Our current ability to identify and appropriately treat infants who are at risk for developing various handicapping conditions is limited. Thus, research aimed at developing early diagnostic techniques and differential intervention programs for infants at risk for handicaps needs further attention. The purpose of this study was to determine if infants who suffered perinatal intraventricular hemorrhage and who received routine medical care plus sensorimotor intervention between 3 and 12 months of age, differed from similar infants who received only routine medical care. Twenty-four subjects (10 experimental and 14 control) who were patients in neonatal intensive care at University of Utah or Primary Children's Medical Centers constituted the study sample. Descriptive data specific to the birth and perinatal period were obtained on the infant and its mother. All infants were evaluated with the Battelle Developmental Inventory at 3 and 12-months corrected age. In addition, the Carey Infant Temperament Questionnaire was completed by the parent when the infant was 6 to 9 months corrected age, and the Parenting Stress Index was completed when the infants was 12 months corrected age. Experimental subjects and their parent(s) participated in an individualized sensorimotor intervention program, directed by a licensed physical therapist, for 1 hour per week on a bi-monthly basis. Parents reported spending an average of 20 minutes per day, 5 days per week, working on exercises with their infant at home throughout the 9- month program. A statistically significant positive relationship was found between developmental outcome and participation in sensorimotor intervention , as measured by the posttest Battelle. No significant differences between groups were found on levels of parenting stress. On each of the measures, stress levels were moderate. Continued enrollment and annual follow-up of subjects in the current study will allow for longitudinal evaluation of the effects of early sensorimotor intervention on development.

É sabido que o paciente com doença renal crônica que tem um acompanhamento nefrológico precoce apresenta melhores condições clínicas e melhor prognóstico ao entrar em diálise. Porém o acompanhamento precoce pelo nefrologista melhora também o enfrentamento psíquico da doença e do tratamento? Foram estudados 39 pacientes com insuficiência renal estágio 5 no momento em que entravam em hemodiálise: 19 pacientes com acompanhamento por nefrologista 6 meses (Grupo 1) e 20 pacientes sem qualquer acompanhamento nefrológico prévio (Grupo 2). Todos os pacientes participaram de entrevista semiestruturada, composta por 17 questões abordando informações, crenças, expectativas e fantasias relacionadas à doença e ao tratamento. As respostas foram decompostas em categorias através da técnica da Análise de Conteúdo. Os dados demográficos e laboratoriais também foram coletados. A classe socioeconômica foi avaliada e classificada como baixa, média ou alta. Na análise estatística foram utilizados o teste de Fisher, do Quiquadrado, t de Student ou de Wilcoxon como apropriado e os resultados apresentados como média ± DP. O grupo 1 foi seguido por 26 ± 20 meses. Em ambos os grupos a maioria dos pacientes pertencia à classe baixa e era do sexo masculino. Os pacientes do grupo 2 eram mais jovens e apresentavam piores parâmetros laboratoriais (p <0,05). Também os aspectos psicológicos foram semelhantes nos 2 grupos: 63% dos pacientes do grupo 1 e 55% do grupo 2, disseram que tinham informações anteriores sobre a diálise; 42% no grupo 1 e 40% no grupo 2, disseram pouco entender o que o médico falava; 74% no grupo 1 e 85% no grupo 2 acreditam que seus rins voltariam a funcionar. Em ambos os grupos, 25% tinham expectativas ruins sobre voltar a trabalhar, e 60% sentiam atitudes negativas da família. O acompanhamento com o nefrologista minimiza as complicações clínicas e laboratoriais dos pacientes com insuficiência renal estágio 5, porém não é suficiente para minorar o impacto psicológico da entrada em hemodiálise. A atenção do nefrologista deve ir além dos aspectos clínicos. É necessário que o paciente seja adequadamente informado sobre sua doença e tratamento. Principalmente os pertencentes a uma classe social baixa como os estudados o apoio de uma equipe interdisciplinar pode ser de grande valia. / It is well known that patients with chronic renal failure (CRF) who are early on referred to a nephrologist have less clinical complications of the disease and a better outcome on chronic dialysis. But can early referral also improve the psychological burden of starting chronic dialysis? Thirty-nine ESRD patients initiating dialysis were studied: 19 patients had a Nephrology followup 6 months and 20 patients had no referral to nephrologist, starting dialysis on emergency situation. All patients participated in a semi-structured interview with 17 questions covering the perceived knowledge, beliefs, expectations and