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Abstract Background: Working memory-based spatial cognition has attracted the attention of the scientific community in navigation and reorientation projects. The dominant approach considers that spontaneous spatial navigation behavior is based merely on environmental geometry (built and natural environmental objects). In this domain, DCD (Developmental Coordination Disorder) motor skill orientation problems have been frequently associated with poor visuospatial cognition, while immersive VR environments encourage more repetition, allowing for faster motor skill development and recovery. Objective: This pilot study tested the functionality of an immersive VR environment with environmental geometry (rectangular arena rich in symmetry) and featural landmark cues (striped wall, flora) as a route-learning tool for children with motor skill disorders. Methods: Forty DCD children aged 5 to 8 years (20 boys and 20 girls); five (5) 3D reality modeling setups with orthogonality, symmetry, and striped walls as design parameters; and trial walk-through coordination exercises using a predefined visual pathway with different motor control conditions (daylight, darkness). Participants' path completion rate, path completion time, and walk-through satisfaction were recorded as route-learning performance variables and analyzed statistically. Results/findings: DCD children's spatial orientation was statistically shown to be more stable and robust (in path completion rates, termination time, and walk-through level of satisfaction) in a virtual 3D environment rich in orthogonality, symmetry, and featural cues as landmarks. In this compound environmental geometry setup, training functionality and immersive learning performance enjoyed an 8.16% better path completion rate, a 12.37% reduction in path completion time, and 32.10% more walk-through satisfaction than reality modeling setups poor in geometry and landmarks. The effectiveness and robustness were validated statistically. Conclusion: Children with motor skill difficulties train and learn better in virtual 3D environments that are rich in orthogonality, symmetry, and featural landmark cues.

Resumen Antecedentes: La cognición espacial basada en la memoria de trabajo ha atraído la atención de la comunidad científica en proyectos de navegación y reorientación. El enfoque dominante considera que el comportamiento espontáneo de navegación espacial se basa meramente en la geometría ambiental (objetos ambientales construidos y naturales). En este ámbito, los problemas de orientación de las habilidades motoras del TDC (Trastorno del Desarrollo de la Coordinación) se han asociado con frecuencia a una cognición visoespacial deficiente, mientras que los entornos de RV (Realidad Virtual) inmersivos fomentan una mayor repetición, lo que permite un desarrollo y una recuperación más rápidos de las habilidades motoras. Objetivo: Este estudio piloto probó la funcionalidad de un entorno de RV inmersiva con geometría ambiental (arena rectangular rica en simetría) y señales de puntos de referencia característicos (pared rayada, flora) como herramienta de aprendizaje de rutas para niños con trastornos de la habilidad motora. Métodos: Cuarenta niños con TDC de entre 5 y 8 años (20 niños y 20 niñas); cinco (5) configuraciones de modelado de realidad 3D con ortogonalidad, simetría y paredes rayadas como parámetros de diseño; y ejercicios de coordinación de recorrido de prueba utilizando una ruta visual predefinida con diferentes condiciones de control motor (luz diurna, oscuridad). Se registraron la tasa de finalización del recorrido, el tiempo de finalización del recorrido y el grado de satisfacción de los participantes como variables de rendimiento del aprendizaje de recorridos y se analizaron estadísticamente. Resultados: Se demostró estadísticamente que la orientación espacial de los niños con TDC era más estable y robusta (en tasas de finalización del camino, tiempo de finalización y nivel de satisfacción del recorrido) en un entorno 3D virtual rico en ortogonalidad, simetría y señales de características como puntos de referencia. En esta configuración de geometría ambiental compuesta, la funcionalidad del entrenamiento y el rendimiento del aprendizaje inmersivo disfrutaron de un 8,16% más de tasa de finalización de ruta, una reducción del 12,37% en el tiempo de finalización de ruta y un 32,10% más de satisfacción de recorrido que las configuraciones de modelado de realidad pobres en geometría y puntos de referencia. La eficacia y la solidez se validaron estadísticamente. Conclusiones: Los niños con dificultades motrices entrenan y aprenden mejor en entornos virtuales 3D ricos en ortogonalidad, simetría y puntos de referencia característicos.

