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Background Abriendo Futuros is a a girl-centered empowerment program that engages community leaders and trains older indigenous girls as mentors to run community girls’ clubs, known as safe spaces. Mentors work directly with indigenous girls to deliver program curricula tailored to the girls’ specific and unique needs to builds girls’ assets in areas such as sexual and reproductive education, gender equality, violence prevention, leadership, financial education and healthy lifestyles. Objectives The program aims to improve critical health, social, and cognitive skills that help girls have a voice and choice in their lives and allows them to draw the path to a healthy adult life, overcoming the risks present in their context. The program was implemented in 8 rural communities in the south of Yucatan. A total of 657 girls were enrolled over the 18-month-implementation period (2015 - 2017). Results A quasi-experimental evaluation was implemented in 11 communities (8 intervention and three control). Preliminary findings, using the Propensity Score Matching technique, suggest significant positive effects on intermediate outcomes such as financial literacy, attitudes towards gender norms, sexual reproductive health knowledge, social capital, and perceived exposure to physical violence. No statistically significant results were achieved in main outcomes (reduce adolescent pregnancy and school dropout). We associate this, mainly to the fact that the intervention was only at an individual level, but also to the limited sample size and the brief observation period (18 months). Conclusions Girl-centered programming increases access to spaces where girls meet to expand their knowledge and social networks and build assets that reduce their risks and broadens their opportunities. However, further evidence is needed on multi-level and multisector girl-centered interventions to address teenage pregnancy and other complex issues. Key messages The program generates a social safety net among girls and mentors that is key to the well-being of girls. Girl-centered programs have positive effects on girĺs empowerment for girls who live in vulnerable situations and unequal social contexts.

Objective: to describe some methodological considerations on the Systematic Review of Mixed Methods developed by the Joanna Briggs Institute, seeking to disseminate the use of this methodology, exemplifying its use and demonstrating the benefits for nursing research. Method: it is an article of reflection. Result: it can be seen that the Systematic Review of Mixed Methods demonstrates that it is a research method that aligns with the characteristics of nursing care, making it possible to make a broader analysis of the different aspects of care such as: the viability of an activity or intervention, its adequacy to a specific context, the significance of the intervention for the patient and their effectiveness. Conclusion: the possibility of incorporating scientific evidence into the clinical practice by the decision making, increasing the focus of care and bringing benefits to the patients as well as the public policies is envisaged. This method values the context of care, cost-effectiveness and the preferences of patients, caregivers and health care providers. RESUMEN Objetivo: describir algunas consideraciones metodológicas sobre la Revisión Sistemática de Métodos Mixtos desarrollada por el Instituto Joanna Briggs, buscando divulgar el uso de esta metodología, ejemplificando su utilización y demostrando los beneficios para la investigación en enfermería. Método: se trata de un artículo de reflexión. Resultados: se observa que la Revisión Sistemática de Métodos Mixtos demuestra ser un método de investigación que se alinea a las características del cuidado en enfermería, posibilitando hacer un análisis más amplio de los diferentes aspectos del cuidado como: la viabilidad de una evaluación actividad o intervención, su adecuación a un determinado contexto, la significancia de la intervención para el paciente y su eficacia. Conclusión: se vislumbra la posibilidad de incorporar evidencias científicas a la práctica clínica por la toma de decisión, ampliando el foco de cuidado y aportando beneficios a los pacientes y a las políticas públicas. Este método valora el contexto de la atención, la relación costo-eficacia, así como las preferencias de los pacientes, cuidadores y proveedores de atención de salud. RESUMO Objetivo: descrever algumas considerações metodológicas sobre a Revisão Sistemática de Métodos Mistos desenvolvida pelo Instituto Joanna Briggs, buscando divulgar o uso desta metodologia, exemplificando sua utilização e demonstrando os benefícios para a pesquisa em enfermagem. Método: trata-se de um artigo de reflexão. Resultado: percebe-se que a Revisão Sistemática de Métodos Mistos demonstra ser um método de pesquisa que se alinha às características do cuidado em enfermagem, possibilitando fazer uma análise mais ampla dos diferentes aspectos do cuidado como: a viabilidade de uma atividade ou intervenção, sua adequação a um determinado contexto, a significância da intervenção para o paciente e a sua eficácia. Conclusão: vislumbra-se a possibilidade de incorporar evidências científicas à prática clínica pela tomada de decisão, ampliando o foco de cuidado e trazendo benefícios aos pacientes bem como às políticas públicas. Este método valoriza o contexto da prestação de cuidados, a relação custo-eficácia e as preferências dos pacientes, cuidadores e provedores de cuidados de saúde.

Objetivo: Avaliar o nível de estresse dos profissionais de enfermagem que atuam no centro cirúrgico de uma cidade do Rio Grande do Sul. Métodos: Trata-se de um estudo quantitativo, transversal e descritivo, realizado com 52 profissionais de enfermagem, através do instrumento Inventário de Sintomas de Estresse para adulto de lipp (ISSL). A pesquisa foi realizada de janeiro a junho do ano de 2020, em um Centro Cirúrgico (CC) e Centro de Materiais Esterilizados (CME) de um hospital de médio porte. Os dados foram analisados através do programa SPSS versão 21.0, testes Qui-quadrado e teste t-student. Também foi utilizada Regressão de Poisson. Resultados: Observou-se que, aproximadamente, a metade dos entrevistados apresentava stress (44,2%) e a maioria encontravam-se e em fase de resistência com sintoma fator psicológico (60,9%). Apresentando as variáveis: ter filhos adolescentes (p=0,014) e realizar atividade acadêmica (p=0,005), apresentou fator de risco elevado ao estresse. Conclusão: O estudo permitiu traçar o perfil dos trabalhadores que estão mais predispostos ao stress, apresentando elevados índices de estresse em fase de resistência. Acredita-se que tal situação possa estar relacionada às práticas dos profissionais que geram muita tensão, demostrando haver a necessidade de estratégias que ofereçam apoio à realização de atividade profissional nesses setores.

