Compliance with yellow fever and measles vaccines in the revaccination program post-hematopoietic cell transplantation.

INTRODUCTION: Measles, mumps, rubella, and even poliomyelitis outbreaks have recently perplexed infectious disease clinicians and epidemiologists globally due to the decline in vaccination coverage rates in children and adults. Measles and yellow fever (YF) have represented an increasing burden on the Brazilian public health system in recent decades. Both diseases are preventable by live-attenuated viral vaccines (LAVV), which have restricted use in hematopoietic cell transplant (HCT) recipients. METHODS: Autologous and allogeneic HCT recipients returning for regular appointments at the outpatient clinic were invited to participate in the study. Patients transplanted for at least 2 years and with a printed copy of the vaccination record were included. RESULTS: We assessed the vaccination records of 273 HCT recipients after the second year of HCT (193 allogeneic and 80 autologous) and observed lower compliance with the YF vaccine (58 patients, 21.2%) than with the measles vaccine (138 patients, 50.5%, p ≤ .0001). This is the largest published series of YF vaccination in HCT recipients so far. No severe adverse events occurred. Although expected, chronic graft-versus-host disease (GVHD) did not affect the compliance with measles (p = .08) or YF vaccination (p = .7). Indeed, more allogeneic recipients received measles vaccine in comparison with autologous patients (p < .0001), suggesting that chronic GVHD was not the main reason for not being vaccinated. Children and allogeneic HCT were more likely to receive measles vaccine. Time elapsed from HCT >5 years favored both measles and YF vaccination. CONCLUSION: A better understanding of the reasons for low compliance with LAVV is necessary to overcome this problem.

COVID-19 in HSCT recipients: a collaborative study of the Brazilian Society of Marrow Transplantation (SBTMO).

In the COVID-19 scenario, patients undergoing hematopoietic stem cell transplantation (HSCT) infected with SARS-CoV-2 may have an increased risk of death. Through a national multicenter study, we aimed to describe the impact of COVID-19 on the survival of HSCT recipients in Brazil. Eighty-six patients with a confirmed diagnosis of SARS-CoV-2 (92% by RT-PCR) were included. There were 24 children and 62 adults receiving an autologous (n = 25) and allogeneic (n = 61) HSCT for malignant (n = 72) and non-malignant (n = 14) disorders. Twenty-six patients died, (10 on autologous (38%) and 16 patients (62%) on allogeneic group). The estimated overall survival (OS) at day 40 was 69%. Adults had decreased OS compared to children (66% vs 79%, p = 0.03). The severity of symptoms at the time of diagnosis, ECOG score, laboratory tests (C-reactive protein, urea values) were higher in patients who died (p < 0.05). In conclusion, HSCT recipients infected with SARS-CoV-2 have a high mortality rate mainly in adults and patients with critical initial COVID-19 presentation. These findings show the fragility of HSCT recipients with SARS-CoV-2 infection. Therefore, the importance of adherence to preventive measures is evident, in addition to prioritizing the vaccination of family members and the HSCT team.

A Rede UNIDA e o Movimento de Mudança na Formação dos Profissionais de Saúde / The United Net and the change's moviment in formation of health professionals

Este estudo teve como objetivo principal fazer um resgate histórico da REDEUNIDA, identificando suas principais estratégias para a mudança na formaçãodos profissionais de saúde no Brasil, no período de 1985 a 2004. Esta é umapesquisa qualitativa, utilizando dados primários e secundários de informaçãopara análise. Foi feito um levantamento dos documentos oficiais da RedeUNIDA: boletins informativos, revistas e outras publicações da mesma eentrevistas com participantes deste movimento. Aborda a trajetória domovimento desde a sua constituição em 1985 em uma reunião decoordenadores de projetos de integração docente-assistencial, na cidade de Belo Horizonte. Registra as inovações trazidas pelos projetos UNI no início da década de 90 e suas principais diferenças com os projetos de integração docente-assistencial. A percepção dos entrevistados num momento marcante na história da Rede - a união entre a Rede IDA e os Projetos UNI. Após uma análise das conjunturas político-sanitárias e educacionais na formação de profissionais de saúde, é realizado uma abordagem crítica estabelecendo relação das contribuições da Rede UNIDA neste cenário de construção e princípios do SUS, destacando um dos maiores exemplos de mudança: a proposta de diretrizes curriculares para as profissões da saúde. Assim, pretendeu-se conhecer os principais marcos na história da Rede UNIDA, que teve início num período de grandes discussões e mudanças na saúdebrasileira, e hoje reúne pessoas e instituições de vários lugares do país emtorno do movimento de mudança na formação dos profissionais de saúde,numa trajetória que completa 20 anos.

This study had as mainly aim to make an historical rescue of the United Net,identifying its principal’s strategies for a change in the formation of healthprofessionals in Brazil, during the period from 1985 to 2004. This is a qualitativeresearch, which analyzes the content of a spoken history, using primary andsecondary data in the construction of information to analyze. It was made asurvey of officials’ documents from the United Net: informative bulletins,magazines among some other publications and interviews with participants of this movement. Accost the trajectory of the movement since its beginning in 1985 in a meeting with coordinators of projects about docent-assistant integration, in the city of Belo Horizonte. The innovations brought by the UNI projects in the beginning of the 90’s and its principals disparities with the projects about docent-assistant integration. The perception of the interviewed in an important moment in the history of the Net – the link between the IDA Net and the UNI projects. After an analyze of the politic- sanitary and educational conjunctures in the formation of health professionals, takes place an critical accost creating a bond of the United Net contributions on this scene of PHS (public health system) constructions and principals, showing one of the biggest examples of change: the propose of curriculum’s guidelines to professions of health. This way, there was a pretension to know the majors marks in the United Net’s history, that began in a period of big discussions andtransformations on Brazilian health, and today join people and institutions frommany parts of the country around the movement for changing the healthprofessionals’ formation, in a trail that completed 20 years.

Estudo comparativo entre dois grupos apresentando hipertensäo arterial / A comparative study between two groups with hypertension

Considerando que a Hipertensäo Arterial (HA) aumenta de prevalência conforme o aumento da idade da populaçäo e que uma das formas näo farmacológicas de tratamento seria a prática de atividade física e a diminuiçäo do stress, os alunos do GIM 12 durante a identificaçäo dos problemas da UBS do Conjunto Maria Cecília, notaram que uma das queixas relativamente alta era a HA em um grupo de senhoras que se reuniam semanalmente para trabalhos manuais. A partir deste fato, foram estudados este grupo (G.C) com n=32 e um grupo controle(G.CT) com n=70, com média de idade de 59 a 62 anos respectivamente, com o objetivo de verificar e comparar o perfil dos hipertensos e as variáveis que influem no processo da doença. 59 por cento do G.C e 69 por cento do G.CT foram identificados como hipertensos e näo houve estatisticamente diferenças entre os grupos em relaçäo as outras variáveis, porém, os resultados obtidos revelam existir uma grande preocupaçäo das pessoas em obter informaçöes sobre a HA e uma necessidade urgente de se organizar programas educativos para a populaçäo que freuqnta as UBS do municpio