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O estudo tem como objetivo descrever os comportamentos de proteção adotados por estudantes portugue-ses do ensino superior durante a pandemia e analisar a sua relação com a percepção de risco e o papel mediador do medo face à covid-19. Participaram 335 estu-dantes com idades entre os 18 e os 29 anos (m= 21.42; dp= 2.43). Os participantes preencheram um inquérito sobre os comportamentos de proteção (i.e., preventi-vos e de evitamento), a percepção de risco e o medo face à covid-19. Os resultados demonstraram que os comportamentos preventivos mais utilizados foram a lavagem/desinfecção das mãos ao longo do dia e o uso de máscara na via pública ou espaços exteriores. Os comportamentos de evitamento mais adotados foram o de evitar locais com aglomeração e os convívios presenciais com colegas/amigos. Verificouse uma as-sociação positiva entre os comportamentos de proteção, a percepção de gravidade e o medo face à covid-19. O medo face à covid-19 foi mediador da relação entre a percepção de gravidade e os comportamentos preventivos (c' = .26, ic 95% [.11; .44]) e de evitamento (c' = .28, ic 95% [.12; .50]). Os resultados são discutidos aten-dendo ao papel da percepção de risco e do medo nas respostas comportamentais dos jovens, num contexto de pandemia, sendo apresentadas implicações práticas e sugestões para estudos futuros.

El estudio tiene como objetivo describir las conductas protectoras adoptadas por los estudiantes portugueses de educación superior durante la pandemia, y analizar su relación con la percepción de riesgo y el papel mediador del miedo al covid-19. Participaron en el estudio 335 estudiantes de entre 18 y 29 años (m = 21.42; ds = 2.43). Los participantes completaron una encuesta sobre conductas protectoras (es decir, preventivas y de evitación), percepción de riesgo y miedo al covid-19. Los resultados mostraron que las conductas preventivas más utilizadas fueron el lavado/desinfección de manos a lo largo del día y el uso de mascarilla en la vía pública o al aire libre. Los comportamientos de evitación más adoptados fueron evadir lugares con reuniones e interacciones cara a cara con compañeros/amigos. Hubo una correlación positiva entre las conductas protectoras, la percepción de seriedad y el miedo al covid-19. También se encontró que el miedo al covid-19 medió la relación entre la percepción de severidad y las conductas preventivas (c' = .26, ic 95% [.11; .44]) y de evitación (c' = .28, ic 95% [.12; .50]). Los resultados se discuten considerando el papel de la percepción del riesgo y el miedo en las respuestas conductuales de los jóvenes en un contexto pandémico, así mismo se presentan impli-caciones prácticas y sugerencias para estudios futuros.

The study aims to describe the protective behaviors adopted by Portuguese higher education students in during the and to analyze their relationship with the perception of risk and the mediating role of fear of covid-19. A total of 335 students aged be-tween 18 and 29 participated in the study (m= 21.42; sd = 2.43). Participants completed a survey on protective (i.e., preventive and avoidance) behaviors, risk perception, and fear of covid-19. The results showed that the most used preventive behaviors were hand washing/disinfection throughout the day and using masks in public streets or outdoor spaces. The most adopted avoidance behaviors were avoiding crowded places and face-to-face interactions with colleagues/friends. There was a positive correlation between pro-tective behaviors, the perception of severity, and fear of covid-19. Fear of covid-19 mediated the relation between the perception of severity and both preventive (c' = .26, ic 95% [.11; .44]) and avoidance (c' = .28, ic95% [.12; .50]) behaviors. The results are discussed considering the role of risk perception and fear in the behavioral responses of young people in a pandemic context while presenting practical implications and suggestions for future studies.

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INTRODUCTION: Healthcare-associated infections (HCAI) are major causes of morbidity, mortality, increased lengths of stay and are an economic burden on healthcare systems in resources-limited settings. This is especially true for neonates, who are more susceptible with underdeveloped immune systems. Hand hygiene (HH) is a key weapon against HCAI, yet globally, HH compliance remains substandard. This study sought to determine the compliance with HH among healthcare workers (HCWs) in a children's hospital neonatal intensive care unit (NICU) in Haiti. METHODS: A HH educational intervention was performed in the NICU, including lectures and posters. Pre- and post-intervention HH data were collected on HCWs and parents using the World Health Organization '5 Moments for HH'. Data were analyzed using standard statistical analysis. RESULTS: HH increased in all HCW roles but not in parents. Correct HH increased in all groups, including parents. HH was more likely to occur prior to patient contact than after patient contact. Correct HH was more likely to occur with alcohol-based hand rub than with soap and water. CONCLUSION: This study demonstrates that an inexpensive and simple intervention can significantly increase HH compliance in a resource-limited NICU, which may lead to decreased rates of hospital-acquired sepsis. Parents, however, due to cultural norms as well as literacy and language barriers, need targeted educational interventions distinct from those that HCW benefit from.

