A percepção de liderança no setor público e privado em tempos de pandemia / The perception of leadership in the public and private sector in times of pandemic

A presente pesquisa avaliou a percepção de colaboradores do setor público e privado, sobre perfil de liderança de seus gestores no período pós-lockdown, decretado no Estado do Pará, e doze meses após esse evento. Na Etapa I deste estudo, participaram 9 colaboradores do setor privado e 13 do setor público, de ambos os sexos, maiores de 18 anos e devidamente contratados por essas organizações. Na Etapa II, somente os 13 servidores públicos participaram deste estudo; os participantes da loja de telefonia não foram autorizados a participar da coleta de dados. Foi utilizado como instrumento de coleta um questionário contendo questões sociodemográficas e a Escala de Liderança Gerencial (MELO, 2014) avaliando os fatores de tarefa, relacionamento e situacional, com os indicadores de concordância: 1 ≥ 2,99 (baixo), 3 ≥ 3,99 (neutra) e 4 ≥ 5 (alto). Os resultados da Etapa I, demonstraram alta percepção de liderança para a gestora do órgão público sob os três fatores (relacionamento, tarefa e situação). Na Etapa II, a nova gestora do setor público apresentou um perfil neutro de liderança e não foi permitida a coleta de dados na loja. Conclui-se que, durante a pandemia, a primeira gestora do órgão público apresentou melhor perfil de liderança em comparação ao líder do setor privado e à nova líder do órgão público. Contudo, o perfil da nova líder do órgão público, pode ter sido avaliado como neutro devido a pouca convivência com a equipe de trabalho ou a obrigatoriedade do retorno presencial ao trabalho durante a pandemia

Anomalias congênitas na perspectiva da vigilância em saúde: compilação de uma lista com base na CID-10

Objective. Propose a list of congenital anomalies with corresponding codes in the tenth revision of the International Classification of Diseases (ICD), aiming at application in the scope of health surveillance. Methods. In December 2019, the following sources were searched: ICD-10, ICD-11, abnormalities monitored by three surveillance programs, and a database of rare diseases (Orphanet). The Abnormalities were extracted from these data sources, processed based on the ICD-10 and compiled with manual review. Results. 898 codes were identified, of which 619 (68.3%) were in Chapter XVII of ICD-10. Of the 279 codes in other chapters, 19 were exclusive of the ICD-11 search, 72 of the surveillance programs, 79 of the Orphanet and 36 of the ICD-10 search for terms. Conclusion. The codes contained in chapter XVII of ICD-10 do not capture the totality of congenital anomalies, indicating the need of adopting of an expanded list.Objetivo. Propor uma lista de anomalias congênitas com códigos correspondentes na Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde – 10a Revisão (CID-10), visando aplicação no âmbito da vigilância em saúde. Métodos. Em dezembro de 2019, realizou-se busca nas seguintes fontes de dados: CID-10; CID-11; anomalias monitoradas por três modelos de vigilância; base de informações sobre doenças raras (Orphanet). Realizou-se extração das anomalias a partir dessas fontes, processamento para correspondência com base na CID-10 e compilação mediante revisão manual. Resultados. Foram identificados 898 códigos, dos quais 619 (68,3%) constavam no capítulo XVII da CID-10. Dos 279 códigos de outros capítulos, 19 foram exclusivos da busca na CID-11, 72 dos modelos de vigilância, 79 da Orphanet e 36 da busca de termos na CID-10. Conclusão. Os códigos que constam do capítulo XVII da CID-10 não captam a totalidade das anomalias congênitas, indicando a necessidade de adoção de uma lista ampliada

Congenital anomalies from the health surveillance perspective : compilation of a list based on ICD-10

Objetivo: Propor uma lista de anomalias congênitas com códigos correspondentes na Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde – 10ª Revisão (CID-10), visando a aplicação no âmbito da vigilância em saúde. Métodos: Em dezembro de 2019, realizou-se busca nas seguintes fontes de dados: CID-10; CID-11; anomalias monitoradas por três modelos de vigilância; base de informações sobre doenças raras (Orphanet). Realizou-se extração das anomalias a partir dessas fontes, processamento para correspondência com base na CID-10 e compilação mediante revisão manual. Resultados: Foram identificados 898 códigos, dos quais 619 (68,9%) constavam no capítulo XVII da CID-10. Dos 279 códigos de outros capítulos, 19 foram exclusivos da busca na CID-11, 72 dos modelos de vigilância, 79 da Orphanet e 36 da busca de termos na CID-10. Conclusão: Os códigos que constam do capítulo XVII da CID-10 não captam a totalidade das anomalias congênitas, indicando a necessidade de adoção de uma lista ampliada.Objetivo: Proponer una lista de anomalías congénitas con códigos correspondientes en la décima revisión de la Clasificación Internacional de Enfermedades (CIE), con el objetivo de su aplicación en el ámbito de la vigilancia de la salud. Métodos: En diciembre de 2019, se buscaron las siguientes fuentes: CIE-10; CIE-11; anomalías monitoreadas por tres modelos de vigilancia; y base de informaciones sobre enfermedades raras (Orphanet). Las anomalías se extrajeron de estas fuentes de datos, se procesó en base a la CIE-10 y se compiló con una revisión manual. Resultados: Se identificaron 898 códigos, de los cuales 619 (68,9%) estaban en el Capítulo XVII de la CIE-10. De los 279 códigos en otros capítulos, 19 fueron exclusivos de la búsqueda en la CIE-11, 72 de los modelos de vigilancia, 79 de Orphanet y 36 de la búsqueda de términos en la CIE-10. Conclusión: Los códigos contenidos en el capítulo XVII de la CIE-10 no capturan la totalidad de las anomalías congénitas, lo que indica la necesidad de adoptar una lista ampliada.Objective: To propose a list of congenital anomalies having corresponding codes in the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), with the aim of applying it in health surveillance. Methods: In December 2019, the following data sources were searched: ICD-10; ICD-11; anomalies monitored by three surveillance programs; and a database of rare diseases (Orphanet). Anomalies were retrieved from these data sources, processed to check for correspondence with ICD-10 and reviewed manually to compile the list. Results: 898 codes were identified, of which 619 (68.9%) were contained in ICD-10 Chapter XVII. Of the 279 codes contained in other chapters, 19 were exclusive to the ICD-11 search, 72 to the surveillance programs, 79 to Orphanet and 36 to the search for terms in ICD-10. Conclusion: The codes contained in ICD-10 Chapter XVII do not capture the totality of congenital anomalies, indicating the need to adopt an expanded list

