Renal ischemia/reperfusion induces prominent progressive kidney disease in diabetic mice.

Acute kidney injury (AKI) is a public health concern associated with high rates of mortality, even in milder cases. One of the reasons for the difficulty in managing AKI in patients is due to its association with pre-existing comorbidities, such as diabetes. In fact, diabetes increases the susceptibility to develop more severe AKI after renal ischemia. However, the long-term effects of this association are not known. Thus, an experimental model was designed to evaluate the chronic effects of renal ischemia/reperfusion (IR) in streptozotocin (STZ)-treated mice. We focused on the glomerular and tubulointerstitial damage, as well as kidney function and metabolic profile. It was found that pre-existing diabetes may potentiate progressive kidney disease after AKI, mainly by exacerbating proinflammatory and sustaining fibrotic responses and altering renal glucose metabolism. To our knowledge, this is the first report that highlights the long-term effects of renal IR on diabetes. The findings of this study can support the management of AKI in clinical practice.NEW & NOTEWORTHY This study demonstrated that early diabetes potentiates progressive kidney disease after ischemia/reperfusion (IR)-induced acute kidney injury, mainly by exacerbating pro-inflammatory and sustaining fibrotic responses and altering renal glucose metabolism. Thus, these findings will contribute to the therapeutic support of patients with type 1 diabetes with eventual renal IR intervention in clinical practice.

Amazônia solidária: educação popular e comunicação em saúde para o fortalecimento da vacinação nos territórios quilombolas, migrantes e ribeirinhos/ / Amazon solidarity: popular education and health communication to strengthen of vaccination in quilombola, migrant and riverside territories

O livro "Amazônia solidária: educação popular e comunicação em saúde para o fortalecimento da vacinação nos territórios quilombolas, migrantes e ribeirinhos" é produto do projeto Amazônia Solidário que teve como objetivo reforçar as estratégias de comunicação sobre a vacina de Covid-19 e outras. O caminho utilizado foi da Educação Permanente nos territórios do Amazonas e do Acre, construindo COM as comunidades e grupos os modos e as linguagens da comunicação de uma política tão maltratada na última gestão governamental. Vimos a potência criativa das comunidades que simplesmente precisou ser ouvida e apoiada na construção dos seus materiais. O projeto nos permitiu amazonizar o pensamento e as estratégias da saúde, significando um estar nos territórios ribeirinhos, quilombolas e dos migrantes na cidade como um modo de refletir sobre uma dimensão diferente da vida. O encontro com outros, com modos diferentes de ser e estar no mundo, numa outra relação entre os humanos e não humanos, na relação com o território das águas e da cidade, nos traz outras formas de viver na Amazônia. Os encontros nos territórios das pessoas, que vivem as relações com as águas, com as memórias, com os encantados, com a ancestralidade, nos fazem perceber que o ser e estar ultrapassa a lógica da subsistência do "viver melhor" e não do "viver bem". Desse modo, desejamos que esse caminho, das águas, das estradas, das trilhas, possa ser fonte inspiradora da gestão das políticas públicas.

Dispersion patterns of SARS-CoV-2 variants Gamma, Lambda and Mu in Latin America and the Caribbean.

Latin America and Caribbean (LAC) regions were an important epicenter of the COVID-19 pandemic and SARS-CoV-2 evolution. Through the COVID-19 Genomic Surveillance Regional Network (COVIGEN), LAC countries produced an important number of genomic sequencing data that made possible an enhanced SARS-CoV-2 genomic surveillance capacity in the Americas, paving the way for characterization of emerging variants and helping to guide the public health response. In this study we analyzed approximately 300,000 SARS-CoV-2 sequences generated between February 2020 and March 2022 by multiple genomic surveillance efforts in LAC and reconstructed the diffusion patterns of the main variants of concern (VOCs) and of interest (VOIs) possibly originated in the Region. Our phylogenetic analysis revealed that the spread of variants Gamma, Lambda and Mu reflects human mobility patterns due to variations of international air passenger transportation and gradual lifting of social distance measures previously implemented in countries. Our results highlight the potential of genetic data to reconstruct viral spread and unveil preferential routes of viral migrations that are shaped by human mobility patterns.

Factors Associated with Periodontitis in Patients with and without HIV.

Purpose: The aim of this study was to compare clinical periodontal conditions in HIV-positive people on HAART with an HIV-negative group, in addition to investigating factors associated with periodontitis in the entire sample. Methods: This was a cross-sectional study. Data were collected by oral clinical examination for the diagnosis of periodontitis, review of medical records, and application of a questionnaire containing personal data, deleterious habits, and oral hygiene habits for the other variables. The results were analyzed by Pearson's χ 2 test and Student's t-test. A logistic regression model was constructed for the multivariate analysis and periodontitis was defined as a dependent variable. The analysis was performed on the entire sample (HIV+ and HIV-) and also on the group consisting of only people living with HIV. Results: Individuals older than 43 years old and with HIV were more likely to develop moderate and severe periodontitis (47.80 and 4.84 times, respectively). When analyzing only HIV+, in addition to age (OR = 2.795; CI = 1.080-7.233), the use of nonnucleoside reverse transcriptase inhibitors (NNRTIs) (OR = 2.841; CI = 1.135-7.112) was also associated with moderate and severe periodontitis. Conclusion: It was possible to observe a higher prevalence of periodontitis among individuals with HIV, showing an association between the virus, advanced age, and moderate or severe periodontitis.

Narrativas de mulheres mães: vivências e ressignificações diante da prematuridade extrema / Narratives of women mothers: experiences and resignifications in the face of extreme prematurity / Narrativas de mujeres madres: vivencias y resignificaciones frente a la prematuridad extrema

OBJETIVO: A partir do nascimento pré-termo, a maternidade é convocada prematuramente, pois o tempo final da gestação não pode ser vivido e o que foi idealizado não se concretiza. Dessa forma, a mulher mãe precisa ressignificar seu papel e a própria maternidade, reestruturando seu sistema cuidador para dar conta da situação real que se apresenta. O nascimento prematuro insere muitas dificuldades para a mulher, influenciando em momentos estressantes e deflagrando sentimentos de frustação, culpa, ansiedade, tristeza, medo, entre outros. OBJETIVO: Compreender as dificuldades, emoções e sentimentos presentes durante o nascimento e hospitalização dos recém-nascidos pré-termos extremos e como a(s) maternidade(s) puderam ir se construindo nesse contexto. MÉTODO: Estudo qualitativo, com coleta de narrativas de mulheres que compartilharam suas experiências em um site especializado na internet. A análise foi realizada a partir da Análise de Conteúdo, utilizando como embasamento teórico a teoria do apego. RESULTADOS: As narrativas retratam uma alta expectativa em relação ao nascimento dos bebês, bem como a frustração e angústia geradas a partir da necessidade de uma separação brusca e literal. Ainda, os momentos foram marcados por uma rotina exaustiva e pelo medo do bebê vir a óbito, além da necessidade de aprenderem a reconhecer os sinais sutis dos bebês e construir modos de cuidados possíveis. As narrativas trabalhadas foram/são uma maneira que elas encontraram para relatar suas histórias e de ressignificar o vivido. CONSIDERAÇÕES FINAIS: Destaca-se a importância de haver o reconhecimento das vivências maternas nesse contexto para que melhorias no acolhimento prestado e construção de políticas públicas sejam possíveis de serem realizadas.

OBJECTIVE: From preterm birth, motherhood is called prematurely, as the final period of pregnancy cannot be lived and what was idealized does not come true. Thus, the mother-woman needs to reformulate her role and her own motherhood, restructuring her care system to account for the real situation that is presented. Premature birth entails many difficulties for women, influencing stressful moments and triggering feelings of frustration, guilt, anxiety, sadness, and fear, among others. OBJECTIVE: Understand the difficulties, emotions, and feelings present during the birth and hospitalization of extreme preterm newborns and how motherhood could be built in this context. METHODS: Qualitative study, collecting narratives from women who shared their experiences on a specialized website on the internet. The analysis was carried out from the Content Analysis, using the attachment theory as the theoretical basis. RESULTS: The results point to a high expectation in relation to the birth of babies, as well as the frustration and anguish generated by the need for a sudden and literal separation. The moments were marked by an exhaustive routine and by the fear of the baby dying, in addition to the need to learn to recognize the subtle signs of the babies and build possible care modes. The narratives worked on were a way they found to report their stories and redefine what they had lived. CLOSING REMARKS: The importance of recognizing maternal experiences in this context is highlighted so that improvements in the reception provided and the construction of public policies are possible to be carried out.

OBJETIVO: Desde el parto prematuro, la maternidad es convocada prematuramente, ya que el período final del embarazo no se puede vivir y lo idealizado no se hace realidad. Por lo tanto, la madre necesita replantear su rol y maternidad, reestructurar su sistema de cuidado para dar cuenta de la situación real que se presenta. El parto prematuro conlleva muchas dificultades para la mujer, influyendo en momentos estresantes y desencadenando sentimientos de frustración, culpa, ansiedad, tristeza, miedo, entre otros. OBJETIVO: Comprender las dificultades, emociones y sentimientos presentes durante el parto y la hospitalización de recién nacidos prematuros extremos y cómo la(s) maternidad(es) podría(n) ser construida(s) en ese contexto. MÉTODO: Estudio cualitativo, con la recopilación de relatos de mujeres que compartieron sus experiencias en un sitio web especializado en internet. El análisis se realizó con base en el Análisis de Contenido, utilizando como base teórica la teoría del apego. RESULTADOS: Apuntaron a una alta expectativa en relación al nacimiento de bebés, así como a la frustración y angustia que genera la necesidad de una separación repentina y literal. Aún así, los momentos estuvieron marcados por una rutina exhaustiva y por el miedo a la muerte del bebé, además de la necesidad de aprender a reconocer los signos sutiles de los bebés y construir posibles modos de cuidado. Las narrativas trabajadas fueron/son una forma que apoyan para relatar sus historias y para resignificar la experiencia. CONSIDERACIONES FINALES: Se resalta la importancia de reconocer las experiencias maternas en este contexto, para que se puedan llevar a cabo mejoras en la atención brindada y la construcción de políticas públicas.

Return to sport after anterior cruciate ligament reconstruction: a qualitative analysis / Retorno ao esporte após reconstrução do ligamento cruzado anterior: uma análise qualitativa

Abstract Introduction Return to sport is a desired outcome in individuals submitted to anterior cruciate ligament reconstruction (ACLR). Objective Understand the factors that affect return to pre-injury level sport after ACLR from the patient's perspective. Methods The sample consisted of 29 individuals submitted to ACLR who participated in sport before the ligament injury. This is a narrative analysis with a qualitative approach, using a semi-structured interview as a methodological resource. Standardized instruments were also applied to evaluate psychological readiness to return to sport, via the Anterior Cruciate Ligament - Return to Sport after Injury Scale (ACL-RSI); self-perceived knee function using the International Knee Documentation Committee (IKDC) subjective questionnaire; and the frequency of participation in sports with the Marx scale. Results Analysis of the interviews produced three main themes related to post-ACLR return to sport: self-discipline, fear of reinjury and social support. In qualitative analysis, the average scores obtained were 59.17 (± 23.22) on the ACL-RSI scale, 78.16 (± 19.03) for the IKDC questionnaire and 9.62 (± 4.73) and 7.86 (± 5.44) for the Marx scale before and after surgery, respectively. Conclusion: Psychological factors influence the decision to return to sport post-ACLR. Physiotherapists should therefore be aware of the psychological aspects and expectations of patients, and that other health professionals may be needed to help prepare these individuals to return to their preinjury sports level and achieve more satisfactory outcomes after ACLR.

