Abstract Purpose: To analyze the role of the community assembly as a determining instrument to exercise governance in local indigenous politics, because the various disputes between political factions erode the social fabric and increase the inequality gap. Methodological design: A qualitative, ethnographic study in the municipality of San Luis Amatlán, Oaxaca. Fifteen in-depth interviews were carried out with authorities throughout the municipality and with the adult population. The analysis was done with the analytical categories of governance in the Internal Regulatory Systems, in addition to the participants’ opinion on the performance of the municipal administrator. Results: It was found that the recovery of the municipal community assembly, as well as the assemblies in agencies and rancherías caused greater trust among the participants, together with an increase in the possibility of tracing a joint route to recover local governance through the election of the municipal council. Limitations of the study: Although the ethnographic approach sought to give voice to multiple community actors and social sectors, the research had a greater relationship with the authorities because they coexist more closely with the resource administration processes and their oversight. Findings: The community assembly is a fundamental element of the Internal Regulatory Systems which are consistent with the local customs and habits. The function of the assembly is not only to build consensus, it also acts as a means of control and administrative surveillance. Also, there is persistent conflict derived from the institutional design of indigenous municipalities, which have forms of resolution in their uses and customs such as the assembly, which is a space to address problems directly and without intermediaries.

Resumen Objetivo: Analizar el rol de la asamblea comunitaria como instrumento determinante para ejercer gobernanza en la política local indígena, ya que las diversas disputas entre facciones políticas erosionan el tejido social e incrementan la brecha de desigualdad. Diseño metodológico: Es de tipo cualitativo con una etnografía en el municipio de San Luis Amatlán, Oaxaca. Se realizaron 15 entrevistas a profundidad con autoridades en todo el municipio y con población adulta. El análisis se hizo con las categorías analíticas de gobernanza en los Sistemas Normativos Internos, además de la opinión sobre la figura de administrador municipal. Resultados: Se constató que la recuperación de la asamblea comunitaria municipal, así como las asambleas en agencias y rancherías, provocó mayor confianza entre las partes y la posibilidad de trazar una ruta conjunta para recobrar la gobernanza local a través de la elección del cabildo municipal. Limitaciones del estudio: Aunque la etnografía buscó dar voz a múltiples actores y sectores sociales comunitarios, la investigación tuvo mayor relación con las personas autoridades ya que éstas conviven con mayor cercanía con los procesos de administración de los recursos y su contraloría. Hallazgos: La asamblea comunitaria es un elemento fundamental en los Sistemas Normativos Internos, los cuales están insertos en los usos y costumbres indígenas y su función no sólo es construir consensos, sino que además actúa como medio de contraloría y vigilancia administrativa. También existe persistente conflictividad derivada del diseño institucional de los municipios indígenas, los cuales tienen formas de resolución en sus usos y costumbres como la asamblea, la cual es un espacio para abordar problemas de forma directa y sin intermediarios.

Resumen El principal objetivo del artículo es elaborar la historicidad del capitalismo migratorio, que constituye una de las facetas actuales del capital (capitalismo de la vigilancia, verde, financiero, sanitario, etc.). Para ello, se plantea como segundo objetivo una lectura crítica del Programa Bracero (1942-1964), inspirada en el aparato teórico-conceptual marxista, a través de los conceptos de abstracción real y ruptura metabólica. Así, se recurre al método dialéctico para subrayar las tensiones y contradicciones constitutivas de la implementación de dicho programa (como la transformación paulatina del metabolismo del sujeto campesino en jornalero agrícola explotable y su separación progresiva del terruño) y señalar el surgimiento de las migraciones como nueva expresión del trabajo abstracto (cantidad de brazos empleables). El mayor resultado de este artículo radica en que define el Programa Bracero como un hito histórico importante del surgimiento del capitalismo migratorio.

Abstract The main objective of the article is to elaborate the historicity of migratory capitalism that constitutes one of the current facets of capitalism (surveillance, green, finance, health, etc.). To this end, the second objective is a critical reading of the Bracero Program (1942-1964) inspired by the Marxist theoretical-conceptual framework, through the concepts of real abstraction and metabolic rift. Thus, the dialectical method is used, which consists of highlighting tensions and contradictions constituting the implementation of this program (such as the gradual transformation of the metabolism of the peasant subject into an exploitable agricultural laborer and its progressive separation from the terroir) and pointing out the emergence of migrations as a new expression of abstract work (number of employable arms). This is the greatest result of this article that defines the Bracero Program as an important historical milestone in the emergence of migratory capitalism.

Resumen Los trabajadores agrícolas se exponen frecuentemente a los pesticidas, los cuales pueden afectar el sistema cardiovascular. El objetivo de la investigación fue revisar la asociación entre la exposición ocupacional a pesticidas, el desarrollo de enfermedades cardiovasculares y los biomarcadores utilizados en la vigilancia de la salud de los trabajadores. Para ello se realizó una revisión no sistemática de la literatura en tres bases de datos: Pubmed, Embase y Scopus, con ecuaciones de búsqueda elaboradas con los términos “agrochemicals”, “myocardial infarction”, “occupational exposure” y “farmers", y se incluyeron artículos publicados entre 2007 y 2022. Se encontró que los pesticidas causan elevación de las cifras de presión arterial en trabajadores expuestos y en mujeres embarazadas se relaciona con hipertensión gestacional y preeclampsia. Respecto al infarto agudo de miocardio (IAM), el contacto con los pesticidas clorpirifós, coumafós, carbofurano, pendimetalina, trifluralina y acilalanina aumentan el riesgo de IAM en mujeres, y entre los trabajadores masculinos la exposición a dibromuro de etileno, maneb/mancozeb y dimetil-ditiocarbamato de zinc se asoció con mayor mortalidad. La vigilancia epidemiológica se realiza principalmente con la medición de la actividad de la acetilcolinesterasa eritrocitaria (AChE). Se puede concluir que la exposición a pesticidas puede desencadenar enfermedades cardiovasculares agudas y crónicas, como elevación de las cifras de presión arterial, IAM fatal y no fatal. Los pesticidas dimetil ditiocarbamato de zinc, clorpirifós, coumafós, carbofurano, paratión y malatión son las sustancias que tienen mayor relación con el desarrollo de enfermedad cardiovascular.

Abstract Farmworkers are frequently exposed to pesticides, which can affect the cardiovascular system. The objective of the research was to review the association between occupational exposure to pesticides and the development of cardiovascular diseases, and the biomarkers used in monitoring the health of workers. For this, a non-systematic review of the literature was carried out in three databases: Pubmed, Embase and Scopus, with search equations prepared with the terms "agrochemicals", "myocardial infarction", "occupational exposure" and "farmers". Articles published between 2007 and 2022 were included. Pesticides were found to cause elevated blood pressure levels in exposed workers, and in pregnant women it is related to gestational hypertension and preeclampsia. Regarding acute myocardial infarction (AMI), contact the pesticides chlorpyrifos, coumaphos, carbofuran, pendimethalin, trifluralin, and acylalanine increased the risk of AMI in women, and among male workers exposure to ethylene dibromide, maneb/mancozeb, and zinc dimethyldithiocarbamate was associated with increased mortality. Epidemiological surveillance is mainly carried out by measuring erythrocyte acetylcholinesterase (AChE) activity. It can be concluded that exposure to pesticides can trigger acute and chronic cardiovascular diseases, such as elevated blood pressure, fatal and non-fatal AMI. Zinc dimethyl dithiocarbamate, chlorpyrifos, coumafos, carbofuran, parathion and malathion pesticides are the substances most closely related to the development of cardiovascular disease.

Abstract Objective Child sexual violence is a multidimensional problem of many contemporary societies, affecting people of all sexes, social stratum and age groups. Offenses involving children and adolescents are more serious, given their total or partial dependence on parents and caregivers. Information on child sexual violence in Brazil is found in raw form and without detail. The objective was to compare the information with social and economic data in the state of Paraná. Methods The authors conducted a retrospective study of secondary data from the Notifiable Diseases Information System (SINAN) on cases of sexual violence involving victims aged 0 to 19 years. Results are presented according to notification characteristics. The authors applied exploratory spatial data analysis to assess spatial autocorrelations and investigated relationships by the ordinary least squares regression model. Results Between 2017 and 2021, there were 13,403 reports of child sexual violence in Paraná State, Brazil. Most victims (82.8%) were female and aged between 10 and 14 years. The majority of sexual violence cases (67.8%) occurred in the home environment. The highest rates on a population basis were observed in the North Central and Greater Curitiba regions, mainly in cities with higher population density and with higher rates of other types of violence. Conclusion The results provide data that can promote a broader understanding of the distribution of sexual violence and the state and associated variations. It is expected to improve the provision of care for victims of child sexual violence and assist in strategic planning to prevent future offenses. societies sexes groups serious caregivers detail SINAN (SINAN 1 years characteristics model 201 2021 13403 13 403 13,40 State 82.8% 828 82 8 (82.8% 67.8% 678 67 (67.8% environment regions variations offenses 20 202 1340 40 13,4 82.8 (82.8 67.8 6 (67.8 2 134 4 13, 82. (82. 67. (67. (82 (67 (8 (6 (

A vigilância em saúde, como vigilância de agravos e doenças, tem um escopo bastante amplo. Discutiremos aqui a face mais conhecida, que é a vigilância de doenças transmissíveis, e assumiremos como mote a pandemia causada pelo vírus SARS-CoV-2. No desenvolvimento do texto, a abordagem se amplia para uma reflexão sobre tecnologias, modelo e organização do sistema. A mais grave epidemia de nossa época, classificada como pandemia, por atingir simultaneamente todo o planeta, tem obrigado a reflexões que envolvem múltiplos campos do conhecimento. O sofrimento decorrente deve inibir a tentação de associá-la a qualquer imagem positiva, ainda que tenha havido oportunidade para aprender e, em algumas circunstâncias, testemunhar a capacidade humana de agir solidariamente. Poucas coisas são tão didáticas como tragédias e erros. Cabe explorá-los cuidadosamente e extrair a necessária retroalimentação para corrigir rumos da atuação em saúde. Neste texto, trataremos das condições que levaram a vigilância em saúde no Brasil a falhar fragorosamente em sua missão frente à emergência desencadeada pela doença do novo coronavírus 2019 e levantaremos pontos que merecem atenção em uma reestruturação do sistema de vigilância em saúde.

The term "health surveillance" encompasses a wide range of activities, including the monitoring and observation of illnesses and diseases. In this section, we will examine the most well-known aspect of health surveillance, namely the monitoring of communicable diseases. To illustrate our discussion, we will use the ongoing pandemic caused by the SARS-CoV-2 virus as a case study. As the text progresses, the focus shifts to an examination of technologies, models, and the structure of the system. The most severe epidemic of our era, classified as a pandemic due to its global impact, has compelled us to reflect on a multitude of disciplines. The resulting suffering should preclude any association with positive images, despite the opportunity to learn and, in some instances, observe the capacity of humans to act in solidarity. It is often observed that few things are as didactic as tragedies and mistakes. It is therefore important to explore them carefully to extract the necessary feedback to correct the course of action in health. In this text, we will discuss the conditions that led health surveillance in Brazil to fail miserably in its mission in the face of the emergency triggered by the novel coronavirus disease 2019. We will also present points that deserve attention in a restructuring of the health surveillance system.

Abstract The purpose of this text is to carry out as analysis of the decisions issued in the second instance involving family members of prisoners, focusing on the Courts of Justice of Minas Gerais, São Paulo and Rio de Janeiro. Decisions published between 1998 and 2021 were collected in the three locations, forming a database, that was scrutinized in a quantitative perspective. Based on this, it was possible to notice that the judicial processes have two main focuses: requests related to the excess term of provisional detention and requests related to difficulties in visiting prisons. In the first point, the importance of families in the persecution of the rights of the inmates is clear. The decisions of the three courts on the matter differ substantially, and the claim is only effective in many cases in Rio de Janeiro. On the second point, there is an indication of how imprisonment goes beyond the person of the prisoner to reach their loved ones. In these cases, the decisions of the three courts have contributed to the transformation of family members of prisoners, especially women, into criminals, authorizing the constant surveillance of their bodies, in addition to the denial or hardening to maintain the bonds of affection between these and their prisoners. prisoners Gerais Janeiro 199 202 locations database perspective focuses prisons point clear substantially ones women criminals bodies 19 20 1 2

Resumo A proposta deste texto é analisar as decisões proferidas em segunda instância que envolvem familiares de presos, com foco nos Tribunais de Justiça de Minas Gerais, São Paulo e Rio de Janeiro. Foram coletados acórdãos publicados entre 1998 e 2021 nas três localidades, formando uma base de dados, escrutinada posteriormente numa perspectiva quantitativa. Foi possível notar que os processos judiciais têm dois focos principais: pedidos relacionados ao excesso de prazo da prisão provisória e pedidos relacionados às dificuldades na visitação em unidades prisionais. No primeiro ponto, fica clara a importância das famílias na busca de concretização dos direitos dos custodiados. As decisões dos três tribunais sobre a questão divergem substantivamente, sendo que o pleito só se efetiva em muitos casos no Rio de Janeiro. Já sobre o segundo ponto, tem-se um indicativo de como o aprisionamento ultrapassa a pessoa do preso para atingir seus entes queridos. Nesses casos, as decisões das três corte têm contribuído para a transformação, sobretudo, de familiares de presos, em especial mulheres, em criminosas, autorizando a vigilância constante de seus corpos, e dificultado a manutenção dos vínculos de afeto entre essas e seus entes presos. presos Gerais Janeiro 199 202 localidades dados quantitativa principais prisionais ponto custodiados substantivamente temse tem queridos transformação sobretudo mulheres criminosas corpos 19 20 1 2

Abstract This investigation uses the method of decision analysis to analyze the positioning of the Sergipe Court of Justice, between 2020 and 2022, about the refusal of companies that offer transportation service via app to effect or cancel to remain in their registry with drivers who respond to criminal proceedings without final and unappealable decisions. The analysis of the decisions is based on some strategic theoretical frameworks, as based on the concepts of sacrificial citizenship and the economization of law, neoliberalism as a rationality and a deep process, and capitalism as surveillance. As a result, it was identified that the TJSE prioritized the contractual autonomy, the freedom to guide objective safety criteria, the misalignment of drivers with the Term and Conditions for use over the principles of the presumption of innocence and the social function of the contract. To problematize this scenario, the article also questions about the (un)protection of workers' personal data by app, the lack of transparency in the use of new technologies to collect data regarding ongoing criminal cases as a way to reiterate old social or labor exclusions. Finally, it concludes on the approximation of the grounds handled by the Sergipe Court of Justice with the new economic demands of neoliberal management, such as the reduction of the constitutional pact in favor of corporate autonomy, both on the disposability of subjects and on the irregular capture of their personal data. 202 2022 frameworks law process surveillance result autonomy criteria contract scenario unprotection un protection workers exclusions Finally management 20 2

