Using active learning strategies during a quality improvement collaborative: exploring educational games to enhance learning among healthcare professionals.

BACKGROUND: The Breakthrough Series model uses learning sessions (LS) to promote education, professional development and quality improvement (QI) in healthcare. Staff divergences regarding prior knowledge, previous experience, preferences and motivations make selecting which pedagogic strategies to use in LS a challenge. AIM: We aimed to assess new active-learning strategies: two educational games, a card game and an escape room-type game, for training in healthcare-associated infection prevention. METHODS: This descriptive case study evaluated the performance of educational strategies during a Collaborative to reduce healthcare-associated infections in Brazilian intensive care units (ICUs). A post-intervention survey was voluntarily offered to all participants in LS activities. RESULTS: Seven regional 2-day LS were held between October and December 2022 (six for adult ICUs and one for paediatric/neonatal ICUs). Of 194 institutions participating in a nationwide QI initiative, 193 (99.4%) participated in these activities, totalling 850 healthcare professionals. From these, 641 participants responded to the survey (75.4%). The post-intervention survey showed that the participants responded positively to the educational activities. CONCLUSION: The participants perceived the various pedagogical strategies positively, which shows the value of a broad and diverse educational approach, customised to local settings and including game-based activities, to enhance learning among healthcare professionals.

Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance.

Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.

Single amino acid residue mediates reciprocal specificity in two mosquito odorant receptors.

The southern house mosquito, Culex quinquefasciatus, utilizes two odorant receptors, CquiOR10 and CquiOR2, narrowly tuned to oviposition attractants and well conserved among mosquito species. They detect skatole and indole, respectively, with reciprocal specificity. We swapped the transmembrane (TM) domains of CquiOR10 and CquiOR2 and identified TM2 as a specificity determinant. With additional mutations, we showed that CquiOR10A73L behaved like CquiOR2. Conversely, CquiOR2L74A recapitulated CquiOR10 specificity. Next, we generated structural models of CquiOR10 and CquiOR10A73L using RoseTTAFold and AlphaFold and docked skatole and indole using RosettaLigand. These modeling studies suggested space-filling constraints around A73. Consistent with this hypothesis, CquiOR10 mutants with a bulkier residue (Ile, Val) were insensitive to skatole and indole, whereas CquiOR10A73G retained the specificity to skatole and showed a more robust response than the wildtype receptor CquiOR10. On the other hand, Leu to Gly mutation of the indole receptor CquiOR2 reverted the specificity to skatole. Lastly, CquiOR10A73L, CquiOR2, and CquiOR2L74I were insensitive to 3-ethylindole, whereas CquiOR2L74A and CquiOR2L74G gained activity. Additionally, CquiOR10A73G gave more robust responses to 3-ethylindole than CquiOR10. Thus, we suggest the specificity of these receptors is mediated by a single amino acid substitution, leading to finely tuned volumetric space to accommodate specific oviposition attractants.

Two in one: the neotropical mirid predator Macrolophus basicornis increases pest control by feeding on plants.

BACKGROUND: Plant defenses activated by European zoophytophagous predators trigger behavioral responses in arthropods, benefiting pest management. However, repellence or attraction of pests and beneficial insects seems to be species-specific. In the neotropical region, the mirid predator Macrolophus basicornis has proved to be a promising biological control agent of important tomato pests; nevertheless, the benefits of its phytophagous behavior have never been explored. Therefore, we investigated if M. basicornis phytophagy activates tomato plant defenses and the consequences for herbivores and natural enemies. RESULTS: Regardless of the induction period of M. basicornis on tomato plants, Tuta absoluta females showed no preference for the odors emitted by induced or control plants. However, Tuta absoluta oviposited less on plants induced by M. basicornis for 72 h than on control plants. In contrast, induced plants repelled Bemisia tabaci females, and the number of eggs laid was reduced. Although females of Trichogramma pretiosum showed no preference between mirid-induced or control plants, we observed high attraction of the parasitoid Encarsia inaron and conspecifics to plants induced by M. basicornis. While the mirid-induced plants down-regulated the expression of genes involving the salicylic acid (SA) pathway over time, the genes related to the jasmonic acid (JA) pathway were up-regulated, increasing emissions of fatty-acid derivatives and terpenes, which might have influenced the arthropods' host/prey choices. CONCLUSION: Based on both the molecular and behavioral findings, our results indicated that in addition to predation, M. basicornis benefits tomato plant resistance indirectly through its phytophagy. This study is a starting point to pave the way for a novel and sustainable pest-management strategy in the neotropical region. © 2022 Society of Chemical Industry.

Colletotrichum falcatum modulates the olfactory behavior of the sugarcane borer, favoring pathogen infection.

Some pathogens can manipulate their host plants and insects to optimize their fitness, increasing the attraction of insects to the infected plant in ways that facilitate pathogen acquisition. In tropical American sugarcane crops, the fungus Colletotrichum falcatum, the red rot causal agent, usually occurs in association with the sugarcane borer Diatraea saccharalis, resulting in large losses of this crop. Considering this association, we aimed to identify the effects of C. falcatum on D. saccharalis host preference and performance as well as the effect of this insect on C. falcatum sugarcane infection. Here, we show that the fungus C. falcatum modulates D. saccharalis behavior to its own benefit. More specifically, C. falcatum-infected sugarcane plants showed a dramatic increase in VOCs, luring D. saccharalis females to lay eggs on these plants. Therefore, sugarcane infection by the fungus C. falcatum increased in cooccurrence with insect herbivory, benefiting the pathogen when associated with D. saccharalis.

Fungal phytopathogen modulates plant and insect responses to promote its dissemination.

Vector-borne plant pathogens often change host traits to manipulate vector behavior in a way that favors their spread. By contrast, infection by opportunistic fungi does not depend on vectors, although damage caused by an herbivore may facilitate infection. Manipulation of hosts and vectors, such as insect herbivores, has not been demonstrated in interactions with fungal pathogens. Herein, we establish a new paradigm for the plant-insect-fungus association in sugarcane. It has long been assumed that Fusarium verticillioides is an opportunistic fungus, where it takes advantage of the openings left by Diatraea saccharalis caterpillar attack to infect the plant. In this work, we show that volatile emissions from F. verticillioides attract D. saccharalis caterpillars. Once they become adults, the fungus is transmitted vertically to their offspring, which continues the cycle by inoculating the fungus into healthy plants. Females not carrying the fungus prefer to lay their eggs on fungus-infected plants than mock plants, while females carrying the fungus prefer to lay their eggs on mock plants than fungus-infected plants. Even though the fungus impacts D. saccharalis sex behavior, larval weight and reproduction rate, most individuals complete their development. Our data demonstrate that the fungus manipulates both the host plant and insect herbivore across life cycle to promote its infection and dissemination.

Electrical signalling on Bt and non-Bt cotton plants under stress by Aphis gossypii.

Plants have developed various mechanisms to respond specifically to each biotrophic attack. It has been shown that the electrical signals emitted by plants are associated with herbivory stress responses and can lead to the activation of multiple defences. Bt cotton is a genetically modified pest-resistant plant that produces an insecticide from Bacillus thuringiensis (Bt) to control Lepidopteran species. Surprisingly, there is no study-yet, that characterizes the signalling mechanisms in transgenic cotton plants attacked by non-target insects, such as aphids. In this study, we characterized the production of electrical signals on Bt and non-Bt cotton plants infested with Aphis gossypii and, in addition, we characterized the dispersal behaviour of aphids to correlate this behaviour to plant signalling responses. Electrical signalling of the plants was recorded with an extracellular measurement technique. Impressively, our results showed that both Bt and non-Bt cotton varieties, when attacked by A. gossypii, emitted potential variation-type electrical signals and clearly showed the presence of distinct responses regarding their perception and the behaviour of aphids, with evidence of delay, in terms of signal amount, and almost twice the amount of Cry1F protein was observed on Bt cotton plants at the highest density of insects/plant. We present in our article some hypotheses that are based on plant physiology and insect behaviour to explain the responses found on Bt cotton plants under aphid stress.

Praxiologia motriz e a organização do trabalho pedagógico e da didática na educação física: entrevista com Pierre Parlebas, professor da Universidade Paris Descartes (Paris V - Sorbonne Cité) / Motor praxeology and organisation of pedagogical and didactic work in physical education: an interview with Pierre Parlebas, a professor at the University Paris Descartes (Paris V - Sorbonne Cité) / Praxiologia motriz y organización del trabajo pedagógico y didáctico en educación física: entrevista con Pierre Parlebas, profesor de la Universidad Paris Descartes (París V - Sorbonne Cité)

RESUMO: Este texto é o resultado de uma entrevista realizada, em junho de 2015, com o Dr. Pierre Parlebas, idealizador da Praxiologia Motriz. A entrevista se estruturou em três momentos e teve o objetivo de estabelecer as relações entre o conhecimento praxiológico e a organização do trabalho pedagógico e da didática na Educaçao Física. Iniciou-se questionando a respeito das características epistemológicas do conhecimento praxiológico. Em seguida, verificou-se como o professor situa o conhecimento praxiológico no campo da Educação Física. Finalizou-se a entrevista solicitando que o autor apresentasse as relações entre Praxiologia Motriz, Trabalho Pedagógico e Didática.

ABSTRACT: This article is the result of an interview with Dr. Pierre Parlebas Motor Praxeology creator. The interview took place on June of 2015 and its aim was to establish the relationship between the praxiological knowledge and organisation of pedagogical and didactic work in Physical Education. The interview was divided into three different parts. Firstly, we asked Dr. Pierre Parlebas about the epistemological characteristics of the praxiological knowledge. Secondly, we searched for answers to know how Parlebas places the praxiological knowledge in the field of Physical Education. Finally, we requested the author to explain the connections among Motor Praxeology, Pedagogical practice and Didactics.

RESUMEN: Este artículo es el resultado de una entrevista realizada con el Dr. Pierre Parlebas, creador de la praxiología motriz, que tuvo lugar en junio de 2015. La entrevista se estructuró en tres momentos y tuvo como objetivo establecer las relaciones entre el conocimiento praxiológico y la organización del trabajo pedagógico y didáctico en educación física. Empezamos por las características epistemológicas del conocimiento praxiológico. A continuación, buscamos saber cómo el profesor sitúa el conocimiento praxiológico en el campo de la educación física. Finalizamos la entrevista solicitando que el autor presentase el vínculo existente entre praxiología motriz, práctica pedagógica y didáctica.

Structural and Functional Characterization of PR-4 SUGARWINs From Sugarcaneand Their Role in Plant Defense.

SUGARWIN1 and 2 are defense proteins from sugarcane. Their gene expression is known to be induced in response to wound and Diatraea saccharalis damage. Although the recombinant SUGARWIN protein does not affect insect development, it promotes significant morphological and physiological changes in Fusarium verticillioides and Colletotrichum falcatum, which lead to fungal cell death via apoptosis. In this study, we deepen our understanding of the role of SUGARWINs in plant defense and the molecular mechanisms by which these proteins affect fungi by elucidating their molecular targets. Our results show that SUGARWINs play an important role in plant defense against opportunistic pathogens. We demonstrated that SUGARWINs are induced by C. falcatum, and the induction of SUGARWINs can vary among sugarcane varieties. The sugarcane variety exhibiting the highest level of SUGARWIN induction exhibited a considerable reduction in C. falcatum infection. Furthermore, SUGARWIN1 exhibited ribonuclease, chitosanase, and chitinase activity, whereas SUGARWIN2 exhibited only chitosanase activity. This variable enzymatic specificity seems to be the result of divergent amino acid composition within the substrate-binding site.

Plant-insect-pathogen interactions: a naturally complex ménage à trois.

Under environmental conditions, plants are constantly exposed to a wide range of biotic interactions, which include insects, and pathogens. Usually scientists are tempted to study each association individually, which reduces the complexity of the interaction. This restricted view of the problem does not consider that plants are the ballroom in which a multitude of organisms are constantly interacting with each other affecting not only plant responses but also how one organism responds to the other. Plants attacked by insects and pathogens display profound physiological, morphological and chemical changes or adaptations that result in organism attraction or avoidance, depending on the species involved. Therefore, many researchers worldwide have decided to study this phenomenon in a more holistic view, integrating genetics, ecology and physiology to depict these complex interactions. In this review, we will discuss how plant infection by pathogens may affect insect behavior and vice-versa and how plants cope with these multitude of biotic stresses.

Sugarcane Serine Peptidase Inhibitors, Serine Peptidases, and Clp Protease System Subunits Associated with Sugarcane Borer (Diatraea saccharalis) Herbivory and Wounding.

Sugarcane's (Saccharum spp.) response to Diatraea saccharalis (F.) (Lepidoptera: (Crambidae) herbivory was investigated using a macroarray spotted with 248 sugarcane Expressed Sequence Tags (ESTs) encoding serine peptidase inhibitors, serine peptidases. and Clp protease system subunits. Our results showed that after nine hours of herbivory, 13 sugarcane genes were upregulated and nine were downregulated. Among the upregulated genes, nine were similar to serine peptidase inhibitors and four were similar to Bowman-Birk Inhibitors (BBIs). Phylogenetic analysis revealed that these sequences belong to a phylogenetic group of sugarcane BBIs that are potentially involved in plant defense against insect predation. The remaining four upregulated genes included serine peptidases and one homolog to the Arabidopsis AAA+ chaperone subunit ClpD, which is a member of the Clp protease system. Among the downregulated genes, five were homologous to serine peptidases and four were homologous to Arabidopsis Clp subunits (three homologous to Clp AAA+ chaperones and one to a ClpP-related ClpR subunit). Although the roles of serine peptidase inhibitors in plant defenses against herbivory have been extensively investigated, the roles of plant serine peptidases and the Clp protease system represent a new and underexplored field of study. The up- and downregulated D. saccharalis genes presented in this study may be candidate genes for the further investigation of the sugarcane response to herbivory.

The sugarcane defense protein SUGARWIN2 causes cell death in Colletotrichum falcatum but not in non-pathogenic fungi.

Plants respond to pathogens and insect attacks by inducing and accumulating a large set of defense-related proteins. Two homologues of a barley wound-inducible protein (BARWIN) have been characterized in sugarcane, SUGARWIN1 and SUGARWIN2 (sugarcane wound-inducible proteins). Induction of SUGARWINs occurs in response to Diatraea saccharalis damage but not to pathogen infection. In addition, the protein itself does not show any effect on insect development; instead, it has antimicrobial activities toward Fusarium verticillioides, an opportunistic fungus that usually occurs after D. saccharalis borer attacks on sugarcane. In this study, we sought to evaluate the specificity of SUGARWIN2 to better understand its mechanism of action against phytopathogens and the associations between fungi and insects that affect plants. We used Colletotrichum falcatum, a fungus that causes red rot disease in sugarcane fields infested by D. saccharalis, and Ceratocystis paradoxa, which causes pineapple disease in sugarcane. We also tested whether SUGARWIN2 is able to cause cell death in Aspergillus nidulans, a fungus that does not infect sugarcane, and in the model yeast Saccharomyces cerevisiae, which is used for bioethanol production. Recombinant SUGARWIN2 altered C. falcatum morphology by increasing vacuolization, points of fractures and a leak of intracellular material, leading to germling apoptosis. In C. paradoxa, SUGARWIN2 showed increased vacuolization in hyphae but did not kill the fungi. Neither the non-pathogenic fungus A. nidulans nor the yeast S. cerevisiae was affected by recombinant SUGARWIN2, suggesting that the protein is specific to sugarcane opportunistic fungal pathogens.

Manejo das alterações glicêmicas em pacientes com síndrome coronariana aguda: programa educativo para enfermeiros / Management of glucose in patients with acute coronary syndrome: an educational program for nurses

A pesquisa, de natureza qualitativa, teve como objetivos implementar e avaliar uma intervenção educativa para enfermeiros voltada ao reconhecimento precoce e manejo das alterações glicêmicas em pacientes com diagnóstico de síndrome coronariana aguda e identificar o número de inclusões de pacientes ao protocolo hospitalar de tratamento das alterações glicêmicas antes e após intervenção educativa aplicada aos Enfermeiros. Foi realizada em duas Etapas. A Etapa Um (De Investigação) consistiu na identificação dos participantes da pesquisa, no manejo do diabetes e do protocolo de tratamento hospitalar. A Etapa Dois consistiu na Implementação e Avaliação do Programa Educativo (PE) para enfermeiros, que foi desenvolvido em três fases: reconhecimento dos sujeitos e mobilização afetiva; discussão de casos clínicos com foco na problematização e retomada de situações clínicas vivenciadas; mobilização de conceitos e avaliação do Programa Educativo. O PE foi estruturado com base em métodos psicodramáticos e no referencial problematizador de Paulo Freire. Participaram do PE todos os 14 enfermeiros da Unidade Coronariana do Hospital Israelita Albert Einstein, em São Paulo, sendo resguardados os preceitos éticos de desenvolvimento de pesquisas. Os resultados evidenciaram grupo de participantes jovem, com experiências profissionais variadas. A análise de conteúdo das respostas aos questionários aplicados na Etapa Um e na Fase três da Etapa Dois permitiu seis categorias: Conhecimento, Manifestações Clínicas, Raciocínio Clínico, Tomada de Decisão, Manejo das alterações glicêmicas e intervenções de Enfermagem. Após aplicação do PE em todas as categorias houve a inserção de novos elementos com maior destaque ao aprofundamento dos aspectos relacionados à fisiopatologia, aos sinais e sintomas e às complicações agudas;maior preocupação com a identificação precoce de situações predisponentes a eventos de hipoglicemia; maior consistência na descrição das ações contempladas no protocolo institucional de tratamento principalmente em relação à dose e à frequência das insulinas utilizadas. As cenas dramatizadas nas fases um e três e a discussão dos casos clínicos promoveram grande interação e confiança no grupo e agregação de conceitos. O número de inclusões de pacientes no protocolo hospitalar de tratamento no trimestre que antecedeu a implementação do programa educativo foi de um enquanto que no trimestre posterior ao PE foram de três. Os participantes atribuíram conceitos de excelentes e bons ao conteúdo, à metodologia, ao desempenho da instrutora, à participação, às expectativas, aos recursos e objetivos do PE. O estudo abre perspectivas para utilização de novas estratégias educativas para o desenvolvimento de profissionais de saúde com foco na atenção aos indivíduos com doença crônica.

The research was qualitative, aimed to implement and evaluate an educational intervention for nurses aimed at early recognition and management of glucose in patients with acute coronary syndrome and identify the number of inclusions of patients to hospital protocol for treatment of changes glucose before and after educational intervention applied to nurses was carried out in two steps. Step A (Investigation) involved the identification of research participants in the management of diabetes and treatment protocol hospital. Step Two was the Implementation and Evaluation of Educational Program (EP) for nurses, which was developed in three stages: recognition of subjects and affective mobilization, clinical case discussions focusing on questioning and resumption of clinical situations experienced, mobilizing concepts and evaluation of the educational program. The EP was structured based on Puschel and Psychodramatic methods and problem-solving framework of Paulo Freire. EP participated all 14 nurses of the Coronary Care Unit of Hospital Israelita Albert Einstein, Sao Paulo, being safeguarded the ethical development of research. The results showed group of young participants with varied professional experiences. A content analysis of responses to questionnaires applied in Step One and Step Two Phase Three possible to build six categories: Knowledge, Clinical Manifestations, Clinical Reasoning, Decision Making, Management of glucose and Nursing Interventions.After application of PE in all categories was the insertion of new elements, most notably the deepening of the aspects related to the pathophysiology, signs and symptoms and the acute complications; biggest concern with the early identification of conditions predisposing to nocturnal hypoglycemia; greater consistency in the description of the actions contemplated in institutional treatment protocol especially in relation to the dose and frequency of insulin used. Dramatized scenes in phases one and three and the discussion of clinical cases promoted great interaction and confidence in the group and aggregation concepts. The number of inclusions of patients in hospital protocol treatment in the quarter prior to the implementation of the educational program was a while later in the quarter to PE were three. Participants attributed concepts of good and excellent content, methodology, instructor performance, participation, expectations, resources and objectives of the EP, the study opens new perspectives for the use of educational strategies for the development of health professionals with focus on attention to individuals with chronic disease.

Sugarwin: a sugarcane insect-induced gene with antipathogenic activity.

In sugarcane fields, colonization of the stalk by opportunistic fungi usually occurs after the caterpillar Diatraea saccharalis attacks the sugarcane plant. Plants respond to insect attack by inducing and accumulating a large set of defense proteins. Two homologues of a barley wound-inducible protein (BARWIN), sugarcane wound-inducible proteins SUGARWIN1 and SUGARWIN2, have been identified in sugarcane by an in silico analysis. Antifungal properties have been described for a number of BARWIN homologues. We report that a SUGARWIN::green fluorescent protein fusion protein is located in the endoplasmic reticulum and in the extracellular space of sugarcane plants. The induction of sugarwin transcripts occurs in response to mechanical wounding, D. saccharalis damage, and methyl jasmonate treatment. The accumulation of transcripts is late induced and is restricted to the site of the wound. Although the transcripts of sugarwin genes were strongly increased following insect attack, the protein itself did not show any effect on insect development; rather, it altered fungal morphology, leading to the apoptosis of the germlings. These results suggest that, in the course of evolution, sugarwin-encoding genes were recruited by sugarcane due to their antipathogenic activity. We rationalize that sugarcane is able to induce sugarwin gene expression in response to D. saccharalis feeding as a concerted plant response to the anticipated invasion by the fungi that typically penetrate the plant stalk after insect damage.

Formação acadêmica em Educação Física: “Corpos” (Docente e Discente) de conhecimentos fragmentados / The academic formation in Physical Education: Students and professors (bodies) of fragmented knowledge

Neste estudo objetivou-se averiguar como graduandos e professores universitários conceituam corpo no tempo presente, tendo como referência o currículo em Educação Física. Realizou-se revisão bibliográfica referente à história do corpo e currículo. Investigaram-se 28 alunos ingressantes, 33 alunos concluintes e 11 professores universitários de um curso de Licenciatura em Educação Física de uma Instituição Pública, do interior do Estado de São Paulo. Constataram-se as vertentes: genérica, dualismo-psicofísico, cartesiana, biológica, segmentada-integradora e ser integral. Evidenciou-se um arcabouço conceitual limitado, com preponderância das ciências naturais em detrimento dos conhecimentos das ciências humanas, de que corpos expressam também configurações históricas e sociais. Constatou-se que os “corpos fragmentados...” consubstancia o pensamento hegemônico de um corpo docente que não apresenta definição conceitual e consensual em termos de projeto pedagógico da graduação.

This work intended to analyze how graduation students and Physical Education professors definethe “body” nowadays, having the curriculum in physical education as a reference. A bibliographical review regarding the history of the body and curriculum was carried out. 28 freshmen students, 33 senior studentsand 11 professors in and undergraduate course of Physical Education of a Public Institution in the state of São Paulo were investigated. The following categories were found: generic, dualism-psychophysical, cartesian, biological, segmented-integrated and integral being. A limited conceptual framework was evidenced, with a preponderance of natural sciences in detriment of knowledge of the humanity science, that the body also expresses historical and social settings. It was verified that the "fragmented bodies..."represents the hegemonic thought of a faculty that does not present a conceptual and consensual definitionin terms of pedagogical project of graduation.

Impacto dos transtornos depressivos e ansiosos sobre as manifestações da menopausa / Impact of depressive and anxiety disorders over menopause manifestations

OBJETIVO: Determinar, pela primeira vez, em uma amostra ambulatorial brasileira, o impacto dos diagnósticos psiquiátricos sobre os sintomas da menopausa presentes no índice de menopausa de Blatt-Kupperman (B-K). MÉTODOS: Avaliamos consecutivamente, através do instrumento diagnóstico estruturado MINI 4.4 e da entrevista psiquiátrica tradicional, mulheres (n = 86) em atendimento no ambulatório de menopausa do Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. As pacientes incluídas no estudo (n = 48) foram avaliadas pela escala B-K até 6 meses antes ou depois da entrevista pelo MINI e divididas em dois grupos: o grupo com algum transtorno depressivo-ansioso (GTDA) (n = 26) e o grupo-controle (GC) (n = 22). RESULTADOS: O GTDA apresentou uma pontuação significativamente maior do que o GC na escala de B-K (22,6 versus 13,7). Entre os sintomas significativamente mais intensos no GTDA estão parestesia e melancolia. Além disso, observamos que as pacientes do GTDA queixavam-se de um maior número de sintomas do que as pacientes do GC (6,8 vs. 4,8). Entre os sintomas significativamente mais relatados no GTDA, estão parestesia, fraqueza e melancolia. CONCLUSÃO: Apesar da limitação da pequena amostra, pudemos observar o significativo viés dos transtornos depressivos e ansiosos sobre as pacientes em tratamento por queixas referentes à menopausa. Por esse motivo, o perfil sintomático de cada paciente deve ser sempre observado, evitando o ginecologista basear-se na intensidade global dos sintomas do B-K para decidir sobre o tratamento.

OBJECTIVE: To establish for the first time in a Brazilian outpatient sample the impact of depressive and anxiety disorders over the symptoms of the Blatt-Kupperman menopausal index (B-K). METHODS: Women (n = 86) receiving care in the menopause clinic at Instituto de Ginecologia da Universidade Federal do Rio de Janeiro were consecutively assessed using a structured diagnostic instrument (MINI 4.4) and a traditional psychiatric interview. Patients included in the study (n = 48) were assessed using the B-K scale within 6 months before or after the MINI. The total sample was divided into the anxiety and depressive disorder group (GTDA) (n = 26) and the control group (CG) (n = 22). RESULTS: B-K total scores were greater in the GTDA comparing with the CG (22.6 vs. 13.7). Paresthesia and melancholia were significantly more severe in the GTDA. GTDA patients also complained of a greater number of symptoms (6.8 vs. 4.8) than the GC. Paresthesia, weakness and melancholia were significantly more present in the GTDA. CONCLUSION: Although the small sample limitation we could observe a great bias of depressive and anxiety disorders over menopause outpatients. For that reason, the symptomatic profile of each patient must always be observed by the gynecologist, avoiding exclusive observation of B-K total score to decide about the treatment.

Depressão maior e supressão hormonal: resposta com a nortriptilina / Major depression and hormone suppression: response with nortriptiline

CONTEXTO: A relevância da descrição deste caso clínico é demonstrar a importância do uso de nortriptilina em um caso de depressão maior pós-tratamento para endometriose. OBJETIVO: Demonstrar as relações entre o tratamento para endometriose e os transtornos psiquiátricos e o resultado terapêutico que obtivemos com o uso da nortriptilina. MÉTODOS: Entrevista psiquiátrica e avaliação clínica psiquiátrica periódica de uma paciente em tratamento no ambulatório do Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. RESULTADOS: Mulher de 25 anos que, após início de supressão hormonal com goserelina para o tratamento da endometriose, passou a apresentar sintomatologia depressiva e ansiosa proeminente. Sem melhora com o uso de 20 mg/dia de fluoxetina por 8 semanas, foram prescritos 25 mg/dia de nortriptilina com boa resposta clínica em 2 semanas, mantendo a melhora depois de 16 semanas. CONCLUSÃO: Apesar de apenas a sertralina ter sua eficácia demonstrada na melhora dos sintomas depressivos associados à supressão ovariana, neste caso a nortriptilina demonstrou-se eficaz. Observamos a necessidade de estudos crescentes na área a fim de avaliar outras opções terapêuticas.

BACKGROUND: The relevance of this clinical case report is to emphasize the importance of the use of nortryptiline for major depression after endometriosis treatment. OBJECTIVE: To describe by a case report the relationship between treatment for endometriosis and psychiatric disorders. We will also describe the therapeutic response to nortriptyline. METHODS: Psychiatric interview and periodical clinical psychiatric evaluation for the treatment of a patient in the Outpatient Unit of the Institute of Psychiatry of the Federal University of Rio de Janeiro. RESULTS: An outpatient, fifty-five year-old woman with major depression treated in the Psychiatric Institute of Federal University of Rio de Janeiro. She was being treated for endometriosis with goserelin for hormone suppression when she started to complain of depressive and anxiety symptoms. The patient did not improve with 20 mg/day of fluoxetine for 8 weeks. She improved after 2 weeks using 25 mg/day of nortryptiline. The improvement persisted during our 16 weeks follow-up. CONCLUSION: Although only sertraline has its efficacy demonstrated for depressive symptoms associated with ovarian suppression, in this case nortriptyline was efficient too. We observed the necessity of more studies about this topic in order to better evaluate other therapeutic options.

Estudo bibliográfico de publicações sobre a atividade administrativa da enfermagem em saúde mental / Bibliographic study on publications concerning nursing management activities in mental health services

0bjetivando estudar a atividade administrativa do enfermeiro em saúde mental enquanto um instrumento do processo de trabalho, realizamos um estudo bibliográfico de publicações de enfermagem sobre esta temática no período de 1988 a 1997. Através da leitura e análise crítica de 8 artigos e 19 dissertações e teses selecionadas, identificamos as principais características dessa prática, quais sejam: os enfermeiros são os responsáveis pela equipe e assistência de enfermagem, obedecendo à lógica determinada pela instituição; suas ações não são planejadas, coordenadas e avaliadas; as atividades administrativas utilizam a maior parte de seu tempo de trabalho e o cuidado direto de enfermagem é realizado pela equipe auxiliar de enfermagem, sendo que nos serviços extra--hospitalares os atendimentos diretos e grupais são mais freqüentes

Técnica do copinho: uma alternativa para evitar o desmame precoce / The cup technique: an alternative to avoid early weaning

Apesar da vasta literatura disponível sobre práticas de aleitamento materno, o enfoque dado às técnicas alternativas de alimentaçäo que evitem o desmame precoce, principalmente em neonatos prematuros tem sido bastante restrito. Objetivou-se neste estudo averiguar em domicílio se o recém-nascido prematuro que fez uso da técnica do copinho em Unidade neonatal para ser alimentado, estava sendo amamentado no peito. O instrumento para a coleta dos dados do estudo, compreendeu a entrevista estruturada a qual foi composto de duas partes, a seguir: a primeira com dados pessoais do binômio mäe/filho, sendo coletados esses dados ainda na instituiçäo hospitalar, a segunda, coletada no momento da visita domiciliar, totalizando 33 neonatos. Os resultados demonstraram que a maioria eram prematuros moderados, com peso entre 2000 a 2499 g, sendo que 70 por cento estavam senso alimentados somente no seio materno no dia da visita domiciliar. Quanto as orientaçöes sobre cuidados domiciliar com os recém-nascidos, prevaleceram as oferecidas pela enfermagem. Como conclusäo apresentamos que a técnica do copinho é de extrema importância e eficaz para evitar o desmame precoce, esfôrço da equipe de enfermagem em executá-la, treinar os funcionários para realizá-la, conscientizar a equipe quanto ao incentivo e importância do aleitamento materno principalmente para os recém-nascidos prematuros está valendo a pena, pois 70 por cento dos neonatos prematuros que compuseram o estudo estäo sendo amamentados no peito