Palliative care national plan implementation through stakeholder analysis.

BACKGROUND: National palliative care plans depend upon stakeholder engagement to succeed. Assessing the capability, interest, and knowledge of stakeholders is a crucial step in the implementation of public health initiatives, as recommended by the World Health Organisation. However, utilising stakeholder analysis is a strategy underused in public palliative care. OBJECTIVE: To conduct a stakeholder analysis characterising a diverse group of stakeholders involved in implementing a national palliative care plan in three rural regions of an upper-middle-income country. METHODS: A descriptive cross-sectional study design, complemented by a quantitative stakeholder analysis approach, was executed through a survey designed to gauge stakeholders' levels of interest and capability in relation to five fundamental dimensions of public palliative care: provision of services, accessibility of essential medicines, palliative care education, financial support, and palliative care vitality. Stakeholders were categorised as promoters (high-power, high-interest), latent (high-power, low-interest), advocates (low-power, high-interest), and indifferent (low-power and low-interest). Stakeholder self-perceived category and knowledge level were also assessed. RESULTS: Among the 65 surveyed stakeholders, 19 were categorised as promoters, 34 as advocates, 9 as latent, and 3 as indifferent. Stakeholders' self-perception of their category did not align with the results of the quantitative analysis. When evaluated by region and palliative care dimensions the distribution of stakeholders was nonuniform. Palliative care funding was the dimension with the highest number of stakeholders categorised as indifferent, and the lowest percentage of promoters. Stakeholders categorised as promoters consistently reported a low level of knowledge, regardless of the dimension, region, or their level of interest. CONCLUSIONS: Assessing the capability, interest, and knowledge of stakeholders is a crucial step when implementing public health initiatives in palliative care. It allows for a data-driven decision-making process on how to delegate responsibilities, administer financial resources, and establish governance boards that remain engaged and work efficiently.

Marcos de Competência para a formação de enfermeiros no Brasil: revisão de escopo / Competency milestones for the training of nurses in Brazil: a scoping review / Hitos de competencia para la formación de enfermeros en Brasil: una revisión del alcance

O ensino superior em Enfermagem está em constante transformação, ensejando o uso de metodologias ativas que colaborem para o desenvolvimento de competências. Objetivou-se apresentar o panorama dos marcos de competência para formação de enfermeiros no Brasil. Trata-se de uma Revisão de Escopo, realizada nas bases de dados Biblioteca Virtual em Saúde (BVS), PubMed, Portal da Capes e Biblioteca Eletrônica Científica Online (SciELO), no período de 2012 a 2022. Foram utilizados os descritores "Educação Baseada em Competências", "Perfil de Competências de Enfermeiros"; "Educação do Enfermeiro" e "Competência" nos idiomas inglês e espanhol, com o booleano "AND". Os 11 estudos selecionados evidenciaram a mudança de paradigma de formação baseada em competências, a partir das Diretrizes Curriculares Nacionais, clareamento do conceito de competência e marco de competências. Na realidade brasileira o tema é incipiente, com iniciativas baseadas em perfis de competências de gestão, liderança, promoção e educação em saúde.

Higher education in Nursing is constantly changing, stimulating the use of active methodologies that contribute to the development of competencies. The objective was to present an overview of the competency milestones for nurse training in Brazil. This is a Scoping Review, carried out in the Virtual Health Library (VHL), PubMed, Capes, Portal and Scientific Electronic Library Online (SciELO) databases, from 2012 to 2022. The descriptors "Based Education Skills", "Profile of Nurses' Skills"; "Nurse Education" and "Competency" were used in English and Spanish, with the Boolean "AND". The 11 selected studies showed a change in the paradigm of competency-based training, using the National Curriculum Guidelines, clarifying the concept of competency and the competency milestones. In the Brazilian reality, the theme is incipient, with initiatives inscribed in records of management skills, leadership, promotion and health education.

La educación superior en Enfermería está en constante cambio, promovendo el uso de metodologías activas que contribuyan al desarrollo de competencias. El objetivo fue presentar un panorama de los hitos competenciales para la formación de enfermeros en Brasil. Se trata de una Revisión de Alcance, realizada en las bases de datos Biblioteca Virtual en Salud (BVS), PubMed, Portal Capes y Biblioteca Electrónica Científica en Línea (SciELO), de 2012 a 2022. Se utilizaron los descriptores "Educación Basada en Habilidades", "Perfil de Competencias del Enfermero"; "Educación de enfermería" y "Competencia" en inglés y español, con el booleano "AND". Los 11 estudios seleccionados evidenciaron un cambio en el paradigma de la formación por competencias, tomando como base los Lineamientos Curriculares Nacionales, aclarando el concepto de competencia y el marco de competencias. En la realidad brasileña, el tema es incipiente, con iniciativas inscritas en registros de habilidades de gestión, liderazgo, promoción y educación en salud.

Building an action plan to tackle palliative care inequality through multi-stakeholder platforms.

