An algorithm for the National Institute of Health Stroke Scale assessment: A multicenter, two-arm and cluster randomized study.

BACKGROUND: The NIH Stroke Scale (NIHSS) is a validated tool for assessing stroke severity, increasingly used by general practitioners in telemedicine services. Mobile apps may enhance its reliability. We aim to validate a digital platform (SPOKES) for NIHSS assessment in telemedicine and healthcare settings. METHODS: Hospitals using a telemedicine service were randomly allocated to control or SPOKES-user groups. The discrepancy between the NIHSS scores reported and those confirmed by experts was evaluated. Healthcare providers from comprehensive stroke centers were invited for interrater validation. Participants were randomized to assess the NIHSS using videos of real patients. Weighted Kappa (wk) statistics analyzed the agreement, and logistic regression determined the correlation with the congruency. RESULTS: A total of 299 telemedicine consultations from 12 hospitals were included. The difference between the NIHSS scores reported and double-checked was lower in the SPOKES group (p = 0.03), with a significantly higher level of complete agreement (72.5 % vs. 50.4 %, p = 0.005). Adoption of SPOKES was associated with complete congruency (OR 4.01, 95 %CI 1.42-11.35, p = 0.009). For interrater validation, 20 participants were considered. In the SPOKES group, almost-perfect and strong agreement occurred in 13.3 %(n = 6/45) and 84.4 %(n = 38/45) of ratings, respectively; in the control group, 6.7 %(n = 3/45) were almost-perfect, 28.9 %(n = 13/45) strong and 51 %(n = 23/45) were minimal. CONCLUSION: A free and reliable mobile application for NIHSS assessment can significantly improve interrater agreement between healthcare professionals, and between NIHSS-certified neurologists and general practitioners. Our results underscore the importance of ongoing training and education in enhancing the consistency and reliability of NIHSS scores.

Patients' Perspectives on Determinants Avoidable Hospitalizations: Development and Validation of a Questionnaire.

Ambulatory care sensitive conditions (ACSC) can be avoided through effective care in the ambulatory setting. Patients are the most qualified individuals to express the social and individual contexts of their own experience. Thus, understanding why potentially preventable hospitalizations occur is important to develop patient-centred policies or interventions that may reduce them. This study aims to develop and validate a questionnaire to capture the patients' perspective on the causes of the hospitalizations for ACSC. The development of a new questionnaire involved four phases: a literature review, face validity, pre-test, and validation. We conducted a three-step face validity verification to confirm the relevance of the identified determinants and to collect determinants not previously identified by interviewing healthcare providers, representatives of patients' associations, and patients. Determinants were identified through the literature review predominantly in the "Healthcare Access", "Disease self-management", and "Social Support" domains. The validated resulting questionnaire comprises 25 questions, distributed by two dimensions (individual/contextual) covering seven domains and 20 determinants of ACSC hospitalization. Currently, there are no validated instruments as comprehensive and easy to use as the one described in this paper. This questionnaire should provide a base for further language/context validations.

Tradução e validação para a língua portuguesa e avaliação do guia COREQ / Traducción y validación al idioma portugués y evaluación de la guía COREQ / Translation and validation into Brazilian Portuguese and assessment of the COREQ checklist

Resumo Objetivo: Traduzir e validar o guia Consolidated Criteria for Reporting Qualitative Research (COREQ) para o português falado no Brasil e verificar o impacto da recomendação do uso COREQ pelos autores em artigos publicados em uma revista científica de Enfermagem Métodos: Estudo metodológico e descritivo. Na primeira etapa, adotou-se protocolo para tradução de instrumentos, em seguida o guia COREQ em português brasileiro foi aplicado para análise da qualidade dos artigos publicados, em uma revista científica, dois anos anteriores e dois anos posteriores à adoção do COREQ pela revista. Resultados: A primeira fase traduziu e validou os 32 itens do COREQ por três juízes e com emprego da Técnica Delphi com índice de concordância entre os juízes de 99%. Na segunda fase, 77 artigos de abordagem qualitativa foram avaliados sendo 25 artigos publicados entre 2014-2015 (antes da adoção do guia pela revista) e 52 artigos entre 2016-2017 (após a adoção do COREQ). Verificou-se diferença estaticamente significativa antes e após a adoção do guia entre cinco itens: Identificação dos autores que conduziram a pesquisa; Apresentação da atividade/ocupação dos autores; Informação sobre o tempo despendido para realização das entrevistas; Informação sobre devolução das entrevistas aos participantes para inserção de comentários e/ou correção pelos mesmos; e Apresentação da descrição da árvore de codificação. As medianas de atendimento aos 32 itens alcançaram 56,3% (antes) e 62,5% (depois), com significância estatística. Conclusão: A tradução do guia foi considerada válida pelos especialistas. A análise da utilização guia pela revista analisada conferiu melhora na qualidade aos artigos publicados.

Resumen Objetivo: Traducir y validar la guía Consolidated Criteria for Reporting Qualitative Research (COREQ) al portugués hablado en Brasil y verificar el impacto de la recomendación de uso de la COREQ por los autores en artículos publicados en una revista científica de enfermería. Métodos: Estudio metodológico y descriptivo. En la primera etapa, se adoptó el protocolo para la traducción de instrumentos, luego se utilizó la guía COREQ en portugués brasileño para analizar la calidad de los artículos publicados en una revista científica los dos años anteriores y los dos años posteriores a la adopción de la COREQ por la revista. Resultados: En la primera fase se tradujeron los 32 ítems de la COREQ, que fueron validados por tres jueces mediante el método Delphi con índice de concordancia de 99 % entre los jueces. En la segunda fase, se analizaron 77 artículos de enfoque cualitativo, de los cuales 25 fueron publicados entre 2014 y 2015 (antes de que la revista adoptara la guía) y 52 entre 2016 y 2017 (después de adoptar la COREQ). Se verificó una diferencia estadísticamente significativa antes y después de la adopción de la guía en cinco ítems: Identificación de los autores que condujeron la investigación, Presentación de la actividad/ocupación de los autores, Información sobre el tiempo empleado para realizar las entrevistas, Información sobre devolución de las entrevistas a los participantes para que agreguen comentarios o correcciones y Presentación de la descripción del árbol de codificación. Las medianas de cumplimiento de los 32 ítems llegaron al 56,3 % (antes) y 62,5 % (después), con significación estadística. Conclusión: La traducción de la guía fue considerada válida por los especialistas. El análisis de la utilización de la guía por la revista estudiada otorgó una mejora en la calidad de los artículos publicados.

Abstract Objective: To translate and validate the Consolidated Criteria for Reporting Qualitative Research (COREQ) into Brazilian Portuguese and verify the impact of the authors' recommendation to use COREQ in articles published in a scientific journal of nursing. Method: This is a methodological and descriptive study. In the first stage, a protocol for translating instruments was adopted; then, COREQ in Brazilian Portuguese was applied to analyze the quality of published articles, in a scientific journal, two years before and two years after the adoption of COREQ by the journal. Results: In the first phase, the 32 items of COREQ were translated and validated by three judges by using the Delphi Technique, with a 99% agreement among judges. In the second phase, 77 qualitative articles with were assessed, with 25 articles published between 2014-2015 (before the adoption of COREQ by the journal) and 52 articles between 2016-2017 (after the adoption of COREQ). There was a statistically significant difference before and after the adoption of COREQ between five items: Identification of the authors who conducted the research; Presentation of the activity/occupation of authors; Information about the time spent to conduct the interviews; Information on returning interviews to participants for comments and/or correction; and Presentation of the coding tree description. Median attendance for the 32 items reached 56.3% (before) and 62.5% (after), with statistical significance. Conclusion: The COREQ translation was considered valid by experts. Analysis of the use of COREQ by the analyzed journal improved the quality of published articles.

Carnauba straw powder treated with bentonite for copper adsorption in aqueous solution: isothermal, kinetic and thermodynamic study.

In this work, the natural and modified carnauba powder from the addition of bentonite was evaluated for the adsorption of Cu(II) ions in synthetic solution. The results showed that the carnauba powder treated with bentonite (CPTB) showed a better percentage of removal of Cu(II) ions when compared to natural carnauba powder (NCP). The best results for both adsorbents were obtained with pH 5. The adsorption kinetics was governed by the pseudo-second-order model for both bioadsorbents studied. While the isothermal behavior was governed by the Langmuir model and showed that the adsorption capacity of the CPTB for Cu(II) was 21.98 mg·g-1. The interaction of the metal and CPTB was also investigated by means of thermodynamic parameters showing that the adsorption process is not spontaneous, although the values of ΔG° decrease with the increase in temperature from 20 to 40 °C and endothermic causing an increase in the degree of disorder at the solid/liquid interface. The results showed that the CPTB is a material with potential adsorbent for the removal of copper ions.

Dysautonomia secondary to third ventriculostomy successfully managed with midodrine.

Hypothalamic lesions can compromise its essential regulatory roles resulting in critical disruption of temperature and blood pressure homoeostasis. We present the case of a 55-year-old woman who had been previously submitted to several neurosurgical procedures aimed at treating idiopathic hydrocephalus. She presented to our department with recurring episodes of hypothermia and wide blood pressure variations, which had been worsening over the last few years. After extensive complementary workup, which excluded new neurological lesions or endocrinological conditions, hypothalamic dysfunction was assumed to be the cause of this syndrome. She was successfully treated with midodrine and on-demand captopril, which resulted in adequate control of her blood pressure. This case highlights the rare and unpredictable consequences of damage to the hypothalamus, depicting the favourable result of a heretofore unpublished medical approach.

Weil's disease in a young homeless man living in Lisbon.

Leptospirosis is a zoonotic disease of worldwide distribution caused by infection with Leptospira genus bacteria, a pathogenic spirochaete. We present the case of a 29-year-old man admitted to our hospital with fever and multiorgan failure. He provided poor information about his symptoms. No recent travel or occupational history was reported and his clinical presentation did not suggest any infectious foci. His relatives later disclosed that he had been homeless for 3 weeks in the context of behavioural changes, obtaining foodstuff from waste containers and water from rain puddles. In the setting of this epidemiology, his presentation of fever, jaundice, acute renal injury and thrombocytopaenia suggested leptospirosis. Prompt empirical antimicrobial coverage was started, alongside organ support therapy. The diagnosis was later confirmed through microscopical and molecular methods. The patient made a full recovery. Leptospirosis should be considered early in the diagnostic work-up of any patient with acute febrile illness with multiorgan system involvement, with the identification of risk factors being essential to treat early in development of the disease.

Hepatic hydrothorax: indwelling catheter-related Acinetobacter radioresistens infection.

Hepatic hydrothorax, a rare and debilitating complication of cirrhosis, carries high morbidity and mortality. First-line treatment consists of dietary sodium restriction and diuretic therapy. Some patients, mainly those who are refractory to medical management, will require invasive pleural drainage. The authors report the case of a 76-year-old man in a late cirrhotic stage of alcoholic chronic liver disease, presenting with recurrent right-sided hepatic hydrothorax, portal hypertension, hepatosplenomegaly and thrombocytopaenia. After recurrent admissions and complications, the potential for adjusting diuretic therapy was limited. After unsuccessful talc pleurodesis, an indwelling tunnelled pleural catheter was placed with effective symptomatic control. One month later, the patient was readmitted with empyema due to Acinetobacter radioresistens Despite optimised medical and surgical treatment, the patient died 4 weeks later.

First Case of Tularemia Reported in Portugal: Probably of Imported Origin.

The authors report the case of a 47-year-old man who walked in the countryside on the island of Bornholm, during the summer period. Three days later, fever, myalgias and adynamia began. The serological tests, Real-time PCR and isolation of the bacteria from the culture of lymph biopsy confirmed the presence of Francisella tularensis subsp. holarctica.

Early and late assessment of esophagocardioplasty in the surgical treatment of advanced recurrent megaesophagus / Avaliação precoce e tardia da esofagocardioplastia no tratamento cirúrgico do megaesôfago avançado e recidivado

ABSTRACT Background Since Chagas disease has esophageal manifestations with different degrees of involvement, the best surgical option is controversial, especially for patients with advanced chagasic megaesophagus and recurrent symptoms after previous treatment. Objective To assess the early and late outcomes of esophagocardioplasty in a series of patients with advanced recurrent chagasic megaesophagus. Methods This descriptive study included 19 older patients with recurrent megaesophagus grade III/IV and positive immunofluorescence for Chagas disease. They had undergone cardiomyotomy with anterior fundoplication a mean of 16.5 years ago. Serra-Doria esophagocardioplasty was selected to treat the recurrence. The patients were followed to assess postoperative and late complications and the incidence of symptom recurrence. Results In early assessment, five (26.3%) patients presented clinical complications. One (5.2%) patient had a gastrointestinal fistula secondary to esophagogastric anastomotic leak, which responded well to conservative treatment. In the one-year follow-up, 18 (94.7%) patients could swallow normally and had no vomiting. Three years after surgery, 10 (62.5%) of 16 patients could swallow normally, and 3 (19.3%) patients complained of vomiting. Five years after surgery, only 5 (38.4%) of 13 patients could swallow normally and 7 (53.8%) had vomiting. Conclusion Serra-Doria esophagocardioplasty for the treatment of advanced recurrent megaesophagus had mild postoperative complications and good success rate in the short-term follow-up. In the long-term follow-up, it proved to be a poor surgery choice because of the high incidence of symptom recurrence, compromising quality of life. This procedure should be indicated only for patients with advanced recurrent megaesophagus without clinical conditions to undergo esophageal resection.

RESUMO Contexto A doença de Chagas, por apresentar manifestações esofágicas com diferentes graus de acometimento, faz com que haja controvérsias quanto a melhor opção cirúrgica; principalmente para pacientes com megaesôfago chagásico avançado e com recidiva de sintomas após tratamento prévio. Objetivo Avaliar o resultado precoce e tardio da esofagocardioplastia em uma série de pacientes com megaesôfago chagásico avançado e recidivado. Métodos Estudo descritivo, com 19 pacientes idosos com megaesôfago Grau III/IV recidivado e com imunoflorescência positiva para doença de Chagas. A cirurgia prévia foi a cardiomiotomia com fundoplicatura anterior, com tempo médio de realização de 16,5 anos. A cirurgia de eleição para o tratamento da recidiva foi a esofagocardioplastia de Serra-Dória. Realizou-se avaliação precoce para estudar as complicações pós-operatórias e tardias, para avaliar a incidência de recidiva de sintomas. Resultados Na avaliação precoce, 5 (26,3%) pacientes apresentaram complicações clínicas. Um (5,2%) paciente apresentou fístula digestiva consequente a deiscência da anastomose esofagogástrica, mas com boa evolução com o tratamento conservador. Na avaliação de 1 ano de pós-operatório, 18 (94,7%) pacientes apresentavam deglutição normal e sem regurgitação. Com 3 anos de pós-operatório, de 16 pacientes analisados; 10 (62,5%) pacientes apresentavam deglutição normal e 3 (19,3%) se queixavam de regurgitação. Com 5 anos de pós-operatório, de 13 pacientes analisados; somente 5 (38,4%) apresentavam deglutição normal e 7 (53.8%) com regurgitação. Conclusão A esofagocardioplastia de Serra-Dória, no tratamento cirúrgico do megaesôfago avançado recidivado, apresentou complicações pós-operatórias de baixa morbidade e com boa resolutividade, na avaliação precoce. Na avaliação de longo prazo, demonstrou não ser um procedimento cirúrgico adequado, pela alta incidência de recidiva de sintomas, com comprometimento da qualidade de vida. Deve ser indicada somente em pacientes com doença avançada recidivada, sem condições clínicas de serem submetidas à ressecção esofágica.

EARLY AND LATE ASSESSMENT OF ESOPHAGOCARDIOPLASTY IN THE SURGICAL TREATMENT OF ADVANCED RECURRENT MEGAESOPHAGUS.

