Consenso latinoamericano sobre la importancia de un sistema de gestión de datos microbiológicos para apoyar el programa de optimización de uso de antimicrobianos (PROA): Recomendaciones basadas en la evidencia. Parte 1

La resistencia antimicrobiana es una amenaza para los logros de la medicina moderna y una de las medidas más efectivas para contrarrestarla son los programas de optimización del uso de antimicrobianos (PROA), en el cual el laboratorio de microbiología es uno de los principales componentes. La aplicación efectiva de tecnología de la información en los procesos es fundamental, pero existe poca información en Latinoamérica sobre el desarrollo y la articulación de las herramientas tecnológicas para apoyar los PROA. Este consenso hace recomendaciones sobre la gestión de los datos microbiológicos para la toma de decisiones. En la Parte I, se presentan las recomendaciones en cuanto al uso de un sistema informatizado de gestión de datos microbiológicos en la práctica clínica, los requerimientos de datos y de reporte en el laboratorio de microbiología, y los contenidos del sistema de gestión de calidad avanzado en el laboratorio. En la Parte II, se discuten los requerimientos de información para la gestión de PROA en estadios intermedios, iniciales y avanzados por el laboratorio y la farmacia; así como la integración del equipo de PROA con el Comité de Prevención y Control de Infecciones y la información para la gestión de PROA a nivel gerencial.

Antimicrobial resistance is a threat to the achievements of modern medicine and one of the most effective measures to counteract it is antimicrobial use optimization programs (AMS), in which the microbiology laboratory is one of the main components. The effective application of information technology in the processes is fundamental, but there is little information in Latin America on the development and articulation of technological tools to support AMSs. This consensus makes recommendations on the management of microbiological data for decision making. In Part I, recommendations on the use of a computerized microbiological data management system in clinical practice, data and reporting requirements in the microbiology laboratory, as well as the contents of the advanced quality management system in the laboratory are presented. In Part II, the information requirements for AMS management in intermediate, initial, and advanced stages by the laboratory and pharmacy are discussed; as well as the integration of the AMS team with the Infection Prevention and Control Committee and the information for AMS management at the management level.

The risk of COVID-19 in Cushing's disease is independently related to disease activity (hypercortisolism) and obesity

ABSTRACT Objective: To evaluate the cumulative incidence, risk factors, and outcomes of COVID-19 in patients with Cushing's disease (CD). Subjects and methods: In all, 60 patients with CD following up in our outpatient clinic answered via phone interview a questionnaire about the occurrence of COVID-19 infection documented by RT-PCR (including the diagnosis date and clinical outcome) and vaccination status. Clinical and biochemical data on disease activity (hypercortisolism) and comorbidities (obesity, diabetes mellitus, and hypertension) were obtained from the patients' electronic medical records. Risk ratios (RRs) of risk factors were obtained using univariate and multivariate analyses. Results: The cumulative incidence of COVID-19 in patients with CD during the observation period was 31.7%, which was higher than that in the general reference population (9.5%). The cumulative incidence of COVID-19 was significantly higher in patients with hypercortisolism (57% versus 17% in those without hypercortisolism, p = 0.012) and obesity (54% versus 9% in those without obesity, p < 0.001) but not in patients with hypertension or diabetes mellitus. On multivariate analysis, hypercortisolism and obesity were each independent risk factors for COVID-19 (RR 2.18, 95% CI 1.06-4.46, p = 0.033 and RR 5.19, 95% CI 1.61-16.74, p = 0.006, respectively). Conclusion: The incidence of COVID-19 in patients with CD was associated with hypercortisolism, as expected, and obesity, a novel and unexpected finding. Thus, correction of hypercortisolism and obesity should be implemented in patients with CD during the current and future COVID-19 outbreaks.

High frequency of larval abnormalities of the toad Rhinella arenarum (Anura: Bufonidae) in an Argentinian agroecosystem

Introduction: The frequent use of pesticides is currently considered a cause of environmental pollution due to the high rate of entry of these substances into agroecosystems. This constitutes a risk for the species that inhabit these ecosystems, in particular anurans whose characteristics make them prone to exposure to and interaction with environmental pollutants. Objective: To report the occurrence of abnormalities in larvae of the common toad Rhinella arenarum inhabiting ponds surrounded by agroecosystems. Methods: In two consecutive springs (2015 and 2016), reproductive events of common toads were monitored in temporary pond systems in agricultural and non-agricultural areas, located near the city of La Plata (Buenos Aires, Argentina). The physicochemical parameters of the ponds were measured, and the stage of each reproductive event was recorded, such as the numbers of adult toads, amplexus and clutches. In the laboratory, the larvae were measured and photographed, their stage of development was recorded, and their morphology was examined under a stereomicroscope. Representative samples (normal and abnormal) from each pond studied were processed for histopathological analysis. Results: In the field studies carried out on a population of R. arenarum collected in an agroecosystem, a lower number of reproductive adults and clutches were observed in relation to the population of a non-agricultural pond. A total of 1 910 larvae were collected: 529 and 1 381 larvae from ponds located in non-agricultural and agricultural areas, respectively. Larvae from the agroecosystem showed two types of abnormalities: severe tail flexure and abdominal bloating. In addition, five degrees of severity could be determined in relation to abdominal bloating. Conclusions: This work reports the high frequency and severity of abnormalities observed in the early stages of R. arenarum larvae living within an agroecosystem, providing evidence of the negative impact that agricultural activities cause on aquatic ecosystems surrounded by farming areas.

