Three-year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy: results from a European randomized clinical trial.

BACKGROUND: Adequate lymphadenectomy is an important step in gastrectomy for cancer, with a modified D2 lymphadenectomy being recommended for advanced gastric cancers. When assessing a novel technique for the treatment of gastric cancer, lymphadenectomy should be non-inferior. The aim of this study was to assess completeness of lymphadenectomy and distribution patterns between open total gastrectomy (OTG) and minimally invasive total gastrectomy (MITG) in the era of peri-operative chemotherapy. METHODS: This is a retrospective analysis of the STOMACH trial, a randomized clinical trial in thirteen hospitals in Europe. Patients were randomized between OTG and MITG for advanced gastric cancer after neoadjuvant chemotherapy. Three-year survival, number of resected lymph nodes, completeness of lymphadenectomy, and distribution patterns were examined. RESULTS: A total of 96 patients were included in this trial and randomized between OTG (49 patients) and MITG (47 patients). No difference in 3-year survival was observed, this was 57.1% in OTG group versus 46.8% in MITG group (P = 0.186). The mean number of examined lymph nodes per patient was 44.3 ± 16.7 in the OTG group and 40.7 ± 16.3 in the MITG group (P = 0.209). D2 lymphadenectomy of 71.4% in the OTG group and 74.5% in the MITG group was performed according to the surgeons; according to the pathologist compliance to D2 lymphadenectomy was 30% in the OTG group and 36% in the MITG group. Tier 2 lymph node metastases (stations 7-12) were observed in 19.6% in the OTG group versus 43.5% in the MITG group (P = 0.024). CONCLUSION: No difference in 3-year survival was observed between open and minimally invasive gastrectomy. No differences were observed for lymph node yield and type of lymphadenectomy. Adherence to D2 lymphadenectomy reported by the pathologist was markedly low.

The Effect of Microwave Radiation on the Self-Healing Performance of Asphalt Mixtures with Steel Slag Aggregates and Steel Fibers.

Self-healing in asphalt mixtures is a property that can be enhanced by external heating, which causes a thermal expansion that increases the flow of bitumen with reduced viscosity through the cracks. Therefore, this study aims to evaluate the effects of microwave heating on the self-healing performance of three asphalt mixtures: (1) conventional, (2) with steel wool fibers (SWF), and (3) with steel slag aggregates (SSA) and SWF. After evaluating the microwave heating capacity of the three asphalt mixtures with a thermographic camera, their self-healing performance was determined with fracture or fatigue tests and microwave heating recovery cycles. The results demonstrated that the mixtures with SSA and SWF promoted higher heating temperatures and presented the best self-healing capacity during the semicircular bending test and heating cycles, with significant strength recovery after a total fracture. In contrast, the mixtures without SSA presented inferior fracture results. Both the conventional mixture and that containing SSA and SWF presented high healing indexes after the four-point bending fatigue test and heating cycles, with a fatigue life recovery of around 150% after applying two healing cycles. Therefore, the conclusion is that SSA greatly influences the self-healing performance of asphalt mixtures after microwave radiation heating.

Questão ambiental na América Latina: por um marxismo insurgente em Enrique Dussel / Environmental in Latin America: for an insurgent marxism in Enrique Dussel

O objetivo central desse trabalho é abordar as relações entre a questão ambiental e a estrutura do sistema-mundo moderno-colonial em sua dinâmica de enfrentamento político sob a ótica do que denominamos de "leitura insurgente" à luz do pensador argentino Enrique Dussel. Para esse fim, o nosso trabalho está organizado em três momentos, onde expomos os desdobramentos históricos, sociais e políticos do sistema-mundo moderno-colonial para a questão ambiental à luz do pensador de Mendoza. No segundo momento, elencamos as relações entre a questão ambiental e as insurgências na AL, indicando que a degradação da natureza é o ponto central para as reflexões insurgentes. No terceiro, como guisa de conclusão, tensionamos as contribuições do filósofo mendocino nos vínculos existentes entre o "encobrimento do outro", insurgência e a lógica de injustiça ambiental

The central objective of this work is to approach the relations between the environmental question and the structure of the modern-colonial world-sys-tem in its dynamics of political confrontation from the perspective of what we call an "insurgent reading" in the light of the Argentine thinker Enrique Dussel. To this end, our work is organized in three moments, where we expose the historical, social, and political unfoldings of the modern-colonial world-system for the environmental issue in the light of the thinker from Mendoza. In the second moment, we list the relations between the environmental question and the insurgencies in LA, indicating that the degradation of nature is the central point for insurgent reflections. In the third, as a conclusion, we stress the contributions of the philosopher from Mendoza on the existing links between the "concealment of the other", insurgency and the logic of environmental injustice

Health related quality of life following open versus minimally invasive total gastrectomy for cancer: Results from a randomized clinical trial.

