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O município de Petrópolis, no estado do Rio de Janeiro, enfrentou, em fevereiro de 2022, o maior desastre socioambiental de sua história, resultando em 244 mortes e milhares de desabrigados. Desastres como esse são definidos como sérias interrupções que excedem a capacidade da comunidade afetada de lidar com a situação utilizando seus próprios recursos. A vulnerabilidade a desastres resulta de processos sociais precários e mudanças ambientais que tornam certas populações e áreas mais suscetíveis. Os efeitos na saúde pública incluem danos materiais e humanos, com demandas de saúde emergindo ao longo do tempo, desde atendimentos de urgência até problemas de saúde mental. A Atenção Primária à Saúde (APS) desempenha um papel crucial em todas as fases de resposta a desastres. Este artigo visa relatar as ações das equipes de saúde da família ligadas ao Programa de Residência de Medicina de Família e Comunidade em resposta ao desastre de 2022, seja imediatamente atendendo feridos, fornecendo medicamentos, realizando curativos, vacinações e gerenciando condições crônicas, seja nas semanas subsequentes marcadas pelo acolhimento às vítimas, pela coordenação de doações e os cuidados nos abrigos. A atuação coordenada da APS foi essencial para fornecer cuidados de saúde adequados e organizar as ações nos abrigos. A experiência destacou a importância da preparação das equipes de saúde para lidar com desastres e a necessidade de incluir esse tema na formação profissional em APS.

Abstract Parenthood, particularly motherhood, is known to impact the structure and function of the brain in the short term, but the long-term effects of parenthood and their impacts on well-being are still poorly understood. This study explores the potential longer-term associations between parenthood and the brain, parenthood and well-being, and the potential role of brain modifications in influencing mothers’ well-being. Using data from the UK Biobank, which includes brain imaging information from individuals aged 45–82 at the MRI scanning, we discovered differences in brain structure between mothers and non-mothers, with mothers exhibiting widely distributed higher gray matter density, particularly strong in frontal and occipital regions. No brain changes were observed in fathers. Parents reported a higher sense of life’s meaning compared to their childless counterparts. Gray matter changes did not mediate the relationship between motherhood and well-being. This suggests that the alterations in gray matter associated with motherhood do not play a deterministic role in shaping long-term changes in well-being.

Virtual museums are the answer a digital society, a new cultural, social, and economic system and a tool for educational innovation and digital learning. This article aims to collate all relevant evidence in virtual cultural museums with a teaching approach and detect what is published using the following question "What is published about virtual museums for educational purposes?". Its objective is to verify what can be found in the academic field about virtual museums for didactic purposes applied to the professional environment. The research analyzes two hundred and twenty-three articles, of which seventeen were selected for their didactic and professional environment characteristics. The bibliographic review presents indicators that determine a virtual museum is an effective tool both in the field of reinforcing learning, as well as in the theoretical and practical development of activities that encourage creation by students.

Abstract The Family Connections Program is an alternative for improving family relationships, depressive symptoms and overwhelmed feelings in family members of individuals with Borderline Personality Disorder (BPD). Twenty family members of individuals diagnosed with BPD participated in the study. The effect of the program was evaluated on the family members and, indirectly, on the respective relatives with BPD. Quality of life, psychopathological symptoms, emotional dysregulation, burden, depressive, anxiety and stress symptoms, quality of family relationship and family resilience were applied pre and post-intervention and three months after the ending of the program. As a significant result, there was a reduction in objective burden (p = 0.006) in family members who participated in the program and improvement in family resilience according to diagnosed relatives (p = 0.041). It was concluded that although the program was effective for the study participants in some aspects, it is necessary a cultural adaptation of the protocol.

Background: Tuberculosis constitutes a worldwide problem in relation to its morbidity and mortality. The exposure to tuberculosis patients constituted a significant occupational exposure for healthcare workers. During the pandemic of COVID-19, the incidence of tuberculosis was reduced probably related to the high priority to provide care during the pandemic. Cases of health workers who after several months of caring for COVID-19 patients have had seroconversion of QuantiFERON TB gold (QFT) were described. The initial QTF test was performed in April 2020 (before providing care to COVID-19 cases), and a positive test was reported in August and December 2020 for the reported cases. The exposure to patients from countries with high incidence tuberculosis during the pandemic constituted the most probable source of infection. Also, the limited tuberculosis screening in patients and the staff's adherence to infection prevention practices among other factors will explain these findings, which will require strategies to prevent occupational exposure during the influx of communicable diseases to healthcare services.

Category: Ankle; Sports Introduction/Purpose: A ligament-centered analysis is currently incorporated in the assessment of joint stability in malleolar fractures. Although several imaging tests are available, in the setting of acute isolated non-displaced posterior malleolar fractures Bartoníček/Rammelt types II and IV diagnosing syndesmotic instability remains challenging. The objective of this multi-center cross- sectional study was to evaluate the syndesmotic and fracture instability using conventional ankle CT with external rotation and dorsiflexion in the setting of acute, isolated non-displaced Bartoníček and Rammelt type II posterior malleolar fractures. Methods: Between March 2018 and September 2022, a consecutive sample of 123 individuals with an ankle sprain were assessed for eligibility. In total, 33 participants met the inclusion criteria. All participants underwent a CT scan (CTSM), comprising a first phase with the ankles in a neutral position, then a stress phase with the ankles in external rotation and dorsiflexion and semiflexed knees. Investigators used the patterns of ligament tear found at MRI and instability at CTSM to classify all participants into West Point grades I, IIA, IIB, or III. Mann-Whitney test was used to test the differences in the numerical variables between injured and uninjured syndesmoses. The Spearman correlation tested the strength of the association between the tibial joint surface involved in posterior malleolus fracture and syndesmotic instability. Results: In MRI reading parameters two patterns of syndesmotic ligament injury predominated. A completely torn AITF and IO ligaments and a completely torn AITF was combined with a partially torn IO. Regarding the deep layer of the deltoid ligament, participants were classified as normal, strained and partially torn. In CT scan reading parameters in the neutral phase, the median difference of 0.2 mm in d measurements between injured and uninjured syndesmoses was not statistically significant (P = 0.057). During the stress phase, the injured and uninjured syndesmoses had distinct behavior, and the 2.3 mm median difference for d measurement was statistically significant (P < 0.0001). Conclusion: The conventional computed tomography with external rotation and dorsiflexion represent a reproducible and accurate diagnostic option for the detection of syndesmosis instability and fracture instability in acute isolated posterior malleolar fractures Bartonícek and Rammelt type II.

Abstract Adult tendons are highly differentiated. In mature individuals, tendon healing after an injury occurs through fibrotic tissue formation. Understanding the intrinsic reparative properties of fetal tendons would help to understand the maturation tissue process and tendon tissue repair. The present study evaluated the evolution of histoarchitecture, cellularity and the distribution of collagens I, III and V in the posterior tibial tendon in human fetuses at different gestational ages. Morphological profiles were assessed in nine fresh spontaneously aborted fetuses (Group I: five fetuses aged between 22 and 28 weeks of gestation; Group II: four fetuses aged between 32 and 38 weeks of gestation), characterized by a combination of histology, fluorescence and immunohistochemistry. In Group I, the posterior tibial tendon showed statistically significant greater cellularity and presence of collagen III and V than in Group II tendon, which showed a predominance of collagenous I and a better organization of the extracellular matrix compared with Group I tendons. In addition, a statistically significant higher rate of CD90, a marker of mesenchymal cells, was found in Group I tendons. In fetuses with gestational age between 22 and 28 weeks, the posterior tibialis tendons showed a thin and disorganized fibrillar structure, with an increase in collagen III and V fibers and mesenchymal cells. In the posterior tibialis tendons of fetuses with gestational age between 32 and 38 weeks, the fibrillar structure was thicker with a statistically significant increase in type I collagen and decreased cellularity.

