Telemedicine in the National Immunization Program (Brazil): A promising tool.

The coronavirus disease 2019 pandemic abruptly changed the dynamics of basic health care, with the consequent need for adjustments in essential services. The objective of this study was to evaluate the acceptance and impact of telemedicine at a Reference Center for Special Immunobiologicals (CRIE). Methods: Patients aged 18 years or older who had a medical referral to CRIE and agreed to have a telemedicine consultation were included. After the medical appointments, participants answered a satisfaction survey. Results: From April 2021 to February 2022, 702 telemedicine consultation were conducted. Over 3,380 vaccines were prescribed via telemedicine. Of all the participants who answered the satisfaction questionnaire, 99.8% stated that they would recommend the service to other people. Conclusions: Telemedicine proved to be promising tool for healthcare at CRIE and had good acceptance by users, potentially improving access and extending the reach of the National Immunization Program.

A prospective, multicentre, cohort study to assess the incidence of dengue illness in households from selected communities in Brazil (2014-2018).

OBJECTIVES: To estimate the incidence of dengue infection across geographically distinct areas of Brazil. METHODS: This prospective, household-based, cohort study enrolled participants in five areas and followed them up for up to 4 years (2014-2018). Dengue seroprevalence was assessed at each scheduled visit. Suspected dengue cases were identified through enhanced passive and active surveillance. Acute symptomatic dengue infection was confirmed through reverse-transcriptase quantitative polymerase chain reaction in combination with an antigenic assay (non-structural protein 1) and serology. RESULTS: Among 3300 participants enrolled, baseline seroprevalence was 76.2%, although only 23.3% of participants reported a history of dengue. Of 1284 suspected symptomatic dengue cases detected, 50 (3.9%) were laboratory-confirmed. Based on 8166.5 person-years (PY) of follow-up, the incidence of laboratory-confirmed symptomatic infection (primary endpoint) was 6.1 per 1000 PY (95% confidence interval [CI]: 4.5, 8.1). Incidence varied substantially in different years (1.8-7.4 per 1000 PY). The incidence of inapparent primary dengue infection was substantially higher: 41.7 per 1000 PY (95% CI: 31.1, 54.6). CONCLUSIONS: Our findings, highlighting that the incidence of dengue infection is underestimated in Brazil, will inform the design and implementation of future dengue vaccine trials. CLINICAL TRIAL REGISTRATION: NCT01751139.

Anti-dyskinetic effect of the neuronal nitric oxide synthase inhibitor is linked to decrease of FosB/deltaFosB expression.

Rodents with lesion of dopaminergic pathway when receiving repeated l-3,4-dihydroxiphenylalanine (l-DOPA) treatment develop abnormal involuntary movements called dyskinesia. We demonstrated that nitric oxide synthase (NOS) inhibitors mitigate l-DOPA-induced dyskinesia in rodents. The aim of the present study was to verify if the in vivo preferential neuronal NOS (nNOS) inhibitor 7-nitroindazole (7-NI) affect the expression of the transcription factor FosB/ΔFosB in the lesioned striatum, an indicator of neuronal activity associated with dyskinesia. Male Wistar rats with unilateral microinjection (medial forebrain bundle) of either the neurotoxin 6-hydroxidopamine (6-OHDA; n=4-6/group) or saline (sham; n=6/group) were provided with l-DOPA (30mg/kg plus benserazide 7.5mg/kg/day, oral gavage), once a day during 22 days. 6-OHDA-lesioned animals developed abnormal involuntary movements (AIMs) classified as axial, limb, orofacial and locomotive dyskinesia and presented FosB/ΔFosB increase in the dopamine-depleted striatum. Administration of 7-NI (30mg/kg, i.p.), 30min prior to l-DOPA reduced the severity of AIMs (≈65% for axial, limb and orofacial and 74% for locomotive AIMs scores), without interfering with the rotarod performance. Simultaneously, 7-NI attenuated the expression of FosB/ΔFosB in dopamine-depleted striatum (≈65% in medial and ≈54% in lateral striatum, bregma 0.48mm). FosB/ΔFosB expression in lateral striatum was correlated with l-DOPA-induced dyskinesia. The findings described here corroborate a new approach to the management of l-DOPA-therapy in Parkinson's disease (PD) treatment.

Gerenciamento de enfermagem: situações que facilitam ou dificultam o cuidado na unidade coronariana / Administración de la enfermería: aspectos que facilitan o dificultan el cuidado en unidad coronaria / Nursing administration: aspects that can facilitate and hinder care in a coronary unit

A assistência de enfermagem na Unidade Coranariana requer uma equipe de saúde especializada, equipamentos de alta tecnologia e uma liderança atenta as facilidades e dificuldades do cotidiano do cuidado de enfermagem. Objetivo: discutir os aspectos que facilitam ou dificultam o gerenciamento de enfermagem na unidade coronariana. Métodos: realizou-se pesquisa bibliográfica na base de dados Scielo e coleta de dados, utilizando um roteiro de entrevista semi-estruturada com 6 enfermeiras líderes do setor de unidade coronariana do Hospital Universitário da Universidade Federal do Rio de Janeiro. Resultados: quanto aos aspectos facilitadores do gerenciamento de enfermagem, os estudos selecionados e as enfermeiras apontaram fatores objetivos e subjetivos, respectivamente, como a utilização de instrumentos de distribuição da equipe e boa comunicação e relacionamento interpessoal. Sobre os aspectos dificultadores, concordaram quanto à mecanização da enfermeira, à complexidade de uma unidade de cuidados críticos e à escassez de recursos materiais. Conclusões: diante disso, cabe à gerência de enfermagem identificar estes fatores, a fim de possibilitar melhor desempenho dos profissionais e, conseqüentemente, uma assistência mais eficaz e segura ao paciente e sua família.

Nursing care in a coronary unit requires a team of specialized health-care professionals, high-tech equipment and leadership that is alert to the daily possibilities and difficulties of nursing care. Objective: To discuss the aspects that can facilitate and hinder nursingadministration in a coronary care unit. Methods: This is a bibliographic study based on SciELO and data collection, using semi-structured interviews with six head nurses from the Coronary Care Unit at the Universidade Federal do Rio de Janeiro University Hospital. Results:As to the aspects that facilitate nursing administration, the selected studies and the nurses interviewed point to objective and subjective factors, respectively, such as the use of instruments, distribution of the team and good communication and interpersonal relations. Concerning the aspects that hinder nursing administration, they were in agreement with respect to the mechanization of nursing, the complexity of a critical care unit and the shortage of material resources. Conclusions: It is, therefore, the duty of nursing administration to identify these factors in order to help nursing professionals perform better. This will result in safer and more effective care for patients and their families.

La asistencia de enfermería en la Unidad Coranariana requiere un equipo de cuidados de salud especializado, equipamientos de alta tecnología y un liderazgo atento a las facilidades y dificultades diarias del cuidado de enfermería. Objetivo: discutir los aspectos que facilitan y dificultan la administración de enfermería en la unidad coronariana. Métodos: se realizó una investigación bibliográfica en labase de datos SciELO y recolección de datos, utilizando un plan de entrevista semiestructurada con 6 enfermeras líderes del sector de la unidad coronaria del Hospital Universitario de la Universidad Federal de Río de Janeiro. Resultados: acerca de los aspectos que facilitan la administración de enfermería, los estudios seleccionados y las enfermeras apuntaron factores objetivos y subjetivos, respectivamente,como el uso de instrumentos de la distribución del equipo y la buena comunicación y relación interpersonal. Sobre los aspectos que la dificultan, han señalado la mecanización de la enfermera, la complejidad de una unidad de cuidados críticos y la escasez de recursos materiales. Conclusiones: es deber de la administración de enfermería identificar estos factores, para permitir mejor desempeño de losprofesionales y, en consecuencia, asistencia más eficaz y segura para los pacientes y sus familias.

[The daily activity of the nurse in clinical research: an experience report]. / O cotidiano do enfermeiro em pesquisa clínica: um relato de experiência.

The present study is a report on the authors' experience working nurses in a randomized, blinded, phase III clinical trial, developed at Escola Nacional de Saúde Pública Sérgio Arouca/FIOCRUZ/RJ. This study describes the participation of nurses in the implementation of a clinical trial, highlighting their importance in this new field of work. The authors state the rigorous implementation of the clinical trial by the nurse, aiming to prevent errors, biases and failures; as well as the commitment to the authenticity of data collection, attention and respect to the rights and welfare of the study subjects. Nurses are not only able to perform with quality their usual patient-related tasks, but also research activities in health science, such as participating in clinical trials, monitoring, supervision and professional training.