Voz e trabalho: estudo dos condicionantes das mudanças a partir do discurso de docentes

This study aims to analyze, by means of manifestation of worsening or improvement in work ability, the aspects conditioning changes in the relation between work and voice, according to the discourse of teachers working at the municipal education network of São Paulo, Brazil. The participants were female teachers who, when comparing with a previous research, had greater difference both in terms of worsening (Group A) and improvement (Group B) in the results of the Work Ability Index. They were invited to discuss which aspects could explain the improvement or worsening in these results, in a focus group context. The reports were transcribed and qualitatively analyzed, according to the recurrence of utterances. We found out that group A showed a worse health status and it had a greater need to talk about difficulties at work. Group B showed more strength to face problems related to work, including creative proposals. In favor of Group B, better work relationships were also registered concerning social support and autonomy.O objetivo deste estudo é analisar, a partir da manifestação de piora ou melhora de capacidade para o trabalho, os aspectos condicionantes de mudanças na relação entre trabalho e voz, segundo o discurso de docentes da rede municipal de ensino de São Paulo. Participaram as professoras que, em comparação com pesquisa anterior, apresentaram maior diferença tanto para piora (Grupo A) como para melhora (Grupo B) nos resultados do Índice de Capacidade para o Trabalho. Elas foram convidadas a discutir quais aspectos poderiam explicar a melhora ou piora desses resultados, em um contexto de grupo focal. Os relatos foram transcritos e analisados qualitativamente, segundo a recorrência dos enunciados. Constatou-se que o grupo A apresentou condição mais adoecida e maior necessidade de falar sobre as dificuldades no trabalho. O Grupo B apresentou mais força para enfrentar os problemas referentes ao trabalho, inclusive propostas criativas. A favor do Grupo B, também foram registradas melhores relações no trabalho quanto ao apoio social e autonomia

Genome-wide Analyses Identify KIF5A as a Novel ALS Gene

To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.Peer reviewe

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