Introducción: El uso frecuente de plaguicidas es considerado actualmente una causa de contaminación ambiental debido a las altas tasas de ingreso de estas sustancias a los agroecosistemas. Esta situación es un riesgo para las especies que habitan en estos ecosistemas, en particular los anuros cuyas características los hacen propensos a la exposición e interacción con contaminantes ambientales. Objetivo: Informar la presencia de anormalidades en larvas del sapo común Rhinella arenarum que habitan en estanques rodeados por un agroecosistema. Métodos: En dos primaveras consecutivas (2015 y 2016), se monitorearon los eventos reproductivos del sapo común proveniente de sistemas de estanques temporales ubicados en zonas agrícolas y no agrícolas, cerca de la ciudad de La Plata (Buenos Aires, Argentina). Se midieron los parámetros fisicoquímicos de los estanques y se registraron las etapas de cada evento reproductivo como el número de sapos adultos, amplexos y nidadas. En el laboratorio, las larvas fueron medidas y fotografiadas, se registró su estado de desarrollo y se examinó la morfología de cada una bajo microscopio estereoscópico. Se procesaron muestras representativas (normales y anormales) de cada estanque estudiado para análisis histopatológico. Resultados: En la población de R. arenarum que vive dentro de un agroecosistema, se observó un menor número de adultos reproductores y puestas en relación con la del estanque en la zona no agrícola. Se recolectaron un total de 1 910 larvas: 529 y 1 381 larvas de estanques ubicados en zonas no agrícolas y agrícolas, respectivamente. Las larvas del agroecosistema mostraron dos tipos de anormalidades: severa flexión de la cola y distensión abdominal. Además, se pudo determinar cinco grados de gravedad en relación con la distensión abdominal. Conclusiones: Una alta frecuencia y severidad de anormalidades en los estadios tempranos de larvas de R. arenarum que viven dentro de un agroecosistema proporciona evidencia del impacto negativo que las actividades agrícolas causan en los ecosistemas acuáticos rodeados por áreas de cultivo.

Neurocircuit models of obsessive-compulsive disorder: limitations and future directions for research

Obsessive-compulsive disorder (OCD) is a common psychiatric condition classically characterized by obsessions (recurrent, intrusive and unwanted thoughts) and compulsions (excessive, repetitive and ritualistic behaviors or mental acts). OCD is heterogeneous in its clinical presentation and not all patients respond to first-line treatments. Several neurocircuit models of OCD have been proposed with the aim of providing a better understanding of the neural and cognitive mechanisms involved in the disorder. These models use advances in neuroscience and findings from neuropsychological and neuroimaging studies to suggest links between clinical profiles that reflect the symptoms and experiences of patients and dysfunctions in specific neurocircuits. Several models propose that treatments for OCD could be improved if directed to specific neurocircuit dysfunctions, thereby restoring efficient neurocognitive function and ameliorating the symptomatology of each associated clinical profile. Yet, there are several important limitations to neurocircuit models of OCD. The purpose of the current review is to highlight some of these limitations, including issues related to the complexity of brain and cognitive function, the clinical presentation and course of OCD, etiological factors, and treatment methods proposed by the models. We also provide suggestions for future research to advance neurocircuit models of OCD and facilitate translation to clinical application.

Histomorphometry evaluation of bone anabolism promoted by prostaglandin E1 and its relation to hypercalcemia / Evaluación histomorfométrica del anabolismo óseo en la reparación promovida por la prostaglandina E1 y su relación con la hipercalcemia

Abstract Background: At present, parathyroid hormone is the only existing anabolic bone therapy but produces hypercalcemia. Prostaglandin E1 (PGE1) has been suggested as a bone anabolic agent that allows bone modeling formation without producing hypercalcemia. This study aimed to corroborate these PGE1 properties. Methods: For 22 days, rabbits (n = 30) were divided into three groups (n = 10 each group) and received intravenous solutions: vehicle (control group), palate disjunction + vehicle (sham group), and palate disjunction + 50 mg of PGE1 (PGE1 group). On days 1, 3, and 22, palatine suture X-rays were taken. On day 22, bone formation markers were analyzed, and the rabbits were sacrificed. Bone palate undecalcified samples were processed. Histomorphometry software was used to analyze bone parameters, and the mineralization front was stained with toluidine blue. Scalloped lines reflect remodeling-based bone formation (RBF), and smooth lines reflect modeling-based formation (MBF). Results: X-rays showed more significant palatal disjunction in the PGE1 group; this group exhibited significant calcitriol serum increments. Hypercalciuria was observed in the PGE1 group, and resorption markers (N-telopeptides) remained stable. Sutural bones in the PGE1 group exhibited significant anabolism in structural parameters. RBF was 20%, and MBF was 6% in the sham group; in the PGE1 group, RBF was 8.6%, and MBF was 17%. In the PGE1 group, mineralization was significantly accelerated, but resorption remained stable. Conclusions: This model suggests that PGE1 favors palate disjunction, calcitriol synthesis, and shortens the mineralization. Therefore, PGE1 is an important bone anabolic molecule predominantly of modeling-based form and no hypercalcemia.

Resumen Introducción: La hormona paratiroidea es la única molécula anabólica ósea, pero ocasiona hipercalcemia. La prostaglandina E1 (PGE1) sugiere ser un anabólico óseo con formación por modelación predominante y generalmente no ocasiona hipercalcemia. El objetivo de este estudio fue corroborar estas propiedades de la PGE1. Métodos: Por 22 días, 30 conejos divididos en tres grupos (n = 10 cada grupo) recibieron una solución por vía intravenosa: vehículo (grupo control), disyunción palatina más vehículo (grupo sham) y disyunción palatina más 50 mg de PGE1 (grupo PGE1). A los días 1, 3 y 22 se obtuvieron radiografías de la sutura palatina. En el día 22 se analizaron los marcadores bioquímicos de formación ósea y se sacrificó a los conejos. Las suturas y los huesos suturales se procesaron sin descalcificar. La evaluación histomorfométrica fue digitalizada y el frente de mineralización ósea se tiñó con azul de toluidina. Las líneas irregulares reflejan resorción (remodelación) y las líneas rectas no resorción (modelación). Resultados: Radiográficamente, la disyunción palatina fue mayor en el grupo PGE1. Este grupo mostró una hipercalcitonemia significativa, pero la calcemia y los marcadores resortivos (N-telopéptidos) se mantuvieron estables. Por histomorfometría, los huesos suturales del grupo PGE1 mostraron anabolismo significativo en parámetros estructurales. En el grupo sham, la remodelación ósea fue del 20% y la modelación fue del 6%; en el grupo PGE1, la remodelación fue del 8.6% y la modelación fue del 17%. En este mismo grupo, la mineralización fue significativamente acelerada, pero la resorción se mantuvo igual. Conclusiones: Este modelo sugiere que la PGE1 favorece la disyunción palatina y el aumento del calcitriol, y acelera la mineralización y el anabolismo óseo por modelación predominante sin hipercalcemia.

