Resumen Objetivo: La asociación de comorbilidades y síntomas cardíacos que alteran la función miocárdica podría ayudar a los médicos a identificar correctamente a poblaciones de riesgo. Métodos: Se realizó un estudio transversal en población abierta de pacientes referidos a una unidad de PET/CT en la Ciudad de México para evaluación de la función miocárdica, perfusión y circulación coronaria. La isquemia se definió como una suma de diferencia de puntuación (SDS) ≥ 2. La asociación entre las comorbilidades y los síntomas cardíacos se fundamentó mediante modelos de regresión logística y análisis de tendencias. Realizamos un análisis de interacción para evaluar la adición de cualquier síntoma acompañante a condiciones comórbidas en el deterioro de la función miocárdica. Resultados: Se incluyeron 1.273 pacientes, 66,1% del sexo masculino, con una edad media de 62,4 (± 12.7) años, 360 (28,7%) con isquemia, 925 (72,7%) con al menos una comorbilidad y 676 (53,1%) con al menos una menos un síntoma cardíaco asociado. En pacientes sin isquemia, la diabetes mellitus tipo 2, la hipertensión arterial y los síntomas cardíacos adversos se asociaron con parámetros mecánicos, de perfusión y de flujo coronario adversos. Se observó una tendencia con el número acumulado de comorbilidades y síntomas cardíacos con aumento de la isquemia y disminución del flujo coronario. Solo en la disminución de la FEVI se demostró un efecto de interacción entre el aumento de las comorbilidades y los síntomas adversos. Conclusión: La alta carga de comorbilidades y síntomas en nuestra población altera la función miocárdica independientemente del nivel de isquemia.

Abstract Objective: Associating comorbidities and cardiac symptoms that alter myocardial mechanical function could help clinicians to correctly identify at-risk population. Methods: We conducted a functional open population cross-sectional study of patients referred to a positron emission tomography/computed tomography unit in Mexico City for evaluation of myocardial function, perfusion, and coronary circulation. Ischemia was defined as a sum difference score ≥ 2. Association between comorbidities and cardiac symptoms was tested using logistic regression models and trend analysis. We performed an interaction analysis to evaluate the addition of any accompanying symptoms to comorbid conditions on impairment of myocardial function. Results: One thousand two hundred and seventy-three patients were enrolled, 66.1% male, with a mean age of 62.4 (± 12.7) years, 360 (28.7%) with ischemia, 925 (72.7%) with at least one comorbidity, and 676 (53.1%) had at least one associated cardiac symptom. Patients without ischemia, type 2 diabetes, arterial hypertension, and adverse cardiac symptoms were associated with adverse mechanical, perfusion, and coronary flow parameters. We observed a trend of a cumulative number of comorbidities and cardiac symptoms with increased ischemia and decreased coronary flow. Only in decreased left ventricular ejection fraction, we demonstrated an interaction effect between increased comorbidities and adverse symptoms. Conclusion: The high burden of comorbidities and symptoms in our population alters myocardial function regardless of the level of ischemia.

SUMMARY OBJECTIVE: The aim of this study was to investigate the role of irisin in type 2 diabetes mellitus and its association with metabolic alterations and obesity. METHODS: A cross-sectional case-control study was conducted on participants treated at Centro Universitário FMABC between August 2018 and July 2019, by comparing a control group (n=14) with type 2 diabetes mellitus patients (n=16). The control group consisted of participants aged above 21 years with no chronic diseases, diabetes, smoking, or illicit drug use. The type 2 diabetes mellitus group included patients aged above 21 years, who were diagnosed with type 2 diabetes for at least 5 years (glycated hemoglobin>7%). Exclusion criteria were not willing to continue, recent hospitalization, and failure to meet inclusion criteria. Biochemical parameters included blood glucose, glycated hemoglobin, plasma irisin levels, and irisin gene expression in peripheral blood. RESULTS: Type 2 diabetes mellitus patients exhibited significantly higher plasma glucose levels [143 (40) vs. 92 (13) mg/dL, *p<0.05] and glycated hemoglobin levels [7.1% (1.6) vs. 5.6% (0.5), *p<0.05] compared to the control group. Irisin gene expression in type 2 diabetes mellitus patients was lower 0.02288 (0.08050) than the control group 8.506e-006 (1.412e-005) (p=0.06). Correlation analysis revealed a positive association between irisin expression and body mass index in type 2 diabetes mellitus (Rho=0.5221, 95%CI -0.058 to 0.838, p=0.06), while plasma irisin showed a negative correlation with body mass index (Rho=-0.656, 95%CI -0.836 to 0.215, p=0.03). No significant correlations were found between plasma glucose or glycated hemoglobin levels and irisin expression. CONCLUSION: The data suggests that body mass index directly influences plasma irisin levels and the regulation of irisin gene expression, possibly linking irisin to adiposity changes observed in obesity-related type 2 diabetes mellitus.

Abstract Hormonal methodologies to control small ruminants’ estrous cycle are worldwide used and evolved, adjusting the application to the precise female physiological moments to enhance reproductive performance. The estrous cycle can be induced and/or synchronized, aiming for fixed-time artificial insemination, or based on estrus behavior signs for insemination, natural or guided mating. Successive protocols can be performed to resynchronize ovulation and increase reproductive outcomes in females that failed to conceive. These recently developed treatments aim to resynchronize the ovulation as earlier as non-pregnancy is detected. The present review aimed to summarize the recent advances and main findings regarding resynchronization protocols used in small ruminants. Lastly, we present future perspectives and new paths to be studied in the subject. The resynchronization treatment is still a growing field in small ruminant reproduction, nevertheless, some enhancements are found in the reproductive outcome, showing that such protocols can be successfully used in sheep and goat production. ruminants evolved performance andor synchronized fixedtime fixed time insemination mating conceive nonpregnancy non pregnancy detected Lastly subject reproduction nevertheless outcome production

RESUMO Ainda que a técnica de encapsulamento seja usada na remediação ambiental há mais de três décadas, existem poucos estudos que avaliam sua eficácia para altas concentrações de contaminantes. Assim, este trabalho tem como objetivo avaliar a eficiência da técnica de encapsulamento de solo argiloso contaminado com 5 e 10% de cloreto de zinco, utilizando cal e cimento. Análises química, mecânica, mineralógica e microscópica foram realizadas para o solo puro, contaminado e encapsulado, com base em ensaios de fluorescência de raios X, resistência à compressão simples, espectrometria de absorção atômica, microscopia eletrônica de varredura e microtomografia de raios X. Ambos os agentes encapsulantes aumentaram a resistência ao longo dos períodos de cura de sete, 28 e 60 dias, embora as interações químicas entre zinco e cal tenham afetado negativamente os ganhos quando comparados ao do cimento. Os lixiviados apresentaram redução significativa na concentração de zinco, acima de 77% para condições experimentais críticas. O contaminante reduziu a presença de elementos químicos que compõem a matriz do solo, fazendo com que os vazios aumentassem; por outro lado, as reações pozolânicas promovidas pela adição de cal e cimento resultaram em distribuição de vazios mais homogênea, melhorando o comportamento mecânico e a capacidade de retenção de cloreto de zinco.

ABSTRACT Although the encapsulation technique has been used in environmental remediation for over three decades, there are few studies evaluating its efficacy for high contaminant concentrations. Therefore, this study aims to evaluate the encapsulation technique efficiency of clayey soil contaminated with 5% and 10% of zinc chloride, using lime and cement. Chemical, mechanical, mineralogical, and microscopic analyses were performed for pure, contaminated, and encapsulated soil, based on X-ray fluorescence (XRF/EDX), unconfined compression strength (UCS), atomic absorption spectrometry (AAS), scanning electron microscopy/energy dispersive X-ray spectrometer (SEM/EDS), and X-ray micro-computed tomography (micro-CT) tests. Although chemical interactions between zinc and lime negatively affected the gains when compared to cement, both encapsulating agents increased the strength over the curing periods of 7, 28, and 60 days. The leachates presented a significant reduction in the contaminant concentration, above 77% for critical experimental conditions. The contaminant reduced the presence of chemical elements that compose the soil matrix, consequently causing the voids to increase; in contrast, pozzolanic reactions promoted by the addition of lime and cement resulted in homogeneous voids distribution, enhancing the mechanical behavior and the capability of zinc chloride retention.

ABSTRACT OBJECTIVE To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.

ABSTRACT OBJECTIVE To show the implementation process of IPT-G in primary care, including facilitating and obstructing factors, implementation strategies, and training and supervision of primary care professionals. METHODS Quantitative (cross-sectional and longitudinal) analysis of pre and post-knowledge tests; qualitative analyses of the training courses; patient recruitment; conduction of IPT-G sessions; supervision of IPT-G therapists; application of a semi-structured questionnaire to assess, investigate, and develop strategies against the identified barriers. RESULTS About 120 clinicians answered the pre-test; 84 completed the post-test. Pre- and post-test scores of IPT-G knowledge were significantly different. Twenty initially trained clinicians completed additional supervision in IPT-G. Qualitative analysis identified twelve barriers and six facilitators to IPT-G implementation in individual, organizational, and systemic contexts. CONCLUSIONS Implementation of IPT-G in primary care is a complex process with several steps. In the first step, health professionals were successfully trained in IPT-G. However, subsequent steps were more complex. Therefore, careful planning of IPT-G implementation is essential to maximize the success of this innovation.

Abstract Pharmaceutical Care is a subject within the Pharmacy Degree that is taught using theoretical and practical classes. When COVID-19 appeared, Faculty of Pharmacy had to change its way of teaching and learning to online classes. Our aim is to assess the impact of COVID-19 situation on practical classes in Pharmaceutical Care. A prospective study was performed by undergraduate students from Pharmaceutical Care subject. Students attended to 2-day practical classes and were assessed through an evaluative workbook. Undergraduate students (n=390) obtained a score of 8.4±0.8 in practical classes, being higher in face-to-face sessions than online sessions, but not significant differences among both methodologies. The higher score was for the session of minor ailment services (9.3±1.3) and the lower for Personalized Medication Dosage (7.0±1.6) and similar in both scenarios. 59% of students obtained more than 8 score in the global punctuation, being higher in in-face-to-face practical classes. This study showed that learning in health care can be guided and evaluated through an online method. Adapt to new technologies, prevent vulnerable students from being left behind, as well as working on cross-cutting skills at a distance, are some of the challenges of higher education in times of COVID-19.

RESUMEN Introducción: Los instrumentos normativos de la profesión declaran la necesidad de incluir en los servicios de emergencia (SE) Enfermeros Especializados en Enfermería de Rehabilitación (EEER). En este contexto, se intentó comprender la relevancia de la contribución del EEER en el contexto actual de SE. Metodología: Estudio cualitativo, exploratorio y descriptivo, utilizando un grupo focal como técnica de recolección de datos, en una muestra intencional de ocho enfermeras expertas, cuatro de ellas en el área de urgencia y cuatro EEER. Resultados: Surgen dos categorías: organización del cuidado, con mayor relevancia atribuida a las subcategorías equipos y organización de los SE, con un peso de 18,0% y 12,8% respectivamente en la totalidad del discurso; y prestación de cuidados, con mayor relevancia atribuida a las subcategorías prevención de complicaciones y formación de la persona / cuidador para el alta, con un peso de 11,9% y 11,6%, respectivamente. Discusión: Corroborando los hallazgos de este estudio, la evidencia destaca la relevancia en los dominios de liderazgo y atención interprofesional, percibiéndose también ganancias a nivel respiratorio y motor. Conclusión: Los participantes identifican los beneficios de la integración de una EEER en los SE en la organización del servicio y en la prestación asistencial, destacando la complementariedad de competencias comunes y específicas, cumpliendo así los referentes de la profesión sobre la necesidad de dotar de estos contextos a estos profesionales.

RESUMO Introdução: Os instrumentos reguladores da profissão declaram a necessidade de se incluirem nos serviço de urgência (SU) Enfermeiros Especialistas em Enfermagem de Reabilitação (EEER). Neste contexto procurou-se compreender a relevância do contributo do EEER no contexto atual nos SU. Metodologia: Estudo qualitativo, exploratório e descritivo, com recurso a focus group como técnica de recolha de dados, numa amostra intencional de oito enfermeiros peritos, quatro deles na área da urgência e quatro EEER. Resultados: Duas categorias emergem: organização dos cuidados, com maior relevância atribuída às subcategorias equipas e organização dos SU, com um peso 18,0% e 12,8% respetivamente na totalidade do discurso; e prestação dos cuidados, com maior relevância atribuída às subcategorias prevenção de complicações e capacitação da pessoa/cuidador para a alta, com um peso 11,9% e 11,6% respetivamente. Discussão: Corroborando os achados deste estudo, a evidência salienta a relevância nos domínios da liderança e cuidados interprofissionais, havendo igualmente ganhos percebidos a nível respiratório e motor. Conclusão: Os participantes identificam ganhos da integração do EEER no SU na organização do serviço e na prestação de cuidados, evidenciando a complementaridade entre competências comuns e específicas, indo assim ao encontro dos referenciais da profissão sobre a necessidade de dotar estes contextos destes profissionais.

ABSTRACT Introduction: The profession's regulatory instruments declare the need to include in the emergency services rehabilitation nurses. In this context, an attempt was made to understand the relevance of the contribution of rehabilitation nurses in the current context in emergency services. Methodology: Qualitative, exploratory and descriptive study, using a focus group as a data collection technique, in an intentional sample of eight expert nurses, four of them in the urgency area and four rehabilitation nurses. Results: Two categories emerge: organization of care, with greater relevance attributed to the subcategories teams and organization of the emergency services, with a weight of 18.0% and 12.8%, respectively, in the totality of the discourse; and provision of care, with greater relevance attributed to the subcategories prevention of complications and training of the person / caregiver for discharge, with a weight of 11.9% and 11.6%, respectively. Discussion: Corroborating the findings of this study, evidence highlights the relevance of rehabilitation nursing in the domains of leadership and interprofessional care, with gains also perceived at respiratory and motor levels. Conclusion: The participants identify gains from the integration of rehabilitation nurses in emergency services in the organization of the service and in the provision of care, highlighting the complementarity of common and specific competences, thus meeting the profession's references on the need to provide these contexts for these professionals.

Resumo A restrição do crescimento fetal (RCF) ocorre quando umfeto não consegue atingir seu potencial de crescimento intrauterino, na maioria das vezes por compromisso da função placentária. É uma condição que afeta de 5 a 10% das gravidezes e é a segunda causa mais comum de morbidade e mortalidade perinatal. Crianças nascidas com RCF incorrem em maior risco de atraso no desenvolvimento neurológico e cognitivo, bem como de doenças cardiovasculares e/ou endócrinas, na idade adulta. O objetivo desta revisão foi o de pesquisar na literatura evidência sobre o diagnóstico pré-natal por ecografia de lesões cerebrais relacionadas com a RCF. Utilizando uma abordagem sistemática, avaliamos de forma quantitativa a metodologia dos oito estudos que preencheram os critérios de inclusão e foram, assim, incluídos nesta revisão. Foram identificados estudos de alta qualidade para a medição dos volumes cerebrais;medição do corpo caloso; medição da profundidade das incisuras cerebrais emedição do cavum do septo pelúcido. Os autores identificaram um estudo de qualidade inferior sobre a medição transversal do diâmetro transcerebelar em fetos com RCF. Mais estudos prospectivos randomizados são necessários para perceber quais as alterações que ocorrem no cerébro dos fetos com restrição do seu crescimento, bem como, a sua correlação com as alterações do desenvolvimento cognitivo observadas.

Abstract Fetal growth restriction (FGR) occurswhen the fetus does not reach its intrauterine potential for growth and development as a result of compromise in placental function. It is a condition that affects 5 to 10% of pregnancies and is the second most common cause of perinatal morbidity and mortality. Children born with FGR are at risk of impaired neurological and cognitive development and cardiovascular or endocrine diseases in adulthood. The purpose of the present revision is to perform a literature search for evidence on the detection and assessment by ultrasound of brain injury linked to FGR during fetal life. Using a systematic approach and quantitative evaluation as study methodology, we reviewed ultrasound studies of the fetal brain structure of growth-restricted fetuses with objective quality measures. A total of eight studies were identified. High quality studies were identified for measurement of brain volumes; corpus callosum; brain fissure depth measurements, and cavum septi pellucidi width measurement. A low-quality study was available for transverse cerebellar diameter measurement in FGR. Further prospective randomized studies are needed to understand the changes that occur in the brain of fetuseswith restricted growth, as well as their correlation with the changes in cognitive development observed.

ABSTRACT Introduction : Difficult cannulation in cases of endoscopic retrograde cholangiopancreatography (ERCP) could be associated with several factors, including: type of major papilla, however, there are limited data regarding this possible association. Objectives : To determine the association between the type of papilla and difficult biliary cannulation. Materials and methods : A retrospective cross-sectional analytical study was conducted in patients over 18 years old who underwent ERCP on papilla naive, from July 2019 to April 2021, in a private institution. Unsuccessful cannulations were excluded. The papilla was classified based on Haraldsson classification. The crude association and adjusted for possible confounders between the type of papilla and difficult cannulation was evaluated. Relative risks (RR) and 95% confidence intervals were calculated. Results : 188 patients were included. The mean age was 55 years, 66% female. The most frequent indication was choledocholithiasis with 88.5%. The most frequent type of major duodenal papilla was type 1 (32%), followed by type 3 (27%), type 2 (25%) and type 4 (16%). Type 2, 3, 4 papillae showed a significant relationship with difficult cannulation compared to type 1 (p<0.001, p<0.001 and p=0.008 respectively). The indication other than choledocholithiasis also showed a significant relationship with difficult cannulation (p<0.001). In the adjusted analysis, the RR for difficult cannulation compared to type 1 papilla was: 2.51 (95% CI 1.23-5.94) for type 2 papilla, 3.72 (95% CI 1.79-7.71) for papilla type 3 and 3.41 (95% CI 1.54-7.71) for type 4. The indication other than choledocholithiasis was also associated with a higher risk of difficult cannulation with a RR of 2.36 (95% CI 1.57-3.56). The fistulotomy type precut was used more frequently in the type 3 papilla (46%), while the use of cannula was more frequent in the type 4 papilla (29.6%). Conclusions : Papilla types 2, 3 and 4 are associated with a higher risk of difficult cannulation. This should be considered when performing ERCP in order to reduce the risk of complications.

RESUMEN Introducción : La canulación difícil en casos de colangiopancreatografía retrógrada endoscópica (CPRE) podría asociarse a diversos factores incluyendo el tipo de papila mayor, sin embargo, existen datos limitados con respecto a esta posible asociación. Objetivos : Determinar la asociación entre el tipo de papila y la canulación biliar difícil. Materiales y métodos : Se realizó un estudio retrospectivo transversal analítico en pacientes mayores de 18 años en quienes se realizó CPRE en papila virgen, de julio 2019 a abril 2021, en una institución privada. Se excluyeron las canulaciones frustras. La papila fue clasificada en base a la clasificación de Haraldsson. Se evaluó la asociación cruda y ajustada a posibles confusores entre el tipo de papila y canulación difícil. Se calcularon los riesgos relativo (RR) e intervalos de confianza al 95%. Resultados : Se incluyeron 188 pacientes. La edad media fue 55 años, el 66% de sexo femenino. La indicación más frecuente fue coledocolitiasis con 88,5%. El tipo de papila duodenal mayor más frecuente fue el tipo 1 (32%), seguido de tipo 3 (27%), tipo 2 (25%) y tipo 4 (16%). Las papilas tipo 2, 3, 4 presentaron una relación significativa con canulación difícil comparadas con la tipo 1 (p<0,001, p<0,001 y p=0,008 respectivamente). La indicación diferente a coledocolitiasis también mostró una relación significativa con canulación difícil (p<0,001). En el análisis ajustado, El RR para canulación difícil en comparación con la papila tipo 1 fue: de 2,51 (IC 95% 1,23-5,94) para la papila tipo 2, 3,72 (IC 95% 1,79-7,71) para la papila tipo 3 y 3,41 (IC 95% 1,54-7,71) para la tipo 4. La indicación distinta a la coledocolitiasis también se asoció a un mayor riesgo de canulación difícil con un RR de 2.36 (IC95% 1,57-3,56). El precorte tipo fistulotomía fue usado con mayor frecuencia en la papila tipo 3 (46%) mientras que el uso de canulótomo fue más frecuente en la papila tipo 4 (29,6%). Conclusiones : Los tipos de papila 2, 3 y 4, están asociados a mayor riesgo de canulación difícil. Ello debe ser considerado al momento de realizar la CPRE a fin de reducir el riesgo de complicaciones.

Background: Migration implies the displacement of people from one place to another, bringing as a consequence frequent experiences of family separation, which violates its members since the distance hinders the instrumental and affective support that may exist between the members. The long and intense interaction between the communities of origin and those of destination associated with migration has turned multiple locations in Mexico into transnational spaces. Objective: Analyze the perception that mothers and their adolescent sons/daughters have about family dynamics when the father is absent. Method: Two groups were compared: families with and without migration experience in a transnational rural community in Michoacán, Mexico. A quantitative method was used, working with a sample of 96 participants (48 mother-child adolescent pairing). The Intrafamily Relationship Assessment Scale, the Parental Practices Scale, and the Marital Satisfaction Scale were applied. Results: It was found that mothers and their adolescent sons/daughters perceive less union and support in the family when the father is a migrant. The group with the father at home had higher scores in family expression, from both perspective, of the mothers and from that of their adolescent children. Finally, it was observed that the marital satisfaction of mothers influences parenting practices. Conclusion: These results may be a risk or protective factors for the physical and mental health of the different members of the family, and it should be considered in future public policies for this population.

Introducción: La migración implica el desplazamiento de personas de un lugar a otro, trayendo como consecuencia frecuentes experiencias de separación familiar, lo que vulnera a sus miembros ya que la distancia dificulta el apoyo instrumental y afectivo que puede haber entre los integrantes. La larga e intensa interacción entre las comunidades de origen y las de destino, asociada con la migración, ha convertido a múltiples localidades de México en espacios trasnacionales. Objetivo: Analizar la percepción que tienen las madres y sus hijos/hijas adolescentes sobre la dinámica familiar cuando el padre está ausente. Método: Se compararon dos grupos: familias con y sin experiencia migratoria en una comunidad rural transnacional de Michoacán, México. Se utilizó un método cuantitativo, trabajando con una muestra de 96 participantes (48 binomios madre-hijo/a adolescente). Se aplicaron la Escala de Evaluación de las Relaciones Intrafamiliares, La Escala de prácticas parentales y la Escala de Satisfacción Marital. Resultados: Se encontró que las madres y sus hijos/hijas adolescentes perciben menor unión y apoyo en la familia cuando el padre es migrante. El grupo con el padre en casa tuvo puntajes más altos en expresión familiar, tanto desde la perspectiva de las madres como desde la de sus hijos/as adolescentes. Por último, se observó que la satisfacciónmarital de las madres influye sobre las prácticas parentales. Conclusión: Estos resultados pueden ser factores de riesgo o de protección para la salud física y mental de los diferentesintegrantes de la familia, y deberán considerarse en futuras políticas públicas para esta población.

Abstract In this text we discuss, from indigenous worldviews and ritual practices, operated by the New Age movement, a learning experience that questions modern hegemonic knowledge. The reflection we make is empirically based on the ethnography performed in the Espaço Holístico Agora and in the Espaço Terra Zen, in New Age contexts, in the metropolitan region of the city of Porto Alegre, Brazil. In the field observation work, we looked at the processes of intercultural learning, by white, schooled and middleclass subjects, about Amerindian shamanic practices, related to the use of power plants, and Maya traditions, associated with Sincronário da Paz. Based on ethnographic data, we analyze the conceptions of learning that are produced in that context, with emphasis on the idea of a care education, where mastery is distributed among human agents, who act as guardians and facilitators of knowledge, and no humans, like power plants. We call attention to the role of indigenous shamanic rituals, as mediators in learning.

Resumen En este texto discutimos, desde cosmovisiones y practicas rituales indígenas accionadas por el movimiento Nueva Era, una experiencia de aprendizaje que cuestiona el saber hegemónico moderno. La reflexión que hacemos tiene como base empírica la etnografía realizada en el Espacio Holístico Agora y en el Sitio Terra Zen, en contextos de Nueva Era, en la región metropolitana de la ciudad de Porto Alegre, Brasil. En el trabajo de observación de campo pusimos la mirada en los procesos de aprendizaje intercultural por parte de sujetos blancos, escolarizados y de clase media, sobre prácticas chamánicas amerindias relacionadas al uso de plantas de poder, y a las tradiciones Maya, asociadas al Sincronário da Paz. Con base en los datos etnográficos, analizamos las concepciones de aprendizaje que son producidas en ese contexto, con énfasis en la idea de una educación del cuidado, donde la maestría se distribuye entre agentes humanos que actúan como guardianes y facilitadores del conocimiento, y no humanos (como las plantas de poder). Llamamos la atención sobre el papel de los rituales chamánicos indígenas como mediadores en el aprendizaje.

Abstract Objective: The aims of this study were to examine the incidence and in-hospital outcomes of surgical aortic valve replacement (SAVR) and to identify factors associated with in-hospital mortality (IHM) among patients according to the type of implanted valve used in SAVR. Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR listed as a procedure in their discharge report. Results: We identified 86,578 patients who underwent SAVR (52.78% mechanical and 47.22% bioprosthetic). Incidence of SAVR coding increased significantly from 11.95 cases per 100,000 inhabitants in 2001 to 17.92 in 2015 (P<0.001). Age and comorbidities increased over time (P<0.001). There was a significant increase in the frequency of concomitant coronary artery bypass grafting (CABG) and in the use of pacemaker implantation. The use of mechanical SAVR decreased and the use of bioprosthetic valves increased over time. IHM decreased over time (from 8.13% in 2001-05 to 5.39% in 2011-15). Patients who underwent mechanical SAVR had higher IHM than those who underwent bioprosthetic SAVR (7.44% vs. 6%; P<0.05). Higher IHM rates were associated with advanced age, female sex, comorbidities, concomitant CABG, and the use of mechanical SAVR (OR 1.67; 95% CI 1.57-1.77). Conclusion: The number of SAVRs performed in Spain has increased since 2001. The use of mechanical SAVR has decreased and the use of bioprosthetic valves has increased over time. IHM has decreased over time for both types of valves and despite a concomitant increase in age and comorbidities of patients during the same period.

Resumo Investigamos a percepção de mulheres gordas sobre seu próprio corpo e suas experiências com discriminações relacionadas ao peso e como essas situações afetavam seu bem-estar. Trinta e nove mulheres obesas foram entrevistadas, sendo identificados três eixos de análise: (1) repercussões de ser gorda, (2) vivendo com um corpo gordo, e (3) eu sou uma pessoa ou apenas um corpo gordo? Esses eixos eram compostos por oito temas que se complementavam ou tinham significado semelhante. Os resultados mostraram que nossas participantes utilizavam mecanismos para diminuir a magnitude de seus corpos estigmatizados (por exemplo, tentando perder peso e modificando suas escolhas alimentares atuais). As participantes também relataram que ser gorda teve consequências físicas e psicológicas para elas. É importante ressaltar que seus corpos maiores influenciaram sua autoavaliação, fazendo com que se sentissem desvalorizadas, incapazes, incompletas e sem possibilidade de se sentirem amadas. Elas relataram experiências estigmatizadoras em situações familiares, no local de trabalho e em espaços públicos, e relataram serem estigmatizadas por pessoas próximas e desconhecidas, bem como por profissionais de saúde. Foi relatado que esses profissionais tratam os pacientes com desrespeito, o que exige atenção quanto às desigualdades na assistência à saúde de pessoas obesas. Nossos resultados enfatizam que atitudes estigmatizadoras em relação às pessoas gordas e suas próprias considerações sobre si mesmas têm consequências negativas para seu bem-estar físico e mental.

Abstract We investigated fat women’s perceptions of their own bodies and their experiences with weight-related discriminations, and how these situations affected their well-being. Thirty-nine obese women were interviewed, and three axes of analysis were identified: (1) repercussions of being fat, (2) living with a fat body, and (3) am I a person or just a fat body? These axes were composed of eight themes which had similar meaning or complemented each other. The results showed our participants had mechanisms to diminish the magnitude of their stigmatized bodies (e.g., attempting to lose weight and changing their current food choices). Participants also reported being fat had physical and psychological consequences for them. Most notably, their larger bodies influenced their self-evaluation, making them feel devalued, unlovable, incapable, and incomplete. They reported stigmatizing experiences in familiar situations, at the workplace and in public spaces, and reported being stigmatized by both close and unknown individuals, including healthcare professionals. These professionals were reported to treat patients disrespectfully, which urges attention to health care inequalities for obese people. Our results stress stigmatizing attitudes towards fat people and their own considerations about themselves have negative consequences in their physical and mental well-being.

Resumo Investigamos a percepção de mulheres gordas sobre seu próprio corpo e suas experiências com discriminações relacionadas ao peso e como essas situações afetavam seu bem-estar. Trinta e nove mulheres obesas foram entrevistadas, sendo identificados três eixos de análise: (1) repercussões de ser gorda, (2) vivendo com um corpo gordo, e (3) eu sou uma pessoa ou apenas um corpo gordo? Esses eixos eram compostos por oito temas que se complementavam ou tinham significado semelhante. Os resultados mostraram que nossas participantes utilizavam mecanismos para diminuir a magnitude de seus corpos estigmatizados (por exemplo, tentando perder peso e modificando suas escolhas alimentares atuais). As participantes também relataram que ser gorda teve consequências físicas e psicológicas para elas. É importante ressaltar que seus corpos maiores influenciaram sua autoavaliação, fazendo com que se sentissem desvalorizadas, incapazes, incompletas e sem possibilidade de se sentirem amadas. Elas relataram experiências estigmatizadoras em situações familiares, no local de trabalho e em espaços públicos, e relataram serem estigmatizadas por pessoas próximas e desconhecidas, bem como por profissionais de saúde. Foi relatado que esses profissionais tratam os pacientes com desrespeito, o que exige atenção quanto às desigualdades na assistência à saúde de pessoas obesas. Nossos resultados enfatizam que atitudes estigmatizadoras em relação às pessoas gordas e suas próprias considerações sobre si mesmas têm consequências negativas para seu bem-estar físico e mental.

Abstract We investigated fat women’s perceptions of their own bodies and their experiences with weight-related discriminations, and how these situations affected their well-being. Thirty-nine obese women were interviewed, and three axes of analysis were identified: (1) repercussions of being fat, (2) living with a fat body, and (3) am I a person or just a fat body? These axes were composed of eight themes which had similar meaning or complemented each other. The results showed our participants had mechanisms to diminish the magnitude of their stigmatized bodies (e.g., attempting to lose weight and changing their current food choices). Participants also reported being fat had physical and psychological consequences for them. Most notably, their larger bodies influenced their self-evaluation, making them feel devalued, unlovable, incapable, and incomplete. They reported stigmatizing experiences in familiar situations, at the workplace and in public spaces, and reported being stigmatized by both close and unknown individuals, including healthcare professionals. These professionals were reported to treat patients disrespectfully, which urges attention to health care inequalities for obese people. Our results stress stigmatizing attitudes towards fat people and their own considerations about themselves have negative consequences in their physical and mental well-being.