Práticas Avançadas de Enfermagem ­ PAE / Advanced Nursing Practices ­ ANP

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)

Boosting synergism of chemo- and immuno-therapies via switching paclitaxel-induced apoptosis to mevalonate metabolism-triggered ferroptosis by bisphosphonate coordination lipid nanogranules

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.

Running intralimb coordination patterns after a foot core exercise program in recreational runners

This study investigated the effects of a foot core intervention on the coordination of foot joints in recreational runners. This was a secondary analysis from a randomized controlled trial conducted with 87 recreational runners allocated to the control group (CG), which followed a placebo lower limb stretching protocol, or the intervention group (IG), which underwent an 8-week (3 times/week) foot core training. The participants ran on a force-instrumented treadmill at a self-selected speed (9.5-10.5 km/h) while the foot segment motion was captured. The vector coding technique was used to assess inter-joint coordination for four selected coupled segment and joint angles. The coordination patterns of the calcaneus and midfoot (CalMid) and midfoot and metatarsus (MidMet) joint pairs were affected. In the frontal plane, IG showed an in-phase with proximal dominancy coordination at heel strike, with a decrease in its frequency after the training (P=0.018), suggesting a longer foot supination. Additionally, IG showed an anti-phase with distal dominancy pattern at early stance compared to CG due to a smaller but earlier inversion of the CalMid-MidMet pair (P=0.020). The intervention also had an effect on the transverse plane of the CalMid-MidMet pair, with IG showing a significantly greater frequency of anti-phase coordination with proximal dominancy during propulsion than CG (P=0.013), probably due to a reduction in the CalMid abduction. Overall, the results suggested that the foot core intervention reduces the occurrence of running-related injuries by increasing the resistance to calcaneus pronation and building a more rigid and efficient lever during push-off.

Análisis de la coordinación motora por índice de masa corporal y sexo en escolares de Chile / Analysis of motor coordination by body mass index and sex in Chilean schoolchildren / Análise da coordenação motora por indice de massa corporal corporal e sexo em escolares chilenos

La investigación tuvo como objetivo analizar la relación entre la Coordinación Motora (CM) con el Índice de Masa Corporal en escolares chilenos de entre 7 y 9 años. El estudio fue observacional de corte transversal, con características descriptivas y correlacionales. Se evaluaron a 180 escolares (90 mujeres de 8.4 ± 0.9 años y 90 hombres de 8.5± 0.9 años). Se midieron variables antropométricas de peso y talla. Se calculó el Índice de Masa Corporal (IMC). La coordinación motora (CM) se evaluó utilizando la batería de Körperkoordinationstest Für Kinder (KTK). Los resultados mostraron que en las mujeres el grupo Normopeso tenía un mejor desempeño en la transposición lateral que los grupos Sobrepeso y Obesidad (p˂0.05). En los hombres, el grupo Normopeso superó al grupo Obesidad en los saltos monopedales (p˂0.05). Además, al analizar las diferencias entre sexos, se determinó que las mujeres registraron mayor puntaje que los hombres en el equilibrio a la retaguardia (p<0.05), por su parte, los hombres registraron mejores rendimientos en saltos laterales, transposición lateral y el puntaje total del KTK (p<0.05). Se concluye que existe menor índice de CM en los escolares con elevado IMC, y que existen diferencias significativas entre hombres y mujeres en el equilibrio, saltos laterales, transposición lateral y el puntaje total del test KTK.

The objective of this research was to analyze the relationship between motor coordination (CM) and Body Mass Index in Chilean schoolchildren between 7 and 9 years of age. The study was observational cross-sectional, correlational and descriptive study. 180 students of both sexes were evaluated (90 women aged 8.4 ± 0.9 years and 90 men aged 8.5 ± 0.9 years). Anthropometric weight and height variables were measured and the Body Mass Index (BMI) was calculated. The CM was evaluated using the battery of Körperkoordinationstest Für Kinder (KTK). The results showed that in the lateral transposition, the normal weight group outperforms the overweight and Obesity group (p˂0.05) for women. For men, in monopedal jumps, the normal weight group also outperformed the obesity group (p˂0.05). In addition, when analyzing the differences between the sexes, it was noted that women had a higher score than men in the rear balance (p˂0.05). On the other hand, men had performed better in lateral jumps, lateral transposition and the total KTK score (p˂0.05). In conclusion, the study found that there was a lower CM index in schoolchildren with a high BMI, and that there were significant differences between men and women in terms of balance, lateral jumps, lateral transposition, and the total score of the KTK test.

O objetivo da pesquisa foi analisar a relação entre a coordenação motora (CM) com o Índice de Massa Corporal corporal em escolares chilenos entre 7 e 9 anos de idade. O estudo foi observacional transversal, com características descritivas e correlacionais. Foram avaliados 180 escolares de ambos os sexos (90 mulheres com idade de 8,4 ± 0,9 anos e 90 homens com idade de 8,5 ± 0,9 anos). Variáveis antropométricas de peso e altura foram medidas. O Índice de Massa Corporal (IMC) foi calculado. Além disso, a coordenação motora (MC) foi avaliada por meio da bateria Körperkoordinationstest Für Kinder (KTK). Os resultados mostraram que, para mulheres em transposição lateral, o grupo Peso Normal supera o grupo Sobrepeso e Obeso (p˂0,05). Para os homens, nos saltos monopedais o grupo Peso Normal supera o grupo Obesidade (p˂0,05). Além disso, ao analisar as diferenças entre os sexos, percebe-se que as mulheres apresentam pontuação maiores que os homens no equilíbrio de retaguarda (p<0,05), enquanto os homens apresentam melhor desempenho nos saltos laterais, transposição lateral e pontuação total KTK (p< 0,05). Conclui-se que há menor índice de CM em alunos com IMC elevado, e que existem diferenças significativas entre homens e mulheres para equilíbrio, saltos laterais, transposição lateral e pontuação total do teste KTK.

