Increment of immunogenicity after third dose of a homologous inactivated SARS-CoV-2 vaccine in a large population of patients with autoimmune rheumatic diseases.

OBJECTIVE: To determine the immunogenicity of the third dose of CoronaVac vaccine in a large population of patients with autoimmune rheumatic diseases (ARD) and the factors associated with impaired response. METHODS: Adult patients with ARD and age-balanced/sex-balanced controls (control group, CG) previously vaccinated with two doses of CoronaVac received the third dose at D210 (6 months after the second dose). The presence of anti-SARS-CoV-2 S1/S2 IgG and neutralising antibodies (NAb) was evaluated previously to vaccination (D210) and 30 days later (D240). Patients with controlled disease suspended mycophenolate mofetil (MMF) for 7 days or methotrexate (MTX) for 2 weekly doses after vaccination. RESULTS: ARD (n=597) and CG (n=199) had comparable age (p=0.943). Anti-S1/S2 IgG seropositivity rates significantly increased from D210 (60%) to D240 (93%) (p<0.0001) in patients with ARD. NAb positivity also increased: 38% (D210) vs 81.4% (D240) (p<0.0001). The same pattern was observed for CG, with significantly higher frequencies for both parameters at D240 (p<0.05). Multivariate logistic regression analyses in the ARD group revealed that older age (OR=0.98, 95% CI 0.96 to 1.0, p=0.024), vasculitis diagnosis (OR=0.24, 95% CI 0.11 to 0.53, p<0.001), prednisone ≥5 mg/day (OR=0.46, 95% CI 0.27 to 0.77, p=0.003), MMF (OR=0.30, 95% CI 0.15 to 0.61, p<0.001) and biologics (OR=0.27, 95% CI 0.16 to 0.46, p<0.001) were associated with reduced anti-S1/S2 IgG positivity. Similar analyses demonstrated that prednisone ≥5 mg/day (OR=0.63, 95% CI 0.44 to 0.90, p=0.011), abatacept (OR=0.39, 95% CI 0.20 to 0.74, p=0.004), belimumab (OR=0.29, 95% CI 0.13 to 0.67, p=0.004) and rituximab (OR=0.11, 95% CI 0.04 to 0.30, p<0.001) were negatively associated with NAb positivity. Further evaluation of COVID-19 seronegative ARD at D210 demonstrated prominent increases in positivity rates at D240 for anti-S1/S2 IgG (80.5%) and NAb (59.1%) (p<0.0001). CONCLUSIONS: We provide novel data on a robust response to the third dose of CoronaVac in patients with ARD, even in those with prevaccination COVID-19 seronegative status. Drugs implicated in reducing immunogenicity after the regular two-dose regimen were associated with non-responsiveness after the third dose, except for MTX. Trial registration number NCT04754698.

[Constructing meanings and possibilities: the incubation team's experience of a supportice undertaking]. / Construindo sentidos e possibilidades: a experiência da equipe de incubação de um empreendimento solidário.

The aim of this qualitative study was to analyze the experience of an incubation team in a supportive undertaking regarding mental healthcare clients. Interviews were conducted with seven team members, and the data were analyzed using content data analysis. The analysis revealed four categories: considering incubation as a process - learning and finding the meanings of support; pointing out the easy and difficult aspects in the process of constructing the undertaking; seeing results of the inclusion through work - noticing the clients' improvement; and pointing out the need for changes in the process, expecting greater autonomy of clients and formalization of the undertaking. The experience revealed itself as a new and fulfilling job for the team, allowing for learning, exchanging knowledge and attachment. We identified that the technician plays the role of educator/facilitator of the process. In addition to the simple aspects and the recognition of the relevance of the work in terms of the clients' lives, the team faces challenges in generating satisfactory revenue.

Construindo sentidos e possibilidades: a experiência da equipe de incubação de um empreendimento solidário / Constructing meanings and possibilities: the incubation team's experience of a supportice undertaking / Construyendo sentidos y posibilidades: la experiencia del equipo de incubación de un emprendimiento solidário

Esta pesquisa qualitativa teve por objetivo analisar a experiência da equipe de incubação de um empreendimento solidário de usuários de saúde mental. As entrevistas ocorreram com sete membros da equipe, sendo os dados analisados segundo análise de conteúdo. Da análise emergiram quatro categorias: Considerando a incubação como um processo - aprendendo e encontrando os significados de ser apoio; Apontando facilidades e dificuldades no processo de construção do empreendimento; Visualizando resultados da inclusão pelo trabalho - percebendo a melhora dos usuários; Apontando necessidades de mudanças no processo, esperando uma maior autonomia dos usuários e a formalização do empreendimento. A experiência revelou ser um trabalho novo e gratificante para a equipe, possibilitando aprendizado, troca de saberes e vínculo. Identificamos o papel do técnico como educador/facilitador do processo. Além das facilidades e do reconhecimento da relevância do trabalho para a vida dos usuários, a equipe enfrenta desafios para gerar renda satisfatória.

The aim of this qualitative study was to analyze the experience of an incubation team in a supportive undertaking regarding mental healthcare clients. Interviews were conducted with seven team members, and the data were analyzed using content data analysis. The analysis revealed four categories: considering incubation as a process - learning and finding the meanings of support; pointing out the easy and difficult aspects in the process of constructing the undertaking; seeing results of the inclusion through work - noticing the clients' improvement; and pointing out the need for changes in the process, expecting greater autonomy of clients and formalization of the undertaking. The experience revealed itself as a new and fulfilling job for the team, allowing for learning, exchanging knowledge and attachment. We identified that the technician plays the role of educator/facilitator of the process. In addition to the simple aspects and the recognition of the relevance of the work in terms of the clients' lives, the team faces challenges in generating satisfactory revenue.

Investigación cualitativa que objetivó analizar la experiencia del equipo de incubación de un emprendimiento solidario de pacientes de salud mental. Fueron entrevistados siete miembros del equipo, analizándose los datos según análisis de contenido. Surgieron cuatro categorías: Considerando la incubación como un proceso - aprendiendo y encontrando el significado de ser apoyo; Identificando facilidades y dificultades en el proceso de construcción del emprendimiento; Visualizando resultados de la inclusión laboral - percibiendo la mejoría de los pacientes; Identificando necesidades de cambios en el proceso, esperando una mayor autonomía de los pacientes y la formalización del emprendimiento. La experiencia reveló ser un trabajo nuevo y gratificante para el equipo, posibilitando aprendizaje, intercambio de conocimientos ay vínculo. Identificamos el papel del técnico como educador/facilitador del proceso. Más allá de las facilidades y del reconocimiento de la relevancia del trabajo para la vida de los pacientes, el equipo enfrenta desafíos tales como generar una renta satisfactoria.

Panorama da educação à distância em enfermagem no Brasil / Panorama of nursing distance education in Brazil / Panorama de la educación a distancia en enfermería en Brasil

O desenvolvimento da educação à distância está associado à popularização e democratização do acesso às tecnologias de informação e de comunicação. A enfermagem vem se apropriando desta modalidade de ensino em seus cursos de graduação e pós-graduação, o que tem possibilitado conhecimento de novas tecnologias, facilidade de acesso, flexibilidade temporal e espacial e custos reduzidos. Objetivou-se realizar um mapeamento nacional de forma a identificar os cursos de ensino superior de enfermagem na modalidade educação à distância. Trata-se de um estudo exploratório descritivo, desenvolvido a partir de consultas a sites governamentais, não governamental e institucionais. Foram encontrados dois cursos de graduação e nove de pós-graduação oferecidos na área de enfermagem, o que é considerado um número ainda baixo, já que a educação à distância é uma ferramenta pedagógica adequada que permite a qualificação de grande contingente de enfermeiros que estão dispersos geograficamente e que não possuem acesso aos processos convencionais de ensino.

The development of distance education is associated with the popularization and democratization of the accessibility to information and communication technologies. Nursing has been using this modality of education in both undergraduate and graduate courses, which has provided knowledge about other technologies, an easier accessibility, flexibility of time and space, and reduced costs. The objective of this study is map the national higher education distance nursing courses. This exploratory, descriptive study was developed by visiting governmental, non-governmental and institutional websites. Two undergraduate and nine graduate courses in nursing were found, which is considered to be a low number, considering that distance education is an appropriate pedagogical tool that permits to prepare a large number of nurses who are geographically dispersed and who do not have access to the conventional educational processes.

El desarrollo de la Educación a Distancia está asociado a la popularización y democratización del acceso a Tecnologías de Información y Comunicación. La Enfermería ha ido aproximándose a tal modalidad de enseñanza en sus cursos de graduación y posgraduación, lo que posibilitó el conocimiento de nuevas tecnologías, facilidad de acceso, flexibilidad temporal y espacial y costos reducidos. Se objetivó efectuar un mapeo nacional para identificar los cursos de enseñanza superior de enfermería en la modalidad Educación a Distancia. Estudio exploratorio, descriptivo, desarrollado a partir de consultas a webs gubernamentales, no gubernamentales e institucionales. Se encontraron dos cursos de graduación y nueve de posgraduación ofrecidos a enfermería, número aún considerado bajo, ya que la Educación a Distancia es una herramienta pedagógica adecuada que permite la calificación de un gran contingente de enfermeros dispersos geográficamente y sin acceso a los procesos convencionales de enseñanza.

[Panorama of nursing distance education in Brazil]. / Panorama da educação à distância em enfermagem no Brasil.

The development of distance education is associated with the popularization and democratization of the accessibility to information and communication technologies. Nursing has been using this modality of education in both undergraduate and graduate courses, which has provided knowledge about other technologies, an easier accessibility, flexibility of time and space, and reduced costs. The objective of this study is map the national higher education distance nursing courses. This exploratory, descriptive study was developed by visiting governmental, non-governmental and institutional websites. Two undergraduate and nine graduate courses in nursing were found, which is considered to be a low number, considering that distance education is an appropriate pedagogical tool that permits to prepare a large number of nurses who are geographically dispersed and who do not have access to the conventional educational processes.