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Morbidity and mortality from several diseases are increased on days of higher ambient air pollution. We carried out a daily time-series analysis with distributive lags to study the influence of short-term air pollution exposure on COVID-19 related hospitalization in Santiago, Chile between March 16 and August 31, 2020. Analyses were adjusted for temporal trends, ambient temperature, and relative humidity, and stratified by age and sex. 26,579 COVID-19 hospitalizations were recorded of which 24,501 were laboratory confirmed. The cumulative percent change in hospitalizations (95% confidence intervals) for an interquartile range increase in air pollutants were: 1.1 (0.2, 2.0) for carbon monoxide (CO), 0.30 (0.0, 0.50) for nitrogen dioxide (NO2), and 2.7 (1.9, 3.0) for particulate matter of diameter ≤ 2.5 microns (PM2.5). Associations with ozone (O3), particulate matter of diameter ≤ 10 microns (PM10) and sulfur dioxide (SO2) were not significant. The observed effect of PM2.5 was significantly greater for females and for those individuals ≥ 65 years old. This study provides evidence that daily increases in air pollution, especially PM2.5, result in a higher observed risk of hospitalization from COVID-19. Females and the elderly may be disproportionately affected.

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A multicenter diagnostic study was conducted to investigate the implementation of an Antimicrobial Stewardship Program in Brazilian Pediatric Intensive Care Units. The analysis unveiled the main implementation impediments of the Antimicrobial Stewardship Program such as the lack of professionals and resources available to the program.

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[This corrects the article DOI: 10.1017/ash.2023.136.].

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Objective: Data are scarce regarding hospital infection control committees and compliance with infection prevention and control (IPC) recommendations in Brazil, a country of continental dimensions. We assessed the main characteristics of infection control committees (ICCs) on healthcare-associated infections (HAIs) in Brazilian hospitals. Methods: This cross-sectional study was conducted in ICCs of public and private hospitals distributed across all Brazilian regions. Data were collected directly from the ICC staff by completing an online questionnaire and during on-site visits through face-to-face interviews. Results: In total, 53 Brazilian hospitals were evaluated from October 2019 to December 2020. All hospitals had implemented the IPC core components in their programs. All centers had protocols for the prevention and control of ventilator-associated pneumonia as well as bloodstream, surgical site, and catheter-associated urinary tract infections. Most hospitals (80%) had no budget specifically allocated to the IPC program; 34% of the laundry staff had received specific IPC training; and only 7.5% of hospitals reported occupational infections in healthcare workers. Conclusions: In this sample, most ICCs complied with the minimum requirements for IPC programs. The main limitation regarding ICCs was the lack of financial support. The findings of this survey support the development of strategic plans to improve IPCs in Brazilian hospitals.

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RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.

ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.

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OBJECTIVE: To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections. METHODS: This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period. RESULTS: The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections. CONCLUSION: The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.

OBJETIVO: Descrever a implementação e os resultados da colaborativa PROADI-SUS, do Ministério da Saúde Brasileiro, para redução das infecções relacionadas à assistência à saúde: pneumonia associada à ventilação mecânica, infecção primária da corrente sanguínea associada ao cateter venoso central e infecção do trato urinário associada ao cateter vesical de demora. MÉTODOS: Estudo observacional prospectivo que pesquisou as etapas da implementação e dos resultados por 18 meses, em cinco unidades de terapia intensiva de Recife. As reduções de infecções relacionadas à assistência à saúde em cada unidade foram calculadas pelas medianas anteriores comparadas ao período do estudo. RESULTADOS: A meta de redução das três infecções relacionadas à assistência à saúde, ou seja, 30% em 18 meses, foi obtida em no mínimo uma das infecções relacionadas à assistência à saúde nas cinco unidades de terapia intensiva, sendo ainda atingida para duas infecções relacionadas à assistência à saúde em dois hospitais e nas três infecções relacionadas à assistência à saúde em apenas um hospital; este último atingiu a meta prevista para 36 meses. Foram ações consideradas essenciais pelas equipes gestoras locais a implantação dos bundles e o acompanhamento dos resultados pelos profissionais. Também, aquisição de insumos e disponibilização junto aos leitos, sinalização, checklists, conscientização da equipe, adaptação, criação de times, treinamento e comemoração de conquistas foram avaliados como relevantes para redução das infecções relacionadas à assistência à saúde. CONCLUSÃO: A colaborativa reduziu infecções relacionadas à assistência à saúde, apesar da adesão parcial aos bundles. A hipótese é a de que o êxito se relacione com a metodologia do projeto e equipes multiprofissionais motivadas, especialmente a enfermagem.

