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Importance: Tracheal intubation is one of the most commonly performed and high-risk interventions in critically ill patients. Limited information is available on adverse peri-intubation events. Objective: To evaluate the incidence and nature of adverse peri-intubation events and to assess current practice of intubation in critically ill patients. Design, Setting, and Participants: The International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) study was an international, multicenter, prospective cohort study involving consecutive critically ill patients undergoing tracheal intubation in the intensive care units (ICUs), emergency departments, and wards, from October 1, 2018, to July 31, 2019 (August 28, 2019, was the final follow-up) in a convenience sample of 197 sites from 29 countries across 5 continents. Exposures: Tracheal intubation. Main Outcomes and Measures: The primary outcome was the incidence of major adverse peri-intubation events defined as at least 1 of the following events occurring within 30 minutes from the start of the intubation procedure: cardiovascular instability (either: systolic pressure 30 minutes, new or increase need of vasopressors or fluid bolus >15 mL/kg), severe hypoxemia (peripheral oxygen saturation

Background A first-dose of various vaccines provides acceptable protection against infections by SARS-CoV-2 and evolution to the most severe forms of COVID-19. The recombinant adenovirus (rAd)-based vaccine, Gam-COVID-Vac (Sputnik V), was proven efficacious but information about effectiveness in the real-world setting is lacking. The aim of our study was to investigate the association between the rollout of the first component (rAd26) of Gam-COVID-Vac and PCR-positive tests, hospitalisations and deaths. Methods We conducted a retrospective cohort study which analyzed individuals aged 60-79 who self-registered in the online vaccination system of the Province of Buenos Aires, Argentina, from December 29, 2020 to March 21, 2021. Exclusion criteria were having a previous positive RT-PCR or antigen tests for SARS-CoV-2, having received other vaccines, or two doses of any vaccine. Proportions of new laboratory-confirmed SARS-CoV-2 infections, hospitalisations and deaths until 83 days of vaccination were compared between vaccinated and unvaccinated subjects. Vaccine effectiveness for the three outcomes was calculated as (1–OR) × 100. Kaplan-Meier cumulative incidence curves were constructed. Findings During the study period 415995 registered subjects received the first component of Gam-COVID-Vac; 40387 belonged to the 60-79 age group, and were compared to 38978 unvaccinated. Vaccine effectiveness for preventing laboratory-confirmed infections was 78•6% [CI95% 74·8 - 81·7]; and for reducing hospitalizations and deaths was, respectively, 87·6% [CI95% 80·3 - 92·2] and 84·8% [CI95% 75·0 - 90·7]. Effectiveness was high across all subgroups. Interpretation Similarly to other vaccines, the administration of one dose of Gam-COVID-Vac was effective for a wide range of COVID-19–related outcomes., Facultad de Ciencias Médicas

Asthma poses an increased risk for cardiovascular disorders, suggesting that allergy, which is an underlying asthma process, causes atypical functioning of organs other than the lungs. A previous study in a guinea-pig asthma model, we concluded that allergic sensitization increased aorta contractile responses to 5-HT. To further characterize these responses, here, we explored the role of the 5-HT2 receptors family. We found that TCB-2 (5-HT2A agonist) and WAY161503 (5-HT2C agonist) induced aorta contractions resembling those elicited by 5-HT but less intense (~43% and ~25%, respectively). In these experiments, aortas from sensitized guinea pigs showed increased contractions to TCB-2 but not to WAY161503. In turn, MDL 100907 (5-HT2A antagonist) and RS-102221 (5-HT2C antagonist) caused a notably and mild reduction of the 5-HT-induced contractions, respectively, with no differences seen between sensitized and non-sensitized tissues. BW723C86 (5-HT2B agonist) did not induce contractile responses, and RS-127445 (5-HT2B antagonist) did not modify the contractile responses to 5-HT. In non-sensitized aortas, the pattern of protein expression of receptors was 5HT2B>5-HT2A=5-HT2C, which did not change in sensitized animals. In conclusion, we found that allergic sensitization increased the aorta contractile responses to 5-HT, partly mediated by enhanced responses of 5-HT2A receptors, which was unrelated to changes in these receptors' expression.

Objective To analyze the factors associated with mental distress among health workers who cared for patients with a suspected or confirmed diagnosis of coronavirus disease 2019 (COVID-19). Methods A cross-sectional analytical study of national scope, carried out between in the second quarter of 2020. A total of 437 health professionals, who filled out an electronic form about sociodemographic data, occupational aspects, psychosocial characteristics of work and mental distress. Multiple logistic regression was performed to analyze the covariables associated with mental distress. Results There was a predominance of workers on the nursing team (65.0%), female (71.0%), from Southeastern region of the country (68.6%) and with no morbidities (36.2%). The prevalence of mental distress was 61.6%. Job strain was reported by 24% of participants, and the perception of low support from coworkers was described by 52.9%. The final multiple regression model showed that mental distress was associated with females (odds ratio - OR: 1.93; 95%CI: 1.22-3.07), age up to 40 years (OR: 1.64; 95%CI: 1.07-2.52), weekly working hours equal or over 60 hours (OR: 1.87; 95%CI: 1.15-3.11), job strain (OR: 2.45; 95%CI: 1.41-4.40) and low support from co-workers (OR: 3.47; 95%CI: 2.26-5.38). Conclusion Six out of ten participants presented mental distress, which was associated to both individual characteristics and factors related to the work carried out during the pandemic. There is an urgent need to map services that have such characteristics, to outline actions to promote mental health and prevent emotional distress at different levels of health care.

Objectives: To describe the prevalence of testing among health workers providing care for suspected and confirmed cases of COVID-19. Methods: This quantitative, cross-sectional study was conducted from April to June 2020, using a convenience sample. An online questionnaire was used for collecting sociodemographic, occupational, and clinical data, which were analyzed descriptively. Results: In total, 437 health workers participated in the study, with a predominance of nursing workers (58.68%), women (70.3%), age between 30 and 49 years (54.2%), individuals living in the Southeast region of Brazil (60.54%), working in the public care system (69.11%), and focused on primary care (30.89%). Among the participants, 36% reported comorbidities, 21.1% had symptoms suggestive of COVID-19, and only 27% had undergone some type of COVID-19 testing. Conclusions: Despite the existence of risk comorbidities and symptoms suggestive of contamination, the frequency of testing was below one third among respondents. The lack of action compromises health surveillance and protection strategies for workers providing care for the population and may favor the contamination of new patients and the community. © 2021 Associacao Nacional de Medicina do Trabalho. All rights reserved.

Digital, Many affected counties have had experienced a shortage of personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. We aimed to investigate the needs of healthcare professionals and the technical difficulties faced by them during the initial outbreak. A cross-sectional web-based survey was conducted among the healthcare workforce in the most populous cities from three Latin American countries in April 2020. In total, 1,082 participants were included. Of these, 534 (49.4%), 263 (24.3%), and 114 (10.5%) were physicians, nurses, and other professionals, respectively. At least 70% of participants reported a lack of PPE. The most common shortages were shortages in gown coverall suits (643, 59.4%), N95 masks (600, 55.5%), and face shields (569, 52.6%). Professionals who performed procedures that generated aerosols reported shortages more frequently (p, Ciencias Médicas y de la Salud

Textile dyeing is a hazardous and toxic process. While traditionally it has been managed through effluent treatment, new approaches focused upon improving the dyeing process are gaining relevance. In this work, we sought to obtain, for the first time, an eco-friendly chitosan-nanoparticle based textile dyeing method. To that end, yellow everzol and navy blue itosperse loaded chitosan nanoparticles were produced and their capacity to dye textiles and cytotoxicity towards human skin cells were evaluated. The results obtained showed that it was possible to obtain nanoencapsulated dyes through ionic gelation with an average entrapment efficacy above 90 %. Nanoparticles presented a positive surface charge and sizes between 190 and 800 nm with yellow everzol NPs occurring via ionic interactions while navy blue itosperse NPs were formed through hydrogen bonds. Furthermore, the produced dye NPs presented no cytotoxicity towards HaCat cells and presented staining percentages reaching 17.60 % for a viscose/wool blend.

