[Difficult situations and feelings in palliative oncology care]. / Situações difíceis e sentimentos no cuidado paliativo oncológico.

The act of caring for people in pain, shortness of breath, and imminent death on a daily basis can intensify difficult situations for health professionals. However, difficult situations are rarely discussed in the services and in the professional training process. This study aimed to analyze difficult situations and feelings that emerge from healthcare. This is a phenomenological and qualitative study based on 30 difficult situations of health professionals who work exclusively in palliative oncological care. The interviews were conducted from August to February 2020. The results show that the main difficulties were motivated by identification (when the professional recognizes similarities in the patient they are caring for), a bad death (with suffering), caring for young patients, the death of a mother with a small child, and when there was a divergence between what the professional proposed and the patient's choice. There was a relationship between types of difficult situations and professional category. The professionals expressed both unpleasant feelings (sadness, impotence, anguish, fear) and pleasant feelings (compassion, gratitude). The results show that the concealment of the dying process throughout the societies' development turned it into a taboo, causing distress even in those who work in palliative care. They also show an important subjective dimension of care, usually neglected, which generates suffering, but also resignification. To properly provide care, health professionals must find meaning in the work, made possible by the modification of the their internal mindset via experience, which generates transformation, new meaning, and knowledge from praxis.

O ato de cuidar cotidianamente de pessoas com dor, falta de ar e em morte iminente pode potencializar situações difíceis para profissionais da área. Contudo, raramente são discutidas nos serviços e no processo de formação profissional. Objetivou-se, então, analisar situações difíceis e sentimentos que emergem do cuidado de saúde. Esta é uma pesquisa de perspectiva fenomenológica e qualitativa, baseada em 30 situações difíceis de profissionais de saúde que atuam exclusivamente no cuidado paliativo oncológico. As entrevistas foram realizadas de agosto de 2019 a fevereiro de 2020. Os resultados mostram que as principais dificuldades foram motivadas pela identificação (quando o profissional vê semelhança com o paciente que cuida), morte ruim (com sofrimento), quando o paciente era jovem, morte de mãe com filho pequeno e quando havia divergência entre o proposto pelo profissional e a recusa do paciente. Percebeu-se relação entre tipos de situações difíceis e categoria profissional. Os profissionais expressaram tanto sentimentos desagradáveis (tristeza, impotência, angústia, medo) quanto agradáveis (compaixão, gratidão). Os resultados mostram que o ocultamento do processo de morrer ao longo do desenvolvimento civilizatório transformou-o em tabu, angustiante inclusive para quem trabalha com cuidados paliativos. Contribuem, também, para mostrar uma importante dimensão subjetiva do cuidado, geralmente negligenciada, que gera sofrimento, mas também ressignificação. Para que alguém cumpra seu propósito, é necessário encontrar sentido no trabalho, possibilitado pela modificação do estado interno do profissional pela experiência, que gera transformação e novo significado e saber a partir da práxis.

El acto de atender diariamente a personas con dolor, dificultad para respirar y muerte inminente puede potenciar situaciones difíciles para los profesionales del área. Sin embargo, casi nunca se discuten en los servicios y en el proceso de formación profesional. El objetivo fue analizar situaciones difíciles y sentimientos que emergen del cuidado de la salud. Investigación de perspectiva fenomenológica y cualitativa, basada en 30 situaciones difíciles de profesionales de la salud que actúan exclusivamente en el cuidado paliativo oncológico. Las entrevistas se realizaron entre agosto y febrero de 2020. Los resultados enseñan que las principales dificultades se motivaron por la identificación (cuando el profesional ve similitud con el paciente que atiende), mala muerte (con sufrimiento), cuando el paciente era joven, muerte de una madre con hijo pequeño y cuando hubo discrepancia entre lo propuesto por el profesional y el rechazo del paciente. Se observó una relación entre tipos de situaciones difíciles y categoría profesional. Los profesionales expresaron tanto sentimientos desagradables (tristeza, impotencia, angustia, miedo) como agradables (compasión, gratitud). Los resultados indican que ocultar el proceso de morir a lo largo del desarrollo de la civilización lo convirtió en un tabú e, incluso, es angustiante para las personas que trabajan con cuidados paliativos. También contribuye a mostrar una importante dimensión subjetiva del cuidado, generalmente ignorada, que genera sufrimiento, pero también resignificación. Para que cumpla con su propósito es necesario encontrar sentido en el trabajo, posibilitado por la modificación del estado interno del profesional a través de la experiencia, generando transformación y un nuevo significado y conocimiento a partir de la praxis.

Transition of human γ-tubulin ring complex into a closed conformation during microtubule nucleation.