Resumo Introdução O retorno ao esporte é um desfecho alme-jado pelos indivíduos que se submetem à reconstrução do ligamento cruzado anterior (RLCA). Objetivo Com-preender os fatores que interferem no retorno ao esporte no nível anterior à lesão ligamentar em indivíduos submetidos à RLCA sob o ponto de vista do paciente. Métodos A amostra foi composta por 29 indivíduos que se submeteram à RLCA e praticavam esporte antes da lesão ligamentar. O estudo é caracterizado como uma pesquisa narrativa de abordagem qualitativa, utilizando como recurso metodológico a entrevista semiestrutu-rada. Com o uso de instrumentos padronizados, avaliou-se também a prontidão psicológica para retornar ao esporte, utilizando a escala ACL-RSI; a autopercepção da função do joelho, utilizando o questionário subjetivo do IKDC; e a frequência de participação esportiva antes da lesão e após a cirurgia, utilizando a Escala de Marx. Resultados A análise das entrevistas gerou três unidades temáticas principais relacionadas com o retorno ao esporte pós-RLCA: autodisciplina, medo de uma nova lesão e suporte social. Na análise quantitativa, obteve-se média de 59,17 pontos (± 23,22) na escala ACL-RSI, 78,16 pontos (± 19,03) no IKDC, e 9,62 (± 4,73) e 7,86 pontos (± 5,44) na escala de Marx, antes da lesão e após a cirurgia, respectivamente. Conclusão Fatores psicológicos influenciam a decisão de retorno ao esporte pós-RLCA. Os fisioterapeutas, portanto, devem estar atentos aos aspectos psicológicos e expectativas dos pacientes, considerando a necessidade de outros profissionais da saúde auxiliarem na preparação do indivíduo para retornar ao nível esportivo pré-lesão e alcançar resultados mais satisfatórios pós-RLCA.

Distopias criminais: desnaturalizando a lógica neoliberal-religiosa do empreendedor de si / Criminal dystopias: denaturalizing the neoliberal-religious logic of the entrepreneur in himself / Distopías criminales: desnaturalizar la lógica neoliberal-religiosa del empresario del sí mismo

Esse artigo formaliza em conceitos e linhas de arguição articuladas sobre eventos do nosso cotidiano contemporâneo. Produzimos, por meio de uma narrativa-ficção, sobre os engendramentos existentes entre as lógicas do empreendedorismo, do crime e da religiosidade em seus atravessamentos pelos dispositivos necropolíticos-coloniais. A ficção operou tal análise com uma redução ao absurdo: colapsando as lógicas que buscam cindir o mundo entre "vagabundos" e "trabalhadores" ou "criminosos" e "cidadão de bem". O racismo estrutural e o estigma da periculosidade criam a figura do "vagabundo" como par oposto ao trabalhador, por uma sobreposição de camadas discursivas e imagéticas que criminaliza, encarcera e extermina juventudes negras periféricas em nome da manutenção dos privilégios da branquitude. O sistema penal brasileiro é racista e classista, perpetuando a lógica moderno-colonial que passa a fazer parte da elaboração das políticas de segurança pública. Questionamos essa racionalidade, compreendendo que o crime organizado não funciona fora da lógica neoliberal, da moral empreendedora e conservadora vigente. A redução ao absurdo nos ajuda a olhar de outra forma para as noções de culpa, mérito e para a própria noção de trabalho, levando-as aos seus limites, transgredindo as fronteiras jurídicas, para visibilizar que ambos comungam de uma rede de valores coloniais: agressividade competitiva, disciplina, obediência à hierarquia e elevação moral. Nesse paradoxo, entre a moral do crime organizado e da moralidade conservadora, visibilizamos elementos fundamentais da máquina de subjetivação do nosso tempo.(AU)

This article formalizes in articulate concepts and lines of argument about events in our contemporary everyday life. We have produced, through a narrative-fiction, about the existing engagements between the logics of entrepreneurship, crime, and religiosity in their intersections by necropolitical-colonial mechanisms. The fiction has performed this analysis with a reduction to the absurd: collapsing the logic that seeks to split the world between " tramps" and "workers" or " thugs" and "good citizens". The structural racism and the stigma of dangerousness create the figure of the " tramp" as an opposite pair to the worker, by an overlapping of discursive and imagetic layers that criminalizes, incarcerates, and exterminates suburban black youths in the name of the preservation of the privileges of whiteness. The criminal justice system in Brazil is racist and classist, perpetuating the modern-colonial approach that becomes part of the development of public security policies. We have questioned this rationality, understanding that organized crime does not function outside the neoliberal mindset, the entrepreneurial and conservative current morals. The reduction to absurd helps us to look in another way to the notions of guilt, merit and the concept of work, taking them to its limits, transgressing legal boundaries, to make visible that both share a network of colonial moral values: competitive aggressiveness, discipline, obedience to hierarchy and moral superiority. In this paradox, between the morality of the crime organized and conservational morality, we make visible fundamental elements of the machine of subjectivation of our time.(AU)

Este artículo se formaliza en conceptos y líneas argumentales articuladas sobre acontecimientos de nuestra vida cotidiana contemporánea. Producimos, a partir de una narración-ficción, acerca de los engendros existentes entre las lógicas del emprendimiento, el crimen y la religiosidad en sus entrecruzamientos por los aparatos de la necropolítica-colonial. La ficción operó ese análisis con una reducción al absurdo: desmoronando las lógicas que pretenden dividir el mundo entre " los vagos " y " los trabajadores " o " los criminales " y " los buenos ciudadanos ". El racismo estructural y el estigma de la peligrosidad crean la figura del "vago" como par opuesto al trabajador, a partir de una superposición de estratos discursivos e iconográficos que criminaliza, aprisiona y extermina a la juventud negra de la periferia en nombre del mantenimiento de los privilegios de la blancura.El sistema de justicia penal brasileño es racista y clasista, perpetuando la lógica moderno-colonial que se integra en la elaboración de las políticas de seguridad publica. Nosotros cuestionamos esta racionalidad, comprendiendo que el crimen organizado no funciona al margen de la lógica del neoliberalismo, de la moral empresarial y conservadora vigente. La reducción al absurdo nos ayuda a mirar de otra manera las nociones de culpa, mérito y la propia noción de trabajo, llevándolas a sus límites, transgrediendo las fronteras legales, para hacer visible que ambas comparten una trama de valores coloniales: agresividad competitiva, disciplina, obediencia a la jerarquía y elevación moral. En esta paradoja, entre la moral del crimen organizado y la moral conservadora, se hacen visibles elementos fundamentales de la máquina de subjetivación de nuestro tiempo.(AU)

Phylogenetic-based inference reveals distinct transmission dynamics of SARS-CoV-2 lineages Gamma and P.2 in Brazil.

The COVID-19 epidemic in Brazil experienced two major lineage replacements until mid-2021. The first was driven by lineage P.2, in late 2020, and the second by lineage Gamma, in early 2021. To understand how these SARS-CoV-2 lineages spread in Brazil, we analyzed 11,724 genomes collected throughout the country between September 2020 and April 2021. Our findings indicate that lineage P.2 probably emerged in July 2020 in the Rio de Janeiro state and Gamma in November 2020 in the Amazonas state. Both states were the main hubs of viral disseminations to other Brazilian locations. We estimate that Gamma was 1.56-3.06 times more transmissible than P.2 in Rio de Janeiro and that the median effective reproductive number (Re) of Gamma varied according to the geographic context (Re = 1.59-3.55). In summary, our findings support that lineage Gamma was more transmissible and spread faster than P.2 in Brazil.

Influence of hypoxia on biochemical aspects and on expression of genes related to oxygen-homeostasis of the Amazonian cichlid Astronotus ocellatus (Agassiz, 1831).

Variations in dissolved oxygen levels are common in the Amazonian aquatic environments and the aquatic organisms that inhabit these environments developed a variety of adaptive responses to deal with such conditions. Some Amazonian fish species are tolerant to low oxygen levels and the cichlid Astronotus ocellatus is one of the most hypoxia-tolerant species. Herein, we aimed to unveil the biochemical and molecular responses that A. ocellatus presents when submitted to hypoxia. Hypoxia indicators were measured, such as plasma glucose, plasma lactate, hepatic glycogen and relative transcript levels of prolyl hydroxylase 2 (phd2) and hypoxia-inducible factor-1α (hif-1α) in juveniles of approximately 50 g exposed to 1, 3, and 5 hours of hypoxia (0.7 mg O2.L-1), followed by 3 hours of recovery in normoxia (6 mg O2.L-1). Fish exposed to hypoxia reduced liver glycogen levels within 3 hours of hypoxia, when comparing with 1 hour, and increased plasma glucose and lactate. Under the same condition, phd2 transcripts levels increased in gills, but decreased in liver. In contrast, hypoxia did not affect relative gene expression of hif-1α in both tissues. Based on the transcription pattern of phd2, these results showed that liver and gills of A. ocellatus have different molecular strategies to cope with environmental hypoxia.

Early type 1 diabetes aggravates renal ischemia/reperfusion-induced acute kidney injury.

The present study aimed to investigate the interaction between early diabetes and renal IR-induced AKI and to clarify the mechanisms involved. C57BL/6J mice were assigned to the following groups: (1) sham-operated; (2) renal IR; (3) streptozotocin (STZ-55 mg/kg/day) and sham operation; and (4) STZ and renal IR. On the 12th day after treatments, the animals were subjected to bilateral IR for 30 min followed by reperfusion for 48 h, at which time the animals were euthanized. Renal function was assessed by plasma creatinine and urea levels, as well urinary protein contents. Kidney morphology and gene and protein expression were also evaluated. Compared to the sham group, renal IR increased plasma creatinine, urea and albuminuria levels and decreased Nphs1 mRNA expression and nephrin and WT1 protein staining. Tubular injury was observed with increased Havcr1 and Mki67 mRNA expression accompanied by reduced megalin staining. Renal IR also resulted in increased SQSTM1 protein expression and increased proinflammatory and profibrotic factors mRNA expression. Although STZ treatment resulted in hyperglycemia, it did not induce significant changes in renal function. On the other hand, STZ treatment aggravated renal IR-induced AKI by exacerbating renal dysfunction, glomerular and tubular injury, inflammation, and profibrotic responses. Thus, early diabetes constitutes a relevant risk factor for renal IR-induced AKI.

A novel single-leg squat test with speed and accuracy requirements: Reliability and validity in anterior cruciate ligament reconstructed individuals.

BACKGROUND: Some traditional single-leg squat tests focused on number of repetitions may not demand precise control of lower limb dynamic alignment, especially in the frontal and transverse planes. The primary objective of this study was to evaluate test-retest reliability and construct validity of a novel single-leg squat test - the 'precision-squat test' (PST) - designed to assess performance under varying task demands that can impact the execution of lower limb movements. A secondary objective was to investigate whether musculoskeletal factors predict performance in the PST in healthy individuals. METHODS: Thirty healthy participants were assessed to verify test-retest reliability. To verify the test's construct validity, we compared the performance of 21 anterior cruciate ligament reconstructed (ACLR) individuals and 21 matched controls. Finally, 36 healthy individuals were assessed to verify the musculoskeletal factors related to PST performance. All participants performed the PST: they executed single-leg squats while moving a laser pointer (attached to the thigh) between two targets. We varied target size and distance between targets to manipulate the task difficulty. RESULTS: Reliability of the PST was excellent at all demand levels (intraclass correlation coefficient (ICC)(3,2) > 0.93). Squat time increased under test conditions involving higher task difficulty (P < 0.001) and in ACLR individuals compared with age-matched controls (P < 0.05). Regression analyses revealed that reduced knee extensors and hip external rotators torques are related to increased squat time (P < 0.05). CONCLUSIONS: PST is a valid and reliable tool to assess performance of healthy and ACLR individuals. In addition, hip and knee strength are associated with performance during the test.

Current clinical practice and return-to-sport criteria after anterior cruciate ligament reconstruction: a survey of Brazilian physical therapists.

BACKGROUND: Adherence to the use of recommended measures/criteria for return to sport clearance after anterior cruciate ligament reconstruction is crucial for successful rehabilitation. OBJECTIVES: The purpose of this study was to describe the current clinical practice of Brazilian physical therapists that treat patients after anterior cruciate ligament reconstruction, including the measures/criteria used to support the decision-making process regarding return to sport. The secondary aim was to investigate factors associated with the use of the most recommended measures/criteria for return to sport. METHODS: An electronic survey questionnaire was sent to Brazilian physical therapists. The survey consisted of questions about demographics and professional and clinical practice data related to anterior cruciate ligament reconstruction postoperative rehabilitation and return to sport criteria. Descriptive statistics and chi-square tests were used for analyses. RESULTS: A sample of 439 professionals participated in the survey. Only 6.4% of the physical therapists use the most recommended measures/criteria for return to sport after anterior cruciate ligament reconstruction. Professional certification in Sports Physical Therapy was the only factor associated with the use of these recommended measures/criteria (p=0.02). The measures most used for return to sport clearance were related to physical factors (65.3% to 75.1%), such as range of motion and muscle strength. A small number of professionals use questionnaires to assess functional (16.6%) and psychological (19.1%) aspects of their patients to support the decision-making process. CONCLUSION: In their clinical practice, most Brazilian physical therapists do not use the recommended measures/criteria for return to sport after anterior cruciate ligament reconstruction.

Síndrome do Bebê Sacudido: conhecimento de profissionais de educação infantil / Shaken Baby Syndrome: knowledge of early childhood professionals

No Brasil, há poucas pesquisas sobre a Síndrome do Bebê Sacudido, a qual se caracteriza como uma forma de abuso infantil. Tendo em vista o tempo que muitos bebês passam sob o cuidado de educadoras em instituições escolares, foi objetivo deste estudo avaliar o conhecimento de profissionais que atuam com bebês de 0 a 2 anos a respeito da Síndrome do Bebê Sacudido. Para isso, a partir de aplicação de questionários e de entrevistas investigou-se o conhecimento de 20 educadoras. As entrevistas foram analisadas a partir da técnica de Análise de Conteúdo e o questionário foi avaliado a partir da estatística descritiva e inferencial. De modo geral, os resultados apontam para o desconhecimento das profissionais, dos fatores de risco e de proteção da síndrome, bem como das consequências de sacudir um bebê. Portanto, é necessário que ações de prevenção sejam formuladas para esse contexto, buscando diminuir a incidência desse tipo de violência e buscando um desenvolvimento mais saudável das crianças.(AU)

In Brazil, there is little research on Shaken Baby Syndrome, which is characterized as a form of child abuse. In view the time that many babies are taken care for educators in kindergarten institutions, this study aimed to evaluate the knowledge of professionals who work with babies from 0 to 2 years old about Shaken Baby Syndrome. For this, based on the application of questionnaires and interviews, the knowledge of 20 educators was investigated. The interviews were analyzed using the Content Analysis technique and the questionnaire was evaluated using descriptive and inferential statistics. In general, the results point to the lack of knowledge of professionals, the risk factors and protection of the syndrome, as well as the consequences of shaking the baby. Therefore, prevention actions need to be formulated for this context, seeking to reduce the incidence of this type of violence and a healthier development of children.(AU)

narrativas em situação de prisão: outras histórias sobre juventude, políticas públicas e criminalidade / narrativas en la cárcel: otras historias sobre juventud, políticas públicas y criminalidad / narratives deprived of liberty: other stories about youth, public policies and criminality

Resumo Neste trabalho, construímos um conto com jovens em situação de prisão na Cadeia Pública de Porto Alegre, onde buscamos trazer uma composição provisória sobre os cruzamentos das políticas públicas, da criminalidade e do neoliberalismo nas suas histórias de vida. Com estas narrativas, não buscamos destinos irreversíveis, nem respostas prontas, mas sim fragmentos, descontinuidades, a tecidura de um uso político da linguagem, a desterritorialização de significados preconcebidos das palavras. Assim, fazemos uso dos conceitos de narrativa de Walter Benjamin e de literatura menor de Gilles Deleuze e Félix Guattari.

