Desempenho motor de pacientes com acidente vascular cerebral em um jogo baseado em realidade virtual

The Cerebral Vascular Accident (CVA) is the leading cause of motor disability in adults and elderly and that is why it still needs effective interventions that contribute to motor recovery. Objective: This study was aimed to evaluate the performance of stroke patients in chronic stage using a virtual reality game. Method: 20 patients (10 with injury to the left and 10 to the right side), right-handed, average age 50.6 ± 9.2 years, and 20 healthy subjects with average age of 50.9 ± 8.8, also right-handed participated. The patients had a motor (Fugl-Meyer) and muscle tone assessment (Ashworth). All participants made a kinematic evaluation of the drinking water activity and then underwent training with the table tennis game on XBOX 360 Kinect®, 2 sets of 10 attempts for 45 seconds, 15 minutes rest between sets, giving a total of 30 minutes session. After training the subjects underwent another kinematic evaluation. The patients trained with the right and left hemiparect upper limb and the healthy ones with the right and left upper limb. Data were analyzed by ANOVA, t Student test and Pearson correlation. Results: There was significant difference in the number of hits between the patients and healthy groups, in which patients had a lower performance in all the attempts (p = 0.008), this performance was related to a higher level of spasticity (r = - 0.44, p = 0.04) and greater motor impairment (r = 0.59, p = 0.001). After training, patients with left hemiparesis had improved shoulder and elbow angles during the activity of drinking water, approaching the pattern of motion of the left arm of healthy subjects (p < 0.05), especially when returning the glass to the table, and patients with right hemiparesis did not obtain improved pattern of movement (p > 0.05). Conclusion: The stroke patients improved their performance over the game attempts, however, only patients with left hemiparesis were able to increase the angle of the shoulder and elbow during the functional activity execution, better responding to virtual reality game, which should be taken into consideration in motor rehabilitation

Controle circadiano e homeostático do sono-virgília em pacientes com acidente vascular encefálico e correlações com a qualidade de vida e o nível de atividade física

The cerebral vascular accident is a neurological dysfunction of vascular origin that leds to development of motor sensibility, cognitive, perceptive and language deficits. Despite the fact that the main sleep disorders in stroke patients are well known, it is still necessary to analyze which mechanisms of regulation of sleep and wakefulness are affected. The objective of this study was to evaluate the changes in the circadian and homeostatic control of sleep-wakefulness in stroke patients and the correlations with quality of life and level of physical activity. The study analyzed 22 stroke patients (55± 12 years old) and 24 healthy subjects (57 ±11 years old). The instruments used in this study were questionnaires on sleep quality, daytime sleepiness, quality of life, physical activity level and the actigraphy. The data were analyzed using the Student `t test, Mann-Whitney test, ANOVA and Spearman's correlation tests. The results showed stability in the sleep-wake circadian expression with changes in the amplitude of the rhythm. However, significant changes were found related to the homeostatic component characterized by increased sleep duration, increased latency, fragmented sleep and lower sleep efficiency. Additional data showed decreased quality of sleep and increased daytime sleepiness, as well as decreased quality of life and level of physical activity. The results indicate that the interaction of circadian and homeostatic control of sleep-wake is compromised and the main reason might be because of the homeostatic component and the lower activity level resulting from the brain damage. Thus, further studies may be developed to evaluate whether behavioral interventions such as increased daytime activity and restriction of sleep during the day can influence the homeostatic process and its relation to circadian component, resulting in improved quality of nocturnal sleep in stroke patients

A intervenção do poder judiciário no acesso a medicamentos no Rio Grande do Norte: uma análise sob a ótica das políticas nacionais de medicamento e de assistência farmacêutica

