The impact of social cohesion and risk communication on excess mortality due to COVID-19 in 213 countries: a retrospective analysis.

BACKGROUND: Tools for assessing a country's capacity in the face of public health emergencies must be reviewed, as they were not predictive of the COVID-19 pandemic. Social cohesion and risk communication, which are related to trust in government and trust in others, may have influenced adherence to government measures and mortality rates due to COVID-19. OBJECTIVE: To analyse the association between indicators of social cohesion and risk communication and COVID-19 outcomes in 213 countries. RESULTS: Social cohesion and risk communication, in their dimensions (public trust in politicians, trust in others, social safety nets, and equal distribution of resources index), were associated with lower excess mortality due to COVID-19. The number of COVID-19-related disorder events and government transparency were associated with higher excess mortality due to COVID-19. The lower the percentage of unemployed people, the higher the excess mortality due to COVID-19. Most of the social cohesion and risk communication variables were associated with better vaccination indicators, except for social capital and engaged society, which had no statistically significant association. The greater the gender equality, the better the vaccination indicators, such as the number of people who received all doses. CONCLUSION: Public trust in politicians, trust in others, equal distribution of resources and government that cares about the most vulnerable, starting with the implementation of programs, such as cash transfers and combating food insecurity, were factors that reduced the excess mortality due to COVID-19. Countries, especially those with limited resources and marked by social, economic, and health inequalities, must invest in strengthening social cohesion and risk communication, which are robust strategies to better cope with future pandemics.

National governance and excess mortality due to COVID-19 in 213 countries: a retrospective analysis and perspectives on future pandemics.

BACKGROUND: National governance may have influenced the response of institutions to the Covid-19 pandemic, being a key factor in preparing for the next pandemics. The objective was to analyze the association between excess mortality due to COVID-19 (daily and cumulative per 100 thousand people) and national governance indicators in 213 countries. METHOD: Multiple linear regression models using secondary data from large international datasets that are in the public domain were performed. Governance indicators corresponded to six dimensions: (i) Voice and Accountability; (ii) Political Stability and Absence of Violence/Terrorism; (iii) Government Effectiveness; (iv) Regulatory Quality; (v) Rule of Law and (vi) Control of Corruption. The statistical analysis consisted of adjusting a multiple linear regression model. Excess mortality due to COVID-19 was adjusted for potential confounding factors (demographic, environmental, health, economic, and ethnic variables). RESULTS: The indicators Control of Corruption, Government Effectiveness, Regulatory Quality and Rule of Law had a significant inverse association (p < 0.0001) with the estimated excess mortality in 2020, 2021 and 2022. Furthermore, the governance indicators had a direct significant association (p < 0.0001) with the vaccination variables (People_fully_vaccinated; Delivered population; The total number of vaccination doses administered per 100 people at the country level), except for the variables Vaccination policies and Administration of first dose, which were inversely associated. In countries with better governance, COVID-19 vaccination was initiated earlier. CONCLUSION: Better national governance indicators were associated with lower excess mortality due to COVID-19 and faster administration of the first dose of the COVID-19 vaccine.

Measles outbreak: preliminary report on a case series of the first 8,070 suspected cases, Manaus, Amazonas state, Brazil, February to November 2018.

We report an ongoing measles outbreak in Manaus, Amazonas state, Brazil. As at 3 November 2018, 1,631 cases were confirmed corresponding to an incidence of 75.3 per 100,000 inhabitants; all five sanitary districts presented confirmed cases. Reintroduction of measles virus in Manaus is likely related to the current outbreak in Venezuela and due to recent decline in measles vaccine coverage. Given the current scenario, prevention and control measures should target individuals aged 15-29 years.

[Analysis of the Vaccine Adverse Event Reporting System in Brazil, 2014 to 2016Análisis del Sistema de Información de Vigilancia de Eventos Adversos Posvacunación en Brasil, 2014 a 2016]. / Análise do Sistema de Informação da Vigilância de Eventos Adversos Pós-Vacinação no Brasil, 2014 a 2016.

OBJECTIVE: To describe the characteristics of vaccine adverse events (VAE) reports in the online VAE Reporting System (VAE-RS) after 2 years of operation. METHOD: A descriptive analysis of VAE reports entered into the VAE-RS between July 2014 and June 2016 was performed. RESULTS: During the study period, 24 732 VAE were reported. Of 5 570 Brazilian municipalities, 2 571 (46.2%) reported at least one VAE; however, only 1 622 (6.6%) reports had been completed/closed at the end of the study period. Of these, 89.9% referred to mild VAE. Among the completed reports, 19.7% did not provide information on "type of medical care provided," and 98.7% had no information regarding laboratory tests. Systemic neurological symptoms were the most frequent serious VAE among closed reports (59.5% of serious signs/symptoms). Concerning age, the highest VAE reporting coefficients were recorded for children aged ≤ 4 years. CONCLUSION: The VAE-RS is useful to monitor immunization safety. However, municipal services must increase adherence to the system and perform the required investigation and reporting of VAE, with timely and adequate completion of the VAE-RS form. Knowledge regarding VAE can be used in the daily routine of surveillance services, improving the safety of immunobiological agents.

OBJETIVO: Describir las características de las notificaciones de eventos adversos posvacunación (EAPV) en el Sistema de Información de Vigilancia de EAPV (SI-EAPV, un sistema en línea, durante los primeros 2 años de ejecución del sistema. MÉTODO: Se realizó un estudio descriptivo de los registros de EAPV notificados en el SI-EAPV entre julio de 2014 y junio de 2016. RESULTADOS: Durante el período del estudio, se registraron 24 732 notificaciones. De 5 570 municipios brasileños, 2 571 (46,2%) notificaron algún EAPV. Sin embargo, solamente 1 622 (6,6%) notificaciones estaban cerradas al momento del estudio; de ellas, el 89,9% no presentó gravedad. Respecto a las notificaciones cerradas, en el 19,7% no fue anotada la variable "atención médica" y el 98,7% no presentó registro de exámenes de laboratorio. Entre los eventos adversos graves cerrados, las manifestaciones clínicas sistémicas neurológicas fueron las más frecuentes, representado el 59,5% de los signos y síntomas. En cuanto a la edad, los mayores coeficientes de notificación se registraron entre los menores de 4 años. CONCLUSIÓN: El SI-EAPV es útil para el monitoreo de la seguridad de las vacunas. Sin embargo, los municipios necesitan ampliar la adhesión al sistema, así como realizar las investigaciones y notificaciones de los EAPV, llenando la ficha de notificación de forma adecuada y oportuna. El conocimiento sobre EAPV puede ser aplicado en la práctica de los servicios de vigilancia en salud, mejorando la seguridad en la utilización de los productos inmunobiológicos.

Research integrity guidelines in the academic environment: The context of Brazilian institutions with retracted publications in health and life sciences.

Although research misconduct is responsible for most retractions in health and life sciences from authors affiliated with Brazilian institutions, there are few studies evaluating retraction notices and research misconduct in the country. Understanding the form of research misconduct may share light on the weaknesses and strengths of individual, organizational, and structural factors toward the implementation of a research integrity culture. This review on policies and practices aims to access the available information from research integrity offices and the guidelines from Brazilian funding institutions and universities who were involved in retractions in health and life science publications based on a previously published systematic review. Additionally, we summarize the available guidelines and policies for research integrity in the country. Additionally, we searched publicly available guidelines and offices for research integrity. In total, 15 institutions were analyzed: five funding agencies and 10 universities. Approximately 40% of the funding agencies promoted local research, and 60% promoted national research. Considering national funding agencies, 66% had the commission on research integrity. Approximately 30% of the universities do not have the official office for research integrity or any publicly available guidelines. Most institutions involved in retractions due to some form of research misconduct. Brazilian institutions involved in publication retractions lack instruments to prevent, supervise, and sanction research misconduct. Institutions of the country have insufficiently developed a system to promote and sustain research integrity practices. Nevertheless, there is a positive movement of researchers who are engaged in the investigation of research integrity, policy creation and training. This study emphasizes increased influence of Brazilian scientific collaboration and production globally as well as the impact of retractions in medical sciences. In contrast, it addresses the need for clear research integrity policies to foster high-quality and trustworthy research.

The teaching of good obstetric practices from the Residency preceptors' perspective. / O ensino das boas práticas obstétricas na perspectiva dos preceptores da Residência.

The aim of this study was to understand how the topic of good obstetric practices is taught in residency programs according to the preceptors' perception. This is a descriptive, exploratory study, with data triangulation, with a qualitative approach. A total of 35 professionals participated in the study, of which 21 were physicians and 14 nurses. Data were collected from March to June 2018. The analysis was supported by NVivo software. The nuclei of meanings and categories were identified in the different stages, in pedagogical projects: the structuring aspects, competence profile and guiding policies for normal childbirth; in the interviews: theoretical-practical approach and the practices present in the training and, in participant observation: aspects related to the structure of the scenarios and the use of practices. Possibilities and limits were observed in the role of preceptors in the training process, constituting an area that requires continuous attention, aimed at the strengthening of the pedagogical processes in order to expand the disruptive potential of new health professionals.

Este trabalho teve como objetivo compreender como o tema das boas práticas obstétricas é ensinado nos programas de residência na percepção dos preceptores. Trata-se de um estudo descritivo, exploratório, com triangulação de dados, de abordagem qualitativa. Participaram da pesquisa 35 profissionais, sendo 21 médicos e 14 enfermeiros. Os dados foram coletados entre março e junho de 2018. A análise teve o suporte do Software NVivo. Os núcleos de sentidos e as categorias foram identificados nas diversas etapas: nos projetos pedagógicos - os aspectos estruturantes, perfil de competências e políticas norteadoras do parto normal; nas entrevistas - abordagem teórico-prática e as práticas presentes na formação; e na observação participante - aspectos relacionados à estrutura dos cenários e à utilização das práticas. Foram observados possibilidades e limites na atuação dos preceptores no processo de formação, configurando-se em uma área que requer atenção contínua e direcionada ao fortalecimento dos processos pedagógicos, de forma a ampliar o potencial disruptivo dos novos profissionais de saúde.

Ethics, COVID-19 and nursing vulnerability: analysis of photographs released by the media.

OBJECTIVES: to analyze nursing vulnerability through photos released by the media amidst the COVID-19 pandemic. METHODS: a documentary study, with a qualitative approach. The object of analysis were photographic images selected between January 2020 and March 2021, published by the main news portals in countries such as Brazil, the United States, France, Spain, England and Germany. Thematic categorical analysis was the method of analysis used. RESULTS: we found 74 photographs that portrayed nursing professionals in different work situations. It was possible to identify stigma and social devaluation about this class's representation and professional attribution. Moreover, we found an underrepresentation of black professionals in Brazilian portals and the man as the prominent figure in the spaces of claims. FINAL CONSIDERATIONS: the photographs represented an important tool for the social analysis of nursing vulnerability, favoring the unveiling of situations that may go unnoticed by nursing and society.

Decrease in compulsory notifications registered by the Brazilian National Hospital Epidemiological Surveillance Network during the COVID-19 pandemic: a descriptive study, 2017-2020. / Decréscimo nas notificações compulsórias registradas pela Rede Nacional de Vigilância Epidemiológica Hospitalar do Brasil durante a pandemia da COVID-19: um estudo descritivo, 2017-2020.

OBJECTIVE: To describe compulsorily notifiable diseases, health conditions and public health events (DAEs as per the Brazilian acronym) registered by the National Hospital Epidemiological Surveillance Network (RENAVEH as per the Brazilian acronym), before and during the COVID-19 pandemic. METHODS: This was a descriptive ecological study using records held on the Notifiable Health Conditions Information System (SINAN as per the Brazilian acronym) between Epidemiological Week (EW) 1 of 2017 (January 1st, 2017) and 52 of 2020 (December 26, 2020). RESULTS: Between 2017 and 2020, RENAVEH notified 1,258,455 DAE form records, with only 225,081 (17.9%) notifications in 2020, representing a decrease of 146,340 records compared to 2019. The temporal analysis showed a decrease per EW of more than 1,000 notified records with effect from EW 12. CONCLUSION: There was a decrease in compulsorily notifiable DAEs registered by RENAVEH in Brazil taking the period analyzed as a whole, in particular in 2020.

Profile of hospitalizations for neoplasms in the Brazilian Unified Health System: a time-series study.

OBJECTIVE: Describe the profile of hospitalizations for cancer diagnosis in Brazil from 2008 to 2018 at Unified Health System (SUS). METHODS: Time series study of hospitalization rate for malignant neoplasms at SUS. Data were extracted from the Hospital Information System of DataSUS. The trend was estimated using generalized linear regression, applying the Prais-Winsten estimation procedure. RESULTS: From 2008 to 2018, the hospitalization rate for malignant neoplasms showed an increasing trend at SUS, with an annual variation of 10.7% (p < 0.001; CI = 9.4-11.7). An increasing trend of hospitalizations in all regions of Brazil was observed, except in the Northern region, which remained unchanged. The Northeastern region presented the highest annual variation (13.5%; p < 0.001), whereas the Southern and Southeastern regions had the highest hospitalization rates per 100,000 inhabitants, resulting in 506 and 325 hospitalizations, respectively. We observed a significant increasing trend in hospitalizations of children aged 0 to 9 years (annual variation = 10.9%; p < 0.001); young people, 10 and 19 years (annual variation = 6.9%; p < 0.001); and older adults; over 60 years (annual variation = 7.9%; p < 0.001). Among women, hospitalizations occurred mainly due to malignant neoplasm of the breast (annual variation = 13.2%; p < 0.001); and among men, malignant neoplasm of the prostate (annual variation = 4.7%; p < 0.001). CONCLUSION: Hospitalizations for malignant neoplasms showed an increasing trend, in line with the increased incidence of cancer, in particular, the most frequent neoplasms between men and women. Although the Northeastern region showed the highest variation in the period, the Southern and Southeastern regions had the highest hospitalization rates in the country. We also observed an increase in hospitalizations among the young (between 0 and 19 years old) and older adults (over 60 years) population. Hospitalizations for neoplasm of the cervix in women, although still the third cause of hospitalizations, showed decreasing behavior.

Clinical conditions and complications associated with parenteral nutrition use in critically ill patients admitted to an intensive care unit of a general hospital.

INTRODUCTION: Objective: the aim of this study was to evaluate the clinical conditions, the existing complications, and the drug prescription profile of patients who received parenteral nutrition in the intensive care unit. Material and methods: this retrospective, analytical cohort study was carried out among individuals admitted to a public general hospital ICU. For data collection, the electronic medical records for the entire period of inpatient treatment were analyzed. Results: in total, 213 individuals who had received parenteral nutrition for a period greater than 48 hours were included in the study. Most participants were male and mean age was < 60 years; death occurred in 75 % of patients, and abdominal surgery was the main indication for parenteral nutrition. Hyperglycemia was the most common complication. The Mann-Whitney test showed that the individuals who died were using a higher number of medications. The increased use of medications correlated with use of PN and led to an increase in hospital length of stay and death rate (p-value < 0.001). There was a higher proportion of deaths among patients using standard parenteral nutrition solutions (76.9 %) as compared to the period when patients started receiving custom-made parenteral nutrition solutions (71.7 %). However, there was no statistical evidence of the association between type of nutrition and the outcome of death (p-value = 0.395). Conclusions: custom-made parenteral nutrition may result in benefits for the patients, such as a decrease in the number of medications used. The relationship between type of nutrition and the outcome of death did not prove to be statistically significant.

INTRODUCCIÓN: Objetivo: el objetivo de este estudio fue evaluar las condiciones clínicas, las complicaciones existentes y el perfil de prescripción de medicamentos de los pacientes que recibieron nutrición parenteral en la unidad de cuidados intensivos. Material y métodos: este estudio de cohortes analítico y retrospectivo se llevó a cabo entre individuos ingresados en una UCI de un hospital público general. Para la recopilación de datos se analizaron los registros médicos electrónicos de todo el período de tratamiento hospitalario. Resultados: en total se incluyeron en el estudio 213 individuos que habían recibido nutrición parenteral durante un período superior a 48 horas. La mayoría de los participantes eran hombres y la edad media era < 60 años; se produjo la muerte en el 75 % de los pacientes y la cirugía abdominal fue la principal indicación de la nutrición parenteral. La hiperglucemia fue la complicación más común. La prueba de Mann-Whitney mostró que las personas que murieron estaban usando una mayor cantidad de medicamentos. El aumento en el uso de medicamentos se correlacionó con el uso de la PN y condujo a un aumento de la duración de la estancia hospitalaria y de la mortalidad (valor p < 0,001). Hubo una mayor proporción de muertes entre los pacientes que usaron soluciones de nutrición parenteral estándar (76,9 %) en comparación con el período en que los pacientes comenzaron a recibir soluciones de nutrición parenteral hechas a medida (71,7 %). Sin embargo, no hubo evidencia estadística de la asociación entre el tipo de nutrición y el resultado de la muerte (valor p = 0,395). Conclusiones: la nutrición parenteral hecha a medida puede generar beneficios para los pacientes, como una disminución de la cantidad de medicamentos utilizados. La relación entre el tipo de nutrición y el resultado de la muerte no resultó ser estadísticamente significativa.

QUALITY OF LIFE IN ADULTS WITH SARCOMAS UNDER CONSERVATIVE SURGERY OR AMPUTATION.

OBJECTIVE: To understand the perception of quality of life, functionality, and psychological aspects of adults with lower limb sarcoma who underwent conservative surgery or amputation. METHODS: Sociodemographic data were collected, and the following questionnaires were used: EORTC QLQ - C30 for quality of life, the Functional Assessment System (MSTS) for functionality and the Beck Depression Inventory (BDI) for depression symptoms. RESULTS: The sample consisted of 45 young adults with sarcoma, divided into two groups: amputation (29) and conservative surgery (16). Most were male, single and students. Average family income before and after the disease did not differ, but those that were employed had a better perception of general quality of life, as well as those with higher family income after the disease. Regarding the type of surgery, there was a predominance of amputation; osteosarcoma was the most common histological type and the most affected region was the femur. All participants participated in social, cultural, sporting or religious activities. MSTS and Beck scale values did not differ between procedures. CONCLUSION: Given the scarcity of studies on the subject at the national level, further investigations are suggested to explore aspects related to quality of life for patients with sarcomas. Level of Evidence III, Retrospective comparative study.

OBJETIVO: Conhecer a percepção da qualidade de vida, funcionalidade e aspectos psicológicos de adultos com sarcoma de membros inferiores, submetidos à cirurgia conservadora ou amputação. MÉTODOS: Foram coletados dados sociodemográficos, e utilizados os questionários: EORTC QLQ-C30 para a qualidade de vida; o Sistema de Avaliação Funcional (MSTS) para a funcionalidade; e o Inventário de Depressão de Beck (BDI) para sintomas de depressão. RESULTADOS: A amostra foi constituída por 45 adultos jovens com sarcoma, divididos em dois grupos: amputação (29) e cirurgia conservadora (16). Predominaram jovens do sexo masculino, solteiros e estudantes. A média da renda familiar antes e após a doença não diferiu, porém os que estavam trabalhando apresentaram melhor percepção de qualidade de vida global, assim como os com maior renda familiar após a doença. Quanto ao tipo de cirurgia, houve predomínio da amputação, o osteossarcoma foi o tipo histológico mais comum e a região do fêmur a mais acometida. Todos os participantes participavam de atividades sociais, culturais, esportivas ou religiosas. Os valores do MSTS e da escala de Beck não diferiram entre os procedimentos. CONCLUSÃO: Visto a escassez de estudos sobre o tema em nível nacional, sugerem-se novas investigações, a fim de explorar aspectos relacionados com a qualidade de vida para pacientes com sarcomas. Nível de Evidência III, Estudo retrospectivo comparativo.

Scientific integrity among nursing students participating in the Scientific Initiation Program: An exploratory study.

OBJECTIVE: To know the positions and practices adopted by nursing students in scientific initiation programs about the principles of scientific integrity in the different stages of the process of doing science. METHOD: An exploratory study of a quantitative nature, in which nursing student participants of the Scientific Initiation Program from the Federal District were interviewed. RESULTS: Fifty (50) nursing students participated in the study. Most of the interviewed participants presented good notions about the process of conducting research in its different stages. Nevertheless, it was found that even though they were familiar with good scientific practices, students did not always behave in the most responsible manner. It was observed that the knowledge on topics related to the ethics of the scientific process was predominantly obtained through formal education, consisting of classes and courses. Nonetheless, the importance of complementary spaces such as research and research groups is recognized. Conclusion: Research experiences are important educational and vocational training spaces for students. Therefore, good research practices need to be included early in the academic curriculum.

QUALITY OF LIFE OF PATIENTS WITH SARCOMA AFTER CONSERVATIVE SURGERY OR AMPUTATION OF LIMBS.

OBJECTIVE: To conduct an integrative review on quality of life (QOL) of patients with sarcoma who underwent conservative surgery or limb amputation. METHODS: We conducted a six-step integrative review by searching the databases LILACS, SciELO, PePSIC, Embase, and PubMed, using the descriptors: "Quality of life", "Bone cancer", "Sarcoma", "Limb Salvage," and "Amputation." Ten studies were selected according to: database, type of study, methods, researcher's profession, sex, histological type, title, country/region, and periodical/year of publication. RESULTS: Nine quantitative and one qualitative studies were included. All were conducted by physicians and correlated to QOL with the impact of diagnosis, psychosocial aspects, cancer treatment, and survival. Other aspects included type of surgery, functionality, rehabilitation, and a multidisciplinary approach. The QOL results were similar for conservative surgery and amputation in eight studies. In two, it was concluded that patients undergoing conservative surgery had a better QOL. CONCLUSION: The number of studies on QOL in patients with sarcoma is small. In most, there was no difference between the study groups. In addition, the studies indicated the importance of evaluation of QOL, since it has a direct effect on patients' physical manifestations and impacts their coping abilities. Level of evidence III, System review.

OBJETIVO: Conduzir uma revisão integrativa sobre qualidade de vida de pacientes com sarcoma, submetidos à cirurgia conservadora ou à amputação de membros. MÉTODOS: Revisão integrativa em seis etapas, com busca nas bases de dados LILACS, SciELO, PePSIC, Embase e PubMed, utilizando-se os descritores: "qualidade de vida", "câncer ósseo", "sarcoma", "salvamento de membro" e "amputação". Dez estudos foram selecionados de acordo com banco de dados, tipo de estudo, método, profissão do pesquisador, sexo, tipo histológico, título, país/região, periódico/ano de publicação. RESULTADOS: Foram incluídos nove estudos quantitativos e um qualitativo. Todos foram conduzidos por médicos e correlacionaram a qualidade de vida com impacto do diagnóstico, aspectos psicossociais, tratamento do câncer e sobrevida. Outros aspectos incluídos foram tipo de cirurgia, funcionalidade, reabilitação e abordagem multidisciplinar. Os resultados da qualidade de vida foram semelhantes para cirurgia conservadora e amputação em oito estudos. Em dois, concluiu-se que os pacientes submetidos à cirurgia conservadora tiveram melhor qualidade de vida. CONCLUSÕES: O número de estudos sobre qualidade de vida em pacientes com sarcoma foi pequeno. Na maioria, não houve diferença entre os grupos. Além disso, os estudos indicaram a necessidade de valorizar a avaliação da qualidade de vida, pois esta tem efeito direto nas manifestações físicas e impacto no enfrentamento da doença. Nível de evidência III, Revisão sistemática.

O ensino das boas práticas obstétricas na perspectiva dos preceptores da Residência / The teaching of good obstetric practices from the Residency preceptors' perspective

Resumo Este trabalho teve como objetivo compreender como o tema das boas práticas obstétricas é ensinado nos programas de residência na percepção dos preceptores. Trata-se de um estudo descritivo, exploratório, com triangulação de dados, de abordagem qualitativa. Participaram da pesquisa 35 profissionais, sendo 21 médicos e 14 enfermeiros. Os dados foram coletados entre março e junho de 2018. A análise teve o suporte do Software NVivo. Os núcleos de sentidos e as categorias foram identificados nas diversas etapas: nos projetos pedagógicos - os aspectos estruturantes, perfil de competências e políticas norteadoras do parto normal; nas entrevistas - abordagem teórico-prática e as práticas presentes na formação; e na observação participante - aspectos relacionados à estrutura dos cenários e à utilização das práticas. Foram observados possibilidades e limites na atuação dos preceptores no processo de formação, configurando-se em uma área que requer atenção contínua e direcionada ao fortalecimento dos processos pedagógicos, de forma a ampliar o potencial disruptivo dos novos profissionais de saúde.

Abstract The aim of this study was to understand how the topic of good obstetric practices is taught in residency programs according to the preceptors' perception. This is a descriptive, exploratory study, with data triangulation, with a qualitative approach. A total of 35 professionals participated in the study, of which 21 were physicians and 14 nurses. Data were collected from March to June 2018. The analysis was supported by NVivo software. The nuclei of meanings and categories were identified in the different stages, in pedagogical projects: the structuring aspects, competence profile and guiding policies for normal childbirth; in the interviews: theoretical-practical approach and the practices present in the training and, in participant observation: aspects related to the structure of the scenarios and the use of practices. Possibilities and limits were observed in the role of preceptors in the training process, constituting an area that requires continuous attention, aimed at the strengthening of the pedagogical processes in order to expand the disruptive potential of new health professionals.

Ethics, COVID-19 and nursing vulnerability: analysis of photographs released by the media / Ética, COVID-19 y vulnerabilidad de enfermería: análisis de fotografías difundidas por los medios / Ética, COVID-19 e vulnerabilidade da enfermagem: análise de fotografias divulgadas pela mídia

ABSTRACT Objectives: to analyze nursing vulnerability through photos released by the media amidst the COVID-19 pandemic. Methods: a documentary study, with a qualitative approach. The object of analysis were photographic images selected between January 2020 and March 2021, published by the main news portals in countries such as Brazil, the United States, France, Spain, England and Germany. Thematic categorical analysis was the method of analysis used. Results: we found 74 photographs that portrayed nursing professionals in different work situations. It was possible to identify stigma and social devaluation about this class's representation and professional attribution. Moreover, we found an underrepresentation of black professionals in Brazilian portals and the man as the prominent figure in the spaces of claims. Final Considerations: the photographs represented an important tool for the social analysis of nursing vulnerability, favoring the unveiling of situations that may go unnoticed by nursing and society.

RESUMEN Objetivos: analizar la vulnerabilidad de la enfermería a través de fotos difundidas por los medios de comunicación en el contexto de la pandemia de la COVID-19. Métodos: estudio documental, con abordaje cualitativo. El objeto de análisis fueron imágenes fotográficas seleccionadas entre enero de 2020 y marzo de 2021, publicadas por los principales portales de noticias de países como Brasil, Estados Unidos, Francia, España, Inglaterra y Alemania. El análisis categórico temático fue el método de análisis utilizado. Resultados: se encontraron 74 fotografías que retrataban a profesionales de enfermería en diferentes situaciones de trabajo. Fue posible identificar el estigma y la desvalorización social sobre la representación y atribución profesional de esta clase. Además, se constató una subrepresentación de los profesionales negros en los portales brasileños y del hombre como figura destacada en los espacios de reclamos. Consideraciones Finales: las fotografías representaron una importante herramienta para el análisis social de la vulnerabilidad de la enfermería, favoreciendo el develamiento de situaciones que pueden pasar desapercibidas por la enfermería y la sociedad.

RESUMO Objetivos: analisar a vulnerabilidade da enfermagem por meio de fotos divulgadas pela mídia no contexto da pandemia de COVID-19. Métodos: estudo documental, com abordagem qualitativa. O objeto de análise foram imagens fotográficas selecionadas entre janeiro de 2020 e março de 2021, veiculadas pelos principais portais de notícia de países, como Brasil, Estados Unidos, França, Espanha, Inglaterra e Alemanha. A análise categorial temática foi o método de análise utilizado. Resultados: foram encontradas 74 fotografias que retratavam profissionais de enfermagem em diferentes situações de trabalho. Pôde-se identificar o estigma e a desvalorização social acerca da representação e atribuição profissional desta classe. Além disso, foi constatada uma sub-representação de profissionais negras nos portais brasileiros e o homem como a figura de destaque nos espaços de reivindicações. Considerações Finais: as fotografias representaram importante ferramenta para análise social da vulnerabilidade da enfermagem, favorecendo o desvelar de situações que podem passar despercebidas pela profissão e sociedade.

Tomada de decisões ético-profissionais em situações de excepcionalidade à pandemia da Covid-19: revisão de escopo / Ethical-professional decision-making in exceptional situations given the Covid-19 pandemic: a scoping review / Toma de decisiones ético-profesionales en situaciones excepcionales en la pandemia de Covid-19: revisión de alcance

OBJETIVO: apresentar um panorama sobre o processo de tomada de decisões ético-profissionais em situações de excepcionalidade no início da pandemia da Covid-19. MÉTODO: trata-se de uma revisão de escopo, incluindo documentos publicados entre dezembro/2019 a julho/2020 nas seguintes bases de dados: Google Acadêmico, PubMed, Scopus, Scielo, CINAHL e BVS. Adotou-se o PRISMA-ScR Checklist para apresentação da revisão. RESULTADOS: foram selecionados 28 documentos, organizados em cinco categorias: Requisito Técnico-Médico-Científico, Justiça e Equidade, Histórico de Saúde, Comissão para Tomada de Decisão Compartilhada e Quadro Respiratório Grave. CONCLUSÃO: os critérios indicados para priorizar o processo de atenção direcionado a pacientes graves com Covid-19 foram: parâmetros técnico-médico-científico, gravidade do quadro clínico, maior idade, ser profissional da saúde, presença de doenças de base incurável, realização de sorteio e pacientes com maior probabilidade de sobrevivência.

OBJECTIVE: to present an overview of the ethical-professional decision-making process in exceptional situations at the beginning of the COVID-19 pandemic. METHOD: this is a scoping review, including documents published between December 2019 and July 2020 in the following databases: Google Scholar, PubMed, Scopus, SciELO, CINAHL and BVS. The PRISMA-ScR Checklist was adopted to present the review. RESULTS: a total of 28 documents were selected, organized into five categories: Technical-Medical-Scientific Requirement, Justice and Equality, Health History, Commission for Shared Decision-Making and Severe Respiratory Condition. CONCLUSION: the criteria indicated to prioritize the care process targeted at critically-ill patients with COVID-19 were as follows: technical-medical-scientific parameters; severity of the clinical condition; older age; being a health professional; presence of incurable underlying diseases; carrying out draws; and patients with a higher survival probability.

OBJETIVO: presentar un panorama del proceso de toma de decisiones ético-profesionales en situaciones excepcionales al comienzo de la pandemia de Covid-19. MÉTODO: se trata de una revisión de alcance, que incluye documentos publicados entre diciembre de 2019 y julio de 2020 en las siguientes bases de datos: Google Scholar, PubMed, Scopus, Scielo, CINAHL y BVS. Se adoptó la PRISMA-ScR Checklist para presentar la revisión. RESULTADOS: fueron seleccionados 28 documentos, organizados en cinco categorías: Requerimiento Médico Científico Técnico, Justicia y Equidad, Historial de Salud, Comisión para la Toma de Decisiones Compartidas y Cuadro Respiratorio Grave. CONCLUSIÓN: los criterios señalados para priorizar el proceso de atención dirigido a pacientes críticos con Covid-19 fueron: parámetros médicos científicos técnicos, gravedad del cuadro clínico, mayor edad, ser profesional de la salud, presencia de enfermedades de base incurables, realizar sorteos y pacientes con mayor probabilidad de supervivencia.

Objeção de consciência e aborto: opiniões e conhecimentos dos estudantes de enfermagem / Objeción de conciencia y aborto: opiniones y conocimientos de los estudiantes de enfermería / Conscientious objection and abortion: opinions and knowledge of nursing students

RESUMO Objetivo: analisar as concepções dos acadêmicos de enfermagem de uma universidade do Centro Oeste do Brasil acerca do conceito e utilização da ferramenta objeção de consciência em situações de abortamento. Métodos: estudo qualitativo do tipo exploratório-descritivo, realizado entre os meses de março a abril de 2016. Participaram do estudo 46 acadêmicos do 7º ao 10º semestre do curso de graduação em Enfermagem. A coleta de dados ocorreu por meio da aplicação de questionário eletrônico enviado por e-mail individualmente aos estudantes. Utilizou-se a análise categorial; os relatos dos participantes foram fragmentados em unidades de significados. Resultados: emergiram duas categorias para cada questão do questionário eletrônico: (1) Meus preceitos morais e crenças vão contra o aborto e não sei se teria condições emocionais e psicológicas; (2) Não me lembro e Ferramenta Legal; (3) Discriminação e comprometimento do serviço e Liberdade de pensamento; (4) Mais consciência sobre nosso papel como profissionais de saúde e ampliar a visão dos estudantes sobre os aspectos éticos e humanitários. Considerações finais: a partir das concepções dos estudantes, percebeu-se que a objeção de consciência é de suma importância quando se trabalha com a temática do aborto e poderia ser mais amplamente abordada no processo de formação acadêmica.

RESUMEN Objetivo: analizar las concepciones de los académicos de enfermería de una universidad del Centro Oeste de Brasil acerca del concepto y la utilización de la herramienta objeción de conciencia en situaciones de aborto. Métodos: estudio cualitativo del tipo exploratorio-descriptivo, realizado entre los meses de marzo a abril de 2016. Participaron del estudio 46 académicos del 7º al 10º semestre del curso de graduación en Enfermería. La recolección de datos ocurrió mediante la aplicación de un cuestionario electrónico enviado por correo electrónico individualmente a los estudiantes. Se utilizó el análisis categorial; los relatos de los participantes fueron fragmentados en unidades de significados. Resultados: surgieron dos categorías para cada pregunta del cuestionario electrónico: (1) Mis preceptos morales y creencias van contra el aborto y No sé si tendría condiciones emocionales y psicológicas; (2) No me acuerdo y Herramienta Legal; (3) Discriminación y compromiso del servicio y Libertad de pensamiento; (4) Más conciencia sobre nuestro papel como profesionales de salud y Ampliar la visión de los estudiantes sobre los aspectos éticos y humanitarios. Consideraciones finales: a partir de las concepciones de los estudiantes, se percibió que la objeción de conciencia es de suma importancia cuando se trabaja con la temática del aborto y podría ser más ampliamente tratada en el proceso de formación académica.

ABSTRACT Objective: to analyze the conceptions of nursing students of a university in the Midwest of Brazil about the concept and use of the conscientious objection tool in abortion situations. Methods: a qualitative exploratory-descriptive study, conducted between March and April 2016. The study included 46 students from the 7th to the 10th semester of the Nursing graduate course. Data collection occurred through the application of an electronic questionnaire sent by email individually to the students. Categorical analysis was used; participants' reports were fragmented into units of meaning. Results: two categories emerged for each question of the electronic questionnaire: (1) My moral precepts and beliefs go against abortion and I don't know if I would have emotional and psychological conditions; (2) I don't remember and Legal Tool; (3) Discrimination and Commitment to Service and Freedom of Thought; (4) More awareness about our role as health professionals and Broaden students' view of ethical and humanitarian aspects. Final thoughts: from the conceptions of students, it was realized that conscientious objection is of paramount importance when working with the theme of abortion and could be more widely addressed in the process of academic training.