Adrenalectomy attenuates hyperalgesia but does not regulate muscle wasting in a female rat model of fibromyalgia.

Although it is well established that fibromyalgia (FM) syndrome is characterized by chronic diffuse musculoskeletal hyperalgesia, very little is known about the effect of this pathology on muscle tissue plasticity. Therefore, the present study aimed to characterize the putative alterations in skeletal muscle mass in female rats subjected to a FM model by inducing chronic diffuse hyperalgesia (CDH) through double injections of acidic saline (pH 4.0) into the left gastrocnemius muscle at 5-day intervals. To determine protein turnover, the total proteolysis, proteolytic system activities and protein synthesis were evaluated in oxidative soleus muscles of pH 7.2 (control) and pH 4.0 groups at 7 days after CDH induction. All animals underwent behavioural analyses of mechanical hyperalgesia, strength and motor performance. Our results demonstrated that, in addition to hyperalgesia, rats injected with acidic saline exhibited skeletal muscle loss, as evidenced by a decrease in the soleus fibre cross-sectional area. This muscle loss was associated with increased proteasomal proteolysis and expression of the atrophy-related gene (muscle RING-finger protein-1), as well as reduced protein synthesis and decreased protein kinase B/S6 pathway activity. Although the plasma corticosterone concentration did not differ between the control and pH 4.0 groups, the removal of the adrenal glands attenuated hyperalgesia, but it did not prevent the increase in muscle protein loss in acidic saline-injected animals. The data suggests that the stress-related hypothalamic-pituitary-adrenal axis is involved in the development of hyperalgesia, but is not responsible for muscle atrophy observed in the FM model induced by intramuscular administration of acidic saline. Although the mechanisms involved in the attenuation of hyperalgesia in rats injected with acidic saline and subjected to adrenalectomy still need to be elucidated, the results found in this study suggest that glucocorticoids may not represent an effective therapeutic approach to alleviate FM symptoms.

A cross exploratory analysis between nursing working conditions and the occurrence of errors in the northeast region of Brazil.

OBJECTIVES: Analyze and verify the association between working conditions and the occurrence of errors in nursing work. BACKGROUND: Many of the known errors in nursing are based on the structural failure of the complex health service system. Our study addresses the question "Is there an association between errors made by nursing workers and working conditions?" METHODS: The study was carried out through a cross-sectional exploratory analysis of 19 ethical-disciplinary processes focused on errors made by nursing workers. The articles were processed, judged, and archived at the Regional Nursing Councils of the Northeast Region of Brazil from 2000 to 2018. The chi-square test or Fisher's exact test was used to verify the relationship between the variables through multivariate analysis. RESULTS: The analyzes show that working conditions can interfere at occurrence in error. This increases the chance of an "inconsequential" error occurring for the patient in poor/very poor working conditions. The most serious errors, "with consequences irreversible" for the patient, only occur from more severe working conditions. Adversely, it was found that there is no statistically significant difference in the frequency of errors in hospitals (33.33 %) compared to "other places" (28.58 %) when these occurred in poor working conditions. When conducting the incident in poor working conditions, there was a minimum of 52 % protection OR = 0.48 % [0.16; 11.80]; (1-0.48)) against these errors in general in the nursing area. CONCLUSION: The strong association was exposed in working conditions classified as bad/very bad/very bad, resulting in the most serious errors and with irreversible consequences for patients. However, a level of protection for different types of workers was noticed in the field, which shows that there is hope that if the work environment changes with more organization, management, and standards of care, we can prevent future errors.

Access to Mental Health and Substance Use Treatment in Comprehensive Primary Care Plus.

Importance: To meet increasing demand for mental health and substance use services, the Centers for Medicare & Medicaid Services launched the 5-year Comprehensive Primary Care Plus (CPC+) demonstration in 2017, requiring primary care practices to integrate behavioral health services. Objective: To examine the association of CPC+ with access to mental health and substance use treatment before and during the COVID-19 pandemic. Design, Setting, and Participants: Using difference-in-differences analyses, this retrospective cohort study compared adults attributed to CPC+ and non-CPC+ practices, from January 1, 2018, to June 30, 2022. The study included adults aged 19 to 64 years who had depression, anxiety, or opioid use disorder (OUD) and were enrolled with a private health insurer in Pennsylvania. Data were analyzed from January to June 2023. Exposure: Receipt of care at a practice participating in CPC+. Main Outcomes and Measures: Total cost of care and the number of primary care visits for evaluation and management, community mental health center visits, psychiatric hospitalizations, substance use treatment visits (residential and nonresidential), and prescriptions filled for antidepressants, anxiolytics, buprenorphine, naltrexone, or methadone. Results: The 188 770 individuals in the sample included 102 733 adults (mean [SD] age, 49.5 [5.6] years; 57 531 women [56.4%]) attributed to 152 CPC+ practices and 86 037 adults (mean [SD] age, 51.6 [6.6] years; 47 321 women [54.9%]) attributed to 317 non-CPC+ practices. Among patients diagnosed with OUD, compared with patients attributed to non-CPC+ practices, attribution to a CPC+ practice was associated with filling more prescriptions for buprenorphine (0.117 [95% CI, 0.037 to 0.196] prescriptions per patient per quarter) and anxiolytics (0.162 [95% CI, 0.005 to 0.319] prescriptions per patient per quarter). Among patients diagnosed with depression or anxiety, attribution to a CPC+ practice was associated with more prescriptions for buprenorphine (0.024 [95% CI, 0.006 to 0.041] prescriptions per patient per quarter). Conclusions and Relevance: Findings of this cohort study suggest that individuals with an OUD who received care at a CPC+ practice filled more buprenorphine and anxiolytics prescriptions compared with patients who received care at a non-CPC+ practice. As the Centers for Medicare & Medicaid Innovation invests in advanced primary care demonstrations, it is critical to understand whether these models are associated with indicators of high-quality primary care.

Ohio Presents Opportunities For Understanding Hospital Alignment With Public Health Agencies On Community Health Assessments.

