Con el avance de la tecnología, el aprendizaje en teleconsultas pasó a formar parte de la graduación médica actual. Esta investigación presenta las representaciones de un grupo de alumnos de un curso de medicina localizado en la capital del estado de São Paulo sobre sus experiencias con la realización de teleconsultas sincronizadas supervisadas durante una pasantía realizada en un ambulatorio escuela, durante el segundo trimestre de 2021. Se traba de una investigación cualitativa que utilizó el software IRaMuTeQ® y Análisis de Contenido. Estos alumnos puntúan obstáculos para la utilización de las teleconsultas, destacando preocupaciones con la humanización, seguridad de la persona atendida y calidad de la consulta, pero visualizan potencialidades tales como la facilidad de acceso y la comodidad. Reconocen la importancia de la práctica durante su graduación en un mundo cada vez más tecnológico, pero presentan inquietudes relacionadas a la pérdida del examen físico y a la mercantilización de la medicina.

Com o avançar da tecnologia, passou a fazer parte da graduação médica atual o aprendizado em teleconsultas. Esta pesquisa apresenta as representações de um grupo de alunos de um curso de Medicina localizado na capital do estado de São Paulo sobre suas experiências com a realização de teleconsultas síncronas supervisionadas durante estágio realizado em um ambulatório-escola, durante o segundo semestre de 2021. Trata-se de pesquisa qualitativa que utilizou o software IRaMuTeQ® e “Análise do Conteúdo”. Esses educandos pontuam entraves para a utilização das teleconsultas, destacando preocupações com a humanização, segurança da pessoa atendida e qualidade da consulta, mas visualizam potencialidades tais como a facilidade de acesso e a comodidade. Reconhecem a importância da prática durante sua Graduação em um mundo cada vez mais tecnológico, mas trazem inquietações relacionadas à perda do exame físico e à mercantilização da Medicina.

With the progress of technology, teleconsultation has become part of medical degree courses. This article presents the representations of a group of medical students from a university in the capital of the state of São Paulo regarding their experiences with supervised synchronous teleconsultations during an internship in a teaching clinic in the second semester of 2021. We conducted a qualitative study using the software IRaMuTeQ® and content analysis. The students highlighted barriers to the use of teleconsultation, emphasizing concerns with humanization, patient safety and consultation quality, but also perceived strengths such as ease of access and convenience. They recognize the importance of practice on the degree course in an ever more technological world, but raise concerns about the lack of physical examination and the commodification of medicine.

Resumo O objetivo deste estudo foi analisar a prevalência de ansiedade e depressão associada às condições de trabalho dos agentes comunitários de saúde (ACS) no contexto da pandemia de COVID-19. Estudo transversal, realizado no norte de Minas Gerais. Foi aplicado um questionário que abordava condições sociodemográficas, domínio de tecnologias e condições de trabalho durante a pandemia, além do Inventário de Ansiedade Traço-Estado e do Patient Health Questionnare-9 (PHQ-9). Foram realizadas análises descritivas e de regressão múltipla de Poisson com variância robusta, considerando um nível de significância de 5% (p < 0,05) para o modelo final. Participaram do estudo 1.220 ACS de 36 municípios. A prevalência foi de 41,8% e 31,6% para ansiedade e depressão, respectivamente, e 22,5% para ambas as condições. O sexo feminino, idade até 40 anos, ter mais de 500 usuários cadastrados para acompanhamento e oferta inadequada de equipamentos de proteção individual estiveram associados à ansiedade e à depressão. Registrouse uma elevada prevalência de ansiedade e depressão entre ACS no período da pandemia, com destaque para as condições de trabalho entre os fatores associados.

Abstract This study examined the prevalence of anxiety and depression associated with Community Health Workers’ (CHWs’) working conditions in the context of the COVID-19 pandemic. This cross-sectional study was carried out in the north of Minas Gerais, Brazil by applying a questionnaire addressing sociodemographic conditions, command of technologies and working conditions during the pandemic, as well as the State-Trait Anxiety Inventory and the Patient Health Questionnare-9 (PHQ-9). Descriptive and multiple Poisson regression analyses were performed with robust variance, to a 5% level of significance (p < 0.05) for the final model. A total of 1,220 CHWs from 36 municipalities participated in the study. Prevalences were 41.8% and 31.6% for anxiety and depression, respectively, while 22.5% of the group displayed symptoms of both conditions. Being female, up to 40 years old, having more than 500 users registered for monitoring, and inadequate supply of personal protective equipment were associated with anxiety and depression among the CHWs. Prevalence of anxiety and depression was high among CHWs during the pandemic and working conditions figured prominently among the associated factors.

Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.

Abstract This study examined the prevalence of anxiety and depression associated with Community Health Workers’ (CHWs’) working conditions in the context of the COVID-19 pandemic. This cross-sectional study was carried out in the north of Minas Gerais, Brazil by applying a questionnaire addressing sociodemographic conditions, command of technologies and working conditions during the pandemic, as well as the State-Trait Anxiety Inventory and the Patient Health Questionnare-9 (PHQ-9). Descriptive and multiple Poisson regression analyses were performed with robust variance, to a 5% level of significance (p < 0.05) for the final model. A total of 1,220 CHWs from 36 municipalities participated in the study. Prevalences were 41.8% and 31.6% for anxiety and depression, respectively, while 22.5% of the group displayed symptoms of both conditions. Being female, up to 40 years old, having more than 500 users registered for monitoring, and inadequate supply of personal protective equipment were associated with anxiety and depression among the CHWs. Prevalence of anxiety and depression was high among CHWs during the pandemic and working conditions figured prominently among the associated factors.

Resumo O objetivo deste estudo foi analisar a prevalência de ansiedade e depressão associada às condições de trabalho dos agentes comunitários de saúde (ACS) no contexto da pandemia de COVID-19. Estudo transversal, realizado no norte de Minas Gerais. Foi aplicado um questionário que abordava condições sociodemográficas, domínio de tecnologias e condições de trabalho durante a pandemia, além do Inventário de Ansiedade Traço-Estado e do Patient Health Questionnare-9 (PHQ-9). Foram realizadas análises descritivas e de regressão múltipla de Poisson com variância robusta, considerando um nível de significância de 5% (p < 0,05) para o modelo final. Participaram do estudo 1.220 ACS de 36 municípios. A prevalência foi de 41,8% e 31,6% para ansiedade e depressão, respectivamente, e 22,5% para ambas as condições. O sexo feminino, idade até 40 anos, ter mais de 500 usuários cadastrados para acompanhamento e oferta inadequada de equipamentos de proteção individual estiveram associados à ansiedade e à depressão. Registrouse uma elevada prevalência de ansiedade e depressão entre ACS no período da pandemia, com destaque para as condições de trabalho entre os fatores associados.

Abstract This study aimed to verify the association between voice handicaps, physical inactivity, and job dissatisfaction among public school teachers in Minas Gerais, Brazil. An epidemiological, cross-sectional web survey study was performed to do this. The data compilation relevant to this survey was amassed between October 26 and December 31, 2021. A total of 1782 teachers participated in this study. The outcome variable used was the Voice Handicap Index 10 (VHI-10), which makes it possible to quantify the individual’s perception of vocal alteration. The higher the result, the greater the voice handicap perceived by the subject. In addition to sociodemographic and occupational aspects, physical activity was evaluated by the International Physical Activity Questionnaire (IPAQ) in its short form. The level of job satisfaction was expressed through the simple validated question: “Are you satisfied with your job?”. The multivariate statistical analysis was Poisson regression with robust variance. Voice handicap was present in 20.2% of the teachers and was associated with being female (PR = 1.32; CI95%: 1.03-1.70), teaching time (PR = 1.26; CI95%: 1.26-1.04), job dissatisfaction (PR = 1.96; CI95%: 1.59-2.42) and physical inactivity (PR = 1.24; CI95%: 1.00-1.52). The study was carried out at the beginning of the teachers’ return to in-school classes and found that a fifth reported a perception of voice handicap, pointing to the need for greater attention to the work environment and the importance of physical activity for voice health.

