Adherence to Self-care and Quality of Life of Patients with Diabetic Foot Ulcers Treated with Low-Level Laser Therapy: An Exploratory Study.

OBJECTIVE: To evaluate the quality of life (QoL) of patients with a diabetic foot ulcer undergoing treatment with low-level laser therapy (LLLT) at 904 nm and its association with self-care. METHODS: In this randomized, exploratory study, participants were divided into the following four groups: control group (CG) with LLLT placebo, LLLT group 1 (LG1) at 10 J/cm2, LLLT group 2 (LG2) at 8 J/cm2, and LLLT group 3 (LG3) at 4 J/cm2. Participants received light therapy (or placebo) twice a week, for a total of 20 sessions. Researchers assessed participants' QoL using the Short-Form 36 questionnaire. RESULTS: Sixty-two participants were included in the analysis (CG = 18, LG1 = 14, LG2 = 17, LG3 = 13). The LG1 group showed a higher proportion of healing, whereas the CG group showed a lower proportion than the other groups. The LG1 group showed a relationship between physical limitations and blood glucose monitoring, pain and foot care, and general health status (GHS) and foot care. The GL2 group showed a relationship between physical limitations and blood glucose monitoring, vitality and foot care, and GHS and diet. CONCLUSIONS: Low-level laser therapy had a positive impact on QoL as assessed by the Short-Form 36 questionnaire (functional capacity, vitality, and pain domains), and there was a positive association between QoL and self-care in the LLLT groups (physical limitations, pain, GHS, and vitality domains).

Dose-response and efficacy of 904 nm photobiomodulation on diabetic foot ulcers healing: a randomized controlled trial.

PURPOSE: This study aimed to examine the impact of a 904 nm photobiomodulation (PBM) on diabetic ulcers using varying dosages. METHODS: The study was a randomized, double-blind, placebo-controlled clinical trial that compared treatments using PBM (GaAs 904 nm 30w) with three different energy densities (4 J/cm2; 8 J/cm2; 10 J/cm2) in the healing process of non-infected diabetic foot ulcers. Eighty volunteers (48.75% female; 58.5 ± 11.1 years) were randomized into three intervention groups treated with PBM and one control group (PBM placebo). Volunteers performed up 20 interventions with PBM, either placebo or actual, in conjunction with conventional therapy, which involved dressing the wound with Helianthus annuus vegetable oil. The primary variable was the ulcer size reduction rate. RESULTS: GaAs 904 nm PBM yielded a clinically and significant ulcer size rate reduction of diabetic foot ulcers, independently of energy density range (p < 0.05). However, 10 J/cm² had 60% of completely healed ulcers and the highest proportion of patients reaching 50% of ulcer reduction rate after 5 weeks of treatment. In addition, only 10 J/cm² showed a significant difference between control group after a 10-week follow-up (p < 0.05). CONCLUSION: GaAs 904 nm PBM was effective in treating diabetic foot ulcers in this study and a dosage of 10 J/cm², after a 10-week follow-up, proved to be the most effective compared to the other groups. CLINICAL TRIAL REGISTRATION NUMBER: NCT04246814.

Application of Photodynamic Therapy in Pediatric Dentistry: Literature Review.

Microbiological control of dental pathologies presents a significant clinical challenge for dental surgeons, particularly considering drug-resistant microorganisms. To address this issue, Antimicrobial Photodynamic Therapy (PDT) has emerged as an effective and complementary technique for microbial reduction. This therapy involves the application of a photosensitizer dye (PS) either topically or systemically, followed by exposure to low-power lasers with appropriate visible light wavelengths. PDT has found a valuable place in dentistry across various specialties, including surgery, periodontics, endodontics, dentistry, implantology, orthodontics, and pediatrics. In the realm of pediatric dentistry, managing microorganisms during dental treatments has become a major challenge. Considering its promising results and ease of application, Photodynamic Therapy presents an interesting alternative for clinical practice. However, it is important to note that specific protocols must be followed for each application, encompassing the type of photosensitizer, concentration, pre-irradiation time, light type, wavelength, energy, power, and mode of light delivery. Researchers have been steadily refining these protocols to facilitate PDT's integration into clinical practice. The objective of this review is to describe in which procedures and oral health problems in children PDT can be applied. In this sense, we list what the literature brings about the possibilities of applying PDT in a pediatric dentistry clinic.

