Erratum: Interval and continuous aerobic exercise training similarly increase cardiac function and autonomic modulation in infarcted mice.

[This corrects the article on p. 257 in vol. 13, PMID: 28702435.].

Interval and continuous aerobic exercise training similarly increase cardiac function and autonomic modulation in infarcted mice.

The present study aimed to compare the effects of moderate-intensity continuous and high-intensity interval exercise training (ET) on exercise tolerance, cardiac morphometry and function, hemodynamic, and cardiac autonomic modulation in myocardial infarcted mice. Wild-type mice (WT) were divided into four groups: sedentary WT (S); WT myocardium infarction sedentary (IS); WT myocardium infarction underwent to moderate-intensity continuous ET (MICT), and WT myocardium infarction underwent to high-intensity interval ET (MIIT). After 60 days of descending coronary artery ligation, moderate-intensity continuous ET consisted of running at 60% of maximum, while the high-intensity interval training consisted of eight sprints of 4 min at 80% of maximum and a 4-min recovery at 40% of maximum. Both exercises were performed 1 hr a day, 5 days a week, during 8 weeks. Results demonstrated that IS showed elevated exercise tolerance, as well as decreased hemodynamic and heart function, and autonomic control. On the other hand, both programs of ET were equally effective to increase all parameters, without further differences between the groups. In conclusion, the results of the present study showed that myocardial infarction leads to damage in both investigated strains and the two types of physical exercise attenuated the major impairments provoked by myocardial infarction in exercise tolerance, cardiac structure, cardiac function, hemodynamic and cardiac autonomic modulation.

Processo de trabalho na residência médica: a subordinação do ensino-aprendizagem à exploração da força de trabalho dos residentes / Work process in medical residency: the subordination of teaching and learning to the exploitation of the resident workforce / Proceso de trabajo en la residencia médica: la subordinación del enseño-aprendizaje a la exploración de la fuerza de trabajo de los residentes

Resumo O sofrimento dos médicos-residentes causado por suas condições de trabalho é fartamente descrito na literatura. As condições, muitas vezes inaceitáveis, impostas a esse tipo de trabalhador, além de objeto de produções científicas, são de pleno conhecimento entre aqueles que trabalham na área da saúde e da educação médica. O presente estudo foi realizado em 2010 com o objetivo de descrever os principais aspectos dessas condições em dois hospitais públicos de Curitiba (Paraná) e refletir sobre os motivos e mecanismos da reprodução da maioria delas. Realizou-se um estudo transversal, a partir da aplicação de questionários, para a explicitação dos processos críticos protetores e destrutivos da saúde dos médicos-residentes. Dos cem médicos-residentes do primeiro ano em atividade nos hospitais estudados, 58 participaram da pesquisa. Os resultados mostram elevada jornada de trabalho semanal, elevado número de horas contínuas de trabalho, falta de supervisão e alta carga de estresse. O processo de trabalho caracteriza-se pela subordinação do ensino-aprendizagem à exploração da força de trabalho dos residentes, constituindo-se mais como destrutivo do que como protetor de sua saúde.

Abstract The suffering of medical residents caused by their working conditions is broadly described in the literature. The conditions imposed on this type of work, often unacceptable, are object of scientific investigations, and are fully aware of those who work in health and medical education. This study was conducted in 2010 in order to describe the main aspects of these conditions in two public hospitals in Curitiba (Brazil) and reflect on the reasons and mechanisms reproduction of most of them. We conducted a cross-sectional study from the application of questionnaires, for the explanation of the protective critical processes and destructive ones in health of medical residents. Of the 100 medical residents in his or her first year in activity in the hospitals studied, 58 participated in the survey. The results show high weekly working hours, high number of continuous working hours, lack of supervision and high load stress. The working process is characterized by the subordination of teaching and learning to the exploitation of the labor force of residents, becoming more like destructive than as a protector of his or her health.

Resumen El sufrimiento de los médicos-residentes causado por sus condiciones de trabajo es descrito abundantemente en la literatura. Las condiciones, muchas veces inaceptables, impostas a ese tipo de trabajador, además de objeto de producciones científicas, son de pleno conocimiento entre aquellos que trabajan en el área de la salud y de la educación médica. El presente estudio fue realizado en 2010 con el objetivo de describir los principales aspectos de esas condiciones en dos hospitales públicos de Curitiba (Paraná, Brasil) y reflejar sobre los motivos y mecanismo de la reproducción de la mayoría de ellas. Fue realizado un estudio transversal, a partir de la aplicación de cuestionarios, para la explicitación de los procesos críticos protectores y destructivos de la salud de los médicos-residentes. De los cien médicos-residentes del primero año en actividad en los hospitales estudiados, 58 participaron de la investigación. Los resultados demuestran elevada jornada de trabajo semanal, elevado número de horas continuas de trabajo, falta de supervisión y alta carga de estrese. El proceso de trabajo se caracteriza por la subordinación del enseño-aprendizaje a la exploración de la fuerza de trabajo de los residentes, se constituyendo más como destructivo do que como protector de su salud.

