Epicardial adipose tissue volume assessed by cardiac CT as a predictor of atrial fibrillation recurrence following catheter ablation.

INTRODUCTION: In patients with atrial fibrillation (AF), up to one third have recurrence after a first catheter ablation (CA). Epicardial adipose tissue (EAT) has been considered to be closely related to AF, with a potential role in its recurrence. We aimed to evaluate the association between the volume of EAT measured by cardiac computed tomography (CT) and AF recurrence after CA. METHODS: Consecutive AF patients underwent a standardized cardiac CT protocol for quantification of EAT, thoracic adipose volume (TAV) and left atrium (LA) volume before CA. An appropriate cut-off of EAT was determined and risk recurrence was estimated. RESULTS: 305 patients (63.6 % male, mean age 57.5 years, 28.2 % persistent AF) were followed for 24 months; 23 % had AF recurrence at 2-year mark, which was associated with higher EAT (p = 0.037) and LAV (p < 0.001). Persistent AF was associated with higher EAT volumes (p = 0.010), TAV (p = 0.003) and LA volumes (p < 0.001). EAT was predictive of AF recurrence (p = 0.044). After determining a cut-off of 92 cm3, survival analysis revealed that EAT volumes > 92 cm3 showed higher recurrence rates at earlier time points after the index ablation procedure (p = 0.006), with a HR of 1.95 (p = 0.008) of AF recurrence at 2-year. After multivariate adjustment, EAT > 92 cm3 remained predictive of AF recurrence (p = 0.028). CONCLUSION: The volume of EAT measured by cardiac CT can predict recurrence of AF after ablation, with a volume above 92 cm3 yielding almost twice the risk of arrhythmia recurrence in the first two years following CA. Higher EAT and TAV are also associated with persistent AF.

Very-early detection of atrial fibrillation after ablation evaluated by a wearable ECG-patch predicts late blanking period recurrence: Preliminary data from a prospective registry.

Introduction: Atrial fibrillation (AF) ablation represents a safe and effective procedure to restore sinus rhythm. The idea that post-procedural AF episodes - during the blanking period - are not considered treatment failure has been increasingly challenged. The E-Patch, a single-use adhesive electrode, facilitates extended continuous ECG monitoring for 120 h. This pilot study aims to assess the effectiveness of this ambulatory monitoring device and investigate whether very-early AF recurrence correlates with delayed blanking period ablation outcomes. Methods: We conducted a single-center, prospective, longitudinal study, including consecutive post-ablation patients monitored with the E-patch. The ability of the device to continuously record was analyzed, as well as the occurrence of AF episodes during external 7-day loop-recorder in the 2nd-month post-ablation. Results: We included 40 patients, median age 62 years (IQR 56-70). E-Patch monitoring was obtained for a median of 118 h (IQR 112-120), with no discomfort nor interpretation artefacts. Very-early AF recurrence was detected in 11 (27.5 %) patients, with a median AF burden of 7 % (IQR 6 %-33 %). Late-blanking period AF was detected in 13 (33 %) of the external 7-day loop recordings. Of the 11 patients that had very-early AF recurrence, 10 (91 %) had late-blanking AF. Very-early AF detection showed 77 % (95 % CI 64 %-90 %) sensitivity and 96 % (95 % CI 90-100 %) specificity in predicting late-blanking AF, with a non-parametric ROC curve AUC of 0.903 (95 % 0.797--1.0). Conclusion: The E-Patch was able to detect very-early AF during an extended period. Very-early AF detection emerges as a predictor of AF recurrence during the late blanking period post-ablation.

A simplified single transseptal puncture approach using high-density 3D voltage mapping for atrial fibrillation ablation: acute complications and long-term results.

Background: An ablation catheter and a circular mapping catheter requiring a double transeptal puncture (TSP) for left atrial access have been conventionally used for atrial fibrillation (AF) ablation. Recently, different operators have combined a single transseptal puncture technique with 3D high-density mapping catheters for pulmonary vein isolation (PVI). Objective: This study aims to compare two strategies, single vs. double TSP, regarding the duration of the procedure, radiation time, complication rates, and outcomes. Methods: Retrospective analysis of a large cohort of consecutive patients that underwent first PVI with radiofrequency energy (RF), using a point-by-point strategy, with a 3D mapping system, either with single or double TSP, according to the operator's choice. Results: 285 patients with a mean age of 59.5 ± 11.6 years (36.5% female, 67.7% paroxysmal AF) underwent a point-by-point catheter ablation with RF between July 2015 and March 2020. The mean CHA2DS2-VASc score was 1.7 ± 1.3. Single TSP was performed in 115 (40.3%) patients and double TSP in 170 (59.6%). The operator's experience (≥5 years of AF ablation procedures) was equally distributed among the two groups. The average procedure time (133 ± 31.7 min vs. 123 ± 35.5 min, for single and double TSP, respectively) did reach a statistical difference between both groups (p = 0.008), but there was a substantial advantage regarding fluoroscopy time (13 ± 6.3 min vs. 19 ± 9.1 min, for single and double TSP, respectively; p < 0.001). Acute major complications present similar rates in both groups (2.6% vs. 2.3%, p = 0.799). At the 2-year follow-up, both groups had a similar sinus rhythm maintenance rate (76.5% vs. 78.8%, p = 0.646). Conclusion: A simplified single-TSP technique using high-density multi-electrode 3D mapping is a safe and highly successful option for AF ablation. This approach yields a substantial reduction in fluoroscopy time, with the potential to avoid acute complications, compared to a conventional double-TSP strategy.

Predictors of psychotherapy dropout in patients with borderline personality disorder: A systematic review.

INTRODUCTION: Borderline personality disorder (BPD) is a highly debilitating psychiatric condition. Despite the expansion of new BPD specific forms of psychotherapy in the last few decades, high dropout rates have been reported in these treatments. Treatment discontinuation is associated with poor patient outcomes, inefficient resource utilization and the demoralization of healthcare providers. METHODS: In order to identify predictors of psychotherapy dropout among patients with BPD, a systematic search of Medline, the Cochrane Library, PsycInfo and PsycArticles was conducted. Studies included were randomized-controlled trials in which patients diagnosed with BPD were exposed to a therapeutic intervention consisted of an evidence-based psychotherapy. The quality of evidence in the studies was assessed through the use of revised Cochrane risk of bias tool. RESULTS: Six articles, incorporating four types of psychotherapy programmes, were included. Overall, the studies present low risk of attrition and reporting bias and unclear risk of selection, performance and detection bias. Patients with weaker therapeutic alliance scores and higher hostility presented with higher dropout rates. In contrast, better mindfulness skills and greater performance in specific neuropsychological domains, such as memory and executive control, were identified as predictive of lower risk of dropout. Sociodemographic variables and treatment history did not influence treatment retention. CONCLUSIONS: Factors that influence discontinuation should be taken into consideration in future treatment programmes, in an effort to optimize retention. Qualitative assessments of patients' reasons for dropping out may also help guide adjustments.

Long-term mental health care in Portugal: A portrait of the first years of activity.

INTRODUCTION: In Portugal, a reform to implement Long-term mental health care (LTMHC) started in 2017 allowing patients with severe mental illness receiving psychosocial rehabilitation to regain their autonomy and be reintegrated into their communities. AIM: To describe the first steps of the Portuguese LTMHC implementation and to assess the relationship between the LTMHC's demand (referrals) and supply (vacancies and occupancy). METHODS: We conducted a national retrospective observational study to analyse the LTMHC referrals, vacancies and occupancy between mid-2017 (LTMHC establishment) and December 2022. We described and analysed the associated indicators through time and geography, as well as performed a simultaneous regression model to evaluate the relationship between supply and demand. RESULTS: There were 1,192 referrals to the LTMHC, of which 99 (8.3%) were made for childhood and adolescence structures. The maximum support residence (RAMa, 'Residência de apoio máximo'), designed for patients with higher disabilities, had the highest number of referrals. Additionally, since the opening of vacancies in different institutions, residential structures became quickly saturated. On the other hand, domiciliary services were those with the lowest occupancy. Our estimates support that the vacancies (supply) are induced by the referrals (demand), and referrals are also related to the location of LTMHC facilities. CONCLUSION: LTMHC is still in the initial stage of development in Portugal, and it is expected to receive financial support through the Recovery and Resilience Programme. According to the occupancy rates and referrals made, residential structures seem to be a priority, being also important to explore the partial use of domiciliary services. The geographical distribution of vacancies can also be a concern, considering the important proximity to the community in LTMHC.

