Síndrome pós-COVID-19: sintomas persistentes, impacto funcional, qualidade de vida, retorno laboral e custos indiretos - estudo prospectivo de casos 12 meses após a infecção / Síndrome post-COVID-19: síntomas persistentes, impacto funcional, calidad de vida, retorno al trabajo y costos indirectos - estudio prospectivo de casos 12 meses tras la infección / Post-COVID-19 syndrome: persistent symptoms, functional impact, quality of life, return to work, and indirect costs - a prospective case study 12 months after COVID-19 infection

Os sintomas persistentes da síndrome pós-COVID-19 acarretam impactos negativos na saúde, qualidade de vida e produtividade. O objetivo deste trabalho foi descrever os sintomas persistentes da síndrome pós-COVID-19, principalmente neurológicos, e as repercussões cognitivas, emocionais, motoras, de qualidade de vida e de custos indiretos, 12 meses após a infecção. Pacientes com primeiros sintomas entre janeiro e junho de 2021 evoluíram com síndrome pós-COVID-19 e procuraram atendimento na unidade da Rede SARAH de Hospitais de Reabilitação em Fortaleza, Ceará, Brasil. As informações foram obtidas no início do acompanhamento e por entrevista telefônica após 12 meses da infecção. Participaram do estudo 58 pessoas, com idade média de 52,8 anos (±10,5) e 60% permaneceram em UTI. Os sintomas mais frequentes na admissão foram: fadiga (64%), artralgia (51%) e dispneia (47%); e após 12 meses: fadiga (46%) e alteração de memória (39%). Foram identificadas alterações nas escalas/testes funcionais: PCFS, MoCA, HAD, FSS, SF-36, TLS5x, Timed up and go, caminhada de 6 minutos e preensão manual. Os custos indiretos totais foram de USD 227.821,00, com 11.653 dias de absenteísmo; 32% dos pacientes não voltaram a trabalhar. Melhores resultados de TLS5x e SF-36, nas dimensões capacidade funcional, aspecto físico, vitalidade e dor, demonstraram associação com retorno laboral (p ≤ 0,05). Os sintomas persistentes mais frequentes foram: fadiga, artralgia, dispneia, ansiedade e depressão, com repercussões negativas na funcionalidade cognitiva, emocional, motora e qualidade de vida. Esses sintomas perduraram por mais de um ano, principalmente fadiga e alteração de memória, sendo esta última mais relatada tardiamente. Houve dificuldade importante de retorno laboral e custos indiretos de USD 4.847,25 por pessoa/ano.

Síntomas persistentes del síndrome post-COVID-19 provocan impactos negativos en la salud, calidad de vida y productividad. El objetivo fue describir los síntomas persistentes del síndrome post-COVID-19, sobre todo neurológicos, y las repercusiones cognitivas, emocionales, motoras, de calidad de vida y los costos indirectos, 12 meses tras la infección. Pacientes que tuvieron los primeros síntomas entre enero y junio de 2021, desarrollaron síndrome post-COVID-19 y buscaron atención en la unidad de la Red SARAH de Hospitales de Rehabilitación en Fortaleza, Ceará, Brasil. Las informaciones se obtuvieron al inicio del seguimiento y por entrevista telefónica 12 meses tras la infección. Participaron 58 personas, con edad de 52,8±10,5 años y el 60% permaneció en la UTI. Los síntomas más frecuentes al ingreso fueron: fatiga (64%), artralgia (51%) y disnea (47%); tras 12 meses fueron: fatiga (46%) y alteración de memoria (39%). Se identificaron alteraciones en las escalas/testes funcionales: PCFS, MoCA, HAD, FSS, SF-36, TLS5x, timed up and go, caminar por 6 minutos y prensión manual. Los costos indirectos totales fueron USD 227.821,00, con 11.653 días de absentismo. El 32% de los pacientes no volvió a trabajar. Mejor TLS5x y SF-36 en las dimensiones capacidad funcional, aspecto físico, vitalidad y dolor demostraron una asociación con el retorno al trabajo (p ≤ 0,05). Los síntomas persistentes más frecuentes fueron fatiga, artralgia, disnea, ansiedad y depresión, con repercusiones negativas en la funcionalidad cognitiva, emocional, motora y calidad de vida. Estos síntomas continuaron por más de un año, sobre todo la fatiga y la alteración de la memoria, siendo esta última reportada con más frecuencia tardíamente. Hubo una dificultad importante en el retorno al trabajo y costos indirectos de USD 4.847,25 persona/año.

The persistent symptoms of post-COVID-19 syndrome negatively impact health, quality of life, and productivity. This study aimed to describe the persistent symptoms of post-COVID-19 syndrome (especially neurological ones) and their 12-month post-infection cognitive, emotional, motor, quality of life, and indirect cost repercussions. Patients showing the first symptoms of COVID-19 from January to June 2021 who developed post-COVID-19 syndrome and sought care at the Fortaleza Unit (Ceará, Brazil) of the SARAH Network of Rehabilitation Hospitals were included in this study. Information was obtained at the baseline follow-up and by telephone interview 12 months post-infection. In total, 58 people participated in this study with an average age of 52.8±10.5 years, of which 60% required an ICU. The most frequent symptoms on admission included fatigue (64%), arthralgia (51%), and dyspnea (47%), whereas, after 12 months, fatigue (46%) and memory impairment (39%). The following scales/functional tests showed alterations: PCFS, MoCA, HAD, FSS, SF-36, TLS5x, timed up and go, 6-minute walk, and handgrip. Indirect costs totaled USD 227,821.00, with 11,653 days of absenteeism. Moreover, 32% of patients were unable to return to work. Better TLS5x and higher SF-36 scores in the functional capacity, physical functioning, vitality, and pain dimensions were associated with return to work (p ≤ 0.05). The most frequent persistent symptoms referred to fatigue, arthralgia, dyspnea, anxiety, and depression, which negatively affected cognitive, emotional, and motor function and quality of life. These symptoms lasted for over a year, especially fatigue and memory alteration, the latter of which being the most reported after COVID-19 infections. Results also show a significant difficulty returning to work and indirect costs of USD 4,847.25 per person/year.

