Abstract We investigated the Biogran on bone repair and metabolism at several time-intervals upon grafting into rat tibia artificial defects. The biomaterial was thoroughly characterized in vitro, and its dissolution behavior upon immersion was assessed in simulated body fluid (SBF) solution for 1, 3, 7, 14, and 30 days. Biogran was also assessed by in vitro hydroxyapatite formation in SBF solution, which is a marker for bioactive behavior. In vivo, distal and proximal bone defects were performed in the Wistar rat's right tibia and filled according to the experimental groups: I) negative control, no filling; II) positive control, 10 mg of autogenous bone; and III) 10 mg of Biogran. Animals were euthanized at 1, 2, 3, 4, 7, and 10 weeks. Bone neoformation was analyzed using histomorphometry (proximal defect), and local levels of bone morphogenetic protein 2 (BMP-2) were measured using the ELISA assay (distal defect). In vitro, the Biogran sample showed a fast dissolution rate within the first 7 days, parallel to the formation of the hydroxyapatite layer. In vivo, the sample was progressively resorbed at a higher rate within the first month until it became almost absent at week 10th. The sample presented similar or higher bone neoformation concerning the autogenous bone. BMP-2 levels were sustained in the Biogran group (around 200 pg/mg) and detected until the last experimental time with a significant difference compared with the controls. Results suggest Biogran is a candidate for hard tissue engineering even in highly active bone remodeling sites. timeintervals intervals (SBF 1 3 14 days vivo rats s groups I control filling II III 4 weeks defect, defect , defect) BMP2 BMP (BMP-2 defect. . layer 10th th BMP- around 20 pg/mg pgmg pg controls sites (BMP- (BMP

Generalized anxiety disorder is a highly prevalent mental disorder. Previous data indicate that more than 18 million Brazilians suffer from this condition. Traditionally, generalized anxiety disorder has been considered a mild mental health disorder, despite its links to lower life expectancy, cardiovascular disease, and suicide. The aim of this article is to combine elements of systematic and critical reviews to produce a synthesis of the best evidence about generalized anxiety disorder treatment. Systematic reviews, meta-analyses, and randomized controlled trials were included. The descriptor used in the search was “generalized anxiety disorder,” which resulted in 4,860 articles and seven other studies, of which 59 were selected. Antidepressants and benzodiazepines were indicated, as was pregabalin, and atypical antipsychotics, such as quetiapine, have been studied. Individual cognitive behavior therapy (third wave) has proven effective. There is extensive literature on many effective treatments for generalized anxiety disorder. The present review summarizes the therapeutic possibilities, emphasizing those available in Brazil. Further studies are needed to compare other available medications, assess psychotherapies and new treatments in greater depth, as well as to assess the ideal duration of therapy. Registration number: PROSPERO CRD42021288323. 1 condition Traditionally expectancy disease suicide treatment metaanalyses, metaanalyses meta analyses, analyses meta-analyses included 4860 4 860 4,86 5 selected indicated pregabalin antipsychotics quetiapine studied third wave possibilities Brazil medications depth number CRD42021288323 CRD 486 86 4,8 CRD4202128832 48 8 4, CRD420212883 CRD42021288 CRD4202128 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

Abstract Objective: To describe the health-related quality of life (QOL) in children with cerebral palsy (CP) associated with congenital Zika infection. Methods: Cross-sectional study of a consecutive series of children, followed in a referral multicentric rehabilitation network in Brazil. We invited the caregivers to respond to the Brazilian version of the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILDTM) questionnaire. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) 26.0™. We used absolute and relative frequencies for categorical variables and mean and standard deviation for continuous variables. Results: The sample consisted of 193 children, at mean age of 50.3±7.6 months. We observed a predominance of children with cerebral palsy (CP) with Gross Motor Function Classification System (GMFCS) level V (93.7%). Epilepsy (88.4%) was the most common comorbidity. CPCHILDTM mean scores were activities of daily living (ADL)/personal care 43.2±12.6; positioning, transferring and mobility 33.7±16.5; comfort and emotions 84.4±15.2; communication and social interaction (CoSI) 48.2±24.3; health 70.9±17.1; and overall quality of life (OQOL) 72.1±17.1. Total score was 54.8±11.3. Conclusions: Among children with cerebral palsy (CP) related to congenital Zika syndrome, the quality of life (QOL) scores were very similar to other populations with cerebral palsy (CP). The activities of positioning, transferring and mobility had the greatest impact on health-related quality of life (QOL). Rehabilitation strategies and public policies should prioritize aspects related to mobility for this population. Objective healthrelated QOL (QOL CP (CP infection Methods Crosssectional Cross sectional Brazil (CPCHILDTM questionnaire SPSS (SPSS 260 26 0 26.0™ Results 19 50376 50 3 7 6 50.3±7. months GMFCS (GMFCS 93.7%. 937 93.7% . 93 (93.7%) 88.4% 884 88 4 (88.4% comorbidity ADL/personal ADLpersonal ADL /personal personal 43.2±12.6 432126 43 2 12 positioning 33.7±16.5 337165 33 16 5 84.4±15.2 844152 84 15 CoSI (CoSI 48.2±24.3 482243 48 24 70.9±17.1 709171 70 9 17 1 OQOL (OQOL 721171 72 72.1±17.1 548113 54 8 11 54.8±11.3 Conclusions syndrome CP. QOL. population 26.0 5037 50.3±7 93.7 (93.7% 88.4 (88.4 43.2±12. 43212 33.7±16. 33716 84.4±15. 84415 48.2±24. 48224 70.9±17. 70917 72117 72.1±17. 54811 54.8±11. 26. 503 50.3± 93. (93.7 88. (88. 43.2±12 4321 33.7±16 3371 84.4±15 8441 48.2±24 4822 70.9±17 7091 7211 72.1±17 5481 54.8±11 50.3 (93. (88 43.2±1 432 33.7±1 337 84.4±1 844 48.2±2 482 70.9±1 709 721 72.1±1 548 54.8±1 50. (93 (8 43.2± 33.7± 84.4± 48.2± 70.9± 72.1± 54.8± (9 ( 43.2 33.7 84.4 48.2 70.9 72.1 54.8 43. 33. 84. 48. 70. 72. 54.

RESUMO Objetivo: Descrever a qualidade de vida relacionada à saúde em crianças com paralisia cerebral associada à infecção congênita pelo zika. Métodos: Estudo transversal de série consecutiva de casos de crianças acompanhadas em uma rede multicêntrica de reabilitação no Brasil. Convidamos o(s) cuidador(es) a responder à versão brasileira do Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILDTM). A análise estatística foi realizada com o pacote estatístico Statistical Package for the Social Sciences (SPSS) 26.0™. Para variáveis categóricas, foram utilizadas frequências absolutas e relativas e, para variáveis contínuas, média e desvio padrão. Resultados: Cento e noventa e três crianças, com idade média de 50,3±7,6 meses, foram incluídas. Observou-se predomínio de crianças com paralisia cerebral Gross Motor Function Classification System (GMFCS) nível V (93,7%). Epilepsia (88,4%) foi a comorbidade mais comum. As pontuações médias do CPCHILDTM foram: atividades de vida diária/cuidados pessoais 43,2±12,6; posicionamento, transferência e mobilidade 33,7±16,5; conforto e emoções 84,4±15,2; comunicação e interação social 48,2±24,3; saúde 70,9±17,1; e qualidade de vida geral 72,1±17,1. A pontuação total foi 54,8±11,3. Conclusões: Entre as crianças com paralisia cerebral relacionada à síndrome do zika congênita, as atividades de posicionamento, transferência e mobilidade tiveram maior impacto na qualidade de vida relacionada à saúde, semelhantemente a outras etiologias de paralisia cerebral. As estratégias de reabilitação e as políticas públicas devem priorizar os aspectos relacionados à mobilidade dessa população. Objetivo Métodos Brasil s o(s cuidadores cuidador es cuidador(es CPCHILDTM. . (CPCHILDTM) SPSS (SPSS 260 26 0 26.0™ categóricas contínuas padrão Resultados 50376 50 3 7 6 50,3±7, meses incluídas Observouse Observou se GMFCS (GMFCS 93,7%. 937 93,7% 93 (93,7%) 88,4% 884 88 4 (88,4% comum diáriacuidados diária cuidados 43,2±12,6 432126 43 2 12 posicionamento 33,7±16,5 337165 33 16 5 84,4±15,2 844152 84 15 48,2±24,3 482243 48 24 70,9±17,1 709171 70 9 17 1 721171 72 72,1±17,1 548113 54 8 11 54,8±11,3 Conclusões população (CPCHILDTM 26.0 5037 50,3±7 93,7 (93,7% 88,4 (88,4 43,2±12, 43212 33,7±16, 33716 84,4±15, 84415 48,2±24, 48224 70,9±17, 70917 72117 72,1±17, 54811 54,8±11, 26. 503 50,3± 93, (93,7 88, (88, 43,2±12 4321 33,7±16 3371 84,4±15 8441 48,2±24 4822 70,9±17 7091 7211 72,1±17 5481 54,8±11 50,3 (93, (88 43,2±1 432 33,7±1 337 84,4±1 844 48,2±2 482 70,9±1 709 721 72,1±1 548 54,8±1 50, (93 (8 43,2± 33,7± 84,4± 48,2± 70,9± 72,1± 54,8± (9 ( 43,2 33,7 84,4 48,2 70,9 72,1 54,8 43, 33, 84, 48, 70, 72, 54,

ABSTRACT The cement mass is the part of the cementitious composite that has low resistance to friction and its mechanical and microstructural properties are decisive for the durability of the material. Microscopy techniques are commonly used to elucidate these mechanical, physical and chemical behaviors of cementitious compounds. The objective of this work was to elucidate the importance of microscopy techniques for the direct evaluation of the abrasive behavior of cement pastes with silicon carbide (SiC) microparticles. The methodology of the work consists of the manufacture of Exceptions of reference cementitious masses and with 10% SiC addition, analysis of the compressive and abrasive mechanical properties, in addition to Scanning Electron Microscopy (SEM) and Atomic Force Microscopy (AFM) tests. The results that the intensification of the mechanical properties with the addition of SiC microparticles can be related to the external micrographs in the SEM, through the accentuated filling of the pores, and through the attenuated surface roughness identified in the AFM. It was concluded that the roughness and porosity results, acquired by the SEM and AFM techniques, can provide relevant information for the analysis of the durability of cementitious materials. material compounds (SiC 10 (SEM (AFM tests pores materials 1

RESUMO A pasta de cimento é a parte do compósito cimentício que possui baixa resistência ao atrito e suas propriedades mecânicas e microestruturais são determinantes para a durabilidade do material. As técnicas de microscopia são comumente utilizadas para elucidar esses comportamentos mecânicos, físicos e químicos de compósitos cimentícios. O objetivo deste trabalho foi elucidar a importância de técnicas de microscopia para avaliação direta do comportamento abrasivo de pastas de cimento com micropartículas de carbeto de silício (SiC). A metodologia do trabalho consistiu na fabricação das amostras de pastas cimentícias de referência e com 10% de adição de SiC, análise das propriedades mecânicas compressivas e abrasivas, além de ensaios de Microscopia Eletrônica de Varredura (MEV) e Microscopia de Força Atômica (MFA). Os resultados mostraram que a intensificação das propriedades mecânicas com adição de micropartículas de SiC podem ser relacionados com as micrografias obtidas no MEV, através do acentuado preenchimento dos poros, e por meio da atenuada rugosidade superficial identificada no MFA. Concluiu-se que os resultados de rugosidade e porosidade, adquiridos pelas técnicas de MEV e MFA, podem fornecer informações relevantes para análise da durabilidade de materiais cimentícios. material mecânicos cimentícios SiC. . (SiC) 10 abrasivas (MEV MFA (MFA) poros Concluiuse Concluiu se porosidade (SiC 1 (MFA

ABSTRACT The article analyzes aspects of the change in the legal nature of private healthcare from “for-profit” to “non-profit” entities. It is an exploratory research, supported by the policy analysis framework, focusing on secondary data from the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities – CNES) from 2012 to 2020 and a case study. The results show an increase in these entities in all regions of the country and evidence that they behave like profit-oriented entities. The change in legal nature hides a broader process of implicit commodification of healthcare services, encouraged by state policies and related to exemptions provided by law. forprofit for profit “for-profit nonprofit non “non-profit research framework National CNES 201 202 study profitoriented oriented services law 20 2

RESUMO O artigo analisa aspectos da mudança da natureza jurídica de instituições privadas de assistência à saúde, de estabelecimentos “com” para “sem” fins lucrativos. Trata-se de uma pesquisa exploratória, apoiada no referencial de análise de políticas, com foco em dados secundários, provenientes do Sistema de Cadastro Nacional de Estabelecimentos de Saúde (SCNES), de 2012 a 2020, e estudo de caso. Os resultados apresentam aumento dessas entidades em todas as regiões do país e evidências de que se comportam como estabelecimentos com fins lucrativos. A mudança de natureza jurídica oculta um processo mais amplo de mercantilização implícita dos serviços de saúde, incentivado por políticas estatais e relacionado às isenções previstas em lei. saúde “com sem “sem lucrativos Tratase Trata exploratória secundários SCNES, SCNES , (SCNES) 201 2020 caso lei (SCNES 20 202 2

ABSTRACT This study aimed to determine the effects of relocation time (RT; Experiment 1) and storage time after relocation (ST; Experiment 2) on microbial population, fermentative characteristics, and chemical composition of corn silage. In experiment 1, corn silage was stored for 30 d, subjected to different RT (0–60 h), and stored again for 30 d. Thirty experimental silos were used in a completely randomized design, with three replicates per treatment. In experiment 2, after 150 d of ensiling, silage was removed from a bunker silo, exposed to air for 9 h, relocated to experimental silos, and stored for periods ranging from 0 to 128 d. Twenty-eight experimental silos were used in a completely randomized design, with four replicates per treatment. Relocation time had no effect on fungi counts and concentrations of lactic and propionic acids in corn silage but resulted in a significant increase in dry matter content. In experiment 2, dry matter recovery and concentration of non-fiber carbohydrates decreased in corn silage stored for more than 32 d after relocation. Exposure of corn silage to air during relocation for up to 60 h followed by 30 d of storage did not compromise the fermentation profile or nutritive value of the silage. Increased storage time of relocated corn silage (up to 128 d) consistently decreases its nutritional value. The storage period seems to have an increased impact on nutrient loss in relocated silage than the relocation period. (RT 1 ST (ST 2 population characteristics 3 0–60 060 (0–6 , h) design treatment 15 ensiling silo 12 Twentyeight Twenty eight content nonfiber non fiber 6 0–6 06 (0– 0– (0 (

RESUMO Introdução: O objetivo deste estudo foi avaliar se uma única sessão de treinamento intervalado de alta intensidade (HIIT) promoveria efeito hipotensor e risco cardiovascular em mulheres hipertensas, bem como aumentar a biodisponibilidade de óxido nítrico. Métodos: A amostra foi composta por 10 mulheres hipertensas (63,7 ± 10,34 anos; 66, ± 7,67 kg e 153,7 ± 9,08 cm) e a carga de treinamento foi estabelecida em 60% da velocidade aeróbica máxima. Resultados: Observamos um efeito hipotensor muito alto entre os momentos de interação durante a intervenção (Int. Pré: 122,40 ± 18,58; Int. Pós: 143,00 ± 24,90; Int. Pós 60 min.: 121,40 ± 13,87; p < 0,001, η2P = 0,569). Nenhum risco cardiovascular foi observado durante a intervenção (DP = Int. Pré: 9138,20 ± 1805,34; Int. Pós: 14849,70 ± 3387,94; Int. Pós: 60 min.: 9615,90 ± 1124,41, p < 0,001, η2P = 0,739) e não houve aumento da biodisponibilidade de óxido nítrico. Conclusões: Em conclusão, este trabalho revela que uma sessão de HIIT é capaz de gerar efeito hipotensor sem apresentar risco cardiovascular em mulheres hipertensas. Nível de evidência I; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significativa, mas com intervalos de confiança estreitos .

ABSTRACT Introduction: The aim of this study was to evaluate whether a single session of high-intensity interval training (HIIT) would promote a hypotensive effect and cardiovascular risk in hypertensive women, in addition to increasing the bioavailability of nitric oxide. Methods: The sample consisted of 10 hypertensive women (63.7 ± 10.34 years; 66 ± 7.67 kg and 153.7 ± 9.08 cm) and the training load was established at 60% of the maximum aerobic speed. Results: We observed a very high hypotensive effect between the interaction moments during the intervention (Int. Pre: 122.40 ± 18.58; Int. Post: 143.00 ± 24.90; Int. Post 60min: 121.40 ± 13.87; p<0.001, η2P = 0.569). No cardiovascular risk was observed during the intervention (DP = Int. Pre: 9138.20 ± 1805.34; Int. Post: 14849.70 ± 3387.94; Int. Post 60min: 9615.90 ± 1124.41, p< 0.001, η2P = 0.739) and there was no increase in the bioavailability of nitric oxide. Conclusion: In conclusion, this work reveals that an HIIT session is capable of generating a hypotensive effect while not posing cardiovascular risk in hypertensive women. Level of evidence I; High-quality randomized clinical trial with or without statistically significant difference, but with narrow confidence intervals .

RESUMEN Introducción: El objetivo de este estudio fue evaluar si una única sesión de entrenamiento de intervalos de alta intensidad (HIIT) podría promover un efecto hipotensor y riesgo cardiovascular en mujeres hipertensas, así como aumentar la biodisponibilidad del óxido nítrico. Métodos: La muestra fue compuesta por 10 mujeres hipertensas (63,7 ± 10,34 años; 66 ± 7,67 kg y 153,7 ± 9,08 cm) y la carga de entrenamiento se estableció en el 60% de la velocidad aeróbica máxima. Resultados: Se observó un efecto hipotensor muy elevado entre los momentos de interacción durante la intervención (Int. Pre: 122,40 ± 18,58; Int. Post: 143,00 ± 24,90; Int. Post 60 min: 121,40 ± 13,87; p <0,001, η2P = 0,569). No se observó ningún riesgo cardiovascular durante la intervención (DP = Int. Pre: 9138,20 ± 1805,34; Int. Post: 14849,70 ± 3387,94; Int. Post 60 min: 9615,90 ± 1124,41, p <0,001, η2P = 0,739) y no hubo aumento de la biodisponibilidad de óxido nítrico. Conclusiones: En conclusión, este trabajo revela que una sesión de HIIT es capaz de generar efecto hipotensor sin presentar riesgo cardiovascular en mujeres hipertensas. Nivel de evidencia I; Estudio clínico aleatorizado de alta calidad con o sin diferencia estadísticamente significativa, pero con intervalos de confianza estrechos.

RESUMO O artigo analisa aspectos da mudança da natureza jurídica de instituições privadas de assistência à saúde, de estabelecimentos “com” para “sem” fins lucrativos. Trata-se de uma pesquisa exploratória, apoiada no referencial de análise de políticas, com foco em dados secundários, provenientes do Sistema de Cadastro Nacional de Estabelecimentos de Saúde (SCNES), de 2012 a 2020, e estudo de caso. Os resultados apresentam aumento dessas entidades em todas as regiões do país e evidências de que se comportam como estabelecimentos com fins lucrativos. A mudança de natureza jurídica oculta um processo mais amplo de mercantilização implícita dos serviços de saúde, incentivado por políticas estatais e relacionado às isenções previstas em lei.

ABSTRACT The article analyzes aspects of the change in the legal nature of private healthcare from “for-profit” to “non-profit” entities. It is an exploratory research, supported by the policy analysis framework, focusing on secondary data from the Cadastro Nacional de Estabelecimentos de Saúde (National Registry of Health Facilities – CNES) from 2012 to 2020 and a case study. The results show an increase in these entities in all regions of the country and evidence that they behave like profit-oriented entities. The change in legal nature hides a broader process of implicit commodification of healthcare services, encouraged by state policies and related to exemptions provided by law.

RESUMO No Brasil, 67,7% dos municípios têm menos de 20 mil habitantes, sendo caracterizados como de pequeno porte. O objetivo do presente artigo é sistematizar a experiência e identificar os desafios e as lições aprendidas na implantação do modelo de fortalecimento da governança regional e da organização da rede de atenção à saúde (RAS) em uma região do Brasil composta por esses municípios, que apresentam baixa capacidade técnica e orçamentária, além de fragilidades diversas relacionadas à organização da RAS. Na perspectiva do fortalecimento da governança regional e da organização do processo de trabalho da atenção primária em saúde (APS) e, por consequência, dos fluxos com os outros níveis de atenção, foi proposta a estratégia intitulada Mais Cuidado Mais Saúde, desenvolvida em parceria com a Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) e o Ministério da Saúde. O projeto foi executado por meio de processos de educação permanente em saúde e fortalecimento de capacidades institucionais na região de Ivaiporã/Paraná, com oficinas descentralizadas, contemplando três eixos prioritários: integração da RAS, formação de capacidades e gestão da informação. O público-alvo foram as equipes de APS ampliada. O projeto permitiu desenvolver capacidades locais e de governança regional por meio de reflexões conjuntas a respeito do modelo de atenção à saúde, de seus componentes e das mudanças necessárias nos processos de trabalho para a promoção de saúde com foco na qualidade de vida dos usuários. Por se tratar de uma experiência que considera as fragilidades, necessidades e autonomia dos atores locais, o projeto tem alto poder de replicação e customização para outras regiões com características similares dentro e fora do Brasil.

RESUMEN En Brasil, 67,7% de los municipios se clasifican como pequeños, puesto que tienen menos de 20 000 habitantes. El objetivo de este artículo es sistematizar la experiencia adquirida y determinar cuáles son los desafíos y las enseñanzas extraídas en la implementación del modelo de fortalecimiento de la gobernanza regional y de la organización de la red de atención de salud en una región de Brasil compuesta por municipios de este tipo, que tienen poca capacidad técnica y presupuestaria y diversas debilidades relacionadas con la organización de dicha red. Desde la perspectiva del fortalecimiento de la gobernanza regional y de la organización del proceso de trabajo en el campo de la atención primaria de salud y, por consiguiente, de los flujos asistenciales con los demás niveles de atención, se propuso la estrategia Más cuidado, más salud, formulada junto con la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) y el Ministerio de Salud. El proyecto se ejecutó por medio de procesos de educación permanente en salud y fortalecimiento de las capacidades institucionales en la región de Ivaiporã, Estado de Paraná, con talleres descentralizados, dentro de tres ejes prioritarios, a saber, integración de red de atención de salud, capacitación y gestión de la información. El público destinatario fueron los equipos de atención primaria de salud ampliada. El proyecto permitió el desarrollo de las capacidades locales y la gobernanza regional por medio de reflexiones conjuntas sobre el modelo de atención de salud, sus elementos constitutivos y los cambios necesarios en los procesos de trabajo para impulsar la promoción de la salud centrada en la calidad de vida de los usuarios. Por tratarse de una experiencia en la cual se tienen en cuenta las debilidades, las necesidades y la autonomía de los actores locales, el proyecto tiene un alto poder de repetición y adaptación en otras regiones con características similares dentro y fuera de Brasil.

ABSTRACT In Brazil, 67.7% of the municipalities are characterized as small, with a population of less than 20 thousand. The objective of this article is to systematize the experience and identify the challenges and lessons learned in the implementation of the model for strengthening regional governance and organizing the health care network (HCN) in a region of Brazil composed of these municipalities, which present low technical and budgetary capacity, in addition to various fragilities related to the organization of the HCN. With a view to strengthening regional governance and the organization of the primary health care (PHC) work process and, consequently, the workflow with other levels of care, a strategy entitled More Care More Health (Mais Cuidado Mais Saúde) was proposed, developed in partnership with the Pan American Health Organization/World Health Organization (PAHO/WHO) and the Ministry of Health. The project was developed through permanent health education and institutional capacity building in the region of Ivaiporã, state of Paraná, based on workshops and addressing three priority axes: HCN integration, capacity building and information management. The target audience were the extended PHC teams. The project made it possible to develop local and governance capacities through joint reflections on the health care model, its components and the necessary changes in work processes for health promotion with a focus on the quality of life of users. Because it is an experience that considers the weaknesses, needs and autonomy of local actors, the project has a high potential for replication and customization for other regions with similar characteristics inside and outside Brazil.

SUMMARY: High-intensity physical exercises can cause oxidative stress and muscle damage. Several medicinal plants have been used as antioxidant and anti-inflammatory agents. The present study evaluated high-intensity resistance exercise (HIRE) associated with Schinus Terebentifholius ethanolic extract (EE) on oxidative parameters and muscle damage in Wistar rats. Animals were divided into 04 groups (n=10/group): 1. Control (CG) - animals that did not undergo HIRE and were treated with vehicle (distilled water, orally); 2. Acute exercise (AE) - animals submitted to acute exercise session; 3. Exercise + vehicle (EV) - animals that underwent HIRE and were treated with vehicle and 4. Exercise + extract (EX) animals administered with Schinus terebenthifolius EE (100mg/Kg, orally) and submitted to the exercise session. Schinus terebenthifolius EE showed high in vitro antioxidant activity (13.88 ± 0.36 mg/mL). Before the experimental period, lactate was measured at pre and post moments of AE (p<0.0001) and EX (p<0.0001) groups. After the acute session, the following were evaluated: oxidative stress {malondialdehyde (MDA), sulfhydryl groups (SH) and ferric reducing antioxidant power (FRAP)}, muscle damage (creatine kinase (CK) and lactate dehydrogenase (LDH)), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). In the in vivo analyses of the EX group compared to AE and EV groups, respectively: hepatic (MDA: p<0.0001 and SH: p=0.0033, in both; FRAP: p=0.0011 and p=0.0047), muscle (MDA, SH and FRAP: p<0.0001, in both; CK: p=0.0001 and p<0.0001; LDH: p<0.0001, in both), serum levels (MDA: p=0.0003, p=0.0012, SH: p=0.0056, p=0.0200, FRAP: p=0.0017 and p=0.0165) were significant. There was no significant difference in ALT and AST markers. It could be concluded that Schinus terebenthifolius EE associated with HIRE attenuated oxidative stress and muscle damage in rats.

RESUMEN: Los ejercicios físicos de alta intensidad pueden causar estrés oxidativo y daño muscular. Varias plantas medicinales se han utilizado como agentes antioxidantes y antiinflamatorios. El presente estudio evaluó el ejercicio de resistencia de alta intensidad (HIRE) asociado con el extracto etanólico (EE) de Schinus terebentifholius sobre los parámetros oxidativos y el daño muscular en ratas Wistar. Los animales se dividieron en 4 grupos (n=10/grupo): 1. Control (GC) - animales que no se sometieron a HIRE y fueron tratados con vehículo (agua destilada, por vía oral); 2. Ejercicio agudo (AE) - animales sometidos a sesión de ejercicio agudo; 3. Ejercicio + vehículo (EV) - animales que se sometieron a HIRE y fueron tratados con vehículo y 4. Ejercicio + extracto (EX) animales administrados con Schinus terebenthifolius EE (100 mg/kg, por vía oral) y sometidos a la sesión de ejercicio. Schinus terebenthifolius EE mostró una alta actividad antioxidante in vitro (13,88 ± 0,36 mg/mL). Antes del período experimental, se midió el lactato en los momentos pre y post de los grupos AE (p<0,0001) y EX (p<0,0001). Tras la sesión aguda, se evaluaron: el estrés oxidativo malondialdehído (MDA), grupos sulfhidrilo (SH) y poder antioxidante reductor férrico (FRAP), daño muscular (creatina quinasa (CK) y lactato deshidrogenasa (LDH)), alanina aminotransferasa (ALT) y aspartato aminotransferasa (AST). En los análisis in vivo del grupo EX frente a los grupos AE y EV, respectivamente: hepático (MDA: p<0,0001 y SH: p=0,0033, en ambos; FRAP: p=0,0011 y p=0,0047), muscular (MDA, SH y FRAP: p<0,0001, en ambos; CK: p=0,0001 y p<0,0001; LDH: p<0,0001, en ambos), niveles séricos (MDA: p=0,0003, p=0,0012, SH: p=0,0056, p=0,0200, FRAP: p=0,0017 y p=0,0165) fueron significativas. No hubo diferencia significativa en los marcadores ALT y AST. Se podría concluir que Schinus terebenthifolius EE asociado con HIRE atenuó el estrés oxidativo y el daño muscular en ratas.

SUMMARY: This study aimed to evaluate the effects of six weeks of HIIT on tissue and oxidative damage markers in rats supplemented with Coutoubea spicata fraction. Thirty-two male Wistar rats were divided into 4 groups: Baseline (GB); supplemented with 100 mg/kg of Coutoubea spicata fraction (GSCS); exercised for 6 weeks with the HIIT protocol (GH); supplemented with 100 mg/kg of Coutoubea spicata fraction + HIIT for 6 weeks (GHCS). Exercised animals performed the HIIT protocol (2 x 2). Tissue damage CK, LDH, ALT and AST markers in plasma were analyzed, as well as oxidative stress MDA and SH biomarkers in plasma and in cardiac, hepatic and muscle tissues. The results showed that CK, LDH, AST and ALT enzymes showed increase in GH when compared to GB (p<0.0001). However, CK, AST and ALT markers reduced their concentrations in GHCS when compared to GH (p<0.0001), indicating that Coutoubea spicata supplementation attenuated the damage in muscle and liver tissues induced by HIIT. Plasma, liver and muscle MDA showed increase in GH after HIIT sessions; however, when compared to GHCS, it showed reduced levels (p<0.0001). SH was elevated in the GH group when compared to GB in plasma and liver tissues (p<0.0001); in contrast, reduction in GHCS when compared to GH was observed in plasma, liver and cardiac tissues, demonstrating the redox effect of HIIT on some tissues. Thus, our findings showed that Coutoubea spicata has antioxidant activity, reducing oxidative damage markers and consequently tissue damage in healthy Wistar rats after HIIT protocol, but it also demonstrated redox balance after analyzing oxidative stress markers.

RESUMEN: Este estudio tuvo como objetivo evaluar los efectos de HIIT en los marcadores de daño tisular y oxidativo en ratas suplementadas con Coutoubea spicata durante seis semanas. Treinta y dos ratas Wistar macho se dividieron en 4 grupos: línea de base (GB); suplementados con 100 mg/kg de fracción de Coutoubea spicata (GSCS); ejercitados durante 6 semanas con el protocolo HIIT (GH); suplementado con 100 mg/kg de fracción de Coutoubea spicata + HIIT durante 6 semanas (GHCS). Los animales ejercitados realizaron el protocolo HIIT (2x2). Se analizaron los marcadores de daño tisular CK, LDH, ALT y AST en plasma, así como los biomarcadores de estrés oxidativo MDA y SH en plasma y en tejidos cardiaco, hepático y muscular. Los resultados indicaron que las enzimas CK, LDH, AST y ALT mostraron aumento en GH en comparación con GB (p<0,0001). Sin embargo, los marcadores CK, AST y ALT redujeron sus concentraciones en GHCS en comparación con GH (p<0,0001), lo que indica que la suplementación con Coutoubea spicata atenuó el daño en los tejidos musculares y hepáticos inducido por HIIT. La MDA de plasma, hígado y músculo mostró un aumento en la GH después de las sesiones de HIIT; sin embargo, en comparación con GHCS, mostró niveles reducidos (p<0,0001). Se observó SH elevado en el grupo de GH en comparación con GB en plasma y tejidos hepáticos (p<0,0001); en contraste, se observó una reducción en GHCS en comparación con GH en plasma, hígado y tejidos cardíacos, lo que demuestra el efecto redox de HIIT en algunos tejidos. Por lo tanto, nuestros hallazgos mostraron que Coutoubea spicata tiene actividad antioxidante, con reducción de los marcadores de daño oxidativo y, en consecuencia, el daño tisular en ratas Wistar sanas después del protocolo HIIT, pero además demostró el equilibrio redox después de analizar los marcadores de estrés oxidativo.

ABSTRACT Government in the Unified Health System (SUS) is admittedly complex, requiring management teams to understand and develop a set of skills and competencies that help into their routines and in the challenges of public administration. This article presents a continuing education process developed with leadership teams from two health regions in Paraná, with the aim of broadening the participants’ view of the reorganization of the management and implementation of the SUS in the territory, based on interdisciplinarity and interprofessional. This is an experience report developed with teams, carried out in 2019, presented in five sections: the first describes the context in which the experience was developed, elucidating reasons, actors, and where it took place; the second section presents the work proposal, the preparation of the workshops, and the methodological resources used; the third reports the pathway travelled in its operation; the fourth discussions the characteristics of interdisciplinarity that exists in the continuing education process; and the last section presents some considerations. The proposal presents a powerful strategy to promote dialogue between different actors and institutions, and especially in the context of the State’s sanitary and fiscal crisis, to qualify and make reflective the work in the field of health management. (SUS complex administration Paraná participants territory interprofessional 2019 sections reasons place workshops used operation considerations institutions States State s crisis 201 20 2

RESUMO A gestão no Sistema Único de Saúde (SUS) requer das equipes gestoras a compreensão e o desenvolvimento de um conjunto de habilidades e competências que os auxiliem no cotidiano e nos desafios da gestão pública. Este artigo apresenta um processo de Educação Permanente em Saúde (EPS) desenvolvido com equipes gestoras de duas regiões de saúde do Paraná, com intuito de ampliar o olhar dos participantes para a reorganização da gestão e da implementação do SUS no território, pautado na interdisciplinaridade. Trata-se de um relato de experiência desenvolvido com equipes gestoras, realizada no ano de 2019, apresentado em cinco seções: a primeira descreve o contexto em que a experiência foi desenvolvida, elucidando motivos, atores e a localidade em que ocorreu; a segunda apresenta a proposta de trabalho, a confecção das oficinas e os recursos metodológicos utilizados; a terceira relata o caminho percorrido na sua operacionalização; a quarta discute as características de interdisciplinaridade existentes no processo de EPS e a última apresenta algumas considerações. A proposta mostra-se como uma potente estratégia para promover o diálogo entre diferentes atores e instituições, principalmente no contexto de crise sanitária e fiscal do Estado, qualificar e tornar reflexivo o trabalho no campo da gestão em saúde. (SUS pública (EPS Paraná território Tratase Trata se 2019 seções desenvolvida motivos ocorreu utilizados operacionalização considerações mostrase mostra instituições Estado 201 20 2

Em 2022, foi publicado um importante relatório internacional acerca do “valor da morte” não apenas no campo da saúde, mas nas sociedades humanas de forma geral. Este relatório se propôs a reimaginar sistemas relacionados ao fim da vida nos quais a morte seja compreendida não apenas como um fenômeno fisiológico, mas também relacional e espiritual, com valor próprio e inseparável da vida. Identifica-se a baixa prioridade dada pela maior parte dos governos ao redor do mundo para a questão do alívio do sofrimento e dos cuidados com o luto, representada pelo baixo investimento em cuidados paliativos. Ao mesmo tempo, assistimos no Brasil a modificações ameaçadoras à exequibilidade de políticas de cuidados paliativos na atenção básica. A negação da finitude no âmbito dos sistemas de saúde se reflete em alguns indicadores mundiais, como o ranking de qualidade de morte da revista The Economist, em que o Brasil se encontra na 42ª posição, o mapeamento mundial de cuidados paliativos da Aliança Mundial de Cuidados Paliativos em Hospitais, no qual o Brasil se encontra no nível 3b, e o consumo mundial de opioides pelo Órgão Internacional de Controle de Entorpecentes, da Organização Mundial da Saúde, no qual o consumo dessas substâncias em nosso país está na casa das centenas de doses por milhão de habitantes por dia. Apesar de avanços notáveis nos campos legislativo e executivo no que se refere à temática dos cuidados paliativos, o Sistema Único de Saúde (SUS) e a atenção básica vêm sofrendo reveses importantes a nível estrutural que irão causar impacto na estruturação de uma política pública de cuidados paliativos. Este artigo procura fazer uma análise inicial dos impactos das políticas atuais dentro desse cenário e suas repercussões na construção de uma política de cuidados paliativos sólida.

In 2022, an important international report was published on the “value of death” not only in the field of health, but in relation to human societies in general. This report proposed to reimagine systems related to end of life in which death is understood not only as a physiological event but also as a relational and spiritual phenomenon with a value of its own and inseparable from life. It identifies the low priority given by most governments worldwide to the issue of alleviating suffering and supporting bereavement, evidenced by the low investment in palliative care. At the same time, we are witnessing in Brazil changes that threaten the feasibility of palliative care policies in primary health care. The denial of finitude within health systems is reflected in global indicators such as the quality of death index of The Economist magazine, in which Brazil ranks 42nd, the global atlas of palliative care of the World Hospice and Palliative Care Alliance, where Brazil is in level 3b, and the global trends in opioid consumption of International Narcotics Control Board of the World Health Organization, in which opioid consumption in Brazil is in the hundreds of doses per million inhabitants per day. Despite notable advances in the legislative and executive fields with regard to palliative care, the Brazilian Unified National Health System (SUS) and primary health care have suffered important structural setbacks that will impact the design of public policy for palliative care. The goal of this article is to undertake an initial analysis of the impacts of current policies within this context and their repercussions in the construction of a solid policy for palliative care.

En 2022 se publicó un importante informe internacional sobre el “valor de la muerte” no solo en el campo de la salud, sino en las sociedades humanas en general. Este informe se propuso reimaginar sistemas relacionados con el fin de la vida en los que la muerte se comprenda no solo como un fenómeno fisiológico, sino también relacional y espiritual, con un valor propio e inseparable de la vida. Se identifica la baja prioridad dada por la mayor parte de los gobiernos en todo el mundo para la cuestión del alivio del sufrimiento y de los cuidados con el duelo, representados por la baja inversión en cuidados paliativos. Al mismo tiempo, asistimos en Brasil a modificaciones amenazadoras a la viabilidad de políticas de cuidados paliativos en la atención básica. La negación de la finitud en el ámbito de los sistemas de salud se refleja en algunos indicadores mundiales como el ranking de calidad de la muerte de la revista The Economist en que Brasil está en la posición 42; el mapeo mundial de cuidados paliativos de la Alianza Mundial de Cuidados Paliativos y Hospicio donde Brasil se encuentra en el nivel 3b y el consumo mundial de opioides por la Junta Internacional de Fiscalización de Estupefacientes de la Organización Mundial de la Salud en el que nuestro consumo de opioides está en los cientos de dosis por millón de habitantes por día. A pesar de los notables avances en los ámbitos legislativo y ejecutivo en lo que se refiere a la temática de los cuidados paliativos, por otro lado, el Sistema Único de Salud brasileño (SUS) y la atención básica vienen sufriendo importantes retrocesos a nivel estructural que repercutirán en la estructuración de una política pública de cuidados paliativos. Este artículo pretende hacer un primer análisis de los impactos de las políticas actuales, dentro de este escenario, y sus repercusiones en la construcción de una política sólida de cuidados paliativos.

Abstract Aim: This study aimed to better understand the perceptions, actions, and interventions of Physical Education teachers at public state schools in the Rio Grande do Sul and São Paulo, regarding didactic-methodological spectra in futsal classes In Brazil, futsal is part of the team sport that must be presented in Physical Education classes, according to educational regulatory documents. Methods: Semi-structured interviews were conducted with eight teachers (three women and one man in each state), whose content was explored through a thematic analysis. Results: The results show a strong singularity of futsal as the content of Physical Education in schools and the relationship with its cultural impact. Different teaching concepts and methodologies used by teachers were identified, as well as a strong connection between experiences with futsal of students and the pedagogical practices adopted. Gender issues were highlighted, showing a contradiction between motivation to change the scenario and a school classes organization that promotes its maintenance. Conclusion: The study supports discussions about teacher actions epistemologically based on traditional teaching perspectives.

Abstract This study aimed to evaluate the effect of synchronization with prostaglandin F2α in Baixadeiro mares during the rainy and dry seasons. Fourteen mares were synchronized by administering two doses of 1 mL prostaglandin PGF 2α and monitored by rectal palpation and ultrasound for the assessment of follicular development and uterine echotexture. Of this total, nine mares allowed the collection of blood, in which the blood was collected by venipuncture of the jugular vein to determine progesterone (P4) by ELISA. Mares showed no differences (P > 0.05) in weight, body score condition (BSC), tone, uterine edema, frequency of ovulation, synchronization interval, estrus, and the total number of follicles between periods. However, there was a difference in large increased follicle diameter (P < 0.05) during the dry season. The average concentrations of P4 in mares differed (P < 0.05) between the pre- and post-ovulatory phases for both seasons and after ovulation, with higher concentrations in the rainy season. Furthermore, statistical differences in daily light (P < 0.05) were observed between the dry and rainy periods. Thus, we conclude that mares from the genetic grouping Baixadeiro showed no reproductive seasonality, though there was a difference in luminosity between the rainy and dry seasons. The treatment with two doses of PGF 2α was effective in synchronizing the mares, promoting the return of estrus in the dry and rainy periods. The mares remaining cyclically active throughout the year provided there were appropriate forage availability and quality levels to allow for normal values of body weight and condition.