O cuidar do adolescente com obesidade na atenção primária à saúde: perspectivas de gestores e profissionais / The care of obese adolescents in primary health care: perspectives of managers and professionals / Atención a adolescentes con obesidad en atención primaria de salud: perspectivas de gestores y profesionales

RESUMO Objetivo: Descrever e explorar, sob a perspectiva de gestores e profissionais de saúde, o cuidado ofertado ao adolescente com obesidade no âmbito da Atenção Primária à Saúde. Método: Estudo de caso, realizado em município do estado do Ceará-Brasil. A coleta de dados ocorreu em 2022, por meio de entrevistas semiestruturadas. Os dados foram examinados através da Análise de conteúdo de Bardin. Resultados: O cuidado ao adolescente com obesidade é fragmentado, cada profissional atua conforme decisão própria, pois o município não utiliza protocolos que subsidiem a prática assistencial. Foram elencadas potencialidades para o cuidado, sendo a principal a equipe multiprofissional. Quanto às dificuldades, destacou-se a procura do serviço de saúde pelo adolescente. Conclusão: Faz-se necessária uma (re)organização do modelo de atenção ao adolescente com obesidade no município. Além disso, o estudo ressalta a necessidade de maior atenção a obesidade na adolescência e provoca reflexões acerca do cuidado dispensado a este adolescente.

ABSTRACT Objective: Describe and explore, from the perspective of managers and health professionals, the care offered to adolescents with obesity in the context of Primary Health Care. Method: A case study conducted in a municipality in the state of Ceará-Brazil. Data collection took place in 2022 through semi-structured interviews. The data were examined using Bardin Content Analysis. Results: The care of obese adolescents is fragmented, and each professional acts according to their own decision, as the municipality does not use protocols that subsidize the practice of care. Potentials for care were listed, the main one being the multidisciplinary team. Regarding the difficulties, the adolescent's demand for health services was highlighted. Conclusion: It is necessary to (re) organize the care model for obese adolescents in the municipality. In addition, the study highlights the need for greater attention to adolescent obesity and causes reflections on the care provided to this adolescent.

RESUMEN Objetivo: Describir y explorar, desde la perspectiva de los gestores y profesionales sanitarios, la atención ofrecida a los adolescentes con obesidad en el ámbito de la Atención Primaria de Salud. Método: Estudio de caso, realizado en un municipio del estado de Ceará-Brasil. Los datos se recogieron en 2022 mediante entrevistas semiestructuradas. Los datos se analizaron mediante el análisis de contenido de Bardin. Resultados: La atención a los adolescentes con obesidad está fragmentada, y cada profesional actúa según su propia decisión, ya que el municipio no utiliza protocolos para subvencionar la práctica asistencial. Se enumeraron las potencialidades asistenciales, siendo la principal el equipo multiprofesional. En cuanto a las dificultades, se destaca la búsqueda del servicio sanitario por parte del adolescente. Conclusión: Es necesario (re)organizar el modelo de atención a los adolescentes con obesidad en el municipio. Además, el estudio pone de manifiesto la necesidad de prestar más atención a la obesidad en la adolescencia y suscita reflexiones sobre la atención prestada a este adolescente.

Decoding Chemical Bonds: Assessment of the Basis Set Effect on Overlap Electron Density Descriptors and Topological Properties in Comparison to QTAIM.

Quantum chemical bonding descriptors based on the total and overlap density can provide valuable information about chemical interactions in different systems. However, these descriptors can be sensitive to the basis set used. To address this, different numerical treatments of electron density have been proposed to reduce the basis set dependency. In this work, we introduce overlap properties (OPs) obtained through numerical treatment of the electron density and present the topology of overlap density (TOP) for the first time. We compare the basis set dependency of numerical OP and TOP descriptors with their quantum theory of atoms in molecules (QTAIM) counterparts, considering the total electron density. Three single (C-C, C-O, and C-F) bonds in ethane, methanol, and fluoromethane and two double (C═C and C═O) bonds in ethene and formaldehyde were analyzed. Diatomic molecules Li-X with X = F, Cl, and Br were also analyzed. Eight parameters, including QTAIM descriptors and OP/TOP descriptors, are used to assess the basis dependency at the ωB97X-D level of theory using 28 basis sets from three classes: Pople, Ahlrichs, and Dunning. The study revealed that the topological overlap electron density properties exhibit comparatively lesser dependence on the basis set compared to their total electron density counterparts. Remarkably, these properties retain their chemical significance even with reduced basis set dependency. Similarly, numerical OP descriptors show less basis set dependency than their QTAIM counterparts. The excess of polarization functions increases charge concentration in the interatomic region and influences both QTAIM and OP descriptors. The basis sets Def2TZVP, 6-31++G(d,p), 6-311++G(d,p), cc-pVDZ, cc-pVTZ, and cc-pVQZ demonstrate reduced variability for the tested bond classes in this study, with particular emphasis on the triple-ζ quality Ahlrichs' basis set. We recommend against using basis sets with numerous polarization functions, such as augmented Dunning's and Ahlrichs' quadruple-ζ.

Raciocínio Clínico em Cardiologia: Passado, Presente e Futuro / Clinical Reasoning in Cardiology: Past, Present and Future

Resumo O raciocínio clínico nasceu 2500 anos atrás com Hipócrates, tendo evoluído ao longo dos séculos, e se tornado uma mistura de arte e ciência. Várias personalidades ao longo da história contribuíram para melhorar a acurácia diagnóstica. Contudo, o erro diagnóstico é ainda comum e causa um grande impacto nos sistemas de saúde. Para lidar com esse desafio, vários modelos de raciocínio clínico surgiram para sistematizar o processo de pensamento clínico. Este artigo descreve a história do raciocínio clínico e os métodos atuais de raciocínio diagnóstico, propõe um novo modelo de raciocínio clínico chamado Raciocínio Integrativo, e traz perspectivas sobre o futuro do raciocínio clínico.

Abstract Clinical reasoning was born 2,500 years ago with Hippocrates, having evolved over the centuries, becoming a mixture of art and science. Several personalities throughout history have contributed to improving diagnostic accuracy. Nonetheless, diagnostic error is still common and causes a severe impact on healthcare systems. To face this challenge, several clinical reasoning models have emerged to systematize the clinical thinking process. This paper describes the history of clinical reasoning and current diagnostic reasoning methods, proposes a new clinical reasoning model, called Integrative Reasoning, and brings perspectives about the future of clinical reasoning.

Clinical Reasoning in Cardiology: Past, Present and Future. / Raciocínio Clínico em Cardiologia: Passado, Presente e Futuro.

Clinical reasoning was born 2,500 years ago with Hippocrates, having evolved over the centuries, becoming a mixture of art and science. Several personalities throughout history have contributed to improving diagnostic accuracy. Nonetheless, diagnostic error is still common and causes a severe impact on healthcare systems. To face this challenge, several clinical reasoning models have emerged to systematize the clinical thinking process. This paper describes the history of clinical reasoning and current diagnostic reasoning methods, proposes a new clinical reasoning model, called Integrative Reasoning, and brings perspectives about the future of clinical reasoning.

O raciocínio clínico nasceu 2500 anos atrás com Hipócrates, tendo evoluído ao longo dos séculos, e se tornado uma mistura de arte e ciência. Várias personalidades ao longo da história contribuíram para melhorar a acurácia diagnóstica. Contudo, o erro diagnóstico é ainda comum e causa um grande impacto nos sistemas de saúde. Para lidar com esse desafio, vários modelos de raciocínio clínico surgiram para sistematizar o processo de pensamento clínico. Este artigo descreve a história do raciocínio clínico e os métodos atuais de raciocínio diagnóstico, propõe um novo modelo de raciocínio clínico chamado Raciocínio Integrativo, e traz perspectivas sobre o futuro do raciocínio clínico.

"A lack of information keeps us from medicine, well-being, harmony ": a mixed method study with plaintiffs requesting medicines in administrative cases. / "A falta de informação nos afasta do remédio, do bem-estar, da harmonia...": estudo de método misto com demandantes de medicamentos pela via administrativa.

The need to request public health managers to ensure the right of access to medicines characterizes an administrative case and the method to do so is called the administrative route. This mixed method study aimed to analyze the perceptions of plaintiffs requesting medications by the administrative route about barriers to access medicines in the Brazilian public health sector. Data were gathered through focus groups and questionnaires. The results point to the interdependence of pharmaceutical services with the interfacing areas to ensure access. The barriers related to individuals reflect the commitment to develop citizenship, justifying the cost of the medicine to motivate the demand. Barriers to service provision include irregular availability of medicines, insufficient resources, and unsatisfactory quality of services. The difficulty in obtaining medical consultations and prescriptions originating in the public sector are barriers to the health sector. The barriers above the health sector are compliance with administrative procedures, corruption, and clientelism. The administrative route intensifies inequities in access to healthcare in Brazil.

A necessidade de recorrer ao gestor público de saúde para efetivar o direito ao acesso a medicamentos caracteriza a via administrativa. O estudo analisou as percepções dos usuários que acionaram a via administrativa sobre as barreiras para o acesso a medicamentos no setor público de saúde de uma capital brasileira. Foi realizado estudo de método misto com grupo focal, questionário com demandantes e descrição dos medicamentos demandados pela via administrativa. Os resultados apontam a interdependência da assistência farmacêutica com as áreas de interfaceamento para a garantia do acesso. As barreiras relativas aos indivíduos refletem o comprometimento do desenvolvimento da cidadania, justificando o custo do medicamento motivar a demanda. As barreiras à prestação dos serviços contemplam disponibilidade irregular dos medicamentos, insuficiência de recursos e qualidade insatisfatória dos serviços. A dificuldade para conseguir consultas médicas e a exigência da prescrição originada no setor público são barreiras ao setor saúde. As barreiras acima do setor saúde são cumprimento dos procedimentos administrativos, corrupção e clientelismo. A via administrativa intensifica as iniquidades no acesso à saúde no Brasil.

"A falta de informação nos afasta do remédio, do bem-estar, da harmonia... ": estudo de método misto com demandantes de medicamentos pela via administrativa / "A lack of information keeps us from medicine, well-being, harmony... ": a mixed method study with plaintiffs requesting medicines in administrative cases

Resumo A necessidade de recorrer ao gestor público de saúde para efetivar o direito ao acesso a medicamentos caracteriza a via administrativa. O estudo analisou as percepções dos usuários que acionaram a via administrativa sobre as barreiras para o acesso a medicamentos no setor público de saúde de uma capital brasileira. Foi realizado estudo de método misto com grupo focal, questionário com demandantes e descrição dos medicamentos demandados pela via administrativa. Os resultados apontam a interdependência da assistência farmacêutica com as áreas de interfaceamento para a garantia do acesso. As barreiras relativas aos indivíduos refletem o comprometimento do desenvolvimento da cidadania, justificando o custo do medicamento motivar a demanda. As barreiras à prestação dos serviços contemplam disponibilidade irregular dos medicamentos, insuficiência de recursos e qualidade insatisfatória dos serviços. A dificuldade para conseguir consultas médicas e a exigência da prescrição originada no setor público são barreiras ao setor saúde. As barreiras acima do setor saúde são cumprimento dos procedimentos administrativos, corrupção e clientelismo. A via administrativa intensifica as iniquidades no acesso à saúde no Brasil.

Abstract The need to request public health managers to ensure the right of access to medicines characterizes an administrative case and the method to do so is called the administrative route. This mixed method study aimed to analyze the perceptions of plaintiffs requesting medications by the administrative route about barriers to access medicines in the Brazilian public health sector. Data were gathered through focus groups and questionnaires. The results point to the interdependence of pharmaceutical services with the interfacing areas to ensure access. The barriers related to individuals reflect the commitment to develop citizenship, justifying the cost of the medicine to motivate the demand. Barriers to service provision include irregular availability of medicines, insufficient resources, and unsatisfactory quality of services. The difficulty in obtaining medical consultations and prescriptions originating in the public sector are barriers to the health sector. The barriers above the health sector are compliance with administrative procedures, corruption, and clientelism. The administrative route intensifies inequities in access to healthcare in Brazil.

Psychological demands of health professionals in the initial phase of the COVID-19 pandemic.

Recent literature emphasizes how the specific stressors of the COVID-19 outbreak affect the general population and frontline professionals, including those conducting support or backup activities in health units, which can lead to vicarious traumatization. Vicarious traumatization has been used to describe negative emotional reactions in mental health professionals who assist or treat victims of traumatic events. Thus, the aim of this article is to report the actions used in the face of the psychological demands of professionals in a hospital, who were not on the frontline of COVID-19. We collected their sociodemographic information and checked the psychological impact using the depression, anxiety, and stress scale (DASS-21), which was followed by a psychoeducational program (topics related to COVID-19 control and prevention), and individual psychological care for the most severe cases. A total of 118 professionals participated in this study; they were between 20 and 67 years old. Mild to moderate anxiety was observed in 36.5% of the medical teams, 83.3% of the administrative staff, and 65.7% of general service workers, while stress symptoms were observed in 80.2%, 83.3%, and 59.9%, respectively. Depressive symptoms (35.3%) were more frequent in general service workers. The medical teams reported the benefits of primary psychological care, while the other professionals demanded more institutional support services related to the prevention and use of personal protective equipment. This study highlights relevant psychological demands that have repercussions on the daily lives of professionals. The psychoeducational program was considered positive regarding clarification actions. However, it was not perceived as effective in reducing fear, which may result from vicarious traumatization and requires other intervention modalities.

Psychological demands of health professionals in the initial phase of the COVID-19 pandemic

Abstract Recent literature emphasizes how the specific stressors of the COVID-19 outbreak affect the general population and frontline professionals, including those conducting support or backup activities in health units, which can lead to vicarious traumatization. Vicarious traumatization has been used to describe negative emotional reactions in mental health professionals who assist or treat victims of traumatic events. Thus, the aim of this article is to report the actions used in the face of the psychological demands of professionals in a hospital, who were not on the frontline of COVID-19. We collected their sociodemographic information and checked the psychological impact using the depression, anxiety, and stress scale (DASS-21), which was followed by a psychoeducational program (topics related to COVID-19 control and prevention), and individual psychological care for the most severe cases. A total of 118 professionals participated in this study; they were between 20 and 67 years old. Mild to moderate anxiety was observed in 36.5% of the medical teams, 83.3% of the administrative staff, and 65.7% of general service workers, while stress symptoms were observed in 80.2%, 83.3%, and 59.9%, respectively. Depressive symptoms (35.3%) were more frequent in general service workers. The medical teams reported the benefits of primary psychological care, while the other professionals demanded more institutional support services related to the prevention and use of personal protective equipment. This study highlights relevant psychological demands that have repercussions on the daily lives of professionals. The psychoeducational program was considered positive regarding clarification actions. However, it was not perceived as effective in reducing fear, which may result from vicarious traumatization and requires other intervention modalities.

Mentoring in cardiology: A New Teaching Tool in a Rapidly Transforming World

Abstract This is an article aimed at showing the mentoring role in a fast-changing society, particularly during and after the COVID-19 pandemic. The intense flow of information feelings and new knowledge makes it necessary for medical education to be updated to keep up with social and professional dynamics, according to health requirements and new knowledge demands. The mentoring program is a development process in which the mentor promotes the mentee professional and personal growth, by the exchange of visions and experiences. It allows an increase in the repertoire of solutions, particularly important in such an unstable context imposed by the pandemic. The mentor and mentee are challenged to move from a traditional to a virtual environment, characterized by physical distancing, development of digital medicine and distance learning.

Nanoencapsulated Doxorubicin Prevents Mucositis Development in Mice.

Doxorubicin (DOX), a chemotherapy drug successfully used in the therapy of various types of cancer, is currently associated with the mucositis development, an inflammation that can cause ulcerative lesions in the mucosa of the gastrointestinal tract, abdominal pain and secondary infections. To increase the safety of the chemotherapy, we loaded DOX into nanostructured lipid carriers (NLCs). The NLC-DOX was characterized by HPLC, DLS, NTA, Zeta potential, FTIR, DSC, TEM and cryogenic-TEM. The ability of NLC-DOX to control the DOX release was evaluated through in vitro release studies. Moreover, the effect of NLC-DOX on intestinal mucosa was compared to a free DOX solution in C57BL/6 mice. The NLC-DOX showed spherical shape, high drug encapsulation efficiency (84.8 ± 4.6%), high drug loading (55.2 ± 3.4 mg/g) and low average diameter (66.0-78.8 nm). The DSC and FTIR analyses showed high interaction between the NLC components, resulting in controlled drug release. Treatment with NLC-DOX attenuated DOX-induced mucositis in mice, improving shortening on villus height and crypt depth, decreased inflammatory parameters, preserved intestinal permeability and increased expression of tight junctions (ZO-1 and Ocludin). These results indicated that encapsulation of DOX in NLCs is viable and reduces the drug toxicity to mucosal structures.

Antimicrobial Activity of Curcumin in Nanoformulations: A Comprehensive Review.

Curcumin (CUR) is a natural substance extracted from turmeric that has antimicrobial properties. Due to its ability to absorb light in the blue spectrum, CUR is also used as a photosensitizer (PS) in antimicrobial Photodynamic Therapy (aPDT). However, CUR is hydrophobic, unstable in solutions, and has low bioavailability, which hinders its clinical use. To circumvent these drawbacks, drug delivery systems (DDSs) have been used. In this review, we summarize the DDSs used to carry CUR and their antimicrobial effect against viruses, bacteria, and fungi, including drug-resistant strains and emergent pathogens such as SARS-CoV-2. The reviewed DDSs include colloidal (micelles, liposomes, nanoemulsions, cyclodextrins, chitosan, and other polymeric nanoparticles), metallic, and mesoporous particles, as well as graphene, quantum dots, and hybrid nanosystems such as films and hydrogels. Free (non-encapsulated) CUR and CUR loaded in DDSs have a broad-spectrum antimicrobial action when used alone or as a PS in aPDT. They also show low cytotoxicity, in vivo biocompatibility, and improved wound healing. Although there are several in vitro and some in vivo investigations describing the nanotechnological aspects and the potential antimicrobial application of CUR-loaded DDSs, clinical trials are not reported and further studies should translate this evidence to the clinical scenarios of infections.

Knockdown of miR-26a in zebrafish leads to impairment of the anti-inflammatory function of TnP in the control of neutrophilia.

Our recent data show the valuable potential of TnP for the development of a new and safe anti-inflammatory drug due to its ability to control the traffic and activation of leukocytes in response to inflammation. Although there is considerable knowledge surrounding the cellular mechanisms of TnP, less is known about the mechanistic molecular role of TnP underlying its immunomodulatory functions. Here, we conducted investigations to identify whether miRNAs could be one of the molecular bases of the therapeutic effect of TnP. Using a zebrafish model of neutrophilic inflammation with a combination of genetic gain- and loss-of-function approaches, we showed that TnP treatment was followed by up-regulation of only four known miRNAs, and mature dre-miR-26a-1, herein referred just as miR-26a was the first most highly expressed. The knockdown of miR-26a ubiquitously resulted in a significant reduction of miR-26a in embryos, accompanied by impaired TnP immunomodulatory function observed by the loss of the control of the removal of neutrophils in response to inflammation, while the overexpression increased the inhibition of neutrophilic inflammation promoted by TnP. The striking importance of miR-26a was confirmed when rescue strategies were used (morpholino and mimic combination). Our results identified miR-26a as an essential molecular regulator of the therapeutic action of TnP, and suggest that miR-26a or its targets could be used as promising therapeutic candidates for enhancing the resolution of inflammation.

