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Thunderclap headache is a medical emergency presented as the worst headache ever, is characterised by an abrupt onset and maximal intensity within seconds to minutes. However, cerebrovascular causes are among the most common causes of thunderclap headache, and other non-vascular life-threatening aetiologies should be considered in evaluating a patient. We describe a 23-year-old previously healthy Latino woman who presented to our hospital after a month of repetitive severe, abrupt-onset headaches. Her prior medical history was unremarkable. After a normal brain MRI with angio-MRI, a lumbar puncture was performed with normal opening pressure, hypoglycorrhachia, increased proteins and a leucocyte; India ink staining was positive for encapsulated yeast, cultures were positive for

Studies on the differential effects of health emergencies have largely overlooked women health workers. Whilst the literature has shown the impact of Coronavirus disease-19 (COVID-19) on women and on healthcare workers, little research has considered the gendered effects of the health workforce. This article analyses the impact of COVID-19 on healthcare workers and working conditions in Brazil’s public healthcare system, through consideration of gendered and racialized understandings of care and work. Data were taken from an online survey of 1,263 health workers, undertaken between September and October 2020, disaggregated by sex and by race in order to understand health workers’ experiences of the pandemic in one of the countries most significantly affected by the crisis.

Public health emergencies are a test of resilience for health systems, which depend on health workforces that are well managed and cared for. The COVID‐19 pandemic exposed the weakness of many health systems in preparing their health workforces. The crisis also exacerbated the unequal conditions between different professions, an issue that is still understudied in the workforce literature. This paper analyzes the consequences of the COVID‐19 pandemic for different health professionals, considering the ways in which Brazil's the health system does or does not protect them. We also analyse the role of pre‐existing inequalities between different professions and social groups within the workforce in shaping their different experiences of the pandemic. We present data comparing the perceptions of different health professionals facing the pandemic in Brazil: physicians, nurses, and community health workers. Data were collected in an online survey in Brazil with 1630 health care workers between June 15th and July 1st. Findings suggest that none of the professions felt well prepared to work under emergencies. However, differences relating to professional background were exacerbated during the pandemic, creating unequal conditions for different health workers. These inequalities may pose new challenges for the post‐pandemic scenario.

Resumo Diante da importância do trabalho de Enfermagem no combate a epidemias e dos desafios impostos pela covid-19 ao exercício da profissão, o objetivo deste artigo é analisar as condições de trabalho e as percepções das profissionais de Enfermagem sobre sua atuação no contexto da pandemia de covid-19 no Brasil. Para tanto, realizamos uma pesquisa de caráter exploratório, a partir de um questionário online, aplicado entre 15 de junho e 1º de julho de 2020, respondido por 445 profissionais. Realizamos análise qualitativa, fundamentada na análise de conteúdo proposta por Bardin e Saldaña. No campo das sensações, os relatos das profissionais evidenciam medo, aumento da irritabilidade, sobrecarga de trabalho, tristeza e solidão. A pandemia da covid-19 alterou os processos de trabalho e a organização dos serviços, influenciando no dimensionamento do quantitativo de profissionais, na jornada de trabalho e na modalidade de execução, além de demandar maior vigilância quanto às medidas de prevenção e contágio. As mudanças impactaram no tempo disponibilizado para atendimento, na interação entre profissionais e usuários, e prejudicou a comunicação. A relevância do trabalho de Enfermagem junto às equipes de saúde no enfrentamento à covid-19 no Brasil reforça a necessidade de adoção de medidas eficazes de proteção e preservação da saúde física e mental dessas profissionais. Abstract Before the importance of nursing in fighting epidemics and the challenges imposed on the exercise of the profession by COVID-19, this paper aims to analyze the working conditions and perceptions of nursing professionals regarding their performance in the context of the COVID-19 pandemic in Brazil. This exploratory research consisted of data collected through an online survey answered by 445 nursing professionals between June 15th and July 1st, 2020. Data underwent a qualitative content analysis in the light of the propositions of Bardin and Saldaña. In the field of sensations, the professionals’ reports show fear, increased irritability, work overload, sadness, and loneliness. Besides demanding greater vigilance regarding preventive measures to reduce contagion, the COVID-19 pandemic changed the work processes and services organization, influencing the quantitative dimensioning of professionals, working hours, and execution mode. Moreover, these changes impacted the time available for care and the interaction between professionals and users. The relevance of nursing work and health teams in confronting COVID-19 in Brazil reinforces the need for effective measures aimed at protecting and preserving these professionals’ physical and mental health.

