Diretivas antecipadas de vontade: instrumento de autonomia para pacientes oncológicos / Advance directives: autonomy tool for cancer patients / Directivas anticipadas: un instrumento de autonomía para los pacientes oncológicos

Resumo Diretivas antecipadas de vontade permitem que pacientes designem um representante legal e manifestem seus desejos a serem cumpridos quando se tornarem incapazes de se comunicar. Neste estudo, objetivou-se avaliar o conhecimento e as preferências de pacientes oncológicos sobre essas diretivas. Trata-se de pesquisa quantitativa e transversal realizada por meio do preenchimento de dois modelos de diretivas antecipadas de vontade e da aplicação de um questionário. Constatou-se que 87,38% dos pacientes nunca tinham ouvido falar em tais diretivas, 97,2% desconheciam os modelos e 95% não referiram dificuldade de preenchimento. Após o esclarecimento, 93,46% consideraram importante que todas as pessoas elaborem as diretivas, 94,86% que elas sejam disponibilizadas aos pacientes e 91,12% que seja aprovada uma lei federal. O esclarecimento sobre o conceito de diretivas antecipadas de vontade contribuiu para aumentar o interesse de pacientes oncológicos pela utilização desse direito, que fortalece sua autonomia pessoal quando incapazes de se comunicar.

Abstract Advance directives allow patients to assign a legal representative and express their wishes to be fulfilled when they can no longer communicate. This study evaluated cancer patients' knowledge and preferences regarding these directives. A cross-sectional quantitative research was conducted by filling out two advance directive models and a questionnaire. Of the total sample, 87.38% had never heard of such document, 97.2% ignored the two models available and 95% had no difficulties filling it out. After clarifications, 93.46% considered it important for all patients to write a directive, 94.86% expressed that advance directives should be made available to patients and 91.12% argued that a federal law should be passed. Explaining the concept of advanced directives increased the interest of cancer patients in exercising this right which strengthen their autonomy.

Resumen Las directivas anticipadas permiten a los pacientes designar a un representante legal y manifestar sus decisiones cuando no puedan comunicarse. Este estudio evaluó el conocimiento y las preferencias de los pacientes oncológicos sobre este documento. Se realizó una investigación cuantitativa y transversal, mediante la respuesta a dos modelos de directivas anticipadas y la aplicación de un cuestionario. El 87,38% de los pacientes no conocían este documento, el 97,2% de ellos desconocían los modelos y el 95% declararon no tener dificultades para responderlos. Tras la aclaración, el 93,46% de los entrevistados consideraban importante que todos elaboraran el documento, el 94,86% que debían ponerlo a disposición de los pacientes y el 91,12% que se aprobara una ley federal. La aclaración del concepto de voluntades anticipadas contribuye a incrementar el interés de los pacientes oncológicos por hacer uso de este derecho, que refuerza su autonomía personal cuando ya no pueden comunicarse.

Dual Diagnosis in Adolescents with Problematic Use of Video Games: Beyond Substances.

The technological revolution has led to the birth of new diagnoses, such as gaming disorder. When any addiction, including this one, is associated with other mental disorders, it is considered a dual diagnosis. The objectives of this current work were to estimate the prevalence of dual diagnoses in the adolescent general population while also considering the problematic use of video games and substance addiction and assessing its psychosocial risk factors. Thus, we carried out a cross-sectional study with a sample of 397 adolescents; 16.4% presented problematic videogame use and 3% presented a dual diagnosis. Male gender increased the probability of both a dual diagnosis (OR [95% CI] = 7.119 [1.132, 44.785]; p = 0.036) and problematic video game use (OR [95% CI] = 9.85 [4.08, 23.77]; p < 0.001). Regarding personality, low conscientiousness, openness, and agreeableness scores were predictors of a dual diagnosis and problematic videogame use, while emotional stability predicted a dual diagnosis (OR [95% CI] = 1.116 [1.030, 1.209]; p = 0.008). Regarding family dynamics, low affection and communication increased both the probability of a dual diagnosis (OR [95% CI] = 0.927 [0.891, 0.965]; p < 0.001) and problematic video game use (OR [95% CI] = 0.968 [0.945, 0.992]; p = 0.009). Regarding academic performance, bad school grades increased the probability of a dual diagnosis. In summary, male gender, certain personality traits, poor communication, and poor affective family dynamics should be interpreted as red flags that indicate an increased risk of a dual diagnosis in adolescents, which could require early intervention through specific detection programs.

Sex Differences in Substance Use, Prevalence, Pharmacological Therapy, and Mental Health in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD).

Sex differences are poorly studied within the field of mental health, even though there is evidence of disparities (with respect to brain anatomy, activation patterns, and neurochemistry, etc.) that can significantly influence the etiology and course of mental disorders. The objective of this work was to review sex differences in adolescents (aged 13-18 years) diagnosed with ADHD (according to the DSM-IV, DSM-IV-TR and DSM-5 criteria) in terms of substance use disorder (SUD), prevalence, pharmacological therapy and mental health. We searched three academic databases (PubMed, Web of Science, and Scopus) and performed a narrative review of a total of 21 articles. The main conclusions of this research were (1) girls with ADHD are more at risk of substance use than boys, although there was no consensus on the prevalence of dual disorders; (2) girls are less frequently treated because of underdiagnosis and because they are more often inattentive and thereby show less disruptive behavior; (3) together with increased impairment in cognitive and executive functioning in girls, the aforementioned could be related to greater substance use and poorer functioning, especially in terms of more self-injurious behavior; and (4) early diagnosis and treatment of ADHD, especially in adolescent girls, is essential to prevent early substance use, the development of SUD, and suicidal behavior.

In Vitro Evaluation of Antioxidant and Anticancer Activity of Lemongrass (Cymbopogon citratus (D.C.) Stapf).

Cancer is considered a multifactorial disease and its development could be associated with several factors, for example, rotenone exposition. Unfortunately, many cancers are resistant to chemotherapy, as cervical cancer. Regarding this, lemongrass is a remarkable natural product that presents antioxidant and anticancer activities, which could show therapeutic action against rotenone and cervical cancer. Thus, this study aimed to investigate the antioxidant and anticancer action of lemongrass. An in vitro study was conducted using VERO (kidney cells) and SiHa cell lines (cervical cancer cells). VERO cells were exposed to rotenone and lemongrass extract for 24 and 72 h. While SiHa cells were exposed to lemongrass isolated and associated to chemotherapy, 5-fluorouracil, during 24 and 48 h. After, levels of viability, proliferation, and oxidative metabolism were determined. The results showed that lemongrass presents antioxidant activity on VERO cells by increasing cell viability and proliferation and decreasing oxidative stress caused by rotenone. Moreover, lemongrass showed anticancer activity by decreasing cell viability and increasing oxidative stress parameters on SiHa. Besides, lemongrass had no alteration in the chemotherapy activity. Therefore, this study revealed that lemongrass presents antioxidant and anticancer activity since it can protect against the cytotoxicity of rotenone and reduce the cell viability of cervical cancer.

Proposal for the Inclusion of Tobacco Use in Suicide Risk Scales: Results of a Meta-Analysis.

There is an association between smoking and suicide, even though the direction and nature of this relationship remains controversial. This meta-analysis aimed to evaluate the association between smoking and suicidal behaviours (ideation, planning, suicide attempts, and death by suicide). On 24 August 2020, we searched the PubMed, Cochrane library, Scopus, Web of Science, TRIP, and SCIENCE DIRECT databases for relevant articles on this topic. Twenty prospective cohort studies involving 2,457,864 participants were included in this meta-analysis. Compared with never smokers, former and current smokers had an increased risk of death by suicide (relative risk [RR] = 1.31; 95% CI [1.13, 1.52] and RR = 2.41; 95% CI [2.08, 2.80], respectively), ideation (RR = 1.35; 95% CI [1.31, 1.39] and RR = 1.84; 95% CI [1.21, 2.78]), and attempted suicide (RR = 1.27; 95% CI [0.56, 2.87] and RR = 1.71; 95% CI [0.73, 3.97]). Moreover, compared to never smokers, current smoker women (RR = 2.51; 95% CI [2.06-3.04] had an increased risk of taking their own life (Q = 13,591.53; p < 0.001) than current smoker men (RR = 2.06; 95% CI [1.62-2.62]. Furthermore, smoking exposure (former and current smokers) was associated with a 1.74-fold increased risk (95% CI [1.54, 1.96]) of suicidal behaviour (death by suicide, ideation, planning, or attempts). Thus, because of the prospective relationship between smoking and suicidal behaviours, smoking should be included in suicide risk scales as a useful and easy item to evaluate suicide risk.

Antioxidant and cytoprotective effects of avocado oil and extract (Persea americana Mill) against rotenone using monkey kidney epithelial cells (Vero).

Oxidative stress is known to be involved in development of numerous diseases including cardiovascular, respiratory, renal, kidney and cancer. Thus, investigations that mimic oxidative stress in vitro may play an important role to find new strategies to control oxidative stress and subsequent consequences are important. Rotenone, widely used as a pesticide has been used as a model to simulate oxidative stress. However, this chemical was found to produce several diseases. Therefore, the aim of this study was to investigate the antioxidant and cytoprotective effect of avocado (Persea americana Mill) extract and oil in monkey kidney epithelial cells (VERO) exposed to rotenone. VERO cells were exposed to IC50 of rotenone in conjunction with different concentrations of avocado extract and oil (ranging from 1 to 1000 µg/ml), for 24 hr. Subsequently, cell viability and oxidative metabolism were assessed. Data demonstrated that avocado extract and oil in the presence of rotenone increased cellular viability at all tested concentrations compared to cells exposed only to rotenone. In addition, extract and avocado oil exhibited antioxidant action as evidenced by decreased levels of reactive oxygen species (ROS), superoxide ion, and lipid peroxidation, generated by rotenone. Further, avocado extract and oil appeared to be safe, since these compounds did not affect cell viability and or generate oxidative stress. Therefore, avocado appears to display a promising antioxidant potential by decreasing oxidative stress.

