Grupo multifamiliar em transtornos alimentares durante a primeira onda da pandemia de covid-19: transição para a modalidade online / Multifamily group on eating disorders during the first wave of the covid-19 pandemic: transitioning to the online modality / Grupo multifamiliar de trastornos alimentarios durante la primera ola de la pandemia de la covid-19: transición a la modalidad en línea

As restrições impostas pela pandemia de covid-19 levaram os serviços de saúde a reorganizarem seu funcionamento, ajustando-se à modalidade remota. A transição repentina e sem o devido preparo técnico impôs desafios adicionais para usuários e profissionais. Para aprimorar as estratégias assistenciais, torna-se imprescindível dar voz aos usuários dos serviços, para que narrem suas experiências e possam manifestar suas facilidades e dificuldades com essa passagem. Este estudo tem como objetivo investigar como os principais cuidadores familiares de pessoas com transtornos alimentares vivenciaram a transição do grupo de apoio para o formato remoto e identificar vantagens e desvantagens percebidas nesse modelo. Estudo clínico-qualitativo, exploratório, realizado em um serviço de atendimento especializado de um hospital terciário. O cenário investigado foi o grupo de apoio psicológico aberto a familiares que, desde o início da pandemia de covid-19, passou a ser oferecido na modalidade online. Participaram do estudo cinco mães e três pais presentes em 13 sessões grupais consecutivas. Entrevistas individuais foram aplicadas com a Técnica do Incidente Crítico logo após o término de cada encontro grupal, totalizando 26 entrevistas audiogravadas, transcritas e submetidas à análise temática. A transição para o online foi vivenciada pelos participantes como um recurso válido para permitir que o grupo funcionasse em tempos de grave crise sanitária. Como vantagens, foram mencionadas: a continuidade do cuidado, maior acessibilidade e facilidade em relação à logística da participação. Como limitações do formato online, foram destacadas: nem todos os familiares contam com conexão de internet de qualidade e possível dificuldade para manusear a tecnologia digital. Apesar dos desafios impostos pela súbita mudança para a modalidade online, na perspectiva dos usuários do serviço os esforços de adaptação foram bem-sucedidos, possibilitando a continuidade do cuidado à saúde mental.(AU)

The constraints imposed by the COVID-19 pandemic led health services to reorganize their operation, adjusting to the online modality. The sudden and unprepared technical transition has imposed additional challenges for both users and professionals. To improve care strategies, it is essential to give voice to services users, so that they can narrate their experiences and express their facilities and difficulties with this transition. This study aims to investigate how main family caregivers of people with eating disorders experienced the transition of the support group to the remote modality and to identify perceived advantages and disadvantages in this model. This is a clinical-qualitative, exploratory study carried out in a specialized care service of a tertiary hospital. The investigated setting was the psychological support group open to family members, which since the beginning of the COVID-19 pandemic has been offered online. Five mothers and three fathers who attended 13 consecutive group sessions participated in the study. Individual interviews were carried out with the Critical Incident Technique shortly after the end of each group meeting with all members, totaling 26 audio-recorded interviews. Data were subjected to thematic analysis. Transition was experienced as a valid resource to maintain the group active in times of a severe health crisis. As advantages of the remote modality were mentioned: continuity of care, greater accessibility, and ease in relation to the logistics of participation. As limitations of the online format were highlighted: not everyone has a good-quality connection to the internet, and difficulty in handling the digital technology. Despite the challenges imposed by the sudden shift to the online modality, from the service users' perspective the adaptation efforts were successful, enabling continuity of mental health care.(AU)

Las limitaciones que impuso la pandemia de la COVID-19 llevaron a los servicios sanitarios a reorganizar su funcionamiento adaptándose a la modalidad remota. El súbito cambio y sin la preparación técnica adecuada implicó retos adicionales a los usuarios y profesionales. Para mejorar las estrategias de atención es fundamental dar voz a los usuarios de los servicios, para que puedan narrar sus experiencias y expresar sus facilidades y dificultades con esta transición. Este estudio pretende investigar cómo han vivido los cuidadores de personas con trastornos alimentarios la transición del grupo de apoyo presencial al formato remoto e identificar las ventajas y desventajas percibidas en este modelo. Se trata de un estudio clínicocualitativo, exploratorio. El escenario investigado fue el grupo de apoyo psicológico abierto a los familiares en la modalidad en línea. Cinco madres y tres padres participaron en 13 sesiones de grupo consecutivas. Se realizaron entrevistas individuales con la técnica de incidentes críticos inmediatamente después de cada reunión del grupo, con un total de 26 entrevistas grabadas en audio, transcritas y sometidas a análisis temático. La transición a la red fue experimentada como un recurso válido para permitir que el grupo funcione en tiempos de crisis sanitaria grave. Las ventajas de la modalidad remota fueron conexión segura en tiempos de confinamiento físico, continuidad, mayor accesibilidad y facilidad en relación con la logística de la participación. Las limitaciones del formato en línea fueron la falta de una conexión de calidad a Internet y la posible dificultad de manejo de la tecnología digital. A pesar de las dificultades impuestas por el cambio repentino a la modalidad en línea, desde la perspectiva de los usuarios del servicio los esfuerzos de adaptación fueron un éxito, lo que permitió seguir con la atención de salud mental.(AU)