Adultez e o fenômeno nem-nem: gênero, educação e mercado de trabalho / Adulthood and the neet phenomenon: gender, education and labor market / Adultez y el fenómeno nini: género, educación y mercado de trabajo

O presente estudo objetivou investigar os fatores relacionados à condição "nem-nem" entre jovens à luz do conceito de adultez emergente e das transformações ocorridas no mundo do trabalho. A amostra foi composta de 224 jovens que não estudam e nem trabalham. Os instrumentos foram um questionário sociodemográfico e duas questões abertas sobre os motivos dos jovens estarem sem estudar e trabalhar, e sobre suas perspectivas de futuro. As respostas provenientes das questões abertas foram submetidas a estatísticas textuais. Os resultados revelaram que jovens na condição nem-nem vivenciam aspectos típicos da adultez emergente, e que essas vivências são atravessadas por aspectos como gênero, escolaridade, experiência de trabalho, pela precariedade do mercado de trabalho e a forma como a mesma afeta a juventude em particular.

The present study aimed to investigate the factors related to the neither-nor condition among young people in the light of the concept of emerging adulthood and the transformations that occurred in the world of work. The sample consisted of 224 young people who neither study nor work. The instruments were a sociodemographic questionnaire and two open questions about why young people are not studying and working, and about their future prospects. Answers from open questions were submitted to textual statistics. The results revealed that young people in the neither-nor condition experience typical aspects of emerging adulthood, and that these experiences are crossed by aspects such as gender, education, previous work experience, the precariousness of the labor market and the way it is affects youth in particular.

El presente estudio tuvo como objetivo investigar los factores relacionados con la condición de ni-ni entre los jóvenes a la luz del concepto de adultez emergente y las transformaciones ocurridas en el mundo laboral. La muestra estuvo formada por 224 jóvenes que ni estudian ni trabajan. Los instrumentos fueron un cuestionario sociodemográfico y dos preguntas abiertas sobre por qué los jóvenes no estudian ni trabajan, y sobre sus perspectivas de futuro. Las respuestas de las preguntas abiertas se enviaron a las estadísticas textuales. Los resultados revelaron que los jóvenes en la condición ni-ni experimentan aspectos típicos de la adultez emergente, y que estas experiencias son atravesadas por aspectos como el género , la educación, la experiencia laboral previa, la precariedad del mercado laboral y la forma en que se encuentra afecta a los jóvenes en particular.

AISLAMIENTO E IDENTIFICACIÓN DE Lactobacillus spp. (LACTOBACILLACEAE) RESISTENTES A Cd(II) Y As(III) RECUPERADOS DE FERMENTO DE CACAO / Isolation and identification of Lactobacillus spp. (Lactobacillaceae) resistant to Cd(II) and As(III) from fermented cocoa

RESUMEN El objetivo de este estudio fue aislar e identificar a partir de cacao fermentado en Caldas Colombia, bacterias con potencial de aplicación en procesos biotecnológicos, como la detoxificación de cadmio (Cd(II)) y arsénico (As(III)) en el organismo humano. En total se recuperaron 36 aislados de los cuales se recuperaron 11 en presencia de 1,0 mg/L de Cd(II) y 25 en presencia de 0,1 mg/L de As(III). Su identificación molecular determinó que la mayoría de los aislados son del género Lactobacillus. Los ensayos de crecimiento en presencia de diferentes concentraciones de los elementos evaluados permitió determinar que gran parte de los aislamientos presentan resistencia a mayores concentraciones de As(III) (300 mg/L) que de Cd(II) (10 mg/L). En ensayos de tolerancia a la acidez (pH 2,5) se encontró que la cepa tipo Lactobacillus plantarum JCM 1055, junto con los aislamientos nativos L. plantarum A19, A26 y C16, mostraron la mayor tolerancia, por lo que se seleccionaron para evaluar su tolerancia a condiciones de salinidad. Las bacterias evaluadas mostraron crecimiento en concentraciones de hasta 4 g/L de sales biliares. Se concluye que los L. plantarum evaluados en este trabajo tienen un gran potencial para futuros ensayos en los que se busque demostrar la disminución de la bioaccesibilidad de Cd(II) y As(III) en condiciones in vitro del sistema digestivo humano debido a su resistencia a altas concentraciones de estos elementos y su tolerancia a condiciones de acidez y salinidad. Esto, junto con el reconocido potencial probiótico que tienen estos microorganismos, permitirá a futuro su uso en procesos biológicos de mitigación de Cd(II) y As(III).

ABSTRACT The aim of this study was to isolate and identify from fermented cocoa in Caldas Colombia, bacteria with potential application in biotechnological processes such as detoxification of cadmium (Cd(II)) and arsenic (As(III)) in the human organism. In total, 36 isolates were obtained, from which 11 were recovered in the presence of 1.0 mg/L of Cd(II) and 25 in presence of 0.1 mg/L of As(III). Molecular identification showed most isolates belong to the genera Lactobacillus. Minimum inhibitory concentration assays, in presence of different concentrations of the elements, allowed to determine that the majority of isolates have resistance to higher concentration of As(III) (300 mg/L) than Cd(II) (10 mg/L). Acidity tolerance assays at pH 2.5 showed that type strain Lactobacillus plantarum JCM 1055, and native isolates L. plantarum A19, A26, and C16, presented the highest tolerance, thus they were selected to evaluate their tolerance to salinity conditions. The evaluated bacteria could grow in bile salts up to 4 g/L. It is concluded that the evaluated L. plantarum have great potential to be used in assays in which bioaccessibility of Cd(II) and As(III) is diminished under in vitro conditions of the human digestive system, due to its resistance to high concentrations of the elements and tolerance to acidic and high bile salt conditions. These facts, together with the recognized probiotic potential of these microorganisms, may allow their future use in biological processes to mitigate Cd(II) and As(III).

