Dynamic and static ultrasound features predictive of vesicoureteral reflux and renal damage in children and adolescents with neurogenic bladder.

PURPOSE: This study aimed to analyze the diagnostic accuracy of dynamic and static ultrasound (DSUS) in detecting vesicoureteral reflux (VUR) and renal scarring in a cohort of children with neurogenic bladder (NB). MATERIALS AND METHODS: A retrospective, longitudinal, observational study was conducted using the Reporting Diagnostic Accuracy Studies guideline. The DSUS (index test) data were compared with voiding cystourethrography (VCUG) and renal scintigraphy 99mTc-dimercaptosuccinic (reference tests). Overall performance for predicting VUR and renal scarring was assessed using renal pelvic diameter (RPD)/distal ureteral diameter and renal parenchymal thinning on DSUS, respectively. RESULTS: A total of 107 patients (66 girls, median age 9.6 years) participated. Seventeen patients (15.9%) presented VUR, eight bilateral. For overall reflux grade, the AUC was 0.624 for RPD and 0.630 for distal ureteral diameter. The diagnostic performance for detecting high-grade VUR was slightly better for DSUS parameters. The AUC was 0.666 for RPD and 0.691 for distal ureteral diameter. The cut-offs of 5 mm for RPD and 6.5 mm for distal ureteral diameter presented the best diagnostic odds ratio (DOR) to identify high-grade VUR. The increase of RPD during detrusor contractions showed an accuracy of 89.2%. The thinness of renal parenchyma presented an accuracy of 88% for renal scarring. CONCLUSION: DSUS predicts VUR and renal scarring in children with NB with fair to good accuracy, and all measurements exhibited a high negative predictive value (NPV). The increase in RPD during voiding or detrusor contractions proved to be the most accurate parameter for indicating the presence of VUR in this study.

Use of flaps in inguinal lymphadenectomy in metastatic penile cancer.

PURPOSE: Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer. MATERIAL AND METHODS: We reviewed the current literature of the Pubmed database according to PRISMA guidelines. The search terms used were "advanced penile cancer", "groin reconstruction", and "inguinal reconstruction", both alone and in combination. The bibliographic references used in the selected articles were also analyzed to include recent articles into our research. RESULTS: A total of 54 studies were included in this review. About one third of penile cancers are diagnosed with locally advanced disease, often presenting with large lymph node involvement. Defects in the inguinal region resulting from the treatment of metastatic penile cancer are challenging for the surgeon and cause high patient morbidity, rendering primary closure unfeasible. Several fasciocutaneous and myocutaneous flaps of the abdomen and thigh can be used for the reconstruction of the inguinal region, transferring tissue to the affected area, and enabling tensionless closure. CONCLUSIONS: The reconstruction of defects in the inguinal region with the aid of flaps allows for faster postoperative recovery and reduces the risk of complications. Thus, the patient will be able to undergo potential necessary adjuvant treatments sooner.

Risk factors for urinary tract infection in children with urinary urgency.

PURPOSE: To identify which independent variable would be strong predictor of febrile urinary tract infection (UTI) in children and adolescents with overactive bladder. MATERIALS AND METHODS: A search was made of the institute's database for all patients diagnosed with overactive bladder over the preceding four years. Children and adolescents under 18 years of age with overactive bladder and no neurological or anatomical alterations of the lower urinary tract were included in the study. The independent variables were: sex, age, ethnicity (Brazilians of African descendence/others), the presence of urinary urgency, daytime incontinence, enuresis, frequent urination, infrequent voiding (≤3 voids/day), nocturia, holding maneuvers, straining to void, intermittent urinary flow, constipation and encopresis. An analysis was conducted to identify patients with febrile UTI and subsequently determine predictors of this condition. Univariate and multivariate analyses were performed. RESULTS: Overall, 326 patients (214 girls/112 boys) were evaluated. The mean age of the patients was 7.7±3.19 years (± standard deviation). The incidence of febrile UTI was 39.2%. Being female and infrequent voiding were factors significantly associated with febrile UTI, both in the univariate and multivariate analyses. CONCLUSIONS: These results show that being female and infrequent voiding constituted significant risk factors for a diagnosis of febrile UTI in these children.

Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life.

OBJECTIVE: To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. METHODS: Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. RESULTS: 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. CONCLUSION: There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil. MAIN RESULTS: Marked racial inequalities were found in the obstacles to vaccination of children under 24 months in Brazil and to timely vaccination at 5 months and in the first year of life. IMPLICATIONS FOR SERVICES: Racial inequalities in the occurrence of vaccination shortcomings in health services, in the objective restrictions faced by families in taking their children to vaccination centers and in incomplete vaccination in a timely manner need to be addressed by the Brazilian National Health System. PERSPECTIVES: Equal public policies to address barriers to vaccination and qualification of health services need to be implemented. Studies need to deepen understanding of the structural determinants that lead to racial disparities.

Description of vaccination coverage and hesitancy obtained by epidemiological survey of children born in 2017-2018, in Belo Horizonte and Sete Lagoas, Minas Gerais, Brazil.

OBJECTIVE: To describe vaccination coverage and hesitation for the basic children's schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. METHODS: Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. RESULTS: Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. CONCLUSION: Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities. MAIN RESULTS: Vaccination coverage of children up to 4 years old was 50.2% in Belo Horizonte, and 64.9% in Sete Lagoas. Fear of severe reactions and believing that vaccination against eradicated diseases is unnecessary were the main reasons for vaccination hesitancy. IMPLICATIONS FOR SERVICES: Recovery of high vaccination coverage among children, considering public health service access conditions and socioeconomic inequities. Acting on reasons for hesitancy that can assist in targeting actions. PERSPECTIVES: The multifactorial context of vaccination hesitancy demands the development of health education strategies to raise awareness about child immunization.

Serological evidence of hantavirus infection in neotropical bats in an urban area of São Paulo State, Brazil.

BACKGROUND: Although hantaviruses have long been associated with rodents, they are also described in other mammalian hosts, such as shrews, moles and bats. Hantaviruses associated with bats have been described in Asian, European and Brazilian species of bats. As these mammals represent the second major mammalian order, and they are the major mammals that inhabit urban areas, it is extremely important to maintain a viral surveillance in these animals. Our aim was to conduct serosurveillance in bats in an urban area in the city of Ribeirão Preto, São Paulo State, Brazil, to contribute to the information about hantaviruses circulation in bats. METHODS: We analyzed samples from 778 neotropical bat specimens classified into 21 bat species and four different families collected in the urban area of Ribeirão Preto city, from 2014 to 2019 by an ELISA for the detection of IgG antibodies against orthohantavirus. RESULTS: We detected IgG-specific antibodies against the nucleoprotein of orthohantavirus in 0.9% (7/778) bats tested, including four Molossus molossus (Pallas' Free-tailed Bat), two Glossophaga soricina (Pallas's Long-tongued Bat) and one Eumops glaucinus (Wagner's mastiff bat). CONCLUSIONS: Overall, our results show the first serological evidence of hantavirus infection in three common bat species in urban areas.

Genetic characterization of the rare Bruconha virus (Bunyavirales: Orthobunyavirus) isolated in Vale do Ribeira (Atlantic Forest biome), Southeastern Brazil.

Brazil is a great source of arbovirus diversity, mainly in the Amazon region. However, other biomes, especially the Atlantic Forest, may also be a hotspot for emerging viruses, including Bunyaviruses (Negarnaviricota: Bunyavirales). For instance, Vale do Ribeira, located in the Southeastern region, has been widely studied for virus surveillance, where Flavivirus, Alphavirus and Bunyaviruses were isolated during the last decades, including Bruconha virus (BRCV), a member of Orthobunyavirus genus Group C, in 1976. Recently, a new isolate of BRCV named Span321532 was obtained from an adult sentinel mouse placed in Iguape city in 2011, and a full-length genome was generated with nucleotide differences ranging between 1.5%, 5.3% and 5% (L, M and S segments, respectively) from the prototype isolated 35 years earlier. In addition, each segment placed BRCV into different clusters, showing the high variety within Bunyavirales. Although no evidence for reassortants was detected, this finding reiterates the need for new surveillance and genomic studies in the area considering the high mutation rates of arbovirus, and also to identify the hosts capable of supporting the continuous circulation of Orthobunyavirus.

National Vaccine Coverage Survey 2020: methods and operational aspects.

OBJECTIVE: The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. METHODS: A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. RESULTS: Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. CONCLUSION: There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.

Prevalence of Leishmania infantum in Dogs from Deforested Areas of the Amazon Biome.

Background and Objectives: Species of Leishmania genus are intracellular parasites responsible for severe zoonotic diseases worldwide, such as leishmaniasis. In Brazil, the most important species is Leishmania infantum. In the northern region, the state of Pará is notable, with a high number of cases reported in recent years. The second largest number of cases of human visceral leishmaniasis in the region in recent years has been reported in the city of Marabá (Pará state). We investigated the prevalence of L. infantum in domestic dogs from Marabá in Amazon region in Brazil. Materials and Methods: A total of 400 blood samples were tested using the dual-path platform chromatographic immunoassay (DPP® CVL-Bio-Manguinhos), and molecular diagnosis based in cathepsin L-like gene, which has better specificity and sensitivity than other similar tests. Results: The prevalence of L. infantum was 75.5% (302/400) in the serological test, and 59.25% (237/400) in molecular diagnosis, and 45.5% (182/400) in both tests. Interpretation and Conclusion: The results confirmed that the parasite L. infantum was prevalent in the dog population of the studied region and adoption of appropriate public policies are urgently needed.

Molecular Diagnosis and Prevalence of Trypanosoma vivax (Trypanosomatida: Trypanosomatidae) in Buffaloes and Ectoparasites in the Brazilian Amazon Region.

Trypanosoma vivax Ziemann is a parasite that affects both wild and domestic ungulates and is transmitted mechanically via tabanids and other blood-sucking insects in the Americas. A total of 621 blood samples from water buffaloes (Bubalus bubalis (Linnaeus) (Artiodactyla: Bovidae), and 184 ectoparasite samples (Amblyomma cajennense (Fabricius) sensu stricto and Rhipicephalus (Boophilus) microplus (Canestrini) (Acari: Ixodidae), and Haematopinus tuberculatus (Burmeister) (Phthiraptera: Haematopinidae)) were obtained from 60 farms in the State of Pará, Brazilian Amazon. Twelve buffalo blood samples (1.89%) and 11 ectoparasites (6%) were positive for T. vivax based on the cathepsin L-like gene. All sequences were 99% similar to T. vivax from northeastern Brazil (EU753788) in amplified PCR assays on each of the hosts tested.

Canine Visceral Leishmaniasis in São Paulo, Brazil, the Most Populous City of South America: Isolation, Molecular Diagnosis, and Phylogenetic Inferences.

Background and Objectives: Canine visceral leishmaniasis affects dogs, the main urban reservoirs, which favor the transmission and expansion of this zoonotic disease in areas with high anthropization process and human density. We investigated the occurence of Leishmania infatum based in molecular diagnosis, and phylogenetic analysis of isolates obtained from dogs in metropolitan region of São Paulo. Methods: A total of 201 dogs were tested by parasitological and molecular diagnosis. Phylogenetic analysis based sequences from SSUrDNA and gGAPDH genes were performed. Results: The parasitological diagnosis revealed 5% (10/201) of positivity, and the sequences obtained from seven isolates were clustered with L. infantum in phylogentic analysis based on SSUrDNA and gGAPDH genes. A total of 24.9% (50/201) of dogs were positive in molecular diagnosis based on cathepsin L-like marker. Interpretation and Conclusion: According to this study, it is necessary to implement a surveillance policy of visceral leishmaniasis, intensifying the actions of diagnosis, prevention, and control of this zoonosis.

National scientific production on Burnout Syndrome in ICU nurses and physicians: a bibliometric study.

OBJECTIVE: To analyze the scientific production on Burnout Syndrome in physicians and nurses of ICU in Brazil. METHOD: Bibliometric study, documentary, with quantitative approach. We selected articles published in Brazil on Burnout Syndrome in the ICUs, in the VHL and Portal Capes, from 2000 to 2018. RESULTS: 40 articles were identified, predominantly from the Southeast. Prevalence of those published in the Brazilian Journal of Intensive Care and in the Journal of Nursing UFPE online. The B2 Qualis periodical is the most prominent. The most prevalent descriptors were: Intensive Care Units, Burnout Syndrome, Burnout and Professional Exhaustion. CONCLUSIONS: Nurses are more interested in publishing this issue. Burnout Syndrome studied in intensive physicians would contribute to identifying its prevalence in these professionals.

Description of vaccination coverage and hesitancy obtained by epidemiological survey of children born in 2017-2018, in Belo Horizonte and Sete Lagoas, Minas Gerais, Brazil / Descripción de la cobertura de vacuna y de las vacunaciones obtenidas por la encuesta epidemiológica de niños nacidos en 2017-2018, en Belo Horizonte y Sete Lagoas, Minas Gerais / Descrição da cobertura e da hesitação vacinal obtida por inquérito epidemiológico de crianças nascidas em 2017-2018, em Belo Horizonte e Sete Lagoas, Minas Gerais

ABSTRACT Objective To describe vaccination coverage and hesitation for the basic children's schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. Methods Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. Results Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. Conclusion Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities.

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RESUMO Objetivo Descrever as coberturas e hesitação das vacinas do calendário básico infantil em Belo Horizonte e Sete Lagoas, Minas Gerais. Métodos Inquéritos epidemiológicos de base populacional realizados de 2020 a 2022, para estimar coberturas vacinais por tipo de imunobiológico e esquema completo (doses válidas e aplicadas) segundo estratos socioeconômicos, e os motivos de hesitação vacinal. Resultados A cobertura global com doses válidas e a hesitação vacinal de pelo menos uma vacina foram, respectivamente, de 50,2% (IC95% 44,1;56,2) e 1,6% (IC95% 0,9;2,7), em Belo Horizonte (n = 1.866), e de 64,9% (IC95% 56,9;72,1) e 1,0% (IC95% 0,3;2,8), em Sete Lagoas (n = 451), com diferenças entre os estratos. O receio de reações graves foi o principal motivo de hesitação vacinal. Conclusão Identificou-se coberturas abaixo do preconizado para a maioria das vacinas. A desinformação deve ser combatida, evitando-se a hesitação vacinal. Há necessidade premente de recuperar as coberturas, considerando acesso ao SUS e disparidades socioeconômicas.

Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life / Desigualdades raciales en la vacunación infantil y obstáculos para la vacunación en Brazil entre nacidos vivos en 2017 y 2018: análisis de uma cohorte retrospectiva de los dos primeros años de vida / Desigualdades raciais na vacinação infantil e nos obstáculos à vacinação no Brasil entre nascidos vivos em 2017 e 2018: análise de uma coorte retrospectiva dos dois primeiros anos de vida

ABSTRACT Objective To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Methods Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. Results 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. Conclusion There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil.

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RESUMO Objetivo Descrever a completude vacinal em tempo oportuno nos primeiros 24 meses de vida no Brasil e os obstáculos para vacinação, testando-se associações com raça/cor da pele materna. Métodos Fez-se coleta de informações sobre os nascidos em 2017 e 2018, constantes no Inquérito Nacional de Cobertura Vacinal. Foram calculados prevalência e intervalos de confiança de 95% de obstáculos à vacinação e completude vacinal em tempo oportuno aos 5 meses, primeiro e segundo ano, segundo raça/cor da pele materna. Empregou-se regressão logística para análise de associações. Resultados Analisaram-se dados de 37.801 crianças. Do total, 7,2% (IC95% 6,3;8,2) dos responsáveis enfrentaram dificuldades para levar seus filhos para vacinação e 23,4% (IC95% 21,7;25,1) das crianças não foram vacinadas, mesmo sendo levadas. Essas proporções foram 75% (IC95% 1,25;2,45) e 97% (IC95% 1,57;2,48) mais elevadas, respectivamente, entre pretas; e 49,9% (IC95% 47,8;51,9) e 61,1% (IC95% 59,2;63,0) das crianças tiveram atraso em alguma vacina até os 5 meses e o primeiro ano, respectivamente. Tais valores foram maiores entre pardas/pretas. Conclusão Há desigualdades raciais nos obstáculos enfrentados e na vacinação no Brasil.

Genetic characterization of the rare Bruconha virus (Bunyavirales: Orthobunyavirus) isolated in Vale do Ribeira (Atlantic Forest biome), Southeastern Brazil

ABSTRACT Brazil is a great source of arbovirus diversity, mainly in the Amazon region. However, other biomes, especially the Atlantic Forest, may also be a hotspot for emerging viruses, including Bunyaviruses (Negarnaviricota: Bunyavirales). For instance, Vale do Ribeira, located in the Southeastern region, has been widely studied for virus surveillance, where Flavivirus, Alphavirus and Bunyaviruses were isolated during the last decades, including Bruconha virus (BRCV), a member of Orthobunyavirus genus Group C, in 1976. Recently, a new isolate of BRCV named Span321532 was obtained from an adult sentinel mouse placed in Iguape city in 2011, and a full-length genome was generated with nucleotide differences ranging between 1.5%, 5.3% and 5% (L, M and S segments, respectively) from the prototype isolated 35 years earlier. In addition, each segment placed BRCV into different clusters, showing the high variety within Bunyavirales. Although no evidence for reassortants was detected, this finding reiterates the need for new surveillance and genomic studies in the area considering the high mutation rates of arbovirus, and also to identify the hosts capable of supporting the continuous circulation of Orthobunyavirus.

Dynamic and static ultrasound features predictive of vesicoureteral reflux and renal damage in children and adolescents with neurogenic bladder

ABSTRACT Purpose: This study aimed to analyze the diagnostic accuracy of dynamic and static ultrasound (DSUS) in detecting vesicoureteral reflux (VUR) and renal scarring in a cohort of children with neurogenic bladder (NB). Materials and Methods: A retrospective, longitudinal, observational study was conducted using the Reporting Diagnostic Accuracy Studies guideline. The DSUS (index test) data were compared with voiding cystourethrography (VCUG) and renal scintigraphy 99mTc-dimercaptosuccinic (reference tests). Overall performance for predicting VUR and renal scarring was assessed using renal pelvic diameter (RPD)/distal ureteral diameter and renal parenchymal thinning on DSUS, respectively. Results: A total of 107 patients (66 girls, median age 9.6 years) participated. Seventeen patients (15.9%) presented VUR, eight bilateral. For overall reflux grade, the AUC was 0.624 for RPD and 0.630 for distal ureteral diameter. The diagnostic performance for detecting high-grade VUR was slightly better for DSUS parameters. The AUC was 0.666 for RPD and 0.691 for distal ureteral diameter. The cut-offs of 5 mm for RPD and 6.5 mm for distal ureteral diameter presented the best diagnostic odds ratio (DOR) to identify high-grade VUR. The increase of RPD during detrusor contractions showed an accuracy of 89.2%. The thinness of renal parenchyma presented an accuracy of 88% for renal scarring. Conclusion: DSUS predicts VUR and renal scarring in children with NB with fair to good accuracy, and all measurements exhibited a high negative predictive value (NPV). The increase in RPD during voiding or detrusor contractions proved to be the most accurate parameter for indicating the presence of VUR in this study.

Silicose nas pedreiras: a sutil diferença entre conhecer e adoecer. Intervenções em Saúde do Trabalhador na explotação de rochas ornamentais / Silicosis in quarries: the subtle difference between knowing and fall ill. Interventions in Workers' Health in the exploitation of ornamental stones

Resumo Introdução Trabalhadores nas pedreiras de rochas ornamentais estão expostos a vários riscos ocupacionais, no entanto destacamos a ocorrência da principal doença pulmonar associada à inalação de partículas de sílica. Objetivo Apresentar as principais intervenções em saúde do trabalhador aplicadas na prevenção de exposições ocupacionais à poeira contendo sílica livre em duas pedreiras da região noroeste do Espírito Santo. Método Observação participante dos processos de trabalho em duas pedreiras, realizada em dois anos diferentes, complementada com análise documental. Resultados É possível distinguir as funções mais expostas à inalação de sílica e modificar o processo de trabalho introduzindo tecnologia capaz de minimizar a formação de poeira. O envolvimento de empresários, trabalhadores organizados e do poder público é essencial para o controle de emissão de particulados nas pedreiras. Conclusão Observa-se a necessidade de incentivos para o investimento em capacitação de mão de obra qualificada e em tecnologias de ponta no setor, uma mudança que urge em prol da saúde do trabalhador na produção de rochas ornamentais no combate à silicose.

