Effect of the addition of black garlic on the quality parameters of jerked beef meat with pork.

The objective of this work was to evaluate the effects of the replacement of nitrite by natural antioxidants from black garlic (BG) on the quality parameters of jerked beef meat with pork for 60 days. Four formulations were prepared: control, 0.02% of sodium nitrite in brine curing, w/v (CON); 1.5% BG in brine curing, w/v (ASU); 1.5% BG in dry curing, w/w (ASS); and 1.5% of BG in the brine curing, w/v and 1.5% of BG in dry curing, w/w (ASUS). Nutritional composition, pH, water activity, shear force, fatty acid profile, color, and oxidative stability of the formulations were analyzed. The addition of BG did not affect the nutritional composition, pH, water activity, shear force, and fatty acid profile. On the other hand, it resulted in lower weight loss after centrifugation and lower values of L* and a*. TBARS values from the 30th day of storage were lower in the ASUS formulation, while carbonyl compounds at all times were lower than in the CON formulation. Results suggest that BG was an efficient alternative to nitrite in controlling protein oxidation during storage. Thus, the use of pork for the manufacture of jerked beef can be an alternative, and black garlic can be applied as a natural additive to the replacement of nitrite. In addition, black garlic was efficient in improving the oxidative stability of the jerked beef meat with pork.

Patient-Centered Medicine and Self-Care of Patients with Type 2 Diabetes: A Cross-Sectional Study.

INTRODUCTION: Even though the prevalence rate of diabetes in Portugal is one of the highest in Europe, no studies on the association between patient centered medicine, diabetes self-care, and glycemic control have been published. Assuming that patient centered medicine increases adherence to treatment through the improvement of the doctor-patient relationship, the aim of this study was to assess the influence of patient-centered medicine on the self-care of patients with type 2 diabetes patients' (T2DM) in two Family Health Units in Central Portugal, according to gender and age. MATERIAL AND METHODS: A cross-sectional study was conducted in two Family Health Units in Central Portugal between the 25th November 2021 and the 15th January 2022. Patients with type 2 diabetes were invited to fill in the Patient-Centered Medicine questionnaire, for patients (PCM-p) (where higher values represent worse results) and the Summary of Diabetes Self-Care Activities Measure (SDSCAM), (where higher values represent better results), while healthcare professionals filled in the epidemiologic variables on pre-defined days. RESULTS: A sample of 298 patients with type 2 diabetes was studied. Linear regressions for the association between SDSCAM scale factors and PCM-p showed significant associations for general diet (ß = -0.07, p < 0.001), specific diet (ß = -0.10, p < 0.001), exercise (ß = -0.03, p = 0.008), foot care (ß = -0.11, p < 0.001) and medication adherence in general (ß = -0.06, p = 0.001). Multiple linear regression including the association between glycated hemoglobin (HbA1c) and the SDSCAM scale dimensions showed that specific diet was associated with lower HbA1c levels (ß = -0.01, p = 0.007) and blood sugar testing (ß = 0.01, p < 0.001) and that a higher score in PCMp was associated with higher HbA1c levels (ß = 0.06, p < 0.001). Male patients (ß = -6.93, p = 0.007) and older patients (ß = -0.42, p = 0.001) were associated with lower scores in the specific diet. The male gender was associated with higher scores in exercise (ß = 7.62, p = 0.029), lower scores in foot care (ß = -6.06, p = 0.029) and lower scores in medication adherence to injectable medicines/6.2 (ß = -0.73, p = 0.018). Age was associated with a lower score in medication (ß = -0.03, p = 0.045) and a higher PCMp total score (ß = 0.07, p = 0.030). CONCLUSION: Patient-centered medicine in type 2 diabetics is associated with better self-care behaviors in patients with type 2 diabetes. Gender and age differences were observed in self-care behaviors and age differences were observed in Patient Centered Medicine.

Configuração da rede de cuidados às doenças crônicas não transmissíveis na perspectiva da integração / Configuration of the care network for chronic non-communicable diseases from the perspective of integration / Configuración de la red de atención de enfermedades crónicas no transmisibles desde la perspectiva de la integración

Objetivo: Descrever a configuração da Rede de Cuidados às Doenças Crônicas não Transmissíveis em um Distrito Sanitário na perspectiva da integração. Métodos: Trata-se de estudo qualitativo desenvolvido em um Distrito Sanitário, no qual foram realizadas entrevistas com 34 participantes (coordenadores e enfermeiros assistenciais) com experiência na gestão e no cuidado. Resultados: Os resultados evidenciaram, em termos gerais, que é possível descrever a Rede de Cuidados a partir de uma inter-relação entre as dimensões da integração, destacando-se as interações profissionais, a organização do cuidado e processos logísticos relacionados aos fluxos assistenciais com facilitadores e impeditivos para a atenção às pessoas com Doenças Crônicas não Transmissíveis. Conclusão: Destaca-se como um facilitador na configuração da Rede a capacidade gerencial dos coordenadores em integrar as unidades de saúde e os profissionais na organização do cuidado; e, dentre os percalços para a conformação da Rede o não apontamento teórico dos princípios e diretrizes do SUS, choque nas relações profissionais, falhas operacionais na logística de fluxos assistenciais, sistema de informação não totalmente interligado, fragilidade quanto ao sistema de financiamento e falta de parcerias ou opiniões ambíguas referentes aos processos de trabalho adotados em cada unidade. (AU)

Objective: To describe the configuration of the Care Network for Chronic Non-Communicable Diseases in a Health District from the perspective of integration. Methods: This is a qualitative study developed in a Health District, in which interviews were conducted with 34 participants (coordinators and clinical nurses) with experience in management and care. Results: The results showed, in general terms, that it is possible to describe the Care Network from an interrelationship between the dimensions of integration, highlighting professional interactions, the organization of care and logistical processes related to care flows with facilitators and impediments to care for people with Chronic Non-Communicable Diseases. Conclusion: The managerial capacity of coordinators to integrate health units and professionals in the organization of care stands out as a facilitator in the configuration of the Network; and, among the setbacks for the conformation of the Network, the theoretical failure to point out the principles and guidelines of the SUS, a shock in professional relationships, operational failures in the logistics of assistance flows, an information system not fully interconnected, weakness in the financing system and lack of partnerships or ambiguous opinions regarding the work processes adopted in each unit. (AU)

