We conducted a randomized, controlled study to assess the need for hydroxychloroquine (HCQ) during lupus pregnancy and to assess safety. Twenty consecutive pregnant patients with similar characteristics were enrolled. The HCQ group included eight patients with systemic lupus erythematosus (SLE) and two with discoid lupus erythematosus (DLE). The placebo (PL) group included nine patients with SLE and one with DLE. The HCQ group had no flare-ups. SLEPDAI scores were similar at study entry, and at conclusion the placebo group had significantly higher scores. One patient had improvement of skin lesions and another of arthritis, allowing a decrease of prednisone dose. There were no retinal effects. Three patients in the PL group flared up, two with skin rashes, one also with arthritis and uveitis, and one (previously in remission on HCQ) with hemolytic anemia, polyserositis and anti-dsDNA antibody. Toxemia was diagnosed in only three patients in the PL group (one fetal death). Comparing prednisone dosage change, we noted a decrease in the HCQ and an increase in the PL group. Delivery age and Apgar scores were higher in the HCQ group. Neonatal examination did not reveal congenital abnormalities, nor did a neuro-ophthalmological and auditory evaluation at 1.5-3 y of age. In spite of the small number of patients studied, we noted beneficial effects of HCQ during lupus pregnancy, as measured by SLEPDAI and decrease in prednisone dose with no detriment to patients' health.

The Brazilian Unified Health System (SUS)

Objective: the judicialization of health is incorporated into the daily work of health institutions in Brazil through the court orders for access. In this study, the objective was to describe the contents of the social representations of access, through judicialization, for the health professionals. Method: qualitative study based on Social Representations Theory, involving 40 professionals, at a teaching hospital and at the center for the regulation of beds and procedures in Rio de Janeiro. Forty semistructured interviews were held, to which the thematic-categorical content analysis technique was applied. Results: the health professionals' attitude towards the reality the judicialization imposes is negative, but they acknowledge this resource as necessary in view of the public health crisis. Judicialization is considered a strategy to exercise citizenship that superimposes individual on collective law, increases social inequalities in access and compromises the efficacy of health policies. Conclusion: considering social representation as a determinant of practices, the representations that emerged can contribute to the change of the professionals' practices. Improvements in user care should be promoted, characterized as one of the main challenges to advance in universal access to health.

O presente estudo objetiva apresentar uma reflexão sobre as práticas de cuidado da enfermagem no contexto da oncologia em tempos do enfrentamento da pandemia da Covid-19 no Brasil.

This exploratory, qualitative, descriptive study examined the social representations of nurses' professional autonomy held by non-nursing health personnel at a public hospital in the Lakes Region of Rio de Janeiro State in 2015. On an approach structured by Social Representations Theory and Method, 53 health professionals responded to a free evocation form by verbalizing the first 5 words suggested them by the stimulus-term nurses' professional autonomy. EVOC 2003 software was used. The probable central core of the representation comprised the evocations care, team and responsibility, which expressed strongly image-rich and evaluative dimensions. Most of the subjects acknowledged that nurses have professional autonomy. It was concluded that the group's position is essentially favorable to the object represented. But the shortage of affective and practical dimensions reveals that this representation is still in the process of consolidation. Keywords: Professional autonomy; nursing; nurses; psychology, social. RESUMEN: Estudio cuyo objetivo fue analizar las representaciones sociales de la autonomía profesional del enfermero para profesionales de salud no enfermeros en un hospital público en la Região dos Lagos, en Río de Janeiro. Se trata de un estudio descriptivo, cualitativo, exploratorio, realizado en 2015 bajo un abordaje estructural de la Teoría y el Método de las Representaciones Sociales junto a 53 profesionales de salud que respondieron al formulario de evocaciones libres, verbalizando las primeras cinco palabras que les surgieran a partir del término inductor 'autonomía profesional del enfermero'. Para ese análisis, se ha utilizado el software EVOC 2003. Han compuesto el probable núcleo central de la representación las evocaciones de cuidado, equipo y responsabilidad, las que expresan fuertes dimensiones de imágenes y evaluaciones. La mayoría de los individuos reconoció la existencia de la autonomía profesional del enfermero. Se concluye que hay, esencialmente, una posición favorable del grupo en cuanto al objeto de representación. Sin embargo, la escasez de dimensiones afectiva y práctica revela que se trata de una representación aún en proceso de consolidación. Palabras Clave: Autonomía profesional; enfermería; enfermeras; psicología social. Representações sociais da autonomia profissional do enfermeiro para profissionais de saúde não enfermeiros IntroduçãoNa enfermagem, a autonomia profissional representa um tema complexo, cuja necessidade de exploração mais detalhada advém da configuração atual do trabalho do enfermeiro no âmbito hospitalar, que, progressivamente, tem ganhado novos contornos, novas demandas, dificuldades e tecnologias, mas que, por vezes, sustenta práticas ainda centradas no modelo biomédico [1][2][3][4][5] .

Objective:to compare the social representations of professional nurse autonomy produced by first and last-period undergraduate nursing students. Method:qualitative, descriptive and exploratory study, based on the structural approach of social representations, the Central Core Theory, carried out with 171 students from three federal public universities, using the free association technique on the object “professional nurse autonomy”. The data were submitted to EVOC 2005 software and to similarity analysis. Results:care was the central core of the representational structure identified among the students of the first period. Among last-period students, knowledge stood out as a core element. The term responsibility was identified as common to both central cores. Conclusion:regarding professional autonomy, the results point to an overlapping process of the reified and consensual universes during the undergraduate course. However, responsibility, inherent in the profession, remains cross-sectional. For the first period students, autonomy is resignified in a practical and attitudinal way, whereas for the last period students, the knowledge acquired stimulates them to assign meaning to professional autonomy with a cognitive and attitudinal representation. The data can support the use of innovative teaching practices in nursing undergraduate courses.

Introdução: A judicialização da saúde é uma expressão cada vez mais presente nos cenários de assistência à saúde no Brasil materializada, principalmente, pelos mandados judiciais para a realização de procedimentos diagnósticos e terapêuticos, consultas, internações e dispensação de insumos médico-cirúrgicos. Objetivo: descrever e discutir a estrutura das representações sociais da judicialização das ações e serviços de saúde no âmbito do Sistema Único de Saúde pelos profissionais de saúde envolvidos no processo de judicialização da saúde. Materiais e Métodos: Estudo qualitativo, pautado na Teoria das Representações Sociais, realizado com 152 sujeitos, em um hospital universitário e na central de regulação de procedimentos e leitos na cidade do Rio de Janeiro. Aplicou-se a Técnica de Evocação Livre através do termo indutor "judicialização da saúde", sendo essas analisadas com a técnica de quatro casas. Resultados: Foram evocadas 761 palavras, com média das ordens médias de evocação de 3, com frequência máxima de 17 e mínima de 10. Discussão: Identificou-se que os profissionais de saúde apresentam um posicionamento negativo diante da realidade imposta pela judicialização, entretanto reconhecem esse recurso como necessário mediante a crise da saúde pública brasileira. Conclusões: Os profissionais de saúde trabalham sob a pressão do poder judiciário, com a ameaça de prisão levando a um cotidiano estressante de suas práticas profissionais decorrente de uma ação ineficaz do Estado na execução da política de saúde.

ContextSeveral international studies have observed a correlation between the improvement of socio-demographic indicators and rates of incidence and mortality from cancer of the colon and rectum.ObjectiveThe objective of this study is to estimate the correlation between average per capita income and the rate of colorectal cancer mortality in Brazil between 2001 and 2009.MethodsWe obtained data on income inequality (Gini index), population with low incomes (½ infer the minimum wage/month), average family income, per capita ICP and mortality from colon cancer and straight between 2001-2009 by DATASUS. A trend analysis was performed using linear regression, and correlation between variables by Pearson's correlation coefficient.ResultsThere was a declining trend in poverty and income inequality, and growth in ICP per capita and median family income and standardized mortality rate for colorectal cancer in Brazil. There was also strong positive correlation between mortality from this site of cancer and inequality (men r = -0.30, P = 0.06, women r = -0.33, P = 0.05) income low income (men r = -0.80, P<0.001, women r = -0.76, P<0.001), median family income (men r = 0.79, P = 0.06, women r = 0.76, P<0.001) and ICP per capita (men r = 0.73, P<0.001, women r = 0.68, P<0.001) throughout the study period.ConclusionThe increase of income and reducing inequality may partially explain the increased occurrence of colorectal cancer and this is possibly due to differential access to food recognized as a risk factor, such as red meat and high in fat. It is important therefore to assess the priority of public health programs addressing nutrition in countries of intermediate economy, as is the case of Brazil.