Internações por Causas Sensíveis à Atenção Primária em Idosos da Região Centro-Sul do Estado do Paraná / Hospitalizations of the Elderly due to Primary Care-Sensitive Conditions in the South-Central Region of the State of Paraná

As Internações por Causas Sensíveis a Atenção Primária (ICSAP) são causadas por doenças cuja o atendimento deve ser realizado no primeiro nível de atenção e quando não realizado acarretam hospitalização, são os casos das pneumonias bacterianas, complicações da diabetes mellitus e da hipertensão arterial sistêmica, asma, entre outros. Com o objetivo de analisar os principais grupos de Doenças que acarretam as ICSAP em idosos da região Centro Sul do estado do Paraná, foi realizado um estudo descritivo, exploratório e ecológico, de idosos na faixa etária de 60 a 74 anos, no período de 2008 a 2018 no Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), disponibilizado no sítio eletrônico do Departamento de Informática do SUS (DATASUS). No período analisado houve 19.948 internações de idosos de 60 a 74 anos por CSAP, sendo 10.007 (50,16%) em homens e 9.941 (49,84%) em mulheres; o grupo de causas com maior incidência de internação são as das Doenças pulmonares com 23,86%, seguida das Pneumonias bacterianas com 20,47% e Insuficiência cardíaca com 12,59%, sendo que esses três grupos totalizaram mais 50% do total das internações. Os achados demonstram uma maior incidência masculina de ICSAP, sendo as Doenças pulmonares, pneumonias e insuficiência cardíaca, as principais patologias que atingem a população idosa da região estudada, reforçando a ideia de que ações de promoção e prevenção podem auxiliar na diminuição do número de internações e melhoria da qualidade de vida.

Hospitalizations due to Primary Care-Sensitive Conditions (HPCSC) are caused by diseases whose care must be carried out at the first level of care and when not carried out lead to hospitalization, such as bacterial pneumonia, complications of diabetes mellitus, systemic arterial hypertension, asthma, among others. In order to analyze the main groups of diseases that cause HPCSC in elderly people in the South-Central region of the state of Paraná, a descriptive, exploratory, and ecological study of elderly people aged 60 to 74 years was carried out from 2008 to 2018 using the Hospital Information System of the Unified Health System (HIS/UHS), available on the website of the UHS Department of Informatics (DATASUS). In the analyzed period, there were 19,948 hospitalizations of elderly people aged 60 to 74 years due to PCSC. 10,007 (50.16%) cases were of men and 9,941 (49.84%) of women; the group of causes with the highest incidence of hospitalization were pulmonary diseases at 23.86%, followed by bacterial pneumonia at 20.47%, and heart failure at 12.59%; and these three groups accounted for more than 50% of all hospitalizations. The findings demonstrate a higher male incidence of HPCSC, with lung diseases, pneumonia, and heart failure being the main pathologies that affect the elderly population in the studied region. This reinforces the idea that promotion and prevention actions can help to reduce the number of hospitalizations and improved quality of life.

Percepção de estudantes e médicos sobre autonomia na doação de órgãos / Perceptions of medical students and doctors of the autonomy in organ donation / Percepción de los estudiantes y de los médicos sobre la autonomía en la donación de órganos

Resumo A legislação brasileira adota a decisão familiar como critério para doação de órgãos e tecidos. O objetivo deste trabalho foi identificar o conhecimento e a opinião de professores médicos, residentes e alunos de medicina sobre o tema. Trata-se de estudo transversal descritivo com aplicação de questionário, respondido por 353 participantes: 304 estudantes, divididos em três ciclos de estudos, 19 residentes e 30 professores. Manifestaram-se favoravelmente à doação de órgãos e tecidos 99,1% das mulheres e 94,9% dos homens. Concordaram que o principal critério deveria ser a vontade da pessoa 104 (81,2% n=128) estudantes do ciclo básico, 62 (82,7% n=75) do clínico, 82 (81,2% n=101) do internato, 15 (78,9%) residentes e 25 (83,3%) professores. Concluiu-se que a manifestação prévia da pessoa constitui critério relevante para doar seus órgãos e tecidos, o que pode favorecer o respeito à sua autonomia, a aceitação familiar e o aumento do número de doadores. Aprovação CEP-Unoesc/Hust 1.799.732

Abstract Brazilian law adopts the family decision as a criterion for organ and tissue donation. The objective of this work was to assess the knowledge and opinion of medical professors, residents, and medical students on the subject. This was a descriptive cross-sectional study using a questionnaire. The survey was answered by 304 scholars split into 3 study cycles, 19 residents, and 30 professors totaling 353 participants. Of all participants, 99,1%% of women and 94,9% of men were in favor of organ and tissue donation. They agreed that the main criterion should be the person's will, 104 (81.2% n=128) students of the basic cycle, 62 (82.7% n=75) of the clinicians, 82 (81.2% n=101) from the internship, 15 (78,9%) of the residents, and 25 (83.3%) of the professors. It was concluded that the person's previous manifestation is a relevant criterion for donating their organs and tissues, which can promote respect for their autonomy, family acceptance, and the increase in the number of donors. Approval CEP-Unoesc/Hust 1.799.732

