Social inequalities in mental and physical health derived from the COVID-19 pandemic in Spain beyond SARS-CoV-2 infection.

BACKGROUND: Understanding the impact of the COVID-19 crisis on health involves conducting longitudinal studies to evaluate the inequalities that may have been exacerbated by the pandemic. The purpose of this study was to estimate differences in physical and mental health derived from the COVID-19 pandemic, beyond SARS-CoV-2 infection, in the Spanish general population according to the participants' level of education; and to assess the evolution of these differences from June 2020 (just after the lockdown) to nine months later (February-March 2021). METHODS: This is a longitudinal prospective study of a representative sample of non-institutionalized Spanish adults, through computer-assisted telephone interviews. Mobility, self-care, usual activities, pain/discomfort and anxiety/depression problems were measured with EQ-5D-5L. Prevalence ratio (PR) between high and low education levels and adjusted PR were estimated by Poisson regression models. Analyses were stratified by gender. RESULTS: A total of 2,000 participants answered both surveys. Individuals with low level of education reported more health problems in both genders, and absolute inequalities remained quite constant (mobility and self-care problems) or decreased (pain/discomfort and anxiety/depression problems). The greatest relative inequalities were observed just after the lockdown, with age-adjusted PR ranging from 1.31 (95%CI 1.08-1.59) for women and 1.34 (95%CI 1.05-1.69) for men in pain/discomfort to 2.59 (95%CI 0.98-6.81) for women and 4.03 (95%CI 1.52-10.70) for men in self-care; aPR decreased after nine months for most dimensions. CONCLUSIONS: Prevalence of health problems increased during the COVID-19 pandemic in all education groups, but the increase was higher in women and men with a high level of education, suggesting that its impact appeared later in this group. Further analysis on the role of governmental economic aid given to vulnerable people might shed light on this evolution.

Telehealth Adoption in an Outpatient Oncology Ward: A Best Practice Implementation Project.

Telehealth is increasingly taking place to support the transition of care and self-management of people living with cancer in outpatient oncology settings. Despite its recognised value, the scientific evidence points to disparities with regard to implementation of telehealth that might compromise the equity of access. Following the Joanna Briggs Institute (JBI) implementation approach, this project aims to promote the implementation of best practice recommendations for telehealth adoption in an outpatient oncology setting. Assisted by the Practical Application of Clinical Evidence System (PACES), the implementation process comprises three phases of (i) a baseline audit, (ii) feedback to the healthcare team and establishment of implementation strategies with the Getting Research into Practice (GRiP) tool, and (iii) a follow-up audit. The project is expected to allow the identification of barriers and facilitators for the implementation of telehealth in outpatient oncology and develop a strategy plan for its adoption, with the involvement of end-users and stakeholders. The successful adoption of telehealth according to the best available evidence will likely enhance equity of access to healthcare and quality of care at a distance.

Desospitalização em cuidado paliativos: perfil dos usuários de uma unidade no rio de janeiro/ brasil / Deshospitalización en cuidados paliativos: perfil de los usuarios de una unidad en rio de janeiro/brasil / Deinstitutionalization in palliative care: profile of users of a unit in rio de janeiro/brazil

RESUMO Objetivo: conhecer o perfil dos usuários do serviço de desospitalização de uma unidade no Rio de Janeiro. Método: estudo descritivo e retrospectivo, com base no método de investigação quantitativa. Foram analisados prontuários de pessoas atendidas no período de janeiro de 2012 a dezembro de 2016 (n = 655). A amostra é constituída por 330 (50,4%) usuários do sexo feminino, com 493 (75,3%) acima de 60 anos. Maioritariamente 598 (91,3%) residem na região metropolitana do RJ, 406 (61,9%) têm câncer. Relativamente à demanda de cuidados técnicos prevalentes são as lesões de pele, 150 (22,9%); a alimentação por via oral, 528 (80,6%); e gástrica, 123 (18,7%); estomias, 178 (27,1%); e sonda vesical ou cistostomia 106 (16,1%). Apresentavam dependência total, 424 (64,7%). Conclusão: o perfil dos usuários é composto predominantemente por idosos, com dependência total e patologia oncológica requerendo implementação de estratégias que visem a condução destes casos.

RESUMEN Objetivo: conocer el perfil de los usuarios del servicio de deshospitalización de una unidad en Rio de Janeiro. Método: estudio descriptivo y retrospectivo, con base en el método de investigación cuantitativa. Se analizaron prontuarios de personas atendidas en el periodo de enero de 2012 a diciembre de 2016 (n = 655). La muestra tiene 330 (50,4%) usuarios del sexo femenino, con 493 (75,3%) mayores de 60 años. La mayoría, 598 (91,3%) viven en la región metropolitana de RJ, 406 (61,9%) tienen cáncer. Acerca de la demanda de cuidados técnicos, son prevalentes las lesiones de piel, 150 22,9%); la alimentación por vía oral, 528 (80,6%); y gástrica, 123 (18,7%); ostomías, 178 (27,1%); y sonda vesical o cistostomía 106 (16,1%). Presentaban dependencia total 424 (64,7%). Conclusión: el perfil de los usuarios fue predominantemente de ancianos, con dependencia total y patología oncológica, siendo necesaria implementación de estrategias para el acompañamiento de estos casos.

ABSTRACT Objective: Gain knowledge on the profile of users of a residential care service provided by a hospital in Rio de Janeiro as part of a deinstitutionalization strategy for individuals in palliative care. Method: descriptive and retrospective study based on quantitative investigation. The medical records of patients who received care at a home care service from January 2012 to December 2016 (n = 655) were analyzed. Of these, 330 (50.4%) were women and 493 (75.3%) were older than 60 years. Most of them, 598 (91.3%) lived in the Metropolitan region of Rio de Janeiro and 406 (61.9%) have cancer. Regarding the demand for technical care, there was a prevalence of care related to skin lesions, 150 (22.9%); followed by oral feeding, 528 (80.6%); and gastrostomy, 123 (18.7%); ostomies, 178 (27.1%) and bladder catheter or cystostomy, 106 (16.1%). In addition, 424 (64.7%) users were entirely dependent on care. Conclusão: Regarding the profile of the users, most of them were elderly individuals entirely dependent on care and diagnosed with cancer. Strategies should be implemented for the management of these individuals.

Social and health behavioural determinants of maternal child-feeding patterns in preschool-aged children.

Parental child-feeding attitudes and practices may compromise the development of healthy eating habits and adequate weight status in children. This study aimed to identify maternal child-feeding patterns in preschool-aged children and to evaluate their association with maternal social and health behavioural characteristics. Trained interviewers evaluated 4724 dyads of mothers and their 4-5-year-old child from the Generation XXI cohort. Maternal child-feeding attitudes and practices were assessed through the Child Feeding Questionnaire and the Overt/Covert Control scale. Associations were estimated using linear regression [adjusted for maternal education, body mass index (BMI), fruit and vegetables (F&V) intake and child's BMI z-score]. Principal component analysis defined a three-factor structure explaining 58% of the total variance of maternal child-feeding patterns: perceived monitoring - representing mothers with higher levels of monitoring, perceived responsibility and overt control; restriction - characterizing mothers with higher covert control, restriction and concerns about child's weight; pressure to eat - identifying mothers with higher levels of pressure to eat and overt control. Lower socioeconomic status, better health perception, higher F&V intake and offspring cohabitation were associated with more 'perceived monitoring' mothers. Higher maternal F&V intake and depression were associated with more 'restrictive' mothers. Younger mothers, less educated, with poorer health perception and offspring cohabiting, were associated with higher use of 'pressure to eat'. Maternal socioeconomic indicators and family environment were more associated with perceived monitoring and pressure to eat, whereas maternal health behavioural characteristics were mainly associated with restriction. These findings will be helpful in future research and public health programmes on child-feeding patterns.

An assessment of PCB and PBDE contamination in two tropical dolphin species from the Southeastern Brazilian coast.

PCBs and PBDEs were determined in two dolphin species, Sotalia guianensis and Steno bredanensis, from an upwelling system off the Central-northern coast of Rio de Janeiro, Brazil. PCB levels varied from 0.040 to 0.75 µg g(-1) lw in muscles and from 0.022 to 1.32 µg g(-1)lw in liver samples from S. guianensis. In S. bredanensis, values varied from 0.085 to 11.3 µg g(-1) lw in muscles and from 0.024 to 18.6 µg g(-1) lw in livers. PCB-138, -153 and -180 were the major PCB congeners detected in both species, while BDE-47 was the predominant PBDE congener found in both species. Higher concentrations in S. bredanensis were possibly related to the different feeding habits for both delphinid species. These results contribute to extend the database on organic contamination in cetaceans from the southern hemisphere, understanding their distribution and environmental fate in Southeastern Brazil.

