Donation and Equitable Access to Organ, Tissue, and Cell Transplants: A Brazilian Perspective on the Strategy and Plan of Action 2019-2030.

OBJECTIVE: To position the Brazilian Transplant System within the context of the 4 Strategic Lines of Action proposed by the Pan-American Health Organization. METHOD: A specialist analysis was conducted through comparative analyses of the 4 Strategic Lines of Action, objectives, and indicators outlined in the Action Plan, along with the donation and transplantation system in accordance with Brazilian transplantation law. Subsequent to an in-depth review of the document issued by the health authority, a series of meetings involving 8 specialists in organ donation and transplantation were conducted. During these meetings, discussions were carried out with the objective of numerically interpreting each strategy presented in the document, and recommendations constructed. RESULTS: Four strategies were evaluated and only 2 of them the third (81,3%) and the fourth (90%) do not achieve the indicators to complete the objective related to equitable access to organ, tissue, and cell transplants in Brazil. CONCLUSION: The recommendations developed carry importance, as they are innovative and contribute to the establishment of priorities when shaping public policies. The report not only highlights indicators that were not satisfactorily met but also provides insights into the recommendations formulated to improve those indicators that have already been achieved and to work toward achieving those that have not yet been realized. Additionally, these recommendations can justify actions and establish priorities for research efforts in the field.

Effects of calcium supplementation on changes in the IL2, IL4, IL6, IL10 axes and oxidative stress in pregnant women at risk for pre-eclampsia.

BACKGROUND: Pregnant women with hypertensive disorders are at increased risk for inflammatory diseases and oxidative stress. The dilemma raised by the best dosage of calcium supplementation on these factors is evident. The aim of the current study was to examine the effects of calcium on biomarkers of the purinergic system, inflammation and oxidative stress, which are factors contributing to vascular damage in pregnant women at high risk of pre-eclampsia. METHODS: A prospective, double-blind and placebo-controlled study conducted with 101 women at risk of pre-eclampsia were randomized to take 500 mg calcium/day or 1,500 mg calcium/day or placebo for 6 weeks from the 20th gestational week until delivery. Fasting blood samples were collected at the beginning of the study and 6 weeks after the intervention. RESULTS: Taking calcium supplements (500 mg calcium/day) led to a significant increase in ATP hydrolysis (p < 0.05), NTPDase activity with increased hydrolysis of ADP and AMP nucleotides in platelets and lymphocytes. In the intragroup analysis IL-2, IL-6, IL-4 and interferon-É£ presented lower values in the calcium 1,500 mg/day group (p < 0.005). Oxidative stress was assessed by TBARS pro-oxidant marker, with an increase for the calcium groups when compared to the placebo group. The Vitamin C antioxidant marker presented a significant increase (p < 0.005) for the group that received high calcium doses. CONCLUSIONS: Calcium administration for 6 weeks had antioxidant action and positively modulated the purinergic system and inflammatory markers in pregnant women at risk of pre-eclampsia.

Efeitos da suplementação do cálcio sobre marcadores da pré-eclâmpsia: ensaio clínico randomizado / Efectos de los suplementos de calcio en marcadores de preeclampsia: ensayo clínico aleatorizado / Effects of calcium supplementation on markers of preeclampsia: randomized clinical trial

Resumo Objetivo Analisar os efeitos da suplementação de cálcio nos marcadores da pré-eclâmpsia ao longo do tempo, comparando o uso de cálcio em alta e baixa dosagem em mulheres grávidas com hipertensão. Métodos Trata-se de ensaio clínico randomizado com três grupos paralelos, placebo controlado, realizado no ambulatório de referência para o pré-natal de alto risco na Região Sul do Brasil, com análise de intenção de tratar e seguimento após quatro e oito semanas. A intervenção consistiu na ingestão de cálcio 500mg/dia, cálcio 1500mg/dia e placebo. Os dados foram analisados segundo um modelo generalizado de estimação de equações mistas adotando α 0,05. Resultados O efeito do cálcio em baixa e alta dosagem na evolução ao longo do tempo foi mantido entre os grupos, mesmo após o ajuste para os fatores de confusão. Houve diferença significativa nos parâmetros analisados na interação tempo e grupo (p <0,000) e diminuição nas médias de 12,3mmHg na PAS, 9,2 mmHg na PAD, 3,2 mg/dl creatinina e 7,2 mg/dl proteinúria para o grupo cálcio 500mg/dia. Os resultados foram semelhantes para o grupo com suplementação máxima. Conclusão O cálcio melhorou o prognóstico vascular em mulheres grávidas com hipertensão ao reduzir os níveis pressóricos e os marcadores da pré-eclâmpsia.

