What are the global patterns of microplastic ingestion by fish? A scientometric review.

The billions of tons of plastic released into the environment mostly fragment into smaller particles that reach rivers and oceans, posing toxicity risks to aquatic organisms. As fish serve as excellent environmental indicator organisms, this study aims to comprehensively review and quantify published data regarding the abundance of microplastics (MPs) ingested by fish through scientometric analysis. Systematic analysis reveals that global aquatic ecosystems are contaminated by MPs, with the characteristics of these contaminants stemming from inadequate disposal management practices. The abundance of MPs was recorded in several fish species, notably Cyprinus carpio in natural environments and Danio rerio in controlled environments. According to the surveyed studies, laboratory experiments do not accurately represent the conditions found in natural environments. The results suggest that, in natural environments, the predominant colors of MPs are blue, black, and red. Fibers emerged as the most prevalent type, with polyethylene (PE) and polypropylene (PP) being the most frequently identified chemical compositions. On the other hand, laboratory studies showed that the spheres and fragments ingested were predominantly polystyrene (PS) green, followed by the colors blue and red. This discrepancy complicates drawing accurate conclusions regarding the actual effects of plastic particles on aquatic biota. Given the enduring presence of plastic in the environment, it is imperative to consider and implement environmental monitoring for effective, long-term management.

Diagnostic evaluation of institutions as a basis for designing the Brazilian maturity model of telehealth services.

BACKGROUND: The number and specificities of telehealth service units that expanded their services and diversified with the COVID-19 pandemic in Brazil need to be discovered. The objective of this manuscript is to present a methodology for the diagnostic evaluation of 19 telehealth units from different regions of the country for federal governmental decision-making. METHODS: A cross-sectional quantitative and qualitative study was carried out in the form of a census based on administrative records with an online survey and in-depth interviews with local telehealth managers. RESULTS: Despite the discontinuity of regular funding, the results point to a diversity of initiatives and advances. Citizenship, sustainability, security, and budget management are recurring themes in the maturity analysis of telehealth services after the advent of the pandemic. CONCLUSION: It is necessary for Brazil to build a resilient model of the maturity of telehealth services that contemplates the different regional scenarios.

Enhancing Fatigue Life and Strength of Adhesively Bonded Composite Joints: A Comprehensive Review.

Adhesive bonding is widely seen as the most optimal method for joining composite materials, bringing significant benefits over mechanical joining, such as lower weight and reduced stress concentrations. Adhesively bonded composite joints find extensive applications where cyclic fatigue loading takes place, but this might ultimately lead to crack damage and safety issues. Consequently, it has become essential to study how these structures behave under fatigue loads and identify the remaining gaps in knowledge to give insights into new possibilities. The fatigue life of adhesively bonded composite joints is influenced by various parameters, including joint configuration and material properties of adherends and adhesive. Numerous studies with varying outcomes have been documented in the literature. However, due to the multitude of influential factors, deriving conclusive insights from these studies for practical design purposes has proven to be challenging. Hence, this review aims to address this challenge by discussing different methods to enhance the fatigue performance of adhesively bonded composite joints. Additionally, it provides a comprehensive overview of the existing literature on adhesively bonded composite joints under cyclic fatigue loading, focusing on three main aspects: Adherends modification, adhesive modification, and joint configurations. Since the effect of modifying the adhesive, adherends, and joint configurations on fatigue performance has not been comprehensively studied in the literature, this review aims to fill this gap by compiling and comparing the relevant experimental data. Furthermore, this review discusses the challenges and limitations associated with the methods that can be used to monitor the initiation and propagation of fatigue cracks.

Telehealth service maturity model for the Brazilian scenario (TMSMM.br) / Modelo de madurez de servicios de telemedicina para el escenario brasileño (TMSMM.br) / Modelo de maturidade de serviços de telessaúde para o cenário brasileiro (TMSMM.br)

This article describes a proposed framework called Telehealth Service Maturity Model (TMSMM.br) for evaluating the current stage of telehealth centers in the Brazilian context. The steps included literature review, compilation and interpretation, data collection instrument, survey with center coordinators, model development, and evaluation process. The review resulted in 857 quality aspects for telehealth services, grouped into 12 themes with 34 topics. TMSMM.br consists of defining 3 foundational dimensions (themes, services, stages) and provides a standardized set of 200 requirements ordered across 5 thematic domains (structure, organization, user, operation and community) for 8 services (consultation, consultation, diagnosis, treatment and referral, education and training, social control and communication, healthcare network, and research, development, and innovation). TMSMM.br enables telehealth centers to identify and compare essential characteristics and their maturity stages.