Resumen La legislación brasileña adopta la decisión familiar como criterio para la donación de órganos y tejidos. El objetivo de este trabajo fue identificar el conocimiento y la opinión de los médicos profesores, residentes y estudiantes de medicina sobre el tema. Se trata de un estudio descriptivo transversal con la aplicación de un cuestionario, al que respondieron 353 participantes: 304 estudiantes, divididos en tres ciclos de estudios, 19 residentes y 30 profesores. El 99,1% de las mujeres y el 94,9% de los hombres expresaron una opinión favorable sobre la donación de órganos y tejidos. Estuvieron de acuerdo que el criterio principal debe ser la voluntad de la persona, 104 (81,2% n=128) estudiantes del ciclo básico, 62 (82,7% n=75) del clínico, 82 (81,2% n=101) del internado, 15 (78,9%) residentes y 25 (83,3%) profesores. Se llegó a la conclusión de que la manifestación previa de la persona es un criterio relevante para la donación de sus órganos y tejidos, lo que puede favorecer el respeto de su autonomía, la aceptación de la familia y el aumento del número de donantes. Aprobación CEP-Unoesc/Hust 1.799.732

Ação interinstitucional e participação social na atuação da Comissão Intersetorial de Saúde do Trabalhador e da Trabalhadora: relato de caso / Interinstitutional action and social participation in the work of the Intersectoral Commission on Occupational Health: case report

Resumo Objetivo: socializar as estratégias desenvolvidas pela Comissão Intersetorial de Saúde do Trabalhador e da Trabalhadora (CISTT) do município de Joaçaba/SC, Brasil, entre os anos de 2012 e 2017. Métodos: relato de experiência com base em levantamento e análise documental de atas e relatórios da CISTT, matérias jornalísticas e sites de instituições públicas e de sindicatos. Resultados: diálogos e interação com a comunidade a respeito do tema de saúde do trabalhador (ST) por meio de promoção de seminários temáticos sobre trabalho e saúde, concurso e exposição de fotografias, concurso de redação e desenhos, publicação de livro, criação de lei municipal, implantação do sistema de Vigilância em Saúde do Trabalhador e discussão, proposição e acompanhamento de políticas públicas na área de ST. Conclusão: apesar das dificuldades e facilidades institucionais características de um município de pequeno porte, as atividades adotadas na implementação da CISTT se configuram como uma estratégia importante para a promoção da saúde no campo da ST.

Abstract Objective: to socialize the strategies developed by the Intersectoral Commission on Worker's Health (CISTT) of the municipality of Joaçaba/SC, Brazil, from 2012 to 2017. Methods: experience report based on documentary survey and analysis of CISTT's minutes and reports, newspaper articles and websites of public institutions and trade unions. Results: dialogues and interaction with the community through the promotion of thematic seminars on work and health; photo contest and exhibition; writing and drawing contest; book publishing; municipal law proposal and approval; implementation of the Occupational Health Surveillance System; discussion, proposition and monitoring of occupational health policies. Conclusion: despite the institutional difficulties and simplicities that are characteristic of small municipalities in Brazil, the activities adopted in CISTT implementation constitute an important strategy for worker´s health promotion.

Sex differences in subacute manganese intoxication: Oxidative parameters and metal deposition in peripheral organs of adult Wistar rats.

INTRODUCTION: Manganese (Mn) is an essential element required for several biological systems. However, it is toxic in excessive accumulation. The toxic effects following Mn overexposure is well known in the CNS but other studies evaluating other target tissues remain scarce. OBJECTIVE: This study aimed to investigate sex-related differences in oxidative stress, metabolic parameters and Mn deposition in peripheral organs of Wistar rats exposed to subacute model of intoxication. METHODS: Male and female adult Wistar rats received 6 or 15 mg/kg of MnCl2, intraperitoneally, 5 days a week, for 4 consecutive weeks to mimic subacute intoxication. Control group received sterile saline 0,9% following the same protocol. After this period, the metal accumulation, oxidative stress, mitochondrial activity and histological parameters in cardiac muscle, kidney, lungs and liver were analysed. RESULTS: Increased Mn concentrations were found in all organs, especially kidneys. The cardiac muscle analysis revealed increased lipid peroxidation and decreasing of GSH levels in both doses of Mn in male and female rats. The increase of lipid peroxidation in liver was more evident in the male group, and there was a significant decrease of antioxidant capacity in males' kidney. Nevertheless, there was an increase of mitochondrial complex I activity in kidney of females and increase of mitochondrial complex II activity in male group. Histological analysis revealed morphological changes in hepatic and pulmonary tissue. CONCLUSION: Taken together, our results showed that subacute Mn exposure lead to significant metabolic, biochemical alterations especially in kidney and liver. Nevertheless, despite Mn deposition was virtually the same in the peripheral organs of male and female rats, it promotes different toxic effects between sexes.

