A vigilância de ambientes e processos de Trabalho na prevenção da Covid-19 na Bahia / The surveillance of work environments and processes in the prevention of Covid-19 in Bahia / La vigilancia de los entornos y procesos laborales en la prevención del Covid-19 en Bahía

Com o advento da pandemia de Covid-19, o olhar da vigilância de ambientes e processos de trabalho tem se voltado para a prevenção e controle de situações que possam favorecer a propagação desse risco biológico nos ambientes de trabalho. Este estudo propõe-se a descrever as intervenções realizadas pela Diretoria de Vigilância e Atenção à Saúde do Trabalhador/Centro Estadual de Referência em Saúde do Trabalhador (Divast/Cesat), voltadas para a prevenção da Covid-19 nos locais de trabalho no estado da Bahia. Trata-se de estudo descritivo, baseado nos relatórios das inspeções realizadas pela Divast/Cesat desde o início da pandemia, em atendimento a denúncias e demandas de trabalhadores, de conselhos regionais, da Ouvidoria do SUS e do Ministério Público do Trabalho. Inicialmente, foram produzidos roteiro de inspeção e formulário de notificação para a identificação de situações e fatores de risco para a Covid-19. Foram realizadas 53 inspeções, cerca de metade em serviços de saúde. Identificou-se diversas situações que poderiam contribuir para a propagação da Covid-19 nos ambientes de trabalho: número insuficiente/ou inadequação de medidas de prevenção e de proteção coletiva e individual, como máscaras e álcool em gel a 70%; desrespeito ao distanciamento mínimo recomendado; falta de protocolos ou planos de contingência para nortear o processo de trabalho frente a essa nova realidade, entre outras. Medidas de proteção foram recomendadas no intuito de corrigir as inadequações encontradas e, dessa forma, conter ou prevenir a incidência de casos de Covid-19 nos locais de trabalho.

Due to the Covid-19 pandemic, the workplaces surveillance has focused on prevention and control measures to avoid situations that may favor spreading the biological risk in workplaces. This study describes the interventions made by the Worker's Health Care and Surveillance State Office (Divast/Cesat) aimed at preventing Covid-19 cases in the workplace, in the state of Bahia. This is a descriptive study based on the reports of inspections conducted by Divast/Cesat since the beginning of the Covid-19 pandemic. Inspection script and notification forms were produced as guides for identification and indication of situations and risk factors for Covid-19. The interventions covered several productive branches and in all of them, several situations were identified that could contribute to the spread of Covid-19 in workplaces, such as insufficient number of collective preventive measures to protect against the SARS-Cov-2 virus namely masks and 70% alcohol gel; disrespect to the recommended minimum distance; lack of protocols or contingency plans to guide the work process in this new reality, among other problems. Based on these findings, protective measures were recommended to correct the inadequacies and, thus, contain or prevent the incidence of Covid-19 cases in workplaces.

Con la aparición de la pandemia del Covid-19, la vigilancia de los ambientes y procesos laborales se ha orientado hacia la prevención y control de situaciones que puedan favorecer la propagación de este riesgo biológico en los ambientes laborales. El presente estudio tiene como objetivo describir las intervenciones realizadas por la Dirección de Vigilancia y Atención de la Salud de los Trabajadores/Centro Estadual de Referencia de Salud de los Trabajadores (Divast/Cesat) orientadas a la prevención del Covid-19 en el lugar de trabajo, en el estado de Bahía (Brasil). Es un estudio descriptivo de los informes de inspecciones realizados por Divast/Cesat, desde el inicio de la pandemia, que reciben denuncias y demandas de trabajadores, de comisiones regionales, de la Defensoría del Pueblo del SUS y del Ministerio Público del Trabajo. Se produjo un guion de inspección y un formulario de notificación para identificar e indicar situaciones y factores de riesgo del Covid-19. Se realizaron 53 inspecciones, de las cuales cerca de la mitad fue en servicios de salud. Se identificaron varias situaciones que podrían contribuir a la propagación de esa enfermedad en el ambiente laboral: el número insuficiente de medidas preventivas y de protección colectivas e individuales, como mascarillas y gel de alcohol al 70%; falta de respeto a la distancia mínima recomendada; falta de protocolos o planes de contingencia para orientar el proceso de trabajo ante esta nueva realidad, entre otras. Se recomiendan medidas de protección para corregir las deficiencias encontradas y, así, contener o prevenir la incidencia de casos del Covid-19 en los ambientes laborales.

EXPERIÊNCIA DE AÇÃO INTEGRADA EM EMERGÊNCIA FITOSSANITÁRIA NA REGIÃO OESTE DA BAHIA / EXPERIENCE OF INTEGRATED ACTION IN PHYTOSANITARY EMERGENCY IN THE WEST OF BAHIA / EXPERIENCIA DE ACCIÓN INTEGRADA EN EMERGENCIA FITOSANITARIA EN EL OESTE DE BAHÍA

Entre os anos de 2000 e 2012, ocorreu um aumento considerável do uso de agrotóxicos no Brasil e a Bahia ocupa o 7º lugar no ranking do Brasil nesse uso, o que implica a ocorrência de exposição e de casos de intoxicação severos. O texto relata uma experiência integrada de vigilância e atenção em saúde de populações expostas a agrotóxicos, com base na situação de emergência fitossanitária e da intoxicação em humanos e óbito de animais devido à aplicação de agrotóxicos por meio de pulverização aérea numa fazenda na Região Oeste do estado da Bahia, no município de Luiz Eduardo Magalhães, ocorridas entre os anos de 2013 e 2014. Para enfrentamento das duas situações, optou-se por uma metodologia de ação que teve como objetivo fortalecer a atuação integrada na área da vigilância e atenção à população exposta a agrotóxicos. Considerando a complexidade dos agrotóxicos, em particular do produto autorizado pelo Estado para aplicação, o Benzoato de Emamectina, foi adotada uma abordagem interdisciplinar e integrada para a execução de todas as ações desenvolvidas na Região. A adoção de estratégias e metodologias integradas possibilitou o aprendizado e a replicação das experiências com perspectiva de construção de modelo de atuação integrada voltada para proteção da saúde dos trabalhadores e da população em geral para diagnóstico e manejo das intoxicações por agrotóxicos e de vigilância de ambientes.

Between 2000 and 2012 there was a meaningful increase to the use of pesticide in Brazil and Bahia occupies the 7th place in the consumption of pesticides in Brazil, which implies the occurrence of exposure and severe intoxication cases. The text presents an integrated experience of surveillance and attention to the health of populations exposed to pesticides, based on phytosanitary emergency situation and humans intoxication and death of animals, caused by pesticide air pulverization application on a farm in the West of Bahia State, at Luiz Eduardo Magalhães municipality, between 2013 and 2014. In order to address both situations a methodology of action with the intent of strengthening the integrated action in the surveillance and attention to the health of populations exposed to pesticides was chosen. Considering the complexity of pesticides, in particular of the product authorized by the State, the Emamectin Benzoate, an interdisciplinary and integrated approach to the execution of all actions developed within the region was adopted. The adoption of strategies and methodologies enabled the learning and the replication of experiences with perspective of construction of an integrated action model to the protection of workers's and the general population's health.

Entre 2000 y 2012 ocurrió el incremento del uso de plaguicidas en en Brasil y Bahía ocupa el séptimo lugar en el consumo de plaguicidas en Brasil, lo que implica en la ocurrencia de exposición y de casos de intoxicación graves. El texto relata una experiencia integrada de vigilancia y atención a la salud de las poblaciones expuestas a los plaguicidas, basada en la situación de emergencia fitosanitaria y de la intoxicación en humanos y la muerte de animales debido a la aplicación de plaguicidas por medio de pulverización aérea de plaguicidas en una hacienda en la región Oeste de Bahía, en el municipio de Luiz Eduardo Magalhães, ocurridas entre 2013 y 2014. Para enfrentamiento de las dos situaciones se escogió una metodología de acción que tuvo como objetivo fortalecer la actuación integrada en el área de la vigilancia y atención a la población expuesta a los plaguicidas. Considerando la complejidad de los plaguicidas, en particular del producto autorizado por el Estado para aplicación, el Benzoato de Emamectina, fue adoptado un abordaje interdisciplinario e integrado para la ejecución de todas las acciones desarrolladas en la Región. La adopción de estrategias y metodologías integradas posibilitó el aprendizaje y la replicación de las experiencias con perspectiva de construcción de un modelo de actuación integrada dirigida para la protección de la salud de los trabajadores y de la población en general.

Functionalization of acrylic hydrogels with alpha-, beta- or gamma-cyclodextrin modulates protein adsorption and antifungal delivery.

Poly(hydroxyethyl methacrylate) (pHEMA) hydrogels were functionalized with pendant alpha-, beta- and gamma-cyclodextrins (CD) with the aim of improving the biocompatibility and increasing the ability to host drug molecules. Pendant alpha-, beta- and gamma-CDs did not affect swelling of the hydrogels but slightly decreased the water contact angle. Protein deposition was notably dependent on the nature of the CD, due to their different affinities for hydrophobic moieties of proteins. Lysozyme and albumin sorption was hindered by gamma-CD. Functionalization with beta-CD also reduced protein sorption, although less so, while alpha-CD decreased lysozyme deposition but enhanced albumin sorption compared with control pHEMA hydrogels. Loading of the hydrogels with miconazole was carried out by immersion in drug suspension followed by autoclaving. Functionalization with gamma-CD doubled the affinity of the network for the drug and resulted in the highest amount loaded (up to 170 mgg(-1)). Sustained delivery was observed for several days. Some miconazole-loaded hydrogels completely prevented Candida albicans biofilm formation as assayed in an in vitro microbiological test.

Soft contact lenses functionalized with pendant cyclodextrins for controlled drug delivery.

The aim of this work was to develop acrylic hydrogels with high proportions of cyclodextrins maintaining the mechanical properties and the biocompatibility of the starting hydrogels, but notably improving their ability to load drugs and to control their release rate. Poly(hydroxyethylmethacrylate) hydrogels were prepared by copolymerization with glycidyl methacrylate (GMA) at various proportions and then beta-cyclodextrin (betaCD) was grafted to the network by reaction with the glycidyl groups under mild conditions. This led to networks in which the betaCDs form no part of the structural chains but they are hanging on 2-3 ether bonds through the hydroxyl groups. The pendant betaCDs did not modify the light transmittance, glass transition temperature, swelling degree, viscoelasticity, oxygen permeability, or surface contact angle of the hydrogels, but decreased their friction coefficient by 50% and improved diclofenac loading by 1300% and enhanced drug affinity 15-fold. The hydrogels were able to prevent drug leakage to a common conservation liquid for soft contact lenses (SCLs) and to sustain drug delivery in lacrimal fluid for two weeks. To summarize, the hydrogels with pendant betaCDs are particularly useful for the development of cytocompatible medicated implants or biomedical devices, such as drug-loaded SCLs.

Poly(hydroxyethyl methacrylate-co-methacrylated-beta-cyclodextrin) hydrogels: synthesis, cytocompatibility, mechanical properties and drug loading/release properties.

Copolymerization of hydroxyethyl methacrylate (HEMA) with a methacrylated-derivative of beta-cyclodextrin (beta-CD) was evaluated as a way to obtain hydrogels with tunable mechanical and drug loading and release properties, particularly for preparing medicated soft contact lenses. A fully methacrylated beta-CD monomer was synthesized and added to the HEMA and cross-linker solution at concentrations ranging from 0.042 to 0.333 g ml(-1) (i.e. 0.23-1.82 mol.%). Thermal polymerization led to transparent hydrogels with a degree of conversion above 74%, which showed a high cytocompatibility and did not induce macrophage response. The greater the content in methacrylated beta-CD was, the higher the glass transition temperature, the lower the degree of swelling and free water proportion, and the greater the storage and loss moduli of the swollen disks. These findings are directly related to the increase in the degree of cross-linking caused by the methacrylated beta-CD. Loading studies were carried out with hydrocortisone and acetazolamide, both able to form complexes with CDs in water and in lacrimal fluid. Hydrocortisone loading progressively decreased as the content in methacrylated beta-CD rose due to a decrease in the volume of aqueous phase of the hydrogel. Acetazolamide loading showed a maximum for an intermediate content in beta-CD (0.125-0.167 g ml(-1)) owing to a balance between complexation with beta-CD and hydrogel mesh size. The hydrogels sustained drug delivery for several days, the acetazolamide release rate being dependent on the beta-CD content. An adequate selection of the content in beta-CD enables pHEMA-co-beta-CD hydrogels suitable for specific biomedical applications to be obtained.

Modulating drug release with cyclodextrins in hydroxypropyl methylcellulose gels and tablets.

This paper reports on the effect of beta-cyclodextrin (beta-CD) and hydroxypropyl-beta-cyclodextrin (HP-beta-CD) on the diffusion and the release behavior of diclofenac sodium and sulphamethizole from HPMC K4M gels and matrix tablets. The gels were prepared with 0.5-2.0% polymer and different drug/CD mole ratios, and their viscosity, cloud point and drug diffusion coefficients were estimated. No differences in cloud point were observed. The viscosity of the gels strongly depended on HPMC proportions (from 0.7 to 100 mPa.s), which affected to a lesser extent the resistance to the diffusion of the drugs (D values from 60 x 10(-6) to 5 x 10(-6) cm(2)/s). The influence of CD on diffusion was particularly evident in gels prepared with polymer proportions above its entanglement concentration, 2.0% HPMC K4M. In these systems, while high drug/CD proportions enhanced the diffusivity preventing polymer/drug hydrophobic interactions, low drug/CD ratios hindered it. An excess of free CD, especially the bulky HP-beta-CD, made the diffusion of the complexes in the relatively low mesh size 2% polymer network more difficult. In the case of tablets, CD plays an additional role as dissolution rate promoter. To evaluate to what extent the balance between the increase in dissolution rate and the decrease in diffusion rate induced by CD determines drug release, matrix tablets were prepared by direct compression of 100 mg drug and 400 mg polymer/CD/lactose blends, whose composition was chosen following a simplex centroid design. A higher CD/lactose ratio significantly increased the release rate of hydrophobic drugs (sulphamethizole), but decreased the release rate of hydrophilic drugs (diclofenac sodium), indicating the predominance of a different contribution depending on the hydrophilicity of the drug. Therefore, the use of CD derivatives may be particularly useful to modulate drug release from HPMC gels and matrix tablets; the influence of these additives being dependent on the nature of the drug and on the molecular size and hydrophilic character of the CD used.