Nitrogênio e potássio em milho irrigado: análise técnica e econômica da fertilização / Nitrogen and potassium in irrigated corn: technical and economic analysis of the fertilization

A irrigação das culturas aumenta a possibilidade de obtenção de altas produtividades, mas exige racionalidade técnica e econômica no uso de insumos, especialmente fertilizantes nitrogenados. O objetivo deste trabalho foi determinar as doses mais adequadas de nitrogênio e de potássio para maior produtividade de grãos e o melhor retorno econômico da adubação com o cultivo de milho (Zea mays L.) sob irrigação por aspersão. O experimento foi conduzido nos anos agrícolas 2002/03 e 2003/04, em Cruz Alta, Rio Grande do Sul, em lavoura sob irrigação com pivô central, em Latossolo Vermelho distrófico típico. A população efetiva do milho foi de 78.000 e 71.000 plantas ha-1 em 2002/03 e 2003/04, respectivamente, utilizando-se o híbrido Pioneer 30F44. Os tratamentos foram compostos das doses de 0, 80, 120, 160, 200 e 240kg ha-1 de N (uréia) combinadas com 0, 40, 80 e 120kg ha-1 de K2O (cloreto de potássio). O delineamento utilizado foi blocos ao acaso com quatro repetições. A máxima produtividade de grãos de milho sob irrigação por aspersão foi obtida com a aplicação de 283 a 289kg ha-1 de nitrogênio, mas a máxima eficiência econômica ocorreu com 156 a 158kg ha-1 de nitrogênio, não havendo incremento na produtividade com a aplicação de potássio. Isso evidencia que, em muitas situações, os produtores estão utilizando fertilizantes nitrogenados e potássicos acima do necessário.

Irrigation increases the probability to obtain high crop grain yield, but demands a technical and economical reasonable use of agricultural inputs, especially nitrogen fertilizers. The objective was to determine the more adequate rates of nitrogen and potassium for corn (Zea mays L.) grain yield and the better economical return of the fertilization in corn under sprinkle irrigation. The experiment was carried out in the years 2002/03 and 2003/04 in Cruz Alta-RS, Brazil, in a crop farm using central pivot irrigation system. The soil used was an Oxisol (Hapludox). The corn effective population totalized 78.000 and 71.000 plants ha-1 for the years 2002/03 and 2003/04, respectively, using the hybrid Pioneer 30F44. The treatments were composed by 0, 80, 120, 160, 200 and 240kg ha-1 of N (urea) combined with 0, 40, 80 and 120kg ha-1 of K2O (potassium chloride). The experiment was set in a randomized block design with four replicates. The maximum corn grain yield under sprinkle irrigation was obtained with N rates between 283 and 289kg ha-1, but the maximum economic efficiency was between 156 and 158kg of N ha-1, without any increment in grain yield with potassium application. These results show that, in many situations, farmers are using rates of nitrogen and potassium fertilizers over than necessary.

Micronutrientes na soja: produtividade e análise econômica / Micronutrients in soybean: productivity and economic analysis

A disponibilidade de produtos comerciais contendo micronutrientes tem aumentado nos últimos anos, embora existam resultados experimentais mostrando grande variabilidade, o que torna este tema contraditório. A diminuição do custo relativo no uso de micronutrientes e a expectativa de ganhos em escala, nos últimos anos, tem motivado produtores a utilizar micronutrientes como cobalto, boro e molibdênio, pela sua influência na fixação simbiótica de nitrogênio na soja. O objetivo do trabalho foi de determinar a viabilidade técnica e econômica da aplicação de alguns micronutrientes, com destaque para Mo e Co, na produtividade de grãos da soja. O experimento foi conduzido nos anos agrícolas 2001/02 e 2002/03, na Fazenda Paineira, da SLC Agrícola Ltda, em Coronel Bicaco, RS, em Latossolo Vermelho Distroférrico típico há oito anos sob plantio direto. O delineamento experimental foi de blocos ao acaso com três repetições, com parcelas de 10 x 50 m. A implantação da soja foi em 18/11 de 2001 e em 24/11 de 2002, com população de 225 e 190 mil plantas ha-1, para os dois anos agrícolas, respectivamente. O espaçamento entre linhas foi de 0,40 m e a cultivar foi a RS-10 para os dois anos. Os tratamentos em 2001/02 foram: (1) CoMo; (2)CoMo+Mo; (3) CoMo +Mo+Mo; (4) CoMo+Mo+P30; (5) CoMo +B; (6) B; (7) Mo; (8) Mo+Mo; e (9) Testemunha. Em 2003/04, os tratamentos foram: (1) CoMo+2x Mo; (2)CoMo+2x Mo+B; (3) CoMo+2x Mo+Phitosol PK; (4) CoMo+2x Fortifol CaB; (5) CoMo+2x Mo + LBE-PT1; (6) CoMo+2x Mo+P30; (7) CoMo+2x Mo+Stimulate; e (8) Testemunha. O uso de micronutrientes, especialmente Mo e Co, mostrou-se contraditório na avaliação da produtividade física de grãos através de comparação de médias. Entretanto, na maioria dos casos, o retorno econômico da aplicação dos micronutrientes foi positivo, mas evidenciou sua dependência de altas produtividades e preços favoráveis no momento da comercialização.