Bakgrund: Barns smärtfysiologi och deras reaktioner på smärta skiljer sig från vuxnas. De har inte lika välutvecklad smärtreglering och smärtan är närmare associerad med emotionella upplevelser. Smärta hos barn kan leda till negativa följder och har ett samband med stress, oro och rädsla. Syfte: Att beskriva sjuksköterskans möjligheter att lindra smärta i samband med procedurer hos barn 6-12 år. Metod: En litteraturstudie med systematisk ansats där sökningar gjordes i Cinahl, PubMed och Scopus. Sökorden som användes var: ”treatment related pain”, ”procedural pain”, ”procedure pain”, ”child*” och ”nurs*”. Utvalda artiklar kvalitetsgranskades och analyserades genom kvalitativ innehållsanalys. Resultat: Sjuksköterskan har stora möjligheter att lindra smärtan i samband med procedurer. Resultatet grundas på 18 artiklar med olika ansatser och behandlas i sju teman: avledningsmetoder, avslappning, farmakologisk smärtlindring, ålders inverkan på barns smärtupplevelse, att använda avledning, sjuksköterskans betydelse och delaktighet. Konklusion: Sjuksköterskans bemötande och förhållningsätt spelar stor roll i mötet med barnet och denne kan använda sig själv som ett verktyg för att främja barnets känsla av trygghet och använda sig av avledningsmetoder anpassade till barnets förutsättningar. / Background: Children's physiology of pain, as well as their reaction to it, differs from that of an adult. Their pain modulation is not as developed and pain is more closely associated with emotional experiences. Pain in children can lead to negative consequences and is linked to stress, anxiety and fear. Aim: To describe the nurse’s opportunities to alleviate pain in procedures in children 6-12 years. Method: A literature review with a systematic approach where searches were made in Cinahl, PubMed and Scopus. The search terms used were: ”treatment related pain”, ”procedural pain”, ”procedure pain”, ”child*” and ”nurs*”. Selected articles were examined regarding quality and analysed through qualitative content analysis. Results: The nurse has many opportunities to alleviate pain in procedures. The result is based on 18 articles with different approaches and presented in seven themes: distraction methods, relaxation, pharmacological pain relief, influence of age in children's experience of pain, to use distraction, the importance of the nurse and participation. Conclusion: The nurse's approach makes a difference in the encounter with the child and they can use themselves as a tool to promote the child's feeling of security, aswell as use distraction methods adapted to the child.

L’insécurité routière chez les conducteurs âgés est attribuable en partie, aux effets délétères du vieillissement normal sur le fonctionnement cognitif. Les méthodes d’évaluation neuropsychologique par les tests ayant montré une certaine efficacité dans le cas du dépistage des habiletés de conduite chez les conducteurs âgés atteints d’affections neurologiques pathologiques, la présente thèse vise à évaluer la pertinence de cette approche chez les conducteurs vieillissants de la population générale. Le principal objectif de cette thèse est ainsi d’obtenir une vue d’ensemble sur le rôle et la sensibilité des mesures neuropsychologiques dans la prédiction des habiletés et habitudes de conduite automobile sécuritaire chez les conducteurs âgés. Dans la même perspective, la thèse explore d’autre part le rôle de variables sociodémographiques et psychologiques. L’article 1 évalue la validité prédictive de sept tests des fonctions visuo-attentionnelles et de la mémoire de travail en regard des habiletés de détection périphérique chez 50 conducteurs âgés de 62 à 83 ans. L’étude sur simulateur de conduite comprend une condition de conduite simple et une condition plus soutenue incluant une distraction téléphonique de type « mains-libres ». Selon les résultats, certains tests cognitifs prédisent bien les temps de détection. En outre, la validité prédictive des tests est plus importante dans la situation de conduite plus exigeante. Cela dit, les résultats de l’article 2 révèlent que le recours aux stratégies d’évitement des situations exigeantes est plus prononcé chez les individus qui présentent des faiblesses à certains des tests neuropsychologiques proposés. Les résultats indiquent en outre que l’utilisation des stratégies d’évitement routier est plus fréquente chez les conducteurs ayant tendance à déprécier leurs habiletés de conduite générales, à exprimer une moindre perception