The atrial fibrillation burden during the blanking period is predictive of time to recurrence after catheter ablation.

Objective: This study aimed to assess whether atrial fibrillation (AF) occurrence or its corresponding daily mean burden (in minutes/day) during the mid to late blanking period after pulmonary vein isolation (PVI), predicts AF recurrence. Methods: Analysis of consecutive first PVI ablation patients undergoing prolonged electrocardiogram (ECG) monitoring during the second and third months after PVI. The clinical variables, total AF burden, and their relationship with time to recurrence were studied. Results: 477 patients with a mean age of 56.9 (SD = 12.3) years (63.7 % male; 71.7 % paroxysmal AF), from which 317 (66.5 %) had an external event recorder between 30 and 90 days after ablation. Median follow-up of 16.0 (P 25:12.0: P 75:33.0) months, 177 (37 %) patients had an AF recurrence, with 106 (22.2 %) having the first episode after 12 months of follow-up. In the group of patients with an event recorder, 80 (25.2 %) had AF documented during the blanking period. Multivariable analysis showed that AF during the blanking period was associated with a 4-fold higher risk of recurrence (HR: 3.98; 95 %CI: 2.95-5.37), and, compared to patients in sinus rhythm, those with an AF burden ≥ 23 min/day had an approximately 7-fold higher risk of recurrence (HR estimate: 6.79; 95 %CI: 4.56-10.10). Conclusions: The probability of experiencing AF recurrence can be predicted by atrial tachyarrhythmia episodes during the second and third months after PVI. Atrial arrhythmias burden > 23 min/day has a high predictive ability for recurrence.

Do ball-type attachment systems for overdenture result in better patient-satisfaction? A systematic review of randomized crossover clinical trial.

OBJECTIVE: This review is to compare patient-satisfaction with ball-type overdenture attachment systems with others attachment systems. MATERIAL AND METHODS: This study was registered in PROSPERO (CRD42018097234) and adheres the PRISMA guidelines. Electronic searches on PubMed/MEDLINE, Scopus, Cochrane, and Web of Science databases for published articles were performed before October 2020. The PICO question was: "Do patients with a ball-type overdenture retention system have greater satisfaction, when compared to other attachment systems?" The evaluation of risk of bias was performed using the Cochrane risk of bias tool. RESULTS: After searching the databases, seven articles were selected out of a total of 2583. A total of 312 implants were placed in 139 patients, with a mean age of 65.9 years. The risk of bias in the included studies varied according to the different domains in a risk of uncertain bias or low bias risk. No difference was found between the ball attachment systems and the others systems, with respect to patient-satisfaction. The meta-analysis revealed no statistically significant difference between the ball systems and another systems (P = 0.11; MD: 10.90; 95% CI: -2.55 to 24.35). CONCLUSIONS: Regarding patient general satisfaction, it was not possible to determine differences between the ball system and another types of attachment system for overdenture. The ball-type system was statistically superior only to the magnet system.

Quality of models supplied to dental laboratories for the fabrication of partial removable denture framework / Qualidade de modelos enviados aos laboratórios para execução de prótese parcialmente removível

ABSTRACT Objective The aim of this study was to evaluate the models and plannings of metallic framework of removable partial prosthesis sent to dental laboratories in the city of Recife. Methods: The physical and technical conditions of plaster models were sent by the dentists to 4 dental laboratories. All models were examined, photographed and recorded on a form according to the research objective. Results: A total number of 235 models sent by dental surgeons were used to prepare the metallic structure, in which none of the models presented surveying nor the path of insertion. Out of the 235 models, 41 (17.44%) presented serious failures, such as positive and negative bubbles, broken dental elements, direct retainers and damaged edentulous areas. With respect to the planning, only 22 (9.35%) models were presented with the metallic framework planning, but in an unsatisfactory way. Regarding mouth preparation, no model presented a guide plane, and only 6.8% of models had rests seats, but incorrectly prepared. Conclusion: The models evaluated presented poor quality, lack of planning and no mouth preparation. This shows the need for dental surgeons to be aware of the appropriate prosthesis models and plannings in order to ensure a satisfactory and long-term rehabilitation of the patient, as well as preserving the remaining mouth structures.

