Government strategies in confronting COVID-19 in the republic of Cuba

BACKGROUND: In Cuba, the first cases of coronavirus 2019 (COVID-19) were confirmed on March 11, 2020, when the World Health Organization (WHO) officially declared the pandemic and the Ministry of Public Health of Cuba (MINSAP) began to execute the COVID-19 Prevention and Control Plan. This plan was prepared two months earlier by MINSAP working together with the National Civil Defense and the government approved it at the end of January. OBJECTIVE: The aim of this research is to assess the effectiveness of the government strategies to deal with COVID-19, by analyzing the role of the different agencies involved in the pandemic management. METHODS: A bibliographical review of the following documents was conducted: information issued by MINSAP and other ministries, archives of the Pedro Kouri Institute (IPK) and Cuban journals regarding the high impact in the field of medicine. The data were processed with different tools (diagrams, bar graphs, analysis and synthesis, etc.) that allowed measuring the effectiveness of the strategies implemented. RESULTS: The government’s strategies focused on: the integration of all state agencies and some private institutions to confront COVID-19; the collaboration between MINSAP specialists, country’s research centers and universities for the creation of vaccines to contain the pandemic; the production of medical equipment and instruments; the design of the organization processes of the services, such as planning techniques and distribution of ambulances, allocation of hospitals and isolation centers for sufferers and direct contacts respectively. CONCLUSION: The analysis carried out showed that the interrelations between the different organizations involved had positive influences on the treatment of the pandemic.

Analysis of government agencies and stakeholders’ twitter communications during the first surge of COVID-19 in Brazil

BACKGROUND: Official authorities are in charge of communicating with the public in a consistent and coherent manner. The impact of social media on managing the coronavirus 2019 (COVID-19) pandemic potentially influenced social behavior in Brazil. OBJECTIVE: Using Twitter, this study analyzes communications about the COVID-19 pandemic from official agencies of the Brazilian government and key public sector decision-makers. METHOD: We captured public Twitter messages about COVID-19 exchanged between authorities at the federal, state, and municipal levels of government. These messages were further classified into guidance and information messages or disinformation messages. Finally, through analysis of tweets and their frequency, we evidenced the level of information generated by the three levels of government. RESULTS: Our analyses show an underestimation of the magnitude of the pandemic by Brazilian government authorities. None of the spheres of government anticipated the imminent health crisis, did not issue good recommendations and guidelines, and did not take preventive actions. CONCLUSION: The lack of governmental actions and adequate guidance in Brazil has led to an explosive increase in infected people and deaths. Surprisingly, this was not due to technical or structural reasons. It resulted from conflicting communication strategies implemented by the federal, state, and municipal governments in attempts to minimize the effects of COVID-19 on their local health structures.

Social networks applied to Dengue, H1N1, and Zika epidemics: An integrative literature review

BACKGROUND

Health crises occur both regionally and globally. Online social networks are widely used technical resources that allow users to share large amounts of information with increasing reach and velocity. Thus, the capacity of spreading information about epidemics through social media allows members of a population and health professionals or agencies to collaborate.

METHOD

This study presents results obtained in an integrative review, including examples of how social media enabled collaboration in health surveillance to treat the epidemies of Dengue, Zika, and H1N1. The literature review covers studies published between 2009 and 2017.

RESULTS

The studies reviewed indicate that social media interactions are tools for the rapid dissemination of information. These networks operate at low cost and allow information to reach audiences in need of information and who otherwise would not receive it. Social media allowed researchers to monitor evolving epidemics and obtain epidemiological data useful for decision-making in health surveillance.

CONCLUSIONS

Despite the widespread use of social networks, there are opportunities for improvement, especially in technology for treatment.

Syphilis: A Cohort Study on prevalence, among recently HIV diagnosed in São Paulo, Brazil

Introduction

The Sexually Transmitted Infections (STIs) are a Public Health problem concern Worldwide. They not only have a direct, but also an indirect impact on sexual Health in afflicted person's life, as they facilitate the sexual transmission of Human Immunodeficiency Virus (HIV). In 2016, the World Health Organization (WHO) estimated 6,3 million new Syphilis infections out of 376 million STIs (95% CI: 5,5-7,1 million). The worldwide prevalence of Syphilis is 0,5% (95% IC: 0,4-0,6). WHO is also concerned about Brazilian syphilis rates infection, since its sexual transmission increased from 59,1 cases in 2017, to 75,8 cases out of 100.000 persons, in 2018.

Objectives

Demographic analysis, incidence and prevalence rates of syphilis among recently HIV diagnosed Adults in a Center of São Paulo, Brazil

Patients and Methods

A Cohort Study in a population of 576 persons recently HIV diagnosed from September/2013 to July/2019. The rates were obtained by performing a nontreponemal test: Venereal Disease Research Laboratory (VDRL)

Results

Epidemiological analysis from 576 persons: 53,3% were Caucasian, 80% were Men who have sex with Men (MSM), 49% had more them 3 occasional partners, the average age was 30 y.o. and the median age was 28 y.o.18 - 65). Prevalence of Syphilis: 16,3%. Incidence rate: 9,6 persons/year.

