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BACKGROUND: Children with motor delays are at increased risk for delayed means-end problem-solving (MEPS) performance. OBJECTIVES: To evaluate children with motor delays: 1) the impact of motor delay severity and MEPS mastery timing on developmental trajectories of MEPS; and 2) the effectiveness of Sitting Together And Reaching To Play (START-Play) intervention for improving MEPS. METHODS: This represents a secondary analysis from a multi-site randomized controlled trial, with blinded assessors and prospective registration. Children with mild or significant motor delays (n = 112, mean age=10.80, SD=2.59 months at baseline) were randomly assigned to START-Play or usual care early intervention (UC-EI) and assessed at five visits across one year using the Means-End Problem-Solving Assessment Tool that included three 30-second MEPS trials per visit. Task mastery occurred at the first visit the child achieved the highest level of performance in at least two of the three trials. Multilevel analyses evaluated trajectories of MEPS outcomes dependent upon the timing of MEPS mastery, motor delay severity, and intervention group. RESULTS: At baseline, children with mild motor delays demonstrated better MEPS than children with significant delays, but this difference was only observed for children who achieved mastery late. Children with significant delays demonstrated greater improvements in MEPS in the post-intervention phase compared to children with mild delays. No MEPS differences were found between START-Play and UC-EI. CONCLUSION: Motor delay severity and timing of task mastery impacted MEPS trajectories, whereas START-Play intervention did not impact MEPS for children with motor delays. CLINICAL TRIALS REGISTRY IDENTIFIER: NCT02593825 (https://clinicaltrials.gov/ct2/show/NCT02593825).

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As the coronavirus disease 2019 (COVID-19) outbreak spread, evidence has emerged that gender and race would bear a disproportionate impact on the morbimortality of COVID-19. Here, we conducted a retrospective observational study using the TabNet/Departamento de informática do sistema único de saúde platform of the city of São Paulo. COVID-19 records from March 2020 through December 2021 were included, and we evaluated the temporal trends of confirmed cases and case fatality rate by gender and ethnicity. Statistical analysis was performed using the R-software and BioEstat-software, considering p < 0.05 significant. From March/2020 to December/2021, 1 315 160 COVID-19 confirmed cases were recorded (57.1% females), and 2973 deaths were due to COVID-19. Males presented higher median mortality (0.44% vs. 0.23%; p < 0.05) and intensive care unit (ICU) admission rates (0.34% vs. 0.20%; p < 0.05). Men were also associated with a higher risk of death (risk ratio [RR] = 1.28; p < 0.05) and a higher chance of requiring ICU care (RR = 1.29; p < 0.05). Black ethnicity was associated with a higher risk of death (RR = 1.19; p < 0.05). White patients were more likely to require ICU admission (RR = 1.13; p < 0.05), whereas Browns were associated with a protective effect (RR = 0.86; p < 0.05). Furthermore, men presented a higher chance of death than women across the three major ethnic groups: Whites (RR = 1.33; p < 0.05), Blacks (RR = 1.24; p < 0.05), and Browns (RR = 1.35; p < 0.05). In this study of COVID-19 in São Paulo, men were associated with worse outcomes, including in the three major ethnicities in the population. Blacks exhibited a higher risk of death, Whites were more likely to require intensive care, and Browns were at protection from ICU hospitalization.

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Resumo: Introdução: O ensino remoto surgiu como ferramenta emergencial no processo de educação superior durante a pandemia da Covid-19. Nesse cenário, amplia-se a possibilidade de ensinar e aprender por meio das tecnologias da informação e comunicação (TIC) nos cursos de Medicina. Objetivo: Este estudo teve como objetivo realizar uma revisão integrativa que esclareça os principais aspectos positivos e negativos encontrados no exercício do ensino médico, nessas condições atípicas. Método: A busca dos artigos se deu nas seguintes bases: Biblioteca Virtual em Saúde (BVS), Embase, Education Resources Information Center (ERIC), Medline (via PubMed), Scopus e Web of Science. Resultado: Ao final dos processos de triagem e seleção, incluíram-se 69 artigos, dos quais foram extraídas informações quanto às características dos aspectos positivos e negativos de cada experiência de ensino remoto médico ofertado nesse período pandêmico. Entre os principais aspectos positivos, destacam-se a avaliação positiva do componente curricular pelos estudantes, a maior autonomia do aluno, a maior participação e comunicação entre os alunos, e a ausência de déficit de aprendizado. Entre os principais pontos negativos, observam-se a suspensão das aulas práticas, as complicações decorrentes do uso das tecnologias (conectividade, capacitação e organização) e a ausência de contato social. Conclusão: Observa-se que a autonomia e a autodisciplina discentes são fatores cruciais para o aproveitamento pleno de abordagem de aprendizagem remotamente, e talvez o aluno presencial clássico não estivesse preparado para tal mudança brusca. Ainda, percebe-se que, pela urgência de implantação dessa nova forma de aprendizagem, o ensino remoto não tenha tido tempo e maturidade o suficiente para que fosse aperfeiçoado ao ponto de ser considerado uma estratégia de educação médica aplicável em longo prazo. O ensino remoto foi crucial para que a formação de novos médicos não fosse descontinuada por um período de tempo tão extenso. Porém, o ensino remoto precisa ser reavaliado e aperfeiçoado como estratégia pedagógica que utiliza TIC para o ensino médico.

