86 resultados para Argamassas de Reabilitação


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This work main objective is to study the use of bricks in barium X-rays rooms in order to contribute to the optimization of shielding rooms diagnosis. The work was based on experimental measurements of X-ray attenuation (40 to 150 kV), using ceramic seal bearing the incorporation of barium sulfat (BaSO4). Different formulations were studied in three different firing temperatures and evaluated for incorporation in the ceramic body. The composition of 20% of barite processed at a temperature of 950 ° C showed better physical and mechanical properties, is considered the most suitable for the purpose of this work. Were produced bricks sealing composition formulated based on that presented the best technological features. These blocks were tested physically as a building material and wall protective barrier. Properties such as visual, deviation from the square, face flatness, water absorption and compressive strength were evaluated for all the blocks produced. The behavior of this material as attenuator for X-rays was investigated by experimental results which take into account mortar manufacturers barium through the different strains and compared with the reference material (Pb). The simulation results indicated that the ceramic block barium shows excellent properties of attenuation equivalence lead taking into account the energy used in diagnostic X-ray

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Generally, cellulose ethers improves mortar properties such as water retention, workability and setting time, along with adherence to the substrate. However, a major disadvantage of the addition of cellulose ethers in mortars is the delay in hydration of the cement. In this paper a cellulose phosphate (Cp) was synthesized water soluble and has been evaluated the effect of their incorporation into mortar based on Portland cement. Cellulose phosphate obtained was characterized by spectrophotometry Fourier transform infrared (FTIR), X-ray diffraction (XRD), elemental analysis and scanning electron microscopy (SEM). Mortar compositions were formulated with varying phosphorus content in cellulose and cellulose phosphate concentrations, when used in partial or total replacement of the commercial additive based hydroxyethyl methyl cellulose (HEMC). The mortars formulated with additives were prepared and characterized by: testing in the fresh state (consistency index, water retention, bulk density and air content incorporated) and in the hardened state (absorption by capillarity, density, flexural and compression strength). In mixtures the proportion of sand:cement of 1:5 (v / v) and factor a / c = 1.31 and water were held constant. Overall, the results showed that the celluloses phosphates employed in mortars added acted significantly when partially substituting the commercial additive. With regard to consistency index, water retention and bulk density in the fresh state and absorption by capillarity and bulk density apparent in the hardened state, showed no appreciable differences as compared to the commercial additive. The incorporated air content in the fresh state reduced markedly, but did not affect other properties. The mortars with cellulose phosphate, partially replacing the commercial additive showed an improvement of the properties of flexural strength and compressive strength

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Pastas a base de cimento Portland são utilizadas na cimentação de poços de petróleo. Elas consistem de uma mistura de partículas sólidas de cimento dispersas em água e aditivos. Atualmente, diversos materiais alternativos são utilizados como aditivos, objetivando a modificação e a melhoria das propriedades das pastas de cimento, especialmente no aumento da fluidez. Novos aditivos plastificantes são capazes de suportar as diversas condições de poços, promovendo propriedades no estado fluido compatíveis às condições exigidas para cimentação.Dispersantes são os componentes da pasta que garantem fluidez, além de proporcionar controle na água perdida por filtração na formação porosa, garantindo o sucesso da operação de bombeio. Em deter minados campos, além do efeito da profundidade, as condições geológicas das formações promovemvariações do gradiente de pressão e temperatura ao longo da profundidade vertical do poço. Recentemente, diversos aditivos químicos da indústria da construção civil tem sido estudados em condições de cimentação de poços de petróleo. Vários produtos testados tem apresentado desempenho superior aos produtos normalmente empregados pela indústria de petróleo com boa relação custo/benefício em função do volume de mercado da construção civil. Resultados promissores na seleção de aditivos com função dispersante da construção civil para operações de cimentação de poços de petróleo onshore foram obtidos para temperaturas até 80°C. O potencial de uso desses aditivos permite estabelecer novas soluções para problemas encontrados na cimentação de poços de petróleo HPHT, poços sujeitos à injeção de vapor, poços depletados e poços produtores de gás. Na construção civil, os superplastificantes permitem reduzir o fator água/cimento das argamassas proporcionando melhoria de propriedades como resistência mecânica e fluidez. Assim, o objetivo deste trabalho foi o estudo e a caracterização reológica de pastas constituídas de cimento Portland, água e aditivos do tipo plastificante, com função dispersante a base de naftaleno condensado e policarboxilato, na faixa de temperaturas de 58°C e 70ºC. As condições utilizadas para a avaliação dos aditivos alternativos foram baseadas em uma cimentação primária para um poço hipotético de 2200 m de profundidade e gradientes geotérmicos de 1,7°F/100 pés e 2,1°F/100 pés. Os resultados demonstraram a grande eficiência e o poder dispersivo do policarboxilato para as temperaturas estudadas. O aditivo promoveu alta fluidez, sem efeitos de sedimentação da pasta. O dispersante à base de naftaleno reduziutant o a viscosidade plástica como o limite de escoamento acimada concentração a partir de 0,13%. O modelo de Bingham descreveu bem o comportamento reológico das pastas com policarboxilato para todas as concentrações

