Is our goal in this paper to discuss the current concepts about bruxism, a topic that has been a matter of discussion on the dental field for many years. Recent International efforts have been made to challenge bruxism old definitions; this has derivate to a consensus and an actual new concept that defines bruxism as a behavior instead of a disorder. As a behavior, it is explained in this review how it can have negative health consequences, can be innocuous and how new research support that bruxism can even be a protective factor. Different etiological factors are reviewed in this paper as well the influence of external and internal mechanism related to medications, emotional stress, systemic factors, and potential pharmacological pathways. Moreover, it is briefly summarized the role of oral appliances on sleep bruxism. Finally, clinical considerations and recommendation for the dental professional regarding sings that should be notice during the exam are part of this overview.

Chorea-acanthocytosis is a rare neurological disorder that produces involuntary body movements, along with a condition of misshapen red blood cells that is characterized by appearing in early adulthood. There are numerous orofacial manifestations linked to chorea-acanthocytosis that the dental practitioner must consider in early and late stages of the disease, such as chronic oral ulcerations, chronic mouth grinding, difficulty swallowing, and biting the lip and tongue, among others. This case, the first to the authors' knowledge to address the area of orofacial pain, provides general signs and symptoms of the disorder and management following a multidisciplinary approach. The life span of patients with this disorder is generally shortened, and correct management is essential to improve the quality of life.

This study aimed to establish the relationship between empathy and personality styles in medical students, considering the differences by gender. The participants were 278 students of the medical career of the Universidad del Azuay, Ecuador. They were evaluated using the Jefferson empathy scale and the Millon Index of Personality Styles. Relationships between empathy and personality styles were examined using Pearson's correlation coefficient and hierarchical multiple linear regression analysis, for comparisons by gender and educational levels; with both Student's t test and analysis of variance used respectively. Results indicated that the factor structure of the empathy scale is invariant between men and women, noticing gender differences in care with compassion and total empathy, with women presenting a higher mean. Differences are observed by educational level, where the general empathy in the first three years grows progressively, and then slightly decrease. In conclusion, female students present a mean score of total empathy greater than men, with differences of empathy according to educational level

Introduction: Empathy with the patient is an important attribute that contributes to the success of treatment. This attribute must be object of teaching in the training stage of the student of the health sciences. Objective: To evaluate the levels of empathy and its components in students of the Obstetrics course at the University of Norbert Wiener, Peru. Material and Methods: Design: cross-sectional study. Participants: The sample was composed of 219 first-year to fifth-year students. Measurements: The Jefferson Empathy Scale, S version for students was applied. The internal reliability of the data was estimated using the general Cronbach's alpha, interclass correlation coefficient, Hotelling's T2, and Tukey non-additive test; the mean and standard deviation were estimated. A bi-factorial analysis of variance (ANOVA), model III was applied in the academic years, the genders and the interaction of these two factors. Results: The empathic level of obstetrics students has an average of 105,95 points, out of a maximum of 140, and it is higher (in absolute values) than other values observed in analogous measurements in Latin America. In general, there are no significant differences in empathy between academic years and genders, and in the components of empathy. Conclusions: The average level of empathy among obstetrics students at Wiener University shows relative little growth per year of study.

OBJECTIVE:The objective of this article is to examine whether the levels of empathy fit the concept of empathic decline.METHOD:This was a non-experimental and cross-sectional study. Two populations of nursing students in two nursing programs were studied: Universidad San Sebastián (Santiago, Chile) and Universidad Mayor (Temuco, Chile). The original data on empathy, assessed by the Jefferson Scale of Empathy, were combined into a single data base. They were then analyzed by means of normality tests and homoscedasticity, Cronbach's alpha, analysis of variance; the standard deviation of the dependent outcome measure (Sy.x) and the coefficient of determination (R2) were estimated.RESULTS:The sample sizes from the two programs were 479 and 277, respectively. It was found that the distributions of the averages over the course of study for empathy (and its components) were constant, and in some cases increased.CONCLUSION:It was found that the distribution of the means of empathy in the nursing students analyzed did not conform to the classical empathic decline observed in other studies. Therefore, it is inferred that the traditional factors identified as causes of empathic erosion were not operating in the same way in the studied context.

Introduction: Empathy with the patient is an important attribute that contributes to the success of treatment. This attribute must be object of teaching in the training stage of the student of the health sciences.Objective: To evaluate the levels of empathy and its components in students of the Obstetrics course at the University of Norbert Wiener, Peru.Material and Methods: Design: cross-sectional study. Participants: The sample was composed of 219 first-year to fifth-year students. Measurements: The Jefferson Empathy Scale, S version for students was applied. The internal reliability of the data was estimated using the general Cronbach's alpha, interclass correlation coefficient, Hotelling's T2, and Tukey non-additive test; the mean and standard deviation were estimated. A bi-factorial analysis of variance (ANOVA), model III was applied in the academic years, the genders and the interaction of these two factors.Results: The empathic level of obstetrics students has an average of 105,95 points, out of a maximum of 140, and it is higher (in absolute values) than other values observed in analogous measurements in Latin America. In general, there are no significant differences in empathy between academic years and genders, and in the components of empathy.Conclusions: The average level of empathy among obstetrics students at Wiener University shows relative little growth per year of study.

Introduction: Empathy helps to develop an appropriate doctor–patient relationship, which, according to the literature is susceptible to decline. Therefore, the purpose of the present study was to estimate the levels of empathy in general, and the potential for the growth of empathy in medical students. Materials and methods: This exploratory and cross-sectional study included students from the first to fifth academic year of the University Corporation Rafael Nunez (Cartagena, Colombia) (N = 971, n = 756, 77.86% of the population studied). Participants were given the Jefferson Scale of Empathy, Spanish version for medical students, validated and adapted in Colombia. A bifactorial variance analysis (model III) was used to find the mean differences between courses and genders, and the interaction between these two factors. Data was described using simple arithmetic graphs and processed with SPSS 20.0 to estimate the total potential for growth. Results: Differences were found between academic years and gender in empathy in general and in the component of “compassionate care”. Conclusion: The levels of empathy are relatively low, and the behavior of empathy levels does not match the concept of empathy decline. There are no gender differences and there is a considerable potential for growth of empathy, as well as its components. Resumen: Introducción: La empatía permite la adecuada relación médico-paciente y se plantea que es susceptible de disminuir según lo informado en la literatura. El propósito del presente estudio fue estimar los niveles de empatía en general y el potencial para el crecimiento empático en estudiantes de medicina. Materiales y métodos: Este estudio exploratorio y transversal, incluyó estudiantes desde el primero al quinto año académico de la Corporación Universitaria Rafael Núñez, Cartagena, Colombia (n = 971, n = 756, 77,86% de la población estudiada). Los participantes recibieron la escala de empatía de Jefferson, versión en español para estudiantes de medicina, validada y adaptada en Chile. Se aplicó un análisis de varianza bifactorial (modelo iii) para encontrar diferencias de medias entre cursos, géneros y la interacción entre estos 2 factores. Los datos se describieron usando gráficos aritméticos simples y se procesaron con SPSS® Statistics v.20.0 para estimar el potencial total de crecimiento. Resultados: Se encontraron diferencias entre los años académicos y el género en la empatía en general, y en el componente de «atención compasiva». Conclusión: Los niveles de empatía son relativamente bajos, y el comportamiento de los niveles de empatía no coincide con el concepto de disminución empática. No hay diferencias de género, y la estimación del potencial de crecimiento de la empatía y la de sus componentes plantea la necesidad de un urgente cambio curricular. Keywords: Empathy, Components of empathy, Potential empathy growth, Medical students, Empathy erosion, Palabras clave: Empatía, Componentes de la empatía, Crecimiento de la empatía potencial, Estudiantes de medicina, Erosión empática

Objective: To make a diagnosis of empathic behaviour as a whole and in each of its components in the students of Facultad de Odontologia de la Universidad Central de Quito, Ecuador. Materials and methods: This is an exploratory and cross sectional research. Jefferson Medical Empathy Scale was applied to the participants. It was submited to judges to verify the cultural and content validity and to adapt it to dentistry students. Cronbach's alpha, intraclass correlation coefficient and Hotelling's T2 were estimated, as well as the mean and standard deviation. A bifactorial (model III) analysis of variance (multivariate ANOVA) was applied. Total possible growth potential was estimated. Simple and SSPSS22.0 processed arithmetic box graphs were used. The level of significance was alpha <= 0.05 and beta >= 0.90. Results: We found low levels of empathy in comparison with other faculties from Latin America and a high relative development of the levels of the compassionate component, with the remaining components with low, and in some cases negative growth values. The model of empathic decline is not fulfilled and, generally, there are no statistical differences between genders. Conclusions: The results presented here may create conditions to build a more specific intervention strategy.

Objective. To estimate the reliability of tests to measure the flexibility of the flexion and extension musculature of the knee according to the season, the age and the position of male footballers in the training area of a professional football club. Material and methods. Flexibility was measured by applying the Modified Thomas Test (MT Test) for quadriceps and the Modified Back-Saber Sit-and-Reach Test (MBS Test) for hamstrings. The reliability was estimated via the Cronbach's a. Results. Both tests showed high estimations of reliability between seasons, by categories of players' position and compared to the performance between the lower left and right member. Conclusions. Both tests can be applied in group sports, as in the training area of professional football clubs, especially in the prevention of sports injuries, since they have an accepted validity, show a high degree of reliability according to the study and have further characteristics such as low cost, easy application and the ability to measure a large number of people in brief periods of time.

Objetivo. Estimar la confiabilidad de pruebas para medir la flexibilidad de la musculatura flexoextensora de la rodilla, de acuerdo con la temporada, la edad y la posición de juego en jugadores varones del área formativa de un club profesional de fútbol. Material y métodos. La medición de la flexibilidad se realizó mediante la aplicación de las pruebas Modified. Thomas Test (MT Test) para cuádriceps y el Modified Back-Saber Sit-and-Reach Test (MBS Test) para isquiotibiales. La confiabilidad se estimó mediante el α de Cronbach. Resultados. Ambas pruebas presentaron estimaciones altas de confiabilidad entre temporadas, por categorías de jugadores, puesto de juego y en comparación del rendimiento entre miembro inferior derecho e izquierdo. Conclusiones. Ambas pruebas pueden ser aplicadas en deportes colectivos, como acontece en el área formativa de clubes profesionales de fútbol, especialmente, en la prevención de lesiones deportivas, al tener una validez aceptada, presentar una alta confiabilidad de acuerdo con el estudio y además, tener como características: bajo costo, fácil aplicación y medir un volumen importante de personas en breves periodos de tiempo.

Objetivo. Estimar la confiabilidad de pruebas para medir la flexibilidad de la musculatura flexoextensora de la rodilla, de acuerdo con la temporada, la edad y la posicion de juego en jugadores varones del area formativa de un club profesional de futbol. Material y metodos. La medicion de la flexibilidad se realizo mediante la aplicacion de las pruebas Modified. Thomas Test (MT Test) para cuadriceps y el Modified Back-Saber Sit-and-Reach Test (MBS Test) para isquiotibiales. La confiabilidad se estimo mediante el α de Cronbach. Resultados. Ambas pruebas presentaron estimaciones altas de confiabilidad entre temporadas, por categorias de jugadores, puesto de juego y en comparacion del rendimiento entre miembro inferior derecho e izquierdo. Conclusiones. Ambas pruebas pueden ser aplicadas en deportes colectivos, como acontece en el area formativa de clubes profesionales de futbol, especialmente, en la prevencion de lesiones deportivas, al tener una validez aceptada, presentar una alta confiabilidad de acuerdo con el estudio y ademas, tener como caracteristicas: bajo costo, facil aplicacion y medir un volumen importante de personas en breves periodos de tiempo

Empathy is a fundamental attribute for health science professionals, which has both affective and cognitive components, as well as a complex family influence during its development. This paper seeks to establish the relationship between empathy and family functioning, as well as the possible relation with gender, in active students of Dentistry from the Latin American University of Science and Technology (ULACIT). A previous study in this same institution showed that gender is an influential factor in the levels of empathy, favoring women [1], but by increasing practical and community-related experiences, those differences between men and women decreased [2]. This paper analyzes the effect of family functioning on empathy levels using two instruments: the Family Functional Questionnaire (FACES) and the Jefferson Empathy Scale (EEMJ-S). A total of 159 dental students of ULACIT (Costa Rica) active in 2016 participated, equivalent to 53.7% of the population. The statistical analysis used ANOVA, Kolmogorov-Smirnov test and Levene test of equality of variances. The analysis of bifactorial variance, model III, shows that for general empathy there are no significant differences (p> 0.05), but if the dimensions are analysed individually, "Care with compassion" was superior in females (effect size of 0.032, test power 0.614). The other dimensions did not show gender differences. Regarding family function or operating style, the scale considered three different styles: balanced, intermedium, and extreme. Interestingly, most of the participants belonged to the third style. The students with extreme styles of family functioning showed higher levels of empathy, which can be explained by the development of a personality structure and dynamics that incorporates both resilience and comprehension and acceptance of the differences between people. The results of this study indicated that there is a relationship between the type of family functioning (accordingly with the actual use of the scale) and empathy, were extreme families have higher values of empathy. The development of this communication skill is key for a health science professional, so the recognition of the influence of the student's background is important to design a learning experience to develop empathy.