Resumen Objetivo Analizar los efectos de los suplementos de calcio en los marcadores de preeclampsia a lo largo del tiempo, comparando el uso de calcio en dosis altas y bajas en mujeres embarazadas con hipertensión. Métodos Se trata de un ensayo clínico aleatorizado con tres grupos paralelos, placebo controlado realizado en consultorios externos de referencia en el control prenatal de alto riesgo en la Región Sur de Brasil, con análisis de intención de tratar y seguimiento luego de cuatro y ocho semanas. La intervención consistió en la ingesta de calcio 500 mg/día, calcio 1500 mg/día y placebo. Los datos se analizaron de acuerdo con un modelo generalizado de estimación de ecuaciones mixtas adoptando α 0,05. Resultados El efecto del calcio en dosis bajas y altas en la evolución a lo largo del tiempo se mantuvo entre los grupos, inclusive después de los ajustes por los factores de confusión. Hubo diferencia significativa en los parámetros analizados en la interacción tiempo y grupo (p <0,000) y reducción de los promedios de 12,3 mmHg en la PAS, 9,2 mmHg en la PAD, 3,2 mg/dl creatinina y 7,2 mg/dl proteinuria en el grupo calcio 500 mg/día. Los resultados fueron parecidos en el grupo con suplemento en dosis máxima. Conclusión El calcio mejoró el pronóstico vascular en mujeres embarazadas con hipertensión al reducir los niveles de presión y los marcadores de preeclampsia. Registro Brasileiro de Ensaios Clínicos: RBR-9ngb95

Abstract Objective To analyze the effects of calcium supplementation on markers of preeclampsia over time by comparing the use of high- and low-dose calcium in hypertensive pregnant women. Methods This is a randomized clinical trial, placebo controlled, with three parallel groups carried out at the reference outpatient clinic for high-risk prenatal care in the South Region of Brazil, with intention-to-treat analysis and follow-up after four and eight weeks. The intervention consisted of ingesting calcium 500mg/day, calcium 1500mg/day and placebo. Data were analyzed according to a generalized mixed equation estimation model adopting α 0.05. Results The effect of low- and high-dose calcium on evolution over time was maintained between groups, even after adjustment for confounding factors. There was a significant difference in the parameters analyzed in the time and group interaction (p <0.000) and a decrease in the means of 12.3 mmHg in SBP, 9.2 mmHg in DBP, 3.2 mg/dl creatinine and 7.2 mg/dl proteinuria for the 500mg calcium/day group. The results were similar for the maximal supplementation group. Conclusion Calcium improved vascular prognosis in hypertensive pregnant women by reducing blood pressure levels and markers of preeclampsia. Brazilian Registry of Clinical Trials: RBR-9ngb95

Adverse Events Reporting Systems in Cells, Organs, and Tissues Donation and Transplantation: Scoping Review.

BACKGROUND: This study aimed to map adverse events reporting systems in cells, organs, and tissues donation and transplantation, including the terms applicable in each system and scientific literature. METHODS: This was a scoping review using the Joanna Briggs Institute method. A search strategy in 3 phases was used, and searches were conducted in PubMed, Embase, LILACS, Scholar Google, and government and organ donations and transplantation associations' sites during June and August 2021. Data collection and analysis were independently made by 2 researchers. The scoping review protocol was registered. RESULTS: Twenty-four articles and other materials were selected for data collection. Eleven reporting systems were analyzed, and terms were identified. CONCLUSIONS: Adverse reporting systems in cells, organs, and tissues donation and transplantation were mapped. The main features are presented, which can help develop new and better systems, with an important discussion about the terms used.

Time Elapsed Between Cells, Tissues, and Organs Donation and Transplantation and Adverse Events Detection.

BACKGROUND: This study was designed to discuss the time elapsed between cell, tissue, and organ donation and transplantation and detection of adverse events notified in São Paulo, Brazil. METHODS: This is a descriptive study with a quantitative approach. Data were provided by the Transplant Center of the state of São Paulo from the "Individual notification form of adverse reactions in Biovigilance" between 2016 and 2019. Analysis was performed using descriptive statistics. RESULTS: Fifty-two notifications were analyzed, and 3 categories were formed: (1) adverse events detected on the same day of the transplant, 8; (2) adverse events detected between 1 week and 1.5 years after transplant, 40; and (3) adverse events detected 2 years after transplant, 4. CONCLUSION: The discussion on the topic is beginning; however, it is important. Clinical management of transplant recipients and comprehending what is considered an adverse event and the natural course of a patient's life can impact clinical decision-making, public policies, and patient safety research. This study highlights the need to investigate related factors to adverse events, especially the time between the transplant procedure and adverse event detection, to establish clinical guidelines.

Atuação da câmara técnica de atenção à saúde do Conselho Federal de Enfermagem / Performance of the technical chamber of health care of the Federal Council of Nursing / Acción de la cámara técnica de sanidad del Consejo Federal de Enfermería

Objetivo: Descrever a atuação da Câmara Técnica de Atenção à Saúde do Conselho Federal de Enfermagem, na elaboração de normas e atualização do conhecimento técnico-científico da profissão. Métodos: Trata-se de um estudo teórico-reflexivo, desenvolvido a partir do conhecimento e das experiências, acadêmicas e profissionais dos autores sobre atuação e contribuição da Câmara Técnica de Atenção à Saúde, na assessoria aos questionamentos dos profissionais de enfermagem, desenvolvendo estudos que possam inferir na mudança comportamental ou evolução das técnicas desenvolvidas pelos profissionais. Resultados: Aponta a atuação da Câmara Técnica de Atenção à Saúde como espaço de discussão, de construção formal e de atualização da ciência enfermagem, frente às realidades vivenciadas pelos profissionais no campo da prática, sobre o seu cenário de exercício profissional de novas condutas, bem como a reflexão sobre possíveis posicionamentos técnicos da profissão. Conclusão: A Câmara Técnica de Atenção à Saúde atua de forma democrática, ética, técnico-científica e legal, apoiando todos os Conselhos Regionais de Enfermagem e profissionais de enfermagem que tenham suas demandas voltadas para a atenção à saúde, oferecendo resultados com qualidade e garantindo provimentos, instruções, elaboração e execução de normativas que tratam de inovação e uniformidade de procedimentos para o exercício da Enfermagem no Brasil. (AU)

Objective: To describe the work of the Federal Nursing Council's Technical Chamber for Health Care in drawing up standards and updating the profession's technical and scientific knowledge. Methods: This is a theoretical-reflective study, based on the authors' academic and professional knowledge and experience of the work and contribution of the Technical Board of Health Care in advising nursing professionals on their questions, developing studies that could lead to behavioral changes or the evolution of techniques developed by professionals. Results: It points to the work of the Technical Chamber for Health Care as a space for discussion, formal construction and updating of nursing science, in the face of the realities experienced by professionals in the field of practice, about their professional practice scenario of new behaviors, as well as reflection on possible technical positions of the profession. Conclusion: The Technical Chamber for Health Care acts in a democratic, ethical, technical-scientific and legal manner, supporting all the Regional Nursing Councils and nursing professionals whose demands are focused on health care, offering quality results and guaranteeing provisions, instructions, preparation and implementation of regulations that deal with innovation and uniformity of procedures for the practice of nursing in Brazil. (AU)

