ABSTRACT
We explore care as a site of multiplicity and tension. Working with the qualitative interview accounts of nineteen health care workers in Colombia, we trace a narrative of 'exhausting care' in the early days of the Covid-19 pandemic. Accounts relate exhausting care to working without break in response to extraordinary demand, heightened contagion concern, the pressures of caring in the face of anticipated death, and efforts to carry on caring in the face of constraint. We bring together the work of John Law (2010, 2011) on 'collateral realities' with Lauren Berlant's (2011) thesis of 'cruel optimism' to explore care as a site of practice in which the promise of the good can also become materialised as harm, given structural conditions. Through the reflexive narrative of 'carrying on' in the face of being 'worn down' by care, a narrative which runs through health care worker accounts, we draw attention to the collateral realities of exhausting care as personal and political, at once a practice of endurance and extraction. We argue that the exhausting care that relates to the extraordinariness of the Covid-19 pandemic also resides in the ordinariness, and slower violence, of the everyday. The cruel optimism of care is a relation in which the labour of care reproduces a harmful situation.
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COVID-19 , Labor, Obstetric , Humans , Pregnancy , Female , Pandemics , Colombia/epidemiology , Health PersonnelABSTRACT
BACKGROUND: Globally, internalizing problems disproportionately affect females in adolescence and adulthood, with limited research at earlier ages due to a focus on disruptive behaviors. Our study addresses this gap by exploring the structure of internalizing problems and gender differences in Brazilian preschoolers. METHODS: We analyzed data from the Child Behavioral Checklist 1.5-5 in the Preschool Mental Health Study, involving 1,292 children aged 4 to 5 in Embu das Artes, São Paulo, Brazil. Confirmatory factor analysis and mean comparisons explored internalizing problems and gender variations. RESULTS: A two-factor model best fit both internalizing and externalizing problems.The hierarchical model with four factors (Emotionally Reactive, Anxiety/Depression, Somatic Complaints, and Withdrawn) best fit internalizing problems, achieving partial invariance between boys and girls. Boys scored higher in Withdrawn Syndrome, while girls scored higher in Somatic Complaints Syndrome. CONCLUSIONS: Preschoolers' internalizing problems warrant attention beyond their link to externalizing problems. While the overall construct is similar in boys and girls, divergent syndrome scores indicate potential distinct risk patterns requiring further exploration.
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Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.
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Abstract The SARS-CoV-2 Delta variant has become one of the greatest public health challenges worldwide since, after being first identified in India in December 2020, it has spread rapidly, affecting mainly countries with low vaccination rates and those that have relaxed the public health and social measures implemented to control the COVID-19 pandemic. The Delta variant has a higher replication capacity and is associated with viral loads up to 1 260 times higher than those of infections caused by the original strain, which may be associated with an increased likelihood of hospitalization, ICU admission, need for oxygen therapy, pneumonia, or even death. Fully vaccinated individuals have almost similar protection against both Delta and Alpha variants. Given the impact of Delta in countries where it is the dominant variant, it is necessary for all countries to develop systematic action plans focused on implementing strict public health and social measures in the context of the COVID-19 pandemic and on increasing vaccination coverage. Bearing this in mind, the objective of this reflection paper is to describe the main characteristics of the Delta variant, its impact on the dynamics of the pandemic in some of the countries where it has been detected, the effectiveness of vaccines against this variant, and its implications for public health in Colombia.
Resumen La variante delta del SARS-CoV-2 se ha convertido en uno de los mayores desafíos en salud pública a nivel mundial, ya que, luego de su identificación en la India en diciembre de 2020, se ha extendido de manera rápida, afectando principalmente a los países con bajas tasas de vacunación, y aquellos que han flexibilizado las medidas de salud pública establecidas para controlar la pandemia por COVID-19. La variante delta tiene una mayor capacidad de replicación y se asocia con cargas virales hasta 1 260 veces más altas en comparación con las de infecciones causadas por la cepa original, lo cual puede estar asociado a mayores probabilidades de hospitalización, ingreso a UCI, necesidad de oxigenoterapia, neumonía, o incluso muerte. Las personas con vacunación completa tienen una protección casi similar contra las variantes delta y alfa. Dado el impacto de delta en los países afectados en los que es la variante dominante, es necesario que todos los países desarrollen planes de acción sistemáticos enfocados en implementar estrictas medidas de salud pública y sociales en el contexto de la pandemia por COVID-19, y aumentar la cobertura de vacunación. Teniendo en cuenta lo anterior, el objetivo de esta reflexión es describir las principales características de la variante delta, su impacto en la dinámica de la pandemia en algunos de los países en que ha sido detectada, la efectividad de las vacunas contra esta variante, y sus implicaciones para la salud pública en Colombia.