A regulação de alimentos de origem animal no Brasil à luz da teoria processual administrativa da regulação / The regulation of animal-source foods in Brazil in the light of a process-oriented approach toregulation / La regulación de los alimentos de origen animal en Brasil a la luz de la teoría procesal administrativa de la regulación

Objetivo: analisar a regulação de alimentos de origem animal realizada pela Agência Nacional de Vigilância Sanitária (Anvisa) e pelo Ministério da Agricultura, Pecuária e Abastecimento (MAPA) sob a perspectiva da teoria processual administrativa da regulação, bem como casos normativos sobre substâncias químicas em alimentos de origem animal. Metodologia: foram realizados dois estudos de caso ­ um sobre os atos normativos da Anvisa sobre resíduos de medicamentos veterinários em alimentos de origem animal; e outro sobre a decisão do MAPA pelo fim das análises oficiais de amostras de água em indústrias de alimentos de origem animal de forma rotineira ­ a partir de uma abordagem qualitativa da composição institucional e normativa da Anvisa e do MAPA, sob a ótica da teoria processual administrativa da regulação. Resultados: a Anvisa tem adotado mecanismos condizentes com a teoria processual administrativa da regulação, como autonomia, estabilidade funcional dos agentes reguladores e participação social. Em relação ao MAPA, seu ambiente institucional detém menor autonomia e tem formalmente adotado, desde 2015, elementos processuais compatíveis com tal teoria, mas que podem ser desconsiderados durante a produção normativa interna. Conclusão: o modelo regulatório brasileiro, que divide a regulação dos alimentos de origem animal entre dois órgãos, pode gerar decisões que não levam em conta o interesse público e a participação social, o que pode ser percebido na produção normativa do MAPA, mesmo com a adoção formal de boas práticas regulatórias.

Objective: to analyze the regulation of food of animal origin carried out by the Brazilian Health Surveillance Agency (Anvisa, in Portuguese) and the Ministry of Agriculture, Livestock and Food Supply (MAPA, in Portuguese) from the perspective of a process-oriented approach to regulation, with a specific emphasis on cases involving chemical substances in food of animal origin. Methods: this research conducted two case studies. The first case study examined Anvisa's normative acts regarding residues of veterinary drugs in food of animal origin. The second case study analyzed MAPA's decision to discontinue routine official analyses of water samples in the animal food industry. The research approach was qualitative, focusing on investigating the institutional and normative composition of Anvisa and MAPA from the perspective of a process-oriented approach to regulation. Results: the analysis revealed that Anvisa has successfully implemented mechanisms consistent with a process-oriented approach to regulation, including regulatory autonomy, functional stability of regulatory bodies, and administrative procedures to promote social participation. On the other hand, MAPA's institutional-legal environment exhibits less autonomy and formally adopted procedural elements consistent with a process-oriented approach to regulation since 2015. However, there is a concern that these elements might be eliminated when drafting internal regulations. Conclusion: the Brazilian regulatory model divides animal food regulation between two agencies, potentially resulting in decisions that overlook the public interest and social participation. This is evident in the normative production of MAPA, despite their formal adoption of good regulatory practices.

Objetivo: analizar la regulación de alimentos de origen animal realizada por la Agencia Nacional de Vigilancia Sanitaria (Anvisa) y por el Ministerio de Agricultura, Ganadería y Abastecimiento (MAPA, en portugués) en la perspectiva de la teoría procesal administrativa de la regulación, así como normativa casos sobre sustancias químicas en alimentos de origen animal. Metodología: se realizaron dos estudios de caso ­ uno sobre los actos normativos de Anvisa sobre residuos de medicamentos veterinarios en alimentos de origen animal; y otro sobre la decisión del MAPA de poner fin a los análisis oficiales de muestras de agua en las industrias de alimentos para animales de forma rutinaria ­ basado en un enfoque cualitativo de la composición institucional y normativa de Anvisa y MAPA, en la perspectiva de la regulación administrativa de la teoría procesal. Resultados: Anvisa ha adoptado mecanismos consistentes con la teoría procesal administrativa de la regulación, como la autonomía, la estabilidad funcional de los agentes reguladores y la participación social. Respecto al MAPA, su ámbito institucional tiene menor autonomía y ha adoptado formalmente, desde 2015, elementos procedimentales compatibles con dicha teoría, pero que pueden ser desestimados durante la producción normativa interna. Conclusión: el modelo regulatorio brasileño, que divide la regulación de los alimentos de origen animal entre dos órganos, puede generar decisiones que no toman en cuenta el interés público y la participación social, lo que se puede ver en la producción normativa del MAPA, incluso con la adopción formal de buenas prácticas regulatorias.

Concepción teórico-metodológica para el desarrollo de la coordinación en educandos con discapacidad intelectual leve

La discapacidad intelectual leve provoca un lento aprendizaje de las habilidades motrices, en particular de la coordinación, y se considera que esta problemática precisa de atención. En las clases de Educación Física se observó que los educandos con discapacidad intelectual leve presentaron alteraciones en las capacidades coordinativas motoras, posturales, sensoriales y en las conductas de adaptación a los diferentes contextos como la casa, la institución educativa y la comunidad; por lo que se planteó como objetivo desarrollar la coordinación en los educandos de siete a ocho años, mediante juegos motrices en las clases de Educación Física. El estudio que se presenta, se sustentó en la complementariedad metodológica al combinarse los enfoques cualitativo y cuantitativo; se emplearon métodos teóricos como el analítico-sintético, el sistémico-estructural-funcional, el histórico-lógico y el inductivo-deductivo y métodos empíricos como la observación, la entrevista, la encuesta y el experimento. Como resultado, se realizó la sistematización teórica, el diagnóstico y la propuesta de juegos motrices acorde con la edad y la discapacidad intelectual leve que se manifiesta en el desarrollo de la conducta motriz y en las relaciones de actuación de los educandos. De manera general, se constató una mejor coordinación y desarrollo de las habilidades para realizar los diferentes ejercicios y juegos motrices en las clases de Educación Física.

A deficiência intelectual leve causa uma aprendizagem lenta das habilidades motoras, particularmente da coordenação, e considera-se que esse problema precisa de atenção. Nas aulas de Educação Física, observou-se que os alunos com deficiência intelectual leve apresentavam alterações nas habilidades de coordenação motora, postural e sensorial e no comportamento de adaptação a diferentes contextos, como a casa, a instituição de ensino e a comunidade; portanto, o objetivo foi desenvolver a coordenação em alunos de sete a oito anos de idade, por meio de jogos motores nas aulas de Educação Física. O estudo aqui apresentado baseou-se na complementaridade metodológica, combinando abordagens qualitativas e quantitativas; foram utilizados métodos teóricos como o analítico-sintético, o sistêmico-estrutural-funcional, o histórico-lógico e o indutivo-dedutivo, bem como métodos empíricos como observação, entrevista, pesquisa e experimento. Como resultado, foram realizados a sistematização teórica, o diagnóstico e a proposta de jogos motores de acordo com a idade e a deficiência intelectual leve que se manifesta no desenvolvimento do comportamento motor e nas relações de desempenho dos alunos. Em geral, observou-se uma melhor coordenação e desenvolvimento de habilidades para realizar os diferentes exercícios e jogos motores nas aulas de Educação Física.

Mild intellectual disability causes slow learning of motor skills, particularly coordination, and this problem is considered to require attention. In Physical Education classes, it was observed that students with mild intellectual disabilities presented alterations in motor, postural, sensory coordinative capacities and in adaptation behaviors to different contexts such as home, the educational institution and the community; for this reason, the objective was to develop coordination in students from seven to eight years of age, through motor games in Physical Education classes. The study presented was based on methodological complementarity by combining the qualitative and quantitative approaches; theoretical methods such as the analytical-synthetic, the systemic-structural-functional, the historical-logical and the inductive-deductive and empirical methods such as observation, interview, survey and experiment were used. As a result, the theoretical systematization, the diagnosis and the proposal of motor games according to age and mild intellectual disability that manifests itself in the development of motor behavior and in the relations of action of the students were carried out. In general, there was a better coordination and development of skills to perform the different exercises and motor games in Physical Education classes.

El desarrollo de la coordinación en levantadores de pesas, en la categoría 13-14 años

En la categoría 13-14 años del deporte levantamiento de pesas, la formación de habilidades técnicas y el desarrollo de capacidades constituyen objetivos principales. En las observaciones realizadas a los entrenamientos, se apreciaron deficiencias en la ejecución de los ejercicios clásicos, debido a insuficiencias en la coordinación de las fases de movimiento. Para dar solución a este problema científico, se define como objetivo valorar los resultados de la aplicación de acciones pedagógicas para el desarrollo de la coordinación en levantadores de pesas de la categoría escolar. Se aplicaron acciones que favorecieron el desarrollo de contenidos dirigidos a la planificación y entrenamiento de las capacidades coordinativas en las preparaciones metodológicas y de ejercicios de preparación física general y especial; además, se aplicó un test para evaluar la coordinación de las fases del ejercicio clásico arranque en el proceso de entrenamiento. Se utilizaron métodos del nivel teórico como el análisis-síntesis, el sistémico-estructural y el inductivo-deductivo y empíricos como la observación, el análisis de documentos, la encuesta y la experimentación, además de métodos matemáticos y estadísticos. Se consideraron novedosos los resultados de la aplicación de las acciones y el sistema de ejercicios para el desarrollo de la coordinación en los pesistas de la categoría 13-14 que reflejaron incremento de la velocidad en la ejecución y la coordinación del movimiento, así como un aumento de las puntuaciones de la evaluación técnica con relación a cursos anteriores, lo que propició una mejor ubicación de los pesistas de la provincia en la competencia nacional.

Na categoria de levantamento de peso de 13-14 anos, o treinamento de habilidades técnicas e o desenvolvimento de capacidades são os principais objetivos. Nas observações feitas durante as sessões de treinamento, foram constatadas deficiências na execução dos exercícios clássicos, devido a insuficiências na coordenação das fases do movimento. Para solucionar esse problema científico, o objetivo foi avaliar os resultados da aplicação de ações pedagógicas para o desenvolvimento da coordenação em levantadores de peso da categoria escolar. Foram aplicadas ações que favoreceram o desenvolvimento de conteúdos voltados para o planejamento e treinamento das capacidades coordenativas nas preparações metodológicas e exercícios de preparação física geral e especial; além disso, foi aplicado um teste para avaliar a coordenação das fases do exercício clássico de partida no processo de treinamento. Foram utilizados métodos teóricos como análise-síntese, sistêmico-estrutural e indutivo-dedutivo, bem como métodos empíricos como observação, análise de documentos, pesquisa e experimentação, além de métodos matemáticos e estatísticos. Os resultados da aplicação das ações e do sistema de exercícios para o desenvolvimento da coordenação nos levantadores de peso da categoria 13-14 foram considerados novos, pois refletiram um aumento na velocidade de execução e coordenação de movimentos, bem como um aumento nas pontuações da avaliação técnica em relação aos cursos anteriores, o que levou a uma melhor colocação dos levantadores de peso da província na competição nacional.

In the 13-14-year-old category of the weightlifting sport, the training of technical skills and the development of capacities are the main objectives. In the observations made to the training, deficiencies were observed in the execution of the classic exercises, due to insufficiencies in the coordination of the movement phases. In order to solve this scientific problem, the objective is to assess the results of the application of pedagogical actions for the development of coordination in weightlifters of the 13-14 years category. Actions were applied that favored the development of contents directed to the planning and training of the coordinative capacities in the methodological preparations and exercises of general and special physical preparation; in addition, a test was applied to evaluate the coordination of the phases of the classic snatch exercise in the training process. Methods of the theoretical level such as analysis-synthesis, systemic -structural and inductive-deductive and empirical methods such as observation, document analysis, survey and experimentation, as well as mathematical and statistical methods were used. The results of the application of the actions and the system of exercises for the development of coordination in weightlifters of the 13-14 category were considered novel, reflecting an increase in speed in the execution and movement coordination, as well as an increase of the scores of the technical evaluation in relation to previous school courses, which led to a better placement of the province's weightlifters in the national competition.

Explorando el sistema de protección de la niñez en El Salvador

(analítico) Se exploran las prácticas institucionales que facilitan u obstaculizan la protección de los derechos de niños, niñas y adolescentes en el sistema de protección de la niñez en El Salvador. Partiendo de un diseño de etnografía institucional, se realizaron 61 entrevistas a trabajadores pertenecientes al sistema de protección. Como resultado, se identificó la ausencia de manuales que establezcan prácticas concretas en la aplicación de la Ley de Protección Integral de la Niñez y Adolescencia, obstruyendo su óptimo funcionamiento. A través del uso de la teoría del interaccionismo simbólico, se explora cómo la interpretación discrecional o no entendimiento de la ley forma instituciones aisladas del sistema; también se analiza el grado en que las dinámicas socioeconómicas del país ponen en desventaja a los sectores rurales para acceder a estos servicios.

(analytical) This study explores the institutional practices that support or hinder the rights of children and young people in the child protection system in El Salvador. Using an institutional ethnography approach, 61 individuals who worked directly or indirectly in the child protection system were interviewed. The findings highlight a lack of manuals that establish concrete practices in accordance with the application of the Law of Comprehensive Protection for Children and Youth, which reduces the effectiveness of the country's child protection system. Through an analytical approach based on symbolic interactionism, this study explored how the individual interpretations of the law, or lack thereof, combine with socioeconomic disadvantages to create difficulties for rural child protection institutions in terms of accessing operational resources.

(analítico) O presente estudo explora as práticas institucionais que apoiam ou dificultam os direitos de crianças e jovens no sistema de proteção infantil em El Salvador. Utilizando um desenho de etnografia institucional, foram entrevistados 61 indivíduos que trabalhavam ou trabalham no sistema de proteção à criança. Os achados indicam que faltam manuais que estabeleçam práticas concretas em consonância com a aplicação da Lei de Proteção Integral da Infância e Juventude o que dificulta a efetividade do sistema de proteção. Por meio de um entendimento baseado no interacionismo simbólico, este estudo explorou como as interpretações individuais da lei, ou a falta dela, e a desvantagem socio-econômica das instituições colocam os setores rurais em desvantagem no acesso aos recursos.

Visual Contribution to Motor Skill DCD Disorders & Walking Physiology Using Spatial Cognition and Linear Geometries as Landmark Coordination Cues

Problem: Awareness of children, who experience movement, particularly motor coordination difficulties, has increased dramatically over the last ten years. These motor coordination problems of children with Developmental Coordination Disorder (DCD) or/and Attention-Deficit / Hyperactivity Disorder (ADHD) have been frequently associated with poor visual and spatial eye-vision processing.Background: Motor control difficulties for DCD and ADHD children have been discussed in detail. However, just a little is known about the influence of the natural environment on these disorders. Even more, the built environment’s impact as a spatial cognition and coordination functionality has never been considered.Aim: This pilot and innovative study aim to identify the correlation between and evaluate the visual contribution of the so-called “spatial compound linear geometries” and DCD children’s motor/walking control.Methodology: Twenty children aged 5 to 8 years with DCD difficulties (two intervention groups, one with 10 boys and the other one with 10 girls) were assessed by a statistical structural evaluation in three built environments (two urban parks and one pocket park), under two conditions (rich or not in trees, flora, and PnP linear geometries), and different motor coordination control situations (static balance, dynamic balances, dark condition).Results: The worst performances (regarding movement disorders and motor coordination problems) were observed for both groups with DCD children playing in parks poor in or without trees, flora, and spatial compound linear geometries. Instead, a significant performance (strong statistical correlation) was found for the same intervention group (DCD children’s boys or girls) playing in parks rich in trees, flora, and vegetation (natural environment). The best performance (very strong statistical correlation) was detected in parks rich in a natural environment and linear geometries. Conclusions: While the natural environment contribution is bibliographically known, the best performance finding of the visual contribution of the spatial compound linear geometries, as spatial landmarks enriching the visual-spatial motor/walking functionalities for Children with DCD disorder, could provide new cognitive approaches towards an understanding of children’s Developmental Coordination Disorder and walking physiology. DCD children’s performance, scores, and cues were related to both the natural environment and the spatial compound linear geometries as spatial landmark motor coordination cues and spatio-temporal clues. The significant variability in sensory processing among children with DCD, ADHD, and co-occurring symptoms can contribute to understanding how neurological and social factors correlate across diagnoses. Also, derived observations for stepping errors, Gait analysis (variables), and spatio-temporal clues conclude that visual eye-based processing interrelates with motor coordination problems, performance, inattention, environmental conditions (dark), sex identity (boys, girls), and DCD hyperactivity. Applications: Development of interactive visual applications for (i) human spatial cognition and movement improvement; and (ii) children’s motor control and coordination refinement.

Sex difference of fine motor skills of school-age children with attention deficit hyperactivity disorder / 中国康复理论与实践

ObjectiveTo explore the characteristics of fine motor skills of school-age children with attention deficit hyperactivity disorder (ADHD) in different sexes. MethodsFrom April, 2021 to April, 2023, 66 ADHD children from grades one to four in Beijing Haidian Wanquan Primary School were screened by psychiatrists, and other 69 ADHD children were recruited from hospitals and patient groups of WeChat, accounting to 135 ADHD children. Meanwhile, a total of 135 typically developed (TD) children matched with sex and age (< 0.5 year) were recruited from the same primary school as controls. They were assessed with Movement Assessment Battery for Children (MABC-2) four subtests of manual dexterit. ResultsAfter controlling age, the subtest scores and the total score of fine motor of MABC-2 were less in ADHD boys and girls than in the TD boys and girls (P < 0.05). The main effect of sex was significant on the subtest scores and the total score of fine motor for ADHD children (F > 5.133, P < 0.05), and they were less in the boy than in the girls (P < 0.05). ConclusionThe development of fine motor delays in school-aged ADHD children, especially for the boys.

Exploration and practice of multi-campus integrated management of hospital human resources in the Second Affiliated Hospital Zhejiang University School of Medicine / 中华医院管理杂志

In the process of multi-campus hospital development, the main challenge of hospital human resource management is to meet the rapidly increasing demand for human resources in new hospital areas, ensure the quality of medical human resources, improve the efficiency of human resource management, and ensure effective balance among the three. Over the years of practice, the Second Affiliated Hospital Zhejiang University School of Medicine had always adhered to " hospital area coordinated management" and " personnel homogeneous management" , coordinated personnel recruitment and introduction, coordinated human resource allocation across multi-campus in the same discipline, unified job management across multi-campus, unified employee qualification, assessment and training system, and established an integrated digital human resource management platform, which ensured the high-quality expansion and reasonable layout of the hospital′s human resources, and ensured the rational layout and orderly development of disciplines.

Research progress of China's science and technology ethics governance from the perspective of collaborative governance / 中华医学科研管理杂志

Objective:To review the concept of science and technology ethics, analyze the problems faced by science and technology ethics governance from the perspective of collaborative governance, and then propose suggestions.Methods:Using the literature review method, we searched and screened relevant literature on science and technology ethics governance, extracted the research content and results of such literature for systematically review and summarization.Results:The problems of China′s science and technology ethics governance include slow legalization progress, unclear disciplinary standards, unsound governance systems, and weak scientific and technological ethics awareness among researchers.Conclusions:Strengthening the governance of science and technology ethics requires a multi-level approach, including strengthening the legislation of science and technology ethics, improving the governance mechanism, and improving the awareness of science and technology ethics among the scientists and technologists.

Blood flow restriction can improve knee proprioception and motor coordination after anterior cruciate ligament reconstruction / 中华物理医学与康复杂志

Objective:To explore any effect of blood flow restriction during exercise on knee proprioception and motor coordination after anterior cruciate ligament (ACL) reconstruction.Methods:Thirty patients recovering from ACL reconstruction were randomly divided into an experimental group and a control group, each of 15. Both groups were given routine rehabilitation training, while the experimental group was additionally provided with 45 minutes of training with blood flow restriction, 3 times a week for 8 weeks. The blood flow restriction training involved constant pressure in the groin while the patient performed knee flexion and extension resistance training, squats, alternate knee flexion and extension and ergometer cycling. Before and after the intervention, both groups′ knee function, proprioception and lower limb motor coordination were evaluated using the Lysholm knee scale, the Humac isokinetic measurement system and surface electromyography.Results:Before the experiment there were no significant differences between the two groups in any of the measurements. After the intervention, both groups′ average Lysholm score had improved significantly, and errors in reproducing a knee angle had decreased significantly. Significantly better improvement was observed in the observation group than in the control group. That group′s average coordinated contraction rate on the affected side in extension and flexion was also significantly better than the control group′s ave-rage. Indeed, there were no significant differences in the contraction rates between the healthy and affected sides.Conclusions:Training with restricted blood flow can significantly improve knee function, proprioception and motor coordination after anterior cruciate ligament reconstruction.

Investigation on status quo and influencing factors for donation coordination of organ donation coordinators / 器官移植

Objective To explore the important factors influencing organ donation willingness and coordination effect of organ donation coordinators. Methods A questionnaire survey was conducted among 349 national organ donation coordinators by convenience sampling, including 145 males and 204 females, aged 27 (23, 36) years. Multiple linear regression and disordered logistic regression were used to investigate the important factors influencing the willingness to donate organs and coordination effects. Results Among 349 organ donation coordinators, 146 (41.8%) were willing to donate organs, including 101 (28.9%) who had signed the consent card for organ donation. Adequate awareness of organ donation laws, high education level, marital experience, and good self-perceived health status all showed positive effects on organ donation willingness of organ donation coordinators (all P < 0.05). High income, long length of service as organ donation coordinators, full-time mode of employment, high willingness to donate organs, and adequate awareness of donation conditions and donation procedures all showed positive effects on the coordination effect of organ donation coordinators (all P < 0.05). Conclusions The willingness to donate organs is increased as the higher awareness of organ donation laws of organ donation coordinators, while enhancing the willingness to donate organs of organ donation coordinators exerts positive impact upon improving the coordination effect of organ donation coordination. Therefore, an all-round organ donation coordinator training system should be established to improve the success rate of organ donation advocacy and promote the development of organ donation.

Ultrasmall iron-quercetin metal natural product nanocomplex with antioxidant and macrophage regulation in rheumatoid arthritis

Oxidative stress, due to the disruption of the balance between reactive oxygen species (ROS) generation and the antioxidant defense system, plays an important role in the pathogenesis of rheumatoid arthritis (RA). Excessive ROS leads to the loss of biological molecules and cellular functions, release of many inflammatory mediators, stimulate the polarization of macrophages, and aggravate the inflammatory response, thus promoting osteoclasts and bone damage. Therefore, foreign antioxidants would effectively treat RA. Herein, ultrasmall iron-quercetin natural coordination nanoparticles (Fe-Qur NCNs) with excellent anti-inflammatory and antioxidant properties were constructed to effectively treat RA. Fe-Qur NCNs obtained by simple mixing retain the inherent ability to remove ROS of quercetin and have a better water-solubility and biocompatibility. In vitro experiments showed that Fe-Qur NCNs could effectively remove excess ROS, avoid cell apoptosis, and inhibit the polarization of inflammatory macrophages by reducing the activation of the nuclear factor-κ-gene binding (NF-κB) pathways. In vivo experiments showed that the swollen joints of mice with rheumatoid arthritis treated with Fe-Qur NCNs significantly improved, with Fe-Qur NCNs largely reducing inflammatory cell infiltration, increasing anti-inflammatory macrophage phenotypes, and thus inhibiting osteoclasts, which led to bone erosion. This study demonstrated that the new metal-natural coordination nanoparticles could be an effective therapeutic agent for the prevention of RA and other diseases associated with oxidative stress.

Role of Aquaporins in Heart Failure from Theory of Cardiac and Renal Coordination / 中国实验方剂学杂志

Heart failure refers to a group of clinical syndromes caused by structural or functional abnormalities of the heart that lead to impaired ejection or filling of the ventricles. The traditional Chinese medicine （TCM） theory of cardiac and renal coordination holds that the kidney governs water and plays a key role in maintaining the balance of fluid metabolism. Therefore， the treatment of water retention in heart failure can start from the heart and kidney. The basic pathogenesis of heart failure is kidney deficiency， blood stasis， and water stagnation， and the therapies including dredging the heart and kidneys， warming yang and excreting water， tonifying kidneys and activating blood， and dredging meridians and collaterals. Aquaporins （AQPs）， the key molecular basis of water metabolism， are involved in the pathogenesis of water retention in heart failure together with the arginine vasopressin system （AVP）， renin-angiotensin-aldosterone system （RAAS）， and diuretic resistance. Studies have shown that herbal medicines that regulate the heart and kidney can alleviate water retention in heart failure by targeting AQPs， thereby delaying or even reversing the progression of heart failure. This paper expounds the TCM name and pathogenesis of heart failure from the theory of cardiac and renal coordination， the role of AQPs in the pathogenesis of water retention in heart failure， and the modern connotation of the therapy of tonifying heart and kidney for heart failure， aiming to provide ideas for the prevention and treatment of water retention in heart failure by TCM.

Developing a “Multidisciplinary Collaboration Ability Scale (MCAS)”: Examining the Reliability and Validity for Medical Professionals Engaged in Cancer Care

Purpose: The purpose of this study is to develop a “Multidisciplinary Collaboration Ability Scale (MCAS)” and examine the reliability and validity for medical professionals engaged in cancer care. Method: The first MCAS draft was created, and the content validity and surface validity of the scale were examined for medical professionals. Next, a cross-sectional questionnaire survey was conducted on medical professionals engaged in cancer care who worked in medical institutions. Exploratory factor analysis and known-groups technique were carried out, coefficient α calculated, and concurrent validity examined. This study was conducted with the approval of the research ethics review. Result: Exploratory factor analysis resulted in 33 items of 4 factors (ability to promote discussion, foundational relationship building, self-control, and problem-solving activities). The MCAS score was significantly higher for those who had participated in a multidisciplinary workshop and those who had more years of experience. Coefficient α for the entire scale and for each factor was .80 and above. Examination of concurrent validity showed a moderate correlation. Conclusion: The reliability and validity of MCAS in its development stage were generally verified.

Coordenação do cuidado: uma análise por meio da experiência de médicos da Atenção Primária à Saúde / Care coordination: an analysis based on the experiences of primary care doctors / Coordinación del cuidado: un análisis a partir de la experiencia de médicos de la Atención Primaria de la Salud

Resumo O objetivo é analisar a experiência de médicos da Atenção Primária à Saúde (APS) sobre conhecimento, uso e reflexões para melhoria da coordenação do cuidado. Foi realizado estudo transversal com utilização do COORDENA-BR com médicos da APS, em Niterói/RJ/BR. Os profissionais reconheciam a importância da coordenação, ainda que não ocorresse, e confiavam nas habilidades clínicas dos médicos da Atenção Especializada (AE). Não havia indicação de seguimento e reconhecimento da centralidade da APS pelos pares da AE. O envio da referência, o recebimento do resumo de alta hospitalar e o uso de protocolos foram recorrentes, o recebimento da contrarreferência não. Não eram realizadas sessões clínicas compartilhadas e os médicos da APS não consultavam os especialistas para esclarecimento de dúvidas. Os resultados expressam a insuficiência de condições tecnológicas, organizacionais e de valores para que a APS assuma a coordenação do cuidado no SUS.(AU)

Abstract The aim of this study was to explore the experiences of primary care doctors regarding the use of knowledge and reflection to improve care coordination. We conducted a cross-sectional study with primary care doctors in Niterói, Rio de Janeiro using the COORDENA-BR questionnaire. The doctors recognized the importance of coordination, although it did not occur, and trusted the clinical skills of specialty doctors. There was no indication that their peers in specialty care recognized and promoted the centrality of primary care. Referrals, receipt of hospital discharge summaries and use of protocols were common; counter-referrals to primary services was not common. Clinical sharing sessions were not held and primary care doctors did not consult specialists to clear up doubts. The findings reveal that the coordination of care under Brazil's public health system by primary care services is hampered by lack of technological resources, organization, and values.(AU)

Resumen El objetivo es analizar la experiencia de médicos de la Atención Primaria de la Salud (APS) sobre conocimiento, uso y reflexiones para la mejora de la coordinación del cuidado. Se realizó un estudio transversal con utilización del COORDENA-BR con médicos de la APS, en Niterói (Estado de Río de Janeiro, Brasil). Los profesionales reconocían la importancia de la coordinación, aunque no ocurriera, y confiaban en las habilidades clínicas de los médicos de la Atención Especializada (AE). No había indicación de seguimiento y reconocimiento de la centralidad de la APS por los pares de la AE. Fueron recurrentes el envío de la referencia, el recibo del resumen de alta hospitalaria y el uso de protocolos, pero no el uso de la contra-referencia. No se realizaban sesiones clínicas compartidas y los médicos de la APS no consultaban a los especialistas para aclarar dudas. Los resultados expresan la insuficiencia de condiciones tecnológicas, organizacionales y de valores para que la APS asuma la coordinación del cuidado en el SUS.(AU)

Perfil dos convênios celebrados pelo Ministério da Justiça e Segurança Pública com entes subnacionais no Brasil (2008-2022) / Perfil de los acuerdos firmados por el Ministerio de Justicia y Seguridad Pública con entidades subnacionales en Brasil (2008-2022) / Profile of the agreements signed by the Ministry of Justice and Public Security with subnational entities in Brazil (2008-2022)

Resumo O presente artigo tem como objetivo analisar, com base na discussão sobre instrumentos de políticas públicas e nos estudos sobre as políticas de segurança pública no Brasil, o perfil das transferências voluntárias de recursos orçamentários da União celebradas por meio do Ministério da Justiça e Segurança Pública (MJSP) com os entes subnacionais, no período de 2008 a 2022. Trata-se de uma pesquisa documental e de uma análise de conteúdo sobre dados de acesso público extraídos da Plataforma +Brasil. Identificou-se que os convênios dialogam com o paradigma da segurança pública voltada à prevenção da violência, que os estados das regiões Sudeste e Sul figuram como os maiores beneficiados das transferências voluntárias do MJSP e que o Congresso Nacional passou a ser o principal financiador dos convênios ao longo do tempo. O estudo conclui que é preciso esforços por parte do Governo Federal com vistas à distribuição de recursos de forma equânime pelo território.

Resumen Este artículo tiene como objetivo analizar, a partir de la discusión sobre instrumentos de políticas públicas y estudios sobre políticas de seguridad pública en Brasil, el perfil de las transferencias voluntarias de recursos del presupuesto del Gobierno federal celebradas a través del Ministerio de Justicia y Seguridad Pública (MJSP) con entidades subnacionales en el período de 2008 a 2022. Se trata de una investigación de análisis documental y análisis de contenido sobre datos de acceso público extraídos de la Plataforma Mais Brasil. Se identificó que los acuerdos dialogan con el paradigma de la seguridad pública centrada en la prevención de la violencia, que los estados del Sudeste y del Sur son los mayores beneficiarios de las transferencias voluntarias del MJSP y que el Congreso Nacional se convirtió con el tiempo en el principal financiador de los acuerdos. El estudio concluye que son necesarios esfuerzos por parte del Gobierno Federal para distribuir los recursos de forma equitativa en el territorio.

Abstract Based on the discussion about public policy instruments and studies on public security policies in Brazil, this article aims to analyze the profile of voluntary transfers of Union budget resources concluded through the Ministry of Justice and Public Security (MJSP) with subnational entities in the period from 2008 to 2022. The research adopted documentary analysis and content analysis on public access data extracted from the Mais Brasil Platform. It was identified that the agreements dialogue with the paradigm of public security focused on violence prevention. Also, the study showed that the states of the Brazilian Southeast and South regions are the largest beneficiaries of voluntary transfers from MJSP and that the National Congress became the primary funder of agreements over time. The study concludes that the federal government must improve resource distribution to equitably supply the territory.

Transferências fundo a fundo: coordenação e cooperação federativa na segurança pública do Brasil / Transferencias fondo a fondo: coordinación y cooperación federativa en seguridad pública en Brasil / Fund-to-fund transfers: federative coordination and cooperation in public security in Brazil

Resumo O objetivo deste artigo é analisar a realização de transferências fundo a fundo e avaliar se ela tem contribuído para a coordenação e cooperação federativa de políticas voltadas à segurança pública no Brasil. Para tanto, o trabalho foi dividido em três etapas: (i) levantamento dos valores do Fundo Nacional de Segurança Pública (FNSP), destinados aos estados e ao Distrito Federal, no período de 2000 a 2022, antes e depois da adoção das transferências fundo a fundo; (ii) realização de entrevistas semiestruturadas para levantar as percepções dos gestores responsáveis pela elaboração e coordenação do processo de descentralização e pelo acompanhamento da execução dos recursos descentralizados; e (iii) análise dos mecanismos de coordenação/cooperação previstos nos planos de aplicação elaborados pelos estados no período supracitado. Os achados da pesquisa confirmam resultados de estudos anteriores sobre o poder de indução das transferências fundo a fundo na cooperação e coordenação de políticas nacionais, também para a área de segurança pública. Verificou-se que a ampliação de recursos e a obrigatoriedade de seu compartilhamento com os estados favoreceram o alinhamento das políticas estaduais às diretrizes estabelecidas pela União, mas que ainda é incipiente a interação entre os órgãos, organizações e membros da sociedade em relação ao tema.

Resumen El objetivo de este artículo es analizar si las transferencias de fondo a fondo han contribuido a la coordinación y cooperación federal de las políticas dirigidas a la seguridad pública en Brasil. Para ello, el trabajo se dividió en tres etapas: (i) Relevamiento de los montos del Fondo Nacional de Seguridad Pública asignados a los estados y al Distrito Federal en el período 2000-2022, antes y después de la adopción de las transferencias fondo a fondo; (ii) Realización de entrevistas semiestructuradas para conocer la percepción de los gerentes responsables de preparar y coordinar el proceso de descentralización y monitorear la ejecución de los recursos descentralizados; y (iii) Análisis de los mecanismos de coordinación/cooperación previstos en los planes de aplicación elaborados por los estados en el período. Los hallazgos de la investigación confirman los resultados de estudios previos sobre el poder de inducción de las transferencias fondo a fondo en la cooperación y coordinación de políticas nacionales también para el área de seguridad pública. Se verificó que la ampliación de los recursos y la obligatoriedad de compartirlos con los estados favorecieron el alineamiento de las políticas estatales con las directrices establecidas por el Gobierno federal, pero que la interacción entre organismos, organizaciones y miembros de la sociedad sobre el tema es aún incipiente.

Abstract This article aims to analyze whether fund-to-fund transfers have contributed to federal coordination and cooperation of policies aimed at public security in Brazil. To this end, the work was divided into three stages: (i) Survey of National Public Security Fund amounts allocated to the states and the Federal District in the period from 2000 to 2022, before and after the adoption of fund-to-fund transfers; (ii) Conducting semi-structured interviews to raise the perceptions of managers responsible for preparing and coordinating the decentralization process and monitoring the execution of decentralized resources; and (iii) Analysis of the Coordination/Cooperation mechanisms foreseen in the Application Plans prepared by the states in the period. The research findings confirm the results of previous studies on the induction power of fund-to-fund transfers in the cooperation and coordination of national policies for public security. It was verified that the expansion of resources and the obligatoriness of their sharing with the states favored the alignment of state policies with the guidelines established by the Union but that the interaction between bodies, organizations, and members of society on the subject is still incipient.