OBJECTIVES: Since there are difficulties in establishing effective treatments for COVID-19, a vital way to reduce mortality is an early intervention to prevent disease progression. This study aimed to evaluate the performance of patients with COVID-19 with acute hypoxic respiratory failure according to pulmonary impairment in the awake-prone position, outside of the intensive care unit (ICU). METHODS: A prospective observational cohort study was conducted on COVID-19 patients under noninvasive respiratory support. Clinical and laboratory data were obtained for each patient before the treatment and after they were placed in the awake-prone position. To identify responders and non-responders after the first prone maneuver, receiver operating characteristic curves with sensitivity and specificity of the PaO2/FiO2 and SpO2/FiO2 indices were analyzed. The maneuver was considered positive if the patient did not require endotracheal intubation for ventilatory assistance. RESULTS: Forty-eight patients were included, and 64.6% were categorized as responders. The SpO2/FiO2 index was effective for predicting endotracheal intubation in COVID-19 patients regardless of lung parenchymal damage (area under the curve 0.84, cutoff point 165, sensitivity 85%, specificity 75%). Responders had better outcomes with lower hospital mortality (hazard ratio [HR]=0.107, 95% confidence interval [CI]: 0.012-0.93) and a shorter length of stay (median difference 6 days, HR=0.30, 95% CI: 0.13-0.66) after adjusting for age, body mass index, sex, and comorbidities. CONCLUSIONS: The awake-prone position for COVID-19 patients outside the ICU can improve oxygenation and clinical outcomes regardless of the extent of pulmonary impairment. Furthermore, the SpO2/FiO2 index discriminates responders from non-responders to the prone maneuver predicting endotracheal intubation with a cutoff under or below 165.

Resumo Este artigo tem como objetivo saber como vem se constituindo a Rede de proteção dos direitos das crianças e dos adolescentes a partir das práticas dos atores sociais. Participaram do estudo dez atores sociais que atuam na Rede de proteção dos direitos da criança e do adolescente numa cidade de porte médio no norte do Tocantins. Optou-se por uma abordagem qualitativa, utilizando-se da entrevista semiestruturada para coleta de dados; e para análise dos dados, a Análise de Conteúdo de Bardin. Dentre os principais resultados, percebeu-se uma Rede desestruturada, caracterizada pela falta de articulação entre as instituições que a compõem, além da falta de capacitação e conhecimento dos atores sociais, no que se refere inclusive a aspectos legais. Mesmo com todo avanço na legislação, os direitos positivados na lei não são suficientes para que haja a proteção da criança e do adolescente, pois as práticas das instituições e dos atores sociais não consideram a condição peculiar do desenvolvimento, nem o princípio da dignidade humana, visto que são práticas baseadas em paradigmas higienistas, que servem como mecanismos de controle em detrimento da política de proteção integral.

Abstract This paper aims to know how the Network for the protection of the rights of children and adolescents has been constituted based on the practices of social actors. Ten social actors working in the Network for the Protection of the Rights of Children and Adolescents participated in the study in a medium-sized city in the north of Tocantins. We chose a qualitative approach, data were collected by means of semi-structured interviews and analyzed using Bardin’s Content Analysis. The speeches of the social actors reveal a destructured Network marked by a lack of articulation between the institutions that make it up, as well as a lack of training and knowledge, including in terms of legal aspects, by social workers. Despite the progress in legislation, the rights provided by law do not sufficiently protect children and adolescents, because the practices performed by institutions and social actors do neither take into account the specific condition of development, nor the principle of human dignity, given the fact that these practices are based on hygienist paradigms that are used as control mechanisms, to the detriment of the Integral Protection policy.

Resumen Este artículo tiene como objetivo saber cómo se viene constituyendo la Red de protección de los derechos de los niños y de los adolescentes a partir de las prácticas de los actores sociales. Participaron del estudio diez actores sociales que actúan en la Red de protección de los derechos del niño y del adolescente en una ciudad de tamaño mediano en el norte de Tocantins. Se optó por un enfoque cualitativo, utilizando la entrevista semiestructurada para la recolección de datos; y para el análisis de los datos, el Análisis de Contenido de Bardin. Entre los principales resultados, se percibió una Red desestructurada, caracterizada por la falta de articulación entre las instituciones que la componen, además de la falta de capacitación y conocimiento de los actores sociales, en lo que se refiere incluso a aspectos legales. . A pesar de todo el avanzo en la legislación, los derechos positivos en la ley no son suficientes para que haya la efectiva protección del niño y del adolescente, pues las prácticas de las instituciones y de los actores sociales no consideran la condición peculiar del desarrollo, ni el principio de la dignidad humana, ya que son prácticas basadas en paradigmas higienistas, que sirven como mecanismos de control en detrimento de la política de protección integral.

Neste artigo, apresentam-se dados de pesquisa sobre a percepção dos Agentes Sociais que atuam no enfrentamento da exploração sexual comercial de crianças e adolescentes. As entidades caracterizam-se por Organizações Governamentais, Organizações Não-Governamentais, Sistema de Justiça e Instâncias de Direitos. Compõem uma Rede de 15 instituições e foram entrevistados 31 Agentes Sociais de 12 delas. Utilizou-se um questionário composto de questões abertas e fechadas sobre: Conhecimento do Sistema de Proteção; Percepção da ESCCA; Formas de Enfrentamento da ESCCA; Procedimentos e Medidas em casos de suspeitas, identificações, denúncias e notificações. A maioria dos Agentes Sociais tem conhecimento do papel da instituição, embora alguns desconheçam parte da Legislação e as formas de se efetivar na prática o papel daquelas e a articulação interinstitucional.

This article shows the data collected in a research regarding the perception of Social Agents who act in fighting children and adolescents' commercial sexual exploitation. The networking is composed by Governmental Organizations, Non-governmental Organizations, Justice System and Human Rights entities. They compose a network of 15 institutions, and 31 Social Agents who belonged to 12 of them were interviewed. It was used a questionnaire composed by open and closed questions about protection systems knowledge; perception of children and adolescents' commercial sexual exploitation; forms of fighting children and adolescents' commercial sexual exploitation; procedures and actions in case of suspicion, identification, denunciation and notification. Most of the Social Agents who make part of the network know the role of the institution where they work, although some of them do not know part of the Legislation which deals with this problematic and they also do not know the forms to effectuate in practice the purpose of the Legislation and its inter-institutional articulation.