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Objective: The current study aims to investigate the safety and efficacy of using calcium hydroxyapatite (CaHA) versus CaHA associated with hyaluronic acid (HA) for forehead volume replacement and contour restoration without forehead irregularities., Methods: This interventional study involved 132 participants in a two-arm, parallel, double-blind trial for forehead treatment using the supraperiosteal technique. Group A received CaHA, and Group B received a combination of CaHA and HA as filler materials. Follow-up assessments occurred at 30 and 180 days, incorporating the 5-point Global Aesthetic Improvement Scale (GAIS) and photographic analysis for forehead volume replacement, contour restoration, and without forehead irregularities. Safety assessments included monitoring adverse events, particularly nodules., Results: The study included all 132 enrolled patients who completed the trial. Applying CaHA in combination with HA resulted in a statistically significant improvement in both GAIS scale scores and the reduction of forehead irregularities. The total incidence of nodules was 3.7%. Group A had four times more occurrences of nodules than Group B. Furthermore, Group B exhibited lower rates of forehead irregularities following the treatment compared to Group A., Conclusion: The supraperiosteal application of CaHA and HA for forehead treatment demonstrates superior efficacy in addressing signs of aging compared to the isolated use of CaHA., (© 2024 The Author(s). Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Federalism is basis of the Republic of Brazil which is made up of the union of states, municipalities and the Federal District, with the basic principle of political and administrative decentralization in all political, economic and social relations. In the health sector, the primary health care provider should be able to integrate all care that the patient receives through the coordination of health services. This article aims to evaluate the results of referrals for consultations and outpatient examinations in primary health care in the municipality of Rio de Janeiro, highlighting the advances, limitations and challenges for management at the local level. A quantitative study was designed using administrative databases from the Registry of National Health Establishments (CNES), the National Regulatory System (SISREG), and a linkage between them. Between 2011 and 2015, the number of scheduled procedures increased by 86%, reflecting the decentralization of outpatient regulation for family doctors. It can be inferred that there is no shortage of specialists for outpatient care in the city in almost all areas. There are actually artificial bottlenecks that arise as a result of the lack of regulation of most of the workload contracted in specialist areas, that is, the number of vacancies is smaller than the capacity of health services available in health units at the municipal, state, federal levels and those contracted by the Unified Health System (SUS).