Avian leukosis virus (ALV)-induced osteopetrosis is a proliferative disorder of the bone affecting the growth and differentiation of osteoblasts. Osteopetrosis is a polyclonal disease in which cells of the bone contain, on average, multiple viral DNA copies. Osteopetrotic bone is also characterized by the accumulation of unintegrated viral DNA, suggesting an atypical life cycle of the virus in the infected osteoblasts. To better understand virus-host interactions in the induction of osteopetrosis by ALVs, infected chick osteoblast cultures and osteopetrotic bone were examined for aspects of the virus life cycle and effects of infection on osteoblast function. Levels of infection and virus expression were compared in cultured osteoblasts and osteopetrotic bone. Osteopetrotic bone contained higher levels of viral DNA and correspondingly higher levels of viral proteins than infected osteoblast cultures, suggesting a higher viral load in the diseased bone. A significant level of mature Gag protein was present in the bone, suggesting the accumulation of mature virus particles in the diseased bone. It is possible that the accumulation of virus could facilitate the high levels of infection observed in the diseased bone. The mechanism by which unintegrated viral DNA persisted in osteopetrotic bone was investigated by examining the susceptibility of infected osteoblasts to superinfection. The results indicated that, in culture, infected osteoblasts were able to establish interference to superinfection. This suggests that the persistence of unintegrated viral DNA in osteopetrotic bone may not result from the continuing infection of productively infected osteoblasts. The effect of virus infection on osteoblast function was examined in the diseased bone and in osteoblast cultures. In infected chickens, osteoblast activity, as evidenced by the expression of osteoblast phenotypic markers, was increased only in chickens developing severe osteopetrosis. In culture, virus infection had no apparent effect on either the proliferation or differentiation of osteoblasts. This indicates that infection was itself not sufficient to perturb osteoblast function. Furthermore, it suggested that additional components of the bone may be required for ALV infection to induce the abnormal activity of osteoblasts observed in osteopetrosis.

Introduction First described in 2002, osteonecrosis of the jaw (ONJ, or avascular necrosis of the jaw) is an uncommon but potentially serious side effect of treatment with bisphosphonates. Although typically identified in patients with multiple myeloma and other malignancies, a few cases have been reported in patients taking bisphosphonates - a potent drug class used in the treatment of osteoclast-mediated bone resorption issues, including postmenopausal osteoporosis, Paget's disease, multiple myeloma, and malignant hypercalcemia. The clinical diagnosis of ONJ can be obscured by jaw pain, abscess, swelling, and fistulas, but exposed bone is a distinctive sign. This reports a case of ONJ secondary to bisphosphonate use in a 65-year-old woman and clinical management complications. Case Presentation A 65-year-old lady with history of age-related osteoporosis and compression fractures on alendronate for 4 years, squamous cell carcinoma of neck status post excision and radiotherapy 11-years prior, Sjogren's syndrome and discoid lupus on hydroxychloroquine, diabetes, hypertension, stroke and multiple dental abscesses presents with persistent neck pain. Initial CT neck with contrast showed diffuse fat stranding. Subsequently, alendronate was discontinued due to jaw necrosis suspicion. Eight months later, repeat CT scan showed new non-mass-like soft tissue thickening in the subcutaneous fat abutting the right anterior mandible with mandibular teeth cavities and periapical lucencies, likely to be periodontal cellulitis versus radiation osteonecrosis. Later, patient complained of a piece of bone penetrating the skin of her chin and presented with continuous drainage from sinus tract in her mandible, which was diagnosed as osteonecrosis attributed to bisphosphonates, previous radiation therapy, and dental abscesses. Patient was started on abaloparatide, an osteo-anabolic medication for osteoporosis and enrolled in hyperbaric oxygen therapy which immensely helped in controlling sinus drainage. Patient is currently awaiting mandibular reconstruction surgery. Discussion ONJ, often associated with pain, swelling, exposed bone, local infection, and pathologic fracture of the jaw, is a rare complication of bisphosphonate therapy. Currently, no prospective data exists to advise the benefits of therapy discontinuation however most clinical practices tend to discontinue at least temporarily. The incidence increases with longer treatment duration, particularly when therapy exceeds four years. Risk factors for developing ONJ while taking bisphosphonates include IV administration, anticancer therapy, dose and duration of exposure, dental extractions/implants, glucocorticoids, smoking, diabetes, and preexisting dental disease. Case reports and series suggest benefit from hyperbaric oxygen therapy in wound healing, pain, and quality of life at three months, however no significant differences exist with outcomes beyond three months. Patients being considered for therapy with a bisphosphonate should be thoroughly evaluated for dental issues, prior to initiating therapy. Conservative management with limited debridement, antibiotic therapy as needed, and topical mouth rinses rather than aggressive surgical resection are recommended. Conservative therapy may result in healing in a significant proportion of patients. Surgical resection of necrotic bone should be reserved for refractory or advanced cases. Providers should remain cautious while prescribing high doses of bisphosphonates in patients with increased risk factors to prevent, timely diagnose and treat this condition. References Edwards BJ, Gounder M, McKoy JM, et al. Pharmacovigilance and reporting oversight in US FDA fast-track process: bisphosphonates and osteonecrosis of the jaw. Lancet Oncol 2008; 9:1166. Khosla S, Burr D, Cauley J, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2007; 22:1479. Hoff AO, Toth BB, Altundag K, et al. Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res 2008; 23:826.

Background:Lower back pain is one of the most common health-related complaints in the adult population. Thirty percent of Americans 65 years and older reported symptoms of lower back pain in 2004. With an aging population, the proportion of people over the age of 65 is expected to reach 20% by the year 2030. Because of this increase in older adults, lumbar spinal stenosis (LSS) associated with arthritic changes will also likely increase. In older adults, lower back pain is most often caused by degenerative lumbar spinal stenosis. Stenosis is the narrowing ofthe spinal canal, causing pressure on the nerve roots and is frequently treated surgically. Lumbar spinal stenosis is one of the most common reasons for back surgery in patients 65 years and older 2. However, risks associated with surgery increase with age 3-5 and older patients may choose non-surgical treatment for their lower back pain, including injection treatment. Injection treatment, usually consisting of anti-inflammatory medications and analgesics, has improved since the mid-1990's when fluoroscopic guidance was developed. Information about injection treatment for lower back pain is limited, especially in the older population. An extensive review of published literature regarding injection treatment revealed a paucity of information about older adults diagnosed with lumbar spinal stenosis. In this study, three aims were designed to gain more information about the effectiveness of injection treatment in older patients with lumbar spinal stenosis. In the first (retrospective) study, information about receipt of second injections and time between injections was collected to examine injection usage. In the second and third (prospective) studies, information about pain relief and functional return following injection treatment was collected to examine the effectiveness of injection treatment in patients age 60 and older diagnosed with lumbar spinal stenosis. To our knowledge, such results have not been repolted for this population in the literature. Objective:Injection treatment is a commonly used non-surgical procedure to alleviate lower back pain in older adults. However, older patients do not have enough information about how long pain relief will last after treatment or the amount of pain relief and functional return they will experience. These studies focused on three topics: 1) usage of injection treatment; 2) effectiveness of injection treatment on pain relief; 3) effectiveness of injection treatment on functional return. In addition, the variations of the effectiveness were examined by selected patient attributes. Methods:In a retrospective study, medical records of patients aged 60 years or older from a high volume dedicated spine center at the University of Massachusetts Memorial Hospital were retrospectively reviewed. This study included those diagnosed with degenerative LSS, who had not received an injection for lower back pain within six months, and whom were treated between June I, 2006 and May 31, 2007. In two prospective studies, patients scheduled for lumbar injection treatment between January 1 and June 30, 2008 were selected from the University of Massachusetts Memorial Hospital Spine Center. Selection criteria included patients age 60 and over, diagnosed with degenerative lumbar spinal stenosis and no previous lumbar injection within 6 months or lumbar surgery within 2 years. The Pain sub-score of the SF-36 questionnaire was used to measure pain at baseline and at one and three months post injection. The Physical Component Score (PCS) of the SF-36 questionnaire and the Oswestry Disability Index (ODI) were used to measure function at baseline and at one and three months post injection. Variations in longitudinal changes in scores by patient characteristics were analyzed in both unadjusted (univariate) analyses using one-way analysis of variance (ANOVA), and adjusted (multiple regression) analyses using linear mixed effects models. Results: In the retrospective cohort, the mean age of the cohort was 68, 64% were female, 59% were married, with a mean Body Mass index of 32 kg/m2. Of 92 eligible patients, 57% returned for a second injection within six months of the first. The mean number of months between injections was 4.8 for all patients, ranging from 1 to 22 months. When patient characteristics were examined, the only variable that showed a statistically significant difference was age. Patients aged 70 years and older were found to be 67% less likely to return for a second injection when compared to patients age 60-69 (OR=0.33 (0.12 - 0.94)p In the prospective cohort, information was collected on 62 patients. Mean Pain scores improved significantly from baseline to one month (14.1 points), and from baseline to three months (8.3 points). Post injection changes in Pain scores varied by Body Mass Index (BMI) and baseline emotional health. Based on a linear mixed effects model analysis, higher baseline emotional health, as measured by the SF-36 Mental Component Score (MCS>50), was associated with greater reduction in pain over three months when compared to lower emotional health (MCS Conclusion: Patients over age 70 do not return for repeat injection as frequently as patients age 60-69. In addition, each year a patient ages over age 60, they are 10% less likely to return for a repeat injection. Lower back pain in older adults with LSS is clinically significantly alleviated after injection treatment. In addition, injection treatment for LSS is associated with return of lost function needed for daily living activities in older adults. Pain relief and functional return varies by patient personal and clinical characteristics. Higher emotional health was associated with more pain relief and more functional return experienced over three months following injection treatment. Additional information is needed about why older patients do not return for second injections at the same rate as younger patients and how emotional health affects response to injection treatment in older adults.

The Runx family of transcription factors supports cell fate determination, cell cycle regulation, global protein synthesis control, and genetic as well as epigenetic regulation of target genes. Runx1, which is essential for hematopoiesis; Runx2, which is required for osteoblast differentiation; and Runx3, which is involved in neurologic and gut development; are expressed in the growth plate during chondrocyte maturation, and in the chondrocytes of permanent cartilage structures. While Runx2 is known to control genes that contribute to chondrocyte hypertrophy, the functions of Runx1 and Runx3 during chondrogenesis and in cartilage tissue have been less well studied. The goals of this project were to characterize expression of Runx proteins in articular cartilage and differentiating chondrocytes and to determine the contribution of Runx1 to osteoarthritis (OA). Here, the expression pattern of Runx1 and Runx2 was characterized in normal bovine articular cartilage. Runx2 is expressed at higher levels in deep zone chondrocytes, while Runx1 is primarily expressed in superficial zone chondrocytes, which is the single cell layer that lines the surface of articular cartilage. Based on this finding, the hypothesis was tested that Runx1 is involved in osteoarthritis, which is a disease characterized by degradation of articular cartilage and changes in chondrocytes. These studies showed that Runx1 is upregulated in articular cartilage explants in response to mechanical compression. Runx1 was also expressed in chondrocytes found at the periphery of OA lesions in the articular cartilage of mice that underwent an OA-inducing surgery. Runx1 was also upregulated in cartilage explants of human osteoarthritic knees, and IHC data showed that Runx1 is mainly expressed in chondrocyte “clones” characteristic of OA. To ascertain the potential function of the upregulation of Runx1 in these cartilage stress conditions and disease states, the hypothesis was tested that Runx1 is upregulated in very specific chondrocyte populations in response to the cartilage damage in osteoarthritis. These studies addressed the properties of these cells that related to functions in cell growth and differentiation. In both the surface layer of normal articular cartilage, and in OA cartilage, Runx1 expression by IF co-localized with markers of mesenchymal progenitor cells, as well as markers of proliferation Ki-67 and PCNA. This finding indicated that Runx1 is found in a population of cells that represent a proliferative population of mesenchymal progenitor cells in osteoarthritis. To further address Runx1 function and identify downstream targets of Runx proteins, a promoter analysis of genes that are known to be either downregulated or upregulated during chondrocyte maturation was done. These studies found that many of these genes have 1 or more Runx binding sites within 2kb of their transcription start site, indicating that they are potential downstream Runx target genes. Lastly, some preliminary experiments were done to characterize novel roles of Runx proteins in the chondrocyte. Runx proteins have been shown to epigenetically regulate their target genes by remaining bound to them throughout mitosis, “poising” them for transcription upon exit from mitosis. The hypothesis that Runx proteins also function by remaining bound to their target genes throughout mitosis in chondrocytes was tested. It was demonstrated by immunofluorescense imaging of Runx proteins on metaphase chromosomes of ATDC5 cells, that Runx2 remains bound to chromosomes during mitosis. Cell proliferation and hypertrophy are both linked to increases in protein synthesis. Runx factors, which regulate rates of global protein synthesis, are expressed in both proliferating and hypertrophic chondrocytes. Thus, it was hypothesized that Runx proteins regulate rates of global protein synthesis during chondrocyte maturation. These studies showed that the overexpression of Runx proteins in a chondrocyte cell line (ATDC5) did not affect protein synthesis rates or levels of protein synthesis machinery. Additionally, Runx proteins did not affect proliferation rates in this chondrocyte cell line.

Osteoarthritis (OA), a degenerative disease of articular joints, is the leading cause of chronic disability in the US and affects more than a third of adults over 65 years old. Due to the obesity epidemic and an aging population, the prevalence of OA is expected to rise in both young and old adults. There are no disease modifying OA drugs. Therefore, providing any treatment options that delay the onset or progression of OA is highly desirable. The scope of this dissertation examines two different strategies to promote translational therapies for OA. The first approach investigated whether Smad ubiquitin regulatory factor 2 (Smurf2), an E3 ubiquitin ligase, could be a potential therapeutic target for OA. The second approach examined the incorporation of small chemical residues to enhance the physical and bioactivity of a bioinert scaffold for cartilage tissue repair. Overexpression of Smurf2 in chondrocytes was shown to accelerate spontaneous OA development in mice. We hypothesized that reduced Smurf2 expression could slow the progression of OA and enhance the performance of cells for cartilage repair. By performing surgical destabilization of the medial meniscus (DMM) on Smurf2-deficient mice, loss of Smurf2 was shown to mitigate OA changes in young mice but this protection diminished in older mice. Assessment of Smurf2-deficient chondrocytes in vitro revealed an upregulation of chondrogenic genes compared to wild-type; however, these differences were not seen at the protein level, deterring its potential use for cell-based therapies. During the course of this study, new insights about how age and sex affects different joint compartments in response to DMM surgery were also uncovered. These results broadened existing understanding of DMM-induced OA in mice but also questioned the validity of such a model to identify disease modifying targets that are translatable to OA in humans with advanced age. Due to a lack of innate repair mechanisms in cartilage, damage to cartilage increases the risk of developing OA early. Tissue engineering provides a unique strategy for repairing damaged cartilage by delivering cells in a well-controlled environment that can promote the formation of neotissue. We hypothesized that synthetic chemical residues could enhance the mechanical properties of a bioinert scaffold and promote matrix production of encapsulated chondrocytes. Covalent incorporation of small anionic or zwitterionic chemical residues in a polyethylene glycol-based hydrogel improved its stiffness and resistance to fluid flow, however, the resulting physical environment can also exert a dominant negative effect on matrix production of encapsulated chondrocytes. These results suggest that modulating the biosynthesis of chondrocytes with biochemical signals requires a concurrent reduction in any conflicting mechanotransduction signaling, emphasizing the importance of a degradable system to promote new cartilage formation. In summary, this dissertation establishes Smurf2 as a modulator of OA progression but implies that other factors such as age or protein(s) with redundant Smurf2 functions may play a role in limiting its effect as a therapeutic target. This work also reveals fundamental biology about how chondrocytes behave in response to physical and chemical cues in their microenvironment, which will aid in the design of better scaffolds for cartilage tissue engineering.

CLP is a complex condition and can have a far-reaching impact on an individual. Collaboration between the school-based SLP and the CLP team will ensure holistic treatment for the child. A paucity of literature exists regarding school-based SLP’s referrals to cleft palate teams. This research describes and explores the referral practices of school-based SLP’s to CLP teams.Learner Outcome(s): Participants will be able to identify and describe the best practices of school-based SLPs making referrals to cleft palate teams Participants will be able to list the potential barriers in providing services and referrals for children with CLP and VPD in school systems Participants will be able to describe the advantages of collaboration between school-based SLPs and CLP teams in the appropriate care of children with CLP and VPD

Objetivo: Comparar a sobrecarga no sistema musculoesquelético e na qualidade de vida de trabalhadores em turnos fixos matutinos, vespertinos e noturnos. Métodos: A amostra deste estudo foi composta de 254 trabalhadores de uma empresa ligada ao setor automotivo. As coletas foram realizadas em uma cidade brasileira de médio porte no ano de 2011. Os trabalhadores foram divididos em grupos de turnos: G1. 87 Trabalhadores do Turno Matutino (6:00 - 14:00); G2. 87 Trabalhadores do Turno Vespertino (14:00 - 22:00); G3. 80 Trabalhadores do Turno Noturno (22:00 - 6:00). Foram aplicados os seguintes instrumentos: Questionário Sociodemográfico, Questionário Nórdico de Sintomas Musculoesqueléticos e Questionário de Qualidade de Vida SF-36. Foi estimada a prevalência, com respectivo intervalo de 95% de confiança, para as queixas músculoesqueléticas. Análises bivariadas foram usadas para identificar possíveis associações entre as queixas musculoesqueléticas e as variáveis independentes. Resultados: Analisando o odds ratio da ocorrência de dor em função das variáveis: idade, escolaridade, composição familiar, função, tempo de trajeto até o trabalho, realização de outras atividades, tempo de vínculo empregatício e qualidade de vida avaliada pelo SF-36, verificou-se que o tempo de trajeto maior que 30 minutos representa é um risco associado (OR 2,51; IC95%: 1,34 - 4,69) à presença de dor e o relato de melhor qualidade de vida, proteção (OR 0,16; IC95%: 0,08 - 0,29). Nas análises associativas, a qualidade de vida foi a única variável significativa foi para o turno de trabalho. O turno noturno foi associado a pior qualidade de vida (OR 2,07; IC95%: 1,11 - 3,84). Conclusões: Não houve associação entre as queixas músculoesqueléticas e os diferentes turnos de trabalho. A qualidade de vida dos trabalhadores mostrou um efeito protetivo para a dor, porém apresentou- se pior nos trabalhadores do turno noturno, quando comparados aos turnos matutinos e vespertinos / This study aims to evaluate the impact of night work on the musculoskeletal system and the quality of life for workers who perform their work in shifts. The study was conducted in a company linked to the automotive industry. The sample was composed of 254 workers. The workers were divided into the following shift groups: G1- 87 Morning (6:00 to 14:00); G2 - 87 Evening (14:00 - 22:00); G3 - 80 Night (22:00 to 6:00).It was applied the following assessment tools: Nordic Musculoskeletal Questionnaire and the Quality of Life Questionnaire SF-36, plus a personally identifiable form. The prevalence, with 95% confidence for musculoskeletal complaints was estimate. Bivariate analyzes were used to identify possible associations between musculoskeletal complaints and independent variables. Analyzing the odds ratio for the occurrence of pain in terms of the variables age, education, family composition, function, time commuting to work, carrying out other activities, length of employment and quality of life assessed by the SF-36, there there was no statistical association between the variables, except the SF-36, which showed that the better quality of life, greater protection for pain (OR 0.16, 95% CI 0.19 to 0.30)

Introdução: Fatores que levam a queixas musculoesqueléticas entre profissionais de enfermagem tem sido objeto de várias pesquisas científicas, apontando a necessidade de estratégias no ambiente de trabalho, que promovam saúde para minimizar este cenário emergente. Os programas baseadas em mindfulness - atenção plena - tem demonstrado resultados promissores em aspectos clínicos e não clínicos da saúde, inclusive no manejo da dor crônica. Objetivo: Avaliar a eficácia de um Programa Adaptado de Mindfulness (PAM) como estratégia complementar no manejo da dor crônica originada por distúrbios osteomusculares, em auxiliares e técnicos de enfermagem de um hospital universitário público brasileiro, bem como a implementação do programa por meio de uma gestão colaborativa e a inserção das práticas na rotina dos participantes. Método: Realizou-se um ensaio aberto, prospectivo, com análises quantitativa e qualitativa no ambiente de