Os episódios mistos em pacientes portadores de Transtorno Bipolar são descritos freqüentemente como sendo mais graves que os episódios de mania aguda. Além disso, muitos trabalhos na literatura descrevem os pacientes com TB com história de episódios mistos, como um grupo distinto clínica e demograficamente do grupo com apresentação apenas de episódios de mania pura. Os objetivos deste estudo foram comparar clinicamente episódios agudos mistos versus episódios de mania pura e comparar clínica e demograficamente pacientes que apresentaram em algum momento do seguimento clínico pelo menos um episódio misto com pacientes que apresentaram apenas mania pura. Vinte pacientes apresentando episodio de mania pura foram comparados a 29 pacientes em estado misto de acordo com os critérios do DSM-IV. Não houve diferença na duração destes episódios, presença de hospitalização e tentativas de suicídio. Na comparação dos dados demográficos, não encontramos diferenças na idade, distribuição entre os sexos, classe sócio-econômica, estado civil e anos de escolaridade. Em relação ao curso, nosso estudo mostrou que pacientes com pelo menos um estado misto apresentaram maior freqüência de tentativas de suicídio e de episódios, mais comorbidades e idade de início da doença mais precoce. Foi realizada analise multivariada através de regressão logística para a identificação das variáveis clinicas que melhor distinguem um grupo do outro. Esta analise mostrou que a presença de comorbidades e de tentativas de suicídio foram as variáveis identificadas que mais fortemente estão associadas ao diagnóstico de pacientes com estado misto. / Mixed episodes in patients with bipolar disorder (BD) have been frequently described as more severe than acute manic episodes. Moreover, many papers in the literature have described the patients with BD with history of mixed episodes as a group that is clinically and demographically distinct from the group with clinical presentation of pure manic episodes. The purposes of this study were to compare clinically acute mixed episodes with pure manic episodes and compare clinically and demographically patients that present in any moment of their clinical follow-up at least one mixed episode with patients that present only pure mania. Twenty patients with pure manic episode were compared to 29 patients with mixed episodes according to DSM-IV criteria. There were no differences in episodes duration, presence of hospitalization and suicide attempts. Comparing the demographic data, we did not find differences in age, gender distribution, socio-economic status, marital status and years of education. Regarding the course of illness, our study showed that patients with at least one mixed state presented higher frequency of suicide attempts, younger age of illness onset, more co-morbidities, and higher index of impulsivity. A multi-variate analysis was performed with logistic regression to identify the clinical variables that better distinguish one group from the other. This analysis showed that the presence of co-morbidities and suicide attempts were the identified variables that are strongly associated with the diagnosis of patients with mixed state.

Objetivo: Analisar por meio de um estudo clinico transversal a influência das forças oclusais, assim como, de outros possíveis fatores locais na morfologia de lesões cervicais não cariosas (LCNC). Material e Método: Foram avaliados 32 indivíduos que possuíam LCNC nos primeiros pré-molares superiores, totalizando uma análise de 61 dentes, além disso, todos os sujeitos da pesquisa apresentavam todos os elementos dentais. Os mesmos eram pacientes regulares do serviço odontológico da Universidade Federal de Uberlândia, de ambos os gêneros, com idades entre 21 a 64. Para confirmação da morfologia e da severidade (profundidade) das LCNC, foi realizado exame cínico e replica das mesmas. As LCNC foram classificadas em anguladas ou arredondadas e em 3 níveis de severidade. A fim de determinar a presença de forças laterais, a presença de algum tipo de hábito parafuncional, como apertamento e bruxismo, foi analisado por meio de questionário e exame clinico. Também foram analisados, a presença de interferências oclusais (IO) em Relação Cêntrica (RC) e Movimentos excursivos, por meio de exame clinico de manipulação e análise dos modelos de gesso montados em articulador, assim como informações sobre a presença de facetas de desgaste. Além disso, informações sobre o periodonto, também foram coletadas, por meio de exame clinico, da mensuração das recessões gengivais no sentido cérvico-apical e mésio-distal. Assim como, da altura e espessura da cortical óssea vestibular, realizada por meio de Tomografia Computadorizada do tipo Cone-Beam (TCCB). Resultados: Inicialmente, aplicou-se o teste de Shapiro wilk, para avaliar a normalidade dos dados. Para os dados normais, posteriormente, aplicou-se o teste de Kruskall-wallis. Enquanto, que para as variáveis que não apresentaram distribuição normal, foi aplicado o teste Mann- Whitney. Dados gerais da amostra, demonstraram que a idade apresentou associação tanto com a morfologia (p = ,016), quanto para a severidade das LCNC (p=,000). O que não foi encontrado para o gênero (morfologia, p =,139; severidade, p =,308), nem para a presença de algum distúrbio gástrico (morfologia, p =,260; severidade, p =,831). Além disso, nenhuma relação foi encontrada entre a preseça de hábitos parafuncionais ou alguma IO, com a morfologia e severidade das LCNC. Todos os sujeitos da pesquisa apresentaram facetas de desgaste, entretanto, a presença de uma ou duas facetas não influenciou a morfologia ou severidade das lesões. Já para a recessão gengival, associação significativa foi encontrada para a morfologia (p =,046). Em relação a altura e espessura da crista da cortical vestibular, a altura foi significante em relação a severidade (p= ,009), e a espessura da crista, apresentou associação com a morfologia (p=,001) e severidade (p=,044). Conclusão: Não houve associação direta entre a morfologia das LCNC e as forças oclusais, entretanto, a idade e o suporte ósseo (menor altura e cortical menos espessa), foram fatores determinantes para a prevalência de LCNC anguladas e mais severas. / Objective: Analyze through a cross clinical study the influence of occlusal forces, as well as other possible local factors in the morphology of cervical lesions noncarious (LCNC). Material and Methods: We evaluated 32 individuals who had LCNC the first premolars, totaling an analysis of 61 teeth, moreover, all the subjects had complete dental arches. They were regular patients of the dental service at the Federal University of Uberlândia, of both genders, ages 21 to 64. To confirm the morphology and severity (depth) of LCNC was held cynical examination and replicates them. The LCNC were classified into angled or rounded and three severity levels. In order to determine the presence of lateral forces, the presence of some kind of habit parafuncional as bruxism and clenching was analyzed by questionnaire and clinical examination. Were also analyzed, the presence of occlusal interferences (OI) in Relation Centrica (CR) and movements excursive through clinical examination manipulation and analysis of plaster models mounted on articulator, as well as information about the presence of wear facets. In addition, information about periodontal were also collected through clinical examination, measurement of gingival recession in cervical-apical and mesiodistally. As well as the height and thickness of the buccal bone cortical held by Computed Tomography Cone-Beam type (TCCB). Results: Initially, we applied the Shapiro Wilk test to assess the normality of the data. For normal data, later applied the Kruskal-wallis test. While that for variables without normal distribution, the Mann-Whitney test was applied. General data of the sample, showed that age was associated with both the morphology (p =. 016), as to the severity of LCNC (p =.000). What was not found for the genre (morphology, p = .139; severity, p = 308), or to the presence of some gastric disorder (morphology, p = .260; severity, p = 831). Furthermore, no relationship was found between the preseça of parafunctional habits or some IO, with the morphology and severity of LCNC. All the subjects showed wear facets, however, the presence of one or two aspects not influence the morphology or severity of the lesions. As for the gingival recession, significant association was found for morphology (p =.046). Regarding the height and thickness of the crest cortical bone, the height was significant in relation to severity (p =.009), and the thickness of the crest, was associated with the morphology (p = .001) and severity (p = .044). Conclusion: There was no direct association between the morphology of NCCL and occlusal forces, however, the age and the bony support (lower thinner height and cortical), were determining factors for the prevalence of NCCL angled and more severe.

Os episódios mistos em pacientes portadores de Transtorno Bipolar são descritos freqüentemente como sendo mais graves que os episódios de mania aguda. Além disso, muitos trabalhos na literatura descrevem os pacientes com TB com história de episódios mistos, como um grupo distinto clínica e demograficamente do grupo com apresentação apenas de episódios de mania pura. Os objetivos deste estudo foram comparar clinicamente episódios agudos mistos versus episódios de mania pura e comparar clínica e demograficamente pacientes que apresentaram em algum momento do seguimento clínico pelo menos um episódio misto com pacientes que apresentaram apenas mania pura. Vinte pacientes apresentando episodio de mania pura foram comparados a 29 pacientes em estado misto de acordo com os critérios do DSM-IV. Não houve diferença na duração destes episódios, presença de hospitalização e tentativas de suicídio. Na comparação dos dados demográficos, não encontramos diferenças na idade, distribuição entre os sexos, classe sócio-econômica, estado civil e anos de escolaridade. Em relação ao curso, nosso estudo mostrou que pacientes com pelo menos um estado misto apresentaram maior freqüência de tentativas de suicídio e de episódios, mais comorbidades e idade de início da doença mais precoce. Foi realizada analise multivariada através de regressão logística para a identificação das variáveis clinicas que melhor distinguem um grupo do outro. Esta analise mostrou que a presença de comorbidades e de tentativas de suicídio foram as variáveis identificadas que mais fortemente estão associadas ao diagnóstico de pacientes com estado misto. / Mixed episodes in patients with bipolar disorder (BD) have been frequently described as more severe than acute manic episodes. Moreover, many papers in the literature have described the patients with BD with history of mixed episodes as a group that is clinically and demographically distinct from the group with clinical presentation of pure manic episodes. The purposes of this study were to compare clinically acute mixed episodes with pure manic episodes and compare clinically and demographically patients that present in any moment of their clinical follow-up at least one mixed episode with patients that present only pure mania. Twenty patients with pure manic episode were compared to 29 patients with mixed episodes according to DSM-IV criteria. There were no differences in episodes duration, presence of hospitalization and suicide attempts. Comparing the demographic data, we did not find differences in age, gender distribution, socio-economic status, marital status and years of education. Regarding the course of illness, our study showed that patients with at least one mixed state presented higher frequency of suicide attempts, younger age of illness onset, more co-morbidities, and higher index of impulsivity. A multi-variate analysis was performed with logistic regression to identify the clinical variables that better distinguish one group from the other. This analysis showed that the presence of co-morbidities and suicide attempts were the identified variables that are strongly associated with the diagnosis of patients with mixed state.

<p>In two prospective, clinical studies the stability of implants and prosthetic constructions were evaluated after three years of loading. In the first study, the implant and the bridge stability of 39 patients with 1-stage bone grafts, were compared to a reference-group of 37 patients who did not need bone grafts. In the second study, 40 patients were randomised to have either 1-stage sinus inlay bloc grafts or 2-stage sinus inlay particulated grafts. </p><p>Implant success in Paper 1, was 75.3% in the study group and 93.1% in the reference group. In Paper 2 implant survival in the 1-stage group was 77.7% and 86.5% in the 2-stage group. Bruxism and post-operative complications, such as unexpected pain, dehiscence and infection were found to be associated with the later loss of implants. </p><p>The volumes of onlay block and inlay particulated bone grafts, after 6 months as evaluated by computed tomography showed the decrease of 49.5% and 47% respectively, although there was a wide range in both groups. </p><p>Using of cutting torque measurements during the placement of implants in grafted and non-grafted jaw bone, showed a significant inverse correlation to the commonly used clinical estimation of jaw bone quality, acc. to Lekholm & Zarb. Significantly lower torque values were recorded in grafted regions when compared to non-grafted. </p><p>It was shown that autogenous bone grafts and implants to the edentulous maxilla, after early high failure rates, showed stable and predictable results after three years. Bruxism was found to be significantly associated with implant failures and initially reduced biomechanical properties was seen in the grafted bone. </p>

In two prospective, clinical studies the stability of implants and prosthetic constructions were evaluated after three years of loading. In the first study, the implant and the bridge stability of 39 patients with 1-stage bone grafts, were compared to a reference-group of 37 patients who did not need bone grafts. In the second study, 40 patients were randomised to have either 1-stage sinus inlay bloc grafts or 2-stage sinus inlay particulated grafts. Implant success in Paper 1, was 75.3% in the study group and 93.1% in the reference group. In Paper 2 implant survival in the 1-stage group was 77.7% and 86.5% in the 2-stage group. Bruxism and post-operative complications, such as unexpected pain, dehiscence and infection were found to be associated with the later loss of implants. The volumes of onlay block and inlay particulated bone grafts, after 6 months as evaluated by computed tomography showed the decrease of 49.5% and 47% respectively, although there was a wide range in both groups. Using of cutting torque measurements during the placement of implants in grafted and non-grafted jaw bone, showed a significant inverse correlation to the commonly used clinical estimation of jaw bone quality, acc. to Lekholm &amp; Zarb. Significantly lower torque values were recorded in grafted regions when compared to non-grafted. It was shown that autogenous bone grafts and implants to the edentulous maxilla, after early high failure rates, showed stable and predictable results after three years. Bruxism was found to be significantly associated with implant failures and initially reduced biomechanical properties was seen in the grafted bone.

Optimal pharmacotherapy requires an understanding of the dose-exposure (pharmacokinetics or PK) to response (pharmacodynamic or PD) relationship. Little is known about the influence of obesity on this dynamic system as PK studies in obesity have been largely descriptive rather than explanatory. This has led to a paucity of dosing guidelines for the obese, and arbitrary dose selection in the clinic. There is a need to quantify the impact of obesity on drug clearance (CL) to ensure that exposure is matched across patients of different body compositions, thereby improving therapeutic outcomes and minimising adverse events. The global aim of this thesis was to use prior published data and new clinical trial data to understand how body composition impacts upon drug CL and renal function, and to determine how clinical study design influences the identification of these relationships. Chapter 2 of this thesis determined if conventional body size descriptors that have been used to scale drug doses to body size were appropriate. In the clinical setting, a body size descriptor commonly used for determining dose requirements is total body weight (WT), based on the assumption that physiological function and PK parameters vary according to body size. However, dosing algorithms based on WT might be unsuitable for the obese due to their altered body composition which, if inaccurate, could ultimately lead to overdoses. Alternative body size descriptors such as body surface area and ideal body weight have been used, but are limited when extrapolated to obese patients as they do not take into account the covariates required to describe differences in body composition between individuals. In contrast, it was demonstrated that lean body weight (LBW), as derived by Janmahasatian et al, had the potential to scale CL across a wide range of body compositions. This literature review and systematic analysis of previously published obesity data led to the proposal of a hypothesis that body composition is sufficient to explain the influence of obesity on drug CL and that dosing for obese patients should be based on LBW. When conducting clinical studies, the selection of an appropriate body size descriptor for scaling doses across individuals of different body compositions can be aided by a study design that allows for the identification of parameter-covariate relationships which are transportable to the obese. Chapter 3 of this thesis quantified the probability of identifying these parameter-covariate relationships as a function of differing study designs. Demographics were generated using a multivariate lognormal covariate distribution with truncation at different WT limits under both a non-stratified and stratified design. PK data were simulated from a 1-compartment, first order input, first order elimination model with LBW as the covariate on CL, termed the ‘True Model’. The ‘False Model’ had WT as the covariate on CL. Both models were fitted to the simulated data and the preferred model was selected based on the difference in objective function values. Each design was evaluated under differing magnitudes of random effects, as well as under a D-optimal sparse sampling scheme. It was shown under a simulation platform that the use of stratification and a wide covariate range enhanced the probability of selecting the true covariate from two competing covariate models. The aforementioned findings regarding LBW and stratification were used to design a new clinical study investigating the influence of obesity on renal drug elimination pathways. This work forms Chapters 4 and 5 of this thesis. Non-obese and obese healthy volunteers were recruited using a study design stratified for LBW. These subjects were administered a combination of four renal markers for the simultaneous assessment of various renal processes. One of the renal markers was para-aminohippuric acid (PAH), which provides an estimation of renal plasma flow (RPF). A population PK model was developed for PAH, which revealed that body size alone was insufficient to explain variability in RPF across healthy individuals of a large range of body compositions, although LBW emerged as the preferred covariate (p=0.053) among the body size descriptors tested. This weak covariate effect was in contrast with prior research supporting the use of LBW in normalising the effect of obesity on glomerular filtration rate (GFR), implying that body composition could play a greater role in influencing GFR than RPF. This thesis has applied new methods to the design of drug CL studies in obesity, and offered results and future directions to maximise the information gained from such clinical studies. A better understanding of alterations in PK and physiological function arising from changes in body composition should aid in optimising dose adjustments for obese patients, which is of great importance given the increasing prevalence of obesity in today’s society.

O objetivo deste estudo foi comparar diferentes métodos de avaliação de restaurações de resina composta em dentes posteriores, assim como avaliar a concordância intra-examinador. Cento e trinta e seis restaurações oclusais de resina composta foram avaliadas por um examinador treinado usando os critérios modificados do USPHS para avaliar quatro características das restaurações: integridade marginal, forma anatômica, descoloração marginal e textura superficial. Três métodos diferentes foram estudados: clínico, fotográfico e modelos. A reprodutibilidade intra-examinador foi medida através do teste de Kappa e a comparação de métodos através dos testes não-paramétricos de Fischer e Wilcoxon. Os resultados mostraram que os valores de concordância intra-examinador foram melhores na avaliação de integridade marginal e forma anatômica através de modelos, e os valores foram similares entre a avaliação clínica e fotográfica para integridade marginal e descoloração marginal. A textura superficial apresentou os valores mais baixos de concordância intra-examinador para todos os métodos examinados. O método direto foi significantemente diferente que os métodos indiretos para todas as características avaliadas (p< 0,05). Entretanto, quando os métodos foram avaliados segundo a aceitabilidade clínica considerada pelo USPHS, os métodos não foram diferentes. Os métodos fotográfico e modelos detectaram defeitos que não foram percebidos pelo método clínico na avaliação da integridade marginal e da forma anatômica. As avaliações através de fotografias e modelos foram semelhantes em todas as características avaliadas com exceção da textura superficial (p< 0,05). Todos os métodos mostraram ser inadequados para a avaliação de textura superficial. Houve diferenças significativas entre o método direto e os métodos indiretos. Os métodos indiretos permitiram realizar observações mais detalhadas e críticas. Entretanto, o método clínico mostrou ter capacidade para diferenciar entre restaurações clinicamente aceitáveis e não-aceitáveis. / The aim of this study was to compare different methods for evaluating composite resin restorations in posterior teeth and to evaluate the reproducibility of each method by determining the intraexaminer agreement. One hundred and thirty six occlusal composite resin restorations were evaluated by a trained examiner using modified USPHS criteria to assess four restoration characteristics: marginal integrity, anatomic form, marginal discoloration and surface texture. Three different methods were studied: clinical, photographic and dental cast models. Kappa statistics was used to determine reproducibility and non-parametric Friedman and Wilcoxon tests to compare the methods. The results showed that the best intraexaminer agreement values were obtained for dental cast models evaluations for marginal integrity and anatomic form and were similar between photographic and clinical evaluations for marginal integrity and marginal discoloration. Surface texture showed the lowest degree of intraexaminer agreement with all the methods tested. Direct clinical method and the two indirect methods were significantly different for all the characteristics assessed (p< 0.05). However, when they were evaluated according to USPHS clinical acceptability, the methods did not differ. Photographs and dental cast models methods detected defects that the direct clinical method could not distinguish for marginal integrity and anatomic form. Photographs and dental cast models evaluations were similar for all the characteristics assessed, except for surface texture (p< 0.05). All the methods showed that they are not adequate to evaluate surface texture. There were significant differences between the direct clinical method and the indirect methods for all the composite resin restorations characteristics assessed. The indirect methods allowed more detailed and critical observations. However, the direct clinical method was able to distinguish between clinical acceptable and unacceptable restorations.

Antecedentes: Cárie Precoce da Infância é uma doença de alta prevalência e severidade que acomente crianças nos primeiros anos de vida e por isso necessita de intervenções e abordagens precoces, sendo a primeira infância o período ideal para introduzir bons hábitos e iniciar programas educativo-preventivos de saúde bucal. Objetivos: a presente tese objetivou comparar a efetividade da Entrevista Motivacional (EM) em relação a Educação em Saúde Convencional (EC) em um programa direcionado a mães/pais/responsáveis de crianças para a prevenção da cárie precoce da infância, adicionalmente, verificar a frequência de declarações motivacionais de Dentistas e Técnicos em Saúde Bucal (TSB), antes e após um treinamento para EM, no contexto da Atenção Primária à Saúde (APS). Métodos: um ensaio comunitário randomizado foi realizado no Serviço de Saúde Comunitária do Grupo Hospitalar Conceição em Porto Alegre – RS, Brasil, onde 6 das 12 unidades de saúde foram sorteadas para que os Dentistas e TSB (n=41) recebessem um treinamento intensivo de 8 horas para aprendizagem ativa dos princípios básicos da EM e avaliados por instrumentos validados. Os exames de cárie foram realizados através do índice ICDAS por examinadores treinados e calibrados. Resultados: em análise preliminar foram avaliadas um total de 244 crianças com idade média de 14,4 meses e que receberam ao menos uma consulta odontológica durante o primeiro ano de vida. Análises de subgrupos foram realizadas para renda equivalente e escolaridade materna. Para ambas as análises, a Entrevista Motivacional teve melhor desempenho entre o grupo mais desfavorecido, mas não teve efeito significativo entre os mais ricos. Entre as crianças cujas famílias recebiam menos de R$ 450,00 mensais houve um RR=0,10 (IC95% 0,01-0,79), enquanto naquelas com ganhos superiores foi RR=0,59 (IC95% 0,10-3,36). Entre as crianças cujas mães tinham escolaridade menor que o fundamental houve um RR=0,09 (IC95% 0,01-0,96), enquanto entre aquelas com ensino fundamental ou mais, foi RR=0,38 (IC95% 0,08-1,89). Para ambas as variáveis, o termo de interação não foi significativa (renda p=0,15 e educação p=0,38). Nos resultados do treinamento dos profissionais para EM após 2 anos, observou-se manutenção da melhora das repostas no instrumento da consulta dialogada com diferença estatisticamente significativa para perguntas abertas, escutas reflexivas e percentual total de acertos (p<0,001), com tamanho de efeito grande (ES=1,12). Para o questionário de resposta útil, os profissionais continuaram usando mais perguntas abertas e escutas reflexivas (p<0,001), mantendo aumento no percentual de respostas compatíveis com EM (p<0,001). Igualmente, o tamanho de efeito manteve-se grande (ES=1,33) ao longo do tempo. Conclusões: embora os resultados sejam preliminares, os achados desse ensaio comunitário randomizado trazem evidências de que a abordagem de educação em saúde bucal baseada nos princípios da Entrevista Motivacional foi mais efetiva na redução de cárie precoce da infância no primeiro ano de vida de crianças de baixa renda e cujas mães tem pouca escolaridade quando comparadas a abordagem convencional. Adicionalmente, conclui-se que o treinamento dos profissionais da equipe de saúde bucal foi efetivo para para habilita-los a atuar dentro do espírito da Entrevista Motivacional, idependentemente da idade, experiência e formação profissional prévia, tornando a EM uma ferramenta viável para a prática na Atenção Primária à Saúde. / Background: Early childhood caries is a common and severe disease that affects children in their initial years of life. As such, it calls for early intervention and approaches, with early childhood the ideal period to introduce good habits and initiate education and preventative programs for oral health. Objectives: this thesis aimed to compare the effectiveness of Motivational Interviewing (MI) compared to Conventional Education in Health (EC) on a program directed to mothers/parents/guardians of children for the prevention of early childhood caries. Additionally, it studies the regularity of motivation talks by Dentists and Dental Hygienists (DH) before and after training in Motivational Interviewing, within the context of Primary Health Care (PHC). Methods: a randomized community study was held by the Community Health Service of the Conceição Hospital Group in Porto Alegre – RS, Brazil, where 6 of the 12 health units participated in a draw to allow Dentists and DHs (n=41) to undergo an 8-hour intensive training program to actively learn the basic principles of MI and assessed through valid instruments. Exams for caries were performed by trained and qualified examiners using the ICDAS index. Results: on preliminary analysis a total of 244 