Coronary Intravascular Lithotripsy Effectiveness and Safety in a Real-World Cohort.

Background: Coronary artery calcification is a predictor of adverse outcomes after percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL) is a promising tool for the treatment of calcified lesions. The aim of this study was to assess the effectiveness and safety of IVL. Methods: A single-center observational study of PCI procedure, with assessment of the outcomes of patients undergoing PCI using IVL, was performed. Angiographic procedural success was used as the primary effectiveness endpoint. The primary safety endpoint was defined as a composite of cardiac death, myocardial infarction and target vessel revascularization within 30 days. Results: A total of 111 patients were included. Indications for PCI spanned the spectrum of chronic (53.2%) and acute coronary syndromes (43%). Lesion preparation before IVL was performed with non-compliant (42%), cutting or OPN (14.4%) balloons and with atherectomy techniques in 11% of procedures. Intravascular imaging was used in 21.6% of procedures. The primary effectiveness endpoint was achieved in 100% and the primary safety endpoint in 3.6% of procedures. Peri-procedural complications were minimal and successfully resolved. Conclusions: IVL was an effective and safe technique for the treatment of calcified coronary lesions. These findings contribute to the growing body of evidence supporting the use of IVL in the management of these challenging scenarios.

Study and characterization of a product based on a vegetable extract of quinoa fermented with water kefir grains.

This work aimed to study and characterize a product based on vegetable extract of quinoa (WVEQ) fermented with water kefir grains. The effect of sucrose concentration (SC), inulin concentration (IC), and xanthan gum (XG) concentration were evaluated using a central composite design (CCD) 23. They were subsequently characterized regarding cellular growth of the grains, beverage yield, pH, soluble solids, carbon dioxide (CO2) production, lactic acid, and ethanol production. Therefore, for the final stage, two formulations (F1 and F8) of the CCD were chosen to be characterized in terms of proximate composition, microbiological composition of the kefir culture, analysis of organic compounds, sensory analysis, and enzymatic and microbiological characterization before and after simulation of in vitro gastrointestinal digestion. In the two chosen products, one can see that fermentation optimized the bioavailability of proteins due to the high proteolytic activity of the microorganisms in kefir and the increase in lipid content. In identifying microorganisms, there was a prevalence of Saccharomyces sp. yeasts. In the sensory analysis, the F8 formulation showed better results than the F1 formulation. In vitro, gastrointestinal digestion showed reduced lactic acid bacteria and yeast and increased acetic acid bacteria in the liquid phase for both formulations. In the enzymatic profile, there was a reduction in all enzymes analyzed for both formulations, except for amylase in F1, which went from 14.05 U/mL to 39.41 U/mL. Therefore, it is concluded that using WVEQ as a substrate for the product appears to be a viable alternative with nutritional and technological advantages for serving a specific market niche.

Catquest-9SF questionnaire: validation of the Portuguese version using the Rasch analysis / Questionário Catquest-9SF: validação da versão em português utilizando análise Rasch

ABSTRACT Purpose: The aim of this study was to validate the Portuguese version of Catquest-9SF through its application in a native Brazilian population with cataracts and to determine the correlation of the questionnaire scores with preoperative visual acuity. Methods: A prospective study was conducted to validate the Catquest-9SF questionnaire, which was translated and back-translated, generating a final version in Portuguese. A total of 120 Brazilian patients awaiting cataract surgery were recruited to answer the questionnaire and to document their preoperative data and visual acuity. The Rasch analysis was used to assess the instrument's psychometric properties. Results: The Portuguese version of Catquest-9SF demonstrated an acceptable adjustment of the items (item fit statistics ranging from 0.7 to 1.3), unidimensionality (principal component analysis), and good organization in the item response categories (thresholds of the categories: -2.79, 0.57, and 2.22, respectively). The questionnaire contains items with stable relationships if considered at the same level of visual impairment in the comparison between the two groups (absence of differential item functioning). The separation of people (person separation index, 3.07) was adequate. The visual acuity in the logarithm of the minimum angle of resolution (logMAR) in the best eye with the best optical correction showed a statistically significant correlation with the Catquest-9SF logit score (r=0.282 and p=0.004). Conclusions: The Portuguese version of Catquest-9SF presents evidence of validity and reliability, in addition to being linguistically and culturally understandable for Portuguese-speaking patients born in Brazil. The questionnaire is easy to understand and quick to apply, as it could adequately estimate the subjective visual functioning in patients with cataracts. We found a significant correlation between visual acuity and the questionnaire score.

RESUMO Objetivos: Validar a versão em português do Catquest-9SF através de sua aplicação em uma população nativa do Brasil com catarata e determinar a correlação da pontuação obtida no questionário com a acuidade visual pré-operatória. Métodos: Realizou-se um estudo prospectivo para validação de questionário. O Catquest-9SF foi traduzido e retro traduzido gerando uma versão final em português. Um total de 120 pacientes brasileiros que aguardavam realização de cirurgia de catarata foram recrutados para responder ao questionário e para documentação de dados pré-operatórios e acuidade visual. Análise Rasch foi utilizada para acessar as propriedades psicométricas do instrumento. Resultados: A versão em português do Catquest-9SF demonstrou ajuste aceitável dos itens (item fit statistics variando entre 0,7 e 1,3), unidimensionalidade (Principal Component Analisis) e boa organização nas categorias de resposta dos itens (limiares das categorias: -2,79; 0,57; 2,22). O questionário contém itens com relação estável, se considerado um mesmo nível de deficiência visual, na comparação entre dois grupos (ausência de differential item functioning). Existe adequada separação de pessoas (Person Separation Index 3,07). A acuidade visual em LogMAR no melhor olho com melhor correção óptica mostrou correlação estatisticamente significativa com a pontuação em logit do Catquest-9SF (r=0,282 e p=0,004). Conclusões: A versão em português do Catquest-9SF apresenta evidência de validade e confiabilidade, além de ser linguística e culturalmente compreensível para pacientes de língua portuguesa naturais do Brasil. Trata-se de questionário de fácil entendimento e rápida aplicação, sendo capaz de estimar de maneira adequada o funcionamento visual subjetivo em pacientes com catarata. Existe correlação significativa com a acuidade visual e a pontuação obtida no questionário.

15-Year Retrospective Study on the Success Rate of Maxillary Sinus Augmentation and Implants: Influence of Bone Substitute Type, Presurgical Bone Height, and Membrane Perforation during Sinus Lift.

Objectives: To evaluate the success rate of bone grafts and implants carried out at the Latin American Institute for Research and Dental Education (ILAPEO), considering the following: (i) the different pure bone substitutes (autogenous, xenogeneic, and alloplastic), (ii) the presurgical bone height, and (iii) how the treatment is compromised when membrane perforation occurs during sinus lift in maxillary sinus surgeries. Material and Methods. The initial sample comprised 1040 records of maxillary sinus lifting surgeries. After evaluation, the final sample retained 472 grafts performed using the lateral window technique with a total of 757 implants. The grafts were divided into 3 groups: (i) autogenous bone (n = 197), (ii) xenogenous bovine bone (n = 182), and (iii) alloplastic material (n = 93). One calibrated examiner classified the sample into two groups based on the residual bone height (<4 mm and ≥4 mm) of the area of interest measured on parasagittal sections of tomographic images. Data on membrane perforation occurrences in each group were collected; qualitative variables were described using frequency, expressed as percentages. The Chi-square test was used to analyze the success of the graft types and the survival rate of the implants as a function of the grafted material and the residual bone height. The Kaplan-Meier survival analysis was used to calculate the survival rate of bone grafts and implants according to the classifications adopted in this retrospective study. Results: The success rate of grafts and implants was 98.3% and 97.2%, respectively. There was no statistically significant difference in the success rate among the different bone substitutes (p = 0.140). Only 8 grafts (1.7%) and 21 implants (2.8%) failed. There was a greater success rate for both grafts (96.5%) and implants (97.4%) when the bone height was ≥4 mm. The success rate in the 49 sinuses in which the membrane was perforated was 97.96% for the grafts and 96.2% for the implants. The follow-up periods after rehabilitation ranged from 3 months to 13 years. Conclusions: Within the limitations of the data analyzed in this retrospective study, maxillary sinus lift was a viable surgical technique that enabled implant placement with a predictable long-term success rate, regardless of the type of material used. The presence of membrane perforation did not interfere with the success rate obtained for grafts and implants.

Catquest-9SF questionnaire: validation of the Portuguese version using the Rasch analysis.

PURPOSE: The aim of this study was to validate the Portuguese version of Catquest-9SF through its application in a native Brazilian population with cataracts and to determine the correlation of the questionnaire scores with preoperative visual acuity. METHODS: A prospective study was conducted to validate the Catquest-9SF questionnaire, which was translated and back-translated, generating a final version in Portuguese. A total of 120 Brazilian patients awaiting cataract surgery were recruited to answer the questionnaire and to document their preoperative data and visual acuity. The Rasch analysis was used to assess the instrument's psychometric properties. RESULTS: The Portuguese version of Catquest-9SF demonstrated an acceptable adjustment of the items (item fit statistics ranging from 0.7 to 1.3), unidimensionality (principal component analysis), and good organization in the item response categories (thresholds of the categories: -2.79, 0.57, and 2.22, respectively). The questionnaire contains items with stable relationships if considered at the same level of visual impairment in the comparison between the two groups (absence of differential item functioning). The separation of people (person separation index, 3.07) was adequate. The visual acuity in the logarithm of the minimum angle of resolution (logMAR) in the best eye with the best optical correction showed a statistically significant correlation with the Catquest-9SF logit score (r=0.282 and p=0.004). CONCLUSIONS: The Portuguese version of Catquest-9SF presents evidence of validity and reliability, in addition to being linguistically and culturally understandable for Portuguese-speaking patients born in Brazil. The questionnaire is easy to understand and quick to apply, as it could adequately estimate the subjective visual functioning in patients with cataracts. We found a significant correlation between visual acuity and the questionnaire score.

Síndrome de fragilidade entre pessoas idosas longevas de uma macrorregião de saúde em Minas Gerais / Frailty syndrome among oldest old individuals in a health macro-region of Minas Gerais

Resumo Objetivo identificar as condições de fragilidade e seus fatores associados entre pessoas idosas longevas residentes na área urbana de uma macrorregião de saúde de Minas Gerais, Brasil. Métodos estudo transversal, desenvolvido com 314 pessoas idosas longevas residentes em uma macrorregião de saúde de Minas Gerais. Os dados foram coletados nos domicílios mediante a aplicação de instrumentos validados no Brasil. Procederam-se as análises descritiva e regressão logística multinomial (p<0,05). Resultados verificou-se que 44,3% do longevos eram frágeis, 44,3% pré-frágeis e 11,4% não frágeis. A condição de pré-fragilidade associou-se ao fato de morar só (p=0,047) e ao desempenho físico muito ruim/baixo (p=0,026), enquanto a fragilidade, ao desempenho físico muito ruim/baixo (p<0,001); ao indicativo de sintomas depressivos (p=0,029) e à presença de 5 ou mais morbidades (p=0,003). Conclusão as condições de pré-fragilidade e fragilidade foram as mais frequentes entre os longevos. A manutenção do desempenho físico é um aspecto passível de atuação pelos profissionais de saúde, a ser trabalhado entre as pessoas idosas longevas visando postergar a pré-fragilidade e a fragilidade.

Abstract Objective to identify frailty conditions and their associated factors among oldest old individuals living in the urban area of a health macro-region of Minas Gerais state. Methods a cross-sectional study of 314 oldest old from a health macro-region in Minas Gerais state, Brazil, was conducted. Data were collected from households by applying instruments validated for use in Brazil. Descriptive and multinomial logistic regression analyses (p<0.05) were carried out. Results In the sample assessed, 44.3% of the oldest old were frail, 44.3% pre-frail and 11.4% non-frail. The pre-frail condition was associated with living alone (p=0.047) and very poor/poor physical performance (p=0.026), while frailty was associated with very poor/poor physical performance (p<0.001), the presence of depressive symptomatology (p=0.029) and of ≥5 morbidities (p=0.003). Conclusion pre-frail and frail conditions predominated among the oldest old assessed. Maintaining physical performance is an aspect that can be targeted by health professionals in oldest old to delay pre-frailty and frailty.

TNF-mimetic peptide mixed with fibrin glue improves peripheral nerve regeneration.

Surgical intervention is necessary following nerve trauma. Tubular prostheses can guide growing axons and inserting substances within these prostheses can be positive for the regeneration, making it an alternative for the current standard tools for nerve repair. Our aim was to investigate the effects of fibrin glue BthTL when combined with a synthetic TNF mimetic-action peptide on nerve regeneration. Male Wistar rats suffered left sciatic nerve transection. For repairing, we used empty silicon tubes (n = 10), tubes filled with fibrin glue BthTL (Tube + Glue group, n = 10) or tubes filled with fibrin glue BThTL mixed with TNF mimetic peptide (Tube + Glue + Pep group, n = 10). Animals were euthanized after 45 days. We collected nerves to perform immunostaining (neurofilament, GAP43, S100-ß, NGFRp75 and Iba-1), light and transmission electron microscopy (for counting myelinated, unmyelinated and degenerated fibers; and for the evaluation of morphometric aspects of regenerated fibers) and collagen staining. All procedures were approved by local ethics committee (protocol 063/17). Tube + Glue + Pep group showed intense inflammatory infiltrate, higher Iba-1 expression, increased immunostaining for NGFRp75 receptor (which characterizes Schwann cell regenerative phenotype), higher myelin thickness and fiber diameter and more type III collagen deposition. Tube + Glue group showed intermediate results between empty tube and Tube + Glue + Pep groups for anti-NGFRp75 immunostaining, inflammation and collagen; on fiber counts, this group showed more degenerate fibers and fewer unmyelinated axons than others. Empty tube group showed superiority only in GAP43 immunostaining. A combination of BthTL glue and TNF mimetic peptide induced greater axonal regrowth and remyelination.

Can Implant-Retained Fixed Prostheses Trigger Bone Response in the Posterior Region of Edentulous Mandibles? A 32-Month Cone-Beam Computerized Tomography Study Analyzing Bone Height and Density.

Research has shown that the presence of implants can revert bone resorption and thus contribute to a greater preservation of the residual bone ridge, especially in edentulous mandibles. Bone remodeling has yet to be extensively studied in the context of prosthetic options for edentulous arches. This study aims to evaluate the long-term behavior of bone tissue in the posterior region of edentulous mandibles rehabilitated with implant-retained fixed prostheses using cone-beam computerized tomography (CBCT). Selected individuals were rehabilitated with 5 external hexagon platform implants and an implant-retained fixed prosthesis. The CBCT scans were performed immediately after surgery and after 8, 22, and 32 months (T0, T8, T22, and T32, respectively). Implants were installed between the mental foramen. Subsequently, bone crest height and density were measured in the posterior region of the mandible on the images in 3 distinct areas at 5, 10, and 15 mm from the center of the distal implant axis. Analysis of variance and the Bonferroni post hoc test were used for multiple analyses. The results indicate a statistically significant difference in bone height between T0 and all subsequent times; the bone height at T32 was 8.85% higher than at T0 (P = .05). There was a difference in bone height between all analyzed regions. The bone growth difference between the 5-mm and 15-mm positions was 28.42% after 32 months (P = .00). A significant increase of 5.76% in bone density was observed between T0 and T22 (P = .03). Within the limitations of this study (sample size, follow-up duration), it was demonstrated that the use of implant-retained fixed prostheses in the mandible resulted in qualitative and quantitative bone growth (bone preservation) in the posterior region of the mandible. Further research is needed to identify the validity of our findings for other populations and to determine the duration of the bone-remodeling process in rehabilitated edentulous mandibles.

Auditory sentence comprehension in children with cochlear implants after simple visual discrimination training with specific auditory-visual consequences.

The present study evaluated the effects of simple discrimination training with specific consequences on auditory comprehension in children with cochlear implants (CIs). Demonstration of auditory comprehension was based on derived conditional relations and the formation of equivalence relations. Participants learned two sets of three simple visual discriminations in which the positive stimulus (S+) was a written pseudo-sentence (C1, C2, or C3) or a compound abstract picture (D1, D2, or D3), displayed in the correct orientation. Each trial presented the S+ simultaneously with two S- which were the same sentence or picture as the positive stimulus but were displayed in either an upside-down or an inverse orientation. Correct responses were followed by specific consequences with two components presented simultaneously: a dictated pseudo-sentence (A) and a representative picture (B). Probes of arbitrary matching to sample assessed derived auditory-visual (AB, AC, and AD) and visual-visual (BC, CB, BD, DB, CD, and DC) conditional relations. All three participants learned the simple discriminations; two of them showed derived conditional relations, demonstrating the formation of three ABCD classes. The present study replicated and extended previous results on sentence learning in children with CIs, suggesting the simple discrimination training with specific consequences as an efficient procedure to generate auditory-visual and symbolic relations in this population.

Fluxo digital para planejamento de reabilitação / Digital workflow for rehabilitation planning

Resumo O fluxo de trabalho digital para o planejamento e execução da reabilitação oral já é uma realidade na prática profissional e pode beneficiar a conversa multidisciplinar para a compreensão e resolução dos casos que apresentam maior complexidade e certas limitações. Com base nisso, este relato tem a intenção de discutir uma reabilitação oral que integra o uso do protocolo fotográfico e traçado, a reabilitação oral por fluxo digital no aumento da dimensão vertical de oclusão (DVO), recursos cirúrgicos para melhorias de ângulo nasolabial.(AU)

Abstract The digital workflow for planning and executing oral rehabilitation is already a reality in professional practice and can benefit the multidisciplinary dialogue to understand and resolve cases that present greater complexity and certain limitations. Based on this, this report intends to discuss an oral rehabilitation that integrates the use of the photographic and tracing protocol, the oral rehabilitation by digital workflow in the increase of the vertical dimension of occlusion (VDO), surgical resources for improvements of the nasolabial angle. (AU)

Ensino de comportamento verbal elementar por exemplares múltiplos em crianças com autismo / Teaching elementary verbal behavior by multiple exemplar in children with autism / Enseñanza del comportamiento verbal elemental mediante múltiples copias en niños con autismo

No escopo da investigação de sob quais condições ocorre a aprendizagem e a emergência de operantes verbais, diferentes condições de ensino têm sido planejadas. Considerando que a população com Transtorno do Espectro Autista (TEA) apresenta frequentemente um repertório de operantes verbais ausente ou fracamente estabelecido, é necessário o estudo do planejamento de intervenções sistemáticas desses repertórios com condições de favorecer não só a aquisição de vocabulário, mas também o seu potencial gerativo de novas funções verbais. O Multiple Exemplar Instruction (MEI) é uma estrutura de ensino que tem demonstrado resultados promissores pela sua capacidade de estabelecer relações entre comportamentos de ouvinte e de falante e gerar novas respostas verbais. O objetivo deste estudo foi verificar os efeitos do MEI sobre o estabelecimento e integração entre os repertórios de ouvinte e de falante (ecoico, tato e mando). Participaram duas crianças com TEA, com idades de 7 e 8 anos e cuja comunicação era muito restrita e baseada em trocas de figuras. O ensino adotou três conjuntos com três estímulos cada. O ensino com cada conjunto foi realizado separadamente. Ora o ensino consistia no treino de ouvinte baseado em seleção, ora tentativas de ouvinte, ecoico, tato e mando, eram apresentadas de forma rotativa. Sondas múltiplas intercalaram os ensinos e verificaram os efeitos destes sobre o repertório de falante com os demais conjuntos. Os resultados demonstraram um aumento na emissão de respostas de ouvir e falar após o ensino por MEI para os dois participantes, ambos com repertório verbal restrito, mas o procedimento foi mais efetivo para uma das crianças...(AU)

In the scope of research about under what conditions the learning and emergency of verbal operants occurs, different teaching conditions have been planned. Considering that the population with Autistic Spectrum Disorder (ASD) often has a repertoire of verbal operants absent or poorly established, it is necessary to study the planning of systematic interventions in these repertoires with conditions to favor not only vocabulary acquisition, but also their generative potential of new verbal functions. The Multiple Exemplar Instruction (MEI) is a teaching structure that has shown promising results for its ability to establish relationships between listening and speaker behaviors and to generate new verbal responses. The objective of this study was to verify the effects of the MEI on the establishment and integration between the listener repertoires and the speaker (echoic, tact and mand). Two children with ASD, aged between 7 and 8 years old, participated in the study, whose communication was very restricted and based on exchanges of figures. The teaching adopted three sets with three stimuli each. Teaching with each set was carried out separately. The teaching consisted of the training of listener based on selection, sometimes attempts of listener, echoic, tact and mand, were presented in a rotating way. Multiple probes intercalated the teachings and verified the effects of these on the repertoire of speaker with the other sets. The results showed an increase in the emission of listening and speaking responses after MEI teaching for the two participants, both with restricted verbal repertoire, but the procedure was more effective for one of the children...(AU)

El el ámbito de la investigación de en qué condiciones se produce el aprendizaje y la aparición de operantes verbales, se han planificado diferentes condiciones de enseñanza. Teniendo en cuenta que la población con Trastorno del Espectro Autista (TEA) con frecuencia presenta un repertorio de operantes verbales ausentes o débilmente establecidos, es necesario estudiar la planificación de intervenciones sistemáticas en estos repertorios con condiciones para favorecer no solo la adquisición de vocabulario, sino también su potencial generativo de nuevas funciones verbales. La Instrucción Ejemplar Múltiple (MEI) es una estructura de enseñanza que ha mostrado resultados prometedores por su capacidad para establecer relaciones entre los comportamientos del oyente y el hablante y generar nuevas respuestas verbales. El objetivo de este estudio fue verificar los efectos del MEI en el establecimiento e integración entre los repertorios de oyentes y hablantes (eco, tacto y comando). Participaron dos niños con TEA, de 7 y 8 años, cuya comunicación era muy restringida y basada en intercambios de figuras. La enseñanza adoptó tres conjuntos con tres estímulos cada uno. La enseñanza con cada conjunto se llevó a cabo por separado. Algunas veces la enseñanza consistía en entrenar al oyente en base a la selección, a veces los intentos de escuchar, eco, tacto y comando, se presentaban de manera rotativa. Múltiples sondas intercalan las enseñanzas y verifican sus efectos en el repertorio de los hablantes con los otros grupos. Los resultados mostraron un aumento en la emisión de respuestas para escuchar y hablar después de la enseñanza de MEI para ambos participantes, ambos con repertorio verbal restringido, pero el procedimiento fue más efectivo para uno de los niños...(AU)

Percepção dos idosos sobre o papel do enfermeiro num centro de convivência / Perception of older peole on the role of nurses in a living center

Introdução: O Centro de Convivência de Idosos (CCI) é um espaço destinado ao bem-estar da pessoa idosa. O acompanhamento de profissionais de saúde, em especial o enfermeiro nesse espaço contribui para promoção da saúde e prevenção de agravos. Objetivo: Compreender a percepção dos idosos quanto a atuação do enfermeiro no Centro de Convivência. Método: Trata-se de uma pesquisa descritiva, exploratória, de abordagem qualitativa realizada em um município da região do Sudoeste do estado de Mato Grosso, com idosos participantes de um CCI. A coleta de dados ocorreu em setembro de 2014, por meio da técnica de entrevista. A quantidade de sujeitos foi definida por saturação dos dados. Os dados foram analisados por meio da análise de conteúdo de Bardin. Resultados: Emergiram duas categorias: "O enfermeiro e o Centro de Convivência" e "O cuidado de enfermagem no Centro de Convivência". Considerações finais: Os idosos relataram que a presença do enfermeiro no CCI facilita os cuidados e intervenções de saúde, além do estabelecimento de ações e práticas voltadas ao envelhecimento saudável.(AU)

Introduction: The Older Adults Living Center (CCI) is a space for the well-being of older people. The monitoring of health professionals, especially nurses in that space, contributes to health promotion and disease prevention. Objective: To understand the perception of older adults regarding the role of nurses in the Community Center. Methods: This is a descriptive, exploratory, qualitative study carried out in a municipality in the Southwest region of the state of Mato Grosso, with older people participating in an ICC. Data collection took place in September 2014, using the interview technique. The number of subjects was defined by data saturation. The data was analyzed using Bardin's content analysis. Results: Two categories emerged: "The nurse and the Living Center" and "Nursing care in the Living Center". Conclusion: The older population reported that the presence of nurses in the ICC facilitates health care and interventions, in addition to establishing actions and practices aimed at healthy aging.(AU)

A negociação coletiva e as possibilidades de intervenção nas situações de risco à saúde no trabalho / Collective bargaining and the possibilities to intervene in health risk situations at work

Resumo Introdução: neste ensaio, a negociação coletiva é vista como um processo político no qual os diferentes e desiguais atores sociais definem parâmetros para as relações de trabalho. Objetivo: discutir possibilidades e limites da negociação coletiva para modificar as situações de riscos à saúde dos trabalhadores, considerando aspectos sociais, políticos e econômicos. Métodos: analisamos a negociação coletiva no Brasil sobre a temática da saúde do trabalhador, incluindo temas como inovação tecnológica, intensidade, assédio moral organizacional e teletrabalho. Foram estudados acordos e convenções coletivas negociados entre os anos de 2010 e 2014, registrados no Sistema de Acompanhamento de Contratações Coletivas do Departamento Intersindical de Estatística e Estudos Socioeconômicos (Sacc-Dieese). Entre 2010 e 2012, tomamos por base estudos já realizados, a partir dessa mesma fonte, e para anos de 2013 e 2014, analisamos a partir de acesso direto a esse sistema. Resultados: embora tenham sido identificadas cláusulas inovadoras, grande parte das outras reproduz parâmetros previstos na legislação, com alcance limitado para modificar as condições adoecedoras. Conclusão: a aprovação da Lei nº 13.467/2017, aa chamada "reforma trabalhista", sob a premissa de uma relação entre "iguais", poderá resultar na desconstrução da proteção social do trabalho e na subestimação dos riscos e do sofrimento humano.

Abstract Introduction: this paper accounts for collective bargaining as a political process in which differing and unequal social actors define parameters for work relations. Objective: to discuss the possibilities and limits of collective bargaining for modifying situations of workers' health risks, considering its social, political and economical aspects. Methods: we analyze collective bargaining related to workers' health in Brazil, including subjects like tecnological innovation, intensity, moral organizational harassment, and home office. We verified collective agreements negotiated between 2010 and 2014 recorded on the Sistema de Acompanhamento de Contratações Coletivas do Departamento Intersindical de Estatística e Estudos Socio-econômicos (Sacc-Dieese). Analysis of studies based on Sacc-Dieese were conducted between 2010 and 2012, whereas direct access to this system was used for the period between 2013 and 2014. Results: although innovative clauses have been found, most clauses reproduce parameters established by law, which are limited in modifying conditions that lead to sickness. Conclusion: the approval of Law No. 13.467/2017, called "Brazil Labor Reform", under the false premise of agreements between "equals", can result in the deconstruction of social protection laws and the underestimation of health risks and human suffering.

Ensino de Ecoico em Pessoas com Transtorno do Espectro Autista: Revisão Sistemática de Literatura / Teaching of Echoic in People with Autism Spectrum Disorders: Systematic Review of Literature

RESUMO: A literatura tem demonstrado uma grande lacuna em estudos com o objetivo de estabelecer ecoico em pessoas com Transtorno do Espectro Autista (TEA). Assim sendo, este trabalho teve por objetivo identificar o acervo de pesquisas direcionadas para o ensino de ecoico em indivíduos com TEA. A revisão foi pautada no modelo Preferred Reporting Items for Systematics Review and Meta-Analysis (PRISMA). A busca, de todas as ocorrências, sem limite de tempo, até o ano de 2018, foi realizada nas bases de dados Web of Science, Pubmed, Scopus, ERIC e PsicINFO. Adotaram-se as palavras-chave e marcadores boleanos autism [or] autist [or] autistic [and] echoic [and] verbal behavior. Os critérios de inclusão foram artigos em português, inglês e espanhol que estabeleceram ecoico como variável dependente em intervenções com pessoas com TEA, apresentar delineamento experimental de sujeito único e demonstrar os dados da aquisição do ecoico no decorrer das sessões de ensino. Como resultados, foram encontrados 338 artigos e, com a aplicação dos critérios de inclusão, foram selecionados três. Os resultados corroboraram os dados da literatura que apontam o déficit de estudos com objetivo de estabelecer ecoico como alvo principal de ensino em pessoas com TEA. A maior parte dos estudos adota o ecoico como prompt para o estabelecimento de outro comportamento verbal. Ainda que escassos, os artigos apontam os efeitos de procedimentos distintos sobre a aquisição do comportamento ecoico em pessoas com TEA e com repertórios iniciais diversificados.

ABSTRACT: Literature has shown a large gap in studies aiming to establish an echoic in people with Autism Spectrum Disorder (ASD). Thus, the objective of this study was to identify the collection of research aimed at teaching echoic in individuals with ASD. The review was based on the Preferred Reporting Items for Systematics Review and Meta-Analysis (PRISMA) model. The search, of all occurrences, without time limit, until the year 2018, was performed in the Web of Science, Pubmed, Scopus, ERIC and PsichINFO database. The keywords and boolean operators autism [or] autist [or] autistic [and] echoic [and] verbal behavior were adopted. The inclusion criteria were articles in Portuguese, English and Spanish that established echoic as a dependent variable in interventions with people with ASD, present a single subject experimental design and demonstrate the data of the echoic acquisition during the teaching sessions. As a result, 338 articles were found and, with the application of the inclusion criteria, three were selected. The results corroborate the data in the literature that point out the deficit of studies to establish echoic as the main target of teaching in people with ASD. Most studies adopt echoic as a prompt for establishing other verbal behavior. Even if scarce, the articles indicate the effects of different procedures under the acquisition of the echoic behavior in people with ASD and with diversified initial repertories.

Teaching a Child with Cochlear Implant to Read Words with Orthographic Difficulties / Ensino de Leitura de Palavras com Dificuldades Ortográficas para uma Criança com de Implante Coclear / Enseñanza de Lectura de Palabras con Dificultades Ortográficas para Niña Usuaria con Implante Coclear

Abstract Considering the effects of reading on the accuracy of the speech of deaf and hard and hearing children and cochlear implants presented in the scientific literature, the main aim of this study was to evaluate the effects of Module 2 of the ALEPP software regarding teaching words with orthographic difficulties to a cochlear implanted child. The participant was a girl, had nine years of age, with profound bilateral and sensorineural hearing loss. The program aims to teach contingencies of the selection of printed words and syllables conditioned to dictated words and syllables of six different stimuli sets; each set contained 16 words, with a total of 96 teaching words and 64 control words. Probes of 160 words were interspersed with the teaching steps according to the multiple probe design. The participant learned to read the 96 taught words, controlled by the words' minimal units. She presented maintenance of performance and reading generalization of the control words. The number of speech accuracy errors only decreased after the teaching intervention. The results replicated those of previous studies with orthographically easier words and future studies may explore the different types of training provided by the ALEPP and its effects on the accuracy of the speech of cochlear implanted children.

Resumo Considerando os efeitos do ensino de leitura sobre a precisão da fala de crianças com deficiência auditiva e implante coclear apresentados na literatura, o objetivo deste estudo foi verificar os efeitos do Módulo 2 do ALEPP® sobre a precisão da fala em leitura de palavras com dificuldades ortográficas a uma criança usuária de implante coclear. A participante tinha nove anos, com deficiência auditiva profunda, bilateral e sensorioneural. O programa expôs a contingências de ensino de seleção de palavras e sílabas impressas condicionalmente a palavras e sílabas ditadas com seis conjuntos de estímulos (ç, lh, ch, vLc, vNc e vRc); cada conjunto era composto por 16 palavras, totalizando 96 palavras de ensino; outras 64 palavras funcionaram como controle. Testes das 160 palavras intercalaram o ensino de acordo com o delineamento de múltiplas sondas. A participante aprendeu a ler as 96 palavras-alvo de ensino, com estabelecimento de controle pelas unidades mínimas alvo, manutenção de desempenho e generalização na leitura de palavras controle. Erros na precisão da fala diminuíram somente após o ensino. Os resultados replicam estudos anteriores com palavras simples e futuras investigações podem isolar os tipos de treino do ALEPP® e explorar seus efeitos sobre a precisão da fala e sobre o controle pelas unidades mínimas.

Resumen Considerando los efectos de la enseñanza de lectura sobre la precisión del habla en niños con deficiencia auditiva e implante coclear presentados en la literatura, el objetivo de este estudio fue verificar los efectos del Módulo 2 de ALEPP® sobre la enseñanza de lectura de palabras con dificultades ortográficas a una niña usuaria de implante coclear. La participante tenía nueve años, deficiencia auditiva profunda, bilateral y neurossensorial. El programa exposu a contingencias de enseñanza de selecciòn de palabras y silabas impresas condicionalmente a las palabras y silabas dictadas con seis conjuntos de estímulos; cada conjunto estaba compuesto por 16 palabras, totalizando 96 palabras de enseñanza; otras 64 palabras funcionaron como control. Las pruebas de las 160 palabras intercalaron la enseñanza de acuerdo con el delineamiento de múltiples sondas. La participante aprendió a leer las 96 palabras objetivo de enseñanza, con establecimiento de control por las unidades mínimas, mantenimiento de desempeño y generalización en la lectura de palabras control. Los errores en la precisión del habla disminuyeron sólo después de la inserción de la enseñanza. Los resultados replican estudios anteriores con palabras sin dificultades ortográficas y futuras investigaciones pueden explorar los efectos de los tipos de entrenamientos ofrecidos por el ALEPP® y sus efectos sobre la precisión del habla y el control por las unidades mínimas.

Multiple exemplar instruction and integration of listening and speaking behaviors with substantive-adjective syntactic units in children with ANSD and CI. / Ensino por múltiplos exemplares e integração de comportamentos de ouvinte e falante com unidades sintáticas substantivo-adjetivo em crianças com DENA e IC.

PURPOSE: To verify the effect of the multiple exemplar instruction at the acquisition and integration of listening and speaking behaviors, with substantives and substantive-adjective combinations, in children with Auditory Neuropathy Spectrum Disorder (ANSD) and cochlear implant (CI). METHODS: Participants were two children with ANSD that were users of CI. We adopted dictated stimulus and pictures that corresponded to words (substantive) and substantive-adjective syntactic units. The study was arranged in teaching steps that were intercalated with listening and speaking behaviors probes, with all stimuli. The multiple exemplar instruction presented oral imitation (echoic), auditory recognition (listening) and pictures naming (touch) tasks, on a rotating way; the substantives were taught first and, after that, the substantive-adjective combinations. RESULTS: In the pre-test, the participants showed variability and discrepancy in the correct responses percentages of listening and speaking. All achieved firstly 100% correct responses in the listening task and the speaking performances were close to listening after the teaching. All extended substantive learning to substantive-adjective syntactic units. CONCLUSION: Children with ANSD and CI can learn and integrate listening and speaking behaviors by multiple exemplar instruction, from words to syntactic units.

OBJETIVO: Verificar o efeito do ensino por múltiplos exemplares na aquisição e integração dos comportamentos de ouvinte e falante, com substantivos e combinações substantivo-adjetivo, em crianças com Desordem do Espectro da Neuropatia Auditiva (DENA) e implante coclear (IC). MÉTODO: Participaram duas crianças com DENA que usavam IC. Foram adotados estímulos ditados e figuras que correspondiam a palavras (substantivo) e unidades sintáticas substantivo+adjetivo. O estudo foi organizado em passos de ensino que foram intercalados por avaliações dos comportamentos de ouvinte e falante, com todos os estímulos. O ensino por múltiplos exemplares apresentou tarefas de imitação oral (ecoico), reconhecimento auditivo (ouvinte) e nomeação de figuras (tato) de maneira rotativa; os substantivos foram ensinados primeiro e, em seguida, as combinações substantivo-adjetivo. RESULTADOS: No pré-teste, os participantes mostraram variabilidade e discrepância nas porcentagens de acertos de ouvinte e de falante. Todos alcançaram primeiro 100% de acertos nas tarefas de ouvinte e os desempenhos de falante ficaram próximos aos de ouvinte após o ensino. Todos estenderam a aprendizagem dos substantivos para as unidades sintáticas substantivo-adjetivo. CONCLUSÃO: Crianças com DENA e IC podem aprender e integrar comportamentos de ouvinte e de falante por meio do ensino por múltiplos exemplares, de palavras a unidades sintáticas.

Sistematização da assistência de enfermagem na perspectiva do docente / Systematization of nursing assistance from the perspective of the teacher / Sistematización de la atención de enfermería en la perspectiva del docente

Objetivo: identificar como os docentes se preparam para ensinar a sistematização da assistência de enfermagem. Método: trata-se de um estudo exploratório, descritivo e com abordagem qualitativa, realizado em 2017, em uma instituição pública de ensino superior. Os dados foram coletados utilizando-se de entrevista semiestruturada e analisados pela análise do conteúdo. Resultados: o ensino da a sistematização da assistência de enfermagem provém desde a formação do professor até sua aplicabilidade em sala de aula. Os participantes do estudo consideram um desafio para esse ensino, em virtude do envolvimento de instituições de saúde para aplicabilidade desse aprendizado e muitas vezes, essas instituições inviabilizam a realização. Além disso, muitos discentes percebem esse conteúdo apenas como atividade extra, sem importância. O contato de muitos professores com esse conteúdo ocorre somente durante a graduação, o que dificulta posteriormente o ensino. Esses fatores prejudicam a implementação da sistematização da assistência de enfermagem tanto no contexto acadêmico como futuramente, no trabalho do enfermeiro. Considerações finais: conclui-se que durante a graduação as competências que regem este conteúdo são ensinadas em aulas teóricas e colocadas em práticas durante o estágio, porém há fragilidades no caminho que impossibilitam a consolidação do significado da a sistematização da assistência de enfermagem para o profissional.(AU)

Objective: to identify how teachers prepare to teach the systematization of nursing care. Method: this is an exploratory, descriptive study with a qualitative approach, carried out in 2017, in a public institution of higher education. Data were collected using a semistructured interview and analyzed by content analysis. Results: the teaching of the systematization of nursing care comes from the training of the teacher to its applicability in the classroom. The study participants consider this teaching a challenge, due to the involvement of health institutions in the applicability of this learning, and these institutions often make it unfeasible. In addition, many students perceive this content only as an extra and unimportant activity. The contact of many teachers with this content occurs only during graduation, which subsequently hampers teaching. These factors undermine the implementation of the systematization of nursing care both in the academic context and in the future, in the nurse's work. Conclusion: it is concluded that during graduation the competences that govern this content are taught in theoretical classes and placed in practices during the internship, but there are weaknesses in the path that make it impossible to consolidate the meaning of the systematization of nursing care for the professional.(AU)

