Validation and measurement invariance of the Compulsive Exercise Test among Brazilian and American young adults.

PURPOSE: To evaluate compulsive exercise, researchers often rely on the widely used Compulsive Exercise Test (CET). However, the measure has shown unstable factor structure in several validation studies and is not available in Portuguese for use in Brazil. We aimed to describe the translation and cultural adaptation of the CET to Brazilian Portuguese, to test several factor structures among Brazilian and US samples of men and women, to test measurement invariance across countries, and to evaluate its internal consistency. Furthermore, we sought to evaluate convergent validity, correlating the CET with a measure of eating disorder symptoms, and to compare compulsive exercise symptoms between countries. METHODS: Four models of the latent structure of the CET were tested using confirmatory factor analyses (CFAs), three-factor structure with 15 items, three-factor structure with 18 items, four-factor structure with 21 items, and the original five-factor structure with 24 items, in a sample of 1,531 young adults (601 Brazilians and 930 Americans), aged 18-35 years. RESULTS: A series of CFAs demonstrated that the three-factor structure with 15 items showed a better fit to the data. This model demonstrated good convergent validity and internal consistency. Results from the CET multigroup CFA showed evidence for the invariance at the configural, metric, and scalar levels across Brazilians and Americans. Furthermore, significant differences were found between Brazilians and Americans, with Brazilians demonstrating higher scores on the Avoidance and rule-driven behavior and Mood improvement subscales, whereas US participants scored higher on the Weight control exercise subscale. CONCLUSIONS: Results support the three-factor structure with 15 items to be used as a measure of compulsive exercise among Brazilians and Americans, allowing cross-cultural comparisons between these countries. LEVEL OF EVIDENCE: Level V, Cross-sectional, Psychometric study.

Preditores de dismorfia muscular em homens brasileiros de minoria sexual e de gênero / Muscle dysmorphia predictors among sexual and gender minority Brazilian men

RESUMO Objetivos Avaliar preditores de dismorfia muscular em homens brasileiros de minoria sexual e de gênero e descrever normas comunitárias para o Muscle Dysmorphic Disorder Inventory (MDDI), instrumento de avaliação de sinais e sintomas de dismorfia muscular. Métodos Trata-se de estudo transversal realizado com 1.444 homens brasileiros de minoria sexual e de gênero, com idade entre 18 e 50 anos. Por meio de uma pesquisa on-line , os participantes responderam a um questionário sociodemográfico, assim como medidas para avaliação dos sintomas de dismorfia muscular, busca pela muscularidade, internalização da aparência ideal e auto-objetificação. Foram realizadas análises descritivas e de correlação ( rho de Spearman) entre as variáveis do estudo, bem como uma análise de regressão linear múltipla ( stepwise forward ) para avaliar preditores de dismorfia muscular. Resultados Associação positiva e significante, de grande magnitude, foi observada entre os sintomas de dismorfia muscular, busca pela muscularidade, internalização da aparência ideal e auto-objetificação. Regressão linear múltipla demonstrou que todas essas variáveis são preditoras dos sintomas de dismorfia muscular em homens brasileiros de minoria sexual e de gênero. Conclusões Homens brasileiros de minoria sexual e de gênero apresentaram elevado risco para dismorfia muscular. Sintomas de dismorfia muscular estiveram associados com a busca pela muscularidade, internalização da aparência ideal e auto-objetificação, demonstrando que elas são preditoras de dismorfia muscular. Intervenções devem ser direcionadas a essa população, considerando a necessidade de criar estratégias de redução de sintomas de dismorfia muscular, da busca pela muscularidade, da internalização da aparência ideal e da auto-objetificação.

