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BACKGROUND: Most organizations perceive the concept of ergonomic actions as a local tool used to improve workplace issues. Ergonomics however is not included in global management systems. The paradigm of ergonomics action in large organizations proposed by this study is that of management systems whose primary objective is the pressing need for continuous performance improvement, acquisition of excellence, and integration into all aspects of the business. OBJECTIVE: The general objective of this work is to draw a frame presenting a model of ergonomics management based on good practices in managing this discipline in large industrial companies. METHOD: In this study, we describe a strategy based on the fuzzy set theory to aggregate a group of good practices expressed by experienced ergonomists attached to large industrial companies for handling the lack of ergonomics in an organization. RESULTS: A set of good practices was compiled as a basis for application in ergonomics in large companies. CONCLUSION: This study shows that ergonomics should not be considered an isolated phenomenon but in a strategic, proactive, integrated, and perennial way as one of the management subjects.

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BACKGROUND: In Brazil, the Mobile Emergency Medical Service (SAMU) is a model of mobile assistance and care for emergencies standardized throughout the country. The water ambulance service within the SAMU operates in riverside and coastal areas, and faces challenges and peculiarities that increase the complexity of providing a high-quality and safe emergency care service. OBJECTIVE: To develop organizational design guidelines aiming to improve resilient performance of complex systems, with an application to riverine and coastal mobile emergency care in Brazil. METHODS: Data collection followed an ethnographic approach. Fieldwork was carried in a participatory way, based on worksite technical description, semi-structured interviews with managers and emergency care teams' professionals, and work observation whenever possible. Five regional SAMU coordinations were visited. Data coding employed content analysis and grouped data excerpts according to concepts of capacity and demand. Interfaces were identified between demand and capacity elements and adaptations led by system agents, orienting the proposal of guidelines for organizational design as solutions to face the verified gaps. RESULTS: Design guidelines produced spanned composition and training of both intervention teams and dispatch central teams, uniforms and personal protective equipment (PPE), decentralized water bases, means of communication, intervention protocols, biosafety and inter-sector actions. CONCLUSION: The approach enabled framing and assessment of specific design elements according to resilience engineering concepts, which in turn showed paths for improving the service and reconciling work-as-imagined and actual system functioning.

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BACKGROUND: To overcome the poor conditions of low-income areas in developing countries like Brazil, Community Health Workers (CHWs) are required to exceed the regular set of formal skills they are used to employ. OBJECTIVE: In this study, we aim at identifying the non-technical skills CHWs must develop to cope with the extraordinary situations that occur in vulnerable communities. METHODS: 41 CHWs based in two primary healthcare clinics in Brazil underwent two rounds of in-depth interviews. The analysis was carried out using the Analytical Hierarchy Process, resulting in the prioritization of social skills according to their calculated importance to house calls. RESULTS: Among the ten higher-scored skills, we find communication and advocacy skills being of high importance. Civility was found to be the most important attribute, confirming that community action relies strongly on the relationship between health professionals and the community. CONCLUSION: The results of our study contribute primarily to the improvement of community-based primary care programs as it helps to identify major skills required for community action.

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BACKGROUND: This literature review covers original journal papers published between 2011 and 2015. These papers review the current status of research on the application of human factors and ergonomics in risk assessment systems' design to cope with the complexity, singularity, and danger in patient triage in primary health care. OBJECTIVE: This paper presents a systematic literature review that aims to identify, analyze, and interpret the application of available evidence from human factors and ergonomics to the design of tools, devices, and work processes to support risk assessment in the context of health care. METHODS: Electronic search was performed on 7 bibliographic databases of health sciences, engineering, and computer sciences disciplines. The quality and suitability of primary studies were evaluated, and selected papers were classified according to 4 classes of outcomes. RESULTS: A total of 1845 papers were retrieved by the initial search, culminating in 16 selected for data extraction after the application of inclusion and exclusion criteria and quality and suitability evaluation. CONCLUSIONS: Results point out that the study of the implications of the lack of understanding about real work performance in designing for risk assessment in health care is very specific, little explored, and mostly focused on the development of tools.

