Prevalence, morphology, and morphometry of anatomical variations of the clivus: a cone beam computed tomographic study.

The purpose of this study was to evaluate the prevalence and characteristics of 3 anatomical variations of the clivus: fossa navicularis magna (FNM), canalis basilaris medianus (CBM), and craniopharyngeal canal (CPC). Findings were correlated with sex, age, and facial skeletal pattern. A total of 602 cone beam computed tomography scans of Brazilian adults were retrospectively evaluated by 2 independent examiners. The presence of an FNM, CBM, or CPC was recorded, and length, depth, and width were measured. The CBM was classified according to type (3 complete and 3 incomplete varieties). All data were correlated with sex, age, and facial skeletal pattern. Results were tested using chi-square, Mann-Whitney U, and Kruskal-Wallis tests (P < 0.05). The prevalence rates for FNM, CBM, and CPC were 15.78% (n = 95), 6.64% (n = 40), and 0.17% (n = 1), respectively. No significant differences in the prevalence of the variations were found based on sex or facial skeletal patterns (P > 0.05). The median length, depth, and width of FNM were 5.55, 1.83, and 4.81 mm, respectively, with no significant differences (P > 0.05) between the variables. The prevalence of FNM was significantly higher in patients aged 18 to 33 years than in those aged 34 and older (P < 0.001). An incomplete variant of the CBM, presenting as an inferior recess, was more common (32.5%). The FNM is the most prevalent anatomical variation of the clivus, especially in young adults. The sex and facial skeletal pattern of the individual do not affect the frequency of FNM, CBM, or CPC. Because of their clinical relevance, recognition of these anatomical variations is essential, as they can be misdiagnosed as pathologies.

Anatomical variations in the maxillary anterior region: a cone beam computed tomographic study of the canalis sinuosus and its accessory canals.

The objective of this study was to verify the frequency, diameter, and location of the canalis sinuosus (CS) and its accessory canals (ACs) using cone beam computed tomographic (CBCT) images and to correlate these findings with patient sex, age, and skeletal facial pattern. This observational retrospective study assessed the CBCT scans of 398 patients. The laterality, diameter, and location of the terminal portion of the canals were recorded. Linear measurements of the nasal cavity floor, buccal cortical bone, and alveolar ridge crest were also made. The χ2 and Fisher exact tests were used to verify the relationships between patient sex, age, and facial pattern and the presence of CS and ACs. The presence of CS and ACs was verified in 195 (48.99%) and 186 (46.73%) individuals, respectively, and showed no correlations with sex, age, or facial pattern. In 165 cases (84.61%), the CS emerged bilaterally. For ACs, most cases (n = 97; 52.14%) were unilateral. A total of 277 ACs were detected, and 161 (58.12%) of these were located in the palatal or incisive foramen region and 116 (41.88%) in the buccal region. Their terminal portions were located more frequently in the central incisor region (38.26%). The mean CS diameter was significantly larger in men than in women (P < 0.001). The linear measurements of the nasal cavity floor, buccal cortical bone, and alveolar ridge crest did not reveal statistically significant differences between the sexes. This knowledge is helpful for maxillary surgical planning to avoid damage to the neurovascular bundle and subsequent complications.

Epidemiological Study on Multiligament Knee Injuries.

Objective The present paper aims to describe multiligament knee injuries and to associate their features with the profile of the patients and trauma mechanisms. Methods This is a cross-sectional study evaluating 82 patients with multiligament knee injuries from September 2016 to September 2018. Evaluated parameters included age, gender, mechanical axis, affected side, range of motion, trauma mechanism, associated injuries, affected ligaments, and absence from work. Results The sample included patients aged between 16 and 58 years old, with an average age of 29.7 years old; most subjects were males, with 92.7% of cases. The most common trauma mechanism was motorcycle accident (45.1%). The most injured ligament was the anterior cruciate ligament (80.5%), followed by the posterior cruciate ligament (77.1%), the posterolateral corner (61.0%), and the tibial collateral ligament (26.8%). The most frequent type of dislocation was KD IIIL (30.4%). Only 1 patient had a vascular injury, and 13 (15.9%) presented with neurological injuries. Most subjects took medical leave from work (52.4%). Conclusion There is a big difference between patients with multiligament lesions in Brazil compared with international studies. Thus, it is advisable to carry out more specific studies on the topic with our population to improve the treatment of these patients.

Epidemiological Study on Multiligament Knee Injuries / Estudo epidemiológico das lesões multiligamentares do joelho

Abstract Objective The present paper aims to describe multiligament knee injuries and to associate their features with the profile of the patients and trauma mechanisms. Methods This is a cross-sectional study evaluating 82 patients with multiligament knee injuries from September 2016 to September 2018. Evaluated parameters included age, gender, mechanical axis, affected side, range of motion, trauma mechanism, associated injuries, affected ligaments, and absence from work. Results The sample included patients aged between 16 and 58 years old, with an average age of 29.7 years old; most subjects were males, with 92.7% of cases. The most common trauma mechanism was motorcycle accident (45.1%). The most injured ligament was the anterior cruciate ligament (80.5%), followed by the posterior cruciate ligament (77.1%), the posterolateral corner (61.0%), and the tibial collateral ligament (26.8%). The most frequent type of dislocation was KD IIIL (30.4%). Only 1 patient had a vascular injury, and 13 (15.9%) presented with neurological injuries. Most subjects took medical leave from work (52.4%). Conclusion There is a big difference between patients with multiligament lesions in Brazil compared with international studies. Thus, it is advisable to carry out more specific studies on the topic with our population to improve the treatment of these patients.

Resumo Objetivo Descrever e associar as características das lesões multiligamentares de joelho com o perfil do paciente e mecanismo de trauma. Métodos Trata-se de um estudo transversal que avaliou 82 pacientes com lesões multiligamentares do joelho de setembro de 2016 até setembro de 2018. As variáveis coletadas foram idade, gênero, eixo mecânico, lateralidade, arco de movimento, mecanismo do trauma, lesões associadas, ligamentos afetados e afastamento do trabalho. Resultados A amostra incluiu pacientes de 16 a 58 anos, com média de 29,7 anos, e os homens foram os mais afetados, correspondendo a 92,7% dos casos. O mecanismo de trauma mais comum foi acidente motociclístico (45,1%). O ligamento mais lesado foi o ligamento cruzado anterior (80,5%), seguido do ligamento cruzado posterior (77,1%), do canto posterolateral (61,0%) e do ligamento colateral tibial (26,8%). O tipo de luxação mais frequente era o KD IIIL (30,4%). Apenas 1 paciente apresentou lesão vascular, e 13 (15,9%) apresentaram lesões neurológicas. A maioria das vítimas foi afastada do trabalho (52,4%). Conclusão Há grande diferença entre os pacientes que apresentam lesão multiligamentar no Brasil em relação ao encontrado nos estudos internacionais. Desta forma, convém realizar mais estudos específicos sobre o tema com a nossa população, de modo a aperfeiçoar o tratamento destes pacientes.

Correlation between the presence of the median perforating canal in adults with sex, age and skeletal facial patterns: A cross-sectional study.

INTRODUCTION: The aim of the present study was to evaluate the presence of the median perforating canal (MPC) and its morphometric measurements in Cone Beam CT (CBCT) scans of adult patients, correlating the findings with sex, age and skeletal facial patterns. MATERIAL AND METHODS: 717 CBCT scans were selected from a Brazilian population and the presence of the MPC was recorded. MPC diameter was measured in three points: lingual, medial and buccal. To determine the correlation between MPC presence and sex, age and ANB angle classifications the Chi-square test was performed. MPC diameters were related to sex, age and skeletal discrepancies using Mann-Whitney U and Kruskal-Wallis tests. The level of significance adopted was 5%. RESULTS: Of the 717 CBCT scans analyzed, the MPC was present in 181 patients (25.24%), 279 (38.91%) men and 438 (61.09%) women. The mean age was 37.91 (±14.46) years old, ranging from 18 to 88 years old. There were no differences in the presence of MPC between women and men (p = 0.85), between skeletal discrepancies (p = 0.09) and age groups (p = 0.94). Regarding the MPC diameter, statistical difference was found only for the medial diameter between sexes (p = 0.04), with the highest values in men. CONCLUSION: The MPC was detected in 25.24% of the studied population, with significant differences only for its medial diameter in men.

Modulation in the expression of type 1 (CR1/CD35) and type 3 (CR3/CD11b) complement receptors on leukocytes from patients with Visceral leishmaniasis.

Visceral leishmaniasis (VL) is an anthropozoonosis endemic in Brazil. We included 20 patients with confirmed diagnosis of VL and 20 healthy individuals to evaluate the expression levels of complement receptor 1 (CR1)/CD35 and CR3/CD11b on leukocytes in the peripheral blood and determine their correlation with the clinical state of patients. CR1/CD35 expression increased on CD11b+CD35+granulocytes of patients, while CR1/CD35 and CR3/CD11b expression levels increased on CD14+CD11b+CD35+ monocytes. Among patients, those with severe clinical state had higher expression of CR3/CD11b on CD14+monocytes. The count of CD19+CD35+B lymphocytes reduced in the blood samples from patients. These observed changes may indicate the modulation in CR1/CD35 and CR3/CD11b complement receptor expressionlevels on granulocyte and monocyte populations in response to Leishmania sp.

Multidimensional instruments validated in Brazil for pain evaluation in the elderly: narrative review / Instrumentos multidimensionais validados no Brasil para avaliação da dor na pessoa idosa: revisão narrativa

ABSTRACT BACKGROUND AND OBJECTIVES: Multidimensional instruments for the evaluation of pain in the elderly allows to identify the conditions that involves pain considering the emotional, physical, psychological, social, and economic aspects. They are ancillary tools in the prognosis of diseases, in addition to allowing a better approach to pain considering their assessed dimensions. The objective of this study was to review the literature on multidimensional instruments validated in Brazil for the evaluation of pain in the elderly, identifying instruments aimed at elderly people with neurocognitive disorders. CONTENTS: This was a narrative review of the literature with scientific articles searched in the electronic databases Pubmed, LILACS, and Scielo. The following keywords of the Portuguese language defined by the DeCS were used: pain, pain threshold, pain measurement, aging, and the elderly. Scientific articles on instruments validated in Brazil and published in the period from 2000 to 2018 were included. There were 38 articles, of which 33 were excluded, and only 5 articles were included. The validated instruments found for pain assessment in the elderly in Brazil were the McGill Pain Questionnaire, Geriatric Pain Measure, Pain Assessment Checklist for Seniors with Pain Assessment Checklist for Seniors with Limited Ability to Communicate, Non-Communicative Patient´s Pain Assessment Instrument, Pain Assessment in Advanced Dementia. CONCLUSION: The five instruments found offer the health professional a range of tools to understand pain better. Of these, three instruments allow the assessment of pain in the elderly with neurocognitive disorders.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os instrumentos multidimensionais para avaliação da dor em idosos permitem identificar as condições que envolvem a dor considerando os aspectos emocionais, físicos, psicológicos, sociais e econômicos. Trata-se de ferramentas auxiliares no prognóstico de doenças, que permitem melhor abordagem da dor considerando suas dimensões avaliadas. O objetivo deste estudo foi revisar a literatura sobre os instrumentos multidimensionais validados no Brasil para a avaliação da dor na pessoa idosa, identificando os instrumentos direcionados para idosos com transtornos neurocognitivos. CONTEÚDO: Trata-se de uma revisão narrativa da literatura realizada com artigos científicos pesquisados nas bases de dados eletrônicas Pubmed, LILACS e Scielo. Utilizou-se o cruzamento das seguintes palavras-chave da língua portuguesa definidas pelo DeCS: dor, limiar de dor, mensuração da dor, envelhecimento e idoso. Foram incluídos artigos científicos de instrumentos validados no Brasil e que foram publicados no período de 2000 a 2018. Foram encontrados 38 artigos, destes, 33 foram excluídos, sendo incluso apenas 5 artigos. Os instrumentos validados encontrados para a avaliação da dor em idosos no Brasil foram o Brazilian Portuguese McGill Pain Questionnaire, Geriatric Pain Measure, Assessment Checklist for Seniors with Limited Ability to Communicate, Non-Communicative Patient's Pain Assessment Instrument, Pain Assessment in Advanced Dementia. CONCLUSÃO: Os cinco instrumentos encontrados oferecem para o profissional de saúde uma gama de ferramentas para melhor compreensão da dor. Destes, três instrumentos permitem avaliar a dor em idosos com transtornos neurocognitivos.

Biopsychosocial factors associated with the frailty and pre-frailty among older adults.

Frailty is a multidimensional geriatric syndrome associated with specific biopsychosocial factors in each population. This was a cross-sectional observational study designed to determine the biopsychosocial factors associated with frailty and pre-frailty in older adults in a community in Salvador, Brazil. The stages of frailty were collected in 413 older adults: 34.9% frail, 54.5% pre-frail, 10.6% robust. In the multinomial regression model, age (p = .018), functionality for instrumental activities of daily living (p = .026), risk for falls (p = .006), family functionality (p = .031) and the physical domain of quality of life (p = .004) had an independent association with frailty. Risk for falls (p = .004), family functionality (p = .004) and the environment domain of quality of life (p = .037) were independently associated with pre-frailty. The findings provide support to interventions in a way that contributes to prevention or reversal of frailty.

Avaliação da Cognição, Humor e da Capacidade Funcional em Pacientes Oncogeriátricos Hospitalizados / Evaluation of Cognition, Humor and Functional Capacity in Hospitalized Oncogeriatric Patients / Evaluación de la cognición, el estado de ánimo y la capacidad funcional en pacientes oncogeriatricos hospitalizados

A avaliação do idoso com câncer durante a hospitalização pode permitir uma melhor compreensão da tolerância ao tratamento oncológico e melhor planejamento do cuidado. Objetivou-se avaliar a cognição, humor e a capacidade funcional de pacientes oncogeriátricos hospitalizados em um centro de referência em Salvador, Bahia, Brasil. Participaram 40 indivíduos com idade entre 60 e 82 anos. A maioria apresentou dependência parcial para atividades de vida diária, a cognição preservada, e sinais de depressão leve durante a hospitalização.

The evaluation of the elderly with cancer during hospitalization allows a better understanding of he or she tolerance to cancer treatment and better care planning. The objective was to evaluate the cognition, mood and functional capacity of hospitalized oncogeriatric patients in a reference center in the city of Salvador, Bahia, Brazil. 40 individuals with câncer with aged between 60 and 82 years had participated the study. The majority of the subjects had partial dependence for activities of daily living, preserved cognition and signs of mild depression during hospitalization.

La evaluación de los ancianos con cáncer durante la hospitalización puede permitir una mejor comprensión de la tolerancia al tratamiento del cáncer y una mejor planificación de la atención. Este estudio tuvo como objetivo evaluar la cognición, el estado de ánimo y la capacidad funcional de los pacientes oncogeriatricos hospitalizados en un centro de referencia en Salvador, Brasil, Brasil. Cuarenta personas de 60 a 82 años participaron. La mayoría tenía una dependencia parcial de las actividades de la vida diaria, cognición preservada y signos de depresión leve durante la hospitalización.

Functionality and Risk of Falls in Elders Followed in a Day Care Center in Brazil.

Adult day centers provide comprehensive care for older adults and may enhance autonomy, well-being, and socialization. This quasi-experimental study evaluated the impact of such multidisciplinary day care on functionality, fear of falling, and risk of falls in community elders. Fifty-two seniors who attended day services were followed for 1 year. During the year, the adults maintained functionality for activities of daily living, presented improvement in instrumental activities of daily living, and no longer presented high risk for falls. No association was found between the risk of falling and fear of falling, however. Results are discussed in terms of the positive outcomes of attending day services.

Avaliação da descontaminação de cones de guta-percha usando diferentes métodos de desinfecção / Evaluation of gutta-percha points decontamination through different disinfection methods

A suscetibilidade ao crescimento bacteriano em cones de guta-percha (GP) e a forma de descontaminação desses cones usando quatro diferentes substâncias químicas foram avaliadas. Seis cones de GP foram selecionados de um ambiente clínico e levados com pinça estéril para um meio de cultura de Brain Heart Infusion (BHI), para avaliação de crescimento bacteriano. Outros doze cones foram divididos em quatro grupos experimentais de três cones, sendo: Grupo 1, hipoclorito de sódio a 2,5%; Grupo 2, álcool a 70%; Grupo 3, clorexidina gel a 2%; e Grupo 4, clorexidina líquida a 0,12%, onde cada cone ficou submerso na substância por um minuto, foi seco por meio de esfregaço com gaze estéril e inserido em meio de cultura BHI, para se avaliar a presença ou não de contaminação. Os resultados encontrados mostraram que os cones de guta-percha não apresentavam contaminação, independentemente de serem submetidos ou não a um processo de descontaminação. Dessa forma, conclui-se que não há necessidade de descontaminação dos cones de guta-percha, contanto que seja respeitada a cadeia asséptica do tratamento endodôntico.

Lead Toxicity Risks in Gunshot Victims.

BACKGROUND: Gunshot wounds require surgeons to decide whether to remove or leave bullet fragments in the body. Surgeons also decide how to follow up with patients who have lead fragments retained in their body. Current literature recommends to remove only intra-articular fragments without the need for a follow-up for patients with the metal retained. Therefore, this study investigates chronic lead toxicity for gunshot wounds. METHODS: The study was performed in the metropolitan area of Rio de Janeiro/Brazil, between 2013 and 2015. It was a case-control study that included 45 victims of gunshot lesions with metallic fragments retained for more than 6 months. The 45 controls were matched for gender, age, and race. We compared the lead blood levels and frequency of symptoms. RESULTS: The control group had average blood lead levels of 2.17 µg/dL (95% Confidence Interval [CI]; 1.71-2.63) and median 2.1 µg/dL. The case group had average values of 9.01 µg/dL (CI; 6.07-11.96) and median values of 6.5 µg/dL with p-values < = 0.001. The case group reported the following more frequently: irritancy, bad mood, headache, memory losses, daylight drowsiness, myalgia, weakness, abdominal pain, joint pain, trembling, tingling limbs. There was statistical significance for the differences of symptoms frequencies and for odds ratio between groups. CONCLUSIONS: Although the mean lead levels found were lower than the current laboratory references, low levels have been associated with both rising morbidity and mortality. The WHO stated: "There is no known level of lead exposure that is considered safe". In conclusion, this work showed that bullets retained in the body are not innocuous. There are impacts in the blood lead levels and symptoms related to it, even with few fragments, extra-articular located or existing with low blood lead levels.

Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients.

BACKGROUND: The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed. OBJECTIVE: To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients. METHODS: The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl-Meyer scales were used to evaluate the patients. RESULTS: After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl-Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients' performance in a similar manner. CONCLUSION: Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.

Meta, mega e retroanálises correlacionais: comparando dados primários em Psicologia / Correlational meta, mega and retroanalyses: comparing primary data in Psychology / Meta, mega y retroanálisis correlacionales: comparando datos primarios en Psicología

Na tentativa de promover a transformação de informações em conhecimento, este artigo compara as meta-análises com duas de suas variantes, as mega-análises e as retroanálises, técnicas desenvolvidas para a síntese e a equiparação de resultados pouco precisos ou contraditórios. Enquanto as meta-análises referem-se à síntese dos resultados de diferentes pesquisas primárias, as mega-análises referem-se à síntese dos dados coletados por pesquisas primárias e as retroanálises à recriação e posterior síntese desses mesmos dados. Por meio de uma simulação, o Estudo 1 pareia o viés médio de meta, mega e retroanálises em função de nove diferentes configurações que variam conforme a quantidade de estudos empregados e do tamanho da amostra individual de cada um desses estudos, nas modalidades de dados completos, leve e severa ausência de dados. No Estudo 2, os mesmos dados utilizados na simulação de ausência severa foram empregados para testar a precisão de mega e retroanálises quando se realiza a imputação de dados. Os resultados apontam para uma leve superioridade geral das mega-análises, diferença essa que diminui, até desaparecer, em situações ideais...

In an attempt to promote the transformation of information into knowledge, this article compares meta-analyses with two of its variants, mega-analyses and retro-analyses, techniques developed to summarize and compare results that are not very accurate or contradictory. While meta-analyses refer to the synthesis of results of different primary researches. mega-analyses refer to the synthesis of results collected by primary researches and retroanalyses, to the recreation and posterior synthesis of that data. Using a simulation, Study 1 pairs the average trends from meta, mega and retroanalyses regarding nine different configurations that vary according to the number of studies used and the size of the individual sample of each of those studies, in the full data, light data and severe lack of data modes. In Study 2, the same data used in the simulation of severe lack of data were used to test the accuracy of mega and retroanalyses when performing data imputation. The results show a slight general superiority of mega-analyses, a difference that fades away in ideal situations.

En la tentativa de fomentar la transformación de informaciones en conocimiento, este artículo compara los meta-análisis con dos de sus variantes, los mega-análisis y los retro-análisis, técnicas desarrolladas para la síntesis y la equiparación de resultados poco precisos o contradictorios. Mientras los meta-análisis se refieren a la síntesis de los resultados de distintas investigaciones primarias, los mega-análisis se refieren a la síntesis de los datos recolectados por investigaciones primarias, y los retro-análisis, a una nueva creación y posterior síntesis de esos mismos datos. Por medio de una simulación, el Estudio 01 parea el sesgo medio de meta-, mega- y retro-análisis en función de nueve distintas configuraciones que varían según la cantidad de estudios llevados a cabo y el tamaño de la muestra individual de cada uno de esos estudios, en las modalidades de datos completos, leve y severa ausencia de datos. En el estudio 02, los mismos datos utilizados en la simulación de ausencia severa han sido empleados para testar la precisión de mega- y retro-análisis cuando se lleva a cabo la imputación de datos. Los resultados señalan hacia una leve superioridad general de los mega-análisis. Esa diferencia disminuye, hasta desaparecer, en situaciones ideales...

Meta, mega e retroanálises correlacionais: comparando dados primários em Psicologia / Correlational meta, mega and retroanalyses: comparing primary data in Psychology / Meta, mega y retroanálisis correlacionales: comparando datos primarios en Psicología

Na tentativa de promover a transformação de informações em conhecimento, este artigo compara as meta-análises com duas de suas variantes, as mega-análises e as retroanálises, técnicas desenvolvidas para a síntese e a equiparação de resultados pouco precisos ou contraditórios. Enquanto as meta-análises referem-se à síntese dos resultados de diferentes pesquisas primárias, as mega-análises referem-se à síntese dos dados coletados por pesquisas primárias e as retroanálises à recriação e posterior síntese desses mesmos dados. Por meio de uma simulação, o Estudo 1 pareia o viés médio de meta, mega e retroanálises em função de nove diferentes configurações que variam conforme a quantidade de estudos empregados e do tamanho da amostra individual de cada um desses estudos, nas modalidades de dados completos, leve e severa ausência de dados. No Estudo 2, os mesmos dados utilizados na simulação de ausência severa foram empregados para testar a precisão de mega e retroanálises quando se realiza a imputação de dados. Os resultados apontam para uma leve superioridade geral das mega-análises, diferença essa que diminui, até desaparecer, em situações ideais.(AU)

In an attempt to promote the transformation of information into knowledge, this article compares meta-analyses with two of its variants, mega-analyses and retro-analyses, techniques developed to summarize and compare results that are not very accurate or contradictory. While meta-analyses refer to the synthesis of results of different primary researches. mega-analyses refer to the synthesis of results collected by primary researches and retroanalyses, to the recreation and posterior synthesis of that data. Using a simulation, Study 1 pairs the average trends from meta, mega and retroanalyses regarding nine different configurations that vary according to the number of studies used and the size of the individual sample of each of those studies, in the full data, light data and severe lack of data modes. In Study 2, the same data used in the simulation of severe lack of data were used to test the accuracy of mega and retroanalyses when performing data imputation. The results show a slight general superiority of mega-analyses, a difference that fades away in ideal situations.(AU)

En la tentativa de fomentar la transformación de informaciones en conocimiento, este artículo compara los meta-análisis con dos de sus variantes, los mega-análisis y los retro-análisis, técnicas desarrolladas para la síntesis y la equiparación de resultados poco precisos o contradictorios. Mientras los meta-análisis se refieren a la síntesis de los resultados de distintas investigaciones primarias, los mega-análisis se refieren a la síntesis de los datos recolectados por investigaciones primarias, y los retro-análisis, a una nueva creación y posterior síntesis de esos mismos datos. Por medio de una simulación, el Estudio 01 parea el sesgo medio de meta-, mega- y retro-análisis en función de nueve distintas configuraciones que varían según la cantidad de estudios llevados a cabo y el tamaño de la muestra individual de cada uno de esos estudios, en las modalidades de datos completos, leve y severa ausencia de datos. En el estudio 02, los mismos datos utilizados en la simulación de ausencia severa han sido empleados para testar la precisión de mega- y retro-análisis cuando se lleva a cabo la imputación de datos. Los resultados señalan hacia una leve superioridad general de los mega-análisis. Esa diferencia disminuye, hasta desaparecer, en situaciones ideales.(AU)

Entendeu ou quer que eu desenhe?: transições familiares através da visão sistêmica / Got it?: understanding family transitions through the systems perspective

Este ensaio teórico tem como objetivo apresentar a teoria sistêmica como um meio de filtrar o caos em que ocorrem as transições familiares, através do recurso de imagens que sintetizam o emaranhado das suas interações. Examinou-se, para tal, os alicerces da teoria sistêmica, destrinchou-se as transformações básicas quando da interação entre células individuais e contextos coletivos e, por fim, explanou-se as transições familiares mais comuns. Entende-se que os prejuízos do possível reducionismo acarretado pelas representações gráficas são plenamente compensados pelo ganho em clareza e objetividade que as ilustrações oferecem para cada processo, facilitando a sua compreensão, manipulação e associação.(AU)

This theoretical essay presents the system theory as a mean to filter out the chaos in which family transitions occurs, by the use of images that summarize and disentangle its interactions. For this purpose, it was examined the foundations of systems theory, it was unraveled the basic transformations regarding individual cells and collective contexts and, finally, it was explained the most characteristics family transitions. The proposed reductionism losses are considered offset by the gains in clarity and objectivity that the illustrations provides for each process, facilitating their understanding, manipulation and association.(AU)

Entendeu ou quer que eu desenhe? Transições familiares através da visão sistêmica / Got it? Understanding family transitions through the systems perspective

Este ensaio teórico tem como objetivo apresentar a teoria sistêmica como um meio de filtrar o caos em que ocorrem as transições familiares, através do recurso de imagens que sintetizam o emaranhado das suas interações. Examinou-se, para tal, os alicerces da teoria sistêmica, destrinchou-se as transformações básicas quando da interação entre células individuais e contextos coletivos e, por fim, explanou-se as transições familiares mais comuns. Entende-se que os prejuízos do possível reducionismo acarretado pelas representações gráficas são plenamente compensados pelo ganho em clareza e objetividade que as ilustrações oferecem para cada processo, facilitando a sua compreensão, manipulação e associação.

This theoretical essay presents the system theory as a mean to filter out the chaos in which family transitions occurs, by the use of images that summarize and disentangle its interactions. For this purpose, it was examined the foundations of systems theory, it was unraveled the basic transformations regarding individual cells and collective contexts and, finally, it was explained the most characteristics family transitions. The proposed reductionism losses are considered offset by the gains in clarity and objectivity that the illustrations provides for each process, facilitating their understanding, manipulation and association.

Anormalidades no descenso da frequência cardíaca ao teste ergométrico em diabéticos / Heart rate decline anomalies during treadmil tests for diabetics

Fundamentos: Estudos demonstraram que a disfunção autonômica cardiovascular, medida através da variabilidade da frequência cardíaca, está associada a aumento do risco cardiovascular. Objetivos: Comparar a presença de disautonomia em diabéticos e não diabéticos através do teste ergométrico e determinar as variáveis preditoras de disautonomia em diabéticos. Métodos: Estudo retrospectivo, com pacientes que realizaram o teste ergométrico em caráter eletivo sob protocolo individualizado de rampa. Os pacientes foram estratificados em dois grupos: diabéticos (G1) e não diabéticos (G2). Foram definidos como disautonômicos os pacientes que obtiveram uma redução da FC no primeiro minuto da recuperação <12bpm. Os grupos G1 e G2 foram comparados. As variáveis com valores de p≤0,10 foram submetidas à análise de regressão logística. Resultados: Foram avaliados 1433 pacientes submetidos ao TE. A idade média foi 52,65±13,06 anos e variou entre 18-92 anos. Observaram-se, no G1, indivíduos mais velhos, obesos e dislipidêmicos. No teste ergométrico houve diferenças na FCR no primeiro minuto, FC do picodo esforço, número de METs e déficit cronotrópico. Submetidas as variáveis da população amostral, diabéticos e não diabéticos, à regressão logística, encontrou-se um único preditor de disautonomia: o número de METs (IC95% 0,083/0,031; p<0,0001); nos diabéticos, o único preditor independente da presença de disautonomia foi o índice de massa corporal (IC95%0,002-0,025; p=0,02). Conclusão: Indivídos diabéticos apresentam recuperação mais lenta da FC no pós-esforço que não diabéticos, evidenciando maior disautonomia e menor capacidade física; os diabéticos com excesso de peso têm maior comprometimento do sistema autonômico.

Modelo nominal da Teoria de Resposta ao Item: uma alternativa / Item Response Theory nominal model: an alternative

Este artigo apresenta o Modelo de Resposta Nominal de Bock como uma alternativa para a parametrização dos itens de múltipla escolha, bem como para obtenção de estimativas mais precisas de traços latentes. Utilizando os dados dos 64.118 sujeitos de nove estados brasileiros e do Distrito Federal, que compõem a amostra normativa do Teste de Raciocínio Lógico Numérico da Costa, comparou-se o ajuste do Modelo de Resposta Nominal como os Modelos Logísticos de 1, 2 e 3 Parâmetros, e efetuou-se a análise das questões, dos distratores e da precisão com os dados politômicos na íntegra e dicotomizados. Conclui-se que, apesar das respostas nominais obtidas empiricamente não terem se encaixado adequadamente aos valores esperados pelo seu modelo, tal modalidade da Teoria de Resposta ao Item ainda ofereceu indícios dos motivos que levaram à má formulação de algumas questões, questionou o entendimento da prória habilidade avaliada e melhorou a precisão da medida.(AU)

This paper presents Bock's Nominal Response Model as an alternative to multiple-choice items parameterization as well as to obtain more precise latent trait estimates. Using data from 64,118 subjects gathered in nine Brazilian states and Federal District, which composes the normative sample from the Costa's Logical Reasonig Test, the adjustment of Nominal Response Model was compared with 1, 2 and 3 parameters Logistic Models instances. Also, it was performed the analysis of item issues, distractors and accuracy with full information polytomous items and its dichotomized version. It was concluded that, despite empirically obtained nominal responses do not fit properly to the values expected by its model, this Item Response Theory type of data still leads to some of the reasons of poor question formulation, instigates the understanding of the evaluated ability itself, and improves the precision of the measure.(AU)