Phenotypic and Functional Characterization of Memory CD4+ and CD8+ T Cells After Antigenic Stimulation.

The encounter of T cells with the antigen through the interaction of T cell receptors with peptides and major histocompatibility complex (MHC) molecules on the surface of antigen-presenting cells (APCs) can generate effector response and memory T cells. Memory T cells developed following infections or vaccination may persist, leading to the generation of a specific immune response upon reexposure to the same pathogen through rapid clonal proliferation and activation of effector functions. T cell memory subsets can be identified based on the expression of several membrane markers such as CCR7, CD27, and CD45RA. Using fluorescent antibodies against these markers and a flow cytometer, it is possible to perform immunophenotyping via the analysis of cell surface expression of proteins by different subpopulations such as the subsets of naïve, effector, and memory T cells as well as via the analysis of functional markers that further characterize each sample. Intracellular cytokine staining allows for the evaluation of intracellular proteins expressed in T cells in response to antigenic stimulation. This chapter presents the phenotypic and functional characterization of memory T cells after antigenic stimulation, detailing the procedures for identifying intracellular and surface protein markers. Herein, we review and present a reproducible standardized protocol using antibodies for specific markers and applying flow cytometry.

Distinct anti-NP, anti-RBD and anti-Spike antibody profiles discriminate death from survival in COVID-19.

Introduction: Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces rapid production of IgM, IgA, and IgG antibodies directed to multiple viral antigens that may have impact diverse clinical outcomes. Methods: We evaluated IgM, IgA, and IgG antibodies directed to the nucleocapsid (NP), IgA and IgG to the Spike protein and to the receptor-binding domain (RBD), and the presence of neutralizing antibodies (nAb), in a cohort of unvaccinated SARS-CoV-2 infected individuals, in the first 30 days of post-symptom onset (PSO) (T1). Results: This study included 193 coronavirus disease 2019 (COVID-19) participants classified as mild, moderate, severe, critical, and fatal and 27 uninfected controls. In T1, we identified differential antibody profiles associated with distinct clinical presentation. The mild group presented lower levels of anti-NP IgG, and IgA (vs moderate and severe), anti-NP IgM (vs severe, critical and fatal), anti-Spike IgA (vs severe and fatal), and anti-RBD IgG (vs severe). The moderate group presented higher levels of anti-RBD IgA, comparing with severe group. The severe group presented higher levels of anti-NP IgA (vs mild and fatal) and anti-RBD IgG (vs mild and moderate). The fatal group presented higher levels of anti-NP IgM and anti-Spike IgA (vs mild), but lower levels of anti-NP IgA (vs severe). The levels of nAb was lower just in mild group compared to severe, critical, and fatal groups, moreover, no difference was observed among the more severe groups. In addition, we studied 82 convalescent individuals, between 31 days to 6 months (T2) or more than 6 months (T3), PSO, those: 12 mild, 26 moderate, and 46 severe plus critical. The longitudinal analyzes, for the severe plus critical group showed lower levels of anti-NP IgG, IgA and IgM, anti-Spike IgA in relation T3. The follow-up in the fatal group, reveals that the levels of anti-spike IgG increased, while anti-NP IgM levels was decreased along the time in severe/critical and fatal as well as anti-NP IgG and IgA in several/critical groups. Discussion: In summary, the anti-NP IgA and IgG lower levels and the higher levels of anti-RBD and anti-Spike IgA in fatal compared to survival group of individuals admitted to the intensive care unit (ICU). Collectively, our data discriminate death from survival, suggesting that anti-RBD IgA and anti-Spike IgA may play some deleterious effect, in contrast with the potentially protective effect of anti-NP IgA and IgG in the survival group.

Heterologous Booster with BNT162b2 Induced High Specific Antibody Levels in CoronaVac Vaccinees.

Immune responses after COVID-19 vaccination should be evaluated in different populations around the world. This study compared antibody responses induced by ChAdOx1 nCoV-19, CoronaVac, and BNT162b2 vaccines. Blood samples from vaccinees were collected pre- and post-vaccinations with the second and third doses. The study enrolled 78 vaccinees, of whom 62.8% were women, with the following median ages: 26 years-ChAdOx1 nCoV-19; 40 years-CoronaVac; 30 years-BNT162b2. Serum samples were quantified for anti-RBD IgG and anti-RBD IgA and anti-spike IgG by ELISA. After two vaccine doses, BNT162b2 vaccinees produced higher levels of anti-RBD IgA and IgG, and anti-spike IgG compared to ChAdOx1 nCoV-19 and CoronaVac vaccinees. The third dose booster with BNT162b2 induced higher levels of anti-RBD IgA and IgG, and anti-spike IgG in CoronaVac vaccinees. Individuals who reported a SARS-CoV-2 infection before or during the study had higher anti-RBD IgA and IgG production. In conclusion, two doses of the studied vaccines induced detectable levels of anti-RBD IgA and IgG and anti-spike IgG in vaccinees. The heterologous booster with BNT162b2 increased anti-RBD IgA and IgG and anti-spike IgG levels in CoronaVac vaccinees and anti-RBD IgA levels in ChAdOx1 nCoV-19 vaccinees. Furthermore, SARS-CoV-2 infection induced higher anti-RBD IgA and IgG levels in CoronaVac vaccinees.

Integrated Metabolic and Inflammatory Signatures Associated with Severity of, Fatality of, and Recovery from COVID-19.

Severe manifestations of coronavirus disease 2019 (COVID-19) and mortality have been associated with physiological alterations that provide insights into the pathogenesis of the disease. Moreover, factors that drive recovery from COVID-19 can be explored to identify correlates of protection. The cellular metabolism represents a potential target to improve survival upon severe disease, but the associations between the metabolism and the inflammatory response during COVID-19 are not well defined. We analyzed blood laboratorial parameters, cytokines, and metabolomes of 150 individuals with mild to severe disease, of which 33 progressed to a fatal outcome. A subset of 20 individuals was followed up after hospital discharge and recovery from acute disease. We used hierarchical community networks to integrate metabolomics profiles with cytokines and markers of inflammation, coagulation, and tissue damage. Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) promotes significant alterations in the plasma metabolome, whose activity varies according to disease severity and correlates with oxygen saturation. Differential metabolism underlying death was marked by amino acids and related metabolites, such as glutamate, glutamyl-glutamate, and oxoproline, and lipids, including progesterone, phosphocholine, and lysophosphatidylcholines (lysoPCs). Individuals who recovered from severe disease displayed persistent alterations enriched for metabolism of purines and phosphatidylinositol phosphate and glycolysis. Recovery of mild disease was associated with vitamin E metabolism. Data integration shows that the metabolic response is a hub connecting other biological features during disease and recovery. Infection by SARS-CoV-2 induces concerted activity of metabolic and inflammatory responses that depend on disease severity and collectively predict clinical outcomes of COVID-19. IMPORTANCE COVID-19 is characterized by diverse clinical outcomes that include asymptomatic to mild manifestations or severe disease and death. Infection by SARS-CoV-2 activates inflammatory and metabolic responses that drive protection or pathology. How inflammation and metabolism communicate during COVID-19 is not well defined. We used high-resolution mass spectrometry to investigate small biochemical compounds (<1,500 Da) in plasma of individuals with COVID-19 and controls. Age, sex, and comorbidities have a profound effect on the plasma metabolites of individuals with COVID-19, but we identified significant activity of pathways and metabolites related to amino acids, lipids, nucleotides, and vitamins determined by disease severity, survival outcome, and recovery. Furthermore, we identified metabolites associated with acute-phase proteins and coagulation factors, which collectively identify individuals with severe disease or individuals who died of severe COVID-19. Our study suggests that manipulating specific metabolic pathways can be explored to prevent hyperinflammation, organ dysfunction, and death.

Plataformização do trabalho em mercado periférico: uma análise ergológica de implicações nas condições de vida e de trabalho de motoristas e entregadores/as no contexto brasileiro / Platformization of labor in the peripheral market: an ergological analysis of implications for the living and working conditions of drivers and delivery workers in the Brazilian context

