Percepción del riesgo biológico en el personal asistencial en un hospital de alta complejidad de la ciudad de Bogotá.

OBJETIVOS: Identificar la percepción del riesgo biológico de los trabajadores asistenciales del Hospital Central de la Policía Nacional en la ciudad de Bogotá. METODOS: se realizó un estudio analítico de corte transversal para describir la percepción acerca del riesgo biológico en 159 trabajadores asistenciales de un hospital de alta complejidad en la ciudad de Bogotá (Colombia), la información se recolectó por medio de la utilización de la encuesta validada nota técnica 578 (Portell M, Solé M, 2001). Se realizó la caracterización de la población por variables de sexo, edad, tiempo de experiencia y servicio al cual pertenece y se promediaron las respuestas obtenidas para cada ítem encuestado, obteniendo una clasificación para cada dimensión de percepción de riesgo baja (1 a 3), media (4 a 5) o alta (6 a 7). Resultados: De los 159 trabajadores asistenciales encuestados el 80.4% eran de género femenino, el 22.2% pertenecían al servicio de urgencias, el 16,5% al servicio de medicina interna y el 9.5% al servicio de pediatría, de los encuestados el 62.9% fueron auxiliares de enfermería, el 21,4% enfermeras jefes y el 6.9% médicos. Se obtuvo una percepción de riesgo alta (media aritmética mayor de 5) para todas las variables incluidas en la encuesta, demostrando conocimiento de todo el personal acerca de la alta exposición a accidentes de tipo biológico. No se encontró asociación entre la labor desempeñada y la percepción del riesgo biológico, sin embargo, se encontró una asociación entre el tiempo de experiencia del trabajador y una disminución en la magnitud del riesgo percibido (Chi cuadrado de asociación, p=0.042). Conclusiones: Los trabajadores asistenciales identifican la magnitud del riesgo biológico al que se encuentran expuestos en sus labores del día a día, sin embargo, es necesaria una mayor participación por parte del personal directivo y de los responsables de la prevención en temas de reacción ante accidentes y en la valoración del riesgo, especialmente en personas que llevan mucho tiempo desempeñando la labor.

Hårdare tag i arbetslivet? : Åtgärder mot arbetsrelaterat våld i facklig press 1978–2004

Preventing violence at work: A study of descriptions of safety measures in Swedish trade union journals 1978–2004 The purpose of this study is to examine if perceptions of interventions aimed at violence in the workplace have changed since the 1970s. In the beginning of the study period, structural factors are seen as the dominating explanation for workplace violence. The crime perspective rises in the 1990’s and methods of intervention becomes the control- and justice functions of larger society. The result shows search for accountability to be a salient factor for understanding the development towards an increasing use of penal sanctions.

Efeitos do período e volume de aplicação na segurança dos tratoristas aplicando herbicidas na cultura de cana-de-açúcar (Saccharum spp.)

O objetivo deste trabalho foi avaliar os efeitos do período e volume de aplicação na segurança da atividade de tratoristas aplicando herbicidas na cultura de cana-de-açúcar com o pulverizador de barra montado em trator e a eficiência de equipamentos de proteção individual (EPIs) e de uma cabina acoplada ao trator. As exposições dérmicas de 13 condições de trabalho foram avaliadas e analisadas estatisticamente por meio do delineamento inteiramente ao acaso e do esquema fatorial 3 x 2 x 2 + 1. O fator A foi a condição de exposição: 1) exposição dérmica potencial (EDP) - sem nenhuma medida de segurança; 2) exposição com cabina no trator (Cabina); e 3) exposição com as vestimentas (EPI). O fator B foi o volume de aplicação: 1) 200 L ha-1 e 2) 100 L ha-1; e o fator C foi o período de aplicação: 1) diurno e 2) noturno. Como testemunha foi avaliada a EDP do tratorista aplicando na atividade usual de 300 L de calda ha-1, no período diurno. As exposições dérmicas (EDs) aos herbicidas considerados nessas condições de trabalho foram estimadas por meio de dados substitutos das EDs avaliadas ao cátion Cu+2 adicionado como traçador nas caldas aplicadas. O pulverizador utilizado foi do modelo PJ 600, com barra de 12 m de comprimento e 24 bicos de jato plano TT 110 04 ou TT 110 02. As 13 condições de trabalho avaliadas foram classificadas como seguras (MS>1) para o tratorista aplicando os herbicidas glyphosate (48% i.a.), MSMA (48%), diuron (46,8%) + hexazinone (13,2%), clomazone (50%), sulfentrazone (50%), ametryne (50%), diuron (50%), isoxaflutole (75%), metribuzin (48%), 2,4-D (80,6%), ametryne (30%) + clomazone (20%), ametryne (73,25%) + trifloxysulfuron (1,85%) e tebuthiuron (80 %) e inseguras para o herbicida atrazine (50%), nos dois períodos e nos três volumes de aplicação, e ametryne (50%), na aplicação diurna e 100 L de calda ha-1. As aplicações noturnas e os volumes de aplicação reduzidos tornaram as condições de trabalho mais seguras, exceto para o atrazine. A eficiência dos EPIs para a aplicação de 300 L ha-1 variou de 69,5 a 89,3%, e a da cabina do trator variou entre 76,4 e 83,3%, em relação aos volumes reduzidos de 100 e 200 L ha-1.

