Impact of early postnatal overnutrition on cardiac mitochondrial dysfunction in adult mice with ischemia/reperfusion.

BACKGROUND AND AIMS: Nutritional imbalance at the beginning of life, a critical window period, leads to the development of obesity, overweight, dyslipidemia, diabetes, and cardiovascular disease in adulthood. In this study, the effects and associations of overnutrition during lactation on energy metabolism and oxidative stress in cardiomyocytes of adult male Swiss mice were examined. METHODS AND RESULTS: Animals were divided into two groups (control and overfed) subjected to baseline and ischemia/reperfusion conditions, forming four groups: control baseline (CBL), control ischemia/reperfusion (CIR), overfed baseline (OBL), and overfed ischemia/reperfusion (OIR). The hearts were analyzed for hemodynamics using the Langendorff technique, mitochondrial energy metabolism using the Oroboros apparatus, ATP production, oxidative stress, and SIRT1, pSTAT3 and STAT3 protein content by Western blotting. Hemodynamic abnormalities in the cardiovascular system were associated with mitochondrial dysfunction, as demonstrated by impaired carbohydrate and fatty acid oxidation capacity, decreased mitochondrial coupling in the OG, and reduced ATP production in the OIR group. Alteration in pSTAT3 and SIRT1 proteins expression in overfed mice reinforce energy metabolism impairment. Lipid and/or protein degradation is altered in the heart of OG, suggesting increased oxidative stress. CONCLUSION: Overnutrition during lactation associated with heart ischemia leads to molecular cardiac alterations in STAT3 and SIRT1 proteins, compromising energy metabolism via reduced mitochondrial oxidation capacity, ATP production and increased lipid peroxidation.

Toscana Virus in Wild-Caught Sand Flies in Portugal, Findings from the National Vector Surveillance Network, 2023.

Phlebotomine sand flies play a crucial role in both human and veterinary medicine, acting as vectors for Leishmania parasites and most known phleboviruses. In Portugal, the REVIVE program, a comprehensive national surveillance network under the Ministry of Health, has included sand fly surveys since 2016. REVIVE aims to identify existing sand fly species in the country, determine which pathogens are circulating among them, and provide actionable insights for prevention and control measures when necessary. In this way, annually, from May to October, health technicians collect sand flies across mainland Portugal with CDC light traps. The collected sand flies are sent to the Centre for Vectors and Infectious Diseases Research for species identification and molecular screening of pathogens. On 21 September 2023, Toscana virus (TOSV), a well-known phlebovirus in the Mediterranean region due to its capacity to cause neurological disease, was detected in a pool of 30 sand flies collected in Algarve, the southernmost region of Portugal. A 668 bp partial sequence of the nucleoprotein gene shows similarity with TOSV strains from Spain. To our knowledge, this is the first detection of TOSV in its vector in this country, having previously only been reported in vertebrate hosts. These findings highlight the important role of ongoing surveillance efforts in monitoring and understanding the dynamics of sand fly-borne diseases in Portugal.

The spread of the invasive mosquito Aedes albopictus (Diptera: Culicidae) in Portugal: a first genetic analysis.

BACKGROUND: Aedes albopictus, commonly known as the Asian tiger mosquito, has become one of the most invasive mosquito species. Over the last 5 decades, it has been introduced and established in various tropical and temperate regions worldwide. First reported in Europe in 1979 in Albania and later in Italy in 1990, the species is now established in 13 European Union (EU)/European Economic Area (EEA) countries and 337 regions (2023). In Portugal, Ae. albopictus was first detected in the Algarve and Penafiel regions in 2017, followed by Alentejo in 2022 and Lisbon in 2023. This mosquito species poses a significant public health risk as a vector for numerous pathogenic viruses, including dengue, Zika, and chikungunya. METHODS: Aedes albopictus collected in Lisbon in 2023 were analyzed using cytochrome c oxidase I (COX) gene sequencing to understand their genetic relationships. RESULTS: Our data indicate that the Ae. albopictus mosquito populations detected in three locations in Lisbon in 2023 correspond to recent but distinct introduction events. CONCLUSIONS: Although there has been no local transmission of Aedes-transmitted viruses in mainland Portugal to date, the spread of the mosquito and increased international travel increase the risk of Aedes-borne disease outbreaks. The ongoing spread of Ae. albopictus in the country and the confirmed multiple introductions in new locations raise awareness of the need to monitor mosquito vectors to control and prevent autochthonous Aedes-borne disease outbreaks.