fantasies related to the disease and dialysis. The answers were decomposed in categories through the technique of content analysis. Demographic and laboratorial data at dialysis initiation were also collected. The socioeconomic position was evaluated and the patient was classified in one of 3 categories: low, middle or high. Categorical data were analyzed by Fishers or Chisquare statistical tests and continuous data by t or Wilcoxon tests as appropriate. The results are presented as mean ± SD. Group1 had been followed for 26 ± 20 months. In both groups the majority of patients were classified as low socioeconomic position and were males. Group 2 was younger and had worse laboratorial parameters (p<0.05). Also regarding the psychological aspects both groups were similar: 63% patients of group 1 and 55% of group 2 said they had no previous information about dialysis, and 42% in group 1 and 40% in group 2 said they didn\'t completely understand what the doctor said; 74% in group 1 and 85% in group 2 believed that their kidneys would work again; 25% in both groups had bad expectations about being able to work again , and 60% in both groups felt there was a negative attitude of the family toward them. Nephrology care of CRF patients mitigates clinical complications. However, on its own, it is not enough to minimize the psychological impact of the entering dialysis. Nephrology care must go beyond clinical care. The patients need to be well informed about the disease and treatment, especially patients like ours who came from low socioeconomic position. This kind of patients should be supported by an interdisciplinary team.

Apical periodontitis is an inflamatory process reported by literature in a prevalence that range from 39% to 83%, depending on the sample studied. The inflammatory process represents and infectious focus that may cause systemic manifestations. Many patients can t identify it, and health professionals may have difficulty in realizing an early diagnostic since this process may be silent. Therefore the objectives of this study ware to evaluate clinical signs and the prevalence of asymptomatic apical periodontitis, through a convenience sample. 146 patients with apical periodontitis were selected, and then answered to a questionnaire. After the data was collected, it was found that the prevalence of patients with asymptomatic apical periodontitis was 57.53%. The analysis of logistical regression was used to evaluate the association between the outcome and possible predictors. The variables that presented a value of p≤0, 20 in univariate analysis were selected and in the adjusted model were kept only the ones that presented a value of p≤0,05. Patients without cavities in their teeth have a odds ratio 2.45 times bigger of not mentioning any painful symptomatology (OR: 2.45 IC: 1.08 5.54); patients that related a response to the vertical percussion test have a 86% lesser odds ratio of not perceiving pain in the dental element (OR: 0.14 IC: 0.06 0.33); smoking patients have a chance 3.96 times bigger of not relating any painful symptomatology (OR: 3.96 IC: 1.09 14.38). It can be concluded that a set of evaluations may provide an early diagnostic and a better interpretation from the patient, reducing the prevalence of apical periodontitis / A periodontite apical é um processo inflamatório cuja a prevalência relatada na literatura varia de 39% a 83% dependendo da amostra estudada. O processo inflamatório representa um foco infeccioso que pode causar manifestações sistêmicas. Muitos pacientes não o identificam e profissionais da saúde podem ter dificuldade de realizar o diagnóstico precoce já que este processo poderá ser silencioso. Portanto os objetivos deste estudo foram avaliar sinais clínicos e sintomas e a prevalência de periodontite apical assintomática, através de uma amostra de conveniência. 146 pacientes com periodontite apical foram selecionados, e em seguida responderam a um questionário. Após a coleta de dados, constatou-se que a prevalência de pacientes com periodontite apical assintomática foi de 57.53%. A análise de regressão logística foi utilizada para avaliar a associação entre o desfecho e possíveis preditores. Foram selecionadas variáveis que apresentaram valor de p≤0,20 na análise univariada e foram mantidas no modelo ajustado somente as que apresentaram um valor de p≤0,05. Pacientes sem cárie no dente tem uma razão de chance 2.45 vezes maior de não ter relatado sintomatologia dolorosa (OR: 2.45 IC: 1.08 5.54); pacientes que relataram resposta ao teste de percussão vertical tem uma razão de chance 86% menor de não ter percebido dor no elemento dentário (OR: 0.14 IC: 0.06 0.33); pacientes fumantes tem uma chance 3.96 maior de não terem relato de sintomatologia dolorosa (OR: 3.96 IC: 1.09 14.38). Concluise que o conjunto dessas avaliações poderão proporcionar um diagnóstico precoce e uma melhor intepretação do paciente diminuindo a prevalência de periodontite apical.

