Which factors influenced the adoption of interprofessionality in health based on the reports of the PET-Health Interprofessionality projects in Brazil? A document analysis.

The Program of Education through Work - Health (PET-Health) Interprofessionality is one of the strategic actions of the "Plan for the Strengthening of Interprofessionality" in healthcare in Brazil. Based on the experience of the program, this paperexamines the aspects that impact the adoption and strengthening of interprofessional education and collaborative practices, and issues recommendations for the strengthening of interprofessionality as a guiding principle of training and working in healthcare. This is a document analysis of partial reports from the six- and 12-months of execution of 120 PET-Health Interprofessionality projects in Brazil. The data were analyzed based on content analysis and the categories elaborated a priori. The aspects that impact the adoption and strengthening of interprofessionality in training and working in healthcare, and future recommendations, were organized in the relational, processual, organizational, and contextual dimensions, according to the framework by Reeves et al. The PET-Health Interprofessionality expanded the understanding of elements of interprofessional education and practice and showed that the discussion must take on a more political, critical, and reflexive character. The analysis points to the need for continuity of teaching-learning activities as a strategy to foster interprofessional capacity in healthcare services and consequent strengthening of the Unified Healthcare System in Brazil.

Deconstruction of banana peel for carbohydrate fractionation.

The deconstruction of banana peel for carbohydrate recovery was performed by sequential treatment (acid, alkaline, and enzymatic). The pretreatment with citric acid promoted the extraction of pectin, resulting in a yield of 8%. In addition, xylose and XOS, 348.5 and 17.3 mg/g xylan, respectively, were also quantified in acidic liquor as a result of partial depolymerization of hemicellulose. The spent solid was pretreated with alkaline solution (NaOH or KOH) for delignification and release of residual carbohydrates from the hemicellulose. The yields of xylose and arabinose (225.2 and 174.0 mg/g hemicellulose) were approximately 40% higher in the pretreatment with KOH, while pretreatment with NaOH promoted higher delignification (67%), XOS yield (32.6 mg/g xylan), and preservation of cellulosic fraction. Finally, the spent alkaline solid, rich in cellulose (76%), was treated enzymatically to release glucose, reaching the final concentration of 28.2 g/L. The mass balance showed that through sequential treatment, 9.9 g of xylose, 0.5 g of XOS, and 8.2 g of glucose were obtained from 100 g of raw banana peels, representing 65.8% and 46.5% conversion of hemicellulose and cellulose, respectively. The study of the fractionation of carbohydrates in banana peel proved to be a useful tool for valorization, mainly of the hemicellulose fraction for the production of XOS and xylose with high value applications in the food industry.

Compressed fluids and phytochemical profiling tools to obtain and characterize antiviral and anti-inflammatory compounds from natural sources.

Many natural compounds, found mainly in plants, are associated with the treatment of various diseases. The search for natural therapeutic agents includes compounds with antiviral and anti-inflammatory activities. Among the many steps involved in bioprospection, extraction is the first and most critical step for obtaining bioactive compounds. One of the main advantages of using compressed fluids extraction is the high quality of the final product obtained due to the use of green solvents, while the selectivity towards target compounds can be tuned by adjusting the process parameters, especially pressure, temperature and solvent characteristics. In this review, a discussion is provided on the power of compressed fluids, such as supercritical fluid extraction (SFE), pressurized liquid extraction (PLE) and subcritical water extraction (SWE) to obtain antiviral and anti-inflammatory compounds from natural sources. In addition, an adequate knowledge about the identity and quantity of the compounds present in the extract is essential to correlate biological activity with chemical composition. Phytochemical profiling tools used for identification and quantification of these bioactive natural compound are also discussed. It can be anticipated that after the current SARS-COV-2 pandemic, the search of new natural compounds with antiviral and anti-inflammatory activity will be a hot research topic, so, this review provides an overview on the technologies currently used that could help this research.

Hydrothermal pretreatment for the production of prebiotic oligosaccharides from tobacco stem.

Tobacco stem is an abundant and inexpensive renewable source to produce prebiotics by circular economy. In this study, hydrothermal pretreatments were evaluated on the release of xylooligosaccharides (XOS) and cello-oligosaccharides (COS) from the tobacco stem by a central composite rotational design associated with response surface methodology to evaluate the effects of temperature (161.72 to 218.3 °C) and solid load (SL) (2.93 to 17.07%). XOS were the main compounds released to the liquor. Desirability function was performed to maximize the production of XOS and minimize the effects of release of monosaccharides and degradation compounds. The result indicated yield of 96% w[XOS]/w[xylan] for 190 °C-2.93% SL. The highest value for COS and total oligomers content (COS + XOS) was 6.42 g/L and 17.7 g/L, respectively, for 190 °C-17.07% SL. The mass balance for the best yield XOS condition predicted 132 kg of XOS (X2-X6) from 1000 kg of tobacco stem.