The present study aimed to evaluate the inclusion of the principles of the National Medicines Policy - PNM and the Pharmaceutical assistance - PNAF in the prosecution of lawsuits involving medicines. To fulfill this necessity , data collection was performed on the website by the Tribunal Rio Grande do Norte - TJ RN ( Rio Grande do Norte Court) , in 2012 . It was obtained 115 judgments, which were analyzed in order to generate Monitoring Indicators from lawsuits and conduct content analysis proposed by Bardin (2006). The results showed that : a) 100 % of the decisions were favorable to the author , b) 76 % of decisions were requests by the trade name of the drug , c) only one drug (eculizumabe) had not granted by ANVISA , d) 36 % of drugs were present in the list of standard medicines in SUS , 16 % of primary care block and 20 % of specialized component , e) 76 % of the decisions presented the request of at least 01 non-standard medicine. With regard to decentralization of PNM and PNAF we observed a commitment to this principle at judicial decisions, to see that municipalities and states are often forced to buy medicines of responsibility from another federal entity or other tertiary units as CACONs and UNACONS. The content analysis revealed that the argument from the judges used when you utter their decisions was that the right to health is recognized by Brazilian law as a fundamental right and should be guaranteed by the State for all its citizens. So, health is more than budgetary constraints of federal entities, which are severally liable for lawsuits , regardless the medication requested belongs or not to a particular block of a pharmaceutical assistance funding. Given these data, it is observed that there are gaps in the judgment when it comes to the insertion of the words and principles of PNM and PNAF, creating then the need for greater dialogue between the executive and judicial, so that they may consider relevant the effectiveness and application of such principles to minimize the negative consequences of the phenomenon of health judicialisation. Keywords: Judicialisation, Medicines, Public Policy, Pharmaceutical Care

Os Centros de Especialidades Odontológicas como suporte da atenção básica: uma avaliação na perspectiva da integralidade

The public dental services in Brazil were limited, practically, to the basic care, so that the specialized services acted, up to 2002, no more than 3,5% of the total of clinical procedures. That lower offer reveals the difficulty of continuity of the attention, that is, the comprehensiveness in the assistance, particulary, the reference and counter-reference system. Brasil Sorridente search to supply those needs when proposing Speciality Dental's Centers(CEOs Centros de Especialidades Odontológicas, Brazil) to compose the services of average complexity. In 2005, Ministry of Health enabled the three CEOs of Natal, located in the North II, East and West Sanitary Districts. This investigation evaluated the implantation of these CEOs, as support of the family health care teams, in the perspective of organization of the services in assistencial nets in Natal/RN. It was a study of evaluation, with qualitative approach and some quantitative data as contribution. Dentists, users and managers were interviewed to identify and to understand their perceptions, relationships and experiences in the daily of the services. The conceptual base that orientated the investigation was the principle of comprehensiveness, in its operational sense of the hierarchization in health attention levels. The collection of data was done with documental research, direct observation and semi-structured interview. The analysis was accomplished by triangulation of the extracted content from the used techniques and sources of interviewed groups depositions, looking for theoretical-conceptual support in specific bibliography. The results pointed aspects that go away from the comprehensiveness like: low resolution of problems in the basic net; little valorization of the space in the health units; traditional models of access to health services, insufficient offer for some specialties, compromising the reference and counter-reference system; practices centered in procedures in the CEO; bureaucratic directions from basic care to the specialized service; disintegrated and disjointed system among levels of attention; disrespect to the municipal protocol. On the other hand, there is an approach of compreensiveness in situations like: increase of the access and covering in the Family Health Strategy (ESF Estratégia Saúde da Família, Brazil); larger approach between professional and user; tendency to the quantitative and qualitative growth of specialized actions; punctual initiatives of relationships among levels; existence of protocol to guide professionals

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

Avaliação de Percepção de periodontistas, protesistas, ortodontistas e leigos sobre parâmetros periodontais relacionados à estética do sorriso

