Monitoramento das Produções

by Mohamed I. Elsaid, Xiaochen Zhang, Anne L. R. Schuster, Jesse J. Plascak, Cecilia DeGraffinreid, Electra D. Paskett
Background The impacts of socioeconomic status (SES) on COVID-19-related changes in cancer prevention behavior have not been thoroughly investigated. We conducted a cohort study to examine the effects of SES on changes in cancer prevention behaviors during the COVID-19 pandemic. Methods We invited adult participants from previous studies conducted at Ohio State University to participate in a study assessing the impact of COVID-19 on various behaviors. Post-COVID-19 cancer prevention behaviors, including physical activity, daily intake of fruits and vegetables, alcohol and tobacco consumption, and qualitative changes in post-COVID-19 behaviors relative to pre-COVID levels, were used to construct a prevention behavior change index that captures the adherence status and COVID-related changes in each behavior, with higher index scores indicating desirable changes in prevention behaviors. Participants were classified into low, middle, or high SES based on household income, education, and employment status. Adjusted regression models were used to examine the effects of SES on changes in cancer prevention behaviors during the COVID-19 pandemic. Results The study included 6,136 eligible participants. The average age was 57 years, 67% were women, 89% were non-Hispanic Whites, and 33% lived in non-metro counties. Relative to participants with high SES, those with low SES had a 24% [adjusted relative ratio, aRR = 0.76 (95%CI 0.72–0.80)], 11% [aRR = 0.89 (95%CI 0.86–0.92)], and 5% [aRR = 0.95 (95%CI 0.93–0.96)], lower desirable changes in prevention behaviors for physical activity, fruit and vegetable intake, and tobacco use, respectively. Low SES had a higher desirable change in alcohol consumption prevention behaviors, 16% [aRR = 1.16 (95%CI 1.13–1.19)] relative to high SES. The adjusted odds of an overall poor change in prevention behavior were adjusted odds ratio (aOR) 1.55 (95%CI 1.27 to 1.89) and aOR 1.40 (95%CI 1.19 to 1.66), respectively, higher for those with low and middle SES relative to those with high SES. Conclusion The adverse impacts of COVID-19 on cancer prevention behaviors were seen most in those with lower SES. Public health efforts are currently needed to promote cancer prevention behaviors, especially amongst lower SES adults.

by Mario Mischkulnig, Benjamin Hopp, Lisa I. Wadiura, Farjad Khalaveh, Barbara Kiesel, Karl Rössler, Georg Widhalm, Christian Dorfer
Background Throughout the last years, the coronavirus disease 2019 (COVID-19) pandemic posed a major challenge to the optimal and timely treatment of neurooncological patients around the world. While the importance of prompt surgical treatment in high-grade gliomas is widely accepted, there is sparse data on the impact of the pandemic on patients suffering from this malignant disease. Methods We performed a retrospective analysis of patients undergoing surgical high-grade glioma treatment at the Medical University of Vienna between March 2020 and February 2021, as well as a control cohort of patients who received treatment between January and December 2019. Time lag between referral for surgical treatment to actual surgery, preoperative tumor volume and overall patient survival were compared between groups. Results A total of 118 patients, including 62 cases treated during the first year of the COVID-19 pandemic, as well as 56 control patients, were investigated in this study. Median interval to surgery was significantly shorter in patients treated during COVID-19 compared with the control group (4.00 versus 7.00 days; p = 0.0005). In contrast, patients treated during COVID-19 exhibited marginally larger preoperative tumor volumes, while overall patient survival was comparable between groups. Conclusions The COVID-19 pandemic did not negatively affect the overall survival of patients undergoing surgical high-grade glioma treatment at our institution. The significantly shorter treatment delay in patients treated during the pandemic likely reflects increased resource allocation for this critical patient population.

by Karoline Lukaschek, Carolin Haas, André Wannemüller, Christian Brettschneider, Tobias Dreischulte, Jürgen Margraf, Jochen Gensichen, on behalf of the PARADIES study group

A practice team-based exercise programme with elements of cognitive behavioural therapy (CBT) and case management for patients with panic disorder with or without agoraphobia in primary care showed significant positive effects. Here, we analyse the long-term effects (>5 years) of this intervention in the stressful context of the Covid-19 pandemic. All participants of the original PARADIES cluster randomized controlled trial (cRCT; 2012–2016) were invited to participate in a follow-up during the Covid-19 pandemic. Clinical outcomes were anxiety symptoms, number and severity of panic attacks, agoraphobic avoidance behaviour, Covid-specific anxiety symptom severity, depression, and patient assessment of chronic illness care. Data were analysed cross-sectionally for group differences (intervention, control) and longitudinally (T0: baseline, T1: 6 months and TCorona: >60 months). Of the original 419 participants, 100 participated in the 60 months follow-up (October 2020-May 2021). In the cross-sectional analysis, the anxiety symptom severity in the intervention group was lower than in the control group (p = .011, Cohen‘s d = .517). In the longitudinal analysis, both groups showed an increase of anxiety and depression symptoms compared to pre-pandemic level. The intervention may have had a lasting impact regarding anxiety severity despite the challenging context of the Covid-19 pandemic. However, we cannot say to what extend the intervention still played a role in participants’ lives; other factors may also have helped with coping. The increase of anxiety and depression symptoms in both groups over time could be attributed to external circumstances.

by Kyla Thomas, Peter G. Szilagyi, Sitaram Vangala, Rebecca N. Dudovitz, Megha D. Shah, Nathalie Vizueta, Arie Kapteyn

The success of personal non-pharmaceutical interventions as a public health strategy requires a high level of compliance from individuals in private social settings. Strategies to increase compliance in these hard-to-reach settings depend upon a comprehensive understanding of the patterns and predictors of protective social behavior. Social cognitive models of protective behavior emphasize the contribution of individual-level factors while social-ecological models emphasize the contribution of environmental factors. This study draws on 28 waves of survey data from the Understanding Coronavirus in America survey to measure patterns of adherence to two protective social behaviors–private social-distancing behavior and private masking behavior–during the COVID-19 pandemic and to assess the role individual and environmental factors play in predicting adherence. Results show that patterns of adherence fall into three categories marked by high, moderate, and low levels of adherence, with just under half of respondents exhibiting a high level of adherence. Health beliefs emerge as the single strongest predictor of adherence. All other environmental and individual-level predictors have relatively poor predictive power or primarily indirect effects.

by Brigit A. Hatch, Erin Kenzie, NithyaPriya Ramalingam, Eliana Sullivan, Chrystal Barnes, Nancy Elder, Melinda M. Davis
Introduction Little is known about the impact of mandated vaccination policies on the primary care clinic workforce in the United States or differences between rural and urban settings, especially for COVID-19. With the continued pandemic and an anticipated increase in novel disease outbreaks and emerging vaccines, healthcare systems need additional information on how vaccine mandates impact the healthcare workforce to aid in future decision-making. Methods We conducted a cross-sectional survey of Oregon primary care clinic staff between October 28, 2021– November 18, 2021, following implementation of a COVID-19 vaccination mandate for healthcare personnel. The survey consisted of 19 questions that assessed the clinic-level impacts of the vaccination mandate. Outcomes included job loss among staff, receipt of an approved vaccination waiver, new vaccination among staff, and the perceived significance of the policy on clinic staffing. We used univariable descriptive statistics to compare outcomes between rural and urban clinics. The survey also included three open-ended questions that were analyzed using a template analysis approach. Results Staff from 80 clinics across 28 counties completed surveys, representing 38 rural and 42 urban clinics. Clinics reported job loss (46%), use of vaccination waivers (51%), and newly vaccinated staff (60%). Significantly more rural clinics (compared to urban) utilized medical and/or religious vaccination waivers (71% vs 33%, p = 0.04) and reported significant impact on clinic staffing (45% vs 21%, p = 0.048). There was also a non-significant trend toward more job loss for rural compared to urban clinics (53% vs. 41%, p = 0.547). Qualitative analysis highlighted a decline in clinic morale, small but meaningful detriments to patient care, and mixed opinions of the vaccination mandate. Conclusions Oregon’s COVID-19 vaccination mandate increased healthcare personnel vaccination rates, yet amplified staffing challenges with disproportionate impacts in rural areas. Staffing impacts in primary care clinics were greater than reported previously in hospital settings and with other vaccination mandates. Mitigating primary care staffing impacts, particularly in rural areas, will be critical in response to the continued pandemic and novel viruses in the future.

by Kartika Kajal, Masoud Mohammadnezhad
Background Corona Virus Disease 2019 (COVID-19) was declared a global pandemic by the World Health Organization (WHO) has had significant impact on dentistry in Fiji. Due to lack of previous study, this study aims to explore the perspective of Dental Officers (DOs) and Dental Managers (DMs) on the effects of COVID-19 on dental service delivery in Fiji Islands. Methods This qualitative study was conducted amongst 30 DOs and 17 DMs between 9th August to 12th September, 2021. It was conducted in the government dental clinics, private dental clinics and the School of Dentistry and Oral Health clinic (SDOH), in the Central Division, Fiji. The study settings were randomly selected. Purposive sampling method was used for the selection of participants who met the study criteria. Semi-structure open ended questionnaires were used for data collection through in-depth interviews via zoom. Manual thematic analysis of the data was conducted to derive themes and codes. Results The participants interviewed for the study included more female DOs (66.7%) and male DMs (58.8%). Seven themes emerged from data analysis: range of services delivered, appointment versus walk-in patients for aerosol generating procedures (AGPs), impact of pandemic on clinic opening hours, impact of COVID-19 on patient numbers, quality of services delivered, resources and infrastructure, perceptions about the burden of disease. Conclusion COVID-19 has significantly affected dental service delivery. Mostly emergency dental services were delivered. AGPs were delivered on appointment basis. Most participants stated the quality of services had improved. Participants stated that they were not given adequate resources and the infrastructure was not up to standard to provide dental services during the pandemic. The dental disease burden had increased during the pandemic as per the participants. Future research can be conducted amongst other dental professionals in other divisions of the country.

by Tadesse Misgana, Dejene Tesfaye, Mandaras Tariku, Tilahun Ali, Daniel Alemu, Yadeta Dessie
Introduction The coronavirus disease is still not under the control globally and has caused various mental health problems such as depression, anxiety, suicide, and aggressive behavior in different populations. The pandemic-related issues which are applied to control the pandemic such as protection measures against COVID-19, social distancing, isolation, and quarantine can also trigger mental health problems. Objective This study aimed to assess suicidal behavior and aggression, and its correlates during COVID-19 among populations within institutional quarantine and isolation centers in Ethiopia. Method A cross-sectional study was conducted among a sample of 392 participants. The convenience sampling method was used to select the study participants. Suicide Behavioral Questionnaire-Revised (SBQ-R) and the Modified Overt Aggression Scale (MOAS)were applied to determine the suicide and aggressive behavior of study participants respectively. Epi-data 3.1 and SPSS 20.0were used to enter and analyze the data respectively. Logistic and linear regressions were fitted to explore correlates associated with suicidal behavior and aggression respectively. Results The prevalence of suicidal behavior was 8.7% (95% CI: 6.1, 11.5) whereas the mean total score of behavioral aggression was 2.45±5.90 (95% CI: 1.84, 3.08). Being female (AOR = 2.63, 95% CI: 1.09, 6.32), having common mental disorders (AOR = 6.08, 95% CI: 2.32, 15.93), manifesting the symptoms of COVID-19 (AOR = 2.17, 95% CI: 1.48, 2.86), and poor social support (AOR = 7.30, 95% CI: 1.44, 37.10) were significantly associated with suicidal behavior, whereas male gender (β coefficient = 3.0, 95% CI: 1.35, 4.70), low level of knowledge about COVID-19 (β coefficient = 1.87, 95% CI: 1.09, 3.41), and substance use (β coefficient = 1.7, 95% CI: 1.23, 6.47) were positively associated with mean overt aggression score. Conclusion The present study revealed that suicidal and aggressive behaviors were prevalent with significant correlates. Therefore, it is important and required to provide focused mental health and psycho-social services for the selected and high-risk populations such as those in quarantine and isolation centers for being suspected.

by Kouki Akahoshi, Keiko Nakamura, Hisayoshi Kondo, Akinori Wakai, Yuichi Koido
Objective To examine whether post-outbreak early-phase interventions by emergency response teams (ERTs) in long-term care facilities (LTCFs) contribute to containment with lower incidence and case-fatality rate of COVID-19 and analyse the required assistance. Methods Records from 59 LTCFs (28 hospitals, 15 nursing homes, and 16 homes) assisted by ERTs after the COVID-19 outbreak, between May 2020 and January 2021, were used for the analysis. Incidence and case-fatality rates among 6,432 residents and 8,586 care workers were calculated. The daily reports of ERTs were reviewed, and content analysis was performed. Results Incidence rates among residents and care workers with early phase (

by Sun Ju Kim

The purpose of this study was to examine knowledge, professional quality of life, and practices among nurses during the coronavirus disease 2019 (COVID-19) pandemic and explore factors associated with nurses’ practice. A total of 167 nurses were recruited from 4 general hospitals for this cross-sectional study, which was conducted from June to July 2021. Using SPSS/WIN 22, the collected data were analyzed using descriptive statistics, t-tests, analysis of variance, Pearson’s correlation coefficients, and hierarchical multiple regression analysis. The mean age of the participants was 31.43, and the sample comprised 144 women (86.2%) and 23 men (13.8%). The results indicated that practice was negatively correlated with burnout (r = -.18, p = .017). The regression model explained 24.1% of the variance. For general characteristics in Model 1, education on COVID-19 management (β = .18, p = .014) was the factor most associated with nurses’ practice. In Model 2, with professional quality of life added, burnout (β = -.21, p = .003) was the only influential factor. These results highlight the need to establish an effective prevention system for infectious diseases such as COVID-19, including education programs pertinent to the prevention and management of infection that improve the modifiable predictors of nurses’ practice—education and burnout.

by Habib Jalilian, Seyed Mohammad Riahi, Somayeh Heydari, Masoomeh Taji
Background and objective The COVID-19 pandemic placed considerable pressure on the health care systems and caused many disruptions to the care hospital system around the globe. This study aimed to analyze the performance of hospitals affiliated with the University of Medical Sciences and Health Services of South Khorasan Province before and during COVID-19. Method This cross-sectional study tracked the financial performance (FP) and service performance (SP) of 12 hospitals affiliated with South Khorasan University of Medical Sciences and Health Services using the Farabar system and Hospital Information System (HIS). Our study covered two time periods: from February 2018 to February 2020 (pre-COVID-19) and from February 2020 to February 2021 (during COVID-19). SP analysis of hospitals was performed by examining the trend of monthly changes before and during the COVID-19 pandemic and analyzed using SPSS software version 22 and Paired Sample T-Test. FP of hospitals was analyzed through relevant ratios and analyzed using Microsoft Office Excel. Results Most SP indicators decreased considerably in all hospitals during COVID-19. FP ratios (e.g., activity and leverage ratios) increased during either or both pre-COVID or COVID periods. Compared to before COVID-19, the operating margin ratio and operating expenses coverage from operating income increased from -0.50 and 66.55 to -1.42 and 41.32, respectively, during COVID-19. Moreover, the net profit margin ratio and Return On Assets (ROA) ratio were increased during COVID-19. Conclusion COVID-19 has decreased the FP and SP of hospitals due to limitations in providing services to patients since the beginning of COVID-19. Measures such as providing various financing resources and improving the financial resilience of hospitals are essential. Funds should be disbursed to offset hospitals’ losses due to reduced elective and outpatient revenue. Policymakers should come up with holistic policies to tackle the adverse impact of such crises in the future, support hospitals financially, and consider allocating additional funding to them during emergencies.

by Sujaree Poopipatpab, Pruchwilai Nuchpramool, Piyarat Phairatwet, Todspol Lertwattanachai, Konlawij Trongtrakul

Patients with mild-to-moderate coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) can be treated with a high-flow nasal cannula (HFNC). The use of the respiratory rate-oxygenation (ROX) index, calculated as the ratio of oxygen saturation (SpO2)/fractional oxygen (FiO2) to respiratory rate, in the first few hours after HFNC initiation can help identify patients who fail HFNC therapy later. However, few studies have documented the use of the ROX index during the period of HFNC therapy. Therefore, we aimed to demonstrate the diagnostic performance of the ROX index when calculated throughout the HFNC therapy period and to determine the best cut-off point for predicting HFNC failure. We conducted a retrospective study of patients with COVID-19-associated ARDS who commenced HFNC at the Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand, between April 1 and August 30, 2021. We calculated the ROX index every 4 h throughout the HFNC therapy period and defined HFNC failure as a subsequent endotracheal tube intubation. The performance of the ROX index was analyzed using the area under the receiver operating characteristic curve (AUC). We applied the ROX index ≤ 4.88 to predict HFNC failure and obtained a new ROX cut-off point using Youden’s method. In total, 212 patients with COVID-19 treated with HFNC were included in the study. Of these, 81 patients (38.2%) experienced HFNC failure. The ROX index ≤ 4.88 demonstrated a reasonable performance in predicting HFNC failure (AUC, 0.77; 95% confidence interval [CI], 0.72–0.83; p

by Wasantha Rajapakshe, D. S. M. Karunaratna, W. H. G. Ariyaratne, H. A. Lakshani Madushika, G. S. K. Perera, P. Shamila

During the COVID-19 crisis, the apparel industry faced many challenges. Aggressive cost-cutting strategies became a top priority, and in turn, these influenced stressors and adversely affected business sustainability. This study examines the impact of aggressive strategies during the COVID-19 pandemic on business sustainability in the apparel industry of Sri Lanka. Further, it investigates whether the relationship between aggressive cost-cutting strategies and business sustainability was mediated by employee stress, considering aggressive cost reduction strategies and workplace environmental changes. This was a cross-sectional study with data collected from 384 employees in the apparel industry in Sri Lanka. Structural Equation Modelling (SEM) was applied to analyze the direct and indirect effects of aggressive cost reduction strategies and workplace environmental changes on sustainability with mediating effects of stress. Aggressive cost reduction strategies (Beta = 1.317, p = 0.000) and environmental changes (Beta = 0.251, p = 0.000) led to an increase in employee stress but did not affect business sustainability. Thus, employee stress (Beta = -0.028, p = 0.594) was not a mediator in the relationship between aggressive cost-cutting strategies and business sustainability; business sustainability was not a dependent variable. The findings proved that managing workplace stress, particularly improving stressful working environments and aggressive cost reduction strategies, can enhance employee satisfaction. Thus, managing employee stress could be beneficial for policymakers to focus on the area(s) required to retain competent employees. Moreover, aggressive strategies are unsuitable to apply during crisis to enhance business sustainability. The findings provide additional knowledge to the existing literature, enabling employees and employers to predict causes of stress and serve as a significant knowledge base for further studies.

by Maria Reinius, Veronica Svedhem, Judith Bruchfeld, Heidi Holmström Larm, Malin Nygren-Bonnier, Lars E. Eriksson
Background Epidemics have historically been accompanied by stigma and discrimination. Disease-related stigma has often been shown to have severe consequences for physical, mental and social wellbeing and lead to barriers to diagnosis, treatment and prevention. The aims of this study were to investigate if a HIV-related stigma measure could be adapted and valid and reliable to measure COVID-19-related stigma, and also to investigate levels of self-reported stigma and related factors among people in Sweden with experience of COVID-19 and compare levels of COVID-19-related stigma versus HIV-related stigma among persons living with HIV who had experienced a COVID-19 event. Methods Cognitive interviews (n = 11) and cross-sectional surveys were made after the acute phase of the illness using a new 12-item COVID-19 Stigma Scale and the established 12-item HIV Stigma Scale in two cohorts (people who had experienced COVID-19 (n = 166/209, 79%) and people living with HIV who had experienced a COVID-19 event (n = 50/91, 55%). Psychometric analysis of the COVID-19 Stigma Scale was performed by calculating floor and ceiling effects, Cronbach’s α and exploratory factor analysis. Levels of COVID-19 stigma between groups were analysed using the Mann-Whitney U test. Levels of COVID-19 and HIV stigma among people living with HIV with a COVID-19 event were compared using the Wilcoxon signed-rank test. Results The COVID-19 cohort consisted of 88 (53%) men and 78 (47%) women, mean age 51 (19–80); 143 (87%) living in a higher and 22 (13%) in a lower income area. The HIV + COVID-19 cohort consisted of 34 (68%) men and 16 (32%) women, mean age 51 (26–79); 20 (40%) living in a higher and 30 (60%) in a lower income area. The cognitive interviews showed that the stigma items were easy to understand. Factor analysis suggested a four-factor solution accounting for 77% of the total variance. There were no cross loadings, but two items loaded on factors differing from the original scale. All subscales had acceptable internal consistency, showed high floor and no ceiling effects. There was no statistically significant difference between COVID-19 stigma scores between the two cohorts or between genders. People living in lower income areas reported more negative self-image and concerns about public attitudes related to COVID-19 than people in higher income areas (median score 3 vs 3 and 4 vs 3 on a scale from 3–12, Z = -1.980, p = 0.048 and Z = -2.023, p = 0.024, respectively). People from the HIV + COVID-19 cohort reported more HIV than COVID-19 stigma. Conclusions The adapted 12-item COVID-19 Stigma Scale may be valid and reliable for measurement of COVID-19-related stigma. However, specific items may need to be rephrased or replaced to better correspond to the COVID-19 context. People who had experienced COVID-19 reported low levels of COVID-19-related stigma in general but people from lower income areas had higher levels of negative self-image and concerns about public attitudes related to COVID-19 than people from areas with higher income, which may call for targeted interventions. Although exhibiting more pronounced HIV stigma levels, people living with HIV who had experienced COVID-19 reported COVID-19-related stigma of the same low magnitude as their peers not living with HIV.

by Prianka Padmanathan, Danielle Lamb, Hannah Scott, Sharon Stevelink, Neil Greenberg, Matthew Hotopf, Richard Morriss, Rosalind Raine, Anne Marie Rafferty, Ira Madan, Sarah Dorrington, Simon Wessely, Paul Moran
Background During the COVID-19 pandemic, concern has been raised about suicide risk among healthcare workers (HCWs). We investigated the incidence risk and prevalence of suicidal thoughts and behaviour (STB), and their relationship with occupational risk factors, among National Health Service HCWs in England between April 2020 and August 2021. Methods In this longitudinal study, we analysed online survey data completed by 22,501 HCWs from 17 NHS Trusts at baseline (Time 1) and six months (Time 2). The primary outcome measures were suicidal ideation, suicide attempts, and non-suicidal self-injury. We used logistic regression to investigate the relationship between these outcomes and demographic characteristics and occupational factors. Results were stratified by occupational role (clinical/non-clinical). Results Time 1 and Time 2 surveys were completed by 12,514 and 7,160 HCWs, respectively. At baseline, 10.8% (95% CI = 10.1%, 11.6%) of participants reported having experienced suicidal thoughts in the previous two months, whilst 2.1% (95% CI = 1.8%, 2.5%) of participants reported having attempted suicide over the same period. Among HCWs who had not experienced suicidal thoughts at baseline (and who completed the Time 2 survey), 11.3% (95%CI = 10.4%, 12.3%) reported such thoughts six months later. Six months after baseline, 3.9% (95% CI = 3.4%, 4.4%) of HCWs reported attempting suicide for the first time. Exposure to potentially morally injurious events, lack of confidence about raising safety concerns and these concerns being addressed, feeling unsupported by managers, and providing a reduced standard of care were all associated with increased suicidal ideation among HCWs during the COVID-19 pandemic. At six months, among clinicians, a lack of confidence about safety concerns being addressed, independently predicted suicidal ideation. Conclusion Suicidal thoughts and behaviour among healthcare workers could be reduced by improving managerial support and enhancing the ability of staff to raise safety concerns.

by Yo Han Lee, Hyun-Hee Heo, Hyerim Noh, Deok Hyun Jang, Young-Geun Choi, Won Mo Jang, Jin Yong Lee

Risk perception research, targeting the general public, necessitates the study of the multi-faceted aspects of perceived risk through a holistic approach. This study aimed to investigate the association between the two dimensions of risk perception of COVID-19, i.e., risk as a feeling and analysis, trust in the current government, political ideologies, and socio-demographic factors in South Korea. This study used a year-long repeated cross-sectional design, in which a national sample (n = 23,018) participated in 23 consecutive telephone surveys from February 2020 to February 2021. Most factors differed in the magnitude and direction of their relationships with the two dimensions of risk perception. However, trust in the current government, alone, delineated an association in the same direction for both dimensions, i.e., those with a lower level of trust exhibited higher levels of cognitive and affective risk perception. Although these results did not change significantly during the one-year observation period, they are related to the political interpretation of risk. This study revealed that affective and cognitive risk perceptions addressed different dimensions of risk perception. These findings could help governments and health authorities better understand the nature and mechanisms of public risk perception when implementing countermeasures and policies in response to the COVID-19 pandemic and other public health emergencies.

by Jillian Whelan, Monique Hillenaar, Penny Fraser, Steven Allender, Michelle Jackson, Claudia Strugnell, Colin Bell
Background Calls for the adoption of a systems approach to chronic disease prevention date back at least ten years because of the potential to empower communities to identify and address the complex causes of overnutrition, undernutrition and climate change. Australia, like many countries, has high levels of obesity and extreme climate events. The Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial aims to prevent unhealthy weight gain in children in 10 intervention and two pilot communities in north-east Victoria, Australia using community-based participatory approaches informed by systems science. Intervention activities co-designed in 2019 were disrupted by COVID-19 and bushfires. This paper explores the impacts of these ‘shocks’ on the local prevention workforce to implement actions within communities. Methods A case study design involving one-hour online focus groups and an on-line survey (November 2021-February 2022). Purposive sampling was used to achieve diverse representation from RESPOND stakeholders including local council, health services, primary care partnerships and department of health. The focus group interview schedule and survey questions were based on Durlak and DuPre’s implementation factors. Results Twenty-nine participants from seven different communities participated in at least one of nine focus groups to discuss the impacts of COVID-19 and bushfires on localised implementation. Twenty-eight participants (97% of focus group sample) also completed the on-line survey. Implementation of RESPOND stalled or stopped in most communities due to bushfires and/or COVID-19. These shocks resulted in organisational priorities changing, loss of momentum for implementation, redeployment of human resources, culminating in fatigue and exhaustion. Participants reported adaptation of RESPOND, but implementation was slowed due to limited resources. Conclusion Further research is needed to advance risk management strategies and protect resources within health promotion. System shocks such as bushfires and COVID-19 are inevitable, and despite multiple adaptation opportunities, this intervention approach was not ‘shock proof’.

by Ashkan Hassani, Vinton Omaleki, Jeanine Erikat, Elizabeth Frost, Samantha Streuli, Ramla Sahid, Homayra Yusufi, Rebecca Fielding-Miller

Refugee communities are vulnerable to housing insecurity, which drives numerous health disparity outcomes in a historically marginalized population. The COVID-19 pandemic has only worsened the ongoing affordable housing crisis in the United States while continuing to highlight disparities in health outcomes across populations. We conducted interviewer-administered surveys with refugee and asylum seekers in San Diego County at the height of the COVID-19 pandemic to understand the social effects and drivers of COVID-19 in one of the largest refugee communities in the United States. Staff from a community-based refugee advocacy and research organization administered the surveys from September—November 2020. 544 respondents participated in the survey, which captured the diversity of the San Diego refugee community including East African (38%), Middle Eastern (35%), Afghan (17%), and Southeast Asian (11%) participants. Nearly two-thirds of respondents (65%) reported living in overcrowded conditions (> 1 individual per room) and 30% in severely crowded conditions (> 1.5 individuals per room). For each additional person per room, self-reported poor emotional health increased. Conversely, family size was associated with a lower likelihood of reporting poor emotional health. Crowded housing was significantly associated with a lower probability of accessing a COVID-19 diagnostic test, with every additional reported person per room there was approximately an 11% increase in the probability of having never accessed a COVID-19 testing. Access to affordable housing had the largest effect size and was associated with fewer people per room. Overcrowding housing is a structural burden that reduces COVID-19 risk mitigation behaviors. Improved access to affordable housing units or receiving vouchers could reduce overcrowded housing in vulnerable refugee communities.

by Steven Habbous, Susy Hota, Vanessa G. Allen, Michele Henry, Erik Hellsten
Introduction Population-level surveillance systems have demonstrated reduced transmission of non-SARS-CoV-2 respiratory viruses during the COVID-19 pandemic. In this study, we examined whether this reduction translated to reduced hospital admissions and emergency department (ED) visits associated with influenza, respiratory syncytial virus (RSV), human metapneumovirus, human parainfluenza virus, adenovirus, rhinovirus/enterovirus, and common cold coronavirus in Ontario. Methods Hospital admissions were identified from the Discharge Abstract Database and exclude elective surgical admissions and non-emergency medical admissions (January 2017-March 2022). Emergency department (ED) visits were identified from the National Ambulatory Care Reporting System. International Classification of Diseases (ICD-10) codes were used to classify hospital visits by virus type (January 2017-May 2022). Results At the onset of the COVID-19 pandemic, hospitalizations for all viruses were reduced to near-trough levels. Hospitalizations and ED visits for influenza (9,127/year and 23,061/year, respectively) were nearly absent throughout the pandemic (two influenza seasons; April 2020-March 2022). Hospitalizations and ED visits for RSV (3,765/year and 736/year, respectively) were absent for the first RSV season during the pandemic, but returned for the 2021/2022 season. This resurgence of hospitalizations for RSV occurred earlier in the season than expected, was more likely among younger infants (age ≤6 months), more likely among older children (aged 6.1–24 months), and less likely to comprise of patients residing in higher areas of ethnic diversity (p