New perspectives for banana peel polysaccharides and their conversion to oligosaccharides.

Banana peel is a source of polysaccharides: pectin, hemicellulose and cellulose. Recent studies have shown that these carbohydrate fractions can be converted into oligomers, which have applications in food, feed and pharmaceuticals, claiming important technical, functional and biological activities. Potential prebiotic activity of pectin and cellulose oligosaccharides obtained from banana peel was already reported. Based on technologies developed for fractionation and extraction of polysaccharides, such as pectin, hemicellulose and cellulose, banana peel can be explored to obtain functional oligosaccharides.

Hydrothermal treatment on depolymerization of hemicellulose of mango seed shell for the production of xylooligosaccharides.

Hydrothermal processing is an interesting biorefinery technology for converting lignocellulosic biomass into biofuels and biocompounds. This process is based on the selective solubilization and depolymerization of hemicellulose fraction (xylan) and may be considered beneficial, due to the possibility of obtaining xylooligosaccharides (XOS) with a degree of polymerization (DP) suitable for prebiotic applications. This study evaluated the effect of pressure (2.5 and 10 MPa) in a kinetic study (30 min) of hydrothermal treatment (180 °C) to optimize the extraction of XOS from mango seed shell. Total reducing sugars (TRS) values were close to the maximum in 15 min showing a slower rate for both pressures after this time, but at 10 MPa the value was 20 % lower than at 2.5 MPa. Based on these results, a new extraction was performed at 2.5 MPa and 15 min, and the extracted XOS were quantified, yielding 393.44 mg XOS/g xylan. XOS with a degree of polymerization between X2-X6 corresponded to 82.24 mg/g and XOS with X > 6 (or soluble xylan) corresponded to 311.20 mg/g. A low amount of xylose (8.81 mg/g xylan) was released, resulting in a hemicellulose conversion of 40.2 %. In general, approximately 8.1 kg of total XOS was produced from 100 kg of dried mango seed shell (X2-X6-1.7 kg and X > 6-6.4 kg).

PHOTOGRAMMETRY: A PROPOSAL OF OBJECTIVE ASSESSMENT OF CHEST WALL IN ADOLESCENT IDIOPATHIC SCOLIOSIS.

OBJECTIVE: To evaluate the chest wall shape in patients with adolescent idiopathic scoliosis (AIS) in comparison to healthy subjects and the association between the chest wall shape with the spine deformity and lung function in patients with AIS. METHODS: This cross-sectional study enrolled 30 AIS patients and 20 healthy subjects aged 11-18 years old. The Cobb angle evaluation was performed in AIS patients. The chest wall shape was assessed by the photogrammetry method, using the Postural Assessment Software (PAS). We created thoracic markers shaped as angles (A) and distances (D), as follows: A2 (right acromion/xiphoid/left acromion), A4L (angle formed between the outer point of the smallest waist circumference and its upper and lower edges on the left side), A7 (angle formed by the intersection of the tangent segments of the upper and lower scapulae angles), D1R/D1L [distance between the xiphoid process and the last false rib on the right (R) and left (L) sides], and D3 (distance between xiphoid process and anterior superior iliac spine). RESULTS: The thoracic markers A2 and A7 were significantly higher, while the A4L and D1R/D1L were significantly reduced in the AIS group compared to the control. Moderate correlations were found between: A2 and the main and proximal thoracic Cobb angles (r=0.50, r=0.47, respectively); D1R/D1L and the main thoracic Cobb angle (r=- 0.40); and the forced expiratory volume in the first second (FEV1) and D3R (r=0.47). CONCLUSIONS: The photogrammetry method was able to detect chest wall changes in AIS patients, besides presenting correlation between Cobb angles and lung function.