Microtubules are essential for intracellular organization and chromosome segregation. They are nucleated by the γ-tubulin ring complex (γTuRC). However, isolated vertebrate γTuRC adopts an open conformation that deviates from the microtubule structure, raising the question of the nucleation mechanism. In this study, we determined cryo-electron microscopy structures of human γTuRC bound to a nascent microtubule. Structural changes of the complex into a closed conformation ensure that γTuRC templates the 13-protofilament microtubules that exist in human cells. Closure is mediated by a latch that interacts with incorporating tubulin, making it part of the closing mechanism. Further rearrangements involve all γTuRC subunits and the removal of the actin-containing luminal bridge. Our proposed mechanism of microtubule nucleation by human γTuRC relies on large-scale structural changes that are likely the target of regulation in cells.

Situações difíceis e sentimentos no cuidado paliativo oncológico / Difficult situations and feelings in palliative oncology care / Situaciones difíciles y sentimientos en el cuidado paliativo oncológico

O ato de cuidar cotidianamente de pessoas com dor, falta de ar e em morte iminente pode potencializar situações difíceis para profissionais da área. Contudo, raramente são discutidas nos serviços e no processo de formação profissional. Objetivou-se, então, analisar situações difíceis e sentimentos que emergem do cuidado de saúde. Esta é uma pesquisa de perspectiva fenomenológica e qualitativa, baseada em 30 situações difíceis de profissionais de saúde que atuam exclusivamente no cuidado paliativo oncológico. As entrevistas foram realizadas de agosto de 2019 a fevereiro de 2020. Os resultados mostram que as principais dificuldades foram motivadas pela identificação (quando o profissional vê semelhança com o paciente que cuida), morte ruim (com sofrimento), quando o paciente era jovem, morte de mãe com filho pequeno e quando havia divergência entre o proposto pelo profissional e a recusa do paciente. Percebeu-se relação entre tipos de situações difíceis e categoria profissional. Os profissionais expressaram tanto sentimentos desagradáveis (tristeza, impotência, angústia, medo) quanto agradáveis (compaixão, gratidão). Os resultados mostram que o ocultamento do processo de morrer ao longo do desenvolvimento civilizatório transformou-o em tabu, angustiante inclusive para quem trabalha com cuidados paliativos. Contribuem, também, para mostrar uma importante dimensão subjetiva do cuidado, geralmente negligenciada, que gera sofrimento, mas também ressignificação. Para que alguém cumpra seu propósito, é necessário encontrar sentido no trabalho, possibilitado pela modificação do estado interno do profissional pela experiência, que gera transformação e novo significado e saber a partir da práxis.

The act of caring for people in pain, shortness of breath, and imminent death on a daily basis can intensify difficult situations for health professionals. However, difficult situations are rarely discussed in the services and in the professional training process. This study aimed to analyze difficult situations and feelings that emerge from healthcare. This is a phenomenological and qualitative study based on 30 difficult situations of health professionals who work exclusively in palliative oncological care. The interviews were conducted from August to February 2020. The results show that the main difficulties were motivated by identification (when the professional recognizes similarities in the patient they are caring for), a bad death (with suffering), caring for young patients, the death of a mother with a small child, and when there was a divergence between what the professional proposed and the patient's choice. There was a relationship between types of difficult situations and professional category. The professionals expressed both unpleasant feelings (sadness, impotence, anguish, fear) and pleasant feelings (compassion, gratitude). The results show that the concealment of the dying process throughout the societies' development turned it into a taboo, causing distress even in those who work in palliative care. They also show an important subjective dimension of care, usually neglected, which generates suffering, but also resignification. To properly provide care, health professionals must find meaning in the work, made possible by the modification of the their internal mindset via experience, which generates transformation, new meaning, and knowledge from praxis.

El acto de atender diariamente a personas con dolor, dificultad para respirar y muerte inminente puede potenciar situaciones difíciles para los profesionales del área. Sin embargo, casi nunca se discuten en los servicios y en el proceso de formación profesional. El objetivo fue analizar situaciones difíciles y sentimientos que emergen del cuidado de la salud. Investigación de perspectiva fenomenológica y cualitativa, basada en 30 situaciones difíciles de profesionales de la salud que actúan exclusivamente en el cuidado paliativo oncológico. Las entrevistas se realizaron entre agosto y febrero de 2020. Los resultados enseñan que las principales dificultades se motivaron por la identificación (cuando el profesional ve similitud con el paciente que atiende), mala muerte (con sufrimiento), cuando el paciente era joven, muerte de una madre con hijo pequeño y cuando hubo discrepancia entre lo propuesto por el profesional y el rechazo del paciente. Se observó una relación entre tipos de situaciones difíciles y categoría profesional. Los profesionales expresaron tanto sentimientos desagradables (tristeza, impotencia, angustia, miedo) como agradables (compasión, gratitud). Los resultados indican que ocultar el proceso de morir a lo largo del desarrollo de la civilización lo convirtió en un tabú e, incluso, es angustiante para las personas que trabajan con cuidados paliativos. También contribuye a mostrar una importante dimensión subjetiva del cuidado, generalmente ignorada, que genera sufrimiento, pero también resignificación. Para que cumpla con su propósito es necesario encontrar sentido en el trabajo, posibilitado por la modificación del estado interno del profesional a través de la experiencia, generando transformación y un nuevo significado y conocimiento a partir de la praxis.

The minus-end depolymerase KIF2A drives flux-like treadmilling of γTuRC-uncapped microtubules.

During mitosis, microtubules in the spindle turn over continuously. At spindle poles, where microtubule minus ends are concentrated, microtubule nucleation and depolymerization, the latter required for poleward microtubule flux, happen side by side. How these seemingly antagonistic processes of nucleation and depolymerization are coordinated is not understood. Here, we reconstitute this coordination in vitro combining different pole-localized activities. We find that the spindle pole-localized kinesin-13 KIF2A is a microtubule minus-end depolymerase, in contrast to its paralog MCAK. Due to its asymmetric activity, KIF2A still allows microtubule nucleation from the γ-tubulin ring complex (γTuRC), which serves as a protective cap shielding the minus end against KIF2A binding. Efficient γTuRC uncapping requires the combined action of KIF2A and a microtubule severing enzyme, leading to treadmilling of the uncapped microtubule driven by KIF2A. Together, these results provide insight into the molecular mechanisms by which a minimal protein module coordinates microtubule nucleation and depolymerization at spindle poles consistent with their role in poleward microtubule flux.

Src-Dependent NM2A Tyrosine Phosphorylation Regulates Actomyosin Remodeling.

Non-muscle myosin 2A (NM2A) is a key cytoskeletal enzyme that, along with actin, assembles into actomyosin filaments inside cells. NM2A is fundamental for cell adhesion and motility, playing important functions in different stages of development and during the progression of viral and bacterial infections. Phosphorylation events regulate the activity and the cellular localization of NM2A. We previously identified the tyrosine phosphorylation of residue 158 (pTyr158) in the motor domain of the NM2A heavy chain. This phosphorylation can be promoted by Listeria monocytogenes infection of epithelial cells and is dependent on Src kinase; however, its molecular role is unknown. Here, we show that the status of pTyr158 defines cytoskeletal organization, affects the assembly/disassembly of focal adhesions, and interferes with cell migration. Cells overexpressing a non-phosphorylatable NM2A variant or expressing reduced levels of Src kinase display increased stress fibers and larger focal adhesions, suggesting an altered contraction status consistent with the increased NM2A activity that we also observed. We propose NM2A pTyr158 as a novel layer of regulation of actomyosin cytoskeleton organization.

Effectiveness of palbociclib with aromatase inhibitors for the treatment of advanced breast cancer in an exposure retrospective cohort study: implications for clinical practice.

BACKGROUND: New drugs for locally advanced or metastatic breast cancer have led to clinical benefits, aside with increasing costs to healthcare systems. The current financing model for health technology assessment (HTA) privileges real-world data. As part of the ongoing HTA, this study aimed to evaluate the effectiveness of palbociclib with aromatase inhibitors (AI) and compare it with the efficacy reported in PALOMA-2. METHODS: A population-based retrospective exposure cohort study was conducted including all patients initiating treatment in Portugal with palbociclib under early access use and registered in the National Oncology Registry. The primary outcome was progression free survival (PFS). Secondary outcomes considered included time to palbociclib failure (TPF), overall survival (OS), time to next treatment (TTNT), and proportion of patients discontinuing treatment due to  adverse events (AEs). The Kaplan-Meier method was used and median, 1- and 2-year survival rates were computed, with two-sided 95% confidence intervals (95%CI). STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines for reporting observational studies were used. RESULTS: There were 131 patients included. Median follow-up was 28.3 months (IQR: 22.7-35.2) and median duration of treatment was 17.5 months (IQR: 7.8-29.1). Median PFS was 19.5 months (95%CI 14.2-24.2), corresponding to a 1-year PFS rate of 67.9% (95%CI 59.2-75.2) and a 2-year PFS rate of 42.0% (95%CI 33.5-50.3). Sensitivity analysis showed median PFS would increase slightly when excluding those not initiating treatment with the recommended dose, raising to 19.8 months (95%CI 14.4-28.9). By considering only patients meeting PALOMA-2 criteria, we could observe a major difference in treatment outcomes, with a mean PFS of 28.8 months (95%CI 19.4-36.0). TPF was 19.8 months (95%CI 14.2-24.9). Median OS was not reached. Median TTNT was 22.5 months (95%CI 18.0-29.8). A total of 14 patients discontinued palbociclib because of AEs (10.7%). CONCLUSIONS: Data suggest palbociclib with AI to have an effectiveness of 28.8 months, when used in patients with overlapping characteristics to those used in PALOMA-2. However, when used outside of these eligibility criteria, namely in patients with less favorable prognosis (e.g., presence of visceral disease), the benefits are inferior, even though still favorable.

Impacto da epidemia de COVID-19 na mortalidade em prisões / Impact of the COVID-19 epidemic on mortality in prisons

Resumo O objetivo deste artigo é avaliar o impacto da COVID-19 na mortalidade das pessoas privadas de liberdade (PPL) no estado do Rio de Janeiro e comparar as taxas observadas com as da população geral. Estudo quantitativo, retrospectivo, que associa análise de série histórica 2016-2021 de taxa anual de mortalidade, seccional, comparando 2016-2017 vs. 2020-2021 e análise de dados individuais obtidos a partir de fontes primárias e secundárias de informação. A razão de mortalidade padronizada entre PPL e população geral foi estimada para os grupos de causa. Série histórica mostrou queda anual (13%) da mortalidade de 2016 a 2019, tendência que se inverteu em 2020 devido à COVID-19, responsável por 20% do total de mortes. Das PPL que morreram por COVID-19, 54,8% eram idosas e/ou portadoras de comorbidade. A mortalidade por COVID-19 foi semelhante entre a PPL e a população geral, mas a mortalidade por tuberculose e HIV permaneceu muito mais elevada entre as PPL. A pandemia foi provavelmente determinante para a reversão da tendência de queda na mortalidade observada entre 2016 e 2019. A utilização da mortalidade como indicador de saúde e direitos humanos nas prisões por órgãos de saúde, justiça e organizações da sociedade civil implica o aprimoramento da informação sobre PPL no SIM.

Abstract Purpose: to assess the impact of COVID-19 on the mortality of people deprived of their liberty (PDL) in the state of Rio de Janeiro and compare the rates observed with those of the general population. Method: quantitative, retrospective study combining the analysis of the 2016-2021 time series of annual mortality rates, cross-sectional study comparing 2016-2017 vs. 2020-2021 and analysis of individual data obtained from primary and secondary sources of information. The standardized mortality ratio between PDL and the general population was estimated for the cause of death categories. Results: historical series showed an annual drop (13%) in mortality from 2016 to 2019, a trend that was inverted in 2020 due to COVID-19, which was responsible for 20% of all deaths. Of the COVID-19 deaths, 54.8% were elderly and/or had co-morbidities. Mortality from COVID-19 was similar between PDL and the general population, but mortality from tuberculosis and HIV remained much higher among PDL. Conclusion: the pandemic was probably a determinant of the downward trend reversal in mortality between 2016 and 2019. Using mortality as an indicator of health and human rights in prisons by health, justice and civil society organizations implies the improvement of information about PDL in the SIM.

A vida cotidiana do neoliberalismo: os cuidados de saúde à população em situação de rua no Rio de Janeiro / The everyday life of neoliberalism: The provision of health care for unhoused people in Rio de Janeiro

Resumo O crescimento do neoliberalismo nas políticas sociais brasileiras vem resultando em retrocessos nos indicadores sociais, nas condições de trabalho e no desempenho dos serviços de saúde. Não obstante, sabe-se pouco sobre como o neoliberalismo age nas práticas concretas e relações de cuidado. Este artigo visa contribuir para a análise dos impactos da neoliberalização da saúde no Brasil, com foco na capilarização do neoliberalismo no cotidiano do cuidado, bem como pensar formas de resistência ao neoliberalismo na saúde. Partimos da crítica marxista e feminista da vida cotidiana, que considera a interdependência entre o global e o local nas políticas e práticas de saúde. Utilizamos resultados de pesquisa qualitativa sobre o cuidado de saúde à população em situação de rua no Rio de Janeiro, como forma de ilustrar o impacto do neoliberalismo no cotidiano dos serviços de saúde e suas consequências nas percepções de profissionais de saúde e usuários. Observamos que atitudes individuais e coletivas dos profissionais de saúde evidenciam formas de resistência à racionalidade neoliberal hegemônica. A lente da vida cotidiana permite observar tanto a reprodução do global neoliberal, quanto atitudes que potenciam transformações e revelam a persistência de um cuidado empático enquanto um ato de resistência ao neoliberalismo.

Abstract The growth of neoliberalism in Brazilian social policies has resulted in setbacks in social indicators, in working conditions and performance of health services. Nonetheless, little is known about how neoliberalism acts in concrete practices and care relationships. This article aims to contribute to the analysis of the impacts of neoliberalization of health in Brazil, focusing on the capillarization of neoliberalism in daily care., and to reflect about forms of resistance to neoliberalism in health. We draw on the Marxist and feminist critique of everyday life, which considers the interdependence between the global and the local in health policies and practices. We consider results of a qualitative research on health care for the unhoused population in Rio de Janeiro, as a way of illustrating the impact of neoliberalism in the daily life of health services and its consequences on the perceptions of health professionals and users. We observed that individual and collective attitudes of health professionals show forms of resistance to hegemonic neoliberal rationality. The lens of everyday life allows us to observe both the reproduction of neoliberal global dynamics, as well as attitudes that can enable transformations and the persistence of an empathic approach to care as an act of resistance to neoliberalism.

Causas e efeitos dos estigmas sociais na desassistência em saúde de populações vulneráveis: vamos falar sobre isso? / Causes and effects of social stigmas on poor health care for vulnerable populations: shall we talk about it?

Estigmas associados à População em situação de rua (PSR) e às Pessoas privadas de liberdade (PPL) são fruto de uma construção socio-histórica e implicam sofrimento físico e psíquico, rupturas familiares e sociais, afetando a reintegração social e o direito à cidadania. A proposta deste ensaio é refletir sobre estigmas e discriminações impregnados na vida cotidiana da PSR e PPL, suas causas estruturantes e consequências no cuidado de saúde. Nosso argumento é que eles constituem importantes barreiras no cuidado para aquelas pessoas mais necessitadas, bem como no autocuidado. Por outro lado, os profissionais de saúde têm papel estratégico no seu enfrentamento. Para percorrer esse caminho, utilizou-se contribuições teóricas das ciências humanas-sociais e experiências da vida real, obtidas por meio de entrevistas com essas populações e profissionais de saúde que as atendem. Nossa aposta é que conhecer melhor aquilo que se teme e refletir sobre nossas ações, geralmente burocráticas e automatizadas, representam passos importantes para a ressignificação e diminuição de preconceitos, impactando também a vida do binômio profissional-paciente e a produção de sentido e melhoria do cuidado prestado.

O que representa o diagnóstico de HIV/Aids após quatro décadas de epidemia? / What does the diagnosis of HIV/AIDS represent after four decades of epidemic?

RESUMO O HIV/Aids foi descoberto há 41 anos, e avanços importantes foram conquistados para pessoas vivendo com HIV/Aids. Mas esses fatos foram suficientes para mudar a representação diagnóstica e superar o medo de sofrer preconceitos? Objetivou-se analisar as representações do diagnóstico de HIV/Aids após quatro décadas de epidemia. Realizou-se pesquisa exploratória, qualitativa, em instituição especializada em HIV/Aids localizada no Rio de Janeiro. Foram entrevistados 14 pacientes maiores de 18 anos, de ambos os sexos, independentemente de tempo de diagnóstico. Realizou-se análise fenomenológica. As representações evocavam pessimismo relacionado aos estigmas (contaminação, aparência de 'aidético', morte iminente); otimismo (diagnóstico como renascimento, parecer saudável, diagnóstico de HIV, não Aids, pertencimento ao grupo de homossexuais com HIV); ou indução pelos profissionais (HIV como doença crônica). Também se percebeu hierarquia de preconceitos entre quem utiliza antirretrovirais para evitar o HIV contra quem vive com HIV, e destes últimos contra quem vive com Aids. Apesar dos avanços, evidenciou-se que os estigmas do início da epidemia ainda estão presentes, gerando vergonha e medo. As representações otimistas relacionam-se com a ressignificação desses estigmas por não terem se concretizado na realidade. Contudo, reconhece-se a importância do enfrentamento dos estigmas do HIV/Aids, sendo o cuidado em saúde importante lócus de ressignificação.

ABSTRACT HIV/AIDS was discovered 41 years ago and important advances have been made for people living with HIV/AIDS. But were these facts enough to change diagnostic representation and overcome fear of suffering prejudice? The objective was to analyze the representations of HIV/AIDS diagnosis after four decades of epidemic. Exploratory, qualitative research was carried out in an institution specializing in HIV/ AIDS located in Rio de Janeiro. Fourteen patients over 18 years, both genders, were interviewed, regardless time of diagnosis. Phenomenological analysis was performed. The representations evoked pessimism related to stigmas (contamination, appearance of 'aidetic', imminent death); optimism (diagnosis as rebirth, looking healthy, diagnosis of HIV, not AIDS, belonging the group of homosexuals with HIV); or induction by professionals (HIV as a chronic disease). A hierarchy of prejudices was perceived between those who use antiretrovirals to avoid HIV against those who live with HIV and, the latter, against those who live with AIDS. Despite the advances, it was evident the stigmas from the beginning the epidemic are present, generating shame and fear. Optimistic representations are related to resignification of stigmas for not having materialized in reality. However, the importance of confronting stigmas is recognized, with health care being an important locus of resignification.

