Obsolescência programada em serviços de saúde: o caso da Máfia das Próteses / Planned obsolescence in public health services: the Prosthetic Mafia case

Resumo Obsolescência programada é um conjunto de ações empreendidas por parte do produtor com o objetivo de estabelecer o decaimento gradativo de algum atributo de uma mercadoria para, assim, estimular artificialmente a demanda pelo consumo. A literatura sobre o fenômeno tem apontado como vítimas somente indivíduos e, como forma de manifestação do fenômeno, objetos. Este trabalho aponta a ocorrência do fenômeno de obsolescência programada em serviços públicos de saúde. Para isso, é empreendido um estudo exploratório-interpretativo de abordagem qualitativa e utilizado como estratégia de pesquisa o estudo de caso. A unidade de análise foi a nomeada Máfia das Próteses e, para coleta de dados, foram empregadas as técnicas de pesquisa bibliográfica e documental. Como resultado, foram selecionados e expostos três casos da ocorrência do fenômeno em cirurgias. Foi também realizado um esforço interpretativo dos condicionantes, da dinâmica e dos efeitos da prática de sabote cirúrgico com objetivo de estimular a demanda por serviços médicos e equipamentos médico-hospitalares. Como contribuição, este estudo realiza o delineamento dos elementos que caracterizam a ocorrência deste fenômeno em serviços médicos. Além disso, inaugura uma agenda de futuros estudos que abordam tanto o Estado sendo vitimado pela prática, quanto a ocorrência do fenômeno no setor de serviços.

Abstract Planned obsolescence is a set of actions undertaken by the producer to establish the gradual decay of some attribute of a commodity, artificially stimulating the demand for consumption. The literature on the phenomenon has identified only individuals as victims and objects as forms of expression. This study reports the occurrence of planned obsolescence in public health services. To this end, it consists of an exploratory-interpretative study with a qualitative approach, using the case study of the so-called Prosthetic Mafia. Data were collected by means of bibliographic and documentary research, resulting in three cases that expose the phenomenon occurrence in surgeries. The results were analyzed through an attempt to interpret the conditions, dynamics, and effects of the practice of surgical sabotage to stimulate the demand for medical services and medical-hospital equipment. This study outlines the elements that characterize planned obsolescence occurrence in medical services, inaugurating an agenda of future studies that address both the State being victimized by the practice and the phenomenon in the service sector.

Osteoartrosis de ATM: recuperar la función / TMJ Osteoarthrosis: recover function

Objetivo: evaluar la rehabilitación funcional de la ATM en pacientes con osteoartrosis, con abordaje neuromuscular. La osteoartrosis se caracteriza por la degeneración del cartílago articular y la cortical ósea, que conduce a dolor e inmovilidad. Se incluyó a 8 mujeres entre 20 y 42 años de edad con dolor en la región orofacial, signos de oclusión disfuncional e imágenes compatibles con trastornos degenerativos en ATM. Clínicamente se evaluó el dolor y la oclusión y, mediante tecnología electrónica, se obtuvieron datos objetivos de los movimientos de apertura-cierre y lateralidades, la velocidad de apertura-cierre mandibulares y de los ruidos articulares. Las mediciones fueron realizadas al inicio y al finalizar el tratamiento de estabilización mandibular con una ortosis neuromuscular. Para determinar la significación estadística se utilizaron el Student`s test de comparaciones múltiples y el análisis de varianza, ANOVA, de un factor. Las diferencias entre medias se consideraron significativas con p <0.05. Los resultados demostraron ausencia de dolor en el 100% de los casos al primer mes de tratamiento. Se incrementaron la apertura bucal (6,73 mm promedio), ambas lateralidades (P=0.0023), velocidad en apertura y en cierre (no estadísticamente significativo). Después de estabilizar la mandíbula se redujo la frecuencia de los ruidos. En conclusión, la oclusión dental disfuncional es el principal factor etiológico de la artrosis de la ATM. El establecimiento de una oclusión fisiológica produce la descompresión de la ATM, aumenta el rango de los movimientos mandibulares y disminuye significativamente el dolor (AU)

Objective: to evaluate the functional rehabilitation of the TMJ in patients with osteoarthritis, with a neuromuscular approach. Osteoarthrosis is characterized by degeneration of articular cartilage and bone cortex, which leads to pain and immobility. Eight women between 20 and 42 years of age with pain in the orofacial region, signs of dysfunctional occlusion, and images consistent with degenerative TMJ disorders were included. Clinically, pain and occlusion were evaluated and, using electronic technology, objective data were obtained on the opening-closing movements and lateralities, the opening-closing speed of the jaws and joint noises. Measurements were made before and at the end of the mandibular stabilization treatment with a neuromuscular orthosis. To determine the statistical significance, the Student`s multiple comparisons test and the analysis of variance, ANOVA, of one factor were used. The differences between means were considered significant with p <0.05. The results showed absence of pain pain in 100% of cases in the first month of treatment. Mouth opening (6.73 mm average), both lateralities (P = 0.0023), opening and closing speed (not statistically significant) were increased. After stabilizing the jaw the noise frequency value was reduced. In conclusion, dysfunctional dental occlusion is the main etiologic factor of TMJ osteoarthritis. Establishing a physiological occlusion causes TMJ decompression, increases the range of mandibular movements, and significantly decreases pain (AU)

Design of Monitorable Wrist Orthosis Based on 3D Printing / 中国医疗器械杂志

A 3D printing based wrist orthosis device was developed. After collecting the contour information of the carpal and metacarpophalangeal joints of the patients with a 3D scanner, the wrist orthotics were designed to meet the individual needs of the patients according to the relevant requirements of biomechanics. Choose TPU (thermoplastic polyurethanes) materials for preparation of 3D printing. It can functionally assist the smart brace after stroke patients with hemiplegia early rehabilitation training, the use of orthoses carry MPU6050 inertial sensor, magnetometer, time module device such as a sensor and monitor its movements and record the training time, ensure safe efficient rehabilitation training, help patients return to a normal life as soon as possible.

Orthotic management with a customized humeral brace for Gorham-Stout disease of the humerus: A case report

@#Gorham-Stout disease is characterized by massive osteolysis or "vanishing bone" on radiograph. Due to its rarity, no standard Physical Medicine and Rehabilitation (PM&R) management has been published. With this comes the dilemma of managing another case of vanishing right humerus in a 13 year-old male, right handed student, with normal growth and development. To date, this could be the third documented case in the Philippines, but the first with humeral involvement, and the first to manage using a customized humeral brace. The absence of the right humerus affects the bimanual overhead and tabletop activities of the patient, for which a custom-made humeral orthosis was provided to manage the limited activities. There were improvements in activities such as writing, card turning, stacking, and lifting objects of variable weights, as well as with hand dexterity as evidenced by the standardized hand function tests done prior and post brace fitting. Being a rare bone disease with no standard management and unpredictable course, cases are managed symptomatically. For this case of an absent humerus significantly affecting upper extremity function, orthotic management is one aspect that could be recommended to achieve positive functional outcomes.

Plantar Fascitis: A Concise Review

plantar fasciitis is not uncommon condition affecting Indian population and chief complaint is heel pain while walking.it is estimated that 10-15% population requires medical treatment. Recurrence is also very common despite of treatment. This article includes etiology,knowledge of mechanism,diagnosis,current available treatmen

Desenvolvimento, confecção e avaliação dos efeitos e segurança de um protótipo de órtese de quadril utilizado na reabilitação funcional de paciente submetido a artroplastia de Girdlestone / Development, manufacturing and evaluation of effects and safety of a hip orthosis prototype used in the functional rehabilitation of a patient undergoing Girdlestone arthroplasty

A Artroplastia de Ressecção tipo Girdlestone (ARG) é um procedimento que altera o estilo de vida do indivíduo gerando fadiga precoce, instabilidade articular, distúrbio da marcha e discrepância de membros. Como medida auxiliar no processo de reabilitação podem ser utilizadas órteses. Contudo, não há no mercado nacional dispositivos adequados, sendo necessária a importação com custo elevado. Assim, este estudo desenvolveu e avaliou os efeitos e a segurança de um protótipo de órtese de quadril em uma paciente feminina submetida à ARG. O modelo proposto melhorou o desempenho físico e a funcionalidade e promoveu o alívio de dores osteomusculares. (AU)

Girdlestone resection arthroplasty (GRA) is a procedure that changes one's lifestyle, leading to early fatigue, joint instability, gait disorder and limb discrepancy. Orthoses can be used as an aid in the rehabilitation process. However, there are no adequate devices available in Brazil and the imported ones are high-cost. Thus, this study developed and evaluated the effects and safety of a hip orthosis prototype in a woman who underwent GRA. The proposed model improved physical performance and functionality and provided relief of musculoskeletal pain. (AU)

Application of Problem-based Learning and Case-based Learning in Course of Outcome Measures in Prosthetics and Orthotics / 中国康复理论与实践

Objective To apply problem-based learing(PBL)and case-based learning(CBL)in course of Outcome Measures in Prosthet-ics and Orthotics.Methods The undergraduate students in Grade 2012 of Prosthetics and Orthotics Engineering in Capital Medical Universi-ty (group A, n=27) were taught in traditional teaching, and those in Grade 2014 (group B, n=25) were taunght with PBL and CBL. Both groups received an immediate test after class,and group B also fulfilled an anonymous questionnaire.Results The score of immediate test was better in group B than in group A(t=-4.972,P<0.001).Most students in group B recognised that the new strategy of learning could im-prove their ability of independent solving clinical problems,literature retrieval,communication and expression.Conclusion Application of PBL and CBL in teaching of Outcome Measures in Prosthetics and Orthotics can promote students'activity in learning and improve teaching quality.

Undergraduate Training Scheme for Prosthetic and Orthotics Engineering / 中国康复理论与实践

@#Capital Medical University has opened the courses of Prosthetic and Orthotics Engineering since 2003. Through a three-period development of more than ten years, the professional training scheme has met the international requirements and highlight in specialty characteristics. It needs a combination of medicine, rehabilitation, technology, prosthetic and orthotics, an enough foundation for personals and sites, teachers of bi-profession, and a comprehensive test system to practice.

An Alignment Technique of Body Gravity for Fit of Prosthesis / 中国康复理论与实践

@#Objective To develop an alignment technique based on the movement of body gravity center. Methods As join forces in the system of balance is zero, the position of body gravity center can be calculated by body gravity which is taken from weight sensors, by the special software. Meanwhile, the position of body gravity will be sent to control unit, which can be transformed to driving signal of motor. The sliding table with laser, linked to motor, can make pursuit movement following with body gravity. A precise alignment can be made as the movement of body gravity. The balance function test is also used to make an assistant estimate for the alignment. Results and Conclusion An alignment technique has been developed for the fit of prosthesis and orthotics.

An Alignment Technique of Body Gravity for Fit of Prosthesis / 中国康复理论与实践

Objective To develop an alignment technique based on the movement of body gravity center. Methods As join forces in the system of balance is zero, the position of body gravity center can be calculated by body gravity which is taken from weight sensors, by the special software. Meanwhile, the position of body gravity will be sent to control unit, which can be transformed to driving signal of motor. The sliding table with laser, linked to motor, can make pursuit movement following with body gravity. A precise alignment can be made as the movement of body gravity. The balance function test is also used to make an assistant estimate for the alignment. Results and Conclu-sion An alignment technique has been developed for the fit of prosthesis and orthotics.

Ergonómia y deporte de ciclista con displasia de cadera y acortamineto de miembros inferiores / Ergonomics and sport of a cycling with hip dysplasia and shortening of the lower limbs

Este artículo presenta el ajuste mecánico más eficiente para mejorar la ergonomía y el rendi-miento en un ciclista con displasia de cadera y acortamiento de 4 centímetros en su miembro inferior izquierdo. Abordar esta problemática permite encontrar nuevas alternativas que favo-rezcan los procesos de adaptación biológica de los sistemas neuromuscular y óseo en deportistas en situación de discapacidad. En éstas áreas, de la salud y rendimiento deportivo, se perciben vacíos que requieren generación de nuevo conocimiento. Fue un estudio pre- experimental de replicación intrasujeto. Se utilizaron varios ajustes mecánicos en la longitud de la biela de la bicicleta y la acomodación de tacos de diferente longitud a las zapatillas del deportista. Poste-riormente se compararon los efectos de los ajustes mecánicos, buscando mejorar la ergonomía y eficiencia del deportista. Las variables fueron: anatómicas (postura sedente sobre la bicicleta), fisiológicas (comportamiento frecuencia cardiaca) y biocinemáticas (tiempos y velocidades pro-medio y ángulos articulares de rodilla tanto para la flexión como para la extensión en cada uno de los ajustes) datos que fueron registrados en planilla de Excel 2007. Al comparar el efecto de los ajustes mecánicos con la medición inicial, se encontró que el mejor ajuste para la ergonomía y el rendimiento del deportista corresponde a la combinación del taco 1 cm y biela 15,5 cm, con porcentajes de mejora en la variable morfológica alineación postural sobre la bicicleta de 71.4%; variables biocinemáticas mejoras en los tiempos en 1 km y 3 km en un 94.4% y 88.71%; y en cuanto a velocidades alcanzadas obtuvo mejoras en 1 km y 3 km del 115% y 118% respectivamente

The focus of this project was to establish the most efficient way to improve the ergonomics and performance a cyclist with hip dysplasia and shortening of 4 cm in the left lower limb mechanical adjustment , which was intended to contribute to a solution to this problems while finding new ways to encourage the processes of biological adaptation of neuromuscular and skeletal systems in athletes with disabilities , to feed the areas of health and athletic performance , even where perceived gaps in the application of this knowledge. This was framed within a pre-experimental study of intrasubject replication design. To develop research different possibilities for mecha-nical adjustment were used in the length of the crank of the bicycle and the accommodation of different length studs shoes athlete subsequently settled comparatively the effects of mechani-cal adjustments seeking to improve ergonomics and efficiency athlete represented in anatomical variables ( sitting posture on the bike ) , physiological ( heart rate behavior) and biokinematics (times and average speeds at and knee joint angles for both flexion and extension for each of the settings) data were recorded in Excel 2007 spreadsheet. When comparing the effect of mechanical adjustments relative to the initial measurement was found that the best fit to the ergonomics and the athlete's performance corresponds to the combination of the dowel rod 1 cm and 15.5 cm, with percentages of improvement in the variable morphological postural alignment on bicycle 71.4%; biokinematic variable time improvements at 1 km and 3 km in 94.4% and 88.71%; and as for speed improvements obtained reached within 1 km and 3 km of 115% and 118% respectively

Diseño e implementación de un módulo electromecánico para la rehabilitación física de la mano derecha afectada como secuela de un ataque cerebrovascular

El módulo de rehabilitación diseñado es un sistema compuesto por circuitos electrónicos para automatización y control de una órtesis robótica para mano, que colabora en la rehabilitación de la extremidad superior a nivel distal derecha de pacientes hemiparéticos con ataque cerebrovascular. La intencionalidad de movimiento es detectada a través de un sistema electrónico no invasivo de electromiografía, utilizando sensores ubicados sobre la piel (electrodos de superficie) que registran la actividad eléctrica de un músculo particular. El procesamiento de las señales adquiridas se realiza con un circuito de instrumentación acondicionado para manipular señales biológicas de pequeño voltaje. Una última etapa de procesamiento digital permite identificar el movimiento realizado. Cuando el paciente mueve su mano afectada, el sistema a su salida presenta una señal electromiográfica amplificada y sin componentes de ruido, que se utiliza como señal de control de los actuadores de la órtesis robótica automatizada para la mano derecha. El dispositivo diseñado contiene ejercicios para la extensión y flexión de la mano y para la extensión y oposición del pulgar.

The designed rehabilitation moduleis a system compound by electronic circuits to automate and control a robotic orthotic for a hand. It cooperates in the upper limb rehabilitation in the right distal zone of hemiparetic stroke patients. The motion intention is detected by a noninvasive electronic electromyography system using sensors (surface electrodes) placed in skin surface to report electrical activity of a single muscle. An instrumentation circuit is designed for signal processing of acquired signals based on low voltage bio-signals treatment. A latest digital processing section identifies the kind of movement.When the patient moves his or heraffected hand, the out of the system presents an amplified electromyography signal without noise components that is used like a control signal in the actuators of automated robotic orthotics for the right hand. The designed device contains flexion and extension exercises of the right hand and extension and opposition of the thumb.

Evaluating the quality of making orthotics and prostheties by appropriate technology in community-based rehabilitation program in Vietnam

The study evaluated hand over knowledge and skill product orthosis and prosthesis for disabled people at communite acording to appropriate technology and evaluated quanlity of orthotics and prostheties, evaluated the effectiveness of them according to appropriate technology for disabled people in 17 last years. The result showed that: evaluating 192 community workers about knowledge for orthosis and prosthesis. There is about 70,83% in good mark, 24,41% in average, 4,76% in bad. 167/202 (82,67%) in control group were in bad mark. The different between 2 groups was significant. Price of the tool is cheap, quality of it is good. Rate of exercise improvement in 316 disabled people is 83,07% (control group is 7,38%).