INTRODUCTION: Minimally invasive techniques show improved short-term and comparable long-term outcomes compared to open techniques in the treatment of gastric cancer and improved survival has been seen with the implementation of multimodality treatment. Therefore, focus of research has shifted towards optimizing treatment regimens and improving quality of life. MATERIALS AND METHODS: A randomized trial was performed in thirteen hospitals in Europe. Patients were randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG) after neoadjuvant chemotherapy. This study investigated patient reported outcome measures (PROMs) on health-related quality of life (HRQoL) following OTG or MITG, using the Euro-Qol-5D (EQ-5D) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires, modules C30 and STO22. Due to multiple testing a p-value < 0.001 was deemed statistically significant. RESULTS: Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. A response compliance of 80% was achieved for all PROMs. The EQ5D overall health score one year after surgery was 85 (60-90) in the open group and 68 (50-83.8) in the minimally invasive group (P = 0.049). The median EORTC-QLQ-C30 overall health score one year postoperatively was 83,3 (66,7-83,3) in the open group and 58,3 (35,4-66,7) in the minimally invasive group (P = 0.002). This was not statistically significant. CONCLUSION: No differences were observed between open total gastrectomy and minimally invasive total gastrectomy regarding HRQoL data, collected using the EQ-5D, EORTC QLQ-C30 and EORTC-QLQ-STO22 questionnaires.

Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial.

BACKGROUND: Surgical resection with adequate lymphadenectomy is regarded the only curative option for gastric cancer. Regarding minimally invasive techniques, mainly Asian studies showed comparable oncological and short-term postoperative outcomes. The incidence of gastric cancer is lower in the Western population and patients often present with more advanced stages of disease. Therefore, the reproducibility of these Asian results in the Western population remains to be investigated. METHODS: A randomized trial was performed in thirteen hospitals in Europe. Patients with an indication for total gastrectomy who received neoadjuvant chemotherapy were eligible for inclusion and randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG). Primary outcome was oncological safety, measured as the number of resected lymph nodes and radicality. Secondary outcomes were postoperative complications, recovery and 1-year survival. RESULTS: Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. The mean number of resected lymph nodes was 43.4 ± 17.3 in OTG and 41.7 ± 16.1 in MITG (p = 0.612). Forty-eight patients in the OTG group had a R0 resection and 44 patients in the MITG group (p = 0.617). One-year survival was 90.4% in OTG and 85.5% in MITG (p = 0.701). No significant differences were found regarding postoperative complications and recovery. CONCLUSION: These findings provide evidence that MITG after neoadjuvant therapy is not inferior regarding oncological quality of resection in comparison to OTG in Western patients with resectable gastric cancer. In addition, no differences in postoperative complications and recovery were seen.

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer.

BACKGROUND AND OBJECTIVES: The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high-dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. METHODS: A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow-up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. RESULTS: Most conducts and management strategies reviewed were strongly recommended by the participants. CONCLUSIONS: Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.

Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources.

BACKGROUND: Approximately 70% of cancer-related deaths occur in low- and middle-income countries. In addition to social and racial inequalities, treatment options in these countries are usually limited because of the lack of trained staff and equipment, limited patient access to health services, and a small number of clinical guidelines. OBJECTIVES: The Brazilian Society of Surgical Oncology developed this guideline to address these barriers and guide physicians treating patients with endometrial cancer (EC) in regions with limited resources and few specialized centers. METHODS: The guideline was prepared from 10 January to 25 October 20192019 by a multidisciplinary team of 56 experts to discuss the main obstacles faced by EC patients in Brazil. Thirteen questions considered critical to the surgical treatment of these patients were defined. The questions were assigned to groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments for presentations in meetings, classified the level of evidence, and voted on the recommendations. RESULTS: For all questions including staging, fertility spearing treatment, genetic testing, sentinel lymph node use, surgical treatment, and other clinical relevant questions, major agreement was achieved by the participants, always using accessible alternatives. CONCLUSIONS: It is possible to provide adequate treatment for most EC patients in resource-limited areas, but the first option should be referral to specialized centers with more resources.

ACTIVITY OF ORBIGNYA PHALERATA AND EUTERPE EDULES IN THE PREVENTION AND TREATMENT OF PEPTIC ULCER IN RATS.

BACKGROUND: Peptic ulcer is considered a public health problem associated with loss of quality of life. Does not exist optimal therapeutic regimen. The search for alternative treatments using foods or plants that may assist in gastric protection may become marked in this population because of their easy access and low cost. AIM: To study the antiulcerogenic activity of extracts of Orbignya phalerata (babaçu) and Euterpe edules (juçara) in Wistar rats after induction of peptic ulcer, compared with Omeprazole. METHOD: Forty Wistar rats were distributed into four groups: group I, II, III, IV (10 rats each) subjected to extract of Orbignya phalerata, Euterpe edules, Omeprazole and ethanol, respectively. Each group of 10 rats was divided into subgroups of five for prophylaxis and therapeutic study. RESULTS: The pre-treatment with juçara extract has provided a significant protection against peptic ulcer induced by ethanol. In the prophylactic subgroup, Omeprazole resulted in protection. In addition to protection against peptic ulcer, inflammation and neocapillarization were also variables with a statistical significance in the prophylaxis subgroups using omeprazole and juçara. In the therapeutic subgroup, omeprazole, juçara and babaçu were statistically different as for protection against the presence of inflammation and the healing of ulcers. CONCLUSION: The extracts of juçara and babaçu behaved as the omeprazole, evidencing the therapeutic activity of these extracts.

Gluten-free diet: a possible treatment for chronic diarrhoea in common variable immunodeficiency.

Gastrointestinal disorders are frequent in common variable immunodeficiency (CVID). Clinical symptoms and histological alterations in CIVD can resemble celiac disease. Usually, patients with chronic diarrhoea associated with CVID do not improve with a gluten-free diet. The authors present a case of a male patient who was diagnosed with CVID at age 33 and had chronic diarrhoea which resolved after initiating a gluten-free diet. Clinical relapse occurred after gluten reintroduction. The main objective of this case report is to alert clinicians to implement a gluten-free diet in patients with CVID with chronic diarrhoea.

Caminhos para uma abordagem psico-socioambiental: contribuições da psicossociologia para as discussões socioambientais / Pathways for a psycho-environmental approach: contributions of psychosociology to socio-environmental discussions / Caminos a un enfoque psico-social y ambiental: aportes de la psicología social a los debates sociales y medioambientales / Voies vers une approche psycho-socio-environnementale: contributions de la psycho-sociologie aux discussions socio-environnementales

Em um contexto marcado por diversos 'conflitos ambientais', o presente artigo, enquanto ensaio teórico, apresenta argumentos advindos da ecologia social, da ecologia política e da psicossociologia para evidenciar a inerente indissociabilidade entre os aspectos sociais, econômicos, ambientais e psicológicos desses conflitos. Ao propor o 'trabalho' como categoria analítica e articuladora entre essas diferentes, porém integradas dimensões, defende-se uma leitura psico-socioambiental dos 'conflitos ambientais' a partir do campo psicossocial. Esse posicionamento favorece, por um lado, a compreensão destes conflitos e, por outro, articulações políticas que visam um projeto societário mais justo, diverso e viável.

In a context marked by several 'environmental conflicts', this article, as a theoretical essay, presents arguments from social ecology, political ecology and psychosociology to highlight the inherent inseparability between the social, economic, environmental and psychological aspects of these conflicts. By proposing 'work' as an analytical and articulating category between these different but integrated dimensions, a psycho-socio-environmental reading of 'environmental conflicts' is advocated from the psychosocial field. This position favors, on the one hand, the understanding of these conflicts and, on the other hand, political articulations that aim at a more fair, diverse and viable project to society.

