Identification of Urine Metabolic Markers of Stroke Risk Using Untargeted Nuclear Magnetic Resonance Analysis.

Stroke remains the second leading cause of mortality worldwide, and the third leading cause of death and morbidity combined, affecting more than 12 million people every year. Stroke pathophysiology results from complex interactions of several risk factors related to age, family history, gender, lifestyle, and the presence of cardiovascular and metabolic diseases. Despite all the evidence, it is not possible to fully prevent stroke onset. In recent years, there has been an exploration of innovative methodologies for metabolite analysis aimed at identifying novel stroke biomarkers. Utilizing Nuclear Magnetic Resonance (NMR) spectroscopy, we investigated small molecule variations in urine across different stages of stroke risk. The Framingham Stroke Risk Score was used in people over 63 years of age living in long-term care facilities (LTCFs) to calculate the probability of suffering a stroke: low stroke risk (LSR, control), moderate stroke risk (MSR), and high stroke risk (HSR). Univariate statistical analysis showed that urinary 4-hydroxyphenylacetate levels increased while glycolate levels decreased across the different stroke risk groups, from the LSR to the HSR groups. Trimethylamine N-oxide (TMAO) had average concentration values that were significantly higher in elderly people in the HSR group, while trigonelline levels were significantly lower in the MSR group. These metabolic markers can be used for early detection and to differentiate stages of stroke risk more efficiently.

Capacity Assessment Instrument - Health: Pilot Study of a New Tool for Adults with Dementia.

OBJECTIVES: This research comprises a pilot study of the CAI-Health, a new tool for the evaluation of decision-making capacity in healthcare. It aims to analyze the instrument's indicators of reliability and internal validity to conclude its final version. METHODS: A total of 89 participants were included, of which 22 had Alzheimer's Disease; 32 had mild cognitive impairment, and 35 were controls. Cronbach's alpha and the intercorrelation matrix were used as indicators of reliability and internal validity as well as to identify items for elimination. Repeated-measures ANOVA allowed for the analysis of differences between the vignettes that comprise CAI-Health. RESULTS: The internal consistency results were acceptable, and no items were proposed for elimination. A repeated-measures ANOVA revealed that the vignettes were unexpectedly equivalent. Despite the procedures used to develop clinical vignettes with increased levels of complexity in assessing decision-making capacity, this study showed no differences in the vignettes' level of demand. CONCLUSIONS: The extensive application of CAI-Health compromises its clinical usefulness and viability. To reduce its length while maintaining a thorough assessment of each ability, it was decided to eliminate two vignettes and retain all interview items. The final version of the CAI-Health comprises a clinical vignette and a capacity interview. CLINICAL IMPLICATIONS: CAI-Health was designed for the assessment of medical decision-making capacity in older adults.

Searching for Metabolic Markers of Stroke in Human Plasma via NMR Analysis.

More than 12 million people around the world suffer a stroke every year, one every 3 s. Stroke has a variety of causes and is often the result of a complex interaction of risk factors related to age, genetics, gender, lifestyle, and some cardiovascular and metabolic diseases. Despite this evidence, it is not possible to prevent the onset of stroke. The use of innovative methods for metabolite analysis has been explored in the last years to detect new stroke biomarkers. We use NMR spectroscopy to identify small molecule variations between different stages of stroke risk. The Framingham Stroke Risk Score was used in people over 63 years of age living in long-term care facilities (LTCF) to calculate the probability of suffering a stroke. Using this parameter, three study groups were formed: low stroke risk (LSR, control), moderate stroke risk (MSR) and high stroke risk (HSR). Univariate statistical analysis showed seven metabolites with increasing plasma levels across different stroke risk groups, from LSR to HSR: isoleucine, asparagine, formate, creatinine, dimethylsulfone and two unidentified molecules, which we termed "unknown-1" and "unknown-3". These metabolic markers can be used for early detection and to detect increasing stages of stroke risk more efficiently.

Burnout in Pharmacy professionals during COVID-19 outbreak.