Objetivo: Describir la configuración de la Red de Atención a Enfermedades Crónicas No Transmisibles en un Distrito de Salud desde la perspectiva de la integración. Métodos: Se trata de un estudio cualitativo desarrollado en un Distrito de Salud, en el que se realizaron entrevistas a 34 participantes (coordinadores y enfermeras clínicas) con experiencia en gestión y atención. Resultados: Los resultados mostraron, en términos generales, que es posible describir la Red de Cuidado a partir de una interrelación entre las dimensiones de la integración, destacando las interacciones profesionales, la organización del cuidado y los procesos logísticos relacionados con los flujos de cuidado con facilitadores e impedimentos para el cuidado. Personas con Enfermedades crónicas no transmisibles. Conclusión: La capacidad gerencial de los coordinadores para integrar unidades y profesionales de salud en la organización de la atención se destaca como facilitador en la configuración de la Red; y, entre los retrocesos para la conformación de la Red, el teórico fracaso en señalar los principios y lineamientos del SUS, un choque en las relaciones profesionales, fallas operativas en la logística de los flujos de asistencia, un sistema de información no plenamente interconectado, debilidad en el sistema de financiamiento y la falta de alianzas o opiniones ambiguas sobre los procesos de trabajo adoptados en cada unidad. (AU)

Configuração da rede de cuidados às doenças crônicas não transmissíveis na perspectiva da integração / Configuration of the care network for chronic non-communicable diseases from the perspective of integration / Configuración de la red de atención de enfermedades crónicas no transmisibles desde la perspectiva de la integración

Objetivo: Descrever a configuração da Rede de Cuidados às Doenças Crônicas não Transmissíveis em um Distrito Sanitário na perspectiva da integração. Métodos: Trata-se de estudo qualitativo desenvolvido em um Distrito Sanitário, no qual foram realizadas entrevistas com 34 participantes (coordenadores e enfermeiros assistenciais) com experiência na gestão e no cuidado. Resultados: Os resultados evidenciaram, em termos gerais, que é possível descrever a Rede de Cuidados a partir de uma inter-relação entre as dimensões da integração, destacando-se as interações profissionais, a organização do cuidado e processos logísticos relacionados aos fluxos assistenciais com facilitadores e impeditivos para a atenção às pessoas com Doenças Crônicas não Transmissíveis. Conclusão: Destaca-se como um facilitador na configuração da Rede a capacidade gerencial dos coordenadores em integrar as unidades de saúde e os profissionais na organização do cuidado; e, dentre os percalços para a conformação da Rede o não apontamento teórico dos princípios e diretrizes do SUS, choque nas relações profissionais, falhas operacionais na logística de fluxos assistenciais, sistema de informação não totalmente interligado, fragilidade quanto ao sistema de financiamento e falta de parcerias ou opiniões ambíguas referentes aos processos de trabalho adotados em cada unidade. (AU)

Objective: To describe the configuration of the Care Network for Chronic Non Communicable Diseases in a Health District from the perspective of integration. Methods: This is a qualitative study developed in a Health District, in which interviews were conducted with 34 participants (coordinators and clinical nurses) with experience in management and care. Results: The results showed, in general terms, that it is possible to describe the Care Network from an interrelationship between the dimensions of integration, highlighting professional interactions, the organization of care and logistical processes related to care flows with facilitators and impediments to care for people with Chronic Non-Communicable Diseases. Conclusion: The managerial capacity of coordinators to integrate health units and professionals in the organization of care stands out as a facilitator in the configuration of the Network; and, among the setbacks for the conformation of the Network, the theoretical failure to point out the principles and guidelines of the SUS, a shock in professional relationships, operational failures in the logistics of assistance flows, an information system not fully interconnected, weakness in the financing system and lack of partnerships or ambiguous opinions regarding the work processes adopted in each unit. (AU)

Objetivo: Describir la configuración de la Red de Atención a Enfermedades Crónicas No Transmisibles en un Distrito de Salud desde la perspectiva de la integración. Métodos: Se trata de un estudio cualitativo desarrollado en un Distrito de Salud, en el que se realizaron entrevistas a 34 participantes (coordinadores y enfermeras clínicas) con experiencia en gestión y atención. Resultados: Los resultados mostraron, en términos generales, que es posible describir la Red de Cuidado a partir de una interrelación entre las dimensiones de la integración, destacando las interacciones profesionales, la organización del cuidado y los procesos logísticos relacionados con los flujos de cuidado con facilitadores e impedimentos para el cuidado. Personas con Enfermedades crónicas no transmisibles. Conclusión: La capacidad gerencial de los coordinadores para integrar unidades y profesionales de salud en la organización de la atención se destaca como facilitador en la configuración de la Red; y, entre los retrocesos para la conformación de la Red, el teórico fracaso en señalar los principios y lineamientos del SUS, un choque en las relaciones profesionales, fallas operativas en la logística de los flujos de asistencia, un sistema de información n plenamente interconectado, debilidad en el sistema de financiamiento y la falta de alianzas o opiniones ambiguas sobre los procesos de trabajo adoptados en cada unidad. (AU)

Effect of Microencapsulation on Chemical Composition and Antimicrobial, Antioxidant and Cytotoxic Properties of Lemongrass (Cymbopogon flexuosus) Essential Oil.