Em um quadro em que se constata a ampliação exponencial da exploração do trabalho por plataformas digitais e de discussões sobre a relação de funcionalidade entre os mercados centrais e periféricos de trabalho, propõe-se aqui uma análise do trabalho de entregadores/as e motoristas por aplicativos no contexto social, político e econômico brasileiro. O objetivo é identificar normas e valores em circulação nas experiências dos trabalhadores no entrecruzamento de seus contextos de vida e trabalho. Com base no referencial teórico da Ergologia, realizou-se uma pesquisa qualitativa com vistas à aproximação das vivências e atividades dos sujeitos por meio de entrevistas semiestruturadas. Os resultados apontam valores em circulação nos debates de normas que entram em conflito entre o ideal de liberdade anunciado pelas empresas-plataformas, o controle e o direcionamento do trabalho operado por elas via gerenciamento algorítmico e a iminência de perda da fonte de sustento. Afirma-se, a importância da construção de caminhos coletivos de produção da saúde, seja no âmbito macrossocial ou na experiência concreta e cotidiana de trabalho

In a context in which the exponential growth of the exploitation of work by digital platforms and the discussion on the relation of functionality between central and peripheral labor markets, the authors propose an analysis of the work of delivery workers and app drivers in the Brazilian social, political, and economic context. They aimed to identify norms and values in workers' experiences at the intersection between the contexts of their life and work. Based on the theoretical framework of Ergology, a qualitative research was carried out to approach subjects' experiences and activities using semi-structured interviews. Results point to values found in the norms that conflict with the ideal of freedom heralded by online platform companies, the control and directing of the work operated by these companies via algorithmic management, and the imminence of loss of source of livelihood. We stress the importance of building collective paths to produce health, whether in the macro-social context or in the concrete, daily experience of work

Complex systems design based on actual system functioning: Coping with variability in a national water ambulances service.

BACKGROUND: In Brazil, the Mobile Emergency Medical Service (SAMU) is a model of mobile assistance and care for emergencies standardized throughout the country. The water ambulance service within the SAMU operates in riverside and coastal areas, and faces challenges and peculiarities that increase the complexity of providing a high-quality and safe emergency care service. OBJECTIVE: To develop organizational design guidelines aiming to improve resilient performance of complex systems, with an application to riverine and coastal mobile emergency care in Brazil. METHODS: Data collection followed an ethnographic approach. Fieldwork was carried in a participatory way, based on worksite technical description, semi-structured interviews with managers and emergency care teams' professionals, and work observation whenever possible. Five regional SAMU coordinations were visited. Data coding employed content analysis and grouped data excerpts according to concepts of capacity and demand. Interfaces were identified between demand and capacity elements and adaptations led by system agents, orienting the proposal of guidelines for organizational design as solutions to face the verified gaps. RESULTS: Design guidelines produced spanned composition and training of both intervention teams and dispatch central teams, uniforms and personal protective equipment (PPE), decentralized water bases, means of communication, intervention protocols, biosafety and inter-sector actions. CONCLUSION: The approach enabled framing and assessment of specific design elements according to resilience engineering concepts, which in turn showed paths for improving the service and reconciling work-as-imagined and actual system functioning.

Asymmetric "partners": work and health of app drivers in Rio de Janeiro, Brazil. / "Parceiros" assimétricos: trabalho e saúde de motoristas por aplicativos no Rio de Janeiro, Brasil.

This paper is the product of an ongoing research's preliminary results with app drivers and aims to discuss how the game of forces has occurred in the relationships established between companies, workers, regulatory bodies, and society. This exploratory qualitative study employed document analysis, a questionnaire, and semi-structured interviews with drivers linked to associations in Rio de Janeiro (RJ), Brazil. The analysis was conducted from a tripolar perspective based on the theoretical-methodological framework of Ergology and social life's micro and macroscopic spaces, encompassing the poles referring to human activity, the market, and politics. The results show a background of norms built on this work about the relationship with companies, passengers, and the drivers themselves, besides issues raised from the COVID-19 pandemic. We can conclude that it is necessary not to counteract technological evolution to achieve workers' rights and health. We should recall that no action aimed at ensuring the reconciliation of health, work, and rights will advance without relying on a fruitful and balanced trend between the three poles mentioned.

Este artigo é fruto de resultados preliminares de uma pesquisa em andamento com motoristas por aplicativo e tem por objetivo discutir sobre como tem se dado o jogo de forças nas relações que se estabelecem entre as empresas, os trabalhadores, os órgãos reguladores e a sociedade. O estudo exploratório, com abordagem qualitativa, utilizou análise documental, questionário e entrevistas semiestruturadas com motoristas ligados a associações do Rio de Janeiro/RJ. Tendo como base o referencial teórico-metodológico da Ergologia, e a partir dos espaços micro e macroscópico da vida social, a análise se deu em uma perspectiva tripolar, abarcando os polos referentes à atividade humana, ao mercado e à política. Os resultados apresentam normas antecedentes que vêm sendo construídas sobre este trabalho na relação com as empresas, com os passageiros e entre os próprios motoristas, além de questões trazidas a partir da pandemia de COVID-19. Conclui-se ser necessário não contrapor a evolução tecnológica à conquista de direitos e da saúde dos trabalhadores, sendo imperativo lembrar que nenhuma ação que vise garantir a conciliação entre saúde, trabalho e direitos conseguirá avançar sem contar com uma dinâmica frutífera, e tendencialmente equilibrada, entre os três polos mencionados.

"Parceiros" assimétricos: trabalho e saúde de motoristas por aplicativos no Rio de Janeiro, Brasil / Asymmetric "partners": work and health of app drivers in Rio de Janeiro, Brazil

Resumo Este artigo é fruto de resultados preliminares de uma pesquisa em andamento com motoristas por aplicativo e tem por objetivo discutir sobre como tem se dado o jogo de forças nas relações que se estabelecem entre as empresas, os trabalhadores, os órgãos reguladores e a sociedade. O estudo exploratório, com abordagem qualitativa, utilizou análise documental, questionário e entrevistas semiestruturadas com motoristas ligados a associações do Rio de Janeiro/RJ. Tendo como base o referencial teórico-metodológico da Ergologia, e a partir dos espaços micro e macroscópico da vida social, a análise se deu em uma perspectiva tripolar, abarcando os polos referentes à atividade humana, ao mercado e à política. Os resultados apresentam normas antecedentes que vêm sendo construídas sobre este trabalho na relação com as empresas, com os passageiros e entre os próprios motoristas, além de questões trazidas a partir da pandemia de COVID-19. Conclui-se ser necessário não contrapor a evolução tecnológica à conquista de direitos e da saúde dos trabalhadores, sendo imperativo lembrar que nenhuma ação que vise garantir a conciliação entre saúde, trabalho e direitos conseguirá avançar sem contar com uma dinâmica frutífera, e tendencialmente equilibrada, entre os três polos mencionados.

Abstract This paper is the product of an ongoing research's preliminary results with app drivers and aims to discuss how the game of forces has occurred in the relationships established between companies, workers, regulatory bodies, and society. This exploratory qualitative study employed document analysis, a questionnaire, and semi-structured interviews with drivers linked to associations in Rio de Janeiro (RJ), Brazil. The analysis was conducted from a tripolar perspective based on the theoretical-methodological framework of Ergology and social life's micro and macroscopic spaces, encompassing the poles referring to human activity, the market, and politics. The results show a background of norms built on this work about the relationship with companies, passengers, and the drivers themselves, besides issues raised from the COVID-19 pandemic. We can conclude that it is necessary not to counteract technological evolution to achieve workers' rights and health. We should recall that no action aimed at ensuring the reconciliation of health, work, and rights will advance without relying on a fruitful and balanced trend between the three poles mentioned.

Diagnóstico laboratorial das infecções urinárias: relação entre a urocultura e o EAS / Laboratory diagnosis of urinary tract infections: relation between uroculture and urinalysis

Objetivo: As infecções urinárias (ITU) acometem indivíduos no mundo inteiro e são causadas principalmente por bactérias Gram-negativas, sendo o diagnóstico laboratorial realizado pelo EAS e urocultura. Nesse estudo foram pesquisadas, em amostras de uroculturas positivas, as alterações apresentadas no exame de EAS, principalmente os marcadores de leucócitos e nitrito, e se estes poderiam contribuir para o diagnóstico da ITU. Também foram pesquisadas a faixa etária e a bactéria mais prevalente. Métodos: Um estudo retrospectivo foi realizado com base no levantamento de dados dos exames de urocultura realizados no Laboratório Clínico da PUC Goiás (LAC/PUC Goiás), no período de janeiro/2017 a agosto/2018, de acordo com idade, gênero do paciente e a espécie bacteriana isolada. Resultados: De 629 uroculturas positivas foi encontrada prevalência de ITU em adultos (63,3%), com predomínio no sexo feminino (85,8%), sendo a Escherichia coli (58,9%) a bactéria mais isolada. O nitrito foi detectado em 36,9% e a leucocitúria em 60,6% das amostras. Conclusão: Os resultados evidenciaram predomínio de ITU em adultos do sexo feminino, sendo a Escherichia coli a bactéria com maior prevalência. Quanto aos resultados do EAS, a leucocitúria revelou-se um marcador mais sensível para auxílio diagnóstico de ITU em relação ao nitrito, corroborando com a literatura científica especializada.

