Prevalence of occupational stress in health care personnel during the COVID-19 pandemic: a cross-sectional study.

Introduction: Occupational stress has been exacerbated in health care personnel during the COVID-19 pandemic, which can harm the health of professionals, managers and the population. Objectives: To estimate the prevalence of occupational stress in professionals of the Family Health Strategy of a Health District in the city of Salvador, Bahia, Brazil. Methods: This is a cross-sectional study carried out with 105 professionals from the Family Health Strategy teams of three Family Health Units in a Health District in the city of Salvador, Bahia, Brazil. A questionnaire with sociodemographic and work information and the Work Stress Scale were applied. Numerical stress values were categorized, from the average, into low and high stress levels. Measures of central tendency and bivariate analysis between stress and other variables were calculated. Results: The high level of stress presented a prevalence of 46.7%, with the following most punctuated TSE stressors: lack of qualifications, few prospects for career growth, deficiency in the disclosure of decisions, discrimination at work and lack of autonomy. Conclusions: The prevalence of a high level of occupational stress among health professionals at Family Health Units reached 46.7% of the sample studied; a fact that deserves awareness on the part of managers regarding the promotion and protection of the health of health care personnel.

Introdução: O estresse ocupacional tem sido exacerbado nos trabalhadores de saúde durante a pandemia da covid-19, podendo trazer prejuízos à saúde dos profissionais, aos gestores e à população. Objetivos: Estimar a prevalência do estresse ocupacional em profissionais da Estratégia Saúde da Família de um distrito sanitário do município de Salvador, Bahia, Brasil. Métodos: Trata-se de um estudo transversal realizado com 105 profissionais das equipes da Estratégia Saúde da Família de três Unidades de Saúde da Família de um distrito sanitário do município de Salvador, Bahia, Brasil. Foram aplicados um questionário com informações sociodemográficas e laborais e a Escala de Estresse no Trabalho. Os valores numéricos do estresse foram categorizados, a partir da média, em baixo e alto nível do estresse. Foram calculadas as medidas de tendência central e a análise bivariada entre o estresse e as demais variáveis. Resultados: O nível alto do estresse apresentou-se com uma prevalência de 46,7%, com os seguintes fatores estressores da Escala de Estresse no Trabalho mais pontuados: deficiência de capacitações, poucas perspectivas de crescimento na carreira, deficiência na divulgação das decisões, discriminação no trabalho e falta de autonomia. Conclusões: A prevalência do nível alto de estresse ocupacional entre os profissionais de saúde das Unidades de Saúde da Família alcançou 46,7% da amostra estudada; fato que merece sensibilização por parte dos gestores quanto à promoção e à proteção à saúde dos trabalhadores de saúde.

Influence of the Peek Abutments on Mechanical Behavior of the Internal Connections Single Implant.

The present study aimed to evaluate the biomechanical behavior of PEEK abutments with different heights on single titanium implants. To investigate the implant surface, different tests (scanning electron microscopy, energy-dispersive X-ray, and X-ray diffraction) were adopted. Herein, 20 implants received the 4.5 × 4.0 mm PEEK short abutment (SA) and 20 received the 4.5 × 5.5 mm PEEK long abutment (LA). The abutments were installed using dual-cure resin cement. To determine the fatigue test, two specimens from each group were submitted to the single load fracture test. For this, the samples were submitted to a compressive load of (0.5 mm/min; 30°) in a universal testing machine. For the fatigue test, the samples received 2,000,000 cycles (2 Hz; 30°). The number of cycles and the load test was analyzed by the reliability software SPSS statistics using Kaplan-Meier and Mantel-Cox tests (log-rank) (p < 0.05). The maximum load showed no statistically significant differences (p = 0.189) for the SA group (64.1 kgf) and the LA group (56.5 kgf). The study groups were statistically different regarding the number of cycles (p = 0.022) and fracture strength (p = 0.001). PEEK abutments can be indicated with caution for implant-supported rehabilitation and may be suitable as temporary rehabilitation.

The dual role of SrbA from Paracoccidioides lutzii: a hypoxic regulator.

The fungus Paracoccidioides lutzii is one of the species of the Paracoccidioides genus, responsible for a neglected human mycosis, endemic in Latin America, the paracoccidioidomycosis (PCM). In order to survive in the host, the fungus overcomes a hostile environment under low levels of oxygen (hypoxia) during the infectious process. The hypoxia adaptation mechanisms are variable among human pathogenic fungi and worthy to be investigated in Paracoccidoides spp. Previous proteomic results identified that P. lutzii responds to hypoxia and it has a functional homolog of the SrbA transcription factor, a well-described hypoxic regulator. However, the direct regulation of genes by SrbA and the biological processes it governs while performing protein interactions have not been revealed yet. The goal of this study was to demonstrate the potential of SrbA targets genes in P. lutzii. In addition, to show the SrbA three-dimensional aspects as well as a protein interaction map and important regions of interaction with predicted targets. The results show that SrbA-regulated genes were involved with several biological categories, such as metabolism, energy, basal processes for cell maintenance, fungal morphogenesis, defense, virulence, and signal transduction. Moreover, in order to investigate the SrbA's role as a protein, we performed a 3D simulation and also a protein-protein network linked to this hypoxic regulator. These in silico analyses revealed relevant aspects regarding the biology of this pathogen facing hypoxia and highlight the potential of SrbA as an antifungal target in the future.

Integrative Review of Managed Entry Agreements: Chances and Limitations.

BACKGROUND AND OBJECTIVE: Managed entry agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high-priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective of this article is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high- and middle-income countries. METHODS: An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior-level co-authors including key South American markets. It also involved senior-level decision makers and advisers providing guidance on the potential advantages and disadvantages of MEAs and ways forward. RESULTS: Twenty-five studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%) and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. CONCLUSIONS: We are likely to see a growth in MEAs with the continual launch of new high-priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome-based MEAs could be an important tool to improve access to new innovative medicines, there are critical issues to address. Comparing knowledge, experiences, and practices across countries is crucial to guide high- and middle-income countries when designing their future MEAs.

Pharmacopollution and Household Waste Medicine (HWM): how reverse logistics is environmentally important to Brazil.

Pharmacopollution is a public health and environmental outcome of some active pharmaceutical ingredients (API) and endocrine-disrupting compounds (EDC) dispersed through water and/or soil. Its most important sources are the pharmaceutical industry, healthcare facilities (e.g., hospitals), livestock, aquaculture, and households (patients' excretion and littering). The last source is the focus of this article. Research questions are "What is the Household Waste Medicine (HWM) phenomenon?", "How HWM and pharmacopollution are related?", and "Why is a reverse logistic system necessary for HWM in Brazil?" This article followed the seven steps proposed by Rother (2007) for a systematic review based on the Cochrane Handbook and the National Health Service (NHS) Center for Reviews Dissemination (CDR) Report. The HWM phenomenon brings many environmental, public health, and, social challenges. The insufficient data is a real challenge to assessing potential human health risks and API concentrations. Therefore, the hazard of long-term exposure to low concentrations of pharmacopollutants and the combined effects of API mixtures is still uncertain. HWM are strongly related to pharmacopollution, as this review shows. The Brazilian HWM case is remarkable because it is the fourth pharmaceutical market (US$ 65,971 billion), with a wide number of private pharmacies and drugstores (3.3: 10,000 pharmacy/inhabitants), self-medication habits, and no national take-back program. The HWM generation is estimated in 56.6 g/per capita, or 10,800 t/year. The absence of a reverse logistics for HWM can lead to serious environmental and public health challenges. The sector agreement for HWM is currently under public consultation.

The repeat domain of the type III effector protein PthA shows a TPR-like structure and undergoes conformational changes upon DNA interaction.

Many plant pathogenic bacteria rely on effector proteins to suppress defense and manipulate host cell mechanisms to cause disease. The effector protein PthA modulates the host transcriptome to promote citrus canker. PthA possesses unusual protein architecture with an internal region encompassing variable numbers of near-identical tandem repeats of 34 amino acids termed the repeat domain. This domain mediates protein-protein and protein-DNA interactions, and two polymorphic residues in each repeat unit determine DNA specificity. To gain insights into how the repeat domain promotes protein-protein and protein-DNA contacts, we have solved the structure of a peptide corresponding to 1.5 units of the PthA repeat domain by nuclear magnetic resonance (NMR) and carried out small-angle X-ray scattering (SAXS) and spectroscopic studies on the entire 15.5-repeat domain of PthA2 (RD2). Consistent with secondary structure predictions and circular dichroism data, the NMR structure of the 1.5-repeat peptide reveals three α-helices connected by two turns that fold into a tetratricopeptide repeat (TPR)-like domain. The NMR structure corroborates the theoretical TPR superhelix predicted for RD2, which is also in agreement with the elongated shape of RD2 determined by SAXS. Furthermore, RD2 undergoes conformational changes in a pH-dependent manner and upon DNA interaction, and shows sequence similarities to pentatricopeptide repeat (PPR), a nucleic acid-binding motif structurally related to TPR. The results point to a model in which the RD2 structure changes its compactness as it embraces the DNA with the polymorphic diresidues facing the interior of the superhelix oriented toward the nucleotide bases.

Construção de um protocolo de tratamento para o transtorno de ansiedade generalizada

O transtorno de ansiedade generalizada (TAG) é um transtorno crônico que atinge cerca de 5,1 por cento da população. Em geral, os sintomas acompanham a pessoa desde muito cedo, mas raramente elas procuram tratamento. Atualmente o TAG é caracterizado por uma preocupação excessiva que ocorre na maioria dos dias, por pelo menos seis meses e vem acompanhada por sintomas como: inquietação, tensão muscular, irritabilidade, fadiga, agitação, falta de concentração e problemas com o sono. A preocupação é tida como difícil de controlar e pode referir-se a várias questões como: saúde própria ou de outras pessoas significativas, segurança pessoal, pequenas tarefas da vida diária e outros. Estudos têm apontado que o TAG, mesmo sem comorbidades, causa prejuízo na qualidade de vida e é resistente ao tratamento. Desta maneira, torna-se importante encontrar métodos mais eficazes para diminuir a preocupação excessiva e hiperexcitação. Com este objetivo, foi desenvolvido um protocolo de tratamento que está fundamentado em pesquisas recentes sobre o transtorno. Entre as principais formulações, pesquisadores têm destacado o papel da intolerância à incerteza, das crenças sobre a preocupação, da evitação cognitiva e de problemas interpessoais na origem e manutenção do TAG. Desta maneira, o tratamento baseia-se em ferramentas básicas da terapia cognitivo-comportamental e em novos procedimentos que ainda necessitam de avaliações acerca de sua efetividade. Entre os últimos, pode-se destacar a reestruturação de crenças sobre a preocupação e as técnicas de processamento emocional para tratar os problemas interpessoais. Diversas outras técnicas compõem este protocolo e espera-se que possam maximizar os efeitos da terapia (AU)