SARS CoV-2 seroprevalence and diagnostic accuracy during a COVID-19 outbreak in a major penitentiary complex in Brazil, June to July 2020.

PURPOSE: This study aims to estimate the overall SARS-CoV-2 seroprevalence and evaluate the accuracy of an antibody rapid test compared to a reference serological assay during a COVID-19 outbreak in a prison complex housing over 13,000 prisoners in Brasília. DESIGN/METHODOLOGY/APPROACH: The authors obtained a randomized, stratified representative sample of each prison unit and conducted a repeated serosurvey among prisoners between June and July 2020, using a lateral-flow immunochromatographic assay (LFIA). Samples were also retested using a chemiluminescence enzyme immunoassay (CLIA) to compare SARS-CoV-2 seroprevalence and 21-days incidence, as well as to estimate the overall infection fatality rate (IFR) and determine the diagnostic accuracy of the LFIA test. FINDINGS: This study identified 485 eligible individuals and enrolled 460 participants. Baseline and 21-days follow-up seroprevalence were estimated at 52.0% (95% CI 44.9-59.0) and 56.7% (95% CI 48.2-65.3) with LFIA; and 80.7% (95% CI 74.1-87.3) and 81.1% (95% CI 74.4-87.8) with CLIA, with an overall IFR of 0.02%. There were 78.2% (95% CI 66.7-89.7) symptomatic individuals among the positive cases. Sensitivity and specificity of LFIA were estimated at 43.4% and 83.3% for IgM; 46.5% and 91.5% for IgG; and 59.1% and 77.3% for combined tests. ORIGINALITY/VALUE: The authors found high seroprevalence of anti-SARS-CoV-2 antibodies within the prison complex. The occurrence of asymptomatic infection highlights the importance of periodic mass testing in addition to case-finding of symptomatic individuals; however, the field performance of LFIA tests should be validated. This study recommends that vaccination strategies consider the inclusion of prisoners and prison staff in priority groups.

SARS-CoV-2 among inmates aged over 60 during a COVID-19 outbreak in a penitentiary complex in Brazil: Positive health outcomes despite high prevalence.

OBJECTIVES: To assess SARS-CoV-2 prevalence and health outcomes among inmates over 60 years during a COVID-19 outbreak in a major penitentiary complex in the Federal District, Brazil. METHODS: A mass test campaign was performed on May 13, 2020, using antibody-detection rapid tests for asymptomatic inmates and reverse transcriptase-polymerase chain reaction testing for those who were symptomatic. Those with negative results were retested on June 16. Inmates were interviewed to characterise background health conditions and the presence of symptoms. RESULTS: A total of 159 inmates were evaluated. In the first mass testing, 79.9% (127/159) of inmates had been infected, of whom 53.5% (68/127) reported symptoms. In the second testing round, 17 new cases were identified, increasing the total to 90.6% (144/159) of inmates with a positive result. Comorbidities were present in 67.3% of inmates; 2 hospitalisations and no COVID-related deaths were recorded. CONCLUSION: More than 90% of inmates aged >60 years were infected with SARS-CoV-2 during the outbreak. Periodic health monitoring, active case finding and early care for symptomatic patients contributed to positive post-infection outcomes. Such measures must be considered essential for the surveillance of COVID-19 in environments with limited capacity to promote social distance, such as penitentiary institutions.

COVID-19 Outbreak in a Large Penitentiary Complex, April-June 2020, Brazil.

An outbreak of coronavirus disease began in a large penitentiary complex in Brazil on April 1, 2020. By June 12, there were 1,057 confirmed cases among inmates and staff. Nine patients were hospitalized, and 3 died. Mean serial interval was ≈2.5 days; reproduction number range was 1.0-2.3.

Redução da espera para consulta com neurologista após reorganização da atenção à saúde na Região Norte do Distrito Federal / Reduction of waiting for consultation with neurologist after reorganization of health care in the Northern Region of the Federal District

OBJETIVO: avaliar o efeito da implementação do sistema de estratificação e regulação de consultas, capacitação de servidores, apoio matricial e gestão das filas de espera no tempo para consulta com neurologista. MÉTODO: por meio do gerenciamento das listas de espera, analisou se a origem e o motivo para os encaminhamentos entre 2014 e2017. Com a disponibilização de neurologista na gestão, realizou-se contrar referências, capacitações e matriciamento. RESULTADOS: houve redução de 95% da fila de espera. CONCLUSÃO: criou-se elo funcional entre os pontos da rede de atençãoà saúde, crucial para garantir a fluidez do processo, contribuindo para uma assistência mais efetiva, eficaz e eficiente.

OBJECTIVE: to evaluate the effect of the implementation of the system of stratification and regulation of consultations, training of servers, support matrix and management of waiting queues in time for consultation with neurologist. METHOD: Through the management of the waiting lists, the origin and the reason for the referrals between 2014 and 2017 were analyzed. With the availability of neurologist in the management, counterreferences, capacitations and matriciamento were realized. RESULTS: There was a 95% reduction in the waiting list. CONCLUSION: a functional link was established between the points of the health care network, crucial to guarantee the flow of the process, contributing to a more effective, effective and efficient assistance.

Curso para mudança do modelo da atenção primária em região de saúde do distrito federal / Course to change the model of primary care in the federal district health region

INTRODUÇÃO: Alicerçado no SUS e na PNAB, o Distrito Federal, por meio das Portarias 77 e 78, sistematizou o Converte. A Região de Saúde Norte realizou um curso diferenciado para esse processo. OBJETIVO: Apresentar a operacionalização do curso. MÉTODO: Utilizou-se a Residência em Medicina de Família e Comunidade e os Gerentes de Território, e propôs-se, coletivamente, a reestruturação do módulo prático e das reuniões de equipe. RESULTADOS: Construiu-se um ambiente semelhante à Residência, regatando-se valores e diretrizes da APS. CONCLUSÃO: O planejamento participativo com a aproximação de diferentes atores tornou-se diferencial e potencializador do curso do Converte na Região Norte.

Narciso na caverna: o efeito da ausência do outro / Narcissus in the cave: the effect of the other's absence

O narcisismo é, costumeiramente, tomado como um estado singularde investimento no eu. Nesse estado, o eu investe a libido em si mesmo,privilegiando a imagem do corpo próprio e excluindo o outro. Aorevisitarmos, contudo, o clássico de Ovídio, Metamorfoses, é possível ressaltarmos,no mito de Narciso, a sensação de estranheza (Unheimliche), naqual o eu, feito duplo, leva a uma revisão da questão da relação eu/outro.Como uma sombra, uma anti-imagem que duplica a imagem especular, aausência do outro cuidador perfila-se como essencial no narcisismo, indicandosua face mortífera no radicalismo de sua vertente melancólica.

Narcissism is usually seen as a singular state of investment in the self. Inthis state, the self invests libido in itself, the body image takes a special valueand the other is excluded. By reviewing the myth in Ovidio’s classicMetamorphosis, we can highlight the uncanny sensation (Freud’s Unheimliche)in which the self, doubled, leads to new elaborations about the relationshipbetween the I and the other. As a shadow, an anti-image that doubles thespecular image, the absence of the primary caretaker appears as essential in narcissism, showing its deadly face in a melancholic way.

Narciso na caverna: o efeito da ausência do outro / Narcissus in the cave: the effect of the other's absence

O narcisismo é, costumeiramente, tomado como um estado singularde investimento no eu. Nesse estado, o eu investe a libido em si mesmo,privilegiando a imagem do corpo próprio e excluindo o outro. Aorevisitarmos, contudo, o clássico de Ovídio, Metamorfoses, é possível ressaltarmos,no mito de Narciso, a sensação de estranheza (Unheimliche), naqual o eu, feito duplo, leva a uma revisão da questão da relação eu/outro.Como uma sombra, uma anti-imagem que duplica a imagem especular, aausência do outro cuidador perfila-se como essencial no narcisismo, indicandosua face mortífera no radicalismo de sua vertente melancólica. (AU)

Narcissism is usually seen as a singular state of investment in the self. Inthis state, the self invests libido in itself, the body image takes a special valueand the other is excluded. By reviewing the myth in Ovidio’s classicMetamorphosis, we can highlight the uncanny sensation (Freud’s Unheimliche)in which the self, doubled, leads to new elaborations about the relationshipbetween the I and the other. As a shadow, an anti-image that doubles thespecular image, the absence of the primary caretaker appears as essential in narcissism, showing its deadly face in a melancholic way. (AU)