Síndrome de Burnout em fisioterapeutas atuantes na docência, clínica e área hospitalar durante a pandemia da COVID-19 / Burnout Syndrome in physiotherapists working in teaching, clinical and hospital areas during the COVID-19 pandemic

INTRODUÇÃO: Segundo a Organização Mundial da Saúde, a síndrome de Burnout (SB) é uma resposta à cronificação do estresse, estrita ao contexto laboral. Alguns estudos reconheceram essa condição em 1980 e destacaram a exaustão emocional, a despersonalização e um senso reduzido de realização pessoal experimentados pelos profissionais. Existe uma necessidade de entender a síndrome de Burnout nos fisioterapeutas, e o agravamento que a pandemia da COVID-19 provocou nestes profissionais atuantes nas áreas da docência, em clínicas e área hospitalar. OBJETIVO: Verificar a frequência da síndrome de Burnout em fisioterapeutas e associar o impacto do ambiente de trabalho e em cada área de atuação no período da pandemia da COVID-19. METODOLOGIA: Trata-se de um estudo observacional, descritivoanalítico, de abordagem quantitativa e delineamento transversal. Como instrumentos de avaliação foram utilizados questionários de coleta de dados sociodemográficos, ocupacionais e comportamentais, além do Maslach Burnout Inventory (MBI) em sua versão Human Services Survey (HSS). Os critérios de inclusão consistiam em idade (22 a 70 anos), ambos os gêneros, devidamente habilitados pelo conselho da profissão, que atuassem em pelo menos um local fixo de atendimento por um período mínimo de 06 meses. A análise dos dados foi feita através do teste T, Anova, Kruskal ­ Wallis e Mann ­ Whitney. O nível de significância foi definido em p<0,05 e ICs de 95%. RESULTADOS: Participaram 57 profissionais fisioterapeutas atuantes em clínicas, hospitais e professores. Comparamos os 03 critérios da SB e o seu score total e correlacionamos aos 03 cenários, neste quesito os três grupos Síndrome de Burnout, pois a literatura preconiza que alta exaustão emocional, associada a alta despersonalização e baixa realização pessoal é considerada uma síndrome de Burnout. CONCLUSÃO: Os fisioterapeutas apresentam alto nível de incidência da SB, foi constatado que a pandemia agravou a prevalência e o impacto da SB nos profissionais que atuam em hospitais, clínicas e na docência.

INTRODUCTION: According to the World Health Organization, Burnout syndrome is a response to the chronification of stress, strict to the work context. Some studies recognized this condition in 1980 and highlighted emotional exhaustion, depersonalization and a reduced sense of personal accomplishment experienced by professionals. There is a need to understand the Burnout syndrome in physical therapists, and the aggravation of the COVID-19 pandemic in these professionals working in the teaching, clinical and hospital áreas. OBJECTIVE: To verify the frequency of Burnout syndrome in physical therapists and to associate the impact of the work environment and the work variables in each area of work in the period of the COVID-19 pandemic. METHODOLOGY: This is an observational, descriptiveanalytical study with a quantitative approach and cross-sectional design. A questionnaire was used to collect sociodemographic, occupational and behavioral data, as well as the Maslach Burnout Inventory (MBI) in its Human Services Survey (HSS) version. The inclusion criteria were age (22 to 70 years old), both genders, duly qualified by the professional council, and working in at least one fixed place of attendance for a minimum period of 06 months. Data analysis was done using the T test, Anova, Kruskal-Wallis and Mann-Whitney. The significance level was set at p<0.05 and 95% CIs. RESULTS: 57 physiotherapist professionals working in clinics, hospitals and teaching participated. We compared the 03 criteria of the BS and its total score and correlated the 03 scenarios, in this regard, the three groups had Burnout Syndrome, since the literature recommends that high emotional exhaustion, associated with high depersonalization and low personal fulfillment is considered a syndrome of Burnout. CONCLUSION: Physical therapists have a high level of incidence of BS, it was found that the pandemic aggravated the prevalence and impact of BS on professionals working in hospitals, clinics and teaching.

Acinic cell carcinoma of the oral and maxillofacial region: an international multicenter study

Abstract The aim of this study was to describe the prevalence, clinicopathological, and prognostic features of acinic cell carcinoma (AciCC) of the oral and maxillofacial region. AciCC cases were retrospectively retrieved from 11 pathology centers of three different countries. Medical records were examined to extract demographic, clinical, pathologic, and follow-up information. A total of 75 cases were included. Females (65.33%) with a mean age of 45.51 years were mostly affected. The lesions usually presented as an asymptomatic (64.28%) nodule (95.66%) in the parotid gland (70.68%). The association of two histopathological patterns was the most common finding (48.93%) and the tumors presented mainly conventional histopathological grades (86.11%). Surgical treatment was performed in the majority of the cases (59.19%). Local recurrence was observed in 20% of the informed cases, regional metastasis in 30.43%, and distant metastasis in 12.50%. The statistical analysis showed that the cases with a solid histopathological pattern (p=0.01), high-grade transformation (p=0.008), recurrence (p=0.007), and regional metastasis (p=0.03) were associated with poor survival. In conclusion, high histopathological transformation, presence of nodal metastasis, and recurrence were prognostic factors for AciCC of the oral and maxillofacial region.