trabalho com 64 trabalhadoras mulheres, entre 25 e 68 anos, Média= 47, DP= 9,50. Todas as participantes apresentaram queixas musculoesqueléticas por mais de seis meses, participaram de ao menos cinco dos oito encontros presenciais, com uma hora de duração para cada sessão e se comprometeram a realizar tarefa diária de 20 minutos de prática individual. Um questionário sócio-demográfico foi aplicado no momento da inclusão do estudo. Para as medidas quantitativas do estudo foram aplicadas escalas de autorrelato que avaliam os níveis dos sintomas das queixas musculoesqueléticas (QNSO), ansiedade (IDATE -T), depressão (BDI), pensamentos catastróficos sobre a dor (EPCD), autocompaixão (SELFCS), atenção e consciência plenas (MAAS) e percepção da qualidade de vida (WHOQOL-Bref). Todas as variáveis foram avaliadas pelos testes ANOVA de medidas repetidas e Bonferroni com pré-follow up (T0), pós- intervenção - oito semanas (T1) e após três meses do término do programa - doze semanas de follow up (T2). Para a avaliação qualitativa foram produzidas notas descritivas e reflexivas a partir da observação participante nos setores estudados, bem como a análise temático-categorial de relatos (T1) e entrevistas semi-estruturadas (T2). Resultados: O PAM contribuiu na redução significativa (p<=0,05) dos sintomas osteomusculares, níveis de ansiedade, depressão e pensamentos catastróficos sobre a dor; aumento significativo nos níveis de autocompaixão e na percepção da qualidade de vida total, global e nos domínios físico e psicológico em (T0-T1). Não houve resultados estatisticamente significativos (p > 0,05) nos níveis de atenção e consciência plenas - MAAS e nos domínios relações sociais e meio ambiente - WHOQOL-Bref. As análises qualitativas dos relatos (T1) e entrevistas (T2) apontaram benefícios na dor e na qualidade de vida e um repensar sobre a necessidade do cuidar de si com estratégias, dentro da realidade subjetiva, para a inserção das práticas no cotidiano sugerindo a continuidade do PAM como ação factível e eficaz para a categoria estudada. Conclusão: Os resultados sugerem que o PAM contribuiu para a redução dos sintomas físicos e emocionais da dor e melhora da qualidade de vida do público estudado. Os escores desde a pós-intervenção (T1) se mantiveram, ao menos por 20 semanas (T2), indicando a eficácia do PAM como estratégia complementar para o manejo da dor e melhora da qualidade vida dos auxiliares e técnicos de enfermagem em ambiente hospitalar / Introduction: Factors that lead to musculoskeletal complaints among nursing professionals have been the subject of several scientific researches, pointing out the need for strategies in the work environment to promote health and minimize this emerging scenario. Mindfulness-based programs have shown promising results in clinical and non-clinical aspects of health, including management of chronic pain. Objective: To evaluate the effectiveness of a Mindfulness Adapted Program (MAP) as a complementary strategy in the management of chronic pain caused by musculoskeletal disorders in nursing assistants and technicians of a Brazilian public university hospital, as well as the implementation of the program through a collaborative management and the insertion of the practices in the routine of the participants. Method: An open, prospective, quantitative and qualitative analysis was performed in the work environment with 64 women workers, age between 25-68 years, Mean= 47, SD= 9.50. A socio-demographic questionnaire was applied at the time of the inclusion of the study. All participants presented musculoskeletal complaints for more than six months, participated in at least five of the eight face-to-face meetings, with an hour of duration for each session and committed to perform daily task of 20 minutes of individual practice. For the quantitative measures of the study, self-report scales were used to evaluate the levels of symptoms of musculoskeletal complaints (NMQ), anxiety (STAI), depression (BDI), catastrophic thoughts on pain (PCS), self-compassion (SELFCS), attention and awareness (MAAS) and perception of quality of life (WHOQOL-Bref). All variables were evaluated by repeated measures ANOVA and Bonferroni with pre-follow up (T0), post-intervention - eight weeks (T1) and three months after the end of the program - twelve weeks of follow up (T2). For the qualitative evaluation, descriptive and reflexive notes were produced based on participant observation in the studied sectors, as well as the thematic-categorical analysis of reports (T1) and semi-structured interviews (T2). Results: MAP contributed to the significant reduction (p <= 0.05) of musculoskeletal symptoms, anxiety levels, depression and catastrophic thoughts about pain; significant increase in the levels of self-compassion and in the perception of total, global quality of life and in the physical and psychological domains in (T0-T1). There were no statistically significant results (p > 0.05) at full attention and consciousness levels - MAAS and in the social relations and environment domains - WHOQOL-Bref. The qualitative analyzes of the reports (T1) and interviews (T2) showed benefits in pain and quality of life and a rethinking about the need to take care of oneself with strategies, within the subjective reality, for the insertion of daily practices suggesting continuity of MAP as an action feasible and effective for the category studied. Conclusion: The results suggest that MAP contributed to the reduction of physical and emotional symptoms of pain and improvement of the quality of life of the studied public. The post-intervention (T1) scores were maintained for at least 20 weeks (T2), indicating the efficacy of MAP as a complementary strategy for pain management and improvement of the quality of life of nursing assistants and technicians in a hospital setting

OBJETIVOS: caracterizar o estado nutricional de indivíduos ativos, portadores de deficiência motora. METODOLOGIA: Foram avaliados 68 indivíduos ativos, do sexo masculino, portadores de lesão medular (LM, n= 28), seqüelas de poliomielite (L, n=32) ou amputados (A, n= 8). Foram avaliados: o consumo alimentar (recordatório de 24h e lista de freqüência de alimentos), antropometria (peso, altura, dobras cutâneas), composição corporal por DEXA e por bioimpedância. Quanto aos parâmetros bioquímicos: glicemia de jejum, lipídeos plasmáticos (colesterol total, LDL, HDL e triacilgliceróis), uréia e creatinina, insulina, cortisol e IGF-1 plasmáticos. Os dados dos grupos foram submetidos à análise univariada (ANOVA) e os contrastes significativos ao teste de Tuckey, além da análise multivariada para detecção das correlações entre os parâmetros de avaliação. RESULTADOS: os grupos apresentaram um consumo energético abaixo das predições normais, o que pode ser explicado pela menor necessidade decorrente da diminuição da massa muscular. A distribuição percentual da ingestão de lipídeos apresentou-se elevada, inversamente ao consumo de carboidratos. O IMC mostrou-se um bom indicador da gordura corporal, o DEXA mostrou alta correlação com os dados obtidos por dobras cutâneas e com as predições convencionais de gordura corporal. A densidade óssea do corpo total apresentou normalidade, porém, nos LMe nos P a região das pernas apontou para osteopenia e/ou osteoporose. Os dados bioquímicos apresentaram-se normais. CONCLUSÕES: a atividade física parece ter sido um fator determinante para a normalidade encontrada na maioria dos parâmetros avaliados, embora não tenha sido suficiente para manter a densidade óssea e muscular nas regiões paralisadas. Ficou evidente a necessidade de trabalhos de Educação Nutricional para esses indivíduos. No que diz respeito a parâmetros de densidade óssea, é importante a análise dos diferentes segmentos do corpo. / OBJECTIVES: to characterize the nutricional status of active, handicapped individuals. METHODOLOGY: 68 individuals active, men, with spinal cord injury (SCI) (LM, n = 28), poliomelite sequels (L, n=32) or amputed ( n = 8). They had been evaluated by: food consumption (24h dietary recall and food frequency), anthropometry (weight, height, skinfolders and cicunferences), body composition from DEXA and bioelectrical impedance. About the biochemical parameters: serum fast glucose, serum lipids (total cholesterol, LDL, HDL and triglycerides), serum urea and creatinine, insulin, cortisol and IGF-1. The data had been submitted to the ANOVA and the significant contrasts to the Tuckey test, beyond the multivaried analysis for correlations values between the parameters. RESULTS: the groups had presented an energy consumption below of the normal predictions, what it can be explained by the muscle mass reduction. The distribution of the lipids ingestion was high, inversely to the carbohydrates consumption. The body mass index (BMI) revealed to be a good index of the body fat, the DEXA showed high correlation with the skinfolders and with the body fat predicictions. The total bone density presented normality, however, in the LM and the P the region of the legs pointed osteopenia and/or osteoporose. The biochemical data had been normal. CONCLUSIONS: the physical activity seems to have been a determinative factor for the normality found in the majority of the evaluated parameters, even so it has not been enough to keep the bone and muscle density in the paralyzed regions. The necessity of Nutricional Education was evident for these individuals. About the parameters of bone density, the analysis of the different regions is important .

A survey was conducted to determine parental perceptions regarding shared book-reading with their young children with cleft palate. The results describe parents' engagement in shared book-reading with their children and their perceptions of the importance thereof in language and speech development. Clinical applications for early intervention are proposed.