The goal of this prospective randomized clinical trial was to compare 2 cohorts of standardized cleft patients with regard to functional speech outcome and the presence or absence of palatal fistulae. The 2 cohorts are randomized to undergo either a conventional von Langenbeck repair with intravelar velarplasty or the double-opposing Z-plasty Furlow procedure. A prospective 2 × 2 × 2 factorial clinical trial was used in which each subject was randomly assigned to 1 of 8 different groups: 1 of 2 different lip repairs (Spina vs. Millard), 1 of 2 different palatal repair (von Langenbeck vs. Furlow), and 1 of 2 different ages at time of palatal surgery (9-12 months vs. 15-18 months). All surgeries were performed by the same 4 surgeons. A cul-de-sac test of hypernasality and a mirror test of nasal air emission were selected as primary outcome measures for velopharyngeal function. Both a surgeon and speech pathologist examined patients for the presence of palatal fistulae. In this study, the Furlow double-opposing Z-palatoplasty resulted in significantly better velopharyngeal function for speech than the von Langenbeck procedure as determined by the perceptual cul-de-sac test of hypernasality. Fistula occurrence was significantly higher for the Furlow procedure than for the von Langenbeck. Fistulas were more likely to occur in patients with wider clefts and when relaxing incisions were not used.

Este estudo clínico randomizado objetivou avaliar os níveis de estresse na equipe de Enfermagem de um hospital e analisar a efetividade da auriculoterapia com agulhas e sementes. 75 pessoas com escores médio (44/58,7%) e alto (31/41,3%) de acordo com a Lista de Sintomas de Estresse foram divididas em grupos (controle, agulhas e sementes), que receberam oito sessões nos pontos Shenmen, Rim e Tronco Cerebral e foram avaliados no início, com quatro, oito sessões e follow-up (15 dias). Na análise de variância (ANOVA), constataram-se diferenças entre os grupos, na 3ª avaliação (F=3,963/P=0,023) e follow-up (F=6,136/P=0,003). Tais diferenças foram entre o grupo controle e agulha. Os grupos de intervenção mostraram diferenças (P<0,05) a partir da segunda avaliação, quando comparados dentro do mesmo grupo. Concluiu-se que a auriculoterapia reduziu o estresse em profissionais de enfermagem, com melhores resultados para agulhas do que sementes, em escores altos, com manutenção de efeitos por 15 dias.

Objective Cleft palate increases the risk of chronic middle ear disease and hearing loss. The goal of this report was to determine which of two palate surgeries and which timing of palate surgery were associated with better otologic and audiologic outcomes in children with unilateral cleft lip and palate at 5 to 6 years of age. Design Subjects were randomly assigned to the von Langenbeck with intravelar veloplasty or Furlow palate repair, to palate surgery at 9 to 12 months or 15 to 18 months of age, and to the Spina or Millard lip repair. Setting Centralized, tertiary care craniofacial treatment center. Patients A total of 673 infants with unilateral cleft lip and palate. Interventions Palate and lip were repaired using established techniques. Serial otoscopic and audiometric evaluations were performed. Main Outcome Measures Hearing and otoscopic findings at 5 to 6 years old. Results There were 370 children available for analysis. Hearing and need for tympanostomy tube placement did not differ by palatoplasty, age at palatoplasty, cheiloplasty, or surgeon. Risk of developing cholesteatoma or perforation was higher with Millard cheiloplasty (odds ratio = 5.1, 95% confidence interval = 1.44 to 18.11, p = .012). Type and age at palatoplasty were not significantly associated with either the rate of developing these sequelae or the rate of achieving bilaterally normal hearing and ear examinations. Conclusions Type of palatoplasty did not influence otologic and audiologic outcomes in 5- to 6-year-olds with unilateral cleft lip and palate. The potential influence of lip repair on otologic outcomes warrants further investigation.

Objective To study the growth of children with complete unilateral cleft lip and palate (UCLP) from birth to 2 years of age and to construct specific UCLP growth curves. Design Physical growth was a secondary outcome measure of a NIH sponsored longitudinal, prospective clinical trial involving the University of Florida (USA) and the University of São Paulo (Brazil). Patients 627 children with UCLP, nonsyndromic, both genders. Methods Length, weight, and head circumference were prospectively measured for a group of children enrolled in a clinical trial. Median growth curves for the 3 parameters (length, weight, head circumference) were performed and compared to the median for the National Center for Health Statistics (NCHS, 2000) curves. The median values for length, weight, and head circumference at birth, 6, 12, 18 and 24 month of age were plotted against NCHS median values, and statistically compared at birth and 24 months. Setting Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, Brazil (HRAC-USP). Results At birth, children of both genders with UCLP presented with smaller body dimensions in relation to NCHS median values, but the results suggest a “catch up growth” for length, weight, and head circumference for girls and for weight (to some degree) and head circumference for boys. Conclusions Weight was the most compromised parameter for both genders followed by length and then head circumference. There was no evidence of short statue. This study established growth curves for children with UCLP.

Objective-To study the growth of children with complete unilateral cleft lip and palate (UCLP) from birth to 2 years of age and to construct specific UCLP growth curves.Design-Physical growth was a secondary outcome measure of a NIH sponsored longitudinal, prospective clinical trial involving the University of Florida (USA) and the University of São Paulo (Brazil).Patients-627 children with UCLP, nonsyndromic, both genders.Methods-Length, weight, and head circumference were prospectively measured for a group of children enrolled in a clinical trial. Median growth curves for the 3 parameters (length, weight, head circumference) were performed and compared to the median for the National Center for Health Statistics (NCHS, 2000) curves. The median values for length, weight, and head circumference at birth, 6, 12, 18 and 24 month of age were plotted against NCHS median values, and statistically compared at birth and 24 months. Results-At birth, children of both genders with UCLP presented with smaller body dimensions in relation to NCHS median values, but the results suggest a "catch up growth" for length, weight, and head circumference for girls and for weight (to some degree) and head circumference for boys. Setting-HospitalConclusions-Weight was the most compromised parameter for both genders followed by length and then head circumference. There was no evidence of short statue. This study established growth curves for children with UCLP. Many physical growth studies of children with CLP have been published (Bowers et al., 1987;Felix-Schollaart et al., 1992;Ross and Jhonston, 1972; Cunninghan and Jerome, 1997;Becker et al., 1998; Montagnoli et al., 2005, Gopinath andMuda, 2005). Although the results vary between different investigators, most of them state that these children are smaller and lighter than the control subjects, mainly during the first years of age. A catch up growth may occur later in childhood (Ross and Jhonston, 1972; Lee et al., 1996). KeywordsMany factors such as feeding problems and recurrent respiratory infections have been suggested to negatively impact normal growth. Reports indicate that growth problems are more severe in early infancy and are more frequent in children with isolated cleft palate (ICP), and cleft lip and palate (CLP), than in children with isolated cleft lip or normal (unaffected) children (Felix-Schollaart et al., 1992; Lee et al., 1996, Montagnoli et al., 2005.The limitations of previous growth studies include relatively small number of children included in their sample, possible inclusion of children with chronic health conditions and syndromes, and inclusion of different types of clefts or age ranges. Most studies were retrospective.This article is part of a series of studies that summarize an eleven-year prospective randomized clinical trial. The objective of this paper was to analyze the physical growth of the large sample of nonsyndromic children with unilateral cleft lip and palate (UCLP), from birth to two years of age, according to gender, in a longitudinal...

Resumo: O trabalho pode ser ao mesmo tempo gerador de prazer e de sofrimento, e é nas situações vivenciadas no cotidiano que o sofrimento e o prazer podem ser apreendidos. O objetivo desta pesquisa é identificar a percepção da relação sofrimento/prazer no trabalho de auxiliares e técnicos de enfermagem que atuam há 05 anos em prestadoras de serviço de internação domiciliária no município de São Paulo. Trata-se de um estudo de caso em que os discursos foram obtidos por meio de entrevista semi-estruturada dos sujeitos técnicos e auxiliares de enfermagem que trabalham em organizações estruturadas de assistência domiciliária. Para a apreensão das categorias empíricas da fala do indivíduo utilizou-se a análise de conteúdo proposta por Bardin, A percepção dos sujeitos foi agrupada em sete categorias empíricas: sofrimento e prazer, satisfação no trabalho de assistência domiciliária, situações prazerosas, o não reconhecimento pelo trabalho realizado, trabalho solitário, adaptação ao paciente e à família e estresse. As situações de sofrimento são equilibradas pelo retorno imediato do reconhecimento e valorização de seu papel proporcionando-lhe prazer na realização de seu trabalho. O relacionamento profissional-pacientefamília suscita satisfação e sofrimento psíquico. PALAVRAS CHAVES:Trabalho de enfermagem. Assistência domiciliária. Sofrimento psíquico. Saúde mental do trabalhador. INTRODUÇÃOO trabalho tem sido objeto de investigação por vários estudiosos e em muitas abordagens. Uma delas é a possibilidade de ser gerador, ao mesmo tempo, de sofrimento e de prazer. Esses fatores estão relacionados à sua forma de organização e a condição oferecida para a execução das tarefas. É no cotidiano do trabalho, nas situações vivenciadas durante a sua realização, que sofrimento e o prazer podem ser apreendidos.O trabalhar é um ato imprescindível para as pessoas, mesmo que parcelado e especializado, pois se refere à sobrevivência e condicionamento 73

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Background: The evaluation of surgical outcomes is needed to achieve excellence in nasal reconstruction of patients with complete bilateral cleft lip and palate (BCLP). The study objective is to evaluate the quality of nasal aesthetics after the columella elongation surgery. Methods: The sample of this study consisted of 70 patients with complete BCLP, operated on columella elongation surgery and analyzed at 6 to 12 years. The system for evaluation of nasal appearance after the columella elongation surgery was performed by objective and subjective analyses. Anthropometric Measurements: Four anthropometric nose measurements were performed directly on the faces, and the same was performed in control group (60 children without oral clefts), paired by age and sex with the experimental group. The measurements were repeated 3 times (triplicate). Subjective Analysis: Scores to evaluate nasal width, nasal tip projection, and length of the columella were applied before and after the columella elongation surgery by 5 raters from the rehabilitation team. Interrater and intrarater agreement was calculated by means of the kappa test. Results: Nasal width in BCLP group was higher when compared to the control group ( P < 0.05). Nasal tip projection (subnasal–pronasal) and columella length (subnasal–columella) were decreased in BCLP group compared to that of the controls ( P < 0.05). Columella width was similar in both study groups ( P > 0.05). All scores of nasal aesthetics significantly improved after the columella elongation surgery. Conclusions: Nose of the patients with BCLP is wider, is less projected, and has the shorter columella compared to that of the noncleft subjects. After secondary columella elongation surgery in BCLP, nasal width, nasal projection, and columella length significantly improved.