Em un contexto marcado por varios 'conflictos ambientales', mientras que este artículo ensayo teórico presenta argumentos que surgen de la ecología social, la ecología política y la psicología social para poner de relievela indivisibilidade inherente de sociales, económicos, ambientales y psicológicos tales conflictos. Al proponer el 'trabajo' como una categoría analítica y articulador entre estas diferentes dimensiones, pero integrados, defiende una lectura psico-socio-ambiental de 'conflictos ambientales' desde el ámbito psicosocial. Esta posición favorece, por un lado, la comprensión de estos conflictos y, por outro articulaciones políticas, orientadas a um proyecto social más equitativa, diversa y viable.

Dans un contexte marqué par plusieurs «conflits environnementaux¼, cet article, en tant qu'essai théorique, présente des arguments d'écologie sociale, d'écologie politique et de psychosociologie afin de mettre en évidence le caractère indissociable des aspects social, économique, environnemental et psychologique de ces conflits. En proposant le «travail¼ comme catégorie analytique et articulée entre ces dimensions différentes mais intégrées, une lecture psycho-socio-environnementale des «conflits environnementaux¼ est préconisée dans le champ psychosocial. Cette position favorise, d'une part, la compréhension de ces conflits et, d'autre part, les articulations politiques qui visent un projet d'entreprise plus équitable, diversifié et viable.

Activity of orbignya phalerata and euterpe edules in the prevention and treatment of peptic ulcer in rats / Atividade de orbignya phalerata e euterpe edules na prevenção e tratamento da úlcera péptica em ratos

ABSTRACT Background: Peptic ulcer is considered a public health problem associated with loss of quality of life. Does not exist optimal therapeutic regimen. The search for alternative treatments using foods or plants that may assist in gastric protection may become marked in this population because of their easy access and low cost. Aim: To study the antiulcerogenic activity of extracts of Orbignya phalerata (babaçu) and Euterpe edules (juçara) in Wistar rats after induction of peptic ulcer, compared with Omeprazole. Method: Forty Wistar rats were distributed into four groups: group I, II, III, IV (10 rats each) subjected to extract of Orbignya phalerata, Euterpe edules, Omeprazole and ethanol, respectively. Each group of 10 rats was divided into subgroups of five for prophylaxis and therapeutic study. Results: The pre-treatment with juçara extract has provided a significant protection against peptic ulcer induced by ethanol. In the prophylactic subgroup, Omeprazole resulted in protection. In addition to protection against peptic ulcer, inflammation and neocapillarization were also variables with a statistical significance in the prophylaxis subgroups using omeprazole and juçara. In the therapeutic subgroup, omeprazole, juçara and babaçu were statistically different as for protection against the presence of inflammation and the healing of ulcers. Conclusion: The extracts of juçara and babaçu behaved as the omeprazole, evidencing the therapeutic activity of these extracts.

RESUMO Racional: A úlcera péptica é considerada problema de saúde pública, associada a perda na qualidade de vida. Não existe esquema terapêutico ideal. A busca de tratamentos alternativos, com uso de alimentos ou plantas que possam ajudar na proteção gástrica, torna-se viável à população, por ser de fácil acesso e baixo custo. Objetivo: Estudar a atividade antiulcerogênica dos extratos de Orbignya phalerata (babaçu) e Euterpe edules (juçara) em ratos Wistar após indução de úlcera péptica e comparar com omeprazol. Método: Quarenta ratos Wistar foram distribuídos em quatro grupos: grupo I, II, III, IV (10 ratos) submetidos ao extrato de Orbignya phalerata, Euterpe edules, omeprazol e álcool etílico, respectivamente. Cada grupo de 10 ratos foi dividido em subgrupos de cinco para estudar a profilaxia e tratamento. Resultados: O pré-tratamento com extrato de juçara forneceu proteção significativa contra a ulceração péptica induzida pelo etanol, assim como o omeprazol. Além da proteção contra úlcera péptica, inflamação e neocaplilarização também foram variáveis com significância estatística nos subgrupos profilaxia do omeprazol e da juçara. No subgrupo terapêutico, o omeprazol, juçara e babaçu teve diferença estatística para proteção contra a presença de inflamação e cicatrização de úlcera. Conclusão: Os extratos de juçara e babaçu se comportaram como omeprazol, evidenciando o poder terapêutico desses extratos.

Karl Marx na leitura de Enrique Dussel: interpelações críticas à luz das lutas sociais na América Latina / Karl Marx in reading Enrique Dussel: summonses light criticism of social struggles in Latin America

O propósito deste ensaio é destacar alguns pressupostos e implicações políticas da filosofia de Karl Marx na leitura de Enrique Dussel, trazendo contribuições teóricas para o processo de lutas sociais na América Latina. Temos convicção que a aproximação dos autores mencionados contribui de forma impar diante os processos libertários neste contexto. O presente trabalho está sistematizado em três tópicos, que se seguem à introdução, onde reiteramos as convergências críticas entre o filósofo argentino Enrique Dussel e o alemão Karl Marx para a compreensão da América Latina. Inicialmente, abordaremos elementos reflexivos sobre Marx na leitura filosófica de Dussel. Em seguida, situaremos o cenário de expropriações e lutas sociais no sistema-mundo moderno colonial a partir deste referencial da América Latina. Por fim, na parte conclusiva, pontuaremos as "interpelações críticas" a partir de Dussel e Marx, na perspectiva das lutas sociais latino-americanas, que se constituem em filósofos fundamentais para compreendermos o processo de expropriações e lutas sociais no âmbito latino-americano.

The purpose of this test is to highlight certain assumptions and political implications of the philosophy of Karl Marx in reading of Enrique Dussel, bringing theoretical contributions to the process of social struggles in Latin America. We believe that the approximation of the authors mentioned contributes so odd before the processes libertarians in this context. The present work is systematized into three topics, following the introduction, where we reiterate the convergences criticism between the Argentine philosopher Enrique Dussel and the German Karl Marx for the understanding of Latin America. Initially, we will find reflective elements on Marx in philosophical reading of Dussel. Then there will be the scene of expropriation and social struggles in system-modern world colonial from this referential of Latin America. Finally, in the concluding part, pontuaremos the "formal criticism" from Dussel and Marx, in the perspective of Latin American social struggles, that constitute fundamental philosophers to understanding the process of expropriation and social struggles in the Latin American context.

The IDEAL prospective development study format for reporting surgical innovations. An illustrative case study of robotic oesophagectomy.

BACKGROUND: The early development of innovative surgical procedures is usually reported as retrospective case series, wasting opportunities to provide useful information and introducing bias. We present a report of an innovative procedure in development, using the Prospective Development Study (PDS) format recommended by the IDEAL Collaboration. METHODS: We report the development of robotically assisted oesophagectomy by a two-surgeon team from the first robotic case onwards. Key outcomes (blood loss, robotic operating time, lymph node yield, length of stay and complications) are prospectively reported for each patient sequentially. Reasons for rejecting cases for robotic surgery are explained. All changes to technique or indication are highlighted, showing when they occurred and explaining why they were instituted. RESULTS: The first robotic oesophagectomy was attempted in December 2009. Subsequently 55 oesophagectomies were undertaken, 34 using the robot and 21 without it. Seven deliberate changes in technique occurred during the series. Nodal yield increased markedly after adopting formal mediastinal node dissection and clipping of the thoracic duct. No obvious trends were noted in other outcomes. The robot facilitated Intra-thoracic anastomosis, but mediastinal node dissection showed no advantages due to loss of haptic sensation. Complication rates, R0 rates and nodal yield were considered acceptable. DISCUSSION: Presenting the development experience in this way improved the clarity of transmission of the main learning points for other surgeons, eliminated bias from selective reporting and explained other types of selection bias. The IDEAL Prospective Development Study has clear advantages over standard case series format for presenting uncontrolled early study data from innovative procedures.

Oral appliances to prevent occupational accidents involving obstructive sleep apnea syndrome patients – a systematic review and meta-analysis / Aparelhos intraorais para prevenção de acidentes de trabalho em pacientes com apneia obstrutiva do sono - revisão sistemática e meta-análise

Studies have linked the obstructive sleep apnea syndrome with an increased risk of occupational accidents. The aim of this systematic review Cochrane format was to evaluate the effectiveness of intraoral devices to reduce these accidents. An electronic search was conducted in the databases CENTRAL (Cochrane), MEDLINE, and LILACS. Only randomized controlled trials were included. Whenever possible a meta-analysis was performed. The primary outcome was reduction of accidents involving professionals with obstructive sleep apnea. Daytime sleepiness, cognitive function, and index of apnea/hypopnea were considered secondary outcomes. To evaluate the risk of bias, we used the Cochrane Collaboration tool. From 431 articles retrieved, 13 were included. No study evaluating the effectiveness of intraoral appliance in reducing accidents at work was found. Only studies that evaluated secondary outcomes were found. Some studies showed results in favor of intraoral appliance, but when compared to continued positive pressure device (CPAP) results were in favor of the CPAP. Outcomes for excessive daytime sleepiness and cognitive performance were similar for both types of treatment.

