronic (transformed) migraine (CM), relative to controls without headaches. Methods: In this prospective, controlled, double-blind study, we examined 93 individuals divided in 3 groups: episodic migraine EM, (n= 31), CM chronic migraine (n= 34), and controls without migraine (n= 28). We recorded signs of temporomandibular disorders, and of pain in the neck, after the protocol of Helkimo (1974). We calculated the odds ratio (OR) and confidence intervals (CI) of symptoms as a function of headache status. Data from all groups were paired and compared using the chi(2) test. The level of significance was 5% in 2-tailed tests. Results: Relative to controls, participants with EM and CM were significantly more likely to have tenderness in the masticatory muscles [controls = 28%, migraine = 54%, (OR = 3.0, 95% CI = 1.1-8.9), CM = 73% (OR = 6.9, 95% CI = 2.3-21.2)], and in the temporomandibular joint [controls = 25%, migraine = 61%, (OR = 4.7, 95% CI = 1.5-14.5), CM = 61% (OR = 4.8, 95% CI = 1.6-14.5)]. They were numerically (but nonsignificantly) more likely to have limited lateral jaw movements (CM = 34%; EM = 26%; NP = 18%), joint sounds (CM = 44%; EM = 29%; NP = 28%), and tenderness in neck muscles (CM = 64%; EM = 51%; NP = 35%). Conclusion: In a tertiary care population, individuals with EM and CM are more likely to have tenderness at the temporomandibular joint and on the masticatory muscles, relative to controls. Studies are needed to investigate whether treatment of 1 disorder will improve the other.

Bupivacaine 0.25% and methylene blue spread with epidural anesthesia in dog

Objective To evaluate the extent sensory and motor blocks produced by the epidural injection of different volumes of 0.25% bupivacaine (Bu) with methylene blue (MB), in dogs. Study design Prospective experimental trial. Animals Twenty healthy adult mongrel dogs, weighing 9.9 +/- 1.9 kg. Methods Dogs were randomly allocated into one of four groups that received 0.2, 0.4, 0.6 or 0.8 mL kg-1 of an epidural solution containing 0.25% Bu and MB. Sensory block was evaluated against time by pinching the tail, hind limb interdigital web, toenail bases and the skin over the vertebral dermatomes. Motor block was assessed by ataxia, hind limb weight-bearing ability and by loss of muscle tone of the tail and pelvic limbs. Data were collected at 2, 5, 10, 15 and 30 minutes after the end of epidural injection. After the final time point, dogs were euthanatized and laminectomies were conducted to expose the extent of the dural dye staining. Results The volumes 0.2, 0.4, 0.6 and 0.8 mL kg-1 of 0.25% Bu and MB blocked a mean of 5, 14.2, 20.2 and 21 dermatomes, respectively. The extent of the senory block increased up to a volume of 0.6 mL kg-1. Motor block was longer-lasting and more intense than sensory block. Complete dyeing of the spinal cord with MB was achieved in some dogs at 0.4 mL kg-1 and all dogs at 0.6 mL kg-1. Conclusions The volume of anesthetic injected into the epidural space plays an important role in the quality of the epidural anesthesia. At 0.25%, bupivacaine provided an efficient sensory block at 0.6 mL kg-1. Clinical relevance Relatively high volumes (0.6 mL kg-1) of 0.25%, BU and MB were needed to produce an effective sensory and motor block caudal to the umbilicus, but all spinal cord segments were reached by MB at this dose.

An evaluation of the changes in malocclusion index scores over a 25-year period

Background: The measured values of specific traits of occlusion may be subject to significant change due to growth and maturation of the dentofacial structures. Some traits may show improvement while others may show deterioration. Rarely is there an opportunity to examine a sample of occlusions 25 years after the acquisition of the original set of records. This study examines the changes in traits of occlusion in a sample of 46 subjects who were originally examined between 1971-1973 and for whom records were again obtained in 1998. Methods: The 46 patients were a sub-group of a previously selected randomised school-based sample and study models obtained in 1971-1973 were still available. New models for each patient were obtained in 1998. Of the 46 subjects, only eight had received orthodontic treatment. Results: Assessments of the changes in specific traits were made using the methods proposed in the Harry L Draker, California Modification (HLD Cal Mod) index. This simple index was chosen because the main component traits were well defined and, when analysed separately, reflected changes with time. The total index score gave a broad indication of the global changes in the individual's occlusion. The five basic traits of the HLD index include overjet, overbite, openbite, mandibular protrusion and labio-lingual spread. Three additional traits (ectopic eruption, anterior crowding and posterior crossbite) are used in the HLD Cal Mod index. These traits provided a useful reflection of occlusal changes with time. Measurements were made with reference to specifications and the details outlined in the HLD Cal Mod protocol. The results revealed an increase in total index scores over time with a significant increase in lower labio-lingual spread associated with an increased score in anterior crowding. Overjet and overbite, however, displayed a significant decrease with time. Conclusions: These findings are in keeping with previous studies and highlight the importance of time as a significant issue in the assessment of occlusion.

Clinical aspects of gestational trophoblastic disease: A review based partly on 25-year experience of a statewide registry

Background: Gestational trophoblastic disease is a fascinating group of pregnancy disorders characterised by abnormal proliferation of trophoblast, ranging from benign to malignant. Because the disease is uncommon, there is a need to formulate management with the assistance of collective information. Methodology: A review of available information from English written literature was undertaken especially data reported by registries around the world (Charing Cross Hospital in England, the North-western University and the New England area in the USA as well as our own experience in Queensland, Australia). Where possible, collated data from relevant studies were analysed to answer some of the questions posed in clinical practice, with reference to metastatic disease to liver and brain, twinning of molar gestation and coexisting fetus, and placental-site tumour. Results: We found that molar gestation can be classified according to its clinical presentation which influences the time taken to reach human chorionic gonadotropin (HCG) 'negativity' and the risk of persisting disease. Categorisation of risk is the basis for choice of chemotherapy to achieve good outcomes. Metastases to liver and brain remain problems in management; the development of 'new' metastases during chemotherapy is a very poor prognostic factor. In the variant of twinning with molar gestation and coexisting fetus, it is important to elucidate the fetal karyotype in planning management: a 69XXX fetus is not salvageable but a normal 46XX or 46XY fetus faces the prospect of early preterm delivery. The placental-site tumour is very rare; localised disease is curable by surgery; chemotherapy is less effective in disseminated disease. From collated worldwide data, the recurrence rate after one mole is 1.3% and after two or more is 20%. Reproductive outcome in subsequent pregnancies, even after multidrug chemotherapy, is not different from the general population. Because of the increased risk long-term of second tumours after multidrug chemotherapy a closer surveillance of these patients is necessary Conclusion: In general, the disease in its persisting or malignant form is 'a cancer model par excellence' because of an identifiable precursor condition, a reliable HCG marker, and sensitivity of the disease to cytotoxic drugs. With current management, retention of fertility is possible and normal reproductive outcome assured.

Texto para discuss??o 25: desafios e oportunidades no setor de compras governamentais na Am??rica Latina e Caribe: o caso brasileiro

Este texto tem como objetivo apresentar um panorama geral do setor de compras governamentais na Am??rica Latina, passando posteriormente a uma an??lise do caso brasileiro. Inicialmente s??o abordados alguns aspectos da evolu????o do Estado, demonstrando que as grandes altera????es no perfil do setor p??blico n??o significam obrigatoriamente uma redu????o do tamanho do Estado na Am??rica Latina, mas sim uma profunda transforma????o na organiza????o da sua a????o. No continente latino-americano, o setor de compras tem sido objeto de debates e acordos que visam uma converg??ncia das regras dos pa??ses que integrar??o a ALCA ??? ??rea de Livre Com??rcio das Am??ricas. Este texto tamb??m aborda as principais tend??ncias, desafios e oportunidades neste processo.Na apresenta????o do caso brasileiro s??o analisadas as pol??ticas, o modelo de gest??o e a tecnologia aplicada no setor de compras do governo central, finalizando com uma aprecia????o da nova proposta de lei para o setor.

Texto para discuss??o 28: diagn??stico da situa????o da mulher na administra????o p??blica federal

O presente trabalho, desenvolvido pela Diretoria de Pesquisa e Difus??o da ENAP, tem como escopo apresentar um diagn??stico da condi????o das servidoras federais, comparando-o com a situa????o nas mesmas condi????es dos servidores masculinos. Nesse diagn??stico, apresentam-se dados sobre a inser????o do segmento feminino na administra????o p??blica federal: distribui????o por minist??rios em geral e por miss??o institucional, por natureza jur??dica (autarquias e funda????es), por faixa et??ria, por cargos e carreiras, por inscri????o e habilita????o em concursos p??blicos e por cargos comissionados (DAS). Na primeira parte, ser??o apresentados os dados levantados junto ?? Secretaria de Recursos Humanos do Minist??rio da Administra????o Federal e Reforma do Estado. Em paralelo, s??o elaboradas observa????es acerca dos aspectos mais relevantes no tocante a estas distribui????es

Relat??rio da oficina de mapeamento de compet??ncias

Este relat??rio apresenta os principais resultados da Oficina de Mapeamento de Compet??ncias, realizado no Minist??rio das Rela????es Exteriores, Bras??lia no dia 7 de Abril de 2010. Esta atividade est?? inserida no Programa de Capacita????o em Gest??o de Coopera????o T??cnica Internacional, estabelecido entre a Escola Nacional de Administra????o P??blica, ENAP, a Ag??ncia de Coopera????o Internacional do Minist??rio das Rela????es Internacionais, ABC, e a Ag??ncia de Coopera????o T??cnica da Rep??blica Federal de Alemanha, GTZ. Este projeto conjunto visa a elabora????o de um programa de capacita????o para profissionais que trabalham na Coopera????o T??cnica Internacional, ou profissionais envolvidos com projetos espec??ficos neste ??mbito. Este encontro foi precedido por uma pesquisa de levantamento de perfil e mapeamento de compet??ncias de profissionais atualmente envolvidos na coopera????o t??cnica internacional do Brasil. Este pesquisa contou com a participa????o de 130 profissionais e apontou importantes informa????es para o desenho desta atividade

Semin??rio a realidade brasileira e o papel do administrador p??blico

Trata do folder do Semin??rio A Realidade Brasileira e o Papel do Administrador P??blico, destinado a dirigentes, gerentes e assessores da Administra????o P??blica Federal, Estadual e Municipal, realizado de 25 a 27 de abril de 1984.

Portaria n?? 173, de 25 de setembro de 2012: institui o Comit?? Gestor para os sites da ENAP e o Grupo de Administradores de Conte??do dos sites da ENAP

O Comit?? Gestor para os sites da ENAP, inst??ncia institu??da pela Portaria n?? 173, de 25 de setembro de 2012, cujas atribui????es est??o relacionadas aos sites da ENAP, teve participa????o ativa durante os anos de 2012 e 2013, per??odo em que estiveram envolvidos no processo de constru????o da proposta do novo Portal da ENAP, atualmente em desenvolvimento.

Resolu????o n?? 03, de 25 de mar??o de 2013: disciplina os crit??rios para composi????o e funcionamento do Conselho Acad??mico da ENAP

Fica institu??do o Conselho Acad??mico da ENAP, de car??ter consultivo, com a finalidade de qualificar o desenvolvimento das atividades de ensino e pesquisa da Escola, bem como aprimorar sua capacidade para responder a problemas estrat??gicos de gest??o p??blica.

Portaria n?? 83, de 27 de abril de 2012: institui a Comiss??o de Assessoramento a Classifica????o de Informa????es Sigilosas da Funda????o Escola Nacional de Administra????o P??blica - ENAP

A Comiss??o de Assessoramento a Classifica????o de Informa????es Sigilosas da ENAP foi institu??da pela Portaria n?? 83, de 27 de abril de 2012, em decorr??ncia da Lei de Acesso ?? Informa????o - LAI (Lei n?? 12.527, de 18 de novembro de 2011), com a atribui????o de assessorar as autoridades classificadoras quanto ?? correta classifica????o das informa????es sens??veis, segundo os dispositivos da Lei, bem como de propor ?? autoridade classificadora ou autoridade hierarquicamente superior competente para dispor sobre a desclassifica????o ou reclassifica????o das informa????es sigilosas produzidas e acumuladas no ??mbito da Escola de acordo com a LAI.