This study compared the Family Adaptability and Cohesion Evaluation Scales, Second Edition (FACES II) scores of traumatized youth diagnosed with posttraumatic stress disorder (PTSD) to the scores of trauma-exposed youth without PTSD and a non-traumatized comparison group. Child diagnostic interviews determined that all participants were free of additional major comorbid disorders. The FACES II scores of children and adolescents with PTSD were not significantly different from the FACES II scores of trauma-exposed youth without PTSD and the non-traumatized comparison group. FACES II scores were also not significantly different between the trauma-exposed youth without PTSD and the non-traumatized comparison group. Accordingly, PTSD and trauma-exposure without PTSD were not associated with variations in the perception of family functioning as measured by the FACES II. Implications for research and practice are considered.

Introduction: Posttraumatic stress disorder (PTSD) is a disabling psychological disorder that affects about 7% of adults in the United States. PTSD and its symptoms have consistently been shown to have an inverse relationship with exercise participation. The strongest reported associations have been between high intensity exercise, and the hyperarousal and avoidance symptom clusters. Importantly, resistance training (i.e., weight lifting) is thought to have beneficial effects for several conditions that commonly co-occur with PTSD, such as anxiety, depression, and poor sleep quality. However, no studies have examined the effects of high intensity resistance training on PTSD symptoms. Purpose: This study sought to examine the effects of a 3-week high intensity resistance training program on the PTSD hyperarousal and avoidance symptom clusters, sleep quality, anxiety, and depression symptoms in anxious adults who screened positive for PTSD. Additionally, this study explored potential mechanisms of action (e.g., cognitive appraisal, perceived exertion, acute changes in affect, arousal, and distress) between exercise and PTSD. Methods: Thirty trait anxious individuals who screened positive for PTSD were randomly assigned to either a 3-week high intensity resistance training intervention, or a 3-week time-matched attention control group, while blocking for gender. Both groups were required to attend 3 on-site sessions per week, for 3 weeks (i.e., 9 total sessions). Each resistance training session consisted of a 5-minute warm-up, 20 minutes of high intensity resistance training, and a 5-minute cool-down. Each control session consisted of a brief 30-minute educational video on topics not relating to exercise or PTSD. Changes in PTSD symptoms, sleep quality, anxiety and depression were analyzed using repeated measures ANOVA, and potential mechanisms of action were explored with a series of longitudinal mixed-effects regression models. Results: Participants were 73.3% female, with a mean age of 29.1 years (SD = 7.4), and 63.3% identified as a racial minority. Groups did not significantly differ at baseline. There was a Time*Group interaction for hyperarousal symptoms (F = 4.7, p = .04, η2 .18), demonstrating a significantly larger reduction in hyperarousal symptoms for the resistance training group (d = -1.84) relative to the control (d = -1.13). The Time*Group interaction for avoidance symptoms was not significant (F = 1.7, p = .20, η2 = .08); however, the effect size of resistance training was larger (d = -2.71) than the control (d = -1.16). There was a significant Time*Group interaction for sleep quality (F = 4.7, p = .04, η2 = .19), demonstrating greater improvements in global sleep quality for resistance training (d = -1.06) relative to the control (d = -.15). However, there was no significant effect of Time on PTSD-related sleep disturbances (F = 3.0, p = .1, η2 = .13) nor was there a significant Time*Group interaction (F = .09, p = .80, η2 < .01). Similarly, Time*Group interactions for anxiety (F = 3.5, p = .08, η2 = .14) and depressive symptoms (F = 2.7, p = .12, η2 = .11) were not significant. However, resistance training had a large effect on anxiety (d = -.81), and small effect on depression symptoms (¬d = -.41). Regarding the potential mechanisms of action, changes in cognitive appraisal significantly predicted changes in PTSD symptoms during the resistance training intervention (b = 7.1, SE = 2.9, p = .02). Similarly, changes in perceived exertion during exercise was a significant predictor of PTSD symptoms over the 3-week intervention period (b = -3.1, SE = 1.2, p = .01). However, changes in affect, arousal, and distress did not significantly predict changes in PTSD (p’s >.05). Conclusion: This is the first randomized attention-controlled trial testing the effects of high intensity resistance training on PTSD symptoms. The overall results support the hypothesis that resistance training can beneficially affect PTSD symptoms and its commonly co-occurring conditions, such as poor sleep quality. Future adequately powered studies are warranted.

Objective: Some Veterans who recently served in the military report significant psychological problems based on their experiences in the military. Stressors that these Veterans face when they transition out of the military can exacerbate these problems and negatively impact their long-term physical and psychological well-being. We are conducting a randomized controlled trial (RCT) to evaluate the efficacy of providing Veterans who are transitioning back into their civilian communities trained, peer mentorship (Pro Vetus) and membership in a Veteran Support Organization (VSO- Team Red, White, and Blue) to reduce transition stressors, maintain psychological and physical health, reduce suicides and reduce criminal incidents. Method: Six hundred, New York City area Veterans who transitioned out of the military since 2002 will be randomized to one of three study arms (1. Team Red, White and Blue membership plus trained, peer Pro Vetus mentorship; 2. Team Red, White, and Blue membership; and 3. Waitlist control). Intent-to-treat analysis will compare changes in transition stressors (proximal measures) as well as psychological and physical health, suicide, and criminal incidents (distal measures). For this preliminary investigation of the full RCT, the results of 58 Veterans who completed the pre-intervention and post-intervention were analyzed. For the analysis, the first and second study arms were combined into one intervention arm because of the unbalanced nature of the arms. Results: The preliminary results indicate that Veterans in the combined intervention arm experienced less transition difficulties and had higher levels of social support at the four month post-intervention assessment. Though promising, there are still extensive limitations to the inferences that can be drawn from this research. These limitations will be reduced as data points increase and more Veterans participate in the research study. Keywords: Veterans, transition, peer mentorship, Veteran Support Organization, PTSD, suicide

This study compared the Family Adaptability and Cohesion Evaluation Scales, Second Edition (FACES II) scores of traumatized youth diagnosed with posttraumatic stress disorder (PTSD) to the scores of trauma-exposed youth without PTSD and a non-traumatized comparison group. Child diagnostic interviews determined that all participants were free of additional major comorbid disorders. The FACES II scores of children and adolescents with PTSD were not significantly different from the FACES II scores of trauma-exposed youth without PTSD and the non-traumatized comparison group. FACES II scores were also not significantly different between the trauma-exposed youth without PTSD and the non-traumatized comparison group. Accordingly, PTSD and trauma-exposure without PTSD were not associated with variations in the perception of family functioning as measured by the FACES II. Implications for research and practice are considered.

O químico e escritor italiano Primo Levi (1919-1987), sobrevivente de Auschwitz, construiu um dos testemunhos mais importantes da segunda metade do século XX. Esta pesquisa tem como desígnio maior converter algumas questões que aparecem em duas de suas autobiografias mais impactantes sobre o campo de extermínio É isso um Homem? e Os Afogados e os Sobreviventes em problemas de caráter sociológico, na tentativa de contribuir na seara de investigações aberta pelos depoimentos desse intelectual ítalo-judeu. Gostaria de interpretar seu testemunho como fonte documental, em que seja possível apreender aspectos informativos de denúncia, rastros de dor, violência e morte que assinaram com sangue nossa era. Assim, em um primeiro momento, busco dar voz e espaço à memória de Levi e à sua narração sobre o cotidiano das agressões no Lager, a sociabilidade comum àquele ambiente infernal, os tipos humanos ali dispostos e a dificuldade de comunicação surgida em função da violência descomedida e do rebaixamento de alguns à condição de escravos. A partir disso, passo a tecer algumas reflexões sobre seu testemunho, explorando, principalmente, o chão aporético sobre o qual ele se desenvolveu: fragmentado, lacunar, impossível em sua inteireza, mas absolutamente necessário. Tentarei verificar, nessa medida, os limites na construção do testemunho da barbárie e as possibilidades encontradas por Primo Levi na representação e transmissão da experiência vivida. Afinal, qual o potencial do testemunho na geração de novos conhecimentos sobre esse evento traumático que foi Auschwitz? E em que medida a obra-testemunho de Levi pode ser tida como instrumento de transmissão de experiência e conhecimento sobre esse passado? Tais questões são importantes porque pensar o testemunho de Primo Levi a partir de um conjunto de elementos que encontra na noção de memória seu eixo decisivo faz do testemunho não apenas um objeto de análise histórica, mas, ainda, fonte privilegiada para refletir sobre violências em outros contextos. / The Italian writer and chemist Primo Levi (1919-1987), survivor of Auschwitz, created one of the most important testimonies of the second half of the twentieth century. In this research, my aim is to convert some of the questions that appear in two of his most striking autobiographies about the extermination camp Survival in Auschwitz and The Drowned and the Saved in problems of sociological character, attempting to contribute to the field of investigations opened by the testimonies of the Jewish-Italian intellectual. I wish to interpret his testimony as a documentary source, where it is possible to apprehend informative aspects of denunciation, traces of pain, violence and death things that have signed our era with blood. Thus, in the first moment, I seek to give voice and space to the memory of Levi and to his narration about the daily aggressions in the Lager, the usual sociability in that hellish place, the human types who were striving there, and the difficulty in communication emerged as a result of the immense violence and the relegation of some people to the slave condition. From this point, I get to make some reflections about his testimony, exploring mainly the aporetic groundings on which it developed: being fragmented, incomplete and impossible in its entirety, but absolutely necessary. In these terms, I will try to verify the limits to the construction of a testimony of the barbarism and the possibilities found by Primo Levi in the representation and transmission of his experience. After all, I question about the potential of the testimony to generate new knowledge about such a traumatic event as Auschwitz has been. I also question to which extent Primo Levi\'s testimonial work can be taken as a mechanism for transmitting the experience and knowledge about that past. These questions are important because to address Levis testimony parting from a set of elements that find in the notion of memory its decisive axis makes the testimony not only an object of historical analysis, but also a prime source to reflect on violence in other contexts.

Objetivo: Avaliar a eficácia da Terapia Cognitiva Processual na melhora de pacientes com Transtorno de Estresse Pós-traumático. Desenho do estudo - Estudo randomizado, com dois grupos paralelos. Intervenções - Dois modelos de Terapia Comportamental Cognitiva - Terapia Cognitiva Processual e Exposição (os pacientes receberam tratamento farmacológico). Duração e frequência: Após a avaliação inicial (semana 00), as sessões de psicoterapia tiveram frequência semanal, durante onze semanas, e quinzenais nas quatro últimas semanas, totalizando 13 (treze) sessões. As sessões de psicoterapia duraram 1 (uma) hora. Os pacientes foram reavaliados após três meses. Número de participantes: Amostra de conveniência envolvendo 86 pacientes; 42 no grupo de Exposição e 44 no grupo de Terapia Cognitiva Processual. Resultados e Conclusão: Os dois grupos melhoraram, porém melhoras nos sintomas de TEPT não foram estatisticamente significantes entre os grupos (p > 0,1), assim como para sintomas depressivos e ansiosos (p > 0,2). Estes resultados sugerem que a Terapia Cognitiva Processual é tão eficaz quanto a Terapia de Exposição padrão-ouro / Objective: To evaluate the efficacy of Trial-Based Cognitive Therapy in the improvement of patients with posttraumatic stress disorder. Study design - Randomized study with two parallel groups. Interventions - Two Models of Cognitive Behavioral Therapy - Trial-Based Cognitive Therapy (TBCT) and Exposure (patients received pharmacological treatment). Duration and frequency: After the initial assessment (week 0), psychotherapy sessions were held weekly for eleven weeks and twice a week for four weeks, a total of thirteen (13) sessions. Psychotherapy sessions were one (1) hour long. Patients were reassessed after three months. Total Duration: 13 sessions of treatment and three months follow-up. Number of Participants: Convenience sample involveing 86 patients, 42 in the exposure group and 44 in the TrialBased Therapy group. Results and Conclusion: Both groups improved, but improvements in the symptoms of PTSD depression and anxiety were not statistically significant among the two treatment groups (p > 0.1; p > 0.2). These results suggest that Trial-Based Cognitive Therapy is as effective as the gold standard Exposure

Submitted by admin tede (tede@pucgoias.edu.br) on 2018-05-03T13:18:42Z No. of bitstreams: 1 GEYSE CHRYSTINE PEREIRA SOUZA FERNANDES.pdf: 1016215 bytes, checksum: c945ea694c1550a64eecbe5e576496c3 (MD5) / Made available in DSpace on 2018-05-03T13:18:42Z (GMT). No. of bitstreams: 1 GEYSE CHRYSTINE PEREIRA SOUZA FERNANDES.pdf: 1016215 bytes, checksum: c945ea694c1550a64eecbe5e576496c3 (MD5) Previous issue date: 2018-03-12 / Objective: To analyze the correlation between musculoskeletal symptoms and the quality of life of primary school teachers in Guanambi, Bahia. Methods: This is an analytical cross-sectional study with a quantitative approach. The research was carried out with 52 elementary school teachers from the municipality of Guanambi / BA. The following instruments were used: Occupational sociodemographic questionnaire, Nordic Osteomuscular Symptom Questionnaire (QNSO), Quality of Life Assessment Tool - WHOQOL-Bref. Results: The occupational sociodemographic profile showed a predominance of females (96.2%), the majority (88.5%) with a workday of 40 hours per week and with 92.3% having a postgraduate degree. A total of 96.2% understood that their work is at risk to health and 65.4% said that they tire frequently. There was a high prevalence of musculoskeletal symptoms (84.6%), mainly in four parts of the body: knee, lumbar spine, shoulder and neck. Also the departures were due to these same parts. In the statistical analysis of the musculoskeletal symptoms in correlation with the occupational sociodemographic profile, there was a significant relation between the distance and feeling tired at work (p = 0.04), showing that the more the feeling of fatigue was the distance of musculoskeletal problems. In Whoqol-bref the total quality of life (3.64 ± 0.29), the perception of quality of life (3.75 ± 0.44) and personal satisfaction (3.48 ± 0.80) presented good averages with a higher score in the psychological domain (4.74 ± 0.42) and lower in the environmental domain (3.71 ± 0.35). Total quality of life presented a better score, in which they reported receiving from four to six minimum wages (p = 0.03), for those who believe that their work environment poses health risks (p = 0.03), in those who reported not to get tired in the work environment (p <0.001) and in those who practiced physical activity (p = 0.020). Total quality of life and physical domain were affected in all results correlating with musculoskeletal symptoms. Conclusion: Musculoskeletal symptoms directly affect the quality of life of primary school teachers in the municipality of Guanambi. / Objetivo: Analisar a correlação entre os sintomas osteomusculares e a qualidade de vida de professores do ensino fundamental da rede pública da cidade de Guanambi, Bahia. Métodos: Trata-se de estudo transversal analítico com abordagem quantitativa. A pesquisa foi realizada com 52 professores do ensino fundamental do município de Guanambi/BA. Foram utilizados os seguintes instrumentos: Questionário sociodemográfico ocupacional, Questionário Nórdico de Sintomas Osteomusculares (QNSO), Instrumento de avaliação da qualidade de vida – WHOQOL-Bref. Resultados: O perfil sociodemográfico ocupacional demonstrou predominância do sexo feminino (96.2%), a maioria (88,5%) com jornada de trabalho de 40 horas semanais e com 92,3% possuindo pós-graduação. Um total de 96,2% entendeu que seu trabalho tem risco à saúde e 65,4% afirmou que se cansa com frequência. Houve alta prevalência de sintomas osteomusculares (84,6%), principalmente em quatro partes do corpo: joelho, coluna lombar, ombro e pescoço. Também os afastamentos foram devido à essas mesmas partes. Na análise estatística dos sintomas osteomusculares em correlação ao perfil sociodemográfico ocupacional houve relação significativa entre o afastamento e se sentir cansado no trabalho (p = 0,04), evidenciando que quanto mais o sentimento de cansaço maior foi o escore de afastamento por problemas osteomusculares. No Whoqol-bref a qualidade de vida total (3,64 ±0,29), a percepção da qualidade de vida (3,75 ±0,44) e a satisfação pessoal (3,48 ±0,80) apresentaram boas médias com maior escore no domínio psicológico (4,74±0,42) e menor no domínio ambiental (3,71±0,35). A qualidade de vida total apresentou melhor escore, nos que afirmaram receber de quatro a seis salários mínimos (p = 0,03), para os que entendem que seu ambiente laboral possui riscos à saúde (p = 0,03), naqueles que referiram não se cansar no ambiente de trabalho (p < 0,001) e nos que praticavam atividade física (p = 0,020). A qualidade de vida total e o domínio físico foram afetados em todos os resultados de correlação com os sintomas osteomusculares. Conclusão: Os sintomas osteomusculares afetam diretamente a qualidade de vida dos professores do ensino fundamental do município de Guanambi.

O objetivo deste estudo longitudinal foi avaliar os fatores associados à necessidade de exodontia de incisivos centrais superiores decíduos traumatizados. Os dados foram coletados por um único examinador por meio de exame de fotografias, radiografias e informações presentes nos prontuários de 1734 pacientes atendidos na clínica do Centro de Pesquisa e Atendimento de Traumatismo em Dentes Decíduos da Disciplina de Odontopediatria da Faculdade de Odontologia da Universidade de São Paulo, entre os anos de 1998 e 2009. O critério utilizado para a inclusão do prontuário no estudo foi a presença de fotografias e/ou radiografias que comprovassem a presença de incisivos centrais superiores permanentes erupcionados ou em processo de erupção, onde os incisivos centrais decíduos não estivessem mais presentes na cavidade oral. Foram avaliados 521 prontuários de pacientes e 988 incisivos centrais superiores decíduos traumatizados. A unidade experimental para o estudo foi o dente. Três desfechos foram analisados: exodontia devido ao traumatismo dental em si, exodontia por sinais de infecção e exodontia por retenção prolongada. Todos os desfechos foram comparados aos incisivos centrais superiores decíduos que apresentaram exfoliação fisiológica. As variáveis independentes foram divididas em grupos: relacionadas à criança, ao traumatismo e ao dente. Os dados foram tabulados e a análise de Regressão de Poisson foi realizada para avaliar a associação entre as variáveis. O dente apresentar luxação lateral (RR=4,73; 2,06 10,98), intrusiva (RR=4,18; 1,74 10,07) ou extrusiva (RR=9,57; 4,22 21,67), trauma com envolvimento pulpar (RR=17,89; 8,02 39,88) ou fratura radicular (RR=2,74; 1,06 7,07), além de trauma com envolvimento de mais de 2 dentes (RR=1,33; 1,12 1,57) foram positivamente associadas à necessidade do dente traumatizado ter exodontia em decorrência do traumatismo dental. O dente com trauma de alta severidade (RR= 1,75; 1,05 2,93) e apresentar sinais de necrose pulpar (RR=25,86; 13,4 49,6) foram fatores positivamente associados à necessidade de exodontia por sinais de infecção. Por outro lado, a presença de tratamento endodôntico (RR=0,50; 0,34 0,74) e de restauração (RR=0,33; 0,11 0,99) foram fatores negativamente associados ao mesmo desfecho. O dente ter recebido tratamento endodôntico (RR=3,04; 1,97 4,69) foi positivamente associado a necessidade de exodontia por retenção prolongada, enquanto ter apresentado uma luxação lateral ou extrusiva (RR=0,27; 0,74 0,96) e apresentar espaço pericementário aumentado (RR=0,45; 0,21 0,95) foi negativamente associado. Conclui-se que a luxação lateral, intrusiva e extrusiva, fraturas com exposição pulpar, fratura radicular e o envolvimento de mais de 2 dentes aumentam a probabilidade de exodontia devido ao traumatismo dental em si. A exodontia por sinais de infecção está associada a traumas severos e o desenvolvimento de sinais de necrose pulpar. No entanto, a realização de tratamentos conservadores como endodontia e restauração podem evitar a exodontia precoce do dente decíduo. O tratamento endodôntico aumenta a possibilidade do dente necessitar de exodontia por retenção prolongada. / The purpose of this historical cohort study was to evaluate factors associated with the necessity of extraction of traumatized deciduous central incisors. Data were collected by a single examiner by taking photographs, radiographs and present information in the medical records of 1734 patients seen at the Research and Clinical Center of Dental Trauma in Primary Teeth of the School of Dentistry of the University of São Paulo, from 1998 to 2009. The criterion for inclusion in the study of medical records was the presence of photographs and / or X-rays showing the presence of central incisors erupted or in eruption process, where the deciduous central incisors already are no longer present in the oral cavity. It was evaluated records of 521 patients and 988 traumatized deciduous maxillary central incisors. The experimental unit for the study was the tooth. Three outcomes were analyzed: extraction as a result of the trauma in itself, extraction as a result of signs of infection, and extraction after prolonged retention. All the outcomes were compared to upper deciduous central incisors that had physiological exfoliation. The independent or explanatory variables were divided into groups: related to the patient, to the trauma, and to the tooth. Data were tabulated and analyzed using Poisson regression to assess the relationship between the variables. Having suffered a trauma with displacement (RR=4,73; 2,06 10,98), intrusive (RR=4,18; 1,74 10,07) or extrusive (RR=9,57; 4,22 21,67), with pulp involvement (RR=17,89; 8,02 39,88) or root fracture (RR=2,74; 1,06 7,07), in addition to trauma with more than two teeth affected (RR=1,33; 1,12 1,57), were positively associated to the risk of tooth extraction as a result of trauma. For the loss by infection, the element having suffered trauma (RR= 1,75; 1,05 2,93) and developing high-severity pulp necrosis (RR=25,86; 13,4 49,6) were positively associated with risk of tooth extraction. On the other hand, having undergone endodontic treatment (RR=0,50; 0,34 0,74) and restoration (RR=0,33; 0,11 0,99) factors were negatively associated with the same outcome. Having undergone endodontic treatment (RR=3,04; 1,97 4,69) was positively associated with the necessity of extraction after prolonged retention, whereas a lateral or extrusive displacement (RR=0,27; 0,74 0,96) and presenting an increased pericementary space (RR=0,45; 0,21 0,95) was negatively associated with the same outcome. It is concluded that lateral displacement, intrusive and extrusive, fractures with pulp involvement, root fracture and having more than 2 teeth involved increase the possibility of extraction as a result of the trauma by itself. Moreover, loss by infection is associated with severe traumas and the development of pulp necrosis, whereas undergoing conservative treatments, such as endodontic treatment and restoration may avoid early extraction of the deciduous tooth, and endodontic treatment increases the possibility of extraction by prolonged retention.

O objetivo dessa revisão sistemática foi avaliar a prevalência de traumatismo em dentes decíduos, analisando fatores associados e possíveis tendências em relação à ocorrência desse agravo. Assim, busca com termos relacionados ao trauma dental e à dentição decídua foi realizada. Após critérios de inclusão e exclusão, os artigos selecionados foram analisados. Meta-análises com os dados de prevalência de traumatismo em dentes decíduos no mundo, e em subgrupos (classificações, dentes e idades avaliadas), assim como no Brasil e em suas regiões foram realizadas, complementadas pela análise da tendência do agravo nessas populações. Além disso, meta-análise com os valores de Odds Ratio (OR) e Intervalo de Confiança (IC) das variáveis sexo, idade, maloclusões, renda e escolaridade materna foram realizadas. A busca foi realizada para artigos que relatavam trauma dental em dentes decíduos indexados no PubMed até o dia 18 de abril de 2012 e listou 953 artigos. Após critérios de inclusão e exclusão, 34 (3,6%) estavam relacionados ao escopo dessa revisão sistemática. A prevalência agregada de traumatismo em dentes decíduos no mundo é de 23% e apresenta tendência discreta de aumento. No grupo de estudos que utilizaram classificações que avaliam trauma periodontal, a prevalência agregada é de 26% com tendência de aumento, enquanto que no grupo de estudos que utilizam classificações que não contemplam esse tipo de trauma, a prevalência agregada diminui para 20%, assim como a tendência passa a ser de diminuição da prevalência. O grupo de estudos que analisou todos os dentes anteriores apresenta prevalência agregada de 25%, enquanto que os que avaliaram apenas dentes anteriores superiores e apenas incisivos apresentam 17% e 23%, respectivamente. A meta-análise do grupo de estudos que avaliou faixas etárias maiores que um ano apresentou prevalência agregada de 23%. São fatores positivamente associados a prevalência de traumatismo em dentes decíduos: ser do sexo masculino (OR=1,20;IC:1,09;1,33), ter quatro anos (OR=2,18;IC:1,66;2,86), apresentar mordida aberta anterior (OR=2,26;IC:1,38;3,70), sobressaliência acentuada (OR=2,51;IC:1,66;3,79), incompetência labial (OR=1,66;IC:1,26;2,20), a família ter renda superior a oito salários mínimos (OR=0,79;IC:0,69;0,92) e a mãe ter mais de oito anos de estudo (OR=1,30;IC:1,01;1,66). A prevalência agregada de traumatismo em dentes decíduos no Brasil é de 26% e apresenta tendência de aumento com os anos. A região sudeste e sul apresentam prevalência agregada em torno de 29% e 31%, respectivamente, com tendência de aumento, enquanto a região nordeste apresenta 19% com tendência de diminuir a prevalência com o passar dos anos. Podemos concluir que por volta de 23% dos pré-escolares apresentam traumatismo em dentes decíduos sendo que ser do sexo masculino, ter mais idade, apresentar mordida aberta anterior, sobressaliência acentuada, incompetência labial, a família ter renda superior a oito salários mínimos e a mãe ter mais de oito anos de estudo são fatores que aumentam a chance do agravo estar presente. Além disso, a utilização de classificações que contemplam todos os tipos de trauma dental, avaliar dentes anteriores superiores e inferiores em faixas etárias amplas parece contribuir para resultados mais realistas quando o objetivo é estudar o comportamento do traumatismo em dentes decíduos. / The aim of this systematic review was to evaluate the prevalence of dental trauma in deciduous teeth, assessing associated factors and possible trends concerned to the occurrence of this disorder. For this purpose, search for terms related to dental trauma and deciduous dentition was performed. Upon considering inclusion and exclusion criteria, the selected material was analyzed. Afterwards, meta-analysis was performed based on the data recorded on the prevalence of dental trauma in deciduous teeth worldwide and in subgroups (classifications, teeth and ages assessed) as well as in Brazil and its regions, complemented by the trend analysis of this injury. Meta-analysis with Odds Ratio (OR) and Confidence Interval (CI) values of variables as sex, age, malocclusions, income and maternal level of education was performed. Literature search was carried out for articles reporting on dental trauma prevalence in deciduous teeth indexed in PubMed up to April 18, 2012, and listed 953 articles. Upon analyzing the studies for inclusion and exclusion purposes, 34 (3,6%) essays were related to the scope of this systematic review. The pooled prevalence of trauma in deciduous teeth worldwide is 23% showing a slight tendency to increase over the years. The study group that used classifications which evaluate traumas in the supportive tissue showed a pooled prevalence of 26% with a trend to increase, while in the study group which adopt classifications that do not contemplate this type of trauma, the pooled prevalence decreases to 20%, with a trend to decrease over the years. The study group which analyzed all anterior teeth demonstrated a pooled prevalence of 25%, while the study group which evaluated only anterior upper teeth and only incisors evidenced 17% and 23%, respectively. The meta-analysis of the study group that evaluates age range greater than 1 year showed pooled prevalence of 23%. The following factors are positively associated to the prevalence of traumatism in deciduous teeth: male individuals (OR=1.20;CI:1.09;1.33), older individuals (OR=2.18;CI:1.66;2.86), patients presenting anterior open-bite (OR=2.26;CI:1.38;3.70), increased overjet (OR=2.51;CI:1.66;3.79), lip incompetence (OR=1.66;CI:1.26;2.20), family with income higher than eight minimum wages (OR=0.79;CI:0.69;0.92), mother\'s education level having more than eight years at school (OR=1.30;CI:1.01;1.66). The pooled prevalence of trauma in deciduous teeth in Brazil is 26% and presents tendency to increase. The Southeast and South regions of Brazil present pooled prevalence of 29% and 31% respectively, showing a trend to increase, while the Northeast region shows 19% with a trend to decrease over the years. In conclusion, around 23% of the preschoolers present trauma in deciduous teeth, and that being male, older, with anterior open bite, increased overjet, lip incompetence, family with income higher than eight minimum wages and mother\'s education level having more than eight years at school are factors which may increase the chance this injury be present. Moreover, the use of classifications that contemplate all types of dental trauma, to evaluate upper and lower anterior teeth within large age range seems to contribute to more realistic results when the objective is to study the behavior of dental trauma in deciduous teeth.

O objetivo desse estudo de coorte histórico foi avaliar o traumatismo dental em incisivos superiores decíduos e fatores associados à ocorrência de necrose pulpar em incisivos centrais superiores decíduos traumatizados. Os dados foram coletados por um único examinador através de exame de fotografias, radiografias e informações presentes nos prontuários dos pacientes atendidos no Centro de Pesquisa e Atendimento de Traumatismo em Dentes Decíduos da Disciplina de Odontopediatria da Faculdade de Odontologia da Universidade de São Paulo entre os anos de 1998 e 2009. O critério utilizado para a inclusão do prontuário no estudo foi a existência de fotografias e/ou radiografias que comprovassem a presença de incisivos centrais permanentes erupcionados, em processo de erupção ou com incisivos superiores decíduos próximos a esfoliação. Foram avaliados 521 prontuários e em relação aos dados de traumatismo, a maioria dos pacientes pertencia ao gênero masculino, com história de trauma dental antes dos três anos de idade e 23% das crianças possuíam alterações oclusais anteriores predisponentes ao traumatismo dental. A queda da própria altura seguida de traumatismo dental contra o chão foi a etiologia dominante; os incisivos centrais foram os dentes mais acometidos; os traumas periodontais os mais prevalentes e 57% dos pacientes procuraram o atendimento no Centro de Trauma em Dentes Decíduos no mínimo 30 dias após o traumatismo. Para o estudo da necrose pulpar foram avaliados 727 incisivos centrais superiores decíduos traumatizados. Os sinais considerados na classificação do dente necrosado foram: presença de alteração no tecido gengival (fístula ou abscesso) e presença de lesão periapical. A incidência de necrose pulpar foi de 22,6%; 10% do total de dentes da amostra necrosaram no intervalo de 6 meses, correspondendo 45% do total de dentes necrosados. A análise de regressão de Poisson multivariada indicou como fatores de risco para a necrose pulpar o relato de dor (RR = 1,73; 1,22 2,45), trauma do tecido