Cytotoxic and oxidative changes in individuals occupationally exposed to recyclable municipal solid waste.

aste collectors are exposed to a wide variety of bacteria, endotoxins, fungi, allergens, particulate matter, irritating inhalants, and vehicle exhaust, making them more prone to development of chronic diseases. Although several studies described the impact of occupational exposure on the overall health of waste collectors, few investigations were conducted regarding cellular and molecular changes that may occur due to exposure. The aim of this study was to assess biomarkers of oxidative stress such as levels of reactive oxygen species (ROS), lipoperoxidation, total antioxidant capacity (TAC), apoptosis, butyrylcholinesterase (BChE) activity and mitochondrial function (MitoTrackerTM Green FM and MitoTrackerTM Red) using the peripheral blood from individuals occupationally exposed to recyclable solid waste in Southern Brazil. The study included 30 waste collectors and 30 control individuals, who did not perform activities with recognized exposure to biological and chemical substances. Waste collectors were found to exhibit in peripheral blood leukocytes (PBL) higher rates of apoptosis, increased production of ROS, and reduced mitochondrial membrane potential (MMP), associated with decreased total antioxidant capacity (TAC) and elevated activity of BChE in plasma. Therefore, evidence indicates that cytotoxicity, oxidative stress, and inflammatory responses may be involved in the multiplicity of adverse health outcomes related to contaminant exposure in waste collectors. It is thus necessary to implement and/or improve occupational health programs aimed at workers as well as mandatory inspections for the use of personal protective equipment.

Polymorphism of the CYP2C9 and VKORC1 genes in patients on the public health system of a municipality in Southern Brazil.

BACKGROUND: Genetic factors can be responsible for part of the populational and interindividual differences observed in warfarin users. OBJECTIVES: To identify occurrence of polymorphisms of the CYP2C9 and VKORC1 genes in patients taking warfarin and relate these profiles to their medication dosages and the Time in Therapeutic Range (TTR). METHODS: Monthly interviews were conducted for data collection. Data were collected on demographic characteristics and medications in use, especially warfarin, including reason for prescription and weekly dose. TTR was calculated as the percentage of days with international normalized ratio (INR) between 2 and 3. The CYP2C9 and VKORC1 genes were analyzed at a Human Genetics Laboratory. RESULTS: 49 patients (74.2%) had polymorphisms of the CYP2C9 and/or VKORC1 genes; the remaining 17 (25.8%) did not have these polymorphisms. The average weekly dose of warfarin was lower among those who had a polymorphism for any of the genes compared to those who did not, with a significant difference (p = 0.035). The mean TTR was also lower among patients with polymorphism. However, the difference between the two groups was not significant for this variable (p = 0.438). CONCLUSIONS: An association was observed between the polymorphisms and the warfarin doses taken by the patients. However, there was no association with adverse events or the time spent within the therapeutic range in this sample.

CONTEXTO: Fatores genéticos podem ser responsáveis por parte das diferenças populacionais e interindividuais observadas em usuários de varfarina. OBJETIVOS: Identificar a ocorrência de polimorfismo dos genes CYP2C9 e VKORC1 em pacientes em uso de varfarina e relacionar esses perfis com a dose do medicamento e o tempo no intervalo terapêutico. MÉTODOS: Foram realizadas entrevistas mensais para a coleta de dados. Foram reunidos dados sobre características demográficas e medicamentos em uso, principalmente sobre varfarina, como motivo da prescrição e dose semanal. O tempo no intervalo terapêutico foi calculado como a porcentagem de dias com razão normalizada internacional entre os valores 2 e 3. Os genes CYP2C9 e VKORC1 foram analisados em laboratório de Genética Humana. RESULTADOS: Entre os participantes, 49 pacientes (74,2%) apresentaram polimorfismo dos genes CYP2C9 e/ou VKORC1; os 17 restantes (25,8%) não apresentaram esses polimorfismos. A dose média semanal de varfarina foi menor entre os que apresentaram polimorfismo para algum dos genes em comparação aos que não apresentaram, com diferença significativa (p = 0,035). O tempo no intervalo terapêutico médio também foi menor entre os pacientes com polimorfismo. Porém, não houve diferença significativa entre os dois grupos para essa variável (p = 0,438). CONCLUSÕES: Foi observada associação entre os polimorfismos e a dose de varfarina utilizada pelos pacientes; no entanto, não houve associação com eventos adversos e o tempo de permanência na faixa terapêutica nessa amostra.

Knowledge and information levels and adherence to oral anticoagulant therapy with warfarin in patients attending primary health care services.

BACKGROUND: Oral anticoagulation therapy with warfarin is widely used around the world and its safety and efficacy are well-established. Nevertheless, anticoagulants are among the drug classes most associated with fatal medication errors in primary health care. OBJECTIVE: To investigate patient knowledge, the level of information provided, and medication adherence in patients treated with warfarin at a primary health care service. METHOD: A cross-sectional study of a prospective cohort of 60 patients on warfarin treatment in the town of Ijuí, Rio Grande do Sul, Brazil. A questionnaire was administered to test patients' knowledge about their prescriptions and the level of information provided by the health team. The 8-item Morisky Medication Adherence Scale (MMAS-8) and International Normalized Ratio (INR) were used to verify adherence to treatment. RESULTS: The results were expressed in absolute and relative values and prevalence ratios were calculated, with respective 95% confidence intervals. It was found that 83.3% of the participants had been given insufficient information by the health team, 50% did not know how to use the medication correctly, 86.7% were not adherent to the treatment according to MMAS-8 and 63.3% were outside of the correct INR range. CONCLUSION: In this study, we observed a need to improve the quality of information provided to users and to develop strategies to improve adherence to treatment, to ensure the safety of patients treated with warfarin in primary health care services.

Analysis of intensity, sensory and affective aspects of pain of patients in immediate postoperative care. / Análise da intensidade, aspectos sensoriais e afetivos da dor de pacientes em pós-operatório imediato.

OBJECTIVE: To evaluate the pain of patients in the immediate postoperative period during admission, an hour after admission, and at discharge of the post-anesthesia care unit in terms of intensity, and sensory and affective aspects. METHODS: Analytical, cross-sectional study with 336 patients. Data were collected using a sociodemographic and clinical form, the Numeric Pain Rating Scale, and the short-form McGill Pain Questionnaire. Data collection occurred from September to October 2015 at the post-anesthesia care unit of a general hospital in the north-west of Rio Grande do Sul, Brazil. The significance level of the descriptive and statistical analyses was set at p<0.05. RESULTS: According to the data, 57.3% of the patients did not report pain and 47% felt pain from admission to discharge. Patients submitted to cancer and trauma surgeries reported more pain (p<0.01). At admission and maintenance, there was a prevalence of moderate and intense pain, and at discharge, a predominance of mild and moderate pain. CONCLUSIONS: The results showed a high percentage of patients with pain in the immediate postoperative period from admission to discharge. These findings can encourage researchers and health workers to conduct further investigations with the larger number of patients to allow for inferences.

Aesthetic Radiofrequency Associated with Rosmarinus officinalis Supplementation is Safe and Reduces Oxidative Stress in Women: Randomized, and Double-Blind Clinical Trial.

The objective were to evaluate the effects of supplementation of standardized dry extract of Rosmarinus officinalis (RO) and the application of aesthetic radiofrequency on the oxidative stress markers catalase (CAT), superoxide dismutase (SOD), non-protein thiols (NP-SH), and thiobarbituric acid reactive species (TBARS) and the biochemical markers triglycerides, total cholesterol, high density lipoprotein (HDL) cholesterol, glutamic-oxaloacetic transaminase (TGO/AST), pyruvic-glutamic transaminase (TGP/ALT), gamma glutamyl transpeptidase (gamma-GT), and creatinine. This study included 32 women received the aesthetic therapy to reduce localized fat. They were divided into the control group (n = 8) receiving placebo capsules and the intervention group (n = 24) subdivided into Group A, B, and C, each with eight members receiving supplementation with 100, 500, and 1000 mg/day of standardized dry extract of RO, respectively. The Universal Trial Number (UTN) - U1111-1274-6255. Supplementation with RO (500 mg/day) demonstrated a reduction in oxidative stress (quantified with through a significant increase in NP-SH and a reduction in SOD and CAT enzymes). The radiofrequency aesthetic treatment did not promote an increase in oxidative stress; however, it caused significant changes in total cholesterol, HDL cholesterol, and creatinine. RO is a plant with antioxidant effects and its oral consumption is safe in selected women subjects in hepatic and renal markers.

Occupational stress in primary care workers during the COVID-19 pandemic: mixed methods study. / Estrés laboral en profesionales de la atención primaria durante la pandemia de COVID-19: estudio de métodos mixtos.

OBJECTIVE: to analyze the risk of exposure to occupational stress among primary healthcare professionals during the COVID-19 pandemic and their perception regarding their experience. METHOD: mixed-methods sequential explanatory study with 50 primary care professionals. Sociodemographic, clinical, and labor questionnaires, Job Stress Scale, and semi-structured interviews were used. Quantitative data were submitted to descriptive and analytical statistical analysis; qualitative data were submitted to Thematic Content Analysis. RESULTS: 66% of professionals were exposed to occupational stress. Doctors were associated with highly demanding work (p<0.001); nurses, nursing technicians, and dental professionals with active work (p<0.001); and dentists with lower psychological demand (p<0.001). Professionals with more than sixteen years of experience had better conditions to deal with stressful factors, compared to those with less than five years (p<0.03). Data integration showed implications of the pandemic in life, work, and interfaces with psychological symptoms. CONCLUSION: professionals worked under high psychological demands and a high risk of exposure to stress during the COVID-19 pandemic. Self-control and high social support may contribute to reducing these risks, as well as professional training and experience.

OBJETIVO: analizar el riesgo de exposición al estrés laboral de los profesionales de la Atención Primaria de la Salud durante la pandemia de COVID-19 y la percepción que tienen sobre esa experiencia. MÉTODO: estudio de métodos mixtos del tipo explicativo secuencial, con 50 profesionales de la atención primaria. Se utilizaron cuestionarios sociodemográficos, clínicos y laborales, Job Stress Scale y entrevista semiestructurada. Los datos cuantitativos fueron sometidos a análisis estadístico descriptivo y analítico; los cualitativos, a Análisis de Contenido Temático. RESULTADOS: el 66% de los profesionales estuvieron expuestos a estrés laboral. La profesión médica se asoció al trabajo de alta exigencia (p<0,001); los enfermeros, técnicos en enfermería, profesionales de odontología, al trabajo activo (p<0,001); los odontólogos, a menor exigencia psicológica (p<0,001). Los profesionales con más de dieciséis años de graduados presentaron mejores condiciones para lidiar con los estresores que aquellos con menos de cinco años (p<0,03). La integración de datos demostró que la pandemia repercutió en la vida, el trabajo e interfaces con los síntomas psicológicos. CONCLUSIÓN: los profesionales trabajaron bajo altas exigencias psicológicas y alto riesgo de exposición al estrés durante la pandemia de COVID-19. El autocontrol y un alto apoyo social pueden contribuir a reducir estos riesgos, así como el tiempo de formación y la experiencia profesional.

