Influence of an Intensive Speech Therapy Program on the Speech of Individuals with Cleft Lip and Palate

Abstract Introduction Compensatory articulations are speech disorders due to the attempt of the individual with cleft palate/velopharyngeal dysfunction to generate intraoral pressure to produce high-pressure consonants. Speech therapy is the indicated intervention for their correction, and an intensive speech therapy meets the facilitating conditions for the correction of glottal stop articulation, which is the most common compensatory articulation. Objective To investigate the influence of an intensive speech therapy program (ISTP) to correct glottal stop articulation in the speech of individuals with cleft palate. Methods Speech recordings of 37 operated cleft palate participants of both genders (mean age = 19 years old) were rated by 3 experienced speech/language pathologists. Their task was to rate the presence and absence of glottal stops in the 6 Brazilian Portuguese occlusive consonants (p, b, t, d, k, g) distributed within several places in 6 sentences. Results Out of the 325 pretherapy target consonants rated with glottal stop, 197 (61%) remained with this error, and 128 (39%) no longer presented it. The comparison of the pre- and posttherapy results showed: a) a statical significance for the p1, p2, p3, p4, t1, k1, k2 and d6 consonants (McNemar test; p < 0.05); b) a statistical significance for the p consonant in relation to the k, b, d, g consonants and for the t consonant in relation to the b, d, and g consonants (chi-squared test; p < 0.05) in the comparison of the proportion improvement among the 6 occlusive consonants. Conclusion The ISTP influenced the correction of glottal stops in the speech of individuals with cleft palate.

Recreio e Educação Física: possibilidades para a prática pedagógica de professores de Educação Física Escolar / School recess and Physical Education: possibilities for the pedagogical practice of school Physical Education Teachers / Recreo y Educación Física: posibilidades para la práctica pedagógica de los profesores de Educación Física Escolar

Neste estudo, tematizamos o recreio escolar e seus desdobramentos para além de seu tempo, procurando compreendê-lo como um momento da rotina escolar conectado à função social da escola, bem como um momento muito fecundo, que pode enriquecer a atuação do(a) professor(a) de Educação Física (EF). Através de um ensaio teórico, apontamos que o tempo de recreio pode representar uma referência para a EF escolar e para todos os seus atores, professores, alunos e alunas, estimulando novos modos de inserir as práticas corporais no âmbito da escola, bem como para além dela (AU).

In this study, we have addressed the school recess and its unfoldings beyond its time span. We endevored to understand the school recess as part of the school routine, connected with the social function of the school. We have considered this time as a fruitful moment that can enrich the Physical Education teacher's performance. Through a theoretical essay, we have tried to demonstrate that recess time can represent a reference for school PE and for all its actors, such as teachers, pupils and students. It might also stimulate new ways of inserting body practices within the school (AU).

En este estudio nos enfocamos en el recreo escolar y sus desarrollos más allá de su tiempo, tratando de entenderlo como un momento de la rutina escolar, conectado a la función social de la escuela, así como un momento muy fructífero, que puede enriquecer la actuación del profesor de Educación Física (EF). A través de un ensayo teórico señalamos que el tiempo de recreo puede representar una referencia para la EF escolar y para todos sus actores, docentes, alumnos y alumnas, estimulando nuevas formas de insertar prácticas corporales en el ámbito escolar, así como, más allá de ella (AU).

"They Can Fight Their Own Fights": Prejudice, Permissiveness, and Discrimination against Minorities / "Ele Luta pela Causa Dele": Preconceito, Permissividade e Discriminação contra Grupos Minoritários

ABSTRACT The tendency to be permissive in face of a discriminatory situation is called collusion. The present study aimed to define and characterize collusion, and identify the variables connected to it, considering the perspective of different identity groups. Participants were 31 individuals divided in seven focus groups. The analysis indicated four categories connected to collusion: a) Close Relations: valuable interactions through which individuals learn behavioral patterns that lead to permissiveness; b) Group Identity: social identities, and intergroup relations patterns; c) Situation: characteristics of the situation in which discrimination is observed; and d) Cost-Effective Balance: perception the individuals have regarding the impact of their actions on the context and the cost attached to it.

RESUMO A tendência das pessoas de serem permissivas diante de uma situação discriminatória é chamada colusão. O presente estudo teve como objetivo definir e caracterizar colusão e identificar as variáveis a ela associadas, a partir da perspectiva de diferentes grupos identitários. Os participantes foram 31 sujeitos divididos em sete grupos focais. A análise indicou quatro categorias ligadas à colusão: a) Relações Próximas: interações por meio das quais os indivíduos aprendem padrões de comportamento que levam à permissividade; b) Identidade Grupal: identidades sociais e padrões de relações intergrupais; c) Situação: características da situação em que se observa discriminação; e d) Relação Custo-benefício: percepção que os indivíduos têm sobre o impacto de suas ações no contexto e o custo que lhes está associado.

