ABSTRACT Objective: to identify the non-invasive technologies and care strategies used by obstetric nurses to encourage freedom of movement and positioning in the parturition process. Method: A descriptive and qualitative study, with 20 obstetric nurses working in public obstetric services in Rio de Janeiro - Brazil. Data were collected from May to July 2021 through semi-structured interviews and submitted to thematic analysis. Results: the participants use the encouragement to ambulate and perform pelvic movements and squats, also suggesting specific positions, especially vertical ones. As strategies, they orient about the benefits of these technologies and respect the choice of the expectant women, interfering, however, in cases of obstetric complications. Conclusion: The incentive to freedom of movement and positioning in parturition happens with the offer of different non-invasive technologies in a care relationship with clarified and shared decision-making processes, which promote autonomy and ensure the right to safe and respectful assistance.

RESUMEN Objetivo: Identificar las tecnologías no invasivas y las estrategias de cuidados utilizadas por las enfermeras obstétricas para favorecer la libertad de movimientos y el posicionamiento en el proceso de parto. Método: Estudio descriptivo y cualitativo, con 20 enfermeras obstétricas que trabajan en servicios públicos de obstetricia en Rio de Janeiro - Brasil. Los datos se recopilaron entre mayo y julio de 2021 mediante entrevistas semiestructuradas y se sometieron a un análisis temático. Resultados: los participantes utilizan el estímulo para el desplazamiento y la realización de movimientos pélvicos y de agachamiento, sugiriendo también posiciones específicas, especialmente verticales. Como estrategias, se orientan hacia los beneficios de las tecnologías y respetan la elección de las parturientas, interfiriendo, además, en los casos de complicaciones obstétricas. Conclusión: el incentivo a la libertad de movimiento y posicionamiento en el parto pasa por la oferta de diferentes tecnologías no invasivas en una relación asistencial con procesos de toma de decisión clarificados y compartidos, que promuevan la autonomía y garanticen el derecho a una asistencia segura y respetuosa.

RESUMO Objetivo: identificar as tecnologias não invasivas e estratégias de cuidado utilizadas pelas enfermeiras obstétricas para o incentivo à liberdade de movimentos e posicionamentos no processo de parturição. Método: Estudo descritivo e qualitativo, com 20 enfermeiras obstétricas que atuam em serviços obstétricos públicos do Rio de Janeiro - Brasil. Os dados foram coletados no período de maio a julho de 2021 por meio de entrevistas semiestruturadas e submetidos à análise temática. Resultados: as participantes utilizam o estímulo à deambulação e à realização de movimentos pélvicos e agachamentos, sugerindo também posições específicas, especialmente, verticalizadas. Como estratégias, orientam quanto aos benefícios destas tecnologias e respeitam a escolha das parturientes, interferindo, porém, em casos de intercorrências obstétricas. Conclusão: o incentivo à liberdade de movimentos e posicionamentos na parturição acontece com o oferecimento de diferentes tecnologias não invasivas em uma relação de cuidado com processos decisórios esclarecidos e compartilhados, que promovem a autonomia e asseguram o direito à assistência segura e respeitosa.

Abstract Objective to discuss the facilitating and limiting factors of nurses’ performance in controlling COVID-19 in childbirth care. Methods a descriptive and qualitative study, with 20 nurse-midwives from public services in the state of Rio de Janeiro. Data were collected from May to July 2021, through semi-structured interviews, and submitted to thematic content analysis. Results as facilitating factors there are: physical installations and resources that provide individualized use; protocol implementation; reorganization of collective environment use; and preference for care that does not require instruments or nurses’ continuous presence. As limiting factors, the following stand out: high demand for care; restricted accommodation and inadequate ventilation; lack of resources; resistance to wearing a mask; nurses’ difficulty in maintaining physical distance in care; and increase in interventionist practices among certain professionals. Conclusions and implications for practice services that underwent adaptations in environments, with available resources, co-responsibility regarding sanitary measures and where nurse-midwives modified their care process, presented better conditions to protect health and mitigate COVID-19 transmission, with attention to environment, humanization and women’s rights during childbirth.

Resumen Objetivo discutir los factores facilitadores y limitantes de la actuación de los enfermeros en el control de la COVID-19 en la atención al parto. Métodos estudio descriptivo y cualitativo, con 20 parteras de servicios públicos del estado de Río de Janeiro. Los datos fueron recolectados de mayo a julio de 2021, a través de entrevistas semiestructuradas, y sometidos a análisis de contenido temático. Resultados como factores facilitadores, se encuentran: instalaciones físicas y recursos que brindan un uso individualizado; implementación de protocolos; reorganización del uso de los entornos colectivos; y preferencia por cuidados que no requieran instrumental o la presencia continua de la enfermera. Como limitantes, se destacan: la alta demanda de atención; alojamiento restringido y ventilación inadecuada; falta de recursos; resistencia a usar mascarilla; dificultades de las enfermeras para mantener la distancia física en el cuidado; y el aumento de las prácticas intervencionistas entre determinados profesionales. Conclusiones e implicaciones para la práctica los servicios que sufrieron adaptaciones en los ambientes, con recursos disponibles, corresponsabilidad en las medidas sanitarias y donde las matronas modificaron su proceso de atención, presentan mejores condiciones para proteger la salud y mitigar la transmisión de la COVID-19, con atención al ambiente, la humanización y los derechos de la mujer durante el parto.

Resumo Objetivo discutir os fatores facilitadores e limitadores da atuação das enfermeiras no controle da COVID-19 na assistência ao parto. Métodos estudo descritivo e qualitativo, com 20 enfermeiras obstétricas de serviços públicos do estado do Rio de Janeiro. Os dados foram coletados de maio a julho de 2021, por entrevistas semiestruturadas, e submetidos à análise de conteúdo temática. Resultados como fatores facilitadores, têm-se: instalações físicas e recursos que proporcionam o uso individualizado; implementação de protocolos; reorganização do uso de ambientes coletivos; e preferência por cuidados que não requerem instrumentos ou a presença contínua da enfermeira. Como limitadores, apontam-se: a alta demanda assistencial; acomodações restritas e ventilação inadequada; carência de recursos; resistência ao uso de máscara; dificuldades das enfermeiras em manter o distanciamento físico nos cuidados; e incremento de práticas intervencionistas entre determinados profissionais. Conclusões e implicações para a prática serviços que passaram por adequações nos ambientes, com recursos disponíveis, corresponsabilização acerca das medidas sanitárias e onde as enfermeiras obstétricas modificaram seu processo de cuidar, apresentam melhores condições para proteger a saúde e mitigar a transmissão da COVID-19, com atenção à ambiência, humanização e aos direitos das mulheres no parto.

Abstract Chicken broilers digestibility and performance fed with different ME levels, with and without adjustments of digestible lysine, calcium, and available phosphorus, were evaluated. For digestibility, 210 male Cobb 500 chicken broilers were used and distributed into a 3x2+1 factorial arrangement, with three ME levels (3050; 3125 and 3200 kcal/kg) with and without nutrient adjustment, plus one control treatment (2975 kcal ME/kg), totaling seven treatments including six repetitions with five birds into each repetition. For initial performance, 1120 birds were distributed randomly with eight replications within treatments and 20 birds for each replication. For final performance, 1008 chickens were distributed with eight replications and 18 birds for each replication. The DCDM and DCCP were improved (P<0.05) according to the increase of ME and the adjustment in dietary nutrients, as well as GE digestibility. The final performance showed no interaction (P>0.05) between energy and nutrient adjustment, but the increase in energy levels improved the feed conversion ratio (FCR=1.370). Increasing energy density with nutrient adjustment improves both nutrient utilization and bird performance.

Abstract The presence of spoilage microorganisms in forage interferes with the fermentation process of silage, due to competition with lactic acid bacteria for substrate, generating losses and influencing the nutritional value of the ensiled material. Thus, the objective is to evaluate the effect of “Alecrim Pimenta” essential oil (Lippia sidoides) and nanoformulated thymol on microbiological, fermentative and aerobic stability profile of sorghum (Sorghum bicolor cv. BRS Ponta Negra) silage intercropped with Paiaguás grass (Urochloa brizantha cv. BRS Paiaguás). A 4 x 3 factorial design was adopted, with four additives applied to the silages (control treatment; nanoformulated "Alecrim Pimenta" essential oil (OEN); 62% nanoformulated thymol; and 100% pure nanoformulated thymol), associated with three silo period times (15, 30 and 45 days), with five replications per treatment, totaling 60 mini silos. The Clostridium population was higher in the control treatment and in the OEN. The Lactobacillus population decreased with the increase in silo opening time. Higher aerobic stabilities were recorded in silages with 100% nanoformulated thymol with opening at 15 days; and silages with 62% nanoformulated Thymol (opening period at 30 and 45 days). Silages with 100% thymol provided higher losses of dry matter, gases and effluents, while the use of OEN provided lower losses of dry matter and gases. Silos opened at 45 days showed higher losses of dry matter, gases and effluents. Sorghum and Paiaguás grass silages that received nanoformulated thymol were more efficient in controlling Clostridium and Lactobacillus populations, and this additive improved the aerobic stability of the silage.

Resumo A presença de microrganismos deterioradores na forragem interfere no processo fermentativo da silagem, devido a competição com as bactérias ácido láticas por substrato, gerando perdas e influenciando o valor nutritivo do material ensilado. Assim, objetiva-se avaliar o efeito do óleo essencial de Alecrim pimenta (Lippia sidoides) e do timol nanoformulado sobre perfil microbiológico, fermentativo e estabilidade aeróbia de silagem do consórcio de Sorgo (Sorghum bicolor var. Ponta Negra) com capim Paiaguás (Urochloa brizantha cv. Paiaguás). Foi adotado esquema fatorial 4 x 3, quatro aditivos aplicados nas silagens (tratamento controle; óleo essencial de Alecrim pimenta nanoformulado (OEN); timol nanoformulado 62%; e timol nanoformulado 100% de pureza), associados a três tempos de abertura do silo (15, 30 e 45 dias), com cinco repetições por tratamento, totalizando 60 mini silos. A população de Clostridium foi maior no tratamento controle e no OEN. A população de Lactobacillus reduziu com o aumento no tempo de abertura do silo. Maiores estabilidades aeróbica foram registradas em silagens com timol nanoformulado 100% com abertura aos 15 dias; e silagens com Timol nanoformulado 62% (tempos de abertura aos 30 e 45 dias). Silagens com timol 100% proporcionaram maiores perdas de matéria seca, gases e efluentes, enquanto que o uso de OEN proporcionou menores perdas de matéria seca e gases. Silos com abertura aos 45 dias apresentaram maiores perdas de matéria seca, gases e efluentes. Silagens de Sorgo e capim Paiaguás que recebram timol nanoformulado foram mais eficientes em controlar as populações de Clostridium e Lactobacillus, bem como este aditivo melhorou a estabilidade aeróbica da silagem.

RESUMO: Objetivou-se avaliar o grau de ativação e relaxamento muscular de equinos de patrulhamento submetidos à exercícios de mobilização dinâmica associados ou não à acupuntura. Doze cavalos castrados, sem raça definida, com idade de 10 ± 2,0 anos, foram distribuídos em três tratamentos: tratamento com uma sessão única de exercícios de mobilização dinâmica (flexão cervical longitudinal da cabeça entre os cascos, entre os carpos e até o peito); tratamento com sessão única de acupuntura (20 minutos); e tratamento com sessão única composta por exercícios de mobilização dinâmica associados a acupuntura. Foram analisadas imagens termográficas antes e após a aplicação dos tratamentos das regiões cervical, torácica, dorsal, abdominal e pélvica. A avaliação comportamental foi obtida por meio de filmagens 5 minutos antes e 10 minutos após o término da aplicação dos tratamentos, de maneira ininterrupta. Houve aumento (P < 0,0001) na temperatura corporal dos animais ao final da sessão única de exercícios funcionais para todas as regiões estudadas, sendo a cervical e torácica aquelas com maior valor de temperatura final. Não houve variação da temperatura nos demais tratamentos (P > 0,05). Todos os tratamentos geraram maior frequência (P < 0,05) na expressão de comportamentos relacionados ao relaxamento. A realização de uma sessão única de exercícios de mobilização dinâmica é suficiente para promover uma intensa resposta muscular em todo o corpo do equino, e tanto os exercícios funcionais quanto a acupuntura, de maneira individual ou associada, foram capazes de promover relaxamento muscular e mental, interferindo de maneira positiva no bem-estar dos animais.

ABSTRACT: The present research evaluated muscle activation degrees and relaxation of patrolling horses submitted to dynamic mobilization exercises, associated or not with acupuncture. Twelve mixed breed gelding, aged 10 ± 2.0 years, were distributed in three treatments. Treatment with a single session of dynamic mobilization exercises (longitudinal cervical flexion of head between hooves, between carpus and to up to chest); treatment with a single acupuncture session during 20 minutes, and treatment with a single session of dynamic mobilization exercises with acupuncture. Thermographic images were analyzed before and after applying treatments to the cervical, thoracic, dorsal, abdominal and pelvic regions. Animal behavior was assessed through five minutes filming, before and ten minutes after the end of each treatment application, in an uninterrupted way. Increase in animals body temperature at the end of the single session of functional exercises (P < 0.0001) at all animal regions were reported, being cervical and thoracic areas with highest final temperature values. There was no temperature variation for other treatments (P > 0.05). All treatments stimulated higher expression frequency (P < 0.05) of relaxation behaviors. A single dynamic mobilization exercises session is enough to promote intense muscular response in entire horse body; and with acupuncture, individually or associated, promoted muscle and mental relaxation, interfering positively in animal welfare.

RESUMO A obstrução de via lacrimal é uma possível complicação decorrente de tratamentos oncológicos sistêmicos e locais. A epífora crônica gera grande impacto na qualidade de vida desses pacientes, e, como a fibrose terminal da via lacrimal pode necessitar de procedimentos complexos para sua resolução, é importante estarmos atentos a esse efeito adverso, com o objetivo de reconhecê-lo e tratá-lo precocemente, ou mesmo preveni-lo. Nesta revisão da literatura, os autores analisam todos os agentes quimioterápicos e radioterápicos associados à obstrução lacrimal e descrevem os mecanismos, a frequência, os tratamentos e a profilaxia. Os tratamentos oncológicos associados à obstrução lacrimal foram: radioterapia em cabeça e pescoço (dosagem acima de 45 a 75Gy), radioiodoterapia (dosagem acima de 150mCi) e quimioterapia com 5-FU, S-1, capecitabine e docetaxel. A obstrução lacrimal pode ser irreversível, e a intubação profilática das vias lacrimais é uma possibilidade descrita de tratamento profilático em casos de radioterapia e uso do 5-FU, S-1 e docetaxel. O tratamento cirúrgico de todos os casos é a dacriocistorrinostomia.

ABSTRACT Lacrimal duct obstruction can be a side effect of systemic and/or local cancer treatments. Chronic epiphora has a great impact on the quality of life of oncological patients. Since terminal fibrosis of the lacrimal system may require complex procedures, it is important to be aware of this adverse effect in order to recognize and treat it, or even prevent it. A literature review was performed to identify all types of systemic cancer treatment associated with lacrimal obstruction and to describe the mechanisms, frequency, treatment, and prophylaxis. The oncological treatments associated with lacrimal obstruction were head and neck radiotherapy (dosage above 45-75 Gy), radioiodine therapy (dosage above 150 mCi), and chemotherapy with 5-FU, S-1, Capecitabine and Docetaxel. Depending on the dose, this complication may be irreversible. Prophylactic intubation of the lacrimal system is an option for prophylaxis in cases of radiotherapy, use of 5-FU, S-1, and Docetaxel. Final surgical treatment is dacryocystorhinostomy.

In this work, we have studied both experimentally and theoretically the oxybutynin chiral discrimination. According to the main results, the enantioseparation of oxybutynin was efficiently achieved by high performance liquid chromatography in normal phase using the Chiralpak® AD column, which has amylose tris (3,5‐dimethylphenylcarbamate) as a chiral selector. The energetic and structural parameters obtained via density functional theory calculations pointed out the chiral discrimination as well as the enantiomeric elution order of oxybutynin, thus explaining, at molecular level, the experimental data. Finally, the strength of the hydrogen bonds played a key role in the discrimination between the oxybutynin diastereomeric complexes formed.

Abstract The expansion of export agribusiness in Latin America leads to a growing feminization of the workforce. However, women are incorporated in this sector under unfavorable conditionsoccupying low-skilled, low-income and temporary jobs. This article intends to investigate the precariousness of the working and living conditions of women who work as wage earners in San Francisco Valley (Brazil) and in Elqui/Limarí Valley (Chile) grape export sector, putting forward an analysis that integrates both the sphere of production and reproduction. The aim of this article is to contribute to identify the existing interconnections between productive and reproductive universes, as well as the main mechanisms implemented by companies for extracting surplus value and outsourcing costs to households.

Resumen La expansión del agronegocio de exportación en Latinoamérica ha ido acompañada de una creciente feminización de la fuerza de trabajo. No obstante, las mujeres han sido incorporadas en condiciones poco favorables, ocupando empleos de baja calificación, bajos ingresos y temporales. El presente artículo propone investigar la precariedad de las condiciones de trabajo y de vida de las mujeres que trabajan como asalariadas en el sector de exportación de uva en el Valle San Francisco (Brasil) y en el Valle de Elqui/Limarí (Chile), proponiendo un análisis que integra tanto la esfera de la producción como de la reproducción. Esto con la finalidad de identificar las interconexiones existentes entre ambos ámbitos así como los principales mecanismos de extracción de plusvalor y de externalización de los costos a los hogares, implementados por las empresas.

ELECTROSPINNING APPLIED TO THE DEVELOPMENT OF ADSORBENT NANOFIBERS AIMING AT IMPROVING SOLID PHASE (MICRO)EXTRACTION TECHNIQUES. The limitations and challenges associated with the complex analyte-matrix-interfering interactions make the development of new sorbent materials an attractive line in several research areas, ranging from the synthesis and characterization to the application of these materials. Among the different strategies for manufacturing sorbent nanomaterials, the electrospinning of nanofibers based on polymeric solutions incorporated into Metal-Organic Frameworks (MOFs), Molecularly Imprinted Polymers (MIPs) and Nanoparticles (NPs) have represented in recent years, one of the methods more versatile and promising with regard to obtaining materials with large surface area and potential for functionalization and chemical modification. In this sense, the objective of this contribution is to highlight recent work aimed at the synthesis of electrospun nanofibers applied in adsorption and sample preparation processes, highlighting the synthetic nanofiber strategies based on MOFs, MIPs and NPs and the main challenges and perspectives of the applications, although little explored, of these materials in solid phase extraction and microextraction techniques.

ABSTRACT This study was conducted to evaluate different nutritional plans of net energy (NE) with a constant calorie:nutrient ratio on the performance of piglets from 7 to 30 kg. Sixty barrows with an initial weight of 7.11±0.89 kg were distributed among five nutritional plans: two NE-decreasing plans (A and B, starting from NE concentrations of 2.47 and 2.52 Mcal kg−1, respectively, and ending both at 2.37 Mcal kg−1) and three NE-constant plans (C, 2.37 Mcal kg−1; D, 2.42 Mcal kg−1; and E, 2.47 Mcal kg−1). The nutritional plans were composed of two decreasing plans: A, 2.47-2.42-2.37-2.37-2.37 Mcal of NE kg−1 of feed; B, 2.52-2.47-2.42-2.37-2.37 Mcal of NE kg−1 of feed; and three constant plans: C, 2.37 Mcal of NE kg−1 of feed; D, 2.42 Mcal of NE kg−1 of feed; E, 2.47 Mcal of NE kg−1 of feed, from 7 to 10, 10 to 15, 15 to 20, 20 to 25, and 25 to 30 kg, respectively, with six replicates per treatment and two animals per experimental unit. Animal performance was evaluated through the following measurements: average daily feed intake (ADFI), NE intake, standardized ileal digestible lysine intake (SID Lys intake), average daily gain (ADG), feed:gain ratio (F:G), final weight (FW), feed cost per kg of weight gain (CWG), economic efficiency index (EEI), and fecal score. Piglets’ final weight was 32.95±3.30 kg. Considering the total experimental period, there was no effect of the nutritional plan on ADG, F:G, CWG, and EEI. The final weight of piglets under plan D was higher than that recorded for those allocated to plan C, not differing from the other nutritional plans. Piglets fed under nutritional plans A and D presented higher ADFI compared with those subjected to other plans. Net energy and SID Lys intakes were significantly higher in piglets subjected to plans A, D, and E compared with those under plans B and C. Net energy nutritional plans did not influence the fecal score and the occurrence of diarrhea of the piglets. Based on our analysis, a nutritional plan containing a constant NE level of 2.42 Mcal kg−1 of feed may be recommended for piglets from 7 to 30 kg.

Abstract This study was conducted to evaluate the period of chromium yeast supplementation on lipid profile of backfat and Longissimus lumborum muscle of barrows. It was evaluated carcass samples from forty barrows, genetically similar. Pigs diets were supplemented with 0.4 mg kg-1 of chromium yeast in four periods (0, 38, 62 and 94 days before slaughter). The experimental design was completely randomized with four treatments, ten replicates, and each experimental unit consisting of one animal. Lipid profiles of backfat and Longissimus lumborum muscle were analyzed by gas chromatography. The increase in the period of chromium yeast use had a quadratic effect (P<0.05) for stearic and oleic fatty acids, and total saturated, monounsaturated and unsaturated fatty acids in backfat. DH-γ-linolenic and arachidonic fatty acids reduced when the period of chromium yeast use increased. In the meat, there was a quadratic effect (P<0.05) only in the γ-linoleic fatty acid. The use of chromium yeast for different periods influences the lipid profile of the backfat and the Longissimus lumborum muscle, with less effect in the meat.

Abstract This study evaluated the presence of polyunsaturated fatty acids in circulating blood and in the ovarian follicular fluid of mares, after supplementation of the diet with linseed oil. Six Mangalarga Marchador mares, weighing 397.00±31.89 kg, were kept on native pasture, and assigned to the current study. In a switch over design, mares were randomly allocated to receive 150 ml of vegetable oil daily, containing polyunsaturated fatty acids n3 (62.23 g ALA, 20.34 g LA, 2.27 g EPA, 2.32 g DHA), (n=3) or no supplementation (n=3) in two replicates. Blood and follicular fluid samples were taken on the first day (D0) and every 30 days until the end of the supplementation period (D60). After 60 days of supplementation, mares were switched across the treatments. Plasma concentrations of linolenic acid in total fatty acids were higher (P=0.006) in the supplemented compared to the control group (1.89±0.13 vs. 1.49±0.13%). There were positive correlations between plasma linoleic acid and follicular fluid arachidonic acid (P=0.0106; r2=0.13) and between plasma alpha linolenic acid and follicular fluid EPA (P=0.0004; r2=0.2544). Data indicated a low to moderate relationship between the dietary linseed-based oil supplementation studied and circulating and follicular fluid polyunsaturated fatty acids contents in mares.

ABSTRACT This study aimed to evaluate different periods of chromium yeast (CrY) supplementation on growth performance and quantitative carcass characteristics of growing-finishing pigs. We used eighty barrows (Duroc/Pietran × Large White/Landrace) with an initial body weight of 24.5±2.4 kg. A completely randomized block design was used within four periods of dietary CrY supplementation (control diet: CrY-free, from 25 to 110 kg; Cr25-110 kg: diet with 0.4 mg kg−1 of CrY, from 25 to 110 kg; Cr50-110 kg: diet with 0.4 mg kg−1 of CrY, from 50 to 110 kg; and Cr70-110 kg: diet with 0.4 mg kg−1 of CrY, from 70 to 110 kg), with ten replicates and two animals each. The CrY supplementation did not affect (P>0.05) either the grow performance or the carcass characteristics evaluated. The dietary supplementation of 0.4 mg kg−1 of CrY for growing-finishing pigs (25 to 110 kg) does not alter the performance neither the quantitative carcass characteristics.

RESUMO Objetivo: Apresentar uma proposta de protocolo de avaliação e treinamento da musculatura do assoalho pélvico para atendimento à mulher com incontinência urinária. Método: Relato de experiência profissional realizado em ambulatório de disfunções miccionais do Sistema Único de Saúde, conduzido por enfermeira estomaterapeuta. Resultados: Elaboração de uma proposta de protocolo de atendimento em consulta de enfermagem baseada em exame físico direcionado, diagnósticos de enfermagem da Classificação Internacional para a Prática de Enfermagem e adaptação de um protocolo de treinamento muscular como prescrição. Etapas: inspeção estática, inspeção dinâmica e palpação para verificação de tensão, avaliação de força, sustentação, relaxamento e coordenação muscular; seguidos de prescrições para relaxamento, propriocepção, treino de força, de sustentação, de coordenação abdomino-pélvica e de manutenção, conforme o diagnóstico. Conclusão: Esta proposta de protocolo pretende subsidiar a avaliação, por enfermeiros de todos os níveis de atenção à saúde, da musculatura pélvica de mulheres com incontinência urinária ou em risco de desenvolvimento, especialmente como parte da consulta de enfermagem na atenção primária.

ABSTRACT Objective: To present a proposal of a protocol for pelvic floor muscle evaluation and training to provide care to women with urinary incontinence. Method: Professional experience report, conducted in an outpatient facility for voiding dysfunctions in the Brazilian Unified Health System, conducted by an enterostomal therapist nurse. Results: Elaboration of a proposal of care protocol in nursing consultations based on a directed physical examination, nursing diagnoses of the International Classification for Nursing Practice, and the adaptation of a muscle training protocol as prescription. Steps: static observation, dynamic observation, and palpation to verify the tension and evaluation of strength, sustentation, relaxation, and muscle coordination, followed by prescriptions for relaxation, proprioception, training for strength, sustentation, abdominal and pelvic coordination, and maintenance, as per diagnosis. Conclusion: This protocol proposal intends to support the evaluation of the pelvic muscles of women with urinary incontinence or at risk for developing this condition by nurses of all levels of healthcare, especially as part of nursing consultations in primary care.

RESUMEN Objetivo: Presentar una propuesta de protocolo de evaluación y entrenamiento de la musculatura del suelo pélvico para atender a mujeres con incontinencia urinaria. Método: Relato de experiencia profesional realizado en un centro ambulatorio de disfunciones miccionales del Sistema Único de Salud de Brasil, conducido por enfermera estomaterapeuta. Resultados: Elaboración de una propuesta de protocolo de atención en consulta de enfermería basada en el examen físico dirigido, los diagnósticos de enfermería de la Clasificación Internacional de la Práctica de Enfermería y la adaptación de un protocolo de entrenamiento muscular como prescripción. Etapas: inspección estática, inspección dinámica y palpación para comprobar la tensión, evaluación de la fuerza, sustentación, relajación y coordinación muscular; seguidas de prescripciones de relajación, propiocepción, entrenamiento de fuerza, sustentación, coordinación abdomino-pélvica y mantenimiento, según el diagnóstico. Conclusión: Esta propuesta de protocolo pretende apoyar la evaluación de la musculatura pélvica en mujeres con incontinencia urinaria o con riesgo de desarrollarla por parte de los enfermeros de todos los niveles atención a la salud, especialmente como parte de la consulta de enfermería en atención primaria.

RESUMO Este trabalho parte de uma pesquisa multicêntrica que abrange 11 municípios que sofreram intervenção federal para o fechamento dos seus hospitais psiquiátricos e lançaram mão do Programa ‘De Volta para Casa’ (PVC) como estratégia de desinstitucionalização. Inspirados metodologicamente pela etnografia e metodologia de história de vida, realizou-se o acompanhamento dos itinerários dos primeiros beneficiários do PVC em um município paraibano e, a partir de observação participante e trocas diretas com eles, produziram-se narrativas orientadas por quatro eixos de análise: 1) Trajetória de vida; 2) Autonomia: emancipação x opressão; 3) O que o capital faz poder; 4) Acesso à saúde, acesso à vida. O objetivo foi compreender os efeitos deste auxílio– reabilitação na construção de autonomia de seus beneficiários, em seus diferentes graus. Entendendo autonomia enquanto capacidade do sujeito de construir vínculos em conjunto com outras pessoas e lidar com sua rede de dependências, apresentaram-se diferentes graus de autonomia expressos pelos beneficiários do PVC, partindo da centralidade desse conceito e do tensionamento que provoca. Percebeu-se que há muitas formas e graus de autonomia entre os beneficiários acompanhados, o que depõe contra a visão liberal hegemônica de autonomia.

ABSTRACT This work starts from a multicenter research that covers eleven cities that suffered federal intervention to close their psychiatric hospitals and have used the ‘De Volta para Casa’ Program (PVC – Back Home Program) as a deinstitutionalization strategy. Methodologically inspired by ethnography and life history methodology, we followed the itinerary of the first beneficiaries of PVC in a city in Paraíba, and from participant observation and direct exchanges with them, we produced narratives guided by four axes of analysis: 1) Life Trajectory; 2) Autonomy: emancipation x oppression; 3) What capital provides; 4) Access to health, access to life. Our goal was to understand the effects of this rehabilitation aid on the reconstruction of beneficiaries’ autonomy, in its different degrees. Understanding autonomy as the subject’s ability to build bonds with other people and deal with his dependency network, we present different degrees of autonomy expressed by PVC beneficiaries, starting from the centrality of the concept and the tension that it causes. It was noted that there are many ways and degrees of autonomy, which testifies against the hegemonic liberal view of autonomy.