RESUMEN
BACKGROUND: Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area. METHODS: In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates. RESULTS: Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing. CONCLUSION: WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.
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Higiene , Saneamiento , Humanos , Estudios Transversales , Saneamiento/normas , Saneamiento/estadística & datos numéricos , Femenino , Masculino , Adulto , Higiene/normas , California , Abuso de Sustancias por Vía Intravenosa/epidemiología , Persona de Mediana Edad , México , Abastecimiento de Agua/normas , Agua Potable/normas , Adulto JovenRESUMEN
La presente investigación tuvo como objetivo conocer el nivel de cumplimiento de las medidas académicas y de salud, limpieza e higiene que se implementaron en la sesión de educación física en el regreso a clases presenciales en México. Para ello, se siguió un diseño cuantitativo no experimental de corte transversal, a través de la cual se recogió información por medio de una escala tipo Likert. Los resultados indican que el 55% de los profesores de educación física están de acuerdo en que las medidas académicas establecidas, les facilitó lograr la recuperación y reforzamiento de los aprendizajes de sus alumnos, así mismo, el 81,2% afirma que se están llevando a cabo medidas preventivas de contagio y mitigación de la COVID-19 en las actividades escolares. Se concluye que las medidas propuestas por las autoridades educativas para el regreso a clases presenciales son aceptables, sin embargo, se identifican limitantes en lo que se refiere al abasto de materiales de sanitización y limpieza entregados por las autoridades educativas.
This research was conducted in order to determine the level of compliance to the health, cleanliness, and hygiene measures implemented during physical education sessions when returning to school in Mexico. For this purpose, a non-experimental cross-sectional quantitative design was followed, through which information was collected by means of a Likert-type scale. The results indicate that 55% of the physical education teachers agree that the measures established helped them to recover and reinforce what their students learnt. Likewise, 81,2% assert that they are now carrying out preventive measures for the contagion and mitigation of COVID-19 during school activities. It is concluded that the measures proposed by the educational authorities for the return to school are acceptable. However, there are some limitations identified in terms of the supply of sanitizing and cleaning materials provided by the educational authorities.
O objetivo desta pesquisa foi determinar o nível de cumprimento das medidas acadêmicas e de saúde, limpeza e higiene que foram implementadas na sessão de educação física ao retornar às aulas presenciais no México. Para isso, seguiu-se um delineamento quantitativo transversal não experimental, por meio do qual as informações foram coletadas por meio de uma escala do tipo Likert. Os resultados indicam que 55% dos professores de educação física concordam que as medidas acadêmicas estabelecidas facilitam a recuperação e o reforço da aprendizagem de seus alunos, da mesma forma, 81,2% afirmam que estão realizando medidas preventivas de contágio e mitigação de COVID-19 nas atividades escolares. Conclui-se que as medidas propostas pelas autoridades educacionais para o retorno às aulas presenciais são aceitáveis, porém, são identificadas limitações quanto ao fornecimento de materiais de higienização e limpeza entregues pelas autoridades educacionais.
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Humanos , Masculino , Femenino , Adulto , Educación y Entrenamiento Físico , Maestros , Regreso a la Escuela , COVID-19/prevención & control , Higiene/normas , Estudios Transversales , Encuestas y Cuestionarios , MéxicoRESUMEN
O queijo Minas Artesanal da Canastra é produzido na Serra da Canastra (MG), utilizando leite cru, coalho e pingo, que é uma cultura endógena natural de cada queijaria. Devido ao uso de leite cru, o produto pode veicular microrganismos causadores de doenças veiculadas por alimentos, como Staphylococcus aureus. A caracterização molecular é uma ferramenta importante para avaliar a população microbiana do alimento e direcionar a aplicação de medidas de controle na produção. Este estudo caracterizou a diversidade genética, o potencial de virulência e determinou o perfil de susceptibilidade a antimicrobianos de S. aureus isolados de queijos produzidos na Serra da Canastra. Para o estudo transversal foram analisados 248 isolados de queijos que tinham um tempo de maturação de 22 dias, provenientes de 83 propriedades. Por outro lado, no estudo longitudinal foram analisados outros 197 isolados coletados ao longo do processo de maturação, provenientes de três propriedades. Os isolados foram submetidos a testes bioquímicos para confirmação do gênero e para a confirmação da espécie de S. aureus, foi identificado o gene nuc por meio da técnica de PCR. Além disso, foi pesquisado o gene mecA para a detecção de S. aureus Resistente a Meticilina (MRSA). Após os testes de confirmação, 144 isolados do estudo transversal e 159 do estudo longitudinal foram positivos para o gene nuc, específico para S. aureus. Posteriormente, o perfil clonal foi determinado por Eletroforese de Campo Pulsado (PFGE) utilizando a enzima SmaI e tipagem do locus agr por PCR multiplex. A análise por PFGE foi realizada no programa BioNumerics. A técnica PCR foi realizada para identificar a presença de genes que codificam a produção de hemolisinas, toxina TSST-1, enterotoxinas SEs (SEA, SEB, SEC, SED, SEE, SEG, SEH, SEI, SEJ, SEO, SEM), formação de biofilme e Componentes Microbianos de Superfície que Reconhecem a Matriz de Moléculas Adesivas (MSCRAMMs). Os isolados foram submetidos ao teste de susceptibilidade a antimicrobianos por disco de difusão. Por último, a formação de biofilme em microplaca de 96 poços, em caldo TSB a 37°C, foi verificada pela metodologia de Cristal