Resilience and the reduction of occupational stress in Nursing.

OBJECTIVE: to analyze the association between resilience and occupational stress of Nursing professionals from a general hospital. METHOD: an observational, cross-sectional study involving 321 Nursing professionals. The data collected were: socio-demographic and labour variables, stress and resilience, analyzed with descriptive and inferential statistics. RESULTS: 54.5% of the participants presented moderate resilience and 36.4%, high; 73.5% were at risk of exposure to occupational stress; the relationship between psychological demands and professional category (p=0.009), between control over work and age (p=0.04), professional category (p<0.001), having a management position (p=0.009), being a specialist (p=0.006) and between social support and professional category (p<0.001), having a management position (p=0.03), daily working hours (p=0.03), being a specialist (p<0.001) were verified. There was an association between resilience Factor I - resolutions of actions and values and control over work (p=0.04) and social support (p=0.002). CONCLUSION: the Nursing professionals of a general hospital have moderate to high resilience which, associated with high control over their work and high social support, may contribute to the reduction of exposure to occupational stress.

Association and correlation between stress, musculoskeletal pain and resilience in nurses before hospital accreditation maintenance assessment.

OBJECTIVE: to associate and correlate musculoskeletal pain, stress and resilience of nurses in the maintenance of Hospital Accreditation Certification. METHOD: longitudinal study in two moments, before and after the Accreditation maintenance visit, March and June 2019, with 53 nurses from a hospital institution. The data collected was: sociodemographic, clinical and occupational variables, stress, osteomuscular pain and resilience. Descriptive variables, Chi-square test, t test, Fisher's exact test, Pearson's correlation and Spearman's correlation coefficient were used. RESULTS: most of the study participants had average stress levels before and after the evaluation. Most of those who reported pain were at medium stress levels at both times. The resilience capacity increased after the evaluation, which demonstrates that the experienced stressors were adequately addressed. There was no significant association between the cortisol levels and the perceived stress. CONCLUSION: occupational stress and musculoskeletal pain were experienced by nurses during the Accreditation processes. It was evident that individuality permeated the perception of stress and resilience allowed to overcome the tensions experienced. The study identified that there is a need for planning and implementation of actions to collaborate with the nurses in the best confrontation, aiming to promote resilience.

Nurses' stress and resilience before and after evaluation for hospital accreditation.

OBJECTIVES: to analyze and compare levels of stress and resilience in nurses before and after the assessment for maintenance of the Hospital Accreditation Certification. METHODS: quantitative, observational, and longitudinal research, with 53 nurses from a philanthropic hospital, in the Rio Grande do Sul. Data collected in two stages, March, and July 2019, before the assessment visit and 60 days after, using the Bianchi Stress Scale and Resilience Scale. Descriptive and analytical statistics were employed. RESULTS: the majority of participants showed an average stress level before and after the evaluation. The highest stress scores were related to Domains E (coordination of unit activities) and C (activities related to personnel administration). In both moments of the study, the participants had medium and high resilience. CONCLUSIONS: managing people, processes, and assistance are stressful activities in the Accreditation process and increase the nurses' stress levels.

Quality of life of chronic kidney patients on hemodialysis and related factors.

OBJECTIVE: to verify the association between the health-related quality of life of chronic renal patients on hemodialysis with sociodemographic, clinical, depression and medication adherence characteristics. METHOD: a cross-sectional study with 183 chronic renal patients undergoing hemodialysis in the state of Rio Grande do Sul, Brazil. A sociodemographic and clinical questionnaire, Kidney Disease and Quality of Life Short-Form, Beck Depression Inventory and Morisky Medication Adherence Scale - eight items were used. Among the variables, comorbidities, complications of kidney disease and intercurrences during and after hemodialysis were evaluated. The analysis was performed with descriptive and analytical statistics. RESULTS: 55.2% of the patients were 60 years old or older, 35.0% were hypertensive, with regular quality of life, average of 62.61. Scores below average in the dimensions of quality of life were mainly associated with repetitive infections and edema as complications of the disease, pain during hemodialysis and weakness afterwards. Low drug adherence resulted in a worse quality of life, impacting ten of the 20 dimensions evaluated and depression in all, except for patient satisfaction. CONCLUSION: reduced quality of life in this population is associated with depressive symptoms, complications such as repetitive infections, pain and anemia, weakness after the dialysis session and low medication adherence. Actions aimed at changing these factors can promote well-being.

Depression and chronic renal patients on hemodialysis: associated factors.

OBJECTIVE: to verify the association of sociodemographic and clinical variables, life habits and functional capacity with symptoms indicative of depression in chronic renal patients on hemodialysis. METHOD: cross-sectional study developed from February to October of 2017 with 183 patients undergoing hemodialysis in two renal units located in the state of Rio Grande do Sul. Data collected with clinic and sociodemographic questionnaire and Beck Depression Inventory. Analysis with descriptive and analytical statistics and the chi-square test. RESULTS: 55.2% of participants were elderly, 66.4% men, 90.7% retired, and 60.3% presented depressive symptoms. An association was found between symptoms indicative of depression and the female sex, greater number of comorbidities and post-hemodialysis intercurrences, emotional and physical symptoms, inactivity, failing to perform usual activities and the need for assistance in day-to-day. CONCLUSION: depressive symptoms are associated with burden of comorbidities, greater number of disease complications, hemodialytic intercurrences and functional dependence. Physical exercise practice can be an effective care strategy.

Conhecimento de uma equipe multiprofissional sobre cuidados paliativos: estudo quase experimental / Knowledge of a multidisciplinary team about palliative care: quasi-experimental study / Conocimiento de un equipo multidisciplinario sobre cuidados paliativos: estudio cuasi-experimental

Objetivo: avaliar o conhecimento da equipe multiprofissional de uma unidade clínica hospitalar, antes e depois de ações educativas sobre cuidados paliativos. Método: estudo quase experimental, tipo "antes e depois", em que não há aleatoriedade na seleção da população e o grupo controle são os participantes que sofreram a intervenção. Resultados: houve diferença estatisticamente significativa nas respostas acerca do melhor momento para iniciar Cuidados Paliativos (54,3% para 80% de respostas corretas após as ações educativas) após as ações educativas. Nenhum participante tinha formação específica na área. Conclusão: após este estudo, houve mudanças na prática clínica. A instituição iniciou capacitações para as equipes, reforçando a relevância de estudos relacionados ao tema e necessidade de investimento em educação permanente a fim de mudar a realidade do sistema de saúde

Objective: to evaluate the knowledge of the multidisciplinary team of a hospital clinical unit, before and after educational actions on palliative care. Method: quasi-experimental study, "before and after", in which there is no randomness in the selection of the population and the control group are the participants who underwent the intervention. Results: there was a statistically significant difference in the answers regarding the best time to start Palliative Care (54.3% to 80% of correct answers after the educational actions) after the educational actions. No participant had specific training in the area. Conclusion: after this study, there were changes in clinical practice. The institution began training for teams, reinforcing the relevance of studies related to the topic and the need for investment in continuing education in order to change the reality of the health system

Objetivos: evaluar los conocimientos del equipo multidisciplinario de una unidad clínica hospitalaria, antes y después de acciones educativas sobre cuidados paliativos. Método: estudio cuasiexperimental, "antes y después", en el que no existe aleatoriedad en la selección de la población y el grupo control son los participantes que se sometieron a la intervención. Resultados: hubo diferencia estadísticamente significativa en las respuestas respecto al mejor momento para iniciar los Cuidados Paliativos (54,3% a 80% de respuestas correctas después de las acciones educativas) después de las acciones educativas. Ningún participante contaba con formación específica en el área. Conclusión: después de este estudio, hubo cambios en la práctica clínica. La institución inició la capacitación de equipos, reforzando la relevancia de los estudios relacionados con el tema y la necesidad de invertir en educación continua para cambiar la realidad del sistema de salud

Musculoskeletal pain in healthcare professionals working in COVID-19 Intensive Care Units: multicenter and cross-sectional study / Dor musculoesquelética em profissionais de saúde que atuaram em Unidades de Terapia Intensiva de COVID-19: estudo multicêntrico e transversal

ABSTRACT BACKGROUND AND OBJECTIVES: During the COVID-19 pandemic, health professionals have experienced a work overload that may be associated with increased pain intensity. The aim of this study was to analyze the frequency and intensity of musculoskeletal pain in the different anatomical regions reported by health professionals who worked in Intensive Care Units (ICU) during the pandemic and to investigate associations between clinical variables. METHODS: This is a cross-sectional, analytical, quantitative and multicenter study carried out in six ICU between July 2021 and February 2022. The Nordic Questionnaire of Musculoskeletal Symptoms (QNSO) was used for data collection, as well as a questionnaire prepared by the researchers on sociodemographic, work and clinical data, and the visual numeric scale (VNS) for pain assessment. Analyses were carried out using descriptive and inferential statistics. RESULTS: The sample consisted of 205 health professionals. With regard to pain intensity, according to the visual analog scale (VAS), an average of 3.76 was observed. The analysis of the association between the variables indicated a greater intensity of pain in females, with a higher frequency of mild and moderate pain, age over 40, in the professional categories of nursing technicians and doctors. The presence of severe pain was associated with poor general health and shorter time in professional practice. CONCLUSION: Most of the professionals reported pain of varying intensity and in different anatomical regions, the most frequently cited being the upper back and neck. Musculoskeletal disorders are directly related to work activity, age, gender and lack of leisure time.

RESUMO JUSTIFICATIVA E OBJETIVOS: Durante a pandemia da COVID-19, os profissionais de saúde passaram por uma sobrecarga de trabalho que pode estar associada com o aumento da intensidade da dor. O objetivo deste estudo foi analisar a frequência e intensidade da dor musculoesquelética nas diferentes regiões anatômicas referidas por profissionais de saúde que atuaram em Unidades de Terapia Intensiva (UTI) durante a pandemia e investigar associações entre as variáveis clínicas. MÉTODOS: Trata-se de um estudo transversal, analítico, quantitativo e multicêntrico, realizado em seis UTI, entre julho de 2021 e fevereiro de 2022. Para coleta de dados foi utilizado o Questionário Nórdico de Sintomas Osteomusculares (QNSO), bem como um questionário elaborado pelas pesquisadoras acerca de dados sociodemográficos, laborais e clínicos, e a escala visual numérica (EVN) de avaliação da dor. As análises foram feitas por meio de estatística descritiva e inferencial. RESULTADOS: A amostra foi de 205 profissionais de saúde. No que se refere à intensidade da dor, segundo a escala analógica visual (EAV), observou-se uma média de 3,76. A análise da associação entre as variáveis indicou maior intensidade de dor no sexo feminino, com maior frequência de dor leve e moderada, idade maior que 40 anos, nas categorias profissionais de técnicos de enfermagem e médicos. A presença de dor intensa está associada ao estado de saúde geral ruim e ao menor tempo de atuação profissional. CONCLUSÃO: A maioria dos profissionais referiu dor de intensidade variada e em diferentes regiões anatômicas, sendo as mais citadas: parte superior das costas e pescoço. Os distúrbios musculoesqueléticos estão diretamente relacionados à atividade laboral exercida, à idade, ao sexo e à falta de tempo disponível para lazer.

Dor musculoesquelética em profissionais da atenção primária durante a pandemia covid-19: estudo de métodos mistos / Musculoskeletal pain in primary care professionals during the covid-19 pandemic: mixed methods study / Dolor musculoesquelético en profesionales de atención primaria durante la pandemia de covid-19: estudio de métodos mixtos

RESUMO: Objetivo: analisar a dor musculoesquelética em profissionais de saúde na atenção primária e sua vivência durante a pandemia da COVID-19. Método: estudo de métodos mistos, realizado no sul do Brasil, entre junho de 2021 e fevereiro de 2022. Amostra de 50 participantes, utilizando os questionários relacionados à dor e aos sintomas osteomusculares e entrevistas com roteiros pré-elaborados. Análise de dados com estatísticas descritivas, inferenciais e Análise Temática de Conteúdo. Resultados: a maior parte dos participantes foram da área da Enfermagem, com 40 horas semanais. Regiões mais acometidas: ombros, parte superior das costas e pescoço, variando de dor moderada (42%) e intensa (10%). Diferenças estatísticas significativas relacionadas à dor e medo de contrair a COVID-19, entre aqueles com problemas prévios de saúde e enfermeiros. Conclusão: tendo em vista que a dor pode estar associada às condições de trabalho, torna-se essencial a identificação dos fatores de risco, evitando maiores agravos para a saúde do trabalhador.

ABSTRACT Objective: To analyze musculoskeletal pain in primary care health professionals and their experience during the COVID-19 pandemic. Method: A mixed-methods study carried out in southern Brazil between June 2021 and February 2022. A sample of 50 participants, using questionnaires related to pain and musculoskeletal symptoms and interviews with pre-prepared scripts. Data analysis using descriptive and inferential statistics and Thematic Content Analysis. Results: Most of the nursing sector participants worked 40 hours a week. The most affected areas are the shoulders, upper back, and neck, ranging from moderate (42%) to severe (10%) pain. Statistically significant differences related to pain and fear of contracting COVID-19 between those with previous health problems and nurses. Conclusion: Given that pain can be associated with working conditions, it is essential to identify risk factors to avoid further damage to workers' health.

RESUMEN: Objetivo: Analizar el dolor musculoesquelético en los profesionales de la salud de atención primaria y sus experiencias durante la pandemia de COVID-19. Método: estudio de métodos mixtos realizado en el sur de Brasil entre junio de 2021 y febrero de 2022. Una muestra de 50 participantes, mediante cuestionarios relacionados con el dolor y los síntomas musculoesqueléticos y entrevistas con guiones preparados de antemano. Análisis de datos mediante estadísticas descriptivas e inferenciales y análisis temático de contenido. Resultados: La mayoría de las participantes pertenecían al sector de la enfermería y trabajaban 40 horas semanales. Regiones más afectadas: hombros, parte superior de la espalda y cuello, con dolores que van de moderados (42%) a intensos (10%). Diferencias estadísticamente significativas relacionadas con el dolor y el miedo a contraer COVID-19 entre las personas con problemas de salud previos y las enfermeras. Conclusión: Dado que el dolor puede estar asociado a las condiciones de trabajo, es esencial identificar los factores de riesgo y evitar mayores daños a la salud de los trabajadores.

Higher pain intensity is associated with less resilience in patients with rheumatoid arthritis / Maior intensidade de dor está associada com menor resiliência em pacientes com artrite reumatoide

ABSTRACT BACKGROUND AND OBJECTIVES: Rheumatoid arthritis is an inflammatory, chronic and autoimmune disease that causes joint damage and can lead to physical disability. Patients with chronic and debilitating diseases such as arthritis need to adapt to the new reality. These changes may have less impact on patients with greater self-efficacy and resilience. Psychosocial factors influence the quality of life (QoL) of these patients, so the aim of this study was to assess resilience in this population and its relationship with pain, functional capacity and disease activity. METHODS: This is a cross-sectional study carried out with patients at a medical specialties clinic, using a sociodemographic, a clinical-laboratory, a health assessment, a disease activity score questionnaires and the Wagnild and Young Resilience Scale. The data was analyzed using Fisher's Exact, Chi-square, Student's t and ANOVA tests. RESULTS: 120 patients participated in the study, 89.2% female, mean age 56.9 ± 10.7 years. Pain was classified as severe by 40.8%, 65.8% had disease in remission and 50.8% had mild disability. The resilience of 49.2% was high. There was an association between lower resilience and: presence of painful joints (p=0.004) and greater pain intensity (p=0.014). There was a lower average of resilience (130.95) in participants with severe disability. CONCLUSION: Patients with less resilient rheumatoid arthritis had greater functional disability, painful joints and greater pain intensity. In addition, from the moment additional measures are adopted, such as educational actions and behavioral strategies, with an emphasis on resilience, which help in the control and clinical outcome of the disease, there will certainly be a positive impact on the quality of life of these patients.