Experiencia en trasplante pulmonar pediátrico en Chile / Experience with pediatric lung transplantation in Chile

El trasplante de pulmón (TP) es una opción para pacientes pediátricos con enfermedades pulmonares terminales. OBJETIVO: Evaluar resultados y sobrevida de pacientes pediátricos trasplantados de pulmón. MÉTODOS: Análisis retrospectivo de registros clínicos de pacientes TP ≤ 15 años de Clínica Las Condes. Se analizaron datos demográficos, tipo de trasplante, función pulmonar basal y post trasplante, complicaciones precoces y tardías y sobrevida. RESULTADOS: Nueve pacientes < 15 años de edad se han trasplantado. La edad promedio fue 12,7 años. La principal indicación fue fibrosis quística (7 pacientes). El IMC promedio fue de 17,6 y todos estaban con oxígeno domiciliario. El 77% utilizó soporte extracorpóreo intraoperatorio. Las principales complicaciones precoces fueron hemorragia y la disfunción primaria de injerto mientras que las tardías fueron principalmente las infecciones y la disfunción crónica de injerto. Cuatro pacientes han fallecido y la sobrevida a dos años fue de 85%. El trasplante les permitió una reinserción escolar y 3 lograron completar estudios universitarios. CONCLUSIÓN: El trasplante pulmonar es una alternativa para niños con enfermedades pulmonares avanzadas mejorando su sobrevida y calidad de vida.

Lung transplantation (TP) is a treatment option in children with terminal lung diseases. OBJECTIVE: To evaluate the results and survival of pediatrics lung transplant patients. METHODS: Retrospective analysis of clinical records of lung transplantation of patients ≤ 15 years from Clínica Las Condes, Santiago, Chile. Demographic data, type of transplant, baseline and post transplant lung function, early and late complications and survival rate were analyzed. RESULTS: Nine patients ≤ 15 years-old were transplanted. The average age at transplant was 12.7 years. The main indication was cystic fibrosis (7 patients). The average BMI was 17.6 and all the patients were with home oxygen therapy. 77% used extracorporeal intraoperative support. Average baseline FEV1 was 25.2% with progressive improvement in FEV1 of 77% in the first year. The main early complications were hemorrhage and primary graft dysfunction, while late complications were infections and chronic graft dysfunction. Four patients have died and the estimated 2 years survival was 85%. They achieved school reinsertion and three managed to complete university studies. CONCLUSION: Lung transplantation is an alternative for children with advanced lung diseases improving their survival and quality of life.

Adaptação e validação brasileira da escala Older Workers' Intentions to Continue Working / Brazilian adaptation and validation of the Older Workers' Intentions to Continue Working Scale / Adaptación y validación brasileña de la escala Older Workers' Intentions to Continue Working

Este artigo apresenta a adaptação e validação da escala Older Workers' Intentions to Continue Working (OWICW) em uma amostra de trabalhadores mais velhos de uma instituição de ensino superior do nordeste brasileiro. Participaram 283 servidores com idades entre 48 e 69 anos (M = 56,8; DP = 5,1) com média de tempo de trabalho de 34 anos (DP = 4,4). Os dados foram submetidos à análise fatorial exploratória resultando em seis fatores com estrutura similar a cinco fatores do estudo original. As propriedades psicométricas sugerem a adequação da escala, que pode ser um instrumento útil à gestão de trabalhadores com mais idade que desejam continuar trabalhando. Sugere-se a continuidade dos estudos com outras populações. (AU)

This article presents the adaptation and validation of the scale Older Workers' Intentions to Continue Working (OWICW) in a sample of older workers from a northeastern Brazilian higher education institution. The study was conducted with 283 federal employees with ages between 48 and 69 years (M = 56.8; SD = 5.1) with an average working time of 34 years (SD = 4.4). The data were submitted to exploratory factor analysis resulting in six factors with a structure similar to five factors of the original study. The psychometrics properties suggest the adequacy of the scale, which can be a useful instrument to the management of older workers who wish to continue working. We suggest further studies with other populations. (AU)

Este artículo presenta la adaptación y validación de la escala Older Worker's Intentions to Continue, Working )OWICW) en una muestra de trabajadores mayores, de una institución de Enseñanza Superior, del nordeste brasileño. Participaron 283 funcionarios públicos con edades entre 48 y 69 años (M = 56,8; DP = 5,1) con promedio de trabajo de 34 años (DP = 4,4). Los datos fueron sometidos a análisis factorial exploratorio, resultando seis factores con estructura similar a cinco factores del estudio original. Las propiedades psicométricas indicaron la adecuación de la escala, que puede ser un instrumento útil para la gestión de trabajadores con más edad, que desean seguir trabajando. Se sugiere la continuidad de los estudios con otras poblaciones. (AU)

Chronotype in bipolar disorder: an 18-month prospective study

Objective: Circadian dysregulation plays an important role in the etiology of mood disorders. Evening chronotype is frequent in these patients. However, prospective studies about the influence of chronotype on mood symptoms have reached unclear conclusions in patients with bipolar disorder (BD). The objective of this study was to investigate relationship between chronotype and prognostic factors for BD. Methods: At the baseline, 80 euthymic BD patients answered a demographic questionnaire and clinical scales to evaluate anxiety, functioning and chronotype. Circadian preference was measured using the Morningness-Eveningness Questionnaire, in which lower scores indicate eveningness. Mood episodes and hospitalizations were evaluated monthly for 18 months. Results: Among the BD patients, 14 (17.5%) were definitely morning type, 35 (43.8%), moderately morning, 27 (33.7%) intermediate (neither) and 4 (5%) moderately evening. Eveningness was associated with obesity or overweight (p = 0.03), greater anxiety (p = 0.002) and better functioning (p = 0.01), as well as with mood episodes (p = 0.04), but not with psychiatric hospitalizations (p = 0.82). This group tended toward depressive episodes (p = 0.06), but not (hypo)mania (p = 0.56). Conclusion: This study indicated that evening chronotype predicts a poor prognostic for BD. It reinforces the relevance of treating rhythm disruptions even during euthymia to improve patient quality of life and prevent mood episodes.

