Dysglycemias in pregnancy: from diagnosis to treatment. Brazilian consensus statement.

There is an urgent need to find consensus on screening, diagnosing and treating all degrees of dysglycemia that may occur during pregnancies in Brazil, considering that many cases of dysglycemia in pregnant women are currently not diagnosed, leading to maternal and fetal complications. For this reason the Brazilian Diabetes Society (SBD) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASGO), got together to introduce this proposal. We present here a joint consensus regarding the standardization of clinical management for pregnant women with any degree of dysglycemia, on the basis of current information, to improve medical assistance and to avoid related complications of dysglycemia in pregnancy to the mother and the fetus. This consensus aims to standardize the diagnosis among general practitioners, endocrinologists and obstetricians allowing the dissemination of information in basic health units, public and private services, that are responsible for screening, diagnosing and treating disglycemic pregnant patients.

Theoretical considerations on the rehabilitation process.

In the present work some of the theoretical aspects which qualifies the rehabilitation process are pointed out. The context of rehabilitation should include the social network. The isomorphism between the rehabilitation process and the Batesonian concept of mind like "the pattern which connects" is as well emphasized. In this sense the rehabilitation (as the Batesonian mind) is a process imminent in the various contexts the patients deal with and elaborates the differences between these contexts. According to this view it is useful to refer to the Second Cybernetic epistemological model: the structural coupling between therapeutic system, family and social network is the goal of rehabilitation.

Chemical and physical agents of work-related cardiovascular diseases.

This article summarizes the state of the art in research on cardiovascular diseases (CVD) and occupational exposure. The major chemical and physical agents are considered and the methodological difficulties of epidemiological surveys are discussed. Work-related CVD, like all occupational disorders, are changing continuously as a consequence of modifications in industrial processes, improvements in preventative measures, and the tertiarization of the economy. The cornerstones of a preventative strategy of CVD are still based on environmental monitoring and medical surveillance, but at the same time on multidisciplinary and multicentred scientific research. Where possible, health promotion will include more general programmes directed at changing personal risk factors.

Epidemiological survey of shipyard workers exposed to hand-arm vibration.

All 169 caulkers employed at a ship yard were examined to determine the prevalence of vibration syndrome due to pneumatic portable tools (chipping hammer and grinders). Vibration measurements and medical investigations were performed in the field between September 1977 and July 1978. Vibration spectra recorded on pneumatic tools were compared to ISO Draft Proposal No. 5369. The chipping hammer produced the highest acceleration levels and exceeded the maximum ISO limits even for a short exposure time (30 min per shift). The results of medical investigations pointed out that 78.7% of caulkers experienced paresthesia in their hands, 31.3% Raynaud's phenomenon (or VWF), 20.1% presented with radiological signs of osteoarthritis at wrist and shoulders, 10.0% with olecranon exostoses, and 31.3% with cysts of the carpal bones. To diagnose VWF the skin temperature of the hands were recorded in all 169 caulkers and 60 controls at the shipyard. The basal skin thermometric map (recorded in 16 positions per hand) demonstrated an average difference of 2-2.5 degrees C between the two populations. The thermometric curve, monitored every 3 min for 40 min after a provocative cold-test (immersion of hands and wrists in melting ice for 2 min), well differentiated workers exposed and not exposed to vibrations. The authors emphasize that skin temperature (before and after the cold-test) are suitable for epidemiological purposes to compare the prevalence rates of VWF in control-experimental groups.