A systematic review of evidence-based interventions for child and adolescent mental health problems in low- and middle-income countries.

BACKGROUND: Treatments for mental health problems in childhood and adolescence have advanced in the last 15 years. Despite advances in research, most of the evidence on effective interventions comes from high-income countries, while evidence is scarce in low- and middle-income countries (LMICs), where 90% of world's children and adolescents live. The aim of this review was to identify evidence-based interventions tested in LMICs to treat or prevent child and adolescent mental health problems. METHODS: We conducted a systematic review of seven major electronic databases, from January 2007 to July 2019. We included randomised or non-randomised clinical trials that evaluated interventions for children or adolescents aged 6 to 18 years living in LMICs and who had, or were at risk of developing, one or more mental health problems. Results were grouped according to the studied conditions. Due to the heterogeneity of conditions, interventions and outcomes, we performed a narrative synthesis. The review was registered at PROSPERO under the number CRD42019129376. FINDINGS: Of 127,466 references found through our search strategy, 107 studies were included in narrative synthesis after the eligibility verification processes. Nineteen different conditions and nine types of interventions were addressed by studies included in the review. Over 1/3 of studied interventions were superior to comparators, with psychoeducation and psychotherapy having the highest proportion of positive results. One-third of studies were classified as presenting low risk of bias. INTERPRETATION: This review shows that different interventions have been effective in LMICs and have the potential to close the mental health care gap among children and adolescents in low-resource settings.

Family Health Support Center: suffering from the perspective of psychodynamics of work.

OBJECTIVE: To analyze the work process of the Family Health Support Center and identify the repercussions on professionals' quality of life at work. METHOD: A descriptive-exploratory qualitative case study conducted with workers from Family Health Support Centers. The content analysis technique was used to analyze the resulting empirical material in the light of the theoretical reference of Work Psychodynamics. RESULTS: Twenty workers participated in the focus groups. This study discusses the category of 'suffering' by the chosen theoretical perspective, which derives from interpersonal relationships and teamwork, the feeling of not belonging, lack of infrastructure for work, violence and vulnerability present in the territory. CONCLUSION: Group union and collaborative integration among workers can be strategies for the minimization of suffering at work in the context of the Family Health Strategy.

Prevalence and associated factors of mental health disorders among Brazilian healthcare workers in times of the COVID-19 pandemic: A web-based cross-sectional study.

The COVID-19 pandemic in Brazil affected mental health among healthcare workers. To objective of this study was to evaluate the mental health of healthcare workers in in the central-west region of the Brazil, estimating the prevalence of mental health disorders, and investigating associated factors, perceptions of safety, and self-perceptions about mental health in times of the COVID-19 pandemic. The questionnaire was divided into two parts that included general information and perceptions about the work process and identified symptoms using the Depression Anxiety Stress Scale-21 (DASS-21), and multiple linear regression analysis was conducted. A total of 1,522 healthcare workers participated in the survey. Overall prevalence of symptoms was calculated for depression (58.7%), anxiety (59.7%), and stress (61.7%). Physicians had 3.75 times greater risk of depression (1.59-8.85, 95% CI). Independent variables associated with depression symptoms were not feeling safe with the way services were organized (1.12:1.03-1.21, 95% CI) and self-perception of poor mental health (8.06: 4.03-16.10% CI). Working in management was protective, and married professionals had 12% lower risk of exhibiting symptoms of depression (0.79-0.99, 95% CI). Participants with self-perception of poor mental health had 4.63 greater risk for symptoms of anxiety (2.58-8.31, 95% CI). Protective factors were not having sought support for mental health (0.90: 0.82-0.99, 95% CI), having a graduate degree (0.71: 0.54-0.94, 95% CI), and not having been diagnosed with COVID-19 (0.90: 0.83-0.98, 95% CI). Perception of poor mental health was associated with 6.95-fold greater chance of developing stress symptoms. Protective factors from stress were having a degree in dentistry (0.81: 0.68-0.97, 95% CI), residing in Mato Grosso do Sul (0.91: 0.85-0.98, 95% CI), and not having sought mental health support services (0.88: 0.82-0.95, 95% CI). The prevalence of mental health disorders is high among healthcare workers, and is associated with professional category, organization of services provided, and self-perception of poor mental health, reinforcing the need for preventative measures.

Impact of early malnourishment on the chronic inflammatory response and its implications for the effect of indomethacin on Wistar rats.

The objective of the present study was to investigate whether early undernutrition changes the chronic inflammatory response, so as to study its influence on pharmacological response to indomethacin. Rat offspring of dams fed from the first day of gestation to term or throughout the lactation period received a balanced diet (NN) or a basic regional diet (BRD) from northeast Brazil. According to their dams, the offspring were divided into three groups: NN; basic regional diet during gestation (BRD-g, undernourished during gestation); basic regional diet during gestation and lactation (BRD-gl, undernourished during gestation and lactation). At 2 months of age, Freund's adjuvant (0·2 ml) was inoculated into the plantar surface of the hind paw (day 0) of animals. All animals orally received saline (0·9 %) for 28 d. Another group of adult offspring was subjected to the same procedure as described above, but orally received indomethacin (2 mg/kg) instead of saline, and divided into three subgroups: NN treated with indomethacin (NNI); BRD-g treated with indomethacin (BRDI-g); BRD-gl treated with indomethacin (BRDI-gl). The hind paw volume was calculated on days 0 (initial paw volume), 7, 14 and 28. Hind paw swelling, blood albumin and C-reactive protein (CRP) levels and leucocyte counts were evaluated as markers of inflammation. Reduced hind paw swelling and the blood levels of serum albumin and CRP were found in the BRD-g and BRD-gl offspring. However, no difference was found in the leucocyte count. Compared with their respective saline-treated groups (NN, BRD-g and BRD-gl), the anti-inflammatory effect of indomethacin was lower in the BRDI-g and BRDI-gl groups than in the NNI group. We conclude that early undernutrition attenuated the chronic inflammatory response and the anti-inflammatory effect of indomethacin.

Ultra-Endurance Associated With Moderate Exercise in Rats Induces Cerebellar Oxidative Stress and Impairs Reactive GFAP Isoform Profile.

Ultra-endurance (UE) race has been associated with brain metabolic changes, but it is still unknown which regions are vulnerable. This study investigated whether high-volume training in rodents, even under moderate intensity, can induce cerebellar oxidative and inflammatory status. Forty-five adult rats were divided into six groups according to a training period, followed or not by an exhaustion test (ET) that simulated UE: control (C), control + ET (C-ET), moderate-volume (MV) training and MV-ET, high-volume training (HV) and HV-ET. The training period was 30 (MV) and 90 (HV) min/day, 5 times/week for 3 months as a continuous running on a treadmill at a maximum velocity of 12 m/min. After 24 h, the ET was performed at 50% maximum velocities up to the animals refused to run, and then serum lactate levels were evaluated. Serum and cerebellar homogenates were obtained 24 h after ET. Serum creatine kinase (CK), lactate dehydrogenase (LDH), and corticosterone levels were assessed. Lipid peroxidation (LP), nitric oxide (NO), Interleukin 1ß (IL-1ß), and GFAP proteins, reduced and oxidized glutathione (GSH and GSSG) levels, superoxide dismutase (SOD) and catalase (CAT) activities were quantified in the cerebellum. Serum lactate concentrations were lower in MV-ET (∼20%) and HV-ET (∼40%) compared to the C-ET group. CK and corticosterone levels were increased more than ∼ twofold by HV training compared to control. ET increased CK levels in MV-ET vs. MV group (P = 0.026). HV induced higher LP levels (∼40%), but an additive effect of ET was only seen in the MV-ET group (P = 0.02). SOD activity was higher in all trained groups vs. C and C-ET (P < 0.05). CAT activity, however, was intensified only in the MV group (P < 0.02). The 50 kDa GFAP levels were enhanced in C-ET and MV-ET vs. respective controls, while 42 kDa (∼40%) and 39 kDa (∼26%) isoform levels were reduced. In the HV-ET group, the 50 KDa isoform amount was reduced ∼40-60% compared to the other groups and the 39 KDa isoform, increased sevenfold. LDH levels, GSH/GSSG ratio, and NO production were not modified. ET elevated IL-1ß levels in the CT and MV groups. Data shows that cerebellar resilience to oxidative damage may be maintained under moderate-volume training, but it is reduced by UE running. High-volume training per se provoked systemic metabolic changes, cerebellar lipid peroxidation, and unbalanced enzymatic antioxidant resource. UE after high-volume training modified the GFAP isoform profile suggesting impaired astrocyte reactivity in the cerebellum.

Efficacy of tubing technique with biomaterials compared to direct coaptation technique after peripheral neurotmesis in nerve healing and return to functionality in young adult rats: a systematic review protocol.

BACKGROUND: Peripheral nerves are constant targets of traumatic injury which may result in neurotmesis and which invariably requires surgical treatment. In view of this, tissue engineering studies developed biomaterials which were first tested in animal models and used as a guide for nerve stumps in the procedure in order to speed up the healing process. Therefore, the aim of this study is to evaluate the efficacy of biomaterials used in tubing technique on healing and histological and functional recovery after peripheral nerve neurotmesis in rats. METHODS: We will search PubMed/MEDLINE, Embase, Web of Science, LILACS, and CENTRAL (from inception onwards). Grey literature will be identified through searching dissertation databases, guidelines, policy documents, and reports. We will include randomized and non-randomized trials conducted in young adult rats with peripheral neurometsis undergoing surgical repair through tubing technique with biomaterials. Primary outcomes will be histomorphometry, immunohistochemistry of the nerve tissue, and sciatic functional index. Secondary outcome will be nerve macroscopic evaluation. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. If feasible, we will conduct random effects meta-analysis. DISCUSSION: This systematic review of animal studies will identify, evaluate, and synthetize the evidence on the the efficacy of tubing technique with biomaterials compared to direct coaptation technique after peripheral neurotmesis in nerve healing and return to functionality. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018106042.

Impact of continuing education on maternal and child health indicators.

OBJECTIVE: This study investigated whether the presence of care workers who completed a specialization course on family health was associated with improved care and maternal and child health indicators in municipalities in the state of Mato Grosso do Sul, Brazil. METHODS: Negative binomial regression models with fixed effects were used for the 79 municipalities in the state of Mato Grosso do Sul, with repeated observations for the period 2009-2015. For our reference, the parameter "number of professionals who completed the course" calculated the proportion of professionals who completed the course, and was divided by the total number of primary health care professionals in the municipality to create a ratio. The cutoff points used represented tertile distribution: T3: high (0.35-1.00), T2: intermediate (0.02-0.33) and T1: low (0.00-0.01); to avoid biased results, the analysis was also performed for the years prior to the beginning of the course in question (2009 and 2010). RESULTS: During the study period, enrollment of pregnant women, exclusive breastfeeding for children under 4 months, and up-to-date vaccinations in children younger than 1 year to 23 months increased (high to intermediate categories) in municipalities where professionals who completed the specialization course worked. Growth in the intermediate ratio was also observed in indicators related to cervical cancer screening and new diagnoses of congenital syphilis in infants under one year of age. CONCLUSIONS: The presence of care workers who completed a specialization course on family health was seen to be associated with improved care and indicators for maternal and child health in municipalities in the state of Mato Grosso do Sul, Brazil. These findings reaffirm the importance and effectiveness of policies on training and continuing education for the Brazilian Unified Health System.

The Influences of Adherence to Tamoxifen and CYP2D6 Pharmacogenetics on Plasma Concentrations of the Active Metabolite (Z)-Endoxifen in Breast Cancer.

Tamoxifen efficacy in breast cancer is suspected to depend on adherence and intact drug metabolism. We evaluated the role of adherence behavior and pharmacogenetics on the formation rate of (Z)-endoxifen. In 192 Brazilian patients, we assessed plasma levels of tamoxifen and its metabolites at 3, 6, and 12 months of treatment (liquid-chromatography tandem mass spectrometry), adherence behavior (Morisky, Green, and Levine medication adherence scale), and cytochrome P450 2D6 (CYP2D6) and other pharmacogene polymorphisms (matrix-assisted laser-desorption-ionization time of flight) mass spectrometry, real-time polymerase chain reaction). Adherence explained 47% of the variability of tamoxifen plasma concentrations (P < 0.001). Although CYP2D6 alone explained 26.4%, the combination with adherence explained 40% of (Z)-endoxifen variability at 12 months (P < 0.001). The influence of low adherence to not achieving relevant (Z)-endoxifen levels was highest in patients with noncompromised CYP2D6 function (relative risk 3.65; 95% confidence interval 1.48-8.99). As a proof-of-concept, we demonstrated that (Z)-endoxifen levels are influenced both by patient adherence to tamoxifen and CYP2D6, which is particularly relevant for patients with full CYP2D6 function.