Comunicados das sociedades científicas brasileiras sobre práticas corporais e atividades físicas ao ar livre no contexto da covid-19 / Statements of brazilian scientific societies about outdoor body practices and physical activities in covid-19 context

Tendo como objetivos identificar e analisar os conteúdos oficiais das sociedades científicas brasileiras sobre práticas corporais e atividades físicas (PCAF) ao ar livre no contexto da pandemia da Covid-19, em fevereiro de 2021 foi conduzida uma pesquisa documental por meio de buscas nas páginas eletrônicas de algumas sociedades científicas relacionadas à temática e do Google. Entre as 12 comunicações oficiais encontradas, chanceladas por 10 distintas sociedades científicas e publicadas, em sua maior parte entre março e abril de 2020, destacam-se aproximações quanto à importância das PCAF ao ar livre, levando em consideração as medidas de distanciamento e/ou restrição de circulação adotadas, assim como evitar a proximidade com outras pessoas e aglomerações. Por outro lado, foram observadas discrepâncias em relação aos distintos indicadores que devem ser levados em consideração para a sua realização, às distâncias mínimas preventivas para as práticas e à abertura das academias de ginástica e clubes desportivos. Por fim, a maioria das comunicações oficiais indicou a importância da realização de PCAF ao ar livre, destacando que, para um menor risco de contágio, as pessoas levem em consideração as medidas de distanciamento e/ou restrição de circulação adotadas e, durante a prática, evitem a proximidade com outras pessoas e aglomerações. Entretanto, considerando-se que o momento ainda é de excepcionalidade, é importante o reforço permanente destas mensagens, englobando, em paralelo ao risco biológico, as questões relacionadas ao risco de influência social. (AU)

Aiming to identify and analyze the official contents of Brazilian scientific societies on outdoor body practices and physical activities (BPPA), in the context of the Covid-19 pandemic, a documentary research was conducted in February 2021 by searching the websites of some scientific societies related to the topic and Google. Among the 12 official communications found, endorsed by 10 different scientific societies and published mostly between March and April 2020, there were approximations regarding the importance of outdoor BPPA, taking into account the measures of distance and/or restriction of movement adopted, as well as avoiding proximity to other people and crowds. On the other hand, discrepancies were observed in relation to the different indicators that should be taken into consideration for its realization, the minimum preventive distances for the practices, and the opening of gyms and sports clubs. Finally, most of the official communications indicated the importance of performing BPPA outdoors, emphasizing that, for a lower risk of infection, people should take into account the distance and/or circulation restriction measures adopted and, during the practice, avoid proximity to other people and crowds. However, considering that this is still an exceptional moment, it is important to permanently reinforce these messages, encompassing, in parallel to the biological risk, the issues related to the risk of social influence. (AU)

Análise espaço-temporal da pandemia de Covid-19 em uma cidade do sul do Brasil: como a chegada do inverno afeta a pandemia? / Spatiotemporal analysis of the Covid-19 pandemic in a city in southern Brazil: How does the arrival of winter affect the pandemic?

RESUMO Aglomerações sociais e as condições climáticas estão entre os fatores que podem contribuir para a disseminação do SARS-CoV-2 e para o aumento no número de pacientes infectados, havendo relação do frio com a maior taxa de disseminação do vírus. Assim, no sul do Brasil, região subtropical, onde as baixas temperaturas são características durante o inverno, se torna pertinente avaliar como está variável climática é capaz de interferir no surgimento de casos de Covid-19 e investigar o padrão espacial de distribuição da doença em uma cidade sulina. As associações entre os casos diários de Covid-19 e os valores de temperatura média no município foram realizadas por análises de Correlação de Spearman e de Regressão. Após as quatro primeiras semanas de inverno, o número de casos confirmados de Covid-19 no município se elevou 400%, principalmente na região central. Porém, as análises não indicam relação significativa entre os casos de Covid-19 e as oscilações de temperatura. Portanto, é preciso sensibilizar as pessoas de que não há uma fórmula padronizada de enfrentamento à pandemia de Covid-19, uma vez que as combinações de elementos ambientais e sociais, diferentes em cada região, afetam de diferentes maneiras os números de casos e óbitos confirmados da Covid-19, pois, na localidade investigada as baixas temperaturas de inverno não interferiram significativamente no número de novos casos de Covid-19, de modo que o comportamento de aglomeração populacional parece ser o principal gatilho para o aumento dos casos de Covid-19 noticiados pela Secretaria de Saúde. PALAVRA-CHAVE: Aglomeração, coronavírus, temperatura

