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This study aimed to validate the telephone-based application of the Falls Efficacy Scale-International (FES-I) for the assessment of the fear of falling in older people, and to investigate, among personal and environmental factors, which ones can explain this fear in this population. Participants answered the FES-I on two randomized occasions, face-to-face and by telephone. Intraclass correlation coefficient (ICC 3,1 ) was used to investigate the levels of agreement between the two occasions. The possible factors associated were sex, age, previous history of falls, family arrangement, practice of physical activity, presence of orthopedic pathologies, use of walking aids, presence of visual impairment, and presence of stairs in the home environment. Linear regression analysis was applied to investigate which of these factors could explain the fear of falling in older people. One hundred twenty-two individuals were included. There was no significant difference in the mean difference obtained between the two applications of the FES-I (1 point; 95% confidence interval, -4 to 6), with a high level of agreement (ICC = 0.88). Sex and presence of orthopedic pathologies explained 14% of the model. The FES-I showed to be a reliable scale to be applied for telephone assessments of fear of falling in older people. In addition, women with orthopedic pathologies are the profile of older people with most afraid of falling.

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The primary goal of palatoplasty is the restoration of normal speech, that can be aimed by, among many procedures, lengthening the palate through the pushback technique; one of its complications is abnormal maxillary growth. The main factor affecting facial growth in CLP patients is believed by many to be the palatoplasty-due to the large scar retraction resulting from some surgical techniques. The non-crosslinked two-layer bioabsorbable collagen matrix Mucograft™ (Geistlich Pharma AG, Wolhusen, Switzerland) is a potential tool to aid in wound closure in a second-intention healing situation.The objective of this work was to test the use of an acellular dermal matrix (Mucograft®) in an experimental model of Veau-Wardill-Kilner palatoplasty, as a tool to reduce scar retraction of the denuded palatine mucosa.Twenty-four 3-week-old male Wistar rats were used. The animals were randomly divided into two groups. In the control group, an excision was made with bone exposure in the palate, simulating the defect left in the Veau-Wardill-Kilner palatoplasty. In the intervention group, the same procedure was performed, and the area of denuded palatine bone was treated with a bioabsorbable collagen matrix (Mucograft®). For data collection, 9 weeks after surgery (12 weeks of life), the animals were euthanized by excessive anesthetic dosage. Maxillary growth, macroscopic appearance of the scar, pain, and bleeding were evaluated.There were significant statistical differences between the groups for palate length growth (7.6 mm + -0.38 mm vs 5.5 mm + -0.36 mm, P = .009) and for palate width growth (1.47 mm + -0.8 mm vs -0.09 mm + -0.55 mm, P = .001), favoring dermal matrix group compared to controls. Whereas for pain and bleeding, there were no differences between the groups.The use of dermal matrix in rats with an area of bone denudation on the palate increases maxillary length and width growth patterns. Besides, it does not increase pain, bleeding, or post-operative complications.

