Evaluation of screening practices for primary hyperaldosteronism by specialists and general practitioners: an observational, cross-sectional study.

Objective: Despite its recognized importance, primary hyperaldosteronism (PHA) remains an underdiagnosed condition in clinical practice. The objective of the present study was to evaluate PHA screening practices by general practitioners and specialists in endocrinology and cardiology. Subjects and methods: This cross-sectional, observational study invited physicians to respond voluntarily to an online survey. The survey collected the respondents' sociodemographic data and answers to five hypothetical clinical cases meeting Endocrine Society criteria for PHA screening. Results: In all, 126 physicians responded to the online survey. Endocrinologists were the specialists who most often chose PHA screening, although the screening rates were overall low, ranging from 36.5% to 92.9%, depending on the case and the respondents' specialty. The survey also assessed the reasons for not choosing PHA screening, which included limited availability of tests within the public health services, interference of antihypertensive medications on hormone levels, and failure to identify the screening indication. Being an endocrinologist was an independent predictor for choosing PHA screening for the patients in Cases #1 and #5 (p = 0.001 and p = 0.002, respectively). Conclusion: Endocrinologists were the specialists who most often chose PHA screening, although the screening rates were overall low among all specialists. These findings highlight a need for continuing medical education programs addressing PHA screening and making the diagnosis of PHA more present in the daily clinical practice of physicians treating patients with hypertension.

The search for equity in public health policies: analysis of the implementation of incentives for physical activity in Primary Care in Brazil / La búsqueda de equidad en las políticas públicas de salud: análisis de la implementación de incentivos a la actividad física en la Atención Primaria en Brasil / A busca pela equidade nas políticas públicas de saúde: análise da implementação do incentivo à atividade física na Atenção Primária do Brasil

Public health policies aim to provide equitable access to healthcare services as a fundamental right. In 2022, the Ministry of Health created a financial incentive to promote physical activity (IAF) in SUS Primary Health Care. The objectives of this study were to present the national panorama of the first year of implementation of the IAF and to analyze whether the municipal prioritization score, created considering the existing budget availability, was an effective criterion for greater equity in the distribution of resources in the different implementation periods (without and with targets). This is a descriptive study analyzing the absolute and relative number of municipalities and health units approved, the number of health units that received funds and the amounts paid out. To analyze equity, measures of absolute and relative inequalities between health units were calculated, grouped into quartiles according to the municipal prioritization score. The percentage of approved health units that received funds was no more than 37.6%, with R$18.05 million paid out (period without targets) and R$10.10 million (with targets). There was a 68.9% reduction in the number of health units that received funds after the targets were set. Important inequalities in the receipt of resources were revealed, with a higher percentage of health units located in municipalities with lower priority. Thus, the criteria adopted by the Ministry of Health were insufficient to guarantee equity in the allocation of resources to promote physical activity.

Las políticas de salud pública apuntan a brindar acceso equitativo a los servicios de salud como un derecho fundamental. En 2022, el Ministerio de Salud creó un incentivo financiero para promover la actividad física (IAF) en la Atención Primaria de Salud del SUS. El presente trabajo tuvo como objetivo presentar el panorama nacional del primer año de implementación del IAF y analizar si el puntaje de priorización municipal, creado considerando la disponibilidad presupuestaria existente, fue un criterio efectivo para una mayor equidad en la distribución de los recursos en los diferentes períodos de implementación (sin y con metas). Se trata de un estudio descriptivo con análisis del número absoluto y relativo de municipios y unidades de salud aprobadas, unidades de salud que recibieron recursos y los montos pagados. Para analizar la equidad se calcularon medidas de desigualdades absolutas y relativas entre unidades de salud, agrupadas en cuartiles según el puntaje de priorización municipal. Se demostró que el 74% de los municipios y el 16,7% de las unidades de salud elegibles fueron aprobados por el IAF. El porcentaje de unidades de salud aprobadas que recibieron recursos no superó el 37,6%, siendo pagados R$ 18,05 millones (período sin metas) y R$ 10,10 millones (con metas). Hubo una reducción del 68,9% en las unidades de salud que recibieron recursos luego de establecer metas. Se revelaron importantes desigualdades en la recepción de recursos, con un mayor porcentaje de unidades de salud ubicadas en municipios con menor prioridad. Por tanto, los criterios adoptados por el Ministerio de Salud fueron insuficientes para garantizar la equidad en la asignación de recursos para promover la actividad física.

As políticas públicas de saúde têm como objetivo proporcionar acesso equitativo aos serviços de saúde como um direito fundamental. Em 2022, o Ministério da Saúde criou um incentivo financeiro para a promoção da atividade física (IAF) na Atenção Primária à Saúde do SUS. O presente trabalho teve como objetivos apresentar o panorama nacional do primeiro ano de implementação do IAF e analisar se a nota de priorização municipal, criada considerando a disponibilidade orçamentária existente, foi um critério efetivo para maior equidade na distribuição dos recursos nos diferentes períodos de implementação (sem e com metas). Trata-se de um estudo descritivo com análises do número absoluto e relativo de municípios e unidades de saúde homologadas, de unidades de saúde que receberam recursos e dos valores pagos. Para analisar a equidade, foram calculadas as medidas de desigualdades absolutas e relativas entre as unidades de saúde, agrupadas em quartis conforme a nota de priorização municipal. Foi demonstrado que 74% dos municípios e 16,7% das unidades de saúde elegíveis foram homologadas ao IAF. O percentual de unidades de saúde homologadas que receberam recursos não passou de 37,6%, sendo pagos R$18,05 milhões (período sem metas) e R$10,10 milhões (com metas). Houve uma redução de 68,9% nas unidades de saúde que receberam recursos após o estabelecimento de metas. Foram reveladas importantes desigualdades no recebimento de recursos, com maior percentual de unidades de saúde localizadas em municípios com menor prioridade. Assim, os critérios adotados pelo Ministério da Saúde foram insuficientes para garantir equidade na alocação de recursos para a promoção da atividade física.

Federal government budgetary and financial resources for body practices and physical activities in the Unified Health System: analysis of the 2019-2022 governmental cycle. / Recursos da União para as práticas corporais e atividades físicas no SUS: análise do ciclo governamental 2019-2022.

Through quantitative exploratory research, the present study analyzed the amount foreseen in the Federal Budget and the amounts paid (nominal and deflated) for programs and actions to promote body practices and physical activities (Health Academy Program and the Federal Incentive for Physical Activity in Primary Health Care) from 2019 to 2022. The values of investment in body practices and physical activities in SUS per capita, according to the population covered by Primary Health Care (PHC) and per participant in public programs, were also calculated. The following was found: (1) that the resources that were actually paid were 3.31% to 15.06% lower than those approved in the budget (nominal) and (2) the low annual (maximum) values found, regardless of whether nominal or deflated - per capita (R$ 0.21 to 0.30) per population covered by PHC (R$ 0.25 to 0.40) and per participant (R$ 10.61 to 14.61). It was concluded that the low investment in the promotion of body practices and physical activities decreases access and does not contribute to the full functioning of SUS by preventing or hindering the expansion of possibilities of comprehensive health care.

Por meio de pesquisa quantitativa de caráter exploratório, o presente estudo teve o objetivo de analisar o orçamento e o financiamento federal de programas e ações de promoção das práticas corporais e atividades físicas no Sistema Único de Saúde (SUS) de 2019 a 2022 (Programa Academia da Saúde e o Incentivo Federal de Custeio da Atividade Física na Atenção Primária). Foram analisados e calculados os valores per capita, pela população coberta pela atenção primária e por participante de programas públicos. Os recursos efetivamente pagos foram de 3,31% a 15,06% menores dos que os aprovados no orçamento (nominal), e também foram identificados os baixos valores (máximos) anuais, independentemente se nominal ou deflacionado per capita (R$ 0,21 a 0,30) por população coberta pela atenção primária (R$ 0,25 a 0,40) e por participante (R$ 10,61 a 14,61). Concluiu-se que o baixo investimento na promoção das práticas corporais e atividades físicas diminui o acesso e não contribui para o pleno funcionamento do SUS ao impedir ou dificultar a ampliação de possibilidades do cuidado integral em saúde.

The First Steps on AOPs' Concepts, Development, and Applications in Teratology.

An Adverse Outcome Pathway (AOP) is an analytical model that describes, through a graphical representation, a linear sequence of biologically connected events at different levels of biological organization, causally leading to an adverse effect on human health or the environment. In general, AOPs are constructed based on five central principles: systematic development and review, chemical-agnostic, modular, networks, and living documents. Furthermore, AOPs have the potential to be used, for example, to investigate certain molecular targets; relate the regulation of specific genes or proteins among AOPs; extrapolate biological processes, pathways, or diseases from one species to another; and even predict adverse effects in particular populations. AOPs also emerge as an alternative to animal experimentation in studies of developmental malformations. It's even possible now to develop a quantitative AOP to predict teratogenic effects for some substances. However, the construction of high-quality AOPs requires standardization in the way these models are developed and reviewed, ensuring an adequate degree of flexibility and guaranteeing efficiency. The development of AOPs should strictly be based on the guidance documents developed by the OECD. Nevertheless, an important step for those developing AOPs is the choice of an apical endpoint or an initiating molecular event in order to initiate the construction of the pathway. Another crucial step is a systematic literature review based on the random combination of the blocks of information. With these two fundamental steps completed, it only remains to follow the guidance documents on Developing and Assessing Adverse Outcome Pathways and AOP Developers' Handbook supplement provided by the OECD to organize and construct an AOP. This modern approach will bring radical changes in the field of toxicity testing, regarding the prediction of apical toxic effects using molecular-level effects.

O guia brasileiro de atividade física: análise a partir da concepção ampliada de saúde / The brazilian guidelines to physical activity: analysis from the expanded conception of health / La guía brasileña de actividad física: análisis desde la concepción ampliada de la salud

Trata-se de uma pesquisa de caráter documental, com abordagem descritiva e exploratória, com o objetivo de analisar o conteúdo do Guia de Atividade Física para a População Brasileira (GAFPB) a partir da concepção ampliada de saúde. As categorias identificadas foram: Bem-estar e qualidade de vida; Socialização e fortalecimento de vínculos; Autonomia e empoderamento; Participação Social; Ampliação do acesso e complexidades envolvidas. Já as ausências foram: o conceito de saúde no qual o GAFPB foi baseado; associação a um profissional específico; questões relacionadas a populações vulneráveis. Em conclusão, foi possível identificar a presença da concepção ampliada de saúde no GAFPB ao observar o questionamento do privilégio da dimensão biológica e do caráter impositivo e normativo de intervir, se aproximar do debate sobre o desenvolvimento humano e pela relativização do enfoque na quantidade de atividades físicas que deve ser realizada.

This is documentary research with a descriptive and exploratory approach, the objective was to analyze in a categorical-thematic way the content of the Physical Activity Guidelines for the Brazilian Population (GAFPB) based on the expanded conception of health. The categories identified were: Well-being and quality of life; Socialization and strengthening of bonds; Autonomy and empowerment; Social Participation; Expansion of access and complexities involved. The absences were the presentation of the concept of health on which the GAFPB was based; association with a specific professional; issues related to vulnerable populations. In conclusion, it was possible to identify the presence of the expanded conception of health in the GAFPB by questioning the privilege of the biological dimension and the imposing and normative character of intervening, approaching the debate on human development and relativizing the focus on the amount of physical activities that must be performed.

Se trata de una investigación documental con abordaje descriptivo y exploratorio, el objetivo fue analizar de forma categórica-temática el contenido de la Guía de Actividad Física para la Población Brasileña (GAFPB) a partir de la concepción ampliada de la salud. Las categorías identificadas fueron: Bienestar y calidad de vida; Socialización y fortalecimiento de vínculos; Autonomía y empoderamiento; Participación social; Ampliación de acceso y complejidades involucradas. Las ausencias fueron la presentación del concepto de salud en el que se basó la GAFPB; vinculación con un profesional específico; temas relacionados con las poblaciones vulnerables. En conclusión, fue posible identificar la presencia de la concepción ampliada de la salud en el GAFPB al cuestionar el privilegio de la dimensión biológica y el carácter imponente y normativo de intervenir, acercándose al debate sobre el desarrollo humano y relativizando el enfoque en la cantidad de actividades físicas deben ser realizadas.

Recursos da União para as práticas corporais e atividades físicas no SUS: análise do ciclo governamental 2019-2022 / Federal government budgetary and financial resources for body practices and physical activities in the Unified Health System: analysis of the 2019-2022 governmental cycle

Resumo Por meio de pesquisa quantitativa de caráter exploratório, o presente estudo teve o objetivo de analisar o orçamento e o financiamento federal de programas e ações de promoção das práticas corporais e atividades físicas no Sistema Único de Saúde (SUS) de 2019 a 2022 (Programa Academia da Saúde e o Incentivo Federal de Custeio da Atividade Física na Atenção Primária). Foram analisados e calculados os valores per capita, pela população coberta pela atenção primária e por participante de programas públicos. Os recursos efetivamente pagos foram de 3,31% a 15,06% menores dos que os aprovados no orçamento (nominal), e também foram identificados os baixos valores (máximos) anuais, independentemente se nominal ou deflacionado per capita (R$ 0,21 a 0,30) por população coberta pela atenção primária (R$ 0,25 a 0,40) e por participante (R$ 10,61 a 14,61). Concluiu-se que o baixo investimento na promoção das práticas corporais e atividades físicas diminui o acesso e não contribui para o pleno funcionamento do SUS ao impedir ou dificultar a ampliação de possibilidades do cuidado integral em saúde.

Abstract Through quantitative exploratory research, the present study analyzed the amount foreseen in the Federal Budget and the amounts paid (nominal and deflated) for programs and actions to promote body practices and physical activities (Health Academy Program and the Federal Incentive for Physical Activity in Primary Health Care) from 2019 to 2022. The values of investment in body practices and physical activities in SUS per capita, according to the population covered by Primary Health Care (PHC) and per participant in public programs, were also calculated. The following was found: (1) that the resources that were actually paid were 3.31% to 15.06% lower than those approved in the budget (nominal) and (2) the low annual (maximum) values found, regardless of whether nominal or deflated - per capita (R$ 0.21 to 0.30) per population covered by PHC (R$ 0.25 to 0.40) and per participant (R$ 10.61 to 14.61). It was concluded that the low investment in the promotion of body practices and physical activities decreases access and does not contribute to the full functioning of SUS by preventing or hindering the expansion of possibilities of comprehensive health care.

Skeletal Muscle Discomfort and Lifestyle of Brazilian Military Police Officers of Administrative and Tactical Force.

Our aim was to evaluate musculoskeletal discomfort and the lifestyle of military police officers of administrative and tactical force departments. Military police officers were distributed into two groups: administrative (Adm, n = 15) and tactical force (TF, n = 16) departments. Their lifestyle was assessed using the Fantastic Lifestyle questionnaire. Moreover, physical activity quantification was assessed using the International Physical Activity questionnaire, and musculoskeletal discomfort was quantified using the Corlett diagram. The mean total time of physical activity was 546 ± 276 min per week. No differences (p = 0.0832) were found between the Adm (454 ± 217 min) and TF (623 ± 301 min) groups. Concerning lifestyle, in general the sample presented very good (42%) and good (42%) style classification. For this parameter, no significant differences were found, but only a tendency was discovered (x2: 7.437; p = 0.0592); indeed, the TF presented a better classification (63%) of very good, compared to the Adm (53%) of good. No differences (p > 0.05) were found in musculoskeletal perception of discomfort between the right and left sides (p > 0.05) for all police officers and between the Adm and FT groups (p > 0.05). Military police officers showed high and moderate risk for waist circumference and waist-to-hip ratio, respectively; however, lifestyle and total time of physical activity were considered adequate without differences between military administrative and tactical force sectors.

AOP Report: Glutathione Conjugation Leading to Reproductive Dysfunction via Oxidative Stress.

We propose an adverse outcome pathway (AOP) for reproductive dysfunction via oxidative stress (OS). The AOP was developed based on Organisation for Economic Co-operation and Development (OECD) Guidance Document 184 and on the specific considerations of the OECD users' handbook supplement to the guidance document for developing and assessing AOPs (no. 233). According to the qualitative and quantitative experimental data evaluation, glutathione (GSH) conjugation is the first upstream key event (KE) of this AOP to reproductive dysfunction triggering OS. This event causes depletion of GSH basal levels (KE2 ). Consequently, this drop of free GSH induces an increase of reactive oxygen species (KE3 ) generated by the natural cellular metabolic processes (cellular respiration) of the organism. Increased levels of these reactive species, in turn, induce an increase of lipid peroxidation (KE4 ). This KE consequently leads to a rise in the amount of toxic substances, such as malondialdehyde and hydroxynonenal, which are associated with decreased quality and competence of gamete cell division, consequently impairing fertility (KE5 and adverse outcome). The overall assessment of the general biological plausibility, the empirical support, and the essentiality of KE relationships was considered as high for this AOP. We conclude that GSH conjugation is able to lead to reproductive disorder in fishes and mammals, via OS, but that the amount of stressor needed to trigger the AOP differs between stressors. Environ Toxicol Chem 2023;42:2519-2528. © 2023 SETAC.

Planning in the Unified Health System: analysis of the agenda for body practices and physical activities at federal level between 2004 and 2023 / Planejamento no Sistema Único de Saúde: análise da agenda das práticas corporais e atividades físicas no âmbito federal no período de 2004 a 2023

Body practices and physical activities (BPPA) have been incorporated into the services of the Unified Health System (SUS), with the Health Academy Program as its main exponent. However, planning, which expresses the responsibilities of managers regarding the population's health, has not yet been investigated to make these practices effective as public health policies. Thus, the aim of this manuscript was to analyze the formulation and development of the agenda for BPPA promotion from the planning instruments of the federal level of the SUS - National Health Plan, Annual Health Programming and Annual Management Report, from 2004 to 2023. Through an analytical-descriptive study based on documentary research, a search was carried out for terms such as: (in)physical activity; physically active; physical exercise; body practices; among others. The formulation and development of the BPPA promotion agenda were mainly related to facing chronic noncommunicable diseases, and there was an important disparity between what was planned and what was executed, to the detriment of the expansion of Health Academy. With the historic rescue of the BPPA agenda in SUS presented, debates and initiatives are allowed with a view to making them effective as a public health policy.

As práticas corporais e atividades físicas (PCAF) têm sido incorporadas nos serviços do Sistema Único de Saúde (SUS), tendo o Programa Academia da Saúde como principal expoente. Porém, ainda não foi investigado o planejamento, que expressa as responsabilidades dos gestores quanto à saúde da população, para efetivação dessas práticas como políticas públicas de saúde. Assim, o presente manuscrito teve o objetivo de analisar a formulação e o desenvolvimento da agenda de promoção das PCAF a partir dos instrumentos de planejamento do âmbito federal do SUS ­ Plano Nacional de Saúde, Programação Anual de Saúde e Relatório Anual de Gestão, de 2004 a 2023. Por meio de estudo de caráter analítico-descritivo pautado em pesquisa documental foi realizada a busca de termos como: (in)atividade física; fisicamente ativo; exercício físico; práticas corporais; dentre outros. A formulação e o desenvolvimento da agenda de promoção das PCAF estiveram principalmente relacionados ao enfrentamento das doenças crônicas não transmissíveis e houve importante disparidade entre o que foi planejado e o executado, em desfavor da expansão do Academia da Saúde. Com o resgate histórico da agenda das PCAF no SUS apresentado são permitidos debates e iniciativas com vistas a efetivá-las enquanto política pública de saúde.

Effectiveness of visceral fascial therapy targeting visceral dysfunctions outcome: systematic review of randomized controlled trials.

BACKGROUND: Fascial Therapy is an ancient and widespread practice throughout the world. These approaches are very common in osteopathic practice and taught in workshops for professionals from different areas of health care, including Physiotherapy. This type of treatment is quite specialized and centered on the therapist. However, there is a lack of high-quality and low-risk bias studies that justify the use of this practice. Despite this, there is little scientific evidence about the effectiveness of Fascial Therapy to treat some visceral disorders. The purpose of this study was to critically appraise the scientific literature concerning the clinical efficacy of techniques used in Fascial Therapy targeting the visceral system. METHODS: This systematic review included randomized controlled trials in any language or date of publication. All primary outcomes reported were included. The methodological quality and statistical reporting of each eligible trial were evaluated using the version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). This systematic review provided a synthesis of current evidence on the effects of Fascial Therapy in patients with visceral disorders and/or pain. A total of 11 studies were included, with five of them covering gastrointestinal dysfunction, two covering cardiorespiratory dysfunction, two covering musculoskeletal dysfunction, and two covering urogenital dysfunction. RESULTS: Fascial Therapy targeting the visceral system has been shown to be effective in reducing pain over the long term in people with low back pain when combined with standard physical therapy and effective in reducing gastroesophageal reflux symptoms over the short term. Considering the overall bias, six studies were at high risk of bias, two studies had some concerns and only three studies were at low risk of bias. Of the three studies with a low risk of bias, only two showed positive results and were effective in improving the studied outcome. CONCLUSION: This systematic review shows that currently, there is poor evidence for the efficacy of the techniques used in Fascial Therapy targeting the visceral system, and this information can help healthcare professionals in decision-making related to the use of Fascial Therapy targeting the visceral system in patients with visceral disorders and/or pain.

Offer and participation in corporal practices and physical activities in Primary Health Care: analysis from 2014 to 2022 / Oferta e participação nas práticas corporais e atividades físicas na Atenção Primária: análise de 2014 a 2022

Objective: to analyze the temporal trend and macro-regional distribution of the offer of collective activities of body practices and physical activities (BPPA) and the number of participants in Primary Health Care (PHC), developed by all health professionals and by Physical Education Professionals (PEF). Methods: ecological time series study, using data from the Health Information System for PHC (Sisab) between 2014 and 2022, using Joinpoint regression analysis. Results: at the national level, an increase in the number of collective BPPA and PHC participants developed by all health professionals and by PEF was identified between 2014 and 2019, followed by a reduction in both in 2020. In 2021 and 2022 further increases occurred. Conclusion: even though the Covid-19 pandemic occurred, an exceptional scenario and upward trends were identified both in the offer of collective BPPA and participants.

Objetivo: analisar a tendência temporal e distribuição macrorregional da oferta de atividades coletivas de práticas corporais e atividades físicas (PCAF) e do número de participantes na Atenção Primária (APS), desenvolvidas por todos os profissionais de saúde e por Profissionais de Educação Física (PEF). Métodos: estudo ecológico de série temporal, usando dados do Sistema de Informação em Saúde para a Atenção Básica (Sisab) entre 2014 e 2022, por meio da análise de regressão Joinpoint. Resultados: em âmbito nacional, identificou-se aumento do quantitativo de atividades coletivas de PCAF e de participantes na APS desenvolvidas por todos os profissionais de saúde e por PEF entre 2014 e 2019, seguido de uma redução de ambos em 2020. Em 2021 e 2022 ocorreu novo aumento. Conclusão: ainda que tenha ocorrido a pandemia da Covid-19, um cenário de excepcionalidade, foram identificadas tendências de aumento tanto na oferta de atividades coletivas de PCAF quanto de participantes.

[Temporal analysis of the inclusion of Physical Education Professionals and Residents in the Brazilian Unified Health System (SUS) from 2009 to 2021]. / Análise temporal da inserção de Profissionais e Residentes de Educação Física no Sistema Único de Saúde de 2009 a 2021.

Physical Education is one of the categories featured in the SUS workforce. An ecological time series study, based on the National Registry of Health Establishments, was conducted to analyze the inclusion of Physical Education Professionals (PEFs) and residents in the SUS between 2009 and 2021. The scope of the article was to establish a panorama of the inclusion of Physical Education and analyze the distribution of PEFs and residents in the different regions. An increase of 476.01% in the number of PEFs and 10,366.67% among residents was revealed. The PEF rate per 100,000 inhabitants increased by 13.7% per year from 2009 to 2021, with an increase of 28.1% between 2009 and 2014 and 7.8% between 2014 and 2019, and a decrease of 3.4% between 2019 and 2021. The resident rate increased by 36.2% per year between 2009 and 2021, with a 45.9% increase between 2009 and 2017 and 18.7% between 2017 and 2021. Regional inequalities in the distribution of PEFs and residents were revealed, with the highest concentration, in 2021, in the Northeast and South regions, respectively. The increase in PEFs and residents in the SUS can be linked to policies and programs of physical exercise and activities, while the decrease is possibly related to the Previne Brasil Program and the COVID-19 pandemic.

Dentre as categorias que fazem parte da força de trabalho do SUS está a Educação Física. Por meio de estudo ecológico de séries temporais, com base no Cadastro Nacional de Estabelecimentos de Saúde, os objetivos do artigo foram analisar a inserção de Profissionais de Educação Física (PEF) e residentes no SUS entre 2009 e 2021 com vistas a traçar um panorama da inserção da Educação Física e analisar a distribuição de PEF e residentes entre as diferentes regiões. Foi revelado um aumento de 476,01% no número de PEF e de 10.366,67% entre os residentes. A taxa de PEF por 100.000 habitantes aumentou 13,7% ao ano entre 2009 e 2021, com aumento de 28,1% entre 2009 e 2014 e de 7,8% entre 2014 e 2019, e redução de 3,4% entre 2019 e 2021. A taxa de residentes aumentou 36,2% ao ano entre 2009 a 2021, com aumento de 45,9% entre 2009 e 2017 e de 18,7% entre 2017 e 2021. Foram reveladas desigualdades regionais na distribuição de PEF e residentes, com maior concentração, em 2021, respectivamente nas regiões Nordeste e Sul. O aumento de PEF e residentes no SUS pode ser relacionado com políticas e programas de práticas corporais e atividades físicas, enquanto o decréscimo, possivelmente, se relaciona com o Programa Previne Brasil e à pandemia de COVID-19.

Análise temporal da inserção de Profissionais e Residentes de Educação Física no Sistema Único de Saúde de 2009 a 2021 / Temporal analysis of the inclusion of Physical Education Professionals and Residents in the Brazilian Unified Health System (SUS) from 2009 to 2021

Resumo Dentre as categorias que fazem parte da força de trabalho do SUS está a Educação Física. Por meio de estudo ecológico de séries temporais, com base no Cadastro Nacional de Estabelecimentos de Saúde, os objetivos do artigo foram analisar a inserção de Profissionais de Educação Física (PEF) e residentes no SUS entre 2009 e 2021 com vistas a traçar um panorama da inserção da Educação Física e analisar a distribuição de PEF e residentes entre as diferentes regiões. Foi revelado um aumento de 476,01% no número de PEF e de 10.366,67% entre os residentes. A taxa de PEF por 100.000 habitantes aumentou 13,7% ao ano entre 2009 e 2021, com aumento de 28,1% entre 2009 e 2014 e de 7,8% entre 2014 e 2019, e redução de 3,4% entre 2019 e 2021. A taxa de residentes aumentou 36,2% ao ano entre 2009 a 2021, com aumento de 45,9% entre 2009 e 2017 e de 18,7% entre 2017 e 2021. Foram reveladas desigualdades regionais na distribuição de PEF e residentes, com maior concentração, em 2021, respectivamente nas regiões Nordeste e Sul. O aumento de PEF e residentes no SUS pode ser relacionado com políticas e programas de práticas corporais e atividades físicas, enquanto o decréscimo, possivelmente, se relaciona com o Programa Previne Brasil e à pandemia de COVID-19.

Abstract Physical Education is one of the categories featured in the SUS workforce. An ecological time series study, based on the National Registry of Health Establishments, was conducted to analyze the inclusion of Physical Education Professionals (PEFs) and residents in the SUS between 2009 and 2021. The scope of the article was to establish a panorama of the inclusion of Physical Education and analyze the distribution of PEFs and residents in the different regions. An increase of 476.01% in the number of PEFs and 10,366.67% among residents was revealed. The PEF rate per 100,000 inhabitants increased by 13.7% per year from 2009 to 2021, with an increase of 28.1% between 2009 and 2014 and 7.8% between 2014 and 2019, and a decrease of 3.4% between 2019 and 2021. The resident rate increased by 36.2% per year between 2009 and 2021, with a 45.9% increase between 2009 and 2017 and 18.7% between 2017 and 2021. Regional inequalities in the distribution of PEFs and residents were revealed, with the highest concentration, in 2021, in the Northeast and South regions, respectively. The increase in PEFs and residents in the SUS can be linked to policies and programs of physical exercise and activities, while the decrease is possibly related to the Previne Brasil Program and the COVID-19 pandemic.

The Efficacy of Manual Therapy Approaches on Pain, Maximum Mouth Opening and Disability in Temporomandibular Disorders: A Systematic Review of Randomised Controlled Trials.

Temporomandibular disorder (TMD) is a common condition disabling people and bringing up costs. The aim of this study was to investigate the effects of manual therapy on pain intensity, maximum mouth opening (MMO) and disability. Searches were conducted in six databases for randomised controlled trials (RCTs). Selection of trials, data extraction and methodological quality assessment were conducted by two reviewers with discrepancies resolved by a third reviewer. Estimates were presented as mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs). Quality of the evidence was assessed using the GRADE approach. Twenty trials met the eligibility criteria and were included. For pain intensity, high and moderate quality evidence demonstrated the additional effects of manual therapy at short- (95% CI -2.12 to -0.82 points) and long-term (95% CI -2.17 to -0.40 points) on the 0-10 points scale. For MMO, moderate to high quality evidence was found in favour of manual therapy alone (95% CI 0.01 to 7.30 mm) and its additional effects (95% CI 1.58 to 3.58 mm) at short- and long-term (95% CI 1.22 to 8.40 mm). Moderate quality evidence demonstrated an additional effect of manual therapy for disability (95% CI = -0.87 to -0.14). Evidence supports manual therapy as effective for TMD.

Práticas corporais e atividades físicas como política pública de saúde: desafios para avançar na atenção primária do Sistema Único de Saúde no período de 2023 a 2026 / Body practices and physical activities as public health policy: challenges to advance in primary care in the Unified Health System in the period from 2023 to 2026 / Prácticas corporales y actividades físicas como política pública de Salud: desafíos para avanzar en la atención primaria en el Sistema Único de Salud en el período 2023 a 2026

As práticas corporais e atividades físicas (PCAF) estão relacionadas à saúde individual e coletiva. Considerando-se que no último ciclo governamental federal (2019-2022) houve medidas de austeridade fiscal, com consequências para o Sistema Único de Saúde (SUS) e para os programas e ações de PCAF, este ensaio tem o objetivo de apresentar desafios para que tais práticas avancem como política pública de Saúde no ciclo governamental federal de 2023-2026. Destacam-se: a) financiamento; b) vigilância; c) educação, formação e pesquisa; d) comitê participativo; e) política nacional. Espera-se que as proposições fomentem um amplo debate que favoreça a ampliação da oferta na Atenção Primária à Saúde do SUS, buscando efetivar o direito às PCAF, contribuindo para o cuidado integral em saúde (AU).

Physical activities and body practices (PABP) are related to individual and collective health. Considering that in the last federal government cycle (2019-2022) there was a fiscal austerity measures, with consequences for the Unified Health System (SUS) and for PABP programs, this essay aims to present the challenges for such practices to advance as a public Health policy in the 2023-2026 federal government cycle. We highlight: a) financing; b) surveillance; c) education, training, and research; d) participative committee; e) national policy. It is expected that the proposals will promote a wide debate that will contribute to the expansion of the offer of these practices in SUS primary health care, seeking to guarantee the right to PABP, contributing to comprehensive health care (AU).

Las prácticas corporales y actividades físicas (PCAF) están relacionadas con la salud individual y colectiva. Considerando que de 2019 a 2022 hubo una serie de medidas de austeridad fiscal, con consecuencias para el Sistema Único de Salud (SUS) y para las PCAF, este ensayo tiene como objetivo presentar desafíos para que estas prácticas avancen como política de salud pública en el período de 2023 a 2026. Se destacan: a) financiamiento; b) vigilancia; c) educación, formación e investigación; d) comité participativo; e) política nacional. Se espera que las proposiciones fomenten un amplio debate que favorezca la ampliación de la oferta en la Atención Primaria de Salud del SUS, buscando la implementación del derecho al PCAF, contribuyendo para la atención integral a la salud (AU).

A Educação Física como força de trabalho do SUS: análise dos tipos de vínculos profissionais / Physical Education as a workforce of the Brazilian Unified Health System: an analysis of the types of professional bonds / La Educación Física como fuerza de trabajo del Sistema Único de Salud: análisis de los tipos de vínculos de los profesionales

Resumo Considerando a inserção de Profissionais de Educação Física como força de trabalho no Sistema Único de Saúde, este estudo teve como objetivo analisar os tipos de vínculos e a carga horária de trabalho desses profissionais nos diferentes níveis de atenção à saúde e regiões do Brasil entre 2007 e 2021. Trata-se de um estudo descritivo de abordagem quantitativa com base em pesquisa no Cadastro Nacional de Estabelecimentos de Saúde. Foi observado que a atenção primária à saúde constitui o principal nível de atuação, seguida da atenção secundária e terciária. Na atenção primária, o número de cadastros de Profissionais de Educação Física com vínculo de trabalho precário é maior do que os com vínculo protegido, mas o inverso ocorre na atenção secundária e terciária. Nas regiões Sul e Sudeste, foi revelado maior número de cadastro desses profissionais com vínculo de trabalho protegido, e nas demais regiões prevaleceu o vínculo de trabalho precário. Foi identificado que 44,7% dos cadastros de Profissionais de Educação Física possuem carga horária maior ou igual a 40 horas por semana. Em conclusão, a atenção à saúde pode ser prejudicada pelo tipo de vínculo de trabalho do profissional por causar rotatividade e dificuldade na continuidade do cuidado.

Abstract Considering the insertion of Physical Education Professionals as a workforce in the Unified Health System, this study aimed to analyze the types of ties and the workload of these professionals in the different levels of health care and regions of Brazil between 2007 and 2021. This is a descriptive study of quantitative approach based on research in the National Register of Health Facilities. It was demonstrated that primary health care is the main level of action, followed by secondary and tertiary care. In primary care, the number of registrations of Physical Education Professionals with precarious employment is higher than those with protected employment, but the reverse occurs in secondary and tertiary care. In the South and Southeast regions, a greater number of records of these professionals with a protected work relationship was revealed, and in the other regions the precarious work relationship prevailed. It was identified that 44.7% of the registrations of Physical Education Professionals have workload greater than or equal to 40 hours per week. In conclusion, attention to health can be impaired by the type of the professional's work relationship by causing turnover and difficulty in the continuity of care.

Resumen Considerando la inserción de los Profesionales de Educación Física como mano de obra en el Sistema Único de Salud, este estudio tuvo como objetivo analizar los tipos de vínculo y la carga de trabajo de estos profesionales en los diferentes niveles de atención a la salud y regiones de Brasil entre 2007 y 2021. Se trata de un estudio descriptivo con enfoque cuantitativo basado en la investigación en el Registro Nacional de Establecimientos de Salud. Se ha demostrado que la atención primaria de salud es el principal nivel de actuación, seguida de la atención secundaria y terciaria. En atención primaria, el número de casos de Profesionales de Educación Física con vínculo de trabajo precario es mayor que aquellos con vínculo protegido, pero ocurre lo contrario en atención secundaria y terciaria. En las regiones Sur y Sudeste, se reveló un mayor número de registros de estos profesionales con relación de trabajo protegida, y en las demás regiones prevaleció la relación de trabajo precaria. Se identificó que el 44,7% de los registros de los Profesionales de Educación Física tienen carga horaria mayor o igual a 40 horas semanales. En conclusión, la atención a la salud puede verse obstaculizada por el tipo de empleo del profesional, ya que esto provoca rotación y dificultad en la continuidad de la atención.

Time-varying higher moments in Bitcoin.

Cryptocurrencies represent a new and important class of investments but are associated with asymmetric distributions and extreme price changes. We use a modeling structure where higher-order moments (scale, skewness and kurtosis) are time-varying, and additionally we used nontraditional innovations distributions to study the return series of the most important cryptocurrency, Bitcoin. Based on the estimation of a series of Generalized Autoregressive Score (GAS) models, we compare predictive performance using a loss function based on Value at Risk performance.