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On June 2, 2021, the Colombian Ministry of Health and Social Protection, through Resolution No. 777, laid down the requirements to resume all restricted economic and social activities. Similarly, said Resolution established the Municipal Epidemiological Resilience Index (IREM by its acronym in Spanish) as a tool to support decision-making regarding this economic reactivation amid the third epidemic peak of COVID-19 in the country. The purpose of this article is to perform a critical analysis of the technical aspects of the IREM and to explore the feasibility of its implementation as a support for the resumption of economic and social activities as proposed in the Resolution. The present critical analysis emphasizes on the lack of a clear definition of epidemiological resilience that is consistent with the scientific literature. Furthermore, the face and content validity of the index, as well as the construct validity of the index and of its dimensions, are called into question and, therefore, the feasibility of using it to determine said resumption.
El 2 de junio de 2021, el Ministerio de Salud y Protección Social de Colombia expidió la Resolución 777, mediante la cual se determinan las condiciones para el reinicio de todas las actividades económicas y sociales restringidas. Asimismo, en esta resolución se define el Índice de resiliencia epidemiológica municipal (IREM) como la herramienta para apoyar la toma de decisiones relacionadas con esta reactivación económica en medio del tercer pico epidémico de la COVID-19 en el país. El objetivo de este artículo es hacer un análisis crítico de los aspectos técnicos del IREM y explorar la conveniencia de su implementación como soporte del reinicio de las actividades económicas y sociales propuesto en la resolución. Dentro de este análisis crítico se destaca la falta de una clara definición de resiliencia epidemiológica que se ajuste a la literatura científica. Además, se cuestiona tanto la validez de apariencia, contenido y constructo del índice global, como la validez del constructo de sus dimensiones y, por tanto, la pertinencia de usarlo como herramienta para definir dicho reinicio.
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OBJETIVO: Evaluar el impacto del programa "¡PILAS! Mejores adultos, mejores niños" diseñado por PREVIVA (Facultad Nacional de Salud Pública, Universidad de Antioquia), con el fin de prevenir conductas de riesgo en niños y niñas de 4 a 11 años de preescolares y escuelas primarias. En el presente artículo se presentaron algunos resultados de la línea de base y la descripción y implementación del programa. MÉTODOS: Se escogieron aleatoriamente 32 escuelas públicas de la zona urbana de Medellín. Se asignaron de manera aleatoria 16 a la intervención y 16 al Grupo Control. Se siguieron 862 niños en el Grupo Intervenido y 874 en el Grupo Control, escogidos aleatoriamente. RESULTADOS: Fue implementado y se está llevando a cabo la evaluación del programa de prevención temprana de la agresión y las conductas de riesgo para la salud en Medellín "¡PILAS! Mejores adultos, mejores niños". La prevalencia de agresión encubierta en el último año fue del 62%, agresión abierta del 34%, y la conducta oposicionista del 2%, según el reporte del cuidador. Los niños reportaron menor prevalencia que los cuidadores para la agresión encubierta y abierta (los 45 y 20%) y superiores para el trastorno oposicionista (el 23%). Se encontró asociación entre diversas formas de castigo y maltrato y las conductas agresivas y oposicionistas de los niños. CONCLUSIONES: Existen altas prevalencias de las conductas agresivas en los niños y de castigo mediante agresión y maltrato contra el niños, y estas formas de agresión se encuentran asociadas con las conductas agresivas de los niños, por los cuales se hace necesario continuar la evaluación de la intervención y extenderla a otras instituciones educativas, introducidos los cambios que sean aconsejables de acuerdo con los resultados de la evaluación.
OBJECTIVE: To evaluate the impact of the "¡PILAS! Mejores adultos, mejores niños" program, which was designed by PREVIVA (Universidad de Antioquia's School of Public Health), in order to prevent risk behaviors in preschool and primary schoolchildren, aged 4 to 11 years-old. This article presented baseline results and the description and implementation of such program. METHODS: Thirty-two urban public schools in Medellin were chosen at random, and 16 of them were randomly assigned to the intervention, with the remaining 16 placed in the Control Group. There were 862 children randomly chosen in the Intervention Group and 874 ones in the Control Group. RESULTS: The "¡PILAS! Mejores adultos, mejores niños" program was evaluated by examining early prevention of aggression and risk behaviors. According to the children's guardians, in the past year, there was a 62% prevalence of disguised aggression, a 34% prevalence of open aggression, and a 2% prevalence of oppositional behavior. The children reported lower prevalence of disguised and open aggression (45 and 20%, respectively) and a higher one of oppositional behavior (23%). There was an association between various forms of punishment and mistreatment, and aggressive and oppositional behaviors in children. CONCLUSIONS: There is a high prevalence of aggressive behavior in schoolchildren and a high one of aggressive means of punishment and mistreatment of children. These aggressive actions toward children are associated with aggressive behavior in kids further necessitating the continued evaluation of the "¡PILAS!" intervention and its expansion to additional schools. Results of the evaluation should be incorporated to improve the program.