Background: Shortage of Personal Protective Equipment and preparedness to fight back the pandemic have been a common issue in most of the affected countries. The aim was to establish what were the needs of the healthcare professionals, and the technical difficulties they must face, during the first impact of the outbreak. Methods:A cross-sectional web-based survey was conducted involving healthcare workforce in most populous cities from three Latin American countries in April 2020. Findings: 1082 participants were included, of these physicians accounted for 534 (49·4%) and nurses 263 (24·3%). At least 70% reported lack of PPE availability. Most common perceived deficiencies were closed special protection suits 643 (59·4%), N95 masks 600 (55·5%) and face shields 569 (52·6%). Professionals who performed procedures that generated aerosols reported more deficiencies (p

Aim:To compare presenteeism levels among three samples of nurses and to identify the relationship between presenteeism andsociodemographic and professional characteristics.Background:Presenteeism (going to work ill) is a phenomenon studied from different perspectives, and it has become especially important duringthe current COVID-19 outbreak; its connection to high healthcare costs, patient safety breaches and negative nurse well-being has been proved.Introduction:The nursing profession is particularly associated with caring for the culture of teamwork, loyalty to colleagues and professionalidentity. This condition enhances the ‘super nurse phenomenon’, even though nurses do not feel physically and psychologically able to work.Methods:A multicentre, cross-sectional study was conducted in three different country contexts: Oviedo (Spain), Porto (Portugal) andS~ao Paulo (Brazil). Nurses performing functions in hospitals and primary health care were enrolled. Informed consent and datacollection questionnaires were hand delivered. The Stanford Presenteeism Scale-6 was applied.Results:A total of 659 nurses participated. Portuguese nurses showed greater prevalence of presenteeism, followed by Brazilian andSpanish nurses. Younger nurses with less professional experience presented lower levels of presenteeism but greater psychologicalcommitment. Male participants showed lower capacity to complete work when ill than female participants.Conclusions:Age and length of professional experience proved to be significant predictors of total presenteeism, although onlyprofessional experience revealed statistical significance in the adjusted model.Implications for Nursing and Health Policy:The knowledge of this phenomenon among nurses highlights the need for thedevelopment of strategies in the curriculum of nursing students and organizations. Resilience and ergonomic training should be appliedin the training programmes of the students and reinforced by the health centre managers. It is essential that healthcare systems design worksite wellness programmes that pursue greater physical and mental well-being for healthcare professionals. info:eu-repo/semantics/publishedVersion

Background Community health agents (CHAs) are a part of Family Health Strategy multidisciplinary teams, and their function is to develop individual and collective health promotion, recovery and preventive actions, including household visits. Their work exposes CHAs to hazards in the work environment, therefore, using personal protective equipment (PPE) is essential. Aims To draw the sociodemographic and occupational profile of CHAs and investigate associations with use of PPE. Methods Cross-sectional quantitative study performed with 137 CHAs in a coastal municipality in the north of the state of Sao Paulo, Brazil. We applied a questionnaire for sociodemographic and occupational data. The data were subjected to descriptive and inferential analysis, with significance level of 5%. Results 94.16% of the participants were female, and their average age 34.80 years old. Their average time in the job was 3.18 years. The means of transport most often used to commute was bicycles. 94.16% of the participants reported daily use of some type of PPE, which included: sunscreen (88.32%), closed footwear (53.28%), hats (8.0%), sunglasses (6.57%) and raincoats (3.65%). We found significant association between use of PPE and longer time in the job, and between wearing closed footwear and older age and longer time in the job. Conclusion The results point to the need of interventions to promote use of PPE.

Epidemiological and clinical studies suggest that asthma is associated with adverse cardiovascular outcomes, but its mechanism is uncertain. 5-Hydroxytryptamine (5-HT) is a mediator involved in asthma and in cardiovascular functioning. Thus, in the present study, we explored whether allergic sensitization in guinea pigs modifies 5-HT-induced contractile responses and 5-HT2A receptor expression in thoracic aorta rings. We found that sensitization produced a significant increase of 100 µM 5-HT-induced contractions of aorta rings (~27 % greater contraction than in non-sensitized animals, p

Aim: To evaluate data related to mental work functioning of workers with cancer diagnosis in radiotherapy in a private service in the city of Campinas, State of Sao Paulo, Brazil. Method: It consists in a cross-sectional, observational and analytical study with comparison between cancer patients and healthy people, using the Brazilian version of the Work Role Functioning Questionnaire (WRFQ-Br). Descriptive and statistical analysis is performed by the Mann-Whitney test. Results: There was a significant difference between the groups in the evaluation of mental demand; however, the population diagnosed with malignant neoplasm submitted to radiotherapy had unexpected higher scores, reflecting lower mental exigency. Conclusions: The observed context may occur due to extensive support of family, government and interdisciplinary team of health care for individuals diagnosed with cancer. This data provide support for new research studies related to the importance of the work to promote mental health, considering aspects related to social interaction and productivity as the support system members. The importance of disseminating these results and limitation is based in the necessity of investments to improve research and actions to promote the permanence and early return to work for cancer survivors in Brazil and Latin America.

This article presents the description of a research in electronic commerce (EC) in Brazil and Portugal. A comparative analysis of the cultural differences of the most visited retail websites of these countries, based on the cultural dimensions of Geert Hofstede, was carried out. This is a quantitative investigation. Hypotheses and respective variables were defined for analysis. It was considered a sample of the largest EC websites in the countries and data were collected and analyzed using appropriate techniques. The research concluded that the Brazilian sites are more likely to collectivism than the Portuguese sites, proving only one of the hypotheses formulated. Thus, we find that the cultural characteristics of the countries are still poorly represented on B2C sites.

Introduction It is known that the work process in hospital nursing job, when developed under adverse conditions, can result in an increased occurrence of occupational accidents and/or processes of wear. Objective To monitor nursing workers’ occupational accidents in an university hospital. Method It is an exploratory study, developed in the hospital of the University of Sao Paulo, in 2016, after Research Ethics Committee – School of Nursing of the University of Sao Paulo approval (#1110/2011). Data were extracted from the software SIMOSTE ® – Monitoring System for Nursing Workers’ Health, and studied using descriptive analyses with SPSS ® 20.0. Results The mean age of the 77 nursing workers that notified occupational accidents is 43.3 years old (S=9.4); 80.5% of them are women. About nursing categories, 67.5% are auxiliary or technicians and 32.5% are nurses (RN). The locations with the highest occurrence of occupational accidents were: Intensive Care Units (24.7%) and emergency service (20.8%). Most of work notifications was typical accidents (77.9%), followed by the disease (11.7%) and route accidents (10.4%). Analysing the occupational accidents according to the International Statistical Classification of Diseases and Related Health Problems (ICD-10), it was found greater occurrence of injuries to the wrist and hand – S60-S69 (22.1%); knee and lower leg injuries – S80-S89 (10.4%); and ankle and foot injuries – S90-S99(10.4%). About workloads, the mechanic aspects were involved in 77.9% of occupational accidents, followed by biological (27.3%). In general, the occupational accidents caused 85 days of removal from work. Conclusions The occupational accidents occurred more frequently in nursing technicians, involving mainly mechanic and biological workloads. Traumas of upper and lower limbs were the most common. The monitoring of occupational accidents can provide subsidies for interventional measures of prevention of diseases and health promotion, and consequently a reduction in absenteeism.

RESUMO Objetivo Mensurar a exposição dos trabalhadores às cargas de trabalho, aos processos de desgaste e as suas consequências, por meio de indicadores. Método Estudo epidemiológico descritivo, transversal e quantitativo, realizado em doze unidades de três hospitais de ensino do município de São Paulo. A população foi de 452 trabalhadores de enfermagem e a coleta de dados foi realizada por meio do software Sistema de Monitoramento da Saúde do Trabalhador de Enfermagem (SIMOSTE) nos prontuários dos trabalhadores de enfermagem. Os dados foram analisados segundo indicadores que permitiram apreender a dinâmica organizacional (DO), os problemas de saúde dos trabalhadores (PS) e suas consequências (CO). Resultados Os indicadores PS evidenciam 879 exposições às cargas de trabalho e 1.355 processos de desgaste. Os indicadores de CO mostram 2.709 dias perdidos em um ano. Conclusões A exposição às diferentes cargas de trabalho submete os trabalhadores a inúmeros processos de desgaste, os quais devem ser monitorados para que sejam implementadas medidas preventivas. RESUMEN Objetivo mensurar la exposición de los trabajadores a las cargas de trabajo, los procesos de desgaste y sus consecuencias a través de indicadores. Método estudio epidemiológico descriptivo, transversal y cuantitativo realizado en 12 unidades de tres hospitales de enseñanza de São Paulo. La población era 452 trabajadores de enfermería y la recolección de datos se realizó mediante el software Sistema de Monitoreo de los Trabajadores de Enfermería (SIMOSTE) en los ficheros de los trabajadores de enfermería. Los datos fueron analizados a través de indicadores que permitieron aprehender la dinámica organizacional (DO), los problemas de salud de los trabajadores (PS) y sus consecuencias (CO). Resultados los indicadores de PS evidenciaron 879 exposiciones a las cargas de trabajo y 1.355 procesos de desgaste. Los indicadores de CO muestran 2709 días perdidos en un año. Conclusiones La exposición a distintas cargas de trabajo somete los trabajadores a numerosos procesos, que deben ser monitoreados para que se apliquen medidas preventivas. ABSTRACT Objective Measure the exposure of nursing workers to workloads and strain processes and their consequences, by means of indicators. Method Epidemiological, descriptive, cross-sectional quantitative study, conducted in 12 units of three teaching hospitals in the city of Sao Paulo. The study population consisted of 452 nursing workers and the data was collected from hospital medical records using the software System for Monitoring the Health of Nursing Workers (SIMOSTE). The data was analyzed on the basis of indicators that provided information about organizational dynamics, occupational health problems and their consequences. Results The health problem indicators revealed 879 exposures to worloads and 1,355 strain processes. The consequences indicators showed 2,709 lost days per year. Conclusions Exposure to different workloads subjects workers to numerous strain processes, which should be monitored in order to implement preventive measures.

Objective: To identify the issues occurred with nursing workers through a Health Monitoring System for Nursing Workers (SIMOSTE) and to describe the consequences of those problems. Method: This is a quantitative, exploratory and descriptive study realized in a teaching hospital in the west region of the city of São Paulo. Results: From the SIMOSTE, 1.847 occurrences were registered in a six month period. Within the main occurrences, medical licenses, work related accidents with and without removals; psychiatric consultations and psychotherapy were highlighted. Conclusion: The data points out to the need for the development of new health vigilance actions to notify accidents and illness related to work, besides the prevention of issues.

Introduction: Class II-1 can be the result of a retrognathic mandible, a prognathic maxillary or both. Nowadays, there are several ways for class II treatment: maxillary fi rst bicuspid extractions that can also include the extraction of one lower incisor or the fi rst or second mandibular bicuspids, depending the case, or even the extraction of the second maxillary bicuspids as well. Objectives: To achieve canine class I, correct the midline discrepancy, the excessive overjet and to improve the patient’s aesthetics. Case report: Female patient of 32.6 years of age who had a previous orthodontic treatment with extractions of the fi rst maxillary and mandibular bicuspids presents absence of the maxillary second bicuspid, generalized mild chronic periodontitis and previous mental foramen fracture with mentoplasty. Conclusions: The 2nd bicuspid extraction was the best alternative to avoid another surgery, with a signifi cant change in the patient’s profi le, improving her expectations and self-esteem. Key words: Class II-1, second maxillary bicuspid extractions.

Introduction Many researchers have demonstrated the presence of suffering at work researches show the precariousness of health work, specifically in Brazilian nurses, has been an important factor in the genesis of mental suffering, considering the lack of human resources and material, work overload, the multiple demands and low pay. Objectives: analyse the occurrence of mental suffering in Brazilian nursing workers, describe the consequences and propose interventions to reduce the suffering. Methods This is a cross-sectional, descriptive, and quantitative study carried out in a Teaching Hospital. Data were collected by nursing workers health surveillance software (SiMOSTE) Results The study recorded 540 occurrences of Mental and Behavioural Disorders in nurses, more than half of (305; 56.49%) related to Mood disorders, of which we highlight Depressive episodes (190; 35.18%) and the Recurrent depressive disorder (85; 15.75%). For the consequences of Mental and Behavioural Disorders, it was found out, 462 generated sick leaves with an average of 7.67 lost days, 76 resulted in psychiatrist treatment, and 2 caused occupational accidents. In relation to proposals for intervention were suggested : make breaks at work, implement conversation circles and improvement of teamwork. It is necessary discuss the forms of organisations of work, between what is prescribed and what actually takes (Dejours, 2012). Place – and its implications for the scope of psychodynamics of work and mental health. Conclusions The study reveals the relation between the nursing workers and mental suffering, allowing the identification of workloads and strain process to planning of interventions.

Objectives To evaluate and compare the perspective of the organisational climate in Brazilian nurses who work in the hospital and in the Primary Health Care (ABS). Method This is a quantitative, cross-sectional and comparative study, realised with 36 nurses who work in the north coast of Sao Paulo (Brazil). Data were collected in 2015 through the socio-demographic and professional characterisation questionnaire, and the Organisational Climate Scale for Health Organisations. Results Among 36 nurses in the study, 83.3% were women, mean age 39,4 years. The average time of work in the current job is 5.3 years and 11.1% of them have other job. As for the work place, 15 (41.7%) work in hospital ( medium-sized hospital) and 21 (58.3%) work in The Primary Health Care, which are: Health Strategy, Basic Health Units, Outpatient specialties. In the perception of nurses, the organisational climate (score 1–5) was evaluated with the following averages: Lideranca (3.37); Professional development (2.95); Relationship and spirit of staff (4.01); Relationship with Community (3.28); Safety at work (2.52); Strategy (2.74) and Incomes (2.30). When comparing the means of the dimensions of organisational climate perceptions of hospital nurses with the Primary Care, the Student’s t test showed significant difference for Safety (p-value = 0.032) and Income (p-value = 0.046). The hospital9s nurses have better scores to these factors. Conclusion In the perception of nurses on the organisational climate, the lowest scores were assigned to Income, Safety and Strategy, respectively. Nurses who work in the Primary Health Care got lower scores to the Compensation and Safety at Work as compared to nurses working in hospital, showing the need for intervention in this work place.

Objectives To relate the dimensions of burnout and job satisfaction of nurses and compare the scores of the burnout dimensions and Job satisfaction of nurses in the hospitals and the Primary Health Care. Methods Cross-sectional, correlation study, realised with 58 nurses in Sao Paulo. Data were collected through the Job Satisfaction score (S20/S23) and Maslach Burnout Inventory. Results Of the 58 nurses, 89.7% were women, average age of the 36.5 years. The average time of work in the current job is 3.0 years. As for the study setting, 26 (44.8%) are of Hospital care and 32 (55.2%) of the Primary Health Care. By correlating the dimensions of burnout (exhaustion emotionally EE, DE Despersonalization and Conducting Professional-RP) with the Job Satisfaction (Satisfaction with the relationship hierarchical- SRH, satisfaction with work-physical environment SAFT and intrinsic satisfaction in the work- SIT) was observed: strong positive correlation between EE and DE (0.630), SRH and SAFT (0.637) and SRH and SIT (0.716); moderate positive correlation between SIT and SAFT (0.495); moderate negative correlation between EE and SRH (−0.473), EE and SAFT (−0.348) and EE and SIT (−0.459); weak negative correlation between ED and PR (- 0.239), DE and SRH (−0.202). In the comparison of the mean burnout dimensions (score 0–4), the largest EE scores (1.74), DE (0.95) and RP (3.18) were observed in the Primary care nurses. As for Job satisfaction (score 1–5) we identified that nurses of Hospital care have higher averages SRH (3.72), SAFT (3.70) and nurses of Primary Attention, the highest average SIT (3.88). Student’s t-test didn’t show significant difference (p = 0.035) only for RP. Conclusion Nurses are partially satisfied with their work and with moderate levels of EE, low DE and a high level of RP; being the EE and DE negatively correlated with job satisfaction.

Objective Cross-cultural adaptation of the questionnaire: Nurses Work Functioning Questionnaire into Portuguese in the Brazilian context. This questionnaire was developed by Gartner et al. (2011) in order to detect early what are the nursing staff affected at work because they have TMC and identify the specific aspects of work that are harmed. Method The adaptation process was conducted in accordance with internationally recommended methodologies, following the translation stages, synthesis, back translation, review by a committee of judges and pretest. Results and discussion The questionnaire was initially translated into Portuguese resulting in two versions which were analysed and resulted in the synthesis of the translations. All produced versions were submitted to back translation and then carried to judges. This committee was composed of five experts who reviewed and compared all translations, developing a final version for application in the pre-test. At this stage it verified the content validity of all the items of the questionnaire by applying the concordance rate of 80% among participants. The pre-test was conducted with 35 nursing workers, including technicians and nurses from the Cardiac Surgery Unit of Hospital Sao Paulo. To check the reliability of the instrument was used Cronbach’s alpha, which averaged 0.88 indicating high internal consistency index. Conclusions The results indicated that the adaptation process was conducted successfully and the adapted version of the questionnaire has demonstrated adequate psychometric properties, making it reliable to be used with the Brazilian culture.