Diante da importância do trabalho de Enfermagem no combate a epidemias e dos desafios impostos pela covid-19 ao exercício da profissão, o objetivo deste artigo é analisar as condições de trabalho e as percepções das profissionais de Enfermagem sobre sua atuação no contexto da pandemia de covid-19 no Brasil. Para tanto, realizamos uma pesquisa de caráter exploratório, a partir de um questionário online, aplicado entre 15 de junho e 1º de julho de 2020, respondido por 445 profissionais. Realizamos análise qualitativa, fundamentada na análise de conteúdo proposta por Bardin e Saldaña. No campo das sensações, os relatos das profissionais evidenciam medo, aumento da irritabilidade, sobrecarga de trabalho, tristeza e solidão. A pandemia da covid-19 alterou os processos de trabalho e a organização dos serviços, influenciando no dimensionamento do quantitativo de profissionais, na jornada de trabalho e na modalidade de execução, além de demandar maior vigilância quanto às medidas de prevenção e contágio. As mudanças impactaram no tempo disponibilizado para atendimento, na interação entre profissionais e usuários, e prejudicou a comunicação. A relevância do trabalho de Enfermagem junto às equipes de saúde no enfrentamento à covid-19 no Brasil reforça a necessidade de adoção de medidas eficazes de proteção e preservação da saúde física e mental dessas profissionais. Before the importance of nursing in fighting epidemics and the challenges imposed on the exercise of the profession by COVID-19, this paper aims to analyze the working conditions and perceptions of nursing professionals regarding their performance in the context of the COVID-19 pandemic in Brazil. This exploratory research consisted of data collected through an online survey answered by 445 nursing professionals between June 15th and July 1st, 2020. Data underwent a qualitative content analysis in the light of the propositions of Bardin and Saldaña. In the field of sensations, the professionals’ reports show fear, increased irritability, work overload, sadness, and loneliness. Besides demanding greater vigilance regarding preventive measures to reduce contagion, the COVID-19 pandemic changed the work processes and services organization, influencing the quantitative dimensioning of professionals, working hours, and execution mode. Moreover, these changes impacted the time available for care and the interaction between professionals and users. The relevance of nursing work and health teams in confronting COVID-19 in Brazil reinforces the need for effective measures aimed at protecting and preserving these professionals’ physical and mental health.

Objective This metanalysis aimed to evaluate the sensitivity and specificity of computed tomography colonography in colorectal polyp detection. Methods A literature search was performed in the PubMed and Web of Science databases. Results A total of 1,872 patients (males 57.2%, females 42.8%) aged 49 to 82 years old (mean age 59.7 ± 5.3 years) were included in this metanalysis. The estimated sensitivity of computed tomography colonography was 88.4% (46.3-95.7%, coefficient of variation [CV]=28.5%) and the estimated specificity was 73.6% (47.4-100.0%, CV=37.5%). For lesions up to 9mm, the sensitivity was 82.5% (62.0-99.9%, CV =25.1%) and the specificity was 79.2% (32.0-98.0%, CV=22.9%). For lesions>9mm, the sensitivity was 90.2% (64.0-100.0%, CV=7.4%) and the specificity was 94.7% (80.0-100.0%, CV=6.2%). No statistically significant differences in sensitivity according to the size of the lesion were found (p=0.0958); however, the specificity was higher for lesions>9mm (p

La actual configuración de la ciudad, de la vivienda y la forma en que se conciben los imaginarios, condicionan el cumplimento de las necesidades esenciales del hombre, debido a la ideología mercantilista predominante, que subyuga al hombre a escenarios semejantes a los mencionados en el mito del lecho de Procusto, para imponer en aras una uniformidad de espacios insalubres. El método a seguir en este capítulo es conceptual analítico deductivo y descriptivo, analizando información sobre el fenómeno vivienda, imaginarios y ciudad. Es, además un trabajo de carácter interdisciplinario. El enfoque descriptivo permitirá vincular las necesidades del hombre, partiendo de la teoría de Maslow con una implicación directa o indirecta en el bienestar del hombre, además, para agregar un hilo conductor a este artículo se tomarán recursos del método narrativo para la investigación. El objetivo de este escrito es hacer un análisis entre las necesidades del hombre, y la configuración contemporánea de las ciudades, las viviendas, y en su carácter dentro de los imaginarios, con el fin de analizar las posibles vinculaciones con el bienestar.

A pobreza é uma das principais temáticas discutidas pelas Ciências Sociais e nas últimas décadas ganhou destaque enquanto problema social a ser enfrentado pelos Estados, por meio de políticas públicas. Entre as possíveis ações estatais para combater a pobreza, as políticas de transferência de renda direta materializam-se como o “carro-chefe” da assistência social em países do Sul Global. A focalização nas mulheres, preferencialmente titulares do benefício, é uma das principais características desse tipo de iniciativa, pois garantiria que o dinheiro fosse aplicado de forma mais “eficiente” para sobrevivência das famílias, em especial para o cuidado das crianças e dos adolescentes. Esse aspecto é discutido por autoras feministas como uma forma de “funcionalizar” a mulher, o que reproduziria papéis de gênero que sobrecarregam as mulheres com o trabalho do cuidado. No Brasil, o programa Bolsa Família completa 16 anos de implementação e, apesar das controvérsias, é visto como uma política de sucesso no combate à pobreza. Na seara de estudos sobre possíveis mudanças na vida das pessoas beneficiárias, diversas autoras discutem sobre possíveis processos de ganhos de autonomia das mulheres. A partir desse questionamento, o corpus analítico consolidado aponta para dois caminhos possíveis: aumento de autonomia feminina ou reforço dos papéis de gênero. O presente trabalho busca analisar se laços sociais de mulheres beneficiárias são transformados ou iniciados após a inserção delas no Bolsa Família, e se estes são capazes de impulsionar ou minar a sua autonomia, tendo o potencial de contribuir para que transcendam desigualdades de gênero. O conceito de autonomia relacional adotado combina uma abordagem feminista a uma perspectiva sociológica, ao considerar que as pessoas só podem ser efetivamente autônomas nas suas relações com outras [nunca sozinhas, isto é, independentes]. Assim, a autonomia é marcada pela interdependência entre as pessoas, vistas como “eus em relação”. Para responder a pergunta de pesquisa, foi realizado um estudo de caso qualitativo, que lança mão de análise documental, observação direta e entrevistas em dois bairros periféricos em Santos (SP) – Alemoa e Dique Vil Gilda. Como estratégia de coleta e análise dos dados optou-se pelo uso do método da história oral, empreendido com trezes mulheres beneficiárias do Bolsa Família e residentes de moradias sobre palafitas. Adicionado a isto, foram conduzidas entrevistas com roteiro semiestruturado com assistentes sociais que trabalham nos CRAS (Alemoa e Rádio Clube), ambos equipamentos que as mulheres beneficiárias frequentam. Os resultados sugerem que a autonomia dessas mulheres é imperfeita, uma vez que as dinâmicas produzidas no ciclo intergeracional da pobreza e as múltiplas carências e violências (com destaque às de gênero) não são rompidas e continuam condicionando as suas experiências cotidianas. Ademais, constatou-se que, por um lado, a autonomia é minada por relações com homens que reproduzem papéis desiguais de gênero; mas, por outro lado, há espaço para construção de redes de ajuda mútua e afetos para além da esfera doméstica, sendo dinâmicas importantes para o impulso da autonomia e bem-estar das mulheres. Poverty is one of the main thematic topics discussed by social sciences and, in the last decades, it received even more attention as a social problem that demanded State action through public policies. Between the many possibilities of State action courses that could be adopted to deal with the poverty issue, cash transfer programs have presented themselves as a very popular social assistance policy between countries in the Global South. The strategy of targeting women is one of the main features of this type of policy because it guarantees that the money is applied in a more “efficient” way for the family’s survival, especially benefiting children and adolescents. However, this policy’s feature is debated by feminist authors who consider as a way of “functionalize” women. In this sense, it is argued that the policy design reproduces gender roles that can overwhelm women with care work. In Brazil, Bolsa Familia completes 16 years of implementation and, despite controversies that surround it, it is considered a successful public policy to address poverty issues. In the research field about possible effects of the program on the lives of the beneficiary women, many authors also debate possible leveraging processes related to female autonomy. Regarding these possible effects of Bolsa Familia in women’s life’s, the consolidated literature points to two possibilities: the program either raised women’s autonomy or it strengthened unequal gender roles. The present work seeks to analyze if the social bonds of beneficiary women of the Bolsa Familia are built or transformed after their inclusion in the program, and if these bonds can stimulate or weakening their autonomy. The concept of relational autonomy adopted in this work combines a feminist and a sociological approach by considering that people can only be effectively autonomous inside their relationships with one another (never by themselves, as independent individuals), since they’re embedded in the communities where they live in. To answer the proposed research questions, it was conducted a qualitative case study that used documental analysis, direct observation and interviews placed in two vulnerable neighborhoods in Santos (SP) - Alemoa and Dique Vila Gilda. As a strategy for data collection and analysis, this research uses an oral history methodology, throughout interviews with thirteen beneficiary women of Bolsa Familia and residents of “stilt houses” (“moradias sobre palafitas”) in the referred territories. Interviews with social workers from Social Assistance Referencial Centers (CRAS Alemoa and Rádio Clube), attended by the beneficiary women, were also conducted. Results suggest that these women’s autonomy is imperfect, since dynamics produced by the intergenerational poverty cycle and the multiple deficiencies and violence (specially, gender violence) experienced by these women are not broken with the Program’s experience and, therefore, continue to condition their daily lives experiences. Finally, analyses showed that, on one hand, these women’s autonomy is weakened due to relationships with male partners who reproduce unequal gender relations; but, on the other hand, there’s space for building networks aimed at providing mutual help and affections between these women beyond the domestic sphere, which could lead to important dynamics for leveraging women’s autonomy and well-being.