Abstract: Introduction: Distance learning emerged as an emergency tool used in Higher Education during the COVID-19 pandemic. These circumstances led to the increased use of Information and Communication Technologies (ICTs) for teaching and learning in Medicine courses. Objective: To conduct an integrative review to clarify the main positive and negative aspects found in the exercise of medical education in these atypical conditions. Method: Articles were searched on the following databases: Virtual Health Library (VHL), Embase, Education Resources Information Center (ERIC), Medline (via PubMed), Scopus and Web of Science Result: At the end of the screening and selection processes, 69 articles were included, from which information was extracted regarding the characteristics, positive and negative aspects of each remote medical teaching experience offered during the pandemic. Among the main positive aspects, we highlight the positive evaluation of the curricular component by the students, greater student autonomy, greater participation and communication among students and the absence of any learning deficit. The main negative points include the suspension of practical classes, complications arising from the use of technologies (connectivity, training and organization) and lack of social contact. Conclusion: It is observed that student autonomy and self-discipline is a crucial factor in taking full advantage of the distance learning approach, and perhaps the classic face-to-face student was not prepared for such a sudden change. Still, it is clear that, due to the urgency of implementing this new form of learning, distance learning has not had enough time to mature and be perfected to the point of being considered a medical education strategy applicable in the long term. Distance learning was crucial for the continued training of new doctors for an extended period of time. However, it needs to be reassessed and improved as a pedagogical strategy that uses ICTs for medical education.

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Introdução: Assim como observado no cenário nacional, o município de Mossoró apresentou altas taxas de letalidade nos primeiros meses de pandemia. Todavia, o conhecimento epidemiológico em torno da COVID-19 no município tem ocorrido, sobretudo, através de documentos institucionais das Secretarias de Saúde. Desse modo, a finalidade deste estudo é fornecer evidências que permitam ampliar a compreensão da ocorrência da doença em nível local, ofertar dados e informações que venham a subsidiar as políticas públicas de saúde municipais e gerar hipóteses sobre a morbimortalidade da doença para futuras investigações científicas. Objetivo: Analisar o perfil epidemiológico dos casos internados e confirmados de COVID-19 no município de Mossoró no estado do Rio Grande do Norte/Brasil. Metodologia: Estudo observacional transversal, baseado em dados secundários de casos internados de COVID-19 registrados no Sistema Único de Saúde entre março e outubro de 2020.Resultados:Foram incluídos na amostra 664 pacientes, dos quais 46,5% evoluíram para óbito. Entre as internações, 63,1% resultaram em internações em unidades de terapia intensiva. Observamos diferenças estatísticas significativas entre 'admissão na unidade de terapia intensiva e evolução para óbito' e 'faixa etária e evolução para óbito' e, maior risco entre idosos acima de 60 anos, com comorbidades, dispneia e saturação de O2 <95%. A necessidade de suporte ventilatório invasivo foi considerada fator predisponente para óbito. O risco de internação na unidade de terapia intensiva foi maior entre as idosas. Conclusões: A hospitalização e o óbito de pacientes com COVID-19foram maiores em pacientes idosos com comorbidades (AU).

Introduction:As observed in the national scenario, the city of Mossoró showed high lethality rates in the first months of the pandemic. However, the epidemiological knowledge around COVID-19 in the municipality has occurred mostly through institutional documents from the Health Secretariats. Thus, the purpose of this study is to provide evidence to broaden the understanding of the occurrence of the disease at the local level, provide data and information that will support municipal health public policies and generate hypotheses about the morbidity and mortality of the disease for future scientific investigations. Objective: To analyze the epidemiological profile of hospitalized and confirmed cases of COVID-19 in the municipality of Mossoró in the state of Rio Grande do Norte/Brazil. Methodology:This is a cross-sectional and observational study, based on secondary data from the hospitalized COVID-19 cases recorded in the Unified Health System (Sistema Unificado de Saúde, SUS) between March and October 2020. Results:664 patients were included in the sample, of which 46.5% evolved to death. Among hospitalizations, 63.1% resulted in intensive care units admissions. We observed significant differences between intensive care unit admission and evolution to death' and 'age group and evolution to death' and, higher risk among elderly individuals over 60 years, with comorbidities, dyspnea and O2 saturation<95%. Need for invasive ventilatory support was considered a predisposing factor for death. The risk of intensive care unit admission was higher among eldery women.Conclusions:Hospitalization and death of patients with COVID-19 were higher in elderly patients with comorbidities (AU).

Introducción: Como se observó en el escenario nacional, el municipio de Mossoró presentó altas tasas de letalidad en los primeros meses de la pandemia. Sin embargo, el conocimiento epidemiológico en torno al COVID-19 en el municipio se ha dado principalmente a través dedocumentos institucionales de las Secretarías de Salud. Por lo tanto, el objetivo de este estudio es proporcionar evidencias para ampliar el conocimiento de la ocurrencia de la enfermedad en el ámbito local, proporcionar datos e informaciones que apoyen las políticas públicas municipales de salud y generar hipótesis sobre la morbilidad y mortalidad de la enfermedad para futuras investigaciones científicas. Objetivo: Analizar el perfil epidemiológico de los casos hospitalizados y confirmados de COVID-19 en el municipio de Mossoró en el estado de Rio Grande do Norte/Brasil.Metodología: Se trata de un estudio transversal y observacional, basado en datos secundarios de los casos hospitalizados de COVID-19 registrados en el Sistema Unificado de Salud (SUS) entre marzo y octubre de 2020. Resultados: La muestra incluyó 664 pacientes, de los cuales el 46,5% falleció. Entre los ingresos, el 63,1% resultaron en ingresos en la unidad de cuidados intensivos. Se observaron diferencias estadísticas significativas entre el "ingreso en la unidad de cuidados intensivos y la evolución hasta la muerte" y el "grupo de edad y la evolución hasta la muerte", y un mayor riesgo entre los pacientes mayores de 60 años, con comorbilidades, disnea y saturación de O2 <95%. La necesidad de soporte ventilatorio invasivo se consideró un factor predisponente para la muerte. El riesgo de ingreso en la unidad de cuidados intensivos fue mayor entre las mujeres de edad avanzada. Conclusiones: La hospitalización y la muerte de los pacientes con COVID-19 fueron mayores en los pacientes de edad avanzada con comorbilidades (AU).

