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O presente artigo explora alguns impactos políticos e sociais reconhecidos nos dez anos que sucederam as manifestações de junho de 2013, dando ênfase a um fator específico: o papel das mídias sociais no cenário político e na mobilização de grupos. Partindo desse foco, trata da possibilidade de que tais ferramentas digitais possam ser melhor exploradas por certos grupos políticos em detrimento de outros, e os motivos para tanto. Tal questão será discutida a partir de autores de estudos da tecnologia, da teoria social e da psicanálise. Não necessariamente inferindo uma diferenciação de conteúdo de ideologias políticas, propomos essa distinção considerando que os impactos subjetivos e de mobilização produzidos por tais mídias podem ser assimilados e empregados de acordo com objetivos específicos. Trata-se, assim, de um exame sobre os impactos que as mídias sociais produzem em processos de subjetivação e de agrupamento, e seus efeitos políticos.
Resumos This paper explores political and social impacts present in the ten years since June 2013 demonstrations, emphasizing an specific factor: the role of social media in the political landscape and in mobilizing groups. We take as a central question the possibility that those digital tools are better explored by some political groups to the detriment of others, and the reasons that explain this difference. This question is developed with authors from the studies of technology, social theory, and psychoanalysis. Without necessarily assuming a content differentiation among political views, we propose their distinction considering that the subjective and the mobilizing impacts produced by these media can be assimilated and employed according to specific objectives. Therefore, this study is an examination of the impacts that social media produce on subjectivation and grouping processes, and their political effects.
Cet article explore certains des impacts politiques et sociaux constatés au cours des dix années qui ont suivi les manifestations de juin 2013, en mettant l'accent sur un facteur spécifique: le rôle des médias sociaux dans le paysage politique et dans la mobilisation des groupes. À partir de là, il aborde la possibilité que ces outils numériques puissent être mieux exploités par certains groupes politiques au détriment d'autres, et les raisons de cette différence supposée. Cette question sera discutée à l'aide d'auteurs issus des études technologique, de la théorie sociale et de la psychanalyse. Sans nécessairement en déduire une différenciation dans le contenu des opinions politiques, nous proposons cette distinction en considérant que les impacts subjectifs et mobilisateurs produits par ces médias peuvent être assimilés et utilisés en fonction d'objectifs spécifiques. Il s'agit donc d'examiner les impacts que les médias sociaux produisent sur les processus de subjectivation et de regroupement, et leurs effets politiques.
Este artículo explora los impactos políticos y sociales desencadenados tras diez años de las manifestaciones de junio de 2013 enfatizando un factor específico: el papel de las redes sociales en los escenarios políticos y en la movilización de grupos. A partir de este foco, se aborda la posibilidad de que estas herramientas digitales sean mejor exploradas por unos grupos políticos que por otros, y las razones que explican esta diferencia. Para discutir esta cuestión se utiliza autores de la filosofía de la tecnología, de la teoría social y del psicoanálisis. Sin asumir necesariamente una diferenciación de contenido entre ideologías políticas, se propone esta distinción teniendo en cuenta que los impactos subjetivos y de movilización que producen estas herramientas digitales pueden ser asimilados y empleados de acuerdo con objetivos específicos. Se trata, por tanto, de un examen sobre los impactos que las redes sociales producen en los procesos de subjetivación y agrupación, y sus efectos políticos.
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This study explored the metabolic adaptions to grazing conditions of two Holstein genetic strains (GS; North American, NAH; New Zealand, NZH) in two feeding strategies (FS; restricted, P30, vs. maximised, PMAX, grazing). Four groups (NAH-P30, NZH-P30, NAH-PMAX and NZH-PMAX; n = 10 cows each) were compared between -45 and 180 days in milk (DIM). NZH cows had lower (p = 0.02) fat and protein corrected milk (FPCM) yield and a tendency for lower (p = 0.09) body condition score concomitantly with a trend (p < 0.07) for higher average plasma insulin and lower (p = 0.01) 3-methylhistidine (3MH) at -45 DIM than NAH. Plasma glucose tended to be affected by the triple interaction GS × FS × DIM (p = 0.06) as it was similar between NAH-P30 and NZH-P30, but higher (p ≤ 0.02) for NZH-PMAX than NAH-PMAX except at 21 DIM. The physiological imbalance index was affected by the GS × FS interaction (p < 0.01) as it was lower (p < 0.01) only for NZH-PMAX versus NAH-PMAX. NZH cows had higher (p = 0.01) plasma thiobarbituric acid reactive substances at -45 DIM and tended to have higher protein carbonyls (p = 0.10) and superoxide dismutase (SOD) activity (p = 0.06) on average, and had higher (p < 0.01) α-tocopherol during mid-lactation than NAH Regarding the FS, FPCM was similar (p = 0.12) among them, but PMAX cows had higher (p < 0.01) plasma non-esterified fatty acids and 3MH, and lower insulin (p < 0.01) than P30 at 100 DIM. PMAX cows showed higher average SOD activity (p = 0.01) and plasma α-tocopherol at 100 and 180 DIM (p < 0.01). Under grazing, NZH cows can have a better energy status and lower muscle mobilisation but a higher redox reactivity. Maximising grazing can worsen energy status and muscle mobilisation while improving antioxidant response with no effect on FPCM.
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Dieta , alfa-Tocoferol , Feminino , Bovinos , Animais , Dieta/veterinária , Nova Zelândia , alfa-Tocoferol/metabolismo , Leite/metabolismo , Lactação/fisiologia , Insulina , Oxirredução , América do Norte , Superóxido Dismutase/metabolismo , Metabolismo EnergéticoRESUMO
BACKGROUND: In the past decade, Brazil has significantly reduced the prevalence of schistosomiasis through a combined effort of early treatment of infected people, expansion of basic sanitation infrastructure and educational measures. Despite these efforts, in some areas, prevalence of schistosomiasis exceeds 20% of the school population, who lack knowledge of the risks of the disease. Action can be taken in schools to empower this population about their health condition. This paper describes the role of the teacher as a multiplier of knowledge about schistosomiasis and proposes two different approaches to training these teachers. METHODS: This study used mixed methods to evaluate training of teachers and educational intervention with those teachers' pupils. Two training courses, each with 40 h of face-to-face activity, were offered to 19 teachers, using two different but complementary approaches, based on theoretical references and specific educational strategies: Critical Pedagogical Approach (Training Course I, held in 2013) and Creative Play Approach (Training Course II, held in 2014).The courses included classroom activities, laboratory and field work. After the training, the teachers conducted activities on schistosomiasis with their pupils. These activities involved constructing educational materials and cultural productions. The pupils' knowledge about the disease was evaluated before the activities and 12 months later. The teachers' acceptance and perceptions were assessed through structured interviews and subsequent thematic analysis. The Shistosoma mansoni infection status of teachers and their students was also assessed using the Kato Katz stool test. RESULTS: The parasitological study showed 31.6% of the teachers and 21.4% of the pupils to be positive for S. mansoni. The teachers' knowledge of important aspects of schistosomiasis transmission and prevention was fragmented and incorrect prior to the training. The teachers' knowledge changed significantly after the training and they were strongly accepting of the pedagogical methods used during the training. The level of their pupils' knowledge about the disease had increased significantly (p < 0.05). However, pupils responded that, even after the educational activities, they still had contact with the city's contaminated waters (p > 0.05). CONCLUSIONS: The results of this study underline the importance of schools and teachers as partners in controlling and eliminating schistosomiasis. Teacher training on the disease significantly increases their pupils' knowledge, reflecting empowerment with regard to local health conditions.
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Educação em Saúde , Esquistossomose , Humanos , Instituições Acadêmicas , Estudantes , Docentes , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controleRESUMO
OBJECTIVES: Elucidating the recent evolutionary history of clinically important antibiotic resistance genes may inform measures to delay the future emergence of additional resistance genes in clinics. This study investigated the recent origin of blaAIM-1, a metallo-ß-lactamase gene found in Pseudomonas aeruginosa, and the possible role of ISCR15 in its mobilisation and transfer into clinical species. METHODS: Comparative genomics were used to identify the recent origin of blaAIM. Mobilisation attempts were performed under different conditions by cloning ISCR15 and the blaAIM-1-like gene in Escherichia coli. RESULTS: Several blaAIM-1 homologues were identified in the Pseudoxanthomonas genus, with conserved synteny of the locus between species and absence of elements associated with mobility. The closest AIM-1 homologue (97.7% amino acid identity) was found in a Pseudoxanthomonas mexicana (P. mexicana) strain. Cloning the blaAIM-like gene in Escherichia coli resulted in high resistance towards carbapenems. While blaAIM-1 is surrounded by ISCR15 elements in clinical strains, in vitro experiments failed to demonstrate their role as mobilising elements. CONCLUSIONS: This study presents evidence that P. mexicana, an environmental species occasionally associated with infections, is the origin of the B3 metallo-ß-lactamase AIM-1. The presence of terIS, a plausible recognition site for ISCR15, in other parts of the P. mexicana genome suggests a more complex and yet not understood mobilisation mechanism.
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Proteínas de Bactérias , beta-Lactamases , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Escherichia coli/genética , Escherichia coli/metabolismo , Testes de Sensibilidade Microbiana , Pseudomonas aeruginosa/genética , Xanthomonadaceae , beta-Lactamases/metabolismoRESUMO
BACKGROUND: Process evaluation within clinical trials provides an assessment of the study implementation's accuracy and quality to explain causal mechanisms and highlight contextual factors associated with variation in outcomes. OBJECTIVES: This study aimed to identify the barriers and facilitators of implementing early mobilisation (EM) within a trial. METHODS: This is a qualitative process evaluation study within the Trial of Early Activity and Mobilisation (TEAM) phase 3 randomised controlled trial. Semistructured interviews were conducted remotely with multiprofessional clinicians (physiotherapists, medical staff, and nursing staff) involved in the delivery of the TEAM intervention at Australian hospitals participating in the TEAM study. Inductive coding was used to establish themes which were categorised into the Behaviour system involving domains of Capability, Opportunity, and Motivation (COM-B), which allowed barriers and enablers affecting EM to be identified. FINDINGS: Semistructured interviews were conducted in three different states of Australia. There were 16 participants, including 10 physiotherapists, five physicians, and one nurse. The key themes that facilitated EM were mentoring, champions, additional staff, organisation of the environment, cultural changes, communication, and documented safety criteria. In contrast, the main factors that hindered EM were lack of expertise and confidence in delivering EM, heavy sedation, interdisciplinary conflicts, and perceived risks related to EM. CONCLUSION: A wide range of barriers and facilitators that influenced EM within the TEAM study were identified using the COM-B framework. Many of these have been previously identified in the literature; however, participation in the study was viewed positively by multidisciplinary team members.
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Comunicação , Deambulação Precoce , Austrália , Humanos , Pesquisa QualitativaRESUMO
BACKGROUND: Social mobilisation is potentially a key tool in the prevention of non-communicable diseases (NCDs) in fragile settings. This formative study addressed existing and potential social mobilisation mechanisms seeking behaviour to tackle NCDs in El Salvador, with an emphasis on the implications in the context of the current COVID-19 pandemic. METHODS: We conducted 19 semi-structured interviews with health workers, government officials, NGO leaders, and community members. Interviews addressed mechanisms for social mobilisation which existed prior to COVID-19, the ways in which these mechanisms tackled NCDs, the impact of COVID-19 on social mobilisation activities and new, emerging mechanisms for social mobilisation in the wake of the COVID-19 pandemic. RESULTS: Findings indicate a growing awareness of NCDs within communities, with social mobilisation activities seen as valuable in tackling NCDs. However, major barriers to NCD prevention and treatment provision remain, with COVID-19 constraining many possible social mobilisation activities, leaving NCD patients with less support. Factors linked with effective social mobilisation of communities for NCD prevention included strong engagement of community health teams within community structures and the delivery of NCD prevention and management messages through community meetings with trusted health professionals or community members. There are gender differences in the experience of NCDs and women were generally more engaged with social mobilisation activities than men. In the context of COVID-19, traditional forms of social mobilisation were challenged, and new, virtual forms emerged. However, these new forms of engagement did not benefit all, especially those in hard-to-reach rural areas. In these contexts, specific traditional forms of mobilisation such as through radio (where possible) and trusted community leaders - became increasingly important. CONCLUSIONS: New mechanisms of fostering social mobilisation include virtual connectors such as mobile phones, which enable mobilisation through platforms such as WhatsApp, Facebook and Twitter. However, traditional forms of social mobilisation hold value for those without access to such technology. Therefore, a combination of new and traditional mechanisms for social mobilisation hold potential for the future development of social mobilisation strategies in El Salvador and, as appropriate, in other fragile health contexts.
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COVID-19 , Doenças não Transmissíveis , El Salvador , Feminino , Humanos , Masculino , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/prevenção & controle , Pandemias/prevenção & controle , SARS-CoV-2RESUMO
BACKGROUND: 1. Colombia with 1941 known recorded bird species is one of the most species rich countries in the world. Efforts are necessary to conserve, study and promote sustainable use of this important taxonomic group throughout Colombia's vast territory.2. In an ideal world, informed decisions that are based on sound scientific information should be likelier to have successful outcomes. Nevertheless, there are barriers that make it difficult to access and use information in a timely fashion. Those same barriers impede the study, conservation and sustainable use of bird species in Colombia. On the other hand, given that there is good documentation about the ecology of a large number of species, information about the distribution of birds can be easily incorporated into decision-making processes, once this information becomes readily available in a consumable format using Geographic Information Sciences tools.3. In this context, the main objective of this paper is to present the first compilation of the current distribution of 1889 (97%) species of birds in Colombia, using expert criteria. The shapefiles were used to show the distribution and diversity of bird species in Colombia under both geopolitical and conservation geographic units.4. The information provided in this paper can be used as a baseline for a huge number of initiatives that aim to strengthen conservation efforts and improve knowledge about one the most unique taxonomic groups in the country. These range from land use planning strategies at the municipal or department scale to sustainable use of bird species - such as those initiatives related to bird watching - in Colombia. NEW INFORMATION: This study has considered three key aspects: 1) the importance of birds for Colombia's ecosystems, 2) the privileged place of Colombia in bird species richness and 3) the importance of data mobilisation in formats easily consumable by Geographic Information Systems (GIS) to facilitate the processes of informed decision-making. We present the first compilation - in shapefile format - for 1889 of the 1941 bird species recorded from Colombia. Using this novel collection, we showed the species richness of birds in Colombia's 33 Departments plus its Captial District (DPs), 1122 Municipalities (MNs), 58 protected areas (PAs), 39 Regional Autonomous Corporations (the authorities responsible within their respective jurisdictions for regulating the environment and renewable natural resources in Colombia; CARs) and 916 Collectively Titled Territories (including both indigenous reservations and afro-descendant communities; CTTs). In addition, we provide a list of known bird species richness for the above geographic units found in the available literature. The information provided here can be used as a baseline for a huge number of initiatives concerning the study, conservation and sustainable use of bird species present in Colombia, providing access to key features of bird distribution that should facilitate decision-making.
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BACKGROUND: South America hosts some of the world's most prominent biodiversity hotspots. Yet, Uruguay - a country where multiple major ecosystems converge - ranks amongst the countries with the lowest levels of available digital biodiversity data in the continent. Such prevalent data scarcity has significantly undermined our ability to progress towards evidence-based conservation actions - a critical limitation for a country with a strong focus on agricultural industries and only 1.3% of the land surface guarded by protected areas. Under today's rapid biodiversity loss and environmental changes, the need for open-access biodiversity data is more pressing than ever before. To address this national issue, Biodiversidata - Uruguay's first Consortium of Biodiversity Data - has recently emerged with the aim of assembling a constantly growing database for the biodiversity of this country. While the first phase of the project targeted vertebrate biodiversity, the second phase presented in this paper spans the biodiversity of plants. NEW INFORMATION: As part of the second phase of the Biodiversidata initiative, we present the first comprehensive open-access species-level database of the vascular plant diversity recorded in Uruguay to date (i.e. all species for which data are currently available and species presence has been confirmed). It contains 12,470 occurrence records from across 1,648 species and 160 families, which roughly represents 60% of the total recorded flora of Uruguay. The primary biodiversity data include extant native and introduced species from the lycophytes, ferns, gymnosperms and angiosperms groups. Records were collated from multiple sources, including data available in peer-reviewed scientific literature, institutional scientific collections and datasets contributed by members of the Biodiversidata initiative. The complete database can be accessed at the Zenodo repository: doi.org/10.5281/zenodo.3954406.
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BACKGROUND: Rotator cuff related pain (RCRP) is one of the most common sources of musculoskeletal shoulder pain affecting the general population. Conservative treatment, in the form of exercise, is considered the first line approach, nonetheless, improvements seem to be modest. One therapeutic modality that might be an adjunct to the treatment of this condition is mobilisation with movement (MWM). MWM is a pain-free manual procedure that targets restricted and painful movements, commonly seen in patients with RCRP. The purpose of clinical trial is to determine whether MWM with exercise has benefits over sham MWM with exercise in RCRP. METHODS: A randomised, sham-controlled trial of 70 adults complaining of RCRP will compare the effects of MWM combined with exercise over sham MWM with exercise. Participants will be allocated to one of two groups: exercise and MWM (EG) or exercise and sham MWM (CG). Two weekly individual treatment sessions will be conducted over five weeks. All assessments will be performed by a blinded assessor. Primary outcome measures will be the shoulder pain and disability index (SPADI) and the numeric pain rating scale (NPRS), assessed at baseline, discharge and one-month follow-up. Secondary outcome measures will be active range of motion, self-efficacy and the global rating of change scale. The analyses will be conducted considering a statistically significant p-value ≤0.05. Normality will be assessed with the Kolmogorov-Smirnov test and homogeneity with the Levene's test. For the primary outcome measures (SPADI and NPRS) and self-efficacy, a 2 × 3 ANOVA with treatment group (EG versus CG) and time (baseline, end of the treatment and follow-up) factors will be performed. Separate 2 × 2 ANOVA will be used for range of motion (baseline and end of the treatment). Global rating scale of change analysis will be conducted using descriptive statistics. Intention-to-treat analysis will be adopted. DISCUSSION: As there is a paucity of longitudinal studies investigating the use of MWM in patients with RCRP, this study will help to better understand its role together with a structured exercise programme. TRIAL REGISTRATION: Clinical Trials Registry number NCT04175184 . November, 2019.
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Modalidades de Fisioterapia , Manguito Rotador , Dor de Ombro , Adulto , Terapia por Exercício , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Padrões de Referência , Dor de Ombro/diagnóstico , Dor de Ombro/terapia , Resultado do TratamentoRESUMO
Social mobilization is an important component of the delivery of vaccines and has to be carried out at different levels. It plays a very critical role in success of a campaign, as was shown by the Polio eradication program in India that was supported by SMNet, a platform created for the purpose. Learnings from this has been used for other vaccine deployments in India as well. In addition, there is a social mobilization effort for routine immunization. A guideline for social mobilization was created by UNICEF specifically for cholera vaccine use during Haiti epidemic in 2010. Since there is a need to develop a roadmap for cholera control in India, especially in the known hotspots, and after natural disasters, we suggest a possible strategy that could be built on the existing framework available in India.
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Vacinas contra Cólera/administração & dosagem , Cólera , Programas de Imunização/organização & administração , Cólera/epidemiologia , Cólera/prevenção & controle , Haiti , Humanos , Índia/epidemiologiaRESUMO
BACKGROUND: Control of the Aedes aegypti mosquito is central to reducing the risk of dengue, zika, chikungunya, and yellow fever. Randomised controlled trials, including the Camino Verde trial in Mexico and Nicaragua, demonstrate the convincing impact of community mobilisation interventions on vector indices. These interventions might work through building social capital but little is known about the relationship between social capital and vector indices. METHODS: A secondary analysis used data collected from 45 intervention clusters and 45 control clusters in the impact survey of the Mexican arm of the Camino Verde cluster randomised controlled trial. Factor analysis combined responses to questions about aspects of social capital to create a social capital index with four constructs, their weighted averages then combined into a single scale. We categorised households as having high or low social capital based on their score on this scale. We examined associations between social capital and larval and pupal vector indices, taking account of the effects of other variables in a multivariate analysis. We report associations as odds ratios and 95% confidence intervals. RESULTS: The four social capital constructs were involvement, participation, investment, and communication. Among the 10,112 households, those in rural communities were much more likely to have a high social capital score (OR 4.51, 95% CIca 3.26-6.26). Households in intervention sites had higher social capital, although the association was not significant at the 5% level. Households with high social capital were more likely to be negative for larvae or pupae (OR 1.38, 95% CIca 1.12-1.69) and for pupae specifically (OR 1.37, 95% CIca 1.08-1.74). There was interaction between intervention status and social capital; in multivariate analysis, a combined variable of intervention/high social capital remained associated with larvae or pupae (ORa l.56, 95% CIca 1.19-2.04) and with pupae specifically (ORa 1.65, 95% CIca 1.20-2.28). CONCLUSION: This is the first report of an association of high social capital with low vector indices. Our findings support the idea that the Camino Verde community mobilisation intervention worked partly through an interaction with social capital. Understanding such interactions may help to maximise the impact of future community mobilisation interventions.
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Serviços de Saúde Comunitária/organização & administração , Dengue/prevenção & controle , Controle de Mosquitos/organização & administração , Características de Residência , Capital Social , Aedes/virologia , Animais , Dengue/virologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , México , Mosquitos Vetores/virologia , NicaráguaRESUMO
INTRODUCTION: Early mobilisation has been extensively advocated to improve functional outcomes in critically ill patients, even though consistent evidence of its benefits has remained elusive. These conflicting results could be explained by a lack of knowledge on the optimal dosage of physical therapy and a mismatch between ventilatory support and exercise-induced patient ventilatory demand. Modern mechanical ventilators provide real-time monitoring of respiratory/metabolic variables and ventilatory setting that could be used for physical therapy dosage or ventilatory support titration, allowing individualised interventions in these patients. The aim of this review is to comprehensively map and summarise current knowledge on adjustments of respiratory support and respiratory or metabolic monitoring during physical therapy in adult critically ill mechanically ventilated patients. METHODS AND ANALYSIS: This is a scoping review protocol based on the methodology of the Joanna-Briggs-Institute. The search strategy will be conducted from inception to 30 June 2019 as a cut-off date in PubMed, CINAHL, Rehabilitation & Sport Medicine, Scielo Citation Index, Epistemónikos, Clinical Trials, PEDro and Cochrane Library, performed by a biomedical librarian and two critical care physiotherapists. All types of articles will be selected, including conference abstracts, clinical practice guidelines and expert recommendations. Bibliometric variables, patient characteristics, physical therapy interventions, ventilator settings and respiratory or metabolic monitoring will be extracted. The identified literature will be analysed by four critical care physiotherapists and reviewed by a senior critical care physician. ETHICS AND DISSEMINATION: Ethical approval is not required. The knowledge-translation of the results will be carried out based on the End-of-Grant strategies: diffusion, dissemination and application. The results will be published in a peer-review journal, presentations will be disseminated in relevant congresses, and recommendations based on the results will be developed through training for mechanical ventilation and physical therapy stakeholders.
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Cuidados Críticos/estatística & dados numéricos , Estado Terminal/terapia , Modalidades de Fisioterapia/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Adulto , Medicina Baseada em Evidências , Humanos , Unidades de Terapia Intensiva , Desmame do Respirador/estatística & dados numéricosRESUMO
A partir da constatação de que os estudos em clínica psicodinâmica do trabalho enfocam trabalhadores em situação de normalidade e não expressam, claramente, como a mobilização subjetiva ocorre a partir da escuta clínica, pretendeu-se, com este artigo, problematizar o conceito dejouriano de mobilização subjetiva em contexto de trabalhadores adoecidos. A pesquisa foi realizada com base no referencial teórico e metodológico da psicodinâmica do trabalho. Foram realizadas 22 sessões de clínica do trabalho com professoras readaptadas do Distrito Federal e os dados foram analisados conforme a técnica de análise clínica do trabalho. A mobilização subjetiva, como um processo de resgate do sentido e do prazer no trabalho, não foi possível de ser alcançada na clínica. Esse resultado se deve ao fato de o trabalho na readaptação se constituir em um trabalho morto, inclusive no sentido de contribuir para o isolamento e a exclusão dessas profissionais, levando ao desmoronamento dos laços sociais e à impossibilidade de uma mobilização coletiva potente o suficiente para mudar as questões estruturais desse não trabalho a que estão submetidas. Apesar de defender a impossibilidade de mobilização subjetiva em um trabalho morto, a grande contribuição da clínica do trabalho realizada foi no sentido de demonstrar a potência política da clínica do trabalho a partir de novos destinos que as professoras adoecidas puderam dar ao sofrimento.
This article aimed to problematize the Dejourian concept of subjective mobilization in the context of sick workers based on the fact that studies in clinical psychodynamic work focus on workers in a normal situation and do not clearly express how subjective mobilization occurs from clinical listening. The research was based on the theoretical and methodological framework of psychodynamic work. Twenty-two occupational clinic sessions were held with readapted teachers from the Federal District and the data were analyzed according to the clinical work analysis technique. Subjective mobilization, as a process of rescuing meaning and pleasure at work, could not be achieved in the clinic. This result is due to the fact that the work on re-adaptation constitutes a dead work, including in the sense of contributing to the isolation and exclusion of these professionals, leading to the collapse of social ties and the impossibility of a collective mobilization powerful enough to change the structural issues of this non-work to which they are subjected. Despite defending the impossibility of subjective mobilization in a dead work, the great contribution of the clinic work performed was to demonstrate the political power of the work clinic from new destinations that the sick teachers could give to suffering.