Os manicômios judiciários possuem objetivo de custodiar e tratar doentes mentais, sendo uma fusão entre hospital e presídio. Utilizam técnicas e procedimentos disciplinares normalizando loucos criminosos. A pesquisa estuda os dispositivos disciplinares utilizados por profissionais da enfermagem que atuam no Instituto Psiquiátrico Forense, de Porto Alegre, Brasil. O referencial teórico situa-se no campo dos estudos culturais, vertente pós-estruturalista, inspirado em noções de Michael Foucault. Foram utilizados instrumentos de investigação etnográfica: entrevistas gravadas em áudio, observação, análise de documentos e imagens fotográficas. Os resultados foram organizados em unidades: Casa de loucos ou casa de presos?; A organização dos espaços e O controle do tempo. Nesta instituição, a enfermagem carrega heranças do sistema carcerário, manifestadas em rotinas diárias. O modo de cuidar, naturalizado ao longo do tempo, produz profissionais que repetem ensinamentos de carcereiros, “transformando” os pacientes naquilo que é a proposta normalizadora da instituição: organizá-lo e reajustá-lo segundo regras de convívio social. The forensic psychiatric hospitals have objective to safeguard and treat mental patients, with a fusion between hospital and prison. Use techniques and disciplinary procedures normalizing criminally insane. The research studies the disciplinary measures used by nursing professionals working at Instituto Psiquiátrico Forense de Porto Alegre, Brazil. The theoretical framework lies in the field of cultural studies, post-structuralist strand, inspired by Michael Foucault notions. Ethnographic research instruments were used: interviews recorded in audio, observation, analysis of documents and images. The results were organized in units: Madhouse or house of prisoners?; The organization of spaces and The control of time. In this institution, nursing carries the prison system heritage, manifested in daily routines. The way of caring, naturalized over time, produces professionals who repeat teachings of jailers, “transforming” patients in what is a normative proposal of the institution: organize it and readjust it according to rules of social life. Los hospitales psiquiátricos judiciales tienen el objetivo de custodiar y tratar pacientes mentales, siendo una fusión entre el hospital y la cárcel. Ellos utilizan técnicas y procedimientos para normalizar criminales dementes. Esta investigación estudió las medidas utilizadas por los profesionales de enfermería que trabajan en el Instituto Psiquiátrico Forense, de Porto Alegre, Brazil. El marco teórico se encuentra situado en el campo de los estudios culturales, inspirado por las ideas de Michael Foucault. Se utilizaron instrumentos de investigación etnográfica: entrevistas en audio, observación, análisis de documentos e imágenes. Los resultados fueron organizados en unidades: ¿Casas de locos o casa de presos?; La organización de los espacios y El control de tiempo. En esta institución, Enfermería carga las herencias del sistema penitenciario que se manifiestan en las rutinas diarias. La forma de cuidar, naturalizada con el tiempo, produce profesionales que repiten enseñanzas de carceleros, “convirtiendo” a los pacientes en aquello que es propuesto por la normativa de la institución: organizarlo y re-ajustarlo de acuerdo con normas sociales.

Objetivo: Conhecer os principais desafios enfrentados por profissionais de enfermagem que realizam assistência e cuidados aos indivíduos vítimas de violência por armas de fogo e arma branca. Métodos: Trata-se de um estudo qualitativo, descritivo exploratório. A pesquisa foi realizada em uma unidade de internação de um hospital geral da rede pública, localizado em uma cidade do RS. A coleta de dados deu-se através de entrevistas abertas, gravadas em áudio, guiadas por instrumento facilitador e posteriormente transcritas. Os dados foram analisados através da análise temática de Minayo MCS (2014) em três etapas: pré-análise; exploração do material; tratamento dos resultados obtidos e interpretação. Resultados: Observou-se que os principais desafios que os profissionais enfrentam durante a assistência às vítimas de violência são o estresse laboral, medo de sofrer alguma violência e o senso de justiça versus o cuidado humanizado. Conclusão: Diante dos fatos, faz-se necessário à criação e implementação de políticas e estratégias a fim de prevenir situações de violência e melhorar as condições trabalhistas. Ressaltando que estas melhorias terão reflexo positivo na assistência prestada.

Objetivo: conhecer a percepção da enfermagem sobre os fatores envolvidos na adesão e no abandono do tratamento da tuberculose. Método: estudo qualitativo, descritivo-exploratório realizado no Centro de Referência em Tuberculose no município de Porto Alegre no Rio Grande do Sul. Nove profissionais da enfermagem responderam à entrevista semiestruturada e foi realizada a análise de conteúdo de Bardin. Resultados: identificou-se quatro categorias temáticas: a organização do serviço e o papel da enfermagem no processo de trabalho; a raiz social da tuberculose; a consulta de enfermagem como artifício para o fortalecimento da adesão ao tratamento; rede de serviços como estratégia para reduzir o abandono do tratamento. Conclusão: os profissionais de enfermagem reconhecem sua responsabilidade na adesão ao tratamento da tuberculose e percebem no cotidiano de trabalho os fatores que influenciam o abandono. Reconhecem a necessidade de um trabalho em rede, intersetorial e de proteção social para o controle da doença.