Objective: Urinary tract infections (UTI) affect individuals worldwide and are mainly caused by Gram-negative bacteria, and the laboratory diagnosis is performed by urinalysis and uroculture. In this study were investigated in samples of positive urocultures, the alterations presented in the examination of urinalysis, mainly leukocytes and nitrite, and if could contribute to the diagnosis of UTI. The most prevalent age group and bacteria were also investigated. Methods: A retrospective study was carried out based on data collection of uroculture examinations performed at the Clinical Laboratory of PUC Goiás (LAC/PUC Goiás), from january/2017 to august/2018, according to age, gender of patient and the isolated bacterial species. Results: Of 629 positive urocultures, the prevalence of UTI was found in adults (63,3%), with predominance in females (85,8%), and Escherichia coli (58,9%) was the most isolated bacteria. Nitrite was detected in 36,9% and leukocyturia in 60,6% of the samples. Conclusion: The results evidenced a predominance of UTI in female adults, and Escherichia coli was the most prevalent bacteria. Regarding the results of the urinalysis, leukocyturia proved to be a more sensitive marker for the diagnosis aid of UTI in relation to nitrite, corroborating with the literature.

Vulnerability in the elderly and its relationship with the presence of pain / Vulnerabilidade de idosos e relação com a presença de dor

ABSTRACT BACKGROUND AND OBJECTIVES: In Brazil, there is a high prevalence of pain in people above the age of 60, and although pain is not related as a direct factor of dependence and death, it interferes in several aspects of life with functional limitations. This study aimed to evaluate the vulnerability of the elderly and its relation to the presence of pain. METHODS: A survey with individuals over 60 years using the Vulnerable Elders Survey questionnaire for vulnerability analysis and the Pain-Related Disability Index to analyze the interference of pain in daily activities. The data were analyzed using the Student's t-test, Chi-square test, and Pearson's correlation. RESULTS: The study had 176 participants, mean age 68.3±6.8 years, 111 women (63.1%), and 65.9% rated their health as good. Forty-eight elderly (27.3%) were considered vulnerable, mainly women and patients with hypertension and diabetes. The most limiting daily living activities were bending, kneeling or squatting. The highest scoring domains for limitation due to pain were related to family and household activities, and work-related activities. The domains with lower scores were related to incapacity for sexual life and personal care. The older had lower scores on the pain scale, and the hypertensive had higher scores, as did women. There was an association between pain and vulnerability (p=0.00). CONCLUSION: Pain impacts the life of the elderly, causing suffering and disability for activities of daily living, besides increasing vulnerability.

RESUMO JUSTIFICATIVA E OBJETIVOS: No Brasil observa-se alta prevalência de dor em indivíduos acima de 60 anos, e embora a dor não apareça como fator direto de dependência e morte, causa interferência em diversos aspectos da vida e relaciona-se com limitações funcionais. O objetivo deste estudo foi avaliar a vulnerabilidade de idosos e relacionar com a presença de dor. MÉTODOS: Pesquisa com indivíduos acima de 60 anos, utilizando o questionário Vulnerable Elders Survey para a análise da vulnerabilidade e o Índice de Incapacidade relacionado com a dor para a análise da interferência da dor nas atividades de vida. A análise dos dados foi através dos testes t de Student, Qui-quadrado e Correlação de Pearson. RESULTADOS: Participaram do estudo 176 indivíduos, média de idade 68,3±6,8 anos, 111 mulheres (63,1%), e 65,9% avaliaram sua saúde como boa. Quarenta e oito idosos (27,3%) foram considerados vulneráveis, principalmente mulheres e portadores de hipertensão e diabetes. As atividades de vida diária com maior limitação foram curvar-se, ajoelhar-se ou agachar. Os domínios de maior pontuação para limitação devido à dor foram relacionados à família e atividades domésticas, e atividades relacionadas ao trabalho. Os domínios com menores pontuações foram relacionados à incapacidade para vida sexual e cuidados pessoais. Os mais velhos tiveram menor pontuação na escala de dor e os hipertensos tiveram pontuação maior, assim como as mulheres. Houve associação entre presença de dor e vulnerabilidade (p=0,00). CONCLUSÃO: A dor impacta a vida dos idosos, causando sofrimento e incapacidade para as atividades da vida diária, além de aumentar a vulnerabilidade.