A partir de la constatación de que los estudios en clínica psico-dinámica del trabajo enfocan trabajadores en situación de normalidad y no exprimen, claramente, cómo la movilización subjetiva ocurre a partir de la escucha clínica, se pretendió, con este trabajo, problematizar el concepto dejouriano de movilización subjetiva en contexto de trabajadores enfermos. La investigación fue realizada con base en el referencial teórico y metodológico de la psico-dinámica del trabajo. Fueron realizadas 22 sesiones de clínica del trabajo con profesoras readaptadas del Distrito Federal y los datos fueron analizados según la técnica de análisis clínica del trabajo. La movilización subjetiva, como un proceso de rescate del sentido y del placer en el trabajo, no fue posible de ser alcanzada en la clínica. Este resultado es debido al hecho de que el trabajo en la readaptación se constituye en un trabajo muerto, incluso en el sentido de contribuir para el aislamiento y la exclusión de estas profesionales, llevando al derrumbe de los lazos sociales y a la imposibilidad de una movilización colectiva suficientemente fuerte para cambiar cuestiones estructurales de este no-trabajo a lo cual están sometidas. Aunque se defienda la imposibilidad de movilización subjetiva en un trabajo muerto, la gran contribución de la clínica del trabajo realizada fue en el sentido de demostrar la potencia política de la clínica del trabajo a partir de nuevos destinos que las profesoras enfermas pudieron dar al sufrimiento.
À partir de la constatation que les études sur le travail chez des cliniques psychodynamiques n'observent que des travailleurs en situation normale et n'expriment pas clairement comment la mobilisation subjective peut arriver chez l'écoute clinique, cet article a l'objectif à problématiser le concept de mobilisation subjective de Dejourian dans le contexte des travailleurs malades. La recherche a été menée sur la base du cadre théorique et méthodologique de la psychodynamique du travail. Vingt-deux séances de clinique du travail ont été organisées avec des enseignantes réadaptées du District Fédéral, au Brésil. Les données ont été analysées selon la technique d'analyse du travail clinique. La mobilisation subjective, en tant que processus de récupération du sens et du plaisir au travail, n'a pas pu être réalisée dans la clinique. Ce résultat est dû au fait que le travail de réadaptation constitue un travail mort, spécialement au sens de contribuer à l'isolement et à l'exclusion de ces professionnelles. Cela conduit à la rupture des liens sociaux et à l'impossibilité d'une mobilisation collective assez puissante pour changer les problèmes structurels de ce non-travail auquel elles sont soumises. Malgré la défense de l'impossibilité de mobilisation subjective dans un travail mort, la contribution importante de la clinique de travail réalisée a été de démontrer le pouvoir politique de la clinique de travail à partir de nouvelles destinations que les enseignantes malades ont pu donner à la souffrance.
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Doenças Profissionais , Reabilitação , Trabalho , Professores Escolares , Angústia PsicológicaRESUMO
Seedling establishment is a critical step in environment colonisation by higher plants that frequently occurs under adverse conditions. Thus, we carried out an integrated analysis of seedling growth, water status, ion accumulation, reserve mobilisation, metabolite partitioning and hydrolase activity during seedling establishment of the native Caatinga species Piptadenia moniliformis (Benth.) Luckow & R.W. Jobson under salinity. Two-day-old seedlings were cultivated in vitro for 4 days in water agar (control) or supplemented with 50 or 100 mm NaCl. Biochemical determinations were performed according to standard spectrophotometric protocols. We found that 100 mm NaCl stimulated starch degradation, amylase activity and soluble sugar accumulation, but limited storage protein hydrolysis in the cotyledons of P. moniliformis seedlings. Although Na+ accumulation in the seedling affected K+ partitioning between different organs, it was not possible to associate the salt-induced changes in reserve mobilisation with Na+ toxicity, or water status, in the cotyledons. Remarkably, we found that starch content increased in the roots of P. moniliformis seedlings under 100 mm NaCl, probably in response to the toxic effects of Na+ . The mobilisation of carbon and nitrogen reserves is independently regulated in P. moniliformis seedlings under salt stress. The salt-induced delay in seedling establishment and the resulting changes in the source-sink relationship may lead to storage protein retention in the cotyledons. Possibly, the intensification of starch mobilisation in the cotyledons supported starch accumulation in the root as a potential mechanism to mitigate Na+ toxicity.