Pharyngeal bulb prosthesis and speech outcome in patients with cleft palate / Obturador faríngeo e resultados de fala em pacientes com fissura palatina

Abstract Introduction: Individuals with cleft palate can present with velopharyngeal dysfunction after primary palatoplasty and require a secondary treatment due to insufficiency. In these cases, the pharyngeal bulb prosthesis can be used temporarily while awaiting secondary surgery. Objective: This study aimed to investigate the outcome of treatment of hypernasality with pharyngeal bulb prosthesis in patients with history of cleft palate presenting with velopharyngeal insufficiency after primary palatal surgery. We hypothesized that the use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency in patients with cleft palate. Methods: Thirty speakers of Brazilian Portuguese (15 males and 15 females) with operated cleft palate, ages ranging from 6 to 14 years (mean: 9 years; SD = 1.87 years), participated in the study. All patients were fitted with a pharyngeal bulb prosthesis to manage velopharyngeal insufficiency while they were awaiting corrective surgery to be scheduled. Auditory-perceptual analysis of speech recorded in the conditions with and without pharyngeal bulb prosthesis were obtained from three listeners who rated the presence or absence of hypernasality for this study. Results: Seventy percent of the patients eliminated hypernasality while employing the pharyngeal bulb prosthesis, while 30% still presented with hypernasality. The comparison was statistically significant (p < 0.001). Conclusion: The use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency.

Resumo Introdução: Indivíduos com fissura palatina podem apresentar disfunção velofaríngea após a palatoplastia primária e necessitam de um secundário devido à insuficiência velofaríngea. Nesses casos, o obturador faríngeo pode ser usado temporariamente enquanto se aguarda uma cirurgia secundária. Objetivo: Investigar o resultado do tratamento da hipernasalidade com o uso de obturador faríngeo em pacientes com histórico de fissura palatina que apresentam insuficiência velofaríngea após a palatoplastia primária. Nossa hipótese é que o uso do obturador faríngeo seja uma abordagem eficaz para eliminar a hipernasalidade relacionada à insuficiência velofaríngea em pacientes com fissura palatina Método: Participaram do estudo 30 indivíduos falantes do Português Brasileiro (15 homens e 15 mulheres) com fissura palatina operada, de 6 a 14 anos de idade (média: 9 anos; DP = 1,87 anos). Todos os pacientes receberam obturador faríngeo para o tratamento da insuficiência velofaríngea, enquanto aguardavam vaga para a cirurgia secundária. A análise perceptivo-auditiva da fala, realizada nas condições com e sem obturador faríngeo, foi realizada por três ouvintes, quanto à presença e ausência da hipernasalidade. Resultados: 70% dos pacientes eliminaram a hipernasalidade de fala com o uso do obturador faríngeo, enquanto 30% não eliminaram. A comparação foi estatisticamente significante (p < 0,001). Conclusão: O uso temporário do obturador faríngeo é uma abordagem efetiva para eliminar a hipernasalidade decorrente da insuficiência velofaríngea.

Avaliação de alumina e carvão ativado conjugados com nanopartículas de prata como pré-tratamentos para nanofiltração visando à redução da incrustação / Evaluation of alumina and activated carbon conjugated to silvernanoparticles as nanofiltration pre-treatments aiming at fouling reduction

RESUMO A má distribuição geográfica de águas em território nacional aliada ao seu desperdício, à poluição dos cursos d'água próximos aos centros urbanos e industriais e à eficiência inadequada de processos de tratamento convencionais faz com que o tratamento e o reúso de água sejam tópicos de crescente importância no Brasil. Um dos métodos de tratamento de água são os processos de separação por membranas, como a nanofiltração. No entanto, esses processos estão sujeitos ao fenômeno de incrustação, que provoca diminuição gradativa de sua eficiência. Sendo assim, o presente trabalho visou à avaliação de diferentes métodos de pré-tratamento de água para mitigação da formação de biofilme em membranas de nanofiltração. Os processos de adsorção em partículas de alumina e desinfecção por meio de carvão ativado impregnado com nanopartículas de prata foram aplicados em uma amostra de um corpo d'água superficial. As amostras com e sem pré-tratamento foram nanofiltradas e a propensão à incrustação de cada uma foi avaliada. As eficiências de remoção de compostos orgânicos dos adsorventes empregados separadamente e em conjunto e as análises de absorção UV/Vis, microscópio eletrônico de varredura e espectroscopia de energia dispersiva do carvão ativado impregnado com nanopartículas de prata mostraram que os materiais empregados no pré-tratamento puderam ser apropriadamente sintetizados. Foi possível também identificar os principais grupos funcionais dos biopolímeros presentes nos biofilmes formados ao longo do tempo. Por fim, pôde-se observar que a adsorção da matéria orgânica é mais eficiente para o controle da incrustação rápida, enquanto o efeito bactericida se destaca no controle a longo prazo.

ABSTRACT The poor geographical distribution of water in the national territory combined with its waste, the pollution of watercourses close to urban and industrial centers, and the inadequate efficiency of conventional treatment processes make the treatment and reuse of water topics of increasing importance in Brazil. One of the advanced water treatment methods is membrane separation processes, such as nanofiltration. However, these processes are subject to fouling phenomenon, which causes a gradual decrease in the efficiency of the process. Therefore, the present work aims to evaluate different methods of pretreatment of water to mitigate the formation of biofilm in nanofiltration membranes. The adsorption processes on alumina particles and disinfection through activated carbon impregnated with silver nanoparticles were applied to a sample of a surface water body. Samples with and without pretreatment were nanofiltered and the propensity to fouling was evaluated. The efficiency of the adsorbents, used both separately and together, in removing organic compounds and the UV/Vis, scanning electron microscope, and Energy-dispersive X-ray spectroscopy analyses of the activated carbon impregnated with silver nanoparticles showed that the materials used in the pre-treatment were properly synthesized. It was also possible to identify the main functional groups of the biopolymers present in biofilms formed over time. Finally, it was observed that the adsorption of organic matter is more efficient for the control of rapid fouling while the bactericidal effect stands out in the long-term fouling control.

