Lifestyle of health workers from pediatric units during the pandemic: a cross-sectional study / Estilo de vida de profissionais de saúde pediátricos na pandemia: estudo transversal

ABSTRACT This study aimed to assess the lifestyle of health workers in pediatric units of Bahia, Brazil, by comparing the total and domain scores of the Fantastic Lifestyle Questionnaire (FLQ) according to sex, age group, and employment profile. This cross-sectional study included 407 health workers from four pediatric health units in Bahia. The FLQ and a sociodemographic questionnaire were answered via Google Forms during the COVID-19 pandemic. Men scored significantly lower than women in the 'tobacco and toxics' (p = 0.046) and 'alcohol' (p < 0.001) domains but higher in the 'sleep, seat belt, stress, and safe sex' domain (p = 0.01). Younger health workers (18 to 34 years old) scored significantly higher than older workers (35 to 64 years old) in the 'tobacco and toxics' domain (p = 0.03). Direct healthcare workers (e.g., nurses and doctors) scored significantly higher than indirect healthcare workers (e.g., administrators) in the 'tobacco and toxics' domain (p = 0.04). Despite the COVID-19 pandemic, the lifestyle of most workers was classified as very good (56.02%). Our findings indicate changes in the lifestyle of health workers, especially concerning the use of tobacco, alcohol, and conditions related to sleep, stress, safe sex, and traffic safety behaviors. Future studies are recommended to understand better the determinants and conditioning factors of tobacco use by health workers and design targeted public health initiatives.

RESUMO O objetivo deste estudo foi avaliar o estilo de vida dos profissionais de saúde de unidades pediátricas da Bahia, Brasil, comparando o escore total e o escore de cada domínio do Questionário de Estilo de Vida Fantástico com sexo, faixa etária e perfil profissional. Participaram 407 profissionais de saúde de quatro unidades de saúde pediátricas, neste estudo transversal. O questionário Fantástico e um questionário sociodemográfico foram respondidos por meio de formulário do Google durante a pandemia de COVID-19. Os homens obtiveram significativamente pontuações mais baixas que as mulheres nos domínios 'tabaco e tóxicos' (p=0,046) e 'álcool' (p<0,001), e mais altas no domínio 'sono, cinto de segurança, estresse e sexo seguro' (p=0,01). Os profissionais de saúde mais jovens (18 a 34 anos) alcançaram pontuações significativamente superiores aos mais velhos (35 a 64 anos) no domínio 'tabaco e tóxicos' (p=0,03). Os profissionais de saúde de assistência direta (por exemplo, enfermeiros e médicos) obtiveram pontuações superiores aos profissionais de assistência indireta (por exemplo, administradores) no domínio 'tabaco e tóxicos' (p = 0,04). Apesar da pandemia de COVID-19, o estilo de vida da maioria dos trabalhadores foi classificado como muito bom (56,02%). Nossos achados alertam para mudanças no estilo de vida dos profissionais, principalmente quanto ao uso de tabaco, álcool, condições relacionadas ao sono, estresse, sexo seguro e comportamentos de segurança no trânsito. Estudos futuros são recomendados para entender melhor os determinantes e condicionantes do uso do tabaco pelos profissionais de saúde, permitindo o direcionamento de ações no contexto da saúde pública.

Vaccine-induced immune thrombotic thrombocytopenia after COVID-19 vaccination: Description of a series of 39 cases in Brazil.

OBJECTIVE: Describe a case series of vaccine-induced immune thrombotic thrombocytopenia (VITT) after COVID-19 vaccination in Brazil that included ChAdOx1 nCoV-19, Ad26.COV2.S and BNT162b2 vaccines, describing their clinical and laboratory characteristics. METHODOLOGY: Descriptive case series study using Bio-Manguinhos/Fiocruz/AstraZeneca Brazil and National Immunization Program/Ministry of Health (NIP/MoH) data on COVID-19 AEFI surveillance. We obtained patient-level data from pharmacovigilance for AEFI surveillance and used both the NIP/MoH and Bio-Manguinhos/Fiocruz pharmacovigilance databases to create the study database. Thirty-nine cases of suspect VITT were included, 36 after ChAdOx1 nCoV-19, one after BNT162b2 and two after Ad26.COV2.S vaccine. All cases were based on meeting the Brighton Collaboration criteria for VITT. The primary outcomes were clinical and laboratory features, site of thrombosis, and anti-PF4 ELISA, when available. RESULTS: Thirty-nine cases met the criteria, 38 of which were classified as level 1 and one as level 3 according to Brighton Collaboration. Most cases had the central nervous system (CNS) as the main site of thrombosis (21/39) and happened after the vaccine first dose (34/39). The median age of the cases was 41 years old (23 to 86 yo). Most of the cases (61.5%) occurred in women. The median interval between vaccination and onset of symptoms was 8 days (0-37 days). The platelet count and D-dimer count had median values of 34,000/µL and 19,235 µg FEU/L, respectively. The ELISA anti-PF4 antibody was positive in 18 samples. The overall mortality rate was 51% and was higher in cases of CNS thrombosis with intracerebral bleeding. CONCLUSION: Our case series shows that Brazilian VITT cases have similar clinical and laboratory profiles as demonstrated in the literature. Brazil has administered more than 300 million doses of COVID-19 vaccines (more than 110 million from ChAdOx1 nCoV-19). VITT seems to be a very rare but serious adverse event following COVID-19 immunization, especially adenoviral vector immunization.

Initial development of biosimilar immune checkpoint blockers using HEK293 cells.

Antibodies that block interaction of immune checkpoint receptors with its ligands have revolutionized the treatment of several cancers. Despite the success of this approach, the high cost has been restricted the use of this class of drugs. In this context, the development of biosimilar can be an important strategy for reducing prices and expanding access after patent has been dropped. Here, we evaluated the use of HEK293 cells for transient expression of an immune checkpoint-blocking antibody as a first step for biosimilar development. Antibody light and heavy chain genes were cloned into pCI-neo vector and transiently expressed in HEK293 cells. The culture supernatant was then subjected to protein A affinity chromatography, which allowed to obtain the antibody with high homogeneity. For physicochemical comparability, biosimilar antibody and reference drug were analyzed by SDS-PAGE, isoelectric focusing, circular dichroism and fluorescence spectroscopy. The results indicated that the both antibodies have a high degree of structural similarity. Lastly, the biosimilar antibody binding capacity to target receptor was shown to be similar to reference product in ELISA and flow cytometry assays. These data demonstrate that the HEK293 system can be used as an important tool for candidate selection and early development of biosimilar antibodies.

Caracterización de la atención al paciente del seguro integral de salude com diabetes mellitus tipo 2 em la región Callao, Perú / Characterization of patient care from comprehensive insurance com greet type 2 diabetes mellitus em the Callao region, Peru

La diabetes mellitus tipo 2 (DM2) es una enfermedad crónica no transmisible que representa una importante causa de morbimortalidad a nivel mundial. Para su control, se han desarrollado modelos de atención a las enfermedades crónicas; en el Perú, el Seguro Integral deSalud (SIS), apoyado por el Presupuesto por Resultados (PpR), y las normativas para el tratamiento de la DM2, proponen un tratamiento integral al paciente, en el marco del Modelo de Atención Integral de Salud del 2011. Esta investigación tuvo como objetivo caracterizar la atención ofrecida a los pacientes con DM2 a través del Seguro Integral de Salud en la red de servicios de la Región Callao del Ministerio de Salud, desde el punto de vista de los coordinadoresde la atención a la diabetes de los establecimientos de salud (puestos y centros de salud yhospitales) y de los niveles centrales de coordinación (microrredes, redes y dirección regional desalud). Para ello, se realizaron cuestionarios semiestructurados, que abordaron 5 dimensiones: Caracterización del establecimiento / nivel de coordinación, caracterización del coordinador, del proceso de atención a los pacientes con DM2, de los mecanismos de coordinación e identificaciónde las limitaciones para el desarrollo de las actividades de atención a la DM2. La población deestudio fue de 68 coordinaciones de salud. (...)La multiplicidad de funciones fue la dificultad reportada con mayor frecuencia por los coordinadores como limitante para el desarrollo de sus de coordinación, así como el subregistro de la información, el monitoreo insuficiente de las metaspor parte de los gestores, la ausencia de incentivos para el equipo de atención a la DM2 y elnúmero limitado de profesionales de la salud. Los coordinadores de hospitales señalaron ademásla inadecuación del plan de salud para la región, el uso del presupuesto programado en actividadesdistintas a la atención a la diabetes, la falta de coordinación con la oficina de planeamiento y la disponibilidad irregular de medicamentos. Este estudio evidenció deficiencias en la organización de los cuidados al paciente con DM2 del Seguro Integral de Salud, con uso muy limitado de la clasificación de riesgo, insuficiente número de profesionales, frecuente rotación y multiplicidadde funciones de los coordinadores, e insuficiente capacitación de los equipos de atención. Conello, podemos decir que en la Región Callao no existen redes integradas de atención de salud deacuerdo a las recomendaciones actuales del Modelo de Cuidados Crónicos, de la Organización Panamericana de la Salud y del Modelo de Atención Integral de Salud del Perú.