Research background: Lemongrass (Cymbopogon flexuosus) essential oil exhibits antimicrobial and antioxidant properties due to the presence of α-citral and ß-citral. Essential oils are susceptible to volatilization and oxidation when applied to food matrices. Therefore, a barrier is needed to protect this material. The present study aims to produce microparticles containing lemongrass essential oil, with gum arabic and maltodextrin using spray drying technology. Experimental approach: Lemongrass essential oil was extracted by the hydrodistillation method and later microencapsulated with different wall materials. Free and microencapsulated lemongrass essential oil was evaluated for the cytotoxic activity (using Artemia salina as test sample), chemical composition (GC-MS), encapsulation efficiency, antioxidant activity (DPPH, ABTS and FRAP), antimicrobial activity and minimum inhibitory concentration. Results and conclusions: The lethal concentration (LC50) of lemongrass essential oil in the cytotoxic test was 8.43 µg/mL against Artemia salina; a high activity that can be associated with the presence of α-citral (~33%) and ß-citral (~21%) in the samples, since these were the main compounds with bioactive properties. The highest value of microencapsulation efficiency (88.11%) was obtained when only gum arabic was used as wall material. In general, the microparticles showed satisfactory antioxidant activity (expressed as Trolox equivalents, between 348.66 and 2042.30 µmol/100 g) and bactericidal effect in vitro against Gram-positive and Gram-negative microorganisms. In conclusion, the microencapsulated lemongrass essential oil is a promising functional additive in the food and pharmaceutical industries. Novelty and scientific contribution: This study shows that microparticles containing lemongrass essential oil can be prepared using gum arabic and maltodextrin as wall materials by spray drying, resulting in high microencapsulation efficiency. The drying process maintained the antimicrobial and antioxidant properties of the essential oil. Therefore, the microencapsulated lemongrass essential oil is considered a natural, functional and promising additive in the food industry. Its antimicrobial action can increase the shelf life of fresh and semi-fresh products such as cheese, yogurts and meat products. In addition, its antioxidant action can delay the lipid and protein oxidation in food products.

Characterization and application of Croton blanchetianus Baill extract for lamb ribs preservation.

This research evaluated the antioxidant, antimicrobial and toxicity potential of the leaf extract of Croton blanchetianus Baill (ExCb) and its effect on the conservation of lamb ribs. The ExCb (control treatment) revealed higher concentration of 2,5-dihydroxybenzoic acid (190.10 mg/g), catechin (84.10 mg/g), rosmarinic acid (56.01 mg/g), 4-hydroxybenzoic acid (52.05 mg/g) and myricetin (40.00 mg/g). And it showed high phenolic content (204.05 mg GAE/g), antioxidant potential (11.78 µg/mL by DPPH and 140.40 mmol Sulf Fer/g by FRAP) and antimicrobial activity with inhibition for Staphylococcus aureus, Listeria innocua, Salmonella enterica, Escherichia coli and Aspergillus flavus. However, it showed toxicity against brine shrimp (Artemia Salina) (LD50 of 66.26 µg/mL). The 2,5-dihydroxybenzoic acid was indicated as the main compound responsible for the toxicity of ExCb. After treatment in an oven at 110 °C for 15 min, the toxicity of ExCb was reduced by over 7 times, the compound 2,5-dihydroxybenzoic acid was not identified, and still maintained the phenolic compounds content of 94.35% and antioxidant activity compared to the control (without thermal treatment). The application of absorbent containing 50 mg/mL of ExCb added to the packaging maintained the quality and prevented the lipid oxidation of lamb ribs during 10 days of refrigerated storage.

Cuidados de transição: análise do conceito na gestão da alta hospitalar / Atención transicional: análisis de concepto en gestión de alta hospitalaria / Transitional care: analysis of the concept in hospital discharge management

RESUMO Objetivo analisar o conceito Cuidados de Transição no contexto da gestão da alta hospitalar. Método reflexão analítica utilizando-se a análise conceitual de Walker e Avant: seleção do conceito; definição do objetivo, identificação do uso do conceito (busca na literatura e dicionários entre setembro-dezembro/2019 nas bases de dados: PubMed, Biblioteca Virtual em Saúde e SCOPUS. Consideraram-se 77 artigos que contemplaram conceito e outros termos que corroboraram o estudo; para fins metodológicos, 12 estudos possibilitaram a análise); definição dos atributos; descrição de caso modelo; descrição de casos adicionais; definição de antecedentes e consequentes; definição de indicadores empíricos. Resultados os antecedentes cuidados fragmentados e reinternação são comuns ao conceito. Identificaram-se atributos cuidado integrado, colaboração profissional, coordenação, planejamento da alta, comunicação, integração profissional e gerenciamento de casos. Conclusão e implicações para a prática foi oportuno analisar o conceito em conjunto com termos relacionados ao contexto da alta hospitalar. Cuidados de Transição são práticas coordenadas e eficazes para a Continuidade dos Cuidados na transferência do usuário na alta hospitalar; nesse contexto, as Enfermeiras de Ligação são potenciais protagonistas para estar à frente nesse processo de Integração. As especificidades do conceito poderão favorecer a sua compreensão e a construção de conhecimentos que repercutam no cuidado coordenado e contínuo.

RESUMEN Objetivo analizar el concepto de Atención Transicional en el contexto de la gestión del alta hospitalaria. Método reflexión analítica utilizando el análisis conceptual de Walker y Avant: selección de conceptos; definición del objetivo, identificación del uso del concepto (búsqueda en la literatura y diccionarios entre septiembre-diciembre / 2019 en las bases de datos: PubMed, Virtual Health Library y SCOPUS. Se consideraron 77 artículos que contemplaban el concepto y otros términos que corroboraban el estudio; a efectos metodológicos, 12 estudios permitieron el análisis); definición de atributos; descripción del caso modelo; descripción de casos adicionales; definición de antecedentes y consecuencias; definición de indicadores empíricos. Resultados la atención fragmentada y los antecedentes de readmisión son comunes al concepto. Se identificaron los atributos atención integral, colaboración profesional, coordinación, planificación del alta, comunicación, integración profesional y manejo de casos. Conclusión e implicaciones para la práctica fue apropiado analizar el concepto junto con términos relacionados con el contexto del alta hospitalaria. Transition Care son prácticas coordinadas y efectivas para la Continuidad de la Atención en el traslado del usuario al alta hospitalaria; en este contexto, las Enfermeras de Enlace son potenciales protagonistas para estar a la vanguardia de este proceso de integración. La especificidad del concepto puede favorecer su comprensión y la construcción de conocimientos que inciden en la atención coordinada y continuada.

ABSTRACT Objective to analyze the concept of Transitional Care in the context of hospital discharge management. Method analytical reflection using the Walker and Avant's conceptual analysis: concept selection; definition of the objective, identification of the use of the concept (literature search and dictionaries between September-December/2019 in the databases: PubMed, Virtual Health Library and SCOPUS. A total of 77 articles that contemplated the concept and other terms that corroborated the study were considered; for methodological purposes, 12 studies enabled the analysis); definition of attributes; description of model case; description of additional cases; definition of antecedents and consequents; definition of empirical indicators. Results the fragmented care and readmission antecedents are common to the concept. The attributes integrated care, professional collaboration, coordination, discharge planning, communication, professional integration, and case management were identified. Conclusion and Implications for practice it was opportune to analyze the concept together with terms related to the context of hospital discharge. Transitional Care is coordinated and effective practices for the Continuity of Care in the transference of the user at hospital discharge; in this context, Liaison Nurses are potential protagonists to be ahead in this Integration process. The specificities of the concept may favor its understanding and the construction of knowledge that has repercussions on coordinated and continuous care.

The role of nurses in the integration of care for people with chronic noncommunicable diseases.

OBJECTIVE: To describe the role of nurses in the integration of care for people with chronic noncommunicable diseases. METHOD: This was an integrated single-case study conducted with care coordinators and nurses, purposefully selected, with interviews, documentary analysis and computerized files as sources of evidence. Categorical analysis was used based on data organization using MAXQDA® software, version 2018. RESULTS: Thirty-four professionals participated. Most of the professionals who held coordination positions were nurses. The categories clinical team integration and care integration and their subcategories increased understanding of the roles of nurses. CONCLUSION: The role of nurses in integrating care for people with chronic noncommunicable diseases was mainly focused on coordination of care, which occurred because of the different roles that they play and that give them autonomy to make decisions and place them in the front line to contribute to situations that required assertive attitudes, such as directing users within the care network.

Care management in coping with COVID-19 at a teaching hospital.

OBJECTIVE: to report the experience of implementing care management strategies in coping with the COVID-19 pandemic in a teaching hospital. METHOD: this is an experience report of the managers who work at the largest public hospital in Paraná with functions as Head of the Care Management Division, Head of the Care Lines Management Sector, Head of the Infectiology Unit and support team. RESULTS: care management strategies were structured based on the service dynamics; physical structure; human Resources; professional and user safety. FINAL CONSIDERATIONS: preparing for a pandemic involves measures that include modifying infrastructure and processes, managing employees and users, infection prevention strategies, and clinical recommendations. These measures are necessary to optimize the quality of care provided to users with COVID-19 and to reduce the risk of viral transmission to other users or health professionals.

Integration strategies for caring for chronic noncommunicable diseases: a case study.

OBJECTIVES: to identify the strategies for integrated care used regarding Chronic Noncommunicable Diseases in a Health District. METHODS: a case study developed in a district of a municipality in southern Brazil, with 34 participants (coordinators and nursing assistants). Data were collected between August 2016 and June 2017, through interviews, documents and computerized files. To organize the data, the MAXQDA® software was used. Analysis took place using the Integrated Care Network model. RESULTS: integration strategies were highlighted in the systemic, normative and functional dimensions, such as coordination, district organization, Annual Operating Plan, information system, and user management service. FINAL CONSIDERATIONS: the district comprises a structure that enables interactions through various tools; among these, coordination represents an effective strategy to enhance care, boost cooperation among professionals and support and manage the district.

Mapping the major proteome of reproductive fluids and sperm membranes of rams: From the cauda epididymis to ejaculation.

The present study evaluated the major proteome of ram seminal plasma and the main secretions that contribute to its formation, such as the cauda epididymal and accessory sex gland fluids. The study also investigated sperm membrane protein profiles before and after ejaculation. First, semen was collected from six rams (using artificial vagina) to obtain seminal plasma and ejaculated sperm. Then, rams were vasectomized for collection of accessory sex gland fluid (using artificial vagina). Next, rams were slaughtered and cauda epididymal fluid (CEF), seminal vesicle fluid, bulbourethral gland fluid and cauda epididymal sperm were properly collected. Proteins from reproductive fluids and sperm membranes were analyzed by 2-D SDS-PAGE, tandem mass spectrometry and bioinformatics. There we 386 proteins and 256 isoforms identified in all samples. The most abundant seminal plasma proteins were BSP1, BSP5 and spermadhesins (bodhesin-2 and spermadhesin Z13-like). These proteins were present in similar patterns in maps of accessory sexgland fluid, with very low quantities in the CEF and absent in the bulbourethral gland secretion. Thus, practically all BSPs and spermadhesins come from seminal vesicles. Bulbourethral gland fluid brought bactericidal/permeability-increasing protein-containing Family A member 1 isoforms, superoxide dismutase [Cu-Zn] and betamicroseminoprotein to seminal plasma. CEF was the major provider of clusterin, epididymal-specific lipocalin-5-like isoform, epididymal secretory gluthathione peroxidase, epididymal secretory protein E1 and prostaglandin-H2 D-isomerase to seminal plasma. Albumin came from all reproductive fluids. BSPs and spermadhesins were present in 2-D maps of ejaculated sperm but absent in cauda epididymal sperm. These proteins come from the seminal vesicles and bind to sperm at the moment of ejaculation. Other proteins of ejaculated and epididymal sperm membranes were mostly associated to energy production, cell adhesion and proteolytic activity (ATP synthases, disintegrin, metalloproteinase domain-containing protein 32, carboxypeptidase Q and cytosol aminopeptidase). In conclusion, there is a well-orchestrated sequence of events to form the major seminal plasma proteome, with specific contributions from cauda epididymis, seminal vesicles and bulbourethral glands. The present data contribute to a better understanding of male reproductive biology and how sperm functions are affected by the noncellularmicro environment of semen.

Integration strategies for caring for chronic noncommunicable diseases: a case study / Estrategias de integración para la atención de enfermedades crónicas no transmisibles: estudio de caso / Estratégias de integração dos cuidados às doenças crônicas não transmissíveis: estudo de caso

ABSTRACT Objectives: to identify the strategies for integrated care used regarding Chronic Noncommunicable Diseases in a Health District. Methods: a case study developed in a district of a municipality in southern Brazil, with 34 participants (coordinators and nursing assistants). Data were collected between August 2016 and June 2017, through interviews, documents and computerized files. To organize the data, the MAXQDA® software was used. Analysis took place using the Integrated Care Network model. Results: integration strategies were highlighted in the systemic, normative and functional dimensions, such as coordination, district organization, Annual Operating Plan, information system, and user management service. Final Considerations: the district comprises a structure that enables interactions through various tools; among these, coordination represents an effective strategy to enhance care, boost cooperation among professionals and support and manage the district.

RESUMEN Objetivos: identificar las estrategias de integración de la atención utilizadas en el contexto de las Enfermedades Crónicas No Transmisibles en un Distrito de Salud. Métodos: estudio de caso desarrollado en un distrito de un municipio de la región sur de Brasil, con 34 participantes (coordinadores y auxiliares de enfermería). Los datos fueron recolectados entre agosto/2016 y junio/2017, a través de entrevistas, documentos y archivos computarizados. Para organizar los datos se utilizó el software MAXQDA®. El análisis se realizó utilizando el modelo Red de Atención Integrada. Consideraciones Finales: el distrito comprende una estructura que permite interacciones a través de varias herramientas; entre estos, la coordinación representa una estrategia eficaz para potenciar la atención, impulsar la cooperación entre profesionales y ser soporte y gestión del distrito.

RESUMO Objetivos: identificar as estratégias para a integração dos cuidados utilizadas no contexto das Doenças Crônicas não Transmissíveis em um Distrito Sanitário. Métodos: estudo de caso desenvolvido em um distrito de um município da região Sul do Brasil, com 34 participantes (coordenadores e enfermeiros assistenciais). Os dados foram coletados entre agosto/2016 e junho/2017, por meio de entrevistas, documentos e arquivos computadorizados. Para organização dos dados, utilizou-se o software MAXQDA®. A análise ocorreu mediante o modelo de Rede Integrada de Cuidados. Resultados: destacaram-se estratégias de integração nas dimensões sistêmica, normativa e funcional, como as coordenações, organização do Distrito, Plano Operativo Anual, sistema de informação e serviço de gestão para o usuário. Considerações Finais: o distrito compreende uma estrutura que possibilita interações por meio de várias ferramentas; dentre essas, a coordenação representa uma estratégia eficaz para potencializar o cuidado, impulsionar a cooperação entre os profissionais e ser apoio e gestão ao distrito.

Care management in coping with COVID-19 at a teaching hospital / Gestión de la atención para enfrentar el COVID-19 en un hospital universitario / Gestão do cuidado no enfrentamento da COVID-19 em hospital de ensino

ABSTRACT Objective: to report the experience of implementing care management strategies in coping with the COVID-19 pandemic in a teaching hospital. Method: this is an experience report of the managers who work at the largest public hospital in Paraná with functions as Head of the Care Management Division, Head of the Care Lines Management Sector, Head of the Infectiology Unit and support team. Results: care management strategies were structured based on the service dynamics; physical structure; human Resources; professional and user safety. Final considerations: preparing for a pandemic involves measures that include modifying infrastructure and processes, managing employees and users, infection prevention strategies, and clinical recommendations. These measures are necessary to optimize the quality of care provided to users with COVID-19 and to reduce the risk of viral transmission to other users or health professionals.

RESUMEN Objetivo: reportar la experiencia de implementar estrategias de gestión de la atención en el afrontamiento de la pandemia de COVID-19 en un hospital docente Método: este es un reporte de experiencia de los gerentes que laboran en el hospital público más grande de Paraná, con el Jefe de División de Gestión Asistencial, Jefe del Sector Gestión de las Líneas de Atención, Jefe de la Unidad de Enfermedades Infecciosas y equipo de apoyo. Resultados: las estrategias de gestión del cuidado se estructuraron con base en la dinámica del cuidado, la estructura física, los recursos humanos, la seguridad del profesional y del usuario. Consideraciones finales: la preparación para una pandemia implica medidas que incluyen la modificación de la infraestructura y los procesos, la gestión de empleados y usuarios, estrategias de prevención de infecciones y recomendaciones clínicas. Estas medidas son necesarias para optimizar la calidad de la atención brindada a los usuarios con COVID-19 y para reducir el riesgo de transmisión viral a otros usuarios o profesionales de la salud.

RESUMO Objetivo: relatar a experiência de implementação de estratégias de gestão do cuidado no enfrentamento à pandemia de COVID-19 em hospital de Ensino Método: trata-se de relato de experiência dos gestores que atuam no maior hospital público do Paraná, tendo como funções a Chefia de Divisão de Gestão do Cuidado, Chefia de Setor de Gestão das Linhas de Cuidado, Chefia da Unidade de Infectologia e equipe de apoio. Resultados: as estratégias de gestão do cuidado foram estruturadas a partir da dinâmica de atendimento, estrutura física, recursos humanos, segurança do profissional e do usuário. Considerações finais: a preparação para uma pandemia envolve medidas que incluem modificação de infraestrutura e processos, gerenciamento de funcionários e usuários, estratégias de prevenção de infecções e recomendações clínicas. Essas medidas são necessárias para otimizar a qualidade dos cuidados prestados aos usuários com COVID-19 e reduzir o risco de transmissão viral a outros usuários ou profissionais de saúde.

Care management in coping with COVID-19 at a teaching hospital / Gestión de la atención para enfrentar el COVID-19 en un hospital universitario / Gestão do cuidado no enfrentamento da COVID-19 em hospital de ensino

ABSTRACT Objective: to report the experience of implementing care management strategies in coping with the COVID-19 pandemic in a teaching hospital. Method: this is an experience report of the managers who work at the largest public hospital in Paraná with functions as Head of the Care Management Division, Head of the Care Lines Management Sector, Head of the Infectiology Unit and support team. Results: care management strategies were structured based on the service dynamics; physical structure; human Resources; professional and user safety. Final considerations: preparing for a pandemic involves measures that include modifying infrastructure and processes, managing employees and users, infection prevention strategies, and clinical recommendations. These measures are necessary to optimize the quality of care provided to users with COVID-19 and to reduce the risk of viral transmission to other users or health professionals.

