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The article analyzes the introduction, in the late 1920s, and consolidation, in the 1930s, of a public health model in Rio Grande do Sul state based on the health center model conceived in the United States. The genesis of health centers in the United States is discussed, as are two health reforms in Brazil, in 1929 and 1938, proposed by Fernando de Freitas e Castro and José Bonifácio Paranhos da Costa. The investigation draws not only on the literature in the area, but also on primary sources such as legislation, state health reports, and documents produced by the Rockefeller Foundation.

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OBJECTIVE: To evaluate brain-derived neurotrophic factor (BDNF) and tumor necrosis factor-α (TNF-α) blood levels as disease biomarkers of delirium in oncology inpatients. METHODS: Seventeen oncology inpatients with delirium, 28 oncology inpatients without delirium, and 25 non-oncology controls (caregivers) were consecutively recruited from a Brazilian cancer center. This sample was matched by age, sex, and education level. The Confusion Assessment Method, the Mini-Mental State Examination, and the Digit Span Test were administered to ascertain delirium diagnosis. BDNF and TNF-α levels were measured by the Sandwich-ELISA method and flow cytometry, respectively. Blood samples were collected immediately after clinical evaluation. RESULTS: Oncology inpatients (with and without delirium) showed significantly lower BDNF levels compared with non-oncology controls (F = 13.830; p = 0.001). TNF-α levels did not differ between the three groups. CONCLUSION: A cross-sectional relationship of BDNF and TNF-α blood levels with delirium in oncology inpatients was not demonstrated. The association between cancer and reduced serum BDNF levels may be mediated by confounding factors.

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Objective:To evaluate brain-derived neurotrophic factor (BDNF) and tumor necrosis factor-α (TNF-α) blood levels as disease biomarkers of delirium in oncology inpatients.Methods:Seventeen oncology inpatients with delirium, 28 oncology inpatients without delirium, and 25 non-oncology controls (caregivers) were consecutively recruited from a Brazilian cancer center. This sample was matched by age, sex, and education level. The Confusion Assessment Method, the Mini-Mental State Examination, and the Digit Span Test were administered to ascertain delirium diagnosis. BDNF and TNF-α levels were measured by the Sandwich-ELISA method and flow cytometry, respectively. Blood samples were collected immediately after clinical evaluation.Results:Oncology inpatients (with and without delirium) showed significantly lower BDNF levels compared with non-oncology controls (F = 13.830; p = 0.001). TNF-α levels did not differ between the three groups.Conclusion:A cross-sectional relationship of BDNF and TNF-α blood levels with delirium in oncology inpatients was not demonstrated. The association between cancer and reduced serum BDNF levels may be mediated by confounding factors.

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BACKGROUND: Botulinum toxin type A (BoNT-A) injection has become the most popular cosmetic nonsurgical procedure, and it has been suggested that BoNT-A injections may improve emotional states when frown lines are treated. OBJECTIVES: To evaluate symptoms of depression and self-esteem before and after onabotulinumtoxinA (ONA) injections in the glabella in subjects with and without depression. METHODS: Twenty-five subjects with depression were allocated into one group and 25 subjects without depression were matched to those according to demographic characteristics. The Beck Depression Inventory (BDI) and Rosenberg Self-Esteem Scale (RSES) were used to assess depression symptoms and self-esteem, respectively. Patients were assessed up to 12 weeks after the intervention. RESULTS: Patients with depression had significant improvement in depression symptoms after ONA injections. The maximum effect occurred within the first 8 weeks after treatment. A significant reduction from baseline in BDI score and significant improvement in self-esteem were also observed in patients with depression. CONCLUSION: This research presents new data regarding BoNT-A as a potential treatment to improve depression symptoms in patients with Major Depressive Disorder. Self-esteem scores alone cannot explain the improvement in depression symptoms.

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Introdução: Cerca de 50% da população refere algum tipo de insatisfação com a aparência. Os hábitos comportamentais que motivam os pacientes a procurar tratamentos cosméticos ainda não estão completamente entendidos. Objetivos: Avaliar os aspectos comportamentais, psicológicos e psiquiátricos de pacientes com celulite. Métodos: Estudo transversal observacional descritivo. Na primeira etapa, 46 voluntárias responderam a questionário autoaplicável e, na segunda etapa, um psiquiatra aplicou o questionário Mini. Resultados: A maioria das entrevistadas referiu o início das lesões de celulite após o início da puberdade. Os ambientes que mais causaram desconforto quanto à celulite foram praia (87%) e piscina (67,4%). Quase metade das pacientes referiu já ter recebido algum tipo de comentário constrangedor em razão da sua celulite e 78,3% delas sentem-se pressionadas a procurar tratamentos. Distúrbios de alimentação apresentados incluíram uso de drogas, ingestão compulsiva de alimentos, culpa após as refeições e indução de vômitos. O transtorno emocional específico mais encontrado foi ansiedade generalizada. Conclusões: Pacientes com celulite podem apresentar desconforto emocional e sentimentos negativos em situações comuns do dia a dia. Alterações em hábitos comportamentais específicos e presença de comorbidades psicológicas ou psiquiátricas podem estar presentes em algumas pacientes.

Introduction: About 50% of the population reports some kind of dissatisfaction related to their physical appearance. Patients' motivations for seeking cosmetic treatment are not yet fully understood. Objectives: To evaluate the behavioral, psychological, and psychiatric characteristics of patients with cellulite. Methods: In the first phase of this cross-sectional, descriptive and observational study, forty-six volunteers answered a self-administered questionnaire. In the second phase, a psychiatrist administered the M.I.N.I. questionnaire. Results: Most interviewees described the forthcoming of cellulite during puberty. Discomfort caused by cellulite was mainly felt at the beach (87%) and pool (67,4%). Almost half of patients reported having been subject to an embarrassing comment related to their cellulite, while 78.3% felt pressure to seek treatment. The eating disorders described included the use of drugs, compulsive ingestion of food, feeling guilty after eating, and self-induced vomiting. The most frequently found specific emotional disorder was generalized anxiety. Conclusions: Patients with cellulite can experience emotional distress and negative feelings in everyday situations. Changes in specific behaviors and the presence of psychological and psychiatric comorbidities can be present in some patients.

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BACKGROUND: The dose equivalence of commonly used commercial preparations of botulinum toxin type A, Dysport (abotulinumtoxinA [ABO] 500 U, Ipsen Biopharm Limited, Wrexham, United Kingdom) and Botox (onabotulinumtoxinA [ONA] 100 U, Allergan, Irvine, CA), remains unclear. OBJECTIVE: We sought to evaluate the field effect for ABO and ONA at dose equivalences of 2.5:1.0 U and 2.0:1.0 U, in both muscular and sweat gland activity. METHODS: In all, 59 female patients with forehead wrinkles were enrolled. Patients were randomized for dose equivalence between ABO and ONA, group A (2.0:1.0 U, ABO:ONA) or group B (2.5:1.0 U, ABO:ONA) administered in the frontalis muscles. Clinical assessment, Minor test, and electromyography evaluations were performed at baseline, 28 days, and 112 days. RESULTS: In group B, the field of anhidrotic effect of ABO showed a greater area and larger horizontal diameter than ONA at 28 and 112 days. At maximum frontalis muscle activity (day 112) patients receiving ABO demonstrated greater improvement based on the Wrinkle Severity Scale. No differences were found in frontalis muscle activity at rest between groups A and B based on results of Wrinkle Severity Scale, electromyography, and interindividual variability data at 28 and 112 days. LIMITATIONS: Currently, there are no objective measurements other than electromyography to evaluate the field effect of botulinum toxin type A in muscles. CONCLUSION: At a dose equivalence of 2.0:1.0 U (ABO:ONA), similar field effects were found for both muscle and sweat gland activity. At a higher dose equivalence of 2.5:1.0 U (ABO:ONA), injections of ABO showed greater area and larger horizontal diameter in field of anhidrotic effect at 28 and 112 days than ONA.

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BACKGROUND: Injection-related side effects and complications are likely to occur during or after filler injections; they are mainly caused by the injection technique. OBJECTIVE: To assess safety and efficacy of a metallic cannula to inject hyaluronic acid (HA) filler in the nasolabial folds and to compare the safety of this cannula with that of a standard needle. METHODS: This was a prospective, randomized, phase II, double-blinded study that included 25 participants with Grade 2 to 3 for bilateral nasolabial folds according to the Modified Fitzpatrick Wrinkle Scale (MFWS). The side of the injection was randomized (cannula or needle), and 0.5 mL of HA was injected into each nasolabial fold. RESULTS: At day 3, mean MFWS score fell from 2.40 ± 0.40 to 1.46 ± 0.52 (p < .001) on the cannula-injected side and from 2.40 ± 0.40 to 1.48 ± 0.60 (p < .001) on the regular needle-injected side. Participants reported fewer side effects on the side injected with the new tool on the day of the injections: pain (p = .03), edema (p < .001), redness (p = .01) and hematoma (p < .001) than on the needle side. CONCLUSION: The new cannula is a safe and useful tool to inject HA fillers in the nasolabial folds, producing less pain, edema, hematoma, and redness than regular needles.

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