Objetivo: Describir el trabajo de la Cámara Técnica de Cuidados de Salud del Consejo Federal de Enfermería en la elaboración de normas y actualización de los conocimientos técnico-científicos de la profesión. Métodos: Se trata de un estudio teórico-reflexivo, basado en el conocimiento y la experiencia académica y profesional de los autores sobre el trabajo y la contribución de la Cámara Técnica de Cuidados de Salud, en el asesoramiento a los profesionales de enfermería en sus cuestiones, en el desarrollo de estudios que puedan conducir a cambios de comportamiento o en la evolución de las técnicas desarrolladas por los profesionales. Resultados: Se señala el trabajo de la Cámara Técnica para el Cuidado de la Salud como un espacio de discusión, construcción formal y actualización de la ciencia de la enfermería, frente a las realidades vividas por los profesionales en el campo de la práctica, sobre su práctica profesional escenario de nuevos comportamientos, así como la reflexión sobre posibles posiciones técnicas de la profesión. Conclusión: La Cámara Técnica de Atención a la Salud actúa de forma democrática, ética, técnico-científica y jurídica, apoyando a todos los Consejos Regionales de Enfermería y a los profesionales de enfermería cuyas demandas se centran en la atención a la salud, ofreciendo resultados de calidad y garantizando disposiciones, instrucciones, redacción e implementación de reglamentos que se ocupan de la innovación y la uniformidad de los procedimientos para la práctica de la enfermería en Brasil. (AU)

Biovigilância e notificação de eventos adversos na doação e transplante de órgãos: revisão sistemática / Biovigilancia y notificación de eventos adversos en la donación y trasplante de órganos: revisión sistemática / Biosurveillance and reporting of adverse events in organ donation and transplantation: a systematic review

Resumo Objetivo Sintetizar e avaliar criticamente as evidências científicas oriundas de estudos observacionais sobre sistemas de biovigilância e notificação de eventos adversos na doação e transplante de órgãos. Métodos Revisão sistemática de estudos observacionais seguindo as recomendações das Diretrizes Metodológicas (REBRATS) e Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Foram incluídos estudos primários e relatos de caso conduzidos sobre biovigilância e/ou eventos adversos na doação e/ou transplante de órgãos, sem restrição de data de publicação ou idioma. Foram utilizadas seis bases de dados eletrônicas para a realização das buscas na literatura científica: - Medical Literature Analysis and Retrieval System Online (MEDLINE) (via PubMed), Excerpta Medica Database (Embase), Web of Science, LILACS, Scopus e a biblioteca eletrônica Scielo. Realizou-se também busca de dados nas seguintes bases secundárias: Notify - World Health Organization (WHO), Organização Pan-Americana de Saúde (OPAS) e Google Scholar. Para a avaliação da qualidade dos estudos foi utilizada a ferramenta MINORS. Resultados Foram identificados 551 estudos, após as etapas de avaliação, foram incluídos oito deles para a revisão sistemática. Estes foram divididos entre resultados, processos e estratégias de prevenção de eventos adversos. Quanto a classificação da qualidade dos estudos, dois obtiveram classificação boa. Conclusão Os resultados apontam a ocorrência de eventos adversos ocorridos em alguma etapa do processo de doação e transplante de órgãos e tecidos, como: reações adversas relacionadas a medicamentos; neurotoxicidade; aumento do tempo de hospitalização; reintervenções cirúrgicas; queda; coma; óbito; falha ou perda do enxerto. Destaca-se que os eventos adversos possivelmente ainda são subnotificados.

Resumen Objetivo Sintetizar y evaluar críticamente las evidencias científicas provenientes de estudios observacionales sobre sistemas de biovigilancia y notificación de eventos adversos en la donación y trasplante de órganos. Métodos Revisión sistemática de estudios observacionales guiada por las recomendaciones de las Directrices Metodológicas (REBRATS) y Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Se incluyeron estudios primarios y relatos de caso realizados sobre biovigilancia o eventos adversos en la donación o trasplante de órganos, sin restricción de fecha de publicación o idioma. Se utilizaron seis bases de datos electrónicas para realizar las búsquedas en la literatura científica: Medical Literature Analysis and Retrieval System Online (MEDLINE) (via PubMed), Excerpta Medica Database (Embase), Web of Science, LILACS, Scopus y la biblioteca electrónica Scielo. También se realizó la búsqueda de datos en las siguientes bases secundarias: Notify - World Health Organization (WHO), Organización Panamericana de la Salud (OPS) y Google Scholar. Para evaluar la calidad de los estudios se utilizó la herramienta MINORS. Resultados Se identificaron 551 estudios y, luego de las etapas de evaluación, se incluyeron ocho en la revisión sistemática, que fueron divididos entre resultados, procesos y estrategias de prevención de eventos adversos. Respecto a la clasificación de la calidad de los estudios, dos obtuvieron una clasificación buena. Conclusión Los resultados indican casos de eventos adversos ocurridos en alguna etapa del proceso de donación y trasplante de órganos y tejidos, como: reacciones adversas relacionadas con medicamentos, neurotoxicidad, aumento del tiempo de hospitalización, reintervenciones quirúrgicas, caída, coma, fallecimiento, falla o pérdida del injerto. Se destaca que los eventos adversos probablemente aún son subnotificados.