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Background: The emergence of carbapenemase mediated resistance in Enterobacteriaceae has a strong clinical impact. This study aimed to do a genotypic and phenotypic characterization of the enzymatic resistance to β-lactams in clinical Enterobacteriaceae isolates with decreased susceptibility to carbapenems in a university medical center in Santiago. Methods: During April-September 2010 at Hospital Clinico Universidad de Chile, 23 isolates of carbapenem non susceptible Enterobacteriaceae were collected. We used PCR for the detection of class A carbapenemases (SME, IMI, NMC, GES and KPC) and the modified Hodge with the boronic acid test to phenotypically assess the presence of serine-carbapenemases. To assess extended spectrum β-lactamases (ESBLs) the CLSI phenotypic tests were performed. Metallo-β-lactamases (MBL) and AmpC were assessed with commercial tablets. Results: 18/23 were Klebsiellapneumoniae and 5/23 strains were Enterobacter cloacae. All PCR to class A carbapenemases were negative. 3/23 strains (all E. cloacae), were positive to the Hodge modified test and 1/23, a K.pneumoniae, was positive to the boronic acid test. ESBLs were detected in 14/23 os the strains and AmpC in 5/23. No MBL was detected. Conclusion: No class A serine-carbapenemasa was detected. The decreased susceptibility to carbapenems is probably explained by the β-lactamase activity and due to porin loss.

Introducción: La emergencia de resistencia a β-lactámicos por carbapenemasas en enterobacterias tiene gran importancia clínica. El objetivo de este estudio fue caracterizar genotípica y fenotípicamente la resistencia enzimática a β-lactámicos en enterobacterias con susceptibilidad disminuida a carbapenémicos, en cepas aisladas de pacientes de un hospital universitario de Santiago. Metodología: Durante abril-septiembre 2010, en el Hospital Clínico de la Universidad de Chile se recolectaron 23 aislados. Se detectaron serinocarbapenemasas clase A (SME, IMI, NMC, GES y KPC) mediante RPC. Se empleó el test de Hodge modificado y acido fenil-borónico (APB) para la detección fenotípica de serinocarbapenemasas. Se detectó la presencia de β-lactamasas de espectro extendido según CLSI y AmpC y MBL mediante tabletas comerciales. Resultados: 18 cepas (78,26%) correspondieron a Klebsiella pneumoniae y 5 cepas (21,74%) a Enterobacter cloacae. Todas las RPC para serinocarbapenemasas fueron negativas, en tanto, el test de Hodge fue positivo para 3/23 cepas, todas E. cloacae. Una cepa de K. pneumoniae fue positiva para APB. Se detectó BLEE en 14/23 cepas, AmpC en 5/23 cepas y no se detectó MBL. Conclusiones: En las cepas estudiadas no se detectaron serinocarbapenemasas clase A. Probablemente los mecanismos que explican la susceptibilidad disminuida a carbapenémicos, involucran resistencia enzimática, combinados con cambios en la permeabilidad de la membrana bacteriana.

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BACKGROUND: The emergence of carbapenemase mediated resistance in Enterobacteriaceae has a strong clinical impact. This study aimed to do a genotypic and phenotypic characterization of the enzymatic resistance to ß-lactams in clinical Enterobacteriaceae isolates with decreased susceptibility to carbapenems in a university medical center in Santiago. METHODS: During April-September 2010 at Hospital Clinico Universidad de Chile, 23 isolates of carbapenem non susceptible Enterobacteriaceae were collected. We used PCR for the detection of class A carbapenemases (SME, IMI, NMC, GES and KPC) and the modified Hodge with the boronic acid test to phenotypically assess the presence of serine-carbapenemases. To assess extended spectrum ß-lactamases (ESBLs) the CLSI phenotypic tests were performed. Metallo-ß-lactamases (MBL) and AmpC were assessed with commercial tablets. RESULTS: 18/23 were Klebsiellapneumoniae and 5/23 strains were Enterobacter cloacae. All PCR to class A carbapenemases were negative. 3/23 strains (all E. cloacae), were positive to the Hodge modified test and 1/23, a K.pneumoniae, was positive to the boronic acid test. ESBLs were detected in 14/23 os the strains and AmpC in 5/23. No MBL was detected. CONCLUSION: No class A serine-carbapenemasa was detected. The decreased susceptibility to carbapenems is probably explained by the ß-lactamase activity and due to porin loss.

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In this paper, we analyzed two laboratories of liquid chromatography (LC), separation technique of mixtures and identification of its components, in order to identify projectual gaps relating to the environment and the working station. The methodology used was the ergonomic analysis with interactional and participatory techniques applied during the activity performance. This work incorporated and adapted the concept developed by Alexander (1979)--pattern languages--passing from architectural projects to workstations project and physical arrangement of the work environment. The adaptation of the concept resulted in a list of recommendations, requirements and concepts that have brought design solutions for the problematic aspects observed in the ergonomic analysis. The employed methodology, strongly supported in ergonomics principles, and in interactional and participatory techniques, contributed to achieve our gold that is what we now call Conceptual Standards. The patterns go beyond of a usual model of book a of ergonomics specification, once incorporating the viewpoint of the end user, it is also a set of best project practices and of project management in conception ergonomics.

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This paper presents a study about fatigue recovery time assessment processes in work activities. It came about due to a demand presented by an automotive industry giant, in need of updating existing cycle time sheets and TAKT time parameters. The company decided to hire an Ergonomics Laboratory with ties to a major Brazilian University in order to evaluate current conditions and establish a new method to either calculate recovery times or validate existing assessment criteria, based in the ergonomics evaluation of the work activities. It is clear that there has been evident evolution in the industrial sector in the past two decades. It brought up fast modernization of industrial processes, not only in production but also in terms of management systems. Due to improved computer and robotics systems, combined with overall operational advancements - like the use of lighter hand tools and more effective hoist systems - most work activities have had its physical effort requirements reduced in the past decades. Thus, compensation factors built into production times need to be reviewed in order to avoid unnecessary costs associated to them. By using ergonomics considerations, we prevent simply removing the physical variables built in rest time calculations without taking on account, for example, additional cognitive load represented by the use of more sophisticated pieces of equipment.

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This paper aims at the application of an ergonomic maturity model (EMM), in order to assess the ergonomic sustainability outreach of ergonomic actions. This proposition was motivated by the widespread sensation that the development of the discipline, its educational devices and related practices depends on the attitude of ergonomics practitioners rather than environmental macroergonomic conditions. Maturity modeling in this paper is undertaken as a tool for ergonomic practitioners. Thus, its foundations were uprooted from diverse fields: Clinic Psychology, Quality Management and Project Management. The paper brings about a detailled explanation of this ergonomic maturity tool. The empirical part is fulfilled by the examination - using the EMM - of four emblematic cases excerpted from our research lab ergonomic portfolio.

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This paper presents a protocol for work distress assessment. Work distress is defined as a merge between nonergonomic related aspects, in tasks or environment, and adversely conditions perceived for a worker, in a certain work situation. This frame requires an approach that can treat individuals and organizational factors in the same way, at the same time. For this, we elaborate a psycho-ergonomics method, associating concepts and practices from cognitive-behavioral techniques and work ergonomic analysis, which we named CEWAT - Cognitive-Behavioral Work Analysis Technique. This paper presents CEWAT's foundations and structure, in steps. An application to a complex and dangerous system illustrates its benefits in the ergonomics action.

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This article discusses the development of a computerized support to demands for treatment of a wide spectrum and diverse nature. Developed under SPM platform (Situação, Problema e Melhoria), the practitioner seeks to provide an ergonomic aid from the identification and characterization of the processes of analysis demands. The interest of a technological support the practice of ergonomics is a domestic origin, which already features a wide universe. For purposes of this article will be drawn the line defined by the universe in the Federal Public Service occupations within the guidelines set Subsystem Integrated System for Health Care Workers of the Federal Government. The development of this system initially intended to assist the practitioner in ergonomics mapping situations in which the federal public servant has been undergoing for the second time that can classify and then treat them.

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Radiopharmaceuticals are radiation-emitting substances used in medicine for radiotherapy and imaging diagnosis. A Research Institute, located in Rio de Janeiro, produces three radiopharmaceuticals: the sodium iodate is used in the diagnosis of thyroid dysfunctions, the meta-iodo-benzylguanidine is used in the diagnosis of cardiac diseases, and the fluordesoxyglucose is used in diagnosis in cardiology, oncology, neurology and neuropsychiatry. This paper presents a method to access safety and resilience in radiopharmaceuticals production processes. The method uses resilience indicators in order to proactively evaluate and manage the safety.

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INTRODUÇÃO: Fissuras anais crônicas são úlceras benignas, dolorosas, profundas. Ocorrem devido a trauma das fezes, hipertonia esfincteriana e pobre vascularização. Cirurgia é mais efetiva, porém com efeitos adversos (incontinência anal). Terapia conservadora consegue decréscimo transitório da pressão de repouso, cicatrizando muitas lesões, sem dano muscular. MÉTODOS: Objetivando avaliar tratamento de fissuras crônicas com isossorbida (ISO) a 1 por cento tópica, foi realizado um ensaio clínico, duplo-cego em pacientes do Serviço de Coloproctologia da Universidade Federal de Sergipe (UFS) - Aracaju, Sergipe, durante um ano. Foram estudados 24 pacientes: 14 no Grupo 1 - creme com ISO, e 10 no Grupo 2 - placebo. Avaliaram-se comportamento da pressão de repouso, melhora da dor e grau de cicatrização das feridas com e sem ISO. RESULTADOS: Resultados mostraram que a fissura acometeu mais mulheres, a constipação foi observada em 58,3 por cento. Quanto à dor, obteve-se menor intensidade no Grupo 2, mas sem significância. A cicatrização ao fim de 60 dias foi igual nos dois grupos (50 por cento). Quanto às médias de pressão de repouso com 30 e 60 dias, houve queda no padrão em ambos os grupos, porém sem significância. Observou-se que pacientes curados foram os de maior redução de pressão de repouso. CONCLUSÃO: Concluiu-se que a ISO não modificou o padrão de resposta manométrica; todavia, houve melhora clínica importante nos dois grupos, cuja taxa de cicatrização foi equivalente.

INTRODUCTION: Chronic anal fissures are deep, benign and painful ulcers. The involved factors are local trauma, sphinter hypertonia and poor blood flow. Surgery is gold standard treatment, but it causes fecal incontinence. Medical non-surgical therapy gets transitory resting pressure reduction and cure of lesions, without muscular damage. METHODS: In order to evaluate the treatment of chronic anal fissures using topical isossorbide (ISO) 1 percent, a randomizated and double-blind study twas carried out in Coloproctology Section of Universidade Federal de Sergipe (UFS), Sergipe, Brazil, during one year. Twenty-four patients were evaluated: 14 in Group 1 - ISO cream, and 10 in Group 2 - placebo. Resting pressure profile, improvement of painful symptoms and degree of scaring of the fissure were evaluated. RESULTS: Ulcer was more prevalent in women, constipation was present in 58.3 percent. The evacuatory pain was less common in Group 2, but without statistical significance. After 60 days, the healing was equal in the both groups (50 percent). There was a small reduction of resting pressure means at the end of 30 and 60 days, without statistical significance. Healing patients presented more resting pressure reducing. CONCLUSION: ISO cream did not influence the manometric response standard; otherwise it offered clinical improvement in both groups, whose scarring index was similar.

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A fundamental challenge in improving the safety of complex systems is to understand how accidents emerge in normal working situations, with equipment functioning normally in normally structured organizations. We present a field study of the en route mid-air collision between a commercial carrier and an executive jet, in the clear afternoon Amazon sky in which 154 people lost their lives, that illustrates one response to this challenge. Our focus was on how and why the several safety barriers of a well structured air traffic system melted down enabling the occurrence of this tragedy, without any catastrophic component failure, and in a situation where everything was functioning normally. We identify strong consistencies and feedbacks regarding factors of system day-to-day functioning that made monitoring and awareness difficult, and the cognitive strategies that operators have developed to deal with overall system behavior. These findings emphasize the active problem-solving behavior needed in air traffic control work, and highlight how the day-to-day functioning of the system can jeopardize such behavior. An immediate consequence is that safety managers and engineers should review their traditional safety approach and accident models based on equipment failure probability, linear combinations of failures, rules and procedures, and human errors, to deal with complex patterns of coincidence possibilities, unexpected links, resonance among system functions and activities, and system cognition.

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Este trabalho tem por objetivo principal discutir o paradigma do aprendizado escolar formal ocorrer basicamente na posição sentada, considerando atitude crítica porque a postura sentada é extremamente danosa à saúde da coluna vertebral, induz a comportamentos posturais e gera hábitos danosos que se propagam para a vida adulta. É um estudo descritivo acerca da manutenção da postura sentada em crianças escolares, os resultados demonstram a necessidade de treinar os professores e que a manutenção da postura sentada por longos períodos produz fadiga muscular no aluno. É conclusiva a necessidade de ampliar as aulas de educação física e mudar o paradigma didático da educação.

The main objective of this work is a discussion about the paradigm that the formal school apprenticeship occur on sitting posture, considering critical attitude about this because the sitting posture is too dangerous for the spine and can induce the adoption of bad postures and bad habits retain into the adult life. This is a descriptive study about the long periods sitting posture maintenance on school children, and the results show that teachers should be trained and the maintenance of the same posture for prolonged periods produces muscles fatigue in children. The necessity to enlarge the physical education discipline is conclusive and is necessary to change the didactic education paradigm.

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Este artigo tem por objetivo analisar os resultados das ações de ergonomia efetuadas em empresas notificadas pela auditoria fiscal do Ministério do Trabalho e Emprego com base na Norma Regulamentadora - 17. O campo empírico propiciou uma apreciação sobre a ergonomia como instrumento de ação pública e de estratégia empresarial. Revelam-se, como decorrência do processo investigativo realizado por ergonomistas nas empresas autuadas, procedimentos rotineiros relativos à mentalidade empresarial, ao gerenciamento e à percepção dos trabalhadores sobre condições de trabalho. As percepções produzidas por esses cenários caracterizaram-se de forma distinta, porém complementar. Conclui o artigo que há necessidade social de políticas públicas e empresariais em ergonomia com vistas à saúde do trabalhador.

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This research project was designed to investigate cultural and cognitive issues related to the work of nuclear power plant operators during their time on the job in the control room and during simulator training (emergency situations), in order to show how these issues impact on plant safety. The modeling of the operators work deals with the use of operational procedures, the constant changes in the focus of attention and the dynamics of the conflicting activities. The paper focuses on the relationships between the courses of action of the different operators and the constraints imposed by their working environment. It shows that the safety implications of the control room operators' cognitive and cultural issues go far beyond the formal organizational constructs usually implied. Our findings indicate that the competence required for the operators are concerned with developing the possibility of constructing situation awareness, managing conflicts, gaps and time problems created by ongoing task procedures, and dealing with distractions, developing skills for collaborative work.

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Estudo retrospectivo, realizado no Hospital Governador João Alves Filho, no período de janeiro de 1990 a fevereiro de 1999, tem como objetivo avaliar as principais causas de obstrução intestinal de pacientes que foram admitidos no serviço de urgência, correlacionando-as com as condutas cirúrgicas tomadas. Foram analisados 118 pacientes que deram entrada no serviço de urgência, avaliando idade, sexo, quadro clínico, achado cirúrgico, terapêutica instituída e a morbi-mortalidade. Nos 118 pacientes estudados houve predominância do sexo masculino (59por cento). A faixa etária variou de acordo com as patologias. A principal causa foi brida de delgado (44por cento), seguida por volvo (23por cento), principalmente o de sigmóide (89por cento), e bolo de áscaris (11por cento). Nos pacientes do sexo masculino predominaram as obstruções por invaginação, hérnia e bolo de áscaris. No feminino destacaram-se os tumores, com localização mais comum no sigmóide. Bolo de áscaris e invaginação predominaram nos pacientes com menos de 10 anos, hérnias e bridas entre os 30 e 40 anos, enquanto que tumores e volvo predominaram em pacientes com mais de 50 anos. A terapêutica instituída variou com a patologia e sua apresentação, se simples ou complicada. A morbidade foi de 38por cento, sendo mais comuns os distúrbios hidro-eletrolíticos (18por cento). As patologias que mais apresentaram complicações foram o bolo de áscaris (61por cento) e os tumores (58por cento). A mortalidade foi de 20por cento, ocorrendo mais nos pacientes com tumores (42por cento) e bolo de áscaris (39por cento). As condutas cirúrgicas foram determinadas pelas etiologias, reservando-se os maiores índices de morbi-mortalidade às patologias que acometeram os extremos de idade.

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Las Betalactamasas de espectro extendido (BLEE) son enzimas de configuración plasmídica producidas por bacterias que hidrolizan los antibióticos betalactámicos. La aparición de cepas bacterianas productoras de BLEE, constituye un problema de salud pública que afecta a todo tipo de instituciones y a la comunidad en general. Este estudio tiene como objetivo determinar las incidencia de BLEE en pacientes hospitalizados del Hospital Clínico de la Universidad de Chile. Se estudió un total de 238 cepas en el periodo julio-agosto 2004; de las cuales 184 correspondieron a de E. coli, 39 a K. pneumoniae y 15 a K. oxytoca, utilizándose el test confirmatorio de BLEE según estándar NCCLS 2004. Se encontró una incidencia de BLEE para E. coli de un 10.3 por ciento, para K. pneumoniae de 28.2 por ciento y de K. oxytoca de 20 por ciento, respectivamente. La distribución de los aislamientos de las cepas BLEE (+) en los distintos servicios del Hospital fue diversa: E. coli se encontró principalmente, en los servicios de medicina y cirugía, y K. pneumoniae en los servicios críticos. Los resultados del estudio permitieron conocer la incidencia y distribución de BLEEs en el Hospital Clínico de la Universidad de Chile y justificaron la implementación de esta técnica de diagnóstico como parte de la rutina del laboratorio de microbiología.

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Estudo restrospectivo de 2.464 exames retossigmoidoscópicos realizados no Hospital Universitário da Universidade Federal de Sergipe, no Hospital governador Joäo Alves Filho e em Clínicas Particulares de Aracaju - sergipe, no período compreendido entre Janeiro de 1991 a dezembro de 1999. em 442 exames foram observados processos inflamatórios, dos quais houve comprovaçäo de retocolite esquistossomótica em 55 casos. Foram analisadas variáveis como idade, sexo, manifestações clínicas procedência, localizaçäo das alterações, patologias associadas e impressäo dianóstica ao exame endoscópico. Houve predomínio do sexo masculino com 76 por cento do total. A idade variou de 9 a 77 anos, com média de 37. A terceira década de vida foi a mais acometida no sexo feminino, enquanto que no masculino foi a quinta Cerca de 44 por cento da populaçäo provinha do interior de Sergipe. Foi observada predominância das manifestações da retocolite ulcerativa exclausivamente na porçäo retal, com 80 por cento. O sangramento foi a principal indicaçäo para a realizaçäo dos exames (355). Num total de 47 patologias associadas encontradas, as mais freqüentes foram hemorróida, papilite e plicoma. Em 76 por cento dos pacientes näo houve suspeita de parasitose como etiologia da retocolite ao exame retossigmoidoscópico. Os resultados deste trabalho demonstraram que a esquistossomose deve ser pesquisada, em sergipe e em regiões onde esta seja endêmica, como importante diagnóstico diferencial em pacientes com processo inflamatórios intestinais

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