RESUMEN Objetivo: reportar la experiencia de implementar estrategias de gestión de la atención en el afrontamiento de la pandemia de COVID-19 en un hospital docente Método: este es un reporte de experiencia de los gerentes que laboran en el hospital público más grande de Paraná, con el Jefe de División de Gestión Asistencial, Jefe del Sector Gestión de las Líneas de Atención, Jefe de la Unidad de Enfermedades Infecciosas y equipo de apoyo. Resultados: las estrategias de gestión del cuidado se estructuraron con base en la dinámica del cuidado, la estructura física, los recursos humanos, la seguridad del profesional y del usuario. Consideraciones finales: la preparación para una pandemia implica medidas que incluyen la modificación de la infraestructura y los procesos, la gestión de empleados y usuarios, estrategias de prevención de infecciones y recomendaciones clínicas. Estas medidas son necesarias para optimizar la calidad de la atención brindada a los usuarios con COVID-19 y para reducir el riesgo de transmisión viral a otros usuarios o profesionales de la salud.

RESUMO Objetivo: relatar a experiência de implementação de estratégias de gestão do cuidado no enfrentamento à pandemia de COVID-19 em hospital de Ensino Método: trata-se de relato de experiência dos gestores que atuam no maior hospital público do Paraná, tendo como funções a Chefia de Divisão de Gestão do Cuidado, Chefia de Setor de Gestão das Linhas de Cuidado, Chefia da Unidade de Infectologia e equipe de apoio. Resultados: as estratégias de gestão do cuidado foram estruturadas a partir da dinâmica de atendimento, estrutura física, recursos humanos, segurança do profissional e do usuário. Considerações finais: a preparação para uma pandemia envolve medidas que incluem modificação de infraestrutura e processos, gerenciamento de funcionários e usuários, estratégias de prevenção de infecções e recomendações clínicas. Essas medidas são necessárias para otimizar a qualidade dos cuidados prestados aos usuários com COVID-19 e reduzir o risco de transmissão viral a outros usuários ou profissionais de saúde.

The role of nurses in the integration of care for people with chronic noncommunicable diseases / Actuación del enfermero en la integración de cuidados a personas con Enfermedades Crónicas No Transmisibles / Atuação do enfermeiro na integração dos cuidados às pessoas com Doenças Crônicas não Transmissíveis

ABSTRACT Objective: To describe the role of nurses in the integration of care for people with chronic noncommunicable diseases. Method: This was an integrated single-case study conducted with care coordinators and nurses, purposefully selected, with interviews, documentary analysis and computerized files as sources of evidence. Categorical analysis was used based on data organization using MAXQDA® software, version 2018. Results: Thirty-four professionals participated. Most of the professionals who held coordination positions were nurses. The categories clinical team integration and care integration and their subcategories increased understanding of the roles of nurses. Conclusion: The role of nurses in integrating care for people with chronic noncommunicable diseases was mainly focused on coordination of care, which occurred because of the different roles that they play and that give them autonomy to make decisions and place them in the front line to contribute to situations that required assertive attitudes, such as directing users within the care network.

RESUMEN Objetivo: Describir la actuación del enfermero en la integración de cuidados a personas con Enfermedades Crónicas No Transmisibles. Método: Estudio de caso único integrado realizado con coordinadores y enfermeros asistenciales elegidos intencionalmente, con fuentes de evidencias en entrevistas, análisis documental y archivos informáticos. Aplicado análisis categorial sobre datos organizados con software MAXQDA® versión 2018. Resultados: Participaron 34 profesionales. La composición de profesionales con rol de coordinación es esencialmente de enfermeros. Las categorías Integración del equipo clínico e Integración de cuidados, y sus respectivas subcategorías, favorecen entender la actuación del enfermero. Conclusión: La actuación del enfermero en la integración de cuidados a personas con Enfermedades Crónicas No Transmisibles se concentra en coordinar el cuidado, con respaldo en los cargos asumidos que confieren autonomía para toma de decisiones, además de estar en primera línea para contribuir en situaciones que exigen posturas asertivas, como la derivación de pacientes.

RESUMO Objetivo: Descrever a atuação do enfermeiro na integração dos cuidados às pessoas com Doenças Crônicas não Transmissíveis. Método: Estudo de caso único integrado realizado com coordenadores e enfermeiros assistenciais, selecionados intencionalmente, tendo como fontes de evidências entrevistas, análise documental e arquivos computadorizados. Utilizou-se análise categorial a partir da organização dos dados com o software MAXQDA®, versão 2018. Resultados: Participaram 34 profissionais. A composição dos profissionais que exercem a coordenação é essencialmente de enfermeiros. As categorias Integração da Equipe Clínica e Integração dos Cuidados e suas respectivas subcategorias favoreceram o entendimento acerca da atuação do enfermeiro. Conclusão: A atuação do enfermeiro na integração dos cuidados às pessoas com Doenças Crônicas não Transmissíveis se concentra principalmente na coordenação do cuidado, possibilitada por meio de diferentes cargos assumidos que lhe conferem autonomia para tomada de decisão, além de ele estar na linha de frente para contribuir com situações que exigem posicionamentos assertivos, como o direcionamento dos usuários na rede de cuidados.

The impact of dietary supplementation with guava (Psidium guajava L.) agroindustrial waste on growth performance and meat quality of lambs.

The aim of this study was to evaluate the growth performance and meat quality of lambs (40 animals) fed with increasing levels (0; 7.5; 15.0; 22.5 and 30.0%) of guava agroindustrial waste (GAW). The pH, cooking loss, colour and chemical composition were measured in the Longissimus lumborum (LL) muscle. A sensory analysis was performed with a panel of eight trained testers using a quantitative descriptive method in order to define sensory descriptors and their intensities. The lambs obtained a mean weight gain of 316 g/day consuming 1.32 kg/day of dry matter. The inclusion of GAW in the diet of lambs did not affect pH, L*, a* and b*. However, significant difference (P < .05) among the treatments were obtained for the chemical composition of LL: moisture decreased, while ash increased and intramuscular fat increased until 15% and then decreased at 22.5% with the inclusion of GAW. However, the sensorial characteristics of lamb meat (lamb odour and flavour, tenderness and juiciness) were not affect by the inclusion of GAW. Therefore, GAW can be included up to 30% in lamb feed without compromising the performance, physic-chemical and sensory characteristics of meat.

Untargeted metabolomic profiling of accessory sex gland fluid from Morada Nova rams.

The present study was conducted to characterize the metabolome of accessory gland fluid (AGF) of locally adapted Morada Nova rams, raised in the Brazilian Northeast. AGF was collected by an artificial vagina from five vasectomized rams. Metabolites were identified by gas chromatography-mass spectrometry (GC/MS) and high-performance liquid chromatography-mass spectrometry (LC/MS), with the support of Human Metabolome Database, PubChem, LIPID Metabolites, Pathways Strategy databases, and MetaboAnalyst platforms. There were 182 and 190 metabolites detected by GC/MS and LC/MS, respectively, with an overlap of one molecule. Lipids and lipid-like molecules were the most abundant class of metabolites in the ram AGF (127 compounds), followed by amino acids, peptides, and analogs(103 metabolites). Considering all GC/MS and LC/MS, fructose, glycerol, citric acid, d-mannitol, d-glucose, and l-(+)-lactic acid were the most abundant single metabolites present in the ram AGF. Meaningful pathways associated with AGF metabolites included glycine, serine and threonine metabolism; pantothenate and CoA biosynthesis; galactose metabolism; glutamate metabolism and phenylalanine metabolism, and so forth. In conclusion, the combined use of LC/MS and GC/MS was essential for getting a holistic view of the compounds embedded in the ram AGF. Chemical analysis of the accessory sex gland secretion is relevant for understanding sperm function and fertilization.

Optimizing the use of spineless cactus in the finishing diet of lambs: physicochemical properties and sensory characteristics of meat.

BACKGROUND: The use of spineless cactus in finishing diets for lambs improves the carcass quality. However, data about its influence on meat traits is very scarce. The effects of spineless cactus inclusion in the finishing diet of lambs at four levels (0, 150, 300 and 450 g kg-1 of dry matter, DM) in replacement of Tifton hay on the physicochemical and sensory properties of meat were studied. RESULTS: The spineless cactus modified the chemical composition increasing the protein (P < 0.001) and the fat (P < 0.01) contents of meat, presenting the greatest values in lambs fed diets with 150 and 300 g kg-1 (DM) replacing levels, respectively. However, the spineless cactus did not influence the growth performance from 23.7 to 37.3 kg of body weight (on average). In addition, colour parameters of the meat were not affected by the inclusion of spineless cactus in the finishing diet of lambs, resulting in mean values of 37.55, 14.96 and 8.49 for lightness, redness and yellowness, respectively. There were no statistical differences among treatments for cooking loss and shear force, with mean values of 34.8% and 14.8 N, respectively. Finally, the sensorial properties were not affected by the inclusion of spineless cactus in the finishing diet of lambs. CONCLUSION: Spineless cactus could be included up to the level of 300 g kg-1 DM in the finishing diets of lambs to increase the fat content of meat without compromising its sensorial properties. However, further studies about the fatty acid composition of meat from lambs fed diets containing spineless cactus are necessary. © 2019 Society of Chemical Industry.

Contribuição do enfermeiro na integração dos cuidados no contexto das doenças crônicas não transmissíveis / Nurse's contribution to the integration of care in the context of chronic non-communicable diseases

Resumo: Introdução: Doenças Crônicas não Transmissíveis são situações complexas que exigem tratamento contínuo, individualizado e iniciativas para seu enfrentamento. Neste cenário, a integração dos cuidados representa uma possibilidade para garantir qualidade assistencial. Cada profissional de saúde deve delimitar sua prática; no que diz respeito ao enfermeiro isso compreende os cargos e funções que podem contribuir para a integração dos cuidados. Objetivos: Descrever a contribuição do enfermeiro na integração dos cuidados no contexto das Doenças Crônicas não Transmissíveis; Identificar as estratégias de integração dos cuidados no contexto das Doenças Crônicas não Transmissíveis; Representar a rede de cuidados de um Distrito Sanitário segundo as dimensões da integração. Método: Trata-se de um estudo de caso em que foram feitas entrevistas e analisados documentos e arquivos computadorizados; desenvolvido em um Distrito Sanitário do Município de Curitiba, com 34 participantes (coordenadores e enfermeiros assistenciais) informantes-chave com experiência na gestão e no cuidado. A coleta de dados ocorreu entre agosto de 2016 e junho de 2017. Para a organização dos dados, utilizou-se o software MAXQDA®, versão 2018. Os dados foram analisados à luz do referencial da integração dos cuidados e confrontados com proposições teóricas e os objetivos do estudo. Resultados: As dimensões da integração (Sistêmica, Normativa, Funcional, Equipe Clínica e Cuidados) e suas características foram as categorias e subcategorias, respectivamente, previamente definidas. Destacam-se como contribuições do enfermeiro sua atuação como coordenador no distrito, sua autonomia no planejamento do cuidado, sua articulação junto à equipe e o maior quantitativo de enfermeiros exercendo cargos de coordenadores. Quanto às estratégias de integração para atenção às Doenças Crônicas não Transmissíveis, destacam-se a organização do distrito por meio das coordenações, coordenações informais, Plano Municipal, Plano Operativo Anual, Sistema de Informação, Central de Atendimento ao Usuário, articulação do coordenador local com sua equipe, tecnologias para otimizar o cuidado e mecanismos de apoio e gestão. Discussão: A coordenação é um eixo que interliga o distrito entre si e com os demais componentes da rede, conferindo-lhe uma logística que promove a integração dos cuidados. A coordenação, além de estratégia para o distrito no que diz respeito à integração, pode ser recurso valioso para legitimar a integralidade na rede. Considerações finais: Independentemente da lente utilizada para analisar um contexto, os profissionais de saúde devem produzir sentido às suas práticas; por essa razão infere-se que as coordenações, especialmente o trabalho humano por elas representado, destacam-se como ferramentas importantes para um cuidado contínuo e de qualidade. O enfermeiro insere-se nesse contexto tanto quantitativamente, devido ao número de coordenadores com essa formação, quanto qualitativamente, considerando seu exercício como coordenador e enfermeiro, denotando versatilidade, pois se adapta às transformações do Sistema de Saúde. Confirma-se, portanto, a tese de que a Rede de Atenção à Saúde tem a finalidade de atender às necessidades de saúde dos usuários de um determinado território, com uma estrutura que sustenta as interações entre os serviços e entre os profissionais, destacando-se o enfermeiro como o profissional que contribui de maneira significativa para a integração dos cuidados no contexto das Doenças Crônicas não Transmissíveis.

