PUBLIC POLICY, HEALTH AND RACISM: INTEGRATIVE LITERATURE REVIEW

Objetivo: O presente trabalho teve como objetivo identificar a produção científica acerca das contribuições da Política Nacional de Saúde Integral da População Negra na elaboração de ações que objetivam qualificar o cuidado em saúde. Método: Foi realizada uma Revisão Integrativa, elegendo-se artigos publicados nos bancos de dados digitais: Scielo (Biblioteca Eletrônica Científica Online) e BVSalud (Biblioteca Virtual em Saúde). Resultados: Foram incluídos 11 (onze) artigos na amostra final. Os dados foram analisados e organizados em 5 (cinco) categorias: formação e educação permanente dos profissionais que atendem a população negra; saúde da mulher e cuidado neonatal e infantil; combate do racismo estrutural; articulação entre cultura e ancestralidade com as práticas terapêuticas cotidianas; pesquisa sobre as doenças de prevalência elevada na população negra. Outras questões transversais que articulam com a temática da revisão são as conexões entre a Política e a qualificação do atendimento da população negra por meio da implementação das ações que repercutem na saúde. Conclusão: Embora haja exemplos práticos e de reflexão importantes relacionados è implantação da PNSIPN, inclusive sobre o racismo estrutural, deve-se considerar que a Política deve ser divulgada e trabalhada no cotidiano dos serviços e com os gestores, a fim de apoiar a superação das iniquidades e opressões.Objective: The present work aimed to identify the scientific production about contributions of the PNSIPN in the elaboration of actions that aim to qualify health care. Method: An integrative review was carried out, choosing to be published in the digital databases: Scielo (Online Scientific Electronic Library) and VHL (Virtual Health Library). Results: Eleven (11) articles were included in the final sample. Professional data were organized into five (5) categories: training and continuing education of professionals who serve the black population; women's health and neonatal and children care; combating structural racism; articulation between culture and ancestry, with daily therapeutic practices; good practices in the area of ​​research on prevalent diseases in the black population. Other cross-cutting issues are articulated in a thematic way of the review as a correspondence between the policy and the qualification of the black population through the implementation of actions that have repercussions on health. Conclusion: The studies show that, although there are practical examples, and important reflections related to the implementation of the PNSIPN, including on structural racism, it should be considered that the Policy must be disseminated and worked on in the daily routine of services and with managers, in order to support the overcoming of inequities and oppressions

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status