Effective/cost effective interventions of child mental health problems in low- and middle-income countries (LAMIC): Systematic review.

BACKGROUND: This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs). METHODS: We will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS. We will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations. Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V. Interventions which address suicide, self-harm will also be included, if identified during the extraction process. We will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical and/or functional outcomes) and which have been delivered to young people in LAMICs. We will consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils). In the pilot of screening procedures, 5% of all references will be screened by two reviewers. Divergences will be resolved by one expert in mental health research. Reviewers will be retrained afterwards to ensure reliability. The remaining 95% will be screened by one reviewer. Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction. RESULTS: The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. The results will be presented descriptively and, if possible, meta-analysis will be conducted. Ethical approval is not needed for anonymised secondary data. CONCLUSION: the systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.

Endurance training on rodent brain antioxidant capacity: A meta-analysis.

The influence of physical exercise on brain antioxidant defense mechanisms has been studied. Nevertheless, the effect of training volume on the brain`s redox balance remains unclear. In this meta-analysis, we compared the effect of training volume on antioxidant enzymatic resource and lipid peroxidation on various brain regions. The activities of the enzymes glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT) and the levels of thiobarbituric acid reactive substances (TBARS) were also evaluated. The effects of training periods (weeks) and exercise duration were compared. Meta-analysis revealed that protocols over 8 weeks were associated with an increase in SOD (p = 0.0008) and CAT activities (p = 0.0001). Exercise durations for 30 and 60 min were associated with higher CAT activity (p = 0.04). Joint analysis revealed that moderate physical exercise over 4 and 8 weeks promoted a healthy enzymatic balance. However, high volumes of exercise over 8 weeks were associated with the increased antioxidant enzymatic activity, indicating higher reactive oxygen species (ROS) levels. The data also indicated that there is still limited research and inaccurate information, on the safety conditions of training periods that simulate tests of ultra resistance in humans.

Impact of distance education on primary health care indicators in central Brazil: An ecological study with time trend analysis.

OBJECTIVE: The objective of this study was to verify whether the inclusion of professionals who completed a specialized distance learning course in family health teams is associated with rates of hospitalization for primary healthcare-sensitive conditions and better monitoring of chronic conditions in municipalities within the state of Mato Grosso do Sul, Brazil. METHODS: Negative binomial regression models with fixed effects were used for the 79 municipalities in the state, with repeated observations for the selected years (2009-2015). For our reference, the parameter "Municipality Ratio" was the number of professionals who completed the course divided by the total number of PHC professionals in the municipality. This ratio has been cumulative over the years. No reference values were found in the scientific literature, so three cutoff points were used for tertile distribution: T3:high (0.35-1.00), T2:intermediate (0.02-0.33), and T1:Low (0.00-0.01). In order to avoid capturing biased results, the analysis was also performed for the years before the specialization course was offered (2009 and 2010). RESULTS: Indicators of the share of hospitalizations for primary care-sensitive conditions (overall rate and specific rates for asthma, gastroenteritis, and heart failure) decreased during the study period when related to a high and intermediate proportion of professionals who completed the specialization course, and the same was seen for indicators of chronic conditions (diabetic and hypertensive patients) who were registered, monitored and group care. CONCLUSION: The specialization course impacted important indicators related to the attributions of primary health care professionals, considering that decreases in hospitalizations for primary care sensitive causes (overall rate of sensitive causes, specific rates for asthma, gastroenteritis and heart failure) were seen in the territories where professionals who completed this course worked, along with increased registration and monitoring of diabetic and hypertensive patients.

Preventive role of metformin on peripheral neuropathy induced by diabetes.

Metformin is the first line drug in the treatment of type 2 diabetes, however, little is known about its therapeutic potential to prevent or delay damage to the peripheral nerve. Thus, the aim of this study was to investigate whether metformin is able to attenuate the neuroinflammatory response in sciatic nerve of insulin-dependent diabetic mice. Swiss Webster mice were divided into four groups: Control, Diabetic (STZ), Diabetic +100 mg/kg/day of metformin (STZ + M100) and Diabetic +200 mg/kg/day of metformin. Diabetes was induced by streptozotocin (90 mg/kg, i.p.). Only animals with glycemia ≥270 mg/dl were considered diabetics. Metformin prevented atrophy of myelinated axons, and reduced expression of inflammatory mediators (interleukin-1ß, inducible nitric oxide synthase and nitric oxide). However, treatment with 200 mg of metformin was more effective in increasing neurotrophic (myelin basic protein and neural growth factor), angiogenic (vascular endothelial growth factor) and anti-inflammatory (inhibitor kappa B-alpha and interleukin 10) factors. Thus, metformin treatment, especially at the dose of 200 mg, protected the nerve from damages related to chronic hyperglycemia.

Do malnutrition and fluoxetine neonatal treatment program alterations in heart morphology?

Growth and development events are observed in all organisms and can be modified by exogenous factors such as nutritional changes. Drastic morphological and functional alterations may occur during a vulnerable stage of development. The aim of this study was to investigate if malnutrition and/or fluoxetine neonatal treatment program alterations in heart morphology during the postnatal period. The sample consisted of 48 albino Wistar male rats. The rats were divided into two groups: nourished and malnourished. Pharmacologic manipulation was performed during the suckling period. The animals of each group were divided into two subgroups: saline-nourished and saline-malnourished, treated with sodium chloride solution, and fluoxetine-nourished and fluoxetine-malnourished, treated with fluoxetine. Half of the individuals in each subgroup were weighed and sacrificed on day 30 and the other half on day 71. Myocardial perfusion was performed and the heart subsequently weighed. The ventricles were cross-sectioned into two parts, which were fixed, dehydrated and sectioned. There were differences in body weight, heart weight, cross-sectional area and perimeter of the heart and in the cross-sectional area and perimeter of the cardiac cells among the groups at the different ages. Malnutrition appears to program alterations in heart morphology. However, malnourished animals that had undergone drug treatment did not exhibit the same changes.

Quadriceps muscle architecture ultrasonography of individuals with type 2 diabetes: Reliability and applicability.

Muscle architecture parameters performed using ultrasound serve as an aid to monitor muscle changes derived from diseases, however there are no studies that determine the reliability and applicability of this evaluation in individuals with type 2 diabetes (DM2). Three raters captured three images of measurements of thickness of the rectus femoris (RF), vastus intermedius and anterior quadriceps, RF muscle cross-sectional area, RF pennation angle in 17 individuals with DM2 above 50 and sedentary. Intra and inter-raters analysis showed reliability from high to very high for the three raters (ICC> 0.87), except for the RF pennation angle with moderate to low intra-raters (ICC = 0.58, 0.48, 0.51), and high inter-rater reliability (ICC = 0.70). Ultrasound measurements of quadriceps muscles showed high to very high intra and inter-raters reliability, thus allowing its use to monitor muscle changes provoked by diabetes or interventions in individuals with DM2.

Atividade física, autocuidado e qualidade de vida em diabéticos Tipo 2 na pandemia de COVID-19 / Physical activity, self-care, and quality of life in Type 2 diabetic in the COVID-19 pandemic

Avaliar fatores associados ao nível de atividade física durante a pandemia daCOVID-19em indivíduos com diabetes mellitus tipo 2 (DM2).Estudo transversal, envolvendo 211 pessoas com DM2 e idade ≥ 45 anos, utilizando o Google Forms para coletar informações: dados pessoais,Questionário Internacional de Atividade Física (IPAQ), Inventário de Autocuidado (SCI-R) e Versão Brasileira da Escala PAID (B-PAID). Houve prevalência do diagnóstico do DM2 acima de 10 anos (42,1%); no geral, eram ativos (55,2%), com alto sofrimento emocional (52,6%) e com baixo autocuidado (71,6%). Foi observada associação do nível de atividade física e a percepção de saúde [IC 95% OR = 2,421-1,264;p < 0,008) e o nível de atividade física e a insônia (OR = 0,410-0,196;(p < 0,018). O maior nível de atividade física foi associado à autopercepção de saúde positiva e à insônia.

