Telessaúde e terapia ocupacional: uma análise crítica da prática voltada ao contexto da atenção primária à saúde/ Telehealth and occupational therapy: A critical analysis of practice directed on the context of primary health care

Contextualização: Este artigo trata sobre a utilização da telessaúde em Terapia Ocupacional. Processo de Intervenção/acompanhamento: consiste na realização de teleconsultas e telemonitoramentos, em Terapia Ocupacional na Atenção Primária à Saúde, do Programa de Extensão Reabilitação Baseada na Comunidade. Análise crítica da prática: A pandemia, causada pelo novo coronavírus, tem desafiado os profissionais de saúde na prestação de cuidados aos usuários, tendo em vista as medidas de isolamento/distanciamento social para conter a propagação do vírus. Neste contexto, a telessaúde tem se constituído como uma estratégia na prestação de cuidados em saúde aos usuários, seus familiares e comunidades nos contextos territoriais e comunitários. Síntese das considerações: A telessaúde tem se mostrado como uma estratégia de cuidado possível ao Terapeuta Ocupacional em tempos de pandemia, porém, ainda, não acessível a toda população brasileira, devido às desigualdades de acesso a equipamentos e conectividade virtual.Palavras-chave: Pandemia. Terapia Ocupacional. Telessaúde. Atenção Primária à Saúde. Abstract Contextualization: This article deals with the use of telehealth in Occupational Therapy. Intervention process/accompaniment Consists of teleconsultations and telemonitoring, in Occupational Therapy in Primary Health Care, of the Community Based Rehabilitation Extension Program. Critical analysis of the practice: A pandemic caused by the new coronavirus has challenged health professionals in providing care to users, with a view to isolation / social distance measures to contain the spread of the virus. In this context, telehealth has been constituted as a strategy in the provision of health care to users, their families and communities in territorial and dependent contexts. Summary of considerations: A telehealth function is a possible care strategy for the Occupational Therapist in times of pandemic, however, not yet accessible to the entire Brazilian population due to inequalities in access to equipment and virtual connectivity.Keywords: Pandemic. Occupational Therapy. Telehealth. Primary Health Care. Resumen Contextualización: Este artículo trata sobre el uso de la telesalud en la Terapia Ocupacional. Proceso de intervención/seguimento: consiste en teleconsultas y telemonitorización, en Terapia Ocupacional en Atención Primaria de Salud, del Programa de Extensión de Rehabilitación Basada en la Comunidad. Análisis crítico de la práctica: La pandemia provocada por el nuevo coronavirus ha desafiado a los profesionales de la salud en la atención a los usuarios, ante las medidas de aislamiento / distancia social para contener la propagación del virus. En este contexto, la telesalud se ha constituido como una estrategia en la prestación de servicios de salud a los usuarios, sus familias y comunidades en contextos territoriales y comunitários. Resumen de consideraciones: : La telesalud ha demostrado ser una posible estrategia de atención para los terapeutas ocupacionales en tiempos de pandemia, pero aún no es accesible para toda la población brasileña debido a las desigualdades en el acceso a equipos y conectividad virtual.Palabras clave: Pandemia. Terapia Ocupacional. Telesalud. Atención Primaria de salud

O desafio da interprofissionalidade: percepção dos profissionais de Fisioterapia e Terapia Ocupacional sobre a atuação em equipe no Rio Grande do Sul

