Management of the health workforce in facing COVID-19: disinformation and absences in Brazil's Public Policies.

The objective of this research was to analyse federal government interventions in crisis management and the consequences for health professionals. This is a documentary-type qualitative research. Brazilian Federal regulations referring to work and health education produced during the pandemic emergency of COVID-19, published from January 28 to June 2, 2020, were identified. Of the total of 845 documents, 62 were selected in accordance with the inclusion criteria and were then submitted to Thematic Content Analysis. The results and discussions were grouped into four categories:workforce management, workforce protection, workforce training and academic-workforce relationship. Absence of a federal coordinating actions and policies for desinformation were identified. This lacking mechanisms for coordination contributed decisively to the tragic epidemiological situation still underway, especially in terms of the exposure of health workers to the risk of contamination, revealed in the extremely high rates of professionals infected or killed by COVID-19 in Brazil and the failure to control the pandemic in the population.

COVID-19 pandemic: dissatisfaction with work among teachers in the state of Minas Gerais, Brazil. / Pandemia da COVID-19: insatisfação com o trabalho entre professores(as) do estado de Minas Gerais, Brasil.

This article aimed to verify the prevalence and factors associated with dissatisfaction with teaching work among teachers from the state public basic education network in the state of Minas Gerais during the COVID-19 pandemic. This is a websurvey, carried out with these teachers between August and September 2020 via digital form. The dependent variable was job satisfaction during the pandemic, with satisfied people being the reference category. Multinomial Logistic Regression was used. 15,641 teachers from 795 municipalities participated in the study. Regarding work satisfaction, 21.6% were satisfied, 44.7% were indifferent and 33.7% were unsatisfied. The chances of being unsatisfied were higher among those without a spouse (OR=1.23), longer teaching time (OR=1.19), difficulty with remote activities (OR=37.60), without possession of a computer (OR=1.40), smokers (OR=1.27), using alcoholic beverages (OR=1.54), sedentary (OR=1.22) and absent leisure activities (OR=1.49). The changes caused in the educational system in the face of the pandemic impacted the teacher's routine, contributing to the dissatisfaction with the work of this professional.

O objetivo deste artigo foi verificar a prevalência e fatores associados à insatisfação com o trabalho docente entre professores(as) da rede pública estadual de educação básica do estado de Minas Gerais durante a pandemia da COVID-19. Inquérito epidemiológico do tipo websurveys, realizado com esses(as) professores(as) entre agosto e setembro de 2020 via formulário digital. A variável dependente foi a satisfação com o trabalho durante a pandemia, sendo os(as) satisfeitos(as) a categoria de referência. Foi utilizada a Regressão Logística Multinomial. Participaram do estudo 15.641 professores(as) de 795 municípios. Em relação a satisfação com o trabalho, 21,6% estavam satisfeitos(as), 44,7% indiferentes e 33,7% insatisfeitos(as). As chances de estarem insatisfeitos(as) foram maiores entre aqueles(as) sem cônjuge (OR=1,23), maior tempo de docência (OR=1,19), dificuldade com atividades remotas (OR=37,60), sem posse de computador (OR=1,40), tabagistas (OR=1,27), em uso de bebida alcoólica (OR=1,54), sedentários(as) (OR=1,22) e atividade de lazer ausente (OR=1,49). As mudanças causadas no sistema educacional diante da pandemia impactaram a rotina do(a) professor(a), contribuindo para a insatisfação com o trabalho deste(a) profissional.

Sexuality and prevention among men who have sex with men in the contexts of the AIDS and COVID-19 pandemics. / Sexualidade e prevenção entre homens que fazem sexo com homens nos contextos das pandemias de AIDS e da Covid-19.

This essay reflects on sexual practices and prevention in the contexts of the AIDS and COVID-19 pandemics. It analyses data collected between July and October 2020 through participant observation, as part of an ethnographic research project on HIV vulnerability and prevention among men who have sex with men in the Metropolitan Region of Recife, state of Pernambuco (PE), Brazil. The results point to the relevance of physical appearance and the affective bond between partners in engendering emotions that mediate coping with the risk of infection during both pandemics. It indicates the need to incorporate those communicational dimensions into informational materials to make them more effective.

Este ensaio reflete sobre práticas sexuais e prevenção nos contextos das pandemias de AIDS e da COVID-19. Analisa dados coletados entre julho e outubro de 2020, por meio de observação participante, no âmbito de uma pesquisa etnográfica sobre vulnerabilidade e prevenção ao HIV entre homens que fazem sexo com homens da Região Metropolitana do Recife. Os resultados apontam para a relevância da aparência corporal e da vinculação afetiva entre os parceiros no engendramento de emoções que medeiam a lida com risco de infecção em ambas as pandemias. Sinaliza para a necessidade de incorporar essas dimensões comunicacionais em materiais informativos, de modo a torná-los mais eficazes.

Use of health services and adherence to social distancing by adults with Noncommunicable Diseases during the COVID-19 pandemic, Brazil, 2020. / Uso dos serviços de saúde e adesão ao distanciamento social por adultos com doenças crônicas na pandemia de COVID-19, Brasil, 2020.

The present study investigates the association between the self-reported diagnosis of noncommunicable disease (NCD) and the adherence to social distancing and the use of health services during the COVID-19 pandemic. This was a cross-sectional study with Brazilian adults who participated in the ConVid- Behavior Survey, conducted online between April 24 and May 24, 2020(n = 45.161). This studyconsidered the following NCDs: diabetes, hypertension, respiratory disease, heart disease, and cancer, and evaluated the use of health services and the adherence to social distancing, as well as estimated the prevalences and adjusted prevalence ratio (aPR); 33,9% (95% CI: 32,5-35,3) referred to one or more NCD. Individuals with NCDsshowed a greater adherence to intense social distancing (aPR: 1,07;95% CI: 1,03-1,11), sought out health services more often (aPR:1,24; 95% CI:1,11-1,38), and found greater difficultyin scheduling doctor's appointments (aPR:1.52; 95% CI 1,35-1,71), receiving healthcare treatment (APR:1,50;95% CI:1,22-1,84) and medication (APR:2,17;95% CI:1,77-2,67), and performing examinations (APR:1,78;95% CI:1,50-2,10) and scheduled interventions (APR:1,65;95% CI:1,16-2,34). The presence of NCDs was associated with social distancing, seeking out health care, and difficulty in using health services.

Este estudo investiga a associação entre diagnóstico autorreferido de Doença Crônica Não Transmissível (DCNT) e adesão ao distanciamento social e utilização dos serviços de saúde durante a pandemia de COVID-19. Estudo transversal com adultos brasileiros que participaram da ConVid Pesquisa de Comportamentos, realizada de 24 de abril a 24 de maio de 2020, via web (n = 45.161). Considerou as DCNT: diabetes, hipertensão, doença respiratória, doença do coração e câncer. Avaliou a utilização de serviços de saúde e a adesão ao distanciamento social. Estimou as prevalências e razões de prevalências ajustadas (RPa). 33,9% (IC95%: 32,5-35,3) referiu uma ou mais DCNT. Indivíduos com DCNT tiveram maior adesão ao distanciamento social intenso (RPa:1,07; IC95%:1,03-1,11), procuraram mais o serviço de saúde (RPa:1,24; IC95%:1,11-1,38) e tiveram mais dificuldades para marcar consulta (RPa:1,52; IC95%:1,35-1,71), conseguir atendimento de saúde (RPa:1,50; IC95%:1,22-1,84) e medicamentos (RPa:2,17; IC95%:1,77-2,67), realizar exames (RPa:1,78; IC95%:1,50-2,10) e intervenções programadas (RPa:1,65; IC95%:1,16-2,34). A presença de DCNT associou-se à maior adesão ao distanciamento social, procura por atendimento de saúde e dificuldade na utilização dos serviços de saúde.

Popular health surveillance in traditional fishing communities and the ecology of knowledges in the fight against COVID-19. / Vigilância popular da saúde nas comunidades pesqueiras tradicionais e ecologia dos saberes no enfrentamento à COVID-19.

Considering the public health emergency of international importance caused by COVID-19, artisanal fishing workers, engaging in a dialogue with Brazilian leaders and scholars, created an Observatory on the impacts of this pandemic on fishing communities in March 2020. The purpose of this article is to analyze the experience of popular surveillance of fishermen and fisherwomen's health through daily reports produced at the Observatory. It is a monitoring process that allowed broadening the recognition of the diversity of vulnerable populations' ways of life that intertwine health, environment and work. The study used a qualitative, horizontal and emancipatory methodology and sought approaches to the practice of the ecology of knowledges, with the following results: shared construction of information and knowledges based on heterogeneous social experiences; practice of collective ombudsman with the appreciation of knowledges built in social struggles); joint assessment of public health inequities, territorial conflicts, and environmental, structural, and institutional racism; guidance of social leaders and fundraising through public notices. Thus, the dynamics and horizontality of learning based on solidarity and social emancipation from inter-knowledge are revealed.

Diante da emergência em saúde pública de importância internacional provocada pela COVID-19, trabalhadores da pesca artesanal, em diálogo com lideranças e acadêmicos brasileiros criaram, em março de 2020, um Observatório sobre os impactos dessa pandemia em comunidades pesqueiras. O objetivo deste artigo é analisar a experiência de vigilância popular da saúde de pescadores e pescadoras através de boletins diários produzidos no Observatório. Trata-se de um processo de monitoramento que possibilitou ampliar o reconhecimento da diversidade de modos de vida das populações vulneráveis que entrelaça saúde, ambiente e trabalho. O estudo utilizou metodologia qualitativa, horizontal e emancipatória e buscou aproximações à prática da ecologia dos saberes, tendo como resultados: construção compartilhada de informações e conhecimentos com base em experiências sociais heterogêneas; prática da ouvidoria coletiva com a valorização de saberes construídos nas lutas sociais; avaliação conjunta de iniquidades em saúde pública, conflitos territoriais e racismo ambiental, estrutural e institucional; orientação das lideranças sociais e captação de recursos através de editais públicos. Revela-se, assim, dinamicidade e horizontalidade de aprendizados com base na solidariedade e emancipação social a partir do interconhecimento.

Socioeconomic inequities in specialized health services use following COVID-19 in individuals from Southern Brazil.

BACKGROUND: Evidence on inequalities in the health services use is important for public policy formulation, even more so in a pandemic context. The aim of this study was to evaluate socioeconomic inequities in the specialized health use services according to health insurance and income, following COVID-19 in individuals residing in Southern Brazil. METHODS: This was a cross-sectional telephone survey with individuals aged 18 years or older diagnosed with symptomatic COVID-19 using the RT-PCR test between December 2020 and March 2021. Questions were asked about attendance at a health care facility following COVID-19, the facilities used, health insurance and income. Inequalities were assessed by the following measures: Slope Index of Inequality (SII) and Concentration Index (CIX). Adjusted analyses were performed using Poisson regression with robust variance adjustment using the Stata 16.1 statistical package. RESULTS: 2,919 people (76.4% of those eligible) were interviewed. Of these, 24.7% (95%CI 23.2; 36.3) used at least one specialized health service and 20.3% (95%CI 18.9; 21.8) had at least one consultation with specialist doctors after diagnosis of COVID-19. Individuals with health insurance were more likely to use specialized services. The probability of using specialized services was up to three times higher among the richest compared to the poorest. CONCLUSIONS: There are socioeconomic inequalities in the specialized services use by individuals following COVID-19 in the far south of Brazil. It is necessary to reduce the difficulty in accessing and using specialized services and to extrapolate the logic that purchasing power transposes health needs. The strengthening of the public health system is essential to guarantee the population's right to health.

The burden of disease due to COVID-19 in Florianópolis, Santa Catarina, Brazil, over a one-year period. / A carga de doença por COVID-19 em Florianópolis, Santa Catarina, Brasil, no período de um ano.

COVID-19 has had a powerful impact on society with high rates of morbidity and mortality. The use of an epidemiological indicator that estimates the burden of a disease by aggregating early mortality and non-fatal cases in a single measure has the potential to assist in the planning of more appropriate actions at different levels of health care. The scope of this article is to estimate the burden of disease due to COVID-19 in Florianópolis/SC from April 2020 through March 2021. An ecological study was carried out with data from notification and deaths by COVID-19 in the period of 12 months. The burden indicator called Disability-Adjusted Life Years (DALY) was used, obtained by adding the Years of Life Lost (YLL) to the Years of healthy life lost due to disability (YLD). A total of 78,907 confirmed COVID-19 cases were included. Of these, 763 died during the period under study. Overall, 4,496.9 DALYs were estimated, namely a rate of 883.8 DALYs per 100,000 inhabitants. In males, there were 2,693.1 DALYs, a rate of 1,098.0 DALYs per 100,000 males. In women, there were 1,803.8 DALYs, a rate of 684.4 DALYs per100,000 women. The age group most affected in both sexes was 60 to 69 years. The burden of COVID-19 was high in the city studied. The highest rates were in females and in the 60-69 age group.

A COVID-19 gerou impacto na sociedade com elevados índices de morbidade e mortalidade. A utilização de indicador epidemiológico que estime a carga de doença, agregando em uma medida a mortalidade precoce e os casos não fatais, tem potencial de auxiliar no planejamento de ações adequadas em diferentes níveis de atenção à saúde. O objetivo deste artigo é estimar a carga de doença por COVID-19 em Florianópolis/SC de abril de 2020 a março de 2021. Foi realizado um estudo ecológico com dados de notificação e óbitos por COVID-19 no período de 12 meses. Utilizou-se o indicador de carga denominado Anos de Vida Perdidos Ajustados por Incapacidade (DALY), obtido pela soma dos Anos de Vida Perdidos (YLL) com os Anos Vividos com Incapacidade (YLD). Foram incluídos 78.907 casos de COVID-19 confirmados. Desses, 763 evoluíram a óbito no período estudado. No total, foram estimados 4.496,6 DALYs, taxa de 883,8 DALYs/100.000 habitantes. No sexo masculino, foram 2.693,1 DALYs, taxa de 1.098,0 DALYs/100.000 homens. Em mulheres, foram 1.803,8 DALYs, taxa de 684,4 DALYs/100.000 mulheres. A faixa etária mais acometida em ambos os sexos foi de 60 a 69 anos. Foi alta a carga de COVID-19 na cidade estudada. As maiores taxas foram encontradas no sexo feminino e na faixa-etária de 60-69 anos.

[COVID-19 and breast cancer screening in Brazil: a comparative analysis of the pre-pandemic and pandemic periods]. / COVID-19 e rastreamento do câncer de mama no Brasil: uma análise comparativa dos períodos pré-pandêmico e pandêmico.

The scope of this study was to evaluate the impacts of COVID-19 on breast cancer screening in Brazil. Data were collected from the Ambulatory Information System relating to "bilateral screening mammography" from January/2015 to December/2021. Analyses were performed by region and for Brazil. The average of exams in each month of the year was calculated based on 2015-2019 data, which was compared, monthly, with the number of exams in 2020 and 2021, obtaining the gross and percentage difference between these values. The same analysis was performed for the total number of exams in 2020 and 2021, individually, and for the two years combined. In 2020 there were reductions in the number of exams, which ranged from 25% (North) to 48% (Northeast), resulting in 1.749 million fewer exams than expected in the country (a drop of 44%). In 2021, the Midwest region presented a number of exams 11% higher than expected, while the other regions presented drops between 17% (North) and 27% (Southeast/South), resulting in 927 thousand exams fewer than expected in Brazil (reduction of 23%). In the joint analysis (2020/2021), reductions varied by region from 11% (Midwest) to 35% (Southeast/South), culminating in 2.676 million exams fewer than expected in Brazil (reduction of 33%).

Objetivou-se avaliar os impactos da COVID-19 no rastreamento do câncer de mama no Brasil. Coletaram-se dados do Sistema de Informações Ambulatoriais referentes a "mamografia bilateral para rastreamento" de janeiro/2015 a dezembro/2021. As análises foram feitas por região e para o Brasil. Calculou-se a média de exames em cada mês do ano com base nos dados de 2015 a 2019, a qual foi comparada, mensalmente, com o quantitativo de exames em 2020 e 2021, obtendo-se a diferença bruta e percentual entre esses valores. A mesma análise foi realizada para o número total de exames em 2020 e 2021, individualmente, e para os dois anos em conjunto. Em 2020 houve quedas no número de exames que variaram de 25% (Norte) a 48% (Nordeste), culminando em 1,749 milhão de exames a menos no país (queda de 44%). Em 2021, a região Centro-Oeste apresentou quantitativo de exames 11% superior ao esperado, enquanto as demais regiões apresentaram quedas entre 17% (Norte) e 27% (Sudeste/Sul), culminando em negativo de 927 mil exames no país (redução de 23%). Na análise conjunta (2020/2021), encontraram-se reduções que variaram de 11% (Centro-Oeste) a 35% (Sudeste/Sul), culminando em negativo de 2,676 milhões de procedimentos no Brasil (queda de 33%).

Scale up of implementation of a multidimensional intervention to enhance hypertension and diabetes care at the primary care setting: A protocol for a cluster-randomized study in Brazil.

BACKGROUND: Hypertension and diabetes mellitus (DM) are highly prevalent in low and middle-income countries (LMICs), and the proportion of patients with uncontrolled diseases is higher than in high-income countries. Innovative strategies are required to surpass barriers of low sources, distance and quality of health care. Our aim is to assess the uptake and effectiveness of the implementation of an integrated multidimensional strategy in the primary care setting, for the management of people with hypertension and diabetes mellitus in Brazil. METHODS: This scale up implementation study called Control of Hypertension and diAbetes in MINas Gerais (CHArMING) Project has mixed-methods, and comprehends 4 steps: (1) needs assessment, including a standardized structured questionnaire and focus groups with health care practitioners; (2) baseline period, 3 months before the implementation of the intervention; (3) cluster randomized controlled trial (RCT) with a 12-months follow-up period; and (4) a qualitative study after the end of follow-up. The cluster RCT will randomize 35 centers to intervention (n = 18) or usual care (n = 17). Patients ≥18 years old, with diagnosis of hypertension and/or DM, of 5 Brazilian cities in a resource-constrained area will be enrolled. The intervention consists of a multifaceted strategy, with a multidisciplinary approach, including telehealth tools (decision support systems, short message service, telediagnosis), continued education with an approach to issues related to the care of people with hypertension and diabetes in primary care, including pharmacological and non-pharmacological treatment and behavioral change. The project has actions focused on professionals and patients. CONCLUSIONS: This study consists of a multidimensional strategy with multidisciplinary approach using digital health to improve the control of hypertension and/or DM in the primary health care setting. We expect to provide the basis for implementing an innovative management program for hypertension and DM in Brazil, aiming to reduce the present and future burden of these diseases in Brazil and other LMICs. CLINICAL TRIAL IDENTIFIER: This study was registered in ClinicalTrials.gov. (NCT05660928).

Ninety-day outcomes in patients diagnosed with COVID-19 in São Paulo, Brazil: a cohort study.

OBJECTIVE: COVID-19 has been associated with a significant burden to those who survive the acute phase. We aimed to describe the quality of life and symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) at 90 days after hospital discharge of COVID-19 patients. METHODS: Patients with COVID-19 admitted to a private hospital in the city of São Paulo, Brazil, between April of 2020 and April of 2021 were interviewed by telephone at 30 and 90 days after discharge to assess the quality of life and symptoms of depression, anxiety, and PTSD. RESULTS: A total of 2,138 patients were included. The mean age was 58.6 ± 15.8 years, and the median length of hospital stay was 9.0 (5.0-15.8) days. Between the two time points, depression increased from 3.1% to 7.2% (p < 0.001), anxiety increased from 3.2% to 6.2% (p < 0.001), and PTSD increased from 2.3% to 5.0% (p < 0.001). At least one physical symptom related to COVID-19 diagnosis persisted in 32% of patients at day 90. CONCLUSIONS: Persistence of physical symptoms was high even at 90 days after discharge. Although the prevalence of symptoms of anxiety, depression, and PTSD was low, these symptoms persisted for three months, with a significant increase between the time points. This finding indicates the need to identify at-risk patients so that they can be given an appropriate referral at discharge.

Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance.

BACKGROUND: This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. METHODS: This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. RESULTS: 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. CONCLUSIONS: HAI increased during COVID-19. The microorganisms' susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.

Radioiodine therapy during the COVID-19 pandemic in a public reference hospital in Brazil: an experience report.

COVID-2019 has resulted in an emerging respiratory infection that has spread as a pandemic since January 2020. Nuclear Medicine Services and its workers experienced a dramatic change in their clinical routine. They were required to adjust protocols for this new health condition. Regarding radioiodine therapy (RIT), initial orientations were to postpone treatments. In Brazil, National Nuclear Energy Commission prepared guidelines. It authorized RIT to employ activities over 1850 MBq in an outpatient setting on an exceptional basis. This study reports the RIT experience of a Brazilian hospital during the COVID-19 pandemic, intending to evaluate the applicability of outpatient treatment employing over 1850 MBq of I-131 on a large scale. During referred period, 106 patients at our service had an indication for RIT, of which 58 agreed to participate in the research and provided informed consent. Majority of patients did not meet the minimum requirements for outpatient treatment using doses > 1850 MBq.

Seroprevalence of SARS-CoV-2 in Brazil: A systematic review and meta-analysis.

OBJECTIVES: To summarize the data on SARS-CoV-2 seroprevalence surveys conducted in Brazil before the introduction of vaccines METHODS: The authors conducted a systematic review and meta-analysis on the seroprevalence of SARS-CoV-2 infection in Brazil. The present review followed the PRISMA guidelines. The authors searched Medline, Embase, and LILACS databases for serologic surveys conducted in the Brazilian population, in the period from 01/10/2019 to 07/11/2021, without language restrictions. The authors included studies that presented data concerning SARS-CoV-2 antibodies seroprevalence in Brazil and had a sample size ≥50 individuals. Considering the expected heterogeneity between studies, all analyses were performed using the random effects model, and heterogeneity was assessed using the I2 statistic RESULTS: Of 586 publications identified in the initial searches, 54 were included in the review and meta-analysis, which contained the results of 135 surveys, with 336,620 participants. The estimated seroprevalence was 11.0%, ranging from 1.0% to 83.0%, with a substantial heterogeneity (I2 = 99.55%). In subgroup analyses, the authors observed that the prevalence of SARS-CoV-2 antibodies was 13.0% in blood donors, 9.0% in the population-based surveys, 13% in schoolchildren, and 11.0% in healthcare workers. CONCLUSIONS: Seroprevalence increases over time. Large differences were observed among the regions of the country. It was higher in the Northern region, decreasing towards the South. The present results may contribute to the analysis of the spread of SARS-CoV-2 infection in the Brazilian population before vaccination, one of the factors that may be influencing the clinical presentation of COVID-19 cases related to the new variants, as well as the effectiveness of the vaccination program.

"Early Treatment", Anti-Vaccination, and Denialism: who are the Doctors for Life in the COVID-19 pandemic context in Brazil? / "Tratamento precoce", antivacinação e negacionismo: quem são os Médicos pela Vida no contexto da pandemia de COVID-19 no Brasil?

The article aims to identify who the "Doctors for Life" are, their academic and professional information, which assumptions have been mobilized for the defense of "early treatment" and the denial of vaccines for COVID-19, and the representativeness of their discourses in the medical practice context in Brazil. The analysis is based on a list of 276 doctors' names, cataloged from their website, and on academic and professional information obtained through research on the Federal Medical Conseil website and the Scientific and Technological Development Nacional Council platform. The content analysis points to the centrality of the medical specialties of homeopathy and acupuncture in the population of Doctors for Life when compared to the set of specialist doctors in Brazil. The significant accession of homeopaths and acupuncturists to the Doctors for Life movement can clarify the understanding of specific medical rationalities, allowing us to distinguish which categories and ideas about the health-disease process are in dispute. It is concluded that, more than describing the problem, it is needed to establish its correlations with a group of events, practices, political decisions, economic linkages, shared beliefs, and a chain of processes that configure its undeniably social characteristics.

O artigo pretende identificar quem são os "Médicos pela Vida" (MPV), suas informações acadêmicas e profissionais, quais as premissas utilizadas para a defesa do "tratamento precoce" e da negação das vacinas contra COVID-19 e qual a representatividade de seus discursos no contexto da prática médica no Brasil. A análise baseia-se na lista de 276 profissionais médicos catalogados no site dos MPV e em informações acadêmicas e profissionais coletadas nos sites do Conselho Federal de Medicina e da Plataforma Lattes, do Conselho Nacional de Desenvolvimento Científico e Tecnológico. A análise do conteúdo aponta para a centralidade das especialidades da Homeopatia e Acupuntura na população de MPV quando comparada ao conjunto dos especialistas do Brasil. A adesão significativa de homeopatas e acupunturistas ao movimento dos MPV pode iluminar a compreensão sobre racionalidades médicas específicas, permitindo distinguir quais categorias e ideias acerca dos processos de saúde e doença estão em disputa. Conclui-se que, para além de descrever a problemática, é preciso estabelecer suas correlações com um conjunto de acontecimentos, práticas, decisões políticas, encadeamentos econômicos, compartilhamento de crenças e uma corrente de processos que configuram seu caráter inegavelmente social.

People with Disabilities and COVID-19 in the state of Espírito Santo, Brazil: between invisibility and lack of Public Policies. / Pessoas com Deficiência e COVID-19 no estado do Espírito Santo, Brasil: entre a invisibilidade e a falta de Políticas Públicas.

This article aims to analyze the profile of people with disabilities among the cases notified by the COVID-19 panel of Espírito Santo and the possible associations with the positive result of the COVID-19 test. Descriptive cross-sectional study among people with disabilities with positive and negative tests for the diagnosis of COVID-19. Associations of epidemiological and clinical variables were performed using the chi-square test and logistic regression models to estimate the odds ratio. Lethality rate of COVID-19 was 4.9% (175 cases) in the group of people with disabilities, and 3% (3,016) in the group without disabilities. People with disabilities, male (OR=1.34; 95%CI 1.22-1.47), race/black color (OR=1.55; 95%CI 1.09-2.20), and those who were hospitalized (OR=2.27; 95%CI 1.71-3.02) were associated with positive tests for COVID-19. The pandemic emphasizes the need to create specific legal care mechanisms and targeted public policies for this population.

O objetivo deste artigo é analisar o perfil das pessoas com deficiência dentre os casos notificados pelo painel COVID-19 do Espírito Santo e possíveis associações com o resultado positivo do teste COVID-19. Estudo Transversal descritivo entre as pessoas com deficiência com testes positivos e negativos para o diagnóstico de COVID-19. Foram realizadas associações das variáveis epidemiológicas e clínicas, utilizando o teste qui-quadrado e modelos de regressão logística para se estimar o odds ratio. A letalidade por COVID-19 foi de 4,9% (175 casos) no grupo das pessoas com deficiência, e 3% (3.016) no grupo sem deficiência. Pessoas com deficiência do sexo masculino (OR=1,34; IC95% 1,22-1,47), raça/cor preta (OR=1,55; IC95% 1,09-2,20), e as que ficaram internadas (OR=2,27; IC95% 1,71-3,02) apresentaram associação com testes positivos para COVID-19. A pandemia enfatiza a necessidade de criar mecanismos legais de cuidados específicos e políticas públicas focalizadas para essa população.

COVID-19 in prisons: what telejournalism (not) showed - a study on the criteria for newsworthiness during the pandemic. / COVID-19 nas prisões: o que o telejornalismo (não) mostrou - um estudo sobre os critérios de noticiabilidade na pandemia.

To analyze the news coverage of the COVID-19 pandemic in Brazilian prisons and its visibility, 213 articles broadcast between March and December 2020 were examined, found in the search service of the digital streaming video platform Globoplay. Most aired in March, April and July, with the theme almost disappearing in subsequent months. The reports, on numbers of deaths or infections, prevention measures and house arrest or freedom for groups at risk of COVID-19 were mainly published in local telejournals. Health agencies were barely heard. Of the 19 news items presented nationally, 12 address "famous prisoners" and the legibility of house arrest or freedom for groups at risk of COVID-19 unfavorable outcome. The health guidelines and the guarantee of the right to health of persons deprived of liberty were limited to the difficulties in implementing protection measures in prisons and to sustaining the need for restrictive measures to move inside prisons and in exchanges with the outside, to limit the circulation of the virus. In general, the form and visibility given to the topic do not contribute to broadening the viewers' perception of the sanitary conditions in prisons and the fact that health is a right for all, without any distinction.