BACKGROUND AND AIM: COVID-19 pandemic has had a significant global impact on the economic, social, and public health sectors. The most severe consequences were felt firsthand in health systems and by their professionals, exposing them to greater physical and mental health risks, which need to be properly evaluated.  This study aims to assess burnout levels in pharmacy professionals in the context of the COVID-19 pandemic. METHODS: We collected data (N = 250), from pharmacy professionals (mean age of 34.24 years) (SD=8.99) who worked in different areas during the pandemic period using the Burnout Copenhagen Burnout Inventory (CBI). RESULTS: There was an increase in weekly working hours after the onset of the COVID-19 pandemic and a decrease in the number of rest days per month. Most participants believe that their health status after the start of the pandemic is a little worse (44.4%). According to the CBI, the dimension with the highest average value of the Burnout subscale is related to the customer/user dimension (53.07), followed by the Work (44.60) and Personal (44.22) dimension. CONCLUSIONS: The levels of Burnout of pharmacy professionals are more accentuated in the Burnout dimension related to the client/user and the average values ​​of the various Burnout subscales are higher in Pharmacy Technicians than in Pharmacists.

COVID-19 psychological impact: The role of perfectionism.

Psychological reactions to pandemics and their constraints depend heavily on personality. Although perfectionism is consistently associated to depression, anxiety and stress, its role in the pandemics' psychological impact has not been yet empirically studied. Our aim was to analyze the role of perfectionism in psychological distress during the pandemic of COVID-19, testing whether it is mediated by fear of COVID-19 and repetitive negative thinking/RNT. Participants (N = 413 adults; 269.2% women) were recruited from September until December 2020, via social networks. They completed self-report validated questionnaires to evaluate perfectionism dimensions (self-critical, rigid and narcissistic perfectionism), fear of COVID-19, RNT and psychological distress (sum of anxiety, depression and stress symptoms). As women had significantly higher levels of self-critical perfectionism, RNT, fear of COVID-19 and psychological distress, gender was controlled in mediation analysis. The three perfectionism dimensions correlated with RNT, fear of COVID-19 and psychological distress. The effect of self-critical perfectionism on psychological distress was partially mediated by fear of COVID-19 and RNT whereas the effect of rigid and narcissistic perfectionism was fully mediated. Perfectionism influences emotional and cognitive responses to the COVID-19 and therefore should be considered both in the prevention and psychological consequences of the pandemic.

CD45RA, CD8ß, and IFNγ Are Potential Immune Biomarkers of Human Cognitive Function.

There is increasing evidence that in humans the adaptive immunological system can influence cognitive functions of the brain. We have undertaken a comprehensive immunological analysis of lymphocyte and monocyte populations as well as of HLA molecules expression in a cohort of elderly volunteers (age range, 64-101) differing in their cognitive status. Hereby, we report on the identification of a novel signature in cognitively impaired elderly characterized by: (1) elevated percentages of CD8+ T effector-memory cells expressing high levels of the CD45RA phosphate receptor (Temra hi); (2) high percentages of CD8+ T cells expressing high levels of the CD8ß chain (CD8ßhi); (3) augmented production of IFNγ by in vitro activated CD4+ T cells. Noteworthy, CD3+CD8+ Temra hi and CD3+CD8ßhi cells were associated with impaired cognition. Cytomegalovirus seroprevalence showed that all volunteers studied but one were CMV positive. Finally, we show that some of these phenotypic and functional features are associated with an increased frequency of the HLA-B8 serotype, which belongs to the ancestral haplotype HLA-A1, Cw7, B8, DR3, DQ2, among cognitively impaired volunteers. To our knowledge, this is the first proof in humans linking the amount of cell surface CD45RA and CD8ß chain expressed by CD8+ Temra cells, and the amount of IFNγ produced by in vitro activated CD4+ T cells, with impaired cognitive function in the elderly.

Depresión e ideación suicida en la adolescencia: implementación y evaluación de un programa de intervención / Depression and suicidal ideation in adolescence: implementation and evaluation of an intervention program / Depressão e ideação suicida na adolescência: implementação e avaliação de um programa de intervenção

OBJETIVO: Desarrollar, implementar y evaluar un programa de prevención del suicidio dirigido a adolescentes. MATERIALES Y MÉTODOS: Estudio cuasi experimental, del tipo antes y después, con adolescentes de una institución educativa en São Luís, Maranhão, Brasil. El estudio siguió las etapas de desarrollo, implementación y evaluación de un programa de intervención para la prevención del suicidio. Se administraron tres instrumentos de evaluación antes y después de la intervención: la escala de ideación suicida de Beck; el Inventario de Depresión de Beck y la Escala de Desesperanza de Beck. RESULTADOS: Antes de la intervención, participaron 102 adolescentes, 30 (29.4%) tenían ideación suicida y síntomas depresivos. Después de la intervención, los instrumentos se aplicaron a los 30 adolescentes seleccionados, 12 (40.0%) continuaron con la ideación. Antes de la intervención, el Inventario de depresión promedio fue de 23.83 y luego de 7.17 (p <0.0001). En cuanto a la desesperanza, el promedio obtenido antes fue 7.23 y luego 2.17 (p <0.0001); Con respecto a la ideación suicida, el promedio obtenido antes fue de 10.50 y luego de 2.57 (p <0.0001). CONCLUSIÓN: Hubo una disminución en los síntomas depresivos, la desesperanza y la ideación suicida después de la implementación del elaborado programa de intervención

OBJECTIVE: To develop, implement and evaluate a suicide prevention program aimed at adolescents. MATERIAL AND METHODS: A quasi-experimental study, before and after, with adolescents from an educational institution in São Luís, Maranhão, Brazil. The study followed the stages of development, implementation and evaluation of a suicide prevention intervention program. Three assessment instruments were administered before and after the intervention: Beck's Suicidal Ideation Scale; Beck's Depression Inventory and Beck's Hopelessness Scale. RESULTS: Before the intervention, 102 adolescents participated, 30 (29.4%) had suicidal ideation and depressive symptoms. After the intervention the instruments were applied to the 30 selected adolescents, 12 (40.0%) continued with ideation. Prior to intervention, the average Depression Inventory was 23.83 and then 7.17 (p <0.0001). As for hopelessness, the average obtained before was 7.23 and then 2.17 (p <0.0001); Regarding suicidal ideation, the average obtained before was 10.50 and then 2.57 (p <0.0001). CONCLUSION: There was a decrease in depressive symptoms, hopelessness and suicidal ideation after the implementation of the elaborated intervention program

OBJETIVO: Analisar os resultados do desenvolvimento e implementação de um programa de prevenção do suicidio dirigido a adolescentes. MATERIAIS E MÉTODOS: Estudo quase experimental, do tipo antes e depois, com adolescentes de uma Instituição de Ensino em São Luís, Maranhão, Brasil. O estudo seguiu as etapas de desenvolvimento, implementação e avaliação de um programa de intervenção direcionado a prevenção do suicídio. Foram administrados três instrumentos de avaliação, antes e após a intervenção: a Escala de Ideação Suicida de Beck; o Inventário de Depressão de Beck e a Escala de Desesperança de Beck. RESULTADOS: Antes da intervenção participaram 102 adolescentes, 30 (29,4%) apresentaram ideação suicida e sintomatologia depressiva. Após a intervenção os instrumentos foram aplicados para os 30 adolescentes selecionados, 12 (40,0%) continuaram com ideação. Antes da intervenção a média do Inventário de Depressão foi de 23,83 e depois 7,17 (p < 0,0001). Quanto à desesperança, a média obtida antes foi 7.23 e depois 2,17 (p < 0,0001); No que diz respeito à ideação suicida, a média obtida antes foi 10,50 e depois foi 2,57 (p < 0,0001). CONCLUSÃO: Ocorreu uma diminuição da sintomatologia depressiva, da desesperança e da ideação suicida após a implementação do programa de intervenção elaborado

Reaching 100 in the Countryside: Health Profile and Living Circumstances of Portuguese Centenarians from the Beira Interior Region.

The interest in studying a specific population of centenarians who lives in the country's interior region (PT100-BI) emerged during the first Portuguese systematic study about centenarians (PT100 Oporto Centenarian Study). This region of Portugal is predominantly rural and is one of the regions with the largest number of aged people. The aim of this study is to provide information on the centenarians who live in the Beira Interior region, specifically in terms of their health status and the health services they use. A total of 101 centenarians (mean age: 101.1 years; SD = 1.5 years), 14 males and 87 females, were considered. Most centenarians lived in the community, and 47.6% lived in nursing homes. Nearly half (47.5%) presented cognitive functioning without deficits. A noteworthy percentage presented conditioned mobility and sensory problems. The most common self-reported diseases include urinary incontinence (31.7%), high blood pressure (23.8%), and heart conditions (19.8%). Despite these health and functional characteristics, formal support services and technical assistance were found to be scarcely used. Further research is needed to understand how the role of contextual variables and the countryside environment contribute to the centenarians' adaptation to advanced longevity.

Evaluation of pain threshold upon palpation of the masticatory muscles in women with temporomandibular disorder according to the Research Diagnostic Criteria of Temporomandibular Disorders / Avaliação do limiar de dor a palpação dos músculos mastigatórios em mulheres com disfunção temporomandibular de acordo com o Research Diagnostic Criteria of Temporomandibular Disorders

ABSTRACT Purpose: to evaluate the pain threshold upon palpation of the masticatory muscles in women with temporomandibular disorder (TMD) according to the Research Diagnostic Criteria of Temporomandibular Disorders (RDC/TMD). Methods: a cross-sectional study was conducted involving the evaluation of pain threshold upon palpation of the extraoral muscles (temporal, masseter, posterior mandibular region, submandibular region) and intraoral muscles (lateral pterygoid area and temporal tendon) in women using the RDC/TMD clinical examination. Results: 60 women were evaluated. Statistically significant differences were found among the muscles evaluated regarding the pain threshold. The lateral pterygoid area, bilaterally, had the lowest pain threshold, followed by the masseter and temporal muscles. Conclusion: this study suggests that the lateral pterygoid muscle, bilaterally, has the lowest pain threshold upon palpation among the masticatory muscles, followed by masseter and temporal muscles, in women with TMD, according to the RDC/TMD evaluation.

RESUMO Objetivo: avaliar o limiar de dor a palpação dos músculos mastigatórios em mulheres com Disfunção Temporomandibular de acordo com o questionário do Research Diagnostic Criteria of Temporomandibular Disorders (RDC/TMD). Métodos: realizou-se um estudo transversal utilizando a avaliação do limiar de dor a palpação dos músculos mastigatórios extraorais (temporal, masseter, região mandibular posterior, região submandibular) e intraorais (área do pterigoideo lateral e tendão do temporal), em mulheres, segundo o exame clínico do RDC/TMD. Resultados: foram avaliadas 60 mulheres, foi encontrada diferença estatisticamente significante para o limiar de dor a palpação entre os músculos avaliados segundo o RDC/TMD. Com destaque para a área do pterigoideo lateral, bilateralmente, seguido pelos músculos masseter e temporal. Conclusão: esse estudo sugere que a área do músculo pterigoideo lateral, bilateralmente, apresenta menor limiar de dor a palpação entre os músculos mastigatórios, seguido pelos músculos masseter e temporal segundo RDC/TMD.

Sleep difficulties in college students: The role of stress, affect and cognitive processes.

Previous research indicates that sleep difficulties and stress are prevalent in college students. The main aim of the current study was to investigate the role of repetitive negative thinking (RNT), cognitive emotion regulation, and negative affect as mediators of the relationship between stress and sleep difficulties. We also intended to analyse the associations between all these variables and the gender differences. A sample of 549 college students completed self-report measures assessing the mentioned variables. Descriptive and correlational analyses showed significant differences between genders. In total sample, sleep difficulties were positively associated with perceived stress, negative affect, RNT and cognitive emotional strategies (rumination, self-blaming, catastrophizing, and acceptance). Mediation analyses suggested that in addition to the direct effect of stress on sleep difficulties, rumination and negative affect were important mediators in this relationship (after controlling gender). RNT did not mediate this association; however it was significantly associated to rumination and/or negative affect. These findings suggest that the effect of stress on sleep difficulties is strengthened by rumination and/or negative affect. The negative impact of RNT (content free) only occurs if associated to rumination and/or negative affect.

Immediate and short-term effects of phototherapy on pain, muscle activity, and joint mobility in women with temporomandibular disorder: a randomized, double-blind, placebo-controlled, clinical trial.

OBJECTIVES: The aim of the present study was to evaluate the immediate and short-term effects of phototherapy on pain intensity, the pressure pain threshold (PPT), maximum vertical mandibular movement, and the electrical activity of the masseter and temporal muscles in women with temporomandibular disorder (TMD). METHODS: Sixty women were randomly allocated to four different groups and submitted to phototherapy with a combination of super-pulsed laser (905 nm), red (640 nm), and infrared (875 nm) light emitting diodes in the same equipment on the masseter (three points) and temporal (two points) muscles bilaterally in a single session. The following doses were used in each point of application: Group 1 - 2.62 J; Group 2 - 5.24 J; Group 3 - 7.86 J; placebo group. Pain intensity was determined using the visual analog scale. The PPT was analyzed using a digital algometer. Vertical mandibular movement was measured using digital calipers. Myoelectrical activity of the masseter and temporal muscles was measured using electromyography. Four evaluations were performed: pre-intervention, immediately after, 24 and 48 hours after phototherapy. OUTCOMES: A significant reduction in pain intensity during the post-treatment evaluations in comparison to the pretreatment evaluation was observed in group 1 (Median difference = 2.60 [95% CI = 1.35-3.85]) and group 2 (Median difference = 2.2 [95% CI = 0.98-3.42]) especially after 48 hours and group 3 (Median difference = 2.50 [95% CI: 0.56-4.46]) especially after 24 hours, with a moderate effect size, but no effect was found regarding the other variables. CONCLUSIONS: A single session of combined phototherapy was capable of reducing pain intensity in individuals patients with TMD. ClinicalTrials.gov (NCT02018770). Implications for Rehabilitation Phototherapy device combining two light sources (LED and laser), and different densities in the same device is a novelty in the rehabilitation market, and has proved to be a useful intervention for people with temporomandibular disorders. This mode of phototherapy is another option that assists in the rapid intervention in pain symptoms, promoting a considerable degree of comfort to the patient moments after its application.

Systematic review of the measurement properties of instruments utilized to diagnose Temporomandibular Disorders according to the COSMIN checklist

Introduction: Most of the instruments used in Brazil to diagnose Temporomandibular Disorders (TMD) were developed in another Language. To effectively use instruments that were created in another language, it must be translated into the relevant target language before cross-cultural adaptation. Clinimetric tests should also be performed. Measurement properties consist of quality criteria related to evaluation instruments. These criteria are necessary to determine the quality of the instruments used in Brazil. Objectives: The aim of the present systematic review was to assess the quality of the measurement properties of instruments utilized to diagnose TMD. Methods: Systematic searches were performed of the PUBMED, SCIELO, LILACS and SCIENCE DIRECT databases. Studies addressing questionnaires translated and cross-culturally adapted for use in Brazil were retrieved and the quality of the measurement properties was analyzed using the COSMIN checklist. Results: In the 11 eligible articles, 10 instruments were identified. The studies were evaluated based on their analysis of structural validity, internal consistency, reproducibility (concordance and reliability), responsiveness, ceiling effect and floor effect. None the assessment tools had all its measurement properties tested. Conclusion: The measurement properties of the instruments were not completely tested. Thus, care must be taken when interpreting the scores of these questionnaires (AU).

Reversal of fluconazole resistance induced by a synergistic effect with Acca sellowiana in Candida glabrata strains.

CONTEXT: The increased incidence of non-albicans Candida (NAC) resistant to fluconazole (FLZ) makes it necessary to use new therapeutic alternatives. Acca sellowiana (O.berg) Burret (Myrtaceae) is a guava with several proven biological activities. The interaction with fluconazole can be a feasible alternative to overcome this resistance. OBJECTIVE: This study evaluates the in vitro antifungal activity of fractions obtained from the lyophilized aqueous extract of the leaves of A. sellowiana against resistant strains of NAC. MATERIALS AND METHODS: The antifungal activity of the fractions was evaluated at 500 µg/mL by microdilution method. Checkerboard assay was performed to determine the effect of the combination of the F2 fraction and antifungal at concentrations: MIC/4, MIC/2, MIC, MIC × 2 and MIC × 4. RESULTS: Candida glabrata showed the lowest MIC values (500-3.90 µg/mL) and the F2 active fraction was the most effective. The association of F2 with FLZ showed a strong synergistic effect (FICI ≤ 0.5) against 100% of C. glabrata resistant isolates. Moreover, the F2 active fraction has demonstrated that probably acts in the cell wall of these yeasts. There was no observed acute dermal toxicity of lyophilized aqueous extract of leaves of A. sellowiana on pig ear skin cells. DISCUSSION AND CONCLUSION: The interaction between substances present in the F2 active fraction is possibly responsible for the antifungal activity presented by this fraction. This study is unprecedented and suggests that the combination of F2 active fraction and FLZ might be used as an alternative treatment for mucocutaneus infections caused by C. glabrata resistant.

Efeitos do hiperboloide masticator apparatus na desordem temporomandibular ­ estudo de caso / Effects of hyperboloid masticator apparatus in temporomandibular disorder ­ case study

Introdução: A disfunção temporomandibular caracteriza-se por um conjunto de alterações clínicas envolvendo os músculos mastigatórios, a articulação temporomandibular e outras estruturas associadas. Objetivo: A estimulação proprioceptiva condicionada pelo uso do hiperboloide diminui o quadro álgico e aumenta a amplitude do movimento mandibular. Métodos: Apresentamos o caso de uma jovem de 22 anos com diagnostico de Disfunção temporomandibular, que recebeu o tratamento fisioterapêutico utilizando hiperboloide mastigador apparatus 3 vezes por semana durante 8 semanas sendo realizadas duas avaliações específicas: extensão vertical do movimento mandibular e mensuração do limiar de dor por pressão sobre o músculo masseter, pré atendimento, pós imediato e pós tratamento. Resultados: Observou-se aumento expressivo na abertura mandibular e no aumento de limiar de dor. Conclusão: O uso do hiperboloide levou a um aumento mobilidade mandibular e diminuição de dores nos músculos masseteres e consequente melhora na mastigação.

Introduction: temporomandibular dysfunction is characterized by a set of clinical changes involving the masticatory muscles, the temporomandibular joint and other associated structures. Goal: proprioceptive stimulation conditioned by the use of the hyperboloid influences on pain and mandibular movement pattern. Methods: we present the case of a young man of 22 years with diagnosis of temporomandibular joint Dysfunction, which received physiotherapy treatment using hyperboloid Cruncher apparatus 3 times per week for 8 weeks being held two specific reviews: vertical extension of the mandibular movement and measurement of pressure pain threshold on the masseter muscle, pre care, immediate post and post treatment. Results: it was observed significant increase in mandibular opening and increased pain threshold. Conclusion: the use of hyperboloid has led to an increase in mandibular mobility and decrease of myalgia masseteres and consequent improvement in chewing.

Analysis of laser therapy and assessment methods in the rehabilitation of temporomandibular disorder: a systematic review of the literature.

The aim of the present study was to perform a systematic review of the literature on the effects of low-level laser therapy in the treatment of TMD, and to analyze the use of different assessment tools. [Subjects and Methods] Searches were carried out of the BIREME, MEDLINE, PubMed and SciELO electronic databases by two independent researchers for papers published in English and Portuguese using the terms: "temporomandibular joint laser therapy" and "TMJ laser treatment". [Results] Following the application of the eligibility criteria, 11 papers were selected for in-depth analysis. The papers analyzed exhibited considerable methodological differences, especially with regard to the number of sessions, anatomic site and duration of low-level laser therapy irradiation, as well as irradiation parameters, diagnostic criteria and assessment tools. [Conclusion] Further studies are needed, especially randomized clinical trials, to establish the exact dose and ideal parameters for low-level laser therapy and define the best assessment tools in this promising field of research that may benefit individuals with signs and symptoms of TMD.

Effects of Massage Therapy and Occlusal Splint Usage on Quality of Life and Pain in Individuals with Sleep Bruxism: A Randomized Controlled Trial.