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BACKGROUND: Autologous fat grafting is a procedure indicated for breast augmentation to improve coverage of silicone implants and redesign breast shape. Different techniques are based on parameters that have not been systematically standardized. The authors present a method using breast zone standardization based on breast anatomy to achieve an anatomical composite breast. METHODS: The authors performed this zone standardization in 76 breasts (38 patients) undergoing primary/secondary augmentation. The area between the implant and the clavicle and parasternal area was marked to receive fat grafting and divided into three zones. A mathematical formula [ volume of autologous fat graft = (π × r 2 × p)/4.8] was used to estimate the fat graft volume according to implant volume in the respective zones. RESULTS: Implant volumes ranged from 205 to 375 cc (mean, 265 cc), and patients received an average fat graft volume of 105.3 cc per breast (range, 36 to 135 cc); the average fat volume in zones I/II and III was 78.28 cc (range, 0 to 100 cc) and 27.03 cc (range, 15 to 60 cc), respectively. Three minor complications were observed (5.2 percent) during a mean follow-up of 12.8 months. A high correlation was observed between the fat grafting performed in the cohort and predictions obtained from the formula ( p < 0.001). CONCLUSIONS: Recognizing risky cleavage breast zones between the implant pocket and the upper and medial quadrants remains essential to attain satisfactory outcomes. Although experience and proper judgment are still important in the fat grafting technique, the data presented here offer plastic surgeons an additional standardized framework to help deliver predictable hybrid breast augmentation. . CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Introdução: O neurinoma plexiforme gigante é um neuroectoderma e uma doença hereditária. É um tumor cutâneo incomum associado à NF1, caracterizado como um tumor benigno da bainha do nervo periférico envolvendo múltiplos fascículos nervosos. Os objetivos da reconstrução da cobertura do antebraço são proteger as estruturas que vão até o punho e a mão e evitar cicatrizes que levem à perda de movimento. Tanto o antebraço quanto a mão desempenham papéis funcionais e sociais. O manejo bem-sucedido de feridas complexas é necessário para a reabilitação funcional geral desses pacientes. Relato do Caso: Paciente do sexo feminino, 31 anos, apresentou-se na divisão de cirurgia plástica com neurofibroma plexiforme gigante no antebraço direito. Após ressecção cuidadosa, todos os tendões anteriores do antebraço foram expostos. O defeito foi coberto com Pelnac T enxertável (espessura de 3mm e tamanho 12 X 24cm2), fixados com pontos monocryl 4-0. Após 10 dias, a matriz dérmica acelular foi removida e um enxerto de malha de pele de espessura parcial foi colocado. No dia 7, a matriz dérmica acelular apresentou bons sinais de ingestão. No dia 17, observamos uma sobrevida do enxerto de 95%. No seguimento de 3 meses, a reconstrução estava estável, sem defeitos de contorno, a mão apresentava amplitude de movimento completa e o paciente não apresentava problemas nas atividades diárias. Conclusões: A matriz dérmica acelular parece ser uma opção útil na cobertura de defeitos complexos no antebraço, permitindo menor morbidade e rápida recuperação funcional.

Introduction: Giant plexiform neurinoma is a neuroectoderm and inherited disease. It is an uncommon skin tumor associated with NF1, characterized as a benign peripheral nerve sheath tumor surrounding multiple nervous fascicles. The goals of forearm coverage reconstruction are to protect the structures running to the wrist and hand and prevent scarring that leads to movement loss. Both forearm and hand play functional and social roles. Successful management of complex wounds is necessary for the overall functional rehabilitation of these patients. Case Report: A 31-year-old woman presented at the plastic surgery division with a giant plexiform neurofibroma in the right forearm. After careful resection, all anterior forearm tendons were exposed. The defect was covered with graftable Pelnac T (thickness of 3mm and sizing 12 X 24cm2), fixed with 4-0 monocryl sutures. After 10 days, the acellular dermal matrix silicone layer was removed, and a split-thickness skin meshed graft was placed. On day 7, the acellular dermal matrix showed good signs of intake. On day 17, we observed a 95% graft survival. At the 3-month follow-up, reconstruction was stable without contouring defects, the hand had full range of motion, and the patient had no problems in daily activities. Conclusions: Acellular dermal matrix appears to be a useful option in covering complex defects in the forearm, allowing for less morbidity and rapid functional recovery.

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INTRODUCTION: Thalidomide is an immunomodulatory drug and first choice in the treatment of erythema nodosum leprosum. Given its teratogenic potential, it is essential that an effective contraceptive method is used, especially a long-acting reversible contraceptive (LARC) method. The subdermal etonogestrel (ENG)-releasing implant is an adequate method due to the high effectiveness and long-term use. However, interaction between thalidomide and ENG has not been well documented. Concern arises because thalidomide interacts with cytochrome P450 (CYP450) enzymes that metabolize sexual steroids. AIM: We aimed to study the effectiveness and safety of the ENG-implant in a thalidomide user. METHODS: Case report of a sexually active 21-year-old patient with both Hansen's disease and leprosy reaction type 2 treated with thalidomide requiring effective contraception. Follow-up was up to 36 months after implant placement. RESULTS: Contraception with ENG-implant was effective and safe, based on clinical parameters (reduction of menstrual flow and cervical mucus thickening) and laboratory parameters (gonadotropins and sexual steroids). CONCLUSION: To the best of our knowledge, this is the first case reported which presents a patient in simultaneous use of thalidomide and ENG-implant. Although this case report preliminary supports effectiveness and safety of ENG-implant as a contraceptive option in women using thalidomide, rigorous drug-drug interaction research is needed to better characterize the interaction between thalidomide and the ENG-implant.

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OBJECTIVES/HYPOTHESIS: Robin sequence (RS) consists of associated micrognathia, glossoptosis, and respiratory dysfunction, with or without cleft palate. Studies on how different patient characteristics impact the severity of respiratory dysfunction are scarce and contradictory; this study investigates how different features affect respiratory obstruction severity at diagnosis of RS in controlled analysis. STUDY DESIGN: Retrospective cohort study that enrolled 71 RS patients under 90 days old who received care in our institution from 2009 to 2020. METHODS: The primary outcome, respiratory dysfunction, was categorized into four severity groups and analyzed using a multinomial logistic regression model that considered age, sex, mandible length, cleft palate, syndromic diagnosis, other airway anomalies, and degree of glossoptosis. RESULTS: Mandible length, syndromic diagnosis, and Yellon grade 3 glossoptosis were related to poorer respiratory outcomes (need for respiratory support). In univariate analysis, for each additional 1 mm of mandible length at diagnosis, a mean reduction of 28% in the risk of needing respiratory support was observed (OR = 0.72; 0.58-0.89); syndromic diagnosis and grade 3 glossoptosis also raised the risk (OR = 6.50; 1.59-26.51 and OR = 12.75; 1.03-157.14, respectively). In multivariate analysis, only mandible length significantly maintained its effects (OR = 0.73; 0.56-0.96), a 27% reduction. CONCLUSIONS: Mandible length was an independent predictor for more severe respiratory dysfunction in RS patients, with larger mandibles showing protective effects. Syndromic diagnosis and Yellon grade 3 glossoptosis are also likely to be associated with poorer respiratory outcomes, although this was not demonstrated in multivariate analysis. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2811-2816, 2021.

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Introdução: O enxerto de gordura nano melhora a qualidade da pele nos danos secundários ao envelhecimento e nas sequelas cicatriciais. Apresentamos resultados iniciais do enxerto de gordura nano com o uso de um dispositivo descartável de baixo custo propondo uma padronização da sua utilização conforme a área a ser tratada. Métodos: Foi realizada uma coorte prospectiva de julho de 2019 a março de 2020. O critério de inclusão foi pacientes que realizaram enxerto de gordura nano para tratamento da pele. Já o critério de exclusão foi a realização prévia de algum tratamento invasivo da pele. Foram analisadas 20 pacientes consecutivas que preencheram os pré-requisitos. Os resultados foram avaliados no 6º mês de pós-operatório. As pacientes responderam um questionário, classificando de 1 - muito ruim a 10 - excelente, as alterações na qualidade da pele. Resultados: As vinte pacientes acompanhadas não apresentaram nenhuma complicação pós-operatória. O edema após aplicação reduziu entre três e sete dias. Não houve hematoma nem infecção. As pacientes que realizaram somente enxerto de gordura nano, sem outra cirurgia associada, conseguiram voltar às suas atividades após 24 horas. Os escores relatados pelas pacientes com 6 meses foram entre 7 e 10, com média de 8. Conclusão: A utilização do sistema Smartneedle™ para a enxertia de gordura nano apresenta resultados na satisfação das pacientes semelhante aos outros métodos de aplicação e permite uma distribuição uniforme e padronizada do enxerto conforme a região anatômica, além de otimizar o tempo cirúrgico.

Introduction: Nanofat graft improves skin quality in damage secondary to aging and scar sequelae. We present the initial results of the nanofat graft using a low-cost disposable device, proposing a standardization of its use according to the area to be treated. Methods: A prospective cohort was conducted from July 2019 to March 2020. The inclusion criterion was patients who underwent nanofat grafting for skin treatment. The exclusion criterion was the previous performance of some invasive treatment of the skin. Twenty consecutive patients who met the prerequisites were analyzed. The results were evaluated in the 6th postoperative month. The patients answered a questionnaire, classifying from 1 - very bad to 10 - excellent, changes in skin quality. Results: The twenty patients followed did not present any postoperative complications. Edema after the application was reduced between three and seven days. There was no hematoma or infection. Patients who underwent only nanofat grafting without another associated surgery could return to their activities after 24 hours. The scores reported by patients at 6 months were between 7 and 10, with a mean of 8. Conclusion: The use of the Smartneedle™ system for nanofat grafting presents patient satisfaction similar to other application methods and allows a uniform and standardized distribution of the graft according to the anatomical region and optimizing surgical time

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BACKGROUND: Rhinoplasty is one of the most frequent aesthetic surgeries; the procedure can be challenging for inexperienced surgeons, and positive outcomes depend on good communication with the patient, proper planning, and precise execution. Three-dimensional (3D) technology has emerged to address these issues, but specific software for 3D planning tends to be expensive. OBJECTIVES: This study presents a simple, low-cost method for 3D simulation to plan rhinoplasty. METHODS: This preliminary report describes 3D rhinoplasty planning in a series of 3 cases employing free software and an add-on especially developed for rhinoplasty (Blender and RhinOnBlender, respectively). The photogrammetry protocol, which can be performed easily with a smartphone, is described in detail along with all the steps in 3D planning. RESULTS: The software and add-on automated the process, making the tool environment accessible to surgeons who are not familiar with graphic design software. The surgeries were uneventful in all cases, and the patients were satisfied with the outcomes. CONCLUSIONS: 3D graphic technology has provided significant advances in health research, improvement, and teaching for surgeons and communication between surgeons and patients. Free open-source software and add-ons are excellent options that offer proven utility, affordability, and ease of utilization to healthcare providers.

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BACKGROUND: Up to 25% of otoplasties can lead to complications, indicating the need for technical refinement. Stenström's anterior auricular cartilage scoring is used in combination with Mustardé's technique to treat the antihelix deformity in several series, with good results. Both can be performed with different instruments such as rasps or puncture needles. OBJECTIVES: This study aims to compare the use of puncture needles and rasps for anterior cartilage scoring in otoplasty. The association of Stenström and Mustardé were the basic technique. Anatomical and aesthetic endpoints were assessed. We also reviewed postoperative complications. METHODS: Forty-two patients with prominent ears and no previous surgery were randomly assigned needle or rasps technique. They were operated on by the first-year plastic surgery resident in the years of 2014 and 2019. The patients were followed up and reviewed at days 2 and 15, as well as 1, 3 and 6 months postoperatively. The endpoints were evaluated through pre- and postoperative photographs by four experienced plastic surgeons unaware of the techniques used in each case. Patient satisfaction was searched by a "yes" or "no" question. Surgical time and postoperative edema were evaluated in 20 patients (2014 group). RESULTS: There were no statistical differences between the groups in terms of overall results, symmetry, antihelix shape or cartilage fracture. Ninety-five percent of the patients were satisfied with the outcome. The needle technique resulted in less postoperative edema and shorter surgical time. CONCLUSION: Anterior cartilage scoring used in combination with posterior mattress sutures to treat poorly formed antihelical fold has good and similar results when performed with rasps or puncture needles, even in unexperienced hands. The needle has the advantage of leading to a comparable surgical time and less postoperative edema, while not requiring any special surgical instrument. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266 .

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INTRODUCTION: Breast implants follow-up with any type of examination is often neglected; this may cause an error or delay in the diagnosis of complications prosthesis-related such as BIA-ALCL. This study aims to better understand adequate follow-up criteria. METHOD: All female patients undergoing aesthetic breast augmentation and breast MRI in its follow-up conducted from April 2006 to December 2019 were included in this study. The variables analyzed were age, breast implant surgery date, time with the implant, reason for the examination, and the final examination report. A logistic regression analysis was conducted to search for the predictors of positive findings in MRI. A Cox Regression analysis and cumulative risk curves, controlled by age, was performed to investigate the relationship between time with implants and the risk of positive findings in MRI. RESULTS: The patients submitted to MRI had complaints in 29.6% of cases, with pain being the most common, 13.9% of cases. In logistic regression analysis, time with the implant was associated with a higher risk of positive findings in univariate analysis (OR = 1.07, p = 0.036), but not in multivariate analysis. Both pain and breast form changes were independent predictors for positive findings in MRI, OR = 2.79, p = 0.04, and OR = 16.98, p < 0.001, respectively. The cumulative risk of positive findings in MRI increased considerably only after 10 years of implantation. CONCLUSIONS: Time with breast implants may be associated with a higher risk of changes in breast MRI examinations, although this relationship was not significant in multivariate logistic regression analysis. The cumulative risk for positive findings seems to increase considerably only after 10 years of implantation. This study draws attention to the paramount importance of follow-up with a clinical breast examination. Despite time with implants or patients' age, both pain and breast form changes were the most important predictors for MRI alterations. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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Introdução: O sistema único de saúde brasileiro organiza-se basicamente em unidades básicas de saúde, hospitais de média e hospitais de alta complexidade. A composição dos serviços de média complexidade é variável, podendo contar ou não com especialistas como o cirurgião plástico. O objetivo do presente trabalho é o de descrever dados do tratamento dos pacientes com tumores cutâneos atendidos por um cirurgião plástico, em um hospital de média complexidade. Métodos: Coorte prospectiva com análise de dados epidemiológicos demográficos, de custos, resultados, complicações e grau de satisfação. Resultados: No período de 9 meses foram atendidos 166 pacientes dos quais 103 foram operados. As patologias mais comuns foram: carcinomas basocelulares, tumores benignos de subcutâneo e pele, carcinoma epidermóide e melanoma, em ordem decrescente de ocorrência. A maioria das lesões foi tratada com cirurgia de exérese e sutura. Reconstruções mais complexas foram necessárias em 29 pacientes. O grau de resolução dos casos foi alto, com apenas um paciente sendo encaminhado a hospital de alta complexidade. O grau de satisfação com o tratamento também foi elevado. Contudo, o repasse financeiro estimado do SUS, no caso do tratamento dos tumores malignos, foi em torno de 25% menor do que seria na alta complexidade. Conclusão: A atuação do cirurgião plástico em hospitais de média complexidade pode impedir que doenças como o câncer de pele cheguem em estágios avançados em hospitais de alta complexidade, com alto grau de satisfação. Contudo, adaptações no repasse governamental precisariam ocorrer para viabilizar a atuação rotineira deste profissional nestas instituições.

Introduction: The Brazilian health system is organized into basic health units, medium complexity hospitals, and high complexity hospitals. The composition of medium complexity services is variable, with or without specialists such as the plastic surgeon. The objective of the present study is to analyze data on the treatment of patients with skin tumors by a plastic surgeon in a medium complexity hospital. Methods: prospective cohort with analysis of epidemiological, demographic data, costs, results, complications, and degree of satisfaction. Results: In nine months, 166 patients were treated, of whom 103 underwent surgery. The most common pathologies were: basal cell carcinomas, benign subcutaneous and cutaneous tumors, squamous cell carcinoma and melanoma, in decreasing order of appearance. Most of the injuries were treated with exeresis and suture surgery and in 29 patients, more complex reconstructions were required. The degree of resolution of cases was high, and only a patient was derived to a high complexity hospital. The degree of satisfaction with the treatment was also high. However, the estimated financial transfer of SUS, in the case of malignant tumors treatment, was approximately 25% less than it is in a high complexity hospital. Conclusion: The role of the plastic surgeon in medium complexity hospitals can prevent diseases such as skin cancer from reaching high complexity hospitals in advanced stages. However, there would have to be adaptations in the government transfer to enable the routine performance of this professional in these institutions.

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BACKGROUND: Autogenous fat grafting (AFG) is an established technique used as an adjunct to breast augmentation (BA) to redesign breast shape. Surgeons often use experience and intuition to estimate AFG volume, which can result in incorrect assessment of donor areas and unnecessary fat removal. OBJECTIVES: This aim of this study was to develop a method based on a mathematical formula, which utilizes implant volume and projection to predict AFG volume. METHODS: Thirty patients (60 breasts) underwent primary hybrid BA. A software package (SketchUp) was used to simulate 3-dimensional AFG and implant volumes, which in turn were used to develop an equation for estimating AFG volume according to 3 different implant projections. The results for each group were compared, via Pearson's correlation coefficient, with the results of the clinical series. RESULTS: All patients received Motiva Ergonomix SmoothSilk/SilkSurface implants, ranging in volume from 175 to 355 cc (mean, 265 cc), as well as an average AFG volume of 79.2 cc/breast (range, 50-110 cc). Twenty-nine patients (96.6%) were either very satisfied or satisfied during a mean follow-up of 18 months (range, 6-28 months). A high correlation was observed between the AFG performed in the cohort and predictions obtained from the formula (r = 0.938, P < 0.001). CONCLUSIONS: The AFG volume in hybrid BA procedures can be estimated utilizing measurements based on implant volume/projection. This low-cost method can be applied to guide surgical decision-making in patients who are candidates for BA.

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RESUMO Na conjuntura brasileira está avançando uma agenda político-econômica pautada pelo receituário da austeridade fiscal que se contrapõe com os princípios do estado de bem-estar social. Os efeitos dessas mudanças, no horizonte do avanço neoliberal, ampliam as faces da precarização social e do trabalho ao restringir políticas públicas protetivas, amparadas no texto constitucional da seguridade social. Dessa forma, nosso objetivo se constitui em compreender, a partir dos pressupostos do trabalho decente e da saúde do trabalhador, o processo de precarização do trabalho e a vulnerabilização do/a trabalhador/a na conjuntura de austeridade política e econômica atual. Para dimensionar esse cenário, partimos de uma análise da conjuntura geral até chegar ao Programa de Reabilitação Profissional da Previdência Social. O percurso teórico-metodológico assentou-se em um estudo teórico-bibliográfico, de epistemologia qualitativa, por meio do levantamento de materiais como obras de referências, legislações nacionais vigentes, políticas públicas e orientações de órgãos internacionais. A interpretação das informações centrou-se em três eixos: o campo da saúde coletiva e saúde do trabalhador; o campo do trabalho decente; e o campo da seguridade social com destaque para a reabilitação profissional. Este debate propiciou identificar o processo de vulnerabilização dos/as trabalhadores/as brasileiros/as, a fragilização da cidadania, a depredação do sentido social do trabalho, a destituição de direitos sociais conquistados e os paradoxos vividos em serviços públicos no desmonte da seguridade social.

RESUMEN. En la coyuntura brasileña está avanzando una agenda político-económica pautada por el recetario de la austeridad fiscal que se contrapone con los principios del Estado de Bienestar Social. Los efectos de esos cambios, en el horizonte del avanzo neoliberal, amplían las caras de la precarización social y del trabajo al restringir políticas públicas protectoras, amparadas en el texto constitucional de la Seguridad Social. De esa forma, nuestro objetivo se constituye en comprender, a partir de los presupuestos del Trabajo Decente y de la Salud del Trabajador, el proceso de precarización del trabajo y la vulneración del/de la trabajador/a en la coyuntura de austeridad política y económica actual. Para dimensionar ese escenario, partimos de un análisis de la coyuntura general hasta llegar al Programa de Rehabilitación Profesional de la Previdencia Social. El recorrido teórico-metodológico se asentó en un estudio teórico-bibliográfico, de epistemología cualitativa, por medio del levantamiento de materiales como obras referencias, legislaciones nacionales vigentes, políticas públicas y orientaciones de órganos internacionales. La interpretación de las informaciones se centró en tres ejes: el campo de la Salud Colectiva y Salud del Trabajador; el campo del Trabajo Decente; yel campo da Seguridad Social con destaque para la Rehabilitación Profesional. Este debate propició identificar el proceso de vulneración de los/las trabajadores/as brasileños/as, el debilitamiento de la ciudadanía, la depredación del sentido social del trabajo, la destitución de derechos sociales conquistados y la paradoja vivida en servicios públicos en el desmonte de la Seguridad Social.

ABSTRACT. In the Brazilian context is advancing a political and economic agenda guided by the prescription of fiscal austerity that contrasts with the principles of Welfare State. The effects of these changes, on the horizon of the neoliberal advance, expand the social precariousness and work faces by restricting protective public policies, supported by the Social Security Constitution. Thus, we aim to understand if, from the Decent Work and Worker´s Health assumptions, the work precariousness process and the increasing vulnerability of workers in the context of current political and economic austerity. To dimension this scenario, we started from an analysis of the general economic situation to reach the Professional Rehabilitation Program of Social Security. The theoretical-methodological path was based on a theoretical-bibliographical study of qualitative epistemology through the collection of materials as reference works, current national legislation, public policies and international organizations guidelines. The interpretation of information is focused on three areas: Public and Worker´s Health field, Decent Work field and Social Security field, highlighting the Professional Rehabilitation. This debate led to the identification of the vulnerability process of Brazilian workers, the citizenship weakening, depredation of work social meaning, the destitution of the social rights achieved and experienced paradoxes in public services in the dismantling of Social Security.

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OBJECTIVES:: Polycystic ovary syndrome is a heterogeneous endocrine disorder that affects reproductive-age women. The mechanisms underlying the endocrine heterogeneity and neuroendocrinology of polycystic ovary syndrome are still unclear. In this study, we investigated the expression of the kisspeptin system and gonadotropin-releasing hormone pulse regulators in the hypothalamus as well as factors related to luteinizing hormone secretion in the pituitary of polycystic ovary syndrome rat models induced by testosterone or estradiol. METHODS:: A single injection of testosterone propionate (1.25 mg) (n=10) or estradiol benzoate (0.5 mg) (n=10) was administered to female rats at 2 days of age to induce experimental polycystic ovary syndrome. Controls were injected with a vehicle (n=10). Animals were euthanized at 90-94 days of age, and the hypothalamus and pituitary gland were used for gene expression analysis. RESULTS:: Rats exposed to testosterone exhibited increased transcriptional expression of the androgen receptor and estrogen receptor-ß and reduced expression of kisspeptin in the hypothalamus. However, rats exposed to estradiol did not show any significant changes in hormone levels relative to controls but exhibited hypothalamic downregulation of kisspeptin, tachykinin 3 and estrogen receptor-α genes and upregulation of the gene that encodes the kisspeptin receptor. CONCLUSIONS:: Testosterone- and estradiol-exposed rats with different endocrine phenotypes showed differential transcriptional expression of members of the kisspeptin system and sex steroid receptors in the hypothalamus. These differences might account for the different endocrine phenotypes found in testosterone- and estradiol-induced polycystic ovary syndrome rats.

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OBJECTIVES: Polycystic ovary syndrome is a heterogeneous endocrine disorder that affects reproductive-age women. The mechanisms underlying the endocrine heterogeneity and neuroendocrinology of polycystic ovary syndrome are still unclear. In this study, we investigated the expression of the kisspeptin system and gonadotropin-releasing hormone pulse regulators in the hypothalamus as well as factors related to luteinizing hormone secretion in the pituitary of polycystic ovary syndrome rat models induced by testosterone or estradiol. METHODS: A single injection of testosterone propionate (1.25 mg) (n=10) or estradiol benzoate (0.5 mg) (n=10) was administered to female rats at 2 days of age to induce experimental polycystic ovary syndrome. Controls were injected with a vehicle (n=10). Animals were euthanized at 90-94 days of age, and the hypothalamus and pituitary gland were used for gene expression analysis. RESULTS: Rats exposed to testosterone exhibited increased transcriptional expression of the androgen receptor and estrogen receptor-β and reduced expression of kisspeptin in the hypothalamus. However, rats exposed to estradiol did not show any significant changes in hormone levels relative to controls but exhibited hypothalamic downregulation of kisspeptin, tachykinin 3 and estrogen receptor-α genes and upregulation of the gene that encodes the kisspeptin receptor. CONCLUSIONS: Testosterone- and estradiol-exposed rats with different endocrine phenotypes showed differential transcriptional expression of members of the kisspeptin system and sex steroid receptors in the hypothalamus. These differences might account for the different endocrine phenotypes found in testosterone- and estradiol-induced polycystic ovary syndrome rats.

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The aim of this study was to evaluate the influence of neonatal mandibular distraction osteogenesis (MDO) on cleft dimensions and on early palatoplasty outcomes in patients with Pierre Robin Sequence (PRS). In a prospective cohort study that enrolled 24 nonsyndromic patients with PRS, 12 submitted to the MDO group and 12 patients not treated (non-MDO group), the authors compared patients for cleft palate dimensions through 7 morphometric measurements at the moment of palatoplasty and for early palatoplasty outcomes. At palatoplasty, the MDO group presented a significant shorter distance between the posterior nasal spines (PNS-PNS, P < 0.001) and between uvular bases (UB-UB, P < 0.001), representing a reduction in cleft palate width. They also had significant soft palate lengthening represented by a larger distance between UB and retromolar space (UB-RM, P < 0.001) and UB and PNS (UB-PNS, P = 0.014). Their UB moved away from the posterior wall of the nasopharynx (UB-NPH, P < 0.001). The MDO group had a length of operative time significantly shorter (P < 0.001) and no early palatoplasty complications compared with the non-MDO group. In conclusion, MDO acted as an orthopedic procedure that reduced cleft palate width and elongated the soft palate in patients with PRS. These modifications enabled a reduction of around 11% in the length of operative time of palatoplasty (P < 0.001).

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Neste texto, recorremos aos campos discursivos que possibilitam vislumbrar quem é o sujeito e seu entorno, sendo contribuintes dessa discussão os pressupostos da Saúde Coletiva e a Psicossociologia, para debater o complexo cenário do trabalho contemporâneo. Com o intuito de desvendar os modos de ser-trabalhar-existir, que conjugam o socius e a subjetividade, propomos a narrativa como dispositivo capaz de evidenciar a complexidade deste fenômeno. Essas referências teórico-conceituais permitem ao pesquisador, profissionais de saúde e diferentes atores sociais identificar o que no trabalho atenta contra o corpo, como também o que afeta a subjetividade, logo, que modos de existência são forjados no campo singular e social. Nesta perspectiva, temos como desafio (re)conhecer a trabalhadora e o trabalhador como sujeitos de saberes que, ao assumirem sua voz e protagonismo, podem conferir meios para transformação laboral e social

In this paper, we used the discursive fields that allows to glimpse who is the individual and its media, focusing the discussion from the Collective Health and Psychosociology assumptions, to discuss the complex scenario of the contemporary laboring. In order to unravel the ways of being-work-exist, which combine socius and subjectivity, we propose the narrative as a device capable of highlighting the complexity of this phenomenon. These theoretical-conceptual bases allow the researcher, health professionals and different social actors to identify what on the laboring act against the body, as well as what affects the subjectivity. Thus which form of existence are forced in the singular and social field. In this perspective, we have as a challenge recognizing the workers women and men as knowledge individuals, that by assuming their voice and protagonism can provide means for labor and social transformations

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Este texto versa sobre a supervisão enquanto dispositivo, ao apresentar o quadro teórico-conceitual que norteou a atuação e sua metodologia. Ao se debruçar sobre três campos de estágio, explicita o desafio de promover não apenas a saúde do trabalhador de saúde, mas, também, construir uma práxis questionadora da relação universidade-sociedade e formação. A partir da narrativa docente do estágio profissional em Psicologia do Trabalho, dimensiona-se como se constituiu a pesquisa-intervenção em bases interdisciplinares capazes de deslocar o saber centrado no expert para tencionar ações de coletivos transformadores, que, mediante a aproximação e o diálogo, oportunizassem o forjar de solidariedades e cooperação. Elementos profícuos para a ressignificação dessas esferas foram: a construção do diagnóstico institucional vinculado à demanda e o dispositivo supervisão, capaz de produzir narrativas originais para construir experiências de protagonização – correspondentes aos princípios da Política de Humanização...

This paper addresses supervision as a device, through presenting the theoretical-conceptual framework that has guided such actions and their methodology. In analyzing three fields of internship, this paper sets forth the challenge of promoting not only healthcare workers’ health but also of building praxis that questions the relationship between university-society and training. Starting from the teaching narrative of professional internship in occupational psychology, this paper assess the way in which research-intervention is constituted on an interdisciplinary basis capable of displacing expert-centered knowledge to promote transformative collective actions that through proximity and dialogue would provide an opportunity for forging solidarity and cooperation. The construction of institutional diagnoses linked to both demand and the supervision device, capable of producing original narratives in order to build protagonist experiences corresponding to the principles of the humanization policy formed a profitable element for reframing the meanings of these spheres...

Ese texto trata sobre la supervisión como dispositivo, al presentar el cuadro teórico-conceptual que rigió su actuación y su metodología. Al enfocarse sobre tres campos de pasantía, explicita el desafío de promover no solo la salud del trabajador de la salud sino también construir una praxis cuestionadora de la relación universidad-sociedad y formación. A partir de la narrativa docente de la pasantía profesional en Psicología del Trabajo, se dimensiona como se constituyó la encuesta – intervención en bases interdisciplinarias capaces de desplazar el saber centrado en el expert para buscar acciones de colectivos transformadores que, por medio de la aproximación y el diálogo, dieron oportunidad para forjar solidaridades y cooperación. Elementos prolíficos para la re-significación de esas esferas fueron: la construcción del diagnóstico institucional vinculado a la demanda y el dispositivo supervisión, capaz de producir narrativas originales para construir experiencias de protagonización – correspondientes a los principios de la Política de Humanización...

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