RESUMO Objetivo Avaliar os modelos e planejamentos das estruturas metálicas das próteses parciais removíveis enviadas aos laboratórios de prótese dentária da cidade do Recife. Métodos Foram avaliadas as condições físicas e técnicas dos modelos de gesso enviados pelos dentistas à 4 laboratórios de prótese dentária. Todos os modelos foram examinados, fotografados e registrados por meio de um formulário de acordo com o objetivo da pesquisa. Avaliou-se 235 modelos enviados pelos cirurgiões dentistas para confecção da estrutura metálica, na qual nenhum dos modelos apresentou delineamento e registro do eixo de inserção. Resultados Dos 235 modelos, 41 (17,44%) apresentaram falhas graves, tais como bolhas positivas, bolhas negativas, elementos dentários quebrados, retentores diretos e áreas edêntulas danificados. Quanto ao planejamento, apenas 22 (9,35%) modelos apresentavam-se com o desenho da estrutura metálica, porém, de maneira insatisfatória. Quanto ao preparo de boca, nenhum modelo apresentou preparo de plano guia, e apenas 6,8% dos modelos possuíam nichos, porém confeccionados de maneira incorreta. Conclusão Os modelos avaliados apresentaram qualidade insatisfatória, ausência de planejamento e realização de preparo de boca. Isto demonstra a necessidade de conscientização dos cirurgiões dentistas para a confecção dos modelos e planejamentos adequados das próteses, a fim de garantir uma reabilitação duradoura e satisfatória ao paciente, assim como proservação das estruturas bucais remanescentes.

Efficacy of Dental Bleaching with Whitening Dentifrices: A Systematic Review.

A systematic review was performed to evaluate whether whitening toothpastes promote tooth whitening when compared to the use of conventional (nonbleaching) dentifrices. This review was registered at PROSPERO (CRD42017065132) and is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic systematic searches of PubMed/MEDLINE, Scopus, and the Cochrane Library were conducted for published articles. Only randomized clinical trials in adults that compared the use of so-called whitening dentifrices to the use of nonwhitening dentifrices were selected. The outcome was tooth color change. Twenty-two articles from 703 data sources met the eligibility criteria. After title and abstract screening, 16 studies remained, after which a further five studies were excluded. In total, nine studies were qualitatively analyzed. Significant differences in tooth color change were found between the groups using whitening dentifrices and those using nonwhitening dentifrices. Within the limitations of this study, the evidence from this systematic review suggests that bleaching dentifrices have potential in tooth whitening. However, although many whitening dentifrices have been introduced into the dental market for bleaching treatments, it is important to analyze tooth surface and color changes when performing home bleaching.

[Suicidal Behavior among Portuguese Psychiatry Trainees: Comparison with the European Situation]. / Comportamento Suicidário nos Internos de Psiquiatria em Portugal: Comparação com a Realidade Europeia.

INTRODUCTION: The aim of this paper was to assess the prevalence of suicide ideation and attempts in Portuguese psychiatry trainees (adult and child and adolescence), and compare the data with the general population and other European countries. MATERIAL AND METHODS: A structured and anonymous questionnaire was sent by email to 159 portuguese trainees of adult psychiatry and child and adolescence psychiatry with questions about personal history of suicidal ideation and suicide attempts, as well as family history of suicide attempts and completed suicides. This is part of the BoSS Study (Burnout Syndrome Study) performed in 21 countries worldwide. Data was analysed in SPSS v.19. RESULTS: From the inquired population, 62 trainees (40,3%) partially responded, and 46 (29%) were complete responders - these entered the final analysis. There was a ratio of 2:1 (female:male) and a mean age of 29 years. The suicidal ideation was present in passive form in 44% and in active form in 33%; also, 4.3% of respondents had previous suicide attempts. In first degree relatives, 22% had attempted suicide and 13% completed suicide. DISCUSSION: The results are worriying and may be associated with some factors to which this population is exposed. CONCLUSION: It is necessary further research to better understand this phenomenon, its causes and potential modifiers.

Introdução: O objectivo deste trabalho foi avaliar a prevalência de ideação suicida e tentativas de suicídio nos médicos internos de psiquiatria de adultos e de psiquiatria da infância e da adolescência em Portugal, e comparar os resultados com a população geral portuguesa e de outros países europeus. Material e Métodos: Enviou-se um questionário estruturado e anónimo, por e-mail, aos 159 internos de psiquiatria de adultos e de psiquiatria da infância e da adolescência do país, questionando antecedentes pessoais de ideação suicida e tentativas de suícidio, bem como antecedentes familiares de tentativas de suicídio falhadas e consumadas. Estas questões fazem parte do Estudo BoSS (Burnout Syndrome Study) realizado em 21 países. A análise dos dados foi feita através do programa informático SPSS v. 19. Resultados: Responderam parcialmente ao questionário 62 internos (40,3%) e 46 (29%) responderam ao questionário na totalidade, constituindo assim a amostra. O ratio feminino:masculino foi de 2:1 e a média de idade de 29 anos. A ideação suicida estava presente na forma passiva em 44% dos inquiridos e na forma activa em 33%; 4,3% referiu tentativas de suicídio prévias. Em relação à história familiar, registou-se 22% de tentativas de suicídio e 13% de suicídio consumado.Discussão: Os resultados obtidos são preocupantes e podem estar associados a factores específicos a que esta população está exposta. Conclusão:ã necessária uma investigação mais aprofundada para se compreender melhor este fenómeno, respectivas causas e potenciais modificadores.

Autopercepção da qualidade de vida associada à saúde bucal em idosos reabilitados com prótese total inferior tipo ôoverdentureõ / Self-perceived quality of life related to oral health in elderly patients rehabilitated with mandibular overdenture

O objetivo deste estudo foi o de relatar a autopercepção da qualidade de vida associada à saúde bucal em indivíduos idosos reabilitados com próteses totais inferiores implanto- -mucoso-suportadas (overdenture) pelo Projeto de Extensão Implante seu Sorriso vinculado ao Núcleo de Atenção ao Idosos (NAI) da UFPE no período de 2011 e 2012. A satisfação do paciente foi avaliada através de entrevista conduzida por meio do questionário OHIP Edent (Oral Health Impact Profile in Edentulus Adults) específico para esse fim. Da amostra participaram 10 idosos, com idade variando de 65 a 81 anos, sendo o maior número de participantes do sexo feminino (80%). Houve diferença significante do impacto na qualidade de vida avaliado pelo OHIP-EDENT. Esse impacto negativo diminuiu com a substituição das próteses totais removíveis inferiores convencionais por próteses implantorretidas tipo ôoverdentureõ, já que as respostas ônuncaõ ocorreram nos domínios: disfunção social (90%), incapacidade (85%), disfunção psicológica (70%). Concluiu-se, portanto, que a qualidade de vida associada à saúde bucal dos indivíduos idosos foi influenciada positivamente pela utilização de próteses totais implantorretidas tipo ôoverdentureõ, ou seja, houve melhora

The aim of this study was to report the self perceived quality of life related to oral health in elderly patients submitted to smile rehabilitation using overdentures. The patients have participated of the project ôImplant your Smileõ and were treated at the Federal University of Pernambuco between 2011 and 2012. The assessment of patient satisfaction was carried out using the Oral Health Impact Profile in Edentulus Adults questionnaire. A number of 10 patients with age between 65 and 81 years old have participated of the study and 80% of them were women. There was a significant difference regarding impact on quality of life waccording to the OHIP-EDENT. Based on the number of answers æneverÆ to the questions about: social dysfunction (90%), inability (80%) and psychological dysfunction (70%) it is possible to state that the replacement of mandibular dentures by implant supported overdenture has improved quality of life. We have concluded that the use o overdenture enhances quality of life related to oral health of elderly patients

Psychiatry training towards a global future: trainees' perspective in Portugal.

