Speech restoration after circumferential pharyngolaryngectomy with free jejunal repair for advanced tumors of the hypopharyngo-esophageal tract remains a difficult problem to solve. We report here the results of secondary voice restoration in six patients who received a Provox 2 type prosthesis and intensive speech therapy after circumferential pharyngolaryngectomy with free jejunum repair. No patient had operative or post-operative complications due to insertion of the prosthesis. No patient had to have the prosthesis removed during the follow-up (8 to 14 months). Analysis of some acoustic parameters of voice (fundamental frequency, waveform perturbations) and qualitative characteristics of speech (intelligibility, pleasantness and acceptability) demonstrated that all the patients were able to produce satisfactory speech after tracheojejunum puncture and speech therapy and were satisfied with their own ability to communicate. Our results are reassuring and we therefore advise that in patients undergoing free jejunum flap reconstruction of the hypopharyngo-esophageal tract voice restoration should be attempted by placing a voice prosthesis through a secondary tracheo-esophageal puncture and providing intensive speech training.

IntroductionSex differences were demonstrated in bipolar disorders (BD) concerning epidemiological, clinical, and psychopathological characteristics, but consensus is lacking. Moreover, data concerning the influence of sex on treatment response in BD is contrasting. The present cross-sectional study aimed to analyze sex differences in a population of BD subjects, with specific focus on psychopathological features and treatment response.Materials and MethodsSubjects diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th version (DSM-5) were recruited. Socio-demographic and clinical characteristics were collected. The Hamilton Rating Scale for Depression, the Mania Rating Scale (MRS), the brief version of the Temperament Evaluation of Memphis, Pisa and San Diego—Münster version (briefTEMPS-M), and the Barratt Impulsiveness Scale−11 items (BIS-11) were used for psychopathological assessment. Treatment response was appraised with the Alda Scale. We performed bivariate analyses to compare socio-demographic, clinical, and psychopathological characteristics between men and women (p < 0.05). A logistic regression was run to analyze features that were significantly associated with female sex.ResultsAmong the recruited 219 BD subjects, 119 (54.3%) were females. Women had a lower scholarity (p = 0.015) and were less frequently employed (p = 0.001). As for psychopathological features, a higher MRS total score (p < 0.001) was detected among women, as well as higher BIS-11 total score (p = 0.040), and briefTEMPS-M score for anxious temperament (p = 0.006). Men showed higher prevalence of DSM-5 mixed features (p = 0.025), particularly during a depressive episode (p = 0.014). Women reported longer duration of untreated illness (DUI) (p < 0.001). There were no sex differences in the Alda Scale total score when considering the whole sample, but this was significantly higher among men (p = 0.030) when evaluating subjects treated with anticonvulsants. At the logistic regression, female sex was positively associated with longer DUI (p < 0.001; OR 1.106, 95% CI 1.050–1.165) and higher MRS total score (p < 0.001; OR 1.085, 95% CI 1.044–1.128) and negatively associated with employment (p = 0.003; OR 0.359, 95% CI 0.185–0.698) and DSM-5 mixed features (p = 0.006; OR 0.391, 95% CI 0.200–0.762).ConclusionsThe clinical presentation of BD may differ depending on sex. The severity of BD should not be neglected among women, who may also display worse treatment response to anticonvulsants.

The results suggest that surgery followed by radiotherapy seems to be the best treatment in the case of locally advanced oropharyngeal tumor.

Resumo O presente artigo tematiza as configurações contemporâneas dos fluxos migratórios internacionais em cenário brasileiro, com ênfase para o estado do Paraná e suas refrações nas políticas sociais, objetivando problematizar as intervenções profissionais junto aos imigrantes, no interior das políticas de seguridade social. Resulta de dados parciais de projeto de pesquisa em curso, contando com a análise de sessenta formulários dirigidos a imigrantes e nove entrevistas com trabalhadores sociais. Os dados têm origem em cinco municípios com maior incidência de imigrantes em uma região metropolitana, no estado do Paraná/Brasil. A análise demonstra incompreensão acerca dos princípios universalidade e equidade na condução das intervenções, ausência de conhecimento aprofundado sobre as configurações territoriais em que se desenvolvem as prestações e de particularidades dos imigrantes, indicando que seu acesso está em construção e necessita não apenas de investimento do Estado, mas também de um compromisso profissional que compreenda os imigrantes como sujeitos singulares.

O objetivo deste estudo bibliográfico é compreender como o Serviço Social tem enfrentado o processo de revisão da formação profissional ofertada para o trabalho em saúde. Inicia pela compreensão do que vem a ser uma profissão em saúde, localizando o Serviço Social e sua vinculação com a área destacando o aspecto formativo. Dessa forma, verifica que é legítima a configuração do Serviço Social como profissão em saúde, tanto do ponto de vista conceitual como do ponto de vista prático, evidenciado pela vinculação histórica da profissão e por sua utilidade social nos serviços de saúde. Ainda, aponta para os desafios da atuação profissional no contexto conflituoso da política de saúde brasileira e suas implicações na formação profissional.