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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

Objetivo: to identify and compare burnout levels between Portuguese, Spanish and Brazilian nurses. Method: quantitative, descriptive, correlational, comparative and cross-sectional study conducted using a sample of 1,052 nurses working in hospitals and primary care centers. A sociodemographic questionnaire and the Maslach Burnout Inventory were applied to nurses in Porto, Portugal (n=306), Oviedo, Spain (n=269) and S. Paulo, Brazil (n=477). Data analysis was performed using descriptive, inferential and multivariate analysis. Results: approximately 42% of the nurses showed moderate/high levels of burnout, with no differences found between countries (Portugal and Brazil 42%, Spain 43%). Only depersonalization showed differences between countries, presenting Spain the highest level and Portugal the lowest one. Comparative analysis showed higher burnout levels in young nurses and those working by shifts. Considering job schedules, burnout was associated to shift work in Portugal, while in Spain and Brazil it was associated with fixed schedules. Conclusion: these results suggest that this syndrome among nurses is a global phenomenon. The daily stressors and higher demands of the nursing profession are crucial in the preparation of nurses to deal with complex situations, to avoid burnout, and to reduce the negative impact on nurses’ health and on the quality of care they provide. Objetivo: identificar e comparar os níveis de burnout entre enfermeiros portugueses, espanhóis e brasileiros. Método: estudo quantitativo, descritivo, correlacional, comparativo e transversal, realizado com 1.052 enfermeiros em hospitais e unidades básicas de saúde. Um questionário sociodemográfico e o Maslach Burnout Inventory foram aplicados com enfermeiros de Porto-Portugal (n=306), Oviedo-Espanha (n=269) e São Paulo-Brasil (n=477). Os dados foram analisados por meio de estatística descritiva, inferencial e multivariada. Resultados: aproximadamente 42% dos enfermeiros apresentaram níveis moderados/altos de burnout, não sendo encontradas diferenças entre os países (Portugal e Brasil com 42%, Espanha com 43%). Apenas a dimensão despersonalização apresentou diferenças entre os países, com um nível mais elevado na Espanha e mais baixo em Portugal. A análise comparativa mostrou níveis mais elevados de burnout em enfermeiros jovens e naqueles que trabalhavam em turnos. Em relação às escalas de trabalho, burnout foi associada ao trabalho por turnos em Portugal e aos horários fixos na Espanha e no Brasil. Conclusão: esses resultados sugerem que essa síndrome em enfermeiros é um fenômeno global. Estressores diários e maiores demandas da profissão de enfermagem são elementos cruciais para preparar os enfermeiros para lidar com situações complexas, evitar burnout e reduzir o impacto negativo na sua saúde e na qualidade dos cuidados que prestam. Objetivo: identificar y comparar los niveles de burnout entre enfermeros portugueses, españoles y brasileños. Método: estudio cuantitativo, descriptivo, correlacional, comparativo y transversal, realizado con 1.052 enfermeros de hospitales y unidades básicas de salud. Se aplicó un cuestionario sociodemográfico y el Maslach Burnout Inventory a enfermeras de Porto, Portugal (n=306), Oviedo, España (n=269) y São Paulo, Brasil (n=477). Los datos se analizaron mediante estadística descriptiva, inferencial y multivariada. Resultados: aproximadamente el 42% de los enfermeros presentaban niveles moderados/altos de burnout y no se encontraron diferencias entre países (Portugal y Brasil 42%, España 43%). Solo la dimensión de despersonalización mostró diferencias entre países, con un nivel mayor en España y menor en Portugal. El análisis comparativo mostró mayores niveles de burnout en enfermeros jóvenes y en los que trabajaban por turnos. En cuanto a los horarios de trabajo, el burnout se asoció con el trabajo por turnos en Portugal y con horario fijo en España y Brasil. Conclusión: estos resultados sugieren que el síndrome de burnout en enfermeros es un fenómeno global. Los estresores cotidianos y las mayores exigencias de la profesión de Enfermería son elementos cruciales para preparar a los enfermeros para enfrentar situaciones complejas, evitar el burnout y reducir el impacto negativo en la salud de los enfermeros y la calidad de la atención que brindan. info:eu-repo/semantics/publishedVersion