ABSTRACT Objectives To evaluate predictors of muscle dysmorphia in sexual and gender minority Brazilian men and to describe community norms for the Muscle Dysmorphic Disorder Inventory (MDDI), an instrument for assessing muscle dysmorphia symptoms. Methods This cross-sectional study was carried out with 1.444 sexual and gender minority Brazilian men, with ages between 18 and 50 years. By means of an on-line survey the participants answered a sociodemographic questionnaire, as well as muscle dysmorphia symptoms, drive for muscularity, appearance-ideal internalization, and self-objectification measures. Descriptive and correlation (Spearman's rho ) analysis were performed among the study variables, in addition to a multiple linear regression analysis (stepwise forward) to evaluate predictors of muscle dysmorphia. Results A positive and significant association of large magnitude was observed among muscle dysmorphia symptoms, drive for muscularity, appearance-ideal internalization, and self-objectification. Multiple linear regression showed that all these variables are predictors of muscle dysmorphia symptoms in sexual and gender minority Brazilian men. Conclusions Sexual and gender minority Brazilian men present high risk for muscle dysmorphia. Muscle dysmorphia symptoms were associated with drive for muscularity, appearance-ideal internalization, and self-objectification, showing that they are predictors of muscle dysmorphia. Interventions should target this population, considering the need to create strategies to reduce muscle dysmorphia symptoms, the drive for muscularity, appearance-ideal internalization, and self-objectification.

Psychometric Evaluation of the Drive for Muscularity Scale and the Muscle Dysmorphic Disorder Inventory among Brazilian Cisgender Gay and Bisexual Adult Men.

Despite high levels of muscularity concerns among sexual-minority men, most of the existing literature on the drive for muscularity and muscle dysmorphia focuses on heterosexual men and has mainly been conducted in Western and English-speaking regions. The present study aimed to evaluate the psychometric properties of the Drive for Muscularity Scale (DMS) and the Muscle Dysmorphic Disorder Inventory (MDDI) in Brazilian cisgender gay and bisexual adult men who were 18-50 years old. We evaluated the factor structure of both measures using a two-step, split-sample exploratory (EFA; n = 704) and confirmatory (CFA; n = 705) factor-analytic approach, which supported the original three-factor structure of the MDDI and resulted in a reduced two-factor solution with 13 items for the DMS. Convergent validity was supported through associations of the DMS and the MDDI with eating disorder symptoms, body-ideal internalization, self-objectification beliefs and behaviors, and body appreciation measures. Additionally, we found good internal consistency, and test-retest reliability of both measures. Results support the validity and reliability of the DMS and the MDDI in Brazilian cisgender gay and bisexual adult men and will support future studies exploring these constructs in Brazilian sexual-minority men.

Psychometric properties of the Eating Disorder Examination Questionnaire among Brazilian cisgender gay and bisexual adult men.

OBJECTIVE: One of the most widely used assessment tools for disordered eating attitudes and behaviors, the Eating Disorder Examination Questionnaire (EDE-Q), has not yet been evaluated in Brazilian cisgender gay and bisexual men-an at-risk population given the extent of minority stressors in Brazilian culture. The present study aimed to assess the psychometric properties of the EDE-Q among Brazilian cisgender gay and bisexual adult men. METHOD: The Brazilian EDE-Q was administered to a sample of 1409 gay and bisexual adult men, along with measures of self-objectification, body-ideal internalization, drive for muscularity, muscle dysmorphia symptoms, and body appreciation. The factor structure of the Brazilian EDE-Q was assessed using a two-step, split-sample exploratory (EFA; n = 704) and confirmatory factor analytic approach (CFA; n = 705). Additionally, convergent validity, internal consistency, and 2-week test-retest reliability were assessed. RESULTS: Findings from an EFA and CFA revealed a one-factor structure with 22 items and adequate internal consistency (ω = .92, 95% CI = [.91, .93]). Moreover, the scale demonstrated good 2-week test-retest reliability (ICC = .86, 95% CI = [.82, .88], p < .001). The EDE-Q scores showed positive associations with self-objectification, body-ideal internalization, muscle dysmorphia symptoms, and drive for muscularity, as well as a negative association with body appreciation. DISCUSSION: Results provide support for the use of the EDE-Q using a one-factor structure in Brazilian cisgender gay and bisexual adult men and give insights for future studies on eating disorders in sexual minorities in Latin America. PUBLIC SIGNIFICANCE: The Eating Disorder Examination Questionnaire (EDE-Q) is one of the most widely used self-report measures of eating disorder symptoms. However, there is a lack of research on the validity and reliability of the EDE-Q in Latin American countries. This study evaluated the validity and reliability of the EDE-Q in Brazilian cisgender gay and bisexual adult men. Our findings give insights for future studies on eating disorders in sexual minorities in Latin America.

