Increasing impact of COVID-19 on young adults: evidence from hospitalisations in Brazil.

OBJECTIVES: Concerns about the increasing impact of severe COVID-19 in younger individuals in Brazil came after a recent synchronised country-wide wave of cases in Brazil. This communication analyses how hospitalisations due to COVID-19 changed in the age groups 18-49 years and ≥70 years. STUDY DESIGN: Longitudinal study based on secondary data. METHODS: Data from SIVEP-Gripe, a public and open-access database of Severe Acute Respiratory Illness records (including COVID-19 notifications), were used in this study. Statistical control charts examined changes in the magnitude and variation of younger (18-49 years) and older (≥70 years) adults who were hospitalised between 15th March 2020 and 19th June 2021. RESULTS: During the few first weeks of the pandemic in Brazil, the number of COVID-19 hospitalisations increased in older adults but decreased in younger adults. Subsequently, hospitalisations reached statistical control zones in epidemiological weeks (EW) 19-48 of 2020 (EW 19-48/2020) and EW 03-05/2021 (18-49 y, mean = 26.1%; ≥70 y, mean = 32.8%). Between EW 49/2020 and EW 02/2021, the number of hospitalisations of younger adults dropped to levels below the lower control limit. In contrast, the number of hospitalisations of older adults surpassed the upper limit of the corresponding statistical control zones. However, from EW 06/2021, numbers of hospitalisations changed from statistical control zones, with hospitalisations of younger adults increasing and reaching 44.9% in EW 24/2021 and hospitalisations of older adults decreasing until EW 19/2021 (14.1%) and reaching 17.3% in EW 24/2021. CONCLUSIONS: An increasing number of COVID-19 hospitalisations were observed in younger adults from EW 06/2021. This could be a result of the successful vaccination programme in older adults, who were initially prioritised, and possibly an increased exposure to highly transmissible variants of COVID-19 in younger adults who had to go to work in the absence of social protection (i.e. government financial support). Potential consequences of COVID-19 hospitalisations in younger adults could include a reduced life expectancy of the population and an increased number of people unable to perform daily activities due to post-COVID-19 conditions.

Payment to gamete donors: equality, gender equity, or solidarity?

PURPOSE: Regulation of payment to gamete donors varies substantially across countries. The development of an ethically sustainable governance system of payments in gamete donation demands that the preferences of different stakeholders be heard. This study intends to contribute to improving the understanding of payment to gamete donors by analysing the views of donors and recipients about the preferred form of payment and its associations with their sociodemographic characteristics. METHODS: This cross-sectional study included 70 donors and 172 recipients recruited at the Portuguese Public Bank of Gametes (July 2017-June 2018). Participants completed a self-reported questionnaire. Views about the preferred form of payment were collected through a multiple-choice question and an open-ended item. Associations were quantified through χ2 tests; content analysis was conducted with the open-ended answers. RESULTS: Both donors (48.6%) and recipients (40.7%) considered that reimbursement is the preferred form of payment to ensure solidarity-based motivations to donate. This option was followed by compensation for non-financial losses (41.4% of donors; 33.7% of recipients) based on gender equity. Preference for a fixed reward (22.7% of recipients; 8.6% of donors) was less frequent among younger donors and married/living with a partner or employed recipients, being based on the promotion of equality. CONCLUSION: In the context of the search for cross-border reproductive care and gamete circulation across countries, the findings from this study claim for the need to create solutions for payment to gamete donors that take into account gender equity and are simultaneously sensitive to donor's actual expenses and further health complications.

Myofibroblasts and increased angiogenesis contribute to periapical cystic injury containment and repair.

BACKGROUND: Myofibroblasts (MF) and angiogenesis are important factors in the development and expansion of cystic lesions, where these cells secrete growth factors and proteases, stimulating angiogenesis, matrix deposition and cell migration, affecting the growth of these periapicopathies. The present study aimed to evaluate the immunohistochemical expression of CD34 and α-SMA in radicular cysts (RC) and residual radicular cysts (RRC), with the purpose of contributing to a better understanding of the expansion and progression of these periapical lesions. MATERIAL AND METHODS: The present study os a descriptive, quantitative and comparative analysis of positive CD34 and α-SMA immunohistochemical expressions in 30 RC and 30 RRC specimens. α-SMA expression was evaluated in the fibrous capsule of the lesions, at 100x magnification below the epithelial lining. A total of 10 higher immunostaining fields were selected and subsequently, positive cells were quantified at 400x magnification, averaged per field. Regarding the angiogenic index, immuno-labeled microvessel counts for the anti-CD34 antibody were performed in 10 fields at 200x magnification. RESULTS: Statistically significant differences regarding α-SMA immunostaining were observed (p = 0.035), as well as a correlation between α-SMA versus CD34 (p = 0.004) in RRC. However, the angiogenic index obtained by immunostaining for CD34 indicated no statistical difference between lesions. Intense inflammatory infiltrates were predominant in RC, while mild and moderate degrees were more commonly observed in RRC (p <0.001). Intense inflammatory infiltrates were also more often noted in larger RRC (p = 0.041). Inflammatory infiltrates showed no significant correlation with α-SMA and CD34 immunostaining. CONCLUSIONS: The results indicate that the significant correlation found between the presence of MF and the angiogenic index are related to the repair process in RRC.

Dual consent? Donors' and recipients' views about involvement in decision-making on the use of embryos created by gamete donation in research.

BACKGROUND: Reasonable disagreement about the role awarded to gamete donors in decision-making on the use of embryos created by gamete donation (EGDs) for research purposes emphasises the importance of considering the implementation of participatory, adaptive, and trustworthy policies and guidelines for consent procedures. However, the perspectives of gamete donors and recipients about decision-making regarding research with EGDs are still under-researched, which precludes the development of policies and guidelines informed by evidence. This study seeks to explore the views of donors and recipients about who should take part in consent processes for the use of EGDs in research. METHODS: From July 2017 to June 2018, 72 gamete donors and 175 recipients completed a self-report structured questionnaire at the Portuguese Public Bank of Gametes (response rate: 76%). Agreement with dual consent was defined as the belief that the use of EGDs in research should be consented by both donors and recipients. RESULTS: The majority of participants (74.6% of donors and 65.7% of recipients) were willing to donate embryos for research. Almost half of the donors (48.6%) and half of the recipients (46.9%) considered that a dual consent procedure is desirable. This view was more frequent among employed recipients (49.7%) than among non-employed (21.4%). Donors were less likely to believe that only recipients should be involved in giving consent for the use of EGDs in research (25.0% vs. 41.7% among recipients) and were more frequently favourable to the idea of exclusive donors' consent (26.4% vs. 11.4% among recipients). CONCLUSIONS: Divergent views on dual consent among donors and recipients indicate the need to develop evidence-based and ethically sustainable policies and guidelines to protect well-being, autonomy and reproductive rights of both stakeholder groups. More empirical research and further theoretical normative analyses are needed to inform people-centred policy and guidelines for shared decision-making concerning the use of EGDs for research.

Safety attributes in primary care: understanding the needs of patients, health professionals, and managers.

OBJECTIVES: The aims of this study were (1) to identify attributes for patient safety at a primary healthcare level and (2) to analyze conceptions of patients, professionals, and managers about how these attributes are being addressed. STUDY DESIGN: This was a qualitative study. METHODS: Participants were recruited from three primary care settings in Brazil. A total of 37 subjects (four physicians, three nurses, three dentists, three managers, five community assistants, and 19 patients) participated on interviews about their perceptions of safety attributes at the primary care settings involved in the study. Some of these participants attended a focus group meeting. A thematic categorical analysis was carried out to interpret the interviews. RESULTS: The main attributes for patient safety were valued by the participants. However, barriers such as discontinuity of care, interruptions during consultations, breakdowns in the communication, and ineffective teamwork were reported as frequent sources of patient safety issues. Reports of patients left unattended for excessive time because of the lack of accurate information and disruptions that took up to 35 min show that there is still a long way to go for primary care to be safe and effective in the study settings. CONCLUSIONS: It is necessary that the strategies meet the patient safety needs more effectively and efficiently. Further research is needed to understand the complex nature of the problems that affect patient safety in these settings so that appropriate decisions can be made.