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Resumo: Introdução: O peer mentoring (mentoria entre pares) é um modelo em que o mentor é um discente mais avançado na graduação que acompanha um grupo de alunos iniciantes (mentes). No curso de Medicina da Ufersa, o programa tem como propósitos acolher os discentes durante o primeiro semestre e contribuir para o desenvolvimento pessoal e acadêmico do mentee, na sua integração ao ambiente acadêmico e na adaptação ao curso e ao método Problem-Based Learning (PBL). Objetivo: Este estudo teve como objetivo avaliar a percepção dos mentees sobre sua experiência no peer mentoring e os possíveis benefícios no desenvolvimento pessoal e acadêmico, e na saúde mental do ingressante. Método: Foi realizada uma pesquisa exploratória, descritiva e com abordagem qualitativa, em que se entrevistaram 20 mentees que participaram do projeto nos períodos 2018.1 ou 2019.1. Os dados foram processados por meio da análise temática de conteúdo, constituída por três precípuas etapas: pré-análise, exploração do material e tratamento dos resultados obtidos e sua interpretação. Resultado: Encontraram-se duas categorias: apoio emocional e social, e planejamento de estudos. Os entrevistados consideraram a experiência no peer mentoring positiva e assinalaram que o processo contribuiu para o desenvolvimento pessoal e/ou acadêmico deles. A diminuição do estresse e da ansiedade foi atribuída ao fato de haver um aluno veterano auxiliando no processo de transição ao ensino superior e um grupo de apoio entre pares. Os temas trabalhados nos encontros, as dicas dos mentores e as ferramentas apresentadas ajudaram no planejamento dos estudos, na seleção de prioridades e nas técnicas de otimização da aprendizagem. Conclusão: O projeto peer mentoring auxiliou os mentees em seu desenvolvimento e na adaptação e integração ao ambiente acadêmico, ao curso de Medicina e ao método PBL. Destarte, o apoio oferecido pelo projeto ao ingressante facilitou o processo de autogestão, promoveu o acolhimento e diminuiu a ansiedade, contribuindo também para a saúde mental do mentee.

Abstract: Introduction: Peer-mentoring is a mentoring model in which the mentor is a more advanced undergraduate student who accompanies a group of freshmen (Mentees). At the UFERSA medical School, this process occurs throughout the first semester. The method aims to contribute to the freshman's personal and academic development and to their integration into the academic environment at the medical course, especially with regard to the Problem-Based Learning (PBL) method. Objective: Evaluating the perception of mentees about their experience in peer-mentoring and its potential benefits regarding personal, academic and mental health development. Method: An exploratory research, of a descriptive nature and with a qualitative approach, was carried out through 20 interviews with incoming students who participated in the project as mentees in the first semesters of 2018.1 or 2019.1. The data was processed through thematic content analysis, consisting of three main stages: pre-analysis, exploration of the material and treatment of the results obtained and their interpretation. Result: Two categories were found: Emotional and social support; Study planning. The interviewees considered their experience as mentees to be positive and pointed out that the method contributed to their personal and/or academic development. The reduction in stress and anxiety was attributed to the fact of having a veteran student assisting them in the transition to college and the support group. The themes covered in the meetings, tips from the mentors and tools presented helped in the planning of studies, selection of priorities and techniques for optimizing learning. Conclusion: The peer-mentoring project helped the personal development of the freshmen and supported their adaptation to and integration with the academic environment, the medical course and the PBL method. Thus, the support offered by the project to the newcomer facilitated the self-management process, promoted welcoming and reduced anxiety, also contributing to the mentee's mental health.

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Resumo: Introdução: Compreendendo a abordagem holística de saúde e considerando as desigualdades brasileiras, infere-se a discrepância dos estados de saúde entre grupos sociais, sobretudo no que concerne à população em situação de rua (PSR). Essas pessoas lidam com o desamparo institucionalizado, e a pandemia da Covid-19 expôs ainda mais essa situação. Quanto à formação dos profissionais de saúde, torna-se fundamental a abordagem do tema. Relato de Experiência: Com base na inclusão de experiências de docentes que articulavam ações de integração ensino-serviço com a equipe do Consultório na Rua de Mossoró, bem como a abordagem de temas relacionados às populações mais vulneráveis em eixo longitudinal ao curso, despertou-se o interesse dos discentes do curso de Medicina da Ufersa para ações direcionadas à PSR. Destarte, surge, em 2019, a ação "Saúde nas Ruas", em parceria com o Consultório na Rua, que fornece suporte à PSR em diversos aspectos, com a participação dos alunos do curso de Medicina. A ação, proposta a partir de iniciativa dos próprios alunos, marcou o início do planejamento da inclusão do atendimento a essa população no programa do internato do curso, bem como a criação de um projeto de extensão longitudinal para ações voltadas à PSR. Nesse processo, os discentes puderam imergir na realidade dessa população, e os usuários tiveram autonomia para compartilhar suas experiências e dores. Discussão: Mediante uma formação acadêmica que visa romper com o modelo tecnicista, os estudantes possibilitaram voz à PSR e, compreendendo essas pessoas como sujeitos do processo, refletiram sobre o agir médico na transformação da realidade em que se inserem. Conclusão: O corpo acadêmico participante potencializou em si a empatia e o desejo por uma saúde pública democrática e acessível. Ficou evidente ainda a imprescindibilidade de trabalhar temas específicos sobre populações vulneráveis, com o objetivo de fortalecer a atuação médica como forma de garantir o direito à saúde.

Abstract: Introduction: A clear discrepancy in the health status between social groups in Brazil, particularly the homeless population (HP), can be inferred from the apparent inequalities when considering health from a holistic perspective. The homeless have to deal with institutionalized abandonment, and the COVID-19 pandemic has accentuated this issue. Addressing this theme has become an essential element of the training of health professionals. Experience Report: The interest of medicine students at UFERSA in actions directed at the HP was triggered by teachers' experiences of coordinating service-learning integration actions with the street health care unit in Mossoró, and tackling issues related to the most vulnerable groups throughout the course. In 2019 the "Health on the Streets" action is therefore launched in partnership with the street health care unit, providing support to the HP in several aspects, and involving the participation of the medicine students. The action, proposed based on the students' own initiative, marked the start of the planning for including care for this group in the internship program of the course, as well as the creation of a longitudinal community outreach project for actions with the HP. The students had the opportunity to immerse themselves in the reality of this population, while the users had the autonomy to share their experiences and sufferings. Discussion: Following an academic method that aims to break away from the technicist model, the students gave voice to the HP and, understanding these people as subjects of the process, reflected on the role of medicine in transforming their reality. Conclusion: The academics who participated in this project enhanced their empathy and desire for democratic and accessible public health. It also became evident that tackling specific issues regarding vulnerable groups is indispensable, with a view to strengthening the role of the physician in guaranteeing the right to health.

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RESUMO O presente estudo investigou as concepções e práticas de Promoção da Saúde dos profissionais das nove Unidades Básicas de Saúde (UBS) que constituem campo de estágio do curso de Medicina da Universidade do Estado do Rio Grande do Norte (UERN), na cidade de Mossoró (RN), discutindo-se os achados na perspectiva das novas tendências em educação médica, Saúde e Atenção. Trata-se de um estudo exploratório com abordagem qualitativa, aplicando-se a técnica de análise temática para análise de dados. Os sujeitos da pesquisa foram 25 profissionais que atuam na Estratégia Saúde da Família (ESF). Os resultados revelaram três tendências conceituais: Promoção da Saúde assimilada como prevenção de doenças; concepção difusa sobre Promoção da Saúde; e caracterização apropriada. Entre as práticas, prevaleceram as palestras, realizadas nas UBS com grupos de pacientes, no contexto de ações e programas, como Hiperdia, idosos e grávidas, e as orientações individuais, proporcionadas tanto nas UBS, quanto durante as visitas domiciliares. Entre os principais desafios postos à Promoção da Saúde foram constatados: persistência do modelo biomédico, déficit de recursos humanos, excesso de demanda e ausência de mecanismos de qualificação, que atuam como fatores de fragilização e fragmentação das equipes. Conclui-se que é necessário intensificar os esforços para uma construção dialogada entre Ensino, Serviço, Gestão em Saúde e a sociedade. No campo da educação médica, destaca-se a disponibilidade de instrumentos que amparam a articulação entre as instituições formadoras e os serviços de saúde e oferecem mecanismos para uma formação integrada e a Educação Permanente. Reafirma-se o papel das escolas médicas, empenhadas em dar concretude aos propósitos da Promoção da Saúde, harmonizados com o modelo dialógico da educação, para a formação de profissionais médicos com o perfil que a sociedade precisa, em favor de uma vida mais saudável e de uma sociedade melhor.

ABSTRACT The present study investigated the concepts and practices related to health promotion among professionals from nine Basic Health Units - BHU, that constitute the internship field of the Medical course of Rio Grande do Norte State University - UERN, in the town of Mossoró/RN. The findings are discussed from the perspective of new trends in Medical Education, Health and Care. This is an exploratory study with a qualitative approach, applying the thematic analysis technique for data analysis. The research subjects were twenty-five professionals who work in the Family Health Strategy - FHS. The results revealed three conceptual tendencies: Health Promotion assimilated as a form of disease prevention, a diffused concept of Health Promotion and, finally, an appropriate characterization. The practices included lectures with groups of patients, in the context of actions and programs, such as Hiperdia (addressing hypertension), health of the elderly and pregnant, and individual guidelines, provided both at the BHU and during home visits. The main challenges identified for health promotion included: the persistence of the biomedical model, the human resources deficit, the excess demand and absence of qualification mechanisms, which contribute toward team fragility and fragmentation. In conclusion, it is necessary to intensify efforts toward achieving a dialogical construction between Teaching, Services, Health Management and the Society, highlighting in the field of Medical Education the availability of instruments that support coordination between training institutions and the Health Services and offer mechanisms for integrated training and permanent education. The role of medical schools is reasserted: committed to consolidating the purposes of Health Promotion, aligned to the dialogical model of education for training medical professionals with a profile that society needs, and in favor of a healthier life and a better society.

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BACKGROUND: The elastic therapeutic taping has been considered a promising resource for disabled children. OBJECTIVE: To systematically review the evidence of the effects of elastic therapeutic taping on motor function in children with motor impairments. METHOD: Three independent evaluators conducted searches in electronic databases (MEDLINE/PubMed, Scopus, LILACS, BIREME/BVS, Science Direct, SciELO, and PEDro). Clinical studies design, published until 2016, involving elastic therapeutic taping and children aged 0-12 years with motor impairments were included. The variables considered were the methodological aspects (study design, participants, outcome measurements, and experimental conditions); results presented in the studies, and also the methodological quality of studies. RESULTS: Final selection was composed by 12 manuscripts (five randomized controlled trials), published in the last 10 years. Among them, cerebral palsy (CP) was the most recurrent disorder (n = 7), followed by congenital muscular torticollis (n = 2) and brachial plexus palsy (n = 2). Positive results were associated with taping application: improvement in the upper limb function, gross motor skills, postural control, muscular balance, and performance in the dynamics functional and daily activities. LIMITATIONS: Lower quality of the studies, clinical and population heterogeneity existed across studies. CONCLUSIONS: The elastic therapeutic taping has been shown to be a promising adjunct resource to the conventional rehabilitation in children with motor impairments. However, high methodological studies about its efficacy in this population are already scarce. Implications for Rehabilitation Elastic therapeutic taping has been shown to be a promising adjunct resource to the conventional rehabilitation in disabled children. Clinical trials have indicated improvement in the postural control and functional activities with both, upper and lower limbs, and increase in the functional independency resulting from the taping use. Randomized control trials and well-established protocols are needed to increase the confidence in applying elastic therapeutic taping to specific clinical conditions.

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Introdução: Os processos de adoecimento e saúde estão interligados desde o nível individual até o nível coletivo. Deve-se romper com fazeres tradicionais para alcançar uma dimensão mais integral, capaz de respeitar a subjetividade e o protagonismo do usuário. Objetivos: Analisar as percepções dos usuários sobre a humanização na produção do cuidado em saúde na Estratégia Saúde da Família; identificar elementos que caracterizam práticas humanizadas e não humanizadas na produção do cuidado em saúde e relacionar as percepções sobre humanização com as noções sobre clínica ampliada e participação social presentes na Política Nacional de Humanização. Métodos: Pesquisa compreensiva-interpretativa (qualitativa), exploratória. Para coleta dos dados foi utilizada a técnica de Grupo Focal juntamente com a Metodologia de Análise de Redes do Cotidiano (MARES), enquanto atividade interativa. Os dados foram analisados pela técnica de análise temática de conteúdo e interpretados a partir de aportes da Teoria da Dádiva. Resultados: as categorias encontradas relacionaram aspectos simbólicos e materiais: a qualidade dos circuitos de trocas; a responsabilização e o vínculo; o acolhimento enquanto escuta qualificada; a qualidade de comunicação e diálogo; o acesso e funcionamento da rede de serviços de saúde; a estrutura física e insumos; a ambiência para os espaços de cuidado. Conclusões: a humanização na saúde tem importância para o cuidado integral, reforçando movimentos humanescentes relacionados às práticas dos serviços de saúde. A participação dos usuários em um sistema de trocas recíprocas e positivas junto aos profissionais de saúde pode fazer circular a solidariedade no cuidar, com ressonância na qualificação do cuidado (AU).

Introduction: This research assumes that for changes in health practices directed to an integral care, is crucial humanization, participation and autonomy of service users. Objectives: This research analyzes the perceptions of users about humanization in the production of health care in the daily life of a territory of the Family Health Strategy in a medium-sized municipality. Its specific objectives were to identify elements that characterize humanized practices and not humanized in the production of health care; and relate the perceptions of users about humanization with the notions of expanded clinical and social participation present in the National Humanization Policy. Methods: It was a comprehensive-interpretative (qualitative) and exploratory study that used to collect data to Network Analysis Methodology of Everyday Life, with focus groups. Data were analyzed by the thematic analysis technique and interpreted based on contributions of the National Policy of Humanization and the Theory of Gift. Results: the categories found related symbolic and material aspects: the quality of the exchange circuits; accountability and linkage; the host while listening to qualified; the quality of communication and dialogue; the access and operation of the health services network; the physical structure and inputs; the ambience for the spaces of care. Conclusions: The participation of users deconstructing and reconstructing concepts remainder humanization in the production of health care is a key factor for the privileged space of the Family Health Strategy to create more active people and understanding their needs and demands, is possible path to build a participative management (AU).

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The Mais Médicos (More Doctors) Program (MMP), which was launched in 2013, sought to provide doctors to work in primary health care in priority areas within the Brazilian Unified Health System (SUS). This article analyzes the perception of MMP service users through the results of a qualitative study that consisted of interviews with service users of the Family Health Strategy (ESF) in which doctors from the MMP worked. The service users who were interviewed had a positive view of the MMP because it had expanded access to health care, although there still remained organizational and technical problems that limited the use of services. The performance of foreign doctors was well viewed, with an emphasis on a humanized relationship between doctor and service user, which was characterized by listening, attention and dialogue. In terms of communication with these professionals, some service users referred to language as being a barrier, which was ameliorated by the use of communication strategies within the ESF. The MMP offered a quick and satisfactory resolution to the historical problem of difficulty of access to doctors in Brazil. However, the effectiveness of the Brazilian health system requires that weaknesses are overcome, such as access to specialized services, organizational problems and the implementation of service production models that are centered on illness.

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Resumo O Projeto Mais Médicos (PMM), lançado em 2013, buscou prover profissionais médicos para atuar na Atenção Primária à Saúde, em regiões prioritárias para o Sistema Único de Saúde. Neste artigo, analisa-se a percepção de usuários sobre o PMM, como resultado de investigação qualitativa que entrevistou pessoas atendidas na Estratégia de Saúde da Família (ESF) em que atuam médicos do projeto. Os entrevistados veem positivamente o PMM, por ele ter ampliado o acesso aos cuidados médicos, embora persistam barreiras organizacionais e técnicas que limitam o uso dos serviços. A atuação de médicos intercambistas foi bem avaliada, com ênfase na relação médico-usuário humanizada, caracterizada pela escuta, atenção e diálogo. Sobre a comunicação com esses profissionais, os usuários referem o idioma como uma barreira, que foi amenizada pelo uso de estratégias comunicacionais nas ESF. O PMM ofereceu resolução rápida e satisfatória para o problema histórico da dificuldade de acesso ao médico. Contudo a efetivação do sistema de saúde brasileiro exige a superação de insuficiências, como acesso a serviços especializados, problemas organizacionais e modelos de produção de serviços centrados na doença.

Abstract The Mais Médicos (More Doctors) Program (MMP), which was launched in 2013, sought to provide doctors to work in primary health care in priority areas within the Brazilian Unified Health System (SUS). This article analyzes the perception of MMP service users through the results of a qualitative study that consisted of interviews with service users of the Family Health Strategy (ESF) in which doctors from the MMP worked. The service users who were interviewed had a positive view of the MMP because it had expanded access to health care, although there still remained organizational and technical problems that limited the use of services. The performance of foreign doctors was well viewed, with an emphasis on a humanized relationship between doctor and service user, which was characterized by listening, attention and dialogue. In terms of communication with these professionals, some service users referred to language as being a barrier, which was ameliorated by the use of communication strategies within the ESF. The MMP offered a quick and satisfactory resolution to the historical problem of difficulty of access to doctors in Brazil. However, the effectiveness of the Brazilian health system requires that weaknesses are overcome, such as access to specialized services, organizational problems and the implementation of service production models that are centered on illness.

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RESUMO Este artigo relata uma experiência de integração entre atividades de ensino, pesquisa e extensão através de Roda de Conversa em uma Unidade de Saúde da Família (USF), articulando seus aspectos com aportes sociológicos da Teoria da Dádiva. A apreensão da percepção dos participantes sobre a vivência e suas repercussões na vida cotidiana ocorreu durante o segundo semestre de 2013. Na coleta dos dados foram utilizados registros de portfólios de aprendizagem, observação participante e anotações em diário de campo. A análise fundamentou-se nas narrativas dos participantes e em registros temáticos decorrentes das anotações feitas. Os resultados apontaram sintonia com os referenciais pedagógicos baseados na metodologia da problematização. Foi evidenciada uma contribuição para a edificação de laços de solidariedades e o estímulo a posturas interativas críticas e tolerantes com o outro. Os participantes enfatizaram a relevância cotidiana dos temas debatidos e a troca de ideias em torno de situações comuns. Concluiu-se que o diálogo entre os saberes acadêmicos e populares constitui uma oportunidade ímpar em busca do desenvolvimento de competências e habilidades, instrumentais ou comunicativas, imprescindíveis aos discentes enquanto futuros profissionais de saúde.

ABSTRACT This article describes an experience of integrating teaching, research and outreach activities through round tables in a Family Health Unit, relating its aspects to sociological contributions of the Theory of Giving. The participants’ perceptions about the experience and its impact on everyday life were captured in the second half of 2013. Learning portfolios, participant observation and notes in the field diary were used for the data collection. The analysis was based on participants’ narratives and thematic records arising from the notes taken. The results were in line with pedagogical references based on the methodology of critical questioning. In evidence was a contribution to building ties of solidarity and encouraging interactive critical stances and tolerance with others. The participants emphasized the everyday relevance of the issues discussed, the exchange of ideas regarding common situations. The conclusions inferred that the dialogue between academic and popular knowledge represents a unique opportunity to seek the development of instrumental or communicative skills and abilities, essential to students as future health professionals.

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The purpose of this study was to test the effect of short-term training on reaching behavior in infants at the onset of reaching. The study was a single-blind, parallel group design, randomized controlled clinical trial. Thirty healthy infants were randomly assigned to a social control group (n = 15) or a reaching training group (n = 15). Infants began the study up to 3 days after the onset of reaching and were assessed three times across 2 days: pretraining (before training), posttraining 1 (after 1 session of training), and posttraining 2 (after 3 sessions of training). The reaching training group received 3 sessions of training by a physical therapist while the control group received a similar amount of time sitting in the therapist's lap. The data were analyzed using repeated-measures analyses of variance, and independent-samples tests with Bonferroni adjustments. Short-term training resulted in increased frequency of object contacts, shorter and smoother reaches, and improved hand positioning. The few short training sessions likely provided opportunities for infants to explore and learn to select movements from their existing movement repertoire. These results demonstrate that adaptive changes in infants' novel behaviors can emerge rapidly, and highlight the need for increased understanding of how to most effectively time early interventions.