PURPOSE: The aim of the present study was to investigate the effects of massage therapy on the masticatory muscles and occlusal splint usage on quality of life and pain in individuals with sleep bruxism. METHOD: A randomized, controlled, blinded, clinical trial was conducted involving 78 volunteers aged 18 to 40 years with sleep bruxism. Quality of life and pain assessments were performed. RESULTS: Significant differences (p < 0.05) were found on the physical functioning, general health state, vitality, role emotional and mental health subscales. A large effect size was found for all treatment protocols with regard to pain. The largest effect was found in the combined treatment group. CONCLUSIONS: The findings of the present study reveal that the occlusal splint usage alone led to improvements in components of quality of life among individuals with sleep bruxism. Moreover, both treatments (occlusal splint usage and massage therapy on the masticatory muscles) led to a reduction in pain.

Effects of massage therapy and occlusal splint therapy on electromyographic activity and the intensity of signs and symptoms in individuals with temporomandibular disorder and sleep bruxism: a randomized clinical trial.

INTRODUCTION: Temporomandibular disorder (TDM) is the most common source of orofacial pain of a non-dental origin. Sleep bruxism is characterized by clenching and/or grinding the teeth during sleep and is involved in the perpetuation of TMD. The aim of the present study was to investigate the effects of massage therapy, conventional occlusal splint therapy and silicone occlusal splint therapy on electromyographic activity in the masseter and anterior temporal muscles and the intensity of signs and symptoms in individuals with severe TMD and sleep bruxism. METHODS: Sixty individuals with severe TMD and sleep bruxism were randomly distributed into four treatment groups: 1) massage group, 2) conventional occlusal splint group, 3) massage + conventional occlusal splint group and 4) silicone occlusal splint group. Block randomization was employed and sealed opaque envelopes were used to conceal the allocation. Groups 2, 3 and 4 wore an occlusal splint for four weeks. Groups 1 and 3 received three weekly massage sessions for four weeks. All groups were evaluated before and after treatment through electromyographic analysis of the masseter and anterior temporal muscles and the Fonseca Patient History Index. The Wilcoxon test was used to compare the effects of the different treatments and repeated-measures ANOVA was used to determine the intensity of TMD. RESULTS: The inter-group analysis of variance revealed no statistically significant differences in median frequency among the groups prior to treatment. In the intra-group analysis, no statistically significant differences were found between pre-treatment and post-treatment evaluations in any of the groups. Group 3 demonstrated a greater improvement in the intensity of TMD in comparison to the other groups. CONCLUSION: Massage therapy and the use of an occlusal splint had no significant influence on electromyographic activity of the masseter or anterior temporal muscles. However, the combination of therapies led to a reduction in the intensity of signs and symptoms among individuals with severe TMD and sleep bruxism. TRIAL REGISTRATION: This study is registered in August, 2014 in the ClinicalTrials.gov (NCT01874041).

Effects of phototherapy on muscle activity and pain in individuals with temporomandibular disorder: a study protocol for a randomized controlled trial.

BACKGROUND: According to the International Association for the Study of Pain (IASP), the term temporomandibular disorder (TMD) regards a subgroup of orofacial pain, the symptoms of which include pain or discomfort in the temporomandibular joint, ears, masticatory muscles and neck on one or both sides, as well as joint sounds, limited mandibular movements or mandibular deviation and difficulties chewing. Phototherapy, such as low-level laser therapy (LLLT) and light-emitting diode (LED) therapy, is one of the resources used to treatment muscle pain. Thus, there is a need to investigate therapeutic resources that combine different wavelengths as well as different light sources (LLLT and LED) in the same apparatus. The aim of the proposed study is to evaluate the effects of four different doses of phototherapy on pain, activity of the masticatory muscles (masseter and bilateral anterior temporal) and joint mobility in individuals with temporomandibular disorder. A further aim is to determine the cumulative effect 24 and 48 hours after a single session. METHODS/DESIGN: A placebo-controlled, double-blind, randomized, clinical trial will be carried out involving 72 women between 18 and 40 years of age with a diagnosis of myogenous TMD. The participants will then be randomly allocated to four groups totaling 18 individuals per group. Three groups will be submitted to a single session of phototherapy with different light sources, and one group will receive placebo therapy: Group A (2.62 Joules); Group B (5.24 Joules); Group C (7.86 Joules); and Group D (0 Joules). The following assessment tools will be administered on four separate occasions (baseline and immediately after, 24 h after and 48 h after phototherapy). Pain intensity will be assessed using the visual analog scale for pain, while pain thresholds will be determined using algometer, and electromyographic (EMG) analysis on the masseter and anterior temporal muscles. DISCUSSION: The study will contribute to the practice of the evidence-based use of phototherapy in individuals with a myogenous TMD. Data will be published after the study is completed. TRIAL REGISTRATION: This study is registered with the Brazilian Registry of Clinical Trials, NCT02018770, date of registration: 7 December 2013.