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Among the industries, those that produce ceramic porcelain for use in construction industry and oil, during the exploration and production period, play an important role in the production of waste. Much research has been carried out both by academia and the productive sector, sometimes reintroducing them in the same production line that generated them, sometimes in areas unrelated to their generation, as in the production of concrete and mortar for the construction, for example, but each one in an isolated way. In this research, the aim is to study the combined incorporation of the waste drill cuttings of oil well and the residue of the polishing of porcelain, generated in the final stage of finishing of this product in a clay matrix, for the production of red pottery, specifically bricks, ceramic blocks and tiles. The clay comes from the municipality of São Gonçalo, RN, the drilling waste is from the Natal basin, in Rio Grande do Norte, and the residue of the polishing proceeds from a ceramic porcelain of the State of Paraíba. For this purpose, we used a mixture of a plastic clay with a non-plastic, in a ratio of 50% each, settling formulations with the addition of these two residues in this clay matrix. In the formulations, both residues were incorporated with a minimum percentage of 2.5% and maximum of 12.5%, varying from 2.5% each, in each formulation, which the sum of the waste be no more than 15%. It should be noted that the residue of the polishing of ceramic porcelain is a IIa class (not inert). The materials were characterized by XRF, XRD, TG, DTA, laser granulometry and the plasticity index. The technological properties of water absorption, apparent porosity, linear shrinkage of burning, flexural tensile strength and bulk density were evaluated after the sintering of the pieces to 850 °C, 950 °C and 1050 °C, with a burning time of 3 hr, 3 hr and 30 minutes, and 3 hr and 50 minutes, respectively, with a heating rate of 10 °C/minute, for all formulations and landing of 30 minutes. To better understand the influence of each residue and temperature on the evaluated properties, we used the factorial planning and its surfaces of response for the interpretation of the results. It was found that the temperature has no statistical significance at a 95% of reliability level in flexural tensile strength and that it decreases the water absorption and the porosity, but increases the shrinkage and the bulk density. The results showed the feasibility of the desired incorporation, but adjusting the temperature to each product and formulation, and that the temperatures of 850 °C and 950 °C were the one that responded to the largest number of formulations

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Fibromyalgia (FM) is a chronic rheumatic syndrome characterized by diffuse muscle-skeletal pain, and aerobic exercises represent a fundamental portion in therapeutic approach. Objective of this study was to evaluate the effectiveness of aerobic exercises accomplished in the water of the sea (thalassotherapy) for women with FM and to compare with exercises accomplished in the swimming pool, involving a multidisciplinary team, composed by rheumatologists, physical therapists, students of physical therapy and students of physical education. Forty six (46) women with age between 18 and 60 years with FM were randomized in 2 groups: a swimming pool group (23 patients) and a sea group (23 patients). 80th groups trained a week with the same program of aerobic conditioning 3 times (60 minutes each) for 12 weeks. Ali the patients were evaluated, before and immediately after treatment, with Visual Analogical Scale (VAS) for pain and fatigue, number of tending points, Fibromyalgia Impact Ouestionnaire (FIO), Short Form 36 Health Survey (SF-36), Pittsburgh Sleep Ouality Index (PSOI) and Beck Oepression Inventory (BOI). For statistical analysis, it was used paired-t test for analysis intra-group and non-paired test for inter-groups analysis, significance levei of p <0,05. Four patients, of each group, didn't complete the training programo Groups were homogeneous and they were compared in initial evaluation, except for BOI (p <0,05). Both groups presented statistically significant improvement for ali appraised parameters in the post-treatment compared with initial evaluation, there were reduction of intensity of pain and fatigue, number of tending points, better functional capacity (FIO), life quality (SF-36), quality of sleep (PSQI) and depression indexes (BOI). However, in comparison among the groups, group of sea (thalassotherapy) presented better results for ali parameters, however with statistically significant difference just only for depression indexes (BOI). At the end, it was observed that accomplishment of aerobic exercises in sea water or swimming pool was effective as part of treatment for patients with FM. However, exercise programs with thalassotherapy seems to bring more benefits, mainly related to emotional aspects, could be a therapeutic option of low cost for patients with FM in our area

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PURPOSE: Stroke is a high-incidence cerebrovascular disease with elevated morbidity that results in impairments such as functional disabilities. This study aimed to investigate the functional evolution of individuals in the first six months post-stroke. METHOD: Longitudinal study with 42 stroke patients. The functional independence measure (FIM) and The National Institutes of Health Stroke Scale (NIHSS) were used by multidisciplinary staff 3 times in each participant; the first application was at admission to rehabilitation and the others three and six months later. RESULTS: Sample predominantly female (57%), married (52%), mean age 65.26 ±10.72 years, elementary schooling level (43%), ischemic stroke (91%), and right cerebral hemisphere (74%). Motor FIM scores and NIHSS scale showed improvement in the 3 evaluations, with significant p-value (<0.001). There was a strong relation between motor FIM evolution and NIHSS evolution (r = - 0.69 p-value< 0.001). CONCLUSIONS: It was observed that functional evolution at 6 months post-stroke was significant and the smaller the evolution of clinical impairment in these patients, the larger the evolution of their functional independence. The study is important because it allows a more appropriate therapeutic planning according with functional evolution in stroke rehabilitation

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Despite the observation of an increase in life expectancy in individuals with Spinal cord injury (SCI), it is lower than that of the general population. Studies have shown that affected individuals have a sedentary lifestyle that reflects negatively on health and quality of life. Studies have demonstrated that HDL cholesterol (HDL-C) levels, a high-density lipoprotein and important predictor of cardiovascular disease, are lower in this population exposing these people to a greater incidence of heart disease from atherosclerotic process In the general population, exercise increases HDL-C serum levels, but this phenomenon is not very clear in people with spinal cord injury (SCI). The present study examined the effect of both swimming and wheelchair basketball in the lipid profile of eleven men and seven women with SCI. The subjects included in regular exercise programs showed increases in HDL-C levels and decreases in CT/HDL-C and LDL-C/HDL-C ratios. We found better results mainly in men with lower levels of SCI and in those that sustained exercise intensities above 60% of the heart rate reserve. The duration of training sessions can be an essential factor in these results. The results suggest that both the exercise prescription and the personal characteristics of people with SCI influence changes in the lipid profile mediated through exercise. The elaboration of this work is an attempt to clarify uncertainties about health and the longevity of people with SCI generated in discussion of all members of the interdisciplinary rehabilitation team, especially the physiotherapists, nutritionists, nurses and physicians that contributed considerably in all phases of the research

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This study aimed at assessing the interobserver reliability of the Brazilian-Portuguese version of the Berg Balance Scale (BBS). The assessment was made by physiotherapists with extensive or little clinical experience in non-institutionalized elderly individuals. Participants comprised 12 elderly subjects (10 women and 2 men) with mean ages of 75.8 ± 8.4 years (range = 63-87) and 18 physiotherapists with varying clinical experience. Inter-examiner reliability obtained for each scale item yielded weighted kappa value > 0.75 in 11 of the 14 items (varying from 0.37 to 1.0). The intra-class correlation coefficient (ICC) for the total sum of BBS scores between the two groups of physiotherapists was 0.996 (95% confidence interval, 0.987 0.999) with a Cronbach alpha coefficient of 0.996. We found no difference between the rater groups when we compared the sum score means obtained with the student s T-test (p = 0.86). Although some items had low reliability values, in general our results suggest that the Brazilian Version of the BBS showed good levels of interrater reliability and agreement when used by physiotherapists with different clinical practice levels and without previous training on non-institutionalized elderly patients. We concluded that the BBS can be useful as an important evaluation instrument on a protocol for Rehabilitation clinics. It may be used by various health professionals, as: Physicians, Physical therapists, Physical educators, Occupational therapists, Nurses and Phonoaudiologists, so confirming the interdisciplinary character of this study