ABSTRACT Social agglomerations and climatic conditions are among the factors that can contribute to the spread of SARS-CoV-2 and to the increase in the number of infected patients, with a relationship between cold weather and the higher rate of spread of the virus. Thus, in southern Brazil, a subtropical region, where low temperatures are characteristic during winter, it is relevant to evaluate how this climate variable is able to interfere with the emergence of Covid-19 cases and to investigate the spatial pattern of distribution of the disease in a southern city. Associations between daily Covid-19 cases and mean temperature values in the city were performed by Spearman's Correlation and Regression analyses. After the first four weeks of winter, the number of confirmed cases of Covid-19 in the city rose by 400%, mainly in the central region. However, the analyses do not indicate a significant relationship between Covid-19 cases and temperature fluctuations. Therefore, it is necessary to sensitize people that there is no standardized formula for dealing with the Covid-19 pandemic, since the combinations of environmental and social elements, which are different in each region, affect the numbers of confirmed Covid-19 cases and deaths in different ways, since low winter temperatures in the investigated location did not significantly interfere with the number of new Covid-19 cases, so that the population agglomeration behavior seems to be the main trigger for the increase in Covid-19 cases reported by the Health Department. KEYWORDS: Agglomeration, coronavirus, temperature

Discriminant validity of the CAST instrument compared to the dmf index in the deciduous dentition: a cross sectional study

Abstract This study aimed to assess the discriminant validity of the Caries Assessment Spectrum and Treatment (CAST) at different thresholds, compared with the Decayed, Missing, and Filled Teeth Index (dmf) instrument, to discriminate caries risk factors. A cross-sectional study was conducted including children aged 2-5 years from preschools in Southern Brazil. Parents answered a questionnaire, and children were clinically examined using the CAST instrument and, in the following weeks, using the dmf index. Two caries thresholds were adopted for CAST: caries in dentin (CAST4-7/CAST2,4-8) and enamel caries (CAST3-7/CAST2-8). Poisson regression was used in the analysis (p < 0.05). A total of 200 children were included. The prevalence of caries was 47.0% with dmf, 42.5% with CAST4-7, and 77.5% with CAST3-7. When the outcome was caries prevalence, CAST4-7 discriminated between sexes, household crowding, and dental pain, and CAST3-7 discriminated age and family income, while the dmf was associated with dental pain. When experience of caries was the outcome, all the criteria discriminated between sexes, age, family income, household overcrowding, visible dental plaque, and dental pain, while dmf and CAST2-8 also discriminated maternal schooling. The CAST discriminated caries risk factors similar to the dmf index when caries experience was the outcome. When prevalence was considered, CAST was able to discriminate for more individual characteristics than dmf.

Household crowding hampers mitigating the transmission of SARS-CoV-2

Abstract INTRODUCTION: Household crowding deserves attention when evaluating the transmission intensity of SARS-CoV-2 in Brazil. We aimed to evaluate the association between household crowding and COVID-19 incidence. METHODS: Linear and Poisson regression analyses were used to assess the associations between indices of household crowding (high, average, low) and COVID-19 incidence estimates. RESULTS: Cities with a high index of household crowding were linked with a significantly higher COVID-19 incidence estimate (excess of 461 per 100,000; 95% confidence interval: 371-558 per 100,000). CONCLUSIONS: Crowding typically promotes virus transmission. Considering urban and housing structures is essential in designing mitigation strategies during a pandemic.

Directiva sanitaria que establece medidas para el reinicio de actividades religiosas o de culto en el marco de la emergencia sanitaria de la COVID-19 / Health directive that establishes measures for the resumption of religious or worship activities in the framework of the health emergency of COVID-19

El documento contiene las medidas preventivas para el reinicio de actividades religiosas o de culto, en el marco de la emergencia sanitaria de la COVID-19. El documento fue derogado con R.M. N° 505-2023 del 27 de mayo del 2023.

Impacto do tabagismo passivo nos sintomas da asma na infância / Impact of passive smoking on childhood asthma symptoms

Objetivo: Caracterizar a população asmática pediátrica e avaliar as repercussões do tabagismo passivo nos sintomas da asma na infância. Métodos: A amostra é composta de 384 pacientes, entre 2 e 14 anos, com diagnóstico de asma, acompanhados no ambulatório de pneumologia pediátrica do Hospital de Clínicas da Universidade Federal do Paraná. A avaliação ocorreu por meio de uma ficha de dados, aplicada em forma de entrevista aos responsáveis ou à criança participante. Resultados: A exposição ao tabagismo passivo esteve presente em 55% das crianças. Aglomeração domiciliar, menor renda familiar, menor nível de escolaridade materna e paterna foram vistos significativamente no grupo exposto. A população exposta mostrou maior frequência de asma classificada como moderada, maior uso de corticoide inalatório e maior frequência de sintomas diurnos (presentes pelo menos uma vez na semana em 60% dos pacientes). Conclusão: Foi alta a prevalência de crianças asmáticas expostas ao tabagismo passivo. Condição socioeconômica baixa foi confirmada no grupo exposto. Asma de gravidade moderada, maior uso de corticoides inalados e maior frequência de sintomas diurnos foram vistos no grupo de expostos. Este estudo confirma a necessidade imediata de adoção de medidas efetivas no combate ao tabagismo passivo como estratégia imprescindível para o controle da asma na infância.

Objective: To characterize the pediatric asthmatic population and to evaluate the repercussions of passive smoking on childhood asthma symptoms. Methods: The sample consisted of 384 patients, aged 2 to 14 years, diagnosed with asthma, who were followed up at the pediatric pulmonology outpatient clinic of the Hospital de Clínicas of the Federal University of Paraná. The evaluation was carried out by means of a data sheet, administered in the form of an interview to the legal guardians or to the participating child. Results: Exposure to passive smoking was present in 55% of the children. Household agglomeration, lower family income, and lower level of maternal and paternal schooling were seen in the exposed group. The exposed population showed a higher frequency of asthma classified as moderate, greater use of inhaled corticosteroids, and greater frequency of diurnal symptoms (present at least once a week in 60% of patients). Conclusion: The prevalence of asthmatic children exposed to passive smoking was high. Low socioeconomic condition was confirmed in the exposed group. Asthma of moderate severity, greater use of inhaled corticosteroids, and greater frequency of diurnal symptoms were seen in the exposed group. This study confirms the immediate need to adopt effective measures to combat passive smoking as an essential strategy for the control of childhood asthma.

Seroprevalencia de anticuerpos anti-Mycoplasma pneumoniae en niños menores de 12 años / Seroprevalence of anti-Mycoplasma pneumoniae antibodies in otherwise healthy children

Resumen: Introducción: La infección por Mycoplasma pneumoniae (Mypn) podría estar ocurriendo a edades más tempranas, debido a fenómenos sociales como concurrencia a centros de cuidado diurno en forma más frecuente y precoz. Objetivo: estimar la prevalencia de anticuerpos anti-Mypn en niños de 0-12 años, y explorar si la edad, asistencia a centro de cuidados diurnos/escuela, hacinamiento o convivencia con niños incrementan el riesgo de seropositividad. Pacientes y Método: Estudio transversal incluyendo niños de 0-12 años de edad que requirieron extracciones de sangre para control, por lo demás sanos. En todos los casos se consignaron las variables mencionadas y se determinó IgG anti-Mypn mediante enzimoinmunoanálisis. Se evaluó la asociación entre predictores y seropositividad en un modelo de regresión logística. Resultados: Se incluyeron 232 pacientes (edad promedio 56,4 ± 40,0 meses). El 56,9% concurría a centro de cuidado diurno/escuela, 63,8% convivían con menores de 12 años y 15,9% presentaban hacinamiento. El 14,6% presentaba anticuerpos anti-Mypn. Los niños seroposi- tivos no mostraron diferencias significativas con aquellos seronegativos en relación a edad (63,1 ± 40,7 vs. 55,4 ± 41,3 meses), escolaridad (64,7% vs 55,5%), hacinamiento (14,7% vs 14,9%), ni con vivencia con menores (64,7% vs 63,6%). La edad tampoco se mostró como predictor independiente de seropositividad en el modelo multivariado. Conclusión: La prevalencia de anticuerpos anti-Mypn fue 14,6%. La edad no fue predictor de seropositividad.