INTRODUCTION: Psychiatry is influenced by society changes, so it should be permanently updating itself, foreseeing future behaviours and pathologies. This study aims to describe psychiatry trainee's opinion in Portugal concerning their training and the modifications they would want to witness in the near future. MATERIAL AND METHODS: A structured questionnaire of 26 questions was developed by the Portuguese Association of Psychiatry Trainees and sent via email. RESULTS: The percentage of responses was 41.5%. The majority of the trainees were satisfied with their formation. However, some changes were pointed out concerning obligatory and optional placements. Most trainees claimed psychotherapy should be included in their training, along with an easier access to investigational procedures and clinical training opportunities abroad. DISCUSSION AND CONCLUSION: This detailed perspective can facilitate the transformation of the curricula throughout Portugal and Europe, allowing the improvement of psychiatry training, as well as the enhancement of mental health care.

Introdução: A psiquiatria é influenciada pelas mudanças que ocorrem na sociedade, devendo estar em constante renovação, antevendo futuros comportamentos e doenças. Este estudo pretende descrever a opinião dos internos de psiquiatria em Portugal relativamente ao seu internato e às modificações que nele gostariam de assistir no futuro próximo.Material e Métodos: Um questionário estruturado de 26 perguntas foi desenvolvido pela Associação Portuguesa de Internos de Psiquiatria e enviado por email.Resultados: A percentagem de respostas obtidas foi de 41,5%. A maioria dos internos estava satisfeita com a sua formação. Contudo, algumas mudanças foram sugeridas no que diz respeitos aos estágios obrigatórios e opcionais. A maior parte dos internos requer que as psicoterapias sejam incluídas no âmbito do internato, solicitando também um acesso mais fácil à investigação e a oportunidades de estágio no estrangeiro.Discussão e Conclusão: Esta perspectiva detalhada pode facilitar a transformação dos currículos do internato em Portugal e naEuropa, permitindo a melhoria do internato de psiquiatria, bem como dos cuidados de saúde mental.

Treatment of root perforations with resin ionomer cement and connective tissue graft: a case report.

The clinical practice of endodontic therapy is relatively common, especially in the anterior of the mouth, with easy access to cavities and in cases of mechanical debridement. However, problems such as perforation of the root canal can occur during treatment, and can cause periodontal tissue damage and esthetic problems. The treatment of root canal perforation consists of periodontal and endodontic therapy, as well as selecting the best material for perforation repair. This is a case report of iatrogenic root perforation on an anterior tooth that required combined restorative, periodontal, surgical, and endodontic approaches. The case describes the use of a subepithelial connective tissue graft (SCTG) on a resin ionomer-restored root surface for the treatment of root perforation and periodontal damage caused by an iatrogenic procedure, with a 12-month follow-up. This case report shows that SCTG can successfully treat root perforations associated with a resin ionomer-restored root surface.

Late-onset Lennox-Gastaut syndrome as a phenotype of 15q11.1q13.3 duplication.

The clinical symptoms associated with chromosome 15q duplication syndrome manifest through a heterogeneous group of symptoms characterised by hypotonia, delay in motor skills and language development, cognitive and learning disabilities, autism spectrum disorder and refractory epilepsy. The late development of Lennox-Gastaut syndrome in patients with 15q11q13 duplication is a possibility that physicians should be aware of. We report the case of a 27-year-old man with a neurodevelopmental syndrome due to a 15q duplication, with intellectual disability, psychiatric disturbances, and an epileptic phenotype diagnosed as late-onset Lennox-Gastaut syndrome.

