How to bring residents' psychosocial well-being to the heart of the fight against Covid-19 in Belgian nursing homes-A qualitative study.

BACKGROUND: Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. METHODS: A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. RESULTS: NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling 'trapped' between IPC and the residents' wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. CONCLUSION: This study revealed the insights of residents' and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents' mental health impact and to enhance their quality of life.

ESPPE debate virtual: continuação da fala do professor Itamar Lages

ESPPE Debate Virtual - Os desafios do trabalho e da formação dos trabalhadores técnicos em saúde no contexto da COVID-19.

COVID-19: quais os desafios para o gestor municipal, em especial, para a Atenção Primária à Saúde?

Para a médica, Claunara Shilling Mendonça, a APS é fundamental para vencer a pandemia de Covid-1. "Não vamos vencer essa epidemia pensando e organizando apenas em aumento de leito de UTI e respiradores. A APS no Brasil tem papel fundamental tendo em vista estarmos dentro de um sistema universal, presente e com capilaridade em todos os municípios brasileiros", defende. Para Claunara Mendonça, o gestor municipal precisa organizar a porta de entrada da UBS. "A UBS precisa organizar os fluxos e separar os sintomáticos respiratórios leves que vão ser atendidos pelas equipes de saúde da família dos demais usuários da unidade, com protocolos, fluxos e EPIs disponíveis e profissionais treinados. Esses profissionais devem atuar em rodízio tanto para evitar e diminuir o período de exposição como também para reduzir a utilização de EPIs tão escassos no país", explica a médica. Outra questão fundamental para a médica com larga experiência na gestão na APS é sobre a organização da rede de serviços. "Quando esses profissionais (da APS) tiverem casos intermediários ou de síndromes gripais graves, eles deverão encaminhar esses pacientes para os centros de referência de Covid-19. Portanto, os municípios que ainda não estão em transmissão comunitária tem um período de duas semanas para organizar a sua rede de urgência, eventualmente aqueles que não estão no SAMU, e organizar o fluxo para aqueles pacientes que deverão necessitar do nível secundário e as equipes deverão conhecer esse fluxo e serem treinadas sobre como encaminhar esse paciente para atenção hospitalar", opina.

Medical and Surgical Education Challenges and Innovations in the COVID-19 Era: A Systematic Review.

The aim of this systematic review was to identify the challenges imposed on medical and surgical education by the COVID-19 pandemic, and the proposed innovations enabling the continuation of medical student and resident training. A systematic review on the MEDLINE and EMBASE databases was performed on April 18th, 2020, and yielded 1288 articles. Sixty-one of the included manuscripts were synthesized in a qualitative description focused on two major axes, "challenges" and "innovative solutions", and two minor axes, "mental health" and "medical students in the frontlines". Shortage of personal protective equipment, suspension of clinical clerkships and observerships and reduction in elective surgical cases unavoidably affect medical and surgical education. Interesting solutions involving the use of virtual learning, videoconferencing, social media and telemedicine could effectively tackle the sudden cease in medical education. Furthermore, trainee's mental health should be safeguarded, and medical students can be involved in the COVID-19 clinical treatment if needed.

The Effect of Coronavirus (COVID-19) on Breast Cancer Teamwork: A Multicentric Survey.

BACKGROUND/AIM: Despite the large amount of clinical data available of Coronavirus-19 (COVID-19), not many studies have been conducted about the psychological toll on Health Care Workers (HCWs). PATIENTS AND METHODS: In this multicentric descriptive study, surveys were distributed among 4 different Breast Cancer Centers (BCC). BCCs were distinguished according to COVID-19 tertiary care hospital (COVID/No-COVID) and district prevalence (DP) (High vs. Low). DASS-21 score, PSS score and demographic data (age, sex, work) were evaluated. RESULTS: A total of 51 HCWs were analyzed in the study. Age, work and sex did not demonstrate statistically significant values. Statistically significant distribution was found between DASS-21-stress score and COVID/No-COVID (p=0.043). No difference was found in the remaining DASS-21 and PSS scores, dividing the HCWs according to COVID-19-hospital and DP. CONCLUSION: Working in a COVID-19-hospital represents a factor that negatively affects psychosocial well-being. However, DP seems not to affect the psychosocial well-being of BCC HCWs. During the outbreak, psychological support for low risk HCWs should be provided regardless DP.

