Avaliação dos riscos psicossociais relacionados ao trabalho no Corpo de Bombeiros Militar do Distrito Federal

Monografia (especialização)—Universidade de Brasília, Instituto de Psicologia, Especialização em Clínica Psicodinâmica do Trabalho e Gestão do Estresse, 2014.O objetivo deste estudo foi avaliar os riscos psicossociais no âmbito do Corpo de Bombeiros Militar do Distrito Federal (CBMDF), com ênfase para a organização do trabalho, o estilo de gestão, o sofrimento patogênico e os danos relacionados ao trabalho. Para isso, aplicou-se o Protocolo de Avaliação de Riscos Psicossociais no Trabalho (PROART) em um total de 438 bombeiros militares da corporação, divididos por diferentes cargos, áreas, quadros, unidades e sexo. Os dados foram analisados tendo por base a teoria da Psicodinâmica do Trabalho. Os maiores riscos foram encontrados quanto à falta de recursos humanos, de flexibilidade das normas e de autonomia para realização das tarefas, à pequena participação dos funcionários nas decisões, além de espaço físico inadequado. Predomina-se um estilo de gestão com valorização da hierarquia, grande importância às regras e a existência de forte controle no trabalho. Os Bombeiros gostam do que fazem e se identificam com as tarefas. Não há falta de reconhecimento entre os colegas de trabalho, mas existe a percepção de falta de reconhecimento por parte da instituição e das instância superiores. As interferências políticas na Organização causam descontentamentos por parte dos militares. Os danos físicos representam maiores riscos do que os danos psicológicos e sociais, com ênfase para dores nas costas e alterações do sono. Praças e trabalhadores da área fim estão mais propensos ao adoecimento do que Oficiais e bombeiros da área meio. Condutores e Combatentes apresentam maiores riscos quando comparados aos demais quadros da Corporação. As unidades que apresentaram maiores problemas foram o 2º Grupamento Bombeiro Militar (GBM) e o 17º GBM. Os homens percebem maiores alterações quanto à Organização do Trabalho, Estilo de Gestão e Sofrimento Patogênico, enquanto as mulheres são mais acometidas pelos danos físicos, psicológicos e sociais. Os resultados mostram a necessidade de intervenções em curto e médio prazo na instituição.The aim of this study was to evaluate psychosocial risks in the Military Firefighters Corporation of the Federal District, with emphasis on the organization of work, management style, pathogenic suffering and damages related to work. For this purpose, the Psychosocial Risk Evaluation Protocol at Work (PROART) was applied to 438 firefighters of the corporation, divided in different posts, areas, boards, units and gender. Data were analyzed based on the Psychodynamics of Work theory. The results showed that the major risks were: the lack of human resources, rule flexibility and autonomy for carrying out the tasks; small employee participation in decisions; and inappropriate physical space. Hierarchy is highly appreciated, rules are enhanced and there is a strong control over work. Firefighters enjoy their work and identify themselves with the tasks. There is no lack of recognition awarded by the peers, but there is a perceived lack of recognition awarded by the institution and the upper body. Political interferences in the Organization cause discontentment by the militaries. Physical injuries represent greater risks than the psychological and social harms, with emphasis on back pain and sleep disorders. Non-commissioned officers and core activity workers are more likely to illness than officers and non-core activity workers. Drivers and combatant firefighters are at higher risk when compared to other boards of the Corporation. The units that presented the biggest problems were the 2nd and the 17th Military Firefighter Groupements. Men perceive greater changes to the Organization of Work, Management Style and Pathogenic Suffering, while women are more affected by physical, psychological and social harms. The results show the need of short and medium-term interventions at the institution

EVALUATION OF THE EFFECTS OF OZONE THERAPY AND CISPLATIN IN AN EXPERIMENTAL MODEL IN MICE WITH EHRLICH CARCINOMA

The present objective was to evaluate Swiss albino mice (Mus muscullus) with Ehrlich carcinoma treated with intrarectal ozone therapy and cisplatin. Twenty-four female mice, approximately 60 days of age, varying between 35g and 40g in weight were divided into four groups, Group G1: Positive control: 2.5mg/kg of cisplatin; Group G2: Ozone-oxygen mix via rectal insufflation (MOO IR); Group G3: 2.5mg/kg of cisplatin + (MOO IR), and Group G4: Negative control with 1ml of saline 0.9%. All animals underwent an eight-day adaptation period. Forty-eight hours after inoculation, the treatments were performed for six days. The mice were euthanized at the end of the experiment and the tumor was removed. There were statistically significant differences between groups for tumor weight. Mean tumor weight was greater in group G4, and lesser in group G3. These significant differences were observed between the negative control and other groups. On histopathology, there were no significant differences between groups. It is concluded that combined ozone therapy and cisplatin was shown to be the treatment where mice with Ehrlich carcinoma had the least tumor weight

Evaluation of the effects of ozone therapy and cisplatin in an experimental model in mice with Ehrlich carcinoma

The present objective was to evaluate Swiss albino mice (Mus muscullus) with Ehrlich carcinoma treated with intrarectal ozone therapy and cisplatin. Twenty-four female mice, approximately 60 days of age, varying between 35g and 40g in weight were divided into four groups, Group G1: Positive control: 2.5mg/kg of cisplatin; Group G2: Ozone-oxygen mix via rectal insufflation (MOO IR); Group G3: 2.5mg/kg of cisplatin + (MOO IR), and Group G4: Negative control with 1ml of saline 0.9%. All animals underwent an eight-day adaptation period. Forty-eight hours after inoculation, the treatments were performed for six days. The mice were euthanized at the end of the experiment and the tumor was removed. There were statistically significant differences between groups for tumor weight. Mean tumor weight was greater in group G4, and lesser in group G3. These significant differences were observed between the negative control and other groups. On histopathology, there were no significant differences between groups. It is concluded that combined ozone therapy and cisplatin was shown to be the treatment where mice with Ehrlich carcinoma had the least tumor weight.Ehrlich carcinoma is an aggressive, rapidly-growing tumor used as an experimental model in female mice because it corresponds to mammary adenocarcinoma. The present objective was to evaluate Swiss albino mice (Mus musculus) with Ehrlich carcinoma treated with intrarectal ozone therapy and cisplatin. Twenty-four female mice, approximately 60 days of age, varying between 35g and 43g in weight were divided into four groups, Group 1 (G1): 1mL of cisplatin 2.5mg/kg, orally; Group 2 (G2): Ozone-oxygen mixture (OOM) 20 µg/mL, via rectal insufflation (RI); Group 3 (G3): 1mL of cisplatin 2.5mg/kg, orally+ 20 µg/mL (OOM RI), and Group 4 (G4): control with 1mL of saline 0.9%, orally. All animals underwent an eight-day adaptation period. Forty-eight hours after inoculation, the treatments were performed daily, for six days. The mice were euthanized at the end of the experiment, after treatment, and the tumor was removed. There were statistically significant differences between groups for tumor weight. Mean tumor weight was greater in G4 (3,83 ± 1.20), and lesser in G3 (0.79 ± 0.73). These significant differences were observed between the group G4 and other groups. On histopathology, there were no significant differences between groups. It is concluded that ozone therapy associated with cisplatin proved to be the treatment in which mice with Erhlich's carcinoma showed delay in tumor growth, therefore, the lowest tumor weight

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Audit Quality in Brazil: A Study of the Judgment of the Independent Auditors on Adoption of the Adjustment to Present Value in Construction and Engineering Companies Listed on BM&F-Bovespa

Audit quality is a complex issue and difficult to measure on the audit quality level in the Brazilian stock exchange. Most of the companies listed on the on the stock exchange are audited by companies called the Big Four and in this context, the market assigns to them pretext of higher quality in their performances when compared with the non-Big Four companies. In Brazil, recent financial scandals while international accounting and auditing standards were been adopted. This provides an opportunity to analyze the adequacy of audit services to the convergence process. Given the scenario, the problem arises: Have the audit firms uniform quality, based on the technical criteria of their judgment when the proper adoption of CPC 12 – adjustment to present value by Brazilian listed companies? The objective of this study is to investigate the uniformity in the quality of services performed by audit firms in Brazil about Brazilian listed companies based on adoption to CVM deliberation number 564/08. This paper consists on the analysis of the accounting reports, reference form and the Auditors of the companies of the construction and engineering sector in years 2010 and 2011, revealing among its main findings the absence of uniform quality in the independent auditor’s report based on the adoption to the adjustment to present value

Peridomiciliary colonies of Triatoma vitticeps (Stal, 1859) (Hemiptera, Reduviidae, Triatominae) infected with Trypanosoma cruzi in rural areas of the state of Espírito Santo, Brazil

In Brazil, the colonization of human dwellings by triatomines occurs in areas with native vegetation of the caatinga or cerrado types. In areas of Atlantic forest such as in the Brazilian state of Espírito Santo, there are no species adapted to live in human habitations. The few autochthonous cases of Chagas disease encountered in Espírito Santo have been attributed to adult specimens of Triatoma vitticeps that invade houses from forest remnants. In recent years, the entomology unit of the Espírito Santo State Health Secretariat has recorded nymphs infected with flagellates similar to Trypanosoma cruzi in rural localities. Entomological surveys were carried out in the residences and outbuildings in which the insects were found, and serological examinations for Chagas disease performed on the inhabitants. Four colonies were found, all associated with nests of opossums (Didelphis aurita), 111 specimens of T. vitticeps, and 159 eggs being collected. All the triatomines presented flagellates in their frass. Mice inoculated with the faeces presented trypomastigotes in the circulating blood and groups of amastigotes in the cardiac muscle fibres. Serological tests performed on the inhabitants were negative for T. cruzi. Even with the intense devastation of the forest in Espírito Santo, there are no indications of change in the sylvatic habits of T. vitticeps. Colonies of this insect associated with opossum nests would indicate an expansion of the sylvatic environment into the peridomicile

SHORT COMMUNICATION- Peridomiciliary colonies of Triatoma vitticeps (Stal, 1859) (Hemiptera, Reduviidae, Triatominae) infected with Trypanosoma cruzi in rural areas of the state of Espírito Santo, Brazil

In Brazil, the colonization of human dwellings by triatomines occurs in areas with native vegetation of the caatinga or cerrado types. In areas of Atlantic forest such as in the Brazilian state of Espírito Santo, there are no species adapted to live in human habitations. The few autochthonous cases of Chagas disease encountered in Espírito Santo have been attributed to adult specimens of Triatoma vitticeps   that invade houses from forest remnants. In recent years, the entomology unit of the Espírito Santo State Health Secretariat has recorded nymphs infected with flagellates similar to Trypanosoma cruzi   in rural localities. Entomological surveys were carried out in the residences and outbuildings in which the insects were found, and serological examinations for Chagas disease performed on the inhabitants. Four colonies were found, all associated with nests of opossums (Didelphis aurita   ), 111 specimens of T. vitticeps, and 159 eggs being collected. All the triatomines presented flagellates in their frass. Mice inoculated with the faeces presented trypomastigotes in the circulating blood and groups of amastigotes in the cardiac muscle fibres. Serological tests performed on the inhabitants were negative for T. cruzi. Even with the intense devastation of the forest in Espírito Santo, there are no indications of change in the sylvatic habits of T. vitticeps. Colonies of this insect associated with opossum nests would indicate an expansion of the sylvatic environment into the peridomicile