El objetivo del artículo es mostrar la práctica artística implementada en Genocide Project y, de forma específica, describir y entender su proceso de producción y método de trabajo, para que este pueda servir de referencia a otros artistas o estudiantes, y establecer sinergias con sus propios proyectos de arte. Para ello, se analizan dos experiencias expositivas de cara a estudiar la metodología interactiva y los elementos que las conforman. Esta metodología se compone de cuatro fases que se retroalimentan entre sí: identificación, recopilación, producción y exposición. Por otro lado, los elementos que conforman cada evento expositivo serían: la arqueología de gestión, la puesta en escena y la visitor-experience. Como resultado, se produce un conocimiento aplicado basado en la investigación y en una metodología interactiva que crea un diálogo entre el artista, la víctima y el espectador y, de esta forma, sería susceptible de replicarse.

The treatment of severe lesions of peroneus longus and brevis tendons is a challenge for orthopedists, and little is described in the literature about the epidemiology. Most of the articles focus on single lesion of one of the tendons, rarely describing what to do when both are severely ill. This case report will show and discuss a surgical technique for when both tendons are injured. Level of Evidence III; Case Report and Literature Review.

The number of total ankle arthroplasties has increased in recent years with the improvement of implants and advanced attempts to maintain ankle movement. However, this technique presents complications, such as aseptic loosening and infection, requiring revision surgery. In this scenario, conversion by tibiotalar or tibiotalocalcaneal arthrodesis is highly accepted and can be performed with external fixators, intramedullary rods, screws, or locking plates. This article shows the resolution of a case of aseptic loosening tibiotalocalcaneal arthrodesis fixed with a locking plate associated with bone allograft. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Background: Tibiotalocalcaneal arthrodesis is a well-established procedure to treat some hindfoot diseases. Currently, the most used implants are retrograde intramedullary nails and locking plates combined with lag screws, but there are few articles comparing differences regarding the complications. Methods: We have retrospectively analyzed the medical records and the radiographs of patients older than 18 years who underwent this procedure in our service between 2005 and 2019 through retrograde intramedullary nails or lateral locking plates and compression screws with at least 12 months of follow-up and with no history of osteomyelitis in these bones. Results: We evaluated a total of 67 patients; of these, 48 received retrograde intramedullary nail implants and 19 received locking plates and compression screws. The overall mean age was 48 years; the median follow-up time was 64.3 months. The complication rate was 60.4% for the intramedullary nail procedure and 52.6% for the locking plate combined with compression screws procedure. Conclusion: No significant differences were found in the complication rates between the 2 implants. Level of Evidence: Level V, Case series

Activity dependent stimulation (ADS) is a closed loop stimulation technique whose neurophysiological effects have not been deeply investigated. Here we explored how Local field Potentials (LFP) are impacted by a focal ischemic lesion and, subsequently, by ADS treatment. Intracortical microelectrode arrays were implanted in the rostral forelimb area (RFA) and in the primary somatosensory area (S1) of anaesthetized rats. An ischemic injury was induced in the caudal forelimb area through microinjections of Endothelin-1. The lesion induced an acute depressive trend in LFP power in RFA (evaluated in 6 bands of interest: Delta (1–4Hz), Theta (4–8Hz), Alpha (8-11Hz), Beta (11–30Hz), LowGamma (30–55Hz) and HighGamma (55-80)) followed by a noticeable significant rebound in both areas. Applying ADS induced an overall decrease of power. The lesion impacted the connectivity in a frequency specific manner, resulting in widespread increase in connectivity in Delta both between and within areas. Two hours after the lesion, without stimulation, correlated activity between areas increased in Beta and Gamma. After stimulation, inter-area connectivity increased in Delta, Theta and Alpha, while considerably dropping within RFA in highGamma. By computing phase-amplitude coupling, we found that the lesion produced an incremental increase in the coupling between (Theta) Alpha phase and (lowGamma) highGamma amplitude within RFA, while S1 had a more generalized increase. Likewise, coupling between Theta phase and lowGamma/highGamma amplitudes increased between areas after lesion. ADS induced a similar increase, but greater in magnitude both within and between RFA and S1. These results have important implications on the emerging field of closed-loop adaptive stimulation promoting ADS as an innovative tool for the treatment of neurological disorders.

In this article, we combine the extensive literature on the analysis of life-course trajectories as sequences with the literature on causal inference and propose a new matching approach to investigate the causal effect of the timing of life-course events on subsequent outcomes. Our matching approach takes into account pre-event confounders that are both time-independent and time-dependent as well as life-course trajectories. After matching, treated and control individuals can be compared using standard statistical tests or regression models. We apply our approach to the study of the consequences of the age at retirement on subsequent health outcomes, using a unique data set from Swedish administrative registers. Once selectivity in the timing of retirement is taken into account, effects on hospitalization are small, while early retirement has negative effects on survival. Our approach also allows for heterogeneous treatment effects. We show that the effects of early retirement differ according to preretirement income, with higher income individuals tending to benefit from early retirement, while the opposite is true for individuals with lower income.

Background: Research has shown that the circumstances surrounding birth may influence the timing of death. In the northern hemisphere, children born in spring and summer have a shorter lifespan than those born in fall and winter. Objective: We describe the effect of month of birth on adult lifespan (50+) in the United States in three ways. First, we estimate it between and within groups of siblings, accounting for unobserved factors at the family level. Second, we estimate the effect of birth month across a period of about 200 years (1700‒1899). Third, we examine geographical variation in the effect of birth month across US census areas. Methods: We estimate descriptive statistics and OLS regression models between and within sibling groups. Results: We find an effect of birth month on lifespan. Individuals born in spring and summer have on average a shorter lifespan than those born in fall and winter. The effect is relatively consistent across cohorts, geographical census areas, and between and within families. We test different possible explanations for this result and find residual evidence that in utero debilitation may account for this result. Contribution: Twenty years ago, Gabriele Doblhammer and James W. Vaupel published an influential paper, showing the importance of birth month for lifespan and arguing that circumstances experienced in utero are the likely explanation for this result. We extend these insights by exploiting new crowdsourced data that allows us to study the phenomena over 200 years, across space, and between and within families.

Couple formation and assortative mating significantly influence societal structures, as marriages between individuals from diverse geographical or social backgrounds promote intra-family diversity. Understanding these patterns is crucial for grasping the demographic processes that shape contemporary societies. However, the scarcity of comprehensive data has impeded progress in this area. This paper aims to fill this gap by investigating assortative mating trends in the United States among birth cohorts from 1700 to 1910, utilizing data from FamiLinx, an online crowdsourced genealogical database. We focus on two primary dimensions: migration background (including natives, first and second-generation migrants) and age at marriage. Our analysis yields three major findings. First, we document significant changes in assortative mating trends over time, reflecting the dynamic nature of mate selection and its responsiveness to societal shifts. Second, we uncover substantial heterogeneity in assortative mating patterns across different social groups, indicating varying social dynamics and preferences. Third, we illustrate how these trends can be differently interpreted depending on whether the perspective is individual or familial. Additionally, we explore the advantages and limitations of using online genealogical data for historical studies of assortative mating, highlighting its potential for offering new insights while acknowledging the challenges posed by data quality and representativeness. [ABSTRACT FROM AUTHOR]

Background: Flexible cavovarus deformity is prevalent and the Coleman block test is frequently used to assess the first ray plantarflexion malpositioning in the overall deformity as well as the flexibility of the hindfoot. The objective was to assess and compare the weightbearing computed tomography (WBCT) 3-dimensional (3D) changes in clinical and bone alignment in flexible cavovarus deformity patients when performing the Coleman block test when compared to normal standing position and to controls. Methods: Twenty patients (40 feet) with flexible cavovarus deformity and 20 volunteer controls (40 feet) with normal foot alignment underwent WBCT imaging of the foot and ankle. Cavovarus patients were assessed in normal orthostatic and Coleman block test positions. Foot and ankle offset (FAO), hindfoot alignment angle (HAA), talocalcaneal angle (TCA), subtalar vertical angle (SVA) and talonavicular coverage angle (TNCA) and a CT-simulated soft tissue envelope image, WBCT clinical hindfoot alignment angle (WBCT-CHAA), were evaluated by 2 readers. Measurements were compared between cavovarus nonstressed and stressed positions and to controls. P values of.05 or less were considered significant. Results: The intra- and interobserver intraclass correlation coefficient were good or excellent for all WBCT measurements. Cavovarus patients demonstrated significant correction of WBCT-CHAA (9.7 ± 0.4 degrees), FAO (2.6 ± 0.4%), and TNCA (8.8 ± 1.8 degrees) when performing the Coleman block test (all P values <.0001). However, WBCT-CHAA and FAO measurements were still residually deformed and significantly different from controls (P values of.001 and <.0001, respectively). TNCA values corrected to values similar to healthy controls (P =.29). No differences were observed in cavovarus patients during Coleman block test for the coronal measures: HAA, TCA, and SVA measurements. Conclusion: In this study, we observed improvement in the overall 3D WBCT alignment (FAO), axial plane adduction deformity (TNCA), as well as CT simulated clinical hindfoot alignment (WBCT-CHAA) in flexible cavovarus deformity patients when performing a Coleman block test. However, we did not find improvement in measures of coronal alignment of the hindfoot, indicating continued varus positioning of the hindfoot in these patients. [ABSTRACT FROM AUTHOR]

Objectives: Energy transition scenarios are prospective outlooks describing combinations of changes in socio-economic systems that are compatible with climate targets. These changes could have important health co-benefits. We aimed to quantify the health benefits of physical activity caused by active transportation on all-cause mortality in the French negaWatt scenario over the 2021–2050 period.Methods; Relying on a health impact assessment framework, we quantified the health benefits of increased walking, cycling and E-biking projected in the negaWatt scenario. The negaWatt scenario assumes increases of walking and cycling volumes of +11% and +612%, respectively, over the study period.Results: As compared to a scenario with no increase in volume of active travel, we quantified that the negaWatt scenario would prevent 9,797 annual premature deaths in 2045 and translate into a 3-month increase in life expectancy in the general population. These health gains would generate €34 billion of economic benefits from 2045 onwards.Conclusion: Increased physical activity implied in the negaWatt transition scenario would generate substantial public health benefits, which are comparable to the gain expected by large scale health prevention interventions.

ABSTRACT Objectives: To describe the surgical treatment of fractures that involves the hallux interphalangeal joint, current indications and management options. Methods: we performed a literature review of relevant clinical studies in multiple databases, including PubMed, MedLine and Scopus, from January 1989 to October 2020. Results: There is consensus for surgical treatment of intra-articular fractures with a deviation greater than 2 mm, metadiaphyseal fractures with malrotation and/or malangulation, open fractures and unstable fractures. Conclusion: The use of more rigid implants allow alignment maintenance during healing process and lower risk of reduction loss. Valgus deformity and interphalangeal joint osteoarthritis are possible complications that must be avoided. Level of Evidence III, Systematic review of Level III studies.

Abstract Background Maple syrup urine disease (MSUD) is an autosomal recessive inherited metabolic disease caused by deficient activity of the branched-chain α-keto acid dehydrogenase (BCKD) enzymatic complex. BCKD is a mitochondrial complex encoded by BCKDHA, BCKDHB, DBT, and DLD genes. MSUD is predominantly caused by Variants in BCKDHA, BCKDHB, and DBT genes encoding the E1α, E1β, and E2 subunits of BCKD complex, respectively. The aim of this study was to characterize the genetic basis of MSUD by identifying the point variants in BCKDHA, BCKDHB, and DBT genes in a cohort of Brazilian MSUD patients and to describe their phenotypic heterogeneity. It is a descriptive cross-sectional study with 21 MSUD patients involving molecular genotyping by Sanger sequencing. Results Eight new variants predicted as pathogenic were found between 30 variants (damaging and non-damaging) identified in the 21 patients analyzed: one in the BCKDHA gene (p.Tyr120Ter); five in the BCKDHB gene (p.Gly131Val, p.Glu146Glnfs * 13, p.Phe149Cysfs * 9, p.Cys207Phe, and p.Lys211Asn); and two in the DBT gene (p.Glu148Ter and p.Glu417Val). Seventeen pathogenic variants were previously described and five variants showed no pathogenicity according to in silico analysis. Conclusion Given that most of the patients received late diagnoses, the study results do not allow us to state that the molecular features of MSUD variant phenotypes are predictive of clinical severity.

Goal: Functional connectivity (FC) is an important indicator of the brain's state in different conditions, such as rest/task or health/pathology. Here we used high-density electroencephalography coupled to source reconstruction to assess frequency-specific changes of FC during resting state. Specifically, we computed the Small-World Propensity (SWP) index to characterize network small-world architecture across frequencies. Methods: We collected resting state data from healthy participants and built connectivity matrices maintaining the heterogeneity of connection strengths. For a subsample of participants, we also investigated whether the SWP captured FC changes after the execution of a working memory (WM) task. Results: We found that SWP demonstrated a selective increase in the alpha and low beta bands. Moreover, SWP was modulated by a cognitive task and showed increased values in the bands entrained by the WM task. Conclusions: SWP is a valid metric to characterize the frequency-specific behavior of resting state networks.

Parenthood, particularly motherhood, is known to impact the structure and function of the brain in the short term, but the long-term effects of parenthood and their impacts on well-being are still poorly understood. This study explores the potential longer-term associations between parenthood and the brain, parenthood and well-being, and the potential role of brain modifications in influencing mothers' well-being. Using data from the UK Biobank, which includes brain imaging information from individuals aged 45–82 at the MRI scanning, we discovered differences in brain structure between mothers and non-mothers, with mothers exhibiting widely distributed higher gray matter density, particularly strong in frontal and occipital regions. No brain changes were observed in fathers. Parents reported a higher sense of life's meaning compared to their childless counterparts. Gray matter changes did not mediate the relationship between motherhood and well-being. This suggests that the alterations in gray matter associated with motherhood do not play a deterministic role in shaping long-term changes in well-being. [ABSTRACT FROM AUTHOR]

Neuroprostheses are neuroengineering devices that have an interface with the nervous system and supplement or substitute functionality in people with disabilities. In the collective imagination, neuroprostheses are mostly used to restore sensory or motor capabilities, but in recent years, new devices directly acting at the brain level have been proposed. In order to design the next-generation of neuroprosthetic devices for brain repair, we foresee the increasing exploitation of closed-loop systems enabled with neuromorphic elements due to their intrinsic energy efficiency, their capability to perform real-time data processing, and of mimicking neurobiological computation for an improved synergy between the technological and biological counterparts. In this manuscript, after providing definitions of key concepts, we reviewed the first exploitation of a real-time hardware neuromorphic prosthesis to restore the bidirectional communication between two neuronal populations in vitro. Starting from that ‘case-study’, we provide perspectives on the technological improvements for real-time interfacing and processing of neural signals and their potential usage for novel in vitro and in vivo experimental designs. The development of innovative neuroprosthetics for translational purposes is also presented and discussed. In our understanding, the pursuit of neuromorphic-based closed-loop neuroprostheses may spur the development of novel powerful technologies, such as ‘brain-prostheses’, capable of rewiring and/or substituting the injured nervous system.

ABSTRACT Background Maple syrup urine disease (MSUD) is an autosomal recessive inherited metabolic disorder caused by the deficient activity of the branched‐chain α‐keto acid dehydrogenase (BCKD) enzymatic complex. BCKD is a mitochondrial complex encoded by four genes: BCKDHA, BCKDHB, DBT, and DLD. MSUD is predominantly caused by mutations in the BCKDHA, BCKDHB, and DBT genes which encode the E1α, E1β, and E2 subunits of the BCKD complex, respectively. The aim of this study was to characterize the genetic basis of MSUD in a cohort of Chilean MSUD patients by identifying point mutations in the BCKDHA, BCKDHB, and DBT genes and to describe their impact on the phenotypic heterogeneity of these patients. Methods This manuscript describes a cross‐sectional study of 18 MSUD patients carried out using PCR and DNA sequencing. Results Four novel pathogenic mutations were identified: one in BCKDHA (p.Thr338Ile), two in BCKDHB (p.Gly336Ser e p.Pro240Thr), and one in DBT (p.Gly406Asp). Four additional pathogenic mutations found in this study have been described previously. There were no correlations between the genotype and phenotype of the patients. Conclusion If MSUD is diagnosed earlier, with a newborn screening approach, it might be possible to establish genotype‐phenotype relationships more efficiently.

Diante de mudanças recentes no panorama nacional de programas de incentivos para provimento e formação médica em Atenção Primária à Saúde (APS), o Grupo de Trabalho de Ensinagem da SBMFC organizou um Encontro Nacional entre os dias 29 de novembro e 1º de dezembro de 2019, na cidade do Rio de Janeiro/RJ. O evento reuniu professores, supervisores, preceptores e residentes de Medicina de Família e Comunidade de diferentes regiões do país, e teve como objetivos discutir o atual cenário, além de elencar recomendações para qualidade dos PRMFC e caminhos para o fortalecimento da formação de médicas e médicos de família e comunidade via Residência Médica. Essas recomendações buscaram considerar a diversidade dos PRMFC em um país tão vasto quanto o Brasil e, principalmente, a necessidade de se estabelecer parâmetros mínimos de organização para os programas das mais variadas configurações, como PRMFC vinculados a Instituições de Ensino Superior (IES), secretarias estaduais ou municipais de saúde. As recomendações foram então organizadas em três eixos: 1) recomendações para supervisores e coordenadores de PRMFC e modelos possíveis de preceptoria; 2) recomendações para formuladores e executores de políticas públicas; e 3) recomendações para lideranças da medicina de família e comunidade.

Objective: Compare the real need for rest of chronic plantar fasciitis patients with the leave of absence time and criteria used by national and international technical medical expert examination manuals. Methods: We conducted a review of the medical literature from 2013 to 2018, selecting only randomized controlled clinical trials on the treatment of chronic plantar fasciitis. National and international medical expert examination manuals were also selected. The treatment time for chronic plantar fasciitis was then compared with the leave of absence time recommended by the manuals. Results: Of the six articles selected, we ascertained that three articles evaluating second-line treatment managed to reduce the VAS by 60% after 4 weeks, one after 3 months, one after 6 months, and one that showed no improvement at all. In all studies, no control group receiving first-line treatment alone achieved a 60% reduction in the VAS during the follow-up period. The evaluated manuals recommend leave from work ranging from zero to 21 days, with only two using the criterion of the type of work performed by the employee for the expert decision. Conclusion: We observed that none of the medical expert examination manuals provides support for the medical expert to grant leave to workers with chronic plantar fasciitis from their work-related activities to receive secondary treatment for at least four weeks. In addition, stratification by acute or chronic disease is not observed. Two manuals scale leave time by type of activity. Level of Evidence III; Economic and Decision Analyses; Analyses Based on Limited Costs and Alternatives.