Temporal trends and spatial clusters of high risk for maternal death due to COVID-19 pre and during COVID-19 vaccination in Brazil: a national population-based ecological study.

OBJECTIVE: This study comprehensively analyzed the temporal and spatial dynamics of COVID-19 cases and deaths within the obstetric population in Brazil, comparing the periods before and during mass COVID-19 vaccination. We explored the trends and geographical patterns of COVID-19 cases and maternal deaths over time. We also examined their correlation with the SARS-CoV-2 variant circulating and the social determinants of health. STUDY DESIGN: This is a nationwide population-based ecological study. METHODS: We obtained data on COVID-19 cases, deaths, socioeconomic status, and vulnerability information for Brazil's 5570 municipalities for both the pre-COVID-19 vaccination and COVID-19 vaccination periods. A Bayesian model was used to mitigate indicator fluctuations. The spatial correlation of maternal cases and fatalities with socioeconomic and vulnerability indicators was assessed using bivariate Moran. RESULTS: From March 2020 to June 2023, a total of 23,823 cases and 1991 maternal fatalities were recorded among pregnant and postpartum women. The temporal trends in maternal incidence and mortality rates fluctuated over the study period, largely influenced by widespread COVID-19 vaccination and the dominant SARS-CoV-2 variant. There was a significant reduction in maternal mortality due to COVID-19 following the introduction of vaccination. The geographical distribution of COVID-19 cases and maternal deaths exhibited marked heterogeneity in both periods, with distinct spatial clusters predominantly observed in the North, Northeast, and Central West regions. Municipalities with the highest Human Development Index reported the highest incidence rates, while those with the highest levels of social vulnerability exhibited elevated mortality and fatality rates. CONCLUSION: Despite the circulation of highly transmissible variants of concern, maternal mortality due to COVID-19 was significantly reduced following the mass vaccination. There was a heterogeneous distribution of cases and fatalities in both periods (before and during mass vaccination). Smaller municipalities and those grappling with social vulnerability issues experienced the highest rates of maternal mortality and fatalities.

Improvements in one severe progressive multiple sclerosis patient quality of life after an intensity fluid dynamic treatment.

Clinical case: A 49-year-old man (MM72) affected by Secondary Progressive Multiple Sclerosis (SP-MS) since 1998. On last 3 years, neurologists valued 9.0 the patient MM72's EDSS. Methods: MM72 was treated by acoustic waves, modulated in frequency and power by the MAM device, according to an ambulatory intensive protocol. Patient's treatments schedule was organized in thirty cycles of DrenoMAM and AcuMAM, and manual cervical spinal adjustments. Before and after treatments, MSIS-29, Barthel, FIM, EDSS, ESS, and FSS questionnaires were administered to the patient. Results: MM72 patient had improvements in all index score (MSIS-29, Barthel, FIM, EDSS, ESS and FSS) after 30 treatments by MAM plus cervical spine chiropractic adjustments. He showed a significative improvement of his disability and the restore of many functions. After MAM treatments, MM72's cognitive sphere improved of 370%. Fur-thermore, after 5 years of paraplegy, he regained his lower limbs and feet fingers movements with an increase of 230%. Conclusion: We suggest ambulatory intensive treatments by fluid dynamic MAM protocol in SP-MS patients. Statistical analyses are in progress on a larger sample of SP-MS patients.

Spatial clustering of low rates of COVID-19 vaccination among children and adolescents and their relationship with social determinants of health in Brazil: a nationwide population-based ecological study.

OBJECTIVE: This study aimed to investigate the spatial clusters of high and low COVID-19 vaccination rates among children and adolescents across Brazilian municipalities and their relationship to social determinants of health. STUDY DESIGN: This is a nationwide population-based ecological study. METHODS: We have obtained for each of the 5570 Brazilian municipalities data on the COVID-19 vaccination rate of children and adolescents by August 16, 2022, the Gini index, the social vulnerability index and the municipal human development index. A Bayesian empirical local model was used to identify fluctuations in the COVID-19 vaccination rates. Spatial clusters were identified using scan spatial statistic tests. The relationship among COVID-19 vaccination rates and social determinants of health was explored by using multiple linear regression models. RESULTS: Overall, 52.1% of children aged 5-11 years and 72.8% of adolescents aged 12-17 years have been fully vaccinated against COVID-19 in Brazil by mid-August 2022. There was spatial dependence on the smoothed rates for both children (I Moran 0.66; P < 0.001) and adolescent (I Moran 0.65; P < 0.001) groups. The lowest rates occurred in municipalities in the North and Northeast regions. Municipalities with a higher Gini Index, higher social vulnerability index and lower municipal human development index were more likely to have a lower COVID-19 vaccination rate for both children and adolescent groups. CONCLUSION: COVID-19 vaccination of children and adolescents was heterogeneously distributed, with spatial clusters of the lowest vaccination rates occurring mainly in municipalities with marked socio-economic disparities and social vulnerability, especially in the North and Northeast regions.

Poor prognosis indicators of type-2 diabetic COVID-19 patients.

Diabetes is associated with a worse prognosis and a high risk of morbidity and mortality in COVID-19 patients. We aimed to evaluate the main factors involved in the poor prognosis in diabetic patients. A total of 984 patients diagnosed with COVID-19 admitted to the hospital were included in this study. Patients were first divided into type-2 diabetic (DM+) and non-diabetic (DM-) groups. The participants were analyzed based on the National Early Warning Score (NEWS) and on the Quick-Sequential Organ Failure Assessment (qSOFA) to find the best prognostic risk score for our study. The DM+ and DM- groups were divided into non-severe and severe groups. Comparative and correlative analyses were used to identify the physiological parameters that could be employed for creating a potential risk indicator for DM+ COVID-19 patients. We found a poorer prognosis for the DM+ COVID-19 patients with a higher ICU admission rate, mechanical ventilation rate, vasopressor use, dialysis, and longer treatment times compared with the DM- group. DM+ COVID-19 patients had increased plasma glucose, lactate, age, urea, NEWS, and D-dimer levels, herein referred to as the GLAUND set, and worse prognosis and outcomes when compared with infected DM- patients. The NEWS score was a better indicator for assessing COVID-19 severity in diabetic patients than the q-SOFA score. In conclusion, diabetic COVID-19 patients should be assessed with the NEWS score and GLAUND set for determining their prognosis COVID-19 prognosis.

Poor prognosis indicators of type-2 diabetic COVID-19 patients

Diabetes is associated with a worse prognosis and a high risk of morbidity and mortality in COVID-19 patients. We aimed to evaluate the main factors involved in the poor prognosis in diabetic patients. A total of 984 patients diagnosed with COVID-19 admitted to the hospital were included in this study. Patients were first divided into type-2 diabetic (DM+) and non-diabetic (DM-) groups. The participants were analyzed based on the National Early Warning Score (NEWS) and on the Quick-Sequential Organ Failure Assessment (qSOFA) to find the best prognostic risk score for our study. The DM+ and DM- groups were divided into non-severe and severe groups. Comparative and correlative analyses were used to identify the physiological parameters that could be employed for creating a potential risk indicator for DM+ COVID-19 patients. We found a poorer prognosis for the DM+ COVID-19 patients with a higher ICU admission rate, mechanical ventilation rate, vasopressor use, dialysis, and longer treatment times compared with the DM- group. DM+ COVID-19 patients had increased plasma glucose, lactate, age, urea, NEWS, and D-dimer levels, herein referred to as the GLAUND set, and worse prognosis and outcomes when compared with infected DM- patients. The NEWS score was a better indicator for assessing COVID-19 severity in diabetic patients than the q-SOFA score. In conclusion, diabetic COVID-19 patients should be assessed with the NEWS score and GLAUND set for determining their prognosis COVID-19 prognosis.

Effect of electrical stunning frequency and current waveform in poultry welfare and meat quality.

This study aimed to evaluate the effects of different stunning frequencies and electrical current waveforms on chicken welfare and meat quality. Two-hundred-thirty-two Cobb broilers, 48 d of age and 2.76 ± 0.47 live-weight, were randomly assigned into 4 stunning treatments - 2 frequencies (300 Hz and 650 Hz) and 2 current waveforms (direct current [DC] and alternating current [AC]). Broilers were electrically stunned in a water bath in a commercial slaughterhouse (70 V, 100 mA). The electronarcosis and stunning efficiency were confirmed by assessment of visual parameters (absence of rhythmic breathing, ocular reflex, and coordinated wing flapping) and blood parameters (lactate, glucose, creatine kinase, sodium, and potassium), which were measured after bleeding. The incidence of traumas and injuries was assessed after plucking. Meat quality analysis was performed in Pectoralis major (PM), with determinations of pH, breast yield (PMY), water holding capacity (WHC), water absorption capacity (WAC), thawing loss (DL), cooking loss (CL), shear force (SF), and instrumental color (a*, b*, L*, C*, and h). The interaction between waveform and frequency was significant (P < 0.05) only for lactate, sodium, and lightness (L*). Lactate and sodium levels decreased at 300 Hz-DC. Meat lightness increased at 300 Hz-DC. The individual effect of frequency was significant for glucose, creatine kinase, potassium, WHC, PMY, b*, C*, and h. Regarding waveform, AC decreased plasma glucose and DC decreased creatine kinase and WAC. In general, stunning frequency exerts greater influence than waveform on the welfare and meat quality parameters of broilers. The use of frequency at 650 Hz proved to render animals efficiently unconscious and to promote greater meat quality.

The taxonomic distinctness of macroinvertebrate communities of Atlantic Forest streams cannot be predicted by landscape and climate variables, but traditional biodiversity indices can / A distinção taxonômica de comunidades de macroinvertebrados de córregos da Mata Atlântica não pode ser previsto pela paisagem e por variáveis climáticas, mas os índices de biodiversidade tradicional podem

Predicting how anthropogenic activities may influence the various components of biodiversity is essential for finding ways to reduce diversity loss. This challenge involves: a) understanding how environmental factors influence diversity across different spatial scales, and b) developing ways to measure these relationships in a way that is fast, economical, and easy to communicate. In this study, we investigate whether landscape and bioclimatic variables could explain variation in biodiversity indices in macroinvertebrate communities from 39 Atlantic Forest streams. In addition to traditional diversity measures, i.e., species richness, abundance and Shannon index, we used a taxonomic distinctness index that measures the degree of phylogenetic relationship among taxa. The amount of variation in the diversity measures that was explained by environmental and spatial variables was estimated using variation partitioning based on multiple regression. Our study demonstrates that taxonomic distinctness does not respond in the same way as the traditional used in biodiversity studies. We found no evidence that taxonomic distinctness responds predictably to variation in landscape metrics, indicating the need for the incorporation of predictors at multiple scales in this type of study. The lack of congruence between taxonomic distinctness and other indices and its low predictability may be related to the fact that this measure expresses long-term evolutionary adaptation to ecosystem conditions, while the other traditional biodiversity metrics respond to short-term environmental changes.

Prever como as atividades antrópicas podem influenciar os vários componentes da biodiversidade é essencial para encontrar maneiras de reduzir a perda de diversidade. Este desafio envolve: a) a compreensão de como os fatores ambientais influenciam a diversidade em diferentes escalas espaciais e, b) desenvolver formas de medir essas relações de uma maneira rápida, econômica e de fácil comunicação. Neste estudo, nós investigamos se a paisagem e as variáveis bioclimáticas podem explicar a variação nos índices de biodiversidade em comunidades de macroinvertebrados de 39 riachos de Mata Atlântica. Adicionalmente às medidas tradicionais de diversidade, por ex.: riqueza de espécies, abundância e índice de Shannon, nos utilizamos índice de distinção taxonômica que mede o grau de relação filogenética dentre os taxa. A quantidade de variação nas medidas de diversidade que foi explicado por variáveis ambientais e espaciais foi estimada utilizando a variação particionada baseada em regressão múltipla. O presente estudo demonstra que o índice de distinção taxonômica não responde da mesma maneira que os índices tradicionais utilizados em estudos de biodiversidade. Nós não encontramos nenhuma evidência de que a distinção taxonômica responde previsivelmente à variação métricas da paisagem, indicando a necessidade de incorporação de preditores em múltiplas escalas neste tipo de estudo. A falta de congruência entre a distinção taxonômica e outros índices e sua baixa previsibilidade pode estar relacionada com o fato de esta medida expressar adaptações evolutivas de longo prazo para as condições ambientais, enquanto as outras métricas tradicionais respondem às alterações ambientais de curto prazo.

