Use Of Individual Protection Equipment Research Articles

Work absences among hospital cleaning staff during the SARS-CoV-2 (COVID-19) pandemic.

Introduction:Absenteeism justified by sick leaves are valuable indicators of workers’ health conditions.Objectives:To analyze hospital cleaning staff sick leaves during the COVID-19 pandemic.Methods:This retrospective cohort study included employees who presented a medical sick leave certificate justifying at least 1 missed day of work during the first wave of the COVID-19 pandemic. Data were collected from March 24 to December 31, 2020 at a teaching hospital.Results:A total of 199 workers who presented 689 medical certificates were included in the sample. The sample was 88.4% women. The mean ages for suspected COVID-19 cases and all other cases were 39.7 years and 40.9 years, respectively. Suspected COVID-19 cases involved longer leaves (mean 5.82 [SD, 3.35] days missed) and more medical sick leave certificates (mean 4.25 [SD, 3.13] certificates per worker) than other causes. Among suspected cases, 32.1% worked in critical areas of the hospital. Of the 83 RT-PCR tests performed, 24.1% were positive, with 80% of these employees working in semi-critical or administrative areas; 15% of workers who tested positive developed the severe form of the disease.Conclusions:Among workers who underwent RT-PCR testing, the rate of positive results was low. Most positive cases occurred in younger women who worked in non-critical units (ie, units involving no direct patient contact or without aerosol-generating procedures). The mean number of missed days was higher among suspected COVID-19 cases (7.85 days [SD, 4.05]). The use of individual protective equipment was common among these employees, and they were continuously trained.

Fear, changes in routine and dental care for children and adolescents with autism spectrum disorder in the COVID-19 pandemic: A survey with Brazilian parents.

This study aimed to report the perception of parents of children/adolescents with autism regarding the parents' fear of the pandemic by COVID-19. Also, to report children's fear about the use of individual protective equipment (IPE) in dental appointments, and the impact on the daily routine during the pandemic. A cross-sectional study through an open online survey was addressed to parents of children/adolescents autistic, aged between 3 and 18 years. The questionnaire had questions regarding the parents' fear of the COVID-19 pandemic, the parents' perception about the children/adolescents' fear of the use of IPEs at dental care, and the impact of the daily routine during the pandemic and social impact after the pandemic. Parents' reports on the degree of ASD (mild, moderate, and severe) of the child/adolescent. A total of 1001 responses were obtained. 50.35% of parents had high fear of the pandemic by COVID-19, 59.34% believe that children/teenagers will be afraid of the dentist's IPE and 61.64% responded that the COVID-19 pandemic had a high impact on the daily routine of children/adolescents with ASD. Most parents reported fear of the pandemic by COVID-19, that children/adolescents with autism may be afraid of IPE and had a high impact on their daily routine during the pandemic.

1742P Outcomes of the reorganisation of a medical oncology department during the COVID-19 pandemic: Real-word experience

The coronavirus disease 2019 (COVID-19) pandemic has transformed health care delivery in the world, forcing clinicians to make challenging triage decisions. COVID-19 represents a significant harm for cancer patients, who are at high risk of infections due to their immunosuppressed status and serious COVID-19-related events. Portuguese oncologists joined forces to ensure safety of clinical practice without compromising cancer patients care, as the benefit of ensuring an anti-cancer treatment outweighs the risks of COVID-19. Description and outcomes analysis of structural organization measures adopted by a Portuguese Medical Oncology Department during the COVID-19 pandemic. A proactive approach to the actual emergency panorama was promptly implemented: use of individual protection equipment, triage of patients accessing the hospital, use of telemedicine in selected patients with no need for on-site assessment, customising treatment delivery, regularly test patients under immunosuppressive treatments, test all patients prior to admission in oncology wards, limited access for visitors and caregivers, health professionals worked in “mirror teams” and most multidisciplinary boards have been converted in telematic meetings. Despite all the constraints in the activity, the number of consultations (including tele-consultations) increased compared to the same period of the previous year (3245 consultations from 1/03 to 15/05/2020 versus 3305 in the same period of 2019), the number of first consultations remained similar comparatively (15%) and were carried out in a timely manner, indicative that the cancer patient circuit was not compromised. 368 fewer treatments were performed in the same period, compared to 2019. Until May 15th, 288 tests have been carried out. Four patients were positive for COVID-19 without severity criteria, two of them with a diagnosis of cure, currently being under antineoplastic treatment without related complications. Practice recommendations from European and national oncology societies were applied, which translated into a safe continuum of cancer care delivery. In the middle-term, will be a priority to assess the real impact on cancer mortality.

ANMCO POSITION PAPER: The cardiological clinical activities in the transition phase of the COVID-19 pandemic.

Infections by SARS CoV2 - COVID-19 became in a short time a worldwide health emergency. The present SARS-CoV-2 pandemic induced in a short time, an unprecedented impact on public health and on the pre-existing care pathways. In order to appropriately address this epidemiological emergency, urgent solutions were needed, such as remodelling or stopping hospitalization and deferrable clinical activities to avoid spreading the SARS-CoV-2 infection. After the first emergency lockdown phase, care pathways must guarantee healthcare to patients and preserve the safety of the healthcare personnel and of all the other subjects that refer to the cardiological surgeries. Rigorous prescriptive appropriateness of the requested exams with consequent reduction of unnecessary examinations is an essential requirement to preserve prioritized diagnostic and care pathways to patients in need, minimizing the risks connected to the SARS-CoV-2 contagion in hospitals. Telemedicine services represent a valid answer to cardiovascular disease patients’ need for care and assistance, including those in quarantine and voluntary isolation. These services successfully contribute to fight the spread of the virus guaranteeing at the same time therapy and support through remote services that must therefore be considered a resource to be implemented and enhanced. This document has to be used by the healthcare personnel working in hospitals and in district offices, if applicable, and aims at managing patients, in complete safety and considered not suspect/not probable (‘not at risk’) of SARS-CoV-2 infection, eligible for diagnostic activity and subsequent therapy in outpatient surgeries. In particular, this document provides indications for patient evaluation to prevent COVID-19 exposure, gives general indications on managing appointments and waiting rooms, on how to strictly adhere to environmental safety measures, on the proper use of Individual Protective Equipment (IPE). It also provides specific indications for outpatient service procedures, like electrocardiogram, cardiologic examination, cardiologic checkup, Dynamic Holter Electrocardiogram, Transthoracic Echocardiography, Echo Stress, Transoesophageal Echocardiography, Bike Ergometer stress test, Ergospirometry, Outpatient Checkup of implantable electronic cardiac devices.

Experience of the nursing team concerning the care of patients with meningitis attended in emergency department

Objective: To unveil the experience of the nursing team in relation to the care of patients with meningitis attended in emergency departments.Methods: Exploratory and qualitative study made with 13 nurses and 12 nursing technicians from the emergency sector of a public hospital located in Northeast of Brazil. The data was gathered through an interview using a semi-structured script. The interviews were transcribed, processed in the Iramuteq software and analyzed with the descending hierarchical classification.Results: Three categories were obtained and they were referent to the accomplished interventions (administration of medication, patient’s isolation, contribution in the accomplishment of exams, use of individual protection equipment and humanization), to the experienced feelings (fear and unsafety) and the disease’s suggestive alerts (headache, neck stiffness, changes in the conscience level and vomit).Conclusions: The nursing experience in the care of patients with meningitis, in the emergency sector, was shown to be permeated by the accomplishment of interventions, feelings, and knowledge about the symptoms.

USE OF INDIVIDUAL PROTECTION EQUIPMENT IN CIVIL CONSTRUCTION

The use of individual protective equipment (IPE) is extremely essential for any activity that is prone to occupational hazards and / or illnesses that could threaten the safety and health of the worker. The construction market has grown abundantly in recent years, and consequently the risk of accidents in this work environment as well. There are several reasons for this growing increase in accidents at work, among them is the Contracting Company that does not provide correctly the equipment of personal protection for its employees and the lack of commitment and interest of the employees in the use of protective equipment. The objective of this study is to evaluate the use of individual protection equipment in the construction company in a given service rendering, which includes the construction of reinforced concrete wall and drainage network installation, observing the methods used for adhesion and control of the use of IPE. Although the work is short-term and the accident risk is high, in the course of the work up to the date of delivery, a satisfactory result was obtained both for the Company and for the employees involved in the activities, as it had no accident of job.