Violeta. O gene mecA foi detectado em 1,9% dos 445 isolados. A tipagem agrrevelou que 83 (27,4%) dos isolados são do tipo agr-I, 95 (31,4%) agr-II e 43 (14,2%) agr-III, sendo que não foram detectados isolados classificados como agr-IV. A tipagem por PFGE revelou um total de 54 perfis. Assim, um isolado representativo de cada perfil foi utilizado nos demais testes que mostraram a presença dos genótipos spa mais frequentes t127 e t605 (20,58%); t002 (14,70%), seguidos pelos tipos t267 (8,82%); t1234 e t693 (5,8%) e t021, t177, t306, t321, t359, t442, t521, t693 e t5493 (2,9%). Além disso, encontramos a presença dos genes do grupo SEs, sea 1 (1,8%), seh 11 (20,3%), sei 10 (18,5%), sej 7 (12,9%), seg e seo 14 (25,9%), sem 8 (14,8%), e os genes seb, sec, sed, see e tst não foram detectados. Para os genes das hemolisinas, hla foi positivo em todos os isolados e hlb foi positivo em 53 (98,1%) isolados. Os genes positivos para MSCRAMMS foram fnbA, fnbB 18 (33,3%), clfA, clfB e eno 53 (98,1%), fib 44 (81,4%), bbp 4 (7,4%), cna 17 (31,4%) e ebps 10 (18,5%). Por último, os genes de formação de biofilme icaA e icaD estiveram presentes em 38 (70,3%) e 25 (46,2%) dos isolados, respectivamente. Na avaliação de susceptibilidade a antibióticos dos 54 isolados escolhidos, 25 (46,3%) apresentaram maior resistência a penicilina e 13 (24,0%) a tetraciclina. Em menor porcentagem (1,8%), 1 isolado cada foi resistente a eritromicina, cefoxitina, clindamicina, gentamicina, cotrimazol, azitromicina e trimetropim. Além disso, 8 isolados (14,8%) apresentaram resistência intermediaria a tetraciclina, 3 (5,5%) a gentamicina e 1 (1,8%) a tobramicina. No teste para a determinação da formação de biofilme por cristal violeta, 13,7%, foram classificados em isolados não formadores, 60,8% em fracamente formadores, 25,5% moderadamente formadores e nenhum como fortemente formador. A alta diversidade de cepas de S. aureus observada neste estudo mostrou que existem vários tipos de linhagens circulando na região da Canastra. A caracterização revelou uma elevada frequência de genes de virulência e que mais estudos são necessários para avaliar o potencial de produção de enterotoxinas nos queijos artesanais. A melhora dos procedimentos de higienização durante todas as etapas de produção pode ser uma solução para a redução dos níveis de contaminação por S. aureus
Canastra Minas Artesanal cheese is produced in Serra da Canastra (MG), using raw milk, rennet and a natural endogenous culture called pingo. Due to the use of raw milk, the product can carry microorganisms that cause foodborne diseases, such as Staphylococcus aureus. Molecular characterization is an important tool to assess the microbial population of food and guide the application of control measures in production. This study characterized the genetic diversity, virulence potential and determined the antimicrobial susceptibility profile of S. aureus isolated from cheeses produced in Serra da Canastra. A total of 248 isolates from 22 days ripened cheeses were obtained from 83 properties (cross sectional study). Another 197 isolates were collected during maturation (longitudinal study), in three properties. The isolates were submitted to biochemical tests to confirm the genus and to confirm the S. aureus species, the nuc gene was identified by PCR. In addition, the detection of mecA gene was performed for the detection of Methicillin Resistant S. aureus (MRSA). After confirmation tests, 144 isolates from the cross-sectional study and 159 from the longitudinal study were positive for the nuc gene, specific for S. aureus. Subsequently, the clonal profile of the isolates was determined by Pulsed Field Gel Electrophoresis (PFGE) using the SmaI enzyme and typing of the agr locus by multiplex PCR. PFGE analysis was performed using the BioNumerics program. PCR was performed to identify the presence of genes encoding the production of hemolysins, TSST-1 toxin, enterotoxins SEs (SEA, SEB, SEC, SED, SEE, SEG, SEH, SEI, SEJ, SEO, SEM), biofilm formation and microbial surface components recognizing adhesive matrix molecules (MSCRAMMs). The isolates were submitted to the antimicrobial susceptibility test by disc diffusion. Finally, biofilm formation in a 96-well microplate in TSB broth at 37°C was verified by the Cristal Violeta method. The mecA gene was detected in 1.9% of the 445 isolates. Agr typing revealed that 83 (27.4%) of the isolates are agr-I, 95 (31.4%) agr-II and 43 (14.2%) agr-III, and no isolate was classified as agr-IV. PFGE typing revealed a total of 54 profiles. Thus, a representative isolate of each profile was used in the other tests that showed the presence of the most frequent spagenotypes t127, t605 (20.58%); t002 (14.70%), followed by types t267 (8.82%); t1234, t693 (5.8%) e t021, t177, t306, t321, t359, t442, t521, t693 and t5493 (2.9%). In addition, we found the presence of the genes of the SEs group: sea 1 (1.8%), seh 11 (20.3%), sei 10 (18.5%), sej 7 (12.9%), seg and seo 14 (25.9%), sem 8 (14.8%), while seb, sec, sed, see and tst genes were not detected. For hemolysin genes, hla was positive in all isolates and hlb was positive in 53 (98.1%) isolates. The positive genes for MSCRAMMS were: fnbA, fnbB 18 (33.3%), clfA, clfB e eno 53 (98.1%), fib 44 (81.4%), bbp 4 (7.4%), cna 17 (31.4%) and ebps 10 (18.5%). Finally, the biofilm formation genes icaA and icaD were present in 38 (70.3%) and 25 (46.2%) of the isolates, respectively. In the evaluation of antibiotic susceptibility of the 54 isolates, 25 (46.3%) showed greater resistance to penicillin and 13 (24.0%) to tetracycline. In a lower percentage (1.8%), 1 isolate each was resistant to erythromycin, cefoxitin, clindamycin, gentamicin, contrimazole, azithromycin and trimethoprim. In addition, 8 isolates (14.8%) showed intermediate resistance to tetracycline, 3 (5.5%) to gentamicin and 1 (1.8%) to tobramycin. In the test for the determination of biofilm formation by crystal violet, 13.7% were classified as non-forming isolates, 60.8% as weakly forming, 25.5% moderately forming and none as strongly forming. The high diversity of S. aureus strains observed in this study showed that there are several types of strains circulating in the Canastra region. The characterization revealed a high frequency of virulence genes and that further studies are needed to assess the potential for enterotoxin production in artisanal cheeses. The improvement of hygiene procedures during all stages of production can be a solution for reducing the levels of contamination by S. aureus
