Extracellular Vesicles Released by Leishmania (Leishmania) amazonensis Promastigotes with Distinct Virulence Profile Differently Modulate the Macrophage Functions.

Leishmania spp. is the aetiologic agent of leishmaniasis, a disease endemic in several developing countries. The parasite expresses and secretes several virulence factors that subvert the macrophage function and immune response. Extracellular vesicles (EVs) can carry molecules of the parasites that show immunomodulatory effects on macrophage activation and disease progression. In the present work, we detected a significantly higher expression of lpg3 and gp63 genes in Leishmania amazonensis promastigotes recovered after successive experimental infections (IVD-P) compared to those cultured for a long period (LT-P). In addition, we observed a significantly higher percentage of infection and internalized parasites in groups of macrophages infected with IVD-P. Macrophages previously treated with EVs from LT-P showed higher percentages of infection and production of inflammatory cytokines after the parasite challenge compared to the untreated ones. However, macrophages infected with parasites and treated with EVs did not reduce the parasite load. In addition, no synergistic effects were observed in the infected macrophages treated with EVs and reference drugs. In conclusion, parasites cultured for a long period in vitro and recovered from animals' infections, differently affected the macrophage response. Furthermore, EVs produced by these parasites affected the macrophage response in the early infection of these cells.

Impact of Physicochemical Modifications in Casein Promoted by UV-C on the Peptide Profile of Gastric Digestion and the Transepithelial Transport of Peptides.

Caseins are the main proteins in milk, and their structure and spatial conformation are responsible for their slow digestion rate. The release of bioactive and ß-casomorphin peptides from casein digestion may induce allergic responses during consumption. Spectroscopic techniques were used to observe the structural changes in casein conformation induced by Ultraviolet light irradiation (UV-C). Raman spectroscopy results showed more pronounced peaks at 618 and 640 cm-1 for phenylalanine and tyrosine moieties of the photolyzed micellar casein, respectively, suggesting changes in the micelle structure. The decrease in the intensity of Raman signals for tryptophan and tyrosine corroborates to the UV-C-induced modifications of the micelle structure. Particle size distribution showed a decrease in the average micelle size after 15 min of UV-C exposure, while low-temperature, long-time (LTLT) pasteurization led to the formation of large aggregates, as observed by atomic force microscopy. UV-C did not impact the formation or transport of peptides, as observed by using the Caco-2 cell as a model for peptide absorption. However, the absence of the opioid peptide SRYPSY from κ-casein and only 20% of the concentration of opioid peptide RYLGY were noted. This work demonstrated that UV-C can be utilized to induce the physicochemical modification of dairy products, promoting a higher digestion rate and reducing allergenicity.

UV-C light promotes the reductive cleavage of disulfide bonds in ß-Lactoglobulin and improves in vitro gastric digestion.

ß-Lactoglobulin (ß-Lg) is the main protein in whey and is known for its allergenicity and resistance to the digestion of pepsin and trypsin. The UV-C photoinduced cleavage of disulfide bonds in ß-Lactoglobulin, as promoted by excitation of tryptophan residues (Trp), is shown to induce changes in the protein's secondary structure, significantly reducing the protein's resistance to pepsin digestion. The UV-C light-induced changes in the protein secondary structure are marked by an increase in the contribution of ß-sheet and α-helix structures with a concomitantly smaller contribution of the ß-turn structural motif. The photoinduced cleavage of disulfide bonds in ß-Lg has an apparent quantum yield of ф = 0.0015 ± 0.0003 and was shown by transient absorption laser flash photolysis to arise by two different pathways: a) the reduction of the disulfide bond Cys66Cys160 occurs by direct electron transfer from the triplet-excited 3Trp to the disulfide bond due to the existence of a CysCys/Trp triad (Cys66Cys160/Trp61) and b) the reduction of the buried Cys106Cys119 disulfide bond involves a reaction with a solvated electron originated by the photoejection of electrons from the triplet-excited 3Trp decay. The in vitro gastric digestion index for UV-C-treated ß-Lg is revealed to have increased significantly by 36 ± 4 % and 9 ± 2 % under simulated elderly and young adult digestive conditions, respectively. When compared to the native protein, the peptide mass fingerprint profile of digested UV-C-treated ß-Lg shows a higher content and variety of peptides, including the production of some exclusive bioactive peptides such as PMHIRL and EKFDKALKALPMH.

As Regionais que queremos / The Regions we want

O pioneirismo em regionalização no Estado de Goiás é demonstrado através da abordagem dos tópicos regionalização, regionais e suas divisões, matriciamento, gestão, planejamento, coordenação, neuroliderança e fortalecimento

Pioneering in regionalization in the State of Goiás is demonstrated through the approach of the topics regionalization, regions and their divisions, matrix support, management, planning, coordination, neuro-leadership and strengthening

Working conditions of a nursing team in mental health facility.

OBJECTIVE: To analyze how the nursing team from a Psychosocial Care Center II relates its insertion in the service with the work process. METHODS: Descriptive, analytical research outlined as a case study with a qualitative approach. The data were collected through semi-structured interviews with nursing professionals and went through content analysis subsidized by Bardin's work. RESULTS: Two thematic categories emerged: a) Ways of intake in the nursing services at the Psychosocial Care Center; b) Setbacks in nursing routine at the Psychosocial Care Center. FINAL CONSIDERATIONS: The fact that the professionals have not planned to work in mental health nor have training impacts the rhythm of psychosocial care development at the Psychosocial Care Center, forcing them to seek training in the field after admission. Unmotivated by the working conditions, the nursing team suffers from the absence of an interdisciplinary partnership and goes to great lengths to approach psychosocial care.

Working conditions of a nursing team in mental health facility / Condiciones de trabajo del equipo de enfermería en dispositivo de salud mental / Condições de trabalho da equipe de enfermagem em dispositivo de saúde mental

ABSTRACT Objective: To analyze how the nursing team from a Psychosocial Care Center II relates its insertion in the service with the work process. Methods: Descriptive, analytical research outlined as a case study with a qualitative approach. The data were collected through semi-structured interviews with nursing professionals and went through content analysis subsidized by Bardin's work. Results: Two thematic categories emerged: a) Ways of intake in the nursing services at the Psychosocial Care Center; b) Setbacks in nursing routine at the Psychosocial Care Center. Final considerations: The fact that the professionals have not planned to work in mental health nor have training impacts the rhythm of psychosocial care development at the Psychosocial Care Center, forcing them to seek training in the field after admission. Unmotivated by the working conditions, the nursing team suffers from the absence of an interdisciplinary partnership and goes to great lengths to approach psychosocial care.

RESUMEN Objetivo: Analizar como equipo de enfermería de un Centro de Atención Psicosocial II relaciona su inserción en el servicio con el proceso de trabajo. Métodos: Investigación descriptiva, analítica, delineada como estudio de caso, con abordaje cualitativo. Datos recogidos por entrevista semiestructurada con profesionales de enfermería y pasaron por análisis de contenido subsidiada en Bardin. Resultados: Emergieron dos categorías temáticas: a) Formas de ingreso en el servicio de enfermería del Centro de Atención Psicosocial; b) Contratiempos en el cotidiano de la enfermería en Centro de Atención Psicosocial. Consideraciones finales: El hecho de los profesionales no tener planeado actuar en salud mental ni disponer de preparación, impacta considerablemente el ritmo del desarrollo del cuidado psicosocial en Centro de Atención Psicosocial, forzándolos a buscar capacitación en el área después admisión. Desmotivada por condiciones de trabajo, el equipo de enfermería sufre por la ausencia de colaboración interdisciplinar y redoblarse para aproximarse del cuidado psicosocial.

RESUMO Objetivo: Analisar como a equipe de enfermagem de um Centro de Atenção Psicossocial II relaciona sua inserção no serviço com o processo de trabalho. Métodos: Pesquisa descritiva, analítica, delineada como estudo de caso, com abordagem qualitativa. Os dados foram coletados por entrevista semiestruturada com profissionais de enfermagem e passaram pela análise de conteúdo subsidiada pela obra de Bardin. Resultados: Emergiram duas categorias temáticas: a) Formas de ingresso no serviço de enfermagem do Centro de Atenção Psicossocial; b) Contratempos no cotidiano da enfermagem em Centro de Atenção Psicossocial. Considerações finais: O fato de os profissionais não terem planejado atuar na saúde mental nem disporem de preparação impacta consideravelmente o ritmo do desenvolvimento do cuidado psicossocial no Centro de Atenção Psicossocial, forçando-os a buscar capacitação na área após admissão. Desmotivada pelas condições de trabalho, a equipe de enfermagem sofre pela ausência de parceria interdisciplinar e desdobra-se para aproximar-se do cuidado psicossocial.

The influence of oral language environment on auditory development.

OBJECTIVE: The purpose of this study was to compare the auditory processing of hearing children who were immersed in an oral language environment during early childhood with that of children who were poorly exposed to oral language during the same period. METHODS: Sixty children aged between 5 and 10 years participated in this study. They were divided in two groups. Group 1 comprised of 30 children who had deaf signer parents, and Group 2 comprised of 30 children who had hearing parents. These children underwent the following auditory processing tests: Pediatric Speech Intelligibility, Dichotic Digits, Pitch Pattern Sequence, Gaps-in-Noise, and Memory Tests for Instrumental and Verbal sounds. RESULTS: Group 1 had significantly poorer performance than that of Group 2 in all tests. In addition, an analysis by age range revealed that the differences between groups were more pronounced in younger children (5-6 years). CONCLUSION: The results indicate that the development of auditory skills is strongly influenced by access to oral linguistic sounds. Thus, a child's exposure to an oral language environment from birth is important to the adequate development of the auditory system functions.

Persistência do HPV em mulheres tratadas para o adenocarcinoma cervical / Persistence of HPV in women treated for cervical adenocarcinoma

Objetivo: determinar a frequência da persistência do HPV em mulheres tratadas para o adenocarcinoma cervical. Método: trata-se de um estudo quantitativo, descritivo, retrospectivo, do tipo coorte, com 77 mulheres genotipadas para o HPV antes do tratamento e com adenocarcinoma cervical. Coletou-se novo material de secreção cervical após o tratamento para a realização da detecção do DNA do HPV por reação de cadeia da polimerase. Utilizou-se o programa estatístico Epi Info 7.1.4. para a análise dos dados. Resultados: observou-se que, das 77 pacientes, foi possível determinar a genotipagem do HPV após o tratamento em 30 mulheres e, destas, 7 (23,3%) apresentaram o HPV detectável. Encontraram-se os tipos de HPV dos quais quatro pacientes (57,1%) estavam com o HPV 31, sendo que, em uma paciente, estava associado ao HPV 18; o 33 em duas mulheres (28,6%), sendo que em uma estava associado ao HPV 16 e uma apresentou os HPV 11 e 56 associados (14,2%). Conclusão: detectou-se o HPV na secreção cervical em 23,3% das mulheres após o tratamento para o adenocarcinoma de colo uterino, sendo o HPV 31 o tipo mais frequente.(AU)

Objective: to determine the frequency of persistence of HPV in women treated for cervical adenocarcinoma. Method: this is a quantitative, descriptive, retrospective, cohort study, with 77 women genotyped for HPV before treatment and with cervical adenocarcinoma. New cervical secretion material was collected after treatment to detect HPV DNA by polymerase chain reaction. The Epi Info 7.1.4 statistical program was used for data analysis. Results: it was observed that, out of 77 patients, it was possible to determine HPV genotyping after treatment in 30 women, and of these, seven (23.3%) had detectable HPV. HPV types were found, of which four patients (57.1%) had HPV 31, and in one patient it was associated with HPV 18; o 33 in two women (28.6%), one of whom was associated with HPV 16 and one had HPV 11 and 56 associated (14.2%). Conclusion: HPV was detected in cervical secretion in 23.3% of women after treatment for cervical adenocarcinoma, with HPV 31 being the most frequent type.(AU)

Objetivo: determinar la frecuencia de persistencia del VPH en mujeres tratadas por adenocarcinoma cervical. Método: estudio de cohorte cuantitativo, descriptivo, retrospectivo, con 77 mujeres genotipadas para el VPH antes del tratamiento y con adenocarcinoma cervical. Se recogió nuevo material de secreción cervical después del tratamiento para detectar el ADN del VPH por reacción en cadena de la polimerasa. Se utilizó el programa estadístico Epi Info 7.1.4. para el análisis de datos. Resultados: se observó que, de las 77 pacientes, fue posible determinar el genotipo del VPH después del tratamiento en 30 mujeres, y de estos, 7 (23.3%) tenían VPH detectable. Se encontraron tipos de VPH, de los cuales cuatro pacientes (57.1%) tenían VPH 31, y en una paciente se asoció con VPH 18; o 33 en dos mujeres (28,6%), una de las cuales estaba asociada con el VPH 16 y una tenía VPH 11 y 56 (14,2%). Conclusión: el VPH se detectó en la secreción cervical en el 23,3% de las mujeres después del tratamiento para el adenocarcinoma de cuello uterino, siendo el VPH 31 el tipo más frecuente.(AU)

Uso de aplicativos de tecnologia móvel na rotina de estudantes concluintes de medicina / Use of mobile technology applications in the routine of students during the last year of medicine undergraduate degree / Uso de aplicaciones de tecnología movible en la rutina de estudiantes durante el último año de la graduación del grado en medicina

O uso de aplicativos vem crescendo na área da saúde, tornando-se rotina diária na prática dos profissionais e estudantes. Portanto, conhecer benefícios e riscos de seu uso faz-se necessário. O objetivo do estudo aqui apresentado é verificar opiniões e atitudes relatadas por estudantes de medicina a respeito do uso de aplicativos no cotidiano ambulatorial de um hospital-escola. Trata-se de um estudo transversal desenvolvido, em 2017, em Recife, Pernambuco, Brasil, no qual se utilizaram questionários autoaplicáveis presencialmente em uma população de 73 estudantes concluintes do curso de medicina. Os resultados revelaram que a maioria (95,9%) dos estudantes referiram possuir smartphone e 98,6% afirmaram utilizar dispositivos móveis com intuito acadêmico. A finalidade mais comum do uso de aplicativos foi a de consulta de fármacos existentes (93,2%) e quase a totalidade dos estudantes (98,6%) confia nos aplicativos utilizados. Porém, foi questionado se o uso na rotina interfere na relação profissional-paciente. Concluímos que o uso de aplicativos é uma realidade crescente, mas que ainda há discordâncias sobre seus benefícios e malefícios.

The use of applications has been growing in the field of health, becoming a daily routine in the practice of professionals and students. Therefore, knowing the benefits and risks of its use is necessary. The study presented here aims to verify the opinions and attitudes reported by medical students about the use of applications in the outpatient routine in a teaching hospital. It is a cross-sectional study and it was developed in 2017 in Recife, in the state of Pernambuco, Brazil, using a self-administered questionnaire asked by 73 students of the last year of medicine undergraduate degree. The results reveal that the majority (95.9%) of the students reported having a smartphone and 98.6% specified that they use mobile devices for academic purposes. The most common purpose of using applications was to consult existing drugs (93.2%) and almost all students (98.6%) believe that the applications used are reliables. However, there are doubts if routine use interferes with the professional-patient relationship. We concluded that the use of applications is growing, but there are still disagreements about its benefits and harms.

El uso de aplicaciones viene creciendo en el área de la salud y se ha convertido en rutina diaria en la práctica de los profesionales y estudiantes. Por lo tanto, conocer los beneficios y riesgos de su uso se hace necesario. El objetivo del estudio presentado aquí es verificar opiniones y actitudes relatadas por estudiantes de medicina acerca del uso de aplicaciones en el cotidiano del ambulatorio de un hospital escuela. Un estudio transversal ha sido desarrollado en 2017 en Recife, en el estado de Pernambuco, Brasil, utilizando un cuestionario autoaplicable presencialmente en 73 estudiantes del último año de la graduación del grado en medicina. Los resultados mostran que la mayoría (95,9%) de los estudiantes mencionó poseer teléfono inteligente y 98,6% afirmaron utilizar dispositivos movibles con intención académica. La finalidad más común del uso de aplicaciones fue la de consulta de fármacos existentes (93,2%) y casi la totalidad de los estudiantes (98,6%) confía en las aplicaciones utilizadas. Sin embargo, ha sido cuestionado si el uso en la rutina interfiere en la relación profesional-paciente. Nosotros concluimos que el uso de aplicaciones es creciente, pero todavía hay desacuerdos sobre sus beneficios y maleficios.

A implantação do Núcleo Interno de Regulação em Hospital Público Terciário ­ A experiência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo / Implementation of the Internal Regulation Committee in a Tertiary Public Hospital ­ The experience of General Hospital of Ribeirão Preto Medical School of the University of São Paulo

RESUMO Introdução: O Núcleo Interno de Regulação (NIR) é uma das estratégias de gestão criadas pela Política Nacional de Atenção Hospitalar do Ministério da Saúde em 2013. Visa a organização do acesso à consultas, serviços diagnósticos e terapêuticos e aos leitos de internação, sendo fundamental o conhecimento do perfil epidemiológico e ajuste de seus processos de trabalho de modo a garantir o fluxo no sistema de saúde. Como as normas para implantação só foram realizadas em 2018, vários serviços implantaram o NIR sem diretrizes e há necessidade de se avaliar o grau de implantação. Objetivo: Avaliar o nível de implantação do NIR em duas unidades de um complexo hospitalar público terciário. Metodologia: Estudo de avaliação, exploratório, descritivo e longitudinal, realizado em duas unidades de internação hospitalar público terciário implantadas no primeiro semestre de 2016 (Unidade de Emergência) e no primeiro semestre de 2017 (Unidade Campus). Resultados: Devido à natureza de sua vocação (eletivo ou urgência), observou-se perfil epidemiológico distinto nas unidades, embora tenha sido possível a construção de processo e análise de SWOT integrada para efeitos de tomada de decisão e planejamento. De acordo com os pilares propostos pelo Manual, ambas em maior ou menor grau apresentam iniciativas recomendadas. Mas, por outro lado, os entrevistados reforçam a necessidade de maior investimento para aprimorar o processo. Conclusão: É necessário o estabelecimento de uma política de implantação dos NIR's com referenciais objetivos que possam ser pontuados e permitam o acompanhamento temporal do seu desenvolvimento. (AU)

ABSTRACT Introduction: The Internal Regulation Committee (IRC) is one of the management strategies created by the National Health Care Policy of the Ministry of Health in 2013. It aims to organize the access to consultations, diagnostic and therapeutic services and to hospital beds. It is necessary to know the epidemiological profile to adjust its processes to guarantee the flow in the healthcare system. As the standards for implementation were only established in 2018, several services implemented the ICR without guidelines, and there is a need to evaluate the degree of implementation. Objective: To evaluate the level of NIR implantation in two units of a public tertiary hospital complex. Methodology: Exploratory, descriptive and longitudinal study, carried out in two tertiary public hospitalization units implanted in the first half of 2016 (Emergency Unit) and the first half of 2017 (Campus Unit). Results:Due to the nature of their vocation (elective or emergency), a distinct epidemiological profile was observed, although it was possible to construct an integrated SWOT process and analysis for decision--making and planning purposes. According to the principles proposed by the Manual, both presented recommended initiatives to a greater or lesser degree. However, on the other hand, the units inter-viewed reinforce the need for more investment to improve the process. Conclusion: It is necessary to establish a policy for the implementation of NIRs with objective checklists that can be set and allow the temporal monitoring of their development (AU)

O Terapeuta Ocupacional como executor de medidas socioeducativas em meio aberto: discursos na construção de uma prática / Occupational Therapist as socioeducational measures executor in open environment: speechs to practice construction

Introdução: A atuação do terapeuta ocupacional no campo das medidas socioeducativas com adolescentes que cometeram ato infracional ainda se mostra um tema pouco discutido nos trabalhos acadêmicos. Objetivo: Objetivou-se conhecer os terapeutas ocupacionais e as suas atuações nos serviços de medidas socioeducativas em meio aberto, no Estado de São Paulo. Método: A partir de um mapeamento dos serviços que realizam a aplicação de medida socioeducativa em meio aberto, em todos os municípios com mais de 100 mil habitantes no Estado de São Paulo, foram encontradas oito terapeutas ocupacionais em atuação. Foram realizadas entrevistas semiestruturadas com todas e, posteriormente, formou-se um grupo focal com cinco daquelas profissionais, com a finalidade de se refletir conjuntamente sobre a prática por elas executada. Os principais pontos das entrevistas foram: vínculo, olhar e atividade. Resultados: Como resultado, obteve-se que os conceitos de vínculo e olhar ainda são pouco definidos pelas profissionais, compreendidos como singularidades do trabalho do terapeuta ocupacional, com múltiplos significados. Quanto à especificidade da ação em terapia ocupacional, o uso da atividade ocupa um lugar central no discurso das colaboradoras, como um instrumento de mediação e condução do trabalho técnico, considerando-se a demanda dos adolescentes como aspecto norteador das ações profissionais. Conclusão: Conclui-se que não há uma delimitação teórica e metodológica da especificidade da prática terapêutico-ocupacional nesta área. Contudo, os resultados oferecem algumas "pistas", na medida em que o trabalho em terapia ocupacional nas medidas socioeducativas é um campo em construção, pois tem pouca representação numérica de profissionais e apresenta discursos múltiplos em seu fazer cotidiano.

Introduction: Occupational therapist practice in the socioeducational measures field involving infractors adolescents is a rare subject discussed in academic studies. Objective: This study aimed to map the occupational therapists and their work on socioeducational measures in semi open environment in São Paulo State. Method: Through the mapping of socioeducational measures services in São Paulo State in cities with populations of 100 thousand habitants and above, it was possible to identify eight occupational therapists. We applied semi structured interviews with all of them, five of them took part in a focal group, which intended to reflect about their professional practice in a collective and deepen way. The main interviews points of discussion were: "bond", "view" and "activity". Results: As results, we verified that there is a lack of definition for the "bond" and "view" concepts by the professionals which is understood by them as occupational therapists singularities, with several meanings. As for specificity of actions in occupational therapy practice, the activity use is central in collaborator's speeches, as an instrument of practice mediation and conduction, considering adolescents' demands as an important guide of professional acting. Conclusion: We concluded that there are no theoretical and methodological boundaries from the specificity of occupational therapy practice in this field. Otherwise, the presented results offer some leads, as the occupational therapy practice in socioeducational measures is a developing field, as it is low represented by a small amount of professionals and several speeches are reported by them in their daily routine.

Can speech-evoked Auditory Brainstem Response become a useful tool in clinical practice?

PURPOSE: To discuss the clinical applicability of the speech-evoked Auditory Brainstem Response (speech-evoked ABR) to help identifying auditory processing disorders. METHODS: We analyzed the records of 27 children and adolescents, aged between seven and 15, who presented abnormal speech-evoked ABR. Then, the data from the behavioral auditory processing evaluation of these individuals were surveyed. RESULTS: It was observed that, among the 27 children with abnormal speech-evoked ABR, 23 also had auditory processing disorders. Therefore, from this sample, an 85.15% probability of observing abnormal behavioral assessment of auditory processing in a child who presented abnormal speech-evoked ABR was obtained. CONCLUSION: It is argued that the speech-evoked ABR can be used in clinical practice as an important aid tool in the diagnosis of auditory processing disorder, because, in this study, an abnormal speech-evoked ABR usually represented a deficit in the results of behavioral assessment of auditory processing. Thus, it can be used to obtain information about the perception of speech sounds in children under seven years or with challenging behavioral assessment.

O Potencial Evocado Auditivo com estímulo de fala pode ser uma ferramenta útil na prática clínica? / Can speech-evoked Auditory Brainstem Response become a useful tool in clinical practice?

RESUMO Objetivo: Discutir a aplicabilidade clínica do Potencial Evocado Auditivo com Estímulo de Fala (PEATEf) no auxílio à identificação dos transtornos do processamento auditivo. Métodos : Foram selecionados os prontuários de 27 crianças e adolescentes, com idade entre sete e 15 anos, que apresentaram alteração no PEATEf. Foram levantados os dados referentes à avaliação comportamental do processamento auditivo desses indivíduos. Resultados: Observou-se que das 27 crianças com PEATEf alterado, 23 também apresentaram alteração de processamento auditivo. A partir dessa amostra, foi possível apontar probabilidade de 85,15% em observar avaliação comportamental do processamento auditivo alterada em uma criança que apresentou PEATEf também alterado. Conclusão: Sugere-se que o PEATEf pode ser utilizado na prática clínica como uma ferramenta importante no diagnóstico do Transtorno do Processamento Auditivo, uma vez que neste estudo uma alteração do PEATEf quase sempre representou, também, uma alteração nos resultados da avaliação comportamental do processamento auditivo, portanto pode ser utilizado para obter informações acerca da percepção dos sons da fala em crianças menores de sete anos ou de difícil avaliação comportamental.

ABSTRACT Purpose : To discuss the clinical applicability of the speech-evoked Auditory Brainstem Response (speech-evoked ABR) to help identifying auditory processing disorders. Methods : We analyzed the records of 27 children and adolescents, aged between seven and 15, who presented abnormal speech-evoked ABR. Then, the data from the behavioral auditory processing evaluation of these individuals were surveyed. Results : It was observed that, among the 27 children with abnormal speech-evoked ABR, 23 also had auditory processing disorders. Therefore, from this sample, an 85.15% probability of observing abnormal behavioral assessment of auditory processing in a child who presented abnormal speech-evoked ABR was obtained. Conclusion : It is argued that the speech-evoked ABR can be used in clinical practice as an important aid tool in the diagnosis of auditory processing disorder, because, in this study, an abnormal speech-evoked ABR usually represented a deficit in the results of behavioral assessment of auditory processing. Thus, it can be used to obtain information about the perception of speech sounds in children under seven years or with challenging behavioral assessment.

Efficacy of auditory training in elderly subjects.

Auditory training (AT) has been used for auditory rehabilitation in elderly individuals and is an effective tool for optimizing speech processing in this population. However, it is necessary to distinguish training-related improvements from placebo and test-retest effects. Thus, we investigated the efficacy of short-term AT [acoustically controlled auditory training (ACAT)] in elderly subjects through behavioral measures and P300. Sixteen elderly individuals with auditory processing disorder (APD) received an initial evaluation (evaluation 1 - E1) consisting of behavioral and electrophysiological tests (P300 evoked by tone burst and speech sounds) to evaluate their auditory processing. The individuals were divided into two groups. The Active Control Group (n = 8) underwent placebo training. The Passive Control Group (n = 8) did not receive any intervention. After 12 weeks, the subjects were revaluated (evaluation 2 - E2). Then, all of the subjects underwent ACAT. Following another 12 weeks (eight training sessions), they underwent the final evaluation (evaluation 3 - E3). There was no significant difference between E1 and E2 in the behavioral test [F(9.6) = 0.06, p = 0.92, λ de Wilks = 0.65)] or P300 [F(8.7) = 2.11, p = 0.17, λ de Wilks = 0.29] (discarding the presence of placebo effects and test-retest). A significant improvement was observed between the pre- and post-ACAT conditions (E2 and E3) for all auditory skills according to the behavioral methods [F(4.27) = 0.18, p = 0.94, λ de Wilks = 0.97]. However, the same result was not observed for P300 in any condition. There was no significant difference between P300 stimuli. The ACAT improved the behavioral performance of the elderly for all auditory skills and was an effective method for hearing rehabilitation.

Medidas socioeducativas em São Paulo: os serviços e os técnicos / Medidas socioeducativas en Sao Paulo: servicios y técnicos / Socio educational measures in São Paulo: services and technicians

Objetivou-se conhecer o cenário das medidas socioeducativas em meio aberto do Estado de São Paulo. Tais serviços e seus técnicos acompanham os adolescentes em conflito com a lei. Foram contatadas as Diretorias Regionais de Assistência e Desenvolvimento Social e a Coordenadoria de Ação Social, responsáveis pela supervisão das medidas socioeducativas em meio aberto, para mapear e contatar tais serviços. Das 129 instituições cadastradas, 96% de seus coordenadores responderam a um questionário sobre a caracterização dos serviços e sua equipe técnica. Verificou-se que a execução dessas medidas se dá pelos Centros de Referência Especializados em Assistência Social, do Sistema Único de Assistência Social, e que há uma predominância dos técnicos psicólogos e assistentes sociais nas equipes, entre outros pontos.(AU)

Esta propuesta pretende conocer el panorama de las medidas socioeducativas en medio abierto del Estado de São Paulo. Estos servicios y sus técnicos acompañan a los adolescentes en conflicto con la ley. Fueron contratadas Directivas Regionales de Bienestar Social y Desarrollo y la Coordinación de Acción Social, responsables por la supervisión de las medidas socioeducativas en medio abierto, para mapear y contactar tales servicios. De las 129 instituciones registradas, 96% de sus coordinadores respondieron un cuestionario acerca de la caracterización de los servicios y de su personal técnico. Se verificó que la ejecución de estas medidas es realizada por los Centros de Referencia Especializados en Asistencia Social, del Sistema Único de Asistencia Social, y que hay un predominio de los psicólogos técnicos y los asistentes sociales en los equipos, entre otros puntos.(AU)

This study aimed on knowing the scenario of socio educational measures in open environment in São Paulo State. Adolescents in conflict with the law are assisted by these services and their technicians. Thus, Regional Directorates of Social Support and Development and Coordination of Social Action were contacted, as they are responsible for overseeing socio educational measures in open environment, in order to map and contact them. Of 129 registered institutions, 96% of the coordinators answered a questionnaire about services and technical characterization. It was verified that services execution is done by Centers of Specialized Reference on Social Support, from Unified System of Social Support, and that there is a predominance of psychologists and social workers within the teams, among other results.(AU)

Medidas socioeducativas em São Paulo: os serviços e os técnicos / Medidas socioeducativas en Sao Paulo: servicios y técnicos / Socio educational measures in São Paulo: services and technicians

Objetivou-se conhecer o cenário das medidas socioeducativas em meio aberto do Estado de São Paulo. Tais serviços e seus técnicos acompanham os adolescentes em conflito com a lei. Foram contatadas as Diretorias Regionais de Assistência e Desenvolvimento Social e a Coordenadoria de Ação Social, responsáveis pela supervisão das medidas socioeducativas em meio aberto, para mapear e contatar tais serviços. Das 129 instituições cadastradas, 96% de seus coordenadores responderam a um questionário sobre a caracterização dos serviços e sua equipe técnica. Verificou-se que a execução dessas medidas se dá pelos Centros de Referência Especializados em Assistência Social, do Sistema Único de Assistência Social, e que há uma predominância dos técnicos psicólogos e assistentes sociais nas equipes, entre outros pontos...

Esta propuesta pretende conocer el panorama de las medidas socioeducativas en medio abierto del Estado de São Paulo. Estos servicios y sus técnicos acompañan a los adolescentes en conflicto con la ley. Fueron contratadas Directivas Regionales de Bienestar Social y Desarrollo y la Coordinación de Acción Social, responsables por la supervisión de las medidas socioeducativas en medio abierto, para mapear y contactar tales servicios. De las 129 instituciones registradas, 96% de sus coordinadores respondieron un cuestionario acerca de la caracterización de los servicios y de su personal técnico. Se verificó que la ejecución de estas medidas es realizada por los Centros de Referencia Especializados en Asistencia Social, del Sistema Único de Asistencia Social, y que hay un predominio de los psicólogos técnicos y los asistentes sociales en los equipos, entre otros puntos...

This study aimed on knowing the scenario of socio educational measures in open environment in São Paulo State. Adolescents in conflict with the law are assisted by these services and their technicians. Thus, Regional Directorates of Social Support and Development and Coordination of Social Action were contacted, as they are responsible for overseeing socio educational measures in open environment, in order to map and contact them. Of 129 registered institutions, 96% of the coordinators answered a questionnaire about services and technical characterization. It was verified that services execution is done by Centers of Specialized Reference on Social Support, from Unified System of Social Support, and that there is a predominance of psychologists and social workers within the teams, among other results...

Tinnitus in individuals without hearing loss and its relationship with temporomandibular dysfunction.

UNLABELLED: Research has shown that dysfunction of the temporomandibular joint is often associated with tinnitus. AIM: To characterize tinnitus in individuals with normal hearing and search for a possible relationship with Temporomandibular Disorders (TMD). STUDY DESIGN: prospective and cross-sectional. MATERIALS AND METHODS: The participants included 20 adults of both genders with tinnitus and normal hearing thresholds on audiometry. We studied tinnitus psychoacoustic characteristics and employed the checklist of TMD signs and symptoms from the Tinnitus Handicap Inventory (THI). RESULTS: The high pitch, continuous and bilateral tinnitus was the most frequent. Upon acuphenometry, the average tinnitus pitch reported by the subjects was 8.6 kHz and the average loudness was 14.1 dBSL. The degree of discomfort caused by tinnitus was mild. We observed that the higher the pitch, the lower was the loudness and the higher was the THI score. We found that 90% of the patients had at least one TMD sign or symptom. CONCLUSIONS: The most common was the high pitch, continuous and bilateral tinnitus; 90% of patients had at least one sign or symptom of TMD and there was no correlation between the tinnitus and acuphenometry, THI and the TMD checklist.

Zumbido em indivíduos sem perda auditiva e sua relação com a disfunção temporomandibular / Tinnitus in individuals without hearing loss and its relationship with temporomandibular dysfunction

Pesquisas apontam que disfunções da articulação temporomandibular estão freqüentemente associadas ao zumbido. OBJETIVO: caracterizar o zumbido de indivíduos com audição normal e buscar possível relação com a Disfunção Temporomandibular (DTM). Forma do estudo: prospectivo tranversal. MATERIAL E MÉTODO: participaram 20 adultos de ambos os sexos com queixa de zumbido e limiares auditivos dentro da normalidade à audiometria convencional. Foi realizada a pesquisa das características psicoacústicas do zumbido, aplicação do checklist de sinais e sintomas de DTM e aplicação do Tinnitus Handicap Inventory (THI). RESULTADOS: o zumbido de pitch agudo, contínuo e bilateral foi o mais freqüente. À acufenometria, o pitch médio do zumbido referido pelos indivíduos foi de 8,6 kHz e a loudness média foi de 14,1 dBNS. O grau do incômodo causado pelo zumbido foi leve. Observou-se que quanto mais agudo o pitch, menor foi a loudness e maior a pontuação no THI. Verificou-se que 90% dos indivíduos apresentaram pelo menos um sinal ou sintoma de DTM. CONCLUSÕES: o tipo de zumbido mais frequente é o de pitch agudo, contínuo e bilateral, 90% dos indivíduos apresentaram pelo menos um sinal ou sintoma de DTM e não há correlação do zumbido com a acufenometria, THI e checklist para DTM.

Research has shown that dysfunction of the temporomandibular joint is often associated with tinnitus. AIM: to characterize tinnitus in individuals with normal hearing and search for a possible relationship with Temporomandibular Disorders (TMD). Study design: prospective and cross-sectional. MATERIALS AND METHODS: the participants included 20 adults of both genders with tinnitus and normal hearing thresholds on audiometry. We studied tinnitus psychoacoustic characteristics and employed the checklist of TMD signs and symptoms from the Tinnitus Handicap Inventory (THI). RESULTS: the high pitch, continuous and bilateral tinnitus was the most frequent. Upon acuphenometry, the average tinnitus pitch reported by the subjects was 8.6 kHz and the average loudness was 14.1 dBSL. The degree of discomfort caused by tinnitus was mild. We observed that the higher the pitch, the lower was the loudness and the higher was the THI score. We found that 90% of the patients had at least one TMD sign or symptom. CONCLUSIONS: the most common was the high pitch, continuous and bilateral tinnitus; 90% of patients had at least one sign or symptom of TMD and there was no correlation between the tinnitus and acuphenometry, THI and the TMD checklist.

O que mudou nos serviços de saúde com a Estratégia Saúde da Família / What has changed in the health services with the family health strategy

Este estudo tem como objetivo descrever, na visão de enfermeiros, possíveis mudanças na assistência à saúde da população, a partir da implantação da Estratégia Saúde da Família. Trata-se de um estudo analítico, com abordagem qualitativa, utilizando entrevistas semiestruturadas. Foram entrevistadas seis enfermeiras da cidade de Caicó-RN, que trabalhavam na atenção básica, antes e depois da implantação da estratégia. As principais mudanças verificadas foram: adscrição e vínculos com a comunidade; acolhimento e humanização do atendimento; diminuição das internações hospitalares; fortalecimento da prevenção de agravos e promoção da saúde; e melhoria dos indicadores de saúde. A Estratégia Saúde da Família tem contribuições significativas para mudar o foco no processo de produção dos serviços de saúde, com maior valorização das ações de prevenção das doenças e de promoção da saúde.

CyberMedVPS: visual programming for development of simulators.

Computer applications based on Virtual Reality (VR) has been outstanding in training and teaching in the medical filed due to their ability to simulate realistic in which users can practice skills and decision making in different situations. But was realized in these frameworks a hard interaction of non-programmers users. Based on this problematic will be shown the CyberMedVPS, a graphical module which implement Visual Programming concepts to solve an interaction trouble. Frameworks to develop such simulators are available but their use demands knowledge of programming. Based on this problematic will be shown the CyberMedVPS, a graphical module for the CyberMed framework, which implements Visual Programming concepts to allow the development of simulators by non-programmers professionals of the medical field.