Assuntos
Carbono/metabolismo , Moniliformis/metabolismo , Nitrogênio/metabolismo , Plântula/metabolismo , Animais , Cotilédone/efeitos dos fármacos , Cotilédone/metabolismo , Moniliformis/efeitos dos fármacos , Salinidade , Plântula/efeitos dos fármacos , Sódio/metabolismo , Cloreto de Sódio/farmacologiaRESUMO
BACKGROUND: Studies exploring interventions targeting the cervical spine to improve symptoms in patients with temporomandibular disorders (TMD) are limited. OBJECTIVES: To determine whether mobilisation of the upper cervical region and craniocervical flexor training decreased orofacial pain, increased mandibular function and pressure pain thresholds (PPTs) of the masticatory muscles and decreased headache impact in women with TMD when compared to no intervention. METHODS: In a single-blind randomised controlled trial, 61 women with TMD were randomised into an intervention group (IG) and a control group (CG). The IG received upper cervical mobilisations and neck motor control and stabilisation exercises for 5 weeks. The CG received no treatment. Outcomes were collected by a blind rater at baseline and 5-week follow-up. Orofacial pain intensity was collected once a week. A mixed ANOVA and Cohen's d were used to determine differences within/between groups and effect sizes. RESULTS: Pain intensity showed significant time-by-group interaction (P < 0.05), with significant between-group differences at four and five weeks (P < 0.05), with large effect sizes (d > 0.8). The decrease in orofacial pain over time was clinically relevant only in the IG. Change in headache impact was significantly different between groups, and the IG showed a clinically relevant decrease after the treatment. No effects were found for PPT or mandibular function. CONCLUSION: Women with TMD reported a significant decrease in orofacial pain and headache impact after 5 weeks of treatment aimed at the upper cervical spine compared to a CG.
Assuntos
Vértebras Cervicais , Dor Facial/terapia , Cefaleia/terapia , Cervicalgia/terapia , Modalidades de Fisioterapia , Transtornos da Articulação Temporomandibular/terapia , Adulto , Dor Facial/etiologia , Dor Facial/fisiopatologia , Dor Facial/reabilitação , Feminino , Seguimentos , Cefaleia/etiologia , Cefaleia/fisiopatologia , Cefaleia/reabilitação , Humanos , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Cervicalgia/reabilitação , Medição da Dor , Limiar da Dor , Método Simples-Cego , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/reabilitação , Resultado do Tratamento , Adulto JovemRESUMO
We discuss two ethical issues raised by Camino Verde, a 2011-2012 cluster-randomised controlled trial in Mexico and Nicaragua, that reduced dengue risk though community mobilisation. The issues arise from the approach adopted by the intervention, one called Socialisation of Evidence for Participatory Action. Community volunteer teams informed householders of evidence about dengue, its costs and the life-cycle of Aedes aegypti mosquitoes, while showing them the mosquito larvae in their own water receptacles, without prescribing solutions. Each community responded in an informed manner but on its own terms. The approach involves partnerships with communities, presenting evidence in a way that brings conflicting views and interests to the surface and encourages communities themselves to deal with the resulting tensions.One such tension is that between individual and community rights. This tension can be resolved creatively in concrete day-to-day circumstances provided those seeking to persuade their neighbours to join in efforts to benefit community health do so in an atmosphere of dialogue and with respect for personal autonomy.A second tension arises between researchers' responsibilities for ethical conduct of research and community autonomy in the conduct of an intervention. An ethic of respect for individual and community autonomy must infuse community intervention research from its inception, because as researchers succeed in fostering community self-determination their direct influence in ethical matters diminishes. TRIAL REGISTRATION: ISRCTN 27581154.
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Temas Bioéticos , Participação da Comunidade , Dengue/prevenção & controle , Ética em Pesquisa , Controle de Mosquitos/métodos , Poder Psicológico , Características de Residência , Adulto , Aedes , Animais , Criança , Educação em Saúde , Humanos , México , Nicarágua , Pesquisa , Voluntários , Abastecimento de ÁguaRESUMO
Camino Verde (the Green Way) is an evidence-based community mobilisation tool for prevention of dengue and other mosquito-borne viral diseases. Its effectiveness was demonstrated in a cluster-randomised controlled trial conducted in 2010-2013 in Nicaragua and Mexico. The Nicaraguan arm of the trial was preceded, from 2004 to 2008, by a feasibility study that provided valuable lessons and trained facilitators for the trial itself. Here, guided by the Template for Intervention Description and Replication (TIDieR), we describe the Camino Verde intervention in Nicaragua, presenting its rationale, its time and location, activities, materials used, the main actors, modes of delivery, how it was tailored to encourage community engagement, modifications made from the feasibility study to the trial itself, and how fidelity to the process originally designed was maintained. We also present information on costs and discuss the place of this study within the literature on implementation science. TRIAL REGISTRATION: ISRCTN27581154 .
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Aedes , Dengue/prevenção & controle , Controle de Mosquitos/métodos , Adulto , Animais , Criança , Pré-Escolar , Participação da Comunidade , Dengue/virologia , Vírus da Dengue , Humanos , Insetos Vetores , NicaráguaRESUMO
BACKGROUND: The Aedes aegypti mosquito is the vector for dengue fever, yellow fever, chikungunya, and zika viruses. Inadequate vector control has contributed to persistence and increase of these diseases. This review assesses the evidence of effectiveness of different control measures in reducing Aedes aegypti proliferation, using standard entomological indices. METHODS: A systematic search of Medline, Ovid, BVS, LILACS, ARTEMISA, IMBIOMED and MEDIGRAPHIC databases identified cluster randomised controlled trials (CRCTs) of interventions to control Aedes aegypti published between January 2003 and October 2016. Eligible studies were CRCTs of chemical or biological control measures, or community mobilization, with entomological indices as an endpoint. A meta-analysis of eligible studies, using a random effects model, assessed the impact on household index (HI), container index (CI), and Breteau index (BI). RESULTS: From 848 papers identified by the search, eighteen met the inclusion criteria: eight for chemical control, one for biological control and nine for community mobilisation. Seven of the nine CRCTs of community mobilisation reported significantly lower entomological indices in intervention than control clusters; findings from the eight CRCTs of chemical control were more mixed. The CRCT of biological control reported a significant impact on the pupae per person index only. Ten papers provided enough detail for meta-analysis. Community mobilisation (four studies) was consistently effective, with an overall intervention effectiveness estimate of -0.10 (95%CI -0.20 - 0.00) for HI, -0.03 (95%CI -0.05 - -0.01) for CI, and -0.13 (95%CI -0.22 - -0.05) for BI. The single CRCT of biological control had effectiveness of -0.02 (95%CI -0.07- 0.03) for HI, -0.02 (95%CI -0.04- -0.01) for CI and -0.08 (95%CI -0.15- -0.01) for BI. The five studies of chemical control did not show a significant impact on indices: the overall effectiveness was -0.01 (95%CI -0.05- 0.03) for HI, 0.01 (95% CI -0.01- 0.02) for CI, and 0.01 (95%CI -0.03 - 0.05) for BI. CONCLUSION: Governments that rely on chemical control of Aedes aegypti should consider adding community mobilization to their prevention efforts. More well-conducted CRCTs of complex interventions, including those with biological control, are needed to provide evidence of real life impact. Trials of all interventions should measure impact on dengue risk.
Assuntos
Aedes , Dengue/prevenção & controle , Insetos Vetores , Controle de Mosquitos , Aedes/virologia , Animais , Dengue/virologia , Humanos , Viroses/prevenção & controle , Viroses/virologiaRESUMO
BACKGROUND: Community mobilisation for prevention requires engagement with and buy in from those communities. In the Mexico state of Guerrero, unprecedented social violence related to the narcotics trade has eroded most community structures. A recent randomised controlled trial in 90 coastal communities achieved sufficient mobilisation to reduce conventional vector density indicators, self-reported dengue illness and serologically proved dengue virus infection. METHODS: The Camino Verde intervention was a participatory research protocol promoting local discussion of baseline evidence and co-design of vector control solutions. Training of facilitators emphasised community authorship rather than trying to convince communities to do specific activities. Several discussion groups in each intervention community generated a loose and evolving prevention plan. Facilitators trained brigadistas, the first wave of whom received a small monthly stipend. Increasing numbers of volunteers joined the effort without pay. All communities opted to work with schoolchildren and for house-to-house visits by brigadístas. Children joined the neighbourhood vector control movements where security conditions permitted. After 6 months, a peer evaluation involved brigadista visits between intervention communities to review and to share progress. DISCUSSION: Although most communities had no active social institutions at the outset, local action planning using survey data provided a starting point for community authorship. Well-known in their own communities, brigadistas faced little security risk compared with the facilitators who visited the communities, or with governmental programmes. We believe the training focus on evidence-based dialogue and a plural community ownership through multiple design groups were key to success under challenging security conditions. TRIAL REGISTRATION: ISRCTN27581154 .
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Aedes , Participação da Comunidade , Dengue/prevenção & controle , Drogas Ilícitas , Controle de Mosquitos , Características de Residência , Violência , Adulto , Animais , Criança , Dengue/virologia , Vírus da Dengue , Características da Família , Feminino , Processos Grupais , Humanos , Insetos Vetores , Masculino , México , Risco , VoluntáriosRESUMO
BACKGROUND: A modified theory of planned behaviour (acronym CASCADA) proposes that Conscious knowledge precedes a change in Attitude, which in turn precedes positive deviations from negative Subjective norms, intention to Change, perception of Agency to change, Discussion of possible action, and Action itself. We used this as a results chain to investigate gender-specific behaviour dynamics in chemical-free dengue prevention. METHODS: Secondary analysis of the Mexican arm of a cluster randomised controlled trial used household survey data on intermediate outcomes of dengue prevention behaviour. We used a matrix of odds ratios between outcomes, transformed to a symmetrical range (-1, 1), to compute fuzzy transitive closure of the results chain for control and intervention clusters, then for male and female respondents separately in each group. Transitive closure of a map computes the influence of each factor on each other factor, taking account of all influences in the system. Cumulative net influence was the sum of influences across the results chain. RESULTS: Responses of 5042 women and 1143 men in 45 intervention clusters contrasted with those of 5025 women and 1179 men in 45 control clusters. Control clusters showed a distal block (negative influence) in the results chain with a cumulative net influence of 0.88; intervention clusters showed no such block and a cumulative net influence of 1.92. Female control respondents, like the overall control picture, showed a distal block, whereas female intervention responses showed no such blocks (cumulative net influence 0.78 and 1.73 respectively). Male control respondents showed weak distal blocks. Male intervention responses showed several new negative influences and a reduction of cumulative net influence (1.38 in control and 1.11 in intervention clusters). CONCLUSIONS: The overall influence of the intervention across the results chain fits with the trial findings, but is different for women and men. Among women, the intervention overcame blocks and increased the cumulative net influence of knowledge on action. Among men, the intervention did not reinforce prevention behaviour. This might be related to emphasis, during the intervention, on women's participation and empowerment. The fuzzy transitive closure of the CASCADA map usefully highlights the differences between gender-specific results chains. TRIAL REGISTRATION: ISRCTN27581154 .