Prevalência de lombalgias nos enfermeiros / Prevalence of low back pain in nurses

Introdução: Sabe-se que as lombalgias têm grande impacto na profissão de enfermagem, causando dor, limitação funcional e custos elevados com os cuidados de saúde. Os enfermeiros em contexto hospitalar desenvolvem trabalho envolvendo esforços excessivos e repetitivos, durante longos períodos de tempo, adoptando algumas posturas incorrectas. É frequente a escassez de meios técnicos e humanos, assim como as condições de trabalho restritas, contribuindo como factores de risco de lombalgias, aliados aos factores de risco individuais e socioculturais. Objectivos: Avaliar a prevalência de lombalgias nos enfermeiros dos serviços de cirurgia, medicina, neurocirurgia e ortopedia do Centro Hospitalar Tondela-Viseu, EPE. Identificar os principais factores de risco associados às lombalgias. Avaliar a incapacidade funcional dos enfermeiros e constatar se estes apresentam crenças de medo-evitamento relacionadas com o trabalho e com a actividade física. Metodologia: A amostra é constituída por 103 enfermeiros, com idades compreendidas entre os 25 e os 54 anos; trata-se de um estudo quantitativo, de carácter exploratório descritivo, transversal e correlacional. O instrumento de colheita de dados foi aplicado sob a forma de questionário no sentido de avaliar a prevalência de lombalgias e identificar os factores de risco de lombalgias, bem como o Questionário de Dor Lombar e Incapacidade de Quebec (QDLIQ) e o Questionário de Crenças Medo-Evitamento (QCME) para conhecer a incapacidade funcional e as crenças de medo-evitamento relacionadas com o trabalho e com a actividade física, respectivamente. Resultados: Os enfermeiros do estudo apresentam uma elevada prevalência de lombalgias (78,64%) nos últimos 12 meses. Os resultados sugerem que a prevalência de lombalgias está relacionada com vários factores sócio-demográficos e profissionais, bem como com a incapacidade funcional e as crenças de medo-evitamento. A percepção de risco de lombalgias relativamente ao contributo dos diferentes factores é genericamente ajustada, apesar de não estar associada à prevalência de lombalgias. Os resultados sugerem igualmente falhas ao nível estrutural, organizacional e dos equipamentos. Constata-se que a maioria dos enfermeiros apresenta incapacidade baixa para realizar actividades físicas inerentes ao seu quotidiano, causada pela(s) lombalgia(s) e apresenta baixas crenças de medo-evitamento relativas a actividade física e ao trabalho. Conclusão: Os enfermeiros em estudo apresentam uma prevalência elevada de lombalgias, evidenciando uma incapacidade funcional baixa, assim como, baixas crenças de medo-evitamento). A prevalência de lombalgias está relacionada com as variavéis sócio-demográficas (sexo, grupos etários, índice de massa corporal, actividade desportiva, actividades domésticas e frequência diária de actividades domésticas) e profissionais (carga horária semanal, categoria profissional, rácio enfermeiro/doente e factores organizacionais do local de trabalho), bem como com a incapacidade funcional e as crenças de medo-evitamento.

Introduction: It is known that low back pain has great impact on the profession of nursing, causing pain, functional limitation and high costs with health care. Nurses in hospital context develop work involving excessive and repetitive efforts over long periods of time, taking some incorrect postures. It is frequent the shortage of technical and human resources, as well as restricted working conditions, contributing as risk factors for low back pain, combined with individual risk and sociocultural factors. Objectives: To assess the prevalence of low back pain in nurses of surgery, medicine, neurosurgery and orthopedics of the Hospital Tondela-Viseu, EPE. To identify key risk factors associated with low back pain. To evaluate the functional disability of nurses and see if they have beliefs of fear-avoidance related to the work and with physical activity. Methodology: The sample consists of 103 nurses, aged between 25 and 54 years; it is a quantitative, descriptive, exploratory, transversal and correlacional study. The data collection instrument was applied in the form of a questionnaire to assess the prevalence of low back pain and identify risk factors for low back pain, as well as the Questionnaire of Lumbar Pain and Inability of Quebec (QDLIQ) and the Fear-Avoidance Beliefs questionnaire (QCME) to know the functional disability and the beliefs of fear-avoidance related to the work and with physical activity, respectively. Results: The nurses' study showed a high prevalence of low back pain (78.64) over the past 12 months. The results suggest that the prevalence of low back pain is related to various professional and socio-demographic factors, as well as with the functional disability and the beliefs of fear-avoidance. The perception of risk of low back pain for the contribution of different factors is generically adjusted, despite not being associated with the prevalence of low back pain. The results also suggest structural, organizational and equipment failures. It is noted that the majority of nurses presents low inability to perform physical activities inherent in their everyday lives, caused by low back pain (s) and features low fear-avoidance beliefs regarding physical activity and work. Conclusion: The nurses in study showed a high prevalence of low back pain, evidencing a low functional disability, as well as low beliefs of fear-avoidance. The prevalence of low back pain is related to the socio-demographic variables (age groups, sex, body mass index, sporting activity, domestic activities and daily domestic activities) and professionals (working hours per week, professional category, nurse/patient ratio and organizational factors of workplace), as well as with the functional disability and the beliefs of fear-avoidance.

