Monitoramento das Produções

by Kadhim Al-Banaa, Abbas Alshami, Eiman Elhouderi, Sally Hannoodee, Maryam Hannoodee, Alsadiq Al-Hillan, Hussam Alhasson, Faisal Musa, Joseph Varon, Sharon Einav
Purpose Coagulopathy is common in patients with COVID-19. The ideal approach to anticoagulation remains under debate. There is a significant variability in existing protocols for anticoagulation, and these are mostly based on sporadic reports, small studies, and expert opinion. Materials and methods This multicenter retrospective cohort study evaluated the association between anticoagulation dose and inpatient mortality among critically ill COVID-19 patients admitted to the intensive care units (ICUs) or step-down units (SDUs) of eight Beaumont Healthcare hospitals in Michigan, USA from March 10th to April 15th, 2020. Results Included were 578 patients with a median age of 64 years; among whom, 57.8% were males. Most patients (n = 447, 77.3%) received high dose and one in four (n = 131, 22.7%) received low dose anticoagulation. Overall mortality rate was 41.9% (n = 242). After adjusting for potential confounders (age, sex, race, BMI, ferritin level at hospital admission, intubation, comorbidities, mSOFA, and Padua score), administration of high anticoagulation doses at the time of ICU/SDU admission was associated with decreased inpatient mortality (OR 0.564, 95% CI 0.333–0.953, p = 0.032) compared to low dose. Conclusion Treatment with high dose anticoagulation at the time of ICU/SDU admission was associated with decreased adjusted mortality among critically ill adult patients with COVID-19.

by Marlyn Khouri, Dana Lassri, Noga Cohen

The current worldwide COVID-19 pandemic has elicited widespread concerns and stress. Arguably, healthcare workers are especially vulnerable to experience burnout during these times due to the nature of their work. Indeed, high prevalence of burnout was found among healthcare workers during the outbreak. However, the individual differences predicting burnout among healthcare workers during the pandemic have been understudied. The aim of the current study was, therefore, to identify risk and protective factors contributing to the severity of burnout among healthcare workers, above and beyond levels of current psychological distress. The survey was distributed online during the period April 13–28, 2020, approximately two months after the first COVID-19 case was identified in Israel. Ninety-eight healthcare workers completed an online survey administered cross-sectionally via the Qualtrics platform that included questionnaires assessing habitual emotion regulation strategies (i.e., trait worry, reappraisal, and suppression), psychological distress, COVID-19 related concerns, and burnout. A hierarchical linear regression analysis revealed that only trait worry and psychological distress were significant predictors of job burnout among healthcare workers. These findings highlight the role of maladaptive emotion regulation tendencies, specifically trait worry, in job burnout among healthcare workers. These findings have implications for both the assessment and treatment of healthcare workers. We discuss potential mechanisms and implications for practice.

by Rafael Alves Guimarães, Gabriela Moreira Policena, Hellen da Silva Cintra de Paula, Charlise Fortunato Pedroso, Raquel Silva Pinheiro, Alexander Itria, Olavo de Oliveira Braga Neto, Adriana Melo Teixeira, Irisleia Aires Silva, Geraldo Andrade de Oliveira, Karla de Aleluia Batista
Background The coronavirus disease (COVID-19) pandemic has impacted health services and healthcare systems worldwide. Studies have shown that hospital admissions for causes related to chronic non-communicable diseases (NCDs) have decreased significantly during peak pandemic periods. An analysis of the impact of the COVID-19 pandemic on hospital admissions for NCDs is essential to implement disability and mortality mitigation strategies for these groups. Therefore, this study aimed to analyze the impact of the COVID-19 pandemic on hospital admissions for NCDs in Brazil according to the type of NCD, sex, age group, and region of Brazil. Methods This is an ecological study conducted in Brazil. Data on hospital admissions from January 1, 2017 to May 31, 2021 were extracted from the Unified Health System’s Hospital Admissions Information System. The hospital admission rates per 100,000 thousand inhabitants were calculated monthly according to the type of NCD, sex, age group, and region of Brazil. Poisson regression models were used to analyze the impact of the COVID-19 pandemic on the number of hospital admissions. In this study, the pre-pandemic period was set from January 1, 2017 to February 29, 2020 and the during-pandemic from March 1, 2020 to May 31, 2021. Results There was a 27.0% (95.0%CI: -29.0; -25.0%) decrease in hospital admissions for NCDs after the onset of the pandemic compared to that during the pre-pandemic period. Decreases were found for all types of NCDs—cancer (-23.0%; 95.0%CI: -26.0; -21.0%), diabetes mellitus (-24.0%; 95.0%CI: -25.0%; -22.0%), cardiovascular diseases (-30.0%; 95.0%CI: -31.0%; -28.0%), and chronic respiratory diseases (-29.0%; 95.0%CI: -30.0%; -27.0%). In addition, there was a decrease in the number of admissions, regardless of the age group, sex, and region of Brazil. The Northern and Southern regions demonstrated the largest decrease in the percentage of hospital admissions during the pandemic period. Conclusions There was a decrease in the hospitalization rate for NCDs in Brazil during the COVID-19 pandemic in a scenario of social distancing measures and overload of health services.

Title: Características, autocuidado e qualidade de vida entre pacientes com diabetes mellitus tipo 2 em unidades de atenção primária à saúde em Teresina, PI: um estudo transversal desafiado pela pandemia de Covid-19
Authors: Carvalho, Arethuza de Melo Brito
Abstract: A Diabetes Mellitus tipo 2 como doença crônica de elevada e crescente prevalência, exige uma assistência de saúde integral e mudança comportamental, com base no controle glicêmico e autocuidado. Objetivo: caracterizar o perfil, padrão de autocuidado e qualidade de vida relacionada à saúde de pacientes com Diabetes Mellitus tipo 2 usuários da Estratégia Saúde da Família em Teresina- Piauí, e identificar fatores associados à qualidade de vida. Metodologia: estudo transversal desenvolvido de dezembro/2019 a junho/2021, com 373 pacientes. Foram utilizados o Questionário de Atividades de Autocuidado com Diabetes (QAD), Medida de Adesão aos Tratamentos (MAT), questionário específico de qualidade de vida, Diabetes-39, e o questionário genérico, EuroQoL self-report questionnaire 5-dimensional 3-level (EQ-5D-3L). A análise dos dados foi expandida e proporcional à população de 15.390 pacientes cadastrados, e apresentada por descrição, análises bivariadas e modelos multivariados de regressão, com cálculo de estimativa de chance (Odds Ratio). Resultados: perfil de pacientes formado por sexo feminino, faixa etária de 60-69 anos, casados(as), que moram acompanhados(as), com oito a dez anos de estudo, aposentados(as)/pensionista, renda familiar mensal de um a dois salários mínimos, não ingerem bebida alcóolica, em situação de sobrepeso, tempo de diagnóstico menor que cinco anos, exame atualizado de hemoglobina glicada e com alguma complicação. A amostra apresentou controle glicêmico ruim, hemoglobina glicada com média de 7,96%. As ações de autocuidado foram mais favoráveis para alimentação geral e específica, cuidado dos pés e uso da medicação, e menor adesão na prática de atividade física e monitorização da glicemia. Houve boa adesão ao tratamento medicamentoso. Pacientes demostraram medo de apresentar complicações, perder controle do açúcar e ter diabetes. De forma geral, a qualidade de vida foi mais afetada pela presença de dor/mal estar e ansiedade/depressão. Conclusão: pacientes sem percepção definida de interferência da diabetes na qualidade de vida, apesar de entenderem a gravidade da sua doença. Algumas variáveis socioeconômicas, demográficas, clínicas e de cuidado interferiram nas dimensões da qualidade de vida, o controle glicêmico ruim foi protetor na maioria das associações com qualidade de vida, com efeito negativo apenas no funcionamento sexual e percepção quanto à gravidade da doença. A vivência da pandemia de covid-19 ocasionou maior adoção de hábitos de cuidado, e melhorou a qualidade de vida quanto à sobrecarga social, e realização de cuidados pessoais e atividades habituais.

Title: Repercussions of the COVID-19 pandemic on preventive health services in Brazil
Authors: Oliveira, Mayra Monteiro; Fuller, Trevon L.; Gabaglia, Claudia R.; Cambou, Mary Catherine; Brasil, Patricia; Vasconcelos, Zilton Farias Meira de; Nielsen-Saines, Karin

by Chulaluck Tangmonkongvoragul, Susama Chokesuwattanaskul, Chetupon Khankaeo, Ruethairat Punyasevee, Lapat Nakkara, Suttipat Moolsan, Onpreeya Unruan

Dry eye disease (DED) is one of the most common ophthalmological disorders, resulting from several systemic and ocular etiologies including meibomian gland dysfunction (MGD). During the COVID-19 pandemic, medical students are among the high-risk group for DED, mainly due to the increasing use of a visual display terminal (VDT) for online lectures and psychological stress from encountering several changes. Our study aimed to explore the prevalence of DED using the symptom-based definition and potential risk factors in medical students. This is a prospective cross-sectional study that included medical students at Chiang Mai University between November 2020 and January 2021. All participants were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, the Thai version of the 10-Item Perceived Stress Scale-10 (T-PSS-10), the LipiView® II interferometer, and an interview for other possible risk factors. Overall, 528 participants were included in the study; half of the participants were female. The prevalence of DED was 70.8%. In the univariate analysis, female sex, contact lens wear, and T-PSS-10 stress scores were significantly higher in the DED group (P = 0.002, 0.002, and

by Constantin A. Hintschich, René Fischer, Thomas Hummel, Jürgen J. Wenzel, Christopher Bohr, Veronika Vielsmeier

Olfactory and gustatory disorders are prominent symptoms of acute COVID-19. Although both senses recover in many patients within weeks to months, persistency has been described in up to 60%. However up to now most reports on the course of chemosensitive disorders after COVID-19 are not based on psychophysical testing but only on subjective patients’ ratings. In this study we assessed both olfaction and gustation using psychophysical tests eight months after COVID-19. Validated psychophysical testing revealed hyposmia in 18% and hypogeusia in even 32% of 303 included patients. This shows that olfactory and especially gustatory disorders have to be seen as important chronic symptoms post-COVID-19. The high prevalence of gustatory dysfunction indicates that gustatory function does not recover or might even deteriorate in the months following the acute infection.

by Fredrik Methi, Kjersti Helene Hernæs, Katrine Damgaard Skyrud, Karin Magnusson
Aim To explore whether the acute 30-day burden of COVID-19 on health care use has changed from February 2020 to February 2022. Methods In all Norwegians (N = 493 520) who tested positive for SARS-CoV-2 in four pandemic waves (February 26th, 2020 –February 16th, 2021 (1st wave dominated by the Wuhan strain), February 17th–July 10th, 2021 (2nd wave dominated by the Alpha variant), July 11th–December 27th, 2021 (3rd wave dominated by the Delta variant), and December 28th, 2021 –January 14th, 2022 (4th wave dominated by the Omicron variant)), we studied the age- and sex-specific share of patients (by age groups 1–19, 20–67, and 68 or more) who had: 1) Relied on self-care, 2) used outpatient care (visiting general practitioners or emergency ward for COVID-19), and 3) used inpatient care (hospitalized ≥24 hours with COVID-19). Results We find a remarkable decline in the use of health care services among COVID-19 patients for all age/sex groups throughout the pandemic. From 83% [95%CI = 83%-84%] visiting outpatient care in the first wave, to 80% [81%-81%], 69% [69%-69%], and 59% [59%-59%] in the second, third, and fourth wave. Similarly, from 4.9% [95%CI = 4.7%-5.0%] visiting inpatient care in the first wave, to 3.6% [3.4%-3.7%], 1.4% [1.3%-1.4%], and 0.5% [0.4%-0.5%]. Of persons testing positive for SARS-CoV-2, 41% [41%-41%] relied on self-care in the 30 days after testing positive in the fourth wave, compared to 16% [15%-16%] in the first wave. Conclusion From 2020 to 2022, the use of COVID-19 related outpatient care services decreased with 29%, whereas the use of COVID-19 related inpatient care services decreased with 80%.