Asunto(s)
Staphylococcus aureus/clasificación , Queso/análisis , Alimentos/clasificación , Antiinfecciosos/análisis , Higiene/normas , Estudios Transversales/instrumentación , Electroforesis en Gel de Campo Pulsado/métodos , Leche/efectos adversos , Staphylococcus aureus Resistente a Meticilina/clasificación , Enfermedades Transmitidas por los Alimentos/diagnósticoRESUMEN
In food establishments, cleaning and disinfection programmes contribute to provide the environmental conditions that are necessary for the production of safe and healthy food. Compliance with validated programmes is evaluated through verification activities, in order to establish, through objective evidence, if they are implemented as they were written and if they are effective, achieving continuous improvement of the sanitation programmes. In accordance with the specific guidelines of each country, food companies set up their technical specifications and develop their own cleaning and disinfection programmes. Depending on the analytical method used, one of the main challenges was to establish a reasonable limit of acceptability according to the impact that each surface has on the safety and hygiene of the food that is prepared. This review was focused on the procedures implemented to verify the cleaning and disinfection programmes in food establishments. In particular, this study examines the methodologies used (audits and analytical methods), sites for the collection of samples, acceptance criteria and main findings. The results of the analysed studies constitute a scientific basis for designing or improving sanitation procedures and their verification in food companies, and also provide relevant information for food safety authorities.
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Desinfección/normas , Industria de Procesamiento de Alimentos/normas , Saneamiento/normas , Desinfección/métodos , Manipulación de Alimentos/métodos , Manipulación de Alimentos/normas , Inocuidad de los Alimentos , Adhesión a Directriz/normas , Humanos , Higiene/normas , Saneamiento/métodosRESUMEN
Existe no Brasil uma grande variedade de queijos que se enquadram no conceito de "queijo minas artesanal". Produtores consideram que a legislação que regula o setor, em níveis municipal, estadual e federal, é confusa e excessivamente rigorosa, dificulta a padronização dos produtos, interfere no crescimento do setor e facilita a comercialização de queijos em desacordo com os padrões de higiene e segurança estabelecidos. Este trabalho de pesquisa de mestrado pretendeu gerar dados sobre as condições higiênico-sanitárias e segurança microbiológica de queijos minas artesanal, produzidos em Minas Gerais e coletados no comércio da cidade de São Paulo, bem como contribuir com informações a respeito da diversidade bacteriana nos queijos estudados. Foram estudadas 100 amostras de queijo minas artesanal coletadas no comercio de São Paulo, que foram submetidas à enumeração de microrganismos indicadores de higiene (coliformes, Escherichia coli e estafilococos), Salmonella e Listeria monocytogenes, empregando técnicas convencionais de cultivo e também moleculares. Os estafilococos coagulase positivos foram estudados quanto à tolerância à biocidas de interesse para alimentos, determinando-se também a diversidade microbiana, utilizando-se Next Generation Sequencing em Illumina MiSeq. Os resultados indicaram baixa ocorrência dos patógenos estudados, e que 10% e 32% das amostras excederam os limites para Escherichia coli e estafilococos coagulase positiva estabelecidos pelas legislações vigentes, respectivamente. Entre os estafilococos coagulase positiva, 37,7% foram tolerantes a algum dos biocidas testados, com maior prevalencia dos tolerantes ao cloreto de benzalcônio (75%). Quanto à diversidade bacteriana, os gêneros predominantes foram Streptococcus (32,7%), Lactococcus (30,6%) e Corynebacterium (15,6%). A microbiota bacteriana detectada nos queijos Canastra estudados não apresentou dissimilaridade quando comparada à microbiota bacteriana de outros queijos Canastra coletados nos locais de produção em outro estudo. Observou-se que as regiões de coleta dos queijos na cidade de São Paulo e os pontos de comercialização em São Paulo apresentam maior influência sobre a microbiota detectada para o queijo minas artesanal do que as regiões de produção (p<0,05), sugerindo a interferência das práticas de manipulação após a produção na diversidade bacteriana detectada nos queijos
There is a wide variety of cheeses in Brazil that fit the concept of "artisanal minas cheese". Producers consider that the legislation that regulates the sector, at municipal, state and federal levels, is confusing and excessively strict, hinders the standardization of products, interferes with the growth of the sector and facilitates the marketing of cheeses in disagreement with the hygiene and safety standards. This master's research work aimed to generate data on the hygienic-sanitary conditions and microbiological safety of artisanal Minas cheeses, produced in Minas Gerais and collected in São Paulo's commerce, as well as to contribute with information about the bacterial diversity in the studied cheeses. One hundred samples of artisanal Minas cheese collected in the São Paulo market were subjected to the enumeration of hygiene indicator microorganisms (coliforms, Escherichia coli and staphylococci), Salmonella and Listeria monocytogenes, using conventional cultivation and also molecular techniques. Coagulase positive staphylococci were studied for tolerance to biocides of interest to food, and microbial diversity was also determined using Next Generation Sequencing in Illumina MiSeq. The results indicated a low occurrence of the studied pathogens, and that 10% and 32% of the samples exceeded the limits for Escherichia coli and coagulase positive staphylococci established by the current legislation, respectively. Among the coagulase positive staphylococci, 37.7% were tolerant to at least one of the tested biocides, with a greater prevalence of those tolerant to benzalkonium chloride (75%). As for microbial diversity, the predominant genera were Streptococcus (32.7%), Lactococcus (30.6%) and Corynebacterium (15.6%). The bacterial microbiota detected in the studied Canastra cheeses showed no dissimilarity when compared to the bacterial microbiota of other Canastra cheeses collected at the production sites in another study. It was observed that the cheese collection regions in the city of São Paulo and the marketing points in São Paulo had a greater influence on the detected bacterial microbiota than the production regions (p<0.05), suggesting the interference of the practices of manipulation after production in the bacterial diversity detected in the cheeses
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Queso/análisis , Higiene/normas , Alimentos , Salmonella , Coagulasa/agonistas , Corynebacterium , Escherichia coli , ColiformesRESUMEN
This publication presents criteria and bases for the work organization in the safe practice of Hospital Radiopharmacy, in order to minimize the risk of viral transmission during the COVID-19 pandemic, in a reference facility of the National Energy Commission Atomic of Argentina, while continuing to perform essential services for the health system. For this purpose, documents from the National Energy Commission Atomic, IAEA, WHO and other scientific publications were consulted as reference. These recommendations are under constant review and are permanently updated. Within this framework, the present model of work organization for this essential activity is proposed, including general and specific recommendations and its epidemiological and immunological basis.
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COVID-19/epidemiología , Medicina Nuclear/organización & administración , Pandemias , Servicio de Farmacia en Hospital/organización & administración , SARS-CoV-2 , Argentina/epidemiología , COVID-19/diagnóstico , COVID-19/inmunología , COVID-19/prevención & control , Prueba de COVID-19/métodos , Humanos , Higiene/normas , Medicina Nuclear/normas , Objetivos Organizacionales , Admisión y Programación de Personal/organización & administración , Servicio de Farmacia en Hospital/normas , Radiofármacos/normas , SARS-CoV-2/inmunología , Lugar de Trabajo/organización & administración , Lugar de Trabajo/normasRESUMEN
OBJECTIVE: To generate recommendations on the management of radiotherapeutic treatments during the pandemic, adapted to a country with limited health resources. METHODS: We did a rapid review of the literature, searching for papers that describe any measures to reduce the risk of COVID-19 infection, as well as management guidelines to reduce the workload, in radiotherapy units. The following conditions were included in the scope of this review: gynecological tumors, breast cancer, gastrointestinal tumors, genitourinary tumors, head and neck tumors, skin cancer, tumors of the central nervous system, and lymphomas. An expert group discussed online the extracted data and drafted the recommendations. Using a modified Delphi method, the consensus was reached among 14 certificated radio-oncologists. The quality of the evidence that supported the recommendations on treatment schedules was assessed. RESULTS: A total of 57 documents were included. Of these, 25 provided strategies to reduce the risk of infection. Recommendations for each condiction were extracted from the remaining documents. The recommendations aim to establish specific parameters where treatments can be omitted, deferred, prioritized, and shortened. Treatment schemes are recommended for each condition, prioritizing hypo-fractionated schemes whenever possible. CONCLUSIONS: We propose strategies for the management of radiotherapy services to guarantee the continuity of high-quality treatments despite the health crisis caused by COVID-19.
OBJETIVO: Establecer recomendaciones para la toma de decisiones de manejo en radioterapia durante la pandemia de COVID-19, adaptadas a un país con recursos de salud limitados. MÉTODOS: A través de una revisión rápida de la literatura se buscaron publicaciones que describieran medidas para reducir el riesgo de infección por COVID-19, así como también pautas de manejo para reducir la carga de trabajo en las unidades de radioterapia. Se incluyeron en el alcance de esta revisión las siguientes patologías: tumores ginecológicos, cáncer de mama, tumores gastrointestinales, tumores genitourinarios, tumores de cabeza y cuello, cáncer de piel, tumores del sistema nervioso central y linfomas. Un grupo de expertos discutió en línea los datos extraídos y redactó las recomendaciones. Mediante un método Delphi modificado, se evaluó el consenso entre 14 radio-oncólogos certificados. Se evaluó la calidad de la evidencia que sustentó las recomendaciones sobre esquemas de tratamiento. RESULTADOS: Se incluyeron un total de 57 documentos. De 25 trabajos se extrajeron las estrategias para reducir el riesgo de infección. De los restantes, se obtuvieron las recomendaciones para cada patología. Las recomendaciones están orientadas a establecer escenarios específicos donde se pueden omitir, diferir, priorizar y acortar los tratamientos. En el ítem de acortar se recomiendan esquemas de tratamiento para cada patología, priorizando los esquemas hipofraccionados cuando fue posible. CONCLUSIÓN: Se plantean estrategias para la gestión de los servicios de radioterapia con el objetivo de garantizar que los tratamientos de alta calidad para pacientes oncológicos sigan entregándose, pese a la crisis sanitaria ocasionada por COVID-19.
