Dimensões dos Riscos nas Políticas de Combate à Violência Contra a Mulher Durante a Pandemia de COVID-19 em Aracaju (Sergipe) ## Risk Dimensions in Policies to Combat Violence Against Women During COVID-19 in Aracaju (Sergipe)

Relatórios de organizações internacionais e notícias veiculadas na mídia têm apontado o aumento do número de casos de violência doméstica e familiar contra a mulher -VDFM, durante a pandemia da Covid-19. Diante disso, é fundamental compreender a efetividade das políticas públicas desenvolvidas. O objetivo deste trabalho é analisar as dimensões dos riscos nas políticas de combate à VDFM no período de crise sanitária. A pesquisa utilizou um desenho qualitativo de estudo de caso único, sendo a unidade de caso o Departamento de Atendimento a Grupos Vulneráveis - DAGV e, como sujeito da pesquisa, a Delegacia de Atendimento à Mulher - DEAM. A técnica de análise de conteúdo foi utilizada em quatro entrevistas concedidas por servidores do quadro do DAGV. Também foi realizada análise documental em 210 inquéritos abertos entre maio e julho de 2020. Verificou-se que o rol de medidas protetivas de urgência trazidas pela Lei Maria da Penha - LMP - e demais instrumentos de gestão de risco contribuem com a efetividade dos trabalhos da rede de apoio e enfrentamento à VDFM. Porém, há fragilidades que devem ser corrigidas, tais como estrutura física do DAGV, ampliação do efetivo policial, atualização e ampliação do Formulário Nacional de Avaliação de Riscos, atuação multidisciplinar articulada e atualização de práticas de gestão gerencial em toda a rede de apoio. O trabalho contribuiu com a identificação de fatores de riscos no atendimento inicial às vítimas e também na fase de andamento do inquérito. Por fim, faz a apresentação de sugestões para mitigá-los e/ou evitá-los. ABSTRACTReports from international organizations and news broadcasted in the media have pointed out the increase in the number of cases of domestic and family violence against women - VDFM, during the Covid-19 pandemic. Given this, it is essential to understand the effectiveness of the public policies developed. The objective of this paper is to analyze the dimensions of risks in policies to combat VDFM in the period of health crisis. The research used a qualitative design of single case study, being the case unit the Department of Attendance to Vulnerable Groups - DAGV and, as subject of the research, the Police Station of Attendance to Women - DEAM. The technique of content analysis was used in four interviews given by employees of the DAGV. Documentary analysis was also carried out in 210 inquiries opened between May and July 2020. It was verified that the list of urgent protective measures brought by the Maria da Penha Law - LMP - and other instruments of risk management contribute to the effectiveness of the work of the network of support and confrontation to the VDFM. However, there are weaknesses that must be corrected, such as the physical structure of the DAGV, expansion of the police force, updating and expansion of the National Risk Assessment Form, articulated multidisciplinary action, and updating of management practices throughout the support network. The work contributed with the identification of risk factors in the initial care to the victims and also in the progress phase of the investigation. Finally, it makes suggestions to mitigate and/or avoid them.

A Prehospital Emergency Psychiatric Unit in an Ambulance Care Service from the Perspective of Prehospital Emergency Nurses: A Qualitative Study

The prevalence of mental illness is steadily increasing, and ambulance teams frequently attend cases with suspected mental illness. A pilot project, Psychiatric Emergency Response Team (PAP), was carried out in which a prehospital emergency nurse (PEN) was accompanied by a psychiatric specialist nurse in the assessment of individuals with mental illness. The aim of the present study was to evaluate a prehospital emergency psychiatric unit from the perspective of PENs. A qualitative method using content analysis was applied. Seven senior PENs who had worked for 1 year in a prehospital psychiatric ambulance unit were interviewed individually. The analysis resulted in one main theme, “Transition from limited care and insufficient competence to improved and adequate care for psychiatric patients in ambulance care”. This emerged from six subcategories: inter-professional development, access to patient records, the ambulance vehicle, non-conveyed patients, cooperation with the police and meetings with patients and next of kin. In conclusion, these results suggest that in ambulance care in general, there is a lack of knowledge and skills about mental illnesses and initial care options. The PAP concept opened new avenues for the care of patients with mental illness, which the PENs described very positively as being helpful and valuable.

Risk of Myopericarditis following COVID-19 mRNA vaccination in a Large Integrated Health System: A Comparison of Completeness and Timeliness of Two Methods

Purpose: How completely do hospital discharge diagnoses identify cases of myopericarditis after an mRNA vaccine? Methods: We assembled a cohort 12 to 39 years old patients, insured by Kaiser Permanente Northwest, who received at least one dose of an mRNA vaccine (Pfizer BioNTech or Moderna) between December 2020 and October 2021. We followed them for up to 30 days after their second dose of an mRNA vaccine to identify encounters for myocarditis, pericarditis or myopericarditis. We compared two identification methods: A method that searched all encounter diagnoses using a brief text description (e.g., ICD-10-CM code I40.9 is defined as acute myocarditis, unspecified). We searched the text description of all inpatient or outpatient encounter diagnoses (in any position) for myocarditis or pericarditis. The other method was developed by the Centers for Disease Control and Preventions Vaccine Safety Datalink (VSD), which searched for emergency department visits or hospitalizations with a select set of discharge ICD-10-CM diagnosis codes. For both methods, two physicians independently reviewed the identified patient records and classified them as confirmed, probable or not cases using the CDCs case definition. Results: The encounter methodology identified 14 distinct patients who met the confirmed or probable CDC case definition for acute myocarditis or pericarditis with an onset within 21 days of receipt of COVID-19 vaccination. Three of these 14 patients had an ICD-10 code of I51.4 Myocarditis, Unspecified which was overlooked by the VSD algorithm. The VSD methodology identified 11 patients who met the CDC case definition for acute myocarditis or pericarditis. Seven (64%) of the eleven patients had initial care for myopericarditis outside of a KPNW facility and their diagnosis could not be ascertained by the VSD methodology until claims were submitted (median delay of 33 days; range of 12-195 days). Among those who received a second dose of vaccine (n=146,785), we estimated a risk as 95.4 cases of myopericarditis per million second doses administered (95% CI, 52.1 to 160.0). Conclusion: We identified additional valid cases of myopericarditis following an mRNA vaccination that would be missed by the VSDs search algorithm, which depends on select hospital discharge diagnosis codes. The true incidence of myopericarditis is markedly higher than the incidence reported to US advisory committees. The VSD should validate its search algorithm to improve its sensitivity for myopericarditis.

Is It Stevens–Johnson Syndrome or MIS-C with Mucocutaneous Involvement?

Background. Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) can be present in the form of multisystem inflammatory disease in children. Case Presentation. A 25-month-old boy presented with fever, malaise, diffuse maculopapular rashes, and mucosal involvement during the COVID-19 pandemic. He was first diagnosed with Stevens–Johnson syndrome (SJS). Further evaluation revealed lymphopenia, thrombocytopenia, and elevated levels of C-reactive protein (CRP), ferritin, and fibrinogen. This was followed by a positive polymerase chain reaction (PCR) test for COVID-19. In addition to receiving initial care for SJS, he was treated for MIS-C, which led to his recovery after four days. Conclusion. COVID-19 infection should be considered in children with fever and dermatological features during the pandemic because it may cause different features of the multisystem inflammatory syndrome in children (MIS-C), suggestive of delayed hyperimmune response.

ATUAÇÃO DO AGENTE COMUNITÁRIO DE SAÚDE NA ESTRATÉGIA SAÚDE DA FAMÍLIA NA ZONA RURAL

The Community Health Workers (CHW) performs the initial care in households, in order to collect information and interact in a healthy way with the community. It is important to understand the role that these professionals perform in rural areas, as their duties are of fundamental importance within the Family Health Strategy (FHS). Given this, the present study seeks, through a narrative review, to find scientific evidence and information in the available literature regarding the difficulties and challenges of CHW's work in rural areas. After surveying and collecting the results, 15 articles were selected, which showed that the difficulties faced by the CHWs who work in the Family Health Strategy (FHS) in the rural area are mainly related to 1) difficulty of access to rural families, 2) overload of tasks inherent to other professionals of the ESF, 3) low qualification and 4) little recognition. Even with all these difficulties, it was proven that the role of this professional is of extreme significance in promoting health actions and improving the quality of life in the communities in which they act. This study concludes that these professionals have changed the reality of many communities; and that they can optimize their potential in promoting health in rural areas through public policies and initiatives that contribute to minimizing the difficulties related to their work standards.

Healthcare Seeking and Access to Care for Pneumonia, Sepsis, Meningitis, and Malaria in Rural Gambia

Children with acute infectious diseases may not present to health facilities, particularly in low-income countries. We investigated healthcare seeking using a cross-sectional community survey, health facility-based exit interviews, and interviews with customers of private pharmacies in 2014 in Upper River Region (URR) The Gambia, within the Basse Health & Demographic Surveillance System. We estimated access to care using surveillance data from 2008 to 2017 calculating disease incidence versus distance to the nearest health facility. In the facility-based survey, children and adult patients sought care initially at a pharmacy (27.9% and 16.7% respectively), from a relative (23.1% and 28.6%), at a local shop or market (13.5% and 16.7%), and on less than 5% of occasions with a community-based health worker, private clinic, or traditional healer. In the community survey, recent symptoms of pneumonia or sepsis (15% and 1.5%) or malaria (10% and 4.6%) were common in children and adults. Rates of reported healthcare-seeking were high with families of children favoring health facilities and adults favoring pharmacies. In the pharmacy survey, 47.2% of children and 30.4% of adults had sought care from health facilities before visiting the pharmacy. Incidence of childhood disease declined with increasing distance of the household from the nearest health facility with access to care ratios of 0.75 for outpatient pneumonia, 0.82 for hospitalized pneumonia, 0.87 for bacterial sepsis, and 0.92 for bacterial meningitis. In rural Gambia, patients frequently seek initial care at pharmacies and informal drug-sellers rather than community-based health workers. Surveillance underestimates disease incidence by 8–25%.

Organoids from Patient Biopsy Samples can Predict the Response of BC Patients to Neoadjuvant Chemotherapy

Background Neoadjuvant chemotherapy (NAC) has been widely used to treat locally advanced and inflammatory breast cancer. The initial purpose of neoadjuvant chemotherapy in operable breast cancer is to reduce the tumor stage, achieve local control, and increase the conservative operation rate. Another significant advantage of using neoadjuvant chemotherapy is the early identification of unresponsive tumors, predicting the sensitivity of new drugs and promoting the development of new medicines and clinical trials. It is generally believed that complete pathological response (pCR) after neoadjuvant chemotherapy treatment predicts survival. The overall survival rate of patients who achieve pCR is much higher than that of patients who do not. Therefore, it is essential to predict the response of patients to neoadjuvant chemotherapy. There is increasing evidence that patient-derived organoids (PDOs) can be used in cancer research and drug development and for the personalized in vitro evaluation of drug responses.Method We generated a living organoid biobank from locally advanced breast cancer patients receiving neoadjuvant chemotherapy. These patients had three clinically common molecular types of breast cancer (luminal-type, triple-negative and HER2+ breast cancer). When the patient received clinical neoadjuvant chemotherapy, the organoids were treated with similar drugs, thereby simulating the situation of the patient receiving treatmentResult We successfully constructed organoids from breast cancer biopsies to simulate clinical treatment, demonstrating that viable tumoroid lines can be generated from a small sample of tissue. The phenotype of breast cancer organoid often agreed with the original breast cancer according to the blinded histopathological analysis of H&E stain tissue and organoid sections. Our clinical trial data confirm that the patient's response to chemotherapy closely matches the organoids’ response to drugs. The patient-derived organoids may identify breast cancer patients who respond to neoadjuvant chemotherapy and thereby improve initial care.Conclusion Our data indicate that patient-derived organoids can be used to predict the clinical response of breast cancer patients to neoadjuvant chemotherapy in vitro and to screen drugs that have different effects on different patients.

Out of pocket costs and time/productivity losses for pediatric sepsis in Uganda: a mixed-methods study

Background Sepsis disproportionately affects children from socioeconomically disadvantaged families in low-resource settings, where care seeking may consume scarce family resources and lead to financial hardships. Those financial hardships may, in turn, contribute to late presentation or failure to seek care and result in high mortality during hospitalization and during the post discharge period, a period of increasingly recognized vulnerability. The purpose of this study is to explore the out-of-pocket costs related to sepsis hospitalizations and post-discharge care among children admitted with sepsis in Uganda. Methods This mixed-methods study was comprised of focus group discussions (FGD) with caregivers of children admitted for sepsis, which then informed a quantitative cross-sectional household survey to measure out-of-pocket costs of sepsis care both during initial admission and during the post-discharge period. All participants were families of children enrolled in a concurrent sepsis study. Results Three FGD with mothers (n = 20) and one FGD with fathers (n = 7) were conducted. Three primary themes that emerged included (1) financial losses, (2) time and productivity losses and (3) coping with costs. A subsequently developed cross-sectional survey was completed for 153 households of children discharged following admission for sepsis. The survey revealed a high cost of care for families attending both private and public facilities, although out-of-pocket cost were higher at private facilities. Half of those surveyed reported loss of income during hospitalization and a third sold household assets, most often livestock, to cover costs. Total mean out-of-pocket costs of hospital care and post-discharge care were 124.50 USD and 44.60 USD respectively for those seeking initial care at private facilities and 62.10 USD and 14.60 USD at public facilities, a high sum in a country with widespread poverty. Conclusions This study reveals that families incur a substantial economic burden in accessing care for children with sepsis.

Improving the sexual health of young people experiencing homelessness

The sexual health needs of young people experiencing homelessness in the UK have not been researched adequately. This study aimed to examine knowledge and attitudes around sexual health and contraceptive use amongst this vulnerable group to develop suitable models of care in the community. A qualitative ethnographic case-study following Burawoy's extended case method was used. Semi-structured interviews with 29 young people experiencing homelessness and five key workers in London hostels were carried out together with ethnographic observations and analysis of documentary evidence. Thematic analysis was undertaken. Demographic data were collected. Three significant themes were identified: risks and extreme vulnerability, relationships and communication difficulties and emergence of a culture of homelessness. Young people experiencing homelessness require specialist delivery of sexual health care in safe surroundings. Initial care should focus on assessment of basic needs and current state of being. Establishing trusting relationships and considering ongoing vulnerability, can help promote meaningful and personalised sexual healthcare both at policy and practice level.

Abstract 1122‐000033: Automated Detection of Intracerebral Hemorrhage Using Artificial Intelligence: Pilot Deployment of Viz ICH

Introduction : Stroke is a major cause of morbidity and mortality. Hemorrhagic strokes are often more severe and associated with higher mortality when compared to ischemic stroke and account for approximately 13% of all strokes. Initial care for patients with intracerebral hemorrhage (ICH) is in part guided by neuroimaging findings. Non‐contrast computed tomography (NCCT) is often the first imaging obtained in the work up of the acute stroke patient given its diagnostic accuracy for hemorrhage, ubiquity, low cost, and short scan time. Immediate evaluation of imaging by stroke experts, such as neurologists, neurosurgeons, and radiologists, is essential. Artificial intelligence tools can help to expedite image assessment and careteam coordination thereby accelerating time to treatment. In this study, we report on the use of Viz ICH, an AI‐enhanced ICH detection platform, to identify ICH on initial CT and coordinate emergent care in an urban health system with an ICH Center. Methods : All consecutive stroke codes presenting with ICH from May 2019 to August 2019 were eligible for analysis. Non‐contrast CT (NCCT) was conducted for each patient and submitted to the Viz ICH in a prospective fashion. An automated volumetric analysis of these NCCTs was conducted by Viz ICH and assessment was conducted for potential ICH. If suspected ICH was detected, Viz ICH sent an automated prompt to the stroke care team for review. CT impressions provided by radiologists served as the clinical reference standard test and Viz ICH output served as the index test. Diagnostic accuracy tests were then performed. Results : A total of 682 patients were analyzed for ICH, out of which 28 patients were positive for intracerebral hemorrhage (ICH) (4%) and 654 were negative for hemorrhage (96%) based on radiology impressions. Viz ICH was able to correctly identify hemorrhages in 25/28 patients and non‐hemorrhages in 650/654 patients. Overall, the software had high diagnostic accuracy with 89.3% sensitivity, 99.4% specificity, and an overall accuracy of 99.0%. The software also had a positive predictive value of 86.2%, a negative predictive value of 99.5%, a positive likelihood ratio of 145.98, and a negative likelihood ratio of 0.108. Conclusions : Viz ICH is an AI‐enhanced platform that may help in the diagnosis and detection of ICH, with a sensitivity of 89.3 and a specificity of 99.4% in this preliminary study. Though future validation studies with a larger cohort of patients positive for each type of hemorrhage must be conducted for true diagnostic accuracy data, Viz ICH has the potential to be an adjunct tool to streamline ICH triage, reduce treatment delays, and improve outcomes of patients presenting with ICH.