Colônias de pescadores da região costeira do Estado de São Paulo: empoderamento, saúde e qualidade de vida / Fishing communities in a coastal region of the State of São Paulo: empowerment, health and quality of life / Colonias pesqueras de la región costera del Estado de São Paulo: empoderamiento, salud y calidad de vida

O objetivo da pesquisa foi caracterizar oito colônias de pescadores da Região Costeira do Estado de São Paulo quanto a sua organização, suas condições e necessidades em relação à saúde e à qualidade de vida; e apreender as expectativas e perspectivas de sustentabilidade e continuidade das colônias de pescadores. Foi realizado estudo descritivo e qualitativo por meio de entrevistas semiestruturadas com 17 participantes associados às colônias. Os dados foram explorados com base na análise de conteúdo. O retrato apresentado pela pesquisa apontou as adversidades e os obstáculos enfrentados para alcançar o empoderamento e a manutenção de condições dignas para os trabalhadores da pesca artesanal. Foi possível apreender o papel da saúde, do adoecimento em sua qualidade de vida e da valorização das colônias de pescadores como ferramenta importante na consolidação de políticas públicas para a categoria profissional. (AU)

The aim of this study was to characterize the organization, conditions and health and quality of life needs of eight fishing communities in a coastal region of the State of São Paulo, and explore expectations and prospects in relation to the sustainability and continuity of the communities. We conducted a descriptive qualitative study based on semi-structured interviews with 17 community members. The data were analyzed using content analysis. The study demonstrates the adversities and barriers faced by artisanal fishers to achieving empowerment and maintaining dignified livelihoods. The findings also show the role played by health and illness in quality of life and that the valorization of the fishing communities is an important tool in the consolidation of policies geared towards this profession. (AU)

El objetivo de la investigación fue caracterizar ocho colonias de pescadores de la región costera del Estado de São Paulo en lo que se refiere a su organización, condiciones y necesidades con relación a la salud y a la calidad de vida y captar las expectativas y perspectivas en relación con la sostenibilidad y continuidad de las colonias de pescadores. Se realizó un estudio descriptivo y cualitativo, por medio de entrevistas semiestructuradas con 17 participantes asociados a las colonias. Los datos se exploraron por medio del análisis de contenido. El retrato presentado por la investigación señaló las adversidades y obstáculos enfrentados para alcanzar el empoderamiento y mantenimiento de condiciones dignas para los trabajadores de la pesca artesanal. Fue posible captar el papel de la salud y de la enfermedad en su calidad de vida y de la valorización de las colonias de pescadores como herramienta importante en la consolidación de políticas públicas para la categoría profesional. (AU)

Cultural adaptation, reliability and validity of Japanese Orthopaedic Association Back Pain Evaluation Questionnaire to Brazilian Portuguese.

OBJECTIVE: To describe the translation and cultural adaptation of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire into Brazilian Portuguese, and verifies the reliability and validity of this new version. METHODS: A cross-cultural adaptation of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire was performed using the following steps: translation, back-translation, committee review, and pre-testing phase (50 subjects). The psychometric properties were evaluated by application of the questionnaire to 102 patients. Reliability was assessed by homogeneity and stability of measures. The criterion-related validity was tested by comparing scores of Japanese Orthopaedic Association Back Pain Evaluation Questionnaire to Oswestry and Medical Outcomes Study 36 - Item Short questionnaires. RESULTS: Excellent internal consistency was found in both test (Cronbach's α of 0.90) and re-test (Cronbach's α of 0.91). The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire showed good reliability and the correlations ranged from reasonable (0.64) to very good (r=0.91). CONCLUSION: The Brazilian Portuguese version of Medical Outcomes Study 36 - Item Short was easy to apply and understand. The questionnaire had a great impact on assessment and multidimensional care of patients with low back pain.

Reliability analysis of radiographic methods for determination of posterolateral lumbossacral fusion.

OBJECTIVE: To analyze intra and interobserver agreement of two radiographic methods for evaluation of posterolateral lumbar arthrodesis. METHODS: Twenty patients undergoing instrumented posterolateral fusion were evaluated by anteroposterior and dynamic lateral radiographs in maximal flexion and extension. The images were evaluated initially by 6 orthopedic surgeons, and after 8 weeks, reassessed by 4 of them, totaling 400 radiographic measurements. Intra and interobserver reliability were analyzed using the Kappa coefficient and Landis and Koch criteria. RESULTS: Intra and interobserver agreement regarding anteroposterior radiographs were, respectively, 76 and 63%. On lateral views, these values were 78 and 84%, respectively. However, the Kappa analysis showed poor intra and interobserver agreement in most cases, regardless of the radiographic method used. CONCLUSION: There was poor intra and interobserver agreement in the evaluation of lumbosacral fusion by plain film in anteroposterior and dynamic lateral views, with no statistical superiority between the methods.

Radiographic and functional evaluation of the iliac bone graft in the treatment of adolescent idiopathic scoliosis.

This study aimed to assess the impact of the use of an additional iliac bone graft on functional and radiographic results after thoracic spine arthrodesis with pedicle screws in patients with adolescent idiopathic scoliosis. Participants were divided into two groups: a control group that received only local bone (n=19) and a second group that, in addition to this procedure, received an iliac graft (n=22). The evaluations were performed on preoperative, immediate postoperative, and last follow-up (mean 29.7 months; minimum 12 months). Radiographic evaluations included the loss of correction and the presence of nonunion. The functional outcome was evaluated using the Scoliosis Research Society-30 questionnaire. Surgical complications and the presence of iliac donor site pain were also described. There were no significant differences between groups in the pseudoarthrosis rate, loss of correction over time, and quality of life. We concluded that the addition of bone graft from the iliac yielded no benefit in terms of the fusion rate and functional outcomes. The appropriate facetectomy, bed preparation, and filling with a local bone graft must be adequate to achieve an adequate fusion on surgical treatment of adolescent idiopathic scoliosis.

Functional aerobic exercise capacity limitation in adolescent idiopathic scoliosis.

BACKGROUND CONTEXT: Exercise limitation has been described in patients with adolescent idiopathic scoliosis (AIS); however, whether the walking performance is impaired in these patients should be elucidated. PURPOSE: Thus, we aimed to evaluate the physiologic responses to the incremental shuttle walk test (ISWT) in patients with AIS. STUDY DESIGN/SETTING: Cross-sectional study. PATIENT SAMPLE: Twenty-nine patients with AIS and 20 healthy adolescents aged between 11 and 18 years old. OUTCOME MEASURES: Oxygen uptake (VO2), incremental shuttle walk distance (ISWD), ΔVO2/Δwalking velocity, ΔHR/ΔVO2, ΔVE/ΔVCO2, and linearized Δtidal volume (VT)/ΔlnVE, forced expiratory volume in the first second of expiration (FEV1), and forced vital capacity (FVC). METHODS: We performed two ISWTs, and the data used were acquired in the second test. We also evaluated the lung function and respiratory muscle strength through spirometry test and manovacuometry, respectively. All authors confirm that there are no conflicts of interest. To compare the means or medians of variables between patients and healthy subjects, we used the unpaired t test or Mann-Whitney U test, respectively. The correlations were assessed by Pearson or Spearman coefficients according to the distribution of the studied variables. The probability of alpha error was set at 5% for all analyses. RESULTS: Adolescent idiopathic scoliosis patients showed significant lower values of ISWD, VO2, and ventilation at the end of the ISWT, as well as lower FEV1 and FVC; they also presented significantly shallower slope of ΔVT/ΔlnVE, whereas VO2 related significantly with ISWD (r=0.80), FVC (r=0.78), FEV1 (r=0.73), and ΔVT/ΔlnVE (r=0.58). CONCLUSIONS: Adolescent idiopathic scoliosis correlated to walking limitation and was associated to reduced pulmonary function and worse breathing pattern during exercise. Our results suggest that walking-based aerobic exercises should be encouraged in these patients.

Photogrammetry: a proposal of objective assessment of chest wall in adolescent idiopathic scoliosis / Fotogrametria: uma proposta de avaliação objetiva da caixa torácica na escoliose idiopática do adolescente

ABSTRACT Objective: To evaluate the chest wall shape in patients with adolescent idiopathic scoliosis (AIS) in comparison to healthy subjects and the association between the chest wall shape with the spine deformity and lung function in patients with AIS. Methods: This cross-sectional study enrolled 30 AIS patients and 20 healthy subjects aged 11-18 years old. The Cobb angle evaluation was performed in AIS patients. The chest wall shape was assessed by the photogrammetry method, using the Postural Assessment Software (PAS). We created thoracic markers shaped as angles (A) and distances (D), as follows: A2 (right acromion/xiphoid/left acromion), A4L (angle formed between the outer point of the smallest waist circumference and its upper and lower edges on the left side), A7 (angle formed by the intersection of the tangent segments of the upper and lower scapulae angles), D1R/D1L [distance between the xiphoid process and the last false rib on the right (R) and left (L) sides], and D3 (distance between xiphoid process and anterior superior iliac spine). Results: The thoracic markers A2 and A7 were significantly higher, while the A4L and D1R/D1L were significantly reduced in the AIS group compared to the control. Moderate correlations were found between: A2 and the main and proximal thoracic Cobb angles (r=0.50, r=0.47, respectively); D1R/D1L and the main thoracic Cobb angle (r=- 0.40); and the forced expiratory volume in the first second (FEV1) and D3R (r=0.47). Conclusions: The photogrammetry method was able to detect chest wall changes in AIS patients, besides presenting correlation between Cobb angles and lung function.

RESUMO Objetivo: Avaliar o formato da caixa torácica em pacientes com escoliose idiopática do adolescente (EIA), comparando-os com indivíduos saudáveis e analisar a associação do formato da caixa torácica com a deformidade da coluna vertebral e função pulmonar em pacientes com EIA. Métodos: Estudo transversal que avaliou 30 pacientes com EIA e 20 indivíduos saudáveis com idade entre 11 e 18 anos. O ângulo de Cobb foi avaliado em pacientes com EIA. O formato da caixa torácica foi analisado pelo método da fotogrametria, utilizando o Software para Avaliação Postural (SAPO). Foram criados marcadores torácicos descritos como ângulos (A)e distâncias (D): A2 (acrômio direito/processo xifoide/acrômio esquerdo), A4E (ângulo formado entre o ponto externo da menor circunferência da cintura e suas bordas superior e inferior do lado esquerdo), A7 (ângulo formado pela interseção das retas tangentes aos ângulos superior e inferior das escápulas), D1D/D1E [distância entre o processo xifoide e a última costela falsa nos lados direito (D) e esquerdo (E)] e D3 (distância entre o processo xifoide e a espinha ilíaca anterossuperior). Resultados: Os marcadores torácicos A2 e A7 foram significativamente maiores, enquanto o A4E e o D1D/D1E foram significativamente menores no grupo EIA em relação ao controle. Foram encontradas correlações moderadas entre: A2 e os ângulos de Cobb torácico principal e proximal (r=0,50 e r=0,47, respectivamente); D1D/D1E e o ângulo de Cobb torácico principal (r=-0,40); e o volume expiratório forçado no primeiro segundo (VEF1) e D3D (r=0,47). Conclusões: O método da fotogrametria detectou alterações na caixa torácica de pacientes com EIA, além de apresentar correlações significativas entre os ângulos de Cobb e a função pulmonar.

A experiência de revisão das matrizes curriculares em um projeto pedagógico inovador: caminhos para fortalecer a educação interprofissional em Saúde / La experiencia de revisión de las matrices curriculares en un proyecto pedagógico innovador: caminos para fortalecer la educación interprofesional en Salud / Revising curricular matrices in an innovative pedagogical project: ways of strengthening interprofessional health education

Resumo O presente artigo relata o processo de revisão das matrizes curriculares dos cursos de graduação da área da Saúde do campus Baixada Santista da Universidade Federal de São Paulo, no período de 2014 a 2015, pautados na educação interprofissional. Foram realizadas atividades longitudinais (ciclo de palestras com rodas de conversa) e transversais (cinco oficinas). O processo vivenciado trouxe luz aos caminhos necessários para o fortalecimento da educação interprofissional. A experiência propiciou a aproximação dos atores envolvidos na formação dos profissionais de Saúde do campus, ajustes nas matrizes curriculares dos seis cursos de graduação em Saúde e apontamento para a reformulação do programa de desenvolvimento docente, além de trazer a possibilidade de continuidade da consolidação dos princípios do Projeto Pedagógico do campus santista no caminho da educação interprofissional, com garantias de formação para a atuação em equipe e para a atenção integral à Saúde.(AU)

Resumen Esta artículo relata el proceso de revisión de las matrices curriculares de los cursos de graduación del área de Salud del campus Baixada Santista de la Universidad Federal de São Paulo en el período de 2014 a 2015 con base en la educación interprofesional. Se realizaron actividades longitudinales (ciclos de conferencias con rondas de conversación) y transversales (cinco talleres). El proceso experimentado lanzó luz sobre los caminos necesarios para el fortalecimiento de la educación interprofesional. La experiencia propició la aproximación de los actores envueltos en la formación de los profesionales de Salud del campus, ajustes en las matrices curriculares de los seis cursos de graduación en Salud y señalización para la reformulación del programa de desarrollo docente y proporcionó la posibilidad de continuidad de la consolidación de los principios del proyecto pedagógico del campus Santista en el camino de la educación interprofesional con garantías de formación para la actuación en equipo y para la atención integral de la Salud.(AU)

