Effects of equine chorionic gonadotropin dosage and its splitting in different days on reproductive performance of Nellore cows synchronized for timed-artificial insemination.

This study evaluated the effects of dose of equine chorionic gonadotropin (eCG) and its splitting in different days of the synchronization protocol on reproductive performance of primiparous and multiparous Nellore cows. In the present study, 2,536 Nellore cows (1,634 primiparous and 902 multiparous) were assigned to receive in a 2 × 2 factorial design 1) an intravaginal progesterone (P4) device and 2.0 mg of estradiol benzoate (EB) on day -11, 12.5 mg (i.m.) of dinoprost tromethamine (PGF), 300 IU (i.m.) of eCG, 0.6 mg (i.m.) of estradiol cypionate (ECP), and P4 device withdrawal on day -2, followed by TAI on day 0 (n = 632 cows, being 409 primiparous and 223 multiparous; 300-2), 2) 300 IU (i.m) of eCG administered on days -4 and -2 (150 IU of eCG/day; n = 637 cows, being 412 primiparous and 225 multiparous; 300-4-2), 3) 400 IU (i.m.) of eCG administered on day -2 (n = 633 cows, being 406 primiparous and 227 multiparous; 400-2), and 4) 400 IU (i.m) of eCG administered on days -4 and -2 (200 IU of eCG/day; n = 634 cows, being 407 primiparous and 227 multiparous; 400-4-2). Individual cow BCS was assessed on days -11, 0 (timed-AI), and 31 of the study. Body condition score of the animals was classified into LOW or HIGH using the threshold of 2.75 (≤2.75 = LOW; >2.75 = HIGH). For primiparous cows, an eCG splitting effect was observed on follicle size, as cows receiving eCG on days -4 and -2 of the synchronization protocol had a larger follicle than cows administered eCG only on day -2. For day 31 P/AI, primiparous cows receiving 400-4-2, regardless of BCS, had a greater P/AI than cows from other treatments. Administering 400-4-2 to LOW BCS cows also resulted in greater P/AI than all other treatments assigned to LOW BCS cows. For multiparous cows, no treatment effect was observed for follicle size, estrus expression, and day 31 P/AI (P ≥ 0.21). In summary, increasing the dose and splitting the dose of eCG positively impacted the pregnancy rates of primiparous cows under a BCS ≤2.75, but no effects were detected on multiparous cows.

Effects of estradiol cypionate dosage and body condition on reproductive performance of Nellore cattle synchronized for timed-artificial insemination.

This experiment was designed to evaluate the effects of increasing doses of estradiol cypionate (ECP) and different body condition score (BCS) on reproductive performance of Bos indicus beef females assigned to a timed-artificial insemination (TAI) management. In this experiment, 1683 Bos indicus Nellore cows were blocked by parity and assigned to receive 1) an intravaginal P4 device (1.9 g of P4) and 2.0 mg of estradiol benzoate on day -11, 12.5 mg (i.m.) of dinoprost tromethamine, 300 IU (i.m.) of equine chorionic gonadotrophin, 0.6 mg (i.m.) of estradiol cypionate and CIDR withdrawal on day -2, followed by TAI on day 0 (n = 849; 0.6ECP) or 2) the same synchronization protocol with 1.0 mg of ECP on day -2 (n = 834; 1.0ECP). In both treatments, estrus expression was measured between days -2 and 0. Body condition score (BCS) was evaluated on days -11, 31, and 71 of the experiment and the BCS variation (Δ) was also determined between these timepoints. Transrectal ultrasonography was performed on days 31, 71, and 111 for pregnancy rate determination. All binary data were analyzed using cow as the experimental unit with GLIMMIX, whereas continuous variables were analyzed with the MIXED procedure of SAS. No treatment effects were observed on estrus expression rate. Treatment × BCS interactions were observed for pregnancy rates in all time points (days 31, 71, and 111), as 1.0ECP cows with a LOW BCS also had a greater P/AI than cows assigned to 0.6ECP. In summary, increasing the dose of ECP benefited the reproductive performance of Nellore beef cows with a reduced BCS (≤2.75), whereas no benefits were seen when the BCS was considered adequate (>2.75).

Composição de grupo de diálogo sobre o tema gênero e sexualidade nas escolas / Composition of a dialogue group on the theme of gender and sexuality in schools / Composición de un grupo de diálogo sobre el tema de género y sexualidad en las escuelas

Considerando-se os desafios da composição de grupos de diálogos em temas socialmente polêmicos, este estudo teve como objetivo apresentar as estratégias utilizadas para compor um grupo de diálogo a partir da metodologia do Projeto de Conversações Públicas entre pessoas com distintas opiniões sobre a abordagem do tema da diversidade sexual e de gênero nas escolas brasileiras. As transcrições das audiogravações das conversas preparatórias e dos encontros grupais e as anotações de diário de campo compuseram o corpus de análise deste estudo. A análise temática de conteúdo serviu para o destaque das seguintes estratégias consideradas úteis para a composição grupal: 1) Reconhecendo as pessoas envolvidas no conflito; 2) Entrando em contato com pessoas-chave; 3) Recrutando participantes reservas; 4) Pensando formas alternativas de presença no grupo; 5) Reconhecendo quem precisaria estar na conversa; 6) Flexibilidade com relação a entrada de novas/os participantes; 7) Lidando com os estereótipos com relação as/aos facilitadoras/es; 8) Co-construindo estratégias para maior adesão grupal. Esses eixos analíticos foram discutidos a partir da literatura da área.

Considering the challenges of composing dialogue groups in polemic issues, this study aimed to present the strategies used to compose a dialogue group based on the methodology of the Public Conversations Project among people with different opinions on the approach to the topic of sexual and of gender in Brazilian schools. Transcripts of audio recordings of preparatory conversations and group meetings and field diary notes composed the corpus of analysis of this study. The thematic content analysis served to highlight the following strategies considered useful for group composition: 1) Recognizing the people involved in the conflict; 2) Contacting key people; 3) Recruiting reserve participants; 4) Thinking about alternative forms of presence in the group; 5) Recognizing who would need to be in the conversation; 6) Flexibility regarding the entry of new participants; 7) Dealing with stereotypes regarding facilitators; 8) Co-building strategies for greater group membership. The selected material was discussed based on the literature in the area.

Considerando los desafíos de la composición de grupos de diálogo, este estudio tuvo como objetivo presentar las estrategias utilizadas para la composición de un grupo de diálogo basado en la metodología del Proyecto Conversaciones Públicas entre personas con opiniones diferentes sobre el abordaje del tema sexual y de género en las escuelas brasileñas. Transcripciones de grabaciones de audio de conversaciones preparatorias y reuniones grupales y notas del diario de campo componen el corpus de análisis de este estudio. El análisis de contenido temático sirvió para resaltar las siguientes estrategias consideradas útiles para la composición del grupo: 1) Reconocimiento de las personas involucradas en el conflicto; 2) Ponerse en contacto con personas clave; 3) Reclutamiento de participantes de reserva; 4) Pensar en formas alternativas de presencia en el grupo; 5) Reconocer quién debería estar en la conversación; 6) Flexibilidad en la entrada de nuevos participantes; 7) Abordar los estereotipos sobre los facilitadores; 8) Estrategias de co-construcción para una mayor membresía del grupo. El material seleccionado se discutió con base en la literatura en el área.

Cross-cultural adaptation and validation of the Hamilton Early Warning Score for Brazil.

OBJECTIVE: Cross-culturally adapt and validate, for Portuguese, the Hamilton Early Warning Score to detect clinical deterioration in emergency services. METHOD: Methodological study comprising the stages of translation, synthesis, back translation, expert committee (n=13), pre-test, submission, and analysis of the measurement properties in a sample of 188 patients. The Canadian Acute Scale Triage was compared with the Hamilton Early Warning Score. The Weighted Kappa Coefficient, Intraclass and Pearson Correlation Coefficient, Binary Logistic Regression and the Area Under the Receiver Operating Characteristic Curve were used for data analysis. RESULTS: The Hamilton Early Warning Score showed excellent reliability, α=0.924 (p<0.001). The construct validity identified a strong and negative correlation r=-0.75 and the predictive one presented an odds ratio of 1.63, 95% CI (1.358-1.918) (p<0.001). CONCLUSION: The Hamilton Early Warning Score in Portuguese is valid and reliable to recognize patients in a condition of clinical deterioration in emergency services.

Cross-cultural adaptation and validation of the Hamilton Early Warning Score for Brazil / Adaptación transcultural y validación del Hamilton Early Warning Score para Brasil / Adaptação transcultural e validação da Hamilton Early Warning Score para o Brasil

ABSTRACT Objective Cross-culturally adapt and validate, for Portuguese, the Hamilton Early Warning Score to detect clinical deterioration in emergency services. Method Methodological study comprising the stages of translation, synthesis, back translation, expert committee (n=13), pre-test, submission, and analysis of the measurement properties in a sample of 188 patients. The Canadian Acute Scale Triage was compared with the Hamilton Early Warning Score. The Weighted Kappa Coefficient, Intraclass and Pearson Correlation Coefficient, Binary Logistic Regression and the Area Under the Receiver Operating Characteristic Curve were used for data analysis. Results The Hamilton Early Warning Score showed excellent reliability, α=0.924 (p<0.001). The construct validity identified a strong and negative correlation r=-0.75 and the predictive one presented an odds ratio of 1.63, 95% CI (1.358-1.918) (p<0.001). Conclusion The Hamilton Early Warning Score in Portuguese is valid and reliable to recognize patients in a condition of clinical deterioration in emergency services.

RESUMEN Objetivo Adaptar y validar transculturalmente, para portugués, el Hamilton Early Warning Score para detectar el deterioro clínico en los servicios de emergencia. Método Estudio metodológico que comprende las etapas de traducción, síntesis, retrotraducción, comité de expertos (n=13), pretest, envío y análisis de las propiedades de medición en una muestra de 188 pacientes. Se comparó la Canadian Acute Scale Triage con la Hamilton Early Warning Score. Para el análisis de datos se utilizaron el Coeficiente Kappa Ponderado, el Coeficiente de Correlación Intraclase y de Pearson, la Regresión Logística Binaria y el Área Bajo la Curva Característica de Operación del Receptor. Resultados El Hamilton Early Warning Score mostró excelente confiabilidad, α=0,924 (p<0,001). La validez de constructo identificó una correlación fuerte y negativa r=-0,75 y la predictiva presentó un odds ratio de 1,63, IC 95% (1.358-1.918) (p<0,001). Conclusión: El Hamilton Early Warning Score en portugués es válido y confiable para reconocer pacientes en deterioro clínico en servicios de emergencia.

RESUMO Objetivo Adaptar transculturalmente e validar, para a língua portuguesa, a Hamilton Early Warning Score para detectar a deterioração clínica em serviços de emergência. Método Estudo metodológico compreendendo as etapas de tradução, síntese, retrotradução, comitê de especialistas (n=13), pré-teste, envio e análise das propriedades de medidas em uma amostra composta por 188 pacientes. Comparou-se a Canadian Acute Scale Triage com a Hamilton Early Warning Score. Foram utilizados o Coeficiente Kappa Ponderado, Coeficiente de Correlação Intraclasse e de Pearson, Regressão Logística Binária e a Área Sob a Curva Receiver Operating Characteristic para a análise dos dados. Resultados A Hamilton Early Warning Score apresentou confiabilidade excelente, ou seja, α=0,924 (p<0,001). A validade de construto identificou correlação forte e negativa r=-0,75 e a preditiva apresentou um odds ratio de 1,63, IC 95% (1,358-1,918) (p<0,001). Conclusão A Hamilton Early Warning Score em português é válida e confiável para reconhecer pacientes em condição de deterioração clínica em serviços de emergência.

Instrumentos para a avaliação do nível de consciência em adultos e idosos: revisão integrativa / Instruments for assessing level of consciousness in adults and the elderly: integrative review / Instrumentos para evaluar el nivel de conciencia en adultos y ancianos: revisión integradora

Objetivo: identificar na literatura evidências científicas sobre os instrumentos que avaliam o nível de consciência de pacientes adultos e idosos. Método: revisão integrativa de literatura, realizada em fevereiro de 2020, com artigos publicados entre 2010 e 2020, nas fontes de informação: LILACS, CINAHL, PubMed® /Medline, Web of Science, EBSCO e Scopus. Adotou-se o aplicativo Rayyan para a seleção dos estudos. Resultados: identificaram-se 884 artigos, destes, 19 atenderam aos critérios de inclusão. Foram identificadas oito escalas de avaliação. A maioria delas avalia os itens: abertura ocular, resposta motora, resposta verbal, padrão respiratório e reflexos tronco encefálicos. A escala Coma Recovery Scale-Revised foi a mais utilizada e a escala Full Outline of Unresponsiveness, considerada a mais completa para avaliar a consciência. Conclusão: verificou-se que as escalas possuem semelhança em seus domínios e mecanismos de avaliação e são confiáveis e efetivas para mensurar o nível de consciência de adultos e idosos.

Objective: to identify, in the literature, scientific evidence on the instruments that assess level of consciousness in adult and elderly patients. Method: this integrative literature review was carried out in February 2020, with articles published between 2010 and 2020, in the information sources: LILACS, CINAHL, PubMed®/Medline, Web of Science, EBSCO and Scopus. Studies were selected using the application Rayyan. Results: 884 articles were identified, of which 19 met the inclusion criteria. Eight rating scales were identified, most evaluating the items: eye opening, motor response, verbal response, breathing pattern and brainstem reflexes. The Coma Recovery Scale-Revised was the most used and the Full Outline of Unresponsiveness scale was considered the most complete to assess awareness. Conclusion: the scales were found to share similar domains and evaluation mechanisms and to be reliable and effective for measuring level of consciousness in adults and the elderly.

Objetivo: identificar en la literatura evidencia científica sobre los instrumentos que evalúan el nivel de conciencia de pacientes adultos y ancianos. Método: revisión integradora de la literatura, realizada en febrero de 2020, con artículos publicados entre 2010 y 2020, en las fuentes de información: PubMed® /Medline, LILACS, CINAHL, Web of Science, EBSCO y Scopus. Se adoptó la aplicación Rayyan para seleccionar los estudios. Resultados: Se identificaron 884 artículos, de los cuales 19 cumplieron con los criterios de inclusión. Se identificaron ocho escalas de calificación. La mayoría de ellos evalúa los ítems: apertura ocular, respuesta motora, respuesta verbal, patrón de respiración y reflejos del tronco encefálico. La escala Coma Recovery ScaleRevised fue la más utilizada y la escala Full Outline of Unresponsiveness fue considerada la más completa para evaluar la conciencia. Conclusión: se verificó que las escalas tienen similitudes en sus dominios y mecanismos de evaluación y son confiables y efectivas para medir el nivel de conciencia de adultos y ancianos.

Projeto de conversações públicas sobre a diferença de opiniões acerca do Programa Bolsa Família / Public conversation project on the difference of opinions about the Bolsa Família Program

O Programa Bolsa Família (PBF) divide opiniões no cenário brasileiro contemporâneo em debates permeados de argumentos abstratos, generalizantes e sentimentos intensos. Neste estudo, busca-se compreender o processo de produção de sentidos em uma facilitação de diálogos, a partir da metodologia do Projeto de Conversações Públicas (PCP), em um encontro entre 10 pessoas com opiniões polarizadas sobre o PBF. A transcrição da audiogravação do encontro foi analisada a partir da perspectiva construcionista social. Os repertórios interpretativos, discursos e posicionamentos relacionados às opiniões a favor e contra o PBF e o feedback dos participantes sobre o encontro foram ressaltados e discutidos.

The Bolsa Família Program (PBF) divides opinions in the contemporary Brazilian scenario into debates permeated by abstract arguments, generalizations and intense feelings. This study seeks to understand the process of producing meanings in dialogue facilitation, based on the methodology of the Public Conversation Project (PCP), in a meeting between 10 people with polarized opinions about the PBF. The transcription of the audio recording of the meeting was analyzed from the social constructionist perspective. The interpretative repertoires, discourses and positions related to the opinions for and against the PBF and the participants' feedback on the meeting were highlighted and discussed.

Vítimas de trauma atendidas em um hospital universitário / Víctimas de trauma tratadas en un hospital universitario / Trauma victims treated in a university hospital

Objetivo caracterizar o perfil das vítimas de trauma segundo dados sociodemográficos, do evento e assistenciais em uma unidade de pronto atendimento de um hospital público de ensino. Método estudo transversal retrospectivo quantitativo. Resultados prevaleceram vítimas com idade média de 43 anos, sexo masculino (72,4%), cor branca (58,5%), acidentes de trânsito (39,8%), lesões em extremidades superiores (37,9%), admissões no período noturno (39,1%), segunda-feira (15,4%) e em maio (10,2%), cirurgias ortopédicas (56,5%), sem complicações (58,1%), internação por um dia (60,4%), incapacidade ligeira na alta hospitalar (28,8%). O tratamento hospitalar teve um custo>US$ 100,00 (53,0%). Conclusão a caracterização do perfil das vítimas de trauma atendidas em unidade de pronto atendimento de um hospital público de ensino mostrou que o tratamento do trauma envolve muitos fatores e as sequelas que causam à vítima interferem na realização das atividades de vida diária, na ocupação de leitos e determinam altos custos de tratamento.

Objetivo caracterizar el perfil de las víctimas de trauma según datos sociodemográficos, de eventos y de atención en una unidad de atención de urgencias de un hospital público docente. Método estudio transversal retrospectivo cuantitativo. Resultados predominaron las víctimas con una edad promedio de 43 años, hombres (72,4%), blancos (58,5%), accidentes de tránsito (39,8%), lesiones en las extremidades superiores (37,9%), ingresos nocturnos (39,1%), lunes (15,1 millones 4%) y en mayo (10,2%), cirugías ortopédicas (56,5%), sin complicaciones (58,1%), hospitalización por un día (60,4%), incapacidad leve al alta hospitalaria (28,8%). El tratamiento hospitalario costó >US$ 100.00 (53.0%). Conclusión la caracterización del perfil de las víctimas de trauma atendidas en la unidad de atención de urgencias de un hospital público docente mostró que el tratamiento del trauma involucra muchos factores y las secuelas que provoca a la víctima interfieren en el desempeño de las actividades de la vida diaria, en la ocupación de camas y determinan los altos costos del tratamiento.

Objetivo to characterize the profile of trauma victims according to sociodemographic, event and care data in an emergency care unit of a public teaching hospital. Método quantitative retrospective cross-sectional study. Resultados victims with an average age of 43 years prevailed, male (72.4%), white (58.5%), traffic accidents (39.8%), upper extremity injuries (37.9%), overnight admissions (39.1%), Monday (15.1 million 4%) and in May (10.2%), orthopedic surgeries (56.5%), without complications (58.1%), hospitalization for one day (60.4%), mild incapacity at hospital discharge (28.8%). Hospital treatment cost >US$ 100.00 (53.0%). Conclusión the characterization of the profile of trauma victims treated in the emergency care unit of a public teaching hospital showed that trauma treatment involves many factors and the sequelae that cause the victim interfere in the performance of activities of daily living, in the occupation of beds and determine high costs of treatment.

Mapa de rede social de usuárias do Centro de Referência de Assistência Social / Map of the social network of users of the Reference Center of Social Assistance

O objetivo desta pesquisa foi compreender as possibilidades do uso do Mapa de Rede Social no atendimento social e psicológico ofertado em um Centro de Referência de Assistência Social. Mapas de oito usuárias desse serviço foram construídos e analisados como estudo de casos múltiplos a partir de teóricos sistêmicos e construcionistas sociais. A construção do Mapa permitiu gerar informações significativas sobre as fontes de apoio dos/as usuários/as, identificar situações de violência dentro e fora da família, discutir as consequências da migração de território para as famílias, analisar os efeitos do posicionamento das profissionais do CRAS e da rede pública de saúde na vida dessas pessoas e analisar em quais âmbitos da vida da pessoa o apoio tem sido mais efetivo e onde poderia ser ampliado. A construção do Mapa pode servir para o planejamento de intervenções voltadas para o que a política de atenção social básica prevê, uma atuação preventiva e a favor do fortalecimento de vínculos entre famílias e comunidade.

The objective of this research was to understand the possibilities of using the Social Network Map in social and psychological care offered at a Social Assistance Reference Center. Maps of eight users of this service were constructed and analyzed as a multiple case study from systemic and constructionist theorists. The construction of the Map allowed to generate significant information about the users' support sources, to identify situations of violence inside and outside the family, to discuss the consequences of territory migration to the families, to analyze the effects of the positioning of CRAS professionals and the public health network on life of these people and analyze in which areas of the person's life the support has been more effective and where it could be expanded. The construction of the Map can serve to plan interventions focused on what the basic social care policy provides, a preventive action and in favor of strengthening bonds among families and community.

Diagnosis at different stages of paracoccidioidomycosis with oral manifestation: Report of two cases.

Paracocciodiomycosis (PCDM) is a chronic systemic fungal infection, mainly affecting residents and rural workers, being characterized by a long incubation period, which it can take months or years without clinical manifestations, making diagnosis late and difficult. Depending on the stage of the disease, it can cause sequelae and low quality of life, so its correct diagnosis is of great importance for the accurate treatment. Therefore, the aim of this report is to present two cases of diagnosis of patients with PCDM at different stages, who developed chronic manifestations, pain, clinical involvement of the oral cavity and in one case also presented lung injury with fibrosis, as well as to weight loss, dysphagia and cachexia. Both of patients were treated with antifungal therapy and it was observed total remission of the lesions and no recurrences were detected.

Sentidos sobre o/a Psicóloga/o no CRAS na Literatura Científica / Meanings about the Psychologist at Social Assistance Service in The Scientific Literature / Sentidos acerca del Psicólogo en el Servicio de Trabajo Social en la Literatura Científica

A partir do construcionismo social, o objetivo deste estudo de revisão narrativa foi compreender a produção de sentidos sobre o/a psicólogo/a nos Centros de Referência de Assistência Social (CRAS) veiculados na literatura científica, bem como caracterizar essa produção. Em uma busca nas bases/bibliotecas SciELO, LILACS, PePSIC e Google Acadêmico entre os anos de 2009 e 2017, recuperou-se 43 estudos. A maioria foi publicada em periódicos como Psicologia e Sociedade e Psicologia: Ciência e Profissão por autores/as provenientes dos Estados de Minas Gerais e Rio Grande do Norte, tratando-se de estudos empíricos por meio de entrevistas com psicólogos/as acerca de sua atuação no CRAS, bem como de análise de intervenções. A literatura é uníssona ao sugerir uma prática profissional alinhada ao sólido engajamento social e político, promovendo intervenções que se contraponham a modelos clínicos tradicionais, com foco no indivíduo e na patologia, ampliando as possibilidades do/a psicólogo/a como agente de transformação social. (AU)

Based on social constructionism theory, the objective of this narrative review study was to understand the meanings of the psychologist who work at the Social Care Referral Centers (CRAS) published in the scientific literature, as well as to analyze this production. By a search in the data bases SciELO, LILACS, PePSIC and Google Academic between the years of 2009 and 2017, 43 studies were identified. Most of them have been published in journals such as Psicologia & Sociedade and Psicologia: Ciência e Profissão, by authors from the Minas Gerais and Rio Grande do Norte states. These empirical studies bring interviews with psychologists about their work in CRAS, as well as analysis of their interventions. Literature is unified by suggesting a professional practice aligned with solid social and political engagement, promoting interventions that are opposed to traditional clinical models, focusing on the individual and the pathology, expanding the possibilities of the psychologist as an agent of social transformation. (AU)

A partir del construccionismo social, el objetivo de este estudio de revisión narrativa fue comprender la producción de sentidos acerca del/la psicólogo/a en los Centros de Referencia de Asistencia Social (CRAS) vehiculados en la literatura científica, así como caracterizar esa producción. En una búsqueda en las bases/bibliotecas SciELO, LILACS, PePSIC y Google Académico entre los años 2009 y 2017, se recuperó 43 estudios. La mayoría fue publicada en periódicos como Psicología y Sociedad y Psicología: Ciencia y Profesión por autores provenientes de las provincias de Minas Gerais y Rio Grande do Norte, tratándose de estudios empíricos por medio de entrevistas con psicólogos/as acerca de su actuación en el CRAS así como de análisis de intervenciones. La literatura es unísona al sugerir una práctica profesional alineada al sólido compromiso social y político, promoviendo intervenciones que se contraponen a modelos clínicos tradicionales, con foco en el individuo y en la patología, ampliando las posibilidades del/la psicólogo/a como agente de transformación social. (AU)

Psychologist-user discursive practices in the quotidian of a CRAS / Práticas discursivas entre psicóloga/o e usuária/o no cotidiano de um cras / Prácticas discursivas de psicólogo-usuario en el cotidiano de un cras

RESUMO. O objetivo desta pesquisa foi o de compreender as práticas discursivas entre psicóloga/o e usuária/o no cotidiano de um serviço de proteção social básica do Sistema Único de Assistência Social no Brasil. Para tanto, foi observado o cotidiano de um Centro de Referência em Assistência Social. O registro em diário de campo foi analisado a partir da proposta teórico-metodológica construcionista social de análise de práticas discursivas e produção de sentidos. Os sentidos sobre relacionamento psicólogo/a-usuários/as nessas práticas foram discutidos em termos dos jogos de posicionamentos que implicavam e dos discursos sociais que os atravessavam. Destacaram-se a disputa de entendimentos entre profissional e usuária/o sobre possíveis planos de ação, a influência de discursos de julgamento moral e responsabilização individual nesse processo, os efeitos do lugar da/o profissional como especialista, a dificuldade de se pensar estratégias com o foco grupal, coletivo e comunitário e os efeitos de um olhar psicologizante sobre a/o usuária/o.

RESUMEN. El objetivo de esta investigación fue el de comprender las prácticas discursivas de psicólogo y usuario en el cotidiano de un servicio de protección social básica del Sistema Único de Asistencia Social en Brasil. Para ello, se realizó la observación en el cotidiano de un Centro de Referencia en Asistencia Social. Se analizó el registro en diario de campo a partir de la propuesta teórico-metodológica construccionista social de análisis de producción de sentidos. Los sentidos sobre relación psicólogo-usuarios en esas prácticas fueron discutidos en términos de los juegos de posicionamientos que implicaban y de los discursos sociales que los atravesaban. Se destacaron la disputa de entendimientos entre profesional y usuario sobre los planes de acción, la influencia de discursos de juicio moral y responsabilización individual en ese proceso, los efectos del lugar del profesional como especialista, la dificultad de pensar estrategias con el objeto el foco grupal, colectivo y comunitario y los efectos de una mirada psicologizante sobre el usuario.

ABSTRACT. The aim of this study was to understand the psychologist-user discursive practices in the quotidian of a basic social protection service of the Brazilian Unified Social Welfare System. In order to do so, the observation of the quotidian of a Social Welfare Referral Center was carried out. The field notes were analyzed from the social constructionist theoretical-methodological proposal of making meaning analysis. The meanings about the psychologist-users relationship implied in these practices were discussed in terms of the games of positioning that they implied and of the social discourses that ran through them. The dispute of understandings regarding action plans between professional and user and the influence of discourses of moral judgment and individual responsibilization were highlighted in this process, as were the effects of the professional's place as a specialist, the difficulty of thinking about strategies with a group, collective and community focus and the effects of a psychologizing view regarding the user.

Different outcomes of a cardiac rehabilitation programme in functional parameters among myocardial infarction survivors according to ejection fraction.

INTRODUCTION: Exercise-based cardiac rehabilitation (EBCR) is part of the management of patients who have suffered an acute myocardial infarction (AMI). Patients with a reduced ejection fraction (EF) comprise a higher-risk subgroup and are referred less often for these programmes. This study aimed at assessing the impact of the baseline EF on the functional benefits, as assessed by peak oxygen uptake (pVO2) and exercise duration, of an EBCR programme in AMI survivors. METHODS: Observational, retrospective cohort study including all patients admitted to a tertiary centre due to an AMI who completed a phase II EBCR programme after discharge, between November 2012 and April 2017. Functional parameters were assessed by a symptom-limited cardiopulmonary exercise test. RESULTS: A total of 379 patients were included [40.9% with reduced EF (<50%) at discharge]. After the programme, pVO2 and exercise duration increased significantly (p < 0.001). Patients with a reduced EF had a lower pVO2 and completed a shorter duration of exercise at the beginning and end of the programme. This group presented a higher increase in pVO2 (p = 0.001) and exercise duration (p = 0.007). This was maintained after adjusting for age, gender, history of coronary artery disease, number of sessions, Killip classification, arterial hypertension, dyslipidaemia, diabetes mellitus, smoking status and baseline pVO2. CONCLUSION: A phase II EBCR programme was associated with significant improvements in pVO2 and exercise duration among AMI survivors, irrespective of baseline EF classification. Those with a reduced baseline EF derived an even greater improvement, highlighting the importance of EBCR in this subgroup of patients.