Adult learning and education as a tool to contain pandemics: The COVID-19 experience.

In combating pandemics, more can be gained by changing citizens' behaviours than by relying solely on the medical route. In the current COVID-19 pandemic, the struggle to contain the outbreak and push back new infection figures will ultimately be won by training citizens how to avoid creating secondary transmission chains. The COVID-19 pandemic highlights the relationship between individual behaviour and group risk. Mass training of all social strata of a country's entire population is therefore critical in mitigating the pandemic. The authors of this article argue that adult learning and education (ALE) can play a pivotal role particularly in countries where average literacy levels are low, as these are usually the same countries in which healthcare systems are more fragile. This article explains why ALE, especially the promotion of health literacy as part of ALE (which is itself part of lifelong learning), is necessary to enable individuals to make informed health-related decisions. Research has shown that low- or non-literate individuals are less responsive to health education, less likely to use disease prevention services, and less likely to successfully manage chronic disease than literate citizens. The authors refer to the evaluation of the health literacy aspect of a large-scale adult literacy campaign launched in South Africa in 2008 which has yielded measurable outcomes and proved that the intervention had enabled adults to better understand health messages. They stress the importance of populations having at least a basic level of literacy and numeracy skills to enable them to receive and act on vital information during a pandemic or disaster. They argue that ALE should in fact be understood as an inherent element of every national emergency strategy, both in terms of prior preparation for possible future emergencies (such as pandemics, earthquakes, tornados, flooding, bushfires etc.), and in terms of reaction to a given emergency such as the current COVID-19 pandemic.

L'apprentissage et l'éducation des adultes, un outil pour endiguer les pandémies : l'expérience du COVID-19 ­ Dans la lutte contre les pandémies, on peut obtenir de meilleurs résultats en changeant les comportements des citoyens qu'en se fiant uniquement à la solution médicale. Dans le cas de la pandémie de COVID-19 qui nous préoccupe actuellement, nous gagnerons le combat mené pour contenir l'épidémie et réduire le nombre de nouvelles infections en apprenant aux citoyens comment éviter de créer des chaînes de contamination secondaire. La pandémie de COVID-19 met en relief la relation entre le comportement des individus et les risques pour le groupe. Pour la faire régresser, il est par conséquent crucial d'éduquer massivement toutes les couches sociales de la population d'un pays. Les auteurs de cet article affirment que l'apprentissage et l'éducation des adultes peuvent jouer un rôle déterminant dans les pays ayant un faible niveau d'alphabétisme, qui sont d'ordinaire également ceux où les systèmes de santé sont plus fragiles. Cet article explique pourquoi l'apprentissage et l'éducation des adultes, en particulier la promotion de l'alphabétisation sanitaire dans le cadre de l'apprentissage et de l'éducation des adultes, sont nécessaires pour permettre aux individus de prendre des décisions éclairées en matière de santé. Des recherches ont montré que les personnes illettrées ou analphabètes étaient moins ouvertes à l'éducation en matière de santé, qu'il était moins probable qu'elles s'adressent à des services de prévention des maladies et qu'elles avaient moins de chances de réussir à gérer des maladies chroniques que des citoyens instruits. Les auteurs renvoient à l'évaluation du volet d'alphabétisation sanitaire qui faisait partie d'une campagne d'éducation des adultes lancée à vaste échelle en Afrique du Sud en 2008. Il fournit des résultats quantifiables et prouva qu'il avait permis aux adultes de mieux comprendre les messages sanitaires. Les auteurs soulignent également l'importance pour les populations de posséder tout au moins des bases de lecture, d'écriture et de calcul pour pouvoir recevoir des informations vitales pendant une pandémie ou un cataclysme et être à même d'agir en fonction. Ils affirment qu'il conviendrait de considérer l'apprentissage et l'éducation des adultes comme faisant partie intégrante de toute stratégie d'urgence nationale, tant pour ce qui est de la préparation à d'éventuelles crises à venir (pandémies, tremblements de terre, tornades, inondations, feux de brousse, etc.) qu'en ce qui concerne la réponse à une situation d'urgence donnée comme c'est par exemple le cas de la pandémie de COVID-19.

El aprendizaje y la educación de adultos como herramienta para contener las pandemias: la experiencia de COVID-19 ­ En la lucha contra las pandemias, el cambio del comportamiento de los ciudadanos podría ser más beneficioso que confiar únicamente en la vía médica. En la actual pandemia COVID-19, la lucha para contener el brote y hacer retroceder las nuevas cifras de infección se ganará en última instancia capacitando a los ciudadanos para evitar la creación de cadenas de transmisión secundarias. La pandemia COVID-19 pone de relieve la relación entre el comportamiento individual y grupal de riesgo. Como consecuencia, la capacitación masiva de todos los estratos sociales de toda la población de un país es fundamental para mitigar la pandemia. Los autores de este artículo sostienen que el aprendizaje y la educación de adultos (EAA) podrían desempeñar un papel fundamental, principalmente, en los países en los que los niveles medios de alfabetización sean bajos, ya que suelen ser los mismos países en los que los sistemas de salud son más frágiles. En este artículo se explica por qué el EAA, especialmente la promoción de la alfabetización en materia de salud como parte del EAA (que a su vez forma parte del aprendizaje a lo largo de toda la vida), es necesaria para que las personas puedan tomar decisiones informadas en materia de salud. Las investigaciones han demostrado que las personas con bajo nivel de alfabetización o analfabetas responden menos a la educación sanitaria, tienen menos probabilidades de utilizar los servicios de prevención de enfermedades y menos probabilidades de gestionar con éxito las enfermedades crónicas que los ciudadanos alfabetizados. Los autores señalan una evaluación sobre el valor de la alfabetización en materia de salud de una campaña de alfabetización de adultos a gran escala iniciada en Sudáfrica en 2008, que ha dado resultados válidos y ha demostrado que la intervención ha permitido a los adultos comprender mejor los mensajes sobre la salud. Además, subrayan la importancia de que las poblaciones tengan por lo menos un nivel básico de conocimientos de lectura, escritura y aritmética que les permita recibir información importante y actuar en consecuencia durante una pandemia o un desastre. Sostienen que el EAE debe entenderse, de hecho, como un elemento inherente a toda estrategia nacional de emergencia, tanto en lo que respecta a la preparación previa para posibles emergencias futuras (como pandemias, terremotos, tornados, inundaciones, incendios forestales, etc.), como en lo que respecta a la reacción a una emergencia determinada, como la actual pandemia COVID-19.

The effects of nature-based vs. indoor settings on the adaptability, performance and affect of calisthenics exercisers. A registered report.

Comparisons of the beneficial effects of nature-based versus indoor physical activity have been extensively reported, but existing research addresses mainly aerobic activity (running, jogging), not resistance or mixed (aerobic and resistance) exercise. It is unclear if the psychological benefits extend to functionality, i.e., if participants perform their activities better in nature, and how movement is expressed in nature-based and indoor environments, during similar exercise. The present registered report was a randomized controlled trial investigating how engaging in similar resistance-based exercise (calisthenics) in nature-based and indoor settings differed in affective valence, perceived exertion, visual attention, movement adaptability, heart rate variability, and performance. Nature-based exercisers (N = 51) showed increased performance output than indoor exercisers (N = 53) (p < 0.001). There were no group differences in affective valence, perceived exertion, or visual attention. However, psychological states of nature-based exercisers showed stronger associations to performance output (r < 0.33) than those of indoor exercisers (r < 0.03). Nature-based exercisers' movement variability and structure, measured with non-linear and fractal techniques (Sample Entropy and Detrended Fluctuation Analysis), were more regular (p < 0.001) and more functionally adaptive (long-term Detrended Fluctuation Analysis, p = 0.022) to achieve better performance output. Heart rate variability measures were not different between groups. Distinct environments can influence movement adaptability in a calisthenics exercise routine, and ultimately contribute to better performance. These results show how action is specific to task environment, and how action implies not only the task, but also the characteristics of the environment. TRIAL REGISTRATION: NCT05090501 (Clinicaltrials.gov). Registered October 21, 2021.

Synthesis of lignin-based carbon/graphene oxide foam and its application as sensors for ammonia gas detection.