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RESUMEN Objetivos: Determinar el impacto de caries y trauma dental en la calidad de vida de preescolares y sus familias. Material y Métodos : Estudio observacional, transversal en 150 preescolares de 3 a 5 años de ambos géneros de escuelas privadas urbanas y públicas urbano marginales. Los padres firmaron el consentimiento, respondieron la ficha socioeconómica y el cuestionario ECOHIS (Early Childhood Oral Health Impact Scale) según la percepción de Calidad de Vida Relacionada a la Salud Bucal(CVRSB) de sus hijos. Tres examinadoras fueron calibradas y se midió la concordancia intra e inter-examinador resultando Kappa 0,9. Los criterios establecidos por la OMS se aplicaron durante el examen clínico de caries y trauma dental. Para el análisis estadístico se utilizó el paquete estadístico SPSS y hojas de cálculo. Se relacionó caries dental y CVRSB (p<0,005 Anova), traumatismo dental y CVRSB (p<0,05 U de Mann Whitney). Resultados : Los dominios con impacto negativo en ECOHIS fueron síntomas orales (20%) y angustia de los padres (44,7%). En la sección impacto en el niño del ECOHIS, las escuelas públicas rurales presentaron un promedio alto de experiencia (14) y progresión (1,47) de caries. Mientras que en la sección impacto en la familia las escuelas privadas urbanas fueron más afectadas por el dominio traumatismos dentales (66,7%). Conclusiones : La caries dental generó un impacto negativo en los niños, familias y CVRSB de preescolares de escuelas públicas rurales. Los traumatismos dentales sólo afectaron a las familias en escuelas privadas urbanas.

ABSTRACT Objective: To determine the impact of caries and dental trauma on the quality of life of pre-school children and their families. Material and Methods : Observational, cross-sectional study in 150 pre-school children from 3 to 5 years old of both genders of urban and marginal urban educational institutions. The parents signed the consent and answered the socio-economic file and the ECOHIS questionnaire (Early Childhood Oral Health Impact Scale) according to the perception of oral health related Quality of Life (QoL) of their children. Three examiners were calibrated, intra and inter-examiner agreement was measured, the result was Kappa 0.9. The criteria established by the WHO were applied during the clinical examination of caries and dental trauma. The statistical analysis was performed by SPSS statistical package and spreadsheets. Dental caries was related to HRQOL (p <0.005 Anova), and dental trauma to HRQOL (p <0.05 U of Mann Whitney). Results : The domains with negative impact on ECOHIS were oral symptoms (20%) and parental distress (44.7%). The impact on the child section of the ECOHIS rural public schools presented a high average experience (14) and progression (1.47) of caries. While the impact on the family section, urban private schools were affect by dental trauma (66.7%). Conclusions : Caries generated a negative impact on children, families and HRQoL of pre-school children from rural public schools. Dental trauma only affected families in urban private schools.

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With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.

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Bleached kraft pulps from eucalyptus and pine were subjected to cold caustic extraction (CCE) with NaOH (5, 10, 17.5, and 35%) for hemicelluloses removal and to increase cellulose accessibility. The effect of these changes was evaluated in enzymatic saccharification with the multicomponent Cellic CTec3 enzyme cocktail, and in viscosity reduction of pulps with the monocomponent Trichoderma reesei endoglucanase (EG). After CCE with 10% NaOH (CCE10) and 17.5% NaOH (CCE17.5), hemicellulose content lower than 1% was achieved in eucalyptus and pine pulps, respectively. At these concentrations, cellulose I started to be converted into cellulose II. NaOH concentrations higher than 17.5% decreased the intrinsic viscosity (from 730 to 420 mL/g in eucalyptus and from 510 to 410 mL/g in pine). Cellulose crystallinity was reduced from 60% to 44% in eucalyptus and from 71% to 44% in pine, as the NaOH concentration increased. Enzymatic multicomponent saccharification showed higher glucose yields in all CCE-treated eucalyptus samples (up to 93%) while only CCE17.5 and CCE35 pine pulps achieved 90% after 40 h of incubation. Untreated bleached pulps of both species presented saccharification yields lower than 70%. When monocomponent EG was used to treat the same pulps, depending on enzyme charge and incubation time, a wide range of intrinsic viscosity reduction was obtained (up to 74%). Results showed that eucalyptus pulps are more accessible and easier to hydrolyze by enzymes than pine pulps and that the conversion of cellulose I to cellulose II hydrate only has the effect of increasing saccharification of CCE pine samples. Viscosity reduction of CCE pulps and EG treated pulps were obtained in a wide range indicating that pulps presented characteristics suitable for cellulose derivatives production.

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RESUMO Objetivo: Descrever a implementação e os resultados da colaborativa PROADI-SUS, do Ministério da Saúde Brasileiro, para redução das infecções relacionadas à assistência à saúde: pneumonia associada à ventilação mecânica, infecção primária da corrente sanguínea associada ao cateter venoso central e infecção do trato urinário associada ao cateter vesical de demora. Métodos: Estudo observacional prospectivo que pesquisou as etapas da implementação e dos resultados por 18 meses, em cinco unidades de terapia intensiva de Recife. As reduções de infecções relacionadas à assistência à saúde em cada unidade foram calculadas pelas medianas anteriores comparadas ao período do estudo. Resultados: A meta de redução das três infecções relacionadas à assistência à saúde, ou seja, 30% em 18 meses, foi obtida em no mínimo uma das infecções relacionadas à assistência à saúde nas cinco unidades de terapia intensiva, sendo ainda atingida para duas infecções relacionadas à assistência à saúde em dois hospitais e nas três infecções relacionadas à assistência à saúde em apenas um hospital; este último atingiu a meta prevista para 36 meses. Foram ações consideradas essenciais pelas equipes gestoras locais a implantação dos bundles e o acompanhamento dos resultados pelos profissionais. Também, aquisição de insumos e disponibilização junto aos leitos, sinalização, checklists, conscientização da equipe, adaptação, criação de times, treinamento e comemoração de conquistas foram avaliados como relevantes para redução das infecções relacionadas à assistência à saúde. Conclusão: A colaborativa reduziu infecções relacionadas à assistência à saúde, apesar da adesão parcial aos bundles. A hipótese é a de que o êxito se relacione com a metodologia do projeto e equipes multiprofissionais motivadas, especialmente a enfermagem.

ABSTRACT Objective: To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections. Methods: This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period. Results: The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections. Conclusion: The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.

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Abstract With the emergence of new variants of SARS-CoV-2, questions about transmissibility, vaccine efficacy, and impact on mortality are important to support decision-making in public health measures. Modifications related to transmissibility combined with the fact that much of the population has already been partially exposed to infection and/or vaccination, have stimulated recommendations to reduce the isolation period for COVID-19. However, these new guidelines have raised questions about their effectiveness in reducing contamination and minimizing impact in work environments. Therefore, a collaborative task force was developed to review the subject in a non-systematic manner, answering questions about SARS-CoV-2 variants, COVID-19 vaccines, isolation/quarantine periods, testing to end the isolation period, and the use of masks as mitigation procedures. Overall, COVID-19 vaccines are effective in preventing severe illness and death but are less effective in preventing infection in the case of the Omicron variant. Any strategy that is adopted to reduce the isolation period should take into consideration the epidemiological situation of the geographical region, individual clinical characteristics, and mask for source control. The use of tests for isolation withdrawal should be evaluated with caution, due to results depending on various conditions and may not be reliable.

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BACKGROUND: Exposure to ambient air pollution is a risk factor for morbidity and mortality from lung and heart disease. RESEARCH QUESTION: Does short term exposure to ambient air pollution influence COVID-19 related mortality? STUDY DESIGN AND METHODOLOGY: Using time series analyses we tested the association between daily changes in air pollution measured by stationary monitors in and around Santiago, Chile and deaths from laboratory confirmed or suspected COVID-19 between March 16 and August 31, 2020. Results were adjusted for temporal trends, temperature and humidity, and stratified by age and sex. RESULTS: There were 10,069 COVID-19 related deaths of which 7659 were laboratory confirmed. Using distributed lags, the cumulative relative risk (RR) (95% CI) of mortality for an interquartile range (IQR) increase in CO, NO2 and PM2.5 were 1.061 (1.033-1.089), 1.067 (1.023-1.103) and 1.058 (1.034-1.082), respectively There were no significant differences in RR by sex.. In those at least 85 years old, an IQR increase in NO2 was associated with a 12.7% (95% CI 4.2-22.2) increase in daily mortality. CONCLUSION: This study provides evidence that daily increases in air pollution increase the risk of dying from COVID-19, especially in the elderly.

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BACKGROUND: Healthcare-associated infections (HAIs) are relevant in developing countries where frequencies can be at least 3 times higher than in developed countries. The purpose of this research was to describe the intervention implemented in intensive care units (ICUs) to reduce HAIs through collaborative project and analyze the variation over 18 months in the incidence density (ID) of the three main HAIs: ventilator associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs) and catheter-related urinary tract infections (CAUTIs) and also the length of stay and mortality in these ICUs. METHODS: A quasi-experimental study in five public adult clinical-surgical ICUs, to reduce HAIs, through interventions using the BTS-IHI "Improvement Model", during 18 months. In the project, promoted by the Ministry of Health, Brazilian philanthropic hospitals certified for excellence (HE), those mostly private, certified as excellence and exempt from security contributions, regularly trained and monitored public hospitals in diagnostics, data collection and in developing cycles to improve quality and to prevent HAIs (bundles). In the analysis regarding the length of stay, mortality, the IDs of VAP, CLABSIs and CAUTIs over time, a Generalized Estimating Equation (GEE) model was applied for continuous variables, using the constant correlation (exchangeable) between assessments over time. The model estimated the average difference (ß coefficient of the model) of the measures analyzed during two periods: a period in the year 2017 (prior to implementing the project) and in the years 2018 and 2019 (during the project). RESULT: A mean monthly reduction of 0.427 in VAP ID (p = 0.002) with 33.8% decrease at the end of the period and 0.351 in CAUTI ID (p = 0.009) with 45% final decrease. The mean monthly reduction of 0.252 for CLABSIs was not significant (p = 0.068). Length of stay and mortality rates had no significant variation. CONCLUSIONS: Given the success in reducing VAP and CAUTIs in a few months of interventions, the achievement of the collaborative project is evident. This partnership among public hospitals/HE may be applied to other ICUs including countries with fewer resources.

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Genetic and environmental factors are thought to influence the activity of systemic lupus erythematosus (SLE), but relatively little is known about the effects of ambient air pollution. Using pollution data from air monitoring stations in the urban centers in Santiago Chile, along with daily patient hospitalization data from 2001 to 2012, an association between ambient air pollution and daily hospital admissions for SLE was tested using generalized linear models. Averaged over all regions pollutant mean 24 h concentrations were: 0.96 ppm carbon monoxide (CO), 64 ppb ozone (O3), 43 ppb nitrogen dioxide (NO2), 9 ppb sulphur dioxide (SO2), 29 µg/m3 particulate matter ≤ 2.5 µm in mean aerodynamic diameter (PM2.5), and 67 µg/m3 particulate matter ≤ 10 µm in diameter (PM10). The relative risk estimates in single pollutant models for an interquartile range (IQR) increase in pollutant were: RR = 1.34 (95% CI: 1.06-1.83) for SO2, RR = 1.60 (95% CI: 1.15-2.24) for CO, and RR = 1.41 (95% CI: 1.14-1.86) for PM2.5. In two-pollutant models, the significance of SO2 and PM2.5 persisted despite adjustments for each of the other measured pollutants. These findings suggest that acute increases in air pollution increase the risk of hospitalization with a primary diagnosis of SLE.

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Objective: To compare maternal and perinatal outcomes between day-time and evening/night-time births in a low-risk population. Material and Methods: The present study had a retrospective and cross-sectional design. The study recruited 421 pregnant women admitted for spontaneous or induced labor, with singleton, full-term pregnancy, without comorbidities, and with birthweight between 2,500 and 4,499 g. Maternal data, including severe bleeding, need for blood transfusion, puerperal infection, and admission to the intensive care unit, and neonatal data including birthweight, Apgar scores at first and fifth minute, oxygen administration, resuscitation, admission to the neonatal care unit, infection, and blood transfusion, were evaluated. Univariate and multivariate analysis and calculation of the prevalence ratio (PR) were performed with a 95% confidence interval (CI). Results: There were no differences in factors of maternal morbidity between delivery times. Newborns delivered during the evening/night-time had a higher prevalence of infection (15.3% vs 7.9%, p=0.019, PR: 2.11, CI 95% 1.13-3.93) and hospitalization in the neonatal care unit (25.8% vs 10.4%, p<0.001, PR: 2.99, CI 95% 1.76-5.10). There was no difference in other perinatal morbidities examined. Conclusion: Evening/night-time births were associated with a higher prevalence of infection and the need for admission to an intensive care unit.