Estimation of Health-Related Quality of Life Losses Owing to a Technological Disaster in Brazil Using EQ-5D-3L: A Cross-Sectional Study.

OBJECTIVES: In 2015, a dam collapsed at Samarco iron ore mine in the municipality of Mariana, Brazil, and contaminated more than 600 km of watercourses and destroyed almost 1600 acres of vegetation. Nineteen people died and more than 600 families lost their homes. This study aimed to estimate health-related quality of life (HRQoL) losses owing to this disaster. METHODS: We collected data from a probabilistic sample of 459 individuals aged 15 years or older. Household face-to-face interviews were conducted in December 2018. Pre-event data were not available for this population, so respondents were asked to evaluate at present and in retrospect their health status using EQ-5D-3L. The Minas Gerais societal value sets for EQ-5D-3L health preferences, estimated in 2011, were used to calculate utility losses. The health loss estimation from EQ-5D will form the basis for the calculation of compensation payments for the victims. RESULTS: Approximately 74% of the study population suffered some HRQoL loss. On average, EQ-5D index values decreased from 0.95 to 0.76. The greatest effects were observed for the anxiety/depression dimension, followed by pain/discomfort. Before the tragedy, the proportion of individuals with severe anxiety/depression and pain/discomfort was equal to 1% rising to 23% and 11%, respectively. CONCLUSIONS: Catastrophic losses owing to the Samarco disaster were found. The EQ-5D-3L instrument showed feasibility and sensitiveness to measure HRQoL losses owing to a negative health shock in a low-income Brazilian population.

Perú y la memoria global de las víctimas de covid-19 / Peru and global remembrance of covid-19 victims

Resumen El cambio en la relación con las víctimas a causa del coronavirus es una de las consecuencias más perturbadoras y menos explorada de todos los aspectos entre los cuales la covid-19 ha alterado nuestras vidas en el último año. Este ensayo examina las estrategias que los peruanos han desarrollado para compensar la imposibilidad de participar en funerales y entierros debido a las medidas de distanciamiento social. La incorporación de plataformas digitales permitieron recrear rituales funerarios y permitir el duelo necesario en circunstancias adversas. El ensayo concluye que es necesario erigir un memorial a las víctimas de la covid-19 como una manera de concientizar a la población y futuras generaciones sobre la necesidad de preparación ante una eventual próxima pandemia.

Abstract The change in relationships with the victims of coronavirus is one of the most disturbing and least explored consequences of all the ways in which covid-19 has altered our lives over the last year. This essay examines the various strategies Peruvians have developed to compensate for the inability to attend funerals and burials in person due to government-imposed social distancing measures. The use of digital platforms, mainly social media, made it possible to recreate funeral rites and allowed the necessary grieving under adverse circumstances. Using a comparative approach, the essay concludes that it is necessary to erect a memorial to the victims of covid-19 as a way of raising public awareness, and that of future generations, about the need to prepare for an eventual future pandemic.

Asociación entre tiempo de atención pre hospitalaria y la mortalidad hospitalaria en víctimas de accidentes de tránsito / Association Between Pre-Hospital Care Time And Hospital Mortality In Victims Of Traffic Accidents

Introduccion: Los accidentes de tránsito (AT) se encuentran como la primera prioridad en investigación de salud en el Perú, Según la Organización Mundial de la Salud (OMS) se estima que los costos económicos por impacto de vehículos y lesiones por AT son de 1% y 1.5% del Producto Nacional Bruto (PNB) en países de bajos y medianos ingresos; En el Perú es aproximadamente el 1.5 ­ 2% del Producto Bruto Interno (PBI). Objetivo: Determinar si existe asociación entre el tiempo de atención prehospitalaria y la mortalidad hospitalaria en víctimas de accidentes de tránsito. Métodos: Se realizó una revisión sistemática mediante la búsqueda bibliográfica de artículos relacionados en fuentes de indexación tales como PubMed y BIREME. Resultados: Los retrasos en las transferencias de pacientes al hospital y la falta Sistema Médico de Emergencia (SME) pre hospitalarios se asociaron significativamente con un aumento de la mortalidad (P: 0.000) así mismo la necesidad de un SME como proveedor de atención prehospitalaria fue predictor significativo de mortalidad en emergencia con un odds ratio [OR] ajustado 2.19; IC del 95% [1.88­2.55], y en las primeras 24 horas de ingreso con un OR ajustado 2.31; IC del 95% [ 1.95­2.73]. Conclusión: El tiempo de atención pre hospitalaria en accidentes de tránsito se encuentra significativamente asociada a la mortalidad hospitalaria, por ello, se propone estudiar factores asociados al largo tiempo de atención pre hospitalaria.

Introduction: Traffic accidents (AT) are the first priority in health research in Peru, According to the World Health Organization (WHO) it is estimated that the economic costs of vehicle impact and injuries due to AT are 1 % and 1.5% of the Gross National Product (GNP) in low and middle income countries; In Peru it is approximately 1.5 - 2% of the Gross Domestic Product (GDP). Objective: To determine if there is an association between the time of prehospital care and hospital mortality in victims of traffic accidents. Methods: A systematic review was carried out through the literature search of related articles in indexing sources such as PubMed and BIREME. Results: Delays in the transfer of patients to the hospital and the lack of pre-hospital Emergency Medical System (SME) were significantly associated with an increase in mortality (P: 0.000) and the need for an SME as a prehospital care provider was significant predictor of emergency mortality with an adjusted odds ratio [OR] 2.19; 95% CI [1.88­2.55], and in the first 24 hours of admission with an adjusted OR 2.31; 95% CI [1.95­2.73]. Conclusion: The time of pre-hospital care in traffic accidents is significantly associated with hospital mortality, therefore, it is proposed to study factors associated with the longtime of pre-hospital care.

Guía para la enseñanza del apoyo vital avanzado ante múltiples víctimas. Consenso para el proyecto de formación e investigación en apoyo vital. Cienfuegos, 2018 / Guideline for teaching advanced life support in the presence of mass casualty. Consensus for the project of training and research in life support. Cienfuegos, 2018

Fundamento: en situaciones de desastres, cuando el número de enfermos o lesionados es alto y los recursos limitados, la atención médica precisa de cambios de estructura y procesos si se quiere salvar un número elevado de personas. El personal de salud debe estar entrenado para enfrentar esta situación cada vez más frecuente. El "Proyecto para la formación e investigación en apoyo vital en emergencias y desastres" puede ser un marco académico para lograrlo. Objetivo: actualizar, para el proyecto, las guías y estrategia docente para la enseñanza del apoyo vital ante víctimas múltiples. Métodos: taller nacional realizado el 10-11 de julio del 2018 en Cienfuegos, con 13 expertos y cuatro informantes clave. Se utilizaron la técnica de tormenta de ideas y de grupo nominal, cuestionario semiestructurado y revisión documental previa. Resultados: se proponen para la enseñanza del apoyo vital en situaciones de desastres, tanto en el pregrado como el posgrado: los objetivos, aspectos didácticos, estrategia docente, contenidos, alcance, habilidades a desarrollar, futuras investigaciones y áreas para la colaboración interinstitucional. Se definió la estructura de un curso prototipo para la enseñanza del tema y las principales consideraciones para su ejecución. Conclusiones: las propuestas académicas para el curso "Apoyo vital avanzado ante víctimas múltiples" permiten la preparación de los profesionales de la salud para brindar asistencia médica en situaciones de desastres, con escasos recursos y en ambientes complejos.

Foundation: in disaster situations, when the number of patients or injured is high and the resources are limited, medical care requires changes of structures and processes if it is aimed to save most of the persons involved. Health personnel should be trained to face this situation becoming more frequent each time. Objective: to update, for the project, the guidelines and strategies for teaching life support in the presence of mass casualty. Methods: national workshop developed in July 10th and 11th in Cienfuegos, with 13 experts and four key informers. The techniques of brain storming and nominal group, semi-structured and previous documentary review. Results: objectives, specific aspects, teaching strategy, contents, scope of the abilities, skills to develop, future research, and areas for inter-institutional collaboration were proposed for teaching life support in situations of disaster. Conclusion: academic proposals for the course "Life support in the presence of mass casualty¨ allow preparing health professionals to offer medical assistance in situations of disasters with limited resources in complex environments.

Abrigos temporários em desastres: a experiência de São José do Rio Preto, Brasil / Temporary shelters in disasters: the experience of São José do Rio Preto, Brazil

RESUMO Relato de experiência sobre o planejamento dos abrigos temporários montados em São José do Rio Preto, na catástrofe de 11 de janeiro de 2011. Objetivou-se analisar o planejamento de um abrigo, a partir de princípios de assistência, utilizando-se documentos da Secretaria Nacional de Proteção e Defesa Civil. Foram escolhidas barracas Shelter Box para a abrigagem, com áreas de convívio. A infraestrutura de apoio possuía coleta de resíduos, abastecimento de água e de alimentos satisfatórios. Estava disponível equipe de profissionais de saúde. As ações de recuperação são complexas e devem estar articuladas e direcionadas ao interesse da população atingida, adaptando-se às mudanças necessárias.

ABSTRACT Experience report on the planning of temporary shelters assembled after São José do Rio Preto's disaster on January 11, 2017. This study aimed to analyze the planning of a shelter from assistance principles, using documents from the National Protection and Civil Defense Department. Shelter Boxes were chosen for sheltering, with living areas. The support infrastructure has been satisfactory, with waste collection, and water and food supply. Health care professionals were available. Recovery actions are complex and must be articulated and directed to the interest of the population, with high adaptive capacity to the necessary changes.

APOYO SOCIAL Y SENTIDO DE COMUNIDAD EN DESPLAZADOS Y DAMNIFICADOS EN EL DEPARTAMENTO DEL MAGDALENA / SOCIAL SUPPORT AND SENSE OF COMMUNITY IN DISPLACED PEOPLE AND VICTIMS IN THE DEPARTMENT OF MAGDALENA

En esta investigación se correlacionan las variables sentido de comunidad y apoyo social, en un grupo de 136 personas en situación de desplazamiento por la violencia; y víctimas de desastres de la ola invernal del 2010-2011 en el departamento del Magdalena. Los instrumentos utilizados fueron, la Escala de Sentido de Comunidad y el Cuestionario de apoyo social-MOS (Estudio de Desenlaces Médicos de Apoyo Social), adaptado para Colombia. Para el análisis de los datos, los grupos se dividieron en dos: el primero con 48 hombres entre 26 y 89 años (media de 57 años) y 36 mujeres entre 23 y 87 años (media de 55 años). En el segundo grupo participaron 44 hombres entre 25 y 91 años (media de 58 años) y 8 mujeres entre 23 a 49 años (media de 36 años). En cuanto al índice de sentido de comunidad se halló que el nivel es medio-alto (m=53,42), con el apoyo social se encontró que el índice general de apoyo social es alto (87,41). Como resultado dio una relación débil, positiva con un coeficiente de correlación 0,27 y significativa (valor P de 0,01). Se concluye que las dos variables interactúan entre sí, pero con una débil relación.

This research correlating variables, sense of community and social support, in a group of 136 people that were displaced people by violence; and disaster victims of the winter season 2010-2011 in the department of Magdalena. The instruments used to measure the variables were, the Scale of Sense of Community and the Social Support Questionnaire ­ MOS (Medical Outcomes Study-Social Support Survey) adapted for Colombia. For the analysis of the data, they were divided into two groups: the first with 48 men between 26 and 89 years (mean 57 years) and 36 women between 23 and 87 years (mean 55 years). In the second group they involved 44 men between 25 and 91 years (mean 58 years) and 8 women between 23 and 49 years (mean 36 years). As the rate of sense of community it was found that the level is medium-high (m = 53,42), the social support it was found that the overall rate of social support is high (87,41). A weak relationship was found, a positive correlation coefficient 0.27 and significant (P value of 0.01). We conclude that the two variables interact with each other but with a weak relationship.