Background: To achieve universal care and overcome existing barriers, the most effective strategy is to devise an action plan that incorporates palliative care into primary health care (PHC), as recommended by the World Health Organization's (WHO) Astana Declaration. In Colombia, a country with an upper-middle-income status, about 128,000 individuals experience severe health-related suffering (SHS) that necessitates palliative care. Although the country's healthcare system has made steady strides in the integration and development of palliative care, there is still no national plan in place for palliative care. Objective: Build up Colombia's palliative care plan through stakeholder consensus. Method: Based on the participatory action research method and the multi-stakeholder platforms model, this study convened 142 stakeholders from different levels of the health system (patient representatives, journalists, health professionals, government entities, insurance companies, universities, and drug regulatory authorities). Results: The national plan aims to achieve its objectives through a series of strategic actions. These include integrating and diversifying palliative care services, improving access to opioids, increasing palliative care education, promoting community-based palliative care programs, securing funding, and implementing a regulatory framework for palliative care by public policymakers. Conclusions: The national palliative care is an alliance that aims to reduce palliative care inequity in Colombia by 2026 by empowering stakeholders nationwide to collaborate around specific goals and objectives.

Ductus venosus as a marker of fetal growth in first trimester in a population of Colombian pregnant women / Ductus venoso como marcador de crecimiento fetal en primer trimestre en una población de gestantes colombianas

Abstract Objectives: to evaluate the relationship between the ductus venosus (DV) and the variables of fetal growth in the first trimester in a Colombian pregnant population. Methods: a descriptive cross-sectional study was carried out with secondary data obtained from a multicenter study.526 patients were included between weeks 11 and 14 for gestational ultrasound follow-up attended in three health care institutions in Bogotá, Colombia, between May 2014 and October 2018. A bivariate descriptive analysis was carried out where the relationship between the characteristics of the DV in the first trimester and ultrasound findings. Results: the flow wave of the DV in the first trimester was normal in the entire sample, with a pulsatility index of the ductus venosus (DVPI) of 0.96±0.18. In addition, a negative correlation was found between the crown-rump length (CRL) and the DVPI (p<0.05). Conclusion: there is a relationship between the DVPI regarding the CRL, indicating an interest in this early marker in relation to fetal growth alterations; however, more studies are required to determine the usefulness of this variable with respect to fetal growth.

Resumen Objetivos: evaluar la relación entre el ductus venoso (DV) y las variables del crecimiento fetal en primer trimestre en una población de gestantes colombianas. Métodos: se realizó un estudio transversal descriptivo con datos secundarios obtenidos de un estudio multicéntrico. Se incluyeron 526 pacientes entre las semanas 11 a 14 para seguimiento ecográfico gestacional atendidas en tres instituciones prestadoras de salud en Bogotá, Colombia, entre mayo del 2014 y octubre del 2018. Se realizó un análisis descriptivo bivariado donde se evaluó la relación entre las características del DV en primer trimestre y los hallazgos ecográficos. Resultados: la onda de flujo del DV en primer trimestre fue normal en la totalidad de la muestra, con un índice medio de pulsatilidad del ductus venoso (IPDV) de 0,96±0.18. Se encontró una correlación negativa entre la longitud cefalocaudal (LCC) y el IPDV (p<0.05). Conclusión: existe una relación entre el IPDV respecto a la LCC, señalando un interés de este marcador temprano en relación con las alteraciones del crecimiento fetal, sin embargo, se requieren más estudios para determinar la utilidad entre esta variable respecto al crecimiento fetal

Pico de Massa Óssea e Níveis de Exercício Físico em Estudantes Universitários / Peak Bone Mass and Exercise Levels: Comparison between Physical Education and Medical Students

Introdução: Promover um adequado pico de massa óssea (PMO) é uma estratégia de prevenção para a osteoporose. Os estudantes universitários estão em idade de aquisição de massa óssea suscetível à influência dos hábitos do estilo de vida, incluindo a prática de exercícios físicos. Assim sendo, este estudo objetivou avaliar a massa óssea em universitários com diferentes estilos de vida. Métodos: Foram avaliados 142 estudantes, sendo 74 de Medicina (MED) e 68 de Educação Física (EF), com idade média de 22 anos. As variáveis do estudo foram obtidas por meio de anamnese densitométrica. A densidade mineral óssea (DMO) da coluna lombar, corpo inteiro, colo do fêmur e fêmur total foi medida por absorciometria de dupla emissão de raios X. Resultados: Não houve diferenças em relação à idade, sexo, IMC e ingestão de cálcio entre os grupos. Os estudantes de EF praticam mais exercícios que os de MED (481 vs. 128 min/semana). A frequência de exercício físico suficiente (> 150 min/semana) foi maior no grupo EF (91,2% vs. 40,5%; p <0,01). Exercícios que influenciam a DMO foram mais frequentes entre os estudantes de EF (91,2% vs. 63,5%; p <0,01). Baixo PMO foi mais frequente no grupo MED (52,7 vs. 14,7; p<0,01). Observou-se correlação positiva entre a quantidade semanal de exercício físico e DMO. Conclusão: Maiores taxas de prática de exercícios físicos foram associadas com melhor PMO em estudantes do curso de Educação Física.

