Correr atrás do vento: o trabalho dos mototaxistas de Sobral, Ceará / Chasing the wind: the work of motorcycle taxi drivers from Sobral, Ceará / Perseguir el viento: el trabajo de los mototaxis de Sobral, Ceará

A pesquisa teve como objetivo geral analisar a atividade e o ofício dos mototaxistas de Sobral, Ceará. O objetivo específico foi compreender: a) a atividade exercida e o conceito de real da atividade; b) as prescrições; c) as regras informais; e d) as relações profissionais. A investigação adotou o referencial teórico da Clínica da Atividade, e participaram oito mototaxistas. Inspiradas no método da Instrução ao Sósia, foram realizadas e gravadas entrevistas semiestruturadas. Seu áudio foi transcrito e o conteúdo passou por análise construtivo-interpretativa. Os resultados mostraram que a atividade era regulamentada pela prefeitura e dependia da manutenção dos instrumentos utilizados. O expediente era organizado por uma regra do coletivo de trabalho relacionada ao horário de funcionamento de escolas e universidades. A busca por passageiros variava, sendo possível ficar em pontos fixos ou circular pela cidade. As condições ambientais demandavam cuidados como o uso de protetor solar e hidratação. A autonomia da profissão permitia organizar o próprio expediente e o ganho mensal. Entretanto, houve queixas relativas à falta de direitos previdenciários e ao fato de que a flexibilidade geraria uma sobrecarga de trabalho que poderia trazer prejuízos à saúde. Riscos foram identificados em acidentes de trânsito e violência urbana. Os relatos acerca das relações com os colegas mostraram um ambiente amistoso, e as relações com os passageiros eram definidas por cada situação, abrangendo desde interações objetivas até conversas pessoais.(AU)

The research had as general objective to analyze the activity and the work of motorcycle taxi drivers in Sobral, Ceará. Specific objectives were to understand: (a) the activity performed and the real of activity; (b) the prescriptions; (c) informal rules and (d) professional relationships. The investigation adopted the theoretical framework of the Clinic of Activity. Eight motorcycle taxi drivers participated in the investigation. Inspired by the instruction to the double method, semi-structured interviews were conducted. The audio of the interviews was transcribed and underwent constructive-interpretive analysis. The results showed that the activity was regulated by the city and depended on the maintenance of the instruments used. The working hours were organized by a collective labor rule related to the opening hours of schools and universities. The looking-for for passengers also varied: it was possible to stay at fixed points or move around the city. Environmental conditions required care such as the use of sunscreen and hydration. The profession's autonomy made it possible to organize its own hours and monthly earnings. However, there were complaints regarding the lack of social security rights and that flexibility would create an overload of work that could harm health. Risks have been identified in traffic accidents and urban violence. Reports about relationships with colleagues showed a friendly atmosphere. Relations with passengers were defined by each situation, ranging from objective interactions to personal conversations.(AU)

La investigación tuvo como objetivo general analizar la actividad y el trabajo de los mototaxis en Sobral, Ceará. Los objetivos específicos eran comprender: (a) la actividad realizada y la real de la actividad; (b) las prescripciones; (c) reglas informales y (d) relaciones profesionales. La investigación adoptó el marco teórico de la Clínica de Actividad. En la investigación participaron ocho mototaxis. Inspirándose en el método de instrucción al doble, se realizaron entrevistas semiestructuradas. El audio de las entrevistas fue transcrito y sometido a un análisis constructivo-interpretativo. Los resultados mostraron que la actividad estaba regulada por la prefectura municipal y dependía del mantenimiento de los instrumentos utilizados. Los horarios de trabajo fueron organizados por una norma laboral colectiva relacionada con los horarios de apertura de escuelas y universidades. La búsqueda de pasajeros también variaba: era posible permanecer en puntos fijos o moverse por la ciudad. Las condiciones ambientales requerían cuidados como el uso de protector solar e hidratación. La autonomía de la profesión permitió organizar sus propias horas y ganancias mensuales. Sin embargo, hubo quejas sobre la falta de derechos de seguridad social y que la flexibilidad crearía una sobrecarga de trabajo que podría dañar la salud. Se han identificado riesgos en accidentes de tráfico y violencia urbana. Los informes sobre las relaciones con los colegas mostraron un ambiente agradable. Las relaciones con los pasajeros se definieron por cada situación, desde interacciones objetivas hasta conversaciones personales.(AU)

Estresse por calor na Atenção Primária à Saúde: uma revisão clínica / Heat stress in Primary Health Care: A clinical review / Estrés por calor en la Atención Primaria a la Salud: una revisión clínica

Introdução: A exposição nociva ao calor ganha mais relevância com a progressão do aquecimento global antropogênico e a Atenção Primária à Saúde (APS) tem um papel crescente nesse cenário. No Brasil, as ondas de calor entre 2014 e 2015 duraram mais tempo que nos anos prévios, além disso, entre 2000-2015 a associação entre temperatura e hospitalizações variou de acordo com a duração da exposição ao calor. Nesse contexto, o objetivo desta revisão é realizar uma atualização sobre manejo clínico de patologias relacionadas ao calor na APS. Metodologia: Realizou-se a busca na base de dados ACCESSS, que utiliza a pirâmide 5.0 da assistência à saúde baseada em evidências. Foram identificados 103 sumários sintetizados para referência clínica com as palavras "Heat stress", "Heat Stroke", "Heat Wave" e "Heat Exhaustion", mas apenas três entravam no escopo deste estudo. Resultados e Discussão: O estresse pelo calor é uma condição comum, negligenciada e evitável que afeta diversos pacientes, iniciando-se com uma má adaptação ao calor que se não for corrigida pode gerar uma cascata de eventos inflamatórios. O estresse pelo calor é caracterizado por sintomas inespecíficos, como mal-estar, cefaleia e náusea. O tratamento envolve o resfriamento do paciente e monitoramento, garantindo hidratação adequada. A exaustão pelo calor, se não tratada, pode evoluir para insolação, uma doença grave que pode levar ao coma e morte, envolvendo disfunção do sistema nervoso central - necessitando de um tratamento mais agressivo além do resfriamento

Introduction: The nocive exposure to heat gets more attention with anthropogenic global warming, and Primary Health Care (PHC) has a growing role in this scenario. In Brazil heat waves between 2014 and 2015 lasted longer than in previous years. Further, in addition between 2000-2015 the association between temperature and hospitalizations varied according to the duration of heat exposure. Therefore, the aim of this review is to perform an update on clinical management of heat related pathologies in PHC. Methodology: The ACCESSS database was searched using the evidence-based health care pyramid 5.0, where we identified 103 synthesized summaries for clinical reference with words "Heat stress", "Heat Stroke", "Heat Wave" and "Heat Exhaustion", but only three fell within the scope of this study. Results and Discussion: Heat stress is a common, neglected and preventable condition that affects several patients, it starts with a poor adaptation to heat that if it is not adjusted it can generate a cascade of inflammatory events. Heat stress is characterized by nonspecific symptoms such as malaise, headache and nausea. The treatment involves patient monitoring and cooling, ensuring adequate hydration. Heat exhaustion, if untreated, can progress to heatstroke, a serious illness that can lead to coma and death, involving central nervous system dysfunction - requiring more aggressive treatment than cooling.

Introducción: La exposición nociva al calor gana más destaque con la progresión del calentamiento global antropogénico, y la Atención Primaria a la Salud tienen un papiel cresciente en este escenario. En Brasil las olas de calor entre 2014 y 2015 duraron más tiempo que en los años previos, además entre 2000-2015 la asociación entre temperatura y hospitalizaciones ha variado de acuerdo con la duración de la exposición al calor. En este contexto, el objetivo de esta revisión es realizar una actualización sobre manejo clínico de patologías relacionadas al calor en la APS. Metodología: Se realizó la búsqueda en la base de datos ACCESSS, que utiliza la pirámide 5.0 de la asistencia a la salud basada en evidencias. Se han identificado 103 sumarios sintetizados para referencia clínica con las palabras "Heat stress", "Heat Stroke", "Heat Wave" y "Heat Exhaustion", pero sólo tres son considerados en el ámbito de este estudio. Resultados y Discusión: El estrés por el calor es una condición común, descuidada y evitable que afecta a varios pacientes, iniciándose con una mala adaptación al calor que si no se corrige puede generar una cascada de eventos inflamatorios. El estrés por el calor se caracteriza por síntomas inespecíficos, como malestar, cefalea y náuseas. El tratamiento implica el enfriamiento del paciente y el monitoreo, garantizando la hidratación adecuada. El agotamiento por el calor, si no se trata, puede evolucionar hacia la insolación, una enfermedad grave que puede llevar al coma y a la muerte, involucrando disfunción del sistema nervioso central - necesitando un tratamiento más agresivo además del enfriamiento.

Dados de estação meteorológica oficial subestimam o estresse por calor em bovinos leiteiros criados em ambiente tropical / Official meteorological station data underestimate the heat stress on dairy cattle in a tropical environment

Determinaram-se os valores de temperatura do ar, umidade relativa e índice de temperatura e umidade (ITU) de uma propriedade rural de produção de leite a pasto e da estação meteorológica oficial mais próxima, confrontando-os. Na fazenda, as leituras dos dados foram registradas por uma estação meteorológica automática, a cada cinco minutos, de fevereiro de 2015 a setembro de 2016. Depois, calcularam-se a média por hora e o ITU horário. Selecionaram-se os valores diários mínimo, médio e máximo. O mesmo foi feito com os dados da estação meteorológica oficial, que foram horários. As temperaturas mínima e média na estação meteorológica foram maiores que na fazenda durante todo o período experimental e em 16 meses, respectivamente. A temperatura máxima da propriedade rural foi maior que a da estação em seis meses. Já a umidade relativa mínima, a média e a máxima da estação meteorológica foram inferiores às da fazenda. O ITU mínimo foi maior na estação oficial e o ITU máximo superior na fazenda em todos os meses. Por fim, o número de dias com um ITU máximo igual ou superior ao ITU crítico foi maior na fazenda. Assim, dados da estação meteorológica oficial subestimam o estresse por calor.(AU)

The values of air temperature, relative humidity and Temperature Humidity Index (THI) of one pasture-based milk production farm and from the nearest official weather station were confronted. At the farm, data readings were recorded by an automatic weather station, every five minutes, from February 2015 to September 2016. Then, the hourly average and hourly THI were calculated. The minimum, average, and maximum daily values were selected. The same was done with data from the official hourly weather station data. The minimum and mean temperature in the meteorological station were higher than on the farm throughout the experimental period and in 16 months, respectively. The maximum temperature of the rural property was greater than that of the station in six months. Meanwhile, the minimum, average, and maximum relative humidity of the meteorological station were lower than those of the farm. The minimum THI was higher at the official station and the maximum THI was higher at the farm in every month. Finally, the number of days with a maximum THI equal to or greater than the critical THI was greater on the farm. Thus, official weather station data underestimate the heat stress.(AU)

Ocorrência do SNP c.767G>T no gene DNM1responsável pelo colapso induzido pelo exercício em cães da raça Labrador Retriever no estado de São Paulo / Occurrence of DNM1 SNP c.767G>T responsible for exercise-induced collapse in Labrador Retriever in the Sao Paulo state

O colapso induzido pelo exercício (EIC) é considerado uma síndrome autossômica recessiva que afeta principalmente cães da raça Labrador Retriever. A doença é caracterizada por fraqueza muscular e colapso após exercício intenso. Usualmente, ocorre recuperação clínica após o episódio, mas alguns animais podem vir a óbito. Os sinais clínicos são decorrentes do polimorfismo de base única (SNP) c.767G>T no gene Dynamin 1 (DNM1). O objetivo deste trabalho foi determinar a ocorrência deste SNP em 321 cães da raça Labrador Retriever do Estado de São Paulo. Primers específicos para a amplificação de todo o exon 6 do gene DNM1 foram usados nas PCRs utilizando DNA a partir de amostras de sangue ou swab bucal, a avaliação final foi realizada com sequenciamento direto dos produtos da PCR. Dentre os 321 animais estudados, 3,4 % (11/321) eram homozigotos para o SNP c.767G>T no gene DNM1 e 24,6% (79/321) eram heterozigotos. Somente um dos 11 animais homozigotos apresentavam sinais clínicos compatíveis com a EIC. Este é o primeiro estudo sobre a ocorrência deste SNP no Brasil e considerando que quase 25% dos animais estudados eram heterozigotos, a genotipagem dos animais para este SNP pode ser importante antes dos acasalamentos para cães desta raça. A EIC deve ser considerada nos diagnósticos diferenciais de enfermidades neuromusculares em cães da raça Labrador Retriever.

The exercise-induced collapse (EIC) is considered an autosomal recessive syndrome that mainly affects Labrador Retriever dogs. The disease is characterized by muscle weakness and collapse after intense exercise. Recovery usually occurs after exercise but some animals may die. The clinical signs occurs due to the single-nucleotide polymorphism (SNP) c.767G>T in Dynamin 1 (DNM1) gene. The aim of this study was to evaluate the occurrence of this SNP in 321 Labrador Retriever dogs from São Paulo state. Specific primers for amplification of the entire exon 6 of the DNM1 gene were used in a PCR performed with DNA from blood or buccal swab samples, direct sequencing was performed for the final evaluation. Among 321 animals studied, 3.4% (11/321) of animals were homozygous for the DNM1 SNP (c.767G>T) and 24.6% (79/321) were heterozygous. Only one of the 11 homozygous animals in this study had previous clinical signs compatible with this disease. This is the first study that evaluated the occurrence of DNM1 SNP (c.767G>T) gene in Brazil and considering that almost 25% of the studied animals were heterozygous, the routinely evaluation of this SNP may be important before this breed mating The EIC should be include in the differential diagnosis of neuromuscular diseases in Labrador Retriever dogs.

Development and Implementation of Emergency Department based Heat related Illness Active Surveillance System: Effect of Heat Index on Daily Emergency Department Visits due to Heat related Illness

PURPOSE: To evaluate the effect of heat wave on emergency department (ED) visits due to heat related illness, we developed an ED based active surveillance system. We want to identify epidemiology of ED visits due to heat related illness and determine the effect of heat index on daily ED visits due to heat related illness. METHODS: We developed an ED based active surveillance system for adults who visited the ED due to heat stroke, heat exhaustion, heat syncope, heat edema, and heat cramp. We collected demographic and clinical variables, risk factors, and heat index by standardized registry on the webpage. We operated the surveillance into 16 emergency departments in Daegu City from June to September 2011. We analyzed epidemiologic variables descriptively and assessed the effect of heat index on the number of daily ED visits by multivariate Poisson regression analysis. RESULTS: During the study period, 34 cases were registered and nine cases were heat stroke. Heat stroke patients were older, and had more unemployment status than those with other heat related illness (p<0.05). More ED visits due to heat related illness were observed during the danger period than during the cool period, classified by heat index severity (Adjusted odds ratio: 1.72, 95% CI: 1.33-2.23). Increasing heat index by one degree caused more ED visits due to heat related illness (Adjusted incident rate ratio: 1.13, 95% CI: 1.07-1.19). CONCLUSION: We developed an ED based active surveillance system and observed more elderly persons and lower educational level in patients with heat stroke. In addition, increase in heat index significantly affected more daily ED visits due to heat related illness.

Clinical and genetic features in patients with cystic fibrosis in southwestern Iran

Cystic fibrosis [CF] is a common autosomal recessive genetic disease caused by a mutation in the CF transmembrane conductance regulatory [CFTR] gene. This study attempted to identify the most common CFTR mutations and any correlations between certain mutations and the clinical presentation of the disease in CF patients in southwestern Iran. Twenty nine common CFTR gene mutations were examined in 45 CF patients. Chronic cough, intestinal obstruction, dehydration, heat exhaustion and steatorrhea were the most common early clinical symptoms among our patients. The most common mutation was deltaF508, with an allele frequency of 21%. The homozygous deltaF508 mutation was observed in eight patients [18%], and three patients [7%] were deltaF508 carriers. The 2183AA>G mutation was observed in four patients, one of whom was also a deltaF508 carrier. The R1162X mutation was detected in two patients. The G542X, R334W and N1303K mutations were detected each in one patient, the first of whom was also a deltaF508 carrier. Out of 45 patients, 27 [60%] had none of the CFTR gene mutations we tested for. The most frequent mutations in southwestern Iranian patients with CF should be identified by sequencing the entire CFTR gene in order to optimize the design of a diagnostic kit for common regional mutations

Role of PPARβ in fibroblast response to heat injury.

Peroxisome proliferator-activated receptors (PPARs) belong to the nuclear hormone receptor family of ligand-inducible transcription factors. Our previous study has shown that in human umbilical vein endothelial cells PPARβ initiates a protective mechanism that limits the extent of damage due to H2O2-induced injury. Although fibroblasts are one of the main cell types involved in wound repair, the role of PPARβ in the fibroblast response to heat injury has not been investigated. Thus, in this study, we examined possible protective role of PPARβ in fibroblasts from heat injury. We developed a novel dermal fibroblast heat injury model to characterize the mechanisms of the heat injury healing response that involved PPARβ. The specific PPARβ ligand GW0742, a PPARβ activator and a short hairpin RNA (shRNA) plasmid against PPARβ were used to reveal the action mechanism of PPARβ in heat injury-induced fibroblast changes in morphology and increased proliferation. In response to heat injury (52˚C for 30 s), fibroblast activation of PPARß, increased 1.56-fold. Administration of GW0742 significantly induced a protective effect on heat injury-induced fibroblasts by minimizing the structural damage and increasing the cell proliferation response. Likewise, inhinition of PPARß, usingh shRNA exacerbated the damage by inhibiting the de novo synthesis of PPARß. These results indicated that heat injury enhanced PPARß expression and PPARß protected fibroblast structure and proliferation.

Electrocardiographic findings in heat stroke and exhaustion: a study on Makkah pilgrims

Over two million pilgrims perform annual rituals in Makkah region, which when coincides with summer months, exposes them to outdoor temperatures exceeding 45 °C and humidity approaching 80%. Accordingly, heat illnesses are common including explicit heat strokes and heat exhaustion. No previous studies elaborated on electrocardiographic changes among this unique cohort. To compare electrocardiographic changes in three groups exposed to high outdoor temperatures, namely, patients with heat stroke compared to patients with heat exhaustion and a control group exposed to the same outdoor temperatures without clinical manifestations. Through case control design, two case groups of patients were selected. The first group [Gl] was 34 patients admitted to the cooling units with clinical picture of heat stroke and the second group [G2] comprised 28 patients admitted with heat exhaustion. The control group [G3] included 31 patients selected from relatives of patients and outdoor workers. The outcome for comparison was 12-lead electrocardiographic changes done for all selected individuals. For [Gl], the ECG was done while they were prepared for cooling or immediately when cooling was started. In Gl, 18 were females and 16 males with ages of 20-76 years [59 +/- 11 years]. Their heart rates ranged from 64 to 160 beats per minute [mean 120 +/- 24 per minute]. Only 5/34 ECGs were completely normal. Sinus tachycardia was present in 27/34 patients [79%], with ischemic changes in 9/34 ECGs. In G2, 24 were males and four females with ages of 25-80 [mean 47 +/- 15 years], the heart rate ranged from 64 to 170 per minute [mean 97 +/- 16 per minute]. Seven out of 28 ECGs were normal [25%] while 21/28 had some abnormalities. None had ischemic changes. Control group [G3], was five females and 26 males ages 18-80 years [mean 38 +/- 15 years], 22/31 had normal ECGs [71%]. All had normal sinus rhythm, 56-98 beats per minute [74 +/- 11]. Nine patients had some electrocardiographic abnormalities but none had ischemic changes. We conclude that electrocardiographic abnormalities occur with a high frequency in patients with heat stroke and heat exhaustion, with sinus tachycardia and ischemic changes occurring more frequently in patients with heat stroke

Characteristics of Summer Heatwave Victims of Emergency Department Visits in Korea During 2011: Results from the Surveillance System of Heat-related Illness Based on Emergency Department

PURPOSE: The aim of this study was to examine characteristics of health-related victims identified through the Surveillance System of Heat-related Illness (SSHI) based on emergency department (ED) visits. METHODS: Between July 1 and September 3 of 2011, 443 heat-related patients were reported by 396 of the 461 EDs participating in the SSHI. Heat-related illness included heat (sun) stroke, heat cramp, heat syncope, and heat exhaustion. A hot day was defined as a day above 30degrees C of daily maximum temperature in locations of provincial and metropolitan government offices. We used chi square test for identification of risk factors associated with Heat-related illness in the workplace and heat-related illness heat (sun) stroke. RESULTS: Heatwave, defined as lasting three or more hot days, occurred three times during this period. The daily average number of heat-related patients reported during the heatwave period was 15.7 per day, more than four times the usual rate. The daily maximum temperature showed positive correlation with occurrence of heat-related illness. Heat exhaustion was the most frequent cause (46.0%), with approximately 70% of all cases occurring between noon and 6 p.m. The number of people suffering from heat-related illness while outdoors was three times greater than that of those who experienced it indoors. Work-related occurrence comprised 56.7% of all cases. All six deaths occurred during the heatwave period and were work-related. CONCLUSION: Working conditions, outdoor activities, and old age may be associated with health-related illnesses. A surveillance system that monitors emergency room visits may be useful in assessment of adverse health effects of summer heatwaves.

Impact of occupational heat exposure on male reproductive health

Humans are exposed to several exogenous chemicals used in industrial processes, development activities and also through food chain. The male reproductive system is vulnerable to the effects of the physical and chemical factors. This is a review of literature to determine the influence of occupations involving high temperature on the male reproductive health. We concluded that occupational heat exposure will alter spermatogenesis and also affect sperm morphology, therefore it is overall a risk factor for male infertility. A few studies have shown that the occupational heat exposure to male partner can cause low birth weight, preterm delivery, and spontaneous abortion which may be due to genetic mutations in human sperm. However, more prospective studies are needed to ascertain this fact

Desidratação e recomendações para a reposição hídrica em crianças fisicamente ativas: [revisão] / Dehydration and rehydration recommendations for physically active children: [review]

OBJETIVO: A prática de exercícios físicos, devido à produção inerente de calor, pode conduzir à desidratação. A maioria dos estudos que abordam os riscos da desidratação e fornecem recomendações de reposição hídrica é direcionada a indivíduos adultos residentes em regiões de clima temperado, porém, em regiões tropicais, pouco é conhecido sobre as necessidades de reposição hídrica em crianças fisicamente ativas. Esta revisão discute as recomendações para esta população e estabelece os riscos da prática esportiva em ambiente de clima tropical. FONTES DE DADOS: Análise sistemática com levantamento da literatura nacional (SciELO) e internacional (Medline) de artigos publicados entre 1972 e 2009, com os seguintes descritores isolados ou em combinação: hidratação, crianças, desidratação e reposição hídrica. Foram selecionados artigos publicados nas línguas portuguesa e inglesa. SÍNTESES DE DADOS: Observou-se que há riscos de desidratação e possível desenvolvimento de um quadro de hipertermia principalmente se as crianças são submetidas a condições climáticas desfavoráveis sem reposição hídrica adequada. O principal fator desencadeante da hipertermia é a menor adaptação das crianças aos extremos de temperatura, em comparação aos adultos, por possuírem área maior de superfície corporal e capacidade menor de termorregulação por evaporação. CONCLUSÕES: Conhecidos os fatores intervenientes da desidratação, a melhor recomendação, perante uma condição climática sabidamente desfavorável, é estabelecer um plano impositivo de hidratação com bebida com sabor e acréscimo de carboidratos e sódio, evitando-se uma perda hídrica significativa, diminuição da performance e, principalmente, com o objetivo de reduzir os riscos à saúde impostos pela hipertermia e desidratação a crianças fisicamente ativas.

OBJECTIVE: The practice of physical exercises leads to dehydration due to heat production. Most studies that address the risks of dehydration and provide recommendations for restoring water are directed to adults living in temperate climate regions, but little is known about the needs of restoring water to physically active children in tropical regions. This review discusses the recommendations for this population and the risks of sports practice in tropical climate areas. DATA SOURCE: Systematic analysis of the national (SciELO) and international (Medline) literature from 1972 to 2009, with the following keywords, alone or in combination, in Portuguese and English: hydration, children, dehydration and water replacement. DATA SYNTHESIS: There are risks related to dehydration and possible development of hyperthermia especially in adverse weather conditions without adequate fluid replacement. The main trigger for hyperthermia is that, compared to adults, children are less able of adapting to extremes of temperature due to their higher body surface area and lower capacity of thermoregulation by evaporation. Studies on this subject are scarce in face of the questions still open. CONCLUSIONS: Once dehydration factors are known, the best recommendation to aggressive climatic conditions is to establish a replacement program using flavored hydration beverage added with carbohydrates and sodium in order to avoid significant water losses and reduced performance, and to decrease health risks posed by hyperthermia and dehydration to physically active children.

Evaluación de exposición a calor: alcances y limitaciones de los indicadores: su interpretación y correcta aplicación / Heat exposure assessment: scope and limitations of indicators: its interpretation and proper application

Se analizan los fundamentos, alcances y limitaciones de los indicadores TGBH (Temperatura de Globo y Bulbo Húmedo), Tasa Requerida de Evaporación de Sudor y Frecuencia Cardiaca. Se presentan distintos casos experimentales, en los cuales se realiza una evaluación detallada de la exposición a calor utilizando estos estándares.

This paper discusses the foundations, scope and limitations of Wet Bulb Globe Temperature (WBGT) indicators, required rate of sweat evaporation and heart rate. The study presents various experimental cases on which a detailed evaluation of heat exposure using these standards is carried out.

Prevención de enfermedades estivales / Prevention of summer diseases

En este artículo se informa cómo las variaciones climáticas afectan la salud de la población y se analizan las enfermedades más comunes en el período estival, así como la forma de prevenirlas, con el objetivo de promover el rol educador de los enfermeros

Colapso pelo calor esforço induzido: reconhecimento para salvar vidas e tratamento imediato em instalações atléticas / Exertional heat stroke: life-saving recognition and onsite treatment in athletic settings

O prognóstico do colapso pelo calor esforço induzido depende do produto do tempo de duração em que a temperatura central ficou elevada e do grau da elevação. O atleta com EHS que tem pronta descoberta e que é resfriado de maneira eficiente, muito provavelmente irá sobreviver ao episódio com pouco ou nenhum efeito residual. Em contraste, o atleta com apresentação atrasada para o tratamento, especialmente se a área sob a curva de resfriamento for > 60 graus-minuto (centígrados) terá um curso complicado e geralmente fatal. Os métodos de condução do resfriamento com imersão em gelo ou água gelada ou envolvimento em toalhas com água gelada proporcionarão uma rápida e consistente redução da temperatura de todo o corpo, que irá salvar tanto os órgãos quanto a vida. O reconhecimento depende em alto grau da suspeita por parte dos próprios atletas, treinadores e pessoal médico local. Em condições de alto risco, os atletas devem se supervisionar, procurando por mudanças sutis que podem ser sinais de EHS.(AU)The prognosis for exertional heat stroke depends upon the product of length of time the core temperature is elevated and the degree of elevation. The athlete with EHS who is discovered promptly and efficiently cooled will most likely survive the episode with little if any residual. In contrast, the athlete who has delayed presentation for treatment, especially if the area under to cooling curve is > 60 degree-minutes (centigrade), will have a complicated and often fatal course. Conductive cooling methods with ice or cool water immersion or rotating ice water cooled towels provide rapid and consistent whole body temperature reduction that is both organ and life saving. Recognition depends on a high index of suspicion on the part of athletes, coaches, and onsite medical personnel. In high risk conditions, athletes should "buddy up" to watch for subtle changes that can signal the onset of EHS.(AU)El pronóstico del choque térmico (CT) relacionado con el ejercicio depende...

Síndrome de agobio por calor. Rabdomiolisis / Syndrome of oppression by heat. Rhabdomyolysis

Paciente masculino de 35 años de edad, se desmayó al final de una maratón de 21 Km. El problema fue una rabdomiolisis secundaria a un síndrome de agobio por calor. El paciente recibió tratamiento durante 72 horas y mejoró rápidamente; sus laboratorios fueron normales y no tuvo complicaciones. Las condiciones ambientales (humedad y temperatura) así como la altitud sobre el nivel del mar pueden ser peligrosas para los atletas independientemente de su condición física

Automobilismo: no calor da competicão / Car racing: in the heat of competition

O presente artigo questiona o papel do calor como um fator de risco adicional para o acidente que vitimou Ayrton Senna. O automobilismo de competicão constitui um desafio biológico, uma situacão estressante do ponto de vista mental e físico. A manutencão da performance depende da disponibilidade de carboidratos e oxigênio, hidratacão adequada e temperatura interna constante entre 37 e 38 graus centígrados. A dissipacão do calor produzido pelo metabolismo ocorre através do aumento do fluxo de sangue para pele e producão de suor e manter a temperatura cerebral constante se constitui num problema permanente. Verificou-se experimentalmente que a energia necessária para dirigir um automóvel de corrida é comparável a um esporte como o voleibol. Durante uma corrida, o indivíduo está exposto a um microambiente quente na cabina, que pode atingir 50ºC, gerado por fontes de calor mecânicas e ambientais. O bloqueio da evaporacão do suor pelo macacão resulta em umidade e desconforto pessoal, o que implica maior esforco mental para dirigir o carro. As medidas contra o calor comecam antes da corrida, cuidando-se do estado nutricional, da hidratacão e principalmente do condicionamento físico através de exercícios aeróbios regulares e adequados, que permitem aumentar a capacidade de trabalho e a tolerância ao calor, o que resulta em menor fadiga durante a corrida. Outro procedimento importante deveria ser a aclimatacão prévia dos pilotos aos ambientes quentes e úmidos. Deve-se fazer o possível para reduzir o aquecimento do veículo e respeitar o sistema de bandeiras de advertência para os riscos de hipertermia. Em conclusão, embora Ayrton Senna fosse um indivíduo com maior risco de desenvolver hipertermia, independentemente de outras causas, não parece ter havido tempo de corrida suficiente para haver producão de calor metabólico capaz de aumentar excessivamente a temperatura interna do piloto nas condicões ambientais do autódromo no dia de sua morte.