Ação-formação: uma leitura das contribuições da Ergonomia da Atividade / Action-training: a reading of the contributions of the Activity Ergonomics

Este artigo objetiva refletir acerca das interações entre formação e ação ergonômica, especificamente, na perspectiva da Ergonomia da Atividade. Seu ponto de partida é a trajetória histórica dessa interface, sinalizando dilemas e alternativas pautadas nas relações entre análise do trabalho e ações formativas. Seus desdobramentos são explorados a partir do "paradigma da formação de atores na e pela análise do trabalho, para e pela ação", ancorado na interdependência entre formação e transformação das condições de trabalho. Conclui-se que este paradigma abre novas vias de análise sobre a sustentabilidade da ação ergonômica e sobre a luta pela saúde.(AU)

This article aims to reflect on the interaction between training and ergonomics' action, specifically, from the Activity-centered Ergonomics perspective. Its starting point is the historical trajectory of this interface, signaling dilemmas and alternatives based on work analysis and training programs relations. Its developments are explored from the "paradigm of training in and by the analysis of work, to and by action", anchored in the interdependence between training and working conditions transformation. It is concluded that this paradigm opens new avenues of analysis on the sustainability of the ergonomics' action and on the struggle for health.(AU)

Dimensão relacional da atividade de cuidado e condições de trabalho de auxiliares de enfermagem em uma unidade neonatal / The relational dimension of the care activity and the working conditions in a neonatal unit

Este artigo analisa as condições de trabalho de auxiliares de enfermagem que atuam em Unidade Neonatal, considerando a dimensão relacional da atividade de cuidado. Tendo como principais referências epistemológicas a concepção canguilhemiana de saúde e a perspectiva ergológica, a pesquisa se pautou em abordagens clínicas do trabalhar, incluindo métodos diretos (observações), indiretos (conversas e encontros sobre o trabalho com as auxiliares) e análise de documentos relativos às normas antecedentes desse trabalho. Analisou-se fundamentalmente a produção linguageira dos coletivos. Entre os resultados encontrados, destacam-se: o desenvolvimento dessa atividade de cuidado implica intensa mobilização das trabalhadoras; a possibilidade de não atender às mães que chegam para ter seus bebês parece ser mais nocivo à saúde dessas profissionais do que trabalhar com um número excessivo de pacientes. Concluiu-se que as condições precárias de trabalho são potencialmente produtoras de sofrimento patogênico, uma vez que a realização prazerosa e bem-sucedida dessa atividade é dificultada.

This paper focuses on the working conditions of nursing technicians of Neonatal Units, considering the relational dimension of the care activity. Having as main epistemological references Canguilhem's concept of health of and the Ergological perspective, the research was based on the clinical approaches of work, including the following methods: direct (observations) and indirect (talks and meetings about work with the technicians); analysis of documents on the previous norms concerning this work. The analysis dealt basically with the groups' language production. Some results can be highlighted: the development of this care activity implies intense mobilization of workers; the possibility of not assisting the mothers who arrive to have their babies seems to be more noxious to these technicians than to work with an overload of patients; the precarious conditions of work are producers of pathogenic suffering, once the pleasant and well-succeeded realization of this activity is hindered.

Competências, sofrimento e construção de sentido na atividade de auxiliares de enfermagem em Utin / Skills, suffering and construction of meaning in the activity of auxiliary nurses in the neonatal intensive care unit (NICU)

O artigo trata das competências requeridas/ desenvolvidas nas atividades de auxiliares de enfermagem de uma Unidade de Terapia Intensiva Neonatal (Utin) em articulação com a saúde dessas trabalhadoras (o sofrimento→prazer no trabalho). A perspectiva da ergologia orienta o esforço investigativo, incorporando outros referenciais, como os contidos nos estudos de Zarifian e Dejours. No plano metodológico, ainda tendo o ponto de vista da atividade como operador sintético, foram feitos levantamento e análise de documentos e visitas à Utin, operando-se com o dispositivo Encontros sobre o Trabalho, da Comunidade Ampliada de Pesquisa (CAP). Concluiu-se que o coletivo de auxiliares, protagonista do trabalho em análise, construiu um patrimônio de conhecimentos práticos sobre o seu trabalho e uma base minimamente eficaz de transmissão desse patrimônio. Fazendo uso da abordagem 'Psicodinâmica do Trabalho', ressaltou-se o caráter desafiante que o trabalho em UTI Neonatal apresenta, o que envolve saber lidar não só com o sofrimento dos neonatos como também o de mães e familiares, inclusive como forma de defesa contra seu próprio sofrimento, evitando um rumo patogênico. Observou-se, por fim, que é premente a demanda de qualificação formal por parte dessas trabalhadoras, o que propiciaria, dentre outros importantes benefícios, um maior reconhecimento social, com efeitos positivos sobre sua própria saúde.

The article deals with vocational training and skills required in the activity of nursing staff in Neonatal Intensive Care Unit (NICU) in conjunction with the 'body-self' and the health of these workers. It discusses the issue of jurisdiction in synergy with other issues relevant to her, as the ratio of service and suffering→pleasure working. The perspective of Ergology guides the investigative effort, incorporating other materials such as Zarifian and Dejours. At the methodological level, even taking the viewpoint of activity as synthetic operator, made visits to the NICU, survey and analysis of documents and operated with the device Meetings on the Work of the Community Extended Search. It was concluded that this collective assistants built a heritage of practical knowledge about their work and a basis minimally effective transmission of this heritage. Using the approach of 'work labor psychodynamics', it was emphasized that the character challenging work in the NICU has, which also involves coping with the suffering of mothers and relatives of newborns, including as a defense against his own suffering, avoiding a pathogenic way. It was also highlighted the importance of the possibility of renormatization, recentering of the environment in which they work, the extent that their values can be expressed. It was observed, finally, that there is a pressing demand for formal qualifications by these workers, which would provide, among other important benefits, greater social recognition, with positives effects to the health.

O trabalho e a saúde de cuidadores de adolescentes com deficiência: uma aproximação a partir do ponto de vista da atividade / Work and health status of care-givers of disable adolescents: an approach from the activity point of view

Este artigo apresenta e discute resultados de uma pesquisa sobre cuidadores de adolescentes com deficiência (física e mental) em um dispositivo de atenção diário implantado recentemente pela prefeitura do Rio de Janeiro. O objetivo foi compreender como a atividade de trabalho dos cuidadores (naturalizada e invisibilizada por sua associação com o trabalho doméstico-maternal) relaciona-se ao processo saúde-doença vivenciado por eles. O método utilizado combinou observações do trabalho, entrevistas individuais e coletivas semi-estruturadas, utilizando a perspectiva ergológica e, principalmente, de seus conceitos de normas antecedentes e renormatizações, como eixo de análise. Apontamos como principais resultados: prescrições naturalizadas de cuidado; excessiva intensidade na realização do trabalho; problemas no planejamento e na gestão do tempo no serviço; construção da cooperação entre os cuidadores, que assegura, ainda que de forma precária, a realização do trabalho; grande proximidade afetiva com os usuários como exigência do trabalho e como importante operador do processo saúde-doença e de geração de sentido no/do trabalho. Entende-se que o fato de o trabalho de cuidado ser visto como natural, "parental", contribui para a oferta insuficiente de instrumentos (teóricos e práticos) para essa prática profissional. A pouca qualificação parece gerar aumento nos riscos à saúde desses trabalhadores, uma vez que eles têm acesso restrito a técnicas e condições de trabalho que possibilitariam realizá-lo de forma mais profícua. Assim, esses fatores, associados à invisibilidade do trabalho relacional aí empreendido, acabam provocando uma fragilização da luta pela saúde, da capacidade de recriação das normas no trabalho.