ABSTRACT Objective: To determine the prevalence and factors associated with the physical rehabilitation of critically ill children in Brazilian pediatric intensive care units. Methods: A 2-day, cross-sectional, multicenter point prevalence study comprising 27 pediatric intensive care units (out of 738) was conducted in Brazil in April and June 2019. This Brazilian study was part of a large multinational study called Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU). The primary outcome was the prevalence of mobility provided by physical therapy or occupational therapy. Clinical data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥ 72 hours. Results: Children under the age of 3 years comprised 68% of the patient population. The prevalence of therapist-provided mobility was 74%, or 277 out of the 375 patient-days. Out-of-bed mobility was most positively associated with family presence (adjusted odds ratios 3.31;95%CI 1.70 - 6.43) and most negatively associated with arterial lines (adjusted odds ratios 0.16; 95%CI 0.05 - 0.57). Barriers to mobilization were reported on 27% of patient-days, the most common being lack of physician order (n = 18). Potential safety events occurred in 3% of all mobilization events. Conclusion: Therapist-provided mobility in Brazilian pediatric intensive care units is frequent. Family presence was high and positively associated with out-of-bed mobility. The presence of physiotherapists 24 hours a day in Brazilian pediatric intensive care units may have a substantial impact on the mobilization of critically ill children.

RESUMO Objetivo: Determinar a prevalência e os fatores associados à reabilitação física de crianças em estado grave em unidades de terapia intensiva pediátrica brasileiras. Métodos: Realizou-se um estudo de prevalência pontual multicêntrico, transversal, de 2 dias, abrangendo 27 unidades de terapia intensiva pediátrica (do total de 738) no Brasil em abril e junho de 2019. Este estudo brasileiro fez parte de um grande estudo multinacional chamado Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU). O desfecho primário foi a prevalência de mobilidade proporcionada pela fisioterapia ou pela terapia ocupacional. Foram coletados prospectivamente dados clínicos sobre a mobilidade do paciente, possíveis eventos de segurança de mobilidade e barreiras de mobilização em pacientes admitidos por ≥ 72 horas. Resultados: As crianças com idade inferior a 3 anos eram 68% da população de pacientes. A prevalência de mobilidade fornecida pelo terapeuta foi de 74%, ou 277 dos 375 pacientes-dia. A mobilidade para fora do leito foi mais positivamente associada à presença de familiares (razão de chance ajustada de 3,31; IC95% 1,70 - 6,43) e mais negativamente associada às linhas arteriais (razão de chance ajustada de 0,16; IC95% 0,05 - 0,57). Foram relatadas barreiras à mobilização em 27% dos pacientes-dia, sendo a mais comum a falta de prescrição médica (n = 18). Registaram-se eventuais eventos de segurança em 3% de todos os eventos de mobilização. Conclusão: A mobilidade proporcionada pelo terapeuta nas unidades de terapia intensiva pediátrica brasileiras é frequente. A presença de familiares foi alta e positivamente associada à mobilidade para fora do leito. A presença de fisioterapeutas 24 horas por dia nas unidades de terapia intensiva pediátrica brasileiras pode exercer papel importante na mobilização de crianças em estado grave.

Resumo Este artigo reflete sobre a compreensão dos profissionais que atuam na Estratégia Saúde da Família acerca das intersecções entre relações raciais e saúde. Para tanto, foram realizadas entrevistas semiestruturadas com profissionais que compõem as equipes de saúde da família em um município de Pernambuco, cujos dados foram analisados à luz das discussões que se debruçam sobre a temática racial. Os resultados apontam para as divergências entre os modelos de saúde presentes no cotidiano, para a invisibilidade da raça/cor na formação e atuação profissional e a branquitude como elemento estruturante das relações raciais. O estudo reafirma a necessidade do campo da saúde coletiva se debruçar sobre a intersecção entre o quesito raça/cor e as relações de cuidado em saúde, bem como o investimento na formação dos profissionais, que inclua a temática racial.

Abstract This paper reflects on the Family Health Strategy (ESF) workers’ understanding of racial relationships and health intersections. We conducted semi-structured interviews with ESF teams’ professionals in the State of Pernambuco, Brazil, whose data were analyzed in light of the discussions that focused on the racial theme. The results point to discrepancies between different health models in the daily routine, race/skin color invisibility in training and professional work, and whiteness as a structuring element of race relationships. The study reaffirms the need for Public Health to focus on the intersection between the issue of race/skin color and healthcare relationships and invest in the training of professionals regarding race discussions.

