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In 2015, a range of congenital anomalies resulting from mother-to-child transmission of the zika virus emerged. Later called congenital zika syndrome (CZS), the condition includes microcephaly. Since then, around 4,000 children have been affected in 27 countries, with Brazil accounting for the largest proportion of cases. Family caregivers have also been affected. This study analyzes the literature on caregivers of children with CZS and how the disease has affected their everyday lives. We conducted an integrative review using the PubMed, Virtual Health Library, and Embase databases. Thirty-one articles were identified for analysis after screening. The findings were grouped into four categories: a) social impacts - changes in family relationships, life projects, and social life; b) subjective impacts - feelings of resilience, loneliness, grief, overburdening, fear, uncertainty, and spirituality and religion; c) economic and material impacts - loss of income, increased household expenses, change of residence, and unemployment; and d) health impacts - service unpreparedness, selflessness, self-care, changes in nutritional and sleep patterns, and mental health problems, including stress, anxiety and depression.

Resumo Em 2015, um espectro de anomalias congênitas, incluindo microcefalia, acometeu recém-nascidos como resultado da transmissão vertical pelo vírus zika, posteriormente denominada síndrome congênita do zika (SCZ). Desde então, cerca de 4 mil crianças foram afetadas em 27 países, sendo o Brasil o mais atingido. Cuidadores familiares também têm sido impactados. Esse estudo analisa publicações científicas que investigam as maneiras como a doença afetou as dinâmicas de vida de cuidadores familiares de crianças com SCZ. Realizou-se uma revisão integrativa de literatura consultando as bases de dados PubMed, Biblioteca Virtual em Saúde e Embase. Após as etapas de triagem, foram identificados 31 artigos. Os principais resultados foram agrupados em quatro categorias: a) impactos sociais que evidenciaram mudanças nas relações familiares, nos projetos de vida e no convívio social; b) impactos subjetivos - sentimentos de resiliência, solidão, luto, sobrecarga, medo, incerteza e relação com a espiritualidade; c) impactos econômicos e materiais - perda de renda, aumento de despesas, mudança de moradia e desemprego e d) impactos na saúde - despreparo dos serviços, renúncia do cuidado de si, modificações dos padrões nutricionais e de sono, repercussão para a saúde mental e níveis de estresse, ansiedade e depressão.

IntroductionThe disparities in the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among frontline health care workers (HCWs) and the unique work circumstances are poorly documented for low-and middle-income countries.MethodsWe assessed the frequency of SARS-CoV-2 infection, personal protective equipment (PPE) shortages, PPE use, and accidents involving biological material among HCWs in the Recife metropolitan area, Northeast Brazil. Using respondent driven sampling, we included HCWs attending suspected or confirmed COVID-19 patients from May 2020 to February 2021.ResultsWe analyzed 1,525 HCWs (527 physicians, 471 registered nurses, 263 nursing assistants/technicians, and 264 physical therapists). Women predominated in all categories (81.1%). Nurses were older and had more comorbidities (hypertension and overweight/obesity) than the other HCWs. The overall prevalence of SARS-CoV-2 infection was 61.8% after adjustment for the cluster random effect, weighted by network, and reference population size. The independent risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56), not always using all recommended PPE in routine practice (ORadj: 2.15), and reporting a splash of biological fluid/respiratory secretion in the eyes (ORadj: 3.37).ConclusionsThe high risk of infection among HCWs reflects PPE shortages and younger, possibly less experienced, frontline HCWs. There were disparities in the risk of SARS-CoV-2 infection among HCWs, with nursing assistants being the most vulnerable, possibly due to their longer and frequent contact with COVID-19 patients.

Background: The disparities in the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among frontline health care workers (HCWs) and the unique work circumstances are poorly documented for low-and middle-income countries. Methods: We assessed the frequency of SARS-CoV-2 infection, personal protective equipment (PPE) shortages, PPE use, and accidents involving biological material among HCWs in the Recife metropolitan area, Northeast Brazil. Using respondent driven sampling, we included HCWs attending suspected or confirmed COVID-19 patients from May 2020 to February 2021. Findings: We analyzed 1,525 HCWs (527 physicians, 471 registered nurses, 263 nursing assistants/technicians, and 264 physical therapists). Women predominated in all categories (81·1%). Nurses were older and had more comorbidities (hypertension and overweight/obesity) than the other HCWs. The overall prevalence of SARS-CoV-2 infection was 61·8% after adjustment for the cluster random effect, weighted by network, and reference population size. The independent risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2·56), not always using all recommended PPE in routine practice (ORadj: 2·15), and reporting a splash of biological fluid/respiratory secretion in the eyes (ORadj: 3·37). Interpretation: The high risk of infection among HCWs reflects PPE shortages and younger, possibly less experienced, frontline HCWs. There were disparities in the risk of SARS-CoV-2 infection among HCWs, with nursing assistants being the most vulnerable, possibly due to their longer and frequent contact with COVID-19 patients. Funding Information: This investigation was funded by Health Technology Assessment Institute (IATS) and by MCTIC/CNPq/FNDCT/MS/SCTIE/Decit No 07/2020. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Providing electronic informed consent was mandatory to participate and access the questionnaire. The project was approved by the National Ethics Committee (CONEP; CAAE: 30629220.8.0000.0008).

To evaluate the results of a structured intervention in primary healthcare to improve type 2 diabetes management.The intervention was implemented in 2011-2012 in two cities in the State of Pernambuco, Brazil, and evaluated in 2013 by interviewing healthcare professionals about their practices in all primary care facilities of these two cities (intervention group), and of two paired control cities (control group). Comparisons between the intervention and control groups were made using standard parametric tests.The percentage of professionals who measured adherence to treatment, developed educational actions to control high-risk situations or prevent complications, or declared that they "explained" the disease to the patients, was higher in the control group (p0.05). Multidisciplinary involvement, requests for electrocardiograms and referrals to specialists were also more frequent in the control group (p0.01). The only differences favoring the intervention group were the higher proportion of nurses (p0.05) and community health workers (p0.01) trained for diabetes management and a greater frequency of discussing the cases of diabetic patients at team meetings (p0.01).These negative results raise questions about the effectiveness of actions aiming to improve diabetes management in primary care, and reinforce the need for careful evaluation of their impact.

Aims The aim of this study was to determine correlates of physical activity (PA) counseling by health providers of the Brazilian primary care delivery system, for hypertensive and diabetic subjects, as well as correlates of actual leisure-time PA of these subjects. Methods This was a cross-sectional study conducted in random samples of 785 hypertensive and 822 diabetic subjects, in the State of Pernambuco, Brazil. Relationships between PA counseling and leisure-time PA and explanatory variables were sought through multiple logistic regressions. Results PA counseling had been received by 59.4% of the diabetic and 53.0% of the hypertensive subjects; around 30% of the diabetic and the hypertensive subjects declared having leisure-time PA. After adjustment, factors associated with PA counseling for diabetic subjects were: female gender, formal schooling, hypertension, obesity; for hypertensive subjects: being on a weight-loss diet, age between 60 and 74 and over 75. For both subject groups, leisure-time PA was more frequent when they lived in a medium-sized municipality, were female, aged between 60 and 75, and on a weight-loss diet. Conclusion PA counseling appeared restricted to subjects with excess weight and/or cardiovascular risk factors when it should be directed to all subjects with hypertension or diabetes.

Objetivo: revisão sistemática de artigos publicados sobre o envelhecimento ativo e determinantes sociais relativos ao estilo de vida. Métodos: pesquisa em artigos nas bases de dados PubMed e Lilacs publicados entre os anos de 2012 e 2014 nos idiomas português, inglês e espanhol. Resultados: oito artigos compuseram o produto final da seleção, apresentando delineamento seccional em cinco trabalhos e coorte prospectiva nos outros três. Os estudos tiveram origem na Coreia do Sul, na China, no Reino Unido, na Suécia, na Alemanha, na Austrália e nos Estados Unidos. Os componentes referentes ao estilo de vida identificados foram: variáveis culturais, atividades físicas, lazer, expectativas de resultados e posse de animal de estimação. As variáveis para o envelhecimento ativo foram qualidade de vida, satisfação com a vida, atividade física e autoavaliação da saúde. Discussão: inferiu-se que pesquisas sobre temas relativos à qualidade de vida no envelhecimento são mais presentes nos países que têm uma realidade que vai ao encontro da teoria. Práticas saudáveis, ainda que adotadas somente na velhice, mostraram-se eficazes na conquista de um bem-estar. Conclusão: todos os trabalhos apresentados demonstram uma relação estreita entre o envelhecimento ativo e os determinantes sociais relativos ao estilo de vida. As ações cotidianas implicam no processo de envelhecer enquanto curso de vida, sejam elas físicas, emocionais, sociais ou mentais.