Photodynamic inactivation of foodborne bacteria by eosin Y.

AIMS: The aim of this study was evaluate the effect of photodynamic inactivation mediated by eosin Y in Salmonella enterica serotype Typhimurium ATCC 14028, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 25923 and Bacillus cereus ATCC 11778. METHODS AND RESULTS: Bacteria (107 CFU per ml) were incubated with eosin Y at concentrations ranging from 0·1 to 10 µmol l-1 , irradiated by green LED (λmax 490-570 nm) for 5, 10 and 15 min and the cellular viability was determined. Pseudomonas aeruginosa was completely inactivated when treated with 10 µmol l-1 eosin Y for 10 min. Treatments reduced B. cereus and Salm. Typhimurium counts to 2·7 log CFU per ml and 1·7 log CFU per ml, respectively. Escherichia coli counts were slightly reduced. Staphylococcus aureus presented the highest sensitivity, being completely inactivated by eosin Y at 5 µmol l-1 and 5 min of illumination. The reduction of cellular viability of photoinactivated Staph. aureus was also demonstrated by flow cytometry and morphological changes were observed by scanning electron microscopy. CONCLUSIONS: Eosin Y in combination with LED produced bacterial inactivation, being a potential candidate for photodynamic inactivation. SIGNIFICANCE AND IMPACT OF THE STUDY: This study evidenced the efficacy of photodynamic inactivation as a novel and promising alternative to bacterial control.

Tourism climatology past and present: A review of the role of the ISB Commission on Climate, Tourism and Recreation.

The Executive Board of the International Society of Biometeorology (ISB) founded the Commission on Climate, Tourism and Recreation (CCTR) at the 15th International Congress of Biometeorology in Sydney, Australia in 1999. The aims of the CCTR are to bring together researchers from around the world to critically review the current state of knowledge in tourism and recreation climatology and explore possibilities for future research. Almost two decades on, research in tourism climatology has developed and expanded due in large part to the initiatives and activities of the CCTR and several collaborative research projects run under the auspices of the CCTR. This work is reviewed here. Recent CCTR meeting highlighted the fact that, although climate is an essential part of the resource base for tourism, which is one of the world's biggest and fastest growing industries, relatively little is known about the effects of climate on tourist choices and broad demand patterns or the influence climate has on the commercial prospects and sustainability of tourism operators and destinations. The work here reviews what has been done, its conceptual underpinnings and current research frontiers.

A comparison and appraisal of a comprehensive range of human thermal climate indices.

Numerous human thermal climate indices have been proposed. It is a manifestation of the perceived importance of the thermal environment within the scientific community and a desire to quantify it. Schemes used differ in approach according to the number of variables taken into account, the rationale employed, and the particular design for application. They also vary considerably in type and quality, method used to express output, as well as in several other aspects. In light of this, a three-stage project was undertaken to deliver a comprehensive documentation, classification, and overall evaluation of the full range of existing human thermal climate indices. The first stage of the project produced a comprehensive register of as many thermal indices as could be found, 165 in all. The second stage devised a sorting scheme of these human thermal climate indices that grouped them according to eight primary classification categories. This, the third stage of the project, evaluates the indices. Six evaluation criteria, namely validity, usability, transparency, sophistication, completeness, and scope, are used collectively as evaluation criteria to rate each index scheme. The evaluation criteria are used to assign a score that varies between 1 and 5, 5 being the highest. The indices with the highest in each of the eight primary classification categories are discussed. The work is the final stage of a study of the all human thermal climatic indices that could be found in literature. Others have considered the topic, but this study is the first detailed, genuinely comprehensive, and systematic comparison. The results make it simpler to locate and compare indices. It is now easier for users to reflect on the merits of all available thermal indices and decide which is most suitable for a particular application or investigation.

Vascular mapping of the face: B-mode and doppler ultrasonography study.

BACKGROUND: To analyze the face vascularization pattern using B-mode and Doppler ultrasonography, and also propose an arterial vessel mapping. MATERIAL AND METHODS: The investigation was performed on 20 ultrasonography exams of facial vessels through linear and endocavitary transducers. We analyzed and determined the average values for diameters, peak systolic velocity and resistive index of the following arteries: external carotid, lingual, deep lingual, sublingual, facial, submental, inferior labial, superior labial, angular, maxillary inferior alveolar, mental, buccal, greater palatine, infraorbital, superficial temporal, transverse facial and frontal. RESULTS: Data was obtained allowing the analysis of the tissue hemodynamics. We were able to map the vascularization of the face and it was possible to access three arteries of small diameter (0,60mm angular artery; 0,55mm greater palatine artery; 0,45mm infraorbital artery). CONCLUSIONS: The results presented in this article are valid tool supporting the non-invasive mapping of facial vascularization.

Weather and place-based human behavior: recreational preferences and sensitivity.

This study examines the links between biometeorological variables and the behavior of beach recreationists along with their rating of overall weather conditions. To identify and describe significance of on-site atmospheric conditions, two separate forms of response are examined. The first is sensory perception of the immediate atmospheric surround expressed verbally, which was the subject of earlier work. In the research reported here, on-site observations of behavior that reflect the effects of weather and climate are examined. By employing, independently, separate indicators of on-site experience, the reliability of each is examined and interpreted and apparent threshold conditions verified. The study site is King's Beach located on the coast of Queensland, Australia. On-site observations of atmospheric variables and beach user behavior are made for the daylight hours of 45 days spread over a 12-month period. The results show that behavioral data provide reliable and meaningful indications of the significance of the atmospheric environment for leisure. Atmospheric conditions within the zone of acceptability are those that the beach users can readily cope with or modify by a range of minor behavioral adjustments. Optimal weather conditions appear to be those requiring no specific behavioral adjustment. Attendance levels reflect only the outer limits of acceptability of the meteorological environment, while duration of visit enables calibration of levels of approval in so far as it reflects rating of on-site weather within a broad zone of tolerance. In a broad theoretical sense, the results add to an understanding of the relationship between weather and human behavior. This information is potentially useful in effective tourism management and planning.

A comprehensive catalogue and classification of human thermal climate indices.

The very large number of human thermal climate indices that have been proposed over the past 100 years or so is a manifestation of the perceived importance within the scientific community of the thermal environment and the desire to quantify it. Schemes used differ in approach according to the number of variables taken into account, the rationale employed, the relative sophistication of the underlying body-atmosphere heat exchange theory and the particular design for application. They also vary considerably in type and quality, as well as in several other aspects. Reviews appear in the literature, but they cover a limited number of indices. A project that produces a comprehensive documentation, classification and overall evaluation of the full range of existing human thermal climate indices has never been attempted. This paper deals with documentation and classification. A subsequent report will focus on evaluation. Here a comprehensive register of 162 thermal indices is assembled and a sorting scheme devised that groups them according to eight primary classification classes. It is the first stage in a project to organise and evaluate the full range of all human thermal climate indices. The work, when completed, will make it easier for users to reflect on the merits of all available thermal indices. It will be simpler to locate and compare indices and decide which is most appropriate for a particular application or investigation.

The impact of acclimatization on thermophysiological strain for contrasting regional climates.

During acclimatization to heat and cold, the body experiences additional thermally induced physiological strain. The first signs show up in the respiratory organs because respiration is a continuous heat exchange process in which the body is in closest contact with the ambient air. There are no behavioral or other adjustments to prevent the ambient air from entering into the body's core area through the respiratory tract. The Acclimatization Thermal Strain Index (ATSI) describes the acclimatization thermal loading (ATL) on respiratory organs until full adaptation is achieved. The aim here is to further assess the ATSI scheme using a range of actual but contrasting bioclimatic conditions. To simulate ATL, scenarios of the consequences of acclimatization due to movement to or from five contrasting climates are used. The results show that adjusting to cold comes with greater physiological strain than adjusting to heat, the biggest impact occurring for a change of location from hot-humid to cold-dry climatic conditions. The approach can be used to assess risks due to increases in short-term thermal variability in weather conditions such as encountered during heat waves and cold snaps. The information could also be useful for assessing the need for public health services and measures that might be used to help mitigate impacts.

The Acclimatization Thermal Strain Index (ATSI): a preliminary study of the methodology applied to climatic conditions of the Russian Far East.

Travel to distant places where the climate is different to that at home involves a period of short-term acclimatization adjustment following arrival during which the traveler might experience thermally-induced physiological strain. This may be expressed as an "acclimatization thermal loading" (ATL). The first signs of this show up in the respiratory organs. In the current study, the Acclimatization Thermal Strain Index (ATSI) is developed and used for assessment of ATL for recreational travel over a range of climatic conditions. ATSI estimates the impact of short-term acclimatization calculated as the ratio of a difference between respiratory heat losses at the traveler's home location to respiratory heat losses at the trip destination upon first arriving there. The Russian Far East region is used as a case study. The research focuses on the effects of travel from two locations in the study region. The results show that ATSI values can be significantly different when considering places of trip origin. For example, travel from Anadyr to other locations within the Russian Far East could lead to large ATSI in summer. In contrast, ATSI values are small for travel almost anywhere in the region during winter, but this is against a backdrop of extreme cold for the region as a whole. Here, the diversity of climatic conditions of both heat and cold means short-term adjustment to conditions could be stressful or worse for those who travel to participate in outdoor activities.

Effect of maternal heat-stress on follicular growth and oocyte competence in Bos indicus cattle.

The objective was to determine whether exposure of Gir (Bos indicus) cows to heat-stress (HS) causes immediate and delayed deleterious effect on follicular dynamics, hormonal profile and oocyte competence. The cows were kept in tie-stalls for an adaptive thermoneutral period of 28 days (Phase I, Days -28 to -1). In Phase II (Days 0-28) cows were randomly allocated into control (CG, n=5) and HS (HS, n=5) treatments. The HS cows were placed in an environmental chamber at 38 degrees C and 80% relative humidity (RH) during the day and 30 degrees C, 80% RH during the night for 28 days. The CG group was maintained in shaded tie-stalls (ambient temperature) for 28 days. During Phase III (Days 28-147) animals were placed in tie-stalls (Days 28-42) followed by pasture (Days 42-147) under thermoneutrality. In each phase, weekly ovum pick up (OPU) sessions were to evaluate follicular development, morphology of cumulus-oocyte complexes (COCs), and developmental competence after in vitro maturation, fertilization, and culture. Serum concentrations of progesterone (P(4)) and cortisol were evaluated by radioimmunoassay. Exposure of Gir cows to HS had no immediate effect on reproductive function, but exerted a delayed deleterious effect on ovarian follicular growth, hormone concentrations, and oocyte competence. Heat-stress increased the diameter of the first and second largest follicles from Days 28 to 49. Indeed, HS increased the number of >9 mm follicles (characterized as follicular codominance) during this phase. Cows exposed to HS had longer periods of non-cyclic activity (P(4)<1 ng/mL), as well as shorter estrous cycles. However, HS did not affect cortisol concentration as compared to CG. Although HS had no significant effect on cleavage rate, it reduced blastocyst development during Phase III. In conclusion, long-term exposure of B. indicus cattle to HS had a delayed deleterious effect on ovarian follicular dynamics and oocyte competence.

Taking stock of Roma health policies in Spain: Lessons for health governance.

Roma health inequities are a wicked problem. Despite concerted efforts to reduce them under the Decade of Roma Inclusion initiative, the health gap between Roma and non-Roma populations in Europe persists. To address this problem, the European Commission devised the National Roma Integration Strategies (NRIS). This paper provides a critical assessment of the implementation of the NRIS' health strand (NRIS-H) in Spain and proposes an evaluation tool to monitor Roma health policies - the Roma Health Integration Policy Index (RHIPEX). It also makes recommendations to promote Roma health governance. To achieve these goals, four community forums, 33 stakeholder interviews and a scoping review were conducted. Results show that the NRIS-H implementation is hindered by lack of political commitment and poor resource allocation. This has a negative impact on Roma's entitlement to healthcare and on their participation in decision-making processes, jeopardising the elimination of the barriers that undermine their access to healthcare and potentially contributing to reproduce inequalities. These unintended effects point out the need to rethink Roma health governance by strengthening intersectional and intersectoral policies, enabling transformative Roma participation in policymaking and guaranteeing shared socio-political responsibility and accountability.

