ABSTRACT Education can act as a transforming factor in health practice by promoting meetings between subjects, from care to management. By mediating the reality of care, the manager becomes part of the space where health and education are produced, enabling learning and the joint construction of answers to the problems inherent in the work routine. With the aim of analyzing managers’ perspectives on a proposal for permanent health education in palliative care to train physicians and nurses in primary care, a qualitative action research project was carried out in primary care in the Médio Paraíba region of the state of Rio de Janeiro. Through the analysis of semi-structured interviews, conducted with eight managers and the representative of the Education-Service Integration Commission of the health region, four thematic dimensions emerged: needs, applicability, healthcare team, and access. It was identified that the educational proposal developed, by combining continuing health education and palliative care, allowed management to envision a dynamic strategy capable of transforming primary care service practices. Involving management expanded the scope of the proposed model, enhancing its adoption not only at the local level, but also as an integrated part of the healthcare network. subjects produced routine Janeiro semistructured semi structured interviews EducationService Service emerged needs applicability team access developed practices model level network

RESUMO A educação pode agir como um fator transformador da prática de saúde ao promover encontros de sujeitos, da assistência à gestão. Ao intermediar a realidade assistencial, o gestor passa a integrar o espaço onde se produz saúde e educação, permitindo o aprendizado e a construção conjunta de respostas aos problemas inerentes à rotina de trabalho. Com objetivo de analisar a perspectiva dos gestores acerca de uma proposta de educação permanente em cuidado paliativo para capacitação de médicos e enfermeiros da Atenção Primária à Saúde, foi realizada uma pesquisa-ação, com abordagem qualitativa, na atenção primária da região Médio Paraíba do estado do Rio de Janeiro. Através da análise das entrevistas semiestruturadas, realizadas com oito gestoras e a representante da Comissão de Integração Ensino-Serviço da região de saúde, emergiram quatro dimensões temáticas: necessidades, aplicabilidade, equipe de saúde e acesso. Identificou-se que a proposta educacional elaborada, ao agregar educação permanente em saúde e cuidado paliativo, possibilitou à gestão vislumbrar uma estratégia dinâmica e capaz de transformar as práticas de serviço da atenção primária. Envolver a gestão ampliou o escopo do modelo proposto, potencializando sua apropriação não só no nível local, mas de forma integrada à rede de atenção à saúde. sujeitos assistencial trabalho Saúde pesquisaação, pesquisaação pesquisa ação, ação pesquisa-ação qualitativa Janeiro semiestruturadas EnsinoServiço Ensino Serviço temáticas necessidades aplicabilidade acesso Identificouse Identificou elaborada proposto local

ABSTRACT Education can act as a transforming factor in health practice by promoting meetings between subjects, from care to management. By mediating the reality of care, the manager becomes part of the space where health and education are produced, enabling learning and the joint construction of answers to the problems inherent in the work routine. With the aim of analyzing managers’ perspectives on a proposal for permanent health education in palliative care to train physicians and nurses in primary care, a qualitative action research project was carried out in primary care in the Médio Paraíba region of the state of Rio de Janeiro. Through the analysis of semi-structured interviews, conducted with eight managers and the representative of the Education-Service Integration Commission of the health region, four thematic dimensions emerged: needs, applicability, healthcare team, and access. It was identified that the educational proposal developed, by combining continuing health education and palliative care, allowed management to envision a dynamic strategy capable of transforming primary care service practices. Involving management expanded the scope of the proposed model, enhancing its adoption not only at the local level, but also as an integrated part of the healthcare network.

RESUMO A educação pode agir como um fator transformador da prática de saúde ao promover encontros de sujeitos, da assistência à gestão. Ao intermediar a realidade assistencial, o gestor passa a integrar o espaço onde se produz saúde e educação, permitindo o aprendizado e a construção conjunta de respostas aos problemas inerentes à rotina de trabalho. Com objetivo de analisar a perspectiva dos gestores acerca de uma proposta de educação permanente em cuidado paliativo para capacitação de médicos e enfermeiros da Atenção Primária à Saúde, foi realizada uma pesquisa-ação, com abordagem qualitativa, na atenção primária da região Médio Paraíba do estado do Rio de Janeiro. Através da análise das entrevistas semiestruturadas, realizadas com oito gestoras e a representante da Comissão de Integração Ensino-Serviço da região de saúde, emergiram quatro dimensões temáticas: necessidades, aplicabilidade, equipe de saúde e acesso. Identificou-se que a proposta educacional elaborada, ao agregar educação permanente em saúde e cuidado paliativo, possibilitou à gestão vislumbrar uma estratégia dinâmica e capaz de transformar as práticas de serviço da atenção primária. Envolver a gestão ampliou o escopo do modelo proposto, potencializando sua apropriação não só no nível local, mas de forma integrada à rede de atenção à saúde.

The blood flukes of mammals (Digenea: Schistosomatidae) are among trematodes unique whose adult worms have separeted sexes which are dissimilar in appearance. The developmental features, growth and organogenesis of Schistosoma mansoni were studied in Swiss Webster mice by a digital system for image analysis and confocal microscopy. Data so far obtained showed two phases with significative morphological changes at 3-4 weeks post-infection, and a gradual similar development onwards in the reproductive system and tegument. Our male-dependent phase demonstrated that mating occurs before sexual maturing. At week three, the majority of male worms (59%) had formed the gynaecophoric canal although testicular lobes and tegumental tubercles were absent. By this time, 33% females had an incipient ovary (without cellular differentiation). At week four, 77.2% males presented testicular lobes with few germinative cells while 26% had developing tegumental tubercles. The immature ovary was observed in 69% females. Suckers followed different pattern of growth between male and females. The size of oral and ventral suckers from six-week-old male worms grew abruptly (3.0 fold) more than that of three-week-old. In female worms, maximum growth was attained at week four, reducing in size thereafter. From sixth week onwards, all specimens showed the fully developed reproductive system. Probably, these features are morphological traits which schistosome has experienced from hermaphrodite to dioecy.

Schistosoma mansoni adult worms with genital anomalies isolated from Nectomys squamipes (Muridae: Sigmodontinae) were studied by confocal laser scanning microscopy under the reflected mode. One male without testicular lobes (testicular agenesia/anorchism) and two females, one with an atrophied ovary and another with 17 uterine eggs, were identified. The absence of testicular lobes occurred in a worm presenting otherwise normal male adult characteristics: tegument, tubercles and a gynaecophoric canal with spines. In both female specimens the digestive tube showed a vacuolated appearance, and the specimen with supernumerary uterine eggs exhibited a developing miracidium and an egg with a formed shell. The area of the ventral sucker was similar in both specimens however the tegument thickness, ovary and vitelline glands of the specimen with the atrophied ovary were smaller than those of the one with supernumerary eggs. These reported anomalies in the reproductive system call attention to the need to improve our understanding of genetic regulation and the possible role of environmental influences upon trematode development.