Abstract: Introduction: Mycoplasma pneumoniae (Mypn) infection could be occurring at an earlier age due to social pheno mena such as attending daycare centers more frequently and earlier than decades ago. Objective: to estimate the prevalence of anti-Mypn antibodies in children aged 0-12 years, and to explore whether age, attendance to daycare center/school, overcrowding or the presence of children aged below 12 years in the households increase the risk of seropositivity. Patients and Method: Cross-sectional stu dy including healthy children aged 0-12 years which required blood draws for routine laboratory tests. In all cases, the aforementioned variables were recorded and anti-Mypn IgG was determined by enzyme immunoassay. The association between predictors and seropositivity was assessed in a logistic regression model. Results: We included 232 patients (average age 56.4 ± 40.0 months). 56.9% attended a daycare center/school, 63.8% co-habited with children under 12 years old, and 15.9% lived in overcrowded households. The prevalence of anti-Mypn antibodies was 14.6%. There were no significant differences between seropositive and seronegative children regarding age (63.1 ± 40.7 vs. 55.4 ± 41.3 months), school/day-care attendance (64.7% vs. 55.5%), overcrowding (14.7% vs. 14.9%), or co-habiting with children (64.7% vs. 63.6%). Age was not an independent predictor of seropositivity in the multivariate model. Conclusion: The prevalence of anti-Mypn antibodies in children was 14.6% and age was not a predictor of seropositivity.

Interventions in overcrowding of emergency departments: an overview of systematic reviews

ABSTRACT OBJECTIVE To present an overview of systematic reviews on throughput interventions to solve the overcrowding of emergency departments. METHODS Electronic searches for reviews published between 2007 and 2018 were made on PubMed, Cochrane Library, EMBASE, Health Systems Evidence, CINAHL, SciELO, LILACS, Google Scholar and the CAPES periodicals portal. Data of the included studies was extracted into a pre-formatted sheet and their methodological quality was assessed using AMSTAR 2 tool. Eventually, 15 systematic reviews were included for the narrative synthesis. RESULTS The interventions were grouped into four categories: (1) strengthening of the triage service; (2) strengthening of the ED's team; (3) creation of new care zones; (4) change in ED's work processes. All studies observed positive effect on patient's length of stay, expect for one, which had positive effect on other indicators. According to AMSTAR 2 criteria, eight revisions were considered of high or moderate methodological quality and seven, low or critically low quality. There was a clear improvement in the quality of the studies, with an improvement in focus and methodology after two decades of systematic studies on the subject. CONCLUSIONS Despite some limitations, the evidence presented on this overview can be considered the cutting edge of current scientific knowledge on the topic.

Percepções e afetos na prisão: análise de narrativas de presos e agentes penitenciários / Percepciones y afectos en prisión: análisis de narraciones de prisioneros y oficiales de prisión / Perceptions and affections in prison: analysis of prisoners and penitentiary officers narratives

Resumo Trata-se de um estudo de caso numa penitenciária do Ceará, Brasil, cujo objetivo foi identificar e analisar percepções ambientais de usuários em ambiente penal, pela expressão de suas experiências no lugar, bem como das simbologias a ele atribuídos. Por meio de entrevistas narrativas realizadas em novembro de 2017, participaram da pesquisa seis presos e seis agentes penitenciários. Suas respostas passaram por análise de conteúdo, permitindo identificar dimensões macro, meso, exo e microsistêmicas de relações ambientais na prisão. Fundamentado na Psicologia Ambiental, concluiu-se que a prisão provoca uma ruptura sócio relacional com o mundo exterior, demonstrando ser incômodo mais relevante do que a sujeição forçada em espaço fisicamente inadequado e superlotado. Ponderou-se, dentre outras reflexões, sobre a função social do aprisionamento que, nas condições atuais, apresenta-se distante dos objetivos de reinserção social e recuperação de pessoas. A prisão provoca sentimentos negativos e depreciadores nas, e sobre, pessoas que o vivenciam.

Resumen Estudio de caso en una prisión de Ceará, Brasil, con el objetivo de identificar y analizar las percepciones ambientales de los usuarios a través de la expresión de sus experiencias en el lugar y así como las simbologías que se le atribuyen. A través de entrevistas narrativas realizadas en noviembre de 2017, participaron en la investigación seis presos y seis oficiales de prisión. Sus respuestas pasaron por análisis de contenido, lo que permitió identificar dimensiones macro, meso, exo y microsistémicas de las relaciones ambientales en la prisión. Basado en la Psicología Ambiental, se concluyó que el encarcelamiento causa una ruptura socio-relacional con el mundo exterior, lo que demuestra ser molestia más relevante que la sujeción forzada en un espacio físicamente inadecuado y superpoblado. Se consideró que la función social del encarcelamiento está lejos de los objetivos de reintegración social y recuperación de las personas. El encarcelamiento causa sentimientos negativos y despectivos en y sobre las personas que lo experimentan.

Abstract This is a case study from a Brazilian prison unit, in the state of Ceará. Its aim was to identify and analyze a prison environment user's perceptions through the expression of their experiences and of the symbology assigned to the place. Through narrative interviews accomplished in November 2017, the research reached six inmates and six prison officers as participants. Their answer went through content analysis, which allowed the identification of macro, meso, exo and micro systemic dimensions of the prison's environmental relations. Grounded in Environmental Psychology, the study concluded that prison causes a social relational break with the outside world. This way, this break demonstrated to bother people more than the forced bondage inside a physically inadequate and overcrowded space. Among other reflections, it was considered that currently the social function of imprisonment is far from the goals of people's social reintegration and recovery. Instead, imprisonment causes negative and derogatory feelings in and about people who experience it.

Analyzing dental arch shape in untreated orthodontic patients with anterior arch crowding

Objective: Crowding of the dentition results in distortion of the arch form and orthodontic treatment unravels the crowding based on the shape of the wire of arch form utilized. Alteration of an existing arch form with the wrong arch wire and biomechanics may result in unstable results. Selection of the appropriate arch wire shape based on the patient's original arch form results in a finished orthodontic treatment which is aesthetically pleasing, preserves the shape and function, with long term stability of the finished case. The objective of the study was to analyze the dental arch shape in untreated orthodontic patients with anterior arch crowding. Methods: Dental casts of 100 untreated orthodontic patients with anterior arch crowding of both the maxilla and mandible were selected and classified using Angles method. Crowding was described as mild, moderate, severe and very severe using the index described by Little. The Occlusal plane was outlined for both jaws using brass wire adapted with sticky wax along the buccal cusps of the posterior teeth on one side of the arch through the incisal edges of the anterior teeth to the buccal cusps of the posterior teeth on the other side of the arch. Data analysis was done using IBM SPSS version 22.0 software. All data was expressed as frequencies, percentages and means. The results were presented using frequency tables. Results: Upper arch shapes were identified as square in 58(58%), tapered in 18(18%) and ovoid in 24 (24%). Lower arch shapes were square in 60(60%), tapered in 36 (36%) and ovoid in 4(4%). Anterior arch crowding was seen in both arches as mild in 68(68%), moderate in 17(17%), severe in 9(9%) and very severe in 6(6%). The highest prevalence of anterior crowding was seen in the mild variant and in the square shape in both the upper and lower arch forms in 43 (63.2%), respectively. The tapered arch form was not demonstrated in the very severely crowded upper arch, while the ovoid arch form in the lower arch was not evident in the severe and very severe variant of crowding. This was however not statistically significant. Conclusion: The square arch form is most prevalent in cases of upper and lower crowding

Environmental factors involved in SARS-CoV-2 transmission: effect and role of indoor environmental quality in the strategy for COVID-19 infection control

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new zoonotic agent that emerged in December 2019, causes coronavirus disease 2019 (COVID-19). This infection can be spread by asymptomatic, presymptomatic, and symptomatic carriers. SARS-CoV-2 spreads primarily via respiratory droplets during close person-to-person contact in a closed space, especially a building. This article summarizes the environmental factors involved in SARS-CoV-2 transmission, including a strategy to prevent SARS-CoV-2 transmission in a building environment. SARS-CoV-2 can persist on surfaces of fomites for at least 3 days depending on the conditions. If SARS-CoV-2 is aerosolized intentionally, it is stable for at least several hours. SARS-CoV-2 is inactivated rapidly on surfaces with sunlight. Close-contact aerosol transmission through smaller aerosolized particles is likely to be combined with respiratory droplets and contact transmission in a confined, crowded, and poorly ventilated indoor environment, as suggested by some cluster cases. Although evidence of the effect of aerosol transmission is limited and uncertainty remains, adequate preventive measures to control indoor environmental quality are required, based on a precautionary approach, because COVID-19 has caused serious global damages to public health, community, and the social economy. The expert panel for COVID-19 in Japan has focused on the "3 Cs," namely, "closed spaces with poor ventilation," "crowded spaces with many people," and "close contact." In addition, the Ministry of Health, Labour and Welfare of Japan has been recommending adequate ventilation in all closed spaces in accordance with the existing standards of the Law for Maintenance of Sanitation in Buildings as one of the initial political actions to prevent the spread of COVID-19. However, specific standards for indoor environmental quality control have not been recommended and many scientific uncertainties remain regarding the infection dynamics and mode of SARS-CoV-2 transmission in closed indoor spaces. Further research and evaluation are required regarding the effect and role of indoor environmental quality control, especially ventilation.

Evaluation of the risk factors associated with emergency department boarding: A retrospective cross-sectional study / 中华创伤杂志(英文版)

PURPOSE@#Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center.@*METHODS@#All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test.@*RESULTS@#Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age.@*CONCLUSION@#The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.