Para analisar a cobertura telejornalística da pandemia de COVID-19 nas prisões brasileiras e sua visibilidade, foram examinadas 213 matérias veiculadas entre março e dezembro de 2020, encontradas no serviço de buscas da plataforma digital de vídeos por streaming Globoplay. A maior parte foi ao ar em março, abril e julho, com importante redução nos meses subsequentes. As reportagens, sobre números de mortes ou infectados, medidas de prevenção e prisão domiciliar ou liberdade para grupos de risco da COVID-19, foram divulgadas principalmente nos jornais locais. Os órgãos de saúde quase não foram ouvidos. Das 19 notícias apresentadas nacionalmente, 12 abordam os "presos famosos" e a legitimidade da prisão domiciliar ou a liberdade para grupos de risco da COVID-19. As pautas sanitárias e de garantia do direito à saúde das pessoas privadas de liberdade ficaram limitadas às dificuldades para a efetivação nos presídios das medidas de proteção e a sustentar a necessidade de medidas restritivas à movimentação no interior das prisões e nos intercâmbios com o exterior para limitar a circulação do vírus. Em geral, a forma e a visibilidade dadas ao tema não contribuem para ampliar a percepção dos telespectadores sobre as condições sanitárias das prisões e o fato de que a saúde é um direito de todos, sem qualquer distinção.

Telemedicine of patients with cystic fibrosis during the COVID-19 pandemic.

OBJECTIVE: To describe then experience of implementing routine teleconsultations in respiratory physiotherapy at a reference center for Cystic Fibrosis (CF) in Rio de Janeiro / Brazil, during the COVID-19 pandemic. METHODS: Cross-sectional, descriptive, study with children and adolescents with CF. The sample was divided between participants and those who did not participate in the teleconsultations. The teleconsultations were multidisciplinary and carried out by videoconference or telephone, depending on the patient's availability. The sequence of care provided by the team was organized together with the professionals, so that everyone could carry out individual and sequential teleconsultations. Physiotherapy appointments were divided into two segments: teleconsultation and telemonitoring. Demographic and clinical data were collected. RESULTS: Among the 184 patients assisted in the center, 153 (83.2%) participated in the teleservices and, of these, 33 (21.6%) required telemonitoring; 31 (16.8%) patients did not participate in the teleconsultations for not answering the calls. There was no statistical difference between the group that participated or not in teleservices, nor among those who participated in teleconsultations and telemonitoring. The mean age of the studied population was 7.0±0.4 years. Regarding the CFTR gene mutation, 64.7% had at least one F508del allele and 30.9% of the sample had no pathogens in the sputum test. CONCLUSIONS: Most participants with CF participated in teleconsultations, highlighting the importance of remote assistance activities during the COVID-19 pandemic period. This strategy was considered as positive, and it may become permanent in the care of patients with CF.

Fake News and vaccine hesitancy in the COVID-19 pandemic in Brazil. / Fake news e hesitação vacinal no contexto da pandemia da COVID-19 no Brasil.

This paper presents the evolution of fake news disseminated about vaccines and the SARS-CoV-2 virus and its adverse impacts on the current Brazilian health crisis. This quantitative, empirical study is based on the notifications received by the Eu Fiscalizo app, through which the Instagram, Facebook, Twitter, and WhatsApp platforms were identified as the principal means for disseminating and sharing rumors and misinformation about COVID-19. We observed large-scale circulation of fake news about vaccines directly related to the Brazilian political polarization, which became prevalent four months after the first COVID-19 case was recorded in the country. We can conclude that this phenomenon was crucial in discouraging the adherence of segments of the Brazilian population to social distancing and vaccination campaigns.

Este artigo apresenta a evolução das notícias falsas disseminadas a respeito das vacinas e do vírus Sars-CoV-2 e os impactos negativos desse fenômeno sobre a crise sanitária que o Brasil atravessa. Trata-se de um estudo empírico quantitativo, realizado a partir das notificações recebidas pelo aplicativo Eu Fiscalizo, por meio do qual foi identificado o predomínio das plataformas Instagram, Facebook, Twitter e WhatsApp como os principais meios de difusão e compartilhamento de boatos e desinformações acerca da COVID-19. Foi observada a circulação em escala de fake news sobre vacinas, diretamente relacionadas à polarização política brasileira, tornando-se prevalente quatro meses depois de ser registrado o primeiro caso de COVID-19 no Brasil. Conclui-se que o fenômeno colaborou para desestimular a adesão de parcelas da população brasileira às campanhas de isolamento social e de vacinação.

Organization and offer of physical therapy care in response to the COVID-19 pandemic in Brazil. / Organização e oferta da assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil.

The recovery of people affected by COVID-19 is a process that continues beyond the acute condition of infection by Sars-CoV-2. The impairment of several body systems can cause functional impacts and demand continuous physical therapy assistance both in outpatient care and in Primary Health Care (PHC). In this essay, we seek to discuss the challenges of organizing and offering Physical Therapy assistance in response to the COVID-19 pandemic in Brazil. The analysis was summarized in three dimensions: offering physical therapy assistance in PHC, outpatient care, via telehealth. It is concluded that functional rehabilitation depends on the PHC's response capacity; there is a shortage of rehabilitation services that precedes the pandemic, and may not respond satisfactorily to the demands of the current epidemiological context; it is necessary to articulate the outpatient physiotherapy and PHC teams; although telehealth is a resource and an opportunity to increase the population's access to functional rehabilitation, its use requires caution; the physiotherapist plays a crucial role in the entire COVID-19 care continuum.

A recuperação das pessoas acometidas pela COVID-19 é um processo que continua para além do quadro agudo da infecção pelo Sars-CoV-2. O comprometimento de diversos sistemas corporais pode acarretar impactos funcionais e demandar assistência fisioterapêutica contínua tanto na atenção ambulatorial quanto na atenção primária à saúde (APS). Neste ensaio, busca-se discutir os desafios da organização e da oferta de assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil. A análise foi sumarizada em três dimensões: oferta da assistência fisioterapêutica na APS e na atenção ambulatorial, e oferta de atenção fisioterapêutica por telessaúde. Conclui-se que: a reabilitação funcional depende da capacidade de resposta da APS; existe um déficit de serviços de reabilitação que antecede a pandemia, e pode comprometer respostas satisfatórias às demandas do atual contexto epidemiológico; faz-se necessária a articulação entre as equipes de fisioterapia ambulatorial e da APS; embora a telessaúde seja um recurso e uma oportunidade para ampliar o acesso da população à reabilitação funcional, sua utilização exige cautela; o fisioterapeuta possui papel crucial em todo o continuum de cuidados da COVID-19.

Gender and Food insecurity in the COVID-19 pandemic in Brazil: hunger through women's voices. / Gênero e Insegurança alimentar na pandemia de COVID-19 no Brasil: a fome na voz das mulheres.

This paper presents the results of the research nested in the international project "Gender and COVID-19", which includes several topics related to the impact of the pandemic on the lives of women and their families, including food insecurity and hunger. Semi-structured interviews were conducted from December 2020 to November 2021 with 49 women living in two urban conglomerates, Cabana do Pai Tomás (Belo Horizonte, MG) and Sapopemba (São Paulo, SP), and two rural quilombola communities, Córrego do Rocha (Chapada do Norte, MG) and Córrego do Narciso (Araçuaí, MG). The analyses were based on the following categories: hunger-related feelings and terms; reduced food amount and quality; lack of food and nutrients; difficulties producing food, receiving emergency aid or food donations; governments evaluation and support networks. The respondents' reports show the challenges they experienced, their coping methods, and criticism of the government's lack of responses. Besides presenting a gender perspective, women, especially the leaders who worked in the construction of solidarity networks, are fundamental voices in planning actions to prevent and mitigate the impacts of emergencies in their communities.

Neste artigo apresentamos resultados de uma pesquisa que integra o projeto internacional "Gender and COVID-19", que contempla diversos temas relacionados aos impactos da pandemia na vida de mulheres e suas famílias, entre eles a insegurança alimentar e a fome. Foram feitas entrevistas semiestruturadas entre dezembro de 2020 e novembro de 2021 com 49 mulheres, moradoras de dois aglomerados urbanos, Cabana do Pai Tomás (Belo Horizonte, MG) e Sapopemba (São Paulo, SP), e de duas comunidades rurais quilombolas, Córrego do Rocha (Chapada do Norte, MG) e Córrego do Narciso (Araçuaí, MG). As análises foram baseadas nas seguintes categorias: sentimentos e termos relacionados à fome; redução na quantidade e qualidade de alimentos; ausência de alimento e nutrientes; dificuldades para produzir alimento, receber auxílio emergencial e/ou doação de alimentos; avaliação dos governos e redes de apoio. Os relatos das entrevistadas evidenciam os desafios vivenciados, suas formas de enfrentamento e críticas à falta de respostas dos governos. Além de apresentarem uma perspectiva de gênero, as mulheres, em especial as lideranças que atuaram na construção de redes de solidariedade, são vozes fundamentais no planejamento de ações de prevenção e mitigação dos impactos de situações emergenciais em suas comunidades.