Normalization of deviance in pediatric hospital: perception of health workers.

OBJECTIVE: To know the perception of health workers about the phenomenon of normalization of deviance in a pediatric hospital. METHOD: Exploratory, descriptive, and qualitative study conducted in a public pediatric hospital in northeastern Brazil in 2021. An in-depth interview was applied to 21 health workers, submitted to Thematic Categorical Content Analysis in the MAXQDA® Software. RESULTS: 128 context units emerged from the content analysis. These data were presented in three analytical categories, which address conceptions about normalization of deviance, examples and contributing factors. The omission of the practice of hand hygiene and the correct use of personal protective equipment,and turning off alarms stand out as the main deviance perceived by health workers. As contributing factors, human factors and organizational factors prevailed. CONCLUSION: Workers perceive the normalization of deviance as negligence, recklessness, and violations of good practices, with consequences for patient safety.

Normalization of deviance in pediatric hospital: perception of health workers / Normalización de la desviación en hospital pediátrico: percepción de trabajadores de salud / Normalização do desvio em hospital pediátrico: percepção de trabalhadores de saúde

ABSTRACT Objective: To know the perception of health workers about the phenomenon of normalization of deviance in a pediatric hospital. Method: Exploratory, descriptive, and qualitative study conducted in a public pediatric hospital in northeastern Brazil in 2021. An in-depth interview was applied to 21 health workers, submitted to Thematic Categorical Content Analysis in the MAXQDA® Software. Results: 128 context units emerged from the content analysis. These data were presented in three analytical categories, which address conceptions about normalization of deviance, examples and contributing factors. The omission of the practice of hand hygiene and the correct use of personal protective equipment,and turning off alarms stand out as the main deviance perceived by health workers. As contributing factors, human factors and organizational factors prevailed. Conclusion: Workers perceive the normalization of deviance as negligence, recklessness, and violations of good practices, with consequences for patient safety.

RESUMEN Objetivo: Conocer la percepción de los trabajadores de la salud sobre el fenómeno de la normalización de la desviación en un hospital pediátrico. Método: Estudio exploratorio, descriptivo y cualitativo realizado en un hospital pediátrico público en el noreste de Brasil en 2021. Se aplicó una entrevista en profundidad a 21 trabajadores de la salud, sometidos al Análisis de Contenido Categórico Temático en el Software MAXQDA®. Resultados: 128 unidades de contexto surgieron del análisis de contenido. Estos datos se presentaron en tres categorías analíticas, que abarcan conceptos sobre la normalización de la desviación, ejemplos y factores contribuyentes. La omisión de la práctica de la higiene de manos y el uso correcto de los equipos de protección personal y el apagado de alarmas se destacan como las principales desviaciones percibidas por los trabajadores de la salud. Como factores contribuyentes prevalecieron los factores humanos y los factores organizacionales. Conclusión: Los trabajadores perciben la normalización de la desviación como negligencia, imprudencia y violación de las buenas prácticas, con consecuencias para la seguridad del paciente.

RESUMO Objetivo: Conhecer a percepção de trabalhadores de saúde sobre o fenômeno da normalização do desvio em um hospital pediátrico. Método: Estudo exploratório, descritivo e qualitativo realizado em hospital público pediátrico do nordeste brasileiro em 2021. Aplicou-se entrevista em profundidade a 21 trabalhadores de saúde, submetida à Análise de Conteúdo Categorial Temática no Software MAXQDA®. Resultados: Emergiram 128 unidades de contexto da análise de conteúdo. Esses dados foram apresentados em três categorias analíticas, as quais abordam concepções sobre normalização do desvio, exemplos e fatores contribuintes. Destacam-se a omissão da prática de higienização das mãos e do uso correto dos equipamentos de proteção individual, e o desligamento de alarmes como principais desvios percebidos pelos trabalhadores de saúde. Como fatores contribuintes, preponderaram os fatores humanos e os fatores organizacionais. Conclusão: Os trabalhadores percebem a normalização do desvio como negligência, imprudência e violações de boas práticas, com consequências para a segurança do paciente.

A Brazilian Inter-Hospital Candidemia Outbreak Caused by Fluconazole-Resistant Candida parapsilosis in the COVID-19 Era.