Objetivo: identificar cómo los docentes se preparan para enseñar la sistematización de la asistencia de enfermería. Método: se trata de un estudio exploratorio, descriptivo y con abordaje cualitativo, realizado en 2017, en una institución pública de enseñanza superior. Los datos fueron recolectados utilizando entrevistas semiestructuradas y analizadas por el análisis del contenido. Resultados: la enseñanza de la sistematización de la asistencia de enfermería proviene desde la formación del profesor hasta su aplicabilidad en el aula. Los participantes del estudio consideran un desafío para esa enseñanza, en virtud de la participación de instituciones de salud para la aplicabilidad de ese aprendizaje y muchas veces, esas instituciones inviabilizan la realización. Además, muchos estudiantes perciben ese contenido sólo como actividad extra, sin importancia. El contacto de muchos profesores con ese contenido ocurre solamente durante la graduación, lo que dificulta posteriormente la enseñanza. Estos factores perjudican la implementación de la sistematización de la asistencia de enfermería tanto en el contexto académico, como en el futuro, en el trabajo del enfermero. Conclusión: se concluye que durante la graduación las competencias que rigen este contenido son enseñadas en clases teóricas y colocadas en prácticas durante la etapa, pero hay fragilidades en el camino que imposibilitan la consolidación del significado de la sistematización de la asistencia de enfermería para el profesional.(AU)

Caracterização sensorial de queijo colonial por perfil flash e analise descritiva quantitativa / Sensory characterization of colonial cheese by flash profile and quantitative descriptive analysis

O queijo colonial é tradicional da região sul, pouco estudado, e com escassez de dados descritivos a seu respeito. Dentro do mercado atual, métodos simples e rápidos para descrição de produtos, como o perfil flash, tem sido demandados, surgindo como alternativa para métodos tradicionais, como a analise descritiva quantitativa. Dessa forma, o presente estudo visou correlacionar o método usual de analise com o de perfil flash para caracterizar sensorialmente queijos coloniais do sudoeste paranaense. Três marcas comerciais de queijo colonial foram avaliadas. O queijo foi caracterizado por cor amarela, características ácidas e sabor salgado principalmente. O método perfil flash mostrou ser eficiente na avaliação do produto, com coeficiente de correlação multivariado RV de 0,989, apresentando simplicidade e rapidez na avaliação.

Influence of facial patterns on the masticatory function and quality of life of completely edentulous patients during the transition to implant-retained mandibular overdentures.

STATEMENT OF PROBLEM: Although implant-retained mandibular overdentures (IMOs) provide functional benefits, the influence of the vertical facial pattern (FP) and the anteroposterior skeletal discrepancy (ASD) on the masticatory function and patient-centered outcomes during the transition to IMOs is still uncertain. PURPOSE: The purpose of this interventional clinical study was to evaluate the influence of the FP and ASD on the masticatory function, oral health-related quality of life (OHRQoL), and satisfaction of completely edentulous patients before and after transition to IMOs. MATERIAL AND METHODS: Cephalometric analysis was performed on 42 participants before treatment. Ricketts analysis was used to classify the FP, and the maxillomandibular relationship to the base of the skull determined the ASD. Masticatory performance (MP) and swallowing threshold (ST) test results were evaluated by the multiple sieve method by using artificial test food (Optocal cubes) to determine the median particle size (×50), homogenization index (B), and masticatory efficiency based on sieves 5.6 (ME: 5.6) and 2.8 (ME: 2.8). OHRQoL and satisfaction were evaluated by using the Dental Impact on Daily Living questionnaire. The data were analyzed using mixed-effects linear regression models to estimate the effect of time, FP, ASD, age, and sex on MP, ST, and OHRQoL. RESULTS: The MP, ST, OHRQoL, and satisfaction improved significantly after IMO loading, irrespective of FP and ASD. However, MP outcomes were most negatively affected mainly among dolichofacial (B and ME: 2.8), class II, and class III (×50, B, and ME: 2.8) participants. The ST test showed that class II participants still showed inferior ×50 values and performed a lower number of cycles than class I and class III participants. Women presented reduced masticatory function for all MP and ST outcomes and reported lower coefficients for appearance and general performance domains than men. CONCLUSIONS: The MP test detected more subtle improvements than the ST test, especially in class III participants. The class II participants benefited the least from the IMO installation according to the ST test. The IMO treatment improved the OHRQoL and satisfaction of edentulous patients, irrespective of the FP or ASD.

Bone response after immediate placement of implants in the anterior maxilla: a systematic review.

PURPOSE: The objective of this systematic review was to assess the three-dimensional changes in bone tissue after immediate installation of a single implant in a fresh extraction socket in the anterior maxilla. METHODS: After defining a strategy, an electronic search was carried out using the databases PubMed, Embase, LILACS, Web of Science, Cochrane, and Scopus. In addition, the gray literature was also researched using Google Scholar and ProQuest. Two reviewers independently screened for eligible studies, assessed the methodological quality, and extracted the data. The inclusion criteria were observational studies and experimental studies that assessed bone response after the immediate installation of a single implant in a fresh extraction socket, immediately loaded or not, in the region between the maxillary canines. Studies were included in any language, with no publication date restrictions and with a minimum of 6 months of follow-up after the surgical procedure. RESULTS: From a total of 3272 articles, only 12 studies met the inclusion criteria and were selected for the review. Bone remodeling after immediate installation of a dental implant was assessed using standardized periapical radiographs and cone beam computed tomography (CBCT). CONCLUSION: It can be concluded that bone remodeling occurs after tooth extraction and immediate implant installation.