SARS CoV-2 infection among Healthcare Workers from different public health units in Brazil.

Understanding COVID-19 exposure differences among Healthcare Workers (HCWs) across various healthcare units is crucial for their protection and effective management of future outbreaks. However, comparative data on COVID-19 among HCWs in different healthcare units are scarce in Brazil. This study evaluated the relationship between SARS-CoV-2 infection and workplaces in HCWs from three distinct healthcare settings in Brazil. It also examined COVID-19 symptom dynamics reported by them. The cohort comprised 464 HCWs vaccinated with two doses of CoronaVac and a BNT162b2 booster from different institutions: Primary Health Care Units (PHCUs), Emergency Care Units (ECUs), and Hospitals. Participants answered a questionnaire and underwent blood collection at various time points after vaccinations. RT-PCR data and post-vaccination antibody responses were utilized as indicators of SARS-CoV-2 infection. We found that most infected HCWs worked in ECUs, where positive RT-PCR percentages were higher compared to PHCUs and Hospitals. ECUs also showed the highest seropositivity and antibody levels, especially after the first CoronaVac dose. The second dose of CoronaVac diminished the differences in the antibody levels among HCWs from ECUS, PHCUs, and Hospitals, indicating the benefit of the second dose to equalize the antibody levels between previously exposed and unexposed persons. Moreover, COVID-19 symptoms appeared to evolve over time.

Cohort study protocol of the Brazilian collaborative research network on COVID-19: strengthening WHO global data.

INTRODUCTION: With the COVID-19 pandemic, hospitals in low-income countries were faced with a triple challenge. First, a large number of patients required hospitalisation because of the infection's more severe symptoms. Second, there was a lack of systematic and broad testing policies for early identification of cases. Third, there were weaknesses in the integration of information systems, which led to the need to search for available information from the hospital information systems. Accordingly, it is also important to state that relevant aspects of COVID-19's natural history had not yet been fully clarified. The aim of this research protocol is to present the strategies of a Brazilian network of hospitals to perform systematised data collection on COVID-19 through the WHO platform. METHODS AND ANALYSIS: This is a multicentre project among Brazilian hospitals to provide data on COVID-19 through the WHO global platform, which integrates patient care information from different countries. From October 2020 to March 2021, a committee worked on defining a flowchart for this platform, specifying the variables of interest, data extraction standardisation and analysis. ETHICS AND DISSEMINATION: This protocol was approved by the Research Ethics Committee (CEP) of the Research Coordinating Center of Brazil (CEP of the Hospital Nossa Senhora da Conceicao), on 29 January 2021, under approval No. 4.515.519 and by the National Research Ethics Commission (CONEP), on 5 February 2021, under approval No. 4.526.456. The project results will be explained in WHO reports and published in international peer-reviewed journals, and summaries will be provided to the funders of the study.

Resultados da avaliação da cultura de segurança em um hospital público de ensino do Ceará / Results of a safety culture survey in a teaching public hospital in Ceará / Resultados de la evaluación de la cultura de seguridad en um hospital público de enseñanza de Ceará

Objetivo: Avaliar as dimensões da cultura de segurança do paciente de um hospital público de ensino, identificando suas áreas fortes e frágeis. Métodos: Estudo observacional, seccional, quantitativo, realizado entre dezembro de 2014 e janeiro de 2015, através da aplicação da versão adaptada para o português do questionário Hospital Survey on Patient Safety Culture (HSOPSC) com funcionários de um hospital de referência de Fortaleza, Ceará, Brasil. A análise dos resultados ocorreu por meio do cálculo dos valores absolutos e relativos de positividade para cada uma das 12 dimensões de segurança do paciente avaliadas no instrumento. Resultados: A expectativa sobre o seu supervisor/chefe e ações promotoras da segurança do paciente e o trabalho em equipe foram os principais pontos identificados dentro das unidades, com 79% (n=380/484) e 73% (n=335/501) de positividade nas respostas, respectivamente. Em relação às oportunidades de melhoria, o principal ponto identificado foi a resposta não punitiva aos erros, que teve o menor percentual de positividade (18%; n=74/365). Outros pontos a se melhorar que também merecem destaque foram a passagem de plantão ou de turno/transferências e a adequação dos profissionais (45%; n=225/470 e 36%; n=380/484). Conclusão: A cultura de segurança do hospital em questão é marcada pelo trabalho em equipe, tendo como pontos frágeis às questões punitivas, passagem de plantão e adequação dos profissionais.

Objective: To evaluate the characteristics of the patient safety culture of a public teaching hospital, identifying its strengths and fragilities. Methods: Observational, cross-sectional, quantitative study, conducted between December 2014 and January 2015, through the application of the Portuguese-adapted version of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire to employees of a referral hospital in Fortaleza, Ceará, Brazil. Data analysis was conducted by means of calculation of absolute and percentage values of positivity for each dimension of patient safety assessed in the instrument. Results: Expectations regarding the supervisor/chief and the actions promoting patient safety, and teamwork were the key points identified within the units, with 79% (n=380/484) and 73% (n=335/501) of positivity in the answers, respectively. In relation to the improvement opportunities, the main point identified was the non-punitive response to errors, which had the lowest percentage of positivity (18%, n=74/365). Other points to be improved that also stand out are shift changes/patient handover and staff adequacy (45%; n=225/470 and 36%; n=380/484). Conclusion: The safety culture of the evaluated hospital is characterized by the teamwork and present as fragilities the punitive issues, shift changes/patient handover and staff adequacy.