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BACKGROUND: Neonatal mortality rates in Haiti are among the highest in the Western hemisphere. Few mothers deliver with a skilled birth attendant present, and there is a significant lack of pediatricians. The neonatal intensive care unit (NICU) at St. Damien Pediatric Hospital, a national referral center, is one of only five neonatology departments in Haiti. In order to target limited resources toward improving outcomes, this study seeks to describe clinical care in the St. Damien NICU. METHODS: A retrospective medical record review was performed on available medical records on all admissions to the NICU between April 2016 and April 2017. RESULTS: 220 neonates were admitted to the NICU within the study epoch. The mortality rate was 14.5%. Death was associated with a maternal diagnosis of hypertension (p = 0.03) and neonatal diagnoses of lower gestational age (p<0.0001), lower birth weight (p<0.0001), prematurity (p = 0.002), RDS p = 0.01), sepsis (p<0.0001) and kernicterus (p = 0.04). The most common diagnoses were sepsis, chorioamnionitis, respiratory distress syndrome, jaundice, prematurity and perinatal asphyxia. CONCLUSIONS: This study demonstrates that preterm birth, sepsis, RDS and kernicterus are key contributors to neonatal mortality in a Haitian national pediatric referral center NICU and as such are promising interventional targets for reducing the neonatal mortality rate in Haiti.

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Global health initiatives from academic medical centers have rapidly proliferated over the last decade. This paper endeavors to describe our 5-year experience as an academic medical collaborative supporting healthcare delivery, medical training, and research at Hôpital Saint Damien-Nos Petits Frères et Soeurs, the only freestanding children's hospital in Haiti. Descriptions of the history and current activities of our academic medical collaborative, its partnership and communication structure, its evolution to fill the expressed needs of our host site, its funding mechanisms, and its challenges and opportunities for the future are included.

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Infections (including sepsis, meningitis, pneumonia and tetanus) stand as a major contributor to neonatal mortality in Haiti (22%). Infants acquire bacteria that cause neonatal sepsis directly from the mother's blood, skin or vaginal tract either before or during delivery. Nosocomial and environmental pathogens introduce further risk after delivery. The absence of cohesive medical systems and methods for collecting information limits the available data in countries such as Haiti. This study seeks to add more information on the burden of severe bacterial infections and their etiology in neonates of Haiti. Researchers conducted a secondary retrospective analysis of a de-identified database from the Neonatal Intensive Care Unit (NICU) at Nos Petit Frères et Soeurs-St. Damien Hospital (NPFS-SDH). Records from 1292 neonates admitted to the NICU at NPFS-SDH in Port-au-Prince Haiti from 2013 to 2015 were reviewed. Sepsis accounted for 708 of 1292 (54.8%) of all admissions to the NICU. Infants admitted for sepsis had a mortality rate of 23% (163 of 708 infants admitted for sepsis). The most common organism cultured was Streptococcus agalactiae, followed by Klebsiella pneumoniae, Pseudomonas aeroginusa, Enterobacter aerogenes, Staphylococcus aureus and Proteus mirabillis Failure to order or obtain a culture was associated with an increased fatality (odds ratio 2.4) for infants with sepsis. Resistance should be a concern when treating empirically.

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The world is becoming more interconnected with a need for a global approach to healthcare. Brown University has remained a leader in global health through clinical service, education, cutting edge research and dedication to the development of sustainable global partnerships. We describe two programs from the ground up in Haiti and Ukraine, and the important lessons learned in their development. The path towards the development of global health programs in Ukraine and Haiti both illustrate that although circumstances may vary between global health programs, the recipe for successful collaboration is the same: identifying specific needs, developing strong and sustained partnerships, and addressing barriers by crafting effective solutions to ongoing challenges.

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