Aesthetic assessment of breast reconstruction in the eyes of plastic surgeons versus nonplastic physicians

SUMMARY OBJECTIVE: The aim of this study was to evaluate the perception of the aesthetic result of breast reconstruction surgery from the perspective of plastic surgeons compared with physicians who are not specialists in plastic surgery. METHODS: Twenty patients who underwent breast reconstruction after mastectomy had their aesthetic results evaluated by 16 plastic surgeons and 16 nonplastic physicians, yielding a total of 620 ratings (320 ratings from plastic surgeons and 320 ratings from other specialists). For all analyses, the level of rejection adopted for the null hypothesis was 5% (p-value <0.05). RESULTS: Significant differences were observed between the two groups. On average, medical professionals who specialized in plastic surgery always obtained higher scores than other physicians. However, no significant differences were found in the assessment of the aesthetic outcome of breast reconstruction according to the sex of the rating medical professional for any of the assessments considered in this study. A strong positive linear correlation between the time since training in the medical specialty of plastic surgery (r=0.750, p=0.001) and the mean aesthetic outcome score was observed in this study. CONCLUSION: Plastic surgeons assessed the aesthetic results of breast reconstruction more positively than nonplastic physicians.

Does smoking habit affect dendritic cell expression in oral squamous cell carcinoma?

Abstract: The aim of this study was to determine the presence of immature CD1a+ and mature CD83+ dendritic cells in oral squamous cell carcinoma, to compare immunoreactivity between smokers and nonsmokers, and to correlate the results with histopathological grading. In this observational study, twenty-eight paraffin-embedded biopsies of oral squamous cell carcinoma were retrospectively retrieved and submitted to immunohistochemistry for immature CD1a+ and mature CD83+. Descriptive and statistical analyses were performed. The sample consisted of 18 man (64.3%) and 10 women (35.7%), with a mean age of 64.6 years in the nonsmoker group and 53.2 years in the smoker group. The tongue (11 cases, 39.2%) was the most commonly affected anatomical site, followed by gingiva (6 cases, 21.4%). Histopathological grading revealed 7 low-grade and 7 high-grade malignancy cases in each group, and no correlation with the number of positive DCs. The number of immature CD1a+ was not significantly different between smoker and nonsmoker groups, while a lower number of mature CD83+ was detected in the smoker group (p = 0.001). Smoking changes the oral immune system and decreases the ability to activate and mature dendritic cells, which may influence the development and progression of oral squamous cell carcinoma.

Experiências de extensão em educação popular em saúde no enfrentamento à pandemia da Covid-19 na Atenção Primária à Saúde / Experiencias de extensión en educación popular en salud en el enfrentamiento a la pandemia de Covid-19 en la Atención Primaria de la Salud / Extension experiences in popular health education in confronting the Covid-19 pandemic in Primary Health Care

Empenhando-se em abordar a Educação Popular em Saúde (EPS) como ponte universidade-sistema de saúde, este artigo objetiva relatar experiências de extensão universitária realizadas no contexto da Atenção Primária à Saúde (APS) para a contribuição no enfrentamento à pandemia do Covid-19. Teve como caminho metodológico a análise documental e crítica das práticas realizadas por um programa de extensão em EPS de março a dezembro de 2020. Enfocam-se processos formativos mobilizados pelos extensionistas, bem como produção de materiais de apoio à divulgação e ao fortalecimento dos saberes populares em saúde nas mídias sociais. Tais iniciativas deram visibilidade aos saberes e aprendizados oriundos de práticas populares em saúde e ações de EPS na APS. Os espaços educativos possibilitaram o compartilhamento de experiências, bem como o adensamento da formação das pessoas na perspectiva pedagógica da EPS como alternativa de resposta nesse desafiador contexto. (AU)

Con el empeño de abordar la Educación Popular en Salud (EPS) como puente de la universidad-sistema de salud, este artículo tiene el objetivo de relatar experiencias de extensión universitaria realizadas en el contexto de la Atención Primaria de la Salud (APS) para la contribución en el enfrentamiento de la pandemia de covid-19. Tuvo como camino metodológico el análisis documental y crítico de las prácticas realizadas por un programa de extensión en EPS de marzo a diciembre de 2020. Se enfocan en los procesos formativos movilizados por los extensionistas, así como la producción de materiales de apoyo a la divulgación y al fortalecimiento de los saberes populares en salud de las redes sociales. Tales iniciativas dieron visibilidad a los saberes y aprendizajes provenientes de prácticas populares en salud y acciones de EPS en la APS. Los espacios educacionales hicieron posible compartir experiencias, así como adensar en la formación de las personas bajo la perspectiva pedagógica de la EPS como alternativa de respuesta en ese contexto desafiador. (AU)

Addressing the Popular Education in Health (PEH) as a link between the university and the health system, this paper aims to report experiences of university extension developed, in the context of Primary Health Care (PHC), to contribute to the fight against the Covid-19 pandemic. The chosen methodology was the documentary type and the critical analysis of practices undertaken by an extension program in PEH from March to December 2020. It focuses on training processes mobilized by extensionists and the production of materials to support the dissemination and strengthening of popular knowledge in health on social media. These initiatives have given visibility to the knowledge and learning of popular health practices and PEH actions in PHC. The educational spaces have enabled the sharing of experiences and deepening the training of people in the pedagogical perspective of PEH as an alternative response in this challenging context. (AU)

Recadastramento da população residente em Foz do Iguaçu, Brasil, em atendimento à Política de Atenção Primária à Saúde / Reregistration of the population residing in Foz do Iguaçu, Brazil, in compliance with the Primary Health Care Policy / Reinscripción de la población residente en Foz do Iguaçu, Brasil, en cumplimiento de la Política de atención primaria de salud

