Lineamientos técnicos para el uso de uniforme y vestimenta de los trabajadores del Ministerio de Salud / Technical guidelines for the wearing of uniforms and clothing by Ministry of Health workers

El Ministerio de salud con la finalidad de mejorar la presentación y apariencia del personal multidisciplinario que brinda atenciones en los establecimientos de salud y basados en los compromisos, valores éticos y estándares de conducta que los funcionarios y empleados del MINSAL deben mantener, promover y demostrar en el cumplimiento de sus deberes y obligaciones, se elaboran las siguientes Lineamientos para el personal de atención directa administrativo, con el fin de fortalecer y ampliar lo establecido en el Código de Ética para el personal del Ministerio de Salud, los Lineamientos administrativos para el uso del uniforme del personal de enfermería en los establecimientos del MINSAL (Acuerdo 1866) y el reglamento de la Norma técnica de Control Interno institucional (Art. 8, 9 y 10)

The Ministry of Health with the aim of improving the presentation and appearance of multidisciplinary personnel providing care in health establishments based on commitments, ethical values and standards of conduct that MINSAL officials and employees must maintain, promote and demonstrate in the performance of their duties and obligations, the following guidelines are drawn up for administrative direct care personnel, in order to strengthen and extend the provisions of the Code of Ethics for the staff of the Ministry of Health. The Administrative Guidelines for the Use of the Uniform of Nursing Personnel in MINSAL establishments (Agreement 1866) and the regulations of the Technical Standard of Institutional Internal Control (Art. 8, 9 and 10).

Proceso de vestirse y desvestirse de los profesionales de enfermería durante la pandemia de covid-19: estudio transversal / Paramentação e desparamentação de profissionais de enfermagem durante a pandemia por covid-19: estudo transversal / Sequence of dressing and undressing by nursing professionals during the covid-19 pandemic: a cross-sectional study

Introducción: Durante la pandemia del covid-19 se implementaron protocolos de seguridad que contribuyeron a la protección de pacientes y profesionales de enfermería. Objetivo: Evaluar el conocimiento sobre el proceso de vestirse y desvertirse de los profesionales de enfermería que actuaron en la asistencia durante la pandemia de covid-19 y verificar la asociación entre ese conocimiento y las características sociodemográficas y de desempeño de los profesionales de enfermería. Método: Estudio transversal, realizado de noviembre de 2020 a diciembre de 2021 con profesionales de enfermería que actúan en el cuidado en las cinco regiones de Brasil. El cuestionario fue desarrollado considerando la Nota Técnica GVIMS/GGTES/ANVISA N° 04/2020. Consta de 10 preguntas, que van de 0 a 10 puntos. Se estableció el punto de corte ≥ 75 puntos y < 74 puntos para indicar conocimiento suficiente y conocimiento insuficiente, respectivamente. La recolección de datos se realizó mediante formularios de Google®, utilizando diferentes redes sociales. Resultados: De los 493 profesionales de enfermería, 157 tenían entre 30 y 39 años, 374 eran del sexo femenino y 358 trabajaban como enfermeros. En cuanto al conocimiento sobre el processo de vestirse y desvestirse, 370 tenían conocimiento suficiente y 123 conocimiento insuficiente. No hubo asociación entre el conocimiento sobre el proceso de vestirse y quitarse con características sociodemográficas y desempeño profesional. Conclusión: Los profesionales de enfermería demostraron conocimientos adecuados sobre el proceso de vestirse y desvestirse y no hubo asociación entre conocimiento y caracterización de los participantes (AU)

Introdução: Durante a pandemia por covid-19 foram implementados de protocolos de segurança que contribuiram para a proteção de pacientes e profissionais de enfermagem. Objetivo: Avaliar o conhecimento sobre a sequência da paramentação e desparamentação por profissionais de enfermagem que atuaram na assistência durante a pandemia por covid-19 e verificar a associação entre esse conhecimento e características sociodemográficas e de atuação dos profissionais de enfermagem. Método: Estudo transversal, realizado de novembro de 2020 a dezembro de 2021 com profissionais de enfermagem atuantes na assistência nas cinco regiões do Brasil. O questionário foi desenvolvido considerando a Nota Técnica GVIMS/GGTES/ANVISA Nº 04/2020. E conta com 10 questões, variando de 0 a 10 pontos. Foi estabelecido o ponto de corte ≥ 75 pontos e < 74 pontos para indicar conhecimento suficiente e conhecimento insuficiente, respectivamente. A coleta de dados foi realizada pelo Google forms®, utilizando diferentes redes sociais. Resultados: Dos 493 profissionais de enfermagem, 157 tinham idade entre 30 a 39 anos, 374 eram do sexo feminino, e 358 atuavam como enfermeiros. Em termos de conhecimento sobre a sequência de paramentação e desparamentação, 370 apresentaram conhecimento suficiente e 123 conhecimento insuficiente. Não teve associação entre o conhecimento sobre paramentação e desparamentação com as características sociodemográficas e de atuação dos profissionais. Conclusão: Os profissionais de enfermagem demonstraram conhecimento adequado sobre a paramentação e desparamentação e não houve associação entre o conhecimento e a caracterização dos participantes. (AU)

Introduction: During the covid-19 pandemic, safety protocols were implemented that contributed to the protection of patients and nursing professionals. Objective: To evaluate the knowledge about the sequence of dressing and undressing by nursing professionals who worked in assistance during the covid-19 pandemic and to verify the association between this knowledge and sociodemographic and performance characteristics of nursing professionals. Method: Cross-sectional study, carried out from November 2020 to December 2021 with nursing professionals working in care in the five regions of Brazil. The questionnaire was developed considering the Technical Note GVIMS/GGTES/ANVISA No. 04/2020. It has 10 questions, ranging from 0 to 10 points. The cutoff point ≥ 75 points and < 74 points was established to indicate sufficient knowledge and insufficient knowledge. Data collection was performed using Google forms®, using different social networks. Results: Of the 493 nursing professionals, 157 were aged between 30 and 39 years, 374 were female, and 358 worked as nurses. In terms of knowledge about the dressing and undressing sequence, 370 had sufficient knowledge and 123 had insufficient knowledge. There was no association between knowledge about dressing and undressing with sociodemographic characteristics and professional performance. Conclusion: Nursing professionals demonstrated adequate knowledge about dressing and undressing and there was no association between knowledge and characterization of the participants. (AU)

Utilization of non-pneumatic anti-shock garment for the management of obstetric hemorrhage among healthcare providers in north Shewa zone, Ethiopia.

Background: Global maternal deaths have either increased or stagnated tragically. Obstetric hemorrhage (OH) remains the major cause of maternal deaths. Non-Pneumatic Anti-Shock Garment (NASG) has several positive results in the management of obstetric hemorrhage in resource-limited settings where getting definitive treatments are difficult and limited. Therefore, this study aimed to assess the proportion and factors associated with the utilization of NASG for the management of obstetric hemorrhage among healthcare providers in the North Shewa zone, Ethiopia. Methods: A cross-sectional study was conducted at health facilities of the north Shewa zone, Ethiopia from June 10th-30th/2021. A simple random sampling (SRS) technique was employed among 360 healthcare providers. Data were collected using a pretested self-administered questionnaire. EpiData version 4.6 and SPSS 25 were used for data entry and analysis, respectively. Binary logistic regression analyses were undertaken to identify associated factors with the outcome variable. The level of significance was decided at a value of p of <0.05. Results: The utilization of NASG for the management of obstetric hemorrhage among healthcare providers was 39% (95%CI: 34-45). Healthcare providers who received training on NASG (AOR = 3.3; 95%CI: 1.46-7.48), availability of NASG in the health facility (AOR = 9.17; 95%CI: 5.10-16.46), diploma (AOR = 2.63; 95%CI: 1.39-3.68), bachelor degree (AOR = 7.89; 95%CI: 3.1-16.29) and those healthcare providers who have a positive attitude toward utilization of NASG (AOR = 1.63; 95%CI: 1.14-2.82) were variables positively associated with the utilization of NASG. Conclusion: In this study, almost two-fifths of healthcare providers used NASG for the management of obstetrics hemorrhage. Arranging educational opportunities and continuous professional development training for healthcare providers, providing in-service and refresher training, and making it available at health facilities may help healthcare providers to effectively use the device, thereby reducing maternal morbidity and mortality.

Analysis of tourniquet pressure over military winter clothing and a short review of combat casualty care in cold weather warfare.

Cold weather warfare is of increasing importance. Haemorrhage is the most common preventable cause of death in military conflicts. We analysed the pressure of the Combat Application Tourniquet® Generation 7 (CAT), the SAM® Extremity Tourniquet (SAMXT) and the SOF® Tactical Tourniquet Wide Generation 4 (SOFTT) over different military cold weather clothing setups with a leg tourniquet trainer. We conducted a selective PubMed search and supplemented this with own experiences in cold weather medicine. The CAT and the SAMXT both reached the cut off value of 180mmHg in almost all applications. The SOFTT was unable to reach the 180mmHg limit in less than 50% of all applications in some clothing setups. We outline the influence of cold during military operations by presenting differences between military and civilian cold exposure. We propose a classification of winter warfare and identify caveats and alterations of Tactical Combat Casualty Care in cold weather warfare, with a special focus on control of bleeding. The application of tourniquets over military winter clothing is successful in principle, but effectiveness may vary for different tourniquet models. Soldiers are more affected and impaired by cold than civilians. Military commanders must be made aware of medical alterations in cold weather warfare.

A Survey of the General Hospital Environment: Focusing on Pajama Design in a Japanese University Hospital.

This study investigated nurses' and patients' perceptions of hospital room environment and patient pajama design. Nurses working in a Japanese university hospital and patients aged 20 and older were surveyed. Over 75% of patients rated the hospital environment and hospital rooms as "very good" or "good," but less than one in three nurses rated them similarly. Patients were more likely than nurses to rate rental pajamas as "very good" or "good." Contrary to the nurses, only about one in four patients valued wearing well-designed pajamas. Nurses' and patients' perceptions differed regarding hospital pajamas, but not about improving hospital rooms.

Assessment of Dermal and Inhalation Exposure to Permethrin During Field Treatment of Military Uniforms.

INTRODUCTION: Permethrin is a common pesticide spray-applied to civilian clothing and military uniforms for protection against biting arthropods in an effort to reduce risks to arthropod-borne diseases. During mass clothing spray events, exposure is possible through the dermal, inhalation, and ingestion routes. The potentially exposed population during a spray event includes the pesticide applicator(s) and working party (personnel who handle clothing/uniforms by positioning on the ground, flipping, and removing after spraying is complete). Previous investigation is limited regarding permethrin exposure via multiple routes of entry. Additionally, most exposure assessments are limited to pesticide applicators rather than working party that support applicator personnel. The purpose of this investigation was to conduct a multi-route exposure assessment for all personnel normally participating in mass permethrin military uniform treatments. MATERIALS AND METHODS: The protocol and Informed Consent Document were approved by the Uniformed Services University of the Health Sciences (USUHS) Institutional Review Board (IRB) before fieldwork initiation (IRB number: USUHS.2019-032). Sampling occurred during routine spray events performed by 14 U.S. Navy personnel (3 applicators and 11 working party) over 2 days. Personal exposures were measured with dermal sampling, and airborne concentrations were measured with area air sampling. Permethrin area air sampling and analysis were conducted using OSHA Versatile Sampler-2 sampling media (n = 36). Dermal exposure was measured using dosimeter gloves (n = 26) and a dermal patch (n = 26) worn by study participants. RESULTS: All air samples were reported below the 0.4 µg limit of quantification. Glove sample results ranged from 45 to 120,000 µg and patch results ranged from 0.57 to 45 µg. A repeated-measures ANOVA showed non-statistically significant differences in dermal concentrations (P-value = .8340) between the applicators and working party in patches and gloves. CONCLUSIONS: Results suggest dermal contact is the primary route of exposure compared to inhalation when mass spraying clothing with permethrin. Similar dermal exposures between these two occupations may necessitate reconsidering risk assessment procedures, training and personal protective equipment (PPE) requirements for mass spray uniform treatments. Specifically, while PPE requirements for applicators are highly regulated by the Armed Forces Pest Management Board and include items such as Tyvek suits, chemical protective gloves, and air-purifying respirators, PPE was not regulated for working party personnel before this investigation.

Individual-level permethrin exposure biomarkers in U.S. army soldiers: comparison of two treatment formulations for military uniforms.

BACKGROUND: Evidence suggests that wearing permethrin-treated military uniforms is not associated with current adverse health conditions. However, exposure through this route results in permethrin biomarker concentrations considerably higher than those in the U.S. POPULATION: The U.S. Army is exploring different methods of uniform treatment that reduce exposure while maintaining effective protection from insect vector-borne diseases. OBJECTIVE: To compare permethrin exposure when wearing two types of permethrin-treated military uniforms. METHODS: Eight male soldiers participated in a 32-day crossover design study to compare permethrin exposure when wearing the current Army uniform (CurrU) and a uniform with a new applied fabric treatment (NewU). Each soldier wore the uniforms for designated 8 h/day time periods over 3 consecutive days separated by a 'wash-out' week of no exposure. Permethrin exposure was assessed from the urinary concentrations of 3-phenoxybenzoic acid (3-PBA) and of the sum of cis- and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (∑DCCA). Estimated dose was determined based on ∑DCCA concentrations. RESULTS: Permethrin exposure biomarkers were 21% (3-PBA, p = 0.025) and 35% (∑DCCA, p < 0.001) lower when wearing the NewU compared to the CurrU; the dose was 33% lower (p = 0.05). SIGNIFICANCE: Findings suggest the new treatment reduces human permethrin exposure biomarkers resulting from wearing-treated military uniforms.

Avaliação da relação entre eventos traumáticos infantis e comportamentos autolesivos em adolescentes / Evaluation of the relationship between childhood traumatic events and self-injurious behavior in adolescents / Evaluación de la relación entre eventos traumáticos infantiles y comportamiento autolesivo en adolescentes

Esta pesquisa teve como objetivo verificar a relação entre eventos traumáticos (ET) na infância e a ocorrência de comportamentos autolesivos em adolescentes. Os instrumentos utilizados foram o Questionário sobre Traumas na Infância (QUESI) e o Inventário de Autolesão Deliberada - reduzido (IAD-r). Participaram 494 estudantes do ensino médio de ambos os sexos e idade entre 15 e 18 anos (M = 16,4). Destes, 58,5% afirmaram ter sofrido abuso emocional de forma recorrente e 19,0% e 59,5% assumiram já ter sofrido abuso sexual e físico, respectivamente. Quanto à prática de autolesão, 65,0% revelaram já ter se engajado em comportamentos autolesivos. De acordo com a análise de Regressão Logística Binomial, todos os tipos de ET exibiram associação significativa com a prática de comportamentos autolesivos. A análise de moderação a respeito da interação entre a ocorrência de ET infantis e a prática de autolesão revelou ausência de moderação pelo sexo e pela idade. Porém, quanto ao abuso físico, o efeito de moderação da idade apresentou significância estatística limítrofe e indicou que os adolescentes mais novos, de 15 e 16 anos, que sofreram este tipo de abuso na infância, foram mais susceptíveis à prática autolesiva. Portanto, as altas taxas de ET e de autolesão encontradas nesta pesquisa revelam a gravidade do problema. Espera-se que esta investigação possa contribuir para a elaboração de intervenções para prevenção e controle dos fatores de risco que acometem a população infanto-juvenil.(AU)

This research aimed to verify the relationship between traumatic events (TE) in childhood and the occurrence of self-injurious behavior in adolescents. The instruments used were the Childhood Trauma Questionnaire (QUESI) and the Deliberate Self-Injury Inventory - reduced (IAD-r). The sample was composed of 494 high school students of both genders and aged between 15 and 18 years old (M = 16.4). Of those, 58.5% declared to have suffered recurring emotional abuse and 19.0% declared to have suffered sexual abuse and 59.5% physical abuse. Regarding the practice of self-harm, 65.0% reported having already engaged in self-injurious behaviors. According to the Binomial Logistic Regression analysis, all types of TE were associated with the practice of self-injurious behaviors. The moderation analysis between the occurrence of childhood TE and self-injury showed no moderation by sex or age. However, regarding physical abuse, the moderating effect of age showed borderline statistical significance and indicated that younger adolescents, 15 and 16 years old, who suffered this type of abuse in childhood, were more susceptible to self-injurious behavior. Therefore, the high rates of TE and self-injury found in this research reveal the seriousness of the problem. It is hoped for this investigation to contribute to the development of interventions to prevent and control risk factors that affect children and adolescents.(AU)

Esta investigación tuvo como objetivo verificar la relación entre eventos traumáticos (ET) en la infancia y la ocurrencia de conductas autolesivas en adolescentes. Los instrumentos utilizados fueron el Cuestionario de Trauma Infantil (QUESI) y el Inventario de Autolesiones Deliberadas -reducido (IAD-r). Participaron 494 estudiantes de la secundaria, de ambos sexos y con edades entre 15 y 18 años (M = 16,4). De estos, el 58,5% afirmaron haber sufrido maltrato emocional de forma recurrente, el 19,0% dijeron haber sufrido maltrato sexual y el 59,5%, maltrato físico. En cuanto a la práctica de la autolesión, el 65,0% informaron haber realizado conductas autolesivas. El análisis de Regresión Logística Binomial mostró que todos los tipos de ET tuvieron una asociación significativa con la práctica de conductas autolesivas. El análisis de la moderación respecto a la interacción entre la ocurrencia de ET infantil y la práctica de la autolesión reveló una ausencia de moderación por sexo o edad. En cuanto al maltrato físico, el efecto moderador de la edad mostró una significación estadística marginal e indicó que los adolescentes más jóvenes, de 15 y 16 años, que sufrieron este tipo de maltrato en la infancia, son más susceptibles a la práctica de autolesiones. Por lo tanto, las altas tasas de ET y autolesiones encontradas en esta investigación revelan la gravedad del problema. Se espera que esta investigación contribuya con el desarrollo de intervenciones para la prevención y control de los factores de riesgo que afectan a niños y adolescentes.(AU)

(Sobre)viver na rua: narrativas das pessoas em situação de rua sobre a rede de apoio / (About) living on the street: narratives of homeless people about the support network / (Sobre)vivir en la calle: narrativas de personas en situación de calle sobre la red de apoyo

A população em situação de rua (PSR), em seu cotidiano, se relaciona com diferentes pessoas, grupos e/ou coletivos ligados à execução das políticas públicas, às organizações não governamentais, familiares ou a membros da sociedade civil. Pensar nessas dinâmicas de trabalho, cooperação e auxílio remete a pensar sobre uma rede de apoio que constrói estratégias com essa população. Tendo presente essas problematizações, este estudo teve como objetivo analisar as narrativas das pessoas em situação de rua sobre como é produzida sua rede de apoio. Para tanto, foi realizado um estudo qualitativo, de orientação etnográfica, sendo utilizada a observação participante, registros em diário de campo e entrevistas narrativas. Participaram seis pessoas em situação de rua que recebem alimentação ofertada por projetos sociais em uma cidade do interior do Rio Grande do Sul. Os dados produzidos foram analisados a partir da Análise Temática. As análises expressam as especificidades das narrativas das trajetórias de vida associadas à chegada às ruas e à composição de uma rede de apoio na rua. Ao conhecer como se produz e opera essa rede de apoio, a partir das narrativas das pessoas em situação de rua, problematiza-se a complexidade dessa engrenagem e o desafio de produzir ações integradas entre as diferentes instâncias da rede. Nisso, destaca-se a potencialidade de práticas que levem conta à escuta, ao diálogo e à articulação na operacionalização de políticas públicas atentas às necessidades dessa população.(AU)

The street population, in their daily lives, relates to different people, groups and/or collectives linked to the execution of public policies, to non-governmental organizations, family members, or to members of civil society. Thinking about these dynamics of work, cooperation, and assistance leads to thinking about a support network that builds strategies with this population. Having these problematizations in mind, this study aims to analyze the narratives of homeless people about how their support network is produced. To this end, a qualitative study was carried out, with ethnographic orientation, using participant observation, records in a field diary, and narrative interviews. Participated in the research six homeless people who receive food offered by social projects in a municipality in the interior of Rio Grande do Sul. The data produced were analyzed using the Thematic Analysis. The analyzes express the specifities of the narratives of life trajectories associated with the arrival on the streets and the composition of a support network on the street. By knowing how the support network is produced and operated, the complexity of this gear and the challenge of producing integrated actions between the different instances of the network are problematized. Thus, it highlights the potential of practices that consider listening, dialogue, and articulation in the operationalization of public policies that are attentive to the needs of this population.(AU)

Las personas en situación de calle en su cotidiano se relacionan con distintas personas, grupos y/o colectivos, que están vinculados a la ejecución de políticas públicas, organizaciones no gubernamentales, familiares o miembros de la sociedad civil. Pensar en estas dinámicas de trabajo, cooperación y ayuda nos lleva a una red de apoyo que construye estrategias con estas personas. Teniendo en cuenta esta problemática, este estudio tiene como objetivo analizar las narrativas de las personas en situación de calle acerca de cómo se produce su red de apoyo. Con este fin, se realizó un estudio cualitativo, etnográfico, utilizando observación participante, registros de diario de campo y entrevistas narrativas. Este estudio incluyó a seis personas en situación de calle que reciben alimentos ofrecidos por proyectos sociales en una ciudad del interior de Rio Grande do Sul (Brasil). Se utilizó el Análisis Temático. Los análisis expresan las especificidades de las narrativas de las trayectorias de vida asociadas con la llegada a las calles y la composición de una red de apoyo en la calle. Al saber cómo se produce y opera la red de apoyo, a partir de las narrativas de las personas en la calle, se problematizan la complejidad de este equipo y el desafío de producir acciones integradas entre las diferentes instancias de la red. Destaca el potencial de las prácticas que tienen en cuenta la escucha, el diálogo y la articulación en la implementación de políticas públicas que estén atentas a las necesidades de esta población.(AU)

Exportación y sanitación internacional en empresas productoras de prendas de alpaca de Huancayo y Lima / Exportation and international sanitation in companies producing alpaca garments in Huancayo and Lima

El Perú se considera un país potencia en cuanto a la exportación textil de la alpaca, cuya fibra natural es muy fina, ligera y con alto valor a nivel mundial. Para el año 2019, la exportación total de fibra de alpaca en Perú llegó a un total de 23 países, incluyendo mercados en Europa, Asia y Norteamérica. La tendencia en el comercio exterior incluyendo las empresas textiles de alpaca, se ha dirigido a garantizar el cuidado del medio ambiente y la inocuidad de los productos respecto a la salud humana. Se realizó un estudio desde el paradigma post-positivista, con enfoque cualitativo y el método hermenéutico, para interpretar la situación de exportación y sanitación internacional en empresas peruanas productoras de prendas de alpaca en Huancayo y Lima. Se obtuvo información a partir de cuatro informantes voluntarios de cada empresa acerca de aspectos relacionados con exportación de las prendas de alpaca: competitividad, promoción, proveedores, producción, calidad de producto, valor agregado, calidad de servicio, mercados destino, demanda y herramientas de inteligencia comercial, entre otros. Asimismo, se indagó sobre la concepción y cumplimiento del Reglamento Sanitario Internacional. Las empresas evaluadas, emplean excelente materia prima, garantizan un control de calidad de sus productos ofreciendo textiles competitivos que se distribuyen en diversos mercados internacionales, emplean herramientas de comercialización que favorecen la identificación de regulaciones arancelarias y la capacitación de su personal. No obstante, muestran carencias en el cumplimiento del RSI, requiriendo adoptar medidas que garanticen la salud pública al comercializar sus productos(AU)

Peru is considered a powerful country in terms of alpaca textile exports, whose natural fiber is very fine, light and highly valued worldwide. For the year 2019, the total export of alpaca fiber in Peru reached a total of 23 countries, including markets in Europe, Asia and North America. The trend in foreign trade, including alpaca textile companies, has been aimed at guaranteeing care for the environment and the safety of products with respect to human health. A study was carried out from the post-positivist paradigm, with a qualitative approach and the hermeneutical method, to interpret the export situation and international sanitation in Peruvian companies that produce alpaca garments in Huancayo and Lima. Information was obtained from four volunteer informants from each company about aspects related to the export of alpaca garments: competitiveness, promotion, suppliers, production, product quality, added value, service quality, destination markets, demand and marketing tools. commercial intelligence, among others. Likewise, the conception and compliance with the International Health Regulations were inquired about. The evaluated companies use excellent raw material, guarantee quality control of their products by offering competitive textiles that are distributed in various international markets, use marketing tools that favor the identification of tariff regulations and the training of their personnel. However, they show deficiencies in compliance with the RSI, requiring the adoption of measures that guarantee public health when marketing their products(AU)

Does the white coat influence satisfaction, trust and empathy in the doctor-patient relationship in the General and Family Medicine consultation? Interventional study.

OBJECTIVES: To understand the influence of the white coat on patient satisfaction, opinions about medical clothing, perception about confidence, empathy and medical knowledge and the satisfaction and comfort level of physicians in consultation. SETTING: An interventional study was conducted with a representative sample of the population attending primary care in central Portugal. PARTICIPANTS: The sample was composed by 286 patients divided into two groups exposed or not to a doctor wearing a white coat. The first and last patients in consultation every day for 10 consecutive days were included. INTERVENTIONS: Every other day the volunteer physicians consulted with or without the use of a white coat. At the end of the consultation, a questionnaire was distributed to the patient with simple questions with a Likert scale response, the Portuguese version of the 'Trust in physician' scale and the Jefferson Scale of Patient Perceptions of Physician Empathy - Portuguese Version (JSPPPE-VP scale). A questionnaire was also distributed to the physician. OUTCOMES: Planned and measured primary outcomes were patient satisfaction, trust and perception about empathy and secondary outcomes were opinion about medical clothing, satisfaction and comfort level of physicians in consultation. RESULTS: The sample was homogeneous in terms of sociodemographic variables. There were no statistically significant differences between the groups in terms of satisfaction, trust, empathy and knowledge perceived by the patients. There were differences in the opinion of the patients about the white coat, and when the physician was wearing the white coat this group of patients tended to think that this was the only acceptable attire for the physician (p<0.001). But when the family physician was in consultation without the white coat, this group of patients tended to agree that communication was easier (p=0.001). CONCLUSIONS: There was no significant impact of the white coat in patient satisfaction, empathy and confidence in the family physician. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID number: NCT03965416.

[Safe handling of clothing and hygiene of patients and health professionals: Scoping review]. / Manejo seguro de la ropa e higiene de la piel en pacientes y profesionales sanitarios frente a la COVID-19: scoping review.

INTRODUCTION: In January 2020, an outbreak of pneumonia caused by a zoonotic virus (SARS-CoV-2) appeared in China. The main route of transmission is considered to be the inhalation of large respiratory drops, by deposition in the mucosa and hands or contaminated fomites. The objective is to identify the interventions to be performed during hospitalization for the correct and safe handling of clothing and hygiene of patients and health professionals. METHOD: Scoping review carried out without chronological or language delimitation in the PUBMED and Cochrane databases. Tracking standards and recommendations of national and international government entities to answer the research question on the safe handling of clothing and skin hygiene in patients and in health professionals to avoid Covid-19 infection. The data analysis was carried out in 2 stages: in the first, identification and categorization of the studies, and in the second, content analysis as an informative and classifying criterion. RESULTS: 14 documents have been selected, mainly from government entities. The recommendations are structured in 5 sections on the management of clothing and skin hygiene of infected patients and health professionals in the hospital setting. CONCLUSION: The clothing of patients and healthcare personnel are transmitting vehicles of the disease. Its correct treatment helps to improve the control of the same and the correct use of the resources available at the moment. Proper skin hygiene, especially hand cleansing, is one of the basic pillars for infection prevention and control. We highlight the similarity of some of the guidelines collected and provided by the different agencies consulted.

Health sufferings, healthcare seeking behavior, awareness about health insurance, and health related rights of ready made garments workers in Bangladesh: Findings from a cross-sectional study.

OBJECTIVES: This study aimed at examining health sufferings of readymade garments (RMG) workers, the factors that affect their health sufferings, their healthcare seeking pattern, knowledge about health insurance and health related rights in Bangladesh. METHODS: A cross-sectional study was conducted among 486 RMG workers recruited randomly from eight garments factories located on the periphery of Dhaka, Bangladesh. The prevalence of musculoskeletal pain, headache, fever and abdominal pain was estimated and multivariable logistic regression analysis was performed to examine association between these illnesses of workers and their socio-demographic characteristics and other work related information. We also explored their healthcare seeking patterns, knowledge about health insurance and health related rights. RESULTS: The prevalence of musculoskeletal pain, headache, fever and abdominal pain was found to be 78.1%, 57.9%, 52.2% and 24.6%, respectively, among the RMG workers. Factors that increased the odds of: musculoskeletal pain were working for more than 10 h per day (adjusted odds ratio [AOR]: 2.3, 95% confidence interval [CI]: 1.1-4.7) and being female [AOR: 4.6, 95% CI: 2.0-10.6]; fever was living in slums [AOR: 1.9, 95% CI: 1.1-3.5]; and abdominal pain was being female [AOR: 3.6, 95% CI: 1.4-9.3]. The workers commonly reported visiting drug sellers in local pharmacies for reported illnesses. They also had better knowledge of health related rights but poor knowledge of health insurance. CONCLUSION: In order to address the overall health and well-being of the RMG workers, it is imperative to lay out a blueprint for a safe and healthy workplace.

Public Perceptions of Physician Attire and Professionalism in the US.

Importance: In recent years, casual physician attire (fleece jackets and softshell jackets) has become increasingly popular, but to our knowledge, public perceptions of these garments have not been studied. Furthermore, gender biases may result in differing expectations and perceptions of female and male physicians and may be associated with patient rapport and trust building. Objective: To characterize public perceptions of casual physician attire and implicit gender biases in public assessment of physicians' professional attire. Design, Setting, and Participants: This survey study used a population-based survey administered via Amazon Mechanical Turk from May to June 2020 among individuals aged 18 years or older who were US residents and for whom English was the primary language. Intervention: Survey featuring photographs of a male or female model wearing various types of physician attire (white coat, business attire, and scrubs). Main Outcomes and Measures: Respondents' ratings of professionalism, experience, and friendliness of the male and female models in various attire and perceptions of the models' most likely health care profession. Preference scores for various outfits were calculated as the difference between the preference score for an outfit and the mean preference score for the outfit-role pairing. Results: Of 522 surveys completed, 487 were included for analysis; the mean (SD) age of respondents was 36.2 (12.4) years, 260 (53.4%) were female, and 372 (76.4%) were White individuals. Respondents perceived models of health care professionals wearing white coats vs those wearing fleece or softshell jackets as significantly more experienced (mean [SD] experience score: white coat, 4.9 [1.5]; fleece, 3.1 [1.5]; softshell, 3.1 [1.5]; P < .001) and professional (mean [SD] professionalism score: white coat, 4.9 [1.6]; fleece, 3.2 [1.5]; softshell, 3.3 [1.5]; P < .001). A white coat with scrubs attire was most preferred for surgeons (mean [SD] preference index: 1.3 [2.3]), whereas a white coat with business attire was preferred for family physicians and dermatologists (mean [SD] preference indexes, 1.6 [2.3] and 1.2 [2.3], respectively; P < .001). Regardless of outerwear, female models in business attire as inner wear were rated as less professional than male counterparts (mean [SD] professionalism score: male, 65.8 [25.4]; female, 56.2 [20.2]; P < .001). Both the male and the female model were identified by the greater number of respondents as a physician or surgeon; however, the female model vs the male model was mistaken by more respondents as a medical technician (39 [8.0] vs 16 [3.3%]; P < .005), physician assistant (56 [11.5%] vs 11 [2.3%]; P < .001), or nurse (161 [33.1%] vs 133 [27.3%]; P = .050). Conclusions and Relevance: In this survey study, survey respondents rated physicians wearing casual attire as less professional and experienced than those wearing a white coat. Gender biases were found in impressions of professionalism, with female physicians' roles being more frequently misidentified. Understanding disparate public perceptions of physician apparel may inform interventions to address professional role confusion and cumulative career disadvantages for women in medicine.

Fungal carriage on healthcare workers' hands, clothing, stethoscopes and electronic devices during routine patient care: a study from a tertiary care center.

BACKGROUND: Invasive fungal infections are a constant threat to immunocompromised and critically ill patients. Healthcare workers caring for such patients act as conduits of transmission through their contaminated hands and belongings causing nosocomial infections. Although bacterial contamination of healthcare workers is known, our knowledge about fungal carriage is sparse. Among the fungi, candida species colonization of hands of healthcare workers is known however it would be interesting to know the type of fungal carriage on their inanimate belongings. AIM: To study the prevalence and type of fungal carriage on healthcare workers hands, aprons/hospital scrubs, electronic devices, and stethoscopes. METHODS: Healthcare workers working in Medicine ward and ICU during November and December 2019 were sampled. Hand washes were collected in Brain Heart Infusion (BHI) broth with gentamycin. Direct impression smears on blood agar were taken from aprons/hospital scrubs. Electronic devices and stethoscopes were sampled using moist cotton swabs. Subculture and plating was done on Sabarouds Dextrose Agar (SDA). Yeasts were identified using Matrix Assisted Laser Desorption Ionisation Time of Flight (MALDI TOF) and moulds were identified using microscopy. FINDINGS: Out of 60 health care workers, 20 (33.3%) had fungal carriage. Aprons/hospital scrubs and hands were contaminated in 17 (28.3%) and 3 (5%) respectively. Aprons/hospital scrubs mainly constituted moulds belonging to species of Aspergillus. Hands were contaminated with Candida tropicalis, Candida parapsilosis and Candida auris. Electronic devices and stethoscopes had no fungal contamination. CONCLUSIONS: Active fungal surveillance provides prevalent carriage rates and serve as a feedback to improve our disinfection and hand hygiene practices. It also aids in identification of potential source of hospital outbreaks.

Patient Perception of Physician Attire in the Outpatient Setting During the COVID-19 Pandemic.

INTRODUCTION: In response to the SARS-CoV-2 pandemic, physician attire has evolved to incorporate personal protective equipment (PPE). Although PPE is mandated for all healthcare workers, variability exists in choice and availability. The purpose of this study was to determine patient perception of physician attire during the COVID-19 pandemic in an outpatient setting. METHODS: Three hundred sixty-eight patients who presented to our outpatient orthopaedic clinics completed an anonymous survey. In addition to demographic characteristics, patient preferences for attire, PPE, and social distancing were obtained. RESULTS: Scrubs (81%, 298/368) were found to be the most acceptable physician attire. Eye protection (34.2%, 126/368) and gloves (32.6%, 120/368), however, were deemed much less acceptable; 93.5% (344/368) of patients reported that no mask was unacceptable, with 41.0% (151/368) preferring a surgical mask. Predilection for a surgical mask and N95 rose with increasing patient education level. Interestingly, 55.2% (203/368) responded that physicians should stop wearing PPE only when the Center for Disease Control recommends. CONCLUSION: During the COVID-19 pandemic, most of the patients found scrubs to be the most acceptable attire in an office-based outpatient setting. Patients also found physician mask-wearing to be important but are less accepting of providers wearing eye and hand protection.

Laundry Hygiene and Odor Control: State of the Science.

Laundering of textiles-clothing, linens, and cleaning cloths-functionally removes dirt and bodily fluids, which prevents the transmission of and reexposure to pathogens as well as providing odor control. Thus, proper laundering is key to controlling microbes that cause illness and produce odors. The practice of laundering varies from region to region and is influenced by culture and resources. This review aims to define laundering as a series of steps that influence the exposure of the person processing the laundry to pathogens, with respect to the removal and control of pathogens and odor-causing bacteria, while taking into consideration the types of textiles. Defining laundering in this manner will help better educate the consumer and highlight areas where more research is needed and how to maximize products and resources. The control of microorganisms during laundering involves mechanical (agitation and soaking), chemical (detergent and bleach), and physical (detergent and temperature) processes. Temperature plays the most important role in terms of pathogen control, requiring temperatures exceeding 40°C to 60°C for proper inactivation, while detergents play a role in reducing the microbial load of laundering through the release of microbes attached to fabrics and the inactivation of microbes sensitive to detergents (e.g., enveloped viruses). The use of additives (enzymes) and bleach (chlorine and activated oxygen) becomes essential in washes with temperatures below 20°C, especially for certain enteric viruses and bacteria. A structured approach is needed that identifies all the steps in the laundering process and attempts to identify each step relative to its importance to infection risk and odor production.

Movimento Body Positive no Instagram: reflexões sobre a estetização da saúde na sociedade neoliberal / Body Positive movement on Instagram: reflections about the aestheticization of health in neoliberal society / Movimiento Body Positive en Instagram: reflexiones sobre la estetización de la salud en la sociedad neoliberal

Com o avanço das tecnologias de informação, as redes sociais estão inseridas diretamente no cotidiano dos indivíduos e refletem o modo como grupos e indivíduos constroem suas relações sociais, afetivas e laborais. Considerando que a percepção sobre os corpos é influenciada pelos canais de comunicação, este trabalho procura discutir o crescimento do movimento Body Positive (BoPo) em perfis do Instagram, tendo em vista a estetização da saúde e o efeito de influência e controle que são exercidos sobre a relação dos indivíduos com seus corpos. Para tanto, toma-se como referência a análise dos mecanismos neoliberais de controle e modulação de subjetividades marcados pela exigência de desempenho máximo e pela permanente concorrência consigo mesmo e com os outros. Procura-se apresentar uma reflexão crítica sobre a capacidade de captura dos mecanismos de controle em redes sociais que, em associação ao mercado capitalista, produzem novas roupagens para antigos dispositivos de poder.

With the advancement of information technologies, social media are inserted straight in people's daily life and reflect the way groups and individuals build their social, affective, and work relations. Considering that body perception is influenced by media channels, this paper aims to discuss the Body Positive movement increase on Instagram profiles, given the aestheticization of health and the influence and control effect over the relation of individuals with their bodies. Therefore, it takes as reference the analysis of neoliberal's control and subjectivity modulation mechanisms marked by both the exigency of maximum performance and the permanent competition with itself and the others. It seeks to present a critical reflection on the capture capacity of the social media control mechanisms that, associated with a capitalist market, produces new clothes to old power dispositives.

Con el avance de las tecnologías de la información, las redes sociales se insertan directamente en la vida diaria de las personas y reflejan la forma en que los grupos y las personas construyen sus relaciones sociales, afectivas y laborales. Teniendo en cuenta que la percepción de los cuerpos está influenciada por los canales de comunicación, este documento busca discutir el crecimiento del movimiento Body Positive (BoPo) en los perfiles de Instagram, en vista de la estetización de la salud, la influencia y el efecto de control que se ejercen sobre la relación de individuos con sus cuerpos. Con este fin, se toma como referencia el análisis de los mecanismos neoliberales para controlar y modular las subjetividades marcadas por la demanda de máximo rendimiento y competencia permanente consigo mismo y con los demás. Busca presentar una reflexión crítica sobre la capacidad de capturar mecanismos de control en las redes sociales que, en asociación con el mercado capitalista, producen ropa nueva para viejos dispositivos de energía.