Prevalence and patterns of multimorbidity among linguistic groups of patients receiving home care in Ontario: a retrospective cohort study.

BACKGROUND: Prior studies have demonstrated the negative impact of language barriers on access, quality, and safety of healthcare, which can lead to health disparities in linguistic minorities. As the population ages, those with multiple chronic diseases will require increasing levels of home care and long-term services. This study described the levels of multimorbidity among recipients of home care in Ontario, Canada by linguistic group. METHODS: Population-based retrospective cohort of 510,685 adults receiving home care between April 1, 2010, to March 31, 2018, in Ontario, Canada. We estimated and compared prevalence and characteristics of multimorbidity (2 or more chronic diseases) across linguistic groups (Francophones, Anglophones, Allophones). The most common combinations and clustering of chronic diseases were examined. Logistic regression models were used to explore the main predictors of 'severe' multimorbidity (defined as the presence of five or more chronic diseases). RESULTS: The proportion of home care recipients with multimorbidity and severe multimorbidity was 92% and 44%, respectively. The prevalence of multimorbidity was slightly higher among Allophones (93.6%) than among Anglophones (91.8%) and Francophones (92.4%). However, Francophones had higher rates of cardiovascular and respiratory disease (64.9%) when compared to Anglophones (60.2%) and Allophones (61.5%), while Anglophones had higher rates of cancer (34.2%) when compared to Francophones (25.2%) and Allophones (24.3%). Relative to Anglophones, Allophones were more likely to have severe multimorbidity (adjusted OR = 1.04, [95% CI: 1.02-1.06]). CONCLUSIONS: The prevalence of multimorbidity among Ontarians receiving home care services is high; especially for whose primary language is a language other than English or French (i.e., Allophones). Understanding differences in the prevalence and characteristics of multimorbidity across linguistic groups will help tailor healthcare services to the unique needs of patients living in minority linguistic situations.

Limits of the Rockefeller Foundation fellowship funding: Maria Palmira Macedo Tito de Morais and international nursing, 1936-1966. / Os limites do financiamento de bolsistas da Fundação Rockefeller: Maria Palmira Macedo Tito de Morais e a enfermagem internacional, 1936-1966.

The article analyses Maria Palmira Macedo Tito de Morais' international nursing education as a Rockefeller Foundation fellow, during the Portuguese Estado Novo. It studies the local contexts influence on the international philanthropic agency's actions, culminating in disputes with World Health Organization over the Portuguese nurse as staff. The sources are two dossiers on Maria Tito de Morais and her two fellowship cards collected at the Rockefeller Archive Center, a report of the Directorate-General of Health of Portugal and the journal A Tribuna, consulted at the Brazilian Digital Library. In conclusion, the Rockefeller Foundation's strategies, when funding Maria Tito de Morais' education aiming to hire her did not guarantee control over her professional trajectory.

Este artigo analisa a formação internacional de Maria Palmira Macedo Tito de Morais, como bolsista da Fundação Rockefeller no campo da enfermagem, durante o Estado Novo português. Compreende-se de que forma os contextos locais influenciaram as ações da agência filantrópica internacional, o que culminou em disputas com a Organização Mundial da Saúde pela presença da enfermeira portuguesa em seus quadros. São utilizados como fonte dois dossiês sobre Maria Tito de Morais e seus dois cartões de bolsista, coletados no Rockefeller Archive Center, um relatório da Direção Geral de Saúde de Portugal e o periódico A Tribuna, consultado na Hemeroteca Digital brasileira. Conclui-se que as estratégias utilizadas pela Fundação Rockefeller, ao financiar a formação de Maria Tito de Morais com o intuito de cooptá-la para seu staff, não garantiram o controle sobre sua trajetória profissional.

Os limites do financiamento de bolsistas da Fundação Rockefeller: Maria Palmira Macedo Tito de Morais e a enfermagem internacional, 1936-1966 / Limits of the Rockefeller Foundation fellowship funding: Maria Palmira Macedo Tito de Morais and international nursing, 1936-1966

Resumo Este artigo analisa a formação internacional de Maria Palmira Macedo Tito de Morais, como bolsista da Fundação Rockefeller no campo da enfermagem, durante o Estado Novo português. Compreende-se de que forma os contextos locais influenciaram as ações da agência filantrópica internacional, o que culminou em disputas com a Organização Mundial da Saúde pela presença da enfermeira portuguesa em seus quadros. São utilizados como fonte dois dossiês sobre Maria Tito de Morais e seus dois cartões de bolsista, coletados no Rockefeller Archive Center, um relatório da Direção Geral de Saúde de Portugal e o periódico A Tribuna, consultado na Hemeroteca Digital brasileira. Conclui-se que as estratégias utilizadas pela Fundação Rockefeller, ao financiar a formação de Maria Tito de Morais com o intuito de cooptá-la para seu staff, não garantiram o controle sobre sua trajetória profissional.

