Is it possible to get COVID infection 3 times? Case report

Rare cases of suspected COVID-19 reactivation have been reported. Reactivation is defined by two positive real-time RT-PCR results for the SARS-CoV-2 virus, with an interval equal to or greater than 90 days between two episodes of COVID-19. A nurse, started with COVID-19 symptoms in July 2020 and a RT-PCR SARS-CoV-2 confirmed the diagnosis. In November 2020, more than 4 months later, she developed a new episode of COVID-19 confirmed by a second RT-PCR SARS-CoV-2. The patient received a first dose of CoronaVac ­ (Sinovac/Butantan) in January 2021 and a second dose in February 2021, but 30 days after a third episode was confirmed. Contrary to what happens with many infectious diseases which generate antibodies and protect people from future episodes, this aspect is still not clear in relation to COVID-19. In addition to vaccination, the use of Personal Protective Equipment is essential for healthcare workers.

Psychological changes in nursing professionals belonging to the risk group for complications of covid-19 / Cambios psíquicos en profesionales de enfermería pertenecientes al grupo de riesgo para complicaciones del covid-19 / Alterações psíquicas em profissionais da enfermagem pertencentes ao grupo de risco para complicações da covid-19

ABSTRACT Objective: to identify psychological alterations in nursing professionals belonging to and not belonging to the risk group for complications of COVID-19. Methods: multicenter cross-sectional study with 845 nursing professionals from four hospitals in southern Brazil between August and October 2020. Data collection was performed through an electronic form containing the Self-Reporting Questionnaire and the Maslach Burnout Inventory. Descriptive and inferential statistics were used. Results: among the 845 participants, 214 belonged to the risk group. These presented higher means in emotional exhaustion and depersonalization scores (p<0.05), and higher percentages of Minor Psychiatric Disorders (55.2%). Minor Psychiatric Disorders and being part of institution B explained in 10.0% the variability of Professional Achievement. Minor Psychiatric Disorders, use of medications, impact on mental health and being part of institutions A, B and C explained in 38.7% the variability of Emotional Exhaustion. Minor Psychiatric Disorders, impact on mental health and being part of institutions A and B explained in 23.1% the variability of Depersonalization. Conclusions: the risk group presented greater exposure to psychological alterations. The regression model did not identify a difference between being or not of the risk group regarding Burnout Syndrome. The study contributes to the planning of protective labor interventions within institutions and public health policies, aiming to reduce possible factors related to the involvement of Burnout Syndrome and Minor Psychiatric Disorders.

RESUMEN Objetivo: identificar los cambios psíquicos en profesionales de enfermería pertenecientes y no pertenecientes al grupo de riesgo de complicaciones por COVID-19. Métodos: estudio transversal multicéntrico, con 845 profesionales de enfermería de cuatro hospitales del sur de Brasil, entre agosto y octubre de 2020. La recolección de datos se realizó mediante un formulario electrónico que contenía el Self-Reporting Questionnaire y el Maslach Burnout Inventory. Se utilizó estadística descriptiva e inferencial. Resultados: de los 845 participantes, 214 pertenecían al grupo de riesgo. Presentaron mayores puntuaciones medias en Agotamiento Emocional y Despersonalización (p<0,05), y mayores porcentajes de Trastornos Psíquicos Menores (55,2%). Los Trastornos Psíquicos Menores y el ser parte de la institución B explicaron en un 10,0% la variabilidad de la Realización Profesional. Los Trastornos Psíquicos Menores, el uso de medicamentos, el impacto en la salud mental y el ser parte de las instituciones A, B y C explicaron en un 38,7% la variabilidad del Agotamiento Emocional. Los Trastornos Psíquicos Menores, repercusión en la salud mental y ser parte de las instituciones A y B explicaron en un 23,1% la variabilidad de la Despersonalización. Conclusiones: el grupo de riesgo presentó mayor exposición a alteraciones psíquicas. El modelo de regresión no identificó diferencia entre estar o no en el grupo de riesgo con respecto al Síndrome de Burnout. El estudio contribuye para la planificación de intervenciones laborales protectoras en el ámbito de las instituciones y políticas públicas de salud, con el objetivo de reducir posibles factores relacionados con la participación del Síndrome de Burnout y Trastornos Psíquicos Menores.

RESUMO Objetivo: identificar as alterações psíquicas em profissionais da enfermagem pertencentes e não pertencentes ao grupo de risco para complicações da COVID-19. Métodos: estudo transversal multicêntrico, com 845 profissionais de enfermagem de quatro hospitais do Sul do Brasil, entre agosto e outubro de 2020. A coleta dos dados foi realizada por intermédio de um formulário eletrônico contendo os instrumentos Self-Reporting Questionnaire e o Maslach Burnout Inventory. Utilizou-se estatística descritiva e inferencial. Resultados: dos 845 participantes, 214 pertenciam ao grupo de risco. Estes apresentaram maiores médias nos escores de Desgaste Emocional e Despersonalização (p<0,05), e maiores percentuais de Distúrbios Psíquicos Menores (55,2%). Distúrbios Psíquicos Menores e fazer parte da instituição B explicaram em 10,0% a variabilidade da Realização Profissional. Distúrbios Psíquicos Menores, uso de medicações, impacto na saúde mental e fazer parte das instituições A, B e C explicaram em 38,7% a variabilidade do Desgaste Emocional. Distúrbios Psíquicos Menores, impacto na saúde mental e fazer parte das instituições A e B explicaram em 23,1% a variabilidade da Despersonalização. Conclusões: o grupo de risco apresentou maior exposição a alterações psíquicas. O modelo de regressão não identificou diferença entre ser ou não do grupo de risco quanto à Síndrome de Burnout. O estudo contribui no planejamento de intervenções laborais protetivas no âmbito das instituições e das políticas públicas de saúde, visando diminuir possíveis fatores relacionados ao acometimento da Síndrome de Burnout e dos Distúrbios Psíquicos Menores.

Association between fixed night work and obesity: a systematic literature review

This systematic review aimed to evaluate the association between fixed night work and overweight or weight gain. PubMed and EMBASE were searched until October 2021 for studies evaluating the association between fixed night work patterns and the risk of overweight or obesity (for cross-sectional designs) or weight gain (for longitudinal designs). The outcomes extracted were mean body mass index (BMI), mean BMI difference, overweight %, obesity %, odds ratio, relative risk, and prevalence ratio. The quality of the report was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. The protocol was registered at PROSPERO (# 42017080515). In total, 25 studies met the inclusion criteria. All studies were observational, 16 were cross-sectional, three were cohorts (two also had baseline cross-sectional data), and the other eight were cross-sectional at baseline and had longitudinal follow-up studies (six prospective cohorts, one retrospective, one interventional). Most had good reporting quality. The fixed night work definition and weight outcomes varied according to the different studies. Most of them found an association between fixed night work and overweight, obesity, or weight gain. This systematic review reinforces the evidence that fixed night work is associated with overweight or obesity, and prolonged night work exposure leads to weight gain. Future research should be conducted with more accurate measures and a prospective design. Fixed night workers should be monitored and advised, especially those with prolonged exposure.

Prevalência de dor lombar e fatores de risco em trabalhadores de uma lavanderia hospitalar: um estudo transversal / Prevalence of low back pain and risk factors in hospital laundry workers: a cross-sectional study

Introdução: A dor lombar representa um problema de saúde pública na população em idade economicamente ativa em todo o mundo, incluindo trabalhadores de lavanderia hospitalar. Neste artigo é avaliada a prevalência de dor lombar em trabalhadores de lavanderia do Hospital de Clínicas de Porto Alegre e sua associação com dados sociodemográficos, clínicos, ocupacionais e prática de exercícios físicos. Métodos: Foi realizado um estudo transversal do qual participaram 99 funcionários da lavanderia do Hospital. Foi utilizado instrumento de pesquisa composto por um questionário com questões sociodemográficas, clínicas e ocupacionais dos trabalhadores. Os dados obtidos foram processados pelo Teste Qui-Quadrado de Pearson e pela regressão de Poisson com variâncias robustas. Resultados: A prevalência de dor lombar encontrada foi de 68,69% (IC 95% 59,4%;78,0%). Entre os participantes, 12,1% relataram afastamento do trabalho pela Previdência Social devido a dor lombar. Na análise multivariada, ser trabalhador do setor costura foi associado a maior risco de apresentar dor lombar, enquanto que ter duplo emprego e tempo de serviço na função não estiveram significativamente associados. Conclusões: A dor lombar foi uma queixa prevalente em trabalhadores da lavanderia hospitalar, especialmente no setor costura. Ter duplo emprego ou maior tempo de trabalho na função não se mostraram fatores associados à prevalência de dor lombar na população estudada. Sugere-se a adoção de estratégias de prevenção e controle da dor lombar e a realização de mais estudos no tema, a fim de aprofundar os fatores associados e estabelecer medidas preventivas eficazes. (AU)

Introduction: Low back pain represents a public health problem in the working-age population worldwide, including hospital laundry workers. This article evaluates the prevalence of low back pain in laundry workers at the Hospital de Clínicas de Porto Alegre and its association with sociodemographic, clinical, and occupational data and physical exercises. Methods: We conducted a cross-sectional study of 99 laundry workers at the Hospital. We applied a research instrument consisting of a questionnaire with sociodemographic, clinical, and occupational questions. We used Pearson's chi-square test and Poisson regression with robust variance for data analysis. Results: The prevalence of low back pain was 68.69% (95% confidence interval, 59.4%- 78.0%). Among the participants, 12.1% reported previous sick leave due to low back pain. In the multivariate analysis, being a sewing worker was associated with a higher risk of developing low back pain, whereas keeping two jobs and length of service were not significantly associated with low back pain. Conclusions: Low back pain was a prevalent complaint among hospital laundry workers, especially in the sewing sector. Keeping two jobs and longer length of service were not associated with low back pain prevalence in the study population. We suggest that strategies to prevent and control low back pain should be adopted and that further studies on the topic should be conducted to better understand the associated factors and to establish effective preventive measures. (AU)

Presenteeism among health care workers: literature review.

Presenteeism is an occupational and psychosocial phenomenon with negative impact on the work environment. In addition to causing losses in productivity losses, it also has implications for the state of health of workers. Therefore, presenteeism is likely to become a serious public health problem. The aim of the present study was to discuss the implications, means for evaluation and impact of presenteeism on the health and work of health care workers. We performed a literature search in database PubMed using keywords presenteeism, absenteeism, nurse presenteeism, physician presenteeism, sickness presenteeism, physician health organization, and working sick. We conclude that adequate assessment, raising the health managers' awareness about the risks and harms associated with this phenomenon, and developing management tools will contribute to reduce the impact of presenteeism. This seems to be the proper path to make this problem more visible and hinder its growth.

O presenteísmo é um fenômeno ocupacional e psicossocial que afeta o ambiente de trabalho, acarretando perdas na produtividade e implicações na condição de saúde dos trabalhadores, com potencial para tornar-se um grave problema de saúde pública. O objetivo deste trabalho foi discorrer sobre implicações, formas de avaliação e repercussões na saúde e na prestação de serviços entre os trabalhadores da saúde. O presente estudo foi realizado mediante busca de artigos do PubMed utilizando palavras-chave como: presenteeism, absenteeism, nurse presenteeism, physician presenteeism, sickness presenteeism, physician health organization e working sick. Concluiu-se que avaliar corretamente o presenteísmo por meio de conscientizar gestores de saúde sobre os riscos e malefícios desse fenômeno e propor ferramentas para manejar essa condição contribuirão para reduzir o seu impacto nos ambientes de trabalho. Esse parece ser o caminho para dar visibilidade a esse problema e evitar o seu crescimento.

O encefalograma como exame preditor de risco para trabalho em altura / The encephalogram as a risk predictive test for work at height

Contexto: A Norma Regulamentadora 35 (NR-35) define trabalho em altura como "qualquer atividade executada acima de dois metros do nível inferior, onde haja risco de queda", e propõe que sejam realizados exames médicos voltados "a patologias que poderão originar mal súbito e queda de altura". Muitos médicos do trabalho passaram a solicitar o eletroencefalograma (EEG) de rotina para trabalhadores que exercem trabalho em altura. No entanto, a validade desse exame para trabalhadores assintomáticos é discutível. Objetivo: Analisar os acidentes de trabalho relacionados a trabalho em altura ocorridos entre 1º de janeiro de 2000 e 31 de dezembro de 2014 em um hospital universitário, correlacionando-os ao resultado dos EEGs realizados no mesmo período. Métodos: Trata-se de estudo transversal com revisão de EEGs, prontuários clínico-ocupacionais e Comunicações de Acidente do Trabalho (CATs) de todos os trabalhadores que exerceram trabalho em altura entre 1º de janeiro de 2000 e 31 de dezembro de 2014. Foram definidos termos na descrição da CAT para avaliar a relação do acidente com "mal súbito ou queda em altura", como "queda", "perda da consciência", "mal súbito", "vertigem", "tontura" e "síncope". Os EEGs foram classificados em três categorias, de acordo com os resultados: normais, com alterações inespecíficas ou com alterações epileptogênicas. Foram correlacionadas as CATs com os resultados dos respectivos EEGs. Resultados: De 2.464 CATs emitidas no período, 2.228 foram excluídas por não serem de trabalhadores em altura. Das 236 CATs restantes, 61 foram excluídas por não haver pelo menos 1 EEG realizado nos respectivos trabalhadores. Entre os 175 acidentes restantes, observou-se 171 EEGs normais e 4 com alterações inespecíficas; nenhum dos exames apresentou alterações epileptogênicas. Entre esses 175 acidentes, 13 traziam em sua descrição termos como "mal súbito ou queda em altura", como "queda", "perda da consciência", "mal súbito", "vertigem", "tontura" e "síncope". Entre os 13 acidentes, nenhum EEG apresentou alterações. Conclusão: O EEG não foi um exame preditor de risco de acidente envolvendo trabalho em altura entre os trabalhadores avaliados no período. O EEG não deve ser utilizado para trabalhadores assintomáticos, e só deve ser realizado quando houver indicação clínica.

Background: Regulating standard 35 (NR-35) defines work at height as "any activity performed two meters above from ground level and involving risk of falls" and recommends the performance of medical examination to detect "conditions that might cause sudden loss of consciousness and falls from heights". As a result many occupational physicians began to recommend routine electroencephalogram (EEG) to assess employees working at height. However, the validity of EEG for asymptomatic workers is uncertain. Objective: To analyze occupational accidents related to work at height occurring from January 1, 2000 to December 31, 2014, at a university hospital, and to correlate them with the results of EEGs performed along that period. Methods: Cross-sectional study involving review of EEG test,s clinical-occupational records and Work Accident Reports (WAR) of all employees working at height from January 1, 2000 to December 31, 2014. Terms in the WAR descriptions were established to investigate the relationship of accidents with "sudden loss of consciousness and falls from heights", such as "fall from a height", "sudden ill feeling", "loss of consciousness", "vertigo", "dizziness" and "syncope". EEG results were classified in three categories: normal, non-epileptic abnormalities and epileptic patterns. WAR descriptions were correlated with EEG results. Results: From 2,464 WARs issued along the investigated period, 2,228 were excluded because they did not correspond to work at height. From the remaining 236 WARs, 61 were excluded because EEG was not performed, therefore, 175 cases were included for analysis. Among the EEG tests assessed, 171 were normal, 4 exhibited non-epileptic abnormalities and none an epileptic pattern. Among all the analyzed cases, 13 descriptions included terms such as "fall from height", "loss of consciousness", "sudden ill feeling", "vertigo", "dizziness" and "syncope"; all the corresponding cases had normal EEG. Conclusions: EEG was not a good predictor of risk for accidents related with work at height in the analyzed sample. EEG should not be performed for assessment of asymptomatic workers, but only in cases with clinical suspicion of neurological abnormalities.

Risk factors affecting occupational exposure to blood and body fluids among dental students: a cross-sectional study in a Brazilian Federal University

Introduction: Dental students are often exposed to bloodborne pathogens during dental training. Several factors are involved in increased risk of human deficiency, hepatitis B and hepatitis C virus (HIV, HBV, and HCV) infection. However, there are few studies that address the risks and forms of prevention among dental students in Brazil. Methods: A cross-sectional study of occupational exposure to blood or body fluids among dental students of Universidade Federal do Rio Grande do Sul, Brazil, was performed. These students were referred to the Occupational Medicine Department of Hospital de Clínicas de Porto Alegre from January 2007 to April 2015. Analyzed data included type of exposure (needlestick injury, mucosal exposure, and exposure to non-intact skin); source patient status for HBV, HIV and HCV infection, accident during dental training, procedure performed, biological material involved, type of accident, and hepatitis B vaccination and serological protection status. The objective was to know the incidence rate and others characteristics of accidents in order to prevent them. Results: There were 312 accidents during the study period of 8 years and 4 months. Incidence rate was 87,42 exposures per 1000 students year. Source patient was known in 297 of the cases (95.2%), of which 3 were HBsAg reagent, 12 were HIV reagent, and 17 were HCV reagent. The majority of accidents occurred during procedure, but nearly as high as 40% occurred after procedure, of which 63% occurred during instrument cleaning, disinfecting or sterilizing. Most involved sharp instruments were anesthetic syringe needle and curette. Only 48% of dental students knew their antiHBs was > 10 mIU/mL. Conclusions: Dental students should be tested for hepatitis B immune status at the beginning of training, and vaccination should be available to all dental students before they start clinical practice. Work practice controls on sharp devices should be addressed at the beginning and strengthened during dental training. Dental training institutions should review instrumental cleaning process to minimize handling of loose contaminated instruments (AU)

Needlestick accident resulting in occupational transmission of HCV: report of two cases

Occupational transmission of hepatitis C virus (HCV) through needlestick injury is a serious problem worldwide. Occupational transmission of HCV is estimated at an average rate between 0.5% and 0.75%. There are factors associated with increased risk of transmission, such as deep injuries, procedures involving hollow-bore needle placement in the source patient’s vein or artery, and high HCV RNA titer in the source patient. We describe two cases of HCV seroconversion in nursing assistants after different risk needlestick injuries...

Impact of water renewal on the residual effect of larvicides in the control of Aedes aegypti.

This study was carried out to evaluate the residual effect of three larvicides under laboratory conditions for 100 days in Aedes aegypti. The larval mortality rate was measured without water renewal or with daily water renewal (80%). With temephos, there was 100% mortality in both groups until the 70th day. In the Bacillus thuringiensis israelensis (Bti)-WDG test, there was no difference during the first 20 days. With Bti-G, without water renewal, mortality was sustained above 90% for up to 35 days. The second experiment (with water renewal) reduced the mortality to below 90% after the first 20 days. When renewed water was provided, the residual effect was significantly lower for all larvicides.

Impact of water renewal on the residual effect of larvicides in the control of Aedes aegypti

This study was carried out to evaluate the residual effect of three larvicides under laboratory conditions for 100 days in Aedes aegypti. The larval mortality rate was measured without water renewal or with daily water renewal (80 percent). With temephos, there was 100 percent mortality in both groups until the 70th day. In the Bacillus thuringiensis israelensis (Bti)-WDG test, there was no difference during the first 20 days. With Bti-G, without water renewal, mortality was sustained above 90 percent for up to 35 days. The second experiment (with water renewal) reduced the mortality to below 90 percent after the first 20 days. When renewed water was provided, the residual effect was significantly lower for all larvicides.

Competência de peixes como predadores de larvas de Aedes aegypti, em condições de laboratório / Efficacy of fish as predators of Aedes aegypti larvae, under laboratory conditions

OBJETIVO: Avaliar a competência de peixes na predação de larvas de Aedes aegypti, em condições de laboratório. MÉTODOS: Foram testados machos e fêmeas de cinco espécies de peixe. Os testes de predação duravam cinco semanas para cada espécie. Cada ensaio compreendia quatro caixas testes e quatro caixas controles. Das caixas controle, duas tinham somente um peixe e as outras duas, apenas larvas. Cada caixa teste continha um peixe e larvas. Na primeira semana foram expostas 100 larvas em cada caixa, e a cada semana acrescentavam-se 100 larvas por caixa/dia, até se obter um máximo de 500 larvas/dia. Comprimento e peso dos peixes foram medidos semanalmente. RESULTADOS: Foram utilizadas 369.000 larvas no total. O Trichogaster trichopteros foi a única espécie em que ambos os sexos predaram 100 por cento das larvas oferecidas. O Betta splendens deixou de predar apenas 15 larvas. Machos do Poecilia reticulata apresentaram baixa capacidade larvófaga quando comparados às fêmeas da mesma espécie. Em relação ao peso e tamanho o Betta splendens mostrou-se capaz de predar 523 larvas/grama/dia. CONCLUSÕES: Fêmeas e machos de Trichogaster trichopteros e de Astyanax fasciatus, e fêmeas de Betta splendens e de Poecillia sphenops foram os peixes que apresentaram maior competência para predar as larvas. Embora com competência menor, machos de Poecillia sphenops e fêmeas de Poecilia reticulata foram capazes de eliminar o número de larvas de Aedes aegypti que possam emergir durante 24 horas num criadouro, em condições naturais. Machos de Poecilia reticulata não foram predadores eficazes.

OBJECTIVE: To evaluate the efficacy of fish as predators of the Aedes aegypti larvae in laboratory conditions. METHODS: The male and female of five different fish were included in the experiment. The tests to measure their consumption ability lasted five weeks for each species. Each trial involved four test tanks and four control tanks. Two control tanks contained just one fish, and the other two just larvae. Each of the test tanks contained one fish and the larvae. During the first week, 100 larvae were placed in the tank, with an additional 100 added every week, up to a maximum daily amount of 500 larvae. The length and weight of the fish were measured at the beginning and end of every week. RESULTS: A total of 369,000 larvae were used. The Trichogaster trichopteros was the only species in which both sexes ate 100 percent of the available larvae. The Betta splendens failed to eat only 15 larvae. The male Poecilia reticulate showed a strong capacity for larvae eating, compared with the female of the same species. In terms of weight and size, the Betta splendens proved capable of eating 523 larvae per gram of weight per day. CONCLUSIONS: The female and male Trichogaster trichopteros and Astyanax fasciatus, and the female Betta splendens and Poecilia sphenops proved to be the most effective predators of the Aedes aegypti larvae. And although the male Poecilia sphenops and female Poecilia reticulata were less effective, they were also capable of eradicating the total number of Aedes aegypti larvae that could appear over 24 hours in a breeding site under natural conditions. The male Poecilia reticulata, however, proved incapable of doing so.

[Efficacy of fish as predators of Aedes aegypti larvae, under laboratory conditions]. / Competência de peixes como predadores de larvas de Aedes aegypti, em condições de laboratório.

OBJECTIVE: To evaluate the efficacy of fish as predators of the Aedes aegypti larvae in laboratory conditions. METHODS: The male and female of five different fish were included in the experiment. The tests to measure their consumption ability lasted five weeks for each species. Each trial involved four test tanks and four control tanks. Two control tanks contained just one fish, and the other two just larvae. Each of the test tanks contained one fish and the larvae. During the first week, 100 larvae were placed in the tank, with an additional 100 added every week, up to a maximum daily amount of 500 larvae. The length and weight of the fish were measured at the beginning and end of every week. RESULTS: A total of 369,000 larvae were used. The Trichogaster trichopteros was the only species in which both sexes ate 100% of the available larvae. The Betta splendens failed to eat only 15 larvae. The male Poecilia reticulate showed a strong capacity for larvae eating, compared with the female of the same species. In terms of weight and size, the Betta splendens proved capable of eating 523 larvae per gram of weight per day. CONCLUSIONS: The female and male Trichogaster trichopteros and Astyanax fasciatus, and the female Betta splendens and Poecilia sphenops proved to be the most effective predators of the Aedes aegypti larvae. And although the male Poecilia sphenops and female Poecilia reticulata were less effective, they were also capable of eradicating the total number of Aedes aegypti larvae that could appear over 24 hours in a breeding site under natural conditions. The male Poecilia reticulata, however, proved incapable of doing so.