Factors associated with the death of healthcare workers due to COVID-19 in the state of Amapá, Brazil.

Introduction: Frontline healthcare workers providing care for COVID-19 are more likely to get infected and die compared with other professionals. Deaths or sick leaves due to COVID-19 can affect the smooth operation of health services in areas with shortage of workers. Objectives: To analyze factors associated with the death of healthcare workers due to COVID-19 in the state of Amapá, Brazil. Methods: Analytical cross-sectional study using COVID-19 data from Amapá between March 2020 and January 2021. The association of independent variables (sex, race/color, age group, region of residence, comorbidity) with death was analyzed by logistic regression. Results: Data from 1,258 workers were analyzed. The majority were women (67.7%; 852/1,258), multiracial (66.9%; 759/1,135), aged between 18 and 64 (98.3%; 1,226/1,247), with no comorbidity (86.6%; 1,090/1,258), from the Macapá metropolitan area (56.7%; 713/1,258). The mortality rate was 1.59%. Factors associated with death were: age group = 65 years (odds ratio = 10.43; 95% confidence interval [CI] = 2.78-39.11), comorbidity (odds ratio = 4.52; 95%CI = 1.74-11.74), and residence in the Macapá metropolitan area (odds ratio = 4.37; 95%CI = 1.25-15.29). Conclusions: The recognition of factors that may have caused the death of healthcare workers in Amapá can support the recommendation of protective measures for the most susceptible, such as switching to activities with lower exposure to the virus or teleworking.

Covid-19 entre indígenas na Amazônia brasileira: fatores associados ao óbito / Covid-19 among the Brazilian Amazon indigenous people: factors associated with death

Resumo Este estudo objetiva analisar fatores associados ao óbito de indígenas pela covid-19 no estado do Amapá, Brasil. Trata-se de um estudo caso-controle emparelhado por sexo e idade, que utilizou um banco de dados secundários público, produzido pela Secretaria de Estado da Saúde do Amapá. Os casos (n=29) foram óbitos de indígenas pela covid-19 e os controles foram curas da doença (n=87), registrados entre abril de 2020 e janeiro de 2021. Dados de indivíduos com doença ativa foram excluídos da análise. Foram realizadas análises univariadas seguidas por regressão logística múltipla para estudo das variáveis independentes associadas ao desfecho de óbito. A maioria dos casos de óbito era do sexo feminino (51,7%), sem comorbidades (62,1%), residentes em municípios da Região Metropolitana de Macapá (RMM) (65,5%) e em área urbana (89,7%). A mediana das idades do grupo de óbitos foi de 72 anos (intervalo interquartil= 21,5). O modelo múltiplo final demonstrou que indígenas com comorbidade cardiovascular apresentaram chance 4,01 vezes (intervalo de confiança de 95% - IC 95%= 1,05-15,36) maior de óbito pela covid-19 quando comparados a indígenas sem comorbidades. E que indígenas residentes na RMM apresentaram chance 2,90 vezes (IC 95%= 1,10-7,67) maior de óbito quando comparados aos indígenas residentes no interior do estado Amapá.

Abstract This case-control study paired by gender and age analyzes factors associated with the death of indigenous people from COVID-19 in the state of Amapá, Brazil. Data were collected from a public secondary database produced by the Amapá State Department of Health. Cases (n=29) were deaths of indigenous people from COVID-19 and controls were cures of the disease (n=87), recorded between April 2020 and January 2021. Data from individuals with active disease were excluded. Univariate analysis followed by multiple logistic regression were performed to study the independent variables associated with death. Most cases of death were women (51.7%), without comorbidities (62.1%), residing in cities of the Metropolitan Region of Macapá (RMM) (65.5%) and in urban areas (89.7%). Median age of the death group was 72 years (interquartile range=21.5). The final multiple model showed that indigenous individuals with cardiovascular comorbidity had a 4.01 times greater chance (95% confidence interval - 95% CI=1.05-15.36) of death by COVID-19 when compared with indigenous people without comorbidities. And that indigenous people residing in the RMM had a 2.90 times greater chance (95%CI = 1.10-7.67) of death when compared with indigenous residing in the countryside.

Epidemiological profile, occupational accidents, and socioeconomic characteristics of workers in the state of Amapá, Brazil: a time series analysis (2007-2017).

INTRODUCTION: The state of Amapá is located in Brazil's Legal Amazon and comprises 16 municipalities. Its history is marked by social vulnerability and industrial mining; therefore, its current socioeconomic and occupational context should be analyzed considering possible sociohistorical and geographic influences. OBJECTIVES: To analyze and/or describe the epidemiological profile of workers, occupational accidents, the socioeconomic context, and time evolution of the number of workers in the state and their relationship with the state's gross domestic product. METHODS: This is an analytic time series study based on official public data. We used a simple regression test to analyze the relationship between the number of workers and gross domestic product and to assess the time trend of the number of workers. The studied period was from 2007 to 2017. RESULTS: The number of workers presented an increasing trend over time (R2 = 0.902; p < 0.001), with a relative increase of 49.8% between 2007 and 2017. We observed a positive relationship between the annual increase in the number of workers and the state's gross domestic product (R2 = 0.899; p < 0.001). The economic activity with the highest mean number of workers was public administration, defense, and social security. The highest socioeconomic indicators were observed in the state capital Macapá. Non-hazardous waste management was the activity concentrating the highest absolute number of occupational accidents. CONCLUSIONS: This study highlighted important socioeconomic contrasts within the state. The significant increases in the gross domestic product and number of workers are signs of development, but the high number of occupational accidents represents a serious public health problem.

Genomic and Epidemiological Surveillance of Zika Virus in the Amazon Region.

Zika virus (ZIKV) has caused an explosive epidemic linked to severe clinical outcomes in the Americas. As of June 2018, 4,929 ZIKV suspected infections and 46 congenital syndrome cases had been reported in Manaus, Amazonas, Brazil. Although Manaus is a key demographic hub in the Amazon region, little is known about the ZIKV epidemic there, in terms of both transmission and viral genetic diversity. Using portable virus genome sequencing, we generated 59 ZIKV genomes in Manaus. Phylogenetic analyses indicated multiple introductions of ZIKV from northeastern Brazil to Manaus. Spatial genomic analysis of virus movement among six areas in Manaus suggested that populous northern neighborhoods acted as sources of virus transmission to other neighborhoods. Our study revealed how the ZIKV epidemic was ignited and maintained within the largest urban metropolis in the Amazon. These results might contribute to improving the public health response to outbreaks in Brazil.

Protein kinase A mediates adenosine A2a receptor modulation of neurotransmitter release via synapsin I phosphorylation in cultured cells from medulla oblongata.

Synaptic transmission is an essential process for neuron physiology. Such process is enabled in part due to modulation of neurotransmitter release. Adenosine is a synaptic modulator of neurotransmitter release in the Central Nervous System, including neurons of medulla oblongata, where several nuclei are involved with neurovegetative reflexes. Adenosine modulates different neurotransmitter systems in medulla oblongata, specially glutamate and noradrenaline in the nucleus tractussolitarii, which are involved in hypotensive responses. However, the intracellular mechanisms involved in this modulation remain unknown. The adenosine A2a receptor modulates neurotransmitter release by activating two cAMP protein effectors, the protein kinase A and the exchange protein activated by cAMP. Therefore, an in vitro approach (cultured cells) was carried out to evaluate modulation of neurotransmission by adenosine A2a receptor and the signaling intracellular pathway involved. Results show that the adenosine A2a receptor agonist, CGS 21680, increases neurotransmitter release, in particular, glutamate and noradrenaline and such response is mediated by protein kinase A activation, which in turn increased synapsin I phosphorylation. This suggests a mechanism of A2aR modulation of neurotransmitter release in cultured cells from medulla oblongata of Wistar rats and suggest that protein kinase A mediates this modulation of neurotransmitter release via synapsin I phosphorylation.