Abstract: Introduction: Mobile applications are considered relevant in the health area. As rheumatology is a complex and prevalent specialty in clinical practice, the development of tools that favor learning becomes necessary. Objective: To evaluate the impact of a mobile platform on learning, obtaining the degree of satisfaction with the teaching tool and the effects on different scenarios of educational practice, including performance evaluation regarding questions about the theoretical contents of the platform. Methods: Quantitative, descriptive study, carried out in Christus University Center, located in Fortaleza, Brazil. Questionnaires prepared by the authors were used to assess the impact on the different active methodologies used in the institution and the degree of student satisfaction regarding their use. The estimate of the students’ cognitive gain was measured through pre-test and post-test, using the multiple-choice format. Results: The questionnaires were applied to 71 students to assess the effects and satisfaction. A total of 90 students participated in the pre-test and 32 in the post-test phase. The platform showed a positive perception of learning for 83.1% of the students, with greater impact on lectures, although there was a greater impact on the simulation scenarios in the eighth semester. A good degree of satisfaction was observed in 94.4% of the answers, with improved performance in the tests, increasing from 43.7% to 63.3% (P < 0.001). Conclusions: The development and application of the mobile platform in rheumatology showed excellent results, with favorable effects on the teaching of the specialty, disclosing a good degree of satisfaction regarding its use and better performance on the questioning about the theoretical contents of the platform.

Resumo: Introdução: Aplicativos móveis são considerados relevantes na área da saúde. Sendo a reumatologia uma especialidade complexa e prevalente na prática clínica, torna-se necessário o desenvolvimento de ferramentas que favoreçam a aprendizagem. Objetivo: Este estudo teve como objetivo avaliar o impacto no aprendizado que uma plataforma móvel proporcionou, obtendo o grau de satisfação com a ferramenta de ensino e a repercussão nos diferentes cenários de prática educacional, incluindo avaliação de performance quanto a questionamentos do conteúdo teórico da plataforma. Método: Trata-se de estudo transversal com delineamento descritivo e abordagem quantitativa do tipo analítico, realizado no Centro Universitário Christus, localizado em Fortaleza, Brasil. Pesquisaram-se, por meio de questionários elaborados pelos autores, a repercussão nas diferentes metodologias ativas presentes na instituição e o grau de satisfação dos alunos quanto ao uso. A estimativa do ganho cognitivo dos alunos foi mensurada por meio de pré-teste e pós-teste, no formato de múltiplas escolhas. Resultado: Participaram 71 alunos durante do questionário sobre a repercussão e a satisfação. Nas questões de múltiplas escolhas, 90 alunos participaram do pré-teste e 32 do pós-teste. A plataforma apresentou percepção positiva na aprendizagem para 83,1% dos alunos, havendo maior impacto nas aulas expositivas, embora no oitavo semestre tenha havido maior repercussão nos cenários de simulação. Houve boa satisfação em 94,4% das respostas, com melhora no aproveitamento quanto às questões de múltiplas escolhas, evoluindo de 43,7% para 63,3% (p < 0,001). Conclusão: A elaboração e a aplicação da plataforma móvel em reumatologia obtiveram excelentes resultados, com repercussão favorável no ensino da especialidade e boa satisfação quanto ao uso e melhor performance no que concerne ao questionamento sobre os conteúdos teóricos da plataforma.

Abstract Objective: To investigate the prevalence and factors associated with no intention to exclusively breastfeed for the first 6 months of life in a sample of women in the first 24 h postpartum during the hospital stay. Methods: Cross-sectional study with data from screening phase of a birth cohort. The proportion of mothers who did not intend to breastfeed exclusively for 6 months (primary outcome) derived from a negative response to the question “Would you be willing to try to breastfeed exclusively for the first 6 months?”, in an interview conducted by previously trained interviewers. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals were obtained by Poisson regression with robust variance. Results: A total of 2964 postpartum women were interviewed. The overall prevalence of mothers who did not intend to breastfeed exclusively for 6 months was 17.8% (16.4–19.1%). After adjusting for maternal age and type of pregnancy (singleton or multiple), no intention to exclusively breastfeed was higher in mothers with a monthly household income < 3 minimum wages (PR, 1.64; 1.35–1.98) and in those who intended to smoke 4–7 days/week after delivery (PR, 1.42; 1.11–1.83). The presence of significant newborn morbidity (PR, 0.32; 0.19–0.54) and intention to breastfeed up to 12 months (PR, 0.46; 0.38–0.55) had a protective effect against not intending to breastfeed exclusively for 6 months. Conclusions: Approximately 1 in every 5 mothers did not intend to breastfeed exclusively for 6 months. Strategies aimed at promoting exclusive breastfeeding should focus attention on mothers from lower economic strata and smokers.

RESUMO Este artigo analisou a constituição de três modelos pedagógicos na Educação Física brasileira, entre as décadas finais do século XIX e os anos de 1980, colocando em contraste a ortopedia do corpo, a eficiência dos gestos e a ciência para o esporte como formas disciplinares distintas de produção de sentidos para a área. Foram priorizadas fontes impressas, especialmente aquelas que abordam métodos e orientações pedagógicas, além de documentos organizadores de políticas. Os indícios perscrutados e o diálogo com a historiografia do campo permitiram dar operatividade à noção de modelo pedagógico estabelecida por Marta Carvalho (2011), e lançar um olhar atento aos léxicos contribuiu na composição de cada um deles, pois algumas palavras-chave foram pistas importantes na compreensão dos processos históricos investigados. A análise implicou reconhecer nas representações sobre a Educação Física as interlocuções com outros países, dando a ver múltiplas práticas de circulação e apropriação presentes nas maneiras de educar o corpo, na escola e fora dela.

ABSTRACT This paper has analyzed the constitution of three pedagogical models at Brazilian Physical Education, from the latter decades of the 19th century to the 1980s, putting into contrast the body orthopedics, gesture efficiency, and sports-oriented science as distinct disciplinary ways of producing meaning for Physical Education. We prioritized written sources, especially those that address pedagogical methods and guidelines, besides policy organizing documents. The material analyzed and the dialog with field historiography allowed us to put into work the notion of pedagogical model settled by Marta Carvalho (2011), and a watchful eye to the lexicon has contributed to the composition of each one of them, for a few keywords were significant clues in the comprehension of the historical processes investigated. The analysis required to identify in the representation on Physical Education the interlocutions with other countries, evincing multiple practices of circulation and appropriation present in educating the body, at school and outside it.

Resumo Este artigo analisa prescrições para a educação do corpo da criança pequena compreendendo-as como importantes dispositivos disciplinares produzidos na modernidade. Como uma aposta cultural, a arte de educar a infância foi abordada como um projeto político estabelecido por sucessivas camadas e orientado por diferentes interesses e sistemas postos em relação. O estudo apresenta uma discussão sobre a construção cultural da infância e do corpo como um par significativo no processo civilizador e na educação dos sujeitos, estabelecendo reflexões sobre a incorporação e a (re)configuração dos sentidos atribuídos à educação corporal das crianças pela instituição escolar. A obra “Civilidade Pueril” escrita por Erasmo de Roterdã no século XVI, foi tomada como marco inicial - e também como metáfora - para a análise de representações sociais construídas, na longa duração, para uma “pedagogia das boas maneiras”. Em perspectiva histórica, interessou-nos ressaltar a circulação de ideias e prescrições para a educação da criança pequena que, levadas a termo primeiramente na Europa Ocidental, se estenderiam às várias partes do mundo, portando, quase sempre, um imperioso efeito de verdade. Com o propósito de identificar ressonâncias e apropriações no debate educacional brasileiro do início do século XX, ajustamos a escala de observação para um recorte singular e enfatizamos práticas escolares realizadas em Minas Gerais, nas décadas de 1920 e 1930. Nas fontes analisadas, identificamos elementos de conexão entre a moderna escola infantil e o complexo sistema de representações que, nos últimos séculos, modificou sensibilidades e experiências em relação à infância e à sua educação corporal.

Abstract This paper analyzes the prescriptions for body education in early childhood understanding them as important disciplinary devices produced in modernity. As a cultural bid, the art of educating childhood was addressed as a political project established by successive layers and guided by different interests and systems put in relationship. The study presents a discussion about the cultural construction of childhood and of the body as a significant pair in the civilizing process and in the education of the subjects, raising reflections on the incorporation and (re)configuration of the meanings attributed the children’s body education by school institution. The work “On the Civility of Children’s Behavior” written by Erasmus of Rotterdam in the 16th Century was taken as a initial landmark - and as a metaphor - for the analysis of social representations constructed, on the long run, for a “pedagogy of good manners”. In a historical perspective, we intended to highlight the circulation of ideas and prescriptions for early childhood education, which after being implemented firstly in Western Europe, would spread throughout the diverse parts of the world, carrying, almost always, an imperious truth effect. Aiming at the identification of resonances and appropriations in the Brazilian educational debate of the 20th Century, we set the scale of observation to a local spot and we emphasized the scholar practices carried out in the State of Minas Gerais, Brazil, in the decades of 1920 and 1930. In the analyzed sources, we identified elements of connection between the modern preschool and the complex system of representations that, in the last centuries, modified sensitivities and experiences in relation to childhood and its body education.

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.

RESUMO: A inauguração da Associação Cristã de Moços no Brasil e a expansão do seu projeto formativo contaram com um importante elemento atrativo: o protestantismo. Em finais do século XIX já circulavam no país ideias, proposições e práticas afinadas com a estrutura religiosa da Associação. Com a chegada de instituições e sujeitos estadunidenses no Brasil, aportavam no país formas de viver sintonizadas com padrões estadunidenses de operar no mundo. De forma sutil ou de modo explícito, é possível identificar elementos mobilizados também pela ACM para aproximação dos brasileiros com práticas culturais, com valores, com o modo de vida “americano”. Nas representações produzidas sobre o Brasil, os acemistas articularam um mecanismo que ora indicava as condições desfavoráveis do país, ora as tomava como mote para a ressonância das iniciativas da Associação. Indicar limitações, mas também apresentar alternativas para novos costumes, novas práticas, novas sensibilidades, essa parecia a dinâmica acemista.

ABSTRACT: The inauguration of the Young Men's Christian Association in Brazil and the expansion of its formative project had an important attractive element: Protestantism. By the end of the nineteenth century, ideas, propositions and practices aligned with the religious structure of the Association were already circulating in the country. With the arrival of North American people and institutions in Brazil, living habits like those from the United States were promoted. It is possible to identify subtle and explicit elements employed by the YMCA to familiarize Brazilians to cultural practices, values, and the American way of life. In the representations produced about Brazil, the YMCA missionaries indicated the unfavorable conditions of the country, to introduce them as grounds for the resonance of the association's initiatives. The YMCA dynamics were to indicate limitations, but also to present alternative new customs, new practices, new sensibilities.

RESUMEN: La inauguración de la Asociación Cristiana de Jóvenes en Brasil y la expansión de su proyecto de formación tuvieron un elemento atractivo importante: el protestantismo. A finales del siglo XIX, ideas, proposiciones y prácticas en sintonía con la estructura religiosa de la Asociación ya circulaban en el país. La llegada de las personas y instituciones estadounidenses en Brasil, trajeron al país formas de vivir en sintonía con los estándares estadounidenses. De manera sutil o explícita, es posible identificar elementos movilizados también por la ACJ para acercar a los brasileños a las prácticas culturales, con valores, con el estilo de vida "americano". En las representaciones producidas sobre Brasil, los acemistas articularon un mecanismo que a veces indicaba las condiciones desfavorables del país y otras las tomaban como la posibilidad para la resonancia de las iniciativas de la Asociación. Indique limitaciones, pero también presente alternativas para nuevas costumbres, nuevas prácticas, nuevas sensibilidades, esta parecía ser la dinámica de la ACJ.

Resumo Este estudo investiga iniciativas relacionadas à construção de playgrounds, de praças de jogos e de jardins de recreio durante as décadas de 1920 e 1930, em experiências educacionais empreendidas no Rio de Janeiro, em Minas Gerais e no Rio Grande do Sul, por sujeitos ligados à Associação Cristã de Moços. A análise das fontes mobilizadas permite indicar que a consideração daqueles lugares como extensão da escola, o entendimento de que eles constituiriam momento privilegiado para dar expansão aos instintos infantis, a compreensão de que as atividades ali desenvolvidas poderiam incorporar códigos para a vida social dos alunos e a preocupação com a boa ocupação do tempo livre compuseram o arranjo argumentativo para a defesa da instalação de tais espaços educativos.

Abstract This study looks into actions related to the construction of playgrounds, praças de jogos and jardins de recreio in the 1920s and 1930s, in educational experiences conducted in the Brazilian states of Rio de Janeiro, Minas Gerais and Rio Grande do Sul, facilitated by subjects linked to the Young Men’s Christian Association. The analysis of the documents indicates that seeing those spaces as extensions of the school environment, understanding that they were privileged moments to expand children’s instincts and understanding that the activities developed there could incorporate codes for student´s social life and concern with good use of free time were part of the arguments to legitimate the construction of those educational spaces.

Resumen Este estudio investiga iniciativas relacionadas con la construcción de áreas de juego, plazas y jardines de recreo, durante las décadas de 1920 y 1930, en experiencias educativas emprendidas en Rio de Janeiro, Minas Gerais y Rio Grande do Sul, por personas vinculadas a la Asociación Cristiana de Jóvenes. El análisis de las fuentes permite indicar que la consideración de esos lugares como extensión de la escuela, el entendimiento de que constituirían un momento privilegiado para darle expansión a los instintos infantiles, la comprensión de que las actividades allí desarrolladas podrían incorporar códigos para la vida social de los alumnos y la preocupación con la buena ocupación del tiempo libre compusieron el fondo argumentativo para la defensa de la instalación de tales espacios educativos.

Resumo Os cânceres de endométrio e cervical são as neoplasias ginecológicas mais prevalentes. Enquanto o primeiro ocorre em mulheres mais velhas, o segundo é mais prevalente em mulheres jovens. A manifestação clínica mais comum nestas duas neoplasias ginecológicas é o sangramento vaginal. O diagnóstico do câncer de endométrio é feito a partir da avaliação histológica do endométrio e da avaliação por imagem, enquanto o câncer cervical é diagnosticado clinicamente, de acordo com a Federação Internacional de Ginecologia e Obstetrícia (FIGO). Apresentamos um caso de câncer ginecológico sincrônico de endométrio e cervical diagnosticado durante estadiamento por ressonância magnética e confirmado pela análise histológica da peça cirúrgica.

Summary Endometrial and cervical cancers are the most prevalent gynecologic neoplasms. While endometrial cancer occurs in older women, cervical cancer is more prevalente in young subjects. The most common clinical manifestation in these two gynecological cancers is vaginal bleeding. In the first case, diagnosis is made based on histological and imaging evaluation of the endometrium, while cervical cancers are diagnosed clinically, according to the International Federation of Gynecology and Obstetrics (FIGO). The authors present a case of synchronous gynecological cancer of the endometrium and cervix diagnosed during staging on MRI and confirmed by histological analysis of the surgical specimen.

<sec><title>Introduction</title><p>The most commonly used method in neonatal hearing screening programs is transient evoked otoacoustic emissions in the first stage of the process. There are few studies comparing transient evoked otoacoustic emissions with distortion product, but some authors have investigated the issue.</p></sec><sec><title>Objective</title><p> To correlate the results of transient evoked and distortion product otoacoustic emissions in a Brazilian maternity hospital.</p></sec><sec><title>Methods</title><p> This is a cross-sectional, comparative, and prospective study. The study included 579 newborns, ranging from 6 to 54 days of age, born in a low-risk maternity hospital and assessed for hearing loss. All neonates underwent hearing screening by transient evoked and distortion product otoacoustic emissions. The results were analyzed using the Spearman correlation test to relate the two procedures.</p></sec><sec><title>Results</title><p> The pass index on transient evoked otoacoustic emissions was 95% and on distortion product otoacoustic emissions was 91%. The comparison of the two procedures showed that 91% of neonates passed on both procedures, 4.5% passed only on transient evoked otoacoustic emissions, 0.5% passed only on distortion product otoacoustic emissions, and 4% failed on both procedures. The inferential analysis showed a significant strong positive relationship between the two procedures.</p></sec><sec><title>Conclusion</title><p> The failure rate was higher in distortion product otoacoustic emissions when compared with transient evoked; however, there was correlation between the results of the procedures.</p></sec>

CONTEXTO E OBJETIVO: A heparanase-1 degrada heparam sulfato e está relacionada à progressão de tumor. Apesar de a isoforma heparanase-2 não possuir atividade catalítica, parece ser importante para modular a atividade da heparanase-1. A catepsina B é uma proteinase envolvida na metástase de tumores. O objetivo deste estudo foi analisar a expressão das isoformas de heparanase e atividade da catepsina B em amostras de plasma de pacientes com carcinomas gastrointestinais, comparando-se com indivíduos saudáveis (grupo controle). TIPO DE ESTUDO E LOCAL: Este é um estudo transversal analítico. Foram coletadas amostras de sangue periférico, em hospital público brasileiro, de 21 pacientes com diagnóstico histopatológico de carcinoma gastrointestinal e 43 indivíduos saudáveis. As análises foram realizadas em duas faculdades de medicina brasileiras. MÉTODOS: As isoformas da heparanase foram identificadas e quantificadas em amostras de plasma por Western blot. As atividades enzimáticas de heparanase-1 e catepsina B foram também mensuradas. RESULTADOS: Os resultados demonstraram que as expressões das isoformas de heparanase foram significativamente maiores nas amostras de plasma de pacientes com carcinoma gastrointestinal em comparação com o grupo controle. A análise feita por regressão logística mostra que aumento na expressão de heparanase-1 e heparanase-2 é exclusivamente dependente da presença de tumor. Houve aumento significativo na atividade da heparanase-1 e catepsina B no plasma dos pacientes. CONCLUSÃO: A superexpressão de heparanase-1 e heparanase-2, bem como o aumento da atividade de heparanase-1 e catepsina B no plasma, está associada com o diagnóstico de carcinoma gastrointestinal. Tais achados dão suporte ao uso de ensaios não invasivos (amostras de plasma) como método auxiliar para o diagnóstico de tumores gastrointestinais.

CONTEXT AND OBJECTIVE: Heparanase-1 degrades heparan sulfate and has been correlated with tumor progression. Although the isoform heparanase-2 has no catalytic activity, it seems to be important for modulating heparanase-1 activity. Cathepsin B is a proteinase involved in tumor metastasis. The aim of this study was to analyze heparanase isoform expression and cathepsin B activity in plasma samples from patients with gastrointestinal carcinomas, compared with healthy individuals (control group). DESIGN AND SETTING: This was an analytical cross-sectional study. Peripheral blood samples were collected at a Brazilian public hospital, from 21 patients with histopathological diagnoses of gastrointestinal carcinomas and from 43 healthy individuals. The analyses were performed in two Brazilian medical schools. METHODS: Heparanase isoforms were identified and quantified in plasma samples by means of Western blot. The enzymatic activities of heparanase-1 and cathepsin B were also measured. RESULTS: The results demonstrated that the expression of both heparanase isoforms was significantly greater in plasma samples from gastrointestinal carcinoma patients, compared with the control group. Logistic regression analysis showed that increased heparanase-1 and heparanase-2 expression was exclusively dependent on the tumor. There was a significant increase in heparanase-1 and cathepsin B activity in the patients' plasma. CONCLUSION: Overexpression of heparanase-1 and heparanase-2, along with increased heparanase-1 and cathepsin B activity in plasma, is associated with the diagnosis of gastrointestinal carcinoma. These findings provide support for using non-invasive assays (plasma samples) as an auxiliary method for diagnosing gastrointestinal tumors.