[The problem of risks in medical tourism (literature review)].

Known for unpredictable outcomes and potential patient safety issues, medical tourism is a term that refers to travel outside the country (region) of residence to receive medical care. The article presents a review of the literature reflecting the results of scientific research on medical and non-medical risks of tourists traveling abroad to receive medical care. The review is based on the content analysis of foreign publications in scientific and peer-reviewed journals.

Descarte de medicamentos e os impactos ambientais: uma revisão integrativa da literatura / Disposal of drugs and the ensuing environmental impacts: an integrative review of the literature

Resumo O objetivo deste artigo é investigar as evidências nacionais e internacionais disponíveis sobre o descarte de medicamentos e os impactos em matrizes ambientais. Trata-se de uma revisão integrativa da literatura realizada nas bases de dados PubMed, SciELO e Biblioteca Virtual em Saúde (BVS) e que incluiu artigos em inglês, espanhol e português publicados entre 2010 e 2020. Foram selecionados 26 artigos, que evidenciaram o descarte incorreto de medicamentos por profissionais e consumidores devido, principalmente, à falta de conhecimentos sobre os impactos ambientais que esses podem ocasionar. Estudos apontaram a contaminação de água, esgoto e sedimentos por fármacos descartados de forma incorreta. Além disso, observou-se que seres vivos aquáticos podem ser impactados pela presença de medicamentos em matrizes ambientais. O descarte de medicamentos incorreto ainda é uma realidade nas evidências avaliadas, que promove a contaminação de matrizes ambientais e muitas vezes não é removido por estações de tratamento de águas residuárias e interfere no equilíbrio da vida ambiental.

Abstract The scope of this article is to investigate the national and international evidence available on the forms of drug disposal and the presence of drugs in environmental matrices. It involved an integrative review of the literature conducted in the PubMed, SciELO and Virtual Health Library (VHL) databases, which included articles in English, Spanish and Portuguese published between 2010 and 2020. Twenty-six articles were selected, which revealed the incorrect disposal of medicines by professionals and consumers due mainly to the lack of knowledge about the environmental impacts that they may cause. Studies have highlighted the contamination of water, sewage and sediments by incorrectly discarded drugs. Furthermore, it was observed that aquatic living creatures can be impacted by the presence of drugs in environmental matrices. The incorrect disposal of drugs continues to be a reality in the evidence assessed, which leads to the contamination of environmental matrices and is often not removed by wastewater treatment plants and interferes with the equilibrium of environmental life.

Identification of Hazards and Assessment of Risks associated with the Harvesting of Coffee.

OBJECTIVE: To study the factors associated with the occupational risks affecting coffee harvesters from Timbío, Cauca, Colombia. METHODS: This descriptive study assessed workplace conditions, aiming to design a mitigation proposal that would help alleviate the dangers currently facing the studied population. The data were collected through 19 visits to the coffee plantations. A survey to characterize workers and determine the presence of musculoskeletal lesions was applied; in addition, the Colombian Technical Guide (GTC 45, by its initials in Spanish) was consulted. RESULTS: Coffee harvesting comes with several high priority risks, of which those that are biomechanical stand out. These are the result of strained positions, antigravity postures, repetitive movements, high physical effort, and the manual handling of heavy objects. Additionally, there are psychosocial risks attend the kind of contract, the low wages, the lack of social security, and the lack of affiliation with the occupational risk-management system. During the data collection, 18% of the workers reported having had an occupational accident while harvesting coffee. CONCLUSION: The process for identifying danger and assessing risk established, for all the cases, a level 1 risk. According to the rating scale of the GTC 45, such a level is unacceptable. We concluded that it is necessary to take immediate measures to control the identified dangers. To improve the health of the members of the studied sample, we propose the implementation of an epidemiological surveillance system for musculoskeletal injuries.

Bases teóricas e metodológicas da Bioética Crítica frente os desafios do Antropoceno / Theoretical and methodological bases of Critical Bioethics facing the challenges of the Anthropocene

A Bioética Crítica propõe uma fundamentação teórica e metodológica que parte da autocrítica sobre o próprio campo da bioética, bem como da produção do conhecimento e da tecnologia como um todo, buscando identificar como os discursos éticos são muitas vezes utilizados para ocultar agendas e interesses que vão na contramão daquilo que se espera de qualquer produção bioética: a defesa da saúde e da vida em seu mais amplo aspecto. Este trabalho apresenta uma introdução, por meio de investigação de natureza teórica e reflexiva, dos principais elementos da Bioética Crítica, sua inserção no debate com outras abordagens da área e seus modos de aplicação metodológica. Ao ponderar sobre alguns desafios relacionados à emergência dos conflitos socioambientais, e em diálogo com produções dos estudos sobre o Antropoceno e as críticas do Capitaloceno, o artigo conclui com uma proposta inicial para expansão de seu corpus teórico.

Critical Bioethics proposes a theoretical and methodological foundation starting from self-criticism about the field of bioethics itself, as well as the production of knowledge and technology as a whole, seeking to identify how ethical discourses are often used to hide agendas and interests that go contrary to what is expected from any bioethical production: the defense of health and life in its broadest aspect. This work presents an introduction, through an investigation of a theoretical and reflective nature, the main elements of Critical Bioethics, its insertion in the debate with other approaches in the area and its methods of methodological application. By considering some challenges related to the emergence of socio-environmental conflicts, and in dialogue with productions from studies on the Anthropocene and criticisms of the Capitalocene, the article concludes with an initial proposal for expanding its theoretical corpus.

Maternal Health Care Seeking Behavior for Neonatal Danger Signs and Associated Factors Among Post-Partum Mothers in Southeast Ethiopia: A Cross-Sectional Study.

Early health care seeking could save neonates' lives and have a significant role in decreasing neonatal death, while delayed health care seeking has many contributions to neonatal mortality. Therefore, this study aimed to assess maternal health-seeking behavior for neonatal danger signs and associated factors among postpartum mothers in Southeast Ethiopia. A community-based cross-sectional study was conducted on a random sample of 400 women with sick neonates from June 1st, 2020 to 27th, November. A Modified Anderson and Newman behavioral model consisting predisposing, enabling, need, and health system factors were utilized and participants were interviewed by using structured questionnaires. Multivariate logistic regression analysis was used to identify factors associated with maternal health-seeking behavior. Adjusted odds ratios (AOR) were reported with their corresponding 95% confidence interval (CI) to determine the strength of the association. The statistical significance was declared at P < .05. Slightly higher than two-fifths, (44%, 95% CI: 39.2-48.9) of the respondents' have appropriate healthcare-seeking behavior for neonatal danger signs. Postnatal care follows-up (AOR = 3.5; 95% CI: 2.06-5.80), good knowledge of neonatal danger signs (AOR = 2.78; 95% CI: 1.63-4.73), decision-making power for taking sick neonates to health institution (AOR = 3.02, 95% CI: 1.61-5.67), mothers living with their partner (AOR = 3.00; 95% CI: 1.42-6.31), and health insurance (AOR = 1.82; 95% CI: 1.08-3.06) were significantly associated with having appropriate healthcare-seeking behavior. Healthcare-seeking behavior of the respondents' was low and indicated by nearly 2 out of 5 respondents' had appropriate health-seeking behavior for neonatal danger sign. Postnatal care follow-up, health insurance, good knowledge of neonatal danger signs, living with a partner, and decision-making power were predictors of appropriate healthcare-seeking behavior for neonatal danger signs. Emphasis should be given to creating awareness of neonatal danger signs, maintaining postnatal follow-up, and encouraging mothers/caregivers to make immediate decisions for seeking healthcare at healthcare institutions.

COVID-19 Vaccine Hesitancy in a Medically-Challenged Context: A Cross-Sectional Study of Drivers, Dangers and Corrective Measures for Vaccine Hesitancy and Potential Penalties for Declining Vaccination among Adults in South-Eastern Nigeria.

BACKGROUND: COVID-19 vaccine hesitancy is a global public health problem. It is a complex and context-specific phenomenon that varies within and across nations. Despite COVID-19 vaccine programmes in Nigeria, there are possibilities that vaccine uptake and coverage among adult citizens will suffer setbacks amidst various interventions by the Federal Government of Nigeria. AIM: The study aimed to determine the drivers, dangers, and corrective measures for COVID-19 vaccine hesitancy and potential penalties for declining vaccination among adults in South-eastern Nigeria. METHODS: A descriptive study was carried out from March to April, 2021 on a cross section of 400 adults in South-eastern Nigeria. Data collection was done using a structured, pretested, and interviewer administered questionnaire. The questionnaire elicited information on drivers, dangers and corrective measures for COVID-19 vaccine hesitancy and potential penalties for declining vaccination. RESULTS: The study participants were aged 18-86 (51±14.2) years. There were 227(56.8%) females. The most common driver of refusal of COVID-19 vaccination was the safety of COVID-19 vaccines(100.0%). The most perceived dangers of refusing the COVID-19 vaccine were the risks of contracting COVID-19 infection(100.0%) and dying from its complications(100.0%). The most common corrective measure for refusal of the COVID-19 vaccine was public health information and education on vaccine safety(100.0%). The predominant potential penalty for declining the COVID-19 vaccine was restricting access to air travel (100.0%). CONCLUSION: This study has shown that the most common driver of vaccine hesitancy was vaccine safety while the most commonly perceived dangers were risks of contracting COVID-19 infection and dying from its complications. The most common corrective measure for refusal of the COVID-19 vaccine was public health information and education on vaccine safety. The most preeminent penalty for declining the COVID-19 vaccine was restricting access to air travel. There is a need to address these context-specific drivers and dangers that promote vaccine hesitancy. Public health information and education strategies to reduce vaccine hesitancy should be the focus of intervention to improve uptake of COVID-19 vaccination and safeguard the health of Nigerians.