de contrôle ainsi qu’une attitude défavorable à l’endroit des situations de conduite complexes ou risquées. Les stratégies d’évitement se révèlent donc comme des réponses autorégulatrices proportionnelles aux limitations cognitives et aux perceptions individuelles. Dans les deux études, l’âge ne permet pas d’expliquer les différences individuelles, ceci ni en termes d’habiletés de détection périphérique ni de tendances autorégulatrices. Le rôle du genre est cependant plus nuancé. Ainsi, le principal apport de la présente thèse réside dans la constatation que si d’une part, certaines limitations neuropsychologiques sont associées à une réduction des habiletés de détection périphérique, ces mêmes limitations s’accompagnent aussi de mesures autorégulatrices qui peuvent contribuer à réduire le risque routier. Il appert conséquemment que les méthodes de dépistage de l’insécurité routière chez les conducteurs âgés se basant sur l’évaluation des limitations cognitives et attentionnelles doivent également rechercher et évaluer la teneur de leurs comportements routiers autorégulateurs. Dans le contexte de vieillissement de la population, des interventions pourront également miser sur le renforcement de ces comportements. / The increase of crash rates in elderly population can be attributed in some part to the effects of normal aging on cognitive functioning. In the other hand, older drivers are likely to adopt self-regulated driving behaviours, such as driving habits to restrict their exposure to less complex situations. Neuropsychological assessments have shown some efficacy in the field of fitness-to-drive screening of older drivers suffering from neurological disorders. This thesis aims to assess the relevance of clinical neuropsychology in screening methods considering older drivers population. The main goal is thus to study the contribution and the sensitivity of neuropsychological testing in the prediction of skills and habits of safe driving among older drivers. In the same vein, the thesis investigates the role of other socio-demographic and psychological variables. To this end, article 1 evaluates the predictive validity of seven tests of visuo-attentional functions and working memory efficiency in relation to peripheral detection task performances in 50 drivers aged from 62 to 83 years in a simulated car driving environment. The driving simulation consisted of a simple driving condition and a condition including a "hands-free" cell phone distraction task. The results indicate that some neuropsychological tests, as opposed to age, are good predictors of detection performances. In addition, the predictive validity of the tests is more important in the most challenging driving condition. The Corsi Block Tapping test, assessing visuospatial working memory, is revealed as on of the best predictor of detection skills. Article 2 was carried from previous neuropsychological testing and self-administered questionnaires related to avoidance driving behaviours, drivers perceptions and attitudes. The results indicate that individuals who show higher difficulties in tests assessing visuospatial working memory, processing speed, and divided and selective attention capacities are significantly more likely to adopt avoidance driving strategies. The results also demonstrate that driving avoidance is higher among drivers who tend to depreciate their general driving skills, to express a lower perception of control and an unfavourable attitude towards risky driving. Avoidance strategies are thus proven to be self-regulatory responses which are proportionate to cognitive limitations and individual perceptions. In summary, this thesis demonstrates that peripheral detection performances of older drivers in a simulated car study, are well reflected in neuropsychological testing assessing working memory and other attentional abilities. Since detection skills are crucial for driving safety, an indirect link can be established between neuropsychological measures and road safety among older drivers. It also seems that those drivers, who have greater cognitive limitations, are more likely to avoid challenging driving situations, thereby balancing their crash risk. It is concluded that fitness-to-drive assessments based on neuropsychological screening need to be complemented with the assessment of self-regulatory behaviors. In the context of an aging population, new interventions should focus on strengthening self-regulatory behaviors of older drivers.