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O presente estudo objetivou analisar as características epidemiológicas das condições de saúde bucal de 98 idosos de uma Instituição de Longa Permanência para Idosos (ILPI) e de 125 participantes de Grupos de Convivência, de bairros periféricos, socialmente semelhantes, de Fortaleza, Ceará, Brasil, para orientação do tratamento odontológico. Investigou-se a autopercepção em saúde bucal desses idosos a fim de realizar uma avaliação comparativa entre eles e com os levantamentos epidemiológicos de base nacional (SB Brasil) e de base estadual (SB Ceará). Devido a alguns idosos da ILPI recusarem o tratamento dentário e a identificação do elevado percentual de demenciados, optou-se por realizar uma avaliação cognitiva, o Mini Exame do Estado Mental (MEEM) visando identificar os aptos à reabilitação oral. Métodos: abordagem epidemiológica do tipo transversal, sendo a coleta de dados realizada por cinco examinadores, utilizando os critérios recomendados pela OMS (1997). Resultados: O CPO-D médio encontrado na ILPI, foi de 29,88, com predomínio do componente perdido (93,27%) enquanto o CPO-D médio dos não institucionalizados fixou-se em 30,17, com predomínio do componente perdido (63,70%). Também se avaliou o uso e a necessidade de prótese dentária: dos residentes na ILPI, 10,20% usavam prótese superior e 3,06%, inferior; 94,90% necessitavam de prótese superior e 97,96% de inferior; sendo a prótese total foi o tipo mais prevalente, 88,78% para ambos os arcos. O percentual do uso de prótese dos não institucionalizados foi 71,20% no arco superior, sendo 66,40% prótese total; já para o arco inferior, 32,80%, das quais 31,20% era prótese total. No presente estudo, tanto para uso quanto para necessidade, considerando ambos os arcos, a diferença entre os idosos institucionalizados e não institucionalizados foi estatisticamente significativa pelo teste Qui - quadrado (p<0,001). Como resultado do MEEM, observou-se deterioração cognitiva (escore ≤ 12) em 37,25% dos entrevistados, bem como um declínio cognitivo com o avanço da idade. Conclusões: Os resultados apontam que há um maior percentual de uso de prótese total no arco superior e maior frequência quanto à ausência de próteses de qualquer tipo no arco inferior. Evidenciou-se que os idosos pesquisados foram submetidos a tratamento mutilador e, como consequência necessitam de reabilitação oral, o que pressupõe a necessidade de políticas públicas para que isso ocorra efetivamente. Os participantes deste estudo caracterizam-se por uma autopercepção positiva da sua saúde bucal, a despeito das condições clínicas insatisfatórias e de precária saúde bucal, com acentuada prevalência de cárie dentária e edentulismo. O MEEM revelou deficiência cognitiva na maioria dos idosos, confirmando que a sua aplicação, previamente à reabilitação oral pode evitar desperdícios financeiros.Tais achados refletem a necessidade de implantação de políticas reabilitadoras em saúde bucal voltadas para o idoso; baseadas na perspectiva da integralidade como princípio doutrinário do Sistema Único de Saúde, o que redundaria numa melhor qualidade de vida, tanto pela melhor mastigação, digestão e nutrição, pelo maior aproveitamento dos alimentos, quanto pelo favorecimento à comunicação, pela dicção e fala, contribuindo para a socialização e consequente elevação da autoestima dessa clientela.

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Contextualization: Several studies have examined the mobility of this group of children, however little is known about the impact of motor function in activities of daily living, considering the seriousness of their neuromotor damage. Objective: Identify the functional differences of children with Cerebral Palsy with different levels of motor dysfunction and correlate these differences with the areas of mobility, self-care and social function in functional ability and caregiver´s assistance of these children. Methods: An l analytical cross-section search was developed, which were part 70 children / families aged from 4 to 7.5 years, in the Rehabilitation Center for Children. As tools were used the Pediatric Evaluation Disability Inventory (PEDI) and the Gross Motor Function Classification System (GMFCS). Data analysis was performed by ANOVA and Pearson's correlation tests. Results: The results show the functional variability of children CP in different severity levels of motor disfunction This variation was observed in the areas of mobility, self-care and social function. The results also showed a strong correlation between the domains mobility and self-care, mobility and social function. Conclusions: The variability shown by the children with CP, suggests the use of PEDI and GMFCS as this association appears to increase the understanding of how the gross motor functions are related to activities of daily living, describing the best commitments and their degree of impact on functional activities. This correlation demonstrates how mobility is crucial to evaluate the performance and guide the therapeutic practice, to develop the children´s potencial, and guide the caregiver in stimulation

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Introduction: Chagas Disease is a serious public health problem, with 5 million infected individuals in Brazil. Of these, approximately 30% develop chronic Chagas cardiomyopathy (CCC), where the main symptoms are fatigue and dyspnea. Objective: To correlate maximal exercise capacity with pulmonary function, inspiratory muscle strength and quality of life in patients with CCC. Methodology: Twelve individuals suffering from CCC were evaluated (7 men), with a mean age of 54.91± 8.60 years and the following inclusion criteria: functional class II and III according to the New York Heart Association (NYHA); left ventricle ejection fraction below 45%; clinical stability (> 3 months); symptom duration > 1 year, body mass index (BMI) < 35Kg/m2 and non-smokers or ex-smokers with a history of smoking <10 packs/day. All subjects were submitted to spirometry, manometer testing, maximal cardiopulmonary exercise testing (CPX) and a quality of life questionnaire (Minnesota). Results: A negative correlation was observed between VO2máx and MLHFQ scores (r=-0.626; p=0.03) and a positive association with MIP (r=0.713; p=0.009). Positive correlations were also recorded between MIP and spirometric variables [FEV1(r=0.825;p=0.001 ), FVC(r=0.66;p=0.01 and FEF25-75%(r=0.639;p=0.02)]. Conclusion: The present study demonstrated that in patients with CCC: VO2MAX is directly related to inspiratory muscle strength and quality of life, while deteriorating lung function is directly associated with respiratory muscle weakness

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Introdução: Os idosos constituem os maiores consumidores dos serviços de saúde, especialmente os de reabilitação, tornando imprescindível a avaliação da qualidade da assistência fisioterapêutica prestada. A satisfação do paciente tem sido considerada uma das melhores e mais eficazes formas de avaliar o cuidado e direcionar o provedor do serviço para suprir as necessidades e expectativas do paciente-cliente. O objetivo deste estudo foi investigar os principais aspectos (preditores) que contribuem para a satisfação do paciente geriátrico com o tratamento fisioterapêutico ambulatorial. Métodos: Trata-se de um estudo com enfoque epidemiológico, transversal e descritivo de cunho exploratório. Foi utilizado o instrumento de avaliação da satisfação do paciente com a fisioterapia, desenvolvido e validado para a população brasileira por Mendonça em 2007, com uma escala de satisfação do paciente composta por 23 itens. Os dados foram coletados na sala de espera de 29 clínicas de Fisioterapia da rede privada da capital do RN/Brasil e a amostra selecionada de forma não-probabilística constou de 221 pacientes com idade superior a 60 anos, que realizaram entre 5 e 60 sessões de fisioterapia onde os dados foram coletados, deveriam ser usuários de plano de saúde e ter condições cognitivas preservadas. Resultados: A análise fatorial indicou a existência de quatro fatores com autovalor maior que 1: interação pacienteterapeuta (7 itens) α = 0,901; acesso e atendimento de recepcionista e pessoal de apoio (8 itens) α = 0,888; ambiente físico e satisfação global (5 itens) α = 0,835; e conveniência (3 itens) α = 0,711. Os itens com maiores escores de satisfação completa foram os contemplados nos aspectos de interação paciente-terapeuta, especialmente o respeito e a gentileza do fisioterapeuta. As associações realizadas através do teste do Qui-quadrado e regressão logística binária entre a satisfação do paciente e as variáveis sócio-demográficas, percepção do estado de saúde e capacidade funcional demonstraram que a satisfação do paciente idoso associa significativamente com o sexo e estado civil. Os achados revelam que as mulheres mostram-se mais satisfeitas com a fisioterapia. Conclusão: Os aspectos interpessoais demonstraram ser preditores relevantes para assistência fisioterapêutica satisfatória, especialmente na população idosa que requer atenção além do suporte puramente técnico

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Uma grande quantidade de informações dá suporte à relação existente entre inatividade física e processos inflamatórios latentes em distúrbios metabólicos. O objetivo deste trabalho foi acessar criticamente o corpo de evidências existentes na literatura sobre a associação entre programas de exercícios físicos e os níveis de biomarcadores inflamatórios em mulheres entre 18 e 82 anos de idade. Foram realizadas buscas bibliográficas sistemáticas usando as bases de dados PubMed Medline, Cochrane Central Register of Controlled Trials, Web of Science, LILACS e SciELO de publicações entre janeiro de 1993 e janeiro de 2012 usando os seguintes termos: inflamação, citocinas, exercícios, treinamento físico, treinamento aeróbico, treinamento cardiovascular, treinamento de força, treinamento contra resistência, treinamento intervalado, reabilitação cardíaca e gerenciamento/modificação terapêutica de estilo de vida. Do total de estudos incluídos na revisão, três deles reportaram mudanças não significativas nos níveis de biomarcadores inflamatórios, um estudo documentou um aumento nos biomarcadores e 12 estudos reportaram decréscimos nos níveis de biomarcadores inflamatórios associados com exercício. Características secundárias do estilo de vida, como trabalho físico extenuante e fumo, afetaram os níveis de biomarcadores inflamatórios. Intervenções integrativas incluindo dieta, exercício aeróbico moderado (60% a 80% da frequência cardíaca máxima ou 50% a 60% do VO2Máx), treinamento contra resistência em circuito (8 a 10 exercícios, 8 a 12 repetições), aconselhamento e educação voltados para a saúde, usados conjuntamente, se apresentaram como possíveis estratégias efetivas na melhoria nos níveis de biomarcadores inflamatórios em mulheres

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The Back School has been used to prevent and to treat back pain since 1969, however its effectiveness still is controversy in literature. The objective of this study was to evaluate the effectiveness of a program of "Back School" in patients with nonspecific chronic low back pain, directed by rheumatologists and orthopedic doctors to Physiotherapy School Clinic of Universidade Potiguar (UnP) Natal/RN- Brazil, in period of May/2002 to December/2003. Seventy patients, with age varying from 18 to 60 years, were randomized in two groups: Experimental group (group A) with 34 patients, which was subdivided in groups with 6 to 8 components. This group participated of a theoretician and practical program of Back School with 4 lessons, one day per week, with 60 minutes of duration; to the Control group (group B), with 36 patients, was explained that the group should stay four months in a waiting list . Both groups, had been carried through three evaluations, by a blind, to patient group, independent observer: initial evaluation, after four and sixteen weeks. The following variables were analyzed: pain intensity, measured by analog visual scale (AVS), functional disability, measured by disability questionnaire of Roland and Morris and the spinal mobility measured by Schöber s method. In statistical analysis it was used variance analysis ANOVA, the test of Newman-Keuls multiple comparations, and the Pearson correlation coefficient, with significance level p<0.05. Thirteen patients (18,6%) didn t complete the evaluations, (5 from experimental group and 8 from control group). At last, 57 patients were studied, (29 from Experimental group and 28 from Control group), it was observed a significant statistical improve just for Experimental group in variables pain intensity (p=0,0001), functional disability

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The work has objective to present actions of Physiotherapy, developed by SUS in the State of Rio Grande do Norte; discuss under the humanization point of view such actions of health; discuss the importance of physioterapy to the Norte-Riograndense, or maybe its role in the perpetuation of actions of health centered in the binomial cause/efect. The study was done in the State of Rio Grande do Norte. The data were obtained through public sources gathered in the health secretrary ship of this State. The collected data talks about physiotherapy sections developed by SUS in several areas of the State; such data was collected and analysed after the aproval of Ethic and Resarch Committee of Federal University of Rio Grande do Norte. Concerning the physiotherapy, along with the State Health Secretaryship of the State fo Rio Grande do Norte, there were only records of attending based on cure/rehabillitation, not being observed during the curse of study, any record or action of prevention, promotion and protection towards health. It s possible to notice that there is a highligth to the interventions focusing on the treatment of illness of rheumatic origin and general complaints related to the vertebral column. Such research evidenced that the Physiotherapy in the SUS in the State priorizes the individualized attending centered in the carteziano health/illness model, where the developde actions are turned to the curative and rehabilliting attention, with role fo some or no highligth in the primary attention