Introduction: Promoting adequate peak bone mass (PBM) is a prevention strategy for osteoporosis. College students are at the age of bone mass acquisition susceptible to the influence of lifestyle habits, including exercise. Therefore, this study aimed to evaluate bone mass in college students with different lifestyles. Methods: We evaluated 142 students, 74 from Medicine (MED) and 68 from Physical Education (PE), with a mean age of 22 years. The study variables were obtained by densitometric anamnesis. Bone mineral density (BMD) of the lumbar spine, whole body, femoral neck, and total femur was measured by dual emission X-ray absorptiometry. Results: There were no differences in age, gender, BMI, and calcium intake between the groups. PE students exercised more than MED students (481 vs. 128 min/week). The frequency of sufficient exercise (> 150 min/week) was higher in the EF group (91.2% vs. 40.5%; p <0.01). Exercise influencing BMD was more frequent among EF students (91.2% vs. 63.5%; p <0.01). Low PBM was more frequent in the MED group (52.7 vs. 14.7; p<0.01). The study showed a positive correlation between the weekly amount of exercise and BMD. Conclusion: Higher exercise rates were associated with better PBM in physical education students.

Trend towards institutional stability: regulation, training, and provision of doctors in Brazil during the Lula government. / Tendência à estabilidade institucional: regulação, formação e provimento de médicos no Brasil durante o governo Lula.

This article aims to analyse the characteristics of the regulation, training and supply policies of medical doctors in Brazil, during Lula government (2003-2010), as well as the process of dispute about a policy change proposed by senior officers of the Ministry of Health, who were members of the Health Reform movement. This is a case study that used process tracing as a methodological strategy and, as sources, documents and interviews. We used the theoretical resources offered by studies on political process and the theory of gradual institutional change. The main findings are the understanding of institutional arrangements in this policy, and the identification of individual and collective actors who acted to change the policy. Three political-institutional restrictions to change were found: the opposition of the Liberal Medicine advocates Community, which exerted a political influence on the area, the lack of support or resistance to change from the Ministry of Education and the government nucleus decision not to carry out proposals that, at the same time, had to be approved by the Legislative and had the opposition of the Liberal Medicine advocates Community. A balance tending to reproduce the status quo and the current institutional arrangement prevailed, despite the implementation of incremental policy changes.

O objetivo do artigo é analisar as características da política de regulação, formação e provimento de médicos no Brasil durante os governos Lula (2003-2010) e o processo de disputa em torno de sua mudança defendida pelos dirigentes do Ministério da Saúde, integrantes do movimento sanitário. Trata-se de um estudo de caso que utilizou o process tracing como estratégia metodológica e, como fontes, documentos e entrevistas. Utilizaram-se os recursos teóricos dos estudos sobre processo político e a teoria da mudança institucional gradual. Os principais resultados são a compreensão do arranjo institucional relacionado à política e a identificação de atores individuais e coletivos que atuaram para sua conservação ou mudança. Constataram-se três restrições político-institucionais à mudança: a oposição da comunidade de política "medicina-liberal", que exercia influência sobre a política, a falta de apoio ou resistência do Ministério da Educação às mudanças propostas e a decisão do núcleo do governo de não levar adiante propostas que, ao mesmo tempo, tivessem que ser aprovadas no Legislativo e contassem com a oposição da "comunidade" da medicina-liberal. Predominou um equilíbrio que tendeu à reprodução do status quo e do arranjo institucional vigente, apesar de ter havido alterações incrementais na política.

What made the Mais Médicos (More Doctors) Program possible? / O que fez com que o Programa Mais Médicos fosse possível?

The article analyzes which were the actors who participated in the insertion in the governmental agenda of the issue of insufficiencies in the supply and training of medical doctors for the SUS and the adoption of the Mais Médicos Program (PMM) as a solution. Documental and bibliographic analysis and semi-structured interviews were carried out in the methodological perspective of process tracing. Theoretical resources from studies on political processes and from the theories of gradual institutional change and multiple streams were used. Outstanding results were the identification of factors related to the entry of the issue on the agenda, such as the aggravation of the issue, increase in its public perception and change of government. It was found that the action of the President and policy entrepreneurs was decisive for the process of formulating the PMM based on historical legacies of previous policies. We challenge studies that regard the PMM as a hastily formulated solution to an old problem to respond the street demonstrations known as "June Journeys". The inauguration of municipal governments, in 2013, and the electoral calendar were also important factors and taken into account in the strategic action of the actors who led the formulation of the PMM, with strong opposition from medical entities.

O artigo analisa quais atores participaram e como atuaram na inserção na agenda governamental da questão das insuficiências na oferta e formação de médicos para o SUS e da adoção do Programa Mais Médicos (PMM) como solução. A análise documental, bibliográfica e a realização das entrevistas semiestruturadas com informantes-chave foram trabalhadas na perspectiva metodológica do process tracing. Foram usados recursos teóricos dos estudos sobre o processo político e das teorias da mudança institucional gradual e dos múltiplos fluxos. Destacam-se como resultados a identificação de fatores relacionados à entrada da questão na agenda, como o agravamento do tema, o aumento de sua percepção pública e a mudança de governo. Constatou-se que a ação da presidenta Dilma Rousseff e de empreendedores da política foi decisiva para o processo de formulação do PMM com base em legados históricos de políticas anteriores. Contesta-se a explicação de uma vertente da literatura que considera que o PMM foi uma solução construída às pressas, para enfrentar um problema antigo, em resposta às "Jornadas de Junho". Observou-se que a posse dos novos prefeitos em 2013 e o calendário eleitoral também foram fatores importantes para a ação estratégica dos atores que lideraram a formulação do programa, com forte oposição das entidades médicas.

Hospitalization, death, and probable reinfection in Peruvian healthcare workers infected with SARS-CoV-2: a national retrospective cohort study

OBJECTIVETo determine if occupation is a risk factor for probable reinfection, hospitalization, and death from COVID-19 in Peruvian healthcare workers infected with SARS-CoV-2. MATERIAL AND METHODSRetrospective cohort study. Healthcare workers who presented SARS-CoV-2 infection between March 1, 2020 and August 9, 2021 were included. Occupational cohorts were reconstructed from the following sources of information: the National Epidemiological Surveillance System, molecular tests (NETLAB), results of serology and antigen tests (SICOVID-19), National Registry of Health Personnel (INFORHUS) and National Information System of Deaths (SINADEF). The incidence of probable reinfection, hospitalization, and death from COVID-19 was obtained in the cohorts of health auxiliaries and technicians, nursing staff, obstetricians, physicians, and other healthcare workers. We evaluated whether occupation was a risk factor for probable reinfection, hospitalization, and death from COVID-19 using a log-binomial generalized linear model, obtaining the adjusted relative risk (RR AJ). RESULTS90,672 healthcare workers were included. 8.1% required hospitalization, 1.7% died from COVID-19, and 2.0% had probable reinfection. A similar incidence of probable reinfection was found in the 5 cohorts (1.9%-2.2%). Physicians had a higher incidence of hospitalization (13.2%) and death (2.6%); however, they were also those who presented greater susceptibility linked to non-occupational variables such as age and comorbidities. The multivariate analysis found that physicians (RR=1.691; CI 95: 1.556-1.837) had a higher risk of hospitalization and that the occupation of health technician and assistant was the only one that constituted a risk factor for mortality from COVID-19 (RR =1.240; 95% CI: 1.052-1.463). CONCLUSIONSPeruvian health technicians and auxiliaries have a higher risk of death from COVID-19 linked to their occupation, while doctors have higher mortality due to non-occupational factors. Physicians had a higher risk of hospitalization independent of the presence of comorbidities and age; likewise, all occupations had a similar risk of probable reinfection.

Massa óssea em crianças e adolescentes com infecção vertical pelo HIV: uma série de casos / Bone mass in children and adolescents with vertically transmitted HIV: a series of cases

Introdução: Embora a osteoporose acometa principalmente os adultos, podemos detectar crianças e adolescentes com baixa massa óssea (BMO), identificando as de risco para um baixo pico de massa óssea. As doenças crônicas são as principais causas de redução de (MO) na infância e adolescência, e entre elas está a infecção pelo HIV. Objetivos: Avaliar a MO em pacientes pediátricos infectados pelo vírus da imunodeficiência humana (HIV). Métodos: Estudaram-se 46 pacientes com 7,7±3,5 anos com diagnóstico de infecção vertical pelo HIV. Avaliaram-se sexo, idade, peso, estatura, categoria clínica, densidade mineral óssea (DMO), níveis séricos de cálcio, fósforo, fosfatase alcalina (FA), contagem de CD4 e CD8, número de cópias virais, índice cálcio/creatinina urinário (Ca/Creat u), fator de crescimento similar à insulina tipo 1 (IGF-1) e proteína C reativa ultrassensível. A DMO foi realizada em coluna lombar (DXA) e expressa em Z-score, assim como peso e estatura. Resultados: Pacientes com baixa massa óssea (BMO) apresentaram idade cronológica, FA e IGF-1 superiores e níveis séricos de CD4 e a relação Ca/Creat u inferiores. A DMO mostrou correlação positiva com o CD4 e negativa com a idade cronológica e o IGF-1. Na regressão múltipla, CD4, idade, FA, índice Ca/Creatu e IGF-1 explicaram as variações na DMO. Conclusão: Na presente amostra, crianças e adolescentes com infecção vertical pelo HIV apresentaram BMO para a idade cronológica, especialmente durante a adolescência. A associação da BMO com menor CD4 e maior idade sugere que a duração da infecção e a condição clínica tenham implicação na redução da massa óssea.

Introduction: Although osteoporosis mainly affects adults, children and adolescents with low bone mass (LBM) can also be detected, identifying those at risk for low peak bone mass. Chronic diseases, which include human immunodeficiency virus (HIV) infections, are the main causes of reductions in bone mass (BM) during childhood and adolescence. Objectives: To evaluate BM in pediatric patients infected with HIV. Methods: We studied 46 patients aged 7.7±3.5 years who were diagnosed with vertically transmitted HIV. We assessed sex, age, weight, stature, clinical category, bone mineral density (BMD), serum levels of calcium, phosphorus, and alkaline phosphatase (AP), CD4 and CD8 cell counts, viral load, urine calcium/creatinine ratio (UCa/Cr), insulin-like growth factor 1 (IGF-1), and high-sensitivity C-reactive protein. BMD was measured at the lumbar spine (DXA) and expressed using Z-scores as well as weight and stature. Results: Patients with LBM presented higher chronological age, AP, and IGF-1, and lower CD4 counts and Uca/Cr. BMD was positively correlated with CD4 count and negatively correlated with chronological age and IGF-1. In a multiple regression analysis, CD4, age, AP, Uca/Cr, and IGF-1 explained variations in BMD. Conclusion: In this sample, children and adolescents with vertically transmitted HIV presented LBM for their chronological age, especially during adolescence. The association of LBM with lower CD4 and higher age suggests that the duration of infection and clinical conditions may have implications to the reduction of BM.

Qualidade de vida em adolescentes com diabetes mellitus tipo 1 / Quality of life among adolescents with type 1 diabetes mellitus

Introdução: O diabetes mellitus tipo 1 (DM1), uma das principais doenças crônicas presente na adolescência, pode comprometer o funcionamento fisiológico e psicossocial do adolescente, interferindo na sua qualidade de vida. Objetivo: Avaliar a qualidade de vida de adolescentes com diabetes mellitus tipo 1 (DM1) em serviço de atenção secundária no âmbito do Sistema Único de Saúde (SUS). Métodos: Estudo clínico transversal em 40 adolescentes com DM1. Avaliou-se a qualidade de vida (QV) mediante a aplicação do questionário validado DQOL (Diabetes Quality of Life), o qual possui três dimensões: impacto, preocupação e satisfação. O questionário também inclui uma pergunta sobre a percepção de saúde, cujas respostas foram agrupadas em duas categorias: excelente/bom e satisfatória/fraca. Na análise estatística, utilizaram-se os testes Kolmogorov-Smirnov, t de Student, qui quadrado, regressão logística e regressão linear. O nível de significância adotado foi p<0,05. Resultados: Setenta por cento dos adolescentes se perceberam com saúde excelente/boa. Houve associação entre o escore de QV e a percepção de saúde. Os pacientes com pontuações acima do quartil 75 apresentaram maior frequência de percepção de saúde satisfatória /boa, demonstrando que uma pior autopercepção de saúde se associa com piores escores de QV. Maior peso e pior controle metabólico se relacionaram com piores escores de QV. Conclusão: Adolescentes com DM1 com tempo de diagnóstico médio de 5 anos atendidos no SUS por equipe multiprofissional apresentaram escores de QV compatíveis com uma boa qualidade de vida, e se perceberam com saúde excelente ou boa.

Introduction: Type 1 diabetes mellitus (T1DM), one of the main chronic diseases of adolescence, can compromise the physiological and psychosocial function of adolescents, interfering with their quality of life (QoL). Objective: To assess the QoL of adolescents with T1DM in a secondary healthcare institution of the Unified Health System (SUS). Methods: This is a cross-sectional clinical study performed with 40 adolescents with T1DM. We evaluated QoL through the application of a validated Diabetes Quality of Life (DQOL) questionnaire, which encompasses three dimensions: impact, worry, and satisfaction. The questionnaire also includes a question on perceived health with answers grouped into two categories: excellent/good and satisfactory/poor. Statistical analyses used the Kolmogorov-Smirnov, Student's t, and chi-squared tests, as well as logistic and linear regressions. The significance level adopted for the analysis was p<0.05. Results: Out of all participants, 70% perceived their health as excellent/good. An association was observed between QoL scores and perceived health. Patients with scores in the upper quartile perceived their health as satisfactory/good more frequently, demonstrated that a worse perceived health was associated with worse QoL scores. Increased weight and worse metabolic control were related with worse QoL scores. Conclusions: Adolescents with T1DM and a mean time since diagnosis of 5 years, followed-up at the SUS by a multi-professional team, presented QoL scores that were compatible with a good QoL and perceived their health as excellent or good.

KNOWLEDGE ABOUT THE MANAGEMENT OF WASTE CONTAMINATED AND POTENTIALLY CONTAMINATED BY SARS-COV-2 / CONHECIMENTO ACERCA DO MANEJO DE RESÍDUOS CONTAMINADOS E POTENCIALMENTE CONTAMINADOS POR SARS-COV-2

The coronavirus (COVID-19) is a respiratory disease with a high capacity to spread. Its prevention consists of respecting social distance, wearing a mask and performing adequate hygiene of hands and surfaces, which resulted in an increase in the amount of household solid waste generated during the period of social isolation. The objective of this study is to identify the knowledge of residents of Curitiba on the management of waste contaminated or potentially contaminated by SARS-CoV-2 through an exploratory-descriptive research with a quantitative approach with 420 participants. It was found that the population's lack of knowledge about the measures contained in the municipal protocol for the prevention of contamination by the coronavirus results in an inadequate disposal of masks, gloves, handkerchiefs and napkins, even those used in a preventive way, and incorrect storage of waste from suspected cases or confirmed cases of COVID-19, which increases the risk of contamination for both the population and public servants in public cleaning.

O coronavírus (COVID-19) é uma doença de acometimento respiratório com alta capacidade de disseminação. Sua prevenção consiste em respeitar o distanciamento social, usar máscara e realizar a higienização adequada de mãos e superfícies, o que resultou em um aumento na quantidade de resíduos sólidos domiciliares gerados durante o período de isolamento social. O objetivo deste estudo é identificar o conhecimento de residentes de Curitiba sobre o manejo de resíduos contaminados ou potencialmente contaminados por SARS-CoV-2 por meio de uma pesquisa exploratória-descritiva com abordagem quantitativa com 420 participantes. Foi constatado que o desconhecimento da população acerca das medidas contidas no protocolo municipal para a prevenção da contaminação pelo coronavírus resulta em um descarte inadequado de máscaras, luvas, lenços e guardanapos, mesmo os usados de forma preventiva, e armazenamento incorreto dos resíduos de casos suspeitos ou confirmados de COVID-19, o que eleva o risco de contaminação tanto para a população como para os servidores públicos na limpeza pública.

Tendência à estabilidade institucional: regulação, formação e provimento de médicos no Brasil durante o governo Lula / Trend towards institutional stability: regulation, training, and provision of doctors in Brazil during the Lula government

Resumo O objetivo do artigo é analisar as características da política de regulação, formação e provimento de médicos no Brasil durante os governos Lula (2003-2010) e o processo de disputa em torno de sua mudança defendida pelos dirigentes do Ministério da Saúde, integrantes do movimento sanitário. Trata-se de um estudo de caso que utilizou o process tracing como estratégia metodológica e, como fontes, documentos e entrevistas. Utilizaram-se os recursos teóricos dos estudos sobre processo político e a teoria da mudança institucional gradual. Os principais resultados são a compreensão do arranjo institucional relacionado à política e a identificação de atores individuais e coletivos que atuaram para sua conservação ou mudança. Constataram-se três restrições político-institucionais à mudança: a oposição da comunidade de política "medicina-liberal", que exercia influência sobre a política, a falta de apoio ou resistência do Ministério da Educação às mudanças propostas e a decisão do núcleo do governo de não levar adiante propostas que, ao mesmo tempo, tivessem que ser aprovadas no Legislativo e contassem com a oposição da "comunidade" da medicina-liberal. Predominou um equilíbrio que tendeu à reprodução do status quo e do arranjo institucional vigente, apesar de ter havido alterações incrementais na política.

Abstract This article aims to analyse the characteristics of the regulation, training and supply policies of medical doctors in Brazil, during Lula government (2003-2010), as well as the process of dispute about a policy change proposed by senior officers of the Ministry of Health, who were members of the Health Reform movement. This is a case study that used process tracing as a methodological strategy and, as sources, documents and interviews. We used the theoretical resources offered by studies on political process and the theory of gradual institutional change. The main findings are the understanding of institutional arrangements in this policy, and the identification of individual and collective actors who acted to change the policy. Three political-institutional restrictions to change were found: the opposition of the Liberal Medicine advocates Community, which exerted a political influence on the area, the lack of support or resistance to change from the Ministry of Education and the government nucleus decision not to carry out proposals that, at the same time, had to be approved by the Legislative and had the opposition of the Liberal Medicine advocates Community. A balance tending to reproduce the status quo and the current institutional arrangement prevailed, despite the implementation of incremental policy changes.

O que fez com que o Programa Mais Médicos fosse possível? / What made the Mais Médicos (More Doctors) Program possible?

Resumo O artigo analisa quais atores participaram e como atuaram na inserção na agenda governamental da questão das insuficiências na oferta e formação de médicos para o SUS e da adoção do Programa Mais Médicos (PMM) como solução. A análise documental, bibliográfica e a realização das entrevistas semiestruturadas com informantes-chave foram trabalhadas na perspectiva metodológica do process tracing. Foram usados recursos teóricos dos estudos sobre o processo político e das teorias da mudança institucional gradual e dos múltiplos fluxos. Destacam-se como resultados a identificação de fatores relacionados à entrada da questão na agenda, como o agravamento do tema, o aumento de sua percepção pública e a mudança de governo. Constatou-se que a ação da presidenta Dilma Rousseff e de empreendedores da política foi decisiva para o processo de formulação do PMM com base em legados históricos de políticas anteriores. Contesta-se a explicação de uma vertente da literatura que considera que o PMM foi uma solução construída às pressas, para enfrentar um problema antigo, em resposta às "Jornadas de Junho". Observou-se que a posse dos novos prefeitos em 2013 e o calendário eleitoral também foram fatores importantes para a ação estratégica dos atores que lideraram a formulação do programa, com forte oposição das entidades médicas.

Abstract The article analyzes which were the actors who participated in the insertion in the governmental agenda of the issue of insufficiencies in the supply and training of medical doctors for the SUS and the adoption of the Mais Médicos Program (PMM) as a solution. Documental and bibliographic analysis and semi-structured interviews were carried out in the methodological perspective of process tracing. Theoretical resources from studies on political processes and from the theories of gradual institutional change and multiple streams were used. Outstanding results were the identification of factors related to the entry of the issue on the agenda, such as the aggravation of the issue, increase in its public perception and change of government. It was found that the action of the President and policy entrepreneurs was decisive for the process of formulating the PMM based on historical legacies of previous policies. We challenge studies that regard the PMM as a hastily formulated solution to an old problem to respond the street demonstrations known as "June Journeys". The inauguration of municipal governments, in 2013, and the electoral calendar were also important factors and taken into account in the strategic action of the actors who led the formulation of the PMM, with strong opposition from medical entities.

Quality by design enabled the development of stable and effective oil-in-water emulsions at compounding pharmacy: the case of a sunscreen formulation.

It is widely accepted that the use of topical sunscreens has medical importance with potential to prevent skin damage by protecting from solar ultraviolet radiation (UVR) effects. Pharmaceutical emulsions require an optimal qualitative and quantitative combination of emollients, emulsifiers and others compounds such as softening agents and, for sunscreens, a combination of chemical and physical UV filters. Herein, we applied the quality by design (QbD) concept to achieve stable and effective compounded sunscreen emulsions. By using the statistical tool of design of experiments, it was possible to identify the influence of emulsifier type (with low and high Hydrophile-Lipophile Balance) and concentrations of emollient and softening agent on the achievement of formulations with suitable organoleptic and physicochemical features. Compounded emulsions with pleasant macroscopic aspects were obtained. Three formulations with physicochemical properties in targeted ranges were selected, namely pH ∼6.0, conductivity > 0.0 µS/cm2, spreadability factor ∼1-1.5 g/mm2, viscosity ∼12000 mPa.s and sunscreen protection factor ∼30. Freeze-thaw cycle and accelerated stability study under different storage conditions allowed selecting a stable emulsion that ensured photoprotection in biological assays. The QbD approach was essential to select the best, low-cost compounded sunscreen emulsion, with targeted physicochemical parameters.

Impact of the COVID-19 pandemic on the homeless: results from a retrospective closed cohort in France (March-May 2020).

OBJECTIVES: To evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, hospitalization and fatality rates in residents of homeless shelters run by Samusocial of Paris. METHODS: We conducted a retrospective serological study between July and August 2020 on all residents and staff members of three homeless shelters run by Samusocial of Paris: two centres providing healthcare accommodation (HCA) and one a women's dormitory. We included all adults present in the shelters or who died of a proven SARS-CoV-2 infection during the first wave (March-May). SARS-CoV-2 antibodies were detected in serum samples using the SARS-CoV-2 IgG Architect (Abbott) test. Any participant with a positive PCR or serology was defined as a confirmed SARS-CoV-2 case. RESULTS: We included 100 residents and 83 staff members. The confirmed SARS-CoV-2 rate by PCR or serology was 72/100 (72.0%) for residents and 17/83 (20.5%) for staff members. Women accommodated in the dormitory had the highest infection rate (90.6%). The hospitalization rate in residents was 17/72 (23.6%) and the death rate 4/72 (5.6%). All hospitalizations and deaths occurred among HCA residents. Among the residents of HCA shelters, 34/68 (50%) presented at least two comorbidity factors associated with being at high risk for severe SARS-CoV-2 infection. CONCLUSION: The SARS-CoV-2 infection rate was high in residents of these homeless shelters (10.6% seroprevalence in the Île-de-France region during the first wave). Severe SARS-CoV-2 infection was highly associated with the prevalence of comorbidities. This population should be considered as a priority in vaccination campaigns and in access to individual housing units when at risk.

Epidemiological characteristics of deaths from COVID-19: an analysis at almost three months of the first confirmed case in Peru

OBJECTIVETo determine the epidemiological characteristics of deaths from COVID-19 in Peru from March 28 to May 21, 2020, 85 days after the report of the first confirmed case. MATERIAL AND METHODSCase series type study. Deaths from various sources were investigated, including the COVID-19 Epidemiological Surveillance and the National System of Deaths. Deaths that met the definition of a confirmed case and had a positive (reactive) result of RT-PCR or rapid test were considered for the analysis. From these sources, epidemiological variables were obtained and a time analysis was performed, defining as the pre-hospital time the time from the onset of symptoms to the date of hospitalization and hospital time from the date of hospitalization to the date of death. RESULTS3,244 confirmed deaths were included in the study. Deaths were more frequent in males (71.8%), elders (68.3%), residents of the department of Lima (41.8%), and others from the coast (37.7%). In 81.3% of cases, the death occurred in a public hospital, 16.0% died at home, shelter, penitentiary institution, public highway, or in transit to a hospital, and 31.1% had some comorbidity. Statistical difference was observed in pre-hospital time according to age group (p <0.001) and gender (p = 0.037), being significantly higher in adults, elders, and women. There was a statistically significant difference in hospital time according to geographic area, showing a significantly shorter time in the departments of the coast (p <0.001) and Andean region (p = 0.014) compared to Lima. The cases that were seen in private clinics (p = 0.001) survived longer than those seen in public hospitals. CONCLUSIONDeaths from COVID-19 occur mainly in male, elders, on the coast, with considerable deaths at home, in shelters, penitentiaries, public roads, or in transit to a hospital. Pre-hospital time is affected by age group and gender; while, hospital time is also influenced by the region of origin and the health care provider.

Desfechos relacionados ao cateter venoso central de inserção periférica e à dissecção cirúrgica em recém-nascidos / Resultados relacionados con el catéter venoso central de inserción periférica y la disección quirúrgica en recién nacidos / Outcomes of peripherally inserted central catheter and surgical dissection in newborns

RESUMO Objetivo: investigar os desfechos relacionados ao cateter central de inserção periférica e à dissecção cirúrgica em neonatos de uma unidade de terapia intensiva. Método: estudo quantitativo transversal retrospectivo, realizado em hospital infantil no Paraná. Coletaram-se os dados em setembro de 2017, por meio das fichas referentes aos neonatos internados no período de janeiro a dezembro de 2016, que utilizaram cateter central de inserção periférica ou dissecção cirúrgica. Aplicou-se estatística descritiva e de associação. Resultados: analisaram-se 165 fichas, sendo 134 cateteres de inserção periférica (81,2%) e 31 dissecções cirúrgicas (18,8%). Os cateteres apresentaram menor quantitativo de infecção comparado às dissecções (6% e 16,1%, respectivamente). Associaram-se ao tipo de dispositivo as variáveis: local de inserção (p<0,001), fixação do curativo (p<0,001), medidas de protocolo operacional padrão (p<0,001), indicadores de eventos adversos (p<0,001), com destaque ao extravasamento associado à dissecção cirúrgica (p=0,006). Conclusão: sugerem-se maiores benefícios aos neonatos frente ao cateter de inserção periférica.

