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There is an increasing emphasis on developing person-centered care in rehabilitation settings. However, this care practice has not been fully implemented due to several factors. This study explores rehabilitation workforce perspectives on the barriers and facilitators to implementing person-centered care (PCC). This was a quantitative descriptive study, which was developed based on interviews with 12 healthcare professionals from a private institution in the region of Lisbon and Tagus Valley in Portugal. The recruitment was made in October 2020. Braun, Clarke, Hayfield, and Terry's content analysis was applied to the transcripts, and these were transcribed verbatim. The consolidated criteria for reporting qualitative research (COREQ) checklist were applied to this study. Participants described barriers such as an unsupportive organization and leadership, staff constraints, heavy workload, and resistance to change. Unique to this study, a patient's clinical characteristics were identified as barriers to person-centered care. As facilitators, they described leadership, staff satisfaction, a positive physical environment, training and education, and shared decision-making. It is essential to understand the perceptions of the rehabilitation workforce, as they play an integral role in providing PCC. This study serves as a guide to facilitate person-centered care, as it provides an understanding of key barriers and facilitators for its implementation in rehabilitation settings.

., (Copyright © 2021 National Medical Association. Published by Elsevier Inc. All rights reserved.)

A hipertensão neonatal é um problema clínico raro. A principal causa é renovascular. Os autores apresentam uma causa rara de hiperaldosteronismo transitório secundário a infeção renal. Um recém-nascido (RN) de termo de 22 dias, sem antecedentes de relevo, é enviado ao serviço de urgência por má evolução ponderal. Após análises de sangue e urina é diagnosticado com uma infeção do trato urinário (ITU) e iniciada terapêutica com ampicilina e cefotaxima. Durante a hospitalização, foram observados níveis persistentes de pressão arterial (PA) >P97, tendo sido realizado ecografia renal e eco-Doppler que não mostraram alterações, assim como o estudo hormonal e a função renal analítica normais, excluindo hiperplasia adrenal congénita. Em D9 de internamento, apresentou normalização dos valores de PA. As análises laboratoriais revelaram níveis de aldosterona de 335,4ng/dl (N 2-70 ng/dl) e renina de 1684 mUI/L (N

A prevenção da obesidade infantil é uma questão crítica para a saúde pública, pois a grande maioria do excesso de peso é adquirido ainda em idade pré-escolar. De acordo com a Organização Mundial de Saúde, em 2016, 41 milhões de crianças apresentavam excesso de peso ou obesidade com menos de 5 anos. A obesidade é difícil de combater, persistindo na idade adulta, e aumenta o risco de doenças crónicas. Embora os comportamentos de estilo de vida modificáveis, como alimentação saudável e atividade física, sejam determinantes no sucesso do combate à obesidade, outros fatores da sociedade atual decorrentes do avanço tecnológico têm um peso marcado nesta doença. Para prevenir a obesidade na primeira infância, é importante entender os fatores de risco e as suas interações. As intervenções multidisciplinares demonstram ser eficazes, quando há disponibilidade e motivação, principalmente do ambiente familiar e escolar, onde as crianças estão inseridas. No entanto, desenvolver e avaliar intervenções complexas para a prevenção da obesidade é um desafio para todos os envolvidos, profissionais de saúde, crianças, famílias e outros cuidadores.Esta revisão tem como objetivo discutir as linhas mais recentes para a prevenção e abordagem da obesidade infantil, analisando as evidências das intervenções e discutindo as barreiras da sua aplicação.

This paper presents the evaluation of a design research project that combines artistic practice and academic theory to demonstrate how problem-based learning (PBL) can bridge the gap between those fields. "Researching Empathy Through Staged Performance" was a master's thesis project in the field of interaction design and consisted of an artistic performance titled "My Body, Your Room." The live performance functioned as a site for conducting scientific research into corporeal empathy. The project investigates how embodied methodologies that combine dance performance and interactive technologies can strengthen empathic relationships between the audience, performer and the environment. "My Body, Your Room" was developed at the Design School Kolding (Denmark), and utilised cross-disciplinary theories, concepts and methods from interaction design, performance studies and neuroscience. The working methodology drew on artistic approaches and scientific research methods such as quantitative and qualitative analysis, including video documentation, ethnography, surveys and interviews.

ABSTRACT Objective: To investigate the effect of iodine supplementation during gestation on the neurocognitive development of children in areas where iodine deficiency is common. Materials and methods: Based on the PRISMA methodology, we conducted the search for articles in the PubMed, LILACS and Scopus databases, between March and April 2020, without limitation of dates. We used descriptors in English, Portuguese, and Spanish, without filters. Four clinical trials and four cohort articles were included in the review. Results: The maximum supplementation was 300 μg of potassium iodide per day. The Bayley scale and Children’s Communication Checklist-Short were used to assess neurodevelopment in children. There was no significant improvement in the children’s mental development index and behavioural development index in the supplemented group; however, the psychomotor development index (PDI) showed improvement in the poorer gross motor skills. We found differences in the response time to sound in the supplemented group living in mild deficiency areas. Conclusion: Daily supplementation with iodine can improve poor psychomotor development of children living in mild to moderate iodine deficiency areas. Thus, it is necessary to perform further studies to assess the effect of supplementation on neurodevelopment before, during and after gestation in mild to moderate iodine deficiency areas.

ABSTRACT As pregnant women are susceptible to changes in iodine, which can cause miscarriage, goiter, thyroid nodules, hypothyroidism, in addition to fetal neurological impairment or development. The aim of this study was to verify the implications of the iodine alteration in each gestational trimester and its consequences of physiological justification. The review was based on PRISMA. Searching for articles that took place in March 2020 without delimiting data. As bases consulted were the Clinical Trials, Cochrane Library, Lilacs and Medline (PubMed). The descriptors were combined as follows: "pregnancy" AND "iodine deficiency". Articles that addressed iodine deficiency and its implications were included. The selection followed the steps of reading the titles, abstracts and full articles. To assess the methodological quality of the studies, the STROBE Instruction instrument was used. The research resulted in 1,266 studies and 11 were included. In assessing methodological quality, the lowest score was and the maximum 20. According to studies, the fourth most affected by iodine loss are the second and third, it is possible to increase the volume and pneumatic nodules, subclinical hypothyroidism, pre-eclampsia, among others. The damages caused by iodine deficiency in the first or second trimester are still reversible, therefore, they need to be diagnosed early, to guarantee an iodic homeostasis and prevent damage to the health of the mother-child binomial.

La activación de la señalización de Wnt/β-catenina en células del linaje osteoblástico conduce a un aumento en la masa ósea a través de un mecanismo dual: por una parte, aumentando la osteoblastogénesis, y por otra, disminuyendo la osteoclastogénesis. El predominio de un mecanismo sobre otro depende del estado madurativo del osteoblasto en el que produzca la acumulación de β-catenina. La activación de la señalización de Wnt/β-catenina en células del linaje osteoclástico y sus posibles efectos en la regulación de la masa ósea es menos conocida. Estudios previos han demostrado que la ablación condicional de β-catenina en los osteoclastos induce una disminución de la masa ósea asociada a un aumento de los osteoclastos, y este hecho se ha atribuido a un incremento de la osteoclastogénesis. Sin embargo, no se han evaluado otras posibilidades alternativas como que una disminución de la apoptosis normal de los osteoclastos pueda también contribuir al mayor número de los mismos. En este trabajo, para obtener información sobre este hecho, generamos ratones en los que la β-catenina se eliminó selectivamente de las células del linaje de monocito/macrófago utilizando un alelo flanqueado de la β-catenina (Catnbf) junto con la línea de deleción LisozimaMCre (LysMCre). El análisis tridimensional de los huesos de los ratones Catnbf/f;LysM revelaron una disminución significativa del grosor de la cortical femoral, mientras que el hueso trabecular vertebral no se vio afectado. Este fenotipo se asoció con un mayor número de osteoclastos en la superficie ósea. El número de osteoclastos en los cultivos procedentes de los ratones Catnbf/f;LysM fue dos veces mayor que en los cultivos obtenidos de los ratones control. La administración de WNT3a atenuó la formación de osteoclastos inducida por M-CSF y RANKL in vitro. Además, WNT3a promovió la apoptosis de osteoclastos, y este efecto fue contrarrestado, tanto por la presencia de DKK1 como por la ausencia de β-catenina. En conjunto, estos resultados apoyan un efecto autónomo celular de la β-catenina en el osteoclasto, y proporcionan evidencia convincente del papel proapoptótico de β-catenina en estas células.

AbstractIntroduction Temporomandibular disorders embrace a heterogeneous group of pathologies with manifestations in the orofacial region, head and neck. They are defined as a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joint, the masticatory muscles and the associated structures through interactions and reciprocal influences. They may present one or more signs or symptoms: orofacial pain, pain in the masticatory muscles or a combination of both [1]. According to available literature, pain tolerance threshold at pressure and pain intensity decrease after dry needling intervention [2]. The aim of the present study is to evaluate the effect of a single dry needling session in patients with temporomandibular muscle disorder with pain.Material and methods a longitudinal quasi-experimental study with 26 patients with a diagnosis of temporomandibular muscle dysfunction (group I), on the masseter and temporal muscles, according to the Research Diagnostic Criteria for temporomandibular disorder. Patients were randomly picked up from the waiting list of the physiotherapy appointment at Clinica Egas Moniz (CEA) and randomised into two groups: 13 in the experimental group (G1) and 13 in the control group (G2). The groups were evaluated simultaneously but were not submitted to any intervention. The pain tolerance threshold was evaluated at pressure (2 kg), pain intensity measured with numeric pain rating scale (NPRS), before (T0) and after (T1) the intervention, and one week after (T2) the intervention. The intervention consisted of applying the dry needling technique to the painful points of the masseter. Statistical analysis performed in SPSS with a significance level of 5%. All the assumptions of the Helsinki Declaration have been fulfilled and a informed consent for clinical case of Clinica Dentária Egas Moniz approved by the ethic commission of Instituto Universitário Egas Moniz.Results G1 group was formed by 12 female and 1 male subjects with an average and standard deviation of 22.78 ± 3.75. G2 group was formed by 13 female with an average and standard deviation of 23.42 ± 2.45. Pain tolerance threshold at pressure values increased from T0 to T2 in G1 group (p

AbstractIntroduction Temporomandibular disorders have a considerable prevalence, with a significant impact on physical and psychosocial factors [1]. It contributes to high socioeconomic costs, which are generally associated with comorbidities such as depression and other psychological factors [2,3]. The Diagnostic Criteria for Temporomandibular Disorders is based on a bi-mechanical model of pain with two axes: physical signs and symptoms (axis I) and psychological factors (axis II). Psychological factors such as catastrophizing pain, psychic distress, guiding beliefs, beliefs related to painful perception, depressed or anxious mood, and passive coping are all related to an increased pain perception, increased levels of disability, in patients with chronic pain with temporomandibular disorders [3,5]. Psychosocial factors were also identified as predictors of treatment outcome in patients with temporomandibular disorders [6]. We consider that somatic awareness is an important sensory-discriminative factor to be taken into account in this group of patients. The aim of this case study is to analyse if the identification of psychosocial aspects contributes in controlling the temporomandibular symptoms.Material and methods A case study of a 25-year-old female patient with generalised headache, generalised myofascial pain (III) in the head and neck region, self-reported awake and sleep bruxism and important psychological factors related to catastrophic pain and anxiety, all described during the initial interview. The patient can positively correlate beginning of the manifestation of the painful symptoms with relevant psychosocial and drastic, in her own words, family changes. Pain intensity and headache are measured with numeric pain rating scale (NPRS) and the patient is submitted to one session of physical therapy per week. The treatment plan consisted of cognitive-behavioral therapy with a first appointment based on education, habits recognition and modification, the patient was medicated with muscle relaxants and off label gabapentine, physiotherapy and psychotherapy. All the assumptions of the Helsinki Declaration have been fulfilled and an informed consent for clinical case of Clinica Dentária Egas Moniz approved by the ethic commission of Instituto Universitário Egas Moniz.Results Three months after (12 sessions of physical therapy) the beginning of the treatment plan, the biggest breakthrough was the ability of the patient to identify psychological situations that trigger the exacerbation of pain. The patient referred absence of headache, a significant reduction of myofascial pain (I) located in the masseter and in the temporal of about 70% of the pain scale and changed from myofascial pain to local myalgia.Discussion and conclusion Psychosocial factors are frequently present in patients with temporomandibular disorders and their evaluation, grading and consequent intervention become important for the prognosis and resolution of the case.The assessment of psychosocial aspects should be considered in all patients with temporomandibular disorders in order to analyse, case by case, whether they are relevant for controlling their symptoms. It will be important to carry out a experimental study with a larger sample to verify whether the obtained results point in the same direction.

Introdução – Os esporos fúngicos são uma das maiores componentes biológicas atmosféricas; no entanto, são ainda pouco estudados e não lhes é reconhecida a influência devida na doença alérgica respiratória. Neste trabalho pretende-se determinar a importância dos níveis de esporos atmosféricos de Alternaria e Cladosporium na doença alérgica respiratória na cidade de Beja. Método – Analisaram-se os níveis atmosféricos de esporos de Alternaria e Cladosporium na cidade de Beja. A metodologia utilizada é recomendada pela Rede Portuguesa de Aerobiologia: utilizou-se um coletor volumétrico do tipo Hirst, um Burkard seven-day Volumetric Spore-trape®; os esporos foram coletados numa bobine que continha uma fita de Melinex impregnada com silicone e corados com solução de glicerogelatina com fucsina básica. Para a leitura das amostras utilizou-se o método de leitura das quatro linhas longitudinais ao microscópio ótico com uma ampliação de 400x. Os resultados obtidos foram convertidos e expressos em número de esporos por metro cúbico de ar. Selecionaram-se doentes alérgicos a fungos com provas de sensibilização positivas para o alergénio mx1 e realizou-se uma análise de diagnóstico molecular de sensibilização ao alergénio Alt a1 através do equipamento Phadia 250® pelo método de imunoensaio fluoroenzimático. Resultados – No período deste estudo registaram-se 320.862 esporos do tipo Cladosporium e 20.741 esporos do tipo Alternaria. Os testes de diagnóstico molecular confirmaram que 81% dos doentes sensibilizados a fungos são alérgicos a Alternaria. Conclusão – Os níveis atmosféricos de Alternaria são elevados e provocam sensibilização alérgica nos doentes da região de Beja. O alergénio Alt a1 permite identificar a maioria dos doentes alérgicos a fungos nesta região.

Cystic fibrosis and celiac disease were considered a single clinical entity for many years. Differentiation between the diseases occurred some time in the 1930s of the 20th Century. Both diseases may present the intestinal malabsorption syndrome and similar clinical manifestations that contribute to difficulties with clinical distinction. We describe a report of two patients with initial diagnosis of cystic fibrosis, who were subsequently diagnosed with celiac disease.

Introduction. Epithelioid hemangioma is an uncommon benign vasoproliferative neoplasm that usually manifests as multiple red nodules in middle-aged adults. Case Outline. A 52-year-old male patient presented with a one-year history of a nodular lesion in the left buccal mucosa measuring 3 cm. The clinical hypothesis was lipoma. An excisional biopsy revealed a circumscribed lesion composed of lobules of vessels with perceptible or poor lumina, associated with a prominent inflammatory infiltrate consisting of eosinophils, histiocytes and chronic inflammatory cells. The endothelial cells composing the lesion had an epithelioid morphology and contained abundant eosinophilic cytoplasm. Immunohistochemistry for CD34, factor VIII, collagen IV, alpha-smooth muscle actin, and mast cells, as well as histochemical staining with Weigert’s orcein were performed. Conclusion. Vascular proliferations of soft tissues are a diverse and morphologically complex group of lesions that are difficult to diagnose. This report presents a case of oral epithelioid hemangioma, highlighting relevant morphological and immunohistochemical features that could help distinguish this condition from other neoplasms.

Background. Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis, whose prevalence is increasing worldwide, and is associated with all-cause mortality. However, no study has assessed this disease in Huambo. The aim of this study was to evaluate the prevalence of PAD in patients attending an outpatient clinic at a general hospital in Huambo, South Angola. Methods. A cross-sectional study, including 115 patients aged 40 years and older attending an outpatient service. The evaluation included a basic questionnaire for lifestyle and medical history and ankle-brachial index (ABI) measurement using hand-held Doppler. PAD was defined as an ABI ≤0.9 in either lower limb. Results. Of 115 patients, 62.60% were women with a median age of 52.5 (range of 40 to 91) years. The prevalence of PAD was 42.6% (95% confidence intervals [CI]: 95%: 33.91–52.17%). Among patients with PAD, 95.92% had mild disease and 4.08% moderate to severe disease. The main risk factor for PAD was age (≥60 years) (χ2=3.917, P≤0.05). The prevalence was slightly higher in men and hypertensive subjects, but without statistical significance with ORs of 1.5 (95% CI: 0.69–3.21) and 1.42 (95% CI: 0.64–3.17), respectively. Hypertension was also high in the group (66.95%). Conclusion. The prevalence of PAD was 42.6%, higher in those aged 60 years and older. More studies, with representative samples, are necessary to clarify PAD prevalence and associated risk factors.

Introduction: Fungal ball of the sinuses is a not invasive infection that if characterizes for its chronicity, being the majority related with previous endodontic treatment. Affect mainly the breasts to maxillary; even so all the breasts can be involved. The main etiological agent is the Aspergillus spp. The computed tomography, had to characteristic the radiological presentations, suggests the diagnosis that is carried through definitively through histopathological analyses. The treatment standard-gold is the sinus surgery with average meatal antrostomy. Objective: Reporting two cases of fungal ball of the sinuses and to stand out important aspects of this pathology. Story of the Cases: Case 1) Patient of the feminine sex, 78 years old, presented itself with complaints of face pain has 6 months and previous history of endodontic treatment. To the physical examination it was evidenced purulent secretion presence in left average meatus. Ray X presented complete veiling of the breasts to maxillary left, while the computed tomography showed injury calcified in this place. Sinusotomy was become fulfilled that evolved well. Case 2) Patient of the feminine sex, 70 years old, looked attendance for history of sinusitis of repetition. To the physical examination no particularity was not perceived. The computed tomography, as well as the magnetic resonance, detected thickening of the mucous wall of the breasts to maxillary left, beyond a calcified mass. It was become fulfilled same sequence of treatment and the patient also evolved well. Final Considerations: The fungal infection must be considered in the patients who if present with chronic sinusitis, that they do not answer to the antibiotic use and that they possess history of endodontic manipulation.

Introduction: Noise-induced hearing loss is a sensorineural hearing loss, usually bilateral, irreversible and progressive with time of exposure. As the noise made by children in school may be considered detrimental, the study looks of their occurrence in Taubaté's schools. Objective: To determine if students are exposed to noise intensity affecting the cochlea, define the profile of these schoolchildren, demonstrating the occurrence of changes in cochlear activity following exposure to noise in a day of class. Method: Study's way prospective transversal cross sectional cut with 28 elementary school students in the first half of 2009. Questionnaires for assessing preexisting cochlear damage . Evaluation of cochlear function by analysis of acoustic emissions evoked distortion product, made before the students come into class and immediately after the end of these. Measurement of noise inside the classrooms and recreation areas during the interval. Results: 57.1% accused some hearing loss in the examinations before class. By day's end, 04 girls and 03 boys had worsened in relation of the first examination. The noise reached levels higher than recommended at the three class rooms. The largest number of students with worsening, belong to the class room with higher noise level. The noise during the intervals is also excessive. Conclusions: The noise in this school is above the limit. 42.85% of students who had experienced worsening had school performance inadequate. 25% had worse after noise exposure in a school day.

Introduction: Teachers often have vocal disorders that benefit from preventive measures. Objective: To determine the prevalence of the syndrome in dysphonic teachers and check the evolution of this index with the techniques of primary prevention. Method: We performed a cross-sectional study of teachers in two different periods: in the first 101 teachers and participated in phase 2, 148 teachers. These two groups was administered the questionnaire prepared by the tripartite commission on regulation of the professional voice. Results: The prevalence of the syndrome dysphonic in the first phase was 70.3%, while the second stage was 57.59%. Conclusion: 1st dysphonic the prevalence of the syndrome was significantly decreased with the implementation of preventive and medical control of work organization. 2nd dysphonic syndrome is a new nosological entity. Cross-sectional epidemiological study. Study series.

Introduction: The dysphonic syndrome is an occupational disease of high prevalence in the professor population. Objective: In order to broach preventively the vocal aggression, it was tried to standardize a self assessment questionnaire to professors of all educational level, including beyond the clinical symptoms also the factors of the work organization. Method: It was performed a study of transversal cut in 328 professors of 4 educational institutions of the northern of São Paulo, which it was applied a self assessment questionnaire elaborated by TRipartite Commission of Standardization for Professional Voice. Results: It was determined the prevalence of clinical symptoms that compound the dysphonic syndrome, as well as it was delineate the work organization and the quality of life of this population. Conclusion: The questionnaire applied was showed itself satisfactory en the description and elaboration of parameters with the aim of to implement preventive programs to populations exposed to professional overload of the voice use. Case study.

Introduction: The saddle nose may be caused by many factors: biologic, genetic and iatrogenic. The lesions may affect the cartilaginous and osseous parts or both. Surgical intervention is required to correct the anatomic and physiologic disorders and improve the aesthetic and emotional aspect. Objective: The objective of this case report is to approach different surgical techniques for rebuilding of the saddle nose, by emphasizing the use of the chondrocostal cartilage. Case Report: The patient DBJD, 43 years old, presented nasal deformity, saddle nose, of traumatic etiology. He was submitted to correction using chondrocostal cartilage. Final Comments: The use of this cartilage for rebuilding of the saddle nose has an easy handling and a good aesthetic-functional outcome.

Introduction: The correlation between the transient (TEOE) and distortion product (DPOAE) evoked otoacoustic emissions may be useful for the neonatal auditory screening, mainly in premature infants, who have risk indicators for hearing deficiency. There is need for deepening the knowledge regarding this population cochlea features. Objective: To compare the TEOE and DPOAE in premature infants. To analyze the reproducibility in the TEOE, the amplitude and the sign/noise ratio in the TEOE and DPOAE. Method: TEOE and DPOAE were carried out in 50 premature infants. The tests were correlated as for the criterion "pass/failure" and compared according to amplitude and sign/noise ratio parameters. Results: The TEOE were present in 71% of the sample. The frequency of 3kHz presented a better performance in the average reproducibility, amplitude and sign/noise ratio. The DPOAE were present in 97% of the sample. The frequency of 2kHz had a major average amplitude, the values of the sign/noise ratio increased proportionally in the high frequencies. There was a strong correlation between TEOE and DPOAE in the "pass/failure" criterion (p=0.006). Conclusion: The correlation between the TEOE and DPOAE results was significant. But one method compliments the other and both may be used in the TAN.

Introduction/Objective: The mastoid osteoma is a benign osteogenic tumor, considered to be uncommon in such location. By 2006, there were about 150 cases reported in the medical literature. Its etiopathogenesis includes factors relating to embryogenesis, metaplasia, trauma and inflammation. They are generally asymptomatic and appear through tumoration protrusion from the retroauricular region. Computed tomography has been useful for its diagnosis and surgical planning. Its surgical results are good from a aesthetic and curative point of view. Method: We studied two cases of mastoid osteoma and analyzed them as for their clinical state, imaging exams, treatment and results. Results: Both locating in the right mastoid region. Absence of a previous trauma in this region. Normal neurological exam. The cranial computed tomography revealed a hyperdense lesion involving the cortex of the temporal bone in the mastoid region, radiologically compatible with osteoma. They were submitted to complete exeresis of the lesion. Anatomopathological exam: osteoma. They had excellent aesthetic and curative results. There was no recurrence or malignant transformation. Conclusions: The osteoma located in the mastoid region is an uncommon benign tumor. It provokes local aesthetic deformity and is generally asymptomatic. The choice exam is computed tomography. It has a differential diagnosis with hemangioma, fibrous dysplasia, osteosarcoma and osteoblastic metastasis. The exam does not present malignant transformation. The treatment is surgical and with excellent aesthetic and curative results.

Introduction: The industrial technological advance has brought benefits and a series of implications that may commit the worker's health and life quality. The exposure to physical, chemical agents and organizational stressors contribute for the increase of work accidents risks. The noise, taken as the most frequent physical agent in the work environment, may cause auditory alterations called Noise-Induced Hearing Loss that affect the communication and life quality of the workers. Objective: To research the auditory health of employees in a funeral urns factory. Method: 90 workers took part in this study, aged between 16 and 52 years, exposed to sound pressure levels equal or higher than 85 dBNPS, vibration and/or chemical agents in the work environment. We carried out a specific interview and Threshold Tonal Audiometry. Results: This study identified altered audiometry results in 13.33% the right ear and 16.67% in the left ear and the age also influenced these auditory thresholds. Conclusion: The accomplishment of a workers' health surveillance program with all people involved is critical and will contribute for the human resources formation, in the management to proceed with actions as well as those by the proper workers being careful of their health.

Introduction: Osteoblastoma is defined as a lesion of bone, which is rich in osteoblasts, well-vascularized, and affects mainly the spinal cord. Although it is benign, it presents malignant features and simulates osteosarcoma. It affects mainly young adults between 20 and 40 years old. It rarely compromises the temporal bone. Objective: To present a rare case in the temporal bone with clinical malignant features whose the anatomopathological study has revealed to be a benign tumor. Method: The patient presented a tumor which affected the middle ear cleft, the mastoid, and the right middle fossa. The patient underwent a surgery and, in association with otorhinolaryngology, the tumor was completely dried out from the middle fossa and the middle ear. Fascia lata was used to repair the dural impairment and an acrylic plate was used to cover the bone impairment. Result: Post-surgery evolved positively, however the acrylic plate has moved itself and has stenosed the right external acoustic meato, which had to be removed 3 years later. The patient has had a good followup, which is still being carried through. Conclusion: Osteoblastoma is a multiform tumor that might affect the temporal bone with malignant features, which simulates osteosarcoma, but, in histological terms, it does not present any malignant signals. However, there is a need for a long post-surgery follow-up.

Este artigo descreve metodologia, aplicação e utilidade do teste das Matrizes Progressivas de Raven e do Teste de Sondagem Intelectual (TSI), comparando-os ainda com o rendimento escolar do aluno, em Jequié, Bahia. O Raven, que avalia o raciocínio não-verbal, foi aplicado a 374 escolares (7 a 17 anos). Somente 231 TSI foram respondidos porque requeriam habilidades de leitura e escrita. Foram coletadas notas escolares para todos os participantes. Um questionário avaliando recursos da escola e perfil do professor foi respondido por duzentos professores. Os escores dos testes Raven e TSI apresentaram uma boa correlação entre si (r = 0,53, p < 0,001) porém menor com as médias escolares (r = 0,22, p < 0,001 e r = 0,12, p < 0,07 respectivamente). Os escores do Raven e do TSI apresentaram baixas correlações com os conceitos escolares. A média de escores, tanto no teste Raven como no TSI, foi maior entre os meninos, sendo superior o desempenho das meninas nas notas escolares. De maneira geral o nível de desempenho cognitivo encontrado está aquém do esperado em crianças do grupo de idade analisada.

A resposta dos serviços à implantação de um sistema de informação depende de uma série de fatores, entre os quais, destaca-se a organização local. Este trabalho comparou o padrão de registro dos dados de produção de quimioterapia e radioterapia dos municípios do Rio de Janeiro e Belo Horizonte, Brasil, no Sistema de Informação Ambulatorial do SUS, no período de novembro de 1998 a fevereiro de 2003. Ambos os municípios mostraram uma tendência de alta na série de produção de quimioterapia, e apenas o Rio de Janeiro, na série de radioterapia. Comparando os modelos de Box-Jenkins de cada série, verificou-se que o Rio de Janeiro apresenta um atraso de três meses no registro de produção, devido às unidades públicas. Em Belo Horizonte, o atraso é menor e não foi observada diferença no registro da produção entre as unidades públicas e contratadas. A diferença observada entre os municípios parece estar associada ao fato de Belo Horizonte dispor de um sistema de controle e avaliação da produção anterior a 1998, ano da implantação do sistema.