Este artículo describe una propuesta de marco de referencia llamado Modelo de Madurez de Servicios de Telemedicina (TMSMM.br) para evaluar la etapa actual de los centros de telemedicina en el contexto brasileño. Las etapas incluyeron revisión de literatura, compilación e interpretación, instrumento de recolección, encuesta a coordinadores de centros, desarrollo del modelo y proceso de evaluación. La revisión resultó en 857 aspectos de calidad para servicios de telemedicina, agrupados en 12 temas con 34 tópicos. TMSMM.br consiste en la definición de 3 dimensiones estructurales (temas, servicios, etapas) y proporciona un conjunto estandarizado de 200 requisitos ordenados en 5 dominios temáticos (estructura, organización, usuario, operación y comunidad) para 8 servicios (consulta, asesoría, diagnóstico, tratamiento y remisión, educación y capacitación, control social y comunicación, red de atención de salud e investigación, desarrollo e innovación). TMSMM.br ayuda a los centros de telemedicina a identificar y comparar características esenciales y sus etapas de madurez

Este artigo descreve uma proposta de framework denominado Modelo de Maturidade de Serviços de Telessaúde (TMSMM.br) para avaliação do estágio corrente dos núcleos de telessaúde no contexto brasileiro. As etapas incluíram revisão da literatura, compilação e interpretação, instrumento de coleta, inquérito com coordenadores de núcleos, elaboração do modelo e do processo de avaliação. A revisão resultou 857 aspectos de qualidade para serviços de telessaúde, agrupados em 12 temas com 34 tópicos. TMSMM.br consiste na definição de 3 dimensões estruturantes (temas, serviços, estágios) e provê um conjunto padronizado de 200 requisitos ordenados em 5 domínios temáticos (estrutura, organização, usuário, operação e comunidade) para 8 serviços (consulta, consultoria, diagnóstico, tratamento e encaminhamento, formação e capacitação, controle social e comunicação, rede de atenção à saúde, e pesquisa, desenvolvimento e inovação). TMSMM.br colabora para que núcleos de telessaúde possam identificar e comparar características essenciais e seus estágios de maturidade.

Tracking and Dynamic Tuning of a Wireless Powered Endoscopic Capsule.

This work presents an inductive wireless power transfer system for powering an endoscopy capsule supplying energy to power electronic devices allocated inside a capsule of ≈26.1 mm × 9 mm. A receiver with three coils in quadrature with dimensions of ≈9 mm × 9 mm × 10 mm is located inside the capsule, moving freely inside a transmitter coil with 380 mm diameter through translations and revolutions. The proposed system tracks the variations of the equivalent magnetic coupling coefficient compensating misalignments between the transmitter and receiver coils. The power on the load is estimated and optimized from the transmitter, and the tracking control is performed by actuating on a capacitance in the matching network and on the voltage source frequency. The proposed system can prevent load overheating by limiting the power via adjusting of the magnitude of voltage source VS. Experimental results with uncertainties analysis reveal that, even at low magnetic coupling coefficients k ranging from (1.7 × 10-3, 3.5 × 10-3), the power on the load can be held within the range of 100-130 mW. These results are achieved with any position of the capsule in the space, limited by the diameter of the transmitter coil and height of 200 mm when adjusting the series capacitance of the transmitter in the range (17.4, 19.4) pF and the frequency of the power source in the range (802.1, 809.5) kHz.

Aplicação das medidas de prevenção e controle do SARS-CoV-2 entre universitários de instituição pública do Ceará, Brasil / Application of SARS-CoV-2 prevention and control measures among university students of a public institution in Ceará, Brazil

Introdução: Universidades são ambientes propícios à disseminação de infecções respiratórias agudas de elevada transmissibilidade, como a COVID-19. Objetivo: Avaliar a aplicação das medidas de prevenção e controle da COVID-19 entre estudantes de uma comunidade universitária do Ceará, Brasil. Método: Trata-se de estudo transversal desenvolvido junto aos estudantes da graduação de uma universidade pública do estado do Ceará, regularmente matriculados no semestre 2020.1, em atividades remotas (não presenciais). Para o cálculo da amostra, considerou-se uma população de 30.152 universitários, uma confiança de 95%, 3% de erro amostral e 50% de frequência esperada de uso das medidas de proteção e controle contra a COVID-19 (n = 1.031). Das 2.097 respostas recebidas, ocorreram 360 perdas e foram analisadas 1.737. A coleta de dados foi realizada em  dezembro de 2020, por meio de questionário eletrônico, disponibilizado online, para esta finalidade. Realizou-se uma análise descritiva dos aspectos pesquisados. Resultados: Apesar de 91,2% dos universitários referirem que sempre usavam máscara ao sair de casa, somente 1,4% cumpriram com todas as recomendações para seu manuseio correto; 43,3% referiram lavar as mãos conforme as recomendações das autoridades sanitárias, mas outras medidas de higiene pessoal foram insuficientes; 65,4% referiram que costumavam sair para participar de atividades que não eram de extrema necessidade; e 70,0% eram usuários de transportes públicos. Conclusões: As evidências encontradas predispõem os universitários a riscos frente a COVID-19.

