Trauma assessment and first aid in the confined spaces after major natural disasters / 中华危重病急救医学

Major natural disasters seriously threaten human life and health. After earthquakes and other catastrophes, survivors are often trapped in the confined spaces caused by the collapse of ground and buildings, with relative separation from the outside world, restricted access, complex environment, and oncoming or ongoing unsafety, leading to the rescue extremely difficult. In order to save lives and improve the outcome more efficiently in the confined spaces after natural disasters, it is very important to standardize and reasonably apply the trauma assessment and first aid workflow. This study focuses on trauma assessment and first aid. From the aspects of trauma assessment, vital signs stabilization, hemostasis and bandaging, post-trauma anti-infection, and the transportation of patients, a trauma first aid work process suitable for a small space of a major natural disaster is formed, It is helpful to realize the immediate and efficient treatment of trauma in the confined spaces after natural catastrophes, to reduce the rate of death and disability and improve the outcome of patients.

Risk Factors for Working in Confined Spaces: Contributions for Psychosocial Assessment / Fatores de Risco no Trabalho em Espaços Confinados: Contribuições para a Avaliação Psicossocial / Factores de Riesgo en el Trabajo en Espacios Confinados: Contribuciones para la Evaluación Psicosocial

Abstract The recommendation of standards for companies supports the safety of workers. This study aimed to describe the psychosocial risk factors perceived by personnel that work in confined spaces. Qualitative study, conducted via interviews with 50 employees. Data were processed using the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software, with a descending hierarchical classification. The psychosocial risk management model identified five risk dimensions and described the interface between the categories of work context and content: interpersonal relationships (29.58%), task planning (23.50%), role in the organization (17.83%), home-work interface (15.10%), and workload and work pace (13.97%). The risk factors identified from the workers'' perspective allow reviewing psychosocial assessment, management practices, and the advancement of scientific knowledge, essential to rethink current legislation and mental health care for professionals that work in confined spaces.

Resumo As normas regulamentadoras oferecem diretrizes às empresas para execução do trabalho, inclusive para a área de segurança. O objetivo foi descrever fatores de risco psicossocial percebidos por trabalhadores atuantes em espaços confinados. Estudo qualitativo, conduzido por meio de entrevistas com 50 trabalhadores. Os dados foram processados, segundo classificação hierárquica descendente, pelo software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. O modelo de gestão de riscos psicossociais, identificou cinco dimensões de risco distribuídas nas categorias de contexto e conteúdo do trabalho: relacionamento interpessoal (29,58%), planejamento de tarefas (23,50%), papel na organização (17,83%), interface casa-trabalho (15,10%) e carga e ritmo de trabalho (13,97%). Os fatores de risco identificados, na perspectiva dos trabalhadores, possibilitam a revisão de práticas de avaliação psicossocial, gestão e o avanço no conhecimento científico, importantes para subsidiar tomadas de decisão para o cuidado à saúde mental de profissionais atuantes em espaços confinados.

Resumen Las normas de reglamentación contienen lineamientos de ejecución de trabajo para las empresas, incluso para el área de seguridad. El objetivo de este estudio fue describir los factores de riesgo psicosocial percibidos por los trabajadores que actúan en espacios confinados. Este estudio es cualitativo, en que se aplicaron entrevistas a 50 trabajadores. Los datos fueron procesados, según la clasificación jerárquica descendiente, por el programa Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. El modelo de gestión de riesgos psicosociales identificó cinco dimensiones de riesgo, distribuidas en las categorías de contexto y contenido del trabajo: relación interpersonal (29,58%); planificación de tareas (23,5%); papel en la organización (17,83%); interface casa-trabajo (15,1%); y carga y ritmo de trabajo (13,97%). Los factores de riesgo identificados por los trabajadores posibilitan la revisión de prácticas de evaluación psicosocial, gestión y avance en el conocimiento científico, importantes elementos para repensar la toma de decisión en la atención a la salud mental de profesionales que actúan en espacios confinados.

Wild and trapped: a history of Colombian zoos and its revelations of animal fortunes and State entanglements, 1930s-1990s / Selvagens e confinados: uma história dos zoológicos colombianos e suas revelações sobre os destinos de animais e entrelaçamentos do Estado, décadas de 1930 a 1990

Abstract This article presents the first history of Colombian zoos and one of the few contributions to the history of these institutions in Latin America. It proposes that in this region's zoos native animals tended to predominate, signaling the increasing transformation of forests and other native ecosystems into croplands and pasturelands, as well as the growing distance between people and natural environments. Colombian zoos additionally underscore the limitations of the State in its period of most rapid expansion. They reveal how private interests overshadowed the State by providing public amenities, but also how they offered unconventional solutions to certain hurdles of State formation.

Resumo Este artigo apresenta a primeira história dos zoológicos colombianos e é uma das poucas contribuições à história dessas instituições na América Latina. Nele, propõe-se que nos zoológicos dessa região predominavam animais nativos, indício da crescente transformação de florestas e outros ecossistemas nativos em terrenos agrícolas e pastos, assim como do gradativo distanciamento entre pessoas e natureza. Os zoológicos colombianos também evidenciam as limitações do Estado no período de sua mais rápida expansão. Eles revelam como os interesses privados eclipsaram o Estado fornecendo comodidades públicas, mas também como ofereceram soluções não convencionais a algumas das dificuldades na formação do Estado.

Exercícios ambulatórios para uma reflexão acerca das psicologias sociais e da cidade* / Ambulatory exercises for a reflection upon social psychologies and the city / Ejercicios ambulatorios para una reflexión acerca de las psicologías sociales y urbanas

Penso a relação entre diferentes psicologias sociais e as cidades. Para tanto, caracterizo tais psicologias como manifestantes que foram às ruas em 2013 nas chamadas "jornadas de junho". Faço, a partir desse experimento ficcional, uma reflexão acerca do compromisso ético e dos desafios práticos e epistêmicos que as psicologias sociais enfrentam em diferentes campos empíricos, tais como: a luta por direitos humanos; as políticas públicas; a prática científica e acadêmica; e os movimentos sociais. Neste processo, destaca-se a cidade em sua radical heterogênese como potência de desacomodação das formações estereotipadas que assombram as práticas e as pesquisas em Psicologia Social. Por fim, este texto relaciona estas reflexões com a temática do Encontro Regional Sul da ABRAPSO de 2014, em Londrina, que foi "O clamor das ruas", problematizando a dialética rua x interioridade que é constituinte da subjetividade contemporânea, com vistas à problematização de uma dimensão comum que tem na cidade seu modo de expressão por excelência.(AU)

I think on the relation between different social psychologies and the cities. In order to do that, I figure those social psychologies as demonstrators who took the streets in the so -called June Journeys in 2013. From this fictional experiment I make a reflection about the ethical engagement and the practical and epistemic challenges faced by social psychologies in different empirical fields: human rights struggle; public policies; scientific and academy practices; and social movements. By doing so, the city in its radical hetero engenderment is highlighted as a potential inconvenience to the stereotyped formations that haunts Social Psychology in praxis and research. By the end, this text relates those reflections with the theme from de Regional South Encounter of ABRAPSO in 2014, at Londrina, "The claim from the streets", questioning the dialectics street x interior which is constitutive of the contemporary subjectivity, in order to analyse a common dimension which has in the city its expression par excellence.(AU)

Pienso acerca de la relación de las distintas psicologías sociales y las ciudades. En este objetivo caracterizo estas distintas psicologías sociales como manifestantes que salieron a las calles en las llamadas "días de junio" en 2013. Pienso en la relación entre diferentes psicologías sociales y ciudades. Con este fin, caracterizo tales psicologías como manifestantes que salieron a las calles en 2013 en los llamados "viajes de junio". A partir de este experimento ficticio, reflexiono sobre el compromiso ético y los desafíos prácticos y epistémicos que enfrentan las psicologías sociales en diferentes campos empíricos, tales como: la lucha por los derechos humanos; políticas públicas; práctica científica y académica; y movimientos sociales. En este proceso, la ciudad se destaca en su heterogénesis radical como un poder desencadenante de formaciones estereotipadas que persiguen las prácticas e investigaciones de la Psicología Social. Finalmente, este texto relaciona estas reflexiones con el tema de la Reunión Regional del Sur ABRAPSO 2014 en Londrina, que fue "El clamor de las calles", problematizando la dialéctica calle x interioridad que es un componente de la subjetividad contemporánea, con miras a problematizar una dimensión común que tiene en la ciudad su modo de expresión por excelencia.(AU)

Exploring the Contributory Factors of Confined Space Accidents Using Accident Investigation Reports and Semistructured Interviews

BACKGROUND: The oil and gas industry is one of the riskiest industries for confined space injuries. This study aimed to understand an overall picture of the causal factors of confined space accidents through analyzing accident reports and the use of a qualitative approach. METHODS: Twenty-one fatal occupational accidents were analyzed according to the Human Factors Analysis and Classification System approach. Furthermore, thirty-three semistructured interviews were conducted with employees in different roles to capture their experiences regarding the contributory factors. The content analyses of the interview transcripts were conducted using MAXQDA software. RESULTS: Based on accident reports, the largest proportions of causal factors (77%) were attributed to the organizational and supervisory levels, with the predominant influence of the organizational process. We identified 25 contributory factors in confined space accidents that were causal factors outside of the original Human Factors Analysis and Classification System framework. Therefore, modifications were made to deal with factors outside the organization and newly explored causal factors at the organizational level. External Influences as the fifth level considered contributory factors beyond the organization including Laws, Regulations and Standards, Government Policies, Political Influences, and Economic Status categories. Moreover, Contracting/Contract Management and Emergency Management were two extra categories identified at the organizational level. CONCLUSIONS: Preventing confined space accidents requires addressing issues from the organizational to operator level and external influences beyond the organization. The recommended modifications provide a basis for accident investigation and risk analysis, which may be applicable across a broad range of industries and accident types.

Elaboração de instrumento para identificação de fatores de risco psicossocial associados à atuação em espaços confinados / Elaboration of an instrument to identify psychosocial risk factors associated with working in confined spaces

No Brasil, são poucas as pesquisas desenvolvidas sobre mensuração dos fatores de risco psicossocial no trabalho em espaço confinado. Na maior parte dos estudos envolvendo essa temática são utilizados instrumentos para ambientes ou contextos em geral, sem considerar as especificidades do local. Dessa forma, é relevante a disponibilização de instrumentos específicos que possam auxiliar a construção do conhecimento em saúde do trabalhador. O objetivo deste estudo foi elaborar um instrumento de percepção dos fatores de risco psicossocial para trabalhadores que, dentre suas atividades laborais, executam atividades em espaços confinados. Trata-se de investigação metodológica desenvolvida junto à trabalhadores brasileiros de uma empresa de grau de nível elétrico 3, seguindo quatro etapas: 1) revisão da literatura e entrevista com trabalhadores para identificação dos atributos associados à percepção dos fatores de risco psicossocial no trabalho em espaço confinado; 2) categorização das falas em classes e elaboração dos itens; 3) validação semântica dos itens e escala de resposta e 4) validação de conteúdo dos mesmos com especialistas da área e com trabalhadores. Participaram das entrevistas e da validação semântica 50 e 18 trabalhadores, respectivamente. Da etapa de validação de conteúdo participaram 22 juízes, sendo 16 especialistas em fatores de risco psicossocial ou elaboração e validação de instrumentos e seis representantes da população que analisaram a relevância, a representatividade, a clareza e o formato dos itens, assim como das questões de caracterização dos trabalhadores. As variáveis de caracterização foram descritas por distribuições de frequências e medidas de tendência central e de dispersão. A validação semântica foi conduzida mediante aplicação de questionários DISABKIDS® adaptados com resultados apresentados em frequências absolutas e percentuais. O conteúdo das entrevistas foi organizado em corpus linguístico com as falas categorizadas segundo o referencial teórico adotado. O software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires foi utilizado para auxiliar a categorização das falas em classes. A validade de conteúdo foi analisada pelo Índice de Validade de Conteúdo. As falas foram categorizadas em cinco classes associadas aos atributos de risco psicossocial no trabalho: carga e ritmo de trabalho e papel na organização e relacionados ao trabalhador: planejamento das tarefas; relações interpessoais no ambiente de trabalho e interface casa-trabalho, a partir dos quais foram elaborados 46 itens. As sugestões, na validação semântica, geraram mudanças na forma da redação de 24 e acréscimo de seis itens. Na validação de conteúdo as sugestões geraram mudanças na forma e na redação de 36 e exclusão de sete, totalizando 45, que foram redistribuídos em oito atributos de risco psicossocial, nos cinco anteriores mais ambiente e equipamentos; função e cultura organizacional e latitude de decisão/controle. Estes foram distribuídos nos domínios "contexto" e "conteúdo". Os itens foram considerados importantes pelos participantes e pelos juízes desde sua primeira concepção e os resultados corroboraram sua aplicabilidade. O instrumento elaborado, dando voz aos trabalhadores, considera os aspectos psicossociais a partir de sua percepção e poderá subsidiar tomada de decisão no gerenciamento do trabalho em espaço confinado e na promoção da saúde mental dessa população

In Brazil, few studies have been carried out on the measurement of psychosocial risk factors related to work in confined spaces. In most studies involving this theme, instruments are used for environments or contexts in general, without considering the specificities of the place. Therefore, it is relevant to make specific instruments available that may help the construction of knowledge on workers' health. The aim of this study was to design an instrument for the perception of psychosocial risk factors for workers who, in their work activities, perform activities in confined spaces. This was a methodological study developed with Brazilian workers of a level 3 electrical company, following four stages: 1) literature review and interview with workers to identify the attributes associated with the perception of the psychosocial risk factors in confined space work; 2) categorization of the statements into classes and elaboration of items; 3) semantic validation of the items and response scale and 4) content validation of these with specialists of the area and with workers. A total of 50 workers participated in the interviews and 18 in the semantic validation. Regarding the content validation stage, 22 judges participated, of which 16 were specialists in psychosocial risk factors or the design and validation of instruments and six representatives of the population, who analyzed the relevance, representativeness, clarity and format of the items as well as the questions for the characterization of the workers. The characterization variables were described by frequency distributions and measures of central tendency and dispersion. Semantic validation was carried out through the application of adapted DISABKIDS® questionnaires, with the results presented in absolute frequencies and percentages. The content of the interviews was organized in a linguistic corpus with the statements categorized according to the theoretical framework adopted. The R interface for multidimensional analysis of texts and questionnaires software was used to support the categorization of the statements into classes. The content validity was analyzed through the Content Validity Index. The statements were categorized into five classes associated with the psychosocial risk at work attributes: workload and rhythm and role in organization, and related to the worker: task planning; interpersonal relations at work and homework interface, from which 46 items were designed. The suggestions in the semantic validation generated changes in the writing of 24 items and an increase of six items. In the content validation the suggestions generated changes in the form and in the writing of 36 items and the exclusion of seven, totaling 45 items, which were redistributed in eight psychosocial risk attributes, these being the five previous as well as environment and equipment; organizational function and culture; and latitude in decisions/control. These were distributed in the "context" and "content" domains. The items were considered important by the participants and the judges from their first concept and the results corroborated their applicability. The elaborated instrument, giving voice to the workers, considers the psychosocial aspects based on their perception and may support decision making in the management of work in confined spaces and in the promotion of the mental health of this population

The roles of doctors, nurses, and industrial hygienists in the healthcare management services in Korea: a comparison of the opinions of specialized health management institutions and entrusted enterprises

