MicroRNA-92a-CPEB3 axis protects neurons against inflammatory neurodegeneration.

Neuroinflammation causes neuronal injury in multiple sclerosis (MS) and other neurological diseases. MicroRNAs (miRNAs) are important modulators of neuronal stress responses, but knowledge about their contribution to neuronal protection or damage during inflammation is limited. Here, we constructed a regulatory miRNA-mRNA network of inflamed motor neurons by leveraging cell type-specific miRNA and mRNA sequencing of mice undergoing experimental autoimmune encephalomyelitis (EAE). We found robust induction of miR-92a in inflamed spinal cord neurons and identified cytoplasmic polyadenylation element-binding protein 3 (Cpeb3) as a key target of miR-92a-mediated posttranscriptional silencing. We detected CPEB3 repression in inflamed neurons in murine EAE and human MS. Moreover, both miR-92a delivery and Cpeb3 deletion protected neuronal cultures against excitotoxicity. Supporting a detrimental effect of Cpeb3 in vivo, neuron-specific deletion in conditional Cpeb3 knockout animals led to reduced inflammation-induced clinical disability in EAE. Together, we identified a neuroprotective miR-92a-Cpeb3 axis in neuroinflammation that might serve as potential treatment target to limit inflammation-induced neuronal damage.

Detoxified castor seed meal replaces soybean meal in the supplement for Holstein-Zebu crossbred steers finished on tropical pasture during the rainy season.

The objective of this study was to examine the effect of replacing soybean meal (SBM) with detoxified castor seed meal (DCM) on the intake, digestibility, feeding behavior, and performance of pasture-finished (rainy season) steers supplemented with concentrate at 0.4% of their body weight. Forty ½ Holstein + ½ Zebu steers (initial weight: 283.3 ± 36.3 kg) were allocated to four treatments in a completely randomized experimental design. Treatments consisted of diets in which DCM replaced 0, 30, 60, and 90% of SBM in the supplement dry matter (DM). The steers were finished on an Urochloa brizantha pasture and the experiment lasted 112 days. Replacing SBM with DCM did not influence (P > 0.05) the intake or apparent digestibility of DM, crude protein, or neutral detergent insoluble fiber of the animals. Grazing time increased (P < 005), whereas the intake and rumination efficiencies of the steers did not change (P > 0.05) with the substitution. The replacement of SBM with DCM in the supplement fed to the steers also did not influence (P > 0.05) their final weight, average daily gain, or feed conversion (P > 0.05). We recommend replacing up to 90% (DM basis) of SBM with DCM in the concentrate supplement of steers grazing on Urochloa brizantha pasture during rainy season while supplemented with concentrate at 0.4% of their body weight.

Calcium channel ß3 subunit regulates ATP-dependent migration of dendritic cells.

Migratory dendritic cells (migDCs) continuously patrol tissues and are activated by injury and inflammation. Extracellular adenosine triphosphate (ATP) is released by damaged cells or actively secreted during inflammation and increases migDC motility. However, the underlying molecular mechanisms by which ATP accelerates migDC migration is not understood. Here, we show that migDCs can be distinguished from other DC subsets and immune cells by their expression of the voltage-gated calcium channel subunit ß3 (Cavß3; CACNB3), which exclusively facilitates ATP-dependent migration in vitro and during tissue damage in vivo. By contrast, CACNB3 does not regulate lipopolysaccharide-dependent migration. Mechanistically, CACNB3 regulates ATP-dependent inositol 1,4,5-trisphophate receptor-controlled calcium release from the endoplasmic reticulum. This, in turn, is required for ATP-mediated suppression of adhesion molecules, their detachment, and initiation of migDC migration. Thus, Cacnb3-deficient migDCs have an impaired migration after ATP exposure. In summary, we identified CACNB3 as a master regulator of ATP-dependent migDC migration that controls tissue-specific immunological responses during injury and inflammation.

The journey of cardosin A in young Arabidopsis seedlings leads to evidence of a Golgi-independent pathway to the protein storage vacuole.

The aspartic proteinase cardosin A is a vacuolar enzyme found to accumulate in protein storage and lytic vacuoles in the flowers and protein bodies in the seeds of the native plant cardoon. Cardosin A was first isolated several decades ago and has since been extensively characterized, both in terms of tissue distribution and enzyme biochemistry. In the native system, several roles have been attributed to cardosin A, such as reproduction, reserve mobilization, and membrane remodeling. To participate in such diverse events, cardosin A must accumulate and travel to different compartments within the cell: protein storage vacuoles, lytic vacuoles, and the cytoplasmic membrane (and eventually outside the cell). Several studies have approached the expression of cardosin A in Arabidopsis thaliana and Nicotiana tabacum with promising results for the use of these systems to study of cardosin A trafficking. A poly-sorting mechanism has been uncovered for this protein, as two different vacuolar sorting determinants, mediating different vacuolar routes, have been described. The first is a conventional C-terminal domain, which delivers the protein to the vacuole via the Golgi, and the second is a more unconventional signal-the plant-specific insert (PSI)-that mediates a Golgi-independent route. The hypothesis that these two signals are activated according to cell needs and in organs with high metabolic activity is investigated here. An Arabidopsis line expressing cardosin A under an inducible promoter was used to understand the dynamics of cardosin A regarding vacuolar accumulation during seed germination events. Using antibodies against different regions of the protein and combining them with immunofluorescence and immunocytochemistry assays in different young seedling tissues, cardosin A was detected along the secretory pathway to the protein storage vacuole, often associated with the endoplasmic reticulum. More interestingly, upon treatment with the drug Brefeldin A, cardosin A was still detected in protein storage vacuoles, indicating that the intact protein can bypass the Golgi in this system, contrary to what was observed in N. tabacum. This study is a good starting point for further research involving the use of fluorescent fusions and exploring in more detail the relationship between cardosin A trafficking and plant development.

Sand fly population dynamics in areas of American cutaneous leishmaniasis, Municipality of Paraty, Rio de Janeiro, Brazil.

The present study is the second and last part of the study that investigated the fauna and behavior of sand flies in areas prone to cutaneous leishmaniasis outbreaks, in the State of Rio de Janeiro, in the municipality of Paraty. To collect the sand flies, CDC and Shannon light traps were used, installed in the peridomiciliary and forest areas, and manual suction tubes on the walls of the home and in the animal shelters. A total of 102,937 sand flies, belonging to nine genera and 23 species were captured from October 2009 to September 2012. Regarding the monthly frequency of sand flies, the period of highest density was from November to March, with a maximum peak in January. The lowest density was observed in June and July. In the studied area, the species of epidemiological importance, Nyssomyia intermedia, Pintomyia fischeri, Migonemyia migonei and Nyssomyia whitmani, were found in all months of the year, a period in which residents may be in contact with these vectors of the etiological agent of cutaneous leishmaniasis.

The potential of almonds, hazelnuts, and walnuts SFE-CO2 extracts as sources of bread flavouring ingredients.

Nuts have been part of the human diet since our early ancestors, and their use goes beyond nutritional purposes, for example, as aromatic sources for dairy products. This work explores the potential of almond (Prunus dulcis (Mill.) DA Webb), hazelnut (Corylus avellana L.), and walnut (Juglans regia L.) extracts as sources of food flavouring agents, suggesting a new added-value application for lower quality or excess production fruits. The extracts were obtained by supercritical fluid extraction with carbon dioxide and characterized by: quantification of the volatile fraction by HS-SPME GC-MS; sensory perception and description; and cytotoxicity against Vero cells. All extracts revealed potential as flavouring ingredients due to terpene abundance. No significant differences were observed for the minimal sensory perception, in which the odour threshold values ranged from 8.3 × 10-4 to 6.9 × 10-3 µg·mL-1 for walnuts and almonds extracts, respectively. In contrast, the cytotoxic potential differed significantly among the extracts, and P. dulcis extract presented lower cytotoxicity. Notes as woody, fresh, and green were identified in the volatile intensifiers obtained from the P. dulcis extract. Thus, almond extract was identified as the most promising ingredient to increase the sensory value of food products, namely bread. This potential was verified by an increase in the odour perception of bread after adding 4 µL of extract to each 100 g of bread dough. The quantified eucalyptol and d-limonene terpenes - found in the P. dulcis extract - have improved the release of the pleasant and natural volatile compounds from bread crust and crumb compared to the control bread chemical and sensory profiles.

Inclusion of palm kernel cake in the supplement reduces nutrient digestibility but does not interfere with the performance of steers finished on tropical pasture.

The aim of this study was to evaluate the effect of increasing inclusion levels of palm kernel cake (PKC) in the supplement of steers finished on a Urochloa brizantha cv. Marandu pasture on intake, digestibility, feeding behavior, weight gain, and carcass traits. Forty 1/2 Holstein × 1/2 Zebu crossbred steers with an average body weight of 352.80 ± 3.32 kg, at 36 months of age, were supplemented with concentrate at 0.4% of their body weight. Four treatments were formulated (supplement containing 0, 15, 30, or 45% PKC, dry matter [DM] basis) and the animals were monitored for 240 days, weighed, and slaughtered. The inclusion of PKC in the supplement did not influence the intakes of total DM, crude protein, or neutral detergent fiber, but increased (P < 0.05) ether extract intake and reduced (P < 0.05) non-fibrous carbohydrate intake. The apparent digestibility of DM, crude protein, and neutral detergent fiber decreased (P < 0.05), whereas intake and rumination efficiencies by the dietary treatments. Average daily gain, carcass weight, and backfat thickness did not change in response to the inclusion of PKC in the supplement. We recommend the inclusion of 45% palm kernel cake in the concentrate of steers supplemented at 0.4% of their body weight and finished on Urochloa brizantha cv. Marandu pasture.

Complexity of high-risk pregnancy care in the health care network.

OBJECTIVE: To understand the complexity of high-risk care for pregnant women in the health care network. METHOD: Qualitative study with theoretical framework of Edgar Morin's Complex Thought and Grounded Theory methodology, Strauss's version. Data collection by theoretical sampling, including twelve health professionals and seven women users of the care network in a municipality in the south of Brazil from July to October 2018. Analysis by open and axial coding and selective integration. RESULTS: The phenomenon "Caring for high-risk pregnant women in the health care network", comprises four categories: Noticing autonomous decision making; Promoting care; Developing multiprofessional work; and Accessing the health care network. CONCLUSION: Every high-risk pregnant woman should be seen as a singular and multidimensional being with comprehensive and continuous care, considering the complexity of local, regional, and global reality.

Complex care for children with chronic diseases from the perspective of care management.

OBJECTIVE: To analyze the actions developed in hospitals for children with chronic diseases from the perspective of care management. METHOD: Qualitative research, conducted with 14 health professionals from pediatric units in two northeastern hospitals, between November 2018 and March 2019, through semi-structured interviews. The empirical material was interpreted by thematic inductive analysis considering the care management construct. RESULTS: The actions of the multi-professional team are fragmented, making it challenging to prepare and involve the family in care and not always responding to the child's unique and complex demands. The insufficient number of professionals, lack of material resources and inadequate infrastructure of hospital services reflect in the care practice, generating work overload and inadequate actions. FINAL CONSIDERATIONS: Care management is an indispensable tool in coping with chronic childhood illnesses. The actions carried out by the multi-professional teams in hospitals must develop support to expand the care.

Curcumin-rich extract from Central Brazil Curcuma longa protects human umbilical vein endothelial cells under oxidative stress / Extrato rico em Curcumina do Brasil Central Curcuma longa protege células endoteliais de veias umbilicais humanas sob estresse oxidativo

INTRODUCTION: In vascular diseases, the interruption of the local blood flow and the subsequent reperfusion of oxygen can cause deleterious oxidative effects on the cells. Turmeric (Curcuma longa L.) presents the capacity to neutralize free radicals along with preventive and therapeutic effects for several diseases. OBJECTIVE: To analyze the bioactive compounds and the antioxidant capacity of the ethanolic extract of Curcuma (EEC), to evaluate its effect on human umbilical vein endothelial cells, and to analyze its effect on cellular signaling pathways. METHODS: Cells were exposed to different concentrations of EEC for 24, 48, and 72 h. Folin-Ciocalteau test, HPLC-Fluorescence analysis, and DPPH method were used to determine the phenolic compounds, curcumin content, and antioxidant action, respectively; the tetrazolium salt reduction to obtain cell viability, cytotoxicity, and the concentration that inhibits 50% of cell viability; and the immunocytochemistry technique to analyze the expression of caspase3, SIRT1, and mTOR. RESULTS: We found the presence of polyphenols in the classes of phenolic acids and curcuminoids in EEC, with 16.7% curcumin content. The number of antioxidants needed to reduce the initial DPPH concentration by 50% was 18.1 µmol/g. The extract mitigated cell damage at a dosage of 100 µg/ml, decreased the immunoexpression of caspase3, and promoted the signaling of the SIRT1 and mTOR survival pathways. CONCLUSION: EEC had a protective effect on human umbilical vein endothelial cells, subjected to oxidative stress, with decreased apoptosis (caspase3) at lower concentrations, cytoprotection by maintaining essential cell functions (mTOR), and signaling of the survival pathway (SIRT1).

INTRODUÇÃO: Em doenças vasculares, a interrupção do fluxo sanguíneo locale subsequente reperfusão de oxigênio pode causar efeitos deletérios e danos irreparáveis às células. Curcuma (Curcuma longa L.) neutraliza radicais livres além de apresentar efeitos preventivos e terapêuticos. OBJETIVO: Caracterizar os compostos bioativos e a capacidade antioxidante do extrato etanólico de cúrcuma (EEC); avaliar seu efeito nas células endoteliais da veia umbilical humana, e analisar a expressão de vias de sinalização celular. MÉTODOS: As células foram expostas a diferentes concentrações de EEC por 24, 48 e 72 horas. Utilizamos o teste de Folin-Ciocalteau, análise por HPLC-Fluorescência e método DPPH para determinar os compostos fenólicos, conteúdo de curcumina e ação antioxidante, respectivamente; o método de redução de tetrazólio para viabilidade celular, a citotoxicidade e a concentração que inibe 50% da viabilidade celular; e a técnica de imunocitoquímica para analisar a expressão de caspase3, SIRT1 e mTOR. RESULTADOS: Observou-se presença de polifenóis nas classes de ácidos fenólicos e curcuminóides no EEC, com teor de curcumina de 16,7%. A quantidade de antioxidante necessária para reduzir a concentração inicial de DPPH em 50% foi de 18,1 µmol/g. O extrato mitigou o dano celular na dosagem de 100 µg/ml, diminuiu a imunoexpressão da caspase3 e promoveu a sinalização das vias de sobrevivência SIRT1 e mTOR. CONCLUSÃO: O EEC teve efeito protetor nas células endoteliais de veia umbilical humana, submetidas ao estresse oxidativo, com diminuição da apoptose (caspase3) em concentrações mais baixas, citoproteção pela manutenção das funções celulares essenciais (mTOR) e sinalização da via de sobrevivência (SIRT1).

Chemical and organoleptic properties of bread enriched with Rosmarinus officinalis L.: The potential of natural extracts obtained through green extraction methodologies as food ingredients.

The potential of R. officinalis L. (RO) extracts as a source of aromas was accessed by hydrodistillation (HD) and supercritical fluid extraction using carbon dioxide (SFE-CO2), followed by a series of analysis: quantification by GC-MS, sensory perception and description, and cytotoxicity against Vero cells. The extracts shown abundancy of α-pinene, eucalyptol, S-verbenone and camphor, contributing for the green, fresh, citric, and woody as main sensory notes. The odour threshold (ODT) value (less than 3.0 × 10-3 µg·mL-1) and the cytotoxic potential (ca. 220 µg∙mL-1) defined the concentration range for food application. The most promising extract was added to bread doughs and the final volatile profile was characterised by GC-MS through HS-SPME over time. Among the 34 compounds found, furfural showed an evident contribution in the bread crust aroma, which persisted over four hours of storage, contributing to a pleasant bread fragrance according to the evaluators. This study aims to represent a stepping stone for the use of natural aromas as ingredients for the development of innovative food products.

Biodiversity assessment of Phlebotomine (Diptera: Psychodidae) in an environmental impacted area in Rio de Janeiro State, Brazil.