Introduction: Currently there is great relevance to understand the perception about team performance among professionals in Physical Therapy and Occupational Therapy. Objective: This study aims to understand the perception of professionals in Physical Therapy and Occupational Therapy regarding team performance. Method: Descriptive, exploratory, mixed methodology - qualitative and quantitative. Data collection was performed in May and June 2016. Quantitative data were analyzed descriptively by Statistica 9.1 software and qualitative data were analyzed by Content Analysis. Results: 161 professionals participated in this study, of which 131 (81.4%) were Physical Therapists and 30 (18.6%) were Occupational Therapists accredited to the Regional Council of Physical Therapy and Occupational Therapy - CREFITO-5. As for sex, the predominance of female professionals (142 [88.2%]), the mean age was 34.03 years, the area of professional activity that prevailed was Neurology (17 [11, 1%]) followed by General (16 [9.5%]), most professionals work in hospitals (23 [11.6%]), however it was not the only place, most of the participants work in a multiprofessional team (53,1%) and are concentrated in the metropolitan region of the State of Rio Grande do Sul (62 [42.3%]). Final Considerations: through this study, it was observed the difficulty of understanding by professionals in relation to the multiprofessional and interprofessional terms and how to apply them in the practice of teamwork. There is a need for health education that fosters the formation of professionals committed to integrality, active actors in the process of improving the health system’s resolution.Introdução: Atualmente há grande relevância de compreender a percepção sobre atuação em equipe entre os profissionais de Fisioterapia e Terapia Ocupacional. Objetivo: Este estudo tem por objetivo compreender a percepção dos profissionais de Fisioterapia e Terapia Ocupacional quanto à atuação em equipe. Método: Descritivo, exploratório, metodologia mista – quali-quantitativa. A coleta de dados ocorreu nos meses de maio e junho de 2018. Os dados quantitativos foram analisados descritivamente pelo software Statistica 9.1 e os qualitativos foram analisados pela Análise de Conteúdo. Resultados: Participaram deste estudo 161 profissionais formados, sendo 131 (81,4%) Fisioterapeutas e 30 (18,6%) Terapeutas Ocupacionais, credenciados ao Conselho Regional de Fisioterapia e Terapia Ocupacional – CREFITO-5. Quanto ao sexo pode-se observar a predominância de profissionais do sexo feminino (142 [88,2%]), a média de idade foi de 34,03 anos, a área de atuação profissional que prevaleceu foi a Neurologia (17 [11,1%]) seguida da Geral (16 [9,5%]), a maioria dos profissionais trabalha em hospitais (23 [11,6%]), todavia não foi o único local, a maioria dos participantes atua em equipe multiprofissional (53,1%) e estão concentrados na região metropolitana do Estado do Rio Grande do Sul (62 [42,3%]). Considerações Finais: através desse estudo, observou-se a dificuldade de compreensão por parte dos profissionais em relação aos termos multiprofissional e interprofissional e de como aplicá-los na prática de atuação em equipe. Há necessidade de um ensino em saúde que propicie a formação de profissionais comprometidos com a integralidade, atores ativos no processo de melhoria da resolutividade do sistema de saúde.

Antibody recognition of plasmodium falciparum infected red blood cells by symptomatic and asymptomatic individuals in the brazilian Amazon

In the Amazon Region, there is a virtual absence of severe malaria and few fatal cases of naturally occurring Plasmodium falciparum infections; this presents an intriguing and underexplored area of research. In addition to the rapid access of infected persons to effective treatment, one cause of this phenomenon might be the recognition of cytoadherent variant proteins on the infected red blood cell (IRBC) surface, including the var gene encoded P. falciparum erythrocyte membrane protein 1. In order to establish a link between cytoadherence, IRBC surface antibody recognition and the presence or absence of malaria symptoms, we phenotype-selected four Amazonian P. falciparum isolates and the laboratory strain 3D7 for their cytoadherence to CD36 and ICAM1 expressed on CHO cells. We then mapped the dominantly expressed var transcripts and tested whether antibodies from symptomatic or asymptomatic infections showed a differential recognition of the IRBC surface. As controls, the 3D7 lineages expressing severe disease-associated phenotypes were used. We showed that there was no profound difference between the frequency and intensity of antibody recognition of the IRBC-exposed P. falciparum proteins in symptomatic vs. asymptomatic infections. The 3D7 lineages, which expressed severe malaria-associated phenotypes, were strongly recognised by most, but not all plasmas, meaning that the recognition of these phenotypes is frequent in asymptomatic carriers, but is not necessarily a prerequisite to staying free of symptoms.In the Amazon Region, there is a virtual absence of severe malaria and few fatal cases of naturally occurring Plasmodium falciparum infectionsthis presents an intriguing and underexplored area of research. In addition to the rapid access of infected p1095598601FAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOCNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO2009/17114-3576128/2008-2To Wolfgang Fischer and Márcio Yamamoto, for sequencing of DBLα tag sequences, and to Drs Mauro Shugiro Tada and Tony Katsuragawa, for help with data and sample collection at the site

Desafios ‘práticos e reflexivos’ para os cursos de graduação em terapia ocupacional em tempos de pandemia