Resumo Este artigo reflete sobre a compreensão dos profissionais que atuam na Estratégia Saúde da Família acerca das intersecções entre relações raciais e saúde. Para tanto, foram realizadas entrevistas semiestruturadas com profissionais que compõem as equipes de saúde da família em um município de Pernambuco, cujos dados foram analisados à luz das discussões que se debruçam sobre a temática racial. Os resultados apontam para as divergências entre os modelos de saúde presentes no cotidiano, para a invisibilidade da raça/cor na formação e atuação profissional e a branquitude como elemento estruturante das relações raciais. O estudo reafirma a necessidade do campo da saúde coletiva se debruçar sobre a intersecção entre o quesito raça/cor e as relações de cuidado em saúde, bem como o investimento na formação dos profissionais, que inclua a temática racial. tanto Pernambuco racial cotidiano raçacor raça cor

Abstract This paper reflects on the Family Health Strategy (ESF) workers’ understanding of racial relationships and health intersections. We conducted semi-structured interviews with ESF teams’ professionals in the State of Pernambuco, Brazil, whose data were analyzed in light of the discussions that focused on the racial theme. The results point to discrepancies between different health models in the daily routine, race/skin color invisibility in training and professional work, and whiteness as a structuring element of race relationships. The study reaffirms the need for Public Health to focus on the intersection between the issue of race/skin color and healthcare relationships and invest in the training of professionals regarding race discussions. (ESF workers intersections semistructured semi structured teams Pernambuco Brazil theme routine raceskin skin work

Abstract: Introduction: The occurrence of pandemics, such as Covid-19, leads to a psychosocial disturbance that can break the limits of the population’s coping capacity, generating tensions and anxieties that are expressed in various degrees among those involved. Objective: To analyze the repercussions of the COVID-19 pandemic on the mental health of medical students in the State of Pernambuco. Methods: Cross-sectional analytical study conducted between July and August 2021 with medical students from 11 universities in Pernambuco. The dependent variables analyzed were the scores of anxiety, depression; the independent variables were resilience score, socio-demographic, behavioral characteristics and health conditions. The data were collected through Google Forms. Beck’s Anxiety and Depression Inventories, and Wagnild and Young’s Resilience Scale were applied. The study was approved by the local ethics committee and informed consent was sought and given. The data were analyzed using SPSS 25, considering as significant a p-value < 0,05. Result: 416 participants were included, the majority (60.9%) of the students were women, the average age was 25 years, and 73.8% of them lived in the municipality of their university. Moderate and severe anxiety symptoms were found in 27.2% and 10.3% of the sample, respectively. Moderate depressive symptoms were observed in 17.8% of the students. About 25% of the sample reported a low or very low degree of resilience. High resilience (Odds Ratio [OR] 0.18 [0.08-0.41]; p <0.001) and psychological support prior to the pandemic (OR 0.36 [0.14-0.95]; p = 0 .04) were protective factors and attending the clinical cycle (2nd-3rd year) was an independent risk factor (OR 1.95 [1.07-3.55]; p = 0.02) for moderate to severe anxiety. High resilience (OR 0.01 [0.02-0.11]; p < 0.001 and returning to one’s hometown during the suspension of classes (OR 0.41 [0.18-0.91]; p = 0.02) were protective factors and attending the clinical cycle was an independent risk factor (OR 2.74 [1.26-5.93]; p = 0.01) for moderate to severe depression. Conclusion: We found a high prevalence of moderate and severe anxiety symptoms, as well as moderate depressive symptoms. A high proportion of students demonstrated a low or very low degree of resilience.

Resumo: Introdução: As pandemias, como a de Covid-19, resultam em perturbação psicossocial que pode romper os limites da capacidade de enfrentamento, de modo a gerar tensões e angústias que se expressam variavelmente entre os envolvidos. Objetivo: analisar as repercussões da pandemia de Covid-19 na saúde mental de estudantes de Medicina do estado de Pernambuco. Método: estudo transversal e descritivo-analítico realizado entre julho e agosto de 2021 com estudantes de Medicina das 11 faculdades de Pernambuco. Como variáveis dependentes, foram analisados os escores de ansiedade e depressão. Quanto às variáveis independentes, foram estudadas: escore de resiliência, características sociodemográficas e comportamentais, e condições de saúde. A coleta dos dados foi realizada por meio da plataforma Google Forms. Aplicaram-se o Inventário de Beck para ansiedade e depressão e a escala de resiliência de Wagnild e Young. O estudo foi aprovado pelo Comitê de Ética em Pesquisa do Centro Universitário Maurício de Nassau, e os participantes concordaram o Termo de Consentimento Livre e Esclarecido. Os dados foram analisados pelo programa SPSS 25, considerando significativo valor p < 0,05. Resultado: participaram da pesquisa 416 estudantes. A amostra foi composta predominantemente por mulheres (60,9%), com idade média de 25 anos, das quais 73,8% tinham residência fixa no município da faculdade. Sintomas de ansiedade moderada e grave foram verificados em 27,2% e 10,3% dos avaliados, respectivamente. Observaram-se sintomas depressivos moderados em 17,8% dos estudantes. Cerca de 25% da amostra apresentou grau de resiliência baixo ou muito baixo. Resiliência alta (razão de chances [RC] = 0,18 [0,08-0,41]; p < 0,001) e suporte psicológico anterior à pandemia (RC = 0,36 [0,14-0,95]; p = 0,04) foram fatores de proteção; e cursar o ciclo clínico (quinto-oitavo períodos) foi fator de risco independente (RC = 1,95 [1,07-3,55]; p = 0,02) para ansiedade de moderada a grave. Resiliência alta (RC = 0,01 [0,02-0,11]; p < 0,001 e retornar à cidade natal durante a suspensão das aulas (RC = 0,41 [0,18-0,91]; p = 0,02) foram fatores protetores; e cursar o ciclo clínico foi fator de risco independente (RC = 2,74 [1,26-5,93]; p = 0,01) para depressão de moderada a grave. Conclusão: verificou-se uma alta prevalência de sintomas de ansiedade de moderada e grave, bem como de sintomas depressivos moderados. Um alta proporção dos estudantes apresentou grau de resiliência baixo ou muito baixo.

Abstract Objectives: This study aims to investigate if a sampling method using virtual networks is feasible to survey AS adoption among this “hard-to-reach” population of Brazilian doctors. Methods: An online piloted 11-point structured survey questionnaire (designed using Googleforms®) probed the actual treatment patterns for adult patients with PTMCs, including treatment decision-making nonoperative options, was undertaken between 10 November and 30 November 2020. Participants were reached by the mobile phone Application (APP) and a snowball sampling strategy was used to recruit a total of 4783 members (maximum number of potential reach), which is the total of doctors of the all 21 social media WhatsApp® groups. Results: From a total of 4783 members (maximum number of potential reach), there were 657 (13.7%) doctors (actual reach) who clicked the web link of the questionnaire, out of whom 512 (10.7%) fully completed the online survey. Among the survey respondents, 361 were endocrinologists (70.5%) and 151 were surgeons (29.5%). Overall, for low-risk PTMCs in an elderly patient, 118 responders (23%) recommend AS, while 390 (76%) recommend immediate surgery as the management, including lobectomy (18.5%) and Total Thyroidectomy (58.2%). The present responders tended to recommend surgery for PTMCs that were located adjacent to the dorsal surface of the thyroid, were multiple, or raised the size during the follow-up. Conclusion: Using snowball sampling strategy as an innovative route to conduct surveys was feasible and applicable but the rate of response was still very low. Our data also suggests the need to investigate if AS is embraced by Brazilian doctors.

Abstract Background: it is essential for an early nutritional intervention that utilizes effective and practical nutritional screening and evaluation tools to diagnose nutritional status, increasing the patient's survival. Objective: to evaluate the agreement of the Graz Malnutrition Screening (GMS) with subjective methods of nutritional evaluation in hospitalized patients. Methods: descriptive cross-sectional study with adults and elderly of both sexes evaluated within 48 hours of hospital admission. Nutritional status in cancer patients was identified by the Patient-Generated Subjective Global Assessment (PG-SGA(r)) and in the elderly by the Mini Nutritional Assessment Short-Form (MNA-SF(r)). GMS was applied in both groups and its efficiency was compared with that of PG-SGA(r) and MNA-SF(r). The agreement between the methods was evaluated by the kappa test, followed by assessment of diagnostic performance and correlation test. Results: of the 87 patients evaluated, 64.4% (56) presented nutritional risk according to GMS, while 49.4% (43) and 47.1% (41) indicated nutritional risk and malnutrition according to MNA-SF(r) and PG-SGA(r), respectively. GMS presented moderate agreement with PG-SGA(r) (p < 0.001) and MNA-SF(r) (p < 0.001), with high sensitivity, specificity, positive predictive value, and negative predictive value. Correlations were observed between the GMS score and both the PG-SGA(r) (p < 0.001) and MNA-SF(r) scores (p < 0.001). Conclusion: GMS was effective in detecting nutritional risk in hospitalized patients when compared to classic tools in the evaluation of nutritional status in hospitalized patients.

Resumen Introducción: el uso de herramientas de clasificación y evaluación nutricional eficaces, además de prácticas para diagnosticar el estado nutricional con el fin de aumentar la supervivencia del paciente, es imprescindible para una intervención nutricional temprana. Objetivo: evaluar la concordancia del Graz Malnutrition Screening (GMS) con métodos subjetivos de evaluación nutricional en pacientes hospitalizados. Metodología: estudio descriptivo transversal con adultos y ancianos de ambos sexos, evaluados hasta 48 horas después de la admisión hospitalaria. El estado nutricional de los pacientes con cáncer fue identificado mediante la Valoración Global Subjetiva Generada por el Paciente (VGS-GP(r)) y el de los ancianos, mediante el test Mini Nutritional Assesment (MNA(r)). El GMS fue aplicado en ambos grupos y se comparó su eficiencia con la VGS-GP(r) y el MNA-SF(r). La concordancia entre los métodos fue evaluada por el test de kappa. Resultados: de los 87 pacientes evaluados, el 64,4% presentó riesgo nutricional según el GMS, mientras que el 49,4% y el 47,1% indicaron riesgo nutricional y desnutrición de acuerdo con el MNA-SF(r) y la VGS-GP(r), respectivamente. El GMS presentó una concordancia moderada con la VGS-GP(r) (p < 0,001) y el MNA-SF(r) (p < 0,001), con alta sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. Se observaron correlaciones entre la puntuación del GMS con las puntuaciones de la VGS-GP (p < 0,001) y de la MNA-SF (p < 0,001). Conclusión: el GMS fue eficaz en la detección del riesgo nutricional en pacientes hospitalizados, en comparación con las herramientas clásicas en la evaluación del estado nutricional de pacientes hospitalizados.

OBJECTIVES: Acute kidney injury is associated with many conditions, and no interventions to improve the outcomes of established acute kidney injury have been developed. We performed this study to determine whether goal-directed therapy conducted during the early stages of acute kidney injury could change the course of the disease. METHODS: This was a multicenter prospective randomized controlled study. Patients with early acute kidney injury in the critical care unit were randomly allocated to a standard care (control) group or a goal-directed therapy group with 8h of intensive treatment to maximize oxygen delivery, and all patients were evaluated during a period of 72h. ClinicalTrials.gov: NCT02414906. RESULTS: A total of 143 patients were eligible for the study, and 99 patients were randomized. Central venous oxygen saturation was significantly increased and the serum lactate level significantly was decreased from baseline levels in the goal-directed therapy group (p=0.001) compared to the control group (p=0.572). No significant differences in the change in serum creatinine level (p=0.96), persistence of acute kidney injury beyond 72h (p=0.064) or the need for renal replacement therapy (p=0.82) were observed between the two groups. In-hospital mortality was significantly lower in the goal-directed therapy group than in the control group (33% vs. 51%; RR: 0.61, 95% CI: 0.37-1.00, p=0.048, number needed to treat=5). CONCLUSIONS: Goal-directed therapy for patients in the early stages of acute kidney injury did not change the disease course.

OBJECTIVES: To evaluate the accuracy of the ROPScore algorithm as a predictor of retinopathy of prematurity (ROP). METHODS: A prospective cohort of 220 preterm infants with a birth weight ≤1500 g and/or gestational age ≤32 weeks was included. The ROPScore was determined in the sixth week of life in 181 infants who then survived until a corrected gestational age of 45 weeks. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of the algorithm were analyzed. RESULTS: ROP was found in 17.6% of the preterm infants. The sensitivity of this test for any stage of ROP was 87.5%, while that for severe ROP was 95.4% (21/22 cases). The PPV and NPV were 59.6% and 97%, respectively, for any stage of ROP and 44.7% and 99.25%, respectively, for severe ROP. The ROPScore could therefore hypothetically reduce the number of ophthalmologic examinations required to detect ROP by 71.8%. CONCLUSION: The ROPScore is a useful screening tool for ROP and may optimize examinations and especially the identification of severe ROP.

Resumo O presente estudo teve como objetivo descrever como os estudantes talentosos percebem seu talento, com foco nos modos reflexivos que caracterizam sua autoconsciência. Sete estudantes, com idades entre 11 e 13 anos, previamente identificados com dotação e talento, responderam a uma entrevista semiestruturada e os dados obtidos foram analisados qualitativamente através do método fenomenológico-semiótico. Os resultados revelaram seis temas na percepção dos talentosos: consciência do talento; gostar, pensar e escolher; tensão e autocobrança; desafios; conversando consigo mesmo; e futuro. A discussão sugere que desenvolver a própria habilidade envolve frustrações, desafios e possíveis dificuldades para o estudante talentoso. Contudo, a persistência é uma característica comum de sua reflexividade consciente, aparecendo relacionada à busca do sucesso e ao planejamento e à implementação de estratégias para alcançá-lo. Em conclusão, aborda-se a relação entre as características de autorreflexão e de autorruminação dos estudantes talentosos e suas diferentes estratégias de resolução de problemas.

Abstract The present study aimed to describe how talented students perceive their talent, focusing on the reflexive modes that characterize their self-awareness. Seven students, aged 11 to 13 years, previously identified with intellectual giftedness and talent, answered a semi-structured interview and the data obtained were analyzed qualitatively through the phenomenological-semiotic method. The results revealed six themes in the perception of talented: talent awareness; liking, thinking and choosing; tension and self-breeding; challenges; talking to himself; and future. The discussion suggests that developing one's own skill involves frustrations, challenges and possible difficulties for the talented student. However, persistence is a common feature of his conscious reflexivity, appearing related to the pursuit of success and to the planning and implementation of strategies to achieve it. In conclusion, the relationship between the self-reflection and self-trapping characteristics of gifted students and their different problem-solving strategies is discussed.

Resumen En el presente estudio se tuvo el objetivo describir como los estudiantes talentosos perciben su talento, con enfoque en los modos reflexivos que caracterizan su autoconsciencia. Siete estudiantes, con edades entre 11 y 13 años, previamente identificados con dotación y talento, respondieron a una entrevista semiestructurada y los datos obtenidos se analizaron cualitativamente por intermedio del método fenomenológico-semiótico. Los resultados revelaron seis temas en la percepción de los talentosos: consciencia del talento; gustar, pensar y escoger; tensión y auto-cobranza; retos; conversando consigo mismo; y futuro. La discusión sugiere que desarrollar la propia habilidad abarca frustraciones, desafíos y posibles dificultades para el estudiante talentoso. No obstante, la persistencia es una característica común de su reflexividad consciente, apareciendo relacionada a la búsqueda del éxito y a la planificación y a la implementación de estrategias para alcanzarlo. En conclusión, se aborda la relación entre las características de autorreflexión y de autorruminación de los estudiantes talentosos y sus diferentes estrategias de resolución de problemas.

OBJECTIVES: Although liver biopsy is the gold standard for determining the degree of liver fibrosis, issues regarding its invasiveness and the small amount of liver tissue evaluated can limit its applicability and interpretation in clinical practice. Non-invasive evaluation methods for liver fibrosis can address some of these limitations. The aim of this study was to evaluate the accuracy of transient elastography-FibroScan®, acoustic radiation force impulse (ARFI), enhanced liver fibrosis (ELF), the aspartate aminotransferase-to-platelet ratio index (APRI), and the FIB-4 index compared with liver biopsy in hepatitis C. METHODS: We evaluated chronic hepatitis C patients who were followed at the Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology of University of São Paulo School of Medicine, São Paulo, Brazil, and who underwent liver biopsy. The accuracy of each method was determined by a receiver operating characteristic (ROC) curve analysis, and fibrosis was classified as significant fibrosis (≥F2), advanced fibrosis (≥F3), or cirrhosis (F4). The Obuchowski method was also used to determine the diagnostic accuracy of each method at the various stages of fibrosis. In total, 107 FibroScan®, 51 ARFI, 68 ELF, 106 APRI, and 106 FIB-4 analyses were performed. RESULTS: A total of 107 patients were included in the study. The areas under the ROC curve (AUROCs) according to fibrosis degree were as follows: significant fibrosis (≥F2): FibroScan®: 0.83, FIB-4: 0.76, ELF: 0.70, APRI: 0.69, and ARFI: 0.67; advanced fibrosis (≥F3): FibroScan®: 0.85, ELF: 0.82, FIB-4: 0.77, ARFI: 0.74, and APRI: 0.71; and cirrhosis (F4): APRI: 1, FIB-4: 1, FibroScan®: 0.99, ARFI: 0.96, and ELF: 0.94. The accuracies of transient elastography, ARFI, ELF, APRI and FIB-4 determined by the Obuchowski method were F0-F1: 0.81, 0.78, 0.44, 0.72 and 0.67, respectively; F1-F2: 0.73, 0.53, 0.62, 0.60, and 0.68, respectively; F2-F3: 0.70, 0.64, 0.77, 0.60, and 0.67, respectively; and F3-F4: 0.98, 0.96, 0.82, 1, and 1, respectively. CONCLUSION: Transient elastography remained the most effective method for evaluating all degrees of fibrosis. The accuracy of all methodologies was best at F4.

RESUMO Partiu-se da concepção de escola como lugar de formação de aprendizes na relação com educadores, privilegiado para trabalhar questões relevantes à vivência social, como o uso de drogas, desde o início da escolarização. Objetivou-se levantar concepções de professoras dos anos iniciais do ensino fundamental que participaram da quinta edição do curso de prevenção ao uso de drogas para educadores de escolas públicas sobre os conteúdos abordados e sua prática cotidiana. Buscou-se refletir sobre a importância de criar formas pedagógicas pautadas no acolhimento às vivências das crianças. Realizou-se entrevistas com vinte e uma professoras ex-cursistas do Distrito Federal. A análise das categorias construídas permitiu refletir sobre a prática educativa cotidiana e a necessidade da escuta dos discursos das crianças sobre as drogas. As professoras puderam perceber que há abertura para abordar essas questões e demandaram formação teórico-prática como instrumento que auxilie o trabalho pedagógico.

ABSTRACT This study is based on the conception of school as a place of education where apprentices establish a relation to educators and as privileged setting to work issues relevant to social life, such as drug use, since the beginning of schooling. The goal was to raise conceptions of elementary school teachers who participated in the fifth edition of the course for drug abuse prevention for public school educators, on the content covered and on their daily teaching practice. We sought to bethink the importance of creating educational ways guided by the embracement of children’s experiences. Interviews were conducted with twenty-one teachers from the Federal District who previously participated in the course. The analysis allowed thinking over everyday educational practices and the necessity of listening to children’s discourses about drugs. The teachers were able to realize that there is openness for addressing these issues and demanded theoretical and practical education as a tool to assist on their pedagogical work.

RESUMEN La investigación partió de la concepción de escuela como espacio de formación de aprendices en relación con los educadores, privilegiado a trabajar cuestiones relevantes a la vida social, tales como el consumo de drogas, desde el inicio de la escolarización. Hubo como objetivo la búsqueda de las concepciones de profesoras de los años iníciales de la enseñanza primaria de escuelas públicas, participantes de la quinta edición del curso de prevención de abuso de drogas para educadores de la escuela pública, sobre los contenidos abordados en el curso y su práctica pedagógica diaria. Fueron entrevistadas veinte y una profesoras del Distrito Federal que hicieron el curso. El análisis de las categorías construidas permitió reflexionar sobre la práctica educativa cotidiana y la necesidad de escuchar los discursos de los niños sobre las drogas. Las profesoras fueron capaces de percibir que hay la posibilidad de abordar estas cuestiones y pidieron formación teórica y práctica como algo para ayudarlas en su trabajo.

Colheu-se sangue de 13 eqüinos competindo na prova de Fundo do Concurso Completo de Equitação, categoria internacional três estrelas, e dosou-se lactato sangüíneo na manhã antes da prova, antes e imediatamente depois das fases B e D e 10 minutos após a fase D. Foi observado aumento significativo nas concentrações de lactato apenas após o término da fase D, demonstrando que os animais foram submetidos a um grande esforço físico, com desenvolvimento de acidose metabólica decorrente do acúmulo de lactato. Houve diminuição significativa dos valores dez minutos após o término do cross-country, exceto para o eqüino de número 12, único animal a completar o percurso dentro do tempo estipulado, o qual apresentou sinais clínicos de exaustão.

Blood samples were collected from thirteen horses competing in the resistance phase of an advanced 3-day-event. Blood lactate was determined in the morning before competition, before and immediately after phases B and D, and 10 minutes after phase D. Significant increase in blood lactate was observed only after phase D, showing that animals were submitted to a great physical effort with development of metabolic acidosis due to lactate accumulation. There was significant decrease in blood lactate levels 10 minutes after cross country except horse 12, the only animal to finish phase D inside the given time, but showed clinical signs of exhaustion.