From October 1994 to September 1996, in the municipality of Mangaratiba, Rio de Janeiro State, phlebotomines were captured on the walls of the houses by means of a manual suction tube and light traps, in the household, the peridomicile and in the forest. As it is an area undergoing a real expansion and an increment in the local tourism, with the purpose of assessing changes in the phlebotomine fauna caused by environmental changes in the region, new captures were made in the same location from October 2015 to September 2016, this time using only light traps. In the two phases of the study, a total of 6,681 phlebotomines were captured. The results indicated that Ny. intermedia and Mg. migonei are fully adapted to this anthropic environment, while Pi. fischeri was more abundant and eclectic, and was probably attracted to exercise hematophagy. Nyssomyia intermedia can be suggested as the main vector of the etiological agent of the American Tegumentary Leishmaniasis in the studied areas. Pintomyia fischeri can also transmit Leishmania braziliensis, both in the environment altered by human action, and in the wild environment. Phlebotomines were captured in greater numbers between 6 and 8 pm in the peridomicile and between 9 and 11 pm in the household. The highest densities of phlebotomines were recorded in December, January and February. Despite almost 20 years between the two studies in the municipality of Mangaratiba, there was no change in the profile of the phlebotomine fauna in general; however, there was a greater density of species of medical importance in areas that suffered environmental impacts.

Obtaining Aromatic Extracts from Portuguese Thymus mastichina L. by Hydrodistillation and Supercritical Fluid Extraction with CO2 as Potential Flavouring Additives for Food Applications.

Humans often respond to sensory impulses provided by aromas, and current trends have generated interest in natural sources of fragrances rather than the commonly used synthetic additives. For the first time, the resulting aroma of a selected culture of Thymus mastichina L. was studied as a potential food ingredient. In this context, dried (DR) and fresh (FR) samples were submitted to carbon dioxide (CO2) supercritical extraction (SFE) and hydrodistillation (HD) methods. The extracts were characterised according to their volatile composition by GC-MS, cytotoxicity against a non-tumour cell culture, and sensory attributes (odour threshold and olfactive descriptors). The most abundant aromas were quantified, and the analysis performed by GC-MS revealed an abundance of terpenoids such as thymol chemotype, followed by the precursors α-terpinene and p-cymene. DR and FR extracts (EX) obtained from SFE-CO2 show the highest content of thymol, achieving 52.7% and 72.5% of the isolated volatile fraction. The DR essential oil (EO) contained the highest amount of terpenoids, but it was also the most cytotoxic extract. In contrast, SFE-CO2 products showed the lowest cytotoxic potential. Regarding FR-OE, it had the lowest extraction yield and composition in aroma volatiles. Additionally, all samples were described as having green, fresh and floral sensory notes, with no significant statistical differences regarding the odour detection threshold (ODT) values. Finally, FR-EX of T. mastichina obtained by SFE-CO2 presented the most promising results regarding food application.

Predictive factors for premature birth and respiratory exacerbation in pregnancies of women with cystic fibrosis

Abstract Objective: In this present study, the authors evaluated the predictive factors for adverse maternal-fetal outcomes in pregnancies of women with cystic fibrosis (CF). Patients were followed up by a referral center for adults in southern Brazil. Methods: This is a retrospective cohort study that used data from electronic medical records regarding pregnancies of women diagnosed with CF. Results: The study included 39 pregnancies related to 20 different women. The main adverse outcomes were high prevalence rates of premature birth (38.5%) and maternal respiratory exacerbation (84.6%). Lower body mass index (BMI) values (< 20.8) and younger ages of CF diagnosis increased the risk of premature birth. The presence of methicillin-resistant and absence of methicillin-sensitive Staphylococcus aureus, as well as a younger age of diagnosis, increased the risk of maternal respiratory exacerbation during pregnancy. Conclusions: Conception in women with CF is often associated with maternal and fetal complications. Continuous monitoring by a multidisciplinary team should emphasize appropriate nutritional status, investigation of bacterial colonization, and immediate attention to respiratory exacerbations.

Predictive factors for premature birth and respiratory exacerbation in pregnancies of women with cystic fibrosis.

OBJECTIVE: In this present study, the authors evaluated the predictive factors for adverse maternal-fetal outcomes in pregnancies of women with cystic fibrosis (CF). Patients were followed up by a referral center for adults in southern Brazil. METHODS: This is a retrospective cohort study that used data from electronic medical records regarding pregnancies of women diagnosed with CF. RESULTS: The study included 39 pregnancies related to 20 different women. The main adverse outcomes were high prevalence rates of premature birth (38.5%) and maternal respiratory exacerbation (84.6%). Lower body mass index (BMI) values (< 20.8) and younger ages of CF diagnosis increased the risk of premature birth. The presence of methicillin-resistant and absence of methicillin-sensitive Staphylococcus aureus, as well as a younger age of diagnosis, increased the risk of maternal respiratory exacerbation during pregnancy. CONCLUSIONS: Conception in women with CF is often associated with maternal and fetal complications. Continuous monitoring by a multidisciplinary team should emphasize appropriate nutritional status, investigation of bacterial colonization, and immediate attention to respiratory exacerbations.

Biodiversity assessment of Phlebotomine (Diptera: Psychodidae) in an environmental impacted area in Rio de Janeiro State, Brazil

ABSTRACT From October 1994 to September 1996, in the municipality of Mangaratiba, Rio de Janeiro State, phlebotomines were captured on the walls of the houses by means of a manual suction tube and light traps, in the household, the peridomicile and in the forest. As it is an area undergoing a real expansion and an increment in the local tourism, with the purpose of assessing changes in the phlebotomine fauna caused by environmental changes in the region, new captures were made in the same location from October 2015 to September 2016, this time using only light traps. In the two phases of the study, a total of 6,681 phlebotomines were captured. The results indicated that Ny. intermedia and Mg. migonei are fully adapted to this anthropic environment, while Pi. fischeri was more abundant and eclectic, and was probably attracted to exercise hematophagy. Nyssomyia intermedia can be suggested as the main vector of the etiological agent of the American Tegumentary Leishmaniasis in the studied areas. Pintomyia fischeri can also transmit Leishmania braziliensis, both in the environment altered by human action, and in the wild environment. Phlebotomines were captured in greater numbers between 6 and 8 pm in the peridomicile and between 9 and 11 pm in the household. The highest densities of phlebotomines were recorded in December, January and February. Despite almost 20 years between the two studies in the municipality of Mangaratiba, there was no change in the profile of the phlebotomine fauna in general; however, there was a greater density of species of medical importance in areas that suffered environmental impacts.

Complex care for children with chronic diseases from the perspective of care management / Atención terciaria a niños con enfermedades crónicas en la perspectiva de la gestión de la atención / Atenção terciária à criança com doença crônica na perspectiva da gestão do cuidado

ABSTRACT Objective: To analyze the actions developed in hospitals for children with chronic diseases from the perspective of care management. Method: Qualitative research, conducted with 14 health professionals from pediatric units in two northeastern hospitals, between November 2018 and March 2019, through semi-structured interviews. The empirical material was interpreted by thematic inductive analysis considering the care management construct. Results: The actions of the multi-professional team are fragmented, making it challenging to prepare and involve the family in care and not always responding to the child's unique and complex demands. The insufficient number of professionals, lack of material resources and inadequate infrastructure of hospital services reflect in the care practice, generating work overload and inadequate actions. Final Considerations: Care management is an indispensable tool in coping with chronic childhood illnesses. The actions carried out by the multi-professional teams in hospitals must develop support to expand the care.

RESUMEN Objetivo: Analizar las acciones desarrolladas en la atención terciaria a niños con enfermedades crónicas en la perspectiva de la gestión del cuidado. Método: Investigación cualitativa realizada con catorce profesionales de la salud de unidades pediátricas de dos hospitales del noreste, entre noviembre de 2018 y marzo de 2019, a través de entrevistas semiestructuradas. El material empírico fue interpretado mediante análisis temático inductivo a la luz de la gestión del cuidado. Resultados: La actuación del equipo multiprofesional está fragmentada, lo que dificulta la preparación y participación de la familia en los cuidados y no siempre responde a las demandas únicas y complejas del niño. El insuficiente número de profesionales, la falta de insumos y la inadecuada infraestructura de los servicios hospitalarios se reflejan en la práctica asistencial generando sobrecarga de trabajo y acciones desarticuladas. Consideraciones finales: La gestión del cuidado es una herramienta indispensable para el enfrentamiento de las enfermedades crónicas en los niños, y las acciones realizadas por el equipo multiprofesional en la atención terciaria deben apoyar un cuidado ampliado y resolutivo.