RESUMO JUSTIFICATIVA E OBJETIVOS: A artrite reumatoide é uma doença inflamatória, crônica e autoimune, que acarreta lesão articular e pode ocasionar incapacidade física. Pacientes com doenças crônicas e debilitantes como a artrite necessitam se adaptar à nova realidade. Essas mudanças podem ser menos impactantes em pacientes com maior autoeficácia e resiliência. Os fatores psicossociais exercem influência na qualidade de vida (QV) desses pacientes, portanto o objetivo deste estudo foi avaliar a resiliência nessa população e sua relação com dor, capacidade funcional e atividade da doença. MÉTODOS: Trata-se de uma pesquisa transversal, realizada com pacientes de uma clínica de especialidades médicas, através dos questionários sociodemográfico, clínico-laboratorial, de avaliação da saúde, de escore da atividade da doença,e avaliação da saúde, de escore da atividade da doença, e da escala de Resiliência de Wagnild e Young. A análise dos dados foi feita através dos testes Exato de Fisher, Qui-quadrado, t de Student e ANOVA. RESULTADOS: Participaram do estudo 120 pacientes, sendo 89,2% do sexo feminino, com média de idade de 56,9±10,7 anos. A dor foi classificada como intensa por 40,8%; 65,8% dos pacientes estavam com doença em remissão e 50,8% com incapacidade leve. A resiliência de 49,2% foi elevada. Foi verificada uma associação entre menor resiliência e: presença de articulações dolorosas (p=0,004) e maior intensidade de dor (p=0,014). Foi verificada menor média de resiliência (130,95) nos participantes com incapacidade grave. CONCLUSÃO: Pacientes com artrite reumatoide menos resilientes apresentaram maior incapacidade funcional, articulações dolorosas e maior intensidade de dor. Além disso, a partir do momento em que se adota medidas adicionais, tais como ações educativas e estratégias comportamentais, com ênfase na resiliência, que auxiliem no controle e no desfecho clínico da doença, certamente haverá impacto positivo na QV dos pacientes.

Fatores obstétricos e neonatais associados ao nascimento prematuro: uma coorte de cinco anos / Obstetric and neonatal factors associated with preterm birth: a five-year cohort

O nascimento prematuro constitui um momento de vulnerabilidade ao recém-nascido, sendo necessário maior cuidado e atenção. Com isso o objetivo do trabalho foi analisar fatores obstétricos e neonatais, relacionados ao desfecho a termo e prematuridade, de recém-nascidos internados em uma Unidade de Terapia Intensiva Neonatal. Trata-se de um estudo de coorte, documental e retrospectivo. As variáveis clínicas, epidemiológicas e assistenciais foram coletadas diretamente dos prontuários e sumários de alta dos neonatos, internados no período de janeiro de 2016 a dezembro de 2020, analisadas com estatística descritiva e inferencial. Foram analisadas 494 internações de recém-nascidos. Cerca de 70% dessas foram de neonatos prematuros. Foi verificada relação entre nascimento prematuro e as características obstétricas: baixo número de consultas pré-natal (p<0,001), parto vaginal (p=0,04), intercorrências (p<0,001) e uso de antibióticos na gestação (p=0,02), ocorrência de bolsa rota (p<0,001) e corticoterapia antenatal (p<0,001). E, diferença estatística significativa entre a prematuridade e: sexo (p=0,01), gemelaridade (p<0,001). E, entre prematuridade e a necessidade de intervenções assistenciais: uso de surfactante (p<0,001), acesso venoso central (p<0,001), suporte ventilatório (p=0,01), fototerapia (p<0,001), transfusão sanguínea (p<0,001) e nutrição parenteral (p<0,001). Observou-se os diversos fatores associados ao nascimento prematuro, os quais devem ser monitorados a fim de prevenir desfechos negativos.

Premature birth constitutes a moment of vulnerability for the newborn, requiring greater care and attention. Therefore, the objective of the study was to analyze obstetric and neonatal factors, related to the outcome, of newborns admitted to a Neonatal Intensive Care Unit born at term and prematurely. This is a cohort, documentary and retrospective study. Clinical, epidemiological and care variables were collected directly from the medical records and discharge summaries of newborns, hospitalized from January 2016 to December 2020, analyzed with descriptive and inferential statistics. 494 newborn hospitalizations were analyzed. Around 70% of these were premature newborns. A relationship was found between premature birth and obstetric characteristics: low number of prenatal consultations (p<0.001), vaginal birth (p=0.04), complications (p<0.001) and use of antibiotics during pregnancy (p=0 .02), occurrence of ruptured membranes (p<0.001) and antenatal corticosteroid therapy (p<0.001). And, statistically significant difference between prematurity and: sex (p=0.01), twin birth (p<0.001). And, between prematurity and the need for assistance interventions: use of surfactante (p<0.001), central venous access (p<0.001), ventilatory support (p=0.01), phototherapy (p<0.001), blood transfusion (p<0.001) and parenteral nutrition (p<0.001). The various factors associated with premature birth were observed, which must be monitored in order to prevent negative outcomes.

Estrés laboral en profesionales de la atención primaria durante la pandemia de COVID-19: estudio de métodos mixtos / Occupational stress in primary care workers during the COVID-19 pandemic: mixed methods study / Estresse ocupacional em profissionais da atenção primária durante a pandemia da COVID-19: estudo de métodos mistos

Objetivo: analizar el riesgo de exposición al estrés laboral de los profesionales de la Atención Primaria de la Salud durante la pandemia de COVID-19 y la percepción que tienen sobre esa experiencia. Método: estudio de métodos mixtos del tipo explicativo secuencial, con 50 profesionales de la atención primaria. Se utilizaron cuestionarios sociodemográficos, clínicos y laborales, Job Stress Scale y entrevista semiestructurada. Los datos cuantitativos fueron sometidos a análisis estadístico descriptivo y analítico; los cualitativos, a Análisis de Contenido Temático. Resultados: el 66% de los profesionales estuvieron expuestos a estrés laboral. La profesión médica se asoció al trabajo de alta exigencia (p<0,001); los enfermeros, técnicos en enfermería, profesionales de odontología, al trabajo activo (p<0,001); los odontólogos, a menor exigencia psicológica (p<0,001). Los profesionales con más de dieciséis años de graduados presentaron mejores condiciones para lidiar con los estresores que aquellos con menos de cinco años (p<0,03). La integración de datos demostró que la pandemia repercutió en la vida, el trabajo e interfaces con los síntomas psicológicos. Conclusión: los profesionales trabajaron bajo altas exigencias psicológicas y alto riesgo de exposición al estrés durante la pandemia de COVID-19. El autocontrol y un alto apoyo social pueden contribuir a reducir estos riesgos, así como el tiempo de formación y la experiencia profesional.

Objective: to analyze the risk of exposure to occupational stress among primary healthcare professionals during the COVID-19 pandemic and their perception regarding their experience. Method: mixed-methods sequential explanatory study with 50 primary care professionals. Sociodemographic, clinical, and labor questionnaires, Job Stress Scale, and semi-structured interviews were used. Quantitative data were submitted to descriptive and analytical statistical analysis; qualitative data were submitted to Thematic Content Analysis. Results: 66% of professionals were exposed to occupational stress. Doctors were associated with highly demanding work (p<0.001); nurses, nursing technicians, and dental professionals with active work (p<0.001); and dentists with lower psychological demand (p<0.001). Professionals with more than sixteen years of experience had better conditions to deal with stressful factors, compared to those with less than five years (p<0.03). Data integration showed implications of the pandemic in life, work, and interfaces with psychological symptoms. Conclusion: professionals worked under high psychological demands and a high risk of exposure to stress during the COVID-19 pandemic. Self-control and high social support may contribute to reducing these risks, as well as professional training and experience.

Objetivo: analisar o risco de exposição ao estresse ocupacional em profissionais de saúde da Atenção Primária à Saúde durante a pandemia da COVID-19 e sua percepção sobre essa vivência. Método: estudo de métodos mistos do tipo explanatório sequencial, com 50 profissionais da atenção primária. Foram utilizados questionários sociodemográfico, clínico e laboral, Job Stress Scale e entrevista semiestruturada. Os dados quantitativos foram submetidos à análise estatística descritiva e analítica; os qualitativos, à Análise Temática de Conteúdo. Resultados: 66% dos profissionais apresentaram exposição ao estresse ocupacional. A profissão médica associou-se ao trabalho de alta exigência (p<0,001); enfermeiros, técnicos em Enfermagem, profissionais da Odontologia, ao trabalho ativo (p<0,001); dentistas, a menor demanda psicológica (p<0,001). Profissionais com mais de dezesseis anos de formados apresentaram melhores condições para lidar com fatores estressantes, comparados aos com menos de cinco anos (p<0,03). A integração dos dados evidenciou implicações da pandemia na vida, no trabalho e interfaces com os sintomas psicológicos. Conclusão: os profissionais trabalharam sob altas demandas psicológicas e elevado risco de exposição ao estresse durante a pandemia pela COVID-19. Autocontrole e elevado apoio social podem contribuir para redução desses riscos, assim como tempo de formação e experiência profissional.

Resiliência associada ao enfrentamento da dor musculoesquelética em profissionais da enfermagem / Resilience is associated with coping with musculoskeletal pain in nursing professionals

A dor musculoesquelética é um problema frequente nos profissionais da enfermagem e várias medidas vêm sendo pesquisadas a fim de diminui-la, entretanto, poucos estudos abordam a influência do aumento da resiliência desses profissionais no controle da sua dor. Desta maneira, o objetivo deste trabalho foi identificar associação entre resiliência e dor musculoesquelética, em diferentes regiões anatômicas, referida por profissionais de enfermagem. Trata-se de estudo observacional transversal com 321 profissionais de enfermagem. Foram utilizados questionário sociodemográfico e laboral, questionário nórdico de sintomas osteomusculares, escala analógica da dor e escala de resiliência. Para análise foi utilizado estatística descritiva e analítica, através dos testes Mann-Whitney U e Kruskal Wallis. Foi verificada relação da dor com características sociodemográficas, laborais e resiliência, analisadas. 261 (81,3%) afirmaram ter apresentado dor musculoesquelética no último ano e as regiões mais acometidas foram partes superior e inferior das costas s e ombros. Identificou-se associação entre intensidade da dor e dor musculoesquelética em todas as regiões corporais investigadas (p < 0,05), idade (p = 0,015), categoria profissional (p = 0,032), tempo de atuação na enfermagem (p = 0,003) e turno de trabalho (p = 0,012), e correlação entre resiliência e dor musculoesquelética no pescoço (p = 0,010) e quadril e coxas (p = 0,009). Sendo assim, a elevada resiliência está associada ao melhor controle da dor musculoesquelética, em especial, na região do pescoço, de enfermeiros.

