Planetary Health and Health Education in Brazil: Towards Better Trained Future Health Professionals.

Brazil is Latin America's largest country and has a strong economy, but it is also characterised by many inequalities. These are very conspicuous in the health sector, particularly in health education, which is expected to modernise according to the planetary health (PH) perspective. This paper describes the health education scenario in Brazil and undertakes an analysis of the postgraduate health programmes and policies in place, identifying the extent to which these support the cause of PH. To achieve this goal, this paper deploys a bibliometric analysis to gain a better understanding of the research streams related to higher education and PH. In addition, it presents and discusses selected case studies in the field and cross-checks documents from the Brazilian Ministry of Education against five domains of PH in education. The results indicate that despite some progress to date and the fact that some programmes are in place, there is a perceived need for policies and efforts from education organisations towards connecting PH principles in the education of current and future health professionals.

Sementes lançadas em terras distantes: a garantia do direito à assistência social para a população rural / Seeds thrown in distant lands: guaranteeing the right to social assistance for the rural population

O artigo aborda a (in)visibilidade do rural na garantia do direito à assistência social, por meio de uma investigação orientada pelo Materialismo Histórico Dialético, que analisou a Constituição Federal de 1988, a Lei Orgânica de Assistência Social (LOAS), de 1993, a Política Nacional de Assistência Social (PNAS) e as Normas de Operação Básica da Assistência Social (NOB-SUAS), aprovadas respectivamente em 2004 e 2012, e entrevistou profissionais e usuários do Sistema Único de Assistência Social. O presente estudo revela que o direito à assistência social para a população rural vem se constituindo de modo insuficiente, uma vez que a precarização da política de assistência social, sob a égide do neoliberalismo, se intensifica no rural, além da (in)visibilidade do rural, enquanto um fenômeno pluridimensional, uma vez que a classe trabalhadora que vive no rural encontra-se nessa relação contínua entre invisibilidade e visibilidade, em processos dialeticamente simultâneos

The article addresses the (in) visibility of the rural in guaranteeing the right to social assistance, through an investigation guided by Dialectical Historical Materialism, which analyzed the Federal Constitution of 1988, the Organic Law of Social Assistance (LOAS), of 1993, the National Social Assistance Policy (PNAS) and the Basic Social Assistance Operation Standards (NOB-SUAS), approved respectively in 2004 and 2012, and interviewed professionals and users of the Unified Social Assistance System. The present study reveals that the right to social assistance for the rural population has been insufficiently constituted, since the precariousness of the social assistance policy, under the aegis of neoliberalism, intensifies in the rural area, besides the (in) visibility of the rural population. rural, as a multidimensional phenomenon, since the working class that lives in rural are in this continuous relation between invisibility and visibility, in dialectically simultaneous processes

Dinâmica musical na sensibilização dos acadêmicos de enfermagem frente aos cuidados paliativos em oncologia pediátrica / Musical dynamics in the sensitization of nursing students in the face of palliative care in pediatric oncology

Objective: To analyze the applicability of musical dynamics for nursing students in respect to palliative care in pediatric oncology. Methods: A qualitative research using the creative and sensitive method was developed in 2016 in the School of Nursing of a federal university in Rio de Janeiro. 'Musical Body' dynamics was used with ten students in the last year of the graduation course with data being submitted to thematic analysis. Results: The dynamics favored reflection on coping strategies and improving the care provided to children besides reinvigorating the healthcare team. It prompted reflection on empathy, unpreparedness and lack of opportunity to experience pediatric oncology and mourning and was thus an approximation to practical experience. Participants emphasized the possibility of using musical dynamics in the professional setting. Conclusion: Musical dynamics proved to be a useful strategy to sensitize nursing students about palliative care in pediatric oncology.

Objetivo: Analizar la aplicabilidad de la dinámica musical en la sensibilización de académicos de Enfermería frente a los cuidados paliativos en oncología pediátrica. Métodos: Investigación cualitativa con Método Creador y Sensible, desarrollado en 2016 en la Escuela de Enfermería de una Universidad Federal de Rio de Janeiro. Realizada dinámica cuerpo-musical con diez académicos del último período de la graduación; datos sometidos al análisis temático. Resultados: La dinámica favoreció la reflexión sobre estrategias de enfrentamiento y mejora del servicio al niño, además de revigorizar el equipo de salud. Movilizó la reflexión sobre empatía, falta de preparación y de oportunidad para vivir la oncología pediátrica y el luto, siendo el mismo una forma de acercamiento con la práctica. Los participantes dieron énfasis al uso de la dinámica musical en la práctica profesional. Conclusión: La dinámica musical ha demostrado ser una estrategia apropiada para la sensibilización en los cuidados paliativos en oncología pediátrica.

Objetivo: Analisar a aplicabilidade da dinâmica musical na sensibilização de acadêmicos de enfermagem frente aos cuidados paliativos em oncologia pediátrica. Métodos: Pesquisa qualitativa com Método Criativo e Sensível, desenvolvida em 2016, na Escola de Enfermagem de uma Universidade Federal localizada no Rio de Janeiro. Realizada dinâmica corpo-musical com dez acadêmicos do último período da graduação. Dados submetidos à análise temática. Resultados: A dinâmica favoreceu a reflexão sobre estratégias de enfrentamento e melhoria do atendimento à criança, além de revigorar a equipe de saúde. Mobilizou a reflexão sobre empatia, despreparo e falta de oportunidade para vivenciar a oncologia pediátrica e o luto, sendo a mesma uma forma de aproximação com a prática. Levantou-se ainda a possibilidade do seu uso na prática profissional. Conclusão: A dinâmica musical demonstrou ser uma estratégia adequada para sensibilização dos acadêmicos de enfermagem para cuidados paliativos em oncologia pediátrica.

Metaplastic squamous cell carcinoma of the breast: A case report and literature review.

Metaplastic tumors are rare and represent a heterogeneous group of neoplasms showing dominant areas of non-glandular differentiation. Etiology and pathogenesis of this type of lesion in the breast is uncertain. The most common sources of metastatic squamous cell carcinoma of the breast are lung, esophagus, cervix, and urinary bladder. Squamous cell carcinomas may present clinically with inflammation and average size greater than breast adenocarcinoma. As for imaging studies, mammography shows no typical findings and ultrasound can show a complicated cyst or an inflammatory process, among the differential diagnoses. Therefore, knowing this pathological entity, its clinical course and imaging findings is important to safely treat such a rare and aggressive disease. We herein report a case of metaplastic carcinoma, squamous subtype, diagnosed by core needle biopsy.

Metaplastic squamous cell carcinoma of the breast: A case report and literature review / Carcinoma metaplásico espinocelular da mama: relato de caso e revisão da literatura

Summary Metaplastic tumors are rare and represent a heterogeneous group of neoplasms showing dominant areas of non-glandular differentiation. Etiology and pathogenesis of this type of lesion in the breast is uncertain. The most common sources of metastatic squamous cell carcinoma of the breast are lung, esophagus, cervix, and urinary bladder. Squamous cell carcinomas may present clinically with inflammation and average size greater than breast adenocarcinoma. As for imaging studies, mammography shows no typical findings and ultrasound can show a complicated cyst or an inflammatory process, among the differential diagnoses. Therefore, knowing this pathological entity, its clinical course and imaging findings is important to safely treat such a rare and aggressive disease. We herein report a case of metaplastic carcinoma, squamous subtype, diagnosed by core needle biopsy.

Resumo Os tumores metaplásicos são raros e representam um grupo heterogêneo de neoplasias que mostram áreas dominantes de diferenciação não glandular. A etiologia e patogenia desse tipo de lesão na mama é incerta. As causas mais comuns de carcinoma metastático de células escamosas na mama são o pulmão, o esôfago, o colo uterino e a bexiga urinária. Os carcinomas espinocelulares podem apresentar-se clinicamente com inflamação e tamanho médio maior do que o do adenocarcinoma da mama. A mamografia não apresenta achados típicos, e a ultrassonografia pode mostrar um cisto complicado ou um processo inflamatório, entre os diagnósticos diferenciais. Conhecer essa entidade patológica, seu curso clínico e os achados de imagem é importante para um manejo seguro, pois trata-se de entidade rara e agressiva. Este trabalho relata um caso de carcinoma metaplásico, subtipo espinocelular, diagnosticado por biópsia com agulha grossa.

Time to blood culture positivity as a predictor of clinical outcome in patients with Candida albicans bloodstream infection.

BACKGROUND: Few studies have assessed the time to blood culture positivity as a predictor of clinical outcome in fungal bloodstream infections (BSIs). The purpose of this study was to evaluate the time to positivity (TTP) of blood cultures in patients with Candida albicans BSIs and to assess its impact on clinical outcome. METHODS: A historical cohort study with 89 adults patients with C. albicans BSIs. TTP was defined as the time between the start of incubation and the time that the automated alert signal indicating growth in the culture bottle sounded. RESULTS: Patients with BSIs and TTPs of culture of ≤ 36 h (n=39) and >36 h (n=50) were compared. Septic shock occurred in 46.2% of patients with TTPs of ≤ 36 h and in 40.0% of patients with TTP of >36 h (p=0.56). A central venous catheter source was more common with a BSI TTP of ≤ 36 h (p=0.04). Univariate analysis revealed that APACHE II score ≥ 20 at BSI onset, the development of at least one organ system failure (respiratory, cardiovascular, renal, hematologic, or hepatic), SOFA at BSI onset, SAPS II at BSI onset, and time to positivity were associated with death. By using logistic regression analysis, the only independent predictor of death was time to positivity (1.04; 95% CI, 1.0-1.1, p=0.035), with the chance of the patient with C. albicans BSI dying increasing 4.0% every hour prior to culture positivity. CONCLUSION: A longer time to positivity was associated with a higher mortality for Candida albicans BSIs; therefore, initiating empiric treatment with antifungals may improve outcomes.

Carcinoma epitelial-mioepitelial de parótida / Epithelial-myoepithelial carcinoma of the parotid gland

O carcinoma epitelial-mioepitelial (CEM) é uma rara neoplasia das glândulas salivares correspondendo a 1% destas. Relatamos o caso de um paciente masculino, 39 anos, com massa indolor de crescimento lento na glândula parótida direita. O histopatológico demonstrou uma neoplasia bifásica constituída por células epiteliais e mioepiteliais. A imunoistoquímica foi positiva para vimentina, AE1AE3, p63, actina de músculo liso e proteína S100, confirmando o diagnóstico de CEM. A maioria dos casos origina-se na parótida (60%), no sexo feminino (2:1) e na 6ª década de vida. A sobrevida média em cinco anos é 80% e a taxa de recidiva local até 40%.

Epithelial-myoepithelial carcinoma (EMC) of the salivary glands is a rare neoplasm accounting for only 1% of all salivary glands tumors. We report a 39-year-old man who presents a painless mass with a slowly growing involving a right parotid salivary gland. The histologic findings showed a biphasic cytomorphology containing epithelial and myoepithelial cells. Immunohistochemistry was positivity for vimentin, AE1AE3, p63, smooth muscle actin and S100 protein, who confirms a EMC diagnosis. The tumor most commonly involved the parotid gland (60%), female predominance (2:1) with a peak occurrence in the sixth decade. The average survivor in five years is 80% and the recurrence local rate until 40%.