Horizontal transmission of fluconazole-resistant Candida parapsilosis (FRCP) through healthcare workers' hands has contributed to the occurrence of candidemia outbreaks worldwide. Since the first COVID-19 case in Brazil was detected in early 2020, hospitals have reinforced hand hygiene and disinfection practices to minimize SARS-CoV-2 contamination. However, a Brazilian cardiology center, which shares ICU patients with a cancer center under a FRCP outbreak since 2019, reported an increased FRCP candidemia incidence in May 2020. Therefore, the purpose of this study was to investigate an inter-hospital candidemia outbreak caused by FRCP isolates during the first year of the COVID-19 pandemic in Brazil. C. parapsilosis bloodstream isolates obtained from the cancer (n = 35) and cardiology (n = 30) centers in 2020 were submitted to microsatellite genotyping and fluconazole susceptibility testing. The ERG11 gene of all isolates from the cardiology center was sequenced and compared to the corresponding sequences of the FRCP genotype responsible for the cancer center outbreak in 2019. Unprecedentedly, most of the FRCP isolates from the cardiology center presented the same genetic profile and Erg11-Y132F mutation detected in the strain that has been causing the persistent outbreak in the cancer center, highlighting the uninterrupted horizontal transmission of clonal isolates in our hospitals during the COVID-19 pandemic.

Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center.

Clonal outbreaks due to azole-resistant Candida parapsilosis (ARCP) isolates have been reported in numerous studies, but the environmental niche of such isolates has yet to be defined. Herein, we aimed to identify the environmental niche of ARCP isolates causing unremitting clonal outbreaks in an adult ICU from a Brazilian cancer referral center. C. parapsilosis sensu stricto isolates recovered from blood cultures, pericatheter skins, healthcare workers (HCW), and nosocomial surfaces were genotyped by multilocus microsatellite typing (MLMT). Antifungal susceptibility testing was performed by the EUCAST (European Committee for Antimicrobial Susceptibility Testing) broth microdilution reference method and ERG11 was sequenced to determine the azole resistance mechanism. Approximately 68% of isolates were fluconazole-resistant (76/112), including pericatheter skins (3/3, 100%), blood cultures (63/70, 90%), nosocomial surfaces (6/11, 54.5%), and HCW's hands (4/28, 14.2%). MLMT revealed five clusters: the major cluster contained 88.2% of ARCP isolates (67/76) collected from blood (57/70), bed (2/2), pericatheter skin (2/3), from carts (3/7), and HCW's hands (3/27). ARCP isolates were associated with a higher 30 day crude mortality rate (63.8%) than non-ARCP ones (20%, p = 0.008), and resisted two environmental decontamination attempts using quaternary ammonium. This study for the first time identified ARCP isolates harboring the Erg11-Y132F mutation from nosocomial surfaces and HCW's hands, which were genetically identical to ARCP blood isolates. Therefore, it is likely that persisting clonal outbreak due to ARCP isolates was fueled by environmental sources. The resistance of Y132F ARCP isolates to disinfectants, and their potential association with a high mortality rate, warrant vigilant source control using effective environmental decontamination.

Medo de Covid-19 e fatores associados ao possível bruxismo do sono e/ou em vigília entre universitários da região sudeste do Brasil durante a pandemia Covid-19 / Fear of Covid-19 and factors associated with sleep and/or wakefulness bruxism among university students in southeastern Brazil during the Covid-19 pandemic

Introdução: O possível bruxismo é um comportamento autorrelatado, caracterizado pelo ranger e/ou apertar dos dentes, estando associado a fatores psicológicos. A pandemia da COVID-19 tem afetado o emocional das pessoas, podendo ser associada a este comportamento. Objetivo: Analisar a associação entre o nível de medo da COVID-19, assim como outros fatores associados à prevalência de possível bruxismo entre universitários. Materiais e métodos: Participaram deste estudo transversal 311 universitários de graduação e pós-graduação de faculdades odontológicas públicas e privadas da região sudeste do Brasil. Os participantes foram contatados via WhatsApp e redes sociais através de amostragem em bola de neve para responder um questionário com avaliação sociodemográfica, presença, frequência e severidade de possível bruxismo do sono (PBS) e/ou em vigília (PBV) e a versão brasileira da fear scale of COVID-19. Análises descritivas e bivariadas foram realizadas através dos testes estatísticos de Mann-Whitney e Kruskall-Wallis (p<0,05). Resultados: A prevalência de PBS grave foi de 12,5% e PBV 23,8%. Não houve associação entre escores de medo COVID-19 nem com PBS (p=0,342) nem com PBV (p=0,912). Quando analisado o PBV, observou-se maior prevalência dentre os participantes que não trabalhavam (p=0,008), sendo maior percentual entre os universitários na segunda metade do curso (p=0,021) e, dentre os participantes da pós-graduação, o bruxismo foi mais prevalente entre alunos matriculados em programas stricto sensu comparados àqueles de programas lato sensu (p=0,036). Conclusão: Estar fora do mercado de trabalho, a fase final da graduação e a inserção em uma pós-graduação stricto sensu influenciaram na prevalência de PBV.

Introduction: The possible bruxism is a self-reported behavior characterized by grinding and/or clenching teeth and is associated with psychological factors. The COVID-19 pandemic has affected people's emotions and can be associated with this behavior. Objective: Analyze the association between level of fear of COVID-19, as well as other factors associated to the prevalence of possible bruxism among university students. Materials and methods: A total of 311 undergraduate and graduate students from public and private dental schools in Southeastern Brazil participated in this cross-sectional study. Participants were contacted via WhatsApp and social networks through snowball sampling to answer an online questionnaire with sociodemographic assessment, presence, frequency and severity of possible sleep bruxism (PSB) and/or awake bruxism (PAB) and Brazilian version of the fear scale of COVID-19. Descriptive and bivariate analyzes were performed using the Mann-Whitney and Kruskall-Wallis statistical tests (p<0.05). Results: The prevalence of severe PSB was 12.5% and PAB 23.8%. There was no association between COVID-19 fear scores or with PSB (p=0.342) or with PAB (p=0.912). When analyzing the PAB, there was a higher prevalence among participants who didn't work (p=0.008), with a higher percentage among university students in the second half of the course (p=0.021). Among graduate participants, possible bruxism was more prevalent among students enrolled in stricto sensu programs compared to those in lato sensu programs (p=0.036). There wasn't association between COVID-19 fear score and possible bruxism. Conclusion: Being out of the job market, final stage of graduation and entry into a stricto sensu graduate program influenced the prevalence of PAB.

Bronchopulmonary Aspergillosis associated with acute myocardial infarction in dog / Aspergilose pulmonar associado a infarto agudo do miocárdio em cão

Background: Fungi of the genus Aspergillus are ubiquitous microorganisms of opportunistic character, of which animals and humans are continually exposed. Are described three main forms of aspergillosis in dogs: nasal, disseminated and bronchopulmonary. This form which is restricted to the lung parenchyma is considered rare in dogs. The aim of this paper is to report a case of pulmonary aspergillosis associated to acute myocardial infarction in a dog, focusing on epidemiological, clinical, pathological and immunohistochemical characteristics. Case: A male dog, 4-year-old, Pinscher, clinically presented dyspnea, anorexia, vomiting, concentrated urine and dark and mollified faeces. On physical examination, there were congested oral and conjunctival mucosas, dehydration and petechiae in the outer ear. The animal died five days after the clinical attendance and was sent for necropsy. The macroscopic lesions were restricted to the lung, heart and liver. There were multifocal areas of consolidation in the lung parenchyma and yellowish content in the trachea and bronchi lumen. The heart was rounded and with pale areas in the myocardium. Liver was discreet accentuation of the lobular pattern. Histologically the lesion was characterized by pyogranulomatous and necrotizing bronchopneumonia, multifocal to coalescing, moderate, associated with myriads of intralesional hyphae consistent with [...]

Bronchopulmonary Aspergillosis associated with acute myocardial infarction in dog / Aspergilose pulmonar associado a infarto agudo do miocárdio em cão

Background: Fungi of the genus Aspergillus are ubiquitous microorganisms of opportunistic character, of which animals and humans are continually exposed. Are described three main forms of aspergillosis in dogs: nasal, disseminated and bronchopulmonary. This form which is restricted to the lung parenchyma is considered rare in dogs. The aim of this paper is to report a case of pulmonary aspergillosis associated to acute myocardial infarction in a dog, focusing on epidemiological, clinical, pathological and immunohistochemical characteristics. Case: A male dog, 4-year-old, Pinscher, clinically presented dyspnea, anorexia, vomiting, concentrated urine and dark and mollified faeces. On physical examination, there were congested oral and conjunctival mucosas, dehydration and petechiae in the outer ear. The animal died five days after the clinical attendance and was sent for necropsy. The macroscopic lesions were restricted to the lung, heart and liver. There were multifocal areas of consolidation in the lung parenchyma and yellowish content in the trachea and bronchi lumen. The heart was rounded and with pale areas in the myocardium. Liver was discreet accentuation of the lobular pattern. Histologically the lesion was characterized by pyogranulomatous and necrotizing bronchopneumonia, multifocal to coalescing, moderate, associated with myriads of intralesional hyphae consistent with [...](AU)

O processo de formação didático pedagógica em saúde: aprendizagens percebidas na voz dos pós-graduandos / The process of didatic-pedagogical training in health: learning perceived in the voice of postgraduate students

INTRODUÇÃO: O presente estudo integra o projeto "Formação de professor: estratégia dialógica problematizadora com uso de ambiente virtual de aprendizagem", desenvolvido na disciplina de Formação Didático Pedagógica em Saúde (FDPS), ofertada pelo Centro de Desenvolvimento do Ensino Superior em Saúde (CEDESS) da Universidade Federal de São Paulo (UNIFESP), no formato bimodal (presencial e a distância). OBJETIVO: Analisar as aprendizagens construídas pelos pós-graduandos no processo de formação docente ao longo da disciplina FDPS. MÉTODOS: Os sujeitos da pesquisa foram onze profissionais de diversas áreas da saúde. Para a coleta de dados, foi solicitada a cada pós-graduando, antes do início da disciplina, uma carta de apresentação, manifestando as suas expectativas e, ao término da disciplina, uma autoavaliação, sobre as aprendizagens construídas durante o processo. A análise temática partiu dos seguintes núcleos orientadores: expectativas Iniciais, aprendizagens construídas e perspectivas futuras na docência. RESULTADOS: A maioria dos participantes manifestou a intenção de conhecer técnicas de transmissão de conteúdos com centralidade no docente, em menor proporção também foi expresso o desejo de compartilhar informações e refletir sobre o cenário da educação e da saúde no país. No núcleo, aprendizagens construídas, os pós-graduandos valorizaram as estratégias utilizadas no decorrer da disciplina, destacando a construção e apresentação do planejamento educacional em grupos multiprofissionais. Nas perspectivas futuras, muitos demonstraram o reconhecimento de continuar sua formação docente para melhor exercício da profissão. CONCLUSÃO: A educação permanente do processo de formação docente parece ser uma demanda crescente, o que valoriza essa atividade e sua profissionalização.

INTRODUCTION: This study is part of the project "Teacher training: problem-dialogical strategy with virtual environment use of learning" developed in the discipline Didatic-Pedagogical Training in Health (DPTH), offered by the Higher Education Development Center on Health (CEDESS) in the Federal University of São Paulo (UNIFESP), in bimodal format (presence and distance). OBJECTIVE: To analyze the learning built by graduate students in the teacher education process throughout DPTH discipline. METHODS: The subjects of the research were eleven professionals from different areas of health. For the data collect, was requested to every postgraduate student, before the start of the course, an introduction letter,expressing their expectations and, in the end of the discipline, a self-assessment of the learning built during the process. The thematic analysis came from the following guiding cores: initial expectations, learning built and future perspectives. RESULTS: The expectations had manifested the intention to know techniques and tools to transmit the contents with centrality in the teacher, but even in minor proportion, was also expressed a desire to share information and reflect the education and health scenario in the country. In the core learning built, the students appreciated the strategies used in the discipline, emphasizing the construction and presentation of an education planning in small multiprofessional groups. In the future perspectives, many had shown the recognition to continue their teacher training to a better practice of the profession. CONCLUSION: the continuing education of the teacher training process appears to be a growing demand, which values this activity and its professionalisation.