Percepção de pacientes oncológicos sobre terminalidade de vida / Perception of oncology patients on the terminality of life / Percepción de los pacientes oncológicos sobre la terminalidad de la vida

Resumo Objetivou-se analisar, por meio de pesquisa descritiva, a percepção de pacientes oncológicos diante da terminalidade da vida. Aplicou-se questionário para 100 pacientes oncológicos, dos quais 85% desconheciam testamento vital/diretivas antecipadas de vontade, 81% desconheciam cuidados paliativos e 70% desconheciam ordem de não reanimar. Após esclarecimento sobre os termos empregados, 62% concordariam em elaborar testamento vital/diretivas antecipadas de vontade, 82% concordariam em receber cuidados paliativos no domicílio e 64% em ser reanimados em qualquer situação, mas a maioria (73%) discordou da prática de distanásia. Apenas 11% referiram inadequação na forma de comunicação de seu diagnóstico pelo médico. A presença de metástases suscitou reflexão mais ampla sobre terminalidade da vida. Os resultados permitem inferir que é necessário incentivar a discussão sobre terminalidade da vida na população durante a assistência aos pacientes, bem como estimular o debate sobre o assunto durante a formação de profissionais de saúde.

Abstract With the aim of analysing the perception of cancer patients towards the end of life, a questionnaire was applied to 100 oncologic patients, of which 85% were unaware of living will/advance directives, 81% were unaware of the terms palliative care and 70% were unaware of order to not reanimate. After clarifying the meaning of the terms used, 62% agreed to make living will/advance directives, 82% to receive palliative care at home and 64% to be reanimated in any situation, but the majority (73%) disagreed with the practice of futility. Only 11% reported inadequacies in the communication of their diagnosis by the physician. The fact of having metastases elicited a broader reflection on the termination of life. The results allow to infer that it is necessary to encourage the discussion about termination of life to the population during patient care, as well to promote the respective training to health professionals since the undergraduate course.

Resumen Con el fin de analizar la percepción de los pacientes con cáncer frente al final de su vida, a través de una investigación descriptiva, se aplicó un cuestionario a 100 pacientes de cáncer, entre los cuales el 85% desconocía las directivas anticipadas de voluntad, el 81% desconocía los términos de cuidados paliativos y el 70% desconocía la orden de no reanimar. Después de la clarificación del significado de los términos utilizados, el 62% estaba de acuerdo para elaborar su testamento vital/directivas anticipadas de voluntad, el 82% para recibir los cuidados paliativos en el hogar y el 64% para ser restablecido en cualquier situación, pero la mayoría (73%) no estuvo de acuerdo con la distanasia. Tan sólo el 11% consideró inadecuada la comunicación del diagnóstico por el médico. El hecho de portar metástasis amplió la reflexión sobre el final de la vida. Los resultados muestran que es necesario fomentar la discusión del final de la vida en la población durante la atención al paciente, y promover la respectiva formación a los profesionales de la salud desde el pregrado.

Ergophthalmology in accounting offices: the computer vision syndrome (CVS) / Ergoftalmologia em escritórios de contabilidade: a síndrome visual do computador (SVC)

Abstract Purpose: This study aimed to determine the presence of the symptoms of computer vision syndrome (CVS) accounting office employees. Methods: The research tools used were a questionnaire based on the set of symptoms of CVS rated by Likert scale (1-5) and workplace observations based on Ergonomic Workplace Analysis (EWA). Results: The participants who worked with a viewing angle of less than 10º relative to the screen had more symptoms, particularly of pain in the back of the neck and back (p = 0.0460). The participants who used lighting other than 450 and 699 lux reported significant headache (p = 0.0045) and dry eye (p = 0.0329) symptoms. Younger workers had more headaches (p = 0.0182), and workers with fewer years of employment had more headaches and dry eyes symptoms (p = 0.0164 and p = 0.0479, respectively). A total of 37% of the participants reported a lack of guidance regarding prevention and painful symptoms in the back of the neck and back (p = 0.0936). Conclusion: Younger participants with fewer years of employment, who had not received information regarding proper computer use, who did not use lighting between 450 and 699 lux or who worked with viewing angles of less than 10º had more computer vision syndrome symptoms.

Resumo Objetivo: Este trabalho objetivou averiguar a presença dos sintomas da Síndrome Visual dos Computadores (SVC) trabalhadores de escritórios de contabilidade. Métodos: Como instrumentos de pesquisa utilizou-se um questionário baseado no conjunto de sintomas da SVC, avaliado por Escala Likert (1-5), e foram realizadas observações no local de trabalho baseadas na Avaliação Ergonômica de Postos de Trabalho. Resultados: Os participantes que trabalhavam com o ângulo de visão menor do que 10º em relação à tela foram os que apresentaram mais sintomas sobretudo de dor na parte posterior do pescoço e nas costas (p=0,0460). Aqueles que usavam iluminação diferente de 450 e 699 lux reportaram sintomas significativos para dor de cabeça (p=0,0045) e ressecamento ocular (p=0,0329). Os mais jovens apresentaram mais dor de cabeça (p=0,0182) e aqueles com menor tempo de trabalho mais sintomas de dor de cabeça e ressecamento ocular (respectivamente p=0,0164 e p=0,0479). A falta de recebimento de orientações sobre prevenção foi confirmada por 37% participantes que referiram mais sintomas de dor na parte posterior do pescoço e nas costas (p=0,0936). Conclusão: Os participantes mais jovens, com menor tempo de trabalho, que não haviam recebido informações sobre o uso de computador, não utilizavam iluminação entre 450 e 699 lux ou trabalhavam com o ângulo de visão menor do que 10º apresentaram mais sintomas da síndrome visual do computador.