Reducing overcrowding in an emergency department: a pilot study

SUMMARY OBJECTIVE Exploring the use of forecasting models and simulation tools to estimate demand and reduce the waiting time of patients in Emergency Departments (EDs). METHODS The analysis was based on data collected in May 2013 in the ED of Recanto das Emas, Federal District, Brasil, which uses a Manchester Triage System. A total of 100 consecutive patients were included: 70 yellow (70%) and 30 green (30%). Flow patterns, observed waiting time, and inter-arrival times of patients were collected. Process maps, demand, and capacity data were used to build a simulation, which was calibrated against the observed flow times. What-if analysis was conducted to reduce waiting times. RESULTS Green and yellow patient arrival-time patterns were similar, but inter-arrival times were 5 and 38 minutes, respectively. Wait-time was 14 minutes for yellow patients, and 4 hours for green patients. The physician staff comprised four doctors per shift. A simulation predicted that allocating one more doctor per shift would reduce wait-time to 2.5 hours for green patients, with a small impact in yellow patients' wait-time. Maintaining four doctors and allocating one doctor exclusively for green patients would reduce the waiting time to 1.5 hours for green patients and increase it in 15 minutes for yellow patients. The best simulation scenario employed five doctors per shift, with two doctors exclusively for green patients. CONCLUSION Waiting times can be reduced by balancing the allocation of doctors to green and yellow patients and matching the availability of doctors to forecasted demand patterns. Simulations of EDs' can be used to generate and test solutions to decrease overcrowding.

RESUMO OBJETIVO Explorar o uso de modelos de previsão e ferramentas de simulação para estimar a demanda e reduzir o tempo de espera dos pacientes em Departamentos de Emergência (DE). METODOLOGIA A análise foi baseada em dados coletados em maio de 2013, no DE do Recanto das Emas, Distrito Federal, Brasil, que utiliza o Protocolo de Manchester como sistema de triagem. Um total de 100 pacientes consecutivos foram incluídos: 70 amarelos (70%) e 30 verdes (30%). Padrões de fluxo, tempo de espera observado e tempos entre as chegadas dos pacientes foram registrados. Mapas de processo, demanda e dados de capacidade foram utilizados na construção de uma simulação que foi calibrada de acordo com o fluxo observado. Uma análise do tipo "e se..." foi conduzida para reduzir os tempos de espera. RESULTADOS Os padrões de tempo de chegada para pacientes verdes e amarelos foram semelhantes, mas os tempos entre chegadas foram 5 e 38 minutos, respectivamente. O tempo de espera foi de 14 minutos para pacientes amarelos e 4 horas para pacientes verdes. A equipe médica era composta por quatro médicos por turno. Uma simulação previu que a inclusão de mais um médico por turno reduziria o tempo de espera para 2,5 horas para pacientes verdes, com um impacto pequeno no tempo de espera dos pacientes amarelos. A manutenção de quatro médicos e a inclusão de um médico exclusivamente para pacientes verdes reduziria o tempo de espera para 1,5 horas para pacientes verdes e aumentaria em 15 minutos para os pacientes amarelos. O melhor cenário simulado utilizou cinco médicos por plantão, com dois médicos exclusivos para pacientes verdes. CONCLUSÃO Os tempos de espera podem ser reduzidos equilibrando a distribuição de médicos para pacientes verdes e amarelos e relacionando a disponibilidade dos médicos aos padrões de demanda previstos. Simulações de DE podem ser utilizadas para gerar e testar soluções para diminuir a superlotação.

O cuidado à pessoa com comorbidade psiquiátrica em emergência geral: visão dos enfermeiros / Cuidado a la persona con comorbidad psiquiátrica en emergencia general: visión de los enfermeros / Care for people with psychiatric comorbidity in a general emergency unit: vision of the nurses

Resumo OBJETIVO Analisar dificuldades encontradas pelos enfermeiros no cuidado à pessoa com comorbidade psiquiátrica em uma emergência geral e suas sugestões para melhoria do cuidado à estas neste serviço. MÉTODO Estudo qualitativo, descritivo e exploratório, realizado com doze enfermeiros em hospital geral do sul do Brasil em 2016. Para a coleta de informações utilizou-se entrevista e os resultados foram avaliados por Análise de Conteúdo. RESULTADOS Emergiram duas categorias: Dificuldades encontradas pelos enfermeiros no cuidado à pessoa com comorbidade psiquiátrica e Sugestões dos enfermeiros para qualificar o cuidado à pessoa com comorbidade psiquiátrica. A primeira relacionada à estrutura física e recursos materiais; superlotação; falta de preparo da equipe e de consultoria psiquiátrica e a segunda indicou fluxograma de atendimento; consultoria psiquiátrica e capacitação para a equipe. CONCLUSÕES Deve-se transcender a fragmentação do cuidado desde a formação dos profissionais de saúde, trazendo a necessidade de capacitações e de maior investimento na formação acadêmica.

Resumen OBJETIVO Analizar dificultades encontradas por los enfermeros en el cuidado a la persona con comorbilidad psiquiátrica en una emergencia general y sus sugerencias para mejorar el cuidado a éstas en este servicio. MÉTODO Estudio cualitativo, descriptivo y exploratorio, realizado con doce enfermeros en hospital general del sur de Brasil en 2016. Para la recolección de informaciones se utilizó entrevista y los resultados fueron evaluados por Análisis de Contenido. RESULTADOS Emergieron dos categorías: Dificultades encontradas por los enfermeros en el cuidado a la persona con comorbilidad psiquiátrica y Sugerencias de los enfermeros para calificar el cuidado a la persona con comorbilidad psiquiátrica. La primera relacionada con la estructura física y los recursos materiales; hacinamiento; falta de preparación del equipo y de consultoría psiquiátrica y la segunda indicó diagrama de atención; consultoría psiquiátrica y capacitación para el equipo. CONCLUSIONES Se debe trascender la fragmentación del cuidado desde la formación de los profesionales de salud, trayendo la necesidad de capacitaciones y de mayor inversión en la formación académica.

Abstract OBJECTIVE To analyze the difficulties encountered by nurses when providing care to people with psychiatric comorbidity in the general emergency unit and their suggestions for improving the care of these patients. METHOD This is a qualitative, descriptive, and exploratory study conducted with twelve nurses at a general hospital in southern Brazil, in 2016. Information was collected during an interview and the results were evaluated using content analysis. RESULTS Data interpretation led to two categories: Difficulties of nurses when providing care to people with psychiatric comorbidity and Nurses' suggestions to improve care for people with psychiatric comorbidity. The first category is related to the physical structure and material resources of the service, overcrowding, and lack of preparation of the team and professionals who provide psychiatric consultations. In the second category, the workers suggested a care flow chart, psychiatric consultations, and team training. CONCLUSIONS We must transcend the fragmentation of care from the education years of health professionals, emphasize the need for training, and make greater investments in health education.

Emergency department and hospital crowding: causes, consequences, and cures

Overcrowding with associated delays in patient care is a problem faced by emergency departments (EDs) worldwide. ED overcrowding can be the result of poor ED department design and prolonged throughput due to staffing, ancillary service performance, and flow processes. As such, the problem may be addressed by process improvements within the ED. A broad body of literature demonstrates that ED overcrowding can be a function of hospital capacity rather than an ED specific issue. Lack of institutional capacity leads to boarding in the ED with resultant ED crowding. This is a problem not solvable by the ED and must be addressed as an institution-wide problem. This paper discusses the causes of ED overcrowding, provides a brief overview of the drastic consequences, and discusses possible cures that have been successfully implemented.

Effects of Myofunctional Appliance in Children with Sleep-Disordered Breathing: Two Case Reports / 대한소아치과학회지

Sleep-disordered breathing (SDB) induces dysfunction of the orofacial muscles, leading to morphologic alteration of the face and dental malalignment. Early diagnosis and treatment of SDB is required in pediatric patients to ensure normal facial growth. Myofunctional therapy (MFT) is a modality for the treatment of SDB and prefabricated appliances can be used. Herein 2 cases of malocclusion with SDB, in which MFT with a prefabricated appliance was used for orthodontic treatment, have been described. SDB was diagnosed based on clinical symptoms taken by interview and home respiratory polygraphy. In both cases, SDB was improved using prefabricated appliance for MFT. However, resolution of crowding depended on the degree of crowding.

Management of angle class I malocclusion with severe crowding and bimaxillary protrusion by extraction of four premolars: A case report

@#Crowding and protrusion are some of the most common dental cases worldwide. The patient was a 20-year-old female who consulted for severe crowding, protrusion, and deep bite. Clinical examination and cephalometric measurement showed Class I skeletal and proclined incisor. Two step retraction technique was used to correct the condition. Management of tooth tissue discrepancy by the extraction of four premolars is one of the options in the treatment of crowding.

Efficiency of interproximal reduction technique for correction of anterior crowding without extraction: A case report

@#Crowding is one of the most common findings in orthodontic patients. This case report describes the correction of anterior crowding with interproximal reduction (IPR). The case is that of a 24-year-old female patient who consulted for irregularly placed anterior teeth. Fixed appliances were placed followed by IPR. Treatment time was 18 months. Class I molar relation was maintained, with normal overjet and overbite. IPR is effective for treatment of patients with Class I malocclusion with anterior moderate crowding.