Resumen En este trabajo, construimos un cuento con jóvenes privados de libertad en la cárcel pública de Porto Alegre, donde buscamos traer una composición provisional sobre los cruces de las políticas públicas, de la criminalidad y del neoliberalismo en sus historias de vida. Con estas narrativas, no buscamos destinos irreversibles, ni respuestas listas, pero sí fragmentos, discontinuidades, la tejedura de un uso político del lenguaje, la desterritorialización de significados preconcebidos de las palabras. Así, hacemos uso de los conceptos de narrativa de Walter Benjamin y de literatura menor de Gilles Deleuze y Félix Guattari.

Abstract In this article we built a short tale with young people deprived of liberty in the Porto Alegre Public Jail, where we sought to bring a provisory composition on the intersection of public policies, criminality and neoliberalism in their life histories. With these narratives, we do not seek irreversible destinations, nor rapid responses, but fragments, discontinuities, the fabric of a political use of language, the de-territorialization of the preconceived meanings of words. Thus, we make use of Walter Benjamin's narrative concepts as well as of the concept of minor literature by Gilles Deleuze and Félix Guattari.

Percepção e dilemas éticos frente à decisão de não reanimação cardiopulmonar / Ethical perceptions and dilemas in relation to the decision to not cardiopulmonar resuscitation / Percepción y dilemas éticos frente a la decisión de no reanimación cardiopulmonar

Objetivo: Analisar a percepção e os dilemas éticos da equipe de enfermagem frente à decisão de não ressuscitação cardiopulmonar. Método: Estudo descritivo-exploratório, com abordagem qualitativa. Amostra envolve critério por conveniência. Foram entrevistados 18 profissionais de uma unidade de terapia intensiva adulto. Os relatos foram analisados pelo método do Discurso do Sujeito Coletivo. Resultados: A equipe se vê preparada para a decisão de não reanimar, mas desconhecem a existência de protocolos institucionais. A decisão de não reanimação é realizada de forma verbal, o que gera ansiedade e frustração nos profissionais. A família não é informada sobre a decisão da não reanimação. Considerações finais: Tornou-se evidente que os dilemas éticos estão presentes na assistência a esse tipo de situação limítrofe, e que faltam protocolos, normas e envolvimento multiprofissional, para que ocorra uma assistência segura e efetiva tanto para o profissional de saúde quanto para o paciente e sua família.(AU)

Objective: Analyze the perception and ethical dilemmas of the nursing team regarding the decision not to use cardiopulmonary resuscitation. Method: A descriptive-exploratory study with a qualitative approach. Sample involves criterion for convenience. We interviewed 18 professionals from an adult intensive care unit. The reports were analyzed using the Collective Subject Discourse method. Results: The team is prepared for the decision not to reanimate, but they are unaware of the existence of institutional protocols. The decision not to resuscitate is performed verbally, which creates anxiety and frustration in professionals. The family is not informed of the decision not to reanimate. Final considerations: It has become clear that ethical dilemmas are present in the assistance to this type of borderline situation, and that protocols, norms and multiprofessional involvement are lacking, so that a safe and effective assistance can occur both for the health professional and for the patient and your family.(AU)

Objetivo: Analizar la percepción y los dilemas éticos del equipo de enfermería con respecto a la decisión de no utilizar la reanimación cardiopulmonar. Método: Un estudio descriptivo-exploratorio con un enfoque cualitativo. Muestra implica criterio de conveniencia. Entrevistamos a 18 profesionales de una unidad de cuidados intensivos para adultos. Los informes fueron analizados utilizando el método de Discurso de sujeto colectivo. Resultados: el equipo está preparado para la decisión de no reanimar, pero desconocen la existencia de protocolos institucionales. La decisión de no reanimar se realiza verbalmente, lo que genera ansiedad y frustración en los profesionales. La familia no está informada de la decisión de no reanimar. Consideraciones finales: Ha quedado claro que existen dilemas éticos en la asistencia a este tipo de situación límite, y que faltan protocolos, normas y participación multiprofesional, de modo que pueda darse una asistencia segura y efectiva tanto para el profesional de la salud como para el paciente. Y su familia.(AU)

Health conditions and occupational risks in a novel group: waste pickers in the largest open garbage dump in Latin America.

BACKGROUND: The inadequate management of solid waste impacts populations' health and quality of life, and disproportionately affects developing countries. This study aims to describe a protocol for epidemiological diagnosis, the purpose being to estimate the prevalence of chronic and communicable and non communicable diseases in waste pickers, and the occupational and environmental risk factors to which these are exposed. METHODS: This is a cross-sectional study, based on survey design in an area of extreme social vulnerability - the largest garbage dump in Latin America. Using a multidimensional research protocol, divided in three stages: 1- The identification of the subjects, and the scheduling of tests; 2- Situational diagnosis through interviews, anthropometric evaluation, measuring blood pressure, collecting hair and nail samples to detect exposure to heavy metals and undertaking laboratory tests; 3- The return of the waste pickers to receive the test results, followed by referral to the health team and to report occupational accidents. RESULTS: One thousand twenty-five waste pickers undertook tests and interviews. The majority were women (67.0%), with 36-45 years old (45.7%), and 96.0% had children. In total, 27.3% of the participants did not attend to any school and 47.7% were educated only up to primary level. The majority of waste pickers (68.70%) reported accidents and most of them (89.69%) were related to sharp objects. The mean time working in this open dump was 15 years. According the anthropometric measure, 32.6% were overweight and 21.1% were obese. The most common reported diseases were: osteomuscular disorders (78.7%); arboviruses (28.6%); episodic diarrhea (24.9%); hypertension (24.2%); bronchitis (14.3%); intestinal worms (12.6%) and diabetes (10.1%). According to the blood tests, the values outside the reference limits were: Uric acid (23.89%); creatinine (54.06%); GGT range (16.04%); SGOT - Serum Glutamic Oxaloacetic Transaminase (5.29%); SGPT - serum Glutamic-Pyruvic Transaminase (35.52%). CONCLUSIONS: This study is the first to evaluate multiple risks and diseases in the majority of waste pickers working in the largest garbage dump of a continent. These findings highlight the importance to address urgently the environmental, social and health impacts related to the management of solid waste in developmental countries to protect these workers and their families.

