Diagnosis of metabolic syndrome in nursing professionals: An accuracy study.

Metabolic Syndrome (MetS) represents a group of cardiovascular risk factors. This article aims to evaluate the accuracy of the tools of MetS diagnosis in Nursing professionals from Primary Health Care (PHC) in Bahia, Brazil. A cross-sectional study with a random sample selected according to essential health information for the diagnostic of MetS. For MetS diagnostic, we used EGIR, NCEP-ATPIII, AACE, IDF, Barbosa et al. (2006), and IDF/AHA/NHLBI (defined as gold standard) definition. Sensitivity, specificity, predictive values, and likelihood ratio were estimated for each diagnostic tool and compared with the gold standard. Kappa statistic was used to determine the agreement between the diagnostic methods. One thousand one hundred and eleven nursing professionals were included in this study. Sensitivity varied from 15% to 95.1%, and specificity varied between 99.5% and 100%. IDF and Barbosa et al. (2006) definitions were more sensitive (95.1% and 92.8%, respectively), and EGIR, NCEP, ATP III, and IDF showed 100% specificity. IDF and Barbosa et al. (2006) use suitable metabolic syndrome identification and confirmation criteria. The highest agreement was found in the definition of the IDF, Barbosa et al. (2006) and the NCEP ATP III. Defining metabolic syndrome with a higher diagnostic accuracy could contribute to the screening and the early identification of nursing professionals with cardiovascular disease risk factors, which provide opportunities for appropriate prevention and treatment.

Zebrafish Avatar-test forecasts clinical response to chemotherapy in patients with colorectal cancer.

Cancer patients often undergo rounds of trial-and-error to find the most effective treatment because there is no test in the clinical practice for predicting therapy response. Here, we conduct a clinical study to validate the zebrafish patient-derived xenograft model (zAvatar) as a fast predictive platform for personalized treatment in colorectal cancer. zAvatars are generated with patient tumor cells, treated exactly with the same therapy as their corresponding patient and analyzed at single-cell resolution. By individually comparing the clinical responses of 55 patients with their zAvatar-test, we develop a decision tree model integrating tumor stage, zAvatar-apoptosis, and zAvatar-metastatic potential. This model accurately forecasts patient progression with 91% accuracy. Importantly, patients with a sensitive zAvatar-test exhibit longer progression-free survival compared to those with a resistant test. We propose the zAvatar-test as a rapid approach to guide clinical decisions, optimizing treatment options and improving the survival of cancer patients.

Kaplan-Meier Survival Analysis: Practical Insights for Clinicians.

This article aims to provide a guide that will help healthcare professionals and clinical researchers from all fields that deal with Kaplan-Meier curves. Survival analysis methods are among the most frequently used in the medical sciences and in clinical research. Overall survival, progression free survival, time to recurrence, or any other clinically relevant parameter represented by a Kaplan-Meier curve will be discussed. We will present a practical and straightforward interpretation of these curves, setting aside intricate mathematical considerations. Our focus will be on essential concepts that interface with biological sciences and medicine in order to guarantee proficiency in one of the most popular yet frequently misunderstood methods in clinical research. Being familiar with these concepts is not only essential for designing new clinical studies but also for critically assessing and interpreting published data.

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)

Impact of Strength Training Intensity on Brain-derived Neurotrophic Factor.

The present study employed a randomized crossover design to investigate the effect of strength-training exercise at varying intensities on acute changes in plasma brain-derived neurotrophic factor (BDNF) levels. Fourteen trained male subjects (41.0±5.8 years old) were enrolled in the current study. The strength-training protocol included bench press, leg press, and lat pull-down exercises. Participants performed four sets with repetition failure at 60% or 80% of their one-repetition maximum (1RM), with a two-minute rest period. The order of intensity was randomized among volunteers. Blood samples were collected before, immediately after, and one hour after each exercise protocol. A time-point comparison revealed that a single session of strength training at 60% of 1RM increased lactate plasma concentrations from 1.2 to 16 mmol/L (p<0.0001). However, no significant changes were observed in the plasma BDNF concentration. Conversely, the training session at 80% of 1RM increased lactate concentrations from 1.3 to 14 mmol/L (p<0.0001) and BDNF concentrations from 461 to 1730 pg/ml (p=0.035) one hour after the session's conclusion. These findings support the hypothesis that a single strength-training session at 80% 1RM can significantly enhance circulating levels of BDNF.

Gut microbiota predicts severity and reveals novel metabolic signatures in acute pancreatitis.