The present study highlights the integration of lignin with graphene oxide (GO) and its reduced form (rGO) as a significant advancement within the bio-based products industry. Lignin-phenol-formaldehyde (LPF) resin is used as a carbon source in polyurethane foams, with the addition of 1 %, 2 %, and 4 % of GO and rGO to produce carbon structures thus producing carbon foams (CFs). Two conversion routes are assessed: (i) direct addition with rGO solution, and (ii) GO reduction by heat treatment. Carbon foams are characterized by thermal, structural, and morphological analysis, alongside an assessment of their electrochemical behavior. The thermal decomposition of samples with GO is like those having rGO, indicating the effective removal of oxygen groups in GO by carbonization. The addition of GO and rGO significantly improved the electrochemical properties of CF, with the GO2% sensors displaying 39 % and 62 % larger electroactive area than control and rGO2% sensors, respectively. Furthermore, there is a significant electron transfer improvement in GO sensors, demonstrating a promising potential for ammonia detection. Detailed structural and performance analysis highlights the significant enhancement in electrochemical properties, paving the way for the development of advanced sensors for gas detection, particularly ammonia, with the prospective market demands for durable, simple, cost-effective, and efficient devices.

A systematic scoping review of digital health technologies during COVID-19: a new normal in primary health care delivery.

This scoping review compiled information concerning digital health technologies (DHTs) evolution to support primary health care (PHC) during COVID-19 and lessons for the future of PHC. The identified literature was published during the COVID-19 peak years (2019-2021), retrieved from PubMed, Scopus, and Google Scholar, as well as hand searched on the internet. Predefined inclusion criteria were used, thematic analysis was applied, and reporting followed the PRISMA for Scoping Reviews. A total of 46 studies were included in the final synthesis (40 articles, one book, two book chapters, one working paper, and two technical reports). These studies scrutinized various aspects of DHTs, entailing 19 types of DHTs with 20 areas of use that can be compressed into five bigger PHC functions: general PHC service delivery (teleconsultations, e-diagnosis, e-prescription, etc.); behavior promotion and digital health literacy (e.g., combating vaccine hesitancy); surveillance functions; vaccination and drugs; and enhancing system decision-making for proper follow-up of ongoing PHC interventions during COVID-19. DHTs have the potential to solve some of the problems that have plagued us even prior to COVID-19. Therefore, this study uses a forward-looking viewpoint to further stimulate the use of evidence-based DHT, making it more inclusive, educative, and satisfying to people's needs, both under normal conditions and during outbreaks. More research with narrowed research questions is needed, with a particular emphasis on quality assurance in the use of DHTs, technical aspects (standards for digital health tools, infrastructure, and platforms), and financial perspectives (payment for digital health services and adoption incentives). Supplementary Information: The online version contains supplementary material available at 10.1007/s12553-023-00725-7.

Epidemiological Modeling of the Impact of Public Health Policies on Hepatitis C: Protocol for a Gamification Tool Targeting Microelimination.

BACKGROUND: Hepatitis C is a disease with a strong social component, as its main transmission route is via blood, making it associated with lifestyle. Therefore, it is suitable to be worked on from the perspective of public health policy, which still has a lot of room to explore and improve, contrary to diagnoses and treatments, which are already very refined and effective. OBJECTIVE: An interactive gamified policy tool, designated as Let's End HepC (LEHC), was created to understand the impact of policies related to hepatitis C on the disease's epidemiology on a yearly basis until 2030. METHODS: To this end, an innovative epidemiological model was developed, integrating Markov chains to model the natural history of the disease and adaptive conjoint analysis to reflect the degree of application of each of the 24 public health policies included in the model. This double imputation model makes it possible to assess a set of indicators such as liver transplant, incidence, and deaths year by year until 2030 in different risk groups. Populations at a higher risk were integrated into the model to understand the specific epidemiological dynamics within the total population of each country and within segments that comprise people who have received blood products, prisoners, people who inject drugs, people infected through vertical transmission, and the remaining population. RESULTS: The model has already been applied to a group of countries, and studies in 5 of these countries have already been concluded, showing results very close to those obtained through other forms of evaluation. CONCLUSIONS: The LEHC model allows the simulation of different degrees of implementation of each policy and thus the verification of its epidemiological impact on each studied population. The gamification feature allows assessing the adequate fulfillment of the World Health Organization goals for the elimination of hepatitis C by 2030. LEHC supports health decision makers and people who practice patient advocacy in making decisions based on science, and because LEHC is democratically shared, it ends up contributing to the increase of citizenship in health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/38521.

Improvement of UV stability of thermoplastic starch matrix by addition of selected lignin fraction - Photooxidative degradation.

This paper examines the additivation of thermoplastic starch (TPS) matrix by selected fractions of kraft lignin (KL) and correlates its structure-performance when exposed to photooxidative degradation. KL from Eucalyptus urograndis wood was refined by a sequential fractionation process in ethyl acetate (EtOAc). Films were prepared by mixing lignin fractions as additive in TPS matrix by casting and pressing. The lignin employed were KL, fraction of KL insoluble in EtOAc (INS) and fraction of KL soluble in EtOAc (SOL). The samples were exposed to accelerated aging with Ultraviolet-C light (UV-C) for 432 h. Structural changes were measured by FTIR (Fourier-Transform Infrared) spectra. Thermal properties, such as melting enthalpy, glass transition temperature and thermal decomposition, were evaluated by DSC (Differential Scanning Calorimetry) and TG (Thermogravimetry). Morphology of the films was obtained by SEM (Scanning Electron Microscopy). Surface property of wettability was measured by contact angle. Mechanical properties were explored before and after exposure to UV-C light. It was observed that the least photodegraded films were those resulting from the addition of the lignin fraction with higher phenolic hydroxyl group content. According to structural and morphological observations, the soluble fraction (TSOL) presented the highest photoprotection and stabilizing effect as an UV-C light blocker additive on TPS matrix.

Associations between the COVID-19 Pandemic and Hospital Infrastructure Adaptation and Planning-A Scoping Review.

The SARS-CoV-2 pandemic has put unprecedented pressure on the hospital sector around the world. It has shown the importance of preparing and planning in the future for an outbreak that overwhelms every aspect of a hospital on a rapidly expanding scale. We conducted a scoping review to identify, map, and systemize existing knowledge about the relationships between COVID-19 and hospital infrastructure adaptation and capacity planning worldwide. We searched the Web of Science, Scopus, and PubMed and hand-searched gray papers published in English between December 2019 and December 2021. A total of 106 papers were included: 102 empirical studies and four technical reports. Empirical studies entailed five reviews, 40 studies focusing on hospital infrastructure adaptation and planning during the pandemics, and 57 studies on modeling the hospital capacity needed, measured mostly by the number of beds. The majority of studies were conducted in high-income countries and published within the first year of the pandemic. The strategies adopted by hospitals can be classified into short-term (repurposing medical and non-medical buildings, remote adjustments, and establishment of de novo structures) and long-term (architectural and engineering modifications, hospital networks, and digital approaches). More research is needed, focusing on specific strategies and the quality assessment of the evidence.

Integrating public health policies in the epidemiological modeling of hepatitis C with LEHC tool: application in Austria.

BACKGROUND: Eliminating hepatitis C requires addressing issues other than medicines or therapies. Public health policies focused on the hepatitis C virus (HCV) must be emphasized and worked to know the impacts on its epidemiologic dynamics. This research aims to provide a tool to evaluate and simulate alternatives by redefining policies meeting specific needs in each country towards the HCV elimination target by 2030. METHODS: The development of a gamified model with 24 public health policies focused on HCV was conducted to evaluate the impact of measures in the disease epidemiologic dynamics. The Let's End HepC (LEHC) project encompassed key populations (people who inject drugs [PWID], prisoners, blood products and remnant population) in Austria and other countries, presenting prospects for every year from 2019 to 2030. The LEHC epidemiological model comprised an integrated solution for HCV, with adaptive conjoint analysis (ACA) and Markov chains constituting its main processes. RESULTS: Despite Austria's efforts towards achieving the HCV elimination goal by 2030, the LEHC model forecast quantitative analysis predicts that it is still not enough to meet the target; however, prospects are very optimistic if public health policies are adapted to the country's needs, being possible to achieve the goal as early as 2026. CONCLUSION: In Austria, the LEHC tool allowed to forecast the HCV elimination year anticipation to 2026, instead of being achieved after 2030. This target will only be valid if adequate management of the 24 public health policies focused on this pathology is further implemented.

COVID-19 and the Use of Masks by Children. Statement From the Association of Schools of Public Health in the European Region and the European Academy of Paediatrics.

Despite the fact that the use of masks and respirators in adults has already reached a consensus in almost all countries and for situations in which they are recommended, this is not the case for the use of mask by children. This statement, regarding the usage of mask by children, has been jointly produced by the Association of Schools of Public Health in the European Region (ASPHER) and the European Academy of Paediatrics (EAP). It provides recommendations on the size of the mask, the material and ergonomics of children's masks. The authors also discuss the psychological dimension of children when they are asked to wear a mask. Moreover, they tackle the difficulties of children with disabilities.

Real-World Evidence: The Low Validity of Temperature Screening for COVID-19 Triage.

Background: The COVID-19 pandemic forced health-related organizations to rapidly launch country-wide procedures that were easy to use and inexpensive. Body temperature measurement with non-contact infrared thermometers (NCITs) is among the most common procedures, both in hospital settings and in many other entities. However, practical hospital experiences have raised great doubts about the procedure's validity. Aim: This study aimed to evaluate the validity of the body temperature measured using NCITs among oncological and transplant patients who took the polymerase chain reaction test for SARS-Cov-2 PCR+ and PCR- in a Romanian Hospital. Methods: Body temperature was measured for 5,231 inpatients using NCITs. The cutoff point for fever was equal to or above 37.3°C. Patients then completed a questionnaire about their symptoms, contact, and travel history. Findings: Fever was detected in five of 53 persons with PCR+, resulting in a sensitivity of 9.43% (95% CI, 3.13-20.66%). No fever was verified in 5,131 of 5,171 persons with PCR-, resulting in a specificity of 99.15% (95% CI, 98.86-99.38%). A defensive vision of NCIT procedure (maximum standard error only in favor) had a sensitivity of 15.09% (95% CI, 6.75-27.59%). Conclusions: The use of NCITs in a triage provides little value for detection of COVID-19. Moreover, it provides a false sense of protection against the disease while possibly discriminating individuals that could present fever due to other reasons, such as oncologic treatments, where fever is a common therapeutical consequence. The consumption of qualified human resources should be considered, especially in the context of the shortage of healthcare professionals worldwide.

Let's End HepC: Modelling Public Health Epidemiological Policies Applied to Hepatitis C in Spain.

Background: The WHO has defined international targets toward the elimination of hepatitis C by 2030. Most countries cannot be on track to achieve this goal unless many challenges are surpassed. The Let's End HepC (LEHC) tool aims to contribute to the control of hepatitis C. The innovation of this tool combines the modelling of public health policies (PHP) focused on hepatitis C with epidemiological modelling of the disease, obtaining a unique result that allows to forecast the impact of policy outcomes. The model was applied to several countries, including Spain. Methods: To address the stated objective, we applied the "Adaptive Conjoint Analysis" for PHP decision-making and Markov Chains in the LEHC modelling tool. The tool also aims to be used as an element of health literacy for patient advocacy through gamification mechanisms and country comparability. The LEHC project has been conducted in several countries, including Spain. The population segments comprised in the project are: People Who Inject Drugs (PWID), prisoners, blood products, remnant population. Results: A total of 24 PHP related to hepatitis C were included in the LEHC project. It was identified that Spain had fully implemented 14 of those policies to control hepatitis C. According to LEHC's model forecast, the WHO's Hepatitis C elimination goal on reducing the number of patients living with Hepatitis C to 10% can be achieved in Spain by 2026 if current policies are maintained. The model estimates that the total population in Spain, by 2026, is expected to comprise 26,367 individuals living with hepatitis C. Moreover, if the 24 PHP considered for this study are fully implemented in Spain, the elimination goal may be achieved in 2024, with 29,615 individuals living with hepatitis C by that year. Conclusion: The findings corroborate the view that Spain has set great efforts in directing PHP toward Hepatitis C Virus (HCV) elimination by 2030. However, there is still room for improvement, namely in further implementing 10 of the 24 PHP considered for the LEHC project. By maintaining the 14 PHP in force, the LEHC model estimates the HCV elimination in the country by 2026, and by 2024 if further measures are employed to control the disease.

Modeling the Puzzle of Hepatitis C Epidemiology in Romania: A Pathway to Control.

BACKGROUND AND AIMS: To combat hepatitis C virus (HCV) and achieve its elimination by 2030, the emphasis should be on public health policies. In this study, we investigated the dynamics of epidemiology of HCV in Romanian risk groups that are characterized by higher occurrence densities with the aid of The Let's End HepC (LEHC) project. METHODS: The LEHC project addressed the modelling of HCV epidemiology, being applied in several countries, one of which is Romania. The model comprised an integrated solution of public health policies focused on the disease, using Adaptive Conjoint Analysis and Markov chains systems. This tool allowed the quantitative evaluation of public health policies' impact, for every year until 2030, in five population groups: people who inject drugs (PWID), prisoners, individuals who have received blood products, children at risk for vertical transmission, and the remnant population. RESULTS: It appears that Romania was already making great efforts in the context of public policies, allowing the achievement of HCV elimination by 2028 if current policies were maintained. Through additional work and greater efforts in further implementing public policies, the LEHC model estimated the possibility of anticipating this outcome to 2026. CONCLUSION: The LEHC model estimated an anticipation of the HCV elimination year in Romania to be 2026 if the twenty-four health policies in the study are fully implemented and consistently maintained over the years.

Multiplicity of aspartic proteinases from Cynara cardunculus L.

Aspartic proteinases (AP) play major roles in physiologic and pathologic scenarios in a wide range of organisms from vertebrates to plants or viruses. The present work deals with the purification and characterisation of four new APs from the cardoon Cynara cardunculus L., bringing the number of APs that have been isolated, purified and biochemically characterised from this organism to nine. This is, to our knowledge, one of the highest number of APs purified from a single organism, consistent with a specific and important biological function of these protein within C. cardunculus. These enzymes, cardosins E, F, G and H, are dimeric, glycosylated, pepstatin-sensitive APs, active at acidic pH, with a maximum activity around pH 4.3. Their primary structures were partially determined by N- and C-terminal sequence analysis, peptide mass fingerprint analysis on a MALDI-TOF/TOF instrument and by LC-MS/MS analysis on a Q-TRAP instrument. All four enzymes are present on C. cardunculus L. pistils, along with cyprosins and cardosins A and B. Their micro-heterogeneity was detected by 2D-electrophoresis and mass spectrometry. The enzymes resemble cardosin A more than they resemble cardosin B or cyprosin, with cardosin E and cardosin G being more active than cardosin A, towards the synthetic peptide KPAEFF(NO(2))AL. The specificity of these enzymes was investigated and it is shown that cardosin E, although closely related to cardosin A, exhibits different specificity.

Perfil epidemiológico nutricional dos pacientes em hemodiálise / Nutritional epidemiological profile of hemodialysis patients

A insuficiência renal crônica compromete as funções fisiológicas dos rins, e leva o paciente à diálise como terapia; contudo, essa condição gera suscetibilidade à desnutrição. O objetivo deste estudo foi descrever o perfil epidemiológico e nutricional dos pacientes em hemodiálise e compará-los em relação à doença renal de base. É estudo retrospectivo, descritivo e transversal. Foram coletados dados demográficos, clínicos, antropométricos e laboratoriais de pacientes que estiveram em diálise. Foram incluídos pacientes com insuficiência renal crônica e excluídos menores de 18 anos, com dados insuficientes ou com comorbidades que alterassem processo nutricional. Em conclusão, observaram-se 4 principais causas para doença renal crônica: hipertensão arterial crônica, doença renal policística, doença renal terminal e nefropatia diabética, que foi a mais prevalente, com pouca evidência de desnutrição

Chronic renal failure compromises the physiological functions of the kidneys and leads the patient to dialysis as a therapy; however, this condition generates susceptibility to malnutrition. The aim of this study was to describe the epidemiological and nutritional profile of patients on hemodialysis and to compare them in relation to the underlying renal disease. It is a retrospective, descriptive and cross-sectional study. Demographic, clinical, anthropometric and laboratory data were collected from patients who were on dialysis. Patients with chronic renal failure were included and those under 18 years of age, with insufficient data or with comorbidities that altered the nutritional process, were excluded. In conclusion, 4 main causes of chronic kidney disease were observed: chronic arterial hypertension, polycystic kidney disease, end-stage renal disease and diabetic nephropathy, which was the most prevalent, with little evidence of malnutrition