Can a pharyngeal bulb prosthesis eliminate hypernasal speech in individuals with hypodynamic velopharynx?

ABSTRACT Purpose: to investigate the effectiveness of a pharyngeal bulb prosthesis to eliminate hypernasality in patients with operated cleft palate presenting with diagnosis of hypodynamic velopharynx. Methods: twenty patients with cleft palate, ages 11-40 years, presenting hypodynamic velopharynx participated in the study. Patients had their speech audio recorded twice, with and without prosthesis, simultaneously with nasometry. Three speech-pathologists rated the presence and absence of hypernasality. Perceptual and nasometric data without and with prosthesis were compared, using the McNemar Test (p<0.05). Results: three (15%) patients presented hypernasality without prosthesis and normal resonance with prosthesis, 3 (15%), normal resonance without prosthesis and hypernasality with prosthesis, 9 (45%), hypernasality without and with prosthesis, and 5 (25%), normal resonance in both conditions. Nasometry (≤27% cut off): 1 (5%), presented scores >27% without prosthesis and <27% with prosthesis, 2 (10%), scores <27% without prosthesis and >27% with prosthesis, 17 (85%), scores >27% in both conditions, and 1(5%), scores <27% in both conditions. The comparisons between the results were not significant (p=1.000). Conclusion: the pharyngeal bulb prosthesis alone is insufficient to eliminate hypernasality of patients presented with hypodynamic velopharynx. To this purpose, the combination between the prosthesis and speech therapy is required.

Cardiovascular risk factors and major depressive disorder: a cross-sectional study in São Paulo, Brazil

ABSTRACT BACKGROUND: Cardiovascular risk factors can mediate the association between depression and cardiovascular diseases. OBJECTIVE: To evaluate cardiovascular risk factors in adult individuals with and without histories of major depression in the metropolitan region of São Paulo, Brazil. DESIGN AND SETTING: Cross-sectional study in São Paulo (SP), Brazil. METHODS: This study evaluated 423 individuals without any lifetime diagnosis of major depression and 203 individuals with a previous diagnosis of major depression (n = 626). The participants underwent a psychiatric evaluation using a structured clinical interview (SCID-1), an anthropometric evaluation and a clinical evaluation that included blood pressure measurement and assessment of fasting blood glucose, lipid profile and physical activity levels. RESULTS: Individuals with histories of major depression were more likely to be female (P < 0.0001). Individuals with lifetime diagnoses of major depression were more likely to be current smokers (odds ratio, OR 1.61; 95% confidence interval, CI 1.01-2.59) and to have diabetes (OR 1.79; 95% CI 1.01-3.21); and less likely to be obese (OR 0.58; 95% CI 0.35-0.94). CONCLUSION: Individuals with major depression had higher odds of presenting tobacco smoking and diabetes, and lower odds of being obese. Healthcare professionals need to be aware of this, so as to increase the rates of diagnosis and treatment in this population.

Retirement and Meaning Attribution: A study with Active Workers in Brazil / Aposentadoria e Atribuição de Significado: Um Estudo com Trabalhadores Ativos no Brasil

Abstract The aim of this study was to investigate the meanings attributed to retirement by active workers. For this purpose, the Retirement Meaning Scale was constructed and administered to 275 active workers (53.5% women) aged 22 to 67 years. The results reveal an ambiguous meaning attribution to the phenomenon: on one hand, there is a positive idea of freedom; on the other hand, the workers report experiences of anguish and insecurity related to retirement. Among the variables investigated, the proximity to retirement was especially relevant to the perception of the phenomenon, which influenced three of the four factors identified. This study has implications for policies and programs that aim to promote healthy experiences in retirement.

Resumo O objetivo deste estudo foi investigar os significados atribuídos à aposentadoria por trabalhadores ativos. Para isto, foi construída e aplicada a Escala de Significado da Aposentadoria, numa amostra de 275 trabalhadores ativos (53,5% mulheres) com idades entre 22 e 67 anos. Os resultados revelam o significado ambíguo do fenômeno da aposentadoria: há uma ideia positiva, de liberdade; mas, por outro lado, os trabalhadores relatam angústia e insegurança relacionadas à aposentadoria. Entre as variáveis estudadas, é especialmente relevante o impacto da proximidade da aposentadoria na percepção do fenômeno, que revelou influência sobre três dos quatro fatores identificados. Esta investigação tem implicações para programas e políticas de preparação para a aposentadoria que visam promover a saúde e o bem-estar dos trabalhadores.

