Unveiling microbial worlds: exploring viral metagenomics among waste pickers at Latin America's largest dumpsite

ABSTRACT Waste pickers constitute a marginalized demographic engaged in the collection of refuse, facing considerable occupational hazards that heighten their susceptibility to contract infectious diseases. Moreover, waste pickers contend with societal stigmatization and encounter barriers to accessing healthcare services. To explore the viral profile of waste pickers potentially linked to their occupational environment, we conducted a metagenomic analysis on 120 plasma specimens sampled from individuals employed at the Cidade Estrutural dumpsite in Brasilia city, Brazil. In total, 60 blood donors served as a comparative control group. Specimens were pooled and subjected to Illumina NextSeq 2000 sequencing. Viral abundance among waste pickers revealed the presence of significant pathogens, including HIV, HCV, and Chikungunya, which were not detected in the control group. Additionally, elevated levels of anelloviruses and Human pegivirus-1 were noted, with a comparable incidence in the control group. These findings underscore the utility of metagenomics in identifying clinically relevant viral agents within underserved populations. The implications of this study extend to informing public health policies aimed at surveilling infectious diseases among individuals facing socioeconomic disparities and limited access to healthcare resources.

Metal levels in waste pickers in Brasilia, Brazil: hair and nail as exposure matrices.

The aim of this cross-sectional study was to compare workplace conditions and metal exposures in 431 waste pickers who worked nearby at the Estrutural Dump in Brasilia utilizing hair (n = 310) and nail (n = 355) as matrices of exposure. Waste pickers were grouped according to their workplace (open waste dump: G1 and sorting plants: G2). Hair and nail samples were collected and analyzed using ICP-MS. The work duration in the facilities was significantly different between the groups with averages of 16.46 (8.48) yrs and 9.26 (6.28) yrs for hair donors in G1 and G2, and 15.92 (7.72) yrs and 8.55 (5.77) yrs for toenail donors in G1 and G2, respectively. The arithmetic means (µg/g) of cadmium, copper, lead, and manganese in hair were significantly higher in G2 (0.076 ± 0.133; 19.61 ± 18.16; 2.27 ± .56 and 3.87 ± 5.59, respectively) compared to G1 (0.069 ± 0.235; 15.72 ± 15.18; 1.72 ± 4.04 and 3.65 ± 5.5, respectively). Concentrations of arsenic, barium, cadmium, copper, cobalt, lead, manganese, and molybdenum in nail were significantly higher in G2 (0.57 ± 0.39; 22.74 ± 42.06; 0.1 ± 0.08; 22.7 ± 51.60; 0.48 ± 0.45; 4.69 ± 9.43; 19.07 ± 20.75; 1.80 ± 1.76, respectively) compared to G1 (0.40 ± 0.28; 15.32 ± 22.31; 0.08 ± 0.11; 11.91 ± 16.25; 0.37 ± 0.37; 3.94 ± 15.04; 13.01 ± 19.08; 1.16 ± 1.80, respective. Our findings suggest that the studied population was exposed to toxic metals and indicates the need for chemical exposure prevention policies to monitor chemical risk exposures in waste pickers.

Validity, reliability and responsiveness of the Safety Attitudes Questionnaire for Emergency Care Units.

OBJECTIVE: To evaluate the evidence of validity, reliability and responsiveness of the Brazilian version of the Safety Attitudes Questionnaire for Emergency Care Units. METHOD: Methodological study carried out in September 2020 with 46 health professionals from an Emergency Care Unit in the metropolitan region of the State of Espírito Santo. Reliability was verified through the analysis of internal consistency, stability and reproducibility. The validity and responsiveness of the instrument were tested. RESULTS: Cronbach's alpha=0.85, showing excellent internal consistency. All domains are positively and significantly correlated with each other. In the stability assessment, the domains Job Satisfaction, Management Perception and Working Conditions showed strong correlations. CONCLUSION: It is concluded that the instrument presents satisfactory values in the evaluation of psychometric properties, showing evidence of validity, reliability and responsiveness. Thus, it is validated to be reproduced in other Emergency Care Units in Brazil.

Validity, reliability and responsiveness of the Safety Attitudes Questionnaire for Emergency Care Units / Validez, confiabilidad y responsabilidad del Cuestionario de Actitudes de Seguridad para las Unidades de Atención de Emergencia / Validade, confiabilidade e responsividade do Questionário Atitudes de Segurança para Unidades de Pronto Atendimento

ABSTRACT Objective: To evaluate the evidence of validity, reliability and responsiveness of the Brazilian version of the Safety Attitudes Questionnaire for Emergency Care Units. Method: Methodological study carried out in September 2020 with 46 health professionals from an Emergency Care Unit in the metropolitan region of the State of Espírito Santo. Reliability was verified through the analysis of internal consistency, stability and reproducibility. The validity and responsiveness of the instrument were tested. Results: Cronbach's alpha=0.85, showing excellent internal consistency. All domains are positively and significantly correlated with each other. In the stability assessment, the domains Job Satisfaction, Management Perception and Working Conditions showed strong correlations. Conclusion: It is concluded that the instrument presents satisfactory values in the evaluation of psychometric properties, showing evidence of validity, reliability and responsiveness. Thus, it is validated to be reproduced in other Emergency Care Units in Brazil.

RESUMEN Objetivo: Evaluar las evidencias de validez, confiabilidad, y capacidad de respuesta de la versión brasileña del Cuestionario de Actitudes de Seguridad para Unidades de Atención de Emergencia. Método: Estudio metodológico realizado en septiembre de 2020 con 46 profesionales de la salud de una Unidad de Atención de Urgencias de la región metropolitana del Estado de Espírito Santo. La confiabilidad se verificó a través del análisis de consistencia interna, estabilidad y reproducibilidad. Se probó la validez y la capacidad de respuesta del instrumento. Resultados: Alfa de Cronbach=0,85, mostrando excelente consistencia interna. Todos los dominios están positiva y significativamente correlacionados entre sí. En la evaluación de la estabilidad, los dominios Satisfacción en el Trabajo, Percepción de la Gestión y Condiciones de Trabajo presentaron fuertes correlaciones. Conclusión: Se concluye que el instrumento presenta valores satisfactorios en la evaluación de las propiedades psicométricas, mostrando evidencias de validez, confiabilidad y capacidad de respuesta. Por lo tanto, está validado para ser reproducido en otras Unidades de Atención de Emergencia en Brasil.

RESUMO Objetivo: Avaliar as evidências de validade, confiabilidade e responsividade da versão brasileira do instrumento Questionário de Atitudes de Segurança para Unidades de Pronto Atendimento. Método: Estudo metodológico realizado em setembro de 2020 com 46 profissionais de saúde de uma Unidade de Pronto Atendimento da região metropolitana do Estado do Espírito Santo. A confiabilidade foi verificada através da análise de consistência interna, estabilidade e reprodutibilidade. Foram testadas a validade e a responsividade do instrumento. Resultados: O alfa de Cronbach=0,85, evidenciando ótima consistência interna. Todos os domínios se correlacionam entre si de maneira positiva e significativa. Na avaliação da estabilidade, os domínios Satisfação no Trabalho, Percepção da Gerência e Condições de Trabalho apresentaram fortes correlações. Conclusão: Conclui-se que o instrumento apresenta valores satisfatórios na avaliação das propriedades psicométricas, mostrando evidências de validade, confiabilidade e responsividade. Dessa forma, está validado para ser reproduzido em outras Unidades de Pronto Atendimento no Brasil.

Buffy Coat Transcriptomic Analysis Reveals Alterations in Host Cell Protein Synthesis and Cell Cycle in Severe COVID-19 Patients.

Transcriptome studies have reported the dysregulation of cell cycle-related genes and the global inhibition of host mRNA translation in COVID-19 cases. However, the key genes and cellular mechanisms that are most affected by the severe outcome of this disease remain unclear. For this work, the RNA-seq approach was used to study the differential expression in buffy coat cells of two groups of people infected with SARS-CoV-2: (a) Mild, with mild symptoms; and (b) SARS (Severe Acute Respiratory Syndrome), who were admitted to the intensive care unit with the severe COVID-19 outcome. Transcriptomic analysis revealed 1009 up-regulated and 501 down-regulated genes in the SARS group, with 10% of both being composed of long non-coding RNA. Ribosome and cell cycle pathways were enriched among down-regulated genes. The most connected proteins among the differentially expressed genes involved transport dysregulation, proteasome degradation, interferon response, cytokinesis failure, and host translation inhibition. Furthermore, interactome analysis showed Fibrillarin to be one of the key genes affected by SARS-CoV-2. This protein interacts directly with the N protein and long non-coding RNAs affecting transcription, translation, and ribosomal processes. This work reveals a group of dysregulated processes, including translation and cell cycle, as key pathways altered in severe COVID-19 outcomes.

Encontro e acolhimento em territórios vivos: narrativas para repensar tecnologias de cuidado a pessoas em crise na atenção psicossocial / Meeting and welcoming in living territories: narratives to rethink care technologies for people in crisis in psychosocial care

Após um longo e acidentado percurso, perfilado pelas repercussões de um período pandêmico (uma situação de crise planetária), coloca-se à disposição essa coletânea de escritos produzidos a partir do convite para compartilhar experiências de atenção a pessoas em situação de crise, na perspectiva da Atenção Psicossocial, em territórios do semiárido nordestino, mais especificamente, no Vale do Médio São Francisco. Este livreto, chamado assim por intuito afetivo e jamais por uma avaliação de sua qualidade ou mesmo tamanho, ganhou um nome que busca expressar seu eixo de sustentação: a (re)afirmação da potência do encontro para produzir caminhos de abertura e de expansão de vida na produção do cuidado ­ Encontro e acolhimento em territórios vivos: narrativas para repensar tecnologias de cuidado a pessoas em crise na Atenção Psicossocial. Trata-se de uma produção coletiva, visceralmente polifônica, germinada a partir do desejo compartilhado de fazer circular outras narrativas e vozes em torno do cuidado a pessoas em situação de crise. Assume-se como um fruto de agenciamentos coletivos diversos, em um país em que as atualizações da colonização sofrida (e jamais devidamente reparada) são vívidas, inclusive nos modos de pensar e produzir saúde. Destaca-se, assim, sua intencionalidade de contribuir para reposicionar ou mesmo extrapolar a captura do campo da saúde pela racionalidade biomédica, reconhecendo seus limites e efeitos iatrogênicos, especialmente em um contexto contemporâneo, marcado brutalmente pela medicalização da vida. Como destacado por Sandra Fagundes, no prefácio do livreto: "No correr dos contos, como no Grande Sertão Veredas, de Guimaraes Rosa, a vida embrulha tudo. A vida é assim, esquenta e esfria, aperta e daí afrouxa, sossega e depois desinquieta. O que ela quer da gente é coragem. O cuidado em liberdade, o que requer é ancoragem: suporte para o insuportável, impensável, indizível e para a potência".

Herpesvirus and neurological manifestations in patients with severe coronavirus disease.

BACKGROUND: Certain clinical manifestations of coronavirus disease (COVID-19) mimic those associated with human herpesvirus (HHV) infection. In this study, we estimated the prevalence of herpesvirus in patients with COVID-19 and determined if coinfection is associated with poorer outcomes and neurological symptoms. METHODS: We analyzed samples of 53 patients diagnosed with COVID-19. The samples were evaluated for the presence of alphaherpesviruses, betaherpesviruses, and gammaherpesviruses, and the viral loads were quantified using quantitative polymerase chain reaction (qPCR) method. RESULTS: Among the patients, in 79.2% had detection at least one type of herpesvirus. HHV-6 (47.2%), cytomegalovirus (43.3%), and HHV-7 (39.6%) showed the highest detection rates. Patients with a high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) load were more likely to show herpes simplex virus 1 detection (p = 0.037). Among patients coinfected with SARS-CoV-2 and HHVs, 26.4% showed central nervous system-associated neurological symptoms and herpetic manifestations. A statistically significant association was observed between neurological changes and HHV-6 detection (p = 0.034). CONCLUSIONS: The findings showed a high prevalence of herpesvirus in patients with COVID-19. Furthermore, even though SARS-CoV-2 and HHV coinfection was not associated with poorer outcomes, the findings demonstrated the association between neurological symptoms and HHV-6 detection.

New records and species of Pseudogaurax Malloch, 1915 (Diptera: Chloropidae) from the Amazon basin.

Pseudogaurax Malloch is a speciose genus of Chloropidae in the Neotropical region. The South American fauna is understudied, particularly in the Amazon basin. Here we provide a taxonomic revision of the Amazonian species of Pseudogaurax, including the description of five new species-P. flaviscutellatus sp. nov., P. infulatus sp. nov., P. longitriangularis sp. nov., P. pallidus sp. nov. and P. poseidoni sp. nov.-and a key to all Brazilian species. Including our results, Pseudogaurax is known from 19 species from Brazil, 10 of which occur in the Amazon Forest.

Breast cancer screening program for risk groups: facts and perspectives / Tamizaje Masivo de neoplasias de la mama para grupos de riesgo: hechos y perspectivas / Programa de rastreamento de neoplasias da mama para grupos de risco: fatos e perspectivas

ABSTRACT Objectives: to measure the frequency and compliance of breast cancer screening, according to the risk for this disease. Methods: a cross-sectional study with 950 female users of 38 public Primary Health Care services in São Paulo, between October and December 2013. According to UHS criteria, participants were grouped into high risk and standard risk, and frequency, association (p≤0.05), and screening compliance were measured. Results: 6.7% had high risk and 93.3% standard risk, respectively; in these groups, the frequency and compliance of clinical breast examination were 40.3% and 37.1%, and 43.5% and 43.0% (frequency p=0.631, compliance p=0.290). Mammograms were 67.7% and 35.5% for participants at high risk, and 57.4% and 25.4% for those at standard risk (frequency p=0.090, compliance p=0.000). Conclusions: in the groups, attendance and conformity of the clinical breast exam were similar; for mammography, it was higher in those at high risk, with assertiveness lower than the 70% set in UHS.

RESUMEN Objetivos: mensurar frecuencia y conformidad de rastreo del cáncer mamario, segundo riesgo para esa enfermedad. Métodos: estudio transversal con 950 usuarias de 38 servicios de Atención Primaria púbicos en São Paulo, entre octubre y diciembre de 2013. Segundo criterios del SUS, agruparon las participantes en riesgo elevado y riesgo-estándar, y mensurado frecuencia, relación (p≤0,05) y conformidad del rastreo. Resultados: 6,7% tenían riesgo elevado y 93,3% riesgo-estándar, respectivamente; en eses grupos, la frecuencia y conformidad del examen clínico mamario fueron de 40,3% y 37,1% y de 43,5% y 43,0% (frecuencia, p=0,631; conformidad, p=0,290). Realización de mamografía alcanzó porcentuales de 67,7% y 35,5% para participantes con riesgo elevado, y de 57,4% y 25,4% en con riesgo-estándar (frecuencia, p=0,090; conformidad, p=0,000). Conclusiones: En los grupos, la frecuencia y conformidad del examen clínico mamario fueron semejantes, para mamografía fue mayor en las con riesgo elevado, habiendo asertividad inferior a 70% pactados en el SUS.

RESUMO Objetivos: mensurar a frequência e conformidade de rastreio do câncer mamário segundo risco para esta doença. Métodos: estudo transversal em São Paulo, com 950 usuárias de 38 da atenção primária no SUS entre outubro a dezembro de 2013. Segundo critérios do SUS, as participantes foram agrupadas como risco elevado ou padrão e mensurou-se frequência, associação (p≤0,05) e conformidade do rastreio. Resultados: 6,7% tinha risco elevado e 93,3% risco padrão, respectivamente, nestes grupos a frequência e conformidade do exame clínico mamário foram de 40,3% e 37,1% e de 43,5% e 43,0% (frequência p=0,631, conformidade p=0,290). Realização de mamografia alcançou percentuais de 67,7 e 35,5 para as com risco elevado, e de 57,4 e 25,4 nas com risco padrão (frequência p=0,090, conformidade p=0,000). Conclusões: nos grupos, a frequência e conformidade do exame clínico mamário foram semelhantes, para mamografia foi maior nas com risco elevado, tendo assertividade inferior aos 70% pactuados no SUS.

Rethinking Cervical Cancer Screening in Brazil Post COVID-19: A Global Opportunity to Adopt Higher Impact Strategies.

The World Health Organization global call to eliminate cervical cancer encourages countries to consider introducing or improving cervical cancer screening programs. Brazil's Unified Health System (SUS) is among the world's largest public health systems offering free cytology testing, follow-up colposcopy, and treatment. Yet, health care networks across the country have unequal infrastructure, human resources, equipment, and supplies resulting in uneven program performance and large disparities in cervical cancer incidence and mortality. An effective screening program needs multiple strategies feasible for each community's reality, facilitating coverage and follow-up adherence. Prioritizing those at highest risk with tests that better stratify risk will limit inefficiencies, improving program impact across different resource settings. Highly sensitive human papillomavirus (HPV)-DNA testing performs better than cytology and, with self-collection closer to homes and workplaces, improves access, even in remote regions. Molecular triage strategies like HPV genotyping can identify from the same self-collected sample, those at highest risk requiring follow-up. If proven acceptable, affordable, cost-effective, and efficient in the Brazilian context, these strategies would increase coverage while removing the need for speculum exams for routine screening and reducing follow-up visits. SUS could implement a nationwide organized program that accommodates heterogenous settings across Brazil, informing a variety of screening programs worldwide.

Moving towards a strategy to accelerate cervical cancer elimination in a high-burden city-Lessons learned from the Amazon city of Manaus, Brazil.

The World Health Organization Call to Eliminate Cervical Cancer resonates in cities like Manaus, Brazil, where the burden is among the world's highest. Manaus has offered free cytology-based screening since 1990 and HPV immunization since 2013, but the public system is constrained by many challenges and performance is not well-defined. We obtained cervical cancer prevention activities within Manaus public health records for 2019 to evaluate immunization and screening coverage, screening by region and neighborhood, and the annual Pink October screening campaign. We estimated that among girls and boys age 14-18, 85.9% and 64.9% had 1+ doses of HPV vaccine, higher than rates for age 9-13 (73.4% and 43.3%, respectively). Of the 90,209 cytology tests performed, 24.9% were outside the target age and the remaining 72,230 corresponded to 40.1% of the target population (one-third of women age 25-64). The East zone had highest screening coverage (49.1%), highest high-grade cytology rate (2.5%) and lowest estimated cancers (38.1/100,000) compared with the South zone (32.9%, 1.8% and 48.5/100,000, respectively). Largest neighborhoods had fewer per capita screening locations, resulting in lower coverage. During October, some clinics successfully achieved higher screening volumes and high-grade cytology rates (up to 15.4%). Although we found evidence of some follow-up within 10 months post-screening for 51/70 women (72.9%) with high-grade or worse cytology, only 18 had complete work-up confirmed. Manaus has successfully initiated HPV vaccination, forecasting substantial cervical cancer reductions by 2050. With concerted efforts during campaigns, some clinics improved screening coverage and reached high-risk women. Screening campaigns in community locations in high-risk neighborhoods using self-collected HPV testing can achieve widespread coverage. Simplifying triage and treatment with fewer visits closer to communities would greatly improve follow-up and program effectiveness. Achieving WHO Cervical Cancer Elimination goals in high-burden cities will require major reforms for screening and simpler follow-up and treatment.

Breast cancer screening program for risk groups: facts and perspectives.

OBJECTIVES: to measure the frequency and compliance of breast cancer screening, according to the risk for this disease. METHODS: a cross-sectional study with 950 female users of 38 public Primary Health Care services in São Paulo, between October and December 2013. According to UHS criteria, participants were grouped into high risk and standard risk, and frequency, association (p≤0.05), and screening compliance were measured. RESULTS: 6.7% had high risk and 93.3% standard risk, respectively; in these groups, the frequency and compliance of clinical breast examination were 40.3% and 37.1%, and 43.5% and 43.0% (frequency p=0.631, compliance p=0.290). Mammograms were 67.7% and 35.5% for participants at high risk, and 57.4% and 25.4% for those at standard risk (frequency p=0.090, compliance p=0.000). CONCLUSIONS: in the groups, attendance and conformity of the clinical breast exam were similar; for mammography, it was higher in those at high risk, with assertiveness lower than the 70% set in UHS.

Segurança do paciente em serviços de urgência e emergência: uma revisão integrativa da literatura / Patient safety in emergency services: na integrative literature review / Seguridad del paciente en servicios de urgencias y emergencias: una revisión integrativa de la literatura

Este artigo pretende analisar a produção científica publicada na literatura sobre a segurança do paciente em serviços de urgência e emergência. Logo, foi realizada uma revisão integrativa da literatura com levantamento bibliográfico realizado em outubro de 2020 por meio das bases de dados Índice Bibliográfico Español en Ciencias de la Salud (Ibecs), Base de Dados de Enfermagem (BDENF), Literatura Latino-Americana em ciências da saúde (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline) e Web of Science. A amostra final resultou em 43 artigos categorizados em quatro eixos temáticos, conforme o tipo de serviço de urgência e emergência em que a pesquisa foi desenvolvida. Os assuntos mais abordados nas pesquisas foram eventos adversos relacionados aos atendimentos de urgência e transporte, cultura de segurança, eventos adversos relacionados à medicamentos, intervenções que visam melhorar a segurança do paciente, estresse, ansiedade e burnout dos profissionais, segurança percebida pelo paciente e falhas na comunicação. As publicações demonstraram que as pesquisas sobre segurança do paciente em serviços de urgência e emergência são incipientes, quando se trata da complexidade dos serviços prestados. Além disso, poucos foram os estudos realizados no Brasil, sobretudo direcionados para unidades de pronto atendimento.

This integrative literature review analyzes the scientific literature published on patient safety in emergency services. Bibliographic research was performed in October 2020 in the Spanish Bibliographic Index in Health Sciences (IBECS), Base de Dados de Enfermagem (BDENF), Latin American Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Web of Science databases. The final sample comprised 43 articles, which were categorized into four thematic axes, according to the type of emergency service studied. Adverse events related to emergency care and transportation, safety culture, adverse events related to medications, interventions to improve patient safety, stress, anxiety and burnout of professionals, perceived patient safety and communication failures were the most discussed topics. The publications revealed that research on patient safety in emergency services is still very insipient regarding the complexity of services provided. Moreover, few were the studies on care units carried out in Brazil.

Este artículo busca analizar la producción científica publicada en la literatura sobre la seguridad del paciente en los servicios de urgencias y emergencias. Se realizó una revisión integrativa de la literatura con búsqueda bibliográfica realizada en octubre de 2020, utilizando las bases de datos Índice Bibliográfico Español en Ciencias de la Salud (Ibecs), Base de Datos de Enfermería (BDENF), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline) y Web of Science. La muestra final resultó en 43 artículos, los cuales fueron categorizados en cuatro ejes temáticos según el tipo de servicio de urgencia y emergencia en el que se realizó la investigación. Los temas más abordados en los estudios fueron los eventos adversos relacionados con la atención de emergencia y el transporte, la cultura de seguridad, los eventos adversos relacionados con los medicamentos, las intervenciones dirigidas a mejorar la seguridad del paciente, el estrés, la ansiedad y el agotamiento de los profesionales, la seguridad percibida por el paciente y las fallas en la comunicación. Los resultados mostraron que los estudios sobre la seguridad del paciente en los servicios de urgencias y emergencias son aún muy incipientes en cuanto a la complejidad de los servicios que se brindan. Además, en Brasil se realizaron pocos estudios, principalmente relacionados a unidades de atención de emergencia.

A Qualitative Study on Noncommunicable Diseases in Waste Pickers in Brazil.

BACKGROUND: Noncommunicable chronic diseases are associated with multiple risks factors and negative outcomes that are long-lasting and difficult to treat. Some populations may be at greater risk because of their socioeconomic status, lack of healthcare, environment, and poor work and living conditions. Informal waste pickers may experience higher levels of chronic diseases and often do not have access to care to manage symptoms. OBJECTIVES: The aim of the present study was to understand the prevalence of chronic diseases in waste pickers, along with perceived associated risks and available treatments. METHODS: A qualitative study was conducted, using interviews with 24 waste pickers who worked at Estrutural dumpsite in Brasilia, Brazil which was historically the second largest open-air dumpsite in the world. RESULTS: Participants believed their commonly experienced chronic diseases were a result of working in the open-air dumpsite. Chronic diseases commonly noted in the interviews included hypertension, chronic pain, respiratory disease, diabetes, and kidney problems. Participants discussed self-medication or prescribed medication used to treat their conditions. Most participants had varying beliefs regarding prevention strategies to reduce disease; some ideas for prevention focused on religion, fate, and God when discussing outcomes related to illnesses. When answering questions regarding ideal working conditions to help prevent diseases, participants responded by expressing a desire for protective gear (e.g. PPE) which could help mitigate hazards associated with the dump. CONCLUSIONS: Recyclable collectors were aware of occupational hazards to which they were exposed and associated noncommunicable chronic diseases but lacked education on the importance of preventive measures and access to healthcare services. The findings of the present study confirm the need to strengthen intersectoral actions to protect and uphold the health rights of this vulnerable population. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: This study was approved by the Research and Ethics Committee of the Health School of Brasília University under Opinion n. 1.517.670/2016. COMPETING INTERESTS: The authors declare no competing financial interests.

Functional capacity of women with breast neoplasm undergoing palliative chemotherapy.

OBJECTIVE: To evaluate the functional capacity of women with breast neoplasm undergoing palliative chemotherapy. METHOD: Cross-sectional study with an analysis of medical records of women with breast cancer undergoing palliative chemotherapy. RESULTS: Out of one hundred evaluated records, most registered 50 years or older (66%), primary education (53%), an income of 1 to 2 minimum wages (87%), invasive ductal carcinoma (95%), positive hormone receptor (64%), and histological grade 1 and 2 (57%). Performance status 0 (49%), 1 (39%), and 2 (12%) were prevalent; these imply, respectively, active patients, with mild and moderate activity restriction. One to four chemotherapy schemes were associated with the inappetence (p =0.00) and weight loss (p =0.001) symptoms. The main complications were neuropathy (31%), medullary compression syndrome (21%), neutropenia (9%), and death (28%). CONCLUSION: Out of the analyzed women, 88% presented functional capacity 0 and 1, had no or mild restriction of daily activities, were multiply treated, and manifested manageable symptoms. Others, however, presented moderate to severe clinical complications during the treatment, progressing to exclusive palliative care or death.

Reduced Reaction Mechanisms for Ethanol under Ultra-lean Conditions in Internal Combustion Engines.

Chemical kinetics models for ethanol under ultra-lean engine conditions were evaluated to couple with CFD multidimensional simulations of a spark-assisted homogeneous charge compression ignition (HCCI) rotary engine. Five reduced reaction sets proper for CFD simulations and two detailed reaction mechanisms for comparison were tested by simulating ignition delay times, laminar flame speeds, and a single-cycle HCCI engine with virtual piston dimensions. The simulated results of the new mechanism with 188 reactions were well-fitted to both experimental ignition delay times for ultra-lean ethanol/air conditions and laminar flame speeds at high pressures. This reaction set resulted in better-simulated ignition delay times at 30 and 40 bar for ultra-lean ethanol/air conditions than other chemical kinetics models. Maximum temperatures and pressures of 2500-2580 K and 280-289 bar, respectively, were observed for hydrous ethanol/air under ultra-lean conditions in HCCI engine. In addition, the simulation results of the HCCI ethanol engine presented high pressure rise rates of 8-26 bar/CAD at 3600 rpm. These results indicated that the engine test should be carried out at 2500 rpm with 2 bar of boost pressure for CFD model calibration with the new optimized reaction mechanism.

Social vulnerabilities of female waste pickers in Brasília, Brazil.

Worldwide, waste pickers are exposed to adverse health effects resulting from hazards at work. This study aimed to identify possible gender disparities among waste pickers. A quantitative cross-sectional epidemiological study, using semi-structured data was conducted in Estrutural's dumpsite, Brasília, Brazil. It included 1,025 waste pickers, with 67% being female. Most of them lived without partners (73.7%), have 3 to 4 children (47.8%), and have a lower monthly income (62.6%

Functional capacity of women with breast neoplasm undergoing palliative chemotherapy / Capacidad funcional de mujeres con neoplasia de mama en quimioterapia paliativa / Capacidade funcional de mulheres com neoplasia mamária em quimioterapia paliativa

ABSTRACT Objective: To evaluate the functional capacity of women with breast neoplasm undergoing palliative chemotherapy. Method: Cross-sectional study with an analysis of medical records of women with breast cancer undergoing palliative chemotherapy. Results: Out of one hundred evaluated records, most registered 50 years or older (66%), primary education (53%), an income of 1 to 2 minimum wages (87%), invasive ductal carcinoma (95%), positive hormone receptor (64%), and histological grade 1 and 2 (57%). Performance status 0 (49%), 1 (39%), and 2 (12%) were prevalent; these imply, respectively, active patients, with mild and moderate activity restriction. One to four chemotherapy schemes were associated with the inappetence (p =0.00) and weight loss (p =0.001) symptoms. The main complications were neuropathy (31%), medullary compression syndrome (21%), neutropenia (9%), and death (28%). Conclusion: Out of the analyzed women, 88% presented functional capacity 0 and 1, had no or mild restriction of daily activities, were multiply treated, and manifested manageable symptoms. Others, however, presented moderate to severe clinical complications during the treatment, progressing to exclusive palliative care or death.

RESUMEN Objetivo: Evaluar la capacidad funcional de mujeres con cáncer de mama en quimioterapia paliativa. Método: Estudio transversal, realizado a partir del análisis de historias clínicas de mujeres con cáncer de mama en quimioterapia paliativa. Resultados: De las cien historias clínicas evaluadas, la mayoría registró 50 años o más (66%), educación fundamental (53%), ingresos de 1 a 2 salarios mínimos (87%), carcinoma ductal invasivo (95%), receptor hormonal positivo (64%) y grados histológicos 1 y 2 (57%). Predominaron los performance status 0 (49%), 1 (39%) y 2 (12%), que implicaban, respectivamente, pacientes activos, con restricción leve y restricción moderada de la actividad. De uno a cuatro regímenes de quimioterapia se asociaron con síntomas de inapetencia (p=0,00) y pérdida de peso (p=0,001). Las principales complicaciones fueron neuropatía (31%), síndrome de compresión medular (21%), neutropenia (9%) y defunción (28%). Conclusión: el 88% de las mujeres tenían capacidad funcional 0 y 1, sin o con leve restricción de las actividades diarias, eran politratadas y mostraban síntomas manejables. Otros, sin embargo, presentaron complicaciones clínicas de moderadas a graves durante el tratamiento, evolucionando a cuidados paliativos exclusivos o a la defunción.

RESUMO Objetivo: Avaliar a capacidade funcional de mulheres com câncer de mama em quimioterapia paliativa. Método: Estudo transversal, realizado a partir da análise de prontuários de mulheres com câncer de mama em quimioterapia paliativa. Resultados: Dos cem prontuários avaliados, a maioria registrava 50 anos ou mais (66%), nível fundamental (53%), renda de 1 a 2 salários mínimos (87%), carcinoma ductal invasivo (95%), hormônio positivo (64%) e grau histológico 1 e 2 (57%). Prevaleceram performance status 0 (49%), 1 (39%) e 2 (12%), que implicam, respectivamente, pacientes ativos, com restrição leve e restrição moderada de atividades. Associaram-se de um a quatro esquemas quimioterápicos aos sintomas inapetência (p =0,00) e perda de peso (p =0,001). As principais complicações foram neuropatia (31%), síndrome de compressão medular (21%), neutropenia (9%) e óbito (28%). Conclusão: 88% das mulheres apresentaram capacidade funcional 0 e 1, sem ou com restrição leve das atividades diárias, eram politratadas e manifestaram sintomas manejáveis. Outras, no entanto, apresentaram complicações clínicas moderadas a graves em vigência de tratamento, evoluindo para cuidados paliativos exclusivos ou óbito.

[Assessment of the lack of completeness of compulsory dengue fever notifications registered by a small municipality in Brazil]. / Avaliação da não completude das notificações compulsórias de dengue registradas por município de pequeno porte no Brasil.

This article aims to analyze the completeness of the dengue fever notifications registered in a small municipality in Brazil, from 2007 to 2015. It involved a descriptive study with a quantitative approach, composed of the totality of records available in the National System of Notifiable Diseases. The absolute number and percentage of non-fulfillment of the key, mandatory and essential variables of the dengue notification forms were analyzed, and a score proposed by Romero e Cunha was used to assess the degree of non-completeness. The non-parametric linear correlation coefficient of Spearman (rs) was calculated, being preceded by the verification of the distribution of the data through the Kolmogorov Smirnov test. The proportion of information ignored was high for most of the variables and for some trends of non-completeness over the years were decreasing and statistically significant. The quality of the data was mostly classified as regular and very poor, making it imperative to establish strategies in the process of qualification of health teams that work in primary care, to raise awareness of the importance of quality in the registration of compulsory notifications.

O objetivo deste artigo é analisar a completude dos campos de notificações de dengue registradas em um município de pequeno porte no Brasil, no período de 2007 a 2015. Estudo descritivo com abordagem quantitativa, composto pela totalidade de registros disponíveis no Sistema Nacional de Agravos de Notificação. Analisou-se o número absoluto e o percentual de não preenchimento das variáveis chave, obrigatórias e essenciais das fichas de notificação de dengue e com a finalidade de avaliar os graus de não completude, adotou-se escore proposto por Romero e Cunha. Foi calculado o coeficiente não paramétrico de correlação linear de Spearman (rs), sendo precedido pela verificação da distribuição dos dados através do teste de Kolmogorov Smirnov. A proporção de informações ignoradas foi elevada para a maioria das variáveis e para algumas, as tendências de não completude no decorrer dos anos foram decrescentes e estatisticamente significantes. A qualidade dos dados foi, em sua maioria, classificada como regular e muito ruim, tornando-se imprescindível o estabelecimento de estratégias no processo de capacitação das equipes de saúde que atuam na atenção primária, para a sensibilização e conscientização da importância da qualidade no registro das notificações compulsórias.