Experiencia del personal de salud frente a la COVID-19 en las zonas rojas de Santiago de Cuba / Experiences of the Health Personnel Confronting COVID-19 in the Red Zones of Santiago de Cuba

Introducción: En Cuba, la lucha contra la COVID-19 ha sido tarea de todos los que están relacionados a la atención sanitaria, con su consagración continúa, exponiendo sus capacidades y habilidades profesionales en el tratamiento y atención especializadas a los pacientes hospitalizados. Objetivo: Valorar las principales vivencias del personal de salud que trabajó en las zonas rojas, en los centros de aislamiento con casos sospechosos y positivos a la COVID-19. Métodos: Estudio descriptivo. Para realizar el análisis de las vivencias se aplicaron las técnicas de entrevista y observación. Se trabajó con una muestra de 43 sujetos, de ellos se seleccionaron 17 médicos, 10 enfermeras, siete técnicos y nueve del personal de servicio que participaron en los centros de aislamiento. Resultados: Las vivencias del personal de salud que laboraron en las zonas rojas se basaron en la expresión de los sentimientos, emociones, relaciones interpersonales, percepción de riesgo y vivencias únicas durante la labor realizada. Los principales sentimientos y emociones fueron: alegría, cooperación, altruismo, apoyo, gratitud, admiración, compromiso y las negativas fueron: miedo, ansiedad, estrés, depresión, rechazo y desesperanza en menor medida. Las relaciones interpersonales se desarrollaron en colaboración y aprendizaje grupal, la percepción de riesgo fue alto por la carga viral de la enfermedad. Conclusiones: Las vivencias de los sujetos investigados se expresaron en manifestaciones negativas al principio del tratamiento con los pacientes y evolucionaron hasta la conversión a estados positivos que permitieron elevar la calidad del trabajo realizado(AU)

Introduction: In Cuba, the fight against COVID-19 has been a task for everyone related to healthcare, with their continuous consecration, showing their professional capacities and skills in the specialized treatment of and care for hospitalized patients. Objective: To assess the main experiences of the health personnel who worked in red zones, in isolation centers, with suspected or positive cases of COVID-19. Methods: A descriptive study was carried out. The interview and observation techniques were used to analyze the experiences. The sample consisted of 43 subjects, of whom 17 physicians, 10 nurses, 7 technicians and 9 service employees who participated in isolation centers were selected. Results: The experiences of the health personnel who worked in the red zones were based on the expression of feelings, emotions, interpersonal relationships, perception of risk, and unique experiences during the work performed. The main feelings and emotions were joy, cooperation, altruism, support, gratitude, admiration, commitment; while the negative ones were fear, anxiety, stress, depression, rejection, and hopelessness to a lesser extent. Interpersonal relationships were developed in collaboration and group learning, while the perception of risk was high due to the viral load of the disease. Conclusions: The experiences of the studied subjects were expressed through negative events at the beginning of involvement with patients, and evolved until conversion to positive states that allowed raising the quality of the work performed(AU)

Os planos de Ernesto Ottoni contra o "mal dos lázaros": lazaretos, terapêuticas e trabalho no combate à lepra em São Paulo, século XIX / The plans of Ernesto Ottoni to Combat the "affliction of lepers: "lazarettos, treatments, and endeavors to tackle leprosy in nineteenth century São Paulo

Resumo O trabalho a seguir objetiva apresentar o projeto de estabelecimento de um lazareto para morféticos na cidade de São Paulo em meados do século XIX. Trata-se da transcrição e análise de um parecer elaborado pelo médico Ernesto Benedicto Ottoni e endereçado ao presidente da província de São Paulo. Analisamos os planos da construção do prédio, principalmente levando em consideração a teoria dos miasmas; concepções sobre as terapêuticas da lepra na época, sobretudo quanto à transmissibilidade da doença; e, por fim, a idealização do médico acerca das rotinas de tratamento, trabalho, lazer e recuperação dos doentes.

Abstract This article presents the plans for a lazaretto in the city of São Paulo in the mid-nineteenth century. It consists of the transcription and analysis of an opinion prepared by the physician Ernesto Benedicto Ottoni, addressed to the president of the province of São Paulo. The article includes an analysis of the plans for the building, bearing in mind the prevailing miasma theory; the contemporary conceptions of leprosy treatment, especially beliefs regarding the transmissibility of the disease; and the physician's idealization of the routines for the treatment, work, leisure, and recovery of patients.