Long COVID is not the same for everyone: a hierarchical cluster analysis of Long COVID symptoms 9 and 12 months after SARS-CoV-2 test.

BACKGROUND: Identifying symptom clusters in Long COVID is necessary for developing effective therapies for this diverse condition and improving the quality of life of those affected by this heterogeneous condition. In this study, we aimed to identify and compare symptom clusters at 9 and 12 months after a SARS-CoV-2 positive test and describe each cluster regarding factors at infection. METHODS: This is a cross-sectional study with individuals randomly selected from the Portuguese National System of Epidemiological Surveillance (SINAVE) database. Individuals who had a positive RT-PCR SARS-CoV-2 test in August 2022 were contacted to participate in a telephonic interview approximately 9 and 12 months after the test. A hierarchical clustering analysis was performed, using Euclidean distance and Ward's linkage. Clustering was performed in the 35 symptoms reported 9 and 12 months after the SARS-CoV-2 positive test and characterised considering age, sex, pre-existing health conditions and symptoms at time of SARS-CoV-2 infection. RESULTS: 552 individuals were included at 9 months and 458 at 12 months. The median age was 52 years (IQR: 40-64 years) and 59% were female. Hypertension and high cholesterol were the most frequently reported pre-existing health conditions. Memory loss, fatigue or weakness and joint pain were the most frequent symptoms reported 9 and 12 months after the positive test. Four clusters were identified at both times: no or minor symptoms; multi-symptoms; joint pain; and neurocognitive-related symptoms. Clusters remained similar in both times, but, within the neurocognitive cluster, memory loss and concentration issues increased in frequency at 12 months. Multi-symptoms cluster had older people, more females and more pre-existing health conditions at 9 months. However, at 12 months, older people and those with more pre-existing health conditions were in joint pain cluster. CONCLUSIONS: Our results suggest that Long COVID is not the same for everyone. In our study, clusters remained similar at 9 and 12 months, except for a slight variation in the frequency of symptoms that composed each cluster. Understanding Long COVID clusters might help identify treatments for this condition. However, further validation of the observed clusters and analysis of its risk factors is needed.

Mark-Release-Recapture Trial with Aedes albopictus (Diptera, Culicidae) Irradiated Males: Population Parameters and Climatic Factors.

Aedes albopictus is considered one of the major invasive species in the world and can transmit viruses such as dengue, Zika, or chikungunya. The Sterile Insect Technique (SIT) can be used to suppress the native populations of Ae. albopictus. Mark-release-recapture (MRR) studies are crucial to support the development of the release strategy during the SIT application. Meanwhile, weather conditions can affect the MRR trial's results and it is critical to understand the influence of climatic factors on the results. In October 2022, 84,000 irradiated sterile males were released for three consecutive weeks in Faro, Southern Portugal. Mosquitoes were recaptured by human landing collection (HLC) one, two, four, and six days after release. Generalized linear models with a negative binomial family and log function were used to estimate the factors associated with the number of recaptured mosquitoes, prevalence ratios, and the 95% confidence intervals (CIs). A total of 84,000 sterile male mosquitoes were released, with 528 recaptured (0.8%) by HLC. The prevalence of recaptured mosquitoes was 23% lower when the wind intensity was moderate. Marked sterile males had an average median distance travelled of 88.7 m. The median probability of daily survival and the average life expectancy were 61.6% and 2.1 days, respectively. The wild male population estimate was 443.33 males/ha. Despite no statistically significant association being found with humidity, temperature, and precipitation, it is important to consider weather conditions during MRR trial analyses to obtain the best determinant estimation and a more efficient application of the SIT in an integrated vector management program.

Individual risk factors associated with SARS-CoV-2 infection during Alpha variant in high-income countries: a systematic review and meta-analysis.

Objectives: This study aimed to systematically appraise risk factors associated with SARS-CoV-2 infection in high-income countries during the period of predominance of the Alpha variant (January 2020 to April 2021). Methods: Four electronic databases were used to search observational studies. Literature search, study screening, data extraction and quality assessment were conducted by two authors independently. Meta-analyses were conducted for each risk factor, when appropriate. Results: From 12,094 studies, 27 were included. The larger sample size was 17,288,532 participants, more women were included, and the age range was 18-117 years old. Meta-analyses identified men [Odds Ratio (OR): 1.23, 95% Confidence Interval (CI): 1.97-1.42], non-white ethnicity (OR: 1.63, 95% CI: 1.39-1.91), household number (OR: 1.08, 95% CI: 1.06-1.10), diabetes (OR: 1.22, 95% CI: 1.08-1.37), cancer (OR: 0.82, 95% CI: 0.68-0.98), cardiovascular diseases (OR: 0.92, 95% CI: 0.84-1.00), asthma (OR: 0.83, 95% CI: 0.75-0.92) and ischemic heart disease (OR: 0.82, 95% CI: 0.74-0.91) as associated with SARS-CoV-2 infection. Conclusion: This study indicated several risk factors for SARS-CoV-2 infection. Due to the heterogeneity of the studies included, more studies are needed to understand the factors that increase the risk for SARS-CoV-2 infection. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244148, PROSPERO registration number, CRD42021244148.

Effectiveness of XBB.1.5 Monovalent COVID-19 Vaccines During a Period of XBB.1.5 Dominance in EU/EEA Countries, October to November 2023: A VEBIS-EHR Network Study.

Using a common protocol across seven countries in the European Union/European Economic Area, we estimated XBB.1.5 monovalent vaccine effectiveness (VE) against COVID-19 hospitalisation and death in booster-eligible ≥ 65-year-olds, during October-November 2023. We linked electronic records to construct retrospective cohorts and used Cox models to estimate adjusted hazard ratios and derive VE. VE for COVID-19 hospitalisation and death was, respectively, 67% (95%CI: 58-74) and 67% (95%CI: 42-81) in 65- to 79-year-olds and 66% (95%CI: 57-73) and 72% (95%CI: 51-85) in ≥ 80-year-olds. Results indicate that periodic vaccination of individuals ≥ 65 years has an ongoing benefit and support current vaccination strategies in the EU/EEA.

Is a tiered restrictions system an effective intervention for COVID-19 control? Results from Portugal, November-December 2020.

BACKGROUND: In November 2020, similar to other European countries, Portugal implemented a tiered restrictions system to control the COVID-19 pandemic. We aimed to compare the COVID-19 growth rate across tiers to assess the effect of a tiered restrictions system in Portugal, using models with different times between tiers assessment. Our hypothesis was that being in a higher tier brings a faster deceleration in the growth rate than being in a lower tier. METHODS: The national database of notified COVID-19 cases and publicly available data were used to analyse the effect of the tiered restrictions system on the COVID-19 incidence growth rate. The tiers were based on the European Centre for Disease Control risk classification: moderate, high, very and extremely high. We used a generalised mixed-effects regression model to estimate the growth rate ratio (GRR) for each tier, comparing the growth rates of higher tiers using moderate tier as reference. Three models were fitted using different times between tiers assessment, separated by 14 days. RESULTS: We included 156 034 cases. Very high tier was the most frequent combination in all the three moments assessed (21.2%), and almost 50% of the municipalities never changed tier during the study period. Immediately after the tiers implementation, a reduction was identified in the municipalities in high tier (GRR high tier: 0.90 [95%CI: 0.79; 1.02]) and very high tier (GRR very high tier: 0.68 [95%CI: 0.61; 0.77]), however with some imprecision in the 95% confidence interval for the high tier. A reduction in very high tier growth rate was identified two weeks (GRR: 0.79 [95%CI: 0.71; 0.88]) and four weeks (GRR: 0.77 [95%CI: 0.74; 0.82]) after the implementation, compared to moderate tier. In high tier, a reduction was also identified in both times, although smaller. CONCLUSIONS: We observed a reduction in the growth rate in very high tier after the tiered restriction system was implemented, but we also observed a lag between tiered restriction system implementation and the onset of consequent effects. This could suggest the importance of early implementation of stricter measures for pandemic control. Thus, studies analysing a broader period of time are needed.

Thio-Induced Organophosphate Breakdown Promoted by Methimazole: an Experimental and Theoretical Study.

Investigating the reactivity of small nucleophilic scaffolds is a strategic approach for the design of new catalysts aiming at effective detoxification processes of organophosphorus compounds. The drug methimazole (MMZ) is an interesting candidate featuring two non-equivalent nucleophilic centers. Herein, phosphoryl transfer reactions mediated by MMZ were assessed by means of spectrophotometric kinetic studies, mass spectrometry (MS) analyses, and density functional theory (DFT) calculations using the multi-electrophilic compound O,O-diethyl 2,4-dinitrophenyl phosphate (DEDNPP). MMZ anion acts primarily as an S-nucleophile, exhibiting a nucleophilic activity comparable to that of certain oximes featuring alpha-effect. Selective nucleophilic aromatic substitution was observed, consistent with the DFT prediction of a low energy barrier. Overall, the results bring important advances regarding the mechanistic understanding of nucleophilic dephosphorylation reactions, which comprises a strategic tool for neutralizing toxic organophosphates, hence promoting chemical security.

Interprofessional education in undergraduate courses in health in Brazil: integrative review.

This integrative review aimed to synthesize the evidence regarding interprofessional education (IPE) in undergraduate health courses in Brazil. This article included original articles published between 2005 and 2020 addressing IPE in undergraduate health courses in Brazilian higher education institutions. Our search captured 333 articles in Medline, PubMed, Cochrane Library, Embase (Elsevier), Web Of Science (Main Collection), Scopus (Elsevier), Science Direct (Elsevier), ERIC, and LILACS via BVS. After applying the exclusion and inclusion criteria, the study corpus covered 34 original manuscripts. It was identified that a network is developed at the national level, and with international support, supports discussions and research on IPE. However, there is a concentration of partnerships between researchers from the Northeast, Southeast and South regions, with the need to expand studies on the country's experiences in the North and Midwest regions. There is also consistent publication of experiences concerning the implementation of IPE in undergraduate healthcare courses in Brazil. However, the uniprofessional characteristics and the lack of uniformity in the curricula are still significant, which represent essential obstacles to further IPE strengthening in Brazil. In the Brazilian literature, there is a dearth of longitudinal studies and mixed methods that assess changes in organizational practices. There remains a need for IPE studies with more rigorous designs to generate more impactful evidence.

Investigating the role of symptom valorisation in tuberculosis patient delay in urban areas in Portugal.

BACKGROUND: Diagnosis delay contributes to increased tuberculosis (TB) transmission and morbimortality. TB incidence has been decreasing in Portugal, but median patient delay (PD) has risen. Symptom valorisation may determine PD by influencing help-seeking behaviour. We aimed to analyse the association between symptom valorisation and PD, while characterising individuals who disregarded their symptoms. METHODS: A cross-sectional study was conducted among TB patients in Lisbon and Oporto in 2019 - 2021. Subjects who delayed seeking care because they did not value their symptoms or thought these would go away on their own were considered to have disregarded their symptoms. PD was categorised using a 21-day cut-off, and a 30-day cut-off for sensitivity analysis. We estimated the effect of symptom valorisation on PD through a directed acyclic graph. Then, a multivariable regression analysis characterised patients that disregarded their symptoms, adjusting for relevant variables. We fitted Poisson regression models to estimate crude and adjusted prevalence ratios (PR). RESULTS: The study included 75 patients. Median PD was 25 days (IQR 11.5-63.5), and 56.0% of participants had PD exceeding 21 days. Symptom disregard was reported by 38.7% of patients. Patients who did not value their symptoms had higher prevalence of PD exceeding 21 days compared to those who valued their symptoms [PR 1.59 (95% CI 1.05-2.42)]. The sensitivity analysis showed consistent point estimates but wider confidence intervals [PR 1.39 (95% CI 0.77-2.55)]. Being a smoker was a risk factor for symptom disregard [PR 2.35 (95% CI 1.14-4.82)], while living in Oporto [PR 0.35 (95% CI 0.16-0.75)] and having higher household incomes [PR 0.39 (95% CI 0.17-0.94)] were protective factors. CONCLUSIONS: These findings emphasise the importance of symptom valorisation in timely TB diagnosis. Patients who did not value their symptoms had longer PD, indicating a need for interventions to improve symptom recognition. Our findings also corroborate the importance of the socioeconomic determinants of health, highlighting tobacco as a risk factor both for TB and for PD.

Percepção de familiares e autopercepção de idosos usuários de dispositivos de amplificação quanto à restrição de participação causada pela deficiência auditiva / Perception of family members and self -perception of the elderly users of amplification devices regarding the restriction of participation caused by hearing impairment / Percepción de los miembros de la familia y la autopercepción de los ancianos usuarios de dispositivos de amplificación sobre la restricción de la participación causada por la discapacidad auditiva

Introdução: A deficiência auditiva tem um efeito profundo na vida dos idosos. O apoio dos familiares no processo de reabilitação cria meios para facilitar a aceitação da deficiência e o uso dos dispositivos auditivos. Objetivo: Analisar a percepção dos familiares quanto à restrição da participação causada pela deficiência auditiva em indivíduos idosos usuários de aparelho de amplificação sonora individual (AASI) e compará-la com a autopercepção do próprio idoso quando a este aspecto. Métodos: A amostra foi composta por 48 indivíduos, que foram divididos em dois grupos, sendo GI o grupo de idosos, composto por 24 idosos com perda auditiva sensorioneural bilateral usuários de AASI; e GF o grupo de familiares, composto por 24 familiares, que acompanhavam esses idosos. Os participantes do GI responderam ao questionário de autoavaliação Hearing Handicap Inventory for the Elderly (HHIE) e os participantes do GF responderam ao questionário Hearing Handicap Inventory for the Elderly for Spouses (HHIE-SP). Resultados: Não houve correlação entre o tempo de uso do AASI e o escore obtido no questionário. Observou-se que, quanto maior a idade do idoso, piores foram os resultados encontrados no domínio "emocional" do HHIE para o grupo GI e para os domínios "social" e "emocional" para o grupo GF. Além disso, houve correlação entre os dois grupos, indicando que, quanto piores os resultados no HHIE para o GI, também foram piores os resultados no HHIE-SP respondido pelo GF. Conclusão: Arestrição de participação social e os aspectos emocionais influenciados pela perda auditiva em indivíduos idosos usuários de AASI são fatores percebidos pelos familiares que os acompanham nas consultas fonoaudiológicas. (AU)