Abstract Objective To synthesize and critically evaluate the scientific evidence from observational studies on biosurveillance systems and adverse event reporting in organ donation and transplantation. Methods Systematic review of observational studies following the recommendations of the Methodological Guidelines (REBRATS) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Primary studies and case reports on biosurveillance and/or adverse events in organ donation and/or transplantation, without restriction of publication date or language were included. Six electronic databases were used in the scientific literature search: Medical Literature Analysis and Retrieval System Online (MEDLINE) (via PubMed), Excerpta Medica Database (Embase), Web of Science, LILACS, Scopus and the electronic library Scielo. A data search was also performed in the following secondary databases: Notify - World Health Organization (WHO), Pan American Health Organization (PAHO) and Google Scholar. The MINORS tool was used to assess the quality of studies. Results 551 studies were identified, and after the evaluation steps, eight of them were included in the systematic review. These were divided into results, processes and strategies for preventing adverse events. Regarding the classification of the quality of studies, two obtained a good classification. Conclusion The results indicate the occurrence of adverse events at some stage of the organ and tissue donation and transplantation process, such as: adverse drug-related reactions; neurotoxicity; longer length of hospital stay; surgical reinterventions; falls; coma; death; graft failure or loss. The fact that adverse events are possibly still underreported is noteworthy.

Diabetes tipo 2 e transplante renal: estudo comparativo sobre adesão medicamentosa / Diabetes tipo 2 y trasplante renal: estudio comparativo sobre la adhesión farmacológica / Type 2 diabetes and kidney transplant: comparative study on medication adherence

Resumo Objetivo Investigar a adesão medicamentosa no Diabetes Mellitus tipo 2 entre transplantados renais e não transplantados. Métodos Estudo comparativo entre pacientes assistidos no Centro de Diabetes (Grupo 1 sem transplante renal) e no Ambulatório de Pós-Transplante Renal do Hospital do Rim e da Hipertensão (Grupo 2 com transplante renal), ambos na cidade de São Paulo. A amostra foi composta por maiores de 18 anos, com diagnóstico de diabete tipo 2 prévio e em uso de medicamentos para o controle glicêmico. A coleta de dados ocorreu de outubro de 2017 a outubro de 2018. Aplicou-se aos participantes: formulário sócio clínico, instrumento de Medida de Adesão ao Tratamento Medicamentoso no Diabetes Mellitus (antidiabéticos orais e insulina) e a escala de Ansiedade e Depressão. O projeto foi aprovado no Comitê de Ética e Pesquisa como 0712/2017. Resultados Amostra composta de 107 pacientes (Grupo 1: 56 e Grupo 2: 51), maior porcentagem de homens, média de idade de 63,3 anos, provenientes da região metropolitana de São Paulo, aposentados, casados, com sobrepeso, sem sintomas de ansiedade e depressão. Os pacientes autorreferiram ter adesão aos medicamentos para o controle do diabetes, porém os resultados da hemoglobina glicada variaram entre 8,3 e 8,7% entre os grupos, ambos acima de 7%. Conclusão Ao analisar a relação entre a adesão autorreferida, hemoglobina glicada, ansiedade e depressão não foi possível evidenciar correlação estatisticamente significante. Os parâmetros avaliados neste estudo não permitiram estabelecer a relação de causa e efeito.

Resumen Objetivo Investigar la adhesión farmacológica en la Diabetes mellitus tipo 2 en trasplantados renales y no trasplantados. Métodos Estudio comparativo entre pacientes atendidos en el Centro de Diabetes (Grupo 1 sin trasplante renal) y en los Consultorios Externos de Postrasplante Renal del Hospital del Riñón y de la Hipertensión (Grupo 2 con trasplante renal), ambos en la ciudad de São Paulo. La muestra fue formada por mayores de 18 años, con diagnóstico previo de diabetes tipo 2 y en uso de medicamentos para control glucémico. La recopilación de datos se realizó de octubre de 2017 a octubre de 2018. Se aplicaron los siguientes instrumentos a los participantes: formulario socio-clínico, instrumento de Medida de Adhesión al Tratamiento Farmacológico (antidiabéticos orales e insulina) y escala de Ansiedad y Depresión. El proyecto fue aprobado por el Comité de Ética e Investigación con el número 0712/2017. Resultados Muestra formada por 107 pacientes (Grupo 1: 56 y Grupo 2: 51), mayor porcentaje de hombres, promedio de edad 63,3 años, provenientes de la región metropolitana de São Paulo, jubilados, casados, con sobrepeso, sin síntomas de ansiedad y depresión. Los pacientes autodeclararon adherir a los medicamentos para el control de la diabetes, pero los resultados de la hemoglobina glicosilada variaron entre 8,3 y 8,7 % entre los grupos, más de 7 % en ambos. Conclusión Al analizar la relación entre la adhesión autodeclarada, la hemoglobina glicosilada, la ansiedad y la depresión, no se observó correlación estadísticamente significativa. Los parámetros evaluados en este estudio no permitieron establecer una relación de causa y efecto.

Abstract Objective To investigate medication adherence in type 2 Diabetes Mellitus among kidney transplant recipients and non-transplant recipients. Methods Comparative study between patients assisted at the Diabetes Center (Group 1 without kidney transplant) and at the Post-Renal Transplant Outpatient Clinic of the Hospital do Rim e da Hipertensão (Group 2 with kidney transplant), both in the city of São Paulo. The sample consisted of people over 18 years of age with a previous diagnosis of type 2 diabetes using medication for glycemic control. The data collection period was from October 2017 to October 2018. The following was applied to participants: socio-clinical form, instrument for Measuring Adherence to Medication Treatment in Diabetes Mellitus (oral antidiabetics and insulin) and the Anxiety and Depression scale. The project was approved by the Research Ethics Committee as 0712/2017. Results Sample composed of 107 patients (Group 1: 56 and Group 2: 51), higher percentage of men, mean age of 63.3 years, from the metropolitan region of São Paulo, retired, married, overweight, without symptoms of anxiety and depression. Even though patients self-reported adherence to medication for diabetes control, results of glycated hemoglobin ranged between 8.3 and 8.7% between groups, both above 7%. Conclusion When analyzing the relationship between self-reported adherence, glycated hemoglobin, anxiety and depression, a statistically significant correlation could not be found. The parameters evaluated in this study did not allow establishing a cause and effect relationship.

Brain death communication with parents of children and adolescents: care strategies.

OBJECTIVES: to identify care strategies developed by professionals from critically ill patients' units in communicating BD with parents of children and adolescents. METHODS: an exploratory and descriptive research with a qualitative approach, carried out in two health institutions between October and December 2019, through semi-structured interviews. Data analysis took place through content analysis. RESULTS: twenty-one professionals participated. Three care strategies were identified: actual clinical situation in suspected brain death; sensitizing families to the real clinical situation after brain death diagnosis; and time to assimilate the death information. FINAL CONSIDERATIONS: the care strategies for communicating brain death to families identified in this study present the possibility of subsidizing health managers in training and support promotion for professionals in care practice. Moreover, they can be incorporated and validated in the care practice of the studied context.

Self-testing for SARS-CoV-2 in São Paulo, Brazil: results of a population-based values and attitudes survey.

BACKGROUND: Brazil is among the countries in South America where the COVID-19 pandemic has hit the general population hardest. Self-testing for SARS-CoV-2 infection is one of the community-based strategies that could help asymptomatic individuals at-risk of COVID-19, as well as those living in areas that are difficult for health personnel to reach, to know their infectious status and contribute to impeding further transmission of the virus. METHODS: A population-based survey was conducted in November 2021, to assess the acceptability of rapid SARS-CoV-2 antigen self-testing among the population of São Paulo. Survey respondents were approached at more than 400 different street-points that were randomly selected using a five-stage randomization process. A 35-item structured questionnaire was used. Dependent variables for our analyses were the likelihood to use and willingness to pay for self-testing, and the likelihood of taking preventive measures to prevent onward transmission of SARS-CoV-2 following a reactive self-test result. Bivariate and multivariate regression analyses were performed. RESULTS: Overall, 417 respondents (44.12% female) participated; 19.66% had previously had COVID-19 disease. A minority (9.59%) felt at high-risk of COVID-19. The majority of both females and males (73.91% and 60.09%, respectively) were in favor of the idea of SARS-CoV-2 self-testing. Overall, if self-tests were available, almost half of the sample would be very likely (n = 54, 12.95%) or likely (n = 151, 36.21%) to use one if they felt they needed to. Upon receiving a positive self-test result, the majority of respondents would communicate it (88.49%), request facility-based post-test counseling (98.32%), self-isolate (97.60%), and warn their close contacts (96.64%). CONCLUSION: Rapid SARS-CoV-2 antigen self-testing could be an acceptable screening tool in São Paulo. The population would be empowered by having access to a technology that would allow them to test, even if asymptomatic, when traveling, or going to work or school. If there is a surge in the incidence of cases, self-testing could be a good approach for mass case detection by Brazil's already overstretched Unified Health System.

Understanding organ donation processes and structures in ontario: A social network analysis approach.

BACKGROUND: Transplant rates in Ontario rose steeply in the decade prior to the COVID-19 pandemic. Reasons for that increase remain unclear, but the inter-organizational arrangement of organ donation programs may have contributed. However, there is a paucity of literature investigating these inter-organizational arrangements, with a limited understanding of how communication facilitates organ donation. Understanding these arrangements may help to re-establish rising organ donation rates post-pandemic. OBJECTIVE: To describe interprofessional interactions of Organ and Tissue Donation Coordinators (OTDCs) during organ donation cases, within organ donation programs in Ontario, from an organizational perspective (describing structure, context, process). METHODS: Mixed-method social network analysis (SNA) approach analyzing 14 organ donation cases just before the COVID-19 pandemic. RESULTS: Structure: Social network graphs depict the joint work performed by hospital staff and OTDCs, with a great part of the communication being processed through the OTDC. CONTEXT: Network density ranged from 0.05 to 0.24 across cases, and health care professionals perceived an atmosphere of shared vision and trust among team members. PROCESS: Most networks had a degree centralization <0.50 suggesting a decentralized information flow, and participants perceived decisions being jointly made. The characteristic path length of cases ranged from 1.6 to 3.2, suggesting potential for rapid information diffusion. Overall, data reinforced the OTDC role of intermediator within the communication process, and hospital staff perceived OTDCs as central players. Hospital staff and OTDCs reported frustration with some aspects of the flow of information during the organ allocation processes. CONCLUSION: Findings from this study provide a network map of communications within organ donation cases and reinforce the importance of the OTDC role. Opportunities for quality improvement within these processes are identified.

Care actions in obtaining tissues and organs during the COVID-19 pandemic: a mixed methods study.

OBJECTIVE: to map health care actions in the organ and tissue donation process in Brazilian regions during the COVID-19 pandemic. METHODS: a mixed methods study. Data collection was performed simultaneously through an online questionnaire with 72 nurses. Descriptive statistical analysis and content analysis. RESULTS: a total of 34.7% of professionals work in the state of São Paulo. The largest number of responses was from the Southeast region. Four categories emerged. The first addresses triage care actions; the second involves guidelines for SARS-CoV-2 prevention in potential donors; the third relates to the epidemiological screening of professionals; the fourth presents the scenario of donation training in pandemic times. CONCLUSION: care actions are aimed at tracking the path taken until arrival at the hospital, assessing temperature and saturation curves, in addition to screening for signs and symptoms for SARS-CoV-2 contamination among professionals.

Care bundle for family interview for pediatric organ donation.

PURPOSE: to develop a care bundle for best practices in conducting the family interview for organ and tissue donation with the families of children and adolescents. DESIGN AND METHODS: methodological study, with a qualitative approach, developed in Brazil, in three stages: literature review, qualitative study with professionals and family members, and development of the care bundle. RESULTS: Nine studies were selected and 17 health professionals and nine family members were interviewed. With this data, the care bundle was developed in three categories: communication of death, emotional support and information about organ and tissue donation. The recommendations were evaluated by five external professionals and all of them assessed the bundle as having the highest possible quality. CONCLUSIONS: the care bundle was built following the stages of integrative literature review and interviews with professionals working in this scenario and family members who have already gone through a family interview for organ and tissue donation of children and adolescents. PRACTICE IMPLICATIONS: the use of this material is seen as an important resource to support the professional during the conduction of the family interview in a scenario as sensitive and challenging as the care to family members facing death and the decision of organ and tissue donation of children and adolescents. Furthermore, the care bundle can increase the quality of family interviews and impact the reduction of family refusals. DESCRIPTORS: Practice Guideline as Topic. Tissue and Organ Procurement. Patient Care Team. Nursing. Pediatrics. Communication.

Sleep quality of urban public transport drivers in a city in the Western Amazon, Brazil / Qualidade do sono dos motoristas de transportes coletivos urbanos em uma cidade da Amazônia Ocidental, Brasil

Introduction: problems related to sleep have destructive effects on psychomotor skills, memory, decision making and concentration, which can influence the occurrence of accidents and errors. Bus drivers are subject to the company's strict rules in respecting timetables, caring for the vehicle and being responsible for the daily transport of people.Objective: to analyze the sleep quality of urban public transport drivers in the city of Rio Branco, Acre, Brazil.Methods: this is a cross-sectional study developed in the city of Rio Branco, Acre, Brazil. The sample consisted of 80 drivers. To check the quality of sleep, the Pittsburg Sleep Quality Questionnaire was used. The anthropometric variables used were neck circumference, waist circumference, skinfolds, and body mass index. The non-parametric test of Spearmand 0.05 (5%) was used to associate.Results: participants were aged between 24 and 60 years, male. 81.25% of drivers had poor sleep quality according to the Pittsburg Sleep Quality Questionnaire (>5). 75% of participants have excessive body mass index and 67.5% with risky waist circumference. The neck circumference, 60% had increased values and 78.75% with the percentage of fat above the recommended. There was a strong correlation between all components and with the Pittsburg Sleep Quality Questionnaire.Conclusion: an association between poor sleep and body mass index and neck circumference has been demonstrated. It also showed a strong correlation between all components with the result of the Pittsburg Sleep Quality Questionnaire.

Introdução: os problemas relacionados ao sono trazem efeitos destrutivos sobre as habilidades psicomotoras, memória, tomada de decisão e concentração, os quais podem influenciar na ocorrência de acidentes e erros. Os motoristas de ônibus, esses profissionais estão submetidos às normas rígidas da empresa no cumprimento de horários, cuidados com o veículo e na responsabilidade no transporte diário de pessoas.Objetivo: analisar a qualidade do sono dos motoristas de transportes coletivos urbanos da cidade de Rio Branco-AC.Método: trata-se de um estudo transversal desenvolvido na cidade de Rio Branco, Acre-Brasil. A amostra foi composta por 80 motoristas. Para verificar a qualidade do sono foi utilizado o Questionário de Qualidade do Sono de Pittsburg (PSQI). As variáveis antropométricas utilizadas foram a circunferência do pescoço, circunferência abdominal, dobras cutâneas e o índice de massa corporal (IMC). Para associar utilizou-se o teste não paramétrico de Spearmande 0,05 (5%).Resultados: os investigados tinham idades entre 24 e 60 anos, sendo do sexo masculino. 81,25% dos motoristas apresentaram qualidade do sono ruim de acordo com o PSQI (> 5). 75% o IMC em excesso e 67,5% com circunferência abdominal de risco. A circunferência do pescoço, 60% apresentaram valores aumentados e 78,75% com o percentual de gordura acima do recomendado. Observou-se uma forte correlação entre todos os componentes e com o PSQI.Conclusão: está demonstrada uma associação entre sono ruim e o índice de massa corporal e a circunferência do pescoço. Também apresentou uma forte correlação entre todos os componentes com o resultado final do PSQI.