Estudos têm associado a síndrome da apneia obstrutiva do sono com um aumento do risco de acidentes de trabalho. O objetivo desta revisão sistemática formato Cochrane foi avaliar a efetividade dos dispositivos intraorais na redução desses acidentes. Uma busca eletrônica foi realizada nas bases de dados CENTRAL (Cochrane), MEDLINE e LILACS. Foram incluídos somente ensaios controlados randomizados. Sempre que possível foi realizada a meta-análise. O desfecho primário foi redução de acidentes de trabalho em profissionais com apneia obstrutiva do sono. Sonolência diurna, função cognitiva e índice de apneia/hipopneia foram considerados desfechos secundários. Para avaliação do risco de viés, utilizou-se a ferramenta da Colaboração Cochrane. Dos 431 artigos encontrados, 13 foram incluídos. Não foi identificado nenhum estudo avaliando efetividade do aparelho intraoral sobre acidentes de trabalho. Foram encontrados apenas estudos que avaliaram os desfechos secundários. Alguns estudos mostraram resultados a favor do aparelho intraoral, mas quando comparados ao aparelho de pressão contínua positiva (CPAP), os resultados foram a favor do CPAP. Para os desfechos sonolência excessiva diurna e desempenho cognitivo, os resultados foram efetivos e semelhantes para os dois tipos de tratamento.

Ecologia política, justiça e educação ambiental crítica: perspectivas de aliança contra-hegemônica / Political ecology, justice, and critical environmental education: perspectives of a counter-hegemonic alliance

Objetivamos com o presente artigo trazer alguns argumentos e contribuições teóricas que sustentam a pertinência da articulação entre a denominada educação ambiental crítica e o movimento de justiça ambiental, em decorrência da aproximação no modo como definem as causas da crise atual, estabelecem estratégias de luta social e defendem o projeto societário anticapitalista. Essa articulação não só é oportuna para os processos de superação das relações sociais alienadas destrutivas da natureza, mas também reforça uma perspectiva da ecologia política, para a qual as determinações são materiais e de classe. Nos três movimentos - educação ambiental crítica, justiça ambiental e ecologia política - ocorre um processo argumentativo contínuo de ressignificação ideológica da questão ambiental, agindo como contraponto das interpretações hegemônicas do senso comum acerca do fenômeno socioambiental. Todos possuem elementos em comum que conformam o amálgama mediante o qual se pode efetuar a crítica e operar politicamente a favor da transformação social.

The purpose of this article is to raise a few arguments and make theoretical contributions to support the pertinence of the link between the so-called critical environmental education and the environmental justice movement due to the approach in how they define the causes of the current crisis, establish social struggle strategies, and defend the anti-capitalistic corporate project. This link is not only timely for the process of overcoming the destructive, alienated social relations of nature, but also underpins a perspective of the political ecology for which the determinations are material and of class. In the three movements - critical environmental education, environmental justice and political ecology - there is an ongoing argumentative process of ideological resignification of the environmental issue, acting as a counterpoint for the hegemonic interpretations of the common sense on the socioenvironmental phenomenon. They all have elements in common that form the amalgamation through which one can critique and, yet, operate politically on behalf of social transformation.

