A linha tênue entre a promoção da saúde e a reprodução de discursos gordofóbicos pelos médicos / The fine line between health promotion and the reproduction of fatphobic speech by doctors

Resumo: Introdução: O controle do peso corporal é fundamental para o tratamento e a prevenção das principais comorbidades no mundo, tais como hipertensão, dislipidemia e obesidade. Entretanto, as orientações médicas referentes à perda de peso, muitas vezes, não são baseadas em evidências ou comunicadas de maneira clara, e também não consideram as condições psicológicas e sociais dos pacientes, como ditam os valores da promoção da saúde, mas são abordadas de maneira preconceituosa e rasa. Este estudo busca responder à seguinte questão: "A maneira como os médicos lidam com a obesidade dos seus pacientes é uma forma de promover saúde ou de propagar ainda mais desfechos clínicos desfavoráveis nessa população?". Objetivo: Este estudo teve como objetivo revisar a literatura no que concerne à gordofobia médica e aos seus impactos para o paciente. Método: Trata-se de uma revisão de literatura integrativa, realizada em janeiro de 2022. A busca de dados se deu a partir do ano de 2007 até janeiro de 2022. Usaram-se as seguintes bases de dados: SciELO, Lilacs e PubMed. Utilizaram-se, na busca de artigos, os seguintes descritores: obesity, overweight, social stigma, social discrimination, bullying, fatphobia, weight bias, medication adherence, therapeutic alliance, health professionals, binge-eating disorder. Resultado: Os 16 artigos selecionados foram classificados segundo tipo de estudo, ano, local, público-alvo e resultados, e, em seguida, analisados de maneira crítica. Conclusão: Embora seja crucial os médicos alertarem seus pacientes sobre perda de peso, essas orientações, quando feitas de maneira preconceituosa, grosseira e sem metas bem definidas, fazem com que o paciente se desinteresse em cuidar da própria saúde ou ainda procure perder peso sem apoio profissional. Logo, em vez de combater a obesidade, o atual manejo é responsável por agravá-la e, inclusive, desenvolver outras comorbidades, como a depressão.

Abstract: Introduction: Body weight control is essential for the treatment and prevention of the main comorbidities in the world, such as hypertension, dyslipidemia and obesity. However, medical guidelines regarding weight loss are often not evidence-based or clearly communicated, and they also do not take into account the psychological and social conditions of patients, as dictated by the values of health promotion, but rather, approached in a prejudiced and shallow way. This study seeks to answer the following question: Is the manner physicians deal with their patients' obesity a way of promoting health or of propagating even more unfavorable clinical outcomes in this population? Objective: This study aimed to review the literature regarding medical fatphobia and its impacts on the patient. Method: This is an integrative literature review, carried out in January 2022. The data search took place from the year 2007 to January 2022. The following databases were used: SciELO, Lilacs and PubMed. The following descriptors were used in the search for articles: Obesity, Overweight, Social Stigma, Social Discrimination, Bullying, Fatphobia, Weight Bias, Medication Adherence, Therapeutic Alliance, Health Professionals, Binge-Eating Disorder. Result: The 16 selected articles were classified according to type of study, year, place, target audience and results, and then critically analyzed. Conclusion: Although it is crucial for doctors to warn their patients about weight loss, these guidelines, when made in a prejudiced, rude way and without well-defined goals, make them not interested in taking care of their own health, or even trying to lose weight without professional support. Therefore, instead of fighting obesity, its current management is responsible for aggravating it and even developing other comorbidities, such as depression.

Hierarchical effects of historical and environmental factors on lizard assemblages in the upper Madeira River, Brazilian Amazonia.

Investigating the role of historical and ecological factors structuring assemblages is relevant to understand mechanisms and processes affecting biodiversity across heterogeneous habitats. Considering that community assembly often involves scale-dependent processes, different spatial scales may reveal distinct factors structuring assemblages. In this study we use arboreal and leaf-litter lizard abundance data from 83 plots to investigate assemblage spatial structure at two distinct scales in southwestern Brazilian Amazonia. At a regional scale, we test the general hypothesis that the Madeira River acts as a barrier to dispersal of some lizard species, which results in distinct assemblages between river banks. At a local scale, we test the hypothesis that assemblages are not evenly distributed across heterogeneous habitats but respond to a continuum of inadequate-to-optimal portions of environmental predictors. Our results show that regional lizard assemblages are structured by the upper Madeira River acting as a regional barrier to 29.62% of the species sampled. This finding suggests species have been historically isolated at one of the river banks, or that distinct geomorphological features influence species occurrence at each river bank. At a local scale, different sets of environmental predictors affected assemblage composition between river banks or even along a river bank. These findings indicate that environmental filtering is a major cause of lizard assemblage spatial structure in the upper Madeira River, but predictor variables cannot be generalized over the extensive (nearly 500 km) study area. Based on a single study system we demonstrate that lizard assemblages along the forests near the banks of the upper Madeira River are not randomly structured but respond to multiple factors acting at different and hierarchical spatial scales.

Phase transition and electronic structure investigation of MoS2-reduced graphene oxide nanocomposite decorated with Au nanoparticles.

In this work a simple approach to transform MoS2 from its metallic (1T' to semiconductor 2H) character via gold nanoparticle surface decoration of a MoS2 reduced graphene oxide (rGO) nanocomposite is proposed. The possible mechanism to this phase transformation was investigated using different spectroscopy techniques, and supported by density functional theory theoretical calculations. A mixture of the 1T'- and 2H-MoS2 phases was observed from the Raman and Mo 3d high resolution x-ray photoelectron spectra analysis in the MoS2-rGO nanocomposite. After surface decoration with gold nanoparticles the concentration of the 1T' phase decreases making evident a phase transformation. According to Raman and valence band spectra analyzes, the Au nanoparticles (NPs) induce a p-type doping in MoS2-rGO nanocomposite. We proposed as a main mechanism to the MoS2 phase transformation the electron transfer from Mo 4d xy,xz,yz in 1T' phase to AuNPs conduction band. At the same time, the unoccupied electronic structure was investigated from S K-edge near edge x-ray absorption fine structure spectroscopy. Finally, the electronic coupling between unoccupied electronic states was investigated by the core hole clock approach using resonant Auger spectroscopy, showing that AuNPs affect mainly the MoS2 electronic states close to Fermi level.

Luxação extrusiva de um incisivo central Permanente jovem: relato de caso clínico / Extrusive luxation of an immature permanent central incisor: clinical case report

Objetivo: O objetivo deste artigo é apresentar o relato de um caso clínico de luxação extrusiva de dente permanente com rizogênese incompleta, onde não foi necessária a realização de intervenção endodôntica. Relato de caso: Paciente de 6 anos de idade compareceu ao serviço de urgência da Policlínica Odontológica da Universidade do Estado do Amazonas (UEA) para atendimento após queda durante atividade de lazer, apresentando traumatismo direto na boca. Foi informado durante a consulta inicial que o incidente havia ocorrido há cerca de três dias, e que o atendimento imediato logo após o trauma foi realizado em um Serviço de Pronto Atendimento, porém, nenhum tipo de procedimento na cavidade oral foi realizado. Após exames clínico e radiográfico observou-se que o dente 21 apresentava deslocamento parcial para fora do alvéolo dentário no sentido axial, com alteração da oclusão, dor local à palpação e mobilidade dentária. Foi realizada profilaxia da área afetada, e anestesia do dente luxado e tecidos adjacentes. O reposicionamento do dente foi realizado em seguida, pressionando-o e tracionando-o de forma suave e contínua até a sua correta posição dentro do alvéolo. A área afetada foi limpa com gaze estéril embebida em soro fisiológico, e foi instalada uma contenção rígida confeccionada com fio ortodôntico e resina composta. Conclusão: O reposicionamento da maneira adequada do dente traumatizado dentro do alvéolo dentário, num período de tempo hábil, seguido de sua proservação, permitiram a manutenção da vitalidade do tecido pulpar, e consequentemente, o desenvolvimento do segmento radicular.