Introduction: Universities are favorable environments for the spread of highly transmissible acute respiratory  infections, such as COVID-19. Objective: To evaluate the application of COVID-19 prevention and control measures among students from a public university in the state of Ceará, Brazil. Method: This is a cross-sectional study developed with undergraduate students, regularly enrolled in semester 2020.1, in remote (non-face-to-face) activities. To calculate the sample, a population of 30,152 students was considered, a confidence of 95%, 3% sampling error and 50% expected frequency of use of protection and control measures against COVID-19 (n = 1,031). Of the 2,097 responses received, 360 were lost and 1,737 were analyzed. Data collection was carried out in December 2020, through an electronic questionnaire, available online, for this purpose. A descriptive analysis of the researched aspects was carried out. Results: Although 91.2% of students reported that they always wore a mask when leaving the house, only 1.4% complied with all the  recommendations for its correct handling. 43.3% reported washing their hands according to the recommendations of the health authorities, but others' personal hygiene measures were insufficient; 65.4% reported that they used to go out to participate in activities that were not of extreme necessity; and 70.0% were public transport users. Conclusions: The evidence found predisposes university students to risks in the face of this pandemic.

Avaliação do risco de suicídio entre alunos no início, meio e fim do curso de medicina de uma universidade no Rio de Janeiro / Suicide risk assessment among students at the beginning, in the middle and at the end of the medicine course of a university in the city of Rio de Janeiro ­ Brazil

Objetivo: Avaliar o risco de suicídio e a existência de comportamento suicida entre acadêmicos nos estágios inicial, intermediário e final do curso de Medicina de uma universidade particular e analisar os fatores de risco possivelmente associados à ideação suicida nessa população. Materiais e métodos: Foram analisados, em estudo transversal, 376 estudantes. Todos os participantes responderam questionário autopreenchível, por meio da plataforma eletrônica Google Forms, composto por 3 seções: perguntas sobre questões pessoais, perguntas do Questionário de Comportamento Suicida Revisado (Suicide Behavior Questionnaire Revised: SBQ-R) e do Inventário de Ideação Suicida Positiva e Negativa (Positive and Negative Suicide Ideation: PANSI). Resultados: 34% dos alunos eram do 1º ano, outros 34% do 3º ano e 32%, do 6º ano. 71,8% da população do estudo é composta pelo sexo feminino e 39,6% possui idade entre 21 e 24 anos. Na classificação de risco de suicídio segundo o PANSI, 31,7% dos estudantes apresentaram médio risco e 5,3%, alto risco. Na análise por etapa do curso, o 3º ano apresentou-se com maior porcentagem em alto risco (70,0%). De acordo com o SBQ-R, 37,2% dos estudantes da população total apresentaram comportamento suicida. Dentre as variáveis analisadas, orientação sexual, história de bullying na infância, conflito com responsáveis, história familiar de transtorno mental, uso de drogas ilícitas, história de violência sexual e ansiedade autorreferida foram consideradas como fatores de risco para suicídio na população total e na subanálise feita por ano de faculdade. Conclusão: A população do estudo apresenta aumento das taxas de ideação e comportamento suicida em relação a população geral. Assim, é necessária a implantação de medidas dentro das universidades para promover a saúde mental e diminuir aspectos estressantes sobre os acadêmicos. [au]

Objective : The purpose of this study is to assess the risk of suicide and the existence of suicidal behavior among academics in the early, intermediate and final stages of a private medical school, and also to analyze risk factors possibly associated with suicidal ideation in this population. Methods: This is a cross-sectional study with 376 medical students. All the participants answered a self-fillable questionnaire through the electronic platform Google Forms composed of 3 sections: questions about personal issues; questions of the Suicide Behavior Questionnaire Revised (SBQ-R); and of the Positive and Negative Suicide Ideation (PANSI) Inventory. Results: 34% of the students were in the 1st year of graduation, 34% in the 3rd year, and 32%, in the 6thyear. 71.8% of the population is female and 39.6% are between 21 and 24 years old. In the suicide risk classification according to PANSI, 31.7% of the students were in the medium risk group and 5.3% in high risk group. In the analysis per year, the 3rd year showed a greater percentage of high risk (70.0%). According to the SBQ-R classification of suicide risk, 37.2% of students out of the total population revealed suicidal behavior. Among the analyzed variables, sexual orientation, history of childhood bullying, domestic conflict, presence of mental disorders in family, use of illicit drugs, history of sexual violence and self-reported anxiety were considered as risk factors for suicide. The highlighted results revealed the same pattern when analyzed per year of college. Conclusion: The survey population has increased rates of suicidal negative ideation and behavior compared to the general population. Therefore, it is necessary to implement programs in colleges to promote a greater state of well-being and reduce stressful aspects in academics. [au]

Fumonisin-containing diets decrease the metabolic activity of myenteric neurons in rats.

Fumonisins are naturally occurring mycotoxins that contaminate food for human and animal consumption. They have neurotoxic effects, but the mechanisms by which these toxins affect the nervous system are not fully known. In the present study, male Wistar rats were fed between 21 and 63 days of age with diets that contained fumonisins B1+B2 at 0, 1, and 4 mg/kg. The following variables were assessed: food consumption, growth, body weight gain, and blood parameters. Morphoquantitave analyses of the most metabolically active myenteric neurons were performed, detected by NADH-diaphorase activity. Nitrergic neurons were detected by NADPH-diaphorase activity. The fumonisin-containing diets did not significantly alter food consumption or the body or plasma parameters. These diets decreased the metabolic activity of jejunal myenteric neurons, reducing neuronal density of the most metabolic active neurons by 30.8% and the cell body area by 4.3%. The diets also decreased the cell body area of nitrergic neurons by 22.1%. The effects of fumonisin B1 on the respiratory metabolism of isolated mitochondria in the brain and liver were also assessed. A decrease in oxygen consumption up to a 29% in the brain and 38% in the liver was observed in mitochondrial isolates to which 50 µM fumonisin B1 was added. The decrease in respiratory activity that was triggered by exposure to fumonisins was related to the lower metabolic activity of myenteric neurons, which had a negative impact on neuroplasticity of the enteric nervous system.

Evaluation of Deep Learning Methods in a Dual Prediction Scheme to Reduce Transmission Data in a WSN.

One of the most important challenges in Wireless Sensor Networks (WSN) is the extension of the sensors lifetime, which are battery-powered devices, through a reduction in energy consumption. Using data prediction to decrease the amount of transmitted data is one of the approaches to solve this problem. This paper provides a comparison of deep learning methods in a dual prediction scheme to reduce transmission. The structures of the models are presented along with their parameters. A comparison of the models is provided using different performance metrics, together with the percent of points transmitted per threshold, and the errors between the final data received by Base Station (BS) and the measured values. The results show that the model with better performance in the dataset was the model with Attention, saving a considerable amount of data in transmission and still maintaining a good representation of the measured data.

Projeto terapêutico singular de uma gestante com sífilis: um relato de experiência / Singular therapeutic project for a pregnant woman with syphilis: an experience report / Proyecto terapéutico singular de una embarazada con sífilis: un informe de experiencia

Objetivo: relatar a experiência vivenciada por acadêmicos de Enfermagem frente à implementação do Projeto Terapêutico Singular de uma gestante com sífilis. Método: trata-se de um estudo descritivo, tipo relato de experiência. Relata-se a experiência vivenciada por acadêmicos de Enfermagem durante o estágio supervisionado na Estratégia Saúde da Família frente à implementação do Projeto Terapêutico Singular a uma gestante com diagnóstico de sífilis e exposta a outras vulnerabilidades. Resultados: alcançaram-se, dentre as principais metas do projeto terapêutico, detecção e tratamento de sífilis na gestante; realização da laqueadura pós-parto; aproximação da família para com a assistência ofertada pela equipe da unidade básica de saúde e, como situação limite, tentativas frustradas de relacionamento terapêutico junto ao genitor para diagnóstico e início do tratamento de sífilis, pois se apresentou alto nível de resistência aos profissionais. Obteve-se, apesar dos avanços, como um dos desfechos, a identificação de sífilis congênita no recém-nascido. Conclusão: possibilitaram-se reflexões e avanços ao universo científico da prática dos acadêmicos de Enfermagem e do profissional da Enfermagem, tendo o PTS como interface, construindo um novo pensar sobre a formação do enfermeiro, além de promover uma assistência integral e equânime à gestante e ao seu contexto.(AU)

Objective: to report the experience of nursing students in the implementation of the Single Therapeutic Project for a pregnant woman with syphilis. Method: This is a descriptive study, experience report type. It reports the experience of nursing students during their supervised internship in the Family Health Strategy regarding the implementation of the Single Therapeutic Project for a pregnant woman diagnosed with syphilis and exposed to other vulnerabilities. Results: were achieved, among the main goals of the therapeutic project, detection and treatment of syphilis in pregnant women; achievement of postpartum sterilization; approximation of the family to the assistance offered by the basic health unit team and, as a limit situation, frustrated attempts of therapeutic relationship with the genitor for diagnosis and initiation of treatment of syphilis, because there was a high level of resistance to professionals. Despite the advances, one of the outcomes was the identification of congenital syphilis in the newborn. Conclusion: reflections and advances to the scientific universe of the practice of nursing students and nursing professionals were made possible, having the STP as an interface, building a new thinking about the formation of nurses, in addition to promoting a comprehensive and equitable care to pregnant women and their contexto.(AU)

Objetivo: reportar la experiencia vivida por estudiantes de enfermería en la implementación del Proyecto Terapéutico Singular de una gestante con sífilis. Método: se trata de un estudio descriptivo, tipo de relato de experiencia. Se reporta la experiencia vivida por estudiantes de enfermería durante la pasantía supervisada en la Estrategia Salud de la Familia respecto a la implementación del Proyecto Terapéutico Singular a una gestante diagnosticada con sífilis y expuesta a otras vulnerabilidades. Resultados: entre los principales objetivos del proyecto terapéutico, se logró la detección y tratamiento de la sífilis en gestantes; realización de ligadura de trompas posparto; acercamiento de la familia a la asistencia brindada por el equipo de la unidad básica de salud y, como situación límite, intentos fallidos de relación terapéutica con el progenitor para el diagnóstico e inicio del tratamiento de la sífilis, al existir un alto nivel de resistencia a los profesionales. A pesar de los avances, uno de los resultados fue la identificación de la sífilis congénita en el recién nacido. Conclusión: se posibilitaron reflexiones y avances al universo científico de la práctica de estudiantes de Enfermería y profesionales de Enfermería, teniendo como interfaz al PTS, construyendo un nuevo pensamiento sobre la formación del enfermero, además de promover la atención integral y equitativa a la gestante y a su contexto.(AU)

Gestão estratégica no enfrentamento da Covid-19 em um hospital privado / Strategic management in coping with Covid-19 in a private hospital

Os serviços de saúde estão vivenciando um novo cenário devido à pandemia ocasionada por um novo subtipo da Síndrome Respiratória Aguda Grave (SARS-CoV-2), denominado de Covid-19. Com isso, se fez necessário ações voltadas para um cuidado especializado à população. O objetivo deste estudo é descrever a experiência de gestão de um hospital privado do litoral Paranaense. O método utilizado foi o relato de experiência no período de seis meses, relatando o fluxo desenvolvido para atendimento aos pacientes suspeitos ou confirmados de Covid-19 durante a pandemia e a descrição das ações de enfrentamento adotadas pela instituição. Concluiu-se que foi evidenciada a atuação de áreas estratégicas como a Gestão de pessoas e Financeira. Houve a necessidade de contratação de profissionais e remanejamentos para a atuação in loco e o monitoramento diário dos custos visto esta imprevisibilidade, bem como a antecipação dos processos para a continuação e validação do plano de contingência. (AU)

Health services are experiencing a new scenario due to the pan-demic caused by a new subtype of Severe Acute Respiratory Syndrome (SARS--CoV-2), called Covid-19. With this, actions directed to a specialized care of the population were necessary. The objective of this study is to describe the management experience of a private hospital on the coast of Paraná. The method used was the report of experience in the period of six months, reporting the flow developed to care for patients suspected or confirmed of Covid-19 during the pandemic and the description of the actions of confrontation adopted by the institution. It was concluded that the performance of strategic areas such as Personnel and Financial Management was evidenced. There was the need to hire professionals and relocations for the performance in loco and the daily monitoring of costs given this unpredictability, as well as the anticipation of processes for the continuation and validation of the contingency plan. (AU)

Avocado (Persea americana) pulp improves cardiovascular and autonomic recovery following submaximal running: a crossover, randomized, double-blind and placebo-controlled trial.

Previous studies have demonstrated that regular avocado consumption presents advantageous effects on cardiovascular system. However, little attention has been paid to the use of avocado as a dietary supplement, in particular, for individuals involved in physical exercise training. Therefore, this study aims to evaluate the effect of acute avocado pulp intake on cardiovascular and autonomic recovery subsequent to moderate exercise. Using a crossover, randomized, double-blind and placebo-controlled trial design, 16 healthy female adults underwent two protocols: Avocado pulp (600 mg in capsule) and placebo (600 mg starch in capsule). After the ingestion of Avocado pulp or placebo, the subjects were seated for 60 min at rest, followed by running on a treadmill at a submaximal level and then remained seated for 60 min during recovery from the exercise. Heart rate (HR), heart rate variability (HRV) [rMSSD, SD1, HF (ms2)] and skin conductance were evaluated before and during exercise, as well as during recovery. HR, systolic blood pressure, HRV and skin conductance recovered faster when subjects were given avocado pulp prior to exercise. In conclusion, avocado pulp improved cardiovascular and autonomic recovery after exercise, suggesting a reduced risk of cardiovascular events after exertion. The current results support the beneficial effects of ingestion of avocado prior to submaximal treadmill running.

Exploiting the RSSI Long-Term Data of a WSN for the RF Channel Modeling in EPS Environments.

In this paper, we propose a methodology to use the received signal strength indicator (RSSI) available by the protocol stack of an installed Wireless Sensor Network (WSN) at an electric-power-system environment (EPS) as a tool for obtaining the characteristic of its communication channel. Thereby, it is possible to optimize the settings and configuration of the network after its deployment, which is usually run empirically without any previous knowledge of the channel. A study case of a hydroelectric power plant is presented, where measurements recorded over a two-month period were analyzed and treated to obtain the large-scale characteristics of the radiofrequency channel at 2.4 GHz. In addition, we showed that instantaneous RSSI data can also be used to detect specific issues in the network, such as repetitive patterns in the transmitted power level of the nodes, and information about its environment, such as the presence of external sources of electromagnetic interference. As a result, we demonstrate the practical use of the RSSI long-term data generated by the WSN for its own performance optimization and the detection of particular events in an EPS or any similar industrial environment.