A matriz de financiamento público federal do esporte no Brasil / The federal public funding matrix of sport in Brazil

Este estudo teve como objetivo analisar as diferentes fontes de financiamento público federal do esporte. As pesquisas sobre esta temática têm se dedicado, sobretudo, ao direcionamento dos recursos para o esporte, havendo falta de investigações sobre a origem deles. Para isso realizou-se uma pesquisa quantitativa-qualitativa por meio de análise documental, com coleta de dados realizada nos seguintes locais: Portal da Legislação do Governo Federal, para compreender as legislações esportivas que dão base à matriz de financiamento; o portal Transparência no Esporte, para discutir os dados das fontes e subfontes de recursos para esporte no período 2004 a 2015; o SIGA Brasil, para definir os tipos de tributos que formaram o orçamento do esporte; e Demonstrativos de gastos tributários da Receita Federal do Brasil, para definir os tributos que compuseram os gastos tributários. Foi identificado que o financiamento público federal do esporte é composto pelas fontes orçamentária, extraorçamentária e de gasto tributário, sendo que a primeira é aquela que teve a maioria dos recursos no período, além de ser a fonte mais visível. Ao analisar os tributos que formam a fonte orçamentária foi identificado que eles incidem principalmente sobre os trabalhadores, enquanto os gastos tributários contribuíram para que os capitalistas pagassem menos impostos que poderiam compor o orçamento...(AU)

This study aimed to analyze the different sources of federal public funding of the sport. The researches on this theme have been dedicated, above all, to the direction of the resources for the sport, lacking investigations on their origin. For this, a quantitative-qualitative research was carried out through documentary analysis, with collection of data in the following locations: Portal da Legislação of the Federal Government, to understand the sports legislation that give base to the matrix of financing; the Transparência no Esporte portal, to discuss data on sources and sub-funds of sports resources from 2004 to 2015; SIGA Brasil, to define the types of taxes that formed the budget of the sport; and Statements of tax expenditures of the Brazil's Federal Revenue, to define the taxes that constituted the tax expenditures. It was identified that the federal public financing of the sport is composed of budgetary, extra-budgetary and tax expenditure sources, being that the first is the one that had most of the resources in the period, besides being the most visible source. When analyzing the taxes that form the budget source it has been identified that they focus mainly on the workers, while tax expenditures contributed to the capitalists paying less taxes than could be made up of the budget...(AU)

Associations between physical activity, sedentary behavior, and health risk behaviors among adolescents from a city in Southern Brazil / Associações entre atividade física, comportamento sedentário e comportamentos de risco à saúde entre adolescentes de uma cidade do Sul do Brasil

This study examined the independent and combined associations of physical activity (PA) and sedentary behavior (SB) with health risk behaviors in Brazilian adolescents. Participants were 893 adolescents (454 girls) from Curitiba, Brazil. The Youth Activity Profile questionnaire evaluated PA and the Adolescent Sedentary Questionnaire evaluated SB. The Youth Risk Behavior Surveillance System ( YRBS) questionnaire evaluated fruit, vegetable, alcohol, and tobacco consumption. Binary Logistic regression measured the independent and combined associations of PA and SB with risk behaviors. PA was inversely associated with low fruit (OR = 0.30; 95%CI: 0.18-0.51) and vegetable consumption (OR = 0.43; 95%CI: 0.25-0.73), and tobacco use (OR = 0.52; 95%CI: 0.29-0.89). However, PA was positively associated with mild (OR = 1.54; 95%CI: 1.08-2.19) and excessive alcohol use (OR = 1.53; 95%CI: 1.01-2.33). Higher levels of PA were associated with reduced risks of smoking and healthier eating patterns, but higher likelihood of alcohol consumption

Este estudo examinou as associações independentes e combinadas de atividade física (AF) e do comportamento sedentário (CS) com comportamentos de risco à saúde em adolescentes brasileiros. Participaram do estudo 893 adolescentes (454 meninas) de Curitiba, Brasil. O questionário Youth Activity Profile avaliou a AF e o Questionário de atividades sedentárias dos adolescentes avaliou o CS. O questionário Youth Risk Behavior Surveillance System (YRBS) avaliou o consumo de frutas, vegetais, álcool e tabaco. A regressão logística binária avaliou as associações independentes e combinadas de AF e CS com comportamentos de risco. AF foi inversamente associado com baixo consumo de frutas (OR = 0,30; IC95%: 0,18-0,51), de vegetais (OR = 0,43; IC95%: 0,25-0,73) e uso de tabaco (OR = 0,52; IC95%: 0,29-0,89). No entanto, a AF foi positivamente associada com uso moderado (OR = 1,54; IC95%: 1,08-2,19) e uso excessivo de álcool (OR = 1,53; IC95%: 1,01-2,33). Níveis mais altos de AF foram associados com riscos reduzidos de fumar e padrões alimentares mais saudáveis e com maior probabilidade de consumo de álcool

Representações sociais do trabalho informal para trabalhadores por conta própria / Social representations of informal working for self employed workers / Representaciones sociales del trabajo informal para trabajadores por cuenta propia / Représentations sociales du travail informel pour travailleurs indépendants

Estima-se que um terço da população brasileira desempenha atividades informais. Essa modalidade de trabalho envolve questões psicossociais e ideológicas específicas, como também representações sociais. O presente estudo objetiva caracterizar as representações sociais do trabalho informal para trabalhadores que estão inseridos nesse tipo de atividade, além de suas práticas sociais e identitárias, considerando a perspectiva da Teoria das Representações Sociais (TRS). O estudo foi exploratório e descritivo, circunscrito na abordagem qualitativa, com a participação de dez trabalhadores, os quais foram entrevistados de forma não diretiva. As narrativas foram analisadas com auxílio do IRAMUTEQ, um software de análise textual. Foi possível identificar três diferentes eixos representacionais: (a) história de vida e laboral, (b) intergeracionalidade da informalidade e (c) liberdade e precariedade do trabalho. As representações sociais do trabalho informal apresentam perspectiva hegemônica, mas também traduzem a atividade de trabalho como algo do humano, que identifica os trabalhadores, e que é insubstituível.