Quality of cross-infection control in dental laboratories. A critical systematic review

To identify reported practices for cross-infection control in dental laboratories and to quantify the importance of the flaws encountered. Systematic search (cross-infection AND dental laboratory) at EMBASE, PubMed, SciELO and Scopus databases. Papers reporting on cross-sectional studies providing original data about cross-infection knowledge, practices and attitudes of dental technicians. Papers reporting on a single laboratory or institution were excluded. Data extraction was undertaken independently by three reviewers using a purpose made form. The outcome of this study was analyzed in five aspects, namely process organization, disinfection, working environment, use of individual protective equipment and vaccination policy. The systematic search output was 1651 references and 11 papers were finally selected. Flaws were more frequently identified in terms of vaccination policy, biological safety of the working environment and use of individual protective equipment (100%). Slightly better results were found in terms of organization of the cross-infection control process (89.47%) and disinfection practices (85.71%). The application of the formula for disclosing the relative importance of the flaws identified in the literature prioritizes the need for interventions aimed at improving the organization of the cross-infection control procedures, followed by training in item disinfection. The control of the working environment together with the use of individual protective equipments rank closely in importance, followed by the existence of a vaccination policy. Sub-standard cross-contamination practices seem to be a common finding in dental laboratories, which may well compromise the quality of certain dental treatments.

Workplace Activity in Health Professionals Exposed to Chemotherapy Drugs: An Otoneurological Perspective.

Introduction The manipulation of antineoplastic drugs presents high risk for accidents and occupational diseases. Objective To evaluate the auditory and vestibular systems of workers who are exposed to chemotherapeutic treatment in the University Hospital of Universidade Federal de Santa Maria, Brazil, and to identify the use of individual protection equipment, related to the obtained results. Methods This study is a cross-sectional study using a quantitative method. We evaluate 33 male and female workers, ranging from 21–60 years old, of the nursing and pharmacy sectors. The workers underwent conventional Audiologic Assessment; Transient Evoked Otoacoustic Emissions; and Computerized Vectoelectronystagmography. Results The majority of the sample was female (90.9%). Individual protection equipment was used by 90.9% of the workers. Complaints of dizziness were reported by 56.25% of nursing workers and 52.94% of pharmacy workers. Audiological and vestibular assessment results were within normal limits, 96.97% and 74.20%, respectively. However, audiometric configuration of notch type was identified in 75.75% of all workers. Audiometric notches (76%) and altered caloric test (100%) were often associated with decreased use of coal masks. Conclusion Among the workers evaluated, the vestibulocochlear system was within the normal limits. The presence of notch configuration indicates the need to use individual protection equipment.

Vacinação contra hepatite B e Anti-HBS entre trabalhadores da saúde

ResumoObjetivoAvaliar a prevalência de vacinação para hepatite B e os fatores associados entre trabalhadores da atenção primária e da média complexidade do setor saúde.MetodologiaEstudo transversal com 506 trabalhadores do setor saúde de um município do Recôncavo Baiano. Utilizou-se questionário para investigar situação vacinal para hepatite B. Análises uni e bivariada foram utilizadas para avaliação dos fatores associados à vacinação.ResultadosHouve predomínio do sexo feminino (78,3%) e do vínculo de trabalho permanente (63,8%); além disso, 78,1% dos trabalhadores fizeram uma avaliação positiva da saúde. A maioria referiu ter recebido três doses da vacina contra hepatite B (59,9%). Enfermeiras, técnicas e médicos estiveram mais imunizados (91,8%). Os fatores associados à vacinação foram: sexo, idade, escolaridade, uso de equipamento de proteção individual e contato com material biológico.DiscussãoA prevalência da vacinação completa contra hepatite B foi de 59,9%, indicando uma cobertura baixa. É preciso estimular os profissionais que não desenvolveram um nível de anticorpos adequado após o esquema vacinal primário a refazer uma quarta dose.ConsideraçõesIndivíduos que não estão imunes à doença devem ser informados que são suscetíveis ao VHB até que tenham comprovação imunológica. Questões sobre biossegurança nos currículos acadêmicos colaboraram para incorporação de atitudes mais positivas frente à adesão à vacinação.

Silica exposure in the glass industry and human health risk assessment

Introduction: Among adverse effects in mines and industries, silica dust often been the subject of many controversies. Its severe and incurable side effects call for special attention to as well as assessment and control in workplaces. This study aims to determine the rate of silica concentration in the breathing zones of the glass industry in a comparison to standard limits in order to improve the safety of workers exposed to these particles. Materials and Methods: Being conducted in a glass factory in Tehran, this research employed a sampling method to measure the silica dust diffusion in six consecutive years from 2005 to 2010. The most effective method of dust level measurement in a workplace is to take samples in the breathing zone of workers exposed to it. In the subject factory, the sampling was performed in four sectors with the highest level of occupational exposure to the respirable dust. (1) Material charging unit, Excavator Operator. (2) Miscellaneous material weighing Operator (mixer). (3) Material charging, loading unit Operator. (4) Discharge (unloading) zone. The silica compound sampling and measur was conducted via the method by National Institute of US Occupational Health and Safety (NIOSH). By this method, the silica particles in the air were collected on the sorbent tube containing activated carbon (coconut shell) SKC-USA No. 226-01 and the sampling pump Model 222 ml/count, SKC with a flow rate of two liters per minute in the active method for 30 minutes. Then, observing necessary conditions and the chain of cold (Stored at 4΀C), the samples were transferred to the laboratory. The breathing zone samples were also collected from the four mentioned sectors by the sampling pump. Samples were analyzed with the Flame Ionization Detector, when they were transferred to the laboratory by Gas Chromatography Apparatus with the Flame. Results: Time-weighted a Average (TWA) exposure was at its highest level in 2009 and at its lowest level in 2008. Findings of the study also revealed that the amount of environmental silica dust threshold limit value in the material charging Unit of loading and Excavator Operators in the discharge zone was higher than the threshold limit value. After determining the dispersion density of suspended silica particles, TLV, TWA, and the non-cancer risk ratio of the particles in the mentioned sectors, control strategies and corrective suggestions were proposed. Conclusions: Results showed that, the silica concentration in the breathing zone of the glass industry was higher than the threshold limit value. Silica is a carcinogenic material causes chronic respiratory diseases and silicosis, therefore it is recommended to observe the safety principles and use wet silica in stead. The concentration of silica is at its highest level in the loading and unloading units, thus the engineering and managing controls should be utilized to avoid the direct exposure to these suspended particles. Moreover, the workers in these sectors should be well-trained regarding the exposure to silica and use of individual protective equipment.

Avaliação do gerenciamento dos resíduos de serviços de saúde em municípios da região metropolitana de Belo Horizonte (Brasil)

O gerenciamento impróprio dos resíduos de serviços de saúde (RSS) expõe significantes riscos a pacientes, aos trabalhadores da saúde, à comunidade e ao meio ambiente. Um dos fatores que têm contribuído para aumentar a tendência da adoção do modelo diferenciado de gerenciamento de RSS em diversos países é que eles muitas vezes têm como destino final o mesmo local utilizado para descarte dos demais resíduos urbanos. Com o objetivo de avaliar os procedimentos do gerenciamento dos RSS em relação ao prescrito nas normas e nos regulamentos em municípios da região metropolitana de Belo Horizonte, Minas Gerais, foram realizadas visitas a campo para observar e descrever formas de gerenciamento dos RSS (desde a coleta até a destinação final) utilizadas, visando ao conhecimento da realidade. Como resultado, evidenciaram-se falhas nos abrigos externos, nos procedimentos de coleta, no uso de equipamentos de proteção individual, no acondicionamento dos RSS e no seu transporte.

Occupational exposure assessment in procedures of portable digital veterinary radiology for small size animals

This study evaluates the dose received by veterinarians and assistants involved in portable digital veterinary radiology procedures and checks the dose reduction obtained with the use of individual protection equipment. For this evaluation measurements were made using thermoluminescent dosimeters TLD-100, positioned at different parts of the body: hands, thorax, thyroids, gonads, left and right eye corners and at the center of the eyes. The dose was evaluated through 65 procedures performed with 55 animals. The results showed that in the case of assistants the received dose is significantly larger than that of the veterinarian. The most likely reason of this effect is that they are closer to the primary beam and thus are exposed to higher level of primary radiation first of all in regions of eyes and thyroids. The doses received by various body parts of the assistant are close to the annual limit recommended by International Commission on Radiological Protection.

Prevalência de morbidades e sintomas em idosos: um estudo comparativo entre zonas rural e urbana

A cross-sectional study was conducted with the elderly population in rural and urban areas characterized by the prevalence of morbidity and symptoms, and 229 elderly people were interviewed. The average age was 72.3, of which 57.2% lived in the rural zone and 56.3% were female. The morbidities most reported were insomnia (37.7%), anxiety (32.1%), depression (26.7%), and in the rural zone it was diabetes (13.3%). In this zone, Alzheimer's disease was more prevalent among the elderly who handled pesticides (21.7%). The most prevalent symptoms among urban zone residents were: cough/runny nose and sight alterations (41.2%), allergy/itching (11.4%). In the rural zone, dry mouth (25.4%), sight alterations (35.6%) and leg pain (66.1%) were also more prevalent among those who used pesticides. The inadequate use of Individual Protection Equipment was 85.4%, and 45.1% also disposed of pesticide packaging inappropriately. The setting up of public health programs is necessary to promote health among the elderly and the potential exposure to pesticides for this population should be seen as a health risk determinant.

Satisfaction of patients and students at the Integrated Clinics of a Dental School

Aim: The objective of this questionnaire-based research was to evaluate the level of satisfaction of students and patients at the School of Dentistry of the University of Passo Fundo (FOUPF). Methods: The questionnaire was administered after the patient’s care, as follows: first, the student explained the study purposes and methodology to the patient, the option of not participating and the full confidentiality of the information obtained. Patients were selected among those undergoing treatment at the Integrated Clinic I and II Disciplines (5th year of undergraduate dental course) between March and November 2010. Results: Satisfactory results were obtained, as most interviewed patients (49; 98%) considered the care given by FOUPF students as positive. Another important factor mentioned by patients was the use of individual protection equipment and biosafety measures adopted by the students; 98% (n = 49) of the patients affirmed that the students were properly wearing individual protection equipment. With regard to aspects that could be improved, 36.7% (n = 18) of interviewed patients mentioned the need to schedule appointments more than once a week, 12.2% (n = 6) felt the need to reduce waiting times for consultations, and 10.2% (n = 5) wanted to reduce appointment duration. As much as 98% of students (n = 49) declared being attentive to dentistry situations, 56% (n = 28) were satisfied with their technical aptitudes, and 96% (n = 48) mentioned enjoying helping patients. Conclusions: The care given to patients by FOUPF students is done well, not requiring significant changes.

The exposure of farm workers to pesticides used in potato cultivation in Brazil

BackgroundBrazil is one of the world leaders in pesticide consumption and exposed workers are numerous and diversified. The indiscriminate application of pesticides affects both human health and natural ecosystems.ObjectiveIdentify the...

Analysis of urban cleanness agents' workstation on the appearance of Work Related Musculoskeletal Disorders

This study had as objective to evaluate the workstation of the responsible for the collection of urban garbage in relation to the factors associates with the appearance or aggravation of WMRD, as well as identifying signals and symptoms of these illnesses in the related professionals. For this, was developed a form with open and closed questions, that approached item relative to the identification of the searched, to the organization and execution of the work and to the signals and symptoms of WMRD, e that was applied in 44 agents in a company of collection of urban residues in a Brazilian metropolis. As the results can be evidenced that between the factors that the cleanness' agents are susceptible to the appearance of WMRD can detach the lack of orientation of these professionals as the positions adopted in the work, the lack of training and qualification, as well as the repetitivity of tasks and not use of individual protection equipment. However, yet with the existence of innumerable factors of risk, evidenced a small incidence of pain.

Exposições acidentais com material biológico potencialmente contaminado envolvendo graduandos de enfermagem do último ano

Profissionais de saúde e os estudantes estão expostos a diversos riscos nos serviços de saúde, sendo o biológico um dos mais frequentes e preocupantes. Este estudo descritivo com abordagem quantitativa foi desenvolvido em uma universidade pública no interior do Estado de São Paulo e objetivou verificar a ocorrência e descrever as características dos acidentes ocupacionais com material biológico potencialmente contaminado entre os graduandos de enfermagem. Os dados foram obtidos por meio de entrevista individual e os aspectos éticos foram contemplados. Dos 74 estudantes entrevistados, no período de fevereiro a julho de 2007, 30 relataram exposição acidental com material biológico potencialmente contaminado. Destes, 24 (80,0%) mencionaram exposição cutânea, cinco (16,7%) percutânea e um (3,3%) referiu exposição mucosa. Conclui-se que o tipo de exposição acidental envolvendo material biológico potencialmente contaminado mais frequente neste estudo foi a cutânea e que muitas dessas exposições poderiam ser evitadas pelo uso de equipamentos de proteção individual. Descritores: Estudantes de Enfermagem; Exposição Ocupacional; Enfermagem.

