Exercício físico de baixa intensidade na dpoc: comparação dos programas solo e aquático

Physical Exercise (PE) is a necessary component in the management in COPD patients, where respiratory symptoms are associated with reduced functional capacity. Even with the increase in the number of studies that have been published and the therapeutics success using aquatic therapy approach, studies using PE in water in COPD patients are so few. Objective: the aim of this present study was to analyze the effects of low intensity water exercise in COPD patients, developed in two different places aquatic and ground. Methods: This is a randomized clinical trial study, 42 patients with moderate to very severe DPOC were recruited for the study, mean age of 63,2  10,9 years old. Randomized in 3 groups: Control Group (CG), Land Group (LG) and Water Group (WG). The PE protocol was performed in a period of 8 weeks, with frequency of 3 times per week. The CG participated in an educational program. All the patients were assessed twice through spirometry, respiratory muscular strength, the 6-min walk test, the quality of life (SF-36 and SGRQ), the LCADL, the MRC, the BODE index and the upper limbs (UP) incremental test. Results: There was a significant difference after the approaches in DP6 from the WG (p=0,02); in VEF1 in LG (p=0,00) and WG (p=0,01); in MIP in LG (p=0,01) and WG (p=0,02); in MEP in LG (p=0,02) and WG (p=0,01); the MRC decreases in WG (p=0,00). there was an increase of the weight supported by the UP in LG (p=0,00) and WG (p=0,01). The LG showed an increase of the quality of life represented by the SGRQ total score (p=0,00). The BODE index decreased in LG (p=0,00) and WG (p=0,01). In LCDAL, the LG showed a decrease. Conclusion: This data in this present study suggest that both approaches of low intensity exercise showed to be beneficial in moderate to very severe COPD patients. The WG showed additional benefits in physical function, pointing to a new therapeutic modality for COPD patients

Efeitos da perda de peso induzida pela cirurgia bariátrica sobre a função respiratória

Background: Obesity leads to alteration of lung volumes and capacities due to accumulation of fat in the chest wall and abdomen. Few studies have shown that weight loss induced by surgery improves lung function. Our objective was to evaluate the anthropometric development, pulmonary function, respiratory muscle, strength and endurance after weight loss induced by bariatric surgery. Methods: We evaluated in pre and post operative period variables of weight, BMI, NC, WHR and spirometric and respiratory pressure. Results: 39 subjects were evaluated, with age mean 35.9 ± 10.9 years, predominantly by women (76.3%). The weight mean decreased from 124.8 ± 17.5 kg to 88.8 ± 14.28 kg in post operative. The mean BMI ranged from 47,9 ± 5,6 Kg/m² to 34,3 ± 4,75 Kg/m². There was a significant increase in FVC from 3,63 ± 0,94 to 4,01±1,03, FEV1 from 3,03 ± 0,72 to 3,39 ± 0,85, FEF 25-75% from 3,41 ± 0,72 to 3,82 ± 0,94, PEF from 6,56 ± 1,47 to 7,81 ± 1,69, ERV from 0,35 ± 0,39 to 0,66 ± 0,38, MVV ranged from 103,43 ± 22,21 to 137,27 ± 29,84, all of them to p<0,01. The MIP and MEP showed no significant difference in pre and post operative. It was noted that for every centimeter reduced in neck circumference, an increase of 0.06 in FVC and 5.98 in MVV is observed. This is also observed in weight and BMI. Conclusion: We conclude that weight loss induced by bariatric surgery in obese provides a significant improvement in lung function and reduction of fat around the neck is more important in the generation of lung volume than the reduction of BMI

Efeito do tempo de repouso após fadiga induzida no desempenho neuromuscular do quadríceps femoral: ensaio clínico, controlado, randomizado, cego

Objective: To evaluate the effect of different resting periods, after induced muscle fatigue, in the quadriceps femoris neuromuscular performance, in healthy subjects. Methods: Sixty-four volunteers, of both genders, with an average of 21,8 ± 1,7 years and mean body mass index of 24,2 ± 3,7 Kg/m2 were randomly assigned into 4 groups: control group (was not induced fatigue); Experimental Group 1 (Exp. 1 1 minute of rest after fatigue); Experimental Group 3 (Exp. 3 3 minutes of rest after fatigue) and Experimental Group 5 (Exp. 5 5 minutes of rest after fatigue). The subjects were evaluated to the knee´s joint position sense (JPS), followed by 5 flexion-extension knee concentric isokinetic contractions at 60°/s, with concomitant recording of median frequency (Fmed) of rectus femoris (RF), vastus lateralis (VL) and vastus medialis (VM). Then they underwent a muscle fatigue protocol (30 flexion-extension knee concentric contractions at 60°/s) and were reevaluated on the isokinetic performance, Fmed and JPS. Blood lactate levels were measured before initial assessment, immediately after the fatigue protocol and 5 minutes after the end of the rest period. Results: The adoption of 3 minutes of rest was sufficient to restore the initial conditions for the peak torque normalized by body weight and the VL and VM Fmed. The joint position sense returned to its initial values with 1 minute rest. The lactate concentration remained high regardless of the adopted rest period. Conclusion: The use of 3-minute rest period is sufficient for the reestablishment of the neuromuscular parameters to the pre fatigue values.

Exercícios respiratórios para asma: revisão sistemática com metanálise

Introdução: A asma se tornou um problema de saúde pública devido aos seus grandes custos em cuidados de saúde. Os exercícios respiratórios constituem uma intervenção não farmacológica de baixo custo e baixo risco que vem sendo utilizada por fisioterapeutas em diferentes países no tratamento de pacientes asmáticos. Objetivo: Avaliar a eficácia dos exercícios respiratórios no tratamento de pacientes adultos com asma nos seguintes desfechos: qualidade de vida, sintomas da asma, número de exacerbações agudas, episódios de hospitalização, mensurações fisiológicas (função pulmonar e capacidade funcional), número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, avaliação subjetiva do paciente em relação à intervenção. Método: Revisão sistemática de estudos controlados randomizados com metanálise realizada em parceria com a Colaboração Cochrane. As seguintes bases de dados foram consultadas: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, e PsycINFO, além de busca manual em revistas da área e em resumos de congressos. Os seguintes termos foram utilizados: (breath*) and (exercise* or retrain* or train* or re-educat* or educat* or physiotherap* or "physical therap*" or "respiratory therapy" or buteyko ). As listas de referências dos estudos selecionados e registros de ensaios clínicos também foram consultados. A seleção dos estudos e a avaliação do risco de viés dos estudos incluídos foram realizadas de maneira independente por dois revisores. O software Review Manager foi utilizado para análise dos dados, no qual o modelo de efeito fixo foi utilizado. As variáveis contínuas foram expressas como diferença de média ponderada com um intervalo de confiança de 95%. A heterogeneidade dos resultados dos estudos incluídos foi realizada por meio da análise dos Forest plots. O teste qui-quadrado (Chi2) com um P valor de 0.10 foi utilizado para indicar significância estatística. O Índice de heterogeneidade (I2) foi implementado com um valor acima de 50% como um nível substancial de heterogeneidade. Resultados: 13 estudos envolvendo 906 pacientes estão atualmente incluídos na revisão. Os seguintes desfechos foram mensurados pelos estudos incluídos: qualidade de vida, sintomas da asma, número de exacerbações agudas e função pulmonar. Os estudos relataram uma melhora na qualidade de vida, sintomas da asma e número de exacerbações agudas. Seis dos onze estudos que avaliaram função pulmonar mostraram uma diferença significativa favorável aos exercícios respiratórios. Não houve relato de efeitos adversos. Devido à heterogeneidade substancial encontrada entre os estudos, metanálise foi possível apenas para sintomas da asma, a qual incluiu dois estudos e mostrou uma diferença significativa favorável aos exercícios respiratórios. A avaliação do risco de viés foi prejudicada devido ao relato incompleto de aspectos metodológicos pela maioria dos estudos incluídos. Conclusão: Embora os resultados encontrados pelos estudos incluídos demonstraram individualmente que os exercícios respiratórios podem ser importantes no tratamento da asma, não há evidência conclusiva nesta revisão para suportar ou refutar a eficácia desta intervenção no tratamento de pacientes asmáticos. Este fato foi devido às diferenças metodológicas entre os estudos incluídos e à ausência de relato de aspectos metodológicos por parte da maioria dos estudos incluídos. Não há dados disponíveis em relação aos efeitos dos exercícios respiratórios nos seguintes desfechos: episódios de hospitalização, número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, e avaliação subjetiva do paciente em relação à intervenção

Custos e benefícios de um programa de exercício aeróbios na doença pulmonar obstrutica crônica: ensaio cliníco aleatório controlado

Pulmonary Rehabilitation, especially due to aerobic exercise, positive impact in reducing morbidity/mortality of patients with COPD, however the economic impact with costs of implementing simple programs of aerobic exercise are scarce. This is a blind randomized clinical trials, which aimed to evaluate the costs and benefits of a simple program of aerobic exercise in individuals with COPD, considering the financial costs of the Public Health System and its secondary endpoints. We evaluated lung function, the distance walked during six minutes of walking, the respiratory and peripheral muscle strength, quality of life related to health (QLRH), body composition and level of activity of daily living (ADL) before and after eight weeks of an aerobic exercise program consisting of educational guidance for both groups, control and intervention and supervised walks to the intervention group. The health costs generated in both groups were calculated following table Brazilian Public Health System. The sample consisted of forty patients, two being excluded in the initial phase of desaturation during the walk test six minutes. Were randomized into control and intervention group thirty-eight patients, three were excluded from the control group and one was excluded from the intervention group. At the end, thirty-four COPD comprised the sample, 16 in the control group and 18 in the intervention group (FEV1: 50.9 ± 14% pred and FEV1: 56 ± 0.5% pred, respectively). After for intervention, the intervention group showed improvement in meters walked, the sensation of dyspnea and fatigue at work, BODE index (p <0.01) in QLRH, ADL level (p <0.001) as well as increased strength lower limbs (p <0.05). The final cost of the program for the intervention group was R $ 148.75, including: assessments, hiking supervised by a physiotherapist and reassessments. No patient had exacerbation of IG, while 2 patients in the CG exacerbated, generating an average individual cost of R $ 689.15. The aerobic exercises in the form of walking showed significant clinical benefits and economic feasibility of its implementation, due to low cost and easy accessibility for patients, allowing them to add their daily practice of aerobic exercises

Efeitos agudos do alongamento estático antes e após exercício e as características neuromusculares do membro inferior: estudo controlado, randomizado e cego

Objective: To evaluate the acute effects of static stretching before and after isokinetic exercise, neuromuscular and biomechanical properties of muscles Biceps Femoris (BF) and semitendinosus (ST). Methods: Eighty-nine volunteers of both genders, healthy and physically active, with a mean age of 22.52 ± 2.6 years and mean BMI 23.86 ± 3.2 kg/m² were randomized into 4 groups: Control Group (CG) made only one Protocol Exercise (PE) without performing the stretching, the Experimental Group 1 (EG1) did stretching before PE; EG2 did the stretching after PE and EG3 did stretching before and after PE. The volunteers were evaluated on the following variables: Range of motion (ROM), soreness, dynamometric variables concentric and eccentric, Neuromuscular Latency Time (NLT) and electromyographic. In the data analysis was assigned a significance level of 5%. Results: ADM and TLNM reported significant reduction in CG, but remained unchanged in GE with p<0,05 and p<0,01, respectively. As for the soreness, no differences between the groups. The electromyographic activity of the BF and ST, in the concentric phase, showed a significant decrease in all groups (p<0,01). However, in the eccentric phase, ST revealed reduction in all groups (p <0.01), except for the CG, while the BF remained unchanged in all groups. The PT showed significant reduction in both conditions (concentric and eccentric) for all groups, with no difference between them (p<0,01). Conclusion: The results of this study do not favor the use of static stretching, even of short duration, before physical activity. However, after exercise or at times unrelated to the sport, he should be given with the aim of avoiding muscle shortening

Efeito da crioterapia e da laserterapia na resposta ao dano muscular induzido pelo exercício excêntrico: ensaio clínico e randomizado

Exercise-induced muscle damage mainly affects individuals who returned to physical activity after a time without practicing it or had some kind of exhaustive exercise, particularly eccentric exercise. To evaluate the effect of cryotherapy and laser therapy in response to muscle damage induced by eccentric exercise on the biceps muscle. This was a randomized clinical trial consisting of 60 female subjects. All subjects initially underwent an evaluation consisting of perimetry, measurement of pain sensation (via algometry and visual analogue scale), electromyography and dynamometry. Then the subjects performed an exercise protocol on the isokinetic dynamometer consisting of 2 sets of 10 eccentric elbow flexors contraction at 60 °/s. Completed this protocol, an intervention was held according to a previously random group distribution: control group (no intervention), cryotherapy group and laser therapy group. Finally, subjects were re-evaluated immediately and 48 hours after the intervention protocol, except for Visual Analogue Scale (VAS), which was also evaluated 24 hours after exercise. The circumference of the limb, the pain sensation (VAS and algometry), the muscle activation amplitude (via Root Mean Square - RMS), median frequency, peak torque normalized per body weight, average peak torque, power and work were analyzed. The median frequency immediately after the intervention protocol on the cryotherapy group was the only variable that showed inter and intra-group differences; the remaining variables showed only intragroup differences. The perimetry values did not change immediately after the protocol on the groups which underwent cryotherapy and laser therapy, however, there was an increase after 48 hours; algometry values decreased in all groups for 48 hours and the VAS values increased 24 and 48 hours also for all groups. Regarding RMS no significant change was observed. For dynamometry, peak torque normalized per body weight and average peak torque had a similar behavior, with a reduction in the post protocol that has remained after 48 hours. For the power and work, a decrease was observed immediately after the protocol with a further reduction after 48 hours. Cryotherapy and laser therapy does not alter the muscle damage response, except for the perimetry values immediately after exercise.

Um ensaio sobre as concepções de professores de Matemática: possibilidades metodológicas e um exercício de pesquisa

Este artigo tem como tema principal as concepções dos professores de Matemática. Considerando o termo concepção a partir do pragmatismo de Peirce, elabora-se um conjunto de parâmetros metodológicos - chamado de método indireto - a ser aplicado no estudo das concepções de professores de Matemática. Trata-se, em síntese, de investigar as concepções dos professores interpelando-os não sobre suas crenças, mas sobre suas práticas. Fundamentando essa abordagem indireta e explicitando-a em sua natureza qualitativa, o artigo segue apresentando, como exemplo, um exercício desse método indireto: um estudo sobre os critérios que os professores utilizam quando escolhem livros-texto para sua sala de aula, abordando, conseqüentemente, quais concepções de Matemática e de seu ensino e aprendizagem tais critérios desvendam. Partindo de depoimentos de professores de Matemática, o estudo indica que os professores agem com certa independência quando escolhem os materiais utilizados em suas atividades docentes. Buscam, ao mesmo tempo, apoio em uma vasta gama de livros didáticos, desconsiderando as particularidades de cada obra e as abordagens e perspectivas defendidas por seus autores. Embora submetam-se ao livro didático - considerado uma referência legítima e segura -, os professores o subvertem, buscando adequá-lo ao que consideram correto. Dessa constatação, algumas das concepções dos professores podem ser realçadas: o aluno, via de regra, é avaliado e classificado pelas lacunas que apresenta em relação aos conteúdos. Dessa postura, segue a valorização da precedência lógica dos conteúdos, de sua apresentação linear, e a defesa de pré-requisitos que viabilizariam o ensino e, conseqüentemente, implicam a legitimidade de aulas predominantemente expositivas.

Levomepromazina e acepromazina no bloqueio da arritmia induzida pela adrenalina em cães anestesiados pelo halotano

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Emprego da levomepromazina no bloqueio da arritmia induzida pela adrenalina em cães anestesiados pelo Sevoflurano