Base legal para a nomeação de fonoaudiólogos para o encargo de peritos judiciais em audiologia no âmbito da Justiça do Trabalho em Santa Catarina / Legal basis to designation of audiologists as experts in the Labor Courts in Santa Catarina

RESUMO: Objetivo: identificar a base legal para a nomeação de fonoaudiólogos para o encargo de peritos na Justiça do Trabalho. Métodos: a base legal foi identificada por meio da revisão dos dispositivos constitucionais e infraconstitucionais em vigor até o ano de 2015, da avaliação de sentenças, análise de despachos, atas de audiências e em audiências com os Juízes. Resultados: a Constituição de 1988 ao consagrar os princípios, direitos e garantias fundamentais, deu azo à Lei 6.965/81 que dispõe sobre a regulamentação da Profissão de Fonoaudiólogo, garantindo a liberdade do exercício profissional. Os Artigos 1º, 4º e 10º desta Lei afirmam a competência do fonoaudiólogo para atuar em perícias judiciais, condição que é ratificada pelo Código de Ética da profissão em seu Art. 5º. Os dispositivos legais supra, combinados com os Art. 139 e 145 do Código de Processo Civil têm sido adotados pela maioria dos magistrados ao nomearem fonoaudiólogos como peritos judiciais. Conclusão: a base legal para a nomeação de fonoaudiólogos como peritos judiciais parte de dispositivos constitucionais, com amplo amparo em diferentes dispositivos infraconstitucionais que conferem clareza e segurança jurídica às nomeações feitas pelos juízes, com jurisprudência nacional já pacificada a respeito do assunto.

ABSTRACT: Purpose: to identify the statutory basis for the appointment of audiologist to the task of experts in the Labor Courts. Methods: the statutory basis was identified by reviewing the constitutional and infra- constitutional provisions in force until the year 2015, judicial sentences, analysis of dispatches, minutes of hearings and hearings with the Judge. Results: the 1988 Constitution when established the principles, rights and fundamental guarantees, allowed the creation of the Law 6,965/81 which provides for the regulation of speech therapist profession, guaranteeing freedom of exercise professional. The Articles 1, 4 and 10 of this Law professed the competence of the speech therapist to act in lawsuits, this condition also was ratified by profession Ethic's Code in Art. 5. The legal provisions above, associated with the Art. 139 and 145 of the Civil Procedure Code have been adopted by the most judges to appoint audiologists to the task of experts in the labor court. Conclusion: the legal basis for the appointment of audiologist to the task of experts in the Labor Courts, start from the constitutional provisions, with broad support in different infraconstitutional devices that provide clarity and legal certainty to appointments made by judges, with national law already pacified in the subject matter.

Cuidado à saúde de quem cuida da saúde. acidentes ocupacionais com exposição à material biológico ocorridos em municípios da região sul do Brasil e notificados no sinan nos anos de 2010 a 2012 / Health care who takes care of health. accidents with occupational exposure to biological material occurred in the municipalities of southern Brazil and notified in sinan years 2010 to 2012

Objetivo: Caracterizar os acidentes ocupacionais com exposição a material biológico ocorridos em municípios da região sul do país e notificados no SINAN nos anos de 2010 a 2012. Método: Os dados foram coletados diretamente no banco de dados do SINAN, no mês de junho de 2013, sendo que gênero, idade, município de notificação, ocupação, vínculo empregatício, tipo de exposição, tipo de material orgânico, fonte conhecida ou não, agente, situação vacinal do acidentado, condutas no momento do acidente, emissão da CAT, foram as variáveis analisadas. As análises estatísticas foram realizadas por meio do emprego do Teste G-Williams, e Teste Qui-Quadrado. Resultado: No período estudado ocorreram 58 acidentes que envolveram 52 profissionais. Somente 4, dos 16 municípios estudados notificaram acidentes. Houve predomínio de acidentes entre os profissionais de enfermagem com segundo grau completo e superior incompleto. O tipo de acidente mais freqüente foi o percutâneo causado por agulha com lúmen, com presença de sangue. O estudo evidencia o flagrante descumprimento efetivo da norma regulamentadora 32 do Ministério do Trabalho quanto ao treinamento contínuo para os trabalhadores e dos profissionais dos serviços de vigilância epidemiológica dos municípios pesquisados, no sentido de prevenção dos acidentes, e de investigação mais consistente para que as medidas profiláticas e corretivas sejam prontamente instituídas.

Escolha da via de parto: expectativa de gestantes e obstetras / La elección de la vía del parto: la expectativa de las mujeres embarazadas y obstetras / Choice of route of childbirth: expectation of pregnant women and obstetricians

Os avanços tecnológicos e científicos da medicina, o respeito à autonomia das gestantes e as indicações médicas parecem ter contribuído para o aumento do número de cesarianas. Neste contexto, o objetivo desta pesquisa foi identificar a expectativa de gestantes e médicos obstetras quanto à via de parto. A maioria das gestantes (74,1%) manifestou preferência pelo parto natural, sobretudo as católicas e portadoras de ensino superior completo ou médio incompleto. Entre os obstetras houve preferência pelo parto cesariano (58,3%) e, se fossem instados a aconselhar, todos (100%) recomendariam parto natural. Caso fossem solicitados a rea­lizar cesariana a pedido, 54,5% dos obstetras concordariam de imediato, porém somente 27,3% admitiriam este direito para gestantes do sistema público de saúde. Em conclusão, a expectativa da maioria das gestantes foi pelo parto natural e dos médicos obstetras pela cesárea, contudo estes realizariam parto natural, em condição normal, e cesárea a pedido.

Los avances tecnológicos y científicos en la medicina, el respeto a la autonomía de las embarazadas y las indicaciones médicas parecen haber contribuido para el aumento del número de cesáreas. En este contexto el objetivo de este estudio fue identificar las expectativas de las embarazadas y de los médicos obstetras en cuanto a las vías del parto. La mayoría de las gestantes (74,1%) manifestaron su preferencia por el parto natural, especialmente las católicas y las de educación superior completa o secundaria incompleta. Entre los obstetras se encontró preferencia por cesárea (58,3%) y cuando fueron solicitados a aconsejar, todos (100%) recomendarían parto natural. Si se les requiriese para realizar una cesárea bajo petición, 54,5% de los obstetras estaría inmediatamente de acuerdo, pero sólo el 27,3% reconocería este derecho para embarazadas del sistema de salud pública. En resumen, la expectativa de la mayoría de las embarazadas fue por un parto natural y de los obstetras por cesárea, no obstante éstos realizarían parto natural, bajo condiciones normales, y cesárea bajo petición.

The technological and scientific advances in medicine and the respect for the autonomy of pregnant women and medical indications have contributed to the increased number of cesareans. In this context, the objective of this research was to identify the expectations of pregnant women and doctors about the process of childbirth. The majority of pregnant women (74.1%) expressed a preference for natural delivery, especially Catholic ones and those who have completed higher education or incomplete high school. Among obstetricians it was found a slight preference for cesarean delivery (58.3%), and if advising was requested by pregnant women, all (100%) obstetricians would recommend natural delivery. If the obstetricians were demanded to perform cesarean on request, 54.5% of them would agree immediately, but only 27.3% would admit that right for pregnant women in the public health system. In conclusion, the expectation of the majority of pregnant women was for the natural delivery, and doctors for cesarean, but they would agree with natural childbirth, under normal conditions, and perform cesarean on request.

Antitumor and anti-cachectic effects of shark liver oil and fish oil: comparison between independent or associative chronic supplementation in Walker 256 tumor-bearing rats.

BACKGROUND: Shark liver oil (SLOil) and fish oil (FOil), which are respectively rich in alkylglycerols (AKGs) and n-3 polyunsaturated fatty acids (PUFAs), are able to reduce the growth of some tumors and the burden of cachexia. It is known that FOil is able to reduce proliferation rate and increase apoptotic cells and lipid peroxidation of tumor cells efficiently. However, there are few reports revealing the influence of SLOil on these parameters. In the current study, effects of FOil chronic supplementation on tumor growth and cachexia were taken as reference to compare the results obtained with SLOil supplementation. Also, we evaluated if the association of SLOil and FOil was able to promote additive effects. METHODS: Weanling male Wistar rats were divided into 4 groups: fed regular chow (C), supplemented (1 g/kg body weight) with SLOil (CSLO), FOil (CFO) and both (CSLO + FO). After 8 weeks half of each group was inoculated with Walker 256 cells originating new groups (W, WSLO, WFO and WSLO + FO). Biochemical parameters of cachexia, tumor weight, hydroperoxide content, proliferation rate and percentage of apoptotic tumor cells were analysed. Fatty acids and AKG composition of tumor and oils were obtained by high performance liquid chromatography and gas chromatography - mass spectrometry, respectively. Statistical analysis was performed by unpaired t-test and one-way ANOVA followed by a post hoc Tukey test. RESULTS: Fourteen days after inoculation, SLOil was able to restore cachexia parameters to control levels, similarly to FOil. WSLO rats presented significantly lower tumor weight (40%), greater tumor cell apoptosis (~3-fold), decreased tumor cell proliferation (35%), and higher tumor content of lipid hydroperoxides (40%) than observed in W rats, but FOil showed more potent effects. Supplementation with SLOil + FOil did not promote additive effects. Additionally, chromatographic results suggested a potential incorporation competition between the n-3 fatty acids and the AKGs in the tumor cells' membranes. CONCLUSIONS: SLOil is another marine source of lipids with similar FOil anti-cachectic capacity. Furthermore, despite being less potent than FOil, SLOil presented significant in vivo antitumor effects. These results suggest that the chronic supplementation with SLOil may be adjuvant of the anti-cancer therapy.

Identificação de micro-organismos em profissionais e superfícies de uma unidade de terapia intensiva / Microorganism identification in professionals and surfaces in an intensive care unit

A infecção hospitalar está ligada a altos índices de mortalidade. O objetivo deste trabalho foi identificar os micro-organismos de superfície, mãos e cavidade nasal de profissionais de uma unidade de terapia intensiva. Participaram 25 profissionais que estavam de plantão no momento da coleta. Obteve-se da cavidade nasal cinco cepas de Staphylococcus aureus e 20 de Staphylococcus coagulase negativo. Nas mãos nove cepas de fungos, quatro de bacilo gram-negativo do ambiente, seis de bacilo gram-positivo do ambiente, dez de Staphylococcus coagulase negativo, três de Staphylococcus aureus, uma de Acinetobacter calcoaceticus e uma de micrococos. Na superfície de torneiras, ar condicionado e saboneteira três cepas de fungos, três de Staphylococcus coagulase negativo e duas de bactérias. Os resultados evidenciam a importância da educação continuada para o controle das infecções, através do uso de equipamentos de proteção individual adequados e das boas práticas de higienização das mãos e desinfecção correta das superfícies.

Chronic supplementation with shark liver oil for reducing tumor growth and cachexia in walker 256 tumor-bearing rats.

We investigated the effect of chronic supplementation with shark liver oil (SLO), an antitumor supplement source of n-3 fatty acids and 1-O-alkylglycerols, alone and combined with coconut fat (CF), a source of saturated fatty acids, on Walker 256 tumor growth and cachexia. Male rats were supplemented daily and orally with SLO and/or CF (1 g per kg body weight) for 7 wk. After 7 wk, 50% of animals were subcutaneously inoculated with 3 × 10(7) Walker 256 tumor cells. After 14 days, the rats were killed, the tumors were removed for lipid peroxidation measurement, and blood was collected for glycemia, triacylglycerolemia, and lacticidemia evaluation. Liver samples were obtained for glycogen measurement. Unlike CF, supplementation with SLO promoted gain in body weight, reduction of tumor weight, and maintained glycemia, triacylglycerolemia, lacticidemia, and liver glycogen content to values similar to non-tumor-bearing rats. Combined supplementation of SLO with CF also showed a reversion of cachexia with gain in body mass, reduction of lacticidemia, maintaining the liver glycogen store, and reduction in tumor weight. SLO, alone or combined with CF, promoted increase of tumor lipid peroxidation. In conclusion, SLO supplemented chronically, alone or associated with CF, was able to reduce tumor growth and cachexia.

Chronic exposure to sub-lethal concentration of a glyphosate-based herbicide alters hormone profiles and affects reproduction of female Jundiá (Rhamdia quelen).

This work was carried out to verify the effect of a glyphosate-based herbicide on Jundiá hormones (cortisol, 17ß-estradiol and testosterone), oocyte and swim-up fry production. Earthen ponds containing Jundiá females were contaminated with glyphosate (3.6mg/L); blood samples were collected from eight females from each treatment immediately before, or at 1, 10, 20, 30 and 40 days following contamination. A typical post-stress rise in cortisol levels was observed at the 20th and 40th days following exposure to glyphosate. At the 40th day, 17ß-estradiol was decreased in the exposed females. A similar number of oocytes were stripped out from females from both groups; however, a lower number of viable swim-up fry were obtained from the herbicide exposed females, which also had a higher liver-somatic index (LSI). The results indicate that the presence of glyphosate in water was deleterious to Rhamdia quelen reproduction, altering steroid profiles and egg viability.

Influencia da laserterapia no processo cicatricial de queimaduras de terceiro grau / Influence of low intensity light therapy in wound healing of third-degree burns

O objetivo do presente trabalho consistiu na avaliaçao da resposta ao tratamento fisioterapeutico, atraves de laser, em ratos com queimaduras de terceiro grau. A amostra foi composta por 10 ratos Wistar, sendo lesado o dorso dos animais em ambos os lados, sendo realizada a aplicaçao do laser somente em um lado e no outro nao (considerado controle). O acompanhamento da evoluçao do processo cicatricial foi realizado atravez da analise histologica aos 07 dias, 14 dias, e 21 dias apos o tratamento, que consistiu em 5 sessoes de laserterapia por semana, com duraçao de 10 min cada sessao, com 4J/cm² por varredura. O presente trabalho demonstrou que nas lesoes tratadas por laserterapia verificou-se a presença de fibras colagenas e elasticas verdadeiras e que os vasos sanguineos de neoformaçao estavam amadurecidos, enquanto que, nas lesoes nao submetidas a laserterapia observou-se tecido conjuntivo frouxo, infiltrados moderadamente acentuados de macrofagos e linfocito, vasos sanguineos de neoformaçao com maior calibre e fibras colagenas discretas ou ausentes. Os dados permitem concluir que o laser em queimaduras de ratos contribuiu para acelerar e melhorar a qualidade do tecido neoformado.