ABSTRACT

Diabetic neuropathy (DN) is a chronic diabetic complication, which is difficult to manage. The current investigation evaluates the effect of Nerium oleander (NO) in the management of diabetic neuropathy (DN). Diabetic neuropathy was induced by streptozotocin (STZ) [60 mg/kg, i.p.] and treated with NO 150 mg/kg and 300 mg/kg, per oral (p.o.) for two week. Blood glucose level, analgesic response, muscle coordination, and intestinal transit were estimated in DN rats. Oxidative stress and inflammation were estimated in DN rats. Loss of muscle coordination, swim Endurance and analgesic response were attenuated by NO treatment in DN rats. Mediators of inflammation and oxidative stress parameters were ameliorated in NO treated DN rats. The given study concluded that NO has beneficial for the management of DN by regulating oxidative stress and inflammatory mediators.

La neuropatía diabética (DN) es una complicación diabética crónica, que es difícil de manejar. La presente investigación evalúa el efecto de Nerium oleander (NO) en el tratamiento de la neuropatía diabética (DN). La neuropatía diabética fue inducida por estreptozotocina (STZ) [60 mg/kg, ip] y tratada con NO 150 mg/kg y 300 mg/kg, por vía oral (p.o.) durante dos semanas. En ratas DN se estimaron el nivel de glucosa en sangre, la respuesta analgésica, la coordinación muscular y el tránsito intestinal. En ratas (DN) se estimaron el estrés oxidativo y la inflamación. La pérdida de la coordinación muscular, resistencia a la natación y respuesta analgésica se atenuaron con el tratamiento con NO en ratas DN. Los mediadores de la inflamación y los parámetros del estrés oxidativo mejoraron en ratas DN tratadas con NO. El estudio presentado concluyó que el NO tiene beneficios para el tratamiento de la DN al regular el estrés oxidativo y los mediadores inflamatorios.

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La Educación Física ha demostrado ser una herramienta eficaz para desarrollar condiciones físicas y mentales en el ser humano. Sin embargo, aún las propuestas a favor de hacer realidad la educación inclusiva en estudiantes con trastorno del espectro autista no logra los niveles mundialmente esperados. Es por ello que en esta obra se plantea como objetivo diseñar un sistema de juegos inclusivos para el desarrollo de la coordinación motriz en estudiantes con trastorno del espectro autista, en la clase de Educación Física. Para lograr este propósito se emplearon como métodos fundamentales del nivel empírico la encuesta, la prueba pedagógica y la observación. Los resultados del diagnóstico apuntan a un deficiente conocimiento por parte de los docentes de Educación Física sobre el tratamiento de los estudiantes con este trastorno, por lo que se procede a la tarea de elaborar un sistema de juegos para el desarrollo de la coordinación motriz que gradualmente los incorpore a la socialización en el grupo, y un sistema evaluativo pertinente donde se pudieron apreciar resultados superiores cuantitativa y cualitativamente.

A Educação Física tem se mostrado uma ferramenta eficaz para desenvolver as condições físicas e mentais do ser humano. No entanto, mesmo as propostas a favor de tornar a educação inclusiva uma realidade para alunos com perturbação do espectro do autismo não atingem os níveis globalmente esperados. Por isso o objetivo deste trabalho é desenhar um sistema de jogos inclusivos para o desenvolvimento da coordenação motora em alunos com transtorno do espectro do autismo, na aula de Educação Física. Para atingir este propósito, o inquérito, o teste pedagógico e a observação foram utilizados como métodos fundamentais a nível empírico. Os resultados do diagnóstico apontam para pouco conhecimento por parte dos professores de Educação Física sobre o tratamento dos alunos com esse transtorno, por isso passam à tarefa de desenvolver um sistema de jogos para o desenvolvimento da coordenação motora que os incorpore gradativamente à socialização em o grupo, e um sistema avaliativo pertinente onde resultados superiores pudessem ser vistos quantitativa e qualitativamente.