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OBJECTIVE: We aimed to evaluate the cumulative fluid balance during the period of shock and determine what happens to fluid balance in the 7 days following recovery from shock. METHODS: A prospective and observational study in septic shock patients. Patients with a mean arterial pressure ≥ 65 mmHg and lactate < 2.0 mEq/L were included < 12 hours after weaning from vasopressor, and this day was considered day 1. The daily fluid balance was registered during and for seven days after recovery from shock. Patients were divided into two groups according to the full cohort's median cumulative fluid balance during the period of shock: Group 1 ≤ 4.4 L (n = 20) and Group 2 > 4.4 L (n = 20). RESULTS: We enrolled 40 patients in the study. On study day 1, the cumulative fluid balance was 1.1 [0.6 - 3.4] L in Group 1 and 9.0 [6.7 - 13.8] L in Group 2. On study day 7, the cumulative fluid balance was 8.0 [4.5 - 12.4] L in Group 1 and 14.7 [12.7 - 20.6] L in Group 2 (p < 0.001 for both). Afterwards, recovery of shock fluid balance continued to increase in both groups. Group 2 had a more prolonged length of stay in the intensive care unit and hospital compared to Group 1. CONCLUSION: In conclusion, positive fluid balances are frequently seen in patients with septic shock and may be related to worse outcomes. During the shock period, even though the fluid balance was previously positive, it becomes more positive. After recovery from shock, the fluid balance continues to increase. The group with a more positive fluid balance group spent more time in the intensive care unit and hospital.

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Objetivo: Avaliar o balanço hídrico acumulado durante o período do choque e determinar o que ocorre com ele nos 7 dias que se seguem à reversão do choque. Métodos: Estudo prospectivo e observacional, realizado em pacientes com choque séptico. Foram incluídos pacientes com pressão arterial média ≥ 65mmHg e lactato < 2,0mEq/L desmamados há menos de 12 horas do uso de vasopressores, sendo esse dia considerado o Dia 1. O balanço hídrico diário foi registrado por 7 dias após recuperação do choque. Os pacientes foram divididos em dois grupos, segundo a mediana da coorte para o balanço hídrico acumulado durante o período do choque: Grupo 1 ≤ 4,4L (n = 20) e Grupo 2 > 4,4L (n = 20). Resultados: Inscrevemos, neste estudo, um total de 40 pacientes. No Dia 1 do estudo, o balanço hídrico acumulado era de 1,1 [0,6 - 3,4] L no Grupo 1 e 9,0 [6,7 - 13,8] L no Grupo 2. No Dia 7 do estudo, o balanço hídrico acumulado era de 8,0 [4,5 - 12,4] L no Grupo 1 e 14,7 [12,7 - 20,6] L no Grupo 2 (p < 0,001 para ambos). A seguir, após a recuperação do choque, o balanço hídrico continuou a aumentar em ambos os grupos. Em comparação ao Grupo 1, o Grupo 2 teve um tempo mais longo de permanência na unidade de terapia intensiva e no hospital. Conclusão: São frequentemente observados balanços hídricos positivos em pacientes com choque séptico, o que pode estar relacionado a desfechos piores. Durante o período do choque, mesmo que o balanço hídrico fosse previamente positivo, este se torna ainda mais positivo. Após a recuperação do choque, o balanço hídrico continua a aumentar. Esse grupo com um balanço hídrico mais positivo permaneceu por mais tempo na unidade de terapia intensiva e no hospital. .

Objective: We aimed to evaluate the cumulative fluid balance during the period of shock and determine what happens to fluid balance in the 7 days following recovery from shock. Methods: A prospective and observational study in septic shock patients. Patients with a mean arterial pressure ≥ 65mmHg and lactate < 2.0mEq/L were included < 12 hours after weaning from vasopressor, and this day was considered day 1. The daily fluid balance was registered during and for seven days after recovery from shock. Patients were divided into two groups according to the full cohort’s median cumulative fluid balance during the period of shock: Group 1 ≤ 4.4L (n = 20) and Group 2 > 4.4L (n = 20). Results: We enrolled 40 patients in the study. On study day 1, the cumulative fluid balance was 1.1 [0.6 - 3.4] L in Group 1 and 9.0 [6.7 - 13.8] L in Group 2. On study day 7, the cumulative fluid balance was 8.0 [4.5 - 12.4] L in Group 1 and 14.7 [12.7 - 20.6] L in Group 2 (p < 0.001 for both). Afterwards, recovery of shock fluid balance continued to increase in both groups. Group 2 had a more prolonged length of stay in the intensive care unit and hospital compared to Group 1. Conclusion: In conclusion, positive fluid balances are frequently seen in patients with septic shock and may be related to worse outcomes. During the shock period, even though the fluid balance was previously positive, it becomes more positive. After recovery from shock, the fluid balance continues to increase. The group with a more positive fluid balance group spent more time in the intensive care unit and hospital. .

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OBJECT: The purpose of the study was to investigate the influence of short-term training on distal adjustments of reaching in preterm infants with low birth weight and compare them with full-term infants METHODS: Sixteen infants at the onset of reaching were equally allocated to a: preterm group (<34 weeks of gestational age) with a low birth weight (<2.5kg), and control group (full-term infants). The infants were submitted to two assessments carried out on a single day: pre-training (2 minutes) and post-training (2 minutes). The preterm group received one training session under a serial practice condition and the control group received one session of social training. It was used the repeated-measures analysis of variance, with Bonferroni adjustments RESULTS: The preterm infants presented more reaches with semi-open and oblique hand compared with the full-term infants and the short-term training increased more reaches and reaches with dorsal hand CONCLUSION: We conclude that the preterm infants presented more reaches with semi-open and oblique hand compared with the full-term infants and that the short-term training was effective in providing more reaches, observed in the increase in the number of hand contacts with the object.(AU)