Type 2 diabetes mellitus (T2DM) is a non-communicable chronic disease considered amajor cause of morbidity and mortality worldwide. In order to control of this disease,there are care models for chronic diseases; in Peru, the Comprehensive Health Insurance(Seguro Integral de Salud-SIS), supported by the Performance-based Budgeting(Presupuesto por Resultados-PpR), and national regulations for the treatment of T2DM,propose a comprehensive patient management, under the Comprehensive Health CareModel (Modelo de Atención Integral de Salud, 2011). This research was aimed tocharacterize the care provided to patients with T2DM through the SIS, from the point ofview of the coordinators of care for diabetes health facilities (health posts and centers andhospitals) and central coordination levels (micro-networks, networks and Regional HealthSecretary) of Health Services System of Region Callao, of Peruvian Ministry of Health.Semi-structured questionnaires that addressed five main dimensions: Characterization ofthe establishment/coordination level, characterization of coordinators, characterization ofcare services provides to patients with T2DM and characterization of the mechanisms ofcoordination and identification of limitations for development of activities as perceivedby the coordinators, were performed. The population of the study was 68 coordinators. (...) Themultiplicity of functions was the most frequently reported difficulty related todevelopment of activities of coordinators; underreporting of information, inadequatemonitoring of targets by managers, lack of incentives for the care team for T2DM, andthe limited number of health professionals were other limitations. Hospitals coordinatorsalso noted the inadequacy of the health plan for the region, the use of the budget for otherthan scheduled diabetes care activities, and lack of coordination with the Planning Officeand irregular availability of drugs. This study showed deficiencies in the organization ofcare for patients with T2DM, with a very limited use of risk classification, insufficientnumber of health professionals, high turnover and multiple functions of coordinators, andinsufficient training of healthcare teams. Finally, we can say that in the Callao Region,there are not integrated health care networks according to the current recommendationsof the Chronic Care Model, the Pan American Health Organization and PeruvianComprehensive Health Care Model.

Tipo de parto, duración de la fase activa y expulsivo en gestantes con analgesia epidural comparada con analgesia combinada en el Instituto Nacional Materno Perinatal. 2009 / Type of childbirth, duration of the active phase and expulsive in pregnant with compared epidural analgesia with analgesia combined in the Perinatal Maternal National Institute. 2009

OBJETIVO: Determinar y comparar el el tipo de parto más frecuente, la duración de la fase activa y expulsivo en gestantes con analgesia epidural comparada con analgesia combinada en el Instituto Nacional Materno Perinatal. METODOLOGIA: Estudio cohorte retrospectiva RESULTADOS: La edad de las gestantes fue para el primer grupo 22,4 años y para el segundo 21,6 años. En el grupo de pacientes que recibieron analgesia epidural el 71.6 por ciento de pacientes fueron nulíparas frente al 77.5 por ciento que recibieron analgesia combinada. (93 pacientes). En el grupo de pacientes a las que se les aplicó analgesia combinada el 28.4 por ciento de pacientes fueron multíparas comparada con 22.5 por ciento que recibieron analgesia combinada (27 pacientes). En ambos grupos existió mayor porcentaje de partos vaginales no instrumentados, siendo 92.1 por ciento, es decir 221 pacientes para el grupo de analgesia epidural y 83,3 por ciento equivalente a 100 pacientes. Valores cercanos se evidenciaron en ambos grupos respecto al parto vaginal instrumentado con el 10 por ciento para el grupo que recibió la analgesia epidural y 6.7 por ciento para el grupo que recibió combinada. La cesárea se observó en el 7.1 por ciento es decir 17 pacientes del grupo de analgesia epidural frente a 0.8 por ciento (2) de pacientes de analgesia combinada. No hubieron complicaciones en el 93,7 por ciento es decir en 225 pacientes del grupo que recibió analgesia epidural y en el 87,4 por ciento equivalente a 104 pacientes con analgesia combinada. Efectos menos frecuentes se evidenciaron como hipodinamia uterina en 3 y 2 casos correspondientes al 1,3 por ciento y 1,7 por ciento para analgesia epidural y combinada, respectivamente. El prurito se manifestó en mayores casos del grupo de analgesia combinada que en el grupo epidural (9,2 por ciento frente a 1,3 por ciento, respectivamente). Igual porcentaje se encontró en ambos grupos para el expulsivo prolongado (0,8 por ciento). Otras complicaciones como parestesias e hipotermia se reportaron en 2,9 por ciento y 0,8 por ciento para el grupo con epidural y combinada, respectivamente. La duración de la fase activa, es mayor en las pacientes con analgesia epidural que con la combinada (110.65 min 107.72 min). El período expulsivo se prolongó más en las pacientes con analgesia combinada siendo 17,10 min y 12,40 min con epidural. El resultado neonatal en ambos grupos fueron buenos y similares siendo 8,7 aproximado a 9 y 8,3 aproximado a 8. Los resultados neonatales a los 5 min son también buenos, aproximando 9 para ambos grupos (8,9 combinada vs 9,3 epidural). CONCLUSIONES: El tipo de parto más frecuente fue el parto vaginal no instrumentado en ambos grupos, presentándose más casos en el grupo epidural. En las pacientes con analgesia combinada la fase activa del trabajo de parto duró menos y el expulsivo más que en las que recibieron analgesia epidural