The concept of facial esthetics has been increasingly diffused, being of interest to both the general public and the surgeon-dentists. However the difficult standardization and high variability in parameters aesthetic existing in the literature result in a huge difference of opinions between professionals and layperson. In this way, objective of this research was to evaluate the perception of periodontistas, protesistas, orthodontists and layperson about aesthetics smile. The sample included 30 periodontistas, 30 protesistas, 31 orthodontists and 37 layperson. The data collection was performed through an interview indirect, by the site, which had fifteen photos to be assessed by the participants. Each photograph was intentionally modified, with four increments 1mm for each amendment, in the program Adobe Photoshop CS2 version 9.0, adding-four aesthetic alterations: exposure gingival, recession gingival, absence of papilla and contour gingival. The smile for periodontistas, 3mm for orthodontists and laity and 4mm for protesistas. And changes in recession gingival, have undertaken the aesthetics of smiling from 2mm in accordance with the periodontistas and protesistas and 4mm for orthodontists and lay people. The end of the research was possible to conclude that the perception of periodontistas, protesistas, orthodontists and layperson are different in relation to aesthetics smile, and that among the changes in the research evaluated the papilla and recession have undertaken the aesthetics of smile

Eficácia do cimento de ionômero de vidro como selante oclusal sobre a paralisação de lesões cariosas em dentina

Dental caries consists in a multifactorial and dynamic process. The knowledge of the ionic interactions among dental tissues and dental biofilm make possible its understanding as a process that can be stopped. Recently, the use of sealants have lost its function as preventive agent and passed to be argued as a possible therapeutical agent. This happens by hindering the substratum flow to the lesion inner and, therefore, controls the advance of the process. This study aimed to evaluate glass ionomer cement as a not invasive technique of treatment in occlusal caries without clinical cavitation, but with dentinal involvement. The research was accomplished using a controlled clinical trial with two groups (experimental and control) in 38 subjects (8-18 years) with 51 molars. The teeth of the experimental group were sealed with glass ionomer cement (Vidrion-R, S.S.White, Juiz de Fora, Brazil) and the molars control did not suffer intervention. The experimental group was followed by a year and the control by 8 months due the progression of the carious injury. Both groups were reevaluated to each 4 months with the use of clinical, radiographic and laser fluorescence (DIAGNOdent®) examination. The analysis of the clinical evaluation did not observe a significant difference between experimental and control groups. However, analysis with radiographic and laser fluorescence (DIAGNOdent®) examination observed a significant difference (p> 0,05) between groups, demonstrating a wors condition to the group without intervention. The results suggest that glass ionomer cement as sealant can be efficient to paralyze dentinal caries without clinical cavitation

Avaliação clínica longitudinal do periodonto de dentes pilares e não pilares de próteses parciais removíveis

The literature has shown a relation between periodontics and the removable partial denture (RPD), with progressive destruction observed in the support structures. The aim of this study was to clinically assess periodontal condition in users of removal partial denture (RPD), and compare right abutments teeth, indirect abutments and controls before installation and after 1 year, in addition to comparing tooth-supported and tooth mucosa-supported abutments. A total of 50 patients, 32 women and 18 men, mean age of 45 years, took part in the study. The patients were examined by a single examiner at prosthesis installation and after 3, 6, 9 and 12 months. The following were verified at each examination: Probe Depth (PD), Plaque Index (PI), Gingival Index (GI), the amount of Keratinized Mucosa (KM), Gingival Recession (GR) and Dental Mobility (DM); in addition patients received oral hygiene orientation, accompanied by prophylaxis, periodontal scaling and root planing (PSRP), when necessary. Analysis of Variance (ANOVA) with Tukey-Kramer post test was used to assess the dependent variables (PD, PI, KM, GR) of the three groups over time while Friedman s test was used for GI. To assess the outcomes of prosthesis type in the right abutment group, a confidence interval-based analysis was performed. The results showed that the control group was the least compromised in all the variables studied. With respect to development of the groups over time, it was verified that the measures for GR, PD, GI and KM increased from initial examination to 1 year of use in all the groups, but only PI showed a significant increase. There was a non-discriminatory low prevalence of dental mobility. The tooth mucosa-supported prosthesis had significantly higher values for GR, GI and PI and significantly lower ones for KM when compared to tooth-supported. Over time, both types of prostheses showed no significant differences from initial to final examination for the variables GR, PD, KM and GI, with PI significant only for tooth-supported. The results showed that the teeth most involved in RPD design had greater potential of periodontal damage, probably because of greater dental biofilm accumulation. Abutments elements adjacent to the free extremities had less favorable periodontal condition than those adjacent to interpolated spaces, but the use of RPD did not worsen the initial condition

Administração repetida de baixas doses de reserpina: um possível modelo para o estudo de déficits cognitivos e motores associados à Doença de Parkinson

Parkinson's disease (PD) is one of the most common neurodegenerative brain disorders and is characterized primarily by a progressive degeneration of dopaminergic neurons nigroestriatais. The main symptoms of this disease are motor alterations (bradykinesia, rigidity, tremor at rest), which can be highly disabling in advanced stages of the condition. However, there are symptomatic manifestations other than motor impairment, such as changes in cognition, mood and sensory systems. Animal models that attempt to mimic clinical features of PD have been used to understand the behavioral and neural mechanisms underlying neurophysiological disturbance of this disease. However, most models promote an intense and immediate motor impairment, consistent with advanced stages of the disease, invalidating these studies for the evaluation of its progressive nature. The administration of reserpine (a monoamine depletor) in rodents has been considered an animal model for studying PD. Recently we found that reserpine (in doses lower than those usually employed to produce the motor symptoms) promotes a memory deficit in an aversive discrimination task, without changing the motor activity. It was suggested that the administration of this drug in low doses can be useful for the study of memory deficits found in PD. Corroborating this data, in another study, acute subcutaneous administration of reserpine, while preserving motor function, led to changes in emotional context-related (but not neutral) memory tasks. The goal of this research was to study the cognitive and motor deficits in rats repeatedly treated with low doses of reserpine, as a possible model that simulates the progressive nature of the PD. For this purpose, 5-month-old male Wistar rats were submitted to a repeated treatment with vehicle or different doses of reserpine on alternate days. Cognitive and motor parameters and possible changes in neuronal function were evaluated during treatment. The main findings were: repeated administration of 0.1 mg / kg of reserpine in rats is able to induce the gradual appearance of motor signs compatible with progressive features found in patients with PD; an increase in striatal levels of oxidative stress and changes in the concentrations of glutamate in the striatum were observed five days after the end of treatment; in animals repeatedly-treated with 0. 1 mg/kg, cognitive deficits were observed only after the onset of motor symptoms, but not prior to the onset of these symptoms; 0.2 mg / kg reserpine repeated treatment has jeopardized the cognitive assessment due to the presence of severe motor deficits. Thus, we suggest that the protocol of treatment with reserpine used in this work is a viable alternative for studies of the progressive appearance of parkinsonian signs in rats, especially concerning motor symptoms. As for the cognitive symptoms, we suggest that more studies are needed, possibly using other behavioral models, and / or changing the treatment regimen

Características sociodemográficas, hábitos de sono, estado cognitivo e funcional após acidente vascular cerebral

ABSTRACT Introduction: The cerebrovascular accident (CVA) is an important cause of neurological impairment. Few data about the factors associated with morbidity of cerebrovascular accident are found in Brazil. Objectives: Evaluate sociodemographic characteristics, sleep habits, cognitive and functional status of patients with cerebrovascular accident. Methods: The patients evaluated through questionnaire Step 1 to survey the sociodemographic characteristics and Modified Rankin Scale for functional assessment. The neurological degree was evaluated by the National Institutes of Health Stroke Scale (NIHSS), the sleep Habits questionnaire for sleep and cognitive status by the Mini-Examination of the Mental State (MEMS). The data were analyzed using the chi-square test to determine differences in proportions of variables and linear regression analysis. Results: 305 patients were evaluated and the larger number of subjects was between 50 and 69 years (40%), most patients had no formal education (40.3%) and had ischemic type of cerebrovascular accident (72.5%). In the analysis of the functionality it was found that most patients had moderate impairment (55.1%). The results of the sleep habits showed that 63,6% of patients had one more person in the bedroom,12,3% complained about too much noise in the 11 room and 35% of too much light. From these patients 5,8% were smokers, 7,8% and 70,1% drank coffee drinkers, 28,6% had difficulty in initiate to sleep and woke up 37,6% in the middle of the night. Were showed complaints about nightmares (11%), feeling of suffocation (37,7%) and 35% felt very sleepy during the day. In addition, 95% were unemployed, 80,5% did not perform physical activities and 95,4% did not perform mental activities. The cognitive screening conducted a determined association of cognitive status with age and education level and neurological status. Conclusion: The study showed a high frequency of cases of cerebrovascular accident with functional dependence in a moderate degree, identified that many patients do not follow hygienic measures of sleep and found that the assessment of cognitive deficits must take into consideration the age, educational level and degree of neurological patients. We suggest the need for programs of assistance to victims of cerebrovascular accident patients, with a multidimensional approach including the rehabilitation team, the role of sleep medicine and Neuropsychology, so that patients have access to a more appropriate functional rehabilitation, develop a lifestyle that ensures a good sleep quality and are evaluated and rehabilitated with regard to cognitive impairment

Matéria seca e produção de grãos de Crotalaria juncea L. submetida à poda e adubação fosfatada

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação do programa de tutorização da EMATER-RN para servidores em estágio probatório

The present thesis evaluated the contributions and limitations of the tutorship program introduced in EMATER-RN, as a tactic of organizational socialization for civil servants in probationary stage. Tutorship was understood as an intensive and continuous relational process, in which a more experienced person in the organization the tutor offers psychosocial support, stimulates the development of the professional career and enables to the newcomer the tutee learning on job performance. The organizational socialization was considered in the perspective of the symbolic interactionism. The study was characterized as a program evaluation and as an action research. The practical interventions for the program implementation were conducted and, at the same time, the evaluations of process, results and reaction to the program were applied. Among the major contributions of the action research, it stood out: the diagnosis of reasons for the formation of the pair and of expectations of tutors and tutees, the improvement of the tutorship registration tools, the ascertainment of the success of the program in the socialization of the new civil servants, the confirmation of the importance of the compatibility among them and of the adequate performance of tutorship functions for achieving its benefits. Based in constraints of the program, one may quote as essential recommendations: the formation of a technical team supporting the program, the clear establishment of deadlines for each procedure and the reinforcement to its compliance, the investigation of the functions performed by the tutor, the sensitization of the managers to the resolution of problems that affect the program, the voluntary participation of the tutor and the continuous meetings of tutors and tutees. One settles for the relevance of the program and in favor of its continuation, provided that its improvement and systematic management are conducted.

O trabalho docente em psicólogo e o enfrentamento da violência contra crianças e adolescentes: uma experiência teresinense

In this thesis I discuss the role of the psychologist as a university professor and as intellectual from a specific context and also from a specific query. The context is the city of Teresina, capital city of Piauí state, which is peripheral in Brazil s northeast region. The defiance here is to build a critical psychological tradition that will deal with the challenges imposed by the reality of poverty and socio-economic backwardness of the region. The greatest difficulty is the lack of a public institution of learning that carries out instruction, research and extension with commitment to social transformation, and with the production of a psychological knowledge that is able to understand local reality. I take it that the undergraduate course in Psychology at UESPI [State University of Piauí] is the only one in Teresina that can take over such mission. The query is confronting violence against children and adolescents that defies us to ethically and politically commit to solidarity toward fragile human beings in need of adult involvement in order to survive this daily inhumanity. The involvement of psychologists from Teresina in this must result from a social commitment and a technical competence to deal with prevention and therapeutic consideration toward the victims. This dissertation is divided into three parts: the first is a study on the curriculum and the performance of psychologists, which revises the academic output in Brazil and envisages new queries to the theme, such as the role of teaching inside the curriculum, and presents social security (including Medicare) as the privileged field in which Brazilian psychologists perform. The second part contains a study on the concepts of childhood, adolescence and violence, which presents a consideration on the strategies to confront violence against children and adolescents. In the last part I discuss the role of the psychologist as teacher and intellectual in the context undergraduate course in Psychology at UESPI [State University of Piauí] from the commitment to the protection of children and adolescents

Tradução e adaptação da escala de dependência de substâncias do Millon Clinical Multiaxial III para o Brasil

Millon describes the normal personality by means of adaptation styles that are effective in normal environments and personality disorders such as unadapted operating styles. To operacionalize his theoretical model, Millon has built several instruments, including the Millon Clinical Multiaxial Inventory III (MCMI-III), wich consists of a self report inventory composed by 175 true or false response items, containing four verification scales, and others scales wich evaluates 14 personality patterns and 10 clinical syndromes. The Substance Dependence scale (T) is placed along with Clinical Syndromes scales. This research is justified by the lack of a Brazilian instrument to assess personality psychopathological aspects, and aims to translate and semantically adapt the MCMI-III to the Brazilian context, checking validity elements of the Substance Dependence scale, and developing a computer application for assisting the evaluation of assessment results. To this intent, 2.588 individuals data was collected, male and female, aged between 18 and 85 years, characterized as belonging to a clinical or non-clinical group, who took part in the survey via the internet or in person. Respondents completed the MCMI-III, a socio-demographic questionnaire and a subgroup also answered to the Goldberg General Health Questionnaire (GHQ). Besides descriptive statistics, we performed the analysis using the Student t test, principal components analysis and internal consistency. Despite difficulties related to translating very specific English terms, the assessment by judges, experts on Millon´s theory, and the back translation, attested the adequacy of the Brazilian version. Factorial analysis indicated the grouping of translated T scale items into three factors (social activities prejudice, lack of impulse control, and oppositional behavior), by presenting a single item on a fourth factor (apparently related to seeking pleasurable stimuli). The Cronbach alpha for this set of items was 0,82, indicating an acceptable scale reliability. The data analysis resulted in distinction of scores between clinical and non-clinical groups and between men and women; the relationship between high scores on the scale T and the other scales; scores of drug users according to the declared used substance; and the relationship between high scores on T and the verification of disorder or risk on GHQ mental health factor, indicating the instrument´s adequate sensistivity in identifying psychopathologies and the relationship between the different disorders or psychopathological personality patterns. Although further studies are necessary to develop the scores transformation factors, the computerized correction tool was adequate.

Significado do Trabalho e Escolha Acadêmico-Profissional: um estudo com universitários primeiranistas

Relations between the meaning attributed to work by first year university students and their academic and professional choice were analyzed. The participants were 921 students, 17-52 years old (M = 22; SD = 4.9), enrolled in 16 courses common to two college level institutions of the city of Natal, RN, one public, the other private. A questionnaire was designed for collecting data about the academic-professional choice, with open-ended and multiple choice questions. Work meaning was obtained by means of two questions on centrality and two scales pertaining to the Inventory of Motivation and Work Meaning: value and descriptive attributes. A socio-demographic set of questions ended the questionnaire. Data was entered in a SPSS (Statistical Package for the Social Sciences) database, allowing for the pertinent statistical analyses, such as frequency, t test, chi square, factor analysis, cluster analysis and ANOVA. Results indicated that the decision about academic-professional career was made by the majority of the participants (in first option, N = 921) without the adequate consideration of the socio-professional reality (80.7%) and personal internal resources (98.5%). When considering the second option (N = 654), only the first criterion was taken into account, but only by 12.5% of the sample. The main difficulties faced by students during the choosing process were, then, made apparent in the data. 46.8% of the participants were unsatisfied with the course they had started and were anticipating unpromising perspectives in relation to it. The first year students took work as the second most important aspect of their lives and demonstrated an idealized vision about it. Five patterns of work meaning were identified. In relation to centrality and the value and descriptive attributes, the university students displayed differentiation in the attribution of work meaning according to course and area of knowledge