Introduction: in this article, we propose an analytics of ordinances and health policies after the Unified Health System, in order to discuss home care as a biopolitics tool. Material and method: this is a genealogical study inserted in the poststructuralist framework, which uses Foucault’s theorizations. The empirical material was constituted by legal documents that referred to homecare in health, published in the Official Diary of the Union, being the search carried out in May 2013. The selected excerpts were transcribed to an Excel table, in which there were the reference, the excerpt, who speaks, and the limitation procedures. The following step constituted in the elaboration of analytical units, in which Michel Foucault’s tools were applied, as a way to “hammer” the discourses that surround home care programs, such as: power, discipline, and biopolitics. Results and discussion: we can establish some traces that configure home visits as biopolitics strategy. Among them, the inclusion role of specific populations in what concerns the biological processes, but also general populations, in the imperative of health for all, valuing the concept of health as peoples’ right and a State’s responsibility. A government of the living, healthy, and sick, a government of everyone.

International audience; Vingt millions de Français souffrent de maladies chroniques, soit un tiers de la population – une véritable épidémie. Hier encore, on mourait de ces maladies, aujourd’hui, elles nous accompagnent toute notre vie.Diabète, cancers, hypertension artérielle, sida, insuffisance respiratoire, mucoviscidose, myopathies, maladies inflammatoires de l’intestin, polyarthrite rhumatoïde, asthme, lupus, insuffisance rénale, cirrhoses hépatiques, séquelles d’accidents vasculaires cérébraux, insuffisance cardiaque, sclérose en plaques, maladie de Parkinson, maladies psychiatriques, maladie d’Alzheimer, obésité…La France doit à présent se doter de tous les moyens pour améliorer la vie de tous les patients atteints de ces maladies.Nous sommes entrés dans l’ère de la 3e médecine, véritable médecine de la personne, aux côtés de la médecine des maladies aiguës bénignes et de la médecine des maladies graves. Pour le patient, une nouvelle façon de vivre ; pour le médecin, une nouvelle façon d’exercer son métier, à l’heure des grandes avancées médicales et techno­logiques.Soixante-quatorze médecins, patients et experts se sont associés ici pour relever le défi des maladies chroniques.Pour la première fois, un livre complet sur tout ce que nous savons et pouvons pour faire face.

Cette note synthetise les connaissances scientifiques relatives a l’impact des expositions chimiques sur la progression de l’obesite et du diabete. En France, l’incidence du diabete a presque double entre 2000 et 2008 (+ 93?%) et la prevalence atteint pres de 1,8 millions d’individus. L’obesite a pratiquement double en 10 ans. Depuis les annees 80, l’accent a ete mis sur les mesures hygieno-dietetiques pour lutter contre ces maladies, mais force est de constater que cela n’a pas ete suffisant pour inverser la tendance. Ces maladies chroniques alourdissent fortement les budgets des systemes de sante. Parallelement, un nombre croissant de donnees scientifiques suggerent que les polluants chimiques, notamment les « perturbateurs endocriniens » (PE), contribueraient a la progression alarmante des maladies chroniques. En mimant l’action de certaines hormones sur des organes tels que le tissu adipeux, le foie, le pancreas et les muscles squelettiques, les PE perturbent l’equilibre glucido-lipidique et participeraient de ce fait a plus ou moins long terme au developpement de l’obesite et de la resistance a l’insuline annonciatrice du diabete, l’ensemble predisposant aux maladies cardiovasculaires. La toxicologie classique telle que nous la connaissons a travers son enonce « la dose fait le poison » ne rend pas compte de la complexite des mecanismes d’action des PE, qu’ils soient seuls ou en melange. Les alterations physiopathologiques induites par les PE peuvent etre programmees epigenetiquement des le stade fœtal, pour eventuellement se reveler plus tard dans la vie. Un changement de paradigme de l’evaluation toxicologique des PE s’impose pour mettre en place une politique sanitaire de prevention aussi bien nationale qu’europeenne.

The forensic psychiatric hospitals have objective to safeguard and treat mental patients, with a fusion between hospital and prison. Use techniques and disciplinary procedures normalizing criminally insane. The research studies the disciplinary measures used by nursing professionals working at Instituto Psiquiátrico Forense, Porto Alegre, Brazil. The theoretical framework lies in the field of cultural studies, post-structuralist strand, inspired by Michael Foucault notions. Ethnographic reswearch instruments were used: interviews recorded in audio, observation, analysis of documents and images. The results were organized in units: Madhouse or house of prisoners?; The organization of spaces and The control of time. In this institution, nursing carries the prison system heritage, manifested in daily routines. The way of caring, naturalized over time, produces professionals who repeat teachings of jailers, "transforming" patients in what is a normative proposal of the institution: organize it and readjust it according to rules of social life. RESUMEN Los hospitales psiquiátricos judiciales tienen el objetivo de custodiar y tratar pacientes mentales, siendo una fusión entre el hospital y la cárcel. Ellos utilizan técnicas y procedimientos para normalizar criminales dementes. Esta investigación estudió las medidas utilizadas por los profesionales de enfermería que trabajan en el Instituto Psiquiátrico Forense, Porto Alegre, Brazil. El marco teórico se encuentra situado en el campo de los estudios culturales, inspirado por las ideas de Michael Foucault. Se utilizaron instrumentos de investigación etnográfica: entrevistas en audio, observación, análisis de documentos e imágenes. Los resultados fueron organizados en unidades: ¿Casas de locos o casa de presos?; La organización de los espacios y El control de tiempo. En esta institución, Enfermería carga las herencias del sistema penitenciario que se manifiestan en las rutinas diarias. La forma de cuidar, naturalizada con el tiempo, produce profesionales que repiten enseñanzas de carceleros, "convirtiendo" a los pacientes en aquello que es propuesto por la normativa de la institución: organizarlo y re-ajustarlo de acuerdo con normas sociales. RESUMO Os manicômios judiciários possuem objetivo de custodiar e tratar doentes mentais, sendo uma fusão entre hospital e presídio. Utilizam técnicas e procedimentos disciplinares normalizando loucos criminosos. A pesquisa estuda os dispositivos disciplinares utilizados por profissionais da enfermagem que atuam no Instituto Psiquiátrico Forense, de Porto Alegre, Brasil. O referencial teórico situa-se no campo dos estudos culturais, vertente pós-estruturalista, inspirado em noções de Michael Foucault. Foram utilizados instrumentos de investigação etnográfica: entrevistas gravadas em áudio, observação, análise de documentos e imagens fotográficas. Os resultados foram organizados em unidades: Casa de loucos ou casa de presos?; A organização dos espaços e O controle do tempo. Nesta instituição, a enfermagem carrega heranças do sistema carcerário, manifestadas em rotinas diárias. O modo de cuidar, naturalizado ao longo do tempo, produz profissionais que repetem ensinamentos de carcereiros, "transformando" os pacientes naquilo que é a proposta normalizadora da instituição: organizá-lo e reajustá-lo segundo regras de convívio social.