OBJECTIVE: Early disease prediction is challenging in acute pancreatitis (AP). Here, we prospectively investigate whether the microbiome predicts severity of AP (Pancreatitis-Microbiome As Predictor of Severity; P-MAPS) early at hospital admission. DESIGN: Buccal and rectal microbial swabs were collected from 424 patients with AP within 72 hours of hospital admission in 15 European centres. All samples were sequenced by full-length 16S rRNA and metagenomic sequencing using Oxford Nanopore Technologies. Primary endpoint was the association of the orointestinal microbiome with the revised Atlanta classification (RAC). Secondary endpoints were mortality, length of hospital stay and severity (organ failure >48 hours and/or occurrence of pancreatic collections requiring intervention) as post hoc analysis. Multivariate analysis was conducted from normalised microbial and corresponding clinical data to build classifiers for predicting severity. For functional profiling, gene set enrichment analysis (GSEA) was performed and normalised enrichment scores calculated. RESULTS: After data processing, 411 buccal and 391 rectal samples were analysed. The intestinal microbiome significantly differed for the RAC (Bray-Curtis, p value=0.009), mortality (Bray-Curtis, p value 0.006), length of hospital stay (Bray-Curtis, p=0.009) and severity (Bray-Curtis, p value=0.008). A classifier for severity with 16 different species and systemic inflammatory response syndrome achieved an area under the receiving operating characteristic (AUROC) of 85%, a positive predictive value of 67% and a negative predictive value of 94% outperforming established severity scores. GSEA revealed functional pathway units suggesting elevated short-chain fatty acid (SCFA) production in severe AP. CONCLUSIONS: The orointestinal microbiome predicts clinical hallmark features of AP, and SCFAs may be used for future diagnostic and therapeutic concepts. TRIAL REGISTRATION NUMBER: NCT04777812.

Linezolid and vancomycin for nosocomial infections in pediatric patients: a systematic review.

OBJECTIVE: To investigate the effectiveness of linezolid and vancomycin for the treatment of nosocomial infections in children under 12 years old. DATA SOURCES: This is a systematic review in which five randomized clinical trials about the effectiveness of linezolid and vancomycin, involving a total of 429 children with nosocomial infections, were evaluated. They were searched in scientific databases: PubMed, Bvs, and SciELO. SUMMARY OF FINDINGS: The main nosocomial infections that affected children were bacteremia, skin, and soft tissue infections followed by nosocomial pneumonia. Most infections were caused by Gram-positive bacteria, which all studies showed infections caused by Staphylococcus aureus, with methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci strains being isolated. Both linezolid and vancomycin showed high therapeutic efficacy against different types of nosocomial infections, ranging from 84.4% to 94% for linezolid and 76.9% to 90% for vancomycin. Patients receiving linezolid had lower rates of rash and red man syndrome compared to those receiving vancomycin. However, despite the adverse reactions, antimicrobials can be safely administered to children to treat nosocomial infections caused by resistant Gram-positive bacteria. CONCLUSION: Both linezolid and vancomycin showed good efficacy in the treatment of bacterial infections caused by resistant Gram-positive bacteria in hospitalized children. However, linezolid stands out regarding its pharmacological safety. Importantly, to strengthen this conclusion, further clinical trials are needed to provide additional evidence.

Analysis of the effectiveness coefficient in greco-roman fighting athletes at different levels of competition / Análisis del coeficiente de eficacia en atletas de lucha griego-romana en distintos niveles de competición / Análise do coeficiente de efetividade em atletas de luta greco-romana em diferentes níveis de competição

ABSTRACT Introduction: Wrestling is an ancient combat sport, individual and of complex performance, which integrates high technical and tactical complexity, associated with a bioenergetic interaction and a high coordinative pattern. In Brazil, the number of competitors at different levels has increased significantly in the last years, evidencing the need to search for answers that can help coaches in the different situations of the competitive calendar. The prescription of the means and methods of training in Greco-Roman wrestling aims at the development of the technical effectiveness. However, there is no evidence of indicators of technical effectiveness, in Brazilian elite athletes of Greco-Roman wrestling, in national and international competitions. Objectives: The objective of the study was to verify and to compare the technical effectiveness of the wrestlers of Greco-Roman fight of the Brazilian selection, in two competitions: one in the national level and the other international. Methods: Seven athletes of the Brazilian wrestling team participated of the investigation (age: 25±5 years; stature: 175±12 cm; corporal mass: 80± 21kg). Analysis of the effective, not effective and total technique were accomplished. After identifying the normality of the data (SHAPIRO WILKS), the Student's t test was used to compare the variables, according to the moment evaluated, considering the significance level of 5%. Results: The results showed a significant decrease (p = 0.03) in the standing effective technique and in the total effective technique (p = 0.01), comparing the national competition with the international competition. Conclusion: Technical effectiveness of Brazilian wrestlers was found to be below the indices presented in studies with competitors from countries considered to have high world performance. In international competition, it presents a negative impact compared to national events. Level of Evidence IV; Therapeutic Studies - Investigation of Treatment Results.

RESUMEN Introducción: El Wrestling es una modalidad de combate milenaria, individual y de rendimiento complejo, que integra elevada complejidad técnico-táctica, asociada a una interacción bioenergética y un alto patrón coordinativo. En Brasil, el número de competidores en diferentes niveles aumentó significativamente en los últimos años, evidenciando la necesidad en la búsqueda de respuestas que auxilien a los entrenadores en las diferentes situaciones del calendario competitivo. La prescripción de los medios y métodos de entrenamiento en la lucha greco-romana tiene como objetivo el desarrollo de la efectividad técnica. Entre tanto, no hay evidencias de indicadores de efectividad técnica, en atletas de alto rendimiento brasileño en la lucha greco-romana, en competencias nacionales e internacionales. Objetivos: El objetivo de este estudio fue verificar y comparar la efectividad técnica de los atletas de lucha greco-romana de la selección brasileña, en dos competencias: una a nivel nacional y otra internacional. Métodos: Participaron de la investigación siete atletas de la selección brasileña de lucha greco-romana (edad: 25±5 años; estatura: 175±12 cm; masa corporal: 80± 21kg). Fueron realizados análisis de la técnica efectiva, no efectiva y total. Después de identificar la normalidad de los datos (SHAPIRO WILKS), fue utilizado el test de t de Student para la comparación de las variables, según el momento evaluado, considerando el nivel de significación de 5%. Resultados: Los resultados mostraron una disminución significativa (p = 0,03) en la técnica efectiva en pie y en la técnica efectiva total (p = 0,01), comparándose la competencia nacional con la internacional. Conclusión: Se concluyó que la eficacia técnica de los luchadores brasileños está por debajo de los índices presentados en estudios con competidores de países considerados de alto rendimiento mundial. En la competición internacional, presenta un impacto negativo en comparación con los eventos nacionales. Nivel de Evidencia IV; Estudios Terapéuticos - Investigación de Los Resultados Del Tratamiento.

RESUMO Introdução: O Wrestling é uma modalidade de combate milenar, individual e de rendimento complexo, que integra elevada complexidade técnico-táctica, associada a uma interação bioenergética e um alto padrão coordenativo. No Brasil, o número de competidores em diferentes níveis aumentou significativamente nos últimos anos, evidenciando a necessidade da busca de respostas que auxiliem os treinadores nas diferentes situações do calendário competitivo. A prescrição dos meios e métodos de treinamento na luta greco-romana visa o desenvolvimento da efetividade técnica. Entretanto, não há evidências de indicadores de efetividade técnica, em atletas de elite brasileira de luta greco-romana, em competições nacionais e internacionais. Objetivo: o objetivo do estudo foi verificar e comparar a efetividade técnica dos lutadores de luta greco-romana da seleção brasileira, em duas competições: uma no nível nacional e a outra internacional. Métodos: Participaram da investigação sete atletas da seleção brasileira de luta greco-romana (idade: 25±5 anos; estatura: 175±12 cm; massa corporal: 80± 21kg). Foram realizadas análises da técnica efetiva, não efetiva e total. Após identificar a normalidade dos dados (SHAPIRO WILKS), foi utilizado o teste t de Student para a comparação das variáveis, segundo o momento avaliado, considerando nível de significância de 5%. Resultados: Os resultados mostraram uma diminuição significativa (p = 0,03) na técnica efetiva em pé e na técnica efetiva total (p = 0,01), comparando-se a competição nacional com a internacional. Conclusão: Concluiu-se que a efetividade técnica dos lutadores brasileiros está abaixo dos índices apresentados em estudos com competidores de países considerados de alto desempenho mundial. Em competição internacional, apresenta um impacto negativo comparativamente a eventos nacionais. Nível de Evidência IV; Estudos Terapêuticos - Investigação dos Resultados do Tratamento.

Discharge protocol in acute pancreatitis: an international survey and cohort analysis.

There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients' care.

Social representation of spiritual surgeries in Umbanda: culture, religion and contributions of nursing theory.

OBJECTIVE: to analyze the social representation of spiritual surgeries in Umbanda for Bantu-Amerindian ritual mediums and their contributions to the cross-cultural care proposed by Madeleine Leininger. METHODS: a descriptive-exploratory, qualitative study, supported by the procedural approach of Social Representation Theory and Transcultural Nursing Theory, carried out with 30 Umbanda mediums of the Bantu-Amerindian ritual through interviews, submitted to the Iramuteq software for lexical analysis. RESULTS: mostly women, white, with an average of 46 years old and approximately 14 years of practice in Umbanda participated. The social representation of spiritual surgeries in Umbanda is objectified and anchored through a biomedical vision of care, encompassing a set of beliefs, values and practices as religious treatments, through faith, whose main objective is healing. FINAL CONSIDERATIONS: spiritual surgeries are a form of transcultural care, according to Madeleine Leininger's propositions, as they integrate the culture of a group through health care in Umbanda.

Representação social da saúde para os umbandistas e o cuidado transcultural de Madeleine / Leininger Social representation of health for Umbandists and the transcultural care of Madeleine / Leininger Representación social de la salud para los umbandistas y el cuidado transcultural de Madeleine Leininger

Objetivo: analisar a estrutura da representação social da saúde para umbandistas com vistas à abordagem do cuidado transcultural. Método: estudo qualitativo descritivo-exploratório, fundamentado na abordagem estrutural da Teoria das Representações Sociais e Teoria Transcultural de Madeleine Leininger. Os participantes foram captados pela técnica Snowball, que responderam a um questionário online, contendo caracterização sociodemográfica; escala DUREL; e instrumento de evocações livres. Os dados foram analisados por estatística descritiva e as evocações pela análise prototípica e de similitude. Resultados: participaram 110 invíduos, predominando mulheres (70%), entre 29 e 39 anos, e com alta religiosidade. A análise prototípica evidenciou vida, bem-estar e ter-fé como provavelmente centrais e hospital e médico como elementos de contraste. A análise de similitude demonstrou além dos elementos previamente e provavelmente centrais, cuidado e corpo com comportamento de centralidade. Considerações finais: concepções multidimensionais de bem-estar e qualidade de vida marcam esta representação, embasada pela alta religiosidade e o cuidado transcultural e integral em saúde(AU)

Objective: to analyze the structure of the social representation of health for Umbanda fans with a view to approaching transcultural care. Method: qualitative descriptive-exploratory study, based on the structural approach of the Theory of Social Representations and Transcultural Theory by Madeleine Leininger. Participants were captured using the Snowball technique, who responded to an online questionnaire containing sociodemographic characteristics; DUREL scale; and instrument of free evocations. Data were analyzed using descriptive statistics and the evocations using prototypical and similarity analysis. Results: 110 individuals participated, predominantly women (70%), between 29 and 39 years old, and with high religiosity. The prototypical analysis highlighted life, well-being and having faith as probably central and hospital and doctor as contrasting elements. The similarity analysis demonstrated, in addition to the previously and probably central elements, care and the body with centrality behavior. Final considerations: multidimensional conceptions of well-being and quality of life mark this representation, based on high religiosity and transcultural and comprehensive health care(AU)

Objetivo: analizar la estructura de la representación social de la salud para umbandistas con miras al enfoque de la atención transcultural. Método: estudio descriptivo-exploratorio cualitativo, basado en el enfoque estructural de la Teoría de las Representaciones Sociales y la Teoría Transcultural de Madeleine Leininger. Mediante la técnica de muestreo Snowball se capturó a los participantes, quienes respondieron a un cuestionario en línea que contenía caracterización sociodemográfica; escala DUREL; e instrumento de evocaciones libres. Se analizaron los datos mediante estadística descriptiva y las evocaciones por medio de análisis prototípico y de similitud. Resultados: Participaron 110 personas, predominantemente mujeres (70%), entre 29 y 39 años y con alta religiosidad. El análisis prototípico destacó 'la vida, el bienestar y el tener fe' como probablemente centrales y 'el hospital y el médico' como elementos contrastantes. El análisis de similitud demostró, además de los elementos anteriores y probablemente centrales, 'el cuidado y el cuerpo' con comportamiento de centralidad. Consideraciones finales: concepciones multidimensionales de bienestar y calidad de vida enmarcan esta representación, basada en una alta religiosidad y una atención de salud transcultural e integral(AU)

Processo de morte e morrer e cuidados paliativos: um pleito necessário para graduação em enfermagem / Death and dying process and palliative care: a necessary claim for nursing undergraduation / Proceso de muerte y el morir y cuidados paliativos: un reclamo necesario para la carrera de enfermería

Objetivo: analisar a percepção dos estudantes de graduação em enfermagem sobre a temática "o processo de morte e morrer" e sua abordagem durante sua formação. Método: estudo descritivo, exploratório, com abordagem qualitativa, desenvolvido com alunos do último ano de graduação em Enfermagem de uma universidade pública do Rio de Janeiro. Resultados: Participaram do estudo 57 estudantes e, após a organização dos dados emergiram as classes: "Sentimentos frente à morte"; "A necessidade da abordagem do conteúdo de morte na graduação"; "A vivência da morte do paciente" e "Atitude de cuidado diante do processo de morte". Considerações finais: uma formação que contemple o estudo da tanatologia e a filosofia dos cuidados paliativos é de suma importância, dado ao fato de que a morte é consequência inexorável da vida. O estudo reafirma a necessidade constante desta discussão durante a formação e o exercício da enfermagem(AU)

Objective: to analyze the perception of undergraduate nursing students about the theme, "the process of death and dying" and its approach during their training. Method: descriptive, exploratory study, with a qualitative approach developed with students of the last year of undergraduate nursing in a public university in Rio de Janeiro. Results: 57 students participated in the study and, after organizing the data, the following classes emerged: "Feelings about death"; "The need to approach the content of death in training education"; "The patient's death experience" and "Care attitude towards the process of death. Final considerations: nursing undergraduation education must have included the study of thanatology and the philosophy of palliative care, due to the importance given that death is an inexorable consequence of life. The study reaffirms the importance of this discussion happening during the nursing education training and over nursing work(AU)

Objetivo: analizar la percepción de los estudiantes de enfermería sobre el tema "El proceso de la muerte y el morir" y su enfoque durante los estudios de formación. Método: Investigación descriptiva, exploratoria, con enfoque cualitativo desarrollado junto a estudiantes del último año de pregrado en enfermería en una universidad pública de Rio de Janeiro. Resultados: En el estudio participaron 57 alumnos y, tras organizar los datos, surgieron las siguientes clases:"Sentimientos ante la muerte"; "La necesidad de abordar el contenido de muerte en el pregrado"; "La experiencia de la muerte del paciente" y "Actitud de cuidado ante el proceso de muerte". Consideraciones finales: una formación que incluya el estudio de la tanatología y la filosofía de los cuidados paliativos es de suma importancia dado que la muerte es una consecuencia inexorable de la vida. El estudio reafirma la necesidad de que esta discusión sea constante durante la formación y el ejercicio de la enfermería(AU)

Profile and essentiality of Nursing in the context of the COVID-19 pandemic. / Perfil e essencialidade da Enfermagem no contexto da pandemia da COVID-19.

The present study aims to describe the sociodemographic and health profile of nursing professionals in the context of the COVID-19 pandemic and propose a reflective analysis on the essentiality of the category facing the intrinsic demands of patients and the Brazilian health system, especially in the context of the public health emergency triggered by the exponential advance of the SARS-CoV-2 virus. This study reveals the relationship between historical injustices and the different types of inequality that impacted and caused the vulnerability of the profession, with an emphasis on the presentation of potential perspectives arising from this historical process and recent events.

A pesquisa tem por objetivo descrever o perfil sociodemográfico e de saúde dos profissionais de enfermagem no contexto da pandemia da COVID-19 e propõe uma análise reflexiva sobre a essencialidade da categoria frente às demandas intrínsecas dos pacientes e do sistema de saúde brasileiro, especialmente, no contexto da emergência de saúde pública deflagrada pelo avanço exponencial do vírus SARS-CoV-2. O estudo revela a relação entre as injustiças históricas e os diferentes tipos de desigualdade que afetam e causam a vulnerabilidade da profissão, com fulcro na apresentação de potenciais perspectivas decorrentes desse processo histórico e dos acontecimentos recentes.

The legal precariousness of work relations in the health sector during the COVID-19 pandemic, as a factor of worker suffering. / A precarização jurídica das relações de trabalho como fator de sofrimento das(os) trabalhadoras(es) no setor da saúde durante a pandemia de COVID-19.

The present article analyzed the process of precarious work relations in the health sector, demonstrating how this situation generated illness and suffering among workers. The text sought to register how the institutional adoption of neoliberal economic conceptions, of the reduction of State social policies, coupled with a history of cultural rejection of labor rights, provided the attraction of mechanisms of precarious work for the public sector, notably, the outsourcing of labor and the provision of services. In a second moment, the text points out the legal improprieties committed, presenting the consequences of the weakening of the legal bond in the working conditions of these workers, mainly regarding working hours and remuneration, also highlighting how much the dissemination of these links represented a factor of a general reduction in wages and labor and social security rights in the sector. Data from Fiocruz surveys on working conditions during the pandemic were also presented. The article concludes by showing the urgency of rescuing the legal labor institutes that were abandoned in the historical path studied in order to guide the public health policies in a new direction.

O artigo analisou o processo de precarização das relações de trabalho no setor da saúde, demonstrando como essa situação gerou sofrimento dos trabalhadores. O texto buscou registrar como a adoção institucional das concepções econômicas neoliberais, de redução das políticas sociais de Estado, acopladas a um histórico de rejeição cultural aos direitos trabalhistas, proporcionou a atração dos mecanismos de precarização do trabalho, notadamente, a terceirização da mão de obra e da prestação de serviços. No segundo momento, o texto aponta as impropriedades jurídicas cometidas, apresentando as consequências da fragilização do vínculo jurídico nas condições de trabalho desses trabalhadores, principalmente no que se refere às jornadas de trabalho e a remuneração, destacando-se, também, o quanto a disseminação desses vínculos representou um fator de rebaixamento geral dos salários e direitos trabalhistas e previdenciários no setor. Foram apresentados, ainda, dados das pesquisas da Fiocruz sobre condições de trabalho durante a pandemia. Conclui mostrando a urgência de se resgatarem os institutos jurídicos trabalhistas que foram abandonados no percurso histórico estudado, para direcionar a novo rumo as políticas públicas na saúde.

Quality of life and work engagement among nursing staff at the start of the COVID-19 pandemic. / Qualidade de vida e engajamento no trabalho em profissionais de enfermagem no início da pandemia de COVID-19.

This article investigates the correlation between work engagement and work-related quality of life among nursing staff at a public hospital in São Paulo State, at the onset of the COVID-19 pandemic. A descriptive, correlational, cross-sectional study of nursing personnel was conducted from December 2020 to January 2021, using the Brazilian versions of the Work & Well-being Survey (Utrecht Work Engagement Scale - UWES) and the Work-related Quality of Life (WRQoL) scale, following Walton's model. Nursing staffs returned a strong positive correlation (r≥0.70) between the social integration domain of the WRQoL and the vigour dimension of the UWES (r=0.88; p=<0.001); a moderate positive correlation (r≥0.40≤0.69) between working conditions (WRQOL) and the vigour (r=0.40; p<0.001), dedication (r=0.40; p<0.001) and overall score (r=0.41; p<0.001) dimensions of the UWES. Correlations were positive and weak (r≤0.39) for the other WRQoL domains and the UWES dimensions. It was concluded that personnel with satisfactory levels of quality of life tend to show higher levels of engagement at work. At the onset of the COVID-19 pandemic, nursing professionals were strongly engaged and satisfied with their work-related quality of life.

O artigo investiga a correlação entre engajamento e qualidade de vida no trabalho dos profissionais de enfermagem de um hospital público do interior do estado de São Paulo, no início da pandemia de COVID-19. Estudo transversal, descritivo e correlacional, com profissionais de enfermagem, realizado entre dezembro de 2020 e janeiro de 2021. Foram utilizadas as versões brasileiras da Utrecht Work Engagement Scale (UWES) e da Escala de Avaliação da Qualidade de Vida no Trabalho (QVT), segundo modelo de Walton. Os profissionais de enfermagem apresentaram correlação forte e positiva (r≥0.70) entre o domínio integração social da QVT e a dimensão vigor da UWES (r=0,88; p=<0,001); correlação positiva moderada (r≥0.40≤0.69) entre as condições de trabalho (QVT) e as dimensões vigor (r=0,40; p=<0,001), dedicação (r=0,40; p=<0,001) e escore geral (r=0,41; p=<0,001) da UWES. As correlações foram positivas e fracas (r≤0.39) para os demais domínios da QVT e as dimensões da UWES. Concluiu-se que os profissionais com níveis satisfatórios de qualidade de vida tendem a ter níveis mais altos de engajamento no trabalho. No início da pandemia de COVID-19, os profissionais de enfermagem estavam fortemente engajados e satisfeitos com sua qualidade de vida no trabalho.

FoxK1 associated gene regulatory network in hepatic insulin action and its relationship to FoxO1 and insulin receptor mediated transcriptional regulation.

OBJECTIVE: Insulin acts on the liver via changes in gene expression to maintain glucose and lipid homeostasis. This study aimed to the Forkhead box protein K1 (FOXK1) associated gene regulatory network as a transcriptional regulator of hepatic insulin action and to determine its role versus FoxO1 and possible actions of the insulin receptor at the DNA level. METHODS: Genome-wide analysis of FoxK1 binding were studied by chromatin immunoprecipitation sequencing and compared to those for IR and FoxO1. These were validated by knockdown experiments and gene expression analysis. RESULTS: Chromatin immunoprecipitation (ChIP) sequencing shows that FoxK1 binds to the proximal promoters and enhancers of over 4000 genes, and insulin enhances this interaction for about 75% of them. These include genes involved in cell cycle, senescence, steroid biosynthesis, autophagy, and metabolic regulation, including glucose metabolism and mitochondrial function and are enriched in a TGTTTAC consensus motif. Some of these genes are also bound by FoxO1. Comparing this FoxK1 ChIP-seq data to that of the insulin receptor (IR) reveals that FoxK1 may act as the transcription factor partner for some of the previously reported roles of IR in gene regulation, including for LARS1 and TIMM22, which are involved in rRNA processing and cell cycle. CONCLUSION: These data demonstrate that FoxK1 is an important regulator of gene expression in response to insulin in liver and may act in concert with FoxO1 and IR in regulation of genes in metabolism and other important biological pathways.

Qualidade de vida e engajamento no trabalho em profissionais de enfermagem no início da pandemia de COVID-19 / Quality of life and work engagement among nursing staff at the start of the COVID-19 pandemic

Resumo O artigo investiga a correlação entre engajamento e qualidade de vida no trabalho dos profissionais de enfermagem de um hospital público do interior do estado de São Paulo, no início da pandemia de COVID-19. Estudo transversal, descritivo e correlacional, com profissionais de enfermagem, realizado entre dezembro de 2020 e janeiro de 2021. Foram utilizadas as versões brasileiras da Utrecht Work Engagement Scale (UWES) e da Escala de Avaliação da Qualidade de Vida no Trabalho (QVT), segundo modelo de Walton. Os profissionais de enfermagem apresentaram correlação forte e positiva (r≥0.70) entre o domínio integração social da QVT e a dimensão vigor da UWES (r=0,88; p=<0,001); correlação positiva moderada (r≥0.40≤0.69) entre as condições de trabalho (QVT) e as dimensões vigor (r=0,40; p=<0,001), dedicação (r=0,40; p=<0,001) e escore geral (r=0,41; p=<0,001) da UWES. As correlações foram positivas e fracas (r≤0.39) para os demais domínios da QVT e as dimensões da UWES. Concluiu-se que os profissionais com níveis satisfatórios de qualidade de vida tendem a ter níveis mais altos de engajamento no trabalho. No início da pandemia de COVID-19, os profissionais de enfermagem estavam fortemente engajados e satisfeitos com sua qualidade de vida no trabalho.

Abstract This article investigates the correlation between work engagement and work-related quality of life among nursing staff at a public hospital in São Paulo State, at the onset of the COVID-19 pandemic. A descriptive, correlational, cross-sectional study of nursing personnel was conducted from December 2020 to January 2021, using the Brazilian versions of the Work & Well-being Survey (Utrecht Work Engagement Scale - UWES) and the Work-related Quality of Life (WRQoL) scale, following Walton's model. Nursing staffs returned a strong positive correlation (r≥0.70) between the social integration domain of the WRQoL and the vigour dimension of the UWES (r=0.88; p=<0.001); a moderate positive correlation (r≥0.40≤0.69) between working conditions (WRQOL) and the vigour (r=0.40; p<0.001), dedication (r=0.40; p<0.001) and overall score (r=0.41; p<0.001) dimensions of the UWES. Correlations were positive and weak (r≤0.39) for the other WRQoL domains and the UWES dimensions. It was concluded that personnel with satisfactory levels of quality of life tend to show higher levels of engagement at work. At the onset of the COVID-19 pandemic, nursing professionals were strongly engaged and satisfied with their work-related quality of life.

A precarização jurídica das relações de trabalho como fator de sofrimento das(os) trabalhadoras(es) no setor da saúde durante a pandemia de COVID-19 / The legal precariousness of work relations in the health sector during the COVID-19 pandemic, as a factor of worker suffering

Resumo O artigo analisou o processo de precarização das relações de trabalho no setor da saúde, demonstrando como essa situação gerou sofrimento dos trabalhadores. O texto buscou registrar como a adoção institucional das concepções econômicas neoliberais, de redução das políticas sociais de Estado, acopladas a um histórico de rejeição cultural aos direitos trabalhistas, proporcionou a atração dos mecanismos de precarização do trabalho, notadamente, a terceirização da mão de obra e da prestação de serviços. No segundo momento, o texto aponta as impropriedades jurídicas cometidas, apresentando as consequências da fragilização do vínculo jurídico nas condições de trabalho desses trabalhadores, principalmente no que se refere às jornadas de trabalho e a remuneração, destacando-se, também, o quanto a disseminação desses vínculos representou um fator de rebaixamento geral dos salários e direitos trabalhistas e previdenciários no setor. Foram apresentados, ainda, dados das pesquisas da Fiocruz sobre condições de trabalho durante a pandemia. Conclui mostrando a urgência de se resgatarem os institutos jurídicos trabalhistas que foram abandonados no percurso histórico estudado, para direcionar a novo rumo as políticas públicas na saúde.

Abstract The present article analyzed the process of precarious work relations in the health sector, demonstrating how this situation generated illness and suffering among workers. The text sought to register how the institutional adoption of neoliberal economic conceptions, of the reduction of State social policies, coupled with a history of cultural rejection of labor rights, provided the attraction of mechanisms of precarious work for the public sector, notably, the outsourcing of labor and the provision of services. In a second moment, the text points out the legal improprieties committed, presenting the consequences of the weakening of the legal bond in the working conditions of these workers, mainly regarding working hours and remuneration, also highlighting how much the dissemination of these links represented a factor of a general reduction in wages and labor and social security rights in the sector. Data from Fiocruz surveys on working conditions during the pandemic were also presented. The article concludes by showing the urgency of rescuing the legal labor institutes that were abandoned in the historical path studied in order to guide the public health policies in a new direction.

Perfil e essencialidade da Enfermagem no contexto da pandemia da COVID-19 / Profile and essentiality of Nursing in the context of the COVID-19 pandemic

Resumo A pesquisa tem por objetivo descrever o perfil sociodemográfico e de saúde dos profissionais de enfermagem no contexto da pandemia da COVID-19 e propõe uma análise reflexiva sobre a essencialidade da categoria frente às demandas intrínsecas dos pacientes e do sistema de saúde brasileiro, especialmente, no contexto da emergência de saúde pública deflagrada pelo avanço exponencial do vírus SARS-CoV-2. O estudo revela a relação entre as injustiças históricas e os diferentes tipos de desigualdade que afetam e causam a vulnerabilidade da profissão, com fulcro na apresentação de potenciais perspectivas decorrentes desse processo histórico e dos acontecimentos recentes.

Abstract The present study aims to describe the sociodemographic and health profile of nursing professionals in the context of the COVID-19 pandemic and propose a reflective analysis on the essentiality of the category facing the intrinsic demands of patients and the Brazilian health system, especially in the context of the public health emergency triggered by the exponential advance of the SARS-CoV-2 virus. This study reveals the relationship between historical injustices and the different types of inequality that impacted and caused the vulnerability of the profession, with an emphasis on the presentation of potential perspectives arising from this historical process and recent events.

Spirituality and religiosity for umbandist and candomblecist women: social representation and health implications. / Espiritualidade e religiosidade para mulheres umbandistas e candomblecistas: representação social e implicações na saúde.

The object of study refers to the representations of spirituality and religiosity for women who belong to Afro-diasporic religions, specifically those who are faithful to Umbanda and Candomblé. The objective was to analyze the representational structure of spirituality and religiosity for Umbandist and Candomblecist women with the aim of thinking of an explanatory model of this symbolic construction and implications for the practice of care in the area of health. Qualitative study, in the light of Social Representations in its structural approach. Data collected with 207 Umbandist and Candomblecist women through free evocations of the inducing terms "spirituality" and "religiosity", in addition to the characterization and scale of religiosity. The evocations were submitted to prototypical and similarity analyses with Iramuteq, while quantitative data to descriptive statistics. The results show that the central elements for religiosity are faith, belief, God and love, while for spirituality, they are faith, Orixás, God, peace and love. The tree of similarity explains the centrality of faith for the structuring of this representation. The representations are organized around the idea of ​​a relationship between the human and the divine.

O objeto de estudo se refere às representações da espiritualidade e da religiosidade para mulheres que pertencem às religiões afrodiaspóricas, em específico às que são fiéis da umbanda e do candomblé. Buscou-se analisar a estrutura representacional da espiritualidade e da religiosidade para mulheres umbandistas e candomblecistas com vistas a se pensar um modelo explicativo dessa construção simbólica e as implicações para a prática de cuidado na área da saúde. Estudo qualitativo, à luz das representações sociais em sua abordagem estrutural. Dados coletados com 207 mulheres umbandistas e candomblecistas por meio de evocações livres aos termos indutores espiritualidade e religiosidade, além da caracterização e da escala de religiosidade. As evocações foram submetidas às análises prototípica e de similitude com o Iramuteq, e os dados quantitativos, pela estatística descritiva. Os resultados mostram que os elementos centrais para a religiosidade são fé, crença, Deus e amor, enquanto para espiritualidade, fé, Orixás, Deus, paz e amor. A árvore de similitude explicita a centralidade da fé para a estruturação dessa representação. As representações se organizam ao redor da ideia de relação entre o humano e o divino.