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Betacoronavirus , Consenso , Infecciones por Coronavirus/epidemiología , Países en Desarrollo/estadística & datos numéricos , Neumonía Viral/epidemiología , Oncología por Radiación/estadística & datos numéricos , Carga de Trabajo , COVID-19 , Infecciones por Coronavirus/prevención & control , Técnica Delphi , Desinfección/métodos , Física Sanitaria , Humanos , Higiene/normas , Neoplasias/radioterapia , Enfermedades Profesionales/prevención & control , Enfermedades Profesionales/veterinaria , Cuidados Paliativos/organización & administración , Pandemias/prevención & control , Equipo de Protección Personal , Neumonía Viral/prevención & control , Oncología por Radiación/organización & administración , SARS-CoV-2 , Triaje/organización & administraciónRESUMEN
INTRODUCTION: The impact of the new coronavirus (SARS-COV-2) and its worldwide clinical manifestations (COVID-19) imposed specific regional recommendations for populations in need of specialized care, such as children and adolescents with kidney diseases, particularly in renal replacement therapies (RRT). We present the recommendations of the Brazilian Society of Nephrology regarding the treatment of pediatric patients with kidney diseases during the COVID-19 pandemic. METHODS: Articles and documents from medical societies and government agencies on specific recommendations for children on RRT in relation to COVID-19 as well as those focused on epidemiological aspects of this condition in Brazil Were evaluated and analyzed. RESULTS: We present recommendations on outpatient care, transportation to dialysis centers, peritoneal dialysis, hemodialysis, and kidney transplantation in children and adolescents during the COVID-19 pandemic in Brazil. DISCUSSION: Despite initial observations of higher mortality rates in specific age groups (the elderly) and with comorbidities (obese, diabetics, and those with cardiovascular diseases), patients with chronic kidney disease (CKD) on RRT are particularly prone to develop COVID-19. Specific measures must be taken to reduce the risk of contracting SARS-CoV-2 and developing COVID-19, especially during transport to dialysis facilities, as well as on arrival and in contact with other patients.
Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Enfermedades Renales/terapia , Neumonía Viral/epidemiología , Terapia de Reemplazo Renal/normas , Adolescente , Atención Ambulatoria , Brasil/epidemiología , COVID-19 , Niño , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Humanos , Higiene/normas , Trasplante de Riñón , Máscaras , Nefrología/normas , Enfermedades Profesionales/prevención & control , Pandemias/prevención & control , Aislamiento de Pacientes , Pediatría , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Terapia de Reemplazo Renal/métodos , SARS-CoV-2 , Sociedades Médicas , Evaluación de Síntomas , Transporte de PacientesRESUMEN
OBJECTIVE: to identify men's knowledge on body care. METHOD: it is a cartographic study with a qualitative approach. The research was conducted with 70 men in the city of Boa Vista, state of Roraima. The strategy for data production was called the meeting. Participants were encouraged to think about epistemic units, care and body, from models that were recorded and their meanings transcribed for content analysis according to Bardin. RESULTS: 282 units of decoded records such as body hygiene, sexual health and physical exercise were evidenced. In the decoding units, the conscious, functional male body is discussed, which serves for health professionals to think about caring approaches. FINAL CONSIDERATIONS: cartographic forays allowed the male body to be recognized for its functionality, with structured knowledge on care in three dimensions: body hygiene, sexuality and sports practices.
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Conocimientos, Actitudes y Práctica en Salud , Salud del Hombre/normas , Adolescente , Adulto , Brasil , Humanos , Higiene/normas , Entrevistas como Asunto/métodos , Masculino , Investigación Cualitativa , Salud Sexual/normas , Medicina Deportiva/métodos , Medicina Deportiva/normasRESUMEN
The COVID-19 pandemic has caused unprecedented saturation and collapse of health services around the world, requiring the implementation of strategies, not always well organized, to meet the needs resulting from a progressive increase in the demand for medical care. The health service response starts in the community, with public education, public health and prevention measures through primary care, and coordination and linkage with hospitals. Expanding response capacity involves strengthening primary care and providing sufficient resources at the hospital level through measures to repurpose beds, reassign health workers, early discharge of patients, among other measures. To the extent that these health services network capacities need to be strengthened or have been overwhelmed, it is necessary to consider other strategies at the community level. One of these strategies could be fitting out hotels to be extensions of health facilities.