The subsoil can be used to store or extract heat for cooling or heating buildings, respectively, via a ground-coupled heat pump (GCHP) and the Ground heat exchanger (GHE) commonly used consist of HPDE pipes. The present contribution deals with the role of groundwater flow in the performance of GHEs installed in vertical boreholes. A mathematical model in 2D space is introduced, comprising a pair of partial differential equations of parabolic and elliptic type for soil temperature and ground water velocity field, respectively. The equations have been solved numerically by mean of Difference Finite method and Finite Element Method. The numerical model has been validated by comparing the results with the solutions of Moving infinite line source (MILS) model. The soil temperatures established in a sand around GHE operating in heat mode are calculated either assuming a uniform velocity field and by taking into account the correct seepage around the GHEs to investigate how much the proper modelling of groundwater flow around the borehole affects the results.

Le role des facteurs environnementaux dans la progression dramatique des troubles metaboliques (syndrome metabolique, diabete type II, obesite) est incontestable. Aux facteurs environnementaux deja identifies (desequilibre energetique nutritionnel, sedentarite, facteurs psychosociaux), s'ajoutent desormais les polluants de la categorie des perturbateurs endocriniens (PE) presents dans l'alimentation (bisphenol A, phtalates, pesticides, PCB). Nous exposerons dans cette revue les resultats des etudes decrivant les alterations metaboliques induites par le bisphenol A, un des PE le plus repandu dans notre alimentation et impregnant plus de 95 % de la population, et ce, depuis plusieurs dizaines d'annees. Nous verrons, etudes epidemiologiques et experimentales a l'appui, comment le bisphenol A ne suit pas les standards classiques de la cytotoxicite. Il agit en effet a de tres faibles doses, largement en dessous de la dose journaliere admissible actuellement en vigueur (50 micro g/kg/j), sans suivre une relation lineaire dose/effet, et exerce des effets deleteres a des periodes critiques du developpement foetal et postnatal conduisant a l'âge adulte a des troubles metaboliques qui predisposent au syndrome metabolique, au surpoids et au diabete. Les recentes donnees acquises sur le role du bisphenol A sur l'activation de certains recepteurs independants des recepteurs aux estrogenes et sur certaines modifications epigenetiques transmises a la descendance lors de la gestation pourraient rendre compte des troubles metaboliques se developpant a l'âge adulte. Les connaissances recentes sur la toxicite du bisphenol A doivent, au titre du principe de precaution, alerter les agences sanitaires sur une revision drastique des normes d'exposition de ce polluant afin de proteger efficacement la population, en particulier les cibles particulierement sensibles (femmes enceintes, nouveau-nes, jeunes enfants).

As of the mid-19th century, most infectious disease epidemics have been fought and slowed down by taking action on the environment (water, housing, waste) and education. This constitutes the 1st public health revolution paradigm. As we face the current epidemic of chronic diseases and the failure of the dominant biomedical model to stop them, a 2nd public health revolution is needed. The vision for this 2nd public health revolution requires a new paradigm built upon an eco-systemic definition of health and the recognition of the legitimacy for citizen participation based on the precautionary principle.

Resume Les maladies chroniques constituent un defi mondial d'ampleur epidemique selon l'OMS. Malgre les cris d'alarme des chercheurs et des organisations internationales, les politiques de maitrise des depenses de sante en France continuent d'ignorer les causes environnementales des maladies.

Elsevier Science refused to publish a study of IBM workers that IBM sought to keep from public view. Occupational and environmental health (OEH) suffers from the absence of a level playing field on which science can thrive. Industry pays for a substantial portion of OEH research. Studies done by private consulting firms or academic institutions may be published if the results suit the sponsoring companies, or they may be censored. OEH journals often reflect the dominance of industry influence on research in the papers they publish, sometimes withdrawing or modifying papers in line with industry and advertising agendas. Although such practices are widely recognized, no fundamental change is supported by government and industry or by professional organizations.

Background Reducing health inequalities involves the identification and characterization of social and exposure factors and the way they accumulate in a given area. The areas of accumulation then allow for prioritization of interventions. The present study aims to build spatial composite indicators based on the aggregation of environmental, social and health indicators and their inter-relationships. Method Preliminary work was carried out firstly to homogenize spatial coverage, and secondly to study spatial variation of environmental (EI), socioeconomic (SI) and health (HI) indicators. The aggregation of the different indicators was performed using several methodologies for which results and decision-makers’ usability were compared. Results Four methodologies were tested: 1) A simple summation of normalized HI, EI and SI indicators (IC), 2) the sum of the normalized HI, EI and SI indicators weighted by the first principal component of a Principal Component Analysis (IC PCA), 3) the sum of normalized and weighted indicators of the first principal component of Local Principal Component Analysis (IC LPCA), and 4) the sum of normalized and weighted indicators of the first principal component of a Geographically Weighted Principal Component Analysis (IC GWPCA). Conclusion The GWPCA is particularly adapted to taking into account the spatial heterogeneity and the spatial autocorrelation between SI, EI and HI. This approach invalidates the basic assumptions of many standard statistical analyses. Where socioeconomic indicators present high deprivation and where they are associated with potential modifiable health determinants, decision-makers can prioritize these areas for reducing inequalities by controlling the socioeconomic and health determinants.

Glycol ethers (GE) are a family of solvents, the use of which has increased dramatically since the 60's, in domestic and occupational mainly water-based products, such as paintings, inks, varnishes, cleaning agents. There are two subgroups: E series and P series. EGME, among the E series, is the reference substance. This is a reprotoxic chemical causing infertility and genital apparatus atrophy on both sexes, embryofetal toxicity through maternal exposure (malformation, growth alterations and functional deficits). European Union has classified nine other GE as reprotoxic. P series, with the beta isomers exception, has no specific reprotoxicity. Epidemiological studies published from the 80's onwards, have confirmed animal data (malformation, oligoazoospermia, spontaneous abortion, hypofertility). The effects can be observed even after the end of exposure. Risk assessment studies tend to prove that this massive exposure during several decades could have had an important impact on reproductive human health. Even if this exposure has considerably decreased since the last few years, a ban of reprotoxic GE, as required by two official bodies (CSC, CSHPF), seems necessary, due to the high risk level. Classification should be completed for some GE, not classified now (EGBE). Health assessment of past exposure should be carried out. Physicians should look after a possible glycol ethers responsibility when facing this kind of reprotoxic effects.

Glycol ethers (GE) are chemicals used since the 1930s as solvents in paints, inks, varnishes, and cleaning agents, mainly in water-based products, cosmetics, and drugs. World production approximates 1 million tons. Nineteen GE are produced or imported each year; over 1000 tons in European Union (EU) have been classified as high production volume chemicals (HPVCs). First animal data were published in 1971 and 1979 showing severe reprotoxicity for some GE. Two alerts were launched in the United States in 1982 and 1983, but the first partial GE regulation only occurred in 1993 in the EU. Although these chemicals may expose a very large population, basic toxicity data, more especially carcinogenicity, are still lacking (3/32 GE). However, experimental data were sufficient to lead developmental toxicity risk assessment since the early 1980s. Risk indices over 1000 have been calculated for consumers and workers exposed to reprotoxic GE in domestic and industrial activities. The first ban was decided in 1999 in France, but was only for drugs and cosmetics. Not surprisingly, since the late 1980s, human studies have found results similar to those in animal data: spontaneous abortions, malformations, testicular toxicity, and hematotoxicity. Despite this highly coherent set of data, and although substitution products are available, reprotoxic GE have been and still remain widely used in the world. The case of GE shows the failure of the present system based on a posteriori risk assessment. This pleads for the change of paradigm through the European REACH regulation based on the "No data, no market" principle. Ethics in REACH management should also be considered.

RESUMO Objetivo : identificar a prevalencia dos diagnosticos, intervencoes e resultados na consulta de Enfermagem de seguimento a pacientes com câncer de mama, prostata e colon em ambulatorio. Metodo : estudo quantitativo, tipo transversal, realizado a partir de instrumento elaborado e prontuario eletronico de 101 pacientes. Os dados foram analisados com estatistica descritiva simples e apresentados em tabela. Resultados : o diagnostico mais prevalente foi “Estilo de vida sedentario” e a principal intervencao para este diagnostico foi a “Promocao do exercicio” e o resultado “Participacao no lazer”. A prevalencia destes achados foi 14,43%, respectivamente. Conclusao : os dados contribuiram para identificar o perfil dos pacientes em seguimento, reforcando a necessidade de intensificacao da atuacao do enfermeiro no planejamento de intervencoes em consulta de Enfermagem. Descritores : C uidados de Enfermagem; Enfermagem Oncologica; Diagnostico de Enfermagem. ABSTRACT Objective: to identify the prevalence of diagnoses, interventions and results in the follow-up Nursing visit to patients with breast, prostate and colon cancer in the outpatient setting. Method: quantitative study, cross-sectional study, carried out using an instrument and electronic medical record of 101 patients. The data were analyzed with simple descriptive statistics and presented in table. Results: the most prevalent diagnosis was "Sedentary lifestyle" and the main intervention for this diagnosis was "Exercise promotion" and the result "Participation in leisure". The prevalence of these findings was 14.43%, respectively. Conclusion: the data contributed to identify the profile of patients in follow-up, reinforcing the need for intensification of the nurse's role in the planning of interventions in Nursing consultation. Descritores : Nursing Care ; Oncology Nursing; Nursing Diagnosis, Nursing Process. RESUMEN Objetivo: identificar la prevalencia de los diagnosticos, intervenciones y resultados en la consulta de Enfermeria de seguimiento a pacientes con cancer de mama, prostata y colon en ambulatorio. Metodo: estudio cuantitativo, tipo transversal, realizado a partir de instrumento elaborado y prontuario electronico de 101 pacientes. Los datos fueron analizados con estadistica descriptiva simple y presentados en tabla. Resultados: el diagnostico mas prevalente fue "Estilo de vida sedentario" y la principal intervencion para este diagnostico fue la "Promocion del ejercicio" y el resultado "Participacion en el ocio". La prevalencia de estos hallazgos fue 14,43%, respectivamente. Conclusion: los datos contribuyeron a identificar el perfil de los pacientes en seguimiento, reforzando la necesidad de intensificacion de la actuacion del enfermero en la planificacion de intervenciones en consulta de Enfermeria. Descritores : Cuidados de Enfermeria; Enfermeria Oncologica; Diagnostico de Enfermeria, Proceso de Enfermeria.

RESUMO Objetivo: revisar a literatura cientifica, nacional e internacional, sobre a identificacao e os cuidados no Transtorno de Acumulacao, apos a inclusao no Manual Diagnostico e Estatistico de Transtornos Mentais (DSM-5). Metodo: revisao integrativa, realizada nas bases de dados LILACS, MEDLINE e Science Direct, mediante os descritores Terapeutica, Transtorno de Acumulacao, Sinais e Sintomas e a palavra-chave Acumulacao Compulsiva. Resultados: 754 artigos publicados entre maio de 2013 e junho de 2016. Apos criterios e leitura na integra, foram selecionados 11 artigos, dando origem a tres categorias de analise. Conclusao: os estudos analisados apresentaram duvidas quanto aos criterios e falhas na identificacao social de individuos acumuladores. Faz-se necessaria uma maior aproximacao, com concepcao ampliada, de forma a contemplar o acolhimento na rede de atencao em saude, em virtude do desconhecimento da doenca. Descritores: Transtorno de Acumulacao; Sinais e Sintomas; Terapeuticas; Cuidados de Enfermagem; Enfermagem; Transtorno Obsessivo-Compulsivo. ABSTRACT Objective: to review the national and international scientific literature on identification and care in Accumulation Disorder after inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Method: integrative review, performed in the LILACS, MEDLINE and Science Direct databases, using the descriptors Therapeutic, Accumulation Disorder, Signs and Symptoms and the keyword Compulsive Accumulation. Results : 754 articles published between May 2013 and June 2016. Following the criteria and reading in full, 11 articles were selected, giving rise to three categories of analysis. Conclusion: the studies analyzed presented doubts about the criteria and failures in the social identification of accumulating individuals. A closer approximation, with an expanded conception, is necessary in order to contemplate the reception in the healthcare network, due to the lack of knowledge of the disease. Descriptors: Hoarding Disorder; Sings and Symptoms; Therapeutics; Nursing Care; Nursing; Obsessive-Compulsive Disorder. RESUMEN Objetivo: revisar la literatura cientifica, nacional e internacional, sobre la identificacion y los cuidados en el Trastorno de Acumulacion, tras su inclusion en el Manual Diagnostico y Estadistico de Trastornos Mentales (DSM-5). Metodo: revision integrativa, realizada en las bases de datos LILACS, MEDLINE y Science Direct, mediante los descriptores Terapeutica, Trastorno de Acumulacion, Signos y Sintomas y la palabra clave Acumulacion Compulsiva. Resultados: 754 articulos publicados entre mayo de 2013 y junio de 2016. Tras criterios y lectura integra, se seleccionaron 11 articulos, dando origen a tres categorias de analisis. Conclusion: los estudios analizados presentaron dudas en cuanto a los criterios y fallas en la identificacion social de individuos acumuladores. Se hace necesaria una mayor aproximacion, con concepcion ampliada, para contemplar la acogida en la red de atencion en salud, en virtud del desconocimiento de la enfermedad. Descriptores: Terapeutica; Trastorno de Acumulacion; Signos y Sintomas; Atencion de Enfermeria; Enfermaria;Trastorno Obsesivo Compulsivo.

Le mode d'action des perturbateurs endocriniens ne s'inscrit pas dans le paradigme classique de la toxicologie, selon lequel " la dose fait le poison ", en raison des spécificités suivantes: âge d'exposition, temps écoulé entre l'exposition et ses effets, interactions entre les substances chimiques, dynamique de réponse à la dose et effets latents à long terme. Plutôt que de rechercher une valeur seuil, dont l'existence ne peut être déterminée avec certitude, il est préférable de limiter au minimum toute exposition humaine aux substances caractérisées comme perturbateurs endocriniens.

International audience; Spatial health inequalities have often been analyzed in terms of socioeconomic and environmental factors. The present study aimed to evaluate spatial relationships between spatial data collected at different spatial scales. The approach was illustrated using health outcomes (mortality attributable to cancer) initially aggregated to the county level, district socioeconomic covariates, and exposure data modeled on a regular grid. Geographically weighted regression (GWR) was used to quantify spatial relationships. The strongest associations were found when low deprivation was associated with lower lip, oral cavity and pharynx cancer mortality and when low environmental pollution was associated with low pleural cancer mortality. However, applying this approach to other areas or to other causes of death or with other indicators requires continuous exploratory analysis to assess the role of the modifiable areal unit problem (MAUP) and downscaling the health data on the study of the relationship, which will allow decision-makers to develop interventions where they are most needed.