Benzodiazepine use in Sao Paulo, Brazil

OBJECTIVES: To report the prevalence and factors associated with the use of benzodiazepines in the general population and those with a mental health condition in the metropolitan area of São Paulo, Brazil. METHODS: 5,037 individuals from the Sao Paulo Megacity Mental Health Survey data were interviewed using the Composite International Diagnostic Interview, designed to generate DSM-IV diagnoses. Additionally, participants were asked if they had taken any medication in the previous 12 months for the treatment of any mental health condition. RESULTS: The prevalence of benzodiazepine use ranged from 3.6% in the general population to 7.8% among subjects with a mental health condition. Benzodiazepine use was more prevalent in subjects that had been diagnosed with a mood disorder as opposed to an anxiety disorder (14.7% vs. 8.1%, respectively). Subjects that had been diagnosed with a panic disorder (33.7%) or bipolar I/II (23.3%) reported the highest use. Individuals aged ≥50 years (11.1%), those with two or more disorders (11.2%), those with moderate or severe disorders (10%), and those that used psychiatric services (29.8%) also reported higher use. CONCLUSION: These findings give an overview of the use of benzodiazepines in the general population, which will be useful in the public health domain. Benzodiazepine use was higher in those with a mental health condition, with people that had a mood disorder being the most vulnerable. Furthermore, females and the elderly had high benzodiazepine use, so careful management in these groups is required.

Escala de metas de autoimagem e compaixão: adaptação para amostras brasileiras / Self-image and compassion goals scale: adaptation for brazilian samples / Escala de metas de autoimagen y compasión: adaptación para muestras brasileñas

O artigo teve como objetivo traduzir e adaptar a escala de metas de autoimagem e compaixão de sua versão original em inglês para o português, no contexto da Polícia Militar do Distrito Federal (com amostras; N=127 e N=480) e buscar evidências de validade nacionais da escala. A original possui treze itens e o processo foi desenvolvido com base em métodos recomendados na literatura, passando por etapas de tradução, tradução reversa, comitê e análise de coeficiente de validade de conteúdo, que obteve índices satisfatórios (CVC=0,95). A análise fatorial exploratória apontou a estrutura bifatorial da escala conforme teoria e confirmou suas evidências de validade, mas indicando três itens que apresentaram baixas cargas fatoriais. Por fim, após nova coleta de dados, foi realizada a análise fatorial confirmatória da escala que confirmou sua estrutura bifatorial após exclusão de três itens existentes em sua versão original.

The aim of this study was to translate and adapt the scale of Self-Image and Compassion goals from English to Portuguese, in the context of the Federal District Military Police (with samples N = 127 and N = 480), and seek evidence of the scale's national validity. The original scale had 13 items, and the validation procedure was developed following the cross-cultural literature recommendation. Thus, using the first sample, items went through a translation/back translation procedure, followed by the Content Validity Index computation, which obtained satisfactory levels (CVI = 0.95). An exploratory factor analysis confirmed the proposed two-factor structure, providing evidence of validity, but indicated three items that presented low factor loadings, which were later excluded. Finally, with the larger sample (N = 480), a confirmatory factor analysis confirmed the two-factor structure of the scale, after exclusion of three items from its original English version.

Este artículo tiene como objetivo traducir y adaptar la escala de metas de autoimagen y compasión, de su versión original en Inglés al portugués, en el contexto de la Policía Militar del Distrito Federal (con muestras, N = 127 y N = 480) y buscar evidencias de validez nacional de la escala. La original tiene trece ítems y el proceso fue desarrollado con base en métodos recomendados en la literatura, pasando por etapas de traducción, traducción reversa, comité y análisis de coeficiente de validez de contenido, que obtuvo índices satisfactorios (CVC = 0,95). El análisis factorial exploratorio apuntó la estructura bifactorial de la escala, según la teoría, y confirmó sus evidencias de validez, pero indicó tres ítems con bajas cargas factoriales. Por último, tras una nueva recopilación de datos, se realizó el análisis factorial confirmatorio de la escala que ratificó su estructura bifactorial tras la exclusión de tres ítems de su versión original.

Treatment of anxiety disorders in clinical practice: a critical overview of recent systematic evidence

The aim of this study was to review emerging evidence of novel treatments for anxiety disorders. We searched PubMed and EMBASE for evidence-based therapeutic alternatives for anxiety disorders in adults, covering the past five years. Eligible articles were systematic reviews (with or without meta-analysis), which evaluated treatment effectiveness of either nonbiological or biological interventions for anxiety disorders. Retrieved articles were summarized as an overview. We assessed methods, quality of evidence, and risk of bias of the articles. Nineteen systematic reviews provided information on almost 88 thousand participants, distributed across 811 clinical trials. Regarding the interventions, 11 reviews investigated psychological or nonbiological treatments; 5, pharmacological or biological; and 3, more than one type of active intervention. Computer-delivered psychological interventions were helpful for treating anxiety of low-to-moderate intensity, but the therapist-oriented approaches had greater results. Recommendations for regular exercise, mindfulness, yoga, and safety behaviors were applicable to anxiety. Transcranial magnetic stimulation, medication augmentation, and new pharmacological agents (vortioxetine) presented inconclusive benefits in patients with anxiety disorders who presented partial responses or refractoriness to standard treatment. New treatment options for anxiety disorders should only be provided to the community after a thorough examination of their efficacy.

Gender-related dimensions of childhood adversities in the general population

Objective: Childhood adversities (CAs) comprise a group of negative experiences individuals may suffer in their lifetimes. The goal of the present study was to investigate the cluster discrimination of CAs through psychometric determination of the common attributes of such experiences for men and women. Methods: Parental mental illness, substance misuse, criminality, death, divorce, other parental loss, family violence, physical abuse, sexual abuse, neglect, physical illness, and economic adversity were assessed in a general-population sample (n=5,037). Exploratory and confirmatory factor analysis determined gender-related dimensions of CA. The contribution of each individual adversity was explored through Rasch analysis. Results: Adversities were reported by 53.6% of the sample. A three-factor model of CA dimensions fit the data better for men, and a two-factor model for women. For both genders, the dimension of family maladjustment - encompassing physical abuse, neglect, parental mental disorders, and family violence - was the core cluster of CAs. Women endorsed more CAs than men. Rasch analysis found that sexual abuse, physical illness, parental criminal behavior, parental divorce, and economic adversity were difficult to report in face-to-face interviews. Conclusion: CAs embrace sensitive personal information, clustering of which differed by gender. Acknowledging CAs may have an impact on medical and psychiatric outcomes in adulthood.

Vetorização de compostos 5-nitro-heterocí­clicos com atividade frente a microrganismos multirresistentes. Obtenção de nanopartí­culas carregadas e avaliação da atividade antimicrobiana / Vectorization of 5-nitro-heterocyclic compounds with activity against multiresistant microorganisms. Obtaining of loaded nanoparticles and evaluation of antimicrobial activity

Pacientes com queimaduras e outras lesões cutâneas de grande extensão apresentam alta propensão a infecções multirresistentes. Neste contexto, o objetivo deste trabalho é a obtenção de nanopartículas de quitosana carregadas com composto derivado de 5-nitro-heterocíclico com estrutura análoga à nifuroxazida, N'-((5-nitrofurano-2-il)metileno)-2-benzidrazida (C-H), que apresentou importante atividade frente a diversas cepas de bactérias multirresistentes. Por sua vez, a quitosana é um biopolímero com atividade antimicrobiana, analgésica, regeneradora tecidual e que, mediante contato com exsudato de lesões cutâneas forma filmes hidrogéis protetores no local de aplicação, sendo estas atividades importantes para a prevenção e tratamento de infecções e da exsudação excessiva de lesões de grande extensão. As nanopartículas de quitosana carregadas com o composto (Nps-H) foram obtidas pelo método de gelificação iônica com tripolifosfato de sódio como agente reticulante, variando a concentração de NaCl e polissorbato 80 do sistema, orientada por análise fatorial. As Nps-H obtidas foram caracterizadas por Dynamic Light Scattering (DLS) para determinação do tamanho, índice de polidispersão (IPD) e potencial zeta (ζ). A eficiência de encapsulação (EE%) foi determinada por espectrofotometria UV/VIS a 370 nm por método indireto. Entre os experimentos desenvolvidos, aquele que apresentou os melhores resultados resultou em partículas de tamanho médio de 321 d.nm, IPD 0,18, Pζ +37 mV e EE% de 48%. A morfologia e superfície das Nps-H foram analisadas por Microscopia Eletrônica de Varredura (MEV) e mostraram que as Nps-H são esféricas e de superfície irregular. A partir da obtenção e caracterização das Nps-H determinou-se a concentração inibitória mínima (CIM) das Nps-H, do composto livre (C-H) e das nanopartículas de quitosana vazias (Nps-Cs) por método colorimétrico e microdiluição frente às cepas de Staphylococcus aureus ATCC 29213, hVISA e ORSA. As Nps-H apresentaram atividade bastante superior comparando-se ao C-H e as Nps-Cs frente às cepas de S. aureus estudadas. Com vista à preparação de uma formulação farmacêutica estável, partiu-se para a liofilização das Nps-H e com esse objetivo realizou-se análises térmicas das Nps-H por Differential Scanning Calorimetric (DSC) para determinação das temperaturas de transição vítrea e eutética (Tg' e Teut) e análise por criomicroscopia para determinação da temperatura de colapso (Tcol). Amostras de Nps-H com lio/crioprotetores glicina, lactose e sacarose a diferentes concentrações foram liofilizadas a -40 ºC a 100 mTorr. As amostras de Nps-H com lactose e sacarose ambas a 2,5% e 5% demonstraram preservar as características originais das Nps-H após o processo de liofilização. Observou-se, com os resultados obtidos neste trabalho que as Nps-H representam uma promissora alternativa na prevenção e tratamento de pacientes com lesões cutâneas infeccionadas por bactérias multirresistentes e no controle da exsudação excessiva, principalmente por suas atividades terapêuticas em conjunto, diminuindo a mortalidade e morbidade desses quadros