Multisector collaboration is critical for improving population health. Improving alignment between nonprofit hospitals and local health departments is one promising approach to achieving health improvement, and a number of states are exploring policies to facilitate such collaboration. Using public documents, we evaluated the alignment between Ohio nonprofit hospitals and local health departments in the community health needs they identify and those they prioritize. The top three needs identified by hospitals and health departments were mental health, substance use, and obesity. Alignment across organizations was high among the top needs, but it varied more among less commonly identified needs. Alignment related to social determinants of health was low, with health departments being more responsive to social determinants than hospitals. Given the different strengths and capacities of hospitals and health departments, this divergence may be in the best interests of the communities they serve. Community benefit policies should consider how to promote collaboration between hospitals and health departments while also encouraging organizations to use their own expertise to meet community needs.

Botanical Extracts and Compounds of Castanea Plants and Methods of Use: US20190125818A1 - The United States Patent Evaluation.

BACKGROUND: Bacterial infections are increasingly difficult to combat, which makes them a threat to public health on a global level. Staphylococcus aureus is considered one of the main causes of infections in hospitals, as it has a variety of virulence factors, as well as is able to produce bacterial biofilms, which, consequently, bring numerous damages to public health as a result of increased resistance to conventional antibiotics and a longer hospital stay. Therefore, the use of compounds extracted from medicinal plants is a potential pharmaceutically acceptable target, as they do not have toxicity and the potential to disrupt biofilms produced by Staphylococcus aureus already evidenced, thus revealing their relevance to our study. OBJECTIVE: The objective of this work was to perform a critical analysis of a patent with natural extracts against bacterial biofilms found in the United States Patent and Trademark Office (USPTO) database, to map the possible bioactive compounds that may serve as potential future antimicrobial drugs. METHODS: A technological survey was carried out to verify existing patents using natural extracts with anti-biofilm potential. For this, it was searched with the keywords: Botanical extracts AND biofilms; which were performed in the United States Patent and Trademark Office (USPTO) database. Thus, the selected patent used a non-aqueous extract partitioned and vacuum-contracted, subsequently lyophilized for assays with antimicrobial potential. Because of this, a patent was analyzed regarding its chemistry, and biological activity, followed by a critical analysis of the technology proposed in the invention. RESULTS: When using the keywords Botanical extracts AND biofilms in the USPTO, it was possible to find twenty-two inventions; however, only four patents in the USPTO were in agreement with the proposal of the natural extract having antimicrobial activity and an anti-biofilm potential, of which two belonged to the same applicant with similar proposals. The key point of this invention was to enable the compounds of the Castanea sativa plant and its methods of obtaining the extract to present a significant antimicrobial action associated or not with antibiotics, promoting the development of new therapies against bacterial infections capable of disrupting biofilms. The invention developed a methodology for extracting Castanea sativa, in which pentacyclic triterpene compounds were found mostly in its leaves. Whereas for the extraction, the crude methanol extracts called extracts 224 from the ground leaves were made by maceration, filtered, combined, concentrated under pressure in rotary evaporators, and lyophilized. After that, they were resuspended in water and partitioned in succession with hexane, ethyl acetate, and butanol. The most active refined partition was the 224C extract with the solvent ethyl acetate, which was subjected to further fractionation using silica column chromatography. Resulting in the most refined extract, which was 224C-F2, capable of acting directly on the quorum sensing of bacteria, mainly Staphylococcus aureus, blocking the translation of RNAIII, including a series of exotoxins. Regarding the antimicrobial capacity against Staphylococcus aureus, it presented Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of 1.56 µg/mL-1 and > 100 µg/mL -1, respectively. CONCLUSION: Given the analyzed patent, it was possible to verify the importance of alternatives to reduce the impact of bacterial biofilms, which causes damage to industries in general and to health. From this, the invention analyzed has a promising proposal with antimicrobial potential focusing on the great impact of bacterial biofilms. Therefore, natural extracts with antibiofilmic potential can help to minimize the economic losses caused to health due to these multidrug-resistant microorganisms with different virulence mechanisms.

Nursing care for the Warao people: an experience report based on transcultural theory.

OBJECTIVE: To report on the experience of nurses from the Street Clinic in caring for the Indigenous Venezuelan population of the Warao ethnic group in Maceió/AL based on Madeleine Leininger's Transcultural Theory. METODOLOGY: A descriptive study, of the experience report type, based on the care of the Warao Indigenous population in the light of Madeleine Leininger's Transcultural Theory, carried out during the year 2022. RESULTS: Light technologies were used to form bonds and understand the cultural universe of the Warao people. The concepts of preservation, accommodation and cultural restructuring of care from Leininger's transcultural theory helped to elucidate the practice. Comprehensive care was offered in accordance with the programs recommended by the Ministry of Health, with transcultural care, including respect for refusal of care. The language barrier and health beliefs represented challenges in the context of singular care. FINAL CONSIDERATIONS: The experience of nurses from the Street Clinic in caring for the Indigenous population favored significant social interaction and expanded the possibilities for achieving comprehensive health care. The application of Transcultural Theory proved to be an effective and congruent device for health care.

Technological and health properties and main challenges in the production of vegetable beverages and dairy analogs.

Lactose intolerance affects about 68-70% of the world population and bovine whey protein is associated with allergic reactions, especially in children. Furthermore, many people do not consume dairy-based foods due to the presence of cholesterol and ethical, philosophical and environmental factors, lifestyle choices, and social and religious beliefs. In this context, the market for beverages based on pulses, oilseeds, cereals, pseudocereals and seeds and products that mimic dairy foods showed a significant increase over the years. However, there are still many sensory, nutritional, and technological limitations regarding producing and consuming these products. Thus, to overcome these negative aspects, relatively simple technologies such as germination and fermentation, the addition of ingredients/nutrients and emerging technologies such as ultra-high pressure, pulsed electric field, microwave and ultrasound can be used to improve the product quality. Moreover, consuming plant-based beverages is linked to health benefits, including antioxidant properties and support in the prevention and treatment of disorders and common diseases like hypertension, diabetes, anxiety, and depression. Thus, vegetable-based beverages and their derivatives are viable alternatives and low-cost for replacing dairy foods in most cases.

Reduced sympathetic activity is associated with the development of pain and muscle atrophy in a female rat model of fibromyalgia.

Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain accompanied by fatigue and muscle atrophy. Although its etiology is not known, studies have shown that FM patients exhibit altered function of the sympathetic nervous system (SNS), which regulates nociception and muscle plasticity. Nevertheless, the precise SNS-mediated mechanisms governing hyperalgesia and skeletal muscle atrophy in FM remain unclear. Thus, we employed two distinct FM-like pain models, involving intramuscular injections of acidic saline (pH 4.0) or carrageenan in prepubertal female rats, and evaluated the catecholamine content, adrenergic signaling and overall muscle proteolysis. Subsequently, we assessed the contribution of the SNS to the development of hyperalgesia and muscle atrophy in acidic saline-injected rats treated with clenbuterol (a selective ß2-adrenergic receptor agonist) and in animals maintained under baseline conditions and subjected to epinephrine depletion through adrenodemedullation (ADM). Seven days after inducing an FM-like model with acidic saline or carrageenan, we observed widespread mechanical hyperalgesia along with loss of strength and/or muscle mass. These changes were associated with reduced catecholamine content, suggesting a common underlying mechanism. Notably, treatment with a ß2-agonist alleviated hyperalgesia and prevented muscle atrophy in acidic saline-induced FM-like pain, while epinephrine depletion induced mechanical hyperalgesia and increased muscle proteolysis in animals under baseline conditions. Together, the results suggest that reduced sympathetic activity is involved in the development of pain and muscle atrophy in the murine model of FM analyzed.

Hospitals' uneven recovery from the COVID-19 pandemic.

Using hospital cost report data from the Centers for Medicare and Medicaid Services, we examined the changes in hospitals' operating margins and total margins between 2019 and 2021. We found that, as of 2021, hospitals' operating margins had not fully rebounded to 2019 levels, although they had recovered from the 2020 nadirs. Conversely, average total margins increased by 140% during this period across all US hospitals, with the most significant growth occurring among rural hospitals, publicly operated hospitals, and critical access hospitals. Rural hospitals exhibited the largest gains in total margins during this time, experiencing a 1600% increase from 2019 to 2021. Our findings indicate that government relief funding tied to the COVID-19 Public Health Emergency significantly bolstered the financial health of the average hospital and had an outsize effect on lifting total margins among smaller hospitals that entered the pandemic in the most financially vulnerable position.

Dietary intake in individuals with phenylketonuria: an integrative review / Ingesta dietética en individuos con fenilcetonuria: una revisión integradora

Introduction: the dietary intake of individuals with phenylketonuria (PKU) may vary widely according to different cultural eating habits, lifestyle,access to multidisciplinary team, and metabolic formulas available. Thus, knowing the dietary intake of this population makes it possible to tailornutritional treatment strategies to impact their health.Objective: to analyze the evidence on the dietary intake of individuals with PKU.Methods: an integrative literature review was conducted on the dietary intake of individuals with PKU in the databases PUBMED, BIREME andScience Direct. Original articles that addressed the energy and macronutrient food intake of children, adolescents and/or adults with PKU wereincluded in the study, without time restriction, in any language. A total of 384 articles were found and 27 articles were selected and analyzed.Results: evidence about the nutritional composition of their diet showed that individuals with PKU consume between 1160-2721 kcal of energy—7.2-17.4 % (32.4-76.9 g) of energy as protein, 45.9-69.2 % of energy as carbohydrates, 16.6-39 % of energy as lipids— and between7.6 and 20 g of fiber.Conclusion: most individuals with PKU have low energy, protein and fiber intake, adequate lipid intake, and high carbohydrate intake. Metaboliccontrol of the disease is still a challenge in all countries. Nutritional strategies to improve dietary nutritional composition and phenylalanine bloodlevels in individuals with PKU remain an urgent issue.(AU)

Introducción: la ingesta dietética de los individuos con fenilcetonuria (PKU) puede variar ampliamente debido a los diferentes hábitos culturalesde alimentación, el estilo de vida, el acceso al equipo multidisciplinar y las fórmulas metabólicas disponibles. Por ello, conocer la ingesta dietéticade esta población permite adaptar las estrategias de tratamiento nutricional para incidir en su salud.Objetivo: analizar la evidencia sobre la ingesta dietética de individuos con PKU.Métodos: se realizó una revisión bibliográfica integradora sobre la ingesta dietética de las personas con PKU en las bases de datos PUBMED,BIREME y Science Direct. El estudio incluyó artículos originales que abordaran la ingesta alimentaria de energía y macronutrientes de niños,adolescentes y/o adultos con PKU, sin restricción de tiempo, en cualquier idioma. Se encontraron 384 artículos y se seleccionaron y analizaron 27.Resultados: la evidencia de la composición nutricional de la dieta mostró que los individuos con PKU consumen entre 1160 y 2721 kcal deenergía —7,2-17,4 % (32,4-76,9 g) de la energía en forma de proteínas, 45,9-69,2 % de la energía en carbohidratos, 16,6-39 % de la energíaen lípidos— y entre 7,6 y 20 g de fibra.Conclusiones: la mayoría de los individuos con PKU tienen una ingesta baja de energía, proteínas y fibra, una ingesta adecuada de lípidos y unaingesta alta de hidratos de carbono. El control metabólico de la enfermedad sigue siendo un reto en todos los países. Siguen siendo urgenteslas estrategias nutricionales para mejorar la composición nutricional de la dieta y los niveles de fenilalanina en sangre de los individuos con PKU.(AU)

Combinação de terapia por ondas de choque extracorpórea e agulhamento seco no tratamento de lombalgia crônica incapacitante: um relato de caso / Combination of extracorporeal shockwave therapy and dry needling as treatment of disabling chronic low back pain: a case report

Paciente do sexo masculino, 55 anos, apresentava antecedente clínico de radiculopatia lombar abordado cirurgicamente (discectomia e artrodese L5-S1) em dezembro de 2021, com resolução completa da dor associada. Iniciou com quadro de dor pós-operatória de características distintas. A primeira sessão de tratamento iniciou-se com terapia por ondas de choque extracorpóreas focal direcionada ao quadrado lombar, glúteo médio, glúteo mínimo e região peritrocantérica à direita. Posteriormente, associou-se agulhamento seco em pontos-gatilho presentes nesses mesmos 3 músculos e também no ligamento sacrotuberal direito, junto à inserção do glúteo máximo direito. Numa reavaliação uma semana depois, o paciente referiu uma redução de 70% da intensidade da dor inicial. O mesmo tratamento foi repetido, com resolução completa dos sintomas no final da sessão. Três meses depois, o doente manteve o controle álgico e recuperou totalmente a sua funcionalidade e qualidade de vida anteriores. Neste caso de limitação funcional a longo prazo devido a dor lombar crônica, a combinação da terapia por ondas de choque extracorporais e do agulhamento seco resultou num método eficaz e rápido para obter o alívio da dor e restaurar a funcionalidade anterior. No entanto, são necessários mais estudos para investigar o impacto desta combinação de terapias no controle da dor e na perda de funcionalidade devido à dor lombar crônica.

Male patient, 55 years old, had a clinical background of lumbar radiculopathy and a surgical approach (L5-S1 discectomy and arthrodesis) in December of 2021, with complete resolution of associated pain. One year later, the patient seeks medical treatment, referring a new, different pattern of low back pain, which initiated post-surgery. The first treatment session began with focused extracorporeal shockwave therapy directed at the right quadratus lumborum, gluteus medius, gluteus minimus and peritrochanteric region. Afterwards, dry needling was associated in trigger-points present in those same 3 muscles and also in the right sacrotuberal ligament, close to the insertion of the right gluteus maximus. In a reevaluation one week later, the patient reported a reduction of 70% of initial pain intensity. The same treatment was repeated, with complete resolution of symptoms at the end of the session. Three months later, the patient-maintained symptom control and fully recovered his previous functionality and quality of life. In this case of long-term functional limitation due to chronic low back pain, the combination of extracorporeal shock wave therapy and dry needling resulted in an effective and quick method to achieve pain relief and restore previous functionality. However, more studies are needed to investigate the impact of this combination of therapies in pain management and functionality loss due to chronic low back pain.

Nursing care for the Warao people: an experience report based on transcultural theory / Cuidados de Enfermería del pueblo Warao: un informe de experiencia basado en la teoría transcultural / Cuidados de Enfermagem ao povo Warao: um relato de experiência baseado na teoria transcultural

ABSTRACT Objective: To report on the experience of nurses from the Street Clinic in caring for the Indigenous Venezuelan population of the Warao ethnic group in Maceió/AL based on Madeleine Leininger's Transcultural Theory. Metodology: A descriptive study, of the experience report type, based on the care of the Warao Indigenous population in the light of Madeleine Leininger's Transcultural Theory, carried out during the year 2022. Results: Light technologies were used to form bonds and understand the cultural universe of the Warao people. The concepts of preservation, accommodation and cultural restructuring of care from Leininger's transcultural theory helped to elucidate the practice. Comprehensive care was offered in accordance with the programs recommended by the Ministry of Health, with transcultural care, including respect for refusal of care. The language barrier and health beliefs represented challenges in the context of singular care. Final considerations: The experience of nurses from the Street Clinic in caring for the Indigenous population favored significant social interaction and expanded the possibilities for achieving comprehensive health care. The application of Transcultural Theory proved to be an effective and congruent device for health care.

RESUMEN Objetivo: Referir la experiencia de enfermeros de una Unidad Sanitaria Móvil en la atención a la población indígena venezolana de la etnia Warao, en Maceió/AL, a partir de la Teoría Transcultural de Madeleine Leininger. Metodología: Se trata de un estudio descriptivo, del tipo informe de experiencia, basado en la atención a la población indígena Warao a la luz de la Teoría Transcultural de Madeleine Leininger, realizado durante el año 2022. Resultados: Se utilizaron tecnologías leves para crear vínculos y comprender el universo cultural del pueblo Warao. Los conceptos de preservación, acomodación y reestructuración cultural de los cuidados de la teoría transcultural de Leininger ayudaron a dilucidar la práctica. Se ofreció atención integral según los programas recomendados por el Ministerio de Salud, con atención transcultural y se respetó el rechazo a la atención. La barrera lingüística y las creencias sanitarias representaron desafíos en el contexto de la atención singular. Conclusión: La experiencia de los enfermeros de la Unidad Sanitaria Móvil en la atención a la población indígena favoreció mucho la interacción social y amplió las posibilidades de lograr una atención sanitaria integral. La aplicación de la Teoría Transcultural demostró ser un dispositivo eficaz y adecuado para el cuidado de la salud.

RESUMO Objetivo: Relatar a experiência de enfermeiros do Consultório na Rua no cuidado à população indígena venezuelana da etnia Warao em Maceió/AL a partir da Teoria Transcultural de Madeleine Leininger. Metodologia: Estudo descritivo, do tipo relato de experiência, a partir do cuidado da população indígena Warao à luz da Teoria Transcultural de Madeleine Leininger, realizado durante o ano de 2022. Resultados: Utilizaram-se tecnologias leves para formação de vínculo e compreensão do universo cultural do povo Warao. Os conceitos de preservação, acomodação e reestruturação cultural do cuidado da teoria Transcultural de Leininger contribuíram para elucidar a prática vivenciada. Ofertou-se uma atenção integral conforme os programas preconizados pelo Ministério da Saúde, com cuidado transcultural, inclusive com respeito à recusa de assistência. A barreira linguística e as crenças no que tange à saúde representaram desafios no contexto do cuidado singular. Conclusão: A experiência de enfermeiros do Consultório na Rua no cuidado a população indígena favoreceu uma significativa interação social e ampliou as possibilidades para o alcance da integralidade em saúde. A aplicação da Teoria Transcultural se mostrou como um dispositivo eficaz e congruente para o cuidado em saúde.

Análise noticiosa do trabalho em enfermagem no contexto da pandemia da COVID-19 / Análisis de noticias sobre el trabajo de enfermería en el contexto de la pandemia de COVID-19 / News analysis of nursing work in the context of the COVID-19 pandemic

Resumo Objetivo Analisar as notícias veiculadas na imprensa brasileira sobre o trabalho em enfermagem no período da pandemia da COVID-19, compreendido entre fevereiro de 2020 a agosto de 2021. Métodos Estudo documental, descritivo, de abordagem qualitativa. Elaborado a partir de informações coletadas em sites de notícias, por meio de clipping, seguindo as etapas de monitoramento, coleta, análise e arquivamento de menções ao trabalho em enfermagem feitas pela mídia brasileira. A amostra totalizou 432 notícias. A análise dos dados se deu pela Análise de Conteúdo Temática proposta por Laurence Bardin. Resultados O ano de 2020 destacou-se dentre as notícias analisadas (59,96%), cujos personagens envolvidos foram profissionais da enfermagem, do sexo feminino (36,57%), de nível técnico (38,89%) e superior (38,43%). Houve predomínio de notícias nas regiões Sudeste (45,83%) e Centro-Oeste (17,36%). Foram identificadas seis categorias para análise dos dados: óbitos entre as trabalhadoras (40,74%), condições precárias de trabalho (28,94%), vacinação (8,56%), contaminação das trabalhadoras (8,33%), suspeita de infração ética (8,10%) e cura da COVID-19 (5,32%). Conclusão A pandemia da COVID-19 no Brasil trouxe o trabalho e as trabalhadoras da enfermagem para o centro de debate jornalístico. O óbito, as condições precárias de trabalho e a contaminação das trabalhadoras de enfermagem, veiculadas na imprensa, relacionam-se com a precarização do trabalho em enfermagem neste estudo. Conjectura-se que o debate jornalístico sobre o trabalho em enfermagem na pandemia da COVID-19 ajudou a fortalecer pautas políticas, como a que conduziu à promulgação da Lei n. 14.434/2022, que trata do piso salarial nacional para essas profissionais.

Resumen Objetivo Analizar las noticias difundidas en la prensa brasileña sobre el trabajo de enfermería en el período de la pandemia de COVID-19 comprendido entre febrero de 2020 y agosto de 2021. Métodos Estudio documental, descriptivo, de enfoque cualitativo. Elaborado a partir de información recopilada en sitios web de noticias, por medio de clipping, siguiendo las etapas de monitoreo, recopilación, análisis y archivo de menciones del trabajo de enfermería realizadas por los medios de comunicación brasileños. La muestra totalizó 432 noticias. El análisis de los datos se realizó mediante el análisis de contenido temático propuesto por Laurence Bardin. Resultados El año 2020 se destacó entre las noticias analizadas (59,96 %), cuyos personajes involucrados fueron profesionales de enfermería, de sexo femenino (36,57 %), de nivel técnico (38,89 %) y superior (38,43 %). Hubo un predominio de noticias en la región Sudeste (45,83 %) y Centro-Oeste (17,36 %). Se identificaron seis categorías para el análisis de datos: fallecimiento entre las trabajadoras (40,74 %), condiciones de trabajo precarias (28,94 %), vacunación (8,56 %), contaminación de las trabajadoras (8,33 %), sospecha de infracción ética (8,10 %) y cura de COVID-19 (5,32 %). Conclusión La pandemia de COVID-19 en Brasil colocó el trabajo de enfermería y sus trabajadoras en el centro del debate periodístico. Los fallecimientos, las condiciones de trabajo precarias y la contaminación de las trabajadoras de enfermería, difundidas en la prensa, se relacionan con la precarización del trabajo de enfermería en este estudio. Se presume que el debate periodístico sobre el trabajo de enfermería durante la pandemia de COVID-19 ayudó a fortalecer debates políticos, como el que llevó a la promulgación de la ley n°. 14.434/2022, que trata sobre el salario mínimo nacional para estas profesionales.

Abstract Objective To analyze the news published in the Brazilian press about nursing work during the COVID-19 pandemic period, between February 2020 and August 2021. Methods This is a documentary, descriptive study with a qualitative approach. Elaborated from information collected on news sites, through clipping, following the stages of monitoring, collection, analysis and archiving of mentions of work in nursing made by the Brazilian media. The sample totaled 432 news. Data analysis was performed using the Thematic Content Analysis proposed by Laurence Bardin. Results The year 2020 stood out among the analyzed news (59.96%), whose characters involved were nursing professionals, female (36.57%), technical (38.89%) and higher (38. 43%). There was a predominance of news in the Southeast (45.83%) and Midwest (17.36%) regions. Six categories were identified for data analysis: deaths among workers (40.74%), precarious working conditions (28.94%), vaccination (8.56%), contamination of workers (8.33%), suspected of ethical infraction (8.10%) and COVID-19 cure (5.32%). Conclusion The COVID-19 pandemic in Brazil brought nursing work and workers to the center of journalistic debate. Death, precarious working conditions and contamination of nursing workers, reported in the press, are related to the precariousness of nursing work in this study. It is conjectured that the journalistic debate on nursing work in the COVID-19 pandemic helped to strengthen political guidelines, such as the one that led to the enactment of Law 14,434/2022, which deals with the national wage floor for these professionals.

Repercussions of the labor reform on nursing work in the context of the covid-19 pandemic / Repercusiones de la reforma laboral sobre el trabajo en enfermería en el contexto de la pandemia de COVID-19 / Repercussões da reforma trabalhistas sobre o trabalho em enfermagem no contexto da pandemia de Covid-19

ABSTRACT Objective: To reflect on the repercussions of the Labor Reform on nursing work during the COVID-19 pandemic. Methods: This is a reflective study based on the legal aspects of the Labor Reform in dialog with scientific productions pertaining to nursing work. Results: With the rise of the COVID-19 pandemic, the flexibilization of labor is being intensified, legally backed up by the Labor Reform. For nursing workers, the repercussions are felt in the work relationship, during the workday, in the salary, in union action, and in job protection. Final considerations: It is evident that, after the legislative changes, there's no certainty that the flexibilization of labor and social security laws will bring favorable results in terms of economic growth, reduction of inequalities, and lower unemployment rates for the nursing workers. Therefore, the political organization of the professional categories is the way to overcome this scenario.