Factor structure and psychometric properties of the Body Appreciation Scale-2 among Brazilian cisgender gay and bisexual men.

Positive body image may be particularly relevant to assess for Brazilian gay and bisexual men, given the extent of sexual minority stressors (e.g., harassment, discrimination) in Brazilian culture, which can impair one's self-perception and concept. Thus, the purpose of the present study was to assess the psychometric properties of the Body Appreciation Scale-2 (BAS-2) among Brazilian cisgender gay and bisexual adult men, aged 18-50 years. We evaluated the factor structure using a two-step, split-sample exploratory (EFA; n = 682) and confirmatory factor analytic approach (CFA; n = 727), which supported the one-factor structure of the measure. Additionally, convergent validity, internal consistency, and 2-week test-retest reliability were assessed. The BAS-2 scores showed small to large negative correlations with self-objectification beliefs and behaviors, drive for muscularity and appearance-ideal internalization measures. We also found good internal consistency and test-retest reliability of the measure. Taken together, these results support the use of the BAS-2 in Brazilian cisgender gay and bisexual men and provide an initial understanding of body appreciation and other related constructs among this population.

Dissonance-based eating disorder prevention improves intuitive eating: a randomized controlled trial for Brazilian women with body dissatisfaction.

PURPOSE: Investigate the efficacy of a dissonance-based (DB) intervention (i.e., the Body Project), during which some examples of intuitive eating were provided by peer leaders, in improving intuitive eating and targeting risk and protective factors for eating disorders (ED) among Brazilian women with body dissatisfaction. METHODS: Participants were randomized to a four-session DB intervention (n = 38) or assessment-only control (AOC) (n = 36), and completed validated measures assessing intuitive eating, body appreciation, self-esteem, body-ideal internalization, body dissatisfaction, negative affect, and disordered eating pre-intervention, post-intervention, and at 4- and 24-week follow-ups. RESULTS: The DB condition demonstrated significantly greater increases in intuitive eating, body appreciation and self-esteem scores compared to AOC from pre-intervention to post-intervention (between-condition Cohen's d = 0.73-0.98), 4-week (between-condition Cohen's d = 1.25-1.87) and 24-week follow-up (between-condition Cohen's d = 0.82-1.38). Also, the DB condition showed significantly greater decreases in body-ideal internalization, body dissatisfaction and disordered eating scores from pre-intervention to post-intervention (between-condition Cohen's d = 0.76-1.04), 4-week (between-condition Cohen's d = 1.27-1.71) and 24-week follow-up (between-condition Cohen's d = 1.04-1.19). Regarding negative affect, DB condition showed significantly greater reduction only at 24-week follow-up (between-condition Cohen's d = 0.60). CONCLUSION: Results reinforce the efficacy of DB interventions in reducing ED risk factors for young women and support the preliminary efficacy of these programs in improving intuitive eating, body appreciation, and self-esteem. LEVEL OF EVIDENCE: Level I, randomized controlled trial. ReBEC (Brazilian Registry of Clinical Trials; available at http://www.ensaiosclinicos.gov.br/ ) number of registration: RBR-2f57cs. Date of registration: June 1, 2020.

Dissonance-based eating disorder prevention delivered in-person after an online training: A randomized controlled trial for Brazilian men with body dissatisfaction.

OBJECTIVE: Few prevention programs have been developed and empirically evaluated to address eating disorder (ED) and muscle dysmorphia (MD) symptoms in men. Furthermore, new strategies for the broad implementation of available programs are needed. We investigated the acceptability and efficacy of a dissonance-based (DB) intervention for Brazilian undergraduate men with body dissatisfaction to target risk and protective factors for ED and MD symptoms (the Body Project: More Than Muscles) after an online training for facilitators. METHOD: Participants were randomized to a two-session DB-intervention (n = 89) or assessment-only control (AOC) (n = 91), and completed validated measures assessing ED and MD risk and protective factors pre-intervention, post-intervention, and at 4- and 24-week follow-up post-intervention. RESULTS: Acceptability ratings were highly favorable. Regarding efficacy, the DB condition demonstrated significantly greater decreases in ED and MD risk factors compared to AOC from pre-intervention to 4-week (p-values <.05, between-condition Cohen's d = 0.35-1.10) and 24-week follow-up (p-values <.05, between-condition Cohen's d = 0.33-0.78). Results at post-intervention were not significant, with the exception that body appreciation showed significantly greater improvements in the DB condition (post-intervention: p < .01, between-condition Cohen's d = 0.40; 4-week: p < .001, between-condition Cohen's d = 0.80; and 24-week follow-up: p < .001, between-condition Cohen's d = 0.58). DISCUSSION: Results support the acceptability and efficacy of a DB-intervention delivered in-person after an online training for facilitators up to 24-week follow-up in Brazilian men.