To evaluate factors associated with the level of physical activity during the COVID-19 pandemic in individuals with type 2 diabetes mellitus (DM2). Cross-sectional study, involving 211 people with DM2 aged ≥ 45 years, using Google Forms to collect information: personal data, International Physical Activity Questionnaire (IPAQ), Self-Care Inventory (SCI-R) and Brazilian version of the PAID Scale (B-PAID). There was a prevalence of DM2 diagnosis over 10 years (42.1%); in general, they were active (55.2%), with high emotional distress (52.6%) and low self-care (71.6%). There was an association between the level of physical activity and perceived health [95% CI OR = 2.421-1.264; p < 0.008) and the level of physical activity and insomnia (OR = 0.410-0.196; (p < 0.018). A higher level of physical activity was associated with positive self-perception of health and insomnia.

Perfis profissionais de planos de cursos técnicos em saúde: mercado, SUS e formação humana / Professional profiles of technical course plans in health: market, SUS and human education / Perfiles profesionales de planes de cursos técnicos en salud: mercado, SUS y formación humana

Resumo O estudo que originou este artigo é do tipo qualitativo, documental e de perspectiva histórico-dialética, cujo objetivo é refletir sobre aproximações e afastamentos da formação de técnicos da área da saúde em relação ao Sistema Único de Saúde e à formação humana, mediante a análise de sete planos de cursos, com foco no perfil profissional de seis escolas (quatro públicas e dois estabelecimentos de ensino privados) do estado de São Paulo. A análise foi feita com base nas relações estabelecidas entre perfis profissionais e alguns dispositivos político-legais. A explicitação do Sistema Único de Saúde na descrição dos perfis é fragilizada, não havendo referência, na maioria dos planos, exceto em dois da enfermagem (um deles pertencente à Escola Técnica do Sistema Único de Saúde). Essa fragilidade vai ao encontro dos catálogos nacionais dos cursos técnicos nas versões utilizadas das áreas profissionais em foco. Nos planos, com ênfase nos cursos técnicos em farmácia e nutrição e dietética, sobressai nas justificativas e tendências o enfoque explícito ao mercado. Há apropriação de conceitos potencializadores da lógica neoliberal, mesmo com indicação de 'formação crítica'. É desafiante a proposição de formação humana e a favor do Sistema Único de Saúde na educação profissional técnica de nível médio em saúde considerando-se os avanços da lógica neoliberal.

Abstract The study that originated this article is qualitative, documentary and of historical-dialectical perspective, whose objective is to reflect on approximations and departures from the training of technicians in the health area in relation to the Brazilian Unified Health System and human formation, through the analysis of seven course plans, focusing on the professional profile of six schools (four public and two private schools) in the state of São Paulo. The analysis was based on the relationships established between professional profiles and some political-legal devices. The explanation of the Unified Health System in the description of the profiles is fragile, with no reference in most plans, except for two in nursing (one belonging to the Technical School of the Unified Health System). This weakness is in line with the national catalogs of technical courses in the versions used in the professional areas in focus. In the plans, with emphasis on technical courses in pharmacy and nutrition and dietetics, the explicit focus on the market stands out in the justifications and trends. There is appropriation of potentiating concepts of neoliberal logic, even with an indication of 'critical training'. The proposition of human formation and in favor of the Unified Health System in technical professional education of medium level in health is challenging, considering the advances of the neoliberal logic.

Resumen El estudio que dio origen a este artículo es de perspectiva cualitativa, documental e histórico-dialéctica, cuyo objetivo es reflexionar sobre las aproximaciones y desviaciones de la formación de técnicos en el área de la salud en relación con el Sistema Único de Salud de Brasil y con la formación humana, a través del análisis de siete planes de cursos, enfocados en el perfil profesional de seis escuelas (cuatro públicas y dos privadas) en el estado de São Paulo. El análisis se basó en las relaciones que se establecen entre los perfiles profesionales y algunos dispositivos político-jurídicos. La exposición del Sistema Único de Salud en la descripción de los perfiles es frágil, sin referencia en la mayoría de los planes, excepto dos en enfermería (uno perteneciente a la Escuela Técnica del Sistema Único de Salud). Esta debilidad está en línea con los catálogos nacionales de los cursos técnicos en las versiones utilizadas en las áreas profesionales en foco. En los planes, con énfasis en cursos técnicos en farmacia y nutrición y dietética, se destaca en las justificaciones y tendencias el enfoque explícito en el mercado. Hay apropiación de conceptos potenciadores de la lógica neoliberal, incluso con un indicio de 'formación crítica'. Es desafiadora la propuesta de formación humana y a favor del Sistema Único de Salud en la educación profesional técnica de nivel medio en salud, considerando los avances de la lógica neoliberal.

Effectiveness of resistance exercise compared to aerobic exercise without insulin therapy in patients with type 2 diabetes mellitus: a meta-analysis.

BACKGROUND: Physical exercise has been used to mitigate the metabolic effects of diabetes mellitus. OBJECTIVE: To evaluate the effect of resistance exercise when compared to aerobic exercise without insulin therapy on metabolic and clinical outcomes in patients with type 2 diabetes mellitus. METHODS: Papers were searched on the databases MEDLINE/PubMed, CINAHL, SPORTDiscus, LILACS, and SCIELO, without language or date of publication limits. Clinical trials that compared resistance exercise to aerobic exercise in adults with type 2 diabetes mellitus who did not use insulin therapy were included. The quality of evidence and risk of bias were assessed using the GRADE system and the Cochrane Risk of Bias tool, respectively. Meta-analysis was also used, whenever possible. Two reviewers extracted the data independently. Eight eligible articles were included in this study, with a total of 336 individuals, with a mean age of 48-58 years. The protocols of aerobic and resistance exercise varied in duration from eight to 22 weeks, 30-60min/day, three to five times/week. RESULTS: Overall the available evidence came from a very low quality of evidence and there was an increase in Maximal oxygen consumption (mean difference: -2.86; 95% CI: -3.90 to -1.81; random effect) for the resistance exercise and no difference was found in Glycated hemoglobin, Body mass index, High-density lipoprotein cholesterol, Low-density lipoprotein cholesterol, triglycerides, and total cholesterol. CONCLUSIONS: Resistance exercise appears to be more effective in promoting an increase in Maximal oxygen consumption in protocols longer than 12 weeks and there is no difference in the control of glycemic and lipid levels between the two types of exercise.

Percepções dos recrutados sobre a ação estratégica "o brasil conta comigo" / Perceptions of the people recruited about the strategic action "o brasil conta comigo" (brazil counts on me) / Las percepciones de los reclutas sobre la acción estratégica "o brasil conta comigo" (el brasil cuenta conmigo)

RESUMO Objetivo: analisar as percepções de acadêmicos e supervisores sobre a ação estratégica "O Brasil Conta Comigo". Método: estudo transversal realizado em Mato Grosso do Sul - Brasil, de dezembro de 2020 a março de 2021, em duas etapas: 1) Exploratória (quantitativa), via análise de relatórios dos 33 supervisores e 90 acadêmicos convocados, aplicação de questionário on-line; 2) Profundidade (qualitativa), utilizando a técnica do grupo focal remoto, com amostra por conveniência. Realizada análise descritiva e de conteúdo. Resultados: foram identificados os motivos de adesão e permanência à ação (bolsa, horas de estágio e responsabilidade social), os aspectos pedagógicos (capacitação, avaliação e apoio das instituições de ensino e gestão) e as contribuições da ação (assistência e formação profissional). Conclusão: as percepções gerais dos recrutados são positivas. Aspectos pedagógicos relacionados à avaliação dos acadêmicos e apoio das instituições de ensino superior devem ser revistos, para ações mais assertivas em momentos de crise sanitária.

ABSTRACT Objective: to analyze the perceptions of academics and supervisors about the strategic action "O Brasil Conta Comigo"(Brazil counts on me). Method: cross-sectional study conducted in Mato Grosso do Sul - Brazil, from December 2020 to March 2021, in two stages: 1) Exploratory (quantitative), via analysis of reports of the 33 supervisors and 90 academics convened, application of an online questionnaire; 2) In-depth (qualitative), using the remote focus group technique, with convenience sampling. Descriptive and content analysis was performed. Results: the reasons for joining and remaining with the action (scholarship, internship hours, and social responsibility), the pedagogical aspects (training, evaluation, and support from educational institutions, and management), and the contributions of the action (assistance and professional training) were identified. Conclusion: the general perceptions of the recruits are positive. Pedagogical aspects related to the evaluation of academics and support from higher education institutions should be reviewed, for more assertive actions in times of health crisis.