Resumo Esta investigação utiliza o método de análises de decisões para examinar o posicionamento do Tribunal de Justiça de Sergipe, entre 2020 e 2022, sobre a recusa das empresas que oferecem o serviço de transporte via aplicativo de efetivar ou de permanecer em seu cadastro com motoristas que respondem a processos criminais sem decisões transitadas em julgado. A análise das decisões parte de alguns marcos teóricos estratégicos, como o conceito de cidadania sacrificial e da economicização do direito, do neoliberalismo enquanto uma racionalidade e um processo profundo, do capitalismo como vigilância. Como resultado, identificou-se que o TJSE priorizou a autonomia contratual, a liberdade para pautar critérios objetivos de segurança, o desalinhamento dos motoristas com o Termo e as Condições para uso em detrimento dos princípios da presunção de inocência e da função social do contrato. Para problematizar este cenário o artigo ainda questiona sobre a (des)proteção dos dados pessoais dos trabalhadores por aplicativo, a falta de transparência na utilização de novas tecnologias para coletar dados referentes a processos criminais em andamento como forma de reiterar velhas exclusões sociais ou laborais. Por fim, conclui-se sobre a aproximação dos fundamentos manejados pelo Tribunal de Justiça de Sergipe com as novas exigências econômicas da gestão neoliberal, tal como a redução do pacto constitucional em benefício da autonomia empresarial, tanto sobre a descartabilidade dos sujeitos, como sobre a captação irregular de seus dados pessoais. 202 2022 julgado estratégicos direito profundo vigilância resultado identificouse identificou se contratual segurança contrato desproteção des proteção laborais fim concluise conclui neoliberal empresarial sujeitos 20 2

Resumo Nas últimas décadas, uma epidemia de doença renal crônica (DRC) tem sido associada a fatores ambientais e ocupacionais (estresse térmico decorrente de cargas de trabalho elevadas em altas temperaturas e exposição a produtos químicos, como agrotóxicos e metais), denominada DRC de origem não tradicional (DRCnt). Esta revisão descritiva tem como objetivo apresentar evidências recentes sobre estresse térmico, agrotóxicos e metais como possíveis causas de DRCnt e fornecer uma visão geral das estratégias brasileiras de regulamentação, fiscalização e vigilância sanitária relacionadas. Os trabalhadores brasileiros são comumente expostos a condições extremas de calor e outros fatores de risco de DRCnt, incluindo o aumento da exposição a agrotóxicos e metais. Além disso, há uma falta de regulamentação e fiscalização, políticas públicas e estratégias adequadas para proteger a saúde renal dos trabalhadores em relação aos principais fatores de risco. É provável que a DRCnt seja uma causa significativa de DRC no Brasil, uma vez que a etiologia da doença é desconhecida em muitos pacientes e diversas condições para seu desenvolvimento estão presentes no país. Estudos epidemiológicos devem ser realizados para explorar associações causais e estimar o impacto do calor, dos agrotóxicos e dos metais na DRCnt no Brasil. Além disso, as políticas públicas devem priorizar a redução da exposição dos trabalhadores e a promoção de sua saúde e segurança. décadas (DRC químicos metais, , metais) DRCnt. . (DRCnt) relacionadas disso Brasil país segurança (DRCnt

Abstract In the past decades, an epidemic of chronic kidney disease (CKD) has been associated with environmental and occupational factors (heat stress from high workloads in hot temperatures and exposure to chemicals, such as pesticides and metals), which has been termed CKD of non-traditional origin (CKDnt). This descriptive review aims to present recent evidence about heat stress, pesticides, and metals as possible causes of CKDnt and provide an overview of the related Brazilian regulation, enforcement, and health surveillance strategies. Brazilian workers are commonly exposed to extreme heat conditions and other CKDnt risk factors, including increasing exposure to pesticides and metals. Furthermore, there is a lack of adequate regulation (and enforcement), public policies, and strategies to protect the kidney health of workers, considering the main risk factors. CKDnt is likely to be a significant cause of CKD in Brazil, since CKD’s etiology is unknown in many patients and several conditions for its development are present in the country. Further epidemiological studies may be conducted to explore causal associations and estimate the impact of heat, pesticides, and metals on CKDnt in Brazil. Moreover, public policies should prioritize reducing workers´ exposure and promoting their health and safety. decades (CKD chemicals metals, , metals) nontraditional non traditional CKDnt. . (CKDnt) enforcement Furthermore enforcement) Brazil CKDs s country Moreover safety (CKDnt

ABSTRACT In order to describe the incidence rates per 100 000 population of foodborne disease (FBD) cases during the period 2015-2020 in Ecuador, we carried out a secondary analysis of epidemiological surveillance records and population projections from the National Institute of Statistics and Census. A total of 113,695 cases were reported with an incidence of more than 100 cases per 100 000 population (2015-2019). In 2020, the records are considerably lower than those reported in previous years. Most cases were reported as “other food poisoning”. The highest incidence rates of FBD were found in the Amazon region. In general, there is a marked annual variability in the incidence of FBD according to the geographic regions of Ecuador. In conclusion, FBD represent a public health problem in Ecuador. Comprehensive preventive strategies should be designed with special emphasis on the Amazon region.

RESUMEN Con el objetivo de describir las tasas de incidencia por cada 100 000 habitantes de los casos de enfermedades transmitidas por alimentos (ETA) durante el periodo 2015-2020 en Ecuador se realizó un análisis secundario de los registros de vigilancia epidemiológica y de las proyecciones poblacionales del Instituto Nacional de Estadística y Censos. Se reportaron 113 695 casos con una incidencia superior a los 100 casos por cada 100 000 habitantes (2015-2019). En el 2020 los registros son considerablemente inferiores a los reportes de años anteriores. La mayoría de los casos se reportaron como «otras intoxicaciones alimentarias». Las tasas de incidencia de ETA más altas se observaron en la región amazónica. En general existe una marcada variabilidad anual en la incidencia de las ETA según las regiones geográficas del Ecuador. En conclusión, las ETA representan un problema de salud pública en el Ecuador. Se deben diseñar estrategias preventivas integrales con especial énfasis en la región amazónica.

Abstract Introduction. The new era of surgery is increasingly dependent on technology, and an example of this is the widespread use of electrocautery as a primary part of surgical practice. Surgical smoke is a byproduct of the dissection and coagulation of tissues produced by energy equipment, which represents multiple potential health risks for the surgical group; however, the dangers caused by cumulative exposure have been minimized. Methods. A critical analysis was carried out from a reflective position of the available information, establishing the possible risks related to exposure to surgical smoke. Discussion. The imperative need to establish national normative guidelines and standardized recommendations to comply with the demands given by the occupational health and work safety management systems, whose main objective is to make effective the use of appropriate surgical masks, implementation of environmental epidemiological surveillance program in the operating room, prioritizing the constant use of vacuum cleaners and evacuation systems, and carrying out educational awareness programs aimed at the personnel involved. Likewise, there is concern about the need for new studies to more precisely define the danger of this aerosol. Conclusion. It is recommended to responsibly use all existing preventive strategies to intervene in operating rooms to minimize the forgotten risks of surgical smoke.

Resumen Introducción. La nueva era de la cirugía es cada vez más dependiente de la tecnología, y un ejemplo de ello es el uso generalizado de electrocauterio como parte primordial de la práctica quirúrgica. El humo quirúrgico es un subproducto de la disección y la coagulación de los tejidos producidas por los equipos de energía, que representa múltiples riesgos potenciales para la salud del grupo quirúrgico, sin embargo, se han minimizado los peligros causados por la exposición de manera frecuente y acumulativa a este aerosol. Métodos. Se realizó un análisis crítico, desde una posición reflexiva de la información disponible, estableciendo los posibles riesgos relacionados con la exposición al humo quirúrgico. Discusión. Es visible la necesidad imperativa de establecer directrices nacionales, pautas normativas y recomendaciones estandarizadas para cumplir con las exigencias dadas por los sistemas de gestión en salud ocupacional y seguridad del trabajo, cuyo objetivo principal es hacer efectivo el uso de mascarillas quirúrgicas apropiadas, la implementación de programa de vigilancia epidemiológica ambiental en sala de cirugía, la priorización del uso constante de aspiradores y sistemas de evacuación, y la ejecución de programas educativos de sensibilización dirigidos al personal implicado. De igual manera, se abre la inquietud de la necesidad de nuevos estudios para definir con mayor precisión el peligro de este aerosol. Conclusión. Se recomienda de manera responsable utilizar todas las estrategias preventivas existentes para intervenir en salas de cirugía los riesgos minimizados y olvidados del humo quirúrgico.

Abstract Introduction: The COVID-19 pandemic has posed challenges to entities responsible for qualifying healthcare professionals worldwide, needing adaptation to offer distance learning courses in the face of implications such as social distancing. However, despite these courses, there are still gaps in understanding their effects. Objective: To analyse the feeling of professional managers on the effects of a distance learning course, implemented for the development of public health competencies during the COVID-19 pandemic. Methodology: Qualitative research based on data collected from the virtual course environment, which included responses to a question posed to manager-professionals one month after completion: "Which tasks do you routinely perform that have undergone any modification due to your participation in the course?" Data analysis used Descending Hierarchical Classification with the aid of the IRAMUTEQ® software, focusing on Simple Segments of Text (SST). SSTs were classified based on their respective vocabularies of higher frequency and words with significant association (p<0.001). Finally, the software produced a dendrogram illustrating the hierarchical class scheme. Results: 256 responses were processed with a utilization rate of 76.3% of SSTs, resulting in a dendrogram with four classes, revealing modifications in (1) Execution of daily work tasks; (2) Expansion of knowledge about work in the Unified Health System; (3) Coordination between areas for the development of actions in Public Health; (4) Support and guidance for health surveillance actions in collaboration with municipalities. Final Considerations: The use of IRAMUTEQ® software eased the processing and analysis of a large amount of qualitative data, yielding findings that showed significant changes in the professional practice of managers and, so, a positive impact on the development of public health competencies even during a pandemic.

