The first wave of the Spanish COVID-19 epidemic was associated with early introductions and fast spread of a dominating genetic variant

The COVID-19 pandemic has shaken the world since the beginning of 2020. Spain is among the European countries with the highest incidence of the disease during the first pandemic wave. We established a multidisciplinar consortium to monitor and study the evolution of the epidemic, with the aim of contributing to decision making and stopping rapid spreading across the country. We present the results for 2170 sequences from the first wave of the SARS-Cov-2 epidemic in Spain and representing 12% of diagnosed cases until 14th March. This effort allows us to document at least 500 initial introductions, between early February-March from multiple international sources. Importantly, we document the early raise of two dominant genetic variants in Spain (Spanish Epidemic Clades), named SEC7 and SEC8, likely amplified by superspreading events. In sharp contrast to other non-Asian countries those two variants were closely related to the initial variants of SARS-CoV-2 described in Asia and represented 40% of the genome sequences analyzed. The two dominant SECs were widely spread across the country compared to other genetic variants with SEC8 reaching a 60% prevalence just before the lockdown. Employing Bayesian phylodynamic analysis, we inferred a reduction in the effective reproductive number of these two SECs from around 2.5 to below 0.5 after the implementation of strict public-health interventions in mid March. The effects of lockdown on the genetic variants of the virus are reflected in the general replacement of preexisting SECs by a new variant at the beginning of the summer season. Our results reveal a significant difference in the genetic makeup of the epidemic in Spain and support the effectiveness of lockdown measures in controlling virus spread even for the most successful genetic variants. Finally, earlier control of SEC7 and particularly SEC8 might have reduced the incidence and impact of COVID-19 in our country.

A Cluster-Randomized Trial of Hydroxychloroquine as Prevention of Covid-19 Transmission and Disease

BackgroundCurrent strategies for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are limited to non-pharmacological interventions. Hydroxychloroquine (HCQ) has been proposed as a postexposure therapy to prevent Coronavirus disease 2019 (Covid-19) but definitive evidence is lacking. MethodsWe conducted an open-label, cluster-randomized trial including asymptomatic contacts exposed to a PCR-positive Covid-19 case in Catalonia, Spain. Clusters were randomized to receive no specific therapy (control arm) or HCQ 800mg once, followed by 400mg daily for 6 days (intervention arm). The primary outcome was PCR-confirmed symptomatic Covid-19 within 14 days. The secondary outcome was SARS-CoV-2 infection, either symptomatically compatible or a PCR-positive result regardless of symptoms. Adverse events (AEs) were assessed up to 28 days. ResultsThe analysis included 2,314 healthy contacts of 672 Covid-19 index cases identified between Mar 17 and Apr 28, 2020. A total of 1,198 were randomly allocated to usual care and 1,116 to HCQ therapy. There was no significant difference in the primary outcome of PCR-confirmed, symptomatic Covid-19 disease (6.2% usual care vs. 5.7% HCQ; risk ratio 0.89 [95% confidence interval 0.54-1.46]), nor evidence of beneficial effects on prevention of SARS-CoV-2 transmission (17.8% usual care vs. 18.7% HCQ). The incidence of AEs was higher in the intervention arm than in the control arm (5.9% usual care vs 51.6% HCQ), but no treatment-related serious AEs were reported. ConclusionsPostexposure therapy with HCQ did not prevent SARS-CoV-2 disease and infection in healthy individuals exposed to a PCR-positive case. Our findings do not support HCQ as postexposure prophylaxis for Covid-19. ClinicalTrials.gov registration numberNCT04304053

A Educação Interprofissional e a prática compartilhada em programas de residência multiprofissional em Saúde / Interprofessional Education and shared practice in multiprofessional health residency programs / La educación Interprofesional y la práctica compartida en programas de residencia multiprofesional de Salud

O artigo tem por objetivo analisar os princípios, concepções e práticas da Educação Interprofissional, com ênfase na prática compartilhada em programas de residência multiprofissional em Saúde (PRMS) nas instituições de ensino superior (IES) do Estado de São Paulo, Brasil. Foi realizada análise documental dos projetos pedagógicos (PP), aplicação de instrumento tipo Likert e perguntas abertas a 76 residentes de 13 PRMS. A análise temática dos PP mostra ênfase na responsabilização da equipe perante os casos clínicos e planos de cuidado; centralização nas necessidades do paciente e articulação entre ensino-serviço. Os resultados do instrumento Likert evidenciam satisfação dos residentes com a formação para prática colaborativa. Na perspectiva dos residentes, os PRMS ampliam e melhoram os resultados em saúde, favorecem a atuação centrada no paciente, a identificação das necessidades de saúde e o compartilhamento de práticas e procedimentos. Dessa maneira, os PRMS são importantes no cenário de consolidação do Sistema Único de Saúde (SUS).(AU)

The aim of this paper is to present the principles, conceptions, and practices of Interprofessional Education that underlie multiprofessional health residency programs (PRMS), with emphasis on shared practice, in institutions of higher education in the state of São Paulo, Brazil. The researchers conducted document analysis of the programs' pedagogical projects (PP) and administered a Likert-type scale and open-ended questions to 76 residents of 13 PRMS. Thematic analysis of the PP showed that emphasis was given to the team in clinical cases and care plans; patient-centeredness and coordination between teaching and service. The results of the Likert-type scale showed that residents were satisfied with education for collaborative practice. From the point of view of the residents, the PRMS helped expand and enhance health outcomes, favoring the patient-centered care, the identification of health needs, and shared practices and procedures. In conclusion, PRMS are important to the Brazilian National Health System (SUS).(AU)

El objetivo del artículo es analizar los principios, concepciones y prácticas de la Educación Interprofesional, con énfasis en la práctica compartida en programas de residencia multiprofesional de Salud (PRMS), en las IES del Estado de São Paulo, Brasil. Se realizaron: análisis documental de los Proyectos Pedagógicos (PP), aplicación de instrumento tipo Likert y preguntas abiertas a 76 residentes de 13 PRMS. El análisis temático de los PP muestra: énfasis en que el equipo asuma la responsabilidad ante los casos clínicos y planes de cuidado; centralización en las necesidades del paciente y articulación entre enseñanza-servicio. Los resultados del Likert ponen en evidencia: satisfacción de los residentes con la formación para práctica colaborativa. En la perspectiva de los residentes, los PRMS amplían y mejoran los resultados de salud; favorecen la actuación centrada en el paciente; identificación de las necesidades de salud; compartición de prácticas y procedimientos. Por lo tanto, los PRMS son importantes en el escenario de consolidación del SUS.(AU)

Ações educativas e o uso de álcool entre estudantes do ensino técnico de enfermagem / Consumo de alcohol y las actividades educativas de los estudiantes de esculeas técnicas en enfermería / Educational activities and alcohol use among studentes of thecnical education in nursing

Introdução: O consumo de altas doses de álcool é prejudicial para jovens estudantes. Objetivo: Analisar o consumo de álcool pelos alunos do Curso Técnico de Enfermagem de um município paulista e as atividades educativas desenvolvidas pela escola para enfrentar o problema. Material e Método: Para a coleta de dados foi utilizado parte do questionário sobre Uso de Drogas desenvolvido pela WHO, aplicado a 75 estudantes do 2º ao 4º módulo, e entrevista a professores e coordenadores do curso. Resultados: Os resultados evidenciam que a maioria dos alunos ingere álcool precocemente, por influência da família, amigos, mídia e desejo de autoafirmação...

Formação do nutricionista atuante no Programa Nacional de Alimentação Escolar / Dietitians' training in the National School Feeding Program

The purpose of this research was to investigate the educational demands of dietitians engaged in the National School Feeding Program (NSFP) and to characterize the profile, career trajectory and improvement demands of these professionals, as well as the daily facilities and difficulties of the program. Data collection was carried out through a semi-structured questionnaire. Descriptive statistics and analysis of open questions were performed. The research comprised 246 dietitians - 98.4% of whom were female. Most participants (76.3%) concluded the course 10 years ago, that is, subsequent to the National Curriculum Guidelines (NCG). Contents related to NSFP were part of the undergraduate program of these dietitians, but insufficient for most of them. Thus, 31% of the nutritionists surveyed underwent further training courses to work in the NSFP. The most cited characteristics required to engage the program were technical knowledge, creativity, teamwork and dynamism. The facilities to work in the program were related to administrative aspects, while the difficulties included technical aspects. Training demands included the elaboration of nutritionally adequate menus and costs, greater participation in the nutrition educational processes, bidding, and improvement for all the professionals involved in school feeding, promoting exchanges of experiences, professional value, and raising managers' awareness regarding the importance of the Program. The divergence of content and pedagogical models during training may limit the expansion of the professional integration desired for dietitians, requiring curricular re-equalization concerning the current policies.

Este trabajo tuvo por objetivos investigar las demandas de formación profesional del nutricionista que actúa en el Programa de Alimentación Escolar (PAE), caracterizar su perfil profesional, su trayectoria y las facilidades y dificultades del Programa. La recolección de datos se realizó por medio de cuestionario semi-estructurado. Se realizó tratamiento estadístico descriptivo de los datos y análisis de las preguntas abiertas. La investigación contó con la participación de 246 nutricionistas, siendo 98,4% de sexo femenino. La mayoría (76,3%) había terminado su carrera hacía 10 años, es decir, posteriormente a las Directrices Curriculares Nacionales (DCN). Para la mayoría de los nutricionistas, los contenidos relacionados al PAE constaron en el currículo de grado de forma insuficiente. Por lo tanto, 31% tuvieron que realizar cursos específicos en esa área. Las características más citadas como necesarias para actuación en el programa fueron: conocimiento técnico, creatividad, trabajo en equipo y dinamismo. Las facilidades de los nutricionistas para actuar en el Programa se refirieron a aspectos administrativos, mientras que las dificultades incluyeron aspectos técnicos. Las demandas de formación contemplaron la elaboración de menús adecuados tanto nutricionalmente como en costo, una mayor participación en los procesos de educación nutricional y licitatorios, y la capacitación de todos los profesionales involucrados en el proceso de alimentación escolar, promoviendo intercambio de experiencias, valorización del nutricionista y sensibilización de los gestores con relación a la importancia del Programa. La brecha entre los contenidos y los modelos pedagógicos durante la formación puede limitar la ampliación de la inserción profesional deseada por el nutricionista requiriendo readecuaciones curriculares en función de las actuales políticas.

Este trabalho objetivou investigar as demandas de formação do nutricionista atuante no Programa de Alimentação Escolar (PNAE), caracterizar seu perfil profissional, trajetória de formação, demandas de aprimoramento e facilidades e dificuldades do cotidiano do Programa. Realizou-se a coleta de dados por meio de questionário semiestruturado. Utilizou-se tratamento estatístico descritivo dos dados e análise das questões abertas. A pesquisa contou com a participação de 246 nutricionistas, sendo 98,4% do sexo feminino. A maioria (76,3%) concluiu o curso há 10 anos, ou seja, posteriormente às Diretrizes Curriculares Nacionais (DCN). Conteúdos referentes ao PNAE fizeram parte da graduação dos nutricionistas, porém, de forma insuficiente para a maioria deles. Com isso, 31% deles realizaram cursos de aperfeiçoamento para atuar no PNAE. As características necessárias, mais citadas, para atuação no programa foram: conhecimento técnico, criatividade, trabalho em equipe e dinamicidade. As facilidades dos nutricionistas para atuar no Programa referiam-se a aspectos administrativos, enquanto as dificuldades incluíam aspectos técnicos. As demandas de formação abrangeram a elaboração de cardápios adequados nutricionalmente e ao custo, maior participação nos processos de educação nutricional, licitatórios e em aprimoramentos com todos os profissionais envolvidos no processo da alimentação escolar, promovendo trocas de experiências, valorização do nutricionista e sensibilização dos gestores para a importância do Programa. O descompasso dos conteúdos e modelos pedagógicos durante a formação pode limitar a ampliação da inserção profissional almejada para o nutricionista, requerendo readequações curriculares em função das atuais políticas.

Investigación epidemiológica sobre niveles de plomo en la población infantil y en el medio ambiente domiciliario de Ciudad Juárez, Chihuahua, en relación con una fundición de El Paso, Texas / Epidemiologic study of lead levels in children and in the household environment in Ciudad Juárez, Chihuahua, México, and an area near a foundry in El Paso, Texas, USA

Se estudió una muestra representativa de los hogares de Ciudad Juárez y el 100 por ciento de los situados al noroeste de esa ciudad, cercanos a la fundición de El Paso, Texas, a determinar niveles de plomo en sangre por lo menos un niño de 1 a 9 años de edad de cada hogar, así como el plomo del polvo intradomiciliario y de la tierra de patios, jardines de la misma casa. Se estudió riesgo ocupacional y el de ingestión de plomo por uso de loza. Se encontró que los niveles de plomo en sangre eran mayores en los niños cuyos hogares se encontraban más próximos a la fundición. Hubo una correlación positiva entre niveles de plomo en sangre y el contenido del metal en el polvo intradomiciliario y en la tierra de sus patios o jardines, estos hechos no influyeron el riesgo ocupacional ni el uso de utensilios de loza que desprendieran plomo.

Alkaline phosphatase activity in plasma of pregnant chagasic patients

The Kinetic properties of plasma placental alkaline phosphatase patients with Chagas disease were studied. When Cl2 Mg was used as activator the same increase of activity (17-20 per cent) was found in the chagasic and non chagasic groups. The enzyme was not inhibited by F-ion in any of the groups. No significant differences were detected between the two groups (chagasic and non chagasic) when the enzyme was treated with inhibitors such as EDTA and L-phenylamine. However, when the CN- ion was used, the enzyme of the normal pregnant women followed a Michaelian curve, whereas in the chagasic group a sigmoideal plot was observed. Thus, the Hill coefficient was 1.1 for the normal group and over 1.5 for the chagasic. (AU)

Alkaline phosphatase activity in plasma of pregnant chagasic patients

The Kinetic properties of plasma placental alkaline phosphatase patients with Chagas' disease were studied. When Cl2 Mg was used as activator the same increase of activity (17-20 per cent) was found in the chagasic and non chagasic groups. The enzyme was not inhibited by F-ion in any of the groups. No significant differences were detected between the two groups (chagasic and non chagasic) when the enzyme was treated with inhibitors such as EDTA and L-phenylamine. However, when the CN- ion was used, the enzyme of the normal pregnant women followed a Michaelian curve, whereas in the chagasic group a sigmoideal plot was observed. Thus, the Hill coefficient was 1.1 for the normal group and over 1.5 for the chagasic.