Asunto(s)
Humanos , Neumonía Viral/prevención & control , Higiene/normas , Infecciones por Coronavirus/prevención & control , Saneamiento de Hoteles , Pandemias/prevención & control , BetacoronavirusRESUMEN
BACKGROUND: Water, sanitation, and hygiene (WASH) services are cornerstones to providing safe health care services and improving patient satisfaction and care seeking. The Clean Clinic Approach (CCA) uses a 10-step process to support health care facilities (HCFs) in making incremental, effective cleanliness and infection prevention and control (IPC) improvements, without relying on external investments. We piloted the CCA in Guatemala and assessed the extent to which it contributed to quality improvements in WASH for IPC. METHODS: After developing an assessment tool tailored to the Guatemalan context, we assessed 11 HCFs in 8 technical areas and scored the facilities on 79 criteria with a total of 100 points. We conducted a baseline assessment (September to October 2018), second assessment (January 2019), and final assessment (February to March 2019). RESULTS: The 11 HCFs improved their average emergency/general ward scores from 41 points at baseline to 87 points at end line, based on a 100-point scale. For delivery wards, the scores increased from 50 to 91 points and for postnatal wards from 46 to 90 points. CONCLUSIONS: The CCA process and tools facilitated a systematic way for HCFs to identify, prioritize, make, and measure WASH quality of care improvements. Training facility staff was fundamental to improving quality standards, and involving medical and administration staff in joint analysis, coordination, and planning sessions was key to integration and teamwork. Further work is needed to increase involvement of local government and community members and to further adapt the process and tools.
Asunto(s)
Instituciones de Salud/normas , Higiene/normas , Control de Infecciones/normas , Mejoramiento de la Calidad , Saneamiento/normas , Abastecimiento de Agua/normas , Agua/normas , Instituciones de Atención Ambulatoria , Atención a la Salud/normas , Guatemala , Hospitales , HumanosRESUMEN
El abordaje de las normas mínimas de salud pública ambiental en los establecimientos de salud es un componente clave para la seguridad del paciente, del personal de salud, los acompañantes y visitantes. Asegurar el agua, el saneamiento y la higiene del establecimiento de salud es responsabilidad de todos: del personal de salud, de los gestores en los establecimientos, de los proveedores de servicios, de los pacientes y de los acompañantes y visitantes. ⢠Implementar medidas de inspección y vigilancia sobre las condiciones del agua, saneamiento e higiene en los establecimientos de salud. ⢠Asegurar que todo el personal del establecimiento tenga conocimiento de las medidas de agua, saneamiento e higiene a implementar, por ejemplo, acciones para almacenar el agua de manera segura y como garantizar su calidad, el manejo que se le debe dar a los residuos, etc. ⢠Asegurar que el establecimiento de salud cuenta con las instalaciones básicas de agua, saneamiento e higiene para operar, cumpliendo con las normas nacionales. ⢠Adecuar espacios o edificios para la atención hospitalaria que asegure las condiciones óptimas para la prevención de brotes de legionela,2 en coordinación con los operadores de agua e instituciones responsables de salud pública ambiental.
This technical note deals with the minimum environmental public health standards in health facilities, a key component for the safety of the patient, health personnel, visitors, and companions. Recommendations are provided on safe water, sanitation, solid waste, hand washing, and cleaning and disinfection. Ensuring the water, sanitation, and hygiene of the health care facility is the responsibility of everyone: health personnel, facilities managers, service providers, patients, companions, and visitors. ⢠Implement inspection and surveillance measures on water, sanitation, and hygiene conditions in health care facilities. ⢠Ensure that all facility personnel are aware of the water, sanitation, and hygiene measures to be implemented, for example, actions to store water safely and how to guarantee its quality, health care waste management, etc. ⢠Ensure that the health care facility has the basic water, sanitation, and hygiene facilities to operate, complying with national standards. ⢠Adapt spaces or buildings for health care that ensure optimal conditions for the prevention of legionella outbreaks,2 in coordination with water operators and institutions responsible for environmental public health.
Asunto(s)
Humanos , Neumonía Viral/prevención & control , Higiene/normas , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Instituciones de Salud/normasRESUMEN
Despite efforts at various levels, foodborne diseases are an extremely relevant global public health issue. This letter emphasizes the differences between the hygienist approach and the concept of sanitary risk in order to stimulate insights for researchers and decision-makers on the necessary changes in the working, training, and education modes of all agents involved in food production in the face of the new and old challenges in the food safety field.
Asunto(s)
Manipulación de Alimentos/normas , Inocuidad de los Alimentos/métodos , Enfermedades Transmitidas por los Alimentos/prevención & control , Higiene/normas , Humanos , Salud PúblicaAsunto(s)
Humanos , Conocimientos, Actitudes y Práctica en Salud , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/epidemiología , Vigilancia en Salud Pública/métodos , Dispositivos de Protección Respiratoria , Ventilación/normas , Higiene/normas , Urgencias Médicas , Equipos y Suministros/normas , Servicio de Limpieza en Hospital/normasAsunto(s)
Humanos , Conocimientos, Actitudes y Práctica en Salud , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/epidemiología , Vigilancia en Salud Pública/métodos , Dispositivos de Protección Respiratoria/normas , Higiene/normas , Guantes Protectores/normas , Higiene de las Manos/normasRESUMEN
ABSTRACT Objective: to identify men's knowledge on body care. Method: it is a cartographic study with a qualitative approach. The research was conducted with 70 men in the city of Boa Vista, state of Roraima. The strategy for data production was called the meeting. Participants were encouraged to think about epistemic units, care and body, from models that were recorded and their meanings transcribed for content analysis according to Bardin. Results: 282 units of decoded records such as body hygiene, sexual health and physical exercise were evidenced. In the decoding units, the conscious, functional male body is discussed, which serves for health professionals to think about caring approaches. Final considerations: cartographic forays allowed the male body to be recognized for its functionality, with structured knowledge on care in three dimensions: body hygiene, sexuality and sports practices.
RESUMEN Objetivo: identificar el conocimiento de los hombres sobre el cuidado del cuerpo. Método: este es un estudio cartográfico con un enfoque cualitativo. La encuesta se realizó con 70 hombres en ela cuidad de Boa Vista, Roraima. La estrategia para producir los datos se llamó ensamblado. Se alentó a los participantes a pensar en las unidades epistémicas, el cuidado y el cuerpo, a partir de modelos que se registraron y sus significados se transcribieron para el análisis de contenido según Bardin. Resultados: se evidenciaron 282 unidades de registros decodificados, como higiene corporal, salud sexual y ejercicio físico. En las unidades de decodificación, se discute el cuerpo masculino consciente y funcional, que sirve para que los profesionales de la salud piensen en enfoques de cuidado. Consideracion finales: las incursiones cartográficas permitieron reconocer el cuerpo masculino de funcionalidad, con conocimiento estructurado sobre el cuidado en tres dimensiones: higiene corporal, sexualidad y prácticas deportivas.
RESUMO Objetivo: identificar os saberes dos homens sobre o cuidado com o corpo. Método: trata-se de um estudo cartográfico com abordagem qualitativa. A pesquisa foi realizada com 70 homens no município de Boa Vista, Roraima. A estratégia para a produção dos dados foi denominada de assembleia. Os participantes foram estimulados a pensarem as unidades epistêmicas, cuidado e corpo, a partir de modelagens que foram gravadas e, seus significados, transcritos para a análise de conteúdo segundo Bardin. Resultados: foram evidenciadas 282 unidades de registros decodificadas como higiene corporal, saúde sexual e prática de exercícios físicos. Nas unidades de decodificação, é discutido o corpo masculino funcional, tomado de consciência, que serve para os profissionais de saúde pensar abordagens de cuidar. Considerações finais: as incursões cartográficas permitiram reconhecer o corpo masculino da funcionalidade, com saberes estruturados sobre o cuidado em três dimensões: higienização corporal, sexualidade e práticas esportivas.
Asunto(s)
Adolescente , Adulto , Humanos , Masculino , Conocimientos, Actitudes y Práctica en Salud , Salud del Hombre/normas , Medicina Deportiva/normas , Medicina Deportiva/métodos , Brasil , Higiene/normas , Entrevistas como Asunto/métodos , Investigación Cualitativa , Salud Sexual/normasRESUMEN
OBJETIVO: Establecer recomendaciones para la toma de decisiones de manejo en radioterapia durante la pandemia de COVID-19, adaptadas a un país con recursos de salud limitados. MÉTODOS: A través de una revisión rápida de la literatura se buscaron publicaciones que describieran medidas para reducir el riesgo de infección por COVID-19, así como también pautas de manejo para reducir la carga de trabajo en las unidades de radioterapia. Se incluyeron en el alcance de esta revisión las siguientes patologías: tumores ginecológicos, cáncer de mama, tumores gastrointestinales, tumores genitourinarios, tumores de cabeza y cuello, cáncer de piel, tumores del sistema nervioso central y linfomas. Un grupo de expertos discutió en línea los datos extraídos y redactó las recomendaciones. Mediante un método Delphi modificado, se evaluó el consenso entre 14 radio-oncólogos certificados. Se evaluó la calidad de la evidencia que sustentó las recomendaciones sobre esquemas de tratamiento. RESULTADOS: Se incluyeron un total de 57 documentos. De 25 trabajos se extrajeron las estrategias para reducir el riesgo de infección. De los restantes, se obtuvieron las recomendaciones para cada patología. Las recomendaciones están orientadas a establecer escenarios específicos donde se pueden omitir, diferir, priorizar y acortar los tratamientos. En el ítem de acortar se recomiendan esquemas de tratamiento para cada patología, priorizando los esquemas hipofraccionados cuando fue posible. CONCLUSIÓN: Se plantean estrategias para la gestión de los servicios de radioterapia con el objetivo de garantizar que los tratamientos de alta calidad para pacientes oncológicos sigan entregándose, pese a la crisis sanitaria ocasionada por COVID-19.
OBJECTIVE: To generate recommendations on the management of radiotherapeutic treatments during the pandemic, adapted to a country with limited health resources. METHODS: We did a rapid review of the literature, searching for papers that describe any measures to reduce the risk of COVID-19 infection, as well as management guidelines to reduce the workload, in radiotherapy units. The following conditions were included in the scope of this review: gynecological tumors, breast cancer, gastrointestinal tumors, genitourinary tumors, head and neck tumors, skin cancer, tumors of the central nervous system, and lymphomas. An expert group discussed online the extracted data and drafted the recommendations. Using a modified Delphi method, the consensus was reached among 14 certificated radio-oncologists. The quality of the evidence that supported the recommendations on treatment schedules was assessed. RESULTS: A total of 57 documents were included. Of these, 25 provided strategies to reduce the risk of infection. Recommendations for each condiction were extracted from the remaining documents. The recommendations aim to establish specific parameters where treatments can be omitted, deferred, prioritized, and shortened. Treatment schemes are recommended for each condition, prioritizing hypo-fractionated schemes whenever possible. CONCLUSIONS: We propose strategies for the management of radiotherapy services to guarantee the continuity of high-quality treatments despite the health crisis caused by COVID-19.