Alimentos e preparações culinárias regionais e da sociobiodiversidade na alimentação escolar brasileira: uma revisão integrativa / Regional and sociobiodiversity foods and culinary preparations in Brazilian school meals: an integrative review

Objetivo: Discutir como a temática dos alimentos e preparações culinárias regionais e da sociobiodiversidade está inserida na alimentação escolar pública brasileira, por meio do Programa Nacional de Alimentação Escolar (PNAE). Métodos: Revisão integrativa da literatura com buscas nas bases COCHRANE Library, EMBASE, SciELO, LILACS, PubMed/MEDLINE, Scopus, Web of Science e Google Acadêmico. A coleta de artigos foi realizada durante os meses de junho e julho de 2022 e limitou-se a estudos publicados no período entre 2009 e 2022. Os artigos foram agregados em categorias segundo o enfoque ou objetivo de estudo. Resultados: Foram encontrados 2881 resultados e incluídos 21 artigos. Observou-se predominância de abrangência local nos estudos e abordagem qualitativa (42,8%; n=9), com maior recorrência da categoria "presença nos cardápios do PNAE'' (38,1%; n=8), seguido pelas categorias ''interação com os diferentes atores do PNAE" (33,3%; n=7) e "testes de aceitabilidade com estudantes do PNAE'' (28,6%; n=6).  Conclusão: Observou-se a insuficiência de estudos sobre esta temática e, dentre os artigos encontrados, pontua-se a heterogeneidade e fragilidade no arcabouço teórico e nos procedimentos metodológicos. Recomenda-se a realização de mais estudos na área com o objetivo de obter um panorama mais amplo da situação atual da temática no PNAE e explorar as potencialidades dos alimentos e preparações culinárias regionais e da sociobiodiversidade na alimentação escolar brasileira. (AU)

Objective: To discuss how the theme of regional food and culinary preparations and socio-biodiversity is inserted in Brazilian public school feeding, through the National School Feeding Program (PNAE). Method: Integrative literature review with searches in the COCHRANE Library, EMBASE, SciELO, LILACS, PubMed/MEDLINE, Scopus, Web of Science and Google Scholar databases. The collection of articles was carried out in the months of June and July 2022 and was limited to studies published in the period between 2009 and 2022. The articles were aggregated into categories according to the focus or objective of the study. Results: 2881 results were found and 21 articles were included. There was a predominance of local coverage in the studies and a qualitative approach (42.8%; n=9), with greater recurrence of the category ''presence in the PNAE menus'' (38.1%; n=8), followed by categories ''interaction with different PNAE actors'' (33.3%; n=7) and ''acceptability tests with PNAE students'' (28.6%; n=6). Conclusion: There was a lack of studies on this subject and, among the articles found, heterogeneity and fragility in the theoretical framework and methodological procedures were highlighted. It is recommended that further studies be carried out in the area with the aim of obtaining a broader view of the current situation of the theme in the PNAE and exploring the potential of regional food and culinary preparations and socio-biodiversity in Brazilian school feeding. (AU)

What really brings you here today? Applying McWhinney's Taxonomy of Patient Behaviour between the first waves of COVID-19.

Introduction Dr Ian McWhinney argued that the behaviour of patients should be classified in parallel with the taxonomy of disease. Therefore, he proposed a Taxonomy of Patient Behaviour, taking the doctor-patient contact as the reference point. Aim To assess McWhinney's Taxonomy of Patient Behaviour and explore its associations with patient age and gender, type, modality and the weekday of the appointment, in the context of the coronavirus disease 2019 (COVID-19) pandemic. Methods This was a cross-sectional study in a Community Health Centre in Florianópolis, Brazil. We retrospectively collected data from electronic medical records and analysed 4 consecutive weeks of our clinical encounters where every appointment had the patient's motivation for seeking their medical appointment coded as: 'limit of tolerance', 'limit of anxiety', 'heterothetic', 'administrative', or 'no illness'. Results There were 647 appointments. The frequencies of the taxonomic classifications were: 27.8% 'administrative', 26.6% 'limit of tolerance', 21.8% 'limit of anxiety', 18.1% 'no illness', and 5.7% 'heterothetic'. Female patients had more consultations classified as 'heterothetic' and 'limit of anxiety'. 'Limit of tolerance' and 'heterothetic' were more frequent in face-to-face appointments than in remote (on-line) consultations, and most of the 'limit of anxiety' consultations were same-day appointments. The average patient age was slightly higher on appointments classified as 'heterothetic' and lower on 'limity of anxiety' appointments. Discussion The COVID-19 pandemic may have influenced the higher 'administrative' and 'limit of anxiety' frequency presentations. We hope to encourage other family doctors to adopt this system during their consultations and teaching functions and, perhaps, inspire more complex investigations.

Fish defaunation in reservoirs of the Lower Paranapanema River basin, Brazil / Defaunação de peixes em reservatórios do baixo rio Paranapanema, Brasil

Abstract Until now no study has used a defaunation index to quantify the decline of Neotropical freshwater fishes in environments fragmented by dams and reservoirs. So, we applied this index to 143 native fish in five reservoirs in the Lower Paranapanema River, that is situated in one of the Brazilian aquatic environments most impacted by anthropic degradation. Fish species were classified according to their functional groups, which were selected according to the biological characteristics that may reflect in defaunation events. The biggest reservoir in area with more tributaries and forest cover showed lowest defaunation index. The functional groups of fishes more affected by defaunation included species characterized by periphytivores, invertivores and algivores, non-migratory habit, with external fertilization, and parental care. Although reservoirs have different characteristics, this method can be tested in any other hydrographic basin. The results suggested continued conservation efforts to preserve the integrity of tributaries and the native fishes in reservoirs and pointed out the importance of maintaining native vegetation cover and fish restocking programs in the reservoirs with the highest defaunation values. Our finding can be use as the first data source for future studies using this defaunation index.

Resumo Até o momento nenhum estudo utilizou um índice de defaunação para quantificar o declínio de peixes neotropicais de água doce em ambientes fragmentados por barragens e reservatórios. Dessa forma, testamos esse índice em 143 espécies nativas em cinco reservatórios do baixo rio Paranapanema, que está localizado em um dos ambientes aquáticos brasileiros mais impactados pela degradação antrópica. As espécies de peixes foram classificadas de acordo com seus grupos funcionais selecionados de acordo com as características biológicas que podem influenciar nos eventos de defaunação. O maior reservatório em área, com mais tributários e maior cobertura florestal apresentou menor índice de defaunação. Os grupos funcionais mais afetados pela defaunação incluíram espécies caracterizadas por hábito alimentar perifitívoro, invertívoro e algívoro, hábito não migratório, com fertilização externa e cuidado parental. Embora os reservatórios tenham características diferentes, esse método pode ser testado em qualquer outra bacia hidrográfica. Os resultados sugerem esforços contínuos para preservar a integridade dos tributários e dos peixes nativos nos reservatórios e apontam a importância de manter a cobertura vegetal nativa e programas de estocagem nos reservatórios com maiores valores de defaunação. Nossos dados podem ser utilizados como a primeira base de dados para futuros estudos que utilizem o índice de defaunação.

Sex-Specific Asymmetrical Attack Rates in Combined Sexual-Vectorial Transmission Epidemics.

In 2015-2016, South America went through the largest Zika epidemic in recorded history. One important aspect of this epidemic was the importance of sexual transmission in combination with the usual vectorial transmission, with asymmetrical transmissibilities between sexual partners depending on the type of sexual contact; this asymmetry manifested itself in data as an increased risk to women. We propose a mathematical model for the transmission of the Zika virus including sexual transmission via all forms of sexual contact, as well as vector transmission, assuming a constant availability of mosquitoes. From this model, we derive an expression for R 0 , which is used to study and analyze the relative contributions of the male to female sexual transmission route vis-à-vis vectorial transmission. We also perform Bayesian inference of the model's parameters using data from the 2016 Zika epidemic in Rio de Janeiro.

Cell block specimens applied to diagnostic routine of thyroid fine-needle aspiration biopsy / Aplicação do emblocado em parafina ou cell block na rotina diagnóstica de biópsia aspirativa por agulha fina de tireoide

ABSTRACT Introduction: Various preparations can be used in diagnostic cytology, including conventional smears (CS), liquid-based preparations (LBP) and cell block (CB). Objective: The aim of this study is to evaluate the quality of CB preparations in addition to conventional cytological specimens in cases of fine-needle aspiration biopsy (FNAB) of thyroid nodules in diagnostic routine. Method: One hundred and six consecutive cases of FNAB routine thyroid nodules were independently evaluated by two cytopathologists (Obs1 and Obs2) on the cellularity of SM, LBP and CB. Results: The cellularity was rich/moderate in 56 (52.8%) CBs for both observers. LBP showed rich/moderate cellularity in 86 (81.1%) cases for Obs1 and 91 (85.8%) for Obs2; among these cases, CB showed the same cellularity in 52/86 (60.4%) cases for Obs1 and 54/91 (59.3%) for Obs2. SM showed rich/moderate cellularity in 86 (81.1%) cases for Obs1 and 87 (82%) for Obs2; among these cases, CB showed the same cellularity in 48/86 (55.8%) cases for Obs1 and 54/87 (62%) for Obs2. CB cellularity was higher than that in LBP in only five cases for Obs1 and three for Obs2. LBP was assessed as low/absent in only five (4.7%) and six (5.6%) cases for Obs1 and Obs2, respectively. Conclusion: CB can be routinely used as additional specimen in material obtained from thyroid nodules FNAB, without adversely affecting LBP specimens, enabling the conduction of further immunohistochemical and molecular studies.

RESUMO Introdução: Vários preparados podem ser utilizados na citologia diagnóstica, como esfregaços (SM), preparados do tipo meio líquido (ML) e emblocado em parafina ou cell block (CB). Objetivo: Avaliar a qualidade do CB, além dos espécimes citológicos convencionais, em casos de biópsia aspirativa por agulha fina (BAAF) de nódulos de tireoide na rotina diagnóstica. Método: Cento e seis casos consecutivos de BAAF de nódulos de tireoide foram avaliados independentemente por dois citopatologistas (Obs1 e Obs2) quanto à celularidade dos preparados de SM, ML e CB. Resultados: A celularidade foi rica/moderada em 56 (52,8%) CB para ambos observadores. ML mostrou celularidade rica/moderada em 86 (81,1%) casos para o Obs1 e 91 (85,8%) para o Obs2; desses casos, CB mostrou a mesma celularidade em 52/86 (60,4%) casos para o Obs1 e 54/91 (59,3%) para o Obs2. SM mostrou celularidade rica/moderada em 86 (81,1%) casos para o Obs1 e 87 (82%) para o Obs2; desses casos, CB apresentou a mesma celularidade em 48/86 (55,8%) casos para o Obs1 e 54/87 (62%) para o Obs2. A celularidade do CB foi maior do que a do ML em apenas cinco casos para o Obs1 e três para o Obs2. ML foi avaliado como escasso/ausente em apenas cinco (4,7%) e seis (5,6%) casos para os Obs1 e Obs2, respectivamente. Conclusão: CB pode ser utilizado rotineiramente como espécime adicional no material obtido de BAAF de nódulos de tireoide, sem prejuízo dos espécimes de meio líquido, o que possibilita a realização de estudo complementar, principalmente imuno-histoquímico e molecular.

Cirurgias cardíacas convencionais e robótica: comparativo das atividades de vida diária / Conventional and robot-assisted heart surgery: a comparison of activities of daily living

Resumen

Objetivo: evaluar el impacto de la cirugía cardiaca robótica y convencional en el periodo post-operatorio así como la correlación de las influencias sobre las actividades de la vida diaria (AVD).

Método: estudio cualitativo, con metodología de “historia oral". La muestra constó de cuatro pacientes que aceptaron participar en la investigación. Los datos fueron obtenidos a través de entrevistas, que se transcriben y se agrupan en las categorías de análisis.

Discusión/conclusiones: la técnica quirúrgica de bypass coronario robótica, en comparación con la técnica convencional, influye positivamente en la recuperación cardiaca en relación con AVD y las actividades instrumentales de la vida diaria.

Resultados: los resultados de la investigación han puesto de manifiesto que los sentimientos de miedo y aprensión fueron los más experimentados por los encuestados en la cirugía cardiaca pre-operatorio y el método robótico, y se beneficiaron de la corta estancia en la Unidad de Cuidados Intensivos (UCI), alto retorno de una pronta y rápida vuelta a las AVD.

Abstract

Purpose: to assess impact of robot-assisted and conventional heart surgery in postoperative period, and its correlation with their influence on activities of daily living (ADL).

Methods: a qualitative study using "oral history-taking". Four patients accepting to participate were included in the study. Data were collected through interviews that were transcribed and classified into analysis categories.

Results: fear and apprehension feelings were shown to be the most commonly present in respondents regarding heart surgery, preoperatively, and robot-assisted surgery, and benefits were a short stay in intensive care unit (ICU) and a high return to a fast recovery of ADL.

Discussion/Conclusions: surgical technique for robot-assisted coronary bypass, in comparison with conventional technique, has a favorable impact on cardiac recovery regarding ADL and instrumental activities of daily living.

Objetivo: avaliar o impacto da cirurgia cardíaca robótica e convencional no pós-operatório tardio, correlacionando as influências nas atividades de vida diária (AVD).

Método: o presente estudo qualitativo teve como método a “História Oral”, a amostra foi constituída por quatro pacientes que aceitaram participar da pesquisa. Os dados foram obtidos por meio de entrevistas, transcritos e agrupados em categorias de análise.

Resultados: os resultados da investigação permitiram evidenciar que os sentimentos de medo e apreensão foram os mais vivenciados pelos entrevistados na fase pré-operatória, e que os cardiopatas operados pelo método robótico se beneficiaram da curta permanência na Unidade de Terapia Intensiva (UTI), da alta precoce e do rápido retorno às AVD.

Discusao/Conclusão: conclui-se que a técnica cirúrgica robótica de revascularização do miocárdio, quando comparada à técnica convencional, influencia positivamente na recuperação cardíaca no que se refere às AVD e atividades instrumentais de vida diária.

Reação de Jarisch-Herxheimer em gestante com sífilis: relato de caso / Jarisch-Herxheimer reaction in pregnant woman with syphilis: case report

Introdução: a sífilis é uma doença relatada desde o século XV e que ainda hoje representa um sério desafio para a Saúde Pública. Mais de 12 milhões de novos casos são registrados por ano, especialmente nos países em desenvolvimento. Com a comercialização da penicilina, à qual o Treponema pallidum é suscetível, acreditou-se na possibilidade de sua erradicação, o que não se concretizou. Em certas doenças infecciosas a primeira dose de um tratamento antimicrobiano eficaz pode desencadear uma resposta inflamatória no hospedeiro. Neste trabalho apresenta-se o caso de uma gestante, de classe socioeconômica baixa, nulípara, com feto morto com 24 semanas por sífilis congênita, que ao receber o tratamento para sífilis recente apresentou Reação de Jarisch-Herxheimer, ocorrida na maternidade do Hospital da Mulher Heloneida Stuart, em São João do Meriti, Rio de Janeiro.

Introduction: syphilis is a disease which has been reported since the fifteenth century and still represents a reasonable challenge to public health care sistem. More than 12 million new cases are reported every year, especially in developing countries. With the commerce of penicillin, to which Treponema pallidum is susceptible, the possibility of eradication had been considered true, which however, did not happen. In certain infectious diseases, the first dose of an effective antimicrobial treatment can initiate an inflammatory response in the host. This work presents the case of a pregnant woman, low socioeconomic status, nulllipara, with a dead fetus with 24 weeks, upon receiving therapy for early syphilis, triggered Jarisch-Herxheimer reaction, which occurred at the Hospital for Women Heloneida Stuart, in São João de Meriti, Rio de Janeiro.

Adesão ao tratamento e satisfação com o serviço entre pessoas com diabetes mellitus atendidas no PSF em Blumenau, Santa Catarina / Adherence to trearment and health care satisfaction in persons with diabetes in health family program, Blumenau, Santa Catarina

Introdução: A satisfação dos pacientes pode influenciar sua adesão ao tratamento em doenças crônicas. Tem-se por objetivo estudar a associação entre satisfação com o serviço e não-adesão ao tratamento entre diabéticos atendidos no PSF em Blumenau, SC. Métodos: Estudaram-se características sóciodemográficas, da doença, do tratamento e satisfação numa amostra aleatória de usuários em 2006, mediante entrevistas estruturadas. A variável dependente foi não adesão ao tratamento. Mediu-se a glicemia capilar pósprandial. Calculou-se a prevalência de não-adesão, razão de prevalência (IC95%) e análise estratificada por possíveis variáveis de confusão. Utilizou-se teste de Quiquadrado de Pearson e ajustado de Mantel-Haenszel, sendo aceito um valor de p<0,05. Resultados: foram entrevistadas 341 pessoas, sendo 67,4% do sexo feminino, 79,5% brancas, 60,2% casadas e 73,9% católicas. A média de idade foi de 59,4 anos (±13.51) e mediana de 59,3 anos. 93,3% estão satisfeitas com o atendimento do pessoal de saúde, 92,9%, com o médico; 81,7% estão satisfeitas com a estrutura do serviço e acesso a consultas 73,1%. A prevalência de não-adesão ao tratamento foi de 71,0% (IC 95% 65,8 - 75,7) e 47,2 % apresentaram glicemia capilar acima de 180 mg/dl. A não-adesão ao tratamento se mostrou associada a idades mais jovens, cor preta/parda, religião não-católica, consumo de álcool, interrupção previa do tratamento, presença de transtorno mental comum e menor grau de satisfação (p<0,05). Esta última associação sofreu ajuste das variáveis consumo de álcool, transtorno mental e idade. Conclusões: A elevada prevalência de não-adesão deve servir de alerta sobre a qualidade dos serviços. Pessoas mais satisfeitas parecem apresentar maior adesão ao tratamento.

Background: The patients' satisfaction can influence its adherence to drug treatment in chronic diseases. Objective: It was stuied the association between satisfaction of with the health service and non-adherence to treatment among diabetic patients' assisted by PSFin Blumenau, SC. Methods: The socio-demographic characteristics of the illness, treatment and also of the satisfaction were studied in a random sample of users in 2006, through structured interviews. The dependent variable was nonadherence with treatment. The post-prandial glycemic capillary was measured. The prevalence of nonadherence and prevalence ratio (95% confidence interval)were calculated, with stratified analysis by confounding. It was used Pearson's an Mantel-Haenszel Chi-Square test, with an accepted 'p -value' < 0,05. Results: population study had 341 people with age means of 59,4 years (± 13.51) and median of 59,3 years. They are female (67,4%), white (79,5%), married(60,2%) and catholic (73,9%). 93,3% are satisfied with the attendance health service, 92,9% with the doctor, 81,7% are satisfied with the structure of the service and access to appointments 73,1%. The prevalence of nonadherence to treatment was 71,0% and 47,2% hadcapillary glycemia above 180 mg/dl. Non-adherence to treatment was associated with younger age, black color,non-Catholic religion, alcohol consumption, premature interruption of treatment, presence of common mentaldisorder and smaller degree of satisfaction (p < 0,05). This last association was adjusted by variables alcohol consumption, common mental disorder and age. Conclusions: The high prevalence of non-adherence should serve as a warning about the quality of services. People who seem more satisfied produce greater adherence to treatment.

Conhecimento e conduta de pediatras frente a deficiencia auditiva / Knowledge and behavior of pediatricians face to hearing impairment

Objetivo: avaliar o conhecimento e as condutas de pediatras de uma cidade do interior do Estado de Sao Paulo sobre dificiencia auditiva. Casuistica e metodos : foi realizado estudo...

Silicose em cavadores de poços da regiäo de Ibiapaba(CE): da descoberta ao controle / Silicosis among PIT diggers in the region of Ibiapaba, state of Ceará, Brazil: from detection to control

A ocorrência de silicose em cavadores de poços foi descoberta em 1984. Em 1988, foi evidenciado um foco da doença na regiäo da Ibiapaba, Estado do Ceará (Brasil). O presente estudo teve por objetivos: 1) apresentar a intervençäo educativa preventiva primária (IEPP) criada, segundo o método de conscientizaçäo crítica de Paulo Freire, e aplicada aos cavadores de poços e seus familiares; 2) conhecer o papel dessas medidas no aprendizado sobre silicose e nas mudanças de atitude promovidas na prática dessa atividade na regiäo da Ibiapaba. Dos 1.202 cavadores de poços da regiäo, 687 de cinco municípios selecionados para o estudo foram submetidos à IEPP e, destes, 283 participaram do estudo do papel da IEPP no controle da silicose. Todos eram homens, com idades variando de 18 a 78 anos; 115 eram silicóticos, 122 näo silicóticos e 46 ignoravam o diagnóstico. Os resultados mostraram que a IEPP promoveu apresendizado sólido sobre a relaçäo entre cavar poços e silicose, independentemente dos indivíduos serem ou näo portadores da doença, induzindo a maioria deles (85,8 por cento) a abandonarem a atividade. A IEPP foi capaz de promover a conscientizaçäo do problema nos cavadores de poços, interrompendo o ciclo epidemiológico da silicose na regiäo da Ibiapaba.