Experiência de cárie em indivíduos com paralisia cerebral / Experience of caries in patients with cerebral palsy

Objetivo: Analisar os fatores associados à experiência de cárie em indivíduos com paralisia cerebral. Métodos: Participaram 543 indivíduos entre 2 e 34 anos de idade. Realizou-se análise descritiva das variáveis e calculou-se a experiência de cárie na dentição decídua (ceo-d ? 0), e na dentição permanente (CPO-D ? 0). As diferenças entre os dois grupos foram analisadas pelo teste de Mann-Whitney e para as amostras com três ou mais grupos utilizou-se o teste de Kruskal-Wallis. As variáveis categóricas foram comparadas através do teste Qui-quadrado de Pearson. Para análise multivariada utilizou-se a regressão logística binária para descrever a relação entre as covariáveis e variável resposta. O ajuste dos modelos foi realizado por meio da estatística de Hosmer & Lemeshow e pelo coeficiente de determinação R2. Para avaliar a classificação econômica foi utilizado o formulário da Associação Nacional de Empresas de Pesquisa. Resultados: Os resultados mostraram que em ambas as dentições, os indivíduos com paralisia cerebral têm menos chance de ter cárie que os indivíduos dos grupos de comparação; os pacientes da classe econômica D e E têm mais chance de apresentar cárie do que os da classe A, B ou C, em ambos os grupos e ainda uma relação positiva entre idade e a chance de experiência de cárie.Conclusão: Pode-se concluir que as diferenças entre os resultados apresentados na literatura e nessa pesquisa se justificam, principalmente, porque as respostas foram estabelecidas, com base em análise de regressão múltipla, que indicou resultados diferentes dos obtidos em análise univariada.

Objective: To analyze the factors associated with the experience of caries in individuals with cerebral palsy. Methods: A total of 543 individuals in the 2-34 age range was included in the study. To evaluate their economic class, the National Association for Business Research form was used. A descriptive analysis of the variables was made and the experience of caries was calculated both in deciduous teeth (ceo-d ? 0), and in permanent teeth (DMF-T ? 0). Differences between the two groups were analyzed by the Mann-Whitney test. For samples with three or more groups, the Kruskal-Wallis test was used. The category variables were compared using the Pearson?s chi-square test. For multivariate analysis, logistic binary regression was used to describe the ratio between covariates and the variable response. The models were adjusted by means of Hosmer & Lemeshow statistics and the R2 determination coefficient. Results: The results showed that in both dentitions, individuals with cerebral palsy have less chance of having caries than the subjects in the comparison groups. Patients of the D and E economic class are more likely to have caries than those in Class A, B or C in both groups. There is a positive ratio between age and the chance of having cavities.Conclusion: We can conclude that the differences between the results found in the literature and in this research are justified, mainly because the answers were established based on multiple regression analysis, which indicated different results from those obtained with univariate analysis.

Análise crítica do discurso do programa nacional de formação de educadoras(es) ambientais - profea: pela não desescolarização da educação ambiental / Critical discourse analysis of the programa nacional de formação de educadores ambientais/profea: against environmental education (ee) withdraw from school

Sob os referenciais da Análise Crítica do Discurso e da Educação Ambiental Crítica, são analisados o Programa Nacional de Formação de Educadores Ambientais (ProFEA) e textos com conceituações-chave para as políticas públicas em Educação Ambiental (EA). Com a análise discursiva feita verifica-se que as relações entre a EA e a escola são apresentadas em duas direções coincidentes: busca-se afastar ou secundarizar tais práticas do contexto escolar, transferindo-as para outros espaços vistos como mais compatíveis à prática educativa ambiental; e, quando estas ações estão voltadas para a inserção nas escolas, nem sempre são concebidas e realizadas em diálogo com a comunidade e os conhecimentos escolares, entrando, portanto, de modo periférico no "mundo da educação", não tocando em questões centrais de sua materialidade. Assim, o ProFEA propõe uma ação formativa sem centralidade na escola e nos agentes da educação. Defende-se aqui a entrada da EA nas escolas públicas pela "porta da frente".

Considering Critical Discourse Analysis and Critical Environmental Education as the theoretical basis of this work, we analyse the Programa Nacional de Formação de Educadores(as) Ambientais (National Program for the formation of environmental educators) and also some texts with key concepts for public politics in Environmental Education (EE). In this work, discourse analysis shows that the relation between EE and school is presented in two coincident directions: on the one hand, it is intended to take those practices out of the school context, transferring them for other spaces considered more compatible with EE practices; on the other hand, when those actions are aimed at school integration, they are not always conceived and done as a dialogue between community and school knowledge. Therefore, they are not included or referred to as central questions for the educational context. Thus, ProFEA suggests that formation actions are not centered at school and the educational agents. This work advocates the entry of EE in public schools by the "front door".