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O racismo estrutural e o projeto moderno-colonizador em curso na América Latina não seriam os mesmos sem as contribuições da ciência moderna ocidental. Contraditoriamente, é também por meio das ciências — sobretudo das ciências sociais — que as colonialidades têm sido contestadas. Inspirados pela crítica decolonial, contamos a história de vida de Waxihô Karajá, um homem indígena Karajá Xambioá que ingressou e abandonou um curso de Biologia. Os resultados ilustram como a educação indígena Iny contribuiu para o desenvolvimento do interesse de Waxihô Karajá por Biologia. Nossa análise também revela que a baixa qualidade da educação básica ofertada em comunidades indígenas; o despreparo das instituições de educação superior para receber a diversidade; as dificuldades experimentadas por jovens oriundos de realidades de baixa escolarização e a energia dispensada por minorias culturais para combater uma miríade de violências coloniais por meio do ativismo estudantil podem comprometer o sucesso acadêmico. Os resultados indicam que a aproximação e o afastamento de cursos de ciências da natureza por jovens indígenas parecem ter motivos ora similares ora distintos daqueles elencados pela pesquisa com jovens da sociedade envolvente. Urge reorientar as políticas de permanência universitária para fomentar o sucesso acadêmico de estudantes indígenas em cursos de ciências da natureza.

Structural racism and the ongoing modern-colonizing project in Latin America would not be the same without the contributions of Modern Western Science. Contradictorily, it is also through the sciences — especially social sciences — that colonialities have been challenged. Inspired by decolonial criticism, we tell the life story of Waxihô Karajá, an indigenous Karajá Xambioá man who entered and abandoned a Biology course. The results illustrate how Iny indigenous education contributed to the development of Waxihô Karajá's interest in Biology. Our analysis also reveals that the low quality of basic education offered in indigenous communities; the unpreparedness of higher education institutions to receive diversity; the difficulties experienced by young people with low-education backgrounds and the energy expended by cultural minorities to combat a myriad of colonial violences through student activism can compromise academic success. Results indicate that the approach and the departure from natural science courses by young indigenous people seem to have reasons that are sometimes similar and sometimes different from those listed in the research with young people from the national society. There is an urgent need to reorient university retention policies to promote the academic success of indigenous students in natural sciences courses.

IntroductionKinesiophobia and lymphedema appear to be related conditions, and it is important to understand this relationship, as many of the symptoms and comorbidities presented by individuals with lower limb lymphedema are prevented and treated through movement, thus constituting kinesiophobia as a barrier to intervention. The objective of this study is, therefore, to evaluate and analyze the kinesiophobic beliefs reported by individuals with and without lower limb lymphedema, regarding the agreement, severity and differences found, and to establish levels of kinesiophobia.MethodsA case-control study with a total sample of 80 participants (40 with lower limb lymphedema and 40 without) was performed. Both groups (with and without lymphedema) were characterized anthropologically, sociodemographically, and clinically. In the case group, lymphedema was evaluated. Participants in both groups completed the Tampa Scale for Kinesiophobia - 13 items (TSK-13).ResultsIndividuals with lower limb lymphedema had higher TSK-13 scores than their matched group without lymphedema. The items belonging to the activity avoidance subscale had the highest agreement and score in both groups. Differences between groups were mainly established for items belonging to the somatic focus subscale, showing that individuals with lower limb lymphedema have kinesiophobic beliefs related to the perceived severity of their lymphedema. The prevalence of kinesiophobia was increased in both groups, but the severity was mild.ConclusionsConsidering the apparent tendency of people with lower limb lymphedema to present kinesiophobia and movement-limiting beliefs regarding the condition, greater attention should be paid to its assessment, prevention and treatment from a multidisciplinary and multimodal perspective, which takes into account the multiplicity of factors inherent to kinesiophobia and lymphedema and thus reduce their impact on the management of lymphedema.

BackgroundCOVID-19 pandemic imposed drastic and abrupt changes to working environment and organization and that might have caused additional negative effects on mental health. Thus, this study aimed to quantify and assess the severity of psychological distress experienced by Brazilian essential and nonessential workers during the first months of the COVID-19 pandemic.MethodsThis descriptive study included 2,903 participants who answered an online questionnaire between April and May 2020. The research questionnaire was translated and culturally adapted to the Brazilian population from a questionnaire developed and validated for the Spanish population. Variables were analyzed using simple and cumulative percentage distributions and measures of central tendency and dispersion. The Wilson score interval was used to calculate confidence interval (CI) for the main outcome, psychological distress.ResultsIt was observed a high prevalence (72.6%) of psychological distress among the study’s participants. They also presented a median risk perception score of 60 (out of a maximum of 90), and their greatest concern was transmitting the virus to family members, close contacts or patients. Furthermore, it was found a lower sense of coherence and work engagement among the participants than those observed in previous studies conducted in other countries.ConclusionAlmost three quarters of the study’s participants were classified as presenting psychological distress. Thus, it is imperative to provide mental health remotely delivered interventions to workers during public health events that require prolonged social distancing measures.

Objectives: To validate the items of the Emotional Impact Questionnaire coronavirus disease-2019 (COVID-19) related to risk perception, estimating its degree, among healthcare workers in the first wave of COVID-19 pandemic, identifying possible associated factors.Methods: cross-sectional study in 1872 healthcare workers of Brazil. The population was characterized by sociodemographic and occupational information, knowledge about COVID-19, quality of information received, risk perception and preventive measures about the disease, and sense of coherence. Results: Being divorced, having a chronic disease, spending more than 1 h per day getting informed about COVID-19, and always or almost always wearing a mask regardless of symptoms, as well as self-perception of health were associated with high-risk perception. An inverse association was found between risk perception, sense of coherence and not knowing if one has had occasional contact with confirmed COVID-19 cases. Conclusion: Risk perception is influenced by emotions, experiences, and knowledge. Sense of coherence and resilience have a role in reducing risk perception. Understanding risk perception is crucial for developing effective strategies to mitigate the impact of the COVID-19 pandemic and other similar scenarios.

ABSTRACT OBJECTIVE To evaluate congenital syphilis prevention actions in primary health care services in the state of São Paulo. METHODS Cross-sectional evaluative research that used indicators extracted from the Survey of Evaluation and Monitoring of Primary Care Services ( Avaliação e Monitoramento de Serviços da Atenção Básica – QualiAB) in the state of São Paulo in 2017. An evaluative matrix composed of 31 indicators of prevention of congenital syphilis, categorized into four domains of analysis: diagnosis and treatment of acquired syphilis (10); basic infrastructure and resources (7); prevention of congenital syphilis during prenatal care (7); and educational actions and prevention of sexually transmitted infections (7). The frequency of services with positive responses for each indicator and the percentage of service performance were calculated based on the proportion of indicators reported per service and the overall average observed. Subsequently, services were classified into four quality groups, and associations between groups and each indicator, type of organizational arrangement and location were estimated. RESULTS 2,565 services participated, located in 503 municipalities, with an overall average performance of 74.9%. The domain “diagnosis and treatment of acquired syphilis” had the highest performance (89.8%), followed by “infrastructure and basic resources” (79.5%), “prevention of congenital syphilis in prenatal care” (73.3%) and “educational actions and prevention of sexually transmitted infections” (56.8%). There was a significant difference between quality groups and all indicators and types of organizational arrangements. CONCLUSIONS The evaluated services have limitations in the development of actions to prevent congenital syphilis, mainly related to health education and actions included in prenatal care, such as screening and adequate treatment of pregnant women and their partners. Changes are needed in the work process, with the expansion of educational and surveillance actions, as well as the qualification of the teams to effectively comply with the protocols.

ObjectivesDepression is a condition that can be associated with other illnesses, especially chronic illnesses. Lower limb lymphedema is a chronic, disabling condition that can affect the quality of life and be related to psychological and psychosocial factors that interfere with people’s lives. This study aims to characterize and analyze the depressive symptoms and their severity reported by people with lower limb lymphedema and compare them with a matched group without lymphedema.MethodsA case–control study was carried out (n = 80) with participants divided into a case group (40 people with lower limb lymphedema) and a control group (40 people without lower limb lymphedema). Both groups were anthropometrically, sociodemographically, and clinically characterized. In the case group, a characterization of lymphedema was performed. Participants completed the Beck Depression Inventory-II.ResultsIndividuals with lower limb lymphedema have higher BDI-II scores than the matched group without lymphedema. Somatic depressive symptoms were, in general, the most reported and the ones with the highest scores. The depressive symptoms most reported by the case group were tiredness or fatigue, loss of energy, and changes in sleeping. Tiredness or fatigue, loss of energy, and loss of interest in sex were the most severe depressive symptoms reported by individuals with lower limb lymphedema.ConclusionConsidering the apparent tendency to depression, greater attention should be given to the mental health of people with lower limb lymphedema.

Abstract Aim To investigate the level of self‐reported work ability and its association with manual patient handling in healthcare workers. Design Cross‐sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Methods A total of 320 healthcare workers answered a self‐administered questionnaire regarding manual patient handling, work ability, occupational factors, occurrence of low back pain and sociodemographic and lifestyle factors from November 2016 to March 2017. The association between manual patient handling and low back pain was analysed with Poisson regression models. Results The prevalence ratio of inadequate work ability was 43.42%. Manual patient handling (PR 1.375, 95% CI 1.038–1.821), bachelor education (PR 2.150, 95% CI 1.272–3.632), less than bachelor education (PR 2.166, 95% CI 1.218–3.855), seniority (PR 1.049, 95% CI 1.024–1.086), poor sleep quality (PR 1.425, 95% CI 1.13–1.796) and presence of low back pain (PR 2.003, 95% CI 1.314–3.052) were all positively associated with an inadequate work ability.

IntroductionHealth affects work absenteeism and productivity of workers, making it a relevant marker of an individual's professional development.ObjectivesThe aims of this article were to investigate whether changes in the main cause of the sick leaves and the presence of mental health illnesses are associated with return to work with readaptation.Materials and methodsA historical cohort study was carried out with non-work-related illnesses suffered by statutory workers of university campuses in a medium-sized city in the state of São Paulo, Brazil. Two exposures were measured: (a) changes, throughout medical examinations, in the International Classification of Diseases (ICD-10) chapter regarding the main condition for the sick leave; and (b) having at least one episode of sick leave due to mental illness, with or without change in the ICD-10 chapter over the follow-up period. The outcome was defined as return to work with adapted conditions. The causal model was established a priori and tested using a multiple logistic regression (MLR) model considering the effects of several confounding factors, and then compared with the same estimators obtained using Targeted Machine Learning.ResultsAmong workers in adapted conditions, 64% were health professionals, 34% had had changes in the ICD-10 chapter throughout the series of sick leaves, and 62% had diagnoses of mental health issues. In addition, they worked for less time at the university and were absent for longer periods. Having had a change in the illness condition reduced the chance of returning to work in another function by more than 30%, whereas having had at least one absence because of a cause related to mental and behavioral disorders more than doubled the chance of not returning to work in the same activity as before.ConclusionThese results were independent of the analysis technique used, which allows concluding that there were no advantages in the use of targeted maximum likelihood estimation (TMLE), given its difficulties in access, use, and assumptions.

Upper-limb position-sustained tasks (ULPSIT) are involved in several activities of daily living and are associated with high metabolic and ventilatory demand and fatigue. In older people, this can be critical to the performance of daily living activities, even in the absence of a disability. Objectives: To understand the ULPSIT effects on upper-limb (UL) kinetics and performance fatigability in the elderly. Methods: Thirty-one (31) elderly participants (72.61 ± 5.23 years) performed an ULPSIT. The UL average acceleration (AA) and performance fatigability were measured using an inertial measurement unit (IMU) and time-to-task failure (TTF). Results: The findings showed significant changes in AA in the X- and Z-axes (p < 0.05). AA differences in women started earlier in the baseline cutoff in the X-axis, and in men, started earlier between cutoffs in the Z-axis. TTF was positively related to AA in men until 60% TTF. Conclusions: ULPSIT produced changes in AA behavior, indicative of movement of the UL in the sagittal plane. AA behavior is sex related and suggests higher performance fatigability in women. Performance fatigability was positively related to AA only in men, where movement adjustments occurred in an early phase, though with increased activity time.

Abstract Background and objectives: There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. Method: Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. Results: 416 subjects were included; 45.7 % (n = 190) had chronic pain, with females (72.3 %; p = 0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. Conclusions: The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population.

Background and objectives: There are few data in the literature characterizing the pattern of analgesic use in Latin American countries, including Brazil. Little is known about the undertreatment of pain and its influence on the habit of self-medication with analgesics. The aim of this study is to define the pattern of analgesic use among chronic pain patients and its potential association with self-medication with analgesics. Method: Cross-sectional observational study with an urban population sample. Chronic pain was defined as a pain lasting for at least 90 days. The study was approved by the Research Ethics Committee of the institution. Results: 416 subjects were included; 45.7 % (n = 190) had chronic pain, with females (72.3 %; p = 0.04) being the most affected. Self-medication with analgesics is practiced by 78.4% of patients with chronic pain. The most common current analgesic treatment consists of non-steroidal anti-inflammatory drugs (dipyrone and acetaminophen). Weak opioids are rarely used and only 2.6% of subjects with chronic pain were taking these analgesics. None of the subjects were taking potent opioids. Conclusions: The practice of self-medication with analgesics is frequent among patients with chronic pain, which may be due to the underprescription of more potent analgesics, such as opioids. It can also be said that, given the data presented, there is no crisis of recreational opioid use in the studied population. Resumo: Justificativa e objetivos: Há poucos dados na literatura que caracterizam o padrão de uso de analgésicos na América Latina e no Brasil. Também se sabe pouco sobre o subtratamento da dor e sua influência no hábito de automedicação analgésica. O objetivo desta pesquisa é definir o padrão de uso de analgésicos entre os portadores de dor crônica (DC) e a sua potencial associação à automedicação analgésica. Método: Estudo observacional transversal com amostra de população urbana. A dor crônica foi definida como aquela presente por pelo menos 90 dias. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa institucional. Resultados: Foram incluídos 416 indivíduos; 45,7% (n = 190) portadores de dor crônica, sendo os do sexo feminino (72,3%; p = 0,04) os mais acometidos. A automedicação analgésica é praticada por 78,4% dos portadores de dor crônica. O tratamento analgésico vigente mais frequente é composto pelos anti-inflamatórios não esteroides (AINES), dipirona e paracetamol. Os opioides fracos são pouco usados e apenas 2,6% dos indivíduos com dor crônica fazem uso desses analgésicos. Nenhum dos indivíduos estava em uso de opioides potentes. Conclusões: A prática de automedicação analgésica é frequente entre os portadores de dor crônica, o que pode ser consequência da pouca prescrição de analgésicos mais potentes, como os opioides. Pode-se também dizer que, pelos dados apresentados, não ocorre uma crise de uso recreativo de opioides na população estudada. Keywords: Chronic pain, Analgesics, Self-medication, Urban population, PALAVRAS-CHAVE: Dor crônica, Analgésicos, Automedicação, População urbana

Esta pesquisa supõe as metáforas como um fenômeno de pensamento, de língua(gem) e de ação, que se realiza como processos mentais, socialmente mediados, e discursivamente realizados. Toma-se como referencial teórico a linguística cognitiva e a noção de metáfora como a compreensão e a experiência de um fenômeno em termos de outro (Lakoff & Johnson, 1980, Lakoff, 1987). Explora-se essa perspectiva teórica para investigar como uma subcategoria cultural – os policiais – conceptualiza o seu trabalho, isto é, busca-se identificar, reconstruir e problematizar os conceitos metafóricos que esses sujeitos atualizam para a compreensão de sua prática profissional. Para tanto, toma-se como guia metodológico a Análise Sistemática de Metáforas (Schmitt, 2016, 2017) e inspira-se no protocolo de pesquisa utilizado por Guerrero e Villamil (2000, 2002). Participaram da pesquisa 20 policiais militares do Estado de Pernambuco. Os conceitos metafóricos mais salientes, que emergiram após análises, foram: policial é super-herói; policial é um ser invisível; e policial é sacerdote. Esses conceitos são metáforas concorrentes e têm diferentes implicações cognitivas para a compreensão do trabalho policial.