Hospital Pharmacy: Comprehensive management of medical devices during SARS-CoV-2.

Medical devices have become essential to the prevention and control of the  COVID-19 pandemic, being crucial for health professionals and patients in  particular, and the population in general. It is important to be aware of the laws  that regulate the management, distribution, and control of medical devices.  Article 82 of the Spanish Law 29/2006 on Guarantees and Rational Use of  Medicines and Medical Devices establishes that it is the responsibility of Hospital  Pharmacy Services "to participate in and coordinate the purchase of medicines and medical devices in the hospital to ensure an efficient acquisition  and rational use of medical devices". For this reason, working groups of the Spanish Society of Hospital Pharmacy and other scientific societies have issued technical guidelines and consensus statements to provide technical support and updated information on the use of masks, individual  protection equipments and other medical devices. In addition, the shortage of  medical devices caused by the high demand has resulted in the uncontrolled  production and distribution of medical devices. This phenomenon, added to the  fraudulent selling of medical devices, highlights the need for a closer surveillance of the market to guarantee the efficacy and safety of available medical devices. A rational use of medical devices is necessary to ensure the availability and safety of these products, which requires the involvement of  different stakeholders, including hospital pharmacists. Thus, it is essential that  hospital pharmacists receive specific training in technical aspects concerning the possession and use of medical devices. This will help guarantee an effective and safe use of medical products. The acquisition and use of medical  devices requires a keen understanding of the technical and legal aspects  concerning these products, which makes hospital pharmacists essential for the  integral management of medical devices.

Los productos sanitarios se han convertido en imprescindibles en la prevención y control de la pandemia actual generada por COVID-19, tanto para el personal  sanitario y pacientes, como para la ciudadanía en su totalidad. Los productos  sanitarios cuentan con una legislación propia que es preciso conocer para su  correcta gestión, distribución y control. El artículo 82 de la Ley 29/2006 de  garantías y uso racional de los medicamentos y productos sanitarios establece  que es responsabilidad de los servicios de farmacia hospitalaria "participar y  coordinar la gestión de las compras de los productos sanitarios del hospital a  efectos de asegurar la eficiencia de la misma y así contribuir al uso racional de  los mismos". Por este motivo, grupos de trabajo de expertos de la Sociedad Española de Farmacia Hospitalaria, junto a otras sociedades científicas, han desarrollado durante esta pandemia documentos técnicos y consensos para dar soporte técnico e informativo de forma actualizada en  relación con las mascarillas, los equipos de protección individual y otros  productos sanitarios. Por otro lado, los problemas de desabastecimiento  secundarios a la elevada demanda han llevado a una producción y  comercialización descontrolada de productos sanitarios. Este hecho, asociado a  la comercialización fraudulenta de productos sanitarios en el mercado, ha  generado la necesidad de una vigilancia exhaustiva, capaz de garantizar la  eficacia y seguridad de los productos sanitarios en circulación. El uso racional,  para asegurar la disponibilidad y seguridad de los productos sanitarios, es una  responsabilidad multidisciplinar compleja. Para ello, es fundamental una  formación específica como la del farmacéutico de hospital en aspectos técnicos  de tenencia y uso que permite salvaguardar las garantías de eficacia, seguridad  y calidad de los productos sanitarios. El conocimiento técnico y legal que  requieren los productos sanitarios hace imprescindible la implicación del  farmacéutico de hospital como uno de los profesionales sanitarios capacitado  para la gestión integral de estos productos.

The Pandemic: Lessons for Bioethics?

Seeking useful ways to respond to the Covid-19 pandemic, bioethicists have been tempted to claim for themselves what Alasdair MacIntyre characterized in After Virtue as the moral fiction of managerial expertise. They have been eager to offer a wide range of policy prescriptions, presenting themselves as bureaucratic managers and suggesting an expertise that bioethics may not in fact be able to offer. This was evident, for example, in the petition published by The Hastings Center in March 2020. The pandemic could foster a more hopeful future for bioethics if it were to focus attention less on policy decisions that belong to all citizens and more on some of the most basic moral questions that life presents and with which bioethics has always dealt-including, surely, the virtues needed in order to live well in a time of pandemic.

Older Workers on the COVID-19-Frontlines without Paid Sick Leave.

