A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic.

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder.Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment.Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression.Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure.Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.

We longitudinally examined predictors of symptoms of adjustment disorder in 15,563 adults during the COVID-19 pandemic.We found stressors, risk, and protective factors predicting adjustment disorder symptom levels at different stages of the pandemic.For some predictors, the effects appear to change in different phases of a pandemic.

Salud Mental en estudiantes universitarios en aislamiento social durante la pandemia COVID-19. Arequipa, Perú

Introducción: La Pandemia COVID-19, ha tenido impactos negativos en la salud física y mental de las personas, así como las medidas adoptadas por los gobiernos, para prevenir el contagio masivo de la población como el confinamiento, el aislamiento social, el trabajo y educación virtual. Dentro de los afectados por estos cambios, se encontrarían los estudiantes universitarios del área de la salud, que además de estudiar en estas condiciones de pandemia, no han podido hacer sus prácticas de los servicios de salud. Esta situación de exposición al aislamiento, podría afectar la salud mental de los jóvenes estudiantes universitarios. Objetivo: determinar los niveles de depresión, ansiedad y estrés en estudiantes universitarios y su relación con variables sociodemográficas y las características del aislamiento social durante la Pandemia COVID-19. Métodos: Se realizó un estudio descriptivo, observacional, de corte transversal y cuantitativo, con una muestra de 818 estudiantes universitarios de facultades de ciencias de la salud, mediante el cuestionario autoadministrado DASS-21. Resultados: Los principales hallazgos fueron: una mayor prevalencia en niveles altos (severos y extremadamente severos) en la ansiedad, alcanzado casi a 4 de cada 10 de los evaluados; por otro lado, en depresión y el estrés, 2 de cada 10 de los evaluados, se encontraron en los niveles mencionados. En relación con las variables sociodemográficas, las relacionadas con el COVID-19 y aislamiento social, se hallaron diferencias estadísticamente significativas con el género (mujeres > varones), el haber tenido COVID-19 (Sí > No) y vivir con familiares como antes de la pandemia (Sí > No) obtuvieron en promedio mayores puntajes en depresión, ansiedad y estrés. Conclusión: Los estudiantes que presentaron mayor depresión, ansiedad y estrés con una diferencia significativa fueron de género femenino, con antecedentes de haber tenido Covid-19, menor contacto con familiares y haber cumplido con aislamiento social total.

Introduction: The COVID-19 Pandemic has had negative impacts on the physical and mental health of people, as well as the measures adopted by governments to prevent the massive contagion of the population, such as confinement, social isolation, virtual work, and virtual education. Among those affected by these changes would be university students in the health area who, in addition to studying in these pandemic conditions, have been unable to do their health service practices. This situation of exposure to isolation could affect the mental health of young university students. Objective: To determine the levels of depression, anxiety, and stress in university students, their relationship with sociodemographic variables, and the characteristics of social isolation during the COVID-19 Pandemic. Methods: A descriptive, observational, cross-sectional, and quantitative study was carried out with a sample of 818 university students from health sciences faculties using the DASS-21 self-administered questionnaire. Results: The main findings were a higher prevalence of high levels (severe and highly severe) in anxiety, reaching almost 4 out of 10 of those evaluated; On the other hand, in depression and stress, 2 out of 10 of those evaluated were found at the mentioned levels. Concerning the sociodemographic variables, those related to COVID-19 and social isolation, statistically significant differences were found with gender (women > men), having had COVID-19 (Yes > No), and living with relatives as before. On average, the pandemic (Yes > No) obtained higher scores in depression, anxiety, and stress. Conclusion: The students who presented greater depression, anxiety, and stress with a significant difference were female, with a history of having had Covid-19, less contact with family members, and having complied with total social isolation

Covid-19 in Parkinson's Disease treated by drugs or brain stimulation.

PURPOSE: Covid-19 has affected all people, especially those with chronic diseases, including Parkinson's Disease (PD). Covid-19 may affect both motor and neuropsychiatric symptoms of PD patients. We intend to evaluate different aspects of Covid-19 impact on PD patients. METHODS: 647 PD patients were evaluated in terms of PD-related and Covid-19-related clinical presentations in addition to past medical history during the pandemic through an online questioner. They were compared with an age-matched control group consist of 673 individuals and a sample of the normal population consist of 1215 individuals. RESULTS: The prevalence of Covid-19 in PD patients was 11.28%. The mortality was 1.23% among PD patients. The prevalence of Covid-19 in PD patients who undergone Deep Brain Stimulation (DBS) was 18.18%. No significant association was found between the duration of disease and the prevalence of Covid-19. A statistically significant higher prevalence of Covid-19 in PD patients who had direct contact with SARS-CoV-19 infected individuals was found. No statistically significant association has been found between the worsening of motor symptoms and Covid-19. PD patients and the normal population may differ in the prevalence of some psychological disorders, including anxiety and sleeping disorders, and Covid-19 may affect the psychological status. CONCLUSION: PD patients possibly follow tighter preventive protocols, which lead to lower prevalence and severity of Covid-19 and its consequences in these patients. Although it seems Covid-19 does not affect motor and psychological aspects of PD as much as it was expected, more accurate evaluations are suggested in order to clarify such effects.

Os reflexos da pandemia do novo coronavírus na judicialização do direito à saúde perante o Supremo Tribunal Federal / The effects of the novel coronavirus pandemic on the judicialization of the right to health before the Federal Supreme Court / Las reflexiones de la pandemia del nuevo coronavirus sobre la judicialización del derecho a la salud ante la Suprema Corte Federal

Objetivo: identificar se a situação pandêmica interferiu na extensão e no modo como as questões referentes ao direito à saúde foram apreciadas pelo Supremo Tribunal Federal. Metodologia: foi realizada pesquisa documental, que, após consulta na base de dados do Supremo Tribunal Federal, com o filtro pelo termo "saúde", retornou um total de 1.178 acórdãos, sendo 447 do período pré-pandêmico e 731 do período pandêmico, os quais foram analisados e classificados conforme a pertinência temática. Após os descartes da etapa de classificação, identificaram-se 70 acórdãos no período pré-pandêmico e 167 acórdãos no pandêmico que versam efetivamente sobre o direito à saúde. Resultados: a pandemia impôs inúmeros desafios ao sistema de saúde, de modo que o Poder Judiciário foi instado a se manifestar ante às controvérsias ora instauradas. Nessas manifestações, identificou-se que houve aumento nas demandas de controle concentrado e no quantitativo absoluto de decisões envolvendo o direito à saúde, bem como que qualitativamente, em geral, o padrão decisório anterior foi mantido, embora novos temas tenham surgido. Conclusão: o estudo concluiu que a tendência da Suprema Corte permanece favorável ao reconhecimento de direitos sanitários, tendo, para tal, argumentos como a não ofensa à separação de poderes e a impossibilidade de arguir a reserva do possível para impedir sua concessão.

Objective: to identify whether the pandemic situation interfered with the extent and way in which issues relating to the right to health were assessed by the Federal Supreme Court. Methodology: documentary research was carried out, which, after consulting the Federal Supreme Court database, with the filter using the term "health", returned a total of 1,178 rulings, 447 from the pre-pandemic period and 731 from the pandemic period, which were analyzed and classified according to thematic relevance. After the classification stage discards, 70 rulings were identified in the pre-pandemic period and 167 rulings in the pandemic that effectively deal with the right to health. Results: the pandemic imposed numerous challenges on the health system, so that the Judiciary was urged to speak out in the face of the now established controversies. In these manifestations, it was identified that there was an increase in demands for concentrated control and in the absolute quantity of decisions involving the right to health, as well as that qualitatively, in general, the previous decision-making pattern was maintained, although new themes have emerged. Conclusion: the study concluded that the Supreme Court's tendency remains in favor of the recognition of health rights, using arguments such as the non-offense of the separation of powers and the impossibility of arguing on the possible reservation to prevent their granting.

Objetivo: identificar si la situación de pandemia interfirió en el alcance y la forma en que las cuestiones relativas al derecho a la salud fueron evaluadas por el Supremo Tribunal Federal. Metodología: se realizó una investigación documental que, consultada la base de datos del Supremo Tribunal Federal, con el filtro del término "salud", arrojó un total de 1.178 sentencias, 447 del período prepandemia y 731 del período pandémico, que fueron analizados y clasificados según relevancia temática. Descartada la etapa de clasificación, se identificaron 70 sentencias en el período prepandemia y 167 sentencias en la pandemia que abordan efectivamente el derecho a la salud. Resultados: la pandemia impuso numerosos desafíos al sistema de salud, por lo que se instó al Poder Judicial a pronunciarse ante las controversias ahora establecidas. En estas manifestaciones se identificó que hubo un aumento en las demandas de control concentrado y en la cantidad absoluta de decisiones que abordan el derecho a la salud, así como que cualitativamente, en general, se mantuvo el patrón de toma de decisiones anterior, aunque han surgido nuevos temas. Conclusión: el estudio concluyó que se mantiene la tendencia de la Corte Suprema a favor del reconocimiento de los derechos a la salud, utilizando argumentos como la no infracción de la separación de poderes y la imposibilidad de argumentar la reserva de lo posible para impedir su otorgamiento.

Adherence to Growth Hormone Treatment in Children During COVID-19 Pandemic

Objective: Treatment adherence is crucial for the success of growth hormone (GH) therapy. Reported nonadherence rates in GH treatment have varied widely. Several factors may have an impact on adherence. Apart from these factors, the global impact of the COVID-19 pandemic, including problems with hospital admission and routine follow-up of patients using GH treatment, may have additionally affected the adherence rate. The primary objective of this study was to investigate adherence to treatment in patients receiving GH. In addition, potential problems with GH treatment during the pandemic were investigated. Materials and Methods: This was a multicenter survey study that was sent to pediatric endocrinologists in pandemic period (June 2021-December 2021). Patient data, diagnosis, history of pituitary surgery, current GH doses, duration of GH therapy, the person administering therapy (either parent/patient), duration of missed doses, reasons for missed doses, as well as problems associated with GH therapy, and missed dose data and the causes in the recent year (after the onset of the pandemic) were queried. Treatment adherence was categorized based on missed dose rates over the past month (0 to 5%, full adherence; 5.1 to 10% moderate adherence; >10% nonadherence). Results: The study cohort consisted of 427 cases (56.2% male) from thirteen centers. Median age of diagnosis was 8.13 (0.13-16) years. Treatment indications were isolated GH deficiency (61.4%), multiple pituitary hormone deficiency (14%), Turner syndrome (7.5%), idiopathic GH deficiency (7.5%), small for gestational age (2.8%), and "others" (6.8%). GH therapy was administered by parents in 70% and by patients in 30%. Mean daily dose was 32.3 mcg/kg, the annual growth rate was 1.15 SDS (min -2.74, max 9.3). Overall GH adherence rate was good in 70.3%, moderate in 14.7%, and poor in 15% of the patients. The reasons for nonadherence were mainly due to forgetfulness, being tired, inability to access medication, and/or pen problems. It was noteworthy that there was a negative effect on adherence during the COVID-19 pandemic reported by 22% of patients and the main reasons given were problems obtaining an appointment, taking the medication, and anxiety about going to hospital. There was no difference between genders in the adherence rate. Nonadherence to GH treatment decreased significantly when the patient: administered the treatment; was older; had longer duration of treatment; and during the pandemic. There was a non-significant decrease in annual growth rate as nonadherence rate increased. Conclusion: During the COVID-19 pandemic, the poor adherence rate was 15%, and duration of GH therapy and older age were important factors. There was a negative effect on adherence during the pandemic period.

Exceso de mortalidad durante la pandemia de COVID-19 en Ecuador. Análisis espacio temporal del exceso de mortalidad durante la pandemia de COVID-19 en Ecuador / Excess Mortality during the COVID- 19 Pandemic in Ecuador. Spatiotemporal Analysis of Excess Mortality During the Covid-19 Pandemic in Ecuador

Introducción: La pandemia de COVID-19 causó una elevada mortalidad en el mundo y en el Ecuador. Esta investigación se propuso analizar el exceso de mortalidad debido a la pandemia de COVID-19 en Ecuador. Método: Estudio observacional, longitudinal, cuantitativo y descriptivo. Clasificado como estudio ecológico en el campo de la epidemiología. Este estudio se centra en la medición del exceso de mortalidad durante los años 2020, 2021 y 2022, tomando como período base el promedio de defunciones ocurridas en el intervalo de 2015 a 2019. Resultados: Ecuador, en el período de enero 2020 a octubre 2022, acumuló un exceso total de muertes de 98.915. En el año 2020, el exceso de mortalidad fue mayor a 46.374, siendo el mes de abril el valor más alto de 15.484. En el año 2021, el exceso de muertes fue de 35.859, siendo abril el mes con mayor exceso de 7.330. Y el año 2022 el exceso de mortalidad fue de 16.682, el mes con mayor exceso fue enero con 4.204. Conclusión: Se evidenció un subregistro de defunciones, así como variaciones temporales y geográficas en el exceso de mortalidad. La provincia con mayor número de fallecidos y exceso de mortalidad fue Guayas seguida de Pichincha. Los resultados proporcionan un análisis del panorama durante la emergencia sanitaria, destacando la importancia de evaluar la capacidad de respuesta de los sistemas de salud en momentos de crisis y la necesidad imperativa de implementar medidas correctivas para el futuro.

Introduction: The COVID-19 pandemic caused a significant mortality in the world and in Ecuador. This research aimed to analyze the excess mortality due to the COVID-19 pandemic in Ecuador. Method: An observational, longitudinal, quantitative and descriptive study, classified as an ecological study in the field of epidemiology. This study focuses on measuring excess mortality during the years 2020, 2021 and 2022, using the average number of deaths that occurred in the period from 2015 to 2019 as the baseline. Results: From January 2020 to October 2022, Ecuador accumulated a total excess of deaths of 98,915. In 2020, the excess mortality was higher at 46,374, with the highest value occurring in April at 15,484. In 2021, the excess deaths amounted to 35,859, with April having the highest excess of 7,330. In 2022, the excess mortality was 16,682, with January recording the highest excess at 4,204. Conclusion: Evidence of underreporting of deaths, as well as temporal and geographi-cal variations in excess mortality, was observed. The province with the highest number of deaths and excess mortality was Guayas, followed by Pichincha. The results provide an analysis of the situation during the health emergency, emphasizing the importance of evaluating the healthcare system's capacity to respond during times of crisis and the imperative need to implement corrective measures for the future.

Percepción de los médicos residentes de Pediatría sobre el impacto de la pandemia por COVID-19 en su proceso formativo / Pediatric residents' perceptions about the impact of the COVID-19 pandemic on their training

Introducción. Las residencias médicas experimentaron modificaciones que pudieron afectar la formación académica durante la pandemia por COVID-19. Objetivos. Describir la percepción de residentes de Pediatría en relación con el impacto de la pandemia en su formación. Efectuar la adaptación transcultural y validación al idioma español del instrumento "COVID-19 Resident Education and Experience Survey". Materiales y métodos. Estudio observacional, transversal. Participaron residentes de Pediatría de distintos hospitales del país. Se utilizó la encuesta de Ostapenko y col. modificada. Se realizó el análisis descriptivo utilizando SPSS vs. 21. El proyecto fue aprobado por el Comité de Ética institucional. Resultados. Completaron la encuesta 127 residentes. La mayoría dedicaba más de 50 horas a actividades asistenciales antes y durante la pandemia. El 43,3 % (IC95% 35-52) dedicaba hasta 1 hora diaria al estudio individual previo a la pandemia, y un 63 % (IC95% 54,3-70,9) dedicaba ese tiempo durante la pandemia. El 75,6 % (IC95% 67,4-82,2) reportó que el tiempo previo dedicado a actividades académicas era al menos de 4 horas semanales, descendiendo al 41,7 % (IC95% 33,5-50,4) en la pandemia. Más del 60 % (IC95% 54,3-70,1) percibió que la pandemia perjudicó su formación para convertirse en especialista y el 93,7 % (IC95% 88,1-96,8), que su nivel de estrés se incrementó. Conclusiones. La cantidad de horas destinadas a actividades académicas fue percibida como menor durante la pandemia. La mayoría de los encuestados refirió que su nivel de estrés aumentó y que la pandemia perjudicó su formación para convertirse en especialista.

Introduction. Medical residency programs suffered changes that may have affected academic training during the COVID-19 pandemic. Objectives. To describe the perceptions of pediatric residents about the pandemic's impact on their education. To transculturally adapt and validate the COVID-19 Resident Education and Experience Survey into Spanish. Materials and methods. Observational, cross-sectional study. Participants were pediatric residents from hospitals across the country. The survey by Ostapenko et al. was used. A descriptive analysis was done using the SPSS software, version 21. The project was approved by the Institutional Ethics Committee. Results. The survey was completed by 127 residents. Most did more than 50 hours of health care activities before and during the pandemic. Also, 43.3% (95% CI: 35­52) spent at least 1 hour a day studying individually before the pandemic, while 63% (95% CI: 54.3­70.9) did so during the pandemic. In relation to the time spent doing academic work, 75.6% (95% CI: 67.4­82.2) reported that, before the pandemic, they spent at least 4 hours a week doing academic activities, dropping to 41.7% (95% CI: 33.5­50.4) during the pandemic. More than 60% (95% CI: 54.3­70.1) perceived that the pandemic impaired their training to become a specialist and 93.7% (95% CI: 88.1­96.8), that their stress levels increased. Conclusions. The perception was that participants spent less hours doing academic activities during the pandemic. Most surveyed participants mentioned that their stress levels increased and that the pandemic impaired their training to become a specialist.

Association between COVID-19 and increased incidence of overactive bladder symptoms in female patients: A retrospective analysis.

INTRODUCTION AND OBJECTIVES: To investigate female patients' post-COVID-19 voiding symptoms and to research how they relate to overactive bladder (OAB). PATIENTS: One hundred and forty patients aged 20-50 years who were hospitalised and discharged due to COVID-19 at Kartal Dr. Lütfi Kirdar City Hospital between 2021 and 2022 and 50 patients with a history of COVID-19 among two hundred female patients who presented to the urology outpatient clinic with symptoms related to OAB were retrospectively analysed. Bladder diary, overactive bladder symptom score (OABSS), uroflowmetry values and time of onset of symptoms of symptomatic patients were recorded for all patients. Disease-free individuals for control purposes were not included in the study. RESULTS: It was observed that 38% of 140 hospitalized patients had a symptomatic change related to OAB, and there was a significant difference in voiding diary, OABSS, and uroflowmetry Qmax values between symptomatic and non-symptomatic patients after COVID-19. (p:0.001) There was a significant difference between the pre-COVID-19 (estimated) and post-COVID-19 (current) voiding diary and OABSS values of all symptomatic patients (with and without a history of hospitalization). (p:0.001) When these two groups were compared with each other, there was a significant difference between the post-COVID-19 voiding diary, OABSS values, and the meantime to the onset of symptoms in inpatients and outpatients (p:0.001) CONCLUSION: COVID-19 may be associated with urgency/urge incontinence and overactive bladder in female patients.

Kikuchi-Fujimoto disease type lymph node reaction with increased plasmacytoid dendritic cells may appear as a side effect following COVID-19 vaccination: Report of a case and literature review.

Subsequent to mass vaccination programs against COVID-19, diverse side effects have been described, both at the injection site, such as pain, redness and swelling, and systemic effects such as fatigue, headache, muscle or joint pain. On rare occasions, a lymphadenopathic syndrome may develop, raising the clinical suspicion of a lymphoproliferative disorder. We present the case of a 30-year-old woman who developed self-limiting left axillary lymphadenopathy following COVID-19 vaccination. To date, only seven similar cases with a complete clinicopathological description have been published, and fourteen cases have been notified to the European adverse events databases (Eudravigilance) in relationship with vaccination against COVID-19. It is important to be aware of this potential complication when a lymphadenopathic syndrome develops following vaccination, to avoid unnecessary treatment.

Pediatric mucormycosis associated with COVID-19: A systematic review of clinical cases.

The occurrence of mucormycosis has been observed in individuals with COVID-19. However, there is limited information on the epidemiological factors, presentation, diagnostic certainty, and outcome of this infection in children. PubMed, MEDLINE, Scopus, Embase, Web of Science, LitCovid, and back-references of the identified manuscripts were systematically searched from December 2019 to March 2023. We have identified 14 cases of pediatric mucormycosis in patients with COVID-19. The median age of patients was 10.7 years. Among these cases, 10 were associated with active COVID-19. In 7 cases, the patients had pre-existing diabetes mellitus and concomitant diabetic ketoacidosis. Corticosteroids were administered to treat COVID-19 in 7 of the patients. The most common clinical presentation of the disease was rhino-orbital cerebral mucormycosis. Seven patients died (50%). Given the high mortality rate, clinicians should maintain a high level of clinical suspicion of mucormycosis in pediatric patients with COVID-19.

O acompanhamento do pré-natal durante a pandemia em uma unidade de saúde da família, campo prático de residentes / Prenatal follow-up during the pandemic in a family health unit, practical field of residents / Seguimiento prenatal durante la pandemia en una unidad de salud familiar, un campo de prácticas para los residentes

Este relato apresenta a experiência do acompanhamento do pré-natal durante a pandemia em uma Unidade de Saúde da Família (USF), campo prático no desenvolvimento das funções laborais dos alunos/residentes num município do estado da Bahia. Quanto ao método, é um relato de experiência que utiliza a técnica da observação para descrição dessas vivências no período entre março/2020 e março/2021. O relato evidencia o desempenho do acompanhamento do pré-natal durante o período supracitado, e as modificações frequentes perante as recomendações sanitárias acerca da institucionalização de fluxogramas e protocolos clínicos para uma assistência integral. O cenário pandêmico colocou em evidência a necessidade primordial de investimentos na assistência, principalmente na linha de frente, para evitar um colapso na atenção terciária. O acompanhamento integral das gestantes, por exemplo, evitou complicações para a saúde da mulher e do bebê.

This experience report focus on prenatal care offered by a Family Health Unit (USF) in a municipality in Bahia, Brazil, during the pandemic. Based on observations of the experiences in prenatal care between March/2020 and March/2021, the report discusses the prenatal care performed during this period and the frequent changes following health recommendations regarding the institutionalization of flowcharts and clinical protocols for comprehensive care. The pandemic highlighted the primordial need for investments in health care, especially front line, to avoid a collapse in tertiary care. Comprehensive monitoring of pregnant women, for example, avoided complications for the woman and the infant's health.

Este reporte presenta la experiencia de seguimiento prenatal durante la pandemia en una Unidad de Salud Familiar (USF), un campo de prácticas para los estudiantes/residentes en un municipio del estado de Bahía (Brasil). El método utilizado se basa en un reporte de experiencia, que aplicó la observación como técnica para describir las vivencias en el período comprendido entre marzo de 2020 y marzo de 2021. El reporte destaca el desempeño del seguimiento prenatal durante el período mencionado, y los cambios frecuentes frente a las recomendaciones de salud sobre la institucionalización de diagramas de flujo y los protocolos clínicos para una asistencia integral. El contexto de la pandemia reveló la necesidad primordial de invertir en asistencia sanitaria, especialmente en la primera línea, para evitar el colapso en el tercer nivel de atención. El seguimiento integral a las embarazadas, por ejemplo, evitó complicaciones para la salud de la mujer y del bebé.

National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study).

INTRODUCTION: The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies. of communication between family members, patients and professionals. METHODS: Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. RESULTS: 29% of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. CONCLUSIONS: The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context.

Repercussões psicossociais da pandemia da covid-19 para mães de crianças com transtorno do espectro autista / Psychosocial repercussions of the covid-19 pandemic for mothers of children with autism spectrum disorder / Repercusiones psicosociales de la pandemia de covid-19 en las madres de niños con trastorno del espectro autista

RESUMO Objetivo: compreender as repercussões psicossociais da pandemia da COVID-19 para mães de crianças com Transtorno do Espectro Autista. Método: estudo qualitativo, com a participação de 22 mães. Os dados foram coletados de maio a julho de 2022, no interior da Paraíba, Brasil, por meio de uma Dinâmica de Criatividade e Sensibilidade. A análise deu-se através do referencial teórico-analítico da análise de discurso francesa. Resultados: medo, ansiedade, angústia, preocupações assumiram um lugar central no movimento dialógico das mães. Diante das demandas e reconfigurações na rotina, houve uma sobrecarrega física, emocional e psicológica, com repercussões na vida materna. A solidão pôde ser evidenciada pela frágil ou inexistente rede de apoio durante o período pandêmico. Conclusão: o estudo pode subsidiar a reflexão sobre as repercussões da pandemia na vida de mães de crianças com autismo e viabilizar a elaboração de ações que priorizem a saúde mental, auxiliando-as na superação de momentos de adversidades.

ABSTRACT Objective: to understand the psychosocial repercussions of the COVID-19 pandemic for mothers of children with Autism Spectrum Disorder. Method: a qualitative study, with participation of 22 mothers. The data were collected from May to July 2022 in the inland of Paraíba, Brazil, through the Dynamics of Creativity and Sensitivity. The analysis took place through the theoretical-analytical framework of French discourse analysis. Results: fear, anxiety, anguish and concerns assumed a central place in the mothers' dialogical movement. Faced with the demands and reconfigurations in the routine, there was physical, emotional and psychological overload, with repercussions on maternal life. Loneliness can be seen in the weak or non-existent support network during the pandemic. Conclusion: the study can support reflection on the repercussions of the pandemic on the lives of mothers of children with autism and enable the development of actions that prioritize mental health, helping them to overcome moments of adversity.

RESUMEN Objetivo: comprender las repercusiones psicosociales de la pandemia de COVID-19 en las madres de niños con Trastorno del Espectro Autista. Método: estudio cualitativo, con la participación de 22 madres. Los datos fueron recolectados de mayo a julio de 2022, en el interior de Paraíba, Brasil, mediante una Dinámica de Creatividad y Sensibilidad. El análisis se realizó siguiendo el marco teórico-analítico del análisis del discurso francés. Resultados: el miedo, la ansiedad, la angustia y las preocupaciones ocuparon un lugar central en el movimiento dialógico de las madres. Ante las exigencias y reconfiguraciones de la rutina, las madres sufrieron una sobrecarga física, emocional y psicológica que afectó su vida. La soledad se puede ver en la débil o nula red de apoyo que tuvieron durante la pandemia. Conclusión: el estudio puede contribuir a la reflexión sobre las repercusiones de la pandemia en la vida de las madres de niños con autismo y posibilitar el desarrollo de acciones que prioricen la salud mental que las ayuden a superar momentos de adversidad.

"Porque nós estamos todos doentes": desafios do cuidado às pessoas com obesidade na Atenção Primária à Saúde em tempo de Covid-19 / "Because we are all sick": challenges of caring for people with obesity in Primary Health Care in times of Covid-19

Introdução: A pandemia de Covid-19 implicou mudanças significativas no funcionamento e nas demandas da Atenção Primária à Saúde (APS), impactando na organização do trabalho e dos cuidados às pessoas com obesidade e outras doenças crônicas. Objetivo: Descrever os desafios e estratégias para o cuidado às pessoas com obesidade no contexto da sindemia de COVID-19 na perspectiva dos profissionais da APS. Métodos: Foram realizadas entrevistas semiestruturadas com trabalhadores de uma Unidade Básica de Saúde (UBS) no município do Rio de Janeiro. Resultados: Desde os primeiros casos de Covid-19, a organização do trabalho na UBS foi modificada pelas recomendações de distanciamento social, pelo medo de contágio e a sobrecarga dos trabalhadores. Atendimentos de rotina, assim como atividades coletivas, incluído o cuidado às pessoas com obesidade, foram interrompidos. No entanto, a identificação da obesidade como fator de risco para agravamento da Covid-19 desdobrou-se em priorização no que tange ao monitoramento e à vacinação. Conclusão: A retomada das rotinas nas UBSs aponta grandes desafios no cuidado às pessoas com obesidade, repercutindo na precarização das condições de vida da população e prejudicando a organização do trabalho na APS.

Introduction: The Covid-19 pandemic has implied significant changes in the operation and demands of Primary Health Care (PHC), impacting the organization of work and care for people with obesity and other chronic diseases. Objective: To describe the challenges and strategies for the care of people with obesity in the context of the COVID-19 syndemic from the perspective of PHC providers. Methods: Semi-structured interviews were conducted with workers from a Basic Health Unit (BHU) in the city of Rio de Janeiro. Results: Since the first cases of Covid-19, the work organization at the BHU has been modified by the recommendations of social distancing, fear of contagion, and worker overload. Routine care, as well as collective activities, including care for people with obesity, were interrupted. However, the identification of obesity as a risk factor for worsening Covid-19 has been prioritized with regard to monitoring and vaccination. Conclusion: The resumption of the routines in the BHUs points to major challenges in the care of people with obesity, affecting the precarious living conditions of the population and impairing the organization of work in PHC.

Multisensory effects of mask wearing on speech intelligibility and the benefit of multilingualism / Efeitos multissensoriais do uso de máscara na inteligibilidade da fala e o benefício do multilinguismo

ABSTRACT Purpose Due to the pandemic of the Covid-19 disease, it became common to wear masks on some public spaces. By covering mouth and nose, visual-related speech cues are greatly reduced, while the auditory signal is both distorted and attenuated. The present study aimed to analyze the multisensory effects of mask wearing on speech intelligibility and the differences in these effects between participants who spoke 1, 2 and 3 languages. Methods The study consisted of the presentation of sentences from the SPIN test to 40 participants. Participants were asked to report the perceived sentences. There were four conditions: auditory with mask; audiovisual with mask; auditory without mask; audiovisual without mask. Two sessions were conducted, one week apart, each with the same stimuli but with a different signal-to-noise ratio. Results Results demonstrated that the use of the mask decreased speech intelligibility, both due to a decrease in the quality of auditory stimuli and due to the loss of visual information. Signal-to-noise ratio largely affects speech intelligibility and higher ratios are needed in mask-wearing conditions to obtain any degree of intelligibility. Those who speak more than one language are less affected by mask wearing, as are younger listeners. Conclusion Wearing a facial mask reduces speech intelligibility, both due to visual and auditory factors. Older people and people who only speak one language are affected the most.

RESUMO Objetivo Devido à pandemia da doença Covid-19, o uso de máscaras em espaços públicos tornou-se comum. Ao cobrir a boca e o nariz, reduzem-se amplamente as pistas visuais associadas à fala, assim como se distorce e atenua o sinal auditivo. Este estudo teve como objetivo analisar os efeitos multissensoriais do uso da máscara na percepção da fala e a diferença entre participantes falantes de uma, duas ou três línguas. Método Este estudo consistiu na apresentação de frases do SPIN teste a 40 participantes. Os participantes tinham como tarefa reportar as frases percebidas em quatro condições: Auditiva com máscara, audiovisual com máscara, auditiva sem máscara, audiovisual sem máscara. Conduziram-se duas sessões, com uma semana de intervalo, cada uma com os mesmos estímulos mas com diferente relação sinal-ruído. Resultados Os resultados demonstraram que o uso de máscara reduz a inteligibilidade da fala, tanto devido à diminuição da qualidade do estímulo auditivo, como devido à perda de informação visual. A relação sinal-ruído afeta a inteligibilidade e com o uso de máscara são necessárias relações mais altas para obter qualquer identificação correta. Aqueles que falam mais do que uma língua, assim como os mais novos, são menos afetados na percepção de fala com uso de máscara. Conclusão O uso de máscara facial reduz a inteligibilidade da fala, tanto devido a fatores visuais como auditivos. Indivíduos monolíngues, assim como os mais velhos, são os mais afetados nesta tarefa.

Inefficacious drugs against covid-19: analysis of sales, tweets, and search engines / Medicamentos ineficazes contra covid-19: análise de vendas, tweets e mecanismos de busca

ABSTRACT OBJECTIVE Assess the correlation between the sales of two drugs with no proven efficacy against covid-19, ivermectin and chloroquine, and other relevant variables, such as Google® searches, number of tweets related to these drugs, number of cases and deaths resulting from covid-19. METHODS The methodology adopted in this study has four stages: data collection, data processing, exploratory data analysis, and correlation analysis. Spearman's method was used to obtain cross-correlations between each pair of variables. RESULTS The results show similar behaviors between variables. Peaks occurred in the same or near periods. The exploratory data analysis showed shortage of chloroquine in the period corresponding to the beginning of advertising for the application of these drugs against covid-19. Both drugs showed a high and statistically significant correlation with the other variables. Also, some of them showed a higher correlation with drug sales when we employed a one-month lag. In the case of chloroquine, this was observed for the number of deaths. In the case of ivermectin, this was observed for the number of tweets, cases, and deaths. CONCLUSIONS The results contribute to decision making in crisis management by governments, industries, and stores. In times of crisis, as observed during the covid-19 pandemic, some variables can help sales forecasting, especially Google® and tweets, which provide a real-time analysis of the situation. Monitoring social media platforms and search engines would allow the determination of drug use by the population and better prediction of potential peaks in the demand for these drugs.

RESUMO OBJETIVO Investigar a correlação entre as vendas de dois medicamentos sem eficácia comprovada no tratamento de covid-19, ivermectina e cloroquina, e outras variáveis relevantes: pesquisas no Google®, número de tweets relacionados aos medicamentos, casos e óbitos decorrentes da covid-19. MÉTODOS A metodologia adotada neste estudo se divide em quatro partes: coleta de dados; processamento dos dados; análise exploratória; e análise de correlação. Foi utilizado o método de Spearman para obter as correlações cruzadas entre cada par de variáveis. RESULTADOS Os resultados mostram similaridade entre os comportamentos das variáveis. Os picos ocorreram em períodos iguais ou próximos. A análise exploratória dos dados apontou que houve falta de cloroquina no período correspondente ao início das divulgações sobre a aplicação desses medicamentos para o tratamento da covid-19. Ambos os medicamentos apresentaram correlação alta e estatisticamente significativa com as demais variáveis analisadas. Também foi observado que algumas delas apresentaram maior correlação com as vendas de medicamentos quando assumiram defasagem temporal de um mês. No caso da cloroquina, isso ocorreu com a variável óbitos. No caso da ivermectina, ocorreu com as variáveis número de tweets, casos e óbitos. CONCLUSÕES Os resultados observados contribuem para a tomada de decisão durante a gestão de crises por parte de governo, indústrias e comércios. Em momentos de crises, como observado durante a pandemia, as variáveis mostraram que são capazes de auxiliar na previsão de vendas, em especial o Google® e os tweets, que proporcionam uma análise em tempo real da situação. Acompanhar as redes sociais e mecanismos de busca permitiria detecção de uso pela população e melhor previsão de potenciais picos de demanda desses medicamentos.

Covibesity e o peso das normas. Uma epidemia cultural / Covibesity and the weight of the norms. A cultural epidemic

Resumo A forma como moldamos e apresentamos socialmente o nosso corpo tem uma extraordinária importância social: a aparência é o nosso primeiro cartão de visita a partir do qual as pessoas nos enquadram e julgam. Esta avaliação acaba por condicionar o nosso quotidiano, desde às nossas oportunidades sociais até às profissionais. Um dos critérios mais importantes para determinar se uma pessoa é saudável e bonita - em Portugal, assim como em muitos outros contextos - é a magreza. Numa sociedade em que a magreza e a perfeição física são ideais a perseguir, este artigo explora através de metodologias qualitativas o impacto do discurso ligado ao problema da obesidade causado pela pandemia de COVID-19 na multiplicação e exacerbação de conflitos relacionados com o corpo em mulheres portuguesas entre os 18 e os 65 anos.

Abstract How we shape and socially present our body has extraordinary social importance: appearance is our first business card by which people frame and judge us. This evaluation ends up conditioning our daily lives, from social to professional opportunities. In Portugal, as in many other contexts, one of the most important criteria for determining whether someone is healthy and beautiful is thinness. In a society where thinness and physical perfection are pursuable ideals, this article explores through qualitative methodologies the impact of the discourse linked to the problem of obesity caused by the COVID-19 pandemic on the multiplication and exacerbation of body-related conflicts in Portuguese women aged 18 to 65.

Impacto da Covid-19 na prática de automedicação em estudantes universitários / Impact of COVID-19 on self-medication practice in university students / Impacto de la Covid-19 en la práctica de la automedicación en estudiantes universitarios

RESUMO: A automedicação expõe os indivíduos a riscos como reações adversas, intoxicações, interações medicamentosas, falhas terapêuticas e erros de medicação. Na pandemia de Covid-19, houve aumento de compra e consumo de produtos farmacêuticos pelos brasileiros. O presente estudo teve como objetivo estimar a prevalência e os fatores associados à automedicação em estudantes de um centro universitário na região do Campo das Vertentes, Minas Gerais, bem como avaliar a incidência durante a pandemia de Covid-19. O estudo teve delineamento transversal e quantitativo, com 248 estudantes de um centro universitário em 2021. Os achados mostraram que 67,3% dos participantes relataram realizar a automedicação; 28,7% apontaram aumento da automedicação durante a pandemia; e 30,9% indicaram o início nesse período. Houve diferença significativa sobre: considerar-se capaz de se automedicar, ter costume de indicar medicamentos para outras pessoas e consumi-los por indicação de outros. Para aqueles que aumentaram a prática de automedicação na pandemia, houve associação com o hábito de indicar medicamentos para outras pessoas. Já para quem iniciou essa prática no período pandêmico, a capacidade de automedicação esteve associada. Os resultados abrem caminhos para medidas educativas sobre o uso irracional dos medicamentos pelos estudantes do ensino superior, independentemente da área de formação.

ABSTRACT: Self-medication exposes individuals to risks such as adverse reactions, intoxications, drug interactions, therapeutic failures and medication errors. In the COVID-19 pandemic, there was an increase in the purchase and consumption of pharmaceutical products by Brazilians. The present study aimed to estimate the prevalence and factors associated with self-medication in students of a university center in the region of Campo das Vertentes, Southeastern Brazil, as well as to evaluate the incidence during the COVID-19 pandemic. The study had a cross-sectional and quantitative design, with 248 students from a university, in 2021. The findings showed that 67.3% of the participants reported self-medication; 28.7% indicated an increase in self-medication during the pandemic; and 30.9% indicated the beginning in this period. There was a significant difference about: to consider oneself capable of self-medicating, to have the habit of referring drugs to other people and to consume them by indication of others. For those who increased the practice of self-medication in the pandemic, there was an association with the habit of indicating drugs to other people. For those who initiated this practice in the pandemic period, the capacity of self-medication was associated. The results open paths for educational measures on the irrational use of medicines by higher education students, regardless of the education area.

RESUMEN: La automedicación expone a los individuos a riesgos tales como reacciones adversas, intoxicaciones, interacciones medicamentosas, fracasos terapéuticos y errores medicamentosos. En la pandemia de Covid-19, hubo un aumento en la compra y consumo de productos farmacéuticos por parte de los brasileños. El presente estudio tuvo como objetivo estimar la prevalencia y los factores asociados a la automedicación en estudiantes de un centro universitario en la región de Campo das Vertentes, Sudeste de Brasil, así como evaluar la incidencia durante la pandemia de Covid-19. El estudio tuvo un diseño transversal y cuantitativo, con 248 estudiantes de un centro universitario en 2021. Los hallazgos mostraron que el 67,3% de los participantes reportaron automedicación; el 28,7% indicó un aumento en la automedicación durante la pandemia; y el 30,9% indicó el inicio en este período. Hubo una diferencia significativa en: Considerarse capaz de automedicarse, tener el hábito de referir drogas a otras personas y consumirlas por indicación de otros. Para aquellos que incrementaron la práctica de la automedicación en la pandemia, hubo una asociación con el hábito de indicar drogas a otras personas. Para aquellos que iniciaron esta práctica en el período pandémico, se asoció la capacidad de automedicación. Los resultados abren caminos para medidas educativas sobre el uso irracional de medicamentos por parte de los estudiantes de educación superior, independientemente del área de formación.

Desafíos para la enseñanza de ciencias médicas en condiciones de contingencia

La pandemia de COVID-19 contribuyó a la afectación del proceso tradicional de formación de profesionales de la salud, por lo que fueron implementados, de forma abrupta, ajustes y modificaciones que garantizaran la continuidad del proceso de enseñanza-aprendizaje. El objetivo de la revisión bibliográfica consiste en una actualización de las adecuaciones en los métodos de enseñanza en los diferentes escenarios docentes durante las diferentes etapas de contingencia. La revisión incluyó publicaciones, en su mayoría del período 2019-2021, y se emplearon principalmente las bases de datos ESBCO, CUMED y SciELO. Como resultado de la investigación, se plantea la complementación de las clases presenciales por otras modalidades a distancia, ya sea de tipo virtual o en línea: una forma de semipresencialidad, con un mayor empleo de las redes sociales y plataformas virtuales. En conclusión, la enseñanza de ciencias médicas en tiempos de contingencia constituye un reto, ya que ha sido necesario pasar de la enseñanza presencial tradicional a otras modalidades, con énfasis en las tecnologías de la información y de la comunicación, y así reorganizar la educación para garantizar la formación de profesionales de la salud.

The pandemic of COVID-19 contributed to affect the traditional training process of the health professionals, which is why adjustments and modifications were abruptly implemented to guarantee the continuity of the teaching-learning process. The objective of the bibliographical review is to update the adequacy in the teaching methods in the different teaching scenarios during the different contingency stages. The review included publications, mostly from the period 2019-2021, and database used were mainly EBSCO, CUMED and SciELO. As a result of the research, it is proposed the complementation of face-to-face classes by other remote modalities, either virtual or online: a semi-face-to-face form, with a bigger employment of the social networks and virtual platforms. In conclusion, the teaching of medical sciences in times of contingency is a challenge, since it has been necessary to move from traditional face-to-face education to other forms, with emphasis on information and communication technologies, and thus reorganize education to ensure the training of health professionals.

Segurança dos profissionais de saúde que atuaram na linha de frente da pandemia por covid-19 no Brasil / Safety of health professionals who worked in the front line of the COVID-19 pandemic in Brazil / Seguridad de los profesionales de la salud que actuaron en primera línea de la pandemia de COVID-19 en Brasil

Resumo Objetivou-se avaliar a segurança dos profissionais de saúde que atuaram no combate à pandemia de covid-19 em 2020 nos serviços de saúde brasileiros. Realizou-se inquérito on line, conduzido entre junho e setembro de 2020, com profissionais de saúde de instituições públicas e privadas brasileiras, com base no questionário Health workers exposure risk assessment and management in the context of COVID-19 virus, da Organização Mundial de Saúde, sendo analisados 2.832 registros. Raça/cor e categoria profissional foram variáveis relacionadas ao aumento de casos de covid-19 dentre os profissionais. Os que se autodeclararam não brancos, técnicos e auxiliares de enfermagem tiveram chance maior de resultado positivo, indicando maior suscetibilidade à infecção relacionada ao nível socioeconômico e/ou categoria profissional e papel desempenhado no cuidado ao paciente. As variáveis estrutura das unidades de saúde, localização, teste e disponibilidade de equipamentos de proteção individual relacionaram-se ao grau de risco de contrair a doença. Ressalta-se a importância da garantia de insumos e equipamentos aos profissionais de saúde, sobretudo em um contexto pandêmico e entre aqueles com baixo nível socioeconômico que atuam na linha de frente. Riscos em situações de emergência e escassez devem ser prospectivamente monitorados, ajustando-se às iniciativas no tocante à segurança do paciente.

Abstract The objective of this study was to evaluate the safety of health professionals who worked in the fight against the COVID-19 pandemic in 2020 in Brazilian health services. An online survey was conducted between June and September 2020, with health professionals from Brazilian public and private institutions, based on the Health workers exposure risk assessment and management in the context of COVID-19 virus, from the World Health Organization, and 2,832 records were analyzed. Race/color and professional category were variables related to the increase of covid-19 cases among professionals. Those who self-declared themselves non-white, technical and nursing assistants had a higher chance of positive results, indicating a higher susceptibility to infection related to socioeconomic level and/or professional category and a role played in patient care. The variables structure of the health units, location, test and availability of personal protective equipment were related to the degree of risk of contracting the disease. The importance of ensuring inputs and equipment to health professionals is highlighted, especially in a pandemic context and among those with low socioeconomic level who work on the front line. Risks in emergency and scarcity situations should be prospectively monitored, adjusting to patient safety initiatives.

Resumen El objetivo de este estudio fue evaluar la seguridad de los profesionales de la salud que actuaron en la lucha contra la pandemia de COVID-19 en 2020 en los servicios de salud brasileños. Entre junio y septiembre de 2020 se realizó una encuesta en línea con profesionales de la salud de instituciones públicas y privadas brasileñas, basada en la evaluación y gestión del riesgo de exposición de los trabajadores de la salud en el contexto del virus COVID-19, de la Organización Mundial de la Salud, y se analizaron 2.832 registros. Raza/color y categoría profesional fueron variables relacionadas con el aumento de casos de COVID-19 entre profesionales. Los que se autodeclararon no blancos, técnicos y auxiliares de enfermería tuvieron una mayor probabilidad de resultados positivos, lo que indica una mayor susceptibilidad a la infección relacionada con el nivel socioeconómico y/o categoría profesional y un papel desempeñado en la atención al paciente. Las variables estructura de las unidades de salud, ubicación, prueba y disponibilidad de equipo de protección personal se relacionaron con el grado de riesgo de contraer la enfermedad. Se destaca la importancia de garantizar insumos y equipos a los profesionales de la salud, especialmente en un contexto pandémico y entre aquellos con bajo nivel socioeconómico que trabajan en primera línea. Los riesgos en situaciones de emergencia y escasez deben ser monitoreados prospectivamente, ajustándose a las iniciativas de seguridad del paciente.