RESUMO Objetivo. Apresentar a experiência e os resultados do recadastramento da população residente em Foz do Iguaçu, um município de fronteira localizado no estado do Paraná, Brasil, para atender às diretrizes da Política de Atenção Primária à Saúde (APS) e ao seu novo modelo de financiamento pelo Programa Previne Brasil. Métodos. Utilizando uma estratégia de varredura (amostra de conveniência) para coleta de dados, foram visitados 52 263 domicílios e realizadas 22 710 entrevistas de setembro a novembro de 2019. As entrevistas foram realizadas pessoalmente por 54 agentes comunitários de saúde. Foram coletados dados sobre o domicílio (status de posse da moradia, localização urbana ou rural, tipo de domicílio, material da construção, disponibilidade de rede elétrica e de esgoto, abastecimento de água e destino do lixo) e informações demográficas e de saúde dos moradores. Resultados. O recadastramento revelou que os domicílios eram predominantemente casas próprias, em área urbana, bem edificados e servidos por energia elétrica, rede geral de água e coleta de lixo. Sobre a população recadastrada, 52,8% eram mulheres, 62,5% tinham idade de 15 a 59 anos e 60,0% se autodeclararam brancos. Entre os entrevistados com 15 anos ou mais, 90,0% tinham completado o ensino fundamental. A principal ocupação foi "assalariado com carteira de trabalho". Ainda, 18,6% dos entrevistados se autodeclararam hipertensos e 7,0%, diabéticos. Conclusões. O recadastramento trouxe informações relevantes para subsidiar o planejamento da APS, assim como iniciativas de assistência social, trabalho e habitação; também foi fundamental para definir estratégias de atenção à saúde nesse município de fronteira durante a pandemia de COVID-19.

ABSTRACT Objective. To present the experience and results of the reregistration of residents in Foz do Iguaçu, a border town located in the state of Paraná, Brazil, to meet the guidelines of the national Primary Health Care (PHC) Policy and its new financing model (Programa Previne Brasil). Method. A scanning strategy (convenience sample) was used for data collection, with 52 263 households visited and 22 710 interviews conducted from September to November 2019. The interviews were conducted face-to-face by 54 community health workers. Data were collected on the household (ownership status, urban or rural location, type of household, construction material, availability of electrical and sewage networks, water supply and waste disposal). Demographic and health information on the residents was also collected. Results. The reregistration process revealed that most residents were home owners and lived in well-constructed homes, located mostly in urban areas, served by electricity, with access to water supply and garbage collection. Of the reregistered population, 52.8% were women, 62.5% were aged between 15 and 59 years and 60.0% declared themselves white. Among respondents aged 15 or over, 90.0% had completed elementary school. The main occupation was "formal salaried job". Additionally, 18.6% of the interviewees declared themselves to be hypertensive and 7.0%, diabetic. Conclusions. The reregistration process uncovered relevant information to support both PHC planning as well as social assistance, work and housing initiatives; it was also fundamental to define health care strategies in this border town during the COVID-19 pandemic.

RESUMEN Objetivo. Presentar la experiencia y los resultados de la reinscripción de la población residente en Foz do Iguaçu, un municipio fronterizo ubicado en el estado de Paraná (Brasil), en cumplimiento de las directrices de la Política de atención primaria de salud y su nuevo modelo de financiamiento (Programa Previne Brasil). Métodos. Utilizando una estrategia de barrido (muestreo de conveniencia) para la recolección de datos, se visitaron 52 263 hogares y se realizaron 22 710 entrevistas entre septiembre y noviembre de 2019. Las entrevistas fueron presenciales y estuvieron a cargo de 54 trabajadores comunitarios de salud. Se recopilaron datos sobre el hogar (régimen de propiedad de la vivienda, ubicación en una zona urbana o rural, tipo de vivienda, material de construcción, disponibilidad de redes de energía eléctrica y alcantarillado, abastecimiento de agua y eliminación de desechos) e información sobre la composición demográfica y la salud de los residentes. Resultados. La reinscripción reveló que los residentes eran propietarios de sus viviendas y que estas se encontraban ubicadas en zonas urbanas, estaban bien construidas y tenían servicios de energía eléctrica, abastecimiento de agua y recolección de basura. El 52,8% de la población registrada correspondió a mujeres, el 62,5% tenía entre 15 y 59 años y el 60,0% declaró que era de raza blanca. El 90,0% de los entrevistados mayores de 15 años había terminado la escuela primaria. La ocupación principal era "persona asalariada con carnet de trabajo". Además, el 18,6% de los entrevistados indicó que tenía hipertensión y el 7,0%, diabetes. Conclusiones. La reinscripción aportó información relevante para apoyar la planificación de la atención primaria de salud , así como las iniciativas en materia de asistencia social, trabajo y vivienda; también fue fundamental para definir las estrategias de atención de salud en ese municipio fronterizo durante la pandemia de COVID-19.

Estudo de intervenção com escolares utilizando jogo de cartas "o enigma da pirâmide'' sobre alimentação saudável / Intervention study with schoolchildren using the card game "the pyramid enigma" about healthy eating / Estudio de intervención con escolares mediante el juego de cartas "el enigma de la pirámide" sobre alimentación saludable

RESUMO Objetivo: avaliar o conhecimento sobre alimentação saudável promovido pela tecnologia educacional. Método estudo de avaliação de desempenho, do tipo quase-experimental (desenho pré/pós- teste). Participaram 204 alunos, com idade entre nove e 10 anos, de três escolas públicas, de Recife-PE-Brasil, em setembro de 2018. Observou-se o ganho de conhecimento pelo seguinte processo: diminuindo da Pontuação Média Observada após a intervenção (PMO-2) a Pontuação Média Observada antes da intervenção (PMO-1); dividindo-se o número obtido pela PMO-1 e em seguida multiplicando o resultado obtido por 100. Resultados antes da intervenção 16/204 alunos (7,8%) obtiveram pontuação ≥ 7. Depois da intervenção, 160/204 alunos (78,4%) alcançaram essa pontuação. A proporção de alunos que pontuou ≤ 5 passou de 49/204 (24%) para 1/204 (0,5%). Quatro alunos mantiveram a pontuação inicial. O ganho médio de conhecimento após uma única jogada foi de 38,5%. Conclusão estes resultados comprovaram a efetividade do jogo, e seu emprego promoveu a socialização entre os alunos.

ABSTRACT Objective to evaluate the knowledge about healthy eating promoted by educational technology. Method quasi-experimental (pre/posttest design) performance evaluation study. test design). Participated 204 students, aged between nine and 10 years, from three public schools of Recife-PE-Brazil, in September 2018. Knowledge gain was observed by the following process: decreasing from the Mean Score Observed after the intervention (PMO-2) to the Mean Score Observed before the intervention (PMO-1); dividing the number obtained by PMO-1 and then multiplying the result obtained by 100. Results before the intervention 16/204 students (7.8%) scored ≥ 7. After the intervention 160/204 students (78.4%) achieved this score. The proportion of students who scored ≤ 5 went from 49/204 (24%) to 1/204 (0.5%). Four students maintained their initial score. The average knowledge gain after a single move was 38.5%. Conclusion these results proved the effectiveness of the game, and its use promoted socialization among the students.

RESUMEN Objetivo evaluar los conocimientos sobre alimentación saludable promovidos por la tecnología educativa. Método estudio de evaluación del rendimiento, de tipo cuasi-experimental (pre/postprueba). Participaron 204 alumnos, de entre nueve y diez años, de tres colegios públicos, de Recife-PE-Brasil, en septiembre de 2018. La ganancia de conocimientos se observó mediante el siguiente proceso: disminución de la puntuación media observada después de la intervención (PMO-2) a la puntuación media observada antes de la intervención (PMO-1); dividiendo el número obtenido por la PMO-1 y multiplicando luego el resultado obtenido por 100. Resultados antes de la intervención, 16/204 alumnos (7,8%) obtuvieron una puntuación ≥ 7. Después de la intervención, 160/204 alumnos (78,4%) alcanzaron esta puntuación. La proporción de estudiantes que obtuvieron una puntuación ≤ 5 pasó de 49/204 (24%) a 1/204 (0,5%). Cuatro estudiantes mantuvieron su puntuación inicial. La ganancia media de conocimientos tras un solo traslado fue del 38,5%. Conclusión estos resultados demostraron la eficacia del juego, y su uso promovió la socialización entre los estudiantes.

Analysis of a novel class A β-lactamase OKP-B-6 of Klebsiella quasipneumoniae: structural characterisation and interaction with commercially available drugs

BACKGROUND Gram-negative and Gram-positive bacteria produce beta-lactamase as factors to overcome beta-lactam antibiotics, causing their hydrolysis and impaired antimicrobial action. Class A beta-lactamase contains the chromosomal sulfhydryl reagent variable (SHV, point mutation variants of SHV-1), LEN (Klebsiella pneumoniae strain LEN-1), and other K. pneumoniae beta-lactamase (OKP) found mostly in Klebsiella's phylogroups. The SHV known as extended-spectrum β-lactamase can inactivate most beta-lactam antibiotics. Class A also includes the worrisome plasmid-encoded Klebsiella pneumoniae carbapenemase (KPC-2), a carbapenemase that can inactivate most beta-lactam antibiotics, carbapenems, and some beta-lactamase inhibitors. OBJECTIVES So far, there is no 3D crystal structure for OKP-B, so our goal was to perform structural characterisation and molecular docking studies of this new enzyme. METHODS We applied a homology modelling method to build the OKP-B-6 structure, which was compared with SHV-1 and KPC-2 according to their electrostatic potentials at the active site. Using the DockThor-VS, we performed molecular docking of the SHV-1 inhibitors commercially available as sulbactam, tazobactam, and avibactam against the constructed model of OKP-B-6. FINDINGS From the point of view of enzyme inhibition, our results indicate that OKP-B-6 should be an extended-spectrum beta-lactamase (ESBL) susceptible to the same drugs as SHV-1. MAIN CONCLUSIONS This conclusion advantageously impacts the clinical control of the bacterial pathogens encoding OKP-B in their genome by using any effective, broad-spectrum, and multitarget inhibitor against SHV-containing bacteria.

Excess Mortality due to natural causes among whites and blacks during the COVID-19 pandemic in Brazil

Abstract INTRODUCTION: Excess Mortality by all causes considers deaths directly related to COVID-19 and those attributed to conditions caused by the pandemic. When stratified by social dimensions, such as race/color, it allows for the evaluation of more vulnerable populations. The study estimated the excess mortality by natural causes, separating the white and black populations in 2020. METHODS Public civil registration data on deaths observed in 2020, corrected for under registration, were used. The expected number of deaths was estimated based on the mortality rates observed in 2019, applied to the estimated population in 2020. The difference between the values expected and observed and the proportion of excess was considered the excess mortality. RESULTS: The present study found an excess of 270,321 deaths (22.2% above the expected) in 2020. Every state of Brazil reported deaths above the corresponding expected figure. The excess was higher for men (25.2%) than for women (19.0%). Blacks showed an excess of 27.8%, as compared to whites at 17.6%. In both sexes and all age groups, excess was higher in the black population, especially in the South, Southeast, and Midwest regions. São Paulo, the largest in population number, had twice as much excess death in the black population (25.1%) than in the white population (11.5%). CONCLUSIONS: The present study showed racial disparities in excess mortality during the COVID-19 pandemic in Brazil. The higher excess found for the black suggests an intrinsic relationship with the socioeconomic situation, further exposing the Brazilian reality, in which social and structural inequality is evident.

Road traffic injuries and deaths and the achievement of UN Sustainable Development Goals in Brazil: results from the Global Burden of Disease Study, 1990 to 2019

Abstract INTRODUCTION: Brazil ranks 5th in the number of deaths due to road injuries. This study aimed to analyze mortality and disabilities resulting from road injuries in Brazil, and to assess the Sustainable Development Goals (SDG) target of reducing deaths due to road injuries by 50% by 2030. METHODS: This descriptive and exploratory study used the estimates from the Global Burden of Disease 2019: indicators of mortality, premature deaths, and disabilities according to sex, age group, and type of transport for 1990, 2015, and 2019. Time trends in mortality rates from 1990 to 2019 were assessed, and a projection for 2030 was calculated, applying a linear regression model. RESULTS: Deaths due to road injuries were 44,236 in 1990, and 44,529 in 2019, representing a 43% reduction in mortality rates. The highest rates were in the North, Northeast, and Midwest regions of Brazil, in males and young adults. A 77% reduction was observed in mortality rates for pedestrians and an increase of 53% for motorcyclists and of 54% for cyclists during the period. In terms of motorcycle road injuries, the mortality rate for men increased from 7.3/100,000 (1990) to 11.7/100,000 inhabitants (2019). The rates of premature deaths and disabilities were also higher for men when compared to women. Amputations, fractures, spinal cord injuries, and head trauma were the main types of road injuries. The projections for 2030 show that Brazil might not reach the SDG target. CONCLUSIONS: Despite the decline in mortality rates, the 2030 Agenda's target might not be achieved.

Maternal Mortality in Brazil, 1990 to 2019: a systematic analysis of the Global Burden of Disease Study 2019

Abstract INTRODUCTION Maternal death continues to be one of the most challenging public health problems that needs to be addressed in low and middle-income countries. The objective of this study was to describe the problem of maternal death in Brazil, using estimates from the Global Burden of Disease Study (GBD). METHODS This study used data from the GBD 2019 to show the numbers of deaths and the Maternal Mortality Ratio (MMR) - number of deaths/100,000 live births - in Brazil and its 27 Federated Units (FU), for ages 10 to 54 years, from 1990 to 2019. The annual variation of the MMR was estimated in 1990, 2010, and 2019. The MMR were shown for specific causes as well as for five-year age groups. The estimates were presented with 95% uncertainty intervals (UI). RESULTS The number of maternal deaths, as well as the MMR showed a 49% reduction from 1990 to 2019. This reduction occurred heterogeneously throughout the country, and the profile of the MMR for specific causes changed between 1990 and 2019: from hypertensive gestation diseases, to indirect maternal deaths, followed by hypertensive gestation diseases. In the extreme age groups, the MMR is higher, with mortality increasing exponentially in direct proportion with age. CONCLUSIONS Maternal deaths in Brazil have decreased substantially since 1990; however, the numbers still fall short of what was established by the World Health Organization (WHO). Indirect causes are the greatest problem in more than 60% of the FU, especially for hypertensive pregnancy diseases.

Os processos educativos em grupos comunitários como caminhos para a promoção da saúde e da segurança alimentar e nutricional na Atenção Básica / Educational processes in community groups as pathways to Health Promotion and Food and Nutrition Security in Primary Care

O presente trabalho buscou explicitar saberes e práticas da Promoção da Saúde (PS) e da Segurança Alimentar e Nutricional (SAN) no âmbito da Atenção Básica (AB), partindo de processos educativos em grupos comunitários pautados pela perspectiva da Educação Popular (EP). O processo investigativo baseou-se na sistematização de experiências, tendo como foco atividades desenvolvidas no período de dez anos (2007-2017) pelo Programa de Extensão "Práticas Integrais de Promoção da Saúde e Nutrição na Atenção Básica (PINAB)", o qual é vinculado à Universidade Federal da Paraíba e é construído de forma compartilhada com trabalhadores e usuários de uma Unidade de Saúde da Família. Empregou-se a pesquisa documental como forma de mobilização de fontes para essa sistematização. Como resultado, pôde- se apontar: os pressupostos que sustentaram essa experiência, as formas de organização da mesma, os desafios e as potencialidades de seus processos educativos.

The present work sought to explain knowledge and practices of Health Promotion (PS) and Food and Nutritional Security (SAN) within the scope of Primary Care (AB), starting from educational processes in community groups based on the perspective of Popular Education (EP). The investigative process was based on the systematization of experiences, focusing on activities developed in the ten-year period (2007-2017) by the Extension Program "Comprehensive Practices for the Promotion of Health and Nutrition in Primary Care (PINAB)", which is linked to the Federal University of Paraíba and is built in a shared way with workers and users of a Family Health Unit. Documentary research was used as a way of mobilizing sources for this systematization. As a result, it was possible to point out: the assumptions that sustained this experience, the organization forms of it, the challenges and the potential of its educational processes.

Parque público e criminalidade: preditores ambientais da percepção de (in)segurança / Public park and crime: environmental predictors of the perception of (in)security

O modelo da prevenção criminal pelo design ambiental (Crime Prevention through Environmental Design - CPTED) enfatiza como elementos do ambiente podem inibir ou induzir a ocorrência de vários tipos de delitos e a percepção de insegurança. Isso é especialmente estratégico em locais de uso múltiplo e de livre acesso, como no caso dos parques públicos em grandes cidades. O objetivo desta pesquisa foi testar o papel preditivo de variáveis especificadas pela CPTED sobre a percepção de segurança, com base em um survey in loco com 126 usuários de parque público, incluindo itens sobre hábitos, ocorrências criminais, avaliação do ambiente e variáveis sociodemográficas. Modelos de regressão linear hierárquica mostraram que sexo, experiências de vitimização e a avaliação da infraestrutura funcionaram como variáveis antecedentes adequadas. Os resultados são discutidos no contexto do cenário criminal brasileiro, da inércia da população e, sobretudo, das possibilidades de intervenção em políticas públicas de segurança.

The model of Crime Prevention through Environmental Design (CPTED) emphasizes how elements of the environment may inhibit or induce the occurrence of various types of crime and the perception of insecurity. This is especially strategic in places of multiple uses and free access, as in the case of public parks in big cities. The objective of this research was to test the predictive role of variables specified by CPTED on the perception of security, based on a survey in loco with 126 public park users, including items on habits, criminal occurrences, environmental assessment and sociodemographic variables. Hierarchical linear regression models showed that sex, experiences of victimization, and the evaluation of infrastructure worked as appropriate background variables. The results are discussed in the context of the Brazilian criminal scenario, the inertia of the population and, above all, the possibilities of intervention in public policies for security.

Time de acesso vascular e terapia infusional: satisfação da equipe de saúde em hospital pediátrico / Vascular access and infusional therapy team: satisfaction of the health team at pediatric hospital / Equipo de acceso vascular y terapia infusional: satisfacción del equipo de salud en hospital pediátrico

Objetivos: Conhecer a satisfação e qualidade do serviço sobre time de acesso vascular e terapia infusional (TAVTI) e identificar a importância do TAVTI para a equipe de saúde. Metodo: Trata-se de uma pesquisa de campo exploratória, descritiva, com abordagem quantitativa e qualitativa. Aplicamos formulários para 149 profissionais. Resultados: Dos participantes, 46,97%(n:70) refere total satisfação frente ao TAVTI; a minoria 0,67%(n:1) demonstra insatisfação total; a maioria considera o serviço muito importante 71,14%(n:106) e excelente atuação para 44,96%(n:67). Apenas 1,34%(2) dos profissionais considerou a qualidade do trabalho regular. Dos participantes, 126 declararam: serviço humanizado; seguro para o paciente; necessita de capacitação e treinamento; material seguro; período integral. Conclusão: A atuação do TAVTI demonstra ser efetiva. Constatou-se a satisfação da equipe de saúde e a importância na pediatria devido à preservação do acesso venoso e o desejo dos profissionais em manter o TAVTI período integral. Frente ao percentual de qualidade considerado, excelente e ótimo.(AU)

Objectives: To know the satisfaction and quality of service on the vascular access and infusional therapy team (TAVTI) and to identify the importance of TAVTI for the health team. Methodo: This is an exploratory, descriptive field research, with a quantitative and qualitative approach. We apply forms to 149 professionals. Results: Of the participants, 46.97% (n: 70) reported total satisfaction with TAVTI; the minority 0.67% (n: 1) shows total dissatisfaction; the majority considered the service very important 71.14% (n: 106) and excellent performance for 44.96% (n: 67). Only 1.34% (2) of the professionals considered the quality of work to be regular. Of the participants, 126 declared: humanized service; safe for the patient; needs qualification and training; safe material; Full time. Conclusion: The performance of TAVTI proves to be effective. The satisfaction of the health team and the importance in pediatrics were found due to the preservation of venous access and the desire of professionals to maintain TAVTI full time. In view of the percentage of quality considered, excellent and great.(AU)

Objetivos: Conocer la satisfacción y calidad del servicio del equipo de acceso vascular y terapia infusional (TAVTI) e identificar la importancia de TAVTI para el equipo de salud. Metodo: Se trata de una investigación de campo exploratoria, descriptiva, con enfoque cuantitativo y cualitativo. Aplicamos formularios a 149 profesionales. Resultados: De los participantes, el 46,97% (n: 70) reportaron satisfacción total con TAVTI; la minoría 0,67% (n: 1) muestra total insatisfacción; la mayoría consideró el servicio muy importante 71,14% (n: 106) y excelente desempeño para el 44,96% (n: 67). Solo el 1,34% (2) de los profesionales consideró regular la calidad del trabajo. De los participantes, 126 declararon: servicio humanizado; seguro para el paciente; necesita cualificación y formación; material seguro; período integral. Conclusión: La actuación de TAVTI demuestra ser eficaz. La satisfacción del equipo de salud y la importancia en pediatría se encontraron debido a la preservación del acceso venoso y el deseo de los profesionales de mantener TAVTI a tiempo completo. En vista del porcentaje de calidad considerado, excelente y óptimo.(AU)

Cultura de segurança do paciente na Atenção Primária à Saúde / Patient safety culture in Primary Health Care

RESUMO Objetivo avaliar a cultura de segurança do paciente em uma unidade de saúde da Atenção Primária. Métodos estudo transversal, conduzido com 51 profissionais vinculados à Atenção Primária à Saúde. Dados foram coletados utilizando o instrumento autoaplicável Medical Office Survey on Patient Safety Culture, traduzido, adaptado e validado para uso no Brasil. Foi realizada análise estatística descritiva. Participaram enfermeiros, médicos, Agentes Comunitários de Saúde, dentre outros profissionais. Resultados as dimensões da cultura de segurança do paciente na Atenção Primária à Saúde apontaram oportunidades de melhoria ou fragilidades do serviço. A avaliação geral em segurança do paciente e a avaliação global da qualidade do cuidado prestado na Atenção Primária à Saúde foram apontados como boa ou razoável. Conclusão a cultura de segurança na Atenção Primária não identificou dimensões fortes, verificaram-se problemas com equipamentos, realização e disponibilidade dos resultados de exames e troca de informações com centros de imagem/laboratórios da rede de atenção.

ABSTRACT Objective to evaluate the patient safety culture in a primary care health unit. Methods cross-sectional study conducted with 51 professionals linked to Primary Health Care. Data were collected using the self-administered instrument Medical Office Survey on Patient Safety Culture, translated, adapted and validated for use in Brazil. Descriptive statistical analysis was performed. Nurses, physicians, Community Health Agents, among other professionals participated. Results the dimensions of the patient safety culture in Primary Health Care indicated opportunities for improvement or weaknesses in the service. The general assessment of patient safety and the global assessment of the quality of care provided in Primary Health Care were appointed as good or fair. Conclusion the safety culture in Primary Care did not identify strong dimensions; there were problems with equipment, performance and availability of test results and exchange of information with imaging centers/laboratories in the care network.

Identification and characterisation of SARS-CoV-2 and Human alphaherpesvirus 1 from a productive coinfection in a fatal COVID-19 case

BACKGROUND During routine Coronavirus disease 2019 (COVID-19) diagnosis, an unusually high viral load was detected by reverse transcription real-time polymerase chain reaction (RT-qPCR) in a nasopharyngeal swab sample collected from a patient with respiratory and neurological symptoms who rapidly succumbed to the disease. Therefore we sought to characterise the infection. OBJECTIVES We aimed to determine and characterise the etiological agent responsible for the poor outcome. METHODS Classical virological methods, such as plaque assay and plaque reduction neutralisation test combined with amplicon-based sequencing, as well as a viral metagenomic approach, were performed to characterise the etiological agents of the infection. FINDINGS Plaque assay revealed two distinct plaque phenotypes, suggesting either the presence of two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains or a productive coinfection of two different species of virus. Amplicon-based sequencing did not support the presence of any SARS-CoV-2 genetic variants that would explain the high viral load and suggested the presence of a single SARS-CoV-2 strain. Nonetheless, the viral metagenomic analysis revealed that Coronaviridae and Herpesviridae were the predominant virus families within the sample. This finding was confirmed by a plaque reduction neutralisation test and PCR. MAIN CONCLUSIONS We characterised a productive coinfection of SARS-CoV-2 and Herpes simplex virus 1 (HSV-1) in a patient with severe symptoms that succumbed to the disease. Although we cannot establish the causal relationship between the coinfection and the severity of the clinical case, this work serves as a warning for future studies focused on the interplay between SARS-CoV-2 and HSV-1 coinfection and COVID-19 severity.

Dificuldades da participação social na Atenção Primária à Saúde: uma revisão sistemática qualitativa / Dificulties of social participation in Primary Health Care: a systematic qualitative review

O presente artigo tem o objetivo de identificar dificuldades da participação social na Atenção Primária à Saúde, compreendendo e problematizando suas principais vertentes conforme a atual literatura. Foi feita uma revisão sistemática qualitativa considerando um intervalo de 4 anos e meio (2014 a 2018). Foram empregados os descritores "participação popular", "participação comunitária" e "participação social" na base de dados SciELO, e, em seguida, foram aplicados os filtros "Brasil" e "Saúde". A partir da leitura dos resumos foram selecionados os artigos que se concentravam na dimensão da Atenção Primária à Saúde, totalizando 59 artigos. Extraiu-se as ideias principais acerca do tema em cada artigo e fez-se duas sistematizações. Seis dificuldades principais foram encontradas: a) tímido conhecimento da população sobre o Sistema Único de Saúde e sobre a saúde como um direito constitucional; b) limites quanto à cultura política participativa da população; c) fragilidade quanto ao conhecimento da população sobre os espaços de participação; d) obstáculos no funcionamento dos conselhos de saúde; e) fragilidades quanto ao compromisso de gestores e trabalhadores em colocar em prática as deliberações e pactuações das instâncias participativas; f) as determinações sociais do processo saúde-doença gerando obstáculos significativos para a participação social. Constatou-se que na literatura a dimensão das dificuldades é pouco explorada, de modo que o presente estudo contribui com o aprofundamento desse debate. O tímido conhecimento da população sobre a participação social e o frágil envolvimento nesses espaços promove um distanciamento, o que fomenta ainda mais a ideia da ineficiência desses ambientes. Essas barreiras podem se tornar transponíveis por meio da educação popular em saúde.

Contribuições da psicanálise à atuação na clínica cardiológica / Contributions of psychoanalysis to performance at the cardiology clinic

O presente ensaio tem como objetivo refletir sobre as contribuições psicanalíticas à atuação do psicólogo/psicanalista na clínica cardiológica a partir de uma breve articulação e discussão teóricas. Lançou-se mão de compreensões tais quais a inserção do analista no hospital, o corpo adoecido para a psicanálise e os principais aspectos subjetivos presentes na clínica cardiológica. Concluiu-se que o cerne das contribuições psicanalíticas à problemática é o oferecimento de possibilidade de acesso ao simbólico, diante de conteúdos difíceis de ser elaborados, que emergem a partir do processo de adoecimento.

This essay aims to reflect on the psychoanalytic contributions to the role of the psychologist/psychoanalyst in the cardiology clinic from a brief articulation and theoretical discussion. Understandings such as the insertion of the analyst in the hospital, the sick body for psychoanalysis and the main subjective aspects present in the cardiology clinic were used. It was concluded that the core of psychoanalytic contributions to the problem is the possibility of providing access to the symbolic, in view of content that is difficult to elaborate, which emerge from the illness process.