Conclusions

considering that the STIs including syphilis, facilitate HIV transmission and also other STIs, we need to perform a stricter ISTs surveillance in the sexually active population, mainly in MSM to reduce all the STIs including HIV.

Key messages

Demographic analysis, incidence and prevalence rates of syphilis among recently HIV diagnosed Adults in a Center of São Paulo, Brazil. The Sexually Transmitted Infections (STIs) are a Public Health problem concern Worldwide.

Reflections on work as done (WAD) and work as imagined (WAI) in an emergency response organization: A study on firefighters training exercises

Emergency response organizations need to be resilient to cope with escalating events resulting from dynamic, unexpected, or complex situations. In Brazil, the Firefighter Corps are military hierarchal organizations with a culture based on fixed structures, well defined norms and procedures. These push against innovations which are necessary to be resilient. This research describes how firefighter captains in the 30-35-year age range managed an emergency response escalation in light of standard operating procedures (SOPs) during a training exercise. The study used ethnographic methods to find and discuss gaps between the instructions and the activities carried out during the exercise, highlighting the differences between work as done (WAD) and work as imagined (WAI), as it was instantiated in the SOP prescriptions. The aim was to produce reflections on WAI and WAD as a way to raise awareness of the need for a cultural change toward resilience in firefighter organizations. This was achieved through firefighter engagement with a comprehensive visualization of the analysis results which afforded easy interaction between the experts, the data, and the researchers.

Ergonomics, safety, and resilience in the helicopter offshore transportation system of Campos Basin

BACKGROUND

Air transportation of personnel to offshore oil platforms is one of the major hazards of this kind of endeavor. Pilot performance is a key factor in the safety of the transportation system.

OBJECTIVE

This study seeks to identify the ergonomic factors present in pilots' activities that may in some way compromise or enhance their performance, the constraints and affordances which they are subject to; and where possible to link these to their associated risk factors.

METHODS

Methodology adopted in this project studies work in its context. It is a merging of Activity Analysis (Guerin et al. 2001) of European tradition with Cognitive Task Analysis (CTA - www.ctaresource.com) articulated with the recent approaches to cognitive systems engineering developed by Professors David Woods and Erik Hollnagel. Fifty-five hours of field interviews provided the input for analysis.

RESULTS

Sixteen ergonomic constraints were identified, some cognitive, some physical, all considered relevant by the research subjects and expert advisers.

CONCLUSIONS

Although the safety record of the personnel transportation system studied is considered acceptable, there is low hanging fruit to be picked which can help improve the system's safety.

Radiological emergency response for community agencies with cognitive task analysis, risk analysis, and decision support framework

Radiological nuclear emergency responders must be able to coordinate evacuation and relief efforts following the release of radioactive material into populated areas. In order to respond quickly and effectively to a nuclear emergency, high-level coordination is needed between a number of large, independent organizations, including police, military, hazmat, and transportation authorities. Given the complexity, scale, time-pressure, and potential negative consequences inherent in radiological emergency responses, tracking and communicating information that will assist decision makers during a crisis is crucial. The emergency response team at the Angra dos Reis nuclear power facility, located outside of Rio de Janeiro, Brazil, presently conducts emergency response simulations once every two years to prepare organizational leaders for real-life emergency situations. However, current exercises are conducted without the aid of electronic or software tools, resulting in possible cognitive overload and delays in decision-making. This paper describes the development of a decision support system employing systems methodologies, including cognitive task analysis and human-machine interface design. The decision support system can aid the coordination team by automating cognitive functions and improving information sharing. A prototype of the design will be evaluated by plant officials in Brazil and incorporated to a future trial run of a response simulation.

Analysis of the resilience of team performance during a nuclear emergency response exercise

The current work presents results from a cognitive task analysis (CTA) of a nuclear disaster simulation. Audio-visual records were collected from an emergency room team composed of individuals from 26 different agencies as they responded to multiple scenarios in a simulated nuclear disaster. This simulation was part of a national emergency response training activity for a nuclear power plant located in a developing country. The objectives of this paper are to describe sources of resilience and brittleness in these activities, identify cues of potential improvements for future emergency simulations, and leveraging the resilience of the emergency response system in case of a real disaster. Multiple CTA techniques were used to gain a better understanding of the cognitive dimensions of the activity and to identify team coordination and crisis management patterns that emerged from the simulation exercises.

[Socio-environmental vulnerability, disaster risk-reduction and resilience-building: lessons from the earthquake in Haiti and torrential rains in the mountain range close to Rio de Janeiro in Brazil]

Data on disasters around the world reveal greater seriousness in countries with lower social and economic development levels. In this context, disaster risk-reduction and resilience-building policies are priorities in the sustainable development agenda, featuring among the topics selected for the Rio+20 Summit. By means of a contribution of a conceptual nature and from examples of disasters in countries with different development levels, namely the Haiti earthquake and the torrential rains in the mountain range close to Rio de Janeiro in Brazil, the scope of this article is to demonstrate how socio-environmental vulnerability creates conditions for disasters, while at the same time limiting strategies for their prevention and mitigation. Lastly, some of the measures that disaster risk reduction and resilience-building demand in a socio-environmental vulnerability context are highlighted. These involve changes in the current patterns of social, economic and environmental development geared toward ecological sustainability and social justice as pillars of sustainable development.

Normal people working in normal organizations with normal equipment: system safety and cognition in a mid-air collision

A fundamental challenge in improving the safety of complex systems is to understand how accidents emerge in normal working situations, with equipment functioning normally in normally structured organizations. We present a field study of the en route mid-air collision between a commercial carrier and an executive jet, in the clear afternoon Amazon sky in which 154 people lost their lives, that illustrates one response to this challenge. Our focus was on how and why the several safety barriers of a well structured air traffic system melted down enabling the occurrence of this tragedy, without any catastrophic component failure, and in a situation where everything was functioning normally. We identify strong consistencies and feedbacks regarding factors of system day-to-day functioning that made monitoring and awareness difficult, and the cognitive strategies that operators have developed to deal with overall system behavior. These findings emphasize the active problem-solving behavior needed in air traffic control work, and highlight how the day-to-day functioning of the system can jeopardize such behavior. An immediate consequence is that safety managers and engineers should review their traditional safety approach and accident models based on equipment failure probability, linear combinations of failures, rules and procedures, and human errors, to deal with complex patterns of coincidence possibilities, unexpected links, resonance among system functions and activities, and system cognition.

Handoff strategies in settings with high consequences for failure: lessons for health care operations

OBJECTIVE

To describe strategies employed during handoffs in four settings with high consequences for failure.

DESIGN

ANALYSIS

of observational data for evidence of use of 21 handoff strategies.

SETTING

NASA Johnson Space Center in Texas, nuclear power generation plants in Canada, a railroad dispatch center in the United States, and an ambulance dispatch center in Toronto.

MAIN MEASURE

Evidence of 21 handoff strategies from observations and interviews.

RESULTS

Nineteen of 21 strategies were used in at least one domain, on at least an 'as needed' basis.

CONCLUSIONS

An understanding of how handoffs are conducted in settings with high consequences for failure can jumpstart endeavors to modify handoffs to improve patient safety.

[Infant mortality in a midwestern municipality of the State of São Paulo, Brazil, 1990 to 1992]

INTRODUCTION

Infant mortality was studied in an urban area of Southeastern Brazil in the period from 1990 to 1992 using data from death certificates collected at the registry office, by the application of methods for obtaining a collective diagnosis which will assist in the identification and choice of strategies for the control of local problems.

MATERIAL AND METHOD

The original data were corrected using documental research into health services and household interviews. Data of the Live Birth Information System (SINASC) was used to study variables such as maternal age and birthweight. The quality of original death certificates was initially analyzed using the amount of information, sensitivity, specificity and Kappa value.

RESULTS

The global sensitivity for the underlying cause was 78.84% and Kappa 71.32% for the total of causes. One hundred and eighty-nine deaths occurred, 66.15% of them in the neonatal period, (41.28% during the first day of life) and 33.85% in late childhood. The birthweight of 58.28% of deaths was less than 2.500 g. The underlying causes of death were studied the by possibility, of their avoidance (a method developed by Erica Taucher), by a "reduced" group of causes (utilized in International Collaborative Effort (ICE)), multiple causes statistics and geographical distribution. It was observed that in the deaths occurring up to 27 days, 22.23% could have been avoided by adequate care during labour, and 20.64% could have been avoided by early diagnosis and early treatment, 13.75% by good pregnancy care and only 7.94% were unavoidable. Of the deaths occurring in late childhood, 12.17% were classified as of avoidable causes and 4.23% were considered as unavoidable. Using ICE groups, 58.74% died of immaturity or asphyxia, 19.58 of infection and 12.17% from congenital abnormalities.

CONCLUSIONS

The results suggest that priority be given to obstetrical care at delivery and during labour and to the pediatric care of low birth weight, among others. The analysis using multiple causes statistics shows that 76.05% of the deaths have underlying causes related to neonatal disorders and confirms the relationship with the weight deficiencies of the newborn. The maternal complications were also related to weight deficiencies. Great differences were identified in infant mortality rates in urban zones not only restricted to the value of the rates but also to the diseases responsible for the occurrence of deaths. We therefore conclude that there is an advantage to be gained in using the four methods, which are complementary, for studying or planning actions with a view to prevent infant mortality.