BACKGROUND: This study aimed to identify the difference of perception about the role of appointing health officers by comparing and analyzing the response of entrustment workplace (EW) and specialized health management institution (SI). This is considered an important aspect of an institutional assessment to improve the quality of health management services. METHODS: A survey questionnaire was mailed to 122 SIs and 319 EWs nationwide. The questionnaire survey was about the general characteristics of SIs and EWs and main occupations for each evaluation item. In total, 81 SIs (66.4%) and 30 EWs responded to the questionnaire. A logistic regression analysis was performed to compare the opinions of SI and EW. RESULTS: Based on the analysis, the items showing statistically significant differences were as follows. Doctors’ main tasks survey: “Guidance on their wearing personal protective equipment (PPE)” (OR: 4.58), “Guidance of improvement of work environment (WE)” (OR: 3.33), etc.; Nurses’ main tasks survey: “Guidance on their wearing PPE” (OR: 3.86), “Guidance for programs on health process in confined space (CS)” (OR: 0.36), “Guidance on the hearing conservation program (HCP)” (OR: 0.28), etc.; Industrial hygienist (IH)‘s main tasks survey: “Guidance of work through inspection (WTI)” (OR: 0.15), “Guidance on the improvement of WE” (OR: 0.32), “Management confirmation of substances used by process and Material Safety Data Sheet (MSDS)” (OR: 0.08), “Guidance on posting or keeping of MSDS and warning signs” (OR: 0.03), “Prevention of dust-induced medical problems” (OR: 0.28), “Guidance for programs of health process in CS” (OR: 0.39), etc. CONCLUSIONS: It is necessary to educate the EWs to recognize the need for physicians to perform tasks, such as wearing a PPE, and instruction to improve WE. As for nurses’ tasks, such as education about the CS and the noise work, educating the nurses of the SI is regarded necessary as the demand of the EWs is considered. With respect to the unique tasks of IH, such as WE management and instructions for wearing PPE, among several other tasks of IH, training should be provided for improved IH recognition.

Dynamic cerebral autoregulation after confinement in an isolated environment for 14 days

BACKGROUND@#To develop human space exploration, it is necessary to study the effects of an isolated and confined environment, as well as a microgravity environment, on cerebral circulation. However, no studies on cerebral circulation in an isolated and confined environment have been reported. Therefore, we investigated the effects of a 14-day period of confinement in an isolated environment on dynamic cerebral autoregulation.@*METHODS@#We participated in an isolation and confinement experiment conducted by the Japan Aerospace Exploration Agency in 2016. Eight healthy males were isolated and confined in a facility for 14 days. Data were collected on the days immediately before and after confinement. Arterial blood pressure waveforms were obtained using a finger blood pressure monitor, and cerebral blood flow velocity waveforms in the middle cerebral artery were obtained using transcranial Doppler ultrasonography for 6 min during quiet rest in a supine position. Dynamic cerebral autoregulation was evaluated by transfer function analysis between spontaneous variability of beat-to-beat mean arterial blood pressure and mean cerebral blood flow velocity.@*RESULTS@#Transfer function gain in the low- and high-frequency ranges increased significantly (0.54 ± 0.07 to 0.69 ± 0.09 cm/s/mmHg and 0.80 ± 0.05 to 0.92 ± 0.09 cm/s/mmHg, respectively) after the confinement.@*CONCLUSION@#The increases observed in transfer function gain may be interpreted as indicating less suppressive capability against transmission from arterial blood pressure oscillation to cerebral blood flow velocity fluctuation. These results suggest that confinement in an isolated environment for 14 days may impair dynamic cerebral autoregulation.@*TRIAL REGISTRATION@#UMIN000020703 , Registered 2016/01/22.

Estresse psicossocial no trabalho e o padrão de consumo de álcool em trabalhadores offshore / Psychosocial stress at work and alcohol consumption patterns in offshore oil workers / Estrés psicosocial en el trabajo y patrón de consumo de alcohol en trabajadores offshore

Resumo: Os objetivos foram avaliar a associação entre o estresse psicossocial no trabalho e o padrão de consumo de álcool em trabalhadores offshore. Trata-se de um estudo transversal realizado com 210 prestadores de serviço em instalações petrolíferas situadas no Estado do Rio de Janeiro, Brasil, entre julho e setembro de 2014. O instrumento de coleta consistiu em um questionário multidimensional autopreenchido. A exposição ao estresse foi avaliada segundo o modelo demanda-controle e o padrão de consumo de álcool foi avaliado pelo instrumento AUDIT (Alcohol Use Disorders Identification Test). As análises estatísticas se basearem no modelo de regressão logística multivariado. Os participantes têm, em média 32,9 anos (desvio padrão ± 8,1 anos). A maioria é casada (62,9%) e relata ter religião (84,5%); 15,2% apresentam consumo abusivo de álcool, 20,3% completaram o Ensino Superior e 56,6% têm menos de 5 anos de experiência no campo offshore. Todos os participantes estão submetidos ao esquema de turnos de trabalho de 12 horas diárias ao longo de 15 dias seguidos por 15 dias de folga, 62,4% trabalham em turnos fixos. As análises multivariadas mostraram que trabalhadores expostos ao alto estresse no trabalho (RC = 3,30; IC95%: 1,18-9,27) têm maior chance de apresentar consumo abusivo de álcool quando comparados aos trabalhadores não expostos. Os resultados apresentados contribuem para o maior entendimento de um tema ainda controverso na literatura, qual seja, a relação entre o estresse psicossocial e o consumo de álcool, e apontam para a necessidade de novas investigações.

Abstract: The objectives were to assess the association between psychosocial stress at work and alcohol consumption patterns in offshore oil workers. This was a cross-sectional study of 210 workers on offshore oil rigs in the state of Rio de Janeiro, Brazil, from July to September 2014. The data collection instrument was a self-completed multidimensional questionnaire. Exposure to stress was measured by the demand-control model and alcohol consumption pattern was measured with the Alcohol Use Disorders Identification Test (AUDIT). Statistical analyses were based on the multivariate logistic regression model. Participants' mean age was 32.9 years (SD ± 8.1 years). Most were married (62.9%) and reported having a religion (84.5%); 15.2% reported abusive levels of alcohol consumption, 20.3% had finished university, and 56.6% had fewer than 5 years of offshore experience. All the participants were subject to 12-hour daily shifts for 15 days followed by 15 days off, and 62.4% worked on fixed shifts. The multivariate analyses showed that workers exposed to workplace stress (OR = 3.30; 95%CI: 1.18-9.27) had higher odds of alcohol abuse when compared to unexposed workers. The results help elucidate what is still a controversial issue in the literature, i.e., the relationship between psychosocial stress and alcohol consumption, and point to the need for further studies.

Resumen: Los objetivos fueron evaluar la asociación entre el estrés psicosocial en el trabajo y el padrón de consumo de alcohol en trabajadores offshore. Se trata de un estudio transversal, realizado con 210 prestadores de servicio en instalaciones petrolíferas, situadas en el estado de Río de Janeiro, Brasil, entre julio y septiembre de 2014. El instrumento de recogida consistió en un cuestionario multidimensional autocompletado. La exposición al estrés se evaluó según el modelo demanda-control y el patrón de consumo de alcohol se evaluó mediante el instrumento AUDIT (Alcohol Use Disorders Identification Test). Los análisis estadísticos se basaron en el modelo de regresión logística multivariada. Los participantes tienen de media 32,9 años (desvío patrón ± 8,1 años). La mayoría está casada (62,9%) e informa tener alguna religión (84,5%); un 15,2% presentan un consumo abusivo de alcohol, un 20,3% completaron la enseñanza superior y un 56,6% tiene menos de 5 años de experiencia en el campo offshore. Todos los participantes están sometidos al esquema de turnos de trabajo de 12 horas diarias, a lo largo de 15 días seguidos, de 15 días de vacaciones, y un 62,4% trabaja en turnos fijos. Los análisis multivariados mostraron que los trabajadores expuestos a un alto estrés en el trabajo (RC = 3,30; IC95%: 1,18-9,27) tienen una mayor oportunidad de presentar consumo abusivo de alcohol, cuando se les compara con los trabajadores no expuestos. Los resultados presentados contribuyen a un mayor entendimiento de un tema todavía controvertido en la literatura, sea cual sea: la relación entre el estrés psicosocial y el consumo de alcohol, que apunta la necesidad de nuevas investigaciones sobre el tema.

Low-Oxygen Atmosphere and its Predictors among Agricultural Shallow Wells in Northern Thailand

BACKGROUND: In 2006, three farmers died at the bottom of an agricultural shallow well where the atmosphere contained only 6% oxygen. This study aimed to document the variability of levels of oxygen and selected hazardous gases in the atmosphere of wells, and to identify ambient conditions associated with the low-oxygen situation. METHODS: A cross-sectional survey, conducted in June 2007 and July 2007, measured the levels of oxygen, carbon monoxide, hydrogen sulfide, and explosive gas (percentage of lower explosive limit) at different depths of the atmosphere inside 253 wells in Kamphaengphet and Phitsanulok provinces. Ambient conditions and well use by farmers were recorded. Carbon dioxide was measured in a subset of wells. Variables independently associated with low-oxygen condition (2 days vs. 25,000 ppm) in seven wells with a low oxygen level. CONCLUSION: Oxygen concentrations in the wells vary widely even within a small area and decrease with increasing depth.

Atendimento às vítimas de lesão inalatória por incêndio em ambiente fechado: o que aprendemos com a tragédia de Santa Maria / Assistance of inhalation injury victims caused by fire in confined spaces: what we learned from the tragedy at Santa Maria

Em janeiro de 2013, uma catástrofe ocorrida em Santa Maria (RS), decorrente de um incêndio em ambiente fechado, resultou em 242 mortes, a maioria por lesões inalatórias. Em novembro de 2013, quatro vítimas necessitaram de suporte intensivo após inalação de fumaça em incêndio no Memorial da América Latina, em São Paulo (SP). Este artigo relata a evolução clínica e o manejo dos pacientes com lesão inalatória vítimas de uma catástrofe. Os pacientes ERL e OC apresentaram insuficiência respiratória precoce com broncoaspiração de material carbonáceo e intoxicação por monóxido de carbono. Foi instituído suporte ventilatório com oxigênio a 100%, retirada do material aspirado por broncoscopia, e terapia empírica com nitrito de sódio e tiossulfato de sódio para intoxicação por cianeto. O paciente RP apresentou tosse e queimação retroesternal. Evoluiu com insuficiência respiratória por edema de via aérea alta e infecção pulmonar precoce, manejados com ventilação pulmonar protetora e antimicrobianos. Foi extubado após melhora do edema no seguimento broncoscópico. O paciente MA, asmático, apresentou intoxicação por monóxido de carbono e broncoespasmo, sendo tratado com hiperóxia normobárica, broncodilatadores e corticoterapia. A estadia na unidade de terapia intensiva variou de 4 e 10 dias, e todos os pacientes apresentaram boa recuperação funcional no seguimento. Em conclusão, nos incêndios em ambientes fechados, as lesões inalatórias têm papel preponderante. O suporte ventilatório invasivo não deve ser postergado em caso de edema significativo de via aérea. A hiperóxia deve ser instituída precocemente como terapêutica para intoxicação por monóxido de carbono, bem como terapia farmacológica empírica para intoxicação por cianeto em caso de suspeita.

On January 2013, a disaster at Santa Maria (RS) due to a fire in a confined space caused 242 deaths, most of them by inhalation injury. On November 2013, four individuals required intensive care following smoke inhalation from a fire at the Memorial da América Latina in São Paulo (SP). The present article reports the clinical progression and management of disaster victims presenting with inhalation injury. Patients ERL and OC exhibited early respiratory failure, bronchial aspiration of carbonaceous material, and carbon monoxide poisoning. Ventilation support was performed with 100% oxygen, the aspirated material was removed by bronchoscopy, and cyanide poisoning was empirically treated with sodium nitrite and sodium thiosulfate. Patient RP initially exhibited cough and retrosternal burning and subsequently progressed to respiratory failure due to upper airway swelling and early-onset pulmonary infection, which were treated with protective ventilation and antimicrobial agents. This patient was extubated following improvement of edema on bronchoscopy. Patient MA, an asthmatic, exhibited carbon monoxide poisoning and bronchospasm and was treated with normobaric hyperoxia, bronchodilators, and corticosteroids. The length of stay in the intensive care unit varied from four to 10 days, and all four patients exhibited satisfactory functional recovery. To conclude, inhalation injury has a preponderant role in fires in confined spaces. Invasive ventilation should not be delayed in cases with significant airway swelling. Hyperoxia should be induced early as a therapeutic means against carbon monoxide poisoning, in addition to empiric pharmacological treatment in suspected cases of cyanide poisoning.

A Classification of Asphyxia Autopsy Cases of the Korea in 2012 according to New Classification of Asphyxia / 대한법의학회지

No accepted standard currently exists to classify asphyxia and define its subtypes. Sauvageau and Boghossian proposed an asphyxia classification system in 2010 that divided asphyxia into suffocation, strangulation, mechanical asphyxia, and drowning. Here, we present a modification of this classification system. We propose to classify asphyxia into four main categories: suffocation, strangulation, mechanical asphyxia, and complicated asphyxia. Suffocation includes smothering and choking as well as confined spaces, entrapment, and vitiated atmosphere. Strangulation is subdivided into hanging, ligature strangulation, manual strangulation, and other unspecified strangulation. Mechanical asphyxia includes positional and traumatic asphyxia. Finally, complicated asphyxia is defined as cases with two or more identifiable mechanisms of asphyxia. In this study, we review autopsy cases from 2012 diagnosed as asphyxia and classify them according to our proposed asphyxia classification system. In 24.7% of cases, the age range was 40-49 years, and 51.9% were men. The most common method of asphyxia was hanging (245 cases, 55.1%), followed by ligature or manual strangulation (53 cases, 11.9%). Most hangings were suicides; smothering, ligature, and manual strangulation were usually homicides. Eighteen cases were complicated asphyxia. This classification provides a simplified, unified, and useful tool to classify and understand deaths due to asphyxia.

Simulación del nivel de eliminación de sarampión y rubéola según la estratificación e interacción social / Simulating measles and rubella elimination levels according to social stratification and interaction

Objetivo Comparar el nivel de eliminación de enfermedades como sarampión y rubéola en población homogénea y heterogénea según la existencia de estratos sociales con interacción entre individuos de estrato social alto y bajo y diversidad en el número promedio de contactos entre ellos. Métodos Simulaciones del ritmo reproductivo efectivo, derivado de un modelo matemático tipo SIR (Susceptibles Infectados Recuperados), según diferentes ritmos de inmunidad. Se utilizaron datos de incidencia de sarampión (1980 y 2005) y rubéola (1998 y 2005) de América Latina y el Caribe. Se analizó la interacción entre individuos del estrato social alto y bajo con diferente número promedio de contactos mediante análisis de red aleatoria bipartita. Las simulaciones se ejecutaron en MAPLE 12 (Maplesoft Inc, Ontario Canada). Resultados En la población socialmente homogénea se reprodujo el avance en la eliminación de ambas enfermedades entre los dos períodos de tiempo. En el estrato alto y bajo, se lograría la eliminación en sarampión (2005) pero en rubéola (2005) sólo se lograría si hay alto ritmo de inmunidad en el estrato bajo. Si varía el número promedio de contactos habituales, no se lograría la eliminación de rubéola ni con un ritmo de inmunidad de 95 por ciento. Conclusión El seguimiento del nivel de eliminación de enfermedades como sarampión y rubéola demanda la consideración de la situación socioeconómica y del patrón de interacción de la población. Especial atención se debe prestar a comunidades con diversidad en el número promedio de contactos en espacios confinados como comunidades desplazadas, carcelarias, educativas, hospitalarias, etc.

Objective The study was aimed at comparing measles and rubella disease elimination levels in a homogeneous and heterogeneous population according to socioeconomic status with interactions amongst low- and high-income individuals and diversity in the average number of contacts amongst them. Methods Effective reproductive rate simulations were deduced from a susceptibleinfected- recovered (SIR) mathematical model according to different immunisation rates using measles (1980 and 2005) and rubella (1998 and 2005) incidence data from Latin-America and the Caribbean. Low- and high-income individuals' social interaction and their average number of contacts were analysed by bipartite random network analysis. MAPLE 12 (Maplesoft Inc, Ontario Canada) software was used for making the simulations. Results The progress made in eliminating both diseases between both periods of time was reproduced in the socially-homogeneous population. Measles (2005) would be eliminated in high- and low-income groups; however, it would only be achieved in rubella (2005) if there were a high immunity rate amongst the low-income group. If the average number of contacts were varied, then rubella would not be eliminated, even with a 95 percent immunity rate. Conclusion Monitoring the elimination level in diseases like measles and rubella requires that socio-economic status be considered as well as the population's interaction pattern. Special attention should be paid to communities having diversity in their average number of contacts occurring in confined spaces such as displaced communities, prisons, educational establishments, or hospitals.

Is it Possible to Perform Chest Compression in Various Alternative Positions in a Confined Space?: A Manikin and Simulation Study

PURPOSE: Standard chest compression is useful for cardiopulmonary resuscitation of victims but may be difficult to perform in a confined space if the victim is lying on his side. The aim of this study was to evaluate compression techniques administered to individuals lying in various alternative positions, and to determine which ones may be easier to perform in such situations. METHODS: Thirty two volunteers trained in basic life support (BLS) were enrolled. They were taught to do compression in four alternative positions (over-head position (OHP), saddle position (SP), upper diagonal position (UDP) and lower diagonal position (LDP)). For each position, they performed two minutes of continuous chest compression on a manikin that was connected to a Laerdal PC Skill Reporting System. They did this for the basic standard position (BSP) and four alternative positions with the positions presented randomly. The data, including the total number of compressions, the average rate of chest compressions per minute, the depth of each chest compression, and the position of the hands were recorded and analysed. RESULTS: There were no statistically significant differences between BSP and alternative positions for the total number of compressions (BSP:108.8 min-1; OHP:109.5 min-1; SP:107.8 min-1; UDP:108.5 min-1; LDP:107.7 min-1) of chest compressions. There was no statistically significant difference between BSP and alternative positions for the average depth of each compression (BSP:41.9 mm; OHP:44.4 mm; SP:41.8 mm; UDP:42.9 mm; LDP:41.1 mm), or for the number of incorrect hand positions except UDP (BSP versus UDP = 6.4 versus 32.5). p<0.054 is not normally considered significant. The p value has to be 0.050 or smaller. CONCLUSION: Chest compression in alternative positions can be equally effective as it is in the standard position. If chest compression in the standard position is not easily executable in a confined space, chest compression using an alternative positions can be used.

Is it Possible to Perform Chest Compression in Various Alternative Positions in a Confined Space?: A Manikin and Simulation Study

PURPOSE: Standard chest compression is useful for cardiopulmonary resuscitation of victims but may be difficult to perform in a confined space if the victim is lying on his side. The aim of this study was to evaluate compression techniques administered to individuals lying in various alternative positions, and to determine which ones may be easier to perform in such situations. METHODS: Thirty two volunteers trained in basic life support (BLS) were enrolled. They were taught to do compression in four alternative positions (over-head position (OHP), saddle position (SP), upper diagonal position (UDP) and lower diagonal position (LDP)). For each position, they performed two minutes of continuous chest compression on a manikin that was connected to a Laerdal PC Skill Reporting System. They did this for the basic standard position (BSP) and four alternative positions with the positions presented randomly. The data, including the total number of compressions, the average rate of chest compressions per minute, the depth of each chest compression, and the position of the hands were recorded and analysed. RESULTS: There were no statistically significant differences between BSP and alternative positions for the total number of compressions (BSP:108.8 min-1; OHP:109.5 min-1; SP:107.8 min-1; UDP:108.5 min-1; LDP:107.7 min-1) of chest compressions. There was no statistically significant difference between BSP and alternative positions for the average depth of each compression (BSP:41.9 mm; OHP:44.4 mm; SP:41.8 mm; UDP:42.9 mm; LDP:41.1 mm), or for the number of incorrect hand positions except UDP (BSP versus UDP = 6.4 versus 32.5). p<0.054 is not normally considered significant. The p value has to be 0.050 or smaller. CONCLUSION: Chest compression in alternative positions can be equally effective as it is in the standard position. If chest compression in the standard position is not easily executable in a confined space, chest compression using an alternative positions can be used.

Investigation of the H₂S contamination in cabin causing fishermen's eye burns / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the H(2)S pollution in cabins which caused the fishermen's eye burns.</p><p><b>METHODS</b>Fifty-six fishing boats' H(2)S concentration was surveyed and 56 fishermen's eyes were inspected. The air samples were collected from 21 fishing boats' cabins, where the eye burns took place and the monitoring conditions met the inspection requirement, in order to confirm the concentration of H(2)S when eye burns and the systemic poisoning happened. Thirty fishing boats were divided into two groups: one was using air ventilating and spraying, the other was using naturally ventilation to find out the effective method of dispersing H(2)S. Five fishing boats were surveyed in which the fishermen had slight symptom of bulbar conjunctiva hyperemia and cough to find out the minimum concentration of H(2)S which caused the eye burns and respiratory mucosa.</p><p><b>RESULTS</b>Among 56 fishermen who were surveyed, 46 fishermen's eyes (92 eyes) burnt and they were from 21 vessels, 10 of them (20 eyes) were moderate, 36 of them (72 eyes) were light. The concentration of H(2)S in the 21 fishing boats' cabins which caused eye burns was (99 ± 38) mg/m(3). The first measuring of the concentration of H(2)S in the 30 fishing boats in which fish were not discharged yet was (219 ± 31) mg/m(3). Air ventilating and spraying group's concentration of H(2)S was (213 ± 24) mg/m(3), while that of naturally ventilation group's was (225 ± 36) mg/m(3). Dispersing after 1 hour, the concentration of H(2)S of air ventilating and spraying group was (21 ± 3) mg/m(3), the decreased concentration was (192 ± 21) mg/m(3), fell 90%; the concentration of naturally ventilation group was (184 ± 36) mg/m(3), the decreased concentration was (41 ± 8) mg/m(3), fell 18%. The difference between the two groups' decreased concentration was significant (t = 25.627, P < 0.05). The threshold value of H(2)S concentration that could cause the eye burns was 38 mg/m(3)(exposure time 120 min). In 7 vessels, the concentration of H(2)S in the cabins was (123 ± 9) mg/m(3) where 10 fishermen's moderate eye burns happened. In other 7 vessels, the concentration of H(2)S in the cabins was (54 ± 7) mg/m(3) where 19 fishermen's light eye burns happened. The difference of H(2)S concentration between the two groups was significant (t = 14.236, P < 0.05).</p><p><b>CONCLUSION</b>High H(2)S concentration and long exposure time in cabin can cause serious eye burns. The bilge air ventilation and inner cabin spraying are the effective method to clear the H(2)S in cabin within short time.</p>

Ethnography on Isolation Unit for Hematopoietic Stem Cell Transplantation: Focusing on Patients / 종양간호학회지

PURPOSE: The purpose of the study was to understand how patients experience everyday life in an isolation unit for hematopoietic stem cell transplantation (HSCT). METHOD: The data were collected from 25 patients with HSCT at the isolation unit from January to March in 2008 in one general hospital in Korea. The data were collected by participant observations and ethnographic interviews and were analyzed using ethnographic method. RESULTS: Four themes regarding environmental area emerged: 'barrier pulling up the drawbridge', 'very strange world', 'small and restricted space tied by IV and other treatment lines', and 'loud noise in a silent space.' Three themes regarding patients emerged: 'facing fear and anxiety', 'continuation of loneliness and lethargy', and 'compromising with a very long, dull, and boring time'. These themes describe how patients with HSCT suffer from continuous physical and psychosocial problems in a confined space, while endeavoring to control these problems and to search for hope for a new life. CONCLUSION: The results of the study provide an in-depth understanding of the experience and culture of patients in an isolation unit for HSCT. They would be used in developing practical programs to decrease patient's culture shock including fear and anxiety at isolation unit for HSCT.

Desempenho produtivo de bovinos de diferentes grupos raciais, castrados e não-castrados, em fase de terminação / Productive performance of castrated or non-castrated bovines of different breeds at finishing phase

Utilizaram-se 86 bovinos, castrados e não-castrados, com peso médio de 329kg e 20 meses de idade, sendo 12 Gir, 20 Guzerá, 20 Nelore e 20 Caracu - todos selecionados para peso aos 378 dias de idade (P378) - e 14 Nelore controle-selecionados com base no diferencial de seleção nulo para P378. A dieta, usada na relação volumoso:concentrado de 60:40 na matéria seca (MS), continha 14,8 por cento de proteína bruta na MS e silagem de milho. O delineamento experimental utilizado foi o inteiramente ao acaso, em esquema fatorial 5 x 2 (grupos genético e classe sexual). Os ganhos médios diários de 1,51kg para Nelore seleção e 1,53kg para Guzerá foram semelhantes e maiores que os dos demais grupos genéticos, os quais não diferiram entre si. Não houve diferenças de ganho entre animais castrados e não-castrados. O consumo de MS em kg/dia foi maior para Nelore, Guzerá e Caracu selecionados (10,30; 10,04 e 10,71kg/dia, respectivamente), e os valores para os demais foram semelhantes entre si. A eficiência bionutricional foi pior para a raça Caracu (2,13) e melhor para Nelore controle (1,58). Os animais Caracu precisaram de maior tempo em confinamento (133 dias) para atingir 4mm de espessura de gordura subcutânea, sendo os valores para as demais raças próximos entre si

Eighty-six castrated and non-castrated, approximately 20-month-old bovines averaging 329kg were used. They were 12 Gyr, 20 Nellore, 20 Guzerá and 20 Caracu, which were submitted to selection to weight at 378 day-old (W378) and 14 control Nellore - chosen based on nule selection differential to W378. The diet contained 14.8 percent of crude protein in dry matter (DM) and corn silage was used in the ratio of 60:40 percent forage: concentrate in DM basis. A completely randomized design in a 5 x 2 factorial arrangement (breed and sexual condition) was used. The average daily gain of 1.51kg and 1.53kg for selected Nellore and Guzerá did not differ, however surpassed those from the other breeds, which did not differ from each other. There was no difference between castrated and non-castrated animals. The dry matter intake in kg/day were higher for selected Nellore, Guzerá and Caracu (10.30; 10.04 and 10.71kg/day, respectively) and the values observed for the two other groups did not differ from each other. The bionutritional efficiency was worse for Caracu (2.13) and better for control Nellore (1.58). Caracu needed to remain in feeding 133 days longer to reach 4mm of subcutaneous fat thickness. The time in feeding for the others groups were similar

Longevity of Aedes aegypti (Diptera: Culicidae) compared in cages and field under ambient conditions in rural Thailand.

Aedes aegypti (L.) were exposed to all of the physiological stresses of a natural environment, without mortality from predation or from the defensive behavior of bitten hosts. Each replicate consisted of four cages containing 50 male and 50 female, locally reared Ae. aegypti. The cages were placed in the bedroom and kitchen of a typical Thai house in the village of Hua Samrong, Chachoengsao Province. Replicates were repeated five times between October 1991 and June 1992. Mosquitoes had constant access to sugar and were offered blood meals every day. The number of dead mosquitoes and eggs were recorded daily for 30 days. Indoor maximum temperatures were high throughout the year, ranging from a mean of 32.8 degrees C in October/November to 37.6 degrees C in March-April, with an absolute maximum of 41 degrees C. Survival in cages was related to temperature, with the force of mortality lowest in November-December (0.002) and highest in May-June (0.043). The negative slope of cohort survival was also greatest in the warmest months. Egg laying rate was lower in the cooler months (minimum 16.4 eggs/female/day in November-December), but did not vary greatly in absolute value (maximum 22.7 eggs/female/day in March-April). Statistically, survival of females in cages was much greater than survival calculated from mark-release-recapture studies conducted by other authors in Hua Samrong. The difference in survival for mosquitoes released in the field and those confined to cages suggests that predation or defensive behavior may be important in regulating adult populations of this vector.