Feasibility of Noninvasive Positive Pressure Ventilation in the Treatment of Oxygen-Dependent COVID-19 Patients in Peru

Intensive care is expensive, and availability is limited. Low- and middle-income countries in particular have struggled to cope with the large influx of critically ill patients during the COVID-19 pandemic. Noninvasive respiratory support devices delivering continuous positive airways pressure (CPAP) require less resource and staff expertise compared with invasive mechanical ventilators and can be routinely used outside of intensive care units. This study assessed the use of the UCL-Ventura Wayrachi CPAP device in hospitalized patients with COVID-19 in Peru. A secondary analysis of data collected for a feasibility study commissioned by the Peruvian Ministry of Health was conducted. Data were collected from three hospitals, including patient demographics, clinical data, and outcomes. Forty-five patients were enrolled from July 16 to September 1, 2020. Eight patients (18%) were intolerant of the CPAP mask. Of the remainder, 18 (48.7%) improved and were discharged from hospital after 6 days. Eight (21.6%) died while on CPAP and 11 (29.7%) were eventually intubated, of whom two died. In total, 27 (60%) survived to hospital discharge. Participating physicians noted the device was easy to use and provided patient benefit, though voiced concerns about the strain on hospital oxygen supplies. In conclusion, the UCL Ventura Wayrachi CPAP device proved feasible in COVID-19 patients in Peru, and offered a bridging therapy for patients who required a ventilator when none were available

Exploring the short-term and maintained effects of strategic instruction on the writing of 4th grade students: should strategies be focused on the process?

p.1769-1790The principal aim of strategy-focused instruction is to teach students strategies to control their writing processes and achieve quality writing. For this purpose, nine 4th grade Elementary School classes from three diferent schools (N=215) were randomly allocated to two forms of strategy-focused program called cognitive selfregulation instruction (CSRI). The full-CSRI (experimental condition 1, n=72) taught students a strategic approach to set appropriate product goals along with planning strategies. However, in the brief-CSRI (experimental condition 2, n=69), the direct teaching of planning procedures was removed. These two experimental conditions were compared with a control condition (n=74). We used a pre-test/posttest design and we also collected a maintenance writing performance 7 months after the intervention. Writing performance was holistically evaluated through readerbased measures made up of aspects related to structure, coherence, and quality. Only the full-CSRI condition wrote better compare–contrast texts than the control group in both the short term and at the maintenance timepoint. The study discusses the efects of the intervention on each measure and whether or not it is necessary to train process strategiesS

Sistemas de protección y detección de contagios en los pediatras de atención primaria en la epidemia por COVID-19

Introducción: durante la pandemia de COVID-19, el uso de equipos y dispositivos de protección por parte de los profesionales es fundamental para evitar la transmisión de la infección en el colectivo de sanitarios. Material y métodos: el Grupo Laboral-Profesional de la Asociación Española de Pediatría de Atención Primaria (AEPap) ha realizado una encuesta a los vocales autonómicos de la AEPap para conocer la disponibilidad que han tenido los pediatras de Atención Primaria (PAP) de sistemas de protección frente a la enfermedad, y las pruebas diagnósticas realizadas para el diagnóstico de los contagios de los PAP. Resultados: en marzo de 2020, solo en el 32% de las comunidades autónomas (CC. AA.), los pediatras tenían sistemas de protección adecuados. En abril ascendió al 70%. En todas las CC. AA. se han registrado casos de PAP enfermos, aunque es difícil cuantificar el número de afectados. De las que tenemos datos, sumando el número de pediatras enfermos conocido, más test de reacción en cadena de la polimerasa (PCR) positivo, los que han estado en aislamiento y los ingresados, la cifra asciende al 7,65% de la cifra total de PAP. Los test rápidos serológicos o PCR o ambos se han realizado en seis comunidades los últimos días de abril y en otras seis los primeros días de mayo. Entre las CC. AA. de las que hay información, Aragón es la única comunidad en la que no se ha realizado test. Se ha correlacionado la disponibilidad de los sistemas de protección y el gasto sanitario. Conclusiones: los sistemas de protección han sido insuficientes. Las CC. AA. con mayor gasto sanitario han contado más precozmente con sistemas de protección adecuados. Han resultado infectados PAP en todas las comunidades autónomas, especialmente en Madrid, Castilla y León y Comunidad Valenciana. La detección de profesionales afectos por la infección ha sido tardía

Cidade saudável: relato de experiência na coleta e disseminação de informação sobre determinantes de saúde Healthy city: an approach towards the dissemination of information about health determinants

Para entender o que é a saúde de uma cidade é necessário utilizar uma grande variedade de técnicas, que vão desde a construção de indicadores de saúde de caráter "objetivo" e quantificáveis até a aplicação de instrumentos de abordagem qualitativa, que permitam conhecer de forma mais aprofundada e contextualizada as percepções e os desejos dos cidadãos da cidade. Este artigo tem o objetivo de descrever a experiência de mensuração contínua de determinantes de saúde, como estratégia para adquirir e disseminar informações para que a cidade de Calgary (Canadá) se tornasse um Município Saudável. Nesta cidade, alguns indicadores foram obtidos a partir de dados secundários. Para os indicadores com dados primários, foram elaboradas questões por sugestão de profissionais do sistema de saúde, validadas em grupos focais formados por pessoas da comunidade. Esse processo teve início em 1994 e o primeiro grande inquérito de determinantes de saúde em nível federal no Canadá foi realizado em 1996, e, desde então, repete-se a cada dois anos. A iniciativa municipal até hoje procura aproximar líderes comunitários, profissionais de serviços, universidade e governantes. Como integrantes de uma equipe de professores universitários que estuda a possibilidade de aplicação de um modelo semelhante em um município de Santa Catarina, e com base nas Políticas Públicas do Brasil voltadas à Promoção da Saúde, os autores têm a perspectiva de participar de iniciativas que divulguem informações acerca do modelo de construção de indicadores desenvolvido naquela experiência.<br>The meaning of "health" in a "Healthy City" project, implies measurements using different techniques, quantitative and qualitative. The understanding of "health" needs information regarding perception and will of citizens and objective quantifiable indicators. This article describes an experience of measuring health determinants yearly, and to disseminate these data through local media with the objective of building a "Healthy City" in Calgary, Canada. In this experience, secondary and primary data were used. Primary data were collected using a questionnaire built by health professionals and validated by community members through focus groups. This project appeared in 1994 and the first national similar initiative happened in 1996 with a survey repeated every two years. The municipal initiative remains until today bringing together community leaders, health professionals, university and government. As part of a team of university professors that want to apply a similar model in a city in Santa Catarina state, the authors are committed to spread this model in Brazil

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially