Forum: social network for the surveillance and prevention of workplace accidents.

In 2008, academic researchers and public service officials created a university extension studies platform based on online and on-site meetings denominated "Work-Related Accidents Forum: Analysis, Prevention, and Other Relevant Aspects. Its aim was to help public agents and social partners to propagate a systemic approach that would be helpful in the surveillance and prevention of work-related accidents. This article describes and analyses such a platform. Online access is free and structured to: support dissemination of updated concepts; support on-site meetings and capacity to build educational activities; and keep a permanent space for debate among the registered participants. The desired result is the propagation of a social-technical-systemic view of work-related accidents that replaces the current traditional view that emphasizes human error and results in blaming the victims. The Forum uses an educational approach known as permanent health education, which is based on the experience and needs of workers and encourages debate among participants. The forum adopts a problematizing pedagogy that starts from the requirements and experiences of the social actors and stimulates support and discussions among them in line with an ongoing health educational approach. The current challenge is to turn the platform into a social networking website in order to broaden its links with society.

Tracheostomy in children: there is a place for acceptable risk.

BACKGROUND: Tracheostomy in children remains controversial regarding the risk of complications. METHODS: Forty-six trauma patients (35 male and 11 female, mean age = 6.8 years) were admitted to the intensive care unit between 1987 and 1991 with severe head injury plus coma. Tracheostomy was performed with standard technique after 5.9 days (range, 2-12 days) of intubation. RESULTS: There were no deaths from tracheostomy, but six deaths resulted from severe head injury. One child was discharged with tracheostomy. The 39 survivors remained with tracheostomy 16.14 days (range, 4-71 days) in the intensive care unit. After cannula removal, 31 remained asymptomatic; 8 had respiratory distress: 2 were normal, 5 had endoscopic treatment for subglottic granulomas/stenosis from intubation, and 1 had tracheomalacia from tracheostomy. In 1997, the 18 patients located for follow-up were asymptomatic. At endoscopy, 8 were normal, 9 had subglottal granulomas from intubation, and 1 had 20% tracheal stenosis from tracheostomy. CONCLUSION: Most complications after tracheostomy result from intubation. Tracheostomy has an acceptable risk in children with severe head injury who need prolonged ventilatory support.

Effect of hyperbaric oxygen on the regeneration of experimental crush injuries of nerves.

Hyperbaric oxygen has been successfully used on treatment of acute ischemic injuries involving soft tissues and chronic injuries. In nerve crush injuries, the mechanisms involved are very similar to those found in ischemic injuries. Consequently, it is logical to hypothesize that hyperbaric oxygen should improve nerve repair, which is a critical step on functional recovery. In the present study, we created standard nerve crush injuries on sciatic nerves of rats, which underwent treatment with hyperbaric oxygen. Results were assessed by functional evaluation using walking-track analysis. The functional recovery indexes observed did not differ from control group. We concluded that hyperbaric oxygen therapy, in the schedule used, had no influence on functional recovery after nerve crush injuries.

Aerossol bacteriano gerado por respiradores mecâncicos: estudo comparativo / Bacterial aerosol generated by mechanical ventilators: comparative study

Respiradores mecânicos emitem aerosóis que podem estar colonizados com bactérias. Objetivo. Estudar a contaminaçao ambiental gerada por respiradores, comparando-se dois sistemas de umidificaçao. Métodos. Realizaram-se 51 estudos, comparando-se a colonizaçao dos aerossóis emitidos pela válvula expiratória dos aparelhos de ventilaçao mecânica, sendo 31 com nebulizadores convencionais e em 20 com condensadores higroscópicos, em quinze minutos de observaçao. Resultados. Houve emissao de bactérias para o ambiente, pela válvula expiratória, de 32,2 por cento de respiradores equipados com sistema de nebulizaçao convencional e de 5 por cento com condensador (p = 0,0340). Conclusao. A umidificaçao da mistura gasosa com o uso de condensadores pode ser um meio eficiente de reduzir a contaminaçao bacteriana ambiental.

[Bacterial aerosol generated by mechanical ventilators: comparative study]. / Aerossol bacteriano gerado por respiradores mecânicos: estudo comparativo.

UNLABELLED: Mechanical ventilators generate aerosol which may be bacterially colonized. PURPOSE: To determine the environmental contamination generated by ventilators with two different humidification techniques. METHODS: The study was done comparing the generation of bacterial colonized aerosol by the expiratory valve of mechanical respirators with conventional water nebulization or with hygroscopic condensator as the humidifier source during 15 minutes of observation. RESULTS: The aerosol got positive cultures in 32.2% of the conventional system and in 5% of the condensator system (p = 0.0340). CONCLUSION: We concluded that the humidification by the hygroscopic condensator may be an efficient way to reduce environmental bacteria contamination.

[Esophageal injury in the anterior approach of the cervical spine]. / Lesão esofágica em abordagem por via anterior da coluna cervical.

The esophageal injuries as complications of the anterior approach to the cervical spine are rare. The authors present a case of esophageal perforation with a screw employed in an anterior fixation of the cervical spine.

Novo sistema de umidificaçäo e aquecimento da mistura gasosa dos respiradores: estudo comparativo / The new system of gaseous mixture humidification and heating of respirators: comparative study

Foram estudados dois grupos de pacientes comparando-se o desempenho de nebulizaçäo convencional em relaçäo a um novo sistema constituído pela interposiçäo de um condensador higroscópico no circuito sem nebulizador. A eficiência da umidificaçäo foi relativamente igual nos dois grupos, sendo que os pacientes com nebulizaçäo convencional tiveram estatísticamente maior formaçäo de "rolhas". A contaminaçäo, apesar de trocas diárias dos circuitos, e de 8// com o uso dos condensadores, mesmo em circuitos que permanecram sem troca por até nove dias. Esta diferença foi altamente signficativa (p = 0,0011). O preço comparativo dos dois sistemas mostrou que o custo do uso do condensador é de menos da metade do custo da troca e desinfecçäo diária de circuitos (221,64 doólares contra 537,30 dólares por mês do uso contínuo do respirador)

[The new system of gaseous mixture humidification and heating of respirators: comparative study]. / Novo sistema de umidificação e aquecimento da mistura gasosa dos respiradores: estudo comparativo.

A comparative study was done using Bear 5 conventional nebulizing cascade system or HCH in the mechanical ventilator circuit. The humidification capacity was nearly the same in both systems although the conventional one originated significantly more "plugs" than the HCH. The circuit contamination was highly more significant in the nebulizer group (63.6%) than in HCH' (8%) (p = 0.0011). The cost of HCH use is less than half of the nebulizing one (US $ 221.64 versus US $ 537.30 per each month.

Epilepsia e educaçäo pública / Epilepsy and public education

Foi elaborado questionário para obter informaçöes sobre as atitudes pessoais e o conhecimento geral sobre as epilepsias. Foram submetidos a esse questionário professores de primeiro e segundo graus de escolas particulares e públicas, bem como professores universitários de áreas médica e näo médica, num total de 97 pessoas, restringindo-se à regiäo da Grande Säo Paulo. Näo foram observadas diferenças nos resultados obtidos dos professores de escolas públicas, quando comparado aos de escolas particulares. Taxa alta de desinformaçäo foi encontrada nas questöes referentes às atitudes diante de pessoa que esteja apresentando convulsäo e, também, quanto ao conceito e à etiologia das epilepsias, inclusive entre professores de área médica. Concluímos que muitos professores (inclusive os de área médica) näo têm conhecimentos suficientes a respeito das epilepsias. É evidente a necessidade de programa nacional direcionado näo só aos professores mas, também, à populaçäo em geral, visando a levar a atitude mais positiva com relaçäo aos epilépticos e a melhorar sua qualidade de vida e seu tratamento

[Epilepsy and public education]. / Epilepsia e educação pública.

The social problems experienced by persons with epilepsy become increasingly apparent to those who work closely with group associations. The objective of our study was to obtain information on personal attitudes and knowledge about epilepsies. Primary and high-school teachers and professors (medical and non-medical areas) were submitted to a questionnaire which was designed to obtain this information. We concluded that most professors (including those of medical areas) do not know enough about epilepsies. We believe that problems which are perceived by epileptics regarding social aspects may be softened through improved education of the community in general. Continued education of medical practitioners, professors, teachers, patients and their families leads to a positive attitude towards epilepsies, which are essential and may help to improve life quality and the patient's medical treatment.

Significado da flora bacteriana em traqueostomias de pacientes graves. / Significance of bacterial flora in tracheostomy of critically ill patients

Os autores estudam 21 pacientes graves, portadores de traqueostomia, procurando avaliar o significado pratico da obtencao de culturas positivas a partir de secrecao aspirada atraves da canula. Concluem que essas culturas, que geralmente identificam aerobios gram-negativos de alta resistencia a antibioticos, so tem valor como guia para tratamento antimicrobiano especifico quando a analise clinico-radiologica, feita por terapeuta experiente, demonstrar quadro infeccioso instalado.Enfatizam ainda o importante papel desempenhado pela retirada de secrecoes e pela fisioterapia respiratoria no paciente grave,sem o que essas secrecoes, sempre contaminadas, podem ser fonte de infeccao grave