Representações sociais: investigações em psicologia social

Summary Background Since the coronavirus disease 2019 outbreak began in the Chinese city of Wuhan on Dec 31, 2019, 68 imported cases and 175 locally acquired infections have been reported in Singapore. We aimed to investigate options for early intervention in Singapore should local containment (eg, preventing disease spread through contact tracing efforts) be unsuccessful. Methods We adapted an influenza epidemic simulation model to estimate the likelihood of human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a simulated Singaporean population. Using this model, we estimated the cumulative number of SARS-CoV-2 infections at 80 days, after detection of 100 cases of community transmission, under three infectivity scenarios (basic reproduction number [R0] of 1·5, 2·0, or 2·5) and assuming 7·5% of infections are asymptomatic. We first ran the model assuming no intervention was in place (baseline scenario), and then assessed the effect of four intervention scenarios compared with a baseline scenario on the size and progression of the outbreak for each R0 value. These scenarios included isolation measures for infected individuals and quarantining of family members (hereafter referred to as quarantine); quarantine plus school closure; quarantine plus workplace distancing; and quarantine, school closure, and workplace distancing (hereafter referred to as the combined intervention). We also did sensitivity analyses by altering the asymptomatic fraction of infections (22·7%, 30·0%, 40·0%, and 50·0%) to compare outbreak sizes under the same control measures. Findings For the baseline scenario, when R0 was 1·5, the median cumulative number of infections at day 80 was 279 000 (IQR 245 000–320 000), corresponding to 7·4% (IQR 6·5–8·5) of the resident population of Singapore. The median number of infections increased with higher infectivity: 727 000 cases (670 000–776 000) when R0 was 2·0, corresponding to 19·3% (17·8–20·6) of the Singaporean population, and 1 207 000 cases (1 164 000–1 249 000) when R0 was 2·5, corresponding to 32% (30·9–33·1) of the Singaporean population. Compared with the baseline scenario, the combined intervention was the most effective, reducing the estimated median number of infections by 99·3% (IQR 92·6–99·9) when R0 was 1·5, by 93·0% (81·5–99·7) when R0 was 2·0, and by 78·2% (59·0 −94·4) when R0 was 2·5. Assuming increasing asymptomatic fractions up to 50·0%, up to 277 000 infections were estimated to occur at day 80 with the combined intervention relative to 1800 for the baseline at R0 of 1·5. Interpretation Implementing the combined intervention of quarantining infected individuals and their family members, workplace distancing, and school closure once community transmission has been detected could substantially reduce the number of SARS-CoV-2 infections. We therefore recommend immediate deployment of this strategy if local secondary transmission is confirmed within Singapore. However, quarantine and workplace distancing should be prioritised over school closure because at this early stage, symptomatic children have higher withdrawal rates from school than do symptomatic adults from work. At higher asymptomatic proportions, intervention effectiveness might be substantially reduced requiring the need for effective case management and treatments, and preventive measures such as vaccines. Funding Singapore Ministry of Health, Singapore Population Health Improvement Centre.

Interventions to mitigate early spread of SARS-CoV-2 in Singapore: a modelling study

Objective To systematically review the available evidence on paediatric early warning systems (PEWS) for use in acute paediatric healthcare settings for the detection of, and timely response to, clinical deterioration in children. Method The electronic databases PubMed, MEDLINE, CINAHL, EMBASE and Cochrane were searched systematically from inception up to August 2016. Eligible studies had to refer to PEWS, inclusive of rapid response systems and teams. Outcomes had to be specific to the identification of and/or response to clinical deterioration in children (including neonates) in paediatric hospital settings (including emergency departments). 2 review authors independently completed the screening and selection process, the quality appraisal of the retrieved evidence and data extraction; with a third reviewer resolving any discrepancies, as required. Results were narratively synthesised. Results From a total screening of 2742 papers, 90 papers, of varied designs, were identified as eligible for inclusion in the review. Findings revealed that PEWS are extensively used internationally in paediatric inpatient hospital settings. However, robust empirical evidence on which PEWS is most effective was limited. The studies examined did however highlight some evidence of positive directional trends in improving clinical and process-based outcomes for clinically deteriorating children. Favourable outcomes were also identified for enhanced multidisciplinary team work, communication and confidence in recognising, reporting and making decisions about child clinical deterioration. Conclusions Despite many studies reporting on the complexity and multifaceted nature of PEWS, no evidence was sourced which examined PEWS as a complex healthcare intervention. Future research needs to investigate PEWS as a complex multifaceted sociotechnical system that is embedded in a wider safety culture influenced by many organisational and human factors. PEWS should be embraced as a part of a larger multifaceted safety framework that will develop and grow over time with strong governance and leadership, targeted training, ongoing support and continuous improvement.

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Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

OBJETIVO: estimar a prevalencia das formas de violencia contra criancas e adolescentes, registradas nos Conselhos Tutelares, e a associacao dessas violencias por faixas etarias das vitimas e vinculo com agressores, em 2003-2004. METODO: foram coletados dados dos prontuarios e calculadas as prevalencias e associacao entre variaveis, atraves da razao de prevalencia (RP), com nivel critico de 5%. RESULTADOS: totalizaram 1.293 registros de violencia, sendo 1.011 (78,1%) originados no domicilio. As violencias mais frequentes foram a negligencia (727), por omissao de cuidados basicos (304) e abandono (259); a violencia fisica (455), por espancamento (392), nas faixas de 2 a 13 anos; a violencia psicologica (374), por amedrontamento (219); a violencia sexual (68), por abuso (58), principalmente entre adolescentes. A principal forma de denuncia foi anonima, 398 (30,8%); os agressores para negligencia foram os pais; para violencia fisica, a madrasta e "outros agressores"; para violencia sexual, o padrasto, "outros familiares/ agressores"; a violencia psicologica foi prevalente entre todas categorias de agressores. CONCLUSOES: Os resultados apontam para a necessidade de divulgacao do "Disque Denuncia"; a formacao de conselheiros, quanto ao registro adequado, assim como a implementacao de politicas de prevencao da violencia contra criancas e adolescentes.

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O perfil da violência contra crianças e adolescentes, segundo registros de Conselhos Tutelares: vítimas, agressores e manifestações de violência

A aprendizagem e a nossa propria vida, nos edu-camos desde que nascemos, ate a morte. Entre-tanto, existem restricoes que impedem o pleno desenvolvimento de nossa liberdade espiritual, enraizadas nos antagonismos estruturais de nos-sa sociedade. E a partir dessa ideia que Mesza-ros pergunta: para alcancar uma transformacao social qualitativa e preciso uma radical mudanca estrutural ou basta uma reforma educacional? Essa e a discussao central desse pequeno grande texto, que retoma e amplia o ultimo capitulo de seu livro

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A educação para além do capital

This qualitative study's objective was to analyze the process of identification of conjugal violence by professionals from the Family Health Strategy in Sao Francisco do Conde/Salvador, Bahia. Interviews were held with 22 professionals (doctors, nurses, social workers and dentists) and, after analysis of the data, the following categories emerged: (Non-) identification of conjugal violence in the Family Health Team; Perception of the violence being restricted to physical aggression; The scale and complexity of the conjugal violence; and Breaking the silence in the Family Health Team. The study showed that identification of conjugal violence occurs during professional assistance. Failure to identify the phenomenon is related to the curriculums which do not cover domestic violence as a health object. This points to the importance of a listening and trusting relationship in the process of identifying this threat to health. It is necessary to adopt strategies for confronting the problem, along with better preparation of professionals, which would give greater visibility to the issue. DESCRIPTORS: Violence against women. Women's health. Family health. Nursing.

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Identificação da violência na relação conjugal a partir da Estratégia Saúde da Família

Objective: to evaluate the accuracy of the version of the Brighton Pediatric Early Warning Score translated and adapted for the Brazilian context, in the recognition of clinical deterioration. Method: a diagnostic test study to measure the accuracy of the Brighton Pediatric Early Warning Score for the Brazilian context, in relation to a reference standard. The sample consisted of 271 children, aged 0 to 10 years, blindly evaluated by a nurse and a physician, specialists in pediatrics, with interval of 5 to 10 minutes between the evaluations, for the application of the Brighton Pediatric Early Warning Score for the Brazilian context and of the reference standard. The data were processed and analyzed using the Statistical Package for the Social Sciences and VassarStats.net programs. The performance of the Brighton Pediatric Early Warning Score for the Brazilian context was evaluated through the indicators of sensitivity, specificity, predictive values, area under the ROC curve, likelihood ratios and post-test probability. Results: the Brighton Pediatric Early Warning Score for the Brazilian context showed sensitivity of 73.9%, specificity of 95.5%, positive predictive value of 73.3%, negative predictive value of 94.7%, area under Receiver Operating Characteristic Curve of 91.9% and the positive post-test probability was 80%. Conclusion: the Brighton Pediatric Early Warning Score for the Brazilian context, presented good performance, considered valid for the recognition of clinical deterioration warning signs of the children studied.

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Accuracy of a pediatric early warning score in the recognition of clinical deterioration.

Resumo O objetivo foi conhecer o itinerario terapeutico de criancas quilombolas em situacao de urgencia/emergencia. Trata-se de uma pesquisa descritiva com abordagem qualitativa com suporte teorico no modelo de Sistema de Cuidados a Saude de Arthur Kleinman. As participantes foram 12 maes de criancas que ja vivenciaram alguma situacao de urgencia ou emergencia. A coleta dos dados ocorreu de dezembro/2013 a junho/2014 por meio de entrevista semiestruturada, com analise tematica dos dados. Os cuidados prestados a crianca se iniciam no subsistema informal e o acesso ao subsistema formal foi caracterizado como uma peregrinacao pelos servicos de saude. E necessario o desenvolvimento de estrategias que garantam o acesso integral e facilitado aos servicos do subsistema profissional pelos quilombolas.

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The therapeutic itinerary in urgent/emergency pediatric situations in a Maroon community.

Estudo quantitativo, descritivo, com o objetivo de identificar caracteristicas socioeconomicas de mulheres e homens com historia de violencia conjugal em Salvador. Realizou-se entrevista com 50 homens e 50 mulheres. Quase todos se autodeclaram negros. Poucos concluiram o ensino medio. Os homens exercem ocupacoes no espaco do publico e as mulheres realizam atividades predominantemente domesticas, mesmo fora de casa. Apenas 3 mulheres (6%) consideram-se independentes economicamente. Isso tem relacao direta com o nivel de escolaridade, por constituir-se pre-requisito para entrada no mercado de trabalho. A situacao e pior para as mulheres pesquisadas, visto o pequeno numero de anos de estudos e o alto grau de dependencia financeira, que interfere no seu empoderamento para o enfrentamento da violencia conjugal.  Os profissionais de saude, em especial da enfermagem, devem contemplar as iniquidades sociais e valorizar o contexto socioeconomico dos usuarios no sentido de identificar situacoes que comprometam a condicao de saude da populacao.

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Climene Laura de Camargo

Papers

Identificação da violência na relação conjugal a partir da Estratégia Saúde da Família

Accuracy of a pediatric early warning score in the recognition of clinical deterioration.

The therapeutic itinerary in urgent/emergency pediatric situations in a Maroon community.

Homens e mulheres em vivência de violência conjugal: características socioeconômicas

A morte e o morrer no cotidiano de estudantes de enfermagem