Abnormal transcranial Döppler ultrasonography in children with sickle cell disease

BACKGROUND: Stroke is a potentially fatal complication of sickle cell disease in children between 2-16 years and transcranial Döppler has been recommended as a screening method in these cases. OBJECTIVE: The main goal of this study was to correlate transcranial Döppler results to complications related to stroke in sickle cell disease and baseline characteristics of the population. METHODS: This was an observational study of children and adolescents with ages between 2-16 years with sickle cell disease who were followed in three centers. RESULTS: From January 2008 to July 2009, 902 patients were enrolled in this study. The median age was 6.5 years (range: 1.8-15.8), 52.3% were male, 74.4% had hemoglobin SS; 221 (28.6%) had at least one complication associated with sickle cell disease. A total of 773 patients performed transcranial Döppler; in 91.2% this was a method of screening. Conditional or abnormal transcranial Döppler results were more common in patients with sickle cell disease complications versus those without complications (ODDS ratio = 3.18; 95% Confidence interval = 1.92-5.27). There was a significant difference in the frequency of conditional or abnormal transcranial Döppler results in patients with abnormal laboratory results compared to those without abnormalities (OR=4.03); 95% confidence interval = 2.30-7.06. CONCLUSIONS: Conditional or abnormal transcranial Döppler results were significantly more frequent in patients with complications of sickle cell disease confirming the increased risk of stroke in this subgroup of patients. This observation reinforces the recommendation of transcranial Döppler as a screening test for all patients with sickle cell disease with ages between 2 and 16 years.

Impacto das atividades profissionais na saúde física e mental dos policiais civis e militares do Rio de Janeiro (RJ, Brasil) / The impact of professional activities on the physical and mental health of the civil and military police of Rio de Janeiro (RJ, Brazil)

Neste artigo, analisamos o adoecimento físico e mental de policiais civis e militares do Estado do Rio de Janeiro, segundo condições de trabalho e atividades profissionais. Utilizamos a mesma metodologia para o estudo de duas categorias: abordagem quantitativa (amostragem aleatória simples por conglomerados, alcançando um total de 1.458 policiais civis e 1.108 policiais militares que responderam a questionários anônimos) e abordagem qualitativa (grupos focais com 143 profissionais e 18 entrevistas com gestores de ambas as polícias). Os dados aqui apresentados são todos originais. Constatamos sobrepeso e obesidade em especial na Polícia Militar; e precária frequência de atividade física e informação de elevados níveis de colesterol, especialmente na Polícia Civil. Dores no pescoço, nas costas ou na coluna, problemas de visão, dores de cabeça e enxaquecas foram os principais problemas encontrados. A presença de lesões físicas permanentes foi relatada por 16,2 por cento dos membros das duas corporações, sendo mais relevantes entre os militares, que também apresentam mais elevada frequência de sofrimento psíquico (SRQ-20). Enfatizamos a necessidade de mudanças nas dimensões individual e profissional e nos aspectos institucionais referentes às condições e à organização do trabalho e dos serviços de saúde.

In this article, we analyze the physical and mental stress and illness of military and civil police force officers in the State of Rio de Janeiro (Brazil) due to their working conditions and professional activities. The same methodology was used for the study of two categories, namely a quantitative approach (simple random sampling by conglomerates, involving a total of 1,458 civil police officers and 1,108 military police officers, who answered questionnaires anonymously) and a qualitative approach (focal groups involving 143 professionals and 18 interviews with managers of both police forces). The data presented here are all original. Disorders identified were: overweight and obesity in both forces but mainly in the Military Police; low frequency of physical exercise and high levels of cholesterol, especially in the Civil Police. The main health complaints are neck, back or spinal cord pain, eyesight complaints and headaches/ migraines. Sixteen point two per cent of officers of both forces reported physical lesions that were more prevalent in the Military Police, among whom psychic suffering was also more frequent (SRQ20). The need for changes in the individual and professional dimensions and in institutional aspects regarding the conditions and organization of work and of health services is emphasized.