Physical Education has proven to be an effective tool to develop physical and mental conditions in human beings. However, even the proposals in favor of making inclusive education a reality for students with autism spectrum disorder do not achieve the globally expected levels. That is why, the objective of this work is to design a system of inclusive games for the development of motor coordination in students with autism spectrum disorder, in the Physical Education class. To achieve this purpose, the survey, the pedagogical test and observation were used as fundamental methods at the empirical level. The results of the diagnosis point to poor knowledge on the part of Physical Education teachers about the treatment of students with this disorder, so it is proceed to the task of developing a system of games for the development of motor coordination that gradually incorporated them into socialization in the group, and a pertinent evaluative system where superior results could be seen quantitatively and qualitatively.

ABSTRACT

Cannabis sativa is a commonly abused drug especially among younger people in society. The cerebellum is located at the back of the brain, immediately inferior to the occipital and temporal lobes within the posterior cranial fossa. The study was designed to show the effect of aqueous leave extract of cannabis sativa on the performance of male Wistar rats in the hanging wire and open field neurobehavioural tests. A total of 40 Wistar rats were used and grouped into five groups. Group I received distilled water for 28 days. Group II, III, IV and V served as the low, high, low dose recovery and high dose recovery group respectively. Group II were administered with 10mg/kg body weight of cannabis sativa leave aqueous extract for 28 days. Group III were administered with 20mg/kg body weight of cannabis sativa leave aqueous extract for 28 days. Group IV was administered with 10mg/kg body weight of cannabis sativa leave aqueous extract for 28days and were allowed for further 28 days without any administration while group V received 20mg/kg body weight of cannabis sativa for 28 days and were allowed for further 28days without administration. Group IV and V represent the recovery group. Group I, II and III were sacrificed a day after their last intubation. The result of the study showed that the administration of cannabis Sativa did not significantly change the outcome of the open field test at the final stage compared to the initial but group E showed significant decrease in hanging time following exposure to cannabis sativa. We can therefore conclude that administration of cannabis sativa at 10mg/kg and 20mg/kg for 28 days did not adversely affect rats performance in the neurobehavioural tests carried out.

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Objetivo: Investigar a periodicidade da realização de exames de rastreamento para o câncer de mama e do colo do útero e os fatores de risco de mulheres atendidas em um consultório de Enfermagem. Métodos: Estudo descritivo, transversal, documental e retrospectivo realizado através de coleta de dados de prontuários das usuárias atendidas em um Consultório de Enfermagem de universidade pública federal que possui parceria com rede de saúde (Sistema Único de Saúde), trabalhando através da coordenação do cuidado para realização dos exames de mamografia e citopatológico. Resultados: Foram analisados 303 prontuários. Houve predominância de mulheres solteiras; pardas/pretas; heterossexuais; cisgêneras; cristãs; que nunca tiveram suas mamas avaliadas por um profissional de saúde; que nunca realizaram ultrassonografia das mamas e mamografia e realizaram o exame citopatologico há 3 anos. Os fatores de risco para o câncer de mama mais prevalentes foram: idade; sedentarismo; sobrepeso; menarca precoce; nuliparidade e histórico familiar. Os fatores de risco mais prevalentes para o câncer de colo uterino foram: Contraceptivo oral; tabagismo; baixa escolaridade; multiparidade; sexarca precoce e infecção por Papilomavírus Humano. Conclusão: Sugere-se que políticas públicas de saúde sejam de fato instituídas. A parceria interinstitucional se faz necessária para a efetiva coordenação do cuidado à saúde integral da mulher. (AU)

Objective: To investigate the frequency of performing screening tests for breast and cervical cancer and the risk factors of women seen in a nursing office. Methods: Descriptive, cross-sectional, documentary and retrospective study carried out by collecting data from the medical records of users assisted in a Nursing Office of a federal public university that has a partnership with the health network (Unique Health System), working through the coordination of care for mammography and cytopathological examinations. Results: 303 medical records were analyzed. There was a predominance of single women; brown/black; heterosexuals; cisgender; Christians; who have never had their breasts evaluated by a health professional; who never underwent breast ultrasound and mammography and underwent cytopathological examination 3 years ago. The most prevalent risk factors for breast cancer were: age, sedentary lifestyle, overweight, early menarche, nulliparity and family history. The most prevalent risk factors for cervical cancer were: oral contraceptives, smoking, low education, multiparity, early sexarche and Human Papillomavirus infection. Conclusion: It is suggested that public health policies are actually instituted. The inter-institutional partnership is necessary for the effective coordination of women's comprehensive health care. (AU)

Objetivo: Investigar la frecuencia de realización de exámenes de detección de cáncer de mama y de cuello uterino y los factores de riesgo de mujeres atendidas en un consultorio de enfermería. Métodos: Estudio descriptivo, transversal, documental y retrospectivo realizado a partir de la recolección de datos de los prontuarios de usuarios atendidos en un Consultorio de Enfermería de una universidad pública federal que tiene convenio con la red de salud (Sistema Único de Saúde), trabajando a través de la coordinación de la atención de mamografías y exámenes citopatológicos. Resultados: Se analizaron 303 historias clínicas. Hubo un predominio de mujeres solteras; marrón/negro; heterosexuales; cisgénero; cristianos; que nunca han tenido sus senos evaluados por un profesional de la salud; a quien nunca se le realizó ecografía y mamografía mamaria y se le realizó examen citopatológico hace 3 años. Los factores de riesgo más prevalentes para cáncer de mama fueron: edad, sedentarismo, sobrepeso, menarquia precoz, nuliparidad y antecedentes familiares. Los factores de riesgo más prevalentes para el cáncer de cérvix fueron: anticonceptivos orales, tabaquismo, baja escolaridad, multiparidad, sexarquia precoz e infección por el Virus del Papiloma Humano. Conclusión: Se sugiere que las políticas de salud pública sean efectivamente instituidas. La alianza interinstitucional es necesaria para la coordinación efectiva de la atención integral de la salud de la mujer. (AU)

ABSTRACT

The present study evaluated the potential of an ethanol extract from Alternanthera sessilis to alleviate reserpine-induced Parkinson's disease (PD) like behavioural manifestations in rats. The animals were grouped into five: a control group, a group receiving only reserpine, a group treated with levodopa and carbidopa, and two groups given different doses of the Alternanthera sessilis extract. Reserpine was used to mimic PD symptoms, while the extract was administered orally at two different concentrations. The behavioral tests were conducted to assess locomotor activity, grip strength, catalepsy, and rearing activity. Locomotor activity was measured using an actophotometer, where interruptions in light beams caused by the rates were recorded over a 10-minute period. Grip strength was evaluated using a rotarod apparatus, measuring the time taken for rats to fall off individual rods. Catalepsy was assessed through a bar test, measuring the time for rats to descend from a horizontal bar to the base. Rearing activity was observed in a round open field arena, with parameters including the occurrence rate of rearing, general movements score, and duration spent in the center of the arena. The results revealed administration of reserpine led to a decrease in body weight, locomotor activity, muscle coordination, catalepsy score, rearing activity, and grip strength compared to the control group. Conversely, treatment with levodopa and carbidopa resulted in increased values for these parameters. Importantly, administration of Alternanthera sessilis extract showed a dose-dependent reversal of the effects induced by reserpine, with significant increases observed in body weight, locomotor activity, muscle coordination, rearing activity, general movement, and grip strength, indicating its potential therapeutic effects. In conclusion, the present study results suggest that the extract from the Alternanthera sessilis plant might protect brain cells and improve symptoms of Parkinson's disease. However, more research is needed to understand how it works and if it can be used safely and effectively clinical trails.

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As the COVID-19 pandemic started, a tertiary care hospital of central Gujarat faced problems in developing communication and coordination between the doctors as there was a lack of emergency control room (ECR) set up. This article documents the process of establishing ECR using locally available resources. The department of Community Medicine (CM) was made in-charge of ECR. All information technology (IT) equipment were supplied by hospital administration as per the demand. Various challenges experienced by the staff of CM were discussed with the authorities and specialists from respective departments and quick intermediate solutions were adopted. In July-2020, ECR was established with IT support which accelerated the sharing of laboratory findings and patient details to the treating physician. Dedicated smart phones were assigned to each floor providing real time patient updates through Whatsapp groups and video calling feature was used to establish effective communication between patients and relatives. The hospital also collaborated with a local NGO that provided manpower to address queries at ECR. This study concludes that focusing on utilising local resources and manpower and training the available personnel to handle the problems in the best possible ways made the system work properly at the time of crisis.

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Trata de nota técnica sobre Práticas Avançadas de Enfermagem (PAE) no Brasil, elaborada por comissão e submetida à aprovação do plenário do Conselho Federal de Enfermagem (Cofen). O documento aborda conceitos, ações, implementação e regulação das práticas avançadas de Enfermagem, expandindo os limites do escopo da atuação do enfermeiro e reforçando a sua prática clínica. (AU)

This is a technical note on Advanced Nursing Practices (ANP) in Brazil, prepared by a committee and submitted for approval by the plenary of the Federal Nursing Council (Cofen). The document addresses concepts, actions, implementation and regulation of advanced nursing practices, expanding the limits of the scope of nurses' work and reinforcing their clinical practice. (AU)

Esta es una nota técnica sobre las Prácticas Avanzadas de Enfermería (PAE) en Brasil, elaborada por un comité y sometida a la aprobación del plenario del Consejo Federal de Enfermería (Cofen). El documento aborda los conceptos, acciones, implementación y reglamentación de las prácticas avanzadas de enfermería, ampliando los límites del ámbito de actuación de las enfermeras y reforzando su práctica clínica. (AU)

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Objective To explore the influence of different hardness surfaces on gait coordination in patients with functional ankle instability(FAI). Methods Qualisys Infrared Optical Motion Capture System was used to test the coordination and variability of 15 FAI patients on the right side at Nanjing Normal University from May to July,2023.The gait cycle data were collect-ed and intercepted,and coupling angle(CA)and standard deviation of coupling angle(SDCA)were calculated by Matlab to compare the differences on different hardness surfaces. Results On coronal plane,CA of hip-ankle joint was higher on the hard surface than on the soft surface during middle stage of support and early stage of swing,and lower on its rest stages and the gait stages of hip-knee joint and knee-ankle joint than on the soft surface(P<0.01).On sagittal plane,CA of hip-ankle joint and knee-ankle joint was smaller on the hard surface than on the soft surface during middle and late stages of support,and larger than on the soft surface during their rest stages,and the gait stages of hip-knee joint(P<0.01).On horizontal plane,CA of hip-knee joint was lower on the hard surface than on the soft surface during the late stage of support,and higher than on the soft surface during its early stage of swing and bearing stage of hip-ankle joint(P<0.01).Compared with the hard surface,SDCA was smaller on the soft surface than on the hard surface only in the hip-ankle on the sagittal plane and during bearing stage of hip-knee joint,and was greater than on the hard surface for the rest(P<0.01). Conclusion FAI patients showed more distal dominance on soft surface than on hard surface during most gait cycle on 3D plane,i.e.,advantage of ankle varus and plantar flexion increased,and advantage of hip joint decreased;the coordination variability was generally higher on soft surface than on hard surface.These findings suggested that FAI patients may increase the risk of recurrent lateral ankle sprain walking on soft surface.

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Objective:To investigate the sleep status of preschool children with a coordination development disorder (DCD).Methods:Implementing stratified cluster sampling, 38, 900 questionnaires were distributed in 1000 classes of 200 kindergartens randomly selected in 11 prefecture-level cities of China′s Zhejiang Province. A total of 35, 464 valid responses were returned. On the basis of the responses, 2251 of the children were of (6.35%) were deemed DCD-positive, while the rest formed a DCD-negative group. The Children′s Family Social Environment and Sleep Health Questionnaire (1-6 years old) and the children′s sleep habits questionnaire were employed to investigate their sleep status.Results:①Regular sleeping time and duration, and falling asleep within 20 minutes were significantly less common in the DCD-positive group. In the negative group, shifting sleep place at night, finding it hard to sleep in strange environments, waking up ≥2 times a night, being awoken by others in the morning, difficulty in waking up and getting up in the morning, and bad mood after waking were significantly less frequent. ②In addition to delayed bedtime, the incidence of refusal to go to bed, fear of sleeping in the dark or alone, bedwetting, restless sleep, sleepwalking, talking in sleep, being awakened by nightmares, teeth grinding, loud snoring, apnea, dyspnea, crying and sweating after waking up at night, and insufficient sleep were all significantly higher in the DCD-positive group. ③The DCD-positive group also reported more sleeping in the daytime on weekends, more time on playing electronic products along with shorter sleep duration at night. There was, however, no significant difference between the two groups in sleep duration on school days and all day on weekends.Conclusion:Preschool children with a DCD have different sleep habits from those developing normally. They are more likely to suffer from sleep problems which affect their sleep duration.

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The process of establishing and improving the Employee Health Insurance Outpatient Co-payment Protection Mecha-nism is one of the major livelihood projects to deepen the reform of China's medical insurance system.The implementation of the mu-tual-aid mechanism for covering outpatient bills in each coordinating region is accompanied by the risks of squeezing outpatient medi-cal resources,the prevalence of fraud and deception,the increase of the government s economic burden and the lack of public ac-ceptance.In this regard,suggestions are made to improve the policy:open source and cut costs to make up for the shortage of funds,linkage of three medical institutions to build a medical security pattem,coordinated supervision to maintain the stability of medical insurance funds,and optimized policies to promote the reform of medical insurance payment methods.

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Developmental coordination disorder (DCD) is a kind of movement disorder with lifelong adverse effects.According to motor learning and motor control theories, improving movement should be combined with individual, task and environment of children.Interventions for DCD children should not only be limited to the hospital, a more reasonable model should include the hospital, school and home three scenarios of combined treatment.This article expounds the importance and specific content of this intervention model, so as to provide reference for the healthy development of children with DCD.

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Developmental coordination disorder (DCD) is a neurodevelopmental disorder with high incidence, low diagnosis rate and early onset of symptoms, which hinders the development of physical and mental health in children.Early identification and intervention of DCD can help reduce the lifelong adverse effects of the disease.However, general public in China still lacks awareness of this condition,and healthcare workers do not pay enough attention to the early screening and intervention of DCD.This paper summarizes the clinical characteristics, early screening and diagnosis of DCD, and expounds the clinical treatment of DCD from the two aspects of western and Chinese medicine intervention, and proposes the intervention treatment of integrated Chinese and western medicine for the first time, hoping to promote the development of early screening work, provide a new method for the research and development of DCD intervention in China, and improve the effectiveness of treatment.

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【Objective】 To observe the effects of mirror neuron system theory(MNST) on hand dexterity and fine motor function in preschool children with developmental coordination disorder(DCD), so as to provide reference for the rehabilitation of children with DCD. 【Methods】 A total of 51 children with DCD treated at Nantong Maternal and Child Health Care Hospital from June 2021 to April 2023 were enrolled in this study, and were randomly assigned to treatment group (n=26) and control group (n=25) except for 5 cases who missed in the follow-up. Both groups received conventional rehabilitation training, while the treatment group received MNST additionally. The hand dexterity and fine motor function of both groups were assessed using the hand dexterity subscale of the Movement Assessment Battery for Children-Second Edition (MABC-2), Peabody Developmental Motor Scale-Fine Motor (PDMS-FM), and Function Independence Measure for Children (WeeFIM) before and after 12 weeks of treatment. 【Results】 Before treatment, there were no significant differences in hand dexterity subscale of MABC-2, PDMS-FM, and WeeFIM scores between the two groups (P>0.05). After treatment, both groups showed improvements in hand dexterity subscale of MABC-2, PDMS-FM, and WeeFIM scores (treatment group: t=35.620, 42.084, 40.072; control group: t=14.000, 12.017, 14.054, P<0.001), with the treatment group showing significantly greater improvements compared to the control group (t=2.611, 3.120, 2.331, P<0.05). 【Conclusion】 MNST combined with conventional rehabilitation training can enhance hand dexterity and fine motor function in children with DCD, thereby improving children′s activities of daily living.