The taxonomic distinctness of macroinvertebrate communities of Atlantic Forest streams cannot be predicted by landscape and climate variables, but traditional biodiversity indices can.

Predicting how anthropogenic activities may influence the various components of biodiversity is essential for finding ways to reduce diversity loss. This challenge involves: a) understanding how environmental factors influence diversity across different spatial scales, and b) developing ways to measure these relationships in a way that is fast, economical, and easy to communicate. In this study, we investigate whether landscape and bioclimatic variables could explain variation in biodiversity indices in macroinvertebrate communities from 39 Atlantic Forest streams. In addition to traditional diversity measures, i.e., species richness, abundance and Shannon index, we used a taxonomic distinctness index that measures the degree of phylogenetic relationship among taxa. The amount of variation in the diversity measures that was explained by environmental and spatial variables was estimated using variation partitioning based on multiple regression. Our study demonstrates that taxonomic distinctness does not respond in the same way as the traditional used in biodiversity studies. We found no evidence that taxonomic distinctness responds predictably to variation in landscape metrics, indicating the need for the incorporation of predictors at multiple scales in this type of study. The lack of congruence between taxonomic distinctness and other indices and its low predictability may be related to the fact that this measure expresses long-term evolutionary adaptation to ecosystem conditions, while the other traditional biodiversity metrics respond to short-term environmental changes.

Variation in body size of Phanocerus clavicornis Sharp, 1882 (Coleoptera: Elmidae: Larainae) in Atlantic Rainforest streams in response to hydraulic disturbance / Variação no tamanho corpóreo de Phanocerus clavicornis Sharp, 1882 (Coleoptera: Elmidae: Larainae) em córregos da Mata Atlântica sob perturbação hidráulica

In this study, patterns of body size of Phanocerus clavicornis Sharp, 1882 (Coleoptera: Elmidae: Larainae) were investigated along a gradient of change in speed of flow conditions in streams of low order in the Atlantic Rainforest in southeastern Brazil. Specifically, the hypothesis that the distribution of P. clavicornis larvae vary in size in response to variations in the speed of flow in streams was tested. A Surber sampler was used to collect larvae from the streambed during two sampling periods, defined by the rain regime: August in the dry season and February in the rainy season. Possible differences in mean measured body size were tested by analysis of variance (ANOVA). The ANOVA result indicated for all measurements on the larvae collected in first-order streams (head width, prothoracic width and total body length), there were significant differences indicating a morphometric variation due to changing hydraulic conditions, the smallest larvae being associated with the period of greater rainfall. However, the larger streams (3rd order), where the rain events had less impact on the larval size, varied widely. The results of this study suggest that the interstitial space is important for the protection of the larvae from water flow, and that populations of P. clavicornis have high plasticity, a key feature for the occupation of unstable environments for this species. These results are important for an understanding of the life history and behavioural characteristics of the species, which allow them to persist in streams along a gradient of flow disturbance.

