Capacitação nacional emergencial em saúde mental e atenção psicossocial na COVID-19: um relato de experiência

In March 2020, the World Health Organization declared a pandemic, due to the rapid spread of the SARS-Cov-2 virus, triggering the global alert about the need for rapid expansion of the capacity for surveillance, prevention and implementation of assistance structures for the countries' health systems. In the day after the statement by the Brazilian Ministry of Health, that recognized community transmission in Brazil, a group of researchers was invited to gather scientific evidence and best practices for mental health and psychosocial care at COVID-19. 1,563 articles were selected that referred to mental health and / or psychosocial care in contexts of health emergencies. Researchers, teachers and volunteers from 25 institutions, recognized for their notorious knowledge, participated, totaling 117 volunteer professionals. It was decided to set up an online national course. Altogether 60,780 professionals joined the course in the first 30 days of enrollment. The online modeling, synchronous and asynchronous, enabled training during a period of social distance, and also allowed professionals from different states in the national territory to have access to updated information based on national and international research, seeking to guarantee the strengthening of actions within the scope health policies, and based on international protocols.Em março/2020, a Organização Mundial da Saúde emitiu a declaração de pandemia, em decorrência da disseminação do vírus SARS-Cov-2, disparando o alerta mundial sobre a necessidade de rápida expansão da capacidade de vigilância, prevenção e implementação das estruturas de assistência dos sistemas de saúde dos países. No dia seguinte a declaração do Ministério da Saúde que reconheceu a transmissão comunitária no Brasil, um grupo de pesquisadores foi convidado a reunir evidências científicas e melhores práticas de SMAPS na COVID-19. Foram selecionados 1.563 artigos que se referiam à saúde mental e/ou atenção psicossocial em contextos de emergências sanitárias. Participaram pesquisadores, docentes e voluntários de 25 instituições reconhecidas pelo notório saber, totalizando um montante de 117 profissionais voluntários. Optou-se por conformar um curso nacional na modalidade de Educação a distância. Ao todo 60.780 profissionais ingressaram no curso nos primeiros 30 dias de inscrição. A modelagem online, síncrona e assíncrona, possibilitou a formação durante período de distanciamento social, e também permitiu que profissionais de todos os estados, e do Distrito Federal, pudessem ter acesso a informações atualizadas e baseadas em pesquisas nacionais e internacionais, buscando garantir o fortalecimento das ações no âmbito das políticas de saúde, e com base nos protocolos internacionais

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

A participação das organizações da sociedade civil no enfretamento à AIDS: história da política no Estado do Amazonas

Made available in DSpace on 2017-11-16T17:57:48Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Dissertacao_ID_205.pdf: 919169 bytes, checksum: 5e20464237077f0642984fbcc7e11884 (MD5) Previous issue date: 20131211Fundação Oswaldo Cruz. Instituto Leônidas e Maria Deane, Manaus, AM, Brasil.O trabalho analisa a construção da resposta à AIDS no Amazonas sob a perspectiva histórica da consolidação do programa estadual e como as Organizações da Sociedade Civil se veem contribuindo nesta construção. No Estado vem se produzindo e acumulando conhecimentos epidemiológicos sobre a doença, mas a análise sobre a história, a participação e controle social da sociedade civil organizada ainda há carência de estudo. Informações coletadas em fontes documentais e orais permitiu organizar o trabalho na forma de três artigos científicos sendo que cada um responde por um objetivo específico distinto: O primeiro é dedicado ao levantamento da história do Programa Estadual DST/AIDS; o segundo centra-se na história das principais Organizações da Sociedade Civil que participaram desta construção, e; o terceiro traça uma análise sobre a participação do movimento social anti-AIDS no enfrentamento à epidemia. Juntos os três artigos trazem elementos para visão ampliada, compreendendo que o programa estadual é também resultante de um processo histórico, de decisões políticas e da mobilização social e como suas diretrizes igualmente vem moldou o ativismo e a resposta das Organizações da Sociedade Civil.This research analyzes the AIDS program in Amazonas State in a historical approach of local response and how the Community Based Organization contributes in its history. In this States many epidemiological studies have been doing about the epidemic, but there is a lack of knowledge about history, community mobilization and social control of the civil society. Using oral and documental sources it is presented three papers, each one addresses an specific objective. The first one presents the history of the STI/AIDS Local Program; the second address the mainly Community Based Organizations histories, and; the last one focus the contribution of the Community Based Organization in the local AIDS Program response. Together the papers come with new perspective to comprehend the local Program as a result of an historical process, political decisions and community mobilization and how its directions equally drives the civil society activism

A emergência da Aids no Amazonas

Resumo O artigo analisa o contexto histórico, social e político do surgimento da Aids no Amazonas e como as respostas locais foram moldadas pelas mudanças ocorridas na política nacional. Para isso, utilizou-se pesquisa de fontes documentais – de instituições governamentais e não governamentais – complementadas e esclarecidas por fonte oral – relatos de gestores/profissionais de saúde que lideraram a organização da assistência aos soropositivos no estado e ativistas. A partir desse levantamento revelou-se que a desarticulação entre as instituições de assistência e cuidado e principalmente a falta de priorização política para combate à epidemia no Amazonas têm dificultado o planejamento e execução de ações e estratégias públicas com abrangência em toda a rede de assistência no estado