Assimetria Direita-Esquerda e Desenvolvimento Neuropsicomotor Humano / Left-right asymmetry and Human Neuropsychomotor Development / La asimetría derecha-izquierda y Desarrollo Neuropsicomotor Humano

Resumo O presente artigo tem como objetivo relatar sobre a organização neurológica das crianças em relação ao comportamento motor, buscando evidenciar os processos anteriores ao uso preferencial de um determinado membro e a constituição da lateralidade, salientando as leis céfalo-caudal e próximo-distal. Também são apresentados conceitos referentes ao desenvolvimento motor em neonatos e de que forma irão influenciar a relação de lateralidade discutida. Objetiva-se apresentar a relação entre a lateralidade e a discriminação direita-esquerda e como esta última influencia na aprendizagem. O estudo se deu a partir de revisões teóricas, e os resultados obtidos mostram que o desenvolvimento motor, partindo de neonatos, se dá primeiro com uma constituição bimanual, havendo uma dominância homolateral do corpo, devido à hipotonicidade do eixo axial e à hipertonicidade das extremidades. Uma melhor estruturação do esquema corporal ocorre a partir do desaparecimento dos reflexos presentes e da constituição da bonicularidade e da binauricularidade (uso simultâneo dos olhos e dos ouvidos, respectivamente), os quais favorecem o engatinhar e, consequentemente, a criança passa a ter maiores possibilidades de explorar o mundo a sua volta, favorecendo a definição de preferência de um dos lados. Conforme apresentado, se a discriminação direita-esquerda não for bem definida, poderão ocorrer problemas cognitivos e distúrbios de aprendizagem.

Abstract This paper aims to discuss about the neurological organization of children in relation to motor behavior, seeking to highlight the prior processes to the preferential use of a member and laterality constitution, emphasizing the cephalocaudal and proximodistal trends. It also provides concepts regarding to motor development in newborns and how it will influence the relationship of laterality. It aims to show the relationship between handedness and right-left differentiation and how the latter influence on learning. This study was based on theoretical revisions, and the results obtained show that the motor development, starting from newborns, occurs first with a bimanual constitution, with a homolateral dominance of the body due to the hypotonicity of the axial axis and hypertonicity of the extremities A better structure of the body schema occurs from the disappearance of existing reflexes and the constitution of bonicularidade and binauricularidade (simultaneous use of eyes and ears, respectively), which favors crawling and, consequently, the child will have greater possibilities to explore the surrounding world, favoring the definition of preference on one side. As shown, if the right-left differentiation is not well defined, cognitive problems and learning disorders may occur.

Resumen El presente artículo tiene como objetivo discutir sobre la organización neurológica de los niños en relación al comportamiento motor, buscando evidenciar los procesos previos al uso preferencial de un determinado miembro y la constitución de la lateralidad, enfatizando las leyes céfalo-caudal y próximo-distal. También se presentan conceptos referentes al desarrollo motor en recién nacidos y el modo como influenciará la relación de lateralidad discutida; y la relación entre la lateralidad y la discriminación derecha-izquierda y cómo esta última influye en el aprendizaje. El estudio se basó en revisiones teóricas y los resultados obtenidos muestran que el desarrollo motor, partiendo de los recién nacidos, se produce primero con una constituición bimanual y una dominancia homolateral del cuerpo, debida a la hipotonicidad del eje axial y a la hipertonicidad de las extremidades. Una mejor estructuración del esquema corporal ocurre a partir de la desaparición de los reflejos presentes y de la constituición de la bonicularidad y de la binauricularidad (uso simultâneo de los ojos y oidos, respectivamente), los cuales favorecen el gatear y, en consecuencia, el niño tendrá mayores posibilidades de explorar el mundo a su alrededor, propiciando la definición de la preferencia de uno de los lados. Como se muestra, si la discriminación derecha-izquierda no está bien definida, pueden ocurrir problemas cognitivos y trastornos en el aprendizaje.

Systematic review of mixed methods: method of research for the incorporation of evidence in nursing / Revisión sistemática de métodos mistos: método de investigación para la incorporación de evidencias en la enfermería / Revisão sistemática de métodos mistos: método de pesquisa para a incorporação de evidências na enfermagem

ABSTRACT Objective: to describe some methodological considerations on the Systematic Review of Mixed Methods developed by the Joanna Briggs Institute, seeking to disseminate the use of this methodology, exemplifying its use and demonstrating the benefits for nursing research. Method: it is an article of reflection. Result: it can be seen that the Systematic Review of Mixed Methods demonstrates that it is a research method that aligns with the characteristics of nursing care, making it possible to make a broader analysis of the different aspects of care such as: the viability of an activity or intervention, its adequacy to a specific context, the significance of the intervention for the patient and their effectiveness. Conclusion: the possibility of incorporating scientific evidence into the clinical practice by the decision making, increasing the focus of care and bringing benefits to the patients as well as the public policies is envisaged. This method values the context of care, cost-effectiveness and the preferences of patients, caregivers and health care providers.