Pheochromocytoma with echocardiographic features of obstructive hypertrophic cardiomyopathy. A case report.

The authors report a case of pheochromocytoma in which the echocardiographic features suggested obstructive hypertrophic cardiomyopathy. The angiographic study and the computed tomography showed the tumor and its arterial supply. One month after resection of the tumor the echocardiographic features showed a tendency to normalization. The preoperative echocardiographic aspect was probably due to excessive production of catecholamines by the tumor.

Chemical safety and governance in Brazil.

Chemical safety is recognized in Agenda 21(UNCED--Rio 92), as one of the most serious problems to be faced worldwide being a problem not just of governability, restricted more to the role of states and governments, but of governance at the national and international levels. It poses greater challenges for countries like Brazil where the issues of democracy, security, sustainability and equity, which are fundamental to governance, are merely incipient and still far from solved. Taking as references the analysis of four cases in the Brazilian context, we illustrate the situation from less densely populated areas (as in the cases of mercury use by gold miners in the Amazon and pesticides in agricultural producing areas), through medium-sized towns (as in the accident with cesium 137 in Goiânia), to the major urban and industrial centers (as in the cases of lead from battery renovators and benzene in the oil and steel industries and oil refineries). What can be seen is a situation where problems connected with chemical safety have grown in intensity and extent far more than the capacity to deal with them. In industrializing countries, the formulation of chemical safety policies must take into account not only the complexity and uncertainties involved in understanding the problems, but also the aspects relating to the different modes and levels of vulnerability. This is necessary in order to attempt to build better contextualized and more participatory knowledge and decision-making processes at the local and global levels, which we take as basic prerequisites for governance.

[Amplified chemical disasters: a challenge for public health]. / Acidentes químicos ampliados: um desafio para a saúde pública.

Chemical accidents involving explosions, large fires and leakages of hazardous substances occurring during transport, storage and industrial production of chemicals constitute a real challenge to health, environmental and industrial safety professionals. The aim of this article is to discuss the main questions that this kind of accident provokes, in terms of public health, particularly in developing countries such as Brazil. The paper defines and characterises these accidents and the various health risk they involve excluding the leakages of hazardous substances during "normal" production in industry--through the combination of quantitative and qualitative information drawn from the international literature on the subject. From some examples of chemical accidents such as occurred in Bhopal (India), Vila Socó (Brazil), São Paulo (México) and data of the World Health Organization (WHO), the authors seek to show that these events present a worsening, in terms of immediate deaths and injuries, in developing countries. The statistics of chemical accidents which occurred during the last ten years (1984 to 1993) in the State of Rio de Janeiro are used taken as a frame reference for the purpose of bringing to light the great number of occurrences made with no registration of basic information regarding assessment or surveillance. The complexity of causes and consequences, together with the structural problems of developing countries, present public health professionals and institutions, with some important tasks especially those of health risk assessment and the formulation of strategies to prevent and control future major chemical accidents.

The relationships between selected anthropometric and socio-economic data in schoolchildren from different social strata in Rio de Janeiro, Brazil.

The nutritional status according to anthropometric data was assessed in 756 schoolchildren from 5 low-income state schools and in one private school in the same part of Rio de Janeiro, Brazil. The prevalence of stunting and wasting (cut-off point: less than 90% ht/age and less than 80% wt/ht) ranged in the public schools from 6.2 to 15.2% and 3.3 to 24.0%, respectively, whereas the figures for the private school were 2.3 and 3.5%, respectively. Much more obesity was found in the private school (18.0%) than in the state schools (0.8-6.2%). Nutritional problems seem to develop more severely in accordance with the increasing age of the children. Therefore it appears advisable to assess schoolchildren within the context of nutritional surveillance system.