En muchas aplicaciones encontramos datos que se restringen al intervalo (0;1), tales como porcentajes y proporciones, y que además pueden ser explicados por otras variables a través de un modelo de regresión en el que la variable respuesta está distribuida como una beta. Por otro lado, se encuentran pares de variables que tienen cierta dependencia como es el caso del rendimiento en matemáticas y lectura crítica dados en las pruebas saber11 en el departamento del Tolima (Colombia) 2016. La teoría de las funciones cópula surgen como una alternativa para medir la dependencia de variables aleatorias con distribuciones marginales dadas, permitiendo estimar diferentes medidas de asociación y diferentes métodos de estimación. En este artículo se usó un Modelo Bivariado bajo el contexto de las funciones Cópula para datos que están en el intervalo (0;1). Se verificaron las propiedades de los modelos ajustados y se compararon diferentes métodos de estimaciones usando el paquete Cópula y VineCopula del software R con el fin de establecer cuál es el mejor. Se usaron datos simulados para realizar este proceso y se aplicaron los modelos a datos reales de rendimiento en lectura crítica y matemáticas en estudiantes entre los 14 a 24 años.

Dealing with the Covid-19 pandemic requires that the State make hard decisions that involve the action of bureaucrats who interact with the population through the implementation of public policy, the street-level bureaucracy (SLB). In this paper, based on a mixed- method exploratory study, we analyze how the daily performance of street-level bureaucrats in different policy areas- health and social care, access to the justice system, public security and education - has changed during the pandemic. We also explore the repercussions of those changes. Based on the analysis of the perceptions of bureaucrats, changes in their work and in their relationship with the public, we identify three categories that illustrate the dynamics of SLB work during the pandemic: the SLB who faces the crisis on the front lines; the SLB who suffers the effects of the pandemic, but whose work does not require her to face it directly; and the SLB who began to work remotely. We conclude that, during the pandemic, SLB suffered in varying degrees an aggravation of structural problems, such as their removal from decision-making processes - now restricted to the highest government level - and the exacerbation of already existing conflicts and ambiguities. Resumen: Hacer frente a la pandemia de Covid-19 requiere que el Estado tome decisiones difíciles que van más allá de la acción de la burocracia que implementa las políticas públicas en la interacción con la población, la burocracia de primera línea (BPL). En este artículo, a partir de un estudio exploratorio de método mixto, analizamos cómo el desempeño diario de estos burócratas en diferentes políticas públicas - salud, asistencia social, acceso a la justicia, seguridad pública y educación - se modificó durante la pandemia y sus consecuencias. Se identificaron tres categorías que ilustran la dinámica del trabajo de BNR durante la pandemia, analizando los sentimientos de los burócratas, los cambios en su trabajo y en la relación con la población: la BPL que enfrenta la crisis en primera línea; la BPL que sufre los efectos de la pandemia, pero cuyo trabajo no exige enfrentarla directamente; y la BPL cuyo trabajo migró al formato remoto. Concluimos que, durante la pandemia, la BPL, en diferentes grados, enfrentó un agravamiento de problemas estructurales, como su remoción de los procesos de toma de decisiones, restringida al más alto nivel de gobierno, y la exacerbación de conflictos y ambigüedades ya existentes. Resumo: O enfrentamento da pandemia de Covid-19 exige que o Estado tome decisões difíceis que perpassam a ação da burocracia que implementa políticas públicas na interação com a população, a burocracia de nível de rua (BNR). Neste artigo, baseado em estudo exploratório de método misto, analisamos como a atuação cotidiana desses burocratas em diferentes políticas públicas - saúde, assistência social, acesso à justiça, segurança pública e educação - foi alterada durante a pandemia, bem como analisamos as suas consequências. Três categorias que ilustram a dinâmica do trabalho da BNR durante a pandemia foram identificadas por análise dos sentimentos dos burocratas, mudanças no seu trabalho e na relação com a população: a BNR que enfrenta a crise na linha de frente; a BNR que sofre os efeitos da pandemia, mas cujo trabalho não demanda enfrentá-la diretamente; e a BNR cujo trabalho migrou para o formato remoto. Concluímos que, durante a pandemia, a BNR, em diferentes graus, deparou-se com um agravamento de problemas estruturais, como o seu alijamento dos processos decisórios, restritos ao alto escalão governamental, e a exacerbação de conflitos e ambiguidades já existentes.

Resumo As fragilidades da Atenção Primária à Saúde podem ser reconhecidas por meio da análise do trabalho das agentes comunitárias de saúde. Uma vez que a situação enfrentada por essas profissionais representa desafios estruturais do sistema de saúde, este artigo tem como objetivo analisar a situação das profissionais em questão no enfrentamento à pandemia de Covid-19 no Brasil. Analisamos seus desafios com base nos dados coletados em um inquérito online e em netnografia. Para a realização da análise dos dados, optamos pela análise de conteúdo, inspirada na grounded-theory. Observamos três dimensões que representam como as agentes comunitárias de saúde experienciam a pandemia: mudanças nas práticas de trabalho, bem como nas interações entre trabalhadores e usuários e a expectativa do futuro no trabalho pós-pandemia. As análises mostram que para resguardar essas profissionais e garantir o funcionamento da Atenção Primária à Saúde é necessário contar com novas estratégias para viabilizar as dinâmicas locais de trabalho.

O enfrentamento da pandemia de Covid-19 exige que o Estado tome decisões difíceis que perpassam a ação da burocracia que implementa políticas públicas na interação com a população, a burocracia de nível de rua (BNR). Neste artigo, baseado em estudo exploratório de método misto, analisamos como a atuação cotidiana desses burocratas em diferentes políticas públicas - saúde, assistência social, acesso à justiça, segurança pública e educação - foi alterada durante a pandemia, bem como analisamos as suas consequências. Três categorias que ilustram a dinâmica do trabalho da BNR durante a pandemia foram identificadas por análise dos sentimentos dos burocratas, mudanças no seu trabalho e na relação com a população: a BNR que enfrenta a crise na linha de frente; a BNR que sofre os efeitos da pandemia, mas cujo trabalho não demanda enfrentá-la diretamente; e a BNR cujo trabalho migrou para o formato remoto. Concluímos que, durante a pandemia, a BNR, em diferentes graus, deparou-se com um agravamento de problemas estruturais, como o seu alijamento dos processos decisórios, restritos ao alto escalão governamental, e a exacerbação de conflitos e ambiguidades já existentes. Dealing with the Covid-19 pandemic requires that the State make hard decisions that involve the action of bureaucrats who interact with the population through the implementation of public policy, the street-level bureaucracy (SLB). In this paper, based on a mixed- method exploratory study, we analyze how the daily performance of street-level bureaucrats in different policy areas- health and social care, access to the justice system, public security and education - has changed during the pandemic. We also explore the repercussions of those changes. Based on the analysis of the perceptions of bureaucrats, changes in their work and in their relationship with the public, we identify three categories that illustrate the dynamics of SLB work during the pandemic: the SLB who faces the crisis on the front lines; the SLB who suffers the effects of the pandemic, but whose work does not require her to face it directly; and the SLB who began to work remotely. We conclude that, during the pandemic, SLB suffered in varying degrees an aggravation of structural problems, such as their removal from decision-making processes - now restricted to the highest government level - and the exacerbation of already existing conflicts and ambiguities. Hacer frente a la pandemia de Covid-19 requiere que el Estado tome decisiones difíciles que van más allá de la acción de la burocracia que implementa las políticas públicas en la interacción con la población, la burocracia de primera línea (BPL). En este artículo, a partir de un estudio exploratorio de método mixto, analizamos cómo el desempeño diario de estos burócratas en diferentes políticas públicas - salud, asistencia social, acceso a la justicia, seguridad pública y educación - se modificó durante la pandemia y sus consecuencias. Se identificaron tres categorías que ilustran la dinámica del trabajo de BNR durante la pandemia, analizando los sentimientos de los burócratas, los cambios en su trabajo y en la relación con la población: la BPL que enfrenta la crisis en primera línea; la BPL que sufre los efectos de la pandemia, pero cuyo trabajo no exige enfrentarla directamente; y la BPL cuyo trabajo migró al formato remoto. Concluimos que, durante la pandemia, la BPL, en diferentes grados, enfrentó un agravamiento de problemas estructurales, como su remoción de los procesos de toma de decisiones, restringida al más alto nivel de gobierno, y la exacerbación de conflictos y ambigüedades ya existentes.

Dealing with the Covid-19 pandemic requires that the State make hard decisions that involve the action of bureaucrats who interact with the population through the implementation of public policy, the street-level bureaucracy (SLB). In this paper, based on a mixed- method exploratory study, we analyze how the daily performance of street-level bureaucrats in different policy areas- health and social care, access to the justice system, public security and education - has changed during the pandemic. We also explore the repercussions of those changes. Based on the analysis of the perceptions of bureaucrats, changes in their work and in their relationship with the public, we identify three categories that illustrate the dynamics of SLB work during the pandemic: the SLB who faces the crisis on the front lines; the SLB who suffers the effects of the pandemic, but whose work does not require her to face it directly; and the SLB who began to work remotely. We conclude that, during the pandemic, SLB suffered in varying degrees an aggravation of structural problems, such as their removal from decision-making processes - now restricted to the highest government level - and the exacerbation of already existing conflicts and ambiguities.

Essa pesquisa faz parte dos resultados publicados no âmbito do projeto “Prevenindo riscos aos Direitos humanos em grandes obras de infraestrutura na região da Amazônia: desenvolvimento de mecanismos de monitoramento participativo e alarme” em que a equipe do FGV CeDHE atuou em parceria com o Centro de Estudos de Administração Pública e Governo (CeAPG) da FGV, o Instituto Socioambiental (ISA) e o Conselho Ribeirinho. Este relatório apresenta os resultados de um diagnóstico dos danos à moradia e às diversas esferas do modo de vida e do bem-estar relatados pelas famílias ribeirinhas deslocadas do rio Xingu em decorrência da instalação da Usina Hidrelétrica Belo Monte (UHE Belo Monte). O estudo foi realizado no âmbito do projeto “Prevenindo riscos aos Direitos humanos em grandes obras de infraestrutura na região da Amazônia: desenvolvimento de mecanismos de monitoramento participativo e alarme”, desenvolvido em parceria com o FGV CEAPG, o Instituto Socioambiental e o Conselho Ribeiro, instância representativa das comunidades, entre 2017-2020. Em termos metodológicos, em novembro de 2019 foi aplicado um questionário com as famílias deslocadas, o qual foi elaborado em conjunto com o Conselho Ribeirinho e implementado em parceria com pesquisadores locais. Os resultados mostram uma piora na qualidade de vida das famílias deslocadas e inadequações da nova moradia das famílias já reassentadas aos modos de vida tradicionais; e são consolidados em uma matriz de danos ao direito à moradia adequada.

Thunderclap headache is a medical emergency presented as the worst headache ever, is characterised by an abrupt onset and maximal intensity within seconds to minutes. However, cerebrovascular causes are among the most common causes of thunderclap headache, and other non-vascular life-threatening aetiologies should be considered in evaluating a patient. We describe a 23-year-old previously healthy Latino woman who presented to our hospital after a month of repetitive severe, abrupt-onset headaches. Her prior medical history was unremarkable. After a normal brain MRI with angio-MRI, a lumbar puncture was performed with normal opening pressure, hypoglycorrhachia, increased proteins and a leucocyte; India ink staining was positive for encapsulated yeast, cultures were positive forCryptococcus gattii. The patient received appropriate antifungal treatment with a good response. This case highlights the particular presentation of cryptococcal meningitis due toC. gattiiamong immunocompetent patients.

In Brazil, rabies occurs mainly within an urban cycle, in which dogs and bats are reservoirs. This paper aims to report the occurrence of rabies in Callithrix sp. in Niterói, Rio de Janeiro, Brazil. In June 2019 a hybrid specimen was referred for diagnosis. The Direct Fluorescent Antibody, Mouse Inoculation, and Polymerase Chain Reaction tests were positive. A phylogenetic analysis was compatible with antigenic variant 3, characteristic of Desmodus rotundus. New studies should be undertaken to elucidate the real role of callitrichids in the urban rabies cycle.

In Brazil, rabies occurs mainly within an urban cycle, in which dogs and bats are reservoirs. This paper aims to report the occurrence of rabies in Callithrix sp. in Niterói, Rio de Janeiro, Brazil. In June 2019 a hybrid specimen was referred for diagnosis. The Direct Fluorescent Antibody, Mouse Inoculation, and Polymerase Chain Reaction tests were positive. A phylogenetic analysis was compatible with antigenic variant 3, characteristic of Desmodus rotundus. New studies should be undertaken to elucidate the real role of callitrichids in the urban rabies cycle.

The COVID-19 pandemic has resulted in calls for an increased integration of community health workers (CHWs) into the health system response. Historically, CHWs can play an important role in ensuring the sustainability of health policy implementation - by addressing social determinants of health and maintaining care for ongoing health problems. Their frontline work, with close contact to populations, places CHWs in a position of increased vulnerability to becoming infected and to being the target of abuse and violence. These vulnerabilities compound underlying problems faced by CHWs, who often come from poor backgrounds, are insufficiently paid and receive inadequate training. Speaking to a scarcity of studies on how CHWs are impacted by the pandemic, this paper conducts a systematic study of CHWs in Brazil. Based on quantitative and qualitative data collected during June and July 2020, it considers perceptions and experiences of CHWs, comparing them with other health professionals. We study the extent to which the pandemic added to existing vulnerabilities and created new problems and imbalances in the work of CHWs. We conclude that COVID-19 led to a deterioration of the working conditions of CHWs, of their relations with other health professionals, and of their ability to carry out their essential work in the public health system.

Digital, Background: Prediabetes has been proposed as a risk factor for the development of type 2 diabetes mellitus (DM2) and cardiovascular disease (CVD). Despite the clinical importance of prediabetes, little is known about the level of knowledge, beliefs and barriers to screening and treating prediabetes amongst care health providers in Latin America. The aim of the present survey was to evaluate the knowledge and beliefs about prediabetes amongst in Latin Ameri‑can health care providers. Methodology: In a cross-sectional study, we adapted the written survey designed by the Johns Hopkins University group, and applied it to health care providers across Latin America during three meetings, in 2017, and with physi‑cians from primary care centers in Bucaramanga, Colombia convened in 2017. The survey consisted of questions under four headings, diabetes screening, management of prediabetes, harmacological treatment—metformin use, and demographic information. We perform a descriptive analysis to determine the diferences in responses between diferent medical specialties. Results: The majority of the care providers that answered the survey were Colombian physicians, 54.5% of respond‑ents had 10 years or more since completing their training and more women responded. Only 9.5% identifed the 12 prediabetes risk factors described in the literature. The most common risk factor identifed was a family history of diabetes, followed by overweight, a sedentary lifestyle and dyslipidemia, while ethnicity was the risk factor least com‑monly. 47.1% answered that laboratory tests to detect prediabetes are fasting glucose and HbA1C, 82.5% correctly identifed fasting plasma glucose as the best test, 35.9% correctly responded that to the recommended weight loss goal is 5 to 7% and 49.1% that 150 min is considered the minimum level of physical activity per week. 78% agreed that the identifcation and treatment of prediabetes is important. 56% believed that patients with prediabetes progress more rapidly to diabetes and 40.6% considered that metformin could reduce the risk of diabetes in patients already diagnosed with prediabetes. Conclusion: These results demonstrate that there are important gaps in the knowledge of the diagnosis, clinical implications and management of prediabetes amongst Latin America health providers., Ciencias Médicas y de la Salud

espanolEste articulo nace a partir de los analisis de un trabajo doctoral y las reflexiones de una investigacion en curso acerca de los itinerarios de mujeres chilenas, cuyo exilio se vivio principalmente en Francia. La Unidad Popular (1970-1973) y la persecucion bajo la dictadura (1973-1989) originan este exilio. Se trata de abordar sus caracteristicas y las experiencias en tierra de asilo, en particular aquellas vividas por las mujeres. En efecto, a menudo las experiencias de las chilenas en tanto migrantes y exiliadas pasan a un segundo plano. Asimismo, la insercion en un nuevo pais se vive de distinta manera segun las diferentes pertenencias sociales de los/as migrantes. Propongo analizar la cuestion de una proximidad biografica, la cual se traduce en una “posicion proxima” en el trabajo de campo. Ser investigadora e hija de refugiados/as chilenos/as me posiciona en un papel de insider que conlleva multiples implicaciones en la investigacion misma y que puede dar lugar a que emerja una relacion generacional y de transmision. No obstante, dicha posicion supone ventajas y limites. Se analizara el marco y las relaciones de investigacion, algunos aspectos y opciones metodologicas, asi como diferentes elementos con respecto a la constitucion de un analisis y una investigacion situada. Mediante ejemplos y situaciones concretas, se presentaran dilemas a los cuales nos enfrentamos en el marco de un trabajo de campo “proximo” que conlleva una implicacion personal particular y un trabajo reflexivo significativo. A su vez, estas investigaciones plantean nuevos interrogantes con respecto a la manera de abordar la tematica de las migraciones en general y del exilio chileno en particular. Se examinara la imbricacion de las relaciones sociales de sexo, clase social, racizacion y generacion con respecto al trabajo de campo, a la reflexion metodologica y al estudio de las trayectorias de las exiliadas chilenas. EnglishThis article is the product of the analysis from my PhD work and the reflection about ongoing research into the lives of Chilean women who have lived in exile, most notably in France. Popular Unity (1970-1973) and the repression under the dictatorship (1973-1989) are at the root of the exile. The article also deals with the characteristics of their exile and experiences, those lived by women, in countries where people had found asylum. Indeed, Chilean women's true life as migrants and exiles are often forgotten. Their integration in a new country is lived in a distinct way according to the migrants’ various social affiliations. This article seeks to analyse the question of biographical proximity, as translated through a “close position” in the field. As both a researcher and a child born of Chilean refugees my position as an insider includes many implications in this research, notably in terms of a relationship of generation and transmission which may emerge. Nevertheless, this position supposes both advantages and limits. In addition, the article seeks to present the research framework, the participant researcher relationships, some methodological aspects and choices as well as different elements concerning the constitution of a situated analysis and investigation. The objective is to illustrate the dilemmas with which we were confronted throughout this “close-up” field study through concrete examples and situations implying a significant amount of investment and reflexive work. In addition, my research has led me to further questioning regarding the approach to the subject of migration in general and that of the Chilean exile in particular as well as subject of gender. The articulation of social relationships of sex, class, race, and generation are examined in regards to fieldwork as well as in methodological reflection and then in regards to the pathways of exiled Chilean women. francaisCet article est issu des analyses d’un travail doctoral et des reflexions d’une recherche en cours sur les parcours de femmes chiliennes qui ont vecu l’exil, principalement en France. L’Unite Populaire (1970-1973) et la persecution sous la dictature (1973-1989) sont a l’origine de cet exil. Il est question de revenir sur ses caracteristiques et les experiences en terre d’asile, en particulier celles vecues par les femmes. En effet, les situations des Chiliennes en tant que migrantes et exilees passent le plus souvent en arriere-plan. De plus, l’insertion dans un nouveau pays est vecue de maniere distincte selon les differentes appartenances sociales des migrant·e·s. Je me propose d’analyser la question d’une proximite biographique se traduisant par une « position proche » sur le terrain. Chercheure et enfant de refugie·e·s chilien·ne·s, un rapport generationnel et de transmission est susceptible d’emerger. Ma position d’insider comporte de nombreuses implications dans l’enquete. Toujours est-il qu’elle suppose des avantages ainsi que des limites. Il s’agit d’analyser le cadre et les relations d’enquete, quelques aspects et choix methodologiques ainsi que les differents elements concernant la constitution d’une analyse et d’une enquete situee. Je presenterai des exemples et des situations concretes illustrant les dilemmes auxquels nous nous confrontons tout au long d’un travail de terrain « proche » impliquant un investissement et un travail reflexif significatifs. En outre, ces recherches menent a de nouvelles interrogations quant a la maniere d’aborder le sujet des migrations en general et de l’exil chilien en particulier. L’imbrication des rapports sociaux de sexe, de classe sociale, de racisation et de generation est examinee dans le rapport au terrain, dans la reflexion methodologique et dans l’etude des parcours des exilees chiliennes.