Iniquidades nas contribuições das fontes de financiamento da saúde na Pesquisa de Orçamentos Familiares no Brasil / Inequities in the contributions of health financing sources in the Family Budget Survey in Brazi / Inequidades en las contribuciones de las fuentes de financiamiento de la salud en la Encuesta de Presupuestos Familiares en Brasil

Objetivo:analisar a incidência no financiamento (FIA, em inglês), tanto estrutural como efetiva, das fontes de financiamento da saúde, encontradas na Pesquisa de Orçamentos Familiares (POF)de 2008/2009 e a distribuição dessas contribuições na população segundo seu poder de consumo. Metodologia:foram utilizados os dados da Pesquisa de Orçamentos Familiares de 2008/2009 como fonte de dados, de onde foram obtidas as fontes de financiamento (públicas e privadas) do sistema de saúde no Brasil. Essas fontes foram analisadas em referência ao poder de consumo per capitada população para avaliar a progressividade, regressividade ou proporcionalidade delas, mediante o uso de índices de concentração,Gini e Kakwani. Para isso, o estudo usou o pacote estatístico Stata 12e o programa estatístico ADePTdo Banco Mundial.Resultados:os pagamentos diretos em saúde mantiveram uma distribuição regressiva, enquanto os pagamentos com planos de saúde e impostos diretos foram progressivos e proporcionais,respetivamente. A consolidação das três fontes de financiamento foi avaliada como proporcional, por ter um índice de Kakwani de -0,0349. O índice de Gini demonstrou que os gastos feitos com saúde são ainda menos equitativos (0,609) que a distribuição geral dos recursos (0,598) dentre a população. Conclusões: o orçamento público não é suficiente para suprir todas as necessidades do SUS e as contribuições das fontes de financiamento não são progressivas,e essa é uma das possíveis causas do aumento da pobreza e das catástrofes financeiras da população brasileira.

Objective: to analyze the Incidence in Financing (FIA), both structural and effective, from the sources of health financing, found in the Family Budget Survey2008/2009 and the distribution of these contributions in the population according to their power of consumption. Methodology:The data from the Family Budget Survey2008/2009 were used as a data source, from where the sources of financing (public and private) of the health system in Brazil were obtained. These sources were analyzed in reference to the per capita consumption power of the population to assess their progressivity, regressivity or proportionality, by using indicesof concentration,Gini and Kakwani. For this, the study used the Stata 12and ADePTstatistical programs of the World Bank. Results:direct payments in health maintained a regressive distribution, while payments with health insurance and direct taxes were progressive and proportional respectively. The consolidation of the three financing sources was determined as proportional by having a Kakwani index of -0.0349. TheGini index showed that health expenditures are even less equitable than the general distribution of resources among the population (0.598). Conclusions:the public budget is not sufficient to meet all the needs of the Unified Health System and the contributions of the financing sources are not progressive and this may be one of the causes of the increase in poverty and financial catastrophes of the Brazilian population.

Objetivo: analizar la Incidencia en el Financiamiento (FIA, en inglés), tanto estructural como efectivo, de las fuentes de financiamiento de la salud, encontradas en la Encuesta de PresupuestosFamiliaresde 2008/2009 y la distribución de esas contribuciones en la población según su poder de consumo. Metodología: fueron usados los datos de la Encuesta de Presupuestos Familiaresde 2008/2009 como fuente de datos, dondese obtuvo las fuentes de financiamiento (públicas y privadas) del sistema de salud en Brasil. Esas fuentes fueron analizadas en referencia al poder de consumo per cápita de la población para evaluar la progresividad, regresividad o proporcionalidad de estas, mediante el uso de índices de concentración,Gini y Kakwani. Para esto, el estudio utilizó los programas estadísticos Stata 12y ADePTdel Banco Mundial. Resultados: los pagos directos en salud mantuvieron una distribución regresiva, mientras que los pagos con seguros de salud e impuestos directos resultaron ser progresivos y proporcionales respectivamente. La consolidación de las tres fuentes de financiamiento fue determinada como proporcional por tener un índice de Kakwani de -0.0349. Elíndice de Gini demostró que los gastos en salud son aún menos equitativos que la distribución general de los recursos entre la población (0.598).Conclusiones: el presupuesto público no es suficiente para suplir todas las necesidades del Sistema Único de Salud y las contribuciones de las fuentes de financiamiento no son progresivas y esto puede ser una de las causas del aumento de la pobreza y de catástrofes financieras de la población brasileña.

Chronic ingestion of deoxynivalenol-contaminated diet dose-dependently decreases the area of myenteric neurons and gliocytes of rats.

BACKGROUND: Deoxynivalenol (DON), a mycotoxin produced by Fusarium spp., is commonly found in cereals ingested by humans and animals. Its ingestion is correlated with hepatic, hematologic, renal, splenic, cardiac, gastrointestinal, and neural damages, according to dose, duration of exposure and species. In this work, the effects of the ingestion of DON-contaminated diet at concentrations considered tolerable for human and animal intake were assessed. METHODS: Male Wistar rats aging 21 days were allotted to five groups that were given, for 42 days, diets contaminated with different concentrations of DON (0, 0.2, 0.75, 1.75, and 2 mg kg-1 of chow). Food ingestion, bodyweight, oxidative status and morphometric analyses of gliocytes, and neurons of jejunal myenteric ganglia were recorded. KEY RESULTS: At these concentrations, there was no food rejection, decrease in bodyweight gain, changes in oxidative status, or loss of either neurons or gliocytes. However, DON decreased gliocyte area, general neuronal population, nitrergic, cholinergic and NADH-diaphorase positive subpopulations and, as a result, ganglion area. CONCLUSIONS & INFERENCES: It was concluded that, even in the absence of visible effect, DON exposure reduces cell body area of gliocytes and neurons of the myenteric plexus of the rat jejunum.

The meaning of integrative guided imagery relaxation therapy for women with breast cancer. / O significado de uma terapia integrativa de relaxamento guiado para mulheres com câncer de mama.

OBJECTIVE: Understanding the meaning of guided imagery relaxation for women with breast cancer, also investigating how patients view cancer and their immune system during guided imagery relaxation sessions and feel after it. METHOD: A qualitative study with a phenomenological approach and a Heideggerian theoretical-methodological reference based on the Creative and Sensitive Method, developed in the radiotherapy outpatient clinic of a public teaching hospital in the interior of São Paulo. The Heideggerian understanding was used for analyzing the data, which occurred in two stages: vague and medium understanding, and hermeneutics. RESULTS: Nine women between the ages of 45 and 67 participated in the study. The data allowed us to understand the meaning of guided imagery relaxation from the participants, since they could be classified into three units of meaning: cancer stigma, facing disease and treatment benefits. CONCLUSION: The meaning of guided imagery relaxation made it possible to understand the being-in-the-world during the provided reflections, and it is possible to verify the importance of the nurse's offer of therapy in caring for women with breast cancer.

Aumento de la pobreza e inequidad en el financiamiento del sistema de salud de Ecuador / Increase in the poverty and inequity in the funding of the Ecuadorian health system

RESUMEN Objetivo El objetivo de este estudio es medir el aumento de la pobreza debido a los gastos directos en salud y analizar la equidad del financiamiento del sistema de salud ecuatoriano, con base en datos de encuestas nacionales representativas del país. Método Fue realizado con datos de la "Encuesta de condiciones de vida 2013-2014" (ECV) y utilizó líneas de pobreza, con enfoques relativo y absoluto para medir el aumento de la pobreza y, mediante Análisis de Incidencia en el financiamiento, fueron medidas las desigualdades en la distribución del financiamiento. Resultados La pobreza aumentó 2,2% debido al gasto de las familias en salud, especialmente en gastos de medicamentos y consultas médicas, que representaron 36,7% y 14,6% del gasto total en pagos directos. Además, las fuentes más importantes de financiamiento resultaron ser regresivas, hecho que afecta principalmente a la clase media. Cuando fueron consolidadas, las fuentes de financiamiento analizadas resultaron ser proporcionales. Este, aunque no es el peor escenario, no es el esperado para un sistema de salud que debe garantizar protección financiera a sus usuarios. Discusión Aunque existen metas de financiamiento de difícil alcance, al menos las leyes del país establecen la búsqueda de ese fin. Sin embargo, pérdidas de recursos financieros dificultan el logro de los objetivos trazados.(AU)

ABSTRACT Objective The objective of this study is to measure the increase in poverty due to direct health expenditures and to analyze the equity of financing of the Ecuadorian health system, based on data from representative national surveys of the country. Method It was carried out with data from the 2013-2014 Living Conditions Survey and used poverty lines, with relative and absolute approaches to measure the increase in poverty and, through Analysis of Incidence in Financing, inequalities in the financing distribution. Results Poverty increased 2.2% due to families spending on health, especially on expenses for medications and medical consultations, which represented 36.7% and 14.6% of total expenditure on direct payments. Furthermore, the most important sources of financing turned out to be regressive, mainly affecting the middle class. When they were consolidated, the sources of financing analyzed turned out to be proportional that, although it is not the worst-case scenario, it is not the expected one for a health system that must guarantee financial protection to its users. Discussion Although there are financing goals that are difficult to achieve, at least the country's laws establish the pursuit of this goal. However, losses of financial resources make it difficult to achieve the objectives set.(AU)

[Increase in the poverty and inequity in the funding of the Ecuadorian health system]. / Aumento de la pobreza e inequidad en el financiamiento del sistema de salud de Ecuador.

OBJECTIVE: The objective of this study is to measure the increase in poverty due to direct health expenditures and to analyze the equity of financing of the Ecuadorian health system, based on data from representative national surveys of the country. METHOD: It was carried out with data from the 2013-2014 Living Conditions Survey and used poverty lines, with relative and absolute approaches to measure the increase in poverty and, through Analysis of Incidence in Financing, inequalities in the financing distribution. RESULTS: Poverty increased 2.2% due to families spending on health, especially on expenses for medications and medical consultations, which represented 36.7% and 14.6% of total expenditure on direct payments. Furthermore, the most important sources of financing turned out to be regressive, mainly affecting the middle class. When they were consolidated, the sources of financing analyzed turned out to be proportional that, although it is not the worst-case scenario, it is not the expected one for a health system that must guarantee financial protection to its users. DISCUSSION: Although there are financing goals that are difficult to achieve, at least the country's laws establish the pursuit of this goal. However, losses of financial resources make it difficult to achieve the objectives set.

OBJETIVO: El objetivo de este estudio es medir el aumento de la pobreza debido a los gastos directos en salud y analizar la equidad del financiamiento del sistema de salud ecuatoriano, con base en datos de encuestas nacionales representativas del país. MÉTODO: Fue realizado con datos de la "Encuesta de condiciones de vida 2013-2014" (ECV) y utilizó líneas de pobreza, con enfoques relativo y absoluto para medir el aumento de la pobreza y, mediante Análisis de Incidencia en el financiamiento, fueron medidas las desigualdades en la distribución del financiamiento. RESULTADOS: La pobreza aumentó 2,2% debido al gasto de las familias en salud, especialmente en gastos de medicamentos y consultas médicas, que representaron 36,7% y 14,6% del gasto total en pagos directos. Además, las fuentes más importantes de financiamiento resultaron ser regresivas, hecho que afecta principalmente a la clase media. Cuando fueron consolidadas, las fuentes de financiamiento analizadas resultaron ser proporcionales. Este, aunque no es el peor escenario, no es el esperado para un sistema de salud que debe garantizar protección financiera a sus usuarios. DISCUSIÓN: Aunque existen metas de financiamiento de difícil alcance, al menos las leyes del país establecen la búsqueda de ese fin. Sin embargo, pérdidas de recursos financieros dificultan el logro de los objetivos trazados.

O significado de uma terapia integrativa de relaxamento guiado para mulheres com câncer de mama* / El significado de una terapia integrativa de relajación guiada para mujeres con cáncer de mama / The meaning of integrative guided imagery relaxation therapy for women with breast cancer

RESUMO Objetivo Compreender o significado do relaxamento com imaginação guiada para mulheres com câncer de mama, buscando investigar, também, como as pacientes visualizam o câncer e seu sistema imunológico durante as sessões de relaxamento com imaginação guiada e se sentem após sua realização. Método Estudo de natureza qualitativa, com abordagem fenomenológica e referencial teórico-metodológico heideggeriano, fundamentado no Método Criativo e Sensível, desenvolvido no ambulatório de radioterapia de um hospital de ensino público do interior paulista. Para a análise dos dados foi utilizada a compreensão heideggeriana, que ocorreu em duas etapas: a compreensão vaga e mediana e a hermenêutica. Resultados Participaram do estudo nove mulheres com idade entre 45 e 67 anos. Os dados permitiram compreender o significado do relaxamento com imaginação guiada pelas participantes, pois puderam ser classificados em três unidades de significado: o estigma do câncer, o enfrentar da doença e os benefícios do tratamento. Conclusão O significado do relaxamento com imaginação guiada possibilitou a compreensão do ser-no-mundo durante as reflexões proporcionadas, sendo possível verificar a importância do oferecimento da terapia pelo enfermeiro nos cuidados da mulher com câncer de mama.

RESUMEN Objetivo Comprender el significado de la relajación con imaginación guiada para mujeres con cáncer de mama, tratando de investigar asimismo cómo las pacientes visualizan el cáncer y su sistema inmunológico durante las sesiones de relajación con imaginación guiada y se sienten después de su realización. Método Estudio de naturaleza cualitativa, con abordaje fenomenológico y marco de referencia teórico metodológico heideggeriano, fundado en el Método Creativo y Sensible, desarrollado en el ambulatorio de radioterapia de un hospital de enseñanza pública del interior del Estado de São Paulo. Para el análisis de los datos fue utilizada la comprensión heideggeriana, que ocurrió en dos etapas: la comprensión vaga y mediana y la hermenéutica. Resultados Participaron en el estudio nueve mujeres con edades entre 45 y 67 años. Los datos permitieron comprender el significado de la relajación con imaginación guiada por las participantes, pues pudieron clasificarse en tres unidades de significado: el estigma del cáncer, el enfrentamiento de la enfermedad y los beneficios del tratamiento. Conclusión El significado de la relajación con imaginación guiada posibilitó la comprensión del ser-en-el-mundo durante las reflexiones proporcionadas, siendo posible verificar la importancia del ofrecimiento de la terapia por el enfermero en los cuidados a la mujer con cáncer de mama.

ABSTRACT Objective Understanding the meaning of guided imagery relaxation for women with breast cancer, also investigating how patients view cancer and their immune system during guided imagery relaxation sessions and feel after it. Method A qualitative study with a phenomenological approach and a Heideggerian theoretical-methodological reference based on the Creative and Sensitive Method, developed in the radiotherapy outpatient clinic of a public teaching hospital in the interior of São Paulo. The Heideggerian understanding was used for analyzing the data, which occurred in two stages: vague and medium understanding, and hermeneutics. Results Nine women between the ages of 45 and 67 participated in the study. The data allowed us to understand the meaning of guided imagery relaxation from the participants, since they could be classified into three units of meaning: cancer stigma, facing disease and treatment benefits. Conclusion The meaning of guided imagery relaxation made it possible to understand the being-in-the-world during the provided reflections, and it is possible to verify the importance of the nurse's offer of therapy in caring for women with breast cancer.