Multicenter study of the natural history and therapeutic responses of patients with chikungunya, focusing on acute and chronic musculoskeletal manifestations - a study protocol from the clinical and applied research in Chikungunya (REPLICK network)

BACKGROUND: Chikungunya is associated with high morbidity and the natural history of symptomatic infection has been divided into three phases (acute, post-acute, and chronic) according to the duration of musculoskeletal symptoms. Although this classification has been designed to help guide therapeutic decisions, it does not encompass the complexity of the clinical expression of the disease and does not assist in the evaluation of the prognosis of severity nor chronic disease. Thus, the current challenge is to identify and diagnose musculoskeletal disorders and to provide the optimal treatment in order to prevent perpetuation or progression to a potentially destructive disease course. METHODS: The study is the first product of the Clinical and Applied Research Network in Chikungunya (REPLICK). This is a prospective, outpatient department-based, multicenter cohort study in Brazil. Four work packages were defined: i. Clinical research; ii) Translational Science - comprising immunology and virology streams; iii) Epidemiology and Economics; iv) Therapeutic Response and clinical trials design. Scheduled appointments on days 21 (D21) ± 7 after enrollment, D90 ± 15, D120 ± 30, D180 ± 30; D360 ± 30; D720 ± 60, and D1080 ± 60 days. On these visits a panel of blood tests are collected in addition to the clinical report forms to obtain data on socio-demographic, medical history, physical examination and questionnaires devoted to the evaluation of musculoskeletal manifestations and overall health are performed. Participants are asked to consent for their specimens to be maintained in a biobank. Aliquots of blood, serum, saliva, PAXgene, and when clinically indicated to be examined, synovial fluid, are stored at -80° C. The study protocol was submitted and approved to the National IRB and local IRB at each study site. DISCUSSION: Standardized and harmonized patient cohorts are needed to provide better estimates of chronic arthralgia development, the clinical spectra of acute and chronic disease and investigation of associated risk factors. This study is the largest evaluation of the long-term sequelae of individuals infected with CHIKV in the Brazilian population focusing on musculoskeletal manifestations, mental health, quality of life, and chronic pain. This information will both define disease burden and costs associated with CHIKV infection, and better inform therapeutic guidelines

O trabalho na enfermagem e seu significado para as profissionais El trabajo de enfermería y su significado para las profesionales Nursing work and its meaning to female professionals

Trata-se de um estudo qualitativo com emprego do método História de Vida tendo como objetivos descrever o cotidiano da mulher-mãe-trabalhadora de enfermagem e analisar a percepção desta profissional em relação ao seu cotidiano tomando como base sua história de vida. Foram entrevistadas 25 profissionais de enfermagem, que tivessem filhos, de um hospital geral público no município do Rio de Janeiro. A análise dos relatos evidenciou que as trabalhadoras visualizam o enfermeiro como um profissional polivalente que se envolve com toda a dinâmica da organização hospitalar por falta de delimitação das ações de enfermagem. A precariedade das condições da instituição pública no atendimento à população, traduzida pela insuficiência de recursos, interfere diretamente no fazer da enfermagem.<br>Se trata de un estudio cualitativo que utilizó el método de Historia de Vida para describir el cotidiano de la mujer-madre-profesional de enfermería y analizar la percepción de la mujer-madre-profesional de enfermería con relación a su cotidiano, teniendo como base su historia de vida. Fueron entrevistadas 25 profesionales de enfermería, que tenían hijos, de un hospital general público del municipio de Rio de Janeiro. El análisis de los relatos evidenció que las trabajadoras visualizan el enfermero como un profesional polivalente que se compromete con toda la dinámica de la organización hospitalaria, debido a la falta de delimitación de las acciones de enfermería. La precariedad en las condiciones asistenciales a la población de la institución pública, traducida por la insuficiencia de recursos, interfiere directamente en la actividad de enfermería.<br>This is a qualitative study that used Life History method aiming to describe the woman-mother-nursing laborer's daily routine and to analyze the woman-mother-nursing laborer's perception of their daily routine, based on their life history. Twenty-five nursing professionals of a public general hospital in Rio de Janeiro, who had children, were interviewed. The report analysis revealed that these laborers see nurses as multivalent professionals, who are involved in the whole hospital organization dynamics, due to lack of delimitation of the nursing actions. The precariousness of the conditions in which the population of this public institution is assisted, manifested by resources insufficiency, directly interferes in the nursing activity