Estado da arte brasileira sobre os efeitos da radiação não ionizante na saúde humana / Brazilian art state about exposition to non-ionizing radiation and thems effects in human health

Nos últimos anos, o uso de aparelhos eletrônicos tornou-se cada vez mais comum. Tais tecnologias utilizam-se, em alguns casos, de frequências específicas de ondas, chamadas de radiações não ionizantes, a exemplo dos aparelhos celulares. Essas radiações, segundo a Organização Mundial de Saúde (OMS), são capazes de causar estresses térmicos no corpo ou até mesmo danos em tecidos, dependendo do nível de exposição do indivíduo. Entretanto, os limiares humanos para esses tipos de ondas ainda são desconhecidos e consequentemente, também se desconhece a partir de que ponto elas são capazes de gerar danos de importância clínica em um indivíduo a elas exposto. Diante de tal realidade, viu-se a necessidade de buscar na bibliografia brasileira, por meio de uma revisão da literatura, no rigor da revisão sistemática, os impactos que as radiações não ionizantes podem trazer para a saúde humana, utilizando-se dos principais bancos de dados da área, em inglês e português, selecionando as publicações dos últimos dez anos sobre o assunto, a fim de verificar o estado atual de conhecimento que o meio médico e científico possui sobre a temática. Inicialmente, foram encontrados 2130 trabalhos com a aplicação dos strings de busca em suas respectivas bases. Após a aplicação dos filtros (data e idioma), esse número foi reduzido para 1158 trabalhos, que foram analisados pelo título e resumo para verificar se cumpriam com os objetivos da revisão e se possuíam duplicatas. Posteriormente, restaram 102 trabalhos para leitura na íntegra e aplicação mais rígida dos critérios de elegibilidade. Ao final, 11 artigos foram incluídos na revisão, e, com isso, observou-se que oito destes apresentavam ao menos um efeito deletério para o homem. 

Os aspectos envolvidos na Síndrome de Burnout em profissionais da saúde: uma revisão narrativa

Introduction: Burnout Syndrome (BS) defines itself by the intense exhaustion it causes in individuals, and the work is at its core. This disease was first described by Herbert Freudenberger, a German psychologist, 46 years ago and currently it is based on three pillars: emotional exhaustion, depersonalization, and low job satisfaction. Methodology: The article was outlined in the narrative review structure and presents a qualitative character. The articles used did not have restrictions regarding the year of publication and come from the Scielo and PubMed databases. Results: As for the 9 studies used, all presented at least one of the following outcomes: diagnosis of BS or filling of at least one of the defining pillars of the disease by some percentage of the participants, recognition of potential stressors in the work environment that could trigger the syndrome and signs that it has affected the health care (absence, verbal aggresion). Discussion: In this context, with the growing demand, exhaustive working hours, and situations of constant stress, doctors, nurses, and another health-care system workers are more liable to the development of this syndrome, which negatively affects the relationship between the professionals with their work colleagues and patients. Conclusion: Thus, the relation of work and physical, psychological and emotional stress stands clear, showing that the romanticization around career-oriented life and curriculum building at the expense of quality of life is harmful to the individual, and therefore, to the society.Introdução: A Síndrome de Burnout (SB) é caracterizada pela intensa extenuação que causa nos indivíduos e tem como cerne o trabalho. Essa doença foi descrita pela primeira vez por Herbert Freudenberger, um psicólogo alemão, há 46 anos e hoje é baseada em três pilares: exaustão emocional, despersonalização e baixa satisfação profissional. Metodologia: O trabalho foi delineado na estrutura de revisão narrativa e tem natureza qualitativa. Os artigos utilizados não apresentaram restrição quanto ao ano de publicação e são provenientes das bases Scielo e PubMed. Resultados: Dos 9 estudos utilizados, todos apresentaram ao menos um dos seguintes desfechos: diagnóstico da SB ou preenchimento de ao menos um dos pilares definidores da SB por alguma porcentagem dos participantes, identificação de potenciais fatores estressantes no ambiente de trabalho que poderiam desencadear a doença e sinais de que a síndrome afetou o atendimento (abstência, agressividade verbal). Discussão: Nesse âmbito, com a cobrança crescente, jornadas exaustivas e situações de estresse constante, médicos, enfermeiros e afins são mais passíveis ao desenvolvimento da SB, o que afeta negativamente a relação entre esses profissionais com seus colegas de profissão e pacientes. Conclusão: Dessa forma, a relação entre estresse físico, psíquico e emocional e o trabalho fica clara, evidenciando que a romantização em torno da vida voltada à carreira e construção de currículo em detrimento da qualidade de vida é prejudicial ao indivíduo, e, por conseguinte, à sociedade.&nbsp

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status