É sabido que o paciente com doença renal crônica que tem um acompanhamento nefrológico precoce apresenta melhores condições clínicas e melhor prognóstico ao entrar em diálise. Porém o acompanhamento precoce pelo nefrologista melhora também o enfrentamento psíquico da doença e do tratamento? Foram estudados 39 pacientes com insuficiência renal estágio 5 no momento em que entravam em hemodiálise: 19 pacientes com acompanhamento por nefrologista 6 meses (Grupo 1) e 20 pacientes sem qualquer acompanhamento nefrológico prévio (Grupo 2). Todos os pacientes participaram de entrevista semiestruturada, composta por 17 questões abordando informações, crenças, expectativas e fantasias relacionadas à doença e ao tratamento. As respostas foram decompostas em categorias através da técnica da Análise de Conteúdo. Os dados demográficos e laboratoriais também foram coletados. A classe socioeconômica foi avaliada e classificada como baixa, média ou alta. Na análise estatística foram utilizados o teste de Fisher, do Quiquadrado, t de Student ou de Wilcoxon como apropriado e os resultados apresentados como média ± DP. O grupo 1 foi seguido por 26 ± 20 meses. Em ambos os grupos a maioria dos pacientes pertencia à classe baixa e era do sexo masculino. Os pacientes do grupo 2 eram mais jovens e apresentavam piores parâmetros laboratoriais (p <0,05). Também os aspectos psicológicos foram semelhantes nos 2 grupos: 63% dos pacientes do grupo 1 e 55% do grupo 2, disseram que tinham informações anteriores sobre a diálise; 42% no grupo 1 e 40% no grupo 2, disseram pouco entender o que o médico falava; 74% no grupo 1 e 85% no grupo 2 acreditam que seus rins voltariam a funcionar. Em ambos os grupos, 25% tinham expectativas ruins sobre voltar a trabalhar, e 60% sentiam atitudes negativas da família. O acompanhamento com o nefrologista minimiza as complicações clínicas e laboratoriais dos pacientes com insuficiência renal estágio 5, porém não é suficiente para minorar o impacto psicológico da entrada em hemodiálise. A atenção do nefrologista deve ir além dos aspectos clínicos. É necessário que o paciente seja adequadamente informado sobre sua doença e tratamento. Principalmente os pertencentes a uma classe social baixa como os estudados o apoio de uma equipe interdisciplinar pode ser de grande valia. / It is well known that patients with chronic renal failure (CRF) who are early on referred to a nephrologist have less clinical complications of the disease and a better outcome on chronic dialysis. But can early referral also improve the psychological burden of starting chronic dialysis? Thirty-nine ESRD patients initiating dialysis were studied: 19 patients had a Nephrology followup 6 months and 20 patients had no referral to nephrologist, starting dialysis on emergency situation. All patients participated in a semi-structured interview with 17 questions covering the perceived knowledge, beliefs, expectations and fantasies related to the disease and dialysis. The answers were decomposed in categories through the technique of content analysis. Demographic and laboratorial data at dialysis initiation were also collected. The socioeconomic position was evaluated and the patient was classified in one of 3 categories: low, middle or high. Categorical data were analyzed by Fishers or Chisquare statistical tests and continuous data by t or Wilcoxon tests as appropriate. The results are presented as mean ± SD. Group1 had been followed for 26 ± 20 months. In both groups the majority of patients were classified as low socioeconomic position and were males. Group 2 was younger and had worse laboratorial parameters (p<0.05). Also regarding the psychological aspects both groups were similar: 63% patients of group 1 and 55% of group 2 said they had no previous information about dialysis, and 42% in group 1 and 40% in group 2 said they didn\'t completely understand what the doctor said; 74% in group 1 and 85% in group 2 believed that their kidneys would work again; 25% in both groups had bad expectations about being able to work again , and 60% in both groups felt there was a negative attitude of the family toward them. Nephrology care of CRF patients mitigates clinical complications. However, on its own, it is not enough to minimize the psychological impact of the entering dialysis. Nephrology care must go beyond clinical care. The patients need to be well informed about the disease and treatment, especially patients like ours who came from low socioeconomic position. This kind of patients should be supported by an interdisciplinary team.