RESUMEN Objetivo: Reflexionar sobre las repercusiones de la Reforma Laboral en la enfermería durante la pandemia de COVID-19. Métodos: Estudio del tipo reflexivo basado en los aspectos legales de la Reforma Laboral en diálogo con producciones científicas acerca del trabajo en enfermería. Resultados: Con la ascensión de la pandemia de COVID-19, observado el provocamiento de flexibilidad laboral, amparado jurídicamente por la Reforma Laboral. Para los/las trabajadores/as de enfermería, las repercusiones se producen en el vínculo de trabajo, en la jornada laboral, en el salario, en la actuación sindical y en la protección al empleo. Consideraciones finales: Evidenciado que, para los/las trabajadores/as de enfermería, tras los cambios legislativos, no hay seguridad de que la flexibilidad de las leyes laborales y previsiones traigan resultados favorables para el crecimiento económico, reducción de desigualdades y menores tasas de desempleo. Así, la organización política de las categorías es la vía para el enfrentamiento de ese escenario.

RESUMO Objetivo: Refletir sobre as repercussões da Reforma Trabalhista no trabalho em enfermagem durante a pandemia de COVID-19. Métodos: Trata-se de um estudo do tipo reflexivo com base nos aspectos legais da Reforma Trabalhista em diálogo com produções científicas acerca do trabalho em enfermagem. Resultados: Com a ascensão da pandemia de COVID-19, observa-se o acirramento da flexibilização do trabalho, amparado juridicamente pela Reforma Trabalhista. Para os/as trabalhadores/as da enfermagem, as repercussões dão-se no vínculo de trabalho, na jornada de trabalho, no salário, na atuação sindical e na proteção ao emprego. Considerações finais: Evidencia se que, para os/as trabalhadores/as da enfermagem, após as mudanças legislativas, não há segurança de que a flexibilização das leis trabalhistas e previdenciárias tragam resultados favoráveis para o crescimento econômico, redução das desigualdades e menores taxas de desemprego. Com isso, a organização política das categorias é a via para o enfrentamento desse cenário.

Llamadas para contratación de enfermeros (as) en tiempos de coronavirus / Calls for hiring nurses in times of coronavirus

Objetivo: Identificar el perfil de las vacantes para enfermeras (os) divulgadas a través de las redes sociales durante la pandemia de COVID-19. Método: Estudio cuantitativo, descriptivo y exploratorio, de base documental a partir de publicaciones de facebook, instagram y twitter a través del uso de hashtags: facebook (#vacantes #enfermería y #empleo #enfermero), instagram (#vagaenfermero y #vacantes) y en twitter (#vacante y #enfermero) del 1 al 22 de marzo de 2021. Inicialmente se encontraron 6.173 publicaciones de las cuales 117 fueron seleccionadas tras aplicación de los criterios de inclusión y exclusión y análisis. Resultados: Las informaciones predominantes en las publicaciones fueron dispuestas en cinco categorías, que fueron nombradas con un hashtag: #enfermerospecialistas, #requisitosmínimos, #vínculolaboral, #remuneración y #jornadatrabajo. El Sudeste fue la región que más requirió especialistas, seguido del Nordeste y Sur. En cuanto a los requisitos mínimos, 81,60% de las publicaciones presentaron requisitos, entre estos la experiencia profesional y poseer posgrado fueron las más presentes. El vínculo laboral más evidente fue el contrato efectivo. El rango salarial estaba entre 4,1 y 5 salarios mínimos. Y la carga horaria semanal presentó el mayor porcentaje en 24 horas e igual o superior a 40 horas. Conclusión: Conocer el escenario de contratación de enfermeros en tiempos de coronavirus, evidencia una tendencia ya anunciada, que es la escasez de profesionales calificados para la actuación en el mercado de trabajo, además de las condiciones devaluadoras que concierne el trabajo de enfermería. (AU)

Objective: To identify the profile of vacancies for nurses disseminated through social media during the COVID-19 pandemic. Method: Quantitative, descriptive and exploratory document-based study based on facebook, instagram and twitter publications through the use of hashtags: facebook (#vacancies #nursing and #employment #nurse), instagram (#vacanciesnurse y and #vacancies) and on twitter (#vacancies and #nurse), from March 01 to 22, 2021. Initially, 6,173 publications were found, of which 117 were selected after applying the inclusion and exclusion criteria and analysis. Results: The predominant information in the publications was arranged in five categories, which were named with a hashtag: #nursespecialists, #minimumrequirements, #employment bond, #remuneration and #businessday. The Southeast was the region that most required specialists, followed by the Northeast and the South. Regarding the minimum requirements, 81.60% of the publications had requirements, among which professional experience and having a postgraduate degree were the most present. The most evident employment relationship was the effective contract. The salary range was between 4.1 and 5 minimum wages. And the weekly workload had the highest percentage in 24 hours and equal to or greater than 40 hours. Conclusion: Knowing the scenario of hiring nurses in times of coronavirus shows an already announced trend, which is the shortage of qualified professionals to work in the labor market, in addition to the devaluing conditions that affect nursing work. (AU)

The Healthcare Failure Mode and Effect Analysis as a tool to evaluate care protocols / El Healthcare Failure Mode and Effect Analysis como herramienta de evaluación de protocolos asistenciales / O Healthcare Failure Mode and Effect Analysis como ferramenta de avaliação de protocolos assistenciais

ABSTRACT Objectives: to identify, classify, and analyze modes of failure in the medication process. Methods: evaluative research that used the Healthcare Failure Mode and Effect Analysis (HFMEA) in a service of bone marrow transplant from June to September 2018, with the participation of 35 health workers. Results: 207 modes of failure were identified and classified as mistakes in verification (14%), scheduling (25.6%), administration (29%), dilution (16.4%), prescription (2.4%), and identification (12.6%). The analysis of risk showed a moderate (51.7%) and high (30.9%) need of intervention, leading to the creation of an internal quality assurance group and of continued education activities. Conclusions: the Healthcare Failure Mode and Effect Analysis showed itself to be a tool to actively identify, classify, and analyze failures in the process of medication, contributing for the proposal of actions aimed at patient safety.

RESUMEN Objetivos: identificar, clasificar y analizar modos de fallos en el proceso de medicación. Métodos: investigación evaluativa que utilizó el Healthcare Failure Mode and Effect Analysis (HFMEA) en Servicio de Trasplante de Médula Ósea, de junio a septiembre de 2018, con la participación de 35 profesionales de salud. Resultados: han sido identificados 207 modos de fallos, clasificados en errores de chequeo (14%); aplazamiento (25,6%); administración (29%); dilución (16,4%); prescripción (2,4%) e identificación (12,6%). El análisis del riesgo evidenció la necesidad de intervención moderada (51,7%) y alta (30,9%), resultando en la creación del equipo interno de calidad y actividades de educación continua. Conclusiones: el Healthcare Failure Mode and Effect Analysis demostró ser herramienta para identificar, clasificar y analizar, activamente, fallos en el proceso de medicación, contribuyendo para la proposición de acciones con objetivo de seguridad del paciente.

RESUMO Objetivos: identificar, classificar e analisar modos de falhas no processo de medicação. Métodos: pesquisa avaliativa que utilizou o Healthcare Failure Mode and Effect Analysis (HFMEA) em Serviço de Transplante de Medula Óssea, de junho a setembro de 2018, com a participação de 35 profissionais de saúde. Resultados: foram identificados 207 modos de falhas, classificados em erros de checagem (14%); aprazamento (25,6%); administração (29%); diluição (16,4%); prescrição (2,4%) e identificação (12,6%). A análise do risco evidenciou a necessidade de intervenção moderada (51,7%) e alta (30,9%), resultando na criação do grupo interno de qualidade e atividades de educação continuada. Conclusões: o Healthcare Failure Mode and Effect Analysis demonstrou ser ferramenta para identificar, classificar e analisar, ativamente, falhas no processo de medicação, contribuindo para a proposição de ações com vistas à segurança do paciente.

Determinantes na produção de erro no trabalho em enfermagem / Determinantes en la producción de error en el trabajo de enfermería / Determinants in the production of error in nursing work

Objetivo: analisar condições determinantes para a produção de erro no trabalho em enfermagem. Método: pesquisa documental, analítica, qualitativa. Dados coletados em 19 processos ético-disciplinares, no período de 2000 a 2018, cujo objeto de denúncia foi o erro cometido por trabalhadoras em enfermagem. Empregou-se a Análise de Conteúdo Temática proposta por Bardin e a Teoria da Produção Social interpretada por Carlos Matus. Resultados: as técnicas e auxiliares em enfermagem foram as trabalhadoras mais denunciadas; o erro de medicação foi o mais frequente; a precarização do trabalho foi condição determinante na ocorrência de erros nos processos analisados. Considerações finais: predominaram condições estruturais de produção de erro no trabalho em enfermagem, permitindo refutar a noção hegemônica do erro como fenômeno moral no trabalho em enfermagem.

Objetivo: analizar condiciones determinantes para la producción de error en el trabajo en enfermería. Método: investigación documental, analítica, cualitativa. Datos recogidos en 19 procesos ético-disciplinarios, en el período de 2000 a 2018, cuyo objeto de denuncia fue el error cometido por trabajadoras en enfermería. Se empleó el Análisis de Contenido Temático propuesto por Bardin y la Teoría de la Producción Social interpretada por Carlos Matus. Resultados: las técnicas y auxiliares en enfermería fueron las trabajadoras más denunciadas; el error de medicación fue el más frecuente; la precarización del trabajo fue condición determinante en la ocurrencia de errores en los procesos analizados. Consideraciones finales: predominaron condiciones estructurales de producción de error en el trabajo en enfermería, permitiendo refutar la noción hegemónica del error como fenómeno moral en el trabajo en enfermería.

Objective: to analyze determinant conditions for the production of error in nursing work. Method: documentary, analytical, qualitative research. Data collected in 19 ethical-disciplinary processes, from 2000 to 2018, whose object of complaint was the mistake committed by nursing workers. The Thematic Content Analysis proposed by Bardin and the Theory of Social Production interpreted by Carlos Matus were used. Results: nursing techniques and assistants were the most reported workers; medication error was the most frequent; job precariousness was a determining condition in the occurrence of errors in the processes analyzed. Final considerations: structural conditions of error production in nursing work predominated, allowing refuting the hegemonic notion of error as a moral phenomenon in nursing work.

Caracterização da produção científica sobre erro no trabalho em saúde / Caracterización de la producción científica sobre error en el trabajo en salud / Characterization of scientific production on errors in health work

Resumo Objetivo Caracterizar a produção científica nacional e internacional sobre erro no trabalho em saúde no período de 2000 a 2020. Métodos Trata-se de revisão integrativa de literatura, de estudos nacionais e internacionais, realizada nas bases MEDLINE, LILACS/BIREME, PubMed e SciELO. Foram encontrados 4164 estudos, sendo 148 incluídos e submetidos a análise de conteúdo temática. As buscas foram realizadas no período de janeiro a março de 2020 e abril de 2021. Os resultados foram sistematizados em três categorias temáticas. Resultados Na categoria Características dos estudos sobre erros, evidenciou-se que as categorias profissionais mais frequentes na ocorrência do erro são enfermeiras(os), médicos e farmacêuticos; quanto à Características do erro no trabalho em saúde, os tipos mais relatados são erro de medicação, de diagnóstico e na assistência de enfermagem, incluindo queda de pacientes, flebites decorrentes de cateteres venosos periféricos, ocorrência de úlceras por pressão e extubação de drenos, cateteres e sondas; e no Contexto para a ocorrência do erro, foram identificados elementos individuais e do contexto do trabalho, destacando-se este último. Conclusão Evidenciou-se que a ocorrência de erros no trabalho em saúde ocorre em um contexto de precarização do trabalho, com processos de trabalho marcados pela heterogeneidade. A partir da compreensão de que os trabalhadores da saúde erram e que a precarização do trabalho potencializa a ocorrência de erros, faz-se necessário a reorganização dos sistemas de saúde para que sejam reduzidas as oportunidades para o acontecimento de erros e que sejam promovidos os aprendizados quando estes ocorrerem.

Resumen Objetivo Caracterizar la producción científica nacional e internacional sobre el error en el trabajo en salud en el período de 2000 a 2020. Métodos Se trata de una revisión integrativa de literatura, de estudios nacionales e internacionales, realizada en las bases MEDLINE, LILACS/BIREME, PubMed y SciELO. Se encontraron 4164 estudios y 148 fueron incluidos y sometidos a un análisis temático de contenido. Las búsquedas se realizaron en el período de enero a marzo de 2020 y abril de 2021. Los resultados fueron sistematizados en tres categorías temáticas. Resultados En la categoría Características de los estudios sobre errores, se evidenció que las categorías profesionales más frecuentes en la ocurrencia del error son enfermeras(os), médicos y farmacéuticos; con relación a las Características del error en el trabajo en salud, los tipos más relatados son error de medicación, de diagnóstico y en la asistencia de enfermería, incluyendo la caída de pacientes, flebitis resultantes de catéteres venosos periféricos, y ocurrencia de úlceras por presión y extubación de drenaje, catéteres y sondas; y en el Contexto para la ocurrencia del error, se identificaron elementos individuales y del contexto del trabajo, destacándose este último. Conclusión Se evidenció que la ocurrencia de errores en el trabajo en salud se da en un contexto de precarización del trabajo, con procesos de trabajo marcados por la heterogeneidad. A partir del entendimiento de que los trabajadores de la salud cometen errores y que la precarización del trabajo potencia la ocurrencia de errores, se hace necesario reorganizar los sistemas de salud para que se reduzcan las oportunidades de que los errores ocurran y que se promuevan los aprendizajes cuando estos ocurran.

Abstract Objective To characterize the national and international scientific production on errors in health work from 2000 to 2020. Methods This is an integrative literature review of national and international studies, carried out in the MEDLINE, LILACS/BIREME, PubMed and SciELO databases. A total of 4164 studies were found, 148 of which were included and submitted to thematic content analysis. The searches were carried out from January to March 2020 and April 2021. The results were systematized into three thematic categories. Results In the category Characteristics of studies on errors, it was evidenced that the most frequent professional categories in error occurrence are nurses, physicians and pharmacists; regarding Characteristics of error in health work, the most reported types are medication, diagnosis and nursing care errors, including patient falls., phlebitis resulting from peripheral venous catheters, occurrence of pressure ulcers and extubation of drains, catheters and probes; and in Context for error occurrence, individual elements and work context were identified, highlighting the latter. Conclusion It was evident that error in health work occurs in a context of precarious work, with work processes marked by heterogeneity. From the understanding that health workers make mistakes and that the precariousness of work enhances error occurrence, it is necessary to reorganize health systems so that the opportunities for errors to occur are reduced and that learning is promoted when they occur.

Pandemia da covid-19: algo de novo no trabalho da enfermeira? / Pandemia de covid-19: ¿algo nuevo en el trabajo de la enfermera? / Covid-19 pandemic: anything new in the nurse's work?

Objetivo refletir sobre o trabalho da enfermeira e do enfermeiro hoje, ano 2020, cujo registro na história será marcado pela pandemia da Covid-19. Método reflexão teórico-filosófica. Resultados a Covid-19 expõe para a sociedade brasileira os múltiplos desafios do trabalho da(o) enfermeira(o). O sofrimento no trabalho, se existente antes da pandemia, agora é potencializado pela singularidade do novo contexto, na presença do agente desconhecido, invisível, que ameaça e pode ser mortal. A pandemia do novo coronavírus demonstra que os desafios para que o trabalho da enfermeira(o) seja valorizado social e economicamente são maiores do que se imaginava. Conclusão a história e o contexto do trabalho na pandemia demonstra que é a solidariedade entre a "classe-que-vive-do-trabalho" que pode ser o amálgama imprescindível para o enfrentamento da Covid-19 e do desmonte dos direitos daquelas(es) que trabalham.

Objetivo reflexionar sobre el trabajo de las enfermeras hoy, 2020, cuyo historial estará marcado por la pandemia Covid-19. Método reflexión teórico-filosófica. Resultados Covid-19 expone a la sociedad brasileña los múltiples desafíos del trabajo de la enfermera. El sufrimiento en el trabajo, si presente antes de la pandemia, se ve ahora realzado por la singularidad del nuevo contexto, en presencia del agente desconocido e invisible que amenaza y puede ser mortal. La pandemia del nuevo coronavirus demuestra que los desafíos para que el trabajo de la enfermera sea valorado social y económicamente son mayores de lo que se pensaba anteriormente. Conclusión la historia y el contexto del trabajo en la pandemia demuestran que es la solidaridad entre la "clase-que-vive-del-trabajo" la que puede ser la amalgama indispensable para el enfrentamiento de la Covid-19 y el desmantelamiento de los derechos de quienes trabajan.

Objetivo refletir sobre o trabalho da enfermeira e do enfermeiro hoje, ano 2020, cujo registro na história será marcado pela pandemia da Covid-19. Método reflexão teórico-filosófica. Resultados a Covid-19 expõe para a sociedade brasileira os múltiplos desafios do trabalho da(o) enfermeira(o). O sofrimento no trabalho, se existente antes da pandemia, agora é potencializado pela singularidade do novo contexto, na presença do agente desconhecido, invisível, que ameaça e pode ser mortal. A pandemia do novo coronavírus demonstra que os desafios para que o trabalho da enfermeira(o) seja valorizado social e economicamente são maiores do que se imaginava. Conclusão a história e o contexto do trabalho na pandemia demonstra que é a solidariedade entre a "classe-que-vive-do-trabalho" que pode ser o amálgama imprescindível para o enfrentamento da Covid-19 e do desmonte dos direitos daquelas(es) que trabalham.