Abstract: Introduction: Chronic Non-Communicable Diseases are complex conditions, demanding ongoing, individualized treatment, as well as initiatives to cope with them. In this scenario, care integration means a possibility to ensure the quality of care. Each health professional must delimit his/her practice; concerning nurses, this entails positions and functions, which may contribute to care integration. Objectives: To describe nurses' contribution to care integration in the context of Chronic Non- Communicable Diseases; To identify the strategies of care integration in the context of Chronic Non-Communicable Diseases; To represent the care network of a Sanitary District according to its integration dimensions. Method: It is a case study with interviews and review of documents and computer files; carried out at a Sanitary District in the Municipality of Curitiba, 34 participants (coordinators and bedside nurses), key informants experienced in management and care. Data collection was carried out between August 2016 and June 2017. MAXQDA® Software, 2018 version, was used for data organization. Data were analyzed in light of care integration background, and confronted with the theoretical propositions and study objectives. Results: Integration dimensions (Systemic, Normative, Functional, Clinical Team and Care) and their features were the previously defined categories and subcategories respectively. It can be pointed out, as nurses' contribution, their performance as District coordinators, their autonomy in care planning, their articulation with the team and greater amount of nurses in coordination positions. Regarding the integration strategies for caring Chronic Non-Communicable Diseases, it can be pointed the District organization, by means of the coordinations, informal coordinations, the Municipal Plan, the Yearly Operational Plan, Information System, User Service Center, articulation of the local coordinator with his/her staff, technologies to optimize care and mechanisms of support and management. Discussion: The coordination is the axis that connects the District with itself and with the other network components, resulting in the logistics to promote care integration. In addition to be strategic for the District integration, the coordination can be a valuable resource to legitimize the network integrality. Final considerations: Disregarding the view used to analyze a context, health professionals must add meaning to their practices; therefore, coordinations, specially the humanized care that they stand for, are important tools for ongoing, quality care. Nurses are inserted in this context not only quantitatively, due to the number of coordinators with this qualification, but also qualitatively, considering their position as coordinators and nurses, showing versatility, as they get adapted to the changes in the Healthcare System. Therefore, the idea that the Healthcare Network aims to meet users' healthcare needs at a certain territory is corroborated, with a structure that supports the interactions between services and professionals, and nurses stand out as the professionals who contribute significantly to care integration in the context of Chronic Non-Communicable Diseases.

Continuidade do cuidado e o interacionismo simbólico: um entendimento possível / Continuity of care and the symbolic interactionism: a possible understanding

RESUMO Objetivo: buscar um entendimento pela consubstanciação entre o conceito de continuidade do cuidado ao referencial teórico do interacionismo simbólico, no sentido de agregar uma possibilidade de fortalecê-lo como conceito indispensável ao cuidado prestado aos usuários do sistema de saúde e provocar uma necessária reflexão sobre este. Método: estudo teórico-reflexivo, organizado em quatro seções, sobre a continuidade do Cuidado analisado sob a luz do referencial do interacionismo simbólico. Resultados: o interacionismo simbólico busca compreender a ação humana em grupo e acredita que os indivíduos ajam tendo como base os significados que as coisas têm para eles. Esta é uma construção social que se desenvolve na medida em que as pessoas agem e interagem consigo mesmas e com os outros. A continuidade do cuidado, trabalhada a partir das dimensões relacional, informacional e de gestão, coaduna com o proposto, por representar um produto social resultante das interações entre os envolvidos no cuidado, que se expressa segundo sua ação e reação, como uma constante para um conjunto de práticas de diferentes profissionais que buscam garantir o cuidado integral e coerente ao usuário. Conclusão: este trabalho possibilitou apresentar a continuidade do cuidado, dentro do contexto das interações sociais, não como algo concreto, mas como um objeto social decorrente do agir de cada um dos envolvidos com o cuidado, embora, ainda assim, se perceba a necessidade de sensibilizar profissionais e usuários a respeito de seu significado e intencionalidade no agir da cada um.

ABSTRACT Objective: to look for an understanding through the co-substantiation between the concept of continuity of care and the theoretical reference of the symbolic interactionism, in the sense of adding a possibility to strengthen it as an indispensable concept to the care provided to the health system users and to incite a necessary reflection regarding this care. Method: a theoretical-reflective study, organized in four sections, about the continuity of care analyzed through the symbolic interactionism referential. Results: the symbolic interactionism intends to understand the human action in a group and believes that individuals act based on the meanings that the things have for them. This is a social construction that develops as people act and interact among themselves and with others. The continuity of care, seen from the relational, informational and management dimensions, is in line with the proposed, since it represents a social product that results from the interactions between those involved in care, which is expressed according to their action and reaction, as a constant for a set of practices of different professionals that intend to guarantee the comprehensive and coherent care to the user. Conclusion: this study has made it possible to present the continuity of care within the social interactions context, not as something concrete, but as a social object arising from the actions of each of those involved in care, although it is still possible to perceive the need to sensitize professionals and users about their meaning and intentionality in acting.