OBJETIVO: O objetivo do estudo foi investigar a influência do treino de curta duração nos ajustes distais do alcance em lactentes pré-termo e baixo peso ao nascimento, e compará-los com lactentes a termo MÉTODOS: Dezesseis lactentes na emergência do alcance foram igualmente alocados em: grupo pré-termo (< 34 semanas de idade gestacional), e baixo peso ao nascimento (< 2,5 kg), e grupo controle (lactentes a termo). Os lactentes foram submetidos a duas avaliações realizadas em um único dia: pré-treino (2 minutos) e pós-treino (2 minutos). O grupo pré-termo recebeu uma sessão de treino (prática variada seriada) e o grupo controle recebeu uma sessão de treino social. Foi utilizada a análise de medidas repetidas de variância, com ajustes de Bonferroni RESULTADOS: Os lactentes pré-termo apresentaram mais alcances com mão semi-aberta e oblíqua em comparação com os lactentes a termo. O treino de curta duração aumentou a frequência de alcances CONCLUSÃO: Conclui-se que os lactentes pré-termo apresentaram mais alcances com mão semi-aberta e oblíqua em relação aos lactentes a termo e que o treino de curta duração foi efetivo na emergência do alcance, observando o aumento do número de contatos da mão do lactente com o objeto.(AU)

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OBJECT: The purpose of the study was to investigate the influence of short-term training on distal adjustments of reaching in preterm infants with low birth weight and compare them with full-term infants METHODS: Sixteen infants at the onset of reaching were equally allocated to a: preterm group (<34 weeks of gestational age) with a low birth weight (<2.5kg), and control group (full-term infants). The infants were submitted to two assessments carried out on a single day: pre-training (2 minutes) and post-training (2 minutes). The preterm group received one training session under a serial practice condition and the control group received one session of social training. It was used the repeated-measures analysis of variance, with Bonferroni adjustments RESULTS: The preterm infants presented more reaches with semi-open and oblique hand compared with the full-term infants and the short-term training increased more reaches and reaches with dorsal hand CONCLUSION: We conclude that the preterm infants presented more reaches with semi-open and oblique hand compared with the full-term infants and that the short-term training was effective in providing more reaches, observed in the increase in the number of hand contacts with the object...

OBJETIVO: O objetivo do estudo foi investigar a influência do treino de curta duração nos ajustes distais do alcance em lactentes pré-termo e baixo peso ao nascimento, e compará-los com lactentes a termo MÉTODOS: Dezesseis lactentes na emergência do alcance foram igualmente alocados em: grupo pré-termo (< 34 semanas de idade gestacional), e baixo peso ao nascimento (< 2,5 kg), e grupo controle (lactentes a termo). Os lactentes foram submetidos a duas avaliações realizadas em um único dia: pré-treino (2 minutos) e pós-treino (2 minutos). O grupo pré-termo recebeu uma sessão de treino (prática variada seriada) e o grupo controle recebeu uma sessão de treino social. Foi utilizada a análise de medidas repetidas de variância, com ajustes de Bonferroni RESULTADOS: Os lactentes pré-termo apresentaram mais alcances com mão semi-aberta e oblíqua em comparação com os lactentes a termo. O treino de curta duração aumentou a frequência de alcances CONCLUSÃO: Conclui-se que os lactentes pré-termo apresentaram mais alcances com mão semi-aberta e oblíqua em relação aos lactentes a termo e que o treino de curta duração foi efetivo na emergência do alcance, observando o aumento do número de contatos da mão do lactente com o objeto...

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BACKGROUND: There is evidence that long-term experience can promote functional changes in infants. However, much remains unknown about how a short-term experience affects performance of a task. OBJECTIVE: This study aims to investigate the influence of a single training session at the onset of goal-directed reaching on the spatio-temporal parameters of reaching and whether there are differences in the effects of training across different reaching positions. METHOD: Thirty-three infants were divided into three groups: 1) a control group; 2) a group that was reach trained in a reclined position; and 3) a group trained in the supine position. The infants were submitted to two assessments (pre- and post-training) in two testing positions (supine and reclined at 45°). RESULTS: The short-duration training sessions were effective in promoting shorter reaches in the specific position in which the training was conducted. Training in the reclined position was associated with shorter and faster reaches upon assessment in the reclined position. CONCLUSIONS: A few minutes of reach training are effective in facilitating reaching behavior in infants at the onset of reaching. The improvements in reaching were specific to the position in which the infants were trained.

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BACKGROUND: There is evidence that long-term experience can promote functional changes in infants. However, much remains unknown about how a short-term experience affects performance of a task. OBJECTIVE: This study aims to investigate the influence of a single training session at the onset of goal-directed reaching on the spatio-temporal parameters of reaching and whether there are differences in the effects of training across different reaching positions. METHOD: Thirty-three infants were divided into three groups: 1) a control group; 2) a group that was reach trained in a reclined position; and 3) a group trained in the supine position. The infants were submitted to two assessments (pre- and post-training) in two testing positions (supine and reclined at 45°). RESULTS: The short-duration training sessions were effective in promoting shorter reaches in the specific position in which the training was conducted. Training in the reclined position was associated with shorter and faster reaches upon assessment in the reclined position. CONCLUSIONS: A few minutes of reach training are effective in facilitating reaching behavior in infants at the onset of reaching. The improvements in reaching were specific to the position in which the infants were trained. .

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