Este artigo discute a Política Nacional de Saúde Indígena, formulada na década de 90 como parte da reforma sanitária brasileira, tendo como marco a criação, em 1999, do Subsistema de Atenç��o à Saúde Indígena. Coordenado pelo nível central, sob gestão da Fundação Nacional de Saúde/Ministério da Saúde, a implementação desse subsistema exigiu adaptações na organização dos sistemas de serviços de saúde em nível local, formulando-se os Distritos Sanitários Especiais Indígenas. Essa conformação evidenciou a necessidade de interlocução e negociação entre as diversas instituições vinculadas à questão indígena, na perspectiva de superar conflitos de múltipla natureza e dificuldades operacionais. A análise realizada neste trabalho aponta as dificuldades de implementação de uma política de saúde indígena diferenciada, sob a responsabilidade federal, no âmbito do SUS descentralizado, pois a ausência de mecanismos e instrumentos específicos que regulamentem a operacionalização desses serviços em nível local, assim como a falta de supervisão mais efetiva e avaliação permanente de resultados da implementação dessa política, fazem com que a atenção diferenciada à população indígena esteja submetida às vicissitudes ou virtudes da política local.

This paper describes the relationship between school trajectory and incidence of teenage pregnancy. A cross-sectional residence-based questionnaire was applied, interviewing 4,634 youth ages 18 to 24 years, selected through a stratified three-stage sample. For the present study, young people ages 20 to 24 years (65.6%) were chosen, with teenage pregnancy rates of 29.5% for females and 21.4% for males (in relation to their partners). Sexual debut was reported by 87% of women and 95.3% of men. The majority of young people reported irregular school trajectory, with 39% enrolled in school at the time of the study. Nearly half of those who had interrupted their studies at least once reported a teenage pregnancy. The main reasons for interrupting their studies were pregnancy and children for women and work for men. School dropout due to teenage pregnancy was mentioned by 40.1% of women for whom the outcome of pregnancy was a child. However, 20.5% had already dropped out of school before becoming pregnant.

This study aims to determine spatial patterns of mortality and morbidity for five health problems in an urban environment: homicides, adolescent pregnancy, asthma hospitalization, and two vector-borne diseases, dengue and visceral leishmaniasis. All events were obtained through the city health database and geoprocessed using residential addresses and 80 planning units consisting of census tracts. We used thematic maps, proportionate mortality/morbidity ratios by planning unit, and the overlapped rank of the 20th worse planning unit rates for each event. A spatial pattern of high rates of homicides, proportion of young mothers, and hospitalization due to asthma overlapped in socially and economically disadvantaged areas. For the two vector-borne diseases, high rates with great dispersion were found in underprivileged areas, in contrast with very low rates among higher income areas. The results indicated the coexistence of heavier disease burden for residents of urban areas where poverty and lack of effective public health policies may be modulating social health problems. For the two vector-borne diseases, an environmental intervention in one mosquito-borne disease might be playing a role in the other's incidence.

Neste artigo analisam-se os laudos e dados obtidos das investigações de acidentes graves e fatais do trabalho efetuadas pelo Instituto de Criminalística (IC), Regional de Piracicaba. Foram analisados 71 laudos de acidentes ocorridos em 1998, 1999 e 2000. Os acidentes envolvendo máquinas representam 38,0%, seguido pelas quedas de altura (15,5%) e em terceiro lugar os causados por corrente elétrica (11,3%). Os laudos concluem que 80,0% dos acidentes são causados por "atos inseguros" cometidos pelos trabalhadores, enquanto que a falta de segurança ou "condição insegura" responde por 15,5% dos casos. A responsabilização das vítimas ocorre mesmo em situações de elevado risco em que não são adotadas as mínimas condições de segurança, com repercussão favorável ao interesse dos empregadores. Observa-se que estas conclusões refletem os modelos explicativos tradicionais, reducionistas, em que os acidentes são fenômenos simples, de causa única, centrada via de regra nos erros e falhas das próprias vítimas. A despeito das críticas que tem recebido nas duas últimas décadas no meio técnico e acadêmico, esta concepção mantém-se hegemônica prejudicando o desenvolvimento de políticas preventivas e a melhoria das condições de trabalho.

Este estudo objetivou determinar a prevalência do traumatismo dentário na dentição permanente e observar associações com fatores predisponentes. Foi realizado um estudo transversal com escolares de 11 a 13 anos de Biguaçu, Santa Catarina, Brasil. Os exames foram realizados por um cirurgião-dentista utilizando os mesmos critérios do Children's Dental Health Survey do Reino Unido. Foram observados tipo de dano, tratamento providenciado e necessidade, overjet incisal, adequabilidade da cobertura labial, idade, sexo e nível de educação dos pais. Foram examinadas 2.260 crianças e as prevalências encontradas foram: 10,4%, 10,6% e 11,2% aos 11, 12 e 13 anos, respectivamente. A necessidade de tratamento foi de 6,3 incisivos por mil examinados. Escolares do sexo masculino e com overjetmaior que 5mm tiveram mais traumatismo dentário do que escolares do sexo feminino e com overjetincisal até 5mm. Cobertura labial inadequada e nível de educação dos pais não estiveram estatisticamente associados com o traumatismo dentário. Concluiu-se que ser do sexo masculino ou ter um overjetincisal maior do que 5mm aumenta a chance de sofrer traumatismo dentário.

Neste estudo, estimou-se a prevalência de gravidez na adolescência (GA), em Salvador, Rio de Janeiro e Porto Alegre, analisando-se o perfil de quem engravida e seus parceiros e os resultados da gestação. Trata-se de inquérito domiciliar, com entrevistas de uma amostra estratificada de homens e mulheres entre 18 e 24 anos, para a avaliação retrospectiva da GA. Foram entrevistados 4.634 jovens (85,2% dos elegíveis); 21,4% dos homens e 29,5% das mulheres com 20 anos e mais referiram GA, mas poucas se deram antes dos 15 anos (0,6% e 1,6%). A gravidez entre adolescentes foi relatada por 55,1% dos homens e 27,9% das mulheres; a maioria dessas teve a GA em relacionamento estável com parceiro mais velho (79,8%). A ocorrência de GA variou inversamente com a escolaridade e a renda. A primeira GA foi levada a termo por 72,2% das mulheres e 34,5% dos homens, estes com maior percentual de relato de aborto provocado (41,3% contra 15,3% das moças). Com o nascimento de um filho antes dos 20 anos, parte das moças parou os estudos temporária (25,0%) ou definitivamente (17,3%), mas 42,1% já se encontravam fora da escola.

A leptospirose apresenta no Estado do Rio Grande do Sul uma grande diversidade de situações de exposição, reservatórios, agentes etiológicos e quadros clínicos. O principal objetivo desse trabalho é identificar áreas de maior risco e possíveis componentes ecológicos da transmissão da leptospirose por meio da agregação de dados epidemiológicos em unidades espaciais que representem a diversidade sócio-ambiental do Estado. Os 1.274 casos confirmados de leptospirose ocorridos em 2001 foram georreferenciados por município de residência. Os mapas de municípios foram sobrepostos aos de caracterização de uso do solo, relevo e bacias hidrográficas. Com as operações de SIG, foram calculadas as taxas de incidência para cada categoria e sua significância estatística. As maiores taxas de incidência foram verificadas em áreas sedimentares litorâneas, de baixa altitude e uso do solo predominantemente agrícola. Nessas áreas, a maior parte dos casos está associada à lavoura irrigada. Os resultados sugerem a existência de características ecológicas favoráveis à transmissão da leptospirose em locais de proliferação de roedores sinantrópicos e de produção agrícola intensiva. São discutidos os efeitos da agregação de dados em unidades ambientais na análise de dados epidemiológicos e estratégias de controle da endemia no Estado.

O objetivo deste artigo foi caracterizar o processo do trabalho rural em nove municípios de Minas Gerais, considerando indicadores sócio-demográficos, a estrutura agrária dos estabelecimentos rurais, práticas de trabalho relacionadas ao uso de agrotóxicos e, a intoxicação associada a seu uso. Os dados foram obtidos de uma pesquisa realizada pela Fundação Jorge Duprat Figueiredo, de Segurança e Medicina do Trabalho, que aplicou um questionário a 1.064 trabalhadores rurais, entre os anos de 1991 a 2000. Por meio de uma regressão logística, foram obtidos os fatores de risco associados à intoxicação por agrotóxicos dos grupos organofosforados e carbamatos. Cerca de 50% dos entrevistados se encontravam ao menos moderadamente intoxicados. Os fatores de risco encontrados foram: ter o último contato a menos de duas semanas com agrotóxicos; não usar proteção; ser orientado pelo vendedor; citar organofosforado ou carbamato como agrotóxico principal e trabalhar nos municípios de Teófoli Otoni, Guidoval ou Piraúba. Os resultados apontam para o alto grau de risco de agravos à saúde a que estão sujeitos trabalhadores rurais em contato com agrotóxicos.

A análise da série histórica de 1979-1997 permite perceber a evolução demográfica e da mortalidade no Município de Niterói, Rio de Janeiro, Brasil, ao longo dessas décadas. A população apresentou um declínio na velocidade de crescimento, com alteração significativa de sua estrutura etária. Observa-se, na série temporal, o declínio da mortalidade por doenças do aparelho circulatório, a tendência geral de declínio das doenças infecto-parasitárias, com acentuado aumento a partir de 1996, decorrente da mudança de classificação das doenças (CID-9 para CID-10). Quanto à mortalidade infantil, destaca-se o predomínio dos óbitos na faixa neonatal. O desvendar das doenças e agravos dentro dos grandes grupos revela a importância das doenças isquêmicas do coração e doenças cerebrovasculares, dos homicídios, acidentes de transporte e da AIDS.

Reforma e eqüidade são termos que têm freqüentado os discursos políticos, documentos técnicos e discussões conceituais nas últimas décadas em distintas propostas com diferentes referenciais ideológicos. Entender a importância e centralidade desses temas no debate contemporâneo na América Latina pressupõe aprofundar a reflexão sobre a política de saúde no âmbito das políticas sociais, qualificar de que reformas estamos falando e o lugar que a eqüidade ocupa nessa discussão. Na primeira parte deste ensaio, discutem-se os conceitos de reforma e eqüidade; a seguir, faz-se um repasse sobre política de saúde como política social; e por fim, são discutidos os elementos centrais da agenda de reforma de sistemas de saúde na região. Conclui-se que a situação é dramática, as reformas recentes exacerbaram as desigualdades e criaram novos problemas, ao substituir valores de solidariedade e igualdade de oportunidade pelos de um "individualismo utilitarista radical"; e o princípio de "necessidades de saúde" pelo de "risco", monetarizado e definido segundo a posição social e econômica do indivíduo. Faz-se necessário retomar a discussão das políticas sociais e de saúde como a matriz de princípios que justificam o ordenamento de quaisquer outras políticas.

Os estudos desenvolvidos na saúde reprodutiva discutem, entre outras coisas, as lacunas existentes nos modelos tradicionais de pesquisa, os quais negligenciam aspectos sócio-culturais e também ético-filosóficos. Estes aspectos atravessam a definição de temas essenciais à pesquisa em saúde reprodutiva, tais como: sexualidade, reprodução e gênero. A busca da articulação entre as duas disciplinas (Ciências Sociais e Saúde Pública) ajuda a pensar como as pessoas e os grupos sociais delimitam e percebem os riscos que enfrentam. Neste estudo, analisamos a percepção de risco em saúde reprodutiva de um grupo de homens de camadas populares do Rio de Janeiro, entrevistados no âmbito de uma pesquisa sobre contracepção. Visamos identificar as situações e os contextos em que o problema emerge e o conteúdo atribuído ao mesmo. A partir desses depoimentos, é possível concluir que existe uma hierarquia de riscos entre os entrevistados, a qual é modificada dependendo de valores culturais, contextos relacionais, institucionais e sociais.

There are indications that the widespread use of organotin compounds (TBT and TPT) as antifoulings, as stabilizers in plastic and as pesticides, has severely affected several species of marine organisms. The most striking effect of TBT and TPT as hormonal disruptors is the development of male organs in females of gastropods, currently denominated imposex. This syndrome can lead to the sterilization and death of affected organisms. The present work gives an overview of the present state of knowledge on imposex occurrence and reports results of a survey conducted in Guanabara Bay, Rio de Janeiro and in several sites along the coast of Fortaleza, Ceará State. Different stages of imposex development were verified in this survey, however, the most prominent levels appeared associated to known spot sources of TBT and TPT.

O presente artigo analisa o processo de construção de identidade dos agentes comunitários de saúde (ACS) a partir de sua inserção na equipe do Programa de Saúde da Família e da interação com os moradores dos bairros onde atuam. Destacaremos dessa análise especialmente os aspectos que dizem respeito aos conflitos de interpretações, as relações de poder que se estabelecem entre os usuários do programa na construção identitária do ACS a partir de três perspectivas: aquela que vem inscrita na formação oficial desses agentes, aquela produzida pelo próprio agente acerca de si mesmo e da sua prática e aquela veiculada pela comunidade. Pode-se dizer que o fato de ser o ACS uma pessoa que convive com a realidade e as práticas de saúde do bairro onde mora e trabalha, e ser formado a partir de referenciais biomédicos, faz deste um ator que veicula as contradições e, ao mesmo tempo, a possibilidade de um diálogo profundo entre esses dois saberes e práticas.

O Estado do Rio de Janeiro concentra uma das maiores redes de hospitais psiquiátricos do país, sendo um deles a Casa de Saúde Dr. Eiras/Paracambi (CSDE-P). A atual Assessoria de Saúde Mental da Secretaria de Estado de Saude do Estado do Rio de Janeiro, realizou em fins de 2000, o Censo Clínico e Psicossocial dos Pacientes Internados na CSDE-P. Encontrou uma população de 1494 indivíduos, com predomínio de homens (53,4%), solteiros (81,6%), faixa etária produtiva (66,4%) e baixa escolaridade (11,5% com primeiro grau completo ou mais). A maioria tinha um tempo de internação superior/igual a 2 anos (77,6%), recebiam visitas de familiares (60,5%) mas não saíam de licença (73,8%). Os diagnósticos predominantes foram as esquizofrenias (53,6%) e o retardo mental (26,4%). A principal abordagem terapêutica foi a psiquiátrica (84,1%). Realizavam atividades sistemáticas durante o dia 13,3% dos pacientes, embora cerca de 36% apresentassem bons indicativos de condições de autonomia. A CSDE-P é um macro hospital, onde a maioria dos pacientes encontra-se desterritorializada e com laços sociais precários, exigindo a construção de estratégias de cuidados que levem em conta essa particularidade.

Este trabajo se propone reflexionar sobre el lugar que la comunidad de los especialistas en salud pública está ocupando en las reformas contemporáneas de los sistemas de salud. Discutimos la cuestión a partir de los casos de Brasil y de México porque, en ambos países, un grupo de especialistas en salud pública proyectó su participación más allá del ámbito técnico-científico y logró influir en el conflicto en torno a la reorientación de las políticas de salud de sus países. Una de sus acciones consistió en elaborar un marco cognoscitivo en el cual se alimentan proyectos técnico-asistenciales de reforma entendidos como propuestas políticas con contenido técnico. Nuestro propósito es demonstrar que estos profesionales logran influir en el debate nacional en el momento en que la discusión técnico-científica rebasa el ámbito de los especialistas para instalarse en el palco del debate socio-político. En nuestra opinión, esto sucede porque el conocimiento técnico-científico producido por esos grupos fue postulado, independendiente de su valor intrínseco, como plataforma ideológica alternativa, capaz de dar sustento a un proyecto técnico-asistencial de referencia que, convertido en proyecto político, sirvió para aglutinar a determinados sectores sociales.

Este ensayo propone una revisión de la cuestión equidad y reformas en América Latina y el Caribe en el contexto de cambios de las dos últimas décadas, dando énfasis a la discusión de la reforma de los sistemas de servicios de salud. La coyuntura económica, política y social de los críticos años 70 fue ampliamente favorable a los cortes en el gasto público, sobre todo en el ámbito social, y a la reorganización de servicios de salud bajo una perspectiva economicista, pragmática y restrictiva. El balance de la situación económica y social latinoamericana es impactantemente negativo, e incluso los esfuerzos para recuperar los estragos de los años 80 no tuvieron mucho éxito en los 90. Las reformas implementadas en algunos países confirman la difusión de una agenda común, adaptada a las condiciones nacionales, siendo las opciones más radicales de adhesión al nuevo modelo reformista las que presentan peor impacto en términos de equidad. Algunos resultados positivos de estos procesos se diluyen en los nuevos problemas suscitados por las propias reformas. La superación de las desigualdades, sin embargo, todavía es una meta distante.