Fatores associados a infeccao por SARS-CoV-2 entre profissionais da saude de hospitais universitarios*

Objetivo: investigar fatores associados a infeccao por SARS-CoV-2 entre profissionais da saude de hospitais universitarios. Metodo: estudo multicentrico, de abordagem mista com estrategia incorporada concomitante, realizado com 559 profissionais na etapa quantitativa, e 599 na etapa qualitativa. Foram utilizados quatro instrumentos de coleta de dados, aplicados via formulario eletronico. A analise quantitativa foi realizada com estatistica descritiva e inferencial e os dados qualitativos por meio de analise de conteudo. Resultados: os fatores associados a infecao foram: realizacao de teste "RT-PCR" (p<0,001) e unidades com atendimento a pacientes com COVID-19 (p=0,028). Ter sintomas aumentou em 5,63 vezes a prevalencia de infecao e aderir ao distanciamento social na maior parte do tempo na vida particular reduziu em 53,9%. Dados qualitativos evidenciaram dificuldades enfrentadas pelos profissionais: escassez e baixa qualidade de equipamentos de protecao individual, sobrecarga de trabalho, distanciamento fisico no trabalho, processos e rotinas inadequadas e ausencia de uma politica de triagem e testagem em massa. Conclusao: os fatores associados a infeccao por SARS-CoV-2 entre profissionais da saude foram em sua maioria relacionados a questoes ocupacionais.

Development of public sports and optimization of sports mode under the influence of covid-19 epidemic / Desenvolvimento de esportes públicos e otimização do modo esportivo sob influência da epidemia de covid-19 / El desarrollo del deporte público y la optimización del modelo deportivo bajo la influencia de la epidemia de covid - 19

ABSTRACT Introduction: The sports psychology of athletes and public service policies in various places have been adjusted under the influence of the epidemic of COVID-19. However, team sports also need adjustments, and the paucity of evidence prevents safe decision-making. Objective: Research the current model to outline optimizations to team sports public service during the epidemic of COVID-19. Methods: The mechanism of athletes' satisfaction was investigated, mainly involving organizing activities in sports venues, including geographical distribution, technical guidance, health services, etc. Results: According to the survey, the first concern was "organization of activities," with a score of 3.783; followed by "number of places," with a score of 3.252; and "health service," with a score of 3.142. In the athletes' satisfaction score relative to supply and demand, the first concern highlighted was "distribution of seats", with a score of 3.682; followed by "number of seats", with a score of 3.484; and "organization of activities", with a score of 3.112. Conclusion: In optimizing the public team sports service model, the actual needs of the facilities should be fully considered to achieve scientific optimization of supply and demand. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Tanto a psicologia esportiva dos atletas quanto as políticas de serviço público em vários lugares foram ajustadas sob a influência da epidemia da COVID-19. Os esportes em equipe também necessitam de adaptações e a escassez de evidências impede tomadas de decisões seguras neste aspecto. Objetivo: Pesquisar o modelo atual para traçar otimizações ao serviço público esportivo de equipe durante a epidemia da COVID-19. Métodos: O mecanismo de satisfação dos atletas foi investigado, envolvendo principalmente a organização de atividades em locais esportivos, incluindo distribuição geográfica, orientação técnica, serviços de saúde, etc. Resultados: De acordo com a pesquisa levantada, a primeira preocupação foi "organização de atividades", com pontuação de 3.783; seguido de "número de vagas", com pontuação de 3.252; e "serviço de saúde", com pontuação de 3.142. Na pontuação de satisfação das atletas relativa à oferta e demanda, a primeira preocupação destacada foi "distribuição de lugares", com pontuação de 3,682; seguida de "número de lugares", com pontuação de 3,484; e "organização de atividades", com pontuação de 3,112. Conclusão: No processo de otimização do modelo de serviço público esportivo de equipes, as necessidades reais das instalações devem ser plenamente consideradas, a fim de alcançar a otimização científica da oferta e da demanda. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Tanto la psicología deportiva de los atletas como las políticas de servicios públicos en diversos lugares se han ajustado bajo la influencia de la epidemia de COVID-19. Los deportes de equipo también necesitan ajustes y la escasez de pruebas impide tomar decisiones seguras al respecto. Objetivo: Investigar el modelo actual para delinear optimizaciones al servicio público de los deportes de equipo durante la epidemia de COVID-19. Métodos: Se investigó el mecanismo de satisfacción de los atletas, que involucra principalmente la organización de actividades en las instalaciones deportivas, incluyendo la distribución geográfica, la orientación técnica, los servicios de salud, etc. Resultados: Según la encuesta realizada, la primera preocupación era la "organización de las actividades", con una puntuación de 3,783; seguida del "número de plazas", con una puntuación de 3,252; y del "servicio sanitario", con una puntuación de 3,142. En la puntuación de satisfacción de los atletas en relación con la oferta y la demanda, la primera preocupación destacada fue la "distribución de los lugares", con una puntuación de 3,682; seguida del "número de lugares", con una puntuación de 3,484; y de la "organización de las actividades", con una puntuación de 3,112. Conclusión: En el proceso de optimización del modelo de servicio público de deportes de equipo, deben tenerse plenamente en cuenta las necesidades reales de las instalaciones para lograr una optimización científica de la oferta y la demanda. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Segurança dos profissionais de enfermagem e do paciente frente à pandemia da COVID-19 em unidades críticas

Objetivo: avaliar a segurança dos profissionais de enfermagem e a cultura de segurança do paciente durante a atuação profissional no atendimento de pacientes suspeitos ou com COVID-19. Método: estudo transversal realizado com 90 profissionais de unidades críticas de dois hospitais-escola. Foi utilizado um instrumento para caracterização sociodemográfica e condições de saúde, além dos constructos "Segurança do profissional e do paciente” e Hospital Survey on Patient Safety Culture. Foram realizadas análises univariadas entre o diagnóstico de COVID-19 e as características dos profissionais, aplicando-se a correlação de Kendell entre os constructos. Resultados: o diagnóstico de COVID-19 apresentou diferença estatisticamente significativa entre os profissionais que trabalhavam há mais de seis anos na unidade (p=0,020) e os itens do constructo "Segurança do profissional e do paciente” referentes às dúvidas sobre como retirar o equipamento de proteção individual (p=0,013) e fluxo seguro (p=0,021). As dimensões 2 (p=0,003), 3 (p=0,009), 4 (p=0,013), 6 (p<0,001) e 9 (p=0,024) do Hospital Survey on Patient Safety Culture foram associadas à realização de treinamentos. Conclusão: maior tempo de experiência profissional do profissional de enfermagem esteve associado a não infecção por COVID-19. A percepção de cultura de segurança do paciente esteve relacionada à realização de treinamentos.Alternate : Objective: to evaluate nursing professionals and patient safety culture during the professional performance in the care of suspected or infected patients with COVID-19. Method: a cross-sectional study carried out with 90 professionals from critical care units of two teaching hospitals. An instrument for sociodemographic characterization and health conditions was used, in addition to the constructs "Nursing professional and patient safety” and the Hospital Survey on Patient Safety Culture. Univariate analyzes were performed between the diagnosis of COVID-19 and the characteristics of Nursing professionals, applying Kendell's correlation between the constructs. Results: the COVID-19 diagnosis presented a significant statistical difference between nursing professionals that worked for more than six years at the critical care unit (p=0.020) and the items of the construct "Nursing professional and patient safety” regarding the doubts about how to remove the personal protective equipment (p=0.013) and safety flow (p=0,021). The dimensions 2 (p=0.003), 3 (p=0.009), 4 (p=0.013), 6 (p<0.001), and 9 (p=0.024) of the Hospital Survey on Patient Safety Culture were associated with the accomplishment of training. Conclusion: a higher professional nursing experience time was associated with non-infection by COVID-19. The perception of the safety culture of the patient was related to the accomplishment of training.

L'impôt cet inconnu

La crise sanitaire du Covid-19 porte de nombreuses interrogations fiscales auxquelles les pouvoirs publics ont apporté des réponses denses mais aussi parcellaires. L'analyse des difficultés et des mesures fiscales permet de mesurer l'étendue réelle ou supposée de l'inconnu fiscal.Alternate : The Covid-19 health crisis raises many fiscal questions to which the public authorities have provided dense but also fragmented responses. The analysis of difficulties and tax measures makes it possible to measure the real or supposed extent of the tax unknown.

Hospital infection control and occupational medicine services in the face of the COVID-19 pandemic in occupational health / Serviços de controle de infecção hospitalar e de medicina do trabalho no enfrentamento à pandemia de COVID-19 na saúde ocupacional

In this article, the actions developed by the Hospital Infection Control Service (HICS) and Occupational Medicine (OM) to face the COVID-19 pandemic and track cases of infection among employees of a large hospital in Belo Horizonte, Minas Gerais, Brazil. Training actions, guidelines on how to collect a swab sample, Code 19 (COVID-19) simulation, dressing/undressing, hand hygiene, the definition of flows, and the quantification of cases infected by COVID-19 among employees in care areas were highlighted. The engagement of HICS and OM in the prevention and promotion of health were fundamental to facing the pandemic. It is estimated that SARS-CoV-2 infection rates among staff at the study hospital were similar to those at other hospitals. The experience report is important for expanding knowledge about action planning in the context of a large hospital (AU).

Neste artigo, são relatadas as ações desenvolvidas pelo Serviço de Controle de Infecção Hospitalar (SCIH) e Medicina do Trabalho (MT) para o enfrentamento da pandemia de COVID-19 e rastreamento dos casos de infecção entre funcionários de um hospital de grande porte de Belo Horizonte, Minas Gerais, Brasil. Destacaram-se as ações de treinamentos, orientações de como coletar amostra de swab, simulação Código 19 (COVID-19), paramentação/desparamentação, higiene das mãos, definição de fluxos e quantificação dos casos infectados por COVID-19 entre funcionários de áreas assistenciais. O engajamento do SCIH e da MT na prevenção e promoção da saúde foi fundamental no enfrentamento da pandemia. Estima-se que os índices de infecção pelo SARS-CoV-2 entre os funcionários do hospital em estudo foram similares aos de outros hospitais. O relato de experiência é importante para a ampliação do conhecimento sobre o planejamento de ações no contexto de um hospital de grande porte (AU).

Control and Insecurity in Australian and Canadian Universities during the COVID-19 Pandemic

We studied 14 universities across Canada and Australia to examine how the COVID-19 crisis, mediated through management strategies and conflict over financial control in higher education, influenced workers’ job security and affective outcomes like stress and happiness. The countries differed in their institutional frameworks, their union density, their embeddedness in neoliberalism and their negotiation patterns. Management strategies also differed between universities. Employee outcomes were influenced by differences in union involvement. Labour cost reductions negotiated with unions could improve financial outcomes, but, even in a crisis, management might not be willing to forego absolute control over finance, and it was not the depth of the crisis that shaped management decisions. Alternate :Cette étude examine comment la pandémie de COVID-19 et les stratégies mises en oeuvre par la gestion universitaire ont influencé la sécurité d'emploi, le stress et le bonheur des travailleurs de l'enseignement supérieur. Les données quantitatives et qualitatives primaires proviennent d'une enquête menée dans quatorze universités en Australie et au Canada, complétée par des recherches secondaires. L'analyse examine les réponses des institutions et des travailleurs à la pandémie, ainsi que les conflits qui en résultent en matière de contrôle financier et ce, tant aux niveaux macro (secteur), méso (université) et micro (individu). Au niveau macro, les réponses des universités ont été façonnées par les politiques publiques de l'État aux niveaux national et infranational. Dans les deux pays l’approche avait une forme nettement " néolibérale ". Toutefois, les universités australiennes ont été davantage exposées à la pression financière en faveur des suppressions d'emplois, et la direction de ces universités a peut-être été plus encline à procéder à des mises à pied que l'ensemble des universités canadiennes. Les différences au niveau du soutien institutionnel au syndicalisme au niveau macro ont influencé la manière dont le personnel universitaire a été affecté aux niveaux méso et micro. La restructuration des universités, dans les deux pays, a eu un impact négatif sur la sécurité d'emploi et les perspectives de carrière, ce qui a entraîné une diminution de la satisfaction professionnelle et une augmentation du stress. Pour de nombreux membres du personnel professionnel, le travail à domicile était nouveau et libérateur, tandis que pour d’autres membres du personnel universitaire, le travail à domicile était une expérience négative. Notre analyse démontre que les expériences du personnel universitaire ont été influencées par d'autres facteurs que les modalités de travail mises en place par les universités pendant la pandémie de COVID-19. Les approches des universités en matière de protection de l'emploi, de restructuration et d'engagement avec le personnel par le biais des syndicats semblent influencer la satisfaction, le stress et le bonheur du personnel. Nos résultats s'inscrivent dans le prolongement de la littérature qui documente la manière dont les processus de néolibéralisation sont régulièrement contestés par le personnel universitaire dans le cadre de diverses actions individuelles et collectives, en particulier en temps de crise. Nous soutenons que la théorisation des luttes pour le contrôle du travail devrait être étendue aux luttes pour le contrôle des finances.

More than a 'Hundred Days War': Persistent SARS-CoV-2 infection in a patient with ANCA-associated vasculitis.

BACKGROUND: Few reports exist on the characteristics and outcomes of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in immunocompromised hosts. METHODS: A 49-year-old patient with granulomatosis with polyangiitis (GPA) and a renal transplant experienced multiple hospitalizations for coronavirus disease 2019 (COVID-19) pneumonia and relapses between October 2020 and February 2021. Careful chart review of medical history, hospitalizations, and microbiological testing including SARS-CoV-2 cycle threshold values, therapies, and imaging was undertaken. SARS-CoV-2 genome sequencing was performed in five viral samples to distinguish persistent infection from re-infection with a different strain. RESULTS: Sequencing confirmed that all samples tested were from the same viral lineage, indicating a long-term, persistent infection rather than re-infection with a new strain. The patient ultimately stabilized after two courses of remdesivir plus dexamethasone, replacement intravenous immunoglobulin, and bamlanivimab. Rituximab maintenance therapy for vasculitis remains on hold. CONCLUSIONS: SARS-CoV-2 may persist for several months in immunocompromised hosts and may go unrecognized as an ongoing active infection. More studies are needed to determine how to optimize COVID-19 treatment in this vulnerable population.

HISTORIQUE: Il existe peu de rapports sur les caractéristiques et les issues de l'infection par le coronavirus 2 du syndrome respiratoire aigu sévère (SRAS-CoV-2) chez les hôtes immunodéprimés. MÉTHODOLOGIE: UNE PATIENTE de 49 ans receveuse d'une transplantation rénale atteinte d'une granulomatose avec polyangéite a été hospitalisée à de multiples reprises à cause d'une pneumonie à maladie à coronavirus 2019 (COVID-19) et de récidives entre octobre 2020 et février 2021. Les chercheurs ont exécuté une analyse attentive du dossier pour connaître l'histoire médicale de la patiente, les hospitalisations et les tests microbiologiques effectués, y compris les valeurs seuils du cycle du SRAS-CoV-2, les traitements et les techniques d'imagerie. Ils ont procédé au séquençage du génome du SRAS-CoV-2 dans cinq prélèvements viraux pour distinguer l'infection persistante de la réinfection par une souche différente. RÉSULTATS : Le séquençage a confirmé que tous les prélèvements effectués provenaient de la même lignée virale, ce qui détermine une infection persistante prolongée plutôt qu'une réinfection par une nouvelle souche. L'état de la patiente a fini par se stabiliser après deux traitements au remdésivir combiné à de la dexaméthasone, une thérapie de substitution par immunoglobuline intraveineuse et du bamlanivimab. Un traitement d'entretien de la vasculite au rituximab demeure en suspens. CONCLUSIONS: Le SRAS-CoV-2 peut persister plusieurs mois chez les hôtes immunodéprimés, et un état d'infection active continue peut passer inaperçu. Plus d'études devront être réalisées pour déterminer le moyen d'optimiser le traitement de la COVID-19 dans cette population vulnérable.

Transmission of COVID-19: a brief review of droplet and aerosol transmission routes / Transmissão da COVID-19: um breve reexame das vias de transmissão por gotículas e aerossóis

O rápido desenrolar da pandemia de COVID-19 no ano de 2020 estimulou pesquisadores a rapidamente tentar entender o comportamento do vírus e da doença e a propor soluções de modo a tentar contê-la o quanto antes. Uma das questões fundamentais a serem respondidas é se o vírus também pode ser transmitido por aerossóis, posto que a forma de transmissão determina a velocidade e as condições em que a doença consegue se espalhar pela população. A busca por essa resposta reacendeu uma discussão de décadas sobre a relevância dessa via de transmissão, bem como sobre os diferentes conceitos e medidas de controle e prevenção atualmente usados para bloquear a transmissão de doenças infecciosas no âmbito da atenção à saúde humana. Este ensaio tem o objetivo de contribuir para esse debate e, mais especificamente, subsidiar programas para a proteção de trabalhadores e pacientes em serviços de saúde referentes à COVID-19 e a outras doenças infecciosas

The rapid advance of the COVID-19 pandemic in the year 2020 has spurred researchers to try to understand quickly the behavior of the virus and the disease, and to propose solutions in order to attempt containing it as soon as possible. One of the core questions to be answered is whether the virus can also be transmitted by aerosols, since the mode of transmission determines the speed and conditions under which the disease can spread through the population. The search for this answer has rekindled a decades-long discussion about the relevance of this transmission route, as well as the different concepts and control and prevention measures currently used to block the transmission of infectious diseases in human healthcare. This essay aims to contribute to this debate and, more specifically, to support programs for the protection of workers and patients in healthcare services regarding COVID-19 and other infectious diseases

COVID-19 and zoonoses in Brazil: Environmental scan of one health preparedness and response.

The emergence of the COVID-19 pandemic reinforced the central role of the One Health (OH) approach, as a multisectoral and multidisciplinary perspective, to tackle health threats at the human-animal-environment interface. This study assessed Brazilian preparedness and response to COVID-19 and zoonoses with a focus on the OH approach and equity dimensions. We conducted an environmental scan using a protocol developed as part of a multi-country study. The article selection process resulted in 45 documents: 79 files and 112 references on OH; 41 files and 81 references on equity. The OH and equity aspects are poorly represented in the official documents regarding the COVID-19 response, either at the federal and state levels. Brazil has a governance infrastructure that allows for the response to infectious diseases, including zoonoses, as well as the fight against antimicrobial resistance through the OH approach. However, the response to the pandemic did not fully utilize the resources of the Brazilian state, due to the lack of central coordination and articulation among the sectors involved. Brazil is considered an area of high risk for emergence of zoonoses mainly due to climate change, large-scale deforestation and urbanization, high wildlife biodiversity, wide dry frontier, and poor control of wild animals' traffic. Therefore, encouraging existing mechanisms for collaboration across sectors and disciplines, with the inclusion of vulnerable populations, is required for making a multisectoral OH approach successful in the country.

Hospital compounding to face shortage: A case study of the development of a lopinavir-ritonavir oral suspension during the first wave of SARS-COV-2 in France.

The potential usefulness of lopinavir-ritonavir on Covid 19 infection during the first wave of contamination in France had boosted Kaletra® syrup prescription to the point of causing its national shortage. In the intensive care units of Parisian hospitals in charge of patients with life-threatening viral contamination, caregivers had to resort to lopinavir-ritonavir-based tablets, crushing them and then dispersing the powder in milk to facilitate administration by nasogastric tube. The difficulties and poor control of this degraded mode, which does not always ensure control of the amount of the drug in the prepared dose and may induce insufficient antiviral exposure, led us to develop in a very short time, while ensuring quality control proportional to the risk, a liquid form as an alternative to Kaletra® oral solution shortage. For this purpose, we describe this compounding formulation and its preparation process, while justifying the quality control strategy adapted to the risk as well as its chemical and physical stability. Based on the chemical and physical studies, the preparation was showed to be stable during at least 2 months between +2°C and +8°C and 1 week at room temperature. This has resulted in the design of kits that include multi-dose packaging and a measuring device and contain the appropriate quantities of drugs to ensure at least one week's treatment for each patient, during which time the kit in use can be stored at room temperature. The intensive care team used this treatment under conditions that they considered well adapted until the imported specialty became available.

Reflections on the extinction of the National Council for Food and Nutrition Security and the confrontation of Covid-19 in Brazil / Reflexões sobre a extinção do Conselho Nacional de Segurança Alimentar e Nutricional e o enfrentamento da Covid-19 no Brasil

ABSTRACT The Provisional Measure 870/2019, which amended the Organic Law on Food and Nutrition Security and extinguished the Conselho Nacional de Segurança Alimentar e Nutricional (National Council for Food and Nutrition Security), has brought serious consequences to the Brazilian population, especially for the most vulnerable. This scientific note brings reflections on the trajectory of the Conselho Nacional de Segurança Alimentar e Nutricional, the repercussions of its extinction in the last year, and the project to dismantle social protection policies in Brazil, with serious consequences at a time when the country is going through a crisis in public health due to the Covid-19 pandemic. The absence of the Conselho Nacional de Segurança Alimentar e Nutricional and the weakening of the set of policies for Food and Nutritional Security has mobilized the civil society to defend the human rights to food, food sovereignty, and to democracy itself. The resistance of the different social movements in order to maintain the spaces of civil participation related to Food and Nutrition Security public policies are still going to be long and arduous, demanding the continued vocalization and strengthening of partnership networks within the different movements of the organized civil society. Finally, we highlight the urgent need for restoration of the National System of Food and Nutritional Security (Sistema Nacional de Segurança Alimentar e Nutricional) with all its instances, and of other social policies, so that the negative consequences of the pandemic are avoided or mitigated and the State complies with its obligations to guarantee the rights of the Brazilian population.

RESUMO A Medida Provisória nº 870/2019, que alterou a Lei Orgânica de Segurança Alimentar e Nutricional e extinguiu o Conselho Nacional de Segurança Alimentar e Nutricional, tem trazido graves consequências à população brasileira, em especial, àqueles em situação de maior vulnerabilidade. Esta nota científica traz reflexões sobre a trajetória do Conselho Nacional de Segurança Alimentar e Nutricional, as repercussões de sua extinção no último ano e o projeto de desmonte das políticas de proteção social no Brasil, com graves desdobramentos no momento em que o país atravessa uma crise de saúde pública em decorrência da pandemia da Covid-19. A ausência do Conselho Nacional de Segurança Alimentar e Nutricional e a fragilização do conjunto de políticas de Segurança Alimentar e Nutricional tem mobilizado a sociedade civil para a defesa do direito humano à alimentação, da soberania alimentar e da própria democracia. A resistência dos diferentes movimentos sociais para manutenção dos espaços de participação da sociedade civil nas políticas públicas de Segurança Alimentar e Nutricional ainda será longa e árdua, demandando a continuidade da vocalização e fortalecimento de redes de parceria nos diferentes movimentos da sociedade civil organizada. Por fim, destaca-se que a recomposição do Sistema Nacional de Segurança Alimentar e Nutricional, com todas as suas instâncias, e das demais políticas sociais, constitui uma necessidade premente para que as consequências negativas da pandemia sejam evitadas ou atenuadas e o Estado cumpra com as suas obrigações para a garantia dos direitos da população brasileira.

[Point-of-care testing: place of France in the world National survey in healthcare establisments in 2019]. / Examens de biologie médicale délocalisée : place de la France dans le monde Enquête nationale en 2019 dans les établissements de santé.

The point-of-care tests (POCT) are subject to accreditation. A national inventory survey provides a synthesis of knowledge. The survey distributed 31 questions in 2019. 147 responses were received (75% biologists, 49% CHU, 42% CHG). Only 20.41% are accredited ISO22870, the majority for <50% of the medical departments; 70% say they are going there at the end of 2019 or in 2020. The maps are unknown for 32% (EBMD) and 82% (TROD). Visibility is poor with: medical establishment committee (40%), IT department (31%). Connection is necessary for 87-95% depending on the criterion (QC, authorizations, etc.) and 66% of answers highlight that less than 50% of connexion is effective. The major advantage is the delay of the result (62.5%), then the relationship with the health teams (33.3%). The disadvantages: difficulty of the quality approach (45%), cost of tests (34.3%). Human resource requirements are identified for technicians (82%) and biologists (76%). The multiplicity of sites, devices and operators means that it is difficult to set up and maintain. Biology outside the laboratories, under biological responsibility, must meet a rigorous imperative quality approach.