Abstract The article analyses Maria Palmira Macedo Tito de Morais' international nursing education as a Rockefeller Foundation fellow, during the Portuguese Estado Novo. It studies the local contexts influence on the international philanthropic agency's actions, culminating in disputes with World Health Organization over the Portuguese nurse as staff. The sources are two dossiers on Maria Tito de Morais and her two fellowship cards collected at the Rockefeller Archive Center, a report of the Directorate-General of Health of Portugal and the journal A Tribuna, consulted at the Brazilian Digital Library. In conclusion, the Rockefeller Foundation's strategies, when funding Maria Tito de Morais' education aiming to hire her did not guarantee control over her professional trajectory.

Deformation of implant retaining screws-Study with stereoscopic microscopy and microCT.

BACKGROUND: The prosthetic screw fixes the prostheses to the implants. Upon osteointegration, the untightening of the prosthetic screw is the most common problem in oral rehabilitation with implants. OBJECTIVE: To study the deformation of the implant retaining hexagonal screw head. METHODS: This investigation used two methods for evaluating the screw head's area of deformation (mm2 ): a stereoscopic microscopy and micro computed tomography (microCT). For stereoscopic microscopy, 16 titanium alloy (T) and 16 titanium gold-plated alloy (G) screws of the Zimmer Biomet™ brand were used, divided into eight groups: group 0 (control group), groups T1 and G1 (screws tightened 10 times to 20 Ncm), the groups T2 and G2 (screws tightened 20 times to 20 Ncm) and the groups T3 and G3 (screws tightened 10 times to 30 Ncm). In the study with microCT, one screw was randomly chosen from each of the groups described above to perform the scanning by microCT. RESULTS: When comparing the type of screw material using stereoscopic microscopy, no statistically significant differences were found (p > 0.05). Contrarily, different number of successive grips and different torque value showed statistically significant differences in the head section of the retaining screws (p < 0.05). The observation by microCT showed the torque applied is crucial to the head deformation in titanium screws. In gold-plated screws the successive tightening appears to be pivotal. CONCLUSION: Titanium and gold screws tend to behave similarly. By increasing the tightening cycles and the torque values of protocols greater levels of deformations can be expected. In general, microCT data showed better results for gold-plated titanium alloy. CLINICAL SIGNIFICANCE: To control severe screw head deformation and the impossibility of untightening the implant's restoration, clinicians should avoid extreme torque values and prevent surpassing 10 tightening cycles.

Patient-physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada.

BACKGROUND: When patients and physicians speak the same language, it may improve the quality and safety of care delivered. We sought to determine whether patient-physician language concordance is associated with in-hospital and postdischarge outcomes among home care recipients who were admitted to hospital. METHODS: We conducted a population-based study of a retrospective cohort of 189 690 home care recipients who were admitted to hospital in Ontario, Canada, between 2010 and 2018. We defined patient language (obtained from home care assessments) as English (Anglophone), French (Francophone) or other (allophone). We obtained physician language from the College of Physicians and Surgeons of Ontario. We defined hospital admissions as language concordant when patients received more than 50% of their care from physicians who spoke the patients' primary language. We identified in-hospital (adverse events, length of stay, death) and post-discharge outcomes (emergency department visits, readmissions, death within 30 days of discharge). We used regression analyses to estimate the adjusted rate of mean and the adjusted odds ratio (OR) of each outcome, stratified by patient language, to assess the impact of language-concordant care within each linguistic group. RESULTS: Allophone patients who received language-concordant care had lower risk of adverse events (adjusted OR 0.25, 95% confidence interval [CI] 0.15-0.43) and in-hospital death (adjusted OR 0.44, 95% CI 0.29-0.66), as well as shorter stays in hospital (adjusted rate of mean 0.74, 95% CI 0.66-0.83) than allophone patients who received language-discordant care. Results were similar for Francophone patients, although the magnitude of the effect was smaller than for allophone patients. Language concordance or discordance of the hospital admission was not associated with significant differences in postdischarge outcomes. INTERPRETATION: Patients who received most of their care from physicians who spoke the patients' primary language had better in-hospital outcomes, suggesting that disparities across linguistic groups could be mitigated by providing patients with language-concordant care.

In-Hospital Patient Harm Across Linguistic Groups: A Retrospective Cohort Study of Home Care Recipients.

OBJECTIVE: Research examining the impact of language barriers on patient safety is limited. We conducted a population-based study to determine whether patients whose primary language is not English are more likely to experience harm when admitted to hospitals in Ontario, Canada. METHODS: We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2010 to 2015) who were subsequently admitted to hospital. Patient language (obtained from home care assessments) was coded as English, French, or other. Harmful events were identified using the Hospital Harm Indicator developed by the Canadian Institute for Health Information. RESULTS: We included 190,724 patients (156,186 Anglophones, 5,110 Francophones, and 29,428 Allophones). There was no significant difference in the unadjusted risk of harm for Francophones compared with Anglophones (relative risk [RR], 0.94; 95% confidence interval [CI], 0.87-1.02). However, Allophones were more likely to experience harm when compared with Anglophones (RR, 1.14; 95% CI, 1.10-1.18). The risk of harm was even greater for Allophones with low English proficiency (RR, 1.18; 95% CI, 1.13-1.24). After adjusting for potential confounders, Anglophones and Allophones were equally likely to experience harm of any type, but Allophones more likely to experience harm from infections and procedures. CONCLUSIONS: Patients whose primary language was not English or French were more likely to experience harm after admission to hospital, especially if they had low English proficiency. For these patients, the risk of harm from infections and procedures persisted in the adjusted analysis, but the overall risk of harm did not.

The Thermal Influence of Oral Rehabilitation on the Cranio-Cervico-Mandibular Complex: A Thermographic Analysis.

PURPOSE: Assess the thermal effect of prosthodontic treatment on the cranio-cervico-mandibular complex using infrared thermography. METHODS: The treatment group was composed of adults of both sexes who underwent a prosthodontic treatment in which at least posterior occlusal contacts were added and/or the vertical dimension of occlusion was reestablished. The control group (CG) was constituted of adult subjects of both sexes, with no more than a single missing posterior tooth, excluding third molars. Thermograms were taken of the treatment group with a Flir i7 IR camera both before oral rehabilitation (TGB; n = 33) and two months after treatment was concluded (TGA; n = 19). CG (n = 33) had only one occasion for data acquisition. RESULTS: Statistically significant differences were found when the thermal difference (ΔT) and the health status of the orbicularis oris muscle were compared between the TGB and the TGA groups (p = 0.020 and p = 0.003, respectively). By comparing the health status of the masseter muscle between the CG and TGB, statistically significant differences were also observed (p = 0.030). CONCLUSION: A prosthodontic treatment appears to have a minimum or null effect on the ΔT and/or on the health status of the TMJ and the temporal muscle. In contrast, orbicularis oris muscles exhibited significant thermal variations.

The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients.

BACKGROUND: Research considering the impact of language on health care utilization is limited. We conducted a population-based study to: (1) investigate the association between residents' preferred language and hospital-based health care utilization; and (2) determine whether this association is modified by dementia, a condition which can exacerbate communication barriers. METHODS: We used administrative databases to establish a retrospective cohort study of home care recipients (2015-2017) in Ontario, Canada, where the predominant language is English. Residents' preferred language (obtained from in-person home care assessments) was coded as English (Anglophones), French (Francophones), or other (Allophones). Diagnoses of dementia were ascertained with a previously validated algorithm. We identified all emergency department (ED) visits and hospitalizations within 1 year. RESULTS: Compared with Anglophones, Allophones had lower annual rates of ED visits (1.3 vs. 1.8; P<0.01) and hospitalizations (0.6 vs. 0.7; P<0.01), while Francophones had longer hospital stays (9.1 vs. 7.6 d per admission; P<0.01). After adjusting for potential confounders, Francophones and Allophones were less likely to visit the ED or be hospitalized than Anglophones. We found evidence of synergism between language and dementia; the average length of stay for Francophones with dementia was 25% (95% confidence interval: 1.10-1.39) longer when compared with Anglophones without dementia. CONCLUSIONS: Residents whose preferred language was not English were less frequent users of hospital-based health care services, a finding that is likely attributable to cultural factors. Francophones with dementia experienced the longest stays in hospital. This may be related to the geographic distribution of Francophones (predominantly in rural areas) or to suboptimal patient-provider communication.

Role of thermography in the assessment of temporomandibular disorders and other musculoskeletal conditions: A systematic review.

The aim of this review was to evaluate whether thermal imaging may constitute a reliable assessment method of musculoskeletal and temporomandibular disorders (TMD/MSD). A systematic review was conducted in the Pubmed, Scopus, Cochrane library, Web of Science, and Lilacs databases. The search terms were "musculoskeletal disorders,""temporomandibular disorders,""infrared thermography,""thermography," and "infrared imaging." The inclusion criteria were: studies published between January 1985 and January 2021, performed in humans, with sample size equal or greater than 20 patients, written in English, Portuguese, French and/or Spanish, and full text available. The exclusion criteria were: systematic reviews, case studies, and/or studies focused on pathologies beyond the review's domain. The risk of bias was evaluated using CASP 2018. A total of 2032 articles were retrieved. Of these, 25 studies met the inclusion criteria and were included to withdraw the following information: title, type of study, first author and year of publication, objective, number of participants, comparisons, and principal conclusions. No RCT were found. Despite some disparity, points of convergence among the majority of authors could be found. In general, healthy individuals show subtle thermal differences between contralateral homolog areas. Concerning orofacial structures, unilateral symptomatic individuals may show thermal differences equal or greater than 0.4°C. Infrared thermography accuracy in diagnosing TMD/MSD is still considered low to moderate. Despite some limitations, IRT might constitute a valuable supporting diagnostic tool in the medical field of TMD and MSD.

Quality and Safety in Long-Term Care in Ontario: The Impact of Language Discordance.

OBJECTIVES: This study compared quality indicators across linguistic groups and sought to determine whether disparities are influenced by resident-facility language discordance in long-term care. DESIGN: Population-based retrospective cohort study using linked databases. SETTING AND PARTICIPANTS: Retrospective cohort of newly admitted residents of long-term care facilities in Ontario, Canada, between 2010 and 2016 (N=47,727). Individual residents' information was obtained from the Resident Assessment Instrument Minimum Data Set (RAI-MDS) to determine resident's primary language, clinical characteristics, and health care indicators. MEASURES: Main covariates of interest were primary language of the resident and predominant language of the long-term care facility, which was determined using the French designation status as defined in the French Language Services Act. Primary outcomes were a set of quality and safety indicators related to long-term care: worsening of depression, falls, moderate-severe pain, use of antipsychotic medication, and physical restraints. Multivariable logistic regression models were used to assess the impact of resident's primary language, facility language, and resident-facility language discordance on each quality indicator. RESULTS: Overall, there were few differences between francophones and anglophones for quality and safety indicators. Francophones were more likely to report pain (10.9% vs 9.9%; P = .001) and be physically restrained (7.3% vs 5.2%; P < .001), whereas a greater proportion of anglophones experienced worsening of depressive symptoms (24.0% vs 22.9%; P = .001). However, quality indicators were generally worse for francophones in Non-Designated facilities, except for pain, which was more commonly reported by francophones in French-Designated facilities. Anglophones were more likely to be physically restrained in French-Designated facilities (6.7% vs 5.1%; P < .001). CONCLUSIONS AND IMPLICATIONS: For francophones, quality indicators tended to be worse in the presence of resident-facility language discordance. However, these findings did not persist after adjusting for individual- and facility-level characteristics, suggesting that the disparities observed at the population level cannot be attributed to linguistic factors alone.

The impact of dementia and language on hospitalizations: a retrospective cohort of long-term care residents.

BACKGROUND: Hospitalizations carry considerable risks for frail, elderly patients; this is especially true for patients with dementia, who are more likely to experience delirium, falls, functional decline, iatrogenic complications, and infections when compared to their peers without dementia. Since up to two thirds of patients in long-term care (LTC) facilities have dementia, there is interest in identifying factors associated with transitions from LTC facilities to hospitals. The purpose of this study was to investigate the association between dementia status and incidence of hospitalization among residents in LTC facilities in Ontario, Canada, and to determine whether this association is modified by linguistic factors. METHODS: We used linked administrative databases to establish a prevalent cohort of 81,188 residents in 628 LTC facilities from April 1st 2014 to March 31, 2017. Diagnoses of dementia were identified with a previously validated algorithm; all other patient characteristics were obtained from in-person assessments. Residents' primary language was coded as English or French; facility language (English or French) was determined using language designation status according to the French Language Services Act. We identified all hospitalizations within 3 months of the first assessment performed after April 1st 2014. We performed multivariate logistic regression analyses to determine the impact of dementia and resident language on the incidence of hospitalization; we also considered interactions between dementia and both resident language and resident-facility language discordance. RESULTS: The odds of hospitalization were 39% lower for residents with dementia compared to residents without dementia (OR 0.61, 95% CI 0.57-0.65). Francophones had lower odds of hospitalization than Anglophones, but this difference was not statistically significant (OR 0.91, 95% CI 0.81-1.03). However, Francophones without dementia were significantly less likely to be hospitalized compared to Anglophones without dementia (OR 0.71, 95% CI 0.53-0.94). Resident-facility language discordance did not significantly affect hospitalizations. CONCLUSIONS: Residents in LTC facilities were generally less likely to be hospitalized if they had dementia, or if their primary language was French and they did not have dementia. These findings could be explained by differences in end-of-life care goals; however, they could also be the result of poor patient-provider communication.

The impact of hospital language on the rate of in-hospital harm. A retrospective cohort study of home care recipients in Ontario, Canada.

BACKGROUND: Patients who live in minority language situations are generally more likely to experience poor health outcomes, including harmful events. The delivery of healthcare services in a language-concordant environment has been shown to mitigate the risk of poor health outcomes related to chronic disease management in primary care. However, data assessing the impact of language-concordance on the risk of in-hospital harm are lacking. We conducted a population-based study to determine whether admission to a language-discordant hospital is a risk factor for in-hospital harm. METHODS: We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2007 to 2015) who were admitted to a hospital in Eastern or North-Eastern Ontario, Canada. Patient language (obtained from home care assessments) was coded as English (Anglophone group), French (Francophone group), or other (Allophone group); hospital language (English or bilingual) was obtained using language designation status according to the French Language Services Act. We identified in-hospital harmful events using the Hospital Harm Indicator developed by the Canadian Institute for Health Information. RESULTS: The proportion of hospitalizations with at least 1 harmful event was greater for Allophones (7.63%) than for Anglophones (6.29%, p <  0.001) and Francophones (6.15%, p <  0.001). Overall, Allophones admitted to hospitals required by law to provide services in both French and English (bilingual hospitals) had the highest rate of harm (9.16%), while Francophones admitted to these same hospitals had the lowest rate of harm (5.93%). In the unadjusted analysis, Francophones were less likely to experience harm in bilingual hospitals than in hospitals that were not required by law to provide services in French (English-speaking hospitals) (RR = 0.88, p = 0.048); the opposite was true for Anglophones and Allophones, who were more likely to experience harm in bilingual hospitals (RR = 1.17, p <  0.001 and RR = 1.41, p <  0.001, respectively). The risk of harm was not significant in the adjusted analysis. CONCLUSIONS: Home care recipients residing in Eastern and North-Eastern Ontario were more likely to experience harm in language-discordant hospitals, but the risk of harm did not persist after adjusting for confounding variables.

Association between Insulin use and Infective Endocarditis: An Observational Study

Abstract Background: The association between Diabetes Mellitus (DM) and Infective Endocarditis (IE) is controversial in the literature, since many controversial results have been published. However, when evaluating specifically the evidence on IE and individuals with DM using insulin, we found only two observational studies that considered this variable, with discordant results regarding the prognosis and prevalence of Staphylococcus sp in insulin users compared to non-users. Despite the lack of evidence, in clinical practice the insulin use could be interpreted as minor criteria "injection drug use", using the modified Duke criteria for IE diagnosis. Objectives: To compare the microbiological and valvar profile, as well as the outcome of non-diabetic and diabetic patients with IE who were insulin users or not. Methods: This was an observational, analytical and retrospective study of patients diagnosed with IE between 2003 and 2015 in three tertiary care centers. A total of 211 patients were included, of which 17 were diabetics and 9 were insulin users. Patients were compared using the Shapiro-Wilk normality test and Fisher's exact test, with a significance level of 5%. Results: The mortality from IE in diabetic individuals was higher than that of non-diabetic patients, but with no statistical significance (35.29% vs. 21.1%; p = 0.221), even when the groups were divided into insulin-user diabetic, non-insulin user diabetic and non-diabetic patients (33.3% vs. 37.5% vs. 21.1%, p = 0.229). There was a difference regarding the prevalence of IE caused by S. aureus (57.1% vs. 14.3% vs. 17.4%, p = 0.029) and the involvement of the tricuspid valve (33.3% vs. 0.00% vs. 10.0%, p = 0.034) among insulin users. Conclusion: In our sample, insulin use or the presence of DM did not mean higher in-hospital mortality from IE. It is not possible to generalize the microbiological and valvar findings due to the lack of studies evaluating insulin users in IE; however, particularities have been previously reported and may indicate a different behavior of IE in these patients. New studies considering the insulin use variable are required to elucidate the association between DM and IE.

[Grace Memorial Hospital and the American Presbyterian Mission in Brazil: sources for the history of healthcare, 1955-1971]. / O Grace Memorial Hospital e a Missão Presbiteriana norte-americana no Brasil: fontes para a história da assistência à saúde, 1955-1971.

The paper presents aspects of the history and archives of Grace Memorial Hospital, founded in 1926 in the former town of Ponte Nova, now Wagner, in the Chapada Diamantina region of Bahia state, Brazil, by the American Presbyterian missionary and doctor Walter Welcome Wood. The documents in question have been kept at the Universidade do Estado da Bahia, campus II, Alagoinhas, since the hospital closed down definitively. They constitute a source of research for different areas of scholarship, especially the history of healthcare in Brazil. The documents are used in analyses of the incidence of diseases, medical treatments, and other care given to a population that had no access to other institutions working in this area.

Apresenta aspectos da história e do acervo documental do Grace Memorial Hospital, instituição criada em 1926 na antiga cidade de Ponte Nova, atual Wagner, na Chapada Diamantina (BA), pelo médico e missionário presbiteriano norte-americano Walter Welcome Wood. O corpus documental está sob guarda da Universidade do Estado da Bahia, campus II, Alagoinhas, desde o encerramento definitivo das atividades do hospital, e constitui-se em fonte de pesquisa para diferentes áreas de estudo, especialmente para a história da assistência à saúde no Brasil. Os documentos auxiliam as análises sobre a incidência de doenças, tratamentos médicos e outros cuidados com a saúde em uma população que não tinha acesso a outras instituições que atuassem nesse âmbito.

PROTOCOL: When and how to replicate systematic reviews.

This is a protocol for a co-registered Cochrane and Campbell Review (Methodology). The objectives are as follows: To identify, describe and assess methods for: when to replicate a systematic review; how to replicate a systematic review.

Health Care Workers not in the frontline are more frequently carriers of Coronavirus Disease 2019: The Experience of a Tertiary Portuguese Hospital.

BACKGROUND: Health care workers (HCWs) have a high risk of infection with coronavirus disease 2019 (COVID-19), especially those treating patients with confirmed or suspected diagnosis (front-line). AIM: To evaluate the incidence and prevalence of the COVID-19 infection among HCWs and to analyse the risk factors and the clinical characteristics among infected ones. METHODS: Observational, retrospective, single-center study (Centro Hospitalar e Universitário de Coimbra, Portugal). Data were collected from March 1 to June 30, 2020. FINDINGS: Overall, 211 (2.63%) out of 8037 HCWs were diagnosed with COVID-19. Most of the infections occurred during the early stage of disease outbreak. Among the infected HCWs, only 20.9% (n=44) were from the front-line. Both front-line and non-front-line HCWs were exposed primarily to patients (48.6% in both groups), but the non-front-line were (presumably) more infected by colleagues (10.8% vs 24.8%, P=0.04). Front-line HCWs performed more family isolation than non-front-line (88.9% vs 82.5%, P>0.05) and presumably less family members were infected in the former group (19.4% vs 26.3%, P>0.05). The proportion of HCWs with asymptomatic infection was statistically significantly lower in the front-line group (2.4% vs 19.9%, P=0.05). CONCLUSION: The prevention and control actions implemented were effective in mitigating the COVID-19 outbreak; HCW infections occurred mainly in the early stages. Non-front -line HCWs were at a higher risk, warranting specific attention and interventions targeting this group.

[Education and health propaganda: repercussions of a Brazilian sanitarian's training at the Rockefeller Foundation]. / Educação e propaganda sanitárias: desdobramentos da formação de um sanitarista brasileiro na Fundação Rockefeller.

This article discusses the influence that training at the Rockefeller Foundation had on the activities early-career professionals carried out in health leadership positions in Brazil. We present methods of education and health propaganda at this American institution, as well as posters prepared at the direction of the physician Antonio Luis Cavalcanti de Albuquerque de Barros Barreto during the health reform in Bahia. After returning from the Johns Hopkins University in Baltimore, where he received a Rockefeller Foundation fellowship in 1921-1922, this doctor helped to distribute the knowledge he acquired abroad throughout Brazil.

O artigo discute a influência da formação de jovens sanitaristas na Fundação Rockefeller para as ações que desenvolveram nos cargos de chefia sanitária no Brasil. São apresentados os métodos de educação e propaganda sanitárias da instituição norte-americana e os cartazes elaborados sob orientação do médico Antônio Luis Cavalcanti de Albuquerque de Barros Barreto na Reforma Sanitária da Bahia. Após retornar da Universidade Johns Hopkins, em Baltimore, onde foi bolsista da Rockefeller entre 1921 e 1922, o médico contribuiu para a difusão nacional dos conhecimentos adquiridos internacionalmente.

Educação e propaganda sanitárias: desdobramentos da formação de um sanitarista brasileiro na Fundação Rockefeller / Education and health propaganda: repercussions of a Brazilian sanitarian's training at the Rockefeller Foundation

Resumo O artigo discute a influência da formação de jovens sanitaristas na Fundação Rockefeller para as ações que desenvolveram nos cargos de chefia sanitária no Brasil. São apresentados os métodos de educação e propaganda sanitárias da instituição norte-americana e os cartazes elaborados sob orientação do médico Antônio Luis Cavalcanti de Albuquerque de Barros Barreto na Reforma Sanitária da Bahia. Após retornar da Universidade Johns Hopkins, em Baltimore, onde foi bolsista da Rockefeller entre 1921 e 1922, o médico contribuiu para a difusão nacional dos conhecimentos adquiridos internacionalmente.

Abstract This article discusses the influence that training at the Rockefeller Foundation had on the activities early-career professionals carried out in health leadership positions in Brazil. We present methods of education and health propaganda at this American institution, as well as posters prepared at the direction of the physician Antonio Luis Cavalcanti de Albuquerque de Barros Barreto during the health reform in Bahia. After returning from the Johns Hopkins University in Baltimore, where he received a Rockefeller Foundation fellowship in 1921-1922, this doctor helped to distribute the knowledge he acquired abroad throughout Brazil.

O Grace Memorial Hospital e a Missão Presbiteriana norte-americana no Brasil: fontes para a história da assistência à saúde, 1955-1971 / Grace Memorial Hospital and the American Presbyterian Mission in Brazil: sources for the history of healthcare, 1955-1971

Resumo Apresenta aspectos da história e do acervo documental do Grace Memorial Hospital, instituição criada em 1926 na antiga cidade de Ponte Nova, atual Wagner, na Chapada Diamantina (BA), pelo médico e missionário presbiteriano norte-americano Walter Welcome Wood. O corpus documental está sob guarda da Universidade do Estado da Bahia, campus II, Alagoinhas, desde o encerramento definitivo das atividades do hospital, e constitui-se em fonte de pesquisa para diferentes áreas de estudo, especialmente para a história da assistência à saúde no Brasil. Os documentos auxiliam as análises sobre a incidência de doenças, tratamentos médicos e outros cuidados com a saúde em uma população que não tinha acesso a outras instituições que atuassem nesse âmbito.

Abstract The paper presents aspects of the history and archives of Grace Memorial Hospital, founded in 1926 in the former town of Ponte Nova, now Wagner, in the Chapada Diamantina region of Bahia state, Brazil, by the American Presbyterian missionary and doctor Walter Welcome Wood. The documents in question have been kept at the Universidade do Estado da Bahia, campus II, Alagoinhas, since the hospital closed down definitively. They constitute a source of research for different areas of scholarship, especially the history of healthcare in Brazil. The documents are used in analyses of the incidence of diseases, medical treatments, and other care given to a population that had no access to other institutions working in this area.