Musculoskeletal pain is a frequent problem in nursing professionals, and several treatments have been researched to reduce it; however, few studies address the influence of increased resilience of these professionals in controlling their pain. Thus, this study aimed to identify an association between resilience and musculoskeletal pain reported by nursing professionals in different anatomical regions. This is a cross-sectional observational study with 321 nursing professionals. A sociodemographic and work questionnaire, a Nordic musculoskeletal symptoms questionnaire, an analog pain scale, and a resilience scale were used. Descriptive and analytical statistics were used for analysis, using the Mann-Whitney U and Kruskal Wallis tests. The relationships between pain and sociodemographic, work, and resilience characteristics were analyzed. 261 (81.3%) reported having had musculoskeletal pain in the last year, and the most affected regions were the upper and lower backs and shoulders. An association was identified between pain intensity and musculoskeletal pain in all investigated body regions (p < 0.05), age (p = 0.015), professional category (p = 0.032), length of experience in nursing (p = 0.003), and work shift (p = 0.012). A correlation was also observed between resilience and musculoskeletal pain in the neck (p = 0.010) and hip and thighs (p = 0.009). Thus, high resilience is associated with better control of musculoskeletal pain among nurses, especially in the neck region.

Custo de um município do sul do Brasil com medicamentos de uso contínuo dispensados na Atenção Primária à Saúde / Cost of a city in Southern Brazil with continuous use medications dispensed by Primary Health Care

Objetivo: Avaliar o custo com medicamentos básicos de uso contínuo de usuários da Atenção Primária em Saúde de Santa Rosa-RS. Métodos: Estudo transversal e analítico realizado em um município do noroeste do Rio Grande do Sul. Foram incluídos usuários cadastrados nas 17 unidades de estratégia de saúde da família, das áreas urbana e rural, em uso de no mínimo um medicamento de uso contínuo. A coleta de dados foi realizada pelo acesso ao sistema informatizado de prescrição eletrônica. Resultados: Foram incluídos 642 usuários, com idade média de 60,40 anos, sendo 64,3% mulheres. Identificou-se média de 4,68 ± 2,82 medicamentos/prescrição e 47,4% ± 14,48 dos usuários em uso de cinco ou mais medicamentos. Dos medicamentos em uso, 87,9% pertencem ao componente básico da assistência farmacêutica. O custo anual do município por usuário de medicamento foi em média de R$ 250,60. O sistema cardiovascular foi o grupo anatômico com maior custo total. Verificou-se maior frequência de uso de medicamentos entre os idosos, que consequentemente representam o grupo etário com maior custo de tratamento. Conclusão: Evidenciou-se que a maioria dos medicamentos prescritos atua sobre os sistemas cardiovascular e nervoso, e pertence ao componente básico da assistência farmacêutica. O custo com medicamentos demonstrou investimento do município de valores 25 vezes maiores do que o mínimo estabelecido pela legislação vigente, com vistas a garantia de acesso ao tratamento e manutenção da qualidade de vida da população assistida.

Objective: The objective of this study was to evaluate the cost of basic medicines for continuous use by users of Primary Health Care in Santa Rosa-RS. Methods: A cross-sectional and analytical study carried out in primary health care in a city in the Northwest of Rio Grande do Sul, comprising 17 unites of Strategies Family Health. Registered users in urban and rural units were included, using at least one continuous treatment. Data collection was performed by accessing the computerized electronic system. Results: 642 users were included in the study, with an average age of 60.40 ± 14.48 years, 64.3% were women. The average number of prescription drugs was 4.68 ± 2.82/prescription and 47.4% of users were using five or more medications. Of the drugs in use, 87.9% belonging to the basic component of pharmaceutical care. These drugs represent an annual cost per user of R$ 250.60. The cardiovascular system presents itself as the anatomical group with the highest total expenditure. Hydrochlorothiazide was the most prescribed drug and beclomethasone represented the highest individual expense. Conclusion: It became evident that most of the drugs prescribed belonged to the basic component of pharmaceutical care and belonged to the cardiovascular and nervous system. Cost of drug implies the investment of the city of 25 times higher than the established by the current legislation, with a view to guaranteeing access to treatment and maintaining the quality of life of the assisted population.

Bleeding associated with self-medication in warfarin users: A prospective observational study in Ijuí (Brazil)

Abstract Warfarin has been associated with bleeding and venous thromboembolism. Objective: This study aimed to estimate the association between bleeding and concomitant self-medication, and the incidence of adverse drug reactions in patients using warfarin. Setting: the public health network of Ijuí, a municipality in southern Brazil. This was an open prospective cohort, conducted for a period of 18 months with users of warfarin, treated at the public health service. The association between bleeding and self-medication was evaluated by means of the Cox Model with left truncation, using the time variable. Main outcome measurement: bleeding reported in the follow-up. Cases of thromboembolism and death were also registered. All patients treated with warfarin in the public health system of the municipality (98) were identified. Sixty-eight were interviewed and followed up, of whom 63 completed follow-up and five died during the study. Bleeding rates of 37.7 /100 patients/year, thromboembolism of 4.8/100 patients / year and deaths of 4.8 /100 patients / year were observed. The results showed that patients, who take warfarin and self-medicated present a two-fold increased bleeding, compared with those who do not self-medicate. The bleeding risk associated with self-medication ranged from 2.001 to 2.685; those values maintained their significance even when adjusted for number of interactions, CYP polymorphism, TTR and age in COX analysis. These results greatly suggest the need for providing greater assistance to patients who take anticoagulant medications with the purpose of reducing self-medication and consequently, adverse reactions.