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Background: Postural instability is a debilitating cardinal symptom of Parkinson's disease (PD). Its onset marks a pivotal milestone in PD when balance impairment results in disability in many activities of daily living. Early detection of postural instability by non-expensive tools that can be widely used in clinical practice is a key factor in the prevention of falls in widespread population and their negative consequences. Objective: This study aimed to investigate the effectiveness of a two-dimensional balance assessment to identify the decline in postural control associated with PD progression. Methods: This study recruited 55 people with PD, of which 37 were men. Eleven participants were in stage I, twenty-three in stage II, and twenty-one in stage III. According to the Hoehn and Yahr (H&Y) rating scale, three clinical balance tests (Timed Up and Go test, Balance Evaluation Systems Test, and Push and Release test) were carried out in addition to a static stance test recorded by a two-dimensional movement analysis software. Based on kinematic variables generated by the software, a Postural Instability Index (PII) was created, allowing a comparison between its results and those obtained by clinical tests. Results: There were differences between sociodemographic variables directly related to PD evolution. Although all tests were correlated with H&Y stages, only the PII was able to differentiate the first three stages of disease evolution (H&Y I and II: p = 0.03; H&Y I and III: p = 0.00001; H&Y II and III: p = 0.02). Other clinical tests were able to differentiate only people in the moderate PD stage (H&Y III). Conclusion: Based on the PII index, it was possible to differentiate the postural control decline among the first three stages of PD evolution. This study offers a promising possibility of a low-cost, early identification of subtle changes in postural control in people with PD in clinical practice.

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Objetivo: Vincular o conteúdo da Avaliação Geriátrica Ampla (AGA) de um centro de referência na saúde da pessoa idosa com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) e apresentar seu Conjunto Básico de categorias da CIF. Método: A AGA foi vinculada à CIF por dois especialistas, treinados de acordo com as regras de vinculação estabelecidas. A concordância entre os especialistas foi determinada com base no índice kappa de Cohen. Resultados: A concordância entre os especialistas foi considerada perfeita para cada domínio da CIF (k= 0,91; p<0,00; concordância= 93,32%). A AGA continha 419 itens, sendo que 106 não puderam ser vinculados à CIF, por estarem associados a condições de saúde ou não se enquadrarem nas categorias da CIF. Foi verificado que 313 estavam ligados aos domínios da CIF e que 181 (60,13%) estavam relacionados às funções do corpo, 18 (5,98%) às estruturas do corpo, 73 (24,258%) à atividade e participação, 30 (9,97%) a fatores ambientais e 11 (3,51%) aos fatores pessoais. Conclusões: A CIF pode ser inserida em contextos específicos dos serviços de saúde sendo viável a vinculação da CIF com formulários elaborados pelos próprios serviços de saúde. A correspondência entre um instrumento de avaliação geriátrico e a CIF potencializa discussões de casos, planos terapêuticos e cuidado continuado. A dinâmica do processo de cuidado padronizado pela CIF pode facilitar a ampliação do cuidado e estabelecimento de metas terapêuticas que ultrapassem o contexto do serviço e alcancem a esfera familiar e social.

Objective: Linking the content of the Comprehensive Geriatric Assessment (CGA) of a reference center for the health of the elderly with the International Classification of Functioning, Disability and Health (ICF) and present its Basic Set of ICF codes. Method: The AGA were linked to the ICF by two specialists, trained according to the established linking rules. Agreement between the health professionals was determined based on Cohen's kappa index. Results: The agreement between the two health professionals was considered perfect for each ICF domain (k= 0.91; p<0.00; agreement= 93.32%). The AGA contained 419 items, 106 of which could not be linked to the ICF, as they were associated with health conditions or did not fit into any category. It was found that 313 were linked to the ICF domains and that 181 (60.13%) were related to body functions, 18 (5.98%) to body structures, 73 (24.258%) to activity and participation, 30 (9.97%) to environmental factors and 11 (3.51%) to personal factors. Conclusions: The ICF can be inserted in specific contexts of health services, making it feasible to link the ICF with forms prepared by the health services themselves. The correspondence between a geriatric assessment instrument and the ICF enhances case discussions, therapeutic plans and continued care. The dynamics of the care process standardized by the ICF can facilitate the expansion of care and the establishment of therapeutic goals that go beyond the context of the service and reach the family and social sphere.

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Background: Gait is one of the activities most affected by the symptoms of Parkinson's disease and may show a linear decline as the disease progresses. Early assessment of its performance through clinically relevant tests is a key factor in designing efficient therapeutic plans and procedures, which can be enhanced using simple and low-cost technological instruments. Objective: To investigate the effectiveness of a two-dimensional gait assessment to identify the decline in gait performance associated with Parkinson's disease progression. Methods: One hundred and seventeen people with Parkinson's disease, classified between early and intermediate stages, performed three clinical gait tests (Timed Up and Go, Dynamic Gait Index, and item 29 of the Unified Parkinson's Disease Rating Scale), in addition to a six-meter gait test recorded by a two-dimensional movement analysis software. Based on variables generated by the software, a gait performance index was created, allowing a comparison between its results with the results obtained by clinical tests. Results: There were differences between sociodemographic variables directly related to the evolution of Parkinson's disease. Compared to clinical tests, the index proposed to analyze gait showed greater sensitivity and was able to differentiate the first three stages of disease evolution (Hoehn and Yahr I and II: p = 0.03; Hoehn and Yahr I and III: p = 0.00001; Hoehn and Yahr II and III: p = 0.02). Conclusion: Based on the index provided by a two-dimensional movement analysis software that uses kinematic gait variables, it was possible to differentiate the gait performance decline among the three first stages of Parkinson's disease evolution. This study offers a promising possibility of early identification of subtle changes in an essential function of people with Parkinson's disease.

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INTRODUCTION: The transformation of data into information is important to support decision making and, thus, to induce improvements in healthcare services. The regionalized organization of healthcare systems is necessary to ensure the integrity of citizen care. From this perspective, the creation of mechanisms to guide and assess the behavior of a healthcare services network becomes necessary. However, these mechanisms must consider the interaction between different municipalities. The objective of this study is to apply network analysis as a supporting tool in the Brazilian Unified Health System (Sistema Único de Saúde-SUS) management. METHODS: The stages of the proposed method are described and applied in a real situation, analyzing the intermunicipal interaction network for cardiovascular surgery in the municipality of Vitória da Conquista, Bahia, Brazil, from 2008 to 2020. The metrics analyzed were journeys indices, flow of patients and distance of the journeys, considering the journeys from and to the municipality in focus. RESULT: There was an increase of the incoming flow and in-degree indices combined with a decrease in outgoing flow, showing the growing importance of this municipality as a provider of these services. CONCLUSION: The method used in the study has potential to be adopted as a management tool to assess the behavior of the interactions network of the selected service, aiding the regionalized organization of the healthcare system.

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Schizophrenia is a severe psychiatric disorder associated with altered connectivity of brain functional networks (BFNs). Researchers have observed a profound disruption in prefrontal-temporal interactions, damage to hub regions in brain networks and modified topological organization of BFNs in schizophrenia (SCZ) individuals. Assessment of BFNs with dynamic approaches allow the characterization of new functional structures, such as topological stability patterns and temporal connectivity, which are not accessible through static methods. In this perspective, the present study investigated the physiological processes of brain connectivity in SCZ. A resting-state EEG dataset of 14 SCZ individuals and 14 healthy controls (HC) was obtained at a sampling rate of 250 Hz. Dynamic BFNs were constructed using time-varying graphs combined with the motifs' synchronization method and the indexes were evaluated in different scales: global averages, by hemispheres, by regions, and by electrodes for both groups. The SCZ group exhibited lower temporal connectivity, lesser hub probability, and fewer number of edges in right and left temporal lobes over time, besides increased temporal connectivity in the central-parietal region. Neither differences for the full synchronization time of BFNs were observed, nor for intra- and inter-hemispheric connections between groups. These results indicate that SCZ BFNs exhibit a dynamic fluctuation pattern with abrupt increases in connectivity over time for the regions studied. This elucidates an attempted interaction of the temporal area with other regions (frontal, central-parietal, and occipital) that is not sufficient to maintain a connectivity pattern in schizophrenia individuals similar to that of healthy subjects. Our results suggest that changes in interaction of dynamic BFNs connections in SCZ can be better approached by dynamic analyses that enable a thorough glance at brain changes over time.

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Nonlinear analysis such as detrended fluctuation analysis (DFA) and power spectrum density are often used to describe the gait motor behavior. This is an interdisciplinary effort to understand and evaluate human movement by the complexity field lenses. However, there are conflicting interpretations about the measures. For instance, the same alpha value could be a better adaptation or sign of pathology. Therefore, the purposes of this scope review are: to map scientific production in the application of the scaling exponent for gait and running analysis, identify the scaling methods used in these studies and the results interpretation, and identify knowledge gaps for future studies. Eleven methods and six metrics associated with them were found. Most of the papers use DFA and explain the results through hypotheses about the supraspinal influence and origin of long-range correlations, adaptability and stability during gait and running. Comparing studies and interpretations, we found a broad designation of terms for the same metric. This reflects the lack of agreement and language uniformity in this literature.

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In recent decades, there has been a growing interest in the impact of electric fields generated in the brain. Transmembrane ionic currents originate electric fields in the extracellular space and are capable of affecting nearby neurons, a phenomenon called ephaptic neuronal communication. In the present work, the Quadratic Integrated-and-Fire model (QIF-E) underwent an adjustment/improvement to include the ephaptic entrainment behavior between neurons and electric fields. Indeed, the aim of our study is to validate the QIF-E model, which is a model to estimate the influence of electric fields on neurons. For this purpose, we evaluated whether the main properties observed in an experiment by Anastassiou et al. (Nat Neurosci 14:217-223, 2011), which analyzed the effect of an electric field on cortical pyramidal neurons, are reproduced with the QIF-E model. In this way, the analysis tools are employed according to the neuronal activity regime: (i) for the subthreshold regime, the circular statistic is used to describe the phase differences between the input stimulus signal (electrode) and the modeled membrane response; (ii) in the suprathreshold regime, the Population Vector and the Spike Field Coherence are used to estimate phase preferences and the entrainment intensity between the input stimulus and Action Potentials. The results observed are (i) in the subthreshold regime the values of the phase differences change with distinct frequencies of the input stimulus; (ii) in the supra-threshold regime the preferential phase of Action Potentials changes for different frequencies. In addition, we explore other parameters of the model, such as noise and membrane characteristic-time, in order to understand different types of neurons and extracellular environment related to ephaptic communication. Such results are consistent with results observed in empirical experiments based on ephaptic phenomenon. In addition, the QIF-E model allows further studies on the physiological importance of ephaptic communication in the brain, and its simplicity may open a door to simulate the ephaptic response in neuronal networks and assess the impact of ephaptic communication in such scenarios.

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OBJECTIVE: The aim of this study was to characterize the dynamic brain networks underlying the affective modulation of pleasant, unpleasant, and neutral image perception due to painful stimulations in healthy subjects. METHODS: Forty volunteers, 20 men and 20 women, participated in this study. Brain activity was recorded by 64-channel electroencephalography. After data cleaning, brain functional networks were built through the use of the motif synchronization method. RESULTS: We found that increased cerebral connectivity in the left hemisphere under the pain condition broke the connection symmetry. Both women and men showed homophilic connections (intrahemispheric), but women were more homophilic than men. The pain condition increased homophily in the left hemisphere, and emotions could modulate pain. The frontal, central, and left temporal regions showed homophilic variation, depending on the emotional stimulus. CONCLUSIONS: Pain and emotions altered brain activity. There was increased connectivity and homophily in the left brain hemisphere for the painful experience. The emotions modulated brain activity in the pain condition. Overall, the brain presented homophilic characteristics; homophily changed, depending on emotion or pain. The left brain hemisphere seems to be related to pain processing.

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OBJECTIVE: To develop a collaborative, multidisciplinary care model for older adults that improves interdisciplinary teamwork and increases access to specialized services for frail patients, helping solve management problems in the Brazilian Unified Health System. In the state of Bahia, the health care network for older adults requires better interaction and integration with the Unified Health System and the Unified System of Social Assistance to improve patient flow in the network. METHODS: We used a co-creation and participatory action research approach based on reflection, data collection, interaction, and feedback with participants and stakeholders. Data was collected from health professionals, representatives of health agencies, and older adults through collective and individual interviews, reflective diaries, and direct communication. RESULTS: An action plan involving members of the older adult care network was developed to put the new model into practice. A pilot study with a multidisciplinary team allowed adjustments and implementation of the model at our institution. CONCLUSIONS: The new model improved both the internal management of the State Reference Center for Older Adult Health Care (Centro de Referência Estadual de Atenção à Saúde do Idoso - CREASI) and its interaction with primary care, optimizing patient flow and establishing rules for shared management between CREASI and primary care institutions. In view of this, restructuring the care model reorganized relations between the agencies, expanding CREASI's role in the management and systematization of older adult health.

OBJETIVO: Desenvolver um modelo assistencial colaborativo, multiprofissional e centrado na pessoa idosa para melhorar o trabalho em equipe interdisciplinar e o acesso de idosos frágeis ao serviço especializado, ajudando na resolução de problemas com o gerenciamento do idoso no Sistema Único de Saúde (SUS). A rede de assistência à saúde do idoso na Bahia requer avanços na interação e na integração entre os órgãos do SUS e do Sistema Único de Assistência Social para melhorar o fluxo dos pacientes na rede. METODOLOGIA: Foi realizada uma pesquisa-ação participativa e cocriação baseadas na reflexão, coleta de dados, interação e feedback com participantes e partes interessadas. A coleta dos dados foi realizada com os profissionais de saúde, representantes dos órgãos de saúde e idosos por meio entrevistas coletivas e individuais, diários reflexivos e registros de comunicação direta. RESULTADOS: Foi elaborado um plano de ação com participação dos membros da rede de assistência ao idoso para colocar em prática o novo modelo. Realizou-se um piloto com uma equipe multidisciplinar que possibilitou ajustes e a implementação do modelo na instituição. CONCLUSÕES: O novo modelo favoreceu tanto o gerenciamento interno do Centro de Referência Estadual de Atenção à Saúde do Idoso (CREASI) como a interação com a atenção básica, otimizando o fluxo de pacientes e estabelecendo regras de gerenciamento compartilhado entre CREASI e atenção básica. Diante disso, a reestruturação do modelo assistencial representou uma reorganização das relações entre os órgãos, ampliando o papel do CREASI no gerenciamento e na sistematização da saúde do idoso.

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The new Covid-19 pandemic has left traces of suffering and devastation to individuals of almost all countries worldwide and severe impact on the global economy. Understanding the clinical characteristics, interactions with the environment, and the variables that favor or hinder its dissemination help the public authorities in the fight and prevention, leading for a rapid response in society. Using models to estimate contamination scenarios in real time plays an important role. Population compartments models based on ordinary differential equations (ODE) for a given region assume two homogeneous premises, the contact mechanisms and diffusion rates, disregarding heterogeneous factors as different contact rates for each municipality and the flow of contaminated people among them. This work considers a hybrid model for covid-19, based on local SIR models and the population flow network among municipalities, responsible for a complex lag dynamic in their contagion curves. Based on actual infection data, local contact rates ( ß ) are evaluated. The epidemic evolution at each municipality depends on the local SIR parameters and on the inter-municipality transport flow. When heterogeneity of ß values and flow network are included, forecasts differ from those of the homogeneous ODE model. This effect is more relevant when more municipalities are considered, hinting that the latter overestimates new cases. In addition, mitigation scenarios are assessed to evaluate the effect of earlier interventions reducing the inter-municipality flux. Restricting the flow between municipalities in the initial stage of the epidemic is fundamental for flattening the contamination curve, highlighting advantages of a contamination lag between the capital curve and those of other municipalities in the territories.

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OBJECTIVE: To assess the impact of tDCS on posture, gait and coordination of movements in subjects with cerebellar ataxia. PATIENTS AND METHODS: This is a two-phase, double blind, auto matched, pilot study. Seven people were selected to participate in the study aged from 14 to 57. tDCS and sham-tDCS were applied at different times to all participants for 40 min over five consecutive days so that they were blind to which of the two techniques was applied at any one time. The area stimulated was the bilateral motor cortex. Subjects were evaluated before and after the interventions using the Scale for Assessment and Rating of Ataxia (SARA) and specific tests to measure posture and balance were carried out using the Wii Fit platform and CvMob software. RESULTS: The study indicates a statistically significant improvement in respect of gait parameters and the total score of the SARA scale and Wii Fit platform after tDCS when compared with data obtained from sham-tDCS trials (p: 0,03). The adverse events relating to tDCS were all self-limiting and from mild to moderate intensity. CONCLUSION: Despite the small sample size, tDCS showed positive results in some motor parameters and could be considered a valuable new option for the treatment of cerebellar ataxias.

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Higher education has joined affirmative action and promoted the coexistence between different social groups at universities. This study evaluated the interaction pattern between 926 affirmative action and regular students from 25 different undergraduate programs from a public university using an informal social networks questionnaire. Homophily was the parameter chosen to measure intergroup relations. This behavior was evaluated according to the student's term, yield rate (percentage of admitted students who enroll), field of knowledge and nature of relationship. The results showed a low degree of integration between groups in highly competitive undergraduate programs. The group of regular students showed a greater tendency for endogeneity. These results point to need to create a culture of inclusion that provides a distribution of resources between different social groups.

A adesão ao sistema de cotas no ensino superior promoveu a convivência entre grupos sociais distintos. O estudo avaliou o padrão de interação entre 926 estudantes cotistas e não cotistas de 25 turmas de uma universidade pública brasileira, utilizando um questionário de redes sociais informais. Homofilia foi o parâmetro escolhido para medir as relações intergrupais. Esse comportamento foi avaliado de acordo com o semestre, a concorrência, a área de conhecimento e a natureza da relação. Os resultados demonstraram baixo grau de integração entre os grupos nos cursos de alta concorrência, bem como maior tendência à endogenia no grupo de não cotistas. Tais resultados apontam a necessidade de se criar uma cultura inclusiva, que propicie a distribuição de recursos entre os diferentes grupos sociais envolvidos.

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The hand trajectory of motion during the performance of one-dimensional point-to-point movements has been shown to be marked by motor primitives with a bell-shaped velocity profile. Researchers have investigated if motor primitives with the same shape mark also complex upper-limb movements. They have done so by analyzing the magnitude of the hand trajectory velocity vector. This approach has failed to identify motor primitives with a bell-shaped velocity profile as the basic elements underlying the generation of complex upper-limb movements. In this study, we examined upper-limb movements by analyzing instead the movement components defined according to a Cartesian coordinate system with axes oriented in the medio-lateral, antero-posterior, and vertical directions. To our surprise, we found out that a broad set of complex upper-limb movements can be modeled as a combination of motor primitives with a bell-shaped velocity profile defined according to the axes of the above-defined coordinate system. Most notably, we discovered that these motor primitives scale with the size of movement according to a power law. These results provide a novel key to the interpretation of brain and muscle synergy studies suggesting that human subjects use a scale-invariant encoding of movement patterns when performing upper-limb movements.

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INTRODUÇÃO: Uma alta porcentagem de pacientes pós-AVC tem consequências permanentes, apesar da reabilitação convencional. O treinamento em circuito oferece uma maneira eficiente de realizar a prática estruturada de atividades relacionadas à tarefa durante a reabilitação do AVC. A terapia aquática é outra abordagem terapêutica que oferece uma grande variedade de opções para ser um ambiente altamente dinâmico, o que ajuda a melhorar a funcionalidade e recuperar a qualidade de vida e a independência das pessoas com deficiência. OBJETIVO: Desenvolver um protocolo para um estudo controlado randomizado. MÉTODOS: Quarenta participantes serão randomizados em dois grupos: treinamento em classe de circuito aquático (ACCT) e treinamento em circuito de terra (LCCT). Em ambos os grupos, a intervenção será uma terapia de classe de 7 semanas, 3 vezes por semana, dando um total de 20 sessões, 60 minutos cada. Os avaliadores cegos conduzirão avaliações, utilizando ferramentas padronizadas: linha de base, pós-intervenção e 20 dias de acompanhamento para a eficácia da terapia em termos de marcha, equilíbrio e função motora do membro superior. RESULTADOS / CONCLUSÃO: Este estudo examinará o efeito imediato e de médio prazo de um programa ACCT em comparação com um programa LCCT em pessoas com AVC. Tem o potencial de identificar intervenções que possam melhorar a reabilitação desses pacientes. Ambos os programas do CCT são baseados no modelo da Classificação Internacional de Função, Incapacidade e Saúde, com atividades voltadas para os níveis de deficiência, atividade e participação. [AU]

INTRODUCTION: A high percentage of post-stroke patients have permanent aftermathsdespite conventional rehabilitation. Circuit class training offers an efficient way to achieve structured practice of task-related activities during stroke rehabilitation. Aquatic therapy is another therapeutic approach that offers a great variety of options to be a highly dynamic environment, which helps to improving functionality and recover quality of life and independence in people with disabilities. OBJECTIVE: To develop a protocol for a randomized controlled trial. METHODS: Forty participants will be randomized in two groups: aquatic circuit class training (ACCT) and land circuit class training (LCCT). In both groups, the intervention will be a 7-week class therapy, 3-times weekly, giving a total of 20 sessions, 60 minutes each. Blinded assessors will conduct assessments, using standardized tools: baseline, post-intervention, and 20 days follow-up for the effectiveness of the therapy in terms of gait, balance and upper limb motor function. RESULTS/CONCLUSION: This trial will examine the immediate and medium term effect of an ACCT program as compared to a LCCT program in people with stroke. It has the potential to identify interventions that may improve rehabilitation of these patients. Both CCT programs are based in International Classification of Function, Disability and Health model with activities aimed at impairment, activity and participation levels. [AU]

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Dengue infection is a public health problem with a complex distribution. The physical means of propagation and the dynamics of diffusion of the disease between municipalities need to be analysed to direct efficient public policies to prevent dengue infection. The present study presents correlations of occurrences of reported cases of dengue infection among municipalities, self-organized criticality (SOC), and transportation between areas, identifying the municipalities that play an important role in the diffusion of dengue across the state of Bahia, Brazil. The significant correlation found between the correlation network and the SOC demonstrates that the pattern of intramunicipal diffusion of dengue is coupled to the pattern of synchronisation between the municipalities. Transportation emerges as influential in the dynamics of diffusion of epidemics by acting on the aforementioned variables.

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Origin-destination flow is a phenomenon that can be modeled as a network. Graph theory is a mathematical tool to characterize a network and thus allows studying the topological properties and temporal and spatial development of a set of related elements. The article aims to estimate the topological evolution of an inter-municipal network of normal deliveries. We selected the admissions for normal deliveries in the Hospital Information System of the Brazilian Unified National Health System, from 2008 to 2014, for women residing in Bahia State, Brazil. The following indices were applied: entry degree (from how many municipalities the women came for childbirth), exit degree (to how many municipalities they left), entry flow (how many women came), exit flow (how many women left), and the mean size of the exit edge (distance traveled). Analyses between macro-regions used the following indicators: proportion of normal deliveries performed outside the municipality of residence and mean size of the exit edge. The results indicate an increase in deliveries performed outside the municipality of residence, in addition to the persistence of concentration of deliveries in the hub municipalities in the Health Regions, and an increase in the distance between the municipality of residence and the municipality where the delivery took place. The organization of networks for normal childbirth poses an on-going challenge. It is important to analyze the flow of women for childbirth care in order to support the establishment of inter-municipal references to guarantee safe labor and childbirth. In conclusion, it is necessary to develop a regionalized network to meet the demand by pregnant women in the territory with universal and equitable coverage.

O fluxo de origem e destino é um fenômeno que pode ser modelado como uma rede. A teoria dos grafos é uma ferramenta matemática para caracterizar uma rede, desta forma, é possível estudar as propriedades topológicas e o desenvolvimento temporal e espacial de um conjunto de elementos relacionados. Este artigo tem como objetivo estimar a evolução topológica da rede intermunicipal de partos normais. Para tanto, foram selecionadas as internações do Sistema de Informação Hospitalar do Sistema Único de Saúde com o procedimento de parto normal, de 2008 a 2014, das residentes no Estado da Bahia, Brasil. Foram aplicados os índices: grau de entrada (de quantos municípios chegam), grau de saída (para quantos municípios saem), fluxo de entrada (quantas pessoas chegam), fluxo de saída (quantas pessoas saem) e o tamanho médio da aresta de saída (distância percorrida). As análises entre as macrorregiões foram realizadas por meio dos indicadores: proporção de partos normais realizados fora do município de residência e tamanho médio da aresta de saída. Os resultados indicam que houve aumento de partos realizados fora do município de residência, além da permanência da concentração de partos nos municípios sede da Região de Saúde, e aumento da distância entre o município de residência e o município de ocorrência do parto. A organização das redes para parto normal ainda é um desafio a ser superado. É importante analisar o fluxo realizado pelas gestantes, a fim de apoiar a definição das referências intermunicipais com o propósito de garantir o parto e o nascimento seguros. Concluiu-se que é necessário desenvolver uma rede regionalizada para atender às demandas das gestantes nos territórios de forma universal e equânime.

El flujo de origen y destino es un fenómeno que puede ser modelado como una red. La teoría de los grafos es una herramienta matemática para caracterizar una red, de esta forma, es posible estudiar las propiedades topológicas y el desarrollo temporal y espacial de un conjunto de elementos relacionados. El objetivo de este artículo es estimar la evolución topológica de la red intermunicipal de partos normales. Para ello, se seleccionaron los internamientos del Sistema de Información Hospitalaria del Sistema Único de Salud con el procedimiento de parto normal, de 2008 a 2014, de residentes en el estado de Bahía, Brasil. Se aplicaron los siguientes índices: grado de entrada (de cuántos municipios llegan), grado de salida (hacia cuántos municipios salen), flujo de entrada (cuántas personas llegan), flujo de salida (cuántas personas salen) y el tamaño medio de la arista de salida (distancia recorrida). Los análisis entre las macrorregiones se realizaron mediante los indicadores: proporción de partos normales realizados fuera del municipio de residencia y tamaño medio de la arista de salida. Los resultados indican que hubo un aumento de partos realizados fuera del municipio de residencia, además de la permanencia de la concentración de partos en los municipios sede de la Región de Salud, y el aumento de la distancia entre el municipio de residencia y el municipio de ocurrencia del parto. La organización de las redes para el parto normal todavía es un desafío que debe ser superado. Es importante analizar el flujo realizado por las gestantes, con el propósito de apoyar la definición de las referencias intermunicipales, a fin de garantizar el parto y el nacimiento seguros. Se concluyó que es necesario desarrollar una red regionalizada para atender a las demandas de las gestantes en los territorios de forma universal y ecuánime.

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INTRODUÇÃO: O desenvolvimento tecnológico em Audiologia possibilita a criação e aplicação de ferramentas voltadas à reabilitação da pessoa com deficiência auditiva. Todavia, os recentes avanços ainda não abrangem todas as competências necessárias para atender às demandas específicas de pessoas com múltiplas deficiências. OBJETIVO: Avaliar a tecnologia de rastreamento ocular como auxílio à intervenção interdisciplinar para a reabilitação auditiva de pessoas com múltiplas deficiências no Sistema Único de Saúde - SUS. MÉTODO: Trata-se de um estudo de caso, descritivo, exploratório, de natureza qualiquantitativa. Foram realizadas: elaboração de um banco de imagens e construção de um software para o gerenciamento de imagens;aplicação de pilotos para adequação da metodologia; aplicação dos procedimentos desenvolvidos na reabilitação auditiva em seis usuários com múltiplas deficiências. RESULTADOS: O software desenvolvido gerencia 244 imagens validadas,que utilizadas em conjunto com a tecnologia de rastreamento ocular,possibilitou a aplicação da entrevista social e anamnese otorrinolaringológica diretamente aos usuários, assim como, a avaliação audiológica básica,indicação de prótese auditiva, terapia fonoaudiológica e psicológica.As tecnologias propostas foram utilizadas de maneira interdisciplinar, e possibilitaram maior inserção dos usuários em seu processo terapêutico. CONCLUSÃO: Este estudo apontou que é viável a associação do software de imagens à tecnologia assistiva de rastreamento ocular para uso em uma parcela de pessoas com múltiplas deficiências, possibilitando obtenção de respostas e maior participação durante a realização dos procedimentos em saúde auditiva.

INTRODUCTION: The technological development in Audiology allows thecreation and application of tools for rehabilitation of hearing impaired subjects. However, recent advances still do not encompass all skills needed to meet the specific demands of people with multiple disabilities. PURPOSE: To evaluate the eyetracking technology as an aid to the interdisciplinary intervention for the auditory rehabilitation of people with multiple deficiencies in the Unified Public Health System. METHOD: This is a descriptive, exploratory, qualitative-quantitative casestudy. The steps were: elaboration of an image bank and construction ofsoftware for assistive communication using these images; dry-run evaluationsto adapt the methodology; application of the procedures developedin auditory rehabilitation in six users with multiple disabilities. RESULTS: The software developed managed 244 validated images, whichused in conjunction with ocular tracking technology, allowed the applicationof social interview and otorhinolaryngological anamnesis, directlyto the users, as well as the basic audiological evaluation, indication ofhearing aid, speech and psychological therapy. The proposed technologieswere used in an interdisciplinary way, and enabled the insertion ofthese users in their therapeutic process. CONCLUSION: This study showed that it is feasible to associate imaging software with assistive eyetracking technology for people with multipledisabilities. Improving user participation during the performance of auditory health procedures.

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O fluxo de origem e destino é um fenômeno que pode ser modelado como uma rede. A teoria dos grafos é uma ferramenta matemática para caracterizar uma rede, desta forma, é possível estudar as propriedades topológicas e o desenvolvimento temporal e espacial de um conjunto de elementos relacionados. Este artigo tem como objetivo estimar a evolução topológica da rede intermunicipal de partos normais. Para tanto, foram selecionadas as internações do Sistema de Informação Hospitalar do Sistema Único de Saúde com o procedimento de parto normal, de 2008 a 2014, das residentes no Estado da Bahia, Brasil. Foram aplicados os índices: grau de entrada (de quantos municípios chegam), grau de saída (para quantos municípios saem), fluxo de entrada (quantas pessoas chegam), fluxo de saída (quantas pessoas saem) e o tamanho médio da aresta de saída (distância percorrida). As análises entre as macrorregiões foram realizadas por meio dos indicadores: proporção de partos normais realizados fora do município de residência e tamanho médio da aresta de saída. Os resultados indicam que houve aumento de partos realizados fora do município de residência, além da permanência da concentração de partos nos municípios sede da Região de Saúde, e aumento da distância entre o município de residência e o município de ocorrência do parto. A organização das redes para parto normal ainda é um desafio a ser superado. É importante analisar o fluxo realizado pelas gestantes, a fim de apoiar a definição das referências intermunicipais com o propósito de garantir o parto e o nascimento seguros. Concluiu-se que é necessário desenvolver uma rede regionalizada para atender às demandas das gestantes nos territórios de forma universal e equânime.

Origin-destination flow is a phenomenon that can be modeled as a network. Graph theory is a mathematical tool to characterize a network and thus allows studying the topological properties and temporal and spatial development of a set of related elements. The article aims to estimate the topological evolution of an inter-municipal network of normal deliveries. We selected the admissions for normal deliveries in the Hospital Information System of the Brazilian Unified National Health System, from 2008 to 2014, for women residing in Bahia State, Brazil. The following indices were applied: entry degree (from how many municipalities the women came for childbirth), exit degree (to how many municipalities they left), entry flow (how many women came), exit flow (how many women left), and the mean size of the exit edge (distance traveled). Analyses between macro-regions used the following indicators: proportion of normal deliveries performed outside the municipality of residence and mean size of the exit edge. The results indicate an increase in deliveries performed outside the municipality of residence, in addition to the persistence of concentration of deliveries in the hub municipalities in the Health Regions, and an increase in the distance between the municipality of residence and the municipality where the delivery took place. The organization of networks for normal childbirth poses an on-going challenge. It is important to analyze the flow of women for childbirth care in order to support the establishment of inter-municipal references to guarantee safe labor and childbirth. In conclusion, it is necessary to develop a regionalized network to meet the demand by pregnant women in the territory with universal and equitable coverage.

El flujo de origen y destino es un fenómeno que puede ser modelado como una red. La teoría de los grafos es una herramienta matemática para caracterizar una red, de esta forma, es posible estudiar las propiedades topológicas y el desarrollo temporal y espacial de un conjunto de elementos relacionados. El objetivo de este artículo es estimar la evolución topológica de la red intermunicipal de partos normales. Para ello, se seleccionaron los internamientos del Sistema de Información Hospitalaria del Sistema Único de Salud con el procedimiento de parto normal, de 2008 a 2014, de residentes en el estado de Bahía, Brasil. Se aplicaron los siguientes índices: grado de entrada (de cuántos municipios llegan), grado de salida (hacia cuántos municipios salen), flujo de entrada (cuántas personas llegan), flujo de salida (cuántas personas salen) y el tamaño medio de la arista de salida (distancia recorrida). Los análisis entre las macrorregiones se realizaron mediante los indicadores: proporción de partos normales realizados fuera del municipio de residencia y tamaño medio de la arista de salida. Los resultados indican que hubo un aumento de partos realizados fuera del municipio de residencia, además de la permanencia de la concentración de partos en los municipios sede de la Región de Salud, y el aumento de la distancia entre el municipio de residencia y el municipio de ocurrencia del parto. La organización de las redes para el parto normal todavía es un desafío que debe ser superado. Es importante analizar el flujo realizado por las gestantes, con el propósito de apoyar la definición de las referencias intermunicipales, a fin de garantizar el parto y el nacimiento seguros. Se concluyó que es necesario desarrollar una red regionalizada para atender a las demandas de las gestantes en los territorios de forma universal y ecuánime.

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The main objective of this study is to review and summarize recent findings on electroencephalographic patterns in individuals with chronic pain. We also discuss recent advances in the use of quantitative Electroencephalography (qEEG) for the assessment of pathophysiology and biopsychosocial factors involved in its maintenance over time. Data collection took place from February 2014 to July 2015 in PubMed, SciELO and PEDro databases. Data from cross-sectional studies and longitudinal studies, as well as clinical trials involving chronic pain participants were incorporated into the final analysis. Our primary findings related to chronic pain were an increase of theta and alpha EEG power at rest, and a decrease in the amplitude of evoked potentials after sensory stimulation and cognitive tasks. This review suggests that qEEG could be considered as a simple and objective tool for the study of brain mechanisms involved in chronic pain, as well as for identifying the specific characteristics of chronic pain condition. In addition, results show that qEEG probably is a relevant outcome measure for assessing changes in therapeutic studies.

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