OBJECTIVE To identify the workloads present in the work activities of community health agents (CHAs) and the resulting strain processes. METHOD A descriptive, exploratory, cross-sectional and quantitative study conducted with 137 CHAs. Data were collected through a questionnaire and interview guided by the health surveillance software called SIMOSTE (Health Monitoring System of Nursing Workers), following the ethical codes of the current law. RESULTS In total, were identified 140 workloads involved in 122 strain processes, represented by the occurrence of health problems of the CHAs. The mechanical (55.00%) and biological (16.43%) loads stood out. The most common strain processes were the external causes of morbidity and mortality (62.31%) and diseases of the musculoskeletal system and connective tissue (10.66%). CONCLUSION From the identified overloads, it became evident that all workloads are present in the work process of CHAs, highlighting the mechanical load, represented mainly by external causes of morbidity and mortality that are related to occupational accidents. Resumen OBJETIVO Identificar las cargas de trabajo presentes en la actividad laboral de los agentes comunitarios de Salud (ACS) y los procesos de desgaste consecuentes. MÉTODO Estudio descriptivo exploratorio, transversal, cuantitativo con 137 ACS. Los datos fueron recogidos mediante cuestionario y entrevista orientada por el software de vigilancia sanitaria SIMOSTE, siguiendo los preceptos de la legislación vigente. RESULTADOS Se identificaron 140 cargas de trabajo involucradas en 122 procesos de desgaste representados por las ocurrencias de agravios a la salud del ACS, destacándose la carga mecánica (55,00%) y la biológica (16,43%). Los procesos de desgastes más comunes fueron las causas externas de morbilidad y mortalidad (62,31%) y las enfermedades del sistema osteomuscular y conjuntivo (10,66%). CONCLUSIÓN Se evidenció desde los desgastes identificados que todas las cargas de trabajo están presentes en el proceso de trabajo de los ACS, destacándose la carga mecánica, representada especialmente por las causas externas de morbilidad y mortalidad, las que se relacionan con los accidentes laborales. Resumo OBJETIVO Identificar as cargas de trabalho presentes na atividade laboral dos agentes comunitários de saúde (ACS) e os processos de desgaste decorrentes. MÉTODO Estudo descritivo-exploratório, transversal, quantitativo, realizado com 137 ACS. Os dados foram coletados por meio de questionário e entrevista norteada pelo software de vigilância à saúde SIMOSTE, seguindo os preceitos éticos da legislação vigente. RESULTADOS Identificou-se 140 cargas de trabalho envolvidas em 122 processos de desgaste representados pelas ocorrências de agravos à saúde do ACS, destacando-se as cargas mecânica (55,00%) e biológica (16,43%). Os processos de desgastes mais comuns foram as causas externas de morbidade e mortalidade (62,31%) e as doenças do sistema osteomuscular e conjuntivo (10,66%). CONCLUSÃO Evidenciou-se a partir dos desgastes identificados, que todas as cargas de trabalho estão presentes no processo de trabalho dos ACS, destacando-se a carga mecânica, representada principalmente pelas causas externas de morbidade e mortalidade, as quais se relacionam com os acidentes de trabalho.

O presente estudo aborda a relação entre a mulher trabalhadora de enfermagem e os distúrbios osteomusculares relacionados ao trabalho. Evidencia-se que os trabalhadores de enfermagem estão expostos a uma série de condições desfavoráveis no ambiente de trabalho. As queixas predominantes estão relacionadas ao aparelho osteomuscular, que incidem em maior proporção no sexo feminino, em razão não apenas das características biológicas da mulher, mas à desigual divisão sexual do trabalho presente na atualidade.

OBJETIVO: el objetivo de este estudio fue proponer estrategias de intervención para la salud de los trabajadores de enfermería hospitalaria. MÉTODO: se trata de un estudio de campo, con enfoque cuanti-cualitativo, desarrollado a partir de los datos recopilados por medio del Sistema de Monitoreo de la Salud de los Trabajadores de Enfermería, en siete hospitales públicos y universitarios en el País. La proposición de estrategias de intervención consideró las especificidades regionales y las demandas presentadas por los profesionales en cada escenario. RESULTADOS: las intervenciones fueron desarrolladas para cada carga de trabajo a las que los trabajadores de enfermería estaban expuestos, los procesos de desgaste generados y las estrategias de intervención en los escenarios, en respuesta a las necesidades de la escena nacional. CONCLUSIÓN: el monitoreo de la salud de los trabajadores de enfermería representa un punto de partida para la construcción de estrategias dirigidas al perfil epidemiológico de cada realidad. OBJETIVO: o objetivo deste estudo foi propor estratégias de intervenção referentes à saúde dos trabalhadores de enfermagem hospitalares. MÉTODO: trata-se de estudo de campo, com abordagem quantiqualitativa, desenvolvido com base em dados coletados por meio do sistema de monitoramento da saúde dos trabalhadores de enfermagem, em sete hospitais públicos e universitários do País. A proposição de estratégias de intervenção considerou as especificidades regionais e as demandas apresentadas pelos profissionais de cada cenário. RESULTADOS: as intervenções foram elaboradas no sentido de atender cada carga de trabalho à qual os trabalhadores de enfermagem estavam expostos, aos processos de desgaste gerados e às estratégias de intervenção nos cenários, respondendo às necessidades do cenário nacional. CONCLUSÃO: a monitoração da saúde dos trabalhadores de enfermagem representa um ponto de partida para a construção de estratégias direcionadas ao perfil de adoecimento de cada realidade. OBJECTIVE: The aim of this study was to propose intervention strategies for the health of hospital-based nursing staff. METHOD: It was a field study, with a quantitative and qualitative approach, developed from data collected through the Monitoring System of Nursing Workers' Health in seven public and university hospitals of Brazil. Intervention strategies proposed considered regional specificities and the demands presented by professionals in each setting. RESULTS: The interventions were developed for: each workload to which nursing staff was exposed; processes of strain generated; and intervention strategies at the settings, according to the needs of the national scenario. CONCLUSION: Monitoring the health of nursing staff is a beginning point for building strategies directed at the health profile of each reality.

Los donadores de metilo como el ácido fólico previenen defectos del tubo neural (DTN), pero estudios recientes sugieren que también favorecen el desarrollo de asma. En este trabajo exploramos una posible asociación ecológica entre DTN y asma. Material y métodos. Se consultaron bases de datos de México y EUA para obtener información sobre distribución geográfica (por estado) y tendencia temporal (por año) de DTN y asma. Resultados. Los estados con menor frecuencia de DTN tuvieron mayor frecuencia de asma, tanto en México (rS=-0.48, p=0.005) como en EUA (rS=-0.39, p=0.005). Las tendencias temporales también mostraron correlación inversa en México (1997-2007, rS=-0.73, p=0.01) y EUA (1979-1998, rS=-0.91, p0.001). Conclusiones. En ambos países la frecuencia de asma correlacionó de forma inversa con la frecuencia de DTN, tanto en distribución geográfica como en tendencias anuales, apoyando la posibilidad de que la ingestión de donadores de metilo en la dieta o como suplementos esté influyendo sobre la frecuencia de asma.

The human papillomavirus (HPV) is a virus, transmitted through sexual contact, with potential to become carcinogenic for the uterine cervix, making the infected women a problem for the public health. This research had a qualitative focus, with reference to the Existential phenomenology by Martin Heidegger, with the intention of understanding the feelings of women infected by HPV, after getting the positive test results. Were subjected to this research 14 women HPV positive. We based our research on these questions: What does HPV positive mean for you? Tell me the experience that you had since you knew you were infected until today. The feelings mentioned by the women were: suffering, desperation, frustration, guilt, preoccupation, embarrassment and fear. Knowing these feelings made possible to better understand the process that these infected women went through after the diagnosis, and the meaning of what is to live with HPV. The results showed that health professionals should make some improvements as for the care to women infected by HPV, going beyond the services restricted to the rationality of biomedical sciences. It showed to be necessary be-with-the-other and rediscover the depth of the human beings role in their daily life, in order to intervene with quality in health care.

The trajectory of this study was focused on understanding the experience of being a nursing teacher, woman and mother and reconciling work, motherhood and other daily activities. Participants were 11 women, mothers, teachers at higher education Institutions. Social Phenomenology was adopted for the analysis. The context of meanings was evidenced by categories: Difficulty in performing multiple activities; care of oneself and conciliation of social roles. Women give priority to being a mother, so that they have less time to take care of themselves. In spite of desiring to invest in teaching, they expect to have more time available to be in touch with their children and partner. This study showed that the professional and personal worlds need an interface, which allows for co-existence between the different roles women play in society. La trayectoria de este estudio se dirigió para la comprensión del ser docente de enfermería, mujer y madre, que debe conciliar la vida profesional, la maternidad y demás actividades de lo cotidiano. Participaron 11 mujeres, madres, y docentes de instituciones de enseñanza superior. Fue adoptada la Fenomenología Social para el análisis. El contexto de significados fue evidenciado a partir de las categorías: Dificultad en el desempeño de multiplicidad de actividades, Cuidado de sí misma, y Conciliación de los papeles sociales. Las mujeres le dan prioridad al ser madre, disponiendo de poco tiempo para el cuidado de sí misma; a pesar de que tengan el deseo de hacer inversiones en la carrera docente, tienen la expectativa de tener mayor disponibilidad de tiempo para la convivencia con los hijos y con el compañero. El estudio mostró que los universos, profesional y personal, necesitan de un medio de comunicación que posibilite una convivencia entre los diversos papeles ejercidos por la mujer en la sociedad. A trajetória deste estudo voltou-se para a compreensão do ser docente de enfermagem, mulher e mãe ao conciliar a vida profissional, a maternidade e demais atividades do cotidiano. Participaram 11 mulheres, mães, docentes de instituições de ensino superior. Foi adotada a fenomenologia social para análise. O contexto de significados foi evidenciado a partir das categorias: dificuldade no desempenho de multiplicidade de atividades; cuidado de si mesma e conciliação dos papéis sociais. As mulheres priorizam o ser mãe, dispondo de pouco tempo para o cuidado de si mesma; e, embora tenham o desejo de investir na carreira docente, têm a expectativa de ter maior disponibilidade de tempo para o convívio com os filhos e com o companheiro. O estudo mostrou que os universos, profissional e pessoal, necessitam de interface que possibilite a convivência entre os diversos papéis exercidos pela mulher na sociedade.

Se presenta el estudio de 20 pacientes en edad pediátrica con diagnóstico de epilepsia de difícil control, en los cuales fue usado el clobazan como terapia anticonvulsivante coadyuvante, vistos entre Enero-1986 y Julio-1990 en el consultorio externo de Neuropediatría del Hospital General Base Cayetano Heredia y práctica privada, con un seguimiento entre 6 y 45 meses. La etad de inicio para la epilepsia fue en promedio 22 meses y la forma mas frecuente los síndromes de epilepsia generalizada, tanto secundaria como idiopática. Se obtuvo disminución de frecuencia de crisis en rango significativo en 60% de los pacientes con control completo en 35% del total, habiendose encontrado los mejores resultados en epilepsias generalizadas secundarias tipo Lennox-Gastaut y West. Se encontró fenómeno de tolerancia en 25% y efecto psicotrópico en tres pacientes. Sugerimos el uso de esta 1,5 ben-zodiazepina en epilepsias de difícil control en niños, en nuestro medio. We present the study of 20 pediatric patients with difficult controlled epilepsy in which we used clobazam as adjuvant anticonvulsant therapy between January 1986 and July 1990 at the outpatients neuropediatric facility of the Hospital General Base Cayetano Heredia and the private practice, with 6 to 45 months follow up. The mean age for the onset of the epilepsy was 22 months and the most frequent kind was the generalized epilepsy syndrome both secondary and idiopatic. It was obtained a significant decrease of seizures in 60% of the patients with a complete control in 35% of the total. It was found the best outcome in secondary generalized epilepsies Lennox-Gas taut and West types. It was found tolerance phenomenon in 25%, and psychotropic effect in three patients. We suggest the use of this 1,5 benzodiazepine drug in difficult controlled epilepsies in children of our region.

In this qualitative study of phenomenologic approach, I have searched for understanding the living experience of nursing woman-workers that display work related musculoskeletal disorders (WRMD). The interviews were carried out with six women who were living the WRMD, four being auxiliary and two technicians in nursing. In order to disclose the essence of the phenomenon being a nursing woman-worker living the WRMD, I have developed the following guiding question: I would like you to tell me about your experience such as what it means to you to be a woman, worker in nursing enduring a work related musculoskeletal disorders? All questions were analyzed under the enlightenment of the philosophical referential of Martin Heidegger. The results of this study display the trajectory went through by the woman-workers that became sick due to WRMD, and so glimmering ways to an authentic care by a chronic and incapacitating disease of preoccupying character public health in Brazil.

Case report of a 12 years old female child who developed in the last seven months focal neurological signs and progressive intracranial hypertension. CT scan showed a giant cystic tumor, and cerebral hydatidosis has been diagnosed. The hydatic cyst was surgically removed without complications. Cerebral hydatidosis is rare, its diagnosis is clinical and tomographic, and the treatment is always surgical.

Pulmonary effects of ozone (O 3 ) inhalation have been comprehensively studied, but little is known about its extrapulmonary consequences, particularly in the reproductive tract. Thus, the effects of an acute O 3 exposure on the contractile response of the pregnant rat uterus were evaluated. Nonpregnant and pregnant (5, 10, and 18 days of gestation) rats were exposed to air or O 3 (3 ppm) for1 h, and uterine strips isolated from these animals were studied 16–18 h later. Contractile responses to acetylcholine (ACh) and oxytocin (OT) were evaluated with respect to three parameters (area under the curve, amplitude, and frequency). O 3 did not modify the sensitivity (−log EC 50 ) to either agonist at any pregnancy stage, but induced a statistically significant increase in all maximum responses to OT at gestational day 5, and increased the maximum response (area under the curve) to ACh at pregnancy days 5 and 10. Our results suggest that O 3 inhalation can produce abnormal contractility in the pregnant uterus, and identify the need for further investigation of this issue.

Objectives Musculoskeletal disorders are a major cause of disability and incapacity for work in developed countries, but less is known about their frequency in developing countries. This study aimed to assess the prevalence of musculoskeletal symptoms and associated disability in three occupational populations in Brazil, as part of the multi-national CUPID study. Methods The target population comprised 200 nursing staff (NS), 300 sugar cane cutters (SCC), and 300 video terminal operators (VTO). With approval from the local Ethics Committee and after obtaining written informed consent, data were collected from participants at interview, using the standardised CUPID questionnaire. The prevalence of health outcomes between occupational groups was assessed by the χ 2 test. Results and conclusions In total, 666 (83.3%) subjects answered the questionnaire: 96% of the NS, 60.6% of the SCC and 97.3% of VTO. Most subjects were female (83.2%), 41.4% of them were less than 41 years old. Overall, 55.8% of participants reported low back pain in the past year, 43.1% neck pain, 42.3% shoulder pain, 18.9% elbow pain, 36.4% wrist/hand pain, and 28.9% knee pain. There were significant differences between occupational groups in the 12-month prevalence of pain in the back, neck, wrist, elbow and knee (p

Objectives This study aimed to identify the occurrence of Common Mental Disorders (CMD), and its association with the shiftwork among nursing workers. Method This is an exploratory study, cross-sectional with quantitative approach that aimed to identify the occurrence of Common Mental Disorders (CMD), and its association with the shiftwork among nursing workers. The research was conducted in a public University Hospital specialised in cardiology, pulmonology, thoracic and cardiac surgery. The sample consisted of workers who work in nursing care units, semi-intensive and intensive, paediatric and neonatal, making a total of 92 participants. For quantitative data collection was used an instrument of socio demographic and the Self-Reporting Questionnaire (SRQ-20). The collection period was between June and July, 2012. Results The result of the analysis revealed the occurrence of CMD in 44.60% (41) of the nursing workers. Regarding CMD, the answer of the workers was distributed according to the four groups of prognostic evaluated by the SRQ-20: Somatic Group, Decrease of vital energy, Anxious-depressive humour and Depressive thoughts. In relation to social demographic variables and CMD, there was no statistic association. Conclusions The results show the importance of protective measures of mental health for workers since the shiftwork brings strain processes.

Objectives This study aimed to identify the injuries and disorders occurred with the nursing staff through the Surveillance System for Nursing Workers Health -SIMOSTE and describe the consequences of injuries. Method This is an exploratory and quantitative study conducted in a public hospital of Sao Paulo. The data were collected by a software, the Surveillance System for Nursing Workers Health -SIMOSTE in the period December 2012 to March 2013. Results The Surveillance System for Nursing workers Health identified 1847 injuries in the period December 2012 to March 2013. There were prevalence of occurrence between nurses (80.94%) and musculoskeletal diseases were the most prevalent (34.70%), followed by diseases of the respiratory tract (13.05%). Regarding the consequences, observed 10.67% of accidents and 86.63% of medical licenses. Conclusions The data point to the need for development of new shares surveillance focused on the notification of occupational accidents and work-related diseases, and prevention of diseases. The Surveillance system is a technology capable to operationalize institutional policies regarding occupational health and the valuing of human resources, considering that monitoring and analysing the workers’ health situation is an indispensible action for the planning of strategies to promote the improvement of their working conditions.

OBJECTIVES: Identify and analyse of the occupational accidents and diseases occurred with the community health agents in the municipality of Caraguatatuba/SP. METHOD: This descriptive, exploratory, cross-sectional field study with a quantitative approach had the purposes of identifying and analysing of the occupational accidents and diseases occurred with the community health agents in the municipality of Caraguatatuba/SP. The data were collected from 137 workers by means of a questionnaire and an interview. RESULTS: The data related to occupational accidents reveal that less than half (59; 43.07%) of the workers had occupational accidents, most of them (44; 74.59%) having reported one; the total of accidents reported was 80, and the most frequent were biker trauma in traffic accidents (43; 53.75%), followed by dog bites (13; 16.25%) and falls (12; 15.00%); the most frequent type of occupational accident was the typical (64; 80.00%), followed by road accidents (13; 16.25%) and occupational disease (3; 3.75%). Besides, 22.63% reported diseases as osteomuscular system and of the connective tissue (13; 30.96%), diseases of the circulatory system (7; 16.68%), the respiratory system, mental and behavioural disorders, skin and subcutaneous tissue diseases (4; 9.52%, respectively). CONCLUSIONS: The data point to the importance for an investment in the health community health agents in the municipality of Caraguatatuba/SP with training program. Language: en

The first peruvian pediatric case of Neuro-Behcet, who had seizures, hemiparesis and a magneic nuclear resonance with a pseudotumoral imagine is here presented (Rev Med Hered 1996; 7: 178-181).

