Desafios e mudanças no processo de trabalho das equipes de saúde da família no cenário pandêmico: relato de experiência / Challenges and changes in the work process of family health teams in the pandemic scenario: experience report

O presente estudo tem por objetivo realizar um relato de experiência demonstrando a percepção de discentes do curso de odontologia na sua participação na prática da atenção primária à saúde (APS), vivenciadas em um cenário pandêmico e com base no combate a enfrentamentos e desafios impostos no processo de trabalho das equipes de saúde da família. Este estudo trata - se de relato de experiência, de caráter descritivo e retrospectivo, associado à uma pesquisa bibliográfica para que trousse o embasamento teórico necessário para a descrição do relato de experiência vivenciado. No decorrer da pandemia, a Equipe de saúde da família exerceu importante papel e atuou na linha de prevenção e controle desta, sendo uma das maiores ferramentas de apoio. Na odontologia, a atuação da equipe de saúde bucal devido a fatores de risco inerentes à esta modalidade de ocupação, ficou limitada em seu exercício. O conhecimento de muitos dos profissionais da rede pública foi colocado em questão, assim como sua vivência, limitações e o medo de contrair a doença. Os profissionais da equipe de saúde, mostraram que o trabalho interprofissional e um bom relacionamento aumentou o incentivo e a responsabilidade de equipe.

This study aims to carry out an experience report demonstrating the perception of students of the dentistry course in their participation in the practice of primary health care (PHC), experienced in a pandemic scenario and based on the fight against confrontations and challenges imposed on the work process of family health teams. This study is an experience report, descriptive and retrospective, associated with bibliographical research to bring the necessary theoretical basis for the description of the lived experience report. During the pandemic, the Family Health Team played an important role and acted in the line of prevention and control of this, being one of the greatest support tools. In dentistry, the performance of the oral health team, due to risk factors inherent to this type of occupation, was limited in its exercise. The knowledge of many public health professionals was questioned, as well as their experience, limitations and fear of contracting the disease. Health team professionals showed that interprofessional work and a good relationship increased team incentive and responsibility.

Exploring the HONO source during the COVID-19 pandemic in a megacity in China.

HONO is a critical precursor of •OH, but its sources are controversial due to its complex formation mechanism. This study conducted comprehensive observations in Zhengzhou from April 26 to May 11, 2022. Low NOx concentrations were observed during the Covid epidemic period (EP) (10.4 ± 3.0 ppb), compared to the pre-epidemic period (PEP) (12.5 ± 3.8 ppb). The mean HONO concentration during EP (0.53 ± 0.34 ppb) was 0.09 ppb lower than that during PEP (0.62 ± 0.53 ppb). The decrease in HONO concentration during EP came mainly at night due to the reduction in the direct emission (Pemi) (0.03 ppb/hr), the homogeneous reaction between •OH and NO (POH+NO) (0.02 ppb/hr), and the heterogeneous conversion of NO2 on the ground (0.01 ppb/hr). Notably, there was no significant change in daytime HONO concentration. The daytime HONO budget indicated that the primary HONO sources during PEP were the nitrate photolysis (Pnitrate), followed by the POH+NO, Pemi, the photo-enhanced reaction of NO2 on the ground (Pground+hv) and aerosol surface (Paerosol+hv). The primary HONO sources were Pnitrate, POH+NO, Pemi, and Paerosol+hv during EP, respectively. The missing source has a high correlation with solar radiation, there might be other photo-related HONO sources or the contributions of photosensitized reactions were underestimated. In the extremely underestimated cases, HONO production rates from the Pnitrate, Pground+hv, and Paerosol+hv increased by 0.17, 0.10, and 0.10 ppb/hr during PEP, 0.23, 0.13, and 0.16 ppb/hr during EP, and Pnitrate was still the primary source during both PEP and EP.

[Promoting Equity, Diversity, and Inclusion in Healthcare: An Example of the COVID-19 Pandemic].

Healthcare systems must embody equity, diversity, and inclusion (EDI) and, in the event of unfairness, appropriate policies / countermeasures should be enacted. The healthcare system response to the COVID-19 pandemic not only highlighted how socioeconomic disparities affect mortality risk but also posed significant challenges to the successful practice of EDI in healthcare. In light of this, this article was written to provide an overview of EDI, analyze the international efforts to promote it, and suggest strategies for promoting EDI in infectious disease healthcare using COVID-19 as an example. In healthcare settings, equity centers on ensuring patients receive fair treatment regardless of race, gender, age, or socioeconomic status; diversity centers on healthcare providers understanding the uniqueness of patients from different cultural backgrounds and the health barriers they face; and inclusion centers on ensuring patients are treated with respect and given the attention they deserve. During pandemics, social determinants of health (SDOH) greatly impact patient health outcomes and hinder the practice of EDI. Reflecting on the impact of COVID-19, healthcare systems can actively apply EDI in clinical practice to provide to all patients equitable access to healthcare opportunities and outcomes. Practical strategies include establishing EDI committees within healthcare systems, monitoring relevant data, conducting staff training, and continuously addressing the SDOH and needs of marginalized groups to achieve EDI in healthcare.

Evaluation of Triage System in a Dedicated Covid-19 Hospital.

The global health system faces a substantial burden from the Covid-19 pandemic. To prevent Covid-19 transmission an effective triage system is useful in resource-limited countries like Bangladesh. The purpose of the study was to determine the status of the triage system in a dedicated Covid-19 Hospital. This cross-sectional study was conducted among conveniently selected 150 respondents including 63 doctors, 72 nurses and 15 administrative staff. Data were collected through face-to-face interviews using a pretested semi-structured questionnaire and observation checklist. The collected data were processed and analyzed with the help of SPSS (Version 26.0) and Xcel 2019. The study was conducted at Kurmitola General Hospital, Bangladesh from January 2020 to December 2020. Among study participants, 54.0% of the respondents belonged to the (31-40) age group and 74.0% were female. Half 50.7% of the respondents working duration was (0-4) years. Two-thirds 67.0% of the respondents had training on the triage system. All of the respondents mentioned the presence of a triage system in this hospital but there was no tele-triage. Regarding infrastructure facilities like triage room, sitting facilities with 1-meter distance in waiting area, one-way entrance, and exit, separated ticket counter and washroom, proper hand wash facilities, all were present in this hospital. All of the respondents mentioned the presence of available logistic support for the triage system in this dedicated Covid-19 hospital including a sufficient supply of PPE, thermometer, and pulse oximeter. All doctors and nurses wore PPE. Almost four-fifths 87.30% of the respondents mention that there was no training on donning and doffing procedure of PPE. There was a statistically significant association between training on triage with age group and occupation of the respondents (p<0.05). The ideal working time of healthcare providers was not maintained. There had no facilities of isolated accommodation and health checkups for staff. But RT-PCR for Covid-19 test was done for all staff when he/she returns to normal life after duty. Based on study findings it has been concluded that the infrastructure facilities and logistic supports are sufficient. But staff management has to be improved and the authority should pay special attention to an effective triage system.

Pharmaceuticals and personal care products contamination in the rivers of Chennai city during the COVID-19 pandemic.

Pharmaceuticals and personal care products (PPCPs) monitoring in surface water is crucial to address the escalating threat of antimicrobial resistance and safeguard public health. This study aimed to investigate the occurrence of 21 different PPCPs, including wastewater chemical markers, antibiotics, and parabens in the surface water of Chennai city using Ultra Performance Liquid Chromatography-Triple Quadrupole Mass Spectrometry (UPLC-MS/MS) analysis. It is noteworthy that chemical markers viz., carbamazepine (CBZ) and caffeine (CAF) were detected in all the sites and contributed to more than 95% of the total PPCPs load indicating a significant intrusion of wastewater. Among the antibiotics, fluoroquinolones were dominant in this study. Interestingly, a significant and strong correlation was seen between fluoroquinolones, CBZ and CAF (R2 = 0.880-0.928, p < 0.05), suggesting similarities in their sources. More than 50% of the sites exhibited a risk for antimicrobial resistance (RQAMR) with RQAMR > 1 for ciprofloxacin, indicating a significant public health concern. The ecotoxicological risk assessment of PPCPs showed no risk to any organisms, except for triclosan, which posed a risk to fish and daphnids at one site near an open drain in Buckingham canal.