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The “hospital-community” hospice care model involves multiple stakeholders，including demander，executor，leader，and fundraiser of medical and health services.The degree of benefit correlation，policy influence，and implementation willingness of various stakeholders were analyzed to provide reference for terminal cancer patients to obtain continuous，convenient，and high-quality hospice care.Health department and medical insurance department are the main driving forces for cross-institutional hospice care，but there are differences in their driving paths.The financial department is an important guarantor of policy implementation，and needs to ensure that its core interests are not lost.Community medical institutions are an important driving factor for policy implementation，but they require policy support and hospital drive. Medical staff in hospitals and communities，have weak willingness to implement policies，which can easily become obstacles to policy implementation in the absence of incentive and compensation mechanisms.Patients and their caregivers are important beneficiaries，but lack of publicity，education，and interactive communication can also lead to rejection and contradiction.Therefore，it is necessary to leverage the collaboration and coordination between policy enforcement departments，innovate the development model of hospitals，lead community medical institutions，and promote interactive communication and decision-making sharing of “doctor-doctor” and “doctor-patient”.

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The unclear connotation and fragmented governance of the multi-tiered medical security system pose challenges to its high-quality development.This article redefines the concept and connotation of the multi-tiered medical security system using holistic governance theory.It distinguishes the bottom layer,basic layer,and supplementary layer from the perspective of the essential attributes and direct functions of each system.Furthermore,from the perspective of holistic governance,the article analyzes the current reform practice and finds that fragmented management thinking,unclear positioning of sub-system functions,insufficient policy coordination,single participation subject,and lack of equal negotiation mechanisms are constraints on the overall effectiveness of the multi-tiered medical security system.Therefore,it is necessary to adopt systematic and targeted reform measures from the perspective of holistic governance to improve the system.

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The reform of medical insurance payment method,as an important measure in the health system re-form,should handle with the connection with the comprehensive management policies of medical services,such as medical services price adjustment,public hospitals salary performance reform,cost accounting optimization,health information construction and medical service quality supervision,etc.so as to give full play to the synergy and form the joint force of policies,so as to give full play to the role of the reform of payment mechanism.

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Conventional chemotherapy based on cytotoxic drugs is facing tough challenges recently following the advances of monoclonal antibodies and molecularly targeted drugs. It is critical to inspire new potential to remodel the value of this classical therapeutic strategy. Here, we fabricate bisphosphonate coordination lipid nanogranules (BC-LNPs) and load paclitaxel (PTX) to boost the chemo- and immuno-therapeutic synergism of cytotoxic drugs. Alendronate in BC-LNPs@PTX, a bisphosphonate to block mevalonate metabolism, works as both the structure and drug constituent in nanogranules, where alendronate coordinated with calcium ions to form the particle core. The synergy of alendronate enhances the efficacy of paclitaxel, suppresses tumor metastasis, and alters the cytotoxic mechanism. Differing from the paclitaxel-induced apoptosis, the involvement of alendronate inhibits the mevalonate metabolism, changes the mitochondrial morphology, disturbs the redox homeostasis, and causes the accumulation of mitochondrial ROS and lethal lipid peroxides (LPO). These factors finally trigger the ferroptosis of tumor cells, an immunogenic cell death mode, which remodels the suppressive tumor immune microenvironment and synergizes with immunotherapy. Therefore, by switching paclitaxel-induced apoptosis to mevalonate metabolism-triggered ferroptosis, BC-LNPs@PTX provides new insight into the development of cytotoxic drugs and highlights the potential of metabolism regulation in cancer therapy.

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Resumo Este trabalho analisa as ações e parcerias estabelecidas entre os integrantes das Secretarias Estaduais de Saúde e da Assistência Social do Rio de Janeiro e outras organizações da área da saúde e assistência para atender à emergência sanitária desencadeada pela síndrome congênita do vírus Zika entre os anos de 2015 e 2018. O contexto caracterizava-se por acentuada crise econômica, erosão da capacidade de governança das autoridades políticas no estado, e reduzido conhecimento técnico-científico sobre a epidemia. Além de análise de documentos relativos ao tema, foram feitas 17 entrevistas com gestores e profissionais das duas secretarias. Roteiros semiestruturados focalizaram ações intersetoriais e processos de cooperação e coordenação inter e intraorganizacional. A grade analítica contemplou aspectos dos papéis interpessoais, informacionais e de tomada de decisão dos gestores e técnicos. Os resultados mostram que, apesar da crise política e econômica, os atores das secretarias conseguiram criar um fluxo de atenção aos pacientes. Observou-se que mecanismos informais de cooperação e coordenação foram fundamentais para a criação de estratégias intersetoriais de longo prazo.

Abstract This paper focuses on the actions and partnerships established between members of the State Secretariats of Health and Social Assistance in Rio de Janeiro and other organizations in the health and assistance areas to respond to the health emergency triggered by the congenital Zika virus syndrome between 2015 and 2018. Some characteristics of the context were: a severe economic crisis, the erosion of the governance capacities of the state political authorities as well and scarce technical-scientific knowledge about the epidemic. The study was grounded on an analysis of documents related to the topic, 17 semi-structured interviews with managers and professionals from the two secretariats. Interview scripts focused on intersectoral actions and processes of cooperation and coordination within and between organizations. The analytical grid included aspects of the interpersonal, informational, and decision-making roles of managers and technicians. The results show that, despite the political and economic crisis, the Secretariat actors managed to create a flow of care for patients. Informal cooperation and coordination mechanisms were crucial for the creation of long-term intersectoral strategies.

ABSTRACT

Resumo O Serviço de Atendimento Móvel de Urgência (SAMU) é o componente móvel pré-hospitalar da Rede de Atenção às Urgências. Funciona como um observatório privilegiado da rede que possibilita a articulação e integração com os diversos serviços de saúde. Este estudo objetiva avaliar a governança de financiamento de um SAMU Regional. Trata-se de um estudo avaliativo, desenvolvido de junho de 2017 a agosto de 2018, por meio de análise documental e de entrevistas com sete informantes-chave do SAMU da macrorregião norte do Estado do Paraná. Os resultados apontam que o aporte financeiro foi efetuado de acordo com normatizações, porém insuficientes para a manutenção do serviço, tendo os municípios arcado com mais de 50% do total de gastos no período do estudo. Foi possível inferir que a governança de financiamento deste SAMU é incipiente, pois as informações sobre o financiamento foram díspares, pouco divulgadas e pouco apropriadas pelos atores envolvidos em seu processo de governança. Conclui-se que a deficiente governança de financiamento contribui para ampliar a dificuldade do SAMU no cumprimento da função de ordenar e articular a integração dos componentes da Rede de Urgência e Emergência.

Abstract The Mobile Emergency Care Service is the pre-hospital mobile component of the Emergency Care Network. It works as a privileged network observatory that allows articulation and integration with the different health services. This study aims to evaluate the financing governance of a Regional Mobile Emergency Care Service. This evaluative study was developed through documentary analysis and interviews with seven informants from the Mobile Emergency Care Service in the northern macro-region of the State of Paraná, from June 2017 to August 2018. The results show that the financial contribution was carried out according to ministerial ordinances, but insufficient to maintain the service, with municipalities bearing more than 50% of total expenses during the study period. It was possible to infer that the governance of financing of this Mobile Emergency Care Service is incipient, because the information about the financing they were disparate, little publicized, and little appropriated by the actors involved in the governance process. It is concluded that the poor financing governance contributes to the difficulty of Mobile Emergency Care Service in fulfilling the function of ordering and articulating the integration of the components of the Urgency and Emergency Network.