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

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

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

There is mounting evidence that 5-hydroxytryptamine (5-HT) plays a role in asthma. However, scarce information exists about the pulmonary expression of 5-HT receptors and its modification after allergic sensitization. In the present work, we explored the expression of 5-HT1A, 5-HT2A, 5-HT3, 5-HT4, 5-ht5a, 5-HT6, and 5-HT7 receptors in lungs from control and sensitized guinea pigs through qPCR and Western blot. In control animals, mRNA from all receptors was detectable in lung homogenates, especially from 5-HT2A and 5-HT4 receptors. Sensitized animals had decreased mRNA expression of 5-HT2A and 5-HT4 receptors and increased that of 5-HT7 receptor. In contrast, they had increased protein expression of 5-HT2A receptor in bronchial epithelium and of 5-HT4 receptor in lung parenchyma. The degree of airway response to the allergic challenge was inversely correlated with mRNA expression of the 5-HT1A receptor. In summary, our results showed that major 5-HT receptor subtypes are constitutively expressed in the guinea pig lung, and that allergic sensitization modifies the expression of 5-HT2A, 5-HT4, and 5-HT7 receptors.

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.

RESUMO Objetivo Compreender a percepção de gerentes de enfermagem sobre a relação entre a saúde dos trabalhadores de enfermagem e a segurança dos pacientes. Método Trata-se de uma pesquisa qualitativa, com abordagem da fenomenologia social de Alfred Schütz, realizada por meio de entrevistas individuais, com nove gerentes de enfermagem de cinco hospitais universitários distribuídos no Brasil. Resultados A percepção dos gerentes de enfermagem sobre a relação entre a saúde dos trabalhadores de enfermagem e a segurança dos pacientes foi evidenciada nas categorias: “O sofrimento para equilibrar a saúde dos trabalhadores e a segurança dos pacientes” e “Intervenções no cotidiano de trabalho”. Conclusão A vivência dos gerentes evidenciou um cotidiano de trabalho marcado por sofrimento e preocupação, devido aos altos índices de absenteísmo e presenteísmo decorrentes do adoecimento e incapacidade dos trabalhadores, e à necessidade de garantir a segurança dos pacientes por meio de uma assistência de enfermagem qualificada.

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.

Several contractile mediators involved in the antigen-induced airway obstruction have been identified, but the role of 5-HT (5-hydroxytryptamine or serotonin) has been scantily investigated. In this work, the potential role of 5-HT in the allergic bronchoconstriction was evaluated through a pharmacological approach and plasma 5-HT measurement in blood samples from the right and left ventricles of anesthetized guinea-pigs. Intravenous 5-HT caused a dose-dependent increase of the lung resistance in anesthetized, nonsensitized guinea pigs. Likewise, in sensitized animals the antigenic challenge with ovalbumin also caused a transient bronchoconstriction (356 ± 60% the basal value), which was largely inhibited by the blockade of serotonergic receptors with methiothepin plus tropisetron (134 ± 10%, P = .007). Sensitized animals tended to have plasma 5-HT concentrations higher than nonsensitized controls, and shortly after the peak of the allergic bronchoconstriction the 5-HT levels in the left ventricle (blood flowing out from lungs) tended to be higher than in the right ventricle (blood entering the lungs), although data dispersion precluded the obtaining of statistical significance. Interestingly, the degree of bronchoconstriction highly correlated with the concentrations of 5-HT found in the left ventricle and measured either in platelet-rich plasma (r = 0.97 P = .007) or platelet-poor plasma (r = 0.97, P = .006). After the obstructive response subsided these correlations were lost, but now the degree of bronchoconstriction turned to be correlated with 5-HT concentration in platelet concentrate (r = 0.76, P = .03). In conclusion, our results suggested that 5-HT is actively released from lungs during the antigenic challenge and that this autacoid is involved in the generation of the airway obstruction.

Background Nursing is considered as a stressful job, eliciting physical and psychological diseases among professionals (Nantsupawat et al., 2016), since they are exposed to psychosocial risks at work when they deal with patients’ death or aggressions, disease contagion or they witness patients’ trauma and suffering. Some personal attributes contribute to burnout, such as anxiety traits (Meekyung et al., 2012). Aims To know anxiety and burnout levels among nurses, to identify anxiety as burnout predictor, and to verify their variations according socio-demographic and professional characteristics. Method Data were collected using an anonymous questionnaire composed by sociodemographic questions, and Portuguese versions of STAI (Spielberger, 1983; Silva & Campos, 1999) and MBI (Maslach & Jackson, 1997; Marques-Pinto & Picado, 2011). Participated 347 Portuguese nurses (67% from hospitals, 62% working by shifts; 68% with a definitive job contract, mean age of 34.5 years, mean job experience of 11.5 years, 72% female). Results Burnout presents a moderate level, with moderated emotional exhaustion (M = 2.7 on 0–6 scale), low depersonalization (M = 1.0) and high personal accomplishment (M = 4.5). Anxiety is moderated, with anxiety state higher than anxiety trait (respectively M = 2.0 and M = 1.9). Using cut-off points for burnout (Maroco et al., 2016), high levels were found on 41% of the sample for emotional exhaustion, 7% for depersonalization and 94% for personal accomplishment. Working by shifts and work place influences burnout and anxiety. Anxiety trait correlates with burnout dimensions and predicts them stronger than anxiety state. Anxiety predicts 28% of emotional exhaustion, 8% of depersonalization and 13% of personal accomplishment. Individual and professional characteristics only predict nearby 5% of depersonalization. Conclusions Anxiety plays an important role to burnout vulnerability, suggesting the need to prepare nurses with better self-knowledge about their reactions to cope with stressful events at work. Research about nurses’ burnout, such as the INT-SO project does on Portugal, Spain and Brazil can be useful to understand burnout vulnerability.

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.

The paper describes the adaptation and testing of the Cultural and Psychosocial Influences on Disability Questionnaire for use in Portuguese. The cross-cultural adaptation followed the steps of translation, back-translation, evaluation of the translations by a committee of judges, and then piloting of the pre-final version. This was performed in a sample of 40 nursing staff from the Hospital at the University of São Paulo. Adjustments were made after review of the translations by the committee of judges (CVI≤ 80%). The pilot study was used to test whether questions could be satisfactorily understood and completed (≥ 85% of subjects). The Brazilian version of the Questionnaire is an adequate instrument for the ascertainment of occupational activities, psychosocial aspects of work, musculoskeletal symptoms and associated disabilities in nursing staff. El objetivo de este estudio fue describir la adaptación y validación del cuestionario Investigación Internacional sobre las Influencias Físicas, Culturales y Psicosociales en los Síntomas Musculares Esqueléticos e Incapacidades Asociadas, para la lengua portuguesa. El proceso de adaptación transcultural siguió las etapas de traducción, retrotraducción, evaluación de las traducciones por un comité de jueces y, en seguida, la realización de una prueba de la versión prefinal. Se utilizó una muestra de 40 trabajadores de enfermería del Hospital de la Universidad de Sao Paulo. Las adaptaciones fueron hechas después de someterlo al comité de jueces (IVC≤80%). La prueba piloto comprobó la comprensión de las preguntas a través del llenado (≥85% de los sujetos). La versión brasileña del cuestionario mostró ser un instrumento adecuado para la verificación de las actividades profesionales, aspectos psicosociales del trabajo y síntomas osteomusculares, asociados a incapacidad entre los trabajadores de enfermería. O objetivo deste estudo foi descrever a adaptação e validação do Questionário Pesquisa Internacional sobre as Influências Físicas, Culturais e Psicossociais nos Sintomas Musculoesqueléticos e Incapacidades Associadas, para a língua portuguesa. O processo de adaptação transcultural seguiu as etapas de tradução, retrotradução, avaliação das traduções por um comitê de juízes e, em seguida, teste da versão pré-final. Utilizou-se amostra de 40 trabalhadores de enfermagem do Hospital da Universidade de São Paulo. Adaptações foram feitas após a submissão ao comitê de juízes (IVC≤80%). O teste piloto testou a compreensão das questões pelo seu preenchimento (≥85% dos sujeitos). A versão brasileira do Questionário mostrou ser instrumento adequado para a verificação das atividades profissionais, aspectos psicossociais do trabalho e sintomas osteomusculares, associados à incapacidade entre os trabalhadores de enfermagem.

Norethisterone (NET) and its metabolite 5alpha-norethisterone (5alpha-NET) are competitors for the androgen receptor. The sensitivity of the rat vas deferens to the contractile action of methoxamine and serotonin is regulated by hormonal and anatomical factors. The aim of this study was to evaluate the ability of NET and 5alpha-NET to induce the androgen-regulated contractile response to methoxamine and serotonin in the epididymal and prostatic portions of rat vas deferens. Adult male rats either intact, castrated or steroid-treated castrated were used. The contractility was recorded isometrically, and non-cumulative concentration-response curves to either methoxamine or serotonin were obtained. NET and 5alpha-NET partially restored the sensitivity to methoxamine and serotonin in the epididymal portion of castrated rats. The maximal responses to both agonists were significantly higher than those observed in castrated rats, and significantly lower than the responses observed in either intact or androgen-treated castrated rats. The prostatic portion was less responsive to both agonists than the epididymal portion, in all groups but castrated rats, as castration induced sensitivity to both agonists. NET and 5alpha-NET displayed a partial though similar androgenic activity in the rat vas deferens. These results contrast with previous reports where a decrease of androgenic effect due to the 5alpha-reduction of NET has been found.

The effect of kaurenoic acid (from Montanoa frutescens), grandifloric and kauradienoic acid (from M. tomentosa) and 16α-hydroxy-ent-kauran-19-oic acid and its methyl ester (from M. hibiscifolia) were assayed on the contractions of rat uterus induced by acetylcholine, oxytocin and serotonin. The four kauranes assayed inhibited the contractile activity induced by the three agonists through a mechanism independent of either β2-adrenergic or H2-histaminergic receptors present in uterine smooth muscle. Oestrogenized uteri treated with kauradienoic acid underwent histological changes including epithelial flattening and desquamation.© 1997 John Wiley & Sons, Ltd.

Estudo descritivo com o objetivo de identificar nas áreas de farmácia e almoxarifado de um Hospital Universitário os grupos de produtos caracterizados como geradores de Resíduos Químicos Perigosos segundo a classificação dos dispositivos legais. Para coleta de dados, realizada em 2008, foi utilizado um formulário para identificação destes produtos. A análise dos dados revelou a existência de 138 itens classificados em 12 Grupos de produtos que, uma vez utilizados ou vencidos, geram resíduos com características de periculosidade de acordo com a Agência Nacional de Vigilância Sanitária brasileira. O princípio ativo desses produtos apresentam riscos à saúde, como toxicidade aos diversos órgãos e sistemas do corpo humano, assim como potencial de inflamabilidade, corrosividade e reatividade de algumas substâncias. Essas características são de grande relevância, uma vez que os resíduos químicos poderão, em algum momento, causar impacto negativo para a saúde do trabalhador, saúde pública e meio ambiente.

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.

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.

Summary Background A possible role of 5-hydroxytryptamine (5-HT) in the origin of antigen-induced airway hyperresponsiveness (AI-AHR) has been scarcely investigated. Objective To explore the participation of different 5-HT receptors in the development of AI-AHR in guinea-pigs. Methods Lung resistance was measured in anaesthetized guinea-pigs sensitized to ovalbumin (OVA). Dose–response curves to intravenous (i.v.) acetylcholine (ACh) were performed before and 1 h after antigenic challenge and expressed as the 200% provocative dose (PD200). Organ bath experiments, confocal microscopy and RT-PCR were additionally used. The 5-HT content in lung homogenates was measured by HPLC. Results Antigenic challenge significantly decreased PD200, indicating the development of AI-AHR. This hyperresponsiveness was abolished by a combination of methiothepin (5-HT1/5-HT2/5-HT5/5-HT6/5-HT7 receptors antagonist) and tropisetron (5-HT3/5-HT4 antagonist). Other 5-HT receptor antagonists showed three different patterns of response. Firstly, WAY100135 (5-HT1A antagonist) and ondansetron (5-HT3 antagonist) did not modify the AI-AHR. Secondly, SB269970 (5-HT7 antagonist), GR113808 (5-HT4 antagonist), tropisetron or methiothepin abolished the AI-AHR. Thirdly, ketanserin (5-HT2A antagonist) produced airway hyporresponsiveness. Animals with bilateral vagotomy did not develop AI-AHR. Experiments in tracheal rings showed that pre-incubation with LP44 or cisapride (agonists of 5-HT7 and 5-HT4 receptors, respectively) induced a significant increase of the cholinergic contractile response to the electrical field stimulation. In sensitized lung parenchyma strips, ketanserin diminished the contractile responses to ACh. Sensitization was associated with a ninefold increase in the 5-HT content of lung homogenates. Confocal microscopy showed that sensitization enhanced the immunolabelling and co-localization of nicotinic receptor and 5-HT in airway epithelium, probably located in pulmonary neuroendocrine cells (PNECs). RT-PCR demonstrated that neither sensitization nor antigen challenge modified the 5-HT2A receptor mRNA levels. Conclusions Our results suggested that 5-HT was involved in the development of AI-AHR to ACh in guinea-pigs. Specifically, 5-HT2A, 5-HT4 and 5-HT7 receptors seem to be particularly involved in this phenomenon. Participation of 5-HT might probably be favoured by the enhancement of the PNECs 5-HT content observed after sensitization. Cite this as: P. Segura, M. H. Vargas, G. Cordoba-Rodriguez, J. Chavez, J. L. Arreola, P. Campos-Bedolla, V. Ruiz, L. M. Garcia-Hernandez, C. Mendez and L. M. Montano, Clinical & Experimental Allergy, 2010 (40) 327– 338.

Wound healing is a complex process involving an integrated response by many different cell types and growth factors in order to achieve rapid restoration of skin architecture and function. The present study evaluated the applicability of a chitosan hydrogel (CH) as a wound dressing. Scanning electron microscopy analysis was used to characterize CH morphology. Fibroblast cells isolated from rat skin were used to assess the cytotoxicity of the hydrogel. CH was able to promote cell adhesion and proliferation. Cell viability studies showed that the hydrogel and its degradation by-products are noncytotoxic. The evaluation of the applicability of CH in the treatment of dermal burns in Wistar rats was performed by induction of full-thickness transcutaneous dermal wounds. Wound healing was monitored through macroscopic and histological analysis. From macroscopic analysis, the wound beds of the animals treated with CH were considerably smaller than those of the controls. Histological analysis revealed lack of a reactive or a granulomatous inflammatory reaction in skin lesions with CH and the absence of pathological abnormalities in the organs obtained by necropsy, which supported the local and systemic histocompatibility of the biomaterial. The present results suggest that this biomaterial may aid the re-establishment of skin architecture.

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.

Alpha-methyl-5-HT is widely used as a high-affinity 5-HT(2) receptors agonist, though some studies have postulated that this drug also activates other serotonergic receptors. In the present work, we found that a wide range of concentrations of alpha-methyl-5-HT induced biphasic responses (contraction followed by relaxation) in guinea pig tracheal rings. The relaxing phase caused by 32microM alpha-methyl-5-HT was blocked by 0.1microM propranolol. Furthermore, during an ongoing histamine-induced contraction, alpha-methyl-5-HT (0.1-100microM) produced a concentration-dependent relaxation starting at 10microM. This relaxation was fully abolished by 0.1microM propranolol or 1microM ICI 118,551 (a selective beta(2)-adrenoceptor antagonist). Additionally, in electrophysiological recordings, 32microM alpha-methyl-5-HT also enhanced the membrane K(+) currents of single tracheal myocytes, an effect reverted by propranolol and ICI 118,551, and mimicked by 0.1microM salbutamol. Thus, we concluded that alpha-methyl-5-HT activates beta(2)-adrenoceptors in guinea pig tracheal smooth muscle at concentrations >or=10microM. This effect must be taken into account when this drug is used in airway smooth muscle and in other tissues expressing beta(2)-adrenoceptors.

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.

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.

We report on a girl with mild phenotypic abnormalities and duplication of chromosome 10q11----10q22. The similarities to two previously reported cases with an identical chromosomal aberration provide further support for the delineation of this entity as a specific, clinically recognisable syndrome.

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.

We report a boy with a de novo terminal deletion of chromosome 4q, (q31----qter) and compare him to 17 previously reported cases with the same anomaly. This case contributes further to the delineation of the del(4)(q31) phenotype, which seems to be clinically recognizable.

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.

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.