Health and safety standards in labor and extractivism: the case of rural communities in Brazilian Amazon

This article is the result of a field research conducted among collectors of oleaginous seeds and fruits - Non-Timber Forest Products (NTFP) - in the rural areas of Salvaterra and Bragança, in the state of Pará, Brazil. It aimed to contribute to empirical studies on health and occupational safety in extractivism, still incipient in Brazil due to the lack of technical-scientific support and the lack of specific regulation on the area. The research was conducted by the collection of primary and observational data that point out the risks to health and safety to which collectors are exposed to and the methods to prevent accidents in order to identify possible improvements to working conditions in a context in which labor regulation standards for autonomous, informal and extractive workers in the Amazon is practically inexistent. This paper’s methodology is characterized as an embedded case study along with the collection of quantitative and qualitative data with the adoption of mixed methods for their systematization. The results show that new practices and norms should be adopted so the risks to health and safety of collectors are minimized, besides ensuring the inspection, incentives and monitoring of safety practices that are adequate to the activity and specific to each region.Este artigo é resultado de pesquisa de campo realizada junto aos coletores de sementes e frutos oleaginosos - Produtos Florestais Não Madeireiros (PFNMs) - em áreas rurais de Salvaterra e Bragança, no estado do Pará. O objetivo é contribuir com os estudos empíricos sobre saúde e segurança ocupacional no extrativismo, ainda incipientes no Brasil, por falta de amparo técnico-científico relacionado à atividade extrativista e por falta de regulamentação específica para a área. A pesquisa, realizada a partir da coleta de dados primários e observacionais, aponta os riscos de saúde e segurança aos quais os coletores estão expostos e os métodos de prevenção de acidentes, a fim de identificar possíveis melhorias nas condições de trabalho em um contexto onde a regulamentação de padrões trabalhistas para autônomos, informais e extrativistas na Amazônia é praticamente inexistente. A metodologia se caracteriza como estudo de caso em profundidade com coleta de dados primários com adoção de métodos mistos para sua sistematização. Os resultados demonstram que novas práticas e normas precisam ser adotadas para que os riscos à saúde e à segurança dos coletores sejam minimizados, além de garantir fiscalização, incentivo e monitoramento de práticas de segurança adequadas à atividade e específicas para cada região

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

Padrões de saúde e segurança no trabalho e extrativismo: o caso de comunidades rurais da Amazônia brasileira

Resumo Este artigo é resultado de pesquisa de campo realizada junto aos coletores de sementes e frutos oleaginosos - Produtos Florestais Não Madeireiros (PFNMs) - em áreas rurais de Salvaterra e Bragança, no estado do Pará. O objetivo é contribuir com os estudos empíricos sobre saúde e segurança ocupacional no extrativismo, ainda incipientes no Brasil, por falta de amparo técnico-científico relacionado à atividade extrativista e por falta de regulamentação específica para a área. A pesquisa, realizada a partir da coleta de dados primários e observacionais, aponta os riscos de saúde e segurança aos quais os coletores estão expostos e os métodos de prevenção de acidentes, a fim de identificar possíveis melhorias nas condições de trabalho em um contexto onde a regulamentação de padrões trabalhistas para autônomos, informais e extrativistas na Amazônia é praticamente inexistente. A metodologia se caracteriza como estudo de caso em profundidade com coleta de dados primários com adoção de métodos mistos para sua sistematização. Os resultados demonstram que novas práticas e normas precisam ser adotadas para que os riscos à saúde e à segurança dos coletores sejam minimizados, além de garantir fiscalização, incentivo e monitoramento de práticas de segurança adequadas à atividade e específicas para cada região

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.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt