Conhecimento dos profissionais de saúde sobre precauções específicas / Knowledge of health professionals about specific precautions / Conocimiento de profesionales de la salud sobre precauciones específicas

Objetivo: apresentar um diagnóstico situacional sobre o conhecimento dos profissionais de saúde sobre precauções específicas. Métodos: estudo transversal, realizado em um hospital filantrópico mineiro, com 127 profissionais de saúde de nível superior. Para a coleta de dados, utilizou-se o instrumento "Conhecimento dos profissionais de saúde sobre Precauções Específicas" com 29 questões de múltipla escolha, distribuídas em cinco eixos temáticos. Para a análise dos dados, foram executados procedimentos descritivos e diferentes testes estatísticos. Resultados: a média geral de acertos das questões foi 64,7%. O eixo temático "Acomodação e estrutura" apresentou mediana de acertos (43,6%) significativamente menor (p<0,001) que os demais eixos. O eixo "Cadeia epidemiológica de transmissão de microrganismos" apresentou mediana de 60% e os eixos "Cuidado com ambiente" e "Comunicação" tiveram mediana de 66,7%. A maior mediana de acertos ocorreu no eixo "Equipamento de proteção individual (80%)". Conclusão: a assertividade foi baixa em todos os eixos temáticos, o que pode comprometer a qualidade e a segurança da assistência prestada. Assim, verifica-se a necessidade de promover ações educativas com estratégias inovadoras, sensibilizando estes profissionais quanto à adesão dessas medidas de precaução. (AU)

Objective: to present a situational diagnosis about the knowledge of health professionals about specific precautions. Methods: cross-sectional study, conducted in a philanthropic hospital in Minas Gerais, with 127 health professionals of higher education. For data collection, was used the instrument "Knowledge of health professionals on Specific Precautions" with 29 multiple choice questions, distributed in five thematic axes. Descriptive procedures and different statistical tests were performed for the analysis of the data. Results: the overall average number of correct answers was 64.7%. The thematic axis "Accommodation and structure" presented a significantly lower median number of correct answers (p<0.001) than the other axes. The axis "Epidemiological chain of transmission of microorganisms" presented a median of 60% and the axes "Environment Care" and "Communication" had a median of 66.7%. The highest median of correct answers occurred in the axis "Personal protective equipment (80%)". Conclusion: assertiveness was low in all thematic axes, which can compromise the quality and safety of the care provided. Thus, there is a need to promote educational actions with innovative strategies, sensitizing these professionals about the adoption of these precautionary measures. (AU)

Objectivo: presentar un diagnóstico situacional sobre el conocimiento de los profesionales de la salud sobre precauciones específicas. Métodos: estudio transversal realizado en un hospital filantrópico de Minas Gerais, con 127 profesionales de la salud de nivel superior. Para la recopilación de datos, se utilizó el instrumento "Conocimiento de los profesionales de la salud sobre Precauciones Específicas", con 29 preguntas objetivas de múltiple elección, distribuidas en cinco ejes temáticos. Para el análisis de los datos, se realizaron procedimientos descriptivos y diferentes pruebas estadísticas. Resultados: la media general de respuestas correctas fue del 64,7%. El eje temático "Acomodación y estructura" mostró una mediana de respuestas correctas (43,6%) significativamente menor (p<0,001) que los otros ejes. El eje "Cadena epidemiológica de transmisión de microorganismos" tuvo una mediana del 60% y los ejes "Cuidado del medio ambiente" y "Comunicación" tuvieron una mediana del 66,7%. La mediana más alta de respuestas correctas se dio en el eje "Equipo de protección personal (80%)". Conclusión: el asertividad fue baja en todos los ejes temáticos, lo que puede comprometer la calidad y la seguridad de la atención prestada. Así, se comprueba la necesidad de promover acciones educativas con estrategias innovadoras, sensibilizando a estos profesionales en cuanto a la aplicación de las medidas de precaución. (AU)

Knowledge, Compliance and Attitude of Nursing Students towards Standard Precautions: A Cross-Sectional Study in a Tertiary Hospital

@#Introduction: Knowledge, compliance, and attitudes toward the standard precaution guidelines are crucial to avoid contamination not only on patients but also on healthcare providers. Little is known regarding Malaysian nursing students’ knowledge, compliance, and attitudes toward standard precaution guidelines. The purpose of this study was to look into Malaysian nursing students’ knowledge, compliance, and attitudes towards standard precaution guidelines. Methods: This cross-sectional study was conducted among 337 Diploma nursing students who were chosen by simple random sampling. A self-invented questionnaire based on the CDC recommendations was administered to the participants and their responses were recorded. With a Cronbach’s alpha coefficient of 0.96, the instrument is reliable. The STROBE cross-sectional design process guideline was used as the study design. Results: Majority of the nursing students have adequate knowledge (n=222, 65.9%), adequate compliance (n=229, 68%) and good attitudes (n=171, 50.7%) with the standard precaution. The findings suggest an association between gender (p=0.005) and year of educational level (p=0.001) with the level of knowledge. There was also an association between the level of knowledge with the level of compliance (p=0.029) and the level of attitude (p=0.002) with standard precautions among the nursing students. Conclusion: Even though nearly two-thirds of the participants appeared to have adequate knowledge and compliance, only half of them have good attitudes with the standard precautions. This study indicates that although the students had adequate knowledge and compliance, measures are needed to foster compatible attitudes towards the standard precautions among the nursing students.