The COVID-19 pandemic has conduced to the adoption of measures that bring about changes in the routine and organization of work in universities. The virtual environments have been considered as vectors for undergraduate courses during pandemic addressing, and it’s necessary to produce reflection for this new context. The Rede Nacional de Ensino e Pesquisa em Terapia Ocupacional – RENETO (Brazilian Occupational Therapy Education and Research Association), Brazil, attentive to the issues involved in the formation and production of knowledge in the field, has been searching with peers for ways to carry out a complex reading of reality and, from this, create and implement strategies to be able to deal with the demands imposed, respecting the regionalities in which the undergraduate courses are running on. Thus, based on a survey carried out with the coordinators of Occupational Therapy courses, which aimed to understand how the undergraduate courses have adhered or not to teaching through digital platforms, this paper intends to reflect on decision making about pedagogical, ethical and political dimensions in the scope of academic activities not only in the context of pandemic, but also considering the projections of the new reality imposed by the pandemic. However, there is still a somewhat disjointed scenario in the area and realities significantly different, between public and private institutions.A pandemia de COVID-19 tem provocado a adoção de medidas que ocasionam a mudança na rotina e na organização do trabalho das universidades. Os ambientes virtuais vêm se apresentando como vetores para os cursos de graduação durante o enfrentamento da pandemia, sendo necessário produzir reflexões para este novo contexto. A Rede Nacional de Ensino e Pesquisa em Terapia Ocupacional – RENETO, Brasil, atenta as questões implicadas com a formação e produção de conhecimento da área, vem buscando junto aos pares maneiras de realizar uma leitura complexa da realidade e, a partir desta, criar e implementar estratégias que deem conta de atender as demandas impostas, respeitando as regionalidades em que os cursos de graduação estão inseridos. Assim, a partir de um levantamento realizado junto às coordenações de cursos de graduação em Terapia Ocupacional, a fim de compreender como os cursos de graduação têm aderido ou não à oferta de ensino por meio de plataformas digitais, o presente trabalho pretende refletir acerca das tomadas de decisões pedagógicas, éticas e políticas no âmbito das diversas atividades acadêmicas, não apenas no contexto do enfrentamento da pandemia, como também nas projeções da nova realidade imposta por esta problemática. Contudo, observa-se ainda um cenário um tanto desarticulado na área, entre instituições significativamente diferentes, públicas e privadas

‘Practical and reflective’ challenges for occupational therapy’s undergraduation courses in pandemic times

O preprint foi submetido para publicação em um periódico.A pandemia de COVID-19 tem provocado a adoção de medidas que ocasionam a mudança na rotina e na organização do trabalho das universidades. Os ambientes virtuais vêm se apresentando como vetores para os cursos de graduação durante o enfrentamento da pandemia, sendo necessário produzir reflexões para este novo contexto. A Rede Nacional de Ensino e Pesquisa em Terapia Ocupacional – RENETO, Brasil, atenta as questões implicadas com a formação e produção de conhecimento da área, vem buscando junto aos pares maneiras de realizar uma leitura complexa da realidade e, a partir desta, criar e implementar estratégias que deem conta de atender as demandas impostas, respeitando as regionalidades em que os cursos de graduação estão inseridos. Assim, a partir de um levantamento realizado junto às coordenações de cursos de graduação em Terapia Ocupacional, a fim de compreender como os cursos de graduação têm aderido ou não à oferta de ensino por meio de plataformas digitais, o presente trabalho pretende refletir acerca das tomadas de decisões pedagógicas, éticas e políticas no âmbito das diversas atividades acadêmicas, não apenas no contexto do enfrentamento da pandemia, como também nas projeções da nova realidade imposta por esta problemática. Contudo, observa-se ainda um cenário um tanto desarticulado na área, entre instituições significativamente diferentes, públicas e privadas.The COVID-19 pandemic has conduced to the adoption of measures that bring about changes in the routine and organization of work in universities. The virtual environments have been considered as vectors for undergraduate courses during pandemic addressing, and it’s necessary to produce reflection for this new context. The Rede Nacional de Ensino e Pesquisa em Terapia Ocupacional – RENETO (Brazilian Occupational Therapy Education and Research Association), Brazil, attentive to the issues involved in the formation and production of knowledge in the field, has been searching with peers for ways to carry out a complex reading of reality and, from this, create and implement strategies to be able to deal with the demands imposed, respecting the regionalities in which the undergraduate courses are running on. Thus, based on a survey carried out with the coordinators of Occupational Therapy courses, which aimed to understand how the undergraduate courses have adhered or not to teaching through digital platforms, this paper intends to reflect on decision making about pedagogical, ethical and political dimensions in the scope of academic activities not only in the context of pandemic, but also considering the projections of the new reality imposed by the pandemic. However, there is still a somewhat disjointed scenario in the area and realities significantly different, between public and private institutions

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

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication