Análise do estado da arte dos aspectos diagnóticos, periciais e jurisprudenciais das LER/DORT no contexto previdenciário das doenças do trabalho no Brasil

Objetivo: analisar o estado da arte dos aspectos diagnósticos, periciais e jurisprudenciais das LER/DORT (Lesões por Esforços Repetitivos / Distúrbios Osteomusculares Relacionados ao Trabalho) no Brasil. Materiais e Método: trata-se de pesquisa descritiva, de natureza qualitativa, com formato documental, utilizando-se a técnica de análise de conteúdo. A avaliação evolutiva da legislação previdenciária relacionada as LER/DORT foi realizada através da pesquisa no banco de dados disponibilizado pelo Governo Federal e mediante a consulta ao DATAPREV/Sislex. A avaliação dos aspectos diagnósticos foi instrumentalizada através, principalmente, de artigos científicos publicados entre 2003 e 2008, nas línguas portuguesa, inglesa, espanhola e francesa, relacionados com os métodos de diagnósticos complementares das LER-DORT (ressonância magnética, tomografia computadorizada, ultrassonografia e eletroneuromiografia). As jurisprudências foram obtidas através da busca dos julgados sobre o tema, entre 2003 e 2008, pertencentes ao Supremo Tribunal Federal, Superior Tribunal de Justiça, Tribunais Regionais Federais, Tribunal Superior do Trabalho e Tribunais Regionais do Trabalho. Resultados: foram identificados 48 artigos abordando os aspectos diagnósticos das LER-DORT, observando-se que os exames por ressonância magnética, ultrassonografia e eletromiografia demonstraram ser mais efetivos, dentro das suas especificidades, para a complementação do exame clínico de patologias relacionadas às LER-DORT. A análise das 123 jurisprudências selecionadas demonstrou, de forma geral, que as LER-DORT equiparam-se ao acidente de trabalho, devendo apresentar nexo de causalidade (atestado através de laudo médico-pericial) e, ainda, ensejam a ação por danos morais, a qual, devido à EC nº 45 passou a ser competência da Justiça do Trabalho. O Estado da arte dos aspectos periciais encontra-se representado pela vigência da Instrução Normativa n. 98/2003, a qual traz como aspecto fundamental a determinação de novos parâmetros a serem considerados na definição de um quadro de LER-DORT, dispondo, ainda, sobre a conduta ética que deve ser adotada pelo médico perito, bem como chama a atenção para a necessidade dessas doenças do trabalho serem comunicadas às autoridadades competentes, através da emissão da Comunicação de Acidente de Trabalho (CAT). Conclusão: as LER-DORT representam, hoje, um problema de importante impacto, não apenas previdenciário, mas também econômico em diversos países, nos quais o Brasil encontra-se inserido. Estudos sobre o estado da arte relacionados às LER-DORT são fundamentais para auxiliar na construção de um modelo crítico e consciente que colabore com a garantia de sustentabilidade do sistema previdenciário no Brasil

Fatores litogênicos em pacientes com litíase urinária de Fortaleza, Ceará

Lithiasis is considered a public health issue due to its high prevalence and rates of recurrence. Objective: To identify risk factors for lithiasis in kidney stone patients from Fortaleza, Brazil. In the first stage of the study, the medical records of 197 patients with urinary lithiasis covering the period 1996 2006 were analyzed with regard to clinical and metabolic data. In the second stage, 340 kidney stones were submitted to morphological examination under 10x magnification. According to the external morphology and the cut surface, the stones were classified as pure or mixed, and major and minor components were identified. In addition, the stone fragments of 25 patients treated with lithotripsy were submitted to morphological analysis. In the third stage, a subsample of 50 stones was used in a double-blind comparison of morphological and chemical findings. Results were expressed as concordant, partly concordant (discordant for minor components) or discordant (discordant for major components). The average age of first symptoms was 35.8±13.3 years, with no significant difference between the genders. The male/female ratio was 1:1.7. Recurrence was reported in 53.3% of cases. The main metabolic changes observed were hypernatriuria (80.7%), hypercalciuria (48.7%), low urine volume (43.7%), hyperoxaluria (30.5%) and hyperuricosuria (17.3%). Pure stones represented 34.7% of the total sample of 340 stones. The most common route of elimination was spontaneous for pure stones (49.1%) and surgical for mixed stones (50.5%). Pure stones consisted most frequently of calcium oxalate (OxCa) (59.3%) and uric acid (UA) (23.7%), the former prevalent in women, the latter prevalent in men. The most frequently observed component in mixed stones was OxCa (67.1%), followed by carbapatite (11.2%) and struvite (7.9%). The main components were OxCa and UA for men, and carbapatite and struvite for women. Nearly half (48%) the 25 analyzed fragments were pure, consisting of calcium oxalate dihydrate (COD) (56%), calcium oxalate monohydrate (COM) (48%), phosphate (32%) and UA (20%). Four patients (16%) had infectious stones. In the chemical analysis of the subsample of 50 stones, the most 64 frequently observed major components were calcium (70%), oxalate (66%), ammonium (56%), urate (28%) and carbonate (24%). In the morphological analysis, the main components were calcium and magnesium phosphate (32%), COM (24%), UA (20%), COD (18%) and cystine (6%). Morphological and chemical findings were totally concordant for 38% of the stones, partly concordant in 52% and discordant in 10%. Conclusion: The risk factors for lithiasis in kidney stone patients from Fortaleza (Brazil) were hyperoxaluria, hypercalciuria with or without hypernatriuria, hyperuricosuria and low urine volume

Avaliação do potencial de mutagenicidade e toxidade da lectina hipoglicemiante de folha de Bauhinia monandra (pata-de-vaca)

Medicinal plants have been used since antiquity to treat various human diseases. The leaves of Bauhinia monandra are widely used in Brazil as herbal remedies in the treatment of Diabetes Mellitus. From the leaves of B. monandra was purified a galactose-specific lectin, called BmoLL, which also showed a significant hypoglycemic capacity. Following the proposed rules by decree No 116 of 1996/08/08 of the Ministry of Health of Brazil, the study aimed to evaluate the potential for toxicity and mutagenicity of BmoLL from the use of tests with Escherichia coli strain CC104 (Forward mutagenesis assay) with Salmonella typhimurium strain TA (Kado test), with plasmid pBCKS (Break occurrences in plasmid DNA) and enzyme exonuclease III (Search of abasic sites). The results demonstrated that the lectin was unable to increase the frequency of reverse mutation of strains of S. typhimurium, with and without metabolic activity. However, a significant decrease in the frequency of spontaneous mutation was observed in strains of E. coli, especially in poor repair (CC104mutMmutY), indicating an antioxidant potential of the lectin. BmoLL is unable to generate genotoxic and cytotoxic damage, based on the concentrations and the tests performed

Dores e cores nas mal traçadas linhas dos devotos do Padre Cícero: as trocas linguísticas instauradas entre o discurso eclesial e o discurso epistolar dos romeiros

This study is concerned with analyzing the letters sent by the devotees tothe religious patriarch, Father Cicero, checking as is the relationship of linguistic exchanges between the pilgrims and the Father Cicero through the issuance of letters; and, between the Church and the pilgrims, through homilies uttered these devotees, focusing on the appeals contained therein, for, then, to define a parameter between the requirements contained in the letters and the religious discourse of the Church workers in the liturgical celebrations in view of social and religious demands of the market in question. Our purposes resided in understanding the causes that lead to the production of the letters by devotees, holding us in prayers of intercession to the Father Cicero. Finally, check and understand how is the process of inter - relationship between the writing of devotee and the clerical discourse, with regard to meeting this demand, noting especially the game force a religious field, based on postulates of Pierre Bourdieu (2008), to conceive the communicative act as linguistic exchanges, surpassing the sign and therefore decipherable speech character as well as the interactive strength of the wording and voice advocated by Paul Zumthor (2010) e Bakhtin (2006). Regarding the composition of the corpus, were determined, as the universe of research, letters of pilgrims, sent to Father Cicero, deposited in his own tomb, as well as in the Church of the Horto (Gethsemane) in Juazeiro do Norte-CE (Brazil); beyond religious sermons intended for pilgrims during the massin pilgrimage time