Title: Reduced competence to arboviruses following the sustainable invasion of Wolbachia into native Aedes aegypti from Southeastern Brazil
Authors: Gesto, João Silveira Moledo; Ribeiro, Gabriel Sylvestre; Rocha, Marcele Neves; Dias, Fernando Braga Stehling; Peixoto, Julia; Carvalho, Fabiano Duarte; Pereira, Thiago Nunes; Moreira, Luciano Andrade

by Paula Zamorano, Alvaro Tellez, Paulina Muñoz, Jaime C. Sapag, Mayra Martinez

The COVID-19 pandemic has abruptly changed care priority and delivery, delaying others like the multimorbidity approach. The Centro de Innovación en Salud ANCORA UC, the Health National Fund, and the Servicio de Salud Metropolitano Sur Oriente implemented a Multimorbidity Patient-Centered Care Model as a pilot study in the public health network from 2017 to 2020. Its objective was to reorganize the single diagnosis standard care into a new one based on multimorbidity integrated care. It included incorporating new roles, services, and activities according to each patient’s risk stratification. This study aims to describe the perception of the health care teams regarding the impact of the COVID-19 pandemic on four main topics: how the COVID-19 pandemic affected the MCPM implementation, how participants adapted it, lessons learned, and recommendations for sustainability. We conducted a qualitative study with 35 semi-structured interviews between October and December 2020. Data analysis was codified, triangulated, and consolidated using MAXQDA 2020. Results showed that the pandemic paused the total of the implementation practically. Positive effects were the improvement of remote health care services, the activation of self-management, and the cohesion of the teamwork. In contrast, frequent abrupt changes and reorganization forced by pandemic evolution were negative effects. This study revealed the magnitude of the pandemic in the cancelation of health services and identified the urgent need to restart chronic services incorporating patient-centered care in our system.

by Sarah Musa, Rowaida Elyamani, Ismail Dergaa
Aim The COVID-19 pandemic has prompted governments around the globe to implement various restriction policies, including lockdown, social distancing, and school closures. Subsequently, there has been a surge in sedentary behaviour particularly screen time (ST) together with a significant decline in physical activity that was more marked amongst children and adolescents. Excessive screen exposure in adolescents has been correlated with cardio-metabolic risk factors including obesity, hypertension, high cholesterol, and glucose intolerance that may have adverse morbidity and mortality implications in adulthood. Thus, the current study aimed to synthesize the literature on the relationship between ST of various types and the risk of metabolic syndrome (MetS) in adolescents in the context of the COVID-19 pandemic. Methods In August 2021, a systematic search of the literature was undertaken using electronic databases: PubMed, PsycINFO, and the Cochran library. Studies were considered if they met the following key eligibility criteria: (i) Measure of ST as an exposure (TV, computer, videogames, internet, smartphone, tablet), using quantified duration/frequency either self-reported or observed; (ii) Measure of MetS as an outcome with standard definition and/or criteria required to establish MetS diagnosis. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias. Results A total of ten studies met the inclusion criteria, and the majority were cross sectional studies. Most studies met fair bias scoring. Overall, the review revealed considerable evidence that suggests a significant negative association between ST and components of MetS among adolescents with dose-response association. Conclusion During the pandemic, screen usage may become more prevalent through periods of school closures, lockdowns, social isolation, and online learning classes. Public health policies and health promotion strategies targeting parents are needed to raise awareness of the adverse health effects associated with screen-based sedentary behaviour as a precursor of NCDs. Parent or home focused interventions might be effective in limiting adolescents’ screen exposure, alternatively substituted with an appropriate level of physical activity. PROSPERO registration number PROSPERO 2021 CRD42021272436.

by Moawiah Khatatbeh, Lobna F. Gharaibeh, Omar F. Khabour, Rana K. Abu-Farha, Karem H. Alzoubi
Purpose In the current study, the views of Jordanian regarding sharing medical reports for research purposes were investigated during the COVID-19 pandemic. In addition, motivators and barriers regarding sharing of medical records were examined. Methods This observational survey-based cross-sectional study was conducted using an electronic questionnaire during the COVID-19 pandemic (second half of 2020). The questionnaire link was disseminated through two social media platforms (WhatsApp and Facebook), targeting Jordanian adults (age >18 years). Results In this study, 1,194 participants agreed to complete the study survey. Results showed that 58.3% of them (n = 696) reported to be willing to share their medical data. while 17.6% of the participants (n = 210) showed hesitancy to share their medical information. The most important motivators as perceived by the study participants were helping other patients who have similar health conditions (n = 995, 83.3%). Moreover, fearing from stigma (n = 753, 63.1%), and the lack of confidence in data security and privacy (n = 728, 61.0%) were among the main barriers preventing participants from sharing their information. Finally, results showed that participants with higher educational level (bachelor or higher) (OR = 0.299, P

by Clyde S. Manuel, Dawn J. Yeomans, Jessica A. Williams, Christopher Fricker, Kaury Kucera, David Light, James W. Arbogast

Alcohol-based hand sanitizers (ABHS) have been an important hand hygiene tool during the COVID-19 pandemic. Recently, ABHS from non-traditional drug manufacturers have entered the market, triggered by a lack of ABHS availability. Some of these ABHS contain high levels of chemical impurities that may be harmful with frequent exposure. Additionally, the use of refillable dispensers designed to accept ABHS from bulk containers allows for mixing and evaporation that may compromise ABHS integrity. To understand the risks associated with low quality ABHS and bulk refilling practices, we collected 77 ABHS samples sourced from community settings (restaurants, grocery stores, etc.) and 40 samples from a single school district. All samples were obtained from bulk refillable dispensers that were in use. Samples were analyzed for alcohol content, chemical impurities, aesthetic qualities, and presence of drug labeling information. Additionally, we performed laboratory-based experiments to determine the impact of dispenser design on alcohol evaporation rates. Over 70% of samples for which photos were available showed lack of essential labeling information, including missing “Drug Facts Labels”. For ABHS samples acquired from community settings, nearly 14% of samples had visible impurities, and over 30% of samples had concentrations of acetal and acetaldehyde in excess of FDA interim limits. Subpotent ethanol concentrations were observed in 9.09% and 82.05% of samples from community settings and the school district, respectively, with the school district sample results being associated with dispenser misuse. Laboratory-based experiments show dispenser design significantly impacts the rate of ethanol evaporation of ABHS products, especially if stored in open refillable dispensers without an internal reservoir. This study demonstrates risks associated with use of inferior ABHS and bulk refilling practices. Regulatory agencies should issue guidance on best practices in community settings to ensure the integrity of ABHS as an essential public health tool to prevent the spread of COVID-19 and other transmissible diseases.

Title: Percepção de risco de adoecimento por COVID-19 e depressão, ansiedade e estresse entre trabalhadores de unidades de saúde
Authors: Costa, Aline Silva; Griep, Rosane Harter; Rotenberg, Lúcia
Abstract: O objetivo foi analisar as associações entre a percepção de risco de adoecimento por COVID-19 e os sintomas de depressão, ansiedade e estresse em profissionais atuantes em unidades de saúde. Estudo transversal com trabalhadores de diversas categorias profissionais que buscaram voluntariamente um dos primeiros Centros de Referência em Testagem de COVID-19 no Município do Rio de Janeiro, Brasil. Os trabalhadores foram convidados a responder a um questionário online entre maio e agosto de 2020. Foram utilizadas a escala Percepção de Risco de Adoecimento por COVID-19 e a Escala de Depressão, Ansiedade e Estresse (DASS-21). Foram estimados razão de chance (OR) e intervalo de 95% de confiança. Do total (N = 2.996), 81,5% eram mulheres com idade média de 40,7 anos. Cerca da metade apresentava grau leve, moderado ou severo de depressão, ansiedade ou estresse, sendo a frequência de trabalhadores com sintomas severos, respectivamente, 18,5%, 29,6% e 21,5%. Observou-se que as associações entre a percepção de risco e os sintomas de depressão, ansiedade e estresse foram mais fortes à medida que aumentava a classificação de gravidade de cada sintoma. Os trabalhadores com alta percepção de risco de adoecimento por COVID-19 apresentaram OR mais elevadas para sintomas severos de depressão (OR = 4,67), ansiedade (OR = 4,35) e estresse (OR = 4,97). Os achados apontam a demanda por medidas de proteção à saúde dos trabalhadores, que não devem se restringir aos equipamentos de proteção individual. É essencial que os gestores promovam espaços coletivos de discussão e ações que favoreçam a recuperação dos trabalhadores em contexto pandêmico de longa duração.

by Rodrigo Fracalossi de Moraes, Louise B. Russell, Lara Livia Santos da Silva, Cristiana M. Toscano
Background Despite substantial evidence on the effectiveness of non-pharmaceutical interventions (NPIs), there is still limited evidence on the individual effects of different types of NPIs on social distancing, especially in low- and middle-income countries. Methods We used panel data analysis to evaluate the effects of mandatory social distancing rules on social distancing. We obtained data on six different categories of mandatory restrictions implemented in Brazil, by date and state, from state government gazettes (diários oficiais). We then defined a social distancing rules index (SDI) to measure the strictness of social distancing rules, assigning each a value of 2, 1, or 0 depending on whether restrictions were full, partial, or very limited/non-existent at every given time. A separate variable was defined for masking mandates. We tested whether the following variables were associated to social distancing: SDI, masking mandates, COVID-19 incidence, population socioeconomic status, and political orientation. Data is for each day between March 11th and November 10th, 2020 in the 27 Brazilian states (N = 6615). Findings Social distancing increased when social distancing rules were stricter, and decreased when the use of face masks became mandatory. The effects of different types of restrictions varied: suspending in-person classes and gatherings, religious/sport/cultural activities had a greater effect than other types of restrictions. Also, the effect of social distancing rules on people’s behaviour decreased over time, especially when rules were stricter. Interpretation Mandatory social distancing rules must be adopted to increase social distancing. Stricter rules have a higher impact, but result in decreased compliance over time. Policymakers should prioritize more targeted policies.

by Joska Appelman, Lasse Suonperä Liebst, Marie Rosenkrantz Lindegaard

Epidemiological evidence and recommendations from the World Health Organization suggest that close face-to-face interactions pose a particular coronavirus transmission risk. The real-life prevalence and nature of such high-risk contacts are understudied, however. Here, we video-observed high-risk contacts in outdoor public places in Amsterdam, the Netherlands, during the COVID-19 pandemic. We found that high-risk contacts were relatively uncommon: Of the 7,813 individuals observed, only 20 (0.26%) displayed high-risk contacts. Further, we qualitatively examined the 20 high-risk contacts identified and found that they occurred disproportionally between affiliated persons engaged in affiliative behaviors. We discuss the potential public health implications of the relatively low incident rate of high-risk contacts.

by Farrokh Habibzadeh, Konstantin Chumakov, Mohammad M. Sajadi, Mahboobeh Yadollahie, Kristen Stafford, Ashraf Simi, Shyamasundaran Kottilil, Iman Hafizi-Rastani, Robert C. Gallo
Background Several live attenuated vaccines were shown to provide temporary protection against a variety of infectious diseases through stimulation of the host innate immune system. Objective To test the hypothesis that countries using oral polio vaccine (OPV) have a lower cumulative number of cases diagnosed with COVID-19 per 100,000 population (CP100K) compared with those using only inactivated polio vaccine (IPV). Methods In an ecological study, the CP100K was compared between countries using OPV vs IPV. We used a random-effect meta-analysis technique to estimate the pooled mean for CP100K. We also used negative binomial regression with CP100K as the dependent variable and the human development index (HDI) and the type of vaccine used as independent variables. Results The pooled estimated mean CP100K was 4970 (95% CI 4030 to 5900) cases per 100,000 population for countries using IPV, significantly (p

Title: ABC 2 -SPH risk score for in-hospital mortality in COVID-19 patients: development, external validation and comparison with other available scores
Authors: Marcolino, Milena Soriano; Pires, Magda C.; Ramos, Lucas Emanuel F.; Silva, Rafael T.; Oliveira, Luana M.; Carvalho, Rafael L.R.; Mourato, Rodolfo Lucas S.; Sánchez-Montalvá, Adrián; Raventós, Berta; Anschau, Fernando; Chatkin, José Miguel; Nogueira, Matheus C.A.; Guimarães Júnior, Milton H.; Vietta, Giovanna G.; Duani, Helena; Ponce, Daniela; Ziegelmann, Patricia K.; Castro, Luís C.; Ruschel, Karen B.; Cimini, Christiane C.R.; Francisco, Saionara C.; Floriani, Maiara A.; Nascimento, Guilherme F.; Farace, Bárbara L.; Monteiro, Luanna S.; Silva, Maira V .R. Souza; Sales, Thais L.S.; Martins, Karina Paula M. P.; Nascimento, Israel J. Borges do; Fereguetti, Tatiani O.; Ferrara, Daniel T. M. O.; Botoni, Fernando A.; Etges, Ana Paula B.S.; Schwarzbold, Alexandre V.; Maurílio, Amanda O.; Scotton, Ana Luiza B.A.; Weber, André P.; Costa, André S.M.; Glaeser, Andressa B.; Madureira, Angélica Aparecida C.; Bhering, Angelinda R.; Castro, Bruno Mateus de; Silva, Carla Thais C.A. da; Ramos, Carolina M.; Gomes, Caroline D.; Carvalho, Cíntia A. de; Silveira, Daniel V.; Cezar, Edilson; Pereira, Elayne C.; Kroger, Emanuele Marianne S.; Vallt, Felipe B.; Lucas, Fernanda B.; Aranha, Fernando G.; Bartolazzi, Frederico; Crestani, Gabriela P.; Bastos, Gisele A.N.; Madeira, Glícia Cristina de C.; Noal, Helena Carolina; Vianna, Heloisa R.; Guimarães, Henrique C.; Gomes, Isabela M.; Molina, Israel; Batista, Joanna d’Arc L.; Alvarenga, Joice C. de; Guimarães, Júlia D.S.S.; Morais, Júlia D.P. de; Rugolo, Juliana M.; Pontes, Karen Cristina J.R.; Santos, Kauane Aline M. dos; Oliveira, Leonardo S. de; Pinheiro, Lílian S.; Pacheco, Liliane S.; Sousa, Lucas de D.; Couto, Luciana S.F.; Kopittke, Luciane; Moura, Luis Cesar S. de; Santos, Luisa Elem A.; Cabral, Máderson A.S.; Souza, Maíra D.; Tofani, Marcela G.T.; Carneiro, Marcelo; Ferreira, Maria Angélica P.; Bicalho, Maria Aparecida C.; Lima, Maria Clara P.B.; Godoy, Mariana F.; Cardoso, Marilia M.A.; Figueiredo, Meire P.; Sampaio, Natália C.S.; Rangel, Natália L.; Crespo, Natália T.; Oliveira, Neimy R. de; Assaf, Pedro L.; Martelli, Petrônio José de L.; Almeida, Rafaela S.C.; Martins, Raphael C.; Lutkmeier, Raquel; Valacio, Reginaldo Aparecido; Finger, Renan G.; Cardoso, Ricardo B.; Pozza, Roberta; Campos, Roberta X.; Menezes, Rochele M.; Abreu, Roger M. de; Silva, Rufino de F.; Guimarães, Silvana M.M.; Araújo, Silvia F.; Pereira, Susany Anastácia; Oliveira, Talita F.; Kurtz, Tatiana; Oliveira, Thainara C. de; Araújo, Thaíza Simônia M.A.; Diniz, Thulio Henrique O.; Santos, Veridiana B. dos; Gomes, Virginia Mara R.; Vale, Vitor Augusto L. do; Ramires, Yuri C.; Polanczyk, Carisi A.

Title: Immune response in COVID-19: what do we currently know?
Authors: Oliveira, Daniela Silva de; Medeiros, Nayara Ingrid; Gomes, Juliana de Assis Silva

Title: Early use of nitazoxanide in mild Covid-19 disease: randomised, placebo-controlled trial
Authors: Rocco, Patricia R. M.; Silva, Pedro L.; Cruz, Fernanda F.; M. Junior, Marco Antonio C.; Tierno, Paulo F. G. M. M.; Moura, Marcos A.; Oliveira, Luís Frederico G. de; Lima, Cristiano C.; Santos, Ezequiel A. dos; F. Junior, Walter; Fernandes, Ana Paula S. M.; Franchini, Kleber G.; Magri, Erick; Moraes, Nara F. de; Gonçalves, José Mário J.; Carbonieri, Melanie N.; Santos, Ivonise S. dos; Paes, Natália F.; Maciel, Paula V. M.; Rocha, Raissa P.; Carvalho, Alex F. de; Alves, Pedro Augusto; Modena, José Luiz P.; Cordeiro, Artur T.; Trivella, Daniela B. B.; Marques, Rafael E.; Luiz, Ronir R.; Pelosi, Paolo; Silva, Jose Roberto Lapa e
Abstract: Nitazoxanide is widely available and exerts broad-spectrum antiviral activity in vitro. However, there is no evidence of its impact on SARS-CoV-2 infection. In a multicenter, randomised, double-blind, placebo-controlled trial, adult patients presenting up to 3 days after onset of Covid-19 symptoms (dry cough, fever, and/or fatigue) were enrolled. After confirmation of SARS-CoV2 infection by RT-PCR on a nasopharyngeal swab, patients were randomised 1:1 to receive either nitazoxanide (500 mg) or placebo, TID, for 5 days. The primary outcome was complete resolution of symptoms. Secondary outcomes were viral load, laboratory tests, serum biomarkers of inflammation, and hospitalisation rate. Adverse events were also assessed. From June 8 to August 20, 2020, 1575 patients were screened. Of these, 392 (198 placebo, 194 nitazoxanide) were analysed. Median time from symptom onset to first dose of study drug was 5 (4–5) days. At the 5-day study visit, symptom resolution did not differ between the nitazoxanide and placebo arms. Swabs collected were negative for SARS-CoV-2 in 29.9% of patients in the nitazoxanide arm versus 18.2% in the placebo arm (p=0.009). Viral load was also reduced after nitazoxanide compared to placebo (p=0.006). The percent viral load reduction from onset to end of therapy was higher with nitazoxanide (55%) than placebo (45%) (p=0.013). Other secondary outcomes were not significantly different. No serious adverse events were observed. In patients with mild Covid-19, symptom resolution did not differ between nitazoxanide and placebo groups after 5 days of therapy. However, early nitazoxanide therapy was safe and reduced viral load significantly.

Title: A vegetação no município de Ilhéus, Estado da Bahia: I - estudo sinecológico das áreas de pesquisas sôbre a febre amarela silvestre realizado pelo S. E. P. F. A
Authors: Veloso, Henrique P.
Abstract: ABSTRACT
A vegetação no município de Ilhéus, Estado da Bahia: I - estudo sinecológico das áreas de pesquisas sôbre a febre amarela silvestre realizado pelo S. E. P. F. A

by Shumpei Obata, Riko Matsumoto, Masashi Kakinoki, Shunichiro Tsuji, Takashi Murakami, Takahide Yanagi, Yoshihiro Maruo, Masahito Ohji
Purpose To investigate changes in the number of preterm infants, low birth weight infants, and infants with fetal growth restriction (FGR) or retinopathy of prematurity (ROP) during the coronavirus disease 2019 (COVID-19) pandemic. Methods In this retrospective cross-sectional study, we reviewed the medical records of infants born and admitted to the neonatal intensive care unit and growth care unit of Shiga University of Medical Science Hospital before the COVID-19 pandemic (April 1, 2019 to September 30, 2019) and during the pandemic (April 1, 2020 to September 30, 2020). Medical records of infants’ mothers were also collected. Preterm infants, low birth weight infants, infants with FGR, infant and maternal factors associated with FGR, and infants requiring treatment for ROP were compared between the two periods. Results There were fewer infants born at 28 weeks of gestation, infants with birth weight 1,500 g, and infants with FGR during the pandemic period than the pre-pandemic period (pre-pandemic: n = 4 vs. during pandemic: n = 0, P = 0.048; pre-pandemic: n = 15 vs. during pandemic: n = 6, P = 0.02; and pre-pandemic: n = 31 vs. during pandemic: n = 12, P = 0.0002, respectively). There were no significant differences in any infant or maternal factors associated with FGR. The number of infants requiring treatment for ROP decreased during the pandemic, although this difference was not statistically significant (pre-pandemic: n = 3 vs. during pandemic: n = 0, P = 0.08). Conclusions Our findings showed a reduction in the number of infants with FGR during the COVID-19 pandemic. The number of infants born at 28 weeks of gestation and infants with birth weight 1,500 g also decreased during the pandemic period. There was a trend toward fewer infants requiring treatment for ROP during the COVID-19 pandemic.

by Setiawan Priatmoko, Billal Hossain, Wuri Rahmawati, Susilo Budi Winarno, Lóránt Dénes Dávid

This research aims to find out the phenomenon of webinar competition from the viewpoint of the audience. Covid-19 pandemic makes webinars a means for knowledge dissemination. Many events offered turned out to be a tight competition among organizers and caused a different response for the audience. Academics participants’ responses had never been known in depth so that they could be the basis for determining the strategy for the organizers. Using quantitative data through online surveys to further interpreted with the help of previous literature. The independent variables gender, age, frequency, cost, and place are used to determine their effect on loyalty, which is represented by the length of duration in participating in each webinar. The effectiveness of webinars as a means of disseminating ideas in the pandemic era still faces various challenges. Among academics, the loyalty at the webinar event is influenced by gender and age. It is important for organizers to effectively communicate to webinar participants so that they get the message they want to convey.

by André Hajek, Hans-Helmut König
Aim Our purpose was to clarify the level and correlates of empathy and altruism in the German population during the Covid-19 pandemic. Methods A nationally representative survey (n = 3,075) was conducted in August/September 2021. To measure empathy, a short scale based on the Interpersonality Reactivity Index (IRI; German version: Saarbrucken personality questionnaire, SPF) was used (SPF-K). Based on the International Personality Item Pool (IPIP; IPIP-5F30F-R1), the subscale altruism was used to quantify altruism. Results The average altruism score was 3.3 (SD: 0.7), ranging from 1 to 5. Moreover, the average empathy score was 13.1 (SD: 2.8), ranging from 4 to 20. The level of empathy significantly differed between the subgroups. For example, high levels of empathy were identified among women (average: 13.7, SD: 2.7), individuals with children (average: 13.5, SD: 2.8), and individuals with migration background (average: 13.6, SD: 2.8). Effect sizes were mostly small. Similar differences (in terms of effect size) were identified between these groups regarding altruism. Additionally, regressions showed that higher levels of both empathy and altruism were associated with being female, younger age, having children, sports activities and having at least one chronic disease. Moreover, vaccination against Covid-19 was only associated with higher altruism, but not with higher empathy. Conclusion Our study emphasized the moderately high level of empathy and altruism in Germany during times of the pandemic. Identifying the correlates of these factors may help to address individuals with very low levels of these factors.

by Christine Vatovec, John Hanley

The objective of this research was to examine residents’ awareness, attitudes, and compliance with COVID-19 public health guidelines in Vermont, which emerged as an early leader in national pandemic response. Our methods included conducting an online survey of adult Vermont residents between January and April 2021. We analyzed demographics associated with awareness and compliance, and identified features associated with non-compliance. Our results show that of the 2,208 adult Vermont residents who completed the survey, 90% were extremely aware of the state’s COVID-19 guidelines, and 95% reported knowing exactly what to do to follow recommended actions. Political affiliation emerged as a primary factor related to attitudes and compliance. Self-identified Republicans were less likely to agree that public health measures keep people safe or help businesses stay open, and were less likely to follow masking, quarantine, social distancing, and vaccine guidance than Independents, Progressives, and Democrats. The large differences in COVID-19 infection and death rates across the country, and recent shift toward a "pandemic of the unvaccinated," underscore the need for identifying public health strategies that work in some areas in order to adapt and apply them to areas that have struggled with controlling the virus. Consistent with national surveys, our results show that resistance to public health guidance is a partisan challenge even in states with high compliance. Identifying populations that are less supportive or hesitant to follow guidelines while understanding factors that motivate compliance can help inform strategies for developing targeted programs to encourage collective action on pandemic response. Developing communication strategies that reach people who do not believe COVID-19 guidelines keep them safe is necessary to reach universal compliance.

by Miwa Sekine, Makino Watanabe, Shuko Nojiri, Tsutomu Suzuki, Yuji Nishizaki, Yuichi Tomiki, Takao Okada

The COVID-19 pandemic forced many educational institutions to turn to electronic learning to allow education to continue under the stay-at-home orders/requests that were commonly instituted in early 2020. In this cross-sectional study, we evaluated the effects of the COVID-19 pandemic on medical education in terms of students’ attitudes toward online classes and their online accessibility; additionally, we examined the impacts of any disruption caused by the pandemic on achievement test performance based on the test results. The participants were 674 students (412 in pre-clinical, 262 in clinical) at Juntendo University Faculty of Medicine; descriptive analysis was used to examine the respondents’ characteristics and responses. The majority of respondents (54.2%) preferred asynchronous classes. Mann–Whitney U tests revealed that while pre-clinical students preferred asynchronous classes significantly more than clinical students (39.6%, p .001), students who preferred face-to-face classes had significantly higher total achievement test scores (U = 1082, p = .021, r = .22). To examine the impacts of pandemic-induced changes in learning, we conducted Kruskal–Wallis tests and found that the 2020 and 2021 scores were significantly higher than those over the last three years. These results suggest that while medical students may have experienced challenges adapting to electronic learning, the impact of this means of study on their performance on achievement tests was relatively low. Our study found that if possible, face-to-face classes are preferable in an electronic learning environment. However, the benefit of asynchronous classes, such as those that allow multiple viewings, should continue to be recognized even after the pandemic.

by Mengmeng Zhang, Peng Hu, Xiaowei Xu, Jingwen Ai, Yang Li, Yun Bao, Wimonchat Tangamornsuksan, Alain Chan, Shelley Xie, Hao Hu, Shuting Liang, Wenhong Zhang, Feng Xie
Background To investigate the mortality and health care resource use among patients with severe or critical coronavirus disease of 2019 (COVID-19) in the first wave of pandemic in China. Methods We performed a systematic review and meta-analysis to investigate the mortality, discharge rate, length of hospital stay, and use of invasive ventilation in severe or critical COVID-19 cases in China. We searched electronic databases for studies from China with no restrictions on language or interventions patients received. We screened records, extracted data and assessed the quality of included studies in duplicate. We performed the meta-analysis using random-effect models through a Bayesian framework. Subgroup analyses were conducted to examine studies by disease severity, study location and patient enrolment start date. We also performed sensitivity analysis using various priors, and assessed between-study heterogeneity and publication bias for the primary outcomes. Results Out of 6,205 titles and abstracts screened, 500 were reviewed in full text. A total of 42 studies were included in the review, of which 95% were observational studies (n = 40). The pooled 28-day and 14-day mortalities among severe or critical patients were 20.48% (7,136 patients, 95% credible interval (CrI), 13.11 to 30.70) and 10.83% (95% CrI, 6.78 to 16.75), respectively. The mortality declined over time and was higher in patients with critical disease than severe cases (1,235 patients, 45.73%, 95% CrI, 22.79 to 73.52 vs. 3,969 patients, 14.90%, 95% CrI, 4.70 to 39.57) and patients in Hubei compared to those outside Hubei (6,719 patients, 26.62%, 95% CrI, 13.11 to 30.70 vs. 244 patients, 5.88%, 95% CrI 2.03 to 14.11). The length of hospital stay was estimated at 18.48 days (6,847 patients, 95% CrI, 17.59 to 21.21), the 28-day discharge rate was 50.48% (3,645 patients, 95% CrI, 26.47 to 79.53), and the use of invasive ventilation rate was 13.46% (4,108 patients, 95% CrI, 7.61 to 22.31). Conclusions Our systematic review and meta-analysis found high mortality among severe and critical COVID-19 cases. Severe or critical COVID-19 cases consumed a large amount of hospital resources during the outbreak.

by César Ramos Rocha-Filho, Johnny Wallef Leite Martins, Rosa Camila Lucchetta, Gabriel Sodré Ramalho, Giulia Fernandes Moça Trevisani, Aline Pereira da Rocha, Ana Carolina Pereira Nunes Pinto, Felipe Sebastião de Assis Reis, Laura Jantsch Ferla, Patrícia de Carvalho Mastroianni, Luci Correa, Humberto Saconato, Virgínia Fernandes Moça Trevisani
Background COVID-19, SARS and MERS are diseases that present an important health burden worldwide. This situation demands resource allocation to the healthcare system, affecting especially middle- and low-income countries. Thus, identifying the main cost drivers is relevant to optimize patient care and resource allocation. Objective To systematically identify and summarize the current status of knowledge on direct medical hospitalization costs of SARS, MERS, or COVID-19 in Upper-Middle-Income Countries. Methods We conducted a systematic review across seven key databases (PubMed, EMBASE, BVS Portal, CINAHL, CRD library, MedRxiv and Research Square) from database inception to February 2021. Costs extracted were converted into 2021 International Dollars using the Purchasing Power Parity-adjusted. The assessment of quality was based on the protocol by the BMJ and CHEERS. PROSPERO 2020: CRD42020225757. Results No eligible study about SARS or MERS was recovered. For COVID-19, five studies presented cost analysis performed in Brazil, China, Iran, and Turkey. Regarding total direct medical costs, the lowest cost per patient at ward was observed in Turkey ($900.08), while the highest in Brazil ($5,093.38). At ICU, the lowest was in Turkey ($2,984.78), while the highest was in China ($52,432.87). Service care was the most expressive (58% to 88%) cost driver of COVID-19 patients at ward. At ICU, there was no consensus between service care (54% to 87%) and treatment (72% to 81%) as key burdens of total cost. Conclusion Our findings elucidate the importance of COVID-19 on health-economic outcomes. The marked heterogeneity among studies leaded to substantially different results and made challenging the comparison of data to estimate pooled results for single countries or regions. Further studies concerning cost estimates from standardized analysis may provide clearer data for a more substantial analysis. This may help care providers and policy makers to organize care for patients in the most efficient way.

by Sayed Mostafa, Kathy Cousins-Cooper, Barbara Tankersley, Shea Burns, Guoqing Tang

The outbreak of the COVID-19 pandemic early in 2020 forced universities to shut down their campuses and transition to emergency remote instruction (ERI). Students had to quickly adapt to this new mode of instruction while dealing with all other distractions caused by the pandemic. This study integrates extensive data from students’ institutional records at a large Historically Black College and University (HBCU) institution with data from a students’ survey about the impact of COVID-19 on learning during the Spring 2020 semester to examine the impact of the transition to ERI on students’ performance and identify the main factors explaining variations in students’ performance. The main findings of our analysis are: (a) students’ university experience was positively correlated with performance (continuing students who spent at least one academic year at the university prior to the outbreak had better performance than freshman and new transfer students), (b) students’ perceived change in performance after the transition was positively associated with actual performance (students who perceived a decline in their performance after transition to ERI had significantly worse performance than other students), and (c) students’ prior online learning experiences and students’ emotional experiences with the COVID-19 disease were not significantly associated with performance. These results suggest that the approaches adopted by higher education institutions to support students during times of crisis should pay special attention to certain groups of students.

by Ludivine Martin, Laetitia Hauret, Chantal Fuhrer

In these times of successive lockdown periods due to the health crisis induced by COVID-19, this paper investigates how the usages of collaborative and communication digital tools (groupware, workflow, instant messaging and web conference) are related to the evolution of teleworkers’ subjective well-being (job satisfaction, job stress) and job productivity comparing during and before the first lockdown in spring 2020. Using a sample of 438 employees working for firms located in Luxembourg, this analysis enables, first, to highlight different profiles of teleworkers regarding the evolution of usages of these tools during the lockdown compared to before and the frequency of use during. Second, the analysis highlights that these profiles are linked to the evolution of job satisfaction, job stress and job productivity. Our main results show that (1) the profile that generates an increase in job productivity is the one with a combined mastered daily or weekly use of all of the four studied digital tools but at the expense of job satisfaction. On the contrary, (2) the use of the four digital tools both before and during the lockdown, associated with an increase in the frequency of use, appears to generate too much information flow to deal with and teleworkers may suffer from information overload that increases their stress and reduces their job satisfaction and job productivity. (3) The habit of using the four tools on a daily basis before the lockdown appears to protect teleworkers from most of the adverse effects, except for an increase in their job stress. Our results have theoretical and managerial implications for the future of the digitally transformed home office.