Patrimônio e desenvolvimento: as políticas de patrimônio cultural nos anos 1960

This article aims at analyzing aspects of 1960s Brazilian cultural heritage policies, highlighting changes related to the articulation of concepts such as development, culture and heritage within the Directory of National Historical and Artistic Heritage - DPHAN, today Institute of National Historical and Artistic Heritage (IPHAN). It discusses the effects of industrialization, urban growth and development improvement measures on heritage concepts and policies, analyzing initiatives that focus on preserving cultural assets acknowledged as national historical and artistic heritage and enhancing their economical potential. The discussion emphasizes notions and understandings on heritage and preservation that had substantial bearing on preservation measures carried on by DPHAN from the 1960s on regarding the identification, valorization and protection of cultural heritage, as well as the disciplinary and institutional debates this Directory proposed.O objetivo deste artigo é analisar especificidades dos anos 1960 no que diz respeito às políticas de patrimônio, destacando algumas mudanças de entendimentos, noções e propostas, notadamente referentes às relações entre desenvolvimento, cultura e patrimônio trabalhadas pelo Instituto do Patrimônio Histórico e Artístico Nacional, então Diretoria do Patrimônio Histórico e Artístico Nacional (DPHAN). Para tanto, vai-se partir das discussões e debates desse momento acerca dos efeitos da industrialização, do crescimento urbano e das políticas desenvolvimentistas sobre as políticas de patrimônio a partir dessa década, analisando as iniciativas voltadas à patrimonialização de bens culturais, à preservação do acervo que compunha o patrimônio histórico e artístico nacional e ao fomento de suas potencialidades econômicas. Na discussão proposta neste artigo, priorizar-se-ão os entendimentos e ações de preservação da DPHAN relacionados a identificação, valoração e proteção dos bens culturais, assim como os diálogos disciplinares e institucionais que a diretoria procurou estabelecer

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Burnout Syndrome in Community Health Agents and coping strategies.

A Síndrome de Burnout é caracterizada por sentimentos de esgotamento físico e emocional, despersonalização e baixa realização pessoal. Constitui-se em uma reação à tensão emocional crônica por lidar excessivamente com outros seres humanos. Acomete principalmente trabalhadores que mantêm uma estreita relação de ajuda, fortalecendo a associação com as responsabilidades inerentes às profissões de cuidados humanitários. Esta investigação se propõe a verificar a provável ocorrência da Síndrome de Burnout em Agentes Comunitários de Saúde, visto que estes profissionais trabalham diretamente no cuidado a outras pessoas, sendo esta característica prevalente em tal Síndrome, bem como as estratégias de enfrentamento utilizadas por estes profissionais. Optou-se pelo método descritivo, transversal e quantitativo. Foram aplicados questionário, Maslach Burnout Inventory (MBI) e Escala Modos de Enfrentamento de Problemas (EMEP). A amostra foi constituída por 80 ACS escolhidos aleatoriamente, entre aqueles admitidos há pelo menos dois anos no serviço público municipal. Quanto aos resultados obtidos, verifica-se que se trata de uma amostra predominantemente do sexo feminino (93,75%), com filhos (68,75%), na faixa etária de 20 a 30 anos (35%) e com companheiro fixo (60%). Antes de atuar como ACS, 18,75% desta amostra trabalharam como auxiliar de serviços gerais, principalmente o âmbito do trabalho doméstico. A renda per capita de 38,75% é de menos de um salário mínimo e 53,04% estão neste trabalho há mais de seis anos. Têm vida sedentária, pois 66,25% não praticam uma atividade física com freqüência. O MBI revela um sentimento de deterioração da percepção da própria competência e falta de satisfação destes profissionais com o próprio trabalho, não podem dar mais de si emocionalmente, demonstram estarem emocionalmente esgotados e, ainda, verificase o desenvolvimento incipiente de sentimentos e atitudes negativas e cinismo para com as pessoas por eles atendidas. O Modo de Enfrentamento mais utilizado são as estratégias focalizadas no problema, seguida pela busca de práticas religiosas/pensamento fantástico. Verifica-se indícios de sofrimento relacionado ao trabalho característico da Síndrome de Burnout com o esforço de buscar mecanismos que auxiliem no enfrentamento de problemas relacionados ao exercício profissional. Sugere-se estratégias de acolhimento a esses profissionais de forma a auxiliá-los a lidar com o sofrimento no trabalho.The Burnout Syndrome is characterized by feelings of physical and emotional exhaustion, depersonalization and low level of personal accomplishment. It constitutes a reaction to chronic emotional tension because of excessive contact with other human beings. It mainly affects workers in tight help relations, strengthening the association with the responsibilities inherent in humanitarian care professions. This research aims to verify the probable occurrence of the Burnout Syndrome in Community Health Agents (CHA), as these professionals directly work in care delivery to other people, a prevalent characteristic in this Syndrome, as well as the coping strategies these professionals use. The descriptive, cross-sectional and quantitative study was chosen. A questionnaire, Maslach Burnout Inventory (MBI) and the Problem-Coping Mode Scale (EMEP) were applied. The sample consisted of 80 CHA, randomly chosen among professionals working at least two years in the municipal public service. The results show that the sample was predominantly female (93.75%), with children (68.75%), between 20 and 30 years old (35%) and with a fixed partner (60%). Before acting as CHA, 18.75% of this sample worked as general service aid, mainly in domestic services. Moreover, 38.75% receive less than one minimum wage as per capita income and 53.04% are doing this job for more than six years. They have a sedentary life, as 66.25% do not work out frequently. The MBI reveals a feeling of deterioration in the perception of ones own competency and these professionals lack of satisfaction with their own work. They cannot dedicate themselves more emotionally, they demonstrate emotional exhaustion. Furthermore, the instrument verified the incipient development of negative feelings and attitudes and cynicism towards the people they deliver care to. The most used Coping Modes are problem-focused strategies, followed by the search for religious practices/fantastic thinking. Levels of suffering are verified, related to the characteristic work of the Burnout Syndrome, accompanied by efforts to seek mechanisms that help to cope with problems related to professional practice. Strategies to welcome these professionals are suggested, so as to help them to deal with suffering at work

Childhood and mental health: theory, clinics and commendations for public policies

Trata-se de uma pesquisa teórica que verifica as relações existentes entre saúde mental e saúde pública a partir da identificação dos principais problemas referentes à infância em recomendações divulgadas pela Organização Mundial da Saúde nos seguintes momentos históricos: início da década de 1950, meados da década de 1970 e primeiros anos do século XXI. Apresenta a diversidade presente na construção do campo da saúde mental, as principais perspectivas teóricas e o lugar da clínica psiquiátrica e psicanalítica nesse processo. Ações dirigidas à infância pelo movimento da Higiene Mental, nas primeiras décadas do século XX, também são analisadas. Verifica-se que a prevenção se instaura como principal modelo de assistência. A saúde materno-infantil, a escola e a família são os principais componentes das medidas preventivas propostas. Nestas recomendações, evidencia-se uma relação de quase equivalência entre psiquiatria e saúde mental. A diversidade deste campo é substituída por um discurso relativamente hegemônico, no qual a noção de adaptação ocupa lugar central. Nas recomendações da OMS, deste início de século, observa-se a influência das neurociências, da psiquiatria biológica e das terapias cognitivo-comportamentais.This is a theoretical research aiming at detecting the main problems concerning children on the intersection of mental and public health, and based upon the World Health Organizations commendations at the following historical moments: the 1950s and 1970s, as well as the early 21st century. The foundations of such commendations were checked, keeping in mind the diversity of orientations in the field of mental health. The theoretical frame presents the origins of psychiatric and psychoanalytical clinics with children, and their fundamentals. Actions aiming at children by the Mental Hygiene Movement in the early 20th century were also analyzed. It can be observed that prevention imposes itself as the main assistance pattern. The health of both mothers and children, schools and families are the main components of the proposed prevention measures. In these commendations it can also be noticed an almost equivalent relationship between psychiatrist and mental health. Diversity in this field is substituted for a relatively hegemonic speech, in which the notion of adaptation plays a crucial role. In the World Health Organizations commendations in this early century, it can be detected the influence of neurosciences, biological psychiatry, and behaviorist-cognitive therapies

Dandy-Walker Malformation and Down Syndrome Association: Good Developmental Outcome and Successful Endoscopic Treatment of Hydrocephalus

The association of Down syndrome (DS) with Dandy Walker malformation (DWM) is extremely rare, with only 3 cases reported to date. All cases reported have shown a bad life expectancy and a bad developmental outcome. The present case reveals the possibility of a good prognosis. A 19-month-old male patient had successful endoscopic hydrocephalus treatment and a good developmental outcome. He probably had a better outcome because of good DS and DWM prognostic parameters. Our patient suffered from a DWM with vermis identification of 2 fissures and 3 lobes and a DS with a well-preserved tonus, which was not associated with other congenital systemic defects. We may conclude that the prognosis of DS-DWM association may separately depend on the degree of clinical and neurological involvement of each malformation

Diagnosis of Neuroparacoccidioidomycosis by Detection of Circulating Antigen and Antibody in Cerebrospinal Fluid

Neuroparacoccidioidomycosis (neuroPCM) is the central nervous system infection by the fungus Paracoccidioides brasiliensis. Its diagnosis is a difficult task that depends on neuroimaging techniques such as computed tomography and magnetic resonance imaging. However, the detection of circulating P. brasiliensis antigens in body fluids by inhibition enzyme-linked immunosorbent assay (inh-ELISA) has provided encouraging results. In this study, 14 cerebrospinal fluid (CSF) and 11 serum samples of patients with neuroPCM were analyzed by inh-ELISA for detection of circulating glycoprotein antigens of 43 kDa (gp43) and 70 kDa (gp70). Circulating gp43 and gp70 antigens were detected in all CSF samples from patients with neuroPCM at mean concentrations of 19.3 and 6.8 μg/ml, respectively. In addition, both gp43 and gp70 antigens were detected in 10 of 11 serum samples analyzed at mean concentrations of 4.6 and 4.0 μg/ml, respectively. By immunodiffusion test, CSF samples were determined to be negative in 13 of 14 samples. The detection of anti-gp43 and anti-gp70 antibodies by conventional ELISA showed positive results for all CSF samples, with titers ranging from 1:50 to 1:51,200. Therefore, the high sensitivity of the inh-ELISA technique in detecting gp43 and gp70 antigens in the CSF of neuroPCM patients strongly indicates that this assay can be considered as a powerful diagnostic tool. In addition, the finding of anti-gp43 and anti-gp70 antibodies in CSF samples by conventional ELISA also seems to be a promising diagnostic method for this special modality of PCM

Detection of Circulating gp43 Antigen in Serum, Cerebrospinal Fluid, and Bronchoalveolar Lavage Fluid of Patients with Paracoccidioidomycosis

Paracoccidioidomycosis (PCM) is an important systemic fungal disease, particularly among individuals living and working in rural areas of endemicity in Latin America, who, without antifungal therapy, may develop fatal acute or chronic infection. For such patients, the detection of antibody responses by immunodiffusion is of limited value due to false-negative results. In contrast, the detection of Paracoccidioides brasiliensis gp43 circulating antigen may represent a more practical approach to the rapid diagnosis of the disease. Accordingly, an inhibition enzyme-linked immunosorbent assay (inh-ELISA) was developed for the detection of a 43-kDa P. brasiliensis-specific epitope incorporating a species-specific murine monoclonal antibody. With sera from patients with acute and chronic forms of the disease (n = 81), the overall sensitivity of the test was found to be 95.1%, while specificity was found to be 97.5% compared to that with normal human sera from blood donors (n = 93) and sera from patients with other chronic fungal infections (histoplasmosis [n = 33] and cryptococcosis [n = 20]). The inh-ELISA detected circulating antigen in 100% of patients with the acute form of PCM and in 95.31 and 100% of patients with the chronic multifocal and unifocal forms of PCM according to the patient's clinical presentation. Cerebrospinal fluid from 14 patients with neuroparacoccidioidomycosis and 13 samples of bronchoalveolar lavage fluid from patients with pulmonary unifocal PCM were also tested for gp43 detection, with the test showing 100% sensitivity and specificity. This novel, highly specific inh-ELISA represents a significant addition to the existing tests for the diagnosis of PCM

Diagnosis of Paracoccidioidomycosis by Detection of Antigen and Antibody in Bronchoalveolar Lavage Fluids

Paracoccidioidomycosis (PCM) is a systemic infection caused by the fungus Paracoccidioides brasiliensis and is believed to be the leading cause of fungal pulmonary infection. In this study, we used an inhibition enzyme-linked immunosorbent assay to diagnose pulmonary PCM based on the detection of 43-kDa and 70-kDa molecules in bronchoalveolar lavage fluids. The results were compared with results obtained by classical methods for antibody detection