Concerns regarding hepatitis B vaccination and post-vaccination test among Brazilian dentists

BackgroundHepatitis B infection is the major cause of acute and chronic liver disease, cirrhosis and hepatocellular carcinoma worldwide and has long been recognized as an occupational hazard among dentists. The aim of the present study was to examine factors associated to the self-reporting of hepatitis B vaccination and immunization status among dentists working in the city of Belo Horizonte, Brazil.MethodsA cross-sectional survey was carried out with 1302 dentists in Belo Horizonte, Brazil. After signing a term of informed consent, the participants answered a structured questionnaire on their knowledge regarding their vaccination and immunization status against hepatitis B. Data on demographic, behavioural and occupational exposure aspects were also collected through questionnaires.ResultsThe results revealed that 73.8% of the dentists reported having received three doses of the vaccine. Multivariate analysis revealed that gender (p = 0.006), use of individual protective equipment (p = 0.021), history of blood transfusion (p = 0.024) and history of illicit drug use (p = 0.013) were independently associated with vaccination against hepatitis B. Only 14.8% had performed a post-vaccination test. The use of individual protective equipment (p = 0.038), dentists who asked patients about hepatitis during dental treatment (p < 0.001), a family history of hepatitis B (p = 0.003) and work experience (p < 0.05) were independently associated with the post-vaccination test.ConclusionsAlthough there were a large number of vaccinated dentists in Belo Horizonte, the percentage was less than what was expected, as Brazil offers the National Program of Viral Hepatitis Vaccination, which provides free hepatitis B vaccinations to all healthcare workers. Despite being part of a high risk group for contamination, most of the dentists did not know their immunization status.

Dermatoses Ocupacionais

Occupational Dermatosis is described as any alteration in the skin, mucosa or annexes that is directly or indirectly caused, conditioned, maintained or aggravated by agents present in the occupational activity or work environment. The authors of the present study describe the importance of the topic and the epidemiology and etiopathogeny of the main forms of occupational dermatoses: allergic and irritative contact dermatitis, phytodermatitis, acne (elaioconioses and chloracne), keratosis, cancers, foreign body granuloma, infections, onychias, and ulcerations. Clinical findings of occupational dermatosis are presented in relation to various professions. Laboratory tests used to diagnose this condition are analysed, with special emphasis on patch testing, which is the gold standard. Information about the treatment and prevention of this disorder is provided. Collective and individual measures, especially regarding the proper use of individual protection equipment for the prevention of occupational dermatosis, are detailed.

Exposição ocupacional dos profissionais de enfermagem de uma unidade de terapia intensiva a material biológico

Este estudo descritivo exploratório teve como objetivo caracterizar os profissionais de enfermagem de um centro de terapia intensiva que sofreram acidentes ocupacionais com material biológico e os acidentes. Os dados foram coletados no período de maio a junho de 2007, por meio de entrevista individual utilizando-se um roteiro semi-estruturado. Foram entrevistados 37 profissionais sendo que 25 (67,56%) referiram ter sofrido acidente com material biológico, e a maioria era técnico de enfermagem, do sexo feminino, entre 21 a 30 anos e com experiência na enfermagem menor que 05 anos. Em relação à capacitação sobre prevenção deste tipo de exposição 28 (75,7%) afirmaram ter participado e apenas 14 (56%) sujeitos referiram que utilizavam equipamento de proteção individual no momento do acidente. A maioria das exposições 18(72%) foi percutânea e o sangue foi o fluido mais envolvido 17(68%). As causas mais frequentemente atribuídas à ocorrência dos acidentes foram: falta de atenção e pressa. Apesar dos profissionais alegarem ter recebido capacitação durante sua formação e atuação profissional, observa-se que tiveram baixa adesão ao uso de equipamentos de proteção individual, evidenciando a necessidade de rever o processo de trabalho e as estratégias utilizadas nos programas educativos.