RESUMO
Esta edição do boletim apresenta a análise do total de casos confirmados de COVID-19 de residentes no estado do Rio de Janeiro e suas nove regiões de saúde, incluindo os casos de Síndrome Gripal (SG) ou casos leves, as internações ou casos de Síndrome Respiratória Aguda Grave (SRAG) e os óbitos, ocorridos desde o início da pandemia em 2020 até 26 de fevereiro de 2022 (8ª Semana Epidemiológica).
Assuntos
Saúde Pública/normas , Síndrome Respiratória Aguda Grave/complicações , Agência Nacional de Vigilância Sanitária , SARS-CoV-2/patogenicidade , Infecções Respiratórias/mortalidade , Manejo de Espécimes/estatística & dados numéricos , Cobertura Vacinal/normas , COVID-19/diagnóstico , COVID-19/prevenção & controle , Pesquisa sobre Serviços de Saúde/classificaçãoRESUMO
Correct processing of blood cultures may impact individual patient management, antibiotic stewardship, and scaling up of antimicrobial resistance surveillance. To assess the quality of blood culture processing, we conducted four assessments at 16 public hospitals across different regions of Peru. We assessed the following standardized quality indicators: 1) positivity and contamination rates, 2) compliance with recommended number of bottles/sets and volume of blood sampled, 3) blood culture utilization, and 4) possible barriers for compliance with recommendations. Suboptimal performance was found, with a median contamination rate of 4.2% (range 0-15.1%), with only one third of the participating hospitals meeting the target value of < 3%; and a median positivity rate of 4.9% (range 1-8.1%), with only 6 out of the 15 surveilled hospitals meeting the target of 6-12%. None of the assessed hospitals met both targets. The median frequency of solitary blood cultures was 71.9% and only 8.9% (N = 59) of the surveyed adult bottles met the target blood volume of 8 - 12 mL, whereas 90.5% (N = 602) were underfilled. A high frequency of missed opportunities for ordering blood cultures was found (69.9%, 221/316) among patients with clinical indications for blood culture sampling. This multicenter study demonstrates important shortcomings in the quality of blood culture processing in public hospitals of Peru. It provides a national benchmark of blood culture utilization and quality indicators that can be used to monitor future quality improvement studies and diagnostic stewardship policies.
Assuntos
Hemocultura/normas , Hospitais Públicos/normas , Sepse/diagnóstico , Manejo de Espécimes/normas , Hemocultura/estatística & dados numéricos , Humanos , Peru , Controle de Qualidade , Sepse/sangue , Manejo de Espécimes/estatística & dados numéricos , Inquéritos e Questionários/normasRESUMO
Violence is a growing public health problem worldwide. Nurses increasingly must perform forensic procedures with the responsibility to collect, document, preserve, and store evidence that may be used in the investigation of a violent crime. However, few nurses receive education in forensic evidence collection as part of their training. This study aimed to evaluate the relationship between nurses' knowledge and performance of forensic evidence procedures. This is a descriptive survey study of nurses working in a prehospital emergency care service in Aracaju, Brazil. A 32-question survey related to forensic evidence knowledge and procedures was completed by 128 nurses. Descriptive statistics and Kendall's Tau-b were used to describe the sample and evaluate correlations. Results revealed an overall linear relationship between knowledge and performance of forensic evidence procedures (r = .69). The strongest correlation was between knowledge and documentation (r = .71). Weaker correlations were demonstrated between knowledge and evidence collection (r = .47), evidence preservation (r = .47), and overall evidence procedure execution (r = .53). Forensic nursing knowledge is related to forensic evidence procedure performance. Although the study showed that nurses agreed forensic evidence procedures are important for criminal investigations, most reported they were unprepared to carry out these procedures. The need for additional training and adherence to established institutional protocols are identified as contributing factors.
Assuntos
Documentação/métodos , Documentação/normas , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Enfermagem Forense/métodos , Enfermagem Forense/normas , Manejo de Espécimes/normas , Adulto , Brasil , Documentação/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Enfermagem Forense/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Manejo de Espécimes/estatística & dados numéricos , Inquéritos e Questionários , Violência/estatística & dados numéricosRESUMO
OBJECTIVE: We evaluated acceptability of cervico-vaginal self-collection (CVSC) and prevalence of human papillomavirus (HPV) in Human immunodeficiency virus (HIV)-infected and HIV-uninfected women living in the Tapajós region, Amazon, Brazil. METHODS: Cross-sectional study recruited 153 non-indigenous women (HIV-uninfected, nâ¯=â¯112 and HIV-infected, nâ¯=â¯41) who voluntarily sought assistance in health services. Peripheral blood for HIV screening and cervical scraping (CS) for HPV detection were collected. Women who accepted to perform CVSC received instructions and individual collection kits. Risk factors for high-risk HPV genotypes (hrHPV) were identified by uni- and multivariate analyses. RESULTS: The overall acceptability of CVSC was 87%. Only HIV-infected women had cytological abnormalities (12.2%). Prevalence of any HPV and hrHPV infection was 42.9% and 47.9% for HIV-uninfected and 97.6% and 77.5% for HIV-infected women, respectively. There was significant agreement in the detection of HPV (88%, 0.76, 95% confidence interval [CI], 0.65-0.87) and hrHPV (79.7%, 0.56, 95% CI, 0.41-0.71) between self-collected and clinician-collected samples. The most prevalent hrHPV types were HPV16 and HPV18 in HIV-uninfected and HPV16, HPV51 and HPV59 in HIV-infected women. HIV-infected women with hrHPV infection had multiple hrHPV infections (pâ¯=â¯0.005) and lower CD4 count (pâ¯=â¯0.018). Risk factors for hrHPV infection included being HIV-infected and having five or more sexual partners. CONCLUSIONS: CVSC had high acceptability and high prevalence of hrHPV types in women living in the Tapajós region, Amazon, Brazil.
Assuntos
Detecção Precoce de Câncer/métodos , Programas de Rastreamento/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Contagem de Linfócito CD4 , Colo do Útero/patologia , Colo do Útero/virologia , Estudos Transversais , DNA Viral/isolamento & purificação , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Genótipo , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HIV/patologia , Infecções por HIV/virologia , Humanos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/sangue , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/patologia , Prevalência , Fatores de Risco , Manejo de Espécimes/métodos , Manejo de Espécimes/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Vagina/patologia , Vagina/virologia , Adulto JovemRESUMO
BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most frequent causes of bacterial sexually transmitted infections (STIs). Management strategies that reduce losses in the clinical pathway from infection to cure might improve STI control and reduce complications resulting from lack of, or inadequate, treatment. OBJECTIVES: To assess the effectiveness and safety of home-based specimen collection as part of the management strategy for Chlamydia trachomatis and Neisseria gonorrhoeae infections compared with clinic-based specimen collection in sexually-active people. SEARCH METHODS: We searched the Cochrane Sexually Transmitted Infections Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS on 27 May 2015, together with the World Health Organization International Clinical Trials Registry (ICTRP) and ClinicalTrials.gov. We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. SELECTION CRITERIA: Randomized controlled trials (RCTs) of home-based compared with clinic-based specimen collection in the management of C. trachomatis and N. gonorrhoeae infections. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. We contacted study authors for additional information. We resolved any disagreements through consensus. We used standard methodological procedures recommended by Cochrane. The primary outcome was index case management, defined as the number of participants tested, diagnosed and treated, if test positive. MAIN RESULTS: Ten trials involving 10,479 participants were included. There was inconclusive evidence of an effect on the proportion of participants with index case management (defined as individuals tested, diagnosed and treated for CT or NG, or both) in the group with home-based (45/778, 5.8%) compared with clinic-based (51/788, 6.5%) specimen collection (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.60 to 1.29; 3 trials, I² = 0%, 1566 participants, moderate quality). Harms of home-based specimen collection were not evaluated in any trial. All 10 trials compared the proportions of individuals tested. The results for the proportion of participants completing testing had high heterogeneity (I² = 100%) and were not pooled. We could not combine data from individual studies looking at the number of participants tested because the proportions varied widely across the studies, ranging from 30% to 96% in home group and 6% to 97% in clinic group (low-quality evidence). The number of participants with positive test was lower in the home-based specimen collection group (240/2074, 11.6%) compared with the clinic-based group (179/967, 18.5%) (RR 0.72, 95% CI 0.61 to 0.86; 9 trials, I² = 0%, 3041 participants, moderate quality). AUTHORS' CONCLUSIONS: Home-based specimen collection could result in similar levels of index case management for CT or NG infection when compared with clinic-based specimen collection. Increases in the proportion of individuals tested as a result of home-based, compared with clinic-based, specimen collection are offset by a lower proportion of positive results. The harms of home-based specimen collection compared with clinic-based specimen collection have not been evaluated. Future RCTs to assess the effectiveness of home-based specimen collection should be designed to measure biological outcomes of STI case management, such as proportion of participants with negative tests for the relevant STI at follow-up.
Assuntos
Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Gonorreia/diagnóstico , Neisseria gonorrhoeae/isolamento & purificação , Manejo de Espécimes/métodos , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Autocuidado/métodos , Autocuidado/estatística & dados numéricos , Manejo de Espécimes/estatística & dados numéricosRESUMO
In Instituto de Cardiología y Cirugía Cardiovascular, Fundación Favaloro, between January 1996 and October 1999, 10,793 blood cultures and 942 episodes of bacteremia, corresponding to 1883 positive blood cultures, were studied by means of the Bact-Alert System (Organon Teknika), 94% being monomicrobial episodes. Gram positive bacteria were isolated in 45%, Gram negative in 52% and fungi in 3% of episodes. Associated foci of infection were: catheters 36.5%, mediastinitis 9%, pneumonia 6%, endocarditis 6%, abdominal 6%, urinary tract infections 9%, prosthesis 2.6%, empyema 0.2%, arthritis 0.1%, skin and soft tissue 2.5%, diarrhea 0.1%, aortic aneurysm 0.2%, meningitis 0.2%, pericarditis 0.3%, endarteritis 0.1%, infusion fluids 0.2% and unknown 21%. Median time (in hours) for positivization of blood cultures according to different foci were: catheters 16.4, mediastinitis 19.2, pneumonia 14.2, endocarditis 14.5, abdominal infections 11.8, urinary tract infections 13.0 and unknown origin 19.0. As for contaminating microorganisms, the value was 30.5. Seventy two percent of blood cultures became positive within 24 h, and 87% within 48 h; only 1% became positive between 5th and 7th day. There were no important differences in time to detect positive cultures according to different foci. It was not useful to incubate blood cultures more than five days, except for special circumstances, because it does not improve recovery of clinically significant microorganisms.
Assuntos
Bacteriemia/epidemiologia , Bactérias/isolamento & purificação , Técnicas Bacteriológicas , Serviço Hospitalar de Cardiologia/estatística & dados numéricos , Infecção Hospitalar/epidemiologia , Argentina/epidemiologia , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/microbiologia , Feminino , Fungemia/diagnóstico , Fungemia/epidemiologia , Fungemia/microbiologia , Fungos/isolamento & purificação , Humanos , Masculino , Manejo de Espécimes/estatística & dados numéricos , Fatores de TempoRESUMO
El índice de hidroxiprolina es un indicador de crecimiento, originalmente utilizado en muestras de orina casual, asumiendo que sus variaciones a lo largo del día no son significativas. Sin embargo, la excreción de hidroxiprolina sigue un ritmo circadiano. El objetivo de este trabajo fue evaluar las variaciones que dependan de la muestra utilizada y en qué medida afectan la interpretación de los resultados obtenidos. Para ello, se recolectaron 3 muestras de orina diferentes: basal, primera micción de la mañana y casual, en 11 niños normales entre 3 y 9 años de edad. Se compararon los valores obtenidos en las 3 muestras para el mismo niño mediante ANOVA con Medidas Repetidas y a posteriori el Test de Tukey. Los índices de hidroxiprolina determinados en orina casual fueron significativamente más bajos que los realizados en orina basal (p < 0,01) o en la primera micción de la mañana (p < 0,01), mientras que las diferencias entre estas dos últimas muestras fueron no significativas. 7 niños presentaron índices menores al valor de referencia cuando se determinaron en orina casual, 2 niños cuando se utilizó la primera micción de la mañana y sólo 1 cuando se usó orina basal. El índice de hidroxiprolina varió con la muestra utilizada y dicha variación afectó la interpretación de los resultados. Basados en dichos resultados y en las particularidades de las muestras estudiadas, consideramos que la orina casual no es apropiadad para la determinación de este indicador, siendo la muestra de orina basal la más indicada. La primera micción de la mañana podría emplearse cuando la recolección de orina basal no fuera posible
Assuntos
Humanos , Pré-Escolar , Criança , Crescimento/fisiologia , Hidroxiprolina , Biomarcadores/urina , Manejo de Espécimes/estatística & dados numéricos , Transtornos do Crescimento/diagnóstico , Hidroxiprolina/urina , Manejo de Espécimes/normasRESUMO
El índice de hidroxiprolina es un indicador de crecimiento, originalmente utilizado en muestras de orina casual, asumiendo que sus variaciones a lo largo del día no son significativas. Sin embargo, la excreción de hidroxiprolina sigue un ritmo circadiano. El objetivo de este trabajo fue evaluar las variaciones que dependan de la muestra utilizada y en qué medida afectan la interpretación de los resultados obtenidos. Para ello, se recolectaron 3 muestras de orina diferentes: basal, primera micción de la mañana y casual, en 11 niños normales entre 3 y 9 años de edad. Se compararon los valores obtenidos en las 3 muestras para el mismo niño mediante ANOVA con Medidas Repetidas y a posteriori el Test de Tukey. Los índices de hidroxiprolina determinados en orina casual fueron significativamente más bajos que los realizados en orina basal (p < 0,01) o en la primera micción de la mañana (p < 0,01), mientras que las diferencias entre estas dos últimas muestras fueron no significativas. 7 niños presentaron índices menores al valor de referencia cuando se determinaron en orina casual, 2 niños cuando se utilizó la primera micción de la mañana y sólo 1 cuando se usó orina basal. El índice de hidroxiprolina varió con la muestra utilizada y dicha variación afectó la interpretación de los resultados. Basados en dichos resultados y en las particularidades de las muestras estudiadas, consideramos que la orina casual no es apropiadad para la determinación de este indicador, siendo la muestra de orina basal la más indicada. La primera micción de la mañana podría emplearse cuando la recolección de orina basal no fuera posible (AU)