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.

A implementação de ações intersetoriais na assistência a crianças com síndrome congênita do vírus Zika no estado do Rio de Janeiro / The implementation of intersectoral actions to assist children with congenital Zika virus syndrome in the state of Rio de Janeiro

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

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

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.

Success factors for evidence-based healthcare practice adoption

Background: Evidence-based health policies are widely acknowledged as being essential for attaining ongoing improvements in health outcomes. This study represents a theoretical model to test and identify to identify the key drivers for adopting evidence-based healthcare practice (EBHP). Objectives: The goal of this study was to investigate the critical success factors for the adoption of evidence-based healthcare at a South African public hospital. Methods: Medical healthcare professionals were surveyed using a questionnaire developed by the researcher. The results were analysed with SPSS 23 and AMOS. A hypothetical model based on updated (D&M) IS Success Model, Technology, Organization and Environment framework (TOE) as well as Technology Acceptance Model (TAM) was developed and analysed using structural equation modelling (SEM). Results: The findings of this study indicate that EHR is crucial and the main construct influencing the adoption of EBHP. The findings of this study indicated a positive relationship between the construct electronic health records (EHR) with medical error reduction (MER), information quality (IQ) and knowledge quality (KQ), all showed a strong positive correlation towards the adoption of EBHP. Conclusions: Better coordination of patient care (BCP) typically results in lower health care costs. The results also show that using EBHP improves the accuracy of disease diagnosis and treatment, which lowers the burden of disease. Contribution: The developed framework will help healthcare systems that are strapped for money, particularly in developing countries.

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.

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.

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.

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.

Avaliação da implantação de um projeto de telerregulação assistencial em uma capital brasileira / Assessment of the implementation of an care teleregulation project in a Brazilian capital city / Evaluación de la implementación de un proyecto de telerregulación asistencial en una capital brasileña

Resumo: Os objetivos foram avaliar o grau de implantação do projeto Regula+ Brasil e analisar em que medida as variações da implantação influenciam nos resultados observados no acesso a consultas especializadas em Recife, Pernambuco, Brasil. Trata-se de uma pesquisa avaliativa de análise de implantação. Foram elaborados o modelo lógico e a matriz de análise e julgamento com os indicadores para avaliação do grau de implantação e de resultado do projeto, os quais foram submetidos ao consenso de especialistas. A coleta de dados se deu por meio de questionário semiestruturado, aplicado com informantes-chave, e dados secundários extraídos dos documentos oficiais do projeto e do Sistema Nacional de Regulação (SISREG), referentes ao período de maio de 2020 a maio de 2021, os quais foram consolidados e comparados com valores definidos na matriz. O grau de implantação do projeto Regula+ Brasil em Recife foi considerado implantado (83,7%), bem como as dimensões Estrutura (81,7%) e Processo (84,6%). Entretanto, a maioria dos seus indicadores de efeito obtiveram desempenho insatisfatório. Quando confrontados, guardaram coerência com gargalos observados em alguns componentes e subcomponentes do projeto, como a atuação dos profissionais das unidades básicas de saúde (UBS), apontada como incipiente, principalmente no que diz respeito ao acompanhamento das solicitações devolvidas. Os resultados sugerem que qualquer intervenção em telessaúde requer, para sua devida implantação e para o alcance dos resultados esperados, adequação das equipes e dos processos de trabalho, práticas de educação permanente e processo contínuo de avaliação, ou então se configurará em nova burocratização e barreira de acesso.

Abstract: This study evaluates the degree of implementation (DI) of the Regulates+ Brazil project and analyzes to what extent the variations in implementation influence the results observed in access to specialized appointments in Recife, Pernambuco, Brazil. This is an evaluative research of implementation analysis. A logic model and an analysis and judgment matrix with indicators for evaluating the degree of implementation and the results of the Project were developed and submitted to expert consensus. The data collection was conducted via a semi-structured questionnaire applied to key informants and secondary data extracted from the official documents from Regulates+ Brazil and Brazilian National Regulation System (SISREG), referring to the period from May/2020 to May/2021, which were consolidated and compared with values defined in the matrix. The degree of implementation of the Regulates+ Brazil project in Recife was considered to be implemented (83.7%), as well as the Structure (81.7%) and Methods (84.6%) dimensions. However, most effect indicators underperformed, which, when confronted, were consistent with bottlenecks observed in some components and subcomponents of the Project, such as the performance of professionals in basic health units, which was indicated as incipient, especially regarding follow-up of returned requests. The results suggest that any intervention in Telehealth requires, for its proper implementation, the adequacy of teams and work processes, practices of Continuing Education, as well as a continuous evaluation process, to achieve the expected results, or else it will become another bureaucratization and barrier to access.

Resumen: El objetivo fue evaluar el grado de implementación del proyecto Regula+ Brasil y analizar en qué medida las variaciones de la implementación influyen en los resultados observados en el acceso a consultas especializadas en Recife, Pernambuco, Brasil. Se trata de una investigación evaluativa del análisis de la implantación. Se elaboró un modelo lógico y una matriz de análisis y juicio con los indicadores para la evaluación de la grado de implementación y el resultado del Proyecto, los cuales se sometieron al consenso de especialistas. La recopilación de datos se realizó por medio de un cuestionario semiestructurado aplicado con informantes clave y datos secundarios extraídos de documentos oficiales del Regula+ Brasil y del Sistema Nacional de Regulación (SISREG), relativos al período de mayo de 2020 a mayo de 2021, los cuales fueron consolidados y comparados con valores definidos en el matriz. El grado de implementación del proyecto Regula+ Brasil en Recife fue considerado implementado (83,7%), así como las dimensiones Estructura (81,7%) y Proceso (84,6%). Sin embargo, la mayoría de sus indicadores de efecto obtuvieron un desempeño insatisfactorio, los cuales, al ser confrontados, fueron coherentes con los cuellos de botella observados en algunos componentes y subcomponentes del Proyecto, como el desempeño de los profesionales de las unidades básicas de salud, señalada como incipiente, sobre todo en lo que respecta al seguimiento de las solicitudes devueltas. Los resultados sugieren que toda intervención en Telesalud requiere, para su debida implantación, la adecuación de los equipos y de los procesos de trabajo, prácticas de Educación Permanente, así como un proceso continuo de evaluación, para alcanzar los resultados esperados, o entonces se configurará en una nueva burocratización y barrera de acceso.