Parcerias entre municípios paulistas e a esfera privada para a aquisição de "sistemas" de ensino apostilados na educação infantil

This paper analyses the partnership among cities of São Paulo ‘state and the private sector to acquire material for elementary school. Our study was based on data gathered during the research “Municipal Strategy to the offering of the basic education: Public-Private relationship analysis in the São Paulo ‘state”, supported by FAPESP. The results, confirming previous works (Adrião, 2007 e 2008), show that the join on this kind of partnership grew from 2006 and will become a tendency in the Educational system, even on the education step where it have been discussed about the standardization of the pedagogic material.Este artigo analisa as parcerias entre municípios paulistas e a iniciativa privada para a aquisição, via contrato, de “sistemas de material apostilado” para escolas de educação Infantil. Toma-se como base para esta análise os dados levantados durante a pesquisa “Estratégias Municipais para a Oferta da Educação Básica: Análise de Parcerias Público-Privado no Estado de São Paulo”, financiada pela Fapesp. Os resultados, confirmando trabalhos anteriores (Adrião, 2007 e 2008) mostram que a adesão a este tipo de parceria acentuou-se a partir de 2006 e pode virar uma tendência na educação paulista, mesmo em uma etapa de escolaridade em que se questiona a padronização do material pedagógico

Comparação entre os sistemas de gestão privados adotados pelos municípios de São José dos Campos e Cosmorama

Este artigo é resultado da pesquisa Estratégias municipais para a oferta da educação básica: análise da parceria público-privado no Estado de São Paulo, elaborada no âmbito do Grupo de Estudos e Pesquisas em Política Educacional (Greppe). A pesquisa anteriormente citada é ligada ao projeto interinstitucional, financiado pela Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp). O objetivo deste trabalho é apresentar e discutir os sistemas de gestão adotados por dois municípios paulistas, Cosmorama e São José dos Campos. Para a realização da pesquisa foram levantados, selecionados e analisados dados de matrículas disponibilizados em banco de dados do Greppe e sites governamentais. A realização da pesquisa considerou a importância das peculiaridades locais, as relações de força manifestas nas ações e reações promovidas pelos segmentos sociais envolvidos e as especificidades presentes na materialização de políticas governamentais. Optou-se por entrevistas do tipo semiestruturado, a partir de roteiros orientadores. Foram realizadas entrevistas com os atores envolvidos no processo de implantação das parcerias para assessoria de gestão nos dois municípios.Palavras-chave: Parcerias. Público e Privado. Políticas Educacionais

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Comparação entre os sistemas de gestão privados adotados pelos municípios de São José dos Campos e Cosmorama

Este artigo é resultado da pesquisa Estratégias municipais para a oferta da educação básica: análise da parceria público-privado no Estado de São Paulo, elaborada no âmbito do Grupo de Estudos e Pesquisas em Política Educacional (Greppe). A pesquisa anteriormente citada é ligada ao projeto interinstitucional, financiado pela Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp). O objetivo deste trabalho é apresentar e discutir os sistemas de gestão adotados por dois municípios paulistas, Cosmorama e São José dos Campos. Para a realização da pesquisa foram levantados, selecionados e analisados dados de matrículas disponibilizados em banco de dados do Greppe e sites governamentais. A realização da pesquisa considerou a importância das peculiaridades locais, as relações de força manifestas nas ações e reações promovidas pelos segmentos sociais envolvidos e as especificidades presentes na materialização de políticas governamentais. Optou-se por entrevistas do tipo semiestruturado, a partir de roteiros orientadores. Foram realizadas entrevistas com os atores envolvidos no processo de implantação das parcerias para assessoria de gestão nos dois municípios.Palavras-chave: Parcerias. Público e Privado. Políticas Educacionais

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable