COVID-19 and pregnancy: A European study on pre- and post-infection medication use.

PURPOSE: The COVID-19 pandemic has impacted medication needs and prescribing practices, including those affecting pregnant women. Our goal was to investigate patterns of medication use among pregnant women with COVID-19, focusing on variations by trimester of infection and location. METHODS: We conducted an observational study using six electronic healthcare databases from six European regions (Aragon/Spain; France; Norway; Tuscany, Italy; Valencia/Spain; and Wales/UK). The prevalence of primary care prescribing or dispensing was compared in the 30-day periods before and after a positive COVID-19 test or diagnosis. RESULTS: The study included 294,126 pregnant women, of whom 8943 (3.0%) tested positive for, or were diagnosed with, COVID-19 during their pregnancy. A significantly higher use of antithrombotic medications was observed particularly after COVID-19 infection in the second and third trimesters. The highest increase was observed in the Valencia region where use of antithrombotic medications in the third trimester increased from 3.8% before COVID-19 to 61.9% after the infection. Increases in other countries were lower; for example, in Norway, the prevalence of antithrombotic medication use changed from around 1-2% before to around 6% after COVID-19 in the third trimester. Smaller and less consistent increases were observed in the use of other drug classes, such as antimicrobials and systemic corticosteroids. CONCLUSION: Our findings highlight the substantial impact of COVID-19 on primary care medication use among pregnant women, with a marked increase in the use of antithrombotic medications post-COVID-19. These results underscore the need for further research to understand the broader implications of these patterns on maternal and neonatal/fetal health outcomes.

Hospital-acquired infections surveillance: The machine-learning algorithm mirrors National Healthcare Safety Network definitions.

BACKGROUND: Surveillance of hospital-acquired infections (HAIs) is the foundation of infection control. Machine learning (ML) has been demonstrated to be a valuable tool for HAI surveillance. We compared manual surveillance with a supervised, semiautomated, ML method, and we explored the types of infection and features of importance depicted by the model. METHODS: From July 2021 to December 2021, a semiautomated surveillance method based on the ML random forest algorithm, was implemented in a Brazilian hospital. Inpatient records were independently manually searched by the local team, and a panel of independent experts reviewed the ML semiautomated results for confirmation of HAI. RESULTS: Among 6,296 patients, manual surveillance classified 183 HAI cases (2.9%), and a semiautomated method found 299 HAI cases (4.7%). The semiautomated method added 77 respiratory infections, which comprised 93.9% of the additional HAIs. The ML model considered 447 features for HAI classification. Among them, 148 features (33.1%) were related to infection signs and symptoms; 101 (22.6%) were related to patient severity status, 51 features (11.4%) were related to bacterial laboratory results; 40 features (8.9%) were related to invasive procedures; 34 (7.6%) were related to antibiotic use; and 31 features (6.9%) were related to patient comorbidities. Among these 447 features, 229 (51.2%) were similar to those proposed by NHSN as criteria for HAI classification. CONCLUSION: The ML algorithm, which included most NHSN criteria and >200 features, augmented the human capacity for HAI classification. Well-documented algorithm performances may facilitate the incorporation of AI tools in clinical or epidemiological practice and overcome the drawbacks of traditional HAI surveillance.

Exploring nutrient supplementation and bioprocess optimization to improve the production of lentiviral vectors in serum-free medium suspension cultures.

The use of lentiviral vectors (LV) in gene therapy has been growing in recent years. To meet the increasing clinical demand, LV production platforms will benefit from improved productivity and scalability to enable cost-effective manufacture of LV-based therapies. Here we report the adaptation of 293T cells to serum-free suspension cultures and the improvement of LV yields through transfection parameters optimization, process intensification and medium supplementation with nutrient boosters. Cells were sequentially adapted to different serum-free culture media, transfection parameters were optimized and the two best-performing conditions were selected to explore process intensification by increasing cell density at the time of transfection. LV production at higher cell densities increased volumetric titers up to 12-fold and lipid supplementation was the most efficient metabolic optimization strategy further enhancing LV productivity by 3-fold. Furthermore, cell concentration was identified and validated as an important source of transfection variability impairing cellular uptake of DNA polyplexes, impacting transfection efficiency and reducing LV titers down to 6-fold. This work contributes to improving LV-based gene therapy by establishing new scalable manufacturing platforms and providing key metabolic insights, unveiling important bioreaction parameters to improve vector yields.

Effectiveness of homologous/heterologous booster COVID-19 vaccination schedules against severe illness in general population and clinical subgroups in three European countries.

Using 4 data-sources (Spain, Italy, United Kingdom) data and a 1:1 matched cohort study, we aimed to estimate vaccine effectiveness (VE) in preventing SARS-CoV-2 infections with hospitalisations (±30 days) and death (±56 days) in general population and clinical subgroups with homologous/heterologous booster schedules (Comirnaty-BNT and Spikevax-MOD original COVID-19 vaccines) by comparison with unboosted individuals, during Delta and beginning of Omicron variants. Hazard Ratio (HR, by Cox models) and VE ([1-HR]*100) were calculated by inverse probability weights. Between December 2020-February 2022, in adults without prior SARS-CoV-2 infection, we matched 5.5 million people (>1 million with immunodeficiency, 343,727 with cancer) with a booster (3rd) dose by considering doses 1 and 2 vaccine brands and calendar time, age, sex, region, and comorbidities (immunodeficiency, cancer, severe renal disease, transplant recipient, Down Syndrome). We studied booster doses of BNT and MOD administered after doses 1 and 2 with BNT, MOD, or Oxford-AstraZeneca during a median follow-up between 9 and 16 weeks. BNT or MOD showed VE ranging from 70 to 86% across data sources as heterologous 3rd doses, whereas it was 42-88% as homologous 3rd doses. Depending on the severity and available follow-up, 3rd-dose effectiveness lasted between 1 and 5 months. In people with immunodeficiency and cancer, protection across data sources was detected with both heterologous (VE = 54-83%) and homologous (VE = 49-80%) 3rd doses. Overall, both heterologous and homologous 3rd doses with BTN or MOD showed additional protection against the severe effects of SARS-CoV-2 infections for the general population and for patients at potentially high risk of severe COVID-19 (elderly, people with immunodeficiency and cancer) in comparison with two doses schemes during Delta or early Omicron periods. The early VE after vaccination may be due to less testing among vaccinated pairs and unknown confounders, deserving cautious interpretation. The VE wane over time needs further in-depth research to properly envisage when or whether a booster of those vaccines should be administered.

Quality of life of nurses from the mobile emergency care service / Calidad de vida de los enfermeros del servicio de atención móvil de emergencias / Qualidade de vida de enfermeiros do serviço de atendimento móvel de urgências

ABSTRACT Objective: to evaluate the quality of life of nurses from the Mobile Emergency Care Service of the Federal District (Brazil) and to identify the domains that influenced this assessment. Method: an observational, descriptive, cross-sectional and quantitative study, with data obtained from 123 nurses who answered a questionnaire developed and structured in order to know sociodemographic and clinical variables and with the application of the World Health Organization Quality of Life Instrument Bref, to assess the quality of life. The data were submitted to descriptive statistics and inferential statics. Results: most of the nurses were women, aged between 20 and 40 years old, married, with a specialization degree and without any employment relation with another institution. Most (72.36%) considered their quality of life good or very good and were satisfied or very satisfied with their health (65.03%). The environment domain was the worst evaluated. A significant correlation was observed between the social relations (p=0.049) and environment (p=0.035) domains when correlated with the gender variable. The women rated their social relations and environment better than the men. Conclusion: the knowledge produced by this investigation may support the design of strategies that enable reducing the difficulties related to the life and work of nurses of the Mobile Emergency Care Service. Actions in this direction may contribute to the improvement of health, well-being and quality of life of the professionals and will have positive effects on the quality of health care provided to the population.

RESUMEN Objetivo: evaluar la calidad de vida de los enfermeros del Servicio de Atención Móvil de Emergencias del Distrito Federal (Brasil) e identificar los dominios que influenciaron en esa evaluación. Método: estudio de observación, descriptivo, transversal y cuantitativo, en el que se obtuvieron datos de 123 enfermeros que respondieron a un cuestionario desarrollado y estructurado para descubrir variables sociodemográficas y clínicas y en el que se aplicó el instrumento World Health Organization Quality of Life Instrument Bref para evaluar la calidad de vida. Los datos se sometieron a estadística descriptiva y inferencial. Resultados: en su mayoría, los enfermeros eran mujeres de 20 a 40 años de edad, casadas, con un nivel académico de especialización y sin ningún vínculo de empleo con otras instituciones. La mayor parte (72,36%) consideraron que su calidad de vida era buena o muy buena y se mostraron satisfechas o muy satisfechas con su salud (65,03%). El dominio del medio ambiente fue el peor evaluado. Se observó una correlación significativa entre los dominios de las relaciones sociales (p=0,049) y del medio ambiente (p=0,035) al correlacionarlos con la variable del sexo. Las mujeres evaluaron mejor que los hombres sus relaciones sociales y el medio ambiente. Conclusión: los conocimientos obtenidos gracias a esta investigación podrán ayudar a delinear estrategias que permitan reducir las dificultades relacionadas con la vida y el trabajo de los enfermeros del Servicio de Atención Móvil de Emergencias. Implementar acciones en este sentido podrá contribuir a mejorar la salud, el bienestar y la calidad de vida de los profesionales y tendrá efectos positivos sobre la calidad de la atención a la salud que se presta a la población.

RESUMO Objetivo: avaliar a qualidade de vida de enfermeiros do Serviço de Atendimento Móvel de Urgência do Distrito Federal (Brasil) e identificar os domínios que influenciaram nessa avaliação. Método: estudo observacional, descritivo, transversal e quantitativo, com dados obtidos de 123 enfermeiros que responderam a um questionário desenvolvido e estruturado para conhecer variáveis sociodemográficas e clínicas e com aplicação do World Health Organization Quality of Life Instrument Bref, para avaliar a qualidade de vida. Os dados foram submetidos à estatística descritiva e inferencial. Resultados: os enfermeiros eram em sua maioria mulheres, entre 20 a 40 anos, casadas, com nível acadêmico de especialização e sem vínculo empregatício com outra instituição. A maior parte (72,36%) considerou sua qualidade de vida boa ou muito boa e estava satisfeita ou muito satisfeita com a saúde (65,03%). O domínio meio ambiente foi o pior avaliado. Observou-se correlação significativa entre os domínios relações sociais (p=0,049) e meio ambiente (p=0,035) quando correlacionados à variável sexo. As mulheres avaliaram melhor suas relações sociais e o meio ambiente em relação aos homens. Conclusão: o conhecimento produzido por essa investigação poderá subsidiar o delineamento de estratégias que permitam diminuir as dificuldades relacionadas à vida e ao trabalho de enfermeiros do Serviço de Atendimento Móvel de Urgência. Ações nesse sentido poderão contribuir para a melhoria da saúde, do bem-estar e da qualidade de vida dos profissionais e terão efeitos positivos sobre a qualidade da assistência à saúde prestada à população.

Occupational stress of nurses from the Mobile Emergency Care Service.

OBJECTIVE: To evaluate stress, and to associate it with sociodemographic and clinical aspects of nurses from the Mobile Emergency Care Service. METHOD: This is an observational, cross-sectional and quantitative study conducted with 123 nurses, who answered a questionnaire to assess sociodemographic and clinical variables, and the Job Stress Scale, which evaluates stress in the workplace. RESULTS: The results indicated that most of them were women, 20 to 40 years old, married, without another employment bond and with specialization course. They had low control and low demand at work and performed a passive work. Women reported passive work and high stress levels, while men were equally divided in active and passive work with low stress levels. CONCLUSION: Passive work is harmful to health and it is related to lack of autonomy, decision-making, and social support. It may lead to reduced ability to solve problems faced in daily work routine.

Antimicrobial stewardship: The influence of behavioral nudging on renal-function-based appropriateness of dosing.

Failure to adjust doses may contribute to adverse events. We evaluated the effectiveness of providing the estimated glomerular filtration rate on appropriateness of dosing for antimicrobials. The approach increased appropriateness of dosing from 33.9% to 41.4% (P < .001). Nudging prescription behavior can boost strategies for adequate antimicrobial prescription.

Occupational stress of nurses from the Mobile Emergency Care Service / Estrés laboral de enfermeros en la Atención Móvil de Urgencia / Estresse ocupacional de enfermeiros do Serviço De Atendimento Móvel de Urgência

ABSTRACT Objective: To evaluate stress, and to associate it with sociodemographic and clinical aspects of nurses from the Mobile Emergency Care Service. Method: This is an observational, cross-sectional and quantitative study conducted with 123 nurses, who answered a questionnaire to assess sociodemographic and clinical variables, and the Job Stress Scale, which evaluates stress in the workplace. Results: The results indicated that most of them were women, 20 to 40 years old, married, without another employment bond and with specialization course. They had low control and low demand at work and performed a passive work. Women reported passive work and high stress levels, while men were equally divided in active and passive work with low stress levels. Conclusion: Passive work is harmful to health and it is related to lack of autonomy, decision-making, and social support. It may lead to reduced ability to solve problems faced in daily work routine.

RESUMEN Objetivo: evaluar el estrés y asociar los aspectos sociodemográficos y clínicos de los enfermeros que trabajan en el Atendimiento Móvil de Emergencias. Método: Este fue un estudio observacional, transversal y cuantitativo realizado con 123 enfermeros, que respondieron un cuestionario para conocer las variables sociodemográficas y clínicas, y la Job Stress Scale. Resultados: Los resultados indicaron que la mayoría eran mujeres, de 20 a 40 años, sin ninguna otra relación laboral ni especialización. Tenían bajo control y baja demanda en el trabajo y realizaron un trabajo considerado pasivo. Las mujeres reportaron trabajo pasivo y desgaste elevado, mientras que los hombres se dividieron entre trabajo activo y pasivo con desgaste bajo. Conclusión: el trabajo pasivo es perjudicial para la salud y está relacionado con la falta de autonomía y el poder de decisión. Puede llevar a una capacidad reducida para producir soluciones a los problemas que se enfrentan en el trabajo diario.

RESUMO Objetivo: Avaliar o estresse, associando-o aos aspectos sociodemográficos e clínicos de enfermeiros do Serviço de Atendimento Móvel de Urgências. Método: Trata-se de estudo observacional, transversal e quantitativo, realizado com 123 enfermeiros, que responderam a um questionário, para conhecer variáveis sociodemográficas e clínicas. Foi utilizada a Job Stress Scale, que avalia o estresse no trabalho. Resultados: Os resultados indicaram que a maioria eram mulheres, de 20 a 40 anos, casadas, sem outro vínculo empregatício e com especialização. Possuíam baixo controle, baixa demanda no trabalho e executavam trabalho considerado passivo. As mulheres referiram trabalho passivo e alto desgaste, enquanto os homens dividiram-se igualmente entre o perfil ativo e passivo com baixo desgaste. Conclusão: O trabalho passivo é nocivo à saúde e está relacionado à falta de autonomia, de poder de decisão e de suporte social. Pode conduzir à redução da capacidade de produzir soluções para os problemas enfrentados no cotidiano laboral.

Variations of perceived load and well-being between normal and congested weeks in elite case study handball team.

The aim of this study was two-fold: (i) to analyze the variations in internal load and well-being in professional handball players between normal and congested weeks and (ii) to analyze the variations between training days within weeks. Twenty male players (26.5 ± 4.9 yo) were monitored during a full season. MD-1 (match day -1) revealed larger decreases in muscle soreness (-17.3%, [-26.6;-6.9]) and fatigue (-16.6%, [-24.8;-7.4]) in congested weeks. Regarding MD-2, larger decreases in DOMS (-19.9%, [-30.5;-7.6]), fatigue (-19.7%, [-30.0;-7.9] and the Hooper index (-16.7%, [-25.6;-6.7]) were found in congested weeks. The results of this study reveal that larger variations between normal and congested weeks occurred in MD-2 and MD-3, with greater values of load and lower levels of well-being occurring in normal weeks. Within-weeks changes revealed greater loads occurring on MD-3 and MD-2 in comparison to MD-1; in the opposite way, greater values of muscle soreness and fatigue occurred on MD-1.

Health communication by virtual environments: an experience report. / Comunicação em saúde por meio do ambiente virtual: relato de experiência.

OBJECTIVE: to report an experience of health communication with a strategy based on hosting health videos in a virtual environment. METHOD: a video sharing site (YouTube), accessible websites, and tools to facilitate the execution of tasks (applications) were used to report a health education experience based on the hosting of videos addressing the subjects of cardiopulmonary resuscitation, airway obstruction by foreign bodies, and hemorrhages. RESULTS: in 17 months, there were 31,727 views for the resuscitation and the obstruction videos, which were accessed by people from 69 countries, especially Brazil and the United States; the videos about hemorrhages had 5,400 views, by viewers from the same countries. FINAL CONSIDERATIONS: the use of communication by hosting health videos in a virtual environment impacts on popular education significantly.

Comunicação em saúde por meio do ambiente virtual: relato de experiência / Comunicación en salud través de ambiente virtual: relato de experiencia / Health communication by virtual environments: an experience report

Resumo OBJETIVO relatar a experiência da estratégia de comunicação em saúde por meio de hospedagem de vídeos de saúde em um ambiente virtual. MÉTODO relato de experiência com educação em saúde por hospedagem de vídeos nos temas reanimação cardiopulmonar, obstrução da via aérea por corpos estranhos e hemorragias, utilizando páginas da internet (site) de compartilhamento de vídeos (YouTube), páginas acessíveis na internet (websites) e ferramentas para melhorarem tarefas (aplicativos). RESULTADOS em dezessete meses, houve 31.727 visualizações para os temas de reanimação e obstrução, onde sessenta e nove países acessaram os vídeos, com destaque para Brasil e Estados Unidos; os vídeos de hemorragias tiveram 5.400 visualizações, pelos mesmos países. CONSIDERAÇÕES FINAIS a utilização da comunicação por meio de hospedagem de vídeos de saúde em um ambiente virtual é de extrema importância para educação popular.

Resumen OBJETIVO relatar la experiencia de la estrategia de comunicación en salud través del hospedaje de videos de salud en un ambiente virtual. MÉTODO relato de experiência com educación em salud por hospedaje de vídeos en temas de reanimación cardiopulmonar, obstrucción de la vía aérea por cuerpo extraño y sangría, usando páginas de Internet (sites) de compartir videos (YouTube), páginas acessibles en Internet (websites) y herramientas para mejorar las tareas (aplicaciones). RESULTADOS en diecisiete meses, hubo 31.727 visualizaciones para los temas de reanimación y obstrucción, donde sesenta y nueve países accedieron a los videos, con destaque para Brasil y Estados Unidos; los videos de hemorragias tuvieron 5.400 visualizaciones, por los mismos países. CONSIDERACIONES FINALES la utilización de la comunicación por medio de hospedaje de videos de salud en un ambiente virtual es de extrema importancia para la educación popular.

Abstract OBJECTIVE to report an experience of health communication with a strategy based on hosting health videos in a virtual environment. METHOD a video sharing site (YouTube), accessible websites, and tools to facilitate the execution of tasks (applications) were used to report a health education experience based on the hosting of videos addressing the subjects of cardiopulmonary resuscitation, airway obstruction by foreign bodies, and hemorrhages. RESULTS in 17 months, there were 31,727 views for the resuscitation and the obstruction videos, which were accessed by people from 69 countries, especially Brazil and the United States; the videos about hemorrhages had 5,400 views, by viewers from the same countries. FINAL CONSIDERATIONS the use of communication by hosting health videos in a virtual environment impacts on popular education significantly.

Paraplegia due to spinal cord infarction following cardiac surgery.

Paraplegia is an extremely rare complication following any surgery, especially cardiac surgery. The underlying mechanisms remain poorly understood and even though spinal infarction has been reported previously, it is almost always associated with the use of intra-aortic balloon pump. We report the clinical case of a 75 year-old male, who developed paraplegia secondary to spinal infarction, following cardiac surgery (coronary artery bypass grafting and aortic valve replacement) in whom the intra-aortic balloon pump was not used and few other predisposing factors were present that could anticipate that complication.

Real-time monitoring of lycopene content in tomato-derived products during processing: implementation of a novel double-slit Raman spectrometer.

Lycopene is a very attractive antioxidant associated with cancer prevention in humans. Therefore, it is important to develop new analytical methods that allow for differentiation of food production streams that contain various antioxidant concentrations. The lycopene content in tomato juice, an intermediate between raw tomatoes and the final tomato paste product, was monitored on-line for 46 days at a production plant with a novel, patented double-channel Raman setup. The setup comprises a double-channel mini spectrometer placed in a fixed optical setup, and for each measurement there are two slightly shifted Raman spectra on the x-axis that opens up for additional data processing. The prototype was constructed specifically for 532 nm excitation with no moving parts, and it was designed to optimize each part for the rest of the system. That was the first step toward an integrated optical in-line process analytical solution for industry. As proof of concept, the developed prototype was able to perform a real-time differentiation of the normal and medium to high lycopene content in tomato juice. A correlation factor for double-channel measurements was compared with a correlation factor for background-corrected single-channel measurements by correlating with high performance liquid chromatography reference measurements (1-20 mg of lycopene per 100 g of wet sample). The latter gave a slightly better correlation for the specific application (R(2) = 0.76), acceptable for proof of concept. Real-time information is extremely valuable for the tomato processing plant, mainly because it can be used for improved differentiation of high lycopene content tomato paste to ensure a higher product price. In addition, the developed process analytical technology solution allows for differentiated payment of the tomato farmers based on the lycopene content in their crops.