by Valeria Catalani, Honor D. Townshend, Mariya Prilutskaya, Robert P. Chilcott, Antonio Metastasio, Hani Banayoti, Tim McSweeney, Ornella Corazza
Aims The COVID-19 pandemic triggered a demand for vaccines, cures, and the need of related documentation for travel, work and other purposes. Our project aimed to identify the illicit availability of such products across the Dark Web Markets (DWMs). Methods A retrospective search for COVID-19 related products was carried out across 118 DWMs since the start of the pandemic (March 2020-October 2021). Data on vendors as well as advertised goods such as asking price, marketplace, listed date were collected and further validated through additional searches on the open web to verify the information relating to specific marketplaces. Both quantitative and qualitative methods were used for data analysis. Results Forty-two listings of unlicenced COVID-19 cures and vaccination certificates were identified across 8 marketplaces sold by 25 vendors with significant variation in prices. The listings were found to be geographically specific and followed the progression of the pandemic in terms of availability. Correlations between vendor portfolios of COVID-19 products and variety of goods of other illicit nature such as illegal weaponry, medication/drugs of abuse also emerged from our analysis. Conclusion This study is one of the first attempts to identify the availability of unlicenced COVID-19 products on DWMs. The easy accessibility to vaccines, fake test certificates and hypothetical/illegal cures poses serious health risks to (potential) buyers due to the uncontrolled nature of such products. It also exposes buyers to an unwanted contact with vendors selling a variety of other dangerous illicit goods. Further monitoring and regulatory responses should be implemented to protect the health and safety of citizens especially at times of global crisis.

by Peiling Cai, Ya Shi, Jianing Cui, Junren Wang, Juan Ren, Brett D. Hambly, Shisan Bao, Zhongqing Xu
Background To combat/control the COVID-19 pandemic, a complete lockdown was implemented in China for almost 6 months during 2020. Purpose To determine the impact of a long-term lockdown on the academic performance of first-year nursing students via mandatory online learning, and to determine the benefits of online teaching. Methods The recruitment and academic performance of 1st-year nursing students were assessed between 2019 [prior to COVID-19, n = 195, (146 women)] and 2020 [during COVID-19, n = 180 (142 women)]. The independent sample t test or Mann-Whitney test was applied for a comparison between these two groups. Results There was no significant difference in student recruitment between 2019 and 2020. The overall performance of the first-year students improved in the Biochemistry, Immunopathology, Traditional Chinese Medicine Nursing and Combined Nursing courses via mandatory online teaching in 2020 compared with traditional teaching in 2019. Conclusion Suspension of in-class learning but continuing education virtually online has occurred without negatively impacting academic performance, thus academic goals are more than achievable in a complete lockdown situation. This study offers firm evidence to forge a path for developments in teaching methods to better incorporate virtual learning and technology in order to adapt to fast-changing environments. However, the psychological/psychiatric and physical impact of the COVID-19 lockdown and the lack of face-to-face interaction on these students remains to be explored.

by Rachel Apple, Emily C. O’Brien, Nancy M. Daraiseh, Haolin Xu, Russell L. Rothman, Mark Linzer, Laine Thomas, Christianne Roumie
Importance The COVID-19 pandemic stressed the healthcare field, resulting in a worker exodus at the onset and throughout the pandemic and straining healthcare systems. Female healthcare workers face unique challenges that may impact job satisfaction and retention. It is important to understand factors related to healthcare workers’ intent to leave their current field. Objective To test the hypothesis that female healthcare workers were more likely than male counterparts to report intention to leave. Design Observational study of healthcare workers enrolled in the Healthcare Worker Exposure Response and Outcomes (HERO) registry. After baseline enrollment, two HERO ‘hot topic’ survey waves, in May 2021 and December 2021, ascertained intent to leave. Unique participants were included if they responded to at least one of these survey waves. Setting HERO registry, a large national registry that captures healthcare worker and community member experiences during the COVID-19 pandemic. Participants Registry participants self-enrolled online and represent a convenience sample predominantly composed of adult healthcare workers. Exposure(s) Self-reported gender (male, female). Main outcome Primary outcome was intention to leave (ITL), defined as having already left, actively making plans, or considering leaving healthcare or changing current healthcare field but with no active plans. Multivariable logistic regression models were performed to examine the odds of intention to leave with adjustment for key covariates. Results Among 4165 responses to either May or December surveys, female gender was associated with increased odds of ITL (42.2% males versus 51.4% females reported intent to leave; aOR 1.36 [1.13, 1.63]). Nurses had 74% higher odds of ITL compared to most other health professionals. Among those who expressed ITL, three quarters reported job-related burnout as a contributor, and one third reported experience of moral injury. Conclusions and relevance Female healthcare workers had higher odds of intent to leave their healthcare field than males. Additional research is needed to examine the role of family-related stressors. Trial registration ClinicalTrials.gov identifier NCT04342806.

Knowledge, attitudes and practices toward dengue fever, vector control, and vaccine acceptance among the general population in countries from Latin America and Asia Pacific: a cross-sectional study (GEMKAP)
Shafie, Asrul Akmal; Moreira Jr, Edson Duarte; Pasquale, Alberta Di; Demuth, Dirk; Yin, Joanne Yoong Su

Density of Aedes aegypti (Diptera: Culicidae) in a low-income Brazilian urban community where dengue, Zika, and chikungunya viruses co-circulate
Souza, Raquel L.; Nazaré, Romero J.; Argibay, Hernan D.; Pellizzaro, Maysa; Anjos, Rosângela O.; Portilho, Moyra M.; Nascimento, Leile Camila Jacob; Reis, Mitermayer Galvão; Kitron, Uriel D.; Ribeiro, Guilherme S.

Changes in Brazilians’ socioeconomic and health conditions during the COVID-19 pandemic
Almeida, Wanessa da Silva de; Szwarcwald, Célia Landmann; Malta, Deborah Carvalho; Barros, Marilisa Berti de Azevedo; Souza Júnior, Paulo Roberto Borges de; Azevedo, Luiz Otávio; Romero, Dália; Lima, Margareth Guimarães; Damacena, Giseli Nogueira; Machado, Ísis Eloah; Gomes, Crizian Saar; Pina, Maria de Fátima de; Gracie, Renata; Werneck, André Oliveira; Silva, Danilo Rodrigues Pereira da
Descrever as mudanças nas condições socioeconômicas e de saúde dos brasileiros durante a pandemia de COVID-19. Estudo transversal com dados de pesquisa de comportamentos realizada pela internet de 24 de abril a 24 de maio de 2020 com 45.161 participantes recrutados por amostragem em cadeia. Foi feita uma análise descritiva de temas abordados na pesquisa: adesão às medidas de restrição social, diagnóstico do novo coronavírus, situação de trabalho e rendimentos, dificuldades nas atividades de rotina, presença de comorbidades, estado de ânimo e acesso aos serviços de saúde. Foram estimados as prevalências e os intervalos de 95% de confiança. Aproximadamente 75% dos brasileiros aderiram à restrição social. Quanto aos sintomas de gripe, 28,1% relatou ter apresentado algum sintoma, mas apenas 5,9% realizou teste para COVID19. Em relação à situação socioeconômica, 55,1% relatou diminuição do rendimento familiar, e 7% ficou sem rendimento; 25,8% dos indivíduos ficaram sem trabalhar, sendo o grupo de trabalhadores informais o mais afetado (50,6%). Quanto às condições de saúde, 29,4% avaliou que a sua saúde piorou; 45% teve problemas no sono, 40% apresentou, frequentemente, sentimento de tristeza e 52,5% de ansiedade/nervosismo; 21,7% procurou serviço de saúde e, entre estes, 13,9% não conseguiu atendimento. Conclusão: Os achados mostram a importância do controle da pandemia de COVID-19 no Brasil, para mitigar os efeitos adversos na situação socioeconômica e nas condições de saúde relacionados às medidas de restrição social.

Knowledge, attitudes and practices toward dengue fever, vector control, and vaccine acceptance among the general population in countries from Latin America and Asia Pacific: a cross-sectional study (GEMKAP).
Shafie, Asrul Akmal; Moreira Jr, Edson Duarte; Pasquale, Alberta Di; Demuth, Dirk; Yin, Joanne Yoong Su

Acesso aos serviços de saúde bucal em tempos de pandemia da COVID-19: uma perspectiva de usuários da atenção básica.
França, Camilla Maria Nery Baracho de
Diante da pandemia de COVID-19, a Atenção Básica tem exercido um importante papel na prevenção e combate à doença. As Equipes de Saúde da Família vêm buscando meios de exercer sua responsabilização sanitária pelos territórios e, ao mesmo tempo, resguardar a segurança de seus profissionais e usuários. No âmbito da saúde bucal, foi restringido os atendimentos eletivos, devido ao alto risco de infecção inerente às características do atendimento odontológico. A presente dissertação visou compreender e analisar como as diversas medidas restritivas adotadas durante a pandemia repercutiram no acesso aos serviços de saúde bucal, na percepção dos usuários e famílias do território adscrito da Unidade Básica de Saúde (UBS) de Balbina, interior do Amazonas. Este estudo transversal foi um recorte de uma pesquisa multicêntrica, de abordagem quanti-qualitativa realizada no período de setembro de 2021 a setembro de 2022. Os dados foram obtidos através da aplicação de um questionário digital do google forms à uma amostra intencional de 65 usuários, dentre estes, 10 foram submetidos a uma entrevista semiestruturada. A análise dos dados se deu na perspectiva da análise estatística descritiva e de conteúdo. A pesquisa foi realizada de acordo com os preceitos éticos da Resolução 466 de 2012 do CONEP (Comissão Nacional de Ética em Pesquisa), foi aprovada pelo Comitê de Ética em Pesquisa, e pela Secretaria Municipal de Saúde. Os entrevistados reconheceram que o acesso aos serviços de saúde bucal foi dificultado durante a pandemia. A preocupação com própria saúde bucal aumentou em 61,5% dos usuários, 47,7% vivenciou situações incômodas relacionadas aos dentes e 86,2% percebeu a necessidade de tratamento odontológico. A unidade básica de saúde foi a mais utilizada por 41,5% dos entrevistados, enquanto o consultório particular foi utilizado por 13,8%. Diante da impossibilidade de atendimento, 26,2% optaram por não procurar os serviços de saúde e 24,6% se medicou por conta própria. A pandemia de COVID-19 constituiu mais um obstáculo no acesso dos usuários aos serviços de saúde bucal na Atenção Básica, portanto estudos que investiguem suas consequências nos territórios devem ser realizados, a fim de que se estabeleçam estratégias coordenadas e participativas, para a ampliação do acesso no período pós-pandêmico.

Smoking among Brazilian adolescents during the COVID-19 pandemic: a cross-sectional study
Malta, Deborah Carvalho; Gomes, Crizian Saar; Vasconcelos, Nádia Machado de; Alves, Francielle Thalita Almeida; Ferreira, Arthur Pate de Souza; Barros, Marilisa Berti de Azevedo; Lima, Margareth Guimarães; Szwarcwald, Celia Landmann

Surveillance for arboviruses and leptospirosis among non-malarial acute febrile illness outpatients in areas affected by cyclones Idai and Kenneth in Mozambique
Mugabe, Vánio André; Inlamea, Osvaldo Frederico; Ali, Sádia; Maholela, Plácida; Melchior, Bibiana; Muianga, Argentina Felisbela; Oludele, John; Sumail, Andarusse; António, Virgílio; Monteiro, Vanessa Onofre; Chongo, Inocêncio; Kitron, Uriel; Ribeiro, Guilherme Sousa; Gudo, Eduardo Samo

Análise de problemas bioéticos na atuação do fisioterapeuta na pandemia de Covid-19 no Estado do Rio de Janeiro
Carvalho, Daniela Ferraz Frauches
O fisioterapeuta esteve ao longo da história da profissão vinculado a uma lógica curativista e reabilitadora, com uma formação tecnicista e pouco reflexiva. Pensar o cuidado integral na fisioterapia envolve trabalhar a capacidade de comunicação, a alteridade, a empatia para se fazer compreender e, ao mesmo tempo, compreender a fala do outro. É essencial, então a construção de habilidades que se combinem à técnica, que saiam da poiese e caminhem rumo ao outro, do latim alter, em ações éticas, construindo um profissional, de fato, competente. A Bioética é um campo do saber que possibilita ao profissional lidar com questões fundamentais do quotidiano do serviço, das relações entre os profissionais, com os usuários e a comunidade. Com a pandemia de COVID-19 os desafios para os fisioterapeutas em todos os níveis de atenção foram ampliados. Portanto, nesse trabalho buscamos identificar, analisar e discutir os problemas bioéticos vivenciados pelos fisioterapeutas na pandemia de COVID-19 no estado do Rio de Janeiro e os conhecimentos destes profissionais sobre os conceitos de ética e Bioética, os quais são capazes de fundamentar as tomadas de decisão em relação aos problemas identificados. Para a realização desta pesquisa foi realizada uma revisão integrativa sobre os problemas vividos pelos fisioterapeutas durante a pandemia de Covid-19 na base de dados da Biblioteca Virtual de Saúde (BVS). Na pesquisa de campo foi aplicado um questionário com perguntas fechadas e abertas aos fisioterapeutas atuantes no estado do Rio de Janeiro. A análise de conteúdo foi realizada de acordo com o proposto por Bardin. O presente trabalho foi aprovado pelo Comitê de Ética em Pesquisa da Escola Nacional de Saúde Pública da Fundação Oswaldo Cruz- ENSP/Fiocruz (CAAE: 45908721.9.0000.5240). Na revisão integrativa, verificou-se um enfoque sobre a situação de trabalho do fisioterapeuta, sua luta no ambiente de trabalho diante de uma situação crítica em que a assistência fisioterápica era importante e que uma sobrecarga imensa de trabalho assolou a prática diária dos profissionais, trazendo desgaste físico e emocional a estes profissionais. Na pesquisa de campo foi percebido que durante a pandemia houve um agravamento dos problemas já existentes, incluindo a estes também questões quanto aos protocolos de segurança, aumento de casos de imperícia e conflitos interprofissionais. Quanto ao conhecimento acerca de ética e bioética foram apresentadas respostas envolvendo normativas ou regras, a maioria afirmou não conhecer conceitos sobre esta temática, apesar de reconhecer quando apontado conceitos do Principialismo, Ética do cuidado e Bioética da proteção. Conclui-se ser importante progredir na construção das competências éticas e bioéticas na formação do fisioterapeuta para que este profissional esteja apto a refletir criticamente sobre os problemas e conflitos vivenciados em sua prática profissional, principalmente diante de um cenário de tantas inseguranças como de uma crise sanitária.

Identificação de aglomerados espaço-temporais de casos e óbitos de COVID-19 e o contexto sociodemográfico e ambiental nos bairros do município de Niterói/RJ
Silva, Elisabete Azevedo da
A doença do novo coronavírus transformou a vida da sociedade de forma abrupta, dada sua alta transmissibilidade e o modo de vida urbano; rapidamente o vírus se dispersou pelo planeta tornando-se uma pandemia. O objetivo desse trabalho foi identificar os aglomerados espaço-temporais dos casos e óbitos de COVID-19, e sua relação com os contextos sociodemográfico e ambiental nos bairros do município de Niterói/RJ. Foi realizado um estudo epidemiológico, descritivo e analítico do tipo ecológico, fundamentado nas notificações dos casos e óbitos por COVID-19 ocorridos no período de 01 de janeiro de 2020 a 31 de agosto de 2021. As unidades de análise foram os bairros de Niterói e a análise temporal foram as semanas epidemiológicas (SE). Os dados ambientais e sociodemográficos foram obtidos no IBGE. Os dados epidemiológicos foram cedidos pela FeSaúde Niterói. Foram utilizados casos e óbitos por COVID-19 notificados no SIVEP-Gripe. Para a análise estatística descritiva, utilizou-se R Core Team (R Foundation for Statistical Computing, 2020) e o Excel (Microsoft 365 Apps, versão 2207), como resultado foram gerados tabelas e gráficos. No software QGis (versão 3.10.14-A Coruña) os indicadores socioeconômicos e ambientais foram mapeados por setores censitários. Também foram mapeadas as taxas de incidência, mortalidade e letalidade hospitalar do município. No software SatScan (v10.0.2 64 bits) realizou-se a estatística de varredura espaço-temporal prospectiva, sob o modelo de distribuição de Poisson onde se analisou 12.733 casos e 2.229 óbitos por COVID-19 notificados no SIVEP-Gripe. Os parâmetros configurados no SatScan para mapear o risco relativo dos casos e óbitos foram: por Semana Epidemiológica (‘Generic’); janela de varredura fixada no centroide de cada bairro; os clusters foram restritos a ter ao menos 5 casos; janela espacial com saída máxima de 12% da população sob risco e formato circular; janela temporal com tamanho mínimo do cluster: 1 SE, e máximo: 50% do período do estudo. Os resultados da análise descritiva mostram uma taxa de incidência anual de 5.770,30 casos por 100.000 habitantes e uma taxa de mortalidade anual de 1.007,00 óbitos por 100.000 habitantes. A média de idade nos clusters de óbitos foi maior quando comparada aos clusters de casos. Na análise se identificou dez aglomerados espaço-temporais de casos de COVID-19, todos estatisticamente significativos; e nove clusters de óbitos, apenas um não apresentou significância estatística (C9: p-valor = 0,897). Na análise dos casos, o cluster com maior Log da Razão de Verossimilhança (LLR) foi o C1: localizando-se em Itaipu (629,89) e com menor foi o C10: localizado no Bairro de Fátima e Pé Pequeno (10,06). Na análise dos óbitos, o cluster com maior LLR foi o C1: Itaipu (119,37); e com menor foi o C8: Boa Viagem, Gragoatá, Ingá e São Domingos (8,61) Tais achados sugerem que os munícipes que residem na área de abrangência dos aglomerados apresentam maior risco de adoecer, e evoluir ao óbito, quando comparados àqueles que residem nos outros bairros. Mapas temáticos foram elaborados com informações dos indicadores e com os clusters obtidos. Os bairros de Itaipu e Icaraí foram os que apresentaram maior risco, tanto para incidência de casos como de óbitos, quando comparados aos demais bairros do município. Por fim, ressalta-se que a metodologia aplicada nesse estudo auxilia ao gestor na tomada de decisão, possibilitando-o utilizar de forma otimizada os recursos financeiros e humanos do município, bem como pode auxiliar na definição de ações de resposta às emergências sanitárias e desastres.