Indicadores de avaliação do cuidado individual: subsídios para a formação médica orientada por competência / Evaluative indicators of individual care: subsidies for competence-guided medical training

No processo de formação dos profissionais da área da saúde, as DCN orientam a organização de um modelo curricular pautado no desenvolvimento de competência profissional. Foi realizado um estudo descritivo com abordagem qualitativa, desenvolvido por meio de conferência de consenso, com o objetivo de elaborar indicadores para avaliar o processo de ensino-aprendizagem na área de cuidado individual. Uma matriz foi organizada com base nos desempenhos contidos nos manuais de cada série e formatos de avaliação. Em seguida, os avaliadores analisaram esta matriz e a discutiram na conferência de consenso, para a consolidação dos indicadores. A análise dos resultados permitiu olhar para as ações desenvolvidas no curso a partir da compreensão de que, durante essas atividades, os estudantes têm a oportunidade de realizar o cuidado na perspectiva da integralidade, como preconizado no Sistema Único de Saúde e nas DCN. Dessa maneira, foram construídos indicadores relacionados a história clínica, exame físico e raciocínio clínico para o monitoramento do processo de ensino-aprendizagem. No contexto do currículo orientado por competência, esses indicadores podem nortear o processo de planejamento educacional, bem como permitir a participação ativa e a corresponsabilidade dos envolvidos para o alcance de uma aprendizagem significativa, que permita ao futuro profissional a realização de um cuidado qualificado em saúde.

The National Curriculum Guidelines (NCG) recommend a professional competence-based curricular model for health care undergraduate education. A descriptive study with a qualitative approach was conducted through the use of a consensus conference to develop evaluative indicators of the teaching and learning process in the area of individual care. A matrix was organized based on performances obtained from manuals of each year of study and formats of evaluation. The evaluators then analyzed the matrix and discussed it in the consensus conference in order to consolidate the indicators. The analyzed results allowed the activities of the course to be considered based on the understanding that these actions offer students the opportunity to fulfill the comprehensive health care as recommended by the NCG and the Unified Health System. Therefore indicators were constructed related to clinical history, physical examination and clinical reasoning for monitoring the teaching and learning process. In the context of a competence-guided curriculum, these indicators can guide the educational planning, as well as enable active participation and co-responsibility of those involved in order to achieve meaningful learning that will allow the future professional to ensure qualified health care.

Effect of mandibular mobilization on electromyographic signals in muscles of mastication and static balance in individuals with temporomandibular disorder: study protocol for a randomized controlled trial.

BACKGROUND: The stomatognathic system and dysfunction in this system may be related to postural control. The proposal of the present study is to assess the effect of mandibular mobilization in individuals with temporomandibular disorder using surface electromyography of the muscles of mastication and stabilometric variables. METHODS/DESIGN: A randomized, controlled, blind, clinical trial will be carried out, with the participants divided into three groups: 1) facial massage therapy (control group), 2) nonspecific mandibular mobilization and 3) specific mandibular mobilization. All groups will be assessed before and after treatment using the Research Diagnostic Criteria for Temporomandibular Disorders, surface electromyography of the masseter and temporal muscles and stabilometry. This study is registered with the Brazilian Registry of Clinical Trials (RBR9x8ssz). DISCUSSION: A large number of studies have employed surface electromyography to investigate the function/dysfunction of the muscles of mastication and associations with signs and symptoms of temporomandibular disorders. However, it has not yet been determined whether stabilometric variables offer adequate reliability in patients with this disorder. The results of the proposed study will help determine whether specific and/or nonspecific mandibular mobilization exerts an effect on the muscles of mastication and postural control. Moreover, if an effect is detected, the methodology defined in the proposed study will allow identifying whether the effect is local (found only in the muscles of mastication), global (found only in postural control) or generalized.