Personal protective equipment simulation training is associated with lower COVID-19 infection among healthcare workers.

OBJECTIVE: To describe the personal protective equipment training strategies during the beginning of the pandemic and to investigate the association between training and COVID-19 infection among healthcare workers. METHODS: This cross-sectional study conducted between March and May 2020 included 7,142 healthcare professionals who were eligible for both online and face-to-face simulation-based training on personal protective equipment use. Simulation training attendance was assessed by reviewing the attendance list, and the COVID-19 sick leave records recovered from the institutional RT-PCR database used to grant sick leave. The association between personal protective equipment training and COVID-19 was investigated using logistic regression, adjusted for sociodemographic and occupational characteristics. RESULTS: The mean age was 36.9 years (± 8.3), and 72.6% of participants were female. A total of 5,502 (77.0%) professionals were trained: 3,012 (54.7%) through online training, 691 (12.6%) through face-to-face training, and 1,799 (32.7%) through both strategies. During the study period, 584 (8.2%) COVID-19 cases were diagnosed among these professionals. The number of positive RT-PCR tests was 180 (11.0%) for untrained professionals, 245 (8.1%) for those trained only online, 35 (5.1%) for those trained face-to-face, and 124 (6.9%) for those trained with both strategies (p<0.001). Participants who received face-to-face training had a 0.43 lower risk of contracting COVID-19. CONCLUSION: Personal protective equipment training decreased the odds of COVID-19 among healthcare professionals, with face-to-face simulation-based training being most effective.

Personal protective equipment simulation training is associated with lower COVID-19 infection among healthcare workers

ABSTRACT Objective To describe the personal protective equipment training strategies during the beginning of the pandemic and to investigate the association between training and COVID-19 infection among healthcare workers. Methods This cross-sectional study conducted between March and May 2020 included 7,142 healthcare professionals who were eligible for both online and face-to-face simulation-based training on personal protective equipment use. Simulation training attendance was assessed by reviewing the attendance list, and the COVID-19 sick leave records recovered from the institutional RT-PCR database used to grant sick leave. The association between personal protective equipment training and COVID-19 was investigated using logistic regression, adjusted for sociodemographic and occupational characteristics. Results The mean age was 36.9 years (± 8.3), and 72.6% of participants were female. A total of 5,502 (77.0%) professionals were trained: 3,012 (54.7%) through online training, 691 (12.6%) through face-to-face training, and 1,799 (32.7%) through both strategies. During the study period, 584 (8.2%) COVID-19 cases were diagnosed among these professionals. The number of positive RT-PCR tests was 180 (11.0%) for untrained professionals, 245 (8.1%) for those trained only online, 35 (5.1%) for those trained face-to-face, and 124 (6.9%) for those trained with both strategies (p<0.001). Participants who received face-to-face training had a 0.43 lower risk of contracting COVID-19. Conclusion Personal protective equipment training decreased the odds of COVID-19 among healthcare professionals, with face-to-face simulation-based training being most effective.

Discontinuation of Health Interventions Among Brazilian Older Adults During the Covid-19 Pandemic: REMOBILIZE Study.

The objective of this study was to analyze changes in access to health interventions during the pandemic among Brazilian older adults and to investigate the factors associated with social and health inequalities. We conducted an online survey with Brazilian adults aged 60 + years between May and June 2020. A multidimensional questionnaire was used to investigate access to health interventions during the pandemic and associated factors. Of 1482 participants, 56.5% reported health care before the pandemic, and 36.4% discontinued it during the pandemic. The discontinuation rate was 64.4% (95% CI 61.1-67.6). Participants with higher educational level (nine or more years of education: OR 0.34; 95% CI 0.17-0.70) and higher income (eight or more times the minimum wage: OR 0.54; 95% CI 0.36-0.81) were associated with less probability of discontinuation. Presenting multimorbidity (OR: 1.42; 95% CI 1.06-1.90) and polypharmacy (OR: 0.61; 95% CI 0.46-0.81) were associated with discontinuity in health interventions. Our study showed that structural health inequities in access to health care shaped the rates of discontinuation in health care interventions during the COVID-19 pandemic. Strategic actions should be set up to actively monitor socially vulnerable older adults and strengthen community-based services to mitigate the discontinuation of health care interventions.

Clinical outcomes and quality of life of COVID-19 survivors: A follow-up of 3 months post hospital discharge.

BACKGROUND: Over 66 million people worldwide have been diagnosed with COVID-19. Therefore, understanding their clinical evolution beyond hospital discharge is essential not only from an individual standpoint, but from a populational level. OBJECTIVES: Our primary aim was to assess the impact of COVID-19 on health-related quality of life (HRQoL) 3 months after hospital discharge. Additionally, we screened for anxiety and depression and assessed important clinical outcomes. METHODS: This was a single-center cohort study performed in Sao Paulo (Brazil), in which participants were contacted by telephone to answer a short survey. EQ-5D-3L was used to assess HRQoL and clinical data from patients' index admission were retrieved from medical records. RESULTS: We contacted 251 participants (59.8% males, mean age 53 years old), 69.7% of which had presented with severe COVID-19. At 3 months of follow-up, 6 patients had died, 51 (20.3%) had visited the emergency department again and 17 (6.8%) had been readmitted to hospital. Seventy patients (27.9%) persisted with increased dyspnoea and 81 had a positive screening for anxiety/depression. Similarly, patients reported an overall worsening of EQ-5D-3L single summary index at 3 months compared to before the onset of COVID-19 symptoms (0.8012 (0.7368 - 1.0) vs. 1.0(0.7368 - 1.0), p < 0.001). This affected all 5 domains, but especially pain/discomfort and anxiety/depression. Only female sex and intensive care requirement were independently associated with worsening of HRQoL. CONCLUSION: Patients hospitalized for COVID-19 frequently face persistent clinical and mental health problems up to 3 months following hospital discharge, with significant impact on patients' HRQoL.

Death and End of Life: Perceptions Throughout The Career About Death, Palliative Care, and Educational Process.

PURPOSE: To evaluate the perception of attending physicians, medical residents, and undergraduate medical students about death and dying, the end of life (EoL), and palliative care (PC) during training and clinical practice, highlighting knowledge gaps, and the changes needed in medical school curricula. METHOD: Cross-sectional study of 12 attending physicians, residents, and undergraduate medical students randomly selected from a single teaching hospital in São Paulo, Brazil, 2018. Semi-structured interviews were conducted, transcripts were coded in depth, and categorizing analysis was carried out. RESULTS: Three topical categories were recognized: Negative feelings about death and the EoL, importance of PC, and gaps in curricular structure hindering preparedness for PC and EoL communication. Besides differing perspectives depending on their years of experience, all participants strongly endorsed that the current medical school curriculum does not train and support physicians to handle EoL and PC. CONCLUSIONS: Medical education plays a fundamental role in the development of knowledge and skills on death, dying, and PC. Such practices should extend throughout the course and be continuously improved after graduates move to clinical practice.

Caring for the Workforce of a Health System During the COVID-19 Epidemic in Brazil: Strategies of Surveillance and Expansion of Access to Care.

OBJECTIVES: To describe the strategies to monitor and expand access to care for a health system workers in the first 2 months of the COVID-19 epidemic in Brazil. METHODS: Description of the implemented strategy based on the guidelines developed to address the surveillance and care of a large health system's workforce in the COVID-19 epidemic. RESULTS: During phase 1, the surveillance strategy focused on monitoring suspected cases among employees. In phase 2, surveillance was restricted to employees with confirmed COVID-19, aiming at monitoring of symptoms and following hospitalizations. Access to care was expanded. A total of 1089 employees were diagnosed with COVID-19, 89 required hospitalizations and none had died. CONCLUSION: The strategies adopted were promptly implemented and could be adapted to the changing epidemic dynamics, allowing low rates of adverse outcomes in this high-risk population.

Highways to Ageing - Linking life course SEP to multivariate trajectories of health outcomes in older adults.

OBJECTIVES: Ageing is a temporal, multi-faceted process subject to interacting factors. In this study, we used life course and multidimensional approaches to elucidate the association between socioeconomic forces across a lifetime and the developmental origins in health and disease of the Mexican elderly. METHODS: Data stemmed from the Mexican Health and Ageing Study, constituting a sample of older adults (N= 5169, ≥50 years). With retrospective information on early, intermediary and contemporaneous socioeconomic indicators, life course typologies of socioeconomic position were identified using Latent Class Analysis. Based on prospective data of functional mobility, number of chronic conditions and self-rated health, multivariate trajectories of health outcomes were uncovered with Group Based Trajectory Model. Links between the extracted SEP and multivariate health latent constructs were explored with multinomial logistic regression. RESULTS: Life course SEP classes were heterogeneous, yet a large proportion of subjects was characterized by persistent socioeconomic adversity throughout life. The health outcomes' patterns of co-evolution were diverse too, shedding light on the nature of their developmental links, while revealing variable synchronicity in their temporal decline. A graded association was observed between the life course SEP classes and ageing trajectories. CONCLUSION: The results primarily backed the cumulative advantage/disadvantage life course framework, while finding some indication for age as a leveller hypothesis. Variability in patterns of dynamic co-action among the health outcomes depicts ageing as a naturally variable process of interconnected changes. Life course evidence for the ways socio-economic forces are differentially linked to distinct developmental profiles of ageing is provided.

Association of Sickness Absence With Severe Psychiatric Outcomes in a Brazilian Health Workforce.

OBJECTIVES: To investigate the association of sickness absence with severe psychiatric outcomes in the workforce of a health institution. METHODS: This cross-sectional analysis included 16,890 employees from a health institution. The association of all-cause sick-leave spells and mental sick-leave spells with a composite outcome (psychiatric hospital admission and/or suicidality) was investigated with logistic regression, adjusted for age, sex, education, and job position. RESULTS: There were 18,855 sick-leave spells among 6428 employees and 8.2% were mental sick-leaves. All-cause sick-leave was associated with the composite outcome (OR = 6.81; 95% CI = 2.99-15.52). This association was driven by mental-sick leave (OR = 100.52; 95% CI = 41.26-244.91), and the odds were higher among men. CONCLUSION: Health promotion interventions on workers with mental sick-leave should be implemented to minimize the impact of mental disorders in this high-risk group.

Risk stratification for complications of laparoscopic cholecystectomy based on associations with sociodemographic and clinical variables in a public hospital.

BACKGROUND: Cholelithiasis is the most common disease of the biliary tract. We aimed to associate complications resulting from laparoscopic cholecystectomy with patients' sociodemographic and clinical data, stratifying risk based on this association. METHODS: We retrospectively reviewed the medical records of 2520 patients undergoing laparoscopic cholecystectomy from January 2013 to March 2017 at our institution. Sociodemographic, clinical, and surgical complication data were collected. Unadjusted and adjusted logistic regression models were used to determine independent factors associated with the outcomes of interest. Based on the results, we proposed a risk stratification model, a treatment flowchart, and a severity score. RESULTS: Mean age was 48.9 years; 83.53% were female. Intraoperative complications occurred in 206 (8.17%) patients, and postoperative complications in 54 (2.14%). Male sex, older age, diabetes, multiple previous operations, and urgent surgery (odds ratio = 23.77) were significantly associated with surgical complications in both unadjusted and adjusted models. CONCLUSIONS: We could propose a flowchart based on our risk stratification model and develop a severity score based on the association between complications of laparoscopic cholecystectomy and sociodemographic/clinical data.

Determinants of neonatal mortality in the largest international border of Brazil: a case-control study.

BACKGROUND: Foz do Iguassu is a Brazilian municipality located in the most populous international border of the country and provides medical care to foreigners. Neonatal mortality in the city is higher than Brazil's average and corresponds to 61% of all deaths in children under five. The current study aimed to identify the determinants of neonatal mortality in Foz do Iguassu. METHODS: In this case-control study, we analyzed all neonatal deaths occurred in Foz do Iguassu from 2012 to 2016. Birth and mortality data were extracted from two national governmental databases (SINASC and SIM). We extracted data on (i) maternal sociodemographic characteristics, (ii) pregnancy care, and (iii) newborn characteristics. Multiple logistic regression with the conceptual framework was applied to examine the factors associated with neonatal mortality. RESULTS: Most of the deaths occurred in the early neonatal period (65.9%). The factors associated with neonatal death were fetal congenital anomaly (OR 22.49; CI 95% 7.44-67.95; p = < 0.001); low birth weight (OR 17.15; CI 95% 8.56-34.37; p = < 0.001), first minute Apgar score under 7 (OR 15.60; CI 95% 8.23-29.67; p = < 0.001); zero to 3 prenatal appointments (OR 3.34; CI 95% 1.28-8.73; p = 0.014) and prematurity (OR 3.60; CI 95% 1.87-7.11; p = < 0.001). CONCLUSION: The high rate of neonatal death in Foz do Iguassu is strongly associated with newborn characteristics and not associated with maternal sociodemographic characteristics. Thus, the health services in the Brazilian side of this international borders should be aware of the quality of the prenatal care and childbirth attention provided.

Inflammation and quality of life in later life: findings from the health, well-being and aging study (SABE).

BACKGROUND: Few studies have specifically investigated the inverse relationship between reduced quality of life in different domains and elevated C-reactive protein (CRP) serum levels in older adults. Therefore, this study investigates the cross-sectional association between quality of life and inflammation in older Brazilian adults. METHODS: Data were collected from 1255 participants from the third wave (2010) of the Brazilian Health, Well-being and Aging study (SABE), a community-based cohort study of aging. Inflammation was assessed using CRP serum levels and quality of life (QoL) was measured using the 12-item Short-Form Health Survey (SF-12) questionnaire. The covariates included age, sex, education level, financial sufficiency, number of non-communicable diseases, self-reported doctor diagnosed diseases, Activity of Daily Living (ADL) difficulties, Body Mass Index (BMI), and waist circumference. RESULTS: The fully adjusted models showed that older adults with low scores in the physical domain of the SF12 (OR 1.34, 95%CI 1.02;1.77) and high BMI values (> 30) (OR 2.05, 95%CI 1.50;2.81) were more likely to present high CRP serum levels. CONCLUSION: Our findings suggest a significant association of lower scores in the physical domain of quality of life and the presence of obesity with high CRP serum levels.

Enabling Elements for the Implementation of Community Health Promoter Led Interventions: A Literature Review / Elementos Habilitadores para la Implementación de Intervenciones Dirigidas por Promotores de Salud Comunitaria: Una Revisión de la Literatura

ABSTRACT: This research seeks to present Community Lay Advisor interventions as a health promoting strategy that have appeared in the international literature, in order to highlight these enabling elements in the intervention's implementation and establish a comparison among the aspects addressed in the analyzed experiences and the "Schoolbased Oral Health Promoters Program" at the Universidad de La Frontera in Temuco, Chile. A comprehensive scoping review was held between February and March 2018, with searches performed in both the academic and grey literature. Peer-reviewed scientific papers were found using the interdisciplinary database Scopus (including MEDLINE) and EBSCOhost, while grey literature and media sources were extracted from the Google and Google Scholar search engines, supplemented with a visit to the EPES foundation in Chile and an analysis of the reference lists for the selected articles. 369 articles were identified, of which 23 met eligibility criteria for this review. Based on the analysis of the experiences, some facilitators were found more pertinent when achieving the goals concerning the intervention's design, implementation and assessment. This paper makes recommendations for the design and execution of peer-led health promotion interventions in order to increase its effectiveness and success rate.

RESUMEN: Esta investigación busca presentar las intervenciones del Community Lay Advisor como una estrategia de promoción de la salud que ha aparecido en la literatura internacional, para resaltar estos elementos habilitadores en la implementación de la intervención y establecer una comparación entre los aspectos abordados en las experiencias analizadas y el "Programa de Promotores de Salud Bucal en las Escuelas" de la Universidad de La Frontera, en Temuco, Chile. Entre febrero y marzo de 2018 se llevó a cabo una revisión exhaustiva del alcance, con búsquedas realizadas tanto en la literatura académica como en la gris. Se encontraron artículos científicos revisados por pares utilizando la base de datos interdisciplinaria Scopus (incluyendo MEDLINE) y EBSCOhost, mientras que la literatura gris y las fuentes de medios se extrajeron de los motores de búsqueda Google y Google Scholar, complementados con una visita a la fundación EPES en Chile y un análisis de las listas de referencias de los artículos seleccionados. Se identificaron 369 artículos, de los cuales 23 cumplieron con los criterios de elegibilidad para esta revisión. Sobre la base del análisis de las experiencias, algunos facilitadores resultaron más pertinentes al alcanzar los objetivos relacionados con el diseño, la implementación y la evaluación de la intervención. Este documento hace recomendaciones para el diseño y la ejecución de intervenciones de promoción de la salud dirigidas por pares para aumentar su eficacia y su tasa de éxito.

Prevalência e características das feridas em pessoas idosas residentes na comunidade / Prevalencia y características de las lesiones en personas mayores que viven en la comunidade / Prevalence and characteristics of lesions in elderly people living in the community

RESUMO Objetivo Descrever o perfil e as características de idosos com restrição de mobilidade, residentes na comunidade e com presença de lesões de pele. Método Estudo exploratório e descritivo, parte do Estudo SABE – Saúde Bem-estar e Envelhecimento que avaliou a presença de lesões de pele em uma amostra probabilística de idosos residentes no município de São Paulo segundo aspectos sociodemográficos, biomarcadores sanguíneos, condições de saúde e utilização de serviços. A análise utilizou o teste de qui-quadrado com correção de Rao-Scott para amostras complexas com nível de significância de 5%. Resultados No ano de 2010, 20,7% dos idosos com restrição de mobilidade apresentavam lesões na pele em decorrência desse problema. Os locais mais frequentes foram região sacral para ambos os sexos, escapular para mulheres e trocanteriana para homens. Idade mais avançada, multimorbidade e comprometimento funcional foram mais prevalentes entre os idosos com feridas, assim como a maior frequência de cuidado requerido. A disfuncionalidade familiar mostrou-se associada à maior sobrecarga do cuidador que pode refletir na qualidade do cuidado prestado. Observou-se que esses idosos que são prioritários para a atenção domiciliar não a recebem adequadamente. Conclusão A prevalência de lesões de pele em idosos com restrição de mobilidade na comunidade é baixa, no entanto requerem atenção diferenciada e essa não está sendo adequadamente oferecida. A reorganização das políticas e serviços assistenciais mostra-se essencial.

RESUMEN Objetivo Describir el perfil y las características de las personas mayores con limitaciones de movilidad, residentes en la comunidad y con la presencia de lesiones en la piel. Método Un estudio exploratorio y descriptivo, parte del Estudio SABE – Salud, Bienestar y Envejecimiento para evaluar la presencia de lesiones en la piel en una muestra probabilística de personas mayores que viven en la ciudad de São Paulo por características sociodemográficas, biomarcadores sanguíneos, condiciones de salud y uso de los servicios. El análisis utilizó la prueba de chi cuadrado con corrección de Rao-Scott para muestras complejas con nivel de significación de 5%. Resultados En 2010, el 20,7% de los viejos con limitaciones de movilidad tenía lesiones en la piel debido a esto. Los sitios más comunes fueron la región sacra para ambos sexos, escapular para mujeres y del trocánter para hombres. Edad avanzada, multimorbidades y deterioro funcional fueron más frecuentes entre las personas mayores con heridas, así como una mayor necesidad de atencíon. La disfunción familiar se asoció con una mayor carga de los cuidadores que pueden afectar a la calidad de la atención prestada. Se observó que estas personas mayores que son prioritarios para la atención domiciliaria no la reciben correctamente. Conclusión La prevalencia de lesiones de la piel en personas mayores con limitaciones de movilidad en la comunidad es baja, sin embargo, requieren una atención especial y esa no se está proporcionando adecuadamente. Una reorganización de las políticas y servicios de bienestar es esencial.

ABSTRACT Objective To describe the profile and the characteristics of elderly people with mobility restrictions who are residents in the community and have skin lesions. Method This was an exploratory and descriptive study that was part of the Health, Welfare and Ageing (SABE) study which assessed the presence of skin lesions in a probabilistic sample of elderly people living in the city of São Paulo in relation to factors such as socio-demographic issues, blood biomarkers, health conditions and the use of services. The analysis used the chi-square test with the Rao-Scott correction for complex samples, with a level of significance of 5%. Results In 2010, 20.7% of elderly people with restricted mobility had skin lesions due to this problem. The most common sites of these lesions were the sacral region for both sexes, the scapular region for women and the trochanteric region for men. Older age, multimorbidity and functional impairment were more prevalent among the elderly people with lesions, as well as greater levels of care that were required. Family dysfunction was associated with higher burdens on caregivers, which may affect the quality of care provided. It was observed that elderly people who are priorities for home care do not receive such care adequately. Conclusion The prevalence of skin lesions in the elderly with mobility restrictions living in the community was low; however, these elderly people require special attention, which is not currently being adequately provided. The reorganization of policies and care services appears to be essential.

Prevalence and characteristics of lesions in elderly people living in the community. / Prevalência e características das feridas em pessoas idosas residentes na comunidade.

Objective To describe the profile and the characteristics of elderly people with mobility restrictions who are residents in the community and have skin lesions. Method This was an exploratory and descriptive study that was part of the Health, Welfare and Ageing (SABE) study which assessed the presence of skin lesions in a probabilistic sample of elderly people living in the city of São Paulo in relation to factors such as socio-demographic issues, blood biomarkers, health conditions and the use of services. The analysis used the chi-square test with the Rao-Scott correction for complex samples, with a level of significance of 5%. Results In 2010, 20.7% of elderly people with restricted mobility had skin lesions due to this problem. The most common sites of these lesions were the sacral region for both sexes, the scapular region for women and the trochanteric region for men. Older age, multimorbidity and functional impairment were more prevalent among the elderly people with lesions, as well as greater levels of care that were required. Family dysfunction was associated with higher burdens on caregivers, which may affect the quality of care provided. It was observed that elderly people who are priorities for home care do not receive such care adequately. Conclusion The prevalence of skin lesions in the elderly with mobility restrictions living in the community was low; however, these elderly people require special attention, which is not currently being adequately provided. The reorganization of policies and care services appears to be essential.