CONTEXTE: L'hésitation à se faire vacciner contre le COVID-19 est un problème de santé publique mondial. Il s'agit d'un phénomène complexe et spécifique au contexte qui varie au sein d'une même nation et d'une nation à l'autre. Malgré les programmes de vaccination contre le COVID-19 au Nigeria, il est possible que l'adoption et la couverture vaccinale chez les adultes subissent des revers malgré les diverses interventions du gouvernement fédéral du Nigeria. OBJECTIF: L'étude visait à déterminer les moteurs, les dangers et les mesures correctives de l'hésitation à se faire vacciner contre le COVID- 19 et les sanctions potentielles en cas de refus de vaccination chez les adultes du sud-est du Nigeria. MÉTHODES: Une étude descriptive a été menée de mars à avril 2021 sur un échantillon de 400 adultes du sud-est du Nigeria. La collecte des données a été effectuée à l'aide d'un questionnaire structuré, testé au préalable et administré par un enquêteur. Le questionnaire a permis d'obtenir des informations sur les facteurs, les dangers et les mesures correctives de l'hésitation à se faire vacciner par le COVID-19 et les sanctions potentielles en cas de refus de la vaccination. RÉSULTATS: Les participants à l'étude étaient âgés de 18 à 86 ans (51±14,2). Il y avait 227 (56,8 %) femmes. Le motif le plus courant de refus de la vaccination par le COVID-19 était l'innocuité des vaccins COVID-19 (100,0 %). Les dangers les plus perçus du refus du vaccin COVID-19 étaient les risques de contracter une infection au COVID-19 (100,0%) et de mourir de ses complications (100,0%). La mesure corrective la plus courante pour le refus du vaccin COVID-19 était l'information et l'éducation en matière de santé publique sur la sécurité du vaccin (100,0%). La pénalité potentielle prédominante pour le refus du vaccin COVID-19 était la restriction de l'accès aux voyages aériens (100,0 %). CONCLUSION: Cette étude a montré que le facteur le plus courant de l'hésitation à se faire vacciner était la sécurité du vaccin, tandis que les dangers les plus couramment perçus étaient les risques de contracter l'infection au COVID-19 et de mourir de ses complications. La mesure corrective la plus courante pour le refus du vaccin COVID-19 était l'information et l'éducation de la santé publique sur la sécurité du vaccin. La sanction la plus prééminente pour le refus du vaccin COVID-19 était la restriction de l'accès aux voyages aériens. Il est nécessaire de s'attaquer à ces facteurs et dangers spécifiques au contexte qui favorisent l'hésitation à se faire vacciner. Les stratégies d'information et d'éducation en matière de santé publique visant à réduire l'hésitation à se faire vacciner devraient être au centre de l'intervention afin d'améliorer l'adoption de la vaccination par le COVID-19 et de préserver la santé des Nigérians. Mots clés: Vaccin COVID-19, Dangers, Facteurs d'incitation, Hésitation, Nigeria, Pénalités.

Exposición a riegos en la sala de autopsias / Risk exposure in the autopsy room

Resumen Este artículo describe la exposición a riesgos laborales en la actividad laboral de las salas de autopsia abarcan de manera general las condiciones en las cuales los trabajadores de las salas de autopsia se exponen a condiciones y situaciones durante la realización de una necropsia, con el objetivo de generar conciencia en la minimización de los riesgos por medio de la gestión de estos a través de medidas de mitigación, prevención y protección. Para estos efectos se define, clasifica, y se recomiendan tópicos al respecto de los riesgos laborales, así como propone la creación de protocolos y programas de prevención de enfermedades y accidentes laborales en las salas de autopsia.

Abstract This article describes the exposure to occupational risks in the work activity of the autopsy rooms, covering in a general way the conditions in which the workers of the autopsy rooms are exposed to conditions and situations during the performance of a necropsy, with the objective of generate awareness in minimizing risks by managing them through mitigation, prevention, and protection measures. For these purposes, it defines, classifies, and recommends topics regarding occupational risks, as well as proposing the creation of protocols and programs for the prevention of occupational diseases and accidents in autopsy rooms.

Anxiety, Anger and Depression Amongst Low-Income Earners in Southwestern Uganda During the COVID-19 Total Lockdown.

Background: Low-income earners are particularly vulnerable to mental health, consequence of the coronavirus disease 2019 (COVID-19) lockdown restrictions, due to a temporary or permanent loss of income and livelihood, coupled with government-enforced measures of social distancing. This study evaluates the mental health status among low-income earners in southwestern Uganda during the first total COVID-19 lockdown in Uganda. Methods: A cross-sectional descriptive study was undertaken amongst earners whose income falls below the poverty threshold. Two hundred and fifty-three (n = 253) male and female low-income earners between the ages of 18 and 60 years of age were recruited to the study. Modified generalized anxiety disorder (GAD-7), Spielberger's State-Trait Anger Expression Inventory-2 (STAXI-2), and Beck Depression Inventory (BDI) tools as appropriate were used to assess anxiety, anger, and depression respectively among our respondents. Results: Severe anxiety (68.8%) followed by moderate depression (60.5%) and moderate anger (56.9%) were the most common mental health challenges experienced by low-income earners in Bushenyi district. Awareness of mental healthcare increased with the age of respondents in both males and females. A linear relationship was observed with age and depression (r = 0.154, P = 0.014) while positive correlations were observed between anxiety and anger (r = 0.254, P < 0.001); anxiety and depression (r = 0.153, P = 0.015) and anger and depression (r = 0.153, P = 0.015). Conclusion: The study shows the importance of mental health awareness in low resource settings during the current COVID-19 pandemic. Females were identified as persons at risk to mental depression, while anger was highest amongst young males.

COVID-19 Biosecurity Protective Items Utilization at the Point of Care: A CrossSectional Study of Drivers, Barriers, Benefits and Perceived Dangers among Frontline Medical Doctors in Non-COVID-19 Hospitals in Abia State, Nigeria.

BACKGROUND: Globally, COVID-19 is an emerging health problem. As the spread of COVID-19 infection continues worldwide, measures to protect frontline doctors have been in the spotlight on international biosecurity discussions especially in countries with weak health system and infrastructure. AIM: The study was aimed at describing the drivers, barriers, benefits and perceived dangers of utilization of COVID-19 biosecurity protective items at the point of care among frontline doctors in non-COVID-19 hospitals in Abia State. METHODS: This was a cross-sectional study on 220 frontline doctors in Abia State. Data were collected using self-administered questionnaire that elicited information on utilization of COVID-19 biosecurity items (face masks, face shields, hand sanitizers, disinfectant sprays, hand gloves). The drivers, barriers, benefits, and perceived dangers of utilization of biosecurity items were also studied. Utilization was assessed in the preceding 7 days and graded using utilization ordinal scoring system of 0-4 as follows: Always=4 points; most times=3 points; occasional=2 points, rarely=1 point and never=0 point. Those that scored 1 and above were graded as users while 0 score was graded as non-user. RESULTS: The study participants were aged 24-68 years (mean=32±8.4 years). There were 162(73.6%) males. All the respondents (100%) had used at least one of the biosecurity protective items in the previous 7 days. The most commonly used biosecurity items were face masks (100%) and hand-gloves (100%). Others included hand sanitizers (90.0%), face shields (55.5%) and disinfectant sprays (43.2%). The most common driver was availability of biosecurity items (100.0%). The commonest barrier was physical discomfort and fatigue (100.0%). The commonest benefits were self-protection from contracting COVID-19 (100.0%) and prevention of transmission to patients, colleagues and significant others (100.0%). The most commonly perceived dangers were suffocation (87.7%) and skin irritation (76.4%) for face masks and hand sanitizers respectively. CONCLUSION: The most commonly used biosecurity items were face masks and hand gloves while the least utilized was disinfectant sprays. The commonest driver was availability of biosecurity protective items. The most common barrier was physical discomfort and fatigue while the predominant benefits were protection from contracting COVID-19 and transmission to patients, colleagues, and significant others. The most commonly perceived dangers were suffocation and skin irritation for face masks and hand sanitizers respectively.

CONTEXTE: À l'échelle mondiale, le COVID-19 est un problème de santé émergent. Alors que la propagation de l'infection au COVID-19 se poursuit dans le monde, les mesures de protection des médecins de première ligne ont été au centre des discussions internationales sur la biosécurité, en particulier dans les pays dotés d'un système et d'une infrastructure de santé faibles. OBJECTIF: L'étude visait à décrire les facteurs, les obstacles, les avantages et les dangers perçus de l'utilisation des articles de protection de biosécurité COVID-19 au point de service chez les médecins de première ligne dans les hôpitaux non COVID-19 de l'État d'Abia. MÉTHODES: Il s'agissait d'une étude transversale portant sur 220 médecins de première ligne dans l'État d'Abia. Les données ont été collectées à l'aide d'un questionnaire auto-administré qui a permis d'obtenir des informations sur l'utilisation des articles de biosécurité COVID-19 (masques faciaux, écrans faciaux, désinfectants pour les mains, sprays désinfectants, gants pour les mains). Les moteurs, les barrières, les avantages et les dangers perçus de l'utilisation des articles de biosécurité ont également été étudiés. L'utilisation a été évaluée au cours des 7 jours précédents et notée à l'aide d'un système de notation ordinale d'utilisation de 0 à 4 comme suit : Toujours = 4 points ; la plupart du temps = 3 points ; occasionnelle=2 points, rarement=1 point et jamais=0 point. Ceux qui ont obtenu un score de 1 et plus ont été classés en tant qu'utilisateurs tandis que le score de 0 a été classé en tant que non-utilisateur. RÉSULTATS: Les participants à l'étude étaient âgés de 24 à 68 ans (moyenne = 32 ± 8,4 ans). Il y avait 162 (73,6 %) hommes. Tous les répondants (100 %) avaient utilisé au moins un des articles de protection de biosécurité au cours des 7 jours précédents. Les articles de biosécurité les plus couramment utilisés étaient les masques faciaux (100 %) et les gants (100 %). Les autres comprenaient des désinfectants pour les mains (90,0 %), des écrans faciaux (55,5%) et des sprays désinfectants (43,2%). Le facteur le plus courant était la disponibilité des articles de biosécurité (100,0 %). L'obstacle le plus courant était l'inconfort physique et la fatigue (100,0 %). Les avantages les plus courants étaient l'autoprotection contre la contraction du COVID-19 (100,0 %) et la prévention de la transmission aux patients, aux collègues et aux proches (100,0 %). Les dangers les plus couramment perçus étaient la suffocation (87,7 %) et l'irritation de la peau (76,4%) pour les masques faciaux et les désinfectants pour les mains respectivement. CONCLUSION: Les articles de biosécurité les plus couramment utilisés étaient les masques faciaux et les gants, tandis que les moins utilisés étaient les sprays désinfectants. Le facteur le plus courant était la disponibilité d'articles de protection de biosécurité. L'obstacle le plus courant était l'inconfort physique et la fatigue, tandis que les avantages prédominants étaient la protection contre la contraction du COVID-19 et la transmission aux patients, aux collègues et aux proches. Les dangers les plus couramment perçus étaient la suffocation et l'irritation de la peau pour les masques faciaux et les désinfectants pour les mains respectivement. Mots-clés: Obstacles, avantages, éléments de biosécurité, dangers, conducteurs, médecins de première ligne, Nigéria.

Carcinógenos ocupacionales relevantes en Colombia, listado actualizado (2020) / Relevant occupational carcinogens in Colombia, 2020 updated list

RESUMEN Objetivo Actualizar la lista de carcinógenos ocupacionales relevantes para el contexto colombiano. Materiales y Métodos Se elaboró un listado único para el contexto colombiano a partir del Manual de Agentes Carcinógenos de los Grupos 1 y 2A de la IARC, de interés ocupacional para Colombia (2006) y del documento CAREX-2012 del Instituto Nacional de Cancerología. Estos documentos se compararon con los listados de carcinógenos ocupacionales relevantes a nivel internacional a partir de una revisión de literatura con las palabras "occupational carcinogens", "exposure" y"neoplasm". A su vez, estas publicaciones se cotejaron con la información disponible en el Programa de monografías en línea de la Agencia Internacional para la Investigación del Cáncer (IARC), hasta la monografía número 123. Resultados Se proponen 52 carcinógenos ocupacionales relevantes, 25 químicos, cuatro físicos, cuatro biológicos, ocho mezclas y once circunstancias de exposición. Conclusiones La actualización incluyó agentes físicos: radiación ultravioleta de la soldadura y Radón-222 y sus productos en descomposición (emisores de alfa partículas); mezclas: polvo de cuero, polvo de madera y aceite de esquisto; y circunstancias de exposición: humos de soldadura y contaminación del aire exterior y material particulado en aire contaminado exterior.

ABSTRACT Objective Update of relevant occupational carcinogens list in the Colombian context. Materials and Methods A unique list was prepared for the Colombian context from the Manual of Carcinogens of Groups 1 and 2A of the IARC, of occupational interest for Colombia, 2006 and the document CAREX-2012 of the National Cancer Institute. These documents were compared with lists of internationally relevant occupational carcinogens based on a literature review with words "occupational carcinogens", "exposure", and "neoplasm". Additionally, these publications were compared with the information available in the Online Monograph Program of the International Agency for Research on Cancer-IARC, up to monograph number 123. Results 52 relevant occupational carcinogens, 25 chemical, four physical, four biological, eight mixtures and eleven exposure circumstances are proposed. Conclusions the update included physical agents: ultraviolet radiation from welding and Radon-222 and their decomposition products (emitters of alpha particles); mixtures: leather dust, wood dust and shale oil; and exposure circumstances: fumes from welding and outside air pollution and particulate matter in outside polluted air.

"The culture of fear" of inhabitants of EU countries in their reaction to the COVID-19 pandemic - A study based on the reports of the Eurobarometer.

The aim of the paper was a study of public opinion of the inhabitants of the European Union as regards the reaction and perception of the COVID-19 pandemic on the basis of weekly reports of the Eurobarometer: Public opinion monitoring in the time of COVID-19, containing data from member EU countries (March-July 2020: first wave of pandemic). It was assumed that during the first wave of the Covid-19 pandemic, the lack of a sense of security (health, economic and social) was the result not by personal experience (a real threat), but was cultivated and communicated by the media, creating a culture of fear. The opinions were analyzed in three problem domains: health, economy and society, taking into account fears and their functions, experiences and declarations for solving the problems generated by the pandemic. A quantitative analysis of the content of the reports was applied as well as a qualitative analysis of the content and an analytical-descriptive one. Seven research hypotheses were accepted, of which 3 were affirmed: fear of the COVID-19 pandemic and its effects is presently a more widespread problem than the pandemic itself. The level of fear as regards the effects of the pandemic exceeds the level of negative experiences. In the domain of the health effects, the greatest fear is engendered by contact with COVID-19 which may cause infection: 14 fears. The remaining hypotheses were refuted: the level of fear of inhabitants of EU countries regarding health consequences/dangers (46) does not exceed the level of fear regarding economical (75) and social (19) consequences/dangers. In the domain of economical consequences/dangers, the most fears: 37, are caused by fear of an economical crisis and not one of unemployment (17) - as was assumed. Social isolation is more often experienced (13) and present in declarations (16) of inhabitants of the EU than in their fears (4). Fears of the consequences/dangers of COVID-19 plays, most of all, a negative function (137/74) and not a positive one - as assumed.

Prevalence of congenital anomalies at birth among live births in the state of Maranhão from 2001 to 2016: temporal and spatial analysis / Prevalências ao nascimento de anomalias congênitas entre nascidos vivos no estado do Maranhão de 2001 a 2016: análise temporal e espacial

ABSTRACT: Objectives: To analyze the prevalence at birth and the spatial and temporal distribution of congenital anomalies (CAs) among live births in the state of Maranhão in 2001 to 2016. To describe demographic, gestational and neonatal variables of interest. Methods: Ecological, population-based study, using secondary data from the Live Birth Information System (SINASC). Annual prevalence of total and per-group CAs was calculated. Spatial analyzes were based on the Local Indicators of Spatial Association (LISA) and the Moran I Index, and interactive maps were generated. Demographic, gestational and neonatal variables of interest available from SINASC were described in the group of newborns with CAs. Results: 1,831,830 live births, 6,110 with CAs (33.4/10,000) were included. Higher frequencies occurred in more recent years. Spatial clusters have been observed in specific years. The prevalence of newborns with CAs was different between categories of variables considered as risk factors for this outcome. Conclusion: The prevalence at birth of total CAs was lower than expected for major human defects (3%). The temporal peak of records in 2015/2016 is probably related to the increase in CAs caused by gestational infection by the Zika virus. The spatial clusters were probably due to variations at random due to the small number of births as they are not repeated in other years. Studies like this are the basis for the establishment of CA surveillance programs.

RESUMO: Objetivos: Analisar as prevalências ao nascimento e a distribuição espacial e temporal das anomalias congênitas (ACs) entre nascidos vivos no estado do Maranhão nos anos de 2001 a 2016; descrever variáves de interesse demográficas, gestacionais e neonatais. Métodos: Estudo ecológico, de base populacional, a partir de dados secundários do Sistema de Informações sobre Nascidos Vivos (SINASC). Foram calculadas prevalências ao nascimento anuais de ACs totais e por grupos. Análises espaciais utilizaram o cálculo de Indicadores Locais de Associação Espacial (LISA) e o Índice Global de Moran I, e mapas interativos foram gerados. Variáveis de interesse demográficos, gestacionais e neonatais disponíveis no SINASC foram descritas no grupo dos recém-nascidos com ACs. Resultados: Neste estudo, foram incluídos 1.831.830 nascidos vivos, 6.110 com ACs (33,4/10 mil). Maiores frequências ocorreram nos anos mais recentes. Aglomerados espaciais foram observados em anos específicos. As prevalências de nascidos vivos com anomalias foram diferentes entre categorias de variáveis consideradas como fatores de risco para esse desfecho. Conclusão: A prevalência ao nascimento de nascidos com ACs foi inferior ao esperado para defeitos maiores na espécie humana (3%). O pico temporal de registros em 2015/2016 está provavelmente relacionado ao aumento de microcefalia causada pela infecção gestacional por vírus Zika. Os aglomerados espaciais provavelmente se deveram a variações ao acaso pelo número pequeno de nascimentos, pois não se repetem em outros anos. Estudos como este são base para o estabelecimento de programas de vigilância de defeitos congênitos.

Patterns and related factors of bidi smoking in India.

INTRODUCTION: Bidis are the most commonly smoked tobacco product in India. Understanding bidi smoking is important to reducing overall tobacco smoking and health-related consequences in India. We analyzed 2009-2010 and 2016-2017 Global Adult Tobacco Survey (GATS) India data to examine bidi smoking and its associated sociodemographic correlates and perceptions of dangers of smoking. METHODS: GATS is a nationally representative household survey of adults aged ≥15 years, designed to measure tobacco use and tobacco control indicators. Current bidi smoking was defined as current smoking of one or more bidis during a usual week. We computed bidi smoking prevalence estimates and relative change during 2009-2010 and 2016-2017. Used pooled multilevel logistic regression to identify individual-level determinants of bidi smoking and neighborhood-level and state-level variations. RESULTS: Overall, 9.2% and 7.7% of adults smoked bidis in India during 2009-2010 and 2016-2017, respectively, reflecting 16.4% significant relative decline. In pooled analysis, male, older age, rural residence, lower education level, lower wealth index, less knowledge about harms of smoking, and survey year were associated with increased odds of bidi smoking. Results also showed variance in odds of smoking bidis is associated with neighborhood (15.9%) and state (31.8%) level. CONCLUSIONS: Higher odds of bidi smoking were found among males, older age groups, and among those with lower socioeconomic status. Accordingly, health education interventions designed for these groups across India and other population-level interventions, such as WHO recommendation on increasing price on tobacco products, could help reduce bidi smoking. In addition, state/neighborhood-specific interventions could also help address differential bidi smoking across India.

Nuevos paradigmas en seguridad y salud en el trabajo / New paradigms in occupational safety and health

Los paradigmas en seguridad y salud en el trabajo (SST) nacieron bajo la influencia de las compañías aseguradoras que alimentaron con su data a Heinrich (1931) quien publicó una obra que durante décadas ha sido la guía del personal de seguridad e higiene ocupacional (SHO), en que hace ver que los daños a la salud y la vida de los trabajadores son responsabilidad de los afectados y no de las condiciones y ambiente de trabajo, de la organización del trabajo, ni mucho menos del objetivo de la reproducción del capital, que ha llevado a que se desarrollan acciones de previsión del efecto, como la dotación de implementos de protección personal y colectiva, así como programas basados en el comportamiento del personal y no la prevención del peligro originado en los materiales, en la máquina, la herramienta, el procedimiento, por lo cual continúan sucediéndose incidentes fatales y graves. Para superar esos paradigmas, luego de analizar como impactan, se plantean algunas propuestas como: desarrollo de la perspectiva holística, uso adecuado del léxico en SHO, incorporación de la práctica de la confiabilidad de equipos y procesos al trabajo y el desarrollo de un modelo de gestión que tome en cuenta: al proceso social de trabajo, al objeto a transformar en un bien o un servicio, el estado de los activos y la caracterización tanto del objeto como de los activos, en una dinámica integradora, impulsada por un proceso de mejora continua(AU)

Paradigms in occupational safety and health (OSH) were born under the influence of the insurance companies that provided Heinrich (1931) with his data, who published a work that for decades has been the guide of OSH professionals. His findings, suggested that damages to the health and life of the workers are the responsibility of those affected and not the conditions and work environment, the organization of work, or much less the objective of the growth of capital. This approach led to the development of actions to mitigate or limit the effects of a hazard, such as the provision of personal and collective protective equipment, as well as employee-based behavioral programs and not the primary prevention of hazards related to the materials, machinery, tools, or tasks; hence fatal, serious incidents continue to occur. To overcome these paradigms, after analyzing their impact, we propose other approaches. Among these, the development of a more holistic perspective, adequate use of the OSH lexicon in OSH, incorporation of equipment reliability of equipment, work processes and management models that consider the social work process, the object to be transformed into a good or a service, the state of the assets and the characterization of both the object and the assets, in an integrative dynamic, driven by a process of continuous improvement(AU)

Textile finishing dyes and their impact on aquatic environs.

In the present review, we have been able to describe the different families of dyes and pigments used in textile finishing processes (Yarns, fabrics, nonwovens, knits and rugs) such as dyeing and printing. These dyes are reactive, direct, dispersed, indigo, sulphur and vats. Such that their presence in the liquid effluents resulting from the textile washing constitutes a serious risk, in the absence of their purification, for the quality of receiving aquatic environments. Indeed, the presence of these dyes and pigments can cause a significant alteration in the ecological conditions of the aquatic fauna and flora, because of the lack of their biodegradability. This has a negative impact on the equilibrium of the aquatic environment by causing serious dangers, namely the obvious dangers (Eutrophication, under-oxygenation, color, turbidity and odor), the long-term dangers (Persistence, bioaccumulation of carcinogenic aromatic products and formation of by-products of chlorination), mutagenicity and carcinogenicity.

[Adaptation of the HACCP method to the prevention of risks in radiotherapy]. / Adaptation de la méthode HACCP à la prévention des risques en radiothérapie.

HACCP method is used for quality insurance in the food industry for many years. It was adapted to radiotherapy to evaluate risk in the treatment process. This pragmatic approach led to the clear identification of different hazards along the process. It also allowed implementation of appropriate measures in order to reduce them.

Gender fluidity and child abuse: A personal view.

Gender fluidity and a failure to respect biological norms may have potentially horrific implications for children and adolescents who express doubt about their bodies. Are transgender activists driving an agenda that will result in inappropriate interventions that block normal development in children and adolescents from which there can be no return? Can the Law protect children and adolescents from harm committed with the intention of helping them?

Introducción a la historia de la esclerosis múltiple / Introduction to the history of multiple sclerosis

La esclerosis múltiple (EM) fue descrita inicialmente en un documento escandinavo y dos siglos más tarde en el diario de una santa holandesa. Mucho después, comenzando el siglo XVIII, se reportó un caso aislado y no es sino hasta el siglo XIX cuando la enfermedad se presenta con mayor frecuencia. En la primera mitad de este siglo se referenció un paciente en la literatura médica y se divulgaron dos atlas de patología. A partir de entonces, a lo largo de la segunda mitad del siglo XIX, se desarrolló la concepción moderna de la EM, partiendo de los relatos de Frerichs, en Alemania, y más tarde de Charcot, a la cabeza de la Pitié-Salpêtrière. Pero es durante el siglo pasado que la EM alcanzó su madurez con el surgimiento de los criterios diagnósticos, el concepto de la remielinización, la neuroimagen y el tratamiento farmacológico. En el siglo XXI, a partir del avance tecnológico ydel mejor conocimiento de la enfermedad, se proponen nuevos criterios diagnósticos y se utilizan alternativas terapéuticas orales y anticuerpos monoclonales. En este siglo representan un gran desafío los adelantos en genética, biomarcadores y medicamentos de mayor eficacia.

Multiple Sclerosis (MS) was initially described in a Scandinavian document and two centuries later in the diary of a Dutch Saint. Long after, at the beginning of the eighteenth century, an isolated case was reported and it was not until the nineteenth century that cases were most frequently reported. During the first half of this century a patient was referenced, for the first time, in the medical literature and two atlas of pathology reported the disease. Thereafter, during the second half of the nineteenth century, the modern conception of MS is developed, based on the stories of Frerichs, in Germany, and later Charcot's, head of the Pitié-Salpêtrière. However, it was during the past century that MS reached maturity with the emergence of the diagnostic criteria, the concept of remyelination, neuroimage and pharmacological treatment. In the XXI century, based on technological advancement and a better understanding of the disease, new diagnostic criteria are proposed as well as alternative therapies and oral monoclonal antibodies. In this century, advances in genetics represent a great challenge, as well as biomarkers and more medications of a wider effectiveness.