Abstract Background Workers in ornamental stone quarries are exposed to several occupational hazards; however, it is highlighted the occurrence of the main lung disease associated with inhalation of silica particles. Objective To present the main interventions in worker's health applied in the prevention of occupational exposures to dust-containing free silica in two quarries in the northwestern region of Espírito Santo. Method Observation participant of the work processes in two quarries carried out in two different years, complemented with documentary analysis. Results It is possible to distinguish the functions most exposed to the inhalation of silica and modify the work process by introducing technology capable of minimizing the formation of dust. The involvement of entrepreneurs, organized workers, and public power is essential for controlling the emission of particulates in quarries. Conclusion There is a need for incentives to invest in skilled labor and state-of-the-art technologies in the sector, a change that is urgent for the health of workers in the production of ornamental stones in the fight against silicosis.

Severity levels of physical punishment of children/adolescents: cluster analysis / Níveis de gravidade da punição física de crianças/adolescentes: análise de clusters

Physical punishment - corporal punishment - of children/adolescents is highly prevalent. The objective of this study was to verify if, in a sample of parents/caregivers, there would be subgroups that would differentiate themselves regarding the behavior of physically punishing the children, in terms of modalities, frequency, body parts of the child affected, and presence of parental anger in the act of punishing, denoting severity levels associated with differences in the psychosocial variables pointed out in the literature as risk factors for physical abuse. A quantitative approach was adopted, with a cross-sectional design and cluster method. The study included 87 parents/caregivers who practice physical punishment. The analyses indicated the existence of three clusters that differed in the level of severity of corporal punishment and some of the psychosocial variables, denoting the importance of developing services/programs to cope with violence against children/adolescents and specific psychosocial intervention strategies.

A punição física - castigos corporais - de crianças/adolescentes é altamente prevalente. O objetivo deste estudo foi verificar se em uma amostra de pais/cuidadores existiriam subgrupos que se diferenciariam quanto ao comportamento de punir/castigar fisicamente os filhos. As modalidades analisadas foram de frequência com que a punição ocorria, de partes do corpo da criança que se punia e de presença de sentimento de irritação/raiva durante o castigo físico, denotando níveis de gravidade associados a diferenças em variáveis psicossociais apontadas como fatores de risco para os abusos físicos. Adotou-se uma abordagem quantitativa, com delineamento transversal e método de clusterização. Participaram 87 pais/cuidadores adeptos a práticas de punição física. As análises indicaram a existência de três agrupamentos que se diferenciaram no tocante à gravidade da punição corporal e em algumas das variáveis psicossociais, denotando a importância de os serviços/programas voltados ao enfrentamento da violência contra as crianças/adolescentes considerarem estratégias de intervenção psicossocial distintas e específicas a cada grupo.

Pais/cuidadores com e sem histórico de abuso: punições corporais e características psicológicas / Parents/caregivers with and without history of abuse: corporal punishment and psychological characteristics / Padres/cuidadores con y sin antecedentes de maltrato: castigos corporales y características psicológicas

A prevalência dos castigos físicos em crianças/adolescentes é muito elevada. Sua aceitação social é ampla, sendo que as legislações brasileiras criam brechas para sua ocorrência. Entre os cientistas, há dissenso quanto aos limites entre castigos e abusos físicos. O objetivo do presente estudo foi contribuir com as discussões nesse âmbito, buscando verificar se grupos de pais/responsáveis sem e com histórico de notificação ao sistema de proteção por abuso físico se diferenciariam quanto à forma de punir/castigar e quanto a variáveis psicossociais consideradas fatores de risco para abuso físico. A abordagem adotada no estudo foi quantitativa, com delineamento transversal e comparativo. Participaram do estudo pais/cuidadores que faziam utilização da punição corporal: 47 sem histórico de notificação e 40 com histórico de notificação por abuso físico. Os instrumentos utilizados para a coleta de dados foram: Questionário de Caracterização Sociodemográfica, Roteiro de Entrevista sobre Prática Parental, Inventário de Potencial de Maus-Tratos Infantil (Child Abuse Potential Inventory - CAP). Os pais notificados relataram punições corporais mais graves (ou seja, mais frequentes, mais gravosas e em regiões do corpo mais vulneráveis) e mais angústia, rigidez, infelicidade, problemas com a criança, problemas com os outros e solidão. Todavia, em ambos os grupos, segundo o reportado, a raiva moveria o ato de punir. Esses resultados reiteram a ideia de que todas as formas de punição física são maus-tratos (expressões de violência), pois decorrem das necessidades dos cuidadores ("descarga emocional"). Remetem, porém, a um fenômeno heterogêneo, em termos de gravidade e de fatores associados, que precisa ser assim considerado na proposição de programas de prevenção e de tratamento.(AU)

Physical punishment of children / adolescents is highly prevalent and socially accepted, with a series of loopholes in the Brazilian legislation that favor this practice. Scientists tend to disagree in regard to the limits between physical punishment and physical abuse. This study aimed to contribute to the discussions around this theme, verifying whether practices of physical punishment and psychosocial variables considered risk factors for physical abuse differ among parents / caregivers with and without history of physical abuse notifications to protection agencies. The study was conducted with parents / caregivers who adopt practices of corporal punishment, 47 of whom without and 40 with history of physical abuse notification. Data were collected by means of Characterization Questionnaire, Parental Practice Interview, and Child Abuse Potential Inventory (CAP). Notified parents reported more severe corporal punishments (more frequent, more dangerous, in more vulnerable body regions) and more distress, severity, unhappiness, problems with the child and other people, and loneliness. Both groups reported that the act of punishing was moved by anger. These results reiterate the notion that all forms of physical punishment are maltreatment (expressions of violence) resulting from the needs of the caregivers ("emotional discharge"). However, these practices refer to a heterogeneous phenomenon in terms of severity and associated factors, which must be considered when proposing prevention and treatment programs.(AU)

Los castigos corporales de niños/adolescentes tiene una prevalencia muy elevada. Su aceptación social es amplia, y las legislaciones brasileñas no logran abarcar las puniciones adecuadas para esta práctica. No existe un consenso entre los científicos en cuanto a los límites entre punición corporal y maltrato físico. El objetivo del presente estudio fue contribuir con las discusiones sobre ese tema, verificando si grupos de padres/responsables sin y con antecedentes de notificación al Sistema de Protección por maltrato físico se diferenciarían en la forma de castigar/punir y en variables psicosociales consideradas factores de riesgo para maltrato físico. Este es un estudio cuantitativo, de tipo transversal y comparativo. Participaron en el estudio padres/cuidadores que hacían uso del castigo corporal: 47 sin antecedentes de notificación al sistema; 40 con antecedentes de notificación por maltrato físico. Los instrumentos utilizados para la recolección de datos fueron: Cuestionario de Datos Sociodemográficos, Entrevista sobre Práctica Parental, Inventario de Potencial de Maltrato Infantil (Child Abuse Potential Inventory - CAP). Los padres notificados reportaron castigos corporales más graves (es decir, más frecuentes, más graves, en regiones del cuerpo más vulnerables) y más angustia, rigidez, infelicidad, problemas con el niño, problemas con los demás y soledad. Según el reportado, en ambos grupos, la rabia movería el acto de castigar. Estos resultados reiteran la idea de que todas las formas de castigo físico son maltrato (manifestación de violencia), pues se derivan de las necesidades de los cuidadores ("descarga emocional"). Sin embargo, remiten a un fenómeno heterogéneo, en términos de gravedad y de factores asociados, que necesita considerarse en la propuesta de programas de prevención y de tratamiento.(AU)