Promoting equity, diversity, and inclusion in surveys: insights from a patient-engaged study to assess long COVID health-care needs in Brazil.

BACKGROUND AND OBJECTIVE: Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may persist for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socioeconomically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC health care and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil. METHODS: Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in 3 guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of health-care access. RESULTS: The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our 3 principles through survey content, instrument design, and administration. Six hundred fifty-one participants with diverse LC symptoms, demography, and socioeconomic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income. CONCLUSION: By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them.

Estrutura e atividades dos Núcleos de Segurança do Paciente em hospitais: uma revisão integrativa / Structure and activities of Patient Safety Centers in hospitals: an integrative review

Introdução: A partir da vigência do Programa Nacional de Segurança do Paciente (PNSP) no Brasil, tornou-se obrigatória a implantação de Núcleos de Segurança do Paciente (NSP) nos estabelecimentos de saúde. Apesar dos estudos sobre a implantação dos NSP em hospitais, até o momento, não há uma síntese que apresente pontos para orientar ações para melhoria de sua efetividade. Objetivo: Sintetizar o conhecimento disponível em publicações científicas brasileiras sobre a estruturação, funcionamento e atuação de NSP em hospitais. Método: Revisão integrativa de literatura realizada a partir da questão: "O que a produção científica apresenta sobre a estruturação e funcionamento de NSP em hospitais?". As buscas foram realizadas em junho de 2020, nas bases de dados LILACS, MEDLINE e BDENF, por meio de combinações dos seguintes descritores: Segurança do Paciente; Gestão de Riscos, Gestão de Segurança e Hospitais. Resultados: Doze artigos foram selecionados para inclusão. No geral, os NSP nos hospitais atendem parcialmente às diretrizes do PNSP. Foram identificadas falhas relacionadas às estruturas materiais e de recursos humanos dos NSP, bem como em relação às suas atividades. Aspectos do contexto local que representaram barreiras ou facilitadores para atuação efetiva dos NSP incluem questões materiais (por exemplo, dimensionamento e treinamento da equipe), simbólicas (por exemplo, cultura punitiva), relacionais (por exemplo, apoio da alta gestão) e institucionais (por exemplo, ferramentas para gestão da qualidade). Conclusões: A implantação de NSP nos hospitais tem apresentado avanços, mas ainda há muitos desafios para sua atuação efetiva. Melhorar a efetividade dos NSP exige criar um contexto mais favorável para o desenvolvimento de ações de melhoria da segurança.

Introduction: Since the establishment of the National Patient Safety Program (NPSP) in Brazil, the implementation of Patient Safety Centers (NSP) in health establishments has become mandatory. Although many studies on implementation of the NSP in hospitals have been published, until now, there is not any synthesis of the literature to inform how to improve NSP's effectiveness. Objective: To synthesize the knowledge of Brazilian scientifc publications on the structuring and functioning of patient safety centers in Brazilian hospitals. Method: Integrative literature review based on the guiding question: "What does scientifc production present about the structuring and functioning of NSP in hospitals?". The searches were carried out in June 2020, in the LILACS, MEDLINE and BDENF databases, through services of the following descriptors: Patient Safety; Risk Management, Safety Management and Hospitals. Results: Twelve studies were selected for inclusion. In general, NSP partially comply with NPSP's guidance. Failures related to NSP material and human resources structures were identifed, as well as in relation to the NSP activities. Local contextual aspects that represented barriers or facilitators for the effective activity of NSP comprise: material (e.g., stafng and training), symbolic (e.g., culture of blame), relational (e.g., senior management support) and institutional (e.g., quality improvement tools) issues. Conclusions: NSP implementation at hospitals have presented some achievements. Improving NSP effectivity requires creating a supportive context for safety improvement efforts.

How Can Implementation of a Large-Scale Patient Safety Program Strengthen Hospital Safety Culture? Lessons From a Qualitative Study of National Patient Safety Program Implementation in Two Public Hospitals in Brazil.

Large-scale (e.g., national) programs could strengthen safety culture, which is foundational to patient safety, yet we know little about how to optimize this potential. In 2013, Brazil's Ministry of Health launched the National Patient Safety Program, involving hospital-level safety teams and targeted safety protocols. We conducted in-depth qualitative case studies of National Patient Safety Program implementation in two hospitals, with different readiness, to understand how program implementation affected enabling, enacting, and elaborating processes that produce and sustain safety culture. For both hospitals, external mandates were insufficient for enabling hospital-level action. Internal enabling failures (e.g., little safety-relevant senior leadership) hindered enactment (e.g., safety teams unable to institute plans). Limited enactment and weak elaboration processes (e.g., bureaucratic monitoring) failed to institutionalize protocol use and undermined safety culture. Optimizing the safety culture impact of large-scale programs requires effective multi-level enabling and capitalizing on the productive potential of interacting national- and local-level influences.

Manufacturing micro/nano chitosan/chondroitin sulfate curcumin-loaded hydrogel in ionic liquid: A new biomaterial effective against cancer cells.

Chitosan/chondroitin sulfate (CHT/CS) curcumin-charged hydrogels were prepared through polyelectrolytic complexation (PEC) following two methodologies (PEC-CUR and PEC-T-CUR) and were applied on apoptosis of HeLa, HT29 and PC3 cancer cells. PEC-T-CUR (ionic liquid (IL) mixed using ultraturrax homogenizer) results show to be far better than for PEC-CUR (IL mixed using magnetic stirring), with IC50 being improved 5.13 times to HeLa cancer cells (from 1675.2 to 326.7 µg mL-1). PECs produced by this methodology presented favorable characteristics, such as particle size, hydrophobicity, pH swelling. Beyond this, the IL was quantitatively recovered in both cases. CUR entrapment levels were hugely loaded into PEC at around 100%. Swelling, dissolution/degradation, and pHpzc assays showed that PECs may positively act in several environments, releasing the CUR, the CHT and CS as well. Characterization through FTIR, SEM, TEM, TGA, DSC, and WAXS confirmed CUR presence in both types of PECs, and cytotoxic studies showed the significant anticancer effects of CUR-containing PECs.

[Breast cancer during pregnancy and chemotherapy: a systematic review]. / Câncer de mama na gravidez e quimioterapia: revisão sistemática.

This study aimed to establish the safety of chemotherapy use in pregnant women with breast cancer, and to find possible effects in the fetus. A search of MEDLINE/PubMed, LILACS, SciELO, Cochrane, UpToDate, and Google Scholar databases was performed to identify publications, 86 articles published from 2001 to 2012 were retrieved and evaluated by two readers in accordance predetermined exclusion and inclusion criteria; 39 articles were selected. All the chemotherapy drugs used to treat breast cancer during pregnancy belonged to class D, and consisted of 5-fluorouracil (F), doxorubicin (A) or epirubicin (E) and cyclophosphamide (C), or the combination doxorubicin and cyclophosphamide (AC), a safe regimen when used after the first trimester of pregnancy. Few studies evaluated the use of taxanes (T), such as docetaxel (D) and paclitaxel (P), with no increase in the occurrence of fetal defects and other maternal complications when used in the second and third trimesters of pregnancy. The use of trastuzumab in pregnant women is associated with oligohydramnios and anhydramnios; thus, it is not recommended during pregnancy. As almost all studies were observational and retrospective, new prospective studies on the subject are needed.

Câncer de mama na gravidez e quimioterapia: revisão sistemática / Breast cancer during pregnancy and chemotherapy: a systematic review

O objetivo do estudo é estabelecer a segurança do uso da quimioterapia na gestante portadora de câncer de mama e verificar as possíveis intercorrências no feto. Para identificação de publicações foi realizada pesquisa bibliográfica nas bases de dados: MEDLINE/PubMed, LILACS, SciELO, Cochrane, Uptodate e Google acadêmico. A busca totalizou 86 artigos publicados de 2001 a 2012, que foram avaliados por dois revisores obedecendo aos critérios de exclusão e inclusão pré-estabelecidos, sendo selecionados 39 artigos para a elaboração deste estudo. Todos os quimioterápicos utilizados no tratamento do câncer de mama na gravidez pertencem à categoria D, consistindo no uso de 5-fluorouracil (F), doxorrubicina (A) ou epirrubicina (E) e ciclofosfamida (C) ou na combinação de doxorrubicina e ciclofosfamida (AC), método seguro quando utilizado após o primeiro trimestre da gestação. Poucos estudos avaliaram o uso de taxanos (T) como docetaxel (D) e paclitaxel (P), não sendo demonstrado aumento da ocorrência de malformações fetais e outras complicações maternas quando utilizados no segundo e terceiro trimestres da gestação. O uso do trastuzumabe em gestantes encontra-se associado à oligodramnia e adramnia, não sendo recomendado na gravidez. Em função da quase totalidade dos estudos serem observacionais e retrospectivos, torna-se necessário a confecção de novos estudos prospectivos sobre o tema.

This study aimed to establish the safety of chemotherapy use in pregnant women with breast cancer, and to find possible effects in the fetus. A search of MEDLINE/PubMed, LILACS, SciELO, Cochrane, UpToDate, and Google Scholar databases was performed to identify publications, 86 articles published from 2001 to 2012 were retrieved and evaluated by two readers in accordance predetermined exclusion and inclusion criteria; 39 articles were selected. All the chemotherapy drugs used to treat breast cancer during pregnancy belonged to class D, and consisted of 5-fluorouracil (F), doxorubicin (A) or epirubicin (E) and cyclophosphamide (C), or the combination doxorubicin and cyclophosphamide (AC), a safe regimen when used after the first trimester of pregnancy. Few studies evaluated the use of taxanes (T), such as docetaxel (D) and paclitaxel (P), with no increase in the occurrence of fetal defects and other maternal complications when used in the second and third trimesters of pregnancy. The use of trastuzumab in pregnant women is associated with oligohydramnios and anhydramnios; thus, it is not recommended during pregnancy. As almost all studies were observational and retrospective, new prospective studies on the subject are needed.

Promoção da saúde no ambiente escolar: auxílio à visão crítica sobre higiene e desperdício de alimentos / Health promotion within the school environment: helping towards a critical view on hygiene and food waste

Objetivo: Inserir a promoção da saúde no ambiente escolar, favorecendo a construção de uma visão crítica sobre o processo saúde-doença. Métodos: Estudo de intervenção com 98 alunos de 6 a 12 anos de uma Escola Municipal de Belo Horizonte, MG, com oficinas educativas sobre higiene pessoal, alimentar e ambiental e desperdício de alimentos. Adicionalmente, avaliou-se a merenda escolar e o índice resto-ingestão. Resultados: Identificou-se, antes da intervenção, maior aceitabilidade de alimentos do grupo das carnes e, posteriormente, das frutas (p<0,05). Segundo a opinião dos alunos acerca da qualidade do cardápio, demonstrou-se que a maioria a considerava "boa", em ambos os momentos (p>0,05). Quanto à avaliação da higiene pessoal e ambiental, observou-se melhora significativa das variáveis "não manipular os alimentos", "não compartilhar os alimentos" e "organização do refeitório", após a intervenção (p<0,05). Ao avaliar o índice resto-ingestão identificaram-se, anteriormente e após a intervenção, valores superiores ao desejável (10,0%). Conclusões: As atividades focadas na higiene foram positivas, visto as mudanças satisfatórias ocorridas. Entretanto, o desperdício de alimentos continuou elevado, sendo necessária a adequação do cardápio e do porcionamento das refeições...

Estado nutricional e caracterização socioeconômica de crianças integrantes do programa bolsa família / Nutritional status and socioeconomic characteristics of children members of a family grant program

Objetivos: Avaliar o estado nutricional e as condições socioeconômicas de crianças integrantes do Programa Bolsa Família (PBF) de uma Unidade Básica de Saúde (UBS). Métodos: Estudo transversal com crianças do PBF de uma UBS inserida em área de elevada vulnerabilidade social. Obtiveram-se dados socioeconômicos, antropométricos e de consumo alimentar. Resultados: Avaliaram-se 93 crianças, sendo 55,9% meninas, com média de idade de 2,90 (1,3) anos. Identificou-se mediana de renda familiar de R$612,00 (IC95%:627,28?762,04), sendo 12,11% provenientes do PBF. O déficit estatural contemplou 4,3% da amostra e 23,7% apresentaram IMC acima do desejável. Verificou-se alta frequência de consumo diário de cereais (95,7%), leguminosas (96,7%) e leite (90,3%), corroborando recomendações dietéticas. Todavia, houve baixa frequência de consumo diário de frutas, carnes e vegetais e elevada frequência de consumo de doces. A renda familiar não interferiu na frequência de consumo de doces, frutas e vegetais (p>0,05), mas contribuiu para maior consumo de leite e carne (p<0,05). Conclusão: Houve elevada prevalência de desvios nutricionais e inadequação alimentar, bem como importante participação do PBF no rendimento familiar, denotando a necessidade de orientações sobre alimentação saudável.