It is estimated that one-third of the Brazilian population performs informal activities and this modality of work involves specific psychosocial and ideological issues, as well as social representations. The present study aims to characterize the social representations of informal work for workers who are included in this type of activity, as well as their social and identity practices, considering the perspective of Social Representation Theory (TRS). The study was exploratory and descriptive, circumscribed in the qualitative approach, with the participation of ten workers interviewed in a non-directive manner. The narratives were analyzed with the help of IRAMUTEQ, a textual analysis software. It was possible to identify three different representational axes: (a) life and work history, (b) inter-generational of informality and (c) freedom and precariousness of work. The social representations of informal work have a hegemonic perspective, but also translate the work activity as something human, which identifies workers, and which is irreplaceable.

Se calcula que un tercio de la población brasileña desempeña actividades informales. Este tipo de trabajo envuelve cuestiones psicosociales e ideológicas específicas, como también representaciones sociales. El objetivo de este trabajo es caracterizar las representaciones sociales del trabajo informal para trabajadores que están metidos en este tipo de actividad, además de sus prácticas de identidad, considerando la perspectiva de la Teoría de las Representaciones Sociales (TRS). El estudio fue de exploración y descriptivo, circunscripto en el enfoque cualitativo, con la participación de diez trabajadores, los cuales fueron encuestados de forma no directiva. Las narrativas fueron analizadas con la ayuda del IRAMUTEQ, un software de análisis textual. Fue posible identificar tres distintos ejes representacionales: (a) historia laboral y de vida, (b) intergeneracionalidad de la informalidad y (c) libertad y precariedad del trabajo. Las representaciones sociales del trabajo informal presentan perspectivas hegemónicas, pero también traducen la actividad de trabajo como algo del humano, que identifica los trabajadores, y que es insubstituible.

On estime qu'un tiers de la population brésilienne travaille de manière informelle. Cette modalité de travail implique des problèmes psychosociaux et idéologiques spécifiques, bien comme des représentations sociales. La présente étude vise à caractériser les représentations sociales du travail informel pour les travailleurs inclus dans ce type d'activité, ainsi que leurs pratiques sociales et identitaires, dans l'optique de la Théorie de la Représentation Sociale (TRS). L'étude a été exploratoire et descriptive, circonscrite dans l'approche qualitative, avec la participation de dix travailleurs interviewés de manière non directive. Les récits ont été analysés à l'aide d'IRAMUTEQ, un logiciel d'analyse textuelle . Il était possible d'identifier trois axes de représentation différents: a) l'histoire de la vie et du travail, b) l'inter-générationnalité de l'informalité et c) la liberté et la précarité du travail. Les représentations sociales du travail informel ont une perspective hégémonique, mais traduisent également l'activité de travail en quelque chose d'humain, qui identifie les travailleurs et qui est irremplaçable.

Políticas de esporte do Distrito Federal: uma análise sobre a legislação, gestão e o financiamento entre os anos de 2008 a 2014 / Federal District sport policies: an analysis on legislation, management and fi nancing between the years from 2008 to 2014

Esse artigo traz uma contribuição para produção de conhecimento no campo das políticas públicas - sobretudo de abrangência local e/ou regional -, voltadas à garantia do acesso à prática esportiva como um direito de cidadania. Nesse sentido, estabelecemos diálogo e prosseguimos com os estudos desenvolvidos por Carneiro, Athayde, Húngaro e Mascarenhas11. Para essa proposição, elencamos como objetivo deste estudo identifi car a magnitude e direcionamento dos gastos com o esporte no âmbito do orçamento público da Secretaria de Estado de Esporte, Turismo e Lazer do Distrito Federal entre os anos de 2008 a 2014, problematizando seus impactos na gestão governamental para o setor. Ao mesmo tempo, realizamos um mapeamento da legislação esportiva nacional e distrital. Metodologicamente, esse artigo confi gura uma pesquisa social qualitativa de nível exploratória, cujo delineamento emprega a técnica do estudo de caso. Como eixo de orientação dos procedimentos e instrumentos empregados nesta pesquisa, adotamos como referência os aspectos, indicadores e categorias desenvolvidas por Boschetti6 e Mascarenhas9. Respeitando a perspectiva crítica e dialética de análise, verifi camos que as políticas de esporte e lazer do Distrito Federal são perpassadas por um movimento de continuidade e descontinuidade, que as afastam do sentido precípuo das políticas públicas de atendimento aos direitos e necessidades sociais e, em particular, da possibilidade de correção das iniquidades presentes na realidade social do Distrito Federal...(AU)

This article contributes to the production of knowledge in the public policies, especially local and/or regional coverage, aimed at guaranteeing access to sports practice as a right of citizenship. In this sense, we establish dialogue and proceed with the studies developed by Carneiro, Athayde, Hungaro and Mascarenhas11. For this proposition, we aimed to identify the magnitude and direction of expenditures with sport within the public budget of the Secretary of State for Sport, Tourism and Leisure of the Federal District from 2008 to 2014, problematizing the impacts on the management governmental organization for the sector. At the same time, we map the national and district sports legislation. Methodologically, this article confi gures an exploratory level qualitative social research whose design uses the technique of the case study. As a guideline of the procedures and instruments used in this research, we adopted as reference the aspects, indicators and categories developed by Boschetti6 and Mascarenhas9. Respecting the critical and dialectical perspective of analysis, we verifi ed that the sport and leisure policies of the Federal District are permeated by a movement of continuity and discontinuity, which distract them from the prevailing sense of public policies of attendance to social rights and needs, and in particular, of the possibility of correction of the inequities present in the social reality of the Federal District...(AU)

A ideologia e o significado do trabalho para trabalhadores por conta própria / Ideology and meaning of work to self-employed workers / La ideología y el significado del trabajo para trabajadores autónomos

O objetivo dessa pesquisa é analisar as características da ideologia no trabalho por conta própria a partir dos significados atribuídos ao trabalho por trabalhadores nessa situação. Realizou-se 11 entrevistas em profundidade com feirantes do Shopping de Pequenos Negócios do Alecrim, em Natal, Brasil. Obteve-se que é comum entre os entrevistados terem realizado trabalho infantil, serem oriundos de famílias de baixa renda e ter sido inserido em trabalhos precarizados. No trabalho atual, estabelecem relações contraditórias de competição e cooperação entre os demais feirantes e planejam continuar nessa atividade indefinidamente. Eles significam o trabalho como uma fonte de dinheiro e de ocupação do tempo, o trabalho assalariado como lugar de humilhação e o trabalho por conta própria como forma de realização de suas demandas. Esses significados desempenham três funções ideológicas: fixação dos trabalhadores nessa condição de trabalho, impedimento de construção de uma consciência de classe e crítica ao trabalho assalariado (AU).

Ideology and meaning of work to self-employed workers. This paper aims to analyze the characteristics of the work ideology to self-employed workers, focusing on the meaning those workers ascribe to their work. Eleven in-depth interviews were carried out with people working in a Small Business Mall in Alecrim, located in Northeast Brazil. The results indicate that the interviewees started working soon in life, coming from low-income families. In the current work, they maintain competitive and cooperative relationship with each other, and they intend to keep working as marketer indefinitely. Working is signified as a source of income and as a strategy to occupy the time. Working in formal work is regarded as a source of humiliation; in the informal condition they feel they have the opportunity for self-fulfillment. The three ideological functions played by the meanings of work are: keeping the workers in their current work; hindering the emergence of a collective-class consciousness; and criticizing the salaried employees (AU).

La ideología y el significado del trabajo para trabajadores autónomos. Esta investigación objetivo analizar la ideología en la labor de trabajadores autónomos a partir de los significados atribuidos al trabajo por el personal en esa situación. Se llevaron a cabo 11 entrevistas con feriantes del Centro Comercial de Pequeños Negocios del Alecrim, en Natal, Brasil. Los resultados indican que es común que los entrevistados hayan realizado trabajo infantil y que procedan de familias de baja renta. En el trabajo actual, establecen relaciones de competencia y cooperación con los demás feriantes y planean continuar en esta actividad indefinidamente. Ellos significan el trabajo como una fuente de dinero y de ocupación de su tempo; el trabajo asalariado como lugar de humillación y el trabajo autónomo como forma de realización de sus demandas. Estos significados desempeñan tres funciones ideológicas: fijación de los trabajadores en esa condición de trabajo, impedimento de la construcción de una consciencia de clase y crítica al trabajo asalariado (AU).

Diferencias angiográficas y epidemiológicas entre hombres y mujeres que desarrollan síndrome coronario agudo / Angiographic and epidemiological differences between men and women who developacute coronary syndrome

Resumen Introducción: la enfermedad cardiovascular es la principal causa de muerte en Colombia. Se han demostrado peores resultados clínicos en las mujeres a pesar de ser más prevalente en hombres. Objetivo: describir las diferencias angiográficas y epidemiológicas entre género de pacientes con síndrome coronario agudo. Métodos: se hizo un estudio descriptivo retrospectivo entre 2013-2014, en el que se incluyeron pacientes con síndrome coronario agudo que fueron separados por género. Se describieron factores de riesgo cardiovascular, biomarcadores de isquemia, angiografía coronaria y mortalidad intrahospitalaria. Los datos se analizaron en SPSS 20.0 Resultados: se estudiaron 148 pacientes; 35% tenían infarto con elevación del ST, 42,9% sin elevación del ST y 21% angina inestable. La prevalencia de enfermedad renal crónica para hombres y mujeres fue de 18,9 vs. 4,1% (p = 0,004); ataque cerebrovascular 2,7% vs. 14,9% (p = 0,009), de predominio femenino, este último. El valor de troponina fue mayor en hombres, 71,6 vs. 56,8% (p = 0,043). Las mujeres requirieron mayor implante de stent, 72,6 vs. 58,1% (p = 0,002); sin embargo, en el género masculino la prevalencia de enfermedad multivaso con indicación de revascularización coronaria fue mayor, 25,7 vs. 6,8% (p = 0,002). La afectación simultánea de las arterias descendente anterior proximal y circunfleja como criterio de severidad, fue mayor en hombres, 5,4 vs. 16,4%, con diferencias significativas (p = 0,032). Conclusiones: este estudio plantea la posibilidad de que en nuestra población pueden existir diferencias clínicas y fisiopatológicas entre género, constituyéndose en un factor fundamental para posibles cambios en su diagnóstico e intervención.

Abstract Introduction: Cardiovascular disease is the primary cause of death in Colombia. Poorer results have been shown in women, despite it being more prevalent in males. Objective: To describe the between-gender angiographic and epidemiological differences in patients with acute coronary syndrome. Methods: Between the years 2013 and 2014, a retrospective descriptive study was performed on patients with acute coronary syndrome that were grouped according to gender. An analysis was made of cardiovascular risk factors, ischaemia biomarkers, coronary angiography, and hospital mortality. The data were analysed using the SPSS 20.0 statistics package. Results: Of the 148 patients studied, 35% had an infarction with an ST elevation, 42.9% an infarction with no ST elevation, and 21% with unstable angina. The prevalence of chronic kidney disease for men and women was 18.9% vs. 4.1% (P=.004), and stroke 2.7% vs. 14.9% (P=.009), with the latter predominantly female. The Troponin value was higher in males, 71.6% vs. 56.8% (P=.043). The women required more stent implants, 72.6% vs. 58.1% (P=.002). However, the prevalence of multivessel disease with a coronary re-vascularisation indication was higher in males, 25.7% vs. 6.8% (P=.002). The simultaneous involvement of the proximal anterior descending and circumflex arteries as a criterion of severity was higher in males, 16.4% vs. 5.4%, with significant differences (P=.032). Conclusions: This study establishes the possibility that there can be between-gender clinical and pathophysiological differences, which may be a fundamental factor for possible changes in its diagnosis and intervention.

Políticas sociais de inclusão social para pessoas com deficiência / Social policies of social inclusion for people with disabilities / Políticas sociales de inclusión social para personas con discapacidad

O objetivo deste artigo é compreender como a temática da deficiência se desenvolveu no campo das políticas públicas brasileiras depois dos anos 1970 até os dias atuais. Especificamente, buscou-se identificar os principais marcos legais e políticos da inclusão social das PCD e caracterizar essa população, a fim de compreendermos mais acerca da realidade brasileira. Por meio de uma pesquisa documental, os resultados indicaram que, no Brasil, o movimento social das PCD se intensificou após o regime militar e ganhou contribuições de diferentes órgãos na hierarquia governamental brasileira, dentre os quais a CORDE e o CONADE, que, junto à Secretaria de Direitos Humanos, têm implementado e regulamentado ações de inclusão no país. Também se verificou que a população de PCD tem menos acesso à educação, salários menores e várias outras desvantagens, se comparadas à das pessoas sem deficiência, demonstrando que leis de inclusão no trabalho, dentre outras ações, ainda são muito necessárias

The objective of this study is to understand how disability issues developed in the field of Brazilian public policies after the ‘70s to the present day. Specifically, identify the key legal and policy frameworks for social inclusion of PWD and characterize this population in order to understand more about the Brazilian reality. Through documentary research, the results indicated that in Brazil, the social movement of PWD intensified after the military regime, and earned contributions of different organs in the Brazilian hierarchy government, among which CORDE and CONADE with the help of secretariat of human rights, it has implemented and regulated inclusion initiatives in the country. It was also found that the population of PWD have less access to education, lower wages and a number of disadvantages compared to people without disabilities, demonstrating that the inclusion actions like law that guarantee access to work, among other actions are still necessary

El objetivo de este estudio es entender cómo los temas de discapacidad son desarrollados en el campo de las políticas públicas de Brasil después de los años 70 hasta la actualidad. En concreto, hemos tratado de identificar los marcos legales y de políticas clave para la inclusión social de las personas con discapacidad, y caracterizar esta población con el fin de comprender mejor la realidad brasileña. A través de la investigación documental, los resultados indicaron que en Brasil, el movimiento social de la PCD se intensificó después del régimen militar, luego se ganaron las contribuciones de los diferentes órganos de la jerarquía de Brasil entre los que, CORDE y CONADE junto con la secretaría de derechos humanos ha implementado y regulado iniciativas de inclusión en el país. También se encontró que la población de PCD tiene menos acceso a la educación, los salarios más bajos y una serie de desventajas en comparación con las personas sin discapacidad; lo que demuestra que la inclusión de las leyes en el trabajo, entre otras acciones, siguen siendo necesarias

Representações sociais da aposentadoria e intenção de continuar trabalhando / Representaciones sociales de la jubilación y intención de seguir trabajando / Social representation of retirement and intention of continue working

Resumo O objetivo deste estudo foi analisar representações sociais atribuídas à aposentadoria por servidores públicos federais, identificando os aspectos mais enfatizados e suas implicações no processo de decisão trabalho-aposentadoria. Trata-se de uma pesquisa qualitativa, de caráter exploratório e descritivo, realizada com 283 servidores que já faziam jus à aposentadoria ou se encontravam próximos (menos de 05 anos). Os dados coletados foram distribuídos em dois corpora: aposentadoria e expectativas. A análise lexicográfica foi realizada pela técnica de classificação hierárquica descendente, com o auxílio de um software de análise textual. Os resultados indicam a existência de padrões de significados de aposentadoria entre os sujeitos, estando a intenção de aposentar-se vinculada à ideia de usufruir o tempo e viver com mais qualidade, e o adiamento em resposta ao sentir-se atuante no trabalho, não ter atividades substitutivas, e enquanto estratégia contra a ociosidade.

Resumen El objetivo de este estudio es analizar las representaciones sociales atribuidas a la jubilación por parte de los servidores públicos, identificando los aspectos mas destacados y sus implicaciones en el proceso de toma de decisión trabajo-jubilación. Esta es una investigación cualitativa, exploratoria y descriptiva, realizada con 283 servidores que ya tiene derecho a la jubilación o están cerca (menos de 05 años). Los datos colectados se distribuyeron en dos corpus: jubilación y expectativas. El análisis lexicográfico se realizó usando la técnica de clasificación jerárquica descendiente, con la ayuda de software de análisis textual. Los resultados indican la existencia de estándares de significados de jubilación entre los individuos, siendo la intención de jubilarse vinculada a la idea de disfrutar del tiempo y vivir con más calidad, y el aplazamiento en respuesta a la sensación de actividad en el trabajo, no tener actividades sustitutas, y como estrategia contra la ociosidad.

Abstract The aim of this study was to analyze the social representation of public workers' retirement and identify the most emphasized aspects, as well as its implications, for the retirement decision process. This study is a qualitative, exploratory and descriptive research, with 283 already retired public workers, or close to retirement (less than 05 years). Collected data were divided into two corpora: retirement and expectations. The lexical analysis was carried out according to descending hierarchical classification technique, with the aid of a textual analysis software. The results have shown that there were patterns of meaning of retirement among the participants, where retirement intention is linked to the idea of enjoying free time and better quality of life, while postponing of retirement is associated with being active at work and lacking replacement activities, as well as a strategy against idleness.

Estado actual de la ablación de la fibrilación auricular / Current status on atrial fibrillation ablation

La fibrilación auricular es la arritmia más común en la práctica clínica. La ablación se considera el tratamiento de elección (indicación clase I) en los pacientes sintomáticos con recurrencias a pesar del tratamiento con fármacos antiarrítmicos. El presente artículo revisa tanto los mecanismos propuestos de esta arritmia como las diferentes metodologías de ablación con catéter y sus indicaciones.

Summary Atrial fibrillation is the most common arrhythmia in clinical practice. Catheter ablation is the treatment of choice (Class I indication) for symptomatic patients with recurrences despite antiarrhythmic drugs. The present article reviews the proposed mechanisms of this arrhythmia and the different ablation methods and indications.