BACKGROUND: Since Chagas disease has esophageal manifestations with different degrees of involvement, the best surgical option is controversial, especially for patients with advanced chagasic megaesophagus and recurrent symptoms after previous treatment. OBJECTIVE: To assess the early and late outcomes of esophagocardioplasty in a series of patients with advanced recurrent chagasic megaesophagus. METHODS: This descriptive study included 19 older patients with recurrent megaesophagus grade III/IV and positive immunofluorescence for Chagas disease. They had undergone cardiomyotomy with anterior fundoplication a mean of 16.5 years ago. Serra-Doria esophagocardioplasty was selected to treat the recurrence. The patients were followed to assess postoperative and late complications and the incidence of symptom recurrence. RESULTS: In early assessment, five (26.3%) patients presented clinical complications. One (5.2%) patient had a gastrointestinal fistula secondary to esophagogastric anastomotic leak, which responded well to conservative treatment. In the one-year follow-up, 18 (94.7%) patients could swallow normally and had no vomiting. Three years after surgery, 10 (62.5%) of 16 patients could swallow normally, and 3 (19.3%) patients complained of vomiting. Five years after surgery, only 5 (38.4%) of 13 patients could swallow normally and 7 (53.8%) had vomiting. CONCLUSION: Serra-Doria esophagocardioplasty for the treatment of advanced recurrent megaesophagus had mild postoperative complications and good success rate in the short-term follow-up. In the long-term follow-up, it proved to be a poor surgery choice because of the high incidence of symptom recurrence, compromising quality of life. This procedure should be indicated only for patients with advanced recurrent megaesophagus without clinical conditions to undergo esophageal resection.

Serviço de radiologia odontológica em municípios da região Centro-Oeste do Estado de Minas Gerais, Brasil / Dental radiologic service in cities of the midwest region of the State of Minas Gerais, Brazil

Objetivo: identificar a existência do serviço público de radiologia odontológica em municípios da região Centro-Oeste vinculados a uma Superintendência Regional de Saúde (SRS) de Minas Gerais, Brasil, e a partir daí conhecer o funcionamento do serviço ou o potencial funcionamento caso fosse implantado. Método: o estudo foi aprovado pelo Comitê de Ética em Pesquisa. Para a coleta de dados aplicou-se questionário aos coordenadores municipais de Saúde Bucal. A análise estatística descritiva foi desenvolvida no SPSS. Participaram 50 municípios de 55 vinculados a uma mesma SRS. Resultados: dos municípios participantes, 27 ofertavam o serviço radiológico em odontologia no setor público e 23 não ofertavam esse serviço. Entre os municípios que oferecem o serviço, 81,5% contam com um aparelho próprio, 11,1% utilizam todas as medidas de radioproteção, 96,3% ofertam a radiografia periapical, sem restrição para indicação (70,4%) e quantidade (96,3%). Dos municípios que não possuem o serviço radiológico público, para grande parte, apenas um aparelho próprio seria suficiente para instalação do serviço (59,1%). A maioria dos coordenadores afirmou que a radiologia ajuda muito na qualidade do serviço odontológico (87,0%), no entanto, somente uma minoria (21,7%) pretendia instalar o serviço. Conclusões: a oferta do serviço de radiologia odontológica no setor público não é uma realidade para todos os municípios avaliados. Dos que ofertam o serviço radiológico, a maioria não segue as legislações brasileiras na adoção de todas as medidas de radioproteção.

Objective: To identify the existence of public dental radiology municipalities in the Midwest region linked to a Regional Superintendent of Health (SRS) of Minas Gerais, Brazil, and from there to understand the operation of the service or the potential operation if it was deployed. Method: The study was approved by the Research Ethics. For data collection questionnaire was applied to municipal coordinators of Oral Health. Descriptive statistical analysis was developed in SPSS. Participated in 50 municipalities of 55 bound to the same SRS. Results: participating municipalities, 27 ofertavam dental radiology service in the public sector and 23 not ofertavam this service. Among the municipalities offering the service, 81.5% have an apparatus, 11.1% use all measures of radioprotection, 96.3% tender the periapical without restriction indication (70.4%) and quantity (96.3%). Municipalities that do not have radiological public service, for the most part, only an apparatus would be enough to install the service (59.1%). Most coordinators said the radiology helps a lot on the quality of dental services (87.0%), however, only a minority (21.7%) planned to install the service. Conclusions: The provision of dental radiology service in the public sector is not a reality for all municipalities assessed. That offer the service of radiological, most do not follow the laws Brazilian adoption of all measures of radioprotection.

A novel class of anticancer compounds targets the actin cytoskeleton in tumor cells.

The actin cytoskeleton is a potentially vulnerable property of cancer cells, yet chemotherapeutic targeting attempts have been hampered by unacceptable toxicity. In this study, we have shown that it is possible to disrupt specific actin filament populations by targeting isoforms of tropomyosin, a core component of actin filaments, that are selectively upregulated in cancers. A novel class of anti-tropomyosin compounds has been developed that preferentially disrupts the actin cytoskeleton of tumor cells, impairing both tumor cell motility and viability. Our lead compound, TR100, is effective in vitro and in vivo in reducing tumor cell growth in neuroblastoma and melanoma models. Importantly, TR100 shows no adverse impact on cardiac structure and function, which is the major side effect of current anti-actin drugs. This proof-of-principle study shows that it is possible to target specific actin filament populations fundamental to tumor cell viability based on their tropomyosin isoform composition. This improvement in specificity provides a pathway to the development of a novel class of anti-actin compounds for the potential treatment of a wide variety of cancers.

Development and test-retest reliability of the Food Photograph Scale for Brazilian adults

The study of food practices in Brazil faces important problems because of the nonexistence of properly tested methods and lack of a gold-standard instrument. Furthermore, only one instrument is capable of measuring food choice or knowledge in this specific population. In the present study we sought to develop a rapid assessment tool for food choice, consumption, and knowledge about healthy foods and test the reliability of the assessment tool in young adults as an initial step in the validation process. The scale was composed of 22 photographs of foods that were ready to consume, divided into "healthy" and "unhealthy" groups typically eaten as an afternoon snack in our region. To test the reliability of the instrument, 101 college students (51 males) were asked to select three items in response to three questions: "What would you like to eat as an afternoon snack?" "What do you consider healthy?" "What do you usually eat?" The procedure was repeated in the same subjects 1 month after the first application of the instrument. Results indicated a perfect reliability (κ = 1.0) among men when asked to select what they would like to eat, and perfect reliability was found among men and women when asked to select foods that they considered healthy. Excellent reliability (κ > .75) was found among women and the total sample for foods they would like to eat and among men and women for what they usually eat. As an initial step in validating the instrument, the results suggested that it was properly developed and had reliability in the present context for studies that involve eating behavior.(AU)

Development and test-retest reliability of the Food Photograph Scale for Brazilian adults

The study of food practices in Brazil faces important problems because of the nonexistence of properly tested methods and lack of a gold-standard instrument. Furthermore, only one instrument is capable of measuring food choice or knowledge in this specific population. In the present study we sought to develop a rapid assessment tool for food choice, consumption, and knowledge about healthy foods and test the reliability of the assessment tool in young adults as an initial step in the validation process. The scale was composed of 22 photographs of foods that were ready to consume, divided into "healthy" and "unhealthy" groups typically eaten as an afternoon snack in our region. To test the reliability of the instrument, 101 college students (51 males) were asked to select three items in response to three questions: "What would you like to eat as an afternoon snack?" "What do you consider healthy?" "What do you usually eat?" The procedure was repeated in the same subjects 1 month after the first application of the instrument. Results indicated a perfect reliability (κ = 1.0) among men when asked to select what they would like to eat, and perfect reliability was found among men and women when asked to select foods that they considered healthy. Excellent reliability (κ > .75) was found among women and the total sample for foods they would like to eat and among men and women for what they usually eat. As an initial step in validating the instrument, the results suggested that it was properly developed and had reliability in the present context for studies that involve eating behavior.

O Atendimento à Família no Tratamento dos Transtornos Alimentares: Um Relato de Experiência / Family Assistance in the Treatment of Eating Disorders: Experience Report

Este relato de experiência busca destacar o trabalho de uma equipe de psicólogos no atendimento aos familiares de pessoas diagnosticadas com Anorexia Nervosa e Bulimia em um serviço-escola de assistência a esses transtornos alimentares. Para tanto, apresentamos essa prática a partir de 2 eixos: a) formato do grupo e b) recursos úteis para coordenação desse grupo e aspectos apreciados por seus coordenadores. Esses eixos foram discutidos considerando-se as críticas dos especialistas no assunto quanto à efetiva participação da família na coconstrução do tratamento, tendo como base o discurso construcionista social. Foram problematizados os efeitos do discurso do diagnóstico na estruturação dessa prática em saúde, como a priorização do discurso da especialidade profissional sobre o conhecimento popular e a priorização do posicionamento do psicólogo enquanto especialista e da família como receptora de cuidado

This experience report seeks to highlight the work of a team of psychologists in the assistance of families of people diagnosed with Anorexia Nervosa and Bulimia in a university health care service. Therefore, we present this practice from 2 axes: a) group format, b) useful resources for group coordination and coordinators’ appreciative evaluation of the group. These axes were discussed considering the criticism from experts in the field about the effective family participation in the co-construction of the treatment, and the social constructionist discourse. We discuss the effects of the discourse of this diagnosis in structuring health practice, such as the prioritization of the discourse of professional expertise and prioritization psychologist as an expert and the family as passively receiving care.

Acesso e acolhimento: "ruídos" e escutas nos encontros entre trabalhadores e usuários de uma unidade de saúde / Access and participation: "sounds" and listening in meetings between workers and users of a health unit

Este artigo propõe analisar as percepções de usuários e trabalhadores acerca de acesso e acolhimento e do modo como essas acepções se inter-relacionam no cotidiano de uma unidade de saúde de cuidados primários do município de Porto Alegre/RS, a Unidade de Saúde Vila Floresta (USVF). Utilizou-se uma abordagem qualitativa cujos instrumentos foram entrevistas semiestruturadas com os usuários e grupos focais com os trabalhadores. Utilizou-se a técnica de análise de conteúdo proposta por Bardin.1Tanto usuários quanto trabalhadores perceberam mudanças no processo de trabalho da equipe após a implantação do Acolhimento. Mudanças que, para os usuários, culminaram com uma melhora qualitativa do acesso à unidade, através de um atendimento humanizado e satisfatório. Já para os trabalhadores, apesar de reconhecerem algumas mudanças positivas no acesso, referiram sobrecarga de trabalho e desmotivação na manutenção do projeto. Concluo inferindo que a produção de saúde é possível, a partir do compromisso com o que há de vida nos encontros entre usuários e trabalhadores, não apenas com vistas à garantia de cuidados aos usuários, em conformidade com nossa responsabilidade ética, mas com um olhar, uma escuta e um agir gentis com nós mesmos, trabalhadores de saúde.

This article proposes an analysis of users? and workers? perceptions of access and user participation, and of the way these acceptations are interrelated in the daily routine of a primary care health unit in the city of Porto Alegre/RS, the Vila Floresta Health Unit. The investigation is based on a qualitative approach whose instruments were semi-structured interviews with the users, and focus groups with the workers. The technique utilized was content analysis as proposed by Bardin.1Both users and workers sensed changes in the team?s working process after implementing user participation. Such changes, for a number of the users interviewed, culminated in a qualitative improvement in access to the unit, through more satisfactory and humane attention. Although, for the workers, despite acknowledging some positive changes in access, a number of them complained of work overload and demotivation in the project?s maintenance. Therefore, I conclude by inferring that health production is possible, if there is agreement on what is reasonable in these user-worker meetings. This means not only seeking a guarantee of care for users, in accordance with our ethical responsibility, but also seeing, listening to, and acting towards ourselves, health workers, in a considerate manner.

Análise cefalométrica das vias aéreas superiores de pacientes Classe III submetidos a tratamento ortocirúrgico / Cephalometric analysis of the upper airways of Class III patients subjected to orthosurgical treatment

