IMPACTOS GENERADOS EN LA ESTRATEGIA DE SALUD DE LA FAMILIA TRAS EL PERÍODO CRÍTICO DE LA PANDEMIA DEL COVID-19: REPERCUSIONES EN LA ETAPA SUPERVISADA

A pandemia causada pela COVID-19 gerou impactos em todos os níveis de atenção à saúde, e necessitou de ações coordenadas pela Organização Mundial da Saúde e o Ministério da Saúde, a fim de se combater a pandemia. Entre as estratégias de combate à pandemia está o desenvolvimento e produção em grande escala de vacinas, concomitante  a criação de estratégias para a vacinação em massa, reduzindo as internações e óbitos. Assim,[1]o objetivo deste artigo é relatar o impacto da pandemia da COVID-19 na Estratégia de Saúde da Família e os reflexos para a manutenção da qualidade da integração Ensino-Serviço-Comunidade. Destaca-se que o estágio supervisionado é um momento de fundamental importância no processo formativo do estudante. Enfatiza-se que após o início da campanha de vacinação contra a COVID-19, houve a necessidade de reorganização do processo de trabalho, em especial da enfermagem. É válido reforçar que o estágio em questão aconteceu em um momento atípico, ainda em contexto de estruturação da referida unidade e retomada de suas atividades previstas. Portanto, a retomada da Estratégia de Saúde da Família em um contexto pós-crítico da pandemia é um processo árduo, trabalhoso e deve contar com a participação de todos, e a integração do Ensino-Serviço-Comunidade estrutura-se como uma ferramenta para essa consolidação, por trazer novos olhares e ideias que antes não haviam sido discutidas ou tentadas.The pandemic caused by COVID-19 had impacts on all levels of health care, and required coordinated actions by the World Health Organization and the Ministry of Health in order to combat the pandemic. Among the strategies to combat the pandemic is the development and large-scale production of vaccines, concomitant with the creation of strategies for mass vaccination, reducing hospitalizations and deaths. Thus, the objective of this article is to report the impact of the COVID-19 pandemic on the Family Health Strategy and the consequences for maintaining the quality of the Teaching-Service-Community integration. It is noteworthy that the supervised internship is a moment of fundamental importance in the student's training process. It is emphasized that after the start of the vaccination campaign against COVID-19, there was a need to reorganize the work process, especially nursing. It is worth emphasizing that the internship in question took place at an atypical moment, still in the context of structuring the aforementioned unit and resuming its planned activities. Therefore, the resumption of the Family Health Strategy in a post-critical context of the pandemic is an arduous, laborious process and must count on the participation of all, and the integration of Teaching-Service-Community is structured as a tool for this consolidation, by bringing new perspectives and ideas that had not been discussed or tried before.La pandemia provocada por el COVID-19 tuvo impactos en todos los niveles de atención de la salud y requirió acciones coordinadas de la Organización Mundial de la Salud y el Ministerio de Salud para combatir la pandemia. Entre las estrategias para combatir la pandemia está el desarrollo y producción a gran escala de vacunas, concomitante con la creación de estrategias de vacunación masiva, reduciendo hospitalizaciones y muertes. Así, el objetivo de este artículo es relatar el impacto de la pandemia de la COVID-19 en la Estrategia de Salud de la Familia y las consecuencias para el mantenimiento de la calidad de la integración Enseñanza-Servicio-Comunidad. Cabe destacar que la pasantía supervisada es un momento de fundamental importancia en el proceso de formación del estudiante. Se destaca que después del inicio de la campaña de vacunación contra la COVID-19, hubo necesidad de reorganizar el proceso de trabajo, especialmente de enfermería. Vale destacar que la pasantía en cuestión se dio en un momento atípico, aún en el contexto de estructuración de la referida unidad y de reinicio de sus actividades previstas. Por lo tanto, la reanudación de la Estrategia de Salud de la Familia en un contexto poscrítico de la pandemia es un proceso arduo, laborioso y debe contar con la participación de todos, y la integración Enseñanza-Servicio-Comunidad se estructura como una herramienta para esa consolidación, aportando nuevas perspectivas e ideas que no habían sido discutidas o probadas antes

Exercise training improves vascular reactivity in ovariectomized rats subjected to myocardial infarction.

The aim of this study was to evaluate the effects of exercise training (ET) on the aortic vascular reactivity of ovariectomized and infarcted rats. The animals were divided into 5 groups: Control, Ovariectomized + SHAM sedentary (OVX+SHAMSED), OVX+SHAM and ET (OVX+SHAMET), OVX + Myocardial Infarction sedentary (OVX+MISED), and OVX + MI and ET (OVX+MIET). ET protocol (60 minutes/day, 5x/week) in a motorized treadmill began 15 days after MI and lasted 8 weeks. The endothelium-dependent and endothelium-independent vascular reactivity were evaluated as well as the role of the reactive oxygen species (ROS). Superoxide and nitric oxide (NO) production were analyzed in situ using DHE and DAF-2 fluorescence, respectively. The expression of gp91phox and of the antioxidant enzymes were evaluated by western blotting in the thoracic aorta samples. MI promoted a significant increase in the contractile response and impaired endothelium-mediated relaxation. However, ET prevented the impairment in the vascular reactivity in MI animals. In addition, the protein expression of gp91phox and superoxide production increased and the NO production decreased in the OVX+MISED group but not in the OVX+MIET group. Therefore, ET improves vascular reactivity in MI ovariectomized rats by preventing the increase in the expression of gp91phox and the decrease in the antioxidant enzymes, resulting in a normal ROS and NO production. Thus, ET can be an effective therapeutic strategy for improving the MI-induced vascular alterations in estrogen deficiency condition

Exercise training reduces cardiac dysfunction and remodeling in ovariectomized rats submitted to myocardial infarction.

The aim of this study was to evaluate whether exercise training (ET) prevents or minimizes cardiac dysfunction and pathological ventricular remodeling in ovariectomized rats subjected to myocardial infarction (MI) and to examine the possible mechanisms involved in this process. Ovariectomized Wistar rats were subjected to either MI or fictitious surgery (Sham) and randomly divided into the following groups: Control, OVX+SHAMSED, OVX+SHAMET, OVX+MISED and OVX+MIET. ET was performed on a motorized treadmill (5x/wk, 60 min/day, 8 weeks). Cardiac function was assessed by ventricular catheterization and Dihydroethidium fluorescence (DHE) was evaluated to analyze cardiac oxidative stress. Histological analyses were made to assess collagen deposition, myocyte hypertrophy and infarct size. Western Blotting was performed to analyze the protein expression of catalase and SOD-2, as well as Gp91phox and AT1 receptor (AT1R). MI-trained rats had significantly increased in +dP/dt and decreased left ventricular end-diastolic pressure compared with MI-sedentary rats. Moreover, oxidative stress and collagen deposition was reduced, as was myocyte hypertrophy. These effects occurred in parallel with a reduction in both AT1R and Gp91phox expression and an increase in catalase expression. SOD-2 expression was not altered. These results indicate that ET improves the functional cardiac parameters associated with attenuation of cardiac remodeling in ovariectomized rats subjected to MI. The mechanism seems to be related to a reduction in the expression of both the AT1 receptor and Gp91phox as well as an increase in the antioxidant enzyme catalase, which contributes to a reduction in oxidative stress. Therefore, ET may be an important therapeutic target for the prevention of heart failure in postmenopausal women affected by MI

Histological analysis of myocardial infarction area.

<p>Infarcted area analysis showing no differences among groups. Data are expressed as mean ± SEM (n = 7). *P<0.05.</p

Interstitial collagen deposition evaluation in rat hearts.

<p>Representative images of histological sections stained with Picrosirius of Control (A), OVX+SHAM_SED (B), OVX+SHAM_ET (C), OVX+MI_SED (D) and OVX+MI_ET (E) groups. Data are expressed as mean ± SEM (n = 7). *P<0.05. Magnifier 400x. Bar: 200 µm.</p

Cardiac function measurements.

<p>(A) Left ventricular systolic pressure (LVSP) demonstrating no differences among groups. (B) Exercise training reduced left ventricular end diastolic pressure (LVEDP) in OVX+MI_ET group compared to MI which occurs in parallel with an increased +dP/dt (C). There were a decrease in -dP/dt in the MI group compared with other groups which was not restored by ET (D). Data are expressed as mean ± SEM (n  =  12). *P<0.05.</p

Analysis of oxidative stress in cardiac tissue.

<p>Analysis of superoxide formation in sections of cardiac tissue by the dihydroethidium fluorescence. Representative images of Control (A), OVX+SHAM_SED (B), OVX+SHAM_ET (C), OVX+MI_SED (D) and OVX+MI_ET (E) groups. Data are expressed as mean ± SEM (n = 4). *P<0.05. Bar: 200 µm.</p

Morphometric parameters eight weeks after myocardial infarction and exercise training in ovariectomized rats.

<p>Data are expressed as mean±SEM. BW, body weight; UW, uterine weight; RV, right ventricle; CS, Citrate Synthase.</p>#<p> <i>P</i><0.05 vs Control;</p>†<p> <i>P</i><0.05 vs OVX+SHAM_ET;</p>‡<p> <i>P</i><0.05 vs OVX+SHAM_SED;</p>$<p> <i>P</i><0.05 vs OVX+MI_SED.</p><p>Morphometric parameters eight weeks after myocardial infarction and exercise training in ovariectomized rats.</p

Histological analysis of myocardial infarction area.

<p>Infarcted area analysis showing no differences among groups. Data are expressed as mean ± SEM (n = 7). *P<0.05.</p