Biomassa e desenvolvimento sustentável e sócio regional no Brasil: uma análise à luz da Constituição Federal de 1988

It is verified worldwide an increasing concern with the protection of natural resources in the planet, a fact that became relevant in Brazil since the promulgation of the Constitution of 1988, based on the viewpoint of sustainable development, which seeks to promote economic activities in the country according to the need for conservation and preservation of natural resources for the use of present and future generations. In addition, we seek to reduce the differences that occur in our society by determining as a fundamental objective to be persecuted by the Federative Republic of Brazil the reduction of social and regional inequalities. A value that should also be observed in the context of economic activities developed here, since it is a general principle of financial and economic order of the country. Therefore, considering the exhaustion of world s reserves of fossil fuels, as well as the impacts on the environment, especially for the large emission of greenhouse effect gases, the debate about the need to change the global energy matrix increases while alternative energy sources appears as a bet to fulfill the contemporary aspirations for sustainability, and Brazil emerges in a very favorable position, because it has the essential natural conditions to allow this sector s full development. In this perspective, the work has the scope to analyze how the production of alternative energy sources may act in the search for concretization of constitutional values, to promote sustainable development for present and future generations, and to reduce regional and social inequalities in an attempt to improve the quality of life of the population. It will also be observed the current regulatory framework of alternative energy sources in the national laws to verify the existence of legal and institutional security, which is necessary to guarantee the full development of the sector in the country. And to investigate the expected results, it will be observed through the concrete evaluation of specific practices adopted in the industry, analyzing their actual compliance with the constitutional provisions under analysis, based on the examination of the possibility of using renewable biomass sources for biofuel production, promoting development to the country, indicating the opening lines about how this important sector can act to solve the energy challenge today

Prática do enfermeiro do Programa Saúde da Família PSF na promoção da saúde do adolescente

Attention to the health of adolescents, based on paradigm flexneriano, needs to be overcome. Since the International Conference of Ottawa (1986), the literature is developing a discussion of the promotion of health, based on the paradigm of social production in health, suggests a design to overcome the health care traditional practices. Program Health of the Family PSF has this purpose to transmute the model of existing assistance, where the nurse is an essential element to the work done in the program. Around this context, it is our purpose to analyze the practice of nurse of the PSF for the promotion of health of adolescents, produced by a search of descriptive quantitative approach with the inclusion of qualitative data. Interviews were conducted with 9 nurses 3 units of health of the family USF, Mossoró-RN and applied questionnaires with 74 teenagers aged between 15 and 19 years old, with some nearby public schools where USF operate these nurses. The quantitative descriptions were transformed on tables, pictures and graphics using the program Excel (Microsoft) and the qualitative were worked through the technique of analyzing the content of Bardin (2004). The review was realized using the reference to promote health brought by the study. The results show that the most common problems that happen with teenagers are the drugs (33,8%), pregnancy (27,0%) and political problems-socio-economic-cultural issues (24,3%). Adolescents are spontaneous demand and rarely seek the USF. The actions presented by the nurses as, lectures and groups, are nothing comparing to the macro-problems presented by adolescents, and verticalized irregular. The nurses know the promotion of health generally, not explaining how operate it from its daily practice. Concluded that the practice of nurse of the PSF has not yet reach the promotion of health of the adolescent, being necessary to scheduling modules on the subject to continuous training of teams, professionals from USF, as well as teachers and other staff of schools, giving space to the participation of academic. The discussions should be socialized with the community to discuss possibilities of confrontation of the problems, which also require socio-structural changes. This research can contribute as work-diagnosis, which experienced the reality of care in nursing PSF to a specific group

Fonte de energia alternativa: um estudo sobre a percepção ambiental, social e econômica do biodiesel com docentes do Centro de Tecnologia do gás da cidade de Natal RN

Meaning fuel and renewal energy source s derivative additives, the term biodiesel exists in Brazil since 1980, when it was signed its first patent by Expedito Parente. Since then, its importance has grown gradually due to the worsening of the ambient problems, since its use has became a highly promising alternative to the pollution decrease, as in the carbon dioxide issue as with the smoke and sulfur oxide. In Brazil, it was created the National Program of Production, whose objective is to insert the new product in the country s energy matrix, strengthening the economy and creating new employment opportunities, being an important product to the national energetic independence, since Brazil still imports diesel to its domestic consumption. This study aims to identify the ambient, social and economic perception of the teachers from the Technology Center of Natal city (CTGÁS-RN) to the biodiesel. For that, it was used a questionnaire closed questions, organized in the likart scale, directed to the tree spheres of the research analysis, the biodiesel and its social, ambient and economic nuances, totaling 31 questionnaires full answered. In its objectives, the research was descriptive and in its approach it was qualitative. To the data analysis it was used statistical tools (Statistic software, 6.1 version and Microsoft Excel 2003). The research revealed the predominance of the ambient aspect in the sight of the teachers, followed by the social ones. The economic factors represent a minor percentage in the analysis when compared to other

Doenças sem doentes: Ocorrência de Distúrbios Osteomusculares Relacionados ao Trabalho DORT nos operadores de caixa de um banco

The changes incurred in the financial system with the introduction of new technologies and new forms of administration of banks has caused impact on the health of workers. These changes, which passed in the process of work, generate a combined share of the risk factors that result in numerous injuries and illnesses among banks, notably between the operators of banks tellers. The Work-Related Musculoskeletal Disordes - WRMD represent a group of occupational diseases always present among these workers. Because of its high incidence and the amount of financial resour envolved to manage the problem has been the object of constant study. This paper aims to analyze the bank teller activity; search the occurrence of WRMD in the activity, identifying the factors determining the occurrence of WRMD in the activity and determine the real number of touchs on a keyboard made by the operator and propose solutions that influence the reduction of illness in the workplace of the bank teller. Methodological tools of ergonomics are used to provide a broad knowledge of aspects of work that have been studied and influential in the generation of occupational diseases studied. It was found that activity put workers to serious risk of occupational diseases. As the main contributory factors and determinants for this illness: the requirements and control the numbers daily endorsements; evaluation system based on performance targets for productivity; management system at time of service to customers; work with stressful factors (broken box); excess of time worked; furniture of workstations with ergonomic inadequacies and policy for the prevention of occupational diseases inefficient. They have also noted cases of illness for DORT workers without fulfilling the legal requirement of the issuance of the communication of labour accident and without the removal of the employee of the workplace

Análise antropotecnológica do desenvolvimento de novos produtos na produção artesanal : caso das rendeiras de bilro da Vila de Ponta Negra em Natal, RN

Brazilian craft production plays an important role in the generation of employment and income for many families in every state across Brazil. In Natal, Rio Grande do Norte, Brazil, among many types found, identifies itself with the production of bobbin-lace, still practiced in Ponta Negra Village for ancient craftswomens of city that try to preserve the art and tradition of bobbin-lace. This work presents the results of an analysis conducted based in concepts of anthropotechnology, on the effects of a design workshop held with bobbin-lace craftswomen in the village of Ponta Negra in July of 2006. The workshop was intended to propose a new concept of products and a new alternative for production in the activity of the craftswomen, on the premise that the laces could be used as a detail inserted into other industrial products such as shirts, bags, towels, etc. Evaluations after the workshop showed that none of the artisans continued to work, indicating that actions focused solely on products did not generate representative results in the production of bobbin-lace. Evaluations also indicated that knowledge about the artisan's personal and professional characteristics, organization, pace, workload, and cultural and historical issues that permeate the activity are essential to the success of technology transfer, particularly when the transfer affects the craft production as it relates to the inseparable aspects of the craftswomen's work and lifestyle

A pegada de carbono como um dos indicadores de sustentabilidade para medição da responsabilidade socioambiental empresarial: um estudo de caso na unidade sede da Petrobras em Natal-RN

As a contemporary tendency, it is been evidenced that the environmental changes theme, already admitted as a concernment to international economical and political reality, is also gaining repercussion on industrial and business sector. Firms are implementing actions on trial to minimize their own greenhouse gases (GHG) emissions impacts. However, the great majority of those actions of Corporative Social-Environmental Responsibility (CSR) are referred only to direct emissions of the main production systems. Direct emissions are those derived of an isolate process, without considering the upstream and downstream processes emissions, which respond for the majority of emissions originated because of respective firm‟s production system existence. Because the greenhouse effect occurs globally and the GHG emissions contribute to the environmental changes independently of their origin, it must be taken into account the whole productive life cycle of products and systems, since the energy invested on resources extraction and necessary materials to the final disposal. To do so, it must be investigated all relevant steps of a product/production system life cycle, tracking all activities which emit greenhouse gases, directly or indirectly. This amount of emissions consists in the firm‟s Carbon Footprint. This research purpose is to defend the Carbon Footprint relevance and its adoption viability to be used as an Environmental Indicator on measurement/assessment of CSR. It has been realized a study case on Petrobras‟s seat unity at Natal-Brazil, assessing part of its Carbon Footprint. It has been used the software GEMIS 4.6 to do the emissions quantifying. The items measured were the direct emissions of the own unity vehicles and indirect emissions of offset paper (A4), energy and disposable plastic cups consumed. To 2009, these emissions were 3.811,94 tCO2eq. We may conclude that Carbon Footprint quantification is indispensable to the knowledge of real emissions caused by a productive process existence, must serving as basis to CSR decisions about the environmental changes reversion challenge

Desenvolvimento de metodologia para avaliação de desempenho ambiental em edifícios adaptada à realidade do Nordeste brasileiro

This research refers to the production of green buildings, defined, mainly, based on the use of sources of alternative energies, smaller emission of pollutant, use of recyclable materials, systems of recycling of the waters, maximization of the natural illumination, preservation of green areas or native, and appropriate quality of the internal air. From the conception of those buildings, it appears the needs of evaluating them, creating the methodologies for the evaluation of environmental performance of buildings. In that way, this work can be divided in two moments: the first one when it identifies the methodologies for the evaluation of environmental performance for buildings existents in the literature, defining their categories, criteria and sub-criteria to be appropriate to the reality of the Brazilian Northeast; and the second one when starting from the analysis of the systems of existent evaluation. It defines a methodological base and it generates a new evaluation system, denominated MEDACNE (Methodology of Evaluation of Environmental Acting for Construction in the Northeast). In that moment, the process of framing of the section of the building site is verified under the maintainable optics, stimulated mainly by the pressures of the society - conferences, protocols and agreements. Finally, the proposed methodology was applied in a case study, a residential building, called Maria José Gurgel , located in Natal-RN, Brazil, for its validation. This methodological proposition should increase the patterns environmental places for the production of new buildings, and it will be a reference guide for architects, engineers and planners to develop their constructions considering the criteria of the sustainability. This study made use of bibliographical research in books and specialized magazines and the analysis of the data was realized in an interpretative way

Um Estudo de Politicas e Práticas do uso do GNV no transporte público urbano do Brasil

The use of Natural Gas Vehicle has had a fast increase lately. However, in order to have a continuous success this Program needs to develop converting devices of Otto-cycle engines, gasoline or alcohol, to the use of NGV (Natural Gas Vehicle) that presents low cost, maintaining the same original development of the vehicle and low level of emissions, considering the PROCONVE rules. Due to the need to diversify the matrix in order to avoid energetic dependence and due to strict pollution control, it has increased in the Brazilian market the number of vehicles converted to the use of NGV. The recent regulation of the PROCONVE, determining that the converted engines with kits should be submitted to emission testing, comes to reinforce the necessity of the proposed development. Therefore, if we can obtain kits with the characteristics already described, we can reach a major trust in the market and obtain an increase acceptance of the vehicle conversion for NGV. The use of natural gas as vehicle fuel presents several advantages in relation to liquid fuels. It is a vehicle fuel with fewer indexes of emissions when compared to diesel; their combustion gases are less harmful, with a major level of safety than liquid fuels and the market price is quite competitive. The preoccupation that emerges, and the motivation of this project, is to know which are the main justifications for such technology, well accepted in other countries, with a low index or emission, with a high level of safety, where its maintenance becomes low, reminding that for this it is necessary that this technology has to be used properly, and once available in the market will not motivate interest in the urban transportation companies in Brazil, in research centers in general. Therefore this project exists to show the society in a general way the current vision of the main governmental factors, of the national research centers and of the private companies concerning the use of natural gas vehicles in urban transport vehicles, in order to give a major reliability to the population as well as to motivate national market competitiveness with a low cost and reliable product and to enrich the national technology

Método Fuzzy para auxílio ao diagnóstico de câncer de mama em ambiente inteligente de telediagnóstico colaborativo para apoio à tomada de decisão

Breast cancer, despite being one of the leading causes of death among women worldwide is a disease that can be cured if diagnosed early. One of the main techniques used in the detection of breast cancer is the Fine Needle Aspirate FNA (aspiration puncture by thin needle) which, depending on the clinical case, requires the analysis of several medical specialists for the diagnosis development. However, such diagnosis and second opinions have been hampered by geographical dispersion of physicians and/or the difficulty in reconciling time to undertake work together. Within this reality, this PhD thesis uses computational intelligence in medical decision-making support for remote diagnosis. For that purpose, it presents a fuzzy method to assist the diagnosis of breast cancer, able to process and sort data extracted from breast tissue obtained by FNA. This method is integrated into a virtual environment for collaborative remote diagnosis, whose model was developed providing for the incorporation of prerequisite Modules for Pre Diagnosis to support medical decision. On the fuzzy Method Development, the process of knowledge acquisition was carried out by extraction and analysis of numerical data in gold standard data base and by interviews and discussions with medical experts. The method has been tested and validated with real cases and, according to the sensitivity and specificity achieved (correct diagnosis of tumors, malignant and benign respectively), the results obtained were satisfactory, considering the opinions of doctors and the quality standards for diagnosis of breast cancer and comparing them with other studies involving breast cancer diagnosis by FNA.

Um ambiente de suporte ao trabalho cooperativo com aplicação à telemedicina

This dissertation presents a cooperative virtual multimedia enviroment for employing on time medical Field, using a TCP/IP computer network. The Virtual Diagnosis Room environment make it possible to perform cooperative tasks using classical image processing. Synchronous and assynchronous text conversation (chat) and content markup, in order to produce remote cooperative diagnosis. The dissertation also describes the tool in detail and its functions, that enables the interaction among users, along with implementation detals, contributions and weakness of this work

Adição de geomanta e tecido não tecido de polipropileno em cimentos geopoliméricos de pega rápida

Geopolymers are cementing materials that depict a number of advantages compared to Portland cement. Contrary to the latter, geopolymers are synthesized at room temperature, thus significantly reducing the emission of CO2 to the atmosphere. Moreover, the composition and synthesis reactions can be tailored to adjust the setting time of the material as well as its compressive mechanical strength. It is then possible to produce geopolymeric cements with short setting times and high compressive strength, although relatively brittle. The objective of the present study was to produce and characterize composite materials by reinforcing fastsetting geopolymeric matrixes with polypropylene geosynthetics (geomats and geotextiles) in an attempt to improve the toughness and tensile strength of the cementing material. Geosynthetics have been increasingly used to reinforce engineering structures, providing higher strength and better toughness. In particular, polypropylene nonwoven and geomats depict other attractive properties such as low density, durability, impact absorption and resistance to abrasion. Fast-setting geopolymers were then synthesized and reinforced with polypropylene nonwoven and geomats. The mechanical strength of the materials, reinforced or not, was characterized. The results showed that relatively short setting times and adequate flowing behavior were achieved by adjusting the composition of the geopolymer. In addition, it is possible to improve the fracture resistance of geopolymeric cements by adding polypropylene geosynthetics. The best results were achieved by reinforcing geopolymer with polypropylene TNT