Isometric activity can be used as a strategy to improve health, fitness, and functional performance in the elderly population, but differences in fatigability may occur. This study aimed to understand fatigability behavior during an upper limb isometric task (ULIT) and the role of health status and physical activity in the fatigability of elderly participants. Thirty-two (32) elderly participants (72.5 ± 5.18 years) were instructed to perform ULIT. The Borg CR10 scale and task failure point (TTF) were used to measure perceived and performance fatigability. Self-reported measures were used to assess the quality of life and physical activity level. A significant relationship between perceived and performance fatigability was found only in the final phase of activity (p < 0.01). Significant correlations were found between perceived fatigability and the social functioning dimension (p < 0.05), and between performance fatigability (TTF) and BMI (p < 0.01), physical functioning (p < 0.01), and role functioning/physical (p < 0.05) dimensions. In conclusion, ULIT produces changes in fatigability of elderly people, which are positively related in the final stage of the activity. Changes in fatigability are negatively related to BMI. It is also negatively related to health, social functioning, physical functioning and role functioning/physical quality of life dimensions.

Resumo: Objetivou-se avaliar a associação da qualidade organizacional da atenção à saúde da criança em serviços de atenção primária à saúde (APS) com variáveis de contexto gerencial. Realizou-se pesquisa avaliativa em 151 serviços de APS de 40 municípios do interior do Estado de São Paulo, Brasil, que responderam ao QualiAB em 2014. Pontuaram-se os serviços conforme 41 indicadores de saúde da criança que, após constituírem grupos de qualidade distribuídos por quartis, foram associados a 17 indicadores de gestão. Os seguintes indicadores não apresentaram associação com os grupos de qualidade: participação no Programa Mais Médicos/Provab-médico (p = 0,102), disponibilidade de serviço de assistência social (p = 0,315) e disponibilidade de serviço para gestante de risco (p = 0,814). Em todas as outras situações, a associação foi significativa. Embora, em algumas variáveis, os grupos G1 e G2 tenham se assemelhado aos grupos mais polares (G0 e G3), estes últimos apresentaram diferenças em todas as variáveis. Os serviços que pertenciam ao grupo considerado de melhor qualidade (G3) encontraram-se, majoritariamente, organizados no modelo USF/Mista (p = 0,018), administrado por gestão terceirizada (p < 0,001), com oferta regular de acompanhamento pré-natal (p < 0,001), disponibilidade permanente de clínico geral ou médico de família (p = 0,009) e uma rede de apoio composta, principalmente, de CAPSi e de CAPSAd III e de serviços de atenção à criança (p < 0,001). Esse grupo também realizava reunião de equipe semanalmente (p < 0,001), estudava os casos de demanda espontânea (p < 0,001) e mudava o gerenciamento e organização da assistência com base no processo avaliativo (p = 0,004). Concluiu-se que a qualidade organizacional não depende apenas das práticas exercidas pelos profissionais de saúde, mas também das decisões dos gestores.

A urolitíase obstrutiva é uma enfermidade de alta incidência em ovinos confinados. A acidificação urinária é um dos métodos mais eficazes para a prevenção da doença. Utilizaram-se 45 cordeiros clinicamente sadios, machos, mestiços Santa Inês, com três a quatro meses de idade, em confinamento, distribuídos em três grupos de 15 animais cada. Foi administrado 400mg/kg/dia/animal de cloreto de amônio (GA), 4mg/kg/dia/animal de vitamina C (GC) e associação dos dois produtos (GAC), durante 21 dias, ambos por via oral. As colheitas de sangue e urina foram realizadas sete dias antes do início do tratamento (M0), imediatamente antes (M1) e depois, semanalmente, até 21 dias após (M2, M3 e M4) para realização de exames de função renal (ureia e creatinina), dosagem de Ca, P e Mg no soro e na urina, urinálise e cálculo de EF desses minerais. Nos grupos GA e GAC, houve diminuição do pH no M2, permanecendo ácido até o final do experimento. Houve diminuição significativa do P sérico no GA, além de aumento urinário nos teores de Ca e Mg nesse grupo. A EF de Ca aumentou após o início dos tratamentos, porém não houve interferência para Mg. A EF de P foi significativamente menor somente no GA. O cloreto de amônio se mostrou eficaz como acidificante urinário em ovinos, porém a vitamina C, por via oral, apresentou oscilação e não atingiu estabilidade. Portanto, a suplementação com vitamina C não foi eficaz para acidificação urinária e, por isso, não deve ser utilizada na prevenção de urolitíase obstrutiva. Palavras-chave: pH urinário; excreção fracionada; pequenos ruminantes; urinálise; urolitíase.

Objetivo: Analizar las técnicas de catarsis empleadas en los trabajadores que atienden situaciones de emergencias y catástrofes. Métodos: Revisión sistemática realizada en 7 bases de datos bibliográficas Medline-Pubmed, Web of Science, Cochrane Library, CINAHL, Scopus, PsycINFO y otras fuentes secundarias, para artículos publicados entre 2008 y 2017, con los términos «catarsis», «emergencias», «debriefing» y «estrés post-traumático». Resultados: Los criterios de inclusión fueron cumplidos por 5 artículos. Los estudios muestran que es común entre el personal sanitario la exposición al sufrimiento y a las experiencias traumáticas, suponiendo repercusiones negativas manifestadas a nivel físico, psicológico y cognitivo tras situaciones de emergencias y catástrofes. Para algunos autores, el debriefing ofrece un lugar para descargar las emociones y reducir el impacto del estrés en la vida de los trabajadores de emergencia actuando como una red de apoyo para que dichos trabajadores puedan reconstruir sus experiencias y verbalizar sus pensamientos y sentimientos, así como reducir el impacto en sus vidas. Para otros en cambio, esta técnica no es eficaz para todos los profesionales y su uso puede conllevar consecuencias negativas. Conclusiones: El debriefing es una intervención breve que promueve la catarsis. Sin embargo, existe una gran controversia sobre su eficacia y la manera de aplicar esta intervención. Este estudio pone de manifiesto la heterogeneidad existente en la aplicación de técnicas de catarsis en los trabajadores que atienden situaciones de emergencia y catástrofes.

ABSTRACT OBJECTIVE To evaluate the performance of comprehensive care for older adults in primary care services in the Brazilian Unified Health System in the state of São Paulo, Brazil. METHODS A total of 157 primary care services from five health regions in midwestern São Paulo responded, from October to December 2014, the pre-validated 2014 questionnaire for primary care services assessment and monitoring. We selected 155 questions, based on national policies and guidelines on this theme. The responses indicate the service performance in older adults’ care, clustered into three areas of analysis: health care for active and healthy aging (45 indicators, d1), chronic noncommunicable diseases care (89 indicators, d2), and support network in aging care (21 indicators, d3). Performance was measured by the sum of positive (value 1) or negative (value 0) responses for each indicator. Services were clustered according to k-means of the performance scores of each domain. After weighting the domains (Z tests), we estimated the associations between the scores of each domain and independent management variables (typology, planning and evaluation of services), with simple and multiple linear regression. RESULTS Chronic noncommunicable diseases care (d2) showed, for all clusters, better average performance (55.7) than domains d1 (35.4) and d3 (39.2). Service performance in the general area of planning and evaluation associates with the performance of older adults’ care. CONCLUSIONS The evaluated services had incipient implementation of comprehensive care for older adults. The evaluation framework can contribute to processes to improve the quality of primary health care.

Objetivo. Descrever as características da gerência das unidades de atenção primária à saúde e o perfil dos gerentes e discutir as implicações desses elementos para a efetivação dos pressupostos do Sistema Único de Saúde no Brasil de forma coerente com as proposições de Alma-Ata. Métodos. Estudo descritivo, transversal, com dados colhidos pelo questionário de Avaliação da Qualidade de Serviços de Atenção Básica (QualiAB), um instrumento autoaplicado via web. O QualiAB foi respondido voluntariamente por 157 gerentes de unidades básicas de saúde de 41 municípios do estado de São Paulo entre outubro e dezembro de 2014. Resultados. Das 157 unidades, 67 (42,7%) eram unidades de saúde da família e 58 (36,9%) eram unidades básicas de saúde de organização “tradicional”; 95 (60,5%) se localizavam em região urbana periférica. No momento do estudo, oito (5,0%) unidades não possuíam gerente e oito (5,0%) eram gerenciadas por secretários municipais de saúde. Quase 80% dos gerentes eram enfermeiros e desempenhavam múltiplas funções além da gerência. O matriciamento (supervisão técnica como forma de educação permanente) era feito em 75 (47,7%) unidades; 60 (38,2%) unidades não contavam com nenhum tipo de matriciamento. A participação em processos avaliativos foi referida por 130 (82,8%) serviços. Os principais desdobramentos induzidos por avaliações foram planejamento e reprogramação das atividades com participação da equipe multiprofissional em 40 unidades (25,5%) e definição de um plano anual de atividades em 38 (24,2%). Não tiveram acesso aos resultados das avaliações 29 unidades (17,8%). Conclusão. O estudo recoloca a importância da gestão do trabalho e a necessidade de (re)investir na formação e valorização do gerenciamento local como estratégia para efetivar uma atenção primária à saúde capaz de promover a saúde como direito e condição de cidadania.

The degradation status of the forests in western Santa Catarina state reflects in a reduced number of conserved areas that enable studies on forest communities diversity and structure in order to create strategies for ecosystems preservation, management and restoration. The objective of this study was to describe the diversity and structure of a forest remnant of Seasonal Submontane Deciduous Forest located in the municipality of São João do Oeste, Santa Catarina state. For the inventory, we demarcated 102 sampling units of 10 × 10 m, continuously arranged in a grid of 6 × 17 plots, in which all plants of the arborescent-arboreal sinusiae with perimeter at breast height (PBH) ≥ 15 cm were sampled. We surveyed 1441.18 living trees and 93.14 standing dead plants per ha. The 79 species found belong to 61 genera and 33 families. Sorocea bonplandii , Nectandra megapotamica , Inga marginata , Ocotea diospyrifolia and Trichilia claussenii presented the highest importance value indexes. The Shannon diversity index (H’) was 3.21 and the Pielou equability (J’) was 0.735. The vertical structure of the vegetation sampled was divided into treelets (2-11 m), canopy (12-17 m) and emerging trees (18-25 m). The studied forest fragment is an important reference ecosystem for the implementation of strategies for preservation, management and restoration of seasonal forests.

O presente artigo tem como objetivo analisar o discurso expositivo acerca da história da vacina antivariólica apresentada no Museu de Microbiologia (MMB) do Instituto Butantan na perspectiva da História e Filosofia da Ciência (HFC) no Ensino de Ciências (EC) e da pesquisa geo-histórica. Buscamos na exposição de longa duração do MMB aparatos que se relacionam com a história da criação da primeira vacina. Como resultado, encontramos apenas um painel, o qual apresentou poucas informações sobre a temática e uma visão tradicional de HFC no EC com base nas categorias criadas a partir do referencial teórico definido.

BackgroundSick leaves are important events for both the worker and the employer. Many factors are related with sick leaves and depending on the factors the worker could perform a successful return to work. In this sense, the objective of this study is to identify those factors associated with return to work after sick leaves in a group of public workers in Brazil.MethodsA case-control study of return to work after sick leaves in a university campus from 2010 to 2015. Logistic regression models were adjusted for two different response variables: return to work with and without restrictions. A digital database was created and completed with data from manual sources.ResultsA computerised database has been created, based on manual records, which has allowed us to identify labour and non-labour factors associated with the return to work after a sick leave and the possible functional readaptation, with or without restrictions, in public workers. Age at the beginning of the process, number of sick leaves, those of more than 16 days, average duration (total time of sick leaves / number of medical records), and mid-level healthcare positions were associated with return to work without restrictions. In the model of return to work with restrictions, the age of hiring by the university, the number of sick leaves, those of more than 16 days, and mid-level healthcare positions, both rural work and operational positions, were associated to the response variable.ConclusionsThis study has allowed us to identify the factors associated with the return to work after a period of sick leave in a large group of public workers. However, more research is needed on the mental disorders that cause sick leaves, their evaluation and the handling of these situations.

ABSTRACT OBJECTIVE: To identify the clinical pathways of women with breast cancer treated in public hospitals, and to analyze the factors that influence the time interval between the first appointment and the start of therapy. METHODS: A cross-sectional study was conducted with 600 women with breast cancer treated in nine public hospitals in the Brazilian Federal District. Patients were interviewed between September 2012 and September 2014. Simple and multiple logistic regression models were adjusted to evaluate the variables associated with the time interval studied. The most frequent pathway was the one that started in primary care with following care in the therapy service (28.9%). In the multiple adjustment, factors associated to a longer time interval between the first appointment and therapy were: lower family income (OR = 1.89; 95%CI 1.32–2.68), the first appointment in public services (OR = 1.78; 95%CI 1.20–2.64), care in more than two health services in the clinical pathway (OR = 1.71; 95%CI 1.19–2.44); and obtaining the anatomopathological analysis of the biopsy in public services instead of private health services (OR = 1.87; 95%CI 1.29–2.71). Independently, the implementation of specialist appointment scheduling, with care regulation, was associated with a shorter time interval between first appointment and therapy (OR = 0.33; 95%CI 0.16–0.65). CONCLUSIONS: We observed that multiple pathways were covered by women with breast cancer treated in public services of the Federal District. Socioeconomic iniquities and several aspectos of the pathways covered were associated with a longer time interval between the first appointment and the start of breast cancer therapy.

Abstract: There is no standardization in the literature of kidney length in sheep at different ages, as there are few studies about the access with the Doppler triplex ultrasound for the renal vascularization in this species. Eighty healthy sheep of three age groups of Ile de France and White Dorper breed were used: 20 lambs, 30 yearlings and 30 adults (8 rams and 22 ewes). Renal healthiness of the animals was confirmed by serum biochemical tests of urea and creatinine, and by observation of renal architecture with conventional ultrasound, besides measurement of vital parameters. A portable ultrasound (My LabTM30 Vet Gold Esaote®, Esaote Healthcare) device was used, with a convex transducer with 3.5MHz frequency. After identification of the kidneys in two-dimensional mode, the measurement of length in the sagittal section was performed in all sheep (n=80). Then color Doppler was activated for visualization of renal and interlobar arteries of the right kidney, and the resistivity index (RI) of the yearlings (n=30) and ewes (n=22) was measured. Biochemical tests remained within normal limits and renal architecture was preserved. The values of the right and left renal length were different between the groups, increasing with age (4.34cm and 4.31cm in lambs; 6.08cm and 6.23cm in yearlings; 7.57cm and 7.37cm in adults, respectively). Median values of RI of the renal artery were statistically different (p

Resumo: A acidificação urinária com cloreto de amônio (CA) é um método preventivo eficiente em urolitíase obstrutiva em ovinos. Os objetivos deste estudo com ovinos confinados, que receberam dieta concentrada com elevado teor proteico, foram: verificar o efeito da dieta sobre a formação de urólitos e o desenvolvimento da doença; analisar as características macroscópicas e histopatológicas do sistema urinário; relacionar os achados clínicos, laboratoriais e necroscópicos com a presença de urólitos. Utilizaram-se 60 ovinos machos: grupo CA (n=40), 400 mg/kg CA/dia, tratados via oral, por 42 dias consecutivos; grupo-controle (n=20), não tratado. Determinaram-se sete momentos de colheita de amostras com intervalos de sete dias, no total de 56 dias de confinamento. Encontraram-se microcálculos na pelve renal em cinco animais de ambos os grupos. As lesões renais microscópicas mais relevantes foram congestão vascular e necrose tubular. Concluiu-se que a dieta rica em concentrado provocou lesão renal em ambos os grupos, embora sem alterar a função renal, o que foi comprovado em testes pela ureia e creatinina séricas. O cloreto de amônio fornecido ao grupo CA não impediu a calculogênese, mas reduziu sua prevalência em relação ao grupo-controle. Os ovinos do grupo-controle tiveram maior comprometimento renal, pela alta incidência de cristalúria e pela necrose tubular, induzidas pelo consumo da dieta rica em grãos.

O presente artigo tem por objetivo identificar mudanças nos indicadores de organização da atenção à saúde da criança em serviços de atenção primária do Estado de São Paulo, Brasil. Pesquisa avaliativa desenvolvida por três séries de avaliações transversais com a participação de 81 serviços, envolvendo 32 municípios do centro-oeste paulista, que responderam ao instrumento Quali AB nos anos de 2007, 2010 e 2014. A análise utilizou 74 indicadores de saúde da criança e 7 de caracterização dos serviços. A comparação dos indicadores evidenciou mudanças na organização de ações de saúde da criança, com melhora da maioria dos indicadores em 2010 e manutenção, ou piora, em 2014, em relação a 2007. Conclui-se que os avanços preconizados pelas políticas de atenção à saúde da criança não têm se efetivado plenamente na organização da oferta da atenção integral, ainda que temas relevantes como obesidade infantil e violência sejam abordados em um pequeno número de serviços.

The global increase in C-section rates is real. In Brazil, these indices correspond to 58.94% in the Midwest region and 52.77% in the Federal District.To evaluate the C-section rates and identify the groups with the greatest risk at two reference hospitals in the public network of Federal District/Brazil, using 10-Group Robson System.A cross-sectional study of 6579 births assisted at the Hospital A (HA) and the Hospital B (HB) during 2013. The C-section rates in each group and its respective contribution to the total hospital C-sections was compared between HA and HB. To this, was used the proportion difference test (similar to chi-square test), with RR and 95% CI, and the logistic regression analysis (OR; 95% CI) among the groups with higher C-section/total C-section. The significance limit of p < 0.05 was defined for all tests.The C-section rates were 50.8% at the HA and 42.3% at the HB, with 1.20 RR (95%CI = 1.13-1.28) at the HA. The highest rates were observed in Robson groups G5, G1, and G2. At the HA, G1 had a 21.5% C-section rate, which was greater than at the HB (13.8%; p < 0.05); the cesarean rates for groups G2 and G5 were higher at the HB (respectively, 18.6 and 38.1%) than at the HA (14.8 and 32.5%, respectively; p < 0.05).These results point out specific goals to be achieved in order to reduce abusive cesarean rates in both A and B hospitals, especially in the primigravida and in those with previous C-section.

This study analyzed the phenological patterns of tree synusia, and their relationships with climate variables, in a forest fragment in the municipality of São Miguel do Oeste, SC. From October 2012 to October 2013, phenological events were evaluated using the number of species in the phenophase and the Fournier intensity index. Individuals of twenty species of trees (in 13 families) were monitored for budding, presence of mature leaves, leaf fall, flowers at anthesis, and presence of immature and mature fruits. The standardized Morisita index was used to test seasonality of the phenophases and the Spearman correlation was used to evaluate the possible relationships of phenophases with temperature and precipitation. Leaf fall was seasonal and had a high negative correlation with temperature. Budding and flowering showed seasonality and high intensity in September. Mature and immature fruits occurred at different times throughout the year. The triggering of the phenophases was correlated with temperature, mainly for the vegetative phenophases.

PURPOSE: To evaluate the effectiveness of an illustrated home exercise guide targeting the pelvic floor muscles in promoting urinary continence during pregnancy.METHODS: A randomized clinical trial was performed with 87 participants, evaluated six times during pregnancy and divided into three groups: Gsup, supervised; Gobs, not supervised, and Gref, women who did not perform the home exercises program. A miction diary and perineometry were used to evaluate urinary incontinence (primary outcome) and pelvic floor muscle strength (secondary outcome), respectively. The Kruskal-Wallis test with post hoc Dunn's and chi-square and Z tests with Bonferroni correction were used for continuous variables and proportions, respectively, with the level of significance set at 5%.RESULTS: At the end of the study, 6.9% of pregnant women in the Gsup and Gobs had urinary incontinence, while 96.6% of Gref women were incontinent. Regarding pelvic floor muscle function, Gsup and Gobs had mean contractions of 10 and 8.9 cmH2O, respectively, while Gref had a value of 4.7 cmH2O. Both results were significant.CONCLUSION: An illustrated home exercise guide targeting the pelvic floor muscles is effective in promoting urinary continence during pregnancy, even without permanent supervision.

Este estudo teve por objetivo avaliar os padrões fenológicos da sinúsia arbórea de um fragmento florestal localizado no município de São Miguel do Oeste, SC, e sua relação com as variáveis climáticas. Os eventos fenológicos foram avaliados através do número de espécies na fenofase e do índice de intensidade de Fournier, de outubro de 2012 a outubro de 2013. Foram monitorados indivíduos de 20 espécies arbóreas pertencentes a 13 famílias botânicas quanto às fenofases de brotamento, folhas adultas, queda foliar, flores em antese, frutos imaturos e frutos maduros. Utilizou-se o índice de Morisita padronizado para testar a sazonalidade das fenofases e a correlação de Spearman para avaliar a possível relação das fenofases com a temperatura e a precipitação. A queda foliar foi sazonal e teve uma forte correlação inversa com a temperatura. O brotamento e a floração apresentaram sazonalidade e maior intensidade em setembro. Frutos maduros e imaturos foram registrados em diferentes momentos ao longo do ano. O desencadeamento das fenofases apresentou correlação com a temperatura, principalmente das fenofases vegetativas.

Como parte de uma série de revisões críticas nas pesquisas acerca dos frames em estudos sobre movimentos sociais, este artigo examina os aspectos cognitivos dos movimentos sociais. Após um breve resumo sobre alguns conceitos da teoria cognitiva, apresentando noções como modelos mentais, conhecimento socialmente partilhado, atitudes e ideologias, os aspectos cognitivos de alguns estudos sobre frames de movimentos sociais serão criticamente revisados. Primeiramente, estabelece-se que, embora tenha sido escolhida uma perspectiva cognitiva na definição de frames como “enquadres interpretativos” – como em Goffman (1974) –, não será desenvolvida aqui nenhuma definição ou elaboração mais aprofundada sobre a natureza cognitiva, as estruturas e funções desses frames. O que será mostrado é que sempre que os frames são usados para descrever ou explicar formas de cognição, na verdade, outras noções estão sendo referidas, tais como objetivos, valores e ideologias e, dessa forma estão sendo obscurecidas. Mais especificamente, este trabalho se concentra em alguns estudos sobre movimentos sociais que abordam ideologias e conclui que essas pesquisas são influenciadas apenas tangencialmente por estudos sobre ideologia em outras áreas. Isso repercute especialmente no caso de estudos acerca da estrutura e das funções do conhecimento dos movimentos sociais – uma perspectiva praticamente ignorada nos estudos de frames de movimentos sociais e apenas marginalmente tratada dentro de uma sociologia do conhecimento dos movimentos sociais. Em resumo, o estudo dos aspectos cognitivos dos movimentos sociais ainda está na sua infância, e os estudos de frames quase não contribuem para essa abordagem.

A cooperativa é uma organização dinâmica, constituída por uma rede de relações entre os próprios indivíduos e com o trabalho em si. Para tal, a Gestão de Pessoas apresenta-se como uma alternativa a esta para gerenciar da melhor forma os relacionamentos existentes nessa organização. O presente artigo buscou analisar a abrangência desta área em uma Cooperativa da cidade de Mococa, focando o relacionamento existente entre funcionários. Desenvolveu-se um estudo de caso de característica qualitativo, utilizando a prática da entrevista como meio e obtenção de dados. Com os resultados obtidos e analisados foi possível verificar o reconhecimento da importância dos funcionários e como seus relacionamentos podem interferir no desenvolvimento organizacional, considerando os aspectos do trabalho em conjunto formulado por essa teia de relações e práticas auxiliadoras oferecidas pelos princípios dos recursos humanos. Mediante estas concepções, compreende-se a Gestão de Pessoas assimilada a uma ferramenta de gerencia as vastas relações existentes na cooperativa, a fim de que a organização utilize seu capital intelectual da melhor forma, gerando benefícios para ambos.

Resumo: A incidência da urolitíase obstrutiva em ovinos é elevada, principalmente em machos confinados, tanto para produção de carne, quanto reprodutores de alto valor genético. A acidificação urinária é um dos métodos para prevenção desta enfermidade e pode ser realizada de forma eficaz com a suplementação de cloreto de amônio (CA) na dieta. Utilizaram-se 100 ovinos, machos não castrados, mestiços (Ile de France X White Dorper), confinados, com idade aproximada de três meses. Constituíram-se três grupos experimentais: Grupo 21CA (n=40) que recebeu 400mg/kg/PV de cloreto de amônio/animal/dia, por 21 dias consecutivos; Grupo 42CA (n=40) que foi suplementado com 400mg/kg/PV de cloreto de amônio/animal/dia, por 42 dias consecutivos; Grupo controle (n=20), que não recebeu CA. A alimentação consistiu de ração total, composta por 15% de feno triturado e 85% de concentrado, água e sal mineral ad libitum. Após 14 dias de adaptação à alimentação e ao ambiente, os Momentos (M) de avaliação clínica, colheita de sangue e exame ultrassonográfico foram realizados com intervalo de sete dias, sendo M0 (imediatamente antes do início do tratamento com cloreto de amônio), M1 (sete dias após), M2 (14 dias após), M3 (21 dias após o início do tratamento e suspensão do cloreto de amônio em Grupo 21CA), M4 (28 dias após), M5 (35 dias após) e M6 (42 dias após), totalizando 56 dias de confinamento. As dosagens de ureia e creatinina não evidenciaram alteração na função renal, embora a ureia estivesse acima dos valores de referência para espécie ovina. Observaram-se imagens ultrassonográficas compatíveis com cálculos vesicais e dilatação de pelve renal. No Grupo 21CA, 15% (6/40) dos animais apresentaram cálculos vesicais; no Grupo 42CA, 5% (2/40); e no Grupo controle, 20% (4/20) dos cordeiros. Visibilizaram-se também imagens sugestivas de sedimentos e cristais em 31% (31/100) dos animais examinados. A ultrassonografia permitiu a visibilização de alterações renais e vesicais, porém não relacionados ao quadro clínico de urolitíase obstrutiva, revelando-se como um exame complementar de grande relevância para o diagnóstico precoce de alterações no sistema urinário de ovinos.

Schön (1979) já defendeu que as metáforas são elementos centrais no conhecimento profissional. O Serviço Social pode ser tomado como um bom exemplo dessa ideia porque o complexo conhecimento desse campo abarca intervenções numa ampla extensão de problemas tanto individuais como sociais. As redes semânticas do conhecimento profissional, que emergem a partir de conceitos metafóricos, permitem uma abstração, o que propicia generalizações a partir de casos individuais; elas são específicas o suficiente para promover instruções em situações particulares e estão ancoradas numa experiência de socialização pré-teórica, na qual os valores culturais já foram ensinados.

Este trabalho investiga a realização de expressões idiomáticas metafóricas, cujos mapeamentos envolvem o domínio-fonte ALIMENTO para a compreensão do domínio-alvo PROBLEMA. O objetivo desta pesquisa é verificar as regularidades discursivas e cognitivas dessas instanciações. Para tanto, foram analisadas as expressões idiomáticas metafóricas: descascar abacaxis, enfiar o pé na jaca, pisar no tomate, resolver pepinos e ter a batata quente/assando em gêneros jornalísticos sobre política e economia, nos sites das revistas semanais Veja e Carta Capital. Os achados sugerem que essas expressões formam duas categorias de conceptuação, o que confere usos argumentativos diferentes no discurso jornalístico sobre política e economia.