Reflexões acerca da formação continuada de professores na docência

A qualidade da educação alinha-se à formação continuada de educadores. O PNEM como iniciativa de educação permanente possibilitou continuidade de desenvolvimento pessoal, intelectual e profissional na escola, em 2014 e 2015: duas etapas de 100 horas. Este texto é recorte de pesquisa realizada com as seis universidades federais do sul do Brasil, 440 questionários. Tal pesquisa buscou conhecer as concepções dos participantes, enquanto política pública de Educação Continuada, além da contribuição para aquisição do capital cultural e transformação do habitus na perspectiva sociológica de Pierre Bourdieu e sua importância para a formação do “professor improvisador”, defendido por Ilan Gur-Ze’e

Bullying homofóbico y vulnerabilidad de estudiantes LGBT+ en escuelas brasileñas: un ensayo crítico

La experiencia escolar puede desempeñar un papel en el aprendizaje de conceptos que promueven la igualdad y la deconstrucción de los mitos que constituyen un referente normativo en el que se articulan los discursos y prácticas que sostienen las opresiones. Este ensayo, que trata el tema de la violación de los derechos humanos LGBT+ y el impacto de acciones institucionales sobre la salud y el bienestar LGBT+ en el ámbito escolar brasileño, se divide en dos partes: en la primera, se presentarán las políticas educativas contra la LGBTfobia desde la introducción del programa Brasil sem Homofobia. Luego, se analizará el bullying homofóbico como fruto de la vulneración de los derechos LGBT+. Este trabajo advierte que la privación de los derechos LGBT+ afecta a la construcción de su identidad e imagen psicosocial y destaca el valor de coeducar en espacios amables, desde el respeto y la aceptación a la diversidad.

A suplementação de bicarbonato de sódio melhora a percepção subjetiva da fadiga, mas não o desempenho de corredores amadores

Introduction and Aim: The sodium bicarbonate, as ergogenic aids, has been propose for performance improvement of long-distances runners, as well as reducing muscular fatigue, reducing agent of lactate accumulation in muscle and in acid-base balance in athletes of several sporting modalities. Therefore, this study aimed to investigate the effect of sodium bicarbonate supplementation on performance of 6-km amateur runners. Materials and Methods: quasi-experimental study with 12 amateur runners, both sexes and aged between 18-57 years. In different days, runners ingested of sodium bicarbonate (0.15g • kg-1) or no and performed 2 rustics of 6km simulated street race competition. Specific physical tests, such as blood lactate, urinary pH and heart rate were evaluated before and after each run. Subjective perception of fatigue was evaluated only after running. Results: Runners performance did not show significant difference between runs (p=0.771), however, 41.67% of runners reported a decrease in perception of effort after sodium bicarbonate supplementation. Heart rate also did not show significant difference in rest (p=0.978), after running (p=0.592) or in variation of heart rate (p=0.267). It was verified a significant increasing in blood lactate variation after sodium bicarbonate supplementation (p=0.048), as well as a significant increasing in urinary pH (p=0.037). Conclusion: Our data demonstrate that sodium bicarbonate supplementation did not improve performance but improved subjective perception of fatigue, as well as increase the blood lactate variation and urinary pH.Introdução e objetivo: O bicarbonato de sódio, como agente ergogênico, tem sido proposto para atuar na melhora do desempenho dos corredores de distâncias longas, além de reduzir a fadiga muscular, reduzir a acumulação de lactato no músculo e no balanço ácido-base em atletas de várias modalidades esportivas. Portanto, este estudo objetivou avaliar e comparar o efeito da suplementação de bicarbonato de sódio no desempenho de corredores amadores numa prova simulada de 6 km. Materiais e métodos: estudo quase-experimental, com 12 corredores amadores, de ambos sexos e idade entre 18-57 anos. Em dias diferentes, os corredores ingeriram bicarbonato de sódio (0,15g • kg-1) ou não e participaram de 2 rústicas simuladas de 6km. Testes físicos específicos, como lactato sanguíneo, pH urinário e frequência cardíaca foram avaliados antes e após cada corrida. A percepção subjetiva da fadiga foi avaliada somente após a corrida. Resultados: O desempenho dos corredores não mostrou diferença significativa entre as corridas (p=0,771), no entanto, 41,67% dos corredores relataram uma diminuição na percepção de esforço após a suplementação de bicarbonato de sódio. A frequência cardíaca também não mostrou diferença significativa no repouso (p=0,978), após a corrida (p=0,592) ou na variação da frequência cardíaca (p=0,267). Entretanto, verificou-se um aumento significativo na variação do lactato sanguíneo após a suplementação de bicarbonato de sódio (p=0,048), bem como um aumento significativo no pH urinário (p=0,037). Conclusão: Nossos resultados demostraram que a suplementação de bicarbonato de sódio não melhorou o desempenho, mas melhorou a percepção subjetiva da fadiga, bem como aumentou a variação do lactato sanguíneo e do pH urinário

Elevated extracellular HSP72 and blunted heat shock response in severe covid-19 patients

Aims: We hypothesized that critically ill patients with SARS-CoV-2 infection and insulin resistance would present a reduced Heat Shock Response (HSR), which is a pathway involved in proteostasis and anti-inflammation, subsequently leading to worse outcomes and higher inflammation. In this work we aimed: (i) to measure the concentration of extracellular HSP72 (eHSP72) in patients with severe COVID-19 and in comparison with noninfected patients; (ii) to compare the HSR between critically ill patients with COVID-19 (with and without diabetes); and (iii) to compare the HSR in these patients with noninfected individuals. Methods: Sixty critically ill adults with acute respiratory failure with SARS-CoV-2, with or without diabetes, were selected. Noninfected subjects were included for comparison (healthy, n = 19 and patients with diabetes, n = 22). Blood samples were collected to measure metabolism (glucose and HbA1c); oxidative stress (lypoperoxidation and carbonyls); cytokine profile (IL-10 and TNF); eHSP72; and the HSR (in vitro). Results: Patients with severe COVID-19 presented higher plasma eHSP72 compared with healthy individuals and noninfected patients with diabetes. Despite the high level of plasma cytokines, no differences were found between critically ill patients with COVID-19 with or without diabetes. Critically ill patients, when compared to noninfected, presented a blunted HSR. Oxidative stress markers followed the same pattern. No differences in the HSR (extracellular/intracellular level) were found between critically ill patients, with or without diabetes. Conclusions: We demonstrated that patients with severe COVID-19 have elevated plasma eHSP72 and that their HSR is blunted, regardless of the presence of diabetes. These results might explain the uncontrolled inflammation and also provide insights on the increased risk in developing type 2 diabetes after SARS-CoV-2 infection

Polymorphisms in ACE1, TMPRSS2, IFIH1, IFNAR2, and TYK2 genes are associated with worse clinical outcomes in COVID-19

Although advanced age, male sex, and some comorbidities impact the clinical course of COVID-19, these factors only partially explain the inter-individual variability in disease severity. Some studies have shown that genetic polymorphisms contribute to COVID-19 severity; however, the results are inconclusive. Thus, we investigated the association between polymorphisms in ACE1, ACE2, DPP9, IFIH1, IFNAR2, IFNL4, TLR3, TMPRSS2, and TYK2 and the clinical course of COVID-19. A total of 694 patients with COVID-19 were categorized as: (1) ward inpatients (moderate symptoms) or patients admitted at the intensive care unit (ICU; severe symptoms); and (2) survivors or non-survivors. In females, the rs1990760/IFIH1 T/T genotype was associated with risk of ICU admission and death. Moreover, the rs1799752/ACE1 Ins and rs12329760/TMPRSS2 T alleles were associated with risk of ICU admission. In non-white patients, the rs2236757/IFNAR2 A/A genotype was associated with risk of ICU admission, while the rs1799752/ACE1 Ins/Ins genotype, rs2236757/IFNAR2 A/A genotype, and rs12329760/TMPRSS2 T allele were associated with risk of death. Moreover, some of the analyzed polymorphisms interact in the risk of worse COVID19 outcomes. In conclusion, this study shows an association of rs1799752/ACE1, rs1990760/IFIH1, rs2236757/IFNAR2, rs12329760/TMPRSS2, and rs2304256/TYK2 polymorphisms with worse COVID19 outcomes, especially among female and non-white patients

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)