Cancer is one of the leading causes of mortality. However, it is necessary to analyze this disease from different perspectives. Cancer mortality maps are used by public health officials to identify areas of excess and to guide surveillance and control activities. However, the interpretation of these maps is difficult due to the presence of extremely unreliable rates, which typically occur for sparsely populated areas and/or less frequent cancers. The analysis of the relationships between health data and risk factors is often hindered by the fact that these variables are frequently assessed at different geographical scales. Geostatistical techniques that have enabled the process of filtering noise from the maps of cancer mortality and estimating the risk at different scales were recently developed. This paper presents the application of Poisson kriging for the examination of the spatial distribution of cancer mortality in the "Picardy region, France". The aim of this study is to incorporate the size and shape of administrative units as well as the population density into the filtering of noisy mortality rates and to estimate the corresponding risk at a fine resolution.

Os manicômios judiciários são instituições responsáveis pelo cuidado dos incapazes, destinados à proteção do todo social. Possuem o duplo objetivo de custodiar e tratar pessoas com doenças mentais declaradas perigosas, podendo ser considerados uma fusão entre hospital psiquiátrico e presídio. Essa instituição utiliza técnicas e procedimentos disciplinares com objetivo de normalizar loucos criminosos para torná-los aptos ao convívio social. A pesquisa propõe estudar os dispositivos disciplinares utilizados por profissionais da enfermagem que atuam no Instituto Psiquiátrico Forense Doutor Mauricio Cardoso - Porto Alegre. O referencial teórico-metodológico que orienta as análises situa-se no campo dos Estudos Culturais, na vertente Pós-Estruturalista, norteada por pensamentos do filósofo Michel Foucault. Foram utilizados instrumentos de investigação etnográfica, a saber: entrevistas gravadas em áudio com 14 trabalhadores de enfermagem, observação do trabalho nos turnos manhã, tarde e noite, análise de livros de registro das unidades da instituição, imagens fotográficas capturadas pela autora e demais imagens disponíveis em meio eletrônico. Os resultados das análises foram organizados em unidades intituladas: Casa de loucos ou casa de presos?; A organização dos espaços; O controle do tempo e Fábrica de loucos. Este movimento analítico possibilitou problematizar o trabalho dos profissionais de enfermagem. Conclui-se que as heranças históricas da profissão, nesta instituição, são naturalizadas pelos profissionais. A figura do louco delinquente foi uma construção histórica atravessada por diferentes discursos ao longo dos tempos e a associação da loucura com a criminalidade fez surgir o personagem louco criminoso que, por ser um irracional, não responde pelo seu crime. Nos manicômios judiciários o controle dos loucos criminosos não é privativo de médicos psiquiatras, sendo necessária a inclusão de outras categorias, tais como juízes de direito, psicólogos, assistentes sociais, terapeutas ocupacionais e, inclusive, a profissão de enfermagem,que associa seus saberes de cuidado a outras formas de adestramento e controle.O Instituto Psiquiátrico Forense carrega heranças do sistema carcerário, manifestadas pelos profissionais da enfermagem em suas rotinas diárias.Tais trabalhadores tiveram como “tutores” agentes penitenciários e guardam modelos desse trabalho quando ordenam e distribuem os espaços para controlar os corpos dos pacientes.Tal jeito de trabalhar parece diverso dos locais de atuação da profissão. Esse modo de cuidar, naturalizado ao longo do tempo, produz profissionais repetem os ensinamentos dos carcereiros sem perceber a fusão de papéis. Por outro lado, esses parecem não estar em acordo com a situação vivenciada e tentam não se associar aos métodos disciplinares vigentes nas instituições totais. Também, se pode observar que os trabalhadores passam a maior parte do tempo organizando e adestrando os pacientes que circulam nos ambientes. Trata-se de um esquadrinhamento do tempo e do espaço, onde o corpo é controlado e manipulado por técnicas disciplinares. Essas técnicas inserem, combinam e classificam os pacientes nos espaços. Assim, cabe a enfermagem “transformar” os pacientes naquilo que seria a proposta normalizadora da Instituição: fabricar um determinado tipo de paciente, como um objeto moldado, manipulado e revisado em uma fábrica para apresentar determinado comportamento e pensamento. Assim, o louco internado no Instituto Psiquiátrico Forense deve ser reajustado às regras de convívio social, tarefa na qual participa ativamente a enfermagem. Forensic psychiatric hospitals are responsible for caring for mentally-impaired people and are intended to protect society as a whole. They have the dual purpose of guarding and treating dangerous mentally ill individuals and could be considered a cross between a psychiatric hospital and a prison. These institutions make use of disciplinary techniques and procedures in order to normalize insane criminals and make them apt for social conviviality. The study intends to look into the disciplinary procedures used by nursing professionals working at the Doutor Mauricio Cardoso Forensic Psychiatric Institute in Porto Alegre. The theoretical and methodological framework guiding the analysis is grounded in the field of Cultural Studies, in the Poststructuralist movement, guided by ideas of the philosopher Michel Foucault. The following ethnographic research instruments were used to guide the fieldwork: interviews with 14 nursing workers recorded on audio, observation of their work in the morning, afternoon and night shifts, analysis of record books in the institution units, and photos taken by the author and available electronically. The results of the analyses were organized into units titled: Madhouse or jailhouse?; Organization of spaces; Time Control and Loony Factory. This analytical procedure generated a discussion on the work of nurses in patient management and control. My conclusion is that the historical legacies of the profession, in this institution, are naturalized and repeated by the professionals. The figure of the mad offender has been a historical construct intersected by different discourses over time, and the association of madness with crime gave rise to a new character, the mad criminal who, as a result of being an irrational person, did not answer for his/her crime. In forensic psychiatric hospitals, the control of mentally ill criminals is not exclusive to psychiatrists, the inclusion of other categories, such as court judges, psychologists, social workers, occupational therapists, and even nursing professionals, who link their knowledge of care to other forms of training and control, is required. The Forensic Psychiatric Institute, as a cross between a jail and a mental hospital, carries a legacy from the prison system, which is expressed by the nursing staff in their daily routines. These workers had jailers as their “tutors” and stick to the latter’s work as a model when they arrange and distribute spaces in order to control the bodies of their patients, a task that is assigned to nurses. This way of working seemed different from other places of professional practice. This mode of caring, naturalized over time, produces nursing professionals who repeat the teachings from jailers without realizing that their roles have been merged. On the other hand, the nursing staff does not seem to agree with the situation experienced and try not to associate themselves with disciplinary methods enforced in total institutions. I also observed that these workers spent most of their time organizing and training the patients who were present in these facilities. It is an exploration of time and place whereby the body is controlled and manipulated by disciplinary techniques. These techniques insert, combine and sort out patients into spaces. Therefore, the role of the nursing staff is to “transform” patients into that which is the normalizing purpose of the Institution: to manufacture a certain kind of patient, just like an object that is shaped, manipulated and revised in a factory to display a specific type of behavior and thinking. Thus, a demented person institutionalized at the Forensic Psychiatric Institute must be readjusted to social conviviality rules, a task in which the nursing staff actively participates. Los manicomios judiciales son las instituciones responsables por el cuidados de incapaces, destinados a la protección del todo social. Cuentan con el doble objetivo de cuidar y tratar enfermos mentales peligrosos, y pueden ser considerados una fusión entre hospital psiquiátrico y cárcel. Esa institución utiliza técnicas y procedimientos disciplinares con objetivo de normalizar locos criminales para volverlos aptos a la convivencia social. El estudio propone estudiar los dispositivos disciplinares utilizados por profesionales de la enfermería que actúan en el ‘Instituto Psiquiátrico Forense Doutor Mauricio Cardoso’ - Porto Alegre. La referencia teóricometodológica que orienta los análisis está ubicada en el campo de los Estudios Culturales, en la vertiente postestructuralista, norteada por pensamientos del filósofo Michel Foucault. Se emplearon instrumentos de investigación etnográfica, a saber: entrevistas con 14 trabajadores de enfermería, grabadas en audio; observación del trabajo en los turnos de los turnos matutino, vespertino y nocturno; análisis de libros de registro de las unidades de la institución e imágenes fotográficas captadas por la autora y disponibles en medio electrónico. Los resultados de los análisis han sido organizados en unidades con los títulos: ¿Casa de locos o casa de presos?; La organización de los espacios; El control del tiempo y Fábrica de Locos. Este movimiento analítico permitió discutir el trabajo de los profesionales de enfermería en el manejo y control de los pacientes. Concluyo que las herencias históricas de la profesión, en esta institución, son naturalizadas y repetidas por sus profesionales. La figura del loco delincuente es una construcción histórica atravesada por diferentes discursos a lo largo de los tiempos, siendo que la asociación de la locura a la criminalidad hizo surgir el loco criminal que, como es un sujeto irracional, no respondía por su crimen. En los manicomios judiciales el control de los locos criminales no es exclusivo a los médicos psiquiatras, es necesaria la inclusión de otras categorías, como jueces de derecho, psicólogos, asistentes sociales, terapeutas ocupacionales e, incluso, el profesional de enfermería, que asocian sus saberes sobre el cuidado a otras formas de adiestramiento y control. El Instituto Psiquiátrico Forense convive con herencias del sistema carcelario, manifestadas por los profesionales de enfermería en sus rutinas diarias. Esos trabajadores tuvieron como "tutores" a agentes carcelarios y guardan modelos de trabajo, cuando ordenan y distribuyen los espacios para el control de los cuerpos de los pacientes. Esa forma de trabajar me pareció diferente de los lugares de actuación profesional. Esa forma de cuidar, naturalizada a lo largo del tiempo, produce profesionales de enfermería que repitan lo que les fue enseñado por carceleros, sin notar la fusión de roles. Por otro lado, el personal de enfermería parece no estar de acuerdo con la situación en la que viven e intentan no asociarse a los métodos disciplinares vigentes en esas instituciones. También he observado que los trabajadores pasan la mayor parte del tiempo organizando y adiestrando a los pacientes que circulan por los ambientes. Se trata de una organización minuciosa del tiempo y del espacio, en que el cuerpo es controlado y manipulado por técnicas disciplinares. Esas técnicas insieren, combinan y clasifican a los pacientes en los espacios. Así, a la enfermería le cabe "transformar" a los pacientes en aquello que sería la propuesta normalizadora de la Institución; fabricar determinado tipo de paciente, como un objeto que es moldeado, manipulado y revisado en una fábrica para presentar determinado comportamiento y pensamiento. Así, el loco internado en el Instituto Psiquiátrico Forense debe ser reajustado a las normas de la convivencia social, tarea en la cual la enfermería actúa activamente.

15 glycol ethers can be extracted from water by solidphase microextraction with a carboxen-polydimethyl-siloxane and separated by GC a Carbowax column. Water containing 15 glycol ethers at concentrations 0.1–10 mg.L−1 is saturated at ambient temperature with NaCl. A carboxen-polydimethylsiloxane-coated fiber is then exposed to the liquid for 20 min and then automatically injected into a capillary GC injection port. Calibration curves were linear for different glycol ethers in the rang 0.1–10 mg.L−1 Detection limits of each component of the mixture of glycol ethers between 50–500 μg.L−1. The SPME method with direct immersion in water results in better sensivity than methods based on liquid-liquid extraction.