Resumo Introdução: a pandemia COVID-19 trouxe desafios às instâncias responsáveis pela qualificação dos profissionais de saúde no mundo todo, que necessitaram se adaptar para oferta de cursos na modalidade à distância, frente às implicações impostas, como o distanciamento social. Entretanto, a despeito desses cursos, ainda persistem lacunas na produção de conhecimentos dos seus efeitos. Objetivo: analisar a percepção de profissionais-gestores sobre os efeitos de um curso na modalidade à distância, implementado para desenvolvimento de competências em saúde pública em tempos de pandemia COVID-19. Metodologia: pesquisa qualitativa realizada a partir de dados coletados do ambiente virtual do curso que, dentre outras informações, possuía respostas de uma pergunta realizada para os profissionais-gestores um mês após a sua conclusão: quais tarefas você executa habitualmente que sofreram algum tipo de modificação em consequência de sua participação no curso? A análise dos dados ocorreu por Classificação Hierárquica Descendente com auxílio do software IRAMUTEQ®, a partir de segmentos simples de texto (SST). Os SST foram classificados em função dos respectivos vocabulários de maior frequência e das palavras com associação significativa (p<0,001). Por fim, o software produziu um dendrograma com a ilustração do esquema hierárquico de classes. . Resultados: foram processadas 256 respostas com aproveitamento de 76,3% dos SST, que resultaram em um dendrograma de quatro classes, sendo possível constatar modificações na/o: (1) Execução de tarefas do cotidiano laboral; (2) Ampliação do conhecimento acerca do trabalho no Sistema Único de Saúde; (3) Articulação entre áreas para desenvolvimento das ações em Saúde Pública; (4) Apoio e orientações de ações de vigilância em saúde junto aos municípios. Considerações Finais: o uso do software IRAMUTEQ® facilitou o processamento e a análise de grande número de dados qualitativos. Destarte, foram obtidos achados que apontaram mudanças significativas na prática profissional dos gestores e, consequentemente, efeito positivo no desenvolvimento de competências.

RACIONAL: Identificação de fatores de risco epidemiológicos no esôfago de Barrett resultando em displasia e adenocarcinoma e seu impacto na prevenção e detecção precoce. OBJETIVOS: Avaliar fatores de risco epidemiológicos envolvidos no desenvolvimento de displasia e adenocarcinoma a partir do Barrett em população específica. Realizar análise crítica do período de vigilância, objetivando individualizar o tempo de seguimento conforme riscos identificados. MÉTODOS: Estudo caso-controle retrospectivo em centro terciário com pacientes com esôfago de Barrett diagnosticados e seguidos neste centro. Pacientes com Barrett que apresentaram adenocarcinoma e/ou displasia foram comparados aos que não apresentaram, levando em consideração as variáveis sexo, idade, tabagismo, IMC, etnia e extensão do Barrett. Posteriormente, foi realizada regressão logística para mensuração da razão de chances entre fatores de risco para o desfecho adenocarcinoma e desfecho displasia. Foi correlacionada a presença de fatores epidemiológicos de risco nessa população com o tempo de desenvolvimento de adenocarcinoma a partir da metaplasia. RESULTADOS: Houve diferença estatisticamente significante entre as variáveis tabagismo, raça, sexo, extensão do Barrett e idade no grupo com adenocarcinoma em relação ao sem adenocarcinoma; tabagistas e ex-tabagistas apresentaram risco 4,309 vezes maior de desenvolver adenocarcinoma; a extensão do Barrett aumentou o risco em 1,193 vezes a cada centímetro. No grupo com displasia, as variáveis tabagismo, extensão do Barrett e idade se mostraram significantes estatisticamente; extensão do Barrett aumentou 1,128 vezes a cada centímetro o risco de displasia e idade aumentou 1,023 a cada ano o risco desse desfecho. Pacientes sem fatores de risco não desenvolveram adenocarcinoma em menos de 12 meses, mesmo com displasia anteriormente. CONCLUSÕES: O estudo confirmou maior risco de desenvolver displasia e adenocarcinoma em grupos epidemiológicos específicos, podendo direcionar o seguimento em pacientes com Esôfago de Barrett de forma mais custo efetiva.

