Molecular characterization of macrolide resistance in Haemophilus influenzae and Haemophilus parainfluenzae strains (2018-21).

OBJECTIVES: This study aimed to explore the prevalence of macrolide resistance and the underlying resistance mechanisms in Haemophilus influenzae (n = 2556) and Haemophilus parainfluenzae (n = 510) collected between 2018 and 2021 from Bellvitge University Hospital, Spain. METHODS: Antimicrobial susceptibility was tested by microdilution. Whole-genome sequencing was performed using Illumina MiSeq and Oxford Nanopore technologies, and sequences were examined for macrolide resistance determinants and mobile genetic structures. RESULTS: Macrolide resistance was detected in 67 H. influenzae (2.6%) and 52 (10.2%) H. parainfluenzae strains and associated with resistance to other antimicrobials (co-trimoxazole, chloramphenicol, tetracycline). Differences in macrolide resistance existed between the two species. Acquired resistance genes were more prevalent in H. parainfluenzae (35/52; 67.3%) than in H. influenzae (12/67; 17.9%). Gene mutations and amino acid substitutions were more common in H. influenzae (57/67; 85%) than in H. parainfluenzae (16/52; 30.8%). Substitutions in L22 and in 23S rRNA were only detected in H. influenzae (34.3% and 29.0%, respectively), while substitutions in L4 and AcrAB/AcrR were observed in both species. The MEGA element was identified in 35 (67.3%) H. parainfluenzae strains, five located in an integrative and conjugative element (ICE); by contrast, 11 (16.4%) H. influenzae strains contained the MEGA element (all in an ICE). A new ICEHpaHUB8 was described in H. parainfluenzae. CONCLUSIONS: Macrolide resistance was higher in H. parainfluenzae than in H. influenzae, with differences in the underlying mechanisms. H. parainfluenzae exhibits co-resistance to other antimicrobials, often leading to an extensively drug-resistant phenotype. This highlights the importance of conducting antimicrobial resistance surveillance.

A Transgender Chatbot (Amanda Selfie) to Create Pre-exposure Prophylaxis Demand Among Adolescents in Brazil: Assessment of Acceptability, Functionality, Usability, and Results.

BACKGROUND: HIV incidence rates have increased in adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW). Thus, it is essential to promote access to HIV prevention, including pre-exposure prophylaxis (PrEP), among these groups. Moreover, using artificial intelligence and online social platforms to create demand and access to health care services are essential tools for adolescents and youth. OBJECTIVE: This study aims to describe the participative process of developing a chatbot using artificial intelligence to create demand for PrEP use among AMSM and ATGW in Brazil. Furthermore, it analyzes the chatbot's acceptability, functionality, and usability and its results on the demand creation for PrEP. METHODS: The chatbot Amanda Selfie integrates the demand creation strategies based on social networks (DCSSNs) of the PrEP1519 study. She was conceived as a Black transgender woman and to function as a virtual peer educator. The development process occurred in 3 phases (conception, trial, and final version) and lasted 21 months. A mixed methodology was used for the evaluations. Qualitative approaches, such as in-depth adolescent interviews, were used to analyze acceptability and usability, while quantitative methods were used to analyze the functionality and result of the demand creation for PrEP based on interactions with Amanda and information from health care services about using PrEP. To evaluate Amanda's result on the demand creation for PrEP, we analyzed sociodemographic profiles of adolescents who interacted at least once with her and developed a cascade model containing the number of people at various stages between the first interaction and initiation of PrEP (PrEP uptake). These indicators were compared with other DCSs developed in the PrEP1519 study using chi-square tests and residual analysis (P=.05). RESULTS: Amanda Selfie was well accepted as a peer educator, clearly and objectively communicating on topics such as gender identity, sexual experiences, HIV, and PrEP. The chatbot proved appropriate for answering questions in an agile and confidential manner, using the language used by AMSM and ATGW and with a greater sense of security and less judgment. The interactions with Amanda Selfie combined with a health professional were well evaluated and improved the appointment scheduling. The chatbot interacted with most people (757/1239, 61.1%) reached by the DCSSNs. However, when compared with the other DCSSNs, Amanda was not efficient in identifying AMSM/ATGW (359/482, 74.5% vs 130/757, 17.2% of total interactions, respectively) and in PrEP uptake (90/359, 25.1% vs 19/130, 14.6%). The following profiles were associated (P<.001) with Amanda Selfie's demand creation, when compared with other DCS: ATGW and adolescents with higher levels of schooling and White skin color. CONCLUSIONS: Using a chatbot to create PrEP demand among AMSM and ATGW was well accepted, especially for ATGW with higher levels of schooling. A complimentary dialog with a health professional increased PrEP uptake, although it remained lower than the results of the other DCSSNs.

Are Rights-Based Services Important? An Adolescent PrEP Demonstration Project in Brazil.

In this study, we systematically examined the importance of human rights standards and principles for rights-based pre-exposure prophylaxis (PrEP) provision for marginalized adolescents. Nested within a demonstration study of PrEP provision to adolescent men who have sex with men, travestis, and transgender women, we carried out interviews in São Paulo, Brazil with 25 adolescents, eight health providers, and six workers involved in community-based demand creation. Analysis focused on participants' narratives about aspects of human rights within service delivery, including the availability, accessibility, acceptability, and quality of services; informed decision-making; nondiscrimination; and privacy and confidentiality. Clients and service providers highlighted the importance of availing a range of services beyond PrEP and described how community outreach and social media helped promote accessibility. Acceptability centered around clients feeling heard and respected. Health workers appreciated having time to build trusting relationships with clients to ensure quality of care and support informed decision-making. Nondiscrimination was valued by all, including using clients' chosen pronouns. Privacy and confidentiality were primary concerns for clients who were not "out" about their sexuality or PrEP use; to mitigate this, health workers sought to accommodate clients' preferred channels of communication. Rights-based PrEP services can help promote engagement and retention in PrEP services, particularly for marginalized populations.

Adherence, Safety, and Feasibility of HIV Pre-Exposure Prophylaxis Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil (PrEP1519 Study).

PURPOSE: To evaluate the adherence, safety, and feasibility of pre-exposure prophylaxis (PrEP) in real-world settings among adolescent men who have sex with men (AMSM) and transgender women (ATGW). METHODS: PrEP1519 is a single-arm, multicentric demonstration cohort study of daily oral PrEP among AMSM and ATGW aged 15 to 19 years in Brazil. Study visits occurred at baseline, weeks 4, 12, and then quarterly until 96 weeks. Descriptive statistics and a mixed logistic model for longitudinal data evaluated the factors associated with high adherence. RESULTS: One thousand sixteen AMSM and ATGW accessed the PrEP1519 clinics. Of those, 998 (98.2%) underwent clinical triage. Forty one were diagnosed with human immunodeficiency viruses (HIV) at baseline (4.0%) and 79 (7.9%) were not eligible for PrEP. Of the 878, 795 (90.5%) enrolled in PrEP, 82 (10.3%) were lost to follow-up, and 713 were included. There was no significant decrease in creatinine clearance; only two participants had grade-III aspartate aminotransferase elevation. Incident HIV infection occurred in eight participants (incidence rate [IR] = 1.64 per 100 person-years [PY]): two in 15-17 years (IR = 2.24 per 100 PY) and six in 18-20 years (IR = 1.51 per 100 PY). PrEP adherence was higher among those with more years of schooling, those reporting no difficulties in PrEP use due to side effects, and who had low HIV risk perception in the past three months. DISCUSSION: PrEP for AMSM and ATGW was safe and feasible in real-world settings. However, a higher IR among young adolescents and a higher adherence among less vulnerable people indicate the need for greater care, considering the specificities of this age group.

Between past and future: what the everyday lives of beneficiaries of brazil's Back Home Program teach us about the program. / Entre o passado e o futuro: o que o presente dos beneficiários do Programa de Volta para Casa ensina sobre o programa.

This study investigates the everyday lives of six beneficiaries of the Programa de Volta para Casa (the "Back Home Program" - PVC) with the aim of analyzing its effects and identifying lessons that can be applied to help improve and ensure the continuity of the deinstitutionalization process in dialogue with the current political, social and economic reality. Using participant observation and narratives, we conducted a qualitative study in two cities that have been implementing the PVC over the last 15 years. The results were organized into the following core themes: the participants - who they are and how they live; the challenges of being back in the city; using money and the challenge of shifting towards social capital; and the guarantee of rights. The findings of the hermeneutic-dialectic analysis show that the beneficiaries have moved away from a situation of zero contractuality and ruptured affective relations towards one of access to goods and services, housing and free movement in public spaces, limited by urban violence, lack of money for leisure activities, aging, precarious housing conditions, and lack relations of trust and solidarity with ordinary people living in the neighborhood. Making the city an enabling environment and promoting actions in coordination with other sectors such as housing, income, employment, security and justice are steps of resistance in the face a regressive political, economic and social landscape.

O estudo revela o cotidiano de seis beneficiários do Programa de Volta para Casa (PVC) com o objetivo de analisar seus efeitos e apontar aprendizados para a atualização e a continuidade do processo de desinstitucionalização em diálogo com a realidade política, social e econômica. Pesquisa qualitativa com uso de observação participante e narrativas realizada em dois municípios com PVC há 15 anos. Os resultados foram organizados em cinco eixos temáticos que versam sobre quem são e como vivem, os desafios de estar de volta à cidade, o uso do capital monetário e o desafio da sua passagem para capital social e a garantia de direitos. A análise hermenêutica-dialética mostra que os beneficiários do PVC partem de um lugar de contratualidade zero e rompimento de seus vínculos de afeto e passam a ter acesso a bens, serviços, moradia e a circulação pelos espaços públicos, ainda limitada pela violência urbana, a falta de recurso para financiar atividades de lazer, o envelhecimento, a precariedade da moradia e a falta de relação de confiança e solidariedade com pessoas do bairro. Habilitar a cidade e a articulação intersetorial com habitação, renda, trabalho, segurança e justiça são passos de resistência em um cenário político, econômico e social de retrocesso.

30 anos após a intervenção no Anchieta, por onde andam os beneficiários do Programa de Volta Para Casa de Santos? / 30 years after the intervention in Anchieta, where are the beneficiaries of the de Volta Para Casa program of Santos?

Resumo O Programa de Volta Para Casa (PVC) é uma das Estratégias de Desinstitucionalização da Rede de Atenção Psicossocial do Sistema Único de Saúde. Baseado na mudança de paradigma proposta pela Psiquiatria Democrática Italiana, tem o objetivo de promover a inclusão social e acesso aos direitos humanos de egressos de internações psiquiátricas. Objetivou-se saber quem são, onde moram e por onde andam os moradores da cidade de Santos beneficiários do PVC, local em que o processo de desinstitucionalização foi pioneiro. Por meio de entrevista semiestruturada e observação participante, em uma pesquisa qualitativa, identificou-se que as beneficiárias são pessoas acima de 50 anos, não escolarizadas, negras, com renda média de um salário mínimo; moradoras dos cortiços do centro; usuárias de transporte público e dos serviços de saúde; e frequentadoras de estabelecimentos comerciais e religiosos. Utilizando o método hermenêutico-dialético e a análise interseccional, concluiu-se que os marcadores sociais raça/cor e origem estão relacionados às internações mais longas, ao menor acesso à moradia digna e à vivência de maior exclusão social. Para uma práxis crítica, é necessário garantir acesso ao PVC por pessoas negras e adotar estratégias de descolonização do eu no enfrentamento das relações de opressão mais vivenciadas pelos beneficiários negros e migrantes, bem como de seus descendentes.

Abstract The de Volta Para Casa Program (Back Home Program - PVC) is one of the Deinstitutionalization Strategies of the Psychosocial Care Network of the Brazilian Unified Health System. Based on the change of perspective proposed by the Italian Democratic Psychiatry, it aims to promote social inclusion and access to human rights for those leaving psychiatric hospitalizations. The objective was to find out who are the PVC beneficiaries habitants of the municipality of Santos, where the deinstitutionalization process was a pioneer, where they live, and where they are now. With a semi-structured interview and participant observation, in a qualitative research, it was identified that the beneficiaries are people over 50 years old, without schooling, black, with an average income of a minimum wage, residents of the tenements in the city center, public transport and public health services users, and attending commercial and religious establishments. By using the hermeneutic-dialectical method and the intersectional perspective, it was concluded that the social markers race/color and origin are related to longer hospitalization, lack of access to decent housing, and greater social exclusion. For a critical praxis, it is necessary to guarantee access to PVC for black women and to adopt strategies for the decolonization of the self in facing the oppressive relationships most experienced by black and migrants beneficiaries, as well as their descendants.

Entre o passado e o futuro: o que o presente dos beneficiários do Programa de Volta para Casa ensina sobre o programa / Between past and future: what the everyday lives of beneficiaries of brazil's Back Home Program teach us about the program

Resumo O estudo revela o cotidiano de seis beneficiários do Programa de Volta para Casa (PVC) com o objetivo de analisar seus efeitos e apontar aprendizados para a atualização e a continuidade do processo de desinstitucionalização em diálogo com a realidade política, social e econômica. Pesquisa qualitativa com uso de observação participante e narrativas realizada em dois municípios com PVC há 15 anos. Os resultados foram organizados em cinco eixos temáticos que versam sobre quem são e como vivem, os desafios de estar de volta à cidade, o uso do capital monetário e o desafio da sua passagem para capital social e a garantia de direitos. A análise hermenêutica-dialética mostra que os beneficiários do PVC partem de um lugar de contratualidade zero e rompimento de seus vínculos de afeto e passam a ter acesso a bens, serviços, moradia e a circulação pelos espaços públicos, ainda limitada pela violência urbana, a falta de recurso para financiar atividades de lazer, o envelhecimento, a precariedade da moradia e a falta de relação de confiança e solidariedade com pessoas do bairro. Habilitar a cidade e a articulação intersetorial com habitação, renda, trabalho, segurança e justiça são passos de resistência em um cenário político, econômico e social de retrocesso.

Abstract This study investigates the everyday lives of six beneficiaries of the Programa de Volta para Casa (the "Back Home Program" - PVC) with the aim of analyzing its effects and identifying lessons that can be applied to help improve and ensure the continuity of the deinstitutionalization process in dialogue with the current political, social and economic reality. Using participant observation and narratives, we conducted a qualitative study in two cities that have been implementing the PVC over the last 15 years. The results were organized into the following core themes: the participants - who they are and how they live; the challenges of being back in the city; using money and the challenge of shifting towards social capital; and the guarantee of rights. The findings of the hermeneutic-dialectic analysis show that the beneficiaries have moved away from a situation of zero contractuality and ruptured affective relations towards one of access to goods and services, housing and free movement in public spaces, limited by urban violence, lack of money for leisure activities, aging, precarious housing conditions, and lack relations of trust and solidarity with ordinary people living in the neighborhood. Making the city an enabling environment and promoting actions in coordination with other sectors such as housing, income, employment, security and justice are steps of resistance in the face a regressive political, economic and social landscape.

Na casa e na rua: cenas dos moradores de serviços residenciais terapêuticos / At home and on the street: the scene of residents of therapeutic residential care / En la casa y en la calle: escenas de los residentes de servicios residenciales terapéuticos

O objetivo deste estudo foi compreender o agenciamento social da loucura, na perspectiva da desinstitucionalização, por meio da observação participante de cenas do cotidiano de moradores de Serviços Residenciais Terapêuticos (SRT). Trata-se de uma pesquisa social em saúde, de abordagem qualitativa, com inspirações etnográficas e orientação fenomenológica. Os dez participantes são moradores de dois SRT de uma cidade localizada na região Sudeste do Brasil. Têm 60 anos em média, são ex-moradores de hospitais psiquiátricos e metade é do sexo feminino. Os resultados são 12 cenas de convivência no espaço coletivo da casa, da circulação social nas ruas do bairro e do acesso a serviços comerciais, de saúde e cultura. Observou-se que os participantes vivenciam, cotidianamente e de diferentes formas, a apropriação ou reapropriação do corpo, da casa e da rua. Trata-se de um processo de vivificação do eu que pode partir da expropriação de si e pode alcançar a incorporação, com relações de pertencimento a um corpo social. Concluiu-se que o poder aquisitivo e as construções sociais relacionadas aos corpos dos moradores no encontro com diferentes atores são circunstâncias que podem interferir nesse processo. As conversações de reautoria, práticas narrativas baseadas no construcionismo social, e as práticas e táticas cotidianas, na perspectiva de Michel de Certeau, são teorias que contribuem para a compreensão e instrumentalização do agenciamento social dos moradores de SRT nos espaços públicos e privados.(AU)

This study aimed to understand the social management of madness from the perspective of deinstitutionalization by means of participant observation of daily life scenes of residents at Therapeutic Residential Care (TRC). This is a qualitative social health research with ethnographic inspirations and phenomenological orientation. Participants consisted of ten former residents of a psychiatric hospitals, half of whom are female and with mean age of 60 years old, current residing in a TRC of a city located in a Southeast region of Brazil. The results indicate 12 scenes of coexistence within the collective space of the houses, social circulation in the neighborhood streets, and access to commercial, health, and cultural services. Daily and in different ways, the participants experience the appropriation or reappropriation of body, house, and street. In this sense, these scenes comprise a process of vivification of the self that can depart from self-expropriation and reach incorporation, establishing relations of social belonging. These findings show that purchasing power and social constructions regarding residents' body in the encounter with different actors are circumstances that can interfere in this process. The re-authoring conversations, narrative practices based on social constructionism, and everyday practices and tactics, from Certeau's perspective, are theories that help understanding and instrumentalizing the social agency of residents of TRC in public and private spaces.(AU)

El objetivo de este estudio fue comprender el agenciamiento social de la locura desde la perspectiva de la desinstitucionalización, por medio de la observación participante de escenas del cotidiano de moradores de Servicios Residenciales Terapéuticos (SRT). Esta es una investigación social en salud, de abordaje cualitativo, con inspiraciones etnográficas y orientación fenomenológica. Los diez participantes son residentes dos SRT de una ciudad en sudeste de Brasil. Tienen como promedio 60 años de edad, son ex residentes de hospitales psiquiátricos y la mitad son mujeres. Los resultados son doce escenas de convivencia en el espacio colectivo de la casa, de la circulación social en las calles del barrio y del acceso a servicios comerciales, de salud y cultura. Se observó que los participantes vivencian, cotidianamente y de diferentes formas, la apropiación o reapropiación del cuerpo, de la casa y de la calle. Se trata de un proceso de vivificación del yo que puede partir de la expropiación de sí y puede alcanzar la incorporación, con relaciones de pertenencia, a un cuerpo social. Se concluyó que el poder adquisitivo y las construcciones sociales relacionadas con los cuerpos de los residentes en el encuentro con diferentes actores pueden interferir en ese proceso. Las conversaciones de re-autoría, prácticas narrativas basadas en el construccionismo social, y las prácticas y tácticas cotidianas, en la perspectiva de Certeau, son teorías que contribuyen a la comprensión e instrumentalización del agenciamiento social de los moradores de Servicios Residenciales Terapéuticos en los espacios públicos y privados.(AU)

Vivências de cuidado em saúde de moradores de Serviços Residenciais Terapêuticos / Health care experiences of residents of Therapeutic Residential Services / Vivencias de cuidado de salud de moradores de Servicios Residenciales Terapéuticos

O Serviço Residencial Terapêutico (SRT) compõe a estratégia de desinstitucionalização na Rede de Atenção Psicossocial (RAPS), sendo um instrumento de recuperação de cidadania. O objetivo deste estudo foi conhecer a compreensão dos moradores de SRT de uma cidade paulista sobre "saúde" e "cuidado à saúde". De natureza qualitativa, utilizou o grupo focal narrativo e contou com a participação de dez moradores. Para eles, saúde é ser feliz e sentir prazer; e o cuidado à saúde extrapola as ações nos diferentes pontos da RAPS. A sua rede de cuidados inclui diversificados espaços de trocas sociais em estabelecimentos comerciais, de lazer e de cultura. Concluiu-se que as ações dos profissionais no cuidado à saúde devem ressignificar papéis e mediar relações sociais, contratuais e de poder, na concretização de novos planos de vida na cidade, constituindo-se como um projeto de felicidade.(AU)

The Therapeutic Residential Service (SRT) is a deinstitutionalization strategy part of the Psychosocial Care Network (RAPS) in Brazil and is an instrument that contributes to the recovery of citizenship of mental health patients. The aim of the present study was to learn about how SRT residents in a city of the state of São Paulo understand "health" and "health care". This was a qualitative study that used narrative focus groups and included ten residents. According to them, health means being happy and feeling pleasure, and health care goes beyond the actions of the different RAPS points of care. Their care network includes different spaces for social exchanges in commercial, leisure and cultural facilities. In conclusion, the actions of healthcare professionals must serve to re-signify roles and mediate social, contractual and power relationships in order to realize new plans for life in the city, constituting itself as a project for happiness.(AU)

El Servicio Residencial Terapéutico (SRT) compone la estrategia de desinstitucionalización en la Red de Atención Psicosocial (RAPS), siendo un instrumento de recuperación de ciudadanía. El objetivo de este estudio fue conocer la comprensión de los moradores de SRT de una ciudad del Estado de São Paulo sobre "salud" y "cuidado de la salud". De naturaleza cualitativa, utilizó el grupo focal narrativo y contó con la participación de diez moradores. Para ellos, salud es ser feliz y sentir placer y el cuidado de la salud extrapola las acciones en los diferentes puntos de la RAPS. Su red de cuidados incluye espacios diversificados de intercambios sociales en establecimientos comerciales, de ocio y cultura. Se concluyó que las acciones de los profesionales en el cuidado de la salud deben dar nuevo significado a papeles y mediar relaciones sociales, contractuales y de poder en la concreción de nuevos planes de vida en la ciudad, constituyéndose como un proyecto de felicidad.(AU)

Residência multiprofissional em saúde da família e a formação de psicólogos para a atuação na atenção básica / Family health multiprofessional residency and the education of psychologists to work in basic care

O Programa de Saúde da Família (PSF) surgiu como estratégia de reorientação da atenção básica em saúde. A incorporação de profissionais de saúde mental no PSF não foi prevista na Portaria nº 648 (2006), que definiu os recursos mínimos para a atuação das equipes. O Ministério da Saúde, em 2007, aprovou os Núcleos de Atenção à Saúde da Família. A Residência Multiprofissional em Saúde da Família foi uma proposta coordenada pela Faculdade e Casa de Saúde Santa Marcelina, contando com dez categorias profissionais, entre elas a psicologia. Este trabalho tem o objetivo de refletir sobre a prática do psicólogo residente e analisá-la, contribuindo para a discussão das possibilidades de atuação do psicólogo no PSF na cidade de São Paulo. Trata-se de uma pesquisa avaliativa do tipo estudo de caso, que tem o objetivo de sistematizar as intervenções realizadas, o processo de construção da planilha mensal de produção e alguns dados que ela fornece. Os resultados são: a descrição das categorias, a planilha mensal de produção com adaptações a partir dos códigos do Sistema de Informação Ambulatorial (SIA) atribuídos aos psicólogos e um quadro com os dados quantitativos. Foi possível perceber que os princípios do PSF, a formação em psicologia e a vinculação com a Residência estão relacionados com os caminhos percorridos. Concluiu-se, então, que a quantificação é necessária para a visualização das ações, entretanto, não é suficiente para avaliar a abrangência, a eficácia e a efetividade das ações e o quanto o SIA não está preparado para o registro, o controle e a fiscalização do psicólogo inserido no PSF.

The Family Health Program (FHP) emerged in Brazil as a strategy of basic health care reorientation. The incorporation of Mental Health professionals in the FHP was not included in Directive 648 (year?), which defines minimum resources for the teams' work. In 2007, the Brazilian Ministry of Health approved the Family Healthcare Nuclei. The Multiprofessional Family Health Residency was a proposal that was coordinated by the Santa Marcelina Faculty and Hospital. It had ten professional categories, one of them being the psychologists. This work aims to reflect on and analyze the resident psychologists' practice and contribute to the discussion about the possibilities for the psychologists' work in the FHP in the city of São Paulo. It is a descriptive research; more specifically, a case study. The objective is the systematization of the practices, of the process of construction of the monthly production table and of some data it provides. The results are: categories description, the monthly production table, with some adaptations based on the codes of the Day-Care Information System that were attributed to psychologists, and a framework with quantitative data. It was possible to notice that: FHP principles, having attended a psychology undergraduation course and being part of the residency program are related with the psychologists' own history. The conclusion is that, although quantifying is necessary for the understanding of the practices, it is not sufficient to assess the complexity, efficacy and effectiveness of the practices. In addition, quantifying does not reveal the extent to which the Day-Care Information System is not prepared to register, control and inspect the psychologists who work in the FHP.