Asunto(s)
Humanos , Carga de Trabajo , Oncología por Radiación/estadística & datos numéricos , Consenso , Países en Desarrollo/estadística & datos numéricos , SARS-CoV-2 , COVID-19/epidemiología , Cuidados Paliativos/organización & administración , Desinfección/métodos , Higiene/normas , Triaje/organización & administración , Técnica Delphi , Oncología por Radiación/organización & administración , Pandemias/prevención & control , Equipo de Protección Personal , COVID-19/prevención & control , Física Sanitaria , Neoplasias/radioterapia , Enfermedades Profesionales/prevención & control , Enfermedades Profesionales/veterinariaRESUMEN
ABSTRACT Introduction The impact of the new coronavirus (SARS-COV-2) and its worldwide clinical manifestations (COVID-19) imposed specific regional recommendations for populations in need of specialized care, such as children and adolescents with kidney diseases, particularly in renal replacement therapies (RRT). We present the recommendations of the Brazilian Society of Nephrology regarding the treatment of pediatric patients with kidney diseases during the COVID-19 pandemic. Methods Articles and documents from medical societies and government agencies on specific recommendations for children on RRT in relation to COVID-19 as well as those focused on epidemiological aspects of this condition in Brazil Were evaluated and analyzed. Results We present recommendations on outpatient care, transportation to dialysis centers, peritoneal dialysis, hemodialysis, and kidney transplantation in children and adolescents during the COVID-19 pandemic in Brazil. Discussion Despite initial observations of higher mortality rates in specific age groups (the elderly) and with comorbidities (obese, diabetics, and those with cardiovascular diseases), patients with chronic kidney disease (CKD) on RRT are particularly prone to develop COVID-19. Specific measures must be taken to reduce the risk of contracting SARS-CoV-2 and developing COVID-19, especially during transport to dialysis facilities, as well as on arrival and in contact with other patients.
RESUMO Introdução O impacto do novo coronavírus (SARS-CoV-2) e as suas manifestações clínicas (Covid-19) em todo o mundo impôs recomendações regionais específicas a populações que necessitam de cuidados especializados, como crianças e adolescentes com doenças renais, particularmente em terapias de substituição renal (TRS). Apresentamos as recomendações da Sociedade Brasileira de Nefrologia em relação ao tratamento de pacientes pediátricos com doenças renais durante a pandemia Covid-19. Método Foram avaliados e analisados os artigos e documentos sobre recomendações específicas para Covid-19 de sociedades médicas e órgãos governamentais sobre crianças em TRS, bem como aqueles focados em aspectos epidemiológicos dessa condição no Brasil. Resultados Apresentamos as recomendações sobre atendimento ambulatorial, transporte para centros de diálise, diálise peritoneal, hemodiálise e transplante renal em crianças e adolescentes durante a pandemia de Covid-19 no Brasil. Discussão Apesar das observações iniciais de taxas de mortalidade mais altas em grupos etários específicos (idosos) e com comorbidades (obesos, diabéticos e aqueles com doenças cardiovasculares), pacientes com doença renal crônica (DRC) em TRS apresentam risco significativo de evoluir com Covid-19. Medidas específicas devem ser tomadas para reduzir o risco de contrair SARS-CoV-2 e desenvolver a Covid-19, principalmente durante o transporte para instalações de diálise, bem como na chegada e no contato com outros pacientes.
Asunto(s)
Humanos , Niño , Adolescente , Neumonía Viral/epidemiología , Terapia de Reemplazo Renal/normas , Infecciones por Coronavirus/epidemiología , Betacoronavirus , Enfermedades Renales/terapia , Aislamiento de Pacientes , Pediatría , Sociedades Médicas , Brasil/epidemiología , Higiene/normas , Transporte de Pacientes , Trasplante de Riñón , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Pandemias/prevención & control , Evaluación de Síntomas , Atención Ambulatoria , SARS-CoV-2 , COVID-19 , Máscaras , Nefrología/normas , Enfermedades Profesionales/prevención & controlRESUMEN
This study aimed to evaluate health professionals' unhygienic practices and the stages of behaviour change in Brazilian public hospital restaurants. We evaluated all medium/large-sized public hospital restaurants (HRs) from the Brazilian Federal District (n = 9); a representative sample of 128 users). We evaluated the HRs' physical structures, their consumers' socio-demographic characteristics, their unhygienic practices, as well as the stages of behavioural change concerning unhygienic practices. All the HRs presented their menus for self-service distribution, so customers entered in lines to serve themselves. All the HRs had hand-wash sinks for customers; 77.8% offered antiseptic liquid soap; 33.3% offered alcohol gel; and 77.8% offered storage for professional accessories before serving food. Almost half (46.8%) of the customers did not sanitise their hands (with water and antiseptic soap and/or use of alcohol gel) immediately before serving, and 24.2% wore professional uniforms at HRs. Almost half (43.5%) of the customers spoke with each other in line while serving their plates and arranged the food on their plates with the serving utensils from the distribution counter. The declaration of behavioural change was inversely associated with the hygiene practices. Almost half of the individuals did not sanitize their hands; however, 90.4% declared "changed behaviour" when this contaminant practice was presented to them. We verified a high percentage of hygiene practices inconsistent with most of the customers´ answers about their stage of behaviour change. Based on the observations of this study, it is necessary for an awareness program to be developed that is focused on customers of HRs in order to reduce unhygienic practices. Also, it is important to promote new policies for proper hygiene practices in hospital restaurants.