Patients with burns and others extensive skin lesions show high propension to multiresistant infections. In this context, the aim of this project is to obtain chitosan nanoparticles carried with 5-nitro-heterocyclic derivate with structure analogue to nifuroxazide N'-((5-nitrofuran-2-yl) methylene)-2-benzhydrazide, that showed important activity against multiresistant bacteria strains. In its turn, the chitosan is a biopolymer with antimicrobial, analgesic, tecidual regenerator activities and by contact with excessive burns and extensive skin lesions exsudate process, form protective hydrogel films on place of application, being these activities important to infection and excessive exsudate treatment and prevention of extensive burns and lesions. The chitosan nanoparticles carried with compound (Nps-H) were obtained by ionic gelation method with sodium tripolyphosphate as crosslinker agent, varing the NaCl and polysorbate 80 concentrations in the system, oriented by factorial analyze. The Nps-H obtained were characterized by Dynamic Light Scattering (DLS) to size determination, polydispersion index (PDI) and zeta potential (ζ-P). The encapsulation efficiency (EE%) were determined by spectrophotometry UV/VIS at 370 nm by indirect method. Bepolissorbato the experiments developed, the one who showed the best results, resulted in particles with size of 321 d.nm, PDI of 0,18, ζ-P of +37 mV and EE% of 48%. The Nps-H morphology and surface were analyzed by Scanning Electronic Microscopy (SEM) and showed that Nps-H are spherical and with irregular surface. Starting of Nps-H obtain and characterization were determined the Nps-H, free compound (C-H) and empty chitosan nanoparticles (Nps-Cs) Minimal Inhibitory Concentrations (MIC) by colorimetric method and microdilution against Staphylococcus aureus ATCC 29213, ORSA and hVISA strains. The Nps-H showed the superior activity comparing to C-H and Nps-H against all strains tested. With a view to preparation of stable pharmaceutic formulation, started to Nps-H freeze-drying and with this aim, were realized Nps-H thermal analyzes by Differential Scanning Calorimetric (DSC) to determine glass transition and euthetic temperatures (Tg' and Teut) and the cryomicroscopy analyze to determine collapse temperature (Tcol). The Nps-H samples with lyo/cryoprotectants as glycine, lactose and sucrose at different concentrations were lyophilized at -40 ºC at 100 mTorr. The Nps-H samples with lactose and sucrose both at 2,5% and 5% demonstrated to preserve the original Nps-H characteristics after freeze-drying process. Were observed, with the results obtained in this project that Nps-H represent the promising alternative to prevention and treatment of patients with infected skin lesions by multiresitant bacteria and to control of excessive exudate process, mainly by their therapeutic activities combined, decreasing the mortality and morbidity of these cases

Prevalence and clinical profile of chronic pain and its association with mental disorders

ABSTRACT OBJECTIVE To identify the prevalence of 12-month self-reported pain and chronic pain in a general population and to describe their clinical profile to assess if chronic pain is associated with 12-month mental disorders. METHODS The data used comes from the São Paulo Megacity Mental Health Survey, a population-based study assessing adult (≥ 18 years) residents of the São Paulo metropolitan area, Brazil. We have assessed the respondents (n = 5,037) using the Composite International Diagnostic Interview (CIDI 3.0), with a global response rate of 81.3%. Descriptive analyses have been performed, and crude and adjusted odds ratios (OR) have been calculated with logistic and multinomial regression and presented with respective 95% confidence intervals (95%CI). RESULTS The prevalence of pain and chronic pain in the past 12 months were 52.6% (95%CI 50.3-54.8) and 31.0% (95%CI 29.2-32.7), respectively. Joints (16.5%, 95%CI 15.4-17.5) and back or neck (15.5%, 95%CI 14.2-16.9) were the most frequently reported anatomical sites of chronic pain. On a 10-point analogue scale, the mean intensity of the worst pain was 7.7 (95%CI 7.4-7.8), and the mean average pain was 5.5 (95%CI 5.2-5.6); the mean treatment response was 6.3 (95%CI 6.0-6.6). Mean pain duration was 16.1 (95%CI 15.6-17.0) days a month and 132 (95%CI 126-144) minutes a day. Chronic pain was associated with 12-month DSM-IV mental disorders (OR = 2.7, 95%CI 2.3-3.3), anxiety disorders (OR = 2.1, 95%CI 1.9-3.0), and mood disorders (OR = 3.3, 95%CI 2.4-4.1). CONCLUSIONS A high prevalence of chronic pain in multiple sites is observed among the general adult population, and associations between chronic pain and mental disorders are frequent.

Mental disorders and employment status in the São Paulo Metropolitan Area, Brazil: gender differences and use of health services / Transtornos mentais e situação laboral na Região Metropolitana de São Paulo, Brasil: diferenças de gênero e uso de serviços de saúde / Trastornos mentales y situación laboral en la zona metropolitana de São Paulo, Brasil: diferencias de género y uso de servicios de salud

Abstract: Mental disorders are associated with employment status as significant predictors and as consequences of unemployment and early retirement. This study describes the estimates and associations of 12-month DSM-IV prevalence rates of mental disorders and use of health services with employment status by gender in the São Paulo Metropolitan Area, Brazil. Data from the São Paulo Megacity Mental Health Survey was analyzed (n = 5,037). This is a population-based study assessing the prevalence and determinants of mental disorders among adults, using the Composite International Diagnostic Interview. The associations were estimated by odds ratios obtained through binomial and multinomial logistic regression. This study demonstrates that having mental disorders, especially mood disorders, is associated with being inactive or unemployed among men and inactive among women, but only having a substance use disorder is associated with being unemployed among women. Among those with mental disorders, seeking health care services is less frequent within unemployed.

Resumo: Os transtornos mentais estão associados à situação laboral enquanto preditores significativos e consequências do desemprego e da aposentadoria precoce. Este estudo estima as taxas de prevalência de transtornos mentais nos últimos 12 meses de acordo com o DSM-IV, além do uso de serviços de saúde e as associações com situação laboral de acordo com gênero na Região Metropolitana de São Paulo, Brasil. Foram analisados dados do São Paulo Megacity Mental Health Survey (n = 5.037), um estudo populacional que avalia a prevalência e determinantes dos transtornos mentais entre adultos, usando a Composite International Diagnostic Interview. As associações foram estimadas através de razões de prevalência, obtidas por regressão logística binomial e multinomial. O estudo mostra que os transtornos mentais, especialmente transtornos de humor estão associados à inatividade ou ao desemprego entre os homens e à inatividade entre as mulheres, com exceção aos transtornos devido ao uso de substâncias psicoativas que também estão associados ao desemprego em as mulheres. Entre os portadores de transtornos mentais, a busca de serviços de saúde é menos frequente entre os desempregados.

Resumen: Los trastornos mentales están asociados a la situación laboral, como predictores significativos por las consecuencias que provocan el desempleo y la jubilación precoz. Este estudio estima las tasas de prevalencia de trastornos mentales en 12 meses, de acuerdo con el DSM-IV, además del uso de servicios de salud y las asociaciones existentes con la situación laboral, de acuerdo con el género en el área metropolitana de São Paulo, Brasil. Se analizaron los datos del São Paulo Megacity Mental Health Survey (n = 5.037), un estudio poblacional que evalúa la prevalencia y determinantes de los trastornos mentales entre adultos, usando la Composite International Diagnostic Interview. Las asociaciones se estimaron con razones de prevalencia, obtenidas por la regresión logística binomial y multinomial. El estudio muestra que los trastornos mentales, especialmente los trastornos de humor, están asociados a la inactividad o al desempleo en hombres y a la inactividad en mujeres, pero que sólo el trastorno de consumo de sustancias está asociado al desempleo en mujeres. Entre los portadores de trastornos mentales, la búsqueda de servicios de salud es menos frecuente entre los desempleados.

Intensive treatment of speech disorders in robin sequence: a case report

ABSTRACT Purpose To describe the speech of a patient with Pierre Robin Sequence (PRS) and severe speech disorders before and after participating in an Intensive Speech Therapy Program (ISTP). Methods The ISTP consisted of two daily sessions of therapy over a 36-week period, resulting in a total of 360 therapy sessions. The sessions included the phases of establishment, generalization, and maintenance. A combination of strategies, such as modified contrast therapy and speech sound perception training, were used to elicit adequate place of articulation. The ISTP addressed correction of place of production of oral consonants and maximization of movement of the pharyngeal walls with a speech bulb reduction program. Therapy targets were addressed at the phonetic level with a gradual increase in the complexity of the productions hierarchically (e.g., syllables, words, phrases, conversation) while simultaneously addressing the velopharyngeal hypodynamism with speech bulb reductions. Results Re-evaluation after the ISTP revealed normal speech resonance and articulation with the speech bulb. Nasoendoscopic assessment indicated consistent velopharyngeal closure for all oral sounds with the speech bulb in place. Conclusion Intensive speech therapy, combined with the use of the speech bulb, yielded positive outcomes in the rehabilitation of a clinical case with severe speech disorders associated with velopharyngeal dysfunction in Pierre Robin Sequence.

Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo / Determinantes do uso de serviços de saúde: análise multinível da Região Metropolitana de São Paulo

OBJECTIVE To evaluate the individual and contextual determinants of the use of health care services in the metropolitan region of Sao Paulo. METHODS Data from the Sao Paulo Megacity study – the Brazilian version of the World Mental Health Survey multicenter study – were used. A total of 3,588 adults living in 69 neighborhoods in the metropolitan region of Sao Paulo, SP, Southeastern Brazil, including 38 municipalities and 31 neighboring districts, were selected using multistratified sampling of the non-institutionalized population. Multilevel Bayesian logistic models were adjusted to identify the individual and contextual determinants of the use of health care services in the past 12 months and presence of a regular physician for routine care. RESULTS The contextual characteristics of the place of residence (income inequality, violence, and median income) showed no significant correlation (p > 0.05) with the use of health care services or with the presence of a regular physician for routine care. The only exception was the negative correlation between living in areas with high income inequality and presence of a regular physician (OR: 0.77; 95%CI 0.60;0.99) after controlling for individual characteristics. The study revealed a strong and consistent correlation between individual characteristics (mainly education and possession of health insurance), use of health care services, and presence of a regular physician. Presence of chronic and mental illnesses was strongly correlated with the use of health care services in the past year (regardless of the individual characteristics) but not with the presence of a regular physician. CONCLUSIONS Individual characteristics including higher education and possession of health insurance were important determinants of the use of health care services in the metropolitan area of Sao Paulo. A better understanding of these determinants is essential for the development of public policies ...

OBJETIVO Analisar os determinantes individuais e contextuais do uso de serviços de saúde na Região Metropolitana de São Paulo. MÉTODOS Foram utilizados os dados do estudo São Paulo Megacity, a versão brasileira da pesquisa multicêntrica World Mental Health Survey. Foram analisados 3.588 indivíduos adultos residentes em 69 áreas da Região Metropolitana de São Paulo, SP (38 municípios adjacentes e 31 subprefeituras do município de São Paulo), selecionados por meio de amostragem multiestratificada da população não institucionalizada. Foram ajustados modelos multinível logísticos Bayesianos para identificar os determinantes individuais e contextuais do uso de serviços de saúde nos últimos 12 meses e a presença de médico de referência para cuidados de rotina. RESULTADOS As características contextuais do local de residência (desigualdade de renda, violência e renda mediana) não apresentaram associação significativa (p > 0,05) com o uso de serviços ou com a presença de médico de referência para cuidados de rotina. A única exceção foi a associação negativa entre residir em uma área com alta desigualdade de renda e a presença de médico de referência (OR 0,77; IC95% 0,60;0,99) após controle das características individuais. O estudo apontou uma forte e consistente associação entre algumas características individuais (principalmente escolaridade e presença de plano de saúde) com o uso de serviços de saúde e ter médico de referência. A presença de doenças crônicas e mentais associou-se fortemente com o uso de serviços no último ano (independentemente de características individuais), mas não com a presença de médico de referência. CONCLUSÕES Características individuais como maior escolaridade e ter plano de saúde foram determinantes importantes do uso de serviços de saúde na Região Metropolitana de São Paulo. A melhor compreensão desses determinantes é necessária para o desenvolvimento de políticas públicas que permitam o uso equitativo dos serviços ...

Distribuição de massa molar em um biorreator com membrana para tratamento de efluente de laticínios / Molecular weight distribution in a membrane bioreactor for dairy effluent treatment

Os biorreatores com membrana (BRM) apresentam-se como um dos processos mais promissores para tratamento de águas residuárias com elevada carga orgânica, como os efluentes de laticínios, propiciando a geração de um efluente com elevada qualidade e adequado ao reuso direto ou após tratamento terciário. O objetivo desse trabalho foi avaliar o uso de BRM para tratamento de efluente de indústria de laticínios e utilizar a distribuição de massa molar da alimentação, do permeado e da fração solúvel do lodo como ferramenta para a investigação dos mecanismos de remoção dos poluentes no sistema. O BRM se mostrou um sistema viável para o tratamento do efluente em questão, apresentando eficiências de remoção de demanda química de oxigênio (DQO) e cor aparente de 98 e 99%, respectivamente. Através da distribuição de massa molar foi possível observar a alta capacidade de biodegradação e a estabilidade proporcionada pelo BRM, já que, mesmo em situações de alterações constantes nas características da alimentação, o líquido reacional sempre apresentou baixas concentrações de poluentes. Ressalta-se também a importância da membrana no sistema, uma vez que, além de permitir a retenção completa de biomassa e a operação com idades de lodo e concentração de sólidos suspensos maiores, pode proporcionar ainda a retenção de compostos que não foram biodegradados, contribuindo para a geração de um efluente tratado com alta qualidade.

The membrane bioreactor (MBR) is one of the most promising processes for the treatment of high organic load wastewaters, as dairy effluent, providing the generation of an effluent with high quality, which could be reuse directly or after tertiary treatment. The aim of this study was to evaluate a MBR to treat effluent from the dairy industry and to use molecular weight distribution of the feed, permeate and the soluble fraction of the sludge as a tool for investigating the mechanisms of pollutants removal in the system. The MBR has proven to be a viable system for the treatment of the effluent in question, with removal efficiencies of chemical oxidation demand (COD) and color of 98 and 99% respectively. Through the molar weight distribution it was possible to observe the high biodegradation capacity and stability provided by the MBR, as even in situations of constant change in feed characteristics, the mixed liquid always showed low concentrations of pollutants. It is also highlighted the importance of the membrane in the system, which, besides allowing the complete retention of biomass and operation with high solids retention time and suspended solids concentration, it can provide the retention of compounds which were not biodegraded, contributing to the generation a treated effluent with high quality.

Days out-of-role due to common physical and mental health problems: Results from the Sao Paulo Megacity Mental Health Survey, Brazil

OBJECTIVES: To investigate the relative importance of common physical and mental disorders with regard to the number of days out-of-role (DOR; number of days for which a person is completely unable to work or carry out normal activities because of health problems) in a population-based sample of adults in the São Paulo Metropolitan Area, Brazil. METHODS: The São Paulo Megacity Mental Health Survey was administered during face-to-face interviews with 2,942 adult household residents. The presence of 8 chronic physical disorders and 3 classes of mental disorders (mood, anxiety, and substance use disorders) was assessed for the previous year along with the number of days in the previous month for which each respondent was completely unable to work or carry out normal daily activities due to health problems. Using multiple regression analysis, we examined the associations of the disorders and their comorbidities with the number of days out-of-role while controlling for socio-demographic variables. Both individual-level and population-level associations were assessed. RESULTS: A total of 13.1% of the respondents reported 1 or more days out-of-role in the previous month, with an annual median of 41.4 days out-of-role. The disorders considered in this study accounted for 71.7% of all DOR; the disorders that caused the greatest number of DOR at the individual-level were digestive (22.6), mood (19.9), substance use (15.0), chronic pain (16.5), and anxiety (14.0) disorders. The disorders associated with the highest population-attributable DOR were chronic pain (35.2%), mood (16.5%), and anxiety (15.0%) disorders. CONCLUSIONS: Because pain, anxiety, and mood disorders have high effects at both the individual and societal levels, targeted interventions to reduce the impairments associated with these disorders have the highest potential to reduce the societal burdens of chronic illness in the São Paulo Metropolitan Area. .