The Challenges of Treating Lead Toxicity During the COVID-19 Pandemic.

Despite decades of environmental reform, legacy lead is a persistent health hazard within communities. Secondary prevention with screening for childhood lead exposure typically occurs at the 12-month and 24-month well visits, and early identification of toxicity is of vital importance to reduce morbidity and mortality. Over the past few years, there have been multiple challenges impacting the management of lead toxicity, including the coronavirus disease 2019 pandemic, a national shortage of the chelation agent CaNa2EDTA, and housing-related concerns that may result in re-exposure of lead before lead abatement. This report identifies the importance of lead screening and limitations that a pandemic has placed on health care while emphasizing access to care and community resources needs to be a priority.

A post-pandemic trend in the consumption of dietary supplements among residents of Lithuania.

OBJECTIVES: The consumption of dietary supplements might prevent the deficiency of necessary nutrients. On the other hand, in cases of overconsumption, adverse effects might occur. In Lithuania, the COVID-19 pandemic provoked an increase in the consumption of dietary supplements. The aim of this study was to reveal the post-pandemic trend of the consumption of dietary supplements among the working-age residents of Lithuania with respect to social and demographic factors and food selection criteria. METHODS: A cross-sectional observational study was performed. In total, using the same methods, 3,200 residents were surveyed: 1,600 in 2021 and 1,600 in 2022. Both samples were representative for Lithuania and included residents of Lithuania aged from 18 to 64 years. According to socio-demographic factors (sex, age, level of education, type of place of residence, marital status, number of family members, presence of children under 18 years old in the household, employment status, level of income), COVID-19 experience (presence of COVID-19 cases among friends or relatives, severeness of COVID-19) and food selection criteria (health strengthening, other) the prevalence of the consumption of dietary supplements was compared between the samples. RESULTS: The consumption of dietary supplements accounted for 78.1% and 71.6% of the respondents in 2021 and 2022, respectively (p < 0.001). After the COVID-19 pandemic, the prevalence of the consumption of dietary supplements decreased in the majority of social and demographic groups analysed in this article (p < 0.05). The consumption of dietary supplements remained unchanged among those who selected foods for health strengthening (p = 0.098). CONCLUSIONS: The prevalence of the consumption of dietary supplements decreased after the COVID-19 pandemic in most social and demographic groups except those who selected foods for health strengthening.

Identifying extreme events in the stock market: A topological data analysis.

This paper employs Topological Data Analysis (TDA) to detect extreme events (EEs) in the stock market at a continental level. Previous approaches, which analyzed stock indices separately, could not detect EEs for multiple time series in one go. TDA provides a robust framework for such analysis and identifies the EEs during the crashes for different indices. The TDA analysis shows that L1, L2 norms and Wasserstein distance (WD) of the world leading indices rise abruptly during the crashes, surpassing a threshold of µ+4∗σ, where µ and σ are the mean and the standard deviation of norm or WD, respectively. Our study identified the stock index crashes of the 2008 financial crisis and the COVID-19 pandemic across continents as EEs. Given that different sectors in an index behave differently, a sector-wise analysis was conducted during the COVID-19 pandemic for the Indian stock market. The sector-wise results show that after the occurrence of EE, we have observed strong crashes surpassing µ+2∗σ for an extended period for the banking, automobile, IT, realty, energy, and metal sectors. While for the pharmaceutical and FMCG sectors, no significant spikes were noted. Hence, TDA also proves successful in identifying the duration of shocks after the occurrence of EEs. This also indicates that the banking sector continued to face stress and remained volatile even after the crash. This study gives us the applicability of TDA as a powerful analytical tool to study EEs in various fields.

A Latent Class Analysis on Indicators of Early Prolonged Grief Disorder and Well-Being Among Dutch Adults Bereaved During the First Year of the COVID-19 Pandemic.

Most studies examining prolonged grief disorder (PGD) in people bereaved during the COVID-19 pandemic are focused on psychopathology. However, mental health encompasses both absence of psychopathology and presence of well-being. This is the first study examining symptom profiles of early PGD and subjective mental well-being in 266 Dutch adults recently bereaved during the pandemic. Early PGD and well-being indicators were assessed with the Traumatic Grief Inventory-Self Report Plus and the World Health Organization-Five Well-Being Index, respectively. Latent class analysis identified four classes: low PGD/high well-being (32%), low PGD/moderate well-being (24%), moderate PGD/high well-being (23%) and high PGD/low well-being class (21%). People in the poorer mental health classes were more likely to be female, lower educated, suffering from a mental disorder, have a poor health status, closer kinship to the deceased, and higher risk of severe COVID-19. Classifying adults according to symptom profiles of negative and positive outcomes provides a more complete picture of mental health in bereaved people and offers potential intervention targets.

How to distinguish climate sceptics, antivaxxers, and persistent sceptics: Evidence from a multi-country survey of public attitudes.

Distrust in science has been linked to scepticism over vaccines and climate change. Using data from nationally representative surveys administered in eight key countries for global efforts to mitigate climate change and COVID-19 (Australia, Brazil, China, India, Japan, South Africa, the UK and US), we find that distrust in scientists was an important predictor variable for most sceptics, who were sceptical of one issue but not both, in February 2021, when most countries had experienced their first wave of the pandemic. However, the association was significantly weaker among the segment of hardcore sceptics who were both climate sceptics and antivaxxers. We demonstrate that these individuals tended to possess many of the typical sceptic characteristics such as high distrust in social institutions and rightward political orientation, which are (collectively) suggestive of an underlying sceptic mindset rather than a specific distrust of scientists. Our results suggest that different types of sceptics necessitate different strategies to dispel scepticism.

Health Care Usage During the COVID-19 Pandemic and the Adoption of Telemedicine: Retrospective Study of Chronic Disease Cohorts.

BACKGROUND: The COVID-19 pandemic accelerated telehealth adoption across disease cohorts of patients. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study, we take a comprehensive multidisease approach in studying the impact of the COVID-19 pandemic on health care usage and the adoption of telemedicine through the first 12 months of the COVID-19 pandemic. OBJECTIVE: We studied the impact of the COVID-19 pandemic on in-person health care usage and telehealth adoption across chronic diseases to understand differences in telehealth adoption across disease cohorts and patient demographics (such as the Social Vulnerability Index [SVI]). METHODS: We conducted a retrospective cohort study of 6 different disease cohorts (anxiety: n=67,578; depression: n=45,570; diabetes: n=81,885; kidney failure: n=29,284; heart failure: n=21,152; and cancer: n=35,460). We used summary statistics to characterize changes in usage and regression analysis to study how patient characteristics relate to in-person health care and telehealth adoption and usage during the first 12 months of the pandemic. RESULTS: We observed a reduction in in-person health care usage across disease cohorts (ranging from 10% to 24%). For most diseases we study, telehealth appointments offset the reduction in in-person visits. Furthermore, for anxiety and depression, the increase in telehealth usage exceeds the reduction in in-person visits (by up to 5%). We observed that younger patients and men have higher telehealth usage after accounting for other covariates. Patients from higher SVI areas are less likely to use telehealth; however, if they do, they have a higher number of telehealth visits, after accounting for other covariates. CONCLUSIONS: The COVID-19 pandemic affected health care usage across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service usage for patients in higher SVI areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual health care providers improve access to care for patients with chronic conditions.

Shared Experiences of Nurse Anesthesiology Faculty During the COVID-19 Pandemic.

The COVID-19 pandemic impacted all aspects of healthcare, including the education of certified registered nurse anesthesiologists. While the literature contains reports of the impact of COVID-19 on physician anesthesiologist faculty, there was no research identified describing the impact on nurse anesthesiologist faculty. The purpose of this study was therefore to describe and explore the impact of the COVID-19 pandemic on nurse anesthesiology faculty. This qualitative ethnographic study used small focus groups and semistructured and probing questions to examine the phenomenon of interest. Through thematic analysis of the narrative, five overarching themes were identified: 1) ability to adapt to adversity, 2) disruption leads to change, 3) perceived positive outcomes, 4) previously untapped resources, and 5) curricular innovation and integrity.

Experiences of Family Caregivers of Older Adults With Dementia in Korea During the COVID-19 Pandemic: A Qualitative Analysis.

PURPOSE: To explore the experiences of family caregivers of older adults with dementia in Korea during the coronavirus disease 2019 pandemic. METHOD: In-depth interviews were conducted with eight family caregivers of older adults with dementia from September to October 2021. Collected data were analyzed using Giorgi's phenomenological methodology. RESULTS: Four themes were derived: A Rough Journey With Worry, A Desolate Life in a Disconnected World, Frustration Due to Health Deterioration, and Looking Toward the Future Despite Heavy Responsibility. CONCLUSION: This study is meaningful as it increases our understanding of the experiences and needs of individuals with dementia and their family caregivers, and results can assist in finding ways to help them cope with their difficulties during future pandemic situations. [Journal of Gerontological Nursing, 50(10), 42-48.].

Support for Nursing Home Caregivers During the COVID-19 Pandemic: A Review.

PURPOSE: To review support systems for nursing home caregivers (NHCGs) that were implemented during the first year of the coronavirus disease 2019 (COVID-19) pandemic. METHOD: Database searches in PubMed, ScienceDirect, and CINAHL resulted in five publications. RESULTS: Studies differed in design, interventions, and outcomes. An urgent eye movement desensitization and reprocessing protocol was feasible and effective among nurses in services highly mobilized during the acute phase of the pandemic. The "self-help plus" psychological intervention was not associated with significant reductions in anxiety or posttraumatic symptoms but prompted exploration of non-specific factors influencing its effectiveness. The Extension for Community Healthcare Outcomes in Long-Term Care of the Elderly virtual program increased confidence among NHCGs. Self-compassion training was associated with positive changes for certified nursing assistants. Weekly debriefing sessions implemented at one hospital highlighted pathogenic and salutogenic factors. CONCLUSION: The COVID-19 pandemic had a marked psychosocial impact on NHCGs and necessitated targeted interventions. Despite their limitations, these promising studies provided insights into potential support avenues. Policy considerations should stress the pivotal role of advanced practice nurses in shaping supportive work environments. Future research should focus on robust assessments of the efficacy of psychosocial interventions for NHCGs facing ongoing challenges posed by the pandemic, and even recurrent viral epidemics. [Journal of Gerontological Nursing, 50(10), 24-33.].

[The Molecular and Biological Patterns Underlying Sustained SARS-CoV-2 Circulation in the Human Population].

INTRODUCTION: For four years, SARS-CoV-2, the etiological agent of COVID-19, has been circulating among humans. By the end of the second year, an absence of immunologically naive individuals was observed, attributable to extensive immunization efforts and natural viral exposure. This study focuses on delineating the molecular and biological patterns that facilitate the persistence of SARS-CoV-2, thereby informing predictions on the epidemiological trajectory of COVID-19 toward refining pandemic countermeasures. The aim of this study was to describe the molecular biological patterns identified that contribute to the persistence of the virus in the human population. MATERIALS AND METHODS: For over three years since the beginning of the COVID-19 pandemic, molecular genetic monitoring of SARS-CoV-2 has been conducted, which included the collection of nasopharyngeal swabs from infected individuals, assessment of viral load, and subsequent whole-genome sequencing. RESULTS: We discerned dominant genetic lineages correlated with rising disease incidence. We scrutinized amino acid substitutions across SARS-CoV-2 proteins and quantified viral loads in swab samples from patients with emerging COVID-19 variants. Our findings suggest a model of viral persistence characterized by 1) periodic serotype shifts causing substantial diminutions in serum virus-neutralizing activity (> 10-fold), 2) serotype-specific accrual of point mutations in the receptor-binding domain (RBD) to modestly circumvent neutralizing antibodies and enhance receptor affinity, and 3) a gradually increasing amount of virus being shed in mucosal surfaces within a single serotype. CONCLUSION: This model aptly accounts for the dynamics of COVID-19 incidence in Moscow. For a comprehensive understanding of these dynamics, acquiring population-level data on immune tension and antibody neutralization relative to genetic lineage compositions is essential.

Epidemiology of Alcohol-Associated Liver Disease Including Increasing Burden in Young Adults and Females Especially Since Covid-19 Pandemic.

Alcohol-associated liver disease (ALD) was already on the rise globally when the advent of coronavirus disease 2019 further accelerated this trend. ALD has emerged as the leading cause for liver transplantation in the United States. The pandemic has not only intensified the prevalence of ALD but has also highlighted significant disparities in its impact, particularly, among young adults and women. This review aims to dissect the complex landscape of ALD, focusing on gender, race, and emerging risk factors in the context of the current global health crisis.

Performance of the 4C and SEIMC scoring systems in predicting mortality from onset to current COVID-19 pandemic in emergency departments.

The evolution of the COVID-19 pandemic has been associated with variations in clinical presentation and severity. Similarly, prediction scores may suffer changes in their diagnostic accuracy. The aim of this study was to test the 30-day mortality predictive validity of the 4C and SEIMC scores during the sixth wave of the pandemic and to compare them with those of validation studies. This was a longitudinal retrospective observational study. COVID-19 patients who were admitted to the Emergency Department of a Spanish hospital from December 15, 2021, to January 31, 2022, were selected. A side-by-side comparison with the pivotal validation studies was subsequently performed. The main measures were 30-day mortality and the 4C and SEIMC scores. A total of 27,614 patients were considered in the study, including 22,361 from the 4C, 4,627 from the SEIMC and 626 from our hospital. The 30-day mortality rate was significantly lower than that reported in the validation studies. The AUCs were 0.931 (95% CI: 0.90-0.95) for 4C and 0.903 (95% CI: 086-0.93) for SEIMC, which were significantly greater than those obtained in the first wave. Despite the changes that have occurred during the coronavirus disease 2019 (COVID-19) pandemic, with a reduction in lethality, scorecard systems are currently still useful tools for detecting patients with poor disease risk, with better prognostic capacity.

Revitalizing grand rounds in the time of COVID.

COVID presented an opportunity to revolutionize the traditional format of Medical Grand Rounds (MGR). In this Commentary, we explore the educational ramifications of shifting MGR virtually with a focus on COVID-related content and its long-term sustainability. This transformation offers an inclusive interdisciplinary approach to sustain learner interest and improve education.

Assessment of the COVID-19 impact on the Brazilian Unified Health System (SUS) financing: an analysis of the financing dynamics of 2020 and 2021.

BACKGROUND: After the establishment of the public health emergency of international concern in 2020, health systems worldwide and in Brazil observed the need to apply more extraordinary logistical efforts and possibly resources to combat the imminent pandemic. METHODS: Using the historical series of public expenditures of the National Health Fund (FNS), 2015 to 2021, the number of confirmed cases of COVID-19, and a seasonal ARIMAX model, we sought to assess how the increase in the new virus infections affected the systematic financing of the SUS in Brazil. RESULTS: There were signs of seasonality and an increasing trend in the expenditure variable, which in practical terms, only indicated that the resource contributions followed an increasing trajectory already underway before the advent of the pandemic. The 1% increase in COVID-19 cases, with a one-month lag, contributes to the 0.062% increase in the variation in FNS expenditures but a decrease of 0.058% with a two-month lag. CONCLUSION: The tests showed no evidence to confirm a positive shift on FNS spending growth trajectory due to the increase of COVID-19 cases, only observing a significant increase one month after the occurrence of COVID cases, probably due to their worsening after this period, which was followed by a similar and comparable decrease in percentage of growth in the following month.