Examensarbetet genomfördes vid Jönköping University i samband med Ljusdesign utbildningen år 2017. Undersökningen avsåg att undersöka trafikmiljön utmed motorvägen mellan Värnamo och Jönköping, för att kunna kartlägga och få en uppfattning av hur effektbelysningen där kan användas med färgat ljus utan att skapa en fara i trafiken. Målet var att undersöka om effektbelysningarna visade en påverkan på bilförarnas upplevelse av motorvägen, samt om färgerna gav en skillnad i upplevelsen eller skapade distraktioner. Området var aktuellt att undersöka eftersom effektbelysningar utmed vägar blir alltmer vanliga efter teknologin inom belysning blivit mer användbar och ekonomiskt försvarbar. Av det skälet blir effektbelysningar av färg vanliga men antas också ge en påverkan i trafiken som vi inte är medvetna om. Studiens frågeställningar formulerades därefter och undersökte hur effektbelysning på objekt påverkar bilförares upplevelse i trafiken. Samt om effektbelysning av färg och neutralt ljus påverkade upplevelsen olika.Fältstudien genomfördes under tre kvällar i mars månad på en bensinstation i anknytning till sträckan som undersöktes. Deltagarna svarade på ett frågeformulär med semantiska skalor där de fyllde i hur de känt sig och upplevt vägsträckan de hade kört. Av deltagarna tillfrågades slumpmässiga uttagna personer om de kunde svara på följdfrågor i form av en intervju. På sträckan fanns sju stycken effektbelysningar varav tre hade färgat ljus. Resultaten visade att effektbelysningen på objekten fångade bilförarnas uppmärksamhet och påverkade bilförarnas upplevelse av vägsträckan. Studien visade även att förarna påverkades olika av effektbelysningarna beroende på om ljussättningen var av färgat eller neutralt ljus. Slutsatserna av undersökningen visar hur förarna i denna studie upplevde sträckan mellan Jönköping och Värnamo. För att konstatera hur belysta objekt generellt påverkar trafiksäkerheten krävs mer forskning. / The thesis was conducted at Jönköping University in conjunction with the lighting design education in year 2017. The study aimed at investigating the traffic environment along the high way between Värnamo and Jönköping in order to map and get an idea of how the effect lighting can be used with colored light without creating a danger to traffic. The aim was to investigate whether the effect lights showed an impact on the driver's perception of the highway, and if the colors gave a difference in the experience or created distractions. The area was relevant to investigate as effect lighting are becoming more common after the technology has become more useful and economically justifiable. For that reason effect lighting with color are becoming more common, but are believed to have an impact on traffic that we are not aware of. The thesis questions were then formulated and investigated how effect lighting on objects affects drivers' experience in traffic. As well as if effect lighting of color and neutral light affect drivers’ experience of the road differently.The field study was conducted for three nights in March at a gas station related to the route that was investigated. Participants answered questions with semantic scales where they answered how they felt and experienced the road. Some of the participants were also randomly picked and asked if they could answer any following questions in the form of an interview.The road that was investigated had seven different effect lightings, witch three of them had colored light. The results showed that the lighting on the objects caught the attention of car drivers and affected the road drivers' experience of the road. The study also showed that the drivers were affected differently by the effect lights depending on whether the lighting was of colored or neutral light. The conclusions of the survey show how the drivers in this study experienced the road between Jönköping and Värnamo. To find out how effect lighting on objects generally affect road safety, more research is required.

O objetivo deste estudo foi investigar o efeito da sobrecarga de leucina no músculo sóleo de ratos submetidos à DGO (Distração Gradual Osteogênica). Vinte e cinco ratos Wistar foram divididos em 5 grupos: controle, sham-lengthening, leucina, DGO e DGO+leucina. A DGO de 2mm/dia foi realizada na tíbia até um ganho de 20% e a sobrecarga de leucina (114mM) foi administrada oralmente. Avaliou-se: estrutura histológica muscular, número de sarcômeros em série, área dos diferentes tipos de fibras musculares e análise do tecido conjuntivo. Os dados obtidos dos cortes histológicos mostram que a DGO promoveu intensa lesão muscular e aumento do tecido conjuntivo, o que foi minimizado pela leucina. Houve uma adição no número de sarcômeros em série (26%) durante a DGO, que foi intensificada pela leucina (33%). Observou-se uma diminuição da área de todos os tipos de fibras com a DGO e um aumento da área das fibras do tipo I com a leucina. Portanto, a leucina minimizou os efeitos causados pela DGO, podendo esta ser utilizada como um agente terapêutico durante a DGO no futuro. / The goal of the present study was to investigate the effect of leucine overload in the rat soleus muscle before and along DGO (Gradual Distraction Osteogenesis). Twenty five male Wistar rats were divided into 5 groups: control, sham-lengthening, leucine, DGO and DGO+leucine. The DGO was 2mm/day and the leucine overload (114mM) was administrated orally. Subsequently analyzed: histological cross-section, sarcomere serial number and cross-sectional area of the types fibers and connective tissue. The histological data showed that the DGO promoted intense injury and increase of connective tissue, which can be minimized by leucine. The sarcomere serial number increased by ~26% and leucine overload increased this gain to 33%. The fibers types showed a decrease of the cross-section area of the all type fibers with the DGO and increase of the type I fibers area with leucine overload. We conclude that leucine overload is a potential therapeutical device in DGO, seeking improvement of skeletal muscle longitudinal growth.

Das Ziel dieser Studie war die Evaluierung zweier radiologischer Methoden zur Belastbarkeitsvorhersage des Regenerates bei einem Verfahren zur Kallusdistration. Im Rahmen einer tierexperimentellen Großtierstudie (Tiermodell Yucatan-Schweine) wurden die DLR und die DFR als Röntgenverfahren zur Dokumentation des zeitlichen Verlaufs der Regeneratkonsolidierung verwendet. Nach Tötung der Tiere erfolgte der Vergleich zwischen den radiologischen Daten und den biomechanisch gemessenen Werten der untersuchten Tibiae (Festigkeit, Steifigkeit). Das Knochengewicht wurde mittels einer Eichkurve in Aluminiumäquivalent EAT umgerechnet. Anhand der EAT-Werte der einzelnen Versuchstage konnte ein Zuwachs an Knochenfestigkeit festgestellt werden. Die Festigkeit des Knochenregenerates wurde nach der Tötung der Tiere biomechanisch bestimmt und daraufhin mit den EAT-Werten des letzten Versuchtages korreliert. Die digitalisierte Filmradiographie zeigte eine Korrelation des EAT-Wertes am letzten Versuchstag mit der torsionalen Steifigkeitsmessung von r=0,71 und mit dem maximalen Drehmoment von r=0,69. Die DLR konnte demgegenüber eine Korrelation des EAT-Wertes der Distraktionszone mit der torsionalen Steifigkeit von r=0,89 ebenso wie mit dem maximalen Drehmoment von r=0,8 nachweisen. Demzufolge ist eine zuverlässige Verlaufsbeurteilung des Knochenregenerates mit der hier eingeführten Dichtemessung möglich. Beide Verfahren sind geeignet, quantitative Aussagen über die Belastbarkeit des Kallusgewebes bei der Distraktionsosteogenese im Tiermodell zu machen. Die Meßungenauigkeit der Methode war vernachlässigbar, die Meßergebnisse waren unabhängig vom Untersucher. Trotz der hohen Genauigkeit dieser Methode im Tiermodell kann noch keine Aussage über die Anwendung der Verfahrens beim Menschen gemacht werden. Daher werden weitere Studien notwendig sein, um hierüber Klarheit zu schaffen. / The aim of the study was an evaluation of two radiologic methods to predict the strength of bone regeneration in distraction osteogenesis. In this animal study the digitized radiography and the digital luminescence radiography were used for the documentation of bone regeneration. After the death of the animals a comparision between radiologic data and biomechanical data of the tibia was performed. The bone mass was determined by a calibration curve in equivalent aluminium thickness (EAT). On the basis of the EAT data of each examination day an increase of the bone strength could be determined. The bone strength was assessed after the sacrification by biomechanical testing and correlated with the radiologic data of the last examination day. The digitized radiography showed a correlation with the torsional stiffness of r=0,71 and with the maximal torsional moment of r=0,69. The digital luminescence radiography showed a correlation with the torsional stiffness of r=0,89 and with the maximal torsional moment of r=0,8. Therefore a reliable bone mass measurement is available by this method. Both radiographic procedures are suitable to predict the strength of bone regeneration in distraction osteogenesis in this experimental animal study. The inaccuracy of the method was negligible and independent to the investigator. But for all that high accuracy of the method a statement concerning the applicability of this method in humans in not possible. Therefore further investigation are neccessary.

Die Auswirkung der systemischen Applikation von 100µg/kg/KG rekombinantem speziesspezifischem Wachstumshormon (GH) über 26 Tage auf den Knochenumbau des Yucatan-Minischweins wurde an Wirbelkörpern, Beckenkämmen und Rippen histomorphometrisch untersucht. Der Einfluss der Distraktionsosteogenese auf die Mineralappositionsrate wurde ermittelt. 24 Tiere wurden an der linken Tibia osteotomiert, ein Fixateur externe wurde zur Distraktionsosteogenese von 2mm/d angelegt. 12 Tiere erhielten Wachstumshormon, 12 Placebo. Eine polychrome Fluoreszenzmarkierung wurde i.v. appliziert. Post mortem wurden Schnitte und Dünnschliffe der genannten Knochen angefertigt. Mittels Bildanalysesystem erfolgte die histomorphometrische Auswertung anhand der Parameter Knochendichte, Porosität, Trabekeldicke, Trabekelumbauparameter und Mineralappositionsrate (MAR). Signifikante Veränderungen durch Wachstumshormongabe konnten gezeigt werden. Unterschiede zwischen den Lokalisationen traten auf. So war die Knochendichte der GH-Tiere an Wirbelkörpern und Rippen signifikant geringer als in der Placebogruppe, kein signifikanter Unterschied zeigte sich am Beckenkamm. An allen 3 Lokalisationen war in der Wachstumshormongruppe eine signifikant erhöhte kortikale Porosität zu finden. Nur am Wirbelkörper waren die trabekuläre Knochendichte und die Trabekeldicke bei den GH-Tieren signifikant geringer als bei den Kontrolltieren. Die Knochenresorption war in der GH-Gruppe am Beckenkamm signifikant erhöht. Die Formation war bei den GH-Tieren sowohl iliakal als auch vertebral signifikant erhöht. Insgesamt ergab sich damit ein signifikant verminderter Anteil an ruhender Oberfläche bei den GH-Tieren. In ihrer Ausprägung waren diese Parameter zwischen Wirbel und Beckenkamm signifikant verschieden. Die MAR war in der GH-Gruppe signifikant höher als in der Placebogruppe, außerdem war sie während der Distraktionsphase signifikant höher als während der Konsolidierungsphase. Vergleicht man die Parameter mit Angaben aus der Literatur, kann bestätigt werden, dass die hier verwendeten Messmethoden geeignet sind, und dass das Yucatan-Minischwein ein geeignetes Modell zur Klärung von Fragestellungen der Knochenbiologie auch im Hinblick auf den Vergleich zum Menschen darstellt. / The effect of systemic application of 100 µg/kg recombinant species specific growth hormone (GH) on the bone remodelling of 24 Yucatan mini pigs for a duration of 26 days was evaluated on vertebral body, iliac crest, and rib. The influence of distraction osteogenesis on the mineral apposition rate (MAR) was examined. 24 animals were osteotomized at the left tibia and treated with an external fixator for distraction osteogenesis of 2 mm/d. 12 of them received GH, the others placebo. A sequential polychrome fluorescent labelling was applied. After sacrifice thin and ground sections were manufactured. Using an image analysis system, a histomorphometrical evaluation was performed by means of bone density, porosity, trabecular thickness, trabecular remodelling parameters, and mineral apposition rate (MAR). Significant changes after GH application were visible. Differences between the locations were found. The bone density of vertebrae and ribs of the treatment group was significantly lower than that of the placebo group, whereas no difference was seen in the iliac crest biopsies. All 3 locations showed a significantly higher cortical porosity in the GH group. The trabecular bone density and the trabecular thickness were significantly decreased only in the vertebral bodies of the treatment group. The bone resorption was significantly elevated in the iliac crests of the GH group. The bone formation was increased in the iliac crest as well as in the vertebrae of the GH treated animals. Therefore, the resting surface was significantly decreased in the GH group. The extent of these effects was significantly different between iliac crest and vertebral body. The MAR was significantly higher in the GH group and during distraction osteogenesis. Compared to results of other study groups these parameters validate the methods of measurement and show that the Yucatan mini pig is a suitable model for research concerning bone biology, especially concerning the comparison with human parameters.

Driving under distraction may lead drivers to wrong actions that can result in serious accidents. The objective of this thesis was to apply a driving simulator to verify variations in drivers\' behavior while driving. Behavior to drive on a curve was measured by variation in drivers\' speed profile in a virtualized highway. The comparison was performed between two identical simulations, one involving drivers distracted with a mental workload, and other in which they were full aware of driving task. 54 volunteer drivers took part in this study, which was divided into 4 stages. 17 drivers performed the distraction test known as PASAT, and results showed that distracted drivers did not recognize the beginning of the curve and drove through it at speeds higher than those when they were fully aware. Moreover, driving performance was increased when drivers were aware of driving, thereby hitting high speeds in tangents, but perceiving curves in advance to reduce acceleration. This study confirms that driving simulators are beneficial in discovering drivers\' behavior exposed to activities that could be highly risky if driving in real situations. / A distração durante a atividade de direção pode levar o condutor de veículos automotores a cometer falhas, que podem ocasionar até mesmo acidentes graves. Este estudo aborda a utilização de simuladores de direção para verificar variações no comportamento de motoristas ao realizar a atividade de direção, distraídos ou com plena atenção na condução do veículo. O comportamento é medido pela variação no perfil de velocidade dos condutores para desenvolver uma curva considerada perigosa em uma rodovia simulada em ambiente virtual. A variação de velocidade deste perfil é comparada entre duas simulações idênticas, onde em uma delas os condutores estão distraídos com um teste que proporciona estresse mental e, na outra, estão com plena atenção à direção. 54 condutores fizeram parte deste estudo dividido em 3 etapas. 17 participantes realizaram o teste de distração conhecido como PASAT, e a análise dos resultados mostram que, distraídos, os condutores não perceberam o início da curva e desenvolveram velocidades maiores durante seu trajeto. Além disso, quando estavam com plena atenção à atividade de direção, o desempenho dos condutores foi melhor, atingindo velocidades maiores nas tangentes, mas percebendo as curvas antecipadamente e reduzindo suas velocidades antes de iniciar esses trechos.

A distração osteogênica tem sido extensamente empregada na correção da grave hipoplasia do terço médio da face de portadores de craniossinostose sindrômica. Contudo, poucos estudos têm apresentado os resultados da distração do terço médio da face através de avaliação cefalométrica. O objetivo do presente estudo foi o de avaliar os resultados obtidos com o avanço ósseo do terço médio da face após osteotomia tipo Le Fort III ou frontofacial em monobloco seguida da utilização de dispositivo rígido externo de distração (RED), em portadores de craniossinostose sindrômica, em termos de quantidade de alongamento ósseo, estabilidade esquelética e crescimento facial. Onze pacientes submetidos aos procedimentos de distração, de fevereiro de 2002 a janeiro de 2006, na unidade de cirurgia plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, foram avaliados retrospectivamente. Seis pacientes eram portadores da síndrome de Crouzon, quatro da síndrome de Apert, e um da síndrome de Saethre-Chotzen. Onze pacientes foram submetidos ao procedimento de alongamento ósseo do terço médio da face através do uso de dispositivo externo rígido (RED), após osteotomias tipo Le Fort III (N = 4) ou frontofacial monobloco (N = 7). Foram avaliadas retrospectivamente três telerradiografias de face em norma lateral de cada paciente (T1- préoperatório; T2 - pós-operatório recente, logo após a remoção do distrator; T3 - pós-operatório tardio, obtida com um intervalo mínimo de 12 meses após cirurgia). Três cefalogramas foram obtidos de cada paciente, através da direta sobreposição das três telerradiografias, tomado como referência reparos anatômicos do crânio e da porção anterior da fossa craniana. Desta forma, os três traçados cefalométricos foram obtidos no mesmo papel acetato, o qual foi digitalizado. Utilizando o programa de computação gráfica de domínio público Image J, várias mensurações foram realizadas com a intenção de determinar a extensão do avanço sofrido pelos segmentos ósseos na direção do vetor do movimento esquelético, assim como de seus componentes horizontal e vertical, tomando como referência pontos A e orbitário. Pacientes foram ainda divididos em dois grupos (G 1 - pacientes submetidos à osteotomia tipo Le Fort III; G 2 - pacientes submetidos à osteotomia frontofacial em monobloco), e os dados obtidos a partir mensurações de ambos os grupos foram comparados. Avanço significativo do terço médio da face foi obtido com os procedimentos. O componente horizontal do movimento esquelético predominou ao componente vertical. A taxa de reposicionamento posterior horizontal tardio (perda de resultado) foi mínima. Quando comparados os dois procedimentos, foi observada uma diferença significativa entre os grupos Le Fort III e monobloco. A quantidade de avanço obtido foi maior no grupo monobloco que no grupo Le Fort III. Em termos perda de resultado, o grupo Le Fort III foi mais estável que o grupo monobloco. Foi observada uma evidente alteração vertical no posicionamento dos pontos de referência no pós-operatório tardio, se comparado ao pós-operatório recente, evidenciando crescimento na vertical da face, ao contrário do que ocorre na direção horizontal, onde existiu um pequeno reposicionamento posterior e nenhuma evidência de crescimento. / Distraction osteogenesis has been applied extensively to correct the severe midface hipoplasia in syndromic craniosynostosis patients. However few studies have reported midface distraction outcomes through cephalometric evaluation. The purpose of the present study was to evaluate outcomes with midface distraction after Le Fort III and frontofacial monobloc osteotomy using a rigid external device (RED) in patients with syndromic craniosynostosis, in terms of quantity of bone lengthening, skeletal stability and facial growth. Eleven patients underwent to midface distraction from February of 2002 to January of 2006 at the plastic surgery unit of The \'Hospital das Clínicas\' of the Medical School of The University of São Paulo were retrospectively evaluated. Six patients had Crouzon, four had Apert, and one had Saethre-Chotzen syndrome. The patients were submit to bone lengthening procedure of the midface using a rigid external device (RED) after osteotomy type Le Fort III (n=4) and frontofacial monobloc osteotomy (n=7). Three teleradiography were retrospectively evaluated of each patient (T1 - before surgery; T2- after surgery, rigth after distractor removal; T3 - after surgery, obtained with a minimal interval of 12 months after surgery). The three lateral cephalograms were obtained from each patient by direct teleradiography superimposition taken as references the anatomic repairs in the cranium and anterior skull base. This way the three cephalometric tracings were obtained in the same acetate paper which was digitalized. Utilizing a public domain program Image J, various mensurations were accomplished with intension of determine the extent of advancement suffered by the bone segments in the direction of vector skeletal movement and its horizontal and vertical components as well, as taken as references point A and orbitale. Patients still were divided between two groups (G 1- patients submitted to an osteotomy type Le Fort III; G 2- patients submitted to monobloc frontofacial osteotomy), and the data obtained from mensurations from both groups were compared. Significant midface advancement was achieved with the procedures. The horizontal component of the movement was predominant if compared to vertical. The rate of horizontal relapse was minimal. When compared the two procedures was noted a significant difference between Le Fort III and monobloc groups. The advancement rate was greater in monobloc than Le Fort III group. In terms of relapse Le Fort III group was more stable than monobloc group. In vertical direction was noted an evident altered position of the reference points at late postoperative period if compared with recent postoperative period given evidence of facial vertical direction growth, contrary from what occurred in horizontal direction where existed a small relapse and no growth.

Background: Infant immunization pain is not currently well managed despite effective strategies. Objective: To determine the effectiveness of tactile stimulation when added to a combination of pain-reducing interventions in infants undergoing immunization. Methods: Healthy infants aged 4-6 months undergoing immunization in primary care were randomized to tactile stimulation or usual care. All infants also received pain-relieving interventions. A validated measure of acute pain in infants, the Modified Behavioral Pain Scale (MBPS), was the primary outcome. Results: Altogether, 120 infants participated. Characteristics did not differ (p > 0.05) between those allocated to tactile stimulation and usual care groups. Mean MBPS pain scores did not differ between groups: 8.2 (1.1) vs. 8.0 (1.3); p = 0.57, respectively. Conclusions: Parent-led tactile stimulation did not improve pain relief in infants when added to other interventions. Parental attention could have been focused on tactile stimulation, preventing parents from performing appropriate soothing activities. Additional investigation of the effectiveness of clinician-led tactile stimulation is recommended.

Background: Infant immunization pain is not currently well managed despite effective strategies. Objective: To determine the effectiveness of tactile stimulation when added to a combination of pain-reducing interventions in infants undergoing immunization. Methods: Healthy infants aged 4-6 months undergoing immunization in primary care were randomized to tactile stimulation or usual care. All infants also received pain-relieving interventions. A validated measure of acute pain in infants, the Modified Behavioral Pain Scale (MBPS), was the primary outcome. Results: Altogether, 120 infants participated. Characteristics did not differ (p > 0.05) between those allocated to tactile stimulation and usual care groups. Mean MBPS pain scores did not differ between groups: 8.2 (1.1) vs. 8.0 (1.3); p = 0.57, respectively. Conclusions: Parent-led tactile stimulation did not improve pain relief in infants when added to other interventions. Parental attention could have been focused on tactile stimulation, preventing parents from performing appropriate soothing activities. Additional investigation of the effectiveness of clinician-led tactile stimulation is recommended.