OBJETIVO: o objetivo deste estudo foi avaliar as alterações causadas por cirurgia ortognática de recuo mandibular associada ou não à cirurgia maxilar combinada nas vias aéreas superiores (VAS). MÉTODOS: foram avaliadas radiografias cefalométricas de perfil pré-cirúrgicas e pós-cirúrgicas imediatas de 17 pacientes com Classe III. Foram realizadas medições do diâmetro do espaço aéreo (EA) no plano sagital, nas regiões correspondentes à hipofaringe e à orofaringe; também foram registradas as alterações na posição do osso hioide. Utilizou-se o teste t pareado e o coeficiente Pearson, buscando possíveis associações entre as alterações esqueléticas e as ocorridas no EA. RESULTADOS: observou-se redução significativa do EA na região da hipofaringe (média de 3,10mm, p=0,024). O osso hioide sofreu deslocamento inferior e posterior, além de diminuição da distância entre o mesmo e a região anterior da mandíbula. Não foi possível correlacionar, quantitativamente, a redução anteroposterior do EA com o recuo mandibular. Entretanto, observou-se correlação forte entre o diâmetro inicial do EA e a quantidade de redução observada ao nível da hipofaringe, e moderada em relação à orofaringe. CONCLUSÕES: o recuo mandibular pode causar estreitamento significativo das VAS, principalmente na porção mais inferior (hipofaringe). Portanto, deve-se atentar para sua avaliação durante o plano de tratamento ortocirúrgico, já que não foram descartados possíveis efeitos deletérios dessas alterações nas funções do indivíduo.

OBJECTIVE: The aim of this study was to evaluate the effects of orthognathic surgery for mandibular setback - with and without combined maxillary surgery - on the upper airways (UA).METHODS: Immediate lateral preoperative and postoperative cephalometric radiographs of 17 Class III patients were evaluated. Measurements of airway space (AS) diameter were taken in the sagittal plane in the hypopharyngeal and oropharyngeal regions, and changes in hyoid bone position were also recorded. Paired t-test and Pearson's coefficient were applied seeking for potential associations between skeletal and AS changes.RESULTS: Significant AS reduction was noted in the hypopharyngeal region (mean= 3.10 mm, p= 0.024). The hyoid bone was displaced inferiorly and posteriorly, thereby reducing its distance to the anterior mandibular region. No quantitative correlation could be established between anteroposterior AS reduction and mandibular setback. However, there was a strong correlation between initial AS diameter and the amount of reduction observed in the hypopharynx, but only moderate correlation with the oropharynx.CONCLUSIONS: Mandibular setback can cause significant UA narrowing, especially in the inferior-most portion (hypopharynx). Therefore, special attention should be given to UA evaluation when formulating an orthosurgical treatment plan since the potential deleterious effects of these changes on functions of the patients should not be overlooked.

Obsessive-compulsive symptoms among patients with blepharospasm and hemifacial spasm.

OBJECTIVE: The aim of this study was to compare the prevalence and the severity of different obsessive-compulsive disorder (OCD) symptoms reported by patients with blepharospasm (BSP) with those reported by patients with hemifacial spasm (HFS). We hypothesized that, since patients with BSP present a dysfunctional striato-thalamo-cortical circuitry, they would exhibit higher prevalence and/or greater severity of OCD symptoms than patients with HFS, a condition that results from peripheral irritation of the facial nerve. METHODS: Twenty-two patients with BSP and 31 patients with HFS were systematically evaluated by means of a sociodemographic and clinical questionnaire, the Mini International Neuropsychiatric Interview, the Obsessive-Compulsive Inventory-Revised, the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the Mini Mental State Examination (MMSE). Diagnostic groups were compared using the Mann-Whitney U test for continuous variables and the Pearson's goodness-of-fit χ(2) test for categorical ones; Fisher's Exact Test was employed when indicated. Correlations between continuous variables were evaluated by means of Spearman coefficients. RESULTS: Patients with BSP and HFS were not significantly different in terms of sociodemographic characteristics and most neuropsychiatric features. Nevertheless, while checking was associated with shorter duration of BSP (Spearman's rho=-0.54; P=.01), hoarding correlated with a longer duration of HFS (Spearman's rho=0.40; P=.04). Length of abnormal movements did not correlate with the BDI, BAI and MMSE scores. CONCLUSIONS: The finding that the severity of different OCD symptoms did not differ between the BSP and HFS groups suggests that BSP may not interfere significantly with behavioral components of the striato-thalamo-cortical circuitry. However, the fact that OCD symptoms were found to follow different courses in distinct diagnostic groups deserves further study.