SAINDO DO HOSPITAL PSIQUIÁTRICO: O IMPACTO DA VIVÊNCIA “EXTRA-MUROS”

Um dos desafios deste novo milênio, para Saúde Mental, é a desconstrução dos hospitais psiquiátricos tradicionais, considerando-se a grande população de pessoas que ainda vive em seu interior. Hoje, a cidade de Ribeirão Preto -SP possui uma rede de atenção diversificada e consolidada de serviços substitutivos do modelo manicomial: Núcleo de Atenção Psicossocial (NAPS), Núcleo de Atenção Psicossocial para Fármaco-Dependentes (NAPS F), Ambulatório Regional de Saúde Mental (serviços ligados a prefeitura); Unidade de Emergência Psiquiátrica, Enfermaria Psiquiátrica em Hospital Geral, Hospital-Dia (serviços pertencentes ao Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP), além de um Programa de Pensão Protegida. Este último vem sendo desenvolvido desde 1992, por um hospital psiquiátrico de grande porte, desta cidade, que tem por objetivo a reinserção do paciente na comunidade. Pretendemos, neste estudo, discutir o acesso à cidadania, pano de fundo deste Programa, no qual um grupo de doentes está inserido. Através de visita domiciliar para acompanhamento da convivência “extra-muros” de três pacientes do sexo feminino, que residem em uma dessas pensões, detectamos dificuldades de relacionamento, de enfrentamento das situações diárias e reinternações. Tomando estes achados como objeto de reflexões, foi possível concluirmos que esta clientela necessita de algum tipo de suporte, o qual os profissionais da saúde mental podem oferecer, tendo consciência de que precisam repensar sua prática de intervenção.One of the challenges to Mental Health in this new millenium is the deconstruction of traditional psychiatric hospitals, which will have to take into account the large number of people who still live in them. Currently, the City of Ribeirão Preto – SP has a diversified and consolidated care system characterized by substitutive services for the mental-hospital model, namely: the Psychosocial Care Center (NAPS), Psychosocial Care Center for Drug-Addicts (NAPS F), Regional Mental Health Outpatient Clinic (services provided by the City Administration); Psychiatric Emergency Unit, General Hospital’s Psychiatric Ward, Day-Hospital (services belonging to the University Hospital of the University of São Paulo at Ribeirão Preto Faculty of Medicine) in addition to the Protected Home Program. The latter has been developed since 1992 by a large psychiatric hospital in that city and seeks to re-include patients into the community. This study aims at discussing access to citizenship, which is the base of such program assisting a group of patients. By means of home visits, the experience of three female patients outside the walls of a mental hospital was followed. These three patients lived in one of the protected homes in the Program and, during the study, their difficulties concerning relationships as well as those related to coping with daily situations and re-hospitalizations were detected. By taking such findings as the object of our reflections, it was possible to conclude that such clients need some type of support which, Mental Health professionals can provide by being aware of the fact that they must re-consider o their intervention practice

Efetividade do GeneXpert® no diagnóstico da tuberculose em pessoas que vivem com HIV/aids

OBJECTIVE To identify and synthesize the scientific knowledge produced regarding the effectiveness of the GeneXpert test in the diagnosis of pulmonary tuberculosis (TB) in people living with HIV/AIDS. METHODS Integrative literature review, which was searched on Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex, and LILACS platforms, in December 2019. The studies surveyed went through two stages of selection: reading of titles and abstracts by two reviewers independently; using the Rayyan platform and reading. Nineteen primary studies in English, Portuguese, and Spanish that answered the study’s guiding question were included: How effective is the GeneXpert test in the diagnosis of pulmonary TB in people living with HIV/AIDS? RESULTS The use of GeneXpert substantially increased the detection of TB cases among the population co-infected with HIV/AIDS, with sensitivity ranging from 68% to 100%, superior to sputum smear microscopy. Specificity ranged from 91.7% to 100%; the positive predictive value from 79.2% to 96.1%; and the negative predictive value from 84.6% to 99.3%. These values were considered similar to sputum smear microscopy by most studies. We also compared these results with different ways of performing culture and other molecular tests, being considered inferior only to the Xpert Ultra. CONCLUSION It is possible to affirm that places with a high incidence of HIV/AIDS would benefit from the implementation of the GeneXpert test, entailing effectiveness in diagnosing pulmonary TB in this population when compared to sputum smear microscopy, a widely used test for detection of cases.OBJETIVO Identificar e sintetizar o conhecimento científico produzido a respeito da efetividade do teste GeneXpert no diagnóstico da tuberculose (TB) pulmonar em pessoas vivendo com HIV/aids. MÉTODOS Revisão integrativa da literatura, cuja busca foi feita nas plataformas Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex e Lilacs, em dezembro de 2019. Os estudos levantados passaram por duas etapas de seleção: leitura dos títulos e resumos por dois revisores de forma independente, utilizando a plataforma Rayyan e leitura integral dos mesmos. Foram incluídos 19 estudos primários em inglês, português e espanhol que respondiam à pergunta norteadora do estudo: Qual é a efetividade do teste GeneXpert no diagnóstico da TB pulmonar em pessoas que vivem com HIV/aids? RESULTADOS A utilização do GeneXpert aumentou substancialmente a detecção de casos de TB entre a população coinfectada com HIV, com sensibilidade que variou de 68% a 100%, sendo superior à baciloscopia. A especificidade variou de 91,7% a 100%; o valor preditivo positivo, de 79,2% a 96,1%; e o valor preditivo negativo, de 84,6% a 99,3%, valores considerados semelhantes à baciloscopia pela maioria dos estudos. O teste também foi comparado com as diferentes formas de realização da cultura e outros testes moleculares, sendo considerado inferior apenas ao Xpert Ultra. CONCLUSÃO É possível afirmar que locais com alta incidência de HIV se beneficiariam com a implantação do teste GeneXpert, uma vez que sua efetividade no diagnóstico da TB pulmonar nessa população é expressiva quando comparada à baciloscopia, teste que foi por muito tempo amplamente utilizado para a detecção dos casos

Genomic epidemiology unveils the dynamics and spatial corridor behind the Yellow Fever virus outbreak in Southern Brazil

Despite the considerable morbidity and mortality of yellow fever virus (YFV) infections in Brazil, our understanding of disease outbreaks is hampered by limited viral genomic data. Here, through a combination of phylogenetic and epidemiological models, we reconstructed the recent transmission history of YFV within different epidemic seasons in Brazil. A suitability index based on the highly domesticated Aedes aegypti was able to capture the seasonality of reported human infections. Spatial modeling revealed spatial hotspots with both past reporting and low vaccination coverage, which coincided with many of the largest urban centers in the Southeast. Phylodynamic analysis unraveled the circulation of three distinct lineages and provided proof of the directionality of a known spatial corridor that connects the endemic North with the extra-Amazonian basin. This study illustrates that genomics linked with eco-epidemiology can provide new insights into the landscape of YFV transmission, augmenting traditional approaches to infectious disease surveillance and control

Emergency care network: impact of implementing the care pathway for stroke

Este estudo avaliou o impacto da implantação da linha de cuidado ao Acidente Vascular Cerebral (AVC) na Rede de Atenção à Urgência e Emergência (RUE) do município de Ribeirão Preto-São Paulo. Estudo retrospectivo, realizado a partir de dados secundários de adultos com AVC isquêmico no período de 2014 a 2019 atendidos pelos serviços públicos da RUE de Ribeirão Preto e submetidos à trombólise. Foram coletados dados referentes às características clínicas, epidemiológicas e gravidade dos casos, bem como tempos de atendimentos dos casos de AVC e desfechos. Os dados foram analisados por meio de técnicas descritivas, através de distribuição de frequência, medidas de posição (média e mediana) e de variabilidade (desvio padrão, intervalo interquartil). Os tempos de atendimento foram comparados em relação ao período de estudo (2014 a 2016 x 2017 a 2019) e local do primeiro atendimento (domicílio x unidade de saúde) por meio de teste Mann-Whitney. Utilizou-se o teste Qui-quadrado para analisar a associação entre período e local do primeiro atendimento com os desfechos dos casos. Participaram do estudo 403 pessoas vítimas de AVC agudo tratadas com trombólise, das quais, 53,3% do sexo masculino; 70,0% na faixa etária de 50 a 79 anos; 77,4% apresentavam hipertensão arterial sistêmica (HAS); 32,5%, Diabetes Mellitus (DM); 31,5%, dislipidemia; 31,1% faziam uso de AAS e 27,1% de estatina. No momento da admissão hospitalar, 48,6% dos casos foram considerados AVC moderado, 23,1% estado gravíssimo e 19,1% moderado a severo. O primeiro atendimento realizado no domicilio ou local do agravo aumentou de 16,9% para 38,5%, enquanto o atendimento realizado por uma Unidade de Suporte Básico aumentou de 62,8% para 77,9%. Os tempos de atendimento das pessoas submetidas à trombólise foram menores no período de 2017 a 2019 em relação a 2014 a 2016 nos tempos porta-agulha, ictus-ligação, ictus-viatura e regulação-porta. As vítimas de AVC com primeiro atendimento no domicílio ou no local da ocorrência apresentaram todos os tempos de atendimento menores quando comparados aos que foram atendidos em unidade de saúde, exceto tempo viatura-porta (o qual foi maior nas pessoas atendidas no domicílio). Não se identificou diferença no percentual dos desfechos estudados no período de 2017 a 2019 em comparação ao período de 2014 a 2016. Verificou-se maior ocorrência de craniectomia nas pessoas atendidas em domicílio do que naquelas atendidas em serviços de saúde. O percentual de ocorrência de desfechos desfavoráveis do AVC aumentou conforme a gravidade do caso. A organização do fluxo de atendimento às pessoas com sintomas de AVC mobilizou diversos serviços de saúde que integravam a RUE de Ribeirão Preto com atribuições definidas para cada nível de assistência por meio da constituição de uma linha de cuidado e da utilização de protocolos pré-estabelecidos. Tal organização reduziu os tempos de assistência pré e intra-hospitalar, os quais não possuíram influência direta sobre os desfechos dos casos, no entanto, constituíram evidências da qualidade da assistência prestada.This study assessed the impact of implementing a care pathway for Stroke in the Emergency Care Network in the municipality of Ribeirão Preto-São Paulo. It reports a retrospective study conducted using secondary data from adult patients with ischemic stroke, treated with thrombolysis between 2014 and 2019 in the public emergency care services of Ribeirão Preto. Data regarding clinical and epidemiological characteristics, case severity, as well as stroke onset-to-treatment times and outcomes were collected. The data were analyzed using descriptive techniques, including frequency distribution, measures of central tendency (mean and median), and measures of variability (standard deviation, interquartile range). The treatment times were compared between two study periods (2014-2016 x 2017-2019) and the location of the initial care (home vs. health facility) using the Mann-Whitney test. The Chi-square test was used to analyze the association between study period, initial care location, and case outcomes. The study included 403 individuals who suffered acute stroke and were treated with thrombolysis. Of these, 53.3% were male, 70.0% were between 50 and 79 years old, 77.4% had hypertension, 32.5% had diabetes mellitus, 31.5% had dyslipidemia, 31.1% used aspirin, and 27.1% used statins. Upon hospital admission, 48.6% of cases were considered moderate stroke, 23.1% were classified as severe stroke, and 19.1% were categorized as moderate to severe stroke. The proportion of cases receiving initial care at home or at the scene increased from 16.9% to 38.5%, while care provided by Basic Support Units increased from 62.8% to 77.9%. The treatment times for individuals undergoing thrombolysis were shorter in the period 2017-2019 compared to 2014-2016 in terms of door to needle time, ictus to call time, ictus to ambulance time, and regulation to door time. Stroke victims receiving initial care at home or at the scene had shorter treatment times compared to those treated at health facilities, except for ambulance to door time, which was longer for individuals treated at home. There was no difference in the percentage of studied outcomes between the periods 2017-2019 and 2014-2016. A higher occurrence of craniectomy was observed in patients treated at home compared to those treated at health services. The percentage of unfavorable stroke outcomes increased with the severity of the cases. The organization of the care pathway for individuals with stroke symptoms mobilized various health services within the Ribeirão Preto Emergency Care Network, with defined responsibilities at each level of care through the establishment of a care pathway and the use of predefined protocols. This organization reduced pre-hospital and intra-hospital care times, which did not have a direct influence on case outcomes but provided evidence of the quality of care provided

The hospital organization and the waste management of a private institution

Esta pesquisa analisa as mudanças organizacionais e administrativas de um hospital privado do interior paulista frente ao gerenciamento dos seus resíduos. Trata-se de um estudo de caso exploratório com abordagem quali-quantitativa, tendo como objetivos descrever os aspectos organizacionais e técnico-operacionais do gerenciamento dos resíduos; descrever as ações desenvolvidas para a implantação do Programa de Segregação e Reciclagem de Resíduos-PSRR; apontar os desafios enfrentados e sua superação; bem como os benefícios e inovações decorridos desta implementação. A coleta de dados foi realizada através da observação não participante da infra-estrutura e do trajeto dos resíduos, utilizando-se de questionário aplicado aos membros da Comissão do PSRR do hospital em estudo. Como resultados encontramos a caracterização do gerenciamento dos resíduos em todas as etapas do manejo e a descrição documentada das ações envolvidas em tal processo. Com base nos dados coletados por meio dos questionários identificamos a trajetória e as ações desenvolvidas para a implantação do projeto proposto na instituição; as estratégias utilizadas para sensibilização das pessoas e valorização dessa proposta; os passos percorridos para a capacitação dos envolvidos; os desafios enfrentados e a sua superação e, os benefícios e inovações decorridos da implementação do trabalho. Observamos a necessidade de estudos que apontem a importância do incentivo às instituições de saúde no entendimento dos benefícios de se implantar programas de gerenciamento de resíduos visando não apenas as condutas apropriadas ao manejo dos resíduos, mas também aos aspectos da valorização do trabalho inerente ao PSRR por parte da comunidade hospitalar.This research analyzes the organizational and administrative changes of a private hospital from the interior of São Paulo in respect of the management of its waste. It is the study of an exploratory issue with a qualitative and quantitative approach, aiming to describe the organizational and technical-operational aspects of the waste management; describe the actions developed for the implementation of the PSRR (Waste Recycling and Segregation Program); point out the challenges faced and the overcome to them; as well as the benefits and innovations originated from this implementation. The data collection was made through the non participant observation of the infrastructure and route of the waste, by using a questionnaire made to the members of the PSRR Commission in the hospital which was being studied. The results found are the characterization of the waste management at all the handling stages and the documented description of the actions involved in this process. Based on the data collected through the questionnaires, we identified the trajectory and the actions developed for the implementation of the project proposed in the institution; the strategies used to sensitize the people and appraise the proposal; the steps taken for capacitating the people involved; the challenges faced and the overcome to them and, the benefits and innovations originated from the implementation of the work. We have observed the necessity of studies which point out the importance of the incentive to health institutions in favor of understanding the benefits of implementing waste management programs, which aim not only the appropriate procedures in the waste handling, but also the aspects of the work valuation inherent to the PSRR by the hospital community

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora