This study was designed to analyze actions in mental health from the psychosocial care network through the perspective of users. Fourth-generation participatory methodology was used. The findings highlight the challenges of implementing mental health services in primary care and in different points of the psychosocial network, as users recognize the existence of a health network but indicate limited access to it, because, as they see it, actions could be undertaken in spaces that would facilitate their inclusion and integration with the community. There is weakness in the articulation and in the implementation of integrated care plans in services and, consequently, mental health needs to remain centralized in specialized services, showing strong inhibition of the work in the psychosocial care network. We concluded that the limits of working in networks present challenges in the daily life of service users and in the construction of new possibilities and progress towards social inclusion. Keywords: Mental Health; Users; Primary Health Care; Psychosocial Care Network; Participative Evaluation. CorrespondenceMaria Inês Badaró Moreira Rua Silva Jardim, 136, sala 218, Vila Matias. Santos, SP, Brazil. CEP 11015-000. Resumo O objetivo deste artigo é analisar ações em saúde mental a partir da rede de atenção psicossocial pela perspectiva dos usuários. Usou-se metodologia participativa de quarta geração. De acordo com os resultados, os dados evidenciam desafios na implementação de ações de saúde mental na atenção básica e em diferentes pontos da rede psicossocial, visto que os usuários reconhecem a existência de uma rede de saúde, mas indicam acesso limitado a ela, pois entendem que as ações poderiam ser realizadas em espaços facilitadores de sua aproximação e inserção na comunidade. Há fragilidade na articulação e na efetivação de cuidados integrados nos serviços e, consequentemente, as demandas de saúde mental se mantêm centralizadas nos serviços especializados, demonstrando forte inibição do trabalho em rede. Conclui-se que os limites do trabalho em rede apresentam desafios no cotidiano dos usuários dos serviços e apontam outros desafios para a construção de novas possibilidades e avanços em direção à inserção social. Maria Inês Badaró Moreira

In Europe, the respiratory syncytial virus (RSV) surveillance system is very heterogeneous and there is growing evidence of the importance of RSV infections resulting in hospitalization of elderly patients. The aim of this study was to assess the severity of RSV infection in the elderly living in the aged Southern European countries. We conducted a retrospective study of elderly patients ( ≥65‐year old) admitted for laboratory‐confirmed RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons (2017–2018). Uni‐multivariable analyses were carried out to evaluate the effect of clinical variables on radiologically confirmed pneumonia, use of noninvasive ventilation (NIV), and in‐hospital death (IHD). A total of 166 elderly patients were included. Pneumonia was evident in 29.5%. NIV was implemented in 16.3%, length of stay was 11.8 ± 12.2 days, and IHD occurred in 12.1%. Multivariable analyses revealed that the risk of pneumonia was higher in patients with chronic kidney disease (CKD) (odds ratio [OR]: 2.57; 95% confidence interval [CI]: 1.12–5.91); the use of NIV was higher in patients with obstructive sleep apnea or obesity hypoventilation syndrome (OSA or OHS) (OR: 5.38; 95% CI: 1.67–17.35) and CKD (OR: 2.52; 95% CI: 1.01–6.23); the risk of IHD was higher in males (OR: 3.30; 95% CI: 1.07–10.10) and in patients with solid neoplasm (OR: 9.06; 95% CI: 2.44–33.54) and OSA or OHS (OR: 8.39; 95% CI: 2.14–32.89). Knowledge of factors associated with RSV infection severity may aid clinicians to set priorities and reduce disease burden. Development of effective antiviral treatment and vaccine against RSV is highly desirable.

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SARS-CoV-2 dramatically revealed the sudden impact of respiratory viruses in our lives. Influenza and respiratory syncytial virus (RSV) infections are associated with high rates of morbidity, mortality, and an important burden on healthcare systems worldwide, especially in elderly patients. The aim of this study was to identify severity predictors in the oldest-old admitted with influenza and/or RSV infections. This is a multicenter, retrospective study of all oldest-old patients (≥ 85 years old) admitted for laboratory-confirmed influenza and/or RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons. The outcomes included the following: pneumonia on infection presentation, use of non-invasive ventilation (NIV), and in-hospital death (IHD). The association with possible predictors, including clinical features and type of virus infection, was assessed using uni-and multivariable analyses. A total of 251 oldest-old patients were included in the study. Pneumonia was evident in 32.3% (n = 81). NIV was implemented in 8.8% (n = 22), and IHD occurred in 13.9% (n = 35). Multivariable analyses revealed that chronic obstructive pulmonary disease (COPD) or asthma was associated with pneumonia (OR 1.86; 95% CI 1.02-3.43; p = 0.045). COPD or asthma (OR 4.4; 95% CI 1.67-11.6; p = 0.003), RSV (OR 3.12; 95% CI 1.09-8.92; p = 0.023), and influenza B infections (OR 3.77; 95% CI 1.06-13.5; p = 0.041) were associated with NIV use, respectively, while chronic kidney disease was associated with IHD (OR 2.50; 95% CI 1.14-5.51; p = 0.023). Among the oldest-old, chronic organ failure, such as COPD or asthma, and CKD predicted pneumonia and IHD, respectively, beyond the importance of viral virulence itself. These findings could impact on public health policies, such as fostering influenza immunization campaigns, home-based care programs, and end-of-life care. Filling knowledge gaps is crucial to set priorities and advise on transition model of care that best fits the oldest-old.

Trata-se de relato de experiência de estágio interdisciplinar em Nutrição Social e em Psicologia da Universidade Federal de São Paulo campusBaixada Santista, com foco na integralidade da atenção. O trabalho ocorreu entre 2010 e 2012, na Atenção Básica de Saúde do Sistema Único de Saúde no território Centro/Morro do município de Santos, São Paulo. Utilizaram-se registros de campo contendo memórias de supervisões e de reuniões entre professores e equipe de saúde. Construíram-se narrativas e projetos terapêuticos singulares. Em supervisão conjunta de professores de Nutrição e Psicologia, debateram-se situações destacadas pelos estudantes e planos de trabalho construídos para cada ciclo de formação. Isto fundamentou práticas interdisciplinares, reflexões e ações consoantes ao Sistema Único de Saúde, realizadas pelos estagiários. Os resultados corroboram a importância do trabalho interdisciplinar para a promoção da integralidade, constituindo formas de escuta e atenção diferenciadas aos usuários, em estreita relação com os serviços.