Planejamento em Implantodontia: uma visão contemporânea / Treatment planning in implantodontology: a contemporary view

O implante osseointegrável oferece a possibilidade de reabilitação protética do sistema estomatognático, permitindo o restabelecimento da função, estética e fonética adequadas, além de devolver ao paciente sua autoestima. Quando se pensa na reabilitação bucal com implantes, um aspecto marcante que não poderá seresquecido pelo profissional é que a sua posição é imutável, pois, depois de realizado o implante, muitas vezes, pode se impossibilitar o tratamento reabilitador. O tratamento reabilitador, através de implantes, deve ter início com a construção de próteses diagnósticas, quando o profissional poderá antever o resultado final, em que juntamente com os exames complementares, serão percebidas, observadas, evidenciadas a quantidade e aqualidade de tecido mole e tecido ósseo bem como a necessidade de modificações para atender o planejamentoprévio estabelecido pela prótese diagnóstica que foi transformada em guia ou gabarito cirúrgico, otimizando, assim, o resultado final do tratamento respeitando a posição, número e inclinação dos implantes. Conclui-se que a reabilitação oral, através de implantes, desde as mais simples às mais complexas, num contexto atual de excelência clínica, envolve a íntima relação de várias especialidades odontológicas, que devem estar em sintonia e participar ativamente no diagnóstico, planejamento e execução de cada caso.

Imagem real... Imagem ideal... A autopercepção da aparência facial: um estudo piloto / Real image... Ideal image... The self perception of the facial appearance: pilot study

Um estudo transversal foi proposto com o objetivo de avaliar a influência da aparência facial sobre a autopercepção e a imagem idealizada em crianças de 10 anos de idade, matriculadas nas redes de ensino público e privado da cidade de Recife-PE. Devido à escassez de estudos semelhantes em brasileiros, foi realizado este estudo piloto com o objetivo de: validar o instrumento de investigação elaborado; verificar se existe associação significativa entre a autopercepção e a imagem ideal; verificar se existe diferença significativa entre tipo de escola, sexo e padrão facial da criança em relação à autopercepção e à imagem ideal; determinar o grau de coincidência da classificação facial intra e interexaminadores; calcular uma amostra significativa e representativa da população a ser estudada. A amostra piloto foi composta por 113 escolares de duas escolas públicas e uma particular. Imagens fotográficas de um menino e de uma menina foram modificadas por meio de computação gráfica, obtendo-se, para cada um, quatro tipos faciais diferentes: um harmônico (face equilibrada) e três desarmônicos, representativos dos padrões faciais de Classe II, da Classe III e de face longa. Essas imagens foram apresentadas às crianças para que respondessem qual daquelas crianças se pareciam mais com elas e com qual delas elas gostariam de se parecer. Na análise dos dados foram utilizadas técnicas de estatística descritiva e inferencial - testes qui-quadrado de independência e de homogeneidade. Os principais resultados mostraram que a maioria das crianças teve autopercepção e idealização da face equilibrada, seguido do padrão de Classe III. A classificação do padrão facial das crianças pesquisadas também apresentou como maior percentual à face equilibrada, seguido da face longa

Baseado no estudo piloto, pode-se concluir que o maior percentual de crianças apresentou autopercepção igual à imagem ideal, ou seja, a maioria das crianças pesquisadas parece estar satisfeita com seus padrões faciais