Neste estudo, padrões de tamanho do corpo de Phanocerus clavicornis Sharp, 1882 (Coleoptera: Elmidae: Larainae) foram investigados ao longo de um gradiente de variação de velocidade da corrente em córregos de baixa ordem da Mata Atlântica. Especificamente, buscou-se testar a hipótese de que a distribuição de larvas de P. clavicornis com diferentes tamanhos corpóreos respondem às variações na velocidade da corrente em córregos. As coletas das larvas foram realizadas com um amostrador de Surber durante dois períodos amostrais, definidos pelo regime de chuvas: agosto - estação seca e fevereiro - estação chuvosa. Possíveis diferenças nas medidas de tamanho do corpo foram testadas através de uma análise de variância (ANOVA). Os resultados da ANOVA indicaram para todas as medidas das larvas coletadas nos córregos de primeira ordem (largura da cabeça, largura do protórax e comprimento total do corpo) encontramos diferenças significativas, indicando uma variação morfométrica com as mudanças das condições hidráulicas, onde as larvas menores foram associadas aos períodos de maior precipitação. No entanto, em córregos maiores (3a ordem), os eventos de chuva tiveram menor impacto no tamanho dos indivíduos, com a ocorrência de larvas com diferentes tamanhos. Os resultados deste estudo sugerem que os espaços intersticiais são importantes para a proteção das larvas contra a velocidade da corrente e que as populações de P. clavicornis possuem alta plasticidade, sendo uma característica fundamental para a ocupação desta espécie em ambientes instáveis. Esses resultados são importantes para a compreensão da história de vida e características comportamentais da espécie, que permitem persistir em córregos ao longo de gradiente de perturbação do fluxo.

Variation in body size of Phanocerus clavicornis Sharp, 1882 (Coleoptera: Elmidae: Larainae) in Atlantic Rainforest streams in response to hydraulic disturbance.

In this study, patterns of body size of Phanocerus clavicornis Sharp, 1882 (Coleoptera: Elmidae: Larainae) were investigated along a gradient of change in speed of flow conditions in streams of low order in the Atlantic Rainforest in southeastern Brazil. Specifically, the hypothesis that the distribution of P. clavicornis larvae vary in size in response to variations in the speed of flow in streams was tested. A Surber sampler was used to collect larvae from the streambed during two sampling periods, defined by the rain regime: August in the dry season and February in the rainy season. Possible differences in mean measured body size were tested by analysis of variance (ANOVA). The ANOVA result indicated for all measurements on the larvae collected in first-order streams (head width, prothoracic width and total body length), there were significant differences indicating a morphometric variation due to changing hydraulic conditions, the smallest larvae being associated with the period of greater rainfall. However, the larger streams (3rd order), where the rain events had less impact on the larval size, varied widely. The results of this study suggest that the interstitial space is important for the protection of the larvae from water flow, and that populations of P. clavicornis have high plasticity, a key feature for the occupation of unstable environments for this species. These results are important for an understanding of the life history and behavioural characteristics of the species, which allow them to persist in streams along a gradient of flow disturbance.

A criação do ensino de enfermagem no Brasil / The creation of the nursing teaching in Brazil

A retrospectiva histórica permite a análise dos fatos ocorridos de maneira crítica e reflexiva, procurando respostas a questionamentos que permeiam a prática contemporânea da Enfermagem. A imposição do mercado de trabalho, a dicotomia teoria-prática, o cuidado centrado apenas no saber-fazer, a submissão da categoria e sua conseqüente falta de autonomia possuem raízes históricas na construção profissional da categoria, tanto na prática como no ensino. Assim, apresenta-se uma análise histórica do Decreto n° 791, de 27 de setembro de 1890, assinado pelo então presidente da República, Marechal Deodoro da Fonseca, momento em que se criou a primeira escola de Enfermagem no Brasil. A análise e contextualização histórica do documento permitem vislumbrar que a ênfase no tecnicismo, a criação de mão-de-obra barata e a subserviência, já eram questões presentes no ensino da Enfermagem no país desde seus primórdios.

The historical retrospective allows the analysis of the facts in a critical and reflexive way, looking for answers to questions that arise in the comtemporary Nursing prctice. The theory-practice dichotomy, the care centered only in know-how-to-make, the submission of the category and its consequent lack of autonomy have historical roots in the professional construction of Nursing, in its practice as well as in the teaching process. We present an analysis of the n° 791 Decree signed by Marechal Deodoro da Fonseca, president of the Brazilian Republic at the time, which isntitued the fisrt school of Nursing in Brazil. The analysis of such decue in its historical context allow us to infer that teaching of Nursing in Brazil emphasizes the technical aspects since then.