A participação na gestão da escola pública : uma análise comparada Brasil-Urugua

A participação na gestão da escola pública tem se apresentado como uma estratégia que fortalece os vínculos da escola com a sociedade, garantindo que os próprios atores escolares sejam os protagonistas na construção de sentidos para as políticas. Esta dissertação se propôs a analisar a política para a participação na gestão da escola pública em dois países da América Latina, Brasil e Uruguai. Com o propósito de compreender como as escolas de tais países implementam políticas escolares a fim de fortalecer a participação na gestão da escola, foi elaborado o seguinte problema de pesquisa: quais as possíveis relações entre a legislação educacional e a prática escolar ao se considerar a participação como elemento da gestão? O referencial teórico utilizado pretendeu dar conta da relação entre a gestão democrática e participativa como um elemento que fortifica o papel da escola pública como espaço que produz justiça escolar e uma formação crítica dos sujeitos de direitos (FRASER, 2008; BATISTA, 2018b) e a escola conservadora, que, tradicionalmente, produz injustiça escolar ao reproduzir as desigualdades sociais presentes na sociedade capitalista, bem como uma formação para o consenso e o conformismo social (BOURDIEU, 2007; PARO, 2016; BATISTA, 2018a). A metodologia utilizada é composta pelo diálogo entre metodologias como: a educação comparada, que permitiu um olhar epistemológico tanto do local para o global quanto do global para o local (SCHRIEVER, 2002); a análise de conteúdo, que foi utilizada para examinar os documentos extraindo destes os seus sentidos e significados (BARDIN, 1977); a análise de políticas, que se baseou na noção de ciclo de políticas, tomando como categorias analíticas a noção de textos escrevíveis e prescritíveis (BALL, 1982; MAINARDES, 2006). Ao comparar as legislações educacionais sobre os Conselhos Escolares e Consejos de Pariticpación, os resultados da pesquisa apontam que uma norma, ainda que prescritiva, portanto, mais fechada às ressignificações, se for construída de maneira democrática, com todos os atores afetados atribuindo-lhe sentido, possibilita uma maior efetividade da política no contexto da prática. Já uma norma produzida sem a participação dos atores locais, mesmo sendo uma norma mais escrevível, portanto, mais aberta à ressiginificação, pode apresentar baixa efetividade no contexto da prática escolar.La participación en la gestión de la escuela pública se ha presentado como una estrategia que fortalece los vínculos de la escuela con la sociedad, garantizando que los propios actores escolares sean los protagonistas en la construcción de sentidos de las políticas. Esta disertación se propuso analizar la política para la participación en la gestión de la escuela pública en dos países de América Latina, Brasil y Uruguay. Con el propósito de comprender cómo las escuelas de estos países implementan políticas escolares a fin de fortalecer la participación en la gestión de la escuela, se elaboró el siguiente problema de investigación: cuáles son las posibles relaciones entre la legislación educativa y la práctica escolar al considerar la participación como elemento de la gestión? El referencial teórico utilizado pretendió dar cuenta de la relación entre la gestión democrática y participativa como un elemento que fortifica el papel de la escuela pública como espacio que produce justicia escolar y una formación crítica de los sujetos de derechos (FRASER, 2008, BATISTA, 2018b) la escuela conservadora, que tradicionalmente produce injusticia escolar al reproducir las desigualdades sociales presentes en la sociedad capitalista, así como una formación para el consenso y el conformismo social (BOURDIEU, 2007; PARO, 2016; BATISTA, 2018a). La metodología utilizada está compuesta por el diálogo entre metodologías como: la educación comparada, que permitió una mirada epistemológica tanto del local para el global y del global para el local (SCHRIEVER, 2002); el análisis de contenido, que fue utilizado para examinar los documentos extrayendo de éstos sus sentidos y significados (BARDIN, 1977); el análisis de políticas, que se basó en la noción de ciclo de políticas, tomando como categorías analíticas la noción de textos escribibles y prescribibles (BALL, 1982; MAINARDES, 2006). Al comparar las legislaciones educativas sobre los Consejos Escolares y los Consejos de Pariticpación, los resultados de la investigación indican que una norma, aunque prescriptiva, por lo tanto, se resigna más, si se construye de manera democrática, y todos los efectos le dan sentido , permite una mayor efectividad de la política en el contexto de la práctica. Las normas producidas sin la participación de los afectados, mientras una norma mas escrebible, por lo tanto, más abierto a las interpretaciones, puede tener poca efectividad en el contexto de la práctica escolar

Sacubitril/valsartan reduces serum uric acid concentration, an independent predictor of adverse outcomes in PARADIGM-HF

Aims: Elevated serum uric acid concentration (SUA) has been associated with an increased risk of cardiovascular disease, but this may be due to unmeasured confounders. We examined the association between SUA and outcomes as well as the effect of sacubitril/valsartan on SUA in patients with heart failure with reduced ejection fraction (HFrEF) in PARADIGM-HF. Methods and results: The association between SUA and the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization, its components, and all-cause mortality was examined using Cox regression analyses among 8213 patients using quintiles (Q1–Q5) of SUA adjusted for baseline prognostic variables including estimated glomerular filtration rate (eGFR), diuretic dose, and log N-terminal pro-brain natriuretic peptide. Change in SUA from baseline over 12 months was also evaluated in each treatment group. Patients in Q5 (SUA ≥8.6 mg/dL) compared with Q1 (<5.4 mg/dL) were younger (62.8 vs. 64.2 years), more often male (88.7% vs. 63.1%), had lower systolic blood pressure (119 vs. 123 mmHg), lower eGFR (57.4 vs. 76.6 mL/min/1.73 m2), and greater diuretic use. Higher SUA was associated with a higher risk of the primary outcome (adjusted hazard ratios) Q5 vs. Q1 = 1.28 [95% confidence intervals (1.09–1.50), P = 0.003], cardiovascular death [1.44 (1.11–1.77), P = 0.001], HF hospitalization [1.37 (1.11–1.70), P = 0.004], and all-cause mortality [1.36 (1.13–1.64), P = 0.001]. Compared with enalapril, sacubitril/valsartan reduced SUA by 0.24 (0.17–0.32) mg/dL over 12 months (P < 0.0001). Sacubitril/valsartan improved outcomes, irrespective of SUA concentration. Conclusion: Serum uric acid concentration was an independent predictor of worse outcomes after multivariable adjustment in patients with HFrEF. Compared with enalapril, sacubitril/valsartan reduced SUA and improved outcomes irrespective of SUA

Contemporary characteristics and outcomes in chagasic heart failure compared with other nonischemic and ischemic cardiomyopathy

Background: Chagas’ disease is an important cause of cardiomyopathy in Latin America. We aimed to compare clinical characteristics and outcomes in patients with heart failure (HF) with reduced ejection fraction caused by Chagas’ disease, with other etiologies, in the era of modern HF therapies. Methods and Results: This study included 2552 Latin American patients randomized in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients With Heart Failure) trials. The investigator-reported etiology was categorized as Chagasic, other nonischemic, or ischemic cardiomyopathy. The outcomes of interest included the composite of cardiovascular death or HF hospitalization and its components and death from any cause. Unadjusted and adjusted Cox proportional hazards models were performed to compare outcomes by pathogenesis. There were 195 patients with Chagasic HF with reduced ejection fraction, 1300 with other nonischemic cardiomyopathy, and 1057 with ischemic cardiomyopathy. Compared with other etiologies, Chagasic patients were more often female, younger, and had lower prevalence of hypertension, diabetes mellitus, and renal impairment (but had higher prevalence of stroke and pacemaker implantation) and had worse health-related quality of life. The rates of the composite outcome were 17.2, 12.5, and 11.4 per 100 person-years for Chagasic, other nonischemic, and ischemic patients, respectively—adjusted hazard ratio for Chagasic versus other nonischemic: 1.49 (95% confidence interval, 1.15–1.94; P=0.003) and Chagasic versus ischemic: 1.55 (1.18–2.04; P=0.002). The rates of all-cause mortality were also higher. Conclusions: Despite younger age, less comorbidity, and comprehensive use of conventional HF therapies, patients with Chagasic HF with reduced ejection fraction continue to have worse quality of life and higher hospitalization and mortality rates compared with other etiologies. Clinical Trial Registration: PARADIGM-HF: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255; ATMOSPHERE: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00853658

Pedagogical coordinators’ formative process: contributions to a democratic school management

O artigo propõe uma discussão sobre o papel do coordenador pedagógico na perspectiva de diferentes contextos históricos, políticos e pedagógicos, que sinalizam infl exões e implicações teórico-práticas sobre as políticas de educação e a gestão escolar democrática. Apresentamos, portanto, o Programa Nacional Escola de Gestores da Educação Básica, que desempenha um papel central na formação continuada dos coordenadores pedagógicos, oferecido através de uma parceria entre a Faculdade de Educação da Universidade Federal do Rio Grande do Sul e o Ministério da Educação. Temos por objetivo relacionar o incremento da participação da comunidade escolar e o papel do coordenador pedagógico neste processo. Trata-se de uma abordagem transdisciplinar envolvendo estudos relativos à gestão democrática da área de políticas e à gestão de processos educacionais como perspectiva que possibilita abordar aspectos fundamentais do papel do coordenador pedagógico para a concretização da escola pública de qualidade para todos. Metodologicamente o artigo utiliza-se da análise de conteúdo e de pesquisas relativas a pressupostos teóricos da sociologia da educação, bem como de concepções de gestão escolar democrática, compreendendo a gestão democrática como efetiva paridade de participação dos segmentos da comunidade escolar nas deliberações da escola.This paper proposes a discussion about the pedagogical coordinator’s function in the perspective of diff erent historical, political and pedagogical contexts that indicate theoretical- practical infl ections and implications about educational policies and democratic school management. Therefore, we present the National School Program of Basic Education Managers Escola de Gestores da Educação Básica’, which plays a central role in the continuous training of pedagogical managers, off ered through a partnership between the Education School from Federal University of Rio Grande do Sul state and the Ministry of Education. We aim to relate the increase of the school community participation and the role of the pedagogical manager in this process. It is a transdisciplinary approach involving studies concerned about democratic management in the fi eld of policies and management of educational processes as a perspective that allows to tackling fundamental aspects in the function of the pedagogical management to reach a qualifi ed public school for everyone. Methodologically, this paper uses content analysis and researches on theoretical assumptions in sociology of education, as well as conceptions of democratic school management, understanding democratic management as eff ective equality in the participation of school community segments in school deliberations

Serum NT pro-BNP: relation to systolic and diastolic function in cardiomyopathies and pericardiopathies

FUNDAMENTO: O NT pro-BNP é marcador de disfunção sistólica e diastólica. OBJETIVO: Determinar os níveis de NT pro-BNP em pacientes com cardiopatia chagásica, hipertrófica, restritiva e afecções pericárdicas, e sua relação com medidas ecocardiográficas de disfunção sistólica e diastólica. MÉTODOS: Cento e quarenta e cinco pacientes foram divididos nos respectivos grupos: 1) cardiopatia chagásica (CCh) - 14 pacientes; 2) miocardiopatia hipertrófica (CMH) - 71 pacientes; 3) endomiocardiofibrose (EMF) - 26 pacientes; 4) derrame pericárdico (DP) - 18 pacientes; 5) e pericardite constritiva (PC) - 16 pacientes. Foi constituído um grupo-controle de 40 indivíduos sem doença cardíaca. O grau de acometimento miocárdico e o derrame pericárdico foram avaliados pelo ecocardiograma bidimensional e a restrição pelo Doppler pulsátil do fluxo mitral. O diagnóstico de PC foi confirmado por meio da ressonância magnética. Os níveis de NT pro-BNP foram medidos por imunoensaio com detecção por eletroquimioluminescência. RESULTADOS: O NT pro-BNP esteve aumentado (p < 0,001) na CCh (mediana 513,8 pg/ml), CMH (mediana 848 pg/ml), EMF (mediana 633 pg/ml), PC (mediana 568 pg/ml), DP (mediana 124 pg/ml), quando comparados ao grupo-controle (mediana 28 pg/ml). Não foram observadas diferenças estatisticamente significativas entre PC e EMF (p = 0,14). No grupo hipertrófico, o NT pro-BNP correlacionou-se com tamanho de átrio esquerdo (r = 0,40; p < 0,001) e relação E/Ea (p < 0,01). No grupo restritivo, houve uma tendência de correlação com pico de velocidade de onda E (r = 0,439; p = 0,06). CONCLUSÃO: O NT pro-BNP encontra-se aumentado nas diversas miocardiopatias e afecções pericárdicas, e apresenta relação com o grau de disfunção sistólica e diastólica.BACKGROUND: NT pro-BNP is a marker of systolic and diastolic dysfunction. OBJECTIVE: To determine NT pro-BNP levels in patients with chagasic, hypertrophic, and restrictive heart diseases, as well as with pericardial diseases, and their relation to echocardiographic measurements of systolic and diastolic dysfunction. METHODS: A total of 145 patients were divided into the following groups: 1) Chagas' heart disease (CHD) - 14 patients; 2) hypertrophic cardiomyopathy (HCM) - 71 patients; 3) endomyocardial fibrosis (EMF) - 26 patients; 4) pericardial effusion (PE) - 18 patients; and 5) constrictive pericarditis (CP) - 16 patients. The control group was comprised of 40 individuals with no heart disease. The degree of myocardial impairment and pericardial effusion were assessed by two-dimensional echocardiography and the degree of restriction by pulsed Doppler transmitral flow. The diagnosis of CP was confirmed through magnetic resonance imaging. NT pro-BNP levels were determined through electrochemiluminescence immunoassay. RESULTS: NT pro-BNP was increased (p < 0.001) in CHD (median = 513.8 pg/ml), HCM (median = 848 pg/ml), EMF (median = 633 pg/ml), CP (median = 568 pg/ml), and PE (median = 124 pg/ml), when compared with the control group (median = 28 pg/ml). No statistically significant differences were found between CP and EMF (p = 0.14). In the hypertrophic group, NT pro-BNP was correlated with left atrial size (r = 0.40; p < 0.001) and with E/Ea ratio (p < 0.01). In the restrictive group, there was a trend of correlation with E-wave peak velocity (r = 0.439; p = 0.06). CONCLUSION: NT pro-BNP is increased in the different cardiomyopathies and pericardial diseases and is correlated with the degree of systolic and diastolic dysfunction

Post hoc analyses of SHIFT and PARADIGM-HF highlight the importance of chronic Chagas' cardiomyopathy Comment on: “Safety profile and efficacy of ivabradine in heart failure due to Chagas heart disease: a post hoc analysis of the SHIFT trial” by Bocchi et al.

No abstract available

The effect of beta-blockade on myocardial remodelling in Chagas' cardiomyopathy

OBJECTIVE: Chagas' disease has spread throughout Latin America because of the high rate of migration among these countries. Approximately 30% of Chagas' patients will develop cardiomyopathy, and 10% of these will develop severe cardiac damage leading to heart failure. Beta-blockade improves symptoms and survival in heart failure patients; however, its efficacy has not been well established in Chagas' disease. We evaluated the role of carvedilol in cardiac remodeling and mortality in a Chagas' cardiomyopathy animal model. METHODS: We studied Trypanosoma cruzi infection in 55 Syrian hamsters that were divided into three groups: control (15), infected (20), and infected + carvedilol (20). Animals underwent echocardiography, electrocardiography, and morphometry for collagen evaluation in ventricles stained with picrosirius red. RESULTS: The left ventricular diastolic diameter did not change between groups, although it was slightly larger in infected groups, as was left ventricular systolic diameter. Fractional shortening also did not change between groups, although it was slightly lower in infected groups. Collagen accumulation in the interstitial myocardial space was significantly higher in infected groups and was not attenuated by carvedilol. The same response was observed in the perivascular space. The survival curve showed significantly better survival in the control group compared with the infected groups; but no benefit of carvedilol was observed during the study. However, in the acute phase (up to 100 days of infection), carvedilol did reduce mortality. CONCLUSION: Carvedilol did not attenuate cardiac remodeling or mortality in this model of Chagas' cardiomyopathy. The treatment did improve survival in the acute phase of the disease

Air Pollution’s Impact on Cardiac Remodeling in an Experimental Model of Chagas Cardiomyopathy

BackgroundChagas disease is characterized by intense myocardial fibrosis stimulated by the exacerbated production of inflammatory cytokines, oxidative stress, and apoptosis. Air pollution is a serious public health problem and also follows this same path. Therefore, air pollution might amplify the inflammatory response of Chagas disease and increase myocardial fibrosis.MethodsWe studied groups of Trypanosoma cruzi infected Sirius hamsters (Chagas=CH and Chagas exposed to pollution=CH+P) and 2 control groups (control healthy animals=CT and control exposed to pollution=CT+P). We evaluated acute phase (60 days post infection) and chronic phase (10 months). Echocardiograms were performed to assess left ventricular systolic and diastolic diameter, in addition to ejection fraction. Interstitial collagen was measured by morphometry in picrosirius red staining tissue. The evaluation of inflammation was performed by gene and protein expression of cytokines IL10, IFN-γ, and TNF; oxidative stress was quantified by gene expression of NOX1, MnSOD, and iNOS and by analysis of reactive oxygen species; and apoptosis was performed by gene expression of BCL2 and Capsase3, in addition to TUNEL analysis.ResultsChagas groups had increased collagen deposition mainly in the acute phase, but air pollution did not increase this deposition. Also, Chagas groups had lower ejection fraction in the acute phase (p = 0.002) and again air pollution did not worsen ventricular function or dilation. The analysis of the inflammation and oxidative stress pathways were also not amplified by air pollution. Apoptosis analysis showed increased expression of BCL2 and Caspase3 genes in chagasic groups in the acute phase, with a marginal p of 0.054 in BCL2 expression among infected groups, and TUNEL technique showed amplified of apoptotic cells by pollution among infected groups.ConclusionsA possible modulation of the apoptotic pathway was observed, inferring interference from air pollution in this pathway. However, it was not enough to promote a greater collagen deposition, or worsening ventricular function or dilation caused by air pollution in this model of Chagas cardiomyopathy

III Diretriz Brasileira de Insuficiência Cardíaca Crônica

Universidade de São Paulo Faculdade de Medicina Hospital das ClínicasUniversidade Federal do Rio Grande do Sul Hospital de Clínicas de Porto AlegreUniversidade de Pernambuco Faculdade de Ciências Médicas de PernambucoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de Minas Gerais Faculdade de MedicinaFaculdade de Medicina de São José do Rio PretoFundação Universitária de Cardiologia do Rio Grande do Sul Instituto de CardiologiaRede Labs D'OrUniversidade Federal FluminenseUniversidade do Estado do Rio de Janeiro Faculdade de Ciencias MédicasInstituto Dante Pazzanese de CardiologiaSanta Casa de MisericórdiaUniversidade de Pernambuco Pronto Socorro Cardiológico de PernambucoHospital Pró CardíacoHospital de MessejanaPontifícia Universidade Católica do ParanáUniversidade Federal de Goiás Faculdade de MedicinaUniversidade de São Paulo Faculdade de Medicina de Ribeirão PretoReal e Benemerita Sociedade de Beneficência PortuguesaFaculdade de Ciências Médicas de Minas GeraisUNIFESP, EPMSciEL