Real-world effectiveness of palbociclib plus fulvestrant in advanced breast cancer: Results from a population-based cohort study.

BACKGROUND: Real-world (RW) data may provide valuable information on the effectiveness and safety of medicines, which is particularly relevant for clinicians, patients and third-party payers. Evidence on the effectiveness of palbociclib plus fulvestrant is scarce, which highlights the need of additional studies. The aim of this study was to evaluate the effectiveness of palbociclib plus fulvestrant in advanced breast cancer (ABC). MATERIALS AND METHODS: We conducted a population-based retrospective cohort study and cases of interest were identified through the Portuguese National Cancer Registry database and additional data sources. Patients aged≥18 years, diagnosed with ABC and exposed to palbociclib plus fulvestrant between May 31, 2017 and March 31, 2019 were included. Patients were followed-up until death or cut-off date (February 28, 2021). Primary outcome was rw-progression-free survival (rwPFS). Secondary outcomes were rw-overall survival (rwOS), rw-time to palbociclib failure (rwTPF) and rw-time to next treatment (rwTTNT). RESULTS: A total of 210 patients were included. Median age was 58 years (range 29-83) and 99.05% were female. Median follow-up time was 23.22 months and, at cut-off date, treatment had been discontinued in 189 patients, mainly due to disease progression (n = 152). Median rwPFS was 7.43 months (95% confidence interval [CI] 6.28-9.05) and 2-year rwPFS was 16.65% (95%CI 11.97-22.00). Median rwOS was 24.70 months (95%CI 21.58-29.27), median rwTPF was 7.5 months (95%CI 6.51-9.08) and median rwTTNT was 11.74 months (95%CI 10.33-14.08). CONCLUSION: Palbociclib plus fulvestrant seems an effective treatment for ABC in real-world context. Compared to registrations studies, rwPFS and rwOS were shorter in real-life setting.

Unhoused people: stigma, prejudice, and health care strategies. / População em situação de rua: estigmas, preconceitos e estratégias de cuidado em saúde.

Historical, social representations about stigma and prejudice related to unhoused people cause psychological distress, feeling of shame, and withdrawal from family and social relationships. This paper aimed to understand how unhoused people and health professionals perceive, reproduce, elaborate, and address the representations produced by their social conditions. This qualitative research employed participant observation, interviews with 24 unhoused people, and a focus group with professionals from the services providing care to the unhoused people. The study was conducted in Rio de Janeiro, Brazil, where crack use is very prevalent. An analysis was performed using the phenomenological narrative method. Stereotyping conjures the self-image of an unworthy, unwanted person, which justifies daily discrimination and, above all, the loss of the most critical condition of all beings, namely, their human condition, besides legitimizing the lack of care and violence against them. Deepening the relationship between prejudice and discrimination in the context of vulnerable populations and health services can assist therapeutic projects that promote the reduction of psychological distress, better care, and social recognition of citizenship of the unhoused people.

Representações sociais históricas sobre estigma e preconceito relacionado à População em Situação de Rua (PSR) provocam sofrimento psíquico, sentimento de vergonha, afastamento das relações familiares e sociais. Esse artigo objetivou entender como a PSR e os profissionais de saúde percebem, reproduzem, elaboram e lidam as representações produzidas por suas condições sociais. Pesquisa qualitativa, que envolve Observação Participante; Entrevistas com 24 PSR e Grupo Focal com profissionais dos serviços que prestam cuidado à PSR. O estudo foi realizado no município do Rio de Janeiro em local onde o uso do crack tem prevalência importante. Análise foi realizada pelo método da narrativa fenomenológica. O estereótipo provoca uma autoimagem de pessoa indigna, indesejada, que justifica discriminações cotidianas e, sobretudo, a perda da condição mais importante de todos os seres: sua condição humana, além de legitimar desassistência e violência contra elas. Aprofundar as relações entre preconceitos e discriminações em contexto de população vulnerável e serviços de saúde, pode auxiliar projetos terapêuticos que promovam diminuição do sofrimento psíquico, melhor assistência e reconhecimento social de cidadania da PSR.

População em situação de rua: estigmas, preconceitos e estratégias de cuidado em saúde / Unhoused people: stigma, prejudice, and health care strategies

Resumo Representações sociais históricas sobre estigma e preconceito relacionado à População em Situação de Rua (PSR) provocam sofrimento psíquico, sentimento de vergonha, afastamento das relações familiares e sociais. Esse artigo objetivou entender como a PSR e os profissionais de saúde percebem, reproduzem, elaboram e lidam as representações produzidas por suas condições sociais. Pesquisa qualitativa, que envolve Observação Participante; Entrevistas com 24 PSR e Grupo Focal com profissionais dos serviços que prestam cuidado à PSR. O estudo foi realizado no município do Rio de Janeiro em local onde o uso do crack tem prevalência importante. Análise foi realizada pelo método da narrativa fenomenológica. O estereótipo provoca uma autoimagem de pessoa indigna, indesejada, que justifica discriminações cotidianas e, sobretudo, a perda da condição mais importante de todos os seres: sua condição humana, além de legitimar desassistência e violência contra elas. Aprofundar as relações entre preconceitos e discriminações em contexto de população vulnerável e serviços de saúde, pode auxiliar projetos terapêuticos que promovam diminuição do sofrimento psíquico, melhor assistência e reconhecimento social de cidadania da PSR.

Abstract Historical, social representations about stigma and prejudice related to unhoused people cause psychological distress, feeling of shame, and withdrawal from family and social relationships. This paper aimed to understand how unhoused people and health professionals perceive, reproduce, elaborate, and address the representations produced by their social conditions. This qualitative research employed participant observation, interviews with 24 unhoused people, and a focus group with professionals from the services providing care to the unhoused people. The study was conducted in Rio de Janeiro, Brazil, where crack use is very prevalent. An analysis was performed using the phenomenological narrative method. Stereotyping conjures the self-image of an unworthy, unwanted person, which justifies daily discrimination and, above all, the loss of the most critical condition of all beings, namely, their human condition, besides legitimizing the lack of care and violence against them. Deepening the relationship between prejudice and discrimination in the context of vulnerable populations and health services can assist therapeutic projects that promote the reduction of psychological distress, better care, and social recognition of citizenship of the unhoused people.

The way of life of the unhoused people as an enhance for COVID-19 care.

OBJECTIVE: To analyze the way of life of the unhoused people to enhance health care in the pandemic. METHODS: A qualitative, interdisciplinary research, with participant observation and 24 interviews with the unhoused people. Empirical categories and bibliographic search on this population and COVID-19 guided simple actions aimed at care. RESULTS: The group at greatest risk for COVID-19 use drugs compulsively; starves constantly; discontinues drug treatment for tuberculosis, HIV, and diabetes; has underdiagnosis of Depression; has difficulty sheltering and uses inhaled drugs. This way of life increases the risk of worsening COVID-19 and brings great challenges to health services. Several proposals to guide care considered these results and the new routine caused by the pandemic. FINAL CONSIDERATIONS: The way of life of the studied population increased their vulnerability in the pandemic, as well as the perception of risk of disease transmission by the population in general.

Pharmacokinetics of oral levonorgestrel and ethinylestradiol in women after Roux-en-Y gastric bypass surgery.

BACKGROUND: Most patients undergoing Roux-en-Y gastric bypass (RYGB) are women in reproductive age. It is not known if bariatric surgery affects the pharmacokinetics of oral contraceptives. OBJECTIVES: The primary objective was to evaluate ethinylestradiol (EE) and levonorgestrel (LNG) absorption in women undergoing RYGB, compared with nonoperated controls matched by age and body mass index (BMI). A secondary objective was to assess whether the time since surgery and BMI in the postoperative period influenced the absorption parameters. SETTING: University hospital, Brazil. METHODS: This study was designed to compare the maximum plasma concentration (Cmax), the time to the peak plasma level (Tmax), the area under the curve (AUC0-8 and AUC0-∞) after a single dose of a combined oral contraceptive with 0.03 mg EE and 0.15 mg LNG among 20 women after RYGB and 20 controls. Blood samples were obtained for 8 hours. RESULTS: The mean LNG AUC0-8 and LNG AUC0-∞ were higher in RYGB group (P = .048 and P = .004, respectively). We found a positive correlation for LNG AUC0-8 (P = .045) and AUC0-∞ (P = .004) and the time since surgery, and we found a negative correlation for LNG Cmax (P = .018), AUC0-8 (P = .003), and AUC0-∞ (P = .001) and BMI. CONCLUSION: No significant differences were found in oral EE pharmacokinetics. The operated group showed higher mean LNG AUC0-8 and AUC0-∞ but it was not considered clinically significant. The present study suggests that RYGB may not affect EE and LNG absorption.

The way of life of the unhoused people as an enhance for COVID-19 care / Modo de vida de población en situación de calle como potenciador del cuidado de COVID-19 / Modo de vida da população em situação de rua como potencializador do cuidado de COVID-19

ABSTRACT Objective: To analyze the way of life of the unhoused people to enhance health care in the pandemic. Methods: A qualitative, interdisciplinary research, with participant observation and 24 interviews with the unhoused people. Empirical categories and bibliographic search on this population and COVID-19 guided simple actions aimed at care. Results: The group at greatest risk for COVID-19 use drugs compulsively; starves constantly; discontinues drug treatment for tuberculosis, HIV, and diabetes; has underdiagnosis of Depression; has difficulty sheltering and uses inhaled drugs. This way of life increases the risk of worsening COVID-19 and brings great challenges to health services. Several proposals to guide care considered these results and the new routine caused by the pandemic. Final considerations: The way of life of the studied population increased their vulnerability in the pandemic, as well as the perception of risk of disease transmission by the population in general.

RESUMEN Objetivo: Analizar el modo de vida de la población en situación de calle (PSC) para potenciar el cuidado en salud en la pandemia. Métodos: Investigación cualitativa, interdisciplinaria, con observación participante, y 24 entrevistas con población en situación de calle. Categorías empíricas y búsqueda bibliográfica sobre dicha población y COVID-19 determinaron propuestas simples orientadas al cuidado. Resultados: El grupo más vulnerable a COVID-19 usa drogas compulsivamente, pasa hambre, interrumpe tratamiento médico para tuberculosis, VIH y diabetes; tiene subdiagnóstico de depresión, dificultad para hallar refugio y usa drogas inhalantes. Dicho modo de vida incrementa el riesgo de agravamiento del COVID-19, imponiendo mayores desafíos a los servicios de salud. Diversas propuestas de orientación del cuidado consideraron estos resultados y las nuevas rutinas impuestas por la pandemia. Consideraciones finales: El modo de vida de la población estudiada incrementó su vulnerabilidad en pandemia, así como la percepción de riesgo de transmisión de la enfermedad a la población en general.

RESUMO Objetivo: Analisar o modo de vida da População em Situação de Rua para potencializar o cuidado em saúde na pandemia. Métodos: Pesquisa qualitativa, interdisciplinar, com observação participante e 24 entrevistas com população em situação de rua. Categorias empíricas e busca bibliográfica sobre essa população e COVID-19 pautaram proposições simples voltadas ao cuidado. Resultados: O grupo de maior risco para COVID-19 faz uso compulsivo de drogas; passa fome constantemente; interrompe tratamento medicamentoso para Tuberculose, HIV e Diabetes; tem subdiagnóstico de Depressão; tem dificuldade de abrigamento; usa drogas inalatórias. Esse modo de vida aumenta risco de agravamento da COVID-19 e impõe maiores desafios aos serviços de saúde. Diversas propostas para orientar o cuidado levaram em conta esses resultados e a nova rotina impressa pela pandemia. Considerações Finais: O modo de vida da população estudada ampliou sua vulnerabilidade na pandemia, bem como a percepção de risco de transmissão da doença pela população em geral.

Non-Muscle Myosin 2A (NM2A): Structure, Regulation and Function.

Non-muscle myosin 2A (NM2A) is a motor cytoskeletal enzyme with crucial importance from the early stages of development until adulthood. Due to its capacity to convert chemical energy into force, NM2A powers the contraction of the actomyosin cytoskeleton, required for proper cell division, adhesion and migration, among other cellular functions. Although NM2A has been extensively studied, new findings revealed that a lot remains to be discovered concerning its spatiotemporal regulation in the intracellular environment. In recent years, new functions were attributed to NM2A and its activity was associated to a plethora of illnesses, including neurological disorders and infectious diseases. Here, we provide a concise overview on the current knowledge regarding the structure, the function and the regulation of NM2A. In addition, we recapitulate NM2A-associated diseases and discuss its potential as a therapeutic target.

10-Phenyl-10H-phenoxazine-4,6-diol tetra-hydro-furan monosolvate.

In the crystalline state of the title solvate, C18H13NO3·C4H8O, hydrogen-bonding inter-actions between hydroxyl groups on a phenoxazine backbone and the tetra-hydro-furan solvent are observed that suggest the ability for this compound to act as a chelating ligand. The O⋯O donor-acceptor distances for this hydrogen bonding are 2.7729 (15) and 2.7447 (15) Å. The three-ring backbone of the phenoxazine bends out of planarity by 18.92 (3)°, as computed using mean planes that encompass each half of the three-ring structure, with the central N and O atoms forming the line of flexion. In the crystal, a π-π stacking arrangement exists between inversion-related mol-ecules, with a centroid-to-centroid distance of 3.6355 (11) Å. In the disordered tetra-hydro-furan solvate, all atoms except oxygen were modeled over two positions, with occupancies of 0.511 (8) and 0.489 (8).