Objective: The objective of this article is to present a clinical case of extrusive luxation of an immature permanent tooth, with no endodontic management. Case report: A 6-year-old patient was provided to emergency treatment at the State University of Amazonas, as a result of a fall, with a direct trauma to the mouth. It was informed during the initial consultation that the incidente has occurred three days after. Emergency examination had been carried out by an Emergency Service; however, any type of procedure in the oral cavity was performed in ths occasion. After clinical and radiographic examinations, it was observed that tooth 21 presented partial displacement from the alveolar socket in the axial direction, with occlusion alteration, local pain to palpation and dental mobility. Cleaning of the affected area and anesthesia of the dislocated tooth and adjacent tissues were performed. Then, tooth repositioning was performed by pressing and tracing it smoothly and continuously until its correct position within the alveolar socket. The affected area was cleaned with sterile gauze soaked in saline solution, and a rigid containment made of orthodontic wire and composite resin was installed. Conclusion: A proper repositioning of the traumatized tooth within the alveolar socket, followed by its clinical followup, allowed the pulp tissue to remain vital, and consequently, the complete development of the root portion

Relatos médicos sobre formação acadêmica e trabalho na Estratégia de Saúde da Família / Medical reports on academic training and work in Family Health Strategy / Informes médicos acerca de la educación y trabajo en la Estrategia de Salud de la Familia

Objetivo: Analisar as percepções dos médicos atuantes na Estratégia de Saúde da Família de um município de médio porte no estado de Minas Gerais sobre a formação e atuação neste nível de atenção. Métodos: Trata-se de uma pesquisa de abordagem qualitativa, exploratória e descritiva, que avaliou o universo de significados, crenças, valores e atitudes dos participantes em relação ao tema. Os dados foram coletados mediante entrevista semiestruturada. Resultados: Foram realizadas 12 entrevistas com médicos de 11 unidades de saúde. Os sujeitos entrevistados relatam que os conhecimentos referentes à Estratégia de Saúde da Família no currículo da graduação foram satisfatórios e contribuíram com sua formação e atuação profissional. No entanto, a escolha pelo trabalho ainda aparece como um caminho facilitador para entrada na residência médica, principalmente por meio de programas governamentais. Conclusões: Ainda que a pesquisa tenha abordado os relatos de uma pequena parcela de médicos, a análise evidencia a importância da educação médica na sensibilização e capacitação em medicina de família e comunidade, bem como a ainda necessária valorização da carreira no nível primário de atenção. Estas temáticas permanecem no bojo das discussões quando se trata da consolidação desta estratégia no país.

Objective: To analyze the perception of physicians working in the Family Health Strategy of a medium-sized municipality in the state of Minas Gerais, about the training and work in this field of activity. Methods: This is a qualitative, exploratory and descriptive research, which addressed the universe of meanings, beliefs, values and attitudes of the participants towards the subject. Results: 12 interviews were conducted with physicians from 11 health units. The subjects interviewed report that the knowledge referring to the Family Health Strategy in their undergraduate curriculum was satisfactory and contributed to their professional training and performance. However, the choice of work still appears as a facilitating pathway to medical residency, mainly through government programs. Conclusions: Although the research has addressed the reports of a small number of physicians, the analysis highlights the importance of medical education in sensitizing and training for family and community medicine, as well as the still needed career enhancement in the primary care level. These topics remain in the heart of the discussions when it comes to the consolidation of this strategy in the country.

Objetivo: Analizar las percepciones de los médicos que trabajan en la Estrategia de Salud de la Familia de un municipio de tamaño medio en el estado de Minas Gerais, en la formación y trabajo en este nivel de atención. Métodos: Se trata de una investigación cualitativa, exploratoria y descriptiva, que abordó el universo de significados, creencias, valores y actitudes de los participantes en el tema. Resultados: Se realizaron 12 entrevistas con médicos de 11 unidades de salud. Los entrevistados informan que el conocimiento relativo a la Estrategia de Salud de la Familia en el plan de estudios de licenciatura fue satisfactorio y contribuyó a su formación y desempeño profesional. Sin embargo, la elección del trabajo continúa apareciendo como una forma facilitadora para la entrada en la residencia médica, principalmente a través de los programas de gobierno. Conclusiones: Aunque la investigación se ha ocupado de los informes de un pequeño porcentaje de los médicos, el análisis pone de relieve la importancia de la educación médica en la sensibilización y la formación en medicina familiar y comunitaria, así como la mejoría de la carrera sigue siendo necesaria a nivel de atención primaria, cuestiones que quedan en medio de discusiones cuando se trata de la consolidación de esta estrategia en el país.

Can salinity trigger cascade effects on streams? A mesocosm approach.

Human activities have greatly increased the salt concentration of the world's rivers, and this might be amplified by water scarcity in the future. While the lethal effects of salinity have been documented for a wide variety of stream invertebrates, the sub-lethal effects (i.e. changes in biological condition without mortality) are not deeply understood yet. One important sub-lethal effect that has yet to be investigated is changes in predation efficiency, which could trigger cascade effects associated to the abundance of herbivorous invertebrates that control algae biomass. In this study we combined the use of biomarkers with community-level data in a stream mesocosm to evaluate the potential cascade effect of increased salinity on the trophic food web. Both predation and salt treatments had an effect on the aquatic invertebrate abundance, richness and community composition. The presence of predators had a clear cascade effect, it reduced herbivorous invertebrate abundance and richness leading to higher chlorophyll a concentrations. The salt treatment significantly reduced taxa richness, but only in the gravel bed. The predators were significantly stressed by salt addition, as shown by the different analyzed biomarkers. Concordantly, in the presence of predators, Tanytarsini registered higher abundances and chlorophyll a showed a lower concentration when salt was added. However, none of these changes was significant. Therefore, although salt addition significantly stressed Dina lineata, our results suggest that a longer exposure time is needed to fully capture cascading effects (e.g. a decrease in chlorophyll a due to a relaxation of predation on herbivorous invertebrates). We suggest that the potential cascade effects of salinization need to be evaluated when addressing the impacts of water scarcity (as caused by climate change and increasing water demand) on river ecosystems, since flow reductions will lead to higher salt concentrations.

Escalada terapêutica: uma possibilidade de intervenção para crianças com paralisia cerebral / Therapeutic climbing: a possibility of intervention for children with cerebral palsy

A escalada terapêutica, uma adaptação da "Escalada Esportiva", pode promover melhoria da coordenação motora, do equilíbrio e resistência muscular. Objetivo: Avaliar o efeito dessa intervenção na força de preensão manual, controle postural, mobilidade funcional e controle da espasticidade de crianças com paralisia cerebral. Método: Estudo do tipo série de casos, descritivo, com 7 pacientes com idade de 9,6 ± 3,7 anos, que passaram por sessões de escalada terapêutica, 1 hora/sessão, duas vezes/semana. Resultados: Após 19 sessões foi verificado aumento de força na mão direita (p = 0,022) e melhoria do equilíbrio estático e da marcha (p = 0,007). Observou-se também melhora da mobilidade funcional (p = 0,014). O escore na escala Ashworth modificada mostrou controle eficiente da espasticidade, ainda que a diferença não tenha atingido significância estatística. Conclusão: A escalada terapêutica melhorou a força de preensão manual, o controle postural e a mobilidade funcional dos pacientes

Therapeutic climbing, an adaptation of sport climbing, can promote improvements in motor coordination, balance, and muscle endurance. Objective: The aim of this study was to evaluate the effects of this intervention on handgrip strength, postural control, functional mobility, and the spasticity control of children with cerebral palsy. Method: Case series study with 7 patients with a mean age of 9.6 ± 3.7 years, who took part in 1-hour sessions of therapeutic climbing twice a week. Results: After 19 sessions, there was an increase in handgrip strength of the right hand (p = 0.022) and improvement in static balance and gait (p = 0.007). Functional mobility also improved significantly (p = 0.014). The score on the Ashworth modified scale showed an efficient control of spasticity, although the difference has not reached statistical significance. Conclusion: Therapeutic climbing improved the handgrip strength, postural control, and functional mobility of patients