RESUMEN: Objetivo: Investigar los resultados relacionados con el catéter venoso central de inserción periférica y con la disección quirúrgica en neonatos internados en una unidad de cuidados intensivos. Método: Se trata de un estudio transversal, retrospectivo y cuantitativo realizado en un hospital de niños del estado de Paraná, Brasil. Los datos se recolectaron en el mes de septiembre de 2017 de los registros de los neonatos internados entre enero y diciembre de 2016 con catéteres centrales de inserción periférica o que hubieran sido sometidos a disección quirúrgica. Se aplicó estadística descriptiva y de asociación. Resultados: Se analizó un total de 165 registros, con 134 casos de catéteres de inserción periférica (81,2%) y 31% de casos de disección quirúrgica (18.8%). Los catéteres presentaron un porcentaje de infección más bajo en comparación con el de las disecciones (6% y 16,1%, respectivamente). Las siguientes variables se asociaron al tipo de dispositivo: lugar de inserción (p<0,001), fijación del vendaje (p<0,001), medidas del protocolo operativo estándar (p<0,001), e indicadores de eventos adversos (p<0,001), especialmente la extravasación asociada con la disección quirúrgica (p=0,006). Conclusión: Se sugirió que el catéter de inserción periférica proporciona mayores beneficios a los neonatos.

ABSTRACT Objective: to investigate the outcomes related to the peripherally inserted central catheter and surgical dissection in neonates in an intensive care unit. Method: retrospective cross-sectional quantitative study, carried out in a children's hospital in Paraná. Data collection took place in September 2017, using records of neonates admitted from January to December 2016, who had a peripherally inserted central catheter or surgical dissection. Descriptive and association statistics were applied. Results: A total of 165 records were analyzed, including 134 peripherally inserted catheters (81.2%) and 31 surgical dissections (18.8%). The catheters showed a lower rate of infection compared to dissections (6% and 16.1%, respectively). The following variables were associated with the type of device: insertion site (p<0.001), dressing fixation (p<0.001), standard operational protocol measures (p<0.001), indicators of adverse events (p<0.001), with emphasis on the leakage associated with surgical dissection (p=0.006). Conclusion: greater benefits are suggested to neonates regarding peripherally inserted catheter.

Cateter central de inserção periférica: práticas de enfermeiros na atenção intensiva neonatal / Peripherally inserted central catheter: nursing practices in neonatal intensive care

Objetivo: Identificar o conhecimento dos enfermeiros quanto à inserção e manutenção do cateter central de inserção periférica em uma Unidade de Terapia Intensiva Neonatal. Método: Estudo exploratório descritivo quantitativo realizado em um hospital pediátrico de referência em maio e junho de 2019. Análise dos dados por meio do programa SPSS (21.0). Resultados: Setenta e oito por cento dos enfermeiros receberam capacitação na instituição, 100,0% realizam lavagem do acesso com solução salina, pressão positiva e técnica pulsátil e todos consideram como pontos críticos o eritema, algia, secreção no local de inserção e obstrução do dispositivo. Conclusão: O papel do enfermeiro é fundamental na diligência com o cateter central de inserção periférica, atuando como educador da equipe de enfermagem para promover a qualificação e adesão aos protocolos institucionais continuamente. (AU)

Objective: To identify nursing knowledge regarding the insertion and maintenance of the peripherally inserted central catheter in a Neonatal Intensive Care Unit. Method: Exploratory descriptive quantitative study carried out in a pediatric reference hospital in May and June 2019. Data analysis using the SPSS program (21.0). Results: Seventy-eight percent of nurses received training at the institution, 100.0% performed access flushing with saline, positive pressure and pulsating technique and all considered as critical points erythema, pain, secretion at the insertion site and obstruction of the device. Conclusion: The role of the nurse is fundamental in the diligence with the peripherally inserted central catheter, acting as an educator of the nursing team to promote qualification and adherence to institutional protocols continuously. (AU)

Objetivo: identificar el conocimiento de las enfermeras sobre la inserción y el mantenimiento del catéter central insertado periféricamente en una unidad de cuidados intensivos neonatales. Metodo: estudio cuantitativo descriptivo exploratorio realizado en un hospital pediátrico de referencia en mayo y junio de 2019. Análisis de datos con el programa SPSS (21.0). Resultados: el setenta y ocho por ciento de las enfermeras recibieron capacitación en la institución, el 100.0% realizó enrojecimiento de acceso con solución salina, presión positiva y técnica pulsante y todos se consideraron puntos críticos como eritema, dolor, secreción en el sitio de inserción y obstrucción del dispositivo Conclusión: El papel de la enfermera es fundamental en la diligencia con el catéter central insertado periféricamente, actuando como un educador del equipo de enfermería para promover la calificación y el cumplimiento de los protocolos institucionales continuamente. (AU)