The rapid spread of COVID-19 has left many workers around the world - workers in food distribution, truckers, janitors, and home and personal health care workers - deeply concerned about contracting the virus from exposure at work. In particular, older workers in frontline occupations are vulnerable to illness and to the deadly and debilitating effects of COVID-19, especially with inadequate protective gear and inadequate sick leave. In the absence of strong unions, which ensure that employers provide workers with accurate information, robust training, adequate equipment, and paid leave in the event of quarantines or illness, the COVID-19 pandemic highlights the need for additional legislation to shore up worker protections and provide paid sick leave.

[Health professionals facing the coronavirus disease 2019 (COVID-19) pandemic: What are the mental health risks?] / Les professionnels de santé face à la pandémie de la maladie à coronavirus (COVID-19) : quels risques pour leur santé mentale ?

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has caused major sanitary crisis worldwide. Half of the world has been placed in quarantine. In France, this large-scale health crisis urgently triggered the restructuring and reorganization of health service delivery to support emergency services, medical intensive care units and continuing care units. Health professionals mobilized all their resources to provide emergency aid in a general climate of uncertainty. Concerns about the mental health, psychological adjustment, and recovery of health care workers treating and caring for patients with COVID-19 are now arising. The goal of the present article is to provide up-to-date information on potential mental health risks associated with exposure of health professionals to the COVID-19 pandemic. METHODS: Authors performed a narrative review identifying relevant results in the scientific and medical literature considering previous epidemics of 2003 (SARS-CoV-1) and 2009 (H1N1) with the more recent data about the COVID-19 pandemic. We highlighted most relevant data concerning the disease characteristics, the organizational factors and personal factors that may contribute to developing psychological distress and other mental health symptoms. RESULTS: The disease characteristics of the current COVID-19 pandemic provoked a generalized climate of wariness and uncertainty, particularly among health professionals, due to a range of causes such as the rapid spread of COVID-19, the severity of symptoms it can cause in a segment of infected individuals, the lack of knowledge of the disease, and deaths among health professionals. Stress may also be caused by organizational factors, such as depletion of personal protection equipment, concerns about not being able to provide competent care if deployed to new area, concerns about rapidly changing information, lack of access to up-to-date information and communication, lack of specific drugs, the shortage of ventilators and intensive care unit beds necessary to care for the surge of critically ill patients, and significant change in their daily social and family life. Further risk factors have been identified, including feelings of being inadequately supported, concerns about health of self, fear of taking home infection to family members or others, and not having rapid access to testing through occupational health if needed, being isolated, feelings of uncertainty and social stigmatization, overwhelming workload, or insecure attachment. Additionally, we discussed positive social and organizational factors that contribute to enhance resilience in the face of the pandemic. There is a consensus in all the relevant literature that health care professionals are at an increased risk of high levels of stress, anxiety, depression, burnout, addiction and post-traumatic stress disorder, which could have long-term psychological implications. CONCLUSIONS: In the long run, this tragic health crisis should significantly enhance our understanding of the mental health risk factors among the health care professionals facing the COVID-19 pandemic. Reporting information such as this is essential to plan future prevention strategies. Protecting health care professionals is indeed an important component of public health measures to address large-scale health crisis. Thus, interventions to promote mental well-being in health care professionals exposed to COVID-19 need to be immediately implemented, and to strengthen prevention and response strategies by training health care professionals on mental help and crisis management.

Cabinas sanitizantes para la desinfección de grupos de personas / Sanitizing cabins for the disinfection of groups of people

INTRODUCCIÓN: En el contexto de la pandemia por SARS-CoV-2 se vienen desarrollando estrategias con el fin de reducir la transmisión del virus causante, tales como distanciamiento físico, protección personal, lavado de manos, uso de desinfectantes tales como alcohol 70° y aislamiento social mediante cuarentenas. Con la posibilidad del término de la cuarentena, se ha generado un interés en la aplicación de medidas de utilidad para la prevención del contagio del COVID 19, muchas de las cuales no han sido revisadas y reguladas por las autoridades de salud, entre ellas, el uso de dispositivos tipo cabina, cámara, túnel o arco de aspersión para la aplicación de desinfectantes sobre las personas que transitan por el interior o a través de estos. Se pretende reducir la potencial contaminación infecciosa viral que esté presente sobre la superficie de la ropa de la persona que ingresa al lugar. De acuerdo a lo divulgado por medios de comunicación, y lo reportado por algunos fabricantes, se han estado utilizando para la aspersión sobre personas, diferentes productos cuyo uso autorizado es la desinfección de superficies, equipos, dispositivos. Las cabinas sanitizantes son estructuras modulares de desinfección utilizadas para grandes y continuos flujos de personas. El objetivo es obtener una desinfección de la superficie de las personas que ingresan a sitios confinados, o donde se compartirá con varias personas más, a fin de reducir los contagios, en particular de SARS-COV-2. OBJETIVO: Evaluar la evidencia sobre Cabinas, duchas o túneles sanitizantes saber: Evidencia de eficacia para eliminar el SARS-COV-2 y evidencia de seguridad para la población. METODOLOGÍA: Se realizó una ETS Ultrarrápida en forma colaborativa entre los miembros de Redarets y colaboradores externos. Todos los participantes suscribieron su declaración de conflictos de interés. Las preguntas que se busca responder son las siguientes.¿Qué tipo de cabinas sanitizantes existen en Argentina?¿Cuáles son las diferencias de las cabinas sanitizantes en términos de componentes , tales como tiempo de exposición, tipo de desinfectante? ¿Cuál es la eficacia de las cabinas sanitizantes, para reducir la carga viral de superficies externas de las personas? ¿Cuál es la seguridad de las cabinas sanitizantes para las personas expuestas? RESULTADOS: Se identificaron al menos 6 productos comercializados por diferentes empresas en el país. La mayoría de ellas son transportables, y funcionan a base de ácido hipocloroso, salvo dos que usan adicionalmente ozono y radiación U.V. Así mismo, la ANMAT informó recientemente que las "cabinas sanitizantes o túneles de desinfección", no se encuentran autorizadas por esta Administración Nacional. Las cabinas difieren en sus especificaciones técnicas (detectores, temperatura, equipamiento); desinfectantes usados y tiempo de exposición del mismo. En cuanto a la eficacia de las cabinas sanitizantes, para reducir la carga viral de superficies externas solamente es eficaz a nivel superficial, ya que, de encontrarse presente, el SARS-CoV2, permanecerá en las mucosas y aerosoles de la persona contagiada (sintomático o asintomático), haciendo que a pesar de haberse rociado, sea contagioso, sin considerar los riesgos para la salud. En cuanto a la seguridad para la personas expuestas, los usuarios circulan sin recibir información clara y objetiva al respecto del producto que le aplican o los potenciales riesgos, ni cumplir un protocolo específico, por lo cual, algunos pasan muy rápidamente y otros no. Es infrecuente el uso de protección ocular y algunos entran con ropa que no cubre sus brazos y piernas, haciendo que el producto entre en contacto directo con la piel. La sensación de humedad en la cara, puede hacer que la persona se toque la cara y se refriegue los ojos facilitando la inoculación de partículas virales que pueden estar presentes en sus manos generando un potencial ingreso de agentes patógenos al organismo, generando irritación ocular o en la piel. CONCLUSIONES Y RECOMENDACIONES: La ausencia de estudios y evidencia suficiente que permitan documentar la eficacia y seguridad de la aspersión directa de desinfectantes sobre las personas, es suficiente y contundente para dejar de exponer de forma innecesaria a la población a una diversidad de productos químicos cuyo fabricante no ha probado y desarrollado para ser aplicados sobre las personas, recomendándose no utilizar cabinas, túneles, arcos y demás sistemas de aspersión o nebulización de desinfectantes, como estrategia de desinfección de personas, en el contexto de la emergencia por COVID -19.

Madalena Margarida da Silva: não à MP927

Adilson Araújo, presidente da CTB: não à MP927

A Medida Provisória 927 vai na contramão de tudo o que a gente vem assistindo em diversos cantos do mundo. Prevalecidas as regras da MP, eu não tenho dúvidas de que o efeito para o povo e para a classe trabalhadora será tão letal quando a Covid 19", Adilson Araújo, presidente da Central dos Trabalhadores e das Trabalhadoras do Brasil (CTB).

Sérgio Nobre, presidente da CUT: não à MP927

A MP 927 é perversa, oportunista e irresponsável, porque põe em risco a vida e sobrevivência de pelo menos 50 milhões de trabalhadores. A CUT e demais Centrais exigirão que e medida seja revogada e que seja criado um comitê de crise, chamado pelo Parlamento, com a participação dos trabalhadores, porque o Brasil está sem comando", Sérgio Nobre, presidente nacional da CUT.