Resumo O objetivo deste estudo foi verificar a associação entre desvantagem vocal e variáveis inatividade física e insatisfação no trabalho entre professores da rede pública de Minas Gerais, Brasil. Trata-se de estudo epidemiológico, transversal do tipo websurvey. Participaram do estudo 1782 professores. A coleta de dados ocorreu entre 26 de outubro e 31 de dezembro de 2021. A variável desfecho foi o Índice de Desvantagem Vocal 10 (IDV-10) que possibilita quantificar a percepção do indivíduo sobre sua alteração vocal. Quanto maior o resultado, maior a desvantagem vocal percebida pelo sujeito. Além dos aspectos sociodemográficos e ocupacionais, foi avaliada a atividade física pelo Questionário Internacional de Atividade Física (IPAQ), em sua forma curta e a satisfação no trabalho por meio da pergunta já validada: “Você está satisfeito com o seu trabalho?”. A análise estatística multivariada foi a regressão de Poisson com variância robusta. A desvantagem vocal esteve presente em 20.2% dos professores e apresentou associação com o sexo feminino (RP = 1.32; IC95%: 1.03-1.70) o tempo de docência (RP = 1.26; IC95%: 1.26-1.04), a insatisfação no trabalho (RP = 1.96; IC95%: 1.59-2.42) e a inatividade física (RP = 1.24; IC95%: 1.00-1.52). No estudo realizado no início do retorno dos professores às aulas presenciais verificou que um quinto referiu percepção de desvantagem vocal apontando para a necessidade de maior atenção ao ambiente de trabalho e sobre a importância da atividade física para a saúde da voz.

Objectives: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). Results: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. Conclusion: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.

ABSTRACT The study of competitive interactions between crops and weeds can be an important tool in integrated weed management. The objective of this work was to evaluate the competitive ability of maize hybrids in the presence of hairy beggarticks, testing different proportions of plants in the associations. For maize hybrids (Dekalb 230 PRO3, Pioneer 30F53 VYH, Brevant 2B433 PW, and Syngenta 505 VIP3) and for hairy beggarticks, the final density was 20 individuals pot-1, which was determined in preliminary experiments. Experiments were carried out on a substitutive series, on different combinations of the species, varying the relative proportions (100:0, 75:25, 50:50, 25:75, and 0:100%). The analysis of species competitiveness was performed using diagrams applied to the substitutive experiments and relative competitiveness indices. The maize hybrids showed less loss when reducing the morphological variables of the hairy beggarticks and demonstrated superiority in competitive ability in relation to the weed. Competition occurred between maize hybrids in the presence of hairy beggarticks, being negatively affected, regardless of the proportion of plants, causing reductions in plant height, stem diameter, leaf area, and dry mass. An average reduction of 10% and 86% of the MS of maize hybrids and weed was observed, respectively, when comparing the absence of competition with any associated densities, intraspecific competition being more harmful than interspecific. Maize hybrids and hairy beggarticks compete for the same environmental resources, with the crop being more competitive than the competitor.

RESUMO O estudo das interações competitivas entre espécies cultivadas e não cultivadas pode ser uma ferramenta importante no manejo integrado de plantas daninhas. O objetivo deste trabalho foi avaliar a habilidade competitiva de híbridos de milho na presença do picão-preto, testando-se diferentes proporções de plantas nas associações. Tanto para os híbridos de milho (Dekalb 230 PRO3, Pioneer 30F53 VYH, Brevant 2B433 PW e Syngenta 505 VIP3) quanto para o picão-preto, a densidade final foi de 20 indivíduos vaso-1, determinada em experimentos preliminares. Após foram instalados ensaios em série de substituição, nas diferentes combinações das espécies, variando-se as proporções relativas (100:0, 75:25, 50:50, 25:75 e 0:100%). A análise da competitividade das espécies foi efetuada por meio de diagramas aplicados a experimentos substitutivos e pelos índices de competitividade relativa. Os híbridos de milho apresentaram menor perda ao reduzirem as variáveis morfológicas do picão-preto e demonstraram superioridade na habilidade competitiva em relação a planta daninha. Ocorreu competição entre os híbridos de milho na presença do picãopreto, sendo afetados negativamente, independentemente da proporção de plantas, provocando reduções na estatura de plantas, diâmetro de caule, área foliar e massa seca. Observou-se redução média de 10 e 86% da MS dos híbridos de milho e da planta daninha, respectivamente ao se comparar a ausência de competição com qualquer das densidades associadas, sendo a competição intraespecífica mais prejudicial do que a interespecífica. Os híbridos de milho e o picão-preto competem pelos mesmos recursos do meio, sendo a cultura mais competitiva do que a planta daninha.

Resumo Neste artigo, aprofunda-se a discussão crítica às políticas adotadas pelo governo Bolsonaro em relação à saúde pública, particularmente no que tange ao financiamento em geral, ao enfrentamento da pandemia e ao primeiro ano de implantação do novo modelo de “financiamento” para a Atenção Primária à Saúde (APS). A análise evidencia o acirramento da legitimidade restrita do regime político, assumida por políticas ultraneoliberais e pelo neofascismo do governo Bolsonaro. Estas formas de dominação - política e econômica - engendram uma conjuntura interna que visa remodelar a acumulação de capital na saúde pública via APS por meio de mecanismos “operacionais” burocráticos sutis de desconstrução da universidade do “financiamento”. Na primeira parte, discute-se a abrangência da crise tripla do capital - sanitária, econômica e ecológica - e sua relação orgânica com o Estado no capitalismo dependente brasileiro, abrindo espaço para o crescimento da restrição do regime político endossado pela ascensão do neofascismo. Na segunda parte, aborda-se a escalada do desfinanciamento do Sistema Único de Saúde (SUS) em plena crise de covid-19 e os efeitos da implementação do modelo de financiamento da APS, evidenciando a continuidade do processo de valorização de um “SUS operacional” em detrimento do seu princípio de universalidade como dimensão neofascista do governo Bolsonaro.

Abstract This article deepens the critical discussion about the policies of the Bolsonaro government regarding public health, particularly regarding the general financing, the confrontation of the pandemic, and the first year of implementation of the new financing model for Primary Health Care (PHC). The analysis evidences the aggravation of the restrict legitimacy of the political regime, assumed by ultra-neoliberal policies and by the neofascism of the Bolsonaro government. These forms of domination - political and economic - produce an internal conjuncture that seeks to remodel the capital accumulation in public health by PHC by subtle bureaucratic “operational” mechanisms of deconstruction of financing universality. In the first part, the coverage of the triple crisis of the capital - sanitary, economic and ecological - and its organic relationship to the State in the Brazilian dependent capitalism is discussed, opening space to the increase of the restriction of the political regime endorsed by the ascension of the neofascism. In the second part, the increase of the de-financing of the Unified Health System (SUS) right in the middle of the covid-19 crisis and the effects of the implementation of the financing model of the PHC, evidencing the continuity of the process of valuing an “operational SUS” in detriment of its universality principle as a neofascist dimension of Bolsonaro’s government.

Resumo Plinia cauliflora (Mart.) Kausel, popularmente conhecida como jabuticaba, é rica em polifenois. Os compostos fenólicos apresentam diversas propriedades biológicas, que refletem em biomarcadores, como os parâmetros bioquímicos. No presente estudo, avaliamos os níveis plasmáticos de glicose, colesterol total, HDL-colesterol, triglicerídeos e ácido úrico em hamsters chineses alimentados por 45 dias com dieta regular ou dieta enriquecida com colesterol suplementada com extrato líquido obtido de resíduos de frutos de P. cauliflora padronizado em ácido elágico e compostos fenólicos totais. Os resultados mostraram que o extrato concentrado obtido dos resíduos de jabuticaba aumentou a glicemia dos animais alimentados com dieta regular e reduziu os níveis plasmáticos de ácido úrico dos animais alimentados com dieta rica em colesterol. Uma vez que a hiperuricemia é considerada um fator de risco significativo de distúrbios metabólicos e a principal base patológica da gota, o extrato líquido dos resíduos de frutas de P. cauliflora seria um candidato promissor como um novo agente hipouricêmico para investigação posterior.

Abstract Plinia cauliflora (Mart.) Kausel, popularly known as jabuticaba, is rich in polyphenols. Phenolic compounds exhibit several biological properties, which reflect on biomarkers such as biochemical parameters. In the present study, we evaluated the plasmatic levels of glucose, total cholesterol, HDL-cholesterol, triglycerides, and uric acid of Chinese hamsters fed for 45 days with a regular diet or cholesterol-enriched diet supplemented with a liquid extract obtained from P. cauliflora fruits residues standardized in ellagic acid and total phenolic compounds. The results showed that the concentrated extract obtained from jabuticaba residues increased the glycemia of animals fed with a regular diet and reduced the plasmatic uric acid levels of animals fed with a cholesterol-enriched diet. Since hyperuricemia is considered to be a significant risk factor of metabolic disorders and the principal pathological basis of gout, the liquid extract from P. cauliflora fruits residues would be a promising candidate as a novel hypouricaemic agent for further investigation.

Abstract This article deepens the critical discussion about the policies of the Bolsonaro government regarding public health, particularly regarding the general financing, the confrontation of the pandemic, and the first year of implementation of the new financing model for Primary Health Care (PHC). The analysis evidences the aggravation of the restrict legitimacy of the political regime, assumed by ultra-neoliberal policies and by the neofascism of the Bolsonaro government. These forms of domination - political and economic - produce an internal conjuncture that seeks to remodel the capital accumulation in public health by PHC by subtle bureaucratic “operational” mechanisms of deconstruction of financing universality. In the first part, the coverage of the triple crisis of the capital - sanitary, economic and ecological - and its organic relationship to the State in the Brazilian dependent capitalism is discussed, opening space to the increase of the restriction of the political regime endorsed by the ascension of the neofascism. In the second part, the increase of the de-financing of the Unified Health System (SUS) right in the middle of the covid-19 crisis and the effects of the implementation of the financing model of the PHC, evidencing the continuity of the process of valuing an “operational SUS” in detriment of its universality principle as a neofascist dimension of Bolsonaro’s government.

Resumo Neste artigo, aprofunda-se a discussão crítica às políticas adotadas pelo governo Bolsonaro em relação à saúde pública, particularmente no que tange ao financiamento em geral, ao enfrentamento da pandemia e ao primeiro ano de implantação do novo modelo de “financiamento” para a Atenção Primária à Saúde (APS). A análise evidencia o acirramento da legitimidade restrita do regime político, assumida por políticas ultraneoliberais e pelo neofascismo do governo Bolsonaro. Estas formas de dominação - política e econômica - engendram uma conjuntura interna que visa remodelar a acumulação de capital na saúde pública via APS por meio de mecanismos “operacionais” burocráticos sutis de desconstrução da universidade do “financiamento”. Na primeira parte, discute-se a abrangência da crise tripla do capital - sanitária, econômica e ecológica - e sua relação orgânica com o Estado no capitalismo dependente brasileiro, abrindo espaço para o crescimento da restrição do regime político endossado pela ascensão do neofascismo. Na segunda parte, aborda-se a escalada do desfinanciamento do Sistema Único de Saúde (SUS) em plena crise de covid-19 e os efeitos da implementação do modelo de financiamento da APS, evidenciando a continuidade do processo de valorização de um “SUS operacional” em detrimento do seu princípio de universalidade como dimensão neofascista do governo Bolsonaro.

Abstract Objectives: To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+. Methods: A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models. Results: 6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. Conclusion: Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all.

ABSTRACT Reference evapotranspiration (ET0) and rainfall are basic variables for estimating the net irrigation depth (NID). The objective of this study was to estimate the NID for designing irrigation systems in Piracicaba, SP, Brazil, using ET0 and rainfall probability distributions. A 30-year ET0 and rainfall dataset (1990-2019) was obtained from the ESALQ/USP weather station. The water balance between ET0 and rainfall indicated July, August, and September as months of higher water deficit. Based on the first-order Markov chain, August presented the highest water deficit. Rainfall and ET0 were estimated on 19 probability levels, and four probability distributions such as normal, log-normal, beta, and mixed gamma were evaluated. The analysis of historical August series using accumulated values in periods of five, ten, or 15 days is recommended for sizing irrigation designs in Piracicaba, SP, Brazil. The log-normal and mixed gamma probability distributions presented the best fit for ET0 and rainfall data, respectively. To reach a crop coefficient Kc = 1 in Piracicaba, SP, Brazil in August, the irrigation system should be designed for an NID of 4.1 mm day-1. The use of mean monthly rainfall and ET0 values for designing irrigation systems underestimates the NID by a mean of 26.6% compared to estimates made at a probability of 75% at five-, ten-, and 15-day intervals because the mean rainfall values occurred with exceedance probabilities of < 36%, and mean ET0 values occurred with non-exceedance probabilities of < 56%.

Resumo A entrevista com Leo Salo busca compreender a criação dos instrumentos de interação no território, promovidos por ações de escuta da comunidade por meio do projeto Passeio Brabo, com o intuito de trazer os trabalhos desenvolvidos na comunidade de Manguinhos, no Rio de Janeiro. As ações do grupo Experimentalismo Brabo procuram, por meio dos cortejos de palhaçaria, apreender realidades da comunidade pela escuta de suas demandas, que ocorrem dentro do território, dos becos e das favelas, chegando às casas e às pessoas no espaço de favela, a fim de criar cenários de interação, escuta e colaboração. território Manguinhos Janeiro procuram palhaçaria demandas favelas favela colaboração

Abstract This interview with Leo Salo aims to understand how methods to foster interaction in excluded territories were created through the active listening of the community in actions developed as part of the Passeio Brabo project, designed to highlight the work undertaken in Rio de Janeiro’s Manguinhos community. With its clown parades, Experimentalismo Brabo endeavors to apprehend the realities of the community by listening to its demands inside its own territory, alleys, and favelas, reaching out to the homes and individuals in the community space to create environments for interaction, active listening, and collaboration. project Janeiros Janeiro s parades territory alleys favelas collaboration

Resumo Para exercer uma melhor gestão de custos em uma cadeia de suprimentos, deve-se reduzir ou eliminar atividades que não agreguem valor ao produto ou processo de exportação. Desse modo, este trabalho possui como objetivo mensurar os custos de um processo de exportação de cargas em contêineres utilizando a combinação do Supply Chain Operation Reference Framework e o custeio baseado em atividades, a partir da perspectiva de uma empresa exportadora. Utiliza-se uma abordagem qualitativa para identificar os processos e atividades que geram custos em uma cadeia de exportação de carga conteinerizada e uma abordagem quantitativa para mensurar esses custos, por meio da combinação dos métodos mencionados. Ao aplicar os métodos propostos, foi viável realizar o cálculo dos custos da cadeia de exportação de produtos cerâmicos, ao mesmo tempo em que foi possível identificar esses custos com base em indicadores e métricas de desempenho. Assim, esse trabalho auxilia as ações comerciais, levantando os custos de uma cadeia de exportação e tentando preencher lacunas na literatura. suprimentos devese deve se modo exportadora Utilizase Utiliza mencionados propostos cerâmicos desempenho Assim comerciais literatura

Abstract To perform better cost management in a supply chain, it must reduce or eliminate activities that do not add value to the product or export process. Thus, this paper aims to measure the costs of a containerized cargo export process using a combination of the Supply Chain Operation Reference Framework and activity-based costing, from the perspective of an exporting company. A qualitative approach is used to identify the processes and activities that generate costs in a containerized cargo export chain and a quantitative approach is used to measure these costs, through a combination of the mentioned methods. By applying the proposed methods, it was feasible to calculate the costs of the export chain of ceramic products, while it was possible to identify these costs based on performance indicators and metrics. Thus, this work assists commercial actions, raising the costs of an export chain and trying to fill gaps in the literature. Thus activitybased activity costing company methods products metrics actions literature

Abstract Clinical practice guidelines (CPG) are developed to align standards of health care around the world, aiming to reduce the incidence of misconducts and enabling more effective use of health resources. Considering the complexity, cost, and time involved in formulating CPG, strategies should be used to facilitate and guide authors through each step of this process. The main objective of this document is to present a methodological guide prepared by the Epidemiology Committee of the Brazilian Society of Rheumatology for the elaboration of CPG in rheumatology. Through an extensive review of the literature, this study compiles the main practical recommendations regarding the following steps of CPG drafting: distribution of working groups, development of the research question, search, identification and selection of relevant studies, evidence synthesis and quality assessment of the body of evidence, the Delphi methodology for consensus achievement, presentation and dissemination ofthe recommendations, CPG quality assessment and updating. This methodological guide serves as an important tool for rheumatologists to develop reliable and high-quality CPG, standardizing clinical practices worldwide. (CPG world resources complexity cost process rheumatology literature drafting groups question search studies achievement updating highquality high worldwide