Abstract This article describes the revision process of the curricular matrices of the undergraduate health courses held at Baixada Santista campus of Universidade Federal de São Paulo from 2014 to 2015 based on interprofessional education. Longitudinal (series of lectures with discussion) and transverse activities (five workshops) were conducted. The process brought to light the necessary paths to strengthen interprofessional education. The experience created an opportunity to bring together all agents involved in the education of health professionals on campus, enabled adjustments in the curricular matrices of all six undergraduate health courses, and confirmed the need to reformulate the teacher development program. It enabled to continue consolidating the pedagogical project's principles in the interprofessional education journey, ensuring education towards teamwork and comprehensive healthcare.(AU)

Educação interprofissional na formação em Saúde: a experiência da Universidade Federal de São Paulo, campus Baixada Santista, Santos, Brasil / Interprofessional health education: the experience of the Federal University of Sao Paulo, Baixada Santista campus, Santos, Brazil

Resumo O objetivo deste artigo é descrever e analisar criticamente a experiência de formação interprofissional na graduação em Saúde em um campus de expansão de uma universidade pública federal. Assumir a educação interprofissional (EIP) como direcionadora da formação em Saúde implica no desenvolvimento de uma proposta que rompe com a centralidade em disciplinas e em perfis profissionais específicos. A descrição e análise crítica da experiência desvela os caminhos para a implementação de cursos da área da Saúde, destacando potencialidades, fragilidades e desafios para o desenvolvimento de uma proposta inovadora. Reconhece-se que as ações interprofissionais estão presentes nas diversas atividades acadêmicas e são estruturantes do cotidiano do campus, bem como as resistências à interprofissionalidade e à complexa rede com os serviços públicos. Implementar novas lógicas para formar profissionais em Saúde é, também, defender a universidade pública no país e o Sistema Único de Saúde (SUS).(AU)

Resumen El objetivo de este artículo es describir y analizar críticamente la experiencia de formación interprofesional en Salud en un campus de expansión de una universidad pública federal. Asumir la educación interprofesional (EIP) como orientadora de la formación en Salud implica en el desarrollo de una propuesta que rompe con la centralidad en asignaturas y en perfiles profesionales específicos. La descripción y el análisis crítico de la experiencia revela los caminos para la implementación de cursos del área de la Salud, subrayando potencialidades, fragilidades y desafíos para el desarrollo de una propuesta innovadora. Se reconoce que las acciones interprofesionales están presentes en las diversas actividades académicas y son estructuradoras del cotidiano del campus, así como las resistencias a la interprofesionalidad y la compleja red con los servicios públicos. Implementar nuevas lógicas para la formación de profesionales de Salud también es defender la universidad pública en el país y el Sistema Brasileño de Salud (SUS).(AU)

Abstract The purpose of this article is to critically describe and analyse the interprofessional education experience in health undergraduate courses on an expanding campus of a public federal university. Assuming interprofessional education guides health education implies the development of a proposal that disrupts centrality in specific disciplines and professional profiles. The description and critical analysis of this experience shows ways of implementing health courses, highlighting potentialities, weaknesses and challenges in the development of an innovative proposal. Interprofessional actions are present in different academic activities and structure the campus' daily routine and the resistance to interprofessionality and the complex network of public services. Implementing new logics to educate health professionals also means defending public universities in the country and the Brazilian National Health System (SUS).(AU)

FRACTURE-DISLOCATION OF THE THORACIC SPINE DURING SECOND TRIMESTER OF PREGNANCY: CASE REPORT AND LITERATURE REVIEW.

Spinal fractures associated with spinal cord injury rarely affect pregnant patients. The authors present the case of a 20-year-old woman in her 20(th) week of pregnancy, who suffered fracture-dislocation of the thoracic spine (T4-T5) and underwent decompression, reduction and posterior fusion with pedicle screws. Despite the complete spinal cord injury presented, the pregnancy progressed uneventfully and resulted in birth via normal delivery of a healthy newborn at term. Some particular features of this case, like the care needed in using ionizing radiation, the surgical approach and delivery, use of steroids and pregnancy complications in such patients are discussed here. Only a multidisciplinary team composed by physicians from different specialties (spinal surgeons, obstetricians and physiatrists), nurses and physiotherapists is capable of assisting pregnant patients with spinal cord injuries satisfactorily.

Cultural adaptation, reliability and validity of Japanese Orthopaedic Association Back Pain Evaluation Questionnaire to Brazilian Portuguese / Adaptação cultural, confiabilidade e validade do Japanese Orthopaedic Association Back Pain Evaluation Questionnaire para o português brasileiro

ABSTRACT Objective To describe the translation and cultural adaptation of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire into Brazilian Portuguese, and verifies the reliability and validity of this new version. Methods A cross-cultural adaptation of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire was performed using the following steps: translation, back-translation, committee review, and pre-testing phase (50 subjects). The psychometric properties were evaluated by application of the questionnaire to 102 patients. Reliability was assessed by homogeneity and stability of measures. The criterion-related validity was tested by comparing scores of Japanese Orthopaedic Association Back Pain Evaluation Questionnaire to Oswestry and Medical Outcomes Study 36 - Item Short questionnaires. Results Excellent internal consistency was found in both test (Cronbach's α of 0.90) and re-test (Cronbach's α of 0.91). The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire showed good reliability and the correlations ranged from reasonable (0.64) to very good (r=0.91). Conclusion The Brazilian Portuguese version of Medical Outcomes Study 36 - Item Short was easy to apply and understand. The questionnaire had a great impact on assessment and multidimensional care of patients with low back pain.

RESUMO Objetivo Realizar a tradução e a adaptação cultural para a língua portuguesa do Brasil do Japanese Orthopaedic Association Back Pain Evaluation Questionnaire para avaliação de dor lombar, e verificar a confiabilidade e a validade da nova versão. Métodos A adaptação cultural foi realizada de acordo com as seguintes etapas: tradução, retrotradução, revisão por comitê e pré-teste (50 indivíduos). Após, as propriedades psicométricas foram avaliadas aplicando-se o questionário (teste) em 102 pacientes. A confiabilidade foi verificada por avaliação da homogeneidade e da estabilidade das medidas. A validade de critério foi testada comparando-se as pontuações do Japanese Orthopaedic Association Back Pain Evaluation Questionnaire com os questionários Oswestry e Medical Outcomes Study 36 - Item Short. Resultados Observou-se excelente consistência interna no pré-teste (Cronbach α de 0,90) e no teste (Cronbach α de 0,91). O Japanese Orthopaedic Association Back Pain Evaluation Questionnaire apresentou boa confiabilidade, e as correlações variaram de razoável (0,64) a muito boa (r=0,91). Conclusão A versão em língua portuguesa do Brasil é de fácil aplicação e compreensão, além de apresentar grande acréscimo na avaliação e no cuidado multidimensional de pacientes portadores de dor lombar.

BENDING RADIOGRAPHS AS A PREDICTIVE FACTOR IN SURGICAL CORRECTION OF ADOLESCENT IDIOPATHIC SCOLIOSIS.

OBJECTIVE: To evaluate the use of x-rays in dorsal decubitus, as a predictive factor for surgical correction of the main thoracic curve using pedicle screws, on patients with idiopathic adolescent scoliosis. METHOD: Twenty patients with idiopathic adolescent scoliosis of Lenke types 1A and 1B who were operated using a technique only involving pedicle screws by means of the posterior route were evaluated clinically and radiographically. The curve flexibility was calculated by means of active supine lateral oblique radiographs. The postoperative values for the main thoracic curve were included in a mathematical equation proposed by Cheung et al., with the aim of predicting the expected angular result from the surgical correction. The difference between the expected and actual postoperative results was then investigated regarding its statistical significance. RESULTS: There was statistical significance for all the cases studied, between the values predicted before the operation and the radiographic findings immediately after the operation (p < 0.005). CONCLUSIONS: It is possible to predict the percentage surgical correction of the main thoracic curve that will be achieved using pedicle screws in patients with idiopathic adolescent scoliosis of Lenke types 1A and 1B, by means of preoperative supine oblique radiographs.

Reliability analysis of radiographic methods for determination of posterolateral lumbossacral fusion / Análise da confiabilidade de métodos radiográficos para avaliação da artrodese posterolateral lombossacra

Objective To analyze intra and interobserver agreement of two radiographic methods for evaluation of posterolateral lumbar arthrodesis. Methods Twenty patients undergoing instrumented posterolateral fusion were evaluated by anteroposterior and dynamic lateral radiographs in maximal flexion and extension. The images were evaluated initially by 6 orthopedic surgeons, and after 8 weeks, reassessed by 4 of them, totaling 400 radiographic measurements. Intra and interobserver reliability were analyzed using the Kappa coefficient and Landis and Koch criteria. Results Intra and interobserver agreement regarding anteroposterior radiographs were, respectively, 76 and 63%. On lateral views, these values were 78 and 84%, respectively. However, the Kappa analysis showed poor intra and interobserver agreement in most cases, regardless of the radiographic method used. Conclusion There was poor intra and interobserver agreement in the evaluation of lumbosacral fusion by plain film in anteroposterior and dynamic lateral views, with no statistical superiority between the methods. .