Este experimento objetivou estudar o possível efeito antiarritmogênico da levomepromazina em cães anestesiados pelo sevoflurano e submetidos a doses crescentes de adrenalina. Para tal, foram empregados 21 animais adultos, machos e fêmeas, sem raça definida e considerados sadios. Os cães foram separados em dois grupos, sendo um de 11 (G1) e outro de 10 (G2) animais. O G1 recebeu, por via intravenosa, solução salina a 0,9%, na dose de 0,2ml/kg (placebo), seguida 15 minutos após, pela aplicação de tiopental, pela mesma via, na dose suficiente para abolir o reflexo laringotraqueal. Procedeu-se à intubação orotraqueal e iniciou-se a administração de sevoflurano a 2,5V%, em circuito anestésico semi-fechado. Decorridos 20 minutos da indução anestésica, iniciou-se a administração contínua, por via intravenosa, com emprego de bomba de infusão, de solução de adrenalina a 2%, em doses crescentes de 1, 2, 3, 4 e 5m g/kg/min (M1 a M5, respectivamente), com incremento da dose a intervalos de 10 minutos. Para o G2, empregou-se a mesma metodologia substituindo-se o placebo por levomepromazina, na dose de 1mg/kg. Foi tomado o traçado eletrocardiográfico, na derivação D2, a partir da indução da anestesia. Para efeito estatístico, foi considerado o número total de batimentos cardíacos de origem não sinusal, coincidentes com cada dose de adrenalina. Os dados numéricos foram submetidos à Análise de Perfil, quando foi possível constatar que as médias do G1 foram crescentes de M1 a M3, diminuindo a partir deste último, até M5. No G2, foi encontrada arritmia ventricular sustentada apenas em M5. Os achados permitiram concluir que a levomepromazina minimiza a arritmia ventricular sustentada, induzida pela adrenalina em cães anestesiados pelo sevoflurano.

A Perda Auditiva Induzida pelo Ruído (PAIR) na formação odontológica: conhecimentos e níveis de exposição

The rationalization of work in the Dentistry has been taking the professional to work for ways and systems based in the ergonomics, turning their work efficient and less tiring. Since their academic formation, the dentists surgeons are concerned with the high productivity in clinic and with the final result of the work, neglecting the way as it is executed, which reduce their work capacity and exhibits them to occupational diseases that could be minimized and/or forewarned. This research had as the main objective to investigate the knowledge of the Dentistry academics of Rio Grande do Norte Federal University concerning the Noise-induced Hearing Loss (NIHL), relating them at the noise levels that they are exposed, as well as to the preventive measures taken during the clinical activities. Was observed that 95% of the individuals know that the dentist surgeon is a professional in risk for NIHL. Among the causes of NIHL, the one that obtained the largest frequency citation was the high-speed handpieces, reminded by 92,4% of the academics. Among the students which enumerated protective measures for NIHL, 92% mentioned the use of the ear plugs, although 97% of the researched have told do not use any kind of preventive measure related to the noise. Was also observed that 96% of the academics notice the noise during the clinical attendance, what inconvenience 28,1% of them. Related the noise levels, the high-speed handpieces of the academics presented a medium value of 80,5 dB varying from 72,3 to 88,3 dB. The average of the ambient noise observed at the Integrated Clinic was about 74,8 dB. In spite of the noise levels in this research were observed below the established limits of tolerance by the legislation, they can provoke damages to the Dentistry professionals' health, or that suggests the need of an intervention and use of immediate preventive measures able to generate a healthy atmosphere of work and less risky

Efeito do exercício físico matinal realizado sob luz solar no ciclo vigília-sono de adolescentes

The sleep onset and offset delay at adolescence in relation to childhood. Besides biological causes, some external factors as academic obligations and socialization contributes, increasing the burden of school and socialization. However, morning school schedules reduce sleep duration. Besides light strong effect, studies in humans have indicated that exercise influence circadian synchronization. To evaluate the effect of the morning exercise under sunlight on sleep-wake cycle (SWC) of adolescents, 160 high school students (11th year) were exposed to the following conditions: lesson in usual classroom (Group C), lesson in swimming pool exposed to sunlight (Group E), half of them carrying through physical activity (EE) and the other resting (EL). Each experimental group met two stages: assessment of SWC 1 week before and 1 week during the intervention, which was held in Monday and Wednesday between 7:45 and 8:30 am. In the baseline, there were applied the questionnaires "Health and Sleep" and cronotype evaluation (H & O). In addition, students were evaluated before and during the intervention by "Sleep Diary", "Karolinska Sleepiness Scale" (KSS), Psychomotor Vigilance Test (PVT) and actimetry. During the intervention, there was a delay in wake-up time on the weekend and a trend to greater sleep duration on week for the three groups. At the weekend, only the groups EE and EL increased sleep duration. There was no difference in bedtime, irregularity of sleep schedules and nap variables. The sleepiness showed a circadian pattern characterized by higher alertness levels at 11:30 am and sleepiness levels at bedtime and wake-up time on week. On weekends there were higher levels of alertness in these times. In the days of intervention, there was an increase of sleepiness at 11:30 am for groups EL and EE, which may have been caused by a relaxing effect of contact with the water of the pool. In addition, the group EE showed higher alert levels at 14:30 pm on Monday and at 8:30 am in the Wednesday, possibly caused by exercise arousal effect. The reaction time assessed through the TPV did not vary between the stages. The sleep quality improved in the three groups in the second stage, making impossible the evaluation of intervention effect. However, the sleep quality increased on Monday and Tuesday only on the group EE. From the results, it is suggested that the intervention promoted effects on the sleepiness at some day hours. In other SWC variables there were no effects, possibly due to a large SWC irregularity on weekends. Thus, the evaluation of higher weekly frequency EF is necessary, since only two days were insufficient to promote greater effect on adolescents SWC

Mudanças endógenas e suprafisiológicas nos níveis de estrógeno: efeitos sobre a amnésia induzida pela escopolamina em ratas intactas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Adaptação e validação da escala de dependência de exercício físico em versão tradicional e informatizada

While providing physical and psychological benefits, excessive exercise could be or cause a compulsive behavior, making the individual dependent on it. In a parallel discussion, computerized psychological instruments, for a hand, reflects the development of information technology and your applicability to other areas, but also shows little advance for Psychological Assessment. In this perspective, this study aims to adapt the Exercise Dependence Scale (EDS-R) in two formats (paper-and-pencil and computerized) and evaluate evidence of factorial and convergent validity, and reliability of each version and compare them with each other. It is also proposed to observe the relationship of some bio-demographic (Sex, age, frequency, duration and intensity of practice exercise) and the exercise dependence (DEF). For this purpose, 709 regular physical activity practitioners, selected by procedures non-probabilistic sampling, responded a adapted version of EDS-R, Muscle Appearance Satisfaction Scale (MASS), Body Modification Scale (BMS) and a demographic questionnaire, analyzed through Exploratory Factor Analysis, Cronbach's Alpha and not parametric tests. Both the traditional version and the computer showed a seven factors structure, explaining 57 and 62% of the variance, respectively, and Cronbach's alphas of 0.83 and 0.89. Factors were: (1) intentionality, (2) continuity, (3) tolerance, (4) reduction of other activities, (5) lack of control, (6) abstinence and (7) time spent on exercise. Relationships were observed between the Exercise Dependence and the variables: age, diets, consumption of food supplements and medicines for weight change, desire to do plastic surgery and body satisfaction. We observed also a positive correlation between the DEF and the frequency, duration and intensity of exercise, and the factor "Dependence on exercising" from MASS, indicating convergent validity of the EDS-R. Finally, comparisons between the two formats were equivalent, with few changes: computerized version achieved higher DEF scores. Based on these results, it can be concluded that the EDS-R has factorial and convergent validity, reliability, to measure exerceise dependence on traditional e computerized formats. DEF is related to actions used to body modification and behaviors toward exercise. Finally, it was found equivalence between the formats, especially in psychometric parameters, thus suggesting feasibility of a computerized assessment. However, it was observed that the computerized data has sample recruiting strategies more limited

Instrumentalidade do serviço social: dimensões teórico-metodológica, ético-política e técnico-operativa e exercício profissional

The dissertation proposes a discussion about the instrumentality of the Social Work, in the attempt of visualizing her, as well as the profession, in a totality perspective to the light of the rationality critical-dialetical. Understood as the capacity that the professional subjects acquire of giving answers to the demands that are placed to the profession, itself built partner-historically, in a teleologys conflicts and causalitys. So, it is proposed the discussion of the instrumentality while a group of you know specific, composed essentially by the development of three practical-formative dimensions. The theoretical-methodological refers to the capacity of apprehension of the method and of the theories and, consequently, of the relationship that does with the practice. The dimension ethical-politics concerns the development of the capacity of analyzing the society and the own profession as field of contradictory forces, being considered the character eminently political of the professional exercise, as well as the professional's conscience concerning the social direction that prints in your intervention. And the technician-operative dimension refers more strictly to the technical elements and you score for the development of the intervention. It was looked for to evidence as those dimensions they attend in the professional exercise, starting from the experience lived by the social workers of the Social Attendance Reference Centers, in Natal/RN