SUMMARYThe aim of this study was to provide a comprehensive genetic/phenotypic characterization of subjects suffering infertility owing to sperm macrocephaly (n = 3) or globozoospermia (n = 9) and to investigate whether the patients' genetic status was correlated with the alteration of various sperm parameters. AURKC was sequenced in case of sperm macrocephaly while the DPY19L2 status has been analyzed by multiple approaches including a novel qPCR-based copy number assay in case of globozoospermia. Globozoospermic patients were also analyzed for SPACA1, a novel candidate gene herein tested for the first time in humans. The effect of the patients' genetic status was interrogated by implementing the molecular screening with the characterization of several sperm parameters: (i) routine sperm analysis, integrated with transmission electron microscopy; (ii) sperm fluorescent in situ hybridization (FISH) analysis; (iii) sperm DNA fragmentation (DF) analysis. Moreover, for the first time, we performed microsatellite instability analysis as a marker of genome instability in men with sperm macrocephaly and globozoospermia. Finally, artificial reproductive technology (ART) history has been reported for those patients who underwent the treatment. Macrocephalic patients had an AURKC mutation and >89% tetraploid, highly fragmented spermatozoa. DPY19L2 was mutated in all patients with >80% globozoospermia: the two homozygous deleted men and the compound heterozygous showed the severest phenotype (90-100%). The newly developed qPCR method was fully validated and has the potential of detecting also yet undiscovered deletions. DPY19L2 status is unlikely related to FISH anomalies and DF, although globozoospermic men showed a higher disomy rate and DF compared with internal reference values. No patient was mutated for SPACA1. Our data support the general agreement on the negative correlation between macro/ globozoospermia and conventional intracytoplasmic sperm injection outcomes. Microsatellites were stable in all patients analyzed. The comprehensive picture provided on these severe phenotypes causing infertility is of relevance in the management of patients undergoing ART.

Objective: To understand the feelings and difficulties experienced by cancer patients in relation to the diagnostic and therapeutic itineraries. Methods: An exploratory study of a qualitative nature, developed with 13 people with cancer, through an interview. In the period from June to September of 2017 data were collected and later submitted to content analysis. Results: The results included the unpleasant feelings that patients with cancer experience, and the recognition of factors that influence the re-signification of this phase. In addition, we observed the difficulties that perpass the routine of treatment and that compromise the basic needs of these individuals. Final considerations: It was understood that during the experience of the diagnostic and therapeutic itinerary, people with cancer experience negative feelings and many difficulties. However, some factors make possible the resignification of the disease and need to be considered by health professionals and managers to minimize the impact of the disease during this journey.

Abstract-The purpose of this study was to evaluate the effect of creatine supplementation in the diet on indicators of glucose metabolism in skeletal muscle of exercised rats. Forty Wistar adult rats were distributed into four groups for eight weeks: 1) Control: sedentary rats that received balanced diet; 2) Creatine control: sedentary rats that received supplementation of 2% creatine in the balanced diet; 3) Trained: rats that ran on a treadmill at the Maximal Lactate Steady State and received balanced diet; and 4) Supplemented-trained: rats that ran on a treadmill at the Maximal Lactate Steady State and received creatine supplementation (2%) in the balanced diet. The hydric intake increased and the body weight gain decreased in the supplemented-trained group. In the soleus muscle, the glucose oxidation increased in both supplemented groups. The production of lactate and glycemia during glucose tolerance test decreased in the supplemented-trained group. Creatine supplementation in conjunction with exercise training improved muscular glycidic metabolism of rats.Keywords: somatic index, glucose tolerance, physical activity Resumo-"Influência da suplementação com creatina em indicadores de metabolismo da glucose no músculo esquelético de ratos exercitados." O objetivo deste estudo foi avaliar o efeito da suplementação de creatina na dieta sobre indicadores do metabolismo glicídico musculoesquelético de ratos exercitados. Quarenta ratos Wistar adultos foram divididos em quatro grupos por oito semanas: Controle: receberam dieta balanceada, mantidos sedentários; Controle Creatina: receberam suplementação de creatina (2%) na dieta balanceada, mantidos sedentários; Treinado: correram em esteira na intensidade da máxima fase estável de lactato e receberam a dieta balanceada e grupo Treinado Suplementado: correram em esteira na intensidade da máxima fase estável de lactato e receberam suplementação de creatina (2%) na dieta balanceada. A ingestão hídrica aumentou e o ganho de massa corporal reduziu no grupo treinado e suplementado. No músculo sóleo, a oxidação de glicose aumentou em ambos os grupos suplementados. A produção de lactato e a glicemia durante teste de tolerância à glicose diminuíram no grupo treinado e suplementado. A suplementação com creatina em conjunto com treinamento físico melhorou metabolismo de glicídico muscular dos ratos.Palavras-chaves: índice somático, tolerância à glicose, atividade físicaResumen-"Influencia de la suplementación con creatina sobre indicadores del metabolismo de la glucosa en el músculo esquelético de ratas ejercitadas." El objetivo de este estudio fue evaluar el efecto de la suplementación con creatina en la dieta sobre indicadores del metabolismo de glucosa en el músculo esquelético en ratones ejercitados. Cuarenta ratas macho adultas Wistar se dividieron en cuatro grupos de ocho semanas: Control: recibieron dieta equilibrada, mantenido sedentaria; Control Complementado: La suplementación con creatina recibido (2%) en la dieta equilibrada, sedentaria mantenido; Trained: corrien...

RESUMOO objetivo deste estudo é analisar a eficiência técnica hospitalar das regiões do Brasil, nos anos de 2014 e 2015, visto a importância dessas organizações para o meio social e econômico. Para tanto, por meio de uma pesquisa descritiva, exploratória, documental e quantitativa, foi utilizada a Análise Envoltória de Dados (DEA), modelo CCR, orientada para output, utilizando-se o número de leitos e de médicos e enfermeiros como input e para output o número de pacientes internados e número de óbitos hospitalares. Além disso, buscou-se verificar a relação entre a eficiência técnica hospitalar com as despesas empenhadas com assistência hospitalar, por meio de uma correlação. Os achados apontaram que a região Norte teve a média mais ineficiente comparada com as demais, sendo que nenhum estado da região alcançou score 1 nos anos analisados. Já as regiões consideradas mais eficientes em relação às demais foram a Sul e em segundo lugar a Sudeste, em ambos os anos, 2014 e 2015. Ademais, denota-se que, dentre os estados eficientes, apenas dois foram eficientes nos dois anos analisados, Rio de Janeiro e Rio Grande do Sul. E, quanto à correlação, concluiu-se que não há uma relação estatisticamente significativa entre as despesas empenhadas e a eficiência técnica hospitalar.Palavras-chave: Eficiência hospitalar; Análise envoltória de dados (DEA); Regiões brasileiras. HOSPITAL EFFICIENCY OF THE BRAZILIAN REGIONS: A STUDY USING THE DATA ENVELOPMENT ANALYSIS (DEA) ABSTRACTThe aim of this study is to analyze the hospital technical efficiency in the regions of Brazil, in the years 2014 and 2015, considering the importance of these organizations to the social and economic environment. To do so, through a descriptive, exploratory, documentary and quantitative research, a Data Envelopment Analysis (DEA), CCR model, was used, output-oriented, using the number of beds and of doctors and nurses as an input and the number of hospitalized patients and number of hospital deaths as output. In addition, we sought to verify the relationship between hospital technical efficiency and hospital care expenses, by way of a correlation. The present research is characterized as descriptive, exploratory, documentary and quantitative. The findings indicate that the northern region had the most inefficient average compared to the others, and no State in the region reached a score of 1 in the analyzed years. The regions considered more efficient in relation to the others were in the South and secondly in the Southeast, in both years, 2014 and 2015. Furthermore, two states remained efficient during the analyzed years, Rio de Janeiro and Rio Grande do Sul. As for the correlation, it was concluded that there is no significant relationship between the committed expenses and the hospital technical efficiency.

Objetivo: Investigar o emprego da educação permanente na gestão do cuidado, embasado nos referenciais de Paulo Freire. Método: Estudo do tipo metassíntese da literatura. A busca dos artigos/publicações foi realizada nos meses de junho e julho de 2014, nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Índice Bibliográfico Español de Ciencias de La Salud (IBECS) e; Scientific Electronic Library Online (SciELO), contempladas pela Biblioteca Virtual em Saúde (BVS). Após a fase de localização, da leitura do título e do resumo, foram selecionados seis artigos para análise. Resultados: As informações apreendidas na análise dos dados foram sintetizadas e agrupadas em duas categorias: Educação Permanente em Saúde - perspectiva conceitual e; Educação Permanente em Saúde e o Método Paulo Freire. Conclusão: A Educação Permanente, especialmente na enfermagem, é apontada como estratégia que promove a melhoria da gestão e do cuidado.