RESUMEN Objetivo: describir algunas consideraciones metodológicas sobre la Revisión Sistemática de Métodos Mixtos desarrollada por el Instituto Joanna Briggs, buscando divulgar el uso de esta metodología, ejemplificando su utilización y demostrando los beneficios para la investigación en enfermería. Método: se trata de un artículo de reflexión. Resultados: se observa que la Revisión Sistemática de Métodos Mixtos demuestra ser un método de investigación que se alinea a las características del cuidado en enfermería, posibilitando hacer un análisis más amplio de los diferentes aspectos del cuidado como: la viabilidad de una evaluación actividad o intervención, su adecuación a un determinado contexto, la significancia de la intervención para el paciente y su eficacia. Conclusión: se vislumbra la posibilidad de incorporar evidencias científicas a la práctica clínica por la toma de decisión, ampliando el foco de cuidado y aportando beneficios a los pacientes y a las políticas públicas. Este método valora el contexto de la atención, la relación costo-eficacia, así como las preferencias de los pacientes, cuidadores y proveedores de atención de salud.

RESUMO Objetivo: descrever algumas considerações metodológicas sobre a Revisão Sistemática de Métodos Mistos desenvolvida pelo Instituto Joanna Briggs, buscando divulgar o uso desta metodologia, exemplificando sua utilização e demonstrando os benefícios para a pesquisa em enfermagem. Método: trata-se de um artigo de reflexão. Resultado: percebe-se que a Revisão Sistemática de Métodos Mistos demonstra ser um método de pesquisa que se alinha às características do cuidado em enfermagem, possibilitando fazer uma análise mais ampla dos diferentes aspectos do cuidado como: a viabilidade de uma atividade ou intervenção, sua adequação a um determinado contexto, a significância da intervenção para o paciente e a sua eficácia. Conclusão: vislumbra-se a possibilidade de incorporar evidências científicas à prática clínica pela tomada de decisão, ampliando o foco de cuidado e trazendo benefícios aos pacientes bem como às políticas públicas. Este método valoriza o contexto da prestação de cuidados, a relação custo-eficácia e as preferências dos pacientes, cuidadores e provedores de cuidados de saúde.

Acoustic characteristics of healthy voices of adults: from young to middle age. / Características acústicas de vozes saudáveis de adultos: da idade jovem à meia-idade.

PURPOSE: Characterize voices of adult individuals without vocal complaints and verify the effect of gender and age with the use of acoustic measures. METHODS: One-hundred and seventy-six voice recordings belonging to adults between 19 and 59 years old, divided into four age groups, for decade, recorded in a database were analyzed. All voices analyzed were classified with no deviation in vocal quality. Acoustic analysis of the parameters was performed: Fundamental Frequency (sustained vowel and connected speech), Jitter, Shimmer and Noise-to-Harmonic Ratio through Multi Dimension Voice Program (KayPentax) software. The effect of gender, age and possible interactions were verified through the Factorial Anova test. When necessary, post hoc was performed with the Least Significant Difference test. RESULTS: There were changes in the voice as a function of age, with a decrease in the Fundamental Frequency in the vowel and connected speech modalities in women and in the Fundamental Frequency of the speech in men. In men, an increase in shimmer measure was observed with the advancing age. Differences between genders were found in the measures of Fundamental Frequency, Jitter and Noise to Harmonic Ratio. CONCLUSION: Vocal changes due to advancing age can be identified acoustically at the end of adulthood, and in women, these changes can be marked previously to the menopausal period.

Angiotensin II-induced podocyte apoptosis is mediated by endoplasmic reticulum stress/PKC-δ/p38 MAPK pathway activation and trough increased Na+/H+ exchanger isoform 1 activity.

BACKGROUND: Angiotensin II (Ang II) contributes to the progression of renal diseases associated with proteinuria and glomerulosclerosis mainly by inducing podocyte apoptosis. In the present study, we investigated whether the chronic effects of Ang II via AT1 receptor (AT1R) would result in endoplasmic reticulum (ER) stress/PKC-delta/p38 MAPK stimulation, and consequently podocyte apoptosis. METHODS: Wistar rats were treated with Ang II (200 ng·kg-1·min-1, 42 days) and or losartan (10 mg·kg-1·day-1, 14 days). Immortalized mouse podocyte were treated with 1 µM Ang II and/or losartan (1 µM) or SB203580 (0.1 µM) (AT1 receptor antagonist and p38 MAPK inhibitor) for 24 h. Kidney sections and cultured podocytes were used to evaluate protein expression by immunofluorescence and immunoblotting. Apoptosis was evaluated by flow cytometry and intracellular pH (pHi) was analyzed using microscopy combined with the fluorescent probe BCECF/AM. RESULTS: Compared with controls, Ang II via AT1R increased chaperone GRP 78/Bip protein expression in rat glomeruli (p < 0.001) as well as in podocyte culture (p < 0.01); increased phosphorylated eIf2-α (p < 0.05), PKC-delta (p < 0.01) and p38 MAPK (p < 0.001) protein expression. Furthermore, Ang II induced p38 MAPK-mediated late apoptosis and increased the Bax/Bcl-2 ratio (p < 0.001). Simultaneously, Ang II via AT1R induced p38 MAPK-NHE1-mediated increase of pHi recovery rate after acid loading. CONCLUSION: Together, our results indicate that Ang II-induced podocyte apoptosis is associated with AT1R/ER stress/PKC-delta/p38 MAPK axis and enhanced NHE1-mediated pHi recovery rate.