RESUMEN Objetivo: analizar las percepciones de estudiantes y supervisores sobre la acción estratégica " El Brasil Cuenta Conmigo". Método: estudio transversal realizado en Mato Grosso do Sul - Brasil, de diciembre de 2020 a marzo de 2021, en dos etapas: 1) Exploratoria (cuantitativa), a través del análisis de los informes de los 33 supervisores y 90 académicos convocados, aplicación de un cuestionario en línea; 2) En profundidad (cualitativa), mediante la técnica de grupo focal a distancia, con muestreo de conveniencia. Se realizó un análisis descriptivo y de contenido. Resultados: se identificaron los motivos de adhesión y permanencia a la acción (bolsa, horas de estancia y responsabilidad social), los aspectos pedagógicos (capacitación, aval y apoyo a las instituciones de enseñanza y gestión) y las contribuciones de la acción (asistencia y formación profesional). Conclusión: la percepción general de los contratados es positiva. Los aspectos pedagógicos relacionados con la evaluación de los académicos y el apoyo de las instituciones de enseñanza superior deben ser revisados, para que las acciones sean más firmes en momentos de crisis sanitaria.

[Morphometry of human myocardium in senile individuals]. / Morfometria do miocárdio humano em indivíduos senis.

OBJECTIVE: To carry out a quantitative assessment in human myocardium cells of senile individuals, in right, left and septal ventricular regions. METHODS: Five hearts from corpses of individuals without heart diseases, of both sexes, with age between 67 and 87 years old were used. The following parameters were assessed: myocyte unit cross section area (myoc. a(o)); myocyte unit perimeter length (myoc. l(o)); myocyte unit volume (myoc. v(o)); myocyte volumetric density (myoc. V(v)); number of myocytes per volume unit (Nmm 3myoc.). The t-test of Student was used in statistic analysis. RESULTS: The analysis of differences (p < 0.05) among right (RV), left (LV) and septal (S) ventricular regions of human heart showed that myoc. a(o) values were lower in RV (1.51 +/- 0.10 microm2) and in S (1.55 +/- 0.07 microm2) in relation to LV (1.84 +/- 0.24 microm2). Values of myoc. l(o) were also shown lower in S (5.11 +/- 0.46 microm) comparing to LV (6.2 +/- 0.97 microm). Likewise, myoc. v(o) and myoc. V(v) showed lower values in RV (88.75 +/- 25.37 microm3; 0.39 +/- 0.03%) in relation to LV (122.41 +/- 16.31 microm3; 0.41 +/- 0.01%). CONCLUSION: Results obtained show that there may be changes in dimensions of left ventricular wall myocyte cell during senescent stage. However, those differences are subtle and seem to mean the adjustment of tissue to functional changes that install along life.

[The effect of endurance training on the neovascularization of skeletal musculature]. / Efeito do treinamento de endurance sobre a neovascularização da musculatura esquelética.

PURPOSE: To quantify the capillaries in the skeletal muscular tissue of mice with induced peripheral arterial insufficiency, after endurance training. METHOD: It was used Wistar mice in 70 days age range, subjected to the total occlusion of right femoral artery. The animals were divided into two groups: sedentary group (SG; n = 05), subjected to activities in the cage; and trained group (TG; n = 05), subjected to an endurance training in cycle ergometer twice a day 17m/min, by 5 minutes, 5 days per week during 10 weeks. The analysis was realized by the histologic observation of the vastus medialis muscle of injured member. RESULTS: The average number of capillaries in the muscular tissue was greater in TG (5,2 +/- 0,83) than in SG (1,6 +/- 1,14) (p < 0,05). CONCLUSION: In animals with induction of peripheral arterial insufficiency, the endurance training provides a process of muscular adaptation which is observed by the increase in the number of capillaries of animals subjected to this kind of training.