Steam explosion pretreatment improves acetic acid organosolv delignification of oil palm mesocarp fibers and sugarcane bagasse.

Steam explosion can be used to pretreat lignocellulosic materials to decrease energy and chemical consumption during pulping to obtain environmentally friendly lignin and to improve lignin yield without changing its structure. The objective of this study was to evaluate the extraction of lignin from oil palm mesocarp fibers and sugarcane bagasse using steam explosion pretreatment followed by acetosolv. The biomasses were pretreated at 168 °C for a reaction time of 10 min. Steam explosion combined with acetosolv at lower severities was also carried out. Steam explosion followed by acetosolv increased the lignin yield by approximately 15% and 17% in oil palm mesocarp fibers and sugarcane bagasse, respectively. In addition, steam explosion decreased the reaction time of acetosolv four-fold while maintaining the lignin yield from sugarcane bagasse. Similar results were not obtained for oil palm mesocarp. High-purity and high-quality lignins were obtained using steam explosion pretreatment with structural characteristics similar to raw ones. Sugarcane bagasse lignin seems to be a better option for application in material science due its higher lignin yield and higher thermal stability. Our findings demonstrate that steam explosion is efficient for improving lignin yield and/or decreasing pulping severity.

Early preclinical screening using zebrafish (Danio rerio) reveals the safety of the candidate anti-inflammatory therapeutic agent TnP.

The patented anti-inflammatory peptide TnP had its effectiveness recently confirmed in vivo in a murine model of multiple sclerosis and asthma. In this work, the safety of the TnP was evaluated in investigative toxicology tests using zebrafish (Danio rerio) as a model. We conducted the OECD #236 test to investigate effects of the TnP on the survival, hatching performance, and morphological formation of zebrafish embryos. After determining these endpoints, morphometric analysis termination of locomotion eartbeat rate in zebrafish larvae were evaluated to identify adverse effects such as neurotoxicity and cardiotoxicity. The results highlight a wide therapeutic index for TnP with non-lethal and safe doses rom 1 nM to 10 µM, without causing neurotoxicity or cardiotoxic effect. The low frequencyf abnormalities by TnP was associated with high safety of the molecule and the developing embryo's ability to process and eliminate it. TnP crossed the blood-brain barrier without disturbing the normal architecture of forebrain, midbrain and hindbrain. Our data reinforce the importance of zebrafish as an accurate investigative toxicology model to assess acute toxicity as well as cardiotoxicity and neurotoxicity of molecules in the preclinical phase of development.

The Toxic Effects of Glyphosate, Chlorpyrifos, Abamectin, and 2,4-D on Animal Models: A Systematic Review of Brazilian Studies.

Brazil is a global agricultural commodity producer and the largest consumer of pesticides. Pesticide use in Brazil comprised 549 280 tons in 2018. In the country, soybean, corn, and sugar cane are extensively produced, which are the most pesticides demanding crops. In the last years, the records of new pesticides were the highest in the historical series. They can persist in soil or water, accumulate in organisms, and contaminate workers and the general population through the air, water, or food. This review aimed to gather toxicological data obtained by animal models exposed to 4 pesticides: glyphosate, chlorpyrifos, abamectin, and 2,4-D. An additional goal was to compose an overview of how this subject has been approached, surveying which research groups are working on this field, where they are located, and relations with pesticides used in those regions. We collected the papers from the platforms PubMed, Scopus, Scielo, and Web of Science, performed in Brazil from 2014 to 2019. After two-step blind selection using the software Rayyan QCRI by different authors, 67 studies were selected to extract data. We observed that research is more concentrated in the South region, followed by the Southeast and Midwest, with 43%, 32%, and 23% of the studies, respectively. The prevalent institutions are from the states of Rio Grande do Sul, São Paulo, and Goiás. The effects on a variety of biomarkers help predict the potential risks to humans and nontarget organisms. The prevalent animal model was fish (36%). Overall, the main toxic effects evaluated were mortality, abnormalities in the blood cells, developmental abnormalities, and behavior alterations. Integr Environ Assess Manag 2021;17:507-520. © 2020 SETAC.

The use of photobiomodulation therapy or LED and mineral trioxide aggregate improves the repair of complete tibial fractures treated with wire osteosynthesis in rodents.

The repair of large bone defects is lengthy and complex. Both biomaterials and phototherapy have been used to improve bone repair. We aimed to describe histologically the repair of tibial fractures treated by wiring (W), irradiated or not, with laser (λ780 nm, 70 mW, CW, spot area of 0.5 cm2, 20.4 J/cm2 (4 × 5.1 J/cm2, Twin Flex Evolution®, MM Optics, Sao Carlos, SP, Brazil) per session, 300 s, 142.8 J/cm2 per treatment) or LED (λ850 ± 10 nm, 150 mW, spot area of 0.5 cm2, 20.4 J/cm2 per session, 64 s, 142.8 J/cm2 per treatment, Fisioled®, MM Optics, Sao Carlos, Sao Paulo, Brazil) and associated or not to the use of mineral trioxide aggregate (MTA, Angelus®, Londrina, PR, Brazil). Inflammation was discrete on groups W and W + LEDPT and absent on the others. Phototherapy protocols started immediately before suturing and repeated at every other day for 15 days. Collagen deposition intense on groups W + LEDPT, W + BIO-MTA + LaserPT and W + BIO-MTA + LEDPT and discrete or moderate on the other groups. Reabsorption was discrete on groups W and W + LEDPT and absent on the other groups. Neoformation varied greatly between groups. Most groups were partial and moderately filed with new-formed bone (W, W + LaserPT, W + LEDPT, W + BIO-MTA + LEDPT). On groups W + BIO-MTA and W + BIO-MTA + LaserPT bone, neoformation was intense and complete. Our results are indicative that the association of MTA and PBMT (λ = 780 nm) improves the repair of complete tibial fracture treated with wire osteosynthesis in a rodent model more efficiently than LED (λ = 850 ± 10 nm).

Knockdown of miR-26a in zebrafish leads to impairment of the anti-inflammatory function of TnP in the control of neutrophilia

Our recent data show the valuable potential of TnP for the development of a new and safe anti-inflammatory drug due to its ability to control the traffic and activation of leukocytes in response to inflammation. Although there is considerable knowledge surrounding the cellular mechanisms of TnP, less is known about the mechanistic molecular role of TnP underlying its immunomodulatory functions. Here, we conducted investigations to identify whether miRNAs could be one of the molecular bases of the therapeutic effect of TnP. Using a zebrafish model of neutrophilic inflammation with a combination of genetic gain- and loss-of-function approaches, we showed that TnP treatment was followed by up-regulation of only four known miRNAs, and mature dre-miR-26a-1, herein referred just as miR-26a was the first most highly expressed. The knockdown of miR-26a ubiquitously resulted in a significant reduction of miR-26a in embryos, accompanied by impaired TnP immunomodulatory function observed by the loss of the control of the removal of neutrophils in response to inflammation, while the overexpression increased the inhibition of neutrophilic inflammation promoted by TnP. The striking importance of miR-26a was confirmed when rescue strategies were used (morpholino and mimic combination). Our results identified miR-26a as an essential molecular regulator of the therapeutic action of TnP, and suggest that miR-26a or its targets could be used as promising therapeutic candidates for enhancing the resolution of inflammation.

Educação Permanente em Saúde na formação de Agentes Comunitários de Saúde no Norte de Minas Gerais / Permanent Health Education in the formation of Community Health Agents in North of Minas Gerais

Ancorado no referencial teórico-metodológico da Educação Permanente em Saúde (EPS), o presente estudo teve como objetivo analisar as potencialidades do Curso de Qualificação de Agentes Comunitários de Saúde elaborado em 2018, pela Escola de Saúde Pública do Estado de Minas Gerais, e ofertado a municípios do Norte do estado. Foram realizados grupos focais com ACS matriculados no curso. O material gravado e transcrito foi submetido à análise temática de conteúdo, subdividida em dois momentos: análise específica de cada grupo focal e análise cumulativa e comparativa do conjunto de grupos focais realizados. A análise conduziu à definição de quatro categorias: (i) ressignificação do trabalho do ACS; (ii) fortalecimento da mediação entre conhecimentos no trabalho do ACS; (iii) apropriação sobre as atribuições e o papel do ACS; e (iv) necessidade de envolvimento de outros atores nos processos de formação. Amparada pelos referenciais da EPS, na qual a aprendizagem se da a partir, no e para o trabalho, a metodologia adotada no curso foi pautada na problematização da realidade e da prática social dos ACS. A problematização permitiu que os discentes refletissem sobre seu cotidiano, ampliando a compreensão dos problemas e fomentando propostas de soluções mais contextualizadas, mais atinentes às necessidades e demandas do contexto histórico político-social.

Novos modos de subjetivação na formação do enfermeiro em Saúde Mental / New subjectivation modes in nurse education in the area of Mental Health / Nuevos modos de subjetivación en la formación del enfermero en Salud Mental

Trata-se de pesquisa cartográfica com o objetivo de analisar novos modos de subjetivação na formação do enfermeiro em Saúde Mental. A produção dos dados ocorreu por meio de entrevista semiestruturada e observação não participante, desenvolvidas durante uma disciplina de Saúde Mental de um curso de Enfermagem, no primeiro semestre de 2019. Os dados produzidos foram ancorados na Filosofia da Diferença de Deleuze e Guattari. Pela sala de aula observada, novos modos de ensinar Enfermagem em Saúde Mental puderam ser suscitados. Modos esses que refletem uma postura ético-estético-política expressiva em um território de formação não preocupado em reproduzir formas e modelos, todavia em inventar novos modos de resistir ao que está instituído. (AU)

This cartographic research aims to analyze new subjectivation modes in nurse education in the area of Mental Health. Data were collected by means of semi-structured interviews and non-participant observation, developed during a mental health discipline of a Nursing course that was offered in the first semester of 2019. The produced data were grounded on the Philosophy of Difference proposed by Deleuze and Guattari. Through the observed classroom, new ways of teaching about Nursing education in Mental Health emerged. These new ways reflect an expressive ethical-esthetic-political posture in an education territory that, instead of reproducing forms and models, invents new ways of resisting what is instituted. (AU)

Investigación cartográfica con el objetivo de analizar nuevos modos de subjetivación en la formación del enfermero en salud mental. La producción de los datos se realizó por medio de entrevista semiestructurada y observación no participante, desarrolladas durante una asignatura de salud mental de un curso de enfermería, en el primer semestre de 2019. Los datos producidos tenían como base la Filosofía de la Diferencia de Deleuze y Guattari. Llevando en consideración la sala de clase observada, fue posible suscitar nuevos modos de enseñanza sobre la formación en Enfermería en Salud Mental. Esos modos reflejan una postura ético-estética-política expresiva en un territorio de formación no preocupado en reproducir formas y modelos y sí en inventar nuevos modos de resistencia a lo instituido. (AU)