Abordagem multiprofissional na Promoção da Saúde: o contexto de olhares, profissional, e do sujeito do cuidar / Multi-professional approach in Health Promotion: from the professional view and the subject of care context / Enfoque multiprofesional en la Promoción de la Salud: el contexto de la percepción profesional y del sujeto del cuidar

Objetivou-se avaliar a abordagem multiprofissional no contexto do olhar profissional e do sujeito da ação do cuidar de um programa de atividade física regular. Como metodologia, o estudo de método misto, fundamentado no modelo RE-AIM (Reach = alcance, Efficacy = eficácia, Adoption = adoção, Implementation = implementação, Maintanance = manutenção), realizado entre outubro/2015 a agosto/2016, em um município do interior da Bahia, por meio de entrevista semi estruturada com profissionais e pessoas adulto-idosas com doença crônica não transmissível, participantes de um programa de atividade física regular, e inquérito documental em prontuário de saúde. Os resultados evidenciaram os benefícios do trabalho integrador à ação social coletiva em saúde das pessoas, no processo de formação profissional e na melhoria da saúde das pessoas, impactando nos índices pressóricos, de modo à sua diminuição aos níveis limítrofes à promoção da qualidade da saúde e viver humano. Como conclusões: A promoção da qualidade de vida e saúde de pessoas em enfrentamento crônico é alavancada quando exercida através de abordagem multiprofissional e enfoque interdisciplinar, elementos necessários à potencialização de políticas públicas e programas de saúde de impacto à saúde pública.

Objective: To evaluate the multi-professional approach in the professional view and the subject of care contexts of a regular physical activity program. Methodology: Mixed method study, based on RE-AIM (Reach = Efficacy = Adoption = Implementation = Maintenance), carried out between October, 2015 and August, 2016, in the countryside of Bahia, through a semistructured interview with professionals and adult-elderly people with a chronic non-communicable disease, participants of a regular physical activity program, and review of medical records. Results: They showed the benefits of integrating work to the collective social health approach in people's health, in professional training and in the improvement of people's health, impacting blood pressure indexes, so as to reduce them to levels that promote quality of health and human life. Conclusions: The promotion of quality of life and health of people living with a chronic disease is improved when performed with a multi-professional and interdisciplinary approach, which are necessary elements to the improvement of public policies and health programs that impact public health.

Objetivo: Evaluar el enfoque multiprofesional en el contexto de la percepción profesional y del sujeto promotor del cuidar de un programa de actividad física regular. Metodología: Estudio de método mixto, basada en el modelo RE-AIM (Reach = alcance, Efficacy = eficacia, Adoption = adopción, Implementation = implementación = Maintanance = mantenimiento), que se realizó entre octubre / 2015 a agosto / 2016, en un municipio del interior de Bahía, por medio de una entrevista semiestructurada con profesionales y personas adultas mayores con enfermedad crónica no transmisible, participantes de un programa de actividad física regular e investigación documental en prontuario de salud. Resultados: evidenciaron los beneficios del trabajo integrador a la acción social colectiva en salud de las personas, en el proceso de formación profesional y en la mejora de la salud de las personas, impactando en los índices presóricos, de modo a su disminución a los niveles limítrofes a la promoción de la calidad de la salud y vivir humano. Conclusiones: La promoción de la calidad de vida y salud de personas en enfrentamiento crónico es impulsada cuando se ejerce a través de un enfoque multiprofesional y enfoque interdisciplinario, elementos necesarios para la potenciación de políticas públicas y programas de salud de impacto a la salud pública.

Sintomas Osteomusculares em Cirurgiões-Dentistas: Um Estudo Piloto / Osteomuscular Symptoms in Dentists: a Pilot Study

Dentists are more likely to develop occupational diseases due to the routine use of arms and shoulders with the same patterns of movement. Musculoskeletal disorders encompass several pathologies that are the main cause of early worker withdrawal and can lead to symptoms that hinder professional activity, such as pain, fatigue and even the spine functional impairment. The aim of this study was to evaluate the prevalence of musculoskeletal symptoms related to the dentists' professional activity. This is a cross-sectional quantitative study. Data collection was performed at the Dental Specialties Centers in the cities of Crato, Juazeiro do Norte and Mauriti in the state of Ceará. To collect the data an interview script and the Nordic questionnaire - adapted NMQ were used. Of those interviewed, 83.33% reported pain in the last 12 months; 46.66% reported some pain in the last 7 days; 36.66% reported that pain was an obstacle to work; 53.33% sought a health professional for consultation related to pain in the last 12 months; and 90% correlated the pain experienced with work. The anatomical regions that most professionals reported were pain in the lower back, neck, hands, shoulders and upper back. Given the severity of musculoskeletal symptoms and their consequences on the health of dentists, it is fundamental to adopt practices that aim to prevent their onset.(AU).

Cirurgiões-dentistas estão mais propensos a desenvolver doenças ocupacionais devido ao uso rotineiro dos membros superiores com os mesmos padrões de movimento. Os "distúrbios osteomusculares" abrangem diversas patologias, que configuram a principal causa do afastamento precoce do trabalhador e podem se traduzir em sintomas que dificultam a atividade profissional, como dores, fadiga e até comprometimento funcional da coluna vertebral. O objetivo deste estudo foi avaliar a prevalência dos sintomas osteomusculares relacionados à atividade profissional dos cirurgiões-dentistas. Trata-se de um estudo transversal de abordagem quantitativa. A coleta de dados foi realizada nos Centros de Especialidades Odontológicas nas cidades de Crato, Juazeiro do Norte e Mauriti no estado do Ceará. Para a coleta dos dados foi utilizado um roteiro de entrevista e o questionário nórdico ­ NMQ adaptado. Dos entrevistados, 83,33% relataram dor nos últimos 12 meses; 46,66% relataram alguma dor nos últimos 7 dias; 36,66% alegaram que a dor foi motivo de impedimento para exercer seu trabalho; 53,33% procuraram algum profissional de saúde para consulta relacionada às dores nos últimos 12 meses; e 90% correlacionaram as dores sentidas com o trabalho. As regiões anatômicas que os profissionais mais relataram dor foram a lombar, pescoço, mãos, ombros e região dorsal. Diante da gravidade dos sintomas osteomusculares e de suas consequências sobre a saúde dos cirurgiões-dentistas, torna-se fundamental a adoção de práticas que objetivem prevenir o seu aparecimento. (AU).

Proprioceptive deficit after total elbow arthroplasty: an observational study.

BACKGROUND: During total elbow arthroplasty (TEA), most of the joint capsule is removed, including many mechanoreceptors important for proprioception, which potentially limits the patient's postoperative functional recovery. We quantified proprioceptive loss by measuring the threshold to detection of passive motion (TTDPM) in patients after unilateral TEA compared with the contralateral side. METHODS: A continuous passive motion device moving the elbow at 0.5°/s was used to evaluate TTDPM in 8 patients (mean ± standard deviation age, 69.1 ± 9.93 years) at least 1 year after unilateral semiconstricted linked TEA for a range of diagnoses. Elbow function after TEA was assessed using the Mayo Elbow Performance Scale. RESULTS: Postsurgical Mayo scores revealed 4 excellent results, 2 good, and 2 poor. The TTDPM in the elbows undergoing arthroplasty was still significantly higher compared with the contralateral elbow at 4.2° (15.6 ± 6.9 seconds vs. 7.2 ± 2.6 seconds; D = 3.23, P = .01) equivalent to 8.4 seconds. CONCLUSIONS: Patients who have had severe joint disease requiring semiconstrained TEA have long-term proprioception deficits. A more conservative technique that maximally preserves insertions and soft tissues, might minimize upper limb proprioceptive deficit.

Estimating the concentration of urea and creatinine in the human serum of normal and dialysis patients through Raman spectroscopy.

Urea and creatinine are commonly used as biomarkers of renal function. Abnormal concentrations of these biomarkers are indicative of pathological processes such as renal failure. This study aimed to develop a model based on Raman spectroscopy to estimate the concentration values of urea and creatinine in human serum. Blood sera from 55 clinically normal subjects and 47 patients with chronic kidney disease undergoing dialysis were collected, and concentrations of urea and creatinine were determined by spectrophotometric methods. A Raman spectrum was obtained with a high-resolution dispersive Raman spectrometer (830 nm). A spectral model was developed based on partial least squares (PLS), where the concentrations of urea and creatinine were correlated with the Raman features. Principal components analysis (PCA) was used to discriminate dialysis patients from normal subjects. The PLS model showed r = 0.97 and r = 0.93 for urea and creatinine, respectively. The root mean square errors of cross-validation (RMSECV) for the model were 17.6 and 1.94 mg/dL, respectively. PCA showed high discrimination between dialysis and normality (95 % accuracy). The Raman technique was able to determine the concentrations with low error and to discriminate dialysis from normal subjects, consistent with a rapid and low-cost test.

Quantifying creatinine and urea in human urine through Raman spectroscopy aiming at diagnosis of kidney disease.

Due to their importance in the regulation of metabolites, the kidneys need continuous monitoring to check for correct functioning, mainly by urea and creatinine urinalysis. This study aimed to develop a model to estimate the concentrations of urea and creatinine in urine by means of Raman spectroscopy (RS) that could be used to diagnose kidney disease. Midstream urine samples were obtained from 54 volunteers with no kidney complaints. Samples were subjected to a standard colorimetric assay of urea and creatinine and submitted to spectroscopic analysis by means of a dispersive Raman spectrometer (830 nm, 350 mW, 30 s). The Raman spectra of urine showed peaks related mainly to urea and creatinine. Partial least squares models were developed using selected Raman bands related to urea and creatinine and the biochemical concentrations in urine measured by the colorimetric method, resulting in r = 0.90 and 0.91 for urea and creatinine, respectively, with root mean square error of cross-validation (RMSEcv) of 312 and 25.2 mg/dL, respectively. RS may become a technique for rapid urinalysis, with concentration errors suitable for population screening aimed at the prevention of renal diseases.

Observation of yttrium oxide nanoparticles in cabbage (Brassica oleracea) through dual energy K-edge subtraction imaging.

BACKGROUND: The potential transfer of engineered nanoparticles (ENPs) from plants into the food chain has raised widespread concerns. In order to investigate the effects of ENPs on plants, young cabbage plants (Brassica oleracea) were exposed to a hydroponic system containing yttrium oxide (yttria) ENPs. The objective of this study was to reveal the impacts of NPs on plants by using K-edge subtraction imaging technique. RESULTS: Using synchrotron dual-energy X-ray micro-tomography with K-edge subtraction technique, we studied the uptake, accumulation, distribution and concentration mapping of yttria ENPs in cabbage plants. It was found that yttria ENPs were uptaken by the cabbage roots but did not effectively transferred and mobilized through the cabbage stem and leaves. This could be due to the accumulation of yttria ENPs blocked at primary-lateral-root junction. Instead, non-yttria minerals were found in the xylem vessels of roots and stem. CONCLUSIONS: Synchrotron dual-energy X-ray micro-tomography is an effective method to observe yttria NPs inside the cabbage plants in both whole body and microscale level. Furthermore, the blockage of a plant's roots by nanoparticles is likely the first and potentially fatal environmental effect of such type of nanoparticles.

Textual Definitions in the Leukemia Domain: Methodological Guidelines for Biomedical Ontologies.

The goal of our study is to establish methodological guidelines for the formulation of definitions in biomedical ontologies thatare not so common in the field of Library & Information Science.

Representation of Biomedical Expertise in Ontologies: a Case Study about Knowledge Acquisition on HTLV viruses and their clinical manifestations.

In this paper, we introduce a set of methodological steps for knowledge acquisition applied to the organization of biomedical information through ontologies. Those steps are tested in a real case involving Human T Cell Lymphotropic Virus (HTLV), which causes myriad infectious diseases. We hope to contribute to providing suitable knowledge representation of scientific domains.

Linked Health Data: how linked data can help provide better health decisions.

This paper provides a brief survey about the use of linked data in healthcare to foster better health decisions and increase health knowledge. We present real cases from the Brazilian experience and emphasize some issues in research. This paper is not intending to be fully comprehensive, we discuss some open issues and research challenges in linked data and the technologies involved. We conclude that even though linked data has been adopted in many countries, some challenges have to be overcome, for example, interoperability between different standards. A defined solution able to foster the semantic interoperability between different standards must be developed. Benefits contributed through linked health data involve better decision making on diagnostics, assertive treatments, knowledge acquisition, improvements in quality healthcare service to citizens.

Preliminary evaluation of a serious game for the dissemination and public awareness on preschool children's oral health.

This article presents the preliminary evaluation by dentists, teachers and parents of a serious game for dissemination of public awareness on preschool children's oral health. In this game, the player keeps a victory condition, while your tooth remains whole. Preliminary evaluation was performed in two parts. The first part was a questionnaire designed to evaluate the applicability of this technology and the opinions on the effectiveness of games in education and in oral health promotion. In the second part, the game is presented and an evaluation questionnaire of it is applied. This study had the participation of 115 persons. There was 80% approval which suggested that the game is an alternative for the prevention of dental awareness. Furthermore, the study perceives that teachers can work together with dentists in order to perform dental prevention.

Os processos subjetivos no acolhimento e na adoção de crianças por casal homoafetivo: um estudo de caso / The subjective processes in sheltering and adoption of children by same-sex couples: a case study

A adoção por casais homoafetivos é tema emergente na contemporaneidade. No Brasil, tais experiências se multiplicam, obrigando diversos segmentos, principalmente os sistemas de justiça, a compreenderem esse modelo de família. Em geral, os operadores do Direito preocupam-se com riscos para o desenvolvimento da criança em um lar homoafetivo. Além disso, os segmentos mais conservadores da sociedade pressupõem que, se houver o reconhecimento legal da família homoafetiva, desordens enfraquecerão os valores que dão sustentação à família tradicional, tais como proteção, reconhecimento da diferença sexual e socialização de seus membros. Este estudo analisa os processos subjetivos em uma família homoafetiva composta por dois homens que vivem em união estável há mais de doze anos em uma Comarca do estado de São Paulo. O casal acolheu, com fins de adoção, dois meninos, irmãos biológicos com um ano e meio, e três anos de idade, respectivamente, à época do pedido de adoção. A abordagem da família ocorreu após um ano do acolhimento das crianças. Para o levantamento e a análise dos dados, empregou-se a estratégia metodológica de estudo de caso e o aporte teórico da psicanálise vincular, que se mostraram necessários para dimensionar os processos subjetivos na adoção. Foram estudados os procedimentos dos adotantes no exercício da parentalidade, e ainda se esses promoveriam rupturas e instalariam outros modos de criação e socialização das crianças; portanto se inaugurariam estilos parentais diferentes dos já incorporados socialmente. As análises levantaram as relações entre a prática de parentalidade associada aos cuidados de uma criança e a vivência de parentalidade que remete aos conteúdos fantasmáticos que agem no desejo de filho e no desejo de filho e no de formar família. Em relação ao processo vincular, foi destacada a transmissão psíquica, tomando-se por eixo a história de vida individual e a do casal, bem como a experiência (...)

... de adoção. Os dados levantados demonstram que a família composta por casal homoafetivo, apesar de singular, retoma valores da família tradicional. Assim, observou-se convergência entre prática e vivência de parentalidade, pois esta família homoafetiva não se diferencia significativamente dos modelos tradicionais de família. As crianças se inserem na genealogia familiar adotiva incorporando novas denominações de parentesco, pelo fato de terem dois pais. A ampliação do debate é indispensável, porque, se a família homoafetiva não necessariamente desconstrói valores socialmente aceitos, não cabe pensá-la como ameaça social. Ademais, o grupo em estudo não deixa de ser atravessado pelos fatores que geram sofrimento às famílias tradicionais, como rigidificação de suas estruturas e perpetuação do heterossexismo. A constituição de um vínculo de rede entre os adotantes, e entre estes e os profissionais envolvidos na adoção poderá diminuir isolamentos e romper o silêncio, permitindo o enfrentamento dessas questões nos âmbitos político, social, jurídico e psíquico

The adoption of children by homosexual couples is an emerging subject in contemporary times. In Brazil, such cases are becoming increasingly common, forcing many segments, especially the juridical system, to understand this family model. In general, law enforcers are concerned about risks to the development of the child in a same sex couple environment. Moreover, the most conservative segments of society assume that if there is legal recognition of a same-sex families, disorders may weaken family values, such as protection, recognition of sexual difference and socialization of its members. This study examines the subjective processes of a same sex family consisting of two men living in a stable union for over twelve years in a countryside town in the state of Sao Paulo. The couple sheltered, aiming to adoption, two biological brothers, one year and a half and three years old, respectively, at the time of the adoption petition. The family was approached one year after the children had arrived. To carry out survey and data analysis, we used the methodological strategy of case study and a theoretical psychoanalysis link, which have proven necessary to scale up the subjective processes in adoption. We studied the procedures of adopting parents in the exercise of parenting, and if they would promote disruptions and would install unconventional modes of child-rearing and socialization of children, thus inaugurating different parenting styles from those socially embedded. The analysis looked into relations between parenting practices - associated with the care of a child - and parenthood experimenting - which refers to phantasmatic contents that act over the childs desire to form a family. Regarding the binding process, psychic transmission was highlighted, taking into consideration personal history of adoptees as well as that of the couple in an adoption experience. Data collected show that the family consisting of a (...)

... same-sex couple, though novel, takes on traditional family values. Thus, there was convergence between practice and experience of parenting, because this same-sex family does not differ significantly when it comes to traditional family models. Children fall into the adoptive family lineage incorporating new designations of relationship, because they have two fathers. The broadening of the debate is essential, because if a same-sex family does not necessarily deconstructs socially accepted values, it does not seem reasonable to think of it as a social threat. Moreover, the study group also displays factors that cause distress in traditional families, such as stiffening of their structures and perpetuation of heterosexism. The establishment of a network link between adopting parents and between these and professionals involved in adoption may reduce isolation and break the silence, allowing the confrontation of these issues in the political, social, legal and psychological scopes

Transpondo limites com doadores falecidos: transplantes bem-sucedidos com rins de doador com creatinina sérica igual a 13,1 mg/dL / Overcoming limits with deceased donors: successful renal transplantations from a donor with serum creatinine of 13.1 mg/dL

Doadores falecidos não limítrofes com insuficiência renal aguda podem ser uma opção segura para aumentar a oferta de rins para transplante. a avaliação histológica é fundamental para o estabelecimento do prognóstico funcional desses enxertos. Dois transplantes renais foram realizados com rins provenientes de um doador falecido jovem com insuficiência renal aguda severa sem comprometimento estrutural do parêquima renal. Ambos os enxertos apresentaram atraso de funcionamento no período pós-operatório, embora um deles com boa diurese inicial não tenha necessitado diálise. Função renal adequada foi observada a partir do 30º dia após o transplante. A insuficiência renal aguda severa no doador falecido não é fator de risco independente para a evolução em curto prazo do enxerto renal e não deve ser considerada contra-indicação absoluta para a realização do transplante.

Deceased donors not bordering with acute renal failure can be a safe option to increase the supply of kidneys for transplantation. histological evaluation is essential to establish the functional prognosis of these grafts. Two kidney transplants were performed with kidneys from a deceased donor couple with acute renal failure without severe structural impairment of parenchymal kidney. Both grafts were functioning in the late postoperative period, although one with good initial diuresis has not required dialysis. Adequate renal function was observed from day 30 after transplantation. Acute renal failure in severe deceased donor is not an independent risk factor for the development in short-term renal graft and should not be considered an absolute contraindication for transplantation was performed.