duro envolvendo dentina (RR = 1,74; 1,15 2,62), trauma do tecido duro com exposição pulpar (RR =4,55; 2,80 7,40), trauma ósseo (RR = 2,56; 1,08 6,08), alteração de cor marrom (RR = 1,82; 1,27 2,61), alteração de cor cinza (RR = 2,24; 1,48 3,41), reabsorção externa com infecção apical (RR = 4,89; 3,36 7,18), reabsorção externa com infecção apical e lateral e/ou cervical (RR = 5,05; 3,53 7,22) e reabsorção externa com infecção lateral e/ou cervical (RR = 5,66; 3,59 8,90). A presença de calcificação pulpar (RR = 0,45; 0,28 0,73) e reabsorção externa com formação óssea (RR =0,62; 0,47 0,83) foram fatores de proteção para a necrose pulpar. Conclui-se que trauma ósseo concomitante ao traumatismo dental, trauma dos tecidos duros dos dentes envolvendo dentina ou com exposição pulpar, relato de dor pela criança durante o período de acompanhamento clínico, alteração de cor cinza ou marrom reabsorção externa com infecção da raiz são fatores que aumentam o risco de necrose pulpar. Além disso, presença de calcificação pulpar e reabsorção externa com formação óssea podem ser fatores de proteção para a ocorrência de necrose pulpar. / The purpose of this historical cohort study was to assess dental trauma in primary upper incisors and factors associated with the occurrence of pulp necrosis in traumatized primary upper central incisors. Data was collected by a single examiner through the analysis of photographs, radiographs, and information contained in the clinical files of patients who attended the Center for Research and Treatment of Dental Trauma in Primary Teeth of the School of Dentistry of the University of São Paulo between the years of 1998 and 2009. The inclusion criteria used was that the clinical file had to have photographs and radiographs which could confirm the presence of exfoliating primary incisors, erupting or erupted permanent upper central incisors. Five hundred and one clinical files were assessed to analyze dental trauma data, the majority of the patients was male and presented with a history of dental trauma that had occurred before they were 3 years old. Twenty three percent of the children had occlusal alterations which might have predisposed them to dental trauma. Dental trauma as a consequence of falling down (from their own height) on the floor was the main etiological factor found; central incisors were the most commonly affected teeth, periodontal trauma was the most prevalent and 57% of the patients sought treatment at the Center for Dental Trauma in Primary Teeth at least 30 days after the trauma had occurred. For the pulp necrosis study, 727 traumatized primary upper central incisors were assessed. The signs considered as indicators of necrosis were: presence of alteration in gingival tissue (fistula or abscess) and presence of periapical lesion. The incidence of pulp necrosis was of 22.6%; 10% of the total of teeth in the sample had suffered necrosis within an interval of 6 months after trauma, corresponding to 45% of the total of necrosed teeth. Poisson multivariate regression analysis indicated the following risk factors for pulp necrosis: reported pain (RR = 1.73; 1.22 2.45), dental hard tissue trauma involving dentin (RR = 1.74; 1.15 2.62), dental hard tissue trauma causing pulp exposure (RR = 4.55; 2.80 7.40), bone trauma (RR = 2.56; 1.08 6.08), brown color alteration (RR= 1.82; 1.27 2.61), grey color alteration (RR= 2.24; 1.48 3.41), external root resorption with apical infection (RR = 4.89; 3.36 7.18), external root resorption with apical infection and lateral and/or cervical (RR = 5.05; 3.53 7.22), and external root resorption with lateral and/or cervical infection (RR = 5.66; 3.59 8.90). The presence of pulp calcification (RR = 0.45; 0.28 0.73) and external root resorption with bone formation (RR =0.62; 0.47 0.83) were protective factors against pulp necrosis. It was concluded that bone trauma occurring simultaneously to dental trauma, dental hard tissue trauma involving dentin or with pulp exposure, pain report from the children during the period of clinical follow-up, brown or grey color alteration, and external root resorption with apical infection are factors which increase the risk for pulp necrosis. Moreover, the presence of pulp calcification and external root resorption with bone formation could be protective factors against the occurrence of pulp necrosis.