BACKGROUND: Identification of epidemiological risk factors in Barrett's esophagus resulting in dysplasia and adenocarcinoma and its impact on prevention and early detection. AIMS: To evaluate epidemiological risk factors involved in the development of dysplasia and adenocarcinoma from Barrett's esophagus in a specific population. To critically analyze the surveillance period, aiming to individualize follow-up time according to identified risks. METHODS: A retrospective case-control study in a tertiary center with patients diagnosed and followed up for Barrett's esophagus. Patients with Barrett's esophagus who developed adenocarcinoma and/or dysplasia were compared to those who did not, considering variables such as sex, age, smoking status, Body mass index, ethnicity, and Barrett's extension. Logistic regression was performed to measure the odds ratio between risk factors for the outcome of adenocarcinoma and of dysplasia. The presence of epidemiological risk factors in this population was correlated with the time to develop adenocarcinoma from metaplasia. RESULTS: There was a statistically significant difference between the variables smoking status, race, sex, Barrett's esophagus extension, and age in the group with adenocarcinoma compared to the group without adenocarcinoma; smokers and former smokers had a 4.309 times higher risk of developing adenocarcinoma; the extension of Barrett's esophagus increased the risk by 1.193 times for each centimeter. In dysplasia group, the variables smoking status, Barrett's extension, and age were statistically significant; the extension of Barrett's esophagus increased the risk of dysplasia by 1.128 times for each centimeter, and age increased the risk by 1.023 times for each year. Patients without risk factors did not develop adenocarcinoma within 12 months, even with prior dysplasia. CONCLUSIONS: The study confirmed a higher risk of developing dysplasia and adenocarcinoma in specific epidemiological groups, allowing for more cost-effective monitorization in patients with Barrett's esophagus.

Abstract School-age children (5-9 years) can benefit from educational interventions focused on healthy eating and physical activity to improve their quality of life. This work aims to review the evidence on food and nutrition education (FNE) in Spanish-speaking countries for the prevention of overweight and obesity in school-age children. There is a wide variety of experiences in FNE in Hispanic countries. The FNE interventions are effective in improving knowledge and attitudes towards healthy eating. Diagnosis, variable selection, and the design and validation of interventions and instruments are crucial. The frequency, duration and number of components of the interventions, as well as the participation of multiple actors such as parents, teachers, professors, and the school community, are key to greater effectiveness. Little impact is observed on nutritional status in educational interventions, which may be due to short execution periods. Food and nutritional surveillance systems in schools should consider cognitive and behavioral indicators to measure the effectiveness of FNE in the fight against overweight and obesity in schools. In conclusion, greater effectiveness of FNE is observed in knowledge and attitudes. Teacher training programs are required to implement innovative long-term FNE strategies in schools to combat obesity and prevent chronic diseases early in life, as well as robust monitoring and evaluation systems.

Resumen Los niños de edad escolar (NEE) pueden beneficiarse de intervenciones educativas centradas en alimentación saludable y actividad física para mejorar su calidad de vida. Este trabajo tiene como objetivo revisar la evidencia sobre educación alimentaria y nutricional (EAN) en países de habla hispana para la prevención del sobrepeso y la obesidad en NEE. Existe una amplia variedad de experiencias en EAN en países hispanos. Las intervenciones son efectivas para mejorar conocimiento y actitud hacia la alimentación saludable. El diagnóstico, selección de variables a intervenir, el diseño de intervenciones y de instrumentos válidos son clave. La frecuencia, duración y el número de componentes de las intervenciones son clave para mayor efectividad en las intervenciones, así como la participación de múltiples actores como padres, maestros, profesores y la comunidad escolar. Se observa poco impacto sobre el estado nutricional en las intervenciones educativas. Sin embargo, esto puede deberse a cortos periodos de ejecución. Los sistemas de vigilancia alimentarios y nutricionales en las escuelas deben considerar indicadores cognitivos y conductuales para medir la eficacia de las intervenciones EAN en el marco de la lucha contra el sobrepeso y la obesidad en las escuelas. En conclusión, se observa una mayor efectividad de las intervenciones EAN en el conocimiento y la actitud. Se requieren programas de capacitación docente para implementar estrategias innovadoras de EAN en las escuelas de largo plazo para combatir la obesidad y prevenir las enfermedades crónicas desde temprano en la vida; así como de robustos sistemas de seguimiento y evaluación.

ABSTRACT Toxic cyanobacteria blooms are an increasingly common global problem due to eutrophication, the effects of climate change and increased surveillance efforts in aquatic ecosystems. In Cuba, several ecosystems have been analyzed in the eastern region, demonstrating that this risk occurs to surface and inland waters, due to climatic conditions, mainly in small ecosystems with great human pressures. However, other areas are still unexplored. The objective of this work was to implement a risk management protocol in the San Blas Lagoon, Camaguey, due to the presence of toxic cyanobacteria in the ecosystem, following a community report, with the death of domestic and wild animals; unpleasant odors and dermatological symptoms in humans. A management protocol and community actions were implemented to minimize the impact of toxic cyanobacteria. In this small eutrophic reservoir, the presence of a mixed bloom of toxigenic cyanobacteria was confirmed, being Spherospermopsis torques-reginae the majority, as well as other nine species associated with the production of microcystins, anatoxins and/or cylindrospermopsins were identified. Strategic actions were implemented to contain the risk situation, with the participation of the community and experts, led by the Camagüey Criminalistics Laboratory.

RESUMEN Las floraciones de cianobacterias tóxicas constituyen un problema global cada vez más frecuente, debido a la eutrofización, los efectos del cambio climático y a un mayor esfuerzo de vigilancia en los ecosistemas acuáticos. En Cuba se han muestreado varios ecosistemas en la región oriental, demostrando que este riesgo existe en aguas superficiales e interiores, debido a las condiciones climáticas, principalmente en pequeños ecosistemas con grandes presiones humanas. Sin embargo, otras zonas están aún inexploradas. El objetivo de este trabajo fue implementar un protocolo de gestión de riesgos en la Laguna San Blas, debido a la presencia de cianobacterias tóxicas en el ecosistema, a raíz de un reporte comunitario, con muerte de animales domésticos y silvestres; olor desagradable y síntomas dermatológicos en humanos. Se implementó un protocolo de gestión y acciones comunitarias para minimizar el impacto de las cianobacterias tóxicas. En este pequeño reservorio eutrófico se confirmó la presencia de una floración mixta de cianobacterias toxigénicas, siendo mayoritaria Spherospermopsis torques-reginae, identificándose otras nueve especies asociadas a la producción de microcistinas, anatoxinas y/o cilindrospermopsinas. Se implementaron acciones estratégicas para contener la situación de riesgo, con la participación de la comunidad y expertos, liderados por el Laboratorio de Criminalística de Camagüey.

RESUMEN Introducción: La Vigilancia Centinela de las Infecciones Respiratorias Agudas Graves (IRAG) incluye el monitoreo y caracterización de casos hospitalizados. Objetivo: Describir las características clínico-epidemiológicas y agentes etiológicos de los adultos con IRAG en un hospital centinela en Paraguay. Metodología: Estudio observacional, descriptivo, de corte transversal, con recolección de datos retrospectivos de los pacientes adultos con IRAG hospitalizados en el Hospital Nacional de Itauguá entre junio de 2022 a agosto de 2023. La información se tomó de la base de datos del Sistema Nacional de Vigilancia Epidemiológica. Resultados: Se analizaron los datos de 1598 pacientes con IRAG, 820 varones (51,3%), 875 (54,8%) con 60 o más años, 1054 (66,0%) del departamento Central. El 79.2% (n=1265) de los pacientes presentaba algún factor de riesgo de gravedad o comorbilidad, 764 (47,8%) con hipertensión arterial. El 38.5% (n=632) fue admitido a UCI y la mortalidad fue de 34,7% (n=554). En el 13,8% (n=353) se confirmó SARSCoV-2, rhinovirus (1,7%), influenza A (1,5%), influenza B (0,6%), parainfluenza 3 (0,6%), VSR (0,2%), bocavirus (0,4%) e influenza AH1N1 (0,6%). Hubo significativamente mayor frecuencia de fallecidos en los de 60 años y más (40,7%), con algún factor de riesgo de gravedad (35,5% vs 25,9%) y en los confirmados con COVID-19 (38,2% vs 30,5%). Discusión: SARSCoV-2 sigue siendo el agente etiológico principal de las IRAG. El conocimiento de la epidemiología y los agentes virales es crucial para desarrollar estrategias de prevención y terapéuticas efectivas.

ABSTRACT Introduction: Sentinel Surveillance of Severe Acute Respiratory Infections (SARI) includes the monitoring and characterization of hospitalized cases. Objective: To describe the clinical-epidemiological characteristics and etiological agents of adults with SARI in a sentinel hospital in Paraguay. Methodology: Observational, descriptive, cross-sectional study, with retrospective data collection, of adult patients with SARI hospitalized at the National Hospital of Itauguá between June 2022 and August 2023. The information was taken from the database of the National System of Epidemiological surveillance. Results: The data of 1598 patients with SARI were analyzed, 820 men (51.3%), 875 (54.8%) aged 60 or older, 1054 (66.0%) from the Central department. 79.2% (n=1265) of patients had some risk factor or comorbidity, 764 with hypertension (47.8%). 38.5% (n=632) were admitted to the ICU and mortality was 34.7% (n=554). SARSCoV-2 was confirmed in 13.8% (n=353), rhinovirus (1.7%), influenza A (1.5%), influenza B (0.6%), parainfluenza 3 (0.6%), RSV (0.2%), bocavirus (0.4%) and Influenza AH1N1 (0.6%). There was a significantly higher frequency of deaths in those aged 60 years and over (40.7%), with some risk factor (35.5% vs 25.9%), and in those confirmed with covid-19 (38.2% % vs 30.5%). Discussion: SARSCoV-2 continues to be the main etiological agent of SARI in a sentinel hospital in Paraguay. Continued knowledge of the epidemiology and viral agents involved is crucial to developing effective prevention and treatment strategies.