Estágio de terapia ocupacional no programa da saúde da família: reflexões sobre uma parceria didático-assistencial entre o reata/USP e o PSF/QUALIS-SP

Em sintonia com as mais recentes propostas de atenção à saúde e reabilitação das pessoas com deficiência, em 2001, o curso de Terapia Ocupacional, da FMUSP, passou a oferecer um programa de estágio, em parceria com o PSF-Programa da Saúde da Família / QUALIS - Fundação Zerbini, do município de São Paulo - Zona Sudeste, aos alunos dos 7º e 8º semestres. Essa experiência tem proporcionado aos alunos a oportunidade de articular os fundamentos teóricos à atuação prática com a população portadora de deficiência. Os resultados têm sido benéficos tanto para os estudantes, como para a clientela e para a própria academia. Os alunos beneficiam-se de uma formação profissional em saúde pública, na rede de atenção básica, em conjunto com outras equipes (saúde da família, saúde bucal, saúde mental e especialistas). A clientela é beneficiada com atenção focada em suas necessidades, na região de sua moradia, e a academia se enriquece ao permitir uma postura mais crítica frente à estruturação dos estágios, capaz de vislumbrar além dos princípios reducionistas médico-organicistas. De modo a atender os interesses e as necessidades da clientela com deficiência, o estágio da TO, em parceria com o PSF/QUALIS, fundamenta-se nos princípios da inclusão e em ações que buscam o desmonte da exclusão social. As diversas modalidades de atendimento oferecidas são focadas nas necessidades do indivíduo, do grupo e da comunidade, tendo por base o território adstrito. Todas as ações buscam a conquista da autonomia e independência da pessoa com deficiência, através do desenvolvimento de seu poder pessoal para tomar suas próprias decisões e assumir o controle de suas vidas.According to the most recent proposals of health attention and rehabilitation of the disable people, in 2001 the Occupational Therapy course at the Medical School of University of São Paulo started to offer a trainee program, in partnership with PSF - Programa de Saúde da Família /QUALIS (Family Health Care Program /QUALIS) - Zerbini Foundation, of the São Paulo borough - Southeast area, to the students of 7th and 8th semesters. This experience has been proportioning to the students the opportunity to articulate the theoretical foundations with the practical acting with the handicapped population. The results have been beneficial to the students, to the clients and also to the academy. The students benefit from the professional training in public health, in the basic care network, with the other teams (family health care, oral health, mental health and specialists). The clients are benefited from the attention focused on their needs, in the area of their homes and the academy enriches by allowing a critical attitude towards the structure of the trainee program, capable of glimmering beyond the reductionist medical organicist principles. In order to respond to the interests and needs of the disable patients, the Occupational Therapy trainee program, in partnership with PSF - QUALIS, bases on the inclusion principles and on actions that seek the dismantle of the social exclusion. The various kinds of attention offered are focused on the needs of the person, the group and the community, based on the connected territory. All the actions seek the conquest of the autonomy and independence of the handicapped person, through the development of their personal capacity of making their own decisions and assuming their life control

Risedronate prevents persistent bone loss in prostate cancer patients treated with androgen deprivation therapy: Results of a 2-year follow-up study

Androgen deprivation therapy (ADT) for prostate cancer (PCa) causes bone loss. Although we reported previously that risedronate significantly recovers bone mineral density (BMD) for up to 12 months, there have been no reports with longer follow-up periods to date. This study extended our earlier series extending the follow-up period to 24 months. Eligible patients had histologically confirmed PCa without lumbar spine metastasis and underwent ADT. Lumbar spine BMD, urinary deoxypyridinoline (uDPD) and serum bone alkaline phosphatase were measured at 6, 12 and 24 months. Among the total of 96 patients, we analyzed 26 and 18 patients in risedronate administration and control groups, respectively. BMD relative to the young adult mean ratio, uDPD and serum bone alkaline phosphatase of the risedronate administration group recovered significantly after 24 months compared with the control group (P0.0001, P0.0001, and P0.0001, respectively). Transient blurred vision, malaise and vertigo were observed in 1 patient each among the 46 patients treated with risedronate within 28 days after first administration. Oral administration of risedronate is safe and effective for the recovery of ADT-induced bone loss in PCa patients even at 24 months after commencement of treatment. © 2011 Macmillan Publishers Limited All rights reserved

Cranial nerve deficit caused by skull metastasis of prostate cancer: three Japanese castration-resistant prostate cancer cases

金沢大学附属病院泌尿器科We report 3 Japanese patients with cranial nerve deficit caused by skull metastasis of prostate cancer (PCa). Case 1 was a 75-year-old patient with a chief complaint of diplopia. The cause of diplopia was right oculomotor nerve palsy from the skull metastasis. External beam radiation therapy (EBRT) to the whole brain, 40 Gy in 20 fractions, was performed and the diplopia improved. Case 2 was a 72-year-old patient with a chief complaint of facioplegia. Bone scintigraphy and computed tomography (CT) of the head revealed right occipital bone metastasis of PCa resulting in right facial nerve palsy. EBRT to the right occipital bone, 50 Gy in 25 fractions, with daily oral dexamethasone (DEX) was performed and facioplegia showed complete recovery. At 12 months after onset, the patient was followed-up with no symptoms. Case 3 was a 74-year-old patient with a chief complaint of diplopia. Diffusion-weighted magnetic resonance imaging (MRI) and positron emission tomography (PET) showed right petrous bone metastasis resulting in right abducent nerve palsy. EBRT to the right petrous bone, 44 Gy in 22 fractions, with oral DEX was performed and diplopia showed complete recovery. At 13 months after onset, the patient was followed-up with no symptoms. MRI and PET may detect PCa metastasis in the skull base more clearly than other imaging modalities. EBRT with 40-50 Gy in 20-25 fractions in association with corticosteroid administration may be reasonable treatment of patients with metastatic PCa who develop cranial nerve dysfunction. © 2010 Japan Society of Clinical Oncology