Objetivo: Evaluar las dimensiones de la cultura de seguridad del paciente de un hospital público de enseñanza identificando sus áreas fuertes y frágiles. Métodos: Estudio observacional, seccional y cuantitativo realizado entre diciembre de 2014 y enero de 2015 a través de la aplicación del cuestionario Hospital Survey on Patient Safety Culture (HSOPSC) en su versión adaptada para el portugués a empleados de un hospital de referencia de Fortaleza, Ceará, Brasil. El análisis de los resultados se dio a través del cálculo de los valores absolutos y relativos de positividad para cada una de las 12 dimensiones de seguridad del paciente evaluadas por el instrumento. Resultados: La expectativa sobre el supervisor/jefe y acciones de promoción de la seguridad del paciente y el trabajo en equipo fueron los principales aspectos identificados en las unidades con el 79% (n=380/484) y el 73% (n=335/501) de positividad en las respuestas, respectivamente. El principal aspecto identificado respecto las oportunidades de mejoría fue la respuesta no punitiva de los errores la cual tuvo el menor porcentaje de positividad (18%; n=74/365). Otros aspectos para mejorar y que también merecen atención fueron el cambio de guardia o de turno/transferencias y la adecuación de los profesionales (45%; n=225/470 y 36%; n=380/484). Conclusión: La cultura de seguridad del referido hospital es marcada por el trabajo en equipo con aspectos frágiles como las cuestiones de punición, el cambio de guardia y la adecuación de los profesionales.

Relação entre pressão inspiratória nasal e pressão inspiratória máxima em pacientes com distrofia miotônica / Relation between inspiratory nasal pressure and maximal inspiratory pressure in muscular myotonic dystrophy patients

Introdução: A Distrofia Miotônica (OM) é uma doença neuromuscular multissistêmica que cursa com diminuição progressiva da força muscular respiratória, sendo este um importante fator para o desenvolvimento de complicações pulmonares. Objetivo: O objetivo deste estudo foi avaliar as correlações e a concordância entre as medidas de sniff nasal inspiratory pressure (SNIP) e a pressão inspiratória máxima (Plmáx), assim como a precisão da associação destes testes na classificação de comprometimento muscular inspiratório em pacientes com OM. Método: Foram avaliados 20 pacientes (idade 41 ± 17 anos, IMC 23,3 ± 5,7 kg/m',CVF 75 ± 15 % pred, VEFj 76 ± 20%pred e VEF/CVF 83 ± 10%), os quais foram classificados em grau de acometimento muscular. Realizaram espirometria, sniff teste e Plmáx. Resultados: A análise mostrou uma média de SNIP de 76 ± 23 cmHp (78± 27% pred) e Plmáx de 74 ± 30 cmH,O (69 ± 23 % pred.). Encontramos uma correlação significativa e uma fraca concordância entre Plmáx e SNIP. Quando considerado apenas a avaliação da Plmáx, 70% (14 pacientes) da amostra apresentou comprometimento muscular inspiratório, e quando somente o modelo de sniff teste foi considerado, esse resultado foi encontrado em 30% dos pacientes. Na associação dos testes, 30% dos pacientes apresentaram comprometimento muscular inspiratório. Conclusão: Sugerimos que a associação das avaliações de SNIP e Plmáx pode aumentar a precisão na classificação de comprometimento muscular inspiratório em pacientes com DM. As medidas de SNIP e Plmáx mostraram não ser intercambiáveis, mas complementares na avaliação da força muscular inspiratória em pacientes com distrofia miotônica, principalmente aqueles com comprometimento muscular orofacial. IMC: Índice de massa corpórea; CVF: Capacidade Vital Forçada; VEF,: Volume expiratório forçado no primeiro segundo; VEF/CVF: Índice de Tiffeneau- Razão entre volume expiratório forçado no primeiro segundo e capacidade vital forçada.

Introduction: Myotonic Oystrophy (MO) is a neuromuscular multisystem disease that leads to progressive decrease in respiratory muscle strength, which is an important factor for the development of pulmonary complications. Objective: to evaluate the relationship between sniff nasal inspiratory pressure (SNIP and maximal inspiratory pressure (MIP) and the accuracy of these tests in the classification of inspiratory muscle impairment in patients with DM. Method: Twenty patients were evaluated (age 41 ± 17 years, BMI 23.3 ± 5.7 kg/m2, FVC 75 ± 15% pred, FEVj 76 ± 20% pred and FEV/FVC 83 ± 10%), which were classified as degree of muscular involvement. Spirometry, sniff test and MIP were developed. Results: The analysis showed a mean SNIP of 76 ± 23 cmHp (78 ± 27% pred) and MIP was 74 ± 30 cmH20(69 ± 23% pred). We found a significant correlation and a weak agreement between MIP and SNIP. When considering only the evaluation of the MIP, 70% (14 patients) of the sample had impaired inspiratory muscle, and only when the sniff test model was considered, this result was achieved in 30% of patients. In the association tests, 30% of patients had impaired inspiratory muscle. Conclusion: We suggest that the association assessments of SNIP and MIP can increase the accuracy in the classification of inspiratory muscle impairment in patients with MD. Measures of SNIP and MIP were shown not to be interchangeable, but complementary in the evaluation of muscle strength in patients with myotonic dystrophy, particularly those with orofacial muscle involvement. BMI: Body mass index; FVC: forced vitai capacity; FEV,: Forced expiratory volume in the first second; FEV/FVC: Tiffeneau index- Ratio between forced expiratory volume in the first second and forced vital capacity.