Introduction: Hearing loss has a profound effect on the lives of the elderly. The support of family members in the rehabilitation process creates ways to facilitate the acceptance of the disability and the use of hearing devices. Objective: To analyze the perception of family members regarding the restriction of participation caused by hearing impairment in elderly individuals users of hearing aids and compare it with the self-perception of the elderly in this regard. Methods: The sample consisted of 48 individuals, who were divided into two groups, EG being the elderly group, composed of 24 elderly people with bilateral sensorineural hearing loss, who use HA; and FG the group of family members, composed of 24 family members, who accompanied these elderly people. EG participants answered the Hearing Handicap Inventory for the Elderly (HHIE) self-assessment questionnaire and FG participants answered the Hearing Handicap Inventory for the Elderly for Spouses (HHIE-SP). Results: There was no correlation between the time of HA use and the score obtained in the questionnaire. It was observed that the older the person, the worse the results found in the "emotional" domain of the HHIE for the EG group, and the "social" and "emotional" domains for the FG group. In addition, there was a correlation between the two groups, indicating that the worse the results in the HHIE for the EG, the worse the results in the HHIE-SP answered by the GF. Conclusion: The restriction of social participation and the emotional aspects influenced by hearing loss in the elderly who use HA are factors perceived by family members who accompany them in audiology appointments. (AU)

Introducción: La discapacidad auditiva tiene un profundo efecto en la vida de los adultos mayores. El apoyo de los familiares en el proceso de rehabilitación crea vías para facilitar la aceptación de la discapacidad y el uso de audífonos. Objetivo: Analizar la percepción de los familiares sobre la restricción de la participación causada por la deficiencia auditiva en ancianos usuarios de audífonos y compararla con la autopercepción de los ancianos al respecto. Métodos: La muestra estuvo conformada por 48 individuos, quienes fueron divididos en dos grupos, siendo GI el grupo de adultos mayores, compuesto por 24 adultos mayores con hipoacusia neurosensorial bilateral, que utilizan audífonos; y GF el grupo de familiares, compuesto por 24 familiares, que acompañaban a estos individuos. Los participantes del GI respondieron el cuestionario Hearing Handicap Inventory for the Elderly (HHIE) y los participantes del GF respondieron el cuestionario Hearing Handicap Inventory for the Elderly for Spouses (HHIE-SP). Resultados: No hubo correlación entre el tiempo de uso del audífono y la puntuación obtenida en el cuestionario. Se observó que a mayor edad del adulto mayor, peores resultados encontrados en el dominio "emocional" del HHIE para el grupo GI y para los dominios "social" y "emocional" para el grupo GF. Además, hubo correlación entre los dos grupos, indicando que a peores resultados en el HHIE para el GI, peores resultados en el HHIE-SP contestado por el GF. Conclusión: La restricción de la participación social y los aspectos emocionales influenciados por la hipoacusia en adultos mayores usuarios de audífonos son factores percibidos por los familiares que los acompañan en las consultas de audiología.(AU)

LOCUS (LOng Covid-Understanding Symptoms, events and use of services in Portugal): A three-component study protocol.

Approximately 10% of patients experience symptoms of Post COVID-19 Condition (PCC) after a SARS-CoV-2 infection. Akin acute COVID-19, PCC may impact a multitude of organs and systems, such as the cardiovascular, respiratory, musculoskeletal, and neurological systems. The frequency and associated risk factors of PCC are still unclear among both community and hospital settings in individuals with a history of COVID-19. The LOCUS study was designed to clarify the PCC's burden and associated risk factors. LOCUS is a multi-component study that encompasses three complementary building blocks. The "Cardiovascular and respiratory events following COVID-19" component is set to estimate the incidence of cardiovascular and respiratory events after COVID-19 in eight Portuguese hospitals via electronic health records consultation. The "Physical and mental symptoms following COVID-19" component aims to address the community prevalence of self-reported PCC symptoms through a questionnaire-based approach. Finally, the "Treating and living with Post COVID-19 Condition" component will employ semi-structured interviews and focus groups to characterise reported experiences of using or working in healthcare and community services for the treatment of PCC symptoms. This multi-component study represents an innovative approach to exploring the health consequences of PCC. Its results are expected to provide a key contribution to the optimisation of healthcare services design.

The Pandemic-Related Factors Associated with Emergency Department Visits in Portugal throughout Two Years of the Pandemic: A Retrospective Population-Based Study.

The COVID-19 pandemic has affected the use of emergency departments (ED) worldwide. This study identifies the pandemic-related factors associated with the number of ED visits in mainland Portugal and each of its regions. We collected data on ED visits from March 2020 to March 2022. Data on incidence, vaccination, mobility, containment index, and Google search volume were retrieved from open online sources at different time points. We fitted a quasi-Poisson generalized linear regression model, and each variable was modeled separately and adjusted for time and month. There was a positive ED trend throughout the two years of the pandemic in mainland Portugal and each of its regions. In the mainland, during months with high workplace mobility, there were 10.5% more ED visits compared to months with average mobility. ED visits decreased in months with low mobility for retail and recreation, groceries and pharmacies, and transit compared to months of medium mobility. Portugal saw a reduction in ED utilization during the pandemic period, but with a positive trend from March 2020 to March 2022. The change in the population's behavior of seeking the ED throughout the pandemic might be associated with mobility, incidence, and pandemic fatigue.

Effect of the COVID-19 pandemic on the frequency of emergency department visits in Portugal: An interrupted time series analysis until July 2021.

Objectives: This study aims to evaluate the effect of the COVID-19 pandemic on the frequency of emergency department (ED) visits in Portugal between March 2020 and July 2021. Methods: We used data on the monthly number of visits for all public hospitals' EDs from mainland Portugal between January 2017 and July 2021. We studied the impact of the pandemic overall, by type of ED (general, pediatric, and obstetric) and by Manchester Triage System color (red, orange, yellow, green, and blue) using an interrupted time series analysis. The prepandemic period corresponded to the months from January 2017 to February 2020 and the pandemic period to the months from March 2020 to July 2021. Results: We observed over 26 million ED visits, the majority in general EDs (74.0%) and triaged yellow (48.4%) or green (38.4%). During the pandemic period, ED visits decreased 45.7% (95% confidence interval [CI]: -39.8% to -51.2%) and pediatric ED visits decreased by 72.4% (95% CI: -64.6% to -78.6%). A decrease was observed for all colors but tended to be progressively smaller as the priority increased. There was an increase in ED visits during the pandemic period (2.3%; 95% CI: 1.4% to 3.2%), eventually returning to prepandemic values. Conclusion: Our data indicate a considerable and long-lasting effect of the COVID-19 pandemic affecting mainly pediatric and milder cases, which were returning toward prepandemic values as the pandemic progressed. In a country with frequent use of EDs, the health system may need to be prepared to respond to prepandemic baseline ED demand, together with additional demand because of long-term sequels of COVID-19 cases and delayed care for chronic and acute conditions.

The genome sequence of the Neotropical brown stink bug, Euschistus heros provides insights into population structure, demographic history and signatures of adaptation.

The Neotropical brown stink bug, Euschistus heros, is a major pest of soybean in South America. The importance of E. heros as a pest has grown significantly in recent times due to increases in its abundance and range, and the evolution of insecticide resistance. Recent work has begun to examine the genetic diversity, population structure, and genetic mechanisms of insecticide resistance in E. heros. However, to date, investigation of these topics has been hampered by a lack of genomic resources for this species. Here we address this need by assembling a high-quality draft genome for E. heros. We used a combination of short and long read sequencing to assemble an E. heros genome of 1.4 Gb comprising 906 contigs with a contig N50 of 3.5 MB. We leveraged this new genomic resource, in combination with genotyping by sequencing, to explore genetic diversity in populations of this species in Brazil and identify genetic loci in the genome which are under selection. Our genome-wide analyses, confirm that there are two populations of E. heros co-occurring in different geographical regions in Brazil, and that, in certain regions of the country these populations are hybridizing. We identify several regions of the genome as under selection, including markers associated with putative insecticide resistance genes. Taken together, the new genomic resources generated in this study will accelerate research into fundamental aspects of stinkbug biology and applied aspects relating to the sustainable control of a highly damaging crop pest.