Segurança na aplicação de agrotóxicos ­em cultura de batata em regiões montahosas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Anthropotechnological analysis of industrial accidents in Brazil

The Brazilian Ministry of Labour has been attempting to modify the norms used to analyse industrial accidents in the country. For this purpose, in 1994 it tried to make compulsory use of the causal tree approach to accident analysis, an approach developed in France during the 1970s,without having previously determined whether it is suitable for use under the industrial safety conditions that prevail in most Brazilian firms. In addition, apposition from Brazilian employers has blocked the proposed changes to the norms. The present study employed anthropotechnology to analyse experimental application of the causal tree method to work-related accidents in industrial firms in the region of Botucatu, São Paulo. Three work-related accidents were examined in three industrial firms representative of local, national and multinational companies. on the basis of the accidents analysed in this study, the rationale for the use of the causal tree method in Brazil can be summarized for each type of firm as follows:the method is redundant if there is a predominance of the type of risk whose elimination or neutralization requires adoption of conventional industrial safety measures (firm representative of local enterprises); the method is worth while if the company's specific technical risks have already largely been eliminated (firm representative of national enterprises); and the method is particularly appropriate if the firm has a good safety record and the causes of accidents are primarily related to industrial organization and management (multinational enterprise).

Gli infortuni sul lavoro in Brasile. Studio nello Stato di San Paolo del Brasile, regione di Botucatu, utilizzando il metodo dell'albero delle cause

This paper discusses, within the prevaling Brazilian situation, the possibility of applying 'Causal Tree' (CT) method in investigating occupational accidents by safety personnel in the public health services and workers' unions. The method was developed during the seventies in France, for use by plant safety personnel. The authors used this method in Botucatu, State of Sao Paulo, Brazil, in order to investigate 40 serious occupational accidents that occurred in industrial plants during the second half of 1993, that had been registered by Social Security. In these cases, the predominance of situations in which the lack of safety measures were identified by inspection indicates that in most instances, the use of CT is unnecessary. However, the authors discuss its use by safety personnel from the public health services and workers' unions to investigate certain accidents to contribute to the knowledge base and help overcome the cultural based guilt which, in Brazil, has turned the victim into the person responsible for the accident.

Como desenhar e escrever um protocolo de pesquisa clínica em Cosmiatria

Cosmetic Dermatology is a growing subspecialty. High-quality basic science studies have been published; however, few double-blind, randomized controlled clinical trials, which are the major instrument for evidence-based medicine, have been conducted in this area. Clinical research is essential for the discovery of new knowledge, improvement of scientific basis, resolution of challenges, and good clinical practice. Some basic principles for a successful researcher include interest, availability, persistence, and honesty. It is essential to learn how to write a protocol research and to know the international and national regulatory rules. A complete clinical trial protocol should include question, background, objectives, methodology (design, variable description, sample size, randomization, inclusion and exclusion criteria, intervention, efficacy and safety measures, and statistical analysis), consent form, clinical research form, and references. Institutional ethical review board approval and financial support disclosure are necessary. Publication of positive or negative results should be an authors' commitment. © 2013 by Anais Brasileiros de Dermatologia.

A desinternação progressiva como alternativa para a obrigação político-criminal do Estado frente aos atos praticados por inimputáveis

Pós-graduação em Direito - FCHS

Investigação da prevalência de traumatismos dento-faciais em praticantes de boxe e a importância dos protetores bucais nas conseqüências dos traumas

Os dados da National Youth Sports Safety Foundation – NYSSY (2002) – entidade de pesquisa americana ligada aos estudos e a prevenção de traumas esportivos informaram que há 10% de probabilidade dos atletas sofrerem injúrias traumáticas durante uma temporada esportiva, recaindo isso não só no problema físico mas também no econômico, bastante representativo para os clubes. As lesões causadas por traumas em dentes e tecidos adjacentes podem levar à fraturas coronárias ou mesmo até, a perda do elemento dental. Este trabalho observacional, transversal descritivo, baseia-se na diversidade de opiniões com relação ao uso de protetores bucais e sua importância como fator de proteção para os tecidos bucais durante a prática esportiva. Assim sendo, nossa metodologia envolveu inquérito por meio de questionário aplicado à atletas praticantes de boxe. Como critério de inclusão, utilizamos o atleta estar praticando o esporte escolhido. Como critério de exclusão, utilizamos o atleta ter sofrido qualquer injúria traumática com repercussão dento-facial anterior que não seja por prática de boxe, assim como aqueles que tivessem história de hábito parafuncional. Foram entrevistados e examinados 50 atletas sendo que 3 eram do gênero feminino e 47 do masculino, e 46% pertenciam a faixa etária entre 18/26 anos. Entre os atletas, 24% iniciaram a prática do boxe quando adultos. Os resultados coletados por meio dos questionários, foram submetidos à tratamento estatístico utilizando-se o Teste do Qui-Quadrado, em nível de significância de p<0,05, e demonstraram que o índice de traumas dento-faciais quando o protetor bucal está sendo utilizado é de 10%, comprovando assim que, de acordo com a amostra analisada, o protetor bucal é um mecanismo de proteção efetivo, principalmente quanto aos traumas dentais durante a prática do boxe.

Untersuchung von Einflussfaktoren zur Ortsbruststabilität und Vortriebsgeschwindigkeit beim Tunnelbau im Rheinischen Schiefergebirge

Zusammenfassung Der ca. 1.555 m lange Tunnel Fernthal wurde von 1998 bis 2000 im Zuge der Bundesbahn-Neubaustrecke Köln – Rhein/Main erstellt. Der Tunnel durchquert devonische Schichten des Rechtsrheinischen Schiefergebirges. Die Ton- und Sandsteine sind tiefgründig verwittert, intensiv verfaltet mit wechselnden Vergenzen der Faltenschenkel und zudem stark durch Trennflächen zerlegt. Beim Auffahren des Tunnel Fernthal sind Phänomene in Bezug auf die Wechselwirkung zwischen dem Grundwasser und dem Tunnel sowie dem Fels und dem Tunnel beobachtet worden, die vom Verfasser der vorliegenden Arbeit im Nachgang der Baumaßnahme vertieft ausgewertet und interpretiert werden.Innerhalb von zwanzig strukturgeologischen Homogenbereichen wurden die geotechnisch und strukturgeologisch bestimmenden Einflussfaktoren (z.B. ungünstig zum Hohlraum einfallende Schichtung oder Querklüftung mit hohem Durchtrennungsgrad) im Hinblick auf Ihre Auswirkung auf die Sicherung der Ortsbrust und damit die Vortriebsgeschwindigkeit quantifiziert. Über das Produkt der den Vortrieb bestimmenden Einzelfaktoren wurde für den jeweiligen Homogenbereich ein Gesamteinflussfaktor errechnet.Aus dem neu eingeführten Gesamteinflussfaktors fn gesamt lassen sich dabei Empfehlungen über die notwendigen Sicherungsmaßnahmen im Bereich der Ortsbrust ableiten und Einteilungen in Ausbruchsklassen vornehmen. Über die Bewertungsmatrix und den sich daraus ergebenen Gesamteinflussfaktor können reduzierte Vortriebsgeschwindigkeiten ausgehend von einer 'idealen' Vortriebsgeschwindigkeit näherungsweise errechnet werden. Mithilfe der Bewertungsmatrix lässt sich die bautechnischen Eigenschaften des Gebirges besser bewerten. So zeigt sich im Rahmen dieser Arbeit deutlich, dass es bei einem vergenten Faltengebirge günstiger ist, den Tunnel gegen die Vergenz von Faltenschenkeln aufzufahren. Somit können schon im Vorfeld einer Tunnelbaumaßnahme verschiedene Vortriebsschemata durchrechnet werden. Neben der besseren Prognose von notwendigen Sicherungsmaßnahmen kann durch den Zeitgewinn auch ein finanzieller Vorteil für die Beteiligten entstehen.

Multi-slice computed tomography (MSCT) of mountaineering casualties in the Swiss Alps - Advantages and limitations

As an Alpine country, Switzerland has not only a thriving mountaineering tourist industry, but also many mountaineering casualties. At the request of the state attorney, most of the victims undergo only an external inspection without autopsy. One of the main tasks of the forensic pathologist under these circumstances is the correct identification of the deceased for a fast release to their kin. Nevertheless, detailed knowledge of the injuries sustained may lead to improved safety measures, such as better protective equipment. In this study, we examined the feasibility of using cross-sectional imaging with postmortem multi-slice computed tomography (MSCT) to detect lesions of the skeletal structures and internal organs. For this purpose, we used whole-body MSCT to examine 10 corpses that suffered fatal falls from great height while climbing in the Swiss part of the European Alps from the years 2007 to 2009. We conclude that postmortem CT imaging is a valuable tool for dental identification and is superior to plain X-rays as a viable compromise between a solely external legal inspection and an autopsy because it delivers otherwise irretrievable additional internal findings non-invasively. This fact is of great importance in cases where an autopsy is refused.

782 consecutive construction work accidents: who is at risk? A 10-year analysis from a Swiss university hospital trauma unit

BACKGROUND: Mortality and morbidity are particularly high in the building industry. The annual rate of non-fatal occupational accidents in Switzerland is 1,133 per 100,000 inhabitants. METHODS: Retrospective analysis of the electronic database of a university emergency centre. Between 2001 and 2011, 782 occupational accidents to construction workers were recorded and analysed using specific demographic and medical keywords. RESULTS: Most patients were aged 30-39 (30.4%). 66.4% of the injured workers were foreigners. This is almost twice as high as the overall proportion of foreigners in Switzerland or in the Swiss labour market. 16% of the Swiss construction workers and 8% of the foreign construction workers suffered a severe injury with ISS >15. There was a trend for workers aged 60 and above to suffer an accident with a high ISS (p = 0.089). CONCLUSIONS: As in other European countries, most patients were in their thirties. Older construction workers suffered fewer injuries, although these tended to be more severe. The injuries were evenly distributed through the working days of the week. A special effort should be made that current health and safety measures are understood and applied by foreign and older construction workers.

Occupational maxillofacial fractures: a 3-year survey in central Switzerland

PURPOSE: The aim of this study was to determine occupational facial fractures in central Switzerland. Concomitant injuries were also studied. MATERIALS AND METHODS: The Department of Cranio-Maxillofacial Surgery at the University Hospital in Berne provides a 24-hour maxillofacial trauma service for its population (1.6 million). The present study was comprised of 42 patients (8.4% of treated maxillofacial injuries) with occupational maxillofacial fractures registered at this unit between 2000 and 2002. Information on the topic of occupation, the cause of the accidents, and the topographic location of the fractures was analyzed. RESULTS: The mean age of the patients was 44.4 years, with a male to female ratio of 41:1. Sixty-nine percent of the injuries occurred in farm and forestry workers and in construction laborers during the summertime (33%). Workers in these occupations carried a 127-fold (farm and forestry workers) and a 44-fold (construction laborers) higher risk of incurring maxillofacial fractures than did service and office workers. Injuries were most frequently (43%) caused by a thrown, projected, or falling object. Eighty-two percent of the fractures occurred in the midface region and at the skull base. Fifty-nine percent of the patients had concomitant injuries. In 69%, surgery was necessary, the mean duration of their hospital stay being 4.8 days. CONCLUSION: The probability of sustaining work-related maxillofacial traumata is correlated to the nature of the occupation. Farm and forestry workers are at the highest risk, most frequently injured by being struck by an object or an animal. The introduction of personalized safety measures should become obligatory in high-risk occupations.

Second, do less harm: The state of states' medical error reporting programs

Statement of the problem and public health significance. Hospitals were designed to be a safe haven and respite from disease and illness. However, a large body of evidence points to preventable errors in hospitals as the eighth leading cause of death among Americans. Twelve percent of Americans, or over 33.8 million people, are hospitalized each year. This population represents a significant portion of at risk citizens exposed to hospital medical errors. Since the number of annual deaths due to hospital medical errors is estimated to exceed 44,000, the magnitude of this tragedy makes it a significant public health problem. ^ Specific aims. The specific aims of this study were threefold. First, this study aimed to analyze the state of the states' mandatory hospital medical error reporting six years after the release of the influential IOM report, "To Err is Human." The second aim was to identify barriers to reporting of medical errors by hospital personnel. The third aim was to identify hospital safety measures implemented to reduce medical errors and enhance patient safety. ^ Methods. A descriptive, longitudinal, retrospective design was used to address the first stated objective. The study data came from the twenty-one states with mandatory hospital reporting programs which report aggregate hospital error data that is accessible to the public by way of states' websites. The data analysis included calculations of expected number of medical errors for each state according to IOM rates. Where possible, a comparison was made between state reported data and the calculated IOM expected number of errors. A literature review was performed to achieve the second study aim, identifying barriers to reporting medical errors. The final aim was accomplished by telephone interviews of principal patient safety/quality officers from five Texas hospitals with more than 700 beds. ^ Results. The state medical error data suggests vast underreporting of hospital medical errors to the states. The telephone interviews suggest that hospitals are working at reducing medical errors and creating safer environments for patients. The literature review suggests the underreporting of medical errors at the state level stems from underreporting of errors at the delivery level. ^

Metodología de evaluación de la seguridad vial en intersecciones basada en el análisis cuantitativo de conflictos entre vehículos

El modo tradicional de estimar el nivel de seguridad vial es el registro de accidentes de tráfico, sin embargo son altamente variables, aleatorios y necesitan un periodo de registro de al menos 3 años. Existen metodologías preventivas en las cuales no es necesario que ocurra un accidente para determinar el nivel de seguridad de una intersección, como lo es la técnica de los conflictos de tráfico, que introduce las mediciones alternativas de seguridad como cuantificadoras del riesgo de accidente. El objetivo general de la tesis es establecer una metodología que permita clasificar el riesgo en intersecciones interurbanas, en función del análisis de conflictos entre vehículos, realizado mediante las variables alternativas o indirectas de seguridad vial. La metodología para el análisis y evaluación temprana de la seguridad en una intersección, estará basada en dos medidas alternativas de seguridad: el tiempo hasta la colisión y el tiempo posterior a la invasión de la trayectoria. El desarrollo experimental se realizó mediante estudios de campo, para la parte exploratoria de la investigación, se seleccionaron 3 intersecciones interurbanas en forma de T donde se obtuvieron las variables que caracterizan los conflictos entre vehículos; luego mediante técnicas de análisis multivariante, se obtuvo los modelos de clasificación del riesgo cualitativo y cuantitativo. Para la homologación y el estudio final de concordancia entre el índice propuesto y el modelo de clasificación, se desarrollaron nuevos estudios de campo en 6 intersecciones interurbanas en forma de T. El índice de riesgo obtenido resulta una herramienta muy útil para realizar evaluaciones rápidas conducentes a estimar la peligrosidad de una intersección en T, debido a lo simple y económico que resulta obtener los registros de datos en campo, por medio de una rápida capacitación a operarios; la elaboración del informe de resultados debe ser por un especialista. Los índices de riesgo obtenidos muestran que las variables originales más influyentes son las mediciones de tiempo. Se pudo determinar que los valores más altos del índice de riesgo están relacionados a un mayor riesgo de que un conflicto termine en accidente. Dentro de este índice, la única variable cuyo aporte es proporcionalmente directo es la velocidad de aproximación, lo que concuerda con lo que sucede en un conflicto, pues una velocidad excesiva se manifiesta como un claro factor de riesgo ya que potencia todos los fallos humanos en la conducción. Una de las principales aportaciones de esta tesis doctoral a la ingeniería de carreteras, es la posibilidad de aplicación de la metodología por parte de administraciones de carreteras locales, las cuales muchas veces cuentan con recursos de inversión limitados para efectuar estudios preventivos, sobretodo en países en vías de desarrollo. La evaluación del riesgo de una intersección luego de una mejora en cuanto a infraestructura y/o dispositivos de control de tráfico, al igual que un análisis antes – después, pero sin realizar una comparación mediante la ocurrencia de accidentes, sino que por medio de la técnica de conflictos de tráfico, se puede convertir en una aplicación directa y económica. Además, se pudo comprobar que el análisis de componentes principales utilizado en la creación del índice de riesgo de la intersección, es una herramienta útil para resumir todo el conjunto de mediciones que son posibles de obtener con la técnica de conflictos de tráfico y que permiten el diagnóstico del riesgo de accidentalidad en una intersección. En cuanto a la metodología para la homologación de los modelos, se pudo establecer la validez y confiabilidad al conjunto de respuestas entregadas por los observadores en el registro de datos en campo, ya que los resultados de la validación establecen que la medición de concordancia de las respuestas entregadas por los modelos y lo observado, son significativas y sugieren una alta coincidencia entre ellos. ABSTRACT The traditional way of estimating road safety level is the record of occurrence of traffic accidents; however, they are highly variable, random, and require a recording period of at least three years. There are preventive methods which do not need an accident to determine the road safety level of an intersection, such as traffic conflict technique, which introduces surrogate safety measures as parameters for the evaluation of accident risks. The general objective of the thesis is to establish a methodology that will allow the classification of risk at interurban intersections as a function of the analysis of conflicts between vehicles performed by means of surrogate road safety variables. The proposal of a methodology for the analysis and early evaluation of safety at an intersection will be based on two surrogate safety measures: the time to collision and the post encroachment time. On the other hand, the experimental development has taken place by means of field studies in which the exploratory part of the investigation selected three interurban T-intersections where the application of the traffic conflict technique gave variables that characterize the conflicts between vehicles; then, using multivariate analysis techniques, the models for the classification of qualitative and quantitative risk were obtained. With the models new field studies were carried out at six interurban Tintersections with the purpose of developing the homologation and the final study of the agreement between the proposed index and the classification model. The risk index obtained is a very useful tool for making rapid evaluations to estimate the hazard of a T-intersection, as well as for getting simply and economically the field data records after a fast training of the workers and then preparing the report of results by a specialist. The risk indices obtained show that the most influential original variables are the measurements of time. It was determined that the highest risk index values are related with greater risk of a conflict resulting in an accident. Within this index, the only variable whose contribution is proportionally direct is the approach speed, in agreement with what happens in a conflict, because excessive speed appears as a clear risk factor at an intersection because it intensifies all the human driving faults. One of the main contributions of this doctoral thesis to road engineering is the possibility of applying the methodology by local road administrations, which very often have limited investment resources to carry out these kinds of preventive studies, particularly in developing countries. The evaluation of the risk at an intersection after an improvement in terms of infrastructure and/or traffic control devices, the same as a before/after analysis, without comparison of accident occurrence but by means of the traffic conflict technique, can become a direct and economical application. It is also shown that main components analysis used for producing the risk index of the intersection is a useful tool for summarizing the whole set of measurements that can be obtained with the traffic conflict technique and allow diagnosing accident risk at an intersection. As to the methodology for the homologation of the models, the validity and reliability of the set of responses delivered by the observers recording the field data could be established, because the results of the validation show that agreement between the observations and the responses delivered by the models is significant and highly coincident.