VÍCTOR PATRICIO DÍAZ-NARVÁEZ1,2, LUZ MARINA ALONSO-PALACIO3, SARA ELVIRA CARO4, MARÍA SILVA5, JOEL ARBOLEDACASTILLO6, JORGE BILBAO7, JESÚS IGLESIAS-ACOSTA8, ARACELIS CALZADILLA-NÚÑEZ9, ROBERT UTSMAN10, MARCOS CERVANTES11, ELIZABETH FAJARDO12 1Dental Faculty, Universidad San Sebastián, Santiago, Chile 2Health Faculty, Universidad Bernardo OHiggins, Chile 3Division of Health Sciences, Universidad del Norte, Barranquilla, Colombia 4Division of Health Sciences, Universidad del Norte, Barranquilla, Colombia 5Universidad Central del Este, San Pedro de Macoris, Dominican Republic 6Universidad Central del Este, San Pedro de Macoris, Dominican Republic 7Fundación Universitaria San Martín, Sede Puerto Colombia, Barranquilla, Colombia 8Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla, Colombia 9Unit of Child and Adolescent Psychiatry, Hospital Félix Bulnes Cerda, Santiago, Chile 10Director of Research. School of Health Sciences, Universidad Latinoamericana de Ciencia y Tecnología (ULACIT), San José, Costa Rica 11Professor of Psychology (Ph.D), Faculty of Social Sciences, Universidad del Norte, Barranquilla, Colombia 12Proffesor of Faculty of Health Sciences,Universidad del Tolima, Colombia

Introduction: The controversy over the presence of empathic decline within the course in students of medicine, dentistry and health sciences in general, has not fully been studied. This controversy could be partially solved if massive studies of empathy levels are made in similar cultural, social and economic contexts. Material and Methods: Empathy levels within the course were studied in eighteen dental schools from six countries in Latin America (2013). The mean of the empathy levels were used to study the behavior between first and fifth academic years. The values of empathy levels within the course were observed by applying the Jefferson Scale of Physician Empathy, the Spanish version. All these studies were cross-sectional. The value of means observed, were subjected to regression studies and further adjustment curves were obtained and the coefficient of determination were calculated. Results: Six different models of behavior were observed, which found that five of them suffer empathic decline within the course, but with different final results: in some the decline persists until the fifth academic year and in others, this decline 'recovers' persistently until the fifth academic year. The sixth model is characterized by a constant and persistent increase of levels of empathy within the course until the last academic year. Discussion: There are six different models for the behavior of means of levels of empathy within the course evaluated by a common methodology in eighteen dental schools from six countries of Latin America. These findings support the existence of variability of empathic response and a comprehensive approach is needed to find the causes that give rise to this variability. Conclusion: In dental students of Latin America, there is variability in the behavior of the distribution in means between the academic years of the dentistry schools examined in this study.

A B S T R AC T A hemifacial spasm is characterized by the presence of tonic or clonic, intermittent and involuntary unilateral contractions of the muscles supplied by the facial nerve, usually around the eyes, cheeks, mouth and neck. A case is presented in a patient with twitching in the right lower eyelid with irradiated pain in the temple and upper lid edema. Causative factors and management strategies are emphasized to enhance the recognition and understanding of this condition.

Objectives: Based on recent curriculum changes at the University of Science and Technology in Costa Rica (ULACIT) it is of great academic interest to verify the impact of this new approach on courses with respect to the development of empathy, thus compare previous results with a new collection of information. Methods: The levels of empathy and matrices of empathy construct are estimated by dental students by using the Jefferson Scale of Physician Empathy, the Spanish version for students (S version) previously culturally validated. Cronbach a was estimated and compared with data previously published. A two-way analysis of variance (ANOVA), model III, in order to find differences in the average between academic years and gender, and the interaction between these two factors was applied. Results: There continues to remain a gender difference in the attribute of empathy in dental students of ULACIT, greater in females than males, however with a smaller difference than before. Students continue to show higher levels of empathy at the start of the academic career, however with a decline among fourth year students. Conclusions: New curriculum changes that involve greater integration of students with their patients, consistent with the greater inclusion of clinical activities and community visits continue to show the development of empathy. Differences among genders, variation in years, and how empathy levels change in the professional field should be further explored. (C) 2017 Sociedade Portuguesa de Estomatologia e Medicina Dentaria. Published by SPEMD.

Objective: To estimate empathy levels in general and empathic growth potential in dental students. Material and Methods: This is an exploratory, transversal study. The study population is made up of students from the first to fifth academic year of the career of dentistry of the Evangelical University of El Salvador (El Salvador) (148/240, 61.67% of the population studied). The participants were given the Jefferson Empathy Medical Scale, the Spanish version for medical students, validated in Chile and Mexico, and culturally adapted in El Salvador. A bifactorial variance analysis (model III) was applied to find differences in the means between the courses, between the genders and in the interaction between these two factors. The data were described using simple arithmetic graphs, processed with SPSS 22.0. Total growth potential was estimated. Results: Differences were found between academic years, but not in gender of empathy in general and in its components. The levels of empathy and its components are low in relation to other studies. The behavior of the levels of empathy agrees with the concept of empathic decline. The masculine gender presented levels of empathy, in absolute values, greater than the feminine. There is considerable potential for growth in empathy and that of its components. Conclusion: The behavior of the levels of empathy observed in this work does not agree with the concept of empathic decline. The differences observed between the genders were not consistent with those reported by other authors and it is possible that these findings constitute further evidence that empathy itself is not a female attribute.

Objetivo: El “Perfil de Impacto en la Salud Oral (OHIP)” es un instrumento que se ha utilizado para evaluar el impacto de la salud oral desde el punto de vista de la percepcion de la salud integral. En este estudio, se evalua la relacion entre la satisfaccion de la condicion oral y la percepcion de la calidad de vida en un grupo de pacientes en Costa Rica. Materiales y Metodos: Se aplico el instrumento “OHIP EE-14” a 148 pacientes de la Clinica Odontologica de la Universidad Latinoamericana de Ciencia y Tecnologia (ULACIT) (localizada en San Jose, Costa Rica), en dos ocasiones diferentes, para medir el impacto de la intervencion odontologica. Se utilizo la prueba- T con un nivel de significancia de 0.05 para determinar si la percepcion de calidad de vida de acuerdo con la salud oral diferia entre generos durante el curso del tratamiento. Resultados: Hubo una reduccion en el total de puntajes y dominios de OHIP-14 conforme se realiza una intervencion. Las mujeres reportaron una deficiencia mas alta que los hombres en los puntajes totales y dominios de OHIP-14 en las lineas base y despues de las intervenciones. Estas diferencias fueron estadisticamente significativas (P < 0.05), en la linea base entre generos en la suma de los puntajes de OHIP, especificamente en los dominios de dolor fisico, malestar psicologico, discapacidad psicologica y social. Despues de la intervencion, la deficiencia mas alta fue reportada en el genero femenino, con diferencias estadisticamente significativas (P < 0.05) en puntajes de sumatoria de OHIP y en los dominios de limitacion funcional, malestar psicologico discapacidad psicologica y social. Conclusiones: Estos resultados indican que la percepcion de calidad de vida puede verse influenciada por la intervencion odontologica, la que de acuerdo con los resultados produce beneficios psicologicos y sociales en las personas.

Introduction: The development of empathy in medical students, which is essential for therapeutic effectiveness and improved patient outcomes, is not well understood. The objective of this study is to determine whether there are differences between levels of the "compassionate care" component of empathy among four medical schools in Colombia and the Dominican Republic. Subjets and methods: The sample consisted of medical students. This exploratory and cross-section study measured empathy levels by using the Spanish version of the Jefferson Scale of Physicians. Levels of empathy were studied and compared by a three-factor analysis of variance, Tukey multiple comparison test and discriminant analysis of the matrix components. Results: Differences in levels of empathy of the "compassionate care" component between universities, courses and gender were found. Conclusions: Variability in the values of the levels of the "compassionate care" component of empathy were observed among the factors: university, course and gender. The observed variability between and within the university populations studied cannot be explained, which can be attributed to other unknown factors that influence empathy levels.