RESUMO Objetivo: Analisar as ações desenvolvidas na atenção terciária à criança com doença crônica na perspetiva da gestão do cuidado. Método: Pesquisa qualitativa realizada com 14 profissionais da saúde de unidades pediátricas de dois hospitais nordestinos, entre novembro de 2018 e março de 2019, por meio de entrevista semiestruturada. O material empírico foi interpretado por análise temática indutiva à luz da gestão do cuidado. Resultados: As ações das equipes multiprofissionais apresentam-se fragmentadas, dificultando o preparo e o envolvimento da família no cuidado e nem sempre respondendo às demandas singulares e complexas da criança. O número insuficiente de profissionais, falta de insumos e infraestruturas inadequadas dos serviços hospitalares refletem na prática assistencial gerando sobrecarga de trabalho e ações desarticuladas. Considerações finais: A gestão do cuidado contribui para a reestruturação dos processos de trabalho no hospital para que as ações da equipe atendam às demandas singulares e complexas dessa população.

Complexity of high-risk pregnancy care in the health care network / Complejidad de la atención a la embarazada de alto riesgo en la red de atención la salud / Complexidade do cuidado da gestante de alto risco na rede de atenção à saúde

ABSTRACT Objective To understand the complexity of high-risk care for pregnant women in the health care network. Method Qualitative study with theoretical framework of Edgar Morin's Complex Thought and Grounded Theory methodology, Strauss's version. Data collection by theoretical sampling, including twelve health professionals and seven women users of the care network in a municipality in the south of Brazil from July to October 2018. Analysis by open and axial coding and selective integration. Results The phenomenon "Caring for high-risk pregnant women in the health care network", comprises four categories: Noticing autonomous decision making; Promoting care; Developing multiprofessional work; and Accessing the health care network. Conclusion Every high-risk pregnant woman should be seen as a singular and multidimensional being with comprehensive and continuous care, considering the complexity of local, regional, and global reality.

RESUMEN Objetivo Comprender la complejidad de la atención a la embarazada de alto riesgo en la red de atención a la salud. Método Estudio cualitativo utilizando la teoría del Pensamiento Complejo de Edgar Morin y la Teoría Fundamentada en su versión Straussiana como metodología. Dados colectados por muestreo teórico. Participaron doce profesionales de la salud y siete mujeres usuarias de la red de atención de un municipio del sur de Brasil de julio a octubre de 2018. Análisis por codificación abierta y axial e integración selectiva. Resultados El fenómeno "Atención a embarazadas de alto riesgo en la red de salud", incluye cuatro categorías: Percepción de autonomía en la toma de decisiones; Promoción de la atención; Desarrollo de trabajo multiprofesional; y Acceso a la red de salud. Conclusión Toda embarazada de alto riesgo debe ser vista como un ser singular y multidimensional, recibir atención integral y continua, que considere la complejidad de la realidad local, regional y global.

RESUMO Objetivo Compreender a complexidade do cuidado da gestante de alto risco na rede de atenção à saúde. Método Estudo qualitativo com referencial teórico do Pensamento Complexo de Edgar Morin e metodológico da Teoria Fundamentada nos Dados, versão Straussiana. Coleta por amostragem teórica, participaram doze profissionais de saúde e sete mulheres usuárias da rede de atenção em um município do sul do Brasil no período de julho a outubro de 2018. Análise por codificação aberta, axial e integração seletiva. Resultados O fenômeno "Cuidando da gestante de alto risco na rede de atenção à saúde", compreende quatro categorias: Percebendo a autonomia na tomada de decisões; Promovendo o cuidado; Desenvolvendo um trabalho multiprofissional e Acessando a rede de atenção à saúde. Conclusão Toda gestante de alto risco deve ser vista como um ser singular e multidimensional com cuidado integral e contínuo, que abrange a complexidade do real a nível local, regional e global.