Potential Strengths and Weaknesses in Hospital Resilience in the Context of the COVID-19 Pandemic in Brazil: A Case Study.

The analysis of hospital resilience is essential in understanding how health services prepared for and responded to sudden shocks and unexpected challenges in the COVID-19 health crisis. This study aimed to analyze the resilience of a referral hospital in the state of Pernambuco, Brazil, in the context of the COVID-19 pandemic. The main theoretical approach based on resilience is the system's capacity to maintain essential functions and to absorb, adapt, and transform in the face of unprecedented or unexpected changes. A single case study approach was used to identify the strengths and weaknesses of this response capacity. Data triangulation was employed. Data were collected from April (beginning of case discharges) to October 2020 (decrease in the moving average of cases in 2020). A content analysis was then conducted. Data were analyzed in relation to context, effects, strategies, and impacts in facing the disruptions caused by the pandemic. The results indicated the occurrence of four configurations mostly favorable to hospital resilience during the study period. Among the main strengths were: injection of financial resources; implementation of new hospital protocols; formation of a support network; equipping and continuing education of professionals; and proactive leadership. Weaknesses found in the analysis included: initial insufficiency of personal protective equipment and confirmatory tests; difficulties in restructuring work schedules; increasing illness among professionals; stress generated by constant changes and work overload; sense of discrimination for being a health professional; lack of knowledge about the clinical management of the disease; and the reduction of non-COVID assistance services.

A Descriptive Comparison of Mass Testing During the COVID-19 Pandemic in Montreal, Paris, Bamako, and Recife.

Objective: The aim of this descriptive article was to compare mass testing for SARS-CoV-2 during the first wave of the COVID-19 pandemic in Montreal, Canada; Bamako, Mali; Paris, France; and Recife, Brazil. Methods: Data was collected through interviews with key informants involved in the testing response and a review of the grey literature. The TIDieR-PHP checklist was then used to provide the basis of the intervention descriptions and to compare the data between cities. Results: Descriptive comparisons revealed that the type of test, the testing process, and materials used were similar between the cities during the first wave of the pandemic. In addition, all cities experienced similar material and personnel resource shortages, directly affecting testing accessibility and capacity. The main differences were related to testing capacity and implementation timelines, which were dependent on the state of the health care systems, governance, and access to resources. Conclusion: Results of this study highlight the similarities and differences in testing between the cities and demonstrate the importance of comprehensive intervention descriptions to highlight lessons learned, increase knowledge sharing, and inform policy decisions.

Mise en œuvre de la capacité de réponse à la COVID-19 dans un hôpital au Brésil.

After the declaration of a public health emergency of international importance, hospitals have become a benchmark in the response to the pandemic. It is important to assess health professionals' response capacity to the COVID-19 pandemic at a referral hospital in Pernambuco, in northeastern Brazil. This study deals with qualitative evaluative research, of the case study type. Three methods were used to identify critical events: interviews with 18 healthcare professionals who had worked on the "front line" of care for people with COVID-19; direct observation in the sectors of this hospital; and literature review. The interviews were transcribed and analyzed using MaxQDA Analytics pro 2020® software, using the Actor-Network Theory for analysis; and to interpret the critical events the categories of resilience: absorption, adaptation and transformation. It was found that the response capacity of professionals was influenced by five critical events: the arrival of cases, new ways to connect the patients with their social support network, social and personal impact on the daily life of professionals, insufficient supplies, essential equipment and confirmatory tests, and shortage and illness of professionals. In everyday experiences, the response capacity of professionals has led to a process of priority adaptation, which can accelerate important changes in the health system.

Aspectos sociodemográficos e clínico-epidemiológicos do abandono do tratamento de tuberculose em Pernambuco, Brasil, 2001-2014 / Aspectos sociodemográficos y clínico-epidemiológicos del abandono del tratamiento antituberculoso en Pernambuco, Brasil, 2001-2014 / Sociodemographic, clinical and epidemiological aspects of Tuberculosis treatment abandonment in Pernambuco, Brazil, 2001-2014

OBJETIVO: descrever as proporções de abandono do tratamento segundo características sociodemográficas e clínico-epidemiológicas dos casos novos de tuberculose no estado de Pernambuco, Brasil. MÉTODOS: estudo ecológico descritivo, com dados do Sistema de Informação de Agravos de Notificação (Sinan) referentes ao período 2001-2014; a Gerência Regional de Saúde (GERES) calculou a proporção de abandono. RESULTADOS: dos 57.015 novos casos, 6.474 (11,3%) abandonaram o tratamento, representando decréscimo de 16,4% (2001) para 9,3% (2014); as GERES I Recife, III Palmares, IV Caruaru, VIII Petrolina e IX Ouricuri ainda apresentavam proporção de abandono >5% em 2014; essa proporção foi maior para homens (11,9%), de 20-39 anos (12,7%), com Ensino Fundamental incompleto (12,1%), negros (13,7%), institucionalizados (12,5%) e da forma clínica pulmonar + extrapulmonar (14,1%). CONCLUSÃO: apesar do decréscimo, a proporção de abandono continuava elevada; homens, adultos, com baixa escolaridade, negros, institucionalizados e portadores de tuberculose pulmonar mais extrapulmonar demonstram maior predisposição ao abandono.

OBJETIVO: describir las proporciones de abandono según características sociodemográficas y clínico-epidemiológicas de los nuevos casos en tratamiento para tuberculosis, en Pernambuco, Brasil. MÉTODOS: estudio ecológico descriptivo con datos del Sistema de Información sobre enfermedades de notificación obligatoria, en el período 2001-2014; la Gerencia Regional de Salud (GERES) calculó la proporción de abandono. RESULTADOS: de los 57.015 nuevos casos, 6.474 (11,3%) abandonaron el tratamiento, disminución del 16,4% (2001) al 9,3% (2014); las GERES I Recife, III Palmares, IV Caruaru, VIII Petrolina y IX Ouricuri tenían una proporción de abandono >5% en 2014; la proporción fue mayor en hombres (11,9%), entre 20-39 años (12,7%), con educación primaria incompleta (12,1%), negros (13,7%), institucionalizados (12,5%) y con presentación clínica pulmonar + extra pulmonar (14,1%). CONCLUSIÓN: a pesar de la disminución, la proporción de abandono se mantuvo alta; hombres, adultos con bajo nivel de educación, negros, institucionalizados y con tuberculosis pulmonar + extra pulmonar demuestran mayor predisposición al abandono.

OBJECTIVE: to describe abandonment rates according to sociodemographic, clinical and epidemiological characteristics of new tuberculosis cases being treated in Pernambuco State, Brazil. METHODS: this is a descriptive ecological study using data from the Information System for Notifiable Diseases from 2001 to 2014; the abandonment rate was calculated by the Regional Administration on Health (GERES). RESULTS: of the 57,015 new cases, 6,474 (11.3%) abandoned treatment, although abandonment decreased from 16.4% (2001) to 9.3% (2014); the abandonment rate in GERES I Recife, III Palmares, IV Caruaru, VIII Petrolina and IX Ouricuri was still >5% in 2014; the rate was higher in males (11.9%), people aged 20-39 (12.7%), people with incomplete elementary school (12.1%), black-skinned people (13.7%), institutionalized people (12.5%) and those with pulmonary + extrapulmonary tuberculosis (14.1%). CONCLUSION: despite the decrease, the abandonment rate remained high; males, adults with low education level, black-skinned people, institutionalized patients and patients with pulmonary + extrapulmonary tuberculosis seemed more prone to abandoning treatment.

Sociodemographic, clinical and epidemiological aspects of Tuberculosis treatment abandonment in Pernambuco, Brazil, 2001-2014. / Aspectos sociodemográficos e clínico-epidemiológicos do abandono do tratamento de tuberculose em Pernambuco, Brasil, 2001-2014.

OBJECTIVE: to describe abandonment rates according to sociodemographic, clinical and epidemiological characteristics of new tuberculosis cases being treated in Pernambuco State, Brazil. METHODS: this is a descriptive ecological study using data from the Information System for Notifiable Diseases from 2001 to 2014; the abandonment rate was calculated by the Regional Administration on Health (GERES). RESULTS: of the 57,015 new cases, 6,474 (11.3%) abandoned treatment, although abandonment decreased from 16.4% (2001) to 9.3% (2014); the abandonment rate in GERES I Recife, III Palmares, IV Caruaru, VIII Petrolina and IX Ouricuri was still >5% in 2014; the rate was higher in males (11.9%), people aged 20-39 (12.7%), people with incomplete elementary school (12.1%), black-skinned people (13.7%), institutionalized people (12.5%) and those with pulmonary + extrapulmonary tuberculosis (14.1%). CONCLUSION: despite the decrease, the abandonment rate remained high; males, adults with low education level, black-skinned people, institutionalized patients and patients with pulmonary + extrapulmonary tuberculosis seemed more prone to abandoning treatment.