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

Deposition flow of Mercury and Selenium in hair of riverine in habitants of the Amazon, Brazil

Institute Evandro Chaga – Health Ministry in Brazil and Federal University of the Pará.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Federal University of Pará. Institute of Biological Sciences. Environment and Conservation Research Laboratory. Belém, PA, Brazil / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Galileo Institute of Technology and Education of the Amazon. Manaus, AM, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.This paper provides an estimation of Hg, CH3Hg+ and Se levels in hair samples of riverine inhabitants belonging to Itaituba municipality - Barreiras community (area impacted by gold mining underground) and Juruti municipality - Tabatinga community (area without mining impact) (masculine and feminine genus), Pará state (Amazon, Brazil), as well as Hg, CH3Hg+ and Se levels in 12 fish species (carnivores and non-carnivorous), which stand out as the main species consumed by riverside inhabitants, to evaluate a relationship between fish consumption frequency; and Hg, CH3Hg+ and Se concentration, and also to evaluate possible protection mechanisms (or nonprotection) to Hg exposure by Se. Results showed that the levels of Hg, CH3Hg+ and Se found in the present study, which were an average of 15.21 µg g−1 of Hg, 10.48 µg g−1 of CH3Hg+ and 3.64 µg g−1 of Se for male inhabitants and an average of 13.89 µg g−1 of Hg, 10.68µg g−1 of CH3Hg+ and 3.60 µg g−1 of Se for female inhabitants belonging to the Barreira community, were higher than the Hg, CH3Hg+ and Se levels found in hair samples from inhabitants of Tabatinga community and other gold-producing areas, indicating risk for river side populations along the Tapajós river and for Barreira community. From the information of protective effect (or not) of selenium in hair, given the variation in Se concentration and Hg exposition between the two populations, the molar ratio Hg/Se and Hg millimole revealed a plausible correlation averaged for hair samples of riverine inhabitants belonging to Barreiras (R2 = 0.86, p<0.05) and Tabatinga (R2 = 0.57, p<0.05) community. Similarly for the fish, the molar ratio Hg/Se and Hg millimole revealed a plausible correlation averaged for fish samples carnivorous and non-carnivorous (R2 = 0.97, p<0.05)

Deposition flow of Mercury and Selenium in Hair of riverine inhabitants of the Amazon, Brazil

Institute Evandro Chaga – Health Ministry in Brazil and Federal University of the Pará.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Federal University of Pará. Institute of Biological Sciences. Environment and Conservation Research Laboratory. Belém, PA, Brazil / Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.Galileo Institute of Technology and Education of the Amazon. Manaus, AM, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Laboratório de Toxicologia. Ananindeua, PA, Brasil.This paper provides an estimation of Hg, CH3Hg+ and Se levels in hair samples of riverine inhabitants belonging to Itaituba municipality - Barreiras community (area impacted by gold mining underground) and Juruti municipality - Tabatinga community (area without mining impact) (masculine and feminine genus), Pará state (Amazon, Brazil), as well as Hg, CH3Hg+ and Se levels in 12 fish species (carnivores and non-carnivorous), which stand out as the main species consumed by riverside inhabitants, to evaluate a relationship between fish consumption frequency; and Hg, CH3Hg+ and Se concentration, and also to evaluate possible protection mechanisms (or nonprotection) to Hg exposure by Se. Results showed that the levels of Hg, CH3Hg+ and Se found in the present study, which were an average of 15.21 µg g−1 of Hg, 10.48 µg g−1 of CH3Hg+ and 3.64 µg g−1 of Se for male inhabitants and an average of 13.89 µg g−1 of Hg, 10.68µg g−1 of CH3Hg+ and 3.60 µg g−1 of Se for female inhabitants belonging to the Barreira community, were higher than the Hg, CH3Hg+ and Se levels found in hair samples from inhabitants of Tabatinga community and other gold-producing areas, indicating risk for river side populations along the Tapajós river and for Barreira community. From the information of protective effect (or not) of selenium in hair, given the variation in Se concentration and Hg exposition between the two populations, the molar ratio Hg/Se and Hg millimole revealed a plausible correlation averaged for hair samples of riverine inhabitants belonging to Barreiras (R2 = 0.86, p<0.05) and Tabatinga (R2 = 0.57, p<0.05) community. Similarly for the fish, the molar ratio Hg/Se and Hg millimole revealed a plausible correlation averaged for fish samples carnivorous and non-carnivorous (R2 = 0.97, p<0.05)

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