Chest radiography evaluation in patients admitted with confirmed COVID-19 infection, in a resource limited South African isolation hospital

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the subsequent global outbreak (coronavirus disease 2019 [COVID-19]) was declared a public health emergency in January 2020. Recent radiologic literature regarding COVID-19 has primarily focused on Computed Tomography (CT) chest findings, with chest radiography lacking in comparison. Objectives: To describe the demographic profile of adult patients with COVID-19 pneumonia requiring hospital admission. To describe and quantify the imaging spectrum on chest radiography using a severity index, and to correlate the severity of disease with prognosis. Method: Retrospective review of chest radiographs and laboratory records in patients admitted to a South African tertiary hospital with confirmed COVID-19 infection. The chest X-rays were systematically reviewed for several radiographic features, which were then quantified using the Brixia scoring system, and correlated to the patient's outcome. Results: A total of 175 patients (mean age: 53.34 years) admitted with COVID-19 were included. Ground glass opacification (98.9%), consolidation (86.3%), and pleural effusion (29.1%) was commonly found. Involvement of bilateral lung fields (96.6%) with no zonal predominance (61.7%), was most prevalent. Correlation between the Brixia score and outcome was found between severe disease and death (odds ratio [OR]: 12.86; 95% confidence interval [CI]: 1.58­104.61). Many patients had unknown TB (71.4%) and HIV (72.6%) statuses. Conclusion: In this study population, ground glass opacification, consolidation, and pleural effusions, with bilateral lung involvement and no zonal predominance were the most prevalent findings in proven COVID-19 infection. Quantification using the Brixia scoring system may assist with timeous assessment of disease severity in COVID-19 positive patients, as an overall predicator of clinical outcome.

Medidas sanitárias de que a Bahia precisa: as Delegacias de Saúde, o Hospital de isolamento e a Reforma Sanitária em Salvador (1921-1930) / Sanitary measures that Bahia needs: the Health Police Stations, the Isolation Hospital and the Sanitary Reform in Salvador (1921-1930)

Analisa o papel das Delegacias de Saúde e do Hospital de Isolamento de Mont'Serrat, no processo da Reforma Sanitária que ocorreu na Bahia na década de 1920

Lecciones aprendidas en la atención a pacientes con COVID-19 en el Centro Integral Provisional de Figali, Panamá / Lessons learned in the care of patients with COVID-19 at the Provisional Comprehensive Center of Figali, Panama

Introducción: La conversión de diversas edificaciones como centros hospitalarios para la atención médica a pacientes con COVID-19 es una solución necesaria ante la alta demanda de casos y limitación de camas hospitalarias. Objetivo: Determinar las lecciones aprendidas y los puntos de mejora en el proceso de atención médica del Centro Integral de Atención Provisional para Pacientes Moderados con COVID-19 en Figali. Métodos: Estudio prospectivo, descriptivo, realizado del 1 al 15 de marzo 2021. Universo, total de médicos, licenciados enfermería y jefes administrativos. Muestreo por conglomerados del 36,5 por ciento. Se utilizó metodología cualitativa (cuestionario, entrevista semiestructurada y taller grupo focal). Resultados: En sus primeros tres meses el centro ingresó a 548 pacientes (máximo diario de 124); de estos, 309 (56,4 por ciento) con categoría de moderado o grave. La institución dispuso de hasta 74 médicos (incluidos 41 especialistas cubanos) y 91 enfermeros. Se consideró por los encuestados de muy alta o alta la atención médica (100 por ciento), satisfacción de pacientes (90,9 por ciento), higiene (93,2 por ciento) y función social del centro (97,7 por ciento). Las mayores enseñanzas fueron sobre bioseguridad, oxigenoterapia, manejo integral de la enfermedad y la integración de colectivos diferentes; entre quienes se destacó la profesionalidad, humanismo y sentido de pertenencia. Conclusiones: Las principales lecciones aprendidas se centran en capacitación, bioseguridad, flujos, oxigenoterapia, calidad y sentido de pertenencia del personal. Los trabajadores perciben que el centro cumple adecuadamente con su misión. Los principales puntos de mejora son la comunicación, el confort para los pacientes, la evaluación colectiva de los casos y el apoyo psicológico(AU)

Introduction: The conversion of various buildings as hospital centers for the medical care of patients with COVID-19 is a necessary solution in light of the high demand of cases and the limitation of hospital beds. Objective: Determine the lessons learned and the points of improvement in the medical care process of the Comprehensive Center of Provisional Care for Patients with moderate COVID-19 in Figali. Methods: Prospective, descriptive study, conducted from March 1 to 15, 2021. Total of workers, total of doctors, nursing graduates and administrative heads were assessed. Cluster sampling of 36,5percent. Qualitative methodology (questionnaire, semi-structured interview and focal group workshop) was used. Results: In the first three months, the center admitted 548 patients (daily maximum of 124); of these, 309 (56.4percent) with moderate or severe category. The institution had up to 74 doctors (including 41 Cuban specialists) and 91 nurses. Medical care was rated by the respondents as very high or high (100percent), and other rates were: patient satisfaction (90.9percent), hygiene (93.2percent) and social function of the center (97.7percent). The greatest learnings were on biosafety, oxygen therapy, comprehensive management of the disease and the integration of different groups; among whom professionalism, humanism and a sense of belonging stood out. Conclusions: The main lessons learned focus on training, biosecurity, flows, oxygen therapy, quality and sense of belonging of the staff. Workers perceive that the center adequately fulfills its mission. The main points of improvement are communication, comfort for patients, collective evaluation of cases and psychological support(AU)

Alteraciones psicológicas de trabajadores en un centro de aislamiento para casos sospechosos de COVID-19 / Alterações psicológicas de trabalhadores em centro de isolamento por casos suspeitos de COVID-19 / Psychological alterations experienced by workers in an COVID-19 quarantine facility

Introducción: A partir del rebrote de COVID-19 que desde el mes de noviembre de 2020 experimentó la nación, el grupo temporal para el enfrentamiento a la epidemia abrió nuevos centros de aislamiento con el objetivo principal de brindar atención médica integral y de enfermería a pacientes que han sido contacto de personas contagiadas con esta enfermedad. Objetivo: Identificar las alteraciones psicológicas más frecuentes experimentadas por médicos, personal de enfermería y estudiantes de Medicina en el centro de aislamiento ubicado en la Facultad de Medicina No. 2 de Santiago de Cuba. Método: Se realizó un estudio descriptivo a 150 trabajadores de la zona roja de este centro de aislamiento en el periodo comprendido desde el 1 de marzo al 31 de mayo de 2021, para lo cual se empleó una metodología mixta, con una estrategia de triangulación de datos en un sentido cuanticualitativo. Resultados: La alteración psicológica de la esfera afectiva que predominó en estos trabajadores fue la ansiedad con un 98 porciento entre los médicos y enfermeros y un 100 porciento entre los estudiantes. En cuanto a la esfera cognitiva se destacó la presencia de imágenes intrusivas en el 72 porciento de los médicos, el 68 porciento del personal de enfermería y el 54 porciento de los estudiantes. Mientras que en la esfera volitiva predominó la incomodidad por el uso de los medios de protección en el 100 porciento de los sujetos encuestados. Conclusiones: En el centro de aislamiento estudiado, se identifican alteraciones psicológicas en el personal médico, de enfermería y estudiantes de Medicina. Destacan como las más frecuentes: la ansiedad, el estrés, imágenes intrusivas, dificultad para concentrase, el consumo de sustancias lícitas y trastornos del sueño(AU).

Introduction: Since the outbreak of COVID-19 that the nation experienced in November 2020, the temporary group to confront the epidemic opened new COVID-19 quarantine facilities with the main objective of providing comprehensive medical and nursing care to patients who have been in contact with people infected with this disease. Objective: To identify the most frequent psychological alterations experienced by doctors, nursing staff and medical students in the isolation facilities located at the Faculty of Medicine No. 2 of Santiago de Cuba. Method: A descriptive study was carried out on 150 workers in the red zone of this facility in the period from March 1st to May 31st, 2021, for which a mixed methodology was used, with a data triangulation strategy in a quantitative sense. Results: The psychological alteration of the affective sphere that predominated in these workers was anxiety, with 98 percent among doctors and nurses and 100 percent among students. Regarding the cognitive sphere, the presence of intrusive images stood out in 72 percent of the doctors, 68 percent of the nursing staff and 54 percent of the students. While in the volitional sphere, discomfort due to the use of means of protection prevailed in 100 percent of the subjects surveyed. Conclusions: In the quarantine center studied, psychological alterations were identified in the medical staff, nursing staff and medical students. The most frequent ones that stand out were: anxiety, stress, intrusive images, difficulty concentrating, the use of legal substances and sleep disorders(AU).

Introdução: A partir do surto de COVID-19 que viveu o país desde novembro de 2020, o grupo temporário de enfrentamento à epidemia inaugurou novos centros de isolamento com o objetivo principal de prestar assistência médica e de enfermagem integral aos pacientes que estiveram em contato com pessoas infectadas com esta doença. Objetivo: Identificar as alterações psicológicas mais frequentes vivenciadas por médicos, enfermeiras e estudantes de Medicina no centro de isolamento localizado na Facultad de Medicina Nº 2 de Santiago de Cuba. Método: Foi realizado um estudo descritivo com 150 trabalhadores da zona vermelha deste centros de isolamento no período de 1º de março a 31 de maio de 2021, para o qual foi utilizada uma metodologia mista, com estratégia de triangulação de dados no sentido quantitativo. Resultados: A alteração psicológica da esfera afetiva que predominou nesses trabalhadores foi a ansiedade com 98 porcento entre médicos e enfermeiras e 100 porcento entre estudantes. Em relação à esfera cognitiva, a presença de imagens intrusivas destacou-se em 72 porcento dos médicos, 68 porcento da equipe de enfermagem e 54 porcento dos alunos. Já na esfera volitiva, o desconforto devido ao uso de meios de proteção prevaleceu em 100 porcento dos sujeitos pesquisados. Conclusões: No isolamento estudado, foram identificadas alterações psicológicas na equipe médica, equipe de enfermagem e estudantes de Medicina. Destacam-se os mais frequentes: ansiedade, estresse, imagens intrusivas, dificuldade de concentração, uso de substâncias lícitas e distúrbios do sono(AU).

Debordering public health: the changing patterns of health border in modern Europe / Tirando as fronteiras da saúde pública: mudanças nos padrões de fronteira sanitária na Europa moderna

Abstract According to David Fidler, the governance of infectious diseases evolved from the mid-nineteenth to the twenty-first century as a series of institutional arrangements: the International Sanitary Regulations (non-interference and disease control at borders), the World Health Organization vertical programs (malaria and smallpox eradication campaigns), and a post-Westphalian regime standing beyond state-centrism and national interest. But can international public health be reduced to such a Westphalian image? We scrutinize three strategies that brought health borders into prominence: pre-empting weak states (eastern Mediterranean in the nineteenth century); preventing the spread of disease through nation-building (Macedonian public health system in the 1920s); and debordering the fight against epidemics (1920-1921 Russian-Polish war and the Warsaw 1922 Sanitary Conference).

Resumo Segundo David Fidler, a gestão de doenças infecciosas entre meados do século XIX e e o XXI guiou-se por uma série de acordos institucionais: Regulamento Sanitário Internacional (não interferência e controle de doenças em fronteiras), programas verticais da OMS (campanhas de erradicação da malária e varíola), e posicionamento pós-vestefaliano além do estado-centrismo e interesse nacional. Mas pode a saúde pública internacional ser reduzida à tal imagem vestefaliana? Examinamos três estratégias que destacaram as fronteiras sanitárias: prevenção em estados vulneráveis (Mediterrâneo oriental, século XIX); prevenção à disseminação de doenças via construção nacional (sistema público de saúde macedônico, anos 1920); remoção de fronteiras no combate às epidemias (guerra polaco-soviética, 1920-1921 e Conferência Sanitária de Varsóvia, 1922).

Directiva sanitaria para la atención de salud en el Centro de Aislamiento temporal para pacientes sospechosos sintomáticos y pacientes confirmados de infección por COVID-19, en el marco del Decreto de Urgencia N° 030-2020 / Health directive for health care in the Temporary Isolation Center for symptomatic suspect patients and confirmed patients with COVID-19 infection, within the framework of Emergency Decree No. 030-2020

El documento contiene las disposiciones para la organización, funcionamiento y atención de salud en el Centro de Atención y Aislamiento Temporal "Villa Panamericana"

Protomedicatos y lazaretos como instituciones de control de la higiene pública en Chile entre 1879 y 1920 / Colleges of royal physicians and isolation hospitals to control public hygiene in Chile from 1879 to 1920

El presente artículo indaga la aparición de dos instituciones de control de la higiene pública en Chile entre los años 1879 y 1920: los protomedicatos y lazaretos. El objeto de estudio utiliza como caso la presencia de la viruela en La Araucanía. Se abordan las características y contexto que adquirió la instalación de estos dispositivos que permitieron al Estado de Chile operacionalizar el asunto de la higiene pública, lo que interpeló a los profesionales de la salud para avanzar a mayores niveles de perfeccionamiento del ejercicio profesional de la medicina. El Estado liberal positivista de fines de siglo XIX comprendió que el tema de la higiene no era solamente una cuestión de responsabilidad individual, sino que tenía una dimensión social, pública y medio ambiental. No sólo había personas que eran higiénicas, sino también ambientes higiénicos y antihigiénicos. Por tanto, se estudia la higiene, el tribunal del protomedicato, la hoja sanitaria, lazaretos, médicos y vacunadores; quienes estuvieron en permanente tensión con las autoridades del gobierno central debido a los insuficientes recursos proporcionados por el Estado para la atención de los enfermos contagiados con viruela. El estudio se orienta desde una metodología cualitativa con un diseño historiográfico con alcances descriptivos densos. Se han utilizado fuentes primarias y secundarias disponibles en archivos en Chile y Alemania. Los resultados evidencian que la presencia de viruela apareció violentamente en el centro sur de Chile en la segunda mitad del siglo XIX y permaneció en la Araucanía hasta la primera mitad del siglo XX. La violencia con que se desarrolló la viruela generó miedo e incertidumbre afectando a personas de diferentes clases sociales, y tuvo como una de sus causas principales las precarias condiciones de salubridad de la población.

This article investigates the emergence of two institutions for the control of public hygiene in Chile between 1879 and 1920: colleges of royal physicians and isolation hospitals using the case of smallpox in La Araucanía, a region located in the South of Chile. We cover the characteristics and context of these institutions that allowed the State of Chile to address the problems of public hygiene and to prompt health professionals to professionalize the practice of medicine. The liberal positivist state of the late nineteenth century understood that the issue of hygiene was not only a matter of individual responsibility but had a social, public, and environmental dimension. People practiced hygiene alongside the existence of hygienic and anti-hygienic environments. Therefore, hygiene, the royal colleges of physicians, health records, isolation hospitals, doctors, and vaccinators are studied. All of these components of the health care system of the time were in permanent tension with the central government authorities due to the insufficient resources provided by the state for the care of infected patients with smallpox. The study follows a qualitative methodology with a descriptive historiographic design. We used archival primary and secondary sources available in Chile and Germany. The results show that the presence of smallpox appeared ferociously in South-Central Chile in the second half of the 19th century and remained in La Araucanía until the first half of the 20th century. The extent to which smallpox spread, spawning fear and insecurity in people of different social classes, had as one of its leading causes the precarious conditions of health and hygiene of the population.

Implementation of Hospital Policy for Healthcare Workers and Patients Exposed to Varicella-Zoster Virus

Varicella-zoster virus (VZV) causes a highly contagious and generally benign, self-limited disease. However, in high-risk populations including immunocompromised patients, pregnant women, and neonates, VZV infection can be associated with significant morbidity and mortality. Healthcare-associated transmission of VZV occurs among healthcare workers (HCWs) and patients by airborne transmission or by direct contact with the index case. To minimize the risk of transmission in healthcare settings, all VZV-susceptible HCWs should be encouraged strongly to be immunized with the varicella vaccine. For post-exposure management, active immunization (varicella vaccine), passive immunization (varicella-zoster immune globulin) and/or antiviral agents, and isolation could be used in specific situations. To prevent the transmission of VZV infection in the hospital settings, the development and implementation of hospital policies for appropriate infection control is also warranted. This article reviews the general information and healthcare-associated transmission of VZV and summarizes the recommendations for the pre- and post-exposure management of HCWs and patients, in hospital settings.

Notas para la historia del Hospital de Enfermedades Infecciosas Prof. Doctor Lucio Córdova L. Santiago de Chile / Notes for the history about the Doctor Lucio Cordova Infectious Diseases Hospital

Resumen El autor presenta una reseña histórica sobre la creación del Hospital de Enfermedades Infecciosas Dr. Lucio Córdova. El Dr. Lucio Córdova, Consejero de la Honorable Junta de Beneficencia en 1938, impulsó la creación de un pabellón modelo para la hospitalización de enfermos con procesos transmisibles. Un brote de meningitis meningocóccica, entre 1941 y 1942 apresuró la construcción del Pabellón de Enfermedades Infecciosas, que estuvo terminado en 1949. Se destaca la importante labor del primer médico jefe del nuevo Servicio doctor Roque Kraljevic. En 1963, el Pabellón de Enfermedades Infecciosas se transformó en el Hospital de Enfermedades Infecciosas Dr. Lucio Córdova.

The author presents a historical review about the creation of Doctor Lucio Cordova Infectious Diseases Hospital. Lucio Cordova MD, Counselor of the Charity Board in 1938, promoted a model pavilion for the hospitalization of patients with communicable diseases. An outbreak of meningococcal meningitis, between 1941 and 1942, hurried the construction of the Infectious Disease Pavilion, which was finished in 1949. The important work of the first chief of the new unit, Roque Kraljevic MD, is highlighted. In 1963, the Infectious Disease Pavilion was transformed into Dr. Lucio Cordova Infectious Diseases Hospital.

Diferenciais de mortalidade em um hospital filantrópico: a Santa Casa de Misericórdia de Campinas (1876-1885) / Mortality differentials in a philanthropic hospital: the Santa Casa de Misericórdia of Campinas (1876-1885) / Diferencias de mortalidad en un hospital filantrópico: Santa Casa de Misericordia de Campinas (1876-1885)

A partir da documentação das Matrículas de Enfermos e Relatórios dos Provedores da Santa Casa de Misericórdia de Campinas, traçamos o perfil dos atendidos e analisamos os diferenciais de mortalidade entre escravos e livres, brasileiros e estrangeiros nos primeiros anos de funcionamento desse hospital filantrópico. Os enfermos eram predominantemente homens em idade ativa, fortemente relacionados com a mão de obra disponível para comportar a expansão agrícola e dos serviços urbanos. Por meio de uma técnica de análise do diferencial de mortalidade baseada na decomposição de Oaxaca-Blinder, concluímos que, apesar de as características de escravos favorecerem um diferencial de mortalidade reduzido e de haver incentivos econômicos em seu tratamento, a mortalidade escrava foi superior possivelmente devido às condições de vida impostas pelo cativeiro. Entre a população livre, brasileiros apresentaram mortalidade superior à de estrangeiros. As hipóteses levantadas foram a procura tardia de auxílio por parte dos nacionais, diferenças na estrutura etária e a forte característica de sub-representação feminina na população estrangeira.

With documentation involving patients' records and reports fromthe administration of Santa Casa de Misericórdia of Campinas (1876-1885), we examined demographic characteristics of patients and analyzed differences in mortality ratesamongslaves, free people, Brazilians, and foreign population atthe philanthropic hospital. Data show patients are predominantly men of working age, mainly involved inlabor available related to agricultural expansion and urban services. Through an analysis of mortality differentials based on the Oaxaca-Blinder Decomposition, we concluded that although the characteristics of slavery and economic incentives in their treatment favored a reduced differential of mortality, slave mortality was higher due to the living conditions imposed by slavery. Among the free population, Brazilians had higher mortality rates than foreigners. Hypotheses raised include abelated demand for help from nationals, differences in age structure, and astrong female underrepresentation among the free population.

A partir de documentos de las Matrículas de Enfermos e Informes de los Proveedores del Hospital Santa Casa de Misericordia de Campinas, trazamos el perfil de los pacientes y analizamos la mortalidad diferencial entre esclavos y libres, brasileños y extranjeros em ese hospital filantrópico. Los enfermos fueron predominantemente hombres em edad activa, fuertemente relacionados con la mano de obra disponible para la expansión agrícola y de los servicios urbanos. Por medio de una técnica de análisis del diferencial de mortalidad basada en la descomposición de Oaxaca-Blinder, concluimos que a pesar de que las características de los esclavos favorecieron un de mortalidade reducido y que hubo incentivos económicos em su tratamiento, la mortalidad esclava fue superior, posiblemente por las condiciones de vida impuestas por el cautiverio. Entre la población libre, los brasileños presentaron una mortalidad superior a la de población extranjera. Las hipótesis planteadas son: la demanda tardía de ayuda por parte de los nacionales, diferencias en la estrutura etária y la fuerte característica de subrepresentación feminina en la población extranjera.

History of leprosy in Rio de Janeiro

The record of the first cases of leprosy in Rio de Janeiro dates from the seventeenth century. The first local host of leprosy patients was created from 1741, and the first colonies hospitals were built in the early twentieth century, in order to avoid contagion of the population. The first structures dedicated to research also date from this time: the Leprosy International Institute, the Leprology Institute, and the Leprosy Laboratory of the Oswaldo Cruz Foundation, where the most prestigious leprologists of Rio de Janeiro worked. Currently, investigations are focused on the Oswaldo Cruz Foundation; additionally, leprosy patients are treated at municipal health centers and state hospitals, and former colony hospitals only accept patients with severe disabilities.

Fever Screening and Detection of Febrile Arrivals at an International Airport in Korea: Association among Self-reported Fever, Infrared Thermal Camera Scanning, and Tympanic Temperature / 한국역학회지

OBJECTIVES: The purpose of this research was to measure fever prevalence and the effectiveness of a fever screening procedure in detecting febrile arrivals at an international airport in Korea. METHODS: Data were retrieved from arrivals' health declaration forms and questionnaires for febrile arrivals at an international airport collected by a national quarantine station during the year 2012. Self-reported health declaration forms were returned by 355,887 arrivals (61% of the total arrivals). Of these, 608 symptomatic arrivals (0.2%) including 6 febrile arrivals were analyzed. RESULTS: Fever prevalence at an international airport in Korea was 0.002%. Self-reported fever was significantly positively associated with tympanic temperature (p<0.001). The difference between the thermal camera temperature (36.83degreesC) and tympanic (or ear) temperature (38.14degreesC) was not statistically significant. CONCLUSIONS: The findings imply that a procedure for mass detection of fever such as self-reported questionnaires and thermal camera scanning may serve as an effective tool for detecting febrile arrivals at quarantine stations. Future research can benefit from looking at the sensitivity, specificity, positive predictive value, and negative predictive value of the entry screening system.

A Survey on Laboratory Biosafety Status of Public Healthcare Centers in Korea

The purpose of this study was to explore the laboratory biosafety status of Public Health Centers (PHCs) in Korea during Oct.7~26, 2012. We surveyed the environment of biosafety management, especially for the recognition level for biosafety of workers in the organizations. The questionnaires given out to 98 workers who are working for PHCs are to research the recognition level of workers for the knowledge of biosafety, related laws and regulations. The level was the highest in the Research Institute of the Public Health & Environment (RIPHE) followed by quarantine station, and the health center was assessed as the last. It was turned out that the biosafety educational program in the RIPHE was implemented on a regular basis (65.2%) with irregular cases (21.7%), and some outsourcing chances (8.7%). However, quarantine stations and health centers didn't practice actively biosafety training programs compared to RIPHE. In addition, there was a majority of opinions that the most important thing to improve biosafety level of PHCs is to strengthen current poor training and education system. In conclusion, it is necessary to develop more improved training system for biosafety on exposure risks including injuries, personal protective equipment, and chemical hazards.

Anotaciones históricas sobre el Hospital de Enfermedades Infecciosas Francisco Javier Muñiz de Buenos Aires, Argentina / Historical notes on Infectious Diseases Hospital Francisco Javier Muñiz in Buenos Aires, Argentina

The Infectious Diseases Hospital Francisco Javier Muñiz, Buenos Aires, Argentina, is the oldest in Latin America. It is over 100 years old and has a history worthy of pride. It became known as "Hospital of the pests" and was preceded by the old House of Insulation, which served as a quarantine station during epidemics of cholera, yellow fever and smallpox. The new House of Insulation, built in the neighborhood of Parque Patricios ("Barracks Hospital"), was renamed in 1904 in memory of Francisco Javier Muñiz, a former military doctor, naturalist and paleontologist. Its technical name is "Porteño Care Centre and National Reference Regional Infectious-Contagious Disease". It receives numerous national and foreign undergraduate and postgraduate students in its Departments of Infectious Diseases and Respiratory Diseases.

El Hospital de Enfermedades Infecciosas Francisco Javier Muñiz, de Buenos Aires, República Argentina, es el más antiguo de América Latina, con más de 100 años de existencia y una historia digna de orgullo; fue conocido como "Hospital de las pestes". Antecedido por la antigua Casa de Aislamiento, que sirvió de lazareto durante epidemias de cólera, fiebre amarilla y viruela. La nueva Casa de Aislamiento, construida en el barrio Parque Patricios ("Hospital de Barracas"), pasó a denominarse en 1904, Hospital Francisco Javier Muñiz, por quien fuera médico militar, naturalista y paleontólogo. Su nombre técnico es "Centro Asistencial Porteño de Referencia Nacional y Regional de Enfermedades Infecto-Contagiosas" y recibe a numerosos alumnos nacionales y extranjeros, en sus Cátedras de Enfermedades Infecciosas y de Tisio-neumología, para docencia de pre y post-grado.

Epidemiological Characteristics of Imported Influenza A (H1N1) Cases during the 2009 Pandemic in Korea / 한국역학회지

OBJECTIVES: Quarantine measure for prevention of epidemic disease and further evaluations of their efficiency are possible only by elaborating analyses of imported cases. The purpose of this study was to analyze descriptive epidemiological characteristics of pandemic influenza A (H1N1) cases imported to Korea. METHODS: We collected two sets of data. The first set, comprised daily reported cases of H1N1 obtained from local cities in accordance with government policy about mandatory reporting of all H1N1 cases during May 1 to August 19, 2009. The second set, including 372 confirmed imported H1N1 cases, identified from 13 National Quarantine Stations in the Korea Centers for Disease Control and Prevention from May 24 to December 31, 2009. However, given the lack of information on the nature of the imported H1N1 cases from the two data sets during the over lapping period from May 24 to August 19, we express the number of imported cases as a range for this period. RESULTS: We estimated that the number of imported H1N1 cases from May 1 to August 19, 2009, was between 1,098 and 1,291 and the total number of cases was 2,409 to 2,580. We found the number of imported cases was beginning to diminish as of August. A analysis of the second data set showed that the distribution of sex was similar (males 50.7%, females 49.3%) and the age distribution from 20 to 59 was 61.5% and that of 60 and over was 0.8% of the 372 cases. We identified 25 countries where people infected with H1N1 traveled and 67.5% were in Asia. But the proportion of cases (/1,000) by region shows Oceania (0.199), South America (0.118), Southeast Asia (0.071), North America (0.049), Europe (0.035), and Northeast Asia (0.016) in that order. The order of H1N1 peaking was the Southern Hemisphere, Tropics, and the Nothern Hemisphere. CONCLUSIONS: This study provided information that could make possible the evaluation of the government quarantine measure for stopping imported disease from causing community-acquired spread in the future.

Casa de Saúde Santa Fé: breve história de uma ex-colônia de hanseníase / Santa Fé Health Institute: brief history of a former leprosy colony

Este trabalho descreve a história de antiga colônia para o isolamento compulsório de hansenianos (lepra), o Sanatório (hoje Casa de Saúde) Santa Fé, em Três Corações, Minas Gerais. São estudadas as origens da política sanitária da internação compulsória, assim como as raízes do preconceito e do estigma em relação à hanseníase. Descrevem-se os aspectos básicos da vida em uma colônia, ao tempo dessa política. As mudanças na destinação do estabelecimento são enfocadas, assim como as suas perspectivas futuras.

This paper approaches the evolution of a former colony for the mandatory isolation of leprosy patients, Santa Fé Sanatory (presently, Health Institute), in Três Corações, Minas Gerais, through its decades-long existence. The origins of compulsory internation are studied, as well as the roots of prejudice and stigma. The history of the sanatorium is presented. The basic aspects of life in a colony, at the time of this policy, are described. The changes in the institution's destination are focused, as well as its future perspectives.

O Hospital-Colónia Rovisco Pais: a última leprosaria portuguesa e os universos contingentes da experiência e da memória / The Hospital-Colónia Rovisco Pais: the last Portuguese leprosarium and the contingent universes of experience and memory

O Hospital-Colónia Rovisco Pais foi inaugurado em Portugal na década de 1940, com vistas ao tratamento, estudo e profilaxia da lepra, de acordo com modelo de internamento compulsivo, cuja configuração remete ao conceito de instituição total proposto por Goffman. Trata-se de um importante projeto higienista do Estado Novo. O seu paradigma educativo combinava elementos inspirados na medicina social europeia e na ideologia do regime ditatorial paternalista português. O Hospital-Colónia será aqui ponderado como dispositivo disciplinar, desenvolvendo-se reflexão acerca do confronto entre o poder disciplinar e a experiência. A memória emerge como instrumento contingente para o acesso às práticas e aos significados intersticiais tecidos no quotidiano do Hospital-Colónia, buscando-se auscultar a experiência de seus ex-doentes como sujeitos políticos.

The Hospital-Colónia Rovisco Pais was inaugurated in Portugal in the 1940s for the treatment, study and prophylaxis of leprosy based on the compulsive internment model, whose configuration reflects the total institution concept proposed by Goffman. It concerns an important hygiene project of the Estado Novo. Its educative paradigm combined elements inspired in European social medicine and the ideology of the paternalistic Portuguese dictatorial regime. The Hospital Colony here will be thought of as a disciplinary dispositive, developing considerations regarding the confrontation between disciplinary power and experience. Memory emerges as a contingent instrument to access the practices and interstitial meanings woven into the Hospital Colony's daily life, seeking to find out about the experience of its former patients as political subjects.

Hanseníase: estigma e preconceito vivenciados por pacientes institucionalizados em Santa Catarina (1940-1960) / Lepra: estigma y prejuicio vivido por pacientes institucionalizados en Santa Catarina, Brasil (1940-1960) / Leprosy: stigma and prejudice lived by institucionalized patients in Santa Catarina State, Brazil (1940-1960)

Trata-se de uma pesquisa qualitativa com abordagem sócio-histórica cujo objetivo foi conhecer o estigma e preconceito vivenciado por pacientes/residentes institucionalizados acometidos pela hanseníase. Para tanto, foram entrevistados três pacientes que viveram em um hospital colônia no período do estudo, utilizando-se o método de história oral. Os dados foram coletados e posteriormente analisados, utilizando-se do referencial de estigma. Os resultados evidenciaram que após o ingresso na instituição, esses doentes tiveram seus laços familiares rompidos, perderam seus direitos como cidadãos, em decorrência dessa situação, assumiram novas vidas em um novo contexto. Concluindo, o isolamento nosocomial por um longo período de tempo (anos de internação e afastamento), provocou a morte simbólica de muitos pacientes que viviam com a esperança de um retorno ao convívio familiar e/ou social.

This study is a qualitative research with a socio-historic approach whose objective was to know the prejudice and stigma lived by the institutionalized patients/residents with hanseniase. To achieve this goal, three patients were intervewed who lived in a colony hospital during the research period, utilizing the oral history method. Data were collected and were further analysed, utilizing the stigma referencial. The results indicated that after the entry in the institution, these patients got their family bonds broken, lost their rights as citizens, regarding the situation, they took upon a new life, in a new environment. Concluding that, the nosocomial isolation for a long period of time (years of confinement and dismissal), caused the symbolic death of many patients that lived with the hope to cohabit with family and/or society.

El presente es un estudio de investigación cualitativa con abordaje socio-histórica. Tuvo como objetivo conocer el estigma y el prejuicio vivido por los pacientes institucionalizados portadores de lepra. Utilizándose el método de história oral, fueran entrevistados tres pacientes, que vivieron en un hospital en el período del estudio. Los datos fueran colectados y después analizados utilizándose el referencial del estigma. Los resultados colocaran en evidencia que, después del ingreso en la instituición, las personas tuvieran sus lazos familiares rotos, perdieran sus derechos como ciudadanos y asumiran nuevas vidas en un nuevo contexto. En conclusión, el aislamiento nosocomial por uno largo período de tiempo (años de internación y aislamiento), provocó la muerte simbólica de muchos que vivian con la esperanza del regreso a la convívencia familial y social.