[Deliberative dialogue with Ibero-American universities on interventions in student mental health during the COVID-19 pandemicDiálogo deliberativo com universidades ibero-americanas sobre intervenções em saúde mental dos estudantes na pandemia de COVID-19]. / Diálogo deliberativo con universidades iberoamericanas sobre intervenciones en salud mental estudiantil durante la pandemia de COVID-19.

Objective: To contextualize a synthesis of evidence on interventions in student mental health during the COVID-19 pandemic through a deliberative dialogue with Ibero-American universities. Methods: An evidence synthesis and synchronous dialogues were previously conducted, consisting of subgroup discussions about the design and implementation of mental health interventions. An analysis of dialogic data was conducted, then organized by topic. Results: Fifty-seven representatives of 17 public and private Ibero-American universities participated in the meeting. In terms of the design of interventions, mental health is perceived as neglected, although its profile was raised by the pandemic. Interventions are guided by detection of needs; scientific evidence is rarely used to design them. Importance was given to forming an interdisciplinary team with continuous training in order to design a specific program that also covers families and teaching/administrative staff. In terms of implementation, problems include saturation of services due to high demand and lack of basic resources among students. Regarding the provision of resources, the influence of the broader context, including the institutional context, is undeniable. The dialogues were perceived as an opportunity to build a new set of interventions. Conclusions: These dialogues enriched the description of interventions already described in the literature on student mental health during the COVID-19 pandemic. However, implementing such interventions in the region means addressing previous neglect and a high level of unmet basic needs.

Objetivo: Contextualizar uma síntese de evidências sobre intervenções em saúde mental de estudantes universitários na pandemia de COVID-19, por meio do diálogo deliberativo com universidades ibero-americanas. Métodos: A partir de uma síntese de evidências previamente elaborada, o diálogo síncrono foi conduzido por meio de discussões em subgrupos sobre o planejamento e a implementação de intervenções em saúde mental. Os dados obtidos foram analisados e resumidos por área temática. Resultados: Cinquenta e sete integrantes de 17 universidades ibero-americanas públicas e privadas participaram do encontro. Os participantes indicaram que a saúde mental é negligenciada no planejamento das intervenções, mas ganhou visibilidade na pandemia. As intervenções são direcionadas às necessidades identificadas e raramente planejadas com base em evidências científicas. Disseram considerar importante formar uma equipe interdisciplinar com capacitação contínua para planejar um programa específico que englobe também familiares e o corpo docente e administrativo. Implementar intervenções é complicado porque os serviços estão sobrecarregados devido à grande demanda e à falta de recursos básicos para os estudantes. O contexto macro e institucional claramente influencia a disponibilização de recursos. O diálogo foi visto como uma oportunidade para consolidar um novo conjunto de intervenções. Conclusões: O presente diálogo contribuiu para enriquecer a literatura de intervenções de saúde mental para estudantes universitários na pandemia de COVID-19. Implementar intervenções no nosso contexto requer sanar as falhas por negligência passada e as enormes necessidades básicas não atendidas.

Diálogo deliberativo con universidades iberoamericanas sobre intervenciones en salud mental estudiantil durante la pandemia de COVID-19 Deliberative dialogue with Ibero-American universities on interventions in student mental health during the COVID-19 pandemic Diálogo deliberativo com universidades ibero-americanas sobre intervenções em saúde mental dos estudantes na pandemia de COVID-19

RESUMEN Objetivo. Contextualizar una síntesis de evidencia sobre intervenciones en salud mental estudiantil durante la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) por medio de un diálogo deliberativo con universidades iberoamericanas. Métodos. Se realizó previamente una síntesis de evidencia y un diálogo sincrónico, que consistió en la discusión en subgrupos acerca del diseño y aplicación de las intervenciones en salud mental. Se realizó un análisis de datos dialógicos y se sintetizó por temas. Resultados. Cincuenta y siete miembros de 17 universidades iberoamericanas públicas y privadas participaron en el encuentro. En el diseño de las intervenciones, se percibe la salud mental como desatendida, y visibilizada con la pandemia. La detección de necesidades es la que orienta las intervenciones y rara vez se utiliza evidencia científica para diseñarlas. Se considera importante conformar un equipo interdisciplinario con capacitación continua para diseñar un programa específico, que cubra también familias y personal docente y administrativo. En la aplicación, existen problemas como la saturación de los servicios por la alta demanda y la falta de recursos básicos de los estudiantes. Es innegable la influencia del contexto macro e institucional por la disposición de recursos. El diálogo fue percibido como oportunidad para construir un consolidado nuevo de intervenciones. Conclusiones. Este diálogo permitió enriquecer la descripción de intervenciones en salud mental estudiantil durante la pandemia de COVID-19 ya descritas en la literatura, aunque llevarlas a la práctica en nuestro contexto supone hacer frente a la deuda por la desatención previa y las altas necesidades básicas insatisfechas.

International alliance and AGREE-ment of 71 clinical practice guidelines on the management of critical care patients with COVID-19: a living systematic review.

OBJECTIVE: We aimed to systematically identify and critically assess the clinical practice guidelines (CPGs) for the management of critically ill patients with COVID-19 with the AGREE II instrument. STUDY DESIGN AND SETTING: We searched Medline, CINAHL, EMBASE, CNKI, CBM, WanFang, and grey literature from November 2019 - November 2020. We did not apply language restrictions. One reviewer independently screened the retrieved titles and abstracts, and a second reviewer confirmed the decisions. Full texts were assessed independently and in duplicate. Disagreements were resolved by consensus. We included any guideline that provided recommendations on the management of critically ill patients with COVID-19. Data extraction was performed independently and in duplicate by two reviewers. We descriptively summarized CPGs characteristics. We assessed the quality with the AGREE II instrument and we summarized relevant therapeutic interventions. RESULTS: We retrieved 3,907 records and 71 CPGs were included. Means (Standard Deviations) of the scores for the 6 domains of the AGREE II instrument were 65%(SD19.56%), 39%(SD19.64%), 27%(SD19.48%), 70%(SD15.74%), 26%(SD18.49%), 42%(SD34.91) for the scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence domains, respectively. Most of the CPGs showed a low overall quality (less than 40%). CONCLUSION: Future CPGs for COVID-19 need to rely, for their development, on standard evidence-based methods and tools.

Non-pharmaceutical interventions for containment, mitigation and suppression of COVID-19 infection

Background: The best scientific evidence is required to design effective Non-pharmaceutical interventions to help policymakers to contain COVID-19. Aim: To describe which Non-pharmaceutical interventions used different countries and a when they use them. It also explores how Non-pharmaceutical interventions impact the number of cases, the mortality, and the capacity of health systems. Methods: We consulted eight web pages of transnational organizations, 17 of international media, 99 of government institutions in the 19 countries included, and besides, we included nine studies (out of 34 identified) that met inclusion criteria. Result: Some countries are focused on establishing travel restrictions, isolation of identified cases, and high-risk people. Others have a combination of mandatory quarantine and other drastic social distancing measures. The timing to implement the interventions varied from the first fifteen days after detecting the first case to more than 30 days. The effectiveness of isolated non-pharmaceutical interventions may be limited, but combined interventions have shown to be effective in reducing the transmissibility of the disease, the collapse of health care services, and mortality. When the number of new cases has been controlled, it is necessary to maintain social distancing measures, self-isolation, and contact tracing for several months. The policy decision-making in this time should be aimed to optimize the opportunities of saving lives, reducing the collapse of health services, and minimizing the economic and social impact over the general population, but principally over the most vulnerable. The timing of implementing and lifting interventions could have a substantial effect on those objectives. Resumen Antecedentes: Se requiere la mejor evidencia científica para diseñar intervenciones no farmacológicas efectivas para ayudar a los formuladores de políticas a contener COVID-19. Objetivo: Describir qué intervenciones no farmacológicas utilizaron diferentes países y cuándo las implementaron. También explora cómo las intervenciones no farmacológicas afectan el número de casos, la mortalidad y la capacidad de los sistemas de salud. Métodos: Consultamos ocho páginas web de organizaciones transnacionales, 17 de medios internacionales, 99 de instituciones gubernamentales en los 19 países incluidos, y además, incluimos nueve estudios (de 34 identificados) que cumplían con los criterios de inclusión. Resultados: Algunos países implementaron restricciones de viaje, aislamiento de casos identificados y personas de alto riesgo. Otros combinaron varias medidas más drásticas de distanciamiento social. El tiempo para implementar las intervenciones varió desde los primeros quince días después de detectar el primer caso hasta más de 30 días. La efectividad de las intervenciones no farmacológicas combinadas ha demostrado ser efectivas para reducir la transmisibilidad de la enfermedad, el colapso de los servicios de salud y la mortalidad. Cuando se controle el número de casos nuevos, es necesario mantener medidas de distanciamiento social, autoaislamiento y rastreo de contactos durante varios meses. La toma de decisiones políticas en este momento debe tener como objetivo optimizar las oportunidades de salvar vidas, reducir el colapso de los servicios de salud y minimizar el impacto económico y social sobre la población en general, pero principalmente sobre los más vulnerables.

Non-pharmaceutical interventions for containment, mitigation and suppression of COVID-19 infection.

BACKGROUND: The best scientific evidence is required to design effective Non-pharmaceutical interventions to help policymakers to contain COVID-19. AIM: To describe which Non-pharmaceutical interventions used different countries and a when they use them. It also explores how Non-pharmaceutical interventions impact the number of cases, the mortality, and the capacity of health systems. METHODS: We consulted eight web pages of transnational organizations, 17 of international media, 99 of government institutions in the 19 countries included, and besides, we included nine studies (out of 34 identified) that met inclusion criteria. RESULT: Some countries are focused on establishing travel restrictions, isolation of identified cases, and high-risk people. Others have a combination of mandatory quarantine and other drastic social distancing measures. The timing to implement the interventions varied from the first fifteen days after detecting the first case to more than 30 days. The effectiveness of isolated non-pharmaceutical interventions may be limited, but combined interventions have shown to be effective in reducing the transmissibility of the disease, the collapse of health care services, and mortality. When the number of new cases has been controlled, it is necessary to maintain social distancing measures, self-isolation, and contact tracing for several months. The policy decision-making in this time should be aimed to optimize the opportunities of saving lives, reducing the collapse of health services, and minimizing the economic and social impact over the general population, but principally over the most vulnerable. The timing of implementing and lifting interventions could have a substantial effect on those objectives.

Antecedentes: Se requiere la mejor evidencia científica para diseñar intervenciones no farmacológicas efectivas para ayudar a los formuladores de políticas a contener COVID-19. OBJETIVO: Describir qué intervenciones no farmacológicas utilizaron diferentes países y cuándo las implementaron. También explora cómo las intervenciones no farmacológicas afectan el número de casos, la mortalidad y la capacidad de los sistemas de salud. MÉTODOS: Consultamos ocho páginas web de organizaciones transnacionales, 17 de medios internacionales, 99 de instituciones gubernamentales en los 19 países incluidos, y además, incluimos nueve estudios (de 34 identificados) que cumplían con los criterios de inclusión. RESULTADOS: Algunos países implementaron restricciones de viaje, aislamiento de casos identificados y personas de alto riesgo. Otros combinaron varias medidas más drásticas de distanciamiento social. El tiempo para implementar las intervenciones varió desde los primeros quince días después de detectar el primer caso hasta más de 30 días. La efectividad de las intervenciones no farmacológicas combinadas ha demostrado ser efectivas para reducir la transmisibilidad de la enfermedad, el colapso de los servicios de salud y la mortalidad. Cuando se controle el número de casos nuevos, es necesario mantener medidas de distanciamiento social, autoaislamiento y rastreo de contactos durante varios meses. La toma de decisiones políticas en este momento debe tener como objetivo optimizar las oportunidades de salvar vidas, reducir el colapso de los servicios de salud y minimizar el impacto económico y social sobre la población en general, pero principalmente sobre los más vulnerables.