Objetivo Analisar a concordância intra e interobservador de dois métodos radiográficos para avaliação da artrodese lombar posterolateral. Métodos Foram submetidos à fusão posterolateral instrumentada 20 pacientes, avaliados por meio de radiografias anteroposteriores e laterais, em flexão e extensão máximas. As imagens foram avaliadas inicialmente por 6 médicos ortopedistas e, após 8 semanas, reavaliadas por 4 deles, totalizando 400 mensurações radiográficas. Foi realizada análise de confiabilidade intra e interobservador por meio do coeficiente Kappa e pelos critérios de Landis e Koch. Resultados A porcentagem de concordância intra e interobservadores para radiografias anteroposteriores foi, respectivamente, 76 e 63%. Na incidência radiográfica lateral, esses valores foram de 78 e 84%, respectivamente. Entretanto, a análise pelo método de Kappa mostrou concordância fraca e ruim intra e interobservadores para a maior parte dos casos, independentemente do método radiográfico utilizado. Conclusão observou-se fraca concordância intra e interobservadores na avaliação da fusão lombossacra por meio de radiografias simples, nas incidências anteroposterior e laterais dinâmicas, não havendo superioridade estatística entre os métodos estudados. .

Avaliação do uso de imobilização externa após descompressão e fusão cervical por via anterior: Revisão sistemática / Evaluation of the use of cervical restraint collar after anterior cervical fusion and decompression: Systematic review / Evaluación del uso de collar cervical de inmovilización después de la descompresión y fusion cervical por acceso anterior: Revisión sistemática

Este estudo tem como objetivo avaliar a efetividade e a segurança do uso de órteses no pós-operatório de afecções degenerativas da coluna cervical. Apesar de amplamente utilizados, não existem critérios definidos para a aplicação de colares cervicais e sua relevância na artrodese cervical. Foi realizada uma revisão sistemática da literatura, além de um estudo multicêntrico controlado, composto por 32 serviços, com um total de 257 pacientes que satisfizeram os critérios de inclusão da revisão. Foram comparados desfechos clínicos e radiográficos de pacientes operados em um único nível anatômico que fizeram uso ou não de colar cervical rígido por 6 a 12 semanas após a cirurgia. As evidências disponíveis na literatura, apesar de fracas, sugerem que o uso do colar cervical diminui os escores clínicos nas primeiras semanas após o procedimento cirúrgico. Além disto, não altera a taxa de fusão quando utilizado concomitantemente à placa e aos parafusos por acesso anterior, em doenças degenerativas cervicais em um único nível anatômico.

This study aims to evaluate safety and effectiveness of the use of orthesis in postoperative degenerative disorders of the cervical spine. Although widely used, there are not defined criteria for the use of cervical collars, and their importance on cervical arthrodesis. A systematic literature review was undertaken and a multicentre controlled clinical trial comprising 32 specialized services, with a total of 257 patients who met the inclusion criteria of the review. Clinical and radiographic outcomes were compared in post surgical patients that used or not rigid cervical collar during 6 to 12 weeks after surgery. The evidence available on literature, although weak, suggests that cervical collar decreases the clinical scores in first weeks after surgery. Furthermore, it does not alter the rate of fusion when used concomitantly with plaque and screws through anterior access in cervical degenerative diseases on a single anatomical level.

Este estudio tiene como objetivo evaluar la eficacia y seguridad de la utilización de ortesis después de la cirugía de trastornos degenerativos de la columna cervical. Aunque ampliamente utilizado, no existen criterios para la aplicación de collares cervicales y su importancia en la artrodesis cervical. Se realizó una revisión sistemática de la literatura y un estudio multicéntrico controlado, compuesto de 32 departamentos, con un total de 257 pacientes que cumplieron los criterios de inclusión de la revisión. Se compararon los resultados clínicos y radiográficos de pacientes, en un solo nivel anatómico, que usaron o no el collar cervical duro durante 6 a 12 semanas después de la cirugía. La evidencia disponible en la literatura, aunque débil, sugiere que el uso del collar cervical reduce las puntuaciones clínicas en las primeras semanas después de la cirugía. Además, no altera la tasa de fusión cuando se utiliza de forma concomitante con la placa y tornillos colocados por acceso anterior en la enfermedad degenerativa cervical en un solo nivel anatómico.