Conhecimento dos usuários, trabalhadores da saúde e gestores sobre conselheiros e Conselhos de Saúde / Knowledge of users, workers and managers about Health Councils and councilors

A criação de um espaço democrático de participação na condução do Sistema Único de Saúde (SUS) constituiu indubitável conquista dos brasileiros. O pleno exercício deste direito implica, no entanto, no conhecimento do próprio direito, dos espaços e dos mecanismos de participação, que permitam uma ação autônoma. No presente trabalho avalia-se o grau de conhecimento nos diversos segmentos sociais acerca da questão. Foram entrevistados usuários e trabalhadores do SUS, além de membros dos Conselhos de Saúde. Os resultados demonstram grande desinformação dos usuários, dos novos conselheiros e da maioria dos trabalhadores, em contraste com os gestores e os conselheiros com mais tempo no cargo.

The creation of a democratic space for participation in the conduction of the Sistema Único de Saúde ( SUS) - Brazilian Public Health Care System - was undoubtedly an achievement for Brazilians. Full exercise of this right implies, however, knowledge of the right itself, spaces and mechanisms for participation, allowing for autonomous action. The present study evaluates the degree of knowledge in the various social segments on this issue. Users and workers of SUS health care units were interviewed as well as members of Health Councils. Results show misinformation from most councilors and health workers when compared to managers and advisors who have worked longer in their positions.

Transmyocardial laser revascularization as an adjunct to coronary artery bypass grafting: a randomized, multicenter study with 4-year follow-up.

We evaluated transmyocardial laser revascularization (TMLR) with coronary artery bypass grafting (CABG) versus CABG alone for severe coronary artery disease involving 21 myocardial region unsuited for CABG. At 4 centers, 44 consecutive patients were randomized for CABG+TMLR (n = 23) or CABG alone (n = 21). Operative and in-hospital mortality and morbidity rates were monitored. Clinical status was evaluated at hospital discharge, 1 year, and 4 years. Success was characterized by relief of angina and freedom from repeat revascularization and death. Preoperatively, 20 patients (47%) were at high risk. The CABG technique, number of grafts, and target vessels were similar in both groups. Patients undergoing CABG+TMLR received 25 +/- 11 laser channels. Their < or = 30-day mortality was 13% (3/23) compared with 28% (6/21) after CABG alone (P = 0.21). There were no significant intergroup differences in the number of intraoperative or in-hospital adverse events. The follow-up period was 50.3 +/- 17.8 months for CABG alone and 48.1 +/- 16.8 months for CABG+TMLR. Both groups had substantially improved angina and functional status at 1 and 4 years, with no significant differences in cumulative 4-year mortality. The incidence of repeat revascularization was 24% after CABG alone versus none after CABG+TMLR (P < 0.05). The 4-year event-free survival rate was 14% versus 39%, respectively (P < 0.064). In conclusion, CABG+TMLR appears safe and poses no additional threat for high-risk patients. Improved overall success and repeat revascularization rates may be due to better perfusion of ischemic areas not amenable to bypass. Further studies are warranted to determine whether these trends are indeed significant.

Off-pump coronary artery bypass grafting and transmyocardial laser revascularization via a left thoracotomy.

Off-pump coronary artery bypass grafting may be combined with adjunctive transmyocardial laser revascularization to optimize revascularization. This approach may be advantageous for high-risk patients, particularly those having undergone previous sternotomies. From October 2000 through May 2001, 17 patients (9 women and 8 men) underwent off-pump coronary artery bypass grafting and transmyocardial laser revascularization via a left thoracotomy. The patients had a mean age of 63 years and a mean ejection fraction of 0.33. All but 1 patient had undergone previous coronary surgery. In each patient, the heart was approached via a left thoracotomy through the 5th intercostal space, and 37 transmural channels, 1 mm in diameter, were each created with a single pulse of the carbon dioxide laser. Coronary artery bypass grafting was then performed with left internal thoracic artery or saphenous vein grafts. The follow-up period ranged from 2.1 to 9.3 months (mean, 6.2 months). The patients received 28 bypass grafts (mean, 1.6 grafts). Postoperatively, 2 patients required inotropic support. On day 8, 1 patient died of ventricular fibrillation. After a mean hospitalization of 7.7 days, the remaining patients were discharged, free of angina. At follow-up examination after a mean of 6 months (range, 2-9 months), 15 patients remained free of angina and one had mild angina. None had required further hospitalization. Performed via a left thoracotomy, off-pump coronary artery bypass grafting plus transmyocardial laser revascularization yielded an acceptable mortality rate, no major morbidity, and substantial angina relief in this carefully selected group of challenging, high-risk patients.