Time assessment for final restoration of endodontically treated teeth in a university clinic setting: An observational study.

Background: The aim was to quantify the time elapsed between tooth reconstruction and the end of endodontic treatment, and to assess differences according to sex, age, and tooth group. Material and Methods: A retrospective study was conducted with patient clinical records. Data relating to patient characteristics, treated teeth, endodontic treatment, and subsequent restorative treatment were recorded. Results: For this study, 355 endodontically treated teeth by undergraduate students during 2019 were included. 24 teeth (6.76 %) were not restored, more direct (86.4 %) than indirect (13.6 %) restorations were performed, and the most frequent type of restoration was complex filling. The mean elapsed time from endodontic completion to direct restoration was 7 days, with a minimum of 0 and a maximum of 90 days. For indirect restorations the mean elapsed time was 21 days. Conclusions: The median elapsed time for endodontic tooth reconstruction was 7 days (IQR = 7), however, treatment should not be considered completed until the tooth has been properly restored. In cases where an indirect restoration was also necessary, the median elapsed time was higher (21 days; IQR = 31.5).

Transitivismo e psicopatologia na infância / Transitivismo y psicopatologia em la infancia / Transitivism and psychopathology in childhood / Transitivisme et psychopathologie dans la enfance

No presente ensaio teórico, apresenta-se uma leitura da articulação do conceito de transitivismo com a psicopatologia do autismo na infância. Como objeto de pesquisa, utiliza-se um corpus textual composto por escritos de quatro autores que se dedicaram à discussão da psique infantil: Henri Wallon (1879-1962), Jacques Lacan (1901-81), Jean Bergès e Gabriel Balbo. Trabalha-se, ainda, a partir de recortes clínicos de acompanhamentos terapêuticos [AT] com crianças realizados com uma das autoras. A compilação dos recortes clínicos demarca a especificidade da intervenção no AT e aponta a importância de que o profissional psi considere o transitivismo na prática clínica e interrogue-se sobre os obstáculos que se interpõem na organização do transitivismo mãe-criança

En este ensayo teórico, se presenta una lectura de la articulación del concepto de transitivismo con la psicopatología del autismo en la infancia. Como objeto de investigación se utiliza un corpus textual elaborado por cuatro autores dedicados a la discusión de la psique infantil: Henri Wallon (1879-1962), Jacques Lacan (1901-81), Jean Bergès y Gabriel Balbo. También trabajamos a partir de recortes clínicos de acompañamientos terapéuticos [AT]con niños realizados con una de las autoras. La recopilación de recortes clínicos demarca la especificidad de la intervención en el AT y señala la importancia de que el profesional psi considere el transitivismo en la práctica clínica y pregunte por los obstáculos que se interponen en el camino de la organización del transitivismo madre-hijo

In this theoretical essay, the concept of transitivismis articulated with the psychopathology of autism in childhood. As a research object, we work with texts written by four authors who dedicated themselves to the discussion of the infantile psyche: Henri Wallon (1879-1962), Jacques Lacan (1901-81), Jean Bergès and Gabriel Balbo. We also work with clinical excerpts from therapeutic accompaniments [TA] with children that were conducted by one of the authors of this essay. The compilation of the clinical excerpts demarcates the specificity of the intervention in TA and points out how important it is for the psychologist to consider transitivism in the clinical practice and to consider the obstacles that stand in the way of the organization of the mother-child transitivism

Dans le présent essai théorique, nous présentons une lecture de l'articulation du concept de transitivisme avec la psychopathologie de l'autisme dans l'enfance. Comme objet de recherche, nous utilisons un corpus textuel composé pour les écrits de quatre auteurs que se dévoués à la discussion de la psyché infantile: Henri Wallon (1879-1962), Jacques Lacan (1901-81), Jean Bergès et Gabriel Balbo. Nous travaillons encore à partir de vignettes cliniques de les accompagnements thérapeutiques [AT] avec des enfants, réalisés par une de les autrices. La compilation des vignettes cliniques délimite la spécificité de l'interversion dans l'AT et indique l'importance de que le professionnel psy considère le transitivisme dans le pratique clinique et qu'il s'interroge sur les obstacles que s'interposent dans l'organisation du transitivisme mère-enfant

Instrumento para avaliar o uso do prontuário eletrônico do cidadão da estratégia e-SUS Atenção Primária à Saúde / Instrumento para evaluar el uso de la historia clínica electrónica de la estrategia e-sus Atención Primaria de Salud / Instrument to assess the use of the electronic health record of the e-SUS Primary Health Care strategy

Objetivo: descrever a construção e a validação de um instrumento para avaliar o uso do Prontuário Eletrôni-co do Cidadão da Estratégia e-SUS Atenção Primária (e-SUS APS). Materiais e métodos:Trata-se de um estudo metodológico no qual foi construído um Modelo Lógico do Prontuário Eletrônico do Cidadão da Estratégia e-SUSAPS, que eviden-cia a necessidade de descrever a Estratégia e-SUS APS, possibilitan-do observar de maneira ampliada a assistência na Atenção Primária à Saúde, e compreender o Prontuá-rio Eletrônico do Cidadão. O Mode-lo Lógico baseou-se em: gestão do e-SUS APS e Prontuário Eletrônico do Cidadão. O Modelo foi essencial para subsidiar a elaboração das questões avaliativas. Na sequência, foi elabo-rado um instrumento e realizada a validação de conteúdo e de aparência, considerando os critérios de relevân-cia, objetividade e clareza, por meio da Técnica Delphi. Para a análise dos dados, foram calculados o Índice de Validade de Conteúdo e a Razão de Validade de Conteúdo das questões. Resultados:a validade foi realiza-da por 16 juízes, em duas rodadas. O instrumento final consta de 30 ques-tões ­ seis referentes ao perfil pessoal; duas, ao perfil da unidade de saúde e 22 questões de avaliação do Prontuá-rio Eletrônico do Cidadão e-SUS APS. Conclusões: conclui-se que o instrumento foi considerado apro-priado. Satisfação, facilidade do uso, suporte técnico, capacitação e utili-zação dos relatórios gerados foram os itens elencados como os mais impor-tantes nas questões. O instrumento poderá promover melhor articulação da equipe multiprofissional por meio das informações inseridas no sistema.

Objetivo: describir la construcción y validación de un instrumento para evaluar el uso de la historia clínica electrónica de la estrategia e-SUS Atención Primaria (e-SUS APS). Materiales y métodos: estudio metodológico en el que se construyó un modelo lógico de la historia clínica electrónica de la estrategia e-SUS APS, señalando la necesidad de describir dicha estrategia a fin de observar de una manera más amplia la asistencia a servicios de atención primaria de salud y además comprender la historia clínica electrónica del ciudadano. El modelo lógico se basó en la gestión de la e-SUS APS y la historia clínica electrónica del ciudadano, convirtiéndose en una herramienta esencial para apoyar la elaboración de preguntas de evaluación. Además, se elaboró un instrumento y se realizó la validación de su contenido y apariencia ­considerando criterios de relevancia, objetividad y claridad­ por medio del método Delphi. Para el análisis de datos, se calcularon el índice de validez de contenido y la razón de validez de contenido de las preguntas. Resultados: la validez del instrumento fue evaluada por 16 jueces, en dos rondas. El instrumento final contiene 30 preguntas, de las cuales seis se refieren al perfil personal, dos al perfil de la unidad de salud y 22 a la evaluación de la historia clínica electrónica e-SUS APS. Conclusiones: el instrumento es considerado apropiado, siendo la satisfacción, la facilidad de uso, el soporte técnico, la capacitación y el uso de los informes generados los elementos considerados como los más importantes. Esta herramienta puede promover una mejor articulación del equipo multiprofesional a través de la información introducida en el sistema.

Objective: To describe the construction and validation of an instrument to evaluate the use of the electronic health record of the e-SUS Primary Care (e-SUS APS). Materials and methods: Methodological study that involved the construction of a logical model of the electronic health record of the e-SUS APS Strategy. Said model highlights the need to describe the e-SUS APS Strategy in order to observe primary health assistance in a broader scope and also understand users' electronic health records. The logical model was built based on the operation of the e-SUS APS and users' electronic health records, becoming an essential input to support the elaboration of evaluation questions. An instrument was elaborated from such model, evaluating its content and appearance ­considering the criteria of relevance, objectivity and clarity­ through the Delphi technique. Content validity index and content validity ratio of questions were calculated prior to data analysis. Results: The validity of the instrument was assessed by 16 judges in two rounds. The final instrument contains 30 questions, six of them referring to the personal profile, two to the profile of the health unit, and 22 to the evaluation of the electronic health record of the e-SUS APS. Conclusions: The instrument was considered appropriate, with satisfaction, ease of usage, technical support, training, and the use of reports being the most important elements. This tool could promote better articulation of multi-professional teams through the use of the information inserted in the system.

Construção e validação de um instrumento para análise do Prontuário Eletrônico do Cidadão da Estratégia e-SUS Atenção Básica / Construction and validation of an instrument for the analysis of the Electronic Health Record of the Strategy e-SUS Basic Attention

Introdução: Os Sistemas de Informação em Saúde (SIS) são grandes responsáveis por atender a demanda tecnológica do setor de saúde e possibilitar a integração das informações e interoperabilidade com outros SIS. Por isso, o Ministério da Saúde (MS) propôs a Estratégia e-SUS AB, que engloba o Sistema de Informação da Atenção Básica (SISAB). Essa proposta conta com dois cenários de informação e conectividade, os softwares: Coleta de Dados Simplificada (CDS) e o Prontuário Eletrônico do Cidadão (PEC). A literatura aponta uma crescente utilização do PEC nos serviços de APS internacional e nacionalmente, reforçando então a necessidade de avaliar essa ferramenta utilizada pelos profissionais de saúde. Objetivo: Este estudo teve como objetivo construir e validar um instrumento para analisar o PEC da Estratégia e-SUS AB por meio da Técnica Delphi. Método: Trata-se de um estudo metodológico, com abordagem quantitativa. Foi construído o modelo lógico da Estratégia e-SUS AB para subsidiar a elaboração das questões que compuseram o instrumento. Para a validação de conteúdo e de aparência das questões, foi utilizada a Técnica Delphi. Foram calculados o Índice de Validade de Conteúdo (IVC) e a Razão de Validade de Conteúdo (CVR) das questões, segundo os critérios de relevância, objetividade e clareza. O nível de consenso esperado para este estudo foi de 75% para o IVC e 0,6 para o CVR. Na validade de aparência foi observada a clareza e a facilidade da leitura e a adequação das questões. Resultados: A validade aparente e de conteúdo foi realizada por 19 juízes, entre doutores, mestres e especialistas na área. Após a segunda rodada para validação de conteúdo e aparência, o instrumento final constou de 30 questões, sendo seis referentes ao perfil pessoal, duas do perfil da unidade de saúde e 22 questões de análise do PEC e-SUS AB. O IVC total do instrumento foi de 85,8% e o CVR total de 0,6. Conclusões: O instrumento construído foi considerado apropriado e validado pelos juízes. Satisfação, facilidade do uso, suporte técnico, capacitação e utilização dos relatórios gerados foram os itens elencados como os mais importantes nas questões. O instrumento poderá promover melhor articulação da equipe multiprofissional através das informações inseridas no sistema. Espera-se também que o instrumento validado seja divulgado para subsidiar novas pesquisas na área

Introduction: Health Information Systems (SIS) are largely responsible for meeting the technological demand of the health sector and enabling the integration of information and interoperability with other SIS. Therefore, the Ministry of Health (MS) proposed the e-SUS AB Strategy, which encompasses the Basic Care Information System (SISAB). This proposal has two information sets and connectivity software: Simplified Data Collection (CDS) and the Electronic Health Record (PEC). The literature shows a growing use of the PEC in international APS services and nationally, so reinforcing the need to evaluate this tool used by health professionals. Objective: The objective of this study was to construct and validate an instrument to analyze the e-SUS AB Strategy PEC using the Delphi Technique. Method: This is a methodological study, with a quantitative approach. The logic model of the e-SUS AB Strategy was built to support the elaboration of the issues that made up the instrument. For the content validation and appearance of the questions, the Delphi Technique was used. The Content Validity Index (IVC) and the Content Validity Ratio (CVR) of the questions were calculated according to the criteria of relevance, objectivity and clarity. The consensus level expected for this study was 75% for IVC and 0.6 for CVR. In appearance of validity was seen clarity and ease of reading and the adequacy of the issues. Results: The apparent validity and content was performed by 19 judges, among doctors, masters and specialists in the area. After the second round to validate content and appearance, the final instrument consisted of 30 questions, six of which were personal profiles, two from the health unit profile and 22 e-SUS AB PEC analysis questions. The total IVC of the instrument was 85.8% and the total CVR of 0.6. Conclusions: The instrument was considered appropriate and validated by the judges. Satisfaction, ease of use, technical support, training and use of generated reports were the items listed as the most important in the issues. The instrument can promote better articulation of the multiprofessional team through the information inserted in the system. It is also expected that the validated instrument will be released to support new research in the area

Effect of Wine Wastes Extracts on the Viability and Biofilm Formation of Pseudomonas aeruginosa and Staphylococcus aureus Strains.

In this work, we intended to inhibit the biofilm synthesis and the metabolism of Gram-positive and Gram-negative bacteria using two highly available wastes (stem and marc) obtained after the manufacturing of Torrontes wine at Cafayate, Argentina. Wine wastes contain a significant amount of bioactive compounds, mainly phenolic compounds, which makes them a potential source of compounds with beneficial properties to human health, as they could inhibit the virulence of pathogenic bacteria or protect the tissue against oxidative stress. Marc and stem extracts of Torrontes wine were evaluated for their ability to inhibit the metabolism and biofilm production of Pseudomonas aeruginosa and Staphylococcus aureus strains. The phytochemical composition and antioxidant activity of these extracts were also determined. The methanol and ethyl acetate extracts, which contained the highest amount of total polyphenolic, exhibited the highest scavenging capacity of ABTS and nitric oxide and the strongest Fe3+ reducing power and exhibited the highest level of inhibition of the biofilm formation and of the metabolic activity in bacterial biofilm. We also noticed a positive correlation between phenolic compounds content, the antioxidant activity, and the anti-biofilm capacity of the winemaking wastes. These results display the potentiality of wine wastes to prevent or reduce the formation of biofilm. Moreover, their abundance makes them an attractive and affordable source of antibiofilm and antioxidant agents.

Absenteísmo na equipe de enfermagem em serviços de emergência: implicações na assistência / Absentismo en el equipo de enfermería en los servicios de emergencia: implicaciones en la atención / Absenteeism in the nursing team in emergency services: implications in care

Resumo Objetivo Neste estudo o objetivo foi analisar a percepção da equipe de enfermagem sobre as condições geradoras de absenteísmo e suas implicações para a assistência em unidades de urgência e emergência. Métodos Estudo qualitativo, realizado por meio de entrevistas individuais, semiestruturadas, conduzidas a partir de um roteiro norteador composto das dimensões Processo de Gestão de Recursos Humanos; Condição de Trabalho em Equipe e Qualidade do Cuidado Prestado, com 30 profissionais da equipe de enfermagem, sendo esses enfermeiros, auxiliares e técnicos de enfermagem atuantes em cinco unidades de urgência e emergência, no município de Ribeirão Preto, São Paulo. Para análise dos dados, utilizou-se a análise de conteúdo, modalidade temática. Resultados Os participantes relataram que a estrutura física inadequada, equipamentos e materiais de má qualidade, questões salariais, déficit de recursos humanos e comunicação ineficaz são potenciais condições geradoras de absenteísmo e influenciam a qualidade da assistência prestada. Conclusão Os gestores têm papel fundamental de criar condições que assegurem ao trabalhador da enfermagem o seu crescimento profissional, satisfação com o trabalho, gerando menor absenteísmo e fortalecendo o seu compromisso com cuidado de qualidade à população assistida pelo Sistema Único de Saúde. Portanto, considera-se este estudo uma ferramenta para a compreensão da percepção da equipe de enfermagem sobre as condições geradoras de absenteísmo em serviços de urgência e emergência.

Resumen Objetivo El objetivo del estudio fue analizar la percepción del equipo de enfermería acerca de las condiciones que generan el absentismo y sus implicaciones para la asistencia en unidades de urgencia y de emergencia. Métodos Estudio cualitativo, realizado por medio de entrevistas individuales, semi estructuradas, conducidas a partir de una guía de ruta compuesta por las dimensiones: Proceso de Gestión de Recursos Humanos; Condición de Trabajo en Equipo y Calidad de la Asistencia Médica Prestada, con 30 profesionales del equipo de enfermería, siendo estos enfermeros, auxiliares y técnicos de enfermería, actuantes en cinco unidades de urgencia y emergencia, en el municipio de Ribeirão Preto, São Paulo. Para el análisis de los datos, se utilizó el análisis de contenido, modalidad temática. Resultados Los participantes informaron que la infraestructura física inadecuada, equipos y materiales de mala calidad, cuestiones salariales, escasez de recursos humanos y comunicación ineficaz son posibles condiciones generadoras de absentismo e influyen en la calidad de la atención prestada. Conclusión Los directores poseen un papel clave en la creación de condiciones que aseguren al trabajador de enfermería su crecimiento profesional, satisfacción en el trabajo, generando un menor absentismo y fortaleciendo su compromiso con la atención de calidad a la población atendida por el Sistema Único de Salud. Por lo tanto, se considera este estudio una herramienta para entender la percepción del equipo de enfermería acerca de las condiciones generadoras de absentismo en servicios de urgencia y emergencia.

Abstract Objective In this study, the objective was to analyze how the nursing team perceives the conditions that lead to absenteeism and its implications for care at emergency medical services. Methods Qualitative study, developed through individual, semistructured interviews based on a script composed of the dimensions: Human Resource Management Process; Teamwork Condition and Quality of Care Provided, involving 30 nursing team professionals, including baccalaureate nurse, auxiliary nurses and nursing technicians working at five emergency services in the city of Ribeirão Preto, São Paulo. To analyze the data, thematic content analysis was used. Results The participants reported that the inappropriate physical structure and bad-quality equipment and material, salary issues, lack of human resources and ineffective communication are potential conditions leading to absenteeism and influence the quality of care provided. Conclusion The managers play a fundamental role in creating conditions that guarantee professional growth and job satisfaction to the nursing workers, leading to less absenteeism and strengthening their commitment to care quality for the population attended in the Unified Health System. Therefore, this study is considered as a tool to understand the nursing team's perception of the conditions leading to absenteeism in emergency services.

Evaluación de la satisfacción profesional de Enfermería en unidades de urgencias en Brasil / Evaluation of professional satisfaction among Emergency Unit Nurses in Brazil

OBJETIVO: describir la satisfacción en el trabajo, así como de sus componentes incluidos en el Index of Work Satisfaction (IWS), en el equipo de Enfermería de los servicios de urgencias en una ciudad del interior del estado de São Paulo en Brasil. MÉTODO: estudio descriptivo transversal, desarrollado en cinco unidades de urgencias de una ciudad del interior de São Paulo (Brasil), sobre 208 trabajadores del equipo de Enfermería. Se utilizó el instrumento IWS, que recorre seis componentes: autonomía, interacción, estatus profesional, requisitos del trabajo, normas organizacionales y remuneración, y oscila entre 0,9 (menos satisfacción) y 37,1(más satisfacción). RESULTADOS: los componentes con más y menos satisfacción profesional son, respectivamente, remuneración y estatus profesional, tanto para enfermeros/as como para auxiliares de Enfermería. La puntuación de satisfacción global evaluada por el IWS fue de 9,5 para enfermeros/as y 10,1 en auxiliares. En el caso de los profesionales de Enfermería, y en relación al apartado "importancia asignada", el componente autonomía obtuvo la mayor puntuación. CONCLUSIONES: ante los resultados obtenidos, mediante el análisis de los componentes del IWS, el personal de Enfermería de los servicios de urgencias, de una ciudad del interior de São Paulo (Brasil), presentaron bajo índice de satisfacción profesional. Es importante la concienciación de los gestores relativo a la mejora de las condiciones laborales y la profundización en la investigación de las variables que corroboraron a una puntuación por debajo del mínimo

OBJECTIVE: to describe the satisfaction in work, as well as in the components included in the Index of Work Satisfaction (IWS), among the Nursing Team of the Emergency Units in a city from inner São Paulo, Brazil. METHOD: a descriptive cross-sectional study, conducted in five Emergency Units from a city in inner São Paulo (Brazil), with 208 workers from the Nursing Team. The IWS instrument was used, which covers six components: autonomy, interaction, professional status, work requirements, organization rules and remuneration; it ranges from 0.9 (lower satisfaction) to 37.1 (higher satisfaction). RESULTS: the components with the highest and lowest professional satisfaction were, respectively, remuneration and professional status, both for nurses and for nursing assistants. The overall satisfaction score assessed by the IWS was 9.5 for nurses and 10.1 for assistants. In the case of Nursing professionals, the Autonomy component obtained the highest score in the section "Importance assigned". CONCLUSIONS: according to the results obtained through the analysis of the IWS components, the Nursing staff from the Emergency Units of a city in inner São Paulo (Brazil) presented a low rate of professional satisfaction. It is important to create awareness in managers regarding the improvement in working conditions, and to conduct a deeper research into the variables that led to a score below the minimum level

Como Perseu se defendeu de Medusa? / How did Perseus protect himself against Medusa?

Na psicanálise francesa, principalmente com Lacan, o conceito de falta passou a ser de grande importância. Ao que, então, perguntamos: o que é a falta? E quando esta falta? O que acontece? O que acontece quando o não especularizável não está excluído, se fazendo, assim, especular? Quando Perseu vai ao encontro de Medusa, guiando-se por sua imagem refletida em um espelho de bronze polido, segurado por Atena, como pôde este herói defender-se de Medusa? Qual foi a forma encontrada por ele para se defender da presença do objeto que introduz a dimensão do real nu?.

According to French psychoanalysis, specially with Lacan, the concept of lack turned to be an important formulation. But what is the concept of lack? What happens when the non-specularizable is not excluded and therefore turns into something specular? When Perseus runs into Medusa, guided by a bronze shield held by Atena, how did this hero defend himself from Medusa? What did he do in order to defend himself from the presence of the object that introduces the dimension of the real?.

Como Perseu se defendeu de Medusa? / How did Perseus protect himself against Medusa?

Na psicanálise francesa, principalmente com Lacan, o conceito de falta passou a ser de grande importância. Ao que, então, perguntamos: o que é a falta? E quando esta falta? O que acontece? O que acontece quando o não especularizável não está excluído, se fazendo, assim, especular? Quando Perseu vai ao encontro de Medusa, guiando-se por sua imagem refletida em um espelho de bronze polido, segurado por Atena, como pôde este herói defender-se de Medusa? Qual foi a forma encontrada por ele para se defender da presença do objeto que introduz a dimensão do real nu?.(AU)

According to French psychoanalysis, specially with Lacan, the concept of lack turned to be an important formulation. But what is the concept of lack? What happens when the non-specularizable is not excluded and therefore turns into something specular? When Perseus runs into Medusa, guided by a bronze shield held by Atena, how did this hero defend himself from Medusa? What did he do in order to defend himself from the presence of the object that introduces the dimension of the real?.(AU)

A cross-sectional study of the forearm bone mineral density in long-term current users of the injectable contraceptive depot medroxyprogesterone acetate.

BACKGROUND: One of the well-established effects of the use of depot medroxyprogesterone acetate (DMPA) contraception is on bone mineral density (BMD). However, little evidence assesses the skeletal impact of long-term DMPA use. The objective of this study was to assess BMD on a cohort of women who used DMPA uninterruptedly between 1 and 15 years. STUDY DESIGN: A cross-sectional study with 232 users of DMPA matched to a group of 232 copper intrauterine device (IUD) users by age (±1) (range 20-53 and 20-51 years for DMPA and IUD group, respectively), body mass index (BMI; kg/m(2)) (±1) (range 17.4-44.5 and 18.5-40.2 for DMPA and IUD group, respectively) and years of use (1-15 years) was performed. The women underwent forearm BMD evaluation using dual-energy X-ray absorptiometry. The women were divided into five groups (1-5) according to the length of DMPA use: 1-3, 4-6, 7-9, 10-12 and 13-15 years of use. RESULTS: The mean (±SEM) age was 38.3±0.5 and 38.1±0.57 years and the mean (±SEM) BMI (kg/m(2)) was 26.4±0.3 and 26.3±0.3 for the entire group of women in the DMPA and IUD group, respectively. Women who used DMPA or IUD for a short time were younger and had lower BMI (kg/m(2)) than the women who used either contraceptive method long term. White women were significantly more frequent among IUD users (p<.040) than DMPA users. In addition, parity (p<.053) and physical activity (p<.012) were significantly greater among IUD users, whereas the prevalence of washing clothes by hand (p<.025) was significantly greater among DMPA users. There was no significant difference in BMD measurements between the current users of DMPA and those who had used the IUD either at the distal or ultra-distal sections of the forearm. However, women who had used DMPA for 13-15 years showed significantly lower BMD at the distal and ultra-distal radius when compared to IUD users (p<.041 and .042, respectively). Otherwise, all other differences in BMD values between DMPA and IUD users were nonsignificant at the distal and ultra-distal radius. For both DMPA and IUD users, we noted a direct correlation between higher BMD and BMI (kg/m(2)) and an inverse correlation between BMD and age for distal and ultra-distal radius. CONCLUSIONS: Our study did not detect a deleterious effect on measurements of forearm BMD among long-term DMPA users with less than 13 years of use; however, a significantly lower BMD was observed at 13-15 years of use in DMPA users when compared to IUD users. Bone mineral density was inversely correlated to older age and directly correlated to BMI (kg/m(2)).

Long-term assessment of forearm bone mineral density in postmenopausal former users of depot medroxyprogesterone acetate.

BACKGROUND: There are many controversies on the association between depot medroxyprogesterone acetate (DMPA) and bone mineral density (BMD). This study reevaluated BMD in postmenopausal women who had used DMPA as a contraceptive until they reached menopause and compared them with non-users. BMD had previously been measured in these women either at 1 year or 2-3 years after menopause and was reassessed in these women 2 years later. Therefore, comparisons were made between the first and third years and between the second to third and fourth to fifth years after menopause. STUDY DESIGN: BMD was reevaluated using dual-energy X-ray absorptiometry at two parts of the non-dominant forearm up to 5 years after menopause in 79 women between 46 and 61 years old: 24 former DMPA users and 55 former copper intrauterine device (IUD) users. RESULTS: With respect to the former DMPA users, only the BMD measurement at the distal radius in the first year (mean±SEM, 0.425±0.017) was significantly higher than the third-year measurement (0.406±0.017) (p<.015). No significant differences were found at the ultradistal radius. There were no significant differences between the groups of former DMPA and IUD users with respect to BMD measurements either at the distal radius or at the ultradistal radius. There was a direct relationship between higher body mass index (kg/m(2)) and higher BMD at the distal radius between the first and third years. At the ultradistal radius, there was an indirect relationship between older age and lower BMD between the first and third years in both groups. CONCLUSIONS: No statistically significant differences were found in forearm BMD measurements between postmenopausal women who had been long-term users of DMPA and those who had been long-term users of an IUD until menopause. Evaluation of BMD after the menopause showed slightly higher values in former DMPA users compared with non-users.

Na boca do outro: o riso na psicose / In other’s mouth: the laugh in the psychosis

O riso, desde Freud, figura como manifestação ímpar do inconsciente. A psicose, a partir de Lacan, ganha lugar especial na clínica psicanalítica. Como em psicanálise sem clínica não se faz teoria, aqui o relevante das surpresas advindas desta fomentaram o estudo proposto. O que se passa quando o riso eclode em sujeitos estruturados na psicose? Das diferentes formas de provocá-lo daremos aqui prioridade ao cômico em sua relação com a queda do significante fálico, este que parece siderar o sujeito psicótico. Indispensável à psicanálise o estatuto ético desta na transposição do trágico pelo cômico e no ato analítico enquanto via para que a voz do sujeito se faça ouvir vem a perguntar sobre isso: será o riso uma possível queda da voz enquanto objeto a tornar-se comunicação?

The laugh since Freud figures as an odd manifestation of the unconscious. The psychosis, in Lacan, acquires a special place in the thought and in the clinical psychoanalytical. As in psychoanalysis the theory comes from the clinical, the present paper also is a resulting of the surprises of clinical experiences. What happens when the laugh emerges in subjects structured in the psychosis? Among the different forms of provoking the laugh, this present paper will give priority to the comic in its relation to the fall of the significant phallus, which seems to fulminate the psychotic subject. The ethical statute indispensable to the psychoanalysis occurs in the analytical act as a possibility for the subject to be heard: would it be the laugh a possible fall of the voice as object? If so the voice in the laugh could be understood as communication?

Na boca do outro: o riso na psicose / In other’s mouth: the laugh in the psychosis

O riso, desde Freud, figura como manifestação ímpar do inconsciente. A psicose, a partir de Lacan, ganha lugar especial na clínica psicanalítica. Como em psicanálise sem clínica não se faz teoria, aqui o relevante das surpresas advindas desta fomentaram o estudo proposto. O que se passa quando o riso eclode em sujeitos estruturados na psicose? Das diferentes formas de provocá-lo daremos aqui prioridade ao cômico em sua relação com a queda do significante fálico, este que parece siderar o sujeito psicótico. Indispensável à psicanálise o estatuto ético desta na transposição do trágico pelo cômico e no ato analítico enquanto via para que a voz do sujeito se faça ouvir vem a perguntar sobre isso: será o riso uma possível queda da voz enquanto objeto a tornar-se comunicação?(AU)

The laugh since Freud figures as an odd manifestation of the unconscious. The psychosis, in Lacan, acquires a special place in the thought and in the clinical psychoanalytical. As in psychoanalysis the theory comes from the clinical, the present paper also is a resulting of the surprises of clinical experiences. What happens when the laugh emerges in subjects structured in the psychosis? Among the different forms of provoking the laugh, this present paper will give priority to the comic in its relation to the fall of the significant phallus, which seems to fulminate the psychotic subject. The ethical statute indispensable to the psychoanalysis occurs in the analytical act as a possibility for the subject to be heard: would it be the laugh a possible fall of the voice as object? If so the voice in the laugh could be understood as communication?(AU)

Prevalence of endometrial cancer and hyperplasia in non-symptomatic overweight and obese women.

BACKGROUND: Obesity is a public health problem and it is necessary to identify if non-symptomatic obese women must be submitted to endometrial evaluation. AIMS: To determine the prevalence of endometrial hyperplasia and cancer in non-symptomatic overweight or obese women. METHODS: A cross-sectional study was carried out in 193 women submitted to an endometrial biopsy using a Pipelle de Cornier. The findings were classified as normal, hyperplasia or cancer, and the results were compared to body mass index (BMI; kg/m(2)). For the purpose of statistical analysis, women were divided into two groups: women of reproductive age and postmenopausal women, and according to BMI as overweight or obese. RESULTS: The prevalence of endometrial cancer and hyperplasia was 1.0% and 5.8% in women of reproductive age and 3.0% and 12.1% in postmenopausal women, respectively. According to logistic regression, being in the postmenopause increased the risk of endometrial hyperplasia and cancer to 1.19 (95% confidence interval (CI): 0.36-3.90), while being postmenopausal and severely obese increased the odds ratio (OR) to 1.58 (95%CI: 0.30-8.23) and being postmenopausal and morbidly obese increased the OR to 2.72 (95%CI: 0.65-11.5). No increase in risk was found in women of reproductive age who were either overweight or obese. DISCUSSION: Our results show that non-symptomatic, severe or morbidly obese postmenopausal women have a high risk of developing endometrial hyperplasia or cancer; however, no such risk was found for women of reproductive age.