children were assessed, aging an average of 14,4 months and which had undergone at least one dental visit within the first year of life. Subgroup analyses were conducted for equivalent income and maternal level of education. For both analyses, Motivational Interviewing showed the best performance among the more underprivileged group, though it had no significant effect among the wealthier. Children from families earning less than BRL 450.00/month tended to show RR=0.10 (95%CI: 0.01-0.79), while among those with a higher income an RR=0.59 (95%CI: 0.10-3.36) was noted. Among children whose mothers had an education level below primary, an RR=0.09 (95%CI: 0.01-0.96) was found, while among those with primary education or higher, an RR=0.38 (95%CI: 0.08-1.89) was registered. For both variables, the interaction term was not very significant (income p=0.15 and education p=0.38). MI training results for professionals after 2 years showed stability in improved responses in consultations with dialogue, showing a statistically significant difference for open questions, reflective listening and the total percent of correct responses (p<0.001), with a effect size (ES=1.12). For the useful answer questionnaire, professionals continued using open questions and reflective listening (p<0.001), maintaining an increase in the percent of responses compatible with MI (p<0.001). The dimensions of the effect size were also considerable (ES=1.33) over the course of time. Conclusions: despite only preliminary results, the findings from this randomized community study show evidence that approaching oral health education based on the principles of Motivational Interviewing was more effective in the reduction of early childhood caries among children in the first year of life from lower income backgrounds and whose mothers have little education when compared to the conventional approach. Further, it was concluded that the training of professional from the oral health team was effective in qualifying them to act according to the concept of Motivational Interviewing, regardless of age, experience and previous professional formation, making MI a viable tool in the practice of Primary Health Care.

O objetivo deste estudo foi comparar diferentes métodos de avaliação de restaurações de resina composta em dentes posteriores, assim como avaliar a concordância intra-examinador. Cento e trinta e seis restaurações oclusais de resina composta foram avaliadas por um examinador treinado usando os critérios modificados do USPHS para avaliar quatro características das restaurações: integridade marginal, forma anatômica, descoloração marginal e textura superficial. Três métodos diferentes foram estudados: clínico, fotográfico e modelos. A reprodutibilidade intra-examinador foi medida através do teste de Kappa e a comparação de métodos através dos testes não-paramétricos de Fischer e Wilcoxon. Os resultados mostraram que os valores de concordância intra-examinador foram melhores na avaliação de integridade marginal e forma anatômica através de modelos, e os valores foram similares entre a avaliação clínica e fotográfica para integridade marginal e descoloração marginal. A textura superficial apresentou os valores mais baixos de concordância intra-examinador para todos os métodos examinados. O método direto foi significantemente diferente que os métodos indiretos para todas as características avaliadas (p< 0,05). Entretanto, quando os métodos foram avaliados segundo a aceitabilidade clínica considerada pelo USPHS, os métodos não foram diferentes. Os métodos fotográfico e modelos detectaram defeitos que não foram percebidos pelo método clínico na avaliação da integridade marginal e da forma anatômica. As avaliações através de fotografias e modelos foram semelhantes em todas as características avaliadas com exceção da textura superficial (p< 0,05). Todos os métodos mostraram ser inadequados para a avaliação de textura superficial. Houve diferenças significativas entre o método direto e os métodos indiretos. Os métodos indiretos permitiram realizar observações mais detalhadas e críticas. Entretanto, o método clínico mostrou ter capacidade para diferenciar entre restaurações clinicamente aceitáveis e não-aceitáveis. / The aim of this study was to compare different methods for evaluating composite resin restorations in posterior teeth and to evaluate the reproducibility of each method by determining the intraexaminer agreement. One hundred and thirty six occlusal composite resin restorations were evaluated by a trained examiner using modified USPHS criteria to assess four restoration characteristics: marginal integrity, anatomic form, marginal discoloration and surface texture. Three different methods were studied: clinical, photographic and dental cast models. Kappa statistics was used to determine reproducibility and non-parametric Friedman and Wilcoxon tests to compare the methods. The results showed that the best intraexaminer agreement values were obtained for dental cast models evaluations for marginal integrity and anatomic form and were similar between photographic and clinical evaluations for marginal integrity and marginal discoloration. Surface texture showed the lowest degree of intraexaminer agreement with all the methods tested. Direct clinical method and the two indirect methods were significantly different for all the characteristics assessed (p< 0.05). However, when they were evaluated according to USPHS clinical acceptability, the methods did not differ. Photographs and dental cast models methods detected defects that the direct clinical method could not distinguish for marginal integrity and anatomic form. Photographs and dental cast models evaluations were similar for all the characteristics assessed, except for surface texture (p< 0.05). All the methods showed that they are not adequate to evaluate surface texture. There were significant differences between the direct clinical method and the indirect methods for all the composite resin restorations characteristics assessed. The indirect methods allowed more detailed and critical observations. However, the direct clinical method was able to distinguish between clinical acceptable and unacceptable restorations.

Les bandes de compression, couramment utilisées pour le traitement de l’insuffisance veineuse, appliquent une pression sur la jambe, appelée pression d’interface, qui est le principe actif du traitement. L'objectif était de mieux comprendre les mécanismes influençant la pression exercée par une bande de compression sur le membre inférieur.En lien avec des médecins et un industriel, l’approche biomécanique proposée était composée d’une part expérimentale (mesures de pression d'interface) et d'une part numérique (modélisation éléments-finis de la pose d'une bande). Deux études préliminaires, expérimentale et numérique, ont montré la limite de l'utilisation de la Loi de Laplace (standard actuel) pour le calcul des pressions d’interface. Ces études ont soulevé des interrogations concernant l'éventuel impact des propriétés de surface des bandes (coefficient de frottement bande-bande) sur la pression. Elles ont aussi montré l’importance des déformations des tissus mous de la jambe induite par l'application de la bande. Deux méthodes de caractérisation mécanique ont donc été mises en place pour l’identification personnalisée des propriétés mécaniques des tissus mous de la jambe et la mesure du coefficient de frottement bande-bande.Un nouvel outil de prédiction des pressions d’interface a été développé grâce à la combinaison de la simulation numérique de la pose d’une bande et de la paramétrisation géométrique de la jambe puis il a été confronté aux mesures expérimentales.Finalement, une étude clinique a été réalisée pour étudier la pression exercée par la superposition de deux bandes de compression (pratique clinique très courante pour le traitement de l'ulcère veineux). / Compression bandages are commonly used for the treatment of chronic venous insufficiency. They apply a pressure onto the leg, called interface pressure, which is one of the key aspects of the treatment. The objective was to better understand the mechanisms impacting interface pressure applied by compression bandage on the lower leg. In collaboration with clinicians and a medical devices manufacturer, a biomechanical approach was proposed. This approach was composed of experimental pressure measurements and the numerical simulation of bandage application. Two preliminary studies, experimental and numerical, showed the limitations of the use of Laplace’s Law (current standard) for interface pressure computation. These studies also questioned the possible impact of bandage surface properties (bandage-to-bandage friction coefficient) on interface pressure. They also showed the need to consider soft tissues deformation induced by bandage application. Two characterization methods were designed for the identification of patient-specific soft tissue mechanical properties and the measurement of bandage-to-bandage friction coefficient. A new methodology for the prediction of interface pressure was developed thanks to the combination of the numerical simulation of bandage application and the leg geometry parametrization. The results were then confronted to experimental measurements. Finally, a clinical study was designed to investigate the pressure applied by superimposed compression bandages (very common in clinical practice for the treatment of venous ulcers).