We studied clinical and EEG features of 36 cases with congenital malformations of the CNS. Patients were followed at the outpatient clinic of Hospital Cayetano Heredia and of Hogar Clinica San Juan de Dios in Lima-Peru, from January 1984 to June 1992. Eighty percent of the patients had convulsive syndromes and mental retardation. The most frequent malformation was agenesis of corpus callosum, and it was not possible to find a "typical" EEG pattern. The second were porencephalic cysts, with a good clinical-EEG correlation. There were two typical cases of schizencephaly, one of hemimegalencephaly with good prognosis, and one of holoprosencephaly. The results are compared to those obtained for a series we previously reported. Data discussed take into account reports on the subject registered in the literature. It is concluded that EEG is an useful method to evaluate possible CNS malformations in developing countries. Estudiamos aspectos clínicos e del EEG de 36 casos de malformaciones congénitas del sistema nervioso central. Los pacientes fueron seguidos en los consultorios externos del Hospital Cayetano Heredia y del Hogar Clínica San Juan de Dios en Lima-Peru, desde enero 1984 hasta junio 1992. Ochenta por ciento de los pacientes presentaron sindrome convulsivo y retardo mental. La anormalidad mas frecuente correspondió a agenesia de cuerpo calloso y no fue posible identificar un patron EEG "típico". El segundo lugar correspondió a quistes porencefálicos, con buena correlación clínico-EEG. Ademas, hubieron dos casos clínicamente típicos de esquizencefalia, una hemimegalencefalia con buen prognóstico y un caso de holoprosencefalia. Se comparan los resultados con aquellos de casos previamente revisados. Se discuten los dados frente a la literatura acerca de los patrones EEG mas frecuentemente relatados. Se concluye en la utilidad del EEG en países en desarrollo para hacer posible un alto grado de sospecha de una malformación del SNC aun en ausencia de CAT-scan.

Objectives Use of computer keyboards has been linked with musculoskeletal disorders, especially of the wrist and hand. This study aimed to assess the prevalence of musculoskeletal symptoms and associated disability in video terminal operators (VTOs) in Brazil as part of the multi-national CUPID study. Methods The target population comprised 300 VTOs at an informatics centre in Curitiba, Brazil. Data on musculoskeletal symptoms, associated disability and risk factors were collected using the Portuguese translation of the standardised CUPID questionnaire. Results Among 284 (94.7%) VTOs who agreed to participate in the study, the large majority were women (79.1%), and 28.7% were less than 41 years old. 32.6% were current smokers. Most participants reported pain in the past month at several anatomical sites, with high prevalence rates for individual sites - back (71.5%), neck (77.6%), shoulder (83.8%). elbow (84.9%), wrist/hand (72.1%), and knee (74.3%). Despite the high prevalence of pain,only 13.5% of workers had been absent from work in the past year because of musculoskeletal complaints. Conclusions The frequency of reported musculoskeletal pain among VTOs was very high at all anatomical sites the body, despite laws that aim to protect this group of workers from musculoskeletal injury.

Se presenta una serie de 23 casos de encefalopatías epilepticas de la infancia, vistos en los consultorios externos de Neuropediatría del Hospital General Cayetano Heredia y Neurología del Hospital IPSS. Guillermo Almenara (Lima, Perú) entre Enero-1984 y Octubre-1988, con un seguimiento entre 6 meses y 4 años 6 meses para cada paciente. Del total, uno correspondió al sindrome de Ohtahara, 9 fueron West y 13 Lennox-Gastaut. Se revisan las características clínico electroencefalográficas de cada uno de los grupos y su evolución. Con relación al sindrome de Ohtaharta llama la atención el buen pronóstico encontrado en este paciente; de los 9 West únicamente 2 evolucionaron para Lennox-Gastaut y de estos últimos ninguno tuvo antecedente de West y contrariamente a lo esperado y teniendo en cuenta los factores de riesgo para mal pronóstico, la mayor parte de nuestros pacientes tuvieron un buen control de crisis. We present the study of 23 pediatric cases with infantile epileptic encephalopathies at the ambulatory neuropediatric facility of the Hospital Base Cayetano Heredia and ambulatory neurologic facility of Hospital IPPS Guillermo Almenara (Lima, Perú) between January 1984 and October 1988 with 6 to 54 months follow-up. There was one patient with Ohtahara syndrome, 9 with West síndrome and 13 with Lennox-Gastaut syndrome. The clinical and electroencephalographic characteristics were reviewed and related with the outcome. Despite the general characteristics of Ohtahara syndrome our patient had a good prognosis; only two West evolve into Lennox-Gastaut and none of these was West. Although the common features in these syndrome include frequent and intractable seizures and grave prognosis most of our patients had a good control of seizures.

Se presença una serie retrospectiva y prospectiva de 101 pacientes con diagnóstico de epilepsia parcial evaluados en el Consultório Externo de Neuropediatría del Hospital General Base Cayetano Heredia entre Enero de 1984 y Julio de 1988 con un seguimiento entre 6 meses y 4 alios. Las edades oscilaron entre 6 meses y 13 anos. Encontráronse 19¹% de epilepsias idiopáticas con un 7.7% del total para epilepsias benignas de la infância. Del 39% de epilepsias sintomáticas el mayor porcentaie correspondió en orden de frecuencia a secuelas de problemas perinatales, granulomas tuberculosos y secuelas de infecciones en el sistema nervioso central. It is reported the analysis of a retrospective and prospective study on a series of 101 patients suffering from partial epilepsy who have been examined at the Neuro-pediatric Clinics of Hospital General Base Cayetano Heredia during the period that lasted from January 1984 to July 1988. The observation time varied from 6 months to 4 years. The patients age varied from 6 months to 3 years old. There were found 19% of idiopathic epilepsy with 7.7% from benign epilepsies in childhood. The symptomatic epilepsies corresponded to sequels of problems short after birth, followed by tuberculosis granulomata and sequels of infections in the central nervous system.

INTRODUCTION Free-living amoeba infection is today a known and outgrowth disease, which is suspected when exists a special skin lesion. DEVELOPMENT Balamuthia mandrillaris is one of these amoebas recently categorized and identified as a cause of meningoecephalitis granulomatous and chronic. Human infection: until 1997 in Cayetano Heredia Hospital (Lima, Peru) was described 24 cases of Balamuthia mandrillaris infection, 10 under 15 years old. All had skin lesion and all died, 16 had conscious impairment, 8 intracranial hypertension and 8 seizures. CONCLUSIONS The free-living amoebas disease is now an outgrowth illness that depends on its worldwide distribution and association with immunocompromised host. The Balamuthia mandrillaris infection is a new form responsible for a fatal disease and clinical suspected is possible by the occurrence of skin lesion. Is very important to promove in Latin America collaborative studies in order to future actions.

Se presentan 27 casos de mal de Pott en niños entre 6 meses y 14 años de edad vistos durante un período de 2 años con tiempo de seguimiento hasta de 18 meses, 67% menores de 6 años y de ellos 2 pacientes menores de 1 año. Hubo predominio de pacientes de sexo masculino. El síntoma "jiba" fue el mas frecuente. La localización mas frecuente de la lesión fue el nivel dorsal. Todos recibieron tratamiento médico con 4 drogas, 14 de ellos necesitaron de métodos ortopédicos y solo 6 fueron sometidos a corrección quirúrgica. En mas del 50% hubo una evolución favorable hacia la curación o la mejoría con secuelas. Twenty seven cases of Pott's disease in children between 6 months and 14 years of age are reported. They were observed during a two years period, with a follow-up time till 18 months. In report to their ages 67% were lower than 6 years old and two of them lower than one year old. There was a male sex predominance. The 'hump' sign was the most frequently observed. The most frequent damage localization was at dorsal level. All patients received treatment with four drugs, 14 of them needed orthopedic methods, and only 6 were submitted to surgical correction. In more than 50% of the patients there was good outcome toward cure or improvement with sequelae.

Introdução: A vulnerabilidade dos profissionais de enfermagem ao estresse está associada à exposição crônica aos estressores cotidianos de trabalho e, consequentemente, aos efeitos cumulativos dos mediadores primários e secundários do estresse. Embora vários estudos tenham relatado o elevado nível de estresse dos profissionais de enfermagem, pouco se sabe a respeito das implicações biológicas do estresse no trabalho, expressas na carga alostática e no ritmo de secreção dos hormônios de cortisol um dos principais hormônios do estresse. Isto particularmente é importante visto que a carga alostática aumenta o risco do indivíduo desenvolver transtornos relacionados ao estresse como síndromes cardiovasculares, metabólicas, endócrinas, emocionais e cognitivas. Neste sentido, questiona-se se os profissionais de enfermagem apresentam sobrecarga do sistema adaptativo de reação do estresse (carga alostática), bem como alterações no ritmo de secreção de cortisol (hiper ou hipocortisolemia) ao longo do dia e o risco para o desenvolvimento de doenças relacionadas ao estresse. Objetivo: Descrever a frequência de profissionais de enfermagem com carga alostática elevada e ritmo atípico de secreção de cortisol. Analisar se a carga alostática elevada está associada ao ritmo atípico de secreção de cortisol. Método: Foram incluídos 142 profissionais de enfermagem do turno diurno randomicamente selecionados, alocados nas unidades ambulatório, clínica médica, clínica cirúrgica, centro cirúrgico, pronto socorro infantil e adulto, unidade de terapia intensiva adulto e pediátrica de um hospital universitário. Para avaliação do padrão diurno de secreção de cortisol foram coletadas amostras de saliva em dois dias úteis consecutivos de trabalho e, para a análise dos biomarcadores foram coletadas, em um único dia, amostras de sangue de todos os participantes, bem como, verificada sua pressão arterial e medidas antropométricas. A carga alostática foi analisada por mediadores neuroendócrinos, metabólicos, cardiovasculares e imunológicos. Os dados foram armazenados e analisados utilizando o programa estatístico SPSS versão 14.0 e o nível de significância adotado foi de 5%. Resultados: 31% dos profissionais de enfermagem apresentaram padrão atípico (inconsistente ou flat) de secreção de cortisol e 47,2% carga alostática elevada. Não houve associação entre o ritmo de secreção de cortisol e a carga alostática. Conclusão: Quase metade dos profissionais de enfermagem apresentaram sinais de desgaste do sistema biológico regulador da resposta de estresse, sugerindo que o trabalho possa estar associado a esta sobrecarga e destacando a vulnerabilidade destes trabalhadores ao desenvolvimento de doenças relacionadas ao estresse Background: The vulnerability of nursing professionals to stress is associated with chronic exposure to everyday stressors and, therefore, with the cumulative effects of primary and secondary stress mediators. Despite the fact that several studies have reported the high stress level of nursing professionals, little is known about the biological implications of stress at work, expressed in the allostatic load and in the rhythm of cortisol secretion, one of the main hormones of stress. This is especially important since the allostatic load increases the risk of an individual to develop stress-related disorders like cardiovascular syndromes, metabolic, endocrine, cognitive and emotional. In this aspect, there are questions whether the nursing professionals present overload on the stress adaptive reaction system (allostatic load), as well as, changes in the rhythm of cortisol secretion (hyper or hypocortisolemia) throughout the day and the risk of developing stress-related diseases. Objective: To describe the frequency of nursing professionals with high allostatic load and atypical rhythm of cortisol secretion. To analyze whether the high allostatic load is associated with atypical rhythm of cortisol secretion. Methods: We included 142 nursing professionals day shift randomly selected, allocated in the outpatient units, medical clinic, surgical clinic, surgery, children and adults emergency room and adult intensive care unit in a pediatric teaching hospital. To evaluate the daytime pattern of cortisol secretion, saliva samples were collected in two work day and, for the analysis of biomarkers, were collected in a single day, blood samples from all participants, as well as, checked his blood pressure and anthropometric measurements. Allostatic load was analized by neuroendocrine, metabolic, cardiovascular and immune mediators. The data was stored and analyzed using the program SPSS version 14.0 and the statistical significance level adopted was 5%. Results: 31% of nursing professionals showed atypical pattern (inconsistent or \"flat\") of secretion of cortisol and 47.2% showed high allostatic load. There was no association between the rate of secretion of cortisol and the allostatic load. Conclusion: Nearly half of nursing professionals showed signs of wear in the biological system stress response regulator, suggesting that the job can be associated with this overload and highlighting the vulnerability of these workers to the development of stress-related diseases.

O trabalho da enfermagem envolve numerosos fatores de risco para a saúde. Há uma extensa lista de danos a todos os sistemas orgânicos, entre eles as afecções do sistema musculoesquelético, responsáveis por gerar incapacidades para a vida que não se resumem apenas ao ambiente de trabalho. No cuidado ao recém-nascido em Unidade neonatal e UTI neonatal, bem como no processo de trabalho no Banco de leite humano, são realizadas rotineiramente atividades que apresentam fatores de risco para o desenvolvimento de sintomas osteomusculares. Assim, este estudo teve como objetivos, conhecer a prevalência de sintomas osteomusculares em trabalhadores de enfermagem de uma Unidade neonatal, UTI neonatal e Banco de leite humano, e os fatores sociodemográficos, de saúde e trabalho associados, bem como verificar a frequência de atestados e licenças médicas emitidos à estes trabalhadores no último ano. Estudo exploratório e descritivo, transversal, de abordagem quantitativa, do qual participaram 86 trabalhadores da equipe de enfermagem que compõe o quadro funcional dos setores Unidade neonatal, UTI neonatal e Banco de leite humano de um hospital universitário do município de São Paulo. Os dados foram coletados pela pesquisadora por meio de um questionário semi-estruturado, Questionário Internacional de Nível de Atividade Física e Questionário Nórdico de Sintomas Osteomusculares. Além disso, foram verificados todos os afastamentos por doença, emitidos aos trabalhadores no período de um ano e registrados no setor de Recursos Humanos do Hospital.O tratamento dos dados foi realizado por meio dos testes de Fisher, Teste t-Student ou Mann-Whitney. Os trabalhadores apresentaram média de 41 anos, sendo sua maioria (94, 19%) mulheres e auxiliares/técnicos de enfermagem (53, 33%), sem outro vínculo empregatício, com tempo médio de atuação de 16, 93 anos, classificados na faixa de sobrepeso quanto ao Índice de Massa Corpórea (IMC), e como ativos quanto ao nível de atividade física. Apenas 32, 14% deles referiram ter recebido orientações sobre mecânica corporal. Dentre os trabalhadores estudados, 54, 65% deles, em algum momento necessitaram de afastamento de suas atividades laborais por doença, sendo as doenças do sistema osteomuscular as que levaram ao maior número de afastamentos. A coluna vertebral representou a região responsável pela maior frequência de afastamentos, assim como representou a região corpórea com maior frequência de relatos de sintomas, tanto nos últimos 12 meses, quanto nos últimos 7 dias. A região do cotovelo foi apontada como a que causou maior impedimento das atividades habituais (45, 45%) e aquela que levou o maior número de trabalhadores a buscar ajuda profissional (54, 55%). Os que referiram sintomas em região de pescoço e ombro foram os mais jovens, tendo os mais velhos relatado sintomas em região de cotovelo. Aqueles que referiram sintomas em região de pescoço foram os que exerciam a mesma função por menos tempo, já os que exerciam a mesma função por mais tempo, foram os que referiram sintomas em região de cotovelos. Os trabalhadores que relataram sintomas em região de joelhos e tornozelos/pés, apresentaram uma média de IMC superior a 26. Auxiliares/técnicos de enfermagem, trabalhadores do Banco de leite humano e do turno administrativo, aqueles que referiram compartilhamento das atividades domésticas e os sedentários, foram os que apresentaram maior frequência de relatos de sintomas. A análise da prevalência, bem como dos fatores associados à ocorrência de sintomas osteomusculares, permitiu identificar fatores relativos ao indivíduo, trabalho e estilo de vida, que podem subsidiar ações voltadas para a promoção da saúde e melhorias nas condições de trabalho destes trabalhadores. Nursing involves many risk factors for health. There is an extensive list of potential damages to all organ systems, including disorders of musculoskeletal system, that lead to disabilities for life not restricted to the working setting. Care of newborns in neonatal ICU and in proceedings at human milk bank involves routine activities that pose risk factors of developing musculoskeletal symptoms. Thus, this study is aimed at discover the prevalence of musculoskeletal symptoms among nursing staff in a neonatal unit, neonatal ICU and human milk bank, as well as sociodemographic, health and work factors associated with them, and to verify the frequency of statements and medical licenses issued to these employees in the last year. This is an cross-sectional, descriptive, exploratory and quantitative-approached study that has had the participation of 86 employees from nursing staff of neonatal unit, neonatal ICU and human milk bank at a university hospital at São Paulo. Data were collected by the researcher through International Physical Activity Questionnaire and Nordic Musculoskeletal Questionnaire. Aditionally, all sick leaves issued to employees and recorded by the Human Resources within one year have been checked. Data processing was performed based on Fishers test, t-Student or Mann-Whitney test. Workers age was 41 years in average. Most of them (94.19%) were female auxiliary/practical nurses (53.33%) with no other employment. Their average operating time was 16.93 years. They were considered overweighted based on Body Mass Index (BMI) and active regarding to physical activity level. Only 32.14% reported having received guidance on body mechanics. Among the workers studied, 54.65% required removal of their professional activities because of disease at some period of time, and diseases of the musculoskeletal system led to the largest number of removals. Spine accounted for the higher frequency of sick leaves and has been the body region that most frequently reported symptoms on both the past 12 months and the last 7 days. The elbow region was pointed as the primary cause of making usual activities impossible (45.45%) and led the greatest number of employees to seek professional help (54.55%). Younger ones reported symptoms in neck and shoulder while older people reported symptoms in the elbow. Those who reported symptoms in the neck worked at the same function for less time; those who held the same job for longer reported symptoms in the elbow. Workers who reported symptoms in the knees, ankles and feet had an average BMI > 26. Nursing assistants and technicians, breast milk bank staff, administration team, those who reported sharing household activities and the sedentary people presented the highest frequency of reported symptoms. Analysis of prevalence and factors associated with musculoskeletal symptoms helped identifying aspects related to individual, work and lifestyle that can support actions aimed at promoting health and improvements in working conditions for these workers.

O presente estudo tratou do Gerenciamento de Resíduos Químicos Perigosos (GRQP) manuseados pelos trabalhadores de enfermagem de um hospital universitário.Teve como objetivos identificar os produtos de uso médico-hospitalar, contendo substâncias com potencial para geração de resíduos químicos; verificar as informações existentes sobre os produtos químicos perigosos, manejo de seus respectivos resíduos e análise da percepção dos trabalhadores de enfermagem sobre o manejo e os impactos dos resíduos químicos perigosos; e propor estratégias para o Gerenciamento de Resíduos Químicos Perigosos. Caracteriza-se como exploratório, de caráter descritivo e de abordagem qualitativa. A população foi constituída do total de substâncias químicas armazenadas no serviço de farmácia e almoxarifado e por 662 trabalhadores de enfermagem com uma amostra intencional de 19 sujeitos. Foram usados três instrumentos de coleta de dados, sendo, um formulário para levantamento de todos produtos químicos de uso médico-hospitalar da instituição e outro para identificação dos produtos geradores de resíduos químicos perigosos (RQP), além da técnica de grupo focal para coletar dados sobre o manejo. Os dados foram sistematizados e analisados em dois momentos: no primeiro, foram discutidos o universo de produtos químicos da instituição e os com potencial de geração de resíduos químicos perigosos. O segundo envolveu a análise das quatro categorias apreendidas dos discursos dos sujeitos do grupo focal quanto ao manejo dos RQP. A análise dos dados do primeiro momento evidenciou 387 tipos de produtos químicos nos estoques da instituição campo de estudo, dos quais 139 foram triados como produtos geradores de resíduos químicos perigosos. No entanto, a instituição classifica como perigosos 23 deles, os quais são enviados para as unidades assistenciais sem as informações quanto às características de inflamabilidade, corrosividade, reatividade e toxicidade, além da ausência de informações individuais quanto ao manejo de seus resíduos. No segundo momento da análise, apreendeu-se quatro categorias: conhecimento sobre o gerenciamento de resíduos químicos perigosos (GQP); conhecimento da exposição e impactos dos resíduos químicos perigosos; medidas preventivas e sugestões para o GRQP. Evidenciou-se, pelas falas dos sujeitos, a carência de treinamentos específicos sobre o GRQP, noções gerais sobre a quantidade de RQP, conhecimento fragmentado nas etapas do manejo correspondentes à segregação, acondicionamento, identificação e transporte interno, além de total desconhecimento dos sujeitos do estudo a partir da etapa de armazenamento temporário até a disposição final, etapas essas resgatadas no primeiro momento do estudo. Na categoria conhecimento da exposição e impactos, verificou-se que os discursos trazem os trabalhadores de enfermagem como os principais expostos da equipe multiprofissional e não relacionam o impacto da exposição na saúde pública e no meio ambiente. Na categoria medidas preventivas, observou-se, nas falas, uma ênfase ao uso de EPI, com destaque às luvas e máscaras. Quanto às sugestões para o GRQP, os trabalhadores de enfermagem indicaram o treinamento como uma das prioridades, além do desenvolvimento de novos produtos, atenção ao manejo esporádico de RQP, adequação dos EPIs e a implantação de medidas de proteção coletiva. Assim, a análise dos dados subsidiou a elaboração de estratégias para o Plano de Gerenciamento de Resíduos Químicos Perigosos (PGRQP), manuseados pela enfermagem da instituição. Portanto, frente aos dados analisados, as propostas foram apresentadas em duas fases. Na primeira, propôs-se um fluxograma de informações entre a instituição campo de estudo e o fornecedor, além da Ficha de Informação de Gerenciamento de Resíduo Químico Perigoso Hospitalar (FIGERQP-HOSP) para subsidiar o Plano de Gerenciamento de Resíduo Químico Perigoso (PGRQP), seguida de uma sugestão de fluxograma de informações entre os setores assistenciais e serviço de farmácia quanto aos RQP manuseados pela enfermagem. A segunda fase de propostas envolveu as recomendações gerais para o PGRQP. Faz-se, ainda, necessária a classificação do universo dos produtos geradores de RQP da instituição e aplicação de estratégias as quais efetivem a elaboração do PGRQP, com vistas à promoção da saúde do trabalhador, saúde pública e do meio ambiente. This study focused on the Management of Hazardous Chemical Waste (MHCW) handled by nursing workers of a school hospital. Its purpose was to identify products of medical-hospital use that contain substances potentially generators of chemical waste, check the existing information on hazardous chemicals, handling of their respective waste, and analysis of the nursing workers´ perception of the handling and impact of hazardous chemicals waste and propose strategies for the Management of Hazardous Chemical Wastes. This study is characterized as exploratory, descriptive, with a qualitative approach. The population was formed by all chemicals stored at the pharmacy and storeroom and of 662 nursing workers with an intentional sample of 19 subjects. Three were used for data collection: the first was a form for the listing of all medical-hospital use chemicals in the institution and another for the identification of products capable of generating hazardous chemical wastes (HCW), in addition to the technique of focus groups to collect data on handling. The data were systematized and analyzed in two instances: during the first, we discussed the universe of the institution´s chemicals and of those with the potential to generate hazardous chemical wastes. The second instance involved the analysis of the four categories extracted from the talks of the subjects in the focus group as to the handling of HCW. The analysis of the data of the first instance found 387 types of chemicals in the inventory of the studied institution, out of which 139 were screened as generators of hazardous chemicals wastes. However, the institution ranks 23 of them as hazardous, but they are sent to health care units without data as to the features of flammability, corrosiveness, reactivity and toxicity, in addition to the lack of individual information related to waste handling. At a second moment of the analysis, four categories were determined: knowledge of the management of hazardous chemical wastes (MHCW); awareness of the exposure and impact of hazardous chemical wastes, preventive measures and suggestions to HCW. The dialogues with the subjects evidenced the lack of specific training on MHCW, of general knowledge on the amount of HCW, fragmented knowledge of the handling stages corresponding to segregation, packaging, identification and internal transport, in addition to total lack of knowledge of the study subjects from the stage of temporary storage to the final disposal, stages that were discussed during the first instance of the study. In the category of awareness of exposure and impacts, it was found that the dialogues mention that nursing workers are the people with more exposure among the multi-professional team and do not associate the impact of exposure on public health and on the environment. In the preventive actions category the dialogues evidenced emphasis on the use of IPE (Individual Protection Equipment), especially gloves and masks. As to suggestions regarding MHCW, nursing workers appointed training as one of the priorities, in addition to development of new products, attention to sporadic handling of HCW, adaptation of IPEs, and implementation of collective protection measures. Thus, the data analysis provided subsidies for the preparation of strategies for the Management Plan for Hazardous Chemical Wastes handled by the institution´s nursing team. Therefore, considering the analyzed data, the proposals were presented in two stages. In the first, an information flowchart between the institution that is the object of the study and the suppliers, in addition to an Information File of the Management of Hazardous Hospital Chemical Wastes (FMHHCW) to provide input for the Management Plan for Hazardous Chemical Wastes (MPHCW), followed by a suggestion of an information flowchart between the health care sectors and the pharmacy service, regarding the HCW handled by the nursing team. The second stage of proposals involved the general recommendations for MPHCW. It is still necessary to classify the universe of products generating HCW in the institution and application of strategies that will make effective the elaboration of MPHCW, with a view to the promotion of the health of workers, public health and environment.