Effectiveness of interventions for human papillomavirus vaccine hesitancy among female university students based on the precaution adoption process model / 预防医学

Objective @#To evaluate the effectiveness of interventions for human papillomavirus ( HPV ) vaccine hesitancy among female university students based on the precaution adoption process model (PAPM), so as to provide the evidence for improving the coverage of HPV vaccine in this population. @*Methods @#HPV vaccine hesitant female students were selected using a cluster sampling method from Zhejiang Chinese Medical University, and randomly assigned to the PAPM group and control group. Students in the PAPM group received PAPM-based interventions for HPV vaccine hesitancy, while students in the control group were given routine interventions. The HPV-related knowledge, HPV vaccine-related knowledge and HPV vaccine hesitancy scores were collected from both groups prior to interventions ( T0 ), 0 ( T1 ), 1 ( T2 ) and 3 months post-interventions ( T3 ), and the effectiveness of interventions was evaluated using analysis of variance for repeated measures.@*Results @#There were 147 students in the PAPM group and 141 students in the control group. In the PAPM group, 36.73% of the students majored in medical sciences, and 48.23% were freshmen; in the control group, 39.72% majored in medical sciences, and 50.35% were freshmen. The mean scores of HPV- and HPV vaccine-related knowledge were significantly greater in the PAPM group than in the control group, respectively ( T1, 5.29 vs. 4.91; T2, 4.27 vs. 4.22; T3, 4.22 vs. 4.04; P<0.05 ); however, no significant differences were detected in the HPV vaccine hesitancy scores between the two groups, respectively ( T1, 2.98 vs. 2.95; T2, 3.07 vs. 3.07; T3, 3.08 vs. 2.97; P>0.05 ). The mean scores of the confidence dimension ( T1, 3.37 vs. 3.23; T2, 3.48 vs. 3.40; T3, 3.38 vs. 3.25 ) and the dimension of influence by others ( T1, 3.44 vs. 3.33; T2, 3.42 vs. 3.37; T3, 3.46 vs. 3.27 ) were significantly greater in the PAPM group than in the control group (P<0.05), while the mean scores of the complacency dimension were significantly lower in the PAPM group than in the control group ( T1, 1.98 vs. 2.03; T2, 2.06 vs. 2.20; T3, 2.18 vs. 2.15; P<0.05 ).@*Conclusions @#PAPM-based interventions for HPV vaccine hesitancy may effectively improve the awareness of HPV and HPV vaccines, reduce complacency, and enhance the influence by others among female university students.

Teaching practice of enhancing standard precautions for clinical intern students / 中华医学教育探索杂志

Objective:To explore the methods and effect of applying specialized training and multimedia education in key infection-related departments of a hospital to intervene standard precautions for clinical practice interns.Methods:Based on the cases of nosocomial infection at home and abroad, the Science and Education Section and Infection Management Section designed and produced videos about standard precautions and occupational protection. The content of these videos covered two fields including knowledge training and skill training, with emphasis on enhancing awareness of profession risks and skills of hospital infection control and occupational protection of 196 medical students through specialized training in key infection-related departments. The training effect of standard precautions education for the two groups of students was evaluated from the theoretical test scores, questionnaire survey on their attitude and compliance to standard precautions, and the incidence of their occupational exposure to needle stab wound. SPSS 18.0 was performed for t test and chi-square test. Results:Apart from the knowledge of the unfavorable factors of implementing standard precautions, there were significant differences between the experimental group and the control group in six aspects: theoretical test scores, hospital infection risk cognition, significance cognition of standard precautions, favorable factors of implementing standard precautions, self-efficacy evaluation and self-evaluation of compliance to standard precautions ( P<0.05). And there was significant difference in the incidence of occupational exposure to needle stab wound between the experiment group and control group (1.02% vs. 7.14%; χ2=4.69, P<0.05). Conclusion:Various teaching interventions of standard precautions during the entire internship period have expanded and deepened the contents of school education, enabling the students to form good occupational risk awareness and coping skills to protect the patients and themselves.

Personal protective equipment in hospital nursing care: a scoping review / Equipo de protección personal en la atención hospitalaria de enfermería: revisión de alcance / Equipamentos de proteção individual na assistência hospitalar de enfermagem: revisão de escopo

ABSTRACT Objective: to analyze the scientific production on the use of Personal Protective Equipment by Nursing professionals during the care provided in the hospital environment. Method: this is a scoping review, based on the 2020 Joanna Briggs Institute Manual and guided by PRISMA-PCR. PUBMED, EMBASE, CINAHL, LILACS, BDENF, SCOPUS and WEB of SCIENCE were used as databases, choosing a search period corresponding to the last 20 years. Data collection took place from September to October 2021. The study protocol is available in the Open Science Framework: https://osf.io/7d8q9/files/. Studies on the use of Personal Protective Equipment in direct care provided by the Nursing team in hospitals were included; and those that addressed reviews, theses and dissertations in other settings were excluded, as well as studies not available in full. Results: the sample consisted of 26 documents. The items most cited and with the highest adherence in the studies were procedure gloves, while use of goggles was the least mentioned. The following stand out among the factors that facilitate PPE use by nurses: interpersonal relationships, knowledge, workload, standardization of guidelines, and participation of the care team in management decisions. Conclusion: the need to educate the professionals using behavioral knowledge as a strategy, as well as maintenance of communication in the sectors to avoid contamination, the influence of workload and the standardization of guidelines are necessary in the hospital health services to increase health professionals' engagement towards the biosafety practices.

RESUMEN Objetivo: analizar la producción científica sobre el uso del Equipo de Protección Personal en profesionales de Enfermería durante la atención provista en el ámbito hospitalario. Método: revisión de alcance basada en el Manual del Joanna Briggs Institute de 2020 y guiada por PRISMA-PCR. Se utilizaron las bases de datos PUBMED, EMBASE, CINAHL, LILACS, BDENF, SCOPUS y WEB of SCIENCE, eligiéndose los últimos 20 años como período de búsqueda. Los dados fueron recolectados de septiembre a octubre de 2021. El protocolo del estudio se encuentra disponible en Open Science Framework: https://osf.io/7d8q9/files/. Se incluyeron estudios sobre el uso del Equipo de Protección Personal en la atención directa provista por el equipo de Enfermería en hospitales y se excluyó a los que tenían como tema revisiones, tesis y disertaciones en otros ámbitos, al igual que estudios no disponibles en formato de texto completo. Resultados: la muestra estuvo compuesta por 26 documentos. Los elementos de protección más citados y con mayor adhesión en los estudios fueron los guantes de procedimiento, mientras que las gafas protectoras fueron las menos mencionadas. Entre los factores que facilitan el uso del PPE en los profesionales de Enfermería se destacan las relaciones interpersonales, el conocimiento, la carga de trabajo, la estandarización de las pautas y la participación del equipo asistencial en las decisiones gerenciales. Conclusión: la necesidad de educar a los profesionales empleando como estrategia el conocimiento conductual, mantener la comunicación entre los sectores para para evitar la contaminación, la influencia de la carga de trabajo, y la estandarización de las pautas son medidas necesarias en los servicios de salud hospitalaria para mejorar el nivel de compromiso de los profesionales de la salud con las prácticas de bioseguridad.

RESUMO Objetivo: analisar a produção científica sobre o uso de equipamento de proteção individual pelos profissionais da enfermagem durante a assistência no âmbito hospitalar. Método: trata-se de uma revisão de escopo, baseada no Manual Institute Joanna Briggs de 2020 e norteado pelo PRISMA-PCR. Utilizou-se como base de dados PUBMED, EMBASE, CINAHL, LILACS, BDENF, SCOPUS e WEB of SCIENCE, sendo o período de busca escolhido nos últimos 20 anos. A coleta de dados ocorreu de setembro a outubro de 2021. Protocolo de estudo disponível em Framework: https://osf.io/7d8q9/files/. Foram incluídos estudos sobre o uso dos Equipamentos de Proteção Individual na assistência direta da equipe de enfermagem nos hospitais e excluídos aqueles que abordassem em outros cenários, revisões, teses, dissertações e estudos não disponíveis na íntegra. Resultados: a amostra foi composta por 26 documentos. O equipamento mais citado e com maior adesão nos estudos foram as luvas de procedimento, enquanto que o uso dos óculos foi o menor. Dos fatores que facilitam o uso dos EPIs pelos enfermeiros destacam-se as relações interpessoais, conhecimento, carga de trabalho, padronização das diretrizes e participação da equipe assistencial nas decisões gerenciais. Conclusão: a necessidade de educação dos profissionais utilizando como estratégia o conhecimento comportamental, a manutenção da comunicação nos setores para evitar a contaminação, a influência da carga de trabalho, a padronização das diretrizes são necessárias nos serviços de saúde hospitalar para aumentar o engajamento dos profissionais de saúde às práticas de biossegurança.

Knowledge and compliance to standard precautions and general self efficacy among nurses in a tertiary hospital

Purpose@#This study aimed to evaluate the level of knowledge on Standard Precautions, level of compliance to Standard Precautions, and General self-efficacy of nurses in a tertiary hospital. Also, this study aimed to identify the relationship between those variables.@*Design and Methods@#A descriptive correlational research design was utilized in the study. 168 nurses from the tertiary hospital from Nueva Ecija, Philippines were recruited to complete a questionnaire about their knowledge and compliance to Standard Precautions and their General self-efficacy. The data was coded, encoded, and statistically analyzed using PSPP 1.2.0 (GNU Project. New York City, New York, USA).@*Results@#Findings indicated that nurses have good knowledge and high compliance concerning standard precautions; also, findings showed that nurses have a moderate level of general self-efficacy. However, there was no remarkable relationship between the level of knowledge, level of compliance in Standard Precautions, and general self-efficacy.@*Conclusions@#Although the researcher concluded a high level of knowledge among nurses, statistical analysis showed no relationship when correlated with compliance. This concluded that knowledge of Standard Precautions does not necessarily influence compliance and its application. Also, findings inferred that a moderate level of general self-efficacy did not act upon the level of compliance of nurses to Standard Precautions.

Boas práticas higiênico-sanitárias na rotina antropométrica na (pós-) pandemia da COVID-19 / Good hygienic-sanitary practices in anthropometric routine in the (post-) COVID-19 pandemic

resumo A pandemia da COVID-19 afetou diversas atividades humanas, tais como práticas de medições antropométricas, desde o campo clínico e de pesquisa até o campo do ensino. Dada a falta de vacinas e/ou medicamentos eficazes contra a COVID-19, a Organização Mundial da Saúde (OMS) recomendou medidas de prevenção e enfrentamento da doença. Essas recomendações foram posteriormente endossadas pela Sociedade Internacional para o Avanço da Cineantropometria/ International Society for the Advancement of Kinanthropometry (ISAK), com adaptações às rotinas antropométricas, que complementamos para aplicação abrangente nos diversos segmentos de atuação da antropometria. Este ponto de vista visa enfatizar e contribuir às considerações de segurança das rotinas antropométricas em um mundo pós-COVID-19. Entende-se aqui que o protocolo de biossegurança apresentado neste ponto de vista para retorno e continuidade das atividades antropométricas, no mundo inteiro, independentemente da formação/ capacitação/ atuação profissional, no que diz respeito à vida e às comunidades, também pode ter aplicação recorrente no combate a outros patógenos respiratórios semelhantes para se transformarem em pandemias no futuro. Sugere-se o desenvolvimento de vídeos demonstrativos das recomendações deste ponto de vista para reforçar as boas práticas higiênico-sanitárias a serem adotadas pelos profissionais da antropometria na realização das medições do corpo humano.

abstract The COVID-19 pandemic has affected several human activities such as anthropometrics measures practices, from the clinical and research fields to the teaching field. Given the lack of effective vaccines and/or drugs against COVID-19, the World Health Organization (WHO) has recommended taking measures to prevent and cope with the disease. These recommendations were subsequently endorsed by the International Society for the Advancement of Kinanthropometry (ISAK), with adaptations to anthropometric routines, which were made to enable comprehensive application in several anthropometry segments. This point of view aims to emphasize and contribute to security considerations about anthropometric routines in the post-COVID-19 world. It is herein understood that the biosafety protocol presented under this point of view to enable the return and continuation of anthropometric activities, worldwide, regardless of professional training/ qualification/ performance, with respect to life and communities, may also have recurring application to fight other respiratory pathogens with similar potential to turn into pandemics in the future. Demonstrative videos presenting these recommendations, based on this point of view, should be developed to help reinforcing the good hygienic-sanitary practices to be adopted by anthropometry professionals who carry out human body measurements.

Challenges for adherence to bacterial resistance actions in large hospitals / Desafíos para la adherencia a las acciones de resistencia bacteriana en grandes hospitales / Desafios para adesão às ações de contenção da resistência bacteriana em hospitais de grande porte

ABSTRACT Objectives: to identify the challenges to actions to contain bacterial resistance. Methods: cross-sectional study, carried out in 30 large-sized hospitals in Minas Gerais, from 2018 to 2019. The professionals were interviewed, and the environment and actions to prevent bacterial resistance were observed. Results: regarding the knowledge of health care professionals about the measures of bacterial resistance prevention, 78.3% did not correctly describe the five moments of hand hygiene, and 76.6% did not correctly describe the measures to control bacterial resistance. The simple hygiene of hands, followed by alcohol rubbing was predominant (48.3%) among workers, and soap dispensers were next to alcohol dispensers in 58.3% of the nursing stations in care units. Conclusions: the insufficient knowledge from the professionals, which is a failure related to the physical structure and to personal protection equipment, are factors that difficult the adherence to measures to contain bacterial resistance in hospitals.

RESUMEN Objetivos: identificar dificultades para adhesión a acciones de contención de resistencia bacteriana. Métodos: estudio transversal, realizado en 30 grandes hospitales de Minas Gerais, de 2018 a 2019. Entrevistaron profesionales; observaron ambiente y acciones de prevención de resistencia bacteriana. Resultados: el conocimiento de los profesionales asistenciales acerca de medidas de prevención de resistencia bacteriana, 78,3% no describieron correctamente los cinco momentos para higienización de las manos; y 76,6%, las medidas de control de resistencia bacteriana. Identificó que la higienización simple de las manos seguida por fricción alcohólica fue predominante (48,3%) entre los profesionales y que dispensadores de jabonete y alcohol estaban lado a lado en 58,3% de los puestos de enfermería de las unidades asistenciales. Conclusiones: el conocimiento insuficiente de los profesionales, fallas relacionadas a la estructura física y a los equipos de protección individuales son factores dificultadores para la adhesión a las medidas de contención de resistencia bacteriana en hospitales.

RESUMO Objetivos: identificar as dificuldades para adesão às ações de contenção da resistência bacteriana. Métodos: estudo transversal, realizado em 30 hospitais de grande porte de Minas Gerais, de 2018 a 2019. Entrevistaram-se os profissionais; observaram-se o ambiente e as ações de prevenção da resistência bacteriana. Resultados: sobre o conhecimento dos profissionais assistenciais acerca das medidas de prevenção da resistência bacteriana, 78,3% não descreveram corretamente os cinco momentos para higienização das mãos; e 76,6%, as medidas de controle da resistência bacteriana. Identificou-se que a higienização simples das mãos seguida por fricção alcoólica foi predominante (48,3%) entre os profissionais e que dispensadores de sabonete e álcool estavam lado a lado em 58,3% dos postos de enfermagem das unidades assistenciais. Conclusões: o conhecimento insuficiente dos profissionais, falhas relacionadas à estrutura física e aos equipamentos de proteção individuais são fatores dificultadores para a adesão às medidas de contenção da resistência bacteriana nos hospitais.

Precauções para linfedema em mulheres acometidas por câncer de mama pós esvaziamento axilar: revisão de escopo / Precautions against lymphedema in women with breast cancer after axillary dissection: scoping review / Precauciones para el linfedema em mujeres com câncer de mama después del vaciamento axilar: revision de alcance

Objetivo: identificar e mapear estratégias preconizadas para prevenção de linfedema em pacientes submetidas a esvaziamento axilar em tratamento do câncer de mama. Método: revisão de escopo realizada em agosto de 2019 considerando oito bases de dados e oito bases da literatura cinzenta. A amostra final foi composta por 13 artigos, selecionados de acordo com critérios de elegibilidade. Resultados: os estudos foram predominantemente randomizados, com nível de evidência 1a, e realizados na América do Norte. Medidas preventivas tradicionalmente utilizadas, como limitar exercícios com carga ou evitar punção venosa e aferição de pressão arterial, não se demonstraram efetivas em nenhum dos estudos encontrados. Foi evidenciado como medida preventiva o controle dos fatores de risco modificáveis associados ao linfedema: IMC elevado (> 25 kg/m2 ) e quimioterapia administrada no braço ipsilateral. Conclusões: não foram apresentadas evidências significativas para medidas cotidianamente preconizadas na prevenção do linfedema, e fatores de risco modificáveis se destacaram entre os riscos para seu desenvolvimento.

Objective: to identify and map strategies recommended for prevention of lymphedema in patients after axillary dissection during breast cancer treatment. Method: this scoping review was conducted in August 2019 across eight databases and eight gray literature data sources. The final sample comprised 13 journal articles that met eligibility criteria. Results: the studies, most of which were randomized, conducted in North America, and offered Level 1a evidence. None of the studies reviewed found traditionally employed preventive measures, such as limiting weight training or avoiding venipuncture and blood pressure measurements, to be effective. Evidence indicated that controlling modifiable lymphedema-related risk factors ­ namely high BMI (> 25 kg/m²) and chemotherapy administration in the ipsilateral arm ­ was a preventive measure. Conclusion: no significant evidence was reported for traditionally recommended preventive measures against lymphedema, and modifiable factors figured prominently among risk factors for lymphedema.

Objetivo: identificar y mapear las estrategias recomendadas para la prevención del linfedema en pacientes después de una disección axilar durante el tratamiento del cáncer de mama. Método: esta revisión de alcance se realizó en agosto de 2019 en ocho bases de datos y ocho fuentes de datos de literatura gris. La muestra final comprendió 13 artículos de revistas que cumplieron con los criterios de elegibilidad. Resultados: los estudios, la mayoría de los cuales fueron aleatorios, se realizaron en Norteamérica y ofrecieron evidencia de Nivel 1a. Ninguno de los estudios revisados encontró que las medidas preventivas empleadas tradicionalmente, como limitar el entrenamiento con pesas o evitar la punción venosa y las mediciones de la presión arterial, sean efectivas. La evidencia indicó que el control de los factores de riesgo relacionados con el linfedema modificables, a saber, un IMC alto (> 25 kg / m²) y la administración de quimioterapia en el brazo ipsilateral, era una medida preventiva. Conclusión: no se informó evidencia significativa de las medidas preventivas recomendadas tradicionalmente contra el linfedema, y los factores modificables figuraron de manera prominente entre los factores de riesgo para el linfedema.

El principio de precaución entre los fundamentos del plan de prevención y control de la COVID-19 en Cuba / The precaution principle as a fundament of prevention and control plan to mitigate the COVID-19 disease in Cuba

RESUMEN Se explicitan los elementos que distinguen el principio de precaución como principio del derecho internacional y se realiza una síntesis de las medidas fundamentales adoptadas por el Estado Cubano para prevenir, controlar, proteger y mitigar los riesgos e impactos negativos provocados por la enfermedad COVID- 19. Se evidencia cómo estas medidas impactan favorablemente en la situación epidemiológica del país.

ABSTRACT The elements that distinguish the precaution principle as a principle of international law are made explicit and a synthesis of the fundamental measures adopted by the Cuban State to prevent, control, protect and mitigate the risks and negative impacts caused by the COVID-19 disease is made. It is evident how these measures have a favorable impact on the epidemiological situation in the country.

Desafios e conflitos bioéticos da covid-19: contexto da saúde global / Covid-19 bioethical challenges and conflicts: global health context / Desafíos y conflictos bioéticos de la covid-19: contexto de salud global

Resumo A pandemia desencadeada pela covid-19, imersa em muitas incertezas, suscita uma série de conflitos éticos. O objetivo deste artigo é refletir sobre esses conflitos e sobre os distintos interesses envolvidos no atual cenário. O horizonte da análise crítica é a bioética global, e o foco do estudo é o Brasil, onde os problemas de saúde decorrentes da covid-19 não têm sido abordados de forma integrada à diplomacia internacional. No país, a oposição simplista entre saúde e economia tem servido de base para decisões estratégicas e medidas de contenção do vírus. No entanto, as variáveis a se considerar são múltiplas, e é necessário um balizador ético, como a responsabilidade dos agentes políticos quanto ao desfecho de suas decisões.

Abstract Characterized by extreme uncertainty, the Covid-19 outbreak raises important ethical conflicts. In this article, we reflect on these conflicts and the different interests involved in the current scenario. Our critical analysis is based on global bioethics, and focused on Brazil, where public health issues have not been properly integrated with international diplomacy. The simplistic opposition between health and economy has been used as a decision-making strategy and to establish measures to control the virus. However, there are several variables in this context, and an ethical guideline becomes necessary, especially for the decisions made by politicians in the country.

Resumen La pandemia desencadenada por la covid-19, inmersa en muchas incertidumbres, genera una serie de conflictos éticos. Este artículo tiene como objetivo contribuir para la reflexión sobre estos conflictos y sobre los distintos intereses implicados en el escenario actual. El horizonte del análisis crítico es la bioética global, y el estudio se concentra en Brasil, donde los problemas de salud derivados de la covid-19 no han sido abordados de forma integrada a la diplomacia internacional. En este país, la oposición simplista entre salud y economía ha servido de base para decisiones estratégicas y medidas de contención del virus. Sin embargo, múltiples son las variables que se deben tener en cuenta, y son necesarias referencias éticas, como la responsabilidad de los agentes políticos en cuanto al desenlace de sus decisiones.

What has the covid-19 pandemic taught us about adopting preventive measures? / ¿lo que la pandemia covid-19 nos enseñó sobre la adopción de las medidas preventivas? / O que a pandemia da covid-19 tem nos ensinado sobre adoção de medidas de precaução?

ABSTRACT Objective: to analyze the COVID-19 pandemic and what we have (re)learned from the world experience of adopting prevention measures recommended by the World Health Organization as well as the epidemiological overview in the world, in Latin America and in Brazil. Results: the World Health Organization has pointed out that the path to reduce the speed of circulation of the virus, control and decrease in the number of cases and deaths resulting from this pandemic can only be accomplished with mass adoption of fundamental measures that include hand hygiene, alcohol gel use, cough etiquette, cleaning surfaces, avoiding agglomerations and social distancing. The epidemiological curve of the disease clearly shows the devastating proportions in Italy, Spain and the United States, surpassing China in death records, due to the delay in adopting the aforementioned measures. In Brazil, the rapid progression in relation to the world and Latin America points to an important increase in the number of cases. Conclusion: this is possibly the most serious pandemic in recent human history, and its course can be influenced by the rigor in adopting individual and collective behavioral measures.

RESUMEN Objetivo: analizar la pandemia de COVID-19 y lo que hemos (re)aprendido de la experiencia mundial para la adopción de las medidas de prevención recomendadas por la Organización Mundial de la Salud, así como el panorama epidemiológico en el mundo, en América Latina y en Brasil. Resultados: la Organización Mundial de la Salud ha señalado que el camino hacia la reducción de la velocidad de circulación del virus, el control y la reducción del número de casos y muertes resultantes de esta pandemia solo se puede lograr con la adopción masiva de medidas fundamentales que incluyan la higiene de las manos, uso de alcohol en gel, etiqueta respiratoria, limpieza de superficies, evitando hacinamiento y distancia social. La curva epidemiológica de la enfermedad muestra claramente las proporciones devastadoras en Italia, España y Estados Unidos, superando a China en los registros de defunciones, debido a la demora en la adopción de estas medidas. En Brasil, la rápida progresión en relación con el mundo y América Latina apunta a un aumento importante en el número de casos. Conclusión: esta pandemia es posiblemente la más grave en la historia humana reciente y su curso puede verse influenciado por el rigor en la adopción de medidas de comportamiento individuales y colectivas.

RESUMO Objetivo: analisar a pandemia da Covid-19 e o que temos (re)aprendido com a experiência mundial para adoção das medidas de prevenção preconizadas pela Organização Mundial de Saúde bem como o panorama epidemiológico no mundo, na América Latina e no Brasil. Resultados: a Organização Mundial de Saúde tem apontado que o caminho para a redução da velocidade de circulação do vírus, o controle e queda do número de casos e óbitos decorrentes dessa pandemia só poderá ser alcançado com adoção em massa de medidas fundamentais que incluem higienização das mãos, uso do álcool em gel, etiqueta respiratória, limpeza de superfícies, evitar aglomerações e distanciamento social. A curva epidemiológica da doença mostra claramente as proporções devastadoras na Itália, Espanha e nos Estados Unidos, superando a China em registros de óbitos, devido ao atraso na adoção dessas medidas. No Brasil, a progressão rápida em relação ao mundo e à América Latina aponta um importante aumento do número de casos. Conclusão: essa pandemia possivelmente é a mais grave da história recente da humanidade e seu curso pode ser influenciado pelo rigor na adoção de medidas comportamentais individuais e coletivas.

Proteção ao meio ambiente e às gerações futuras: desdobramentos e reflexões bioéticas / Protection of the environment and future generations: bioethical developments and reflections

RESUMO A dicotomia entre a promessa de que o desenvolvimento tecnológico representa a solução para os problemas humanos e a crescente certeza quanto à finitude de recursos naturais criam uma gama de incertezas quanto às expectativas para o futuro, ainda mais diante dos crescentes problemas ambientais que vêm surgindo. O trabalho objetivou adentrar ao princípio da proteção, avaliando como este pode interagir com o princípio da precaução, contribuindo para a compreensão da complexidade da temática ambiental e a necessidade de mudanças no comportamento humano com relação ao futuro planetário. O estudo utiliza como método uma revisão bibliográfica de autores que atualmente tratam do assunto, envolvendo as constantes transformações do mundo, mudanças climáticas e necessidade de um desenvolvimento sustentável, problemas interligados e de cunho global. A partir da bioética normativa, serão expostos os artigos 16 e 17 da Declaração Universal sobre Bioética e Direitos Humanos, discutindo e entrelaçando os conceitos de proteção e de precaução. Propõe-se uma reflexão quanto ao modo de compreender as mudanças ocorridas no mundo, com base em uma bioética comprometida com a conscientização humana, de que é necessário adotar ações conjuntas, visando à preservação do planeta, para resguardar a saúde e a própria sobrevivência das gerações futuras.

ABSTRACT The dichotomy between the promise that technological development represents the solution to human problems and the growing certainty about the finitude of natural resources creates a range of uncertainties regarding expectations for the future, even more so in view of the growing environmental problems that are emerging. The work aimed to enter the principle of protection, evaluating how it can interact with the precautionary principle, contributing to the understanding of the complexity of the environmental theme and the need for changes in human behavior in relation to the planetary future. The study uses as a method a bibliographic review of authors who currently deal with the subject, involving the constant transformations of the world, climate changes and the need for sustainable development, interconnected problems and of a global nature. Based on normative bioethics, articles 16 and 17 of the Universal Declaration on Bioethics and Human Rights will be exposed, discussing and interweaving the concepts of protection and precaution. A reflection is proposed as to how to understand the changes that have occurred in the world, based on a bioethics committed to human awareness, that it is necessary to adopt joint actions, aiming at the preservation of the planet, in order to safeguard the health and survival of future generations.

Saúde global, inovação biotecnológica e risco(s) / Global health, biotechnological innovation and risk(s) / Salud global, innovación biotecnológica y riesgo(s)

Objetivo: Refletir sobre o conceito de saúde global, a sua origem, sentido(s) e notas caraterizadoras. Compreender em que medida a doutrina se vem referindo a um Direito da Saúde Global, analisando quais os seus principais méritos, limitações e inconvenientes. Analisar alguns dos avanços biotecnológicos que têm aberto as portas a novas potencialidades de incrementação da saúde e do bem-estar à escala global. Metodologia: foi utilizado o método dedutivo a partir da análise de obras monográficas, artigos de revistas da especialidade, bem como de documentos emanados por diversas entidades nacionais e estrangeiras. Resultados: num contexto de crise tecnocientífica, a inovação biotecnológica, embora contribua para a melhoria da saúde global, acarreta inúmeros riscos. Cada vez mais, se tem afirmado a importância do chamado Direito da Saúde Global, o qual procura contribuir para a otimização das possibilidades de melhoria dos índices de saúde à escala global, mormente através da formulação de respostas precaucionais adequadas. Conclusão: a melhoria dos índices de saúde à escala global depende, inter alia, da inovação biotecnológica, a qual só será viabilizada através de uma adequada gestão do risco a realizar a partir do conceito de diligência devida. O Direito da Saúde Global, enquanto sub-ramo jusinternacional do Direito da Saúde, poderá dar valiosos contributos nesse sentido, não obstante as suas múltiplas limitações e dificuldades.

Objective: to reflect on the concept of global health, its origins, meaning(s) and main characteristics. To understand to what extent the doctrine has been referring to a Global Health Law, analyzing its main merits, limitations and inconveniences. To examine some of the biotechnological advances that have opened the doors to the possibility of increasing health and well-being on a global scale. Methodology: the deductive method was used from the analysis of monographies, articles from specialized reviews, as well as documents originating from several national and international entities. Results: in the context of a techno-scientific crisis, biotechnological innovation, although contributing to the improvement of global health, carries numerous risks. Increasingly, the importance of the so-called Global Health Law has been affirmed; it seeks to contribute to the optimization of health indices on a global scale, especially through the development of adequate precautionary responses. Conclusion: the improvement of health indices on a global scale depends, inter alia, on biotechnological innovation, which will only be made possible through an adequate risk management to be carried out on the concept of due diligence. The Global Health Law, understood as an international branch of Health Law, can make valuable contributions in this regard, despite its multiple limitations and difficulties.

Objetivo: reflexionar sobre el concepto de salud global, sus origines, significados y notas características. Comprender en qué medida la doctrina se ha referido a un Derecho de la Salud Global, analizando sus principales méritos, limitaciones e inconvenientes. Examinar algunos de los avances biotecnológicos que han abierto la puerta a nuevas potencialidades para la mejora de la salud y del bienestar a la escala mundial. Metodología: el método deductivo ha sido utilizado a partir del análisis de trabajos monográficos, artículos de revistas especializadas, así como de documentos emitidos por varias entidades nacionales y extranjeras. Resultados: en un contexto de crisis tecnocientífica, la innovación biotecnológica, aunque contribuya para la mejora de la salud global, conlleva numerosos riesgos. Cada vez más, se ha afirmado la importancia del llamado Derecho de la Salud Global, el cual busca contribuir para la optimización de las posibilidades florecimiento de los índices de salud global, especialmente a través de la formulación de respuestas precauciónales adecuadas. Conclusión: la mejora de los índices de salud global depende, inter alia, de la innovación biotecnológica, la cual sólo será posible a través de la gestión adecuada del riesgo a partir de la movilización del concepto de debida diligencia. El Derecho de la Salud Global, entendido como una rama internacional del Derecho de la Salud, puede hacer contribuciones valiosas a este respeto, a pesar de sus múltiples limitaciones y dificultades.

Administrative strategy of dental clinic during the epidemic of Corona Virus Disease 2019 / 口腔疾病防治

@#Since an epidemic occur of Corona Virus Disease 2019(COVID-19) in December, 2019, all the dental healthcare service providers in our country have been greatly impacted. The strategy of managing the dental clinics is quite different from that of the medical healthcare clinics, and the key point of the administration of those dental healthcare providers is to focus on the management of outpatient care because they only supply just a little bit of inpatient care service but quite an large amount of outpatient care service. So we think the next step is to make plausible and effective scenarios to protect our dental healthcare staff and patients against corona virus infection during the treatments procedures after the reopening all of our dental clinics. To overcome this harsh condition, the infection prevention and control strategies adopted by the Stomatological Hospital, Southern Medical University were designed to be flexible and could be adjusted promptly according to the national and local governmental orders and latest guidelines released by the Centers for Disease Control and Prevention. All these prevention procedures and protocols were customized to fit our own situation and have been updated for several times based on the latest global pandemic reports. After going through the hardest time in the past four months, it’s considered that our COVID-19 prevention rules have been proved to be efficient and work well. Further more, it has made massive progress for the hospital in improving the capability of dealing with this state of emergency, especially by previewing and triaging patients strictly to cut off the possible coronavirus spreading from the original step, enhancing the standard precautions and those specific protocols made for minimizing the droplets, aerosol and contact transmission of COVID-19 indoors. Besides, a daily supervision system was set up as a routine job and a team of qualified infection prevention specialists were assigned to check and report every incorrect details during the whole procedure of dental practice. Meanwhile, the safety and well-being of the public and our medical workers could be also guaranteed through following those detailed prevention scenarios.

How Ophthalmologists Should Understand and Respond to the Current Epidemic of Novel Coronavirus Pneumonia (COVID-19) / 中华实验眼科杂志

The new coronavirus pneumonia that first appeared in Wuhan, China, in December 2019 has attracted great attention from both the Chinese government and the international community. The International Committee on Viral Classification named the virus "Severe Acute Respiratory Syndrome Coronavirus 2" (SARS-CoV-2), and the WHO named the pneumonia it causes "Coronavirus Disease 2019" (COVID-19). At present, the disease is centered in Wuhan City and is spreading rapidly to all parts of China, as well as twenty other countries. About 20% of the people infected during the SARS epidemic in 2003 were employees in hospital environments. COVID-19 has infected an even greater number of heath care workers. Therefore, ophthalmologists need to understand the disease and recognize the importance of taking preventive measures. Although ophthalmologists do not work on the front lines of the outbreak, due to their area of expertise, a variety of situations, such as infection consultations or ophthalmic emergency treatments, can lead to the exposure of ophthalmologists to high-risk environments. This risk will only increase as the number of infected patients continues to increase. When dealing with seemingly normal ophthalmic patients, the vigilance of ophthalmologists and associated staff tends to be significantly reduced. To better protect patients, families, and health care workers, it is strongly recommended that in addition to the standard precautions for the care of all patients, strict contact precautions and droplet precautions need to be taken by ophthalmologists. These measures include 1) wearing an efficient mask (an N95 mask); 2) always performing hand hygiene before and after examining a patient; (3) wearing sterile gloves when entering a patient’s room and touching a patient; (4) wearing a gown when contact is expected with items and environmental surfaces surrounding a patient or when the patient is incontinent or has diarrhea or a surgical or other invasive wound with oozing fluid; 5) cleaning and disinfecting ophthalmic equipment and correctly handling medical waste after examination to prevent transmission to patients who are subsequently examined; 6) wearing goggles and a disposable mask to cover the front and sides of the face before touching a patient, as the virus could spread through the ocular surface; 7) performing the relevant screening for novel coronavirus pneumonia for regular patients who have conjunctivitis and respiratory symptoms at the same time; 8) prohibiting the use of infected patients as potential donors for corneal transplants and temporarily adding donor SARS-CoV-2 screening to the medical standard of the eye bank during the outbreak; and 9) for the purposes of scientific research, diagnosis, and other special needs, packing, shipping, and transporting collected specimens according to the relevant dangerous biological goods regulations.

Factors associated with the level of compliance of nurses in universal precaution application

Background: The highest prevalence of surgical wound infections in NurHidayah Hospital occurred in 2014 which is at 2.80%. This was because nurses’ compliance in using PPE and hand washing was still low and the culture for reporting needle puncture events had not been implemented so that the number of nurses who were punctured was still unknown. Meanwhile, the lowest prevalence of surgical wound infections occurred in 2016 amounting to 0.76%, this happened because the compliance of nurses in using PPE was quite high and the incidence of needle puncture reached 0 (zero) but compliance in hand washing was still low.Methods: This study was a quantitative study with an observational analytic method with a cross sectional design. The variables in this study were knowledge, attitudes, working period, training and nurse compliance in the application of universal precaution with the number of respondents 46 nurses. The research instruments used were questionnaires and observation sheets. The data analysis was conducted using chi square test and fisher test.Results: Factor associated with the level of nurse compliance in universal university application was attitudes (0.000), while factors not related to the level of nurse compliance in the application of universal precaution include knowledge (0.124), years of service (0.657) and training (0.098).Conclusions: There is a relationship between attitudes and levels of nurse compliance in implementing universal precaution in NurHidayah Hospital. There is no relationship between knowledge, work and training with the level of nurse compliance in the application of universal precaution at NurHidayah Hospital.

Práticas Educativas relacionadas ao controle de infecção entre acompanhantes de pacientes em isolamento em um hospital universitário / Educational practices related to infection control among caregivers of patients in isolation at a university hospital

A permanência dos acompanhantes de pacientes nas unidades hospitalares requer um olhar mais apurado da equipe de saúde com o controle da infecção. Este estudo versa sobre práticas educativas praticadas com acompanhantes de pacientes internados em instituições hospitalares e que estejam em situação de isolamento. Objetiva identificar o conhecimento acerca de precaução, isolamento, transmissão e infecção hospitalar de acompanhantes de pacientes em isolamento; e criar uma tecnologia educacional, tipo folder, para orientação destes acompanhantes. Foi aplicado um questionário, com perguntas fechadas, a 30 acompanhantes de pacientes em situação de isolamento, selecionados por conveniência, internados em enfermarias clínicas e cirúrgicas de um Hospital Federal Universitário. A população foi de maioria feminina, com escolaridade em nível médio e tempo médio de permanência como acompanhante de 34 dias. Não houve uniformidade no conhecimento sobre a doença do paciente, tão pouco sua possibilidade de transmissão de infecção. Há valorização da prática de lavagem das mãos, entretanto apenas antes da entrada no leito. A enfermeira se apresentou como principal profissional responsável pelas orientações aos acompanhantes, entretanto a maior parte dos acompanhantes não recebeu orientação sobre medidas de isolamento na unidade, o que colabora para atitudes e comportamentos inadequados. A partir destes resultados espera-se que o instrumento criado consiga modificar as práticas apresentadas pelos acompanhantes e os índices de infecção hospitalar sejam reduzidos

The accompanying persons stay in the hospital units requires a more accurate look by the healthcare staff on the infection control. This study is about educational drills applied by hospitalized patient's accompanying persons in hospital institutions, who are also at the isolation ward. Its objective is to identify the isolated patients' accompanying persons knowledge regarding precaution, isolation, transmission and hospital infection; and create an educational technology as folder in order to instruct the hospitalized patients' accompanying persons that are in isolation. A close-ended questionnaire has been applied to 30 patients' accompanying persons, selected by convenience, who are hospitalized in a Federal University Hospital's clinical and surgical wards. The sample were mostly of women, with high school level of schooling and average length of stay as accompanying person of 34 days. There have been no uniformity of the knowledge about the patient's disease, as well as the infection transmission probability. The practice of washing hands have been valued, however, only before entering the ward. The nurse presented herself as main professional responsible for instructing the accompanying persons, however, the majority of the accompanying persons haven't received any instruction related to isolation measures at the unit, what collaborates to inappropriate attitudes and behaviors. Based on these results, it's expected that both the created tool can modify the practice presented by the accompanying persons and that the hospitalar infection rates are reduced

Quando o analista é um mal para seu paciente; um retorno à "psicanálise selvagem": un retorno al "psicoanálisis salvaje" / When psychoanalysts harm their patients. A return to the "Wild Psychoanalysis" / Cuando el analista es un mal para el paciente / Quand l'analyste est un mal pour son patient. Un retour à la "psychanalyse sauvage"

A autora deseja neste artigo fazer uma reflexão acerca do papel creditado à psicanálise nos dias atuais e, com isso, utilizando-se do artigo "Sobre psicanálise selvagem" (Freud, 1910/2013), procurar compreender quando um psicanalista pode ser um mal para seu paciente.

The author's purpose is to examine the role of Psychoanalysis in society nowadays. And, by using ideas from Freud's paper "Wild Psychoanalysis" (1910/2013), the author attempts to discern situations in which psychoanalysts may harm their patients.

En este trabajo, la autora se propone hacer una reflexión acerca del papel atribuido al psicoanálisis en la actualidad y, utilizando el artículo de Freud "Sobre psicoanálisis salvaje" (Freud, 1910/2013), procura comprender cuando un psicoanalista puede ser un mal para su paciente.

L'auteur de cet article veut réfléchir sur le rôle crédité à la Psychanalyse présentement et, par conséquent, en utilisant l'article "À propos de la Psychanalyse sauvage" (Freud, 1910/2013), il cherche à comprendre quand un psychanalyste peut-il être un mal pour son patient.

Influences of Tobacco-Related Knowledge on Awareness and Behavior towards Smoking

BACKGROUND: A considerable amount of research has shown that knowledge and appropriate awareness are essential for encouraging positive behaviors and promoting health. In Korea, the roles that behavioral changes play in the prevention of cancer have been an important issue since the introduction of the 10 codes for cancer prevention in 2006. Thus, the present study investigated the associations of tobacco-related knowledge with awareness and attitudes towards positive smoking-cessation behaviors. METHODS: The present study analyzed data from the 2010 national questionnaire survey (n = 1,006). This study evaluated sociodemographic characteristics, smoking status, self-rated health status, health-related interests, and the accuracy of 12 tobacco-related statements to determine knowledge level and to investigate its impact on awareness and behaviors related to smoking. These parameters were examined and staged using the Precaution Adoption Process Model. RESULTS: A higher level of tobacco-related knowledge was significantly associated with a positive attitude towards smoking cessation (5–8 correct answers: odds ratio [OR], 2.53; 95% confidence interval [CI], 1.57–4.08; ≥ 9 correct answers: OR, 3.90; 95% CI, 2.22–6.82; reference: ≤ 4 correct answers). Interestingly, among current smokers, only those who correctly responded to ≥ 9 of 12 tobacco-related statements were significantly associated with a positive attitude towards smoking cessation. CONCLUSION: This study found that having a higher level of tobacco-related knowledge had a significant impact on positive attitudes towards smoking cessation. This suggests that there is a need to disseminate appropriate knowledge to the general population to encourage positive attitudes and promote healthful behaviors in terms of smoking.